SP6.8 A systematic review and meta-analysis of bag extraction versus direct extraction for retrieval of gallbladder in laparoscopic cholecystectomy: Is it necessary to use?

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Abstract Aims To evaluate comparative outcomes of gallbladder extraction with bag versus direct extraction in laparoscopic cholecystectomy. Methods 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 endo-bag versus direct extraction of gallbladder in laparoscopic cholecystectomy were included. Outcomes were surgical site infection (SSI), extension of fascial defect to extract the gallbladder, intra-abdominal collection, bile spillage and port-site hernia. Revman 5.4 was used for the data analysis. Results Eight studies were eligible to be included in this review with 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 while the rest were observational studies. The rates of SSI and bile spillage were significantly higher with direct extraction compared to bag extraction [odd ratio (OR)=2.50, P=0.006] and [OR=2.83, P=0.01], respectively. Conversely, extension of fascial defect was higher in endo-bag group [OR=0.22, P=0.00001]. Comparable results were observed regarding intra-abdominal collection [OR=0.01, P=0.51], and port-site hernia rate [OR-0.70, P=0.55] between the two groups. Conclusion Extraction of gallbladder with Endo-bag provides lower rates of SSI and bile spillage with no notable impact on postoperative abdominal collection. Despite the increased need to extend the fascial defect with Endo-bag, the rate of port-site hernia remains similar between both groups.

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