Laparoscopic elective cholecystectomy with and without drain: A controlled randomised trial

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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“…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%

“…The meta-analysis of the RCTs using only a passive drainage (1204 patients) [9,[11][12][13][14][15]] showed a statistically significant lower incidence of abdominal collections in patients without drainage compared to patients with drainage (OR 1.65, 95% CI 1.02-2.68, P = 0.042; I 2 = 0%, χ 2 P = 0.393).…”

Section: Subgroups 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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“…The systematic abdominal cavity drainage after uncomplicated LCH, is unnecessary, a cause of prolongation of postoperative hospital stay and a source of postoperative complications. [14][15][16] In present survey 18% (n=22) of surgeons routinely drain, looking for an association between this unjustified attitude and the characteristics of the surgeon we note a total independence, surgeons with more than 10 years experience used drain as much as the less experienced surgeons, and that HUChir, PChir and PVChir drain as much (5.9% vs 19.6% vs 23.1%) (p=0.356). Also, surgeons using laparoscopy drain as much as surgeons performing open CH.…”

Section: Discussionmentioning

confidence: 58%

Surgical practices during cholecystectomy in Algeria: results of a survey

et al. 2020

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Background: The cholecystectomy is one of the most practiced surgeries; the learned societies published guidelines to improve surgical practices. Guidelines are sometimes not followed, either by negligence, by lack of means or adequate professional environment. So, to know the real practices of surgeons, a survey was conducted.Methods: An anonymous national survey involving all practicing Algerian surgeons was conducted. At the end of the survey, all data were captured and processed using the SPSS v20 software; χ2 tests were used to compare different groups of surgeons.Results: Only 122 responses were retained, twenty-two percent of surgeons perform open cholecystectomy. No surgeon performed routinely cholangiography, 43% extracted the gallbladder using extraction disposal, 18% performed systematic abdominal cavity drainage, all surgeons send the gallbladder to histology for examination and postoperative antibiotic prophylaxis was routinely prescribed by 69% of surgeons. The average postoperative hospitalisation recommended by surgeons was 1.65 days (0-5) days. The experience of the surgeon or his position was associated with lower rates of systematic prescription of antibiotic prophylaxis, and with a lower duration of postoperative hospitalisation.Conclusions: We recommend publication of guidelines of good practices adapted to the socio-professional and economic context of countries.

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“…Hospital stay was longer in the drain group. Several RCTs, published at a later date, confirmed those findings and found it to be associated with longer hospital stay and increased pain [170][171][172][173] (LE2).…”

Section: Drainagementioning

confidence: 54%