It's a randomized control trial to compare early drain removal versus standard drain removal after donor hepatectomy in terms of donor outcomes. We will analyse the data and elucidate the safety of early drain removal using 3x3 rule with routine drain removal.
* Prophylactic abdominal drainage after donor right hepatectomy for LDLT has been a common or even mandatory practice in most transplant centres. * This serves to monitor the occurrence of postoperative intraabdominal bleeding and is used for the detection and drainage of any bile leakage. * Below table mentions both advantages and disadvantages of prophylactic drain placement after hepatectomy. Advantages 1. Early detection of haemorrhage 2. Early detection of bile leak 3. Early reintervention Disadvantages 1\. Increased rates of intraabdominal and wound infection, 2. Increased abdominal pain, 3. Decreased pulmonary function, 4. Prolonged hospital stay, 5. Bowel injury. * Our study in ILBS for ALF donors, the overall complication rate was 20% as per Clavien-Dindo classification, of which a majority (15.9%) had grade 1 or 2 complications. Major complications (3b and above) were seen in 4 (1.0%) patients. Biliary complications were noted in 1.7% only. * In a study by Japanese group concluded that 3 × 3 rule is clinically feasible and allows for the early removal of the drain tube with minimum infection risk after liver resection. The ''3 x 3 rule'': the drain will be removed when the drain fluid bilirubin concentration is \<3 mg/dl on day 3 after operation. * In our institute we remove drain routinely, when output is less than 100ml and serous. That is usually on postoperative day 5-7. * There is no randomized control trail done in donor hepatectomy comparing early versus standard drain removal.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
NONE
Enrollment
108
Abdominal drain placed during surgery removal
ILBS - Parthiban
Delhi, India
safety of drain removal using 3x3 rule - overall complications.
Comprehensive complication index (CCI) - clavin dindo classification
Time frame: patient will be followed upto 3 months after surgery
Post operative pain relief
using Visual analogue score
Time frame: patient will be followed upto 3 months after surgery
Bile leak
standard ISGLS definition - drain bilirubin measured in mg/dl.
Time frame: patient will be followed upto 3 months after surgery
Length of hospital stay
calculated from the day of admission to day of discharge, and based on the number of nights spent in hospital
Time frame: patient will be followed upto 3 months after surgery
Surgical Site Infection (SSI)
patient has at least one of the following: 1. purulent drainage from the superficial incision. 2. organism(s) identified from an aseptically-obtained specimen from the superficial incision or subcutaneous tissue by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment (for example, not Active Surveillance Culture/Testing (ASC/AST)). 3. superficial incision that is deliberately opened by a surgeon, physician\* or physician designee and culture or non-culture based testing of the superficial incision or subcutaneous tissue is not performed AND patient has at least one of the following signs or symptoms: localized pain or tenderness; localized swelling; erythema; or heat. 4. diagnosis of a superficial incisional SSI by a physician\* or physician designee.
Time frame: patient will be followed upto 3 months after surgery
reintervention rate
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
defined as any additional abdominal intervention ( surgical or radiological) during the same hospital stay after the primary operation
Time frame: patient will be followed upto 3 months after surgery
readmission rate
90 day readmission rate - any hospital admission after the index admission.
Time frame: patient will be followed upto 3 months after surgery