Laparoscopic Cholecystectomy With and Without Abdominal Prophylactic Drainage

Ishikawa, Koichi; Murakami, Takashi; Kishihara, Fumiaki; Fukuyama, Yasuro; Masuda, Hiroto; Kitano, Seigo

doi:10.1111/j.1443-1661.2010.01068.x

Cited by 22 publications

(13 citation statements)

References 19 publications

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“…The surgeon performs drain insertion with the expectation that drainage would be helpful for detecting bleeding or bile leak with a color change or a rapid increase in drained fluid in the early postoperative period and that drainage would be effective in preventing the formation of hematoma or biloma. However, several recent studies have reported opposite results . This experimental study showed that the lumen of the inserted drain is quickly surrounded and completely occluded by omental tissue within 48 h and then loses the function of detection.…”

Section: Discussionsupporting

confidence: 83%

“…Because the incidence of these complications is relatively rare, it is expected that the clinical significance of drainage would be very low. Furthermore, some authors assert that the drain can facilitate the bile leak from the superficial bile ductules due to the mechanical irritation from foreign materials of the drain itself, the sucking effect of a closed drain, and the creation of dead space [10,12]. Drains have also been used to remove remnant infectious debris or fluid and to prevent the formation of an intraabdominal abscess.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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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Section: Discussionsupporting

confidence: 83%

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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“…According to Julio and Ishikawa's research the length of hospital stay is shorter when drainage is abandoned [16–18]. Our study also confirmed the shorter hospital stay of patients without drainage.…”

Section: Discussionsupporting

confidence: 83%

Do we really need routine drainage after laparoscopic adrenalectomy and splenectomy?

Major¹,

Matłok²,

Pędziwiatr³

et al. 2011

Videosurgery and Other Miniinvasive Techniques

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IntroductionNot only did the introduction of laparoscopy not dispel the controversy over routine drainage after uncomplicated surgery, but paradoxically it contributed to enlivening the debate on the issue.AimTo determine the usefulness of operative site drainage after “clean”, uncomplicated laparoscopic surgery such as splenectomy or adrenalectomy.Material and methodsOne hundred and seventy-six participants (female : male 114 : 62) operated on in our centre between Jan 2008 and Nov 2010 were included in the prospective study. Adrenalectomy was performed in 122 patients and splenectomy in 54. In some patients no drains were left after the procedure, while the others had drainage employed. The incidence and character of post-operational complications, the necessity of repeat surgery and the length of the hospital stay were analysed.ResultsIn 112 patients (63.6%) the drain was inserted in the operational field, while in the remaining 64 (36.4%) it was not. Out of the whole series of 112 patients with drainage used, complications were observed in 6 cases (5.36%) while in the group of patients without drainage they appeared in 2 (3.12%) of those operated on (p < 0.05). Infectious complications were observed more often in the series with drainage (3.57% vs. 0%, p < 0.05). The hospital stay in patients with drainage was statistically significantly longer than in patients without.ConclusionsBased on the study, no justification for routine drainage after scheduled, uncomplicated laparoscopic adrenalectomy and splenectomy was found. The decision whether to leave a drain should be made for every patient individually.

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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: Discussionsupporting

confidence: 76%

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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Laparoscopic Cholecystectomy With and Without Abdominal Prophylactic Drainage

Abstract: The use of drain after simple elective uncomplicated LC could safely be limited to appropriate patients as judged by the operating surgeon.

Cited by 22 publications

References 19 publications

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

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

Do we really need routine drainage after laparoscopic adrenalectomy and splenectomy?

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

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