scholarly journals Giant gall stone: a rare finding performed with open cholecystectomy

2019 ◽  
Vol 6 (2) ◽  
pp. 630
Author(s):  
Vikrant Sharma ◽  
Vishal Kaundal ◽  
Ankur Sharma ◽  
Gopal Singh ◽  
Payal Shah ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Wide Spectrum ◽  
Open Cholecystectomy ◽  
Gall Stone ◽  
Abdominal Sonography ◽  
Open Procedure ◽  
Calot’S Triangle ◽  
Large Size ◽  
Gall Stones ◽  
Better Than

Very few cases of a giant gall stone (>50mm) are reported worldwide. Author reported a case of a gall stone measuring 80x44x41mm in a 64 years old female who underwent open cholecystectomy at our institution. Gall stones measuring more than 30mm are associated with a higher risk of developing gall bladder carcinoma and any patient who is harbouring a large calculus requires cholecystectomy. Large gall stones when detected on abdominal sonography throw a reasonable surgical challenge as on usual basis, laparoscopic cholecystectomy is an ideal approach for intervention in cholelithiasis. Giant gall stones are also associated with a wide spectrum of diseases including Bouveret syndrome, colonic ileus etc. Once a surgery is planned for a giant gall stone, open procedure is better than laparoscopic cholecystectomy as the latter is difficult to perform owing to the large size of calculus and associated adhesions in the region of Calot’s triangle. It further saves the patient from unnecessary conversion to open procedure that may occur subsequently in due course of surgery that involves a giant calculus. 

scholarly journals Is early conversion of laparoscopic to open cholecystectomy helpful in preventing iatrogenic injuries: a retrospective study from a single unit of a tertiary care centre

2019 ◽  
Vol 6 (7) ◽  
pp. 2332
Author(s):  
Dheer S. Kalwaniya ◽  
Jaspreet S. Bajwa ◽  
S. V. Arya ◽  
Rajkumar C. ◽  
Ashok K. Sharma ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Gall Bladder ◽  
Single Unit ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Gall Stone ◽  
Open Procedure ◽  
Iatrogenic Injuries ◽  
Conversion To Open Cholecystectomy

Background: Gall stone disease is the commonest hepatobiliary problem which is tackled by either laparoscopic or open technique. Since the advent of laparoscopic cholecystectomy by Eric Muhne in 1985, it has become gold standard for gall bladder removal. But a surgeon must be competent enough to convert it into open procedure, provided there are on table complications. Moreover, since laparoscopic surgery has a learning curve, open procedure for any surgery is must for safety of the patient as well as the surgeon.Methods: A retrospective study is done over a period of 4 years (January, 2015 to December, 2018) and data of 469 patients undergoing laparoscopic cholecystectomy in a single unit of Safdarjung Hospital, New Delhi, India has been collected and evaluated for conversion to open procedure on the basis of intraoperative findings. The complications noted and the intraoperative findings and the reasons of conversion to open cholecystectomy have been compared to the previous studies done.Results: Out of total 469 cases, M:F ratio was 1:3.51. Total 40 underwent conversion to open cholecystectomy (8.54%) with M:F ratio of 1:2.07. Most common cause of conversion was dense adhesions in Calot’s triangle along with omentum and bowel. Single patient had agenesis of gall bladder. There was no iatrogenic injury to common bile duct, common hepatic duct and there were no postoperative mortalities.Conclusions: Early conversion to open cholecystectomy is associated with lower intraoperative iatrogenic injuries and hence, lowers postoperative morbidity.

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 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 A study of factors determining difficult surgery among patients undergoing laparoscopic cholecystectomy

2019 ◽  
Vol 6 (9) ◽  
pp. 3322
Author(s):  
Mohhamad Sadik Akhtar ◽  
Parwez Alam ◽  
Yasir Alvi ◽  
Syed Amjad Ali Rizvi ◽  
Mohhmad Habib Raza
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Wall Thickening ◽  
P Value ◽  
Difficult Situation ◽  
Open Procedure ◽  
Conversion To Open Cholecystectomy ◽  
Difficult Procedure ◽  
Upper Abdomen ◽  
High Bmi

Background: With widespread use of laparoscopic cholecystectomy and its applicability in many difficult situation, the chances of complication and difficulty during surgery have increased. This study was done to determine the factors which could preoperatively predict difficulty undergoing laparoscopic cholecystectomy.Methods: The data were obtained from the patients admitted to in wards of General Surgery, JN Medical Collage, Aligarh Muslim University, and Aligarh, India undergoing laparoscopic cholecystectomy. The difficult laparoscopic cholecystectomy was defined as procedures exceeded 70 minutes in duration or those which were converted to open procedure. Dependent variable included demographic factors, clinical and sonographic findings. P value was kept at 0.05.Results: During the study duration, 200 patients were included in the study undergoing for the laparoscopic cholecystectomy and out of this 85 had difficult outcome procedure. High BMI, hypertension, previous upper abdomen surgery, deranges AST and serum creatinine along sonographic findings of gall balder wall thickening and pericholecytsic edema were found to be significantly associated with difficult LC.Conclusions: This study demonstrates that presence of various factors can predict the difficult outcome of laparoscopic cholecystectomy. This can help in minimizing the complication and council the patients regarding difficult procedure and need for conversion to open cholecystectomy, especially relevant for funds-limited settings like India.

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.

Unusual fistula demonstrating the need for an early cholecystectomy

2020 ◽  
Vol 13 (9) ◽  
pp. e235795
Author(s):  
Gregory Harrison ◽  
Roland Fernandes
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Early Cholecystectomy ◽  
Calot’S Triangle ◽  
Initial Episode ◽  
Laparoscopic Assisted ◽  
Definitive Management ◽  
Active Disease

A 79-year-old man developed a spontaneous cholecystocutaneous fistula 12 months after an initial episode of acute cholecystitis. A laparoscopic cholecystectomy procedure was twice abandoned due to extensive adhesions and active disease, limiting safe dissection of Calot's triangle. Abdominal collections formed and a spontaneous cholecystocutaneous fistula developed. Imaging revealed an 11 cm calculus and erosion of the fundus of the gall bladder through the sheath. Definitive management was achieved with a laparoscopic assisted open cholecystectomy.

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

scholarly journals Interval Laparoscopic Cholecystectomy in the Management of Acute Biliary Pancreatitis

HPB Surgery ◽  
2000 ◽  
Vol 11 (5) ◽  
pp. 319-323 ◽  
Author(s):  
M. D. Pinhas Schachter ◽  
M. D. Timor Peleg ◽  
M. D. Oded Cohen
Keyword(s):  
Acute Pancreatitis ◽  
Laparoscopic Cholecystectomy ◽  
Traditional Approach ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Operating Time ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Calot’S Triangle ◽  
Mild Acute Pancreatitis

The timing of laparoscopic cholecystectomy following an attack of acute biliary pancreatitis is controversial. The traditional approach of interval cholecystectomy has been challenged recently. The present study was designed to evaluate the benefits of interval laparoscopic cholecystectomy for patients with mild acute pancreatitis (Ranson less than 3). Nineteen patients with mild pancreatitis underwent ultrasonographic evaluation to confirm the biliary etiology. ERCP was performed in all patients on the first available endoscopy list, and endoscopic sphincterotomy was performed in two patients with calculi or dilated common bile duct on ultrasonographic examination. Medical treatment was administered and laparoscopic cholecystectomy was scheduled after 8–12 weeks to allow the inflammatory process to settle. There were no recurrent attacks of pancreatitis during this period. The degree of difficulty of the laparoscopic procedure was assessed by the presence of adhesions to the gallbladder area, difficulty of dissection in the Calot's triangle, intraoperative bleeding and the need for a drain. Six patients (31.5%) had severe adhesions, difficult dissection of the cystic duct and artery, bleeding and prolonged operating time. In two of these patients (10.5%) the procedure was converted to open cholecystectomy. In conclusion, our results suggest that postponing laparoscopic cholecystectomy in acute pancreatitis patients is not advantageous surgically and does not justify the risk of further morbidity caused by the gallbladder disease.

scholarly journals Laparoscopic cholecystectomy: Conversion rate and complcation

2016 ◽  
Vol 18 (3) ◽  
pp. 43
Author(s):  
BR Malla ◽  
HN Joshi ◽  
N Rajbhandari ◽  
YR Shakya ◽  
B Karki ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conversion Rate ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Conversion To Open Surgery ◽  
Calot’S Triangle ◽  
Conversion Rates ◽  
Conversion To Open Cholecystectomy ◽  
Previous Laparotomy ◽  
History Of

Introduction and Objective: Laparoscopic Cholecystectomy is the standard surgical treatment for gallbladder disease. However, conversion to open surgery is not the complication. Different centers have reported different conversion rates and post operative complications. The objective of this study is to identify conversion rate and post operative complication of laparoscopic cholecystectomyMaterials and Methods: This retrospective study included all laparoscopic cholecystectomies attempted in Dhulikhel hospital during the year 2015. Files of all patients were reviewed to find out the demography of the patients and the indication of Laparoscopic cholecystectomy. The rate of conversion to open cholecystectomy, the underlying reasons for conversion and postoperative complications were analyzed.Results: Out of 324 cases attempted laparoscopic cholecystetomies, two cases with the history of previous laparotomy were excluded to rule out the bias in the result. Out of 322 cases 226(70.18%)were female and 96(29.81%) were male . The mean age was 38 years. Over all conversion rate to open cholecystetomy was 1.86% with frozen calot’s triangle as the most common reason for conversion. The over all postoperative complication was 1.24% with no major bile duct injury.Conclusion: Laparoscopic cholecystectomy can safely be done with low conversion rate and complication.

scholarly journals Study of correlation between pre-operative ultrasonographic findings and difficult laparoscopic cholecystectomy

2018 ◽  
Vol 5 (7) ◽  
pp. 2605
Author(s):  
Himanshu Chindarkar ◽  
Ramesh Dumbre ◽  
Arun Fernandes ◽  
Deepak Phalgune
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wall Thickness ◽  
Bladder Wall ◽  
Fluid Collection ◽  
Gall Stone ◽  
Bladder Wall Thickness ◽  
Gall Stones ◽  
Proper Patient Selection ◽  
Gall Bladder Wall

Background: In laparoscopic cholecystectomy prevention of certain life-threatening complications are dependent on proper patient selection. Some reliable factors to predict difficulty, conversion or complications in laparoscopic cholecystectomy are needed. In the present research attempt was made to study correlation between pre-operative abdominal ultrasonographic findings and difficultly in laparoscopic cholecystectomy.Methods: Sixty patients above age of 18 years with gall stone admitted for elective laparoscopic cholecystectomy were included. Pre-operative ultrasonographic parameters such as gallbladder wall thickness and size, gallstone mobility, common bile duct (CBD) diameter, size and number of calculi, presence of pericholecystic fluid collection were given score of 0 or 1 based on findings being negative or positive respectively. Total score was correlated to intraoperative difficulty of surgery. Operative findings were graded as difficult laparoscopic cholecystectomy if there were presence of dense peri gall bladder adhesions, difficulty in dissection of Calot triangle, tear of gallbladder, bleeding that hindered visual field, abnormal anatomy of biliary tree and buried or intrahepatic gall bladder.Results: Pre-operative USG findings such as gall bladder wall thickness and size, impacted and size of gall stones, CBD diameter, presence of pericholecystic fluid collection were significantly associated with difficult laparoscopic cholecystectomy. Gall bladder wall thickness, pericholecystic fluid collection and impacted gall stones were accurate predictors for difficult laparoscopic cholecystectomy. Higher the pre-operative USG score, higher were the percentage of difficult laparoscopic cholecystectomy and conversion to open cholecystectomy.Conclusions: Pre-operative ultrasonography in the form of the formulated score is a good predictor of difficulty in laparoscopic cholecystectomy.

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