Flavien Prevot1,2, David Fuks1,2, Cyril Cosse1,3,4,5,2, Karine Pautrat6,2, Simon Msika7,2, Muriel Mathonnet8,2, Haitham Khalil9,2, François Mauvais10,2, Jean-Marc Regimbeau11,12,13,14,15. 1. Department of Digestive Surgery, Amiens University Medical Center, Amiens, France. 2. French National Surgical Research Network, Amiens, France. 3. INSERM U1088, Amiens, France. 4. Digestive Surgery Methodology Unit, Amiens University Medical Center, Amiens, France. 5. Clinical Research Center, Amiens University Medical Center, Amiens, France. 6. Department of Digestive Diseases, Lariboisière Hospital, Paris, France. 7. General and Digestive Surgery Department, Louis Mourier Hospital, Colombes, France. 8. Department of Digestive Surgery, Dupuytren Hospital, Limoges, France. 9. Department of Digestive Surgery, Rouen University Medical Center, Rouen, France. 10. Department of Digestive Surgery, Beauvais Hospital, Beauvais, France. 11. Department of Digestive Surgery, Amiens University Medical Center, Amiens, France. regimbeau.jean-marc@chu-amiens.fr. 12. Clinical Research Center, Amiens University Medical Center, Amiens, France. regimbeau.jean-marc@chu-amiens.fr. 13. French National Surgical Research Network, Amiens, France. regimbeau.jean-marc@chu-amiens.fr. 14. EA4294, Jules Verne University of Picardie, Amiens, France. regimbeau.jean-marc@chu-amiens.fr. 15. Department of Digestive and Oncological Surgery, New University Hospital Centre, Avenue René Laennec, Cedex 1, F-80054, Amiens, France. regimbeau.jean-marc@chu-amiens.fr.
Abstract
BACKGROUND: Although the preoperative management of mild and moderate (Grade I-II) acute calculous cholecystitis (ACC) has been standardized, there is no consensus on the value of abdominal drainage after early cholecystectomy. METHODS: In a post hoc analysis of a randomized controlled trial (NCT01015417) focused on the value of postoperative antibiotic therapy in patients with ACC, we determined the value of abdominal drainage in patients having undergone laparoscopic cholecystectomy for Grades I-II ACC. All postoperative complications were analyzed after using a propensity score. A post hoc test was used to assess the statistical robustness of our results. RESULTS: Of the 414 enrolled patients, 178 did not have abdominal drainage (forming the no-drainage group) and 236 had drainage (the drainage group). After matching on PS, the deep incisional site infection was 1.1 versus 0.8 %, p = 0.78. This result is similar for the superficial incisional site infections; the distant infections; the overall morbidity, and the readmission rate. Only the hospital length of stay was significantly longer in the drainage group (3.3 vs. 5.1 days, p = 0.003). Neither abdominal drainage nor the absence of postoperative antibiotic therapy was found to be a risk factor for deep incisional site infections. CONCLUSIONS: The use of abdominal drainage depends on the surgeon's personal preferences but is often used in high-risk populations. However, abdominal drainage does not appear to be of any benefit (in terms of postoperative outcomes) and may even compromise recovery in patients having undergone early laparoscopic cholecystectomy for mild or moderate ACC.
RCT Entities:
BACKGROUND: Although the preoperative management of mild and moderate (Grade I-II) acute calculous cholecystitis (ACC) has been standardized, there is no consensus on the value of abdominal drainage after early cholecystectomy. METHODS: In a post hoc analysis of a randomized controlled trial (NCT01015417) focused on the value of postoperative antibiotic therapy in patients with ACC, we determined the value of abdominal drainage in patients having undergone laparoscopic cholecystectomy for Grades I-II ACC. All postoperative complications were analyzed after using a propensity score. A post hoc test was used to assess the statistical robustness of our results. RESULTS: Of the 414 enrolled patients, 178 did not have abdominal drainage (forming the no-drainage group) and 236 had drainage (the drainage group). After matching on PS, the deep incisional site infection was 1.1 versus 0.8 %, p = 0.78. This result is similar for the superficial incisional site infections; the distant infections; the overall morbidity, and the readmission rate. Only the hospital length of stay was significantly longer in the drainage group (3.3 vs. 5.1 days, p = 0.003). Neither abdominal drainage nor the absence of postoperative antibiotic therapy was found to be a risk factor for deep incisional site infections. CONCLUSIONS: The use of abdominal drainage depends on the surgeon's personal preferences but is often used in high-risk populations. However, abdominal drainage does not appear to be of any benefit (in terms of postoperative outcomes) and may even compromise recovery in patients having undergone early laparoscopic cholecystectomy for mild or moderate ACC.