scholarly journals Optimal timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography

2017 ◽  
Vol 4 (10) ◽  
pp. 3504 ◽  
Author(s):  
Rasmiranjan Sahoo ◽  
Debasish Samal ◽  
A. Pradhan ◽  
Rima Sultana ◽  
Nabakishore Nayak ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conversion Rate ◽  
Open Cholecystectomy ◽  
Secondary Outcome ◽  
Optimal Timing ◽  
Endoscopic Retrograde ◽  
Early Laparoscopic Cholecystectomy ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Background: Nowadays in patients with cholelithiasis with choledocholithiasis, the ideal treatment is endoscopic retrograde cholangiopancreatographic (ERCP) removal of duct stone and laparoscopic cholecystectomy. But when to do and whether we can do it simultaneously or one after another and what interval should be there, that is always controversial. The purpose was an optimal gap for cholecystectomy after ERCP.Methods: We have done a comparison study in 60 patients within a duration of 2 year who had already done ERCP. Group 1, those patients who had laparoscopic cholecystectomy within 72 hours compared with group 2 who had laparoscopic cholecystectomy after an interval of 6 week. Primary outcome was the conversion rate from lap to open cholecystectomy. Secondary outcome was duration of operation, intra-operative difficulties, postoperative morbidity and hospital stay.Results: Of 60 consecutive patients 30 were in group I and 30 were in group II. There is no difference in demographics, laboratory or ultrasonographic findings. The hospital stays in group I is significantly shorter than group II and conversion rate; operative time is higher in group II. No statistically significant difference in post-operative morbidity between both groups.Conclusions: Early laparoscopic cholecystectomy within 72 hr is better than interval (6 week) cholecystectomy after ERCP with shorter hospital stay and less intraoperative difficulties.

scholarly journals Clinical Impact of Preoperative Relief of Jaundice Following Endoscopic Retrograde Cholangiopancreatography on Determining Optimal Timing of Laparoscopic Cholecystectomy in Patients with Cholangitis

2021 ◽  
Vol 10 (19) ◽  
pp. 4297
Author(s):  
Kyu-Hyun Paik ◽  
Yoon Suk Lee ◽  
Won-Suk Park ◽  
Yong Chan Shin ◽  
Woo Hyun Paik
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Conversion Rate ◽  
Open Cholecystectomy ◽  
Optimal Timing ◽  
Endoscopic Retrograde ◽  
Perioperative Morbidity ◽  
Group 1

Background: About 10% of patients with gallbladder (GB) stones also have concurrent common bile duct (CBD) stones. Laparoscopic cholecystectomy (LC) after removal of CBD stones using endoscopic retrograde cholangiopancreatography (ERCP) is the most widely used method for treating coexisting gallbladder and common bile duct stones. We evaluated the optimal timing of LC after ERCP according to clinical factors, focusing on preoperative relief of jaundice. Methods: A total of 281 patients who underwent elective LC after ERCP because of choledocholithiasis and cholecystolithiasis from January 2010 to April 2018 were retrospectively reviewed. We compared the hospital stay, perioperative morbidity, and rate of surgical conversion to open cholecystectomy according to the relief of jaundice before surgery. These enrolled patients were divided into two groups: relief of jaundice before surgery (group 1, n = 125) or not (group 2, n = 156). Results: The initial total bilirubin level was higher in group 1; however, there were no significant differences in the other baseline characteristics including age, sex, American Society of Anesthesiologists score, previous surgical history, white blood cell count, C-reactive protein, and operative time between the two groups. There was also no significant difference in postoperative hospital stay between the two groups (4.5 ± 3.3 vs. 5.5 ± 5.6 days, p = 0.087). However, after ERCP, the waiting time until LC was significantly longer in group 1 (5.0 ± 4.9 vs. 3.5 ± 2.4 days, p < 0.001). There were no statistical differences in the conversion rate (3.2% vs. 3.8%, p = 0.518) or perioperative morbidity (4.0% vs. 5.8%, p = 0.348), either. Conclusions: LC would not be delayed until the relief of jaundice after ERCP since there were no significant differences in perioperative morbidity or surgical conversion rate to open cholecystectomy. Early LC after ERCP may be feasible and safe in patients with cholangitis and cholecystolithiasis.

scholarly journals Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yunxiao Lyu ◽  
Ting Li ◽  
Bin Wang ◽  
Yunxiao Cheng
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Medical Costs ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Group Ii

AbstractThere is no consensus on the optimal timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute cholecystitis (AC). We retrospectively evaluated patients who underwent LC after PTGBD between 1 February 2016 and 1 February 2020. We divided patients into three groups according to the interval time between PTGBD and LC as follows: Group I (within 1 week), (Group II, 1 week to 1 month), and Group III (> 1 month) and analyzed patients’ perioperative outcomes. We enrolled 100 patients in this study (Group I, n = 22; Group II, n = 30; Group III, n = 48). We found no significant difference between the groups regarding patients’ baseline characteristics and no significant difference regarding operation time and estimated blood loss (p = 0.69, p = 0.26, respectively). The incidence of conversion to open cholecystectomy was similar in the three groups (p = 0.37), and we found no significant difference regarding postoperative complications (p = 0.987). Group I had shorter total hospital stays and medical costs (p = 0.005, p < 0.001, respectively) vs Group II and Group III. Early LC within 1 week after PTGBD is safe and effective, with comparable intraoperative outcomes, postoperative complications, and conversion rates to open cholecystectomy. Furthermore, early LC could decrease postoperative length of hospital stay and medical costs.

scholarly journals Assessment of Outcome of Intrathecal Analgesia in Multiparous Women Undergoing Vaginal Delivery

2020 ◽  
Vol 5 (1) ◽  
pp. 153-155
Author(s):  
Sanjay Melville Masih ◽  
Rakesh Kumar Gupta
Keyword(s):  
Vaginal Delivery ◽  
Group Iv ◽  
Normal Vaginal Delivery ◽  
Secondary Outcome ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Multiparous Women ◽  
Group Ii ◽  
Intrathecal Analgesia

Background: The present study was conducted to assess the outcome of intrathecal analgesia in multiparous women undergoing vaginal delivery. Subjects and Methods: The present study was conducted among 80 multiparous women ages ranged 18- 40 years. All patients received 0.5 ml of intrathecal injection of 2.5 mg bupivacaine 0.5% and 1 ml dexamethasone 4 mg plus a 0.5 ml adjuvant. The adjuvants in group I patients were 100 μg morphine, 25 μg fentanyl in group II, 5 μg dexmedetomidine in group III and normal saline in group IV (control group). The primary and secondary outcome was the duration of pain relief, the analgesia onset time, the maximum level of sensory block, the visual analogue scale (VAS) was recorded. Results: The mean duration of analgesia in group I was 182.4 minutes, in group II was 170.5 minutes, in group III was 200.4 minutes and in group, IV was 140.2 minutes. The onset of analgesia was 3.9 minutes, 2.8 minutes, 2.7 minutes and 4.5 minutes in group I, II, III and IV respectively. S1 sensory regression time (minutes) was 181.4, 157.4, 185.3 and 130.6 in group I, II, III and IV respectively. Modified Bromage scale 5 minutes, 15 minutes and 30 minutes after IT in all groups was 0.0. VAS was 1.3, 1.6, 1.6 and 3.1 with significant differences in all groups (P< 0.05). There was non- significant difference in mean age, weight, height and gestational age between all groups (P> 0.05). There was a non- significant difference in APGAR 1, 5, umbilical pH immediately after delivery, neonatal HR after 5minute, 15 minutes and 30 minutes in all groups (P> 0.05). Conclusion: The authors found that dexmedetomidine is a safe and effective adjuvant to intrathecal bupivacaine-dexamethasone in multiparous women undergoing normal vaginal delivery.

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)

scholarly journals Role of scoring system in prediction of difficult laparoscopic cholecystectomy

2017 ◽  
Vol 5 (1) ◽  
pp. 257
Author(s):  
Delie Rhezhii ◽  
Vikas Goyal ◽  
Nitin Nagpal ◽  
Shobhit Kumar Nemma ◽  
Monica Gupta
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Scoring System ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Scoring Systems ◽  
Gall Stones ◽  
Group I ◽  
Conversion To Open Cholecystectomy ◽  
Group Ii

Background: One of the most common reasons for admission to hospital is cholecystectomy and it has a mortality rate of 0.45% to 6%. Many risk factors have been found to be associated laparoscopic cholecystectomy that make it difficult like advance age, male gender, fever, obesity, previous abdominal surgeries, thick gall bladder lining, distention of bladder, presence of gall stones. There have been different scoring systems in literature that determine the risk of conversion to open cholecystectomy. The aim of present study is to determine the role of scoring system in predicting difficult laparoscopic surgery.Methods: The present prospective study was conducted for a period of 1 year in the Department of Surgery at Guru Gobind Singh Medical College, Faridkot, Punjab. The study included all the patients with symptomatic gall stones reporting to the OPD of the hospital. Patients were categorized into two groups after the surgery. Group I included patients who underwent successfully laparoscopic cholecystectomy and group II included those who were converted into an open case. In this study all the entities were provided with a score. Patients with score less than 4 were grouped as difficult. At the end of the study all the data were analyzed to see how scoring system can predict which patients will have easy or difficult laparoscopic cholecystectomy based on postoperative scoring. All the data was recorded in a tabulated form and analyzed using SPSS software.Results: The present prospective analytical study involved 112 subjects; out of these 94 were males and 18 females. The mean age of subjects was 48.2±3.7 years. There were 98 patients in Group I and 8 patients in group II who had didn’t show presence of peri cholecystic fluid. There was 1 patient in Group I and 5 patients in group II who had peri cholecystic fluid on ultrasound. There were 104 subjects with gall was thickness less than 4 mm. There were 95 patients in Group I and 9 patients in group II who had who had who had bladder wall thickness of less than 4 mm.Conclusions: The scoring tool evaluated in our study is useful in evaluating the risk of conversion of laparoscopic cholecystectomy into open cholecystectomy.

scholarly journals Is it Safe to Perform Laparoscopic Cholecystectomy for Acute Calculus Cholecystitis within 7 Days Following Symptom Onset?

2018 ◽  
Vol 56 (214) ◽  
pp. 945-948 ◽  
Author(s):  
Rajesh Poudel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Symptom Onset ◽  
Conversion Rate ◽  
Bivariate Analysis ◽  
Safe Procedure ◽  
Cross Sectional ◽  
Early Laparoscopic Cholecystectomy ◽  
Significant Difference ◽  
Duration Of Surgery

Introduction: Although operation within “golden 72 hours” from the onset of symptoms has been suggested for acute calculus cholecystitis, such early surgery is hardly possible in clinical practice because of variable timing of presentation. The aim of this study is to compare the outcomes of patients undergoing laparoscopic cholecystectomy within 72 hours of symptom onset with patients undergoing surgery after 72 hours up to 7 days of symptom onset for acute calculus cholecystitis.Methods: This is a descriptive cross-sectional study carried out from November 2016 to July 2018. Patients with acute calculus cholecystitis were divided in two groups according to the onset of symptoms. Main outcomes measured were conversion rate, duration of surgery, length of hospital stay and intraoperative complications.Results: Total 64 patients were evaluated. Among which 18 (28.1%) underwent surgery within 72 hours of onset of symptom. Around 46 (71.9%) underwent surgery after 72 hours of symptom onset. On bivariate analysis there were no significant differences in mean duration of surgery, hospital stay and conversion to open surgery between two groups. Conclusions: Early laparoscopic cholecystectomy is a safe procedure when done within 7 days of symptom onset. There were no significant difference in conversion rate, operative time, hospital stay, morbidity and mortality.

scholarly journals Chyawanprash for the prevention of COVID-19 infection among healthcare workers: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Arun Gupta ◽  
Amit Madan ◽  
Babita Yadav ◽  
Pallavi Mundada ◽  
Richa Singhal ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Healthcare Workers ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Rt Pcr ◽  
Randomized Controlled ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Significant Change

AbstractBackgroundCoronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are at high risk of exposure, the standard of care is personal protection from getting infected. Whether Ayurvedic rasayana drug like Chyawanprash can prevent symptomatic infection in frontline health care workers is unknown.ObjectiveTo evaluate the effect of the combination of Chyawanprash and Standard Preventive Regimen compared to the use of Standard Preventive Regimen alone on the proportion of RT-PCR confirmed COVID-19 infections among frontline healthcare workers (HCWs).MethodsAn open-label randomized controlled trial was conducted in the HCWs between 25 to 60 years age currently working in an environment with chance of direct exposure to COVID-19 cases. The interventions to be compared in this trial were Standard Preventive Regimen as per institutional guidelines and based on their roles (Group I) and Ayurvedic Intervention viz., Chyawanprash 12 g twice for 30 days from day of randomization plus Standard Preventive Regimen (Group II). The incidence of RT PCR confirmed COVID-19 cases in both groups, was the primary outcome measure. Evaluation of the safety of the study drug (by any statistically significant change in various biochemical and hematological parameters and occurrence of any adverse drug reactions); incidence of any other infective diseases (bacterial /viral/ fungal / etc.) like upper respiratory tract illness during the study period and any change in the immunoglobulins like IgG, IgM and IgE and inflammatory markers like TNF alpha, IL-6 and IL-10 were the secondary outcome measures.ResultsOut of 193 participants who completed the study, no participant in both groups was COVID-19 positive at the end of one month. In post intervention follow-up, 4 subjects in Group I and 2 subjects in Group II were COVID-19 positive. No adverse drug reaction or any serious adverse event was reported during the study. No clinically significant change in the safety parameters was observed before and after the study. Statistically significant rise in Serum IgG level was seen in Group II but other inflammatory and immune markers did not show statistically significant difference.ConclusionChyawanprash was well tolerated by all the participants in the intervention group but to prove its adaptogenic effect and efficacy as an add-on to the standard care in preventing the occurrence of COVID-19, clinical trial for longer duration with larger sample size is needed.Trial registrationClinical Trials Registry of India vide CTRI/2020/05/025275 dated 20/05/2020Date of IEC approval19.5.2020

scholarly journals A comparative study between laparoscopic and open cholecystectomy in cases of cholecystitis with cholelithiasis: one year experience in tertiary care center

2017 ◽  
Vol 4 (3) ◽  
pp. 903 ◽  
Author(s):  
Ashutosh Shukla ◽  
Sharad Seth ◽  
Alok Ranjan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Blood Loss ◽  
Open Cholecystectomy ◽  
Care Center ◽  
Tertiary Care ◽  
Gall Stone ◽  
Treatment Strategies ◽  
Group I ◽  
Duration Of Surgery ◽  
Group Ii

Background: Gall stones are a major cause of morbidity all over the world. Until the end of 1980’s, open cholecystectomy was the gold standard for treatment of stones in the gall bladder. Laparoscopy has revolutionized surgery causing a re-evaluation of treatment strategies including cholecystectomy, however, it is not completely devoid of pitfalls. This study was undertaken to determine whether laparoscopic cholecystectomy can be recommended over open cholecystectomy as the procedure of choice for the treatment of cholecystitis with cholelithiasis.Methods: This study included a total of 100 patients in the age group 20-70 years diagnosed as calculous cholecystitis on ultrasonography and admitted to the surgical wards of Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India between November 2014 to October 2015. They were divided into two groups. Group I (n = 50) who underwent laparoscopic cholecystectomy and Group II (n = 50) who underwent open cholecystectomy.Results: A comparison of the two groups showed that the duration of surgery was significantly more in Group I (mean 52.32 minutes) as compared to Group II (mean 37.66 minutes) (p <0.001). There was <100 ml blood loss in the majority of Group I cases (94%), however, in Group II, majority had blood loss ≥100 ml (96%) (p <0.001). Mean duration of post-operative pain was 14.68 hours in group I and 27.92 hours in group II (p <0.001). Time taken to restoration of oral feeds, was less in group I (mean 11.68 hours) as compared to group II (mean 17.24 hours). Post-operative hospital stay was a mean of 1.18±0.52 days in Group I and a mean of 4.78±1.42 days in Group II (p<0.001). The time taken for resumption of normal activity was two days and three days (p <0.001) in group I and II respectively. In Group I, average cost of treatment was rupees 10870, but in Group II it was significantly more at rupees 12152 (p = 0.007).Conclusions: Laparoscopic cholecystectomy as a surgical procedure can be recommended over open cholecystectomy in carefully selected patients of gall stone disease.

scholarly journals Impact of hemodialysis on the wellbeing of chronic kidney diseases patients: a pre-post analysis

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Um-e-Kalsoom ◽  
Sabiha Khan ◽  
Israr Ahmad
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Perceived Social Support ◽  
Kidney Diseases ◽  
Chronic Kidney Diseases ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
The Impact

Abstract Background Hemodialysis may have serious psychological impact upon patients suffering from chronic kidney diseases. The aim of the present study is to investigate the impact of hemodialysis on the wellbeing of individuals with chronic kidney diseases (CKD). Result A sample consists of (N = 100) CKD patients referred from neurology ward of Leady Reading Hospital Peshawar. Data was collected from both male (50%) and female (50%) in 2017. Participants were divided into two groups on the basis of pre-set criteria. In group I, individuals with 4–5 stage of CKD referred first time for dialysis treatment were recruited. Group II comprised of CKD patients with 1–3 stage. Demographic data sheet, Pakistan Anxiety and Depression, WHO Quality of Life scale, and Perceived Social support scale (PSS) were used to test the hypotheses. Paired sample t test was use to see the difference between pre- and post-analysis of depression, anxiety, QOL, and PSS in group I (experimental group). Results suggests significant difference on depression (p > .001), anxiety (p > .001), and QOL (p > .001), while no significant difference was reported on perceived social support (p <.673). Findings also indicate no significant difference between group I and group II on QOL depression, anxiety, and PSS. Conclusion The findings concluded that patients under hemodialysis treatment suffered from depression, anxiety, and poor quality of life.

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