A comparative study of open cholecystectomy and laparoscopic cholecystectomy in patients with cholelithiasis

Background: Cholelithiasis is a major cause of morbidity among Indians with a female preponderance. Most of the cases of gallstones are asymptomatic. For a long time, open cholecystectomy (OC) used to be the surgical treatment for cholelithiasis. But with the advent of laparoscopic cholecystectomy (LC) there has been a gradual shift in the treatment with most surgeons preferring LC over OC. Apart from the benefits of decreased hospital stay, lesser postoperative pain and earlier return to normal activity LC are also cosmetically better as compared to OC. Longer operative time and increased incidence of biliary leakage are some pitfalls of LC in initial phase of surgical practice.Methods: A prospective study of 100 patients was carried out in the department of surgery in IQ city medical college and Durgapur city hospital, Durgapur between January 2017 and August 2017 with the aim of comparing open cholecystectomy with laparoscopic cholecystectomy. The patients were randomly assigned into two groups. Group A consisted of patients who underwent laparoscopic surgery while Group B patients underwent open surgery for cholelithiasis.Results: Duration of surgery was longer in OC than LC (72.4min versus 44.7min.). Mean duration of post-operative pain was 18.3hrs in group A as compared to mean duration of 30.7hrs in group B patients. The mean period of post-operative hospital stay was 1.8 days in group A and 4.8 days in group B. Post-operative resumption of normal diet was possible in 2.1 days in OC while it took lesser time (1.2 days) in LC. The rate of surgical site infection was higher in OC as compared to LC.Conclusions: Laparoscopic cholecystectomy can be recommended as first choice operative treatment for patients with cholelithiasis as it provides better cosmetic results, lesser pain, lesser post-operative hospital stay and fewer incidence of surgical site infection.

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Frequency of port site infection following gall bladder removal through Epigastric vs Umbilical port.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.03.6309 ◽

2021 ◽

Vol 28 (03) ◽

pp. 277-281

Author(s):

Bushra Shaikh ◽

Imamuddin Baloch ◽

Azhar Ali Shah ◽

Abdul Sami Mirani ◽

Parkash Lal Lund ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Wound Infection ◽

Port Site ◽

Site Infection ◽

College Hospital ◽

Medical College ◽

Duration Of Surgery ◽

Group A ◽

Group B

Objective: To compare the frequency of port site wound infection following gall bladder removal through umbilical and epigastric port in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Surgical Unit 2, Ghulam Muhammad Mahar Medical College, hospital Sukkur. Period: 1st November 2019 to 30th October 2020. Material & Methods: All cases who underwent four port laparoscopic cholecystectomy were enrolled in two groups. All procedures were performed under general anesthesia. As the last event of surgery gall bladder was retrieved in a glove bag through umbilical port in group A and through epigastric port in group B, both under direct camera vision. Wound infection was considered if there was 3 to 5 grade of wound according to Southampton wound grading system (Figure-1) on 5th postoperative day. All demographics and outcome variables were recorded. Results: Age ranged from 20 to 60 years with mean age of 38.875±8.11 years, BMI 29.973±5.12 Kg/m2, duration of surgery 50.656±8.41 mins and Southampton score was 1.044±1.07 in Group A and mean age of 38.560±6.23 years, BMI 27.437±5.04 Kg/m2, duration of surgery 48.920±8.67 mins and Southampton score was 0.856±0.92 in Group B. In group A, 18 (5.7%)patients developed port site wound infection in contrast to 5 (1.6%) patients in group B (P= 0.006). Conclusion: We conclude that epigastric port retrieval of gall bladder following laparoscopic cholecystectomy results in less port site infection.

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

10.36106/ijsr/3225443 ◽

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)

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A prospective study in peritonitis patients to compare the impact of subcutaneous negative suction closure, conventional primary closure of skin and subcutaneous tissue and open skin technique following laparotomy

International Surgery Journal ◽

10.18203/2349-2902.isj20194068 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3293

Author(s):

Mano Zac Mathews ◽

Sriram Gopalakrishnaiah Subramanyam ◽

Nivedita Mitta

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Abdominal Wall ◽

Subcutaneous Tissue ◽

Site Infection ◽

Abdominal Wall Closure ◽

Suction Drain ◽

Group A ◽

Group B ◽

Negative Suction

Background: Abdominal wall closure in the presence of sepsis presents a challenge to the surgeon. The objective of this study is to determine the advantages and disadvantages of each method to individualise the techniques based on patient profile about surgical site infection, duration of hospitalisation and morbidity.Methods: A prospective comparative study was conducted among 102 operated patients of peritonitis in the Department of General Surgery at St John’s Medical College and Hospital. The patients were divided into three groups, group A, group B and group C. In group A, skin and subcutaneous tissue was closed after draining the subcutaneous space by a negative-suction drain. In group B, the patient’s skin and subcutaneous tissues were closed primarily with continuous sutures without negative suction drain. In group C, the laparotomy wound was closed and the skin was left open. And the outcome compared in the form of wound infection, hospital stay and morbidity. Patients on immunosuppressive therapy and paediatric patients were excluded. Demographic and clinical variables were recorded at the time of admission. SPSS version 18 was used for analysis.Results: The study showed male preponderance and the mean age was 43.2 years. Duodenal perforation was the commonest cause of peritonitis in this study (38.2%). Incidence of surgical site infection was less in Group A (20.6%) compared to group B (52.9%) and group C (29.4%). Duration of hospital stay was also less in Group A patients (9.3±3.6 days) compared to other two groups. 37 patients who were included in the study were diabetic, out of which 25 patients (67.6%) developed surgical site infection.Conclusions: It can be concluded from this study that abdominal wall closure using a sub cutaneous negative suction drain in peritonitis cases reduces the incidence of surgical site infection, duration of hospital stays, subsequent surgeries related to wound dehiscence and its associated morbidity.

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Evaluation of superiority of preemptive analgesia with instillation of 0.5% bupivacaine before rather than after surgery for laparoscopic cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20191875 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1589

Author(s):

Manoj A. Vasava ◽

Jay M. Makadia

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Visceral Pain ◽

Randomized Study ◽

Length Of Hospital Stay ◽

Preemptive Analgesia ◽

Muscular Tissue ◽

Duration Of Surgery ◽

Group A ◽

Group B

Background: The objective of the study was to evaluate the superiority of preemptive analgesia with instillation of 0.5% bupivacaine before rather than after surgery for laparoscopic cholecystectomy.Methods: A prospective, randomized study of 264 patients in whom laparoscopic Cholecystectomy (LC) was conducted in the department of General Surgery at the SSG and Medical College Baroda during a period of 25 months from October 2010 to October 2012. Randomization was done with prepared close enveloped which randomly allocate the patient in either group A or B. Data collected from each patient were: age, sex, ASA score, hospital stay, duration of surgery, no of trocar used, first request for analgesics, vomiting, duration of surgery, intraperitoneal drain was kept or not , length of hospital stay, any other postoperative complication.Results: During the period of 24 months total 264 patients were undergone cholecystectomy. On comparison between Group A and B, data shows that the mean VAS is less at all assessment (4, 8 & 24 hrs) for Group A as compared to Group B. Mean parietal pain score VAS is less for Group B as compared to Group A at all assessments.Conclusions: Use of bupivacaine in optimal dose in GB bed reduced the visceral pain and use in skin, SC tissue, muscular tissue reduced the parietal pain. Use of bupivacaine before GB removal is much more cost effective than after removal of GB.

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Comparison of Frequency of Surgical Site Infection with or without Bile Spillage during Laparoscopic Cholecystectomy

10.53350/pjmhs211561449 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1449-1452

Author(s):

M. Asif ◽

L. A. Deokah ◽

R. N. Malik

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Site Infection ◽

Controlled Trial ◽

Operational Definition ◽

Study Group ◽

Site Infection ◽

Group A ◽

Group B ◽

Bile Spillage

Aim: To compare the frequency of surgical site infection with or without bile spillage during Laparoscopic Cholecystectomy. Methods: This randomized controlled trial was conducted at Department of Surgery, M. Islam Medical and Dental College Gujranwala from March 2020 to September 2020 over the period of 6 months. Total 68 pppatients of acute cholecystitis (as per operational definition) undergoing laparoscopic cholecystectomy either male or female having age from 20 60 years with duration of gal stone (single or multiple) ≥ 6 months were selected. After 2 weeks follow-up, surgical site infection was assed. Results: Mean age of the patients was 39.90 ± 12.04, mean age of patients of study group A was and B was 38.88 ± 13.01 and 40.91 ± 11.08 years respectively. Comparison of frequency of surgical site infection was done between both groups. In study group A (spillage group), SSI was found in 12 (35.29%) patients while in study group B (without spillage group), SSI was noted in 4 (11.76%) patients. Difference of frequency of SSI between the study group A and B was statistically significant (P = 0.022). Conclusion: Results of present study showed that surgical site infection is mostly occurred in patients with spillage of bile during Laparoscopic Cholecystectomy. Most of the patients were belonged to 3rd and 4th decade of life. Significantly higher rate of surgical site infection was noted in female patients of spillage of bile group. Keywords: Bile spillage, Laparoscopic Cholecystectomy, gall bladder, surgical site infection

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Prophylactic Antibiotics in Elective Laparoscopic Cholecystectomy is it Necessary?

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v16i2.24866 ◽

2018 ◽

Vol 16 (2) ◽

pp. 16-18

Author(s):

Anup Sharma ◽

Arun Shah

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Dose ◽

Surgical Site Infection ◽

Prophylactic Antibiotic ◽

Prophylactic Antibiotics ◽

Site Infection ◽

Medical College ◽

Group A ◽

Elective Laparoscopic Cholecystectomy ◽

Group B

Background: Elective laparoscopic cholecystectomy (LC) has a low risk for Surgical Site Infection (SSI). In spite many surgeons still use prophylactic antibiotics. The aim of this study was to find out the need of prophylactic antibiotics in elective LC. Method: This study was carried out from 2017 June to 2018 August in the Department of Surgery Nepalgunj Medical College and Teaching Hospital Kohalpur (NGMC). Patients were placed into two groups. Group A received a single dose of prophylactic antibiotic and group B patients did not receive any prophylactic antibiotic. In both groups the SSI were recorded and compared. Results: Overall SSI was 5(3.33%) among 150. In group A 2 (2.66%) patients had SSI and in group B 3 (4%) had SSI. Using or not using prophylactic antibiotics did not correlate with SSI (p= .154). Conclusions: Prophylactic antibiotic is not recommended in elective LC. Prophylactic antibiotic does not reduce the rate of SSI.

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Comparing SSI In Purse-String Versus Conventional Primary Closure Following Stoma Reversal

Esculapio ◽

10.51273/esc21.251713 ◽

2021 ◽

Vol 17 (1) ◽

pp. 15-19

Author(s):

Sabih Nofal ◽

Anum Arif ◽

Ahsan Khan ◽

Sundus Saif ◽

Abdul Waheed Khan ◽

...

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Primary Closure ◽

Length Of Hospital Stay ◽

P Value ◽

Site Infection ◽

Purse String ◽

Stoma Reversal ◽

Group A ◽

Group B

Objective: To compare the frequency of Surgical Site Infection ( SSI ) and mean length of hospital stay between the Purse-string closure and conventional primary closure techniques for stoma reversal. Methods: The study was carried out in Surgical Unit-III, Lahore General Hospital Lahore from January 5, 2018 to July 5, 2018. The study designed as a Observational Study. Patients undergoing surgery for Ileostomy were randomly divided into two groups, Group-A (Purse-string closure) and Group-B (Conventional primary closure). All the patients were called for follow up checkup on 14th days after operation and after one month. Both of the groups were checked and recorded for SSI after operation and hospital stay. The data was statistically analyzed by using SPSS v23.0.t test (independent sample) used for the comparison of hospital stay mean. Chi-square was also used for the comparison of the frequencies of SSI. Data were stratified for gender and age. A p-value ≤0.05 was considered as significant. Results: A total of 140 patients were enrolled for this study. Patients were divided into two groups i.e. Group- A (Purse-string closure) and Group-B (Conventional primary closure). In group-A, mean duration of hospital stay was 5.7±1.0 days, while 7.3±1.1 days in group-B, which is statistically significant with a p-value of 0.000. In group-A, surgical site infection was in 4(5.7%) patients, while 11(15.7%) patients of group-B, which is statistically significant with a p-value of 0.046. Conclusion: The frequency of surgical site infection and mean length of hospital stay after stoma reversal, purse-string suturing technique is significantly less than conventional primary closure technique. Key Words: Surgical stoma; Ileostomy; Closure; Infection. How to cite: Nofal S., Arif A., Khan A., Saif. S., Khan W.A., Arif A. Comparing SSI in Purse-String Versus Conventional Primary Closure Following Stoma Reversal. Esculapio 2021; 17(01): 15-19

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Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study

Galician Medical Journal ◽

10.21802/gmj.2020.4.3 ◽

2020 ◽

Vol 27 (4) ◽

pp. E202043

Author(s):

Aamir Hussain Hela ◽

Haseeb Mohammad Khandwaw ◽

Rahul Kumar ◽

Mir Adnan Samad

Keyword(s):

Laparoscopic Cholecystectomy ◽

Retrospective Study ◽

Bile Duct ◽

Surgical Site Infection ◽

Tertiary Care Hospital ◽

Open Cholecystectomy ◽

Tertiary Care ◽

Care Hospital ◽

Site Infection ◽

The Mean

Introduction: Laparoscopic cholecystectomy is the most commonly performed surgical procedure of digestive tract. It has replaced open cholecystectomy as gold standard treatment for cholelithiasis and inflammation of gallbladder. It is estimated that approximately 90% of cholecystectomies in the United States are performed using a laparoscopic approach. The aim of this study was to evaluate the outcome of Laparoscopic cholecystectomy in context to its complications, morbidity and mortality in a tertiary care hospital. Methods: This retrospective study was conducted on 1200 patients, who underwent laparoscopic cholecystectomies, during the period from January 2019 to December 2019, at Government Medical College Jammu J & K, India and necessary data was collected and reviewed. Results: In our study, a total of 1200 patients were studied including 216 males (18%) and 984 females (82%). The mean age of the patients was 43.35±8.61. The mean operative time in our study was 55.5±10.60 minutes with range of 45 – 90 minutes. Conversion rate was 2.6%. 2 patients were re-explored. Bile duct injury was found in 6 patients (0.5%). Conclusions: Gallstone disease is a global health problem. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first choice of treatment for gallstones. Gall stone diseases is most frequently encountered in female population. The risk factors for conversion to open cholecystectomy include male gender, previous abdominal surgery, acute cholecystitis, dense adhesions and fibrosis in Calot’ s triangle, anatomical variations, advanced age, comorbidity, obesity, suspicion of common bile duct stones, jaundice, and decreased surgeon experience. The incidence of surgical site infection has significantly decreased in laparoscopic cholecystectomy compared to open cholecystectomy. In our study we could not find any case of surgical site infection.

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Comparison of Early and Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

Annals of Punjab Medical College ◽

10.29054/apmc/2021.1099 ◽

2021 ◽

Vol 15 (1) ◽

pp. 91-94

Author(s):

Muhammad Nasir ◽

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Open Cholecystectomy ◽

Early Laparoscopic Cholecystectomy ◽

Female Patients ◽

Delayed Laparoscopic Cholecystectomy ◽

Conversion To Open Cholecystectomy ◽

Group A ◽

Male Patients ◽

Group B

Background: Laparoscopic Cholecystectomy is now accepted as being safe for acute cholecystitis. However, it has not become routine, because the exact timing and approach to the surgical management remains ill define. Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe Laparoscopic Cholecystectomy. Objective: To compare the early and delayed Laparoscopic Cholecystectomy in the acute phase in terms of frequency of conversion to open cholecystectomy. Study Design: Randomized clinical trial. Settings: Department of Surgery, Divisional Headquarter Hospital, Faisalabad. Punjab Medical College, Faisalabad Pakistan. Duration: Study was carried out over a period of six months from June 2018 to May 2019. Methodology: A total of 152 cases (76 cases in each group) were included in this study. All patients were randomly allocated to either group i.e., group -A early Laparoscopic Cholecystectomy and group-B delayed Laparoscopic Cholecystectomy. Results: Mean age was 39.09 + 8.8 and 37.05+ 8.5 years in group- A and B, respectively. In group-A, male patients were 48 (63.2%) and female patients were 28 (36.8%). Similarly, in group-B, male patients were 41 (53.9%) and female patients were 35 (46.1%). Conversion to open cholecystectomy was required in 6 patients (7.9%) of group-A and 16 patients (21.0%) of group – B. Significant difference between two groups was observed (P= 0.021). Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible in terms of less frequency of conversion to open cholecystectomy.

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Intra-incisional versus intravenous route of antibiotic administration in preventing surgical site infections: a randomized controlled trial

International Surgery Journal ◽

10.18203/2349-2902.isj20181126 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1438

Author(s):

Aditya N. Patil ◽

Veerendra M. Uppin

Keyword(s):

Single Dose ◽

Surgical Site Infection ◽

Tertiary Care ◽

Surgical Site Infections ◽

Intravenous Route ◽

Antibiotic Administration ◽

Site Infection ◽

Open Appendicectomy ◽

Group A ◽

Group B

Background: Surgical site infection (SSI) is one of the most common postoperative complications following abdominal surgeries. Whilst the use of prophylactic antibiotics has been shown to reduce postoperative wound infection, controversy still remains as to the optimum route of administration and the duration of treatment. This study aims to compare the efficacy of a preoperative single dose of a cephalosporin antibiotic (cefotaxime) administered intraincisionally versus that administered intravenously, in preventing postoperative surgical site infections following appendicectomy.Methods: Sixty consecutive cases diagnosed as uncomplicated appendicitis who consented for open appendicectomy at a tertiary care institute were included in the study. Cases were randomized to 2 comparable groups of 30 patients each. Preoperatively, patients in Group A received a single dose of Inj. Cefotaxime 1g intraincisionally while those in Group B received the same intravenously. Incision sites were examined every alternative day starting on postoperative day 3 until removal of sutures. Signs of surgical site infection, if any, were recorded and outcomes were statistically tested for significance.Results: One patient in Group A (3.3%) and 4 patients in Group B (13.3%) showed signs of postoperative surgical site infection (p >0.05) during the follow up period which prolonged their hospital stay.Conclusions: This study showed that a single dose preoperative intraincisional administration of cefotaxime was as effective as intravenous administration for prevention of postoperative surgical site infection after open appendicectomy. Although the difference was not statistically significant, there was a reduced incidence of SSI in individuals who received intraincisional antibiotic. These results are encouraging for a way forward in reducing unnecessary burdening of systemic antibiotics in patients undergoing abdominal surgeries.

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