Sleeve Gastrectomy is a bariatric procedure that restricts food intake by removing a large portion of the stomach. For many patients undergoing this surgery, a temporary surgical drain is placed to manage the immediate post-operative environment. The use of a drain varies based on surgeon preference and patient risk factors, but its presence serves protective functions during initial recovery.
The Role of Surgical Drains in Gastric Sleeve Recovery
A surgical drain, frequently a Jackson-Pratt (JP) drain, is a soft, flexible tube placed near the stomach staple line. The drain serves two primary functions immediately following the operation. The first is active surveillance, monitoring for a staple line leak. Changes in the color or volume of the fluid collected provide an early warning sign of a developing complication.
The second function is managing excess bodily fluids that naturally accumulate after major abdominal procedures. The drain removes serosanguineous fluid—a mix of blood and serum—that would otherwise collect in the surgical space. Collecting this material prevents the formation of fluid pockets like seromas or hematomas, which reduces post-operative pain and minimizes the risk of infection.
Duration and Removal of the Drain
The duration the drain remains in place is determined by the volume and nature of the fluid collected. The drain is temporary and often removed before the patient is discharged from the hospital, typically within one to three days after the procedure. Removal occurs once the output has decreased significantly, indicating that immediate post-operative fluid production has subsided.
If patients are discharged with the drain still in place, it is removed when the output is consistently low, often less than 25 to 30 milliliters over a 24-hour period. This removal occurs during a follow-up clinic visit, sometimes a week or more after surgery. The procedure is quick, performed by a nurse or surgeon once the output criteria are met, and patients report feeling a brief, tugging sensation rather than intense pain.
Caring for the Drain Tube
Proper care of the drain is part of the recovery process if the device remains in place after hospital discharge. Patients must accurately measure and record the output from the collection bulb, typically every eight hours or whenever the bulb is about half full. The measurement, recorded in milliliters (mL) or cubic centimeters (cc), should include the fluid’s color and be logged on a dedicated sheet.
To ensure continuous, effective suction, the tubing must be “milked” or stripped several times a day to prevent clots from blocking the flow. This involves pinching the tubing close to the body with one hand and using the thumb and forefinger of the other hand to firmly slide down the tube toward the collection bulb. This action clears the tubing, pushing stagnant fluid into the bulb and maintaining vacuum pressure.
The insertion site must be kept clean and dry to prevent irritation and infection. If a dressing is required, it should be changed daily or whenever it becomes soiled, using clean gauze and following the surgeon’s instructions for cleaning the surrounding skin. The drain bulb should be secured safely to clothing, often using a safety pin, to prevent accidental pulling or tension on the insertion site, which can be painful and lead to dislodgement.
When to Contact Your Surgical Team
It is important to recognize signs related to the drain that require contacting your surgical team. A sudden cessation of drainage, especially if the collection bulb is no longer compressed and holding suction, can signal a blockage or dislodgement. This lack of output is a concern because fluid may be accumulating internally.
Any significant increase in the volume of drainage, particularly if it changes to bright red blood, should be reported as it may indicate new bleeding. Signs suggesting infection or serious complications require immediate assessment:
- A change in the fluid’s appearance to a cloudy, pus-like, or foul-smelling discharge.
- Signs of infection at the insertion site, such as severe redness, increased swelling, or warmth.
- Systemic symptoms like a high fever or severe abdominal pain not relieved by medication.
- A rapid, persistent heart rate (tachycardia) alongside a drain issue.