Retained surgical drain fragments: A systematic review and case report

Abstract

Aim: Retained surgical drains are an avoidable and serious cause of postoperative morbidity. This study aims to first report on our unit's experience in identifying and managing retained surgical drains and then consolidate current knowledge regarding retained surgical drains, causes and associated complications.Patients and Methods: A systematic review of the literature was performed through searches in electronic databases to identify studies that described incidents involving retained surgical drains. Data were extracted regarding patient and operative characteristics, drain complications and management.Results: A total of 36 case reports and/or series were identified in the literature, with 39 individual cases of retained surgical drains in patients undergoing abdominal, thoracic or orthopaedic procedures. The most common cause for retained drain was fracture of drain tubing. Patients presented with complications ranging from chronic pain, abscess or fistula formation, to migration of the drain fragment into a hollow viscus. In all cases an invasive intervention was required to remove the retained drain. Conclusion:Surgeons should be aware of retained surgical drains as an iatrogenic cause of postoperative morbidity. Contemporary surgical practice should include methods to prevent, identify and manage retained drains and associated complications.

Management of a Complex Fistula Involving Abdominal Wall, Small Bowel, Colon, and Bladder

“…2 Prolonged use of JP drains may contribute to various complications, including infections, herniation, bleeding, persistent tracts, retained foreign bodies, obstruction, and erosion into adjacent tissues. 3,4 Risk of fistula formation increases when drains are left in place for extended periods and are positioned near anastomoses or sutures. 3 Risk of fistulae increases with more rigid drains and in the setting of significant edema; it is thought due to pressure necrosis of an adjacent organ.…”

“…3 Drain tubing fracture has also been reported as a cause of retained drains. 4 In one report, a post-splenectomy patient developed a gastric fistulae due to trauma from drainage tubes inadvertently penetrating the stomach wall. 3 In our patient, the JP drain from the index operation was left in place for 8 months.…”