Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment.
BACKGROUND
Routine prophylactic abdominal drainage after hepatic surgery is still being debated, as it may be unnecessary, possibly harmful, and uncomfortable for patients. This study evaluated the safety of a no-drain policy after liver resection within an Enhanced Recovery after Surgery (ERAS) programme.


METHODS
All hepatectomies performed without prophylactic drainage during 2005-2014 were included. Primary end points were resection-surface-related (RSR) morbidity, defined as the presence of postoperative biloma, hemorrhage or abscess, and reinterventions. Secondary end points were length of stay, total postoperative morbidity, the composite end point of liver surgery-specific complications, readmissions, and 90-day mortality. Uni- and multivariate analyses were performed to identify independent risk factors for RSR morbidity. A systematic search was performed to compare the results of this study to literature.


RESULTS
A total of 538 resections were included in the study. The RSR complication and reintervention rate was 15 and 12%, respectively. Major liver resection (≥3 segments) was an independent risk factor for the development of RSR morbidity (OR 3.01, 95% CI 1.61-5.62; p = 0.001) and need for RSR reintervention (OR 3.02, 95% CI 1.59-5.73; p = 0.001).


CONCLUSIONS
RSR morbidity, mortality, and reintervention rates after liver surgery without prophylactic drainage in patients, treated within an ERAS programme, were comparable to previously published data. A no-drain policy after partial hepatectomy seems safe and feasible.
Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
Edgar M
EM
Wong-Lun-Hing
Victor
V
van Woerden
Toine M
TM
Lodewick
Marc H A
MHA
Bemelmans
Steven W M
SWM
Olde Damink
Cornelis H C
CHC
Dejong
Ronald M
RM
van Dam
D018784:Abdominal Abscess / Q000209:etiology* / Q000601:surgery; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology* / Q000601:surgery; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
Abdominal drainage; Drain; Liver surgery; No-drain; Prophylactic drainage