• 作者：Jaime Ruiz-Tovar^a ; ^{jruiztovar@gmail.com} ; Irene Ortega^b ; Jair Santos^a ; Liliana Sosa^c ; Laura Armañ ; anzas^a ; Marí ; a Diez Tabernilla^a ; Alicia Calero^a ; Antonio Arroyo^a ; Israel Oliver^a ; Salvador Garcí ; a^b ; Rafael Calpena^a
• 关键词：Colecistectom&iacute ; a laparoscó ; pica ; Drenaje ; Absceso intraabdominal
• 刊名：Cirug篓陋a Espa?ola
• 出版年：2012
• 期刊代码：pca87_0009739X
• 类别：med
• 出版时间：May, 2012
• 卷：90
• 期：5
• 页码：318-321
• 文件大小：264 K

Introduction

Classically, a sub-hepatic drain was inserted routinely in a cholecystectomy to prevent intra-abdominal abscesses, possible post-surgical bleeding, and biliary fistulas. Over the years, it has been demonstrated that the systematic use of a drain does not have any benefits, and many studies conclude that, in special circumstances (bleeding, signs of gallbladder inflammation, incidental opening, or suspected bile leak), and depending on the experience of the individual surgeon, the insertion of a drain may be of use.

Material y methods

A prospective study was conducted on 100 elective laparoscopic cholecystectomies performed due to symptomatic cholelithiasis or gallbladder polyps. A sub-hepatic drain was inserted in 15 of them. The indications for inserting it were: in 11 patients as a 鈥渃ontrol鈥?due to a gallbladder bed bleed controlled during surgery, and in 4 due to a gallbladder opening with the excretion of turbid-purulent bile. The main outcomes investigated were the clinical benefit achieved by the insertion of the drain, the hospital stay, and the quantifying of the pain by the patients 24 h after surgery, using a visual analogue scale.

Results

The insertion of a drain was of no benefit to any patient. The median hospital stay increased by 1 day in patients with a drain (P=.002). The median pain score at 24 h was higher in patients with a drain inserted (P=.018).

Conclusion

The insertion of a sub-hepatic drain after elective laparoscopic cholecystectomy increases post-surgical pain and prolongs hospital stay, and does not prevent the occurrence of intra-abdominal abscesses.