Mini-Laparotomy for cholecystectomy in resourced limited settings: a 10 years retrospective hospital-based study

Abstract

Cholecystectomy is a commonly performed abdominal procedure, the gold standard currently is the laparoscopic approach and, however, the facilities and expertise for laparoscopy are not available widely, especially in developing countries. A Mini-laparotomy cholecystectomy is an additional approach that is performed through an incision that is less than 5 cm thus minimizing the complications of the traditional open cholecystectomy and the postoperative hospital stay. The study aims to evaluate the outcome of mini-laparotomy cholecystectomy in terms of operative duration, complications, and hospital stay in a rural hospital. This is a retrospective study conducted in El-Dwaim Teaching Hospital, Sudan. All cases of mini-laparotomy cholecystectomy conducted from March 2009 to December 2020 were included and retrospectively studied. Descriptive statistics were applied using SPSS version 25. A total of 512 mini-laparotomy cases were involved in the study, of those 442 aged more than 40 years. The operation lasted less than 60 minutes for 486 of the participants, and the most frequent cholecystitis complication observed intraoperatively was mucocele, occurring in 70 (13.6%) participants. Intraoperative complications due to mini-laparotomy occurred in 4 (0.8%) cases, in the form of bleeding and none of the observed cases converted into open cholecystectomy. Postoperative complications occurred in the form of wound infection in 7 participants, biliary leak in 1 participant, and fistula formation in 1 participant. Post-operative hospital stay was 24 hours for 458 participants. Mini-laparotomy cholecystectomy is a safe minimally invasive approach with low rates of complications and short postoperative hospital stay, making it an optimum approach in facility-deprived countries.

Preliminary experience with mini-laparotomy cholecystectomy in Jos

“…No wound complications occurred in our study, though some studies on this procedure reported occurrence of wound sepsis,[ 2 10 ] which is likely due to undue traction on the wound edges which leads to tissue damage and subsequent infection.…”

“…All the patients in our study had a 48-h duration of hospital stay, which is comparable to one study. [ 1 ] Some studies have reported shorter hospital stays than ours with mini-laparotomy cholecystectomy[ 2 10 ] and there are others that showed it could even be done on an ambulatory basis. [ 7 29 , 30 ] This procedure is performed through an incision that is, less than 8 cm.…”

“…Low conversion rates have generally been noted with mini-laparotomy cholecystectomy and are consistent with our study in which there was no need to convert. [ 2 6 ]…”

“…There are different techniques described for removing a diseased gall bladder; however, cholecystectomy via the laparoscopic approach is currently regarded as the gold standard. [ 1 2 ] There are numerous drawbacks to setting up this service in low-resource environments and laparoscopy is not widely available in low- and middle-income countries. [ 2 3 ] Apart from the initial capital investment, there are recurrent costs for consumables and maintenance of equipment.…”

“…[ 1 2 ] There are numerous drawbacks to setting up this service in low-resource environments and laparoscopy is not widely available in low- and middle-income countries. [ 2 3 ] Apart from the initial capital investment, there are recurrent costs for consumables and maintenance of equipment. In developing countries, where laparoscopic services are not available or there are breaks in the supply chain of consumables, mini-laparotomy cholecystectomy may be a suitable alternative.…”