scholarly journals Advantage of fundus first method over conventional approach in difficult laparoscopic cholecystectomy: a prospective study

2019 ◽  
Vol 6 (5) ◽  
pp. 1613
Author(s):  
Braja Mohan Mishra ◽  
Rabi Narayana Guru ◽  
Sunil Kumar Kar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Gall Stone ◽  
Antibiotic Use ◽  
Class Iii ◽  
Female Age ◽  
Conversion To Open Cholecystectomy ◽  
A Prospective Study ◽  
Difficult Cases

Background: Fundus first method is a widely accepted and practiced procedure in open cholecystectomy to deal the difficult cases but laparoscopic surgeons still have reserved opinion regarding use of fundus first approach in difficult laparoscopic cholecystectomy (DLC). As in open cholecystectomy fundus first laparoscopic cholecystectomy (FFC) can have advantages over conventional laparoscopic cholecystectomy (CLC) in DLC. So many preoperative, intraoperative, postoperative information were collected in both CLC and FFC and compared to evaluate whether FFC has any advantage over CLC in difficult laparoscopic cholecystectomy.Methods: A total 73 cases were included in the study that underwent laparoscopic cholecystectomy (LC) for gall stone diseases and intraoperatively found to be difficult cases. They were distributed into 4 classes i.e. Class I, Class II, Class III and Class IV according to the type of difficulty encountered during surgery.Results: Out of the 73 patients 24 were male and 49 were Female. Age of patient ranged from 14 to 70 years with mean age of 42.64 years. Out of 38 cases operated with FFC 6 cases (15.78%) needed conversion to open cholecystectomy as compared to 26 out of 35 (71.14%) cases that underwent CLC where conversion was done. Mean duration of hospital stay is 4.19±3.053. Mean hospital stay in FFC is 2.58±1.869 days and that of CLC is 5.14±3.143 which is clearly much higher and statistically significant (p< 0.001) than mean hospital stay in case of FFC.Conclusions: FFC has advantages over CLC in difficult LC i.e. reduced conversion rate, lesser hospital stay and less duration of antibiotic use.

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.

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

2019 ◽  
Author(s):  
Madan Goyal ◽  
R K Goel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Critical View Of Safety ◽  
Recent Onset ◽  
Conversion To Open Cholecystectomy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Collections ◽  
A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

EVALUATION OF CLINICO-RADIOLOGICAL FACTORS PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 63-66
Author(s):  
Wasif Mohammad Ali ◽  
Nazia Nanen ◽  
Atia Zaka Ur Rab ◽  
Syed Amjad Ali Rizvi ◽  
Mehtab Ahmad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Open Cholecystectomy ◽  
Previous History ◽  
Safe Procedure ◽  
Chi Square ◽  
Preoperative Prediction ◽  
Conversion To Open Cholecystectomy ◽  
Chi Square Test ◽  
A Prospective Study

Introduction: Laparoscopic cholecystectomy has become procedure of choice for treatment of symptomatic gallstone [1] disease . Even though it is a safe procedure occasionally it can be difcult and requires conversion to open cholecystectomy for various problems faced during surgery. Preoperative prediction of difcult laparoscopic cholecystectomy and likelihood of conversion to open cholecystectomy will avoid such complications and overall cost of treatment. Aim: To evaluate the clinico-radiological factors predicting difcult laparoscopic cholecystectomy Methods: This was a prospective study conducted from October 2018 to November 2020. Total of 101 patients meeting inclusion criteria undergoing laparoscopic cholecystectomy were included in the study. Various clinical, radiological and biochemical parameters and intraoperative difculties during surgery were recorded. The statistical analysis was done using chi-square test and ANOVA test. Results: The parameters such as sex, age, duration of disease, co-morbid disease, previous history of cholecystitis, palpable gall bladder, BMI, TLC, thickness of gall bladder, largest stone size and impacted stone are found statistically signicant in predicting difcult laparoscopic cholecystectomy and conversion to open cholecystectomy preoperatively. Conclusion: Difcult laparoscopic cholecystectomy may be predicted preoperatively even with a good clinical judgement whereas both clinical and radiological parameters provide a better preoperative prediction of difcult cholecystectomy so that the surgeon can prepared in advance for the complications.

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 Evaluation of relationship of body mass index with severity of cholecystitis

2019 ◽  
Vol 6 (3) ◽  
pp. 868 ◽  
Author(s):  
Varun V. Chauhan ◽  
Bhushan A. Shah ◽  
Shivaratna J. Mahadik ◽  
Rohan P. Videkar
Keyword(s):  
Risk Factor ◽  
Open Cholecystectomy ◽  
Gall Stone ◽  
Stone Disease ◽  
Established Risk Factor ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy ◽  
Gall Stone Disease ◽  
Total Body ◽  
A Prospective Study

Background: Obesity is an established risk factor for gall stone disease. Male sex has also been recently cited as a risk factor for severe symptomatic cholelithiasis. As a possible cause of several difference in regards to the severity of cholecystitis, many physiological differences between the two sexes can be examined. Many studies have been done on the risk factors for developing the gall bladder disease explaining its polygenic nature It is postulated that the total body fat, the main value of which is significantly higher for females than males, may contribute to this sex difference. Only a couple of studies are available on BMI and its effect on severity of cholecystitis hence depicting the need for this study in our setup.Methods: This is a prospective study carried out on 70 patients for cholecystitis whose weight and height measurements had been recorded on admission. Patients were placed in either group-Obese (BMI e” 25kg/m2) or Non-Obese (BMI <25kg/m2). The association between BMI and severity of cholecystitis was investigated.Results: 18% of the laparoscopic cholecystectomy surgeries required conversion to open cholecystectomy due to reasons like severe adhesions to an adjacent organ, etc. Pain in abdomen (100%) was the commonest complaint and was present in all the patients followed by dyspepsia (44%).69% of patients were having complaints for more than 72 hours. No significant difference observed among mean BMI of different grades of severity (p=0.963).Conclusions: There is negative correlation between BMI and grade of severity of cholecystitis and BMI is not a predictor for the conversion from laparoscopic to open cholecystectomy.

scholarly journals Laparoscopic Cholecystectomy for Acute Gallbladder Disease During Index Admission- 11 the Optimum Timing for Surgery

2013 ◽  
Vol 16 (1) ◽  
pp. 11-17
Author(s):  
Md Ibrahim Siddique ◽  
Md Atiar Rahman ◽  
Md Shahadot Hossain Sheikh ◽  
Khander Manzoor Murshed ◽  
Samia Mubin ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Index Admission ◽  
Laparoscopic Procedure ◽  
Complication Rates ◽  
Financial Benefit ◽  
Conversion To Open Cholecystectomy

Background: Laparoscopic cholecystectomy, initially considered a contraindication for the treatment of acute gallbladder disease, is now being practiced for treating acute cholecystitis worldwide. The purpose of the study is to evaluate the outcome of laparoscopic procedure in the management of acute gallbladder disease during the index admission in terms of safety and feasibility, hospital stay and the rates of complications and conversion to open cholecystectomy. Methods: Between January 2009 to December 2011, 174 patients (103 female, 71 male) with median age 43.5 years (range 27-73 years) with the diagnosis of acute gallbladder disease underwent laparoscopic cholecystectomy. Diagnosis of acute cholecystitis was made from history, physical findings and ultrasound evidence of acute inflammatory changes. Results: Median time from onset of symptoms to surgery was 70 hours. Median operative time was 76.5 minutes. Conversion rate was 1.7%. Minor post-operative complications occurred in 13.5% cases of laparoscopic procedure, which did not require further intervention. Median post-operative hospital stay was 2.5 days and total length of hospital stay was median 4.4 days. There was no mortality. Conclusion: In expert hands laparoscopic cholecystectomy for acute gallbladder disease during the index admission is safe with better clinical results, shorter hospital stay and an acceptable conversion and complication rates with additional financial benefit to the patients. DOI: http://dx.doi.org/10.3329/jss.v16i1.14442 Journal of Surgical Sciences (2012) Vol. 16 (1) : 11-17

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.

RETROSPECTIVE STUDY ON OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN THE ELDERLY AT JSS HOSPITAL, MYSURU

2021 ◽  
pp. 34-35
Author(s):  
Sudhir S. ◽  
Deepak Naik P ◽  
Deepak R. Sridhar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
The Elderly ◽  
Age Group ◽  
Elderly Age ◽  
Duration Of Hospital Stay ◽  
Wide Range ◽  
Conversion To Open Cholecystectomy ◽  
Duration Of Surgery

(a) Laparoscopic cholecystectomy is a widely performed surgery in India and across the world for a wide range of indications. It is one of the most commonly performed surgeries, and hence a study based on outcomes of Laparoscopic cholecystectomy in the elderly would go a long way in determining the safety and success of Laparoscopic cholecystectomy in the elderly, and could help in timing surgery more effectively to avoid complications and difculties. (b) Materials and methods: Out of 250 patients who underwent Laparoscopic Cholecystectomy at JSS Hospital in the period starting January 2019 onwards who were selected by randomization, 65 patients t the criteria (age > 60 years) while 185 patients were aged <60. Data regarding comorbidities, duration of surgery, duration of hospital stay, conversion to open cholecystectomy was compiled and studied. (c) Results: A signicant number of the patients in the elderly age group had associated comorbidities. Duration of surgery was prolonged by a mean duration of 9.5 minutes in the elderly. Duration of hospital stay was increased by a mean of 2.2 days in the elderly. Incidence of conversion to open cholecystectomy was also higher in the elderly. (d) Conclusions: Laparoscopic cholecystectomy is a relatively safe and easy surgery with few complications. However, one may experience difculties while operating on the elderly, viz. Adhesions, contracted gall bladder with hepatic adhesions etc., Which may result in longer duration of surgery and higher rates of conversion to open cholecystectomy.

scholarly journals OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH GALLSTONE DISEASE AT A SECONDARY LEVEL CARE HOSPITAL

2018 ◽  
Vol 31 (1) ◽  
Author(s):  
Ahmed TAKI-ELDIN ◽  
Abd-Elnaser BADAWY
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Care Hospital ◽  
Biliary Leakage ◽  
Port Site Hernia ◽  
Conversion To Open Cholecystectomy ◽  
Secondary Hospital

ABSTRACT Background: Laparoscopic cholecystectomy is the most commonly performed operation of the digestive tract. )It is considered as the gold standard treatment for cholelithiasis. Aim: To evaluate the outcome of it regarding length of hospital stay, complications, morbidity and mortality at a secondary hospital. Methods: Data of 492 patients who underwent laparoscopic cholecystectomy were retrospectively reviewed. Patients’ demographics, co-morbid diseases, previous abdominal surgery, conversion to open cholecystectomy, operative time, intra and postoperative complications, and hospital stay were collected and analyzed from patients’ files. Results: Out of 492 patients, 386 (78.5%) were females and 106 (21.5%) males. The mean age of the patients was 49.35±8.68 years. Mean operative time was 65.94±11.52 min. Twenty-four cases (4.9%) were converted to open surgery, four due to obscure anatomy (0.8%), 11 due to difficult dissection in Calot’s triangle (2.2%) and nine by bleeding (1.8%). Twelve (2.4%) cases had biliary leakage, seven (1.4%) due to partial tear in common bile duct, the other five due to slipped cystic duct stables. Mean hospital stay was 2.6±1.5 days. Twenty-one (4.3%) developed wound infection. Port site hernia was detected in nine (1.8%) patients. There was no cases of bowel injury or spilled gallstones. There was no mortality recorded in this series. Conclusions: Laparoscopic cholecystectomy is a safe and effective line for management of gallstone disease that can be performed with acceptable morbidity at a secondary hospital.

scholarly journals Causes and incidence of laparoscopic cholecystectomy conversion to open cholecystectomy in Al Karama teaching hospital

2018 ◽  
Vol 5 (5) ◽  
pp. 1640
Author(s):  
Mohammed Reda Al Ghadhban ◽  
Hussein Ali Alkumasi ◽  
Mohammed Saleem Meziad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Teaching Hospital ◽  
Open Cholecystectomy ◽  
Standard Procedure ◽  
Biliary Duct ◽  
Female Patients ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy ◽  
Male Patients ◽  
A Prospective Study

Background: There is no doubt that laparoscopic cholecystectomy replaced open cholecystectomy as standard procedure for the treatment of symptomatic cholelithiasis. Conversion from laparoscopic cholecystectomy to open cholecystectomy is still required in many circumstance, this study aimed at exploring causes and incidence of conversion.  Methods: This is a prospective study of 200 cases of laparoscopic cholecystectomy cases were performed in ALKARAMA Teaching Hospital from January2009 to January 2011. All cases were followed at the time of surgery by obtaining data sheet for the patient’s age, sex, time from the introduction of ports till decision of conversion and the cause of conversion if present.Results: Out of 200 laparoscopic cholecystectomy, 12 cases were converted into open cholecystectomy (6%). The major causes were : dense adhesions (4),  bleeding (2), anatomical difficulties (2), impacted stone in Hartmann pauch (2), dilated cystic duct (1) and sever inflammation (1). Two of the conversions are males from 45 male patients underwent laparoscopic cholecystectomy, 10 cases are females from 155 female patients underwent laparoscopic cholecystectomy so the percentage of conversion for male patients is 4.44 % while for female patients is 6.45%.Conclusions: The conversion rate in this study is 6% and the most common cause for conversion is dense adhesions in the Calot’s triangle, no biliary duct injury that need conversion is found in this study and the rate for conversion is higher in female patients.

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