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Drain in laparoscopic cholecystectomy in acute calculous cholecystitis: a randomised controlled study
  1. Mithun V Valappil1,
  2. Sumit Gulati1,
  3. Manish Chhabra1,
  4. Ajay Mandal1,
  5. Sanjay De Bakshi1,
  6. Avik Bhattacharyya2,
  7. Supriyo Ghatak1
  1. 1Surgical Gastroenterology, Calcutta Medical Research Institute, Kolkata, India
  2. 2Interventional Radiology, Calcutta Medical Research Institute, Kolkata, India
  1. Correspondence to Dr Supriyo Ghatak, Surgical Gastroenterology, Calcutta Medical Research Institute, Kolkata 700027, India; drsupriyo{at}yahoo.co.in

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.

  • acute cholecystitis, gallstones, laparoscopic cholecystectomy, drain
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Footnotes

  • Contributors SGu and SGh conceived and designed the study. MVV collected the data, performed the analysis and wrote the manuscript. MC, AM and SDB contributed and analysed the data. SGu and SGh reviewed and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional ethics committee PROT/DNB/31/GIS/03/2016 Dr 31 May 2016.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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