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Brucchi F, Mehmeti M, Lauricella S, Faillace G. The use of intra-abdominal prophylactic drainage in laparoscopic cholecystectomy: does it change in relation to surgical expertise? A multicenter case-control retrospective study on postoperative outcomes. Minerva Surg 2024; 79:155-160. [PMID: 37851006 DOI: 10.23736/s2724-5691.23.09934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND The routine use of abdominal drainage (AD) after laparoscopic cholecystectomy (LC) is still controversial. The aim of this expertise-based study is to evaluate the efficacy of prophylactic AD in terms of postoperative complications and analyze the factors linked to AD placement. METHODS This case-control retrospective study included patients with cholelithiasis who underwent LC with AD (AD group) and LC without drainage (no-AD group) in two Italian centers. Allocation to groups was non-randomized and based on surgeons' decisions. Patient's characteristics, operative results, postoperative outcomes, surgeon's expertise related data were compared between the two groups with univariate and multivariate analysis. RESULTS Patients in the two groups were comparable for age, sex ratio, and morbidity. Length of postoperative hospital stay (LOS) in the no-AD group was shorter than the AD group. Patients in the AD group had a higher rate of wound infection. No difference in postoperative pain measured 7 days after the surgery was found. Our results show an association between the first operator's expertise and age and the decision of placing the AD. The operative time seems to be the principal factor impacting the decision whether to place or not the AD. CONCLUSIONS Our results indicate that it is feasible not to insert routine AD after elective LC for cholelithiasis. The use of AD seems to cause more cases of postoperative wound infections, prolongs the LOS and the operative time. The drain placement choice seems to change in relation to the surgeon's expertise.
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Affiliation(s)
- Francesco Brucchi
- State University of Milan, Milan, Italy -
- Department of General Surgery, Hospital of Sesto San Giovanni, Sesto San Giovanni, Milan, Italy -
| | - Megi Mehmeti
- Department of General Surgery, Hospital of Sesto San Giovanni, Sesto San Giovanni, Milan, Italy
| | | | - Giuseppe Faillace
- Department of General Surgery, Edoardo Bassini Hospital, Cinisello Balsamo, Milan, Italy
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Talwar A, Bansal A, Knight G, Caicedo JC, Riaz A, Salem R. Adverse Events of Surgical Drain Placement: An Analysis of the NSQIP Database. Am Surg 2024; 90:672-681. [PMID: 37490700 DOI: 10.1177/00031348231192063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Surgical site drainage is important to prevent hematoma, seroma, and abscess formation. However, the placement of drain placement also predispose patients to several postoperative complications. The aim of this study is to clarify the risk-benefit profile of surgical drain placement. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Procedure-Targeted Databases were used to identify patients who underwent hepatectomy, pancreatectomy, nephrectomy, cystectomy, and prostatectomy. Patients who underwent each procedure were divided into 2 groups based on intraoperative drain placement. Propensity score-matched cohorts of these 2 groups were compared in terms of postoperative adverse events, readmission, reoperation, and length of stay. RESULTS Hepatectomy patients with drains experienced organ space infections (P < .001), sepsis (P < .001), and readmission (P = .021) more often than patients without drains. Patients who underwent pancreatectomy and had drains placed experienced wound dehiscence less frequently than those without drains (P = .04). For hepatectomy, pancreatectomy, nephrectomy, and prostatectomy populations, patients with drains had longer lengths of stay (P < .05). Matched populations across all procedures did not differ in terms of reoperation rate. DISCUSSION Prophylactic surgical drain placement may be associated with increased infectious complications and prolonged length of stay. Further studies are needed to elucidate the complete adverse event profile of surgical drains. Nonetheless, outcomes may be improved with better patient selection or advancements in drain technology.
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Affiliation(s)
- Abhinav Talwar
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois, USA
| | - Ashir Bansal
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gabriel Knight
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA
| | - Juan-Carlos Caicedo
- Department of Surgery, Division of Transplant Surgery, Northwestern University, Chicago, IL, USA
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA
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Charlesworth T, Sampaio E. Effect of hospitalisation on the rate of surgical site infection in dogs with Penrose drains. J Small Anim Pract 2024; 65:181-188. [PMID: 38099425 DOI: 10.1111/jsap.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 09/12/2023] [Accepted: 10/01/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES The aim of this study is to retrospectively report complication and infection rates associated with the use of Penrose drains in a large population of dogs; and to compare complication and infection rates of dogs hospitalised for maintenance of their Penrose drains with those that were discharged home with their drains in place. MATERIALS AND METHODS We performed a retrospective search of medical records from 2014 to 2022 for dogs that had a Penrose drain placed into a wound in one institution. Our population was sub-divided into dogs discharged home with a drain in place; dogs discharged only after drain removal; and dogs recovered part of the time in hospital and part at home (with the drain in situ). Postoperative complications were graded using the Clavien-Dindo scale. RESULTS Two hundred and eight dogs were included. The overall complication rate was 40.9% (85/208), with most complications considered minor. The overall infection rate was 16.9% (35/207). Dogs discharged home with the drain in situ <24 hours after surgery (n=136) had similar complication (39.0%) and infection (16.2%) rates to dogs kept hospitalised for drain care (n=50, 42.9%, 18.4%) and dogs kept hospitalised for >24 hours but discharged with the drain in situ (n=18, 50.0%, 22.2%). CLINICAL SIGNIFICANCE Our study results show no significant influence on the complication or infection rates between dogs that were hospitalised for drain care and those discharged home with drains in situ within 24 hours of surgery.
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Affiliation(s)
| | - E Sampaio
- Eastcott Referrals, Swindon, SN3 3FR, UK
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Lukic A, Pajtak A, Kojundzic H, Gluncic V. A patient endangered by empty surgical drains. Asian J Surg 2023; 46:4893-4894. [PMID: 37321916 DOI: 10.1016/j.asjsur.2023.05.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Anita Lukic
- Varazdin General Hospital, Varazdin, Croatia; University Sjever, Varazdin, Croatia.
| | - Alen Pajtak
- Varazdin General Hospital, Varazdin, Croatia; University Sjever, Varazdin, Croatia
| | | | - Vicko Gluncic
- Department of Anesthesia, Mount Sinai Hospital, Chicago, USA
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Durairaj P, Pamecha V, Mohapatra N, Patil NS, Sindwani G. Early drain removal after live liver donor hepatectomy is safe - a randomized controlled pilot study. Langenbecks Arch Surg 2023; 408:350. [PMID: 37670194 DOI: 10.1007/s00423-023-03088-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 08/28/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION The current study aimed to assess the safety of early drain removal after live donor hepatectomy (LDH). METHODS One hundred eight consecutive donors who met the inclusion criteria were randomized to early drain removal (EDR - postoperative day (POD) 3 - if serous and the drain bilirubin level was less than 3 mg/dl - "3 × 3" rule) and routine drain removal (RDR - drain output serous and less than 100 ml). The primary outcome was to compare the safety. The secondary outcome was to compare the postoperative morbidity. RESULTS Preoperative, intraoperative, and postoperative parameters except for the timing of drain removal were comparable. EDR was feasible in 46 out of 54 donors (85.14%) and none required re-intervention after EDR. There was significantly better pain relief with EDR (p = 0.00). Overall complications, pulmonary complications, and hospital stay were comparable on intention-to-treat analysis. However, pulmonary complications (EDR - 1.9% vs RDR - 16.3% P = 0.030), overall complications (18.8% vs 36.3%, P = 0.043), and hospital stay (8 vs 9, P = 0.014) were more in the RDR group on per treatment analysis. Bile leaks were seen in three donors (3.7% in the EDR group vs 1.9% in RDR, P = 0.558), and none of them required endo-biliary interventions. Re-exploration for intestinal obstruction was required for 3 donors in RDR (0% vs 5.7%; p = 0.079). CONCLUSION EDR by the "3 × 3" rule after LDH is safe and associated with better pain relief. On per treatment analysis, EDR was associated with significantly less hospital stay and lower pulmonary and overall complications. CLINICAL TRIAL REGISTRY Clinical Trials.gov - NCT04504487.
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Affiliation(s)
- Parthiban Durairaj
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Viniyendra Pamecha
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India.
| | - Nihar Mohapatra
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Nilesh Sadashiv Patil
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Gaurav Sindwani
- Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
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Tang TC, Ringwood B, Degroot W. Retrospective characterisation and outcome of surgical treatment for cervical lymph node abscessation in 15 dogs. N Z Vet J 2023; 71:137-144. [PMID: 36735957 DOI: 10.1080/00480169.2023.2176938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CASE HISTORIES Medical records of a private referral hospital (Veterinary Emergency Clinic, Toronto, Canada) and a university teaching hospital (Louisiana State University, Baton Rouge, LA, USA) were reviewed, using the search terms lymphadenectomy, lymph node extirpation, cervical lymphadenitis, and lymph node abscessation. Dogs (n = 15) with a diagnosis of cervical lymph node abscessations confirmed through histopathology that underwent surgery for treatment from January 2015-May 2022 were included in the study. Long-term follow-up data was obtained by an in-person visit or telephone interview with each owner. Dogs that met the inclusion criteria were of various breeds with a median age of 6 (min 0.5, max 12) years. All cases presented with cervical swelling and lethargy, with inappetence and fever in 5/15 dogs. The range of duration of clinical signs prior to treatment was 1-3 weeks. Seven dogs were treated with a short course of antibiotics, with or without prednisone, without successful resolution, before referral. CLINICAL FINDINGS Diagnostic imaging using CT or cervical ultrasound revealed enlargement of unilateral mandibular and retropharyngeal lymph nodes with regional cellulitis and oedema in four dogs, enlargement of unilateral retropharyngeal lymph nodes with regional cellulitis in eight dogs, and a right ventral cervical abscess infiltrating the right medial retropharyngeal lymph nodes with oedema in one dog. Unilateral or bilateral cervical lymph node abscessation was diagnosed by lymphadenectomy and histopathology of affected lymph nodes. Bacterial cultures from samples of excised lymph nodes were positive in six cases. TREATMENT AND OUTCOME Cervical exploration and lymphadenectomy were performed in all cases. Thirteen dogs received antibiotics along with surgical treatment. Resolution was defined as absence of cervical swelling or enlarged lymph node(s) at the time of long-term follow-up (median 300 (min 240, max 1,072) days). Most patients had resolution of clinical signs following surgical excision of affected lymph nodes. Two dogs had complications including recurrence of clinical signs and development of open wounds following surgery. Their clinical signs resolved following additional administration of antibiotics. CONCLUSIONS AND CLINICAL RELEVANCE All dogs in this series had lymphadenectomy of abscessed lymph nodes and showed resolution of clinical signs with a favourable outcome. As 13/15 dogs also received antibiotics in conjunction with surgical treatment, appropriate use of antimicrobials may also play a role in treatment of this disease process.
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Affiliation(s)
- T C Tang
- Louisiana State University Veterinary Teaching Hospital, Baton Rouge, LA, USA
| | - B Ringwood
- Veterinary Emergency Clinic Toronto, Toronto, ON, Canada
| | - W Degroot
- Veterinary Emergency Clinic Toronto, Toronto, ON, Canada
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Akış S, Keleş E, Öztürk UK, Alınca CM, Purut YE, Api M, Kabaca C. The effect of abdominal drainage on post-operative morbidity; a prospective cohort study. J OBSTET GYNAECOL 2022; 42:3212-3217. [PMID: 35962552 DOI: 10.1080/01443615.2022.2109408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was to investigate the effect of drains used in current clinical practice on operation parameters and post-operative morbidity. The comprehensive data obtained through the prospective design were analysed in detail according to whether abdominal drainage was applied. Abdominal drainage was present in 44.1% of patients who met the inclusion criteria. Drains were placed significantly more frequently during oncologic surgery (p = .007). The mean mobilisation (p = .001), first flatus (p = .001), and first oral intake (p = .029) times were longer in the drain group than those in the non-drain group. In patients who underwent oncological surgeries, no significant differences were observed except for the pre-operative duration of bowel preparation (p = .006) and first flatus time (p = .003). Our results suggest that drain placement in gynecological procedures does not provide an additional advantage.IMPACT STATEMENTWhat is already known on this subject? Post-operative drainage of the abdominal cavity has been controversial for many years. However, whether abdominal drainage provides an additional benefit in lower and upper abdominal surgical procedures remains unclear.What do the results of this study add? Most studies have examined post-operative pain and surgical site infections. We examined the relationship between abdominal drainage and demographic and pre-/post-operative clinical features in detail. We demonstrated that abdominal drainage in gynecological procedures may not provide an additional advantage.What are the implications of these findings for clinical practice and/or further research? The present study provides valuable information that can guide physicians in deciding whether to use post-operative abdominal drainage. This topic warrants investigation with randomised data in the future.
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Affiliation(s)
- Serkan Akış
- Department of Gynecologic Oncology, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
| | - Esra Keleş
- Department of Gynecologic Oncology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Uğur Kemal Öztürk
- Department of Gynecologic Oncology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cihat Murat Alınca
- Department of Gynecologic Oncology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yunus Emre Purut
- Department of Gynecologic Oncology, Van Training and Research Hospital, University of Health Sciences, Van, Turkey
| | - Murat Api
- Department of Gynecologic Oncology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Canan Kabaca
- Department of Gynecologic Oncology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Niak R, Gajjala SR, Banoth M, Hulikal N. Drain Versus No-Drain in Patients After Surgery for Early Stage Gynecologic Malignancies: A Randomized Controlled Study. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ragavendra Niak
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Sivanath Reddy Gajjala
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Manilal Banoth
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Narendra Hulikal
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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9
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Tsai YW, Lee SY, Jiang JH, Chuang JH. Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis. BMC Surg 2021; 21:437. [PMID: 34953485 PMCID: PMC8709970 DOI: 10.1186/s12893-021-01413-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background This study examined whether drain placement or not is associated with the postoperative outcomes of pediatric patients following trans-umbilical single-port laparoscopic appendectomy (TUSPLA) for complicated appendicitis. Methods
The medical records of pediatric patients undergoing TUSPLA for acute complicated appendicitis from January 2012 to September 2018 in Kaohsiung Chang Gung Memorial Hospital were reviewed retrospectively. They were classified according to whether they received passive drainage with a Penrose drain (Penrose group) (19), active drainage with a Jackson-Pratt drain with a vacuum bulb (JP group) (16), or no drain (non-drain group) (86). The postoperative outcomes of the three groups were compared. Results Postoperative visual analog scale pain score was significantly higher in the non-drain group than in either the JP group or Penrose group. Patients in the Penrose group had a significantly longer postoperative hospital stay than those in the non-drain group and a higher rate of intra-abdominal abscess, while patients in the JP group had a significantly shorter postoperative hospital stay; moreover, no patient in JP group developed a postoperative intra-abdominal abscess. Conclusions Compared to passive drainage with a Penrose drain or no drain, active drainage with a JP drain shorter the postoperative hospital stay and decreased the risk of postoperative intra-abdominal abscess.
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Affiliation(s)
- Yi-Wen Tsai
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C
| | - Shin-Yi Lee
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C
| | - Jyun-Hong Jiang
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C
| | - Jiin-Haur Chuang
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C..
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Kowal M, Bolton W, Van Duren B, Burke J, Jayne D. Impact of surgical drain output monitoring on patient outcomes in hepatopancreaticobiliary surgery: A systematic review. Scand J Surg 2021; 111:14574969211030118. [PMID: 34749548 DOI: 10.1177/14574969211030118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Surgical drains are widely utilized in hepatopancreaticobiliary surgery to prevent intra-abdominal collections and identify postoperative complications. Surgical drain monitoring ranges from simple-output measurements to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect postoperative complications and impact on patient outcomes. METHODS A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library, and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing hepatopancreaticobiliary surgery were considered. Other invasive methods of intra-abdominal sampling were excluded. RESULTS The search returned 403 articles. Following abstract review, 390 were excluded and 13 articles were included for full review. The studies were classified according to speciality and featured 11 pancreatic surgery and 2 hepatobiliary surgery studies with a total sample of 3262 patients. Postoperative monitoring of drain amylase detected pancreatic fistula formation and drain bilirubin testing facilitated bile leak detection. Both methods enabled early drain removal. Improved patient outcomes were observed through decreased incidence of postoperative complications (pancreatic fistulas, intra-abdominal infections, and surgical-site infections), length of stay, and mortality rate. Isolated monitoring of drain output did not confer any clinical benefits. CONCLUSIONS Surgical drain monitoring has advantages in the postoperative care for selected patients undergoing hepatopancreaticobiliary surgery. Enhanced surgical drain monitoring involving the testing of drain amylase and bilirubin improves the detection of complications in the immediate postoperative period.
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Affiliation(s)
- Mikolaj Kowal
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK University of Leeds, Leeds, UK
| | - William Bolton
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK.,University of Leeds, Leeds, UK
| | - Bernard Van Duren
- University of Leeds, Leeds, UKLeeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Joshua Burke
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK.,University of Leeds, Leeds, UK
| | - David Jayne
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK.,University of Leeds, Leeds, UK
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11
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Sahara K, Tsilimigras DI, Moro A, Mehta R, Hyer JM, Paredes AZ, Beane JD, Endo I, Pawlik TM. Variation in Drain Management Among Patients Undergoing Major Hepatectomy. J Gastrointest Surg 2021; 25:962-970. [PMID: 32342262 DOI: 10.1007/s11605-020-04610-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/08/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although previous studies have suggested that drain management is highly variable, data on drain placement and timing of drain removal among patients undergoing hepatic resection remain scarce. The objective of the current study was to define the utilization of drain placement among patients undergoing major hepatic resection. METHODS The ACS NSQIP-targeted hepatectomy database was used to identify patients who underwent major hepatectomy between 2014 and 2017. Association between day of drain removal, timing of discharge, and drain fluid bilirubin on postoperative day (POD) 3 (DFB-3) was assessed. Propensity score matching (PSM) was used to compare outcomes of patients with a drain removed before and after POD 3. RESULTS Among 5330 patients, most patients had an abdominal drain placed at the time of hepatic resection (n = 3075, 57.7%). Of 2495 patients with data on timing of drain removal, only 380 patients (15.2%) had their drain removed by POD 3. Almost 1 in 6 patients (n = 441, 17.7%) were discharged home with the drain in place. DFB-3 values correlated poorly with POD of drain removal (R2 = 0.0049). After PSM, early drain removal (≤ POD 3) was associated with lower rates of grade B or C bile leakage (2.1% vs. 7.1%, p = 0.008) and prolonged length of hospital stay (6.0% vs. 12.7%, p = 0.009) compared with delayed drain removal (> POD 3). CONCLUSIONS Roughly 3 in 5 patients had a drain placed at the time of major hepatectomy and only 1 in 7 patients had the drain removed early. This study demonstrated the potential benefits of early drain removal in an effort to improve the quality of care following major hepatectomy.
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Affiliation(s)
- Kota Sahara
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amika Moro
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rittal Mehta
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joal D Beane
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Itaru Endo
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Hassan RSEE, Osman SOS, Aabdeen MAS, Mohamed WEA, Hassan RSEE, Mohamed SOO. Incidence and root causes of surgical site infections after gastrointestinal surgery at a public teaching hospital in Sudan. Patient Saf Surg 2020; 14:45. [PMID: 33372624 PMCID: PMC7722425 DOI: 10.1186/s13037-020-00272-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023] Open
Abstract
Background Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays, additional financial burden, and significantly hamper the potential benefits of surgical interventions. Causes of SSIs are multi-factorials and patients undergoing gastrointestinal tract procedures carry a high risk of bacterial contamination. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries. Methods A hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between 1st September and 31st December 2017. We collected data about the socio-demographic characteristics, risk factors of SSI, and isolated microorganisms from patients with SSIs. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05. Results A total of 80 participants were included in the study. The mean age was 51 +/- 16 years and most of the patients (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) of them underwent large bowel surgery. Twenty-two patients (27.5%) developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated from SSI patients was E coli (47.8%), followed by Enterococcus fecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%). Conclusions The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.
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Ballan A, Jabbour S, El Rayess Y, Jabbour K, El Hachem L, Nasr M. Quilting Sutures in Rhytidectomy: A Systematic Review of the Literature. Aesthet Surg J 2020; 40:1157-1164. [PMID: 31784752 DOI: 10.1093/asj/sjz353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Different technical variations exist for the utilization of quilting sutures (QS) in rhytidectomy. No systematic review or meta-analysis of the studies describing the use of QS in facelifts has been published to date to the authors' knowledge. OBJECTIVES The objective of this study was to summarize all the published data regarding the utilization of QS in rhytidectomy, compare QS techniques, and evaluate their effect on postoperative complications. METHODS On April 1, 2019, a systematic search of the Medline, Embase, and Cochrane databases was conducted. All the studies describing the usage of QS in facelifts were included in this review. Studies reporting hematoma rate in a QS group and a control group were included in the meta-analysis part of this study. RESULTS The initial search of the databases yielded 93 results. Four trials were included in the systematic review and 2 were included in the meta-analysis. The total number of included patients with QS was 527. Two studies employed internal QS and the remaining studies utilized external QS. The meta-analysis found a lower rate of hematoma in the QS group (relative risk, 0.02; 95% confidence interval = 0.00-0.13; P < 0.0001). CONCLUSIONS QS can be applied either internally or externally and are very effective in reducing hematomas after facelifts. QS could be a great asset in facelifts but should be utilized with caution because additional work is needed to confirm their safety and efficacy. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Anthony Ballan
- Drs Ballan and Rayess are Residents, Dr S. Jabbour is a Faculty and Dr Nasr is an Associate Professor, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Samer Jabbour
- Drs Ballan and Rayess are Residents, Dr S. Jabbour is a Faculty and Dr Nasr is an Associate Professor, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Youssef El Rayess
- Drs Ballan and Rayess are Residents, Dr S. Jabbour is a Faculty and Dr Nasr is an Associate Professor, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Jabbour
- Dr K. Jabbour is an Assistant Professor, Department of Anesthesia, Faculty of Medicine, Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Lena El Hachem
- Dr Hachem is an Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Marwan Nasr
- Drs Ballan and Rayess are Residents, Dr S. Jabbour is a Faculty and Dr Nasr is an Associate Professor, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
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14
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Earnshaw CH, Kinshuck AJ, Loh C, Tandon S, Jackson SR, Jones TM, Lancaster J. An audit of fifty patients receiving Artiss™ fibrin sealant in lateral selective neck dissections. Clin Otolaryngol 2020; 45:264-267. [PMID: 31782892 DOI: 10.1111/coa.13485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 04/08/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Charles H Earnshaw
- Otolaryngology/Head and Neck Surgery, University Hospital Aintree, Liverpool, UK
| | - Andrew J Kinshuck
- Otolaryngology/Head and Neck Surgery, University Hospital Aintree, Liverpool, UK
| | - Christopher Loh
- Otolaryngology/Head and Neck Surgery, University Hospital Aintree, Liverpool, UK
| | - Sankalap Tandon
- Otolaryngology/Head and Neck Surgery, University Hospital Aintree, Liverpool, UK
| | - Shaun R Jackson
- Otolaryngology/Head and Neck Surgery, University Hospital Aintree, Liverpool, UK
| | - Terry M Jones
- Otolaryngology/Head and Neck Surgery, University Hospital Aintree, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jeffrey Lancaster
- Otolaryngology/Head and Neck Surgery, University Hospital Aintree, Liverpool, UK
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15
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Muoghalu ON, Eyichukwu GO, Iyidobi E, Anyaehie UE, Madu KA, Okwesili IC. A comparison of the use and non-use of closed suction wound drainage in open reduction and internal fixation of femoral shaft fractures. INTERNATIONAL ORTHOPAEDICS 2019; 43:2003-2008. [PMID: 31250086 DOI: 10.1007/s00264-019-04364-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to determine if the routine use of closed suction wound drainage is justified following open reduction and internal fixation (ORIF) of femoral shaft fractures. METHOD This was a prospective comparative study of two study groups: those with post-operative closed suction drainage (WCSD) and those not with closed suction drainage (NWCSD). RESULTS Fifty-six patients, twenty-eight each for the two cohorts, were recruited for this study. Five patients (17.9%) in the WCSD group and only one patient (3.6%) in NWCSD group had surgical site infection (p = 0.20). Four patients (14.3%) in the WCSD group and nine (32.1%) in NWCSD group had wound dressing reinforcements (p = 0.21). CONCLUSION There was generally no statistically significant difference in the incidence of wound infections, strike through bloodstain with wound dressing reinforcement and duration of hospital stay in patients with and without closed suction wound drainage after ORIF of femoral shaft fractures. The duration of the injury may however influence the decision to use or not use wound drain after surgery.
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Affiliation(s)
- Obiora N Muoghalu
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria.
| | | | - Emmanuel Iyidobi
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
| | - Udo E Anyaehie
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
| | - Kenechi A Madu
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
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16
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Weiss E, Mcclelland P, Krupp J, Karadsheh M, Brady MS. Use of Prolonged Prophylactic Antibiotics with Closed Suction Drains in Ventral Abdominal Hernia Repair. Am Surg 2019. [DOI: 10.1177/000313481908500432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Closed suction drains (CSD) are commonly used in ventral hernia repair (VHR), with or without prolonged postoperative prophylactic antibiotics (PPA) for the duration of their use. We examine the evidence that PPA with CSD reduce surgical site infection (SSI) in patients undergoing VHR. We also examine the evidence assessing the association between SSI and CSD in VHR. A systematic review of PubMed, CIHNL, and Cochrane databases was performed to identify studies analyzing rates of SSI with CSD in patients undergoing abdominal VHR and related procedures with or without the concomitant use of PPA. The primary outcome was the rate of SSI. Five studies totaling 772 patients were identified, 525 patients were confirmed to have CSD, and 434 patients received prolonged antibiotics while drains were in place. PPA had no significant effect on SSI in two studies and were associated with decreased SSI in one study (Odds ratio 0.235, 95% confidence interval 0.090–0.617, P = 0.003). Two studies documented a higher rate of SSI in patients with CSD (79% vs 49% and 19% vs 10%) on univariate analysis. One study demonstrated a very low risk of SSI despite CSD (4.2%) and another demonstrated no increased risk with or without CSD. The use of drains is not clearly associated with an increased risk of SSI in VHR, and there is limited evidence to support antibiotic use while the drains are in place to decrease the potential risk. Prospective randomized studies are needed to more clearly assess these associations.
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Affiliation(s)
- Eric Weiss
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Paul Mcclelland
- Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York; and
| | - James Krupp
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Murad Karadsheh
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Mary Sue Brady
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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17
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Jodeh DS, Khavanin N, Cray JJ, Tuite GF, Steinberg JP, Rottgers SA. Postoperative Drain Use in Cranial Vault Remodeling: A Survey of Craniofacial Surgeon Practices and a Review of the Literature. Cleft Palate Craniofac J 2019; 56:1001-1007. [PMID: 30884974 DOI: 10.1177/1055665619836509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The use of subgaleal drains following primary cranioplasty for craniosynostosis has undergone limited investigation. Proposed benefits include prevention of seroma, detection of postoperative bleeding, and cerebrospinal fluid leak. We conducted a systematic review of the literature and surveyed craniofacial surgeons to ascertain the current evidence pertaining to drain use following primary cranioplasty for craniosynostosis and to determine surgical practice patterns. METHODS PubMed and Embase databases were searched to identify relevant articles. Abstracts were reviewed by 2 investigators, and a Cohen κ statistic was calculated. Patient demographic and outcome data were extracted and compared. A 9-question survey was e-mailed to active and associate members of the American Society of Craniofacial Surgeons. RESULTS A total of 7395 unique citations were identified. Only 2 retrospective chart reviews met inclusion criteria. All objective parameters demonstrated no difference between patients with and without drains. A subjective benefit of limiting facial swelling was proposed without objective analysis. Fifty (32.5%) of the 154 craniofacial surgeons responded to the survey. Forty-two percent used postoperative drains. A significant association (P = .01) was found between the belief that drains limited facial swelling and their use. CONCLUSIONS The literature examining postoperative drain use in primary cranioplasty for craniosynostosis is restricted. The current studies show no definite benefit to drain use but are limited in their assessment of key outcomes. There is wide variability among surgeons regarding drain use, and this seems to be motivated by belief and tradition.
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Affiliation(s)
- Diana S Jodeh
- 1 Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Nima Khavanin
- 2 Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James J Cray
- 3 Division of Anatomy, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Gerald F Tuite
- 4 Division of Pediatric Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Jordan P Steinberg
- 2 Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Alex Rottgers
- 1 Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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18
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Mujagic E, Zeindler J, Coslovsky M, Hoffmann H, Soysal SD, Mechera R, von Strauss M, Delko T, Saxer F, Glaab R, Kraus R, Mueller A, Curti G, Gurke L, Jakob M, Marti WR, Weber WP. The association of surgical drains with surgical site infections - A prospective observational study. Am J Surg 2018; 217:17-23. [PMID: 29935905 DOI: 10.1016/j.amjsurg.2018.06.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Surgical drains are widely used despite limited evidence in their favor. This study describes the associations between drains and surgical site infections (SSI). METHODS This prospective observational double center study was performed in Switzerland between February 2013 and August 2015. RESULTS The odds of SSI in the presence of drains were increased in general (OR 2.41, 95%CI 1.32-4.30, p = 0.004), but less in vascular and not in orthopedic trauma surgery. In addition to the surgical division, the association between drains and SSI depended significantly on the duration of surgery (p = 0.01) and wound class (p = 0.034). Furthermore, the duration of drainage (OR 1.24, 95%CI 1.15-1.35, p < 0.001), the number (OR 1.74, 95%CI 1.09-2.74, p = 0.019) and type of drains (open versus closed: OR 3.68, 95%CI 1.88, 6.89, p < 0.001) as well as their location (overall p = 0.002) were significantly associated with SSI. CONCLUSIONS The general use of drains is discouraged. However, drains may be beneficial in specific surgical procedures.
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Affiliation(s)
- Edin Mujagic
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Jasmin Zeindler
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Michael Coslovsky
- Clinical Trial Unit, University of Basel and University Hospital Basel, Spitalstrasse 12, 4031, Basel, Switzerland.
| | - Henry Hoffmann
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Savas D Soysal
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Robert Mechera
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Marco von Strauss
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Tarik Delko
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Franziska Saxer
- Department of Orthopedic Trauma Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Richard Glaab
- Department of Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Rebecca Kraus
- Department of Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Alexandra Mueller
- Department of Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Gaudenz Curti
- Department of Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Lorenz Gurke
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Marcel Jakob
- Department of Orthopedic Trauma Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Walter R Marti
- Department of Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Walter P Weber
- Department of Surgery, University of Basel and University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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19
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Drain Tags: A Reliable Method of Securing Drains in the Neck. Indian J Surg 2018; 80:100-102. [PMID: 29581697 DOI: 10.1007/s12262-017-1696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022] Open
Abstract
Drains are essential in most surgeries. Primary need is elimination of dead space and related consequences but drains per se do have their share of complications, one of them being dislodgment. Complications related to dislodgment can range from inactive drains to damage to critical areas like anastomosis sites. Securing drains using this technique was described by Jayaraj et al. in 1988. Since then, no study was done to determine the efficacy and outcomes of this method. An audit was conducted from 2009 to 2014 at SDM Craniofacial unit to determine the utility of drain fixation. Data was collected of a total of 143 patients from the medical records. This useful technique has the advantage of preventing the drain from displacement and its consequent complications.
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20
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Heiser B, Okrasinski EB, Murray R, McCord K. In Vitro Evaluation of Evacuated Blood Collection Tubes as a Closed-Suction Surgical Drain Reservoir. J Am Anim Hosp Assoc 2017; 54:30-35. [PMID: 29131671 DOI: 10.5326/jaaha-ms-6519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The initial negative pressures of evacuated blood collection tubes (EBCT) and their in vitro performance as a rigid closed-suction surgical drain (CSSD) reservoir has not been evaluated in the scientific literature despite being described in both human and veterinary texts and journals. The initial negative pressures of EBCT sized 3, 6, 10, and 15 mL were measured and the stability of the system monitored. The pressure-to-volume curve as either air or water was added and maximal filling volumes were measured. Evacuated blood collection tubes beyond the manufacture's expiration date were evaluated for initial negative pressures and maximal filling volumes. Initial negative pressure ranged from -214 mm Hg to -528 mm Hg for EBCT within the manufacturer's expiration date. Different pressure-to-volume curves were found for air versus water. Optimal negative pressures of CSSD are debated in the literature. Drain purpose and type of exudates are factors that should be considered when deciding which EBCT size to implement. Evacuated blood collection tubes have a range of negative pressures and pressure-to-volume curves similar to previously evaluated CSSD rigid reservoirs. Proper drain management and using EBCT within labeled expiration date are important to ensure that expected negative pressures are generated.
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Affiliation(s)
- Brian Heiser
- From the Summit Veterinary Referral Center, Tacoma, Washington
| | - E B Okrasinski
- From the Summit Veterinary Referral Center, Tacoma, Washington
| | - Rebecca Murray
- From the Summit Veterinary Referral Center, Tacoma, Washington
| | - Kelly McCord
- From the Summit Veterinary Referral Center, Tacoma, Washington
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Khan S, Rai P, Misra G. Is Prophylactic Drainage of Peritoneal Cavity after Gut Surgery Necessary?: A Non-Randomized Comparative Study from a Teaching Hospital. J Clin Diagn Res 2015; 9:PC01-3. [PMID: 26557562 DOI: 10.7860/jcdr/2015/8293.6577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 07/03/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prophylactic use of intra-peritoneal drain is commonly practiced by surgeons in the hope of early detection of complication and reducing mortality and morbidity. The aim of the study was to determine evidence based value of prophylactic drainage of peritoneal cavity in cases of secondary peritonitis and resection and anastomosis of small and large bowel. MATERIALS AND METHODS One hundred and seventy one (171) cases were included in the study from March 2012-May 2013 that underwent laparotomy for peptic ulcer perforation (PUP), simple and complicated acute appendicitis (appendicular perforation with localized/generalized peritonitis), small bowel obstruction (SBO) and sigmoid volvulus, traumatic and non-traumatic perforation of small and large bowel. Appropriate management was done after resuscitation and investigation. After completion of operation peritoneal cavity was either drained or not drained according operator's preference. They were divided into drain and non-drain groups. Surgical outcome and postoperative complications ≤30 days of operation was noted and compared between two groups. RESULTS No significant difference was observed between drained group and non-drained group in terms of age (32.08±15.99 vs. 35.57 ± 16.42 years), Sex (76M: 42F vs. 40M: 13F), weight 50.9 ± 11.75 vs. 48.4 ± 16.1 kg), height (1.6 ± 0.13 vs. 1.5 ± 0.18 Meter), BMI (20 ± 4.7 vs. 20 ± 7.2), ASA score (p= >0.05). However there was significant difference was observed between drained group and non-drained groups in terms of length of hospital stay (9 ± 4 vs 5 ± 3.4 days), operative duration (115.6 ± 41.0 vs. 80 ± 38.1 minutes), infection rates in dirty wound (40.0% vs 12.5%) and overall postoperative complications (35.85% vs16.11%). CONCLUSION Based on these results, present study suggests that prophylactic drainage of peritoneal cavity after gastrointestinal surgery is not necessary as it does not offer additional benefits for the patients undergoing gut surgery. Moreover, it increases operative duration, length of hospital stay and surgical site infection (SSI).
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Affiliation(s)
- Salamat Khan
- Professor, Department of Surgery, UCMS , Bhairahwa, Nepal
| | - Pranil Rai
- Associate Professor, Department of Surgery, UCMS , Bhairahwa, Nepal
| | - Gorakh Misra
- Assistant Professor, Department of Surgery, UCMS , Bhairahwa, Nepal
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22
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Wong CS, Cousins G, Duddy JC, Walsh SR. Intra-abdominal drainage for laparoscopic cholecystectomy: A systematic review and meta-analysis. Int J Surg 2015; 23:87-96. [DOI: 10.1016/j.ijsu.2015.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/23/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
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23
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Samaiya A. To Drain or Not to Drain after Colorectal Cancer Surgery. Indian J Surg 2015; 77:1363-8. [PMID: 27011566 DOI: 10.1007/s12262-015-1259-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/09/2015] [Indexed: 11/26/2022] Open
Abstract
Prophylactic drainage of abdominal cavity after GI surgery has been widely practiced. The most important signal function of prophylactic drain is to detect early complications. But the same drains could be the cause of some of the complications. Although there is a considerable theoretical and practical evidences in favor of drainage, the dispute about "to drain or not to drain" the peritoneal cavity after elective colorectal surgery remains open. Unfortunately, the principle of drainage is not based on any scientific data. During the last three decades, surgeons have made efforts to investigate the value of prophylactic drainage after colorectal surgery. However, the results of trials are contradictory due to lack of quality and/or statistical power and therefore do not provide an answer to the clinical question. A systematic review of studies suggests that there is insufficient evidence for routine use of drain after colorectal surgery. Despite evidence-based data questioning prophylactic drainage of abdominal cavity in many instances, most surgeons around the world continue to use drains on a routine basis until now. There are strong evidences in literature in favor of no apparent benefit of drainage for supra-peritoneal anastomoses; however, there is still controversies regarding drainage of infra-peritoneal rectal anastomoses.
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Affiliation(s)
- Atul Samaiya
- LN Medical College and JK Hospital, Bhopal, India ; Navodaya Cancer Hospital, Bhopal, MP India ; C-6, Dwarkadham, Karond Bypass Road, Badwai, Near Central Jail, Bhopal, 462038 India
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24
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Wang Z, Chen J, Su K, Dong Z. Abdominal drainage versus no drainage post-gastrectomy for gastric cancer. Cochrane Database Syst Rev 2015; 2015:CD008788. [PMID: 25961741 PMCID: PMC7173737 DOI: 10.1002/14651858.cd008788.pub3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastrectomy remains the primary therapeutic method for resectable gastric cancer. Thought of as an important measure to reduce post-operative complications and mortality, abdominal drainage has been used widely after gastrectomy for gastric cancer in previous decades. The benefits of abdominal drainage have been questioned by researchers in recent years. OBJECTIVES The objectives of this review were to assess the benefits and harms of routine abdominal drainage post-gastrectomy for gastric cancer. SEARCH METHODS We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases (UGPD) Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2014, Issue 11); MEDLINE (via PubMed) (1950 to November 2014); EMBASE (1980 to November 2014); and the Chinese National Knowledge Infrastructure (CNKI) Database (1979 to November 2014). SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing an abdominal drain versus no drain in patients who had undergone gastrectomy (not considering the scale of gastrectomy and the extent of lymphadenectomy); irrespective of language, publication status, and the type of drain. We excluded RCTs comparing one drain with another. DATA COLLECTION AND ANALYSIS We adhered to the standard methodological procedures of The Cochrane Collaboration. From each included trial, we extracted the data on the methodological quality and characteristics of the participants, mortality (30-day mortality), re-operations, post-operative complications (pneumonia, wound infection, intra-abdominal abscess, anastomotic leak, drain-related complications), operation time, length of post-operative hospital stay, and initiation of a soft diet. For dichotomous data, we calculated the risk ratio (RR) and 95% confidence interval (CI). For continuous data, we calculated mean difference (MD) and 95% CI. We tested heterogeneity using the Chi(2) test. We used a fixed-effect model for data analysis with RevMan software, but we used a random-effects model if the P value of the Chi(2) test was less than 0.1. MAIN RESULTS We included four RCTs involving 438 patients (220 patients in the drain group and 218 in the no-drain group). There was no evidence of a difference between the two groups in mortality (RR 1.73, 95% CI 0.38 to 7.84); re-operations (RR 2.49, 95% CI 0.71 to 8.74); post-operative complications (pneumonia: RR 1.18, 95% CI 0.55 to 2.54; wound infection: RR 1.23, 95% CI 0.47 to 3.23; intra-abdominal abscess: RR 1.27, 95% CI 0.29 to 5.51; anastomotic leak: RR 0.93, 95% CI 0.06 to 14.47); or initiation of soft diet (MD 0.15 days, 95% CI -0.07 to 0.37). However, the addition of a drain prolonged the operation time (MD 9.07 min, 95% CI 2.56 to 15.57) and post-operative hospital stay (MD 0.69 day, 95% CI 0.18 to 1.21) and led to drain-related complications. Additionally, we should note that 30-day mortality and re-operations are very rare events and, as a result, very large numbers of patients would be required to make any sensible conclusions about whether the two groups were similar. The overall quality of the evidence according to the GRADE approach was 'very low' for mortality and re-operations, and 'low' for post-operative complications, operation time, and post-operative length of stay. AUTHORS' CONCLUSIONS We found no convincing evidence to support routine drain use after gastrectomy for gastric cancer.
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Affiliation(s)
- Zhen Wang
- The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Gastrointestinal SurgeryNo.6, Shuang Yong RoadNanningGuangxiChina530021
| | - Junqiang Chen
- The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Gastrointestinal SurgeryNo.6, Shuang Yong RoadNanningGuangxiChina530021
| | - Ka Su
- The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Gastrointestinal SurgeryNo.6, Shuang Yong RoadNanningGuangxiChina530021
| | - Zhiyong Dong
- The First Affiliated Hospital of Guangxi Medical UniversityHepato‐Pancreato‐Biliary SurgeryNo.6, Shuang Yong RoadNanningGuangxiChina530021
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25
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Bawahab MA, Abd El Maksoud WM, Alsareii SA, Al Amri FS, Ali HF, Nimeri AR, Al Amri ARM, Assiri AA, Abdul Aziz MI. Drainage vs. non-drainage after cholecystectomy for acute cholecystitis: a retrospective study. J Biomed Res 2014; 28:240-5. [PMID: 25013408 PMCID: PMC4085562 DOI: 10.7555/jbr.28.20130095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/15/2013] [Accepted: 01/16/2014] [Indexed: 11/03/2022] Open
Abstract
Many surgeons practice prophylactic drainage after cholecystectomy without reliable evidence. This study was conducted to answer the question whether to drain or not to drain after cholecystectomy for acute calculous cholecystitis. A retrospective review of all patients who had cholecystectomy for acute cholecystitis in Aseer Central Hospital, Abha, Saudi Arabia, was conducted from April 2010 to April 2012. Data were extracted from hospital case files. Preoperative data included clinical presentation, routine investigations and liver function tests. Operative data included excessive adhesions, bleeding, bile leak, and drain insertion. Complicated cases such as pericholecystic collections, mucocele and empyema were also reported. Patients who needed therapeutic drainage were excluded. Postoperative data included hospital stay, volume of drained fluid, time of drain removal, and drain site problems. The study included 103 patients allocated into two groups; group A (n = 38) for patients with operative drain insertion and group B (n = 65) for patients without drain insertion. The number of patients with preoperative diagnosis of acute non-complicated cholecystitis was significantly greater in group B (80%) than group A (36.8%) (P < 0.001). Operative time was significantly longer in group A. All patients who were converted from laparoscopic to open cholecystectomy were in group A. Multivariate analysis revealed that hospital stay was significantly (P < 0.001) longer in patients with preoperative complications. There was no added benefit for prophylactic drain insertion after cholecystectomy for acute calculous cholecystitis in non-complicated or in complicated cases.
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Affiliation(s)
- Mohammed A Bawahab
- General Surgery Department, Faculty of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Walid M Abd El Maksoud
- General Surgery Department, Faculty of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Saeed A Alsareii
- General Surgery Department, Faculty of Medicine, Najran University, Najran, P.O. 1988, Saudi Arabia
| | - Fahad S Al Amri
- General Surgery Department, Faculty of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Hala F Ali
- General Surgery Department, Faculty of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Abdul Rahman Nimeri
- General Surgery Department, Sheikh Khalifa Medical City, Abu Dhabi, P.O. 51900, United Arab Emirates
| | - Abdul Rahman M Al Amri
- General Surgery Department, Faculty of Medicine, Najran University, Najran, P.O. 1988, Saudi Arabia
| | - Adel A Assiri
- General Surgery Department, Faculty of Medicine, Najran University, Najran, P.O. 1988, Saudi Arabia
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Reiffel AJ, Barie PS, Spector JA. A multi-disciplinary review of the potential association between closed-suction drains and surgical site infection. Surg Infect (Larchmt) 2013; 14:244-69. [PMID: 23718273 PMCID: PMC3689179 DOI: 10.1089/sur.2011.126] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth. METHODS The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed. RESULTS Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine post-operative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement. CONCLUSIONS Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to "cover" an indwelling drain.
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Affiliation(s)
- Alyssa J. Reiffel
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Philip S. Barie
- Department of Surgery, Weill Cornell Medical College, New York, New York
- Department of Public Health, Weill Cornell Medical College, New York, New York
| | - Jason A. Spector
- Department of Surgery, Weill Cornell Medical College, New York, New York
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Abstract
BACKGROUND Gastrectomy remains the primary therapeutic method for resectable gastric cancer. Thought of as an important measure to reduce post-operative complications and mortality, abdominal drainage was used widely after gastrectomy for gastric cancer in previous decades. The benefits of abdominal drainage have been questioned by researchers in recent years. OBJECTIVES The objectives of this review were to access the benefits and harms of routine abdominal drainage post gastrectomy for gastric cancer. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register (Central/CCTR) in The Cochrane Library (2010, Issue 10), including the Specialised Registers of the Cochrane Upper Gastrointestinal and Pancreatic Diseases (UGPD) Group; MEDLINE (via Pubmed, 1950 to October, 2010); EMBASE (1980 to October, 2010); and the Chinese National Knowledge Infrastructure (CNKI) Database (1979 to October, 2010). SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing abdominal drain versus no drain in patients who had undergone gastrectomy (not considering the scale of gastrectomy and the extent of lymphadenectomy; irrespective of language, publication status, and the type of drain). We excluded RCTs comparing one drain with another. DATA COLLECTION AND ANALYSIS From each trial, we extracted the data on the methodological quality and characteristics of the included studies, mortality (30-day mortality), re-operations, post-operative complications (pneumonia, wound infection, intra-abdominal abscess, anastomotic leak, drain-related complications), operation time, length of post-operative hospital stay and initiation of soft diet. For dichotomous data, we calculated the risk ratio (RR) and 95% confidence intervals (CI). For continuous data, we calculated mean differences (MD) and 95% CI. We tested heterogeneity using the Chi(2) test. We used a fixed-effect model for data analysis with RevMan software but we used a random-effects model if the P value of the Chi(2) test was less than 0.1. MAIN RESULTS We included four RCTs involving 438 patients (220 patients in the drain group and 218 in the no-drain group).There was no evidence of a difference between the two groups in mortality (RR 1.73, 95% CI 0.38 to 7.84); re-operations (RR 2.49, 95% CI 0.71 to 8.74); post-operative complications (pneumonia: RR 1.18, 95% CI 0.55 to 2.54; wound infection: RR 1.23, 95% CI 0.47 to 3.23; intra-abdominal abscess: RR 1.27, 95% CI 0.29 to 5.51; anastomotic leak: RR 0.93, 95% CI 0.06 to 14.47); and initiation of soft diet (MD 0.15 day, 95% CI -0.07 to 0.37). However, the addition of a drain prolonged the operation time (MD 9.07 min, 95% CI 2.56 to 15.57) and post-operative hospital stay (MD 0.69 day, 95% CI 0.18 to 1.21) and lead to drain-related complications. Additionally, we should note that 30-day mortality and re-operations are very rare events and, as a result, very large numbers of patients would be required to make any sensible conclusions about whether the two groups were similar. The overall quality of the evidence according to the GRADE approach was "Very Low" for mortality and re-operations, and "Low" for post-operative complications, operation time, and post-operative length of stay. AUTHORS' CONCLUSIONS We found no convincing evidence to support routine drain use after gastrectomy for gastric cancer.
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Affiliation(s)
- Zhen Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuang Yong Road, Nanning, Guangxi, China, 530021
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Grade M, Quintel M, Ghadimi BM. Standard perioperative management in gastrointestinal surgery. Langenbecks Arch Surg 2011; 396:591-606. [PMID: 21448724 PMCID: PMC3101361 DOI: 10.1007/s00423-011-0782-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/08/2011] [Indexed: 01/08/2023]
Abstract
Introduction The outcome of patients who are scheduled for gastrointestinal surgery is influenced by various factors, the most important being the age and comorbidities of the patient, the complexity of the surgical procedure and the management of postoperative recovery. To improve patient outcome, close cooperation between surgeons and anaesthesiologists (joint risk assessment) is critical. This cooperation has become increasingly important because more and more patients are being referred to surgery at an advanced age and with multiple comorbidities and because surgical procedures and multimodal treatment modalities are becoming more and more complex. Objective The aim of this review is to provide clinicians with practical recommendations for day-to-day decision-making from a joint surgical and anaesthesiological point of view. The discussion centres on gastrointestinal surgery specifically.
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Affiliation(s)
- Marian Grade
- Department of General and Visceral Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
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Passive versus active drainage following neck dissection: a non-randomised prospective study. Eur Arch Otorhinolaryngol 2008; 266:121-4. [PMID: 18548264 DOI: 10.1007/s00405-008-0723-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 05/21/2008] [Indexed: 12/21/2022]
Abstract
Drainage is used following neck dissection to prevent the collection of fluid and aid healing. Active drains are thought to be more effective due to their ability to assist adherence of skin flaps and the minimisation of bacterial migration. There is controversy regarding the type of drain (active or passive) which should be used due to concerns about the potential for compromise of free flap pedicles with active drains. A prospective non-randomised study was undertaken to determine if there were any differences in neck healing following neck dissection between active and passive drains. A consecutive series of patients (the majority of whom had free flap reconstruction) were included over an 8 month period and were examined for delayed healing of the neck wound, flap loss, infection, haematoma and fistula. A total of 60 patients underwent 72 neck dissections during the study period (passive: 13, active: 47). The delayed healing rate in patients with passive drains was 54% compared with 6% for active drains (P < 0.001). This difference remained significant irrespective of surgeon grade, nodal status and whether or not a free flap was performed. There was no patient in whom the drain was thought to contribute to free flap loss. This non-randomised study has shown a significant difference in neck healing depending on the type of drain used following neck dissection. Despite the numerical differences between the groups the patients were relatively well matched for the parameters described. This difference in neck healing, combined with the lack of evidence for a contribution to flap loss, suggests active drains should be used following neck dissection in both free flap and non-free flap cases.
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Kumar M, Yang SB, Jaiswal VK, Shah JN, Shreshtha M, Gongal R. Is prophylactic placement of drains necessary after subtotal gastrectomy? World J Gastroenterol 2007; 13:3738-41. [PMID: 17659736 PMCID: PMC4250648 DOI: 10.3748/wjg.v13.i27.3738] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the evidence-based values of prophylactic drainage in gastric cancer surgery.
METHODS: One hundred and eight patients, who underwent subtotal gastrectomy with D1 or D2 lymph node dissection for gastric cancer between January 2001 and December 2005, were divided into drain group or no-drain group. Surgical outcome and post-operative complications within four weeks were compared between the two groups.
RESULTS: No significant differences were observed between the drain group and no-drain group in terms of operating time (171 ± 42 min vs 156 ± 39 min), number of post-operative days until passage of flatus (3.7 ± 0.5 d vs 3.5 ± 1.0 d), number of post-operative days until initiation of soft diet (4.9 ± 0.7 d vs 4.8 ± 0.8 d), length of post-operative hospital stay (9.3 ± 2.2 d vs 8.4 ± 2.4 d), mortality rate (5.4% vs 3.8%), and overall post-operative complication rate (21.4% vs 19.2%).
CONCLUSION: Prophylactic drainage placement is not necessary after subtotal gastrectomy for gastric cancer since it does not offer additional benefits for the patients.
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Affiliation(s)
- Manoj Kumar
- Department of Surgery, Patan Hospital, Kathmandu, Nepal
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Petrowsky H, Demartines N, Rousson V, Clavien PA. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 2005; 240:1074-84; discussion 1084-5. [PMID: 15570212 PMCID: PMC1356522 DOI: 10.1097/01.sla.0000146149.17411.c5] [Citation(s) in RCA: 293] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the evidence-based value of prophylactic drainage in gastrointestinal (GI) surgery. METHODS An electronic search of the Medline database from 1966 to 2004 was performed to identify articles comparing prophylactic drainage with no drainage in GI surgery. The studies were reviewed and classified according to their quality of evidence using the grading system proposed by the Oxford Centre for Evidence-based Medicine. Seventeen randomized controlled trials (RCTs) were found for hepato-pancreatico-biliary surgery, none for upper GI tract, and 13 for lower GI tract surgery. If sufficient RCTs were identified, we performed a meta-analysis to characterize the drain effect using the random-effects model. RESULTS There is evidence of level 1a that drains do not reduce complications after hepatic, colonic, or rectal resection with primary anastomosis and appendectomy for any stage of appendicitis. Drains were even harmful after hepatic resection in chronic liver disease and appendectomy. In the absence of RCTs, there is a consensus (evidence level 5) about the necessity of prophylactic drainage after esophageal resection and total gastrectomy due to the potential fatal outcome in case of anastomotic and gastric leakage. CONCLUSION Many GI operations can be performed safely without prophylactic drainage. Drains should be omitted after hepatic, colonic, or rectal resection with primary anastomosis and appendectomy for any stage of appendicitis (recommendation grade A), whereas prophylactic drainage remains indicated after esophageal resection and total gastrectomy (recommendation grade D). For many other GI procedures, especially involving the upper GI tract, there is a further demand for well-designed RCTs to clarify the value of prophylactic drainage.
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Affiliation(s)
- Henrik Petrowsky
- Department of Visceral and Transplant Surgery, University Hospital, Raemistrasse 100, CH-8091 Zürich, Switzerland
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Araújo GFD, Santos OJD, Santos MFDS, Cuba RMBF, Freitas JVF. Estudo do efeito de dreno de penrose na cavidade peritoneal de ratos. Rev Col Bras Cir 2004. [DOI: 10.1590/s0100-69912004000300003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Estudar o efeito do dreno de Penrose na cavidade peritoneal de ratos. MÉTODO: Foram selecionados 30 ratos Wistar do mesmo sexo,divididos em três grupos de 10 animais, todos submetidos à introdução e fixação de dreno (Penrose) na cavidade peritoneal. Os períodos de observação , após os quais os animais foram mortos para estudo foram: grupo I - 24 horas; grupo II - sete dias; grupo III - 14 dias. RESULTADOS: Foi observada a formação de aderências nos animais dos três grupos, sendo que no grupo I, as aderências foram tênues em seis animais, moderadas em dois e intensas em dois. No grupo II, foi observada aderência tênue em um animal, moderada em cinco e intensas em quatro. CONCLUSÕES: A presença de dreno de Penrose na cavidade peritoneal de ratos induz à formação de aderências.
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Liu CL, Fan ST, Lo CM, Wong Y, Ng IOL, Lam CM, Poon RTP, Wong J. Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases. Ann Surg 2004; 239:194-201. [PMID: 14745327 PMCID: PMC1356212 DOI: 10.1097/01.sla.0000109153.71725.8c] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether abdominal drainage is beneficial after elective hepatic resection in patients with underlying chronic liver diseases. SUMMARY BACKGROUND DATA Traditionally, in patients with chronic liver diseases, an abdominal drainage catheter is routinely inserted after hepatic resection to drain ascitic fluid and to detect postoperative hemorrhage and bile leakage. However, the benefits of this surgical practice have not been evaluated prospectively. PATIENTS AND METHODS Between January 1999 and March 2002, 104 patients who had underlying chronic liver diseases were prospectively randomized to have either closed suction abdominal drainage (drainage group, n = 52) or no drainage (nondrainage group, n = 52) after elective hepatic resection. The operative outcomes of the 2 groups of patients were compared. RESULTS Fifty-seven (55%) patients had major hepatic resection with resection of 3 Coiunaud's segments or more. Sixty-nine (66%) patients had liver cirrhosis and 35 (34%) had chronic hepatitis. Demographic, surgical, and pathologic details were similar between both groups. The primary indication for hepatic resection was hepatocellular carcinoma (n = 100, 96%). There was no difference in hospital mortality between the 2 groups of patients (drainage group, 6% vs. nondrainage group, 2%; P = 0.618). However, there was a significantly higher overall operative morbidity in the drainage group (73% vs. 38%, P < 0.001). This was related to a significantly higher incidence of wound complications in the drainage group compared with the nondrainage group (62% vs. 21%, P < 0.001). In addition, a trend toward a higher incidence of septic complications in the drainage group was observed (33% vs. 17%, P = 0.07). The mean (+/- standard error of mean) postoperative hospital stay of the drainage group was 19.0 +/- 2.2 days, which was significantly longer than that of the nondrainage group (12.5 +/- 1.1 days, P = 0.005). With a median follow-up of 15 months, none of the 51 patients with hepatocellular carcinoma in the drainage group developed metastasis at the drain sites. On multivariate analysis, abdominal drainage, underlying liver cirrhosis, major hepatic resection, and intraoperative blood loss of >1.5L were independent and significant factors associated with postoperative morbidity. CONCLUSION Routine abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases.
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Affiliation(s)
- Chi-Leung Liu
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
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Sasako M, Katai H, Sano T, Maruyama K. Management of complications after gastrectomy with extended lymphadenectomy. Surg Oncol 2000; 9:31-4. [PMID: 11525304 DOI: 10.1016/s0960-7404(00)00019-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- M Sasako
- Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan
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Abstract
In brief A 24-year-old man had been reusing needles to inject anabolic-androgenic steroids intramuscularly and developed a thigh abscess. He was treated with intravenous antibiotics, and the abscess was surgically drained. The case highlights the danger of intramuscular steroid injection and of reusing needles.
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