ROLE OF DRAIN PLACEMENT AFTER UNCOMPLICATED LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY

Abstract

Background: Laparoscopic cholecystectomy is the standard of care for symptomatic gallstone disease, yet many surgeons continue to place a subhepatic drain after uncomplicated procedures despite accumulating evidence questioning the practice. This study evaluated whether routine drain placement after uncomplicated laparoscopic cholecystectomy confers any measurable benefit. Methods: In this prospective randomized controlled study, 100 patients undergoing elective laparoscopic cholecystectomy for symptomatic cholelithiasis were randomized after completion of an uncomplicated procedure to a drain group (n = 50; closed suction subhepatic drain removed at 24 hours) or a no-drain group (n = 50). The primary endpoints were postoperative pain (visual analogue scale, VAS) and length of hospital stay. Secondary endpoints included shoulder tip pain, nausea and vomiting, subhepatic collection on ultrasonography, wound infection, analgesic requirement and time to ambulation; safety endpoints were bile leak, haemorrhage and reintervention. Analysis followed the intention-to-treat principle, with effect sizes reported as mean differences (MD) and relative risks with 95% confidence intervals (CI). Results: The groups were comparable at baseline. Pain was greater in the drain group at 6 hours (5.8 ± 1.2 vs 4.6 ± 1.1; MD 1.2, 95% CI 0.75 to 1.65; Cohen’s d = 1.04; p < 0.001) and 24 hours (4.1 ± 1.0 vs 3.2 ± 0.9; MD 0.9, 95% CI 0.53 to 1.27; p < 0.001). Drained patients required more analgesic doses (MD 1.1, 95% CI 0.71 to 1.49; p < 0.001), ambulated later (MD 2.3 hours, 95% CI 1.36 to 3.24; p < 0.001) and stayed longer (2.7 ± 0.8 vs 1.9 ± 0.6 days; MD 0.8, 95% CI 0.52 to 1.08; p < 0.001). Subhepatic collection (10% vs 14%; risk difference −4.0%, 95% CI −16.7 to 8.7), wound infection, shoulder tip pain and emetic symptoms did not differ significantly. There were no bile leaks, haemorrhages or reinterventions. Conclusion: Routine drainage after uncomplicated laparoscopic cholecystectomy did not reduce complications but increased pain, analgesic use and hospital stay. Routine drainage appears unnecessary in uncomplicated cases and should be reserved for selective intraoperative indications.