Subcutaneous drainage to prevent wound infection in liver resection: a randomized controlled trial

Subcutaneous drainage is considered effective for preventing wound infections, but only anecdotal evidence supports its clinical benefit. The present study evaluated the benefit of subcutaneous drainage in preventing wound infections in patients undergoing liver resection.

Patients scheduled for liver resection were randomly assigned to receive or not receive subcutaneous drains. After suture of the peritoneum and fascia, a 10 Fr drain was placed subcutaneously and connected to a low pressure (under 80 cmH2 O) aspiration reservoir to allow drainage of the full length of the wound. The primary endpoint was wound infection development within 30 days of the liver resection.

We performed liver resections in 260 patients with hepatobiliary malignancies. Between the subcutaneous-drainage group (n = 131) and non-drainage group (n = 129), there were no significant differences in the operative variables. Wound infection occurred in 10 drainage group patients (8%) and 12 patients (9%) in the non-drainage group (P = 0.629); there was no significant difference in the probability of wound infection (P = 0.624). No significant differences were found between the groups for the hospital stay duration (P = 0.363), postoperative complications (P = 0.725) or medical expenses (P = 0.360).

Subcutaneous drainage does not prevent wound infections in patients undergoing liver resection; therefore, its routine use is not justified.