ABSTRACT
Purpose:
The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed.
Methods:
Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal.
Results:
Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique.
Conclusions:
LC can be performed using different techniques, although the use of EBVS is highly recommended.
Key words
Gallbladder Diseases; Cystic Duct; Cholecystectomy, Laparoscopic; Biliary Tract Surgical Procedures
Thumbnail
Thumbnail
Thumbnail
Thumbnail
Thumbnail
Thumbnail
Source: Elaborated by the authors.
Source: Elaborated by the authors.
Source: Elaborated by the authors.
Group A: fundus-first dome-down technique by Hook dissecting instrument and Roeder slipknot applied for cystic duct ligation; group B: conventional technique by Maryland dissecting forceps for gallbladder dissection and electrothermal bipolar vessel sealing for cystic duct seal; group C: conventional technique by electrothermal bipolar vessel sealing for gallbladder dissection and electrothermal bipolar vessel sealing for cystic duct seal; a,bmedian values with unlike superscript letters were significantly different (Dunn’s test P < 0.05). Source: Elaborated by the authors.
IQR: interquartile range; group A: fundus-first dome-down technique by Hook dissecting instrument and Roeder slipknot applied for cystic duct ligation; group B: conventional technique by Maryland dissecting forceps for gallbladder dissection and electrothermal bipolar vessel sealing for cystic duct seal; group C: conventional technique by electrothermal bipolar vessel sealing for gallbladder dissection and electrothermal bipolar vessel sealing for cystic duct seal; *median values were significantly different between groups in this day (Dunn’s test P < 0.05). Source: Elaborated by the authors.
Group A: fundus-first dome-down technique by Hook dissecting instrument and Roeder slipknot applied for cystic duct ligation; group B: conventional technique by Maryland dissecting forceps for gallbladder dissection and electrothermal bipolar vessel sealing for cystic duct seal; group C: conventional technique by electrothermal bipolar vessel sealing for gallbladder dissection and electrothermal bipolar vessel sealing for cystic duct seal; a,bmedian values with unlike superscript letters were significantly different (Dunn’s test, P < 0.05). Source: Elaborated by the authors.