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Hasjim BJ, Grigorian A, Jutric Z, Wolf RF, Yamamoto M, Imagawa DK, Nahmias J. Intra-Operative Abdominal Drain Placement for Gallbladder Cancer Surgery and Risk of Infectious Complications. Surg Infect (Larchmt) 2021; 23:22-28. [PMID: 34494909 DOI: 10.1089/sur.2021.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Routine intra-operative abdominal drain placement (IADP) is not beneficial for uncomplicated cholecystectomies though outcomes in gallbladder cancer surgery is unclear. This retrospective study hypothesized that patients with IADP (+IADP) for gallbladder cancer surgery have a higher risk of post-operative infectious complications (PIC) compared with patients without IADP (-IADP). Patients and Methods: The 2014-2017 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for +IADP and -IADP patients who had gallbladder cancer surgery. Post-operative infectious complications were defined as septic shock, organ/space infection (OSI), or percutaneous drainage. Multivariable analyses were performed to analyze the associated risk of PIC. Results: Of 385 patients, 237 (61.6%) were +IADP. The +IADP patients had higher rates of post-operative bile leak, OSI, re-admission, and increased length of stay (p < 0.05). The +IADP patients were not associated with increased risk of PIC (p > 0.05). Bile leak (odds ratio [OR], 10.61; p < 0.001), peri-operative blood transfusion (OR, 3.77; p = 0.003), biliary reconstruction (OR, 2.88; p = 0.018), and pre-operative biliary stent placement (OR, 3.02; p = 0.018) were the strongest associated risk factors of PIC. Patients with drains in place at or longer than 30 days post-operatively had an increased associated risk compared with patients who did not (OR, 6.88; 95% confidence interval [CI], 2.16-21.86; p < 0.001). Conclusions: More than 60% of gallbladder cancer surgeries included IADP and was not associated with an increased risk of PIC. Intra-operative abdominal drain placement was not associated with an increased risk of PIC, unless drains were left in place for 30 days or longer. Increased risk of PIC was associated with bile leak, peri-operative blood transfusion, pre-operative biliary stent placement, and biliary reconstruction.
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Affiliation(s)
- Bima J Hasjim
- Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Areg Grigorian
- University of Southern California, Department of Surgery, Los Angeles, California, USA
| | - Zeljka Jutric
- Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA.,Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Ronald F Wolf
- Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA.,Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Maki Yamamoto
- Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA.,Division of Surgical Oncology, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - David K Imagawa
- Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA.,Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Jeffry Nahmias
- Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA.,Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
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Mohseni S, Talving P, Kobayashi L, Kim D, Inaba K, Lam L, Chan LS, Coimbra R, Demetriades D. Closed-Suction Drain Placement at Laparotomy in Isolated Solid Organ Injury is Not Associated with Decreased Risk of Deep Surgical Site Infection. Am Surg 2020. [DOI: 10.1177/000313481207801038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to investigate the role of intra-abdominal closed-suction drainage after emergent trauma laparotomy for isolated solid organ injuries (iSOI) and to determine its association with deep surgical site infections (DSSI). All patients subjected to trauma laparotomy between January 2006 and December 2008 for an iSOI at two Level I urban trauma centers were identified. Patients with isolated hepatic, splenic, or renal injuries were included. Study variables extracted included demographics, clinical characteristics, intra-abdominal injuries, drain placement, DSSI, septic events, intensive care unit and hospital length of stay, and in-hospital mortality. Diagnosis of DSSI was based on abdominal computed tomography scan demonstrating an intra-abdominal collection combined with fever and elevated white blood cell count. For the analysis, patients were stratified based on injury severity. To identify an independent association between closed-suction drain placement and DSSI, stepwise logistic regression analysis was performed. Overall, 142 patients met the inclusion criteria with 80 per cent (n = 114) having severe iSOI. In 47 per cent (n = 53) of the patients with a severe injury, an intra-abdominal drain was placed. A drain was placed more often in patients with a blunt trauma with more severe injury defined by Injury Severity Score and abdominal Abbreviated Injury Scale Score and those who underwent splenectomy ( P < 0.05). There was a three-fold increased risk of DSSI in patients subjected to drain placement (odds ratio, 2.8; 95% confidence interval, 1.0 to 8.2; P = 0.046). Subgroup analysis demonstrated those who sustained severe hepatic injury receiving a drain had a significantly increase risk of DSSI ( P = 0.02). There was no statistical difference in the rate of DSSI based on the presence or absence of an intra-abdominal drain after severe splenic injury (17 vs 18%, P = 0.88). The use of intra-abdominal closed-suction drains after iSOI is not associated with decreased risk of DSSI.
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Affiliation(s)
- Shahin Mohseni
- Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care) Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Peep Talving
- Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care) Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Leslie Kobayashi
- Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, University of California, San Diego, California
| | - Dennis Kim
- Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, University of California, San Diego, California
| | - Kenji Inaba
- Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care) Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lydia Lam
- Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care) Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Linda S. Chan
- Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care) Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Raul Coimbra
- Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, University of California, San Diego, California
| | - Demetrios Demetriades
- Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care) Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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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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Drain After Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis. A Pilot Randomized Study. Indian J Surg 2012; 77:288-92. [PMID: 26730011 DOI: 10.1007/s12262-012-0797-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 12/02/2012] [Indexed: 10/27/2022] Open
Abstract
Drainage after laparoscopic cholecystectomy (LC) for acute calculous cholecystitis (ACC) is used without evidence of its efficacy. The present pilot study was designed to address this issue. After laparoscopic gallbladder removal, 15 patients were randomized to have a drain positioned in the subhepatic space (group A) and 15 patients to have a sham drain (group B). The primary outcome measure was the presence of subhepatic fluid collection at abdominal ultrasonography, performed 24 h after surgery. Secondary outcome measures included postoperative abdominal and shoulder tip pain, use of analgesics, and morbidity. Abdominal ultrasonography did not show any subhepatic fluid collection in eight patients (53.3 %) in group A and in five patients (33.3 %) in group B (P = 0.462). If present, median (range) subhepatic collection was 50 mL (20-100 mL) in group A and 80 mL (30-120 mL) in group B (P = 0.573). No significant differences in the severity of abdominal and shoulder pain and use of parenteral ketorolac were found in either group. Two biliary leaks and one subhepatic fluid collection occurred postoperatively. The present study was unable to prove that the drain was useful in LC for ACC, performed in a selected group of patients.
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Picchio M, De Angelis F, Zazza S, Di Filippo A, Mancini R, Pattaro G, Stipa F, Adisa AO, Marino G, Spaziani E. Drain after elective laparoscopic cholecystectomy. A randomized multicentre controlled trial. Surg Endosc 2012; 26:2817-22. [PMID: 22538671 DOI: 10.1007/s00464-012-2252-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 03/13/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Routine drainage after laparoscopic cholecystectomy is still debatable. The present study was designed to assess the role of drains in laparoscopic cholecystectomy performed for nonacutely inflamed gallbladder. METHODS After laparoscopic gallbladder removal, 53 patients were randomized to have a suction drain positioned in the subhepatic space and 53 patients to have a sham drain. The primary outcome measure was the presence of subhepatic fluid collection at abdominal ultrasonography, performed 24 h after surgery. Secondary outcome measures were postoperative abdominal and shoulder tip pain, use of analgesics, nausea, vomiting, and morbidity. RESULTS Subhepatic fluid collection was not found in 45 patients (84.9 %) in group A and in 46 patients (86.8 %) in group B (difference 1.9 (95 % confidence interval -11.37 to 15.17; P = 0.998). No significant difference in visual analogue scale scores with respect to abdominal and shoulder pain, use of parenteral ketorolac, nausea, and vomiting were found in either group. Two (1.9 %) significant hemorrhagic events occurred postoperatively. Wound infection was observed in three patients (5.7 %) in group A and two patients (3.8 %) in group B (difference 1.9 (95 % CI -6.19 to 9.99; P = 0.997). CONCLUSIONS The present study was unable to prove that the drain was useful in elective, uncomplicated LC.
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Affiliation(s)
- Marcello Picchio
- Department of Surgery, Hospital P. Colombo, Via Orti Ginnetti 7, 00049, Velletri, Rome, Italy.
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Tzovaras G, Liakou P, Fafoulakis F, Baloyiannis I, Zacharoulis D, Hatzitheofilou C. Is there a role for drain use in elective laparoscopic cholecystectomy? A controlled randomized trial. Am J Surg 2008; 197:759-63. [PMID: 18926516 DOI: 10.1016/j.amjsurg.2008.05.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 05/30/2008] [Accepted: 05/30/2008] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although the issue of drain use in open cholecystectomy has been adequately addressed by prospective randomized trials, there is lack of evidence on the usefulness of drains in elective laparoscopic cholecystectomy, and the surgeons follow their beliefs and bias on this debate. Therefore, a controlled randomized trial was designed to assess the value of drains in elective laparoscopic cholecystectomy. METHODS During a 5-year period (January 2002 to December 2006), 284 patients were randomized to have a drain placed (group A), whereas 281 patients were randomized not to have a drain (group B) placed in the subhepatic space. End points of this trial were to detect any differences in morbidity, postoperative pain, and hospital stay between the 2 groups. RESULTS There was no mortality in either group and no statistically significant difference in morbidity or hospital stay between the 2 groups. However, postoperative pain was significantly increased in patients who had a drain placed; median visual analog scale (VAS) score was 5 (range 1 to 8) versus 3 (range 1 to 8), in the non-drained group (P < .0001). Interestingly, in 2 of 3 patients in whom a drain was placed against randomization because of bile leak suspicion, a bile leak occurred. CONCLUSIONS The routine use of a drain in elective laparoscopic cholecystectomy has nothing to offer; in contrast, it is associated with increased pain. It would be reasonable, however, to leave a drain if there is a worry about an unsolved or potential bile leak, bearing in mind that drain placement, although sometimes providing a false sense of security, does not guarantee either prevention or treatment of postoperative bile collections, bleeding, or bile peritonitis.
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Affiliation(s)
- George Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece.
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Abstract
BACKGROUND Cholecystectomy is the removal of gallbladder and is performed mainly for symptomatic gallstones. Although laparoscopic cholecystectomy is currently preferred over open cholecystectomy for elective cholecystectomy, reports of randomised clinical trials comparing the choice of cholecystectomy (open or laparoscopic) in acute cholecystitis are still being conducted. Drainage in open cholecystectomy is a matter of considerable debate. Surgeons use drains primarily to prevent subhepatic abscess or bile peritonitis from an undrained bile leak. Critics of drain condemn drain use as it increases wound and chest infection. OBJECTIVES To assess the benefits and harms of routine abdominal drainage in uncomplicated open cholecystectomy. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2006. SELECTION CRITERIA We included randomised clinical trials comparing 'no drain' versus 'drain' in patients who had undergone uncomplicated open cholecystectomy (irrespective of language, publication status, and the type of drain). Randomised clinical trials comparing one drain with another were also included. DATA COLLECTION AND ANALYSIS We collected the data on the characteristics and methodological quality of each trial, number of abdominal collections requiring different treatments, bile peritonitis, wound infection, chest complications, and hospital stay from each trial. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome, we calculated the odds ratio (OR) with 95% confidence intervals (CI) based on intention-to-treat analysis. MAIN RESULTS Twenty eight trials involving 3659 patients were included. There were 20 comparisons of 'no drain' versus 'drain' and 12 comparisons of one drain with another. There was no statistically significant difference in mortality, bile peritonitis, total abdominal collections, abdominal collections requiring different treatments, or infected abdominal collections. 'No drain' group had statistically significant lower wound infection (OR 0.61, 95% CI 0.43 to 0.87) and statistically significant lower chest infection (OR 0.59, 95% CI 0.42 to 0.84) than drain group. We found no significant differences between different types of drains. AUTHORS' CONCLUSIONS Drains increase the harms to the patient without providing any additional benefit for patients undergoing open cholecystectomy and should be avoided in open cholecystectomy.
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Affiliation(s)
- K S Gurusamy
- Royal Free Hospital, Surgery, 291 Greenhaven Drive, Thamesmead, London, UK, SE28 8FY.
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Sánchez-Ortiz R, Madsen LT, Swanson DA, Canfield SE, Wood CG. Closed suction or penrose drainage after partial nephrectomy: does it matter? J Urol 2004; 171:244-6. [PMID: 14665885 DOI: 10.1097/01.ju.0000099940.02698.38] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Prospective studies in the general surgery literature have shown fewer wound related complications with closed suction drainage than with open passive drainage. Nevertheless, some urologists avoid closed suction drains after partial nephrectomy mainly because of a theoretical increased risk of a prolonged urinary leak or delayed hemorrhage. MATERIALS AND METHODS We reviewed the records of 184 patients who underwent 197 consecutive partial nephrectomies at our institution. Closed suction or open passive (Penrose) drainage was used based on surgeon preference. Drain type was compared with duration of use and the incidence of relevant complications. RESULTS A Penrose drain was used in 37.6% (74 of 197) of partial nephrectomies and a closed suction drain was used in 62.4% (123). Clinical characteristics were equivalent between both groups, including age, body mass index, tumor size (mean 3.1 cm), number of renal tumors excised, estimated blood loss and operative time. There was no statistically significant difference in the duration of drainage between the Penrose group (mean 7.1 days) and the closed suction group (7.8 days). While we found variation in the incidence of relevant complications by drain type, none of these differences was statistically significant. Complications included prolonged urinary drainage in 7.6% of cases (8.9% closed suction, 5.4% Penrose), wound infection or perinephric abscess in 3.6% (2.4% closed suction, 5.4% Penrose) and delayed hemorrhage in 1.5% (2.4% closed suction, 0 Penrose). CONCLUSIONS No statistically significant differences in postoperative morbidity were observed between the use of closed suction or Penrose retroperitoneal drains after partial nephrectomy.
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Affiliation(s)
- Ricardo Sánchez-Ortiz
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA
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Memon MA, Memon B, Memon MI, Donohue JH. The uses and abuses of drains in abdominal surgery. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2002; 63:282-8. [PMID: 12066347 DOI: 10.12968/hosp.2002.63.5.2021] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Controversy surrounds the indications for and effectiveness of the abdominal drain. There are a variety of factors which mitigate against formulating rigid guidelines for the indications of drains, but surgeons should understand the benefits and applications of drainage and the tissue responses to the constituent materials. Drains are not a substitute for meticulous surgical technique.
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Thompson JS. 50 years of abdominal surgery at the Southwestern Surgical Congress: common problems and uncommon surgeons. Am J Surg 1998; 175:62S-74S. [PMID: 9558054 DOI: 10.1016/s0002-9610(98)00062-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J S Thompson
- Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280, USA
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Affiliation(s)
- S H Dougherty
- Department of Surgery, Texas Tech University School of Medicine, El Paso
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Sarr MG, Parikh KJ, Minken SL, Zuidema GD, Cameron JL. Closed-suction versus Penrose drainage after cholecystectomy. A prospective, randomized evaluation. Am J Surg 1987; 153:394-8. [PMID: 3551645 DOI: 10.1016/0002-9610(87)90585-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Closed-suction drainage was compared prospectively to open, passive drainage (Penrose drains) in 128 patients undergoing cholecystectomy. Patients were randomized at the time of operation to receive either closed-suction drains (Group I, 67 patients) or Penrose drains (Group II, 61 patients). The preoperative clinical parameters of the two groups were similar. The patients in Group I when compared with those in Group II had a shorter duration of drainage (3.3 days and 4.1 days, respectively, p less than 0.01), a lesser volume of drainage in the first 48 hours postoperatively (78 ml and 132 ml, respectively, p less than 0.001), a decreased incidence of fever on the night of operation (24 of 67 patients and 39 of 61 patients, respectively, p less than 0.05) and on the first postoperative day (26 of 67 patients and 32 of 61 patients, respectively, p less than 0.05), and a lower leukocyte count on the first postoperative day (12,000 cells/mm3 and 14,100 cells/mm3, respectively, 0.05 less than p less than 0.1). Patients in Group I tended to have a lower rate of wound infection (1 of 67 patients versus 5 of 61 patients in Group II, 0.05 less than p less than 0.1) and had a much lower incidence of drain site tenderness (8 of 67 patients in Group I versus 24 of 61 patients in Group II, p less than 0.05). This study demonstrates the superiority of closed-suction drains over open, passive drains after cholecystectomy.
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Elboim CM, Goldman L, Hann L, Palestrant AM, Silen W. Significance of post-cholecystectomy subhepatic fluid collections. Ann Surg 1983; 198:137-41. [PMID: 6870369 PMCID: PMC1353069 DOI: 10.1097/00000658-198308000-00004] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A prospective ultrasound study of the right upper quadrant in 105 patients who had undergone cholecystectomy showed the incidence of fluid collection in the gall bladder fossa to be 24% 2 to 4 days after operation. In all but two patients, these fluid collections were of no clinical significance. The relationship between the presence of fluid and several other variables, such as use of drains and surgical techniques, are discussed.
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