Background and objectives: Routine drainage after laparoscopic cholecystectomy is still controversial. The present meta-analysis was performed to assess the role of drains to reduce complications in laparoscopic cholecystectomy. Methods: An electronic search of the Medline, Science Citation Index Expanded, Scopus and Cochrane library database from January 1990 to June 2013 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in LC. Odds ratio for qualitative variables and standardized mean difference for continuous variables were calculated. Results: Twelve randomized controlled trials were included in the meta-analysis, involving 1939 patients randomized to drain (960) versus no drain (979). Morbidity was lower in the no drain group (odds ratio 1.97, 95% confidence interval 1.26-3.10; p=0.003). Wound infection rate was lower in the no drain group (odds ratio 2.35, 95% confidence interval 1.22-4.51; p=0.01). Abdominal pain 24 hours after surgery was less severe in the no drain group (standardized mean difference 2.30, 95% confidence interval 1.27 to 3.34, p<0.0001). No significant difference was present with respect to presence and quantity of subhepatic fluid collection, shoulder tip pain, parenteral ketorolac consumption, nausea, vomiting, and hospital stay. Conclusion: The present meta-analysis showed a consistent trend in favor of the no drain approach in terms of overall morbidity. In particular, wound infection rate was lower in the no drain group. No evidence is still present in the setting of emergent laparoscopic cholecystectomy. However, it is reasonable to avoid drain insertion when a dry operatory field is obtained at the end of the procedure.

Drainage versus no drainage in laparoscopic cholecystectomy: a meta-analysis / P., Lucarelli; M., Picchio; DI FILIPPO, Annalisa Romina; F., De Angelis; Spaziani, Erasmo. - In: BRITISH JOURNAL OF SURGERY. - ISSN 0007-1323. - STAMPA. - 102 Supplemento 1:(2015), pp. 265-265. (Intervento presentato al convegno ASGBI International Surgical Congress 2014 tenutosi a Harrogate, United Kingdom nel April 30 - May 2; 2014).

Drainage versus no drainage in laparoscopic cholecystectomy: a meta-analysis.

DI FILIPPO, Annalisa Romina;F. De Angelis;SPAZIANI, Erasmo
2015

Abstract

Background and objectives: Routine drainage after laparoscopic cholecystectomy is still controversial. The present meta-analysis was performed to assess the role of drains to reduce complications in laparoscopic cholecystectomy. Methods: An electronic search of the Medline, Science Citation Index Expanded, Scopus and Cochrane library database from January 1990 to June 2013 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in LC. Odds ratio for qualitative variables and standardized mean difference for continuous variables were calculated. Results: Twelve randomized controlled trials were included in the meta-analysis, involving 1939 patients randomized to drain (960) versus no drain (979). Morbidity was lower in the no drain group (odds ratio 1.97, 95% confidence interval 1.26-3.10; p=0.003). Wound infection rate was lower in the no drain group (odds ratio 2.35, 95% confidence interval 1.22-4.51; p=0.01). Abdominal pain 24 hours after surgery was less severe in the no drain group (standardized mean difference 2.30, 95% confidence interval 1.27 to 3.34, p<0.0001). No significant difference was present with respect to presence and quantity of subhepatic fluid collection, shoulder tip pain, parenteral ketorolac consumption, nausea, vomiting, and hospital stay. Conclusion: The present meta-analysis showed a consistent trend in favor of the no drain approach in terms of overall morbidity. In particular, wound infection rate was lower in the no drain group. No evidence is still present in the setting of emergent laparoscopic cholecystectomy. However, it is reasonable to avoid drain insertion when a dry operatory field is obtained at the end of the procedure.
2015
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/574571
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