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The decision to use closed suction drains in abdominal wall reconstruction by robotic transversus abdominis release (RTAR): Are they necessary?

Zachary Sanford, MD, Adam S Weltz, Igor Belyansky, MD, FACS. Department of Surgery, Anne Arundel Medical Center

Introduction: In the field of abdominal wall reconstruction, the utility of drain placement is of debatable value.  We present outcomes evaluating drain placement vs no drain placement at the time of robotic transversus abdominis release (RTAR) technique with placement of mesh in the retromuscular position, a currently understudied subject.

Methods: Retrospective review of a prospectively maintained hernia patient database was conducted identifying individuals who received either drain placement or no drain placement during abdominal wall reconstruction via the RTAR technique from August 2015 to June 2017 at a single high volume hernia center.  Perioperative data and postoperative outcomes between the two groups are presented with statistical analysis for comparison and quality of life (QOL) measures assessed using the Carolina Comfort Scale.

Results: Thirty-five patients were identified for this study, of which 9 had drains placed intraoperatively in the retromuscular position at the conclusion of RTAR (DRN) and 25 underwent RTAR without the placement of draining devices (ND).  The DRN cohort had a mean BMI, defect area, mesh area, and operative time of 37.1, 247 cm2, 940 cm2 and 248 minutes, respectively, compared to 31.8, 157 cm2, 822 cm2, and 305 minutes in the ND group.  All cases utilized medium weight macroporous polypropylene synthetic implantable mesh materials in both the DRN and ND subgroups.  There were no reported postoperative complications, including no development of hematoma, seroma, or surgical site infections in either group.  Hernia recurrence was not identified in either the DRN or ND cohorts through a mean follow up of 200 days (6.7 months).  There were no statistically significant differences in postoperative QOL outcomes. 

Conclusion: Our series review suggests that the use of intraoperative drains may not afford any benefits with the RTAR technique when mesh is placed in the retromuscular position.  Additional postoperative management associated with drain care may be unnecessary.  


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88331

Program Number: P044

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

47

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