A recent study investigated the effect of drain placement on complicated laparoscopic cholecystectomy (cLC) for acute cholecystitis (AC). It retrospectively reviewed patients with AC who underwent cLC between January 2010 and December 2020. 

The study defined cLC as open conversion, subtotal cholecystectomy, adjacent organ injury during surgery, operation time of ≥90 minutes, or estimated blood loss of ≥100 mL. It performed one-to-one propensity score matching to compare the surgical outcomes between patients with and without a drain on cLC.

The study found-

• A total of 216 patients (mean age, 65.8 years; 34.7% females) underwent cLC, and 58.3% underwent intraoperative abdominal drainage.
• In the propensity score-matched cohort, 68.9% of patients underwent early drain removal (≤ postoperative day 3).
• The overall rate of surgical site infection (SSI) was 10.7%.
• Late drain removal showed worse surgical outcomes than no drain placement and early drain removal for overall complications, postoperative hospital stay, and SSI.
• Multivariate analysis showed late drain removal as the most significant risk factor for organ space SSI.

This study shows drain placement is not routinely recommended, even after cLC for AC. A recommendation is to remove the drain early (if placed) because late drain removal is associated with a higher risk of organ space SSI.

Journal of Minimally Invasive Surgery 2022; 25(2): 63-72. https://doi.org/10.7602/jmis.2022.25.2.63