Endobag extraction versus direct extraction of gall bladder specimen during laparoscopic cholecystectomy: is routine usage of endobag mandatory? A prospective cohort study

Background
During laparoscopic cholecystectomy (LC), the optimal method of retrieval of gall bladder (GB) specimen has not been agreed yet. This study aims to determine how mandatory it is to routinely use endobag for GB extraction in comparison with direct extraction (DE).
Settings
The study was conducted at the General Surgery Department of Ain Shams University Hospital.
Patients and methods
This prospective cohort study recruited patients who underwent LC between March 2017 and March 2019. This cohort was divided into two groups: group A had endobag extraction and group B had DE. Both arms were compared regarding procedure-related and postoperative variants.
Findings
This study included 100 patients who presented to Ain Shams University Hospital with different presentations of GB stones. Mean age of participants was 41.34±11.73 years in group A and 42.96±10.53 in group B. Spillage of bile and/or stones took place in the epigastric port-site in eight (16%) individuals of group B, and only one (2%) patient in group A (=0.031). Cases that had endobag extraction stayed in the hospital for only a mean of 23.68±6.26 h in comparison with 27.08±3.23 h of DE cases (=0.001). Port-site infection was discovered in 12% (six patients) of the DE arm and none of the opposing group (=0.027). At 24 h postoperatively, eight (16%) cases of group A and 11 (22%) cases of group B experienced pain (=0.611), and mean visual analog scale score was 1.84±0.91 and 3.14±0.61 in groups A and B, respectively (=0.001).
Interpretation
The use of endobag in LC is not routinely mandatory in uncomplicated GB stones. However, it is highly recommended in complicated GB stones like mucocele and empyema, as it minimizes port-site spillage, port-site infection, visual analog scale scores, and hospital stay.