[Gasless versus conventional laparoscopic cholecystectomy. A randomized trial with regard to technical problems, postoperative course and convalescence].
BACKGROUND
The positive CO2 pneumoperitoneum needed to create the working space for laparoscopic surgery may induce pathophysiological changes. Concern about these changes has led to the introduction of a gasless technique. The aim of the present study was to compare the gasless CLC and GLC with regard to exposure, technical problems, operation time, postoperative pain, clinical course, and convalescence.


METHODS
Fifty consecutive patients with symptomatic gallstones were randomised to conventional (CLC) or gasless laparoscopic cholecystectomy (GLC), with special reference to overall patient satisfaction, technical difficulties, duration of surgery, postoperative pain, and recovery.


RESULTS
The overall exposure of the operative field was poorer in the GLC group, whereas the duration of surgery, steps involved in the cholecystectomy technique, length of hospital stay, and postoperative pain score did not differ significantly. The period to return to normal activity was significantly shorter in the GLC group, six days compared to 8.5 days in the CLC group (p < 0.05). No differences were found in terms of fatigue, dizziness and nausea, and overall satisfaction with the outcome.


CONCLUSIONS
This study shows that convalescence is significantly shorter after laparoscopic cholecystectomy by the gasless technique than by the conventional CO2 technique. However, exposure of the operative field was less than optimal with the gasless technique.
Larsen
Jens Fromholt
JF
Aalborg Sygehus Syd, kirurgisk gastroenterologisk afdeling A, anaestesiologisk afdeling sektion AIOS og kardiologisk afdeling. jfl@dadlnet.dk
Svendsen
Flemming Mariegård
FM
Ejstrud
Per
P
Kristensen
Jørgen Ulrik
JU
Pedersen
Vivi
V
Redke
Finn
F
D002245:Carbon Dioxide; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery; D003289:Convalescence; D006801:Humans; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D020127:Recovery of Function; D016896:Treatment Outcome
D002245:Carbon Dioxide