STUDY OF ADVANTAGES OF MINILAP-CHOLECYSTECTOMY
Journal Title: PARIPEX-Indian Journal of Research - Year 2017, Vol 6, Issue 2
Abstract
Background- In the current era, cholecystectomy is the safest, most effective and widely recommended treatment for gall stone disease. Different methods available are: standard conventional cholecystectomy (CC), laparoscopic cholecystectomy (LC), minilap- cholecystectomy (MC), and natural orifice transluminal endoscopic cholecystectomy (NOTE-C). NOTE-C is in its infancy. LC has overtaken open cholecystectomy as the method of choice. However, laparoscopic facility is not available in large parts of third world countries due to deficiency of money, man, machine at many district hospitals and some tertiary level hospitals. Methods- Between September 2008 and February 2013, in a tertiary care hospital this study was carried out in two groups (CC and MC) of 40 patients each. Our surgical access for MC was by using average 5.5cm (4.5 to 6.5cm) transverse incision involving the Murphy’s point with rectus retracting technique. The incision for CC was either standard Kocher’s subcostal incision or right paramedian incision. Cholecystectomies were done either by fundus first or by retrograde method. Different perioperative and postoperative observations and postoperative complications were noted in both groups and compared. A review of relevant data of LC from the available literature was made so as to infer the validity of MC over CC and LC. Results- MC could be completed successfully although two cases needed extension of incision- one for morbid adhesion and one for CBD exploration. The average operating time was 70min, 60min; blood loss 90ml, 110ml; dose of analgesia 3.5, 7; duration of iv fluid 24-48 hrs, 36-72 hrs; hospital stay 3.5 days,7 days; and return to work 2 weeks, 3 weeks in MC and CC respectively. The recovery was faster and the cosmetic result was acceptable in MC group but not in CC group. Postoperative complication was more in CC group. Mortality was nil in both the groups. The data on LC from literature are almost similar to that of MC. Conclusion- The advantages of MC scores over CC and the benefits come close to that of LC for which minilap-cholecystectomy can be considered as a good and feasible option for cholecystectomy in centers where money, man and machine are constraints to laparoscopic cholecystectomy.
Authors and Affiliations
DR. S. K. PATTANAIK
Keywords
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