Management of Abdominal Drainage after Hepatic Resection

Abstract

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.

Human Stem Cells Promote Liver Regeneration After Partial Hepatectomy in BALB/C Nude Mice

“…Furthermore, the proposed route bears a high potential for translation into clinical practice because of the technically easy access, for example, via drainage tubes placed during liver resection. 41 We observed a less pronounced loss of relative body weight in mice receiving MSC 2 and 3 d after partial hepatectomy, suggesting beneficial systemic implications of MSCdependent decreased liver injury and attenuated metabolic alterations. We noted increased hepatocyte and LSEC proliferation rates in mice receiving MSC analogous to our previous studies with CD133 þ HSC.…”

Totally robotic caudate lobe liver resection: Bridge over troubled water

“…We did not use drainage tubes as a routine. Usually, we perform prophylactic drainage of the surgical site after central hepatectomies, when operative time was longer than 300 min and if bile leak was observed during hepatic transection 10 …”

“…In red (1-4) 8 mm robotic arms. Trocars 2 and 3 are alternately used for the camerawhen operative time was longer than 300 min and if bile leak was observed during hepatic transection 10.…”

Predicting surgical site infections using a novel nomogram in patients with hepatocelluar carcinoma undergoing hepatectomy

“…Hence, SSI prevention has been considered a top priority for improving perioperative outcomes. Previous studies suggest that many factors can influence SSIs in patients undergoing hepatectomy, including age, overweight status, liver function, hepatolithiasis, hypoalbuminemia, anemia, diabetes, repeat hepatectomy, operating time, intraoperative blood loss and transfusion, postoperative bile leakage, and prolonged drainage[3,5,7,9-14]. However, some of these factors remain controversial.…”