Should surgical drainage after lateral transperitoneal laparoscopic adrenalectomy be routine?-A retrospective comparative study

Abstract

Background: Whether to use surgical drains after abdominal surgery or not has received much attention since a hundred years ago. Nowadays, lateral transperitoneal laparoscopic adrenalectomy (LTLA) is a widely used technique to treat adrenal tumors worldwide. However, the placement of drains after LTLA remains controversial.

Methods: Data of 150 patients, who underwent LTLA between October 2014 and September 2020 by the same lead surgeon, were collected, including demographic, pathology, preoperative, operative variables and postoperative complications. The patients were divided into two groups, with and without drainage. The postoperative recovery of the two groups was compared.

Results: Among 150 patients (65 men and 85 women, median age 48 years, median BMI 23.53), 89 patients had no drainage and 61 patients had drainage after surgery. Variables of the two groups were analyzed. Placement of drains correlated with long operative time (P<0.01). Patients with drain had longer hospital stays (P<0.001) and a higher incidence of postoperative complications (P=0.022). Other factors, including tumor size (P=0.61), tumor location (P=0.387), ASA score (P=0.687), pathology (P=0.55), VAS pain score (P=0.41), intraoperative blood loss (P=0.11), were not found to be significantly associated with drain placement. There was no conversion to open surgery in both groups. Moreover, no mortality was observed in either group.

Conclusions: This study revealed that it is feasible and safe not to leave a drain in selective and uncomplicated patients and that surgical drainage should not be routine after LTLA.

Keywords: Lateral transperitoneal laparoscopic adrenalectomy (LTLA); adrenal tumor; drain; postoperative recovery.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/gs-20-829). The authors have no conflicts of interest to declare.

2021 Gland Surgery. All rights reserved.

Figures

Figure 1

Left adrenalectomy (A) Dissection of splenocolic and lienorenal ligament to expose surgical field; (B) the plane between Gerota’s fascia and the tail of pancreas (black arrow) should be developed clearly; (C) isolation and dissection of left adrenal vein (black arrow); (D) mobilization of medial part of gland carefully to avoid injury to spleen vessel (black arrow); (E) mobilization of adrenal posterior and lateral attachments; (F) dissection of upper vessels feeding the gland with the harmonic scalpel; (G) the operative field after removal of specimen; (H) restoration of anatomy structure without drainage.

Figure 2

Right adrenalectomy (A) Incision of hepatocolic and liver triangular ligaments to facilitate cephalad retraction of liver; (B) the junction between the upper pole of kidney and the adrenal gland was incised to help dealing with the inferior vascular pedicles; (C) the inferior arterial vessels were controlled with hemoclips; (D) cautious dissection along the lateral vena cava allowed dissection of middle arterial feeding vessels; (E) exposure and dissection of the right adrenal vein arising the vena cava; (F) inferior phrenic vessels can be easily identified and ligated with hemoclips; (G) the operative field; (H) approximately 8 cm tumor.