Using a 'no drain' policy in 342 laparoscopic hepatectomies: which factors predict failure?

The aim of this study was to identify factors that predict the failure of a 'no drain' policy in laparoscopic hepatectomy.

Surgical outcomes in 342 consecutive patients undergoing laparoscopic hepatectomy were reviewed. Drains were placed only for the following predefined criteria: (i) intraoperative bile leak; (ii) bilioenteric anastomosis, and (iii) increased risk for postoperative bleeding ('no drain' policy). Factors leading to need for postoperative drainage or reoperation were evaluated.

Drains were placed in 44 patients (drainage group). Postoperatively, additional procedures were required in five (11.4%) patients in the drainage group and in 18 (6.0%) patients in the no-drainage group. Multivariate analysis suggested that blood loss of >400 ml [odds ratio (OR) 4.50, 95% confidence interval (CI) 1.41-14.2; P = 0.010] and preoperative chemotherapy (OR = 2.24, 95% CI 0.82-6.48; P = 0.120) may increase the risk for need for postoperative procedures when intraoperative prophylactic drainage is not used.

Prophylactic drainage during liver resection should be considered not only in the presence of uncontrollable bile leak or concern for postoperative bleeding risk, but also in patients who have undergone neoadjuvant chemotherapy and those in whom intraoperative blood loss is >400 ml. Otherwise, a 'no drain' policy is safe and would enhance the advantages of minimally invasive liver surgery.