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Futility of abdominal drain in elective laparoscopic splenectomy

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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.

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Author notes

  1. L. Degrate and C. Zanframundo contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy

    L. Degrate, C. Zanframundo, G. Real, M. Garancini, F. Uggeri, F. Romano & M. Braga

  2. Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    D. P. Bernasconi

  3. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    F. Uggeri, F. Romano & M. Braga

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  1. L. Degrate
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  2. C. Zanframundo
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Contributions

Study conception and design: Degrate L, Zanframundo C, Real G.

Acquisition of data: Degrate L, Zanframundo C.

Analysis and interpretation of data: Degrate L, Zanframundo C, Bernasconi DP.

Drafting of manuscript: Degrate L, Zanframundo C, Real G, Garancini M, Uggeri F.

Critical revision of manuscript: Bernasconi DP, Romano F, Braga M.

Corresponding author

Correspondence to L. Degrate.

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The study was performed in accordance with the ethical standards laid down in the 1946 Helsinki Declaration; ethical committee approval is not required in our institution for retrospective analyses with anonymous data.

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Informed consent was obtained from all individual participants included in our study database.

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Degrate, L., Zanframundo, C., Bernasconi, D.P. et al. Futility of abdominal drain in elective laparoscopic splenectomy. Langenbecks Arch Surg 405, 665–672 (2020). https://doi.org/10.1007/s00423-020-01915-x

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  • DOI: https://doi.org/10.1007/s00423-020-01915-x

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