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Sahm M, Pross M, Hukauf M, Adolf D, Köckerling F, Mantke R. Drain versus no drain in elective open incisional hernia operations: a registry-based analysis with 39,523 patients. Hernia 2023:10.1007/s10029-023-02862-4. [PMID: 37594637 DOI: 10.1007/s10029-023-02862-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Elective open incisional hernia operations are a frequently performed and complex procedure. Prophylactic drainage is widely practised to prevent local complications, but nevertheless the benefit of surgical drain placement remains a controversially discussed subject. Objective of this analysis was to evaluate the current status of patient care in clinical routine and outcome in this regard. METHODS The study based on prospectively collected data of the Herniamed Register. Included were all patients with elective open incisional hernia between 1/2005 and 12/2020 and completed 1-year follow-up. Multiple linear and logistic regression analysis was performed to assess the relation of individual factors to the outcome variables. RESULTS Analysed were data from 39,523 patients (28,182 with drain, 11,341 without). Patients with drain placement were significantly older, had a higher BMI, more preoperative risk factors, and a larger defect size. Drained patients furthermore showed a significant disadvantage in the outcome parameters intraoperative complications, general complications, postoperative complications, complication-related reoperations, and pain at the 1-year follow-up. No significant difference was observed with respect to the recurrent rate. CONCLUSION With 71.3%, the use of surgical drainages has a high level of acceptance in elective open incisional hernia operations. The worse outcome of patients is associated with the use of drains, independent of other influencing factors in the model such as patient or surgical characteristics. The use of drains may be a surrogate parameter for other unobserved confounders.
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Affiliation(s)
- M Sahm
- Clinic for General and Visceral Surgery, Brandenburg Medical School, Hochstraße 29, 14770, Brandenburg, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Nicolaiplatz 19, 14770, Brandenburg, Germany.
| | - M Pross
- Department of Surgery, DRK Kliniken Berlin Köpenick, Salvador Allende Str. 2-8, 12557, Berlin, Germany
| | - M Hukauf
- StatConsult GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - D Adolf
- StatConsult GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - F Köckerling
- Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charité, University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - R Mantke
- Clinic for General and Visceral Surgery, Brandenburg Medical School, Hochstraße 29, 14770, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Nicolaiplatz 19, 14770, Brandenburg, Germany
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2
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Lv Z, Cai Y, Jiang H, Yang C, Tang C, Xu H, Li Z, Fan B, Li Y. Impact of enhanced recovery after surgery or fast track surgery pathways in minimally invasive radical prostatectomy: a systematic review and meta-analysis. Transl Androl Urol 2020; 9:1037-1052. [PMID: 32676388 PMCID: PMC7354299 DOI: 10.21037/tau-19-884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The enhanced recovery after surgery (ERAS) and fast track surgery (FTS) protocols have been applied to a variety of surgeries and have been proven to reduce complications, accelerate rehabilitation, and reduce medical costs. However, the effectiveness of these protocols in minimally invasive radical prostatectomy (miRP) is still unclear. Thus, this study aimed to evaluate the impact of ERAS and FTS protocols in miRP. Methods We searched PubMed, Cochrane Library, Embase, and Web of Science databases to collect randomized and observational studies comparing ERAS/FTS versus conventional care in miRP up to July 1, 2019. After screening for inclusion, data extraction, and quality assessment by two independent reviewers, the meta-analysis was performed with the RevMan 5.3 and STATA 15.1 software. Results were expressed as risk ratio (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs). Results In total, 11 studies involving 1,207 patients were included. Pooled data showed that ERAS/FTS was associated with a significant reduction in length of stay (LOS) (WMD: -2.41 days, 95% CI: -4.00 to -0.82 days, P=0.003), time to first anus exhaust (WMD: -0.74 days, 95% CI: -1.14 to -0.34 days, P=0.0003), and lower incidence of postoperative complications (RR: 0.70, 95% CI: 0.53 to 0.92, P=0.01). No significant differences were found between groups for operation time, estimated blood loss, postoperative pain, blood transfusion rate, and readmission rate (P>0.01). Conclusions Our meta-analysis suggests that the ERAS/FTS protocol is safe and effective in miRP. However, more extensive, long-term, prospective, multicenter follow-up studies, and randomized controlled trials (RCTs) are required to validate our findings.
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Affiliation(s)
- Zhengtong Lv
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Cai
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Huichuan Jiang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Changzhao Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Congyi Tang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Haozhe Xu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Benyi Fan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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3
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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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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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6
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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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7
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Musser JE, Assel M, Guglielmetti GB, Pathak P, Silberstein JL, Sjoberg DD, Bernstein M, Laudone VP. Impact of routine use of surgical drains on incidence of complications with robot-assisted radical prostatectomy. J Endourol 2014; 28:1333-7. [PMID: 24934167 DOI: 10.1089/end.2014.0268] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the impact of eliminating routine drain placement in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) and pelvic lymph node dissection (PLND) on the risk of postoperative complications. PATIENTS AND METHODS An experienced single surgeon performed RALP on 651 consecutive patients at our institution from 2008 to 2012. Before August 2011, RALP with or without PLND included a routine peritoneal drain placed during surgery. Thereafter, routine intraoperative placement of drains was omitted, except for intraoperatively noted anastomotic leakage. We used multivariable logistic regression to compare complication rates between study periods and the actual drain placement status after adjusting for standard prespecified covariates. RESULTS Most patients (92%) did not have ≥grade 2 complications after surgery and only two patients (0.3%) experienced a grade 4 complication. The absolute adjusted risk of a grade 2-5 complication was 0.9% greater among those treated before August 2011 (95% confidence interval [CI] -3.3%-5.1%; p=0.7), while absolute adjusted risk of a grade 3-5 complication was 2.8% less (-2.8%; 95% CI-5.3%-0.1%; p=0.061). RESULTS based on drain status were similar. CONCLUSIONS Routine peritoneal drain placement following RALP with PLND did not confer a significant advantage in terms of postoperative complications. Further data are necessary to confirm that it is safe to omit drains in most patients.
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Affiliation(s)
- John E Musser
- 1 Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center , New York, New York
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8
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Drain After Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis. A Pilot Randomized Study. Indian J Surg 2012; 77:288-92. [PMID: 26730011 DOI: 10.1007/s12262-012-0797-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 12/02/2012] [Indexed: 10/27/2022] Open
Abstract
Drainage after laparoscopic cholecystectomy (LC) for acute calculous cholecystitis (ACC) is used without evidence of its efficacy. The present pilot study was designed to address this issue. After laparoscopic gallbladder removal, 15 patients were randomized to have a drain positioned in the subhepatic space (group A) and 15 patients to have a sham drain (group B). The primary outcome measure was the presence of subhepatic fluid collection at abdominal ultrasonography, performed 24 h after surgery. Secondary outcome measures included postoperative abdominal and shoulder tip pain, use of analgesics, and morbidity. Abdominal ultrasonography did not show any subhepatic fluid collection in eight patients (53.3 %) in group A and in five patients (33.3 %) in group B (P = 0.462). If present, median (range) subhepatic collection was 50 mL (20-100 mL) in group A and 80 mL (30-120 mL) in group B (P = 0.573). No significant differences in the severity of abdominal and shoulder pain and use of parenteral ketorolac were found in either group. Two biliary leaks and one subhepatic fluid collection occurred postoperatively. The present study was unable to prove that the drain was useful in LC for ACC, performed in a selected group of patients.
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9
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Falidas E, Mathioulakis S, Vlachos K, Pavlakis E, Villias C. Strangulated intestinal hernia through a drain site. Int J Surg Case Rep 2012; 3:1-2. [PMID: 22288027 DOI: 10.1016/j.ijscr.2011.06.002] [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: 04/27/2011] [Revised: 05/17/2011] [Accepted: 06/03/2011] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Intra-abdominal drains have been widely used in order to prevent intra-abdominal fluid accumulation and detection of anastomotic leakage. PRESENTATION OF CASE We herein report a case of small bowel herniation followed by strangulation in an 82 year old woman who had undergone sigmoidectomy for colorectal cancer. DISCUSSION Although several complications related to drain usage such as drainsite infection, hemorrhage and intestinal perforation may occur, intestinal incarceration through drain site is rarely reported. CONCLUSION Drains must be used with caution and only if indicated. Careful insertion, regular post-operative or post-removal inspection is strongly recommended.
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Affiliation(s)
- Evangelos Falidas
- 1st Department of General Surgery, 417 NIMTS, Veterans Administration Hospital of Athens, 10-12 Monis Petraki St, Athens 11521, Greece
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10
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Vuković M, Moljević N, Crnogorac S. Incarceration of the appendix into silicone drain holes without signs of appendicytis. JOURNAL OF ACUTE DISEASE 2012. [DOI: 10.1016/s2221-6189(13)60035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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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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12
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Georgiou C, Demetriou N, Pallaris T, Theodosopoulos T, Katsouyanni K, Polymeneas G. Is the Routine Use of Drainage After Elective Laparoscopic Cholecystectomy Justified? A Randomized Trial. J Laparoendosc Adv Surg Tech A 2011; 21:119-23. [DOI: 10.1089/lap.2010.0003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Klea Katsouyanni
- Department of Hygiene, Epidemiology, and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Georgios Polymeneas
- 2nd Surgical Department, Aretaieion Hospital Athens Medical School, Athens, Greece
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13
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Risk–benefit assessment of closed intra-abdominal drains after pancreatic surgery: a systematic review and meta-analysis assessing the current state of evidence. Langenbecks Arch Surg 2010; 396:41-52. [DOI: 10.1007/s00423-010-0716-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 09/09/2010] [Indexed: 12/13/2022]
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14
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Abstract
Anorectal procedures are associated with significant morbidity and include complications of the perineum, which can cause substantial difficulty for the patient. Prevention of perineal complications is key, but many anorectal procedures are performed in difficult situations such as large bulky tumors or inflammatory bowel diseases. In this review, the authors outline many of the complications encountered following both simple and complex anorectal procedures while highlighting best evidence for treatment.
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Affiliation(s)
- James W Ogilvie
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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15
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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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16
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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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Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999. [PMID: 10196487 DOI: 10.1016/s0196-6553(99)70088-x] [Citation(s) in RCA: 1912] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
EXECUTIVE SUMMARY The "Guideline for Prevention of Surgical Site Infection, 1999" presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.1,2 Part I, "Surgical Site Infection: An Overview," describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis. Part II, "Recommendations for Prevention of Surgical Site Infection," represents the consensus of the Hospital Infection Control Practices Advisory Committee (HICPAC) regarding strategies for the prevention of SSIs.3 Whenever possible, the recommendations in Part II are based on data from well-designed scientific studies. However, there are a limited number of studies that clearly validate risk factors and prevention measures for SSI. By necessity, available studies have often been conducted in narrowly defined patient populations or for specific kinds of operations, making generalization of their findings to all specialties and types of operations potentially problematic. This is especially true regarding the implementation of SSI prevention measures. Finally, some of the infection control practices routinely used by surgical teams cannot be rigorously studied for ethical or logistical reasons (e.g., wearing vs not wearing gloves). Thus, some of the recommendations in Part II are based on a strong theoretical rationale and suggestive evidence in the absence of confirmatory scientific knowledge.It has been estimated that approximately 75% of all operations in the United States will be performed in "ambulatory," "same-day," or "outpatient" operating rooms by the turn of the century.4 In recommending various SSI prevention methods, this document makes no distinction between surgical care delivered in such settings and that provided in conventional inpatient operating rooms. This document is primarily intended for use by surgeons, operating room nurses, postoperative inpatient and clinic nurses, infection control professionals, anesthesiologists, healthcare epidemiologists, and other personnel directly responsible for the prevention of nosocomial infections. This document does not: Specifically address issues unique to burns, trauma, transplant procedures, or transmission of bloodborne pathogens from healthcare worker to patient, nor does it specifically address details of SSI prevention in pediatric surgical practice. It has been recently shown in a multicenter study of pediatric surgical patients that characteristics related to the operations are more important than those related to the physiologic status of the patients.5 In general, all SSI prevention measures effective in adult surgical care are indicated in pediatric surgical care. Specifically address procedures performed outside of the operating room (e.g., endoscopic procedures), nor does it provide guidance for infection prevention for invasive procedures such as cardiac catheterization or interventional radiology. Nonetheless, it is likely that many SSI prevention strategies also could be applied or adapted to reduce infectious complications associated with these procedures. Specifically recommend SSI prevention methods unique to minimally invasive operations (i.e., laparoscopic surgery). Available SSI surveillance data indicate that laparoscopic operations generally have a lower or comparable SSI risk when contrasted to open operations.6-11 SSI prevention measures applicable in open operations (e.g., open cholecystectomy) are indicated for their laparoscopic counterparts (e.g., laparoscopic cholecystectomy). Recommend specific antiseptic agents for patient preoperative skin preparations or for healthcare worker hand/forearm antisepsis. Hospitals should choose from products recommended for these activitie
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Affiliation(s)
- A J Mangram
- Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia 30333, USA
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