nach oben

Erschienen in:

01.12.2023 | Research

Effectiveness of no drainage after elective day-case laparoscopic cholecystectomy, even with intraoperative gallbladder perforation: a randomized controlled trial

verfasst von: Huanbing Zhu, Daren Liu, Donger Zhou, Jinhong Wu, Yuanquan Yu, Yun Jin, Dan Ye, Chao Ding, Xiaoxiao Zhang, Bingying Huang, Shuyou Peng, Jiangtao Li

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 1/2023

Einloggen, um Zugang zu erhalten

Abstract

Background

Laparoscopic cholecystectomy (LC) has been carried out as day-case surgery. Current guidelines do not mention the role of drainage after LC. In particular, data stay blank with no prospective study on drainage management when gallbladder perforation (GP) accidentally occurs intraoperatively.

Methods

A randomized controlled trial was conducted to compare clinical outcomes of drainage and no drainage after elective day-case LC. Intraoperative GP was recorded. The primary and secondary outcomes were major and minor complications, respectively.

Results

Two hundred patients were randomized. No major complications occurred in either group. In secondary outcomes, nausea/vomiting, pain, hospital stay, and cost were similar in the drainage group and no drainage group; postoperative fever, WBC, and CRP levels were significantly lower in the no drainage group. GP occurred in 32 patients. Male patients with higher BMI and CRP and abdominal pain within 1 month were more likely to occur GP. Subgroup analysis of GP, primary outcomes, and most secondary outcomes had no difference. Postoperative WBC and CRP were higher in the drainage group. Postoperative fever occurred in 63 patients. Univariate analysis of fever showed that blood loss, drainage, postoperative WBC, CRP, and hospital stay were significant. Multivariable logistic regression analysis demonstrated that drainage was an independent risk factor for fever after LC (OR 3.418, 95% CI 1.392–8.390; p = 0.007).

Conclusions

No drainage after elective day-case LC is safe and associated with fewer complications, even in intraoperative GP. The trial proves that drainage is an independent risk factor for postoperative fever. The use of a drain after LC may lead to an unsuccessful day-case procedure by causing fever, elevated CRP, and extended hospital stay (NCT03909360).

Agresta F, Campanile FC, Vettoretto N et al (2015) Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbeck’s Arch Surg 400(4):429–453CrossRef

Department of Health (2015) The National Health Service (NHS) Plan: a plan for investment, a plan for reform. Department of Health, London

BADS, (2009) Day case laparoscopic cholecystectomy: NHS Institute Rapid Improvement Programme -British Association of Day Surgery. http://rcseng.ac.uk/policy/policy-seminars/day-surgery-and-enhanced-recovery/docs/iansmith2.pdf

Bailey CR, Ahuja M, Bartholomew K et al (2019) Guidelines for day-case surgery 2019: guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia 74(6):778–792PubMedCrossRef

Solodkyy A, Hakeem AR, Oswald N et al (2018) True day case laparoscopic cholecystectomy in a high-volume specialist unit and review of factors contributing to unexpected overnight stay. Hindawi minimally invasive surgery 2018:1260358

Jawaheer G, Evans K, Marcus R (2013) Day-case laparoscopic cholecystectomy in childhood: outcomes from a clinical care pathway. Eur J Pediatr Surg 23(1):57–62PubMedCrossRef

Pucher PH, Brunt LM, Fanelli RD et al (2015) SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy. Surg Endosc 29(11):3074–85PubMedCrossRef

Tazuma S, Unno M, Igarashi Y et al (2017) Evidence-based clinical practice guidelines for cholelithiasis 2016. J Gastroenterol 52(3):276–300PubMedCrossRef

Conrad C, Wakabayashi G, Asbun HJ et al (2017) IRCAD recommendation on safe laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci 24(11):603–615PubMedCrossRef

10.

Wakabayashi G, Iwashita Y, Hibi T et al (2018) Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25(1):73–86PubMedCrossRef

11.

Brockmann JG, Kocher T, Senninger NJ, Schürmann GM (2002) Complications due to gallstones lost during laparoscopic cholecystectomy. SurgEndosc 16:1226–1232

12.

Altuntas YE, Oncel M, Haksal M et al (2018) Gallbladder perforation during elective laparoscopic cholecystectomy: incidence, risk factors, and outcomes. North Clin Istanb 5(1):47–53PubMedPubMedCentral

13.

Picchio M, De Angelis F, Zazza S et al (2012) Drain after elective laparoscopic cholecystectomy. A randomized multicentre controlled trial. Surg Endosc 26(10):2817–22PubMedCrossRef

14.

Robinson JO (1986) Surgical drainage: a historical perspective. Br J Surg 73:422–426PubMedCrossRef

15.

Uchiyama K, Tani M, Kawai M et al (2007) Clinical significance of drainage tube insertion in laparoscopic cholecystectomy: a prospective randomized controlled trial. J Hepatobiliary Pancreat Surg 14:551–556PubMedCrossRef

16.

Dallal RM, Bailey L, Nahmias N (2007) Back to basics-clinical diagnosis in bariatric surgery. Routine drains and upper GI series are unnecessary. Surg Endosc 21:2268–2271PubMedCrossRef

17.

Takada T, Kawarada Y, Nimura Y et al (2007) Tokyo guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Surg 14:1–10PubMedPubMedCentralCrossRef

18.

Sarli L, Costi R, Sansebastiano G et al (2000) Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg 87:1161–1165PubMedCrossRef

19.

Barczynski M, Herman RM (2003) A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc 17:533–538PubMedCrossRef

20.

Nursal TZ, Yildirim S, Tarim A et al (2003) Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy. Langenbecks Arch Surg 388:95–100PubMedCrossRef

21.

Chiche L, Letoublon C (2010) Traitment des complications de la chole´cystctomie. EMC, Techniques chirurgicales—Appareil digestif. Elsevier Masson SAS, Paris, pp 40–960

22.

Gurusamy KS, Koti R, Davidson BR (2013) Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev 03(9):CD006004

23.

Akhunzada TS, Orakzai MA, Khan MA et al (2016) Effectiveness of the use of drains in post laparoscopic cholecystectomies. J Med Sci (Peshawar, Print) 24(1):28–31

24.

Georgiou C, Demetriou N, Pallaris T et al (2011) Is the routine use of drainage after elective laparoscopic cholecystectomy justified? A randomized trial. J Laparoendosc Adv Surg Tech A 21(2):119–123PubMedCrossRef

25.

Muhammad N, Manzar A, Aalii A (2014) Outcome of laparoscopic cholecystectomy with and without drain. Pak J Med Health Sci 8(1):165–167

26.

Tzovaras G, Liakou P, Fafoulakis F et al (2009) Is there a role for drain use in elective laparoscopic cholecystectomy? A controlled randomized trial. Am J Surg 197:759–763PubMedCrossRef

27.

Sharma A, Mittal S (2016) Role of routine subhepatic abdominal drain placement following uncomplicated laparoscopic cholecystectomy: a prospective randomised study. J Clin Diagn Res 10(12):03

28.

Hawasli A, Brown E (1994) The effect of drains in laparoscopic cholecystectomy. J Laparoendosc Surg 4(6):393–398PubMedCrossRef

29.

Mrozowicz A, Rucinski P, Polkowski WP (2006) Routine drainage of the subhepatic area after laparoscopic cholecystectomy Prospective, controlled study with random patient selection. PolskiPrzegladChirurgiczny 78(5):597–609

30.

Gurusamy KS, Samraj K, Mullerat P et al (2007) Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev (4):CD006004

31.

Antoniou S, Koch O, Antoniou G et al (2014) Routine versus no drain placement after elective laparoscopic cholecystectomy: meta-analysis of randomized controlled trials. Minerva Chir 69(3):185–94PubMed

32.

Karabulut Z, Güler Y, Doğan P et al (2021) What should be done for perforation of the gallbladder during laparoscopic cholecystectomy: prophylaxis or treatment? J Laparoendosc Adv Surg Tech A 31(1):54–60PubMedCrossRef

33.

Diez J, Arozamena CJ, Ferraina P et al (1996) Relation between postoperative infections and gallbladder bile leakage during laparoscopic cholecystectomies. Surg Endosc 10:529–532PubMedCrossRef

34.

Mohiuddin K, Nizami S, Fitzgibbons RJ et al (2006) Predicting iatrogenic gall bladder perforation during laparoscopic cholecystectomy: a multivariate logistic regression analysis of risk factors. ANZ J Surg 76(3):130–132PubMedCrossRef

35.

Bas G, Eryilmaz R, Akcakaya A et al (2005) The effect of the degree of histologic inflammation on gallbladder perforation during laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 15(2):130–134PubMedCrossRef

36.

De Simone P, Donadio R, Urbano D (1999) The risk of gallbladder perforation at laparoscopic cholecystectomy. Surg Endosc 13:1099–1102PubMedCrossRef

37.

Suh SW, Park JM, Lee SE et al (2012) Accidental gallbladder perforation during laparoscopic cholecystectomy: does it have an effect on the clinical outcomes? J Laparoendosc Adv Surg Tech A 22(1):40–45PubMedCrossRef

38.

Rice DC, Memon MA, Jamison RL et al (1997) Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy. J Gastrointest Surg 1(1):85–91PubMedCrossRef

39.

Jain N, Neogi S, Bali RS, et al. (2015) Relationship of gallbladder perforation and bacteriobilia with occurrence of surgical site infections following laparoscopic cholecystectomy. Minim Invasive Surg 2015:204508

40.

Kimura T, Goto H, Takeuchi Y, M, et al (1996) Intraabdominal contamination after gallbladder perforation during laparoscopic cholecystectomy and its complications. Surg Endosc 10:888–891PubMedCrossRef

41.

Calik A, Topaloglu S, Topcu S et al (2007) Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy. Surg Endosc 21(9):1578–1581PubMedCrossRef

42.

Kandil T, El Nakeeb A, El Hefnawy E (2010) Comparative study between clipless laparoscopic cholecystectomy by harmonic scalpel versus conventional method: a prospective randomized study. J Gastrointest Surg 14:323–328PubMedCrossRef

43.

Zanghi A, Cavallaro A, Di Mattia P et al (2014) Laparoscopic cholecystectomy: ultrasonic energy versus monopolar electrosurgical energy. Eur Rev Med Pharmacol Sci 18(2 Suppl):54–59PubMed

44.

Jones DB, Dunnegan DL, Soper NJ (1995) The influence of intraoperative gallbladder perforation on long-term outcome after laparoscopic cholecystectomy. Surg Endosc 9:977–980PubMedCrossRef

45.

UygarKalayci M, Veli Akin B, Alis H et al (2008) Short-term effects of gallbladder perforations during laparoscopic cholecystectomy on respiratory mechanics and depth of pain. Surg Endosc 22(5):1317–1320CrossRef

46.

Eikermann M, Siegel R, Broeders I et al (2012) Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 26(11):3003–3039PubMedCrossRef

47.

Myers MB (1962) Drain fever, a complication of drainage after cholecystectomy. Surgery 52:314–317PubMed

48.

Gurer A, Dumlu EG, Dikili E et al (2013) Is a drain required after laparoscopic cholecystectomy? Eurasian J Med 45(3):181PubMedPubMedCentralCrossRef

Titel: Effectiveness of no drainage after elective day-case laparoscopic cholecystectomy, even with intraoperative gallbladder perforation: a randomized controlled trial
verfasst von: Huanbing Zhu
Daren Liu
Donger Zhou
Jinhong Wu
Yuanquan Yu
Yun Jin
Dan Ye
Chao Ding
Xiaoxiao Zhang
Bingying Huang
Shuyou Peng
Jiangtao Li
Publikationsdatum: 01.12.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 1/2023
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-023-02846-z

Neu im Fachgebiet Chirurgie

Vorsicht, erhöhte Blutungsgefahr nach PCI!

10.05.2024 Koronare Herzerkrankung Nachrichten

Nach PCI besteht ein erhöhtes Blutungsrisiko, wenn die Behandelten eine verminderte linksventrikuläre Ejektionsfraktion aufweisen. Das Risiko ist umso höher, je stärker die Pumpfunktion eingeschränkt ist.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Deutlich weniger Infektionen: Wundprotektoren schützen!

08.05.2024 Postoperative Wundinfektion Nachrichten

Der Einsatz von Wundprotektoren bei offenen Eingriffen am unteren Gastrointestinaltrakt schützt vor Infektionen im Op.-Gebiet – und dient darüber hinaus der besseren Sicht. Das bestätigt mit großer Robustheit eine randomisierte Studie im Fachblatt JAMA Surgery.

Chirurginnen und Chirurgen sind stark suizidgefährdet

07.05.2024 Suizid Nachrichten

Der belastende Arbeitsalltag wirkt sich negativ auf die psychische Gesundheit der Angehörigen ärztlicher Berufsgruppen aus. Chirurginnen und Chirurgen bilden da keine Ausnahme, im Gegenteil.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

Effectiveness of no drainage after elective day-case laparoscopic cholecystectomy, even with intraoperative gallbladder perforation: a randomized controlled trial