DOI: http://dx.doi.org/10.18203/2349-2902.isj20160254

A comparative study to evaluate the outcome of routine use of drain verses no drain after laparoscopic cholecystectomy: a tertiary care teaching centre experience

Himesh R. Chauhan, Umesh G. Vaishnav

Abstract


Background: Laparoscopic cholecystectomy (LC) is the currently the gold standard method of cholecystectomy for symptomatic cholelithiasis. The role of routine drainage after LC to decrease postoperative morbidity is still an issue of considerable debate. This study aims to assess the benefits and harms of routine abdominal drainage and to compare the outcome of sub hepatic drainage with no drainage after uncomplicated LC.

Methods: This retrospective study was conducted in two phases, as open, randomized controlled trial (RCT), conducted in general surgery department of Civil Hospital - Sola, Ahmedabad, from April 2013 to March2014 for phase I and From April 2014 to December 2014 for phase II. In this study, in phase I, total 160 patients with chronic calculus cholecystitis underwent LC. Patients were divided into two groups, sub hepatic drainage (group A: 78 patients) or no drainage (group B: 78 patients). The rest 4 patients were excluded either due to conversion or elective sub hepatic drainage. In phase II, 110 consecutive patients were enrolled, who underwent LC with No sub hepatic drainage.

Results: Duration of operation, character and amount of drain fluid (if placed), postoperative ultrasound for sub hepatic collection, postoperative pain, postoperative nausea/vomiting, duration of hospital stay, and preoperative or postoperative complications were noted and analysed. Duration of operation and hospital stay was slightly longer in group A patients (P values 0.002 and 0.029, respectively); postoperative pain perception, nausea/vomiting, and postoperative complications were nearly same in both groups (P value 0.064, 0.078, 0.003, respectively). Sub hepatic fluid collection was more in group A (P=0.002). Phase II results were nearly similar to group B patients in phase I.

Conclusions: Routine sub hepatic drainage after LC is not necessary in uncomplicated cases.


Keywords


Laparoscopic cholecystectomy, Sub hepatic drainage - Drains versus no drains Pnumoperitoneum, Postoperative pain

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References


Petrowsky H, Demartines N, Rousson V, Clavien PA. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg. 2004;240:1074-84.

Robinson JO. Surgical drainage: a historical perspective. Br J Surg. 1986;73:422-6.

Moshe Schein. To Drain or not to Drain? The Role of Drainage in the Contaminated and Infected Abdomen: An International and Personal Perspective. World J Surg. 2008;32:312-21.

Henrik P, Nicolas D, Valentin, Pierre-Alain C. Evidence-based Value of Prophylactic Drainage in Gastrointestinal Surgery. Ann Surg. 2004;240:1074-85.

Mellor SG, Thomas MH, Donnellan BS. Cholecystectomy: safe or not safe to drain? J R Soc Med. 1988;81:566-8.

Fraser I, Everson NW, Nash JR. A randomised prospective trial of two drainage methods after cholecystectomy. Ann R Coll Surg Engl. 1982;64:183-5.

Diez JA, Pujato MR, Ferreres AR. The need of drainage after cholecystectomy. HPB Surg. 1990;3:5-10.

McCormack TT, Abel PD, Collins CD. Abdominal drainage following cholecystectomy: high, low, or no suction? Ann R CollSurg Engl.1983;65:326-328.

Nursal TZ, Yildirim S, Tarim A, Noyan T, Poyraz P, Tuna N, et al. Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy. Langen-becks Arch Surg. 2003;388:95-100.

Lewis RT, Goodall RG, Marien B, Park M, Lloyd-Smith W, Wiegand FM. Simple elective cholecystectomy: to drain or not. Am J Surg. 1990;159(2):241-245.

Chilton CP, Mann CV. Drainage after cholecystectomy. AnnR Coll Surg Engl. 1980;62:60-5.

Salam IM, Mcmullin JP, 0'higgins NJ. A comparison of two types of vacuum drainage atter cholecystectomy. Ann R Coll Surg Engl. 1984;66:190-1.

Hawasli A, Brown E. The effect of drains in laparoscopic cholecystectomy. J Laparoendosc Surg. 1994;4(6):393-8.

Jorgensen JO, Gillies RB, Hunt DR, Caplehom JR, Lumley T. A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy. Aust N Z J Surg. 1995;65(7):466-9.

Abbott J, Hawe J, Srivatsava P, Hunter D, Garry R. Intra-peritoneal gas drain to reduce pain after laparoscopy: randomized masked trial. Obstet Gynecol. 2000;98(1):97-100.

Alexander JI, Hull MG. Abdominal pain after laparoscopy: the value of a gas drain. British J Obstet Gynaecol. 1987;94(3):267-9.

Fredman B, Jedeikin R, Olsfanger D, Flor P, Gruzman A. Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy. Anesth Analg. 1994;79(1):152-4.

Thiebe U, Eggert A. Drainage after laparoscopic cholecystectomy. Minimal Invasive Chirurgie. 1994;3:90-92.

Gurusamy KS, Samraj K, Mullerat P, Davidson BR. Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy (Review). Cochrane review, published in The CochraneLibrary by JohnWiley & Sons, Ltd. 2009;1:1-11.

Elboim CM, Goldman L, Harm L, Palestrant AM, Silen TW. Significance of post-cholecystectomy subhepatic fluid collections. Ann Surg. 1983;198(2):137-141.

Capitanich P, Segundo UL, Malizia P, Herrera J, Iovaldi ML. Usefulness of prophylactic drainage in laparoscopic cholecystectomy. Randomized prospective report. Prensa Medica Argentina. 2005;92(9):623-7.

Mrozowicz A, Rucinski P, Polkowski WP. Routine drainage of the subhepatic area after laparoscopic cholecystectomy. Pro-spective, controlled study with random patient selection. Polski Przeglad Chirurgiczny. 2006;78(5):597-609.

Tzovaras G, Liakou P, Fafoulakis F, Baloyiannis I, Zacharoulis D, Hatzitheofllou C. Is there a role for drain use in elective laparoscopic cholecystectomy? A controlled randomized trial. Am J Surgery. 2009;197:759-63.

Nomdedeu J, Escrig J, Salvador JL. Systematic placement of drains in laparoscopic cholecystectomy. A prospective study. Revista de la Sociedad Valenciana de Patologia Digestiva. 1996;15(4):299-300.

Johansson M, Thune A, Nelvin L, Lundell L. Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Brit J Surgery. 2006;93(1):40-5.

Tsimoyiannis EC, Siakas P, Tassis A, Lekkas ET, Tzourou H, Kambili M. Intraperitoneal normal saline infusion for post-operative pain after laparoscopic cholecystectomy. World J Surg. 1998;22:824-8.