Re-evaluation of the necessity of prophylactic drainage after liver resection.

Abdominal drainage after liver resection is considered unnecessary: however, there still exist a number of cases where drain is effective to prevent serious infectious complications. We re-evaluated the necessity of drain placement after liver resection from the retrospective analysis of postoperative complications with special reference to the need for drain insertion of 140 patients undergoing hepatectomy without intraoperative abdominal drainage from 2007 through 2010. Three patients required drain reinsertion in the early postoperative period (before postoperative Day 7); all had undergone extended right hepatectomy for hepatocellular carcinoma with portal vein thrombus followed by postoperative liver failure. Risk factors for postoperative bile leakage included repeated hepatectomy, operative procedure with exposure of the major Glisson's sheath (i.e., central bisegmentectomy and anterior segmentectomy), and intraoperative bile leakage. However, because the onset of this complication was as late as postoperative Day 19.5, prophylactic drainage does not appear useful. Although not required routinely, prophylactic drainage might be useful in patients undergoing extended hepatectomy, a high-risk hepatectomy procedure exposing the major Glisson's sheath, those with positive intraoperative bile leakage, for hepatocellular carcinoma, and especially complicated with portal vein thrombus.