Laparoscopic Cholecystostomy in Pigs: Technique and Comparison with Traditional Open Cholecystostomy for Surgical Stress

ABSTRACT
This article describes a simple technique of laparoscopic cholecystostomy (LC) and compares the LC technique with open cholecystostomy (OC) for clinical outcome and surgical stress response. LC was performed under general anesthesia using three portals. The gallbladder was fixed to the anterior abdominal wall using two sets of simple interrupted sutures placed between the anterior abdominal wall and gallbladder, rather than the traditional single set. A cauterized incision was made at the gallbladder fundus such that it lay at the center of a purse-string suture; an 18-F Malecot catheter was introduced into the gallbladder lumen through this incision. The mean duration required for completing LC was 38±12 min, which was decreased by 16 min with increasing experience. In a matched group of pigs, OC was performed using the conventional approach. All animals underwent tube cholecystocholangiography and follow-up laparoscopy at 15 days and 1 month after the surgery, respectively. The investigations showed that the gallbladder was viable with no bile leakage or abscess formation and that it remained adherent to the abdominal wall. In addition, the serum concentrations of cortisol, interleukin-6, and C-reactive protein showed that the surgical stress response was lower for LC than OC. Thus, in terms of surgical stress, and possibly operative time, laparoscopic placement of the Malecot catheter using a three-portal approach and two suture anchors may be more beneficial than OC for the creation of a short-term access route into the gallbladder and bile ducts in pigs, under both interventional and experimental settings.
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