Page 16 - World Journal of Laparoscopic Surgery

Riki Singal et al
Table 1: Symptoms Table 2: Ultrasound findings
Group I Group II Ultrasound findings Group I (100) Group II (100)
Symptoms (no. of patients) (no. of patients) Multiple stones 63 40
Pain 87 90 Single stone 37 60
Vomiting 22 24 Group I 2
Dyspepsia 84 89 Group II 10
Fever with jaundice 4 2

Ultrasound Findings only a minority of the cases. In most of the cases the
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fascia was not closed and no port site hernia was seen
In group I, 63 patients (63%) had chronic cholecystitis
with multiple stones on ultrasound study and 37 patients on follow-up of these was patients. Rikki et al performed
200 cases of LC in 2 years time and fascia was not closed
(37%) had chronic cholecystitis with solitary stone. In in all of them and no port site hernia was seen in follow-
group II, 40 patients (40%) had chronic cholecystitis with up of these patients with time, many refinements have
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multiple stones on ultrasound study and 60 patients (60%) been made in decreasing the port number and port size
had chronic cholecystitis with solitary stone (Table 2). leading to evolution of the three-port LC, two-port LC,
Two patients (2%) in groups I and 10 patients (10%) in and even single-port LC. The SILS has been recently
group II had undergone previous lower abdominal surgery. developed as an alternate approach to standard four-port
Three patients (10%) of groups I were converted to LC. In this technique, a single transumbilical incision is
four-port LC, and none of the patients of group II were used to either have three ports through the sheath or have
converted to open cholecystectomy. an adaptor with an inbuilt three-port system. It has been
Mean operative time in three-port LC was 93.16 minutes shown to offer significant improvement in port-related
and 50.66 minutes in four-port LC. This difference in time complications, but is still not widely used due to lack of
is significant as p value. The shortest period for chole- standardization of instruments and a significantly long

cystectomy was 30 minutes, and the longest period was learning curve. 11
150 minutes. No cholecystectomy was done within In the present study, we have compared the two
40 minutes in group I, but in 10 patients (33%), cholecys- methods of LC, i.e., three-port LC and the standard four-
tectomy was done within 40 minutes in group II. port LC. Cases were divided into two groups of 100 each
In 8 patients (27%) of group I, dissection of Calot’s trian- randomly and were designated as groups I and II. In
gle was easy, and in 22 patients (73%), dissection of Calot’s group I, three-port LC was performed, and in group II,
triangle was difficult. In 15 patients (50%) of group II, four-port LC was performed. Most of the patients in the
dissection of Calot’s triangle was easy, and in 15 patients present study were in the age group of 31 to 40 years
(50%), dissection of Calot’s triangle was difficult. (33%), range between 18 and 60 years, with a mean age
Mean number of injections of analgesic (diclofenac) of 39.33 years. Regarding symptoms, all the patients had
required in group I was 1.1 and in group II 1.0. Twenty-five pain as their chief complaint. So, pain was the single most
patients (83%) in group I required one injection of analgesic driving force for the patient to seek treatment. Vomiting
postoperatively, and 29 patients (97%) in group II required was present in only 3% of the patients.
one injection of analgesic postoperatively. In the present study, there was no bleeding due to
vessel injury and its incidence is low because the number
DISCUSSION of cases was less.
In the present study, there were gallbladder perfora-
Laparoscopic cholecystectomy is considered to be the tions iatrogenically with spillage of stones in 10 patients
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procedure of choice for elective cholecystectomy. With (33%) in group I and 3 patients (10%) in group II.
the increasing experience in advanced laparoscopic tech- The complications arising from dropped gallstones
niques, LC is performed by in LC patients are subsequent abscesses and inflamma-
• Four ports of entry into the abdomen (standard tory masses containing gallstones or stone fragments.
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procedure) Morishita et al reported that spilled stones floating
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• Three ports of entry into the abdomen free in the peritoneal cavity may migrate to the pelvic
• Two ports of entry into the abdomen area and become embedded there in the cul-de-sac,
• Single port of entry into the abdomen (SILS) causing a severe reaction. Due to the subsequent inflam-
• NOTES 9 matory reaction, the fertility may be adversely affected
Some surgeons observed that LC can be performed in females.
safely in the majority of cases by the three-port method. Duration of operation through three-port LC was an
It is safe and requires conversion to four-port method in average 31 minutes and in four-port LC was 31.3 minutes. 8
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