Open conversion for laparoscopically difficult cholecystectomy is still a valid solution with unsolved aspects

Abstract Background It is proposed a new running suture technique called Needle Adjustment Free (NAF) technique, or PAN suture. The efficiency and the safety were evaluated in laparoscopic partial nephrectomy. Methods This new running suture technique avoids the Needle Adjustment method used in traditional techniques. The new continuous suture technique (11 patients) was compared with the traditional continuous suture method (33 patients) used in both transperitoneal and retroperitoneal laparoscopic partial nephrectomy (LPN) in terms of suture time (ST), warm ischemia time (WIT), blood loss (BL), open conversion rate and post-op discharge time, post-op bleeding, post-op DVT, ΔGFR (affected side, 3 months post-op). Differences were considered significant when P < 0.05. Results ST in the PAN suture group was 30.37 ± 16.39 min, which was significant shorter (P = 0.0011) than in the traditional technique group which was 13.68 ± 3.33 min. WIT in the traditional technique group was 28.73 ± 7.89 min, while in the PAN suture group was 20.64 ± 5.04 min, P = 0.0028. The BL in entirety in the traditional technique group was 141.56 ± 155.23 mL, and in the PAN suture group was 43.18 ± 31.17 mL (P = 0.0017). BL in patients without massive bleeding in the traditional technique group was significantly greater than in the PAN suture group at 101.03 ± 68.73 mL versus 43.18 ± 31.17 mL (P = 0.0008). The open conversion rate was 0 % in both groups. There was no significant difference between the two groups in postoperative discharge time, post-op bleeding, post-op DVT, ΔGFR (affected side, 3 months post-op). Conclusions The NAF running suture technique, or PAN suture, leading to less ST, WIT and BL, which was shown to be more effective and safer than the traditional technique used for LPN. A further expanded research with larger sample size is needed.

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Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Diagnostics ◽

10.3390/diagnostics11030383 ◽

2021 ◽

Vol 11 (3) ◽

pp. 383

Author(s):

Kojiro Omiya ◽

Kazuhiro Hiramatsu ◽

Yoshihisa Shibata ◽

Masahide Fukaya ◽

Masahiro Fujii ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Magnetic Resonance ◽

Acute Cholecystitis ◽

Signal Intensity ◽

Magnetic Resonance Cholangiopancreatography ◽

Gallbladder Wall ◽

High Signal ◽

Mri Findings ◽

Open Conversion ◽

Preoperative Magnetic Resonance

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.

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Strategic competence for multistep fraction word problems: an overlooked aspect of mathematical knowledge for teaching

Educational Studies in Mathematics ◽

10.1007/s10649-021-10028-1 ◽

2021 ◽

Author(s):

Yasemin Copur-Gencturk ◽

Tenzin Doleck

Keyword(s):

Word Problem ◽

Word Problems ◽

Mathematical Knowledge ◽

Teaching And Learning ◽

Mathematics Learning ◽

Mathematical Knowledge For Teaching ◽

Important Indicator ◽

Strategic Competence ◽

The Usa ◽

Valid Solution

AbstractPrior work on teachers’ mathematical knowledge has contributed to our understanding of the important role of teachers’ knowledge in teaching and learning. However, one aspect of teachers’ mathematical knowledge has received little attention: strategic competence for word problems. Adapting from one of the most comprehensive characterizations of mathematics learning (NRC, 2001), we argue that teachers’ mathematical knowledge also includes strategic competence, which consists of devising a valid solution strategy, mathematizing the problem (i.e., choosing particular strategies and presentations to translate the word problem into mathematical expressions), and arriving at a correct answer (executing a solution) for a word problem. By examining the responses of 350 fourth- and fifth-grade teachers in the USA to four multistep fraction word problems, we were able to explore manifestations of teachers’ strategic competence for word problems. Findings indicate that teachers’ strategic competence was closely related to whether they devised a valid strategy. Further, how teachers dealt with known and unknown quantities in their mathematization of word problems was an important indicator of their strategic competence. Teachers with strong strategic competence used algebraic notations or pictorial representations and dealt with unknown quantities more frequently in their solution methods than did teachers with weak strategic competence. The results of this study provide evidence for the critical nature of strategic competence as another dimension needed to understand and describe teachers’ mathematical knowledge.

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Causes and outcomes of open conversion and aneurysm rupture after endovascular abdominal aortic aneurysm repair: can type ii endoleaks be dangerous?11No competing interests declared.

Journal of the American College of Surgeons ◽

10.1016/s1072-7515(01)01128-0 ◽

2002 ◽

Vol 194 (1) ◽

pp. S98-S102 ◽

Cited By ~ 41

Author(s):

Jacob Buth ◽

Peter L Harris ◽

Corine van Marrewijk

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysm Repair ◽

Aneurysm Rupture ◽

Type Ii ◽

Open Conversion ◽

Competing Interests ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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The Effect of a Probiotic Complex on the Gut-Brain Axis: A Translational Study

Neuropsychobiology ◽

10.1159/000518385 ◽

2021 ◽

pp. 1-11

Author(s):

Vincenzo Nobile ◽

Silvana Giardina ◽

Francesco Puoci

Keyword(s):

Gut Microbiota ◽

Sleep Quality ◽

Cognitive Functions ◽

Short Term Memory ◽

Neuronal Cell ◽

Translational Study ◽

Salivary Cortisol Level ◽

Valid Solution ◽

The Right

Background: The gut-brain axis refers to the network of connections that involve multiple biologic systems, allowing bidirectional communication between the gut and the brain. This communication is mainly mediated by gut microbiota, thanks to its ability to modulate several processes like the production of neurotransmitters. As such, keeping a balanced gut microbiota through probiotic intake could be a valid solution in supporting the right gut-brain communications. Methods: A two-step in vitro screening of five different probiotic strains was carried out to select the best performers in the modulation of stress markers. A first selection on SK-N-DZ neuronal cell lines was performed to evaluate the inhibition of the epigenetic enzyme LSD1, promotion of GABA, and expression of serotonin. Three out of five strains were tested for their ability to promote serotonin synthesis in the Caco2 cell line. As a result, Limosilactobacillus reuteri PBS072 and Bifidobacterium breve BB077 were selected as the best performing strains. To confirm their effects in humans, a proof-of-concept trial was carried out to evaluate stress-related parameters for 28 days of product intake in a group of 30 stressed students. Results: A significant improvement of cognitive functions, in terms of short-term memory, attention, and executive performance, as well as of psychophysiological markers, such as salivary cortisol level, skin conductance, sleep quality, and anxiety, were observed. Conclusions: According to the results, L. reuteri PBS072 and B. breve BB077 are potential probiotic candidates for improving stress resilience, cognitive functions, and sleep quality.

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IS THERE STILL A DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY? — AN EXPLORATIVE AND DESCRIPTIVE STUDY TO IDENTIFY RISK FACTORS AND TO ESTABLISH A SCORING SYSTEM FOR DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY.

10.36106/ijsr/6907785 ◽

2021 ◽

pp. 52-54

Author(s):

Suhas Umakanth ◽

Srinath Subbarayappa ◽

Jayanth Bannur Nagaraja

Keyword(s):

Risk Factors ◽

Laparoscopic Cholecystectomy ◽

Gallstone Disease ◽

Descriptive Study ◽

Gastrointestinal Illness ◽

Prospective Analysis ◽

Open Conversion ◽

Patient Demographics ◽

Low Threshold ◽

Distended Gallbladder

Background: Gallstone disease is among the most common gastrointestinal illness requiring hospitalization. Laparoscopic cholecystectomy is now the preferred approach to its treatment. When performing laparoscopic cholecystectomy, the surgeon should have the low threshold for open conversion in case of difculty. The aim of the study was Pre-operative prediction of difcult laparoscopic cholecystectomy using clinical, ultrasonographic and intraoperative parameters. Methods:This study was done on 200 patients presenting with symptomatic cholelithiasis who underwent laparoscopic cholecystectomy. A prospective analysis of parameters including the patient demographics, laboratory values, radiologic data and intraoperative parameters was performed. Results: The factors which were considered a difculty parameter were males, age>60years, preoperative ERCP, rised amylase, sonographic features of contracted or distended gallbladder and pericholecystic collection. Intraoperative parameters were adhesions around gallbladder, contracted or distended gallbladder inamed gallbladder. Conclusions: The above mentioned factors must be adequately studied and the surgeon and the patient should be prepared for difcult laparoscopic cholecystectomy.

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Operative and Postoperative Complications of Laparoscopic Cholecystectomy: Experience from a Tertiary Care Hospital of Bangladesh

Bangladesh Critical Care Journal ◽

10.3329/bccj.v5i1.32536 ◽

2017 ◽

Vol 5 (1) ◽

pp. 11-16 ◽

Cited By ~ 2

Author(s):

Tapash Kumar Maitra ◽

Mahmud Ekram Ullah ◽

Faruquzzaman ◽

Samiran Kumar Mondol

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Complications ◽

Gall Bladder ◽

Acute Cholecystitis ◽

Invasive Technique ◽

Favorable Result ◽

Age Group ◽

Open Conversion ◽

Female Patients ◽

Complications Of Laparoscopic Cholecystectomy

Background: The technique of laparoscopic surgery has rapidly become popular because of its several advantages over conventional open surgery. The reduction of postoperative pain provided positive human impact, and the reduction of length of hospital stay as well as the earlier return to work generated a positive socioeconomic impact. However, in spite of being a minimally invasive technique, this procedure has different peroperative and postoperative complications which cannot be disregarded.Objective: To evaluate the complications of laparoscopic cholecystectomy in symptomatic and asymptomatic cholelithiasis and other benign gall bladder diseases.Methodology: 172 patients who underwent laparoscopic cholecystectomy were included in this prospective study on the basis of non-randomized convenient sampling from a period of September 30, 2014 to September 30, 2016 in BIRDEM General Hospital, Dhaka, Bangladesh. Data of the patients regarding outcomes and complications were analyzed.Result: Results of this study suggests that 35.5% cases were male and 64.5% patients were female. In male group, most of the patients (18.0%) were in 41-50 years of age group followed by 9.9% in 51-60 years age group, whereas among the female patients these were 33.1% and 15.7% respectively. Mean±SD of age were46±1.7 and 42±1.3 years in case of male and female patients respectively.In 119 (69.2%) out of total 172 cases, laparoscopic cholecystectomy was done for chronic cholecystitis and in 18.6% (32 out of total 172) cases, it was performed for acute cholecystitis. Intra-operative bile leak(11.0%) was found to be the most frequent complications during laparoscopic cholecystectomy. The incidence rates of perforation of gall bladder, stone spillage were 9.3% and 5.2% respectively. Trocar site, vascular, and hepatic bed hemorrhages were 7.0%, 4.7% and 4.0% respectively. Open conversion was done in 17 cases (9.9%). Port site infection and post cholecystectomy syndrome developed in 5.2% and 4.7% cases respectively. The overall mortality was approximately 1.1%. Serious complications likebowel injury and bile duct injury were recorded in 0.6% and 1.2% cases respectively.The results of this study suggest that gender, age, co-morbidities, previous abdominal surgery, acute cholecystitis, obesity, thickened gall bladder wall on ultrasound, history of preoperative ERCPare probablyimportant and clinically significant relevant factors for open conversion of laparoscopic cholecystectomy.Conclusion: In our study, complications of laparoscopic cholecystectomy were similar to those of different centres in western countries. We found laparoscopic cholecystectomy as a safe and effective procedure in almost all patients with cholelithiasis. Proper preoperative work up, awareness of possible complications and adequate training on laparoscopic technique make this operation a safe procedure with favorable result and lesser complications.Bangladesh Crit Care J March 2017; 5(1): 11-16

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