The effectiveness and appropriate management of abdominal drains in patients undergoing elective liver resection: a retrospective analysis and prospective case series

Surg Today. 2013 Apr;43(4):372-80. doi: 10.1007/s00595-012-0254-1. Epub 2012 Jul 14.


Purpose: Although many studies have concluded that prophylactic drain insertion during elective liver resection offers few advantages, we reassessed the clinical value and appropriate management of drain insertion.

Methods: We retrospectively studied the clinical value of abdominal drainage in 167 consecutive patients who underwent hepatectomy, focusing on drainage volumes, bilirubin concentrations, drainage fluid bacterial culture results and short-term postoperative outcomes. The results were then validated prospectively in the next 50 consecutive patients to undergo hepatectomy.

Results: Most of the patients with morbidities such as biliary fistulas, ascites, fluid collection or duodenal perforation (20/24 or 83 %) were treated using operative drainage tubes, avoiding the use of percutaneous drainage procedures. The values obtained with the formula (drainage fluid bilirubin concentration/serum bilirubin concentration) × drainage fluid volume, were greater on both postoperative days (POD) 2 and 3 (P = 0.03 and P < 0.01) in patients with biliary leakage compared with those observed in the patients without leakage. The bacteriologic cultures of drainage fluid were positive less frequently on POD 4 or earlier (7/203) than on POD 5 or later (24/74, P < 0.01). In the validation cohort, new drain removal criteria based on the retrospective results led to successful drain management without additional treatment in 96 % of patients.

Conclusions: Abdominal drainage is effective for both postoperative monitoring and morbidity treatment.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ascitic Fluid / chemistry
  • Ascitic Fluid / microbiology
  • Bile / chemistry
  • Bile / microbiology
  • Drainage / methods*
  • Elective Surgical Procedures*
  • Female
  • Hepatectomy*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Care / methods*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Reproducibility of Results
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult