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Review
. 2014 Oct-Dec;18(4):e2014.00242.
doi: 10.4293/JSLS.2014.00242.

Meta-analysis of drainage versus no drainage after laparoscopic cholecystectomy

Marcello Picchio  1 , Pierino Lucarelli  2 , Annalisa Di Filippo  3 , Francesco De Angelis  3 , Francesco Stipa  4 , Erasmo Spaziani  3
Affiliations
Review

Meta-analysis of drainage versus no drainage after laparoscopic cholecystectomy

Marcello Picchio et al. JSLS. 2014 Oct-Dec.

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.

Keywords: Cholecystectomy; Drainage; Laparoscopy.

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Figures

Figure 1.
Figure 1.
Article identification and selection algorithm.
Figure 2.
Figure 2.
Forest plot showing overall complications in drain group compared with no drain group. M-H, Mantel-Haenszel.
Figure 3.
Figure 3.
Forest plot showing wound infection in drain group compared with no drain group. M-H, Mantel-Haenszel.
Figure 4.
Figure 4.
Forest plot showing presence of subhepatic fluid collection in drain group compared with no drain group. M-H, Mantel-Haenszel.
Figure 5.
Figure 5.
Forest plot showing quantity of subhepatic fluid collection (in milliliters) in drain group compared with no drain group.
Figure 6.
Figure 6.
Forest plot showing severity of abdominal pain 24 hours after surgery in drain group compared with no drain group.
Figure 7.
Figure 7.
Forest plot showing severity of shoulder tip pain 24 hours after surgery in drain group compared with no drain group.
Figure 8.
Figure 8.
Forest plot showing parenteral ketorolac consumption (in milliliters) in drain group compared with no drain group.
See this image and copyright information in PMC

References

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