Hepatic trauma: to drain or not to drain?

Area of Science:

• Surgical Management
• Hepatic Trauma
• Wound Drainage

Background:

• The necessity of drains in managing hepatic wounds has been debated since 1970.
• Previous limited reviews suggested a high intra-abdominal abscess rate with Penrose drains.

Purpose of the Study:

• To compare the efficacy of closed-drainage versus no-drainage in managing hepatic wounds.
• To evaluate the intra-abdominal abscess rates associated with different drainage strategies for hepatic injuries.

Main Methods:

• A retrospective review of 13 patient charts using Penrose drains.
• A prospective study involving 56 patients comparing closed-drainage versus no-drainage.
• Analysis of intra-abdominal abscess rates in both study groups.

Main Results:

• A retrospective review showed a 23% intra-abdominal abscess rate with Penrose drains.
• Prospective analysis revealed a 4.2% abscess rate with closed drainage and 3.1% with no drainage.
• Both closed-drainage and no-drainage strategies demonstrated comparable, low rates of intra-abdominal abscess.

Conclusions:

• The choice between closed-drainage and no-drainage for hepatic wounds should be based on surgeon evaluation of specific patient factors.
• Open drainage is not recommended for hepatic injuries.
• Both closed drainage and no drainage are viable options for managing hepatic wounds, with low associated risks of intra-abdominal abscess.