Drain use after open cholecystectomy: is there a justification?

Abstract

Background Despite randomized trials showing no benefit, drain use after open cholecystectomy continues, perhaps as a result of more complicated patient presentation. We examined the reasons for drain use in patients undergoing open cholecystectomy and evaluated the effect of drain placement on surgical outcomes. Methods Univariate and multivariate analyses compared pre-and intraoperative factors associated with drain placement, and postoperative outcomes in patients undergoing open cholecystectomy at our institution between 2002 and 2007.Results In 160 patients who underwent open cholecystectomy as primary operative procedure, 92 patients (58%) had a drain placed. In 22% of the cases, the surgeon's stated reason for drain placement was hemorrhage, abscess, nonidentification of critical structures, bile spillage, or concern for a bile leak. No reason was provided in78% of the operative reports. Multivariate analysis revealed diagnoses of acute, chronic, or gangrenous cholecystitis (n=120, 75%), intraoperative bile spillage (n=60, 38%), and higher than median intraoperative blood loss (>200 ml) as independent predictors of drain use (all p≤0.042). Patients with drains had increased length of hospital stay, postoperative ICU admissions, rates of hospital re-admission, and use of post-operative endoscopy (all p≤0.04). Patients with and without drains had similar rates of postoperative percutaneous drainage, bile leaks, intra-abdominal abscesses, wound infections, and deaths (all p≥0.121). Conclusions The use of drains after open cholecystectomy was associated with complicated patient presentations: cholecystitis, intraoperative bile spillage, and high intraoperative blood loss. These patients had longer and more complicated postoperative course and more re-admissions. However, use of intraoperative drains was not associated with a reduction in the need for postoperative percutaneous drainage or in improvement in the rates of bile leaks, infections, or deaths.

Drainage versus No Drainage after Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis

“…The conversion rate to open affects the postoperative complications and the length of stay. Bile spillage was a reason to insert a drain after open cholecystectomy 24 and associated with surgical site infections. 25 Third, the characteristics of included patients were not consistent among studies leading to some heterogeneity in our overall analyses.…”

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

“…Traditionally, drains in LC are used for the early detection of bile leaks and any unsuspected hemorrhage and to evacuate abdominal fluid collections without the need for more invasive procedures. A large retrospective series reported the following main reasons to insert a drain after open cholecystectomy: (1) operation for cholecystitis, (2) intraoperative bile spillage, and (3) excessive blood loss during the operation [10]. However, experimental studies showed that when a drain is inserted in the peritoneal cavity that contains no fluids, it is quickly surrounded by omentum and completely occluded within 48 h [11].…”

Laparoscopic Cholecystectomy With and Without Abdominal Prophylactic Drainage

“…While it is difficult to find any published data supporting drain use, concerns for infectious source control and a possible biliary leak have been supported in discussion by Schein 14 . However, Zaydfudim et al 17 . could not find a justification for drain placement in cases of excessive intraoperative blood loss.…”

“…15,16 While it is difficult to find any published data supporting drain use, concerns for infectious source control and a possible biliary leak have been supported in discussion by Schein. 14 However, Zaydfudim et al 17 could not find a justification for drain placement in cases of excessive intraoperative blood loss. In this study, the use of drains after LC was associated with complicated patient presentations: excessive intraoperative blood loss, difficult operation, and intraoperative bile spillage.…”