Laparoscopic sleeve gastrectomy without drain in morbidly obese patient
Mansour M Abdelkhalek
Aim of the study: to prove that the laparoscopic sleeve gastrectomy (LSG) can be safely done without placement of post-operative intraperitoneal drains. Introduction: There is no doubt that the bariatric surgery without placement of postoperative intraperitoneal drains are more comfortable for the patients, The surgeons changes his surgical practice with progress in the bariatric surgery technique and instruments and diagnostic tools that able them for early detection and diagnosis of complication after bariatric surgery that render them does not use drains rottenly post laparoscopic sleeve gastrectomy. Placement of drains does not facilitate detection of staple line leak, abscess, or bleeding. Patients and Methods: 100 patients (80 Female and 20 Male), who underwent LSG in at the AL-Azhar university hospitals and other certified hospitals from Sept. 2014 to Sept. 2016 were done, All operations were performed from the same operative team and laparoscopic sleeve gastrectomy were done without placement of intraperitoneal drain. Results: Operation time range from 25-50 minutes median 37.5 minutes, Intraoperative One case of liver injuries due to lever retractor managed by haemostatic sponge application, 3 cases of stable line bleeding managed by suture and omental wrap. No cases of leaks. One case of intrapertoneal small hematoma at day 9 detected by ultrasound, managed by ultrasound guided aspiration once only, 3 pulmonary infection occurs in x-smoker patients, 3 cases wound infection treated by local debridement and antibiotics. The overall 24-hour postoperative pain score from 0-7 with a median of 3, 5. Discussion: Certain surgeons currently believe that routine drainage can increase the incidence of intra-abdominal and wound infections, exacerbate abdominal pain, reduce lung function, and prolong hospitalization. Placement of drains does not facilitate detection of staple line leak, abscess, or bleeding. Management of surgical patients should improve and surgeons should be able to practice based upon sound scientific principles. Lack of definitive evidence has not helped the resolution of some controversial issues surrounding the use of surgical drainage, our strategy is the early discharge strategy to follow these patients for only the first 2 days in hospital, he get a gastrografin swallow study on 2nd postoperative day to exclude leak before liquid fluid (water) diet is commenced If tolerated fluid diet started.. Whether this strategy provides many advantages. Gastric leaks can be diagnosed either incidentally on a routine upper gastrointestinal series performed postoperatively without any clinical signs. a combination of clinical signs of fever, tachycardia and tachypnea was found to be sensitive and specific for detection of anastomotic leaks. Laparoscopic sleeve gastrectomy without placement of intrapertoneal drian may contribute to a faster recovery, shorter hospital stay, and reduced costs without causing additional surgical complications. And may contribute to early discharge from the hospital, which also reduces costs. Conclusion: Laparoscopic sleeve gastrectomy without drains are safe and It also has the added benefits of the patients satisfaction, it follow the evidence based practice rules without added more risk of complications, less post-operative pain with early ambulation and shorter hospital stay.