What is the UK guidance for draining post-surgical fluid collections?

From the Guidelines

In the UK, post-surgical fluid collections should be drained using percutaneous image-guided techniques, such as Seldinger’s drainage, under the guidance of a multidisciplinary team, including radiologists, colorectal surgeons, and gastroenterologists, as outlined in the 2022 ecco-esgar topical review 1. The decision to drain should be made on a case-by-case basis, taking into account the clinical status and indication for the procedure, as well as the technical details of the intervention and post-procedure aftercare. Key considerations for drainage include:

• The size and location of the collection, with CT-guided percutaneous drainage indicated for deep intra-abdominal or pelvic collections, and US-guided percutaneous drainage preferred for more superficial collections and abscesses 1
• The presence of symptoms, such as pain, fever, or functional impairment, which may indicate the need for drainage
• The risk of complications, such as damage to surrounding tissues and vessels, and consequent haemorrhage, which should be carefully weighed against the benefits of drainage 1 The goal of drainage is to remove the collection and prevent further complications, such as sepsis, while minimizing the risks of intervention. Drainage should be continued until output decreases to a minimal level, and samples should be sent for microbiological analysis to guide antibiotic therapy if infection is suspected. Ultimately, the decision to drain a post-surgical fluid collection should be based on a thorough clinical assessment and a multidisciplinary team discussion, taking into account the individual patient's needs and circumstances, as recommended in the 2022 ecco-esgar topical review 1.

From the Research

UK Guidance for Draining Post-Surgical Fluid Collections

• The UK guidance for draining post-surgical fluid collections is not explicitly stated in the provided studies, but the studies suggest that endoscopic ultrasound-guided drainage and percutaneous drainage are effective methods for managing postoperative fluid collections 2, 3, 4, 5.
• A study from the United Kingdom found that endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections had a high success rate, with 97% of patients with pancreatic pseudocysts and 100% of patients with walled-off necrosis having successful stent placement 5.
• Another study suggested that CT-guided percutaneous drainage is a safe and effective method for draining postoperative abdominal fluid collections, with a success rate of 73.5% 3.
• The choice of drainage method may depend on the size and location of the fluid collection, as well as the presence of infection or other complications 2, 6, 4.

Factors Affecting Drainage Outcomes

• The size of the fluid collection may affect the outcome of drainage, with larger collections potentially requiring combined treatment 4.
• The presence of infection or skeletal involvement may increase the risk of drainage failure 3, 6.
• The type of fluid collection, such as pancreatic pseudocyst or walled-off necrosis, may also affect the outcome of drainage 5.

Drainage Methods

• Endoscopic ultrasound-guided drainage is a minimally invasive method that can be used to drain pancreatic fluid collections and other postoperative fluid collections 2, 4, 5.
• CT-guided percutaneous drainage is another method that can be used to drain postoperative abdominal fluid collections 3, 6.
• Surgical intervention may be necessary in some cases, particularly if the fluid collection is large or if there are complications such as fistulas or bowel necrosis 3, 4.