Routine Abdominal Drainage After Total Gastrectomy

Evidence Against Routine Drainage

The ERAS Society guideline explicitly states there is no evidence supporting routine abdominal drainage following gastrectomy or other upper GI surgery, as stated by the ERAS Society 1, 2
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, according to the World Journal of Emergency Surgery 1, 2
Two randomized controlled trials comparing routine drain use to no drains found similar complication rates, but significantly more postoperative pain in patients with drains, as reported by the World Journal of Emergency Surgery 1, 2

The sensitivity of abdominal drainage for detecting anastomotic leakage ranges from 0-94% across studies, making it an unreliable diagnostic tool, as stated by the World Journal of Emergency Surgery 1, 2
The wide variability in sensitivity means drains cannot be relied upon to detect the most feared complication—esophagojejunal anastomotic leak, according to the World Journal of Emergency Surgery 1, 2

Do not place drains routinely "just in case"—this increases complications without benefit, as warned by the World Journal of Emergency Surgery 1, 2
Do not rely on drain output to rule out anastomotic leak—clinical signs, imaging, and laboratory markers are more reliable, as advised by the World Journal of Emergency Surgery 1, 2
Avoid leaving drains in contact with the anastomosis, as this may increase leak risk rather than detect it, as cautioned by the World Journal of Emergency Surgery 1, 2