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      Laparoscopic elective cholecystectomy with and without drain: A controlled randomised trial

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          Abstract

          BACKGROUND:

          Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Routine drainage after laparoscopic cholecystectomy is an issue of considerable debate. Therefore, a controlled randomised trial was designed to assess the value of drains in elective laparoscopic cholecystectomy.

          MATERIALS AND METHODS:

          During a two-year period (From April 2008 to January 2010), 80 patients were simply randomised to have a drain placed (group A), an 8-mm pentose tube drain was retained below the liver bed, whereas 80 patients were randomised not to have a drain (group B) placed in the subhepatic space. End points of this trial were to detect any differences in morbidity, postoperative pain, wound infection and hospital stay between the two groups.

          RESULTS:

          There was no mortality in either group and no statistically significant difference in postoperative pain, nausea and vomiting, wound infection or abdominal collection between the two groups. However, hospital stay was longer in the drain group than in group without drain and it is appearing that the use of drain delays hospital discharge.

          CONCLUSION:

          The routine use of a drain in non-complicated laparoscopic cholecystectomy has nothing to offer; in contrast, it is associated with longer hospital stay.

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          Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy.

          L Roncoroni, R Costi, L Sarli … (2000)
          Postoperative shoulder-tip pain occurs frequently following laparoscopic cholecystectomy. The aim of this randomized clinical trial was to evaluate the efficacy of a low-pressure carbon dioxide pneumoperitoneum during laparoscopic surgery in reducing the incidence of postoperative shoulder-tip pain. Ninety consecutive patients undergoing laparoscopic cholecystectomy were randomized prospectively into low-pressure (group A) and normal-pressure (group B) laparoscopic cholecystectomy groups. Patients in group A (n = 46) underwent laparoscopic cholecystectomy with 9 mmHg carbon dioxide pneumoperitoneum during most of the operation, and those in group B (n = 44) had laparoscopic cholecystectomy with 13 mmHg pneumoperitoneum. Shoulder-tip pain was recorded on a visual analogue pain scale 1, 3, 6, 12, 24 and 48 h after operation. The low-pressure pneumoperitoneum did not increase the duration of surgery. There were no significant intraoperative or postoperative complications in either group. Fourteen patients (32 per cent) in group B and five (11 per cent) in group A complained of shoulder pain (P<0.05). Mean shoulder-tip pain scores at 12 and 24 h and postoperative analgesia requirements were also significantly lower in the low-pressure laparoscopic cholecystectomy group (P<0.001). A carbon dioxide pneumoperitoneum pressure lower than that usually utilized to perform laparoscopic surgery reduces both the frequency and intensity of shoulder-tip pain following laparoscopic cholecystectomy.
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            Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy.

            Mehmet Akin Tarim, Mehmet Haberal, A. Tuna … (2003)
            Laparoscopic cholecystectomy is associated with a high incidence of postoperative pain, nausea, and vomiting. Pneumoperitoneum created during the operation and residual gas after the operation are two of the factors in postoperative pain and nausea. We studied the effects of a subdiaphragmatic gas drain, which is intended to decrease the residual gas, on postoperative pain, nausea, and vomiting after laparoscopic cholecystectomy. Seventy patients were randomized into two demographically and clinically comparable groups: drainage and control. Postoperative pain, nausea, and vomiting were measured by verbal grading and visual analog scale 2-72 h postoperatively. Analgesic and antiemetic use and incidence of retching, vomiting and other complaints were also recorded. Subdiaphragmatic drain effectively reduced the incidence and amount of subdiaphragmatic gas bubble. The incidence and severity of nausea was lower in the drainage group at 72 h. Although severity of pain was lower at 8 and 12 h in the drainage group, the difference was not significant. There was also no difference between the groups in regard to analgesic and antiemetic use. Subdiaphragmatic drain offers only minor, if any, benefit on postoperative pain, nausea, and vomiting after laparoscopic cholecystectomy, and this effect is probably clinically irrelevant.
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              Randomized comparison between different insufflation pressures for laparoscopic cholecystectomy.

              S Deverakis, G Savanis, J Antoniades … (2003)
              Laparoscopy using carbon dioxide insufflation induces adverse effects in both the cardiovascular and the respiratory function. The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects. However, its effect on tissue trauma and postoperative pain and recovery remains controversial. The aim of this study was to compare tissue trauma, postoperative pain, and recovery in two groups of patients undergoing laparoscopic cholecystectomy, one at insufflation pressure of 8 (LC8) and the other at 15 mm Hg (LC15). Forty patients were randomized, 20 in each group. The characteristics of the patients were similar in the two groups. The procedure was completed in all patients in the LC15 group, but in 2 patients in the LC8 group the pressure was increased to 15 mm Hg to complete the operation. There were no significant differences in postoperative pain scores, analgesic consumption, and the incidence of nausea, vomiting, and shoulder pain between the two groups. C-reactive protein concentrations and white blood cell count rose significantly after surgery, but the increase was similar in the two groups. The median duration of surgery was similar, 23 minutes (range 15-65) in the LC8 group and 25 minutes (range 15-80) in the LC15 group. Using our technique of laparoscopic cholecystectomy, there were no advantages to tissue damage, postoperative pain, and recovery when a low pressure pneumoperitoneum was used.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Minim Access Surg
                Journal ID (iso-abbrev): J Minim Access Surg
                Journal ID (publisher-id): JMAS
                Title: Journal of Minimal Access Surgery
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0972-9941
                ISSN (Electronic): 1998-3921
                Publication date (Print): Jul-Sep 2012
                Volume: 8
                Issue: 3
                Pages: 90-92
                Affiliations
                [1]Department of General Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
                [1 ]Department of General Surgery, Port- fouad General Hospital Port-saied, Egypt
                [2 ]Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
                Author notes
                Address for correspondence: Prof. Gouda Mohamed El-labban, Department of General Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. E-mail: ellabbang@ 123456yahoo.com
                Article
                Publisher ID: JMAS-8-90
                DOI: 10.4103/0972-9941.97591
                PMC ID: 3401723
                PubMed ID: 22837596
                SO-VID: 0edd9349-db51-4200-b8b3-104c2e1890a6
                Copyright © Copyright: © Journal of Minimal Access Surgery
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 03 January 2011
                Date accepted : 09 June 2011
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Surgery
                Keywords: cholecystectomy,postoperative pain,wound infection,hospital stay,laparoscopy,drain
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: cholecystectomy, postoperative pain, wound infection, hospital stay, laparoscopy, drain

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