Feasibility prospective study of laparoscopic cholecystectomy with suprapubic approach.
BACKGROUND
Since the publication of laparoscopic cholecystectomy (LC) using three ports instead of four, no significant evolution has impacted on our clinical practice in order to improve length of stay, postoperative pain, time of recovery and cosmetic results. Recently, a renewed interest has been observed with the suprapubic approach, called occult scar laparoscopic cholecystectomy (OSLC). The aim of this prospective multicentric study was to evaluate the feasibility of OSLC in 2 French centers.


METHODS
From March to September 2014, 60 patients were prospectively included in this study. The operation incisions consisted of an umbilical incision for camera; an incision in the right groin for maneuvers of exposition and a suprapubic incision for instrumental dissection and clipping. Outcome was by operative time, operative complications, hospital length of stay, analgesia required after surgery, and cosmetic outcomes. The Patient Satisfaction Scale and Visual Analog Score (VAS) also were used to evaluate the level of cosmetic result and postoperative pain.


RESULTS
No laparoscopy was converted to an open procedure, the mean operative time was 53±20min. No patient had intraoperative bile duct injury or significant bleeding. The mean length of stay was 1.70±0.76 days. Two patients (3%) experienced postoperative complication (1 intra-abdominal abscess treated by antibiotics and 1 subcutaneous seroma of the 11-mm port wound treated successfully by needle aspiration).


CONCLUSIONS
The technique proved to be safe and feasible with no specific complication and without specific instrument. It offers satisfactory postoperative pain level and good cosmetic results.
Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. Electronic address: leroybertrand8@gmail.com.
B
B
Le Roy
Digestive Surgery Department, Jacques-Lacarin Hospital, 1, boulevard Deniere, 03200 Vichy, France.
N
N
Fetche
Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
E
E
Buc
Biostatistics Unit (DRCI), Clermont-Ferrand University Hospital, 63003 Clermont-Ferrand, France.
B
B
Pereira
Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
F
F
Genty
Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
O
O
Antomarchi
Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
J
J
Gagnière
Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
D
D
Pezet
Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
K
K
Slim
D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011630:Pubic Bone; D016896:Treatment Outcome; D055815:Young Adult
Cholecystectomy; Feasibility; Laparoscopy; Occult scar; Suprapubic