Should routine surgical wound drainage after ventral hernia repair be avoided? A systematic review and meta-analysis

Mohamedahmed, Ali Yasen Y.; Zaman, Shafquat; Ghassemi, Nader; Ghassemi, Alireza; Wuheb, Ali Ahmed; Abdalla, Hiba; Hajibandeh, Shahab; Hajibandeh, Shahin

doi:10.1007/s10029-023-02804-0

Cited by 5 publications

(4 citation statements)

References 33 publications

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“…Overall, there have been few randomized studies on this topic to date, most of which do not differentiate between retromuscular and subcutaneous mesh placement [18,19]. A non-randomized study categorized participants into groups according to the position of drainage.…”

Section: Discussionmentioning

confidence: 99%

“…A Cochrane review has addressed drain placement following hernioplasty; however, it included sublay, onlay, and inlay repairs and could not identify randomized trials [17]. Two recent meta-analyses identi ed only four randomized studies, most of which did not differentiate between the drainage localizations [18,19]. The conclusion was that the use of drains does not lead to increased complications.…”

Section: Introductionmentioning

confidence: 99%

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Effect of retromuscular, periprosthetic drainage after hernioplasty with sublay mesh reinforcement in ventral hernias: less retromuscular fluid collections but longer hospital stay and analgetic use - A randomized controlled trial

Pochhammer,

Ibald,

Weller

et al. 2024

Preprint

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Purpose To determine whether periprosthetic drain insertion for hernioplasty using sublay mesh augmentation reduces retromuscular fluid collections (RFC) and complications. Methods Forty-two patients with open repair of midline hernias (M2-4, W1, European Hernia Society classification) were allocated to groups with or without retromuscular drains. Subcutaneous drainages were used in both groups to avoid confounding from surgical site occurrences due to superficial, subcutaneous fluid collections. The participants underwent clinical and ultrasound assessments on postoperative days (POD) 14 and 30 to detect RFC, subcutaneous seromas, and wound complications. Results In the retromuscular drainage group, the RFC median volume was reduced by 75.2% on POD 14, and by POD 30, no RFC were found [0.2 vs. 25.8 (p < 0.001) and 0 vs. 4.0 (p = 0.02) on PODs 14 and 30, respectively]. The number of patients with RFC ≥ 5 mL was also significantly lower in the drainage group [4 vs. 12 (p = 0.02) and 1 vs. 8 (p = 0.02) on PODs 14 and 30, respectively]. No surgical site infections occurred in either group, but one deep, retromuscular hematoseroma led to revision surgery in the group without drainage. In the drainage group, a significantly longer hospital stay (6.5 days vs. 4 days; p = 0.01) and longer regular analgetic intake (6 vs. 3 days; p = 0.03) were observed. Multivariable regression revealed that retromuscular drainage usage was the only independent predictor of the RFC volume. Conclusion We found that the use of retromuscular drains after hernioplasty with sublay hernia repair reduced retromuscular, periprosthetic fluid collections. Our data further suggest that the use of drains can prevent revision surgery; however, waiving drain use did not increase the risk of infection. Therefore, it might be safe to waive drain use for patients at low risk, leading to shorter hospital stays.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of retromuscular, periprosthetic drainage after hernioplasty with sublay mesh reinforcement in ventral hernias: less retromuscular fluid collections but longer hospital stay and analgetic use - A randomized controlled trial

Pochhammer,

Ibald,

Weller

et al. 2024

Preprint

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“…This practice, however, has not been particularly well studied in the hernia population. [44][45][46][47][48]. While one recent randomized study demonstrated no difference between the size of residual fluid collection between a drain vs. no-drain group, they also demonstrated a significantly lower complication rate in the drainage group, including less risk of dehiscence [46].…”

Section: Complications Of Mesh Placementmentioning

confidence: 99%

“…[44][45][46][47][48]. While one recent randomized study demonstrated no difference between the size of residual fluid collection between a drain vs. no-drain group, they also demonstrated a significantly lower complication rate in the drainage group, including less risk of dehiscence [46]. When a seroma does occur post-operatively, it can most frequently be managed conservatively and most resolve with time, especially if there are no features suggestive of superimposed infection.…”

Section: Complications Of Mesh Placementmentioning

confidence: 99%

Are Surgeons Going to Be Left Holding the Bag? Incisional Hernia Repair and Intra-Peritoneal Non-Absorbable Mesh Implant Complications

Kirkpatrick,

Coccolini,

Tolonen

et al. 2024

JCM

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Ventral incisional hernias are common indications for elective repair and frequently complicated by recurrence. Surgical meshes, which may be synthetic, bio-synthetic, or biological, decrease recurrence and, resultingly, their use has become standard. While most patients are greatly benefited, mesh represents a permanently implanted foreign body. Mesh may be implanted within the intra-peritoneal, preperitoneal, retrorectus, inlay, or onlay anatomic positions. Meshes may be associated with complications that may be early or late and range from minor to severe. Long-term complications with intra-peritoneal synthetic mesh (IPSM) in apposition to the viscera are particularly at risk for adhesions and potential enteric fistula formation. The overall rate of such complications is difficult to appreciate due to poor long-term follow-up data, although it behooves surgeons to understand these risks as they are the ones who implant these devices. All surgeons need to be aware that meshes are commercial devices that are delivered into their operating room without scientific evidence of efficacy or even safety due to the unique regulatory practices that distinguish medical devices from medications. Thus, surgeons must continue to advocate for more stringent oversight and improved scientific evaluation to serve our patients properly and protect the patient–surgeon relationship as the only rationale long-term strategy to avoid ongoing complications.

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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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Should routine surgical wound drainage after ventral hernia repair be avoided? A systematic review and meta-analysis

Cited by 5 publications

References 33 publications

Effect of retromuscular, periprosthetic drainage after hernioplasty with sublay mesh reinforcement in ventral hernias: less retromuscular fluid collections but longer hospital stay and analgetic use - A randomized controlled trial

Effect of retromuscular, periprosthetic drainage after hernioplasty with sublay mesh reinforcement in ventral hernias: less retromuscular fluid collections but longer hospital stay and analgetic use - A randomized controlled trial

Are Surgeons Going to Be Left Holding the Bag? Incisional Hernia Repair and Intra-Peritoneal Non-Absorbable Mesh Implant Complications

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

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