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Abstract
Drainage after cholecystectomy remains routine despite the lack of scientific supportive
data. Numerous clinical studies in the past have attempted to address this controversy
but have failed to resolve the issue for different reasons. These include retrospective
design, inclusion of only selected cases, and randomization before surgery. In this
study 479 patients undergoing cholecystectomy were randomly allocated to a drainage
group (a high-pressure suction drain in Morison's pouch for 48 hours) or a nondrainage
group. Randomization was performed at the time of peritoneal closure. All patients
undergoing cholecystectomy, both elective and urgent, were included and the operations
were performed by all grades of surgeons. There were two deaths from cardiopulmonary
causes, both in the drainage group. No patient required reoperation in either group.
The incidence of both wound infections (15 vs 5; p < 0.05) and chest infections (56
vs 19, p < 0.02) was significantly higher in the drainage group. Three hundred fifty-six
patients underwent abdominal ultrasonography 72 hours after surgery. The number of
subhepatic fluid collections thus detected was significantly higher in the patients
who received a drain (17 vs 6, p < 0.05). None of these collections was clinically
significant. The postoperative hospital stay was longer in the patients with drains
(10.3 vs 9.1 days), but this difference failed to reach statistical significance.
We conclude from this study that the use of a drain after cholecystectomy serves no
useful purpose and is potentially harmful. This practice should be abandoned.
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Article info
Publication history
Accepted:
August 20,
1990
Identification
Copyright
© 1991 Published by Elsevier Inc.
