To drain or not to drain in minimal invasive ventral hernia surgery.

Purpose: Despite the high prevalence of ventral hernias worldwide, intraoperative drain placement remains a controversial topic. The benefit in reducing postoperative complications has not yet been clearly demonstrated. This study investigates whether a drain prevents postoperative complications after minimally invasive ventral hernia repair using the extended-totally-extraperitoneal-(eTEP)-technique.

Methods: This monocentric, retrospective cohort study included all patients who underwent eTEP between 2019 and 2024. Two comparison groups were formed (54 patients with drain,106 patients without) and analysed for potential differences.

Results: There were no significant sociodemographic or clinical differences between the study groups. The defect size was larger in the drain group (drain: 13 cm² (64,5) †, no-drain: 6,5 cm² (21) †, p = 0,025). There were no significant differences regarding frequency of postoperative complications (drain: 13%, no-drain: 8,5%, p = 0,373), surgical site infections (SSI) (drain: 0%, no-Drain: 1,9%, p = 0,550), and surgical site occurrences (SSO) (drain: 13%, no-Drain: 4,7%, p = 0,108). A subgroup analysis showed that robotically operated patients were more frequently provided with drains (rob: 30 (47,6%), lap: 24 (24,7%), p = 0,003), had larger defect sizes (rob: 28 cm² (72)†, lap: 6 cm² (9,87)†, p < 0,001), and received Transversus-abdominis-releases (TAR) more often (rob: 14 (22,2%), lap: 5 (5,2%), p = 0,001).

Conclusion: We found no significant differences between patients with and without drains after eTEP regarding the frequency of postoperative complications, SSOs and SSIs. Our findings do not suggest nor refute that wound drains prevent postoperative complications.