Do drain tubes help reduce risks of post‐operative complications in complex incisional hernia repair (as defined by a recent court ruling)?

Background A recent legal case described in the ANZ Journal of Surgery has sparked significant topical interest in drain tube use in incisional hernia repairs in Australia. This study reviews a single centre experience of drain tube use in incisional hernia repair. Methods Data from online clinical records was collected retrospectively from patients that underwent incisional hernia repair from 1 January 2013 to 31 December 2017. ‘Complexity’ factors of smoking, obesity and lower midline incision (as identified by the legal case) were also used to stratify groups. Results A total of 410 incisional hernia repair cases were identified during the 5‐year period. Median length of stay of the non‐drain placement group was significantly shorter than that of the drain placement group (2 versus 6 days, P < 0.001). In total, 10.8% of patients with drain suffered from post‐op wound infection compared to 3.6% in patients without a drain tube in‐situ ( P = 0.005). Seroma rates were no different with or without a drain (15.7% versus 16.9% P = 0.78). When stratified by ‘complexity’, there was a trend towards increased complications when drains were used. Conclusion Drain tubes were placed in only a small proportion of patients during incisional hernia repairs and were associated with a higher post‐operative wound infection rate. When stratified by the ‘complexity’ factors outlined by the recent legal case, complications in more ‘complex’ patients may actually increase when a drain tube is used.