Drain placement A1A2

Stuffed Penrose drains (often called cigarette drains) made using 3/4-inch Penrose drains stuffed with 2 gauze sponges are used for packing the large, stiff cavity that results after debridement. These drains are introduced into the abdomen through separate stab wounds to the side of the midline incision. The intent of this drain is to fill the cavity and provide compression, rather than strictly to drain the area. The number of drains varies depending on the size of the cavity; in our experience, the number of these drains has ranged from 2 to 12.

In addition, we leave the soft, round Jackson-Pratt, closed suction silicone drains, usually one into each major locale of the debridement cavity.

The stuffed Penrose drains are removed 5-7days postoperatively. We typically remove one every other day, which allows the cavity to close gradually. Jackson-Pratt drains are removed last when they have no output.

A gastrostomy tube placed at the time of the debridement proves useful in many patients. It prevents the need for a nasogastric tube and can be used eventually for enteric feeding. We do not place jejunostomy tubes routinely .

In patients with cholecystitis, a cholecystectomy can be done at this time if the patient is stable and the degree of inflammation in the right upper quadrant makes it safe. Otherwise, cholecystectomy is better left for a later stage.

The abdomen is closed primarily in routine fashion.

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