scholarly journals Assessment of clinical, hematological, radiological parameters for prediction of difficult laparoscopic cholecystectomy at a tertiary health care centre

2018 ◽  
Vol 5 (9) ◽  
pp. 2984
Author(s):  
Abhishek Jina ◽  
Shailendra Kumar ◽  
Vineet Singh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Gall Bladder ◽  
Open Cholecystectomy ◽  
Total Leukocyte Count ◽  
Symptomatic Cholelithiasis ◽  
Upper Abdominal Surgery ◽  
Study Results ◽  
History Of ◽  
Upper Abdominal

Background: Since its introduction in the mid 1980’s, laparoscopic cholecystectomy (LC) has been widely used for symptomatic cholelithiasis. In recent years it has been considered as a gold standard for treatment of symptomatic cholelithiasis. Recent studies have reported that the rate of conversion of LC to open cholecystectomy (OC) is 1.5-19%. The aim of the present study was to predict the difficulties of performing laparoscopic cholecystectomy in symptomatic cholelithiasis. Further, the possibility of converting LC to open cholecystectomy was also investigated using various haematological, clinical, and radiological tool such as USG.Methods: The present prospective study was conducted in in Nehru Hospital of BRD Medical College, Gorakhpur, India over a period of 12 months on in-patients from various surgical wards undergoing LC. The patients were primarily divided into two groups consisting of those undergoing LC and those converted to OC respectively. Parameters like gender, age, body mass index, associated complains, total leukocyte count (TLC) and levels of alkaline phosphatase (ALP) were assessed as potential risk factors for conversion.Results: 50 patients were considered for this study. Results indicated that rate of conversion of LC to OC was found to be maximum for patients belonging to male gender, 31-40 years old, were obese, had previous history of upper abdominal surgery and had raised levels of TLC and ALP. Patients having multiple stones and contracted gall bladder also had a higher incidence of conversion to OC.Conclusions: From results obtained in this study, it could be concluded that parameters like age, gender, obesity, history of upper abdominal surgery, raised levels of TLC and ALP, incidences of multiple stones and contracted gall bladder posed significant risk for LC and acted as predictors for conversion to OC.

scholarly journals Post-Operative Pulmonary Function : A Comparison between Upper Abdominal Open Cholecystectomy and Laparoscopic Cholecystectomy

2014 ◽  
pp. 12-16
Author(s):  
Shahnaz Afroza ◽  
MM Masum-Ul-Haque ◽  
Nibedita Nargis ◽  
Nezamuddin Ahmed ◽  
Lutful Aziz ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Pulmonary Function ◽  
Open Cholecystectomy ◽  
Patient Control Analgesia ◽  
Pulmonary Complications ◽  
Significant Alteration ◽  
Mortality And Morbidity ◽  
Upper Abdominal Surgery ◽  
Upper Abdominal

Postoperative Pulmonary Complications (PPCs) is one of the major cause of perioperative mortality and morbidity in thoracic and upper abdominal surgery. Preoperative risk assessment enables clinicians to reduce perioperative risk in high risk patients.. In upper abdominal surgery, there is a larger alteration in pulmonary functions. This study was performed in 30 patients scheduled for laparoscopic cholecystectomy and for upper abdominal open cholecystectomy. The study revealed that after both laparoscopic & open upper abdominal cholecystectomy there was significant alteration of pulmonary function. There was significant alteration at six hours and after operation which then gradually improved, but it took about 24 hours for its complete recovery. The alteration was more evident in open cholycystectomy. Nevertheless these alterations did not cause any clinical derangement as expressed by SpO2, HR, & BP. The study also showed a significant dose reduction of opioid in case of laparoscopic cholecystomy. The lung function at postoperative ward correlated well with the level of analgesia. But persistent alteration of pulmonary function indicated presence of other mechanical factors. Key Words: Surgery-Lap.Cholecystectomy, Surgery- Upper abdominal, Complication-post- Operative, complication-pulmonary, Patient control analgesia Journal of BSA, Vol. 17, No. 1 & 2, 2004 p.12-16DOI: http://dx.doi.org/10.3329/jbsa.v17i1.4045  

scholarly journals Difficult iatrogenic bile duct injuries following different types of upper abdominal surgery: report of three cases and review of literature

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jerzy Lubikowski ◽  
Bernard Piotuch ◽  
Anna Stadnik ◽  
Marta Przedniczek ◽  
Piotr Remiszewski ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Abdominal Surgery ◽  
Delayed Diagnosis ◽  
Biliary Leak ◽  
Bile Duct Injuries ◽  
Upper Abdominal Surgery ◽  
Different Types ◽  
Upper Abdominal ◽  
Type Of Injury

Abstract Background Iatrogenic bile duct injuries (BDIs) are mostly associated with laparoscopic cholecystectomy but may also occur following gastroduodenal surgery or liver resection. Delayed diagnosis of type of injury with an ongoing biliary leak as well as the management in a non-specialized general surgical units are still the main factors affecting the outcome. Case presentation Herein we present three types of BDIs (Bismuth type I, IV and V) following three different types of upper abdominal surgery, ie. Billroth II gastric resection, laparoscopic cholecystectomy and left hepatectomy. All of them were complex injuries with complete bile duct transections necessitating surgical treatment. All were also very difficult to treat mainly because of a delayed diagnosis of type of injury, associated biliary leak and as a consequence severe inflammatory changes within the liver hilum. The treatment was carried out in our specialist hepatobiliary unit and first focused on infection and inflammation control with adequate biliary drainage. This was followed by a delayed surgical repair with the technique which had to be tailored to the type of injury in each case. Conclusion We emphasize that staged and individualized treatment strategy is often necessary in case of a delayed diagnosis of complex BDIs presenting with a biliary leak, inflammatory intraabdominal changes and infection. Referral of such patients to expert hepatobiliary centres is crucial for the outcome.

Laparoscopic Liver Resection in Patients with a History of Upper Abdominal Surgery

2011 ◽  
Vol 35 (6) ◽  
pp. 1333-1339 ◽  
Author(s):  
Keun Soo Ahn ◽  
Ho-Seong Han ◽  
Yoo-Seok Yoon ◽  
Jai Young Cho ◽  
Ji Hoon Kim
Keyword(s):  
Liver Resection ◽  
Abdominal Surgery ◽  
Laparoscopic Liver Resection ◽  
Upper Abdominal Surgery ◽  
History Of ◽  
Upper Abdominal

scholarly journals A study on clinical and radiological factors for predicting difficult laparoscopic cholecystectomy preoperatively

2017 ◽  
Vol 4 (9) ◽  
pp. 3015
Author(s):  
Arun Prasath S. ◽  
Surag Kajoor Rathnakar ◽  
Nagaraja Anekal L.
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Open Cholecystectomy ◽  
Fluid Collection ◽  
Gall Stone ◽  
Stone Disease ◽  
Elderly Age ◽  
Conversion To Open Cholecystectomy ◽  
Upper Abdominal ◽  
A Prospective Study

Background: Laparoscopic cholecystectomy considered as the gold standard treatment for symptomatic gall stone disease has 1-13% conversion rate to an open procedure due to various reasons. Present study aims to predict difficult laparoscopic cholecystectomy preoperatively using clinical and sonological factors.Methods: This is a prospective study done on 190 patients who were posted for laparoscopic cholecystectomy from March 2015 to February 2017. Parameters taken into consideration were: age, number of previous attacks of acute cholecystitis, impacted gallstone, thickness of GB wall, pericholecystic fluid collection, history of upper abdominal surgery and obesity. All surgeries were performed by surgeons with minimum ten years of experience on laparoscopic cholecystectomy and ultrasound of the abdomen was performed by senior radiologists with experience of minimum five years.Results: Out of 190 patients, difficulty was experienced in 48 patients of which conversion to open cholecystectomy was needed for 11 patients. Elderly age, multiple attacks of pain abdomen (>2), palpable GB, impacted gallstone, thickness of GB wall >3 mm, peri-GB fluid collection, adhesions due to previous abdominal surgery and obesity were all found to be independent risk factors leading to difficult laparoscopic cholecystectomy.Conclusions: Though there is no definite scoring system to predict difficult LC, there is scope for further refinement to make the same less cumbersome and easier to handle using the above clinical and radiological factors.

scholarly journals Clinical study of respiratory complications in patients undergoing elective upper abdominal surgery

2019 ◽  
Vol 6 (3) ◽  
pp. 732
Author(s):  
Praveen C. B. ◽  
Imran Thariq Ajmal
Keyword(s):  
Postoperative Complications ◽  
Abdominal Surgery ◽  
Cost Of Care ◽  
Postoperative Pulmonary Complication ◽  
Respiratory Complications ◽  
Post Surgery ◽  
Upper Abdominal Surgery ◽  
Study Results ◽  
Residual Capacity ◽  
Upper Abdominal

Background: Postoperative pulmonary complication is a major cause of morbidity, mortality, prolonged hospital stay and increased cost of care especially when it involves Upper Abdominal surgery. The predictable changes in lung function include a decrease in vital capacity and functional residual capacity, which are more striking in obese patients and in the supine. Aim is to study the incidence of respiratory complications in patients undergoing elective upper abdominal surgery with identification of risk factors namely Age, Sex, Obesity, Smoking and duration of upper abdominal Surgery for the development of Respiratory complications using a Peak Flow Meter as a bedside predictive test.Methods: Peak expiratory flow rate (PEFR) measurement daily up to 7 days post-surgery, were noted to monitor the occurrence of postoperative respiratory complications.Results: The study results according to our study showed that14 (34.1%) male patients out of 41 had postoperative complications as compared to 15 (48.3%) out of 31 female patients. 30.5% patients were obese and had postoperative complications of 9.75%. Overall 40% of smokers had postoperative complications. Postoperatively sub costal incision had complications (41%) in 36 patients, roof top incisions 4 out of 5 (80%) and para-umbilical incisions 3 out of 4 (75%). 80% of the patients who had upper abdominal transverse incisions developed microatelectasis followed by 75% of patients who had par median incisions.Conclusions: Respiratory complications following elective upper abdominal surgery are influenced by Increasing age and obesity and Smoking affected post-operative pulmonary recovery. Type of incision could also help change the incidence of complications.

Acute cholecystitis: predictive clinico-radiological assessment for conversion of laparoscopic cholecystectomy

2020 ◽  
Vol 61 (11) ◽  
pp. 1452-1462
Author(s):  
Young Rock Jang ◽  
Su Joa Ahn ◽  
Seung Joon Choi ◽  
Ki Hyun Lee ◽  
Yeon Ho Park ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Prothrombin Time ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Acute Calculous Cholecystitis ◽  
Prolonged Prothrombin Time ◽  
Ct Findings ◽  
History Of ◽  
Calculous Cholecystitis

Background Previous studies evaluating predictive factors for the conversion from laparoscopic to open cholecystectomy have reported conflicting conclusions. Purpose To create a risk assessment model to predict the conversion from laparoscopic to open cholecystectomy in patients with acute calculous cholecystitis. Material and Methods A retrospective review of patients with acute calculous cholecystitis with available preoperative contrast-enhanced computed tomography (CT) findings who underwent laparoscopic cholecystectomy was performed. Forty-four parameters—including demographics, clinical history, laboratory data, and CT findings—were analyzed. Results Among the included 581 patients, conversion occurred in 113 (19%) cases. Multivariate analysis identified obesity (odd ratio [OR] 2.58, P = 0.04), history of abdominal surgery (OR 1.78, P = 0.03), and prolonged prothrombin time (OR 1.98, P = 0.03) as predictors of conversion. In preoperative CT findings, the absence of gallbladder wall enhancement (OR 3.15, P = 0.03), presence of a gallstone in the gallbladder infundibulum (OR 2.11, P = 0.04), and inflammation of the hepatic pedicle (OR 1.71, P = 0.04) were associated with conversion. Inter-observer agreement for CT study interpretation was very good (range 0.81–1.00). A model was created to calculate the risk for conversion, with an area under the receiver operating characteristic curve of 0.87. The risk for conversion, estimated based on the number of factors identified, was in the range of 5.3% (with one factor) to 86.4% (with six factors). Conclusion Obesity, history of abdominal surgery, prolonged prothrombin time, absence of gallbladder wall enhancement, presence of a gallstone in the gallbladder infundibulum, and inflammation of the hepatic pedicle are associated with conversion of laparoscopic to open cholecystectomy.

scholarly journals Conversion Rate from Laparoscopic to open Cholecystectomy in AL-kindy Teaching Hospital, Baghdad

2020 ◽  
Vol 15 (2) ◽  
pp. 76-81
Author(s):  
Firas M Rashid
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Gall Bladder ◽  
Gall Bladder Disease ◽  
Bile Duct Stone ◽  
Open Cholecystectomy ◽  
Bladder Disease ◽  
Common Causes ◽  
History Of

Background: laparoscopic cholecystectomy (LC) is getting popularity for the treating of symptomatic gall bladder disease; conversion from laparoscopic to open cholecystectomy (OC) is also common. Objective : To find out the prevalence of causes, risk factors of conversion from LC to OC among  patient suffering from gall bladder disease, and  to explore the most common causes of conversion from laparoscopic to open cholecystectomy. Methods: This prospective study was conducted in the department of general surgery at Alkindy teaching hospital from first of January 2016 to the end of December 2017 .Nine hundred twenty patient were included. Patient age, gender, history of previous abdominal scar, common bile duct stone, ERCP, duration of symptom was included in our study. Results: Seven hundreds twenty –seven patients 74.48% were females and 191  26.52% were males. The mean age of patient presented with gall bladder disease was 40.43 years. Thirty –eight patients were converted to open cholecystectomy. The most common cause of conversation was dense adhesions 42.1% - followed by bleeding 30.1%. Other common causes of conversion were biliary anomalous anatomy 10.5%, common bile injury 5%, visceral injury and technical failure  7%. Conclusion: The main perioperative cause for OC was dense adhesion around gall bladder and the male gender, increasing age, history of common bile duct stone removed by previous ERCP, history of previous surgery, are independent risk factors of difficult laparoscopic cholecystectomy.  

scholarly journals Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Upper Abdominal Surgery

2021 ◽  
Vol 3 (2) ◽  
pp. 1482-1493
Author(s):  
Hamdy Ahmed Mostafa salama ◽  
Salah Ayoub Soliman ◽  
Ayman Fahmy Elramah
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Upper Abdominal Surgery ◽  
Upper Abdominal
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