ReviewIntra-abdominal drainage for laparoscopic cholecystectomy: AÂ systematic review and meta-analysis

- Intra-abdominal drainage (IAD) is a common practice in general surgery.
- Laparoscopic cholecystectomy (LC) is one of the commonest procedure performed by general surgeons.
- In general, the effectiveness of post-operative drainage remains controversial and debatable.
- This article examines the effectiveness of intra-abdominal drainage post LC surgery.

AimTo assess the effectiveness of intra-abdominal drainage (IAD) post laparoscopic cholecystectomy (LC).MethodsMain electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (ClinicalTrial.gov)] were searched for randomised controlled trial (RCT) reporting outcomes of IAD. The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models.ResultsTwelve RCTs involving 1763 patients (897 drained versus 866 without drain) were included in the final pooled analysis. There was no statistically significant different in the rate of intra-abdominal collections (RR 1.08, 95% CI 0.78 to 1.49; p = 0.65). IAD did not reduce the overall incidence of nausea and vomiting (RR 1.10, 95% CI 0.90 to 1.36; p = 0.36) and shoulder tip pain (RR 0.99, 95% CI 0.69 to 1.40; p = 0.93). Drain group had a significant higher pain scores (measured by visual analogue scale) (MD 10.08, 95% CI 5.24 to 14.92; p < 0.00001). IAD prolonged operative time (MD 4.93 min, 95% CI 3.40 to 6.47; p < 0.00001) but not the length of hospital stay (MD 0.22 day, 95% CI −0.45 to 0.89; p = 0.52). Wound infection was found to be unrelated to the use of a drain (RR 1.86, 95% CI 0.95 to 3.63; p = 0.07).ConclusionsThere is no significant advantage of IAD placement. The routine use of abdominal drain seems to have unfavourable clinical outcome and the practice should be carefully re-considered.