Eun Young Kim1, Soo Ho Lee1, Jun Suh Lee1, Young Chul Yoon2, Sung Kyun Park2, Ho Joong Choi3, Dong Do Yoo4, Tae Ho Hong5. 1. Department of Hepato-biliary and Pancreas Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Korea. 2. Department of Hepato-biliary and Pancreas Surgery, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Bupyeong, Korea. 3. Department of Hepato-biliary and Pancreas Surgery, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea. 4. Department of Hepato-biliary and Pancreas Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea. 5. Department of Hepato-biliary and Pancreas Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Korea. gshth@catholic.ac.kr.
Abstract
BACKGROUND: There is a lack of evidence regarding the role of drainage in laparoscopic cholecystectomy (LC) for acutely inflamed gallbladder (AIGB), and drain insertion remains controversial. METHODS:From December 2013 to November 2014, a total of 193 patients who needed LC due to AIGB at the four participating hospitals were entered in this study. After the operation, the patients were randomly assigned to undergo drain insertion (94 patients, 48.7%, group A) or not (99 patients, 51.3%, group B). The surgical outcomes between the two groups were prospectively reviewed. The study was registered at www.clinicaltrials.gov at the inception of enrollment (NCT02027402). RESULTS: Both groups were comparable in terms of patient demographics, operative time and postoperative hospital stay. In 18 cases (9.3%), postoperative morbidities such as bleeding, bile leakage, wound infection or an abscess occurred, and there was no significant difference between the two groups. The visual analog scale pain score measured at 24 h (3.9 ± 1.4 in group A and 3.3 ± 2.0 in group B, P = 0.014) and 48 h (2.1 ± 1.5 in group A and 1.5 ± 1.4 in group B, P = 0.006) was significantly higher in group A. CONCLUSIONS:Routine drain insertion does not prevent or reduce postoperative morbidities after LC for AIGB and can even cause prolonged postoperative pain. This prospective study suggests that routine drain use in LC for AIGB should be reconsidered.
RCT Entities:
BACKGROUND: There is a lack of evidence regarding the role of drainage in laparoscopic cholecystectomy (LC) for acutely inflamed gallbladder (AIGB), and drain insertion remains controversial. METHODS: From December 2013 to November 2014, a total of 193 patients who needed LC due to AIGB at the four participating hospitals were entered in this study. After the operation, the patients were randomly assigned to undergo drain insertion (94 patients, 48.7%, group A) or not (99 patients, 51.3%, group B). The surgical outcomes between the two groups were prospectively reviewed. The study was registered at www.clinicaltrials.gov at the inception of enrollment (NCT02027402). RESULTS: Both groups were comparable in terms of patient demographics, operative time and postoperative hospital stay. In 18 cases (9.3%), postoperative morbidities such as bleeding, bile leakage, wound infection or an abscess occurred, and there was no significant difference between the two groups. The visual analog scale pain score measured at 24 h (3.9 ± 1.4 in group A and 3.3 ± 2.0 in group B, P = 0.014) and 48 h (2.1 ± 1.5 in group A and 1.5 ± 1.4 in group B, P = 0.006) was significantly higher in group A. CONCLUSIONS: Routine drain insertion does not prevent or reduce postoperative morbidities after LC for AIGB and can even cause prolonged postoperative pain. This prospective study suggests that routine drain use in LC for AIGB should be reconsidered.
Authors: Seung Jae Lee; In Seok Choi; Ju Ik Moon; Dae Sung Yoon; Won Jun Choi; Sang Eok Lee; Nak Song Sung; Seong Uk Kwon; In Eui Bae; Seung Jae Roh; Sung Gon Kim Journal: J Minim Invasive Surg Date: 2022-06-15