Day-care laparoscopic cholecystectomy with diathermy hook versus fundus-first ultrasonic dissection: a randomized study

Surg Endosc. 2016 Sep;30(9):3867-72. doi: 10.1007/s00464-015-4691-y. Epub 2015 Dec 10.

Abstract

Background and aim: To examine the impact of day-care laparoscopic cholecystectomy (LC) with ultrasonic scissors dissection versus diathermy hook dissection method in a randomized setting.

Methods: From April 2012 to September 2014, a total of 169 elective day-care patients were randomized to undergo either laparoscopic cholecystectomy with ultrasonic scissors using fundus-first approach (n = 88) or diathermy hook dissection starting from the triangle of Calot (n = 79). Main measures of outcome were operative time, same-day discharge and intraoperative complications. Secondary outcome measures were postoperative pain (numeric rating scale), postoperative nausea and vomiting (PONV), readmissions and 30-day morbidity.

Results: Median operative time was similar in the ultrasonic dissection and diathermy hook dissection groups (45 vs 45 min, p = 0.95). Same-day discharge was possible in 77 patients (87 %) in the ultrasonic dissection group and in 69 patients (87 %) in the diathermy group, p = 0.98. Intraoperative gallbladder perforations, mean intraoperative bleeding, postoperative pain and PONV at 1, 2 and 4 h (p = 0.78) did not differ significantly between the study groups.

Conclusion: Day-care LC using either diathermy hook or ultrasonic dissection resulted in excellent same-day discharge in both groups (87 %). LC with ultrasonic dissection does not offer any clinical advantages compared to diathermy dissection.

Keywords: Cholecystectomy; Day surgery; Laparoscopy; Ultrasonic dissection.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Ambulatory Surgical Procedures*
  • Cholecystectomy, Laparoscopic / methods*
  • Diathermy*
  • Dissection / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Outcome Assessment
  • Ultrasonic Surgical Procedures* / instrumentation