Comparison Between Open and Closed Methods of Establishing Pneumoperitoneum for Laparoscopic Cholecystectomy

Abstract

Background: The initial phase in laparoscopic surgery, including cholecystectomy, is pneumoperitoneum. There are two widely utilized procedures to produce pneumoperitoneum closed and open techniques. Both have advantages and disadvantages. Aims: Comparing open and closed techniques of creating a pneumoperitoneum for laparoscopic cholecystectomy is the goal. Methods: The Surgery Department of Sylhet MAG Osmani Medical College Hospital conducted this prospective comparative observational study from September 2018 to August 2019. This study comprised a total of 138 hospitalized patients, of whom had symptomatic gallstone disease and required cholecystectomy. The patients were split into two groups; 69 were chosen for the closed approach and were referred to as Group A, while the remaining 69 were chosen for the open method and were referred to as Group B. Results: The average age was 44.88 ±12.61 in Group A and 47.12 ±11.62 in Group B. In groups A and B, the male-to-female ratio was 1:2.3 and 1:1.6, respectively. The difference between the two groups was statistically insignificant (p>0.05). The average access time was 7.43 minutes for Group A and 3.14 minutes for Group B. The average access time was substantially longer in group A (p <0.05). 27 patients (39.1%) in group A and 38 patients (55.1%) in group B had gas leaking. The difference was not statistically significant (p>0.05) between the two groups. 15 (21.7%) patients in group A and 5 (7.2%) patients in group B had extraperitoneal insufflation. Extraperitoneal insufflation in group A was considerably (p<0.05) greater. The average surgery was 81.83± 20.21 minutes for Group A and 53.42± 11.63 minutes for Group B. The mean time frames spent on wound closure in groups A and B were 6.61± 1.49 and 2.55 ±0.8 respectively. The mean duration of the procedure and the mean time to close the wound were considerably (p<0.05) higher in group A. No group had any cases of visceral damage, conversion need, haematoma, seroma, subcutaneous emphysema, gas embolism, or port site hernia. In groups A and B, respectively, one (1.4%) patient each had wound discharge and wound infection. The difference between the two groups was not statistically significant (p>0.05). Conclusion: It was preferable to create pneumoperitoneum openly. Considering access time, operating time, times for wound closure, primary port infection, and haemorrhage.