Drainage tube extubation time large collection, surgeons are concerned about the problem, finally help you summarize well!

With the spread of eras concepts and day surgeries, more and more surgical procedures are no longer placed on drainage tubes.

However, ERAS has high requirements for the soft power of medical institutions and the professional ability of medical teams, coupled with traditional surgical concepts, intraoperative bleeding, prevention and conservative thinking, etc., "as long as you are not at ease, place drainage" has become a guideline followed by many surgeons.

It is always uncomfortable to have more than one tube on the body, and when the patient's strong demand for extubation conflicts with the time of extubation printed in the textbook, the time of extubation of the drainage tube becomes a lingering confusion for the surgeon.

There are often questions below the comment area of the previous article, I hope that the general time can help you summarize the extubation time, which is not, it will be arranged today!

Image Source: Edit the screenshot

liver

3 to 5 days postoperatively

Although studies have shown that there is no need for routine drainage tube placement after hepatic resection, there are corresponding prerequisites, such as complete hemostasis during surgery, little bleeding, no significant bile leakage, liver function Child-Pugh grade A or B, and normal preoperative coagulation function.

However, due to large wounds, easy bleeding, and high incidence of bile leakage, intraperitoneal drainage and monitoring are still commonly used after surgery.

Laparoscopic radical resection of hilar cholangiocarcinoma experts recommend that after proper management of the hepatic section, drainage tubes should be placed behind the biliary anastomosis and the liver section to prevent postoperative cholangiopulmonary fistula, but the time of indwelling is not specified.

A study of laparoscopic radical resection of mixed liver cancer concluded that the removal of the drainage tube 2 to 5 days postoperatively did not cause serious complications.

A single-centre study on right hepatic resection showed that the laparoscopic and open groups had a postoperative lapar drainage indwelling time of 3.26 and 4.83 days, respectively, and both were safely discharged.

The duration of drainage tube indwelling after primary liver cancer is usually 3 to 5 days, and it can be seen that the drainage tube placement time after liver cancer surgery is basically in this range.

pancreas

Depending on the drainage traits, flow rate, and amylase determination value, the assay value is removed as soon as possible

Given the high incidence of abdominal complications after PD, current guidelines or consensus literature recommend routine postoperative placement of peritoneal drains for PD.

Domestic single-center and multi-center RCT studies have confirmed that the removal of the drainage tube on day 3 can significantly reduce the incidence of grade II.-IV. complications after PD and shorten the length of hospital stay in patients with a drainage <5000 U/L on days 1 and 3 after pancreatic surgery, and the drainage fluid volume <300 mL/day within 3 days after surgery.

Of course, this is the eras philosophy that suggests that the time for traditional surgical extubation is bound to be extended.

A retrospective analysis of pancreatic duodenectomy in China showed that the postoperative extraction time of the abdominal drainage tube in the robot group was about 10 days, the extraction time of the open group was about 13 days, the robot group for postoperative complications was 30.8%, and the open group was 41.4%, and there was no statistical significance in both groups.

Another retrospective analysis of robotic-assisted pancreatic resection of the distal spleen showed a postoperative pancreatic fistula rate of 13.0%, but in most cases it was only a biochemical fistula, no special treatment was required, and a tube could be discharged with a tube after maintaining unimpeded drainage, and the drainage tube could be removed when drainage was reduced or clean within 3 weeks of surgery.

An article published last year in Frontiers in Surgery showed that laparoscopic pancreatic duodenectomy had an average indwelling time of 7.3 days for abdominal drainage.

It can be seen that the length of the extubation timeline is different, and the indwelling time of robotic surgery is longer, but the indications for extubation are relatively clear: depending on the drainage traits, flow rate, and amylase determination value are removed as soon as possible.

The International Pancreatic Surgery Research Group (ISGPS) "Consensus on Gastrointestinal Anastomosis Reconstruction of Pancreatic Stumps after Pancreatic Duodenectomy" believes that a relatively individualized strategy should be adopted, that is, preventive indwelling abdominal drainage tubes for patients at high risk of pancreatic fistula, and early removal of drainage tubes for low-risk patients.

bile duct

14 days postoperatively / 6 to 8 weeks postoperatively

Traditionally, the extubation time of the T tube is relatively fixed, and the open surgery usually performs T tube angiography 14 days after surgery to observe whether there are stones left in the bile ducts, and to confirm that there are no stones and then remove the T tube.

Although laparoscopic surgery is less invasive, postoperative adhesions and sinus tract formation are slower than those who open the abdomen, and the T tube can be gradually clamped 2 weeks after surgery, and the removal time is appropriate at 6 to 8 weeks, and premature removal of the T tube may cause bile leakage.

stomach

3 to 5 days postoperatively

A retrospective analysis of laparoscopic gastrointestinal tumor surgery (143 cases of radical gastrectomy) showed that the abdominal drainage tube can completely drain erythema and exudates in the abdominal cavity, reduce the occurrence of inflammation, fever and abdominal pain, and promote the recovery of gastrointestinal function.

However, long-term indwelling abdominal drainage tubes may lead to complications such as abdominal infection, which is not conducive to the recovery of gastrointestinal function.

Patients in this study had ≤ 7 days of indwelling peritoneal drainage, but the article also notes that this affects the increase in length of hospital stay.

Although eras-related guidelines and consensus at home and abroad recommend that drainage tubes are not routinely placed after gastric cancer surgery, the surgical team that implements ERAS is very small compared with ordinary medical institutions, and the in-tube is not suitable for most patients, so it is recommended to decide whether to place a drainage tube according to the operation and the patient's comprehensive situation.

The expert consensus on gastrointestinal reconstruction in complete laparoscopic gastric cancer surgery and the surgical procedure guidelines (2018 edition) indicate that drainage tubes should be properly placed near the anastomosis.

For example, prophylactic drainage after laparoscopic distal gastrectomy may be useful for patients with high risk, longer surgical time, and more bleeding, and can be removed 3 to 5 days after surgery, and the indications for removal mainly include a significant reduction or disappearance of drainage fluid, no pancreatic leakage, duodenal stump leakage, anastomotic leak, etc.

intestines

5 to 7 days postoperatively

The Expert Consensus on the Diagnosis, Prevention and Treatment of Surgical Anastomotic Leak for Rectal Cancer in China (2019 Edition) states that pelvic drainage does not reduce the occurrence of anastomotic leak, but can reduce the occurrence of hematoma and infection, and recommends placing drainage tubes next to the anastomotic mouth and at the lowest point of the pelvis.

In the Expert Consensus on the Specifications for the Diagnosis of Postoperative Complications in Gastrointestinal Tumor Surgery in China (2018 Edition), the drainage tube indwelling for >1 week was identified as a Grade I complication of Clavien-Dindo.

Therefore, the postoperative drainage time of patients with bowel cancer should be < 7 days, which is generally 5 to 7 days in the traditional sense, and the amount of drainage fluid is reduced and the color can be removed.

lungs

No air leakage, chest infection, chylothorax, active bleeding

Absence of air leakage is the primary condition for the removal of the chest drainage tube, and there is a great controversy about the drainage indicator, and the recommended indications range from 100 mL to 400 mL/day.

However, this is usually a secondary indicator, and it is more important to focus on the presence of air leakage, chest infection, chylothorax, active bleeding, etc.

Removal of the thoracic drainage tube within 48 hours has been shown to be feasible, reducing the patient's financial burden, reducing postoperative hospital stay, and reducing postoperative pain score. Although early postoperative removal of the drainage tube may increase the incidence of pleural effusion, most self-healing occurs.

The above is only a small number of drainage tube extubation time after thoracoperitoneal surgery combined with traditional and evidence-based concepts, which cannot represent all postoperative drainage tubes, but as long as the extubation indications are firmly grasped, the drainage fluid and laboratory examinations are observed diligently, and the direction of extubation as soon as possible is clear.

bibliography

Yu Ao, Jiao Zichen, Wang Tao. Application of early removal of thoracic drainage tubes after thoracoscopic lung surgery[J]. Chinese Journal of Endoscopic Surgery (Electronic Edition), 2020, 13(6): 347-351.

Zhang Yu, Zhang Zhiyong, Tong Xiaorong, etc. Clinical study on laparoscopic common bile duct exploration in the treatment of bile duct stones[J]. Chinese Journal of Liver Surgery Electronics,2018,7(1):25-29.

[3] Hu Jianchong, Zou Hao, Zhu Chengzhan, etc. Comparison of clinical efficacy of da Vinci robot and open pancreatic duodenectomy[J]. Chinese Journal of Endoscopic Surgery (Electronic Edition),2021,14(2):75-80.

[4] Laparoscopic gymnastic resection of radical cholangiocarcinoma in the hepatic portal, Editorial Board of Chinese Journal of Surgery. Expert recommendations for laparoscopic procedures for radical resection of hepatic hilar cholangiocarcinoma[J]. Journal of Clinical Hepatobiliary Diseases,2019,35(11):2441-2446.

[5] Huang X, Chen Y, Shi X. Laparoscopic hepatectomy versus open hepatectomy for tumors located in right posterior segment: A single institution study. Asian J Surg. 2022 Jan;45(1):110-116. doi: 10.1016/j.asjsur.2021.03.024. Epub 2021 Apr 15.

Huang Xitai, Cai Jianpeng, Chen Wei, etc. Retrospective study on perioperative indexes of robot-assisted preservation of distal spleen pancreaticectomy[J]. Chinese Journal of Practical Surgery,2021,41(12):1407-1409,1422.

Yang Shiye, Guo Lei, Feng Jinkai, etc. Prognosis evaluation and related influencing factors of mixed liver cancer[J]. Chinese Journal of Practical Surgery,2021,41(10):1168-1172.

[8] Sun PJ, Yu YH, Li JW, et al. A Novel Anastomosis Technique for Laparoscopic Pancreaticoduodenectomy: Case Series of Our Center's Experience. Front Surg. 2021 Mar 12;8:583671. doi: 10.3389/fsurg.2021.583671.

[9] Shi J, Li S, Wang Y, Zheng L. Retrospective study on recovery of 521 gastrointestinal tumor patients after laparoscopic surgery. Oncol Lett. 2018 Sep;16(3):3531-3536. doi: 10.3892/ol.2018.9064. Epub 2018 Jul 4.

[10] Expert consensus on the diagnosis, prevention and treatment of anastomosis leak in chinese rectal cancer surgery (2019 edition).

Expert consensus on the registration of postoperative complication diagnosis specifications in gastrointestinal tumor surgery in China (2018 edition).

Edit | Zhang Jie

This article was first published on Lilac Garden's professional platform: Puwai Time