Application of retrograde separation along space between Laennec's capsule and cystic plate combined with Pringle maneuver in difficult laparoscopic cholecystectomy (video attached)
Objective:To evaluate the clinical application value of retrograde separation along the space between Laennec's capsule and cystic plate combined with Pringle maneuver in difficult laparoscopic cholecystectomy (LC).Methods:Clinical data of 98 patients undergoing LC in the First Affiliated Hospital of Jishou University from June 2018 to December 2021 were retrospectively analyzed. Among them,36 patients were male and 62 female, aged 24-85 years with a median age of 49 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the study group (n=58) and control group (n=40) according to surgical procedures. In the study group, LC was performed by using retrograde separation along the space between Laennec's capsule and cystic plate combined with Pringle maneuver, and conventional LC was carried out in the control group. The operation time and intraoperative blood loss between two groups were compared by t test. The incidence of postoperative complications was compared by Fisher's exact probability test.Results:No conversion to open surgery was performed in the study group, and 6 cases in the control group and significant difference was observed (P=0.004). In the study group, the average operation time, intraoperative blood loss and the length of postoperative hospital stay were (63±9) min, (17±6) ml and (7.1±0.9) d, which were significantly less than (80±8) min, (47±6) ml and (7.5±0.9) d in the control group (t=-9.75, -25.25, -2.02; P<0.05). No significant differences were observed in the postoperative drainage volume, postoperative liver function and incidence of postoperative complications between two groups (P>0.05).Conclusions:Application of retrograde separation along the space between Laennec's capsule and cystic plate combined with Pringle maneuver in difficult LC can effectively control the intraoperative bleeding, contribute to achieving safe separation and protecting vital tracts, reduce conversion rate to open surgery, effectively shorten operation time and accelerate postoperative recovery.
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