Routine abdominal drainage for uncomplicated open cholecystectomy

Area of Science:

• Surgical Procedures
• Gastrointestinal Surgery
• Evidence-Based Medicine

Background:

• Cholecystectomy, gallbladder removal, is primarily for symptomatic gallstones.
• Open cholecystectomy involves debate regarding routine abdominal drainage.
• Drains are used to prevent complications like abscess or bile peritonitis, but may increase infection risks.

Purpose of the Study:

• To evaluate the benefits and harms of routine abdominal drainage in uncomplicated open cholecystectomy.
• To compare outcomes between patients with and without abdominal drains.

Main Methods:

• Systematic review of randomized clinical trials comparing 'no drain' versus 'drain' in open cholecystectomy.
• Searched multiple databases including Cochrane, MEDLINE, EMBASE up to April 2006.
• Analyzed data using fixed-effect and random-effects models, calculating odds ratios with 95% confidence intervals.

Main Results:

• Included 28 trials with 3659 patients; 20 compared 'no drain' vs. 'drain'.
• No significant differences in mortality, bile peritonitis, or abdominal collections were found.
• 'No drain' group showed significantly lower wound infection (OR 0.61) and chest infection (OR 0.59).

Conclusions:

• Routine abdominal drainage offers no additional benefit in open cholecystectomy.
• Drains are associated with increased patient harm, specifically higher rates of wound and chest infections.
• Abdominal drains should be avoided in uncomplicated open cholecystectomy procedures.