Moy.02Using aboutmyop.org as an alternative method for post-operative follow-up after elective laparoscopic cholecystectomy – a feasibility study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Prita Daliya ◽  
Jody Carvell ◽  
Judith Rozentals ◽  
Maria Ubhi ◽  
Dileep Lobo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Feasibility Study ◽  
Controlled Trial ◽  
Digital Data ◽  
National Guidelines ◽  
Patient Acceptability ◽  
Safe Alternative ◽  
Operative Care ◽  
Elective Laparoscopic Cholecystectomy

Abstract Introduction The majority of institutions no longer offer routine post-operative follow-up after elective laparoscopic cholecystectomy. National guidelines however recommend the use of post-operative hotlines or planned telephone follow-up for day-case procedures. At a time when NHS resources are limited, a digital solution may provide a safe alternative to telephone or physical follow-up. Our aim was to identify if digital follow-up with aboutmyop.org; a digital data-sharing platform, was equivalent to telephone follow-up. Method Study participants were invited to use aboutmyop.org before and after surgery. Patients were given free choice on whether they opted to use post-operative digital follow-up or routine post-operative care (no follow-up or telephone follow-up). In addition to follow-up compliance, the outcomes measured included 30-day post-operative complications, readmission, and re-operation. Results Of 597 laparoscopic cholecystectomy patients who were offered follow-up, 16.4% opted for digital follow-up, and 33.3% phone follow-up. Over 5 times as many patients who opted for telephone follow-up missed their appointment when compared to those who chose digital follow-up (5.6% vs. 30.9%, p < 0.001). Digital follow-up had a high sensitivity (68.2%-100%) and specificity (100%) for identifying complications at 30-days post-operatively and was completed significantly earlier than phone follow-up (median 6 days vs. 13.5 days, p = 0.001) with high patient acceptability. Conclusion This feasibility study demonstrates that digital follow-up utilising the aboutmyop.org platform is an acceptable alternative modality to telephone follow-up in elective laparoscopic cholecystectomy patients. Future work should aim to compare matched cohorts of patients undergoing digital follow-up, telephone follow-up, and no follow-up as a randomised controlled trial.

scholarly journals Severe Intraoperative Bradycardia during Laparoscopic Cholecystectomy due to Rapid Peritoneal Insufflation

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Mohammed Heyba ◽  
Ahmed Khalil ◽  
Yasser Elkenany
Keyword(s):  
Cardiac Arrest ◽  
Laparoscopic Cholecystectomy ◽  
Flow Rate ◽  
Low Flow ◽  
Postanesthesia Care Unit ◽  
Surgical Team ◽  
Severe Bradycardia ◽  
Elective Laparoscopic Cholecystectomy ◽  
Surgical Operations

Laparoscopy is becoming increasingly popular in gynecological and general surgical operations. There are complications that are inherent to the laparoscopy techniques; amongst them is intraoperative vagal-mediated bradycardia that results from peritoneal stretching. This can occur due to high flow rate of gas during peritoneal insufflation, a practice still happening nowadays. We report a case of a middle-aged hypertensive patient who was undergoing elective laparoscopic cholecystectomy. The patient was assessed more than once preoperatively by the anesthesia team for blood pressure optimization. The patient underwent general anesthesia and developed severe bradycardia immediately after peritoneal insufflation. The management started immediately by stopping the insufflation and deflating the abdomen. Afterwards, atropine was administered intravenously, and CPR was started preemptively according to the ACLS protocol to prevent the patient from progressing into cardiac arrest. She responded to the management and became vitally stable within one minute. After confirming that there was no cardiac or metabolic insult through rapid blood investigations and agreeing that the cause of bradycardia was the rapid insufflation, the surgical team proceeded with the surgery in the same setting using low flow rate of CO2 to achieve pneumoperitoneum. There were no complications in the second time and the operation was completed smoothly. The patient was extubated and shifted to the postanesthesia care unit to monitor her condition. The patient was stable and conscious and later shifted to the wards and discharged on routine follow-up after confirming that there were no complications in the postoperative follow-up. Therefore, it is important to monitor the flow rate of CO2 during peritoneal insufflation in laparoscopic surgery as rapid peritoneal stretch can cause severe bradycardia that might progress into cardiac arrest, especially in hypertensive patients. It is also important for the anesthetist to be vigilant and ready to manage such cases.

scholarly journals Three-Port versus Four-Port Laparoscopic Cholecystectomy: A Randomized Controlled Trial

2019 ◽  
Vol 21 (1) ◽  
pp. 40-43
Author(s):  
Rabin Koirala ◽  
TM Gurung ◽  
A Rajbhandari ◽  
P Rai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Controlled Trial ◽  
Open Cholecystectomy ◽  
Analgesic Requirement ◽  
Safe Alternative ◽  
Average Hospital ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

 Laparoscopic cholecystectomy (LC) is one of the most common surgery performed and is traditionally performed using four ports. With the aim of improving patient’s comfort, port numbers have been reduced to single port. But feasibility and the extra expense that comes with single and double port LC has made them less attractive. Three port LC can be a safe alternative to four port LC, and various research has shown its safety. This study compares the three port LC with the traditional four port LC with the objective of assessing feasibility and benefit of the decreased port number. We evaluated 217 patients who were randomly allocated for three port and four port LC. Both the groups were compared for operative time, assessment of postoperative pain, days of hospital stay and postoperative recovery time after discharge. The parameters were compared using Statistical Package for the Social Sciences (SPSS) version 16. Among 217 patients, 123 underwent three port LC and 94 underwent four port LC. The larger number were females (79.7%), and with comparable age group of patients. Rate of conversion to open cholecystectomy, postoperative pain scale, analgesic requirement, average hospital stay and port site infection rates were comparable in both groups of patients. The average time taken for operation was less in three port LC than the four port LC but this was not statistically significant. There is no significant difference between 3 port and 4 port LC in terms of time required for the surgery, conversion rate, complication and duration of hospital stay.

scholarly journals Elective day-case laparoscopic cholecystectomy: a formal assessment of the need for outpatient follow-up

2013 ◽  
Vol 95 (8) ◽  
pp. e10-e14 ◽  
Author(s):  
GI van Boxel ◽  
M Hart ◽  
A Kiszely ◽  
S Appleton
Keyword(s):  
Patient Satisfaction ◽  
Laparoscopic Cholecystectomy ◽  
Significant Proportion ◽  
Day Case ◽  
Residual Symptoms ◽  
Symptom Resolution ◽  
Case Surgery ◽  
Elective Laparoscopic Cholecystectomy ◽  
Patients Experience

Introduction Elective laparoscopic cholecystectomy (LC) is performed routinely as day-case surgery. Most hospital trusts have a policy of no routine postoperative outpatient follow-up although there are no formal guidelines on this. The aim of this retrospective study was to identify the incidence of complications, the degree of symptom resolution and patient satisfaction with a view to formally appraising the need for outpatient follow-up. Methods Patients who underwent LC in the period between February 2011 and June 2012 were contacted retrospectively by telephone. A standardised questionnaire was used to ascertain the incidence of surgical site infection (SSI), other complications, symptom resolution and patient satisfaction. Results A total of 211 responses were collected. The rate of SSI was 7.6% (n=16), with the only specific risk factor being smoking (p=0.027). All other complications had a combined incidence of 7% (n=15). There was complete resolution of symptoms in 64% of patients. Of the 36% of patients with residual symptoms, 45% described abdominal discomfort or pain, 41% described reflux symptoms and 14% complained of diarrhoea. Patient satisfaction was very high (96%), yet 33% of patients visited their general practitioner postoperatively in relation to their surgery. Conclusions Patients are highly satisfied with elective day-case LC. However, SSI is not uncommon, occurring in 1 in 13 patients. Although the majority of patients experience complete symptom resolution, a significant proportion do not. In our experience, routine outpatient follow-up is not required. Nevertheless, the lack of formal follow-up may prove a missed learning opportunity, potentially resulting in inappropriate patient selection for surgery.

scholarly journals EP.TH.342Using aboutmyop.org to measure quality of life using ePROMs in patients undergoing elective laparoscopic cholecystectomy – a feasibility study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Prita Daliya ◽  
Dileep Lobo ◽  
Simon Parsons
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Cholecystectomy ◽  
Methodological Quality ◽  
Clinical Care ◽  
Well Being ◽  
Drop Out ◽  
Digital Data ◽  
Patient Reported ◽  
Elective Laparoscopic Cholecystectomy

Abstract Introduction The collection of Patient Reported Outcome Measures (PROMs) have many benefits for clinical practice. However, there are also many barriers that prevent it from becoming a part of routine clinical care. The aim of this study was to pilot the use of aboutmyop.org; a digital data-sharing platform, as a means to collecting electronic PROMs (ePROMs) and validate the ePROMs questionnaires used. Method Patients listed for elective laparoscopic cholecystectomy were asked to complete digital versions of the Otago gallstones Condition-Specific Questionnaire (CSQ), and the RAND 36-item health survey (SF36) on aboutmyop.org, pre- and post-operatively. In addition to ePROMs, patient demographics and 30-day clinical outcomes were recorded. An assessment of methodological quality of ePROM questionnaires was also performed. Results Pre-operative ePROMs were completed in 200 laparoscopic cholecystectomy patients. Despite participant drop out a significant improvement in quality of life was seen across all health domains post-operatively when compared to baseline pre-operative values for both disease-specific (emotional functioning; Pre-operative: 48.9, 30-days: 15.6, 3-months: 16.7, 6-months: 7.9, p < 0.05) and generic (emotional well-being; Pre-operative: 60.1, 30-days: 73.7, 3-months: 74.3, 6-months: 73.5, p < 0.05) PROMs. Methodological quality was assessed as good to excellent in both digital questionnaires used in the aboutymyop.org system. Conclusion The collection of ePROMs by a digital utility such as aboutymyop.org is possible with current technological advances. Although it may be an acceptable, and convenient process for patients, and a useful measure of quality of life trends for clinicians, further developmental work is necessary to improve accessibility for patients and reduce reporting bias.

scholarly journals Drain after elective laparoscopic cholecystectomy. A randomized multicentre controlled trial

2012 ◽  
Vol 26 (10) ◽  
pp. 2817-2822 ◽  
Author(s):  
Marcello Picchio ◽  
Francesco De Angelis ◽  
Settimio Zazza ◽  
Annalisa Di Filippo ◽  
Raffaello Mancini ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Controlled Trial ◽  
Elective Laparoscopic Cholecystectomy

scholarly journals Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Kong Jing ◽  
Wu Shuo-Dong
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Rare Complication ◽  
Subtotal Gastrectomy ◽  
Needle Aspiration ◽  
Catheter Drainage ◽  
Billroth Ii ◽  
The Past ◽  
Complications Of Laparoscopic Cholecystectomy ◽  
Elective Laparoscopic Cholecystectomy

Background. Duodenum injury is extremely rare complication of laparoscopic cholecystectomy with potentially fatal consequences.Methods. Over the past 13-year period, 3000 laparoscopic cholecystectomies were performed in our institution. Duodenum injury only occurred in one patient recently who had undergone gastrectomy owing to duodenal diverticulum. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed.Results. We present this case of duodenum injury on the fourth postoperative day after selective laparoscopic cholecystectomy was treated successfully by percutaneous needle aspiration and catheter drainage. The hospital stay was 26 days. No abscess recurred during the follow-up period.Conclusion. Duodenum injuries are extremely rare complications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. Sonographically guided percutaneous needle aspiration and catheter drainage can be used to treat the intraperitoneal abscess. Billroth II subtotal gastrectomy and gastrojejunostomy were beneficial for the treatment.

scholarly journals Comparison of the Number of Attempts in Creating Pneumoperitoneum for Laparoscopic Cholecystectomy Using Direct Trocar Versus Veress Needle Insertion

2021 ◽  
Vol 15 (7) ◽  
pp. 1787-1790
Author(s):  
Kamran Hamid ◽  
Shabbir Ahmad ◽  
Faisal Shabbir ◽  
Amer Latif ◽  
Shahzad A. ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Laparoscopic Cholecystectomy ◽  
Body Mass ◽  
Controlled Trial ◽  
Needle Insertion ◽  
Veress Needle ◽  
Key Words Laparoscopic Cholecystectomy ◽  
Safe Alternative ◽  
Trocar Insertion ◽  
Direct Trocar Insertion

Aim: To compare the number of attempts at creating pneumoperitoneum for laparoscopic cholecystectomy using direct trocar versus veress needle insertion techniques. Design: Randomized controlled trial Place and Duration of Study: Department of Surgery, Allama Iqbal Memorial Hospital Sialkot and Govt. Sardar Begum Teaching Hospital, Sialkot from 27th September 2017 to 26th September 2020. Methodology: Six hundred and eight patients of both male and female patients, having uncomplicated cholelithiasis were selected. All participants were randomized into two equal groups, Group A (direct trocarInsertion) and the Group B (veress needle insertion). All trocars and veress needle used were disposable, with a safety shield. All procedures were carried out by the single experienced surgeons and his team. Data was noted, regarding age, sex, body mass index (BMI) and the number of attempts to create the successful pneumoperitoneum. Results: The number of attempts to create successful pneumoperitoneum in DTI group was significantly feweras compared to VNI group (p=0.026) but we found no statisticallysignificant difference between age, gender, and body mass index. Conclusion: The direct trocar insertion is a safe alternative to veress needle insertion in laparoscopic cholecystectomy because it requires fewernumber of attempts for successful creation of pneumoperitoneum as compared to the veress needle. Key words: Laparoscopic cholecystectomy, Veress needle insertion, Direct trocar insertion, Pneumoperitoneum

scholarly journals Comparison of Bupivacaine injection versus normal saline in port sites & intraperitoneal spray for postoperative pain in laparoscopic cholecystectomy.

2021 ◽  
Vol 28 (7) ◽  
pp. 1028-1032
Author(s):  
Syed Mehmood Ali ◽  
◽  
Hajra Shuja ◽  
Mehak Adil ◽  
Sadaf Bokhari ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Normal Saline ◽  
Controlled Trial ◽  
Test Sample ◽  
Operational Definition ◽  
T Test ◽  
P Value ◽  
Group A ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group B

Objective: To compare mean pain using bupivacaine injection versus normal saline in port sites & intraperitoneal spray in laparoscopic cholecystectomy. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Shaikh Zayed Hospital, Lahore. Period: October 2, 2018 to April 2, 2019. Material & Methods: Laparoscopic cholecystectomy patients were allocated to obtain either bupivacaine 0.25% or regular saline (N / S) randomly by lottery method. In bupivacaine group-A, 15ml 8of 0.25% bupivacaine spray on gall bladder bed, dissection surface and in ports area after surgery. In normal saline group-B received 15 ml of normal saline in the same area and ports after surgery. Pain was measured on VAS as per operational definition. All the data was entered with SPSS v25.0 and analyzed. A t-test study was used to evaluate the mean pain for both groups at 24th hours. In order to address the effect modifiers, the data was stratified for age, gender, and BMI (obese, non-obese). The independent t-test sample after stratification was used taking p-value 0.05 as relevant. Results: A total of 60 patients were included for elective laparoscopic cholecystectomy. In group-A, mean pain score was 3.33±0.81 and 4.37±1.16 in group-B, which is statistically significant with a p-value of 0.0002. Conclusion: This study demonstrates that bupivacaine spray at the surgical bed and in ports site in elective laparoscopic cholecystectomy result in significant lowering of the intensity of postoperative abdominal and shoulder pain.

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