Meta-Analysis of Drainage Versus No Drainage After Laparoscopic Cholecystectomy

Abstract

Background and Objectives:Routine drainage after laparoscopic cholecystectomy is still controversial. This meta-analysis was performed to assess the role of drains in reducing complications in laparoscopic cholecystectomy.Methods:An electronic search of Medline, Science Citation Index Expanded, Scopus, and the Cochrane Library database from January 1990 to June 2013 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in laparoscopic cholecystectomy. The odds ratio for qualitative variables and standardized mean difference for continuous variables were calculated.Results:Twelve randomized controlled trials were included in the meta-analysis, involving 1939 patients randomized to a drain (960) versus no drain (979). The morbidity rate was lower in the no drain group (odds ratio, 1.97; 95% confidence interval, 1.26 to 3.10; P = .003). The wound infection rate was lower in the no drain group (odds ratio, 2.35; 95% confidence interval, 1.22 to 4.51; P = .01). Abdominal pain 24 hours after surgery was less severe in the no drain group (standardized mean difference, 2.30; 95% confidence interval, 1.27 to 3.34; P < .0001). No significant difference was present with respect to the presence and quantity of subhepatic fluid collection, shoulder tip pain, parenteral ketorolac consumption, nausea, vomiting, and hospital stay.Conclusion:This study was unable to prove that drains were useful in reducing complications in laparoscopic cholecystectomy.

‘True Day Case’ Laparoscopic Cholecystectomy in a High-Volume Specialist Unit and Review of Factors Contributing to Unexpected Overnight Stay

“…A recent meta-analysis of 12 randomised controlled trials involving 1939 patients randomised to drain (960) versus no drain (979) demonstrated lower morbidity in the no drain group (OR 1.97 (95% CI 1.26-3.10); P=0.003), lower wound infection (OR 2.35 (95% CI 1.22-4.51); P=0.010), and reduced pain 24 hours postsurgery (Standardised Mean Difference 2.30 (95% CI 1.27-3.34); P<0.0001). However they did not show any difference in the intra-abdominal collections and hospital stay [ 32 ].…”

Nondrainage after Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis Does Not Increase the Postoperative Morbidity

“…Drainage does not prevent complications; otherwise, increase the tube-related complications such as fever, wound infection, wound hernia, or discomfort to patients. Furthermore, the recent published randomized controlled trails and and meta-analysis performed by Picchio [ 15 ] and Bugiantella [ 16 ] were both mainly focused on the issue of the role of the drainage in elective or uncomplicated LC and concluded that there was no evidence to support the use of drain after this surgical procedure [ 4 , 5 , 10 ]. However, there are still limited data on the value of prophylactic drains following LC for patients with ACC.…”

A Comparative Study Between Routine Insertions of Subhepatic Drain Versus No Drain After Elective Laparoscopic Cholecystectomy

“…A study conducted by Shamim [13] showed similar ndings. However, study done by Picchio [14] showed 30 ml of mean subhepatic collection in both drain & without drain group. As per many authors, post-cholecystectomy collection in the subhepatic space are on the whole small, rapidly reabsorbed & essentially similar in size & number whether a drain is used or not.…”