Prophylactic Drain Placement after Gastrectomy Is Associated with Decreased Morbidity

Weindelmayer J, Mengardo V, Ascari F, et al. Prophylactic Drain Placement and Postoperative Invasive Procedures After Gastrectomy: The Abdominal Drain After Gastrectomy (ADIGE) Randomized Clinical Trial. JAMA Surg. 2025;160(2):135-143.

Coffey MR, Lambert KE, Strong VE. Refrain From the Drain? The ADIGE Trial Brings Gastrectomy to the Debate. JAMA Surg. 2025;160(2):143-144.

Available but weak evidence suggests that prophylactic drain placement following partial or total gastrectomy performed with curative intent in patients with gastric cancer reduces postoperative complications and shortens hospital stay. Current clinical practice guidelines recommend against prophylactic drain placement.

This article reported outcomes of a randomized prospective noninferiority trial performed in 11 centers in Italy during the interval 2019–2023. Patients (n = 390) were randomized to receive prophylactic drain placement or no drain. The main outcomes of interest were reoperation or percutaneous drainage within 30 days of the index procedure.

Reoperation or percutaneous drainage was required in 15% of the no drain group compared with 7.7% of the drain group (p = .02). Of note was the observation that reoperation was needed in 12.4% of the no drain group and 5.1% of the drain group.

The authors concluded that prophylactic drain placement was associated with decreased morbidity.

The editorial by Coffey and coauthors agreed with this conclusion and recommended revision of current clinical practice guidelines that encourage omission of drain placement.

Prophylactic Drain Placement after Gastrectomy Is Associated with Decreased Morbidity

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