714 UTILITY, TECHNIQUES, AND OUTCOMES FOR THORACIC DRAINAGE AFTER OESOPHAGECTOMY: A SYSTEMATIC REVIEW

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Charles Bull ◽  
Philip H Pucher ◽  
James Gossage
Keyword(s):  
Enhanced Recovery ◽  
Cochrane Collaboration ◽  
Patient Comfort ◽  
Effusion Rate ◽  
Thoracic Drainage ◽  
Drain Fluid ◽  
Position Type ◽  
Oesophageal Surgery ◽  
Recovery Protocols

Abstract   The routine use of post-operative drains in surgery continues to evolve as part of modern practices. Modern enhanced recovery protocols eschew using abdominal drains due to their impact on patient comfort, mobility, and recovery. This change in practice has not applied to thoracic drainage after oesophagectomy, where one or multiple drains are routinely placed. The aim of this study was to determine the evidence for, and how best to use drains during oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases until Jan 25th, 2021. All studies which compared outcomes for different types or uses of thoracic drainage, or reported outcomes directly related to chest drains in oesophageal surgery were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed by the Newcastle-Ottawa and Jadad Scores. Results 28 studies met the inclusion criteria. Four studies compared drain numbers, three showed similar outcomes and pain reduction using one. A single study showed that another, ‘anastomotic drain’ aided diagnosis and reduced leak mortality. Transhiatal drains had less pain and similar outcomes compared to intercostal drains. Drain fluid amylase aids leak diagnosis, however, accuracy requires drains to remain for 6 days. Removal of drains with daily volumes of less than 300 mL did not impact effusion rate. Complications can arise from drains with a 7% chance of drains migrating into the lumen of a leak and a risk of drain-site metastasis. Conclusion Drain use is a small facet of oesophageal surgery that can have a significant impact on outcomes. There is no evidence for non-drain use. A single transhiatal drain reduces pain without impacting on outcomes. Drains can have a role in diagnosing and managing anastomotic leaks, however, to be accurate drains have to stay in situ for longer. This extends patients discomfort and moves away from ERP trends and other surgical specialities.

Chest drainage after oesophageal resection: A systematic review

2021 ◽  
Author(s):  
Alexander Bull ◽  
Philip H Pucher ◽  
Jesper Lagergren ◽  
James A Gossage
Keyword(s):  
Enhanced Recovery ◽  
Cochrane Collaboration ◽  
Patient Comfort ◽  
Drain Removal ◽  
Thoracic Drainage ◽  
Position Type ◽  
Oesophageal Surgery ◽  
Negative Impacts ◽  
Recovery Protocols ◽  
The Impact

Summary Background Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases. Studies reporting outcomes for different types or uses of thoracic drainage, or outcomes related to drains after trans-thoracic oesophagectomy were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed with Newcastle-Ottawa and Jadad scores. Results Among 434 potentially relevant studies, 27 studies met the inclusion criteria and these included 2564 patients. Studies that examined the number of drains showed pain reduction with a single drain compared to multiple drains (3 studies, n = 103), and transhiatal placement compared to intercostal (6 studies, n = 425). Amylase levels may aid diagnosis of anastomotic leak (9 studies, n = 888). Narrow calibre Blake drains may effectively drain both air and fluid (2 studies, n = 163). Drain removal criteria by daily drainage volumes of up to 300 mL did not impact subsequent effusion rates (2 studies, n = 130). Complications related directly to drains were reported by 3 studies (n = 59). Conclusion Available evidence on the impact of thoracic drainage after oesophagectomy is limited, but has the potential to negatively affect outcomes. Further research is required to determine optimum drainage strategies.

scholarly journals P-OGC13 Chest drainage after oesophageal resection: A systematic review

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Alexander Bull ◽  
Philip Pucher ◽  
Jesper Lagergren ◽  
James Gossage
Keyword(s):  
Enhanced Recovery ◽  
Cochrane Collaboration ◽  
Patient Comfort ◽  
Drain Removal ◽  
Thoracic Drainage ◽  
Position Type ◽  
Oesophageal Surgery ◽  
Negative Impacts ◽  
Recovery Protocols ◽  
The Impact

Abstract Background Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases. Studies reporting outcomes for different types or uses of thoracic drainage, or outcomes related to drains after trans-thoracic oesophagectomy were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed with Newcastle-Ottawa and Jadad scores. Results Among 434 potentially relevant studies, 27 studies met the inclusion criteria and these included 2564 patients. Studies that examined the number of drains showed pain reduction with a single drain compared to multiple drains (3 studies, n = 103), and transhiatal placement compared to intercostal (6 studies, n = 425). Amylase levels may aid diagnosis of anastomotic leak (9 studies, n = 888). Narrow calibre Blake drains may effectively drain both air and fluid (2 studies, n = 163). Drain removal criteria by daily drainage volumes of up to 300ml did not impact subsequent effusion rates (2 studies, n = 130). Complications related directly to drains were reported by 3 studies (n = 59). Conclusions Available evidence on the impact of thoracic drainage after oesophagectomy is limited, but has the potential to negatively affect outcomes. Further research is required to determine optimum drainage strategies.

Elderly Patients Benefit From Enhanced Recovery Protocols After Colorectal Surgery

2021 ◽  
Vol 266 ◽  
pp. 54-61
Author(s):  
Jessica Y Liu ◽  
Sebastian D Perez ◽  
Glen G Balch ◽  
Patrick S Sullivan ◽  
Jahnavi K Srinivasan ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Elderly Patients ◽  
Enhanced Recovery ◽  
Recovery Protocols

scholarly journals Realistic Advantages of Early Surgical Drain Removal after Pancreatoduodenectomy: A Single-Institution Retrospective Study

2021 ◽  
Vol 10 (12) ◽  
pp. 2716
Author(s):  
So-Jeong Yoon ◽  
So-Kyung Yoon ◽  
Ji-Hye Jung ◽  
In-Woong Han ◽  
Dong-Wook Choi ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Single Institution ◽  
Early Removal ◽  
Drain Removal ◽  
Early Return ◽  
Drain Fluid ◽  
Pancreatic Fistulas ◽  
Hospital Stays ◽  
Removal Group ◽  
Surgical Drain

The latest guidelines from the Enhanced Recovery After Surgery (ERAS®) Society stated that early drain removal after pancreatoduodenectomy (PD) is beneficial in decreasing complications including postoperative pancreatic fistulas (POPFs). This study aimed to ascertain the actual benefits of early drain removal after PD. The data of 450 patients who underwent PD between 2018 and 2020 were retrospectively reviewed. The surgical outcomes were compared between patients whose drains were removed within 3 postoperative days (early removal group) and after 5 days (late removal group). Logistic regression analysis was performed to identify the risk factors for clinically relevant POPFs (CR-POPFs). Among the patients with drain fluid amylase < 5000 IU on the first postoperative day, the early removal group had fewer complications and shorter hospital stays than the late removal group (30.9% vs. 54.5%, p < 0.001; 9.8 vs. 12.5 days, p = 0.030, respectively). The incidences of specific complications including CR-POPFs were comparable between the two groups. Risk factor analysis showed that early drain removal did not increase CR-POPFs (p = 0.163). Although early drain removal has not been identified as apparently beneficial, this study showed that it may contribute to an early return to normal life without increasing complications.

New Concept for a Thoracic Drainage System Using Magnetic Actuation

2019 ◽  
Vol 26 (6) ◽  
pp. 705-711
Author(s):  
Daisuke Taniguchi ◽  
Keitaro Matsumoto ◽  
Yoshihiro Kondo ◽  
Tomoshi Tsuchiya ◽  
Ikuo Yamamoto ◽  
...  
Keyword(s):  
Abdominal Cavity ◽  
Drainage System ◽  
Magnetic Actuation ◽  
Thoracic Cavity ◽  
Common Procedure ◽  
Thoracic Drainage ◽  
Drain Fluid ◽  
Laboratory Trial ◽  
General Surgeons ◽  
Effective Drainage

Objectives. Thoracic drainage is a common procedure to drain fluid, blood, or air from the pleural cavity. Some attempts to develop approaches to new thoracic drainage systems have been made; however, a simple tube is often currently used. The existing drain presupposes that it is placed correctly and that the tip does not require moving after insertion into the thoracic cavity. However, in some cases, the drain is not correctly placed and reinsertion of an additional drain is required, resulting in significant invasiveness to the patient. Therefore, a more effective drainage system is needed. This study aimed to develop and assess a new thoracic drain via a collaboration between medical and engineering personnel. Methods. We developed the concept of a controllable drain system using magnetic actuation. A dry laboratory trial and accompanying questionnaire assessment were performed by a group of thoracic and general surgeons. Objective mechanical measurements were obtained. Porcine experiments were also carried out. Results. In a dry laboratory trial, use of the controllable drain required significantly less time than that required by replacing the drain. The average satisfaction score of the new drainage system was 4.07 out of 5, indicating that most of the research participants were satisfied with the quality of the drain with a magnetic actuation. During the porcine experiment, the transfer of the tip of the drain was possible inside the thoracic cavity and abdominal cavity. Conclusion. This controllable thoracic drain could reduce the invasiveness for patients requiring thoracic or abdominal cavity drainage.

scholarly journals A systematic review of enhanced recovery protocols in colorectal surgery

2011 ◽  
Vol 93 (8) ◽  
pp. 583-588 ◽  
Author(s):  
A Rawlinson ◽  
P Kang ◽  
J Evans ◽  
A Khanna
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Perioperative Care ◽  
Enhanced Recovery ◽  
Hospital Readmissions ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Hand Search ◽  
Recovery Protocols ◽  
Randomised Controlled

INTRODUCTION Colorectal surgery has been associated with a complication rate of 15–20% and mean postoperative inpatient stays of 6–11 days. The principles of enhanced recovery after surgery (ERAS) are well established and have been developed to optimise perioperative care and facilitate discharge. The purpose of this systematic review is to present an updated review of perioperative care in colorectal surgery from the available evidence and ERAS group recommendations. METHODS Systematic searches of the PubMed and Embase™ databases and the Cochrane library were conducted. A hand search of bibliographies of identified studies was conducted to identify any additional articles missed by the initial search strategy. RESULTS A total of 59 relevant studies were identified. These included six randomised controlled trials and seven clinical controlled trials that fulfilled the inclusion criteria. These studies showed reductions in duration of inpatient stays in the ERAS groups compared with more traditional care as well as reductions in morbidity and mortality rates. CONCLUSIONS Reviewing the data reveals that ERAS protocols have a role in reducing postoperative morbidity and result in an accelerated recovery following colorectal surgery. Similarly, both primary and overall hospital stays are reduced significantly. However, the available evidence suggests that ERAS protocols do not reduce hospital readmissions or mortality. These findings help to confirm that ERAS protocols should now be implemented as the standard approach for perioperative care in colorectal surgery.

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