The effectiveness and appropriate management of abdominal drains in patients undergoing elective liver resection: a retrospective analysis and prospective case series
Tanaka, K.; Kumamoto, T.; Nojiri, K.; Takeda, K.; Endo, I.
Surgery Today 43(4): 372-380
2013
ISSN/ISBN: 0941-1291 PMID: 22797963 DOI: 10.1007/s00595-012-0254-1
Accession: 056315194
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. 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. 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. Abdominal drainage is effective for both postoperative monitoring and morbidity treatment.