Closed Suction Drainage Research Articles

Non-inferiority of open passive drains compared with closed suction drains in pancreatic surgery outcomes: A prospective observational study

BackgroundPolicies concerning the management of operatively placed drains after pancreatic surgery are still under debate. Open passive drains and closed-suction drains are both used currently in clinical practice worldwide, but there are no reliable data regarding potential differences in the postoperative outcomes associated with each drain type. The aim of the present study was to compare open passive drains and closed-suction drains with regard to postoperative contamination of the drainage fluid and overall morbidity and mortality. MethodsThis study was a prospective, observational analysis of 320 consecutive, standard, partial resections (pancreaticoduodenectomy and distal pancreatectomy at a single institution from April 2016 to April 2017. Either open passive drains (n = 189, 51%) or closed-suction drains (n = 131) were used according to the operating surgeon's choice. Postoperative outcomes, including samples of drainage fluid collected on postoperative day V and sent for microbiologic analysis, were registered. ResultsThe open passive drain and closed-suction drain cohorts did not differ in terms of their clinical features, use of neoadjuvant chemotherapy or preoperative biliary drainage, fistula risk zone, and type of operative procedure. The overall rate of postoperative day V drainage fluid contamination (27.5% vs. 20.6%, P = .1) was similar between the groups. The same results were obtained for each specific procedure. The postoperative outcomes, namely, overall 30-day morbidity, postoperative pancreatic fistula, intra-abdominal fluid collections, percutaneous drainage, wound infections, reintervention, mean duration of hospital stay, and mortality did not differ between the 2 groups. Qualitative microbiologic analysis revealed that after pancreaticoduodenectomy, 61.5% of the bacteria contaminating the drainage fluid were attributable to human gut flora, while after distal pancreatectomy, 84.8% of the bacteria belonged to skin and mucous flora (P < .01), however, the spectrum of bacterial contamination did not significantly differ between the open passive drain and closed-suction drain cohorts. ConclusionThe use of open passive drains and closed-suction drains for major pancreatic resection does not significantly impact the postoperative outcome. The spectrum of drain contamination depends on the specific operative procedure rather than on the type of drain used.

Optimal Use of Surgical Drains: Evidence-Based Strategies.

Closed-suction drains are widely used to reduce the incidence of seroma whenever potential spaces are surgically created. However, few studies have examined the parameters that affect drain efficacy. An in vitro model was created to assess the effects of tubing length, tubing size, tubing type, fluid viscosity, fluid clotting, evacuator type, evacuator squeeze method, evacuator fill, and evacuator pressure on the performance of closed-suction drains. Fluid flow rate through the drain increases with increasing intracavitary tubing length, decreasing extracavitary tubing length, increasing tubing diameter, increasing negative pressure, decreasing fluid viscosity, and the use of perforated rather than fluted drains. Bulbs generate more effective suction when squeezed "side-to-side" than when squeezed "bottom-up," and evacuators were only able to generate half the maximal negative pressure when 25 percent full or greater. Stripping the drain tubing helped relieve obstruction caused by clotting. The authors' findings have practical clinical implications for surgeons hoping to maximize the efficacy of closed-suction drains. Through this comprehensive review of the literature and in vitro analysis of relevant variables that affect drain function, the performance of closed-suction drains can be optimized by increasing intracavitary tubing length, decreasing extracavitary tubing length, increasing tubing diameter, increasing the pressure differential, using perforated drains, squeezing bulbs side-to-side, stripping drain tubing frequently, and evacuating containers whenever they are 25 percent full. Therapeutic, V.

Faut-il encore drainer les réductions mammaires ?

Despite the absence of "evidence-based medicine", the use of closed suction drainage in breast surgery is currently the standard practice. Its goal is to minimize the amount of fluid at the operation site, the dead space that can involve postoperative complications. The purpose of this study is to demonstrate that with or without drainage the complication rate is unchanged. We conducted a retrospective and comparative study of two groups of breast reduction with and without drainage. Every complication has been recorded and statistically analyzed: seroma and hematoma, infections, wound breakdown, skin flap or nipple-areola complex necrosis, fat necrosis and reoperation. A total of 138 breast reductions were performed (37 drained patients and 32 non-drained). Data collection of complications was done on average 10months after the operation (1-15). There was no statistical difference between the two groups regarding the complication rate. Our results confirm the ones found in the literature. Except for specific cases (e.g. gigantomasty), this study demonstrates that after breast reduction, drainage is not appropriate. Drains do not reduce postoperative complications and can increase hospitalization length of stay (inducing higher costs). Furthermore, it is often source of pain, anxiety and discomfort for patients.

Uso de drenos de sucção fechada após artroplastia total de quadril primária: um estudo prospectivo, randomizado e controlado

ObjectiveThis study aimed to investigate drain use in a controlled population of patients with hip osteoarthritis undergoing primary total hip arthroplasty. MethodsThis prospective controlled trial evaluated 93 patients randomized into two groups: a group that received drains and a group that did not. The patients who were randomized to the drain group used a 3.2mm drain placed under the fascia that was kept in place for 24h. Postoperative evaluations were performed after 24h and then three, six, and 12 weeks after total hip arthroplasty. The primary outcome was perioperative blood loss in both groups 24h after total hip arthroplasty. The other parameters that were evaluated included mid‐thigh circumference, the rate of blood transfusion, hematocrit, inflammatory serum levels, and the Harris Hip Score. ResultsThe clinical and laboratory data revealed no differences between the study groups with respect to blood loss and need for blood transfusion, duration of hospital stay, reoperation rate, complications, inflammatory serum markers, and the Harris Hip Score. Patients without closed suction drainage reported higher pain levels after 24h (VAS score 1 vs. 2, p<0.01). ConclusionSimilar clinical and laboratory outcomes were found in both cohorts.

A study on role of continuous suction drain tube in post-mastectomy seroma collection in carcinoma breast

Background: The essential parts of surgical management are breast conservation surgery and modified radical mastectomy of Auchincloss. Seroma is the most common complication following surgery of the breast. By creating negative pressure and obliterating dead space. The continuous suction drain tube procedure has been suggested as one potential technique to reduce the incidence of seroma in breast surgery by creating negative pressure. The aim was to study the effect of continuous suction drain tube in reducing seroma and to compare with standard closed suction drain.Methods: Totally 50 female were observed in the study. Patients undergoing modified radical mastectomy for breast carcinoma were included in this study. During the closure, the wound was closed with a closed-suction drain. Suction drain end was connected to a suction pump which was available in the wards.Results: The age of patients with a peak incidence in the 4th decade of life ranging from 35 years to80 years. The quantity of seroma in the postoperative period was measured on 3rd day, 7th day, 10th day, 12th day and 15th day. There was a significant difference in the seroma quantity postoperatively, thus permitting an earlier removal of drain tube in the study group.Conclusions: The role of continuous suction drain tube in modified radical mastectomy has reduced the formation of seroma significantly has led to the early removal of drains, institution of 1st cycle of chemotherapy before discharging the patient and thus reducing the hospital stay. It has also led to low incidence of flap necrosis postoperatively.

Use of closed suction drainage after primary total hip arthroplasty: a prospective randomized controlled trial

ObjectiveThis study aimed to investigate drain use in a controlled population of patients with hip osteoarthritis undergoing primary total hip arthroplasty. MethodsThis prospective controlled trial evaluated 93 patients randomized into two groups: a group that received drains and a group that did not. The patients who were randomized to the drain group used a 3.2mm drain placed under the fascia that was kept in place for 24h. Postoperative evaluations were performed after 24h and then three, six, and 12 weeks after total hip arthroplasty. The primary outcome was perioperative blood loss in both groups 24h after total hip arthroplasty. The other parameters that were evaluated included mid-thigh circumference, the rate of blood transfusion, hematocrit, inflammatory serum levels, and the Harris Hip Score. ResultsThe clinical and laboratory data revealed no differences between the study groups with respect to blood loss and need for blood transfusion, duration of hospital stay, reoperation rate, complications, inflammatory serum markers, and the Harris Hip Score. Patients without closed suction drainage reported higher pain levels after 24h (VAS score 1 vs. 2, p<0.01). ConclusionSimilar clinical and laboratory outcomes were found in both cohorts.

Preoperative FIBTEM Predicts Postoperative Hemorrhage in Total Knee Arthroplasty.

FIBTEM parameters might predict the amount of postoperative hemorrhage following total knee arthroplasty (TKA), because fibrin polymerization and fibrinolysis have a central role in postoperative hemorrhage following TKA. This study retrospectively evaluated 54 patients who had undergone unilateral primary TKA. Laboratory coagulation parameters, including FIBTEM, were recorded before anesthesia induction and after admission to the postanesthetic care unit. The decrease in hemoglobin (Hb), amount of hemorrhage via closed suction drainage, fluid administration, and amount transfused were reviewed postoperatively. The preoperative FIBTEM amplitudes 10 (A10) and 20 (A20) minutes after clotting time and maximum clot firmness (MCF) had the highest correlations with the postoperative decrease in Hb (p = 0.001, p = 0.002, and p = 0.003, respectively). The preoperative FIBTEM A10 <19 mm, A20 <20 mm, and MCF < 21 mm predicted > 3.0 g/dL postoperative Hb decrement from the postanesthetic Hb value (p = 0.004, p = 0.007, and p = 0.012, respectively). Preoperative FIBTEM can predict the amount of postoperative hemorrhage following TKA.

Closed Suction Drainage after Primary Total Knee Arthroplasty: A Prospective Randomized Trial.

The discussion as to whether or not to use closed suction drainage (CSD) after total knee arthroplasty (TKA) is still ongoing. A multitude of surgical techniques makes comparison between studies difficult. The aim of the present study was to investigate the benefit of CSD versus nondrainage following primary TKA when operating after exsanguination (by means of a rubber Esmarch bandage) with a tourniquet and without any form of hemostasis. A prospective randomized trial was performed with a homogeneous sample of 36 patients with strict inclusion and exclusion criteria. Patients were evaluated preoperatively, on a daily basis during their hospital stay, and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The use of CSD led to a significantly stronger drop in hemoglobin levels by approximately 1 g/dL (p = 0.012). Knee circumference, wound secretion, wound healing, and postoperative range of motion did not show significant differences. All discharge criteria were met in both groups by day 9. Interestingly, patients without CSD reported higher pain levels during the entire postoperative inpatient stay and also at the 6-week follow-up (p = 0.012). These differences could not be observed in longer follow-up. The use of CSD after primary TKA in this study did not lead to indispensable advantages but did lead to increased postoperative blood loss. When evaluating the advantages and disadvantages of the use of CSD after TKA from the data in the literature, special attention must be paid to the operating technique, as it has a strong impact on the results obtained.

Device implantation for patients on antiplatelets and anticoagulants: Use of suction drain

Background and objectivesCardiovascular implantable electronic devices (CIED) are frequently implanted in patients on anti-thrombotic agents. Pocket hematomas are more likely to occur in these patients. The use of a sterile surgical drain in the pulse generator pocket site could prevent hematomas, but fear of infection precludes its use. The objective of the present study is to study the safety and efficacy of surgical drain in patients on antithrombotics undergoing CIED implantations. MethodsThis is a single-centre, retrospective study involving patients undergoing CIED implantations on antithrombotics (antiplatelets and anticoagulants) from August 2013 to July 2016. Patients with high risk of thromboembolism were continued on oral antithrombotics or were bridged with heparin after stopping oral antithrombotics. A sterile close wound suction drain was placed in device pockets following CIED implantations. Post procedure, pressure dressing was applied and removed after 12 h once the drain volume was less than 10 ml in 24 h. ResultsSixty seven patients required surgical drain implantation. Major indications for antithrombotic use were presence of intracoronary stent, atrial fibrillation and mechanical valve replacements. The mean post-procedural hospital stay was 3 ± 0.9 days and mean overall drain was 16.6 ± 8.2 ml. At a mean follow up of 17.6 ± 8.2 months, one patient (1.4%) had pocket hematoma. There were no infections. ConclusionThe use of a surgical drain in CIED implantation significantly reduces the risk of hematoma formation without increasing the risk of infection. Antithrombotic drugs can be safely continued at the time of implantation of cardiac devices.

To use closed suction drain or not after total hip arthroplasty; A randomized controlled trial?

Aim The aim of the study is to provide clinical evidence through an analysis of the pros and cons of using a closed-suction drain (CSD) system after primary total hip arthroplasty. Patients and methods We conducted a prospective, randomized, controlled trial in Assiut University Hospitals between February 2016 and July 2017. In all, 100 patients who underwent primary total hip arthroplasty (cemented and cementless) were enrolled and randomly allocated into two groups of 50 patients each: group A (patients had CSD) and group B (patients had no CSD). Patients with revision surgery, uncontrolled bleeding tendency, liver or renal impairment, and low preoperative hemoglobin (Hb) level less than 11 g/dl were excluded from the study. The primary outcomes were Hb reduction and the number of patients transfused and the volume of blood transfusion per patient. The secondary outcomes were evaluation of the wound [including early surgical site infection (SSI), wound discharge, need for dressing reinforcement, ecchymosis], time for operative procedure, and length of hospital stay. Results Hb reduction was more in the group of CSDs (group A: 3.01 g, group B: 2.57 g, P Conclusion CSD had a negative effect on Hb reduction and rate and volume of blood transfusion (more Hb reduction and subsequently more transfusion requirements), while it had a positive effect on wound condition (less wound discharge, less dressing reinforcements, less ecchymosis), and no effect regarding early SSI, time for surgical procedure, and length of hospital stay.

Additional subcutaneous closed suction drainage and liquid tissue adhesive for wound closure in a surgery with stoma creation to prevent wound infection

Additional subcutaneous closed suction drainage and liquid tissue adhesive for wound closure in a surgery with stoma creation to prevent wound infection

Post-operative wound complications following emergency and elective abdominal surgeries

Background: The post-operative wound complications can be defined as any negative outcome as perceived either by the surgeon or by the patient. Objectives were to study the early and late post-operative wound complication of patients undergoing emergency and elective abdominal surgery, to find out and compare the incidence of post-operative wound complications following emergency and elective abdominal surgery and to find out and compare the factors associated with wound complications following elective and emergency abdominal surgery.Methods: The study was conducted at Dr. D. Y. Patil Medical College and Hospital, DPU University, for a period of 2 years (from July 2015-September 2017) and is a prospective type of study using 100 cases (Group A: Elective and Group B: Emergency abdominal surgeries –50 each). The study was approved by the Institute’s Ethics Committee.Results: 100 patients were operated in our study. The type of collection from surgical site was seropurulent in 4 (8%) patients and purulent in 1 (2%) patient of Group A whereas it was seropurulent in 5 (10%) patients and purulent in 1 (2%) patient of Group B. The type of collection in Closed Suction Drain was Serous in 12 (24%) patients, Serosanguineous in 10 (20%) patients and Seropurulent in 1 (2%) patient of Group A whereas it was Serous in 13 (26%) patients, Serosanguineous in 10 (20%) patients and Seropurulent in 1 (2%) patient of Group B. The post-operative hospital stay for majority of the patients in Group A was ≤10 days (82%) while it was 11-14 days for Group B (54%).Conclusions: Possible complications following elective surgery and those following urgent/emergency surgery, a debatable issue was the possibility of significant differences between them. The emergency laparotomies are also more common than elective laparotomies especially at peripheral centers. These findings suggest that wound complications do occur in elective abdominal surgeries. These can be reduced to a certain extent by careful case selection, improving Hb levels prior to surgery, using adequate prophylaxis and better surgical practices.

Salvage of Infected Breast Implants.

BackgroundImplant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure.MethodsWe retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure, and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection.ResultsThe total infection rate was 4.99% (58 of 1,163 cases) and the total salvage rate was 58.6% (34 of 58). The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus infection was most frequently found, with methicillin resistance in 37.5% of the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction.ConclusionsPreventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However, when infection is due to methicillin-resistant S. aureus and the patient’s clinical symptoms do not improve, surgeons should consider implant removal.

Does the Use of Closed Suction Drains (CSD) in Elective Surgical Procedures Increase Rates of Surgical Site Infections (SSI) in a Resource Limited Setting?

Jean-Louis, Willy Fils MD; MacLee, JeanLouis MD; Jeudy, Andre Patrick MD; Kaseje, Neema C. MD Author Information

Treatment of delayed deep infection after spinal fixation

Objective To explore the efficacy of early aggressive debridement with implant retention, primary wound closure, closed suction drain without irrigation and antibiotic therapy for the treatment of delayed deep infection after spinal fixation. Methods 4 057 patients were underwent dorsal spinal fixation from January 2010 to June 2014. Among them, 42 cases of delayed deep infection after operation were included in the study. There were 25 males and 17 females, with an average age of 68.6±8.1 years (ranged from 53 to 83 years). The diagnosis of delayed deep infection was based on the time of onset, clinical symptoms and signs, imaging and laboratory findings. Surgical debridement was performed immediately after diagnosis of infection. In addition, devitalized and necrotic tissue and biofilms which adhered to the surface of the implant were removed meticulously and thoroughly. Primary wound closure was performed in each patient, and closed suction drains were maintained for about 7-10 d without irrigation. Routine sensitive antimicrobial drugs was applied for 3 months after operation. Results 42 cases were all followed up for 24 to 72 months with an average of 46 months. Among the 42 infected patients, 3 patients were underwent posterior cervical spine surgery and 39 patients were underwent posterior lumbar spine surgery. There were 13 cases of staphylococcus aureus infection, 7 cases of escherichia coli infection, 3 cases of ESBL escherichia coli infection, 3 cases of enterobacter cloacae infection, 2 cases of MRSA, 2 cases of acinetobacter baumannii infection, 2 cases of klebsiella pneumoniae infection, 1 case in enterococcus faecium and pseudomonas aeruginosa and staphylococcus haemolyticus, respectively. There were still 7 patients with negative bacterial culture. 41 cases retained their implant, whereas 1 staphylococcus aureus infection patient had the implants removed because of loosening during debridement. Nevertheless, primary wound healing was found in all patients, and stitches were removed 2 to 3 weeks after debridement. Infections were effectively controlled with no recurrence of infection during the follow-up. The average erythrocyte sedimentation rate was (65.76±20.08) mm/h preoperative, (41.43±14.65) mm/h 1 month postoperative, (10.81±2.72) mm/h 6 months postoperative, and (8.10±5.46) mm/h 12 months postoperative, respectively, the differences were statistically significant. The average C reactive protein was (40.55±16.91) mg/L preoperative, (6.50±2.46) mg/L 1 month postoperative, (4.31±1.26) mg/L 6 months postoperative, and (3.83±1.50) mg/L 12 months postoperative, respectively, the differences were statistically significant. The average procalcitonin was (0.47±0.28) ng/ml preoperative, (0.08±0.06) ng/ml 1 month postoperative, (0.06±0.03) ng/ml 6 months postoperative, and (0.05±0.00) ng/ml 12 months postoperative, respectively, and the differences were statistically significant. Conclusion A timely diagnosis, aggressive and meticulous debridement, high vacuum closed-suction drain, routine and adequate use of antibacterial agents are keys to successfully resolving infection and maintaining implant retention in the treatment of delayed deep infection after spinal fixation. Key words: Infection; Reoperation; Debridement

Prevention of Seroma After Inguinal Lymph Node Dissection by TachoSil Application: A Pilot Study

IntroductionInguinofemoral lymph node dissection is the standard of care for stage III melanoma of the lower extremity with regional lymph node metastasis. Seroma is one of the most common and burdensome postoperative complications after inguinofemoral lymph node dissection. Many measures have been taken to reduce the development of seroma, none with definite success. Patients and MethodWe reviewed the effects of TachoSil patch sealing on the formation of seroma. In the present prospective one-arm single-stage pilot study, 20 patients were scheduled to undergo inguinofemoral lymph node dissection (ILND) with TachoSil application and placement of a standard closed suction drain (CSD) to investigate the effects of TachoSil on the formation of seroma. The presence of seroma after a standard protocol, which included CSD removal 3 days after surgery and the number of aspirations after CSD removal were recorded. In addition, the number and severity of surgical site infections were recorded. ResultsA preplanned futility analysis after the inclusion of 11 patients showed that all patients developed postoperative seroma. The median number of aspirations after CSD removal was 3. This resulted in premature termination of the study. In addition, 10 of the 11 patients developed a surgical site infection. DiscussionNo evidence of a positive effect of TachoSil application on seroma formation after ILND was seen in the present study, and 10 of the 11 patients developed a surgical site infection. ILND remains a surgical procedure with a high incidence of postoperative complications, including seroma. New morbidity-reducing strategies are eagerly awaited, because the TachoSil patches do not seem to have a role in the management of seroma prevention after ILND.

Closed-Suction Drains After Subcutaneous Mastectomy for Gynecomastia: Do They Reduce Complications?

In cases of refractory gynecomastia, surgical excision of excess glandular breast tissue is often warranted. Closed-suction drain placement is commonplace; however, the effect of drains on preventing complications after male breast surgery has not been fully elucidated in the literature. To investigate the effect of drains on reducing seroma and hematoma after subcutaneous mastectomy for gynecomastia. Retrospective chart review of patients undergoing subcutaneous mastectomy for gynecomastia over a 10-year period. Charts were reviewed for demographics, BMI, comorbidities, type of local anesthesia, specimen weight, use of liposuction, and placement of drains. Outcomes were determined by seroma or hematoma in the 30-day postoperative period. A total of 163 breasts were studied (group I=no-drain, n=46; group II=drain, n=117). Group I had a higher rate of clinically significant seromas requiring needle aspiration than group II (6.5 vs 0%, p=0.0214). There was no difference in rates of hematoma (group I vs II, 2.2 vs 6.0%, p=0.443) and total fluid collections (group I vs II, 19.6 vs 16.2%, p=0.647). BMI, use of local anesthesia, specimen weight, and use of liposuction were not significantly associated with postoperative complications. Closed-suction drains may reduce rates of clinically significant seromas requiring needle aspiration. Though drains carry their own pertinent adverse effects (e.g., patient discomfort and anxiety, cost, and additional clinic visits), there remains no universal standard of care and surgeon practices vary widely. Given the potential to reduce seroma rates, we recommend that surgeons consider placing drains and discuss with patients the benefits and risks of drains after surgical treatment of gynecomastia. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Is Closed-Suction Drainage Essential after Minimally Invasive Lumbar Fusion Surgery?: A Retrospective Review of 381 Cases

Is Closed-Suction Drainage Essential after Minimally Invasive Lumbar Fusion Surgery?: A Retrospective Review of 381 Cases

Analysis of factors influencing drain amount, time to drain removal, and seroma formation in patients undergoing immediate expander-implant breast reconstruction

Background: Placement of a closed suction drain is a common cause of patient complaints, such as postoperative pain or discomfort following immediate expander-implant breast reconstruction. This study aims to identify factors that affect drainage volume, time to drain removal, and seroma formation.Methods: A retrospective chart review of prospectively collected data was conducted on patients who underwent immediate expander-implant breast reconstructions following nipple-sparing or skin-sparing mastectomy without skin excision (nipple areolar complex excision only) between February 2010 and April 2015. Daily drainage volume was measured until the drain was removed. Eight independent variables, including acellular dermal matrix (ADM) usage and inflation ratio (the rate of initial inflation volume to mastectomy weight) were analysed by univariable and multivariable analyses.Results: A total of 162 breasts in 148 patients were included in this study. The inflation ratio did not influence the drain amount or days to drain removal. Although the use of ADM was significantly associated with increased drainage during the first 5 postoperative days (p = 0.015), it was not significant when adjusted for time. Old age, larger expander size, and larger drain amount on the first postoperative day were predictors for longer days to drain removal (p < 0.001). Old age had a trend toward higher risk of seroma formation that approached statistical significance (p = 0.057).Conclusions: The use of ADM and initial inflation ratio do not influence days to drain removal or seroma formation. A longer period of drain placement is expected when a larger expander is used or in elderly patients.

The efficacy of active drainage for preventing postoperative organ/space surgical site infections in patients with Crohn’s disease

Patients with Crohn's disease (CD) show a higher incidence of surgical site infections (SSIs) after bowel resection in comparison to other patient populations because CD patients commonly suffer from anemia, malnutrition, and immunosuppression. In comparison to conventional passive drainage, active drainage using a closed-suction drain reportedly reduces postoperative wound-related complications in several diseases. In the present study, we aimed to investigate the incidence of SSI and to identify the risk factors for SSI in patients with CD. We retrospectively analyzed the patient characteristics and perioperative data of 106 CD patients who underwent bowel resection at our institution between January 2000 and June 2016. We statistically analyzed the incidence of different types of SSI (overall, incisional, and organ/space) in relation to patient-related and surgery-related risk factors. Overall postoperative SSIs were diagnosed in 19 patients (17.9%), including incisional SSI (n=16; 15.1%), organ/space SSI (n=7; 6.6%), and both (n=4; 3.8%). A long operative time (p=0.036) and colonic involvement (p=0.011) were significantly associated with the overall risk of developing an SSI. Active drainage significantly reduced the incidence of organ/space SSI (p=0.037). Intraabdominal active drainage was more useful than passive drainage for preventing organ/space SSI development.