The Need of Drainage After Cholecystectomy

Abstract

In an attempt to rationalize the use of intraperitoneal drainage of the subhepatic space after simple, elective cholecystectomy, a prospective study was designed to compare the post-operative course with and without drainage. There was a higher incidence of postoperative fever of unknown origin and wound infection in the drained group. In the group without drainage the hospital postoperative stay was shorter and there were no complications. The results suggest that routine surgical drainage after uncomplicated cholecystectomy is unnecessary and could be a source of postoperative fever and a higher incidence of wound infection.

Routine Sub-hepatic Drainage versus No Drainage after Laparoscopic Cholecystectomy: Open, Randomized, Clinical Trial

“…But many surgeons still continue drainage for reasons based on traditional teaching and anecdotal complications and not on reliable facts and figures [7]. The major reason for drainage is the fear of bile leakage that may lead to bile peritonitis; this is usually due to an aberrant bile duct and not slippage of the cystic duct ligature [3]. Fear of blood collection requiring intervention is another reason for routine drainage after LC [10].…”

“…Whatever the mechanism, the result is a fluid accumulation, most probably serous, adjacent to a drain [17]. The drain may prove dangerous after simple cholecystectomy as infection introduced along a drain may render an otherwise harmless collection of bile a cause of peritonitis [1,3,17]. Also drain may rapidly becomes walled off, and then merely provokes an exudate in response to its own presence [1].…”

“…Most surgeons continue to use routine subhepatic drain for the fear of bile leak and bleeding [2][3][4]. Such complications invariably occurred in spite of subhepatic drainage [3].…”

“…Most surgeons continue to use routine subhepatic drain for the fear of bile leak and bleeding [2][3][4]. Such complications invariably occurred in spite of subhepatic drainage [3]. Easier convalescence, decreased rate of complications, and shortened hospital stay were the advantages of no drainage [3].…”

“…Such complications invariably occurred in spite of subhepatic drainage [3]. Easier convalescence, decreased rate of complications, and shortened hospital stay were the advantages of no drainage [3]. Laparoscopic cholecystectomy (LC), after its advent in 1987, rapidly established itself as the gold standard treatment of gallstones.…”