Nutzen und Risiken der prophylaktischen intraabdominellen Drainage in der elektiven Kolonchirurgie : eine prospektive klinische Beobachtungsstudie
Objective and Methods: This trial investigates the role of drainage in the prevention of complications after elective colorectal resections. Many surgeons continue to place a prophylactic drain after completion of a colorectal anastomosis, despite considerable evidence that this practice may not be useful. Between August 2000 and March 2002, 40 patients (13 men and 27 women), mean age 60,98 years, with either carcinoma, benign tumor, diverticular disease of the sigmoid colon, or another disorder located from the right colon to the rectum were not randomized to undergo either drainage (n=20) with easy-flow-drains or no drainage (n=20). The patients of the both groups were examined about their postoperative course. Drain-related complications include those possibly benefiting from drainage (leakage,intra-abdominal infection, bleeding) and those possibly caused by drainage (wound infection, hernia, intestinal obstruction, fistula) has been questioned. Results: There were 4 patients with fever in the drainage group (dg) and one patient in the non-drainage group (ndg). In the ndg the patients have higher leukocytes.The average loss of weight was 5,4% in ndg and 3,52% in dg, there was a significant difference.The patients of the ndg could be discharged earlier on average than the patients of the dg (14,25 vs 14,85 days).20 patients of the dg and 16 patients of the ndg showed hyponatremia.3 patients of the dg showed hypernatremia. Also there were fewer hyper-/hypokalemias in patients of ndg compared to patients of the dg. (hyperkalemia 3 patients vs. 4 patients, hypokalemia 7 patients vs. 9 patients). Those differences were statistically significant. 15 patients had postoperative complications, the most of these patients had secondary illnesses.Nausea was found in 10 patients of the dg and in 3 patients of the ndg.3 patients of the dg and 2 patients of the ndg were vomiting.During this trial examination it was no relaparatomy needed.The ultrasonographic detection showed that 30% dg patients and 25% ndg patients have intraabdominal fluid.The first flatus in the dg was after 4,8 days and in the ndg after 4,15 days.The dg patients had fewer subjective pain than the patients of the ndg. On average the drains removed after 7,53 days with an average fluid volume of 497,06 ml. Conclusions: In conclusion, we have been unable to demonstrate any advantage for the use of prophylactic drains following colonic anastomosis.There were no differences in the incidence of postoperative complications in the two groups. This prospective, not randomized trial showed that there is no advantage in inserting prophylactic drains after colonic anastomoses and their routine use needs to be reconsidered.
info:eu-repo/classification/ddc/610, Medizin, Kolonchirurgie, intraabdominelle Drainagen
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