Surgical Review: International Journal of Surgery, Trauma and Orthopedics

Study of clinical presentation and management of intestinal obstruction and its evaluation with respect to morbidity and mortality Nutan K.1*, Charokar K.2, Bharang K.3 DOI: https://doi.org/10.17511/ijoso.2020.i03.05 1* Kumari Nutan, PG Resident, Peoples College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India. 2 Kailash Charokar, Associate Professor, Department of Surgery, Peoples College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India. https://orcid.org/0000-0002-0540-6726 3 Krishna Bharang, Associate Professor, Department of Surgery, Peoples College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India.


Introduction
The gallbladder is a pear-shaped reservoir underneath the liver that concentrates and stores bile. Its the fluid secreted by the liver and released into the small intestine that helps indigestion. Cholecystectomy if done laparoscopically has gall bladder perforation, stone spillage, and biliary injury as common complications that mainly occurs while its dissection from hepatic bed resulting in spillage into the peritoneal cavity. The incidence reported ranges from 10% to 40% for perforation and from and those without using a bag (group B; n=25) for gallbladder extraction. PRISM and Microsoft office was used to prepare the graphs. A Chi-Square test was used to compare the categorical data. P-value of < 0.05 is considered as significant. In the present study, laparoscopic cholecystectomy was mostly done in females (62%) as compared to males (38%).  The incidence of infections at the port site (PSI) in patients who underwent lap cholecystectomy using a bag was 4%. This means out of 25 patients who underwent using a bag, one patient had PSI. The incidence of infections at the port site (PSI) in patients who underwent laparoscopic cholecystectomy without a bag was 8%. Means out of 2, two patients had PSI. Out of 3 patients who had PSI, 1 (4%) underwent laparoscopic cholecystectomy with a bag whereas 2 (8%) underwent without a bag (p=0.002).   In group B patient's gall bladder specimen was removed without using endo-bag. In both, the group gall bladder was retrieved via the epigastric port.

Results
The port site was examined on a postoperative day three for any sign of wound infection like redness, induration, pain, and swelling, or any discharge.
Follow up was done for any late infection.
Injection cefuroxime 1gm intravenous as prophylaxis and postoperatively twice a day for 3 days was used.   In the case of acute gall bladder infection, many authors recommend the extraction of the gallbladder in a bag as spillage of infected bile, stones or pus causes infection of the port site [11,12].
Even if the use of a retrieval bag in the abovementioned situations seems justified, there is no strong evidence to support its use in elective surgery. A meta-analysis by Regina et al its found that there is no statistically significant reduction in infection rate when the extraction of the gallbladder was done from the abdominal cavity with a retrieval bag [13]. A.I. Memon et al [15] reported retrieval port site infection 5 % of their patients despite using endobag. Ali Sa et al [16] and Helme et al [17] showed that the best way to avoid complications of spillage and port site contamination is to use endobag. Turk E et al [18]  In the present study out of 3 patients who had PSI, In this study, we used a common surgical glove to reduce the cost of it. Hence using endobag is a simple and cost-effective alternative.
What does the study add to the existing knowledge?
The present study makes the conclusion that when laparoscopic cholecystectomy is done the gallbladder retrieval using an endobag has a better advantage over not using the bag as it prevents spillage and also the incidence of PSI is comparative less.