Fajardo Gómez Roosevelt, Díaz Cuervo Francisco Javier, Cabrera Vargas Luis Felipe, Avella Molano Camilo Andres, Rincón Comba Francisco Alejandro
Surgery Department, Teaching Hospital Fundación Santa Fe de Bogotá, Calle 119 #7-75, Bogotá, 110111, Colombia.
Universidad el Bosque, Bogotá, Colombia.
Surg Endosc. 2023 Jan;37(1):587-591. doi: 10.1007/s00464-022-09362-z. Epub 2022 Jun 7.
Laparoscopic cholecystectomy (LC) is one of the most commonly performed emergency procedures, with approximately 600,000 patients undergoing the procedure every year in the United States. Although LC is associated with fewer complications when compared with open cholecystectomy, the risk for infectious complications, including surgical site infection and intra-abdominal abscess, remains a significant source of postoperative morbidity. The goal of this study is to determine whether the gallbladder retrieval technique during LC affects risk of infectious complications.
We conducted a retrospective comparative study in a minimally invasive surgery high-volume center in Bogota, Colombia. Patients who underwent LC in 2018 to 2020 were identified. The patients were divided into three groups. One group of LC performed using home-made gallbladder retrieval bag (HMGRB), and another group of LC performed using commercial gallbladder retrieval bag (CGRB). The primary outcomes were infectious complications of superficial site infection and intra-abdominal abscess.
A total of 68 (7.58%) patients underwent LC using an HMGRB, and 828 (92.41%) using a CGRB. There was no significant difference in preoperative sepsis, or sex distribution between patient groups. Using t test, we found differences on age distribution among groups (p < 0.01), surgical times (p < 0.01), and length of stay (p = 0.01). When using Chi square, we found differences in Tokyo and Parkland Grading Scale severity (p < 0.01), use of postoperative antibiotics (p < 0.01), and drain use (p < 0.01). Nonetheless, there was no difference in the rate of superficial surgical site infection (p = 0.92).
HMGRB are not associated with increased risk of postoperative intra-abdominal abscess or superficial surgical site infection in comparison with CGRB but imply longer surgical times and length of stay. The use of HMGRB is safe, feasible, and has lower cost during LC.
腹腔镜胆囊切除术（LC）是最常开展的急诊手术之一，在美国每年约有60万患者接受该手术。尽管与开腹胆囊切除术相比，LC的并发症较少，但包括手术部位感染和腹腔内脓肿在内的感染性并发症风险仍是术后发病的重要来源。本研究的目的是确定LC术中胆囊取出技术是否会影响感染性并发症的风险。
我们在哥伦比亚波哥大的一个高容量微创手术中心进行了一项回顾性比较研究。确定了2018年至2020年接受LC的患者。患者被分为三组。一组LC使用自制胆囊取出袋（HMGRB）进行，另一组LC使用商用胆囊取出袋（CGRB）进行。主要结局是浅表部位感染和腹腔内脓肿的感染性并发症。
共有68例（7.58%）患者使用HMGRB进行LC，828例（92.41%）使用CGRB。患者组之间术前脓毒症或性别分布无显著差异。使用t检验，我们发现各组之间年龄分布（p<0.01）、手术时间（p<0.01）和住院时间（p=0.01）存在差异。使用卡方检验时，我们发现东京和帕克兰分级量表严重程度（p<0.01）、术后抗生素使用（p<0.01）和引流使用（p<0.01）存在差异。尽管如此，浅表手术部位感染率无差异（p=0.92）。
与CGRB相比，HMGRB与术后腹腔内脓肿或浅表手术部位感染风险增加无关，但意味着手术时间和住院时间更长。在LC术中使用HMGRB是安全、可行的，且成本较低。
