Stellenwert von Drainagen in der Chirurgie

Abstract

Placing drains is one the most common procedures following operations in surgical disciplines. The indication for placing a drain is, however, usually based on a traditional belief rather than being evidence-based. This paper presents an overview of the literature regarding the indications and the evidence level for placing drains following operations in visceral, vascular, thoracic and orthopeedic surgery as well as traumatology. In visceral surgery the indications for placing drains could be clarified over the past decades but in other surgical fields the level of evidence needs further investigation and clarification through future studies. The available data suggest that in most cases a prophylactic drainage can be avoided. In addition, drains may lead to increased morbidity and higher treatment costs.

Weiterhin keine Evidenz für Drainagen in der Bariatrie

“…Während einige chirurgische Schritte der bariatrischen Chirurgie gut untersucht und kontrovers diskutiert werden, ist die Platzierung einer Drainage in vielen chirurgischen Abteilungen immer noch Standard. Obwohl es kaum Evidenz für eine Drainage gibt, wird sie von einigen Chirurgen als unverzichtbar angesehen [13][14][15]. Der proklamierte Grund für das Einsetzen einer Drainage ist die rechtzeitige Erkennung von Blutungen oder Insuffizienzen.…”

<p>Clinical Pathways For Pancreatic Surgery: Are They A Suitable Instrument For Process Standardization To Improve Process And Outcome Quality Of Patients Undergoing Distal And Total Pancreatectomy? - A Retrospective Cohort Study</p>

“…This measurement is important for a timely diagnosis of a possible postoperative pancreatic fistula, the most frequent complication after distal pancreatectomy. At the same time, the risk of drain-related ascending infection or enteral fistula increases with the time of drain indwelling, so that timely drain removal is recommended once drain fluid shows no increased enzyme levels 42–44…”

Chylous complications of various severity and manifestations within diverse compartments in reconstructive vascular surgery #) #) The manuscript is dedicated to Prof. Dr. Z. Halloul

“…Injured lymphatic vessels and nodes need to be consequently and carefully ligated or sutured since coagulation only cannot be considered reliable in preventing lymphatic fistula(s) [27,32]. Prophylactic insertion of a closed suction drainage does not provide an advantage to definite avoidance of a lymphocele [33].…”