Roberto Cirocchi1, Sherman H Kwan2, Georgi Popivanov3, Paolo Ruscelli4, Massimo Lancia5, Sara Gioia6, Mauro Zago7, Massimo Chiarugi8, Piergiorgio Fedeli9, Rinaldo Marzaioli10, Salomone Di Saverio11. 1. Department of Surgical Science, University of Perugia, Perugia, Italy. Electronic address: cirocchiroberto@yahoo.it. 2. Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia. Electronic address: sherm.k@live.com. 3. Department of Surgery, Military Medical Academy, Sofia, Bulgaria. Electronic address: gerasimpopivanov@rocketmail.com. 4. Emergency Surgery Unit, Faculty of Medicine and Surgery, Torrette Hospital, Polytechnic University of Marche, Ancona, Italy. Electronic address: ruscellipaolo@gmail.com. 5. Department of Surgical Science, University of Perugia, Perugia, Italy. Electronic address: dr.massimolancia@gmail.com. 6. Department of Surgical Science, University of Perugia, Perugia, Italy. Electronic address: saragioia.sg@gmail.com. 7. Department of General Surgery, San Pietro Polyclinic, Ponte San Pietro, Italy. Electronic address: maurozago.md@gmail.com. 8. Emergency Surgery Unit, University of Pisa, Pisa, Italy. Electronic address: massimo.chiarugi@med.unipi.it. 9. School of Law - Legal Medicine, University of Camerino, Camerino, Italy. Electronic address: piergiorgio.fedeli@unicam.it. 10. Department of Emergency and Organ Transplantation (DETO), University Medical School "A. Moro" Bari, Bari, Italy. Electronic address: r.marzaioli@gmail.com. 11. Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; University of Insubria, Surgery I unit, University Hospital of Varese, Italy. Electronic address: salo75@inwind.it.
Abstract
BACKGROUND: Laparoscopic cholecystectomy (LC) is considered to be the gold standard in the early management of acute cholecystitis however, recommendations for routine drain insertion in the acute setting are unavailable. STUDY DESIGN: A systematic review of literature review and metanalysis was conducted. All studies comparing drain versus no drain after LC for acute cholecystitis were included. RESULTS: Seven studies, with 1274 patients, were included. Postoperative wound infection rates (relative risk (RR) 0.30, 95% confidence interval (CI) 0.10 to 0.88; I2 = 0%) and postoperative abdominal collection requiring drainage (RR 1.20, 95% CI 0.35 to 4.12; I 2 = 0%) were lower in the no-drain group, but this was only significant for wounded infections on subgroup analysis of RCTs. Length of stay hospital (mean difference (MD) -0.49, 95% CI -0.89 to -0.09; I 2 = 69%) and operative time (MD -8.13, 95% CI -13.87 to -2.38; I 2 = 92%) were significantly shorter in the no drain group however this was in the context of significant heterogeneity. CONCLUSION: The available data suggests that acute cholecystitis is not an indication for routine drain placement after LC. However, these results must be interpreted with caution due to the limitations of the included studies. In effect, the main issue of this meta-analysis lies on the limitations of the included studies themselves, because of a considerable heterogeneity among the included works, particularly for the inclusion criteria of patients and reported severity of acute cholecystitis. Further work is required to produce evidence which will definitively alter clinical practice. LEVEL OF EVIDENCE: Level 2a (systematic review of cohort studies). Oxford CEBM levels of evidence.
BACKGROUND: Laparoscopic cholecystectomy (LC) is considered to be the gold standard in the early management of acute cholecystitis however, recommendations for routine drain insertion in the acute setting are unavailable. STUDY DESIGN: A systematic review of literature review and metanalysis was conducted. All studies comparing drain versus no drain after LC for acute cholecystitis were included. RESULTS: Seven studies, with 1274 patients, were included. Postoperative wound infection rates (relative risk (RR) 0.30, 95% confidence interval (CI) 0.10 to 0.88; I2 = 0%) and postoperative abdominal collection requiring drainage (RR 1.20, 95% CI 0.35 to 4.12; I 2 = 0%) were lower in the no-drain group, but this was only significant for wounded infections on subgroup analysis of RCTs. Length of stay hospital (mean difference (MD) -0.49, 95% CI -0.89 to -0.09; I 2 = 69%) and operative time (MD -8.13, 95% CI -13.87 to -2.38; I 2 = 92%) were significantly shorter in the no drain group however this was in the context of significant heterogeneity. CONCLUSION: The available data suggests that acute cholecystitis is not an indication for routine drain placement after LC. However, these results must be interpreted with caution due to the limitations of the included studies. In effect, the main issue of this meta-analysis lies on the limitations of the included studies themselves, because of a considerable heterogeneity among the included works, particularly for the inclusion criteria of patients and reported severity of acute cholecystitis. Further work is required to produce evidence which will definitively alter clinical practice. LEVEL OF EVIDENCE: Level 2a (systematic review of cohort studies). Oxford CEBM levels of evidence.
Authors: D Wouters; G Cavallaro; Kristian K Jensen; B East; B Jíšová; L N Jorgensen; M López-Cano; V Rodrigues-Gonçalves; C Stabilini; F Berrevoet Journal: Front Surg Date: 2022-07-13
Authors: Dragos Serban; Bogdan Socea; Simona Andreea Balasescu; Cristinel Dumitru Badiu; Corneliu Tudor; Ana Maria Dascalu; Geta Vancea; Radu Iulian Spataru; Alexandru Dan Sabau; Dan Sabau; Ciprian Tanasescu Journal: Medicina (Kaunas) Date: 2021-03-02 Impact factor: 2.430