Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1993 Dec;218(6):748–753. doi: 10.1097/00000658-199312000-00008

Drainage after elective hepatic resection. A randomized trial.

J Belghiti 1, M Kabbej 1, A Sauvanet 1, V Vilgrain 1, Y Panis 1, F Fekete 1
PMCID: PMC1243070  PMID: 8257225

Abstract

OBJECTIVE: This prospective randomized study determined the influence of closed-suction drainage on the incidence of postoperative complications after elective hepatic resection. SUMMARY BACKGROUND DATA: Routine drainage is no longer advocated after several intra-abdominal surgical procedures. METHODS: A series of 81 patients who underwent elective hepatic resection were randomly allocated to either a nondrainage group (n = 39) and a drainage group with closed-suction drainage (n = 42). Indications for resection were 42 benign lesions and 39 malignant tumors, including 19 with cirrhosis. Major hepatic resection was performed in 25 patients and minor resection, in 56. All patients underwent ultrasonography with puncture for bacteriologic cultures of all fluid collections within the first 5 postoperative days. RESULTS: One patient died in each group. Ultrasonography found a significantly higher rate of subphrenic collections in the drainage group compared with the nondrainage group (respectively, 36% vs. 15%, p < 0.05). These collections were more frequently infected in the drainage group (n = 6) than in the nondrainage group (n = 2). After major liver resection, the rate of intra-abdominal postoperative complications (i.e., subphrenic fluid collections, hematomas, and bilomas) was similar between the two groups. CONCLUSIONS: Minor liver resection is safer without drainage. Major liver resection can be performed with or without abdominal drainage.

Full text

PDF
748

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agrama H. M., Blackwood J. M., Brown C. S., Machiedo G. W., Rush B. F. Functional longevity of intraperioneal drains: an experimental evaluation. Am J Surg. 1976 Sep;132(3):418–421. doi: 10.1016/0002-9610(76)90409-8. [DOI] [PubMed] [Google Scholar]
  2. Brown M. W., Burk R. F. Development of intractable ascites following upper abdominal surgery in patients with cirrhosis. Am J Med. 1986 May;80(5):879–883. doi: 10.1016/0002-9343(86)90632-7. [DOI] [PubMed] [Google Scholar]
  3. Budd D. C., Cochran R. C., Fouty W. J., Jr Cholecystectomy with and without drainage. A randomized, prospective study of 300 patients. Am J Surg. 1982 Mar;143(3):307–309. doi: 10.1016/0002-9610(82)90097-6. [DOI] [PubMed] [Google Scholar]
  4. Cerise E. J., Pierce W. A., Diamond D. L. Abdominal drains: their role as a source of infection following splenectomy. Ann Surg. 1970 May;171(5):764–769. doi: 10.1097/00000658-197005000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Elboim C. M., Goldman L., Hann L., Palestrant A. M., Silen W. Significance of post-cholecystectomy subhepatic fluid collections. Ann Surg. 1983 Aug;198(2):137–141. doi: 10.1097/00000658-198308000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fekete F., Belghiti J., Cherqui D., Langonnet F., Gayet B. Results of esophagogastrectomy for carcinoma in cirrhotic patients. A series of 23 consecutive patients. Ann Surg. 1987 Jul;206(1):74–78. doi: 10.1097/00000658-198707000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Franco D., Karaa A., Meakins J. L., Borgonovo G., Smadja C., Grange D. Hepatectomy without abdominal drainage. Results of a prospective study in 61 patients. Ann Surg. 1989 Dec;210(6):748–750. doi: 10.1097/00000658-198912000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Franco D., Smadja C., Meakins J. L., Wu A., Berthoux L., Grange D. Improved early results of elective hepatic resection for liver tumors. One hundred consecutive hepatectomies in cirrhotic and noncirrhotic patients. Arch Surg. 1989 Sep;124(9):1033–1037. doi: 10.1001/archsurg.1989.01410090039008. [DOI] [PubMed] [Google Scholar]
  9. Gillmore D., McSwain N. E., Jr, Browder I. W. Hepatic trauma: to drain or not to drain? J Trauma. 1987 Aug;27(8):898–902. [PubMed] [Google Scholar]
  10. Hoffmann J., Lorentzen M. Drainage after cholecystectomy. Br J Surg. 1985 Jun;72(6):423–427. doi: 10.1002/bjs.1800720603. [DOI] [PubMed] [Google Scholar]
  11. Hoffmann J., Shokouh-Amiri M. H., Damm P., Jensen R. A prospective, controlled study of prophylactic drainage after colonic anastomoses. Dis Colon Rectum. 1987 Jun;30(6):449–452. doi: 10.1007/BF02556495. [DOI] [PubMed] [Google Scholar]
  12. Iwatsuki S., Geis W. P. Hepatic complications. Surg Clin North Am. 1977 Dec;57(6):1335–1356. doi: 10.1016/s0039-6109(16)41391-5. [DOI] [PubMed] [Google Scholar]
  13. Iwatsuki S., Starzl T. E. Personal experience with 411 hepatic resections. Ann Surg. 1988 Oct;208(4):421–434. doi: 10.1097/00000658-198810000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Matsumata T., Kanematsu T., Okudaira Y., Sugimachi K., Zaitsu A., Hirabayashi M. Postoperative mechanical ventilation preventing the occurrence of pleural effusion after hepatectomy. Surgery. 1987 Sep;102(3):493–497. [PubMed] [Google Scholar]
  15. Mittelman J. S., Doberneck R. C. Drains and antibiotics perioperatively for elective cholecystectomy. Surg Gynecol Obstet. 1982 Nov;155(5):653–654. [PubMed] [Google Scholar]
  16. Monson J. R., Guillou P. J., Keane F. B., Tanner W. A., Brennan T. G. Cholecystectomy is safer without drainage: the results of a prospective, randomized clinical trial. Surgery. 1991 Jun;109(6):740–746. [PubMed] [Google Scholar]
  17. Pachter H. L., Hofstetter S. R., Spencer F. C. Evolving concepts in splenic surgery: splenorrhaphy versus splenectomy and postsplenectomy drainage: experience in 105 patients. Ann Surg. 1981 Sep;194(3):262–269. doi: 10.1097/00000658-198109000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Ronaghan J. E., Miller S. F., Finley R. K., Jr, Jones L. M., Elliott D. W. A statistical analysis of drainage versus nondrainage of elective cholecystectomy. Surg Gynecol Obstet. 1986 Mar;162(3):253–255. [PubMed] [Google Scholar]
  19. Rosemurgy A. S., Statman R. C., Murphy C. G., Albrink M. H., McAllister E. W. Postoperative ascitic leaks: the ongoing challenge. Surgery. 1992 Jun;111(6):623–625. [PubMed] [Google Scholar]
  20. Savage A. P., Malt R. A. Elective and emergency hepatic resection. Determinants of operative mortality and morbidity. Ann Surg. 1991 Dec;214(6):689–695. doi: 10.1097/00000658-199112000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Smadja C., Berthoux L., Meakins J. L., Franco D. Patterns of improvement in resection of hepatocellular carcinoma in cirrhotic patients: results of a non drainage policy. HPB Surg. 1989 Apr;1(2):141–147. doi: 10.1155/1989/31824. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Smith S. R., Gilmore O. J. Surgical drainage. Br J Hosp Med. 1985 Jun;33(6):308, 311, 314-15. [PubMed] [Google Scholar]
  23. Stone H. H. Preoperative and postoperative care. Surg Clin North Am. 1977 Apr;57(2):409–419. doi: 10.1016/s0039-6109(16)41190-4. [DOI] [PubMed] [Google Scholar]
  24. Thompson H. H., Tompkins R. K., Longmire W. P., Jr Major hepatic resection. A 25-year experience. Ann Surg. 1983 Apr;197(4):375–388. doi: 10.1097/00000658-198304000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Trowbridge P. E. A randomized study of cholecystectomy with and without drainage. Surg Gynecol Obstet. 1982 Aug;155(2):171–176. [PubMed] [Google Scholar]
  26. Truedson H. Cholecystectomy with and without intraperitoneal drain. Acta Chir Scand. 1983;149(4):393–399. [PubMed] [Google Scholar]
  27. Williams C. B., Halpin D. S., Knox A. J. Drainage following cholecystectomy. Br J Surg. 1972 Apr;59(4):293–296. doi: 10.1002/bjs.1800590412. [DOI] [PubMed] [Google Scholar]
  28. Yanaga K., Kanematsu T., Takenaka K., Sugimachi K. Intraperitoneal septic complications after hepatectomy. Ann Surg. 1986 Feb;203(2):148–152. doi: 10.1097/00000658-198602000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES