A prospective observational study to study and correlate the clinical and microbiological profile of bile cultures in patients with symptomatic cholelithiasis

Background: Biliary infection has been reported in a significant proportion of patients developing gallstones. Many studies have found biliary microflora in 20% to 46% patients with a post-operative infection rate of 7% to 20% in those who undergo cholecystectomy for symptomatic gallstone disease. Various antibiotics are also used empirically as prophylaxis against post-operative infection. The study was conducted in order to determine the bacteriology and to test its sensitivity to commonly used antibiotics of aspirated bile samples taken during laparoscopic cholecystectomy, and to correlate it with the clinical profile recorded in patients with symptomatic cholelithiasis.Methods: A total of 266 patients who underwent laparoscopic cholecystectomy were included in the study over a two year period. Intra operatively, bile was aspirated from gall bladder and sent for culture and antibiotic sensitivity testing.Results: 14.66% (39 out of 266) patients had positive growth with Escherichia coli most commonly isolated in 9.77% (26/266) patients, followed by the Klebsiella species in 4.89% (13 out of 266) patients. All the cultures were sensitive to amikacin and meropenem, 97.44% to imipenem, and only 43.39% were sensitive to ampicillin. A statistically significant correlation was observed between a positive bile culture with the duration of symptoms (p=0.01874) and gall bladder thickness (p<0.0001). No correlation was seen between bile culture and history of acute cholecystitis, number or size of calculi.Conclusions: The results of this study can help develop local guidelines and recommendations based on Indian data to ensure the rational use of prophylactic antibiotics in patients with symptomatic cholelithiasis.

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Predicting difficult laparoscopic cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20180837 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1094 ◽

Cited By ~ 2

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.

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Laparoscopic management of rare “ H type” duplication of gall bladder

Surgical Update: International Journal of Surgery and Orthopedics ◽

10.17511/ijoso.2020.i06.03 ◽

2020 ◽

Vol 6 (6) ◽

pp. 354-357

Author(s):

Dr. Anurag Mishra ◽

◽

Dr. Md Abu Masud Ansari ◽

Dr. Shivanshu Misra ◽

◽

...

Keyword(s):

Congenital Anomaly ◽

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Gallstone Disease ◽

Current Case ◽

Rare Congenital Anomaly ◽

Live Births ◽

Cholecystoenteric Fistula ◽

Double Gallbladder ◽

Symptomatic Gallstone Disease

A duplicated gallbladder is a rare congenital anomaly with an incidence of 1:4000 live births. Theycan remain asymptomatic and identified incidentally or present as acute cholecystitis, empyema,torsion, cholecystoenteric fistula, Gall bladder lump, or carcinoma. Here the current case is aboutdiscussing a case of a 25-year-old female who presented with symptomatic gallstone disease with aduplicated gallbladder having multiple stones in both the gallbladders. MRCP performedpreoperatively revealed Y type duplication (double Gall bladder with common cystic duct).Laparoscopic cholecystectomy was performed and it finally revealed H type duplication (double Gallbladder with separate cystic ducts for each Gall Bladder).

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Bacteriological analysis of bile in laparoscopic cholecystectomy patients

Journal of Nobel Medical College ◽

10.3126/jonmc.v7i1.20846 ◽

2018 ◽

Vol 7 (1) ◽

pp. 41-44

Author(s):

Ashok Koirala ◽

Dipendra Thakur ◽

Sunit Agrawal ◽

Abhilasha Sharma

Keyword(s):

Escherichia Coli ◽

Laparoscopic Cholecystectomy ◽

Bacterial Colonization ◽

Gall Stone ◽

Age Groups ◽

Stone Disease ◽

Klebsiella Species ◽

Bile Culture ◽

A Prospective Study ◽

Preoperative Prophylaxis

Background: Laparoscopic cholecystectomy is commonly performed operation for symptomatic gall stone disease. The presence of stones within the biliary system is associated with the bacterial colonization of the bile. The aim of this study is to evaluate the bacteriological profile of the bile and to determine appropriate antibiotics for preoperative prophylaxis in laparoscopic cholecystectomy patients. Material & Methods: A prospective study was carried out in NMCTH, Biratnagar from June2017- May 2018. A total of 100 patients admitted through OPD of our hospital for laparoscopic cholecystectomy were studied. About 5ml of bile aspirated from gall bladder was transported to laboratory in sterile syringe for culture and sensitivity. All age groups and both sex were included. Results: Bile culture was positive in 16 patients. The most common organisms isolated from bile was Escherichia coli (50%) followed by Klebsiella species (25%). Histopathological report of all 16 cases revealed chronic cholecystitis. Wound infection was seen in 5% cases and all were bile culture positive. Most sensitive drug was found to be aminoglycoside group followed by piperacilin and tazobactam. Conclusion: Most common organism isolated from bile culture was Escherichia coli. Aminoglycoside group of drugs was found to be more promising compared to other group of drugs. It can be considered as a first line drug for preoperative prophylaxis for patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 41-44

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Acute Laparoscopic Cholecystectomy: Delays in Acute Surgery and Cost Analysis of Aproposed New Service

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363511x579468 ◽

2011 ◽

Vol 93 (7) ◽

pp. 261-265

Author(s):

AJ Cockbain ◽

AL Young ◽

E McGinnes ◽

GJ Toogood

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Meta Analysis ◽

Gallstone Disease ◽

Cochrane Review ◽

Length Of Hospital Stay ◽

Biliary Colic ◽

Complication Rates ◽

Acute Surgery ◽

Symptomatic Gallstone Disease

Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for patients presenting with acute cholecystitis as supported by a recent meta-analysis and Cochrane review. Although the benefit of ALC is less clear in patients with biliary colic, few would disagree that earlier cholecystectomy is preferable for most patients with symptomatic gallstone disease. ALC has similar complication rates to elective laparoscopic cholecystectomy (ELC) and a reduced total length of hospital stay. Recurrent symptoms from untreated gallstone disease are common, with the risk of developing more severe complications such as acute cholecystitis, acute pancreatitis or cholangitis while waiting for an operation. It has been reported that patients awaiting ELC after an acute admission have significantly more general practitioner (GP) attendances than those who receive ALC, that they have an average of one emergency department attendance for symptom recurrence and that one in six requires hospital admission due to the severity of recurrent symptoms.

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Cholelithiasis and laparoscopic cholecystectomy: identifying the appropriate time for operative intervention

International Surgery Journal ◽

10.18203/2349-2902.isj20213269 ◽

2021 ◽

Author(s):

Ravi Kotecha ◽

Vishwa Kotecha

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gold Standard ◽

Complete Resolution ◽

Prospective Observational Study ◽

Surgical Intervention ◽

Gallstone Disease ◽

Duration Of Symptoms ◽

Number Of Patients ◽

Before And After ◽

Group B

Background: Cholelithiasis is the most common among hepatobiliary disease and often requires surgical intervention. Laparoscopic cholecystectomy is the gold standard nowadays. This research paper was done to know appropriate time for laparoscopic cholecystectomy and how much improvement will we get after laparoscopic cholecystectomy.Methods: In our prospective observational study, 118 patients of cholelithiasis, 59 with dyspepsia in one group and 59 without dyspepsia in another group were taken. Both groups patients were analysed with Bucklay validated dyspeptic score before and after laparoscopic cholecystectomy till 6 months postoperatively for score improvement.Results: In our study, we confirmed that there was improvement in Buckley validated dyspeptic score in both group of patients with dyspepsia and without dyspepsia 6 month after laparoscopic cholecystectomy but not complete improvement. Improvement in Buckley validated dyspeptic score 6 months after laparoscopic cholecystectomy was more in patients with less duration of symptoms and less frequency of episode preoperatively and in non-dyspeptic patients.Conclusions: We could conclude that even earlier surgery after onset of symptoms didn’t result in complete resolution of symptoms in both groups particularly in group B (patients with dyspepsia). We can say that weather it is dyspeptic or non-dyspeptic gallstone disease, it has benefit from laparoscopic cholecystectomy but we can also say that improvement achieved is not complete as after laparoscopic cholecystectomy there were still number of patients who had Buckley validated score more than 6 in both groups after 6 months of surgery.

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681 Routine Liver Biopsy to Detect Non-Alcoholic Fatty Liver Disease (NAFLD) During Laparoscopic Cholecystectomy for Symptomatic Gallstone Disease (GD). Is It Justified?

Gastroenterology ◽

10.1016/s0016-5085(08)63995-5 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-853

Author(s):

Antonio Ramos-De la Medina ◽

Federico B. Roesch ◽

Alfonso Perez Morales ◽

Silvia Cid-Juarez ◽

Jose M. Remes-Troche

Keyword(s):

Laparoscopic Cholecystectomy ◽

Liver Disease ◽

Liver Biopsy ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Gallstone Disease ◽

Alcoholic Fatty Liver ◽

Symptomatic Gallstone Disease ◽

Alcoholic Fatty Liver Disease

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Time trend and variability of open versus laparoscopic cholecystectomy in patients with symptomatic gallstone disease

Surgical Endoscopy ◽

10.1007/s00464-013-2902-y ◽

2013 ◽

Vol 27 (9) ◽

pp. 3254-3261 ◽

Cited By ~ 14

Author(s):

Mario Saia ◽

Domenico Mantoan ◽

Alessandra Buja ◽

Chiara Bertoncello ◽

Tatjana Baldovin ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Time Trend ◽

Gallstone Disease ◽

Symptomatic Gallstone Disease ◽

Open Versus

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Course and outcomes of complicated gallstone disease in pregnancy: a single centre experience

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192900 ◽

2019 ◽

Vol 7 (7) ◽

pp. 2686

Author(s):

Nihida Akhter ◽

Irfan Nazir Mir ◽

Sheikh Viqar Manzoor

Keyword(s):

Laparoscopic Cholecystectomy ◽

Average Length ◽

Open Cholecystectomy ◽

Gallstone Disease ◽

Length Of Hospital Stay ◽

Delay In Diagnosis ◽

Medical College ◽

Skilled Personnel ◽

Symptomatic Gallstone Disease ◽

In Pregnancy

Background: The incidence of acute abdomen during pregnancy is approximately 1 in 500 pregnancies. The incidence of symptomatic gallstone disease in pregnancy is reported in approximately 0.2-0.5 per 1,000 pregnancies. Symptoms are similar to those in the nonpregnant state. A delay in diagnosis may increase the risk of perforation. Treatment in most cases is conservative. However, recent trends, newer instrumentation and skilled personnel encourage arranging laparoscopic cholecystectomy at the time of diagnosis.Methods: This study was a retrospective study, included 117 pregnant patients with acute gallstone disease, who were treated and followed-up at Government Medical College, Srinagar, Department of General Surgery and Department of Gynae And Obstetrics, between January 2015 and April 2017.Results: The mean age of patients in our study was 28.6 years. Majority of patients 56 (47.86%) were in is trimester of pregnancy. Parity of the patients varied from 1 to 6, with a mean parity of 2.67. The presentation of majority of patients was colicky pain right upper abdomen,108 (92.30%). All patients had gallstones on USG scan.101(86.32%) patients had acute cholecystitis, while 8 (6.83%) patients had predominant features of acute pancreatitis,8(6.83%) patients had accompanying choledocholithiasis The average wall thickness of gallbladder in our patients was 4.62 mm. Majority 106 (90.59%) patients were managed conservatively. 8 (6.83%) patients underwent cholecystectomy in same admission, after failure of conservative management, 7 patients underwent laparoscopic cholecystectomy and one underwent open cholecystectomy. 3 patients (2.56%), who had features of cholangitis were managed by ERCP. The average length of hospital stay in our patient group was 8.61 days. There was one maternal death reported in our study, there were a total of 8 (6.83%) preterm deliveries.Conclusions: Symptomatic gallstone disease in pregnancy is a common surgical problem. Diagnosis during pregnancy can be difficult, majority of cases can be managed conservatively, intervention whenever indicated must be undertaken.

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