Pelvic drain after low anterior resection of the rectum: pros and cons

Abstract

Low anterior resection, unlike other large bowel resections with anastomosis, is characterized by a high incidence of postoperative complications, repeated surgical interventions, accompanied by high mortality. To reduce these indicators, the creation of a protective stoma and drainage of the pelvis has become widespread. However, the efficiency of pelvic drainage after low anterior resection remains unclear and controversial. This literature review is devoted to the relevance of the problem of efficiency and analysis of studies on this issue. Most randomized trials have not proven the effectiveness of drainage in colorectal surgery, but in these studies, as a rule, little or no attention was paid to draining the small pelvis after total mesorectal excision. This work analyzes the studies of supporters and opponents of pelvic drainage after low anterior resection of the rectum and provides arguments for and against drainage of the pelvic cavity. Although there are randomized trials showing no benefit of pelvic drainage, many clinics use pelvic drain after low anterior resection. The personal experience of the surgeon and the occurrence of intraoperative complications such as bleeding, contamination, technical difficulties in colorectal anastomosis formation has an important role to play in this. A lower rate of repeated operation in the use of pelvic drainage suggests the possibility of conservative treatment.