Perioperative Komplikationsrate der minimalinvasiven suprapubischen transumbilikalen Cholezystektomie. (Retrospektive Beobachtungsstudie)

Background: Laparoscopic cholecystectomy (CHE) is one of the most common surgical procedures nowadays. Beside the classical 4-Trocar-Cholecystectomy (Conventional Laparoscopic Cholecystectomy or CLC), in which the trocars are placed in the upper abdominal quadrants, a lot of modern alternatives were developed. One of these alternatives is the suprapubic-transumbilical CHE, the so-called “Mindener Cholecyctectomy” (MI-CHE). The aim of this study is to evaluate the morbidity and mortality of this procedure. Methods: A retrospective review of all patient`s charts who underwent a cholecystectomy, between 06.11.2008 and 30.06.2020 in our institute was performed. Three surgeons, who practiced the MI-CHE during this period, were selected. The patient’s demographics as well as the data regarding the perioperative mortality and morbidity were evaluated retrospectively. Results: From 2008-2020, a total of 408 MI-CHE were held on or assisted by three different surgeons. In the period from 2008 to 2014, 381 cholecystectomies using the conventional laparoscopic (CLC) or the open cholecystectomy (open CHE) techniques were preformed. The total percentage of the MI-CHE from the total cholecystectomy-procedures preformed until 2014 was 38.8%. The average age of patients in the MI-CHE group in the whole period of study was 54.2 years (±17). The average duration of the operation was 66 minutes (±23) using the MI-CHE-technique, the average length of stay after the MI-CHE was 3.6 days (±3.1). In the period from 2008-2014, the average age of patients in the MI-CHE group was 52.4 years (± 17.2), the average age in the CLC group was 60,9 years (±17.7) and 68,9 years (±15.7) in the open CHE group. The average duration of the operation was 66 minutes (±24) using the MI-CHE-technique, 71 (±36) using the CLC-technique and 110 (±75) for the open cholecystectomy. The average length of stay after the MI-CHE was 3.6 days (±3.1), 4.9 days (±4.1) after CLC und 10.7 days (±8.5) after open CHE. During this period, MI-CHE was performed in 19.4% of the cases for treatment of acute cholecystitis, CLC in 47% and open CHE in 63%. The conversion rate of the MI-CHE was 1 of 408 (0.2%). Complications were documented in 17 of 408 patients following a MI-CHE between 2008 and 2020 (4.1%). The majority of those complications were grade-III (3.9%) according to the Clavien-Dindo-Classification. There were no serious complications and no bile duct- or liver vessel-injuries in the MI-CHE-group. The mortality rate was 0,0%. Conclusion: The morbidity and mortality of the MI-CHE in our study is not higher than CLC as well as compared to the literature. The MI-CHE is a safe method in the treatment of cholecystolithiasis even in cases with acute cholecystitis.