A Systematic Review And Meta Analysis Of Abdominal Drainage After Elective Laparoscopic Cholecystectomy For Benign Gallbladder Diseases

Objective:Whether patients with benign gallbladder disease should undergo elective laparoscopic cholecystectomy(LC)surgery whether to use abdominal drainage has always been controversial.Therefore,we conducted a Meta-analysis based on randomized controlled trials(Randomized controlled trials,RCTs)to explore the effectiveness,safety,and necessity of routine abdominal drainage after LC in patients with benign gallbladder disease by combining relevant research data.Methods:The system searches the Pub Med,Cochrane Library,Embase,Chinese Biomedical Database(CBM),Wanfang Data,CNKI,and VIP databases,and collects and builds the database until January 18,2021 A publicly published RCTs for patients with benign gallbladder disease after LC with or without abdominal drainage.The system review report is based on the system review and Meta-analysis priority report items(Preferred Reporting Items for Systematic Reviews and Meta-analyses,PRISMA)specifications,using Rev Man5.3 software and Stata14.0 software for statistical analysis of the data,It is calculated based on the relative risk(Risk Ratio,RR)and its 95%confidence interval(95%CI).When the I~2value is≤50%,the fixed-effects model is used for Meta analysis,and when the I~2value is>50%,The random effects model is used for Meta analysis.Results:A total of 26 RCTs were included in this study,including 4260 participants(including 2200 in the abdominal drainage group and 2060 in the non-peritoneal drainage group).Meta-analysis results showed:the incidence of intra-abdominal fluid between the two groups[RR=1.05,95%CI(0.81,1.36),P=0.72]and postoperative mortality[RR=0.44,95%CI(0.04,4.72),P=0.50],the differences were not statistically significant.Postoperative placement of abdominal drainage failed to reduce the overall incidence of nausea or/and vomiting[RR=1.16,95%CI(0.95,1.42),P=0.15]and the incidence of shoulder pain[RR=0.88,95%CI(0.68,1.14),P=0.34].The results of the visual analogue scale(VAS)measurement showed that the abdominal drainage group had a higher pain score[MD=1.14,95%CI(0.78,1.51),P<0.001].However,we found that postoperative placement of abdominal drainage will significantly prolong the operation time[MD=6.62,95%CI(3.02,10.22),P=0.003]and postoperative hospital stay[MD=0.64,95%CI(0.27,1.00),P=0.006].In addition,wound infection has nothing to do with the placement of abdominal drainage after surgery[RR=1.65,95%CI(1.01,2.71),P=0.05].Conclusion:In patients with benign gallbladder disease undergoing elective LC,the placement of postoperative abdominal drainage does not bring significant benefits to the patient,but reduces the patient’s quality of life.Therefore,the placement of conventional abdominal drainage after LC is unnecessary.However,in view of the limitations of this study,more prospective studies are needed to further verify these results.