Yamazaki et al reported criteria for removing prophylactic abdominal drains after a hepatic resection. There has been controversy about the use of prophylactic drains but they can provide useful information when used properly. The authors are from Nihon University in Tokyo.
Patient selection: hepatic resection for malignancy with placement of prophylactically-placed abdominal drains
Concerns:
(1) biliary leak (associated with bilirubin concentration > 5 mg/dL)
(2) infection (with bilirubin concentration in drain fluid a predictor of infection)
Predictors of postoperative infection:
(1) elevated drain fluid bilirubin on day 3
(2) elevated drain fluid bilirubin on day 5
(3) duration of surgery > 5 hours (> 300 minutes)
(4) drain site ascites leakage (nursing care for ascites required > 5 times per day)
(5) repeat resection
Prophylactic drains may be placed when the surgeon is concerned about an increased risk for complications (severe cirrhosis, multiple liver resections, large volumes of drainage fluid, wide resection surface).
Rule as formulated as the best time to remove prophylactic drains ("3x3"):
(1) day 3 after operation
(2) drain fluid bilirubin concentration < 3 mg/dL
Ideally there should not be signs of infection and culture of drainage fluid should be negative.
Pulling the drain early reduces the risk of retrograde infection along the drain.
