Ahmed M Hassan, Mohamed Z Ali, Reeham S Ebied, Mohamed Abbas and Magdy Ma Elsebae*
Introduction: With this increase in the prevalence in viral C hepatitis, surgeons now more frequently encounter cirrhotic patients with symptomatic gallstones. Now, when such patients required cholecystectomy, it is performed laparoscopically. However, an abdominal pain, especially radiating to the right shoulder, nausea and vomiting in the postoperative period due to pneumoperitoneum using carbon dioxide gas. The use of c drainage tube after uncomplicated LC in patients without liver cirrhosis, which is supposed to prevent such postoperative events, is an issue of considerable debate. Aim of the work is to evaluate our experience of LC in hepatitis c liver cirrhosis patients from surgical, anesthesia and surgical intensive care aspects. We conducted a prospective, randomized, double blind study to determine the effect of placing of drains after LC in hepatitis c liver cirrhosis patients on the incidence of postoperative pain, nausea and vomiting.
Patients and methods: Forty-four patients with non-complicated chronic calcular cholecystitis and liver cirrhosis were recruited for the study during the period from February 2017 to December 2018. They electively operated upon at the department of general surgery of Theodor Bilharz Research Institute (TBRI) using the laparoscopic technique. The patients were randomly subdivided into two equal groups Group-I (n=22); suction drains will be placed in the sub-hepatic region (Morison’s pouch) and Group-II (n=22), no drains will be placed. Demographic data, preoperative variables, duration of surgery, postoperative shoulder tip pain, vomiting and analgesics requirement evaluated and recorded.
Results: Operative times were not statistically significant of both groups. Drain group I 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 II. The overall incidence of nausea/vomiting was more in group without drain than in drain group which was statistically significant. Patients in Group I had a longer stay in hospital as compared to Group II that was statistically significant.
Conclusion: The routine use of abdominal drain after elective uncomplicated laparoscopic cholecystectomy in patients with liver cirrhosis because its role in reducing post-operative nausea/vomiting is not justified. It increases post-operative pain and hospital stay. Selective use of drain is reasonable if there is a surgical indication like potential bile leak.
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