scholarly journals A comparative study of laparoscopic cholecystectomy with and without abdominal drain

2018 ◽  
Vol 6 (11) ◽  
pp. 3639
Author(s):  
Udit I. Gadhvi ◽  
Dhaval A. Bhimani ◽  
Jaivik Waghela ◽  
Darshil K. Rajgor
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Fluid Collection ◽  
Gall Stone ◽  
Stone Disease ◽  
Abdominal Drain ◽  
Lower Pain ◽  
Drain Group ◽  
The Difference ◽  
Operative Recovery

Background: Laparoscopic surgery has several advantages when compared to open surgery, including faster post-operative recovery and lower pain scores. Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Routine drainage after laparoscopic cholecystectomy is an issue of considerable debate.Methods: Study was randomized, prospective, observational and longitudinal including 100 patients, selected according to inclusion criteria.Results: The sub hepatic fluid collection on first ultrasound at 24hrs was higher in drained group than in non-drained groups. Further, the difference became insignificant on subsequent ultrasound at 72hrs. Incidence of post-operative drain site pain was present in 25% of patients with drain (more at drain site). Incidence drain site infection was present in 16.6% of patients in drain group. Majority of the patients with drain group (n=24) required hospital stay for ≥3 days, while for majority of patients without drain group (n=20), required hospital stay was 1 day.Conclusions: An uncomplicated gall stone disease can be treated by laparoscopic cholecystectomy without need for drain with reasonable safety by an experienced surgeon. With no usage of drain, it is significantly advantageous in terms of post-operative pain, use of analgesics and hospital stay.

scholarly journals A study on clinical and radiological factors for predicting difficult laparoscopic cholecystectomy preoperatively

2017 ◽  
Vol 4 (9) ◽  
pp. 3015
Author(s):  
Arun Prasath S. ◽  
Surag Kajoor Rathnakar ◽  
Nagaraja Anekal L.
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Open Cholecystectomy ◽  
Fluid Collection ◽  
Gall Stone ◽  
Stone Disease ◽  
Elderly Age ◽  
Conversion To Open Cholecystectomy ◽  
Upper Abdominal ◽  
A Prospective Study

Background: Laparoscopic cholecystectomy considered as the gold standard treatment for symptomatic gall stone disease has 1-13% conversion rate to an open procedure due to various reasons. Present study aims to predict difficult laparoscopic cholecystectomy preoperatively using clinical and sonological factors.Methods: This is a prospective study done on 190 patients who were posted for laparoscopic cholecystectomy from March 2015 to February 2017. Parameters taken into consideration were: age, number of previous attacks of acute cholecystitis, impacted gallstone, thickness of GB wall, pericholecystic fluid collection, history of upper abdominal surgery and obesity. All surgeries were performed by surgeons with minimum ten years of experience on laparoscopic cholecystectomy and ultrasound of the abdomen was performed by senior radiologists with experience of minimum five years.Results: Out of 190 patients, difficulty was experienced in 48 patients of which conversion to open cholecystectomy was needed for 11 patients. Elderly age, multiple attacks of pain abdomen (>2), palpable GB, impacted gallstone, thickness of GB wall >3 mm, peri-GB fluid collection, adhesions due to previous abdominal surgery and obesity were all found to be independent risk factors leading to difficult laparoscopic cholecystectomy.Conclusions: Though there is no definite scoring system to predict difficult LC, there is scope for further refinement to make the same less cumbersome and easier to handle using the above clinical and radiological factors.

scholarly journals Fundus first laparoscopic cholecystectomy in patients with gall stone disease and the Fitz-Hugh-Curtis syndrome

2020 ◽  
Vol 8 (6) ◽  
pp. 2062
Author(s):  
Alexander F. Ale ◽  
Mercy W. Isichei ◽  
Danaan J. Shilong ◽  
Solomon D. Peter ◽  
Andrew H. Shitta ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Gall Stone ◽  
Operating Time ◽  
Stone Disease ◽  
Duration Of Hospital Stay ◽  
Duration Of Surgery ◽  
Gall Stone Disease ◽  
The Mean ◽  
Fitz Hugh Curtis Syndrome

Background: To present this experience using the fundus-first technique during laparoscopic cholecystectomy for the management of symptomatic gall stone disease with an intra-operative finding of Fitz-Hugh-Curtis syndrome.Methods: This is a prospective review of patients who had the fundus-first dissection during laparoscopic cholecystectomy. The study was carried out at the Jos University Teaching Hospital (JUTH), and FOMAS hospital, both of which are tertiary hospitals located in Jos. Patients were recruited from January 2017 - January 2019. All patients undergoing laparoscopic cholecystectomy who had an intraoperative diagnosis of Fitz-Hugh-Curtis syndrome, and who had the fundus-first dissection, were included in the study. Patients who had fundus-first dissection for indications other than Fitz-Hugh-Curtis syndrome, were excluded from the study. Demographic and clinical information of patients included age, sex, duration of surgery, complications, and duration of hospital stay. Descriptive statistics were applied.Results: A total of 76 patients had elective laparoscopic cholecystectomies over the study period. Of that number, 17 (22.4%) patients had an intra- operative diagnosis of Fitz-Hugh-Curtis syndrome, and had the fundus-first dissection. The mean patient age was 46.3 years (SD = 11.7 years). All patients were female. The mean operating time was 70 minutes (SD = 23 minutes). The duration of hospital stay was 24 hours. There was one conversion due to uncontrollable intraoperative bleeding.Conclusions: This study revealed that the fundus-first dissection is suitable for removing the gall bladder during laparoscopic cholecystectomy in patients with gall stone disease, and an intraoperative finding of Fitz-Hugh-Curtis syndrome.

scholarly journals A COMPARATIVE STUDY BETWEEN ROUTINE INSERTIONS OF SUBHEPATIC DRAIN VERSUS NO DRAIN AFTER ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

2020 ◽  
pp. 1-3
Author(s):  
Subhadip Sarkar
Keyword(s):  
Abdominal Pain ◽  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Wound Infection ◽  
Statistical Tests ◽  
Abdominal Drain ◽  
Symptomatic Cholelithiasis ◽  
Standard Laparoscopic Cholecystectomy ◽  
Drain Group ◽  
Operative Wound

Introduction: Laparoscopic cholecystectomy is the mainstay of treatment in symptomatic cholelithiasis. Surgeons are still following the old habit of routine Subhepatic drainage following laparoscopic cholecystectomy (LC). However, routine drainage after LC is still a debatable issue. This study aims at evaluating the effects of Subhepatic drainage after standard laparoscopic cholecystectomy in terms of various post-operative parameters. Materials & methods: The study was conducted at the department of General Surgery, ESIC-PGIMSR, Joka, Kolkata from January 2018 to March 2020. We selected 120 patients with symptomatic cholelithiasis & divided them into 2 groups; each having 60 patients, with drain & without drain respectively. Age & sex distribution of the patients, post-operative abdominal pain & right shoulder tip pain, post-operative wound infection, subhepatic collection (24 & 72 hrs after surgery) & post-surgical hospital stay were measured in both groups. Data were analyzed by appropriate statistical tests. Results: We found the incidence of laparoscopic cholecystectomy was highest in the 5th decade & more common in women. The incidence of post-surgical abdominal pain & subhepatic collection were greater in the group of patients with drain in situ which was statistically significant also. Moreover, inserting drain showed increased incidence of post operative wound infection & hospital stay, though these were statistically insignificant. More patients in the non drain group showed post-operative right shoulder tip pain in comparison to the drain group but that was also statistically insignificant. Conclusion: The decision of inserting drain should be taken judiciously on the basis of individual case scenario. The generalized approach of putting abdominal drain after every standard laparoscopic cholecystectomy is not at all beneficial.

Early experience of laparoscopic cholecystectomy in acutely inflamed gallbladder

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Ali Abdul Hussein Handoz ◽  
Ahmed Kh Alsagban
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gall Stone ◽  
The Elderly ◽  
Stone Disease ◽  
Definitive Treatment ◽  
Adjacent Structures ◽  
Common Causes ◽  
Gall Stone Disease ◽  
Male To Female

Gallstones are now among the most important disease in the era of surgery. Definitive treatment of gall stone disease remains cholecystectomy. One of the common causes of emergency surgical referral is acute cholecystitis of which 50-70% cases are seen in the elderly patients.50 patients were treated with laparoscopic cholecystectomy from October 2013 to October 2015. The patient’s age was from 20 to 65 years old with a mean age of 34 ±3 years old. The patients received in the emergency unit and their attack not more than 72 hrs of acute gall stone inflammation were included in this study.From the 50 patients,15 were males (34%) and females were 35 (74%) so the ratio of 1:2of male to female. Problems and complications that facing in this study at time of laparoscopy were mainly adhesions to the adjacent structures like stomach, colon, and omentum. Adhesion into CBD also considered.Early intervention for acute cholecystitis of calculus type by laparoscopy now regarding safe and gold standard approach that should be kept in mind when dealing with such cases.

scholarly journals Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

2018 ◽  
Vol 9 (4) ◽  
pp. 17-22
Author(s):  
Bikash Chandra Ghosh ◽  
Ambar Gangopadhyay
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Gall Stone ◽  
Low Pressure ◽  
Stone Disease ◽  
Care Hospital ◽  
Significant Difference ◽  
Gall Stone Disease ◽  
Standard Pressure ◽  
Symptomatic Gall Stone

Background: Laparoscopic cholecystectomy (LC), the procedure of choice for symptomatic gall stone disease. An emerging trend is to perform Low pressure pnuemoperitonium laparoscopic surgery as it has additive advantages over standard pressure to avoid complications while providing adequate working space.Aims and Objectives: The current study was designed with an aim to compare the advantage of low pressure pneumoperitoneum vs standard pressure pneumoperitoneum in laparoscopic cholecystectomy.Materials and Methods: The study was conducted in the department of General Surgery in R.G.Kar Medical College from January 2014 to June 2015. A total of 52 patients with symptomatic gall stone disease were recruited, 26 patients in each group randomly. Some intraoperative and post-operative parameters were studied.Results: All the intra-operative (IO) cardio-respiratory parameters (Pulse, Mean Arterial Pressure (MAP), End tidal CO2, spO2) were recorded just before incision, 20 minutes intra-operatively and before reversal of general anesthesia (GA). The IO parameters in our study, were found to be significant only at 20 minutes IO and before reversal of GA. The post-operative (PO) parameters (Pulse, MAP, Respiratory rate, spO2) and pain by VAS score at 6 hours, 12 hours and 24 hours post-operatively were studied. In PO period, we observed significant differences at 2 hours post-operatively in all parameters except MAP. There was significant difference in pain at 6, 12 and 24 hours when compared in both groups. The shoulder tip pain (STP) and 2 hours PO nausea and vomiting were found to be significantly higher in Standard pressure Laparoscopic cholecystectomy (SPLC) compared to Low pressure Laparoscopic cholecystectomy (LPLC). The operative time, duration of hospital stay and return to normal life after surgery though had differences but it was statisticallyinsignificant.Conclusion: Low pressure laparoscopic surgery is safe with least post operative complications when performed by experienced surgeons even in patients of ASA III.Asian Journal of Medical Sciences Vol.9(4) 2018 17-22

scholarly journals Bacteriological analysis of bile in laparoscopic cholecystectomy patients

2018 ◽  
Vol 7 (1) ◽  
pp. 41-44
Author(s):  
Ashok Koirala ◽  
Dipendra Thakur ◽  
Sunit Agrawal ◽  
Abhilasha Sharma
Keyword(s):  
Escherichia Coli ◽  
Laparoscopic Cholecystectomy ◽  
Bacterial Colonization ◽  
Gall Stone ◽  
Age Groups ◽  
Stone Disease ◽  
Klebsiella Species ◽  
Bile Culture ◽  
A Prospective Study ◽  
Preoperative Prophylaxis

Background: Laparoscopic cholecystectomy is commonly performed operation for symptomatic gall stone disease. The presence of stones within the biliary system is associated with the bacterial colonization of the bile. The aim of this study is to evaluate the bacteriological profile of the bile and to determine appropriate antibiotics for preoperative prophylaxis in laparoscopic cholecystectomy patients. Material & Methods: A prospective study was carried out in NMCTH, Biratnagar from June2017- May 2018. A total of 100 patients admitted through OPD of our hospital for laparoscopic cholecystectomy were studied. About 5ml of bile aspirated from gall bladder was transported to laboratory in sterile syringe for culture and sensitivity. All age groups and both sex were included. Results: Bile culture was positive in 16 patients. The most common organisms isolated from bile was Escherichia coli (50%) followed by Klebsiella species (25%). Histopathological report of all 16 cases revealed chronic cholecystitis. Wound infection was seen in 5% cases and all were bile culture positive. Most sensitive drug was found to be aminoglycoside group followed by piperacilin and tazobactam. Conclusion: Most common organism isolated from bile culture was Escherichia coli. Aminoglycoside group of drugs was found to be more promising compared to other group of drugs. It can be considered as a first line drug for preoperative prophylaxis for patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 41-44

scholarly journals A study on laparoscopic cholecystectomy, indications, complications and conversion to open in a tertiary care hospital

2019 ◽  
Vol 6 (11) ◽  
pp. 3942
Author(s):  
N. Chandramouli
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Tertiary Care ◽  
Gall Stone ◽  
Stone Disease ◽  
Care Hospital ◽  
Open Conversion ◽  
Calot’S Triangle ◽  
Institutional Ethics ◽  
Gall Stone Disease ◽  
A Prospective Study

Background: Disease of gall bladder, especially the stones, is one of the most common health problems leading to surgical intervention. Laparoscopic cholecystectomy is the gold standard operation for gall stone disease with a good safety profile. The aim of the study was to discuss the indications, complications encountered and open conversion rate of laparoscopic cholecystectomy in a tertiary care hospital.Methods: It was a prospective study, conducted at Sri Adichunchanagiri Hospital and Research Center, B.G. Nagara, Karnataka after the approval from institutional ethics committee (IEC). This study included 30 patients who presented to the ER or OPD with pain abdomen, from October 2018 to March 2019, and diagnosed to have gall stone disease with or without inflammation. All the patients were worked up as per standard institutional protocol. Patients clinical characteristics, ultrasonogram (USG) findings, surgical management and complications were recorded.Results: Mean age was 41.1±6.06. The indications for cholecystectomy in gall stone disease at our institute during the aforementioned timeline were symptomatic gall stones (60%) and calculus cholecystitis (40%). All underwent laparoscopy and 2 patients were converted to open surgery intra-operatively in view of difficulty in dissection of Calot’s triangle. 3 patients had post-operative complications and treated conservatively.Conclusions: Laparoscopic cholecystectomy is a standardised, efficacious procedure for the treatment of gall stone disease whether symptomatic or infected. Complications are minimal but a thorough knowledge of open procedure is also essential in case of intra-operative conversion.

scholarly journals Evaluation of gall bladder mucosal changes in patients undergoing laparoscopic cholecystectomy

2019 ◽  
Vol 6 (11) ◽  
pp. 4108
Author(s):  
Harpreet Singh ◽  
Roop Kishan Kaul ◽  
Naveen Kumar Singh ◽  
Aviral Gupta ◽  
Vikram Singh Yadav
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Bladder Wall ◽  
Gall Stone ◽  
Granulomatous Inflammation ◽  
Stone Disease ◽  
Research Centre ◽  
Mucosal Response ◽  
Gall Bladder Wall ◽  
Mucosal Changes

Background: Histopathological changes induced by gall stone disease or cholelithiasis are diverse including acute inflammation, chronic inflammation, glandular hyperplasia, granulomatous inflammation, cholesterosis, dysplasia and carcinoma. Hence, this study was planned to assess gallbladder mucosal changes in patients undergoing laparoscopic cholecystectomy (LC) and it’s correlation with number and types of stone.Methods: A total of 50 patients with symptomatic cholelithiasis scheduled to undergo laproscopic cholecystectomy (LC) after written and informed consent from October 2015 to October 2018 at Teerthanker Mahaveer Medical College and Research Centre, Moradabad were followed prospectively. Preoperative biochemical profile and ultrasonography of whole abdomen of all the patients was obtained. LC was done under the hands of the skilled and experienced surgeons. Morphologic profile of gallstones was recorded and analysed. Gallbladder mucosal tissues were sent to general pathology department for analysis. Histopathological typing of all the gallbladder mucosal specimens was done and was correlated with the number and type of gallstones.Results: In majority (76%) cases, cholecystitis was found. Hyperplasia was seen in 10% patients. Cholecystitis with metaplasia in 10 percent of the cases and carcinoma in 2 percent of the cases. While correlating the gallbladder mucosal response with the number and type of stones, non-significant results were obtained.Conclusions: There might be some association between gall bladder mucosal changes and gall stone. We cannot say an etiologic and effective correlation from the results of this study; possible mechanism may be gall stone erodes gall bladder wall constantly over a period of time which may constitute a risk. While correlating gallbladder mucosal response with the number and type of stones, non-significant results were obtained.

scholarly journals Can Laparoscopic Cholecystectomy be a Feasible Standard in a Rural set up too? - An Experience of 348 cases from a Peripheral set up of Western Nepal

2017 ◽  
Vol 13 (2) ◽  
pp. 130-133
Author(s):  
A.L. Shrestha ◽  
P. Shrestha ◽  
D. Brown
Keyword(s):  
Socioeconomic Status ◽  
Laparoscopic Cholecystectomy ◽  
Rural Population ◽  
Gall Stone ◽  
Stone Disease ◽  
Uneventful Recovery ◽  
Conversion To Open Cholecystectomy ◽  
Gall Stone Disease ◽  
Set Up ◽  
The Impact

Background Gall stone disease is a common reason for admissions in both acute and elective situations and bears significant morbidity in the rural population of western Nepal. The earlier conventional open method of treatment for the same seems to have been largely seeded by the laparoscopic approach owing to its numerous benefits.Objective To study the clinical profile of patients with symptomatic gall stones with respect to demography and to assess the feasibility of using Laparoscopic cholecystectomy as the next standard in this set up too as guided by the outcome in terms of complications, conversion rates and potential impact it bears on the health and socioeconomic status in this group.Method A retrospective analysis of all the patients undergoing an attempted laparoscopic cholecystectomy from 1st Jestha 2068 to 30th Jestha 2070 was done. Relevant medical records were reviewed to study demography, various indications for operations, intra operative events including conversions and complications.Result Of 348 patients 293(84.19%) were females and 55(15.80%) were males. The mean age was 38.46 years (range 15-76 years). Most of the patients belonged to the Palpa district of Lumbini zone and many were from other surrounding areas. Gall stone disease was commonest in people of Brahmin ethnicity. The operating time was <2 hours for most and most had an uneventful recovery with a mean hospital stay of 3.8 days. The rate of conversion to open cholecystectomy was 6.9% (24 out of 348 patients). Post operative complications were noted in 5 patients (1.42%). Of these 1 sustained a major bile duct injury (0.28%) requiring immediate conversion and repair, 3 had post operative bilioma and 1 had diffuse bleeding from the gall bladder fossa all requiring re explorations. There was no mortality in this study.Conclusion Laparoscopic cholecystectomy is a safe, reliable and a promising option even in the rural peripheral set up. Due to its well known advantages and superiority over the open conventional method and considering the impact that it holds on the overall outcome, morbidity, health and socioeconomic status of the rural population, it can be recommended as an acceptable feasible standard in rural peripheral set up.

scholarly journals The Impact of Patient-Controlled Analgesia on Laparoscopic Cholecystectomy

2007 ◽  
Vol 89 (4) ◽  
pp. 374-378 ◽  
Author(s):  
S Sinha ◽  
V Munikrishnan ◽  
J Montgomery ◽  
SJ Mitchell
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Pain Management ◽  
Stone Disease ◽  
Patient Controlled Analgesia ◽  
Open Operation ◽  
Symptomatic Gallstones ◽  
Elective Laparoscopic Cholecystectomy ◽  
The Impact

INTRODUCTION Laparoscopic cholecystectomy has revolutionised the management of symptomatic gallstones and is increasingly performed as a day-case procedure. The aim of this study was to assess the impact of opioid patient-controlled analgesia (PCA) on elective laparoscopic cholecystectomy. PATIENTS AND METHODS In a prospective, non-randomised, observational study, 76 consecutive patients who underwent elective in-patient laparoscopic cholecystectomy were reviewed. Six patients with complicated gall stone disease and four patients who converted from laparoscopic to an open operation were excluded. RESULTS Of the 66 remaining in the study group, 25 patients received morphine-PCA and, of these, 9 were fit for discharge. In contrast, 41 patients did not receive PCA and, of these, 27 were fit for discharge (P < 0.05). Median Aldrete score in the PCA group was 16 and in the non-PCA group 18 (P < 0.05). Postoperative nausea and vomiting were more common in patients receiving a morphine-based PCA and with in those with higher anti-emetic requirement (10/25 in PCA and 7/41 non-PCA groups; P < 0.05). CONCLUSIONS Routine postoperative opioid PCA prolongs the recovery and in-patient stay following elective laparoscopic cholecystectomy. Its role in postoperative pain management in routine laparoscopic cholecystectomy should be questioned.

Sign in / Sign up

Export Citation Format

Share Document