Routine Drainage of Colorectal Anastomoses: An Evidence-Based Review of the Current Literature

Table 2

Summary of the studies that discouraged routine drainage after colorectal anastomosis.

Studies of antidrainage	Type of study	Level of evidence^†	Level of anastomosis	Method of anastomosis	Use of diverting stoma
Urbach et al. 1999 [14]	Meta-analysis of randomized trials	Ia	Colocolic in 1 trial (52%) and colorectal or coloanal in 3 trials (48%)	Stapled in 11–27% and handsewn in 73–89%	NA
Petrowsky et al. 2004 [15]	Systematic review and meta-analysis	Ia	Colocolic in 2 trials, colorectal in 3 trials, and colocolic or colorectal in 3 trials	NA	NA
Karliczek et al. 2006 [16]	Meta-analysis of randomized trials	Ia	Intraperitoneal in 1 trial, extraperitoneal in 1 trial, and intra- or extraperitoneal in 4 trials	NA	NA
Zhang et al. 2016 [17]	Meta-analysis of randomized trials	Ia	Intraperitoneal in 4 trials, extraperitoneal in 2 trials, and intra-or extraperitoneal in 5 trials	Stapled in 4 trials, and handsewn or stapled in 7 trials	NA
Menahem et al. [18]	Meta-analysis of randomized trials	Ia	Extraperitoneal	Stapled in 1 trial and stapled or handsewn in 2 trials	NA
Rolph et al. 2004 [19]	Cochrane review	IIa	Colocolic in 2 trials and colorectal or coloanal in 1 trial	Stapled in 46.7% and handsewn in 53.3%	NA
Yeh et al. 2005 [20]	Retrospective	VI	Colorectal	J pouch (16%), single stapled (3.5%), double stapled (70.7%), and handsewn (6.8%)	10%
Denost et al. 2016 [21]	Randomized controlled trial	Ia	Infraperitoneal colorectal	Handsewn 46.3% and stapled 53.7%	75%
Boccola et al. 2010 [23]	Retrospective	VI	Colocolic in 46.8%, colorectal in 48%, and ileorectal in 5.2%	Handsewn in 52% and stapled in 48%	6%

NA: not available. † indicates levels of evidence proposed by the Oxford Centre for Evidence-Based Medicine (Meakins JL. Innovations in surgery: the rules of evidence. Am J Surg. 2002; 183: 399–405).