COMPARISON OF GALL BLADDER REMOVEL WITH AND WITHOUT ENDOBAG DURING LAPAROSCOPIC CHOLECYSTECTOMY IN TERM OF PORT SITE INFECTION

Main Article Content

Nida Mumtaz
Ali Hasnain Malik
Sana Ullah Khan
Abdullah Khan
Maleeha Nisar
Shoaib Muhammad

Keywords

port site infection, endobag, gallbladder removal, laparoscopic cholecystectomy.

Abstract

INTRODUCTION: Laparoscopy has become the gold standard approach to cholecystectomy since its introduction 30 years ago, and is one of the most commonly performed general surgical procedures1. LC compared to open approach is the treatment of choice for symptomatic cholelithiasis with the proven benefits of less postoperative pain, shorter hospital stay, improved cosmesis, and increased patient satisfaction2. The present study will compare the port site infection (PSI) in patients whose gallbladder is removed using an endobag compared to no use of endobag. As mentioned above, the retrieval of GB during LC remains a permanent challenge despite huge advances in its operative procedures and perforation of GB during LC can lead to significant morbidity particularly in term of PSI. The results of this study will be compared with other local surgeons and on the basis of results of this study, we will be able to draw conclusions for future research and policy recommendations.


OBJECTIVE: To compare the port site infection between endobag versus no endobag for gallbladder removal during laparoscopic cholecystectomy.
METHODOLOGY: This study was carried out at the department of Surgery, Lady Reading hospital, Peshawar.  Study Design was randomized controlled trial and the period of study was one year from 10th September 2019 to 9th September 2020. The sample size was 448 (224 in each group). All the patients undergoing single port LC for chronic cholecystitis with ASA class 1 and 2, age between 20 – 60 years and either gender were included. All the patients were randomly allocated in two groups by blocked randomization. Patients in group A were subjected to LC with use of endobag for retrieval of GB while patients in group B was subjected to LC with no endobag use for GB retrieval. Once the surgery is completed, standard post-operative protocols was maintained for all patients which includes triple antibiotic regime for all patients, analgesics and daily wound dressings. All the patients were followed up for the next 30 days to detect port site infection. The data collected was analyzed in SPSS version 22.
RESULTS: In this current study patients in group A were subjected to LC with use of endobag for retrieval of GB while patients in group B was subjected to LC with no endobag use for GB retrieval. Mean age in Group A was 44 years with SD ± 15.71 while mean age in Group B was 45 years with SD ± 14.39. In Group A 87(39%) patients were male and 137(61%) patients were female while in Group B 83(37%) patients were male and 141(63%) patients were female. In Group A 4(2%) patients had port site infection and 220(98%) patients didn’t had port site infection while in Group B 13(6%) patients had port site infection and 211(94%) patients didn’t had port site infection.


CONCLUSION: Our study concludes that port site infection was low in endobag as compare to no endobag for gallbladder removal during laparoscopic cholecystectomy.

Abstract 191 | PDF Downloads 92

References

1. Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg. 2015;18:196-204.
2. Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbeck's Arch Surg. 2015;400(4):429-53.
3. Kartal K, Uludag M. Can 4-port laparoscopic cholecystectomy remain the gold standard for gallbladder surgery. Ann Ital Chir. 2016;87:13-7.
4. Garg P, Thakur JD, Garg M. Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg. 2012;16:1618–28.
5. Altuntas YE, Oncel M, Haksal M, Kement M, Gundogdu E, Aksakal N. Gallbladder perforation during elective laparoscopic cholecystectomy: Incidence, risk factors, and outcomes. Northern Clin Istanbul. 2018;5(1):47-51.
6. Sasmal PK, Mishra TS, Rath S, Meher S, Mohapatra D. Port site infection in laparoscopic surgery: A review of its management. World J ClinCas 2015;3(10):864-8.
7. Begum S, Khan MR, Gill R. Cost effectiveness of glove endobag in laparoscopic cholecystectomy: Review of the available literatur. J Pak Med Assoc. 2019;69(Supl. 1):S58
8. Al-Naser MK. Port Site Infections after Laparoscopic Cholecystectomy. Inter J Med Res Health Sci. 2017;6:132-7.
9. Saud AD, Al-Hail MC. Surgical site infection after laparoscopic cholecystectomy. Basrah J Surg.2017;16:119-21
10. Comajuncosas J, Hermoso J, Jimeno J, Gris P, Orbeal R, Cruz A, Parés D. Effect of bag extraction to prevent wound infection on umbilical port site wound on elective laparoscopic cholecystectomy: a prospective randomised clinical trial. Surg Endosc. 2017;31:249–54.
11. Warren DK, Nickel KB, Wallace AE, Mines D, Tian F, Symons WJ, et al. Risk Factors for Surgical Site Infection After Cholecystectomy. Open Forum Infect Dis. 2017;4(2):ofx036
12. Berger-Richardson D, Chesney TR, Englesakis M, Govindarajan A, Cleary SP, Swallow CJ. Trends in port-site metastasis after laparoscopic resection of incidental gallbladder cancer: a systematic review. Surgery. 2017;161(3):618–27
13. Pasquali S, Boal M, Griffiths EA, Alderson D. Vohra RS; CholeS study group; west midlands research collaborative. Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br J Surg. 2016;103(1):27–34.
14. Memon JM, Memon MR, Arija D, Bozdar AG, Talpur MMA. Retrieval of gallbladder through epigastric port as compared to umbilical port after laparoscopic cholecystectomy. Pak J Pharm Sci. 2014;27(6):2165-68.
15. Al-Dhahiry JK, Melek HK, Abduljabbar TK. Laparoscopic cholecystectomy: use of the surgical glove for extraction of gallbladder and spilled gallstones where traditional endobag is not available or expensive. Int J Med Res Prof 2017;3:55-9.
16. Majid MH, Meshkat B, Kohar H, El Masry S. Specimen retrieval during elective laparoscopic cholecystectomy: is it safe not to use a retrieval bag? BMC Surg 2016;16:64.
17. Singh K, Walia DS, Singla A, Banal A, Jangir N. A comparison of benefits and complications of extraction of gallbladder in an endobag using a drain bag versus direct extraction. Int J Anat Radiol Surg. 2018;7:13-8.
18. Narayanswamy T, Prajwal RK. Is endobag effective preventing port site infections in laparoscopic cholecystectomy: Our experience. Int J Surg. 2019;3(4):316-8.
19. Regina DL, Mongelli F, Cafarotti S, Saporito A, Ceppi M, Giuseppe MD. Use of retrieval bag in the prevention of wound infection in elective laparoscopic cholecystectomy: is it evidence-based?. A meta-analysis. BMC Surgery. 2018;18:102.
20. Rehman H, Siddiqa M, Munam A, Khan S. Frequency of port site wound infection after Gall Bladder removal with or without retrieval bag in laparoscopic cholecystectomy. JPMA 2020;70:1533-9.

Most read articles by the same author(s)