Intra-abdominal drains after colorectal resection do not reduce major complications but are associated with higher postoperative ileus

INTRODUCTION: Prophylactic intra-abdominal drains are still frequently used after colorectal resections despite inconsistent evidence regarding clinical benefit. This study evaluated the association between drain use and short-term postoperative outcomes after colorectal surgery.
METHODS: A retrospective observational cohort study was performed at Erzurum City Hospital including adult patients who underwent colorectal resection between January 2020 and October 2025. Patients were categorized as drain or no-drain based on intraoperative drain placement. Primary outcomes included overall postoperative complications, major morbidity (Clavien–Dindo ≥III), anastomotic leakage, surgical site infection, postoperative ileus, reoperation, readmission, in-hospital mortality, and length of stay. Group comparisons were conducted using appropriate univariable tests. Multivariable logistic regression was used to assess independent associations between drain use and key outcomes adjusting for procedure type, tumor localization, and operative approach.
RESULTS: A total of 432 patients were analyzed; 248 (57.4%) received drains and 184 (42.6%) did not. Operative time was longer in the drain group (p=0.039). Rates of overall complications, major morbidity, anasto-motic leakage, surgical site infection, reoperation, readmission, and in-hospital mortality were comparable between groups. Postoperative ileus was significantly more frequent in the drain group (14.9% vs 7.6%, p=0.020). In multivariable analysis, drain use remained independently associated with postoperative ileus (OR 2.17, 95% CI 1.11–4.25; p=0.024). Drain use was not independently associated with overall complications (OR 0.67, 95% CI 0.43–1.05; p=0.080) and showed a non-significant trend toward lower major morbidity (OR 0.51, 95% CI 0.25–1.03; p=0.061).
DISCUSSION AND CONCLUSION: In this single-center cohort, routine intra-abdominal drain placement after colorectal resection was not associated with improved major postoperative outcomes and was independently associated with a higher risk of postoperative ileus. Drain use should be individualized rather than routine.

Keywords: Colorectal surgery, intra-abdominal drain, prophylactic drainage, postoperative ileus, anastomotic leak

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