Is routine drain insertion after laparoscopic cholecystectomy for acute cholecystitis beneficial? A multicenter, prospective randomized controlled trial

Abstract

Background: There is a lack of evidence regarding the role of drainage in laparoscopic cholecystectomy (LC) for acutely inflamed gallbladder (AIGB), and drain insertion remains controversial.

Methods: From December 2013 to November 2014, a total of 193 patients who needed LC due to AIGB at the four participating hospitals were entered in this study. After the operation, the patients were randomly assigned to undergo drain insertion (94 patients, 48.7%, group A) or not (99 patients, 51.3%, group B). The surgical outcomes between the two groups were prospectively reviewed. The study was registered at www.clinicaltrials.gov at the inception of enrollment (NCT02027402).

Results: Both groups were comparable in terms of patient demographics, operative time and postoperative hospital stay. In 18 cases (9.3%), postoperative morbidities such as bleeding, bile leakage, wound infection or an abscess occurred, and there was no significant difference between the two groups. The visual analog scale pain score measured at 24 h (3.9 ± 1.4 in group A and 3.3 ± 2.0 in group B, P = 0.014) and 48 h (2.1 ± 1.5 in group A and 1.5 ± 1.4 in group B, P = 0.006) was significantly higher in group A.

Conclusions: Routine drain insertion does not prevent or reduce postoperative morbidities after LC for AIGB and can even cause prolonged postoperative pain. This prospective study suggests that routine drain use in LC for AIGB should be reconsidered.

Keywords: Acute cholecystitis; Cholecystectomy; Drain; Laparoscopy; Morbidity.