Less pain after transvaginal/transumbilical cholecystectomy than after the classical laparoscopic technique: short-term results of a matched-cohort study
- 283 Downloads
Natural orifice surgery (NOS) is gaining acceptance as an alternative to the traditional laparoscopic technique, especially for cholecystectomy through the transvaginal route. However, NOS remains controversial concerning expected advantages in terms of short- and long-term outcomes and potential side effects. This study was designed to compare short-term outcomes between transvaginal/transumbilical and classical laparoscopic cholecystectomy (LC).
A prospective matched-cohort study compared the authors’ first 50 transvaginal/transumbilical cholecystectomies (TVC) with a group of 50 classical LCs from the corresponding period matched in terms of age, body mass index, and American Society of Anesthesiology classification. In both groups, elective surgery was performed for symptomatic cholecystolithiasis. In the NOS group, a hybrid procedure was performed with one transumbilical rigid instrument and two transvaginal rigid instruments. A numeric rating scale was used for daily pain assessment, initiated postoperatively in the recovery room. Both groups were compared with regard to length of surgery, intra- and postoperative complications, length of hospital stay, postoperative pain, and consumption of analgesics.
The length of surgery and the rate of complications were similar in the two groups. But significant advantages were found for the transvaginal access in terms of pain using Numeric Rating Scale (NRS) on the day of surgery (NRS, 1.5/10 vs 3.1/10; p = 0.003) as well as in the morning (NRS, 1.9/10 vs 2.8/10; p = 0.047) and in the evening (NRS, 1.1/10 vs 1.8/10; p = 0.025) of postoperative day 1, and with regard to the length of the postoperative hospital stay (2.7 vs 3.4 days; p = 0.035).
The findings show that TVC is a safe procedure for female patients. It has a risk comparable with that of classic LC, causes significantly less pain in the early postoperative period, and leads to a significantly shorter hospital stay. Prospective randomized trials are necessary to confirm these results.
KeywordsCholecystolithiasis Classical laparoscopic technique Natural orifice surgery Postoperative pain Transvaginal/transumbilical cholecystectomy
The authors thank Prof. Dr. R. Lefering and PD Dr. S. Sauerland of the Institute for Research in Operative Medicine (IFOM), Cologne, University of Witten/Herdecke, for assistance with the statistical analysis of this study.
Dirk Rolf Bulian, Linda Trump, Jürgen Knuth, Robert Siegel, Axel Sauerwald, Michael A Ströhlein, and Markus Maria Heiss have no conflicts of interest or financial ties to disclose.
- 3.Keus F, Gooszen HG, van Laarhoven CJ (2010) Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis: an overview of Cochrane hepato-biliary group reviews. Cochrane Database Syst Rev CD008318Google Scholar
- 4.Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short-term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev CD003145Google Scholar