Routine Abdominal Drainage is Not Recommended After Total Gastrectomy
Prophylactic abdominal drains should not be routinely placed after total gastrectomy, as they provide no demonstrable benefit in preventing or managing major complications and are associated with increased morbidity and postoperative pain. 1
Evidence Against Routine Drainage
The most recent high-quality evidence strongly argues against routine abdominal drainage:
A 2022 ERAS Society guideline explicitly states there is no evidence supporting routine abdominal drainage following gastrectomy or other upper GI surgery. 1
Observational data from over 140,000 patients demonstrated no beneficial effects of routine abdominal drainage after upper GI surgery, but rather showed increased morbidity rates. 1
Two randomized controlled trials comparing routine drain use to no drains found similar complication rates, but significantly more postoperative pain in patients with drains. 1
A prospective randomized trial of 60 total gastrectomy patients found that the drain group had statistically higher morbidity (37.9% vs 9.7%, p=0.0242) and longer hospital stays (18.8 vs 12.9 days, p=0.0242) compared to the no-drain group. 2
A retrospective study of 499 total gastrectomy patients found no significant difference in major intra-abdominal complications between drainage (6.4%) and non-drainage groups (6.3%, p=0.959), and drains had no impact on early diagnosis or management of complications. 3
Poor Sensitivity for Leak Detection
The sensitivity of abdominal drainage for detecting anastomotic leakage ranges from 0-94% across studies, making it an unreliable diagnostic tool. 1
- This wide variability means drains cannot be relied upon to detect the most feared complication—esophagojejunal anastomotic leak. 1
When Drains May Be Considered (Selective Use Only)
While routine drainage is not recommended, selective drainage may be considered in specific high-risk scenarios:
- Extended lymphadenectomy (D2 dissection) with concern for pancreatic injury or fistula 3
- Intraoperative complications requiring damage control 3
- Surgeon concern for specific technical issues during the procedure 3
Type of Drain If Selectively Used
If a drain is placed for selective indications, closed-suction drains (Jackson-Pratt or Blake drains) are preferred over open drains:
High-pressure vacuum drains are sealed, closed-circuit systems that are efficient, allow easy monitoring, and provide safe disposal of drainage. 4
Low-pressure vacuum drains use gentle pressure to evacuate fluid and air, are easy for patients to manage, and vacuum pressure can be easily reinstated. 4
Common Pitfalls to Avoid
Do not place drains routinely "just in case"—this increases complications without benefit. 1, 2
Do not rely on drain output to rule out anastomotic leak—clinical signs, imaging, and laboratory markers are more reliable. 1
If drains are placed, remove them early (typically within 3-5 days) unless there is a specific indication to continue. 3
Avoid leaving drains in contact with the anastomosis, as this may increase leak risk rather than detect it. 1