Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment

Abstract

Background: Routine prophylactic abdominal drainage after hepatic surgery is still being debated, as it may be unnecessary, possibly harmful, and uncomfortable for patients. This study evaluated the safety of a no-drain policy after liver resection within an Enhanced Recovery after Surgery (ERAS) programme. Methods: All hepatectomies performed without prophylactic drainage during 2005-2014 were included. Primary end points were resection-surface-related (RSR) morbidity, defined as the presence of postoperative biloma, hemorrhage or abscess, and reinterventions. Secondary end points were length of stay, total postoperative morbidity, the composite end point of liver surgery-specific complications, readmissions, and 90-day mortality. Uni- and multivariate analyses were performed to identify independent risk factors for RSR morbidity. A systematic search was performed to compare the results of this study to literature. Results: A total of 538 resections were included in the study. The RSR complication and reintervention rate was 15 and 12%, respectively. Major liver resection (≥3 segments) was an independent risk factor for the development of RSR morbidity (OR 3.01, 95% CI 1.61-5.62; p = 0.001) and need for RSR reintervention (OR 3.02, 95% CI 1.59-5.73; p = 0.001). Conclusion: RSR morbidity, mortality, and reintervention rates after liver surgery without prophylactic drainage in patients, treated within an ERAS programme, were comparable to previously published data. A no-drain policy after partial hepatectomy seems safe and feasible.

Acute care and emergency general surgery in patients with chronic liver disease: how can we optimize perioperative care? A review of the literature

“…Utilization of intra-abdominal drains to help control postoperative ascites and prevent surgical wound complications is a controversial topic. While a more restrict policy for placement of surgical abdominal drains has gained growing support in the literature [ 29 ], its safety in the context of cirrhosis yet remains poorly explored. Better control of postoperative ascites and potential associated surgical wound complications presents a compelling rationale for prophylactic drainage, but the risk of contamination of ascites and increased postoperative fluid shifts should be taken into account.…”

Enhanced Recovery (Eras) After Liver Surgery:comparative Study in a Brazilian Terciary Center

“…Enhanced recovery pathways, in general, discourage the routine use of drains, as there is some evidence that a no-drain policy is safe and feasible after uncomplicated hepatectomies 39 . In our cohort, there was a significance reduction in the placement of abdominal drains in ERAS group, without increasing complications like infected collections, hemorrhage, percutaneous drainage or reoperations.…”

Hepatectomía abierta versus laparoscópica dentro de un programa de ERAS (Enhanced Recovery After Surgery). ¿Hay diferencias?

“…Algunos autores reportan un 20% de colocación de drenajes con la técnica abierta 13 . Coincidimos con la mayoría de los autores en que en un gran número de pacientes la colocación de drenajes en las hepatectomías es innecesario 37 ; tal vez sería conveniente protocolizar en qué pacientes deben dejarse drenajes. Algunos autores hallaron que los pacientes con hepatectomías con una duración superior a 350 minutos, con una pérdida hemática superior a 650 ml o con fuga biliar durante la cirugía son tributarios de colocación de drenajes 38 .…”