A PROSPECTIVE RANDOMIZED TRIAL COMPARING PNEUMOPERITONEUM AND U-SHAPED RETRACTOR ELEVATION FOR LAPAROSCOPIC CHOLECYSTECTOMY

Between April and August 1991, 83 Japanese patients with symptomatic g allstones underwent laparoscopic cholecystectomy in our clinics. A pro spective randomized trial was carried out to examine the safety, effic acy, and complications of the two techniques, pneumoperitoneum vs an e levating method using a U-shaped retractor. Forty-two patients were ra ndomly allocated to the pneumoperitoneum (P) group and 41 to the U-sha ped retractor (U) group. These two groups were well matched with respe ct to age, sex, etiology, and the severity of the chronic cholecystiti s. Laparoscopic resection was successful for 88.1% (37/42) in the P gr oup and 100% (41/41) in the U group. In patients with a severe fibroti c gallbladder, the rate of success was significantly higher (P < 0.05) in the U group (100%, 6/6) than in the P group (11.8%, 1/6). In the m oderately inflamed group, the operation time (mean +/- SD) was signifi cantly (P < 0.01) less in the U group (58.7 +/- 22.7) than in the P gr oup (87.3 +/- 18.3). With the U-shaped retractor the usual surgical in struments can be used, and a rapid and safer laparoscopic cholecystect omy can be carried out. We prefer this approach to a pneumoperitoneum for patients with an inflamed gallbladder as hospital stay and pain ar e minimal.