Drainage of Abdominal Surgery

Download as pdf or txt
Download as pdf or txt
You are on page 1of 7

Review Article

ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2022.43.006912

Drainage in Abdominal Surgery


Marián Bakoš* and Michal Kuťka
Department of Surgery, Faculty hospital, Slovakia
*Corresponding author: Marián Bakoš, Department of Surgery, Faculty hospital, Slovakia 949 76 Nitra, Slovakia

ARTICLE INFO ABSTRACT

Received: April 11, 2022 The application of various drains has been a part of the surgical activity since
ancient times. Today’s modern surgery chooses drainage itself and drainage systems
Published: April 27, 2022 according to clear criteria and purpose. The most used sizes of drains were found to
be 28F, 32F and 36F in adults and 16F, 20F and 24F in children. The most important
criteria for drain selection are drainage efficiency (performance), biostability and
Citation: Marián Bakoš, Michal Kuťka. biocompatibility. Drainage systems are a common part of postoperative surgical
Drainage in Abdominal Surgery. Biomed management and are used to remove fluid collection from the abdominal cavity.
J Sci & Tech Res 43(3)-2022. BJSTR. When draining the peritoneal cavity, it is necessary to be aware of the most common
MS.ID.006912. places of fluid accumulation. Abdominal drainage is not easy, especially due to more
complicated anatomical conditions and the presence of consciousness and intestinal
Keywords: Drains; Drainage; Abdominal
loops. The aim of this review was to evaluate the evidence supporting the systematic
Surgery; Intra-Abdominal Drains
use of abdominal drainage.

Introduction
• They have a restituting effect [1].
Since ancient times, surgical procedures have been associated
with conditions, that have either the cause, or effect of evacuating Characteristics of Drainage Systems and their
liquid media, that are detrimental to the body. To achieve this effect, Effectiveness
various devices, which fall under the collective name “drains”, have The shape of the drains can be straight or shaped. Curved drains
been gradually designed, described, and used. We call the drain a are used in thoracic surgery, where they are applied after surgery
simple or more com-plicated aid or a whole system used to evacuate on the diaphragm. The end of the drain that remains outside the
unwanted fluids from the body [1]. The application of various drains body can be either funnel-shaped to connect to the connector
has been a part of the surgical activity since the days of Hippocrates, (inserted from the outside) or beveled for easier passage through
when various metal, bone, gauze or wick preparations and gauze the chest wall (inserted during internal surgery) [3]. Drains are
combinations were used as means of passive drainage. The oldest manufactured in various lengths and widths. The width of the drain
record of the usage of drainage comes from Hippocrates himself can be marked either by a number according to the Charrier scale,
(480-377 BC). He used a wooden tube to drain the empyema [2]. or the so-called French units. On the Charrier scale, the number 1
Today’s modern surgery is more advanced and precise - it chooses is equal to 0.3 mm and each subsequent number is 0.3 mm larger
drainage itself and drainage systems according to clear criteria and (Figure 1) [2]. The most used sizes were found to be 28F, 32F and 36F
purpose: in adults and 16F, 20F and 24F in children. Polyethylene catheters
• They remove pathological liquid products (purulent fluids, (Intracarth), “J” -shaped catheters are intended for neonatal age [4].
intestinal contents, effusion, etc.) When choosing the size of the lumen of the drain and the various
couplings, it is necessary to proceed from the laws applicable to the
• They remove loose intra-abdominal fluids (bile, pancreatic
dynamics of gases and fluids. Poiseuille’s equation is assumed for
juices, lavage fluids) before they can cause complications.
the gas flow under the assumption of laminar flow. The air flow is

Copyright@ Marián Bakoš | Biomed J Sci & Tech Res | BJSTR. MS.ID.006912. 34642
Volume 43- Issue 3 DOI: 10.26717/BJSTR.2022.43.006912

directly proportional to the square of the drain radius. For humid 2. Drainages with a square cross-section at the beginning of
air, which has a turbulent flow, the Fanning equation applies, and the stream show approximately the same volume flow when
so the flow rate depends on the radius of the drain up to the fifth compared to drains of circular cross-section with the same
power of the radius [5]. cross-sectional area size.

3. For suction drainage, a certain wall resistance against collapse


must be ensured.

4. With the same geometry, the larger the volume flow, the more
side holes of the same size are located on the drain.

5. As the ratio of the sum of the areas of the side openings to the
cross-section of the collecting channel increases, the drainage
capacity increases [7].

Principles for Abdominal Drainage

Figure 1: Drain types –


a) Robinson drain,
b) Jackson-Pratt drain,
c) Silicone drain.

The Most Important Criteria for Drain Selection


Drainage efficiency (performance), biostability and
biocompatibility are the most important criteria. Rubber hoses are
nowadays rejected due to poor biostability and surface structure
deficit. The only exception is their use in T-drainage. As a result of Figure 2: Premises in which fluid accumulates in a lying
secondary structural changes in the drainage material, which are patient –
caused enzymatically, there is a progressive rigidity of the material a) Subphrenic space on the left,
with increasing storage time in the body. Prolonged intra-abdominal b) Paracolic space on the left,
drainage with rubber drains can lead to intestinal erosions. PVC c) Douglas space.
materials should be excluded due to insufficient biocompatibility
[6]. The issue of abdominal drainage has undergone great
development. The advantages and disadvantages of drainage,
Drainage Efficiency
questions of when, how, and what to drain during operations
The total flow of the drainage system is the sum of all the are considered. However, there is some consensus. In elective
individual streams that flow through the openings in the wall of the or minor uncomplicated abdominal surgeries (appendectomy,
collecting channel. The flow in the collecting channel is turbulent, cholecystectomy), most authors are inclined to recommend not
and beliefs are formed. An important parameter is the relationship draining the abdominal cavity. Drainage is always recommended for
of the sum of the areas of all side holes of the drain (f) to the cross- potentially complicated surgical procedures where complications
sectional area of the collecting channel (b). Mainly drainage with may be expected. Drainage should never be conducted by the
a large f:b ratio did not initially show any pressure drop. The side surgical wound - due to the weakening of the wound and the
openings in the rear part of the collecting channel suck the most, possibility of postoperative herniation at the site of the drain and
proportionally more than the openings in the front part. In the the risk of possible infection of the surgical wound. In places where
experiment, the authors tested and evaluated 14 different drainage we do not see, the drain is placed by hand. Direct drainage of the
systems and the following conclusions were drawn: drain with the anastomosis should be avoided [8]. The abdominal
1. The larger the diameter of the drain, the larger the volume cavity is an enclosed space (abdominal compartment) bounded by
flow. The volume flow is the same in each cross section of the a rigid posterior wall and anterior-moving muscular wall. Muscles
tube. form the abdominal cavity with their tension and with their

Copyright@ Marián Bakoš | Biomed J Sci & Tech Res | BJSTR. MS.ID.006912. 34643
Volume 43- Issue 3 DOI: 10.26717/BJSTR.2022.43.006912

activity participate in locomotion, participate in ventilation, etc. are greater in the right hypochondria due to the position of the
When draining the peritoneal cavity, it is necessary to be aware of liver than in the left. Data on intra-abdominal pressure in the early
the most common places of fluid accumulation (Figure 2). In the postoperative period after laparotomy are interesting. While the
vertical position, the lowest stored area of the abdominal cavity is intra-abdominal pressure is around 2 kPa on the first postoperative
the Douglas space, in the horizontal position the subphrenic space day, the fourth postoperative day can reach up to 6 kPa (61.2 cm
on both sides and also the Douglas space [9]. H2O). Changes in intra-abdominal pressure also occur during
artificial lung ventilation and are reflected in a higher incidence of
In the vertical position, the lowest stored area of the abdominal
laparoscopic wound dehiscence. Based on a number of experimental
cavity is the Douglas space, and in the horizontal position the
and clinical studies in the 1990s, intra-abdominal hypertension
subphrenic space on both sides and also the Douglas space. The
has been shown to cause abdominal compartment syndrome,
circulation of fluid between these three spaces is given by the intra-
which is often observed in clinical patients and in patients after
abdominal pressure and the gravity of the fluid (Figure 3). The
severe abdominal trauma [11,12]. An increase in the content of the
activity of the abdominal muscles is reflected in the change in intra-
abdominal cavity as well as the retroperitoneum contributes to the
abdominal pressure. In addition to muscle contraction, the increase
increase of intra-abdominal pressure. Intra-abdominal pressure is
in intra-abdominal pressure may be caused by acute visceral
transmitted to adjacent areas and has adverse effects on cardiac
distension [9,10]. The resting intra-abdominal pressure in the
output, pulmonary ventilation, renal function, and cerebrospinal
horizontal position reaches values in the range of 0.78-1.5 kPa (8-
pressure. Increasing intra-abdominal pressure has an adverse
15.3 cm H2O). At the stand, the pressure increases due to gravity up
effect on visceral perfusion. The more the intra-abdominal pressure
to 2.94 kPa at the bottom of the Douglas space. During respiration,
increases and the longer this increase lasts, the more the blood flow
the intra-abdominal pressure changes by about 0.4 kPa, but with
through the splanchnic area decreases, which is reflected in the
a severe cough, it can reach values of up to 14.7 kPa (150 cm H2O)
lowering of the pH of the intestinal mucosa [13].
[10]. The pressure changes resulting from respiratory movements

Figure 3: Directions of possible fluid propagation in the abdominal cavity (left) Areas where fluid usually accumulates (right)
a) a - Subhepatic space,
b) b - Subphrenic space on the right,
c) c1, c2 - Subphrenic space on the left,
d) d - Paracolic space on the left,
e) e - Douglas space.

Copyright@ Marián Bakoš | Biomed J Sci & Tech Res | BJSTR. MS.ID.006912. 34644
Volume 43- Issue 3 DOI: 10.26717/BJSTR.2022.43.006912

Consequences of increasing intra-abdominal pressure:

1. At values <1.33 kPa (100 mm Hg = 13.6 cm H2O), blood pressure


and cardiac output are within normal limits, but visceral blood
flow is significantly reduced.

2. At 1.99 kPa (15 mm Hg = 20.4 cm H2O) cardiovascular changes


already occur.

3. Renal dysfunction and oliguria may occur at values> 2.66 kPa


(20 mm Hg = 27.2 cm H2O).

4. Anuria occurs at values> 5.32 kPa (40 mm Hg = 54.4 cm H2O).

Abdominal compartment syndrome is characterized by


increased inspiratory pressures, decreased cardiac output,
oliguria, despite normal or increased cardiac pulmonary pressure.
Clinically significant intra-abdominal hypertension is observed
in many conditions such as e.g., in postoperative intra-abdominal
Figure 4: Robbinson’s drain.
bleeding, in complicated intra-abdominal vascular surgery, in
liver transplantation operations, in advanced diffuse peritonitis,
in severe acute pancreatitis, in severe abdominal trauma, but
also in peritoneal insufflation during laparoscopic patients and in
laparoscopic patients. with liver cirrhosis [14]. Properly placed
drain drains fluid from the abdominal cavity either passively (after
a slope, with the participation of intra-abdominal pressure) or
active. In any case, it is necessary to guide the drain as short as
possible from the drained bearing to the body surface. Therefore,
some authors recommend first placing the drain in the drained area
(cavities, bearings) and only then take the drain out of the surgical
wound, in the place where the drain itself is placed on the abdominal
wall [15]. Targeted is the drainage of a certain demarcated area,
where any fluid (bile, blood, pancreatic juice, etc.) is drained.

Drains established near anastomoses can be the first to inform Figure 5: Drainage after stomach surgery Left - subtotal
resection of the stomach Right - gastrectomy with
us about possible suture insufficiency - signal drains. Active
subsequent oesophagoyjuananastomosis with reservoir
drainage is usually not recommended near anastomoses. The formation.
most commonly used closed drainage system in visceral surgery
is Robinson drainage (Figure 4), which consists of a 20F silicone Based on a German questionnaire survey, Böhm found out that
hose with a length of one meter. The end, which is placed in the 90% of them would introduce drainage after gastrectomy. Drains
abdominal cavity, has several holes on the sides and the opposite are most often established in the area of anastomoses, subhepatic
end is connected to a plastic calibrated bag with a volume of 350 space or in the area of the duodenal stump. The average length of
ml. This system is modern and highly hygienic, it also contains drainage was 5.5 days. The suture of the ulcer was always sealed
a shut-off valve that does not allow ascending infection [16]. with a suture [17]. Drainage of the duodenal stump area depends on
Infectious complications associated with bacterial contamination the anatomical conditions, the type of disease, the complexity of the
of the drain are one of the most important risk factors for intra- resection and the type of duodenal stump closure. If the operating
abdominal drainage. Gastric surgery, such as early suture and ulcer surgeon is in doubt, then he drains the duodenal stump area always
sealing, gastric resection BI or BII, vagotomy, require drainage of sufficiently and effectively. The prognosis of early dehiscence of the
the operating room. If a drain is laid, then it usually slopes into the duodenal stump is a very serious complication with high lethality
subhepatic space or Redon’s drain (Figure 5). - up to 50% [18]. After the patient’s condition improves, the fistula

Copyright@ Marián Bakoš | Biomed J Sci & Tech Res | BJSTR. MS.ID.006912. 34645
Volume 43- Issue 3 DOI: 10.26717/BJSTR.2022.43.006912

usually heals spontaneously. The abdominal cavity is still secured are chosen - usually No. 12. It is led out of the perineum forward
by laying a slope drain under the liver. so that the patient does not lie on them. Miles initially closed the
perineal wound primarily. Active drainage was not yet known, and
Use of Drainage in Small and Colon Surgery
ascending infections arose from the catchment drainage. Miles
In simple resections of the small intestine (Meckel’s solved this by introducing open aftercare in the form of so-called
divertuculus), drains are usually not established. In the case of “packing” - longs placed in a thin foil. The healing process was very
acute small bowel surgery, e.g., due to Crohn’s disease, then it lengthy. Secondary healing is always very unpleasant for the patient.
always drains. The most common indications for surgical treatment Today, this method is no longer used, and after rectal extirpation,
in Crohn’s disease are complications in terms of fistulations, primary closure of the perineal wound is always indicated. Active
especially in the ileocecal region [19]. Abdominal drainage after drainage is started at the end of the operation.
colorectal operations depends on the type of operation (acute,
elective) and the scope of the operation. It is not recommended that
the drain lean against the intestinal wall (Figure 6). The abdominal
cavity drains only in cases of major damage to the serous surface
of the intestinal wall or exposure of the lymphatic system in the
retroperitoneum. In these cases, drainage is established in the
area after the resected colon ascendens and/or in the Douglas
space, usually for 48-72 hours. Drainage is always recommended
for operations on the left half of the colon and rectum, even if no
positive effects of prophylactic drainage after colonic elective
procedures have been found in control studies [20]. In the case of
rectal amputations, it is advantageous to introduce Redon drainage
into the resulting cavity through the perineum. Usually, two drains
are introduced. Böhm and co-workers report that 90% of surgeries
in Germany drain the abdominal cavity after resections of the
esophageal loop. They usually drain the Douglas area (54%) or the
anastomosis area (31%). The average length of drainage was 5.6
days [17]. Figure 7: Drainage after low rectal reaction. Drain taken
retroperitoneally.

Drainage in the Pancreas


After resection operations on the pancreas, gravity drains
stored in the environment are used. Surgery is most often indicated
in acute pancreatitis due to signs of peritoneal irritation or septic
condition. If the patient is operated on due to the edematous form
of pancreatitis, bile duct remediation with possible decompression
and drainage of the omental bursa is usually sufficient. In the
necrotic form of acute pancreatitis, we perform neurectomy and
thoroughly drain the area after the slope [21]. In these cases, drains
Figure 6: Drain position to intestinal suture – with a wider diameter are used to prevent their early clogging
a) Incorrect, by necrotic masses. It is also possible to establish a flush lavage
b) Correct (drain should not insist on anastomosis). exchange.

Individual Types of Drainages Used in the Intra-


After rectal resection, it is recommended to drain the Abdominal Inflammatory Process
anastomosis area. This is possible either by the retroperitoneal or
peritoneal route (Figure 7). In this case, the drains perform a signal
Percutaneous Drainage
function. Some literature data emphasize the importance of purging Percutaneous drainage is inserted under CT control or
the presacral space after rectal surgery. After rectal extirpation, the ultrasound [22]. The most common drained deposits are abscesses
perineum is actively drained using Redon’s drains. Larger calibers in the area of peritoneal cavities, intra-parenchymal deposits (liver

Copyright@ Marián Bakoš | Biomed J Sci & Tech Res | BJSTR. MS.ID.006912. 34646
Volume 43- Issue 3 DOI: 10.26717/BJSTR.2022.43.006912

and pancreas abscess), or retroperitoneal abscesses. Other puncture


lesions are most often cysts or pseudocysts of the pancreas. The best
results can be achieved by evacuating well-defined small deposits
with a low viscosity content. Contraindications to percutaneous
drainage include cystic or necrotic tumors, abscesses around
foreign bodies, abscesses associated with intestinal fistulation. The
trocar technique means direct puncture with a drainage set after
the previous targeting. It is always necessary to send a sample for
bacteriological and cytological examination. For secretions of lower
content, drainage with a lumen of 8-10 F is sufficient, for denser
secretions of 10-14 F, exceptionally, a lumen of 16-18 F is used. it
is necessary to monitor the amount of secretion, check the correct
introduction of the drain into the drained deposit, or the amount of
residual secretion in it (CT, ultrasound, sciascopy). With the correct
technique of percutaneous drainage, the efficiency is in the range of
80-90%, lethality up to 1%.

Laparoscopic Remediation of An Inflammatory Deposit


with Standard Drainage of the Abdominal Cavity
Figure 8: Closed continuous peritoneal lavage - drainage
In some workplaces, for example, gastroduodenal ulceration areas in both directions
with peritonitis, small pelvic abscess, tutorial abscess, resp. a. Subhepatic space,
pelviperitonitis. We can also treat perforating appendicitis in this b. Subphrenic space on the right,
way. Proponents of laparoscopy say that perioperative lavage is c. Subphrenic space on the left,
more effective in laparoscopy than in laparotomy surgery if the d. Pericolic space on the left.
abdominal fold is better defined. The main advantage of this method e. Douglas space,
is the minimal trauma of the abdominal wall, there are no possible f. Drain to the gastric major of the stomach,
complications of a severe infection, organ emergencies, etc. [23]. g. Drain to the radix of the mesentery.
Closed Continuous Peritoneal Lavage
Conclusion
The authors of this method (Beger, McKenna) are based on the
concept of peritoneal dialysis [24]. Enclosed continuous peritoneal Drainage systems are a common part of postoperative
drainage is shown in (Figure 8). They involve continuous cleansing surgical management and are used to remove fluid collection
of the cavity of toxins, blood residues, bile, or other secretions, from the abdominal cavity. The drain may be superficial in the
including active enzymes. Repeated laparotomy is usually not subcutaneous tissue, or deep in the organ or cavity. The number
necessary. The disadvantages are mainly the loss of proteins of drains depends on the scope and type of operations. Intra-
(especially albumin - about 1 g / l solution) and electrolytes, we abdominal drainage improves early detection of complications
cannot prevent drainage and obliteration of the drainage spaces (gastrointestinal leakage, bleeding, bile leakage), prevents fluid or
with the risk of the formation of limited deposits of residual pus accumulation, reduces morbidity and mortality, and shortens
infection. Indications for this type of drainage include diffuse hospital stay. The aim of this review was to evaluate the evidence
peritonitis, locally large abscesses (over 0.5l) and non-controlling supporting the systematic use of abdominal drainage. Abdominal
pancreatitis. Standard laparotomy, removal of necrosis, evacuation drainage is not easy, especially due to more complicated anatomical
of purulent deposits, and lavage of the area are followed by conditions and the presence of consciousness and intestinal loops.
insertion of two to four thin catheters into the inflammatory area Very quickly after the insertion of the drain, they envelop the
or fluid collection. From this area, the fluid is then drained through drain and sometimes make it functional. This is even more true for
four to six (according to some authors up to 11) thick drains abdominal vacuum drainage. Fluid (this also applies to the abscess)
placed on the base of the abdominal cavities or directly into the tends to accumulate in the abdominal cavity at certain predilection
area of inflammation (e.g., peripancreatically). It is advantageous sites (Douglas space, retroperitoneal space, subphrenic spaces,
to use two-way drains (Tenckhoff), due to the current lavage and subhepatic space, paracolic spaces - depending on the patient’s
drainage. Continuous lavage in the abraded cavity with a volume position), so the surgeon’s decision to drain is in place and most
of about 1 liter per hour is performed with a solution intended for often applies to these areas. Tubular drains made of biocompatible
peritoneal dialysis. inert material are most suitable for abdominal drainage. Their

Copyright@ Marián Bakoš | Biomed J Sci & Tech Res | BJSTR. MS.ID.006912. 34647
Volume 43- Issue 3 DOI: 10.26717/BJSTR.2022.43.006912

location has drainage success, especially when stored in preformed 12. Papavramidis TS, Marinis AD, Pliakos I, Kesisoglou I, Papavramidou
N (2011) Abdominal compartment syndrome - Intra-abdominal
areas or near parenchymal organs, to minimize the possibility of
hypertension: Defining, diagnosing, and managing. Journal of
clogging with momentum or intestinal loops. Due to the nature of Emergencies, Trauma, and Shock 4(2): 279291.
the effusion that is resolved by abdominal drainage, the expected 13. Carlotti AP, Carvalho WB (2009) Abdominal compartment syndrome: A
drainage fluid content, and other factors, in addition to the simple review. Pediatr Crit Care Med 10(1): 115-120.
tubular drain after abdominal surgery, other drainage systems are 14. Domínguez Fernández E, Post S (2003) Abdominal drainages. Chirurg
used, as mentioned above. 74(2): 91-98.
15. Durai R, Mownah A, Philip CH Ng (2009) Use of drains in surgery: a
References review. Journal of Perioperative Practice 19: 180-186.
1. Ramesh BA, Jayalakshmi BK (2021) Suction Drains. StatPearls. Treasure 16. Böhm B, Neudecker J, Ruff J, Műller JM (1998) Zuganswege und
Island (FL): StatPearls Publishing. Drainagen bei konventioneller Cholezystektomie, Gastrektomie und
2. Puleo FJ, Mishra N, Hall JF (2013) Use of intra-abdominal drains. Clinics Sigmaresektion. Ergebnisse einer Umfrage an deutchen Kliniken.
in Colon and Rectal Surgery 26(3): 174–177. Viszeralchirurgie 33: 316-324.

3. Durai R, Mownah A, Philip CH N (2009) Use of Drains in Surgery: A 17. Cozzaglio L, Cimino M, Mauri G, Ardito A, Pedicini V, et al. (2011)
Review. Journal of Perioperative Practice 19(6): 180-186. Percutaneous transhepatic biliary drainage and occlusion balloon in
the management of duodenal stump fistula. J Gastrointest Surg 15(11):
4. Chestovich PJ, Jennings CS, Fraser DR, Ingalls NK, Morrissey SL, et al. 1977-1981.
(2020) Too Big, Too Small or Just Right? Why the 28 French Chest Tube
Is the Best Size. J Surg Res 256: 338-344. 18. Richards RJ (2011) Management of abdominal and pelvic abscess in
Crohn’s disease. World journal of gastrointestinal endoscopy 3(11):
5. Ostadfar A (2016) Chapter 1 - Fluid Mechanics and Biofluids Principles. 209-212.
Biofluid Mechanics, p. 1-60.
19. Thiede A, Engemann R, Imhof M (1993) Drainagetechniken und
6. Smith SR, Connolly JC, Crane PW, Gilmore OJ (1982) The effect of surgical Drainageprinzipien in der visceralen Chirurgie, Chirurg 64: 90-95.
drainage materials on colonic healing. Br J Surg 69: 153-155.
20. Beattie G, A Siriwardena A (2000) Bacterial infection and extent of
7. Černý J (1992) A kolektív: Špeciálna chirurgia II.-deli, Chirurgia brušných necrosis are determinants of organ failure in patients with acute
orgánov a retroperitonea, I. vydanie, Martin, Dérerova zbierka, Osveta, necrotizing pancreatitis. British Journal of Surgery 87(2): 1020-1024.
pp. 105-779.
21. De Filippo M, Puglisi S, D’Amuri F, Gentili F, Paladini I, et al. (2021) CT-
8. Čapov I, Weschler J (2001) Drény a jejich využití v chirurgických oborech. guided percutaneous drainage of abdominopelvic collections: a pictorial
Czech : 1. Vyd. essay. La Radiologia medica 126(12): 1561-1570.
9. Čihak, Radomír a Miloš GRIM (2013) Anatomie. 2. 3. vydání. Praha 22. Malkov IS, Shaĭmardanov R Sh, Zaĭnutdinov AM, Birial’tsev VN, Lustina
: Grada. NI (2002) Laparoscopic sanitation of the abdominal cavity in combined
treatment of peritonitis. Khirurgiia (Mosk) (6): 30-33.
10. Pavel Petrovický (2001)  Anatomie s topografií a klinickými aplikacemi
(I. svazek). Martin. Osveta, pp. 463. 23. Beger HG, Isenmann R (1999) Surgical management of necrotising
pancreatitis. Surg Clin North Am 79(4): 783-800.
1. Newman RK, Dayal N, Dominique E (2021) Abdominal Compartment
Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing
2022.
11. Schein M, Wittmann DH, Aprahamian CC, Condon RE (1995) The
abdominal compartment syndrome: the physiological and clinical
consequences of elevated intra-abdominal pressure. J Am Coll Surg
180(6): 745-753.

ISSN: 2574-1241
Assets of Publishing with us
DOI: 10.26717/BJSTR.2022.43.006912
Marián Bakoš. Biomed J Sci & Tech Res • Global archiving of articles
• Immediate, unrestricted online access
This work is licensed under Creative • Rigorous Peer Review Process
Commons Attribution 4.0 License
• Authors Retain Copyrights
Submission Link: https://biomedres.us/submit-manuscript.php
• Unique DOI for all articles

https://biomedres.us/

Copyright@ Marián Bakoš | Biomed J Sci & Tech Res | BJSTR. MS.ID.006912. 34648

You might also like