Frequency of Port Site Wound Infection with and Without End Gloves Techniques of Retrieval of Gallbladder in Pouch

Background: The gallbladder is a hollow organ that sits just beneath the right lobe of the liver. Chief functioning of gallbladder is to store gall, also known as bile that is required for digestion of food. Removing gallbladder through small incision in the abdomen is called laparoscopic cholecystectomy. Among benefits of cholecystectomy are decreased need for postoperative analgesia, decreased postoperative pain and shortened hospital stay from 1 week to less than 24 hours. Objective: To compare the frequency of port site wound infection with and without endogloves techniques of retrieval of gallbladder in pouch after laparoscopic cholecystectomy for chronic calculus cholecystitis. Design: It was a randomized controlled trial. Study Settings: This study was conducted at Department of General Surgery, Midland Doctors Medical Institute Tandali Muzaffarabad from July 2019 to July 2021 Material and Methods: A total of 260 cases who fulfilled inclusion criteria were enrolled in the study through wards of Department of General Surgery. Written informed consent was obtained from all the patients. Two groups were made by random division of patients. Conventional laparoscopic cholecystectomy was performed in patients of group I. Through umbilical port gall-bladder was retrieved in these patients, exactly spot on by a sterile surgical hand glove endobag. Vicryl “O” with J-shaped needle was used to close 10mm umbilical port (fascial defect) and 5mm ports were conventionally closed. In patients of group II, conventional laparoscopic cholecystectomy was performed and gall-bladder was retrieved as in patients of group I but without using surgical sterile hand glove endobag. Results: The mean age of the patients in study group was 48.09±15.402 years and in control group it was 47.51±16.48 years. Male to female ratio was 1.06:1. The post-op wound infection was found in 11 (4.23%) patients. Statistically significant difference was found in groups (P<0.05). Conclusion: The use of endoglove technique of retrieval of gallbladder in pouch after laparoscopic cholecystectomy for chronic calculus cholecystitis is safe, cheap, simple and potentially reduces significant port site wound infection compared to without endogloves. Keywords: Laparoscopic Cholecystectomy, Endoglove, Gallbladder (GB).

COMPARATIVE EVALUATION OF COSMETIC OUTCOME BETWEEN CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY & SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY

Aim: Comparative analysis of cosmetic outcome between Single Incision Laparoscopic Cholecystectomy and conventional Laparoscopic Cholecystectomy. Method: Patients suffering from symptomatic cholelithasis were randomly subjected to Single Incision Laparoscopic Cholecystectomy (SILC) and conventional four ports Laparoscopic Cholecystectomy (cLC). Data analyzed included cosmetic outcome, Results: The body image score for SILC group ranged from 30 to 44 with mean score of 40.76 ± 2.773 while that for cLC group ranged from 33 to 42 with mean score of 38.28 ± 1.969. p-value for the comparison stands 0.001 which shows that patients undergoing SILC had better cosmetic perception of their body image compared to cLC group Conclusion: SILC is better cosmetic perception as compare to cLC Keywords: SILC, cLC, Cosmetic outcome

COMPARATIVE EVALUATION OF POST-OPERATIVE PAIN BETWEEN CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY & SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY

AIM: Comparative analysis of post-operative pain between Single Incision Laparoscopic Cholecystectomy and conventional Laparoscopic Cholecystectomy. Method: Patients suffering from symptomatic cholelithasis were randomly subjected to Single Incision Laparoscopic Cholecystectomy (SILC) and conventional four ports Laparoscopic Cholecystectomy (cLC). Data analyzed included duration of surgery, post-operative pain, For assessment of post-operative pain numeric pain scale scoring system was used and pain scoring done at four hours, twelve hours and twenty-four hours post-operatively. Results: The study included fifty patients operated upon from June, 2014 to May, 2014. Twenty-five patients were subjected to SILC and rest of the twenty-five underwent cLC. Pre-operative characteristics of two groups were similar and there was no significant difference between two groups based on age, sex and Body Mass Index. Post-operative pain score was higher for cLC compared to SILC at four, twelve and twenty-four hours post-operatively. The mean pain score at four hours was 4.64 ± 1.89 for SILC versus 7.72 ± 0.84 for cLC (p-value < 0.0001). While the score at twelve and twenty-four hours were 2.96 ± 1.88 and 1.80 ± 1.44 for SILC compared to 5.08 ± 1.15 and 3.80 ± 1.11 for cLC respectively. Conclusion: SILC is superior to cLC compared to post-operative pain as per our study. Keywords: SILC, cLC, post-operative pain

Laparoscopic Cholecystectomy in a patient with Situs Inversus Totalis

There are diagnostic and therapeutic challenges in cases of symptomatic gall bladder disease in patients with situs inversus totalis (SIT), where there is complete reversal of visceral topography in thorax, abdomen or both. The difficulty to treat these patients with conventional laparoscopic cholecystectomy may be more pronounced for right handed surgeon and requires modifications in working ports and their positions. We present a case of laparoscopic cholecystectomy in a patient with SIT, and describe the technical details that enable the safe conclusion of the operation. Bangladesh Crit Care J March 2021; 9(1): 43-45

A COMPARATIVE STUDY OF REDUCED PORT SIZE MINILAPAROSCOPIC CHOLECYSTECTOMY (MLC) VERSUS STANDARD FOUR PORT CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY (CLC).

Background: Reduced port size mini-laparoscopic cholecystectomy (MLC) has widened the horizons of modern laparoscopic surgery. Standard four port conventional laparoscopic cholecystectomy (CLC), which has long been established as the “Gold Standard” for gall bladder diseases, is under reconsideration following the advent of further minimally-invasive procedures including MLC. Our study aims to provide a comparison between MLC and CLC and assesses whether MLC has any added benets. Materials And Methods: A prospective randomized controlled study of 46 patients of gall stone disease was conducted at J.L.N. Medical College, Ajmer. The patients assigned in to two groups (23 in each) group A [Reduced port size mini-laparoscopic cholecystectomy {MLC}] or group B [Standard four port conventional laparoscopic cholecystectomy {CLC}] through randomization. Data was collected prospectively and analysed retrospectively using a predesigned Performa. Results: In our study, both the groups had similar age, body mass index (BMI) and gender distribution. No cases of MLC required insertion of additional ports. The mean operative time for MLC was 63.74 ± 9.50, which is longer than CLC 44.91 ± 14.73. The pain was signicantly lower in mini laparoscopic group which is analysed on 0th ,2nd 7th and 28th post operatively. Patients who underwent MLC were able to return to normal activity earlier than patients undergoing CLC (P < 0.01). Conclusion: Our experience suggests that MLC can safely be used as an alternative to CLC. Compared to CLC, it has the added benet of an early return to work along with excellent cosmetic results. Intraoperative blood loss is comparable in both groups, however the operative time in MLC group higher than the CLC group. Further large scale trials are required to prove any additional benet of MLC

Comparison of Clipless and Clipped Laparoscopic Cholecystectomy at Nishtar Hospital Multan, Pakistan

Objective: To compare the efficacy of clipless cholecystectomy using harmonic scalpel and clipped conventional laparoscopic cholecystectomy. Study design: A randomized control trial. Place and duration of study: Department of general surgery at Nishtar Hospital Multan, from October 1st 2019 to March 31st 2020. Methodology: Total 188 patients of gallstone related cholecystitis were enrolled in the study and were selected using non-probability consecutive sampling technique. All the patients were randomly divided into two equal groups. One group was designated for clipless and the other for conventional clipped laparoscopic cholecystectomy. Age, gender, duration of cholecystitis, duration of Procedure, hospital stay, usefulness in difficult procedures and biliary leakage were recorded for all the patients. Data was entered in SPSS version 23 and analyzed. Results: Operation time was 28.35±7.92 minutes and 21.15±4.47 minutes in clipped and unclipped surgery, respectively (p<0.001). Hospital stay was 2.37±0.60 days in clipped surgery group and 1.71±0.74 days in clipless surgery group (p<0.001). Biliary leakage was reported in 2(2.1 %) patients of the clipped group and 1(1.1%) patients of the unclipped group (p = 0.561). Usefulness of the procedure in difficult cases was documented in 0 (0.0%) of the clipped procedures and in 8 (8.5%) of the clipless procedures (p=0.004). Conclusion: As witnessed from this study, it can be concluded that clipless surgery is a better option as compared to the clipped conventional laparoscopic Cholecystectomy as former is associated with shorter operation time, shorter hospital stay and better usefulness in difficult cases.

Comparison of laparoscopic cholecystectomy using harmonic scalpel with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones.

Objectives: To compare the laparoscopic cholecystectomy using harmonic scalpel with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones in terms of mean operative time and mean intra-operative blood loss. Study Design: Randomized Control trial. Setting: Department of Surgical at Allied Hospital Faisalabad. Period: 6 months Oct 2017 to Mar 2018. Material & Methods: Eighty (80) patients (forty in one group) divided randomly into A (harmonic scalpel group) and B (conventional) group, done under general anesthesia. Total time of operation and blood loss during procedure was noted. Results: Our study showed that mean operative time in Harmonic group (A) was 38.07+5.28 minutes and in Conventional group (B) 63.75+7.62 minutes, (p-value = 0.0001), blood loss in Harmonic group (A) 32.93+8.86ml and 55.53+8.96ml in Conventional group (B), (p-value = 0.0001). Conclusion: It is concluded that the laparoscopic cholecystectomy using harmonic scalpel is significantly better when compared with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones in terms of mean operative time and mean intra-operative blood loss.

COMPARATIVE STUDY OF SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY AND CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY

Background Single Incision Laparoscopic Surgery, is an alternative to conventional multi-port laparoscopic surgeries with the aim to reduce complications associated with multiple incisions and increase cosmesis. In this study we aim to compare the single incision approach vs the conventional approach for laparoscopic cholecystectomy. Materials We conducted a prospective cohort study at a tertiary care set up, comparing 30 patients each undergoing conventional laparoscopic cholecystectomy and single incision laparoscopic cholecystectomy. Data recorded included demographics, intra-operative and post-operative course, duration of hospital stay, hospital cost and expenditure. Results We found out that single incision laparoscopic cholecystectomy is associated with longer operative time (65 mins vs 55 mins), a longer hospital stay (5 days vs 2.5 days) and higher hospital expenditure. Intraoperative complications like bleeding and inadvertent gall bladder perforation were more in the single incision group (10% vs 3.3%), and on follow up, 2 patients from the single incision group had surgical site infection and port site herniation compared to none from the conventional laparoscopy group. The patients reported better cosmetic outcome in the single incision laparoscopic cholecystectomy group. Conclusion Single incision laparoscopic cholecystectomy is better than conventional laparoscopic cholecystectomy with regards to final cosmesis and quality of life parameters, however, it comes with higher economic burden, longer operative times and untoward intra-operative and post-operative events.