Impact of routine use of abdominal drains on the diagnosis, management and outcomes of liver transplant complications
Gustavo Ferreira1,2,3, Andre L. Watanabe1, Natalia C. Trevizoli1, Fernando M. Jorge1, Ana V. Figueira1, Carolina F. Couto1.
1Liver Transplantation Division, Instituto de Cardiologia do Distrito Federal, Brasilia, Brazil; 2Surgery Division, Hospital Metropolitano Doutor Celio de Castro, Belo Horizonte, Brazil; 3Department of Sciences Applied to Surgery and Ophtalmology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Introduction: The routine placement of abdominal drains at the end of the liver transplantation procedure, with one extremity inside the abdominal cavity, close to the liver graft and the anastomosis, and the other one placed on an external closed system, is a common practice in many liver transplantation centers. The rationale for the placement of the abdominal drains is the belief that, in the occurance of surgical complications, such as bleeding or formation of a biliary fistula, the drain will allow for the early diagnosis of that complication, and in some cases may be helpful in the treatment by preventing the accumulation of fluids in the abdominal caviity. However, the placement of abdominal drains can have a negative impact on the outcome of the procedure, either by causing the loss of large amounts of ascitic fluid and worsening electrolyte disturbances, or by increasing the risk of surgical site infections as described by some authors. We have performed an analysis of the impact of the placement of abdominal drains in the liver transplants done in one tertiary center.
Materials and Methods: We have reviewed the medical records of 388 liver transplant patients in a single Brazilian hospital, in the period from 2012 to 2019. In the period from 2012 to 2015, drains were routinely placed in all patients. From 2015 onwards, drains were not placed in any patients. Statistical analysis was performed using Yates corrected Pearson's chi-square for qualitative parameters and t test for quantitative parameters.
Results: Of the 388 patients in the study, abdominal drains (AD) were placed on 162 (42%) of patients, while 226 (58%) used no abdominal drain (NAD). There were 21 cases of significant surgical complication in all patients: 16 cases of bleeding, being 5 in the AD group and 11 in the NAD group (p=0.38); and 5 cases of biliary fistula, being 1 in the AD group and 4 in the NAD group (p=0.32). The time for diagnosis and surgical intervention was not statistically different between the two groups, with a mean of 5 days in the NAD group and 2.2 days in the AD group suffering from bleeding (p=0.1); and a mean of 18.75 days in the NAD and 42 days in the AD group suffering from biliary fistula. Mortality was also not significantly different between groups, with 1 case in each group suffering from bleeding (p=0.54) and one case in the NAD suffering from biliary fistula.
Discussion: The use of abdominal drains did not significantly reduce the time for diagnosis and intervention in patients suffering from post-operative bleeding or biliary fistula. It also had no impact on the mortalirty of patients suffering from these complications.
Conclusions: The use of abdominal drains had no significant impact on the diagnosis, management and outcomes of surgical complications in liver transplant patients. Considering the complications associated with drain placement in other studies, routine placement of abdominal drains in this context may be questioned.
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