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Surgery Today

, Volume 43, Issue 4, pp 372–380 | Cite as

The effectiveness and appropriate management of abdominal drains in patients undergoing elective liver resection: a retrospective analysis and prospective case series

  • Kuniya TanakaEmail author
  • Takafumi Kumamoto
  • Kazunori Nojiri
  • Kazuhisa Takeda
  • Itaru Endo
Original Article

Abstract

Purpose

Although many studies have concluded that prophylactic drain insertion during elective liver resection offers few advantages, we reassessed the clinical value and appropriate management of drain insertion.

Methods

We retrospectively studied the clinical value of abdominal drainage in 167 consecutive patients who underwent hepatectomy, focusing on drainage volumes, bilirubin concentrations, drainage fluid bacterial culture results and short-term postoperative outcomes. The results were then validated prospectively in the next 50 consecutive patients to undergo hepatectomy.

Results

Most of the patients with morbidities such as biliary fistulas, ascites, fluid collection or duodenal perforation (20/24 or 83 %) were treated using operative drainage tubes, avoiding the use of percutaneous drainage procedures. The values obtained with the formula (drainage fluid bilirubin concentration/serum bilirubin concentration) × drainage fluid volume, were greater on both postoperative days (POD) 2 and 3 (P = 0.03 and P < 0.01) in patients with biliary leakage compared with those observed in the patients without leakage. The bacteriologic cultures of drainage fluid were positive less frequently on POD 4 or earlier (7/203) than on POD 5 or later (24/74, P < 0.01). In the validation cohort, new drain removal criteria based on the retrospective results led to successful drain management without additional treatment in 96 % of patients.

Conclusions

Abdominal drainage is effective for both postoperative monitoring and morbidity treatment.

Keywords

Liver resection Abdominal drain Morbidity Bile leak 

Abbreviations

CT

Computed tomography

HCC

Hepatocellular carcinoma

Hx

Hepatectomy

LDLT

Living donor liver transplant

MRSE

Methicillin-resistant Staphylococcus epidermidis

POD

Postoperative day(s)

PS

Prediction score

SE

Standard error

SIRS

Systemic inflammatory response syndrome

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Copyright information

© Springer 2012

Authors and Affiliations

  • Kuniya Tanaka
    • 1
    Email author
  • Takafumi Kumamoto
    • 1
  • Kazunori Nojiri
    • 1
  • Kazuhisa Takeda
    • 1
  • Itaru Endo
    • 1
  1. 1.Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan

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