Abstracts
2000 Digestive Disease Week

# 2224 Randomized Comparison of the Clinical Course of Gasless and Conventional Laparoscopic Cholecystectomy.
Jens F. Larsen, Per Ejstrud, Jrgen Ulrik Kristensen, Vivi Pedersen, Finn Redke, Flemming Svendsen, Aalborg, Denmark

Background: The positive CO2 pneumoperitoneum needed to create the workingspace for laparoscopic surgery induces cardiovascular, neuroendocrine and renal changes. The concerns of these pathophysiological changes have led to the introduction of a gasless method to create the working space for laparoscopic procedures. However few data on the technical and clinical problems using gasless technique are available. Aim of the study: In a randomized setting to compare the technique problems and clinical course of gasless and conventional laparoscopic cholecystectomy. Patients and method: Fifty-two consecutive patients fulfilling the inclusion criteria were randomly allocated to two groups, conventional laparoscopic cholecystectomy(CLC) and gasless laparoscopic cholecystectomy (GLC). Data were collected from December 1, 1998 to October 1, 1999. All elective patients with symptomatic cholecystolithiasis over the age of 18 with a body mass index (BMI ) < 30 were informed and asked for written consent. Patients with acute pancreatitis, cholecystitis, cholangitis, blood diseases, rheumatic diseases, acute infectious diseases, renal or liver diseases were excluded from the study. Following parameters were measured and ranged: exposure of the triangle of Calot, dissection of the galbladder from the liver bed, removal of the galbladder, operation time, complications, conversion rate, postoperative pain at rest and during mobilization, day of discharge, pain medication, day of return to normal function and day of full pain relive, overall results of the operation. Results: The two groups were comparable in age, BMI, sex. Apart from significantly prolonged operation time (28 min.) and significantly difficult exposure of the triangle of Calot in the group with gasless technique no significant differences were found. Conclusion: With regard to postoperative pain and recovery gasless laparoscopic cholecystectomy is comparabel with the conventional laparoscopic method. Though feasible gasless laparoscopic cholecystectomy is technically more difficult than conventional laparoscopic cholecystectomy. Gasless cholecystectomy may be considered in patient in whom the CO2 pneumoperitoneum is a relative or absolute contraindication.