Adrian Maghiar, George Dejeu, Dan Ciurtin, Marius Sfirlea, Codru?a Macovei. Spitalul Pelican Oradea
In our clinic we have a vast experience with sils chole, with over 500 cases in the last 5 years. During this time we have passed through all fases concerning this technique. From early adopters, to trying different ways of performing the surgery, to studying the advantages and complications, studying the worthiness of performing such a technique.
In this study we looked back at all our experience with sils chole, and used all the data we gathers in our previous studies. We performed 536 sils chole during the last 5 years, 214 using the puppeteer technique, 37 using only one grasper to expose the gall bladder, and the rest (285) using the endo grab device. We had 63 conversions from sils, 24 from the puppeteer technique, 7 from using one grasper, 32 from the endo grab group. We considered conversion the need to add one or more trocare, we had no conversions to open surgery. We only had one case of CBD injury, that we resolved laparoscopicaly. Using this data we can safely conclude that is it safe and feasible as a surgical procedure. We then looked at post op complication rates, and given we only had 9 cases we to reopperate, 5 for sub hepatic collection, 3 peri hepatic abcesses, 1 ramâne the CBD stone, all resolved laparoscopicaly, we concluded that it is safe from the post op complication rates point of view also. The next step was to look at the finances. Given that we are from a developing country, with a medical system in continuous change, we are also a private institution, we looked at comparisons between lap chole and sils chole, and the numbers were that if we do not count (it was impossible for us the cuantify) the training needed, it was a difference of less than 1% in cost, more for the sils group (because of the cost of the endo grab device, curbed grspers, we do not use single port device), with identical pay for all cases. Looking at all the data, and taking into consideration the fact that about 20% of patients are asking for this type of procedure, we conclude that sils chole is not dead. It may not be the future gold standard, but it is a viable and safe alternative to the gold standard.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80872
Program Number: P611
Presentation Session: Poster (Non CME)
Presentation Type: Poster
