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Dry Mopping vs. Saline Irrigation of Gallbladder Fossa After Bile Spillage During Laparoscopic Cholecystectomy:
Dujanah S Bhatti1, Raheel Ahmad2
1Plastic and Reconstructive Surgery, Aberdeen Royal Infirmary, Aberdeen, GBR.
Abstract:
Introduction The laparoscopic approach, as compared to open cholecystectomy, is still considered the gold standard, despite a higher incidence of micro insults. The most common approach to treat spilled biliary contents and lost stones in laparoscopic cholecystectomy is the retrieval of the stone through an open approach, or laparoscopically, ending with a peritoneal wash and aspiration. Material and methods We conducted a double-blinded randomized controlled trial. In the study group, patients with bile spillage during cholecystectomy underwent suction of all spilled bile and evacuation of all visible stones followed by dry mopping of the gallbladder fossa with gauze swab through an epigastric port. In the control group, after suction of all bile and visible stones, the gallbladder fossa was washed with 250 ml of saline, and fluid was aspirated through the epigastric port. Results Sixty patients were included (30 patients in each group), 71.6% were female and the rest were male. There was a statistically significant difference in pain scores between the two groups (p=0.001). The dry mopping group had lower pain scores as compared to the other group postoperatively. The incidence of the intraabdominal collection in both groups are statistically insignificant, however, port site infection and intraabdominal collection are higher in the control group (irrigation group). Conclusion Although there is not much literature on the best approach to biliary spillage in laparoscopic cholecystectomy. We believe that dry mopping had better postoperative patient outcome as compared to the saline wash.
Insights
Dry mopping the gallbladder fossa after bile spillage during laparoscopic cholecystectomy resulted in lower postoperative pain scores compared to saline irrigation. This technique may offer a better patient outcome for managing biliary spillage.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Complications
Background:
- Laparoscopic cholecystectomy is the gold standard, but bile spillage and lost stones can occur.
- Current management often involves peritoneal wash and aspiration, with limited evidence on optimal techniques.
- Biliary spillage poses risks, including infection and postoperative pain.
Purpose of the Study:
- To compare the efficacy of dry mopping versus saline irrigation for managing bile spillage during laparoscopic cholecystectomy.
- To evaluate postoperative pain scores and the incidence of intra-abdominal collection and port site infections.
- To determine the optimal approach for minimizing complications associated with biliary spillage.
Main Methods:
- A double-blinded randomized controlled trial involving 60 patients undergoing laparoscopic cholecystectomy with bile spillage.
- Study group: dry mopping of the gallbladder fossa with gauze after suction.
- Control group: saline (250 ml) irrigation of the gallbladder fossa followed by aspiration.
Main Results:
- The dry mopping group reported significantly lower postoperative pain scores (p=0.001).
- While intra-abdominal collection incidence was statistically insignificant between groups, it was higher in the saline irrigation group.
- Port site infections were also more frequent in the saline irrigation group.
Conclusions:
- Dry mopping appears to be a superior method for managing bile spillage during laparoscopic cholecystectomy compared to saline irrigation.
- This technique may lead to improved postoperative patient outcomes, including reduced pain and fewer complications.
- Further research is warranted to solidify best practices for managing biliary spillage in laparoscopic surgery.
