Comparison Outcome of Laparoscopic Cholecystectomy Surgery between Combine Retrograde Caudal-Antegrade Cranial Approach and Retrograde Caudal Approach in Samut Prakan Hospital

Authors

  • Lertvanavit S

Keywords:

Laparoscopic cholecystectomy, Retrograde caudal approach, Antegrade cranial approach, Common bile duct injury, Bile leakage

Abstract

Background: Laparoscopic cholecystectomy (LC) with retrograde caudal approach may be increase bile duct injury and conversion rate in severe inflammation of gallbladder. Extreme vasculobiliary injuries tend to occur when antegrade cranial approach cholecystectomy is performed in the presence of severe inflammation. Although relatively rare, given the high volume of LC, the societal burden of bile duct injury is significant and the resulting effect on patients’ outcomes, ranging from intraoperative repair, liver transplant or even death. Thus the author adjusted technique called combine retrograde caudal-antegrade cranial approach for decrease bile duct complication and conversion rate.

Objectives: To compare outcome of laparoscopic cholecystectomy with combined retrograde caudal -antegrade cranial approach with retrograde caudal approach in Samut Prakan Hospital.

Methods: A retrospective study involved patients with laparoscopic cholecystectomy was conducted between January 2560 and June 2562 in Samut Prakan Hospital. Patients were devided into 2 groups according to retrograde caudal approach, combined retrograde caudal-antegrade cranial approach. All patients’ files were reviewed for baseline characteristics, preoperative and postoperative diagnosis, operative findings’ data, complication of operation. All data were analysis.

Results: Three hundred and twenty three patients were analyzed. One hundred and seventy one patients underwent surgery with retrograde caudal approach and one hundred and fifty two patients underwent surgery with combined retrograde caudal-antegrade cranial approach. Patients with combined retrograde caudal-antegrade cranial approach had significantly shorter median operative time than those of patients with retrograde caudal approach (43.5 minutes vs 50 minutes, p=0.002). Patients with combined retrograde caudal-antegrade cranial approach had significantly shorter median hospital stay than those of patients with retrograde caudal approach (3 days vs 4 days, p=0.02). Patients with combined retrograde caudal-antegrade cranial approach had significantly less conversion rate than those of patients with retrograde caudal approach (3.9% vs 9.9%, p=0.03). Patients with combined retrograde caudal-antegrade cranial approach had significantly less bile duct injury and bleeding from cystic artery than those of patients with retrograde caudal approach (0.7% vs 6.4%, p=0.006 and 1.97% vs 8.7% p=0.008) respectively.

Conclusions: Laparoscopic cholecystectomy with combined retrograde caudal -antegrade cranial approach may be decrease bile duct complication rate and conversion rate compare with retrograde caudal approach. 

References

Dubois F, Icard P, Berthelot G, Levard H. Coelioscopic cholecystectomy: preliminary report of 36 cases. Ann Surg 1990;211:60–2.

Litynski GS. Mouret, Dubois, and Perissat. The Laparoscopic Breakthrough in Europe (1987-1988). JSLS 1999;3:163-7.

Cuschieri A, Berci G, McSherry CK. Laparoscopic cholecystectomy. Am J Surg 1990;159:273.

Zucker KA, Bailey RW, Gadacz TR, Imbembo AL. Laparoscopic guided cholecystectomy. Am J Surg 1991; 161:36–42.

McMahon AJ, Fullarton G, Baxter JN, O’Dwyer PJ. Bile duct injury and bile leakage in laparoscopic cholecystectomy.Br J Surg 1995;82:307-13.

Huang SM, Wu CW, Hong HT, Ming - Liu, King KL, Lui WY. Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg 1993; 80:1590–2.

Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 2003;290:2168–73.

Roslyn JJ, Binns GS, Hughes EF, Saunders-Kirkwood K, Zinner MJ, Cates JA. Open cholecystectomy. A contemporary analysis of 42,474 patients. Ann Surg 1993;218:129–37.

Stewart L, Way LW. Bile duct injuries during laparoscopic cholecystectomy. Factors that influence the results of treatment. Arch Surg 1995;130:1123–8.

Uyama I, Iida S, Ogiwara H, Takahara T, Kato Y, Furuta T, et al. Laparoscopic retrograde cholecystectomy (from fundus downward) facilitated by lifting the liver bed up to the diaphragm for inflammatory gallbladder. Surg Laparosc Endosc 1995;5:431–6.

Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, et al. TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2013;20:89–96.

Hibi T, Iwashita Y, Ohyama T, Honda G, Yoshida M, TakadaT, et al. The “right” way is not always popular: comparison of surgeons’ perceptions during laparoscopic cholecystectomy for acute cholecystitis among experts from Japan, Korea and Taiwan. J Hepatobiliary Pancreat Sci 2017;24:24–32.

Iwashita Y, Ohyama T, Honda G, Hibi T, Yoshida M, Miura F, et al. What are the appropriate indicators of surgical difficulty during laparoscopic cholecystectomy? Results from a JapanKorea-Taiwan multinational survey. J Hepatobiliary Pancreat Sci 2016;23:533–47.

Kelly MD. Laparoscopic retrograde (fundus first) cholecystectomy. BMC Surg 2009;9:19.

Fullum TM, Kim S, Dan D, Turner PL. Laparoscopic “Dome-down” cholecystectomy with the LCS-5 Harmonic scalpel. JSLS 2005;9:51–7.

Huang SM, Hsiao KM, Pan H, Yao CC, Lai TJ, Chen LY, et al. Overcoming the difficulties in laparoscopic management of contracted gallbladders with gallstones: possible role of fundus- down approach. Surg Endosc 2011;25:284–91.

Gupta A, Agarwal PN, Kant R, Malik V. Evaluation of fundus-first laparoscopic cholecystectomy. JSLS 2004;8: 255–8.

Neri V, Ambrosi A, Fersini A, Tartaglia N, Valentino TP. Antegrade dissection in laparoscopic cholecystectomy. JSLS 2007;11:225–8.

Tuveri M, Borsezio V, Calo PG, Medas F, Tuveri A, Nicolosi A. Laparoscopic cholecystectomy in the obese: results with the traditional and fundus-first technique. J Laparoendosc Adv Surg Tech A 2009;19:735–40.

Lirici MM, Califano A. Manag ement of complicated gallstones: results of an alternative approach to difficult cholecystectomies. Minim Invasive Ther Allied Technol 2010;19:304–15.

Strasberg SM, Gouma DJ. ‘Extreme’ vasculobiliary injuries: association with fundus-down cholecystectomy in severely inflamed gallbladders. HPB (Oxford) 2012;14:1–8.

Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180:101-25.

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Published

01-09-2020

How to Cite

1.
Lertvanavit S. Comparison Outcome of Laparoscopic Cholecystectomy Surgery between Combine Retrograde Caudal-Antegrade Cranial Approach and Retrograde Caudal Approach in Samut Prakan Hospital. J DMS [Internet]. 2020 Sep. 1 [cited 2024 Mar. 19];45(2):38-47. Available from: https://he02.tci-thaijo.org/index.php/JDMS/article/view/245305

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