Futility of abdominal drain in elective laparoscopic splenectomy
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ORIGINAL ARTICLE
Futility of abdominal drain in elective laparoscopic splenectomy L. Degrate 1 & C. Zanframundo 1 & D. P. Bernasconi 2 & G. Real 1 & M. Garancini 1 & F. Uggeri 1,3 & F. Romano 1,3 & M. Braga 1,3 Received: 21 April 2020 / Accepted: 22 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose 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. Methods 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 30 days after discharge were considered. Primary endpoint was postoperative morbidity, and secondary endpoint was postoperative hospital length of stay. Results 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 4 days. 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). Conclusion 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. Keywords Splenectomy . Drain . Morbidity . Laparoscopy . Length of hospital stay
Introduction Even with the implementation of minimally invasive surgery and enhanced recovery protocols, the use of drain in elective splenectomy is still controversial [1–4]. A possible rationale to place an intraperitoneal drain is preventing fluid collection and early detecting both postoperative bleeding and enteric or pancreatic L. Degrate and C. Zanframundo contributed equally to this work. * L. Degrate [email protected] 1
Department of Surgery, San Gerardo Hospital, Via Pergolesi 33 20900 Monza Italy
2
Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza Italy
3
School of Medicine and Surgery, University of Milano-Bicocca, Monza Italy
leak [5]. On the other hand, the placement of a surgical drain may be considered a potential determinant of intraperitoneal infectious collection [6, 7], vessels and/or viscera erosio
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