Role of Closed Suction Drains in Obese Patients Undergoing Major Urological Procedures: A Prospective Comparative Study.

BACKGROUND: Obese patients undergoing major urological procedures, such as open radical prostatectomy, open radical cystectomy, and open radical nephrectomy, are at heightened risk of postoperative wound complications, particularly seroma formation, due to increased subcutaneous fat thickness. Closed suction drains in the subcutaneous tissue are hypothesized to mitigate these complications by reducing dead space and fluid accumulation. This prospective, randomized, and comparative study investigates the efficacy of subcutaneous closed suction drains in reducing wound complications in obese patients undergoing these procedures. METHODS: Sixty obese patients (body mass index (BMI) >32 kg/m2, subcutaneous fat thickness ≥3 cm) scheduled for elective open radical prostatectomy, open radical cystectomy, or open radical nephrectomy were randomized into two groups: study (n = 30, with subcutaneous closed suction drains) and control (n = 30, without drains). Exclusion criteria included intraoperative spillage, sepsis, diabetes, malignancy beyond the primary urological condition, steroid therapy, or other factors affecting wound healing. Surgical techniques and wound closure were standardized, with prophylactic antibiotics administered. Subcutaneous fat thickness was measured intraoperatively. Outcomes, including seroma formation, wound infection, hematoma, and wound dehiscence, were assessed clinically over a one-month follow-up. Statistical analysis used chi-square tests, Fisher's exact tests, and logistic regression to evaluate associations. RESULTS: Seroma formation occurred in four (13.33%) patients in the study group and 14 (46.67%) in the control group (p = 0.004). The odds ratio (OR) for seroma formation without drains was 5.6 (95% CI: 1.6-19.8) for subcutaneous fat thickness of 3-3.9 cm and 8.9 (95% CI: 2.1-37.4) for 4-5 cm. Most seromas (75% in the study group, 78.57% in the control group) presented within the first postoperative week. Wound infection occurred in one (3.33%) control group patient (p = 0.99). No hematomas or wound dehiscence were reported. Logistic regression confirmed subcutaneous fat thickness as a significant predictor of seroma formation (p = 0.01). CONCLUSION: Prophylactic closed suction drains significantly reduce seroma formation and surgical site infection (SSI) in obese patients in obese patients undergoing major urological procedures, potentially decreasing postoperative morbidity and healthcare costs. Routine use is recommended in this population, with further research needed to optimize drain duration and evaluate efficacy in non-obese patients or minimally invasive procedures.