Comparison Outcome of Laparoscopic Cholecystectomy Surgery between Combine Retrograde Caudal-Antegrade Cranial Approach and Retrograde Caudal Approach in Samut Prakan Hospital
Keywords:Laparoscopic cholecystectomy, Retrograde caudal approach, Antegrade cranial approach, Common bile duct injury, Bile leakage
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.
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