Top

Hernia

Published in:

24-03-2023 | Incisional Hernia | Original Article

Do surgical drains reduce surgical site occurrence and infection after incisional hernia repair with sublay mesh? A non-randomised pilot study

Authors: V. Louis, S. Diab, A. Villemin, C. Brigand, S. Manfredelli, J.-B. Delhorme, S. Rohr, B. Romain

Published in: Hernia | Issue 4/2023

Abstract

Introduction

Surgical site occurrence (SSO) and surgical site infection (SSI) are common concerns with incisional hernia repair. Intraoperative drain placement is a common practice aiming to reduce SSO and SSI rates. However, literature on the matter is very poor. The aim of this study is to investigate the role of subcutaneous and periprosthetic drain placement on postoperative outcomes and SSO and SSI rates with incisional hernia repair.

Methods

A non-randomised pilot study was performed between January 2018 and December 2020 and included patients with elective midline or lateral incisional hernia repair with sublay mesh placement. Patients were prospectively included, followed for 1 month and divided into three groups: group 1 without drainage, group 2 with subcutaneous drainage, and group 3 with subcutaneous and periprosthetic drains. Drains were placed at surgeon’s discretion. All patients were included in the enhanced recovery program.

Results

One hundred and four patients were included. Twenty-four patients (23.1%) did not have drains (group 1), 60 patients (57.7%) had a subcutaneous drain (group 2) and 20 patients (19.2%) had both a subcutaneous and a periprosthetic drains (group 3). SSO rates were significantly different between the 3 groups: 20.8% in group 1, 20.7% in group 2 and 50% in group 3 (p = 0.03). There was no significant difference in deep and superficial SSI rates between the 3 groups. Subgroup analysis revealed that adding a drain in direct contact with the mesh significantly increased SSO rate but did not influence SSI rate. Length of stay was also significantly increased by the presence of a drain, 3.1 ± 1.9 days for group 1; 5.9 ± 4.8 for group 2 and 5.9 ± 2.5 days for group 3 (p < 0.005).

Conclusion

Drain placement in direct contact with the mesh might increase SSO rate. More studies are necessary to evaluate the actual benefits of drainage after incisional hernia repair.

Available only for authorised users

Burger JWA, Lange JF, Halm JA, Kleinrensink GJ, Jeekel H (2005) Incisional hernia: early complication of abdominal surgery. World J Surg 29:1608–1613. https://doi.org/10.1007/s00268-005-7929-3CrossRefPubMed

Dietz UA, Menzel S, Lock J, Wiegering A (2018) The treatment of incisional hernia. Dtsch Arzteblatt Int 115:31–37. https://doi.org/10.3238/arztebl.2018.0031CrossRef

Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A et al (2015) Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PloS One 10:e0138745. https://doi.org/10.1371/journal.pone.0138745CrossRefPubMedPubMedCentral

Parker SG, Wood CPJ, Sanders DL, Windsor ACJ (2017) Nomenclature in abdominal wall hernias: is it time for consensus? World J Surg 41:2488–2491. https://doi.org/10.1007/s00268-017-4037-0CrossRefPubMedPubMedCentral

Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583. https://doi.org/10.1097/01.sla.0000141193.08524.e7CrossRefPubMedPubMedCentral

Paasch C, Anders S, Strik MW (2018) Postoperative-treatment following open incisional hernia repair: a survey and a review of literature. Int J Surg Lond Engl 53:320–325. https://doi.org/10.1016/j.ijsu.2018.04.014CrossRef

Lindmark M, Strigård K, Löwenmark T, Dahlstrand U, Gunnarsson U (2018) Risk factors for surgical complications in ventral hernia repair. World J Surg 42:3528–3536. https://doi.org/10.1007/s00268-018-4642-6CrossRefPubMedPubMedCentral

Kroese LF, Kleinrensink GJ, Lange JF, Gillion JF, Hernia-Club, (2018) External validation of the European hernia society classification for postoperative complications after incisional hernia repair: a cohort study of 2,191 patients. J Am Coll Surg 226:223-229.e1. https://doi.org/10.1016/j.jamcollsurg.2017.11.018CrossRefPubMed

DeBord J, Novitsky Y, Fitzgibbons R, Miserez M, Montgomery A (2018) SSI, SSO, SSE, SSOPI: the elusive language of complications in hernia surgery. Hernia 22:737–738. https://doi.org/10.1007/s10029-018-1813-1CrossRefPubMed

10.

Romain B, Renard Y, Binquet C, Poghosyan T, Moszkowicz D, Gillion JF et al (2020) Recurrence after elective incisional hernia repair is more frequent than you think: an international prospective cohort from the French Society of Surgery. Surgery 168:125–134. https://doi.org/10.1016/j.surg.2020.02.016CrossRefPubMed

11.

Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316:1575–1582. https://doi.org/10.1001/jama.2016.15217CrossRefPubMed

12.

Levy S, Moszkowicz D, Poghosyan T, Beauchet A, Chandeze MM, Vychnevskaia K et al (2018) Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair. Hernia J Hernias Abdom Wall Surg 22:773–779. https://doi.org/10.1007/s10029-018-1785-1CrossRef

13.

Charleux-Muller D, Hurel R, Fabacher T, Brigand C, Rohr S, Manfredelli S et al (2021) Slowly absorbable mesh in contaminated incisional hernia repair: results of a French multicenter study. Hernia 25:1051–1059. https://doi.org/10.1007/s10029-020-02366-5CrossRefPubMed

14.

Kirchhoff P, Hoffmann H, Köckerling F, Adolf D, Bittner R, Staerkle RF (2018) Is antibiotic prophylaxis mandatory in laparoscopic incisional hernia repair? Data from the herniamed registry. Int J Surg 58:31–36. https://doi.org/10.1016/j.ijsu.2018.08.012CrossRefPubMed

15.

Koscielny A, Widenmayer S, May T, Kalff J, Lingohr P (2018) Comparison of biological and alloplastic meshes in ventral incisional hernia repair. Langenbecks Arch Surg 403:255–263. https://doi.org/10.1007/s00423-017-1639-9CrossRefPubMed

16.

Blatnik JA, Michael Brunt L (2019) Controversies and techniques in the repair of abdominal wall hernias. J Gastrointest Surg 23:837–845. https://doi.org/10.1007/s11605-018-3989-1CrossRefPubMed

17.

Weiss E, McClelland P, Krupp J, Karadsheh M, Brady MS (2019) Use of prolonged prophylactic antibiotics with closed suction drains in ventral abdominal hernia repair. Am Surg 85:403–408CrossRefPubMedPubMedCentral

18.

Wong A, Lee S, Nathan NS, Wang F, Hansen SL, Harris HW et al (2016) Postoperative prophylactic antibiotic use following ventral hernia repair with placement of surgical drains reduces the postoperative surgical-site infection rate. Plast Reconstr Surg 137:285–294. https://doi.org/10.1097/PRS.0000000000001925CrossRefPubMed

19.

Ramshaw B, Dean J, Forman B, Heidel E, Gamenthaler A, Fabian M (2016) Can abdominal wall reconstruction be safely performed without drains? Am Surg 82:707–712CrossRefPubMed

20.

Simchen E, Rozin R, Wax Y (1990) The Israeli study of surgical infection of drains and the risk of wound infection in operations for hernia. Surg Gynecol Obstet 170:331–337PubMed

21.

Luo Y, Mohammed Jinnaah S, Masood D, Hodgson R (2021) Drain tube use in incisional hernia repair: a national survey. Hernia 25:427–433. https://doi.org/10.1007/s10029-019-02115-3CrossRefPubMed

22.

Krpata DM, Prabhu AS, Carbonell AM, Haskins IN, Phillips S, Poulose BK et al (2017) Drain placement does not increase infectious complications after retromuscular ventral hernia repair with synthetic mesh: an AHSQC analysis. J Gastrointest Surg 21:2083–2089. https://doi.org/10.1007/s11605-017-3601-0CrossRefPubMed

23.

Gurusamy KS, Samraj K (2007) Wound drains after incisional hernia repair. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005570.pub2CrossRefPubMedPubMedCentral

24.

Plymale MA, Harris JW, Davenport DL, Smith N, Levy S, Scott Roth J (2016) Abdominal wall reconstruction: the uncertainty of the impact of drain duration upon outcomes. Am Surg 82:207–211CrossRefPubMed

25.

Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298. https://doi.org/10.1001/jamasurg.2016.4952CrossRefPubMed

26.

Slim K, Standaert D (2020) Enhanced recovery after surgical repair of incisional hernias. Hernia 24:3–8. https://doi.org/10.1007/s10029-019-01992-yCrossRefPubMed

27.

Jensen KK (2017) Recovery after abdominal wall reconstruction. Dan Med J 64:B5349PubMed

28.

Société française d’anesthésie et de réanimation (2011) Antibioprophylaxis in surgery and interventional medicine (adult patients). Actualization 2010. Ann Fr Anesth Reanim. 30:168–190. https://doi.org/10.1016/j.annfar.2010.05.012CrossRef

29.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2CrossRefPubMed

30.

Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7. https://doi.org/10.1097/SLA.0b013e318296c732CrossRefPubMed

31.

Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414. https://doi.org/10.1007/s10029-009-0518-xCrossRefPubMedPubMedCentral

32.

Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT et al (2018) European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 22:183–198. https://doi.org/10.1007/s10029-017-1697-5CrossRefPubMed

33.

Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558. https://doi.org/10.1016/j.surg.2010.01.008CrossRef

34.

Parker SG, Halligan S, Blackburn S, Plumb AAO, Archer L, Mallett S et al (2019) What exactly is meant by “loss of domain” for ventral hernia? Systematic review of definitions. World J Surg 43:396–404. https://doi.org/10.1007/s00268-018-4783-7CrossRefPubMed

35.

Gurusamy KS, Allen VB (2013) Wound drains after incisional hernia repair. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005570.pub4CrossRefPubMedPubMedCentral

36.

Willemin M, Schaffer C, Kefleyesus A, Dayer A, Demartines N, Schäfer M, Allemann P (2023) Drain versus no drain in open mesh repair for incisional hernia, results of a prospective randomized controlled trial. World J Surg 47:461–468. https://doi.org/10.1007/s00268-022-06725-4CrossRefPubMed

37.

Luo Y, Masood DEN, Mohammed Jinnaah S, Tacey M, Hodgson R (2020) Do drain tubes help reduce risks of post-operative complications in complex incisional hernia repair (as defined by a recent court ruling)? ANZ J Surg 90:1080–1085. https://doi.org/10.1111/ans.15875CrossRefPubMed

Title: Do surgical drains reduce surgical site occurrence and infection after incisional hernia repair with sublay mesh? A non-randomised pilot study
Authors: V. Louis
S. Diab
A. Villemin
C. Brigand
S. Manfredelli
J.-B. Delhorme
S. Rohr
B. Romain
Publication date: 24-03-2023
Publisher: Springer Paris
Keyword: Incisional Hernia
Published in: Hernia / Issue 4/2023
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-023-02768-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Do surgical drains reduce surgical site occurrence and infection after incisional hernia repair with sublay mesh? A non-randomised pilot study

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2023

A ‘provocative’ MRI: the detective in ambiguous groin symptoms?

Systematic review and meta-analysis of the pre-operative application of botulinum toxin for ventral hernia repair

Autoimmunity and hernia mesh: fact or fiction?

Comment to “From transabdominal to totally extra-peritoneal robotic ventral hernia repair: observations and outcomes”

The impact of comorbidities on postoperative outcomes of ventral hernia repair: the patients’ perspective

Incisional hernia, quality of life and the need for tailored surgery