Novel Application of Hydrodissection in Laparoscopic Cholecystectomy for Gangrenous Gallbladders

Introduction: Laparoscopic cholecystectomy (LC) for gangrenous gallbladders (GGBs) can be challenging and represent a significant number of LC cases, necessitating more efficacious surgical techniques. Currently, the standard treatment for GGBs is blunt dissection which can have high iatrogenic complication rates. To our knowledge, this is the first large retro-spective study conducted on the novel application of hydrodissection (HD) in LCs for GGBs. Methods: In this retrospective study of 386 LCs, data were collected for patient de-mographics, medical comorbidities, operating time (OT), anesthesia time (AT), length of stay (LOS), estimated blood loss, conversion to open procedures, 30-day readmissions, and mortality. Patients were categorized into four groups: (1) Vyas employing HD for GGBs (VHG), (2) non-Vyas group of five surgeons not employing HD for GGBs (NVG), (3) Vyas treating non-GGBs, and (4) non-Vyas group of five surgeons treating non-GGBs. Control groups were age-matched and sex-matched. Statistical analysis used descriptive statistics, Mann-Whitney U testing, and chi-squared testing (a = 0.05).Results: This study demonstrated significantly decreased (P < 0.05) OT (P = 0.001), AT (P < 0.001), LOS (P = 0.015), and conversion to open procedures (P = 0.047) between the VHG and NVG groups, with HD reducing OT by 35.5% compared to blunt dissection. This study did not demonstrate significantly decreased (P > 0.05) estimated blood loss (P = 0.185) and 30-day readmissions (P = 0.531) between the VHG and NVG groups, but they were trending toward significant. There were no mortalities in this study.Conclusions: HD is associated with improved surgical outcomes of LCs for GGBs demon-strated by reduced OT, AT, LOS, and conversion to open procedures. Further multi-institutional studies are needed to validate HD implementation and further dissemination.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study is a large retrospective study on the application of hydrodissection in laparoscopic cholecystectomy (LC) for gangrenous gallbladders (GGBs). It has shown that hydrodissection can reduce operating time, anesthesia time, length of stay, and conversion to open procedures.