PORT – SITE COMPLICATIONS FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

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Dheeraj Yadav*, Anurakshat Gupta, Garima Yadav, SK Manwatkar, “PORT – SITE COMPLICATIONS FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY”, ijmhs, vol. 10, no. 05, pp. 809–819, May 2020.
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Abstract

For more than 100 years open cholecystectomy was the effective treatment for both acute and chronic cholecystitis. After the introduction of Laparoscopic Cholecystectomy (LC) by Philippe Mouret in France in 1987, this became the gold standard treatment for acute/chronic cholecystitis (1), (2). Laparoscopic Cholecystectomy ended attempts for non invasive management of gall stones and offers cure for gall stones with minimally invasive procedure, minimal pain and scarring, and early return of full activity (3).
Various studies confirm that wound infection rates are considerably lower following Laparoscopic Cholecystectomy than those for an open procedure (4).
Due to different modality of creating ports and various approaches in closing the port site leads to variety of results in healing of wounds at that site. This leads on into many complications in some patients. The most common of which are port site infections, hematoma, bilioma and rarely port site hernia. The CDC (Centre of Disease Control) classification of surgical site infection (SSI) includes incisional, which may be “superficial” involving skin and sub cutaneous tissue or “deep” involving fascia and muscles and organ space infections (5). The study published in 2008 in JPMI shows that SSI rate following Laparoscopic Cholecystectomy is 5.78% of which epigastric port involvement is seen in 88% of cases and umbilical port site involvement is seen in 12% (6). These complications are descriptively studied here and assessed such that the best modality could be followed uniformly to prevent complications. We have tried to evaluate different port site complications, their aetiologies, rate at which they occur, in respect to method of port formation, timing of surgery, intra-op difficulties, surgeons experience and patient co-morbidities.

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References

1.Schwartz principles of Surgery 10thEdition. 2.Beal JM, Historical perspective of gallstone disease, Surg gynaecol Obstet1984; 158-181. 3.Sages outcomes initiative, What have welearnt and what is potential? SurgEndosc 2003; 17:365. 4.Does using Laparoscopiccholecystectomy approach decrease the risk of SSI? Ann of surgery 2003; 237:358. 5.Garner JS, Jarvis WR, Hughes JM, CDCdefinitions for Nosocomial infections,Am J of infection control 1998. 6.The frequency of port site infection inLap cholecystectomy, JPMI 2008; 22:66-70. 7.Targarona EM, Balague C, Laparoscopicsurgery and surgical infection. Br Jsurgery, 2000; 87:536-44. 8.Jagdish N, Sameer R, Port sitetuberculosis, a rare complicationfollowing laparoscopic cholecystectomy.Scand J infect Dis 2002; 34(12):928-929 9.Sung WR, Sonya S, Spread of Nontuberculous Mycobacteria from 1993 to2006 in Koreans, J of clinical laboratoryanalysis 2008; 22:415-420. 10.Katoch VW, Infections due to non-tuberculous mycobacteria (NTM). IndianJ Med res 2004; 120:290-304. 11.Vess RW, Anderson RL, Thecolonization of solid PVC surface and theacquisition of resistance to germicides bywater micro-organisms. J Appl BacteriolFeb 1993; 74(2):215-221. 12.David Mark Bunting, Port-Site HerniaFollowing LaparoscopicCholecystectomy. JSLS. 2010 Oct-Dec;14(4): 490–497. 13.Essentials of surgical practice.Abdominal minimal access surgery 20004th edition volume 1:508. 14.Wicks, Scroop. Incisional hernia andsmall bowel obstruction following lapsurgery. CT diagnosis Australas radioAustralia, 2000; 44(3):331-2. 15.Analysis of lap port site complications, Jof minimal access surgery, 2013; 9(2):59-64. 16.Zitser YG, Simchen E, A trend forreduced 15 day wound infection and 6months mortality in Laparoscopic relativeto open cholecystectomy, The Israelistudy of surgical infections, 1997; 5:116-122. 17.Siddiqui K Khan, Comparison offrequency of wound infections open vsLap cholecystectomy, J Ayub collegeAbbottabad, 2006; 18:21-4. 18.Meakins JL, Masteeson BJ, Prevention ofpost op infection, ACS surgery principles& practice web MD 2006; 27-45.

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References

1.Schwartz principles of Surgery 10thEdition.
2.Beal JM, Historical perspective of gallstone disease, Surg gynaecol Obstet1984; 158-181.
3.Sages outcomes initiative, What have welearnt and what is potential? SurgEndosc 2003; 17:365.
4.Does using Laparoscopiccholecystectomy approach decrease the risk of SSI? Ann of surgery 2003; 237:358.
5.Garner JS, Jarvis WR, Hughes JM, CDCdefinitions for Nosocomial infections,Am J of infection control 1998.
6.The frequency of port site infection inLap cholecystectomy, JPMI 2008; 22:66-70.
7.Targarona EM, Balague C, Laparoscopicsurgery and surgical infection. Br Jsurgery, 2000; 87:536-44.
8.Jagdish N, Sameer R, Port sitetuberculosis, a rare complicationfollowing laparoscopic cholecystectomy.Scand J infect Dis 2002; 34(12):928-929
9.Sung WR, Sonya S, Spread of Nontuberculous Mycobacteria from 1993 to2006 in Koreans, J of clinical laboratoryanalysis 2008; 22:415-420.
10.Katoch VW, Infections due to non-tuberculous mycobacteria (NTM). IndianJ Med res 2004; 120:290-304.
11.Vess RW, Anderson RL, Thecolonization of solid PVC surface and theacquisition of resistance to germicides bywater micro-organisms. J Appl BacteriolFeb 1993; 74(2):215-221.
12.David Mark Bunting, Port-Site HerniaFollowing LaparoscopicCholecystectomy. JSLS. 2010 Oct-Dec;14(4): 490–497.
13.Essentials of surgical practice.Abdominal minimal access surgery 20004th edition volume 1:508.
14.Wicks, Scroop. Incisional hernia andsmall bowel obstruction following lapsurgery. CT diagnosis Australas radioAustralia, 2000; 44(3):331-2.
15.Analysis of lap port site complications, Jof minimal access surgery, 2013; 9(2):59-64.
16.Zitser YG, Simchen E, A trend forreduced 15 day wound infection and 6months mortality in Laparoscopic relativeto open cholecystectomy, The Israelistudy of surgical infections, 1997; 5:116-122.
17.Siddiqui K Khan, Comparison offrequency of wound infections open vsLap cholecystectomy, J Ayub collegeAbbottabad, 2006; 18:21-4.
18.Meakins JL, Masteeson BJ, Prevention ofpost op infection, ACS surgery principles& practice web MD 2006; 27-45.

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