Volume 26, Issue 2 (Avicenna Journal of Clinical Medicine-Summer 2019)
Avicenna J Clin Med 2019, 26(2): 93-98 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Eskandarlou M, Hamzeie V. Evaluation of Drain Placement Outcomes in Patients Requiring Splenectomy. Avicenna J Clin Med 2019; 26 (2) :93-98
URL: http://sjh.umsha.ac.ir/article-1-1915-en.html
URL: http://sjh.umsha.ac.ir/article-1-1915-en.html
1- , eskandarlou@gmail.com
Abstract: (5410 Views)
Background and Objective: Splenectomy is one of the most common abdominal surgeries following internal and hematologic diseases, as well as trauma which is along with some complications. This study aimed to investigate the effects and outcomes of drain placement after splenectomy, open splenorrhaphy, or laparoscopy.
Materials and Methods: This descriptive cross-sectional study included patients with various indications who underwent splenectomy with midline or left subcostal incisions in Besat Hospital, Hamadan, Iran, during 2017-2018. It should be noted that the patients underwent drain insertion, and the final outcomes were evaluated after surgery. Regarding the aim of the study, variables, such as hospital stay duration, postoperative infection, the incidence of collection and dehiscence, the duplication of surgical procedures, and secretion levels on days 1 to 5 post-operation were assessed using checklists and clinical examinations. All data were analyzed using SPSS software (version 21.0). A P-value less than 0.05 was considered statistically significant.
Results: According to the results, the mean age of the patients was 42.12±20.26 years. Moreover, out of 31 patients under study, 21 cases were male. In total, 16 (51.6%) and 15 (48.4%) patients underwent splenectomy using subcostal and midline incisions, respectively. The indications for surgery in patients included idiopathic thrombocytopenic purpura (n=10, 32.3%), hemolytic anemia (n=2, 6.45%), trauma (n=7, 22.6%), spleen mass (n=2, 6.5%), diagnostic procedure (n=3, 9.7%), splenomegaly (n=5, 16.1%), and hematological problems along with biliary stone disease (n=2, 6.45%). Regarding the surgical complications, the wound site collection (n=6, 6.45%) and left sub-diaphragmatic and Morison's pouch collection (n=6, 19.35%) were reported in this study. It should be noted that the duplication of the surgery was performed only in one patient, and all the cases had drainage secretions until the third day.
Conclusion: The insertion of the drain after splenectomy not only prevents complications, such as hematoma, seroma, or pancreatic secretion collection below the left diaphragm but also informs the surgeon, in some cases, about bleeding after surgery. Therefore, it seems that the benefits of drain placement may outweigh the risks of not using it.
Materials and Methods: This descriptive cross-sectional study included patients with various indications who underwent splenectomy with midline or left subcostal incisions in Besat Hospital, Hamadan, Iran, during 2017-2018. It should be noted that the patients underwent drain insertion, and the final outcomes were evaluated after surgery. Regarding the aim of the study, variables, such as hospital stay duration, postoperative infection, the incidence of collection and dehiscence, the duplication of surgical procedures, and secretion levels on days 1 to 5 post-operation were assessed using checklists and clinical examinations. All data were analyzed using SPSS software (version 21.0). A P-value less than 0.05 was considered statistically significant.
Results: According to the results, the mean age of the patients was 42.12±20.26 years. Moreover, out of 31 patients under study, 21 cases were male. In total, 16 (51.6%) and 15 (48.4%) patients underwent splenectomy using subcostal and midline incisions, respectively. The indications for surgery in patients included idiopathic thrombocytopenic purpura (n=10, 32.3%), hemolytic anemia (n=2, 6.45%), trauma (n=7, 22.6%), spleen mass (n=2, 6.5%), diagnostic procedure (n=3, 9.7%), splenomegaly (n=5, 16.1%), and hematological problems along with biliary stone disease (n=2, 6.45%). Regarding the surgical complications, the wound site collection (n=6, 6.45%) and left sub-diaphragmatic and Morison's pouch collection (n=6, 19.35%) were reported in this study. It should be noted that the duplication of the surgery was performed only in one patient, and all the cases had drainage secretions until the third day.
Conclusion: The insertion of the drain after splenectomy not only prevents complications, such as hematoma, seroma, or pancreatic secretion collection below the left diaphragm but also informs the surgeon, in some cases, about bleeding after surgery. Therefore, it seems that the benefits of drain placement may outweigh the risks of not using it.
Type of Study: Original |
Subject:
General Surgery
References
1. O'Neill HC, Griffiths KL, Periasamy P, Hinton RA, Hey YY, Petvises S, et al. Spleen as a site for hematopoiesis of a distinct antigen presenting cell type. Stem Cells Int. 2011;2011:954275. PMID: 22190965 DOI: 10.4061/2011/954275
2. Jiménez-García AD, Cardiel-Marmolejo LE, Cerón-García G, Durán-Ortiz S. Splenectomy in abdominal trauma in the General Hospital of Balbuena from January 2010 to December 2014. Rev Med Hosp General Mex. 2018;81(1):35-40. DOI: 10.1016/j.hgmx.2016.11.002
3. Kaza RK, Azar S, Al-Hawary MM, Francis IR. Primary and secondary neoplasms of the spleen. Cancer Imaging. 2010;10(1):173-82. PMID: 20713317 DOI: 10.1102/1470-7330.2010.0026
4. Ardestani A, Tavakkoli A. Laparoscopic versus open splenectomy: the impact of spleen size on outcomes. J Laparoendosc Adv Surg Tech A. 2013;23(9):760-4. PMID: 23781954 DOI: 10.1089/lap.2013.0012
5. Heniford BT, Park A, Walsh RM, Kercher KW, Matthews BD, Frenette G, et al. Laparoscopic splenectomy in patients with normal-sized spleens versus splenomegaly: does size matter? Am Surg. 2001;67(9):854-7. PMID: 11565763
6. Owera A, Hamade AM, Bani Hani OI, Ammori BJ. Laparoscopic versus open splenectomy for massive splenomegaly: a comparative study. J Laparoendosc Adv Surg Tech A. 2006;16(3):241-6. PMID: 16796432 DOI: 10.1089/lap.2006.16.241
7. Ajao OG. Abdominal incisions in general surgery: a review. Ann Ib Postgrad Med. 2007;5(2):59-63. PMID: 25161434
8. Palanivelu C, Jani K, Malladi V, Shetty R, Senthilkumar R, Maheshkumar G. Early ligation of the splenic artery in the leaning spleen approach to laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A. 2006;16(4):339-44. PMID: 16968178 DOI: 10.1089/lap.2006.16.339
9. Crary SE1, Buchanan GR. Vascular complications after splenectomy for hematologic disorders. Blood. 2009;114(14):2861-8. PMID: 19636061 DOI: 10.1182/blood-2009-04-210112
10. Qu Y, Ren S, Li C, Qian S, Liu P. Management of postoperative complications following splenectomy. Int Surg. 2013;98(1):55-60. PMID: 23438277 DOI: 10.9738/CC63.1
11. Lotfy WE, Awad WM, Hamed AM, Gouhar GK, Salem HA. Splenic bed lavage: a new technique to avoid postsplenectomy subphrenic abscess in patients with portal hypertension. Egyp J Surg. 2014;33(2):81-5. DOI: 10.4103/1110-1121.131653
12. Bhandarkar DS, Katara AN, Mittal G, Shah R, Udwadia TE. Prevention and management of complications of laparoscopic splenectomy. Indian J Surg. 2011;73(5): 324-30. PMID: 23024535 DOI: 10.1007/s12262-011-0331-5
13. Vecchio R, Intagliata E, Marchese S, Battaglia S, Cacciola RR, Cacciola E. Surgical drain after open or laparoscopic splenectomy: is it needed or contraindicated? G Chir. 2015;36(3):101-5. PMID: 26188753
14. McNicholas MM, Mueller PR, Lee MJ, Echeverri J, Gazelle GS, Boland GW, et al. Percutaneous drainage of subphrenic fluid collections that occur after splenectomy: efficacy and safety of transpleural versus extrapleural approach. AJR Am J Roentgenol. 1995;165(2):355-9. PMID: 7618556 DOI: 10.2214/ajr.165.2.7618556
15. Lalancette C, Charron D, Laferrière C, Dolcé P, Déziel E, Prévost M, et al. Hospital drains as reservoirs of pseudomonas aeruginosa: multiple-locus variable-number of tandem repeats analysis genotypes recovered from faucets, sink surfaces and patients. Pathogens. 2017;6(3):E36. PMID: 28792484 DOI: 10.3390/pathogens6030036
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Articles Copyright © The Author(s).
Owned by Hamadan University of Medical Sciences
Published by UMSHA Press
Journal Tel: +988138380924
Publisher Tel:+988138380548
Website: http://sjh.umsha.ac.ir
Email: s_ journal[at]umsha.ac.ir
