[Subhepatic drainage in laparoscopic cholecystectomy--a necessity or an overused tradition?]

The subhepatic drainage is mandatorily used in the end of laparoscopic cholecystectomy in the majority of departments of surgery in Czech republic. The preoperative finding of advanced inflammatory alteration or bleeding in operative field is certainly the reason to do so. But it seems that obligatory drainage after uncomplicated laparoscopic cholecystectomy has no real foundation and it is suspiciously an expression of antiquated tradition. From January 1, 2001 to December 31, 2002 the prospective non-randomized study was performed: in the first group of patients the drainage of subhepatic space was used mandatorily (324 patients), in the second group the drainage was used only in indicated cases (365 patients). No statistically significant difference was found between the two groups in postoperative complications (biliary leak, intraabdominal abscess, reoperation). There was the significant difference in surgery times (55 min. in the group with mandatory drainage, 50 min. in the group with indicated drainage, p < 0.05), in term of hospital stay--the patients with mandatory drainage stayed longer in hospital (3.2 day, resp. 2.4 day, p < 0.05). In summary, the mandatory drainage of subhepatic space after laparoscopic cholecystectomy is not associated with lower incidence of postoperative complications. On the other hand, the mandatory drainage has significantly longer surgery time and longer length of hospital stay. The drainage is exceptionally indicated but not mandatorily in uncomplicated operations.