DEAR Drainage extraction after rinsing

by Franziska Oestreich née Veit
Doctoral thesis
Date of Examination:2025-12-16
Date of issue:2025-12-02
Advisor:Prof. Dr. Jochen Gaedcke
Referee:Prof. Dr. Jochen Gaedcke
Referee:Prof. Dr. Anselm Bräuer
Persistent Address: http://dx.doi.org/10.53846/goediss-11662

 

 

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Abstract

English

In our clinic, several cases occurred in which the greater omentum herniated through the drain site during drain removal, requiring surgical repositioning under general anesthesia. To prevent this complication, we introduced a technique of flushing the drain with sterile saline before removal, assuming that omental tissue might be caught in the drain holes and could be released by flushing. A prospective randomized study was conducted including pediatric surgical patients with intraoperatively placed drains. After informed consent, patients were randomized into two groups: Group A received conventional drain removal, while Group B had the drain shortened, flushed with 5 ml of saline, and then removed. Collected data included age, underlying condition, drain size, duration of drain placement, and the occurrence of omental herniation. Herniation of the greater omentum through drain channels is known but extremely rare. Existing literature consists mainly of retrospective reports and case studies, comparable to trocar hernias in adult surgery. The observed findings resemble “special” trocar hernia categories, though technically they do not represent true hernias because no hernia sac is present—more similar to a small abdominal wall dehiscence. Across 32 patients and 41 drains, no cases of omental herniation occurred in either study group. Although this suggests that the complication is exceedingly uncommon, the flushing technique did not produce any disadvantages. Given the heterogeneous pediatric population—varying in age, size, and reactions to stress—the authors conclude that a standardized approach may not always be suitable. Flushing the drain before removal appears particularly useful in situations involving additional risk factors such as young patient age, significant anxiety, crying, or increased intra-abdominal pressure.
Keywords: pediatric surgical; great omentum herniation; drain site hernia
Schlagwörter: Kinderchirurgie; Herniation von omentum majus; Drainagenhernie