Management of Abdominal Drainage after Liver Resection

Tsunemi Matsuda¹⁾²⁾, Shigekazu Takemura²⁾, Kazuki Ohba²⁾, Takahiro Uenishi²⁾, Masao Ogawa²⁾, Tsuyoshi Ichikawa²⁾, Shintaro Kodai²⁾, Hiroji Shinkawa²⁾, Hiromu Tanaka³⁾ and Shoji Kubo²⁾

Department of Medical Safety Management, Osaka City University Hospital¹⁾
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine²⁾
Department of Surgery, Higashisumiyoshi-Morimoto Hospital³⁾

Background: Management of abdominal drainage after liver resection has not been well established. Methods: We compared clinicopathological findings between patients with the long-term abdominal drainage (5 days or more, long-term group, 32 patients) and those with the short-term abodaminal drainage (4 days or less, short-term group, 72 patients) to study the risk factors for the long-term (5 days or more) abdominal drainage. We also studied the management of abdominal drainage in postoperative bleeding, biliary leakage, intraabdominal infection, wound infection, refractory pleural effusion, and refractory ascites in 104 patients who underwent liver resection. Results: The drains were removed on postoperative day 4.1±1.3 if the drainage fluid did not contain bile. The risk factors for the long-term abdominal drainage included lager tumor, segmentectomy and bisegmentectomy, a long operation time, massive blood loss, and a large amount of drainage fluid (200 ml/day at the 4th postoperative day) by univariate analysis and a long operation time, massive blood loss, and a large amount of drainage fluid were independent risk factors by multivariate analysis. Postoperative bleeding did not occur. Biliary leakage developed in one patient in whom an RTBD catheter was placed because of stenosis of the bile duct after central bisegmentectomy. In another patient, biliary leakage developed 16 days after surgery, with intraabdominal infection caused by Staphylococcus aureus infection through the catheter after treatment for biliary leakage. The drainage catheter was replaced in 2 patients in whom refractory pleural effusion or ascites developed. Wound infection developed in one patient. Infection of the drainage site occurred in one patient in whom the catheter was removed 7 days after surgery. There were no differences in the incidence of such postoperative complications between the short-term and long-term groups. Conclusions: Removal of abdominal drainage catheters within 4 days after liver resection is reasonable if the drainage fluid does not contain bile.

Key words
liver resection, abdominal drainage, bile leakage, intraabdominal infection, ascites

Reprint requests
Shoji Kubo Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585 JAPAN

Accepted
July 23, 2008

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