Is routine drain insertion after laparoscopic cholecystectomy for acute cholecystitis beneficial? A multicenter, prospective randomized controlled trial.

BACKGROUND: There is a lack of evidence regarding the role of drainage in laparoscopic cholecystectomy (LC) for acutely inflamed gallbladder (AIGB), and drain insertion remains controversial. METHODS: From December 2013 to November 2014, a total of 193 patients who needed LC due to AIGB at the four participating hospitals were entered in this study. After the operation, the patients were randomly assigned to undergo drain insertion (94 patients, 48.7%, group A) or not (99 patients, 51.3%, group B). The surgical outcomes between the two groups were prospectively reviewed. The study was registered at www.clinicaltrials.gov at the inception of enrollment (NCT02027402). RESULTS: Both groups were comparable in terms of patient demographics, operative time and postoperative hospital stay. In 18 cases (9.3%), postoperative morbidities such as bleeding, bile leakage, wound infection or an abscess occurred, and there was no significant difference between the two groups. The visual analog scale pain score measured at 24 h (3.9 ± 1.4 in group A and 3.3 ± 2.0 in group B, P = 0.014) and 48 h (2.1 ± 1.5 in group A and 1.5 ± 1.4 in group B, P = 0.006) was significantly higher in group A. CONCLUSIONS: Routine drain insertion does not prevent or reduce postoperative morbidities after LC for AIGB and can even cause prolonged postoperative pain. This prospective study suggests that routine drain use in LC for AIGB should be reconsidered.

Carcinoma of the middle bile duct: is bile duct segmental resection appropriate?

AIM: To compare survival between bile duct segmental resection (BDSR) and pancreaticoduodenectomy (PD) for treating distal bile duct cancers. METHODS: Retrospective analysis was conducted for 45 patients in a BDSR group and for 149 patients in a PD group. RESULTS: The T-stage (P < 0.001), lymph node invasion (P = 0.010) and tumor differentiation (P = 0.005) were significant prognostic factors in the BDSR group. The 3- and 5-year overall survival rates for the BDSR group and PD group were 51.7% and 36.6%, respectively and 46.0% and 38.1%, respectively (P = 0.099). The BDSR group and PD group did not show any significant difference in survival when this was adjusted for the TNM stage. The 3- and 5-year survival rates were: stage Ia [BDSR (100.0% and 100.0%) vs PD (76.9% and 68.4%) (P = 0.226)]; stage Ib [BDSR (55.8% and 32.6%) vs PD (59.3% and 59.3%) (P = 0.942)]; stage IIb [BDSR (19.2% and 19.2%) vs PD (31.9% and 14.2%) (P = 0.669)]. CONCLUSION: BDSR can be justified as an alternative radical operation for patients with middle bile duct in selected patients with no adjacent organ invasion and resection margin is negative.