Value of prophylactic abdominal drainage in 1269 consecutive cases of elective liver resection.
BACKGROUND
The value of prophylactic abdominal drainage in patients undergoing hepatectomy is controversial. We carried out a retrospective study to clarify the value of this procedure.


METHODS
The study subjects were 1269 consecutive patients who underwent elective hepatectomy with drain insertion for malignant tumors without associated gastrointestinal procedures or bilio-enteric anastomosis. Symptomatic abdominal fluid collections were treated by the drain salvage method, percutaneous puncture, and/or re-operation, in that order of preference.


RESULTS
One patient died (mortality rate, 0.07%) and 7 patients had postoperative bleeding (0.6%). Bile leakage, found in 111 (8.7%) patients, subsided with retention of the drain in 78 (70%) and use of the drain salvage technique in 8 (7.2%), whereas percutaneous puncture and re-operation were required in 11 (9.9%) and 14 (12.6%). Symptomatic fluid collection, observed in 65 (5.1%) patients, was treated by the drain salvage technique in 20 (31%) patients, while puncture and re-operation were required in 25 (38%) and 20 (31%).


CONCLUSIONS
Placement of drains was effective in a considerable proportion of patients undergoing hepatectomy, with regard to reducing the frequency of development of subphrenic fluid collections and biliary fistula/biloma formation.
Kyoden
Yusuke
Y
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Imamura
Hiroshi
H
Sano
Keiji
K
Beck
Yoshifumi
Y
Sugawara
Yasuhiko
Y
Kokudo
Norihiro
N
Makuuchi
Masatoshi
M
D034841:Abdominal Cavity / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001658:Biliary Fistula / Q000209:etiology / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002915:Chylous Ascites / Q000209:etiology / Q000517:prevention & control; D004322:Drainage / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult