Late open conversion due to countinous sac enlargement

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.

Download Full-text

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.

Download Full-text

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

Download Full-text

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.

Download Full-text

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

Download Full-text

Late open conversion after endovascular abdominal aortic aneurysm repair

Journal of Vascular Surgery ◽

10.1016/j.jvs.2015.02.019 ◽

2015 ◽

Vol 61 (5) ◽

pp. 1350-1356 ◽

Cited By ~ 45

Author(s):

George Kouvelos ◽

Andreas Koutsoumpelis ◽

Andreas Lazaris ◽

Miltiadis Matsagkas

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysm Repair ◽

Open Conversion ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Download Full-text

Open Conversion for Failed Endovascular Repair With Sac Expansion: A Mini-Series

Annals of Vascular Surgery ◽

10.1016/j.avsg.2018.07.011 ◽

2018 ◽

Vol 52 ◽

pp. 5-7

Author(s):

Michele L. Taubman ◽

Abilio A. Coello ◽

Howard E. Katzman ◽

Ignacio Rua ◽

Anthanassios I. Tsoukas ◽

...

Keyword(s):

Endovascular Repair ◽

Open Conversion

Download Full-text

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.

Download Full-text

Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2021213 ◽

2021 ◽

Vol 50 (10) ◽

pp. 742-750

Author(s):

Brian K Goh ◽

Zhongkai Wang ◽

Ye-Xin Koh ◽

Kai-Inn Lim

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Abdominal Surgery ◽

Laparoscopic Liver Resection ◽

Conversion Rate ◽

Perioperative Outcomes ◽

Transfusion Rate ◽

Open Conversion ◽

Previous Abdominal Surgery ◽

Surgeon Experience

ABSTRACT Introduction: The introduction of laparoscopic surgery has changed abdominal surgery. We evaluated the evolution and changing trends associated with adoption of laparoscopic liver resection (LLR) and the experience of a surgeon without prior LLR experience. Methods: A retrospective review of 310 patients who underwent LLR performed by a single surgeon from 2011 to 2020 was conducted. Exclusion criteria were patients who underwent laparoscopic liver surgeries such as excision biopsy, local ablation, drainage of abscesses and deroofing of liver cysts. There were 300 cases and the cohort was divided into 5 groups of 60 patients. Results: There were 288 patients who underwent a totally minimally invasive approach, including 28 robotic-assisted procedures. Open conversion occurred for 13 (4.3%) patients; the conversion rate decreased significantly from 10% in the initial period to 3.3% subsequently. There were 83 (27.7%) major resections and 131 (43.7%) resections were performed for tumours in the difficult posterosuperior location. There were 152 (50.7%) patients with previous abdominal surgery, including 52 (17.3%) repeat liver resections for recurrent tumours, and 60 patients had other concomitant operations. According to the Iwate criteria, 135 (44.7%) were graded as high/expert difficulty. Major morbidity (>grade 3a) occurred in 12 (4.0%) patients and there was no 30-day mortality. Comparison across the 5 patient groups demonstrated a significant trend towards older patients, higher American Society of Anesthesiologists (ASA) score, increasing frequency of LLR with previous abdominal surgery, increasing frequency of portal hypertension and huge tumours, decreasing blood loss and decreasing transfusion rate across the study period. Surgeon experience (≤60 cases) and Institut Mutualiste Montsouris (IMM) high grade resections were independent predictors of open conversion. Open conversion was associated with worse perioperative outcomes such as increased blood loss, transfusion rate, morbidity and length of stay. Conclusion: LLR can be safely adopted for resections of all difficulty grades, including major resections and for tumours located in the difficult posterosuperior segments, with a low open conversion rate. Keywords: Laparoscopic hepatectomy, laparoscopic liver resection, robotic hepatectomy, robotic liver resection, Singapore

Download Full-text