Comparison of drain displacement and complications between conventional drain insertion and extraperitoneal tunneling drain insertion following anterior or low anterior resection: a retrospective comparative cohort study.

Purpose: This study evaluated the effectiveness of the extraperitoneal tunneling (EPT) method for drain fixation compared to conventional drain insertion following (low) anterior resection (AR).

Methods: A retrospective review was conducted on 334 patients who underwent AR with an anastomotic height ≤15 cm from the anal verge at a single center between January 2020 and May 2024. In patients with permanent stoma formation, no drain insertions were excluded.

Results: Of the 334 patients, 192 (57.5%) underwent drain insertion via the conventional method, while 142 (42.5%) underwent the EPT method. No drain-related complications were reported in either group. Drain displacement occurred in 81 patients (24.3%), with a significantly lower rate in the EPT group compared to the conventional group (2.8% vs. 40.1%, P < 0.001). Multivariate analysis identified EPT fixation as a significant factor in reducing drain displacement (odds ratio [OR], 0.043; 95% confidence interval [CI], 0.015-0.123; P < 0.001) whereas postoperative ileus was identified as a significant risk factor for increasing drain displacement (OR, 2.952; 95% CI, 1.594-5.465; P = 0.001). Anastomotic leakage (AL) occurred in 25 patients (7.4%). Among 18 patients with AL but no drain displacement, 16 (88.9%) were successfully treated with drain maintenance and antibiotics alone. Conversely, 4 of 7 patients (57.1%) with AL and drain displacement required surgery or interventional procedures.

Conclusion: This retrospective study suggests that the EPT method may be effective in securing drain tubes, potentially enhancing their clinical utility. Maintaining the drain in its original position could help reduce the need for additional surgical or interventional procedures in AL management.