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Is routine drain insertion after laparoscopic cholecystectomy for acute cholecystitis beneficial? A multicenter,
Eun Young Kim1, Soo Ho Lee1, Jun Suh Lee1
1Department of Hepato-biliary and Pancreas Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Korea.
Insights
Routine drainage after laparoscopic cholecystectomy for acutely inflamed gallbladder does not reduce complications and may increase postoperative pain. Reconsidering routine drain use in these cases is suggested by this study.
Area of Science:
- Surgical innovation
- Gastrointestinal surgery
- Clinical outcomes research
Background:
- Laparoscopic cholecystectomy (LC) is standard for gallbladder issues.
- The utility of drainage in LC for acutely inflamed gallbladder (AIGB) lacks robust evidence.
- Drain insertion in AIGB surgery remains a debated practice.
Purpose of the Study:
- To investigate the impact of routine drain insertion on postoperative outcomes following LC for AIGB.
- To compare complication rates and pain levels between patients with and without surgical drains.
Main Methods:
- A prospective study involving 193 patients undergoing LC for AIGB.
- Patients were randomized into two groups: drain insertion (Group A) or no drain (Group B).
- Surgical outcomes, including morbidities and pain scores, were prospectively assessed.
Main Results:
- No significant difference in postoperative morbidities (bleeding, bile leakage, infection, abscess) between groups.
- Patients who had drains inserted reported significantly higher pain scores at 24 and 48 hours post-surgery.
- Operative time and hospital stay were comparable between the drain and no-drain groups.
Conclusions:
- Routine drain insertion following LC for AIGB does not offer protective benefits against postoperative complications.
- Drainage may be associated with increased postoperative pain, suggesting it should be reconsidered.
- Evidence supports a move away from routine drain use in AIGB laparoscopic cholecystectomy.
Background:
There is a lack of evidence regarding the role of drainage in laparoscopic cholecystectomy (LC) for acutely inflamed gallbladder (AIGB), and drain insertion remains controversial.
Methods:
From December 2013 to November 2014, a total of 193 patients who needed LC due to AIGB at the four participating hospitals were entered in this study. After the operation, the patients were randomly assigned to undergo drain insertion (94 patients, 48.7%, group A) or not (99 patients, 51.3%, group B). The surgical outcomes between the two groups were prospectively reviewed. The study was registered at www.clinicaltrials.gov at the inception of enrollment (NCT02027402).
Results:
Both groups were comparable in terms of patient demographics, operative time and postoperative hospital stay. In 18 cases (9.3%), postoperative morbidities such as bleeding, bile leakage, wound infection or an abscess occurred, and there was no significant difference between the two groups. The visual analog scale pain score measured at 24 h (3.9 ± 1.4 in group A and 3.3 ± 2.0 in group B, P = 0.014) and 48 h (2.1 ± 1.5 in group A and 1.5 ± 1.4 in group B, P = 0.006) was significantly higher in group A.
Conclusions:
Routine drain insertion does not prevent or reduce postoperative morbidities after LC for AIGB and can even cause prolonged postoperative pain. This prospective study suggests that routine drain use in LC for AIGB should be reconsidered.
