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- Title
PS01.207: TRANSHIATAL AND INTERCOSTAL PLEURAL DRAINS AFTER HYBRID IVOR LEWIS ESOPHAGECTOMY: A COMPARATIVE ANALYSIS IN 100 CONSECUTIVE PATIENTS.
- Authors
Bernardi, Daniele; Asti, Emanuele; Sironi, Andrea; Bonitta, Gianluca; Bonavina, Luigi
- Abstract
Background In a previous proof of concept study, transhiatal pleural drain has been shown to be safe and effective after hybrid Ivor Lewis esophagectomy. Aim of the present study was to compare short-term outcomes of trans-hiatal and intercostal pleural drainage. We hypothesized that a trans-hiatal pleural drain introduced through the sub-xyphoid port site incision at laparoscopy could reduce postoperative pain and enhance patient recovery. Methods This was an observational retrospective cohort study. Two methods of pleural drainage were compared in patients undergoing hybrid Ivor Lewis esophagectomy. Patients treated with a transhiatal drain connected to a vacuum bag were compared to an historical cohort of patients treated with the conventional intercostal drain connected to under-water seal and suction. Postoperative morbidity, total and daily drainage output, serum albumin levels, and total dose of paracetamol and ketorolac administered on-demand were recorded. Postoperative complications were scored according to the Dindo-Clavien classification. Results Over a 2-year period, 50 patients with transhiatal drain and 50 with intercostal drains met the criteria for inclusion in the study. Demographic and clinico-pathological variables were similar in the two groups. No conversions from the portable vacuum system to underwater seal and suction occurred. There was no mortality nor statistical significant difference in the rate of grade ≥ 3 postoperative complications. The total volume of drain output and the serum albumin levels were similar in the two groups. The total dose of ketorolac was significantly reduced in patients with transhiatal drain (P < 0.001). The length of hospital stay was similar in the two groups. No complications related to the method of pleural drain occurred up to 3 months after hospital discharge. There was only one hospital readmission in the transhiatal group due to severe nutritional impairment. Conclusion Transhiatal pleural drainage connected to a portable vacuum system can safely replace the intercostal drain after hybrid Ivor-Lewis esophagectomy in selected patients. It has the potential to reduce postoperative pain and use of nonsteroidal antinflammatory drugs, and to enhance recovery from surgery. Disclosure All authors have declared no conflicts of interest.
- Subjects
ESOPHAGECTOMY; SURGICAL complications; ALBUMINS; POSTOPERATIVE pain; DRAINAGE
- Publication
Diseases of the Esophagus, 2018, Vol 31, Issue 13, p108
- ISSN
1120-8694
- Publication type
Article
- DOI
10.1093/dote/doy089.PS01.207