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Review
. 2023 Feb 26;15(2):e35493.
doi: 10.7759/cureus.35493. eCollection 2023 Feb.

A Systematic Review and Meta-Analysis of Bag Extraction Versus Direct Extraction for Retrieval of Gallbladder After Laparoscopic Cholecystectomy

Hussam Khougali Mohamed  1 , Mohamed Albendary  2 , Ali Ahmed Wuheb  3 , Omer Ali  4 , Mohammed Jibreel Mohammed  5 , Mohamed Osman  6 , Mohamed S M Elshikhawoda  7 , Ali Yasen Mohamedahmed  8
Affiliations
Review

A Systematic Review and Meta-Analysis of Bag Extraction Versus Direct Extraction for Retrieval of Gallbladder After Laparoscopic Cholecystectomy

Hussam Khougali Mohamed et al. Cureus. .

Abstract

This analysis aims to evaluate the comparative outcomes of gallbladder extraction with a bag versus direct extraction in laparoscopic cholecystectomy (LC). A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov, and Science Direct. Comparative studies comparing bag versus direct extraction of the gallbladder in LC were included. Outcomes were surgical site infection (SSI), the extension of fascial defect to extract the gallbladder, intra-abdominal collection, bile spillage, and port-site hernia. Revman 5.4 (Cochrane, London, United Kingdom) was used for the data analysis. The results show eight studies were eligible to be included in this review with a total number of 1805 patients divided between endo-bag (n=835) and direct extraction (n=970). Four of the included studies were randomized controlled trials (RCTs) while the rest were observational studies. The rate of SSI and bile spillage were significantly higher in the direct extraction group: odds ratio (OR)=2.50, p=0.006 and OR=2.83, p=0.01, respectively. Comparable results were observed regarding intra-abdominal collection between the two groups(OR=0.01, p=0.51). However, the extension of a fascial defect was higher in the endo-bag group (OR=0.22, p=0.00001), and no difference was observed regarding the port-site hernia rate (OR-0.70, p=0.55). In conclusion, extraction of the gallbladder with an endo-bag provides a lower rate of SSI and bile spillage with similar results regarding post-operative intra-abdominal collection. Although with the endo-bag, the fascial defect will more likely need to be increased to extract the gallbladder. However, the port-site hernia rate remains similar between the two groups.

Keywords: bile spillage; gallbladder removal; laporoscopic cholecystectomy; port site infection; specimen bag.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The PRISMA flow chart
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Risk of bias summary for included RCTs
RCTs: Randomized control trials
Figure 3
Figure 3. Forest plot analysis of SSI
SSI: Surgical site infection, CI: Confidence interval
Figure 4
Figure 4. Forest plot analysis of bile spillage
CI: Confidence interval
Figure 5
Figure 5. Forest plot analysis of fascial extension
CI: Confidence interval
Figure 6
Figure 6. Forest plot analysis of postoperative collection
CI: Confidence interval
Figure 7
Figure 7. Forest plot analysis of port site hernia
CI: Confidence interval
See this image and copyright information in PMC

References

    1. Laparoscopic cholecystectomy. Litwin DE, Cahan MA. Surg Clin North Am. 2008;88:1295–1313. - PubMed
    1. Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost gallstones. Hussain MI, Al-Akeely MH, Alam MK, Al-Abood FM. https://pubmed.ncbi.nlm.nih.gov/21078253/ J Coll Physicians Surg Pak. 2010;20:763–765. - PubMed
    1. Port site infection in laparoscopic surgery: a review of its management. Sasmal PK, Mishra TS, Rath S, Meher S, Mohapatra D. World J Clin Cases. 2015;3:864–871. - PMC - PubMed
    1. The impact of gallbladder retrieval from an epigastric vs. umbilical port on trocar-site complications A prospective randomized study. Kaya C, Bozkurt E, Yazici P. https://pubmed.ncbi.nlm.nih.gov/29051399/ Ann ItalChir. 2017;88:326–329. - PubMed
    1. Dangerous deliveries: lessons learned during retroperitoneal specimen retrieval. Upadhyaya M, Sundararajan LS, Woodward MN. J Pediatr Surg. 2011;46:0. - PubMed

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