Ann Hepatobiliary Pancreat Surg.  2020 Aug;24(3):305-308. 10.14701/ahbps.2020.24.3.305.

Application of suction-type cigarette drain in leak-prone hepatopancreatobiliary surgery

• Hwang S
• Jung DH
• Ha TY

• KMID: 2505343
• DOI: http://doi.org/10.14701/ahbps.2020.24.3.305

Abstract

Backgrounds/Aims
Penrose drain and Jackson-Pratt (JP) drain have benefits and drawbacks in terms of functional reliability of prolonged duration and easiness of bedside management. We have developed a suction-type cigarette drain (SCD) to compensate for the drawbacks. Methods: We have used SCDs in leak-prone or contaminated hepatopancreatobiliary surgeries since 2020. Herein, we describe key elements of our 20-year experience with the management of SCDs. Results: The SCD is available as two-piece and three-piece types. The two-piece SCD is a cigarette drain consisted of a silastic Penrose drain and Jackson-Pratt (JP) drain bearing multiple side holes. The three-piece SCD is a cigarette drain consisted of a silastic Penrose drain, internally located Nelaton catheter with multiple side-holes, and a connecting JP drain tube and bulb. These SCDs were inserted into the abdominal wall with a hemostat clamps and sealed with air-tight ties. Three sets of SCDs were usually inserted in more than 100 cases of patients who underwent pancreatoduodenectomy, and none of them underwent repeat surgery for postoperative pancreatic fistula. In more than 30 patients with extensive abdominal contamination, a single SCD was usually inserted into the high-risk point of fluid collection and none of them underwent repeat surgery to manage collection of abnormal fluid or abscess formation. Conclusions: Our experience suggests that SCD is highly reliable and acceptably convenient for clinical application in abdominal drainage.

Keyword

Penrose drain; Jackson-Pratt drain; Cigarette drain; Pancreatectomy; Abscess

Figure

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  Fig. 1 Intraoperative photograph showing two-piece suction-type cigarette drain. Multiple 1 cm-sized side-holes are made at the 15 cm-long area from one end of a Penrose drain (1). Multiple small side-holes are made at the 15 cm-long area from one end of the Jackson-Pratt (JP) drain tube (2). The JP drain tube is located within the lumen of the Penrose drain matching the side-hole portions, resulting in a cigarette drain (3). The overlapped end of the cigarette drain without side-holes (X) is firmly held by a hemostat clamp and pulled out to penetrate the abdominal wall using the cigarette drain.

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  Fig. 2 Air-tight ties and skin fixation of the two-piece suction-type cigarette drain. The overlapped end of the cigarette drain is tagged and sutured at the skin and the drain tube is tied firmly twice to prevent air leak.

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  Fig. 3 Air-tight ties and skin fixation of the two-piece suction-type cigarette drain. The overlapped end of the cigarette drain is tagged and sutured at the skin and the drain tube is tied firmly twice to prevent air leak.

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  Fig. 4 Intraoperative photograph showing abdominal drain insertion in a patient treated with pylorus-preserving pancreatodudodenectomy for distal bile duct cancer. Three sets of suction-type cigarette drains (1 to 3) and two 3.2 mm-sized Jackson-Pratt drains were inserted in the abdomen, with the two Jackson-Pratt drains inserted at the abdominal wound (A). The running courses of the three suction-type cigarette drains are illustrated at the simple X-ray image of the abdomen (B). PJ denotes pancreaticojejunostomy.

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  Fig. 5 Intraoperative photograph showing insertion of three- piece suction-type cigarette drain in a patient undergone contaminated upper abdominal surgery.

Reference

1. Hwang S, Ha TY, Kim JS, Cheong O, Kim KH, Lee SG. 2004; Clinical application of sution-type cigarette drain for hepatopancreatoabiliary surgery. J Korean Surg Soc. 67:428–431.

2. Swartz AL, Azuh O, Obeid LV, Munaco AJ, Toursavadkohi S, Adams J, et al. 2012; Developing an experimental model for surgical drainage investigations: an initial report. Am J Surg. 203:388–391. discussion 391. DOI: 10.1016/j.amjsurg.2011.09.015. PMID: 22364905.

3. Whitson BA, Richardson E, Iaizzo PA, Hess DJ. 2009; Not every bulb is a rose: a functional comparison of bulb suction devices. J Surg Res. 156:270–273. DOI: 10.1016/j.jss.2009.03.096. PMID: 19691976.

4. Cheng Y, Xia J, Lai M, Cheng N, He S. 2016; Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev. 10:CD010583. DOI: 10.1002/14651858.CD010583.pub3. PMCID: PMC6611488. PMID: 29928755.