Objectives of study :Structured training, skill’s evaluation,regulated granting of privileges, systems approach & judicious use of ES haven’t alleviated the concerns of unfavorable outcomes in LC. Biliary injuries, an index of adverse outcome evaluation have been linked to use of ES. LC can be done without using ES as reported by us earlier. The aim of this study was to compare the outcomes in LS done with or without use of ES.
Methods and procedures :Consecutive, symptomatic cholelithiasis patients requiring LC in a single surgical unit without any exclusion criteria were randomized into control (ES) or study (Non-ES) groups. Uniform “Fast tract module” evaluation & perioperative protocol was followed. Standard equipment was used with all varieties of ES being available. Data were prospectively collected perioperatively. Operative end points were hemo-dynamics instability (HI), need of additional hemostasis (AH), vascular / biliary / duodenal injury (Inj), gallbladder perforation (GBP) by dissecting instrument, operating time (OT) & conversion. Postoperative end poInts were HI, peritonism / constipation >24 hrs, leak indicating Inj., re-exploration (RE), hospital stay (HS), rehospitalization (RH) & mortality (M).
Results :153 patients (107 females, 46 males) irrespetive to time of presentation with all inflammatory grades were included. There was one conversion in the study. Initially it belonged to non ES group but sbsequent use of ES didn’t help in preventing conversion. Peritonism or constipation beyond 24 hrs was seen in 9 cases exclusively in the ES group. Mortality (duodnal ijury & fatal hemo-peritoneum, both manifesting after a clinically normal/stable postoperative interval of 3 days) was seen only in ES group. Rest of the end points were as shown in the table-
Conclusion :Use of ES in LC is associated with adverse outcomes including mortality. Not using ES doesn’t affect the outcome adversely. Hence use of ES routinely in LC is not justified.
Program Number: P141