Drain placement in retromuscular ventral hernia repair: a systematic review and meta-analysis

Marcolin, Patricia; Figueiredo, Sergio Mazzola Poli de; Constante, Marcella Mota; Melo, V. M. F. de; Araújo, S. W. de; Mao, R.-M. D.; Lu, Richard

doi:10.1007/s10029-023-02792-1

Cited by 7 publications

(1 citation statement)

References 22 publications

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“…Importantly, our study did not include a control arm of non-drained patients, and as such, we are unable to establish a true benefit of drains. A recent meta-analysis found that drain placement at the time of retromuscular ventral hernia repair may also reduce the risk of developing a seroma (OR 0.34), though it did not decrease the risk of SSI, hematoma, SSO, or SSOPI [ 24 ]. While it is common practice to place retromuscular drains, the decision-making process surrounding surgical drain management is often based on theoretical assumptions about the significance of the volume of output.…”

Section: Discussionmentioning

confidence: 99%

Analysis of retromuscular drain output and postoperative outcomes for heavyweight versus mediumweight polypropylene mesh following open ventral hernia repair

Essani,

Maskal,

Ellis

et al. 2024

Hernia

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Purpose Heavyweight polypropylene (HWPP) mesh is thought to increase inflammatory response and delay tissue integration compared to mediumweight (MWPP). Reactive fluid volume (i.e., drain output) may be a reasonable surrogate for integration. We hypothesized that daily drain output is higher with HWPP compared to MWPP in open retromuscular ventral hernia repair (VHR). Methods This is a post-hoc analysis of a multicenter, randomized clinical trial conducted March 2017–April 2019 comparing MWPP and HWPP for VHR. Retromuscular drain output in milliliters was measured at 24-h intervals up to postoperative day seven. Univariate analyses compared differences in daily drain output and time to drain removal. Multivariable analyses compared total drain output and wound morbidity within 30 days and hernia recurrence at 1 year. Results 288 patients were included; 140 (48.6%) HWPP and 148 (51.4%) MWPP. Daily drain output for days 1–3 was higher for HWPP vs. MWPP (total volume: 837.8 mL vs. 656.5 mL) (p < 0.001), but similar on days 4–7 (p > 0.05). Median drain removal time was 5 days for both groups. Total drain output was not predictive of 30-day wound morbidity (p > 0.05) or hernia recurrence at 1 year (OR 1, p = 0.29). Conclusion While HWPP mesh initially had higher drain outputs, it rapidly returned to levels similar to MWPP by postoperative day three and there was no difference in clinical outcomes. We believe that drains placed around HWPP mesh can be managed similarly to MWPP mesh.

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Section: Discussionmentioning

confidence: 99%

Analysis of retromuscular drain output and postoperative outcomes for heavyweight versus mediumweight polypropylene mesh following open ventral hernia repair

Essani,

Maskal,

Ellis

et al. 2024

Hernia

View full text Add to dashboard Cite

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Drain vs no drain placement after retromuscular ventral hernia repair with mesh: an ACHQC analysis

Lima,

Keisling,

Zheng

et al. 2024

Surg Endosc

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Drain versus no drain in elective open incisional hernia operations: a registry-based analysis with 39,523 patients

Sahm,

Pross,

Hukauf

et al. 2023

Hernia

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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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Drain placement in retromuscular ventral hernia repair: a systematic review and meta-analysis

Cited by 7 publications

References 22 publications

Analysis of retromuscular drain output and postoperative outcomes for heavyweight versus mediumweight polypropylene mesh following open ventral hernia repair

Analysis of retromuscular drain output and postoperative outcomes for heavyweight versus mediumweight polypropylene mesh following open ventral hernia repair

Drain vs no drain placement after retromuscular ventral hernia repair with mesh: an ACHQC analysis

Drain versus no drain in elective open incisional hernia operations: a registry-based analysis with 39,523 patients

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