Many surgeons routinely use prophylactic abdominal drainage (AD) to remove accumulations at the surgical site. The primary reasons for this practice are as follows: (1) accumulation of blood or fluid at the surgical site can lead to infections, making their removal necessary; and (2) AD aids in the early detection of anastomotic leakage or postoperative bleeding.

However, contrary to the beliefs of many surgeons, studies on prophylactic AD have produced skeptical results, suggesting that it does not significantly affect postoperative morbidity [1,2]. Moreover, the Enhanced Recovery After Surgery (ERAS) guidelines recommend against the routine use of AD after colorectal surgery [3].

Despite these findings, many surgeons continue to use prophylactic AD, likely because they believe that while it may not offer significant advantages, it is at least not harmful. However, research by Hwang et al. suggests that prophylactic AD may be detrimental in terms of pain [4]. The study found no difference in complication rates between the no-AD and AD groups; however, the numerical rating scale score for pain on postoperative day (POD) 2 was statistically significantly lower in the no-AD group. This causal relationship seems reasonable; as patients begin to ambulate, the intraabdominal stimulation from the drain could exacerbate pain. However, the study has limitations, including a small sample size, a single surgeon, a single institution, and a retrospective design. Although the results were statistically significant, a minimal difference was observed in the visual Analogue scale scores between the no-AD and AD groups on POD 2 (3.2 ± 0.8 and 3.4 ± 0.8, respectively; p = 0.043). A larger prospective study is needed to determine whether prophylactic AD truly contributes to postoperative pain.

Based on the above findings, one might conclude that prophylactic AD should be avoided, but this would be an overinterpretation. The degree of increase in pain after this procedure is minor, and there is no difference in other complications. In routine right or left hemicolectomy, where the risk of leakage or postoperative bleeding is rare (about 1%), prophylactic AD may not be appropriate as a routine procedure. However, if a surgeon believes that the risk of leakage or bleeding is higher than usual, using prophylactic AD may be advisable.

In summary, the decision to use prophylactic AD should be individualized depending on the specific case, the surgeon’s preference, and the patient’s condition. It is important to avoid rigidly adhering to the belief that AD must always be used or that it should never be used.

Conflict of interest

The author has no conflicts of interest to declare.

Funding/support

None.