Routine abdominal drains after Roux-en-Y gastric bypass: a prospective evaluation of the inflammatory response.
BACKGROUND
Despite the extensive published data regarding the use of drains in surgery, it is still controversial. Most bariatric surgeons use drains as routinely. However, drains have sometimes have been shown to be unhelpful and even to increase the anastomotic leak rates. The purpose of the present study was to evaluate the peritoneal inflammatory response in the presence of a drain left in place until the seventh postoperative day after bariatric surgery.


METHODS
All patients who underwent open Roux-en-Y gastric bypass from February 2007 to August 2008 were prospectively evaluated. A 24F Blake drain was left in place for 7 days. The peritoneal effluent from the drain was collected for the determination of cytokine levels and for microbiologic analysis.


RESULTS
A total of 107 obese patients were studied. A marked increase in the levels of tumor necrosis factor-α and interleukin-1β was observed by the seventh postoperative day, even in patients without any abdominal complications. Bacterial contamination of the peritoneal effluent was also demonstrated.


CONCLUSIONS
The results of our study have shown that at 7 days after surgery, a marked peritoneal inflammatory response and bacterial contamination are present. These findings could have resulted from the use of the drain for 7 postoperative days.
Salgado
Wilson
W
Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. wsalgado@fmrp.usp.br
Cunha
Fernando de Queiroz
Fde Q
dos Santos
José Sebastião
JS
Nonino-Borges
Carla Barbosa
CB
Sankarankutty
Ajith Kumar
AK
de Castro e Silva
Orlando
O
Ceneviva
Reginaldo
R
D034841:Abdominal Cavity / Q000382:microbiology / Q000473:pathology; D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000378:metabolism / Q000382:microbiology; D004322:Drainage / Q000706:statistics & numerical data*; D005260:Female; D015390:Gastric Bypass / Q000706:statistics & numerical data*; D006801:Humans; D053583:Interleukin-1beta / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology* / Q000378:metabolism / Q000382:microbiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000378:metabolism / Q000382:microbiology; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D053583:Interleukin-1beta; D014409:Tumor Necrosis Factor-alpha