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Article: Abdominal Drainage after Hepatic Resection Is Contraindicated in Patients with Chronic Liver Diseases
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TitleAbdominal Drainage after Hepatic Resection Is Contraindicated in Patients with Chronic Liver Diseases
 
AuthorsLiu, CL2 1
Fan, ST2
Lo, CM2
Wong, Y2
Ng, IOL1
Lam, CM2
Poon, RTP2
Wong, J2
 
Issue Date2004
 
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
 
CitationAnnals Of Surgery, 2004, v. 239 n. 2, p. 194-201 [How to Cite?]
DOI: http://dx.doi.org/10.1097/01.sla.0000109153.71725.8c
 
AbstractObjective: The aim of this study was to determine whether abdominal drainage is beneficial after elective hepatic resection in patients with underlying chronic liver diseases. Summary Background Data: Traditionally, in patients with chronic liver diseases, an abdominal drainage catheter is routinely inserted after hepatic resection to drain ascitic fluid and to detect postoperative hemorrhage and bile leakage. However, the benefits of this surgical practice have not been evaluated prospectively. Patients and Methods: Between January 1999 and March 2002, 104 patients who had underlying chronic liver diseases were prospectively randomized to have either closed suction abdominal drainage (drainage group, n = 52) or no drainage (nondrainage group, n = 52) after elective hepatic resection. The operative outcomes of the 2 groups of patients were compared. Results: Fifty-]seven (55%) patients had major hepatic resection with resection of 3 Coiunaud's segments or more. Sixty-nine (66%) patients had liver cirrhosis and 35 (34%) had chronic hepatitis. Demographic, surgical, and pathologic details were similar between both groups. The primary indication for hepatic resection was hepatocellular carcinoma (n = 100, 96%). There was no difference in hospital mortality between the 2 groups of patients (drainage group, 6% vs. nondrainage group, 2%; P = 0.618). However, there was a significantly higher overall operative morbidity in the drainage group (73% vs. 38%, P < 0.001). This was related to a significantly higher incidence of wound complications in the drainage group compared with the nondrainage group (62% vs. 21%, P < 0.001). In addition, a trend toward a higher incidence of septic complications in the drainage group was observed (33% vs. 17%, P = 0.07). The mean (± standard error of mean) postoperative hospital stay of the drainage group was 19.0 ± 2.2 days, which was significantly longer than that of the nondrainage group (12.5 ± 1.1 days, P = 0.005). With a median follow-up of 15 months, none of the 51 patients with hepatocellular carcinoma in the drainage group developed metastasis at the drain sites. On multivariate analysis, abdominal drainage, underlying liver cirrhosis, major hepatic resection, and intraoperative blood loss of >1.5L were independent and significant factors associated with postoperative morbidity. Conclusion: Routine abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases.
 
ISSN0003-4932
2012 Impact Factor: 6.329
2012 SCImago Journal Rankings: 3.006
 
DOIhttp://dx.doi.org/10.1097/01.sla.0000109153.71725.8c
 
PubMed Central IDPMC1356212
 
ISI Accession Number IDWOS:000188969100010
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorLiu, CL
 
dc.contributor.authorFan, ST
 
dc.contributor.authorLo, CM
 
dc.contributor.authorWong, Y
 
dc.contributor.authorNg, IOL
 
dc.contributor.authorLam, CM
 
dc.contributor.authorPoon, RTP
 
dc.contributor.authorWong, J
 
dc.date.accessioned2008-06-12T06:32:34Z
 
dc.date.available2008-06-12T06:32:34Z
 
dc.date.issued2004
 
dc.description.abstractObjective: The aim of this study was to determine whether abdominal drainage is beneficial after elective hepatic resection in patients with underlying chronic liver diseases. Summary Background Data: Traditionally, in patients with chronic liver diseases, an abdominal drainage catheter is routinely inserted after hepatic resection to drain ascitic fluid and to detect postoperative hemorrhage and bile leakage. However, the benefits of this surgical practice have not been evaluated prospectively. Patients and Methods: Between January 1999 and March 2002, 104 patients who had underlying chronic liver diseases were prospectively randomized to have either closed suction abdominal drainage (drainage group, n = 52) or no drainage (nondrainage group, n = 52) after elective hepatic resection. The operative outcomes of the 2 groups of patients were compared. Results: Fifty-]seven (55%) patients had major hepatic resection with resection of 3 Coiunaud's segments or more. Sixty-nine (66%) patients had liver cirrhosis and 35 (34%) had chronic hepatitis. Demographic, surgical, and pathologic details were similar between both groups. The primary indication for hepatic resection was hepatocellular carcinoma (n = 100, 96%). There was no difference in hospital mortality between the 2 groups of patients (drainage group, 6% vs. nondrainage group, 2%; P = 0.618). However, there was a significantly higher overall operative morbidity in the drainage group (73% vs. 38%, P < 0.001). This was related to a significantly higher incidence of wound complications in the drainage group compared with the nondrainage group (62% vs. 21%, P < 0.001). In addition, a trend toward a higher incidence of septic complications in the drainage group was observed (33% vs. 17%, P = 0.07). The mean (± standard error of mean) postoperative hospital stay of the drainage group was 19.0 ± 2.2 days, which was significantly longer than that of the nondrainage group (12.5 ± 1.1 days, P = 0.005). With a median follow-up of 15 months, none of the 51 patients with hepatocellular carcinoma in the drainage group developed metastasis at the drain sites. On multivariate analysis, abdominal drainage, underlying liver cirrhosis, major hepatic resection, and intraoperative blood loss of >1.5L were independent and significant factors associated with postoperative morbidity. Conclusion: Routine abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases.
 
dc.description.naturepublished_or_final_version
 
dc.format.extent388 bytes
 
dc.format.mimetypetext/html
 
dc.identifier.citationAnnals Of Surgery, 2004, v. 239 n. 2, p. 194-201 [How to Cite?]
DOI: http://dx.doi.org/10.1097/01.sla.0000109153.71725.8c
 
dc.identifier.doihttp://dx.doi.org/10.1097/01.sla.0000109153.71725.8c
 
dc.identifier.epage201
 
dc.identifier.hkuros90465
 
dc.identifier.isiWOS:000188969100010
 
dc.identifier.issn0003-4932
2012 Impact Factor: 6.329
2012 SCImago Journal Rankings: 3.006
 
dc.identifier.issue2
 
dc.identifier.openurl
 
dc.identifier.pmcidPMC1356212
 
dc.identifier.pmid14745327
 
dc.identifier.scopuseid_2-s2.0-0842284002
 
dc.identifier.spage194
 
dc.identifier.urihttp://hdl.handle.net/10722/49027
 
dc.identifier.volume239
 
dc.languageeng
 
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
 
dc.publisher.placeUnited States
 
dc.relation.ispartofAnnals of Surgery
 
dc.relation.referencesReferences in Scopus
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.subject.meshHepatectomy - adverse effects
 
dc.subject.meshHepatitis B, Chronic - complications
 
dc.subject.meshLiver Cirrhosis - complications
 
dc.subject.meshLiver Neoplasms - complications - surgery
 
dc.subject.meshPostoperative Care
 
dc.titleAbdominal Drainage after Hepatic Resection Is Contraindicated in Patients with Chronic Liver Diseases
 
dc.typeArticle
 
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<contributor.author>Lo, CM</contributor.author>
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Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong