POINT OF TECHNIQUE
|Year : 2002 | Volume
| Issue : 2 | Page : 193-194
A modified method of retroperitoneal drain placement following open surgery for kidney and upper ureter
Mitul Y Doshi, BD Kashyapi, AV Rao
Department of Urology, St. George's Hospital, Grant Medical College, Mumbai, India
Mitul Y Doshi
Room No. 30, Resident Doctors' Qrts., St. George's Hospital, Behind C.S.T., Fort, Mumbai - 400 001
Source of Support: None, Conflict of Interest: None
Keywords: Retroperitoneal Space; Drainage
|How to cite this article:|
Doshi MY, Kashyapi B D, Rao A V. A modified method of retroperitoneal drain placement following open surgery for kidney and upper ureter. Indian J Urol 2002;18:193-4
|How to cite this URL:|
Doshi MY, Kashyapi B D, Rao A V. A modified method of retroperitoneal drain placement following open surgery for kidney and upper ureter. Indian J Urol [serial online] 2002 [cited 2019 Nov 13];18:193-4. Available from: http://www.indianjurol.com/text.asp?2002/18/2/193/37646
| Introduction|| |
Retroperitoneal drains (RPD) are routinely placed after open surgery of kidney and upper ureter to allow egress of urine and blood that may leak or ooze. This helps in healing and prevention of complications like suture-line disruption, urinoma and hematoma formation, fibrosis and sepsis.  In practice, inner end of RPD is not under control and frequently changes its position after initial placement leading to complications already mentioned and injury or malfunction of adjacent structures. This prompted us to modify the procedure.
| Method|| |
Before placing the RPD, desired location of inner end is decided. A loop of chronic catgut (1-0) is made by passing it through the fascial covering of posterior abdominal wall muscle (Psoas Major or Quadrates Lumborum) at a site which is 2 to 2.5 cm caudal and lateral to desired location of inner end of RPD. This loop is kept loose. The inner end of RPD is passed through the loop, keeping side holes of RPD away from the loop [Figure - 1](A). The RPD is fixed to the skin and wound is closed. This method keeps inner end of RPD stabilised at desired location postoperatively till it is removed [Figure - 1](B).
| Comparison with Standard Method|| |
When inner end of RPD is not fixed as in standard method, it may slide over to suture line to act as a wick,  gets blocked due to acute angulations and leads to other complications already mentioned [Figure - 2](A). By stabilising the inner end, complications are avoided [Figure - 2](B). During removal of RPD, the catgut loop does not cause any problem as it is wider than the RPD and side holes are away from it.
| Conclusion|| |
RPD placement itself can lead to complications which are best avoided by proper placement.  The described simple maneuver makes RPD placement reliable, stable and without complications.
| References|| |
|1.||Novick A, Streem S. Surgery of kidney. In : Walsh C. Retik AB, Vaughan ED, Wein AJ, eds. Campbell's Urology. 7th edn. Philadelphia. Saunders. 1998: 3: 3043-3044. |
|2.||Naitoh J, Smith R. Complications of renal surgery. In: Taneja S, Smith R. Ehrlich R, eds. Complications of Urologic Surgery. Philadephia. Saunders. 2001; 315-321. |
|3.||Aronson WJ. Complications of ureteral surgery : Management and prevention. In : Taneja S. Ehrlich R, eds. Complications of Urologic Surgery. Philadelphia. Saunders. 2001; 357-358. |
[Figure - 1], [Figure - 2]