Routine versus no drain placement after elective laparoscopic cholecystectomy: meta-analysis of randomized controlled trials.

Routine drainage of the subhepatic space has been a surgical trend of open cholecystectomy, carried on to the era of laparoscopic surgery without substantial evidence. Avoiding the potentially devastating sequelae of an undetected bile leakage is the main rationale behind this practice. Aim of this meta-analysis was to compare evidence on routine drain placement after laparoscopic cholecystectomy versus no drainage. A meta-analysis of randomized controlled trials was conducted; outcome variables included postoperative pain, subhepatic collection, 30-day morbidity, wound-related complications, and drainage interventions. The fixed- and random effects models were used in order to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) or difference in means with 95% confidence interval (CI). Six randomized trials including 1167 patients were identified. Pain scores were significantly higher in the drainage group both at 6-12h (mean difference 1.12, 95% CI 1.01-1.24, P<0.0001) and at 12-24h after surgery (mean difference 1.12, 95% CI 0.86-1.39, P<0.0001). No difference was found with regard to the incidence of subhepatic collection and drainage procedures. A trend in favor of the no drain approach with regard to 30-day morbidity and wound infection was registered, although this was less pronounced after sensitivity analysis. The possible clinical benefit of routine use of abdominal drainage in uncomplicated laparoscopic cholecystectomies requires larger study populations. The approach is however not encouraged on the basis of the present analysis, as it results in increased postoperative pain and overall morbidity.