Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method.
BACKGROUND
Abdominal drainage is a standard procedure after hepatectomy, but this practice has been challenged recently.


METHODS
Between September 2004 and March 2005, 120 consecutive patients who had undergone hepatic resection by the same surgical team were randomly allocated into drainage and no drainage groups (60 in each group). Patient characteristics, preoperative liver function, presence of cirrhosis, resection-related factors and postoperative complications were compared between the two groups.


RESULTS
The groups were comparable in terms of demographics, indications for surgery, preoperative liver function test results, presence of cirrhosis, extent of hepatectomy, intraoperative blood loss and requirement for blood transfusion. Symptomatic subphrenic collection and pleural effusion occurred in four patients (7 per cent) who had abdominal drainage and three (5 per cent) who did not. Local wound complications occurred in 17 (28 per cent) and two (3 per cent) patients respectively (P < 0.001). The postoperative hospital stay was similar in the two groups. Multivariate analysis indicated that the presence of cirrhosis and abdominal drainage were independently related to the development of postoperative wound complications.


CONCLUSIONS
Routine abdominal drainage is unnecessary after elective hepatectomy using the crushing clamp method.
Liver Cancer Institute and Zhong Shan Hospital, Fudan University, Shanghai 200032, China. sunhc@zshospital.com
H-C
HC
Sun
L-X
LX
Qin
L
L
Lu
L
L
Wang
Q-H
QH
Ye
N
N
Ren
J
J
Fan
Z-Y
ZY
Tang
D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D003250:Constriction; D004322:Drainage / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000601:surgery; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D013525:Surgical Instruments; D013528:Surgical Staplers; D016896:Treatment Outcome