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Laparoscopic cholecystectomy (LC) is a standard procedure for gallstones and the standard surgical approach for acute calcular cholecystitis, superseding open cholecystectomy for gallbladder (GB) pathologies. Despite this progress, mortality rates in high-risk cohorts remain substantial, ranging between 3.7% and 41.0%. Moreover, the recommended modality for mucocele which is defined as distension and marked dilatation of the GB associated with dysfunction is LC.
The routine aspiration showed significant less percentage of GB perforation during surgery with similarity for other factors . However, routine aspiration of the GB during uncomplicated LC is considered an unnecessary intervention and therefore not recommended as a routine practice.
Accidental GB perforation occurs in about 20% of laparoscopic cholecystectomies, and bile contamination in the abdominal cavity can cause SSI and lead to the formation of a residual abscess or wound infection.
Grasping a thick and distended GB is one of the most common technical difficulties of laparoscopic cholecystectomy in acute cholecystitis. If the GB is distended it should be decompressed it to avoid conversion to open due to bile duct injury or perforation with spillage of bile and gallstones previously, authors had advocated conversion if iatrogenic perforation occurred.
This study was conducted on patients with symptomatic calcular cholecystitis presented to Aswan university hospital.
The following parameters were measured intraoperative difficulty.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Aspiration group | Experimental |
| |
| Non-Aspiration group | No Intervention |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Laparoscopic needle | Procedure | During classic LC, either with preoperative or accidently intra-operative overdistended GB using a laparoscopic needle to decompress the GB and make the operation much easier |
| Measure | Description | Time Frame |
|---|---|---|
| Difficulty of the operation | the difficulty will be assessed by the following Operative time, Incidence of biliary tree injury, Higher surgeon consultation and Conversion to open chole | 30 days |
| Measure | Description | Time Frame |
|---|---|---|
| Liver bed bleeding | checking post procedures and postoperative through the drain | 30 days |
| 30-day mortality | follow-up the patient in the outpatient and by phone |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ali H Abdelaal | Faculty of Medicine, Aswan University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Aswan University | Aswān | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15019851 | Background | Barrat C, Champault A, Matthyssens L, Champault G. [Iatrogenic perforation of the gallbladder during laparoscopic cholecystectomy does not influence the prognosis. Prospective study]. Ann Chir. 2004 Feb;129(1):25-9. doi: 10.1016/j.anchir.2003.11.011. French. | |
| Background | Calik, A., Topaloglu, S., Topcu, S., Turkyilmaz, S., Kucuktulu, U., & Piskin, B. (2007). Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy. Surgical Endoscopy and Other Interventional Techniques, 21(9), 1578-1581. https://doi.org/10.1007/s00464-006-9159-7 Guzmán-Valdivia, G. (2008). Routine Administration of Antibiotics to Patients Suffering Accidental Gallbladder Perforation During Laparoscopic Cholecystectomy is not Necessary. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 18(6), 547-550. https://doi.org/10.1097/SLE.0b013e3181809e72 Lee, K.-T., Shan, Y.-S., Wang, S.-T., & Lin, P.-W. (2005). Verres needle decompression of distended gallbladder to facilitate laparoscopic cholecystectomy in acute cholecystitis: A prospective study. Hepato-Gastroenterology, 52(65), 1388-1392. Lisotti, A., Linguerri, R., Bacchilega, I., Cominardi, A., Marocchi, G., & Fusaroli, P. (2022). EUS-guided gallbladder drainage in high-risk surgical patients with acute cholecystitis-Procedure outcomes and evaluation of mortality predictors. Surgical Endoscopy, 36(1), 569-578. https://doi.org/10.1007/s00464-021-08318-z Majumder, A., Altieri, M. S., & Brunt, L. M. (2020). How do I do it: Laparoscopic cholecystectomy. Annals of Laparoscopic and Endoscopic Surgery, 5, 15-15. https://doi.org/10.21037/ales.2020.02.06 Mishra, R. K. (2022, June 12). Cholecystectomy for Mucocele of Gallbladder. https://www.laparoscopyhospital.com/streamvideo/index.php?pid=536&p=28 Ponsky, J. L. (1991). Complications of laparoscopic cholecystectomy. The American Journal of Surgery, 161(3), 393-395. https://doi.org/10.1016/0002-9610(91)90605-D Shea, J. A., Berlin, J. A., Bachwich, D. R., Staroscik, R. N., Malet, P. F., McGuckin, M., Schwartz, J. S., & Escarce, J. J. (1998). Indications for and Outcomes of Cholecystectomy. Annals of Surgery, 227(3), 343-350. https://doi.org/10.1097/00000658-199803000-00005 Shirah, B. H., Shirah, H. A., & Albeladi, K. B. (2018). The value of intraoperative percutaneous aspiration of the mucocele of the gallbladder for safe laparoscopic management. Updates in Surgery, 70(4), 495-502. https://doi.org/10.1007/s13304-018-0565-x Siddiqui, M. R. S., Sajid, M. S., Nisar, A., Ali, H., Zaborszky, A., & Hasan, F. (2011). A meta-analysis of outcomes after routine aspiration of the gallbladder during cholecystectomy. International Surgery, 96(1), 21-27. https://doi.org/10.9738/1361.1 Usuba, T., Nyumura, Y., Takano, Y., Iino, T., & Hanyu, N. (2017). Clinical outcomes of laparoscopic cholecystectomy with accidental gallbladder perforation. Asian Journal of Endoscopic Surgery, 10(2), 162-165. https://doi.org/10.1111/ases.12348 Wood, S., Lewis, W., & Egan, R. (2019). Optimising Surgical Technique in Laparoscopic Cholecystectomy: A Review of Intraoperative Interventions. Journal of Gastrointestinal Surgery, 23(9), 1925-1932. https://doi.org/10.1007/s11605-019-04296-9 |
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| ID | Term |
|---|---|
| D041881 | Cholecystitis, Acute |
| D002764 | Cholecystitis |
| ID | Term |
|---|---|
| D005705 | Gallbladder Diseases |
| D001660 | Biliary Tract Diseases |
| D004066 | Digestive System Diseases |
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comparing the efficacy of intra-operative Gallbladder content aspiration in overdistended cases with completion of the operation without aspiration
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Participants agreed to participate in the study and undergo the LC
| 30 days |
| Hospital stays. | total stay in the hospital | 30 days |
| Peritonitis | incidence of peritonitis in the first week of the operation | 30 days |