Drain after elective laparoscopic cholecystectomy. A randomized multicentre controlled trial

Abstract

Background Routine drainage after laparoscopic cholecystectomy is still debatable. The present study was designed to assess the role of drains in laparoscopic cholecystectomy performed for nonacutely inflamed gallbladder. Methods After laparoscopic gallbladder removal, 53 patients were randomized to have a suction drain positioned in the subhepatic space and 53 patients to have a sham drain. The primary outcome measure was the presence of subhepatic fluid collection at abdominal ultrasonography, performed 24 h after surgery. Secondary outcome measures were postoperative abdominal and shoulder tip pain, use of analgesics, nausea, vomiting, and morbidity. Results Subhepatic fluid collection was not found in 45 patients (84.9 %) in group A and in 46 patients (86.8 %) in group B (difference 1.9 (95 % confidence interval -11.37 to 15.17; P = 0.998). No significant difference in visual analogue scale scores with respect to abdominal and shoulder pain, use of parenteral ketorolac, nausea, and vomiting were found in either group. Two (1.9 %) significant hemorrhagic events occurred postoperatively. Wound infection was observed in three patients (5.7 %) in group A and two patients (3.8 %) in group B (difference 1.9 (95 % CI -6.19 to 9.99; P = 0.997). Conclusions The present study was unable to prove that the drain was useful in elective, uncomplicated LC.

Drain After Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis. A Pilot Randomized Study

“…Studies from the era of open cholecystectomy showed that most patients who underwent laparotomy for postcholecystectomy bile peritonitis had drains placed, suggesting that drain placement does not detect this complication effectively [6,[14][15][16]. Drains are also not effective to treat bile leak in elective LC [3,4]. In the present study, both bile leaks occurred after LC with drainage, suggesting that drains may be also useless after LC for ACC in selected patients.…”

“…Moreover, severe bleeding may be rapidly diagnosed because of postoperative hypotension, acute blood loss anemia, and intra-abdominal hypertension. Drains are also not effective to treat bleeding in elective LC [3,4].…”

“…In elective LC for nonacutely inflamed gallbladder, a Cochrane Database Systematic Review concluded that there is no evidence to support the use of drains [2]. Two recent randomized studies confirmed this conclusion [3,4].…”

Laparoscopic cholecystectomy: consensus conference-based guidelines

“…Hospital stay was longer in the drain group. Several RCTs, published at a later date, confirmed those findings and found it to be associated with longer hospital stay and increased pain [170][171][172][173] (LE2).…”

Drainage vs. non-drainage after cholecystectomy for acute cholecystitis: a retrospective study

“…One justification for inserting a drainage tube after laparoscopic cholecystectomy is to deflate carbon dioxide to reduce postoperative pain, although the use of a drainage tube in these cases was found to intensify postoperative pain rather than relieving it[16],[17]. Many authors reported that surgically placed drains have some risk; they have been associated with increased rates of intra-abdominal and wound infection, increased abdominal pain, decreased pulmonary function, and prolonged hospital stay[16],[18],[19].…”