Current practice on the use of prophylactic drain after gastrectomy in Italy: the Abdominal Drain in Gastrectomy (ADiGe) survey
Authors: Mengardo Valentina , Weindelmayer Jacopo , Veltri Alessandro , Giacopuzzi Simone , Torroni Lorena , de Manzoni Giovanni ,   the Italian Gastric Cancer Research Group (GIRCG), the Polispecialistic Society of Young Surgeons (SPIGC), Agresta Ferdinando , Alfieri Rita , Alfieri Sergio , Antonacci Nicola , Baiocchi Gian Luca , Bencini Lapo , Bencivenga Maria , Benedetti Michele , Berselli Mattia , Biondi Alberto , Capolupo Gabriella Teresa , Carboni Fabio , Casadei Riccardo , Casella Francesco , Catarci Marco , Cerri Paolo , Chiari Damiano , Cocozza Eugenio , Colombo Giovanni , Cozzaglio Luca , Dalmonte Giorgio , Degiuli Maurizio , De Luca Maurizio , De Luca Raffaele , De Manzini Nicolò , De Pasqual Carlo Alberto , De Pascale Stefano , De Ruvo Nicola , Di Cosmo Mariantonietta , Di Leo Alberto , Di Paola Massimiliano , Elio Amedeo , Ferrara Francesco , Ferrari Giovanni , Fiscon Valentino , Fumagalli Uberto , Garulli Gianluca , Gennai Andrea , Gentile Irene , Germani Paola , Gualtierotti Monica , Guerini Francesca , Gurrado Angela , Inama Marco , La Torre Filippo , Laterza Ernesto , Losurdo Pasquale , Macrì Antonio , Marano Alessandra , Marano Luigi , Marchesi Federico , Marino Fabio , Massani Marco , Menghi Roberta , Milone Marco , Molfino Sarah , Montuori Mauro , Moretto Gianluigi , Morgagni Paolo , Morpurgo Emilio , Abdallah Moukchar , Nespoli Luca , Olmi Stefano , Palaia Raffaele , Pallabazer Giovanni , Parise Paolo , Pasculli Alessandro , Pericoli Ridolfini Marco , Pesce Antonio , Pinotti Enrico , Pisano Michele , Poiasina Elia , Postiglione Vittorio , Rausei Stefano , Rella Antonio , Rosa Fausto , Rosati Riccardo , Rossi Gianmaria , Rossit Luca , Rovatti Massimo , Ruspi Laura , Sacco Luca , Saladino Edoardo , Sansonetti Andrea , Sartori Alberto , Scaglione Donatella , Scaringi Stefano , Schoenthaler Christian , Sena Giuseppe , Simone Michele , Solaini Leonardo , Strignano Paolo , Tartaglia Nicola , Testa Silvio , Testini Mario , Tiberio Guido Alberto Massimo , Treppiedi Elio , Vagliasindi Alessio , Valmasoni Michele , Viganò Jacopo , Zanchettin Gianpietro , Zanoni Andrea , Zardini Claudio , Zerbinati Antonio 
Published: October 2022

Evidence against the use of prophylactic drain after gastrectomy are increasing and ERAS guidelines suggest the benefit of drain avoidance. Nevertheless, it is unclear whether this practice is still widespread. We conducted a survey among Italian surgeons through the Italian Gastric Cancer Research Group and the Polispecialistic Society of Young Surgeons, aiming to understand the current use of prophylactic drain. A 28-item questionnaire-based survey was developed to analyze the current practice and the individual opinion about the use of prophylactic drain after gastrectomy. Groups based on age, experience and unit volume were separately analyzed. Response of 104 surgeons from 73 surgical units were collected. A standardized ERAS protocol for gastrectomy was applied by 42% of the respondents. Most of the surgeons, regardless of age, experience, or unit volume, declared to routinely place one or more drain after gastrectomy. Only 2 (1.9%) and 7 surgeons (6.7%) belonging to high volume units, do not routinely place drains after total and subtotal gastrectomy, respectively. More than 60% of the participants remove the drain on postoperative day 4–6 after performing an assessment of the anastomosis integrity. Interestingly, less than half of the surgeons believe that drain is the main tool for leak management, and this percentage further drops among younger surgeons. On the other hand, drain’s role seems to be more defined for duodenal stump leak treatment, with almost 50% of the surgeons recognizing its importance. Routine use of prophylactic drain after gastrectomy is still a widespread practice even if younger surgeons are more persuaded that it could not be advantageous.