scholarly journals OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH GALLSTONE DISEASE AT A SECONDARY LEVEL CARE HOSPITAL

2018 ◽  
Vol 31 (1) ◽  
Author(s):  
Ahmed TAKI-ELDIN ◽  
Abd-Elnaser BADAWY
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Care Hospital ◽  
Biliary Leakage ◽  
Port Site Hernia ◽  
Conversion To Open Cholecystectomy ◽  
Secondary Hospital

ABSTRACT Background: Laparoscopic cholecystectomy is the most commonly performed operation of the digestive tract. )It is considered as the gold standard treatment for cholelithiasis. Aim: To evaluate the outcome of it regarding length of hospital stay, complications, morbidity and mortality at a secondary hospital. Methods: Data of 492 patients who underwent laparoscopic cholecystectomy were retrospectively reviewed. Patients’ demographics, co-morbid diseases, previous abdominal surgery, conversion to open cholecystectomy, operative time, intra and postoperative complications, and hospital stay were collected and analyzed from patients’ files. Results: Out of 492 patients, 386 (78.5%) were females and 106 (21.5%) males. The mean age of the patients was 49.35±8.68 years. Mean operative time was 65.94±11.52 min. Twenty-four cases (4.9%) were converted to open surgery, four due to obscure anatomy (0.8%), 11 due to difficult dissection in Calot’s triangle (2.2%) and nine by bleeding (1.8%). Twelve (2.4%) cases had biliary leakage, seven (1.4%) due to partial tear in common bile duct, the other five due to slipped cystic duct stables. Mean hospital stay was 2.6±1.5 days. Twenty-one (4.3%) developed wound infection. Port site hernia was detected in nine (1.8%) patients. There was no cases of bowel injury or spilled gallstones. There was no mortality recorded in this series. Conclusions: Laparoscopic cholecystectomy is a safe and effective line for management of gallstone disease that can be performed with acceptable morbidity at a secondary hospital.

scholarly journals Rate and Risk Factors for Conversion and Complications of Laparoscopic Cholecystectomy.

2018 ◽  
Vol 27 (2) ◽  
pp. 58-62
Author(s):  
MM Sarker ◽  
MK Sarker ◽  
NA Perveen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conversion Rate ◽  
Open Cholecystectomy ◽  
Preoperative Assessment ◽  
Biliary Leakage ◽  
College Hospital ◽  
Excessive Bleeding ◽  
Port Site Hernia ◽  
Conversion To Open Cholecystectomy ◽  
Operative Complications

Laparoscopic Cholecystectomy has become the gold standard for the surgical treatment of gall bladder disease, but conversion to open cholecystectomy and both operative and post operative complications are still inevitable in certain cases. Knowledge of the rate and impact of the underlying reasons for conversion and complications could help surgeons during preoperative assessment and improve the informed consent of patients. In this study we retrospectively evaluated the rate and reasons for conversion and assessed complications of our laparoscopic cholecystectomy series. We included data of 720 consecutive patients who were attempted to laparoscopic cholecystectomy between January 2008 to March 2014 at Islami Bank Medical College Hospital, Rajshahi. The study included 468 (65%) female and 252 (35%) male with mean age of 38 years (range 16-78 years). Conversion to open procedure was carried out in 58 patients with conversion rate of 8.05%. Dense and extensive adhesions were the most common reasons for conversion (21, 36. 2%). The conversion rate due to operative complications was 13.8% of all converted cases. The major operative complications were extrahepatic bile ducts injuries 2(0.3%), duodenal injury 1(0.1%), excessive bleeding 10(1.4%). The incidence of postoperative complications was 2.8%. The most common post-operative complication was wound infection (11, 1. 52%) followed by biliary leakage in 4(0.55%) patients. Delayed complications seen in our series is port site hernia (1,0.13%). Laparoscopic cholecystectomy is the preferred method even in difficult cases. Conversion from laparoscopic to open cholecystectomy should be based on the sound clinical judgment of the surgeon and not be due to a lack of individual expertiseTAJ 2014; 27(2): 58-62

scholarly journals Cost Effective Cholecystectemy in A Rural Tertiary Care Hospital

2017 ◽  
Vol 7 (1) ◽  
pp. 20-22
Author(s):  
Md Shahinur Rahman ◽  
SM Rezaul Islam ◽  
Kamal Pasha ◽  
Md Rashed Alam Chowdhury ◽  
Debabrata Paul ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Cost Effective ◽  
Care Hospital ◽  
Total Cost ◽  
Medical College ◽  
Significant Difference

Background: Laparoscopic cholecystectomy is an accepted alternative to open cholecystectomy. This study was aimed to compare the results of laparoscopic and open cholecystectomy with respect to duration of operation, complications, hospital stay and cost.Materials and Methods: This was a prospective type of study. 200 patients of gallstone disease were randomly selected. 100 patients underwent laparoscopic cholecystectomy and 100 underwent open cholecystectomy from July 2014 to June 2015 in surgery units of Jahurul Islam Medical College Hospital. Data regarding age, sex, operation time, complications, hospital stay and total cost were collected from patient and from hospital record. Then we compared the data of laparoscopic and open cholecystectomy.Results: We found that mean operating time for laparoscopic cholecystectomy was 45 minutes and for open cholecystectomy was 60 minutes.There is no significant difference in incidence of complications between open and laparoscopic procedure. In our study, mean postoperative hospital stay for laparoscopic surgery was 3.5 days and in open cholecystectomy was 6 days. In this study total cost of laparoscopic surgery is less than open surgery though operation team charge is more in laparoscopic surgery.Conclusion: Laparoscopic cholecystectomy is a safe and cost effective alternative to open cholecystectomy.Anwer Khan Modern Medical College Journal Vol. 7, No. 1: Jan 2016, P 20-22

scholarly journals SURGICAL AUDIT - LAPAROSCOPIC CHOLECYSTECTOMY IN A FREE CAMP AT PRIVATE SECTOR HOSPITAL

2020 ◽  
Vol 11 (2) ◽  
pp. 16-20
Author(s):  
Dr. Abdul Ghani Soomro
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Port Site ◽  
Bladder Injury ◽  
Safe Procedure ◽  
Trocar Site ◽  
Port Site Hernia ◽  
Surgical Audit

BACKGROUND & OBJECTIVE: Laparoscopic Cholecystectomy is usual method for the treatment of gall bladder stone disease and is practiced all over the world due to many benefits like fasten the recovery time. Furthermore, it reduced the post-operative pain and period of hospital stay. To conduct Surgical Audit and evaluate safety of Laparoscopic cholecystectomy. METHODOLGY: This prospective study was conducted in a private hospital at Hyderabad during free camps of Laparoscopic Cholecystectomy. Four camps were arranged in 2016 - 2019. Total number of 190 patients  underwent Laparoscopic Cholecystectomy during the study period. The patient's age falls between 12–65 years. A detailed history, relevant investigation and Cardiac fitness were evaluated. All patients underwent four ports Lap-Chole. Data was collected assessed and audit was performed and safety was evaluated. RESULTS: Total 190 patients operated females 88.45% and males 11.55%. 115 (60.50%)were in  the range of 30-35 years followed by 55 (28.95%)patients in the range of 40-50 years.8 (4.20%) patients were converted to open cholecystectomy, 4 due to bleeding from liver bed, 3 patients due to difficult dissection in calots triangle and 1 due to Empyema of gall bladder.10 patients (5.50%) had Trocar site bleeding, 10 patients (5.50%) had gall bladder injury, in 4 cases had spillage of stones and 72 patients (38.50%) developed umbilical port site infection 1 patient develop port site hernia. No mortality was recorded in this study. CONCLUSION: Our Surgical Audit proves that Laparoscopic Cholecystectomy is a safe procedure on the basis of only 4.2% intra operative and 5.5% postoperative complications and gaining wide spread popularity among our population due to less pain, less hospital stay. We recommend other private hospitals to extent such services to our poor population with symptomatic cholelithiasis.

scholarly journals Laparoscopic cholecystectomy: a prospective cohort study assessing the impact of grade of operating surgeon on operative time and 30-day morbidity

2018 ◽  
Vol 100 (3) ◽  
pp. 178-184 ◽  
Author(s):  
H Tafazal ◽  
P Spreadborough ◽  
D Zakai ◽  
N Shastri-Hurst ◽  
S Ayaani ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Cohort Study ◽  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Operative Time ◽  
Gallstone Disease ◽  
Surgical Trainees ◽  
The Impact

Introduction There is an increasing trend towards day case surgery for uncomplicated gallstone disease. The challenges of maximising training opportunities are well recognised by surgical trainees and the need to demonstrate timely progression of competencies is essential. Laparoscopic cholecystectomy provides the potential for excellent trainee learning opportunities. Our study builds upon previous work by assessing whether measures of outcome are still affected when cases are stratified based on procedural difficulty. Material and methods A prospective cohort study of all laparoscopic cholecystectomies conducted at a district general hospital between 2009 and 2014, performed under the care of a single consultant. The operative difficulty was determined using the Cuschieri classification. The primary endpoint was duration of operation. Secondary endpoints included length of hospital stay, delayed discharge rate and 30-day morbidity. Results A total of 266 laparoscopic cholecystectomies were performed during the study period. Mean operative time for all consultant-led cases was 52.5 minutes compared with 51.4 minutes for trainees (P = 0.67 unpaired t-test). When cases were stratified for difficulty, consultant-led cases were on average 5 minutes faster. Median duration of hospital stay was equivalent in both groups and there was no statistical difference in re-attendance (12.9% vs. 15.3% P = 0.59) or re-admission rates (3.2% vs. 8.1% P = 0.10) at 30 days. Conclusions Our study provides evidence that laparoscopic cholecystectomy provides a good training opportunity for surgical trainees without being detrimental to patient outcome. We recommend that, in selected patients, under consultant supervision, laparoscopic cholecystectomy can be performed primarily by the surgical trainee without impacting on patient outcome or theatre scheduling.

scholarly journals Laparoscopic Cholecystectomy for Acute Gallbladder Disease During Index Admission- 11 the Optimum Timing for Surgery

2013 ◽  
Vol 16 (1) ◽  
pp. 11-17
Author(s):  
Md Ibrahim Siddique ◽  
Md Atiar Rahman ◽  
Md Shahadot Hossain Sheikh ◽  
Khander Manzoor Murshed ◽  
Samia Mubin ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Index Admission ◽  
Laparoscopic Procedure ◽  
Complication Rates ◽  
Financial Benefit ◽  
Conversion To Open Cholecystectomy

Background: Laparoscopic cholecystectomy, initially considered a contraindication for the treatment of acute gallbladder disease, is now being practiced for treating acute cholecystitis worldwide. The purpose of the study is to evaluate the outcome of laparoscopic procedure in the management of acute gallbladder disease during the index admission in terms of safety and feasibility, hospital stay and the rates of complications and conversion to open cholecystectomy. Methods: Between January 2009 to December 2011, 174 patients (103 female, 71 male) with median age 43.5 years (range 27-73 years) with the diagnosis of acute gallbladder disease underwent laparoscopic cholecystectomy. Diagnosis of acute cholecystitis was made from history, physical findings and ultrasound evidence of acute inflammatory changes. Results: Median time from onset of symptoms to surgery was 70 hours. Median operative time was 76.5 minutes. Conversion rate was 1.7%. Minor post-operative complications occurred in 13.5% cases of laparoscopic procedure, which did not require further intervention. Median post-operative hospital stay was 2.5 days and total length of hospital stay was median 4.4 days. There was no mortality. Conclusion: In expert hands laparoscopic cholecystectomy for acute gallbladder disease during the index admission is safe with better clinical results, shorter hospital stay and an acceptable conversion and complication rates with additional financial benefit to the patients. DOI: http://dx.doi.org/10.3329/jss.v16i1.14442 Journal of Surgical Sciences (2012) Vol. 16 (1) : 11-17

scholarly journals Port site hernia: Minor but severe complication of laparoscopic cholecystectomy.

2020 ◽  
Vol 27 (08) ◽  
pp. 1717-1721
Author(s):  
Ehsanullah Malik ◽  
Sania Bhatti ◽  
Muharram Ali Abbasi ◽  
Yasmeen Bhatti ◽  
Abdul Sattar Abro ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
College Teaching ◽  
Port Site ◽  
Care Hospital ◽  
Site Infection ◽  
Case Series Study ◽  
Port Site Hernia ◽  
Duration Of Surgery ◽  
The Mean

Laparoscopic cholecystectomy is a gold standard procedure for the management of patients with cholelithiasis with fewer complications but still port site hernia is one of the severe complications if not treated properly may lead adverse result. This usually results from improper closure or infection of the musculoaponeurotic layers of the abdominal wall. The frequency of port site hernia is variable in literature and its association with infection and other co-morbidities is less explored. Objectives: To determine the frequency of port-site hernia after laparoscopic cholecystectomy at a tertiary care hospital Larkana and its association with infection and co-morbidities. Study Design: Descriptive Case Series study. Setting: Department of Surgery, Chandka Medical College Teaching Hospital, Larkana. Period: December 2018 to December 2019. Material & Methods: One hundred forty-eight patients undergoing elective laparoscopic cholecystectomies, who fulfilled the inclusion criteria and gave informed consent were selected for this study. All the patients were followed for 6 months. Data was recorded for age, gender, BMI, smoking and diabetes mellitus status. Infection and port site hernia were observed during the follow-up period. The SPSS version 21 was used for data analysis. Results: The majority of the patients 79 (53.4%) were above the age of 35 years. The mean age of the patients was 40.14 ±11.40 years. Females were younger than males. Among them 19 (12.8%) were males compared to 129 (87.2%) females. Mean BMI (kg/m2) of male patients were 25.98±3.53 and female patients were 24.80±3.04. The mean duration of surgery was 63.72 (+18.20) minutes, mostly accomplished is within 80mins (54.1%).  Out of 148 patients in 5 (3.4%) patients port site hernia was observed. In all these patients wound to get infected and surgery was for a prolonged period. A significant association has been found between port site hernia, operative time and port site infection. However, no significant association has been found between port site hernia and gender, age, smoking and Diabetes (P>0.05). Conclusion: The frequency of port site hernia is low but could be disastrous if the bowel gets obstructed. Using good technique and reducing operative time are effective measures in reducing the port site infection and the port site hernia.

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.

DOES EARLY LAPAROSCOPIC CHOLECYSTECTOMY AFTER ERCP OFFERS SIGNIFICANT BENEFIT IN SURGICAL OUTCOME? A COMPARATIVE STUDY BETWEEN EARLY AND LATE GROUPS

2021 ◽  
pp. 59-61
Author(s):  
Anshul Mathur ◽  
Ketan Patel ◽  
Jitendra Kumar Mangtani ◽  
K.K. Dangayach
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Endoscopic Retrograde ◽  
Endoscopic Retrograde Cholangiopancreaticography ◽  
Early Laparoscopic Cholecystectomy ◽  
Conversion Rates ◽  
Group A ◽  
Group B

Introduction:- Endoscopic retrograde cholangiopancreaticography (ERCP) prior to Laparoscopic Cholecystectomy(LC) is most commonly practiced strategy worldwide for management of co-existing cholelithiasis with choledocholithiasis. The time interval between Endoscopic Retrograde Cholangiopancreaticography (ERCP) and Laparoscopic cholecystectomy (LC) is questionable and varies from 1 day to 6 weeks in different studies. Aims and objectives:- To compare two groups of patients managed with laparoscopic cholecystectomy (after ERCP), EARLY(24 to 72 hours), and LATE(> 6weeks) in terms of mean operative time in minutes, intraoperative difculties, conversion rates to open cholecystectomy, conversion rates to open cholecystectomy, drain insertion required or not, postoperative complications, and duration of hospital stay. Materials and methods:- A prospective randomized comparative study was conducted on 70 patients who presented with concomitant cholelithiasis with choledocholithiasis over a period of January 2019 to June 2020 at the Department of General Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur. After ERCP and stone retrieval patients were randomised into 2 groups using sealed envelope method. Group A underwent early laparoscopic cholecystectomy (24 to 72hours) and Group B underwent late laparoscopic cholecystectomy (after 6 weeks). Data collected, statistical analysis done, results and observations concluded. Result:- We found that mean operative time, intraoperative difculties, post operative complications and mean hospital stay in days were signicantly higher in Group B as compared to Group A. Though the conversion rates to open procedure and requirement of drain insertion were comparatively higher in Group B but were found to be statistically non signicant. Conclusion:- We hereby conclude that early laparoscopic cholecystectomy (24 to 72 hours) after Endoscopic Retrograde Cholangiopancreaticography (ERCP) is better as compared to late laparoscopic cholecystectomy (>6 weeks) after ERCP in patients of cholelithiasis with coexisting choledocholithiasis. So, we recommend performing early Laparoscopic Cholecystectomy (24-72hours) after Endoscopic Retrograde Cholangiopancreaticography (ERCP)

RETROSPECTIVE STUDY ON OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN THE ELDERLY AT JSS HOSPITAL, MYSURU

2021 ◽  
pp. 34-35
Author(s):  
Sudhir S. ◽  
Deepak Naik P ◽  
Deepak R. Sridhar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
The Elderly ◽  
Age Group ◽  
Elderly Age ◽  
Duration Of Hospital Stay ◽  
Wide Range ◽  
Conversion To Open Cholecystectomy ◽  
Duration Of Surgery

(a) Laparoscopic cholecystectomy is a widely performed surgery in India and across the world for a wide range of indications. It is one of the most commonly performed surgeries, and hence a study based on outcomes of Laparoscopic cholecystectomy in the elderly would go a long way in determining the safety and success of Laparoscopic cholecystectomy in the elderly, and could help in timing surgery more effectively to avoid complications and difculties. (b) Materials and methods: Out of 250 patients who underwent Laparoscopic Cholecystectomy at JSS Hospital in the period starting January 2019 onwards who were selected by randomization, 65 patients t the criteria (age > 60 years) while 185 patients were aged <60. Data regarding comorbidities, duration of surgery, duration of hospital stay, conversion to open cholecystectomy was compiled and studied. (c) Results: A signicant number of the patients in the elderly age group had associated comorbidities. Duration of surgery was prolonged by a mean duration of 9.5 minutes in the elderly. Duration of hospital stay was increased by a mean of 2.2 days in the elderly. Incidence of conversion to open cholecystectomy was also higher in the elderly. (d) Conclusions: Laparoscopic cholecystectomy is a relatively safe and easy surgery with few complications. However, one may experience difculties while operating on the elderly, viz. Adhesions, contracted gall bladder with hepatic adhesions etc., Which may result in longer duration of surgery and higher rates of conversion to open cholecystectomy.

scholarly journals The Predictive Factors Associated with Longer Operative Time in Single-Incision Laparoscopic Cholecystectomy

2021 ◽  
Vol 73 (10) ◽  
pp. 672-679
Author(s):  
Weerayut Thowprasert ◽  
Saritphat Orrapin
Keyword(s):  
Abdominal Pain ◽  
Laparoscopic Cholecystectomy ◽  
Predictive Factors ◽  
Operative Time ◽  
Single Incision ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
University Hospital ◽  
Factors Associated ◽  
Conversion To Open Cholecystectomy

Objective: The difficult laparoscopic cholecystectomy (LC) is defined as the presence of one of the followingconditions including prolonged operative time, conversion to open cholecystectomy or significant blood loss. Atpresent, there is no evidence of predictive factors related to longer operative time in single-incision laparoscopiccholecystectomy (SILC). The aim of this study is to determine predictive factors associated with longer operativetime in SILC procedure.Materials and Methods: A retrospective study was conducted of patients with benign gallbladder disease whounderwent SILC in Thammasat University Hospital between October 2014 and December 2020. Patients’ recordswere reviewed. Primary outcomes were preoperative predictive factors associated with DSLC. Secondary outcomeswere perioperative and 3-month postoperative adverse outcomes.Results: 592 SILC procedures were categorized as 80 DSLC and 512 non-difficult SILC (NDSLC). The median(interquartile range) of operative time in all SILC procedure is 48 (38, 62) minutes. The threshold of operative timeof difficult SILC was 72 minutes. The multivariate analysis indicated 5 significant predictive factors. Obesity (bodymass index > 25 kg/m2)) and abdominal pain reflected the difficulty of SILC procedures (p = 0.041 and p = 0.009).Calcified gallbladder showed the highest RR of 14.08 (p = 0.011). Contracted gallbladder and chronic cholecystitiswere also predictive factors with RR of 13.79 and 3.64, respectively (p < 0.001 and p = 0.007).Conclusion: Obesity, abdominal pain, chronic cholecystitis, contracted gallbladder and calcified gallbladder werepreoperative predictive factors. Surgeons should perform the SILC procedure carefully when predictive factors areidentified.

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