Usefulness of double luminal drain with continuous high-pressure aspiration for draining mucinous discharge in abdominal sepsis: prevention of worsening of local inflammation until definitive surgery

Objective

In intra-abdominal abscesses and leakage of intestinal contents, adequate and effective drainage is essential for prevention of MODS and abdominal sepsis. In the management of these conditions, we have preferred a double luminal drain with continuous high-pressure aspiration method (DLD-CHPA) with good outcome. The aim of this procedure is rapid and continuous removing of discharge and pus, maintaining a dry condition of the abscess and fistula, and stimulating granulation; which leads (a) to quickening the closure of the abscess and fistula, and (b) to prevention of worsening of the local condition of the localized abscess and the leaking point of injured intestine until definitive surgery. We presented the preliminary report concerning the former (a) effect of this procedure in the 21st International Symposium. The purpose of this presentation is to clarify both effects of DLD-CHPA by clinical experience.

Materials and methods

DLD-CHPA was performed in 25 patients (with leakage of intestinal juice, duodenal juice, pancreatic juice, or bile, or with continuous production of pus) from April 1999 to March 2002. The volume of discharge soaking in gauze, the character of a wash recovered in intermittent lavage, the grade of local inflammation of skin surrounding the drain (DLD), the volume of aspirated material by DLD-CHPA, the volume of discharge from the wound and drain other than DLD, and the frequency of dressing changes per day were examined before and after CHPA. The fundamental structure of a DLD is same as that of aspiration device used during surgery, which consists of an outer tube with multiple pores (or basket) and an inner tube directly connected with a high-pressure central aspirating system. We use a Duple Drain or 20~26 Fr size of Nelaton Catheter as an outer tube. Some additional side pores are punched out in this outer tube according to the condition of the abscess cavity or fistula, and the velocity and character of the discharge. As an inner tube, we prefer an 8~12 Fr size of aspiration catheter, which is fixed in the position of the tip situated 5 mm behind of the tip of the outer tube by sticking-tape for easy and quick change of the inner tube. The inner tube is frequently changed as soon as it is obstructed due to adhesion of dry material of the discharge. The inner tube is aspirated with a high pressure of central vacuum system (valve of the vacuum system is fully open).

Results

1. Discharge soaking in gauze, a wash recovered in intermittent lavage, local inflammation of the skin surrounding the drain (DLD): the mean grade of all these factors improved with statistical difference after DLD-CHPA (P < 0.001).

2. Volume of aspirated material by DLD-CHPA, volume of discharge from the wound and drain other than DLD, and the frequency of dressing change: the mean volume of discharge from the wound and drain other than DLD was depressed from 880 ± 630 g/day before DLD-CHPA to 270 ± 330 g/day after DLD-CHPA (P < 0.001). The mean volume of aspirated discharge by DLD-CHPA for 3 days was 440 ± 480 g/day. The sum of the volume of discharge and aspirated material after DLD-CHPA is smaller than the volume of discharge before DLD-CHPA, with a statistical difference (P = 0.005). The frequency of dressing change including daily routine procedure was significantly decreased from 7 ± 3/day to 3 ± 1/day (P < 0.001).

3. Prevention of worsening of the local condition of the abscess and leaking point until definitive surgery: in all cases, we were able to perform definitive surgery without worsening of local inflammation, especially inflammation of skin around the drain, even with continuous leakage of intestinal juice or bile.

4. Complications due to DLD-CHPA: there was no complication with DLD-CHPA.

Conclusion

DLD-CHPA is thought to be useful for managing abdominal sepsis by draining mucinous purulent fluid effectively. This procedure can prevent worsening of the local condition of a localized abscess and the leaking point of injured intestine until definitive surgery with continuous leakage of the intestinal juice.