Drainage in laparoscopic cholecystectomy

One of the proposed advantages of drain in laparoscopic cholecystectomy is the removal of residual gas after operation, thus contributing in reducing postoperative morbidity. To assess the value of drains in decreasing the residual gas in elective laparoscopic cholecystectomy, and its effect on postoperative pain, nausea, vomiting and morbidity. From July 2008 to July 2009,150 patients were randomized to 3 groups of 50 patients; [A] subphrenic placed drain, [B] subhepatic placed drain, and [C] no drain. End points of this trial were to detect any differences in postoperative pain, nausea, vomiting and morbidity between the groups measured at different time intervals. Subphrenic drain significantly reduced the incidence and amount of subdiaphragmatic gas bubble [23/50 patients and 5.69 +/- 11.12 cm in group A vs. 48/50 patients and 17.34 +/- 12.21 cm in group C]. Although there were differences in the incidence of nausea and intensity of postoperative pain at different time intervals between drain groups and control group, but the difference was not significant. There was no mortality and no significant difference in the incidence of morbidity. Routine drainage after LC is unnecessary. It would be reasonable, however, to leave a drain if there is a worry about an unsolved or potential bile leak

Randomized, prospective comparison of post-operative pain in low - versus high -pressure pneumoperitoneum in laparoscopic cholecystectomy

CO2 insuflation constitutes the commonest means of creating the pneumoperitoneum [PP], but it is attributed to many post-laparoscopic cholecystecomy adverse effects including pain triggering. The aim of this trial was to evaluate the efficacy of low-pressure CO2 PP during laparoscopic cholecystectomy [LC] in reducing the incidence of postoperative pain. A double-blind, randomized, clinical trial was conducted on 100 patients with symptomatic gall stones. Patients were randomized preoperatively into group A [n=50] who underwent LC with 8 mmHg CO2 PP throughout the procedure and those in group B [n=50] had LC with 12 mmHg CO2 PP. Abdominal and shoulder-tip pain were assessed with verbal rating scale [VRS] scoring at 4, 8, 12 and 24 hours postoperatively. The low-pressure PP did not increase the duration of surgery. There were neither significant peri-operative complications nor conversion to open procedure in either group. A statistical comparison of mean cumulative VRS scores for abdominal and shoulder-tip pain in both groups shows statistical significance at 4, 8, 12 and 24 hours after operation. A CO2 PP at 8 mmHg reduces both the frequency and intensity of abdominal and shoulder-tip pain following LC without increasing the rate of intraoperative complications