Port Laparoscopic Cholecystectomy Research Articles

Three Ports Versus Four Ports Laporoscopic Cholecystectomy

Background: A four trocar laparoscopic cholecystectomy become the standard procedure since the first laparoscopic procedure was reported. But laparoscopic cholecystectomy has gained many steps such as reduction in port number and size. Objective: To compare Clinical results from three ports versus the traditional four ports in laparoscopic cholecystectomy. Patients and Methods: A prospective randomized clinical trial of 100 patients was done on those who were admitted for elective laparoscopic cholecystectomy in Baquba teaching hospital, between April 2014 and March 2015, patients were classified into two groups (A) for three ports and (B) for 4 ports. Variables such as, complications, operative time, postoperative pain, nausea, and vomiting were assessed. Results: One-hundred patients were included in this study, age of them ranged from 18-70 year and a male to female ratio was 1:9. There were no significant differences in demographic data between the two groups. Postoperative pain, analgesic requirements, nausea and vomiting, and hospital stay were slightly more in group B but statistically not significant. Postoperative return to activity was shorter in group A 6.10 versus 7.00 days for group B with (p= 0.021) which is statistically significant. There is no difference in the rate of complications. Conclusion: Three ports laparoscopic cholecystectomy is feasible as an alternative for four ports without any significant complication. Keywords: Laparoscopy; Cholecystectomy; Postoperative complications

Frequency of port site infection following gall bladder removal through Epigastric vs Umbilical port.

Objective: To compare the frequency of port site wound infection following gall bladder removal through umbilical and epigastric port in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Surgical Unit 2, Ghulam Muhammad Mahar Medical College, hospital Sukkur. Period: 1st November 2019 to 30th October 2020. Material & Methods: All cases who underwent four port laparoscopic cholecystectomy were enrolled in two groups. All procedures were performed under general anesthesia. As the last event of surgery gall bladder was retrieved in a glove bag through umbilical port in group A and through epigastric port in group B, both under direct camera vision. Wound infection was considered if there was 3 to 5 grade of wound according to Southampton wound grading system (Figure-1) on 5th postoperative day. All demographics and outcome variables were recorded. Results: Age ranged from 20 to 60 years with mean age of 38.875±8.11 years, BMI 29.973±5.12 Kg/m2, duration of surgery 50.656±8.41 mins and Southampton score was 1.044±1.07 in Group A and mean age of 38.560±6.23 years, BMI 27.437±5.04 Kg/m2, duration of surgery 48.920±8.67 mins and Southampton score was 0.856±0.92 in Group B. In group A, 18 (5.7%)patients developed port site wound infection in contrast to 5 (1.6%) patients in group B (P= 0.006). Conclusion: We conclude that epigastric port retrieval of gall bladder following laparoscopic cholecystectomy results in less port site infection.

Is single port laparoscopic cholecystectomy superior to standard cholecystectomy in post-operative pain?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: is single port laparoscopic cholecystectomy superior to standard cholecystectomy in post-operative pain? Using the reported search, 8083 papers were found. 8 studies were deemed to be suitable to answer the question. The outcomes assessed were post-operative pain differ in single or standard laparoscopic cholecystectomy, all study used VAS (visual analogue scale). The evidence showed no difference in post-operative pain for patients went for single laparoscopic in compared with standard laparoscopic cholecystectomy.

Shoulder Tip Pain in Laparoscopic Cholecystectomy with Active vs Passive Evacuation of Pneumoperitoneum

Objective: The objective of the study was to compare the frequency of severity of shoulder tip pain after active (gas suctioning) and passive removal of pneumoperitoneum among patient undergoing laparoscopic cholecystectomy. Methods: This Observational comparative study was directed in general surgery department of DOW university hospital beginning from February 2016 to February 2017. Two hundred and six patients undergoing standard 4 port laparoscopic cholecystectomy were enrolled equally in either groups. The surgeon evacuated the abdomen by using a multiporous suction tube limiting the negative suction pressure to - 40 mmHg for 2-5 minutes under direct vision in active aspiration group, while in control group, CO2 was removed passively. Pain scores were recorded using visual analog score at 16 hours post-operatively by residents of surgery blinded to the study. Results: Mean VAS pain score at 16 hours in intervention group was much inferior than control group 1.00 ±2.09 vs. 3.06 ± 2.58 ( p < 0.001). Conclusion: Active aspiration of CO2 is an effective method that removes most if not all gas from the abdominal cavity. This will cause statistically significant decrease post-operative discomfort, pain and decrease need of rescue analgesics. Key Words: Laparoscopic cholecystectomy, Pneumoperitoneum, Active Aspiration, shoulder tip pain, post- laproscopic cholecystectomy pain How to Cite: Arif A, Nofal S, Khan MA, Khan AW, Bhatti AM, Ishaq SH. Shoulder tip pain in laparoscopic cholecystectomy with active vs passive evacuation of pneumoperitoneum. Esculapio. 2020;16(04):116-119.

胆囊炎に対する細径鉗子を用いたReduced Port Laparoscopic Cholecystectomy

胆囊炎に対する細径鉗子を用いたReduced Port Laparoscopic Cholecystectomy

Role of a modified epigastric port in reducing post operative pain and causing early ambulation in a patient undergoing laparoscopic cholecystectomy as compared to a standard four port procedure, a randomized controlled study

Background: Standard four port laparoscopic cholecystectomy is the gold standard in the treatment of gall stones. Modified epigastric port laparoscopic cholecystectomy may be considered an alternative, as this procedure maintains the advantages of four ports and does not require any special set of instruments. In this study we aimed to see whether this procedure is comparable to the standard four port laparoscopic cholecystectomy based on the primary objectives of postoperative pain score, degree of ambulation, time to return to normal activities.Methods: Consecutive patients due to undergo laparoscopic cholecystectomy, meeting all the predefined criteria were recruited into the study. The group A was assigned to receive intervention in the form of modified epigastric port laparoscopic cholecystectomy. The group B was assigned to receive intervention in the form of standard four port laparoscopic cholecystectomy. Patients in group A were compared with patients in group B based on multiple pre-defined parameters.Results: Pain scores were significantly better in group A. Degree of ambulation at was significantly better in group A. In respect to the time to resumption of normal activities there was no significant difference between the two groups. When comparing the quality life at 1 month following surgery with SF-36 health survey, the patients in group A did better than patients in group B with respect to the six scales. Conclusions: Modified epigastric port laparoscopic cholecystectomy appears to be significantly better than the standard four port cholecystectomy in terms of postoperative recovery.

Comparative Evaluation of Efficacy of Three Port Versus Standard Four Port Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy has established itself firmly as the “gold standard” for thetreatment of gallstone disease. The present study was conducted to compare three portversus standard fourport laparoscopic cholecystectomy.Materials and Method: The present study was conducted on 120 gall stones patients of both genders. Allpatients were divided into two groups viz. group I who were subjected to the three port technique and groupII patients who were subjected to the conventional four port technique. Intra- operative findings, pain scoreetc. was compared.Results: The mean VAS was 2.14 in group I and 4.30 in group II and mean operative time was 51.2 minutesin group I and 62.1 minutes in group II. Intra- operative complications were perforation seen 6 patients ingroup I and 4 in group II, stone spillage 4 in group I and 3 in group II, bleeding from liver 5 in group I and4 in group II, cystic artery bleeding 2 in group I and 1 in group II. Post- operative complications were feverseen 4 patients in group I and 7 in group II, vomiting 5 in group I and 6 in group II, Basal pneumonitis 3 ingroup I and 5 in group II, seroma 1 in group I and 2 in group II.Conclusion: Authors found that three port laparoscopic cholecystectomy found to be better thanstandardfour port laparoscopic cholecystectomy

Three port versus four port laparoscopic cholecystectomy: a prospective comparative clinical study

Background: Although, traditional laparoscopic cholecystectomy is performed using four-port technique, various modifications were made to further enhance the advantages of laparoscopic cholecystectomy. Aim of the study is to compare the results of three-port and four-port laparoscopic cholecystectomy at single centre in terms of technical feasibility, safety of the procedure, operative time, intra-operative complications, postoperative pain and post-operative analgesia requirement.Methods: It was a prospective comparative study conducted in the department of surgery Smimer medical college Surat, India from July 2018 to July 2019. The study was performed on all adult patients with ultrasound documented cholelithiasis. The total number of patients studied was 50 which were divided into two groups of 25 each.Results: Demographic data were comparable for both study groups. Patients in the 3-port group had shorter mean operative time (47.3±29.8 min versus 60.8±32.3 min) for the 4-port group (p=0.04). Post-operative requirement of analgesia was less in 3 port group as compared to 4 port group. Pain visual analog scale (VAS) score, intra operative complications, post- operative complications and return to normal activity were significant in our study. Hospital stay and patient satisfaction were non- significant.Conclusions: The three-port technique is as safe as the standard four-port technique and can be a viable alternative to four port cholecystectomy with an advantage of less analgesic requirement, early post-operative ambulance, early oral feed, and better cosmetic results.

Comparison of 3-port with standard 4-port laparoscopic cholecystectomy: A clinical trial

Introduction: Since the laparoscopic cholecystectomy was introduced first in 1990, the 4-port laparoscopic cholecystectomy was the gold standard. The 4-port (lateral) is used to hold gallbladder fundus and observe Calot's triangle. It is discussed that the 4-port technique is not required in many patients. Therefore, this study aimed to make a comparison between 3-port and 4-port laparoscopic cholecystectomy methods in the treatment of gallstone disease. Methods: A double-blind clinical trial was performed on patients admitted to Imam Reza Hospital, Birjand, Iran. The patients with gallstone disease (n=60) were randomly assigned into the case (3-port) and control (4-port) groups using balanced block randomization and underwent 3- or 4-port laparoscopic cholecystectomy. Postoperative pain was measured by a visual analog scale four h after surgery. The amount of pain-killer, duration of surgery, as well as length of stay and scars were measured in this study. Data were analyzed statistically in SPSS software (version 18) through the Chi-square test and t-test. A p-value less than 0.05 was considered statistically significant. Results: The groups were compared in terms of demographic characteristics. There were 24 females (80%) and 6 males (20%) in the control group and 25 females (83.4%) and 5 males (16.7%) in the case group (P=0.739). Moreover, the mean ages of the control and case groups were 59.823±7.8 and 61.10±4.7, respectively, and there was no significant difference between the groups in this regard (P=0.348). Furthermore, length of operation (P=0.001) and analgesic consumption (P=0.001) in the 3-port laparoscopic cholecystectomy group were lower than those in the 4-port group; however, the hospital stay (P=0.896) was the same in both groups. Conclusions: The 3-port laparoscopic cholecystectomy is a safe, reliable, and cost-effective method in patients who underwent laparoscopic cholecystectomy.

Prospective Randomized Controlled Study to Compare the Outcome of Standard 4-Port Laparoscopic Cholecystectomy with Single-Incision Laparoscopic Cholecystectomy in Patients with Gallstone Disease

Four-port laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallbladder disease. To reduce the invasiveness of standard four-port laparoscopic cholecystectomy, single-incision laparoscopic cholecystectomy (SILC) has come about an attractive option for the performance of laparoscopic cholecystectomy. There have been no studies on SILC from Indian subcontinent. The present study was designed to compare the outcomes of SILC with the standard four-port LC in a prospective randomized controlled trial. All patients with symptomatic gallstone disease were evaluated between May 2012 and April 2014. Patients were randomized to either standard four-port laparoscopic cholecystectomy (LC group) or single-incision laparoscopic cholecystectomy (SILC group). Demographic profile, preoperative and intraoperative variables, postoperative complications, hospital stay, and pain scores were recorded. WHO-QOL BREF was used for quality of life analysis. Patients were followed up at regular intervals, and satisfaction scores were recorded. Statistical analysis was done using STATA 12 and p value < 0.05 was considered significant. Out of 94 patients, 90 received the intended treatment, and four cases in SILC group were converted to standard four-port cholecystectomy. The demographic profile and preoperative WHO-QOL BREF scores were comparable between the two groups. Severity of adhesions, successful dissection of Calot’s triangle, ergonomics, and overall level of difficulty were also comparable. Operation time was significantly higher in SILC group, but the learning curve was seen to be achieved after 30–35 cases. There was no significant difference in the incidence of immediate postoperative and chronic pain over a mean follow-up of 6 months except for pain score during normal activity in immediate postoperative period which was significantly higher in SILC group. Overall complication rate was significantly higher in SILC group, however the incidence of SSI was not found to be significant among the two groups. There was one case of transient bile leak and one case of intra-abdominal bleeding due to slippage of cystic artery clip. Postoperative quality of life outcomes were similar in the two groups. Although not significant, patients with SILC group had higher cosmetic score compared with the LC group. In conclusion, this study shows that SILC is a safe and feasible with a higher rate of complications but comparable cosmetic and QoL outcomes when compared with standard 4-port cholecystectomy.

Cholecystohepatic duct detected during laparoscopic cholecystectomy: a case report

BackgroundThe cholecystohepatic duct is a rare form of an aberrant hepatic duct that connects to the gallbladder. Although cholecystohepatic duct is reported to be a very rare anomaly, injury of cholecystohepatic duct during cholecystectomy may result in serious complications. Herein, we present a case of cholecystohepatic duct in the ventral branch of the right posterior inferior segmental bile duct detected during laparoscopic cholecystectomy.Case presentationA 77-year-old woman with cholecystolithiasis had been referred to our hospital for surgery. Drip infusion cholecystocholangiography-computed tomography revealed a bile duct branch without communication between the intra- and extrabiliary systems, although the existence of this aberrant hepatic duct was not suspected preoperatively. A 4-port laparoscopic cholecystectomy was performed. After critical view of safety was confirmed, the cystic artery and duct were divided after double clipping. During antegrade mobilization of the gallbladder from the gallbladder bed, a thin, white cord-like material connecting the gallbladder neck and bed was detected. After clipping and dividing it, a cholecystohepatic duct injury was recognized through rechecking the results of the preoperative examinations. Biliary reconstruction was considered unnecessary because of the lesion’s small drainage area. The postoperative course was uneventful, and an enhanced computed tomography performed 6 months after the surgery revealed a dilation in the ventral branch of the right posterior inferior segmental bile duct. The patient’s liver function remained normal, and she had no symptoms of cholangitis 42 months after the surgery.ConclusionsAlthough cholecystohepatic duct is a rare anomaly compared to other aberrant hepatic ducts, surgeons performing cholecystectomy should always keep its existence in mind to avoid serious postoperative complications. Ideally, preoperative detection of cholecystohepatic duct is preferable, but even if it is detected during surgery, the appropriate management according to the drainage area is also important.

3 Port vs 4 Port laparoscopic cholecystectomy in gall stones disease

Background:Gallstones or cholelithiasis constitute a significant health problem in developed societies and developing countries. We have shifted from open cholecystectomy to laparoscopic cholecystectomy as gold standard because of reduced morbidity and mortality. In this study, it is observed that just by reducing the port number, we could further reduce morbidity. Methods of Study: Sixty patients who had gall stone disease and subjected to laparoscopic cholecystectomy were randomized to undergo either the 3 port or 4 port technique. Intraoperative -Operative Time, Difficulty encountered, Post-operative pain was assessed on 12 hrs, 24 hrs pod3 and pod5, analgesic requirement after POD 1, Postoperative stay in hospital, return to normal activityResults: Demographic data was comparable for both groups. Patient in the 3-port group had shorter operative time (54.2+ 12.9 min vs 75.8 +26.28 min), Reduced pain score, reduced analgesic usage(4.1vs 6.3 doses), early discharge(3.6 vs 5 pod), early return to work (4.1 vs 5.8)Conclusion: Hence 3 port laparoscopic cholecystectomy is technically feasible, safe, and beneficial.

Readmission to hospital following laparoscopic cholecystectomy: ameta-analysis.

Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedures. Despite this, patterns of readmission following LC are not well defined. This meta-analysis aimed to determine rates and predictors of readmission. An ethically approved International Prospective Register of Systematic Reviews (PROSPERO)-registered meta-analysis was undertaken searching PubMed, Scopus, Web of Science and Cochrane Library databases from January 2013-June 2018 adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Published literature potentially suitable for data analysis was graded using methodological index for non-randomised studies (MINORS) criteria; papers scoring ≥ 16/24 for comparative and ≥ 10/16 for non-comparative studies were included. A meta-analysis of potential risk factors was performed by computing the odds ratio using Mantel-Haenszel method and fixed-effects model with 95% confidence intervals. Three thousand and eight hundred thirty-two articles were reduced to 44 studies qualifying for a final analysis of 1,573,715 laparoscopic cholecystectomies from 25 countries. Overall readmission rate was 3.3% (range: 0.0-11.7%); 52,628 readmissions out of 1,573,715 LCs. Surgical complications accounted for 76% of reported reasons for readmission, predominantly bile duct complications (33%), wound infection (17%) and nausea and vomiting (9%). Pain (15%) and cardiorespiratory complications (8%) account for the remainder. Obesity, single port LC and day case LC were not associated with increased rates. Pain, nausea and vomiting and surgical complications, particularly bile duct obstruction are the most common causes for readmission. Intra-operative cholangiography may reduce readmission rates. Causes for readmission were inconsistently reported throughout. The mean readmission rate of 3.3% may act as a quality benchmark for improving LC, and clearer reporting of reasons for readmission are required to advance care.

Postoperative Pain after Gallbladder Retrieval from Umbilical and Epigastric Ports in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Objective: To compare the postoperative pain after gallbladder removal from umbilical port site versus epigastric port site, after four ports laparoscopic cholecystectomy. Methods: Randomized controlled trial was performed from January 2017 till January 2018, at a private hospital setup, with patients of either gender, age 18 years and above, planned laparoscopic cholecystectomy for symptomatic cholelithiasis were considered. Patients having polyps in gallbladder, empyema, mucocele or perforated gallbladder requiring emergency surgery were excluded. They were randomly assigned, 65 patients in which gallbladder removed through umbilical port (group A) and 65 in which epigastric port was used for gallbladder removal (group B). Postoperative pain was determined after one day, at the time of discharge from hospital and after one month of surgery, with the help of Numerical Analogue Scale (NAS). Results: From a total of 130 patients, 65 patients in group A had median (IQR) pain scores of 5 (1.5), 4 (1) and 2 (1) as compared to group B pain scores of 4 (1), 2 (1) and 1 (0.5) at one day post-surgery (p-value=0.000), at discharge from hospital (p-value<0.001) and after a month of surgery (p-value<0.001), respectively. A definitive decline in the postoperative pain scores was evaluated in group B from the day of operation till a month after surgery during follow up visits (p-value<0.001). Conclusion: Epigastric port site removal of gallbladder produced less postoperative pain after removal of gallbladder as compared to the umbilical port site. We therefore are in favor of removal of gallbladder from epigastric port site.

TWO PORTS VERSUS FOUR PORTS LAPAROSCOPIC CHOLECYSTECTOMY (THE USE OF STRATEGIC EXTRACORPOREAL STITCHES)

Four ports laparoscopic cholecystectomy (LC) has been the standard for treatment of the symptomatic cholelithiasis. Herein, the experience of two-ports LC regarding its safety and feasibility was given. This study was conducted in Theodor Bilharz Research Institute (TBRI) in the period from November 2017 till April 2018, as a prospective randomized study including one hundred patients with chronic calcular cholecystitis, which were divided into two equal groups. The study compared between group A (GA) which underwent four ports LC and group B (GB) which underwent two ports LC.The results showed that in GA, no cases were converted to open cholecystectomy. But, in GB only two patients converted to three-port laparoscopic cholecystectomy. There were no intraoperative complications encountered in any patient in both groups. In GA, operative time ranged between 28-62 minutes (mean±44.57) while in GB, operative time ranged between 39-134 minutes (mean±59.93); with hospital stay of three days in both groups. The pain score showed statistically significant differences regarding port-site pain (P value = 0.040). Significant lower analgesic demands were recorded in the 2 ports group. Scar satisfaction showed a marked statistically significant differences regarding the aesthetic results between the two groups (P value = 0.0319).

Feasibility and outcomes of 3-port laparoscopic cholecystectomy in the pediatric population

Objective: The objective of this retrospective study was to describe our experience with 3-port laparoscopic cholecystectomy in a total 20 pediatric patients. Method: Data on patient demographics, indication for cholecystectomy, surgical technique, operative time (minutes), complications and length of hospital stay (LOS, day) were recorded. Result: Mean (SD) operative time was 44.8 (9.5, range: 30.0-60.0) minutes and LOS was 2.1(1.2, range: 1.0-5.0) days. Surgery was successful in all patients without development of major complications. Apart from significantly shorter operative time in patients with cholelithiasis than those with other indications for laparoscopic cholecystectomy (median 42.2 vs. 55.0 min, p=0.001), no significant difference was noted in age, operative time and LOS with respect to gender or indications. Conclusion: Our findings indicate safety and efficacy and feasibility of 3-port laparoscopic cholecystectomy in the pediatric population, regardless of indication or gender along with significant advantages regarding the operative time, complication rates and hospital stay.

A comparative evaluation of three port versus standard four port laparoscopic cholecystectomy in SGRRIMHS and SMIH Dehradun

Background: Cholelithiasis is one of most common condition requiring surgical intervention specially in females in Indo-Gangetic belt. Techniques of cholecystectomy have evolved from open to laparoscopic procedures. Efforts have been made to perform it with lesser ports for better operative outcomes like less complications and better cosmetic appearance. This study aims to compare the postoperative outcomes of 4 port versus 3 port laparoscopic cholecystectomy.Methods: This is a prospective comparative study. 104 patients for 4 port laparoscopic cholecystectomy and 110 patients for 3 port cholecystectomy were allocated randomly. Preoperative assessment was done in both the groups and Informed consent was taken. Intra operative parameters like duration of surgery, blood loss, surgical complications were assessed. Postoperative follow up was done at 1 week, and scar assessment at 2 weeks. Findings were entered in Microsoft Excel and analyzed using SPSS by applying t-test and chi-square test.Results: Female: male ratio was 14:1 and age varied between 32-51 years. The mean operative time was in 3 port was 64.6 min and 56.42 min in 4 port (p&lt;0.05). Complications like conversion to open procedure, bleeding from liver bed, cystic artery bleeding and port site infections were comparable in both groups. Analgesic requirement was significantly less after 24 hours in 3 port (p=0.02).Conclusions: 3 ports cholecystectomy is better in terms of lesser postoperative pain, cosmetic outcome, hospital stay, lesser assistance. The authors recommend 3 ports LC as a routine procedure in gallstone diseases.

Modified technique for two ports laparoscopic cholecystectomy: combined safety and economic value

Context The surgeons have tried to reduce the size and number of ports to reduce morbidity and improve the cosmetic appearance in laparoscopic surgery. Aims Assessment of safety and economic value of two-port laparoscopic cholecystectomy using traction stitches after adding left-sided traction stitch to Hartman’s pouch (third stitch) to increase the range of movement (dynamicity) of gall bladder neck (puppet show technique). Patients and methods Between July 2017 and January 2019, 50 patients with symptomatic cholelithiasis were involved into this study (36 females and 14 males) their age 18–65 years (mean±SD=41.6±11.4 years). All the cases were done using two ports; umbilical and epigastric. Three traction stitches were used; one to the fundus and two to the Hartman’s pouch to its right and left sides to increase its range of movement during dissection of the Calot’s triangle (puppet show technique). Statistical analysis used The decreptive data were presented as mean & standard deviation (SD). Data were analyzed using the SPSS package for Windows, version 23, SPSS Inc., Chicago, Illinois, USA. Results The mean operative time was 55.80±18.60 min (30–120 min). There was no need for more trocars or conversion to open surgery. Intraoperative complications occurred in three cases; one had a small liver tear in the gall bladder fossa. The second case had a small diaphragmatic injury (was repaired) and the third case had bleeding from the posterior branch of the cystic artery (was controlled) and spillage of gall stones (were extracted). The postoperative pain was mild in majority of patients (48 cases) and moderate in two patients. All patients started oral feeding and movements 4 h postoperative. The mean hospital stay was 0.950±0.35 days (0.5–2 days). Economically, about $600 were saved for every case (the price of unused disposable two trocars and two graspers). Conclusion Two ports laparoscopic cholecystectomy with three traction stitches (after adding third stitch) (puppet show technique), is an applicable and a safe technique with more patients’ satisfaction due to less scars and better economic value.

Complications of Two Port Laparoscopic Cholecystectomy-Studyof 50 Cases

Background: For the management of Gallstone disease, laparoscopic cholecystectomy has been the the gold standard and is preferred over open cholecystectomy. As patients’ demand has increased for improved postoperative quality of life and cosmesis, surgeons have continued to decrease the number of ports for laparoscopic cholecystectomy. To meet these expectations we adopted two-port techniques at Comilla, Bangladesh. For the last three years we have selected 50 patients where two-port laparoscopic cholecystectomy was trialled. The procedure were successfully performed in 47(94%) &amp; conversion were required in 3(6%) with some accepted complications like epigastric port infection &amp; herniation, post cholecystectomy syndrome, reactionary haemorrhage, bile leakage &amp; biloma, significant epigastric port pain postoperatively &amp; stricture of CBD. The present two port technique not only overcoming specimen extraction difficulties but also contributes to good cosmesis.&#x0D; Objectives: To see the outcome of two port laparoscopic cholecystectomy.&#x0D; Methods: Consecutive 50 patients were admitted in surgery ward of Central medical college, Comilla with gallstone disease over a 3 years period. Diagnosis is confirmed by ultrasound with the assessment of operative feasibility. Data collection sheet was maintained by Microsoft Excel. Data were analyzed manually.&#x0D; Results: In this study 50 patients were included. Among them 34 (68%) were females and 16 (32%) were males (ratio = 2.1:1). Mean age was 35.7 years (range 20–55years).All patient were undergone two port laparoscopic cholecystectomy &amp; successfully accomplished in 47 (94%),conversion were required in 3 (6%) patients. Most common (62%) sonological findings were cholelithiasis with normal size &amp; shape of gall bladder. Mean operative time was 50 minutes. Among the per operative difficulties bleeding were 14%, perforation of gall bladder 10%, spillage of gallstones 6%, epigastric forceps manipulation difficulties 4%,conversion to open cholecystectomy 6%. Most of the patients(80%) admitted in hospital for 2-3 days. 4 (8%) patient had epigastric port infection &amp; 1 (2%) patient developed this site herniation, 3 (6%) patient had post cholecystectomy syndrome,1 (2%) patient had reactionary haemorrhage, 1 (2%) bile leakage &amp; biloma,4(8%) patient had significant epigastric port pain postoperatively, 1 (2%) patient developed delayed stricture of CBD. In all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no problem so far in 3 years follow up. Most patients (90%) returned to work within 2 weeks.&#x0D; Conclusion: Two-port laparoscopic cholecystectomy is a safe procedure &amp; cosmetically rewarding.&#x0D; TAJ 2018; 31(1): 29-37

A study of reduced port laparoscopic cholecystectomy

Background: The objective was to study various technical feasibility and safety, benefit of three port cholecystectomy over four port cholecystectomy.Methods: Total 25 patients have taken part in study with valid consent, in B.J. Medical College, Ahmedabad. All patient study regarding operative time, conversion rate, inta-operative complication, immediate postoperative complication, postoperative pain, requirement of postoperative analgesic, hospital stay, feasibility and safety.Results: Out of 25 patient mean ages 39.5 ranging from 25 to 60. Female 88%, male 12% are in this study. 72% patient have multiple stone, 28% have single stone. 96% and 4% patient has distended and contracted GB respectively. 92% patient have normal GB wall and 8% have thickened GB wall. 8%, 68% and 20% patient were discharge on 3rd, 2nd and 1st postoperative day respectively. Mean postoperative day was 4 ranging from 1 to 10. Conversion rate to open procedure is 12% in this study.Conclusions: Three port cholecystectomy is safe procedure in expert hand. It has less requirement of analgesic with less hospital stay with good cosmetic result.