Abdominal drains in liver transplantation: Useful tool or useless dogma? A matched case-control study

Rougemont, Olivier de; Dutkowski, Philipp; Weber, Markus; Clavien, Pierre‐Alain

doi:10.1002/lt.21676

Cited by 34 publications

(28 citation statements)

References 22 publications

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“…In an analysis by De Rougemont et al, the median in-dwelling time of abdominal drains was short (3 days), and most interventions for complications were performed after removal of the drain (median, 5 days) [9]. Bile leaks due to ischemic necrosis of the common bile duct usually occur between POD 5 and 10, which corresponds to the period after removal of the drain in this study.…”

Section: Discussionmentioning

confidence: 95%

“…Data on this subject are limited. A systematic review of the Cochrane database in 2011 [10] showed that no prospective randomized controlled trial has been performed yet to evaluate the suitability of abdominal drains in LT. One pair-matched analysis [9] and three retrospective studies have been published [1,9,11,12]. None of these was focused on the risk of infection and bile duct complications associated with the placement of a drain.…”

Section: Discussionmentioning

confidence: 99%

“…Prophylactic abdominal drainage after liver transplantation has been used for a long time to monitor postoperative intraabdominal complications such as hemorrhage, bile leaks, and others [1,9]. Nevertheless, potential deleterious adverse events followed by abdominal drainage, such as ascending infection or major protein loss due to ascite drainage [3][4][5], need to be set in contrast to potential but never proven benefits of this practice.…”

Section: Discussionmentioning

confidence: 99%

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Abdominal drainage after liver transplantation from deceased donors

Schwarz

Soliman

Györi

et al. 2015

Langenbecks Arch Surg

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Abdominal drainage after liver transplantation from deceased donors

Schwarz

Soliman

Györi

et al. 2015

Langenbecks Arch Surg

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show abstract

“…Another systematic review and meta-analysis found no evidence to support abdominal drain use after hepato-pancreato-biliary resections [15]. Even in liver transplantation, where use of abdominal drains is widely practiced, a recent study failed to demonstrate any benefits in patients treated with intraoperative drains [16]. Presence of a drain did not expedite re-interventions for hemorrhage or bile leak in patients receiving a liver transplant.…”

Section: Discussionmentioning

confidence: 97%

Drain use after open cholecystectomy: is there a justification?

Zaydfudim

Russell

Feurer

et al. 2009

Langenbecks Arch Surg

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Background Despite randomized trials showing no benefit, drain use after open cholecystectomy continues, perhaps as a result of more complicated patient presentation. We examined the reasons for drain use in patients undergoing open cholecystectomy and evaluated the effect of drain placement on surgical outcomes. Methods Univariate and multivariate analyses compared pre-and intraoperative factors associated with drain placement, and postoperative outcomes in patients undergoing open cholecystectomy at our institution between 2002 and 2007.Results In 160 patients who underwent open cholecystectomy as primary operative procedure, 92 patients (58%) had a drain placed. In 22% of the cases, the surgeon's stated reason for drain placement was hemorrhage, abscess, nonidentification of critical structures, bile spillage, or concern for a bile leak. No reason was provided in78% of the operative reports. Multivariate analysis revealed diagnoses of acute, chronic, or gangrenous cholecystitis (n=120, 75%), intraoperative bile spillage (n=60, 38%), and higher than median intraoperative blood loss (>200 ml) as independent predictors of drain use (all p≤0.042). Patients with drains had increased length of hospital stay, postoperative ICU admissions, rates of hospital re-admission, and use of post-operative endoscopy (all p≤0.04). Patients with and without drains had similar rates of postoperative percutaneous drainage, bile leaks, intra-abdominal abscesses, wound infections, and deaths (all p≥0.121). Conclusions The use of drains after open cholecystectomy was associated with complicated patient presentations: cholecystitis, intraoperative bile spillage, and high intraoperative blood loss. These patients had longer and more complicated postoperative course and more re-admissions. However, use of intraoperative drains was not associated with a reduction in the need for postoperative percutaneous drainage or in improvement in the rates of bile leaks, infections, or deaths.

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“…In some cases, the use of drains may even be related to longer hospital stay and higher postoperative morbidity (47).…”

Section: Prophylatic Drainagementioning

confidence: 99%

The final stage of the laparoscopic procedure: exploring final steps

et al. 2012

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INTRODuCTIONUrologic surgery continues to evolve focusing efforts on adequate treatment of pathologic urologic conditions in a safe and minimally invasive manner (1).Laparoscopic surgery has well defined benefits for the patient and has, over time, become accepted as a standard of care access strategy for the management of benign and malignant Urologic diseases. Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding. Unlike open surgery, at the end of laparoscopic extirpative procedures, the Urologist is often faced with the additional challenges of specimen retrieval and extraction.Laparoscopic specimen entrapment and extraction occur at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrap and safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the "end of the procedure" be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.

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Abdominal drains in liver transplantation: Useful tool or useless dogma? A matched case-control study

Cited by 34 publications

References 22 publications

Abdominal drainage after liver transplantation from deceased donors

Abdominal drainage after liver transplantation from deceased donors

Drain use after open cholecystectomy: is there a justification?

The final stage of the laparoscopic procedure: exploring final steps

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