Drainage of the abdominal cavity in laparoscopy
Drainage of wounds after abdominal surgery or laparoscopy is necessary. Precisely because he manages to output the contents of wounds, ulcers and postoperative remnants of blood from the abdominal cavity. Full drainage of the abdominal cavity when performing a laparoscopy allows to create a sufficient outflow of exudate, creates the perfect conditions for the early rejection of dead tissue and helps wounds to heal faster.
What are the drainages?
The correct choice of drainage ensures good drainage of not only the abdomen but also in other parts of the body. The selection is made taking into account:
- the method of drainage;
- the provisions of drainage in the wound;
- the use of the necessary antibacterial drugs for washing wounds;
- good content of drainage.
Drainage is carried out using:
- rubber, plastic or glass tubes;
- graduates glove rubber;
- purpose-made strips of plastic;
- tampons of gauze inserted into the wound or drained cavity;
- soft probes.
Introduction the drainages of rubber and plastics is often combined with the use of gauze swabs. Also popular cigar drains, consisting of a gauze swab, which is placed in the finger of a rubber glove with cut end. So there was nothing to withdraw pus and outflow was good in the shell to make the hole. Drainage with the use of gauze based on hygroscopic properties of gauze.
For the first time they were used for drainage in the 18th century; in those days this method was based on the fact that the wound was inserted a piece of gauze in the shape of a square, center stitched with a thread made of natural silk. Cheesecloth is well spread, so she covered the bottom of the wound, and after the cavity was filled with tampons, pre-moistened with sodium chloride. Tampons changed from time to time, the gauze has not been touched – thus protecting the fabric from damage. If it was necessary to remove the gauze, then pulled up her silk thread. However, the effect of such short-term tampon every 6 hours it needs to change.
What drainage should I choose?
During a laparoscopy, you must also use a drainage, especially in the case of peritonitis to completely remove all the pus from the abdominal cavity. So, what type of drain to choose?
- Rubber graduates do not have the suction effect.
- Single rubber devices often become clogged with pus, become covered with mucus – thus in a place where they are installed, starts the inflammatory process.
In other cases, described the drainages show good results.
The best materials to install drainage in the treatment of purulent wounds are considered to be tubular fit. Drainage in abdominal surgery or laparoscopy the abdominal cavity is best done with the help of silicone tubing. They have many positive properties and they help to increase the length of stay of the drainage in the wound. Such devices can be repeatedly subjected to a special treatment that ensures their reusability.
In recent years more and more surgeons prefer the trocar is straight and curved pipes with a diameter of 10 cm and a length of not more than 15 see What they are used for sparing surgery – laparoscopy. The choice of tube depends directly on the purpose of the intervention and the distance from the puncture point to the area of impact. For withdrawal of fluid from the abdominal cavity needs to get tube with a diameter of 5 to 8 cm, and to further improve the drainage, they are doing perforations.
General requirements for drainage
The requirements for drainage of the peritoneum in peritonitis present according to the rules of asepsis. The indication for replacement or removal of drainage from the abdominal cavity is the formation around it of inflammation. Sometimes these changes can appear in the output tube from the wound.
To prevent infection in the wound, the tool can be replaced by sterile, but I also need the vessels used to collect the exudate. Since the main purpose of installation of drainage into the peritoneum is the outflow of the residues throughout the healing period, the loss of drainage from the wound after laparoscopy consider a serious problem that can minimize all the efforts of the doctor. To prevent this, drainage is well attached by suture or by adhesive plaster.
During the tubing installation must ensure that it has not been bent, bent, and not only outside but also inside the abdominal cavity. Place the trocar should be so the patient could easily move around and to stay in bed, not touching the drainage and not pulling it accidentally. You also need to ensure that drainage does not become a factor that led to the development of infection.
How is the drainage by laparoscopy?
The procedure for installing drainage is easy. After the introduction of the drainage is treated with an antiseptic solution, the surgeon makes a small incision in the skin and inserts a clip – it allows to easily enter the drain pipe. After installation, the incision is sewn up and the ends of the thread fixed the drainage that he couldn’t fall out. In cases where the tube is no longer needed, its the end of the clamp to prevent infection inside the abdominal cavity, and then removed the drainage. The success of the latter depends on the availability at the peritoneum of pressure; otherwise the fluid will not be able to rise up and go outside. You also need to follow the change of the serous flow. To enhance the effectiveness of these two factors and make drainage of the most successful, the patient is advised to take needed for this position: semi-sitting position.
The location of fluid in each individual case may vary, so choose the most suitable area for drainage needs a doctor. Most of the handsets are at the front wall of the stomach or the lower wall of the diaphragm.
In peritonitis without drainage can not do, because all the remnants of pus must withdraw from the abdominal cavity. The outflow of the contents for this pathology can only be achieved when conducting a laparotomy, debridement and decompression of the small intestine. This whole procedure takes place in several stages.
- By laparotomy provided access to the peritoneum.
- Occurs relief and elimination of the source of the problem.
- Performed minor surgical intervention; major surgery are transferred to a more favourable for the patient period. Thorough periodizacija all parts of the peritoneum, where there is no peritoneal cover.
- Then, it runs a sanitation and drainage installation. To remove the pus and deposition of fibrin gauze categorically prohibited. The composition of the wash liquid does not matter, but the temperature should fluctuate in the range of 4 – 6 degrees.
- Performed decompression of the intestine. In the treatment of diffuse forms do not impose the stoma, and drainage is performed through the anus. If the Supplement decompression intestinal lavage, accelerated recovery of functionality of the gastrointestinal tract, besides, it is not possible to penetrate into the cavity of toxins and microbes.
Drainage with local diffuse peritonitis the peritoneum is carried out with tubes of PVC. After reaching the site, the tube is removed and the laparotomy wound is sutured.
As can be seen from the above, without the drainage, especially in case of peritonitis, not to do only with its help it is possible to remove all remains unnoticed by the doctor after surgery, even if it was gentle, as in laparoscopy. The choice of drainage and care must be performed by a doctor. Yourself to wash it and to change in any case can not – it can lead to inflammation and infection.