Comparison Between Closed and Open Methods for Creating Pneumoperitoneum in Laparoscopic Cholecystectomy

Abstract

Background: To study the efficacy of closed and open methods for creating pneumoperitoneum in laparoscopic cholecystectomy by comparing the two in terms of their outcome and complication. Study Design: Single-centre, prospective, observational study. Materials and study: Purposive sampling method where the inclusion criteria were all patients with cholelithiasis who were advised and consented to laparoscopic cholecystectomy of age 18-70 years were included in the study group. Exclusion criteria include patients with a paraumbilical hernia, a history of upper abdominal surgery, uncontrolled systemic illness, and local skin infection. Sixty cases of cholelithiasis satisfying exclusion and inclusion criteria who underwent elective cholecystectomy during the study period were included. Thirty-one of these cases underwent the closed method, while in the remaining 29 patients open method was adopted. Cases in which pneumoperitoneum created by closed technique were grouped as group A and those by open technique as group B. Parameters comparing the safety and efficacy of the two methods were studied. The parameters were access time, gas leak, visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia. Patients were assessed on the first postoperative day, the seventh postoperative day, and then two months after surgery. Some follow-ups were done telephonically. Results: Out of 60 patients, 31 underwent the closed method, while 29 underwent the open method. Minor complications like gas leak during the procedure was observed more in the open method. The mean access time in the open-method group was less than in the closed-method group. Other complications like visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia were not observed in either group during the allocated follow-up period in the study. Conclusion:Open technique for pneumoperitoneum is as safe and effective as the closed technique.

A Systematic Review and Meta-Analysis of the Outcomes of Laparoscopic Cholecystectomy Compared to the Open Procedure in Patients with Gallbladder Disease

“… 32 37 38 ( B ) common bile duct injury forest plot. 32 36 39 ( C ) Gangrene forest plot 37 39 ( D ) Hospital stay (days) forest plot 26 33 34 36 37 40 41 42 43 ( E ) Major complications forest plot 26 29 31 32 34 37 38 40 44 ( F ) Median hospital stay (days) forest plot. 29 31 38 45 CI, confidence interval; IV, intravenous; LC, laparoscopic cholecystectomy; OC, open cholecystectomy; SD, standard deviation.…”

“… 28 29 30 35 37 38 39 41 ( C ) Risk of bias in non-randomized studies of Interventions (ROBINS-I; Summary). 26 27 28 32 33 34 35 36 38 39 41 43 44 ( D ) ROBINS-I (Graph). ( E ) ROB2 (Summary).…”

Hem-o-lok clip migration to duodenal bulb post-cholecystectomy: A case report

“…Postoperative clip displacement can lead to various complications, such as rectal elevated lesion caused by Hem-o-lok clip migration after prostate cancer surgery, abscess in the fallopian tube caused by Hem-o-lok clip migration after laparoscopic appendectomy, and dysphagia caused by Hem-o-lok clip migration into the esophagus subsequent to clamping of the azygous vein after radical resection of distal esophageal cancer[ 6 - 8 ]. LC and laparoscopic common bile duct exploration (LCBDE) are the most effective way to treat gallbladder stones, gallbladder polyps, and cholecystitis[ 9 , 10 ]. Hem-o-lok clips are commonly utilized for clamping the arteries and ducts of the gallbladder during LC and LCBDE.…”

Incidental gallbladder cancer: what is the prevalence and how do we perform cholecystectomy for presumably benign biliary disease?

“…There were no complications related to either technique. There are several studies comparing both techniques regarding the incidence of major and minor complications, the time required to establish pneumoperitoneum, and the technique’s safety, with divergent results favoring one or the other 23 - 25 .…”