SP3.1.13 Does Single-port laparoscopic appendicectomy provide better outcomes compared to conventional (three-ports) laparoscopic appendicectomy?

Aims To evaluate comparative outcomes of single port laparoscopic appendicectomy (SPLA) and conventional three-port laparoscopic appendicectomy (CLA) in the management of acute appendicitis. Methods A comprehensive systematic review of randomised controlled trials (RCTs) with subsequent meta-analysis of outcomes were conducted following PRISMA standards. Post-operative pain, cosmesis, need for an additional port(s), operative time, Post-operative complications, length of hospital stay(LOS), readmission, and reoperation were the evaluated outcome parameters. Results Sixteen RCTs reporting a total number of 2017 patients who underwent SPLA(n = 1009) or CLA(n = 1008) were included. SPLA showed higher cosmetic score (Mean Difference (MD) 1.11,P= 0.03) but significantly longer operative time (MD 7.08, P = 0.00001) compared to CLA. However, there was no significant difference between SPLA and CLA group in the postoperative pain score at 12 hours (MD -0.13,P=0.69), need for additional port(s) (Risk Ratio (RR)0.03, P = 0.07), postoperative ileus (RR 0.74,P=0.51), SSI ( RR 1.38, P = 0.28), Post-operative intra-abdominal collection (RR 0.00,P=0.62), LOS ( MD -2.41, P = 0.16), readmission to the hospital ( RR 0.45,P=0.22), and return to theatre (RR -0.00, P = 0.49). Subgroup analysis showed that operative time was comparable in adults only subgroup (P = 0.18) while it was significantly loner in paediatrics only subgroup(P = 0.00001). Moreover, LOS was shorter in adults only subgroup (P = 0.003) and no difference observed in paediatrics only subgroup (P = 0.93). Conclusion SPLA is associated with a slightly longer operative time; however, its efficacy and safety are comparable to CLA. Subgroup analysis showed that SPLA has better outcome in adults than paediatrics. Additionally, SPLA offers better post-operative cosmesis.

Surgeon’s physical and mental stress while performing laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is performed either by four port or three port. Although the overall patient outcome has been studied with comparable results, surgeon’s stress level has not been addressed commonly.Objective: To compare the difference in surgeon’s physical and mental stress between three port and four port laparoscopic cholecystectomy.Methods: This prospective randomized comparative study was carried out from January 2014 to August 2014 in patients undergoing laparoscopic cholecystectomy with American technique. Patients were randomized into four port laparoscopic cholecystectomy group and three port laparoscopic cholecystectomy group. Surgery was performed by experienced laparoscopic surgeons. At the end of procedure, surgeons were given questionnaire to evaluate physical and mental stress faced by them based on Visual Analogue Scale. The results obtained were compared.Results: Total 60 cases were evaluated, 30 in each group. Mean age of patients and American society of Anesthesiologists score were not different. Surgeon’s perception regarding physical and mental stress while performing in two different groups was analyzed. The difference is not statistically significant. Neither any of the three port group needed to add additional port nor any of the patients were converted to open surgery. None of the patient in either group developed clinically significant complication.Conclusion: Both the four and three port laparoscopic cholecystectomy techniques are comparable in regards to patient outcome as well as to the physical and mental stress experienced by the surgeons.

ASSESSMENT OF FEASIBILITY AND COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY IN CIRRHOTIC PATIENTS

:Introduction: From the era of absolute contraindication to the phase of preferred treatment, the technique of laparoscopic cholecystectomy advances with time. Here, we report our experience of laparoscopic cholecystectomy in 20 patients of liver cirrhosis. In our institute, laparoscopic cholecystectomy is the preferred choice for cholelithiasis in cirrhotic patient.Methods: In last 2 years, 180 laparoscopic cholecystectomies were performed and 20 patients were cirrhotic. Their data analyzed retrospectively in terms of preoperative optimization, operative technique and results.Results: Laparoscopic cholecystectomy was completed successfully in 19 patients and one was converted to open. Mean operative time was 54 minutes. No additional port was required in all cases. Calot’s first dissection was performed in 18 patients and fundus first technique was used in 2 patients due to unclear anatomy. Liver bed bleeding was present in 16 patients, which was controlled effectively. Subhepatic drain was placed in 12 patients. There was no mortality. Morbidity in two patients was worsening of ascites in one; and incisional hernia in other patient which was converted to open. Port site complications were not noted in any patient and there was no evidence of intraabdominal bleeding or bile leak postoperatively. Blood and component transfusion was required in 2 patients. Average length of hospital stay was 4.8 days.Conclusion: Though laparoscopic cholecystectomy may be difficult in cirrhotic patients but it is feasible and relatively safe. It offers many advantages in cirrhotic patients and associated with low morbidity when compared with open surgery.Keywords: cirrhosis, laparoscopic cholecystectomy, difficult cholecystectomy