Summary:
The subhepatic drainage is mandatorily used in the end of laparoscopic cholecystectomy in the majority of
departments of surgery in Czech republic. The peroperative finding of advanced inflammatory alteration or
bleeding in operative field is certainly the reason to do so. But it seems that obligatory drainage after
uncomplicated laparoscopic cholecystectomy has no real foundation and it is suspiciously an expression of
antiquated tradition. From January 1, 2001 to December 31, 2002 the prospective non-randomized study was
performed: in the first group of patients the drainage of subhepatic space was used mandatorily (324 patients),
in the second group the drainage was used only in indicated cases (365 patients). No statistically significant
difference was found between the two groups in postoperative complications (biliary leak, intraabdominal absces,
reoperation). There was the significant difference in surgery times (55 min. in the group withmandatory drainage,
50 min. in the group with indicated drainage, p < 0.05), in term of hospital stay – the patients with mandatory
drainage stayed longer in hospital (3.2 day, resp. 2.4 day, p < 0.05). In summary, the mandatory drainage of
subhepatic space after laparoscopic cholecystectomy is not associated with lower incidence of postoperative
complications.Onthe other hand, themandatory drainage has significantly longer surgery time and longer length
of hospital stay. The drainage is exceptionally indicated but not mandatorily in uncomplicated operations.
Key words:
laparoscopic cholecystectomy – subhepatic drainage – evidence based medicine
|