Necessity of Abdominal Drainage after Liver Resection

Fumitoshi Hirokawa, Michihiro Hayashi, Yoshiharu Miyamoto, Mitsuhiko Iwamoto, Mitsuhiro Asakuma, Koji Komeda, Tetsunosuke Shimizu, Yoshihiro Inoue and Nobuhiko Tanigawa

Department of General and Gastroenterological Surgery, Osaka Medical College

Background: Many reports have questioned the routine use of prophylactic drainage after liver resection, although many centers still continue using drainage after hepatectomy. We retrospectively evaluated the need for post-liver-resection abdominal drainage. Method: Subjects numbered 259 in a "drainage" group undergoing hepatectomy without biliary or enteric resection or reconstruction with the use of abdominal drainage from May 2001 to December 2007 compared retrospectively to 118 in a "nondrainage" group without drainage from Jan 2008 to Oct 2009. The two groups were compared for postoperative complications, including bile leakage, and postoperative day (POD) discharge to determine the need for posthepatectomy drain placement. Results: Wound infection was significantly lower at 5.9% vs. 13.5% and median POD stay significantly shorter at POD12 vs. POD18 in the nondrainage than the drainage group. Three patients in the nondrainage group had a drain reinserted early postoperatively period before POD 7 and all had undergone extended right hepatectomy for hepatocellular carcinoma with portal vein thrombus followed by postoperative liver failure. Identified risk factors for postoperative bile leakage included repeat hepatectomy, operative procedure exposing of the major Glisson's sheath (i.e. central bisegmentectomy and anterior segmentectomy), and intraoperative bile leakage. The onset of postoperative bile leakage was as late as POD 19.5 (median), prophylactic drainage would not appear useful. Conclusions: While our results indicate that routine abdominal drainage is not necessary after liver resection without concomitant biliary or enteric surgery, prophylactic drainage may be useful in cases in which (1) extended hepatectomy is undergone for hepatocellular carcinoma with portal vein thrombus where postoperative liver failure prediction is extremely important and (2) central bisegmentectomy or anterior segmentectomy is required with intraoperative bile leakage noted where bile leakage would potentially occur postoperatively. In (2), prolonged drainage placement would be expected.

Key words
liver resection, abdominal drainage, postoperative bile leakage, ascites

Reprint requests
Fumitoshi Hirokawa Department of General and Gastroenterological Surgery, Osaka Medical College
2-7 Daigaku-machi, Takatsuki, 569-8686 JAPAN

Accepted
May 19, 2010

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