Abstract
Many surgeons practice prophylactic drainage after cholecystectomy without reliable evidence. This study was conducted to answer the question whether to drain or not to drain after cholecystectomy for acute calculous cholecystitis. A retrospective review of all patients who had cholecystectomy for acute cholecystitis in Aseer Central Hospital, Abha, Saudi Arabia, was conducted from April 2010 to April 2012. Data were extracted from hospital case files. Preoperative data included clinical presentation, routine investigations and liver function tests. Operative data included excessive adhesions, bleeding, bile leak, and drain insertion. Complicated cases such as pericholecystic collections, mucocele and empyema were also reported. Patients who needed therapeutic drainage were excluded. Postoperative data included hospital stay, volume of drained fluid, time of drain removal, and drain site problems. The study included 103 patients allocated into two groups; group A (n = 38) for patients with operative drain insertion and group B (n = 65) for patients without drain insertion. The number of patients with preoperative diagnosis of acute non-complicated cholecystitis was significantly greater in group B (80%) than group A (36.8%) (P < 0.001). Operative time was significantly longer in group A. All patients who were converted from laparoscopic to open cholecystectomy were in group A. Multivariate analysis revealed that hospital stay was significantly (P < 0.001) longer in patients with preoperative complications. There was no added benefit for prophylactic drain insertion after cholecystectomy for acute calculous cholecystitis in non-complicated or in complicated cases.
Highlights
Drainage of body cavities has been practiced in medicine for a long time[1]
This study included 103 patients who had cholecystectomy operation for acute calculous cholecystitis. They were allocated into two groups; group A (n 5 38) for patients with operative drain insertion and group B (n 5 65) for patients without drain insertion
The major reason for drainage is the fear of bile leakage that may lead to bile peritonitis; this is usually due to an aberrant bile duct and not slippage of the cystic duct ligature[12]
Summary
Drainage of body cavities has been practiced in medicine for a long time[1]. Historical reports of drainage of chest empyema and ascites go back to the Hippocratic era[2]. Prophylactic drainage after acute calculous cholecystitis is still controversial, especially for cases with pericholecystic collections, excessive adhesions or empyema. Operative data included excessive adhesions, bleeding, bile leak, drain insertion or not, and if they were complicated cases (peri-cholecystic collection, mucocele or empyema).
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