Get access

Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy

  • Review
  • Intervention

Authors

  • KS Gurusamy,

  • K Samraj,

  • P Mullerat,

  • BR Davidson


Dr Kurinchi Selvan Gurusamy, Research Fellow, Surgery, Royal Free Hospital, 291 Greenhaven Drive, Thamesmead, London, SE28 8FY, UK. kurinchi2k@hotmail.com.

Abstract

Background

Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Drains are used after laparoscopic cholecystectomy to prevent abdominal collections. However, drain use may increase infective complications and delay discharge.

Objectives

The aim is to assess the benefits and harms of routine abdominal drainage in uncomplicated laparoscopic cholecystectomy.

Search strategy

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until March 2007.

Selection criteria

We included all randomised clinical trials comparing drainage with no drainage after laparoscopic cholecystectomy. Randomised clinical trials comparing one type of drain with another were also reviewed.

Data collection and analysis

We collected the data on the characteristics, methodological quality, mortality, abdominal collections, pain, nausea, vomiting, and hospital stay from each trial. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the odds ratio (OR) with 95% confidence intervals (CI) based on intention-to-treat analysis.

Main results

We analysed five trials involving 591 patients randomised to drain (281) versus no drain (310). We also reviewed one trial with 41 patients randomised to suction drain (22) versus closed passive drain (19). The only trial that reported on abdominal collections requiring intervention reported no abdominal collections requiring intervention in either group. Wound infection tended to be higher in those with a drain (OR 15.38, 95% CI 0.86 to 275.74). Drainage was associated with lower shoulder, abdominal pain, and nausea, but this was not statistically significant. Hospital stay was longer in the drain group.

Authors' conclusions

Drain use after elective laparoscopic cholecystectomy reduces early post-operative pain, but increases wound infection rates and delays hospital discharge. We could not find evidence to support the use of drain after laparoscopic cholecystectomy.

Plain language summary

Plain language summary

Drain use is unnecessary after laparoscopic cholecystectomy

Laparoscopic cholecystectomy is the currently preferred method of treatment of symptomatic gallstones. Drain use after laparoscopic cholecystectomy is controversial. This review found that the drain use after laparoscopic cholecystectomy decreases early post-operative pain, but increases wound infection, and delays discharge from hospital. Currently, there is no evidence to support the use of drain after laparoscopic cholecystectomy.

Get access to the full text of this article