Still no evidence for drains in bariatric surgery

BACKGROUND: Registry data show that placement of a drain during bariatric surgery is still the normal practice in many surgical departments. Retrospective studies and a review article could show that the routine placement of a drain in bariatric surgery is useless and also potentially dangerous. Due to the lack of randomized controlled studies there is insufficient evidence on this topic in the literature. OBJECTIVE: In order to further question the use of drains in bariatric interventions, the prospective in-house databank of patients who received a gastric sleeve (SG) or a Roux-enY gastric bypass (RYGB) between January 2010 and June 2016 was retrospectively evaluated. SETTING: A German university hospital. METHODS: During the investigation period a total of 361 operations (219 gastric bypasses and 142 gastric sleeve operations) were carried out. A change in the internal treatment pathway with respect to the placement of drains in 2013 led to the formation of two groups: one where a drain was routinely placed in operations (n= 166) and a second group where a drain was not routinely placed (n= 195). The demographic data were statistically adjusted between the two groups using multiple regression analysis. The results of the operation and the 30-day morbidity were compared. Complications were evaluated according to the Clavien-Dindo classification. RESULTS: In the group with no drain, complications occurred in seven patients. In the group with drainage there were 6 complications. The insufficiency and reoperation rates were not statistically significantly different between the two groups. The average postoperative hospital stay was 1.3 days longer in patients with a drain. Multivariate analysis showed that the placement of a drain was the greatest risk factor for a longer hospital stay. CONCLUSION: Placement of a drain during bariatric interventions should only be considered on an individual basis. The routine placement should be discouraged.