Preoperative predictors of a difficult laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy (LC), the gold standard of treatment of gallstone disease, is a widely performed surgery, but it can become a challenge to complete at times. Aim of present study was to find out the possible preoperative features in a gallstone disease patient that predispose him to having a difficult LC. Methods: All cases of gallstone disease undergoing LC at a tertiary care hospital were studied over one year. Patients with jaundice, abnormal liver function tests, concomitant common bile duct stones, ongoing acute cholecystitis or concurrent gallstone pancreatitis were excluded. Various preoperative clinical, laboratory and ultrasound parameters were studied to see their correlation with different aspects of difficult LC.Results: 166 patients were studied with age ranging from 10-80 years, maximum incidence (36.14%) being in the age group 35-50 years. The time taken for LC increased significantly with increasing age. 70.48% were females but gender status did not affect the difficulty. Pain in the preceding 15 days of surgery increased the operating time as did the association of diabetes mellitus. Increasing body mass index (BMI) also increased the surgery time as well as the conversion rate (7.69% in patients with BMI >30Kg/m2). Clinically palpable gallbladder increased the surgery duration, difficulty and conversion rate. TLC >11000/mm3, contracted gallbladder, wall thickness ≥4mm made LC longer, while multiple stones increased surgeon’s difficulty and impacted stone in gallbladder neck increased the conversion rate.Conclusions: Certain factors that increase the difficulty of LC can be identified preoperatively and this knowledge should be used when planning LC.

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Contemporary Experience with Cholecystectomy: Establishing ‘Benchmarks’ Two Decades after the Introduction of Laparoscopic Cholecystectomy

The American Surgeon ◽

10.1177/000313481307901215 ◽

2013 ◽

Vol 79 (12) ◽

pp. 1253-1257 ◽

Cited By ~ 7

Author(s):

Pascal O. Udekwu ◽

William G. Sullivan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Tertiary Care ◽

Acalculous Cholecystitis ◽

Common Bile Duct Stones ◽

Magnetic Resonance Cholangiopancreatography ◽

Attributable Mortality ◽

Care Hospital ◽

Preoperative Magnetic Resonance

With quality and public reporting of increasing importance, benchmarks are anticipated to grow in relevance. We studied cholecystectomy in a practice in an urban tertiary care hospital. A total of 1083 cholecystectomies were performed in 2008 and 2009. Laparoscopic cholecystectomy was performed in 97.8 per cent of patients with a 2.2 per cent conversion rate. A planned open procedure was performed in only 2.2 per cent of patients. Approximately half of procedures were urgent and performed during an acute hospitalization. Most patients (74%) were female and most patients were overweight or obese (64.8%). Ages into the tenth decade of life were represented. Comorbidities included hypertension, 28.7 per cent; coronary disease, 15.6 per cent; diabetes mellitus, 13.4 per cent; gastroesophageal reflux disease, 10.7 per cent; and asthma, 5.5 per cent. Of female patients, 98 (12.2%) were postpartum and five (0.6%) were pregnant. Of 137 patients without gallstones, 59.1 per cent had biliary dyskinesia and 27 per cent had acalculous cholecystitis. Preoperative magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) were performed in most patients with suspected choledocholithiasis. Intraoperative cholangiograms were performed in 6.9 per cent of patients, 3.3 per cent for abnormal liver function studies. Postoperative ERCP was used in most patients with positive intraoperative cholangiograms. All-cause mortality was 0.8 per cent and attributable mortality was 0.2 per cent. Complications occurred in 7.5 per cent of patients, including retained common bile duct stones in 1.1 per cent, bile duct leak in 0.3 per cent, and common bile duct injury in 0.1 per cent.

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CLINICAL EVALUATION OF LAPAROSCOPIC CHOLECYSTECTOMY WITH REFERENCE TO CONVERSION RATE AND COMPLICATIONS- OUR EXPERIENCE IN A TERTIARY CARE CENTRE OF EASTERN INDIA

10.36106/ijsr/7609683 ◽

2020 ◽

pp. 7-10

Author(s):

Swapnil Sen ◽

Sandeep Kumar

Keyword(s):

Laparoscopic Cholecystectomy ◽

Conversion Rate ◽

Gallstone Disease ◽

Tertiary Care ◽

Gall Stone ◽

Injury Rate ◽

Large Series ◽

Care Centre ◽

Eastern India ◽

Tertiary Care Centre

Cholelithiasis is one of the most common surgical conditions requiring intervention worldwide. Since its introduction nearly four decades ago, laparoscopic cholecystectomy has become the gold standard of treatment for gallstone disease AIM: To critically evaluate our experience of laparoscopic cholecystectomy in a tertiary care centre of eastern India. MATERIALS AND METHODS: Hospital based observational study on 180 patients subjected to elective laparoscopic cholecystectomy with features of gall stone disease and meeting the inclusion and exclusion criteria. RESULTS: Our conversion rate of 10% is somewhat higher than that reported in any other series. This probably reflects that few of our surgeons are in their early learning curve. This can be reduced with the experience of the surgeons. A bile duct injury rate of 0.5% compares favourably with an incidence of 0-1% in several large series. Overall complication rate of 5.5% also compares favourably with an incidence of 1.6-8.6% in several large series. CONCLUSION: Laparoscopic cholecystectomy when performed in properly selected patients is very much effective in the treatment of symptomatic cholelithiasis – in terms of earlier return of bowel function, less postoperative pain, improved cosmesis, shorter length of hospital stay, earlier return of full activity and decreased overall cost. It is vital for the surgeons and patients to understand that conversion to open surgery is not failure; in fact, it implies a safe approach and a sound surgical judgment. The conversion rate is low with experienced surgeons indicating direct relationship between experience and conversion. It should be stressed that conversion if required should be done early rather than after an imminent complication.

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Evaluation of the Bleeding Complications in Laparoscopic Cholecystectomy in a Tertiary Care Hospital: A Cross-Sectional Study

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i31b31705 ◽

2021 ◽

pp. 170-175

Author(s):

Muhammad Kamran Ansari ◽

Inayat Ali Zardari ◽

Shazia Awan ◽

Shahnawaz Laghari ◽

Naeem Karim Bhatti ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Early Recognition ◽

Gallstone Disease ◽

Tertiary Care ◽

Cross Sectional Study ◽

Bleeding Complications ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Mesenteric Vessel

Objective: To determine the frequency of various sources of bleeding in laparoscopic cholecystectomy with special preference to gallbladder bed excluding port site. Methods: This cross-sectional study was consisted of 163 patients admitted through the outpatient department from Peoples Medical College Hospital Nawabshah. Ultrasound of abdomen was done as diagnostic modality and for assessment of gallstone disease. Finally the cases of gallstone were operated through laparoscopic cholecystectomy procedure and observed for sources of bleeding. Results: Out of 163 patients included in this study 138(84.7%) were female and 25(15.3%) patients were male; with female to male ratio of 5.52:1. The mean age was 41.85±7.83 years. Common sources of bleeding in laparoscopic cholecystectomy from liver bed side were 44(27%) cases followed by cystic artery in 17(10.4%) cases, hepatic artery and mesenteric vessel in 1(0.6%) case was observed. Conclusion: Bleeding during laparoscopic cholecystectomy are almost equally common and can prove to be lethal if not identified and managed during the operation. Good surgical technique, awareness and early recognition and management of such cases are keys to success when dealing with this problem.

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Safe Completion of Laparoscopic Cholecystectomy and Its Conversion Rate in a Tertiary Care Hospital

Annals of King Edward Medical University ◽

10.21649/akemu.v23i2.1583 ◽

2017 ◽

Vol 23 (2) ◽

Author(s):

Muhammad Shahid Farooq ◽

Rabia Altaf ◽

Ahmad Uzair Qureshi ◽

Fatima Naumeri ◽

Abrar Ashraf Ali

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Conversion Rate ◽

Tertiary Care Hospital ◽

Open Cholecystectomy ◽

Tertiary Care ◽

Self Awareness ◽

Safe Procedure ◽

Care Hospital ◽

Public Sector Hospital

AbstractObjectives: Laparoscopic cholecystectomy is a very good and safe procedure for the removal of gall bladder. The objective of our study was to see the conversion rate of laparoscopic cholecystectomy in our unit.Methods: This is a retrospective descriptive study. We conducted this study on 167 patients who under-went gall bladder removal in our unit at a Public sector hospital of Lahore.Results: Our study showed that 163 (97.6%) out of 167 patients had safe complete laparoscopic cholecystectomy while 4 (2.4%) had to be converted to open cholecystectomy. About 40% of the procedures completed by laparoscope were difficult. Approximately 98% were completed by consultants and 42% weresafely performed by the senior registrars.Conclusion: Gall bladder surgery can be safely completed with laparoscope with good team effort and self-awareness of team.

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Incidence of Choledocholithiasis in Gallstone Disease in Eastern Zone of India: A Single Centre Study

International Journal of Medical and Dental Sciences ◽

10.18311/ijmds/2017/18800 ◽

2017 ◽

Vol 6 (1) ◽

pp. 1417

Author(s):

Mrigendra Kumar Rai ◽

Vinod Kumar

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Gallstone Disease ◽

Tertiary Care ◽

Gall Stone ◽

Common Bile Duct Stones ◽

Stone Disease ◽

Care Hospital ◽

Bile Duct Stones ◽

Gall Stone Disease

Background: Common bile duct stones are found in 10-15% of patients having gall stone disease and the incidence increases with the age, both in India and in western countries and the majority of common bile duct stones are secondary to gall bladder stones, their incidence is more in Northern India.Objective: To study the incidence of common bile duct stone in patients having gall stone disease in tertiary care hospital.Methods: This was a cross sectional study of 125 patients admitted in different wards of the department of surgery on the basis of symptoms and signs of gall stone disease and latter on trans-abdominal ultrasound and MRCP confirmed that 18.4% of total patients having also choledocholithiasis.Result: Incidence of choledocholithiasis was 18.4% in patients having gall stone disease. It was 3 times more common in females. Maximum incidence 35% in between 40-49 years, obese (52%) and middle socio-economic group (74%).Conclusion: Incidence of choledocholithiasis is in increasing trend and is more common in females in between 40-49 years age group. Obesity is the commonest risk factor.

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SP3.2.10 Establishing an Emergency Surgical Ambulatory Care (ESAC) pathway for acute laparoscopic cholecystectomies: a single centre experience from a District General Hospital

British Journal of Surgery ◽

10.1093/bjs/znab361.076 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Neil Donald ◽

Lavanya Varatharajan ◽

Kumaran Ratnasingham ◽

Shashi Irukulla

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Ambulatory Care ◽

Operating Time ◽

District General Hospital ◽

Gallstone Pancreatitis ◽

Early Laparoscopic Cholecystectomy ◽

Patient Demographics ◽

Day Range ◽

Cost Efficiencies

Abstract Aims Early laparoscopic cholecystectomy is the gold standard for acute cholecystitis and gallstone pancreatitis. In order to deliver this service, a local Emergency Surgical Ambulatory Care (ESAC) pathway with a dedicated ESAC theatre list was established. The aim of this audit was to determine whether ESAC was associated with (1) improved length of stay and (2) cost efficiencies. Methods Consecutive patients who underwent an emergency laparoscopic cholecystectomy between October 2018 to October 2019 were identified. Data related to patient demographics, operating time, complications length of stay (LOS), reason for inpatient stay and re-admissions were collected. A dedicated ESAC service was introduced in July 2020. Outcomes were re-audited (July – December 2020). Results Prior to the introduction of ESAC, 142 patients (42% male, mean age 51 years (range 14 -82 years)) underwent an acute cholecystectomy, of which 13% were discharged on the same day. Median pre-operative LOS was 2 days (range 0-12 days) and median post-operative LOS was 1 day (range 1-16 days). Following the introduction of ESAC, 78 patients (32% male, mean age 49 years (range 22 – 89 years)) underwent an acute cholecystectomy, of which 76% were discharged on the same day and 90% within 1 day. Median pre-operative LOS was 0 days (range 0 to 7 days) and median post-operative LOS was 0 days (range 0-16 days). Conclusions Our results show that the introduction of a dedicated ESAC pathway improved both pre- and post-operative LOS. This subsequently saves approximately £80,000 per annum in hospital bed days.

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ASSESSMENT OF LIVER FIBROSIS IN ALCOHOLIC PATIENTS BY USING FIBROSCAN IN A TERTIARY CARE HOSPITAL

10.36106/ijar/2004149 ◽

2021 ◽

pp. 43-47

Author(s):

Veenit Kumar Prasad ◽

Bapilal Bala ◽

Biswadev Basumazumder ◽

Achintya Narayan Ray

Keyword(s):

Liver Disease ◽

Alcoholic Liver Disease ◽

Transient Elastography ◽

Wide Spectrum ◽

Tertiary Care ◽

Disease Patient ◽

Liver Stiffness ◽

Care Hospital ◽

Non Invasive ◽

Number Of Patients

INTRODUCTION: Alcoholic liver disease is one of the major causes of premature deaths worldwide. Alcohol induced liver injury is the most prevalent cause of liver disease and effects 10% to 20% of population worldwide. Alcoholic liver disease comprises a wide spectrum of pathological changes ranging from steatosis, alcoholicsteato-hepatitis, Cirrhosis and nally hepatocellular carcinoma. Our aims in this study are to detect this change by non invasive method by liver broscan and its clinical implications. MATERIALS AND METHODS: Total 200 patients were taken for observational study, conducted at Coochbehar Government Medical college and hospital both outpatient department and indoor patients from May 2019 to January 2020. Liver stiffness was assessed by ultrasound based method of transient elastography using Fibroscan machine. Gradation of liver stiffness was expressed in kilopascals (KPa). RESULTS: Maximum number of patients of alcoholic liver disease were between 40 - 49 years of age (42.5%). Male patients is 87.5% and female patients 12.5%. distribution of Rural population is 36 % and Urban population is 64%. Majority of population85 patients (42.5%) had fatty liver and 40 patients (20%) have hepatomegaly, 41 patients (20.5%) had Coarse echotexture of liver parenchyma and 54 patients (27%) had Splenomegaly, 62 patients (31%) had Nodular liver and 62 patients. It is observed that 11 patients (5.5%) had Fibroscan score ≤7.5 and 47 patients (23.5%) had broscan score 7.6 -9.9 and 40 patients (20%) had broscan score 10-12.4, 36 patients (18 %) had broscan score 12.5 – 14.6 and 66 patients (33%) have broscan score ≥ 14.7. CONCLUSIONS: Transient Elastography (TE) is a newer non invasive assessment technique to detect the progression of brosis or brosis in alcoholic liver disease patient. Major advantage is it is noninvasive (costeffective) so that we can early detect progression of this cirrhosis and can give efforts to halt the disease progression.

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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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Cynoacrylate surgical glue as an alternative to suturing for mesh fixation in lichtenstein hernia repair

International Surgery Journal ◽

10.18203/2349-2902.isj20181602 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1882

Author(s):

Deepak Jaiswal ◽

TRV Wilkinson ◽

Murtaza Akhtar

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Mesh Fixation ◽

Tertiary Care ◽

Operating Time ◽

Recurrent Hernia ◽

Care Hospital ◽

Lichtenstein Hernia Repair ◽

Average Pain

Background: Tension free repair using mesh in open hernia repair has become more popular in recent years. Chronic pain remains a frequent complication after Lichtenstein inguinal hernia repair. The use of sutures to fix the mesh has been implicated. Fixing the mesh using cynoacrylate glue could avoid this complication. The purpose of the present study is to study the incidence of pain and other complications following inguinal hernia repair performed by the Lichtenstein technique with mesh fixation by cyanoacrylate surgical glue.Methods: T This study was conducted at tertiary care hospital. Inclusion criteria were all patients coming to the hospital with inguinal or inguinoscrotal hernias diagnosed clinically. Exclusion criteria were all complicated inguinal hernia namely obstructed, strangulated, and large hernias with scrotal abdomen, recurrent hernia. Patient not fit for surgery or not consenting to join the study. The patients will be informed about the surgery and thereafter requested to sign an informed consent. Primary outcome was postoperative pain. Secondary endpoints were operating time, surgical site infection and recurrence rate.Results: Total number of 31 cases enrolled in the study of which twenty-two had unilateral and seven had bilateral inguinal hernias. Average pain score on POD 1, 3, 7 was 5.75; 4.53; 3.32 respectively. One patient developed seroma which was managed conservatively. No evidence of recurrence during study period.Conclusions: Cyanoacrylate surgical glue is a reliable method and can be used as an alternative for conventional Lichtenstein hernia repair.

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Outcomes of 27 gauge pars plana vitrectomy for a variety of posterior segment diseases

Journal of the Pakistan Medical Association ◽

10.47391/jpma.12262 ◽

2021 ◽

Vol 71 (11) ◽

pp. 2570-2575

Author(s):

Muhammad Amer Awan ◽

Fiza Shaheen ◽

Kholood Janjua

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Tertiary Care ◽

Operating Time ◽

Retinal Vasculitis ◽

Posterior Segment ◽

Care Hospital ◽

Silicon Oil ◽

Operative Complications ◽

Pars Plana

Objective: To report our experience with 27 gauge (27G) pars plana vitrectomy (PPV) system for a variety of simple to complex posterior segment disorders Methods: Single center, Retrospective, Cohort study. Data of 665 eyes of 574 patients that underwent 27G PPV for a variety of indications from July 2015 to June 2019 at a tertiary care hospital was analyzed. Results: Common surgical indications included; Diabetic tractional retinal detachment (196, 29.5%), vitreous haemorrhage (191, 28.7%), full thickness macular hole (80, 12%), epiretinal membrane (66, 9.9%), endophthalmitis (26, 3.9%), tractional diabetic macular edema (14, 2.1%), ectopia lentis (11, 1.7%), dropped lens matter (13, 2%) and others (68, 10.2%). Mean operating time was 62 ± 37 minutes. With the exception of 2 cases where 20G fragmatome was utilized, no case required conversion to 20 gauge system while a 25G trocar was used for the silicon oil injection. Per-operative complications included; iatrogenic retinal tear (2 eyes, 0.3%) and supra choroidal silicon oil migration (1 eye, 0.15%). Post-operative complications were raised IOP (7 eyes, 1%), endophthalmitis (1 eye, 0.15%), hemorrhagic occlusive retinal vasculitis (1 eye, 0.15%) and retinal detachment (2 eyes, 0.3%). Mean Visual Acuity improved from 1.62 ± 0.68 logarithm of minimum angle of resolution (logMAR) to 0.4 ± 0.38 logMAR (P <0.001). Conclusion: With 3 months follow up time, 27 G PPV has proved to be a safe and effective system for both simpler and complex retinal pathologies requiring significant surgical manipulation. Continuous...

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