Routine Use Of Drains Research Articles

Comparisons of the Clinical Outcomes of Mandible Contouring Surgery With or Without the Use of Intraoral Drains.

Mandible contouring surgery is a common cosmetic procedure aimed at reducing the width of the lower face or correcting chin-related issues by contouring the mandible. Typically, an intraoral drain is placed during procedures involving the reduction of the mandible angle portion to mitigate seroma or hematoma formation. Despite this standard practice, anecdotal evidence suggests that the omission of drains does not significantly impact complication rates or surgical outcomes. A retrospective study was conducted to compare surgical outcomes and complication rates between patients who received intraoral drains (n = 338) and those who did not (n = 132) during mandible contouring surgery. The primary outcomes measured included the incidence of seroma, hematoma, and infection by counting the number of post-operative interventions required to address these complications. Statistical analysis was performed using chi-square tests for categorical variables. A p-value of < 0.05 was considered statistically significant. The incidence of post-operative surgical interventions for bleeding control or hematoma evacuation in the drain group was 0.59% compared to 0% in the no-drain group (p = 0.922). Minimally invasive interventions were required in 2.37% of patients with drains and 3.03% without drains (p = 0.933). Infection rates were 1.18% in the drain group versus 0.76% in the no-drain group (p = 1.0). The study demonstrates no statistically significant difference in complication rates between mandible contouring surgeries performed with or without intraoral drains. These findings suggest that the routine use of drains may be unnecessary, potentially simplifying post-operative care and reducing patient discomfort. 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 .

Routine Use of Neck Drains Following Thyroid Operations to Prevent Complications Is No Longer Advisable.

The use of cervical drains to prevent cervical hematoma or seroma after thyroidectomy remains a controversial issue. Identify clinical and surgical risk factors for hematoma or seroma and evaluate the usefulness of routine use of drains following thyroid surgery. The authors conducted a retrospective multicentric study related to consecutive patients submitted to thyroid surgery in seven Portuguese hospitals between January 2018 and December 2020 (n=945). The data collected included the following parameters: age and gender of the patients, anticoagulation or anti-aggregating therapy, histological diagnoses, type of surgery, the presence or absence of postoperative drains, thyroid weight, length of hospital stay, postoperative complications, and reinterventions. In this study, surgical complications evaluated were limited to the presence of hematoma or seroma. A total of 945 patients who underwent thyroid surgery were included in the study. Twenty-seven patients (2.9%, n=27) experienced complications classified as hematomas or seromas. In the series, significant differences were observed between the two groups according to hypocoagulation or anti-aggregation status (OR=3.62; 95% CI 1.14-11.4) (p=0.001) and the nature of histological diagnosis (toxic vs. non-toxic benign disease) (OR=6.59; 95% CI 1.83-23.7). Hypocoagulation or anti-aggregation status were independently associated with a higher risk of complications. The presence of drains was associated with longer hospitalization periods (p<0.001) and not a decreased need for reintervention. Cervical hematoma or seroma are rare complications associated with both hypocoagulation and anti-aggregation therapy and with the presence of benign toxic pathology. The use of drains does not decrease the need for reintervention and is even associated with a longer length of hospital stay; therefore, their routine use should not be advised.

Alternative to mesh repair for ventral hernias: Modified rectus muscle repair

BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections, adhesions, seromas, fistula formation and significant postoperative pain. The modified rectus muscle repair (RMR) is as an option to repair midline ventral hernias without mesh. AIM To evaluate the short term outcomes when the modified RMR was used to repair ventral hernias. METHODS This was a 5-year prospective study that examined the outcome of all consecutive patients with ventral abdominal wall hernias &gt; 5 cm in maximal diameter who underwent repair using the modified RMR technique in a single surgeon unit. Patients were reviewed in an outpatient clinic at 3, 6 and 12 mo and evaluated for hernia recurrence on clinical examination. Each patient’s abdominal wall was also assessed with using ultrasonography at 24 mo to detect recurrences. All data were examined with SPSS ver 18.0. RESULTS Over the 5-year study period, there were 52 patients treated for ventral hernias at this institution. Four patients were excluded and there were 48 in the final study sample, at a mean age of 56 years (range 28-80). The mean maximal diameter of the hernia defect was 7 cm (range 5-12 cm). There were 5 (10.4%) seromas and 1 recurrence (2.1%) at a mean of 36 mo follow-up. CONCLUSION The authors recommend the modified RMR as an acceptable alternative to mesh repair of ventral hernias. The seroma rate can be further reduced with routine use of drains. The modified RMR also has the benefit of eliminating all mesh-specific complications.

Eliminating the routine use of postoperative drain placement in patients undergoing robotic-assisted radical cystectomy with intracorporeal urinary diversion

IntroductionPerioperative management of patients undergoing radical cystectomy and urinary diversion utilizing both open and minimally invasive techniques have routinely included the use of drains in the operative field. We herein demonstrate the safety of robotic-assisted radical cystectomy (RARC) without the routine use of postoperative drains. MethodsPatients who underwent drainless RARC with intracorporeal urinary diversion between 2017 and 2022 at our institution were reviewed. Baseline and clinical characteristics as well as perioperative and postoperative outcomes were analyzed. The primary study outcome was incidence of postoperative urinary leak or intra-abdominal infectious collections within 90 days of RARC. A univariate and multivariable logistic regression analysis was performed to determine associations between study variables and the primary outcome. ResultsOf 381 patients, 298 (78.2%) were male and median age and BMI were 68 (63, 76) and 26.2 [23.0, 29.8], respectively. Overall 30 and 90-day complication rates were 39.6% and 50.4%, respectively. Twenty-one (5.5%) patients experienced a urine leak or intra-abdominal infectious collections. Sub-group analysis of patients who experienced the primary outcome demonstrated median postoperative day of presentation was day 19, and this group required 16 total additional procedures. On multivariable logistic regression analysis, only prior radiation therapy was associated with the development of the primary outcome of urinary leak or intra-abdominal infectious collection (odds ratio: 15.12, 95% confidence interval [1.52–156.8], p = 0.02). ConclusionDrainless RARC with totally intracorporeal urinary diversion achieved competitive perioperative and complications outcomes compared to prior open and robotic series. In the context of a larger enhanced recovery after surgery protocol in RARC patients, the routine use of drains may be safely omitted.

ThTP6.1 Unplanned Admissions following Elective Laparoscopic Cholecystectomy Day Cases

Abstract Background Laparoscopic Cholecystectomy (LC) represents a significant proportion of surgical caseload in the United Kingdom with over 50,000 operations per year (1). LC is recommended for patients with symptomatic gallstone disease (2). For appropriately selected patients, day case LC is recommended. British Association of Day Surgery (BADS) suggests a benchmark rate of 75% LC to be performed as day cases (3). Aim Retrospective audit of patient outcomes following elective day case LC, compared with national standards, to identify areas of improvements. Method Retrospective analysis of 100 elective planned day case LC at a District General Hospital between May 2021 - May 2022. Results 29 out of 100 patients had unplanned admissions. The most common reason for unplanned admission was intraoperative drain insertion (20/29, 69%), with 85% of these drains removed day 1 or 2 post op. Higher ASA grade patients were more likely to have unplanned admissions; 12.5% of ASA 1 patients vs 32.2% of ASA 2 patients vs 41.2% of ASA 3 patients. Patients with unplanned admissions had higher rates of subsequent re-admission (4/29; 13.8%), compared with day cases (3/71; 4.2%). Conclusion Our audit found the majority of ‘failed day cases’ were a result of intraoperative drain insertion. Drain insertion did not instigate further interventions, but did lengthen patients' stay. BADS recommend avoiding routine use of drains in LC and state that they can also be removed on the day of surgery (3). Our audit also highlights that high ASA cases should be performed earlier in the operative list, allowing for more time for observation to aid same-day discharge.

Recent advances in the treatment of biofilms induced surgical site infections.

Recent advances in the treatment of biofilms induced surgical site infections.

Enhanced recovery after surgery in pediatric spine surgery: systematic review

Objective. To conduct a systematic review of the literature on the use of enhanced recovery after surgery (ERAS) protocols in spinalsurgery of children and adolescents to determine the existing evidence of the effectiveness of ERAS implementation in clinical practice.Material and Methods. The authors conducted a systematic review of the literature on ERAS in spinal and spinal cord surgery in children and adolescents selected in the databases of medical literature and search resources of PUBMED/MEDLINE, Google Scholar, Cochrane Library and eLibrary according to the PRISMA guidelines and the PICOS inclusion and exclusion criteria.Results. A total of 12 publications containing information on the treatment of 2,145 children, whose average age was 14.0 years (from 7.2 to 16.1), were analyzed. In the reviewed publications, the average number of key elements of the ERAS program was 9 (from 2 to 20), and a total of 23 elements used in spinal surgery in children and adolescents were identified. The most commonly used elements were preoperative education and counseling, prevention of infectious complications and intestinal obstruction, multimodal analgesia, refusal of routine use of drains, nasogastric probes and urinary catheters, standardized anesthesia protocol, early mobilization and enteral loading. The introduction of the ERAS protocol into clinical practice allowed to reduce the complication rate in comparison with the control group by 8.2 %(from 2 to 19 %), the volume of blood loss by 230 ml (from 75 to 427 ml), the operation time by 83 minutes (from 23 to 144 minutes), theduration of hospitalization by 1.5 days (from 0.5 to 3 days) and the total cost of treatment by 2258.5 dollars (from 860 to 5280 dollars).The ERAS program was implemented in pediatric clinics in the USA (75 %), France (8 %) and Canada (17 %).Conclusion. The conducted systematic review of the literature allows us to conclude that the technology of enhanced recovery after surgery is a promising technology that improves surgical outcomes and is applicable in pediatric practice. There is a significant shortage of published studies evaluating the implementation of ERAS in pediatric surgical practice in general, and in spinal surgery in particular, which requires further prospective randomized studies to evaluate ERAS in spinal surgery in children and adolescents.

Drain or no drain in Rhomboid excision and Limberg rotational flap for pilonidal sinus

Background: Healing in Rhomboid flap for pilonidal sinus is always a problem. Different measures are applied to reduce the rate of wound infection with variable results. Objectives: To determine the effect of routine use of drain on the rate of early wound complications and additional interventions after Rhomboid flap. Methods: A retrospective chart review of all cases that underwent Rhomboid flap in five years in two tertiary care centres was done. Complication rates such as wound infection, wound disruption, and flap necrosis were evaluated. Results: A total of 38 cases of Rhomboid flap are included for analysis. Out of all cases 37 cases were done for Pilonidal sinus and one case for presacral dermoid cyst. In the first eight cases, flap was made without drain and subsequent 30 cases were done with two suction drains for five days. The rate of superficial wound infection in the group without drain was found to be significantly higher compared with flap with drain 5 (in 8) versus 2 (in 30) (62.5% versus 6.66%, p &lt;0.5). Conclusion: Drain placement after Rhomboid flap is a good intervention to reduce wound infection.

TP7.2.10 The Un-abating Debate of using Drains following Colorectal Anastomosis: a systematic review

Abstract Aims To study whether routine use of drains in colorectal surgery/anastomosis help reduce postoperative complications and whether has a selective role in high risk patients. Methods A systematic search of electronic database performed using PubMed, Embase, and Cochrane Central database. Clinical literature from 1988 to 2018 was reviewed including randomized, non-randomized controlled studies, meta-analysis and systematic reviews for routine use of drain versus no usage of drain at index surgery &amp; compared for clinical benefits. Terms used for search were ‘colorectal’, ‘rectal’, ‘colonic’ surgery/anastomosis’ and drain. Main outcome: anastomotic leak whilst secondary outcome were to study collections, re-surgical intervention, wound infection, DVT/PE, chest complications &amp; mortality. Case reports and small cohort studies (&amp;lt;25 patients) were excluded. Results 2243 patients were included from 14 RCTs, 2 meta-analysis and 3 systematic reviews. 1178 patients in the drain group and 1065 patients in the no drain group. Using Chi square test, data analysis demonstrated no statistically significant differences between the two groups (drains Versus no drains) for anastomotic leakage, P &amp;gt;0.35; re-operation, P &amp;gt;0.41, wound infection, P &amp;gt;0.41; DVT/PE, P &amp;gt; 1.1; chest complications, P &amp;gt; 0.51 and mortality, P &amp;gt;0.48. Conclusions Routine use of drains in colorectal surgery/anastomosis does not confer significant benefit in reducing postoperative complications. However, selective use of drains in the high risk patients for anastomotic leak may have a role but warrants more studies.

A prospective study comparing routine subhepatic drain vs no drain in patients undergoing simple elective laparoscopic cholecystectomy

Background: Cholelithiasis is one of the major causes of morbidity with prevalence rate of 10-20%. Cholecystectomy is the mainstay of treatment of gall stone disease. Open cholecystectomy was the traditional method of treatment. It has now largely been replaced by laparoscopic cholecystectomy. To put a subhepatic drain in laparoscopic cholecystectomy patients routinely is a big question. Our aim is to find out whether routine use of drains in all patients undergoing elective laparoscopic cholecystectomy to be recommended.Methods: A prospective study of 100 cases was carried out in department of surgery in Heritage Institute of Medical Sciences, Varanasi between January 2020 to august 2021 with the aim of making comparisons between drained & non drained laparoscopic cholecystectomy patients. The patients were randomly assigned into two groups. Group A consists of patients with subhepatic drain and in group B no drains were kept.Results: Patients with subhepatic drains have similar pain as compared to non-drain group in immediate post-operative period but had more pain, discomfort, longer hospital stay and required slightly long time for complete wound healing especially of drain port wound and full recovery.Conclusion: Routine subhepatic drain after every case of laparoscopic cholecystectomy is not necessary especially in clear, uncomplicated cases.

Is Routine Use of Drain Really Necessary for Posterior Lumbar Interbody Fusion Surgery? A Retrospective Case Series with a Historical Control Group.

A retrospective case-control study. The usefulness of a drain in spinal surgery has always been controversial. The purposes of this study were to determine the incidence of hematoma-related complications after posterior lumbar interbody fusion (PLIF) without a drain and to evaluate its usefulness. We included 347 consecutive patients with degenerative lumbar disease who underwent single- or double-level PLIF. The participants were divided into 2 groups by the use of a drain or not; drain group and no-drain group. In 165 cases of PLIF without drain, there was neither a newly developed neurological deficit due to hematoma nor reoperation for hematoma evacuation. In the no-drain group, there were 5 (3.0%) patients who suffered from surgical site infection (SSI), all superficial, and 17 (10.3%) patients who complained of postoperative transient recurred leg pain, all treated conservatively. Days from surgery to ambulation and length of hospital stay (LOS) of the no-drain group were faster than those of the drain group (P < 0.001). In a multiple regression analysis, a drain insertion was found to have a significant effect on the delayed ambulation and increased LOS. No significant differences existed between the 2 groups in additional surgery for hematoma evacuation, or SSI. No hematoma-related neurological deficits or reoperations caused by epidural hematoma and SSI were observed in the no-drain group. The no-drain group did not show significantly more frequent postoperative complications than the drain use group, hence the routine insertion of a drain following PLIF should be reconsidered carefully.

The Safety and Efficacy of Using Drainage in Arthroscopic Rotator Cuff Repair

This study aimed to evaluate the effects of not using a drain or placing a drain in the glenohumeral (GH) or subacromial (SA) joint spaces on fluid retention and pain in the early postoperative period and late clinical outcomes. Patients who underwent arthroscopic rotator cuff repair between 2018 and 2020 were included in the study. Before the operation, demographic data, range of motion (ROM), visual analog scale (VAS) scores, Constant-Murley scores has documented. Deltoid muscle diameter (DMD) were measured. The total amount of irrigation used during the surgery and the operation duration were recorded, and the active amount of fluid coming from the drain in patients with a drain was recorded. The first postoperative DMD measure was made in the operating room and accepted as day 0. DMD measurements repeated postoperative first and second day. VAS assessments were performed on the postoperative first and second days. At the outpatient clinic, these measurements were repeated on the first and second weeks after discharge. Functional evaluations were made with ROM and Constant-Murley scores at the final follow-up examination. There was no difference in the amount of drainage between the two groups in which a drain was used. When the three groups were compared among themselves regarding preoperative and postoperative VAS scores, Constant-Murley scores, and DMD, no significant difference was found. We do not recommend the routine use of drains after arthroscopic rotator cuff surgery in terms of cost-effectiveness. Level II: Prospective Cohort Study.

Liver Drains after Surgery, a Real-life Snapshot among the HPB Community: the LI.DR.A.S. World-wide Survey

Background: Although several trials have been conducted, the management of liver drains remains controversial among HPB surgeons. We conducted a world-wide survey to define actual clinical drain practices adopted by liver surgeons in the EA-HPBA, A-HPBA and AP-HPBA communities. Methods: An open survey consisting of 30 questions was prepared and then published on Google – Form, which was then delivered by email to members of the three major chapters of the international hepato-pancreato-biliary association (IHPBA). Results: 191 HPB surgeons responded to the web-survey. Twenty (10.5%) respondents were from the Asian-Pacific region, while 15 (7.9%) were from North America, 13 (6.8%) from South America and 143 (74.9%) from Europe and Africa. One hundred-twelve surgeons (58.6%) reported routine use of abdominal drains liver resection. Eighty-eight (46.1%) respondents responded that drain removal was driven by low volume and low bilirubin levels in the drains; 85 (44.5%) surgeons usually consider removal of the drain on 2-3 post-operative days (POD). In case of minor liver resection, 97 (50.8%) surgeons reported using drains only in select cases. When a major resection (>=3 liver segments) is performed, 134 (70.2%) surgeons preferred to always use a drain. Among patients with cirrhosis, 87 (45.5%) surgeons reported the routine use of drains, while 84 (44.0%) respondents considered drains only selectively. The lack of drains was most prevalent among surgeons from North America (12, 80%); in contrast, 14 (70.0%) surgeons in Asian-Pacific region, 87 (60.8%) in Europe and Africa and 8 (61.5%) in South America were more inclined to employ liver drains routinely (p=0.014). Among surgeons whose practice is mostly mini-invasive liver surgery (n=31), 23 (74.2%) reported draining only in selected cases, while the proportion of surgeons who use drains selectively among surgeons who performed mainly open liver resections was lower (n=56, 35.0%)(p<0.001). Conclusion: Despite several RCTs, use of drains at the time of liver resection remains highly variable. In particular, surgeons from North America, as well as surgeons who predominantly perform minimally-invasive hepatectomy, are much less likely to employ abdominal drains at the time of liver resection.

Risk-benefit analysis of wound drain usage in spine surgery: a systematic review and meta-analysis with evidence summary.

Systematic review, meta-analysis, evidence synthesis. To analyse the literature evidence available to support the usage of wound drain in various scenarios of spine surgery and provide an evidence summary on the surgical practice. We conducted independent and duplicate electronic database searches adhering to PRISMA guidelines in PubMed, Embase, and Cochrane Library till April 2020. Quality appraisal was done as per Cochrane ROB tool, and evidence synthesis was done as per GRADE approach. Five domains of spine surgery with associated key questions were identified. Evidence tables were generated for each question and critical appraisal done as per the GRADE approach. Twenty-three studies (9-RCTs, 4-prospective studies, 10-retrospective studies) were included. Analysis of studies in cervical spine either by anterior or posterior approach and single/multilevel thoracolumbar spinal surgeries did not show any evidence of reduction in surgical site infection (SSI) or haematoma formation with the use of drain. Deformity correction surgeries and surgeries done for trauma or tumour involving spine also did not find any added benefit from the use of wound drains despite increasing the total blood loss. Evidence from this review suggests that routine use of drain in various domains of spine surgery does not reduce the risk of SSI and their absence did not increase the risk of haematoma formation. The current best evidence is presented with its limitations. High-quality studies to address their use in spine surgeries in cervical, trauma, and tumour domains are required to further strengthen the evidence synthesised from available literature.

Redo thyroid surgery without drains.

Redo thyroid surgery is associated with higher risk of hematoma than the initial thyroid surgery. We report a single surgeon's experience of performing redo thyroid surgery without drains. This retrospective single-institutional study evaluates the safety and efficiency of redo thyroid surgery without drains by comparing three groups of patients: those who underwent primary bilateral thyroidectomy (Group 1), those who underwent completion thyroidectomy (Group 2); and those who underwent thyroidectomy for recurrent thyroid diseases (Group 3). The demographic characteristics did not differ among the groups. Substernal extension and hyperthyroidism were more frequent in group 1, whereas the weight of the resected thyroid gland was lower in groups 2 and 3. Hematoma occurred in 5%, 4%, and 4% of patients in Groups 1, 2, and 3, respectively. Postoperative transient hypocalcemia occurred in 19%, 16%, and 21% of patients in Groups 1, 2, and 3 respectively. The postoperative incidence of transient recurrent laryngeal nerve (RLN) paralysis in Groups 1, 2, and 3, was 6%, 7%, and 8%, respectively. The incidence of permanent unilateral RLN paralysis in Groups 2 and 3 was 1%. The postoperative length of stay was 1day in 92% of the patients from all groups. Avoiding the routine use of drains in redo thyroid surgery is safe and effective, it does not increase overall surgical morbidity, and it reduces the overall length of stay in hospital.

Futility of abdominal drain in elective laparoscopic splenectomy.

Despite the implementation of minimally invasive surgery and enhanced recovery protocols, the use of drain in elective splenectomy is still controversial. The aim of this study was to assess whether the abdominal drain can impact on short-term outcome after elective laparoscopic splenectomy. This is a retrospective analysis of a consecutively collected database including all patients who underwent elective laparoscopic splenectomy in our institution between January 2001 and June 2019. Postoperative complications were defined according to a priori criteria and graded according to Clavien-Dindo classification. All complications that occurred during hospitalization or within 30days after discharge were considered. Primary endpoint was postoperative morbidity, and secondary endpoint was postoperative hospital length of stay. One hundred and sixty-one patients were analysed. Intraperitoneal drain was placed in 75 (46.6%) patients. Postoperative complications occurred in 36 (22.4%) patients, while 8 (4.9%) patients had major complications. Median postoperative length of stay was 4days. At multivariate analysis, only malignancy was significantly associated with the onset of complications (OR 3.50; 95% CI 1.1-11.0; p = 0.032). Malignancy, ASA > 2, conversion to open surgery, presence of drain and longer operation were significantly associated with prolonged length of stay. Patients with drain showed a greater unadjusted risk of abdominal collections (RR 10.32; 95% CI 1.3-79.6; p = 0.006). Abdominal drain did not reduce morbidity and prolonged the length of stay following elective laparoscopic splenectomy. Therefore, the present study does not support the routine use of drain in such procedure.

An Observational Study to Compare Use of Drains Versus No Drains After Gynaecology Oncology Surgery at a Tertiary Care Centre

The aim of the study is to evaluate omission of routine use of drains after major gynaecology oncology cancer surgery in day-to-day practice. The study consisted of 130 gynaecology cancer patients in two groups, study group (with no drains) and control group (with drains). The primary aim was to detect whether omitting drains leads to delay in detection of post-operative complications and overall complication rate between the two groups with the secondary aim of finding difference in length of hospital stay. There no patient in either group who required re-exploration for bleeding, bowel or urologic injury. There was statistical non-significant difference in complication rate, 22% versus 30% in study vs. control group, respectively. The overall length of hospital stay was a day less in study group (7.5 days in study group vs. 8.4 days in control group). Routine use of drains in not required in all cases of gynaecological cancer surgery. Case-to-case base approach of using drain can be done without any increase in post-operative complications.

Mastectomy Without Drains Reduces Cost with No Detriment to Patient Outcome

Introduction Use of drains after mastectomy remains highly variable. This study aimed to establish whether simple mastectomy managed without a drain would cost less than the same procedure managed with a drain and whether there would be any difference in complications.Methods Prospective data were collected on all patients undergoing simple mastectomy ± sentinel lymph node biopsy over sixteen months. Surgeons decided intra-operatively whether to place a drain. Data included operative details, mastectomy weight, length of stay and postoperative complications. Costing data were identified by combining hospital finance costs for admission and follow-up appointments along with the cost of consumables.Results One hundred and thirty mastectomies were performed on 119 patients. There was a significant difference in mastectomy weight between drain group patients (n=80, median: 730g) and no drain group patients (n=50, median: 424g) (p=<0.001). The mean cost for drain group patients was £639.77 whilst for the no drain group was £365.46, indicating a potential unit saving of £21944.93 over sixteen months. Length of stay was shorter in the no drain group (range: 1-2 days) than the drain group (range: 1-4 days). The presence or absence of drains did not influence complication rates, with no change in seroma interventions (p=0.803).Conclusions Managing simple mastectomy patients without a drain resulted in no increase in complications or subsequent interventions for seroma. Significant cost savings to both the hospital and to the patient can be achieved by omitting drain use. Routine use of drains in patients undergoing simple mastectomy ± SNB may be unnecessary and costly.

Assessment of Routine Drainage in Elective Thyroid Surgery. A Prospective Randomized Study

Background: At the end of thyroidectomy surgery, there was an area of some debate about insertion of closed suction drain before closure. The decision of routine use of drain depends on the surgeon’s training, experience, and personal preference. Many surgeons prefer to place drain to minimize dead space collection and to prevent or reduce the post-operative hematoma that may be life-threatening so, the insertion of drains was generally accepted, although there are many studies that show no difference in the rate of complication with or without drain insertion. Moreover drain insertion may be accompanied by many hazards such as more hospital stay and post-operative pain. So, the concept of routine use of drain should be revised in the light of recent reports that test the real need for its use. Aim of the study: this study aimed to assess if there was actual benefit from the use of drain in thyroid surgery and to evaluate the necessity of its use in thyroid surgery and to detect hazards of its use. Patients and methods: between June 2015 and July 2018, a prospective randomized study included 87 patients from those had elective thyroid surgery in Al-Hussien University Hospital for different indications. Patients had been categorized into 2 groups; group A (93 patients) for thyroidectomy without insertion of drain and group B (93 patients) for thyroidectomy with insertion of suction drain. In the study, results including: post-operative pain, hospital stay and complications (including wound infection, seromas, post-operative bleeding, hematoma, recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism) were documented. Follow up after patient discharge was done until healing of wounds to detect post-operative complications. Results: the overall postoperative complications rate in the study was low (13 patients) in the two groups. In the non-drained group, there were one case of hematoma ( 2.5 %), 2 cases of seroma ( 5.1 %), one case of RNL palsy ( 2.5 %), one case of transient hypoparathyroidism (2.5 %) and no cases of wound infection, whereas in the other group, there were 2 cases of hematoma ( 5.1 %), 3 cases of seroma ( 7.6 %), 2 case of RNL palsy ( 5.1 %), 2 case of transient hypoparathyroidism ( 5.1 %) and no cases of wound infection. There was no statistical significance between both groups as regard incidence of complications. In the non- drained group, 37 patients (94.8 %) were discharged at the next day after surgery while in the drained group 2 patients (5.1%) only were discharged in the next day and the remaining patients were discharged after removal of drain after 48 hours. The mean hospital stay for the non- drained group was 1.2±1 days and the mean hospital stay for the drained group was 2.1±1 days. Conclusion: in the study, use of drain in thyroid surgery did not have significant effect on the rate of incidence or prevention of postoperative complications. In serious postoperative bleeding, the drain which usually has small pores often become blocked be blood clots and become useless. On contrary, insertion of drain prolongs patient hospital stay and increases postoperative pain. So, routine use of drain in elective thyroid surgery should be prohibited.

Evidence-Based Management of Drains Following Pancreatic Resection: A Systematic Review.

Many pancreatic surgeons continue to use intraperitoneal drains, but others have limited or avoided their use, believing this improves outcomes. We conducted a systematic review and meta-analysis of the literature assessing outcomes in pancreatectomy without drains, selective drainage, and early drain removal. We searched PubMed, Embase, and the Cochrane Library databases and conducted a systematic review of randomized and nonrandomized studies comparing routine intra-abdominal drainage versus no drainage, selective drain use, and early versus late drain removal after pancreatectomy, with major complications as the primary outcome. A meta-analysis of the literature assessing routine use of drains was conducted using the random-effects model. A total of 461 articles met search criteria from PubMed (168 articles), Embase (263 articles), and the Cochrane Library (30 articles). After case reports and articles without primary data on complications were excluded, 14 studies were identified for systematic review. Definitive evidence-based recommendations cannot be made regarding the management of drains following pancreatectomy because of limitations in the available literature. Based on available evidence, the most conservative approach, pending further data, is routine placement of a drain and early removal unless the patient's clinical course or drain fluid amylase concentration suggests a developing fistula.