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Article: Abdominal Drainage after Hepatic Resection Is Contraindicated in Patients with Chronic Liver Diseases

TitleAbdominal Drainage after Hepatic Resection Is Contraindicated in Patients with Chronic Liver Diseases
Authors
Issue Date2004
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
Citation
Annals Of Surgery, 2004, v. 239 n. 2, p. 194-201 How to Cite?
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.
Persistent Identifierhttp://hdl.handle.net/10722/49027
ISSN
2014 Impact Factor: 8.327
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorWong, Yen_HK
dc.contributor.authorNg, IOLen_HK
dc.contributor.authorLam, CMen_HK
dc.contributor.authorPoon, RTPen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2008-06-12T06:32:34Z-
dc.date.available2008-06-12T06:32:34Z-
dc.date.issued2004en_HK
dc.identifier.citationAnnals Of Surgery, 2004, v. 239 n. 2, p. 194-201en_HK
dc.identifier.issn0003-4932en_HK
dc.identifier.urihttp://hdl.handle.net/10722/49027-
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.en_HK
dc.format.extent388 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.comen_HK
dc.relation.ispartofAnnals of Surgeryen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshHepatectomy - adverse effectsen_HK
dc.subject.meshHepatitis B, Chronic - complicationsen_HK
dc.subject.meshLiver Cirrhosis - complicationsen_HK
dc.subject.meshLiver Neoplasms - complications - surgeryen_HK
dc.subject.meshPostoperative Careen_HK
dc.titleAbdominal Drainage after Hepatic Resection Is Contraindicated in Patients with Chronic Liver Diseasesen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0003-4932&volume=239&issue=2&spage=194&epage=201&date=2004&atitle=Abdominal+drainage+after+hepatic+resection+is+contraindicated+in+patients+with+chronic+liver+diseasesen_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailNg, IOL: iolng@hku.hken_HK
dc.identifier.emailPoon, RTP: poontp@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityNg, IOL=rp00335en_HK
dc.identifier.authorityPoon, RTP=rp00446en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1097/01.sla.0000109153.71725.8cen_HK
dc.identifier.pmid14745327en_HK
dc.identifier.pmcidPMC1356212en_HK
dc.identifier.scopuseid_2-s2.0-0842284002en_HK
dc.identifier.hkuros90465-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0842284002&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume239en_HK
dc.identifier.issue2en_HK
dc.identifier.spage194en_HK
dc.identifier.epage201en_HK
dc.identifier.isiWOS:000188969100010-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLiu, CL=7409789712en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridWong, Y=7403041884en_HK
dc.identifier.scopusauthoridNg, IOL=7102753722en_HK
dc.identifier.scopusauthoridLam, CM=36799183200en_HK
dc.identifier.scopusauthoridPoon, RTP=7103097223en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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