Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients

Complications after laparoscopic sleeve gastrectomy (LSG) are usually silent and difficult to interpret. Our purpose was to evaluate the utility of routine placement of intraperitoneal drains at the end of LSG in detection and management of postoperative complications. This is a retrospective study of all patients that underwent LSG by a standard operative team in a 3-year period. Patients were enrolled in Group A when an intraperitoneal drain was placed and Group B when not. Three hundred and fifty-three patients underwent LSG with a median preoperative BMI of 46.4 k/m2. Two hundred and one patients were enrolled in group A and 152 in group B; the two groups were comparable in their characteristics. Staple line leak, bleeding, and abscess were observed in 4%, 2.9%, and 2.5% of group A and 2.6%, 1.9%, and 1.9% of group B and the differences did not reach statistical significance. In 50% of patients with drain and leak, per os blue de methylene test was negative and in another 50% leak took place after the fourth postoperative day when drain was already taken off. Abscesses were observed significantly more often in patients that had suffered postoperative bleeding (p < 0.001) or had undergone laparoscopic adjustable gastric banding (LAGB) in the past (p = 0.02). Placement of drains does not facilitate detection of leak, abscess, or bleeding. Furthermore, they don't seem to eliminate the reoperation rates for these complications. Maybe patients with previous LAGB and intraperitoneal bleeding could benefit from placement of a drain that will remain for more than 5 days.