Criteria for drain removal following liver resection

Yamazaki, Shintaro; Takayama, Tadatoshi; Moriguchi, Masamichi; Mitsuka, Yusuke; Okada, Shunji; Midorikawa, Yutaka; Nakayama, Hisashi; Higaki, Tokio

doi:10.1002/bjs.8916

Cited by 54 publications

(54 citation statements)

References 23 publications

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“…Recent RCTs have not detected any advantages of abdominal drainage after hepatic resection, and most authors concluded that drainage after hepatic resection is unnecessary and does not reduce complications. Nevertheless, prophylactic drains are still commonly placed in many institutions [29] . Surgeons do not fully agree with the contention that drain placement should be avoided since drains may act as conduits for bacterial contamination via ascending infections.…”

Section: Discussionmentioning

confidence: 99%

Management of Abdominal Drainage after Hepatic Resection

Inoué

Imai²,

Kawaguchi³

et al. 2017

Dig Surg

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Background: Routine drainage after partial hepatic resection has long been controversial. Methods: Three hundred and twenty-eight patients who underwent hepatic resections for liver tumors without biliary-enteric and gastrointestinal anastomoses were analyzed using propensity score matching analysis with respect to if and when a prophylactic drain was used and for how long. The criteria for drain placement were established and validated. Results: Our criteria for drain placement were chosen according to postoperative percutaneous abdominal drainage risk factors, organ/space surgical site infections (SSIs), hepatic resection method, intraoperative bile leakage and operative time (≥300 min). The organ/space SSI rate was significantly lower in the group in which abdominal drain removal occurred 2 days after surgery. We decided to remove the abdominal drains on postoperative day 2 when the drain-fluid bilirubin concentration was less than 3 times the serum bilirubin concentration. After our criteria for drain management were developed in 2011, the number of inserted drains, postoperative percutaneous abdominal drainages, postoperative complications, SSI rates and postoperative hospital stays were significantly lower. Conclusions: Our criteria for abdominal drain management facilitate favorable postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Management of Abdominal Drainage after Hepatic Resection

Inoué

Imai²,

Kawaguchi³

et al. 2017

Dig Surg

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“…All patients had radically resectable hepatocellular carcinomas; the tumor diameter measured within 50 mm in a single tumor and within 30 mm in multiple tumors. The operative management strategies that are used at our institution have been described elsewhere (9)(10)(11)(12). Ethics Committee approval was obtained (protocol number: RK-170214-03).…”

Section: Patientsmentioning

confidence: 99%

Perfusion and drainage difference in the liver parenchyma: Regional plane in segment 6

Abe

Yamazaki

Moriguchi

et al. 2017

BST

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“…A number of clamping maneuvers can also be employed to reduced bleeding during the phase in which the liver parenchyma is transected [39,40] . The most commonly performed procedure is the Pringle maneuver in which inflow to the liver is controlled by compressing the hepatic artery and portal vein at the level of the hepatic pedicle.…”

Section: Intra-operative Strategiesmentioning

confidence: 99%

“…If bile is observed then senior colleagues should be informed as imaging studies may be indicated especially if drainage persists or volume increases. Some have advocated the "3× 3" rule (drain-fluid bilirubin level below 3 mg/dL on day 3 after operation) as criterion for removal of prophylactically placed abdominal drains after hepatic resection [70] . Interestingly, a Cochrane review has shown that routine abdominal drainage for uncomplicated liver resection is not needed and if used a closed drain system is associated with less infectious complication and hospital stay than open systems [71] .…”

Section: Drainsmentioning

confidence: 99%

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

Farid

Prasad²,

Morris‐Stiff³

2013

WJGS

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Outcomes in hepatic resectional surgery (HRS) have improved as a result of advances in the understanding of hepatic anatomy, improved surgical techniques, and enhanced peri-operative management. Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period, however, greater acceptance and understanding of HRS has meant that care is transferred, usually after 24-48 h, to a standard ward environment. Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call, and it is therefore important to acknowledge the key points in managing HRS patients. Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken. Increasingly, enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia, careful fluid balance, nutrition and thromboprophlaxis. Complications can occur including liver, renal and respiratory failure, hemorrhage, and sepsis, all of which require prompt recognition and management. We provide an overview of the relevant terminology applied to hepatic surgery, an approach to the post-operative management, and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients. Core tip: Applied anatomy as used in hepatic surgery is different to the traditional morphological teaching. Applied hepatic anatomy is complex but trainees require an understanding of the basic principles to allow an appreciation of the operations performed. Complications require a low threshold of suspicion as they often have important consequences in relation to patient outcome. Recognition of such with rapid alerting of senior staff can facilitate timely and effective management. To date, no universal protocol exists for management of the post-operative period and varies from centre to centre. We provide a practical overview of the terminology, post-operative management, and complications associated with hepatic surgery.

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Criteria for drain removal following liver resection

Abstract: The '3 × 3 rule' (drain-fluid bilirubin level below 3 mg/dl on day 3 after operation) is an accurate criterion for removal of prophylactically placed abdominal drains in liver resection.

Cited by 54 publications

References 23 publications

Management of Abdominal Drainage after Hepatic Resection

Management of Abdominal Drainage after Hepatic Resection

Perfusion and drainage difference in the liver parenchyma: Regional plane in segment 6

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

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