Abstract
Background and Objective:To evaluate the clinical role of the routine use of a drain in an elective laparoscopic cholecystectomy operation applied to patients with symptomatic cholelithiasis not showing acute inflammation.Method:Following laparoscopic removal of the gallbladder, patients were separated into two groups of 30 each, either with subhepatic drain placement or without. The presence of subhepatic fluid collection was evaluated with transabdominal ultrasonography (USG) at 24 hours postoperatively and on the 7th day. The other parameters evaluated were postoperative morbidity, shoulder and abdominal pain.Results:No statistically significant difference was found between the two groups in respect of demographic characteristics and operative details. The median pain score was determined to be statistically significantly higher in the group with a drain applied compared to the group without a drain (p=0.007). In the comparison between the groups of fluid collection on USG at 24 hours and shoulder pain persisting until the 7th day, although seen less in the group with no drain applied, no statistically significant difference was determined (p=0.065, p=0.159). In the examinations made on the 7th day, no hematoma or significant fluid collection was determined on USG and no wound infection was observed in any patient of either group.Conclusion:The routine application of prophylactic subhepatic drain in laparoscopic cholecystectomy procedure did not show any benefit to the patient.
Highlights
Laparoscopic cholecystectomy is the gold standard surgical procedure for symptomatic cholelithiasis
Conventional cholecystectomy has been included in the debates on this subject and several randomised studies have shown that there is no benefit to the routine use of a drain in conventional cholecystectomy.[1]
Some surgeons have considered that these outcomes obtained for conventional cholecystectomy could be valid for a laparoscopic approach and similar results have been obtained in studies on this subject.[2]
Summary
Laparoscopic cholecystectomy is the gold standard surgical procedure for symptomatic cholelithiasis. The role of the routine use of an abdominal drain following laparoscopic cholecystectomy in reducing postoperative morbidity remains. To evaluate the clinical role of the routine use of a drain in an elective laparoscopic cholecystectomy operation applied to patients with symptomatic cholelithiasis not showing acute inflammation. The presence of subhepatic fluid collection was evaluated with transabdominal ultrasonography (USG) at 24 hours postoperatively and on the 7th day. In the comparison between the groups of fluid collection on USG at 24 hours and shoulder pain persisting until the 7th day, seen less in the group with no drain applied, no statistically significant difference was determined (p=0.065, p=0.159). In the examinations made on the 7th day, no hematoma or significant fluid collection was determined on USG and no wound infection was observed in any patient of either group. Conclusion: The routine application of prophylactic subhepatic drain in laparoscopic cholecystectomy procedure did not show any benefit to the patient
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