A Cochrane review included 28 studies with a total of 3 659 subjects who had undergone uncomplicated open cholecystectomy. There were 20 comparisons of 'no drain' versus 'drain' and 12 comparisons of one drain with another. There was no statistically significant difference in mortality, bile peritonitis, total abdominal collections, abdominal collections requiring different treatments, or infected abdominal collections. 'No drain' group had statistically significant lower wound infection (OR 0.61, 95% CI 0.43 to 0.87) and statistically significant lower chest infection (OR 0.59, 95% CI 0.42 to 0.84) than drain group. No significant differences between different types of drains were found.
Another Cochrane review , review"?> included 12 studies with a total of 1831 subjects who had undergone laparoscopic cholecystectomy.
There was no significant difference between the drain group (1/840) (adjusted proportion: 0.1%) and the 'no drain' group (2/841) (0.2%) (RR 0.41; 95% CI 0.04 to 4.37) in short-term mortality in the ten trials with 1681 participants. There was no significant difference between the drain group (7/567) (adjusted proportion: 1.1%) and the 'no drain' group (3/576) (0.5%) in the proportion of patients who developed serious adverse events in the seven trials with 1143 participants (RR 2.12; 95% CI 0.67 to 7.40) or in the number of serious adverse events in each group reported by eight trials with 1286 participants; drain group (12/646) (adjusted rate: 1.5 events per 100 participants) versus 'no drain' group (6/640) (0.9 events per 100 participants); rate ratio 1.60; 95% CI 0.66 to 3.87). There was no significant difference in the quality of life between the two groups (one trial; 93 participants; SMD 0.22; 95% CI -0.19 to 0.63). The proportion of patients who were discharged as day-procedure laparoscopic cholecystectomy seemed significantly lower in the drain group than the 'no drain' group (one trial; 68 participants; drain group (0/33) (adjusted proportion: 0.2%) versus 'no drain' group (11/35) (31.4%); RR 0.05; 95% CI 0.00 to 0.75). There was no significant difference in the length of hospital stay between the two groups (five trials; 449 participants; MD 0.22 days; 95% CI -0.06 days to 0.51 days). The operating time was significantly longer in the drain group than the 'no drain' group (seven trials; 775 participants; MD 5.00 minutes; 95% CI 2.69 minutes to 7.30 minutes). There was no significant difference in the return to normal activity and return to work between the groups in one trial involving 100 participants.
Wound infection was significantly higher in those with a drain (OR 5.86, 95% CI 1.05 to 32.70). Nearly one-third of patients in the 'no drain' group (11/35) could be sent home on the day of surgery in comparison to none (0/33) in the drain group (OR 0.03, 95% CI 0.00 to 0.57). One trial with 41 patients randomised to suction drain (n=22) versus closed passive drain (n=19) suggested that suction drains carried less pain than passive drains.