Do we really need routine drainage after laparoscopic adrenalectomy and splenectomy?

Abstract

IntroductionNot only did the introduction of laparoscopy not dispel the controversy over routine drainage after uncomplicated surgery, but paradoxically it contributed to enlivening the debate on the issue.AimTo determine the usefulness of operative site drainage after “clean”, uncomplicated laparoscopic surgery such as splenectomy or adrenalectomy.Material and methodsOne hundred and seventy-six participants (female : male 114 : 62) operated on in our centre between Jan 2008 and Nov 2010 were included in the prospective study. Adrenalectomy was performed in 122 patients and splenectomy in 54. In some patients no drains were left after the procedure, while the others had drainage employed. The incidence and character of post-operational complications, the necessity of repeat surgery and the length of the hospital stay were analysed.ResultsIn 112 patients (63.6%) the drain was inserted in the operational field, while in the remaining 64 (36.4%) it was not. Out of the whole series of 112 patients with drainage used, complications were observed in 6 cases (5.36%) while in the group of patients without drainage they appeared in 2 (3.12%) of those operated on (p < 0.05). Infectious complications were observed more often in the series with drainage (3.57% vs. 0%, p < 0.05). The hospital stay in patients with drainage was statistically significantly longer than in patients without.ConclusionsBased on the study, no justification for routine drainage after scheduled, uncomplicated laparoscopic adrenalectomy and splenectomy was found. The decision whether to leave a drain should be made for every patient individually.

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

“…However, in Piotr's series bleeding complications were diagnosed on the basis of clinical picture and ultrasonography, not on the volume of the drained fluid. That is why he thinks that routine drainage after splenectomy is not necessary (6).…”

“…Proponents of the use of drainage sustain that drainage is a safe, efficacious in removal of blood, serum, and pancreatic enzymes, and carries little, if any, risk of subsequent infectious morbidity (6).…”

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The use of surgical drain after abdominal surgery has always been a controversial issue.Benefits and risks related to the operatively placed drains in the abdominal cavity have been discussed since a hundred years ago when some surgeons where in favor of the drainage, while skeptic others considered not physiological their use (1, 2).In the common practice intra-abdominal drains have been used to help the surgeons in the post-operative phase to identify post-operative bleeding, to drain and monitor residual intraperitoneal pathologic liquids (such as bile, fecal material, pancreatic juice), and in order to prevent intra-abdominal septic collections (3).So far, however, there is a lack of evidence proving significant benefits of surgical drains and, moreover, drains themselves have been imputed as responsible for related complications which may increase post-operative morbility (1,(4)(5)(6)(7)(8)(9)(10)(11)(12).Similarly, placement of drains after splenectomy has been largely debated. Theoretically, the use of drain in splenectomised patients, whose susceptibility to infections and sepsis due to some microbial agents is well known, might predispose to an increased risk of subphrenic abscess formation and systemic infections (13,14).

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Surgical treatment options for aldosteronomas.

“…The orientation in the abdominal cavity is easier, but the duration of surgery is not a significant advantage. During endoscopic retroperitoneal surgery, the abdominal organs are not mobilized, so new adhesions in the abdominal cavity are avoided after the surgery [16, 17]. During the laparoscopic surgery, the liver is an obstacle for mobilizing the right adrenal, and hence the right adrenalectomy lasts longer than the left (105 ±26 min vs. 77 ±6 min).…”

Cystic Adrenal Lesions - Analysis of Indications and Results of Treatment

“…Currently it is regarded as the golden standard in the treatment of adrenal tumors (24,25). Recently, minimally invasive procedures have become popular, which is reflected in the number of operations performed from a single abdominal incision (26). There have been no detailed randomized studies and no systematic, unifirm classification of adrenal cystic lesions, which gives rise to controversies concerning methods of treatment of this rare pathology of adrenal glands (19).…”