Brief Article
Copyright ©2012 Baishideng. All rights reserved.
World J Surg Proced. Jun 28, 2012; 2(3): 16-20
Published online Jun 28, 2012. doi: 10.5412/wjsp.v2.i3.16
Technique of transcylindrical gas-free cholecystectomy
Enrique-Javier Grau-Talens, Manuel Giner
Enrique-Javier Grau-Talens, Department of Surgery, Hospital Siberia-Serena, 06640 Badajoz, Spain
Manuel Giner, Department of Surgery, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
Author contributions: All authors contributed equally in the study conception and design, analysis and interpretation of data and have critically revised and approved the final version of the manuscript; Grau-Talens EJ acquired the data and the images for this article; Giner M edited the images and wrote and submitted the manuscript.
Supported by Grant FIS PS09_01917 of the Spanish Ministry of Science and Technology
Correspondence to: Manuel Giner, MD, PhD, Professor, Department of Surgery, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain. manginer@med.ucm.es
Telephone: +34-91-4450637 Fax: +34-91-3303183
Received: November 4, 2011
Revised: January 6, 2012
Accepted: February 15, 2012
Published online: June 28, 2012
Abstract

AIM: To describe our method of transcylindrical cholecystectomy (TC) and its potential advantages over other surgical approaches for treating symptomatic gallstones.

METHODS: TC is a modified minilaparotomy performed gas-free through a single cylinder 3.8 cm (or occasionally 5.0 cm) in diameter and 10.0 cm in length. An efficacy, prospective and longitudinal study was conducted. Experience was accumulated over 15 years (1993-2008) and 387 operations, showing the feasibility and safety of TC. Since 2008, we have performed TC under local anesthesia plus sedation in most cases of symptomatic cholelithiasis.

RESULTS: Between 1993 and 2008, TC was carried out in 364 consecutive patients, including 78 acute cholecystitis, 37 acute biliary pancreatitis and 48 suspected choledocholithiasis. In another 23 patients (5.9%), the operation was converted into a subcostal laparotomy. Ten postoperative complications (2.75%) were registered in this series: 5 wound infections, 2 bile leaks (one causing death), 2 hemorrhages (requiring reoperation) and 1 residual stones. Since 2008, TC was planned and started under local anesthesia plus sedation in 60 patients. In another 12 patients (16.7%), the operation was decided, started and completed under general anesthesia. Surgery was satisfactorily completed through the cylinder in all patients of this series. In 13 patients (out of 60; 21.7%), local anesthesia was converted to general anesthesia. Among patients whose operation was attempted under local anesthesia (n = 60), postoperative complications were: 1 wound infection (1.7%), 2 wound seromas (3.3%) and 3 nauseas (5%). All but two patients in this series were discharged from hospital on the day of surgery and all patients were satisfied with the procedure. In our experience using TC, we have not had any cases of main bile duct injury.

CONCLUSION: TC should be considered in the search for the best alternative in the management of gallstone disease, deserving its inclusion in prospective randomized trials.

Keywords: Cholecystectomy; Cholecystitis; Choledocholithiasis; Minimally invasive surgery; Local anesthesia