Routine abdominal drains after laparoscopic Roux-en-Y gastric bypass: a retrospective review of 593 patients.
BACKGROUND
The authors reviewed the benefits of routine placement of closed drains in the peritoneal cavity following laparoscopic Roux-en-Y gastric bypass (LRYGBP). The purpose of the study was to determine whether routine closed abdominal drainage provides diagnostic and therapeutic advantages in the presence of complications such as bleeding and leaks.


METHODS
The medical records of 593 consecutive patients who had undergone LRYGBP from July 2001 through May 2003 were retrospectively reviewed. In all cases, antecolic antegastric LRYGBP was performed. Two 19-Fr Blake closed suction drains were left in place, one at the gastrojejunostomy and the other at the jejunojejunostomy. The incidence of bleeding and leaks was reviewed, and the utility of the drains relative to diagnosis and management was evaluated.


RESULTS
Bleeding presented in 24 patients (4.4%); in 8, the diagnosis was based on increased sanguinous output from the drain and decreased hematocrit. None of the patients with intraabdominal bleeding required reoperation. Of the 10 patients (1.68%) who presented with leaks, the diagnosis was made within 48 hours postoperatively in 5 patients (50%), based on the characteristics of the drain output. Nonoperative management with drainage and total parenteral nutrition was accomplished in 5 (50%) of the 10 patients with leaks. There was no mortality in the series.


CONCLUSIONS
The routine use of abdominal drains after LRYGBP appears to be beneficial. Drains allowed early diagnosis of complications and in most cases, the successful treatment of leaks. When bleeding is suspected or documented, appropriate volume replacement therapy is mandatory to maintain adequate hemodynamic parameters. Drain output may orient the surgeon to take preventive measures such as discontinuing anticoagulation and early fluid resuscitation. In this series, in most cases the bleeding spontaneously stopped and no further surgical management was required.
Chousleb
Elias
E
Division of Minimally Invasive Surgery, and The Bariatric Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
Szomstein
Samuel
S
Podkameni
David
D
Soto
Flavia
F
Lomenzo
Emanuele
E
Higa
Guillermo
G
Kennedy
Colleen
C
Villares
Alexander
A
Arias
Fernando
F
Antozzi
Priscila
P
Zundel
Natan
N
Rosenthal
Raul
R
D016063:Blood Loss, Surgical; D004322:Drainage; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006400:Hematocrit; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D001261:Pulmonary Atelectasis / Q000209:etiology; D012189:Retrospective Studies