Drain provides egress to both bile and blood related serosanguinous collections and does not increase the rate of complications as has been shown in our study'. The higher complication rate in the present study is probably due to non-drainage of leaks and collections in subhepatic space, which subsequently proved deleterious in causing a decrease in diaphragmatic movement on the right side. Thereby more respiratory tract infections, peritoneal reaction to bile leading to unexplained pyrexia and bacterial overgrowth in a suitable medium in subhepatic space led to wound infection despite antibiotic prophylaxis. Transverse incision may be an added factor for higher rate of wound infection.
Authors themselves have shown biliary leaks in 31 per cent of their patients after cholecystectomy and have argued that clinically significant leakage is uncommon. May we ask what would have happened in a patient with significant leak, however uncommon that may be? After all what are they afraid of; drainage after elective cholecystectomy, preventing various complications (which they could not achieve) or drain related problems (which are still rarer). In our prospective study' on 100 patients, where drainage after elective cholecystectomy was provided without prophylactic antibiotics, none of the patients developed wound infection and one patient developed subphrenic abscess and respiratory complication. More importantly in our group drainage did help in detecting significant bile leak* in two patients. We feel that problems due to drainage are over-emphasized. A drain can be used routinely and when removed on the first postoperative day in the absence of excessive soakage, will not lead to increased complications.