~ 211 ~ International Journal of Surgery Science 2025; 9(1): 211-213 E-ISSN: 2616-3470 P-ISSN: 2616-3462 © Surgery Science www.surgeryscience.com 2025; 9(1): 211-213 Received: 11-11-2024 Accepted: 20-12-2024 Ketan Vagholkar Professor, Department of Surgery, D.Y. Patil University School of Medicine, Navi Mumbai. Maharashtra, India Corresponding Author: Ketan Vagholkar Professor, Department of Surgery, D.Y. Patil University School of Medicine, Navi Mumbai. Maharashtra, India Abdominal drain site incisional hernia (Case report) Ketan Vagholkar DOI: https://www.doi.org/10.33545/surgery.2025.v9.i1.D.1171 Abstract Intraperitoneal drains continue to be placed after major abdominal surgeries. The purpose of this is to prevent fluid collection in the dependent area of the peritoneal cavity. This continues to be a topic of debate with no consensus as yet. Abdominal drains by themselves can cause a multitude of complications. Herniation occurring at the site of drain insertion is a rare complication necessitating skillful surgical dissection and treatment. A case of drain site herniation in a 47-year-old patient who had undergone an open transabdominal hysterectomy is presented. Open meticulous layered dissection and placement of the mesh was performed. Post- operative recovery was uneventful. The advantages and disadvantages of abdominal drain is discussed. Keywords: Abdominal, drain, site, incisional, hernia Introduction Drains continues to be a solace to the operating surgeon aptly described by Lawsen Tate that is ‘When in doubt, drain’ [1] . Drains undoubtedly prevent any collection in the peritoneal cavity or in a few cases may even help in early detection of any anastomotic leak. Herniation at the drain site is an uncommon problem and poses a great challenge to the attending surgeon [2] . Case Report A 47-year-old lady presented with pain in the right iliac fossa for the last 2 months. She had undergone abdominal hysterectomy 2 years back through a lower midline abdominal incision. An abdominal tube drain was placed, which was brought out through an incision in the lower right side of the abdomen. The drain removal was followed by discharge and delayed wound healing of the drain site wound. Subsequently the patient was asymptomatic over the next few months. However, over the last 2 months she started complaining of severe abdominal pain in the right lower abdomen at the site of the drain scar. Physical examination revealed tenderness at the site of the drain site scar. No gross swelling was noted at that site. However, there was a slight bulge with impulse on coughing. (Fig.1.) The lower midline scar was irregular. There was no swelling in the vicinity of the midline scar. A CECT was done which revealed herniation in the region of the lower right abdomen underlying the drain site scar (Fig.2.). Patient underwent an open repair. An elliptical incision was made encompassing the scar. (Figure 3) The sac was identified after opening the external oblique aponeurosis. The sac was dissected up to the neck and opened. The herniating omentum was resected. (Figure 4) The defect in the internal oblique was clearly delineated and closed with a 1-0 prolene continuous suture. (Figure 5& 6) A space was created between the external oblique and internal oblique muscle for the placement of the mesh which was fixed with 2-0 interrupted sutures. (Figure 7) External oblique was approximated with 1-0 prolene continuous suture. Subcutaneous tissue was sutured using 2-0 vicryl and finally the skin was closed using staplers. Post-operative recovery was uneventful, staplers were removed on day 12 with complete healing of the incision. Discussion Drain site hernia is a rare condition [2] . As the size of the defect increases, the chances of herniation increase proportionately [2, 3] . A tube >1cm in diameter necessitates a bigger opening in the abdominal wall. Failure to approximate or close the defect after drain removal pre- disposes to the development of an incisional hernia. Infection at the drain site, compromis