COMPARATIVE STUDY BETWEEN MINI-LAPAROSCOPIC CHOLECYSTECTOMY VERSUS STANDARD LAPAROSCOPIC CHOLECYSTECTOMY IN NINEVEH PROVINCE-IRAQ

Background: Laparoscopic cholecystectomy is now the accepted treatment technique for cholelithiasis and cholecystitis symptoms of varying severity. Surgeons are concerned about using a smaller port in miniport laparoscopic cholecystectomy, which may result in complications, additional operations, and conversion to open surgery. Objectives: To compare the advantages and intraoperative complications of miniport laparoscopic cholecystectomy in comparison with standard port laparoscopic cholecystectomy in an Iraqi population in Nineveh province/Iraq. Methods: This is a prospective observational comparative study conducted at Mosul General Hospital and Shingal (Sinjar) General Hospital From the 1st of October 2022 to the end of December 2023. All patients diagnosed with symptomatic gallbladder stones who visited the emergency room and surgical consultation clinic were included in the two groups of the study. The miniport group had a four-port mini laparoscopic cholecystectomy, whereas the standard laparoscopic group received a four-port standard laparoscopic cholecystectomy. The study excluded patients with ASA grade III/IV, previous major abdominal operations, choledocholithiasis or acute cholecystitis, malignancy, pancreatitis on ultrasonography, and BMI > 30. The study included 213 patients, 100 of whom met all inclusion criteria. The questionnaire was consisted from 5 parts. Part one for sociodemographic information. Part two for operation condition. Part three for postoperative pain severity by using Wong-Baker Face Scale after 2, 6, and 12 hours. Part four for analgesic used and part five for cosmesis assess at 7 days after operation. Results: The study includes 100 patients with symptomatic gallstone. The mean age ± standard deviation of the study participants was 41.24 ± 7.51 years. Of them, 63 (63%) patients were females and 37 (37%) were males, with male to female ratio of 1:1.7. Statistically significant difference between the two groups regarding their operation time (mini laparoscopic operation) spend more time (P value < 0.001). Moreover, patients undergoing mini laparoscopic operation reported statistically significant less postoperative pain scores (P value < 0.001). Additionally, patients undergoing mini laparoscopic operation reported statistically significant higher cosmetic score (P value <0.001). Moreover, statistically significant difference between the two groups regarding their conversion rate (higher in mini laparoscopic group) (P value <0.001). On the other hand, patients undergoing standard laparoscopic surgery need statistically significant more postoperative analgesia. (P value = 0.014). No statistically significant difference found between the two groups regarding postoperative complications (P value = 0.472). Conclusion: Mini laparoscopic cholecystectomy can be done with 78% success rate. Skilled surgeons can perform mini laparoscopic cholecystectomy on patients with gallbladder diseases. However, longer follow-up trials are needed to determine the safety of this procedure. Finally, the reasons to choose this technique are lower pain scores and higher cosmetic scores. As a result, it is preferable to do so only in specific instances and leave the decision to the patient.