Do we really need routine drainage after laparoscopic adrenalectomy and splenectomy?

Not only did the introduction of laparoscopy not dispel the controversy over routine drainage after uncomplicated surgery, but paradoxically it contributed to enlivening the debate on the issue.

To determine the usefulness of operative site drainage after "clean", uncomplicated laparoscopic surgery such as splenectomy or adrenalectomy.

One hundred and seventy-six participants (female : male 114 : 62) operated on in our centre between Jan 2008 and Nov 2010 were included in the prospective study. Adrenalectomy was performed in 122 patients and splenectomy in 54. In some patients no drains were left after the procedure, while the others had drainage employed. The incidence and character of post-operational complications, the necessity of repeat surgery and the length of the hospital stay were analysed.

In 112 patients (63.6%) the drain was inserted in the operational field, while in the remaining 64 (36.4%) it was not. Out of the whole series of 112 patients with drainage used, complications were observed in 6 cases (5.36%) while in the group of patients without drainage they appeared in 2 (3.12%) of those operated on (p < 0.05). Infectious complications were observed more often in the series with drainage (3.57% vs. 0%, p < 0.05). The hospital stay in patients with drainage was statistically significantly longer than in patients without.

Based on the study, no justification for routine drainage after scheduled, uncomplicated laparoscopic adrenalectomy and splenectomy was found. The decision whether to leave a drain should be made for every patient individually.