Routine drain or no drain after laparoscopic cholecystectomy for acute cholecystitis

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Evidence-Based Medicine

Background:

• Laparoscopic cholecystectomy (LC) is the standard for acute cholecystitis.
• Routine drain use in acute LC lacks clear recommendations.

Purpose of the Study:

• To evaluate the efficacy and safety of routine drain insertion after LC for acute cholecystitis.
• To synthesize current evidence through a systematic review and meta-analysis.

Main Methods:

• Systematic review and meta-analysis of studies comparing drain versus no drain after LC for acute cholecystitis.
• Included seven studies with 1274 patients.
• Level 2a evidence (systematic review of cohort studies).

Main Results:

• Lower postoperative wound infection rates in the no-drain group (RR 0.30).
• Shorter hospital stay (MD -0.49 days) and operative time (MD -8.13 minutes) in the no-drain group.
• Significant heterogeneity noted, particularly in patient selection and disease severity.

Conclusions:

• Current data suggests routine drain placement is not indicated for acute cholecystitis.
• Results should be interpreted cautiously due to study limitations and heterogeneity.
• Further high-quality research is required to definitively guide clinical practice.