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Drain Versus No Drain in Open Mesh Repair for Incisional Hernia, Results of a Prospective Randomized Controlled Trial

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Title: Drain Versus No Drain in Open Mesh Repair for Incisional Hernia, Results of a Prospective Randomized Controlled Trial
Authors: Willemin, M., Schaffer, C., Kefleyesus, A., Dayer, A., Demartines, N., Schäfer, M., Allemann, P.
Source: World J Surg
World journal of surgery, vol. 47, no. 2, pp. 461-468
Publisher Information: Wiley, 2022.
Publication Year: 2022
Subject Terms: 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Original Scientific Report, Humans, Incisional Hernia, Drainage, Prospective Studies, Surgical Mesh, Incisional Hernia/etiology, Postoperative Complications/etiology, Hernia, Ventral/surgery, Hernia, Ventral/etiology, Drainage/methods, Herniorrhaphy/methods, Hernia, Ventral, Herniorrhaphy, 3. Good health
Description: BackgroundOpen mesh repair of incisional hernia is associated with different local complications, particularly bleeding and seroma formation. Traditionally, drains have been placed perioperatively to prevent these complications, despite the lack of scientific evidence or expert consensus. We formulated the hypothesis that the absence of drainage would reduce number of patients presenting collections or complications. The present study aimed to compare postoperative complication rates after open mesh repair for incisional hernia with or without prophylactic wound drainage.MethodsProspective randomized study using standardized surgical technique and drain placement. The primary endpoint was the evaluation of residual fluid collection with ultrasound on postoperative day 30. Other complications, subdivided into medical and surgical, were analyzed as secondary endpoints.ResultsThere were 144 patients randomized (70 with drain, 74 without drain). No difference was identified between both groups for fluid collection at 30 days (60.3% vs. 62%, p = 0.844). However, less surgical complications were identified in the drain group (21.7% vs. 42.7%, p = 0.007), with a lower wound dehiscence rate (1.5% vs. 9.3%, p = 0.041).ConclusionsProphylactic drainage in open incisional hernia repair does not objectively reduce the rate of postoperative fluid collections. Therefore, our results do not support the use of routine drainage in incisional hernia repair.Trial registrationTrial registration on clinicaltrials.gov (NCT00478348).
Document Type: Article
Other literature type
File Description: application/pdf
Language: English
ISSN: 1432-2323
0364-2313
DOI: 10.1007/s00268-022-06725-4
Access URL: https://pubmed.ncbi.nlm.nih.gov/36520177
http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_AC7BB4A3CC4C1
https://serval.unil.ch/notice/serval:BIB_AC7BB4A3CC4C
https://serval.unil.ch/resource/serval:BIB_AC7BB4A3CC4C.P001/REF.pdf
Rights: CC BY
URL: http://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (http://creativecommons.org/licenses/by/4.0/) .
Accession Number: edsair.doi.dedup.....64119c74d0ae723f25ebdbcb0c4f208b
Database: OpenAIRE
Description
Abstract:BackgroundOpen mesh repair of incisional hernia is associated with different local complications, particularly bleeding and seroma formation. Traditionally, drains have been placed perioperatively to prevent these complications, despite the lack of scientific evidence or expert consensus. We formulated the hypothesis that the absence of drainage would reduce number of patients presenting collections or complications. The present study aimed to compare postoperative complication rates after open mesh repair for incisional hernia with or without prophylactic wound drainage.MethodsProspective randomized study using standardized surgical technique and drain placement. The primary endpoint was the evaluation of residual fluid collection with ultrasound on postoperative day 30. Other complications, subdivided into medical and surgical, were analyzed as secondary endpoints.ResultsThere were 144 patients randomized (70 with drain, 74 without drain). No difference was identified between both groups for fluid collection at 30 days (60.3% vs. 62%, p = 0.844). However, less surgical complications were identified in the drain group (21.7% vs. 42.7%, p = 0.007), with a lower wound dehiscence rate (1.5% vs. 9.3%, p = 0.041).ConclusionsProphylactic drainage in open incisional hernia repair does not objectively reduce the rate of postoperative fluid collections. Therefore, our results do not support the use of routine drainage in incisional hernia repair.Trial registrationTrial registration on clinicaltrials.gov (NCT00478348).
ISSN:14322323
03642313
DOI:10.1007/s00268-022-06725-4