Don’t use drains in uncomplicated open cholecystectomy

Drains increase harm without providing any benefit for patients undergoing open cholecystectomy, a Cochrane Review discovered – they should therefore be avoided.

Cholecystectomy is the term used to describe the surgical removal of a gallbladder. It is performed mainly as a treatment for chronic gallstones. Although many operations are now carried out by laparoscopy, some are still done by open surgery. In these operations there is an ongoing debate about whether drains should be used. Some argue that it will prevent fluid build-up and infections around the patient’s liver after the operation, others say that drains increase wound and chest infections.

To assess the benefits and harms of using a drain in this operation, a team of Cochrane Researchers performed a systematic review. They identified 28 trials involving 3,659 patients.

By assessing all the data, the team found that having or not having a drain did not affect the incidence of death or internal infections. Having a drain did, however, significantly increase the rate of chest and wound infections.

“Our review has shown that routine drain use after open cholecystectomy does not benefit the patient in any way, and does increase their risk of infection; they should no longer be used in this type of operation,” says lead author Dr Gurusamy, who works at the Royal Free Hospital in London.