Indications and Outcomes of Abdominal Drain in Laparoscopic Cholecystectomy in a Tertiary Care Center in Central Nepal: A Descriptive Cross-sectional Study

A Descriptive Cross-sectional Study

  • Sandeep Khanal BPKIHS


Introduction: Laparoscopic Cholecystectomy (LC) is the treatment of choice for symptomatic cholelithiasis. During this procedure, sometimes abdominal drain is placed in the right sub-hepatic space. The main objectives of this study were to assess the indications for the use of intra-abdominal drains (IADs) in elective LCs and its outcomes following LCs.
 Methods: This is a prospective descriptive cross-sectional study conducted between November 2017 and December 2018 in the Department of Surgery of a tertiary level teaching hospital in Kathmandu, Nepal. Sixty patients who underwent elective LC with the placement of intra-abdominal drain were selected for the study. The data were recorded in a preformed proforma and analyzed using MS Excel and Statistical Package for Social Sciences Version 16.0. 
Results: The total LCs performed during this period was 536. The overall prevalence of IAD placement in LC was 11.19% (n=60), with drains placed more frequently among males than females (27.4% v/s 6.3%). Cholelithiasis with cholecystitis (35%, n=21) was the most common indication for elective IAD placement while adhesions (56%, n=34) was the most common intraoperative indication for IAD in LC. Surgical site infection (SSI) and fever were encountered in 15% (n=9) and 5% (n=3) of the patients respectively. SSI was found to have a positive correlation with the operative time (p=0.01), post-operative hospital stay (p=0.003) and age of the patient (p=0.021).
Conclusion: The prevalence of IAD placement in LC in our study was almost double as compared to that of studies in other countries and predominantly more among males than females. Cholelithiasis with cholecystitis and adhesions were the most common indications for IAD placement. SSI in IAD placement was found to be positively correlated with the operative time, post-operative hospital-stay and age of the patient.


1. Chari RS, Shah Shimul. Biliary System. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL editor. Sabiston Textbook of surgery. The Biological Basis of Modern Surgical Practice. 18th ed. India: Elsevier; 2001: 1547-63.
2. National Institute of Health Consensus Development Conference Statement on Gallstones and Laparoscopic Cholecystectomy. Amer J Surg. 1993;165:390-5.
3. Sharma A, Gupta SN. Drainage versus no Drainage after Elective Laparoscopic Cholecystectomy. Kathmandu Univ Med J. 2016; 53(1):69-72.
4. Kama NA, Kologlu M, Doganay M, Reis E, Atli M, Dolapci M. A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg. 2001:181(6);520-5.
5. Surgical Endoscopy, 1998. SAGES guidelines. 12(2), pp.186-188.
6. Sen DO. Laparoscopic cholecystectomy. Amer J Surg. 1993; l1:65,440-3.
7. Kama NA, Doganay M. Dolapei, Reis E, Atli M, Kologlu M. Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc. 2001; 15(9):965-8.
8. Abbott J, Hawe J, Srivastava P, Hunter D, Garry R. Intraperitoneal gas drain to reduce pain after laparoscopy: Randomized masked trial. Obstet Gynecol. 2001; 98(1):97-100.
9. Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg. 2000; 87:1161-5.
10. Lo CM, Fan ST, Liu CL, Lai CS, Wong J. Early decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis. Am J Surg. 1997;173(6):513-7.
11. Halldestam I, Kullman E, Borch K. Defined indications for elective cholecystectomy for gallstone disease. Br J Surg. 2008; 95:620-6.
12. Ahmet G. Is a drain required after laparoscopic cholecystectomy? Eurasian J Med. 2013; 45:181-4.
13. Golash V. A simple technique of inserting an intra-abdominal drain in laparoscopic surgery. Oman Med J. 2009; 24(1): 7-10.
14. Bajracharya A, Adhikary S, Agarwal CS. Laparoscopic cholecystectomy: an experience of university hospital in eastern Nepal. Health Renaissance. 2012; 10(2):134-6.
15. Kim EY, Lee SH, Lee JS, Yoon YC, Park SK, Choi HJ. Is routine drain insertion after laparoscopic cholecystectomy for acute cholecystitis beneficial? A multicenter, prospective randomized controlled trial. J Hepatobiliary Pancreat Surg .2015; 22:551–7.
16. Kumar DL. Laparoscopic Cholecystectomy vs. Open Cholecystectomy in the Treatment of Acute Cholecystitis. J Med Sci Clin Res. 2017; 05:22547–51.
17. Corwin MT, Siewert B, Sheiman RG, Kane RA. Incidentally detected gallbladder polyps: is follow-up necessary?-Long-term clinical and US analysis of 346 patients. Radiology. 2011 Jan; 258:277-82.
18. Mir GH, Bhat SA, Khan T, Wani MA, Mailk AA, Wani KA, et al. Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: An Analysis in a High Risk Group of Patients. J Universal Surg. 2017;.5: 3-19.
19. Shamim M, Memon AS, Bhutto AA, Dahri MM. Reasons of conversion of laparoscopic to open cholecystectomy in a tertiary care institution. J Pak Med Assoc. 2009 Jul; 59(7):456-60.
20. El-Labban G, Hokkam E, El-Labban M, Saber A, Heissam K, El-Kammash S. Laparoscopic elective cholecystectomy with and without drain: A controlled randomised trial. J Minim Access Surg. 2012; 8:90-2.
21. Singh M, Singh K, Chawla IS. Laparoscopic cholecystectomy with and without drainage - a comparative clinical study. Int J Clin Med Res. 2017; 4:117-120.
22. Chauhan VS, Kariholu PL, Saha S, Singh H, Ray J. Can post-operative antibiotic prophylaxis following elective laparoscopic cholecystectomy be completely done away with in the Indian setting? A prospective randomised study. J Minim Access Surg. 2018;14(3):192-6.
23. Cheng, Hang. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg infect. 2017; 18: 722-35.
24. deCarvalho RLR, Campos CC, Franco LMC, Rocha ADM, Ercole FF. Incidence and risk factors for surgical site infection in general surgeries. Rev Lat Am Enfermagem. 2017; 25: e2848.
25. Uçkay I, Agostinho A, Stern R, Bernard L, Hoffmeyer P, Wyssa B. Occurrence of fever in the first postoperative week does not help to diagnose infection in clean orthopaedic surgery. Int Orthop. 2011; 35: 1257-60.
26. Mujagic E, Zeindler J, Coslovsky M, Hoffmann H, Soysal SD, Mechera R, et al. The association of surgical drains with surgical site infections - A prospective observational study. Am J Surg. 2019 Jan;217(1):17-23.
27. Talbot TR, Schaffner W. Relationship between age and the risk of surgical site infection: a contemporary reexamination of a classic risk factor. J Infect Dis. 2005 Apr 1; 191:1032-5.
28. Kaye KS, Schmit K, Pieper C, Sloane R, Caughlan KF, Sexton DJ, et al. The effect of increasing age on the risk for surgical site infection. J Infect Dis. 2005; 191:1056–62.
29. Valappil MV, Gulati S, Chhabra M, Mandal A, Bakshi S, Bhattacharyya A, Ghatak S. Drain in laparoscopic cholecystectomy in acute calculous cholecystitis: a randomised controlled study. Postgrad Med J. 2020 Oct;96(1140):606-9.
30. Tzovaras G, Liakou P, Fafoulakis F, Baloyiannis I, Zacharoulis D, et al. Is there a role for drain use in elective laparoscopic cholecystectomy? A controlled randomized trial. Am J Surg. 2009, 197:759-63.
How to Cite
KHANAL, Sandeep. Indications and Outcomes of Abdominal Drain in Laparoscopic Cholecystectomy in a Tertiary Care Center in Central Nepal: A Descriptive Cross-sectional Study. J Soc Surg Nep, [S.l.], v. 25, n. 2, p. 40-45, dec. 2022. ISSN 2392-4772. Available at: <>. Date accessed: 14 june 2024.