title: The conduct of cholecystectomy: incision, drainage, bacteriology and postoperative complications. Cholecystectomy: to drain or not to drain. A randomized prospective study of 200 patients. Closed-suction versus Penrose drainage after cholecystectomy. A prospective, randomized evaluation. Abdominal Drainage Following Appendectomy and Cholecystectomy Suction drainage of the gallbladder bed does not prevent complications after cholecystectomy: A random control clinical trial Prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland. West of Scotland Laparoscopic Cholecystectomy Audit Group. Subhepatic sonography following cholecystectomy. Influence of intraperitoneal drains on subhepatic collections following cholecystectomy: A prospective clinical trial Passive tube and suction drainage after elective cholecystectomy--a comparison using ultrasonography. A randomised comparison of three drainage systems following cholecystectomy. Randomized trial of drainage after cholecystectomy. Suction vaersus static drainage through a main wound versus a stab incision. Literature searching for randomized controlled trials used in Cochrane reviews: rapid versus exhaustive searches. Drainage in elective cholecystectomy. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis Methods for combining randomized clinical trials: strengths and limitations. [Routine drainage following uncomplicated, elective cholecystectomy? A prospective, randomized study]. Cholecystectomy and drainage: Ultrasonographic and radioisotopic evaluation Cholecystectomy is safer without drainage: the results of a prospective, randomized clinical trial. Elective cholecystectomy without drainage and without prophylactic antibiotics. A prospective randomized trial with clinical and bacteriological aspects. Sump drainage versus static drainage after cholecystectomy. [Elective cholecystectomy with and without subhepatic drainage. A controlled, prospective study]. Abdominal drainage following cholecystectomy: high, low, or no suction? [The "ideal" cholecystectomy. A prospective, randomized study]. A controlled trial of drainage after cholecystectomy A comparison of two types of vacuum drainage after cholecystectomy. Cholecystectomy with and without intraperitoneal drain. Cholecystectomy with and without drainage. A randomized, prospective study of 300 patients. A prospective randomized study of drained and undrained cholecystectomies. Drainage after cholecystectomy. A prospective randomized clinical trial. Intraperitoneal drains and nasogastric tubes in elective cholecystectomy. A randomised prospective trial of two drainage methods after cholecystectomy. Influence of intraperitoneal drainage after cholecystectomy; a prospective ultrasonographic study.
abstract: The benefits of some ancillary techniques of cholecystectomy are exaggerated by retrospective study of selected patients . Therefore , the authors performed a prospect i ve , r and omized study of 100 consecutive patients who underwent simple elective cholecystectomy for chronic cholecystitis and cholelithiasis . No patient was excluded because of incomplete hemostasis or fear of bile leakage . The frequency of pulmonary complications and wound infections was independent of the type of incision -- vertical or subcostal . Peritoneal drainage was found to be unnecessary . Short-term drainage may increase the frequency of postoperative fever , but did not increase pulmonary complications or wound infections . In these patients , intra-abdominal sepsis is rare ; wound infections were uncommon and the gallbladder bile was usually sterile and not the cause of postoperative infection Abstract During the 24-month period commencing January 1975 , 200 patients underwent elective cholecystectomy for chronic cholecystitis . According to a prospect i ve r and omized protocol , 100 patients were drained and an identical number were not drained . The two groups were similar with respect to age , weight , diabetic history , and all other measured clinical parameters . Patients who were not drained had less postoperative fever in terms of actual temperature elevation and duration of fever and were discharged from the hospital earlier . There was no difference in the incidence of wound infection or other complications between the two groups . This study confirms that elective cholecystectomy without drainage of the subhepatic space can be done safely and that less postoperative fever and shorter hospitalization can be expected Closed-suction drainage was compared prospect ively to open , passive drainage ( Penrose drains ) in 128 patients undergoing cholecystectomy . Patients were r and omized at the time of operation to receive either closed-suction drains ( Group I , 67 patients ) or Penrose drains ( Group II , 61 patients ) . The preoperative clinical parameters of the two groups were similar . The patients in Group I when compared with those in Group II had a shorter duration of drainage ( 3.3 days and 4.1 days , respectively , p less than 0.01 ) , a lesser volume of drainage in the first 48 hours postoperatively ( 78 ml and 132 ml , respectively , p less than 0.001 ) , a decreased incidence of fever on the night of operation ( 24 of 67 patients and 39 of 61 patients , respectively , p less than 0.05 ) and on the first postoperative day ( 26 of 67 patients and 32 of 61 patients , respectively , p less than 0.05 ) , and a lower leukocyte count on the first postoperative day ( 12,000 cells/mm3 and 14,100 cells/mm3 , respectively , 0.05 less than p less than 0.1 ) . Patients in Group I tended to have a lower rate of wound infection ( 1 of 67 patients versus 5 of 61 patients in Group II , 0.05 less than p less than 0.1 ) and had a much lower incidence of drain site tenderness ( 8 of 67 patients in Group I versus 24 of 61 patients in Group II , p less than 0.05 ) . This study demonstrates the superiority of closed-suction drains over open , passive drains after cholecystectomy Consecutive patients undergoing emergency appendectomy ( 283 ) or urgent cholecystectomy ( 51 ) were prospect ively studied for the development of postoperative incisional or peritoneal sepsis . Severity of the original peritoneal infection was carefully recorded , while use of a Penrose dam to drain the peritoneum was r and omized according to pre-assigned hospital number . Both aerobic and anaerobic cultures were taken from the abdomen at the time of operation as well as from all postoperative infectious foci . Results demonstrated no essential differences in incidence of wound and peritoneal infection following  appendectomy  for simple or suppurative appendicitis ( 187 ) or following  cholecystectomy  for acute cholecystitis ( 51 ) . However , with gangrenous or perforative appendicitis ( 94 ) , incisional and intra-abdominal infection rates were 43 % and 45 % , respectively , when a drain was used ; yet only 29 and 13 % , respectively , without a drain . These latter differences were significant ( p < 0.001 ) . In addition , intra-abdominal abscesses were three times as likely to drain through the incision than along any tract provided by the rubber conduit . Cultures revealed that hospital pathogens accounted for a greater proportion of wound and peritoneal sepsis after cholecystectomy and appendectomy for simple or suppurative appendicitis if a drain had been inserted than if managed otherwise . By contrast , a mixed bacterial flora was responsible for most infections following appendectomy for gangrenous or perforated appendicitis , irrespective as to use of a drain Some surgeons drain the gallbladder bed routinely , some selectively and some not at all . We aim ed to clarify this confusion by entering 155 consecutive patients undergoing emergency and elective cholecystectomy without exploration of the common bile duct into a r and om control clinical trial . In 78 patients a 3 mm suction drain was left in the gallbladder bed and in 77 the abdomen was closed without drainage . There were no withdrawals , one death ( in the drainage group ) from myocardial infa rct ion and one intraperitoneal abscess complicating postoperative pancreatitis ( in the no‐drainage group ) . Other events studied were postoperative pyrexia , wound infection , respiratory tract infection and duration of hospital stay . In none of these did the two groups differ either clinical ly or statistically . We conclude that drainage or non‐drainage of the gallbladder bed must remain a matter of individual preference Although laparoscopic cholecystectomy has rapidly developed in the treatment of gall bladder disease in the absence of controlled clinical trial data its outcome parameters compared with open cholecystectomy remain unclear . A prospect i ve audit of the introduction of laparoscopic cholecystectomy in the west of Scotl and over a two year period was carried out to attempt to assess this new procedure . A total of 45 surgeons in 19 hospitals performing laparoscopic cholecystectomy su bmi tted prospect i ve data from September 1990 - 1992 . A total of 2285 cholecystectomies were audited ( a completed data collection rate of 99 % ) . Laparoscopic cholecystectomy was attempted in 1683 ( 74 % ) patients and completed in 1448 patients ( median conversion rate to the open procedure 17 % ) . The median operation time in the completed laparoscopic cholecystectomy patients was 100 minutes ( range 30 - 330 ) and overall hospital stay three days ( 1 - 33 ) . There were nine deaths ( 0.5 % ) after laparoscopic cholecystectomy although only two were directly attributable to the laparoscopic procedure . In the laparoscopic cholecystectomy group there were 99 complications ( 5.9 % ) , 53 ( 3 % ) of these were major requiring further invasive intervention . Forty patients ( 2.4 % ) required early or delayed laparotomy for major complications such as bleeding or bile duct injuries . There were 11 ( 0.7 % ) bile duct injuries in the laparoscopic cholecystectomy series , five were noted during the initial procedure and six were recognised later result ing from jaundice or bile leaks . Ductal injuries occurred after a median of 20 laparoscopic cholecystectomies . In conclusion laparoscopic cholecystectomy has rapidly replaced open cholecystectomy in the treatment of gall bladder disease . Although the overall death and complication rate associated with laparoscopic cholecystectomy is similar to open cholecystectomy , the bile duct injury rate is higher The subhepatic placement of prophylactic drains following cholecystectomy remains a common practice despite studies demonstrating the safety of omitting such drains . The accumulation and fate of subhepatic fluid constitute the chief concern . In a prospect i ve comparative study , 76 patients were r and omized into drained and non-drained groups . Postoperative ultrasonographic studies showed no localized fluid accumulations in the majority of instances . Small accumulations of fluid in the gallbladder bed were demonstrated on the initial postoperative sonograms in nine patients in the two groups . Long-term patient follow-up confirmed such fluid , which remained stable or decreased in size , to be clinical ly insignificant In this prospect i ve r and omized study , the influence of an intraperitoneal drain on the incidence and clinical significance of subhepatic collection s occurring in patients after acute or elective cholecystectomy was assessed by ultrasound examination . A total of 112 patients entered the study , of whom 54 received a drain .  There was no significant difference between the drainage and the non‐drainage groups with respect to mean age or sex distribution , the number of patients in whom the gallbladder bed was formally closed ( 27 versus 21 ) nor in the number of acute cholecystectomies performed in either group ( 12 versus 13 ) . Ultrasound detected 10 ( 18 per cent ) collection s in the drainage group and only one ( 1·8 per cent ) in the non‐drainage group ( P < 0·01 , χ2 test ) . None of the collection s required any further treatment and no morbidity occurred that was directly attributable to the presence of the retained fluid . These results suggest that rather than preventing fluid collection s , suction drains may predispose to the development of subhepatic collection s after cholecystectomy Daily ultrasonography of the gallbladder bed was performed in patients with suction or passive tube drains after elective cholecystectomy . A total of 19 patients was r and omized to suction drainage and 17 to passive tube drainage .  A policy of early drain removal was followed . No significant difference was found between the volume drained and the size of collection detected in either group . Significant bile leaks were detected and were adequately drained by suction and passive tube drains . There were no complications from drains . In view of these findings , we advocate short-term drainage of the gallbladder bed after both open and laparoscopic cholecystectomy using the drain of the surgeon 's choice The efficacy of low pressure , high pressure and passive drainage systems have been compared after cholecystectomy .  Symptoms of pain , discomfort and nausea were compared using linear analogue scales and spirometry was used to examine pre-operative and postoperative respiratory function . The low pressure suction drain removed an intraperitoneal marker , gentamicin , more effectively than the high pressure suction drain , but not more effectively than the passive drain . There were no differences in postoperative respiratory function nor in the amount of pain or discomfort between the groups . The passive drain group reported less nausea than the suction drain groups . If a negative pressure drainage system is to be used , a low pressure suction drain should be used in preference to a high pressure system One hundred eighty-four patients who underwent biliary surgery were r and omly allocated to four groups arranaed in a 2 by 2 design . In 92 patients the drain was brought out through the wound and in the other 92 through a stab incision . In half of the patients in each group the drain was connected to a suction system and in the other half to a sterile bag . Suction was found to impair rather than enhance intraperitoneal drainage . In patients who underwent elective cholecystectomy and early operation for acute cholecystitis , the amount of discharge was more than twice as large when suction was omitted than when it was applied . After common duct operations the amount of discharge was very large and there was little difference in cases with and without suction . Prolonged drainage , static or suction , result ed in an increase in the serum haptoglobin level . Analysis of out data suggested that after a few days the drain starts to act as a traumatic stimulus . No difference was found between cases with the drain brought out through a stab incision and those with the drain brought out through the main wound . A number of studies have ascertained the superiority of closed to open drainage . The results of the present trial lead us to recommend that after biliary surgery the closed us to recommend that after biliary surgery the closed drain should not be connected to a suction apparatus and that after elective cholecystectomy the drain should preferably be removed after a few days OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials found in major data bases was compared with those found from other sources . RESULTS The range in the number of data bases search ed per review ranged between one and twenty-seven . The proportion of the trials in the four data bases were Cochrane Controlled Trials Register = 78.5 % , MEDLINE = 68.8 % , Embase = 65.0 % , and Science/Social Sciences Citation Index = 60.7 % . Search ing another twenty-six data bases after Cochrane Controlled Trials Register ( CCTR ) , MEDLINE , and Embase only found 2.4 % additional trials . There was no significant difference between trials found in the CCTR , MEDLINE , and Embase compared with other trials , with respect to adequate allocation concealment or sample size . CONCLUSIONS There was a large variation between review s in the exhaustiveness of the literature search es . CCTR was the single best source of RCTs . Additional data base search ing retrieved only a small percentage of extra trials . Contacting authors and manufacturers to find unpublished trials appeared to be a more effective method of obtaining the additional better quality trials This r and omized , prospect i ve study evaluates drainage of the subhepatic space in patients undergoing simple , uncomplicated cholecystectomy . One hundred twenty-two patients were divided into open ( Penrose ) drainage , closed sump drainage and no drainage groups . Open drainage result ed in increased morbidity and a longer postoperative hospital stay . The best results were in patients without drains . Subhepatic drainage is unnecessary in simple , uncomplicated cholecystectomy The aim of this prospect i ve trial was to determine whether surgical approach ( open versus laparoscopic ) had an impact on morbidity and postoperative recovery after cholecystectomy for acute cholecystitis Methods for combining data from several studies exist and appear to be quite useful . None satisfactorily addresses the question of what studies should be combined . This issue is the most serious method ological limitation . Even studies with statistically significant interaction might still be combined if the effect were in the same direction . Thus , substantial scientific input is required as to what criteria must be met by each potential study . Much can be learned from combining or pooling data but it must be done cautiously . Pooling exercises do not replace well design ed prospect i ve clinical trials . Efforts for establishing basic design criteria to allow for multicentre and multicountry trials to be more easily combined might be useful . A prospect i ve r and omized and controlled study of prophylactic drainage after simple , elective cholecystectomy was carried out . From March 1988 to June 1991 80 patients received an Easy-Flow drain and 80 did not .  Operation and perioperative management were st and ardized . The endpoint of the study was postoperative morbidity , especially postoperative pyrexia and subhepatic fluid collection . The latter was identified by ultrasonography performed daily on postoperative day 1 - 4 . No patient died . The morbidity including postoperative pyrexia revealed no difference between drained and undrained patients . In 19 of the patients with ( 23.8 % ) and in 25 of the patients without drainage ( 31.3 % ) a subhepatic fluid collection could be demonstrated by ultrasonography . This difference was not statistically significant either . We conclude that prophylactic drainage after elective , simple cholecystectomy is of no use for the patient . As subhepatic fluid collection s can be seen in drained as well as in undrained patients it has to be accepted that drainage does not guarantee the removal of subhepatic fluid . Therefore its indicatory function ( bleeding ) and the ability to prevent the patient having biliary peritonitis or local abscess has to be put in doubt Eighty patients undergoing cholecystectomy  were either assigned deliberately ( n=30 ) or r and omized ( n=50 ) to drainage ( n=38 ) or nondrainage ( n=42 ) . Subhepatic collection s were seen on ultrasonography ( US ) after 48 to 72 hours in 12 of 35 patients with drainage and 24 of 42 patients without drainage ( p<0.05 ) . Only two patients with subhepatic collection s were symptomatic , and none required treatment . Postoperative infective complications were seen in 13 of 38 patients with drainage and 4 of 42 without drainage ( p<0.01 ) . Five of 12 patients with drainage and with a collection , and none of the 18 patients without drainage and without a collection had postoperative infective complications ( p<0.05 ) . Cholecystectomy was then performed in 100 patients without using a drain . BULIDA radioisotope scans revealed a bile leak in only 4 of 34 patients studied . Subhepatic collection s were seen on US after 48 to 72 hours in 42 patients . The collection resolved in 22 patients and was smaller in 6 on repeat US . None of the patients with collection was symptomatic , and none required treatment . Postoperative infective complications were seen in 7 of 42 patients with a collection and 5 of 58 patients without a collection ( not significant ) . We conclude that ( 1 ) cholecystectomy with drainage is associated with more infective complications than when a drain is not used ; ( 2 ) cholecystectomy without drainage is safe ; and ( 3 ) asymptomatic nonbilious subhepatic collection s are common after cholecystectomy without drainage but do not require treatment , resolving spontaneously . RésuméQuatre-vingt patients ( 50 par r and omisation ) ont eu un drainage ( n=38 ) ou non ( n=42 ) après cholécystectomie traditionnelle . Une collection soushépatique a été mise en évidence par échographie dans les 48–72 heures postopératoires chez 12/35 patients avec drainage et chez 24/42 patients sans drainage ( p < 0.05 ) . Seulement deux de ces collection s étaient symptomatiques et aucune n'a nécessité de geste thérapeutique . Des complications postopératoires infectieuses ont été observées chez 13/38 patients ayant eu un drainage comparées à 4/42 des patients sans drainage ( p<0.01 ) . Cinq des 12 patients ayant eu un drainage et une collection ont eu une infection postopératoire comparés à aucun des 18 patients sans drainage ni collection ( p<0.05 ) . On a ensuite réalisé 100  cholécystectomies sans drainage . Une scintigraphie au technétium a mis en évidence une fuite biliaire chez 4 des 34 patients étudiés . Une collection soushépatique a été mise en évidence par échographie chez 42 patients . Lors de la surveillance échographique , la collection s'est résorbée spontanément chez 22 patients et a diminué d ' importance chez 6 . Aucune de ces collection s n'étaient symptomatiques et aucune n'a nécessité de geste thérapeutique . Des complications postopératoires ont été observés chez 7/42 patients avec une collection comparés à 5/58 patients sans collection ( différence non significative ) . Nous concluons que : ( 1 ) il y a plus d'infection lorsque l'on draine l'abdomen après une cholécystectomie que lorsque l'intervention se termine sans drainage ; ( 2 ) la cholécystectomie sans drainage est sans danger ; et ( 3 ) des collection s bilieuses asymptomatiques sont fréquentes après cholécystectomie sans drainage , mais elles se résorbent habituellement sans nécessiter d'intervention . ResumenOchenta pacientes sometidos a colecistectomía fueron r and omizados a drenaje ( 38 ) o no drenaje ( 42 ) . Se observaron colecciones subhepáticas en ultrasonografía practicada a las 48–72 horas en 12/35 pacientes con drenaje y en 24/42 pacientes sin drenaje ( p<0.05 ) . Sólo 2 de tales colecciones fueron sintomáticas y ninguna requirió tratamiento . Complicaciones sépticas postoperatorias fueron registradas en 13/38 pacientes con drenaje y en 4/42 sin drenaje ( p<0.01 ) . Cinco de 12 con drenaje y con colección subhepática , y ninguno de 18 sin drenaje y sin colección presentaron complicaciones sépticas postoperatorias ( p<0.05 ) . Después de esta serie se practicaron 100 colecistectomías sin drenaje . La escanografía con radioisótopos , BULIDA , reveló escape biliar en sólo 4 de 34 pacientes estudiados ; se visualizaron colecciones subhepáticas por US a las 48–72 horas en 42 pacientes . La colección se resolvió en 22 y apareció menor en 6 casos en que se repitió la US . Ninguna de estas colecciones fue sintomática y ninguna requirió tratamiento alguno . Se registraron complicaciones sépticas en 7/42 pacientes con colección y en 5/58 sin colección ( ns ) . Nuestra conclusión es que la colecistectomía con drenaje se asocia con un numéro mayor de complicaciones sépticas . La colecistectomía libre de drenaje es un procedimiento seguro ; las colecciones no biliares subhepáticas asintomáticas son frecuentes después de la colecistectomía sin drenaje pero no requieren tratamiento y se resuelven espontáneamente Drainage after cholecystectomy remains routine despite the lack of scientific supportive data . Numerous clinical studies in the past have attempted to address this controversy but have failed to resolve the issue for different reasons . These include retrospective design , inclusion of only selected cases , and r and omization before surgery . In this study 479 patients undergoing cholecystectomy  were r and omly allocated to a drainage group ( a high-pressure suction drain in Morison 's pouch for 48 hours ) or a nondrainage group . R and omization was performed at the time of peritoneal closure .  All patients undergoing cholecystectomy , both elective and urgent , were included and the operations were performed by all grade s of surgeons . There were two deaths from cardiopulmonary causes , both in the drainage group . No patient required reoperation in either group . The incidence of both wound infections ( 15 vs 5 ; p less than 0.05 ) and chest infections ( 56 vs 19 , p less than 0.02 ) was significantly higher in the drainage group . Three hundred fifty-six patients underwent abdominal ultrasonography 72 hours after surgery . The number of subhepatic fluid collection s thus detected was significantly higher in the patients who received a drain ( 17 vs 6 , p less than 0.05 ) . None of these collection s was clinical ly significant . The postoperative hospital stay was longer in the patients with drains ( 10.3 vs 9.1 days ) , but this difference failed to reach statistical significance . We conclude from this study that the use of a drain after cholecystectomy serves no useful purpose and is potentially harmful . This practice should be ab and oned A consecutive series of 50 patients undergoing elective cholecystectomy without prophylactic antibiotics  entered a prospect i ve r and omized trial to compare the post-operative clinical course whether the subhepatic space was drained or not . 26 patients ( mean age 58 yrs ) were drained and 24 patients ( mean age 59 yrs ) were not . The incidence of positive gallbladder bile cultures were respectively 8 and 19 % ( N.S. ) in the drained and undrained groups . The incidence of post-operative mortality , thrombo-phlebitis and intra-abdominal sepsis was zero in both groups . In the drained or undrained series , the incidence of wound infection was respectively 4 % and 0 % ( N.S. ) , that of urinary infection was 8 % and 13 % ( N.S. ) and that of pulmonary atelectasis was 15 and 17 % ( N.S. ) . A further consecutive series of 100 undrained elective cholecystectomies ( 18 % positive bile cultures ) without prophylactic antibiotics was then performed with the same uneventful postoperative course . This study therefore indicates that even in the presence of bacterobilia elective cholecystectomy can be safely performed without subhepatic space drainage and without prophylactic antibiotics Sump drainage was compared with closed static drainage in a r and omized trial using a restricted sequential plan . Sump drains were converted into static drains by closing the air-vent tubes and by omitting suction . Sump drains so converted evacuated more intraperitoneal fluid during the first 24 hours after cholecystectomy than did drains in which the sump was functioning . For drainage after cholecystectomy , the sump drain is inferior to the passive drain in a closed circuit Based on the data of 56 patients undergoing elective cholecystectomy  the value of subhepatic drainage is evaluated in a r and omized controlled clinical trial . The design of the study and the perioperative management of the patients are described in detail and the results analyzed according to clinical course , blood tests and abdominal ultrasound A prospect i ve trial to assess the effect of  suction in an abdominal drain  following cholecystectomy was carried out . Three types of closed drainage system were compared : a simple tube drain , a low negative pressure drain , and a high negative pressure drain :  120 consecutive patients undergoing cholecystectomy were r and omly allocated to one of the three drainage groups . There was no significant difference in postoperative pyrexia , wound infection , chest infection , or hospital stay . This study failed to demonstrate any clinical ly useful difference between high negative pressure , low negative pressure , and static drainage system were compared : a simple tube drain , a low negative used , suction is not necessary and a simple tube drain ( greater than 6 mm internal diameter ) is the most effective form of drainage 200 patients undergoing elective cholecystectomy  were studied in a prospect i ve r and omized manner . This study suggests that the nasogastric tube and postoperative iv-infusions are unnecessary . We continue to use a subhepatic drain . Exception : the senior surgeon in a straightforward case A prospect i ve controlled trial of drainage  after cholecystectomy has been carried out . In a consecutive series of 143 patients undergoing cholecystectomy , 50 patients were r and omly allocated to a drainage group and a further 50 patients to a non‐drainage group . The remaining 43 patients were drained electively because the common bile duct was explored or because of infection or incomplete haemostasis Following cholecystectomy , 50 patients were r and omly allocated for suction drainage by small ( 2.5 mm ) Redivac or large calibre ( 6 mm ) Redivac drains . There were 25 patients in each group . Subhepatic collection was detected by ultrasonic examination in 5 patients on the seventh postoperative day . The smaller drain was used in all of these patients . Of these 5 patients , one developed pulmonary infection , a second had internal bleeding requiring laparotomy , while the remaining 3 were asymptomatic . Subhepatic fluid was not detected in any patient who had the larger drain 383 patients undergoing cholecystectomy for non-acute gallbladder pathology were r and omized with regard to the use of an intraperitoneal drain .  187 patients were drained  , 196 patients were not drained . The postoperative course of temperature and liver laboratory tests , the duration of hospital stay and the postoperative morbidity were studied . There were no obviously significant differences between drained and undrained patients . Thus drainage of the subhepatic space after cholecystectomy as performed in this study , could not be associated with any disadvantages for the patient . The advantage of the intraperitoneal drain , could , because of a failing r and omization in 13 % of the patients not be completely evaluated . The preventive effect of the drain with regard to the incidence of postoperative complications however appeared to be very limited . The use of a prophylactic intraperitoneal drain after cholecystectomy could therefore safely be limited to appropriate patients as judged by the operating surgeon A r and omized , prospect i ve study of 300 cholecystectomies was undertaken to evaluate the merits of drainage through a st and ard Penrose or Chaffin-Pratt sump tube matched against no drainage at all . There was no difference in mortality or length of hospital stay . There was , however , a significantly higher incidence of postoperative pyrexia due to atelectasis and wound infection in the drainage groups . Neither drain fulfilled its objective of providing outflow for a subhepatic collection , thus avoiding bile peritonitis . This study suggests that surgical drainage after every uncomplicated cholecystectomy is unnecessary and unwise One hundred twenty-three patients undergoing elective cholecystectomy at USAF Medical Center Keesler were studied in a prospect i ve r and omized manner to determine the differences in morbidity and mortality following drained and undrained cholecystectomies . The groups were compared for differences in mortality , wound infection , postoperative fever , and length of hospitalization . One death occurred due to an unrelated cause in an undrained patient . Three per cent of the undrained group developed wound infections as compared to five per cent in the drained group . This was not statistically significant . A significant difference occurred in postoperative fever between the drained ( 58 % ) and undrained ( 30 % ) groups . Postoperative hospitalization was also significantly shorter in the undrained group . This study suggests that drainage following elective cholecystectomy is not only unnecessary , but may add to postoperative morbidity and length of hospitalization This prospect i ve clinical study was done to assess the efficacy of postcholecystectomy drainage . A total of 173 cholecystectomized patients were r and omized into two groups ; group A ( 86 patients ) without drainage and group B ( 87 patients ) with drainage . Group B included two types of patients ; B1 ( 52 patients ) with suction drain and B2 ( 35 patients ) with gravity drain .  Evidence of wound infection , chest complications , and duration of hospital stay were recorded in every case . Ninety five patients were assessed for chest complications and subhepatic collection by chest x-ray and abdominal ultrasonography . In group B patients the total amount of fluid drained was measured . The results were analysed by appropriate statistical methods . There was no significant difference in the rate of wound infection or atelectasis in either group , although there was apparent increase of lung complications and subhepatic collection s in Group B1 . The average postoperative hospital stay was significantly increased in group B patients . Considering all the parameters of this study , it was found that drainage with gravity was attended with the least morbidity Abstract The effects of intraperitoneal drains and nasogastric tubes were studied in 100 consecutive patients undergoing elective cholecystectomy without exploration of the common duct . The study was performed as a r and omized trial . Concurrent assessment of the effect of both the drain and the gastric tube was achieved with a 2 by 2 design . A large number of serum tests were systematic ally checked postoperatively . There was one death in a patient treated without either a drain or gastric tube . Apart from that , there were few complications . In accordance with the results of an earlier r and omized trial , no difference in postoperative pyrexia and hospital stay was found between patients with and those without intraperitoneal drains . The concept of drainage fever is therefore refuted . An abnormal increase in the serum bilirubin level was found significantly more often after operations without an intraperitoneal drain . This transient rise is explained as being due to resorption of bile that would otherwise have been discharged via the drain . An abnormal rise in the haptoglobin level also occurred significantly more often in patients in whom intraperitoneal drains were not used . The suggested explanation is that omission of the drain adds to the operation 's traumatic effect . Vomiting occurred significantly more often in patients without nasogastric tubes . The use of intraperitoneal drains and nasogastric tubes is recommended A prospect i ve trial is described in which simple tube drainage was compared with suction drainage after cholecystectomy .  Postoperative chest infection and infected or painful drain wounds were both significantly more common with simple tube drains .  Postoperative discomfort was more frequent with tube drains in situ and wound infection more common in the suction group , but neither of these differences was statistically significant . The mean volume of fluid drained and duration of hospital stay did not differ between methods . It is concluded that both methods are satisfactory , but suction drainage is recommended One hundred and fifty patients were prospect ively r and omised into 3 groups ( 50 in each group ) ; to receive a passive drain , closed suction drain or no drain after elective cholecystectomy . The drain was removed within 24 hours in 84 % of patients and was continued longer only if the amount of drainage was excessive or bilious . On the 3rd post-operative day , an  ultrasound examination  was performed in all patients for detection of subhepatic/subphrenic collection . Collection s were more frequently encountered in the patients without any drain ( 42 % ) followed by passive drain ( 26 % ) and suction drain group ( 20 % ) . Chest complications were frequently noted ( passive drain ; 6 % suction drain , 12 % , and no drain , 8 % ) , however , occurrence of this complication in various groups was similar ( p > 0.1 ) . Two patients ( 4 % ) without drain required ultrasound guided aspiration of subhepatic collection . Mean post-operative hospital stay was nearly equal for all the groups ( passive drain : 4.22 + /- 1 days , suction drain : 4.26 + /- 1.4 days and no drain : 4.62 + /- 2.3 days ) . Drainage reduced the incidence of post-cholecystectomy collection s and need for invasive intervention for collection related complications . However , the type of drainage ( active or passive ) did not influence the incidence of collection , frequency of complications and duration of post-operative hospital stay
target: We found no significant differences between different types of drains .
  Drains increase the harms to the patient without providing any additional benefit for patients undergoing open cholecystectomy and should be avoided in open cholecystectomy
background: BACKGROUND Cholecystectomy is the removal of gallbladder and is performed mainly for symptomatic gallstones .
  Although laparoscopic cholecystectomy is currently preferred over open cholecystectomy for elective cholecystectomy , reports of r and omised clinical trials comparing the choice of cholecystectomy ( open or laparoscopic ) in acute cholecystitis are still being conducted .
  Drainage in open cholecystectomy is a matter of considerable debate .
  Surgeons use drains primarily to prevent subhepatic abscess or bile peritonitis from an undrained bile leak .
  Critics of drain condemn drain use as it increases wound and chest infection .
  OBJECTIVES To assess the benefits and harms of routine abdominal drainage in uncomplicated open cholecystectomy .