Laparoscopic cholecystectomy in hepatitis C liver cirrhosis patients: “to drain or not to drain: impact on postoperative pain”


  • Ahmed Mohamed Abdelaziz Hassan Department of General Surgery, Theodor Bilharz Research Institute, Giza, Egypt
  • Magdy M. A. Elsebae Department of General Surgery, Theodor Bilharz Research Institute, Giza, Egypt
  • Mohamed Abbas Department of General Surgery, Theodor Bilharz Research Institute, Giza, Egypt
  • Hussien Ezzat Department of General Surgery, Theodor Bilharz Research Institute, Giza, Egypt
  • Mohamed Z. Ali Department of Anaesthesiology and Surgical Intensive Care, Theodor Bilharz Research Institute, Giza, Egypt
  • Reeham Said Ebied Department of Anaesthesiology and Surgical Intensive Care, Theodor Bilharz Research Institute, Giza, Egypt



Laparoscopic cholecystectomy, Liver cirrhosis, Drai


Background: When cirrhotic patients with symptomatic gallstones require laparoscopic cholecystectomy (LC), the drainage tube is supposed to prevent postoperative abdominal radiating to the right shoulder, nausea and vomiting due to pneumoperitoneum using carbon dioxide gas. Aim of this work is to evaluate the effect of placing of drains on the incidence of postoperative pain, nausea and vomiting in those patients.

Methods: sixty-four patients with uncomplicated chronic calcular cholecystitis and liver cirrhosis were recruited for the study during the period from February 2017 to February 2019. They electively operated upon at the department of general surgery of Theodor Bilharz Research Institute (TBRI) using laparoscopic technique. Patients were subdivided into two equal groups Group-I (n=32); suction drains were placed in the sub-hepatic region (Morison’s pouch) and Group-II (n=32), no drains were placed. Duration of surgery, postoperative shoulder tip pain and vomiting and analgesics requirement were evaluated and recorded.

Results: Operative time's difference was not statistically significant between the two groups. Drain group had a significant lower shoulder tip pain and analgesic requirement at post-operative 6 and 12 hours but that was higher After 12 hours, than group without drain. The overall incidence of nausea/vomiting was significantly higher statistically in group without drain than in drain group. Patients in drain group had a significantly longer hospital stay as compared to group without drain that was statistically significant.

Conclusions: Although the incidence of pain and nausea/vomiting are less in early  post-operative period after LC  with abdominal drain in hepatitis C liver cirrhosis patients; its routine use is not justified because post-operative pain and analgesic requirement  after 12 hours is higher and hospital stay is longer. 


Nursal TZ, Yildirim S, Tarim A, Noyan T, Poyraz P, Tuna N. Effect of drainage on post-operative nausea, vomiting, and pain after laparoscopic cholecystectomy. Langenbecks Archive of Surgery. 2003;388(2):95-100.

Capitanich P, Segundo UL, Malizia P, Herrera J, Lovaldi ML. Usefulness of prophylactic drainage in laparoscopic cholecystectomy. Randomized prospective report. Prensa Medica Argentina. 2005;92(9):623-7.

Mrozowicz A, Rucinski P, Polkowski WP. Routine drainage of the subhepatic area after laparoscopic cholecystectomy. Prospective, controlled study with random patient selection. Polski Przeglad Chirurgiczny. 2006;78(5):597-609.

Uchiyama K, Tani M, Kawai M, Terasawa H, Hama T, Yamaue H. Clinical significance of drainage tube insertion in laparoscopic cholecystectomy: a prospective randomized controlled trial. J Hepatobiliary Pancreat Surg. 2007;14(6):551-6.

Picchio M, Tzovaras G, Liakou P, Fafoulakis F, Baloyiannis I, Zacharoulis D, Hatzitheofilou C. Is there a role for drain use in elective laparoscopic cholecystectomy? A controlled randomized trial. Am J Surg. 2009;197(6):759-63.

Lucarelli P, Di Filippo A, De Angelis F, Stipa F, Spaziani E. Meta-analysis of drainage versus no drainage after laparoscopic cholecystectomy. JSLS. 2014;18(4):e2014.00242.

Antoniou S, Koch O, Antoniou G, Köhler G, Chalkiadakis G, Pointner R, et al. Routine versus no drain placement after elective laparoscopic cholecystectomy: meta-analysis of randomized controlled trials. Minerva Chir. 2014;69(3):185-94.

Wong CS, Cousins G, Duddy JC, Walsh SR.Intra-abdominal drainage for laparoscopic cholecystectomy: A systematic review and meta-analysis. Int J Surg. 2015;23(Pt A):87-96.

Sharma A, Mittal S. Role of Routine Subhepatic Abdominal Drain Placement following uncomplicated laparoscopic cholecystectomy: a prospective randomised study. J Clin Diagn Res. 2016;10(12):PC03-PC05.

Leandros E, Albanopoulos K, Tsigris C. Laparoscopic cholecystectomy in cirrhotic patients with symptomatic gallstone disease. ANZ J Surg. 2008;78:363–5.

Hamad MA, Thabet M, Badawy A. Laparoscopic versus open cholecystectomy in patients with liver cirrhosis: a prospective randomized study. J Laproendosc Adv Surg Tech A. 2010;20(5):405–9.

Chmielecki DK, Hagopian EJ, Kuo YH, Kuo YL, Davis JM. Laparoscopic cholecystectomy is the preferred approach in cirrhosis: a nationwide, population-based study. HPB (Oxford). 2012;14(12):848-53.

Donatsky AM, Bjerrum F, Gögenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc. 2013;27(7):2275-82.

Sandhu T, Yamada S, Ariyakachon V, Chakrabandhu T, Chongruksut W, Ko-iam W. Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecyst-ectomy, a prospective randomized clinical trial. Surg Endosc. 2009;23:1044–7.

Kandil TS, El Hefnawy E. Shoulder pain following laparoscopic cholecystectomy:factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A. 2010;20:677–682

Wallace DH, Serpell MG, Baxter JN, O’Dwyer PJ. Randomized trial of different insufflation pressures for laparoscopic cholecystectomy. Br J Surg. 1997;84:455–8.

Jackson SA, Laurence AS, Hill JC. Does post-laparoscopy pain relate to residual carbon dioxide? Anaesthesia. 1996;51:485–7.

Bhattacharjee HK, Jalaludeen A, Bansal V, Krishna A, Kumar S, Subramanium R, et al. Impact of standard-pressure and low-pressure pneumo-peritoneum on shoulder pain following laparoscopic cholecystectomy:a randomised controlled trial. Surg Endosc. 2017;31(3):1287-95.

Vijayaraghavan N, Sistla SC, Kundra P, Ananthanarayan PH, Karthikeyan VS, Ali SM, et al. Comparison of standard-pressure and low pressure pneumoperitoneum in laparoscopic cholecyst-ectomy: a double blinded randomized controlled study. Surg Laparosc Endosc Percutan Tech. 2014;24(2):127-33.

Hua J, Gong J, Yao L, Zhou B, Song Z. Low-pressure versus standard-pressure pneumo peritoneum for laparoscopic-holecystectomy: a systematic review and meta-analysis. Am J Surg. 2014;208(1):143-50.






Original Research Articles