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

Abstract

Background It is now established that prophylactic drainage is not needed after laparoscopic cholecystectomy (LC) for chronic calculous cholecystitis. However, the benefit of drains versus their potential harm for acute calculous cholecystitis (ACC) following laparoscopic LC has been questioned. Therefore, we conducted a comparative study to assess the need for drainage. Methods Between January 2014 and October 2016, 212 patients with ACC undergoing LC undergo either drainage (n= 106) or no drainage (n= 106). The primary end points were the number of patients with postoperative drain-related complications, early and late Visual Analogue Scale (VAS) score, and hospital stay. Secondary end points included estimated blood loss, postoperative recovery, analgesia requirement, and cosmetic satisfaction result. Results There was no bile duct injury and mortality in both groups. The overall complication rate was 12.5% with no significant difference between those with or without drainage (P=0.16). Normal activity resumption was significantly faster and the postoperative hospital stay was slightly shorter in the nondrainage group (P =0.03 and P= 0.04, respectively). The early VAS score in the drainage group was significantly higher (p< 0.05). There were no significant differences between the two groups in postoperative hematology test, late VAS score, and patient satisfaction of cosmetic outcome. Conclusion Routine drainage for patients with ACC after LC may not be justified with similar drain-related complications compared with nondrainage group.

Predictive Factors for Drain Placement After Laparoscopic Cholecystectomy

“…This aspect finds confirmation in Lewis et al (37), who showed that no patient without surgical drain required reoperation or subsequent drainage procedure for subhepatic collections formation, as well as no difference in the frequency of wound infections. However, in other studies, such correlations are not confirmed with the statistical consistency (5,20). As a result of our study, patients undergoing LC with surgical drain placement have a longer length of hospital stay than those without the placement of this device, as confirmed in previous studies (5,6).…”

Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications

“…An increased incidence of drain insertion with age was well correlated with the severity of acute cholecystitis in the elderly. This could also be an explanation for the increased incidence of postoperative septic complications, such as wound infection and intra-abdominal collections, described by other authors [ 40 , 41 , 42 ].…”

Post-cholecystectomy acute injury: What can go wrong?

“…A recent meta-analysis has condemned its routine usage of intra-abdominal drainage tube 19. Most of the studies have failed to demonstrate the benefit of placing drainage tube routinely 1920. This is probably due to a very low incidence of complications.…”