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Single Incision versus conventional laparoscopic cholecystectomy: a comparative study using propensity score matching
e492
Electronic Poster Abstracts
presenting here the fate of the spilled over gall bladder stones during laparoscopic cholecystectomy in an old lady. Method: A 52 -year-old woman who presented with discharging sinus that developed four years after LC from one of post surgical site. Radiological studies showed a sinus tract of size around 8 cms. With an abscess formation at the sub hepatic region with some echoreflective structure inside. The whole of the sinus tract was excised and the collection drained. Multiple gall stones were found in the cavity which was spilled during her surgery. Results: The incidence of perforation ranged from 9% to 40% whereas stones retained in 1% e 13%.Recognised symptoms include abdominal pain, fever, abdominal abscess, and the presence of a sinus formation and present in variable time periods .It is crucial to minimise the number of stones spilled by meticulous dissection and use endo bag for specimen retrieval, attempt to retrieve all stray stones and to copiously irrigate the peritoneal cavity. Possibly the most important aspect in the management of stone spillage is documentation. Conclusion: Gallbladder perforation during is a reasonably common problem and may result in spilled stones and may lead to complications. Should spillage occur, clear documentation and a high index of suspicion should be maintained for early recognition and treatment of complications.
EP03D - Electronic Poster: 3D e Biliary Surgical Outcomes
EP03D-001 SINGLE INCISION VERSUS CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY: A COMPARATIVE STUDY USING PROPENSITY SCORE MATCHING J. Y. Jeon1 and J. P. Jung2 1 General Surgery, Hallym University Sacred Heart Hospital, and 2General Surgery, Chuncheon Sacred Heart Hospital, Republic of Korea Purpose: Single incision laparoscopic surgery was developed with the aim of reducing the invasiveness of conventional laparoscopy. We aimed to compare results of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic (CLC) retrospectively. Methods: In this study, one thousand sixty-two patients who underwent laparoscopic cholecystectomy for gallbladder disease were enrolled. SILC was performed using GloveportÒ 431 without the use of inverse triangulation. We performed 3-ports or 4-ports CLC. These patients were divided into two groups; patients who underwent SILC and patients who underwent CLC. Among these patients, 8 patients who were lack of medical records were excluded. To control for different demographic factors in the two groups, propensity case matching was used at a 1:1 ratio. Finally, 646 patients were matched with 323 patients of SILC and 323 patients of CLC. Demographics, pathologic diagnosis, operating time, length of hospital stay, complications, and number of pain killer use were recorded. Results: Length of stay and wound complication were not different between two groups. Conversion to open surgery was not significant. Operating time was longer in CLC
group compared with SILC group (64 minutes vs. 60 minutes; P < 0.05). Higher number of pain killer use was observed in SILC group versus CLC group (P < 0.001). Intraoperative bile spillage was higher in the SILC group. Conclusion: We provide an alternative access system using Gloveport to allow SILC. According to our experiences, SILC using Gloveport without the use of inverse triangulation has been demonstrated to be feasible, effective, and safe for the patient.
EP03D-002 CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS IN OCTOGENARIANS: OUR EXPERIENCE S. Vaccari1, E. Picariello1, A. Romano1, B. Pirrera1, F. Monari2, A. Leone1, M. Del Governatore2, G. -A. Del Gaudio2, V. Tonini2 and M. Cervellera2 1 Policlinico Sant’Orsola-Malpighi-Università degli Studi di Bologna, and 2Policlinico Sant’Orsola-MalpighiUniversità degli Studi di Bolognatudi di Bologna, Italy Introduction: The progressive percentage increase in the number of interventions on elderly patients is due to the demographic increase of old people in the western countries. The aim of this study was clarify the perioperative outcome of octogenarians with acute cholecystitis treated by cholecystectomy. Method: Patients aged 80 years or older who received cholecystectomy from September 2011 to June 2015 due to acute cholecystitis were retrospectively reviewed. Comparison was made between younger and older patients who received cholecystectomy. Results: Among the 599 cholecystectomies 201 patients were admitted for acute cholecystitis during the study period. Fourty-seven (23,3%) octogenarians [GOct] received cholecystectomy as treatment and the median age was 84,5 years (range 80e102). There were 20 males (42,5%). One hundred fifty-four patients (76,7%) were younger than 80-years-old [GYng] and the median age was 59,7 years (range 18e79). Duration of surgical procedure was 97.3 37.5 min [45e 185] and 96.1 38.6 min [40e235] in GOct and GYng, respectively (p = 0.9869). Elderly patients had more complications (31.9% versus 18.2%; p = 0.0658) and a longer median post-operative length of stay (6.7 6.8 versus 4.8 7.3 days, p = 0.8903). No mortality was recorded. On multivariate analysis age older than 80 years was not an independent risk factor for postoperative complications and mortality rate (p = 0.1120 and p = 0.5880, respectively). Conclusions: The results of this study suggest that cholecystectomy for acute cholecystitis in octogenarians is a relatively safe procedure with an acceptable risk of complications and postoperative hospital stay. In our opinion Old age (80) as such does not represent a contraindication for surgical procedure.
HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts
presenting here the fate of the spilled over gall bladder stones during laparoscopic cholecystectomy in an old lady. Method: A 52 -year-old woman who presented with discharging sinus that developed four years after LC from one of post surgical site. Radiological studies showed a sinus tract of size around 8 cms. With an abscess formation at the sub hepatic region with some echoreflective structure inside. The whole of the sinus tract was excised and the collection drained. Multiple gall stones were found in the cavity which was spilled during her surgery. Results: The incidence of perforation ranged from 9% to 40% whereas stones retained in 1% e 13%.Recognised symptoms include abdominal pain, fever, abdominal abscess, and the presence of a sinus formation and present in variable time periods .It is crucial to minimise the number of stones spilled by meticulous dissection and use endo bag for specimen retrieval, attempt to retrieve all stray stones and to copiously irrigate the peritoneal cavity. Possibly the most important aspect in the management of stone spillage is documentation. Conclusion: Gallbladder perforation during is a reasonably common problem and may result in spilled stones and may lead to complications. Should spillage occur, clear documentation and a high index of suspicion should be maintained for early recognition and treatment of complications.
EP03D - Electronic Poster: 3D e Biliary Surgical Outcomes
EP03D-001 SINGLE INCISION VERSUS CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY: A COMPARATIVE STUDY USING PROPENSITY SCORE MATCHING J. Y. Jeon1 and J. P. Jung2 1 General Surgery, Hallym University Sacred Heart Hospital, and 2General Surgery, Chuncheon Sacred Heart Hospital, Republic of Korea Purpose: Single incision laparoscopic surgery was developed with the aim of reducing the invasiveness of conventional laparoscopy. We aimed to compare results of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic (CLC) retrospectively. Methods: In this study, one thousand sixty-two patients who underwent laparoscopic cholecystectomy for gallbladder disease were enrolled. SILC was performed using GloveportÒ 431 without the use of inverse triangulation. We performed 3-ports or 4-ports CLC. These patients were divided into two groups; patients who underwent SILC and patients who underwent CLC. Among these patients, 8 patients who were lack of medical records were excluded. To control for different demographic factors in the two groups, propensity case matching was used at a 1:1 ratio. Finally, 646 patients were matched with 323 patients of SILC and 323 patients of CLC. Demographics, pathologic diagnosis, operating time, length of hospital stay, complications, and number of pain killer use were recorded. Results: Length of stay and wound complication were not different between two groups. Conversion to open surgery was not significant. Operating time was longer in CLC
group compared with SILC group (64 minutes vs. 60 minutes; P < 0.05). Higher number of pain killer use was observed in SILC group versus CLC group (P < 0.001). Intraoperative bile spillage was higher in the SILC group. Conclusion: We provide an alternative access system using Gloveport to allow SILC. According to our experiences, SILC using Gloveport without the use of inverse triangulation has been demonstrated to be feasible, effective, and safe for the patient.
EP03D-002 CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS IN OCTOGENARIANS: OUR EXPERIENCE S. Vaccari1, E. Picariello1, A. Romano1, B. Pirrera1, F. Monari2, A. Leone1, M. Del Governatore2, G. -A. Del Gaudio2, V. Tonini2 and M. Cervellera2 1 Policlinico Sant’Orsola-Malpighi-Università degli Studi di Bologna, and 2Policlinico Sant’Orsola-MalpighiUniversità degli Studi di Bolognatudi di Bologna, Italy Introduction: The progressive percentage increase in the number of interventions on elderly patients is due to the demographic increase of old people in the western countries. The aim of this study was clarify the perioperative outcome of octogenarians with acute cholecystitis treated by cholecystectomy. Method: Patients aged 80 years or older who received cholecystectomy from September 2011 to June 2015 due to acute cholecystitis were retrospectively reviewed. Comparison was made between younger and older patients who received cholecystectomy. Results: Among the 599 cholecystectomies 201 patients were admitted for acute cholecystitis during the study period. Fourty-seven (23,3%) octogenarians [GOct] received cholecystectomy as treatment and the median age was 84,5 years (range 80e102). There were 20 males (42,5%). One hundred fifty-four patients (76,7%) were younger than 80-years-old [GYng] and the median age was 59,7 years (range 18e79). Duration of surgical procedure was 97.3 37.5 min [45e 185] and 96.1 38.6 min [40e235] in GOct and GYng, respectively (p = 0.9869). Elderly patients had more complications (31.9% versus 18.2%; p = 0.0658) and a longer median post-operative length of stay (6.7 6.8 versus 4.8 7.3 days, p = 0.8903). No mortality was recorded. On multivariate analysis age older than 80 years was not an independent risk factor for postoperative complications and mortality rate (p = 0.1120 and p = 0.5880, respectively). Conclusions: The results of this study suggest that cholecystectomy for acute cholecystitis in octogenarians is a relatively safe procedure with an acceptable risk of complications and postoperative hospital stay. In our opinion Old age (80) as such does not represent a contraindication for surgical procedure.
HPB 2016, 18 (S1), e385ee601