Specimen retrieval during elective laparoscopic cholecystectomy: is it safe not to use a retrieval bag?

Muhamed Hamid Majid,Babak Meshkat,Sherif El Masry,Haseeb Kohar

doi:10.1186/s12893-016-0181-y

Muhamed Hamid Majid, Babak Meshkat + Show 2 more

Open Access

https://doi.org/10.1186/s12893-016-0181-y

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Journal: BMC surgery	Publication Date: Sep 19, 2016
Citations: 25	License type: cc-by

Affiliation: Our Lady of Lourdes Hospital, Beaumont Hospital

Abstract

BackgroundSince the introduction of laparoscopic surgery for gallbladder disease different types of retrieval devices have been used to extract the gallbladder from the peritoneal cavity. These devises infer additional costs and may lead to associated risks and complications. We aimed to evaluate the safety of gallbladder retrieval without the use of a retrieval device.MethodsA prospective study was conducted across two teaching hospitals in the Republic of Ireland from July 2010–2013. Patients undergoing planed elective day case laparoscopic cholecystectomy in the two institutions were included in the study. Data were collected on patient demographics, the use of a bag, any need for extension of fascial incision, any unexpected over night stay, any 30-day post operative complications and presence of port site hernia within 1 year surgery.ResultsThere were 373 planned elective day case laparoscopic cholecystectomy performed during the study period. A bag was not used to retrieve the gallbladder in 41 % (n = 152) patients. A retrieval bag was used in the majority of patients (71 %) who required over night stay due to pain. Overall wound infection rate was low (2.4 %), with 57 % of those being in patients where no retrieval bag was used. An increase incision in the fascia was required in 9.7 % of patients. The majority of these were in patients in whom a retrieval bag was used (75 %). At 1 year follow up, there were no recorded cases of port site hernia for the no retrieval bag group and two (0.9 %) cases of umbilical port site hernias in the group where retrieval bag was used.ConclusionIn cases of elective uncomplicated laparoscopic cholecystectomy for radiologically confirmed benign disease there was no benefit in using a retrieval bag. Furthermore, not using a bag was associated with less need for increasing the size of the fascial incision thereby reducing post operative pain and risk of port site hernia.

Highlights

Since the introduction of laparoscopic surgery for gallbladder disease different types of retrieval devices have been used to extract the gallbladder from the peritoneal cavity
At 1 year follow up, there were no recorded cases of port site hernia for the no retrieval bag group and two (0.9 %) cases of umbilical port site hernias in the group where retrieval bag was used
While many retrieval devices have been developed and are frequently used across the world in laparoscopic cholecystectomy, there is no consensus on the optimal retrieval method

Summary

Introduction

Since the introduction of laparoscopic surgery for gallbladder disease different types of retrieval devices have been used to extract the gallbladder from the peritoneal cavity These devises infer additional costs and may lead to associated risks and complications. When the gall bladder is dissected free without spillage of its contents, there is no further benefit in placing it in a retrieval bag and further manipulation by trying to do so may lead to stone spillage. With these factors in mind, we aimed to evaluate

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