Üç Porta Karşı Standart Dört Port Laparoskopik Kolesistektomi: Retrospektif Çalışma

Year 2024, Volume: 19 Issue: 1, 114 - 119, 28.03.2024

Bahtiyar Muhammedoğlu , Sezgin Topuz , Ali İşler Muhammed Alkan Mehmet Buğra Bozan , Mehmet Fatih Yüzbaşıoğlu , Taner Kale

https://doi.org/10.17517/ksutfd.1289174

Abstract

Amaç: Safra kesesi taşı başta olmak üzere benign safra kesesi hastalıklarında altın standart cerrahi yöntem laparoskopik kolesistektomidir ve standart laparoskopik kolesistektomi 4 port kullanarak uygulanır. Laparoskopik cerrahide artan deneyimle birlikte, ağrının, kesi sayısının azaltılması bunlara bağlı yatış süresi ve maliyetinin düşürülmesi kaygıları gündeme gelmiş bu amaca yönelik 3 porttan, tek porttan veya doğal açıklıklardan kolesistektomi uygulanmaya başlanmıştır. Bu çalışmada amacımız hastanemizde 3 port veya 4 porttan uygulanan laparoskopik kolesistektomi olgularımızı karşılaştırmaktır.
Gereç ve Yöntemler: Kahramanmaraş Necip Fazıl şehir hastanesinde 2017-2022 yılları arasında Laparoskopik kolesistektomi uygulanan hastalar, hastanelerin dijital verileri ve ameliyat defterleri yardımıyla tarandı. Hastaların yaş, cinsiyet, ek hastalıkları gibi demografik verileri kaydedildi.
Hastalar 3 port ve 4 portla kolesistektomi uygulananlar olmak üzere iki gruba ayrıldı. Gruplar ameliyat süresi, intraoperatif komplikasyonlar (kanama, safra yolu yaralanması, komşu organ yaralanması), postoperatif komplikasyonlar (kanama, safra fistülü), ameliyat süreleri, yatış süreleri postoperatif hemoglobin ve karaciğer fonksiyon testleri açısından karşılaştırıldı.
Bulgular: Çalışmaya 843 hasta dahil edilmiş olup 262’si erkek (%31.1) ve 581’i (%68.8) kadındı. Yaş ortalaması 50.52 ±16.4 olup yaşları 18 ile 92 yaşları arasında değişmekteydi. 509 (%60.4) hastaya 4 portla ve 334‘üne (%39.6) 3 portla laparoskopik kolesistektomi uygulanmıştı. 3 port ve dört port karşılaştırıldığında istatistiksel olarak yatış süresi (p<0.05), 4 port grubunda yüksekti. Ameliyat süreleri arasında istatistiksel açıdan bir fark saptanmadı. Port sayılarına göre intraoperatif kanama, safra kaçağı, açık cerrahiye geçiş ve ilave port kullanımı açısından fark saptanmamıştır.
Sonuç: Laparoskopik kolesistektomide 3-4 port arasında ameliyat süreleri, postoperatif safra kaçağı ve kanama komplikasyonu açısından fark saptanmamıştır. Komplikasyonlar göz önüne alındığında 3 port uygulamalar en az 4 port kolesistektomi kadar güvenlidir. Prospektif randomize çalışmalar konuyu daha net ortaya koyacaktır.

Keywords

dört port, laparoskopik kolesistektomi, üç port

Supporting Institution

-

Project Number

-

Thanks

-

Three-port versus standard four-port laparoscopic Cholecystectomy: A Retrospective Study

Abstract

Objective: The gold standard surgical method for benign gallbladder diseases, especially gallstones, is laparoscopic cholecystectomy. Standard laparoscopic cholecystectomy is performed using four ports. With the increasing experience in laparoscopic surgery, concerns about reducing pain, the number of incisions, and the associated hospitalization time and cost have come to the fore, and for this purpose, cholecystectomy using three ports, single port or natural openings has begun to be performed. The present study aimed to evaluate and compare 3-port and 4-port laparoscopic cholecystectomy cases in our hospital.

Materials and Methods: Patients who underwent laparoscopic cholecystectomy in Kahramanmaraş Necip Fazıl City Hospital between 2017 and 2022 were retrospectively analyzed using the hospital database and operation notes. Demographic data including age, gender, and comorbidities were recorded. Patients were divided into two groups 3-port and 4-port cholecystectomy. The groups were compared in terms of operation time, intraoperative complications (bleeding, biliary tract injury, adjacent organ injury), postoperative complications (bleeding, biliary fistula), length of hospitalization, postoperative hemoglobin, and liver function tests.

Results: The study included 843 patients. Of these, 262 (31.1%) were male and 581 (68.8%) were female. The mean age was 50.52 ± 16.4 years (range 18 to 92 years). 509 (60.4%) patients underwent 4-port laparoscopic cholecystectomy and 334 (39.6%) underwent 3-port laparoscopic cholecystectomy. When cholecystectomy techniques were compared, the length of hospitalization was statistically higher in the 4-port group (p<0.05). There was no significant difference between the operation times. There was no difference in intraoperative bleeding, bile leakage, conversion to open surgery, and use of additional ports between 3-port and 4-port cholecystectomy.

Conclusion: There was no difference in operation times, postoperative bile leakage, and bleeding complications between 3-port and 4-port laparoscopic cholecystectomy. From the perspective of complications, 3-port procedures are at least as safe as 4-port cholecystectomy. Prospective randomized trials can shed more light on this topic.

Keywords

four port, laparoscopic cholecystectomy, three port

Project Number

-

References

• Reynolds W. The first laparoscopic cholecystectomy. JSLS J Soc Laparoendosc Surg. 2001;5(1):89–94.
• Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy. The new “gold standard”? Arch Surg. 1992;127(8):917–921.
• Aykas A, Karasu Z. Güncel Bilgiler Eşliğinde Kolelitiazis Tedavisinde Laparaskopik ve Açık Kolesistektominin Yeri. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Derg, 2018;13(2):51-53.
• Radkani P, Hawksworth J FT. Surgery for Calculous Biliary Disease Laparoscopic Cholecystectomyle. In: Townsend CM, Beauchamp RD, Evers BM MK, editor. Sabiston Textbook of Surgery. Missouri: Elsevier; 2022. p. 1489–1527.
• Sanabria JR, Clavien PA, Cywes R, Strasberg SM. Laparoscopic versus open cholecystectomy: a matched study. Can J Surg. 1993;36(4):330–336.
• Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg. 2015;18:196–204.
• Kafadar MT, Çetinkaya İ, Aday U, Başol Ö, Bilge H. Acute abdomen due to spilled gallstones: a diagnostic dilemma 10 years after laparoscopic cholecystectomy. J Surg Case Reports. 2020;8:1-3.
• Auyang ED, Hungness ES, Vaziri K, Martin JA, Soper NJ. Human NOTES cholecystectomy: transgastric hybrid technique. J Gastrointest Surg. 2009;13(6):1149–1150.
• Sinan H, Demirbas S, Ozer MT, Sucullu I, Akyol M. Single-incision laparoscopic cholecystectomy versus laparoscopic cholecystectomy: a prospective randomized study. Surg Laparosc Endosc Percutan Tech. 2012;22(1):12–16.
• Trichak S. Three-port vs standard four-port laparoscopic cholecystectomy. Surg Endosc. 2003;17(9):1434–1436.
• Slim K, Pezet D, Stencl J, Lechner C, Le Roux S, Lointier P, et al. Laparoscopic cholecystectomy: an original three-trocar technique. World J Surg. 1995;19(3):394–397.
• Chalkoo M, Ahangar S, Durrani AM. Is fourth port really required in laparoscopic cholecystectomy? Indian J Surg. 2010;72(5):373–376.
• Sanford DE. An Update on Technical Aspects of Cholecystectomy. Surg Clin North Am. 2019;99(2):245–258.
• Al-Azawi D, Houssein N, Rayis AB, McMahon D, Hehir DJ. Three-port versus four-port laparoscopic cholecystectomy in acute and chronic cholecystitis. BMC Surg. 2007;7(1):1-6.
• Wernberg JA, Lucarelli DD. Gallbladder cancer. Surg Clin North Am . 2014;94(2):343–360.
• Kaushik R. Bleeding complications in laparoscopic cholecystectomy: Incidence, mechanisms, prevention and management. J Minim Access Surg. 2010;6(3):59–65.
• Ahmad F, Saunders RN, Lloyd GM, Lloyd DM, Robertson GSM. An algorithm for the management of bile leak following laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2007;89(1):51–56.
• Khorgami Z, Shoar S, Anbara T, Soroush A, Nasiri S, Movafegh A, et al. A randomized clinical trial comparing 4-port, 3-port, and single-incision laparoscopic cholecystectomy. J Invest Surg. 2014;27(3):147–154.
• Nip L, Tong K-S, Borg CM. Three-port versus four-port technique for laparoscopic cholecystectomy: systematic review and meta-analysis. BJS open. 2022;6(2):1-11.
• Cerci C, Tarhan OR, Barut I, Bülbül M. Three-port versus four-port laparoscopic cholecystectomy. Hepatogastroenterology. 2007;54(73):15–16.
• Zgheib H, Wakil C, Al Souky N, Mailhac A, Jamali F, El Sayed M, et al. Liver function tests as predictors of common bile duct stones in acute cholecystitis patients with a chronic history: A retrospective cohort study on the ACS-NSQIP database. Medicine (Baltimore). 2021;100(33):e26885.