Sharma Ankur, Mittal Sushil
Senior Resident, Department of Surgery, Govt Medical College and Rajindra Hospital , Patiala, Punjab, India .
Professor, Department of Surgery, Govt Medical College and Rajindra Hospital , Patiala, Punjab, India .
J Clin Diagn Res. 2016 Dec;10(12):PC03-PC05. doi: 10.7860/JCDR/2016/21142.8983. Epub 2016 Dec 1.
Routine abdominal drainage after laparoscopy cholecystectomy is an issue of considerable debate. Reason for draining is to detect early bile/blood leak and allow CO insufflate during laparoscopy to escape via drain site thereby decreased shoulder tip pain and post-operative nausea and vomiting. But some studies show no difference in post-operative nausea /vomiting/pain between drain and no drain group.
To assess the role of drains following uncomplicated laparoscopic cholecystectomy.
This prospective randomized study was conducted in the Department of General Surgery, Government Medical College and Rajindra Hospital, Patiala. Hundred patients of symptomatic gallstones satisfying the selection and exclusion criteria, undergoing uncomplicated laparoscopic cholecystectomy were included in this study, 50 cases with drains in right subhepatic space (Group I) and 50 cases without drains (Group II). Both groups were compared in terms of post-operative shoulder pain, analgesic requirement, nausea and vomiting, hospital stay and analgesic requirement in patient with drains and without drains. SPSS version 16.0 (Chi-Square Test and Fisher-Exact Test) were used for statistical analysis.
In this study, average operative time in both the groups was same (p-value 0.977). There was more incidence of nausea /vomiting in no drain group than in drain group. Shoulder tip pain was lower in drain group in first 12 hours post-operative. However, after 12 hours, drain group had higher shoulder tip pain than no drain group. Analgesic requirement was higher in no drain group upto 12 hours after which it was higher in drain group (statistically not significant). In terms of hospital stay patients in drain group had a longer stay in hospital as compared to no drain group (2.96 vs 2.26; p <0.001 statistically significant).
Use of drains in uncomplicated laparoscopic cholecystectomy is not advantageous; its role in reducing post-operative nausea/vomiting is insignificant. It increases post-operative shoulder tip pain and hospital stay. Therefore, routine use of drains cannot be justified as it increases morbidity without significant advantage.
腹腔镜胆囊切除术后常规放置腹腔引流管是一个颇具争议的问题。放置引流管的目的是早期发现胆漏或出血，并使腹腔镜手术期间注入的二氧化碳通过引流部位排出，从而减轻肩痛以及术后恶心和呕吐。但一些研究表明，引流组与非引流组在术后恶心/呕吐/疼痛方面并无差异。
评估单纯腹腔镜胆囊切除术后引流管的作用。
本前瞻性随机研究在帕蒂亚拉政府医学院和拉金德拉医院普通外科进行。本研究纳入了100例符合入选和排除标准、接受单纯腹腔镜胆囊切除术的有症状胆结石患者，其中50例在肝下间隙右侧放置引流管（第一组），50例不放置引流管（第二组）。比较两组患者术后的肩部疼痛、镇痛需求、恶心和呕吐情况、住院时间，以及放置引流管和未放置引流管患者的镇痛需求。采用SPSS 16.0版（卡方检验和Fisher精确检验）进行统计分析。
在本研究中，两组的平均手术时间相同（p值为0.977）。非引流组恶心/呕吐的发生率高于引流组。术后12小时内，引流组的肩痛较轻。然而，12小时后，引流组的肩痛比非引流组更严重。非引流组在术后12小时内的镇痛需求较高，之后引流组的镇痛需求更高（统计学上无显著差异）。在住院时间方面，引流组患者的住院时间比非引流组更长（2.96天对2.26天；p<0.001，具有统计学显著差异）。
单纯腹腔镜胆囊切除术中使用引流管并无益处；其在减少术后恶心/呕吐方面的作用不显著。它会增加术后肩痛和住院时间。因此，常规使用引流管不合理，因为它在没有显著益处的情况下增加了发病率。
