Page 36 - World Journal of Laparoscopic Surgery

Ultrasonic Dissection vs Conventional Method
Table 1: Demography of the patients in the clipless laparoscopic Table 2: Intraoperative findings
cholecystectomy and conventional laparoscopic groups Variables CLC group (n 53) CL group (n 59) p value
CLC group (n 53) CL group (n 59) Operative time (mean) 35.91 ± 11.66 41.12 ± 14.23 0.054
Variables (%) (%) p value Gallbladder 7 (13.20%) 12 (20.33%) 0.31
Age (mean) perforation (mean)
<30 13 (24.52) 13 (22.03) 0.54 GB removal time 6 (5–8) 6 (5–10) 0.23
31–40 10 (18.86) 6 (10.16) (median)
41–50 12 (22.64) 12 (20.33) Drain placement 6 (11.32%) 13 (22.03%) 0.13
51–60 8 (15.09) 12 (20.33) Conversion 1 (1.85%) 2 (3.2%) 0.63
61–70 10 (18.86) 16 (27.11)
Sex Table 3: Operative time in clipless laparoscopic cholecystectomy
Male 10 (18.86) 8 (13.55) 0.44 and conventional laparoscopic groups with and without gallbladder
Female 43 (81.13) 51 (86.44) perforation
Previous surgery 6 (11.32) 10 (16.94) 0.39 Operative time CLC group CL group p value
Comorbid condition 14 (26.41) 18 (30.50) 0.63 With GB perforation 46.42 ± 12.85 50.58 ± 14.44 0.34
Diabetes mellitus 7 (13.2) 5 (8.47) 0.41 (mean)
Hypertension 5 (9.43) 10 (16.94) 0.24 Without GB perforation 34.30 ± 9.30 38.70 ± 10.76 0.03
(mean)
Cirrhosis 0 2 (3.38) 0.17
COPD 2 (3.77) 1 (1.69) 0.91 oozing or bile stain and when some collection was anticipated
USG findings in the postoperative period. The drains were usually removed on
Multiple calculi 41 (77.35) 51 (86.44) 0.21 second postoperative day (range 1–14 days) and the total days
Solitary stone 12 (22.64) 8 (13.55) 0.62 required to remove the drain was not significant (p 0.65) between
Acute cholecystitis 4 (7.54) 6 (10.16) the groups (Table 2). Three (2.6%) patients required conversion
to open cholecystectomy in our study, i.e., One (1.85%) in the
CLC group and two (3.2%) in the CL group. The one in the CLC
cholecystitis and the rest [102 (91.07%)] were electively operated group had obscured anatomy with frozen Calot’s triangle and an
for gallstone disease. Four (7.54%) patients in the CLC group enlarged cystic node. The reason for conversion in the CL group
and 6 (10.16%) in the CL group were operated for acute calculus was intraoperative bleeding not controllable laparoscopically and
cholecystitis. The demographics of the patients in both the groups the other one had a dilated CBD with multiple calculi requiring a
were comparable (Table 1). choledochoduodenostomy.
The mean operative time was 38.65 ± 13.28 minutes (range All the patients (100%) in the study group required an analgesic
20–85 minutes). The operative time in the CLC group (35.91 ± in the first 12 hours and majority 109 (97.32%) asked for analgesia in
11.66 minutes) was less when compared to the CL group (41.12 ± the first 24 hours. Fifty-one (96.22%) patients in CLC and 58 (98.3%)
14.23 minutes), though it was not statistically significant (p 0.054). in CL group asked for analgesia in the first 24 hours (0.49). The VAS
A total of 19 (17%) patients had perforation of GB intraoperatively. for pain in the first 12 hours postoperatively was significantly (p <
The operative time was significantly less in those without GB 0.05) less statistically in the CLC group (Table 4). The VAS for pain
perforation (n 93, mean 36.52 ± 13.28 minutes) than in those with at 24 hours postoperatively was also less in the CLC group (2.5 ±
GB perforation (n 19, mean 49.05 ± 13.51 minutes) (p < 0.001). Seven 0.8 vs 2.97 ± 0.87) though it was not statistically significant (p 0.50);
(13.2%) patients in the CLC group and 12 (20.33%) in the CL group and after the first week, it was comparable in both the groups (CLC
had intraoperative GB perforation (p 0.31). The median time taken 1.16 ± 0.47 vs 1.10 ± 0.30; p 0.55).
to remove the GB from its fossa in the CLC group was 6 minutes The amount of blood loss as demonstrated by the median
(IQR of 5–8 minutes), ranging from 3 minutes to 30 minutes; and fall in hemoglobin level was significantly (p 0.001) less in the CLC
in the CL group, it was 6 minutes (IQR of 5–10 minutes), ranging group (Table 4). Majority of the cases [88 (78.57%)] were discharged
from 3 minutes to 26 minutes (Table 2). The time taken to remove on the first postoperative day following surgery and in both the
GB from the fossa was not statistically significant between the two groups, patients were discharged on the same postoperative days
groups (p 0.23). (p 0.23). In our study group, a total of seven (6.25%) patients had
The operative time when compared between patients “who morbidity following surgery: two (3.77%) in the CLC group and
had GB perforation” in the two groups, the CL group took more five (8.47%) in the CL group (p 0.44). In the CLC group, we had one
time but was not statistically significant (50.58 ± 14.44 minutes vs case (1.88%) each with port site infection and bilious drainage. In
46.42 ± 12.85 minutes in CLC group; p 0.34). However, when the “GB the CL group, two cases (3.38%) each with port site infections and
was not perforated,” the operative time was 34.30 ± 9.30 minutes bilious drainage followed by one (1.69%) with chest infection. There
(range 25–80 minutes) in the CLC group and 38.70 ± 10.76 minutes were three (2.67%) cases of port site infection. All of them required
(range 20–65 minutes) in the CL group. The operative time was removal of suture and were managed with daily dressings. One
statistically significantly less in the CLC group (p 0.03) when the GB in the CL group had deep surgical site infection in the epigastric
was not perforated (Table 3). port, which was managed with wound trimming and irrigation
In all 19 (17%) patients required placement of the drain, 6 under local anesthesia, allowed to heal by secondary intention,
(11.32%) in the CLC group and 13 (22.03%) patients in the CL group and discharged on the fourth postoperative day. All the patients
(p 0.13). It was kept mainly after difficult dissection which had were without any adverse consequences in the follow-up and the

122 World Journal of Laparoscopic Surgery, Volume 12 Issue 3 (September–December 2019)