ThP4.13 - To drain or not to drain?! Selective Abdominal Drainage Reduces Morbidity and Re-interventions in Laparoscopic Cholecystectomy and Bile Duct Exploration

Résumé fourni par la source

Abstract Aims To evaluate the indications and benefits of sub-hepatic drainage after laparoscopic cholecystectomy(LC) and bile duct exploration (LCBDE). Methods Utilisation of drains in a prospective database of LC and LCBDE was reviewed. The occurrence of postcholecystectomy bile leakage (PCBL) and abdominal collections was analysed. Results 52.5 % of 6140 patients had drains. PCBL occurred in 43 (1.3%). 20 leaks had choledochotomy LCBDE; 16 before drain removal (10 settling spontaneously, 3 requiring ERCP, 3 relaparoscopy). All 4 occurring after drain removal required percutaneous drains (PCD) or ERCPs. 12 leaks had transcystic explorations; 10 before drain removal (8 settling spontaneously, 1 ERCP, 1 PCD) and 2 after drain removal (1 settled, 1 needed ERCP). 11 PCBLs had LC only; 9 still had drains (6 settled, 1 PCD, 1 ERCP, 1 relaparoscopy) and 2 after drain removal needing relaparoscopy and ERCP. Drains allowed early detection and spontaneous resolution in 24 patients (55.8%) and early detection and intervention prevented serious morbidity in 11 (25.6%). 7 of 8 PCBLs after drain removal required reintervention. 2915 (47.5%) had no drains. 6 had PCBL (0.2%); 5 needing multiple reinterventions; 3 PCD, 2 ERCPs and 3 relaparoscopies. Drains caused complications in six patients (0.18%); one retracted into the abdomen needing relaparoscopy, two drain site infections and 3 had significant pain disappearing when drains were removed. Collections other than PCBL occurred in 19 patients; 8 with drains and 11 after drain removal. They were treated conservatively (9), by PCD (8) or relaparoscopy (2). Conclusions Careful selective abdominal drainage after advanced biliary surgery allows early detection of collections, minimising morbidity and reintervention.

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