Hepatic trauma: to drain or not to drain?

Whether drains should be used in the management of hepatic wounds has been a subject of controversy since 1970. A limited retrospective review of 13 patient charts disclosed an intra-abdominal abscess rate of 23% with Penrose drains. Prospective analysis of 56 patients who qualified for inclusion in a closed-drain versus no-drain study showed a 4.2% and 3.1% intra-abdominal abscess rate, respectively. Results of this study indicate that the use of closed-drainage versus no-drainage should remain the surgeon's choice, depending on evaluation of related factors. In hepatic injury, however, open drainage should not be used.