Routine drain or no drain after laparoscopic cholecystectomy for acute cholecystitis

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.

Post-Caesarean Drain Placement - Minor Procedure Leading to Major Complication

Intra abdominal drain insertion in doubtful cases has been practised since many years. It may be associated with certain minor as well as major complications like drain site haemorrhage, infection, intestinal perforation and even visceral herniation from the site. Herein, we report a case of 28-year-old unbooked G₂P₁L₁ at 33 weeks gestation with previous caesarean, who underwent Lower Segment Caesarean Section (LSCS) in view of breech presentation in labour. On sixth postoperative day, tubular structure herniation through the drain site was observed. She was undertaken for laparotomy and fallopian tube herniation through the drain site was confirmed. Ipsilateral salpingectomy was done. Thus, drain placement lead to prolonged hospital stay and maternal morbidity.