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.

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 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 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.

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 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 Association of metabolic syndrome with complicated gall stone disease: our experience

2019 ◽  
Vol 6 (7) ◽  
pp. 2543
Author(s):  
Narender Kumar ◽  
Somendra Bansal ◽  
Shalu Gupta ◽  
Bhanwar Lal Yadav ◽  
Pradeep Verma ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
General Surgery ◽  
Prospective Observational Study ◽  
Gall Stone ◽  
Daily Practice ◽  
Stone Disease ◽  
P Value ◽  
Gall Stone Disease ◽  
Biliary Pathology ◽  
Surgery Department

Background: Gall stone disease is the most common biliary pathology and frequently encountered in our daily practice. Patients with gall stone that experienced at least one attack of acute cholecystitis is defined as complicated gall stone disease (CGSD). Aim of this study was to find out the association between complicated gall stone disease and the metabolic syndrome.Methods: This prospective, observational study was done from 1st March 2017 to 30th November 2018 in department of general surgery, SMS hospital Jaipur. All patients with cholelithiasis admitted in general surgery department were included. Metabolic syndrome was defined by adult treatment panel III (ATP III) criteria. All patients were divided in two groups: complicated gall stone disease (CGSD) and uncomplicated gall stone disease (UGSD).Results: Mean age was 47.2 years in CGSD group and 46.7 year in UGSD group. Female to male ratio was 8.2:1 in CGSD group and 4:1 in UGSD. Metabolic syndrome was presented in 64 patients (58.2%) of CGSD group and 24 patients (21.8%) of UGSD patients, which was statistically significant (OR 4.986, CI 2.763-8.995, p value <0.001). Five components of metabolic syndrome were compared in both CGSD group and UGSD group. Lower serum HDL-C level and hyperglycemias was statistically significant in CGSD group as compared to UGSD group.Conclusions: Metabolic syndrome can be use to predict complicated gall stone disease. Hyperglycaemia and lower HDL-C associated with CGSD. One should be aware about possible metabolic syndrome background when dealing with gall stone disease patients.

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.

Gastrointestinal Diseases in Pregnancy

2020 ◽  
Author(s):  
Jennifer X Cai ◽  
Punyanganie S. de Silva
Keyword(s):  
Reflux Disease ◽  
Treatment Guidelines ◽  
Gastrointestinal Disease ◽  
Gall Stone ◽  
Gastrointestinal Symptoms ◽  
Gastrointestinal Diseases ◽  
Stone Disease ◽  
Gastrointestinal Disorders ◽  
Esophageal Reflux ◽  
Gall Stone Disease

During pregnancy many chronic gastrointestinal disorders can undergo exacerbations. In addition, pregnant women are often susceptible to new gastrointestinal symptoms. The goal of care is to control symptoms, minimize exposure to excessive tests and medications and rule out any urgent need for surgery.  Efforts should be made to minimize risk to mother and fetus when performing diagnostic endoscopic and radiologic tests. In this chapter, we will review the current management of common gastrointestinal disorders during pregnancy, including gastro-esophageal reflux disease, constipation, appendicitis, inflammatory bowel disease and gall stone disease. The safety of medications used to treat gastrointestinal disease will be reviewed and new treatment guidelines and concepts will be discussed. This review contains 5 tables, 4 figures and 55 references. Key words: appendicitis, cholelithiasis, constipation, Crohn’s disease, gall stones, gastrointestinal disease, gastro-esophageal reflux disease, jaundice, pregnancy, ulcerative colitis 

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