The Value of Peritoneal Drains in the Treatment of Liver Injuries

It has been widely accepted that peritoneal drainage minimizes postoperative intra-abdominal sepsis following liver injury. In a review of 254 patients with liver injury who survived more than one day (blunt, 67.3%; penetrating, 32.7%), 27 patients had peritoneal drainage, only six patients had perihepatic drainage, and in the remaining 21 patients, the drains were positioned to drain nonhepatic injuries. Postoperative intra-abdominal sepsis occurred in 4.8% of the undrained patients and in 7.4% of the drained patients. In seven of the 11 undrained patients who developed postoperative intra-abdominal sepsis, the sepsis would not have been averted by perihepatic drainage because the septic site would not have been included in perihepatic drainage or because the sepsis related to leakage of a pancreaticoduodenectomy anastomosis. Postoperative intra-abdominal sepsis occurred in only 1% of the patients with nonbursting liver injuries. In contrast, 19.6% of the patients with liver bursts developed postoperative intra-abdominal sepsis. Sepsis following liver bursts was not related to the use of or to the avoidance of peritoneal drainage. Based upon these data we conclude that: peritoneal drainage is not indicated for capsular tears or for minor or major liver lacerations, and that the value of peritoneal drainage in the prevention of intra-abdominal sepsis following bursting liver injuries remains unsubstantiated.