scholarly journals Cholelithiasis: causative factors, clinical manifestations and management

2019 ◽  
Vol 6 (6) ◽  
pp. 2133
Author(s):  
Renu Pimpale ◽  
Pradeep Katakwar ◽  
Murtaza Akhtar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Management ◽  
Open Cholecystectomy ◽  
Clinical Manifestations ◽  
Gastrointestinal Disorder ◽  
Xanthogranulomatous Cholecystitis ◽  
Biliary Leak ◽  
Common Complaint ◽  
Causative Factors ◽  
Operative Complications

Background: Cholelithiasis is a common gastrointestinal disorder with an overall prevalence of 2-29%. This study aims to evaluate the evolution of demographic and etiological factors, the clinical manifestations of Cholelithiasis, the surgical management with its post-operative complications and the histopathological findings of the post-cholecystectomy specimen of gallbladder, in central India.Methods: Patients symptomatic or asymptomatic diagnosed ultrasonically as cholelithiasis were included in the study and patients with primary choledocholithiasis were excluded.Results: A total of 92 patients were enrolled, of which 62 (68.89%) were female, with mean age of 45.03yrs ± 13.59. Fifty four patients (58.69%) were having BMI >25. Pain was most common complaint seen in all patients. Jaundice was observed in 13 patients (14.13%) who had associated CBD calculus. Sickling was positive in 8.69% of patients. Lap cholecystectomy was done in 71 (77.17%) patients with a conversion rate of 6.57%. Nineteen (20.65%) were open cholecystectomy with or without CBD exploration and 2 underwent Lap cholecystostomy. Post operatively, surgical site infection was seen in 3 patients (4.22%) of laparoscopic cholecystectomy, 5 patients (26.31%) of open cholecystectomy and biliary leak was seen in 3 patients (15.78%) of open cholecystectomy. Histopathology of gallbladder was chronic cholecystitis in 70 patients (77.77%), malignancy was detected in 5 patients (5.55%) and Xanthogranulomatous cholecystitis in 2 patients (2.22%).Conclusions: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Laparoscopic cholecystectomy offers best surgical management with lesser complications.

Surgical Management of Complex Bile Duct Injuries in Specialized Hepatopancreatobiliary (HPB) Unit

2021 ◽  
Vol 15 (7) ◽  
pp. 1700-1702
Author(s):  
Muhammad Khawar Shahzad ◽  
Tariq Ali Bangash ◽  
Amer Latif ◽  
Hussam Ahmed ◽  
Muhammad Asif Naveed ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Bile Duct ◽  
Hospital Stay ◽  
Surgical Management ◽  
Bile Duct Injury ◽  
Surgical Repair ◽  
Open Cholecystectomy ◽  
Tube Placement ◽  
Bile Duct Injuries

Objective: To describe the surgical management of complex bile duct injuries in a specialized hepatopancreatobiliary unit. Design of the Study: It was a retrospective study. Study Settings: This study was carried out at Department of Anaesthesia and Hepatobiliary Unit, Sheikh Zayed Hospital Lahore from August 2017 to August 2019. Material and Methods: This retrospective study includes 80 patients of bile duct injury who underwent surgical correction of bile duct injury at specialized Hepatopancreatobiliary [HPB] and liver transplant department of Shaikh Zayed Hospital Lahore. All the subjects were evaluated by retrospectively. The information regarding primary operative procedure, drain placement, T-tube placement, presentation, hospital stay, Liver Function Tests [LFTs], level of biliary tract injury and type of surgical procedure obtained from patients records. Results of the Study: During the study period 80 patients – 65 females and 15 male were operated for bile duct injury. Mean age was 39.89 years range 21 to 65 years. Hospital stay ranges from 9 to 36 days with mean of 16.18 days. Patients underwent open cholecystectomy, 43.8% laparoscopic cholecystectomy and in 3 patients procedure was converted from laparoscopic to open. 52.5% patients underwent open cholecystectomy, 43.8 laparoscopic cholecystectomy and in 3 patient’s procedure was converted from laparoscopic to open. Conclusion: It is concluded that the correct long lasting and physiological method to treat injuries of bile duct is only surgical repair. Although, surgical repair of bile duct must be operated by skilled hepatopancreaticobiliary surgeons. A practical method which is selected appropriately and implemented successfully has surely improved surgical outcome without any problem faced during the operation. Keywords: Hepatopancreatobiliary, Bile Duct Injury, Surgical Management

scholarly journals Xanthogranulomatous cholecystitis: A clinicopathological study from a tertiary care health institution

1970 ◽  
Vol 6 (4) ◽  
pp. 472-475 ◽  
Author(s):  
PBS Kansakar ◽  
G Rodrigues ◽  
SA Khan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conversion Rate ◽  
Preoperative Diagnosis ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Tertiary Care ◽  
Chronic Cholecystitis ◽  
Clinical Aspects ◽  
Wall Thickening ◽  
Xanthogranulomatous Cholecystitis

Background: Xanthogranulomatous cholecystitis is an unusual and destructive form of chronic cholecystitis and is indistinguishable from other forms of cholecystitis which makes preoperative diagnosis and surgery difficult. Objectives: To review the demographic and clinical aspects of xanthogranulomatous cholecystitis; to study the possibility of preoperative diagnosis and to identify the causes for difficult surgery. Materials and methods: All cases histopathologically diagnosed as xanthogranulomatous cholecystitis over a period of six years from October 1999 to September 2005 at Kasturba Medical College Hospital, Manipal, India were included in the study. Data of the patients was collected retro and prospectively. Results: A total of 615 patients underwent cholecystectomy out of which 33 (5.2%) were diagnosed to have xanthogranulomatous cholecystitis. Ultrasound abdomen showed gallbladder wall thickening in 19 (57.5%) cases and gallstones in 32 (96.9%) cases. Thirty (90.9%) underwent open cholecystectomy. Gallbladder could be removed totally in 25 (75.6%) cases whereas five (15.2%) had to undergo partial cholecystectomy and in one patient, only cholecystostomy could be performed due to dense adhesions. Laparoscopic cholecystectomy was attempted in 11 patients but successful only in two patients with a conversion rate of 81.8%. Postoperative wound infection was seen in five (15.1%) patients and one (3%) had minor biliary leak which was treated conservatively. Histologically, xanthogranulomatous cholecystitis was associated with malignancy in one (3.03%) patient. There was no mortality. Conclusion: Clinical presentation of xanthogranulomatous cholecystitis was indistinguishable from chronic cholecystitis. Ultrasonography may reveal only non specific findings of calculi and thickened gall bladder wall. Hence preoperative diagnosis is unlikely. Cholecystectomy was usually difficult owing to dense adhesions of gallbladder and Calot's triangle. Conversion rate of laparoscopic cholecystectomy is higher. Morbidity associated with surgery is significant. Key words: Xanthogranulomatous cholecystitis, Cholecystectomy, Malignancy doi: 10.3126/kumj.v6i4.1738   Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 472-475

scholarly journals Rate and Risk Factors for Conversion and Complications of Laparoscopic Cholecystectomy.

2018 ◽  
Vol 27 (2) ◽  
pp. 58-62
Author(s):  
MM Sarker ◽  
MK Sarker ◽  
NA Perveen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conversion Rate ◽  
Open Cholecystectomy ◽  
Preoperative Assessment ◽  
Biliary Leakage ◽  
College Hospital ◽  
Excessive Bleeding ◽  
Port Site Hernia ◽  
Conversion To Open Cholecystectomy ◽  
Operative Complications

Laparoscopic Cholecystectomy has become the gold standard for the surgical treatment of gall bladder disease, but conversion to open cholecystectomy and both operative and post operative complications are still inevitable in certain cases. Knowledge of the rate and impact of the underlying reasons for conversion and complications could help surgeons during preoperative assessment and improve the informed consent of patients. In this study we retrospectively evaluated the rate and reasons for conversion and assessed complications of our laparoscopic cholecystectomy series. We included data of 720 consecutive patients who were attempted to laparoscopic cholecystectomy between January 2008 to March 2014 at Islami Bank Medical College Hospital, Rajshahi. The study included 468 (65%) female and 252 (35%) male with mean age of 38 years (range 16-78 years). Conversion to open procedure was carried out in 58 patients with conversion rate of 8.05%. Dense and extensive adhesions were the most common reasons for conversion (21, 36. 2%). The conversion rate due to operative complications was 13.8% of all converted cases. The major operative complications were extrahepatic bile ducts injuries 2(0.3%), duodenal injury 1(0.1%), excessive bleeding 10(1.4%). The incidence of postoperative complications was 2.8%. The most common post-operative complication was wound infection (11, 1. 52%) followed by biliary leakage in 4(0.55%) patients. Delayed complications seen in our series is port site hernia (1,0.13%). Laparoscopic cholecystectomy is the preferred method even in difficult cases. Conversion from laparoscopic to open cholecystectomy should be based on the sound clinical judgment of the surgeon and not be due to a lack of individual expertiseTAJ 2014; 27(2): 58-62

scholarly journals INFORMATIVE VALUE OF COMPARATIVE ASSESSMENT OF GENERAL CLINICAL INDICATORS IN PATIENTS WITH DESTRUCTIVE CHOLECYSTITIS

2021 ◽  
Vol 21 (3) ◽  
pp. 42-46
Author(s):  
R.B. Abbasaliev
Keyword(s):  
Diabetes Mellitus ◽  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Comparative Assessment ◽  
Control Group ◽  
Clinical Indicators ◽  
Surgical Interventions ◽  
Calculous Cholecystitis

Purpose: comparative assessment of clinical manifestations of the course of destructive calculous cholecystitis before surgical operation. Methods. The study involved 86 patients with destructive cholecystitis (55 women and 31 men). 18 patients with destructive cholecystitis made up group 1, and 14 healthy people formed the control group. Patients with cholecystitis underwent cholecystectomy. The age groups were as following: 18-25, 26-40, 41-60 and 61-75 years. Grouping patients by age and sex enabled to reveal related concomitant diseases and complications of cholecystitis. 48 patients underwent open cholecystectomy, and 38 had laparoscopic cholecystectomy. The study determined the quantitative parameters of various enzymes in blood samples from patients with destructive cholecystitis, and the control group. Results. Standard open cholecystectomy was performed on in 55.8% of cases; consequently, laparoscopic cholecystectomy was performed in 44.2% of cases. A retrospective analysis of the surgical interventions performed has demonstrated 54 (62.8% ) patients had gallstones as a leading cause in the development of cholecystitis; 15 (17.4%) patients had phlegmon, 11 (12.8%) patients had gangrene, 4 (4.7%) patients had polyps, and 2 (2.3%) had gallbladder hypertrophy and complete closure of the lumen. 18 patients who underwent cholecystectomy, had developed various preoperative complications: 13 of them had local peritonitis, 2 patients had partial intestinal obstruction, and 3 were diagnosed as having mechanical jaundice. Local peritonitis was found out as the most common preoperative complication. 16 people had various comorbidities and made 18.6% of all patients. 8 (9.3%) out of 16 of the patients had diagnosis of diabetes mellitus. Conclusion. It should be noted that among all patients who underwent cholecystectomy, various preoperative complications were diagnosed, but local peritonitis was the commonest one. Diabetes mellitus against the background of impaired motility or tone of the intestines, bile ducts and the gallbladder leads to cholestasis and gallbladder inflammation.

scholarly journals A study on surgical management of undescended testis

2018 ◽  
Vol 6 (9) ◽  
pp. 3105
Author(s):  
Mallikarjuna M. ◽  
Mahesh Dhotre ◽  
Shanmukhappa S.
Keyword(s):  
Surgical Management ◽  
Undescended Testis ◽  
Early Age ◽  
Undescended Testes ◽  
Exclusion Criteria ◽  
Common Procedure ◽  
Common Complaint ◽  
Operative Complications ◽  
And Function ◽  
Laparoscopic Orchidopexy

Background: Cryptorchidism which is synonymous with Undescended testes. It is one of the most common congenital anomalies found in children. The aim is to study the surgical management of undescended testis in relation to age, position, side, symptoms, complications and management of undescended testis. This study will present an overview of the current understanding of this challenging problem, mainly concentrating on surgical management.Methods: About 30 cases of undescended testis were included in the study, which were diagnosed with regards to age of presentation, clinical features, inclusion and exclusion criteria and relevant investigations like ultrasonography, diagnostic laparoscopy, CT whereever required. Cases were managed accordingly in the course of study and sampling of cases was taken from Bapuji Hospital and C.G. Hospital, Davangere during the study period.Results: Undescended testis was found more common on right side and most of them presented with the age group of 1-15 years with absence of testis in the scrotum being the most common complaint and hernia was found to be most commonly associated with undescended testis. Most common position of undescended testis was found to be intra-canalicular with most of them being palpable. The only one case had torsion and few of the cases had post operative complications like, wound infection haematoma. Open and laparoscopic orchidopexy can be used as most common procedure in early age group.Conclusions: Undescended testes is eminently treatable in today’s practice with the surgical procedures, an early diagnosis, informed counselling of parents and optimal surgical management offer optimised opportunities for successful placement and function of the testes which lessen the burden of complications.

scholarly journals Xanthogranulomatous Cholecystitis: Our Clinical Experience

2021 ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Gallbladder Cancer ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Xanthogranulomatous Cholecystitis ◽  
Radiological Imaging ◽  
Fibrotic Tissue ◽  
Chronic Inflammatory Condition ◽  
Medical Examinations

Background: Xanthogranulomatous cholecystitis is a rarely encountered chronic inflammatory condition presenting with severely proliferated fibrotic tissue. It usually spreads the neighboring organs, imitates gallbladder cancer and may lead to difficulty in cholecystectomy. Objectives: The present study was directed towards reviewing the results of medical examinations and surgery for xan-thogranulomatous cholecystitis and providing proper surgical treatment for patients with xanthogranulomatous cholecystitis. Methods: This is an observational study in which clinical features of thirty six patients with diagnosis of cholecystitis who were operated in our institute between 2012 and 2019 and found as xanthogranulomatous cholecystitis on pathology were analyzed. Results: The rate of xanthogranulomatous cholecystitis in cholecystectomy patients was found to be 0.6 % (36/5999) in the hospital where this study was performed over 7 years. Xanthogranu-lomatous cholecystitis was not accompanied by gallbladder carcinoma in any of these cases. Xanthogranulomatous cholecystitis could not be diagnosed in any of the patients prior to surgery. Radiological imaging performed before surgery demonstrated cholelithiasis in 29 patients (80.6 %), thickening of the gallbladder wall in 28 patients (77.8%), and suspicious cancer in two patients (5.6%). However, none of the cases of xanthogranulomatous cholecystitis had concomitant gallbladder cancer. Nine (25%) patients underwent open cholecystectomy and Twenty seven patients (75 %) were scheduled to have laparoscopic cholecystectomy, but six of these patients (16,8%) were converted to open cholecystectomy. Conclusion: To conclude, it is still difficult to distinguish xanthogranulomatous cholecystitis from other gallbladder diseases both before and during surgery. The gallbladder commonly adheres to the neighboring organs and tissues and make surgical treatment difficult. A challenging laparoscopy is commonly converted to open surgery, which results in higher rates of complications as compared with standard open or laparoscopic cholecystectomy.

scholarly journals Outpatient Laparoscopic Cholecystectomy

HPB Surgery ◽  
1994 ◽  
Vol 7 (4) ◽  
pp. 261-264 ◽  
Author(s):  
R. Smith ◽  
D. Kolyn ◽  
R. Pace
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Nausea And Vomiting ◽  
Post Operative Period ◽  
Conversion To Open Cholecystectomy ◽  
Operative Complications ◽  
The Future ◽  
Elective Cholecystectomy ◽  
Post Operative Complications

Outpatient Laparoscopic Cholecystectomy was attempted in 98 patients selected from 266 patients presenting for elective cholecystectomy (37%). Two patients required admission following conversion to “open” Cholecystectomy, one patient was admitted for observation because of a technically difficult Laparoscopic Cholecystectomy and 16 patients were admitted because of refractory nausea and vomiting in the early post-operative period. Seventy-nine patients (81%) were able to be discharged home within 4 to 6 hours of surgery, with only one patient requiring readmission to hospital because of the onset of nausea and vomiting. There were no post-operative complications attributable to the outpatient experience. We believe this approach to elective gallbladder pathology can be safely accomplished in selected patients and will be increasingly utilized in the future.

scholarly journals Outcome of laparoscopic cholecystectomy in terms of intraoperative complications in a tertiary care hospital.

2021 ◽  
Vol 29 (01) ◽  
pp. 19-25
Author(s):  
Muhammad Sayyar ◽  
Yousaf Jan ◽  
Shaukat Hussain
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Intraoperative Complications ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Abdominal Ultrasound ◽  
International Studies ◽  
Care Hospital ◽  
Research Committee ◽  
Conversion To Open Cholecystectomy ◽  
Operative Complications

Objectives: The main objective was to evaluate the outcome of laparoscopic cholecystectomy in terms of intra-operative complications and the rate and reasons of conversion to open cholecystectomy. Study Design: Descriptive Study. Setting: Hayatabad Medical Complex, Peshawar. Period: June 2018 to May 2019. Material & Methods: After taking consent of Hospital ethical & research committee, patients admitted with clinical diagnosis of cholelithiasis and chronic cholecystitis, confirmed by abdominal ultrasound, undergoing laparoscopic cholecystectomy fulfilling inclusion criteria were selected. Results: A total of 150 were included in the study. Mean age was 39.2yrs with female to male ratio of 9.75:1. Laparoscopic cholecystectomy was successfully accomplished in 98% cases. In 2% (3 patients) converted cases the most common cause of conversion observed was dense adhesions in the calots triangle. Intra-operative complications were noted in 1.4% patients, those included bile duct injury and leakage from the gallbladder bed. However other complications such as bowel injury, blood vessel injury, and post operative hemorrhage did not occur. Overall morbidity was 1.4% with no mortality. Conclusion: Laparoscopic cholecystectomy is a safe and effective procedure in our setup to the accepted standards, as evident by the national and international studies. And it can be accomplished with minimal morbidity and low rate of conversion with the increasing surgeon’s experience.

scholarly journals A comparative study to assess the post-operative complications between laparoscopic cholecystectomy versus open cholecystectomy

2021 ◽  
Author(s):  
Anurag Salwan ◽  
Rana R. Singh ◽  
Darpan Bansal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Laparoscopic Group ◽  
Developed Countries ◽  
Drainage Tube ◽  
Early Removal ◽  
First Choice ◽  
Operative Complications ◽  
Post Operative Complications

Background: Cholelithiasis is a common problem these days. Earlier it was considered the health problem of the female only. But now it is quite common in the males also. The prevalence of gallbladder stone disease (GBSD) in female to male is 3:1 in 18-65 years age group. In the developed countries GBSD is common and occur in 7% in male and 15% in female with an overall prevalence of 11%. Cholecystectomy is one of the most common operation carried out in general surgery.Methods: Our study was conducted on 60 patients divided in 2 groups of 30 each to compare post-operative complications between laparoscopic cholecystectomy and open cholecystectomy.Results: As per findings of the present study duration of pain, rate of complications and total hospital stay were significantly lower in laparoscopic group. There was early removal of drainage tube, early stitch removal in laparoscopic group.Conclusions: Laparoscopic cholecystectomy can be recommended as first choice operative treatment for patients with cholelithiasis as it provides better cosmetic results, lesser pain, early removal of drainage tube, lesser post-operative hospital stay and fewer incidence of surgical site infection. It should be an available option for all patients requiring elective cholecystectomy.

scholarly journals Surgical management of umbilical and paraumbilical hernias

2017 ◽  
Vol 4 (8) ◽  
pp. 2507
Author(s):  
Purushotham G. ◽  
Revanth K. ◽  
Aishwarya M.
Keyword(s):  
Wound Infection ◽  
Surgical Management ◽  
Surgical Procedures ◽  
Mesh Repair ◽  
Surgical Repair ◽  
Age Groups ◽  
Prolene Mesh ◽  
Tension Free ◽  
Common Complaint ◽  
Operative Complications

Background: To evaluate several types of surgical repair and their morbidity and post-operative complications.Methods: This was a prospective observational surgical study conducted in 50 cases of umbilical and paraumbilical hernias were included, the study was carried out by history, clinical examination, and appropriate investigations for operation were conducted. The patients were treated by either of the two surgical procedures Mayo’s repair or tension free repair using prolene mesh (mesh repair).Results: Umbilical and paraumbilical hernias were more common in females. Highest incidence was noted in 30-40 and 50-60 years age groups. Abdominal swelling was the most common complaint followed by pain. Post-operative complications like wound infection and seroma were noted in both the procedures. These hernias were operated by Mayo’s anatomical repair and tension free hernioplasty (mesh repair). Two recurrences were noted in patients operated by Mayo’s repair. There was no recurrence following mesh repair.Conclusions: Surgery was the main modality of treatment. Fewer complications like wound infection and seroma formation which can be managed conservatively by antibiotics, drainage of the seroma and pus with regular dressings were done. Study emphasizes tension free hernioplasty (mesh repair) to be the procedure of choice for the treatment of umbilical and paraumbilical hernias.

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