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

Abstract

Drainage after laparoscopic cholecystectomy (LC) for acute calculous cholecystitis (ACC) is used without evidence of its efficacy. The present pilot study was designed to address this issue. After laparoscopic gallbladder removal, 15 patients were randomized to have a drain positioned in the subhepatic space (group A) and 15 patients to have a sham drain (group B). The primary outcome measure was the presence of subhepatic fluid collection at abdominal ultrasonography, performed 24 h after surgery. Secondary outcome measures included postoperative abdominal and shoulder tip pain, use of analgesics, and morbidity. Abdominal ultrasonography did not show any subhepatic fluid collection in eight patients (53.3 %) in group A and in five patients (33.3 %) in group B (P00.462). If present, median (range) subhepatic collection was 50 mL (20-100 mL) in group A and 80 mL (30-120 mL) in group B (P00.573). No significant differences in the severity of abdominal and shoulder pain and use of parenteral ketorolac were found in either group. Two biliary leaks and one subhepatic fluid collection occurred postoperatively. The present study was unable to prove that the drain was useful in LC for ACC, performed in a selected group of patients.

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

“…Moreover, the presence of a foreign body like the drain might lead to an increased production of intra-abdominal reactive serum. Not least the drain may not detect a neighboring collection [10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

Drainage versus no drainage after laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis

“…A flow diagram for study inclusion and exclusion is presented in Figure 1. The initial searches generated 585 citations, of which 3 studies [10][11][12] considered to be suitable for the final meta-analysis using the stated eligibility criteria. A total of 382 patients (188 drained versus 194 non-drain patients in emergency LC).…”

“…Heterogeneity was not statistically significant (I 2 =0, P=0.81). Abdominal pain: Two studies [10,11] provided information about the 24 h postoperative abdominal pain. Abdominal pain 24 h after surgery was less severe in the no drain group (MD=0.80, 95% CI 0.47-1.14; P<0.00001) ( Figure 5).…”

“…In the study of Kim [10], the patients were composed of acute edematous cholecystitis, gallbladder empyema and even gallbladder gangrene. However, patients were excluded if they were gangrenous or emphysematous cholecystitis in the study of Lucarelli [11]. For all considerations of limitation, more high-methodological quality RCTs with an adequate number of patients and homogeneously collected data are warranted.…”

“…Nevertheless, some surgeons advocate that drainage of the abdominal cavity has no advantage for detecting bile leakage or bleeding, and it is not helpful for preventing postoperative morbidities. Recently, some studies [9][10][11][12] have indicated that routine drainage is not needed to prevent postoperative after surgery for acutely inflamed gallbladder. There is no solid evidence to support routine abdominal drainage after LC for acute cholecystitis.…”