Is It Necessary To Place Prophylactically an Abdominal Drain To Prevent Surgical Site Infection in Abdominal Operations? A Systematic Meta-Review.

BACKGROUND: There is still uncertainty regarding the use of prophylactic drainage in abdominal surgical procedures. This meta-review aimed to summarize systematic reviews and meta-analyses evaluating abdominal drain placement in patients undergoing abdominal procedures, with a focus on surgical site infection and death from infections. METHODS: Systematic reviews and meta-analyses identified in MEDLINE, EMBASE, CINHAL, Cochrane Central Register of Controlled Trials, World Health Organization Regional Medical Databases, and African Index Medicus were reviewed. RESULTS: Fifteen systematic reviews and meta-analyses concerning prophylactic abdominal drainage in abdominal operations were included in this analysis. The median score of methodologic quality was eight (6-10). The majority of meta-analyses found no benefits of prophylactic drainage in reducing surgical site infection, but no significant differences were identified. Three studies demonstrated a significant difference in favor of no drainage, with two regarding cholecystectomy and one on appendectomy (p < 0.05). The quality of evidence provided by each review was mainly low and very low. CONCLUSIONS: Most reviews fail to detect an increased incidence of surgical site infection in the setting of drainage placement but also fail to attribute any specific benefits to the presence of a drain in abdominal procedures.