Woohyung Lee1, Young Hoon Roh2, Sung Hwa Kang2, Chung Yun Kim3, YoungRok Choi4, Ho-Seong Han4, Hyung Joon Han5, Tae-Jin Song5, Chang Moo Kang6, Woo Jung Lee6, Sung Hoon Choi7, Sung Yub Jeong7, Tae Ho Hong8, Young Kyoung You8, Jae Hoon Lee1, Ju Ik Moon9, In Seok Choi10. 1. Division of Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2. Department of Surgery, Dong-A University Hospital, Dong-A University, College of Medicine, Busan, Republic of Korea. 3. Department of Surgery, Cheongdam Cham TNTN Hospital, Seoul, Republic of Korea. 4. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 5. Department of Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea. 6. Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea. 7. Department of Surgery, Bundang Cha Hospital, College of Medicine, Cha University, Seoul, Republic of Korea. 8. Department of Surgery, Seoul Saint-Mary Hospital, College of Medicine, Catholic University, Seoul, Republic of Korea. 9. Department of Surgery, College of Medicine, Konyang University Hospital, Kunyang University, 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea. 10. Department of Surgery, College of Medicine, Konyang University Hospital, Kunyang University, 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea. choiins@kyuh.ac.kr.
Abstract
BACKGROUND: Although single-incision laparoscopic cholecystectomy (SILC) is a common procedure, the change in its surgical indications and perioperative outcomes has not been analyzed. METHODS: We collected the clinical data of patients who underwent pure SILC in 9 centers between 2009 and 2018 and compared the perioperative outcomes. RESULTS: In this period, 6497 patients underwent SILC. Of these, 2583 were for gallbladder (GB) stone (39.7%), 774 were for GB polyp (11.9%), 994 were for chronic cholecystitis (15.3%), and 1492 were for acute cholecystitis (AC) (23%). 162 patients (2.5%) experienced complication, including 20 patients (0.2%) suffering from biliary leakage. The number of patients who underwent SILC for AC increased over time (p = 0.028), leading to an accumulation of experience (27.4 vs 23.7%, p = 0.002). The patients in late period were more likely to have undergone a previous laparotomy (29.5 vs 20.2%, p = 0.006), and to have a shorter operation time (47.0 vs 58.8 min, p < 0.001). Male (odds ratio [OR]; 1.673, 95% confidence interval [CI] 1.090-2.569, p = 0.019) and moderate or severe acute cholecystitis (OR; 2.602, 95% CI 1.677-4.037, p < 0.001) were independent predictive factors for gallbladder perforation during surgery, and open conversion (OR; 5.793, 95% CI 3.130-10.721, p < 0.001) and pathologically proven acute cholecystitis or empyema (OR; 4.107, 95% CI 2.461-6.854, p < 0.001) were related with intraoperative gallbladder perforation CONCLUSION: SILC has expanded indication in late period. In this period, the patients had shorter operation times and a similar rate of severe complications, despite there being more numerous patients with AC.
BACKGROUND: Although single-incision laparoscopic cholecystectomy (SILC) is a common procedure, the change in its surgical indications and perioperative outcomes has not been analyzed. METHODS: We collected the clinical data of patients who underwent pure SILC in 9 centers between 2009 and 2018 and compared the perioperative outcomes. RESULTS: In this period, 6497 patients underwent SILC. Of these, 2583 were for gallbladder (GB) stone (39.7%), 774 were for GB polyp (11.9%), 994 were for chronic cholecystitis (15.3%), and 1492 were for acute cholecystitis (AC) (23%). 162 patients (2.5%) experienced complication, including 20 patients (0.2%) suffering from biliary leakage. The number of patients who underwent SILC for AC increased over time (p = 0.028), leading to an accumulation of experience (27.4 vs 23.7%, p = 0.002). The patients in late period were more likely to have undergone a previous laparotomy (29.5 vs 20.2%, p = 0.006), and to have a shorter operation time (47.0 vs 58.8 min, p < 0.001). Male (odds ratio [OR]; 1.673, 95% confidence interval [CI] 1.090-2.569, p = 0.019) and moderate or severe acute cholecystitis (OR; 2.602, 95% CI 1.677-4.037, p < 0.001) were independent predictive factors for gallbladder perforation during surgery, and open conversion (OR; 5.793, 95% CI 3.130-10.721, p < 0.001) and pathologically proven acute cholecystitis or empyema (OR; 4.107, 95% CI 2.461-6.854, p < 0.001) were related with intraoperative gallbladder perforation CONCLUSION: SILC has expanded indication in late period. In this period, the patients had shorter operation times and a similar rate of severe complications, despite there being more numerous patients with AC.
Authors: Seung Jae Lee; In Seok Choi; Ju Ik Moon; Dae Sung Yoon; Won Jun Choi; Sang Eok Lee; Nak Song Sung; Seong Uk Kwon; In Eui Bae; Seung Jae Roh; Sung Gon Kim Journal: J Minim Invasive Surg Date: 2022-09-15