Peter F Johnston, MD1, Abdel-Kareem R Beidas, MD1, Andrew Camerota, MD2, Ziad C Sifri, MD1. 1Rutgers New Jersey Medical School, 2Rutgers Robert Wood Johnson Medical School
Introduction: Laparoscopic cholecystectomy has become the standard of care in the US and shows promise in developing countries, but it is not always possible in the setting of a short-term surgical mission. In Peru there exists a large burden of gallbladder disease and limited access to care leading to delays in definitive treatment with some relying on humanitarian organizations for surgery. Surgical missions perform cholecystectomy by open or laparoscopic approach depending on the capacity of the hosting facilities. The aim of this study was compare to these 2 operative approaches in the setting of a surgical mission and identify the main differences.
Methods: A retrospective review was performed of all patients undergoing elective cholecystectomy in Trujillo, Peru during 4 one-week surgical missions from 2014 to 2017. Laparoscopic versus open groups were compared for demographics, mortality, in-hospital complications, operative time, and length of stay (LOS). Analysis was by intention to treat.
Results: Fifty-seven ISHI patients underwent elective cholecystectomy, 28 laparoscopic and 29 open. There were no deaths or bile duct injuries in our series. Two patients undergoing laparoscopic approach were converted to open (7.1%). Complications, LOS, and gender were similar between the two groups. The laparoscopic group were significantly younger and had a significantly longer operative duration (Table). Long term outcomes were not available for analysis.
Conclusion: Laparoscopic and open cholecystectomy appear safe in the setting of short term surgical missions. Neither group suffered major complications. Both had similar immediate outcomes. LOS for both groups was surprisingly similar and shorter than larger series which may possibly due to patient selection. Given similar immediate outcomes and large burden of disease, the open approach should be considered. However, this cost may be extracted in terms of greater pain or longer recovery time for patients, which may outweigh the benefits. Further data is needed to study pain, long term outcomes, and return to work.
|Total (N=57)||Laparoscopic (N=28)||Open (N =29)||p-value|
|Age (mean±SD years)||44±14||41±15||47±12||0.03*|
|Operative time (mean±SD minutes)||82±33||95±34||70±27||0.02*|
|Immediate Complications N (%)||1(1.8)||0||1(3.4)||0.32|
|Length of stay (mean, range)||0.89(0-4)||0.78(0-2)||1(0-4)||0.25|
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86177
Program Number: P476
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster