Comparison of Direct Pressure versus Electrocauterization of Liver Bed for Bleeding Control in Laparoscopic Cholecystectomy
Keywords:Direct pressure, Electrocauterization, Laparoscopic cholecystectomy, Liver bed, Intraoperative bleeding, Post-operative bleeding, Bleeding control, Postoperative Pain.
AbstractBackground: Gallstones are very common worldwide with a prevalence of 6% in men and 29% in women of all ages. Laparoscopic cholecystectomy is the gold standard treatment for gallbladder diseases associated with frequent complication of haemorrhage. Applying direct pressure or electrocauterization can be used for securing hemostasis and pain control. Objective: To compare hemostatic control by direct pressure versus electrocauterization while dissecting the gall bladder from liver bed during laparoscopic cholecystectomy in terms of intra-operative bleeding, Post-operative bleeding and pain. Methods: This randomized controlled trial was conducted at Surgical Unit of Mayo Hospital Lahore. Total 200 patients were enrolled, in 100 patients haemorrhage from liver bed was controlled by applying direct pressure with the help of gauze for 5 minutes (Group A) and remaining 100 patients (Group B) it was controlled by electrocauterization. Intra-operative bleeding. post-operative bleeding, and post-operative pain scores were recorded and all patients were discharged after 24 hours of close monitoring. Results: The mean age of cases in A Group and B group was 40.38 ± 12.30 and 42.15 ± 10.40 years res-pectively. Intraoperative bleeding was secured in 85 (85%) patients in Group-A and in 96(96%) patients in Group-B. Group-B treatment was more effective than Group-A treatment for bleeding (p-value= 0.008). Mean pain score of patients at 12th hour was 4.76 in group A and 5.55 in Group B. It was 3.09 in group A and 3.60 in group B at 24th hour postoperatively with p-value of 0.0001. Conclusion: Electrocauterization is a better technique for hemostasis of liver bed in comparison with direct pressure during laparoscopic cholecystectomy.
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