Minilaparotomy Cholecystectomy Research Articles

Preliminary Experience with Mini-Laparotomy Cholecystectomy in Jos.

Different techniques have been described for removing a diseased gall bladder; however, cholecystectomy via the laparoscopic approach is currently regarded as the gold standard. Laparoscopic surgery services are not widely available in low- and middle-income countries and mini-laparotomy cholecystectomy may be a suitable alternative in such circumstances. This technique achieves cholecystectomy with a smaller incision and affords the advantages of the laparoscopic approach. We report our experience over a 2-year period of 24 consecutive patients from two hospitals who underwent mini-laparotomy cholecystectomy to highlight our outcomes with the procedure. Data were obtained from the surgical theatre procedure register and medical records department of the hospital. During the study period, a total of 24 mini-laparotomy cholecystectomies were performed. Fourteen (58.3%) patients had a clinical diagnosis of calculous cholecystitis whereas 10 (41.7%) patients had symptomatic gallstones. There were four males (16.7%) and 20 females (83.3%) giving a male-to-female ratio of 1:5. The ages ranged from 18 to 68 years with a mean of 46.8 years (standard deviation (SD) = 12.7 years) and the mean operating time was 56.3 min (SD = 7.5 min) and ranged from 45 to 72 min. There was no conversion to the traditional large incision cholecystectomy. There were no intra-operative or post-operative complications and there was no mortality in the study. All the patients were discharged 48 h post-op. Mini-laparotomy cholecystectomy offers the benefits of a minimally invasive procedure such as good cosmesis and short hospital stay. It has a relatively short operative time and a low incidence of complications and can be practised in a low-resource environment, where laparoscopic services are not available.

Patient-reported Outcome Measure (PROM) Rand-36-item Health Survey for Gallstone Disease Patients Five Years Following Surgery: A Prospective Randomized Study.

There are no studies assessing the long-term quality of life (QoL) following three-dimensional laparoscopy cholecystectomy (3D-LC) in patients with cholelithiasis (Chole). A cohort of 200 patients with Chole were randomized into 3D-LC or minilaparotomy cholecystectomy (MC) groups. RAND-36 survey was performed before randomization, four weeks and five years postoperatively. Similar postoperative five years RAND-36 scores were reported in the 3D-LC and MC groups. The MC and 3D-LC groups combined analysis, social functioning (SF, p=0.007), mental health (MH, p=0.001), role physical (RP, p<0.001) and bodily pain (BP, p<0.001) domains increased significantly. In comparison to the Finnish reference RAND-36 (FRR) scores, the scores at five years increased significantly in the MH domain, while four RAND-36 domains; Physical functioning (PF), general health (GH), RP, BP remained significantly lower in comparison to the FRR scores. A relatively similar long-term outcome in the 3D-LC and MC patients is shown. Interestingly, five RAND-36 domains increased during five years follow-up, while four RAND-36 domains remained lower than FRR scores, which may indicate onset of possible new symptoms following cholecystectomy in long-term follow-up.

Surgical Treatment of Traumatic Liver Injury with Development of Biloma, Destructive Cholecystitis and Pseudoaneurysm: a Clinical Case

   Introduction. Traumatic liver injury is associated with the danger of developing various insidious complications, with some of them appearing immediately and others — eventually against a background of apparent clinical recovery. Modern sophisticated methods enable the character and localization of liver complications to be accurately revealed and those complications to be stopped by means of minimally invasive techniques.   Materials and methods. A clinical case of the traumatic hepatic rupture caused by a fall from height and the subsequent development of successive complications, which, except for the primary surgery — suturing of the liver rupture through laparotomy — were stopped by minimally invasive techniques.   Results and discussion. All complications that occurred and were subsequently treated have been divided into seven stages. Stage 1: rapid transfer of the patient to a multidisciplinary hospital. Stage 2: diagnostic laparoscopy followed by laparotomy and suturing of the liver rupture. Stage 3: puncture of the infected biloma. Stage 4: minilaparotomy cholecystectomy. Stage 5: antegrade percutaneous transhepatic drainage of the bile ducts. Stage 6: angiography of the hepatic artery and its branches. Stage 7: endovascular embolization of the pseudoaneurysm cavity.   Conclusion. The authors presented the clinical case in order to demonstrate the feasibility and proper application of minimally invasive techniques to manage various complications of liver injury, avoid resection, save life, and preserve quality of life.

A Possible Role of Interleukin-18 Binding Protein in Immune Regulation of Postoperative Pain: A Prospective Randomized Clinical Trial.

A possible role of interleukin-18 binding protein (IL-18BP) in immune regulation of pain and analgesics following surgery is rarely studied. The aim of this study was to investigate serum IL-18BP values in a cohort of laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) patients and to establish their relationship with other cytokines and number of analgesic doses (NAD) of LC and MC patients postoperatively. Blood levels of IL-18BP, six other interleukins (IL-18, IL-1ra, IL-6, IL-10, IL-1β, and IL-8) and high-sensitivity C-reactive protein were measured before operation (PRE), immediately after operation (POP1), and six hours after operation (POP2) in 114 patients with cholelithiasis. Following surgery, the mean serum IL-18BP values correlated significantly to numeric rating scale (NRS) pain scores at 24 hours (r=0.194, p=0.009). In addition, the mean serum IL-18BP values correlated significantly to NAD (r=0.254, p<0.001). IL-18BP, a soluble antagonist of IL-18, correlates to NRS and NAD in LC and MC patients, which may support a possible role of IL-18BP in immune regulation of postoperative pain.

Effectiveness and predictors of conversion in mini-laparotomy cholecystectomy in developing country: a cohort retrospective study

BackgroundMini laparotomy cholecystectomy (MLC) is an alternative surgical procedure in conditions where laparoscopic cholecystectomy (LC) is not feasible. MLC is a simpler and easier technique compared to LC. MLC involves smaller skin incision, low morbidity rate, and early return to oral diet. MLC has the potential to be the preferred surgical technique in developing countries due to its low cost and availability.MethodA cohort retrospective study was performed on 44 patients who underwent mini laparotomy cholecystectomy due to ineligibility for LC. Patients were documented for successful mini laparotomy or conversion to laparotomy cholecystectomy. There are pre-operative aspects recorded and analyzed to formulate predictor factors for conversion surgery, as well as intra-operative and post-operative aspects. Patients also filled evaluation questionnaire based on Likert Scale about their satisfaction towards result of MLC.ResultMLC is performed in 31 (70.5%) patients while 13 (29.5%) patients underwent conversion to open cholecystectomy. There were no complications nor mortalities observed during and after the surgery. Greater BMI, higher leucocyte count, higher bilirubin level, increasing severity of adhesion, and chronic cholecystitis were found to be statistically significant (p < 0.05) in the conversion surgery group. MLC also resulted in shorter post-operative hospitalization compared to conversion surgery. Patients showed great satisfaction towards the cosmetic aspect and recovery period after MLC procedure.ConclusionMLC is an effective surgery procedure for cholelithiasis and can be safely performed in patients with complication such as cholecystitis and gallbladder adhesion although these conditions increase the risk of conversion surgery.

Minilaparotomy Cholecystectomy: A Forgotten Art in Laparoscopic Cholecystectomy Era (Our Experience from a Peripheral Hospital in North India)

Background: This study aimed to report the experience of performing minilaparotomy cholecystectomy in a peripheral hospital by a single surgeon. Methods: Data collected from 50 consecutive patients undergoing minilaparotomy cholecystectomy by a single surgeon over 18 months at a peripheral hospital were reviewed and studied. The recorded data encompassed demographics, operating time, incision size, conversion rate to open cholecystectomy, perioperative complications, and hospital stay duration. Results: Fifty consecutive patients, who underwent minilaparotomy cholecystectomy for symptomatic cholelithiasis, were studied, among whom 48 patients were females. The participants’ mean age was 45 years. The length of the surgical incision was 4.5 - 6 cm, and only three patients required conversion to open cholecystectomy. The average operating time was 60 minutes; and the average postoperative hospital stay was 2.14 days. Conclusions: Minilaparotomy cholecystectomy is comparable with laparoscopic cholecystectomy in terms of postoperative morbidity, and it is ideal for peripheral hospitals lacking laparoscopic facilities.

Mini-laparotomy for cholecystectomy in resourced limited settings: a 10-year retrospective hospital-based study.

Cholecystectomy is a commonly performed abdominal procedure, the gold standard currently is the laparoscopic approach and, however, the facilities and expertise for laparoscopy are not available widely, especially in developing countries. A Mini-laparotomy cholecystectomy is an additional approach that is performed through an incision that is less than 5 cm thus minimizing the complications of the traditional open cholecystectomy and the postoperative hospital stay. The study aims to evaluate the outcome of mini-laparotomy cholecystectomy in terms of operative duration, complications, and hospital stay in a rural hospital. This is a retrospective study conducted in El-Dwaim Teaching Hospital, Sudan. All cases of mini-laparotomy cholecystectomy conducted from March 2009 to December 2020 were included and retrospectively studied. Descriptive statistics were applied using SPSS version 25. A total of 512 mini-laparotomy cases were involved in the study, of those 442 aged more than 40 years. The operation lasted less than 60 minutes for 486 of the participants, and the most frequent cholecystitis complication observed intraoperatively was mucocele, occurring in 70 (13.6%) participants. Intraoperative complications due to mini-laparotomy occurred in 4 (0.8%) cases, in the form of bleeding and none of the observed cases converted into open cholecystectomy. Postoperative complications occurred in the form of wound infection in 7 participants, biliary leak in 1 participant, and fistula formation in 1 participant. Post-operative hospital stay was 24 hours for 458 participants. Mini-laparotomy cholecystectomy is a safe minimally invasive approach with low rates of complications and short postoperative hospital stay, making it an optimum approach in facility-deprived countries.

Operating During the COVID-19 Pandemic: An Emerging Indication for Minilaparotomy Cholecystectomy

COVID-19 has required changes in the practice of surgery to reduce the risk of transmission of the virus. Proposed mitigation strategies include avoidance of aerosol-generating procedures such as laparoscopy. We report two cases where minilaparotomy cholecystectomy was employed to treat benign biliary disease during the pandemic. A review of the literature supports the use of this surgical technique during the COVID-19 pandemic until laparoscopy can be proven to be safe.

An evaluation of mini-laparotomy cholecystectomy in the laparoscopic era: a rural experience

Laparoscopic cholecystectomy (LC) is the gold standard for the management of symptomatic cholelithiasis and complications of gallstone disease. Mini laparotomy cholecystectomy (MOC) may be a more appropriate option in the resource constrained rural setting due to its widespread applicability and comparable outcome with LC. The study aimed to provide an epidemiological analysis of gallstone disease in the rural population and to evaluate the outcome of MOC in a rural hospital. A retrospective chart analysis of 248 patients undergoing cholecystectomy in a rural regional referral hospital in KwaZulu-Natal from January 2009 to December 2013 was undertaken. Of the 248 patients, the majority were females (n = 211, [85%]). The most frequent indications for cholecystectomy included: biliary colic (n = 115, [46.3%]); acute cholecystitis (n = 80, [32.3%]); gallstone pancreatitis (n = 27, [10.8%]). Forty cases (16.1%) were converted to open cholecystectomy (OC). The median operative time was 40 minutes (range18-57). Twenty-three morbidities (9.3%) occurred including: bile leaks (n = 6, [2.4%]); bleeding from drain site (n = 1, [0.4%]), incisional hernia (n = 8 [3.2%]) and wound sepsis (n = 8 [3.2%]). The median length of hospital stay in patients who underwent MOC was 48 hours (range: 24-72 hours) and the median time to return to work was 10 days (range: 4-14 days). There was one mortality in the entire cohort. MOC is a safe and feasible operation for symptomatic cholelithiasis when cholecystectomy is indicated. The low operative morbidity and mortality in the context of a high risk patient profile and complicated gallstone disease makes this procedure an alternative to LC where LC is inaccessible.

A comparative study of laparoscopic versus mini laparotomy cholecystectomy

Background: Gallstones are common in Indian population and its treatment has shown a decisive shift from open to minimally invasive route. There is no doubt that laparoscopy require longer and steeper learning curve and higher cost, especially in the absence of health insurance to majority of suburban and rural Indian population. However, preferences of patients are changing rapidly due to better level of awareness and availability of healthcare facility. Aims was to study safety and efficacy of laparoscopic cholecystectomy in patients of cholelithiasis by comparing withresults of mini laparotomy cholecystectomy by comparing use of post-operative analgesia, operative Time, post-operative hospital stay, morbidity and mortality.Methods: It is a prospective randomized study of 100 Patients of cholelithiasis aged between 25 years to 65 years operated during 2016-2017 at Dr. D Y Patil medical college Pune. They were divided into mini laparotomy and laparoscopic cholecystectomy group by draw a lot method. Patient’s written valid informed consent for the particular procedure was taken and the pros and cons of both the procedure were explained in detail to the patient. This study was done after due clearance of ethical committee.Results: The median (range) operation time for laparoscopic cholecystectomy was 50-175 min (mean=103.98 min) and 35-95 min (mean=70 min) for mini laparotomy cholecystectomy (p&lt;0.001). During the study period operation time for laparoscopic cholecystectomy showed a tendency to become shorter. The use of Injectable analgesics in case of laparoscopic cholecystectomy (Mean no. of days=1.5) is considerably less than mini laparotomy cholecystectomy (Mean no. of days=3.36). Conversion rate in literature in laparoscopic cholecystectomy ranges from 3% to 15% in well trained hands. In our series it is 6% in spite of being a teaching and training institution.Conclusions: Minimally invasive surgery is better than mini laparotomy cholecystectomy in terms of post-operative pain, analgesic requirement and early return to work. However, mini laparotomy cholecystectomy is preferred method for Surgeons in the beginning of their career and in case of difficult cholecystectomy.

Effective diagnosis for the management of gall stone: a clinical study

Background: Gallstones also known as cholelithiasis, is one of the most occurring and costly gastrointestinal disorder. Management of acute biliary cholelithiasis mainly involves pain control with non-steroidal anti-inflammatory drugs or narcotic pain relievers. However, surgical procedures like laparoscopic and mini-laparotomy cholecystectomy is also use for the management of it.Methods: Present clinical study gives an account of the diagnostic criteria for the effective management of acute biliary cholelithiasis, the diagnosis of gallstones was done by ultrasonography (USG).Results: Present study indicated females more (73.33 %) prone to occurrence of gallstone compared to males (26.67 %). Abdominal pain was the common feature in all the patients, with majority complaining (40 %) pain in right hypochondrium and epigastrium. Dyspepsia along with Nausea and vomiting was associated in 70 % and 66.66 % patients respectively. Tenderness and tenderness of hypochondrium were reported in 70 % and 30 % patients respectively. Ultrasonography served to be the major technique in diagnosing gallstones in the present study with success rate of 98.33 %.Conclusions: The present study concludes male-female ratio for occurrence of gallstones 1:2.75. Pain in the abdomen with nausea/vomiting and dyspepsia is the major clinical feature along with the occurrence of tenderness with elevated leucocytes count as one of the prime diagnostic criteria’s. Present study concluded ultrasonography (USG) as the correct technique in diagnosing gallstones.

Comparative study on Post-Operative complication between mini laparotomy cholecystectomy and standard conventional open cholecystectomy operated patient

Comparative study on Post-Operative complication between mini laparotomy cholecystectomy and standard conventional open cholecystectomy operated patient

Improvement in the quality of life following cholecystectomy: a randomized multicenter study of health status (RAND-36) in patients with laparoscopic cholecystectomy versus minilaparotomy cholecystectomy.

The assessment of the quality of life (QoL) in minilaparotomy cholecystectomy (MC) versus laparoscopic cholecystectomy (LC) with the ultrasonic dissection in both groups has not been addressed earlier. Initially, 109 patients with non-complicated symptomatic gallstone disease were randomized to undergo either MC (n=59) or LC (n=50). RAND-36 survey was conducted preoperatively and at 4weeks and 6months postoperatively. The end point of our study was to determine differences in health status in MC versus LC groups. QoL improved significantly in both groups, and the recovery was similar in the two groups, except from the higher score in 'health change' subscale at 4weeks in MC group [MC score 75.0 (25.0) vs. LC score 56.5 (23.2), p=0.008]. The MC and LC groups combined, RAND-36 scores increased significantly in 'physical functioning' [combined mean (SD) preoperative score 80.5 (23.9) vs. 6-month postoperative score 86.5 (21.7), p=0.015], 'vitality' [64.5 (19.2) vs. 73.5 (18.3), p=0.001], 'health change' [43.0 (21.6) vs. 74.6 (25.4), p=0.0001] and 'bodily pain' scores [57.7 (26.3) vs. 75.5 (25.5), p=0.001], respectively. Four RAND-36 domains indicated statistically significant health status differences in comparing the preoperative and postoperative RAND-36 scores in LC and MC groups combined. Four RAND-36 domains indicated a significant positive change in QoL after cholecystectomy.

The Rationality of Mini-Laparotomy Cholecystectomy in Symptomatic Gallbladder Disease: A Retrospective Cohort Study

Background Mini laparotomy cholecystectomy MC has recently gaining acceptance with increasing popularity as an alternative to open cholecystectomy OC The aim of the present study was to analyze the rationality of MC in gallbladder disease by comparison with laparoscopic cholecystectomy LC and OC Material and Methods Between January and January patients who underwent LC OC or MC were retrospectively analyzed In the MC group the abdominal skin incision was le cm Results Two hundred thirty patients underwent OC patients LC and patients MC The ASA III score was significantly higher in the MC group when compared to the OC and LC groups P lt P lt The frequency of acute cholecystitis was significantly higher in the MC and OC groups than the LC group P lt P lt The number of patients with coronary artery disease CAD was significantly higher in the MC group when compared to LC and OC groups P lt P lt No significant difference was found between the groups regarding the development of postoperative complications P gt The hospitalization period was significantly shorter in the LC group when compared with the OC and MC groups P lt P lt Return to normal daily activity was significantly shorter in the LC group when compared with the OC and MC groups P lt P lt Cost of treatment was significantly less in the MC group than the LC and OC groups P lt P lt Conclusion MC is a safe practical and cost effective procedure which can be considered where LC is not applicable

The plasma 8-OHdG levels and oxidative stress following cholecystectomy: a randomised multicentre study of patients with minilaparotomy cholecystectomy versus laparoscopic cholecystectomy

Objective: The aim of the study was to evaluate the role of 8-OHdG (8-hydroxy-2′-deoxyguanosine) detecting oxidative stress response following cholecystectomy in a randomised multicentre study of patients with minilaparotomy cholecystectomy (MC) versus laparoscopic cholecystectomy (LC).Methods: Initially, 106 patients with non-complicated symptomatic gallstone disease were randomised into MC (n = 56) or LC (n = 50) groups. Plasma levels of the oxidative stress marker 8-OHdG measured at three time points; before (PRE), immediately after (POP1) and 6 h after operation (POP2).Results: The demographic variables and the surgical data were similar in the study groups. The plasma oxidative stress marker 8-OHdG concentrations following surgery in the MC versus LC patients were quite similar. There was no significant correlation between the individual values of the11-point numeric rating pain scale (NRS) versus the plasma 8-OHdG post-operatively in the MC and LC patients. However, there was a statistically significant correlation between the individual values of the plasma 8-OHdG (PRE) versus IL-10 (PRE) for the MC and LC patients (r = 0.214, p = 0.037). There was also a statistically significant correlation between the individual values of the plasma 8-OHdG (POP2) versus IL-1β (POP2) for the MC and LC patients (r = 0.25, p = 0.01).Conclusion: Our results suggest that the oxidative stress marker 8-OHdG concentrations following surgery in MC versus LC patients were quite similar. A new finding with possible clinical relevance is a correlation between the individual plasma values of the 8-OHdG versus anti-inflammatory interleukin IL-10 and 8-OHdG versus IL-1β (proinflammatory) in the MC and LC patients suggesting that inflammation and oxidative stress are related.

Experience in the implementation of minilaparotomy cholecystectomy in acute cholecystitis access complicated about cystic infi ltrates

In this paper shows the results of treatment of 47 patients with a cloelithiasis, complicated by an acute cholecystitis and paravesical infi ltrate by using atypical ways of a cholecystectomy from minilaparotomy access. Criteria and indications for performance universally recognized cholecystectomy from minilaparotomy access, from a bottom and by Pribram are showed. Rational receptions of operating and tool maintenance of a hemostasis are detailed at minicholecystectomy in the conditions of dense paravesical infi ltrate. It is shown that frequency of conversion at the acute cholecystitis complicated by dense infi ltrate, at performance of atypical ways minicholecystectomy, makes 4,2 % that is statistically authentic more low, than at performance standard minicholecystectomy at which frequency of conversion reaches 15 %. Introduction of atypical ways of minicholecystectomy at destructive forms of the acute cholecystitis complicated by dense paravesical infi ltrate, reduces risk of damage of anatomic formations of a hepatoduodenal ligament, and number of intra and postoperative complications from 12,7 to 2,1 %.

Mini Cholecystectomy: a comparison with Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the gold standard procedure for symptomatic gallstones but at a higher price. Recently a few studies comparing mini cholecystectomy to laparoscopic cholecystectomy have shown that mini cholecystectomy has comparable results to laparoscopic cholecystectomy at an affordable price. We compared these two techniques over a period of two years.224 patients were studied, 122 had laparoscopic and 102 had mini laparotomy cholecystectomies. Results showed that operation time and theatre cost were low in mini laparotomy cholecystectomies but these patients required more post operative analgesics. There was no significant difference in total hospital stay and resumption to routine activities. Total cost to hospital and patient was also similar for these two techniques. There were two common bile duct injuries in laparoscopic group and none in mini cholecystectomies and there was no mortality in either group. We conclude that results of mini laparotomy cholecystectomy are very much simi lar to laparoscopic cholecystectomy and it can be used as an alternative to laparoscopic technique.

Minilaparotomy cholecystectomy in elderly and senile patients

Aim. To evaluate the efficacy of minilaparotomy access and programmed treatment of cholecystectomy complications in elderly and senile patients.Methods. 160 patients (113 women and 47 men), who underwent surgery in the period from 2010 to 2012 in the departments of surgery at the Municipal clinical hospital №1 (Bishkek), were followed-up. Patients mean age was 68.4±3.5 years. Cholecystectomy and biliodigestive anastomoses were performed using mini-access in all patients. In addition to clinical and laboratory diagnostic methods, ultrasound examination with gallbladder projection detection on the anterior abdominal wall to select surgical approach was used.Results. The surgery results of 160 elderly and senile patients with acute cholecystitis who underwent minilaparotomy cholecystectomy are presented. In 12 (7.5%) patients after cholecystectomy, choledochotomy (or choledochoduodenostomy) was performed to remove stones from the common bile duct; external drainage of the common bile duct by Ker or A.V. Vishnevskiy was performed on 10 of them, and in 2 cases choledochoduodenoanastomosis by Yurash-Vinogradov was imposed. Complications were registered in 9 (5.6%) patients. 1 patient died as a result of pulmonary embolism developed on the 5th day after the surgery. Conversion rate was 5% (8 patients). Treatment of complications was performed by developed and implemented in the clinic algorithm (regional lymphostimulation, breathing exercises, infrared laser irradiation). The average hospital stay of patients without complications was 7.8±0.87 bed-days, and patients with complications - 9.4±0.14 bed-days.Conclusion. Our observations showed the possibility to perform surgery for acute cholecystitis in elderly and senile patients by the minilaparotomy access in case of taking into account patients general condition, following the surgical technique and the active management of the postoperative period.

Inflammatory response to surgical trauma in patients with minilaparotomy cholecystectomy versus laparoscopic cholecystectomy: a randomised multicentre study

ABSTRACTObjective The aim of the study was to evaluate the inflammatory response to surgical trauma in minilaparotomy cholecystectomy (MC) compared to laparoscopic cholecystectomy (LC). Assessment of inflammatory response to surgical trauma in MC has not been addressed properly. Therefore, we investigated five interleukins (IL) and C-reactive protein (CRP) in MC versus LC group in a prospective randomised trial. Methods Initially, 106 patients with non-complicated symptomatic gallstone disease were randomised into MC (n = 56) or LC (n = 50) groups. Plasma levels of five interleukins (IL-1β, IL-1ra, IL-6, IL-8, IL-10) and hs-CRP were measured at three time points; before operation (PRE), immediately after operation (POP1) and six hours after operation (POP2). The primary end-point of the study was to compare the plasma levels of five interleukins and CRP in LC versus MC group. Results The demographic variables and the surgical data were similar in the study groups. The patients in the MC group had higher elevation of the CRP mean values post-operatively (p = 0.01). However, the patients in the MC group had higher elevation of the IL-1ra mean values post-operatively, the mean pre-/post-operative IL-1ra values being 299/614 pg/ml in the MC group versus 379/439 pg/ml in the LC group (p = 0.003). There was no statistical significance in IL-6 mean values between the MC and LC groups pre- and post-operatively (POP1). However, the patients in the MC group had higher IL-6 mean values six hours post-operatively (POP2), the mean IL-6 values being 27.6 pg/ml in the MC group versus 14.8 pg/ml in the LC group (p = 0.037). In addition, the patients in the MC group had higher elevation of the IL-6 mean values post-operatively, the mean pre-/post-operative IL-6 values being 4.1/27.6 pg/ml in the MC group versus 3.8/14.8 pg/ml in the LC group (p = 0.04). There was no statistical significance in IL-8, IL-10, and IL-1β mean values between the MC and LC groups pre- and post-operatively. Conclusion Our results suggest that the inflammatory response in MC versus LC groups was similar based on the IL-8, IL-10, and IL-1β values. A new finding with possible clinical relevance in the present work is higher relative elevation of the IL-1ra and IL-6 mean values post-operatively in the MC group.

A randomized multicenter study of minilaparotomy cholecystectomy versus laparoscopic cholecystectomy with ultrasonic dissection in both groups

Objective: Ultrasonic dissection (UsD) has been used in laparoscopic cholecystectomy (LC), though it is not the golden standard technique. Applying UsD to cholecystectomy by minilaparotomy (MC) is less common and there are no prospective randomized trials comparing these two techniques. Therefore, we conducted the present study to investigate the use of the UsD in the MC versus the LC procedure. Material and methods: Initially 104 patients with non-complicated symptomatic gallstone disease were randomized into MC (n = 53) or LC (n = 51) groups, both groups using UsD, over a period of 2 years (2013–2015). The study groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score. Results: The demographic variables and the surgical data were similar in the study groups. Similar low postoperative pain scores were reported in the two study groups during the first four hours after surgery. The incidence of nausea/vomiting was similar between the two study groups, 47% in the MC group versus 42% in the LC group. However, the patients in the MC group were treated more frequently with antiemetics, the incidence being 39% in the MC group versus 21% in the LC group (p = 0.02). The pain at rest at 24h after the surgery was similar in the two study groups, but the LC patients reported less pain at the normal activity, the mean of numerical rating scale (NRS) of 0–10 score being 3.9 in the MC group versus 2.9 in the LC group (p = 0.05), and the pain at the quick movement/coughing, the mean NRS being 4.9 in the MC group versus 3.2 in the LC group (p = 0.005). The length of sick leave was 17.4 days in the MC group and 14.4 days in the LC group (p = 0.05). Conclusion: Our results suggest that both MC and LC are feasible and safe options for mini-invasive cholecystectomy. A new finding with clinical relevance in the present work is a relatively similar short-term outcome in the MC and LC althought the LC patients reported significantly lower pain score 24 hours postoperatively and a shorter convalescence.