Globally, gallstone disease is a serious health issue, especially for adults.1 It typically manifests as right upper quadrant pain, nausea, and vomiting, though it can occasionally stay asymptomatic. If left untreated, it can result in obstructive jaundice, acute or chronic cholecystitis, Mirizzi syndrome, gangrenous cholecystitis, empyema gall bladder and in rare cases, carcinoma GB.2 Laparoscopic cholecystectomy, which has been the gold standard surgical procedure for gallstones since 1985, has completely changed the surgical therapy for gallstones.3

“Laparoscopic cholecystectomy has become more popular due to its better cosmetic results, shorter hospital stay, early recovery, and return to work and physical activity. Smaller ports, tiny ports, and decreased ports are examples of less invasive techniques that LC is moving toward as a result of growing surgeon experience and advancements in instruments and equipment. This technique is always evolving to become safer and less invasive.4”

With the introduction of LC, if there is any occurrence of biliary tract injury resulting in bile leakage, hepatic bed drainage can be considered. It is now well accepted that elective LC for asymptomatic cholelithiasis and chronic cholecystitis does not require prophylactic drainage.5

According to some surgeons, draining the subhepatic area does prevent post-operative morbidities and offers very little benefit in identifying bile leakage or bleeding.6 In fact, drainage has been shown to exacerbate drainage-related issues like fever, retrograde wound infection, or haemorrhage, which can cause discomfort to the patients rather than preventing post-operative complications.7,8,9

Small collections are shown to be effectively absorbed by the peritoneum, although big enough leaks to be clinically significant are rare. If they do occur, the drain is occasionally found to be useless because omental plugs or blood clots frequently block them. Additionally, the drains have been implicated for a variety of issues, including the creation of intestinal fistulas, discharge of serous fluid, and the transformation of a sterile collection into an infectious one or can even inflict haemorrhage.10

Aim and Objectives

AIM

 To compare the surgical outcome of laparoscopic cholecystectomy with and without abdominal drain.

OBJECTIVES

To compare the postop-pain and use of analgesics in abdominal drain vs no drain group.

To estimate the duration of hospital stay between lap cholecystectomy with abdominal drain and without drain.

To compare the volume of fluid collection detected in the subhepatic area by USG in post op day in drain vs no drain group.

The present study was executed over a comprehensive one-year period within the Surgery Department from November 2023 to November 2024 at Jorhat Medical College & Hospital, Jorhat, India.

Data Collection Methods:

• Cases selected based on last three years Hospital records.
• From individuals seeking treatment for cholelithiasis and chronic calculus cholecystitis at our facility.
• Informed consent was taken from participants and required to be signed.
• The outcomes were tallied and statistically examined in terms of safety, efficacy, associated risks, quality of life, and early activity resumption.

SAMPLE SIZE – A total of 120 cases of diagnosed uncomplicated chronic calculous cholecystitis were selected and divided into two groups of 60 participants in each group over a one-year period is the anticipated sample size for proposed study.

Patients will be divided into 2 groups:

• Group A (Abdominal drain group): n = 60
• Group B (No drain group): n=60

TYPE OF STUDY – Prospective comparative study.

Sampling Technique:  Purposive sampling 

INCLUSION CRITERIA:

The following criteria were included in the study:

1. Age group 18–60 years
2. Uncomplicated chronic calculus cholecystitis
3. Patients undergoing elective laparoscopic cholecystectomy for other etiology.
4. Patients giving informed consent to participate in the study will be included.

EXCLUSION CRITERIA:

The following criteria were excluded from the study:

1. Obstructive jaundice
2. Conversion to open surgery
3. Intraoperative hemorrhage
4. Intraoperative biliary tract injury
5. Choledocholithiasis.
6. Empyema GB
7. Diabetic patients with uncontrolled sugar levels.
8. Obese patients with BMI ≥30
9. Recurrent episodes of acute cholecystitis leading to dense adhesions with surrounding structures.

METHODOLOGY:

Prior to commencement of this study, ethical clearance was duly acquired from the Institutional Ethics Committee of JMCH. Two groups were divided, Group A (Laparoscopic cholecystectomy with abdominal drain) and Group B (Laparoscopic cholecystectomy without abdominal drain) and post-operative surgical outcomes will be compared. The decision of whether an abdominal drain should be kept or not was decided based on ultrasonography whole abdomen report and intraoperative findings.

In our study post operative pain was assessed by using visual analogue scale with the following gradings: Grade0: Almost pain free; Grade1: Slight pain; Grade2: Average pain; Grade3: More than average pain; Grade4: Moderate pain; Grade5: Severe pain

Study of Cases:

The required information on the patient's age, sex, religion, and residence were documented upon admission.

Following appropriate pre-operative preparation, the cases were clinically examined, investigations conducted, and an operation (Laparoscopic cholecystectomy) was carried out. All the patients were closely observed in their postoperative period of stay till getting discharged and up to a period of 4 weeks for follow-up on outpatient basis.

Table 1: AGE DISTRIBUTION

Mean age: 42.02 years

Standard deviation : 11.19 years

Table 2: GENDER DISTRIBUTION

Table 3: POST OP ABDOMINAL PAIN AFTER 24 HRS

• Chi-square Value:25

• Degrees of Freedom (df): 1
• P-value: < 0.001 (Statistically significant)

Table 4: DURATION OF HOSPITAL STAY

• Chi-square value: ~35.8
• Degrees of freedom (df): 3
• P value: < 0.001 (statistically significant)

Table 5: SUB-HEPATIC COLLECTION POST CHOLECYSTECTOMY

Age distribution: In this study, the mean age of the study subject was 42.02 years with the age group 41-50 undergoing highest laparoscopic cholecystectomy without drain (37.5%). Drain was more commonly used in the age group 51-60. Singh et al ¹¹(2020) reported a similar prevalence in the 40-60 years group, associating gallbladder diseases with older adults.

Gender distribution: In this study, it was observed that female population have undergone laparoscopic cholecystectomy more in comparison to male counterparts. Among female population, 70% females did not require placement of drain whereas in male population higher percentage of males required placement of drain. Females typically experience less severe disease, resulting in a preference for drain-free LC and smoother postoperative recovery, as supported by existing literature of Kumar et al (2019).¹²   Previous studies like Singh et al ¹³ (2020) suggest that males tend to present with more complicated gallbladder diseases, including increased inflammation, fibrosis, or adhesions, often leading to drain placement to prevent postoperative complications.

Post-operative pain: It was observed in our study that 70% individuals who have undergone laparoscopic cholecystectomy without drain did not complain of significant pain whereas 80% of the patients complained of pain in drain group after 24vhours postoperatively.  These findings align with existing literature, of Ahmed et al ¹⁴ (2020) and Gupta et al ¹⁵ (2019), which suggested that the use of drains in LC may contribute to increased post-operative discomfort.

Duration of hospital stay: In our study it was observed that, majority of the patients who have undergone laparoscopic cholecystectomy without drain were discharged on Day 1 and Day 2 whereas the drain group patients got discharged on day 3 and day 4 in higher proportion. This trend aligns with previous studies of Singh et al ¹⁶ (2019) which suggested that routine drain placement can lead to increased post-operative discomfort and delayed recovery.

Sub hepatic collection: The mean fluid collection in the LC with drain group was 24.80 ml, with a standard deviation of 9.404, while in the LC without drain group, it was 24.30 ml, with a standard deviation of 11.500. The mean difference between the two groups was 0.50 ml, which was not statistically significant. This indicates that the presence of a drain did not significantly affect post-operative subhepatic fluid collection, suggesting that routine drainage may not be necessary for preventing fluid accumulation.

The study findings suggest that LC without a drain is associated with less postoperative pain, fewer complications, shorter hospital stay, and faster recovery, making it a preferable approach in uncomplicated elective cases. While drain placement remains necessary in certain complicated cases, its routine use should be reconsidered to enhance patient comfort and outcomes. These results align with global surgical trends advocating for selective rather than routine drain placement in laparoscopic cholecystectomy. Future research with larger sample sizes and long-term follow-ups is recommended to further validate these findings and optimize surgical protocols.  

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