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Is there a place for open cholecystectomy in the laparoscopic era?
Electronic Poster Abstracts This study considered 412 patients who underwent ERCP, from January 2010 to December 2014. Unsuccessful ERCP were excluded and the remaining patients were divided into two age groups: <60 years (Group 1) and >60 years (Group 2). They were analyzed according to gender, indications of ERCP, radiologic findings, therapeutic success and occurrence of immediate adverse events. The main indication in both groups was choledocholithiasis. In group 2, the number of cases of acute cholangitis (p = 0.001), biliary stenosis (p = 0.002) and papillary cancer (p = 0.046) was increased. In this group the indication of urgency ERCP was higher (p = 0.042) as well as the diagnosis of dilatation of the bile duct (p < 0.001). In group 1, successful catheterization and the chance of getting the bile duct clear were significantly higher than in group 2 (p = 0.016, OR = 2.1). The main indications of ERCP were choledocholithiasis, acute cholangitis and biliary strictures. The most frequently performed procedure in both groups was the insertion of prostheses, but more frequently in group 2. On the other hand, in the group of young patients, the success of catheterization and the chance to achieve complete clearance of the biliary tract was significantly higher.
EP03E-016 WHAT IS THE PLACE FOR THREE PORT ACCESS IN LAPAROSCOPIC INTERVAL CHOLECYSTECTOMY (LIC)? M. Shasika Eranda Karunadasa, B. G. N. Rathnasena, K. D. L. Nanayakkara, W. M. S. B. Thilakarathne and M. G. S. R. Kumara Surgery, National Hospital of Sri Lanka, Sri Lanka Introduction: With rising surgeon skill, laparoscopic cholecystectomy has undergone many refinements such as reduction in port number. Three-port technique has been reported to be safe in various clinical trials. However, whether it offers any advantages remains contentious. In this consecutive case series we attempt to find out what really happens when it comes to practice. Methodology: The data was collected from 204 cases of LIC carried out at Ward 27/38 at National Hospital of Sri Lanka, Colombo from April 2010 to March 2015. Postoperative pain was assessed by using a visual analog scale and other measures such as analgesia requirements, length of the operation, postoperative stay, and patient satisfaction score on surgery and scars were also reviewed. Results: Of the 204 patients, seventy nine (38.7%) had cholecystitis and 88 (43.1%) had billiary collic. In addition 23 patients (11.2%) had pre-op ERCP. Three ports technique were used during most of the LICs -146 (71.6%). Main reasons for the fourth port 58 (28.4%) were ongoing inflammation, unclear anatomy and concomitant bile duct exploration 14 (6.8%). Patients in the 3-port group had less pain at port sites. The operative time, overall pain score, analgesia requirements, hospital stay, and patient satisfaction score on surgery and scars were similar. Conclusion: Three-port technique resulted in less individual port-site pain, fewer surgical scars and without any increased risk of bile duct injury. Thus, we recommend it as a safe procedure in elective uncomplicated cases in the experienced hands. HPB 2016, 18 (S1), e385ee601
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EP03E-017 IS THERE A PLACE FOR OPEN CHOLECYSTECTOMY IN THE LAPAROSCOPIC ERA? K. D. L. Nanayakkara, B. G. N. Rathnasena, M. S. E. Karunadasa and W. M. S. B. Thilakarathna Department of Surgery, National Hospital of Sri Lanka, Sri Lanka Introduction: Laparoscopic cholecystectomy (LC) is the gold standard surgical procedure for gall bladder removal. However for the safety of the procedure in difficult situations, it is customary to convert it to an open procedure, which is 5% e 10% worldwide. Here, we present a case series of over 100 patients undergoing laparoscopic cholecystectomy with a zero conversion rate. Materials and methods: A retrospective and prospective data analysis done for 136 consecutive cases of LC from September 2012 to date performed in a surgical unit at National Hospital of Sri Lanka, Colombo. Results: Of the 136 patients, 102 were women (75%) and 34 men with a mean (SD) age of 47.6 years and 56.48 years respectively. Chronic cholecystitis 43 (31.6%), biliary colic 51 (37.5%) were the commonest indications for surgery with 16 patients who presenting with obstructive jaundice due to CBD stones, undergoing choledochoscopic CBD exploration simultaneously. Twenty one patients with acute cholecystitis underwent LC after an interval of 8 weeks. Among these cases 12 had empyema of gall bladder, 5 mucocele of gall bladder and 1 case of choledochoduodenal fistula were managed successfully with zero conversion rate. In 26 difficult cases retrograde cholecystectomy was performed with only 3 subtotal cholecystectomy. Gall stone spillage was the commonest complication in 21 patients (15.44%) and average post-operative hospital stay was 2.6 days. Conclusion: With meticulous dissection, proper intraoperative assessment together with making a decision of early resorting to retrograde cholecystectomy with experienced surgeon, there seems to be no reason for elective open cholecystectomy.
EP03E-018 INCIDENCE OF CHOLEDOCHAL CYST IN HIGHLY SPECIALIZED HOSPITAL IN MEXICO. 20 YEARS EXPERIENCE V. Carrillo-Maciel1, A. L. Acosta-Saludado2, R. Rangel Rodarte3, J. A. Leal Martinez3, S. Ramos Linaje4, J. Garza Sanchez3, J. H. Salazar Gutierrez3, P. Cano Rios5, L. Y. Rodriguez Valenzuela6 and A. A. Pozzobom Oliveira7 1 Surgery, 2Nutricion, Universidad Autonoma de Durango, Mexico, 3Surgery, IMSS, 4Surgery, San Jose, 5Investigador, Universidad Agraria Autonoma Antonio Narro, 6 Anestesiologia, IMSS, and 7Universidad Autonoma de Durango, Mexico Introduction: The choledochal cyst was defined by Douglas in 1852, and after more than 100 years Alonso-Lej proposed an anatomical classification, which was subsequently amended by Todani. It is considered a malformation develops at the junction of the bile duct to the main duct
EP03E-016 WHAT IS THE PLACE FOR THREE PORT ACCESS IN LAPAROSCOPIC INTERVAL CHOLECYSTECTOMY (LIC)? M. Shasika Eranda Karunadasa, B. G. N. Rathnasena, K. D. L. Nanayakkara, W. M. S. B. Thilakarathne and M. G. S. R. Kumara Surgery, National Hospital of Sri Lanka, Sri Lanka Introduction: With rising surgeon skill, laparoscopic cholecystectomy has undergone many refinements such as reduction in port number. Three-port technique has been reported to be safe in various clinical trials. However, whether it offers any advantages remains contentious. In this consecutive case series we attempt to find out what really happens when it comes to practice. Methodology: The data was collected from 204 cases of LIC carried out at Ward 27/38 at National Hospital of Sri Lanka, Colombo from April 2010 to March 2015. Postoperative pain was assessed by using a visual analog scale and other measures such as analgesia requirements, length of the operation, postoperative stay, and patient satisfaction score on surgery and scars were also reviewed. Results: Of the 204 patients, seventy nine (38.7%) had cholecystitis and 88 (43.1%) had billiary collic. In addition 23 patients (11.2%) had pre-op ERCP. Three ports technique were used during most of the LICs -146 (71.6%). Main reasons for the fourth port 58 (28.4%) were ongoing inflammation, unclear anatomy and concomitant bile duct exploration 14 (6.8%). Patients in the 3-port group had less pain at port sites. The operative time, overall pain score, analgesia requirements, hospital stay, and patient satisfaction score on surgery and scars were similar. Conclusion: Three-port technique resulted in less individual port-site pain, fewer surgical scars and without any increased risk of bile duct injury. Thus, we recommend it as a safe procedure in elective uncomplicated cases in the experienced hands. HPB 2016, 18 (S1), e385ee601
e511
EP03E-017 IS THERE A PLACE FOR OPEN CHOLECYSTECTOMY IN THE LAPAROSCOPIC ERA? K. D. L. Nanayakkara, B. G. N. Rathnasena, M. S. E. Karunadasa and W. M. S. B. Thilakarathna Department of Surgery, National Hospital of Sri Lanka, Sri Lanka Introduction: Laparoscopic cholecystectomy (LC) is the gold standard surgical procedure for gall bladder removal. However for the safety of the procedure in difficult situations, it is customary to convert it to an open procedure, which is 5% e 10% worldwide. Here, we present a case series of over 100 patients undergoing laparoscopic cholecystectomy with a zero conversion rate. Materials and methods: A retrospective and prospective data analysis done for 136 consecutive cases of LC from September 2012 to date performed in a surgical unit at National Hospital of Sri Lanka, Colombo. Results: Of the 136 patients, 102 were women (75%) and 34 men with a mean (SD) age of 47.6 years and 56.48 years respectively. Chronic cholecystitis 43 (31.6%), biliary colic 51 (37.5%) were the commonest indications for surgery with 16 patients who presenting with obstructive jaundice due to CBD stones, undergoing choledochoscopic CBD exploration simultaneously. Twenty one patients with acute cholecystitis underwent LC after an interval of 8 weeks. Among these cases 12 had empyema of gall bladder, 5 mucocele of gall bladder and 1 case of choledochoduodenal fistula were managed successfully with zero conversion rate. In 26 difficult cases retrograde cholecystectomy was performed with only 3 subtotal cholecystectomy. Gall stone spillage was the commonest complication in 21 patients (15.44%) and average post-operative hospital stay was 2.6 days. Conclusion: With meticulous dissection, proper intraoperative assessment together with making a decision of early resorting to retrograde cholecystectomy with experienced surgeon, there seems to be no reason for elective open cholecystectomy.
EP03E-018 INCIDENCE OF CHOLEDOCHAL CYST IN HIGHLY SPECIALIZED HOSPITAL IN MEXICO. 20 YEARS EXPERIENCE V. Carrillo-Maciel1, A. L. Acosta-Saludado2, R. Rangel Rodarte3, J. A. Leal Martinez3, S. Ramos Linaje4, J. Garza Sanchez3, J. H. Salazar Gutierrez3, P. Cano Rios5, L. Y. Rodriguez Valenzuela6 and A. A. Pozzobom Oliveira7 1 Surgery, 2Nutricion, Universidad Autonoma de Durango, Mexico, 3Surgery, IMSS, 4Surgery, San Jose, 5Investigador, Universidad Agraria Autonoma Antonio Narro, 6 Anestesiologia, IMSS, and 7Universidad Autonoma de Durango, Mexico Introduction: The choledochal cyst was defined by Douglas in 1852, and after more than 100 years Alonso-Lej proposed an anatomical classification, which was subsequently amended by Todani. It is considered a malformation develops at the junction of the bile duct to the main duct