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, CL1 2
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
2011 Impact Factor: 7.492
2011 SCImago Journal Rankings: 0.617
DOIhttp://dx.doi.org/10.1097/01.sla.0000109153.71725.8c
PubMed Central IDPMC1356212
ReferencesReferences in Scopus
DC Field
Value
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
2011 Impact Factor: 7.492
2011 SCImago Journal Rankings: 0.617
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
Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong