scholarly journals A study of laparoscopic cholecystectomy in rural setup

2018 ◽  
Vol 5 (9) ◽  
pp. 3111
Author(s):  
Avishkar K. Barase
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Dietary Habits ◽  
Financial Burden ◽  
Open Cholecystectomy ◽  
Adult Population ◽  
Randomized Study ◽  
Gall Stone ◽  
Health Sector ◽  
Analgesic Requirement ◽  
Duration Of Surgery

Background: Cholelithiasis is one of the major healthcare problems faced by the adult population all over the world. The disease prevalence is ever increasing because of the changing lifestyles and dietary habits. With emergence of laparoscopic cholecystectomy, it has become standard treatment modality for all kind of patients of gall stone disease. But still in India laparoscopic procedures are not routinely carried out in rural setup. So, we have decided to carry out this prospective study of laparoscopic cholecystectomy in rural setup mainly emphasizing on the cost benefit aspect and its impact on economical aspect of the rural government hospital as well as the patient’s financial burden.Methods: In this prospective randomized study, 60 patients of symptomatic cholelithiasis were grouped into open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) groups randomly (30 each). The preoperative, intra operative and postoperative findings were noted and compared with each other and also with previous studies. The results are compared using paired t test and chi square test.Results: Laparoscopic cholecystectomy was better than open cholecystectomy in terms of less analgesic requirement, postoperative hospital stay, surgical site infection with better cosmetic outcome. The results were comparable regarding intra operative complications. Only duration of surgery was comparatively more in laparoscopic group. Thus, overall laparoscopic cholecystectomy was cost effective alternative as compared to open cholecystectomy.Conclusions: Laparoscopic cholecystectomy is better alternative to open cholecystectomy in term of less intra and postoperative complications as well as decreased financial burden on public health sector and patient point of view.

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.

Feasibility and safety in difficult laparoscopic cholecystectomies; a single surgeon experience.

2020 ◽  
Vol 11 (4) ◽  
pp. 12-16
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Bile Leakage ◽  
Cross Sectional Study ◽  
City Hospital ◽  
Class Iii ◽  
Cross Sectional ◽  
Surgeon Experience ◽  
Conversion To Open Cholecystectomy ◽  
Duration Of Surgery

Background: laparoscopic cholecystectomy is commonly used for the treatment of gallstones. Objective: To determine the feasibility and safety of difficult laparoscopic cholecystectomies. Methodology: This cross sectional study was based on retrospective collection of data from patient records, including 323 patients with difficult laparoscopic cholecystectomies was conducted in Department of Surgery, Sharif Medical City Hospital, and Rasheed Hospital, Lahore from June 2010 to December 2019. Difficult cholecystectomy was defined on intraoperative findings based on Nassar intraoperative scoring system. Feasibility was defined as successful accomplishment of procedure without complication and safety was defined as having no intraoperative or postoperative complications. Results: There were 75 (23.21%) male and mean age was 48±8 years. Class I difficulty was observed in 185 (57.3%) patients, class II difficulty in 83 (25.7%) patients, class III difficulty in 44 (13.6%) patients and class IV difficulty in 11 (3.4%) patients. Mean duration of surgery and mean hospital stay were 98.87±11.76 minutes and 1.91±1 days, respectively. Conversion to open cholecystectomy was done in 10 (3.1%). The procedure was feasible in 313 (96.9%) patients. Overall complications were seen in 19 (5.9%) patients. The complications included Common Bile Duct injury in 1 (0.31%) patient, intraoperative bleeding in 1 (0.3%) patients, bile leakage in 2 (0.62%) patients, postoperative jaundice in 3 (0.93%) patients, superficial infections in 10 (3.1%) patients and deep infections in 2 (0.62%) patients. Safety of laparoscopic surgery was seen in 304 (94.1%) patients. Conclusion: Laparoscopic cholecystectomy in difficult situations was found to be feasible and safe in majority of patients. However, it was associated with a longer operative time.

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

2017 ◽  
Vol 5 (1) ◽  
pp. 253 ◽  
Author(s):  
Pramod Singh ◽  
Sumit Kumar Gupta ◽  
Mukesh Kumar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
City Hospital ◽  
Site Infection ◽  
First Choice ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

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.

scholarly journals Intraperitoneal Hydrocortisone plus Bupivacaine versus Bupivacaine alone for Pain Relief after Laparoscopic Cholecystectomy

2016 ◽  
Vol 3 (2) ◽  
pp. 41 ◽  
Author(s):  
Mahesh Sharma ◽  
Kalpana Kharbuja ◽  
Nil Raj Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Relief ◽  
Normal Saline ◽  
Randomized Study ◽  
Saline Group ◽  
Normal Saline Group ◽  
Analgesic Requirement ◽  
Number Of Patients ◽  
Group A ◽  
Group B

Introduction: Laparoscopic cholecystectomy has been the gold standard in the treatment of gallstones since last decades. Beside several benefits of laparoscopic cholecystectomy compared with open surgery, postoperative pain is still a frequent melancholy.  Hence, pain management is utmost regarding patients' comfort. The main objective of the study was to compare the effect of intraperitoneal hydrocortisone plus bupivacaine with bupivacaine alone on pain relief following laparoscopic cholecystectomy.   Methods: A randomized study was conducted from December 2015 to August 2015 that included 100 patients aged 20 to 60 years of both genders who were found to have symptomatic gallstones and were scheduled for elective laparoscopic cholecystectomy at Lumbini Medical College. Patients randomly received 100 mg hydrocortisone plus 100 mg bupivacaine in 200 ml normal saline (group A) or 100 mg bupivacaine in 200 ml normal saline (group B) into the peritoneum. Post-operative abdominal and shoulder pain were evaluated using Visual Analog Score (VAS). The patients were also followed up for postoperative analgesic requirements, and recovery variables. Data were collected, tabulated and analyzed statistically using SPSS version 19.   Results: Total number of patients in this study were 100. Age and gender among both groups were comparable. VAS scores for pain was significantly lower for group A as compared to group B at 0, 2, 4, 6, 12, and 24 hours. Time of oral intake in hrs for liquids and solids was statistically significant in Group A compared to Group B. Rescue analgesic requirement was also significantly low in Group A compared to Group B. Hospital stay in both group were comparable.   Conclusion: Combination of hydrocortisone plus bupivacaine can relieve pain after laparoscopic cholecystectomy better compared to bupivacaine alone when administered intraperitoneally.

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 Early versus late laparoscopic cholecystectomy in the management of acute cholecystitis: a retrospective study

2019 ◽  
Vol 6 (11) ◽  
pp. 3897
Author(s):  
Deepu Thiyagarajan ◽  
Prince Deva Ruban
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Demographic Data ◽  
Late Complications ◽  
Aged Patients ◽  
Early Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
Duration Of Surgery

Background: Early laparoscopic cholecystectomy (LC) is a life-saving procedure in the management of acute cholecystitis as it helps in prevention of late complications like development of adhesions, haemorrhage and sepsis. The study aims at comparing the outcomes of early versus late laparoscopic cholecystectomy in the management of acute cholecystitis.Methods: A retrospective study was done by analyzing the past 5 years medical records of 250 patients admitted to the emergency department with diagnosis of acute cholecystitis established according to the Tokyo criteria. The relevant clinio-social demographic data of the patients, clinical and radiological parameters, intra-operative and post-operative findings and follow-up data were compared between early and late LC group of patients.Results: The study included 125 middle aged patients who underwent early LC (within 24 hours) and 125 patients who underwent late LC (after 24 4hours). The complication rate, conversion to open cholecystectomy and duration of surgery showed no significant differences between early and late laparoscopic cholecystectomy except for an increased duration of stay among the late LC group.Conclusions: Early LC is an efficient procedure for acute cholecystitis but it has risks of complications which can be minimized by careful selection of patients after clear clinical and radiological evaluation. 

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.

scholarly journals Three-Port versus Four-Port Laparoscopic Cholecystectomy: A Randomized Controlled Trial

2019 ◽  
Vol 21 (1) ◽  
pp. 40-43
Author(s):  
Rabin Koirala ◽  
TM Gurung ◽  
A Rajbhandari ◽  
P Rai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Controlled Trial ◽  
Open Cholecystectomy ◽  
Analgesic Requirement ◽  
Safe Alternative ◽  
Average Hospital ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

 Laparoscopic cholecystectomy (LC) is one of the most common surgery performed and is traditionally performed using four ports. With the aim of improving patient’s comfort, port numbers have been reduced to single port. But feasibility and the extra expense that comes with single and double port LC has made them less attractive. Three port LC can be a safe alternative to four port LC, and various research has shown its safety. This study compares the three port LC with the traditional four port LC with the objective of assessing feasibility and benefit of the decreased port number. We evaluated 217 patients who were randomly allocated for three port and four port LC. Both the groups were compared for operative time, assessment of postoperative pain, days of hospital stay and postoperative recovery time after discharge. The parameters were compared using Statistical Package for the Social Sciences (SPSS) version 16. Among 217 patients, 123 underwent three port LC and 94 underwent four port LC. The larger number were females (79.7%), and with comparable age group of patients. Rate of conversion to open cholecystectomy, postoperative pain scale, analgesic requirement, average hospital stay and port site infection rates were comparable in both groups of patients. The average time taken for operation was less in three port LC than the four port LC but this was not statistically significant. There is no significant difference between 3 port and 4 port LC in terms of time required for the surgery, conversion rate, complication and duration of hospital stay.

scholarly journals Bile Duct Injuries Following Laparoscopic Cholecystectomy

2018 ◽  
Vol 15 (1) ◽  
pp. 14-19
Author(s):  
Mohammad Ibrahim Khalil ◽  
Haridas Saha ◽  
Azmal Kader Chowdhury ◽  
Imarat Hossain ◽  
AZM Mostaque Hossain
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Open Cholecystectomy ◽  
Standard Procedure ◽  
Gall Stone ◽  
Common Bile Duct Injury ◽  
Medical College ◽  
Bile Duct Injuries ◽  
Case Files

Background: Laparoscopic cholecystectomy (LC) is the gold standard procedure for the gall stone diseases.Objective: This study aimed to assess the outcome of laparoscopic cholecystectomy (LC) by determining the frequency of complications especially of bile duct injuries.Methodology: This retrospective study was conducted in the Department of surgery at Dhaka Medical College and Hospital, Dhaka, Bangladesh. The case files of all patients undergoing laparoscopic cholecystectomy (LC) from the year of 2013 to 2015 were retrospectively analyzed. The data were collected according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose resections had to be converted from laparoscopic to open surgery.Results: During the three years a total number of 336 patients were underwent LC for chronic cholecystitis (CC) of which 22(6.5%) developed complications. Among those who developed complications, two patients had major bile duct injuries (0.4%); other 43(12.8%) patients had planned laparoscopic operations converted to open cholecystectomy intra-operatively. None of the patients in this study died as a result of LC.Conclusion: The two patients who had severe common bile duct injury in this study had major anatomical anomalies that were only recognized during surgery.Journal of Science Foundation 2017;15(1):14-19

EVALUATION OF HAEMODYNAMIC AND CAPNOGRAPHIC CHANGES IN OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 58-60
Author(s):  
Bimal Krushna Panda ◽  
Mahendra Ekka ◽  
Sagarika Rout ◽  
Shreemayee Mohapatra ◽  
Anish Rajan ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gold Standard ◽  
Standard Treatment ◽  
Open Cholecystectomy ◽  
Inclusion Criteria ◽  
P Values ◽  
Duration Of Surgery ◽  
Intraoperative Period ◽  
Bladder Pathology ◽  
Elective Cholecystectomy

Introduction: Laparoscopic cholecystectomy is one of the most commonly performed operations worldwide and gold standard treatment for benign gall bladder pathology. Increasing practice of lap cholecystectomy demands concurrent advancement in anaesthetic technique and monitoring standard. Objectives: Comparison of haemodynamic and ETCO2 changes intraoperatively during laparoscopic and open cholecystectomy and evaluation of any additional effects of insufated CO2. Study Design: Hospital based observational study done over 24 months Subjects and methods: 60 patients of both sex scheduled to undergo elective cholecystectomy under general Anaesthesia, selected on the basis of the inclusion criteria , were included in this study. Patients are assigned into two groups namely Group O[ planned for open cholecystectomy] and Group L[laparoscopic cholecystectomy], each group having 30 patients. Heart rate, systolic BP, diastolic BP, mean arterial pressure, EtCO2, SpO2 and ECG monitored continuously and record maintained before surgery, during induction, intubation, extubation and every 10 min interval up to the completion of surgery in both group.CO2 insufation and exsufation time also noted in laparoscopic cholecystectomy cases. Result: Age, sex, weight, height, ASA grade and duration of surgery of all the patients of both the groups were comparable. The HR, MAP and ETCO2 of group L started increasing during the intraoperative period and P values these were statistically signicant from t=20 minutes after intubation to t=60 min. In our study CO2 insufation done within 8 to 15 minutes after intubation. .It is clear from our study that pneumoperitoneum created during laparoscopic cholecystectomy might have caused this increase in HR,MAP and ETCO2. There was a decrease in SpO in Group L during the intraoperative period i.e from t=20 minutes after intubation to t=80 min after intubation and the P values during this 2 period were statistically signicant. Conclusion: From our study we come to the conclusion that in laparoscopic cholecystectomy there is signicant increase in HR, MAP, ETCO2 and decrease in SPO2 following insufation of the abdomen with CO2 and institution of the reverse Trendlenberg position.

Sign in / Sign up

Export Citation Format

Share Document