Drain After Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis. A Pilot Randomized Study

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Innovation and Evidence-Based Practice

Background:

• Laparoscopic cholecystectomy (LC) is standard for acute calculous cholecystitis (ACC).
• The routine use of subhepatic drains after LC for ACC lacks robust evidence supporting its efficacy.
• This study aimed to evaluate the necessity of drainage in this specific patient group.

Purpose of the Study:

• To investigate the efficacy of subhepatic drains in reducing fluid collections after LC for ACC.
• To assess the impact of drains on postoperative pain, analgesic use, and patient morbidity.

Main Methods:

• A randomized pilot study involving 30 patients undergoing LC for ACC.
• 15 patients received a subhepatic drain (Group A), and 15 received a sham drain (Group B).
• Primary outcome: subhepatic fluid collection on ultrasonography at 24 hours; Secondary outcomes: pain, analgesic use, and morbidity.

Main Results:

• No significant difference in subhepatic fluid collection between the drain and sham groups (53.3% vs. 33.3%, P=0.462).
• Median fluid volumes were similar if collections were present (50 mL vs. 80 mL, P=0.573).
• No significant differences in pain severity, analgesic requirements, or overall morbidity were observed.

Conclusions:

• This pilot study did not demonstrate a benefit of using subhepatic drains in LC for ACC.
• The findings suggest that routine drainage may not be necessary in selected patients undergoing LC for ACC.
• Further research is warranted to confirm these results in a larger patient cohort.