scholarly journals Evaluation of gall bladder mucosal changes in patients undergoing laparoscopic cholecystectomy

2019 ◽  
Vol 6 (11) ◽  
pp. 4108
Author(s):  
Harpreet Singh ◽  
Roop Kishan Kaul ◽  
Naveen Kumar Singh ◽  
Aviral Gupta ◽  
Vikram Singh Yadav
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Bladder Wall ◽  
Gall Stone ◽  
Granulomatous Inflammation ◽  
Stone Disease ◽  
Research Centre ◽  
Mucosal Response ◽  
Gall Bladder Wall ◽  
Mucosal Changes

Background: Histopathological changes induced by gall stone disease or cholelithiasis are diverse including acute inflammation, chronic inflammation, glandular hyperplasia, granulomatous inflammation, cholesterosis, dysplasia and carcinoma. Hence, this study was planned to assess gallbladder mucosal changes in patients undergoing laparoscopic cholecystectomy (LC) and it’s correlation with number and types of stone.Methods: A total of 50 patients with symptomatic cholelithiasis scheduled to undergo laproscopic cholecystectomy (LC) after written and informed consent from October 2015 to October 2018 at Teerthanker Mahaveer Medical College and Research Centre, Moradabad were followed prospectively. Preoperative biochemical profile and ultrasonography of whole abdomen of all the patients was obtained. LC was done under the hands of the skilled and experienced surgeons. Morphologic profile of gallstones was recorded and analysed. Gallbladder mucosal tissues were sent to general pathology department for analysis. Histopathological typing of all the gallbladder mucosal specimens was done and was correlated with the number and type of gallstones.Results: In majority (76%) cases, cholecystitis was found. Hyperplasia was seen in 10% patients. Cholecystitis with metaplasia in 10 percent of the cases and carcinoma in 2 percent of the cases. While correlating the gallbladder mucosal response with the number and type of stones, non-significant results were obtained.Conclusions: There might be some association between gall bladder mucosal changes and gall stone. We cannot say an etiologic and effective correlation from the results of this study; possible mechanism may be gall stone erodes gall bladder wall constantly over a period of time which may constitute a risk. While correlating gallbladder mucosal response with the number and type of stones, non-significant results were obtained.

scholarly journals Laparoscopic cholecystectomy in wall echo complex gall stone disease: a study

2017 ◽  
Vol 4 (4) ◽  
pp. 1309
Author(s):  
Bhavinder K. Arora ◽  
Rachit Arora ◽  
Akshit Arora
Keyword(s):  
Gall Bladder ◽  
Bladder Wall ◽  
Gall Stone ◽  
Stone Disease ◽  
Cystic Artery ◽  
The Third ◽  
Calot’S Triangle ◽  
Conversion Rates ◽  
Gall Stone Disease ◽  
Gall Bladder Wall

Background: There are so many subtitles for difficult laproscopic cholecystectomy. Stone in the neck of gall bladder constitutes one of the entities. Wall echo complex is an ultrasound terminology used for cholelithiasis. It has three layers, first the pericholecystic fat between gallbladder and liver. Second layer consists of gall bladder wall. The third layer consists of echogenic stone itself. Wall echo complex is one of the entities which constitute difficult laproscopic cholecystectomy. Wall echo complex in the neck of the gall bladder is particularly difficult gall bladder where the conversion rates are high.Methods: The study was conducted in Department of Surgery. Standard four port cholecystectomy was done in 50 patients. Wall echo complex in all these patients was reported by ultrasonologist. Difficulties in operating wall echo complex cholelithiasis consisted of dissection of neck of gall bladder due to adhesions and a sleeve of fat covering the calot’s triangle. The difficulty of wall echo cholelithiasis was managed by opening the neck of gall bladder and evacuating the stones into a separate latex bag. By this procedure the difficult wall echo cholelithiasis was managed in all cases. Ligaclips were used for ligation of cystic duct, cystic artery and pericholecystic veins.Results: The evacuation of stones from the neck of gall bladder led to an easy cholecystectomy in 46 patients while the four patients had conversion to open cholecystectomy.Conclusions: Wall echo complex although an ultrasonologists entity but is a difficult gall bladder for laproscopic cholecystectomy. 

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.

scholarly journals Predicting difficult laparoscopic cholecystectomy

2018 ◽  
Vol 5 (3) ◽  
pp. 1094 ◽  
Author(s):  
Atul Kumar Gupta ◽  
Nitin Shiwach ◽  
Sonisha Gupta ◽  
Shalabh Gupta ◽  
Apoorv Goel ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Statistical Significance ◽  
Gallstone Disease ◽  
Bladder Wall ◽  
P Value ◽  
Clinical Predictors ◽  
Duration Of Symptoms ◽  
Gall Bladder Wall ◽  
History Of

Background: Laparoscopic cholecystectomy (LC) has become the gold standard treatment for gallstone disease. Though mostly safe occasionally it can be difficult due to various problems faced during surgical procedure. Anticipation of likely difficulty can help in avoiding complications.Methods: With the aim of identifying various predictors of difficulty and their correlation with likely difficulty this prospective study on 50 adults undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis was undertaken. Various clinical, radiological and biochemical predictors and frequency and type of intraoperative difficulty was recorded.Results: In present study adverse clinical factors only showed significant predictive value (p value - 0.005). Adverse radiological predictors although showing trend towards, did not achieve statistical significance (p value 0.065). In clinical predictors duration of symptoms >1yr, History of acute cholecystitis and BMI >30 showed statistically significant association. Age >50yrs, Male gender, radiological predictors (Thickened gall bladder wall, small contracted gall bladder, Single large impacted stone) and deranged LFT did not show significant predictive value.Conclusions: Clinical predictors are most reliable factors. Use of good clinical judgement regarding possibility of and likely difficulty along with understanding of available resources is important in making decision in each case.

scholarly journals Role of gallbladder wall thickness in predicting laparoscopic operability prior to cholecystectomy: a retrospective analysis

2018 ◽  
Vol 5 (5) ◽  
pp. 1885
Author(s):  
Priyank Pathak ◽  
Rihan Zaidi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wall Thickness ◽  
Open Surgery ◽  
Bladder Wall ◽  
Gallbladder Wall ◽  
Bladder Wall Thickness ◽  
Conversion To Open Surgery ◽  
Gall Bladder Wall ◽  
Calculous Cholecystitis

Background: Laparoscopic cholecystectomy is the gold standard procedure for cholecystitis. There are variable rates of conversion of laparoscopic cholecystectomy to open cholecystectomy. Various studies have highlighted gall bladder wall thickness of > 3mm as an independent risk factor for conversion. The purpose of our study is to predict the feasibility of cholecystectomy laparoscopically bases on the pre-operative ultrasound guided measurement of gall bladder wall thickness.Methods: It is a retrospective study conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS) from June 2016 to September 2017. Patient’s pre-operative complete haemogram, liver function tests were also analyzed. Gallbladder wall thickness was estimated by using the maximal obtainable measurement at the fundus. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter.Results: A total of 192 patients were included in this study. Most of the patients were of the age group between 30-40 years, with average age of 37 years and 70% of the patients were females. Out of 192, 176 patients underwent laparoscopic cholecystectomy and 16 patients required conversion to open surgery. Ninety patients (46.8%) had cholecystectomy for acute cholecystitis and one hundred two patients (53.15%) had cholecystectomy for chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 23 patients (25.5%) with acute calculous cholecystitis and greater than 3 mm in 25 patients (24.5%) with chronic calculous cholecystitis. Forty-eight patients, out of a total of 192, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 16 of these patients (33.3%) required conversion to an open cholecystectomy.Conclusions: Gall bladder wall thickness bases on ultrasound is a good predictor for difficult cholecystectomy and conversion to open surgery.

scholarly journals A comprehensive review of the factors predicting technical difficulty in laparoscopic cholecystectomy

2017 ◽  
Vol 4 (4) ◽  
pp. 1147
Author(s):  
Aravind Menon
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Predictive Factors ◽  
Bladder Wall ◽  
Technical Difficulty ◽  
Level Of Evidence ◽  
Calot’S Triangle ◽  
Gall Bladder Wall ◽  
Predictive Risk ◽  
Upper Abdominal

Laparoscopic cholecystectomy is the most common laparoscopic procedure performed all over the world. It has now become the gold standard management for symptomatic gallstones. Aim of the study was to identify and highlight the predictive factors determining intra operative technical difficulty in laparoscopic cholecystectomy. A database search was done in Medline, Google scholar and Journal seek using keywords ‘Laparoscopic Cholecystectomy’, ‘difficult cholecystectomy’ and ‘predictive factors’. 54 abstracts were shortlisted out of which 15 were selected based on the time of publication (after 2005), size of study group, relevance to the title, level of evidence and the journal of publication. Results were compared and reviewed and the conclusion was reached. Fifteen papers were reviewed based on literature search and statistically significant variables predicting the technical difficulty in Laparoscopic cholecystectomy was found. These were age, sex, obesity, previous upper abdominal surgeries, comorbid diseases like Diabetes, acute cholecystitis, raised WBC counts, gall bladder wall thickness more than 3mm, presence of pericholecystitic collection, single impacted stone, multiple stones, contracted gall bladder, adhesions at Calot’s triangle, intrahepatic gall bladder, complications like gangrenous GB and fistulisation. The predictive risk factors reviewed here need to be kept in mind by the laparoscopic surgeon during a laparoscopic cholecystectomy. Though none of them is an absolute contraindication, presence of these factors demand modifications in technique for a safe laparoscopic surgery.

scholarly journals Multiple port sites metastasis after laparoscopic cholecystectomy: a case report

2017 ◽  
Vol 4 (12) ◽  
pp. 4096
Author(s):  
Farhanul Huda ◽  
Sudhir K. Singh ◽  
Arvind Gupta ◽  
Navin Kumar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Radical Surgery ◽  
Histopathological Examination ◽  
Gall Stone ◽  
Stone Disease ◽  
Rare Occurrence ◽  
Port Site Metastasis ◽  
Gall Stone Disease ◽  
Incidental Gallbladder Cancer

Laparoscopic cholecystectomy is a surgical procedure of choice for gall stone disease. Incidental gallbladder cancer is found in about 0.25-3% of patients after routine cholecystectomy. Depending on the stage of tumour, additional radical surgery may be required. In recent years, several reports of port site metastasis have been published. Here, we report a case of a 55-year-old female patient who presented to us with simultaneous multiple port sites metastasis after an interval of 15 months of laparoscopic cholecystectomy for gall stone disease. We recommend the routine use of specimen bag for the retrieval of gall bladder during laparoscopic cholecystectomy and also to send the gall bladder for histopathological examination. To the best of our knowledge, metastasis to more than one port is a very rare occurrence.

scholarly journals Predictive factors for conversion from laparoscopic to open cholecystectomy: an institutional study

2018 ◽  
Vol 5 (8) ◽  
pp. 2894
Author(s):  
Digvijoy Sharma ◽  
Kunduru Nava Kishore ◽  
Gangadhar Rao Gondu ◽  
Venu Madhav Thumma ◽  
Suryaramachandra Varma Gunturi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Bladder Wall Thickness ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy ◽  
Gall Bladder Wall

Background: Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gallstones. However, a conversion to open surgery may be required to complete the procedure safely. The aim of this study is to identify the predictive factors of conversion from laparoscopic to open cholecystectomy in elective setting.Methods: A retrospective review of all patients underwent laparoscopic cholecystectomy electively for symptomatic gallstones from January 2016 to December 2017 was performed. Data considered for analysis were: demographic data, preoperative laboratory values of liver function tests, gall bladder wall thickness on ultrasound, preoperative ERCP, indication for surgery, history of acute cholecystitis, presence of intraoperative adhesions and frozen Calot's triangle. Conversion to open cholecystectomy was chosen as the dependent variable for both, univariate and multivariate analysis.Results: 546 patients underwent laparoscopic cholecystectomy. 333 were females (60.9%) and 213 (39.1%) males, with a mean age of 44.6 years. The most common indication for surgery was symptomatic cholelithiasis. Conversion to open cholecystectomy occurred in 48 cases (8.8%) and the most common reason for conversion was inability to define the Calot’s triangle anatomy due to inflammation/adhesions. Univariate and multivariate analyses of various variables demonstrated that male gender, gall bladder wall thickness >5 mm and presence of previous documented acute cholecystitis had statistically significant co-relation with higher rates of conversion (p<0.001).Conclusions: Presence of acute cholecystitis, gall bladder wall thickness >5mm on preoperative ultrasound and male gender were independent predictor factors for conversion from laparoscopic to open cholecystectomy. Such patients should be properly counselled about the increased risk for conversion and should be operated by surgeons experienced in laparoscopic procedures to reduce the rate of conversion and operative complications.

Retroperitoneal abscess with retained gall-stones as a late complication of laparoscopic cholecystectomy

2016 ◽  
Vol 88 (1) ◽  
Author(s):  
Mateusz Kamiński ◽  
Michał Nowicki
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Female Patient ◽  
Rare Case ◽  
Bladder Wall ◽  
Late Complication ◽  
Retroperitoneal Abscess ◽  
Gall Stones ◽  
Gall Bladder Wall ◽  
Golden Standard

AbstractLaparoscopic cholecystectomy is the golden standard, considering treatment of cholelithiasis. During the laparoscopic procedure one may often observe damage to the gall-bladder wall, as well as presence of gall-stones in the peritoneal cavity, as compared to classical surgery. These gall-stones may be associated with the occurrence of various complications following surgery. The study presented a rare case of a retroperitoneal abscess, as a consequence of retained gall-stones, in a female patient who was subject to laparoscopic cholecystectomy two years earlier.

Ultrasound Measurement of the Gallbladder Wall Thickness in the Assessment of the Risk of Conversion from Elective Laparoscopic Cholecystectomy to Open Surgery — Olkusz County Experience

2016 ◽  
Vol 88 (6) ◽  
Author(s):  
Dariusz Kania
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wall Thickness ◽  
Bladder Wall ◽  
Gallbladder Wall ◽  
Categorical Variables ◽  
Ultrasound Measurement ◽  
Intestinal Fistula ◽  
Bladder Wall Thickness ◽  
Gall Bladder Wall

Abstractwas to assess the risk of intraoperative difficulties, conversion and biliary-intestinal fistula during laparoscopic cholecystectomy on the basis of an ultrasound-measured gall-bladder wall thickness.A prospective study was conducted in 50 patients undergoing laparoscopic cholecystectomy for chronic gallstone-induced cholecystitis. To calculate the relationships between categorical variables, a chi-square (χThe relationship between the gall-bladder wall thickness and the occurrence of intraoperative difficulties in the analysed set is deterministic (AUC = 1), and the wall thickness of ≥ 5 mm allows to predict their occurrence as soon as at the stage of diagnostic evaluation (p < 0.001). In addition, the ultrasound-measured GB wall thickness is a good predictor of conversion (AUC = 0.976; 95% CI 0.444–0.975; p < 0.001) and biliary-intestinal fistula (AUC = 0.935; 95% CI 0.121–0.738; p = 0.001).The results allow prediction of technically difficult laparoscopic cholecystectomies in patients with CCh, and selection of the right surgical team helps to reduce the number of conversions and possible complications. In addition, bearing in mind the above results in everyday practice should facilitate planning and increase effectiveness in the operating room.

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