Editorial Comment on: Andrzej Smereczyński, Teresa Starzyńska, Katarzyna Kołaczyk and Józef Kładny Role of sonography in assessing complications after laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) was introduced to the arsenal of surgical techniques in 1987 and has become the gold standard in treating cholecystolithiasis. In spite of undoubted benefi ts for patients, it is not a complication-free procedure. The type of complications after a classical , i.e. " open " surgery and LC do not differ in a significant way. The difference lies in their prevalence. One of the most common complications is a fl uid collection in the gallbladder bed under the liver. To prevent it from developing, a drain is usually placed under the liver. For many years, it was believed that such a practice is correct , but recent reports indicate that leaving the drain after a planned laparoscopic cholecystectomy may do more damage rather than be benefi cial. Moreover, it may give a false impression of safety since we are convinced that we remain in control over the situation in case of, for instance, a hemorrhage (1). In fac t, when the postoperative bleeding to the peritoneal cavity is intense, a thin Redon drain, which usually remains inserted after the procedure, may become occluded by a thrombus. Decisions are made based on the patient's clinical condition or imaging examinations (including sonography) which can reveal not only a fl uid collection under the liver, but also free fl uid in the peritoneal cavity. The peritoneum secretes considerable amounts of perito-neal fl uid daily. It becomes absorbed completely mainly via the lymphatic channels in the diaphragmatic region. Therefore, detection of a collection of serous fl uid should not be alarming. It will absorb with no consequences for the patient. It has been observed that leaving a drain in the gallbladder bed causes increased fl uid secretion. Moreover, Fraser et al. claim that such a practice may provoke bile leakage form slight bile ducts in the gallbladder bed (2). If it is a suction drain the risk of bile leakage is signifi cant. Thiebe and Eggert observed that leaving the drain caused fl uid to accumulate in the gallbladder bed in 44% of cases Komentarz redakcyjny do artykułu Andrzeja Smereczyńskiego, Teresy Starzyńskiej, Katarzyny Kołaczyk i Józefa Kładnego pt.: Rola ultrasonografi i w ocenie powikłań po laparoskopowym usunięciu pęcherzyka żółciowego