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Intervention Review

Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy

  1. Kurinchi Selvan Gurusamy1,*,
  2. Kumarakrishnan Samraj2,
  3. Pepe Mullerat3,
  4. Brian R Davidson1

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 19 AUG 2007

DOI: 10.1002/14651858.CD006004.pub3


How to Cite

Gurusamy KS, Samraj K, Mullerat P, Davidson BR. Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006004. DOI: 10.1002/14651858.CD006004.pub3.

Author Information

  1. 1

    Royal Free Hospital and University College School of Medicine, University Department of Surgery, London, UK

  2. 2

    John Radcliffe Hospital, Department of General Surgery, Oxford, UK

  3. 3

    Northampton General Hospital, Surgery, Northampton, Northamptonshire, UK

*Kurinchi Selvan Gurusamy, University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. kurinchi2k@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

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 uncomplicated 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 six trials involving 741 patients randomised to drain (361) versus no drain (380). The only patient with abdominal collections requiring intervention belonged to the drain group. Wound infection was significantly higher in those with a drain (OR 5.86, 95% CI 1.05 to 32.70). Drainage was associated with nausea, but this was not statistically significant. Hospital stay was longer in the drain group and the number of patients discharged at the day of operation was significantly reduced in the no drain group (OR 2.45, 95% CI 0.00 to 0.57, 1 trial). We also reviewed one trial with 41 patients randomised to suction drain (22) versus closed passive drain (19). This trial suggests that suction drains carried less pain than passive drains.

Authors' conclusions

Drain use after elective laparoscopic cholecystectomy 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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Drain use seems 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 increases wound infection and delays discharge from hospital. Currently, there is no evidence to support the use of drain after laparoscopic cholecystectomy.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

常規使用腹腔引流術於無併發症的腹腔鏡膽囊切除術

腹腔鏡膽囊切除術是主要治療症狀性膽囊結石的方法。一般在腹腔鏡膽囊切除術後使用引流,以避免凝聚腹部積液。 但是,引流術也可能會增加感染併發症的機率,和延遲出院。

目標

目的是評估無併發症的腹腔鏡膽囊切除術使用常規腹腔引流術的利弊。

搜尋策略

我們搜尋截至2007年3月為止的The Cochrane HepatoBiliary Group Controlled Trials Register , Cochrane Library的 Cochrane Central Register of Controlled Trials (CENTRAL)、MEDLINE、EMBASE和 Science Citation Index Expanded 。

選擇標準

我們收納所有在無併發症的腹腔鏡膽囊切除術後比較使用引流術或不使用引流術的隨機臨床試驗。同時回顧了一種引流法對照另外一種引流法的隨機臨床試驗。

資料收集與分析

我們從每次試驗中收集有關試驗特性、方法學品質、死亡率、腹部積液、疼痛、噁心、嘔吐和住院日等數據。 我們使用RevMan分析軟體以固定效果模式和隨機效果模式分析資料。我們以治療意向,對於每種結果計算勝算比 (odds ratio,OR),95% 信賴區間(CI) 。

主要結論

我們分析6個試驗,共隨機分配741位病人,361人被分配至引流術組,380人被分配至無引流術組。 唯一一個有腹部凝聚而需要干預治療的的病人被分配到引流術組。引流術組的傷口感染率明顯較高(OR 5.86, 95% CI 1.05 32.70)。 引流術和噁心有關,但是並沒有統計顯著性。引流術組的住院日較長, 無引流術組在手術當天就出院的病人人數明顯降低(OR 2.45, 95% CI 0.00 0.57, 1 次試驗)。 我們同時回顧了一個隨機分配41位病人的試驗,22人分配至抽吸引流術組,19人分配至被動引流術組。本次試驗指出抽吸引流術引起的疼痛少於消極引流術。

作者結論

選擇性腹腔鏡膽囊切除術後使用引流術增加傷口感染的機率以及延遲出院。我們沒有發現支持在腹腔鏡膽囊切除術後使用引流術的證據。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在腹腔鏡膽囊切除術後似乎不需要使用引流術。腹腔鏡膽囊切除術是目前治療症狀性膽囊結石的最佳方法。人們對於腹腔鏡膽囊切除術後使用引流術頗有爭議。 本次文獻回顧發現,腹腔鏡膽囊切除術後使用引流術會增加傷口感染的機率及延遲出院。目前,沒有證據支持在腹腔鏡膽囊切除術後使用引流術。