Effect of drainage on postoperative pain after laparoscopic ovarian cystectomy O. S. Kerimoglu 1 , S. A. Yilmaz 1 , A. Pekin 1 , F. İncesu 1 , N. U. Dogan 2 , T. T. İlhan 1 & C. Celik 1 Department of Obstetrics and Gynecology, Faculty of Medicine, 1 Selçuk University, Konya and 2 Akdeniz University, Antalya, Turkey Introduction Laparoscopy is the preferred method for treating ovarian cysts because it is less invasive, has a shorter recovery period and requires a shorter hospital stay compared with open surgery. Aſter laparoscopy, the incidence of postoperative shoulder pain ranges between 35% and 80% and is caused by the irritation of the phrenic nerve from the carbon dioxide remaining in the abdomen (Tsai et al. 2013). e association between laparos- copy and abdominal pain is controversial (Sharp 2013; Shen et al. 2003). Strategies to reduce the incidence of shoulder pain include pulmonary recruitment manoeuvre (Phelps et al. 2008), intraperitoneal local anaesthesia (Kahokehr et al. 2011), intra- peritoneal normal saline infusion (Tsimoyiannis et al. 1998) and reduction in insufflation pressure (Donatsky et al. 2013). However, no reliable method has been made available as yet (Tsai et al. 2013). Postoperative drainage use prevents the accumulation of intraperitoneal fluid that may cause intra-abdominal pain and/or infection or allows the detection of early complications, such as bleeding (Chan et al. 2008). Although some studies have investi- gated the effects of reducing the intra-abdominal residual gas via drainage (Alexander et al. 1987; Crowther et al. 1995; Abbott et al. Correspondence: O. S. Kerimoglu, Department of Obstetrics and Gynecology, Faculty of Medicine, Selçuk University, Selçuklu Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı. Selçuklu, Konya, Turkey. E-mail: ozlemsecilmis@hotmail.com 2001), except for the above-mentioned indications, in laparos- copy, a consensus for this issue has not yet been reached (Swiſt et al. 2002; Raymond et al. 2010). In this prospective, observational study, we compared the out- comes of patients who underwent uncomplicated laparoscopic ovarian cystectomy (LOC) with drainage and without drainage, to investigate the effects of drainage on postoperative shoulder and abdominal pain. Materials and methods e study was approved by the local ethics committee. All patients gave their informed consent. e study enrolled 111 patients between 18 and 60 years of age without any comorbid disease who underwent LOC for benign ovarian cysts at Selcuk University Hospital, between April 2011 and July 2013, and who did not develop any intraoperative complications. Of the patients, 55 (49.5%) had drainage (drainage group) and 56 (50.5%) did not (non-drainage group). e study excluded any patients with pre- operative shoulder, abdominal or pelvic pain, systemic disease, tubo-ovarian abscess, before or during the operation. e patients were operated on by the same surgical team. All patients were given cefazolin 1 g intravenously as a prophylactic antibiotic aſter induction of general anaesthesia. Laparoscopy was performed using a standard four-port method as follows: one 12 mm port was inserted through the umbilicus, and the other 5 mm ports were inserted through the lateral lower abdominal wall and suprapubic area. Laparoscopy was performed using carbon dioxide as the distention medium, which was introduced through a Veress needle placed intraumbilically. e gas pressure was set at 12 mmHg during the procedure. When the cystectomy was complete, the surgeon decided whether a formal drainage system was necessary and the case would be closed with or without drainage. Patients who needed a drainage because of organ injury, bleeding or infection were excluded from the study. Allocation to drain or not to drain was non-randomised and based on surgeon preference in an uncom- plicated study population. For patients closed with drainage, soſt plastic passive drains were inserted into the leſt lateral port side, without negative pres- sure. Intraperitoneal placement of the drain was performed under direct visualisation. e drain was in place for at least 24 h, and it was removed on the first postoperative day. Journal of Obstetrics and Gynaecology, 2014; Early Online: 1–3 © 2014 Informa UK, Ltd. ISSN 0144-3615 print/ISSN 1364-6893 online DOI: 10.3109/01443615.2014.948824 The aim of this prospective study was to investigate the effect of drainage on postoperative shoulder and abdominal pain after uncomplicated laparoscopic ovarian cystectomy (LOC). Allocation to drain or not to drain was non-randomised. There were 55 patients with drainage and 56 patients without drainage. Postoperative shoulder and abdominal pain was assessed using a 10-point visual analogue scale. Postoperative hospital stay in the drainage group was longer than the non- drainage group (p  0.040). Postoperative shoulder pain scores at 6 h and 24 h were similar between the drainage and non- drainage groups (p  0.376 and p  0.847, respectively). Post- operative abdominal pain was higher in the drainage group at 6 h (p  0.009), but was similar at 24 h (p  0.097) between the groups. These data suggest that for LOC, drainage may not be useful to prevent postoperative shoulder pain and also increases postoperative abdominal pain and length of hospital stay. Keywords: Cystectomy, drain, laparoscopy, postoperative pain J Obstet Gynaecol Downloaded from informahealthcare.com by Selcuk Universitesi on 08/21/14 For personal use only.