TP6.1.2 Laparoscopic subtotal cholecystectomy; change in practice over a 10-year period

Abstract Aim Laparoscopic subtotal cholecystectomy is a safe strategy to avoid bile duct injury when a critical view of safety cannot be obtained. This technique may result in fewer open conversions and was introduced in our DGH in 2013. This study describes the change in practice at our centre following introduction of subtotal cholecystectomy. Method Retrospective case series included consecutive cholecystectomies over a ten-year period in a single institution. Cases were divided into subgroups based on operation date; 2009-2012 (Group A) and 2013-2019 (Group B). These groups represent pre- (Group A) and post- (Group B) introduction of laparoscopic subtotal cholecystectomy. Primary outcome was the proportion of patients undergoing laparoscopic total cholecystectomy, laparoscopic sub-total and lap-converted to open cholecystectomy. Secondary outcomes included incidence of bile leak, complication rate, return to theatre, and length of stay. Results There were 4248 cases; 1387 in Group A, and 2861 in Group B. The rate of open conversions was higher in Group A than Group B (4.7% vs. 2.8%, p = 0.003). The rate of laparoscopic total cholecystectomy was higher in Group A than Group B (95.3% vs. 92.8%, p = 0.013). In the subtotal group (n = 114, 3.9% of Group B); 14 (12.3%) patients had bile leak requiring ERCP, 6 (5.3%) underwent re-laparoscopy for inadequate biliary drainage, and median LOS was 2 days. Conclusion Laparoscopic subtotal cholecystectomy has proven to be a safe technique at our centre, reducing the rate of open conversion and length of stay, with a low rate of reintervention for bile leak.

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Clinical results of Visian implantable collamer lens implantation according to various sizes and implantation angles

European Journal of Ophthalmology ◽

10.1177/11206721211033468 ◽

2021 ◽

pp. 112067212110334

Author(s):

Bu Ki Kim ◽

Young Taek Chung

Keyword(s):

Case Series ◽

Clinical Results ◽

Implantable Collamer Lens ◽

Retrospective Case ◽

Significant Difference ◽

Lens Implantation ◽

Group A ◽

The Mean ◽

Group B

Purpose: To investigate the clinical outcomes of Visian implantable collamer lens (ICL) implantation according to lens size and implantation angle. Setting: Onnuri Smile Eye Clinic, Seoul, Republic of Korea. Design: Retrospective case series. Methods: This study included 566 eyes of 283 patients treated with ICL implantation. Patients were divided into three groups: horizontally implanted same-sized ICL (group A), horizontally implanted different sized-ICL (group B: large ICL and small ICL) and same sized-ICL implanted with a different implantation angle (group C: horizontal and vertical). Results: At 12-month follow-up, the mean vault was 0.78 ± 17, 0.48 ± 0.13, 0.71 ± 0.18 and 0.44 ± 0.16 mm when large and small sized ICL was used in group B ( p < 0.001), and when ICL was horizontally and vertically implanted in group C ( p = 0.021), respectively. And the mean SE was −0.11 ± 0.30, −0.34 ± 0.42, −0.3 ± 0.56 and −0.64 ± 0.66 dioptres (D), when the large and the small sized ICL was used group B ( p = 0.039), and when the ICL was horizontally and vertically implanted in group C ( p = 0.036), respectively. No significant difference in UDVA, IOP and ECD between both eyes in groups B and C was observed. No statistical difference was found in the vault between both eyes for groups B and C. Conclusions: The vault was significantly higher and the SE was significantly more hyperopic when a larger-sized ICL was used or the ICL was horizontally implanted compared to when the ICL was vertically implanted.

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Tentorial Incision vs. Retraction of the Tentorial Edge during the Subtemporal Approach: Anatomical Comparison in Cadaveric Dissections and Retrospective Clinical Case Series

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1676077 ◽

2018 ◽

Vol 80 (05) ◽

pp. 441-448

Author(s):

E. Archavlis ◽

L. Serrano ◽

F. Ringel ◽

S. R. Kantelhardt

Keyword(s):

Case Series ◽

Free Edge ◽

Superior Cerebellar Artery ◽

Fast Method ◽

Subtemporal Approach ◽

Cerebellar Artery ◽

Significant Difference ◽

Suture Group ◽

Group A ◽

Group B

Abstract Objective The aim of this study was to compare tentorial incision (group A) versus retraction and tack up suture (group B) of the tentorial edge during the subtemporal approach for surgery in the high basilar region. Design 24 cadaveric dissections and 4 clinical cases of aneurysms of the high basilar region are presented. Assessment included visibility and operability afforded by either tentorial incision creating a dural flap (group A) or retraction of the tentorial edge and tethering with a suture (group B). Four patients, two with superior cerebellar artery aneurysms and two with proximal posterior cerebral artery aneurysms were treated with each approach. Results In the quantitative evaluations, we found no significant difference in the exposure of the posterior cerebral, superior cerebellar, and perforant arteries as well as surgical working area provided by either approach. However, tentorial incision allowed a significantly greater exposure of the basilar artery and the fourth cranial nerve (both p < 0.001). Concerning operability, tentorial incision provided no objective advantage for direct clipping of the high basilar region (groups A vs. B, p > 0.05). Subjectively, clipping of the high basilar segment was feasible using tentorial tethering only. Conclusion Retraction of the free edge of the tentorium downward by tethering with a suture is simple and fast method for exposure of aneurysms in the high basilar region when the pathology does not require a proximal control. In our data the rather more invasive and time consuming tentorial incision provided an additional objectified advantage only for placement of a proximal temporary clip.

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Comparison of Early and Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

Annals of Punjab Medical College ◽

10.29054/apmc/2021.1099 ◽

2021 ◽

Vol 15 (1) ◽

pp. 91-94

Author(s):

Muhammad Nasir ◽

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Open Cholecystectomy ◽

Early Laparoscopic Cholecystectomy ◽

Female Patients ◽

Delayed Laparoscopic Cholecystectomy ◽

Conversion To Open Cholecystectomy ◽

Group A ◽

Male Patients ◽

Group B

Background: Laparoscopic Cholecystectomy is now accepted as being safe for acute cholecystitis. However, it has not become routine, because the exact timing and approach to the surgical management remains ill define. Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe Laparoscopic Cholecystectomy. Objective: To compare the early and delayed Laparoscopic Cholecystectomy in the acute phase in terms of frequency of conversion to open cholecystectomy. Study Design: Randomized clinical trial. Settings: Department of Surgery, Divisional Headquarter Hospital, Faisalabad. Punjab Medical College, Faisalabad Pakistan. Duration: Study was carried out over a period of six months from June 2018 to May 2019. Methodology: A total of 152 cases (76 cases in each group) were included in this study. All patients were randomly allocated to either group i.e., group -A early Laparoscopic Cholecystectomy and group-B delayed Laparoscopic Cholecystectomy. Results: Mean age was 39.09 + 8.8 and 37.05+ 8.5 years in group- A and B, respectively. In group-A, male patients were 48 (63.2%) and female patients were 28 (36.8%). Similarly, in group-B, male patients were 41 (53.9%) and female patients were 35 (46.1%). Conversion to open cholecystectomy was required in 6 patients (7.9%) of group-A and 16 patients (21.0%) of group – B. Significant difference between two groups was observed (P= 0.021). Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible in terms of less frequency of conversion to open cholecystectomy.

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Antibiotic usage rates in bacterial versus nonbacterial diseases: a new way to monitor hospital-acquired infections in children: a retrospective case analysis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20204540 ◽

2020 ◽

Vol 7 (11) ◽

pp. 2176

Author(s):

Jayendra R. Gohil ◽

Chintu C. Chaudary ◽

Sheena D. Sivanandan

Keyword(s):

Antibiotic Usage ◽

Retrospective Case ◽

Hospital Acquired Infections ◽

Group A ◽

Added Benefit ◽

Reduction Of Mortality ◽

Group B ◽

The Cost ◽

Hospital Acquired ◽

Selection Of

Background: While treating children, the selection of antibiotics, when indicated, should be from the point of its effectiveness, safety, suitability, and cost. However, this flow of action does not take place in all cases. Aim of the study was to assess the antibiotic usage in admitted children and mortality.Methods: The case records between January to July 2012 in children wards was evaluated for the use of antibiotics. Patients were grouped into; group A- ‘must use' antibiotic in all, and group B- where antibiotics are not indicated.Results: There were 1852 admissions, including 719 Thalassemia cases. Antibiotic usage was 63% in 1133 cases after excluding thalassemia. Out of 1133 cases, 423 were in group A and 710 cases were in group B. In group B the antibiotic usage was 41%. The mortality was 6.6% and 4.8% in group A and B. Inside group B, mortality was 5.9% versus 4.0% in those administered versus not administered, antibiotics.Conclusions: There was no increase in mortality in patients in whom antibiotics were not prescribed, and no added benefit of prescribing antibiotics was observed in nonbacterial group B disease patients. The mortality was similar in both the groups. In nonbacterial group B, the antibiotics did not offer any advantage in the reduction of mortality, but increased the cost of the treatment, and possibly the chance of development of drug resistance and adverse events. When analysing the hospital antibiotic usage, only the nonbacterial diseases should be considered to get a true picture of the inappropriate prescription of antibiotics.

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OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY WITH &WITHOUT DRAIN

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2015.5.1.613-616 ◽

1969 ◽

Vol 5 (1) ◽

pp. 613-616

Author(s):

MUHAMMAD ASLAM RAl ◽

M FAWAD ASLAM ◽

SARA ASLAM

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Prophylactic Antibiotic ◽

Laparoscopic Approach ◽

Preoperative Assessment ◽

Open Conversion ◽

Abdominal Drain ◽

Port Infection ◽

Group A ◽

Group B

BACKGROUND: Cholecystitis is common health problem and laparoscopic approach to gallstonedisease is procedure of choice. Intra abdominal drain is used to pervert post operative sub hepaticcollection. However drain insertion may increase pain discomfort and delay in discharge.OBJECTIVE: To assess the benefits and harms of drain use in laparoscopic cholecystectomyMATERIAL AND METHODS: A prospective, single centre, Study conducted on 200 patients in needof laparoscopic cholecystectomy at Rai Medical Complex Sargodha (affiliated with Rai MedicalCollege) from April, 2009 to July 2011. All patients, after preoperative assessment, were operated undergeneral anesthesia. Prophylactic antibiotic, inj. cefuroxime 1.5 gm prior to anesthesia and two furtherdoses at 8 hour interval postoperatively were given in chronic cholecystitis and therapeutic doses, forseven days in acute cholecystitis. Patients having choledocholithiasis and open conversion wereexcluded from the study four port techniques were used for laparoscopic cholecystectomy. Patients weredivided randomly in to two groups, 100 patients in each Group A, without drain and group B with drain.Data was recorded on standardized performa.RESULTS: Out of 200 patients, 18 were male and 182 were female .Age range was 20 years to 90years. 02 patients from group B, having acute cholecystitis, had epigastric port infection on 15thpostoperative day. Drainage was done with uneventful healing. One patient from group A had s/hepaticabscess 03 weeks after surgery. Ultrasonographic guided aspiration was done in OPD with goodrecovery .No mortality, no open conversion and no CBD injury. Thirty patients from group A weredischarged within 24 hours , 3 patients having drain were discharged after 72 hours and all others fromboth groups within 48 hours.04 patients from group B had severe shoulder tip pain and relieved afterremoval of drain.Postoperative pain was significantly higher in patients who had drain placed, median VAS was 5(ranging 1-10) versus 3 in non drained group .Especially removal of drain was a painful procedure.CONCLUSION: Routine use of intra abdominal drain in laparoscopic cholecystectomy is of no benefitbut causes more discomfort to patient except in empyaema gallbladder.KEY WORDS: Laparoscopic cholecystectomy, intra abdominal drain.

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Comparison of Outcomes after Phacoemulsification with Two Different Corneal Incision Distances Anterior to the Limbus

Journal of Ophthalmology ◽

10.1155/2019/1760742 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Lijun Wang ◽

Lin Zhao ◽

Xiting Yang ◽

Yi Zhang ◽

Dingying Liao ◽

...

Keyword(s):

Visual Acuity ◽

Anterior Segment ◽

Case Series ◽

Senile Cataract ◽

Retrospective Case ◽

Corneal Incision ◽

Clear Corneal Incision ◽

Corneal Aberrations ◽

Anterior Segment Parameters ◽

Group B

Purpose. To compare visual performance and visual quality outcomes after phacoemulsification with two different clear corneal incision (CCI) distances anterior to the limbus in senile cataract patients. Methods. Retrospective case series. Patients who had undergone phacoemulsification were divided into two groups according to the CCI distances anterior to the limbus. The CCI distances in group A range from 1 mm to 1.5 mm, while those in group B range from 0.5 mm to 1 mm. The visual acuity, refraction, surgically induced astigmatism (SIA), corneal aberrations, anterior segment parameters, and subjective vision quality were evaluated. Results. This study enrolled 54 eyes, with 27 eyes per group. Both groups had significant improvement in postoperative uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) (P<0.05). There were no statistically significant between-group differences in postoperative UDVA, CDVA, SIA, corneal aberrations, anterior segment parameters, or VF-QOL questionnaire performance (P>0.05). Conclusions. The phacoemulsification with CCI distances ranging from 0.5 mm to 1.5 mm is an effective and safe therapy to senile cataract. The CCI distance anterior to the limbus that ranges from 0.5 mm to 1.5 mm is recommended for routine phacoemulsification.

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Comparisons of Visual and Surgical Outcomes after Reuse or Replacement of Dislocated in-the-Bag Intraocular Lens

Journal of Ophthalmology ◽

10.1155/2018/7342917 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Takayuki Baba ◽

Tomohiro Nizawa ◽

Toshiyuki Oshitari ◽

Shuichi Yamamoto

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Intraocular Lens ◽

Refractive Error ◽

Surgical Outcomes ◽

Case Series ◽

Cell Loss ◽

Significant Difference ◽

Group A ◽

Group B

Purpose. To compare the visual and surgical outcomes after a reuse or a replacement of a dislocated in-the-bag intraocular lens (IOL). Methods. This was a retrospective, nonrandomized case series at a single ophthalmological institution. Cases with an in-the-bag dislocation of an IOL were treated by pars plana vitrectomy and the reuse or the replacement of the IOL. The lens was held by intrascleral fixation of the haptics of the IOL under both conditions. The same dislocated IOL was reused in 6 eyes (group A) or it was replaced with another IOL in the other 9 eyes (group B). The pre- and postoperative parameters analyzed included the visual acuity, refractive error, corneal endothelial cell density, and intraocular pressure (IOP). Results. There was no significant difference between the two groups in the postoperative visual acuity (P=0.388), refractive error (P=0.955), IOP (P=0.529), and endothelial cell loss (P=0.940). A breakage or a tilting of the IOL was observed and required replacement in three eyes in the reuse group (P=0.044). Conclusions. Half of the cases with reused in-the-bag dislocated IOL had a breakage or a tilting of the IOL. The replacement of the in-the-bag dislocated IOL is better than the reuse of the IOL with intrascleral haptics fixation.

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A comparative study of open cholecystectomy and laparoscopic cholecystectomy in patients with cholelithiasis

International Surgery Journal ◽

10.18203/2349-2902.isj20175905 ◽

2017 ◽

Vol 5 (1) ◽

pp. 253 ◽

Cited By ~ 1

Author(s):

Pramod Singh ◽

Sumit Kumar Gupta ◽

Mukesh Kumar

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Site Infection ◽

Hospital Stay ◽

Open Cholecystectomy ◽

City Hospital ◽

Site Infection ◽

First Choice ◽

Duration Of Surgery ◽

Group A ◽

Group B

Background: Cholelithiasis is a major cause of morbidity among Indians with a female preponderance. Most of the cases of gallstones are asymptomatic. For a long time, open cholecystectomy (OC) used to be the surgical treatment for cholelithiasis. But with the advent of laparoscopic cholecystectomy (LC) there has been a gradual shift in the treatment with most surgeons preferring LC over OC. Apart from the benefits of decreased hospital stay, lesser postoperative pain and earlier return to normal activity LC are also cosmetically better as compared to OC. Longer operative time and increased incidence of biliary leakage are some pitfalls of LC in initial phase of surgical practice.Methods: A prospective study of 100 patients was carried out in the department of surgery in IQ city medical college and Durgapur city hospital, Durgapur between January 2017 and August 2017 with the aim of comparing open cholecystectomy with laparoscopic cholecystectomy. The patients were randomly assigned into two groups. Group A consisted of patients who underwent laparoscopic surgery while Group B patients underwent open surgery for cholelithiasis.Results: Duration of surgery was longer in OC than LC (72.4min versus 44.7min.). Mean duration of post-operative pain was 18.3hrs in group A as compared to mean duration of 30.7hrs in group B patients. The mean period of post-operative hospital stay was 1.8 days in group A and 4.8 days in group B. Post-operative resumption of normal diet was possible in 2.1 days in OC while it took lesser time (1.2 days) in LC. The rate of surgical site infection was higher in OC as compared to LC.Conclusions: Laparoscopic cholecystectomy can be recommended as first choice operative treatment for patients with cholelithiasis as it provides better cosmetic results, lesser pain, lesser post-operative hospital stay and fewer incidence of surgical site infection.

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Comparison of Dexmedetomidine versus Midazolam in weaning from mechanical ventilation and length of stay in ICU.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.11.4535 ◽

2020 ◽

Vol 27 (11) ◽

pp. 2309-2313

Author(s):

Afia Arshed Dodhy

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Length Of Stay ◽

Significant Relationship ◽

Controlled Trial ◽

Cost Study ◽

Extubation Time ◽

Group A ◽

Surgical Icu ◽

Group B

Objectives: To compare the role of dexmedetomidine versus midazolam as sedative in facilitating early mechanical ventilation weaning thereby decreasing ICU cost. Study Design: Randomized Controlled trial. Setting: Surgical ICU of Lahore General Hospital, Lahore. Period: December 2018 to July 2019. Material & Methods: Total of 60 adult postoperative patients (30 in each group) who required mechanical ventilation in the surgical ICU for minimum 24 hours postoperatively after major pelvi-abdominal operations were included. Patients of group “A” and “B” received midazolam infusion 20-100 mcg/kg/hr & dexmedetomidine infusion 0.2-0.7 μg/kg/hr respectively while being mechanically ventilated. The degree of sedation was measured by using the Richmond agitation sedation score (RASS) every 6 hourly. Extubation time (i.e. time from termination of drug to extubation) was recorded. The time of ICU length of stay was also recorded Results: Mean age of patients was 41.97 ±10.21 and 42.57±10.93 years in group-A and B, respectively. In group-A 18 patients (60%) and in group-B 16 patients (53.0%) were male while 12 patients (40%) in group-A and 14 patients (47.0%) were females. A significant decrease in extubation time was observed in Group-B when compared with the Group-A (p=0.046) along with odds ratio 0.938 while no significant relationship could be proved between length of stay at ICU between two groups. Stratification with regard to age, gender height, weight and type of surgery was carried out. Conclusion: Dexmedetomidine is more favourable than midazolam for sedation in intensive care patients by facilitating early exubation and decreasing the duration of invasive ventilation while no significant relationship could be proved in two groups between length of stay in intensive care unit.

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Peripheral Anterior Chamber Depth and Angle Measurements Using Pentacam After Implantation of Toric and Non-toric Implantable Collamer Lenses

Frontiers in Medicine ◽

10.3389/fmed.2021.610590 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jiao Zhao ◽

Jing Zhao ◽

Wen Yang ◽

Huamao Miao ◽

Lingling Niu ◽

...

Keyword(s):

Anterior Chamber ◽

Anterior Chamber Depth ◽

Case Series ◽

Angle Measurements ◽

Significant Difference ◽

Group A ◽

Icl V4c ◽

Contralateral Eye ◽

Group B ◽

Safety Indices

Purpose: To evaluate the characteristics of peripheral anterior chamber measurements by Pentacam after posterior implantable collamer lenses (ICL) and toric ICL (TICL) with central hole (V4c) implantation.Methods: Prospective, non-randomized consecutive case series. Forty-six patients undergoing ICL implantation in one eye (Group A) and identically sized TICL in the contralateral eye (Group B) in the Refractive Surgery Center of Eye and ENT Hospital of Fudan University were prospectively included. According to ICL/TICL size, these eyes were further divided into four subgroups. Peripheral anterior chamber depth (PACD) and angle (ACA) in nasal and temporal sides were measured using Pentacam pre-operatively and 12-month post-operatively.Results: The safety indices were 1.34 ± 0.32 and 1.25 ± 0.16 and the efficacy indices were 1.20 ± 0.24 and 1.19 ± 0.19 for ICL and TICL groups, respectively. There was no significant difference in pre-operative PACD or ACA between the two groups. Post-operative PACD and ACA were significantly lower than pre-operative values. Variations of PACD and ACA of TICL group were significantly larger than those of ICL group. The change of ACA for 13.2 mm lenses was significantly larger than that of 12.6 mm lenses. Pre-operative CACD and vault were significantly associated with post-operative PACD, while pre-operative ACA and vault were significantly associated with post-operative ACA.Conclusions: Variations of PACD and ACA were greater in eyes after TICL (V4c) implantation compared with identically sized ICL (V4c) implantation and with larger size than smaller size lens implantation. Pre-operative anterior chamber structure and vault affect post-operative PACD and ACA.

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