Is the routine use of drainage after elective laparoscopic cholecystectomy justified? A randomized trial.
BACKGROUND
Laparoscopic cholecystectomy (LC) is the gold standard for the surgical treatment of cholelithiasis. However, the use of drainage after elective LC in literature remains controversial.


METHODS
A randomized study was performed in Larnaka General Hospital. The purpose of the study was to evaluate drainage of the gallbladder bed after elective LC. One hundred sixteen patients were randomly allocated in two groups, sustained an uneventful LC, and were included in the study after an informed consent was obtained. Sixty-three patients were included in drainage group (YD) and 53 patients in nondrainage group (ND). Drain tubes, made of polyethylene, were placed at the end of the procedure in the patients of YD group. Postoperative pain was assessed using two scales: a 10-point visual analog scale and a 5-point verbal response scale. The two groups were evaluated and compared regarding postoperative pain, the time needed for surgery, length of postoperative hospital stay, the postoperative collection of fluid in the subhepatic space, and the incidence of postoperative complications. Chi-square and t-tests were used to evaluate the data, and statistical significance was established at P < .05.


RESULTS
The mean operative time in YD patients was 6.9 minutes longer compared with ND patients (P = .056). The postoperative pain was higher in the YD group by more than one point on the average in the visual analog scale both at 6 and 24 hours (P = .01 and <.001, respectively). When measured with the verbal response scale, the difference in the reported pain was very significant at 24 hours (mean level for YD 1.24 and for ND 0.75). The proportion of patients staying in hospital for >2 days was higher in the YD group: 28.6% of the patients versus 13.2% in the ND group (P = .05). Subhepatic fluid was more often observed in the YD group (47% versus 34% in the ND), but the difference was not statistically significant. There was no statistical difference in the rate of wound infections, shoulder pain, nausea, vomiting, and respiratory infections between the two groups.


CONCLUSIONS
Our results indicate that routine drainage of gallbladder bed after elective LC may not be justified. Drainage causes more postoperative pain, prolongs the operative time and hospital stay, increases the occurrence of fluid in the subhepatic space, and does not protect from other complications.
Surgical Department, Nicosia General Hospital, Nicosia, Cyprus. chr.georgiou@gmail.com
Chrysanthos
C
Georgiou
Nicoleta
N
Demetriou
Theodoros
T
Pallaris
Theodosis
T
Theodosopoulos
Klea
K
Katsouyanni
Georgios
G
Polymeneas
D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery*; D004322:Drainage; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011182:Postoperative Care; D016896:Treatment Outcome