scholarly journals Patterns of complications and outcome of laparoscopic cholecystectomy

2020 ◽  
Vol 7 (2) ◽  
pp. 484
Author(s):  
Prem Chand ◽  
Shivanshu Kundal ◽  
Savijot Singh ◽  
Sangam Papneja ◽  
Jaspal Singh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Side Effects ◽  
Complication Rate ◽  
Open Cholecystectomy ◽  
Standard Procedure ◽  
Major Complication ◽  
Cost Effective ◽  
Conversion To Open Cholecystectomy ◽  
Bladder Pathology ◽  
Major Complication Rate

Background: Cholelithiasis is known to be one of the most common biliary pathologies. Laparoscopic cholecystectomy is the gold standard for the removal of the gallbladder, because of its cosmetic benefit, short stay, cost-effective and lesser side effects. But no procedure is immune to complications and other procedure-related side effects. The present study was conducted to study the patterns of complications and outcome of laparoscopic cholecystectomy.Methods: the present study was conducted prospectively on patients undergoing laparoscopic cholecystectomy for symptomatic gall bladder pathology. the patients undergoing laparoscopic cholecystectomy were distributed and analysed on various parameters i.e. age, sex, ultrasound abdomen findings, complications related to access, per-operative condition of gallbladder, per-operative and postoperative complication.Results: In our study cases major complication rate 1% leading to biliary stricture for which hepaticojejunostomy was done, minor complication rate 11% and conversion to open cholecystectomy rate 2%.Conclusions: It is concluded that laparoscopic cholecystectomy is the safe and standard procedure for the laparoscopic cholecystectomy and its major complication are preventable by strictly following the basic principles of laparoscopic cholecystectomy and keeping a low level of the threshold for converting to open cholecystectomy.

scholarly journals Study of open cholecystectomy for gallbladder disorders

2021 ◽  
Vol 8 (3) ◽  
pp. 826
Author(s):  
Sunil Kumar ◽  
T. Rudra Prasad Reddy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Clinical Judgment ◽  
Open Cholecystectomy ◽  
Standard Procedure ◽  
Demographic Data ◽  
Bile Leak ◽  
Laparoscopic Approach ◽  
Biliary Colic ◽  
Medical College ◽  
Conversion To Open Cholecystectomy

Background: Cholecystectomy is one of the most common surgeries done worldwide. Most common indication is biliary colic due to cholelithiasis. Presently most cholecystectomies are done by laparoscopic approach, however conversion to open cholecystectomy is needed in few circumstances and there are some absolute indications for open cholecystectomy where laparoscopic procedure can’t be done.Methods: This is a prospective observational study of 50 open cholecystectomies operated during March 2017 to Feb 2019 in our medical college. Various data including demographic data of patients, different indications, post-operative complications were documented and analyzed.Results: Mean age of the patients was 40.58 (16-65) years. Female patients were more in number 32 (64%) when compared with males. Maximum patients were in the age group 31-40 years accounting to 17 (34%) of study population. Pain abdomen 24 (48%) was the chief presenting complaint. Cholelithiasis 38 (76%) was the major indication for surgery. Complications like bile leak, bleeding, subphrenic abscess and infection occurred in 04 (08%) patients. Total four cases of laparoscopic cholecystectomy were converted to open cholecystectomy. Mean hospital stay was 7.48 (5-14) days.Conclusions: Even though laparoscopic cholecystectomy is the gold standard in the present era, it is important that the surgeon is also competent in doing open cholecystectomy. Certain conditions require planned open cholecystectomy as the standard procedure. In difficult laparoscopic cases, the surgeon must take timely decision to convert to the open technique. Surgeons experience and proper clinical judgment skills are important in difficult cases.

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.

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.

125 Staged Endovascular Treatment of Ruptured Intracranial Aneurysms: Acute Coiling Followed By Delayed Flow Diversion

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-228
Author(s):  
Erick Michael Westbroek ◽  
Matthew Bender ◽  
Narlin B Beaty ◽  
Bowen Jiang ◽  
Risheng Xu AB ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Major Complication ◽  
Flow Diversion ◽  
Neurological Deficits ◽  
Major Complication Rate ◽  
Ruptured Intracranial Aneurysms

Abstract INTRODUCTION ISAT demonstrated that coiling is effective for aneurysm treatment in subarachnoid hemorrhage (SAH); however, complete occlusion of wide-necked aneurysms frequently requires adjuvants relatively contraindicated in SAH. As such, a limited “dome occlusive” strategy is often pursued in the setting of SAH. We report a single institution series of coiling of acutely ruptured aneurysms followed by delayed flow diversion for definitive, curative occlusion. METHODS A prospectively collected IRB-approved database was screened for patients with aneurysmal SAH who were initially treated by coil embolization followed by planned flow diversion at a single academic medical institution. Peri-procedural outcomes, complications, and angiographic follow-up were analyzed. RESULTS >50 patients underwent both acute coiling followed by delayed, planned flow diversion. Average aneurysm size on initial presentation was 9.5 mm. Common aneurysm locations included Pcomm (36%), Acomm (30%), MCA (10%), ACA (10%), and vertebral (5%). Dome occlusion was achieved in all cases following initial coiling. Second-stage implantation of a flow diverting stent was achieved in 49/50 cases (98%). Follow-up angiography was available for 33/50 patients (66%), with mean follow-up of 11 months. 27 patients (82%) had complete angiographic occlusion at last follow up. All patients with residual filling at follow-up still had dome occlusion. There were no mortalities (0%). Major complication rate for stage I coiling was 2% (1 patient with intra-procedural aneurysm re-rupture causing increase in a previous ICH). Major complication rate for stage 2 flow diversion was 2% (1 patient with ischemic stroke following noncompliance with dual antiplatelet regimen). Minor complications occurred in 2 additional patients (4%) with transient neurological deficits. CONCLUSION Staged endovascular treatment of ruptured intracranial aneurysms with acute dome-occlusive coil embolization followed by delayed flow diversion is a safe and effective treatment strategy.

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.

Diagnostic accuracy and complication rate of image-guided percutaneous transthoracic needle lung biopsy for subsolid pulmonary nodules: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Junghoon Kim ◽  
Choong Guen Chee ◽  
Jungheum Cho ◽  
Youngjune Kim ◽  
Min A Yoon
Keyword(s):  
Diagnostic Accuracy ◽  
Complication Rate ◽  
Needle Biopsy ◽  
Meta Analysis ◽  
Pulmonary Nodules ◽  
Major Complication ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Major Complication Rate ◽  
Higher Sensitivity

Objectives: To determine the diagnostic accuracy and complication rate of percutaneous transthoracic needle biopsy (PTNB) for subsolid pulmonary nodules and sources of heterogeneity among reported results. Methods: We searched PubMed, EMBASE, and Cochrane libraries (until November 7, 2020) for studies measuring the diagnostic accuracy of PTNB for subsolid pulmonary nodules. Pooled sensitivity and specificity of PTNB were calculated using a bivariate random-effects model. Bivariate meta-regression analyses were performed to identify sources of heterogeneity. Pooled overall and major complication rates were calculated. Results: We included 744 biopsies from 685 patients (12 studies). The pooled sensitivity and specificity of PTNB for subsolid nodules were 90% (95% confidence interval [CI]: 85–94%) and 99% (95% CI: 92–100%), respectively. Mean age above 65 years was the only covariate significantly associated with higher sensitivity (93% vs  85%, p = 0.04). Core needle biopsy showed marginally higher sensitivity than fine-needle aspiration (93% vs  83%, p = 0.07). Pooled overall and major complication rate of PTNB were 43% (95% CI: 25–62%) and 0.1% (95% CI: 0–0.4%), respectively. Major complication rate was not different between fine-needle aspiration and core needle biopsy groups (p = 0.25). Conclusion: PTNB had acceptable performance and a low major complication rate in diagnosing subsolid pulmonary nodules. The only significant source of heterogeneity in reported sensitivities was a mean age above 65 years. Advances in knowledge: This is the first meta-analysis attempting to systemically determine the cause of heterogeneity in the diagnostic accuracy and complication rate of PTNB for subsolid pulmonary nodules.

Learning curve for robot-assisted Ivor Lewis esophagectomy

2021 ◽  
Author(s):  
Yu Han ◽  
Yajie Zhang ◽  
Wentian Zhang ◽  
Jie Xiang ◽  
Kai Chen ◽  
...  
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Major Complication ◽  
Robot Assisted ◽  
Ivor Lewis ◽  
Initial Learning ◽  
Cusum Analysis ◽  
Technical Proficiency ◽  
Major Complication Rate ◽  
Two Phases

Summary This study aimed to demonstrate the learning curve of robot-assisted minimally invasive esophagectomy (RAMIE). A retrospective analysis of the first 124 consecutive patients who underwent RAMIE with intrathoracic anastomosis (Ivor Lewis) by a single surgeon between May 2015 and August 2020 was performed. An risk-adjusted cumulative sum (RA-CUSUM) analysis was applied to generate a learning curve of RAMIE considering the major complication rate, which reflected the technical proficiency. The overall 30-day morbidity rate was 38.7%, while the major complication rate was 25.8%. The learning curve was divided into two phases based on the RA-CUSUM analysis: phase I, the initial learning phase (cases 1–51) and phase II, the proficiency phase (cases 52–124). As we compared the proficiency phase with the initial learning phase, significantly decreased trends were observed in relation to the major complication rate (37.3% vs. 18.7%, P = 0.017), total operation time (330.9 ± 55.6 vs. 267.3 ± 39.1 minutes, P < 0.001), and length of hospitalization (10 [IQR, 9–14] days vs. 9 [IQR, 8–11] days, P = 0.034). In conclusion, the learning curve of RAMIE consisted of two phases, and at least 51 cases were required to gain technical proficiency.

scholarly journals Comparison of Early and Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

2021 ◽  
Vol 15 (1) ◽  
pp. 91-94
Author(s):  
Muhammad Nasir ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Female Patients ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
Group A ◽  
Male Patients ◽  
Group B

Background: Laparoscopic Cholecystectomy is now accepted as being safe for acute cholecystitis. However, it has not become routine, because the exact timing and approach to the surgical management remains ill define. Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe Laparoscopic Cholecystectomy. Objective: To compare the early and delayed Laparoscopic Cholecystectomy in the acute phase in terms of frequency of conversion to open cholecystectomy. Study Design: Randomized clinical trial. Settings: Department of Surgery, Divisional Headquarter Hospital, Faisalabad. Punjab Medical College, Faisalabad Pakistan. Duration: Study was carried out over a period of six months from June 2018 to May 2019. Methodology: A total of 152 cases (76 cases in each group) were included in this study. All patients were randomly allocated to either group i.e., group -A early Laparoscopic Cholecystectomy and group-B delayed Laparoscopic Cholecystectomy. Results: Mean age was 39.09 + 8.8 and 37.05+ 8.5 years in group- A and B, respectively. In group-A, male patients were 48 (63.2%) and female patients were 28 (36.8%). Similarly, in group-B, male patients were 41 (53.9%) and female patients were 35 (46.1%). Conversion to open cholecystectomy was required in 6 patients (7.9%) of group-A and 16 patients (21.0%) of group – B. Significant difference between two groups was observed (P= 0.021). Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible in terms of less frequency of conversion to open cholecystectomy.

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.

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