scholarly journals Prediction of difficulties during laparoscopic cholecystectomy by preoperative clinical examination and ultrasonography

2017 ◽  
Vol 4 (4) ◽  
pp. 1335 ◽  
Author(s):  
Arun Kumar ◽  
Kunwar Vishal Singh ◽  
Jugendra Pal Singh Shakya ◽  
Sangita Sahu ◽  
Soniya Dhiman ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Clinical Examination ◽  
Conversion Rate ◽  
Open Cholecystectomy ◽  
Gall Stone ◽  
Stone Disease ◽  
Medical College ◽  
Preoperative Ultrasonography ◽  
Gall Stone Disease ◽  
Symptomatic Gall Stone

Background: Cholelithiasis (gall stone disease) is a well-known disease worldwide. Ultrasonography is the most common screening test for cholecystitis and cholelithiasis. Laparoscopic Cholecystectomy is considered the treatment of choice for symptomatic gall stone disease. It is important to know the different clinical, radiological parameter and specific predictor that give some prediction of difficult LC. The aim of this study was to predict the difficulty of LC and the possibility of conversion to OC before surgery using the clinical and ultrasonographic criteria in our set up.Methods: The present study was carried out in the Department of surgery, Sarojini Naidu Medical College Agra, from November 2014 to October 2016.  A total of 210 patients were enrolled for the laparoscopic cholecystectomy. All patients who were included in the study were undergone detailed history and clinical examination. A number of clinical and ultrasonographical parameters were noted.Results: Amongst the 210 patients admitted for laparoscopic cholecystectomy, 21 (10%) were male and 189 (90%) female, with age ranging from 12–60 years.  The conversion rate in our study was 4.5% (9 of 210). In our study significant pre-operative factors which increased the conversion rate to open cholecystectomy includes male gender, obesity, abdominal scar of previous surgery, contracted and thickened gall bladder and patients having stone impacted at the neck of gall bladder.Conclusions: From this study, we conclude that preoperative ultrasonography is a good predictor of difficult laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.

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 Gall Bladder Retrieval through Umbilical versus Epigastric Port in Conventional Four Ports Laparoscopic Cholecystectomy.

2021 ◽  
Vol 28 (10) ◽  
pp. 1407-1412
Author(s):  
Gul e Lala ◽  
Sajid Malik ◽  
Mian Umar Javed ◽  
Kamran Zaib Khan ◽  
Muhammad Tauqeer Aslam
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Gall Stone ◽  
Stone Disease ◽  
Equal Distribution ◽  
Medical College ◽  
Post Operative Pain ◽  
Gall Stone Disease ◽  
Pros And Cons

Introduction: Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gall stone disease all over the world. In laparoscopic cholecystectomy gall bladder is traditionally removed through umbilical port. In this approach surgeon has to change his position and telescope has to be changed in xiphoid port. Another approach to remove the gallbladder is through 10mm xiphoid port without changing position of telescope and surgeon. Both approaches are compared for their pros and cons regarding post-operative pain at site of removal. Study Design: Randomized control study. Setting: Department of surgery of Allama Iqbal medical college/ Jinnah hospital Lahore. Period: August 2017 to February 2018. Material & Methods: To compare mean post-operative pain in gall bladder retrieval through umbilical versus xiphoid port in four ports laparoscopic cholecystectomy for acute cholecystitis. Patient were divided in two equal groups with first group had their gall bladder retrieved through umbilical port while the other underwent retrieval through xiphoid port. Standard analgesia was used in both groups and post-operative outcome was noted. Results: A total 70 patient with equal distribution in two groups were enrolled to compare post-operative pain at port site comparing umbilical versus xiphoid process. Mean post-operative pain visual analogue scale (VAS) was as lower (p<0.0001) at 1, 6, 12 & 24 hrs. In umbilical port group as compared to xiphoid port group. Conclusion: Mean post-operative pain in gall bladder retrieval umbilical port give advantage in post-operative period regarding significantly reduced pain when compared with xiphoid port in four ports laparoscopic cholecystectomy for acute cholecystitis in selective cases.

scholarly journals Evaluation of patients undergoing cholecystectomy with special reference to post-cholecystectomy syndrome

2018 ◽  
Vol 5 (6) ◽  
pp. 2313
Author(s):  
P. S. Khatana ◽  
Jitendra Kumar ◽  
Deepak Kumar Sharma
Keyword(s):  
Open Cholecystectomy ◽  
Gall Stone ◽  
Stone Disease ◽  
New Delhi ◽  
Biliary Disease ◽  
Medical College ◽  
Number Of Patients ◽  
Gall Stone Disease ◽  
The Mean ◽  
Age Range

Background: Significant percentage of patients remain symptomatic even after the cholecystectomy surgery for gall stone disease. Traditionally, this has been termed Post-Cholecystectomy syndrome which may consist of same symptoms for which cholecystectomy was performed or it may be a new set of symptoms that have developed after cholecystectomy. Aim of this study to find out incidence as well as pre-operative, intra-operative and post-operative determinants for the post- cholecystectomy syndrome.Methods: This is the prospective study, done in the Department of Surgery, Dr BSA Medical College and Hospital, New Delhi. Total 102 number of patients were included in this study, out of which 51 patients underwent open and another 51 patients underwent laparoscopic cholecystectomy.Results: The mean age of the patients was 40.29±10.69 years with an age range of 19 to 80 years. Incidence rate of post cholecystectomy symptoms were16.66% (n=17).  Incidence of post-cholecystectomy syndrome in patients who underwent laparoscopic cholecystectomy were 15.69% (n=8) while in the open cholecystectomy group it was 17.64% (n=9). Out of seventeen symptomatic patients, eight (47.05%) were having the biliary disease while nine patients (52.95%) were having non-biliary cause.Conclusions: As authors studied present symptomatic group of patients thoroughly, it has become clear that the post-cholecystectomy symptoms are multiple and diverse arising from various causes; which in reality has no relation with the removal of gall bladder. Hence the appellation ‘post-cholecystectomy syndrome is inappropriate and instead we have used the term ‘Post-Cholecystectomy Symptoms’ for these patients.

scholarly journals A PROSPECTIVE STUDY OF LAPAROSCOPIC CHOLECYSTECTOMY WITH PARTICULAR REFERENCE TO CONVERSION RATE

2020 ◽  
Vol 4 (10) ◽  
Author(s):  
Sunil Kaval ◽  
Piyush Kumar Saini ◽  
Vishal Agarwal ◽  
Anuj Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gold Standard ◽  
Conversion Rate ◽  
Standard Procedure ◽  
Gall Stone ◽  
Stone Disease ◽  
Daily Routine ◽  
Female Ratio ◽  
Early Return ◽  
Gall Stone Disease

Background: Laparoscopic Cholecystectomy is established as the primary procedure for the vast majority of patients with benign gall bladder disease .1st laparoscopic cholecystectomy record in medical literature was performed in March 1987 by Phillip Mouret, in France and in 1992 accepted as new gold standard procedure across world despite of few complications. Aims and Objectives: To determine the causes of conversion of laparoscopic cholecystectomy to open cholecystectomy. Material and methods: From September 2018 to September 2019, total 85 patients were diagnosed as cholelithiasis admitted in respective unit postings of SVBP hospital Meerut and 53 cases selected for study of laparoscopic cholecystectomy. Workup of patients done with proper history, clinical examination, blood investigations and ultrasonography abdomen. Observations and Results: We performed laparoscopic cholecystectomy in 53 cases with male: female ratio of 1:4.9.Conversion  rate was 7.5% .Most common cause of conversion was frozen calot’s with adhesions ,several other factors aid in conversion like age more than 45 years, male gender and acute phase of cholecystitis. Conclusion:  In our study, we found that laparoscopic cholecystectomy when performed in properly selected patients is very much effective in treatment of symptomatic gall stone disease in term of less complication, less duration of operation and anaesthesia related complication ,cost effectiveness ,early return on work and daily routine activity .Thus laparoscopic cholecystectomy is gold standard procedure for gall stone disease despite of few complications and unavoidable conversion. Keywords: Cccl, BMI

scholarly journals An evaluation of open versus laparoscopic cholecystectomy in tertiary centre

2019 ◽  
Vol 6 (8) ◽  
pp. 2797
Author(s):  
Kanwar Singh Goel ◽  
Sapna Goel ◽  
Sham L. Singla ◽  
Pawan Tiwari
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Age Groups ◽  
Stone Disease ◽  
Average Hospital ◽  
Medical College ◽  
Tertiary Centre ◽  
Gall Stone Disease ◽  
Open Versus ◽  
Surgery Department

Background: Cholecystectomy is a method of treatment for acute or chronic cholecystitis with cholelithiasis or any other diseases of gall bladder. The diagnosis of gall stone disease depends on an accurate history, physical examination, supporting lab investigations and a proper ultrasound of abdomen. After the advent of lap cholecystectomy there is revolution in minimally invasive surgery. Because of better technological innovations, the lap cholecystectomy has become gold standard presently.Methods: This prospective observational study was performed in Surgery Department in SGT Medical College, Budhera, Gurugram, over a period of 2 years from January 2017 to January 2019. Patients were taken from both sexes and all age groups from different units of surgery. A total of 100 patients were taken for study who underwent cholecystectomy.Results: Mean age of patients in our study was 38.64 years. Most patients were females. Procedure adopted was open in 18% patients and lap cholecystectomy in 74% patients. Conversion from laparoscopic to open was done in 8% patients. In 8% patients there were operative complications. Average hospital stay was much less for lap cholecystectomy.Conclusions: After the advent of laparoscopic cholecystectomy, most of the surgeons are performing more and more of laparoscopic cholecystectomy. Here incision is small, pain is less, and hospitalization is shorter. Even in acute cholecystitis, in experienced hand, lap cholecystectomy can be performed safely. The author’s inclination is totally in favour of lap cholecystectomy, except the cases where lap cholecystectomy is contraindicated. 

scholarly journals Study of persistent post laparoscopic cholecystectomy symptoms: a 6 month long follow up of 62 patients

2018 ◽  
Vol 5 (10) ◽  
pp. 3368
Author(s):  
Sagar Soitkar ◽  
Divish Saxena ◽  
Nitin Wasnik ◽  
Murtaza Akhtar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Tertiary Care ◽  
Gall Stone ◽  
Stone Disease ◽  
Complete Relief ◽  
Care Hospital ◽  
Psychiatric Illnesses ◽  
Gall Stone Disease ◽  
Symptomatic Gall Stone

Background: Majority of patient undergoing laparoscopic cholecystectomy for symptomatic gall stone disease is either cured or show improvement in their pre-operative symptoms. However, in few patients these preoperative symptoms may still persist and may continue to bother them even after surgery. The aim of this study is to evaluate and manage these patients with persistent post cholecystectomy symptoms.Methods: 62 patients of diagnosed symptomatic cholelithiasis had undergone laparoscopic cholecystectomy at a tertiary care hospital. They were evaluated with a questionnaire both before and; 3 months and 6 months after surgery. The symptoms present pre-operatively and the symptoms that persisted after laparoscopic cholecystectomy or emergence of any new symptoms were taken into consideration.Results: Out of 62 operated patients, 38 patients (61.3%) were relieved of their symptoms after cholecystectomy on follow up after 3 months whereas 24 patients (38.7%) had persistence of their symptoms. However, at 6 months follow up 16 out of these 24 patients showed improvement of their symptoms. Pain in right hypochondrium and non-specific dyspepsia were the commonest symptoms that were persistent. Thus, in this study 54 (87.1%) patients had complete relief after laparoscopic cholecystectomy and were satisfied with the treatment and in 08 (12.90%) patients the symptoms were not relieved.Conclusions: All the patients undergoing laparoscopic cholecystectomy should be evaluated in detail regarding their symptoms, psychiatric illnesses and be investigated thoroughly so as not to miss any other organic cause for their symptoms and should be counseled regarding persistence of their symptoms even after laparoscopic cholecystectomy.

scholarly journals Laparoscopic cholecystectomy for gall stone disease. A single center experience.

2020 ◽  
Vol 27 (09) ◽  
pp. 1983-1988
Author(s):  
Shehzad Ahmad Qamar ◽  
Munawar Jamil ◽  
Kokab Salim
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Demographic Data ◽  
Gall Stone ◽  
Major Complication ◽  
Stone Disease ◽  
Safe Procedure ◽  
Trocar Site ◽  
Single Center Experience ◽  
Gall Stone Disease

Objectives: Laparoscopic cholecystectomy has turned into the gold standard for patients with symptomatic cholelithiasis. But still this procedure is not complication free. Many a time’s laparoscopic cholecystectomy needs to be converted to open cholecystectomy. Study Design: Observational study. Setting: Civil Hospital Bahawalpur. Period: 3 years from July 2015 to June 2018. Material & Methods: Carried out to review the frequency of complications encountered in laparoscopic cholecystectomy by assessing 400 cases of laparoscopic cholecystectomies. Performa was intended to incorporate important demographic data, history of illness, examination and investigations. Results: The major complication of our procedure was bleeding. Bleeding from the trocar site happened in 11 cases (2.75%), vascular damage in the callots triangle in 2 (0.5%) and from liver bed in 19 (4.75%) cases, followed by biliary leak that happened in 20 (5%) cases. Spilled gallstones were seen in 8(2%), Port site infection in 24 (6%) cases. Common bile channel stricture was accounted for in 5 patients, 14 (3.5%) out of 400 patients were converted to open surgery. Mortality was low for our situation I.e. 1 patient. Conclusion: Laparoscopic cholecystectomy is becoming a safe procedure in terms of complications.

scholarly journals Diagnostic value of upper gastrointestinal endoscopy prior to elective laparoscopic cholecystectomy for symptomatic cholelithiasis

2017 ◽  
Vol 5 (1) ◽  
pp. 105
Author(s):  
Indira Khedkar ◽  
Dinesh Prasad ◽  
Achal Datta
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Gastrointestinal Symptoms ◽  
Stone Disease ◽  
P Value ◽  
Upper Gastrointestinal Endoscopy ◽  
Complete Relief ◽  
Gastrointestinal Lesions ◽  
Gall Stone Disease ◽  
Symptomatic Gall Stone

Background: Laparoscopic cholecystectomy is gold standard surgery for symptomatic gall stone disease which is the commonest disease needs surgical management. Present study was conducted to contribute UGI endoscopy as routine preoperative investigation and the importance of UGI endoscopy to evaluate the association between gastrointestinal symptoms with gallstones and reduce the prevalence of post cholecystectomy pain.Methods: Patients with Ultrasonography suggestive of single or multiple gall stones were included and investigated as per proforma. Upper GI Scopy was done 1 to 2 days prior to laparoscopic cholecystectomy as per inclusion and exclusion criteria. All patients above 18years, with ultrasonographically proven diagnosis of cholelithiasis and with symptoms (typical and atypical) were included.Results: In present study, author have evaluated the different OGD pathologies the most common site of pathology was stomach (72.5%) that was gastritis. Followed by oesophagitis (55%), and Hiatus hernia (16.5) The most common duodenal pathology was duodenitis (6.25%). In present study, 71 patients had pain in epigastrium at presentation which gradually subsided with no complains of pain in 3 months. Statistically significant reduction in pain was appraised at the end of first week itself (p-value <0.0001).Conclusions: Certain symptoms associated with gallstones are not alleviated by cholecystectomy itself and requires further exploration, therefore, patients presenting with symptomatic gall stone disease should undergo routine OGD prior to cholecystectomy as many gastrointestinal lesions may coexist which prevents the complete relief of the symptoms after cholecystectomy.

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.

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