Abandoning the blind legacy passed on horde of routine intra-abdominal drain insertion in cesarean section

Abstract

Introduction: Cesarean section (CS) delivery is the most common major obstetrical surgical operation carried out in and is increasing in incidence throughout the world. The major involves some risks that might include: infection, coagulation problem, loss of blood, bowel or bladder injury, abnormalities of the placenta in subsequent pregnancies.Aim of the study: To evaluate the clinical effectiveness of postoperative CS intra-abdominal drain insertion.

Pathogenesis of peritoneal drain complications; a case report of evolving adnexal evisceration following difficult retrieval of a retained peritoneal drain

“…Routine peritoneal drain placement after cesarean section however remains debatable. A prospective study has found that routine peritoneal drain placement for CS, portends a greater risk of adverse outcomes, than non-placement and thus should be stopped (4). A systematic review also concluded that there is no benefit for routine wound drainage for cesarean section (13).…”

“…Drain site hernia is a later complication that typically occurs after the drain tube had been removed (6). Structures that have been observed in a drain site hernia include small bowel loops, omentum, and the appendix with the risk of obstruction or strangulation (4,5,6). Herniation of the Fallopian tube and ovary could have complicated drain removal in our case with the risk of strangulation, gangrene, tubal blockage, and infertility, which may never be detected if the drainage tube had been pulled out without visualization.…”

“…Other complications of peritoneal drain insertion include; intestinal adhesions and obstruction (5), which resulted in a fatality from prophylactic placement for persistent ascites of chronic liver disease (3). Drain site infection is another recognized complication of peritoneal drain insertion (4,7,13,16). Peritoneal drainage has been associated with a significant increase in the requirement for intravenous antibiotics, late onset of oral feeding, longer operative time, and increased length of hospital stay (19).…”

“…A particular drain could serve any combination of these purposes. Intra-peritoneal drain placement is however associated with some risks ranging from minor unnoticeable, through life-altering such as infertility, to life-threatening as in the case of visceral evisceration or perforation (3,4,5,6). The benefit of routine drain placement for different varieties of abdominal surgeries has remained a debate in contemporary times (4,5,7,8).…”

“…Intra-peritoneal drain placement is however associated with some risks ranging from minor unnoticeable, through life-altering such as infertility, to life-threatening as in the case of visceral evisceration or perforation (3,4,5,6). The benefit of routine drain placement for different varieties of abdominal surgeries has remained a debate in contemporary times (4,5,7,8). The growing knowledge that drains are not as innocuous as earlier considered, calls for careful consideration of the decision to place them.…”