The Improved Mediastinal Drainage Strategy for the Enhanced Recovery System After Esophagectomy

Background. The improved drainage strategy was the transperitoneal placement of a single mediastinal drainage tube after esophagectomy. This study aimed to explore its effect on the incidence of postoperative com-plications, pain scores, and hospital stay.Methods. Data from 108 patients who underwent minimally invasive esophagectomy were retrospectively analyzed. Patients were divided into 2 groups: those in group A were treated with transthoracic placement of mediastinal drain and those in group B were treated with transperitoneal placement. The incidence of post-operative complications, pain scores, and postoperative hospital stay were compared.Results. The maximum pain scores in group B were significantly lower than those in group A from the first to the fourth postoperative days (PODs): POD1, 3.9 +/- 0.7 vs 2.3 +/- 0.7; POD2, 3.5 +/- 0.8 vs 2.1 +/- 0.7; POD3, 3.3 +/- 0.8 vs 1.7 +/- 0.8; and POD4, 3.1 +/- 0.7 vs 1.7 +/- 0.8 (all P < .001). Compared with group A, there were fewer postoperative analgesic drug users in group B (44.6% vs 17.9%; P = .005), fewer cases of pleural effusion (10.7% vs 0%; P = .045), and fewer cases of closed thoracic drainage due to pleural effusion or pneumothorax (14.3% vs 0%; P = .014). There were no significant dif-ferences in the incidence of anastomotic leakage, mediastinitis, major pulmonary complications, major abdominal complications, surgical site infection, and total postoperative complications, without statistical differences in postoperative hospital stay and 30-d mortality (all P > .05).Conclusions. The transperitoneal placement of a single mediastinal drain can reduce postoperative pain and the incidence of pleural effusion, without increasing the incidence of other major postoperative complications and postoperative hospital stay. (C) 2021 by The Society of Thoracic Surgeons