Closed Suction Drainage Research Articles

Are Drains Associated With Infection After Operative Fixation of High-Risk Tibial Plateau and Pilon Fractures?

OBJECTIVES: To determine the association between closed suction drainage and postoperative infection in patients with tibial plateau or pilon fractures. Secondarily, this study assessed if intrawound vancomycin powder modified the association of closed surgical drains with infection. METHODS: Design: Secondary analysis of the Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial (VANCO) trial. Setting: 36 academic trauma centers. Patient Selection Criteria: All patients with high-risk tibia fractures (OTA/AO classification 41B/C or 43B/C) from the VANCO trial were considered. Closed suction drains were placed based on the treating surgeon’s discretion. Patients were randomly assigned to received 1-gram intrawound vancomycin powder in the surgical wound at definitive fixation or the standard infection prevention protocol at each center. Outcome Measures and Comparisons: Deep surgical site infection (SSI) within 6 months. Comparisons were made between patients treated with and without drains. Subgroup analysis also examined the effect of drains in patients with and without intrawound vancomycin powder. RESULTS: Of the 978 study patients, 197 (20%) were treated with drains. Deep infection rates did not significantly differ between patients with or without surgical drains (8% versus 8%, p=0.88). However, intrawound vancomycin powder significantly modified the association of surgical drains on deep SSI (interaction p=0.048). Specifically, patients with drains but no vancomycin powder had the highest deep infection rate (13%; 95% CI, 6% to 19%). When vancomycin powder was used in addition to a drain, deep SSI rates were reduced by 10% (95% CI, 2% to 17%, p=0.01). CONCLUSIONS: This study suggests that closed suction drains after operative fixation of high-risk tibia fractures may not be associated with deep infection in general. However, a secondary analysis raises the possibility that drains are associated with reduced deep infection rates if topical vancomycin powder is used but associated with increased infection rates if vancomycin powder is not used. LEVEL OF EVIDENCE: Level III

Optimal Use of Drain Tubes for DIEP Flap Breast Reconstruction: Comprehensive Review

Background: Deep inferior epigastric perforator (DIEP) flap breast reconstruction is an increasingly popular technique, but controversy exists regarding the optimal use of closed suction drains (CSD) at the abdominal donor site. This narrative review synthesizes current evidence on CSD application, criteria for placement/removal, and complications in DIEP flap procedures. Alternative techniques and implications for postoperative care are also discussed. Methods: A systematic search was conducted in August 2024 across several databases to identify English language studies related to CSD use in DIEP flap breast reconstruction. Inclusion criteria consisted of original research on aspects such as CSD volume criteria, timing, complications, alternatives like progressive tension sutures, and impact on showering and patient outcomes. References from relevant papers were hand-searched. Results: The review found a lack of consensus on CSD protocols, with drainage volume triggering removal varying widely from 5 mL to 80 mL daily. While CSD may reduce seroma/hematoma formation, earlier removal (≤3 days) did not increase complications and shortened hospital stay. Progressive tension sutures show promise as an alternative, with evidence of comparable or reduced complications and improved recovery versus CSD. The safety of early showering with drains remains unclear. Conclusions: Although CSD aims to minimize postoperative complications, more rigorous randomized trials are needed to establish evidence-based practices for the timing of removal and demonstrate the efficacy of emerging drain-free techniques on patient-centered outcomes. Standardized criteria could reduce practice variability. Further research should also explore the long-term impact of drainage strategies on aesthetic and functional results.

Analysis of 398 cases of intradural spinal tumor resection with primary dural closure: surgical outcomes based on the suture material

OBJECTIVE Cerebrospinal fluid (CSF) leak after resection of intradural spinal tumors (IST) represents a significant postoperative challenge. Although various dura suture techniques and materials have been explored experimentally, direct clinical comparative studies are lacking. This study evaluated the effectiveness of specific suture materials in primary dural closure post-IST resection and identified associated risk factors for CSF leak. METHODS A retrospective review was conducted of patients who underwent IST resection surgery at a single institution from January 2012 to February 2021. Patients were categorized on the basis of the dura suture materials used. Eligibility for the study required a posterior midline surgical approach, primary dural closure after durotomy, and absence of closed-suction drainage. RESULTS Of 398 patients who met the inclusion criteria, the overall CSF leak–related surgical complication rate was 4.27% (17/398). The sutures used were 6-0 Prolene for 163 patients and 5-0 silk for 235 patients. Significant differences were observed between the suture groups in the CSF leak rate (Prolene 1.8% vs silk 6.0%, p = 0.046), lumbar drainage insertion rate (Prolene 0.6% vs silk 4.3%, p = 0.031), and length of postoperative bed rest (Prolene 1.07 days vs silk 3.25 days, p < 0.001). Logistic regression analysis indicated a significant association of CSF leak with the use of 5-0 silk (OR 4.11, p = 0.006) and revision surgical procedures (OR 6.73, p = 0.001). CONCLUSIONS Surgical complications related to CSF leaks were significantly lower with the use of 6-0 Prolene sutures compared to 5-0 silk sutures in primary dural closure after IST resection.

Drain versus no-drain at the donor sites of iliac crest bone graft: a retrospective study

BackgroundClosed suction drainage is typically used in orthopaedic surgery to reduce the occurrence of incision complications. However, whether drainage tubes should be routinely placed in iliac crest bone graft surgeries is still unclear. This study aimed to evaluate the effect of closed suction drainage at iliac crest bone donor site on clinical prognosis.Materials and methodsG.Power was used for a prior analysis to estimate the required sample size. 91 patients with tibial plateau fractures who underwent iliac crest harvesting and grafting between January 2019 and January 2022 were enrolled in the study. All surgeries were performed by the same experienced surgeon team. Patients were divided into close suction drainage (CSD) group and no-CSD group according to the use of drainage tube. The demographic and perioperative data of the patients were collected and analyzed.ResultsThere were no significant differences in demographic characteristics between the two groups except that the CSD group had more people with diabetes. The use of closed suction drainage in patients undergoing iliac crest harvest can significantly reduce the incidence of incision complications without increasing pain level and extending hospital stay. However, the closed suction drainage obviously caused the increase of blood loss. More drainage tubes would cause more drainage fluid to flow out. And drainage tube placement may impose a higher financial burden on patients.ConclusionThe closed suction drainage should not be recommended routinely for iliac crest bone graft patients. Only when the patient is at high risk for infection and without severe blood loss, placing a single drainage tube is recommended.Trial registrationThis study was registered at (NCT04807062) and approved by the Ethics Committee of the participating institution (Theoretical No. 2015-003-1).

Prophylactic intra-abdominal drainage during pancreaticoduodenectomy: A systematic review and meta-analysis

Background: Prophylactic abdominal drainage during pancreaticoduodenectomy (PD) is a common treatment strategy for pancreatic fistula. However, its benefits and safety have been the subject of debate. The objective of this meta-analysis and system review is to assess the effects of prophylactic drainage, various types of drainage (active and passive), and the timing of drainage removal (early and late) on the postoperative outcomes of PD. Methods: A systematic literature search was conducted in the PubMed, Web of Science, and Cochrane Library databases as of April 28, 2024. Randomized controlled trials (RCTs) comparing prophylactic abdominal drainage, different drainage patterns, and the timing of drainage removal after PD were included, and the postoperative outcomes were evaluated. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated to aggregate dichotomous outcomes. Meta-analysis was performed using the Mantel-Haenszel fixed- and random-effects models. Results: Nine RCTs, including a total of 1638 patients, were incorporated in our study. The meta-analysis showed no statistically significant differences in postoperative outcomes between the closed-suction drain (CSD) group and the passive drain to gravity (PDG) group. Compared to the late drain removal (LDR) group, the early drain removal (EDR) group had a significant reduction in the incidence of Clinically relevant postoperative pancreatic fistula (CR-POPF) (OR=0.39, 95% CI=0.20 to 0.79; P=0.009), morbidity (OR=0.41, 95% CI=0.20 to 0.84; P=0.01) and intra-abdominal infection (OR=0.40, 95% CI=0.22 to 0.75; P=0.004). For the group of present of drainage and the group of absent of drainage, the patient inclusion criteria of the included studies were too heterogeneous, making meta-analysis inappropriate. Conclusion: The existing evidence is insufficient to negate the necessity of prophylactic drainage after PD. The meta-analysis did not show superiority of any specific approaches of drainage tube. But this review did indicate that patients benefit from EDR in terms of CR-POPF, morbidity and intra-abdominal infection. EDR was recommended for low/intermediate risk patients.

The role of subcutaneous drain in laparotomy patients

Background: In surgical incision wounds, hematoma, serous fluid, and dead space increase the risk of infection because they provide a surface for microbial growth. Subcutaneous drain reduces dead space in the subcutaneous tissue plane, which prevents fluid from accumulating and seroma from forming by removing infectious content, residual effusion, and blood from the wound. This study attempts to determine the efficacy of subcutaneous drain in laparotomy in the management of surgical site infection (SSI). Methods: This prospective study was conducted at the Department of Surgery in various hospitals in Cumilla, Bangladesh. This study includes 150 adult patients aged between 18 to 70 years. A closed subcutaneous suction drain was inserted before the skin was closed in 75 patients at random (drain group), whereas the rest of the 75 patients' subcutaneous suction drains were not kept (no-drain group). Results: The association between comorbidities and SSI in both the drain and no-drain groups were significant, p value <0.001 respectively. SSI was mainly in the group with fewer surgery hours (72.4%). Patients with SSI also have longer hospital stays on average. Conclusions: Patients with SSI have increased morbidity, and those undergoing major procedures are more likely to experience SSI afterwards. The presence of a subcutaneous closed suction drain contributes to reducing SSI.

Role of subcutaneous closed suction drain in the prevention of incisional surgical site infection after loop ileostomy reversal with purse-string skin closure: a retrospective observational study

BackgroundSurgical site infection (SSI) is not rare after loop ileostomy reversal. This study assessed the effects of a subcutaneous closed suction drain on reducing SSIs after loop ileostomy reversal with purse-string skin closure.MethodsThis retrospective study included 229 patients who underwent loop ileostomy reversal with purse-string closure at the Pusan National University Yangsan Hospital between January 2017 and December 2021. We divided the patients into those with a subcutaneous drain (SD group) and those without it (ND group). We analyzed variables that affected SSI occurrence in both groups.ResultsThe SD and ND groups included 109 and 120 patients, respectively. The number of incisional SSIs was significantly lower in the SD than in the ND group (0 vs. 7 events). An average of 35.7 mL of fluid was collected in the drainage bulb during hospitalization. The C-reactive protein level on postoperative day 4 was significantly lower in the SD group than in the ND group. The insertion of a subcutaneous drain was the only factor associated with a reduced incidence of SSIs (p = 0.015).ConclusionsSubcutaneous closed suction drain with purse-string skin closure in loop ileostomy reversal can reduce incisional SSI occurrence.

Shorter Drainage Tube to the Pancreatic Stump Reduces Pancreatic Fistula After Distal Pancreatectomy.

We investigated the relationship between the length of a prophylactic closed-suction drainage tube and clinically relevant postoperative pancreatic fistula (CR-POPF) in distal pancreatectomy (DP). The clinical data of 76 patients who underwent DP using a reinforced stapler for the division of the pancreas at Ehime University Hospital between December 2017 and May 2023 were retrospectively analyzed. Laparoscopic DP was performed in 41 patients (53.9%). Closed-suction drainage was performed using a 19Fr ExuFlow Round Drain with a vacuum bulb. The drainage tube length was defined as the distance between the peripancreatic stump site and the abdominal wall insertion site using abdominal radiography. CR-POPF was observed in 12 patients (15.8%). Univariate analyses demonstrated that male sex (P=0.020), American Society of Anesthesiologists Physical Status (P=0.017), current smoking (P=0.005), and drainage tube length (P<0.001) were significantly associated with CR-POPF. The optimal cut-off value of drainage tube length for CR-POPF was 220mm (area under the receiver operating characteristic curve=0.80). In multivariate analyses, drainage tube length (≥220mm) was the sole independent predictor for CR-POPF (odds ratio, 6.59; P=0.023). According to computed tomography performed ∼1 week after surgery, the median volume of peripancreatic fluid collection was significantly higher in the long drainage tube group than in the short drainage tube group (P<0.001). A drainage tube inserted at a shorter distance to the pancreatic stump may reduce the incidence of CR-POPF after DP.

Suction drain usage has no benefit following revision total hip and knee arthroplasty.

The use of drains after primary total joint arthroplasty (TJA) has shown little benefit. Few studies have investigated drain usage after revision TJA. The purpose of this study was to determine whether utilizing suction drains is beneficial for patients undergoing revision arthroplasty. We performed a comprehensive literature review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from the PubMed, Embase, Web of Science, and Cochrane Library. Inclusion criteria of this review were all original articles written in English investigating the efficacy and safety of closed suction drainage in revision TKA or THA, reporting at least one of the following outcome measures: (1) estimated blood loss (EBL), (2) perioperative hemoglobin change, (3) needs for transfusion, (4) postoperative infection, and (5) wound complications. Articles were excluded if they are not available in English or they included case reports, systematic reviews, comments, editorials, surveys, or animal studies prior to July 22, 2023. A total of six studies met inclusion criteria. In total, 655 patients had a drain while 1765 patients did not have a drain after revision total hip or knee arthroplasty. Primary outcomes included for meta-analysis included estimated blood loss (EBL), postoperative hemoglobin, need for transfusion. Other data extracted includes postoperative infections, and wound complications. Six studies met the inclusion criteria. In total, 655 patients had drains, while 1765 patients did not after revision total hip or knee arthroplasty. The average age of the patients was 66.1+/- 3.4 years, and the average BMI was 30.3 +/-0.8. There was no difference in postoperative infections (p = 0.14), wound complications (p = 0.621) or need for transfusion (p = 0.521) between the two groups. There was also no difference in EBL (Hedges' g CI[-3.52, 2.77]) or postoperative Hb (Hedges' g CI[-1.65, 2.41]) between patients with and without drains. Our results do not show any benefit from drain placement after revision total hip or knee arthroplasty. With the increased cost, time and need for drain removal, this is likely an unnecessary intervention. Level III, systematic review and meta-analysis.

Effectiveness of Surgical Drains in Obese Patients Undergoing Lumbar Discectomy.

Background The placement of postoperative drains after spine surgery is a contentious issue, and its application has changed over time. Obesity itself is an independent risk factor for postoperative complications. Hematomas in the surgical wound are a complication that may necessitate revision surgery. Orthopaedic surgeons frequently use closed drainage in orthopaedic surgery to prevent the formation of a hematoma. It remains unclear whether drains reduce postoperative complications and improve clinical outcomes, especially in obese patients who are already at risk of such complications. Objectives To assess the incidence of surgical site infections (SSI) after lumbar discectomy in obese and morbidly obese patients with or without postoperative wound drainage and compare functional outcomes between both groups. Methodology A hospital-based retrospective study was conducted among 84 patients with obesity who underwent single-level lumbar discectomy at R. L. Jalappa Hospital and Research Centre, Kolar, India from May 2022 to April 2023. Drains were used for patients in Group A and avoided for patients in Group B. Results Postoperative C-reactive protein (CRP) levels in the non-drainage group were much higher than in the drainage group and were statistically significant. There was a statistically significant association found between body mass index (BMI) and postoperative SSI. In Group A, only three patients had SSI while in Group B, eight patients suffered from SSI. Conclusion Closed suction drains were shown to have a positive impact in reducing SSI in patients with obesity. Drain tip culture may be beneficial in detecting SSI at the earliest. Hence, we believe that closed suction drainage can be considered as a standard protocol in obese patients.

A Systematic Review and Meta-Analysis Evaluating the Surgical Outcomes of Progressive Tension Suturing Compared to Drains in Abdominoplasty Surgery.

Closed suction drains are used to prevent seroma formation after abdominoplasty, but evidence of their effectiveness is limited, and they may increase infection risk and patient discomfort. Previous meta-analyses comparing progressive tension suturing (PTS) to drainage (D) in abdominoplasty have been methodologically weak and small in sample size. This study aims to conduct the first robust systematic review comparing PTS and D outcomes in abdominoplasty. Registered on PROSPERO (CRD42022346106), the study searched MEDLINE, EMBASE, CENTRAL, Google Scholar, and Web of Science from 19/09/2022 to 19/02/2024. Data were pooled using a random-effects Mantel-Haenszel model. Risk of bias was assessed with Cochrane's Risk-of-Bias Tool and ROBINS-I tool for randomized controlled trials and observational studies, respectively. The GRADE system evaluated methodological quality. PTS significantly reduced post-operative seroma rates (RR: 0.34; 95% CI: 0.15-0.76; P=0.001) and reoperation rates (RR=0.56; 95%CI: 0.03-9.77; P=0.05) compared to drains, with no significant differences in hematomas, infections, or dehiscence. The review included 24 studies with 750 patients, including 2 RCTs, and was found to be methodologically superior by AMSTAR2 criteria. Subgroup analysis indicated that combining liposuction with PTS significantly reduced seromas (RR: 0.18; 95%CI:0.00-7.39; P<0.00001), infections (RR: 0.16; 95%CI: 0.03-0.86; P = 0.03), and dehiscence (RR:0.11; 95%CI: 0.01-1.01; P=0.05). This robust meta-analysis shows PTS is more effective than drains in reducing seroma and reoperation rates, with no difference in hematomas or infections. Combining liposuction with PTS may be superior to using drains. Larger, high-quality studies are needed to further assess the safety and efficacy of drainless abdominoplasty.

Retrospective study on the feasibility and safety of laparoscopic surgery for complicated fistulizing diverticular disease in a high-volume colorectal center.

We assessed feasibility and safety of laparoscopic sigmoidectomy for complicated fistulizing diverticular disease in a tertiary care colorectal center. A single-center retrospective study of patients undergoing sigmoidectomy for fistulizing diverticular disease between 2011 and 2021 was realized. Primary outcomes were rates of conversion to open surgery and severe postoperative morbidity at 30 days. Secondary outcomes included rates of postoperative bladder leaks on cystogram. Among the 104 patients, 32.7% had previous laparotomy. Laparoscopy was the initial approach in 103 (99.0%), with 6 (5.8%) conversions to laparotomy. Clavien-Dindo grade ≥ III complication rate at 30 days was 10.6%, including two (1.9%) anastomotic leaks. The median postoperative length of stay was 4.0 days. Seven (6.7%) patients underwent reoperation, six (5.8%) were readmitted, and one (0.9%) died within 30 days. Twelve (11.5%) ileostomies were created initially, and two (1.9%) were created following anastomotic leaks. At last follow-up, 101 (97.1%) patients were stoma-free. Urgent surgeries had a higher rate of severe postoperative complications. Among colovesical fistula patients (n = 73), postoperative cystograms were performed in 56.2%, identifying two out of the three bladder leaks detected on closed suction drains. No differences in postoperative outcomes occurred between groups with and without postoperative cystograms, including Foley catheter removal within seven days (73.2% vs. 90.6%, p = 0.08). Laparoscopic surgery for complicated fistulizing diverticulitis showed low rates of severe complications, conversions to open surgery and permanent stomas in high-volume colorectal center.

Clinical Benefits of Reducing Dead Space Using a Closed Suction Drain and Subcutaneous Large-bite Buried Suture Technique to Prevent Superficial Surgical-site Infections Following Primary Closure of a Diverting Stoma.

Surgical-site infections (SSIs) are the most common complication after stoma closure. We propose a new method for wound closure using the subcutaneous large-bite buried suture (SLBS) technique and a closed suction drain (CSD). In this study, we aimed to investigate the efficacy of a combination of the SLBS technique and a CSD to prevent superficial SSIs following stoma closure. We retrospectively analyzed patients who underwent stoma closure between January 2019 and July 2022. Primary closure of the stomal site was performed using the SLBS technique and a CSD for wound closure. The CSD was placed until postoperative day 7. The occurrence of superficial postoperative SSIs was also evaluated. In total, 67 patients were included in the study. Within 30 days postoperatively, nine patients (13%) developed superficial SSIs. Considering the type of stoma, only 1 (2%) of 45 patients with ileostomy showed superficial SSIs, whereas 8 (36%) of 22 patients with colostomy showed superficial SSIs. Univariate analysis of the risk factors associated with the occurrence of superficial SSIs revealed that colostomy (p < 0.001) and hand-sewn anastomosis were significant risk factors (p = 0.019). Multivariate analysis of the risk factors associated with the occurrence of superficial SSIs revealed that colostomy was significant risk factor (p = 0.003). This new method of stoma closure is feasible for preventing superficial SSIs, especially in ileostomy closure.

Post-operative antibiotic prophylaxis in spine surgery patients with thoracolumbar drains: A meta analysis

Closed-suction drains are commonly placed after thoracolumbar surgery to reduce the risk of post-operative hematoma and neurologic deterioration, and may stay in place for a longer period of time if output remains high. Prolonged maintenance of surgical site drains, however, is associated with an increased risk of surgical site infection (SSI). The present study aims to examine the literature regarding extended duration (≥24h) prophylactic antibiotic use in patients undergoing posterior thoracolumbar surgery with closed-suction drainage. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Relevant studies reporting the use of 24-h post-operative antibiotics compared with extended duration post-operative antibiotics in patients undergoing posterior thoracolumbar surgery with closed-suction drainage were identified from a PubMed database query. Six studies were included for statistical analysis, encompassing 1003 patients that received 24h of post-operative antibiotics and 984 patients that received ≥24h of post-operative antibiotics. The SSI rate was 5.16% for the shorter duration group (24h) and 4.44% (p=0.7865) for the longer duration group (≥24h). There is no significant difference in rates of SSI in patients receiving 24h of post-operative antibiotics compared with patients receiving ≥24h of post-operative antibiotics. Shorter durations of post-operative antibiotics in patients with thoracolumbar drains have similar outcomes compared to patients receiving longer courses of antibiotics. Shorter durations of antibiotics could potentially help lead to lower overall cost and length of stay for these patients.

Similar Short-Term Outcomes of Adolescent Idiopathic Scoliosis Surgery with or without Drainage: A Systematic Review of the Literature and Meta-Analysis.

The use of closed suction drains post posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is common practice, although evidence on its impact is limited compared to that for knee and hip arthroplasty. This study aimed to assess the effect of closed suction drainage on short-term post-operative outcomes in AIS surgery. A systematic review following PRISMA guidelines was conducted, including studies comparing outcomes with and without drainage. Data on blood loss, transfusions, hospital stay, and complications were collected and subjected to meta-analysis. Five studies involving 772 patients were analyzed. The meta-analysis found no significant difference in blood transfusion rates (p = 0.107) or hospital stay (p = 0.457) between groups. Complications, including surgical site infections, were more common without drainage, though not statistically significant (p = 0.356). Reintervention rates were higher in the no-drainage group, but not significantly (p = 0.260). Overall, this review found no significant short-term outcome differences, suggesting clinical judgment should guide drainage decisions. Further research, particularly with enhanced recovery protocols, is warranted to clarify drainage's role in AIS surgery.

Prospective Study to Evaluate Efficacy of Single Versus Double Drains in Breast Cancer Patients Undergoing Surgery.

Seroma formation is a common sequel following modified radical mastectomy (MRM), which hinders healing, may prolong hospital stay, and cause a delay in adjuvant treatment. Closed suction drains have been used to prevent formation of seroma; however, the use of a single drain in the axilla along with draining the mastectomy flaps and axilla separately remains a topic of debate. This prospective randomized dual-arm study was conducted in the Department of Endocrine Surgery. All female patients with carcinoma breast diagnosed on core tissue biopsy, undergoing modified radical mastectomy, upfront or post neoadjuvant systemic therapy were included. Patients were randomized into two groups. In the first group, a single drain was placed in the axilla whereas in the second group, a drain each was placed below the mastectomy flaps and the axilla. Patients' particulars and the weight of the mass excised along with the operative detailswere documented. The volume of the drain was recorded daily. The flap drain was removed on postoperative day 5 and the axillary drain was removed when the drain volume was less than 30mL/24h for 2 consecutive days. The period of drain placement, volume of drainage, volume of seroma (if formed), and other complications (if any) were recorded. Patients in the single drain group had a significantly earlier drain removal time as compared to those with double drains (p = 0.01). The number of patients in whom seroma formation had occurred was more in the double drain group, but the difference was not significant. The average volume of aspirated seroma fluid was insignificantly more in the single drain group. The only other complication noticed was flap necrosis-in 5% patients of the double drain group. Total volume of drainage (p < 0.0001) and type of drain (p = 0.0208) were associated with higher rates of seroma formation, whereas BMI (p = 0.0516), weight of excised breast mass (p = 0.407), and age (p = 0.6379) were not associated with the rate of seroma formation. Outcomes in terms of drain volume or seroma formation were statistically indifferent between the two groups. Still, use of only a single axillary drain should be promoted, keeping in mind the earlier drain removal period, better patient compliance, and reduced hospital stay.

Routine closed-suction drainage reduces seromas following totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis.

The value of prophylactic closed-suction drainage in totally extraperitoneal inguinal hernia repair (TEP) is still a matter of controversy. We conducted a meta-analysis of studies examining postoperative seroma rates in patients with or without routine placement of closed-suction drainage tubes. A systematic literature search was conducted for trials comparing the outcome of TEP with or without routine drainage placement. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The odds ratio and standardized mean differences with 95% confidence intervals were calculated. Four studies were identified, involving a total of 1626 cases (Drain: n = 1251, no Drain: n = 375). There was a statistically significant difference noted between the 2 groups regarding postoperative seroma formation favoring the Drain group (odds ratio = 0.12; 95% confidence intervals [0.05, 0.29]; P < .001; 4 studies; I2 = 72%). For the remaining secondary endpoints postoperative urinary retention, recurrence, mesh infection and in-hospital length of stay no statistically significant difference was noted between the 2 study groups. Current evidence suggests that patients who underwent TEP with routine closed-suction drain placement developed significantly fewer seromas without any additional morbidity or prolongation of in-hospital stay.

The efficacy of surgical site suction drain insertion in pterional craniotomy for intracranial cerebral aneurysm.

We evaluated the role of subgaleal closed suction drains in postoperative epidural hematoma (EDH) and wound complications following pterional craniotomy for cerebral aneurysm. We reviewed 5,280 pterional craniotomies performed on 5,139 patients between January 2006 and December 2020. A drain was placed subgalealy and tip of drain was positioned between the bone flap and the deep temporalis. 1,637 cases (31%) had a subgaleal suction drain. We analyzed demographic and clinical variables related to EDH requiring evacuation and wound complications in patients with and without drains. Univariate and multivariate logistic regression analyses were performed to determine the associated risk factors. Fourteen cases (0.27%) of EDH requiring evacuation and 30 cases (0.57%) of wound complications were identified. Univariate analysis found that drain insertion, subarachnoid hemorrhage (SAH), and operation time were associated with EDH, while drain insertion, SAH, male gender, older age, and longer operation time were associated with wound complications. Multivariate analysis found no significant association between drain use and EDH (OR=1.62, p=0.402) or wound complications (OR=1.45, p=0.342). Routine use of subgaleal closed suction drains may not be necessary after pterional craniotomy, as drain insertion was not associated with a reduced risk of EDH requiring evacuation or wound complications.

Endoscopic Mini- or Less-Open Sublay operation with transversus abdominis muscle release using a single-port platform for incisional hernia: A video vignette

The Endoscopic Mini- or Less-open Sublay operation (EMILOS) is a transhernial repair that allows endoscopic dissection and mesh placement in the retrorectus/retromuscular space, and simultaneous transversus abdominis release (TAR) for larger hernias. The operative summary is as follows. 1 A 7-cm longitudinal skin incision was made immediately above the hernial orifice. 2 The hernial sac was circumferentially dissected to the border of the defect, and the abdomen was opened. 3 The posterior rectus sheath (PRS) was incised approximately 5mm lateral to the medial border of the rectus sheath to enter the retrorectus space. 4 Exploratory laparoscopy was performed, and the peritoneum was closed. 5 A single port platform was attached to the wound, and the abdominal wall was insufflated. The retrorectal space was dissected laterally to the outer edge of the rectus abdominis muscle. The linea alba was incised at least 5cm cranially and caudally from the border of the hernia defect to obtain sufficient mesh overlap. 6 The TAR was added to the left side to facilitate medial advancement of the PRS. (7) The PRS was approximated with continuous suture. A self-gripping mesh was trimmed and implanted in the retrorectus space. The mesh was secured with 3-0 absorbable sutures (8) A closed-suction drain was placed on the mesh, and the wound was trimmed and closed. The postoperative course was uneventful. No recurrence was observed at 6-month follow-up. This technique may be advantageous because it allows minimal skin incision with physiological reconstruction of abdominal wall.

Corrugated Rubber Drains Versus Closed Suction Drain in Reducing Superficial Surgical Site Infection in Laparotomy Wounds

Background: Surgical site infections (SSI) remain a substantial problem for patients. Surgery for perforation peritonitis is associated with the highest rate of infective complications, especially surgical site infections because there is contamination of the operative field with microorganisms from endogenous sources. Subcutaneous drains are commonly placed in the operative setting to prevent hematoma or abscess formation in surgical wounds. In contrast to open drains, closed suction drains establish a pressure gradient between the wound and the external environment.Objectives: To evaluate the role of wound drainage in preventing surgical site infections (SSI) in patients undergoing emergency laparotomy and draw comparison between the efficacy of open corrugated rubber drainage and closed suction drainage.Methods: A prospective study was conducted on 50 patients admitted under Department of Surgery, Government Medical College, Jammu, India, between January and July of 2020, who underwent emergency laparotomy for various indications, within 24 hours of admission. All investigations for requisite anaesthesia were conducted on emergency basis. Patients received either corrugated rubber drain (group A), closed suction drain (group B) or no drain (group C) for wound drainage. Patients were followed in the post operative period for development of wound infection.Results: Mean age was 39.2 years with median age of 35 years. Male to female ratio was 1.94:1. 8 out of 19 patients from group A developed wound dehiscence, while only 1 out of 20 patients in group B developed wound dehiscence. 6 out of 11 patients in group C developed wound dehiscence. The difference was statistically significant (P&lt;0.05).Conclusion: Placement of subcutaneous drains in emergency laparotomy wounds is associated with lower incidence of wound infection. Closed suction drains appear to be more effective than open corrugated drains in reducing the risk of SSIs.International Journal of Human and Health Sciences Vol. 08 No. 01 Jan’24 Page: 75-78