Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9584-9591
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9584
Ureteroscopic holmium laser to transect the greater omentum to remove an abdominal drain: Four case reports
Hong-Ming Liu, Guang-Heng Luo, Xiao-Fei Yang, Zhu-Gang Chu, Tian Ye, Zhi-Yong Su, Li Kai, Xiu-Shu Yang, Zhen Wang
Hong-Ming Liu, Guang-Heng Luo, Zhu-Gang Chu, Tian Ye, Zhi-Yong Su, Li Kai, Xiu-Shu Yang, Zhen Wang, Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
Hong-Ming Liu, Zhi-Yong Su, Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
Xiao-Fei Yang, Department of General Surgery, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
Author contributions: Luo GH, Yang XF and Liu HM conceived and designed the study. Chu ZG, Liu HM and Su ZY collected and recorded the patients’ clinical data. Tian Y, Li K and Wang Z assisted with the statistical analyses. Liu HM and Tian Y drafted the manuscript. Luo GH and Yang XS participated in revision of the manuscript. All authors read and approved the final manuscript.
Supported by The National Natural Science Foundation of China, No. 31660293.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guang-Heng Luo, MD, Chief Physician, Director, Doctor, Professor, Department of Urology, Guizhou Provincial People’s Hospital, No. 83 Zhongshan East Road, Nanming District, Guiyang 550002, Guizhou Province, China. lgh2002v@163.com
Received: March 29, 2021
Peer-review started: March 29, 2021
First decision: April 28, 2021
Revised: May 12, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: November 6, 2021
Processing time: 214 Days and 8.6 Hours
Abstract
BACKGROUND

Drainage tube removal is difficult when the greater omentum becomes incarcerated in the drainage tube through the side holes. Currently, known removal methods are either ineffective or will cause additional damage to the patient in a secondary operation. Ureteroscopy and the holmium laser have been used in various surgical techniques in urology, and in theory, they are expected to be a good strategy for solving the problem of tissue incarceration.

CASE SUMMARY

Four patients diagnosed with difficult removal of an abdominal drainage tube following abdominal surgery are reported. All patients underwent surgery to remove the incarcerated greater omentum in the drainage tube using a holmium laser and a ureteroscope, and a new 16-F drain was then placed in the abdominal or pelvic cavity. The efficacy of this technique was evaluated by intraoperative conditions, success rate, and operating time; safety was evaluated by perioperative conditions and the probability of postoperative complications. All four operations went smoothly, and the drains were successfully removed in all patients. The average operating time was 24.5 min. Intraoperatively, the average irrigation volume was 892.0 mL, the average drainage volume was 638.5 mL, and no bleeding or damage to surrounding tissues was observed. Postoperatively, the average drainage volume was 32.8 mL and the new drains were removed within 36 h. All patients were able to get out of bed and move around within 12 h. Their visual analogue pain scores were all below 3. The average follow-up duration was 12.5 mo and no complications such as fever or bleeding were noted.

CONCLUSION

Ureteroscopic holmium laser surgery is an effective, safe and minimally invasive technique for removing drains where the greater omentum is incarcerated in the abdominal drain.

Keywords: Ureteroscope; Holmium laser; Drainage; Greater omentum; Complication of abdominal surgery; Case report

Core Tip: Inability to remove an abdominal drainage tube is a complication of abdominal surgery, and one of the main reasons for this is that the greater omentum can become incarcerated in the drainage tube. We report four cases of difficult removal of an abdominal drainage tube treated with ureteroscopic holmium laser surgery to transect the greater omentum. This may be the first report of the use of this technique to successfully remove drainage tubes. All four patients recovered well after surgery and no complications were observed during follow-up. This strategy successfully decreased the risk of a secondary operation, additional hospitalization and minimized patient discomfort.