Nicola de'Angelis1, Solafah Abdalla2, Maria Clotilde Carra3, Vincenzo Lizzi2, Aleix Martínez-Pérez2, Anoosha Habibi4,5, Pablo Bartolucci4,5, Frédéric Galactéros4,5, Alexis Laurent2,5, Francesco Brunetti2. 1. Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri-Mondor Hospital, AP-HP, Université Paris Est - UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. nic.deangelis@yahoo.it. 2. Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri-Mondor Hospital, AP-HP, Université Paris Est - UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. 3. Rothschild Hospital, AP-HP, University of Paris Diderot, Paris, France. 4. Department of Internal Medicine, Sickle Cell Referral Center, AP-HP, Henri Mondor University Hospital, Créteil, France. 5. UPEC, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de le Recherche Médicale (INSERM) U955, Créteil, France.
Abstract
BACKGROUND: Laparoscopic cholecystectomy (LC) is one of the most frequent surgeries performed in patients with sickle cell disease (SCD). LC in SCD patients is associated with a particularly high postoperative morbidity. The aim of the present study is to assess the safety and feasibility of cholecystectomy performed by mini-laparoscopy with low- and stable-pressure pneumoperitoneum (MLC + LSPP) and to compare the rate of postoperative SCD-related morbidity with standard LC. METHODS: Thirty-five consecutive SCD patients admitted between November 2015 and March 2017 for cholelithiasis requiring surgery were compared with an historical cohort of 126 SCD patients who underwent LC for the same indication. Operative variables, postoperative outcomes, patient and surgeon satisfaction, and costs were evaluated. RESULTS: MLC + LSPP exhibited a mean operative time comparable to LC (p = 0.169). Operative blood loss was significantly reduced in the MLC + LSPP group, and the suction device was rarely used (p = 0.036). SCD-related morbidity (including acute chest syndrome) was significantly higher in the LC group compared with the MLC + LSPP group (18.3 vs. 2.9%; p = 0.029). The mean times to resume ambulation (p = 0.018) and regular diet (p = 0.045) were significantly reduced in the MLC + LSPP group. The mean incision length (all trocars combined) was 28.22 mm for MLC + LSPP and 49.64 mm for LC patients (p < 0.0001). Multivariate regression analysis demonstrated that the only significant predictor of postoperative SCD-related morbidity was the surgical approach (odds ratio: 9.24). Patient and surgeon satisfaction were very high for MLC + LSPP. The mean total cost per patient (surgery and hospitalization) was not different between groups (p = 0.084). CONCLUSION: MLC + LSPP in SCD patients appears to be safe and feasible. Compared with LC, MLC + LSPP in SCD patients is associated with a significantly reduced incidence of postoperative SCD-related morbidity and more rapid ambulation and return to regular diet without increasing the total costs per patient.
BACKGROUND: Laparoscopic cholecystectomy (LC) is one of the most frequent surgeries performed in patients with sickle cell disease (SCD). LC in SCDpatients is associated with a particularly high postoperative morbidity. The aim of the present study is to assess the safety and feasibility of cholecystectomy performed by mini-laparoscopy with low- and stable-pressure pneumoperitoneum (MLC + LSPP) and to compare the rate of postoperative SCD-related morbidity with standard LC. METHODS: Thirty-five consecutive SCDpatients admitted between November 2015 and March 2017 for cholelithiasis requiring surgery were compared with an historical cohort of 126 SCDpatients who underwent LC for the same indication. Operative variables, postoperative outcomes, patient and surgeon satisfaction, and costs were evaluated. RESULTS: MLC + LSPP exhibited a mean operative time comparable to LC (p = 0.169). Operative blood loss was significantly reduced in the MLC + LSPP group, and the suction device was rarely used (p = 0.036). SCD-related morbidity (including acute chest syndrome) was significantly higher in the LC group compared with the MLC + LSPP group (18.3 vs. 2.9%; p = 0.029). The mean times to resume ambulation (p = 0.018) and regular diet (p = 0.045) were significantly reduced in the MLC + LSPP group. The mean incision length (all trocars combined) was 28.22 mm for MLC + LSPP and 49.64 mm for LC patients (p < 0.0001). Multivariate regression analysis demonstrated that the only significant predictor of postoperative SCD-related morbidity was the surgical approach (odds ratio: 9.24). Patient and surgeon satisfaction were very high for MLC + LSPP. The mean total cost per patient (surgery and hospitalization) was not different between groups (p = 0.084). CONCLUSION: MLC + LSPP in SCDpatients appears to be safe and feasible. Compared with LC, MLC + LSPP in SCDpatients is associated with a significantly reduced incidence of postoperative SCD-related morbidity and more rapid ambulation and return to regular diet without increasing the total costs per patient.
Authors: Lieneke J Draaijers; Fenike R H Tempelman; Yvonne A M Botman; Wim E Tuinebreijer; Esther Middelkoop; Robert W Kreis; Paul P M van Zuijlen Journal: Plast Reconstr Surg Date: 2004-06 Impact factor: 4.730
Authors: S Celarier; S Monziols; M O Francois; V Assenat; P Carles; M Capdepont; C Fleming; E Rullier; G Napolitano; Q Denost Journal: Trials Date: 2020-02-22 Impact factor: 2.279