Outcomes of laparoscopic cholecystectomy done with surgical energy versus done without surgical energy: a prospective-randomized control study

Objective Laparoscopic cholecystectomy (LC), a gold standard procedure can be done without energized dissection (ED). We did a randomized study for the outcomes of LC done with ED or without ED, i.e., with cold dissection (CD). Methods and Procedures At a tertiary level institution, open-ended prosp...

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Bibliographic Details
Published in:	Surgical endoscopy Vol. 28; no. 11; pp. 3059 - 3067
Main Authors:	Agarwal, Brij B., Agarwal, Nayan, Agarwal, Krishna A., Goyal, Karan, Nanvati, Juhil D., Manish, Kumar, Pandey, Himanshu, Sharma, Shruti, Ali, Kamran, Mustafa, Sheikh T., Gupta, Manish K., Saluja, Satish, Agarwal, Sneh
Format:	Journal Article
Language:	English
Published:	Boston Springer US 01-11-2014 Springer Nature B.V
Subjects:	Abdominal Surgery Cholecystectomy Cholecystectomy, Laparoscopic - methods Cholecystitis - surgery Clinical outcomes Common Bile Duct - injuries Dissection Dissection - methods Energy Female Gallbladder Gastroenterology Gynecology Hepatology Hospitals Humans Information systems Informed consent Intraoperative Complications - epidemiology Laparoscopy Length of Stay Medical education Medicine Medicine & Public Health Mortality Patients Postoperative Complications - etiology Postoperative Period Proctology Prospective Studies Surgery Ultrasonic Therapy India Cold dissection CBD injury Patient-reported outcomes Laparoscopic cholecystectomy Complications of laparoscopic cholecystectomy Surgical energy
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Summary:	Objective Laparoscopic cholecystectomy (LC), a gold standard procedure can be done without energized dissection (ED). We did a randomized study for the outcomes of LC done with ED or without ED, i.e., with cold dissection (CD). Methods and Procedures At a tertiary level institution, open-ended prospective-randomized control study was conducted between September 2008 and June 2013. Consecutive, unselected, consenting candidates for LC were enrolled following standard ethics, informed consent, anesthesia, and clinical pathway protocol. They were allocated to control group (LC with ED) or study group (LC with CD, as per our published technique with the option for rescue ED). The study points were based upon Clavien–Dindo grading of postoperative complications. They were either, peri-operative events potentially affecting, hospital stay (Grade I) or Grade II–V, e.g., peri-operative hemodynamic instability, needing intervention/blood transfusion, injury to biliary ducts/hollow viscous, postoperative biliary leak, postoperative re-intervention, re-hospitalization, mortality, and any adverse event during a 90-day follow-up period. The data were prospectively collected in an integrated “hospital information system” that could be retrieved only by independent external coordinators. Results Demographics, co-morbidities, and gallbladder inflammation profile of the control group ( n = 361) and study group ( n = 384) were comparable. There was no rescue ED usage in the study group. Hospital stay (Grade I adverse outcome dependent) was longer, i.e., 1.6 ± 1.03 in the control versus 1.35 ± 1.2 days in the study group ( p < 0.001). Grade II–IV complications were significantly more ( p < 0.009) in control group. There was one common bile duct (CBD) injury in each group. The index bilio-enteric anastomosis for CBD injury in control group failed and needed a revision with multiple interventions. There was one grade V adverse outcome, i.e., mortality in the control group. Conclusion Avoiding the use of ED in LC is associated with better outcomes.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	0930-2794 1432-2218
DOI:	10.1007/s00464-014-3579-6