The use of drainages in abdominal surgery is characterized by tradition and personal experience of the surgeon. There are only a few high-quality, randomized studies on the use of prophylactic drainages. The risk of postoperative mediastinitis leads surgeons to maintain the use of drainages in esophageal anastomosis. The use of drainages in gastric and small bowel surgery appears to be negligible. There are evidence grade A recommendations for hepatobiliary surgery (without biliodigestive anastomosis) to abstain from the use of drainages. One prospective, randomized study showed an advantage of surgery without drainage in pancreatic resections (and bilioenteric anastomosis). The situation is clear for colorectal surgery. Several prospective, randomized studies have shown the advantages of avoiding drainages. The use of drainages in perforated appendicitis appears to be associated with an increased rate of postoperative complications. There are no general recommendations for the use of drainages in cases of peritonitis. The few high-quality studies published show that the use of drainages in visceral surgery has to be questioned continuously. High-quality clinical studies are necessary to obtain evidence-based recommendations for the use of drainages in visceral surgery.
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