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[Gasless versus conventional laparoscopic cholecystectomy. A randomized trial with regard to technical problems,
Jens Fromholt Larsen1, Flemming Mariegård Svendsen, Per Ejstrud
1Aalborg Sygehus Syd, kirurgisk gastroenterologisk afdeling A, anaestesiologisk afdeling sektion AIOS og kardiologisk afdeling. jfl@dadlnet.dk
Introduction:
The positive CO2 pneumoperitoneum needed to create the working space for laparoscopic surgery may induce pathophysiological changes. Concern about these changes has led to the introduction of a gasless technique. The aim of the present study was to compare the gasless CLC and GLC with regard to exposure, technical problems, operation time, postoperative pain, clinical course, and convalescence.
Material And Methods:
Fifty consecutive patients with symptomatic gallstones were randomised to conventional (CLC) or gasless laparoscopic cholecystectomy (GLC), with special reference to overall patient satisfaction, technical difficulties, duration of surgery, postoperative pain, and recovery.
Results:
The overall exposure of the operative field was poorer in the GLC group, whereas the duration of surgery, steps involved in the cholecystectomy technique, length of hospital stay, and postoperative pain score did not differ significantly. The period to return to normal activity was significantly shorter in the GLC group, six days compared to 8.5 days in the CLC group (p < 0.05). No differences were found in terms of fatigue, dizziness and nausea, and overall satisfaction with the outcome.
Discussion:
This study shows that convalescence is significantly shorter after laparoscopic cholecystectomy by the gasless technique than by the conventional CO2 technique. However, exposure of the operative field was less than optimal with the gasless technique.