• Yuki Bekki, Yo-Ichi Yamashita, Shinji Itoh, Norifumi Harimoto, Ken Shirabe, and Yoshihiko Maehara.
• Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan, y-bekki@surg2.med.kyushu-u.ac.jp.
• World J Surg. 2015 Oct 1; 39 (10): 2543-9.

BackgroundRandomized clinical trials have demonstrated the limited efficacy of prophylactic drains following hepatic resection. However, many surgeons still insist on using prophylactic drains. This study was designed to identify patients who require prophylactic drains to manage or monitor postoperative complications after hepatic resection.MethodsData were retrospectively collected from 316 patients who underwent hepatic resection and received a prophylactic drain. The patients were divided into two groups according to whether the drain was used to manage or monitor the following postoperative complications: bile leakage (prophylactic drains were used to monitor and treat bile leakage) and postoperative hemorrhage (the drainage fluid was macroscopically bloody and required drain fluid blood counts and monitoring to assess the need for transfusion or reoperation). The results were then validated in a separate cohort of 101 patients.ResultsIn 25/316 patients (7.9 %), the prophylactic drains were clinically effective, being used to manage bile leakage in 18 patients and hemorrhage in 8. Intraoperative bile leakage (P = 0.021) and long operation time (≥ 360 min) (P = 0.017) were independent predictors of bile leakage. Intraoperative blood loss (≥ 650 ml) (P = 0.0009) was an independent predictor of hemorrhage. In the subsequent 101 patients, prophylactic drains were clinically effective in patients with one of these predictors with sensitivity, specificity, and false-negative rates of 88.9, 62.0, and 1.7 %, respectively.ConclusionA prophylactic drain should be considered following hepatic resection for patients with intraoperative bile leakage, operation time of ≥ 360 min, or blood loss of ≥ 650 ml.

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