233. UTILITY OF SINGLE TRANSHIATAL CHEST DRAINAGE AFTER MINIMALLY INVASIVE OESOPHAGECTOMY: A PROPENSITY-SCORE MATCHED STUDY OF FEASIBILITY

Abstract Background The routine placement of intercostal chest drains remains common practice following minimally invasive oesophagectomy (MIO). Chest drains may contribute to increased post-operative pain and morbidity. The aim of this study was to compare the outcomes of transhiatal chest drain with intercostal chest drain. We analysed use of analgesia, length of hospital stay, and postoperative pulmonary morbidity following MIO. Methods This was a retrospective case-control study of patients undergoing elective MIO at a quaternary centre in Western Australia between September 2016 and September 2023. To reduce confounding, propensity score matching was performed. All patients were identified from a prospectively maintained database. In patients undergoing MIO with exclusive transhiatal drainage, a 19 French Blake’s drain was advanced through the hiatus into the right pleural cavity and positioned adjacent to the anastomosis. Results Thirty patients were included in the study, fifteen of whom had exclusively transhiatal drain placement. Mean total daily oral morphine dose equivalent was significantly lower in the transhiatal drain group (58mg+/-35.8) compared with intercostal drain group (100.8mg+/-64.0) on day 1 (p=0.04). There is no statistically significant difference between the total oral morphine use on days 3 (p=0.44) and 6 (p=0.97). No significant difference was observed in reintervention rate (p=1.00), length of stay (p=0.78) or postoperative pulmonary complications (p=1.00). Conclusion The results of this study suggest that transhiatal drain placement following MIO is associated with a reduction in post-operative pain and no increase in pulmonary complications or length of stay. Larger, prospective studies are needed to further evaluate the safety of single transhiatal chest drain placement following MIO.