scholarly journals Is gender a determinant for the outcome of laparoscopic cholecystectomy?

2020 ◽  
Vol 7 (12) ◽  
pp. 3959
Author(s):  
Akshay Bahadur ◽  
S. D. Bisht ◽  
Yanshul Rathi ◽  
Ashish Shukla ◽  
Aman Aggarwal
Keyword(s):  
Risk Factor ◽  
Laparoscopic Cholecystectomy ◽  
Open Surgery ◽  
Gallstone Disease ◽  
Female Group ◽  
Conversion To Open Surgery ◽  
Significant Difference ◽  
Male Sex ◽  
Operative Findings ◽  
The Impact

Background: Currently, laparoscopic cholecystectomy is one of the most desirable procedures to treat symptomatic gallstone disease. Yet, various risk factors govern its conversion to open surgery. The impact of male sex as a risk factor for conversion has been a questionable issue.  The study aimed to evaluate the role of male sex on outcomes of laparoscopic cholecystectomy.Methods: As per inclusion and exclusion criteria, medical records of all the patients aged 18-70 years who underwent elective LC for a period of 14 months were accessed retrospectively. Data related to patients’ demographic details, intra-operative and post-operative findings was recorded and subjected to analysis.Results: Out of 232 selected cases, 17.67% were males and 82.32% were females. Mean age in both gender groups was similar (p=0.139). Body mass index was also found to be similar in both the groups (p=0.232). There was no significant difference (p=0.85) in the mean operative time between men (29.37±9.29) and women (28.88±15.66). Conversion to open surgery was seen only in female group (1.57%) but it is not significantly from the male group (p=0.42). No significant difference was observed in both groups regarding unwanted intra-operative events (p=0.231) and post-operative complications (p=0.70) and post- operative stay (p=0.50).Conclusions: This study suggests that male gender may not be considered as an independent risk factor for outcome of laparoscopic cholecystectomy. However, extensive research in future may cast further light on this issue.

scholarly journals A study of impact of gender on operative findings and outcome in patients undergoing laparoscopic cholecystectomy

2016 ◽  
Vol 4 (1) ◽  
pp. 390 ◽  
Author(s):  
Saurabh Kumar ◽  
Praveen Kumar ◽  
Ram K. Verma ◽  
Akshat Agarwal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Surgery ◽  
Gallstone Disease ◽  
Female Group ◽  
Conversion To Open Surgery ◽  
Conversion Rates ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
One Year ◽  
Operative Findings

Background: Gallstone disease (GSD) is a prevalent health problem around the globe and the treatment of choice for symptomatic GSD is laparoscopic cholecystectomy (LC). There are many factors that influence the operative findings, conversion rates and the outcome of surgery. Male gender has been considered by some to be an adverse factor in this regard. Through this study we intend to find out the role of gender in the operative findings and outcome of laparoscopic cholecystectomy.Methods: All the patients undergoing laparoscopic cholecystectomy at SMI Hospital, Dehradun during one year period were included in the study with certain exceptions. The details of clinical presentation, operative findings and conversion rates, duration of surgery and peri-operative complications were recorded separately for male and female patients and compared.Results: A total of 402 patients were included in the study. 72 (17.9%) were male and 330 (82%) were female. The mean duration of surgery was significantly greater in the male group (66 min) as compared to female group (60.5 min). The rate of conversion to open surgery was not significantly different in the two groups. There was no significant difference in frequencies of complications in the two groups.Conclusions: Gender has little role as far as overall morbidity and conversion to open surgery are concerned in patients undergoing laparoscopic cholecystectomy.

scholarly journals Is the Male Gender an Independent Risk Factor for Complication in Patients Undergoing Laparoscopic Cholecystectomy for Acute Cholecystitis?

2015 ◽  
Vol 100 (5) ◽  
pp. 854-859 ◽  
Author(s):  
Peter C. Ambe ◽  
Lothar Köhler
Keyword(s):  
Risk Factor ◽  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Independent Risk Factor ◽  
Standard Procedure ◽  
Male Gender ◽  
Conversion To Open Surgery ◽  
Male Group ◽  
Significant Difference ◽  
Male Patients

This paper was designed to investigate the gender dependent risk of complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. Laparoscopic cholecystectomy is the standard procedure for benign gallbladder disorders. The role of gender as an independent risk factor for complicated laparoscopic cholecystectomy remains unclear. A retrospective single-center analysis of laparoscopic cholecystectomies performed for acute cholecystitis over a 5-year period in a community hospital was performed. Within the period of examination, 1884 laparoscopic cholecystectomies were performed. The diagnosis was acute cholecystitis in 779 cases (462 female, 317 male). The male group was significantly older (P = 0.001). Surgery lasted significantly longer in the male group (P = 0.008). Conversion was done in 35 cases (4.5%). There was no significant difference in the rate of conversion between both groups. However the rate of conversion was significantly higher in male patients > 65 years (P = 0.006). The length of postoperative hospital stay was significantly longer in the male group (P = 0.007), in the group > 65 years (P = 0.001) and following conversion to open surgery (P = 0.001). The male gender was identified as an independent risk factor for prolonged laparoscopic cholecystectomy on multivariate analysis. The male gender could be an independent risk factor for complicated or challenging surgery in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.

scholarly journals The Impact of a Dedicated “Hot List” on the In-Patient Management of Patients With Acute Gallstone-Related Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Saurabh Jamdar ◽  
Vishnu V. Chandrabalan ◽  
Rami Obeidallah ◽  
Panagiotis Stathakis ◽  
Ajith K. Siriwardena ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
Operating Theatre ◽  
Index Admission ◽  
Biliary Disease ◽  
Time Period ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Time Periods ◽  
The Impact

Background: Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. This study assesses the impact of dedicated theatre capacity provided by a specialist surgical team on rates of index admission cholecystectomy.Methods: This clinical cohort study compares the management of patients with symptomatic gallstone disease admitted to a tertiary care university teaching hospital over two equal but chronologically separate time periods. The periods were before and after service reconfiguration including a specialist HPB service with dedicated operating theatre time allocation.Results: There was a significant difference in the number of admissions over the two time periods with a greater proportion of patients having index admission surgery in the second time period with correspondingly fewer having more than one admission during this latter time period. In the second time period 43% of patients underwent index admission cholecystectomy compared to 23% in the first (P < 0.001). The duration of surgery was shorter for patients undergoing surgery during the second time period [135 (102–178) min in the first period and in the second period 106 (89–145) min] (P = 0.02).Discussion: This paper shows that the concentration of theatre resources and surgical expertise into regular theatre access for patients undergoing urgent laparoscopic cholecystectomy is an effective and safe model for dealing with acute biliary disease.

A Randomized, Double Blind Clinical Study to Assess the Effects of a Gamma-oryzanol-enriched Rice Bran Oil on Lipid Profile in the Hypercholesterolemic Patients

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S64-S69
Keyword(s):  
Risk Factor ◽  
Cholesterol Level ◽  
Rice Bran ◽  
Serum Cholesterol ◽  
Disease Risk ◽  
Rice Bran Oil ◽  
P Value ◽  
Significant Difference ◽  
Gamma Oryzanol ◽  
The Impact

Background: Hypercholesterolemia is a risk factor for developing coronary artery disease. Lifestyle modification including an intake of healthy food as well as medication have approved effect in lowering serum cholesterol. Objective: The primary objective of the present study was to determine the impact of a gamma-oryzanol-enriched rice bran oil, a product of Thailand, on serum cholesterol level. Materials and Methods: A total of in 54 hypercholesterolemic patients were divided into two groups; RBOh (20,000 ppm of gammaoryzanol, n = 27), and RBOn (5,000 ppm gamma-oryzanol, n = 27). The assigned RBO (15 ml) was intake each day for 8 weeks. Fasting serum lipids were measured at baseline and at the 4th and 8th weeks of the intervention. All patients were advised about lifestyle modifications. Results: When compared to the baseline, subjects received RBOh showed a significant difference in 2 parameters including a reduction of cholesterol level at 8th weeks (p-value = 0.0101), and decrease in LDL-C level at the end of 8th weeks (p-value = 0.0013). In the group treated with RBOn, a significant increase in HDL-C level at the end of 8th weeks (p-value = 0.0303) without any effect on total cholesterol or LDL was observed. No sign of toxic effect on liver or renal functions was seen in both treatment groups. Conclusion: RBO with gamma-oryzanol-enriched could decrease cholesterol and LDL-C level in hypercholesterolemic patients. Therefore, gamma-oryzanol-enriched RBO is a functional food that may reduce cardiovascular disease risk factor. Keywords: Hypercholesterolemia, Rice bran oil, Gamma-oryzanol, Oryza sativa

scholarly journals Impact of health disparities on treatment for single-suture craniosynostosis in an era of multimodal care

2021 ◽  
Vol 50 (4) ◽  
pp. E13
Author(s):  
Caitlin Hoffman ◽  
Alyssa B. Valenti ◽  
Eseosa Odigie ◽  
Kwanza Warren ◽  
Ishani D. Premaratne ◽  
...  
Keyword(s):  
Open Surgery ◽  
Statistical Significance ◽  
Demographic Data ◽  
Tertiary Care ◽  
Insurance Status ◽  
Significant Difference ◽  
Race Ethnicity ◽  
The Impact ◽  
Type Of Surgery ◽  
Surgical Group

Craniosynostosis is the premature fusion of the skull. There are two forms of treatment: open surgery and minimally invasive endoscope-assisted suturectomy. Candidates for endoscopic treatment are less than 6 months of age. The techniques are equally effective; however, endoscopic surgery is associated with less blood loss, minimal tissue disruption, shorter operative time, and shorter hospitalization. In this study, the authors aimed to evaluate the impact of race/ethnicity and insurance status on age of presentation/surgery in children with craniosynostosis to highlight potential disparities in healthcare access. Charts were reviewed for children with craniosynostosis at two tertiary care hospitals in New York City from January 1, 2014, to August 31, 2020. Clinical and demographic data were collected, including variables pertaining to family socioeconomic status, home address/zip code, insurance status (no insurance, Medicaid, or private), race/ethnicity, age and date of presentation for initial consultation, type of surgery performed, and details of hospitalization. Children with unknown race/ethnicity and those with syndromic craniosynostosis were excluded. The data were analyzed via t-tests and chi-square tests for statistical significance (p < 0.05). A total of 121 children were identified; 62 surgeries were performed open and 59 endoscopically. The mean age at initial presentation of the cohort was 6.68 months, and on the day of surgery it was 8.45 months. Age at presentation for the open surgery cohort compared with the endoscopic cohort achieved statistical significance at 11.33 months (SD 12.41) for the open cohort and 1.86 months (SD 1.1473) for the endoscopic cohort (p < 0.0001). Age on the day of surgery for the open cohort versus the endoscopic cohort demonstrated statistical significance at 14.19 months (SD 15.05) and 2.58 months (SD 1.030), respectively. A statistically significant difference between the two groups was noted with regard to insurance status (p = 0.0044); the open surgical group comprised more patients without insurance and with Medicaid compared with the endoscopic group. The racial composition of the two groups reached statistical significance when comparing proportions of White, Black, Hispanic, Asian, and other (p = 0.000815), with significantly more Black and Hispanic patients treated in the open surgical group. The results demonstrate a relationship between race and lack of insurance or Medicaid status, and type of surgery received; Black and Hispanic children and children with Medicaid were more likely to present later and undergo open surgery.

scholarly journals Does the male gender govern conversion of laparoscopic cholecystectomy?

2019 ◽  
Vol 6 (1) ◽  
pp. 14-20
Author(s):  
Kishor Manandhar ◽  
Sujita Manandhar
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Laparoscopic Cholecystectomy ◽  
Operating Time ◽  
Male Gender ◽  
Female Group ◽  
Emergency Visit ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy ◽  
Upper Abdominal

Introductions: Laparoscopic cholecystectomy (LC) occasionally demands conversion to open cholecystectomy (OC) because of multiple risk factors. This study was conducted to find out whether male gender is a stand-alone risk factors for conversion of LC to OC. Methods: This was a comparative analysis of conversion of LC to OC in patients operated for symptomatic cholelithiasis during June 2017 to May 2018 at Bir hospital, National Academy of Medical Sciences, Kathmandu, Nepal. The patients were divided into two groups: male (group 1) and female (group 2). Study variables included gender, America Society of Anesthesiologist class, history of upper abdominal pain within six weeks prior to surgery, upper abdominal surgery, emergency department visit due to upper abdominal pain, adhesion of gallbladder to adjacent structure and body mass index. Binominal logistic regression analysis of risk factors for conversion was conducted. Odds ratio (95% CI) was calculated. The p value ≤ 0.05 was considered statistically significant. Results: Among 151 patients (male 39, female 112), 7 (4.6%, male 3 and female 4) had conversion from LC to OC. Male gender itself as an isolated risk factor had no significant association to conversion (p=0.303). There was no significant difference found for age, operating time and hospital stay. Previous emergency visit (p=0.020) and adhesion (p<0.030) were associated with conversion. Conclusions: Male gender had no significant association for conversion of LC to open. Previous emergency visit due to upper abdominal pain and adhesion of gallbladder were associated risk factors for conversion.

scholarly journals DOES MALE GENDER INCREASE THE RISK OF LAPAROSCOPIC CHOLECYSTECTOMY?

2019 ◽  
Vol 32 (2) ◽  
Author(s):  
Júlio Cezar Uili COELHO ◽  
Giuliano Ohde DALLEDONE ◽  
Wagner SCHIEL ◽  
Jacqueline de Pauli BERBARDIN ◽  
Christiano M. P. CLAUS ◽  
...  
Keyword(s):  
Risk Factor ◽  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Perioperative Complications ◽  
Male Gender ◽  
Female Group ◽  
Intraoperative Complication ◽  
Study Protocols ◽  
Conversion To Open Cholecystectomy

ABSTRACT Background: Laparoscopic cholecystectomy is the preferable treatment for chronic or acute cholecystitis. Some factors may increase the rate of laparoscopic conversion to open cholecystectomy and perioperative complications. The role of gender as a risk factor for laparoscopic cholecystectomy is controversial. Aim: To evaluate the role of the gender on the operative findings and outcome of laparoscopic cholecystectomy. Method: All patients who underwent laparoscopic cholecystectomy for chronic or acute cholecystitis were included. Demographic, clinical, laboratory, imaging exams, intraoperative and postoperative data were obtained and analyzed. The data was obtained retrospectively from electronic medical records and study protocols. Results: Of a total 1,645 patients who were subjected to laparoscopic cholecystectomy, 540 (32.8%) were men and 1,105 (67.2%) were women. Mean age was similar in both genders (p=0.817). Operative time has longer in the male (72.48±28.50) than in the female group (65.46±24.83, p<0.001). The rate of acute cholecystitis was higher in the male (14.3%) than in the female group (5.1%, p<0.001). There was no difference between the genders in regard to the rate of conversion (p=1.0), intraoperative complication (p=1.0), postoperative complication (p=0.571), and operative mortality (p=1.0). Conclusion: Male gender is not an independent risk factor for laparoscopic conversion and perioperative complications.

scholarly journals Laparoscopic cholecystectomy: a prospective cohort study assessing the impact of grade of operating surgeon on operative time and 30-day morbidity

2018 ◽  
Vol 100 (3) ◽  
pp. 178-184 ◽  
Author(s):  
H Tafazal ◽  
P Spreadborough ◽  
D Zakai ◽  
N Shastri-Hurst ◽  
S Ayaani ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Cohort Study ◽  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Operative Time ◽  
Gallstone Disease ◽  
Surgical Trainees ◽  
The Impact

Introduction There is an increasing trend towards day case surgery for uncomplicated gallstone disease. The challenges of maximising training opportunities are well recognised by surgical trainees and the need to demonstrate timely progression of competencies is essential. Laparoscopic cholecystectomy provides the potential for excellent trainee learning opportunities. Our study builds upon previous work by assessing whether measures of outcome are still affected when cases are stratified based on procedural difficulty. Material and methods A prospective cohort study of all laparoscopic cholecystectomies conducted at a district general hospital between 2009 and 2014, performed under the care of a single consultant. The operative difficulty was determined using the Cuschieri classification. The primary endpoint was duration of operation. Secondary endpoints included length of hospital stay, delayed discharge rate and 30-day morbidity. Results A total of 266 laparoscopic cholecystectomies were performed during the study period. Mean operative time for all consultant-led cases was 52.5 minutes compared with 51.4 minutes for trainees (P = 0.67 unpaired t-test). When cases were stratified for difficulty, consultant-led cases were on average 5 minutes faster. Median duration of hospital stay was equivalent in both groups and there was no statistical difference in re-attendance (12.9% vs. 15.3% P = 0.59) or re-admission rates (3.2% vs. 8.1% P = 0.10) at 30 days. Conclusions Our study provides evidence that laparoscopic cholecystectomy provides a good training opportunity for surgical trainees without being detrimental to patient outcome. We recommend that, in selected patients, under consultant supervision, laparoscopic cholecystectomy can be performed primarily by the surgical trainee without impacting on patient outcome or theatre scheduling.

scholarly journals Laparoscopic cholecystectomy in patients with liver cirrhosis: review of intraoperative measures and recommendations

2021 ◽  
Author(s):  
Tamer M. Abdelrahman
Keyword(s):  
Liver Cirrhosis ◽  
Laparoscopic Cholecystectomy ◽  
Open Surgery ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Intraabdominal Pressure ◽  
Biliary Stones ◽  
Conversion To Open Surgery ◽  
Trocar Placement ◽  
Surgical Teams

AbstractSymptomatic biliary stones are related with higher morbidity and mortality rates in patients with liver cirrhosis, especially when patients undergo surgery. The difficulty of cholecystectomy is worsened by liver cirrhosis, especially in patients with extensive liver fibrosis and portal hypertension.Laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis. However, it can be challenging in many aspects and poses a greater degree of difficulty and thus should be performed by experienced surgical teams, who follow the recommendations and take in mined the special precautions which requested to increase safety of the operation and avoid  or reduce the morbidity and mortality , and also who able to tackle the more frequent intraoperative incidents or complications.In this review, we focus on of the technical difficulties and intraoperative recommendations that could be used to approach laparoscopic cholecystectomy in this patient population (trocar placement, intraabdominal pressure, visualization, gallbladder dissection, adjunct for hemostasis, intraperitoneal drains, and conversion to open surgery), and the alternative which can be used in advanced cases  

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