Anne Mattila1, Johanna Mrena2, Hannu Kautiainen3, Juha Nevantaus4, Ilmo Kellokumpu2. 1. Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland. anne.mattila@ksshp.fi. 2. Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland. 3. Unit of Primary Health Care, Helsinki University Hospital, 00029, Helsinki, Finland. 4. Department of Anesthesiology and Intensive Care, Central Hospital of Central Finland, Jyväskylä, Finland.
Abstract
BACKGROUND AND AIM: To examine the impact of day-care laparoscopic cholecystectomy (LC) with ultrasonic scissors dissection versus diathermy hook dissection method in a randomized setting. METHODS:From April 2012 to September 2014, a total of 169 elective day-care patients were randomized to undergo either laparoscopic cholecystectomy with ultrasonic scissors using fundus-first approach (n = 88) or diathermy hook dissection starting from the triangle of Calot (n = 79). Main measures of outcome were operative time, same-day discharge and intraoperative complications. Secondary outcome measures were postoperative pain (numeric rating scale), postoperative nausea and vomiting (PONV), readmissions and 30-day morbidity. RESULTS:Median operative time was similar in the ultrasonic dissection and diathermy hook dissection groups (45 vs 45 min, p = 0.95). Same-day discharge was possible in 77 patients (87 %) in the ultrasonic dissection group and in 69 patients (87 %) in the diathermy group, p = 0.98. Intraoperative gallbladder perforations, mean intraoperative bleeding, postoperative pain and PONV at 1, 2 and 4 h (p = 0.78) did not differ significantly between the study groups. CONCLUSION: Day-care LC using either diathermy hook or ultrasonic dissection resulted in excellent same-day discharge in both groups (87 %). LC with ultrasonic dissection does not offer any clinical advantages compared to diathermy dissection.
RCT Entities:
BACKGROUND AND AIM: To examine the impact of day-care laparoscopic cholecystectomy (LC) with ultrasonic scissors dissection versus diathermy hook dissection method in a randomized setting. METHODS: From April 2012 to September 2014, a total of 169 elective day-care patients were randomized to undergo either laparoscopic cholecystectomy with ultrasonic scissors using fundus-first approach (n = 88) or diathermy hook dissection starting from the triangle of Calot (n = 79). Main measures of outcome were operative time, same-day discharge and intraoperative complications. Secondary outcome measures were postoperative pain (numeric rating scale), postoperative nausea and vomiting (PONV), readmissions and 30-day morbidity. RESULTS: Median operative time was similar in the ultrasonic dissection and diathermy hook dissection groups (45 vs 45 min, p = 0.95). Same-day discharge was possible in 77 patients (87 %) in the ultrasonic dissection group and in 69 patients (87 %) in the diathermy group, p = 0.98. Intraoperative gallbladder perforations, mean intraoperative bleeding, postoperative pain and PONV at 1, 2 and 4 h (p = 0.78) did not differ significantly between the study groups. CONCLUSION: Day-care LC using either diathermy hook or ultrasonic dissection resulted in excellent same-day discharge in both groups (87 %). LC with ultrasonic dissection does not offer any clinical advantages compared to diathermy dissection.
Entities:
Keywords:
Cholecystectomy; Day surgery; Laparoscopy; Ultrasonic dissection
Authors: Yucel Cengiz; Jan Dalenbäck; Gunnar Edlund; Leif A Israelsson; Arthur Jänes; Mats Möller; Anders Thorell Journal: Surg Endosc Date: 2009-08-18 Impact factor: 4.584
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