EFFICACY AND OUT COMES OF CLOSED VERSUS OPEN LAPAROSCOPIC CHOLECYSTECTOMY: A COMPARATIVE PROSPECTIVE STUDY
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Keywords
Pneumoperitoneum, Veress needle, Hasson's method, Laparoscopy, Cholecystectomy
Abstract
Background: The word laparoscopy originated from the Greek word Laparo - which means abdomen, and scopion meaning to examine. Laparoscopy is the art of evaluating the abdominal cavity and its contents.
Laparoscopic cholecystectomy (LC) is the gold standard operation for gallstone disease. Both closed/Veress and open/Hasson’s techniques are commonly employed and have their typical indications for use. A prospective study was carried out in the Department of General Surgery, DR KNSMIMS, GADIA, BARABANKI,UP, INDIA., from June 2024 to May 2025, with the aim to compare the efficacy, safety and post operative out comes of closed/Veress and open/Hasson’s procedure of access to the abdomen during laparoscopic cholecystectomy (LC). A total of 100 patients, undergone LC who were randomly allotted into 2 groups with 50 cases each:
group A: closed/Veress needle method and group B: open/Hasson’s method. All the patients that participated in this study were belonged to the age group of 18-70 years out of which majority were 21-45 years old. In this study, the mean time required to create pneumoperitoneum by closed method (group A) was 8.23 seconds while by open method (group B), it was 6.91 seconds with p value <0.001. There were 7 cases of gas leak from the port side, Six recorded in the open method of establishment of pneumoperitoneum. Closed/Veress and open/Hasson’s method of establishing pneumoperitoneum in laparoscopic cholecystectomy was equally safe in terms of major complications. Closed/Veress method gave faster access to the abdomen as compared to the open method, (Gr-A- 5.36 ± 1.33 minutes and Gr. B- 7.91 ± 1.46 minutes, respectively, p value <0.0001). Open/Hasson’s method was associated with more primary port site complications (4/50 vs. 1/50, p value 0.029) and troublesome intraoperative gas leaks (6/50 vs. 1/50, p value <0.001). Open technique for primary peritoneal access port for laparoscopic cholecystectomy did not impart any additional benefits in terms of safety and morbidity profile in patients undergoing LC.
Conclusion: Open technique for pneumoperitoneum was as safe and effective as the closed technique.
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DR SANJEET KUMAR
PG RESIDENT-3, DEPARTMENT OF GENERAL SURGERY, DR KNSMIMS, GADIA, BARABANKI,UP, INDIA
DR GURASHISH SINGH GULATI
PG RESIDENT-3, DEPARTMENT OF GENERAL SURGERY, DR KNSMIMS, GADIA, BARABANKI,UP, INDIA
DR RAVI SINHA
PROFESSOR & HOD, DEPARTMENT OF GENERAL SURGERY, DR KNSMIMS, GADIA, BARABANKI,UP, INDIA