Page 109 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Subcutaneous drains in laparotomy incisions
Prophylactic routine placement of subcutaneous drains after laparotomy is occasionally used to decrease wound complications: infection, hematoma, seroma or wound dehiscence(88). However, there are several disadvantages to the routine use of subcutaneous drains. Namely, they cause patient discomfort and pain at removal, they hinder early mobilisation and demand additional nursing care. Therefore their use should be driven by a proven bene t.
One systematic review(89) and several RCTs (90-98) on the use of subcutaneous drains in abdominal surgery were found. They cover a wide range of operative indications: liver surgery, colorectal surgery, cholecystectomy, gynaecological surgery, caesarean section, and gastric bypass surgery. With few exceptions, most studies did not show a bene t for the use of subcutaneous drains. However, none of these studies had incisional hernias or burst abdomen as primary or secondary endpoint.
Postoperative binders
One systematic review on the use of abdominal binders was found(86). The review included four RCT’s (99-102) and a national survey by questionnaire on the use of abdominal binders in French surgical practice(86). One additional recent RCT was identi ed(103). The French survey reported that postoperative support of the wound with an abdominal binder is common practice after major laparotomies in many surgical departments (94% use them in some patients). It is expected to reduce postoperative pain and to improve early mobilisation of the patients. Moreover 83% of users expect a bene t in the prevention of abdominal wall dehiscence(86). No signi cant improvement for the short term bene ts was found by the small RCTs from the review(98, 99, 101, 102). The additional study by Clay et al.(100) found a signi cant lower VAS (Visual Analogue Scale) score for pain at the fth postoperative day and no adverse e ect on postoperative lung function. No studies were found that had burst abdomen or incisional hernias as a primary or secondary endpoints.
5
EHS guidelines
Statement
The routine placement of a subcutaneous drain during closure of abdominal wall incisions is NOT recommended.
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strong
107