The use of drains in abdominal surgery
Surgeons are often faced with the decision of whether or not to drain the peritoneal cavity and, if so, when. Drainage is usually considered beneficial when there is a well-localized, thick-walled collection of fluid. Management is less clear, however, when the problem affects the entire peritoneal cavity. Since the appearance of Yates’ classic paper on drains in 1905,1 it has been thought that a fibrous capsule rapidly forms around drainage tubes placed in the peritoneal cavity, causing the drains to seal off and drain only a small, localized area.
Most experimental work on drains has been performed in animals. In this study, the occasion of elective surgery was used to examine the flow pattern of radiopaque contrast material injected through drain tubes placed during operation.
Materials and methods
In two patients undergoing elective cholecystec-tomy for calculous disease of the gallbladder, Shir-ley sump tubes were placed for drainage of the hepatic portal area. Immediately after the abdominal wall and skin were closed, approximately 30 ml of 50% diatrizoate sodium (Hypaque) was injected through the sump tube, and a roentgenogram was obtained in the operating room. Subsequent studies were performed in the radiology department. All injections were performed by hand, utilizing 50% Hypaque as the contrast material. The patient in Case 1 had studies performed on postoperative days 1 and 3; the patient in Case 2 had studies performed on postoperative days 1, 2, 3, and 5.
In Case 1, the opaque material spread throughout the lesser omental sac with no . . .