title: The role of peri-hepatic drain placement in liver surgery: a prospective analysis.
abstract: BACKGROUND
  The standard use of an intra-operative perihepatic drain (IPD) in liver surgery is controversial and mainly supported by retrospective data. The aim of this study was to evaluate the role of IPD in liver surgery.
  
  
  METHODS
  All patients included in a previous, randomized trial were analysed to determine the association between IPD placement, post-operative complications (PC) and treatment. A multivariate analysis identified predictive factors of PC.
  
  
  RESULTS
  One hundred and ninety-nine patients were included in the final analysis of which 114 (57%) had colorectal liver metastases. IPD (n = 87, 44%) was associated with pre-operative biliary instrumentation (P = 0.023), intra-operative bleeding (P < 0.011), Pringle's manoeuver(P < 0.001) and extent of resection (P = 0.001). Seventy-seven (39%) patients had a PC, which was associated with pre-operative biliary instrumentation (P = 0.048), extent of resection (P = 0.002) and a blood transfusion (P = 0.001). Patients with IPD had a higher rate of high-grade PC (25% versus 12%, P = 0.008). Nineteen patients (9.5%) developed a post-operative collection [IPD (n = 10, 11.5%) vs. no drains (n = 9, 8%), P = 0.470]. Seven (8%) patients treated with and 9(8%) without a IPD needed a second drain after surgery, P = 1. Resection of ≥3 segments was the only independent factor associated with PC [odds ratio (OR) = 2, P = 0.025, 95% confidence interval (CI) 1.1-3.7].
  
  
  CONCLUSIONS
  In spite of preferential IPD use in patients with more complex tumours/resections, IPD did not decrease the rate of PC, collections and the need for a percutaneous post-operative drain. IPD should be reserved for exceptional circumstances in liver surgery.
authors.affiliation: Division of General Surgery, Service of Hepatobiliary and Pancreatic Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Butte
authors.forename: Jan
authors.initials: J
authors.lastname: Grendar
authors.forename: Oliver
authors.initials: O
authors.lastname: Bathe
authors.forename: Francis
authors.initials: F
authors.lastname: Sutherland
authors.forename: Sean
authors.initials: S
authors.lastname: Grondin
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
mesh_terms: D016208:Databases, Factual; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome