Postoperative complications following single-incision laparoscopic cholecystectomy: a retrospective analysis in 360 consecutive patients

Effect of retrieval bags in preventing surgical site wound infection during elective laparoscopic cholecystectomy in liver cancer patients: A meta-analysis

A meta-analysis research was implemented to appraise the effect of retrieval bags (RBs) in preventing surgical site wound infection (SSWI) in elective laparoscopic cholecystectomy (ELC) in liver cancer (LC) patients. Inclusive literature research until April 2023 was done, and 1273 interconnected researches were reviewed. From a total of 11 researches that were chosen, 2559 ELC procedures in LC patients were at the starting point of the researches: 1273 of them were utilising RBs and 1286 were controls. Odds ratio (OR) and 95% confidence intervals (CIs) were utilised to appraise the consequence of RBs in preventing SSWI in ELC in LC patients by the dichotomous approach and a fixed or random model. RBs had significantly lower SSWI (OR, 0.54; 95% CI, 0.38-0.76, p < 0.001) compared with controls in ELC in LC patients. However, no significant difference was found between RBs and controls in ELC in LC patients in bile spillage (OR, 0.51; 95% CI, 0.21-1.24, p = 0.14), fascial extension (OR, 0.54; 95% CI, 0.07-4.11, p = 0.55), postoperative collection (OR, 0.66; 95% CI, 0.24-1.76, p = 0.40) and port site hernia (OR, 0.72; 95% CI, 0.25-2.06, p = 0.54). RBs had significantly lower SSWI, and no significant difference was found in bile spillage, fascial extension, postoperative collection and port site hernia compared with controls in ELC in LC patients. However, caution needs to be taken when interacting with its values because there was a low sample size in some of the chosen researches and a low number of researches were found for some of the comparisons in the meta-analysis.

Outcome of single-incision laparoscopic cholecystectomy compared to three-incision laparoscopic cholecystectomy for acute cholecystitis

BACKGROUNDS/AIMS

While single-incision laparoscopic cholecystectomy (SILC) has advantages in cosmesis and postoperative pain, its utilization has been limited. This study raises the possibility of expanding its indication to acute cholecystitis with the novel method of solo surgery under retrospective analysis.

METHODS

We compared the outcomes of SILC (n = 58) to those of three-incision laparoscopic cholecystectomy (TILC; n = 117) for acute cholecystitis, being performed from March 2014 to December 2015.

RESULTS

Intraoperative results, including the operation time, did not differ significantly, except for drain catheter insertion (p = 0.004). Each group had 1 case of open conversion due to common bile duct injury. There was no significant difference in the length of hospital stay. Either group by itself was not a risk factor for complications, but in preoperative drainage for intraoperative perforation, 3 factors of intraoperative perforation, biliary complication, and history of upper abdominal operation for additional port, only American Society of Anesthesiology (ASA) scores for postoperative complication of Clavien-Dindo grades III and IV were significant risk factors.

CONCLUSIONS

Our study findings showed comparative outcomes between both groups, providing evidence for the safety and feasibility of SILC for acute cholecystitis.

Low long-term incidence of incisional hernia after cholecystectomy: A systematic review with meta-analysis

BACKGROUND

Various surgical approaches are available for cholecystectomy, but their long-term outcomes, such as incidence of incisional hernia, are largely unknown. Our aim was to investigate the long-term incidence of incisional hernia after cholecystectomy for different surgical approaches.

METHODS

This systematic review and meta-analysis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A protocol was registered on PROSPERO (CRD42020178906). Three databases were searched for original studies on long-term complications of cholecystectomy with n > 40 and follow-up ≥6 months for incisional hernia. Risk of bias within the studies was assessed using the Newcastle-Ottawa Scale and the Cochrane "risk of bias" tool. Meta-analysis of the incidence of incisional hernia after 6 and 12 months was conducted when possible.

RESULTS

We included 89 studies. Of these, 77 reported on multiport or single-incision laparoscopic cholecystectomy. Twelve studies reported on open cholecystectomy and 4 studies on robotic cholecystectomy. Weighted mean incidence proportion of incisional hernia after multi-port laparoscopic cholecystectomy was 0.3% (95% confidence interval 0-0.6) after 6 months and 0.2% after 12 months (95% confidence interval 0.1-0.3). Weighted mean incidence of incisional hernia 12 months postoperatively was 1.5% (95% confidence interval 0.4-2.6) after open cholecystectomy and 4.5% (95% confidence interval 0.4-8.6) after single-incision laparoscopic cholecystectomy. No meta-analysis could be conducted for robotic cholecystectomy, but incidences ranged from 0% to 16.7%.

CONCLUSION

We found low 1-year incidences of incisional hernia after multiport laparoscopic and open cholecystectomy, whereas risks of incisional hernia were considerably higher after single-incision laparoscopic and robotic cholecystectomy.

Use of retrieval bag in the prevention of wound infection in elective laparoscopic cholecystectomy: is it evidence-based? A meta-analysis

Background

Surgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases. During the operation the gallbladder is commonly extracted with a retrieval bag. We conducted a meta-analysis to clarify whether its use plays a role in preventing infections.

Methods

Inclusion criteria: elective cholecystectomy, details about the gallbladder extraction and data about local or systemic infection rate. Exclusion criteria: cholecystitis, jaundice, concurrent antibiotic therapy, immunosuppression, cancer. A comprehensive literature search of PubMed, Cochrane Library and MEDLINE databases was carried out independently by two researchers, according to the PRISMA guidelines and applying the GRADE approach. Terms used were (“gallbladder”AND(“speciment”OR“extraction”OR“extract”))OR(“gallbladder”OR“cholecystectomy”)AND(“bag”OR“retrieval|”OR|“endobag”OR“endocatch”).

Results

The comprehensive literature revealed 279 articles. The eligible studies were 2 randomized trials and a multicentre prospective study. Wound infections were documented in 14 on 334 (4,2%) patients operated using a retrieval bag versus 16 on 271 (5,9%) patients operated without the use of a retrieval bag. The statistical analysis revealed a risk ratio (RR) of 0.82 (0.41–1.63 95% CI). Concerning sensitivity analysis the estimated pooled RR ranged from 0.72 to 0.96, both not statistically significant. Harbord test did not reveal the occurrence of small-study effect (p = 0.892) and the funnel-plot showed no noteworthy pattern.

Conclusions

The results of this review highlight the paucity of well-designed large studies and despite limitations related to the low level of evidence, our meta-analysis showed no significant benefit of retrieval bags in reducing the infection rate after elective laparoscopic cholecystectomy. In absence of acute cholecystitis, accidental intraoperative gallbladder perforation or suspected carcinoma their use, to date, may not be mandatory, so that, further studies focusing on complex cases are needed.

Electronic supplementary material

The online version of this article (10.1186/s12893-018-0442-z) contains supplementary material, which is available to authorized users.

Single-incision laparoscopic cholecystectomy using instrumental alignment in robotic single-site cholecystectomy

Purpose

There is no standardized single-incision laparoscopic cholecystectomy (SILC) technique in contrast to robot single-site cholecystectomy (RSSC). We tried to implement the array of instruments used in RSSC to SILC.

Methods

A series of 108 consecutive patients underwent SILC between September 2014 and July 2017 by 2 surgeons. The indication was benign disease of the gallbladder. The perioperative outcomes were reviewed. We used the 4-channel Glove port and conventional laparoscopic instruments.

Results

The study subjects consisted of 29 males and 79 females, and the mean age was 44.4 years (range, 16–70 years). Mean body mass index was 24.1 kg/m². The mean working time was 25.0 ± 10.7 minutes and total operation time was 44.4 ± 12.4 minutes. There were 7 cases of conversion (additional 1 port in 4 patients, additional 2 ports in 2, and conventional 4 port technique in 1). Bile spillage from the gallbladder during the procedure occurred in 17 (15.7%). There were no postoperative complications. Postoperative hospital stay was 2.0 ± 0.6 days.

Conclusion

The alignment of the instruments in a RSSC was successfully implemented into a SILC, so that an equally effective operation was possible.

Transumbilical single-incision laparoscopic cholecystectomy: long-term review from a single center

BACKGROUND

Currently, researches about single-incision laparoscopic cholecystectomy (SILC) are various, but long-term reviews assessing relevant complications after SILC with considerable amount of case series are rare.

STUDY DESIGN

We retrospectively reviewed a large series of 529 patients undergoing SILC to assess the long-term postoperative recovery, including postoperative complications, retained symptoms, and quality of life. Finally, we assessed its associated risk factors related to SILC patients' recovery in the long term.

RESULTS

During a mean follow-up period of 36.8 ± 8.8 months after SILC, 402 (76.0 %) patients underwent complete resolution. Frequent diarrhea (12.1 %) and recurrent omphalitis (5.9 %) were most commonly seen among other complications and retained symptoms within overall the patients. We identified 1 (0.3 %) incision hernia and 1 (0.3 %) intra-abdominal abscess among overall the patients, while 3 (0.8 %) common bile duct stones and 1 (0.3 %) biliary pancreatitis among the patients with symptomatic cholelithiasis during long-term review period. No significant differences were identified between patients with symptomatic cholelithiasis and gallbladder polyps when considering other incidences (all p > 0.05). Patients undergoing SILC with older age (p = 0.023) or female gender (p = 0.020) contributed to complete resolution.

CONCLUSIONS

SILC via traditional devices is feasible and safe with acceptable postoperative incidence rate in the long run. Patients with older age or female gender, who have no severe systemic diseases, tend to benefit more from the surgical intervention.

R-LESS right colectomy with the single-site® robotic platform

BACKGROUND

Use of robotics has exemplified single-site procedures by restoring the correct hand-instrument alignment and providing stable, stereoscopic visual field. Technique was initially introduced by the manufacturers for cholecystectomy, but experienced teams quickly extended the indications to more complex procedures. We hereby present a case of a patient that underwent robotic right colectomy and omentectomy through the single-site(®) platform.

METHODS

A single-site procedure was offered to our 58-year-old male patient with carcinoma of the ascending colon and he gave written consent for it. The VESPA(®) single-site platform was used according to the standards of the manufacturing company. The single-site port(®) was placed at the umbilicus. Rest of setup and procedure steps were based on the multiport technique. An extended omentectomy accompanying the right colectomy has not previously reported to our knowledge. After sufficient mobilization specimen was exteriorized through the umbilicus, excised and the anastomosis was performed using linear staplers.

RESULTS

Console time was 164 min and total operation time was 221 min. Intraoperatively, there was no need for conversion, additional ports or blood transfusions. Total console time was 164 min. Lacking of wristed instruments and bipolar energy were regarded as serious limitations. No drains were used. Patient did not require ICU stay and had no postoperative complaints. He was given liquid diet on PO day #2 and he was discharged on PO day #4.

CONCLUSIONS

Robotic single-site right colectomy is safe and feasible in selected cases. Experience from single-site robotic cholecystectomy is a useful basis to expand the indications to more complex procedures. Further development of the instruments and large number of cases may justify the indications for using this technique in the future.

A rare case of subcapsular liver haematoma following laparoscopic cholecystectomy

Laparoscopic cholecystectomy is a commonly performed surgical procedure for the treatment of symptomatic cholelithiasis. As with all surgical procedures, it carries risk, with the most commonly reported complications including infection, bile leak and bleeding. One unusual complication is subcapsular liver haematoma, the diagnosis presented here. This is a rare occurrence; only a small number of cases have been reported in the literature and as yet no conclusive cause or management plan has been found. Iatrogenic liver trauma, the use of oral and intravenous non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants have all been named as possible contributing factors. Particularly, the use of ketorolac has been associated with four reported cases of subcapsular haematoma following laparoscopic cholecystectomy. The case reported here refutes that hypothesis, as neither NSAIDs nor anticoagulants were used during the treatment of this patient.