Is Prophylactic Abdominal Drainage Necessary After Laparoscopic Colectomy For Colon Cancer? A Propensity Score-Matched Analysis

Background: In 2018, the Enhanced Recovery After Surgery (ERAS) Society recommended against routine drainage after colorectal surgery. However, the evidence is relatively old and few studies were performed in low-to-middle income country (LMIC) setting. This study aimed to compare outcomes of laparoscopic colectomy with and without prophylactic drainage for colon cancer.Methods: A retrospective study was performed from 2018 to 2021 with patients who underwent laparoscopic colectomy with D3 lymphadenectomy for colon cancer. The use of prophylactic drainage was depended on routine practice of surgeons. Outcomes were postoperative complications and postoperative hospital length of stay. The drain and no-drain groups were compared using propensity score-matched (PSM) analysis.Results: The study included 143 patients (59 in the drain group and 84 in the no-drain group). The PSM resulted in 94 patients (47 in each group). Median age was 62 years. The most frequent was right hemicolectomy (33.6%), followed by left hemicolectomy (32.2%), sigmoid colectomy (21%), extended right hemicolectomy (9.8%), transverse hemicolectomy (2.1%), and total colectomy (1.4%). Postoperative hospital stay was significantly shorter in the no-drain group (median of 5 versus 6 days). The no-drain group also had lower rate of complications (23.8% versus 30.5% and 23.4% versus 34% before and after matching respectively) and less severe complications based on Clavien-Dindo classification, but the difference was not significant.Conclusions: Laparoscopic colectomy without prophylactic drainage is safe in the treatment of colon cancer. This approach can shorten postoperative hospital stay and should be applied even in the LMIC setting.Main novel aspect: Laparoscopic colectomy without prophylactic drainage for colon cancer can be applied in low-to-middle income settings.

A COMPARATIVE RANDOMIZED STUDY TO EVALUATE THE ROLE OF DRAINS IN ELECTIVE AND EMERGENCY ABDOMINAL SURGERIES

Background: Abdominal drainage following gastrointestinal surgery has often been a matter of contention. Advances in surgical techniques and perioperative patient care have consistently decreased postoperative complication rates. Aim: To determine the evidence-based value of prophylactic drainage versus non drainage in gastrointestinal surgeries and relative complications and morbidity associated with it. Material and Methods: A total of 82 patients were included in our study. All patients were divided into two groups- Group A and Group B randomly. Post-operatively patients were monitored and evaluated based on pre-determined outcome measures. Results: In our study out of 82 patints no signicant difference was seen (p value>0.01) when drain was compared to non drainage in routine surgeries with respect to ileus duration, anastomotic leak, surgical site infection, mortality, etc. Conclusions: When abdominal drain is routinely put, with its associated consequences, no clinical benet is derived. Therefore drainage in abdominal surgeries should not be routinely used in all patients however it can be used selectively in specic patients with clear indications.

A prospective interventional study to compare the efficacy of syringe suction drainage system for prevention of subcutaneous seroma formation as compared to abdominal closure without a drain

Background: Seroma is a sterile collection of serous fluid in the subcutaneous tissue. The incidence ranges from 15-81%.Prophylactic drainage of wounds is aimed to reduce the wound complications and thereby the associated morbidity. Obese patients are at higher risk.There is documented beneficial effect of subcutaneous drains in obese gravida patients undergoing caesarean delivery.The most common complications of cesarean section (CS) are superficial surgical site complications including sepsis, seroma formation and breakdown.The likelihood of seroma formation without drains is 7.5 times more.Hence this study was conducted to assess the efficacy of syringe suction drainage system in prevention of seroma formation in patients undergoing CS.Methods: The study was conducted in the Department of Obstetrics and Gynaecology at the Dr. Vithalrao Vikhe Patil Foundation’s Medical College and Hospital over a period of twelve months from December 2019 to December 2020. A comparative study was conducted on 100 patients who had undergone lower segment caesarean section and had a subcutaneous layer of more than 1.5 cm. We used a drainage system made of a nasogastric tube no 10 attached to a 10 cc disposable syringe creating negative pressure for 50 of those patients.Results: Out of 50 patients in whom the drain was not used 7 developed discharge from wound and 2 patients developed wound gape while only 2 patients developed discharge from wound among those who had the drain placed.Conclusion: The syringe suction drain system is an efficient and cost effective method for prevention of subcutaneous seroma in patients undergoing CS.

A Systematic Review and Meta-Analysis of Wound Complications after a Caesarean Section in Obese Women

(1) Background: Caesarean sections in obese patients are associated with an increased risk of surgical wound complications, including hematomas, seromas, abscesses, dehiscence, and surgical site infections. The aim of the present study is to perform a meta-analysis and systematic review of the current literature focusing on the strategies available to decrease wound complications in this population. (2) Methods: We reviewed the data available from the PubMed and the Science Direct databases concerning wound complications after caesarean sections in obese women. The following key words were used: “caesarean section”, “cesarean section”, “wound complication”, “wound morbidity”, and “wound infection”. A total of 540 papers were retrieved, 40 of which were selected for the final systematic review and whereas 21 articles provided data for meta-analysis. (3) Results: The conducted meta-analyses revealed that the use of prophylactic drainage does not increase the risk of wound complications in obese women after a caesarean sections (pooled OR = 1.32; 95% CI 0.64–2.70, p = 0.45) and that vertical skin incisions increase wound complications (pooled OR = 2.48; 95% CI 1.85–3.32, p < 0.01) in obese women, including extremely obese women. (4) Conclusions: Subcutaneous drainage does not reduce the risk of a wound complications, wound infections, and fever in obese women after caesarean sections. Negative prophylactic pressure wound therapy (NPWT) may reduce the risk of surgical site infections. The evidence of using a prophylactic dose of an antibiotic before the caesarean section is still lacking.

Systematic review and meta-analysis of the efficacy of prophylactic abdominal drainage in major liver resections

Prophylactic drainage after major liver resection remains controversial. This systematic review and meta-analysis evaluate the value of prophylactic drainage after major liver resection. PubMed, Web of Science, and Cochrane Central were searched. Postoperative bile leak, bleeding, interventional drainage, wound infection, total complications, and length of hospital stay were the outcomes of interest. Dichotomous outcomes were presented as odds ratios (OR) and for continuous outcomes, weighted mean differences (MDs) were computed by the inverse variance method. Summary effect measures are presented together with their corresponding 95% confidence intervals (CI). The certainty of evidence was evaluated using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach, which was mostly moderate for evaluated outcomes. Three randomized controlled trials and five non-randomized trials including 5,050 patients were included. Bile leakage rate was higher in the drain group (OR: 2.32; 95% CI 1.18–4.55; p = 0.01) and interventional drains were inserted more frequently in this group (OR: 1.53; 95% CI 1.11–2.10; p = 0.009). Total complications were higher (OR: 1.71; 95% CI 1.45–2.03; p < 0.001) and length of hospital stay was longer (MD: 1.01 days; 95% CI 0.47–1.56 days; p < 0.001) in the drain group. The use of prophylactic drainage showed no beneficial effects after major liver resection; however, the definitions and classifications used to report on postoperative complications and surgical complexity are heterogeneous among the published studies. Further well-designed RCTs with large sample sizes are required to conclusively determine the effects of drainage after major liver resection.

Is totally laparoscopic gastrectomy without prophylactic drains feasible for patients with distal gastric cancer? The experience of China National Cancer Center

Background Prophylactic drains have been used to remove intraperitoneal collections and to detect complications early in open surgery. In the last decades, Gastric cancer minimally invasive surgery has been widely carried out throughout the world. However, little has been reported on routine prophylactic abdominal drainage after totally laparoscopic distal gastrectomy. To evaluate the feasibility of without prophylactic drains in totally laparoscopic distal gastrectomy in selective patients. Methods Data of distal gastric cancer patients underwent totally laparoscopic distal gastrectomy with and without prophylactic drainage at China National Cancer Center/Cancer Hospital from February 2018 to August 2019 were reviewed. The outcomes of patients with and without a prophylactic drainage were compared. Results A total of 420 patients who underwent surgery for gastric cancer were identified; of these, 88 patients who received totally lapaoscopic distal gastrectomy were included. The incidence of concurrent illness was higher in the drain group, (48.8% vs. 27.7%, p = 0.041). The overall postoperative complication rate was 19.5% in the drain group (n = 47), and 10.6% in the no-drain group (n = 41), there were no significant differences between two groups (p > 0.05). The need for percutaneous catheter drainage (PCD) was also not significantly different between groups (9.8% vs. 6.4%, p = 0.700). However, patients with larger BMI (≥ 29) are prone to postoperative complications (p = 0.042). In addition, more operating time cost in the drain group than in the no-drain group (188.10 ± 38.89 min vs. 164.30 ± 36.97 min, p < 0.05). The number of days after surgery until the initiation of soft diet (5.34 ± 2.27 days vs. 4.17 ± 2.13 days, p < 0.05) and first flatus (4.29 ± 1.45 days vs. 3.55 ± 1.83 days, p = 0.041) were greater in the drain group. Conclusions Without prophylactic drainage may reduce surgery time and result in faster recovery. Routine prophylactic drains are not necessary in selective patients. A prophylactic drain may be useful in patients at higher risk.

The Dilemma of Drains after Pancreatoduodenectomy: Still an Issue?

Background and Aims: Routine drainage after pancreatoduodenectomy is a controversial issue. In this article, we present and discuss the current evidence on abdominal drains in pancreatic surgery. Material and Methods: Review of the pertinent English-language literature. Results: There is a growing body of evidence showing a lack of benefit of prophylactic drainage after pancreatoduodenectomy. Randomized trials have reported similar outcomes with or without routine drains. If drains were used, early removal was found to be superior to late removal in patients with a low risk of postoperative pancreatic fistula. Consequently, criteria for early drain removal have been developed based on the measurement of drain amylase levels. On the contrary, there exists a subgroup of patients where drains may have a role. In patients with high risk of pancreatic fistula formation, such as those having a soft pancreatic texture, small pancreatic duct and high body mass index, the placement of drains may give sentinel information about future clinical deterioration. The drain may thus help reduce failure-to-rescue rates. Conclusion: Despite much research, there are many unanswered questions regarding drains in pancreatic surgery. It is evident that routine drainage should be abandoned for a more selective strategy. Furthermore, what is needed is a postoperative warning score that early on can identify patients at risk of a pancreatic fistula, without the routine placement of drains.