Passive tube and suction drainage after elective cholecystectomy--a comparison using ultrasonography. Elective cholecystectomy without drainage and without prophylactic antibiotics. A prospective randomized trial with clinical and bacteriological aspects. Suction drainage of the gallbladder bed does not prevent complications after cholecystectomy: A random control clinical trial Infection after laparoscopic cholecystectomy: are antibiotics really necessary? [Routine drainage following uncomplicated, elective cholecystectomy? A prospective, randomized study]. The effect of drains in laparoscopic cholecystectomy. Cholecystectomy is safer without drainage: the results of a prospective, randomized clinical trial. Cholecystectomy with and without drainage. A randomized, prospective study of 300 patients. Cholecystectomy with and without intraperitoneal drain. Drainage in elective cholecystectomy. The conduct of cholecystectomy: incision, drainage, bacteriology and postoperative complications. Effect of Cefazolin Prophylaxis on Postoperative Infectious Complications in Elective Laparoscopic Cholecystectomy: A Prospective Randomized Study Randomized trial of drainage after cholecystectomy. Suction vaersus static drainage through a main wound versus a stab incision. Influence of intraperitoneal drains on subhepatic collections following cholecystectomy: A prospective clinical trial Abdominal Drainage Following Appendectomy and Cholecystectomy Cholecystectomy: to drain or not to drain. A randomized prospective study of 200 patients. A prospective randomized study of drained and undrained cholecystectomies. Incidence, Risk Factors, and Prevention of Biliary Tract Injuries during Laparoscopic Cholecystectomy in Switzerland Are prophylactic antibiotics required for elective laparoscopic cholecystectomy? Surgical infections after laparoscopic cholecystectomy: ceftriaxone vs ceftazidime antibiotic prophylaxis. A prospective study. Influence of intraperitoneal drainage after cholecystectomy; a prospective ultrasonographic study. Comparison of frequency of wound infection: open vs laparoscopic cholecystectomy. The need for antibiotic prophylaxis in elective laparoscopic cholecystectomy: a prospective randomized study. Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Laparoscopic Cholecystectomy for Acute Cholecystitis: Prospective Trial A controlled trial of drainage after cholecystectomy A randomized study of cholecystectomy with and without drainage. Abdominal drainage following cholecystectomy: high, low, or no suction? Routine Administration of Antibiotics to Patients Suffering Accidental Gallbladder Perforation During Laparoscopic Cholecystectomy is not Necessary Prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland. West of Scotland Laparoscopic Cholecystectomy Audit Group. Laparoscopic Cholecystectomy for Acute Cholecystitis: Is It Really Safe?
Daily ultrasonography of the gallbladder bed was performed in patients with suction or passive tube drains after elective cholecystectomy . A total of 19 patients was r and omized to suction drainage and 17 to passive tube drainage .  A policy of early drain removal was followed . No significant difference was found between the volume drained and the size of collection detected in either group . Significant bile leaks were detected and were adequately drained by suction and passive tube drains . There were no complications from drains . In view of these findings , we advocate short-term drainage of the gallbladder bed after both open and laparoscopic cholecystectomy using the drain of the surgeon 's choice A consecutive series of 50 patients undergoing elective cholecystectomy without prophylactic antibiotics  entered a prospect i ve r and omized trial to compare the post-operative clinical course whether the subhepatic space was drained or not . 26 patients ( mean age 58 yrs ) were drained and 24 patients ( mean age 59 yrs ) were not . The incidence of positive gallbladder bile cultures were respectively 8 and 19 % ( N.S. ) in the drained and undrained groups . The incidence of post-operative mortality , thrombo-phlebitis and intra-abdominal sepsis was zero in both groups . In the drained or undrained series , the incidence of wound infection was respectively 4 % and 0 % ( N.S. ) , that of urinary infection was 8 % and 13 % ( N.S. ) and that of pulmonary atelectasis was 15 and 17 % ( N.S. ) . A further consecutive series of 100 undrained elective cholecystectomies ( 18 % positive bile cultures ) without prophylactic antibiotics was then performed with the same uneventful postoperative course . This study therefore indicates that even in the presence of bacterobilia elective cholecystectomy can be safely performed without subhepatic space drainage and without prophylactic antibiotics Some surgeons drain the gallbladder bed routinely , some selectively and some not at all . We aim ed to clarify this confusion by entering 155 consecutive patients undergoing emergency and elective cholecystectomy without exploration of the common bile duct into a r and om control clinical trial . In 78 patients a 3 mm suction drain was left in the gallbladder bed and in 77 the abdomen was closed without drainage . There were no withdrawals , one death ( in the drainage group ) from myocardial infa rct ion and one intraperitoneal abscess complicating postoperative pancreatitis ( in the no‐drainage group ) . Other events studied were postoperative pyrexia , wound infection , respiratory tract infection and duration of hospital stay . In none of these did the two groups differ either clinical ly or statistically . We conclude that drainage or non‐drainage of the gallbladder bed must remain a matter of individual preference OBJECTIVE To establish the incidence of infection after laparoscopic cholecystectomy , and assess the need for antibiotic prophylaxis . DESIGN Prospect i ve open study . SETTING University teaching hospital , United Kingdom . SUBJECTS 253 consecutive patients undergoing laparoscopic cholecystectomy between September 1990 and January 1993 . INTERVENTIONS A single intravenous dose of cefuroxime 1.5 g at induction of general anaesthesia . MAIN OUTCOME MEASURES Infective complications . RESULTS Patients were review ed at two weeks and 12 months . At two weeks there had been two wound infections ( one resolved spontaneously and the other required removal of a gallstone from the subcutaneous tissue ) , two chest infections ( treated with antibiotics orally and physiotherapy ) , and one subhepatic abscess ( drained percutaneously under ultrasonographic control ) . No other complications were reported at 12 months . CONCLUSIONS Routine antibiotic prophylaxis may be unnecessary during elective laparoscopic cholecystectomy , but a r and omised controlled trial is necessary to confirm this A prospect i ve r and omized and controlled study of prophylactic drainage after simple , elective cholecystectomy was carried out . From March 1988 to June 1991 80 patients received an Easy-Flow drain and 80 did not .  Operation and perioperative management were st and ardized . The endpoint of the study was postoperative morbidity , especially postoperative pyrexia and subhepatic fluid collection . The latter was identified by ultrasonography performed daily on postoperative day 1 - 4 . No patient died . The morbidity including postoperative pyrexia revealed no difference between drained and undrained patients . In 19 of the patients with ( 23.8 % ) and in 25 of the patients without drainage ( 31.3 % ) a subhepatic fluid collection could be demonstrated by ultrasonography . This difference was not statistically significant either . We conclude that prophylactic drainage after elective , simple cholecystectomy is of no use for the patient . As subhepatic fluid collection s can be seen in drained as well as in undrained patients it has to be accepted that drainage does not guarantee the removal of subhepatic fluid . Therefore its indicatory function ( bleeding ) and the ability to prevent the patient having biliary peritonitis or local abscess has to be put in doubt A prospect i ve controlled r and omized study was performed on 100 patients undergoing elective laparoscopic cholecystectomy to evaluate the benefit of routine drainage in simple uncomplicated procedures . The 100 patients were r and omized into two groups . Group 1 patients ( n = 50 ) had a drain placed through the epigastric trocar site . The drain was removed before their discharge unless bile or blood was present . Group 2 patients ( n = 50 ) did not have a drain placed . Eleven patients in group 2 ( no drain ) ( 22 % ) were discharged on the same day of surgery ( within 8 h ) , and the remaining 89 patients in both groups were discharged the day after surgery ( within 23 h ) . There were no wound infections or postoperative fever in either group . There were minor but not statistically significant differences between the two groups in postoperative severity and duration of abdominal pain , shoulder pain , and nausea . Furthermore , the two groups were similar in respect to postoperative recovery time and return to work Drainage after cholecystectomy remains routine despite the lack of scientific supportive data . Numerous clinical studies in the past have attempted to address this controversy but have failed to resolve the issue for different reasons . These include retrospective design , inclusion of only selected cases , and r and omization before surgery . In this study 479 patients undergoing cholecystectomy  were r and omly allocated to a drainage group ( a high-pressure suction drain in Morison 's pouch for 48 hours ) or a nondrainage group . R and omization was performed at the time of peritoneal closure .  All patients undergoing cholecystectomy , both elective and urgent , were included and the operations were performed by all grade s of surgeons . There were two deaths from cardiopulmonary causes , both in the drainage group . No patient required reoperation in either group . The incidence of both wound infections ( 15 vs 5 ; p less than 0.05 ) and chest infections ( 56 vs 19 , p less than 0.02 ) was significantly higher in the drainage group . Three hundred fifty-six patients underwent abdominal ultrasonography 72 hours after surgery . The number of subhepatic fluid collection s thus detected was significantly higher in the patients who received a drain ( 17 vs 6 , p less than 0.05 ) . None of these collection s was clinical ly significant . The postoperative hospital stay was longer in the patients with drains ( 10.3 vs 9.1 days ) , but this difference failed to reach statistical significance . We conclude from this study that the use of a drain after cholecystectomy serves no useful purpose and is potentially harmful . This practice should be ab and oned A r and omized , prospect i ve study of 300 cholecystectomies was undertaken to evaluate the merits of drainage through a st and ard Penrose or Chaffin-Pratt sump tube matched against no drainage at all . There was no difference in mortality or length of hospital stay . There was , however , a significantly higher incidence of postoperative pyrexia due to atelectasis and wound infection in the drainage groups . Neither drain fulfilled its objective of providing outflow for a subhepatic collection , thus avoiding bile peritonitis . This study suggests that surgical drainage after every uncomplicated cholecystectomy is unnecessary and unwise 383 patients undergoing cholecystectomy for non-acute gallbladder pathology were r and omized with regard to the use of an intraperitoneal drain .  187 patients were drained  , 196 patients were not drained . The postoperative course of temperature and liver laboratory tests , the duration of hospital stay and the postoperative morbidity were studied . There were no obviously significant differences between drained and undrained patients . Thus drainage of the subhepatic space after cholecystectomy as performed in this study , could not be associated with any disadvantages for the patient . The advantage of the intraperitoneal drain , could , because of a failing r and omization in 13 % of the patients not be completely evaluated . The preventive effect of the drain with regard to the incidence of postoperative complications however appeared to be very limited . The use of a prophylactic intraperitoneal drain after cholecystectomy could therefore safely be limited to appropriate patients as judged by the operating surgeon This r and omized , prospect i ve study evaluates drainage of the subhepatic space in patients undergoing simple , uncomplicated cholecystectomy . One hundred twenty-two patients were divided into open ( Penrose ) drainage , closed sump drainage and no drainage groups . Open drainage result ed in increased morbidity and a longer postoperative hospital stay . The best results were in patients without drains . Subhepatic drainage is unnecessary in simple , uncomplicated cholecystectomy The benefits of some ancillary techniques of cholecystectomy are exaggerated by retrospective study of selected patients . Therefore , the authors performed a prospect i ve , r and omized study of 100 consecutive patients who underwent simple elective cholecystectomy for chronic cholecystitis and cholelithiasis . No patient was excluded because of incomplete hemostasis or fear of bile leakage . The frequency of pulmonary complications and wound infections was independent of the type of incision -- vertical or subcostal . Peritoneal drainage was found to be unnecessary . Short-term drainage may increase the frequency of postoperative fever , but did not increase pulmonary complications or wound infections . In these patients , intra-abdominal sepsis is rare ; wound infections were uncommon and the gallbladder bile was usually sterile and not the cause of postoperative infection Background In patients with symptomatic cholelithiasis ,  laparoscopic cholecystectomy  ( LC ) is the st and ard method of treatment . Laparoscopic cholecystectomy has a low rate of postoperative infections probably owing to smaller wounds and minimal tissue damage compared with the open procedure . Objectives This study assessed the effect of cefazolin prophylaxis on postoperative infection in patients undergoing elective laparoscopic cholecystectomy .  Additionally , we determined the risk factors of cases with postoperative infection . Patients and Methods A total of 753 patients were enrolled in the study . Among these , 206 were excluded from the study . As a result , 547 patients with symptomatic cholelithiasis who underwent elective laparoscopic cholecystectomy were selected for this prospect i ve study . Patients were r and omized consecutively and divided into 2 groups : patients in the cefazolin ( CEF ) group ( n = 278 ) received 1 g of cefazolin and those in the control group ( n = 269 ) received 10 mL of isotonic sodium chloride solution . Patient characteristics and overall surgical outcomes were compared between the groups . All patients were followed for development of postoperative infections . Results Postoperative infections occurred in 4 patients in the CEF group and in 2 patients in the control group ; no significant difference existed in this regard(P = .44 ) . Risk of infection increased in patients with previous cholecystitis and /or endoscopic retro grade cholangiopancreatography ( P < 0.001 ) , patients with ruptured gallbladders , and patients for whom a suction drain was used ( respectively , P < 0.001 and P < 0.001 ) . Conclusions No correlation existed between cefazolin prophylaxis and postoperative infections in elective laparoscopic cholecystectomy patients . There may be an increased risk of infection in patients with previous cholecystitis or endoscopic retro grade cholangiopancreatography . In addition , there was an increased risk of postoperative infection in patients with gallbladder rupture and suction drain use One hundred eighty-four patients who underwent biliary surgery were r and omly allocated to four groups arranaed in a 2 by 2 design . In 92 patients the drain was brought out through the wound and in the other 92 through a stab incision . In half of the patients in each group the drain was connected to a suction system and in the other half to a sterile bag . Suction was found to impair rather than enhance intraperitoneal drainage . In patients who underwent elective cholecystectomy and early operation for acute cholecystitis , the amount of discharge was more than twice as large when suction was omitted than when it was applied . After common duct operations the amount of discharge was very large and there was little difference in cases with and without suction . Prolonged drainage , static or suction , result ed in an increase in the serum haptoglobin level . Analysis of out data suggested that after a few days the drain starts to act as a traumatic stimulus . No difference was found between cases with the drain brought out through a stab incision and those with the drain brought out through the main wound . A number of studies have ascertained the superiority of closed to open drainage . The results of the present trial lead us to recommend that after biliary surgery the closed us to recommend that after biliary surgery the closed drain should not be connected to a suction apparatus and that after elective cholecystectomy the drain should preferably be removed after a few days In this prospect i ve r and omized study , the influence of an intraperitoneal drain on the incidence and clinical significance of subhepatic collection s occurring in patients after acute or elective cholecystectomy was assessed by ultrasound examination . A total of 112 patients entered the study , of whom 54 received a drain .  There was no significant difference between the drainage and the non‐drainage groups with respect to mean age or sex distribution , the number of patients in whom the gallbladder bed was formally closed ( 27 versus 21 ) nor in the number of acute cholecystectomies performed in either group ( 12 versus 13 ) . Ultrasound detected 10 ( 18 per cent ) collection s in the drainage group and only one ( 1·8 per cent ) in the non‐drainage group ( P < 0·01 , χ2 test ) . None of the collection s required any further treatment and no morbidity occurred that was directly attributable to the presence of the retained fluid . These results suggest that rather than preventing fluid collection s , suction drains may predispose to the development of subhepatic collection s after cholecystectomy Consecutive patients undergoing emergency appendectomy ( 283 ) or urgent cholecystectomy ( 51 ) were prospect ively studied for the development of postoperative incisional or peritoneal sepsis . Severity of the original peritoneal infection was carefully recorded , while use of a Penrose dam to drain the peritoneum was r and omized according to pre-assigned hospital number . Both aerobic and anaerobic cultures were taken from the abdomen at the time of operation as well as from all postoperative infectious foci . Results demonstrated no essential differences in incidence of wound and peritoneal infection following  appendectomy  for simple or suppurative appendicitis ( 187 ) or following  cholecystectomy  for acute cholecystitis ( 51 ) . However , with gangrenous or perforative appendicitis ( 94 ) , incisional and intra-abdominal infection rates were 43 % and 45 % , respectively , when a drain was used ; yet only 29 and 13 % , respectively , without a drain . These latter differences were significant ( p < 0.001 ) . In addition , intra-abdominal abscesses were three times as likely to drain through the incision than along any tract provided by the rubber conduit . Cultures revealed that hospital pathogens accounted for a greater proportion of wound and peritoneal sepsis after cholecystectomy and appendectomy for simple or suppurative appendicitis if a drain had been inserted than if managed otherwise . By contrast , a mixed bacterial flora was responsible for most infections following appendectomy for gangrenous or perforated appendicitis , irrespective as to use of a drain Abstract During the 24-month period commencing January 1975 , 200 patients underwent elective cholecystectomy for chronic cholecystitis . According to a prospect i ve r and omized protocol , 100 patients were drained and an identical number were not drained . The two groups were similar with respect to age , weight , diabetic history , and all other measured clinical parameters . Patients who were not drained had less postoperative fever in terms of actual temperature elevation and duration of fever and were discharged from the hospital earlier . There was no difference in the incidence of wound infection or other complications between the two groups . This study confirms that elective cholecystectomy without drainage of the subhepatic space can be done safely and that less postoperative fever and shorter hospitalization can be expected One hundred twenty-three patients undergoing elective cholecystectomy at USAF Medical Center Keesler were studied in a prospect i ve r and omized manner to determine the differences in morbidity and mortality following drained and undrained cholecystectomies . The groups were compared for differences in mortality , wound infection , postoperative fever , and length of hospitalization . One death occurred due to an unrelated cause in an undrained patient . Three per cent of the undrained group developed wound infections as compared to five per cent in the drained group . This was not statistically significant . A significant difference occurred in postoperative fever between the drained ( 58 % ) and undrained ( 30 % ) groups . Postoperative hospitalization was also significantly shorter in the undrained group . This study suggests that drainage following elective cholecystectomy is not only unnecessary , but may add to postoperative morbidity and length of hospitalization Abstract . Bile duct injury ( BDI ) during  laparoscopic cholecystectomy ( LC )  which may result in patient disability or death are reported to occur more frequently when compared to open surgery . The aim of this nationwide prospect i ve study beyond the laparoscopic learning curve was to analyze the incidence , risk factors , and management of major BDI . During a 3-year period ( 1995–1997 ) 130 items of all LC data were collected on a central computer system from 84 surgical institutions in Switzerl and by the Swiss Association of Laparoscopic and Thoracoscopic Surgery and evaluated for major BDIs . Simple biliary leakage was excluded from analysis . There were 12,111 patients with a mean age of 55 years ( 3–98 years ) enrolled in the study .  The overall BDI incidence was 0.3 % , 0.18 % for symptomatic gallstones , and 0.36 % for acute cholecystitis . In cases of severe chronic cholecystitis with shrunken gallbladder , the incidence was as high as 3 % . Morbidity and mortality rates were significantly increased in BDIs . BDI was recognized intraoperatively in 80.6 % , in 64 % of cases by help of intraoperative cholangiography . Immediate surgical repair was performed laparoscopically ( suture or T-drainage ) in 21 % ; in 79 % , open repair ( 34 % simple suture , 66 % Roux-en-Y reconstruction ) was needed . The BDI incidence did not decrease during the last 7 years . In 47 % , BDIs were caused by experienced laparoscopic surgeons , perhaps because they tend to operate on more difficult patients . In conclusion , the incidence of major BDIs remains constant in Switzerl and at a level of 0.3 % , which is still higher when compared to open surgery . However , most cases are now detected intraoperatively and immediately repaired which ensures a good long-term outcome . For preventing such injuries , exact anatomical knowledge with its variants and a meticulous surgical dissecting technique especially in case of acute inflammation or shrunken gallbladder are m and atory BACKGROUND Some clinicians administer prophylactic antibiotics routinely before laparoscopic cholecystectomy , and the results of some of the studies in the literature support this practice . We conducted a prospect i ve r and omized trial to determine whether administration of prophylactic antibiotics is necessary during routine laparoscopic cholecystectomy in low-risk patients . STUDY DESIGN Two hundred fifty patients without evidence of acute inflammation , common duct stones , or other indications for antibiotics were r and omized to receive three perioperative doses of cefazolin or no prophylaxis and followed up for complications up to 30 days postoperatively . The primary end point was the occurrence of a major infectious complication , defined as that causing a systemic response , delaying discharge , or leading to readmission . Minor infectious problems were also noted , defined as those causing local symptoms only . RESULTS One hundred twenty-eight patients were r and omized to receive prophylactic antibiotics  ( PA group ) , 122 to receive none  ( NONE group ; two patients in this group were actually given preoperative antibiotics ) . Only one major complication occurred ( in a patient in the NONE group ) , an abscess in the presence of a bile leak , despite the administration of antibiotics when the leak was discovered several days before infectious problems arose . There were four minor problems : two lower urinary tract infections and one superficial wound infection in a NONE patient and one urinary tract infection in a PA patient ( not significant ) ; all were easily managed . The prophylactic antibiotics did not sterilize the bile , and infectious complications were not associated with weight , inflammation found at the time of operation , reported stone or bile spill-age , or conversion to open operation . CONCLUSIONS Prophylactic antibiotics are not necessary for elective laparoscopic cholecystectomy in low-risk patients The incidence of surgical infections  after laparoscopic cholecystectomy is reported to be < 2 % , because of the minimal trauma due to this approach . We report the results of a prospect i ve study of antibiotic prophylaxis in laparoscopic cholecystectomy , comparing ceftriaxone vs ceftazidime .  From Jan 1 to Dec 31 2002 a consecutive series of 242 cholecystectomies were performed , consisting in 18 open cholecystectomies and 224 laparoscopic cholecystectomies , 7 of which ( 3.1 % ) were converted to open cholecystectomies for technical and /or anatomical reasons . One hundred and eleven patients received 1 g i.v . ceftazidime 1 h before surgery , and 105 patients 1 g i.v . ceftriaxone on an alternate basis . Thirty-nine patients ( 17.4 % ) with acute cholecystitis received at least one booster dose at the end of the operation ; 30 out of 39 were given further therapy for 2 - 3 days , i.e. 1 g i.v . bid . Twenty-two patients treated elsewhere with ceftriaxone or ceftazidime before surgery were transferred to another prophylactic regimen . The final diagnosis in the laparoscopic cholecystectomy group was 219 bile stones , 3 adenomas , and 2 occult carcinomas .  We had 4 complications ( 1.8 % of 217 laparoscopic cholecystectomies ) , 2 of which were minor ( infection of the umbilical access by S. aureus ) and 2 major ( 1 biliary fistula [ accessory duct ] and 1 acute pancreatitis ) , both treated conservatively . Positive bile cultures ( 27 cases ) were unrelated to the clinical course . The incidence of infections after laparoscopic cholecystectomy in our prospect i ve series was < 2 % . Ceftriaxone is confirmed as the gold st and ard in biliary tract surgery , but ceftazidime was equivalent ( no statistical difference between the two antibiotics , P=0.59 NS ) . Ultra-short prophylaxis is enough in most cases , except in cholecystitis . We found no correlation between positive bile cultures and surgical infections after laparoscopic cholecystectomy . The umbilicus was the preferred site of infection in obese patients after the laparoscopic procedure . Major complications are usually related to technical pitfalls One hundred and fifty patients were prospect ively r and omised into 3 groups ( 50 in each group ) ; to receive a passive drain , closed suction drain or no drain after elective cholecystectomy . The drain was removed within 24 hours in 84 % of patients and was continued longer only if the amount of drainage was excessive or bilious . On the 3rd post-operative day , an  ultrasound examination  was performed in all patients for detection of subhepatic/subphrenic collection . Collection s were more frequently encountered in the patients without any drain ( 42 % ) followed by passive drain ( 26 % ) and suction drain group ( 20 % ) . Chest complications were frequently noted ( passive drain ; 6 % suction drain , 12 % , and no drain , 8 % ) , however , occurrence of this complication in various groups was similar ( p > 0.1 ) . Two patients ( 4 % ) without drain required ultrasound guided aspiration of subhepatic collection . Mean post-operative hospital stay was nearly equal for all the groups ( passive drain : 4.22 + /- 1 days , suction drain : 4.26 + /- 1.4 days and no drain : 4.62 + /- 2.3 days ) . Drainage reduced the incidence of post-cholecystectomy collection s and need for invasive intervention for collection related complications . However , the type of drainage ( active or passive ) did not influence the incidence of collection , frequency of complications and duration of post-operative hospital stay BACKGROUND The objective of this quasi experimental study was to compare the frequency of wound infection between  open cholecystectomy ( OC ) and laparoscopic cholecystectomy ( LC ) conducted in Surgical Unit IV , Jinnah Hospital Lahore from June 2005 to January 2006 . METHODS 100 patients undergoing elective cholecystectomy for symptomatic gallstones were studied . The patients were allocated in the two groups of 50 each by simple r and om technique . Group-I underwent OC and Group-II underwent LC . The patients were then followed up for four weeks to pick up signs of wound infection . In case of infection , the degree of infection and the remedial measures done were documented and the results analysed . RESULTS In LC group there was only one case of Class-II wound infection i.e. 2 % . In case of OC there were three cases of wound infection i.e. 6 % . Out of these , two were of Class-IIl and one of Class-Il . CONCLUSION While there was no wound infection in cases of chronic Cholecystitis in both groups , the frequency of wound infection was three times as common in OC as compared to LC in Acute Cholecystitis/Empyema HYPOTHESIS The need for antibiotic treatment when performing elective laparoscopic cholecystectomy may not be as important as it is thought . This study assesses the real efficacy of antibiotic prophylaxis in elective laparoscopic cholecystectomy  with respect to the postoperative infection rate . DESIGN A prospect i ve r and omized study on the routine use of antibiotic prophylaxis in laparoscopic cholecystectomy . SETTING University teaching hospital , La Sapienza , Italy . PATIENTS Eighty-four patients r and omly placed into 2 groups ( A [ n = 44 ] and B [ n = 40 ] ) immediately before undergoing laparoscopic cholecystectomy . METHODS Before anesthesia was administered , group A received intravenously 2 g of cefotaxime sodium diluted in 100 mL of isotonic sodium chloride solution ; group B , 10 mL of isotonic sodium chloride solution in 100 mL of saline . A gallbladder bile sample for culture was withdrawn intraoperatively from all patients . In both groups , age , sex , weight , duration of surgery , presence of diabetes , American Society of Anesthesiologists patient classification score , preoperative autologous blood donation , antibiotic administration , intraoperative gallbladder rupture , findings from bile culture positive for bacteria , episodes of colic within 30 days before surgery , length of postoperative hospital stay , and number of septic complications were recorded . All data were correlated by univariate and multivariate analyses with the onset of septic phenomena . RESULTS In group A , 3 cases of wound infection , 1 case of subhepatic abscess from bile leakage , and 1 case of urinary tract infection were observed ; group B , 4 cases of wound infection , 1 case of bronchopneumonia , and 2 cases of urinary tract infection . Comparison of data showed no statistically significant difference between the groups . Findings from bile examination in patients with sepsis complications were positive in 5 patients in group A and in 6 in group B ( P = .91 ) . Multivariate analysis showed diabetes mellitus and colic episodes within 30 days before surgery as independent factors significantly associated to the onset of infectious complications . CONCLUSIONS In elective laparoscopic cholecystectomy , antibiotic treatment did not seem to affect the incidence and severity of infections or the degree of bile contamination After laparoscopic cholecystectomy , CO2 remains within the peritoneal cavity , commonly causing pain . This prospect i ve r and omized study was performed to determine the efficacy of intraperitoneal normal saline and bupivacaine infusion on  postoperative pain after laparoscopic cholecystectomy . Three hundred patients were r and omly assigned to one of six groups of 50 patients each . Group A patients served as controls . In group B patients , normal saline was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated . After suction , a subhepatic closed drain was left for 24 h. In group C patients , bupivacaine 1.5 mg/kg in solution 2.5 mg/ml , minus 15 ml of this solution , which was infiltrated in the trocar wounds , was infused under the right hemidiaphragm at the end of the cholecystectomy . In group D patients , bupivacaine was given as in group C , but a subhepatic drain was left for 24 h. In group E patients , normal saline was used as in group B plus bupivacaine as in group C. Group F patients were treated as in group E , but a subhepatic drain was left for 24 h. In all groups , 15 ml of a 2.5 mg/ml bupivacaine solution was infiltrated in the trocar wounds . Postoperatively , analgesic medication usage , nausea , vomiting , and pain scores were recorded at 2 , 6 , 12 , 24 , 36 , 48 , and 72 h. Postoperative pain was reduced significantly in the patients of the treatment groups vs. the controls . Between treatment groups , patients in groups B , E , and F had the best results , while those in groups C and D had significantly greater pain than those in groups B , E , and F. It is concluded that postoperative pain after laparoscopic cholecystectomy can be significantly reduced by intraperitoneal normal saline infusion subdiaphragmatically and after its postdeflation suction , bupivacaine infusion in the same area , or without bupivacaine in case a subhepatic drainage has been needed BACKGROUND Emergency laparoscopic cholecystectomy has been advocated for the treatment of acute cholecystitis ; however it can be a difficult task , especially in public hospitals , with relatively high conversion and complication rates . Percutaneous cholecystostomy is a simple and effective procedure allowing patients to recover from the acute event and undergo elective laparoscopic surgery at a later stage . METHODS We prospect ively assessed a protocol of initial conservative treatment in patients admitted with acute cholecystitis . Patients who did not respond to medical treatment were treated by percutaneous cholecystostomy .  Following discharge the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary . The details of the operation were collected with emphasis on complications and conversion rate . RESULTS During a 3-year period , 224 patients who were admitted with acute calculous cholecystitis entered the protocol . Fifty-four patients did not improve under medical treatment and percutaneous cholecystostomy was performed . In spite of adequate drainage , 5 patients still did not improve : 3 patients were successfully operated upon urgently and recovered , while 2 patients who had severe concomitant diseases and multi-organ failure , died . Forty-nine patients were discharged with the catheter and later re-evaluated for elective operation . In 7 patients common bile duct stones were found and were removed by ERCP prior to the elective operation . Twenty-five patients underwent delayed laparoscopic cholecystectomy with a low conversion rate ( 8 % ) , and only minor complications ( 16 % ) . CONCLUSIONS Conservative treatment and delayed operation is still an acceptable choice in the treatment of acute cholecystitis . Percutaneous cholecystostomy is an effective tool , with high success rate and low morbidity , and allows for better pre-operative evaluation of the biliary system and safe interval laparoscopic surgery . Laparoscopic cholecystectomy after drainage of the gall bladder is a low morbidity procedure with relatively low conversion rate Abstract . This prospect i ve study determines the indications for and the optimal timing of laparoscopic cholecystectomy ( LC ) following the onset of acute cholecystitis . It also evaluates preoperative and operative factors associated with conversion from laparoscopic cholecystectomy to open cholecystectomy in the presence of acute cholecystitis . Having been established as the procedure of choice for elective cholelithiasis , LC is now also used for management of acute cholecystitis . Under these circumstances the procedure may be difficult and challenging . Certain favorable and unfavorable conditions may be present that influence the conversion and complication rates . Information about these conditions may be helpful for elucidating the optimal circumstances for LC or when the procedure is best avoided . We performed LC on an emergency basis as soon as the diagnosis was made on all patients presenting with acute cholecystitis from January 1994 to December 1995 . All preoperative , operative , and postoperative data were collected on st and ardized forms . Of the 137 patients registered , 130 were eligible for the audit . Seven patients found by laparoscopic intraoperative cholangiography to have choledocholithiasis were converted for common bile duct exploration and were excluded from the study . Altogether 93 patients ( 72 % ) underwent successful LC and 37 ( 28 % ) needed conversion to open cholecystectomy . The conversion rate of acute gangrenous cholecystitis ( 49 % ) was significantly higher than that for uncomplicated acute cholecystitis ( 4.5 % ) ( p < 0.00001 ) and for hydrops ( 28.5 % ) and empyema of the gallbladder ( 28.5 % ) ( p= 0.004 ) . The difference in conversion between the group with acute necrotizing ( gangrenous ) cholecystitis and the two groups with hydrops and empyema of the gallbladder was not statistically significant ( p= 0.07 ) . The complication rates of acute cholecystitis , hydrops , empyema of the gallbladder , and gangrenous cholecystitis were 9.0 % , 9.5 % , 14.0 % , and 20.0 % , respectively ( p= NS ) . Patients with an operative delay of 96 hours or less from the onset of acute cholecystitis had a conversion rate of 23 % , whereas a delay of more than 96 hours was associated with a conversion rate of 47 % ( p= 0.022 ) . The complication rate was 8.5 % in the laparoscopic group and 27 % in the converted group ( p= 0.013 ) . Patients over 65 years of age , with a history of biliary disease , a nonpalpable gallbladder , WBC count over 13,000/cc , and acute gangrenous cholecystitis were independently associated with a high LC conversion rate ; male patients , finding large bile stones , serum bilirubin over 0.8 mg/dl , and WBC count over 13,000/cc were independently associated with a high complication rate following laparoscopic surgery with or without conversion . Generally , LC can be performed safely for acute cholecystitis , with acceptably low conversion and complication rates . Different forms of cholecystitis carry various conversion and complication rates in selected cases . LC for acute cholecystitis should be performed within 96 hours of the onset of disease . Predictors of conversion and complications may be helpful when planning the laparoscopic approach to acute cholecystitis A prospect i ve controlled trial of drainage  after cholecystectomy has been carried out . In a consecutive series of 143 patients undergoing cholecystectomy , 50 patients were r and omly allocated to a drainage group and a further 50 patients to a non‐drainage group . The remaining 43 patients were drained electively because the common bile duct was explored or because of infection or incomplete haemostasis Routine drainage of the bed of the gallbladder following  cholecystectomy  remains controversial . A prospect ively r and omized series of 100 instances of cholecystectomy for chronic and subsiding acute cholecystitis are review ed . Postoperative fever was lowered , the need for dressing changes was virtually eliminated and hospital stay was shortened in patients who did not undergo drainage . No complications attributable to drain avoidance were seen A prospect i ve trial to assess the effect of  suction in an abdominal drain  following cholecystectomy was carried out . Three types of closed drainage system were compared : a simple tube drain , a low negative pressure drain , and a high negative pressure drain :  120 consecutive patients undergoing cholecystectomy were r and omly allocated to one of the three drainage groups . There was no significant difference in postoperative pyrexia , wound infection , chest infection , or hospital stay . This study failed to demonstrate any clinical ly useful difference between high negative pressure , low negative pressure , and static drainage system were compared : a simple tube drain , a low negative used , suction is not necessary and a simple tube drain ( greater than 6 mm internal diameter ) is the most effective form of drainage Introduction Accidental rupture of the gallbladder is an event which occurs in up to 20 % of laparoscopic cholecystectomies , mainly in those where dissection is difficult , or during extraction when the gallbladder is withdrawn directly through the laparoscope port . It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection . It is common practice , therefore , for the surgeon to prescribe the application of an antibiotic at the moment when gallbladder perforation occurs . Objective To compare 2 groups of similar patients , to determine whether administration of antibiotics , started during surgery , is actually useful in reducing the risk of residual abscess or infection in the surgical wound . Patients and Method The study considered a total of 166 patients who had suffered accidental perforation of the gallbladder during elective laparoscopic cholecystectomy . This total was divided at r and om into 2 groups : group A ( 80 patients ) who received a dose of 1 g of Cefotaxime at the moment of gallbladder rupture , followed by 2 more doses at intervals of 8 hours in the immediate postoperative period ; and group B ( 86 patients )  who did not receive any antibiotic treatment at all . The dependent variables observed were surgical wound infection and residual abscess : and the control variables were age , sex , length of operation time , intercurrent illnesses , and American Society of Anesthesiologists ( ASA ) classification . Results Two patients ( 2.5 % ) in group A developed a surgical wound infection , against 3 cases ( 3.4 % ) in group B , the result having no statistical significance . No patients developed residual abscess . In a multivariant analysis , the following were identified as independent factors significantly associated with the onset of surgical wound infection ( P<0.001 ) : diabetes mellitus , being over 60 years of age , operation time lasting longer than 70 minutes , and ASA 3 . Conclusions Routine application of an antibiotic to patients experiencing accidental perforation of the gallbladder during laparoscopic cholecystectomy is not necessary . In the case of patients with diabetes mellitus , those who are older than 60 , or who have an ASA classification of 3 or more , or if the operation itself is likely to last more than 70 minutes , the recommendation is to start antibiotic therapy in the preoperative phase immediately before surgery Although laparoscopic cholecystectomy has rapidly developed in the treatment of gall bladder disease in the absence of controlled clinical trial data its outcome parameters compared with open cholecystectomy remain unclear . A prospect i ve audit of the introduction of laparoscopic cholecystectomy in the west of Scotl and over a two year period was carried out to attempt to assess this new procedure . A total of 45 surgeons in 19 hospitals performing laparoscopic cholecystectomy su bmi tted prospect i ve data from September 1990 - 1992 . A total of 2285 cholecystectomies were audited ( a completed data collection rate of 99 % ) . Laparoscopic cholecystectomy was attempted in 1683 ( 74 % ) patients and completed in 1448 patients ( median conversion rate to the open procedure 17 % ) . The median operation time in the completed laparoscopic cholecystectomy patients was 100 minutes ( range 30 - 330 ) and overall hospital stay three days ( 1 - 33 ) . There were nine deaths ( 0.5 % ) after laparoscopic cholecystectomy although only two were directly attributable to the laparoscopic procedure . In the laparoscopic cholecystectomy group there were 99 complications ( 5.9 % ) , 53 ( 3 % ) of these were major requiring further invasive intervention . Forty patients ( 2.4 % ) required early or delayed laparotomy for major complications such as bleeding or bile duct injuries . There were 11 ( 0.7 % ) bile duct injuries in the laparoscopic cholecystectomy series , five were noted during the initial procedure and six were recognised later result ing from jaundice or bile leaks . Ductal injuries occurred after a median of 20 laparoscopic cholecystectomies . In conclusion laparoscopic cholecystectomy has rapidly replaced open cholecystectomy in the treatment of gall bladder disease . Although the overall death and complication rate associated with laparoscopic cholecystectomy is similar to open cholecystectomy , the bile duct injury rate is higher Abstract . The prospect ively collected data from 530 cholecystectomies performed in a university clinic from October 1989 to March 1991 were analyzed after 1 to 3 years of follow-up . The aim of this study was to compare the results of laparoscopic cholecystectomy ( LC ) for acute cholecystitis with that for routine symptomatic gallbladders . The preoperative , intraoperative , and postoperative parameters of 424 routine ( noninflamed ) LCs and 54 LCs for acutely inflamed gallbladders were compared under the “ intention to treat ” principle . Operating time was longer in the inflamed group ( median 97 minutes versus 75 minutes;p < 0.0001 ) . Significantly more adhesions ( 20 % versus 8 % ) , more blood loss ( 48 % versus 19 % ) , a higher incidence of bile spillage ( 28 % versus 12 % ) , and lost stones ( 19 % versus 8 % ) were encountered in patients with acute cholecystitis . Common bile duct ( CBD ) injuries were also more frequent in that group ( 5.5 % versus 0.2%;p = 0.005 ) . The rate of conversion to open surgery was higher than with routine LCs ( 13 % versus 4 % ) . There were two deaths in the routine LC group and none in the acutely inflamed group . There was no difference in postoperative pain intensity or postoperative fatigue according to visual analog scale measurements . Patients with acute cholecystitis stayed only 1 day longer ( median 4 days versus 3 days ) in hospital . The quality of life scores indicate return to almost normal values by the 14th postoperative day . Long-term follow-up ( 1–3 years ) did not reveal any delayed clinical adverse effects . In summary , LC for inflamed gallbladders has a higher conversion rate than LC for routine symptomatic gallbladders . If successfully performed , it has definite benefit for the patient in terms of better postoperative recovery . The trade-off is that the risk of CBD injury is significantly higher
We found no significant differences between different types of drains .
Drains increase the harms to the patient without providing any additional benefit for patients undergoing open cholecystectomy and should be avoided in open cholecystectomy
BACKGROUND Cholecystectomy is the removal of gallbladder and is performed mainly for symptomatic gallstones .
Although laparoscopic cholecystectomy is currently preferred over open cholecystectomy for elective cholecystectomy , reports of r and omised clinical trials comparing the choice of cholecystectomy ( open or laparoscopic ) in acute cholecystitis are still being conducted .
Drainage in open cholecystectomy is a matter of considerable debate .
Surgeons use drains primarily to prevent subhepatic abscess or bile peritonitis from an undrained bile leak .
Critics of drain condemn drain use as it increases wound and chest infection .
OBJECTIVES To assess the benefits and harms of routine abdominal drainage in uncomplicated open cholecystectomy .