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Objective:To determine the risk factors of drainage time longer than 1 day in patients with selective abdominal drainage after laparoscopic cholecystectomy.Methods:The clinical data related to patients with selective abdominal drainage undergoing laparoscopic cholecystectomy from November 2009 to November 2019 at Chinese PLA General Hospital were retrospectively analyzed. Of 233 patients enrolled into this study, there were 147 males and 86 females, with a median aged 59.0 (47.5, 65.5) years old. The patients were divided into drainage time 1 day group of 65 patients and longer than 1 day group of 168 patients according to postoperative drainage time. The baseline data and perioperative data were collected, the risk factors correlated with drainage time longer than 1 day were analyzed.Results:The drainage time was 1 in the 1 day group and 2~8 in another group. Among the 233 patients, there was one with biliary leakage and 14 patients had abdominal bleeding, all of them healed after 2~3 days. All of the 233 patients were recovered when discharged. Independent risk factors related to drainage time longer than 1 day include BMI≥28 kg/m 2 ( OR=3.443, 95% CI: 1.411-8.405, P=0.007), operation time ≥65 min ( OR=2.570, 95% CI: 1.310-5.045, P=0.006), thickness of gallbladder wall ≥0.5 cm ( OR=12.720, 95% CI: 1.350-5.478, P=0.005), postoperative stomachache ( OR=13.537, 95% CI: 1.685-108.748, P=0.014) and postoperative fever ( OR=8.156, 95% CI: 1.035-64.249, P=0.046). Conclusion:For patients undergoing selective abdominal drainage after laparoscopic cholecystectomy with BMI ≥28 kg/m 2, operation time ≥65 min, gallbladder wall thickness ≥0.5 cm, postoperative abdominal pain and fever, clinicians should appropriately prolong the drainage time to ensure medical safety.
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OBJECTIVE: To clarify the value of unconventional prophylactic drain placement in laparoscopy assisted D2 gastrectomy for gastric cancer.METHODS: The clinical data of 193 patients with gastric cancer who underwent laparoscopy-assisted D2 Gastrectomy in Department of General Surgery,Chinese PLA General Hospital between February 2017 and February 2018 were analyzed retrospectively.The patients were divided into two groups according to whether the abdominal drain was placed.The drain group comprised 150 patients with routine prophylactic intraabdominal drain placement and the no drain group comprised 43 patients without intra-abdominal drain placement after laparoscopy-assisted D2 gastrectomy.The general information,post-operative recovery and the incidence of postoperative complications were compared in the two groups.RESULTS: There was no significant difference in the general information and postoperative complications in the two groups.The no drain group had shorter hospital stay[(7.17±0.14)d vs.(10.88±0.88) d,(P<0.05)],and shorter exhaust time[(3.39±0.21)d vs.(4.30±0.16)d,P<0.01],less pain [VAS(3.23±0.61) vs.(5.39±0.42),(P<0.05)] and less times of wound dressing change after operation [(3.53±0.52)vs.(7.81±1.05),(P<0.05)] compared with the drain group.CONCLUSION: The unconventional prophylactic drain placement in laparoscopy assisted D2 gastrectomy is safe and feasible.Unnecessary drain placement should be avoided.
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Objective To investigate the safety and feasibility of not placing prophylactic drainage after colorectal anastomosis.Methods A total of 100 patients with colorectal cancer who were admitted to the Sichuan Provincial People's Hospital from July 2007 to March 2009 were randomly divided into drainage group (50 patients) and non-drainage group (50 patients) according to the random number table.A drainage tube was placed after colorectal anastomosis in the drainage group,while no drainage tube was placed in patients in the non-drainage group.The duration of postoperative hospital stay,mortality and morbidity of the 2 groups were compared.All data were analyzed by using the chi-square test or t test.Results Two patients(1 from each group) were excluded in the study,and no death or pulmonary infection were found in the remaining 98 patients.The numbers of patients whose course was complicated by anastomotic leakage and wound infection were 2 and 7 in the drainage group,and 1 and 5 in the non-drainage group.The duration of postoperative hospital stays were ( 11.5 ± 2.4)days in the drainage group and(10.6 ± 2.2)days in the non-drainage group.There were significant differences in the morbidity and duration of postoperative hospital stay between the 2 groups(x2 =0.00,0.38,t =1.428,P ＞ 0.05).Conclusion It is safe and feasible not to place a prophylactic peri-anastomotic drainage tube after colorectal anastomosis.
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Objective To investigate the application of abdominal drainage after liver resection.Methods From Jan 2008 to June 2009,210 consecutively admitted patients undergoing liver resection by the same surgical team were chronologically allocated into drainage group(120)and non-drainage group (90).Patient's preoperative characteristics,operation-related factors,postoperative complications and hospital stay were compared between the two groups.Results Postoperative complications were comparable between the two groups,which was not significantly different among preoperative characteristics and operation-related factors(P>0.05).Mortality was 0.8% in drainage group and 1.1% in non-drainage group,again,the difference was not significant(X~2=0.042,P>0.05).Snrgical complications were significantly higher in drainage group than in non-drainage group,especially for abdominal infection and ascites occurrence(P<0.05).The hospital stay was significantly longer in the drainage group(13.1 ±5.2)days than the non-drainage group(11.4±5.6)days.Conclusions Postoperative abdominal drainage is not necessary for patients undergoing liver resection,furthermore,abdominal drainage increases postoperative complications.
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Commercially available intra-abdominal drains such as Penrose drain or closed suction drain have some demerits in either functional reliability of prolonged duration or easiness of bedside management. To cope with these demerits, we devised a Suction-type Cigarette Drain (SCD) and evaluated its usefulness. We made multiple side-holes at a silastic Penrose drain and a silastic tube. These two tubes were integrated as like a conventional cigarette drain. The outside portion of SCD was tightly tied to prevent air leak and the inner drainage tube was connected to a suction bag. SCD was applied to 26 cases of various hepatopancreatobiliary operations including pancreatoduodenectomy (n=10), distal pancreatectomy (n=4), hepatic posterior segmentectomy (n=3), partial cholecystectomy (n=7), and emergent laparotomy after liver transplantation (n=2). There was no significant fluid collection around the SCD in follow-up computed tomogram of all patients. All SCD remained functioning well at the time of removal (mean 13 days). There was no skin irritation, with the exception of 1 patient. Our experience supports that SCD is highly reliable and acceptably convenient for clinical use. We think that this type of intra-abdominal drainage deserves applying to various hepatopancreatobiliary operations.