The possibilities of single-port laparoscopic access in cholecystectomy after operations on the abdominal cavity organs

Abstract

Aim. To assess the possibility and effectiveness of single-port access in cholecystectomy using for chronic calculous cholecystitis in patients who were previously operated on the abdominal organs. Materials and Methods . For the period from September 2015 to March 2017, 27 patients were been operated by laparoscopic cholecystectomy using single-port access for chronic calculous cholecystitis. All patients were divided into 2 groups. The first group included 12 (44.4%) patients with previous surgery on the abdominal organs, who were performed laparotomy. The second group (2) included 15 (55.5%) patients who didn’t have surgical interventions on the abdominal organs. Results and Discussion . The average duration of surgical intervention in patients of the 1 st group (n = 12) was 87.66 ± 4.03 minutes. In all cases chronic calculous cholecystitis was observed. There was no transition to open cholecystectomy. The average bed-day was 2.41 ± 0.20. Drainage of the abdominal cavity was carried out only for 7 patients (58.3%). In 7 (58.3%) patients opioid analgesics were prescribed once to reduce postoperative pain. Activation of patients occurred on the first day after the operation. After 2 days the ultrasound of the abdominal cavity was performed. In 2 (16.6%) patients there was a slight accumulation of fluid in the region of the removed gallbladder that did not require puncture. Patients in the second group in all cases were performed a single-port cholecystectomy without additional trocars. The average duration of the operation was 38.93 ± 1.85 minutes. In all cases chronic calculous cholecystitis was observed. Conversions to the open methodology have not been noted. The average bed-day was 2.06 ± 0.07.Drainage of the abdominal cavity has not been performed. In 2 (13.3%) cases opioid analgesics were prescribed once for postoperative pain relieving. Activation of patients occurred on the next day after the operation. After 2 days on the day of releasing from the hospital the ultrasound of the postoperative zone was performed, fluid accumulation in the area of the gallbladder bed was noted in 1 (6.6%) of the patient. Conclusions. The use of single-port access in laparoscopic cholecystectomy performing is an effective way. The features of a single port structure provide the possibility of curved instruments additional application, increase the number of single-port laparoscopic interventions in patients with chronic calculous cholecystitis.