COMPLICATIONS OF INTRA ABDOMINAL DRAINS: A SINGLE CENTER EXPERIENCE

Objective: To compare frequency of intra-abdominal complications in drainage and non-drainage group among patents who underwent intra-abdominal surgeries. Study Design: Comparative prospective study. Place and Duration of Study: Department of Surgery, Pakistan Ordinance Factory, Wah Cantt, from Mar 2018 to Jul 2018. Methodology: There were 32 patients, 16 in each group. Patients were selected through the process of consecutive sampling. Patients were randomly divided into two groups (random number table method); group A patients underwent intra-abdominal drain while group B was non-drainage group. Patients were followed up for 7 days and observed for complications. Results: Total 32 patients were included in the study. There were 14 (43.8%) males and 18 (56.3%) females. Mean age of patients was 43.2 ± 9.5 years. Drain group showed significantly low anastomosis leakage (p=0.02), wound infection (p=0.05), mortality (p=0.04), pulmonary complications (p=0.05) and bleeding (p=0.03) as compared to the non-drain group. Conclusion: Intra-abdominal drains are associated with several complications. Anastomosis leakage is the most common complication following pulmonary complications and bleeding. However, drains help in early detection of complications and timely management of such complications leads to better outcome of a surgical procedure.

Clinical Efficacy and Safety of Neuroendoscopic Surgery for Severe Ventricular Thalamic Hemorrhage

Objective To summarize and analyze the clinical efficacy and safety of neuroendoscopic surgery in the treatment of patients with severe ventricular thalamic hemorrhage. Methods Eight-three patients with severe ventricular thalamic hemorrhage were treated in the Neurosurgery Department of Anqing Hospital Affiliated to Anhui Medical University from July 2019 to August 2021. Of the 83 patients, 41 underwent neuroendoscopic surgery and 42 underwent simple extraventricular drainage. The hospital stay, GCS scores on the 1st and 14th days postoperatively, the incidence of intracranial infections, and the clearance of postoperative hematomas were compared and analyzed between the two groups. The patients were followed up to 6 months. The prognosis was evaluated by the activity of daily living (ADL) score. A head CT or MRI was obtained to determine whether there was hydrocephalus, cerebral infarction, or other related complications. Results The postoperative hospital stay was 17.42±1.53 days, the GCS score was 6.56±0.21 points on day 1 and 10.83±0.36 points on day 14, intracranial infections occurred in three patients (7.31%) and the hematoma clearance rate was 83.6±5.18% in the neuroendoscopy group, all of which were significantly better than the simple extraventricular drainage group (P < 0.05). After 6 months of follow-up, 28 patients (68.29%) had a good prognosis, 5 patients (12.19%) died, and 4 patients(9.75%)had hydrocephalus in the neuroendoscopy group. In the extraventricular drainage group, the prognosis was good in 15 patients (35.71%), death in 12 patients (28.57%), and hydrocephalus in 17 patients (40.47%). The follow-up results showed that the good prognosis, mortality, and incidence of hydrocephalus in the neuroendoscopy group were significantly better than the extraventricular drainage group (P < 0.05). Conclusion Compared with traditional ventricular-puncture drainage, simultaneous endoscopic sinus surgery for severe ventricular thalamic hemorrhage had a higher hematoma clearance rate, fewer intracranial infections, and hydrocephalus, which together improve the clinical prognosis, and is thus recommended for clinical use.

Transhiatal Chest Drainage Reduces The Frequency of Postoperative Thoracentesis In Transmediastinal Esophagectomy For Esophageal Cancer: A Retrospective Study

Background: Transmediastinal esophagectomy for esophageal cancer occasionally results in the postoperative accumulation of pleural effusion despite the preservation of the mediastinal pleura. Transhiatal chest drainage has reported utility in thoracic esophagectomy; however, its use in transmediastinal esophagectomy remains unelucidated. This study aimed to evaluate the effectiveness and safety of transhiatal chest drainage in transmediastinal esophagectomy.Methods: This retrospective study included patients who underwent transmediastinal esophagectomy for esophageal cancer from 2018 to 2020. The transhiatal chest drainage involved the insertion of a 19-Fr Blake® drain from the inferior hepatic space to the left thoracic cavity through the hiatus. The drainage group comprising 13 patients was compared with the non-drainage group comprising 13 patients in whom a transhiatal chest drainage tube was not placed during transmediastinal esophagectomy.Results: The frequency of thoracentesis in the drainage group was significantly lower than that in the non-drainage group (p = 0.03). There were no significant differences between the two groups in terms of the occurrence of other postoperative complications, duration of oxygen administration, and postoperative hospital stay.Conclusions: Transhiatal chest drainage could evacuate pleural effusion effectively and safely after transmediastinal esophagectomy. Therefore, this procedure is clinically useful in transmediastinal esophagectomy for esophageal cancer.

Retrospective study of active drainage in the management of anastomotic leakage after anterior resection for rectal cancer

Objective Anastomotic leakage (AL) is the most serious postoperative complication following anterior resection for rectal cancer. We aimed to investigate the efficacy of active drainage for the management of AL. Methods This was a retrospective study using information from a database of patients who underwent colorectal resection without a defunctioning ileostomy at our center between September 2013 and January 2021. We identified 122 cases with definitive AL who did not require revision emergent laparotomy. Among these patients, we evaluated those who received active drainage to replace the original passive drainage. Results There were 62 cases in the active drainage group and 60 cases in the passive drainage group. The active drainage group had a shorter mean AL spontaneous resolution time (26.9 ± 3.3 vs. 32.2 ± 4.8 days) and lower average hospitalization costs (82,680.6 vs. 92,299.3 renminbi (RMB)) compared with the passive drainage group, respectively. Moreover, seven patients in the passive drainage group subsequently underwent diverting stoma to resolve the Al, while all ALs resolved spontaneously after replacing the passive drainage with active drainage. Conclusions Our study suggests that active drainage may accelerate the spontaneous resolution of AL.

Comparative study of suction drainage placement in cementless hip replacement among patients undergoing extended thromboprophylaxis: a prospective randomized study

Background The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary hip replacement. This study aimed to assess the safety of not using suction drainage after primary hip replacement in a population of patients undergoing extended thromboprophylaxis. Methods In this prospective randomized study, all patients were qualified for primary hip replacement and were divided into two groups: with and without drainage. The inclusion criterion was idiopathic hip osteoarthritis. The exclusion criteria were secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. We performed an intention-to-treat analysis. Clinical, laboratory, and radiographic parameters were measured for the first three days after surgery. Hematoma collection, due to extended thromboprophylaxis, in the joint and soft tissues was evaluated precisely. The patients underwent follow-up for 30 days. Results The final analysis included a total of 100 patients. We did not find any significant statistical differences between groups in terms of hip fluid collection (9.76 vs. 10.33 mm, with and without drainage, respectively; mean difference, 0.6 mm; 95 % confidence interval [CI] -2.8 to 3.9; p = 0.653), estimated blood loss (1126 vs. 1224 ml; mean difference, 97.1 ml; 95 % CI -84.1 to 278.2; p = 0.59), and hemoglobin levels on postoperative day 3 (11.05 vs. 10.85 g/dl; mean difference, 0.2; 95 % CI -2.1 to 2.5; p = 0.53). In addition, the other parameters did not show significant differences between groups. Notably, two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group. Conclusions We conclude that the use of closed suction drainage after primary hip replacement is a safe procedure in patients undergoing extended thromboprophylaxis. Further research is warranted to validate these findings. Trial registration The study was successfully registered retrospectively at Clinicaltrial.gov with the identification number NCT04333264 03 April 2020.

Temporary application of ox muzzle drainage in knee arthroscopic surgery

Background: Ox muzzle drainage is temporary a type of drainage system surrounding the anterior internal and lateral incision of knee arthroscopy. In order to make the operation visual field clear, reduce the operation time, reduce the knee pain；Methods: A total of 104 patients with meniscal associated injury who underwent knee arthroscopic meniscus between May 2014 and June 2017 were retrospectively analyzed. Temporary use during surgery Ox muzzle drainage was applied in 51 patients, while the other 53 patients were served as conventional group. The volume of irrigation fluid drained from the knee articular cavity, duration of operation, operative view clarity and occurrence of anterior knee pain.Visual clarity was evaluated with a numerical rating scale.Results: The irrigation fluid volume was significantly greater, while duration of operation was markedly shorter in the ox muzzle drainage group than the control (3200–6200ml：1700-4500ml，14-49min：22-63min，t=11.494，t=9.846，P<0.01). The operative view clarity in the ox muzzle drainage group was obviously better than the control (87.42%：66.09%，t=5.474，P<0.05). The incidence of anterior knee pain was lower than that of the control group(c2=11.105，P<0.01).Conclusions: Ox muzzle drainage temporary is feasible for intra-operative irrigation and stretching of the fat pad in knee arthroscopy, It is conducive to the operation of surgical instruments, shortening the operation time, reducing the injury of the subpatellar fat pad and the occurrence of anterior knee pain.

Double versus single T-tube drainage for frank cysto-biliary communication in patients with hepatic cystic echinococcosis: a retrospective cohort study with median 11 years follow-up

Background Partial peri-cystectomy (PPC) is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide. Cysto-biliary communication (fistula, leakage, rupture) is a problematic issue in CE patients. T-tube is a useful technique in situations where an exploration and decompression are needed for common bile duct (CBD). However, postoperative biliary complications for cystic cavity still remains to be studied in depth. Methods A retrospective cohort analysis of CE cases in our single center database from 2007 March to 2012 December was performed. Patients (n = 51) were divided into two cohorts: double T-tube drainage (one at CBD for decompression and one at the fistula for sustaining in cystic cavity, n = 23) group and single T-tube drainage cohort (only one at CBD for decompression, n = 28). Short-/long-term postoperative complications focusing on biliary system was recorded in detail and they were followed-up for median 11 years. Results Overall biliary complication rates for double and single T-tube drainages were 17.4% vs. 39.3% (P > 0.05). Short-term complications ranged from minor to major leakages, cavity infection and abscess formation, and prevalence was 17.4% vs. 21.4% (P > 0.05) respectively for double and single T-tube groups; most importantly, double T-tube drainage group had obvious advantages regarding long-term complications (P < 0.05), which was biliary stricture needing surgery and it was observed only in single T-tube drainage group. Conclusions Double T-tube drainage had better outcomes without procedure-specific postoperative biliary complications than single T-tube drainage. Meanwhile, we recommend long-term follow-up when comparing residual cavity related biliary complications in CE patients as it could happen lately.

USG GUIDED PERCUTANEOUS NEEDLE APIRATION VERSUS USG GUIDED PIGTAIL CATHETER DRAINAGE IN THE MANAGEMENT OF LIVER ABSCESS - A PROSPECTIVE RANDOMISED CONTROLLED STUDY

Background: The aim of this study was to determine and compare the therapeutic effectiveness and safety of USG guided percutaneous continuous catheter drainage and USG guided percutaneous needle aspiration in the treatment of liver abscess in Trichy. Methods: This is a prospective randomised comparative study of 50 patients, presented in outpatient and emergency department at the hospital, randomised equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of their treatment was measured in terms of duration of hospital stay, time taken for improvement of clinical symptoms, time taken for 50% reduction in cavity size and total or near total reduction of abscess cavity. Independent t-test was used to analyse these parameters. Results: The success rate was significantly better in catheter drainage group. Patients in pigtail catheter drainage group showed earlier clinical improvement (p 0.000) and 50% reduction in abscess cavity volume (p 0.000) and near total reduction of abscess cavity was earlier (p 0.019) as compared to those who underwent percutaneous needle aspiration. Conclusion: Our study concludes that percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration in respect to clinical improvement, reduction of cavity and success rate.

Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage

Background To investigate whether tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage has better short-term outcomes than non-intubated approach with chest tube drainage. Methods Data were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Peri-operative outcomes between two groups were compared. Results After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 min in tubeless group and 52.8 min in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. Side effects were rare and mild, including cough and hemoptysis. No re-intervention or readmission occurred. The postoperative VAS score was significantly lower in tubeless group. Conclusions Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.