Post-Laparoscopic Surgery: Managing Drainage and Fluid Leakage Concerns

Postoperative drainage issues after laparoscopic surgery?

Hello Doctor, I underwent laparoscopic surgery for intestinal volvulus last week, and the twisted segment of the small intestine was not resected during the procedure.
On the 7th postoperative day, the drain was removed, and I have been covering the area with a 4x4 gauze pad after disinfecting with Betadine.
I would like to ask if it is normal for the gauze pad to become wet over two-thirds within about an hour at times.
Is this an indication of excessive drainage? Should I return for a follow-up? What amount of drainage is considered normal? (Note: It has been two days since my discharge (9 days post-surgery), and I need to change the entire gauze pad approximately 7-10 times a day, with varying frequency; sometimes I need to change it every hour, while other times it can go 5 hours without needing a change.
The drainage fluid is light yellow, occasionally with a very faint reddish tint, and has no odor.
The wound is not red or swollen, and I have no fever or pain.)

A Guang, 20~29 year old female. Ask Date: 2020/12/30

Dr. Chen Jiaming reply Surgery

Based solely on the amount of drainage you described, it does seem to be on the higher side.
Generally, after the removal of an abdominal drain, suturing is not typically performed, as the wound is expected to heal naturally over a few days.
However, if there is a persistent high level of drainage, it may delay the natural healing process.
Although it appears that the fluid is likely just ascitic fluid, you might consider returning for a follow-up appointment to discuss this with your physician and request assistance with suturing to reduce the inconvenience of home care.

Reply Date: 2020/12/30

More Info

After undergoing laparoscopic surgery for bowel volvulus, it is understandable to have concerns regarding drainage and fluid leakage from the surgical site. Your description of the drainage situation provides important clues about the healing process and potential complications.

Firstly, it is not uncommon for patients to experience some degree of fluid drainage from the surgical site after laparoscopic procedures. The amount and nature of this drainage can vary significantly among individuals. In your case, the fact that you are experiencing a significant amount of drainage, with the dressing becoming saturated within an hour or so, raises some questions about the normalcy of this situation.

Understanding Post-Surgical Drainage
1. Nature of the Drainage: The fluid you describe as "light yellow" with occasional very faint red tinge is likely serous fluid, which is a normal part of the healing process. However, the presence of any blood, even if faint, can indicate that there might be some bleeding at the surgical site. The absence of foul odor and the lack of redness, swelling, or pain are positive signs, suggesting that there may not be an active infection.

2. Volume of Drainage: The amount of drainage that is considered "normal" can vary. Generally, a small amount of serous drainage is expected in the first few days post-surgery. However, if you find yourself needing to change the dressing 7-10 times a day, especially if it becomes saturated within an hour, this could be indicative of excessive drainage. It is important to monitor the volume and characteristics of the fluid closely.

3. When to Seek Medical Attention: Given that you are experiencing a high frequency of dressing changes and significant drainage, it would be prudent to consult your surgeon or healthcare provider. They can assess whether this level of drainage is within the expected range for your specific situation or if it indicates a complication such as a seroma (a pocket of clear fluid that can develop after surgery) or a potential leak from the surgical site.

Recommendations for Management
- Keep the Area Clean and Dry: Continue to use your antiseptic solution (like Betadine) to clean the area, but ensure that you are not irritating the skin around the wound. Change the dressing as needed, especially if it becomes saturated.

- Monitor for Changes: Keep an eye on the drainage. If it becomes more bloody, changes in color, or if you develop any signs of infection (increased redness, swelling, warmth, or fever), seek medical attention immediately.

- Follow-Up Appointments: It may be beneficial to schedule a follow-up appointment with your surgeon, especially if the drainage does not decrease or if you have any concerns. They may want to evaluate the wound to ensure proper healing and rule out any complications.

Conclusion
In summary, while some drainage is normal after laparoscopic surgery, the volume and frequency you are experiencing warrant further evaluation. It is always better to err on the side of caution when it comes to post-operative care. Regular follow-ups and open communication with your healthcare provider are key to ensuring a smooth recovery process. If in doubt, do not hesitate to reach out to your surgical team for guidance.

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