CLINICAL OUTCOME OF STUMP CLOSURE TECHNIQUES AFTER SUBTOTAL CHOLECYSTECTOMYOUR EXPERIENCE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 49
Abstract
BACKGROUND Laparoscopic cholecystectomy has replaced open cholecystectomy as the surgical procedure of choice for Gall Stone disease. The presence of risk factors such as frozen Calot’s triangle in acute cholecystitis, oedematous tissue in severe acute cholecystitis, have been associated with the risk of injury to the common bile duct and bleeding, and high mortality and morbidity to the patient; so laparoscopic subtotal cholecystectomy has been advocated as a safer technique in preventing injuries to the common bile duct. The present study was conducted to compare different techniques of Stump Closure in subtotal cholecystectomy. Bile leakage after Subtotal Cholecystectomy (SC) is clinically serious. To prevent such leakage, we developed a new surgical technique in which a free piece of omentum is plugged into the gallbladder stump (omentum plugging technique- omentum was plugged into the stump and stump closed with interrupted stitches). We compared the results with other group where the stump was sutured with end-to-end interrupted stitches without omentum. MATERIALS AND METHODS In this observational study, the prospectively collected data of patients who had undergone laparoscopic cholecystectomy for gall stone disease from January 2015 to March 2018 were reviewed retrospectively in Karpagam Medical College. Among all laparoscopic cholecystectomies, we analysed the outcome of stump closure of patients who had undergone subtotal cholecystectomy with the omentum plugging technique (omentum plugging and suturing group) and were compared with those of patients who had undergone subtotal cholecystectomy without the omentum plugging technique, but only suturing (Control group). The outcomes of interest were perioperative data and postoperative complications including bile leakage, necessity for interventions for complications and duration of hospitalisation. RESULTS The total number of laparoscopic cholecystectomies between January 2015 and March 2018 for cholelithiasis was 800 patients. In that the total number of patients who had undergone subtotal cholecystectomy was 48. 6% of the patients underwent subtotal cholecystectomy. 21 patients (44%) in the Omental Plugging Technique (OPT) and 24 patients (50%) in the interrupted Stump Closure alone without OPT Technique were in the control group. In the Omentum fixing group, only 2 patients (10%) developed bile leakage, but in the stump closure technique without Omentum 12 patients (50%) developed bile leakage, in that 9 patients (75%) in control group without omentum plugging required post-operative intervention. In omentum plugging, only 1 (50%) patient required post-OP intervention. The duration of post-operative hospitalisation and cost of treatment was less in the Omentum Plugging Technique Group. 3 patients’ stump could not be closed and left open, so they were not included in the study. CONCLUSION The omentum plugging and fixing technique appears to be an effective operative technique for preventing post-operative bile leakage in selected situations of subtotal cholecystectomy when a “difficult gallbladder” is encountered compared to the control group purely suturing of stump. We observed that omentum plugging technique with suturing prevents bile leakage after subtotal cholecystectomy compared to closure with only sutures and has the additional advantages of early return to work and reduced cost of treatment.
Authors and Affiliations
Shanker M. C. R. S. , Kavitha Shanker
Keywords
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- EP ID EP549022
- DOI 10.14260/jemds/2018/1161
- Views 72
- Downloads 0
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