Laparoskopik kolesistektomide Calot üçgeninin lateralden mediale disseksiyonunun değerlendirilmesi: Vaka-kontrol çalışması

Öz

Amaç: Laparoskopik kolesistektomide Calot üçgeninin diseksiyonunun intraoperatif sonuçlarını; klasik yöntemle ve sistik kanalın arkasından sistik artere doğru, lateralden mediale yapılan disseksiyonla karşılaştırmayı amaçladık.

Yöntem: Grup 1'de (n = 60) periton; önde Hartmann poşunun anterior yüzeyi boyunca kese lateral yüzeyine dek disseke edildi. Grup 2'de (n = 60) peritoneal diseksiyon, sistik kanalın arka tarafından sistik artere doğru, lateralden mediale doğru yapıldı. Hastaların demografik özellikleri, sistik kanal disseksiyon süresi, sistik arter disseksiyon zamanı ve intraoperatif kanama miktarı da dahil olmak üzere veriler kaydedildi.

Bulgular: Medyan sistik kanal ve sistik arter diseksiyon süreleri sırasıyla 308,00 (IQR = 68-927) sn ve 403,50 (IQR = 98-1045) sn idi. Grup 1'de sistik kanal ve sistik arter diseksiyonu için bu değerler sırasıyla 347,90±186,33 ve 469,73±225,02 sn idi. Grup 2'de median sistik kanal ve sistik arter diseksiyon süreleri sırasıyla 285,50 (IQR = 68-927) sn ve 389,50±143,28 saniye idi. Calot üçgeni disseksiyon zamanında (p sırasıyla 0,122, 0,075) ve gruplar arasındaki intraoperatif kan kaybı miktarı arasında istatistiksel olarak anlamlı fark yoktu (p=0,852).

Tartışma: Bu tekniğin laparoskopik kolesistektomi yapılan hastalarda kabul edilebilir bir süre içinde güvenli bir şekilde uygulanabileceğini düşünmekteyiz. Aynı zamanda laparoskopik kolesistektomiye yeni başlayanlar, sol elini kullanan cerrahlar ile safra ve vasküler anomalileri olan hastalar için güvenli bir alternatif seçenek olarak göründüğünü düşünmekteyiz.

Anahtar Kelimeler

• Laparoskopik kolessistektomi,Lateral disseksiyon,Medial disseksiyon,Calot üçgeni

Assessment of lateral to medial dissection of Calot’s triangle in laparoscopic cholecystectomy: A case-control study

Abstract

Aim: We aimed was to compare intraoperative results of the dissection of the Calot’s triangle through classical method and the dissection starting from the posterior side of the cystic duct toward the cystic artery along lateral to the medial surface in LC.

Methods: In Group 1 (n=60), peritoneum was dissected anteriorly along medial to the lateral surface of the Hartmann’s pouch. In Group 2 (n=60), the peritoneal dissection started from the posterior side of the cystic duct toward the cystic artery along lateral to the medial surface of the Hartmann’s pouch. Data including demographic characteristics of the patients, cystic duct dissection time, cystic artery dissection time, and intraoperative bleeding amount were recorded. 

Results: The median cystic duct and cystic artery dissection times were 308.00 (IQR=68-927) sec and 403.50 (IQR=98-1045) sec, respectively. In Group 1, these values were 347.90±186.33 and 469.73±225.02 sec for cystic duct and cystic artery dissection, respectively. In Group 2, the median cystic duct and cystic artery dissection times were 285.50 (IQR=68-927) sec and 389.50±143.28 sec, respectively. There was no statistically significant difference in the Calot’s triangle dissection time (p=0.122 and p=0.075, respectively) and intraoperative blood loss amount between the groups (p=0.852).

Conclusions: Our study results suggest that this technique can be safely performed in an acceptable time in LC patients. It also appears to be a safe alternative option for residents, left-handed surgeons, and patients with biliary and vascular abnormalities.

Keywords

• Laparoscopic cholecystectomy,Lateral dissection,Medial dissection,Calot’s triangle

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