The role of abdominal drainage after major hepatic resection

No-Mortality Liver Resection for Hepatocellular Carcinoma in Cirrhotic and Noncirrhotic Patients

“…Moreover, opinions are not always unanimous; some authors have actually affirmed the importance of drain placement. 67 Fortunately, postoperative massive bleeding is a rare occurrence, but it is an extremely alarming complication. The frequency of perihepatic infected fluid collections has been reported to be 2% to 20%, 66 biliary fistulas occurred in up to 8% of patients, 66,68 and immunodeficiency and poor wound healing in cirrhotic patients affect these complications.…”

Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment

“…Some studies have reported advantages of prophylactic drain placement such as early drainage of bile leaks, preventing subphrenic collection, detecting postoperative hemorrhage, and removing ascites [3][4][5][6] . Other studies have indicated that the risks of prophylactic intra-abdominal drains, including drain-related bleeds, ascending intra-abdominal infections by retrograde contamination, and impaired pulmonary function, outweigh the benefits [1,7,8] .…”

Total bilirubin amount in drainage fluid can be an early predictor for severe biliary fistula after hepatobiliary surgery

“…It can also be useful for the treatment of these complications (7,8). With the recent advances in surgical and perioperative management techniques, however, several studies have suggested that prophylactic placement of a drain is not always necessary after hepatobiliary surgery and that prophylactic drainage may, in fact, increase the risk of complications, including retrograde infection (19).…”

“…An undrained biliary fistula may be further complicated by abdominal abscess formation and sepsis, necessitating long-term drainage or even surgical intervention (6). Therefore, an abdominal drain is routinely placed prophylactically in many institutions to prevent this postoperative morbidity sequence (7,8). On the contrary, however, several recent studies have reported that prophylactic drainage after hepatic resection may not reduce morbidity, but may, in fact, increase the risk of reactive ascites and/ or retrograde infections, resulting in prolongation of the patient's hospital stay (9)(10)(11)(12)(13)(14)(15).…”