PURPOSE: Although many studies have concluded that prophylactic drain insertion during elective liver resection offers few advantages, we reassessed the clinical value and appropriate management of drain insertion. METHODS: We retrospectively studied the clinical value of abdominal drainage in 167 consecutive patients who underwent hepatectomy, focusing on drainage volumes, bilirubin concentrations, drainage fluid bacterial culture results and short-term postoperative outcomes. The results were then validated prospectively in the next 50 consecutive patients to undergo hepatectomy. RESULTS: Most of the patients with morbidities such as biliary fistulas, ascites, fluid collection or duodenal perforation (20/24 or 83 %) were treated using operative drainage tubes, avoiding the use of percutaneous drainage procedures. The values obtained with the formula (drainage fluid bilirubin concentration/serum bilirubin concentration) × drainage fluid volume, were greater on both postoperative days (POD) 2 and 3 (P = 0.03 and P < 0.01) in patients with biliary leakage compared with those observed in the patients without leakage. The bacteriologic cultures of drainage fluid were positive less frequently on POD 4 or earlier (7/203) than on POD 5 or later (24/74, P < 0.01). In the validation cohort, new drain removal criteria based on the retrospective results led to successful drain management without additional treatment in 96 % of patients. CONCLUSIONS: Abdominal drainage is effective for both postoperative monitoring and morbidity treatment.
PURPOSE: Although many studies have concluded that prophylactic drain insertion during elective liver resection offers few advantages, we reassessed the clinical value and appropriate management of drain insertion. METHODS: We retrospectively studied the clinical value of abdominal drainage in 167 consecutive patients who underwent hepatectomy, focusing on drainage volumes, bilirubin concentrations, drainage fluid bacterial culture results and short-term postoperative outcomes. The results were then validated prospectively in the next 50 consecutive patients to undergo hepatectomy. RESULTS: Most of the patients with morbidities such as biliary fistulas, ascites, fluid collection or duodenal perforation (20/24 or 83 %) were treated using operative drainage tubes, avoiding the use of percutaneous drainage procedures. The values obtained with the formula (drainage fluid bilirubin concentration/serum bilirubin concentration) × drainage fluid volume, were greater on both postoperative days (POD) 2 and 3 (P = 0.03 and P < 0.01) in patients with biliary leakage compared with those observed in the patients without leakage. The bacteriologic cultures of drainage fluid were positive less frequently on POD 4 or earlier (7/203) than on POD 5 or later (24/74, P < 0.01). In the validation cohort, new drain removal criteria based on the retrospective results led to successful drain management without additional treatment in 96 % of patients. CONCLUSIONS: Abdominal drainage is effective for both postoperative monitoring and morbidity treatment.
Authors: J Arend; K Schütte; J Weigt; S Wolff; U Schittek; S Peglow; K Mohnike; C Benckert; C Bruns Journal: Chirurg Date: 2015-02 Impact factor: 0.955
Authors: Edgar M Wong-Lun-Hing; Victor van Woerden; Toine M Lodewick; Marc H A Bemelmans; Steven W M Olde Damink; Cornelis H C Dejong; Ronald M van Dam Journal: Dig Surg Date: 2017-03-25 Impact factor: 2.588
Authors: Jean M Butte; Jan Grendar; Oliver Bathe; Francis Sutherland; Sean Grondin; Chad G Ball; Elijah Dixon Journal: HPB (Oxford) Date: 2014-07-16 Impact factor: 3.647