Paschalis Gavriilidis1, Ernest Hidalgo2, Nicola de'Angelis3, Peter Lodge2, Daniel Azoulay4. 1. Department of HPB and Transplant Surgery, St James's University Hospital, Beckett Str, Leeds LS9 7TF, UK; Department of HPB Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France. 2. Department of HPB and Transplant Surgery, St James's University Hospital, Beckett Str, Leeds LS9 7TF, UK. 3. Department of HPB Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France. 4. Department of HPB Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; INSERM U 955, Créteil, France. Electronic address: daniel.azoulay@hmn.aphp.fr.
Abstract
AIM: The benefit of prophylactic drainage after uncomplicated hepatectomy remains controversial. The aim of this study was to update the existing evidence on the role of prophylactic drainage following uncomplicated liver resection. METHODS: Cochrane, Medline (Pubmed), and Embase were searched. The Medline search strategy was adopted for all other databases. A grey literature search was performed. Meta-analyses were performed with Review Manager 5.3. Primary outcomes were mortality and ascitic leak, secondary outcomes were infected intra-abdominal collection, chest infection, wound infection of the surgical incision, biliary fistula, and length of stay. RESULTS: The incidence of ascitic leak was higher in the drained group (Odds Ratio = 3.33 [95% Confidence Interval: 1.66-5.28]). Infected intra-abdominal collections, wound infections, chest infections, biliary fistula, length of stay and mortality were not statistically different between groups. CONCLUSIONS: The routine utilisation of drains after elective uncomplicated liver resection does not translate into a lower incidence of postoperative complications. Therefore, based on the current available evidence, routine abdominal drainage is not recommended in elective uncomplicated hepatectomy.
AIM: The benefit of prophylactic drainage after uncomplicated hepatectomy remains controversial. The aim of this study was to update the existing evidence on the role of prophylactic drainage following uncomplicated liver resection. METHODS: Cochrane, Medline (Pubmed), and Embase were searched. The Medline search strategy was adopted for all other databases. A grey literature search was performed. Meta-analyses were performed with Review Manager 5.3. Primary outcomes were mortality and ascitic leak, secondary outcomes were infected intra-abdominal collection, chest infection, wound infection of the surgical incision, biliary fistula, and length of stay. RESULTS: The incidence of ascitic leak was higher in the drained group (Odds Ratio = 3.33 [95% Confidence Interval: 1.66-5.28]). Infected intra-abdominal collections, wound infections, chest infections, biliary fistula, length of stay and mortality were not statistically different between groups. CONCLUSIONS: The routine utilisation of drains after elective uncomplicated liver resection does not translate into a lower incidence of postoperative complications. Therefore, based on the current available evidence, routine abdominal drainage is not recommended in elective uncomplicated hepatectomy.
Authors: C Hobeika; F Cauchy; E Weiss; S Chopinet; A Sepulveda; F Dondero; L Khoy-Ear; B Grigoresco; S Dokmak; F Durand; B Le Roy; C Paugam-Burtz; O Soubrane Journal: BJS Open Date: 2021-01-08