Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Milton S Hershey Medical Center, PO Box 850 MC H149, Hershey, PA 17033, USA.
Obes Surg. 2012 Jan;22(1):177-81. doi: 10.1007/s11695-011-0560-5.
Routine drain use after laparoscopic Roux-en-y gastric bypass (LRYGB) is still practiced by many bariatric surgeons. After a patient in our program experienced intestinal obstruction secondary to a drain, we reevaluated our practice and hypothesized drains would be of no benefit and potentially harmful after LRYGB. Retrospective record review of all patients undergoing LRYGB from August 2005 to August 2009 was performed. As we changed our practice in December 2006, we have two comparable groups: one with a drain placed at surgery and one without. All operations were otherwise performed in an identical fashion by three fellowship-trained university surgeons. We compared outcomes between the two groups, particularly regarding gastrojejunal (GJ) leaks. Jejunojejunal (JJ) leaks, unlikely to be captured by these drains, were not studied. A total of 755 LRYGBs were performed during the study period, the first 272 patients with routine drains and the subsequent 483 without. Demographics were statistically similar between the two groups. There were four GJ leaks in the drain group (1.47%) and three in the nondrain group (0.62%). Among the drain patients, two required operation and two were treated nonoperatively. Among the nondrain patients, two required operation and one was treated nonoperatively. The leak and reoperation rates between the groups were not statistically different (p = 0.154 and p = 0.514). Routine drains likely have no benefit after LRYGB. Clinical parameters such as tachycardia, fever, oliguria, and increasing abdominal pain should guide further investigation for and treatment of a leak.
常规引流在腹腔镜 Roux-en-y 胃旁路术（LRYGB）后仍被许多减重外科医生使用。在我们的项目中的一位患者因引流管而发生肠梗阻后，我们重新评估了我们的做法，并假设引流管在 LRYGB 后没有益处，而且可能有害。对 2005 年 8 月至 2009 年 8 月期间接受 LRYGB 的所有患者进行了回顾性病历记录回顾。由于我们在 2006 年 12 月改变了做法，因此我们有两个可比的组：一组在手术时放置引流管，另一组没有。所有手术均由三位接受过 fellowship 培训的大学外科医生以相同的方式进行。我们比较了两组之间的结果，特别是胃空肠（GJ）漏的情况。Jejunojejunal（JJ）漏，不太可能被这些引流管捕获，因此未进行研究。在研究期间共进行了 755 例 LRYGB，前 272 例患者常规引流，随后 483 例患者未引流。两组患者的人口统计学特征相似。引流组有 4 例 GJ 漏（1.47%），无引流组有 3 例（0.62%）。在引流患者中，有 2 例需要手术，2 例接受非手术治疗。在无引流患者中，有 2 例需要手术，1 例接受非手术治疗。两组之间的漏诊和再次手术率无统计学差异（p=0.154 和 p=0.514）。LRYGB 后常规引流可能没有益处。心动过速、发热、少尿和腹痛加剧等临床参数应指导进一步对漏诊的调查和治疗。
