Is left lateral sectionectomy of the liver without operative site drainage safe and effective?

Abstract

Despite its limited benefits, operative site drainage after elective hepatectomy is routinely used. This study aimed to investigate the safety and effectiveness of left lateral sectionectomy without operative site drainage. Methods: This study retrospectively collected data from 31 patients who underwent elective left lateral sectionectomy between January 2017 and June 2020. Based on whether operative site drainage was used, the patients were divided into two groups: drainage and non-drainage of the operative site and a comparative analysis was conducted. Results: A total of 31 patients underwent left lateral sectionectomy during the study period. Of these, 22 patients were diagnosed with hepatocellular carcinoma; three, with intrahepatic cholangiocarcinoma; three, with liver metastasis; and three, with benign liver disease. Ten patients underwent laparoscopy. No significant differences were observed between the open and laparoscopic surgery groups. In the univariate analysis, there were no significant differences in the pre-, intra-, and postoperative clinicopathological factors between the non-drainage and drainage groups. The hospitalization period in the non-drainage group was significantly shorter than in the drainage group (8.44 days vs. 5.87 days, p < 0.05). In the operative site drainage non-use group, there were no cases of intraperitoneal fluid collection requiring additional procedures. Conclusions: Routine use of surgical drainage for left lateral sectionectomy of the liver to prevent intraperitoneal fluid collection is unnecessary.

The effect of placing prophylactic abdominal drainage tube after hepatobiliary surgery on postoperative infection: A systematic review and meta‐analysis

“…According to its purpose, it can be divided into therapeutic drainage and preventive drainage, and the abdominal drainage after hepatobiliary surgery is mainly preventive drainage 7 . Preventive drainage is mainly to monitor the occurrence of pancreatic fistula, biliary fistula, intestinal fistula, gastric fistula, active bleeding or wound infection in the abdominal cavity after surgery, and routine retention of preventive abdominal drainage tube is still relatively common 8 …”

“…7 Preventive drainage is mainly to monitor the occurrence of pancreatic fistula, biliary fistula, intestinal fistula, gastric fistula, active bleeding or wound infection in the abdominal cavity after surgery, and routine retention of preventive abdominal drainage tube is still relatively common. 8 However, in recent years, with the idea of surgery (enhanced recovery after surgery [ERAS]) accelerated rehabilitation popularization and application, some scholars put the safety and effectiveness of the drainage tube after abdominal surgery questioned. 8 Some researchers believe that prophylactic drains provide outlets for fluid, pus, blood, or necrotic debris, and may also be conduits for bacterial proliferation retrograde infection.…”

“…8 However, in recent years, with the idea of surgery (enhanced recovery after surgery [ERAS]) accelerated rehabilitation popularization and application, some scholars put the safety and effectiveness of the drainage tube after abdominal surgery questioned. 8 Some researchers believe that prophylactic drains provide outlets for fluid, pus, blood, or necrotic debris, and may also be conduits for bacterial proliferation retrograde infection. Infection ascending through the insertion of the drainage tube may also cause fluid accumulation in the abdominal cavity and may be aggravated by foreign body reaction to the drainage tube.…”

“… 7 Preventive drainage is mainly to monitor the occurrence of pancreatic fistula, biliary fistula, intestinal fistula, gastric fistula, active bleeding or wound infection in the abdominal cavity after surgery, and routine retention of preventive abdominal drainage tube is still relatively common. 8 …”