In 1954, Redon first proposed VSD that increased drainage efficacy and wound healing rate [2]. In 1995, Qiu et al. applied abdominal VSD for the first time in China [3]. Later, many studies have shown that VSD is effective in controlling abdominal infection, clearing abscess and shortening healing time [4, 5, 6].
In conventional VSD after abdominal surgery, however, foam materials should be placed between the abdominal soft tissues and the side hole of VSD tube. Otherwise, the soft tissues may be exposed to the side hole, triggering focal necrosis of the intestinal wall. Besides, granulated tissues may also grow into the foam material [7]. However, in laparoscope-guided open surgery, it is unfeasible to put the foam material into or out of the abdomen. In 1983, an original patent was issued, which described a novel drainage method named Blake drain. The inventor's name is Larry W. Blake. The Blake drain's design has 4 open fluted channels to prevent the plugging of draining perforations. The drain today continues to be a popular drain of choice for surgeons in all subspecialties.[8]
We herein report a novel Blake drain method by transforming the end of drainage tube. we made two bar-shaped cuts at the end of drainage tube, 4-5 cm long and 2-3 cm long (Figure 1). In this way, the side hole of the tube was transformed into two cuts to prevent the omentum or other soft tissues being incarcerated. The pressure could also be dispersed through both relatively long cuts. Even if the tissues were suctioned, extubation could be quickly and easily performed. The outside of the drain tube was connected with a negative ball. With this technique, foam or other materials were unneeded, which significantly simplified the procedures of VSD. Therefore, this technique is especially suitable for laparoscopic surgeries.
Perforated appendicitis is common in children. Their omentum has not yet fully developed, and the appendix tissue is much thinner than that of adults. As a result, abdominal contamination becomes much more severe in children with perforated appendicitis, making postoperative drainage always necessary [9]. VSD has been extensively in clinical application, but its use in laparoscopic surgeries is rarely reported. In the present study, we treated 20 cases of laparoscopic appendectomy with this novel Blake drain. To convenience the drainage, the end of the drainage tube is inserted into the Douglas pouch, a site far below the omentum. Early off-bed activities can also promote apocenosis through the tube. After that, we tried this technique in laparoscopic pyeloplasty that is always challenged by the lodged tube. In a case prior to this study, for example, we used ureteroscope to remove the drainage tube that had suctioned the omentum tissues into its side holes. Notably, in pyeoplasty treated with this novel Blake drain, the end of tube was still fixed near the renal pelvis stoma, and tissue plugging and other complications were not found, highly suggestive of its effectiveness and safety.
The novel technique is simple, safe and effective for VSD following laparoscopic surgery. It can prevent plugging of soft tissues into the tube.