Muscle-splitting mini-incision cholecystectomy under spinal anesthesia: cost-effective equitable minimally invasive surgery in laparoscopy era
Conventional open cholecystectomy has been increasingly replaced by laparoscopy which requires resources for expensive equipment, training, and maintenance. Muscle-splitting mini-incision cholecystectomy under spinal anesthesia has comparable outcomes to laparoscopy and requires fewer resources. This study analyzes the feasibility and outcome of muscle-splitting mini-incision cholecystectomy under the spinal.
Consecutive cases of muscle-splitting mini-incision cholecystectomy ‘MC’ during 3- years ending in Dec 2019, at a periphery hospital in Janakpur, province-2, Nepal, were included. Complicated cholelithiasis (pancreatitis, jaundice, cholangitis, dilated common bile duct) was excluded. Written informed consents were obtained. The need for general anesthesia, complications during and after surgery, and patient satisfaction were analyzed descriptively. Ethical approval was obtained.
Out 148 MC completed under spinal. Six (4.1%) required fentanyl for shoulder discomfort. Mild post-operative pain was reported by 124 (83.8%) at 6 h and 146 (98.6%) at 12 h. The intravenous drip was stopped after surgery and oral liquid with analgesics started in 2 h in 143 (96.6%). Post-operative antibiotic was given in nine, 2 (1.4%) fistulas, 4 (2.7%) diabetic, and 3 (2%) mucocele. Mean hospital stay was 1-night. Wound complications occurred in 6 (2.8%). Overall, 144 (97.3%) were satisfied and would recommend to others. Selective histopathology was sent for three revealed adenocarcinomas in one. There was no bile-duct injury, re-surgery, or mortality.
Muscle-splitting mini-incision open cholecystectomy-MC under spinal anesthesia is safe and effective with less postoperative pain, early feeding, short hospital stays, less demand for resources, and good patient satisfaction.
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