A comparative study of laparoscopic cholecystectomy with and without abdominal drain
DOI:
https://doi.org/10.18203/2320-6012.ijrms20184421Keywords:
Abdominal drain, cholecystectomy, Drains versus no drains, Laproscopic cholecystectomyAbstract
Background: Laparoscopic surgery has several advantages when compared to open surgery, including faster post-operative recovery and lower pain scores. Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Routine drainage after laparoscopic cholecystectomy is an issue of considerable debate.
Methods: Study was randomized, prospective, observational and longitudinal including 100 patients, selected according to inclusion criteria.
Results: The sub hepatic fluid collection on first ultrasound at 24hrs was higher in drained group than in non-drained groups. Further, the difference became insignificant on subsequent ultrasound at 72hrs. Incidence of post-operative drain site pain was present in 25% of patients with drain (more at drain site). Incidence drain site infection was present in 16.6% of patients in drain group. Majority of the patients with drain group (n=24) required hospital stay for ≥3 days, while for majority of patients without drain group (n=20), required hospital stay was 1 day.
Conclusions: An uncomplicated gall stone disease can be treated by laparoscopic cholecystectomy without need for drain with reasonable safety by an experienced surgeon. With no usage of drain, it is significantly advantageous in terms of post-operative pain, use of analgesics and hospital stay.
References
Mellor SG, Thomas MH, Donnellan BS. Cholecystectomy: safe or not safe to drain? J R Soc Med. 1988;81:566-8.
Fraser I, Everson NW, Nash JR. A randomised prospective trial of two drainage methods after cholecystectomy. Ann R Coll Surg Eng. 1982;64:183-5.
Diez JA, Pujato MR, Ferreres AR. The need of drainage after cholecystectomy. HPB Surg. 1990;3:5-10.
McCormack TT, Abel PD, Collins CD. Abdominal drainage following cholecystectomy: high, low, or no suction? Ann R Coll Surg Eng. 1983;65:326-8.
Najmaldin A, Guillou P. A guide to laparoscopic surgery. Wiley-Blackwell; 1998:22-39.
Koc M, Ertan T, Tez M, Kocpinar MA, Kilic M, Gocmen E, Aslar AK. Randomized, prospective comparison of postoperative pain in low‐versus high‐pressure pneumoperitoneum. ANZ J Surg. 2005;75(8):693-6.
Hay DW, Carey MC. Pathophysiology and pathogenesis of cholesterol gallstone formation. Semin Liver Dis. 1990;10:159-70.
Ryan J, Cohen S, gallbladder pressure-volume response to gastrointestinal hormones. Am J Physiol. 1976;230:1461-5.
Fisher RS, Rock E, Levin G, Malmud L. Effects of somatostatin on the gallbladder emptying. Gastroenterology. 1987;92:885-90.
Ivy AC, Oldberg E. A hormone mechanism for gallbladder contraction and evacuation. Am J Physiol. 1928;86:599.
Bauer AJ, Hanani M, Murr TC, Szurszewski JH. Intracellular recording from gallbladder ganglia of opossums. Am J Physiol. 1991;260:G299-306.
Fisher RS, Rock E, Malmud LS. Gallbladder emptying response to sham feeding in humans. Gastroenterology. 1986 Jun 1;90(6):1854-7.
