Do We Need Sub-Hepatic Drainage After Elective Laparoscopic Cholecystectomy?

Abstract

Objectives: To analyze the advantages and disadvantages of placing a sub-hepatic drain after elective minimally invasive gallbladder removal surgery, identifying specific patient symptoms and pathological findings where this procedure is recommended.

Methodology: This randomized controlled study was conducted at PAC Hospital Kamra and PAF Hospital Islamabad, from October 2020 to September 2022. Through non-probability consecutive sampling 100 participants undergoing elective LC were included in the study. Recruited participants were randomly divided in to two groups. Group A with abdominal drains and Group B Without abdominal drain. After surgery, every patient has been closely monitored in order to estimate factors like mean operating time, mean hospital stay, nausea vomiting and postoperative pain. Data has been summarized and analyzed through SPSS version 21.

Results: The average age of the individuals in group A and B was 39.92±14.03 and 40.24±12.91 years, respectively. Most of the participants with the abdominal drains were in the age group 18-30 years. The average surgery time in both the study groups was 103.54±32.29 and 90.76±26.9 minutes respectively, indicating a highly significant difference with a p value of <0.0001. For group A, a notable 30% of the participants had to deal with post-operative nausea and vomiting (PONV). By comparison, a mere 12% of the individuals in group B encountered similar discomfort with statistically significant p value of 0.002. In group A, half of the participants reported experiencing pain after surgery, whereas in the other group, only 22% of the participants complained of post-operative pain. The difference was statistically significant, with a p-value of less than 0.0001. The mean hospitalization time for both study groups was 4.46±1.66 days (Group A) and 3.02±1.88 days (Group B), with a p value of <0.0001, indicating a highly significant difference.

Conclusion: In simple gallstone disease, a competent surgeon may safely perform LC without draining the gallbladder bed. Patients benefit greatly in terms of reduced postoperative pain, analgesia requirement, nausea and vomiting (PONV) and length of hospital stay. It may not be necessary to place a drain if the operating area is kept dry.