The Value of Abdominal Drainage After Laparoscopic Cholecystectomy for Mild or Moderate Acute Calculous Cholecystitis: A Post Hoc Analysis of a Randomized Clinical Trial

Prevot, F.; Fuks, David; Cossé, Cyril; Pautrat, Karine; Msika, Simon; Mathonnet, Muriel; Khalil, Haitham; Mauvais, F.; Régimbeau, Jean-Marc

doi:10.1007/s00268-016-3605-z

Cited by 16 publications

(10 citation statements)

References 45 publications

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“…The median length of stay was significantly longer patients treated by postoperative antibiotics (6 days [1-50]) compared to patients not treated by postoperative antibiotics (4 days [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]), (p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Very few published studies have evaluated the enhanced recovery strategy for emergency surgery. 12,13 As it has been shown that the management of ACC does not require postoperative drainage, 14 postoperative antibiotic prescription should be based on guidelines and should be avoided whenever possible in order to simplify patient management. The use of standardised pathways developed by the operative team could help to reduce variation in practice by individual clinicians.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Are the recommendations for post-operative antibiotics in patients with grade I or II acute calculous cholecystitis being applied in clinical practice?

Dembinski¹,

Guerin²,

Slim³

et al. 2020

HPB

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Background: There is a level-1 evidence indicating that postoperative antibiotics are unnecessary following cholecystectomy for grade I or II acute calculous cholecystitis (ACC). We wanted to evaluate the applications of this recommendation in clinical practice four years after the original publication in ABCAL-participating centers.Methods: A retrospective analysis of patients operated for grade I or II ACC from January to December 2016 in ABCAL-participating centers was performed. Inclusion criteria were the same as for the ABCALstudy. The primary endpoint was the postoperative antibiotic administration rate. The secondary endpoints were postoperative outcomes.Results: Of the 283 patients included, 64% received postoperative antibiotics. Only 19% received antibiotics after POD1. The perioperative outcomes were similar between those that did or did not receive antibiotics after POD1. The median [range] length of stay was significantly shorter in patients who did not receive postoperative antibiotics (4 days [1-20]) compared to the others (6 days [1-50], p > 0.001). Conclusion:Despite strong recommendations included in the Tokyo 2018 guidelines, the results of the ABCAL-study are poorly applied even if the absence of postoperative antibiotics has no impact on morbidity. It is important to stress that postoperative antibiotics are not necessary after cholecystectomy for grade I or II ACC.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Are the recommendations for post-operative antibiotics in patients with grade I or II acute calculous cholecystitis being applied in clinical practice?

Dembinski¹,

Guerin²,

Slim³

et al. 2020

HPB

Self Cite

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“…A flow diagram for study inclusion and exclusion is presented in Figure 1. The initial searches generated 585 citations, of which four studies [10][11][12]17 considered to be suitable for the final meta-analysis using the stated eligibility criteria. A total of 796 patients (424 drained vs 372 no-drain patients in emergency LC).…”

Section: Search Results and Reporting Qualitymentioning

confidence: 99%

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

Tao

2019

The American Surgeon™

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To conduct a randomized controlled trial (RCT), meta-analysis to assess the effectiveness of drains in reducing complications after laparoscopic cholecystectomy (LC) for acute cholecystitis needs to be carried out. An electronic search of PubMed, Embase, Science Citation Index, and the Cochrane Library from January 1990 to January 2018 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in LC for acute cholecystitis. The outcomes were calculated as odds ratios (ORs) with 95 per cent confidence intervals (CIs) using RevMan 5.2. Four RCTs, which included 796 patients, were identified for analysis in our study. There was no statistically significant difference in the rate of morbidities (OR = 1.23, 95% CI 0.55–2.76, P = 0.61). Abdominal pain was more severe in the drain group 24 hours after surgery (mean difference = 0.80, 95% CI 0.47–1.14; P < 0.00001). No significant difference was present with respect to wound infection rate and hospital stay. The use of abdominal drainage does not appear to be of any benefit in patients having undergone early LC for acute cholecystitis.

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“…Results from a meta-analysis of 13 RCTs had a high evidence level because of the homogenous population and the inclusion of more than 500 cases (217)(218)(219)(220)(221)(222)(223)(224)(225)(226)(227)(228)(229) . There is no disadvantage for patients without drain placement because the mortality rate was not different with or without a drain.…”

Section: Rationalementioning

confidence: 99%

The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018

Ohge

Mayumi

Haji³

et al. 2020

Surg Today

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Background The guidelines for the prevention, detection, and management of gastroenterological surgical site infections (SSIs) were published in Japanese by the Japan Society for Surgical Infection in 2018. This is a summary of these guidelines for medical professionals worldwide. Methods We conducted a systematic review and comprehensive evaluation of the evidence for diagnosis and treatment of gastroenterological SSIs, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Modifications were made to the guidelines in response to feedback from the general public and relevant medical societies. Results There were 44 questions prepared in seven subject areas, for which 51 recommendations were made. The seven subject areas were: definition and etiology, diagnosis, preoperative management, prophylactic antibiotics, intraoperative management, perioperative management, and wound management. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the results of the meta-analysis, recommendations were graded using the Delphi method to generate useful information. The final version of the recommendations was published in 2018, in Japanese. Conclusions The Japanese Guidelines for the prevention, detection, and management of gastroenterological SSI were published in 2018 to provide useful information for clinicians and improve the clinical outcome of patients.

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The Value of Abdominal Drainage After Laparoscopic Cholecystectomy for Mild or Moderate Acute Calculous Cholecystitis: A Post Hoc Analysis of a Randomized Clinical Trial

Cited by 16 publications

References 45 publications

Are the recommendations for post-operative antibiotics in patients with grade I or II acute calculous cholecystitis being applied in clinical practice?

Are the recommendations for post-operative antibiotics in patients with grade I or II acute calculous cholecystitis being applied in clinical practice?

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

The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018

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