Predictive Factors of Drain Insertion After Laparoscopic Cholecystectomy: A Cohort Study

Background:

Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallstones, offering benefits such as reduced pain, shorter hospital stays, and faster recovery. However, postoperative complications like bile leakage, hemorrhage, and infection remain concerns. Many surgeons use intraoperative drains routinely to prevent these complications, though evidence increasingly suggests selective use may be preferable. Few studies have systematically identified which patient or intraoperative factors predict the need for drain placement.

Objective:

To identify demographic, clinical, and intraoperative predictors of surgical drain placement after LC, enabling evidence-based, selective drain use.

Methods:

* Design: prospective cross-sectional study at Safeer Al-Husain Hospital, Karbala, Iraq.
* Population: 559 patients undergoing LC.
* Data Collection: Patient demographics, operative details, intraoperative findings, and drain usage were extracted from standardized hospital records.
* Statistical Analysis: Associations between patient/surgical variables and drain placement were assessed using univariate and multivariate logistic regression. Statistical significance was defined as p < 0.05.

• Drain (Other): We want to put a assess the predictive factors for prophylactic drain after cholecystectomy.

Primary outcomes

• Proportion of patients undergoing laparoscopic cholecystectomy who require intraoperative drain insertion [Immediately post-op, day zero]

Secondary outcomes

• Operative time [Day 0 (intraoperative period)]: Duration of laparoscopic cholecystectomy measured in minutes, from first incision to closure
• Incidence of intraoperative bile or stone spillage [Day 0 (intraoperative period)]: Documented occurrence of bile leakage or gallstone spillage during the procedure.
• Gallbladder wall thickness [Baseline (preoperative imaging)]: Preoperative ultrasound measurement of gallbladder wall thickness and its association with drain placement.
• Presence of adhesions [Day 0 (intraoperative period)]: Intraoperative finding of pericholecystic or omental adhesions
• Patient demographics [Baseline (before surgery)]: Age, Gender (male/female), Body Mass Index,
• Clinical presentation [Baseline (preoperative assessment)]: Acute inflammation, chronic inflammation, biliary colic, acute on chronic inflammation
• Trocar insertion technique [Intraoperative]: Easy blind, difficult blind, easy open, difficult open, or Veress needle.
• Gallbladder anatomy [Intraoperative]: Classical, adhesions, anomaly
• Common bile duct anatomy [Intraoperative]
• Number of clips used [Intraoperative]
• Hepatic bed status [Intraoperative]: None, oozing, active bleeding
• Gallbladder extraction technique [Intraoperative]: Without manipulation, evacuation of content, wound extension, extension + evacuation, endobag
• Other adverse events [Intraoperative]

Sex: All

Inclusion Criteria:

* Underwent laparoscopic cholecystectomy (LC) at Safeer Al-Husain Hospital, Karbala, Iraq.
* Both male and female patients.
* Diagnosed with gallstone disease, including:

  * Chronic cholecystitis
  * Acute cholecystitis
  * Acute-on-chronic cholecystitis
  * Biliary colic

Exclusion Criteria:

* Conversion from laparoscopic to open cholecystectomy prior to completion of the procedure.
* Patients undergoing emergency surgery for gallbladder perforation with generalized peritonitis, where standard laparoscopic cholecystectomy was not feasible.

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• Arkan Shubber AbdulKhaliq Al-hamdany, F.I.B.M.S., Study director, Iraqi Ministry of Health, Karbala Health Directorate