K S Gurusamy1, K Samraj, P Mullerat, B R Davidson. 1. Royal Free and University College School of Medicine, University Department of Surgery, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG. 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 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.
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 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.