Efficacy of unconventional abdominal drainage after laparoscopic hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Xi , HU Zhaohui , PENG Yonghai ,  LUO Hua

Department of Hepatobiliary Surgery, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding?author：

LUO Hua, Email: luohuamyzzyy@163.com

Keywords：

laparoscopy hepatectomy; abdominal drainage; bile leakage; abdominal bleeding; abdominal infection

DOI：

10.7507/1007-9424.202005030

Video：

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Objective To evaluate the safety and efficacy of unconventional abdominal drainage after laparoscopic hepatectomy.Methods The clinicopathologic data of patients who underwent laparoscopic hepatectomy for liver tumors in the Mianyang Central Hospital from June to December 2019 and met the inclusion criteria were retrospectively collected. Based on whether drainage tube was placed in the abdominal cavity during operation, the patients were divided into non-catheterized group (without drainage tube) and catheterized group (with drainage tube). The intraoperative data and postoperative complications (e.g. intraabdominal hemorrhage, bile leakage, abdominal infection, and liver failure) were compared between the two groups. Then, the intraoperative data and postoperative conditions of liver cancer and non-liver cancer patients with or without abdominal drainage tube were compared and analyzed.Results A total of 117 eligible patients were included in the study. The non-catheterized group had 59 patients and the catheterized group had 58 patients. The patients with liver cancer had 84 patients (44 non-catheterized patients and 40 catheterized patients) and the patients without liver cancer had 33 patients (15 non-catheterized patients and 18 catheterized patients). ① On the whole, the groups were comparable in the baseline data between the non-catheterized group and the catheterized group, such as gender, age, HBV infection, body mass index, hepatic function index, liver stiffness value, disease category, etc. (P>0.05). Compared with the catheterized group, the non-catheterized group had earlier off-bed activities and earlier flatus time (P<0.001), and shorter postoperative hospital stay (P=0.030). However, no statistically significant differences were found in other indicators between the two groups (P>0.05). ② Whether the patients had liver cancer or not, the non-catheterized patients still had earlier off-bed activities and earlier flatus time as compared with the catheterized patients (P<0.001). Among the patients with liver cancer, no difference was found in postoperative hospital stay. However, among the patients without liver cancer, the non-catheterized patients had shorter postoperative hospital stay than the catheterized patients (P=0.042). No statistically significant differences were found in other indicators between the catheterized patients and non-catheterized patients (P>0.05).Conclusion For technologically skilled laparoscopic hepatectomy center, selectively not placing peritoneal drainage tube after surgery might better promote the health of patients.

Citation： CHEN Xi, HU Zhaohui, PENG Yonghai, LUO Hua. Efficacy of unconventional abdominal drainage after laparoscopic hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(9): 1089-1093. doi: 10.7507/1007-9424.202005030 Copy

1.	郭成, 姚英民. 腹腔鏡肝切除術的臨床應用及發展現狀. 西安交通大學學報 (醫學版), 2019, 40(6): 843-852.
2.	中國醫師協會外科醫師分會微創外科醫師委員會. 腹腔鏡肝切除術加速康復外科中國專家共識 (2017 版). 中國實用外科雜志, 2017, 37(5): 517-524.
3.	楊佳, 閆沛靜, 司牟博, 等. 腹腔鏡膽囊切除術后放置腹腔引流隨機對照試驗的 Meta 分析. 腹腔鏡外科雜志, 2019, 24(6): 433-441.
4.	Lee J, Choi YY, An JY, et al. Do all patients require prophylactic drainage after gastrectomy for gastric cancer? the experience of a high-volume center. Ann Surg Oncol, 2015, 22(12): 3929-3937.
5.	Denost Q, Rouanet P, Faucheron JL, et al. To drain or not to drain infraperitoneal anastomosis after rectal excision for cancer. Ann Surg, 2017, 265(3): 474-480.
6.	Yamashita Y, Hamatsu T, Rikimaru T, et al. Bile leakage after hepatic resection. Ann Surg, 2001, 233(1): 45-50.
7.	Sakamoto K, Tamesa T, Yukio T, et al. Risk factors and managements of bile leakage after hepatectomy. World J Surg, 2016, 40(1): 182-189.
8.	Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg, 2005, 12(5): 351-355.
9.	Cauchy F, Fuks D, Nomi T, et al. Incidence, risk factors and consequences of bile leakage following laparoscopic major hepatectomy. Surg Endosc, 2016, 30(9): 3709-3719.
10.	田亞麗, 陳蓮, 孫青, 等. 解剖性肝切除術后腹腔感染并發癥分析. 中華普通外科雜志, 2019, 34(9): 762-765.
11.	Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery, 2011, 149(5): 713-724.
12.	中華醫學會外科學分會外科手術學學組, 中國醫療保健國際交流促進會加速康復外科學分會肝臟外科學組. 肝切除術后加速康復中國專家共識 (2017 版). 中華肝臟外科手術學電子雜志, 2017, 6(4): 254-260.
13.	Fong Y, Brennan MF, Brown K, et al. Drainage is unnecessary after elective liver resection. Am J Surg, 1996, 171(1): 158-162.
14.	Gavriilidis P, Hidalgo E, de'Angelis N, et al. Re-appraisal of prophylactic drainage in uncomplicated liver resections: a systematic review and meta-analysis. HPB (Oxford), 2017, 19(1): 16-20.
15.	Inoue Y, Imai Y, Kawaguchi N, et al. Management of abdominal drainage after hepatic resection. Dig Surg, 2017, 34(5): 400-410.
16.	Sun HC, Qin LX, Lu L, et al. Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method. Br J Surg, 2006, 93(4): 422-426.
17.	Zheng SM, Li H, Li GC, et al. Risk factors, treatment and impact on outcomes of bile leakage after hemihepatectomy. ANZ J Surg, 2017, 87(7-8): E26-E31.26-31.
18.	Wada S, Hatano E, Yoh T, et al. Is routine abdominal drainage necessary after liver resection? Surg Today, 2017, 47(6): 712-717.
19.	Tanaka K, Kumamoto T, Nojiri K, et al. The effectiveness and appropriate management of abdominal drains in patients undergoing elective liver resection: a retrospective analysis and prospective case series. Surg Today, 2013, 43(4): 372-380.
20.	Shwaartz C, Fields AC, Aalberg JJ, et al. Role of drain placement in major hepatectomy: a NSQIP analysis of procedure-targeted hepatectomy cases. World J Surg, 2017, 41(4): 1110-1118.
21.	Miyazaki S, Takasaki K, Yamamoto M, et al. Liver regeneration and restoration of liver function after partial hepatectomy: the relation of fibrosis of the liver parenchyma. Hepatogastroenterology, 1999, 46(29): 2919-2924.

1. 郭成, 姚英民. 腹腔鏡肝切除術的臨床應用及發展現狀. 西安交通大學學報 (醫學版), 2019, 40(6): 843-852.
2. 中國醫師協會外科醫師分會微創外科醫師委員會. 腹腔鏡肝切除術加速康復外科中國專家共識 (2017 版). 中國實用外科雜志, 2017, 37(5): 517-524.
3. 楊佳, 閆沛靜, 司牟博, 等. 腹腔鏡膽囊切除術后放置腹腔引流隨機對照試驗的 Meta 分析. 腹腔鏡外科雜志, 2019, 24(6): 433-441.
4. Lee J, Choi YY, An JY, et al. Do all patients require prophylactic drainage after gastrectomy for gastric cancer? the experience of a high-volume center. Ann Surg Oncol, 2015, 22(12): 3929-3937.
5. Denost Q, Rouanet P, Faucheron JL, et al. To drain or not to drain infraperitoneal anastomosis after rectal excision for cancer. Ann Surg, 2017, 265(3): 474-480.
6. Yamashita Y, Hamatsu T, Rikimaru T, et al. Bile leakage after hepatic resection. Ann Surg, 2001, 233(1): 45-50.
7. Sakamoto K, Tamesa T, Yukio T, et al. Risk factors and managements of bile leakage after hepatectomy. World J Surg, 2016, 40(1): 182-189.
8. Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg, 2005, 12(5): 351-355.
9. Cauchy F, Fuks D, Nomi T, et al. Incidence, risk factors and consequences of bile leakage following laparoscopic major hepatectomy. Surg Endosc, 2016, 30(9): 3709-3719.
10. 田亞麗, 陳蓮, 孫青, 等. 解剖性肝切除術后腹腔感染并發癥分析. 中華普通外科雜志, 2019, 34(9): 762-765.
11. Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery, 2011, 149(5): 713-724.
12. 中華醫學會外科學分會外科手術學學組, 中國醫療保健國際交流促進會加速康復外科學分會肝臟外科學組. 肝切除術后加速康復中國專家共識 (2017 版). 中華肝臟外科手術學電子雜志, 2017, 6(4): 254-260.
13. Fong Y, Brennan MF, Brown K, et al. Drainage is unnecessary after elective liver resection. Am J Surg, 1996, 171(1): 158-162.
14. Gavriilidis P, Hidalgo E, de'Angelis N, et al. Re-appraisal of prophylactic drainage in uncomplicated liver resections: a systematic review and meta-analysis. HPB (Oxford), 2017, 19(1): 16-20.
15. Inoue Y, Imai Y, Kawaguchi N, et al. Management of abdominal drainage after hepatic resection. Dig Surg, 2017, 34(5): 400-410.
16. Sun HC, Qin LX, Lu L, et al. Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method. Br J Surg, 2006, 93(4): 422-426.
17. Zheng SM, Li H, Li GC, et al. Risk factors, treatment and impact on outcomes of bile leakage after hemihepatectomy. ANZ J Surg, 2017, 87(7-8): E26-E31.26-31.
18. Wada S, Hatano E, Yoh T, et al. Is routine abdominal drainage necessary after liver resection? Surg Today, 2017, 47(6): 712-717.
19. Tanaka K, Kumamoto T, Nojiri K, et al. The effectiveness and appropriate management of abdominal drains in patients undergoing elective liver resection: a retrospective analysis and prospective case series. Surg Today, 2013, 43(4): 372-380.
20. Shwaartz C, Fields AC, Aalberg JJ, et al. Role of drain placement in major hepatectomy: a NSQIP analysis of procedure-targeted hepatectomy cases. World J Surg, 2017, 41(4): 1110-1118.
21. Miyazaki S, Takasaki K, Yamamoto M, et al. Liver regeneration and restoration of liver function after partial hepatectomy: the relation of fibrosis of the liver parenchyma. Hepatogastroenterology, 1999, 46(29): 2919-2924.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Efficacy of unconventional abdominal drainage after laparoscopic hepatectomy

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