Practical experience of a no abdominal drainage policy in patients undergoing liver resection.

BACKGROUND/AIMS: Routine use of abdominal drainage after liver resection is controversial. The aim of this study was to investigate the practical application of a "no abdominal drainage" policy for consecutive patients undergoing hepatic resection.

METHODOLOGY

The present trial included 60 consecutive patients who underwent elective hepatic resection. Fifty-two patients underwent no abdominal drainage, and in the remaining eight drainage was necessary because of gross contamination of the surgical field associated with bilioenteric anastomosis, uncontrollable bile leakage from the cut surface of the liver, or the surgeon's preference. Patient demographics, intraoperative data, and postoperative complications and mortality were evaluated.

RESULTS

There was no hospital death. Eight complications occurred in 8 patients in the no-drainage group (morbidity rate 15.4%, 8/52): bleeding, abscess, ascites requiring peritoneal tap, pleural effusion requiring thoracentesis, and pneumonia in one case each, and three cases of wound infection. Three complications were encountered in 2 patients in the drainage group (morbidity rate 25%, 2/8): bleeding, infected biloma and pleural effusion in one case each. Postoperative hospital stay tended to be shorter in the no-drainage group (10.7 +/- 3.9 days) than in the drainage group (15.6 +/- 6.4 days) (p = 0.07). Considering early uneventful removal of the drain on the morning of postoperative day 1, half of the drained patients might have not required drainage. Furthermore, in the setting of concomitant bilioenteric anastomosis (n=4), one patient underwent hepatectomy uneventfully without drainage, and two of three patients with drainage had their drains removed successfully on day 1. The third patient retained the drain for an unnecessarily long period, but did not develop subsequent complications.

CONCLUSIONS

Our data support the view that prophylactic abdominal drainage is unnecessary in most patients who undergo elective hepatic resection. Bilioenteric anastomosis may not be a contraindication for a no abdominal drainage policy.