Drainage is unnecessary after elective liver resection

Fong, Yuman; Brennan, Murray F.; Brown, Karen T.; Heffeman, Nancy; Blumgart, Leslie H.

doi:10.1016/s0002-9610(99)80092-0

Cited by 228 publications

(161 citation statements)

References 18 publications

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“…This meta-analysis, however, included 3 RCTs on liver resection only, with low sample size [78,79]. Kyoden et al [80] assessed the value of prophylactic drainage in a retrospective cohort study including 1269 consecutive elective liver resections.…”

Section: Prophylactic Abdominal Drainagementioning

confidence: 99%

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

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Background Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus. Methods A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline. Five independent reviewers selected relevant articles. Quality of randomized trials was assessed according to the Jadad score and CONSORT statement. The level of evidence for each item was determined using the GRADE system. The Delphi method was used to validate the final recommendations. Results A total of 157 full texts were screened. Thirty-seven articles were included in the systematic review, and 16 of the 23 standard ERAS items were studied specifically for liver surgery. Consensus was reached among experts after 3 rounds. Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted. The use of postoperative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay. Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery. Early oral intake and mobilization are recommended. There is no evidence to prefer epidural to other types of analgesia. Conclusions The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.

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Section: Prophylactic Abdominal Drainagementioning

confidence: 99%

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

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“…Abdominal drains are not used routinely given the conclusive results of three separate trials showing no benefit of routine drainage (22,23). Prospective large series (24) have further confirmed that drains are not of benefit other than in specific circumstances.…”

Section: Drainsmentioning

confidence: 99%

Early recovery pathway for hepatectomy: data-driven liver resection care and recovery

Warner¹,

Jutric²,

Nisimova³

et al. 2017

Hepatobiliary Surg. Nutr.

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“…In the RCT of 120 patients undergoing exploratory laparotomy for liver resection by Fong et al [18], patients were randomized to drained or undrained groups. Drains were removed after a minimum of 4 d as long as drainage was non-bilious.…”

Section: Intra-abdominalmentioning

confidence: 99%

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

Reiffel

Barie

Spector

2013

Surgical Infections

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Background: Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth. Methods: The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed. Results: Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine postoperative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement. Conclusions: Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to ''cover'' an indwelling drain.

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Drainage is unnecessary after elective liver resection

Cited by 228 publications

References 18 publications

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Early recovery pathway for hepatectomy: data-driven liver resection care and recovery

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

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