Drainage is unnecessary after elective liver resection.
OBJECTIVE
A prospective, randomized trial was performed to determine if intra-abdominal drainage catheters are necessary after elective liver resection.


METHODS
Between April 1992 and April 1994, 120 patients subjected to liver resection, stratified by extent of resection and by surgeon, were randomized to receive or not receive operative closed-suction drainage. Operative blood loss was not an exclusion criteria, and no patient who consented to the study was excluded.


RESULTS
Eighty-seven patients (73%) had resection of one hepatic lobe or more (27 lobectomies, 54 trisegmentectomies, and 6 bilobar atypical resections) and 33 had less than a lobectomy (8 wedge resections or enucleations, 9 segmentectomies, and 16 bisegmentectomies). Eighty-four patients (70%) had metastatic cancer and 36 patients (30%) had primary liver pathology. There were no differences in outcome, including length of hospital stay (no drain, 13.4 +/- 0.9 days; drain, 13.1 +/- 0.8 days; P = not significant [NS]), mortality (no drain, 3.3%; drain, 3.3%), complication rate (no drain, 43%; drain, 48%; P = NS), or requirement for subsequent percutaneous drainage (no drain, 18%; drain, 8%; P = NS). All infected collections (n = 3) occurred in operatively drained patients. Two other complications were directly related to the operatively placed drains. One patient developed a subcutaneous abscess at the drain site, and a second developed a subcutaneous drain tract tumor recurrence as the only current site of recurrence.


CONCLUSIONS
In the first 50 consecutive resections performed since the conclusion of this trial, only 4 patients (8%) have required subsequent percutaneous drainage. We conclude that abdominal drainage is unnecessary after elective liver resection.
Fong
Y
Y
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Brennan
M F
MF
Brown
K
K
Heffernan
N
N
Blumgart
L H
LH
D000005:Abdomen; D000038:Abscess / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D017558:Elective Surgical Procedures; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007902:Length of Stay; D008107:Liver Diseases / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome