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Demouron M, Selvy M, Dembinski J, Mauvais F, Cheynel N, Slim K, Sabbagh C, Regimbeau JM. Feasibility and Effectiveness of an Enhanced Recovery Program after Early Cholecystectomy for Acute Calculous Cholecystitis: A 2-Step Study. J Am Coll Surg 2022; 234:840-848. [DOI: 10.1097/xcs.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Siembida N, Sabbagh C, Chal T, Demouron M, Rossi D, Dembinski J, Regimbeau JM. Absence of abdominal drainage after surgery for secondary lower gastrointestinal tract peritonitis is a valid strategy. Surg Endosc 2022; 36:7219-7224. [PMID: 35122148 DOI: 10.1007/s00464-022-09080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Management of abdominal drainage after surgery for secondary lower gastrointestinal tract peritonitis (LGTP) is not a standardized procedure. A monocentric study was carried out in 2016 in our centre. (PI study) to evaluate the interest of drainage. Our objective was to revaluate, our actual use of abdominal drainage after peritonitis (PII study). STUDY DESIGN We examined retrospectively patients who underwent surgery for secondary sub-mesocolic community-acquired peritonitis (January 2016-December 2019). Study exclusion criteria were primary peritonitis, peritoneal dialysis, nosocomial peritonitis, postoperative peritonitis, upper gastrointestinal tract peritonitis, peritonitis due to appendicitis, peritonitis requiring the implementation of Mikulicz's drain, and peritonitis in which the peritoneum was not described in the surgical report (i.e., the same criteria that the PI study which included 141 patients from January 2009 to January 2012). The primary endpoint was the rate of abdominal drainage. The secondary endpoints were the patient rate without a peritoneum description, major complications rate (Clavien ≥III), abscess rate, mortality rate and the length of stay in the non-drain group (D - ) and in the drain group (D + ) in PII study. Primary and secondary endpoints were also compared between PI and PII studies. Risk factors for post-operative abscess were also research. RESULTS Of the 150 patients included 33% were drained vs 84% of the 141 patients included in PI study (p < 0.001). In PII study peritoneum was described in 80.3% of patients vs 69% in PI study (NS, p = 0.06). Comparing the two groups D - and D + , no significant differences were found in major complications (respectively 45% vs 32%, p = 0.1), reoperation rate (respectively 25% vs 22%, p = 0.7), death rate (respectively 25% vs 14%; p = 0.1) and mean length of stay (respectively 12 days vs 13 days, p = 0.9). The abscess rate was significantly lower in the D - group (10% vs 30%, p = 0.002). Comparing PI and PII studies, there was no difference about major complications (35% vs 35%, p = 0.1), reoperation (16% vs 17.5%, p = 0.5), abscess rate (15% vs 8.5%, p = 0.1) and mortality (14.5% vs 17.5%, p = 0.7). The length of stay was longer in PI study than in P II (14 days vs 9 days, p = 0.03). Drainage (p = 0.005; OR = 4.357; CI [1.559-12.173]) and peritonitis type (p = 0.032; OR = 3.264; CI [1.106-9.630]) were abscess risk factors. CONCLUSION This study therefore showed that drainage after surgery for LGTP may not be necessary and that, at least at the local level, surgeons seem to be inclined to discontinue it systematically. It may therefore be worthwhile to conduct a randomised control trial to establish recommendations on drainage after surgery for LGTP.
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Affiliation(s)
- Nicolas Siembida
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France
| | - Tami Chal
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France
| | - Marion Demouron
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France
| | - Davide Rossi
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France
| | - Jeanne Dembinski
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France.,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 1 rue du Professeur Christian Cabrol, 80054, Amiens Cedex, France. .,SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes-Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, 80054, Amiens, France.
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Ohge H, Mayumi T, Haji S, Kitagawa Y, Kobayashi M, Kobayashi M, Mizuguchi T, Mohri Y, Sakamoto F, Shimizu J, Suzuki K, Uchino M, Yamashita C, Yoshida M, Hirata K, Sumiyama Y, Kusachi S. The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018. Surg Today 2021; 51:1-31. [PMID: 33320283 PMCID: PMC7788056 DOI: 10.1007/s00595-020-02181-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The guidelines for the prevention, detection, and management of gastroenterological surgical site infections (SSIs) were published in Japanese by the Japan Society for Surgical Infection in 2018. This is a summary of these guidelines for medical professionals worldwide. METHODS We conducted a systematic review and comprehensive evaluation of the evidence for diagnosis and treatment of gastroenterological SSIs, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Modifications were made to the guidelines in response to feedback from the general public and relevant medical societies. RESULTS There were 44 questions prepared in seven subject areas, for which 51 recommendations were made. The seven subject areas were: definition and etiology, diagnosis, preoperative management, prophylactic antibiotics, intraoperative management, perioperative management, and wound management. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the results of the meta-analysis, recommendations were graded using the Delphi method to generate useful information. The final version of the recommendations was published in 2018, in Japanese. CONCLUSIONS The Japanese Guidelines for the prevention, detection, and management of gastroenterological SSI were published in 2018 to provide useful information for clinicians and improve the clinical outcome of patients.
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Affiliation(s)
- Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan.
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Seiji Haji
- Department of Surgery, Soseikai General Hospital, Kyoto, Japan
| | - Yuichi Kitagawa
- Department of Infection Control, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Masahiro Kobayashi
- Laboratory of Clinical Pharmacokinetics, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Motomu Kobayashi
- Perioperative Management Center, Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Toru Mizuguchi
- Division of Surgical Science, Department of Nursing, Sapporo Medical University, Sapporo, Japan
| | - Yasuhiko Mohri
- Department of Surgery, Mie Prefectural General Medical Center, Mie, Japan
| | - Fumie Sakamoto
- Infection Control Division, Quality Improvement Center, St. Luke's International Hospital, Tokyo, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Katsunori Suzuki
- Division of Infection Control and Prevention, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Motoi Uchino
- Division of Inflammatory Bowel Disease Surgery, Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Chizuru Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | | | | | - Shinya Kusachi
- Department of Surgery, Tohokamagaya Hospital, Chiba, Japan
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Cirocchi R, Kwan SH, Popivanov G, Ruscelli P, Lancia M, Gioia S, Zago M, Chiarugi M, Fedeli P, Marzaioli R, Di Saverio S. Routine drain or no drain after laparoscopic cholecystectomy for acute cholecystitis. Surgeon 2020; 19:167-174. [PMID: 32713729 DOI: 10.1016/j.surge.2020.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/29/2020] [Accepted: 04/04/2020] [Indexed: 12/24/2022]
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.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Perugia, Italy.
| | - Sherman H Kwan
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria.
| | - Paolo Ruscelli
- Emergency Surgery Unit, Faculty of Medicine and Surgery, Torrette Hospital, Polytechnic University of Marche, Ancona, Italy.
| | - Massimo Lancia
- Department of Surgical Science, University of Perugia, Perugia, Italy.
| | - Sara Gioia
- Department of Surgical Science, University of Perugia, Perugia, Italy.
| | - Mauro Zago
- Department of General Surgery, San Pietro Polyclinic, Ponte San Pietro, Italy.
| | | | - Piergiorgio Fedeli
- School of Law - Legal Medicine, University of Camerino, Camerino, Italy.
| | - Rinaldo Marzaioli
- Department of Emergency and Organ Transplantation (DETO), University Medical School "A. Moro" Bari, Bari, Italy.
| | - Salomone Di Saverio
- 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.
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Dembinski J, Guérin O, Slim K, Navarro F, Paquet JC, Tuech JJ, Pocard M, Mauvais F, Faucheron JL, Regimbeau JM. Are the recommendations for post-operative antibiotics in patients with grade I or II acute calculous cholecystitis being applied in clinical practice? HPB (Oxford) 2020; 22:1051-1056. [PMID: 31974047 DOI: 10.1016/j.hpb.2019.10.2442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/23/2019] [Accepted: 10/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a level-1 evidence indicating that postoperative antibiotics are unnecessary following cholecystectomy for grade I or II acute calculous cholecystitis (ACC). We wanted to evaluate the applications of this recommendation in clinical practice four years after the original publication in ABCAL-participating centers. METHODS A retrospective analysis of patients operated for grade I or II ACC from January to December 2016 in ABCAL-participating centers was performed. Inclusion criteria were the same as for the ABCAL-study. The primary endpoint was the postoperative antibiotic administration rate. The secondary endpoints were postoperative outcomes. RESULTS Of the 283 patients included, 64% received postoperative antibiotics. Only 19% received antibiotics after POD1. The perioperative outcomes were similar between those that did or did not receive antibiotics after POD1. The median [range] length of stay was significantly shorter in patients who did not receive postoperative antibiotics (4 days [1-20]) compared to the others (6 days [1-50], p > 0.001). CONCLUSION Despite strong recommendations included in the Tokyo 2018 guidelines, the results of the ABCAL-study are poorly applied even if the absence of postoperative antibiotics has no impact on morbidity. It is important to stress that postoperative antibiotics are not necessary after cholecystectomy for grade I or II ACC.
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Affiliation(s)
- Jeanne Dembinski
- Department of Digestive Surgery, Amiens, University of Picardie, Avenue René Laennec, 80054, Amiens Cedex, France
| | - Orlane Guérin
- Department of Digestive Surgery, Amiens, University of Picardie, Avenue René Laennec, 80054, Amiens Cedex, France
| | - Karem Slim
- Clermont-Ferrand University Hospital, Department of Digestive Surgery, Clermont-Ferrand, France
| | - Francis Navarro
- Montpellier University Hospital, Hepatic, Biliary, Pancreatic Transplantation Department, Montpellier, France
| | | | - Jean-Jacques Tuech
- Rouen University Hospital, Department of Digestive Surgery, Rouen, France
| | - Marc Pocard
- Lariboisière University Hospital, Department of Digestive Surgery, Paris, France
| | - François Mauvais
- Beauvais Hospital, Digestive Surgery Department, Beauvais, France
| | - Jean-Luc Faucheron
- Grenoble University Hospital, Department of Digestive Surgery, Grenoble, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens, University of Picardie, Avenue René Laennec, 80054, Amiens Cedex, France; SSPC (Simplifications des Soins Patients Chirurgicaux Complexes, Or Simplification of Surgical Patient Care), Unit of Clinical Research, University of Picardie Jules Verne, Amiens, France.
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Enhanced Recovery After Emergency Surgery: Utopia or Reality? Cir Esp 2020; 99:258-266. [PMID: 32532473 DOI: 10.1016/j.ciresp.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/19/2020] [Accepted: 04/26/2020] [Indexed: 11/20/2022]
Abstract
Enhanced Recovery After Surgery (ERAS) constitutes the application of a series of perioperative measures based on the evidence, in order to achieve a better recovery of the patient and a decrease of the complications and the mortality. These ERAS programs initially proved their advantages in the field of colorectal surgery being progressively adopted by other surgical areas within the general surgery and other surgical specialties. The main excluding factor for the application of such programs has been the urgent clinical presentation, which has caused that despite the large volume of existing literature on ERAS in elective surgery, there are few studies that have investigated the effectiveness of these programs in surgical patients in emergencies. The aim of this article is to show ERAS measures currently available according to the existing evidence for emergency surgery.
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Yang J, Liu Y, Yan P, Tian H, Jing W, Si M, Yang K, Guo T. Comparison of laparoscopic cholecystectomy with and without abdominal drainage in patients with non-complicated benign gallbladder disease: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e20070. [PMID: 32443316 PMCID: PMC7253658 DOI: 10.1097/md.0000000000020070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/30/2020] [Accepted: 03/31/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate whether conventional postoperative drainage is more effective than not providing drainage in patients with non-complicated benign gallbladder disease following laparoscopic cholecystectomy (LC). METHODS A search of the electronic databases MEDLINE, EMBASE, Web of science, Cochrane Library, and Chinese Biomedical Database (CBM) was conducted for randomized controlled trials (RCTs) reporting outcomes of LC surgery with and without an abdominal drain. RESULTS Twenty-one RCTs involving 3246 patients (1666 with drains vs 1580 without) were included in the meta-analysis. There were no statistically significant differences in the rates of incidence of intra-abdominal fluid (RR: 1.10; 95% CI: 0.81-1.49; P = .54) or post-surgical mortality (RR: 0.44; 95% CI: 0.04-4.72; P = .50) between the two groups. Abdominal drains did not reduce the overall incidence of nausea and vomiting (RR: 1.16; 95% CI: 0.95-1.42; P = .15) or shoulder tip pain (RR: 1.03; 95% CI: 0.76-1.38; P = .86). The abdominal drain group displayed significantly higher pain scores (MD: 1.07; 95% CI: 0.69-1.46; P < .001) than the non-drainage patients. Abdominal drains prolonged the duration of the surgical procedure (MD: 5.69 min; 95% CI: 2.51-8.87; P = .005) and postoperative hospital stay (MD: 0.47 day; 95% CI: 0.14-0.80; P = .005). Wound infection was found to be associated with the use of abdominal drains (RR: 1.97; 95% CI: 1.11-3.47; P = .02). CONCLUSIONS Currently, there is no evidence to support the use of routine drainage after LC in non-complicated benign gallbladder disease. Further well-designed randomized clinical trials are required to confirm this finding.
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Affiliation(s)
- Jia Yang
- Gansu Provincial Hospital, Lanzhou, Gansu
- Ningxia Medical University, Yinchuan, Ningxia
- Institution of Evidence Based Medicine, Gansu Province Hospital
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | - Yang Liu
- Gansu Provincial Hospital, Lanzhou, Gansu
- Ningxia Medical University, Yinchuan, Ningxia
| | - Peijing Yan
- Institution of Evidence Based Medicine, Gansu Province Hospital
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | | | | | - Moubo Si
- Gansu Provincial Hospital, Lanzhou, Gansu
- Institution of Evidence Based Medicine, Gansu Province Hospital
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | - Kehu Yang
- Institution of Evidence Based Medicine, Gansu Province Hospital
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | - Tiankang Guo
- Gansu Provincial Hospital, Lanzhou, Gansu
- Institution of Evidence Based Medicine, Gansu Province Hospital
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Picchio M, De Cesare A, Di Filippo A, Spaziani M, Spaziani E. Prophylactic drainage after laparoscopic cholecystectomy for acute cholecystitis: a systematic review and meta-analysis. Updates Surg 2019; 71:247-254. [PMID: 30945148 DOI: 10.1007/s13304-019-00648-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/25/2019] [Indexed: 12/26/2022]
Abstract
In the literature, there is a large evidence against the use of drains in laparoscopic cholecystectomy (LC) in elective surgery. However, evidence is lacking in the setting of acute cholecystitis (AC). The present meta-analysis was performed to assess the role of drains to reduce complications and improve recovery in LC for AC. An electronic search of the MEDLINE, Science Citation Index Expanded, SpringerLink, Scopus, and Cochrane Library database from January 1990 to July 2018 was performed to identify randomized clinical trials (RCTs) that compare prophylactic drainage with no drainage in LC for AC. Odds ratio (OR) with confidence interval (CI) for qualitative variables and mean difference (MD) with CI for continuous variables were calculated. Three RCTs were included in the meta-analysis, involving 382 patients randomized to drain (188) versus no drain (194). Morbidity was similar in both the study groups (OR 1.23; 95% CI 0.55-2.76; p = 0.61) as well as wound infection rate (OR 1.98; 95% CI 0.53-7.40; p = 0.31) and abdominal abscess rate (OR 0.62; 95% CI 0.08-4.71; p = 0.31). Abdominal pain 24 h after surgery was less severe in the no drain group (MD 0.80; 95% CI 0.46-1.14; p < 0.000). A significant difference in favor of the no drain group was found in the postoperative hospital stay (MD 1.05; 95% CI 0.87-1.22; p < 0.000). No significant difference was present with respect to postoperative fluid collection in the subhepatic area and operative time. The present study shows that prophylactic drain placement is useless to reduce complications in LC performed to treat AC. Postoperative recovery is improved if drain is not present.
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Affiliation(s)
- Marcello Picchio
- Department of Surgery, Hospital "P. Colombo", Via Orti Ginnetti 7, 00049, Velletri, Italy.
- Via Giulio Cesare, 58, 04100, Latina, Italy.
| | - Alessandro De Cesare
- Department of Surgery, Sapienza University of Rome-Polo Pontino, Via Firenze, 04019, Terracina, Italy
| | - Annalisa Di Filippo
- Department of Surgery, Sapienza University of Rome-Polo Pontino, Via Firenze, 04019, Terracina, Italy
| | - Martina Spaziani
- Department of Surgery, Sapienza University of Rome-Polo Pontino, Via Firenze, 04019, Terracina, Italy
| | - Erasmo Spaziani
- Department of Surgery, Sapienza University of Rome-Polo Pontino, Via Firenze, 04019, Terracina, Italy
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Xu M, Tao YL. Drainage versus No Drainage after Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis. Am Surg 2019. [DOI: 10.1177/000313481908500138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To conduct a randomized controlled trial (RCT), meta-analysis to assess the effectiveness of drains in reducing complications after laparoscopic cholecystectomy (LC) for acute cholecystitis needs to be carried out. An electronic search of PubMed, Embase, Science Citation Index, and the Cochrane Library from January 1990 to January 2018 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in LC for acute cholecystitis. The outcomes were calculated as odds ratios (ORs) with 95 per cent confidence intervals (CIs) using RevMan 5.2. Four RCTs, which included 796 patients, were identified for analysis in our study. There was no statistically significant difference in the rate of morbidities (OR = 1.23, 95% CI 0.55–2.76, P = 0.61). Abdominal pain was more severe in the drain group 24 hours after surgery (mean difference = 0.80, 95% CI 0.47–1.14; P < 0.00001). No significant difference was present with respect to wound infection rate and hospital stay. The use of abdominal drainage does not appear to be of any benefit in patients having undergone early LC for acute cholecystitis.
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Affiliation(s)
- Ming Xu
- Department of General Surgery, The Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China and
| | - You-Liang Tao
- Department of General Surgery, Linan People's Hospital, Linan, China
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Guerin O, Regimbeau JM. Re: Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2018; 25:E5. [PMID: 29878694 DOI: 10.1002/jhbp.556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Orlane Guerin
- Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, F-80054 Amiens Cedex 01, France.,Simplification of Care of Complex Surgical Patients, Unit of Clinical Research, University of Picardie Jules Verne, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Avenue René Laennec, F-80054 Amiens Cedex 01, France.,Simplification of Care of Complex Surgical Patients, Unit of Clinical Research, University of Picardie Jules Verne, Amiens, France
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11
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Gilbert A, Ortega-Deballon P, Di Giacomo G, Cheynel N, Rat P, Facy O. Intraperitoneal drains move. J Visc Surg 2017; 155:105-110. [PMID: 29102315 DOI: 10.1016/j.jviscsurg.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The use of surgical drains is the subject of much debate but they continue to be commonly used. The phenomenon of drain migration from their desired position following surgery has not been studied. The aim of this study was to evaluate the incidence of the displacement of surgical drains among patients undergoing abdominal gastrointestinal surgery. PATIENTS AND METHODS We performed a review of all patients who underwent an early CT-scan postoperatively after abdominal gastrointestinal surgery prior to drain mobilization, between January 2013 and April 2016 in the Dijon University Hospital Center. Pre-and intra-operative data (number, type and position of drains) and postoperative data (imaging and evolution) were collected retrospectively. RESULTS This study included 125 patients. Thirty-five (28%) were found to have a displacement of at least one drain from its original position. Forty-one (19.8%) of the 207 studied drains had moved. Postoperative morbidity was not higher in patients with displaced drains (P=0.51). None of all the studied preoperative and operative factors have been found to be a risk factor for drain displacement. CONCLUSION Surgical drains displacement is frequently encountered in patients undergoing digestive abdominal surgery. In our experience, this phenomenon does not seem to have any clinical implications. When a benefit is expected from the use of surgical drains, intraperitoneal fixation appears to be necessary.
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Affiliation(s)
- A Gilbert
- Service de chirurgie générale, digestive, cancérologique et urgences, CHU François-Mitterrand, 14, rue Paul-Gaffarel, 21000 Dijon, France.
| | - P Ortega-Deballon
- Service de chirurgie générale, digestive, cancérologique et urgences, CHU François-Mitterrand, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - G Di Giacomo
- Service de chirurgie générale, digestive, cancérologique et urgences, CHU François-Mitterrand, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - N Cheynel
- Service de chirurgie générale, digestive, cancérologique et urgences, CHU François-Mitterrand, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Rat
- Service de chirurgie générale, digestive, cancérologique et urgences, CHU François-Mitterrand, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - O Facy
- Service de chirurgie générale, digestive, cancérologique et urgences, CHU François-Mitterrand, 14, rue Paul-Gaffarel, 21000 Dijon, France
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