Purpose of Jackson-Pratt Drain After Incision and Drainage
Routine use of JP drains after incision and drainage is generally not recommended, as current evidence shows no benefit in preventing complications and may actually increase surgical site infections and prolong hospitalization. 1
Evidence Against Routine Drain Use
The most recent 2023 consensus guidelines from the World Society of Emergency Surgery provide clear guidance on this issue:
Key Findings from High-Quality Evidence
Drains do not reduce mortality, morbidity, infections, anastomotic leaks, or re-interventions compared to no drain use in both elective and emergency surgical settings 1
Closed suction drains (like JP drains) are associated with increased surgical site infections in trauma patients undergoing emergency laparotomy for hollow visceral injuries 1
Drains delay hospital discharge and provide no benefit in earlier detection of fluid collections, based on a prospective international study of 1,805 patients 1
Drain-related morbidity is substantial, including fever, wound infections, peritoneal fluid accumulation, and wound dehiscence 1
Specific Clinical Scenarios
Complicated appendicitis: The World Society of Emergency Surgery explicitly discourages drain use after appendectomy for perforated appendicitis, as drains provide no benefit in preventing intra-abdominal abscess formation and lead to longer hospitalization 1, 2
Perforated peptic ulcer: Closure with omental patch technique is safe without prophylactic drainage 1
Emergency colorectal surgery: Recent data from the EuroSurg Collaborative found no benefit for drain use 1
Official Guideline Recommendation
The World Society of Emergency Surgery and WHO discourage routine, prophylactic use of intra-abdominal surgical drains in clean and clean-contaminated cases due to lack of evidence supporting benefit. 1, 3
- Level of evidence: Low
- Recommendation grade: Weak
When Drains Might Be Considered
The situation may differ in heavily contaminated abdominal cases, though this requires individualized assessment 1. However, even in these scenarios, the default should be no drain unless there is a compelling specific indication.
Common Pitfall to Avoid
The traditional teaching that drains "prevent fluid accumulation" is not supported by modern evidence. Drains do not reduce collection rates and may paradoxically increase infection risk through providing a conduit for bacterial entry 1.