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The safety of omitting prophylactic abdominal drainage after laparoscopic liver resection: Retrospective analysis of 100 consecutive cases.

ABSTRACT: Introduction:Whether prophylactic abdominal drainage after laparoscopic liver resection (LLR) is necessary remains unclear. This study aimed to evaluate the safety of omitting prophylactic abdominal drainage after LLR. Methods:A retrospective analysis of 100 consecutive patients who underwent LLR at Osaka Rosai Hospital from April 2011 to November 2018 was performed. During this period, prophylactic abdominal drainage was routinely omitted during LLR without biliary anastomosis. The primary endpoint was the frequency of additional abdominal drainage. The secondary endpoint was the rate of postoperative complications. Results:Ninety-six patients (96%) underwent partial resection or lateral segmentectomy, and 89 patients (89%) were Child-Pugh grade A. The median operative time was 102 (range, 31-274) minutes. The median blood loss was minimal (range, 0-280 ml), and blood transfusion was performed for one patient (1%). One case (1%) was converted to open surgery. Additional abdominal drainage was required for one patient (1%) with an intraabdominal abscess. Postoperative complications were seen in 5 patients (5%). High-grade complications (?grade III according to the Clavien-Dindo classification) were seen in two patients (2%). There were no cases of reoperation or perioperative death. The median postoperative hospital stay was 8 (range, 4-65) days. Conclusions:Prophylactic abdominal drainage could be safely omitted for selected patients and operative procedures.

SUBMITTER: Wakasugi M

PROVIDER: S-EPMC7136585 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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The safety of omitting prophylactic abdominal drainage after laparoscopic liver resection: Retrospective analysis of 100 consecutive cases.

Wakasugi Masaki M Shimizu Junzo J Makutani Yusuke Y Koga Chikato C Murakami Masahiro M Furukawa Haruna H Sueda Toshinori T Matsumura Tae T Miyagaki Hiromichi H Tei Mitsuyoshi M Kawabata Ryohei R Hasegawa Junichi J

Annals of medicine and surgery (2012) 20200402

<h4>Introduction</h4>Whether prophylactic abdominal drainage after laparoscopic liver resection (LLR) is necessary remains unclear. This study aimed to evaluate the safety of omitting prophylactic abdominal drainage after LLR.<h4>Methods</h4>A retrospective analysis of 100 consecutive patients who underwent LLR at Osaka Rosai Hospital from April 2011 to November 2018 was performed. During this period, prophylactic abdominal drainage was routinely omitted during LLR without biliary anastomosis. T ...[more]

PMID: 32280459

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Project description:IntroductionProphylactic intra-peritoneal drainage has been considered to be an effective measure to reduce postoperative complications after pancreatectomy. However, routinely placed drainage during abdominal surgery may be unnecessary or even harmful to some patients, due to the possibility of increasing complications. And there is still controversy about the prophylactic intra-peritoneal drainage after pancreatectomy. This meta-analysis aimed to analyze the incidence of complications after either pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) in the drain group and no-drain group.MethodsData were retrieved from four electronic databases PubMed, EMBASE, the Cochrane Library and Web of Science up to December 2020, including the outcomes of individual treatment after PD and DP, mortality, morbidity, clinically relevant postoperative pancreatic fistula (CR-POPF), bile leak, wound infection, postoperative hemorrhage, delayed gastric emptying (DGE), intra-abdominal abscess, reoperation, intervened radiology (IR), and readmission. Cochrane Collaboration Handbook and the criteria of the Newcastle-Ottawa scale were used to assess the quality of studies included.ResultsWe included 15 studies after strict screening. 13 studies with 16,648 patients were analyzed to assess the effect of drain placement on patients with different surgery procedures, and 4 studies with 6,990 patients were analyzed to assess the effect of drain placement on patients with different fistula risk. For patients undergoing PD, the drain group had lower mortality but higher rate of CR-POPF than the no-drain group. For patients undergoing DP, the drain group had higher rates of CR-POPF, wound infection and readmission. There were no significant differences in bile leak, hemorrhage, DGE, intra-abdominal abscess, and IR in either overall or each subgroup. For Low-risk subgroup, the rates of hemorrhage, DGE and morbidity were higher after drainage. For High-risk subgroup, the rate of hemorrhage was higher while the rates of reoperation and morbidity were lower in the drain group.ConclusionsIntraperitoneal drainage may benefit some patients undergoing PD, especially those with high pancreatic fistula risk. For DP, current evidences suggest that routine drainage might not benefit patients, but no clear conclusions can be drawn because of the study limitations.

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The safety of omitting prophylactic abdominal drainage after laparoscopic liver resection: Retrospective analysis of 100 consecutive cases.

Publications

The safety of omitting prophylactic abdominal drainage after laparoscopic liver resection: Retrospective analysis of 100 consecutive cases.

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