Surgical drainage.

The principle factor governing the efficacy of a drain is the tissue reaction to the constituent material. This was appreciated during the early development of drainage. Modern materials have been available for more than 20 years but have escaped sound clinical evaluation. In abdominal surgery there is virtually no evidence to support routine intraperitoneal drainage especially with latex rubber unless it is intended to create a fibrous tract as with T-tube drainage of the biliary tree. When drainage is used either static symphonage (Fig. 7), low pressure suction or sump suction with a bacterial air inlet filter should be employed. Silicone rubber (Silastic) tubes are the preferred material. In the parietes closed suction drainage is safe and has achieved a sound reputation for improving healing where serosanguinous oozing is expected. High pressure suction is probably the most effective system. Because of the risk of infection, open drainage systems should, in general, be avoided, especially where a prosthesis is present. Finally, if in doubt, all surgeons should recall the words of Halsteads in 1898 "No drainage at all is better than the ignorant employment of it" rather than the advice of Lawson Tait.