Is the Routine Use of Drainage After Elective Laparoscopic Cholecystectomy Justified? A Randomized Trial

Georgiou, Chrysanthos; Demetriou, Nicoleta; Pallaris, Theodoros; Theodosopoulos, T.; Katsouyanni, Klea; Polymeneas, G.

doi:10.1089/lap.2010.0003

Cited by 39 publications

(47 citation statements)

References 14 publications

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“…In Piotr's series, infectious complications were observed in 10% of the patients who had drainage after splenectomy. The Authors reported a shorter hospital stay in patients without drainage (6), data which is confirmed also by other surgeons (29)(30)(31)(32). Accordingly, Cohn (13) found a ten-fold increased risk of infectious complications in the splenic fossa, an increased risk which was observed also by Cherise et al (14).…”

Section: Discussionmentioning

confidence: 52%

Surgical drain after open or laparoscopic splenectomy: is it needed or contraindicated?

Vecchio¹,

Intagliata²,

Marchese³

et al. 2015

GCHIR

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The use of surgical drain after abdominal surgery has always been a controversial issue.Benefits and risks related to the operatively placed drains in the abdominal cavity have been discussed since a hundred years ago when some surgeons where in favor of the drainage, while skeptic others considered not physiological their use (1, 2).In the common practice intra-abdominal drains have been used to help the surgeons in the post-operative phase to identify post-operative bleeding, to drain and monitor residual intraperitoneal pathologic liquids (such as bile, fecal material, pancreatic juice), and in order to prevent intra-abdominal septic collections (3).So far, however, there is a lack of evidence proving significant benefits of surgical drains and, moreover, drains themselves have been imputed as responsible for related complications which may increase post-operative morbility (1,(4)(5)(6)(7)(8)(9)(10)(11)(12).Similarly, placement of drains after splenectomy has been largely debated. Theoretically, the use of drain in splenectomised patients, whose susceptibility to infections and sepsis due to some microbial agents is well known, might predispose to an increased risk of subphrenic abscess formation and systemic infections (13,14). This assertion, however, has been resized in other studies (15-17). The increased risk of loco-regional or systemic infections in drained patients following splenectomy, has been related to associated, not intra-operatively recognized, injuries to the pancreatic tail and/or to the bowel, or they have been ascribed to the drainage system itself (18).In this study, we report our experience in a large series of open and laparoscopic splenectomies where the left sub-phrenic drainage has been routinely used. We attempt to answer if in our experience drainage could have

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Section: Discussionmentioning

confidence: 52%

Surgical drain after open or laparoscopic splenectomy: is it needed or contraindicated?

Vecchio¹,

Intagliata²,

Marchese³

et al. 2015

GCHIR

View full text Add to dashboard Cite

show abstract

“…The meta‐analysis shows no statistically significant differences in wound infection and in mortality rates depending on the use or not of the drain. The drain may be a bacterial entrance toward peritoneal cavity, but morbidity is not statistically increased if short‐term drains are used in LC, as shown by Picchio and Georgiou . With regard to mortality, the result is reasonably not significant because LC is a well‐standardized surgical procedure and the presence or absence of the drainage is not related to this very rare complication.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, seven studies [9][10][11][12][13][14][15] were included in the metaanalysis with a total of 1310 patients.…”

Section: Meta-analysismentioning

confidence: 99%

To drain or not to drain elective uncomplicated laparoscopic cholecystectomy? A systematic review and meta‐analysis

Bugiantella

Vedovati

Becattini

et al. 2014

J Hepato Biliary Pancreat

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Laparoscopic cholecystectomy (LC) has largely replaced conventional cholecystectomy in the past decade. However, there are still limited data about the value of prophylactic sub-hepatic drainage for elective uncomplicated LC. We carried out a systematic review of the literature in order to perform a meta-analysis about this issue. An unrestricted search in MEDLINE, EMBASE and Cochrane Library up to 31 December 2013 was performed. Overall, seven high-methodological quality randomized controlled trials (RCTs) were included in the meta-analysis, resulting in 1310 patients totally. The incidence of abdominal collections, wound infection and overall mortality according to the presence or absence of the sub-hepatic drainage were metaanalyzed. Sub-hepatic drainage showed an increase in the abdominal collection rate in patients who underwent elective uncomplicated LC (OR 1.56, 95% CI 1.00-2.43) if compared to patients without drainage. A non-significant correlation was found in overall mortality and infection rates. The meta-analysis shows that the presence of the sub-hepatic drainage does not reduce the incidence of abdominal collection after uncomplicated LC, whereas it does not influence wound infection and mortality rates, postoperative pain and hospital stay.

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“…Drains have also been used to remove remnant infectious debris or fluid and to prevent the formation of an intra‐abdominal abscess. However, several investigators have reported that the drain itself could become a bacterial entrance into the peritoneal cavity, which could cause ascending infection and result in wound infection at the insertion site of the drain . In our study, one intra‐abdominal abscess and four wound infections were observed in the group with drainage.…”

Section: Discussionmentioning

confidence: 99%

Is routine drain insertion after laparoscopic cholecystectomy for acute cholecystitis beneficial? A multicenter, prospective randomized controlled trial

Kim

Lee

et al. 2015

J Hepatobiliary Pancreat Sci

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Is the Routine Use of Drainage After Elective Laparoscopic Cholecystectomy Justified? A Randomized Trial

Cited by 39 publications

References 14 publications

Surgical drain after open or laparoscopic splenectomy: is it needed or contraindicated?

Surgical drain after open or laparoscopic splenectomy: is it needed or contraindicated?

To drain or not to drain elective uncomplicated laparoscopic cholecystectomy? A systematic review and meta‐analysis

Is routine drain insertion after laparoscopic cholecystectomy for acute cholecystitis beneficial? A multicenter, prospective randomized controlled trial

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