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Xiao M, Wu WQ, Wan ZM, Lin X, Yan XZ, Meng JJ, Lin GL, Zheng SS, Li QY. Does drainage tube affect recovery after laparoscopic cholecystectomy? Hepatobiliary Pancreat Dis Int 2024:S1499-3872(24)00102-4. [PMID: 39098556 DOI: 10.1016/j.hbpd.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 07/17/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Min Xiao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310010, China
| | - Wei-Qiang Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310010, China
| | - Zhen-Miao Wan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310010, China
| | - Xin Lin
- General Surgery, Cancer Center, Department of Vascular Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Xiu-Zhi Yan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Nursing, Shulan (Quzhou) Hospital, Quzhou 324000, China
| | - Jing-Jing Meng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Nursing, Shulan (Quzhou) Hospital, Quzhou 324000, China
| | - Guo-Ling Lin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310010, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310010, China
| | - Qi-Yong Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310010, China.
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Lee SJ, Choi IS, Moon JI, Yoon DS, Choi WJ, Lee SE, Sung NS, Kwon SU, Bae IE, Roh SJ, Kim SG. Optimal drain management following complicated laparoscopic cholecystectomy for acute cholecystitis: a propensity-matched comparative study. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:63-72. [PMID: 35821685 PMCID: PMC9218398 DOI: 10.7602/jmis.2022.25.2.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/10/2022] [Indexed: 04/24/2023]
Abstract
PURPOSE This study was performed to investigate the effect of drain placement on complicated laparoscopic cholecystectomy (cLC) for acute cholecystitis (AC). METHODS This single-center retrospective study reviewed patients with AC who underwent cLC between January 2010 and December 2020. cLC was defined as open conversion, subtotal cholecystectomy, adjacent organ injury during surgery, operation time of ≥90 minutes, or estimated blood loss of ≥100 mL. One-to-one propensity score matching was performed to compare the surgical outcomes between patients with and without drain on cLC. RESULTS A total of 216 patients (mean age, 65.8 years; 75 female patients [34.7%]) underwent cLC, and 126 (58.3%) underwent intraoperative abdominal drainage. In the propensity score-matched cohort (61 patients in each group), early drain removal (≤postoperative day 3) was performed in 42 patients (68.9%). The overall rate of surgical site infection (SSI) was 10.7%. Late drain removal demonstrated significantly worse surgical outcomes than no drain placement and early drain removal for overall complications (13.1% vs. 21.4% vs. 47.4%, p = 0.006), postoperative hospital stay (3.8 days vs. 4.4 days vs. 12.7 days, p < 0.001), and SSI (4.9% vs. 11.9% vs. 31.6%, p = 0.006). In the multivariate analysis, late drain removal was the most significant risk factor for organ space SSI. CONCLUSION This study demonstrated that drain placement is not routinely recommended, even after cLC for AC. When placing a drain, early drain removal is recommended because late drain removal is associated with a higher risk of organ space SSI.
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Affiliation(s)
- Seung Jae Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
- Corresponding author In Seok Choi, Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea, Tel: +82-42-600-9142, Fax: +82-42-543-8956, E-mail: , ORCID: https://orcid.org/0000-0002-9656-3697
| | - Ju Ik Moon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Dae Sung Yoon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Won Jun Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Sang Eok Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Nak Song Sung
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Seong Uk Kwon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - In Eui Bae
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Seung Jae Roh
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Sung Gon Kim
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Fathi F, Kamani F, Farahmand AM, Rafieian S, Vahedi M. Effect of routine abdominal drainage on postoperative pain after uncomplicated laparoscopic cholecystectomy for cholelithiasis: A randomised controlled trial. Ann Med Surg (Lond) 2022; 74:103353. [PMID: 35198175 PMCID: PMC8844757 DOI: 10.1016/j.amsu.2022.103353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 11/02/2022] Open
Abstract
This is a prospective randomized controlled trial to investigate the effect of routine abdominal drainage on postoperative pain after uncomplicated laparoscopic cholecystectomy for cholelithiasis. This study was a single-center randomized controlled trial performed at the general surgery ward of Taleghani hospital, in Tehran, Iran, from July 2018 to October 2018. Patients were randomly divided into two parallel groups, one receiving routine abdominal drainage and the other receiving no treatment. Postoperative pain was measured by the Universal Pain Assessment Tool (UPAT) 0, 2, 4, 6, 12, and 24 h postoperatively. A total of 60 patients (30 patients in the study and control groups) were included. GLM repeated measure analysis showed a significant time*treatment effect for routine abdominal drainage in decreasing UPAT scores from baseline to 24 h after surgery (F = 4.59, df = 3.98, P-value = 0.001). Our findings demonstrated that abdominal drainage significantly reduces postoperative pain 0, 2, 4, 6, and 12 h after surgery (P-value<0.05). We also showed that abdominal drainage increases the time to first morphine sulfate administration and decreases the total dose of morphine sulfate administration (P-value<0.001). Moreover, we demonstrated that abdominal drainage decreases the average postoperative pain (P-value<0.001) and does not lead to any considerable side effects. However, 24 h after surgery, no significant pain-relieving effect was evident for abdominal drainage. In conclusion, insertion of abdominal drainage leads to decreased postoperative pain. Future studies need to investigate the optimal time for removal of the abdominal drain. This trial was prospectively registered in the Iranian Registry of Clinical Trials with a registration ID of IRCT20130706013875N2.
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Serban D, Socea B, Balasescu SA, Badiu CD, Tudor C, Dascalu AM, Vancea G, Spataru RI, Sabau AD, Sabau D, Tanasescu C. Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:230. [PMID: 33801408 PMCID: PMC8002041 DOI: 10.3390/medicina57030230] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Background and Objectives: This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. Materials and Methods: A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who underwent emergency cholecystectomy. The patients included in the study group were divided into four age subgroups: A ≤49 years; B: 50-64 years; C: 65-79 years; D ≥80 years. Results: Surgery after 72 h from onset (p = 0.007), severe forms, and higher American Society of Anesthesiologists Physical Status Classification and Charlson comorbidity index scores (p < 0.001) are well correlated with older age. Both cardiovascular and surgical related complications were significantly higher in patients over 50 years (p = 0.045), which also proved to be a turning point for increasing the rate of conversion and open surgery. However, the comparative incidence did not differ significantly between patients aged from 50-64 years, 65-79 years and over 80 years (6.03%, 9.09% and 5.8%, respectively). Laparoscopic cholecystectomy (LC) was the most frequently used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgery related complications, and the incidence of acute cardiovascular events in the early postoperative period (p < 0.001). Conclusions: The degree of systemic inflammation was the main factor that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with increased surgical and systemic postoperative morbidity, while stroke and chronic renal insufficiency were correlated with a high risk of cardiovascular complications. With adequate perioperative care, the elderly has much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay.
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Affiliation(s)
- Dragos Serban
- 4th Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
| | - Bogdan Socea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
- Department of Surgery, “Sf. Pantelimon” Emergency Hospital, 021659 Bucharest, Romania
| | | | - Cristinel Dumitru Badiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
- Department of Surgery, “Bagdasar Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania
| | - Corneliu Tudor
- 4th Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Ana Maria Dascalu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
| | - Geta Vancea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
| | - Radu Iulian Spataru
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
- Department of Pediatric Surgery, Emergency Clinic Hospital for Children “Maria S. Curie”, 41451 Bucharest, Romania
| | - Alexandru Dan Sabau
- 3rd Department Surgery, Faculty of Medicine, “Lucian Blaga” University Sibiu, 550169 Sibiu, Romania; (A.D.S.); (D.S.); (C.T.)
| | - Dan Sabau
- 3rd Department Surgery, Faculty of Medicine, “Lucian Blaga” University Sibiu, 550169 Sibiu, Romania; (A.D.S.); (D.S.); (C.T.)
| | - Ciprian Tanasescu
- 3rd Department Surgery, Faculty of Medicine, “Lucian Blaga” University Sibiu, 550169 Sibiu, Romania; (A.D.S.); (D.S.); (C.T.)
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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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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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Valappil MV, Gulati S, Chhabra M, Mandal A, Bakshi SD, Bhattacharyya A, Ghatak S. Drain in laparoscopic cholecystectomy in acute calculous cholecystitis: a randomised controlled study. Postgrad Med J 2019; 96:606-609. [PMID: 31871250 DOI: 10.1136/postgradmedj-2019-136828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/25/2019] [Accepted: 12/09/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is paucity of evidence regarding the role of drain in laparoscopic cholecystectomy (LC) in acute calculous cholecystitis (ACC), and surgeons have placed the drains based on their experiences, not on evidence-based guidelines. This study aims to assess the value of drain in LC for ACC in a randomised controlled prospective study. PATIENTS AND METHODS All patients with mild and moderate ACC undergoing LC were assessed. Preoperatively, patients with choledocholithiasis, Mirizzi syndrome and biliary stent were excluded. Intraoperatively or postoperatively, patients with complications, partial cholecystectomies and malignancies were excluded. Patients were randomised using computer-generated random numbers into two groups at the end of cholecystectomy before closure. Requirement of radiologically guided (ultrasonography () or CT) percutaneous aspiration/drainage of symptomatic intra-abdominal collection or reoperation; continuation of parenteral antibiotics beyond 24 hours or change in antibiotics empirically or based on peritoneal fluid culture sensitivity; requirement of postoperative USG or CT scan based on postoperative clinical course; wound infection rates; postoperative pain using numeric rating scale at 6 and 24 hours; and the duration of hospital stay in both groups were noted. RESULTS Forty-two out of 50 consecutive patients were randomised into two equal groups. Pain score at 6 and 24 hours was less in patients without drain. All other complication rates and duration of stay were similar in both groups. CONCLUSIONS Drains should not be placed routinely after LC in ACC as it increases pain and does not help in detecting or decreasing complications.
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Affiliation(s)
- Mithun V Valappil
- Surgical Gastroenterology, Calcutta Medical Research Institute, Kolkata, India
| | - Sumit Gulati
- Surgical Gastroenterology, Calcutta Medical Research Institute, Kolkata, India
| | - Manish Chhabra
- Surgical Gastroenterology, Calcutta Medical Research Institute, Kolkata, India
| | - Ajay Mandal
- Surgical Gastroenterology, Calcutta Medical Research Institute, Kolkata, India
| | - Sanjay De Bakshi
- Surgical Gastroenterology, Calcutta Medical Research Institute, Kolkata, India
| | - Avik Bhattacharyya
- Interventional Radiology, Calcutta Medical Research Institute, Kolkata, India
| | - Supriyo Ghatak
- Surgical Gastroenterology, Calcutta Medical Research Institute, Kolkata, India
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Bostanci MT, Saydam M, Kosmaz K, Tastan B, Bostanci EB, Akoglu M. The effect on morbidity of the use of prophylactic abdominal drain following elective laparoscopic cholecystectomy. Pak J Med Sci 2019; 35:1306-1311. [PMID: 31488997 PMCID: PMC6717480 DOI: 10.12669/pjms.35.5.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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.
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Affiliation(s)
- Mustafa Taner Bostanci
- Mustafa Taner Bostanci, Department of General Surgery, Diskapi Yildirim Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet Saydam
- Mehmet Saydam, Department of General Surgery, Diskapi Yildirim Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Koray Kosmaz
- Koray Kosmaz, Department of General Surgery, Ankara Training and Research Hospital, Ankara, Turkey
| | - Baki Tastan
- Baki Tastan, Department of General Surgery, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Erdal Birol Bostanci
- Erdal Birol Bostanci, Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Musa Akoglu
- Musa Akoglu, Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
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10
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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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11
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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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12
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Alexander HC, Bartlett AS, Wells CI, Hannam JA, Moore MR, Poole GH, Merry AF. Reporting of complications after laparoscopic cholecystectomy: a systematic review. HPB (Oxford) 2018; 20:786-794. [PMID: 29650299 DOI: 10.1016/j.hpb.2018.03.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Consistent measurement and reporting of outcomes, including adequately defined complications, is important for the evaluation of surgical care and the appraisal of new surgical techniques. The range of complications reported after LC has not been evaluated. This study aimed to identify the range of complications currently reported for laparoscopic cholecystectomy (LC), and the adequacy of their definitions. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for prospective studies reporting clinical outcomes of LC, between 2013 and 2016. RESULTS In total 233 studies were included, reporting 967 complications, of which 204 (21%) were defined. One hundred and twenty-two studies (52%) did not provide definitions for any of the complications reported. Conversion to open cholecystectomy was the most commonly reported complication, reported in 135 (58%) studies, followed by bile leak in 89 (38%) and bile duct injury in 75 (32%). Mortality was reported in 89 studies (38%). CONCLUSION Considerable variation was identified between studies in the choice of measures used to evaluate the complications of LC, and in their definitions. A standardised set of core outcomes of LC should be developed for use in clinical trials and in evaluating the performance of surgical units.
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Affiliation(s)
- Harry C Alexander
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Adam S Bartlett
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Auckland City Hospital, Auckland, New Zealand
| | - Cameron I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jacqueline A Hannam
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matthew R Moore
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Garth H Poole
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Middlemore Hospital, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Auckland City Hospital, Auckland, New Zealand.
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13
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Prevot F, Fuks D, Cosse C, Pautrat K, Msika S, Mathonnet M, Khalil H, Mauvais F, Regimbeau JM. The Value of Abdominal Drainage After Laparoscopic Cholecystectomy for Mild or Moderate Acute Calculous Cholecystitis: A Post Hoc Analysis of a Randomized Clinical Trial. World J Surg 2017; 40:2726-2734. [PMID: 27351713 DOI: 10.1007/s00268-016-3605-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although the preoperative management of mild and moderate (Grade I-II) acute calculous cholecystitis (ACC) has been standardized, there is no consensus on the value of abdominal drainage after early cholecystectomy. METHODS In a post hoc analysis of a randomized controlled trial (NCT01015417) focused on the value of postoperative antibiotic therapy in patients with ACC, we determined the value of abdominal drainage in patients having undergone laparoscopic cholecystectomy for Grades I-II ACC. All postoperative complications were analyzed after using a propensity score. A post hoc test was used to assess the statistical robustness of our results. RESULTS Of the 414 enrolled patients, 178 did not have abdominal drainage (forming the no-drainage group) and 236 had drainage (the drainage group). After matching on PS, the deep incisional site infection was 1.1 versus 0.8 %, p = 0.78. This result is similar for the superficial incisional site infections; the distant infections; the overall morbidity, and the readmission rate. Only the hospital length of stay was significantly longer in the drainage group (3.3 vs. 5.1 days, p = 0.003). Neither abdominal drainage nor the absence of postoperative antibiotic therapy was found to be a risk factor for deep incisional site infections. CONCLUSIONS The use of abdominal drainage depends on the surgeon's personal preferences but is often used in high-risk populations. However, abdominal drainage does not appear to be of any benefit (in terms of postoperative outcomes) and may even compromise recovery in patients having undergone early laparoscopic cholecystectomy for mild or moderate ACC.
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Affiliation(s)
- Flavien Prevot
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
- French National Surgical Research Network, Amiens, France
| | - David Fuks
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
- French National Surgical Research Network, Amiens, France
| | - Cyril Cosse
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
- INSERM U1088, Amiens, France
- Digestive Surgery Methodology Unit, Amiens University Medical Center, Amiens, France
- Clinical Research Center, Amiens University Medical Center, Amiens, France
- French National Surgical Research Network, Amiens, France
| | - Karine Pautrat
- Department of Digestive Diseases, Lariboisière Hospital, Paris, France
- French National Surgical Research Network, Amiens, France
| | - Simon Msika
- General and Digestive Surgery Department, Louis Mourier Hospital, Colombes, France
- French National Surgical Research Network, Amiens, France
| | - Muriel Mathonnet
- Department of Digestive Surgery, Dupuytren Hospital, Limoges, France
- French National Surgical Research Network, Amiens, France
| | - Haitham Khalil
- Department of Digestive Surgery, Rouen University Medical Center, Rouen, France
- French National Surgical Research Network, Amiens, France
| | - François Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
- French National Surgical Research Network, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France.
- Clinical Research Center, Amiens University Medical Center, Amiens, France.
- French National Surgical Research Network, Amiens, France.
- EA4294, Jules Verne University of Picardie, Amiens, France.
- Department of Digestive and Oncological Surgery, New University Hospital Centre, Avenue René Laennec, Cedex 1, F-80054, Amiens, France.
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14
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Picchio M, Lucarelli P, Di Filippo A, De Angelis F, Stipa F, Spaziani E. Meta-analysis of drainage versus no drainage after laparoscopic cholecystectomy. JSLS 2014; 18:e2014.00242. [PMID: 25516708 PMCID: PMC4266231 DOI: 10.4293/jsls.2014.00242] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Routine drainage after laparoscopic cholecystectomy is still controversial. This meta-analysis was performed to assess the role of drains in reducing complications in laparoscopic cholecystectomy. METHODS An electronic search of Medline, Science Citation Index Expanded, Scopus, and the Cochrane Library database from January 1990 to June 2013 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in laparoscopic cholecystectomy. The odds ratio for qualitative variables and standardized mean difference for continuous variables were calculated. RESULTS Twelve randomized controlled trials were included in the meta-analysis, involving 1939 patients randomized to a drain (960) versus no drain (979). The morbidity rate was lower in the no drain group (odds ratio, 1.97; 95% confidence interval, 1.26 to 3.10; P = .003). The wound infection rate was lower in the no drain group (odds ratio, 2.35; 95% confidence interval, 1.22 to 4.51; P = .01). Abdominal pain 24 hours after surgery was less severe in the no drain group (standardized mean difference, 2.30; 95% confidence interval, 1.27 to 3.34; P < .0001). No significant difference was present with respect to the presence and quantity of subhepatic fluid collection, shoulder tip pain, parenteral ketorolac consumption, nausea, vomiting, and hospital stay. CONCLUSION This study was unable to prove that drains were useful in reducing complications in laparoscopic cholecystectomy.
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Affiliation(s)
| | | | | | | | - Francesco Stipa
- Department of Surgery, Hospital "S. Giovanni-Addolorata," Rome, Italy
| | - Erasmo Spaziani
- Department of Surgery, University of Rome "La Sapienza," Terracina, Italy
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