Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri-Mondor Hospital, AP-HP, Université Paris Est - UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Rothschild Hospital, AP-HP, University of Paris Diderot, Paris, France.
Surg Endosc. 2018 May;32(5):2300-2311. doi: 10.1007/s00464-017-5925-y. Epub 2017 Nov 2.
Laparoscopic cholecystectomy (LC) is one of the most frequent surgeries performed in patients with sickle cell disease (SCD). LC in SCD patients is associated with a particularly high postoperative morbidity. The aim of the present study is to assess the safety and feasibility of cholecystectomy performed by mini-laparoscopy with low- and stable-pressure pneumoperitoneum (MLC + LSPP) and to compare the rate of postoperative SCD-related morbidity with standard LC.
Thirty-five consecutive SCD patients admitted between November 2015 and March 2017 for cholelithiasis requiring surgery were compared with an historical cohort of 126 SCD patients who underwent LC for the same indication. Operative variables, postoperative outcomes, patient and surgeon satisfaction, and costs were evaluated.
MLC + LSPP exhibited a mean operative time comparable to LC (p = 0.169). Operative blood loss was significantly reduced in the MLC + LSPP group, and the suction device was rarely used (p = 0.036). SCD-related morbidity (including acute chest syndrome) was significantly higher in the LC group compared with the MLC + LSPP group (18.3 vs. 2.9%; p = 0.029). The mean times to resume ambulation (p = 0.018) and regular diet (p = 0.045) were significantly reduced in the MLC + LSPP group. The mean incision length (all trocars combined) was 28.22 mm for MLC + LSPP and 49.64 mm for LC patients (p < 0.0001). Multivariate regression analysis demonstrated that the only significant predictor of postoperative SCD-related morbidity was the surgical approach (odds ratio: 9.24). Patient and surgeon satisfaction were very high for MLC + LSPP. The mean total cost per patient (surgery and hospitalization) was not different between groups (p = 0.084).
MLC + LSPP in SCD patients appears to be safe and feasible. Compared with LC, MLC + LSPP in SCD patients is associated with a significantly reduced incidence of postoperative SCD-related morbidity and more rapid ambulation and return to regular diet without increasing the total costs per patient.
腹腔镜胆囊切除术（LC）是镰状细胞病（SCD）患者最常进行的手术之一。SCD 患者的 LC 术后发病率特别高。本研究旨在评估使用低压稳定气腹的迷你腹腔镜胆囊切除术（MLC+LSPP）的安全性和可行性，并比较与标准 LC 相关的术后 SCD 发病率。
将 2015 年 11 月至 2017 年 3 月期间因胆石症需要手术而收治的 35 例连续 SCD 患者与因同一指征接受 LC 的 126 例 SCD 患者的历史队列进行比较。评估手术变量、术后结果、患者和外科医生满意度以及成本。
MLC+LSPP 的平均手术时间与 LC 相当（p=0.169）。MLC+LSPP 组的手术出血量明显减少，且很少使用吸引器（p=0.036）。与 MLC+LSPP 组相比，LC 组的 SCD 相关发病率（包括急性胸部综合征）显著更高（18.3%比 2.9%；p=0.029）。MLC+LSPP 组患者恢复行走（p=0.018）和常规饮食（p=0.045）的时间明显缩短。MLC+LSPP 组的总切口长度（所有套管针的总和）为 28.22 毫米，LC 患者为 49.64 毫米（p<0.0001）。多变量回归分析表明，术后 SCD 相关发病率的唯一显著预测因素是手术方式（优势比：9.24）。MLC+LSPP 的患者和外科医生满意度非常高。两组患者的平均每位患者总费用（手术和住院）无差异（p=0.084）。
SCD 患者的 MLC+LSPP 似乎是安全可行的。与 LC 相比，SCD 患者的 MLC+LSPP 术后 SCD 相关发病率显著降低，且行走和恢复常规饮食更快，而每位患者的总费用无增加。
