Mohamed Hussam Khougali, Albendary Mohamed, Wuheb Ali Ahmed, Ali Omer, Mohammed Mohammed Jibreel, Osman Mohamed, Elshikhawoda Mohamed S M, Mohamedahmed Ali Yasen
General and Upper Gastrointestinal Surgery, University Hospital Hairmyres, Glasgow, GBR.
General Surgery, Peterborough City Hospital, Peterborough, GBR.
Cureus. 2023 Feb 26;15(2):e35493. doi: 10.7759/cureus.35493. eCollection 2023 Feb.
This analysis aims to evaluate the comparative outcomes of gallbladder extraction with a bag versus direct extraction in laparoscopic cholecystectomy (LC). A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov, and Science Direct. Comparative studies comparing bag versus direct extraction of the gallbladder in LC were included. Outcomes were surgical site infection (SSI), the extension of fascial defect to extract the gallbladder, intra-abdominal collection, bile spillage, and port-site hernia. Revman 5.4 (Cochrane, London, United Kingdom) was used for the data analysis. The results show eight studies were eligible to be included in this review with a total number of 1805 patients divided between endo-bag (n=835) and direct extraction (n=970). Four of the included studies were randomized controlled trials (RCTs) while the rest were observational studies. The rate of SSI and bile spillage were significantly higher in the direct extraction group: odds ratio (OR)=2.50, p=0.006 and OR=2.83, p=0.01, respectively. Comparable results were observed regarding intra-abdominal collection between the two groups(OR=0.01, p=0.51). However, the extension of a fascial defect was higher in the endo-bag group (OR=0.22, p=0.00001), and no difference was observed regarding the port-site hernia rate (OR-0.70, p=0.55). In conclusion, extraction of the gallbladder with an endo-bag provides a lower rate of SSI and bile spillage with similar results regarding post-operative intra-abdominal collection. Although with the endo-bag, the fascial defect will more likely need to be increased to extract the gallbladder. However, the port-site hernia rate remains similar between the two groups.
本分析旨在评估在腹腔镜胆囊切除术（LC）中使用取物袋与直接取出胆囊的对比结果。通过以下数据库进行了系统的在线检索：PubMed、Scopus、Cochrane数据库、虚拟健康图书馆、Clinical trials.gov和ScienceDirect。纳入了比较LC中使用取物袋与直接取出胆囊的对比研究。观察指标为手术部位感染（SSI）、取出胆囊时筋膜缺损的扩大情况、腹腔内积液、胆汁渗漏和穿刺孔疝。使用Revman 5.4（Cochrane，英国伦敦）进行数据分析。结果显示，有八项研究符合纳入本综述的标准，共有1805例患者，分为内取物袋组（n = 835）和直接取出组（n = 970）。纳入的研究中有四项为随机对照试验（RCT），其余为观察性研究。直接取出组的SSI和胆汁渗漏发生率显著更高：优势比（OR）分别为2.50，p = 0.006和OR = 2.83，p = 0.01。两组在腹腔内积液方面观察到类似结果（OR = 0.01，p = 0.51）。然而，内取物袋组的筋膜缺损扩大情况更高（OR = 0.22，p = 0.00001），在穿刺孔疝发生率方面未观察到差异（OR = 0.70，p = 0.55）。总之，使用内取物袋取出胆囊可降低SSI和胆汁渗漏的发生率，在术后腹腔内积液方面结果相似。虽然使用内取物袋时，更有可能需要扩大筋膜缺损以取出胆囊。然而，两组的穿刺孔疝发生率仍然相似。
