Is routine placement of surgical drains necessary after elective hepatectomy? Results from a single institution

Routine drainage is no longer used after many major abdominal procedures. However, the role of routine surgical drainage after hepatic resection is unclear. Of the two randomized trials published, one concluded drainage is unnecessary after hepatectomy, and another concluded it could be used after major resections only. Between January 1999 and December 2003, 211 elective hepatic resections were performed by two surgeons at Auckland Hospital. Drains were used routinely by one surgeon (n = 126), while another routinely did not drain (n = 85). Patients undergoing a biliary reconstruction were not included in this analysis. Patient and clinical data were recorded prospectively, and no outcome analyses were performed until 2004. The demographic features were similar between the drained and non-drained groups. There were no differences in length of hospital stay (no drain, 7 +/- 0.8 days; drain, 7 +/- 0.9 days: P = not significant [NS]), in mortality (no drain, 1.2%; drain, 1.6%: P = NS), biliary fistula (no drain, zero cases; drain, two cases: P = NS), or overall complication rate (no drain, 50.5%; drain, 54.7%: P = NS). Both groups had similar rates of postoperative collection (no drain, four patients [5%]; drain, five patients [4%]: P = NS), and there was no difference in the use of percutaneous drainage of collections between the groups (no drain, four patients [5%]; drain, two patients [2%]: P = NS). Multivariate analysis showed that intraoperative blood loss of 2000 ml or greater (relative risk [RR], 1.57; 95% confidence interval [CI], 1.39-1.75; P < 0.01), number of segments resected (RR, 1.4; 95% CI, 1.21-1.89; P < 0.01), and presence of steatosis/fibrosis or cirrhosis (RR, 1.6; 95% CI, 1.01-2.1; P < 0.05) to be predictive of postoperative complications. The presence of a surgical drain was not predictive of complications. Routine surgical drainage after elective hepatectomy is not necessary.