Surgical drain after open or laparoscopic splenectomy: is it needed or contraindicated?

Abstract

The use of surgical drain after abdominal surgery has always been a controversial issue.Benefits and risks related to the operatively placed drains in the abdominal cavity have been discussed since a hundred years ago when some surgeons where in favor of the drainage, while skeptic others considered not physiological their use (1, 2).In the common practice intra-abdominal drains have been used to help the surgeons in the post-operative phase to identify post-operative bleeding, to drain and monitor residual intraperitoneal pathologic liquids (such as bile, fecal material, pancreatic juice), and in order to prevent intra-abdominal septic collections (3).So far, however, there is a lack of evidence proving significant benefits of surgical drains and, moreover, drains themselves have been imputed as responsible for related complications which may increase post-operative morbility (1,(4)(5)(6)(7)(8)(9)(10)(11)(12).Similarly, placement of drains after splenectomy has been largely debated. Theoretically, the use of drain in splenectomised patients, whose susceptibility to infections and sepsis due to some microbial agents is well known, might predispose to an increased risk of subphrenic abscess formation and systemic infections (13,14). This assertion, however, has been resized in other studies (15-17). The increased risk of loco-regional or systemic infections in drained patients following splenectomy, has been related to associated, not intra-operatively recognized, injuries to the pancreatic tail and/or to the bowel, or they have been ascribed to the drainage system itself (18).In this study, we report our experience in a large series of open and laparoscopic splenectomies where the left sub-phrenic drainage has been routinely used. We attempt to answer if in our experience drainage could have

Sonication of Abdominal Drains: Clinical Implications of Quantitative Cultures for the Diagnosis of Surgical Site Infection

“…Moreover, serous appearance of the exudates at the insertion point of the drain was also related to the detection of a pathogen. In light of our results and the results of Vecchio et al [13] and Fan et al [30], we dare to recommend that implants should be removed as soon as appearance at the insertion point becomes serous. Early removal of the drains plays an important role in diminishing incidence of abdominal infections [13,30].…”

“…At the present time, little information exists in the literature about their usefulness, and the use of abdominal drainage after surgery is, therefore, often dogmatic. Some surgeons have reported that their use is associated with complications as a risk of ascending infections [13,20].…”

“…Essentially, drains may be classified as ''active'' when they are connected to a suction device or ''passive'' when their function depends on gravity [13]. The type of drainage tubing evaluated in this study was ''active.''…”

Topical hemostasis in laparoscopic surgery

“…The duration stay, volume and content of the drainage are significantly shorter if the hemostasis is made by devices after liver resection (10). The fibrin sealant after liver resection is effective in decreasing drainage's volume, postoperative blood transfusion, complications and hospital stay (11).…”

Experience of application of TachoSil in laparoscopic surgeries

“…Гемостаз центральных разрывов селезенки при помощи препарата Тахокомб осуществлять не следует, так как в этом случае велика опасность вторичного кровотечения. В данной ситуации выполняется спленэктомия [6].…”