scholarly journals Laparoscopic subtotal cholecystectomy in severe cholecystitis with unclear anatomy

2020 ◽  
Vol 7 (12) ◽  
pp. 3929
Author(s):  
Maged Rihan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Common Bile Duct Stones ◽  
Hospital Length Of Stay ◽  
Safe Procedure ◽  
Female Ratio ◽  
Subtotal Cholecystectomy ◽  
Port Site Hernia ◽  
Significant Difference

Background: Aim of the study was to determine the differences between laparoscopic cholecystectomy and laparoscopic subtotal cholecystectomy as regards bile duct injury and post-operative complications rates in patients with severe cholecystitis and obscure anatomy.Methods: We retrospectively reviewed the charts and postoperative outcomes of 293 patients with severe cholecystitis who underwent either laparoscopic cholecystectomy or laparoscopic subtotal cholecystectomy between September 2011 and January 2020. Patients with intraoperative altered anatomy which leaded to difficult dissection were defined as having severe cholecystitis.Results: There were 304 cholecystectomies done for patients with severe cholecystitis. Of those, 203 underwent laparoscopic cholecystectomy (LC group), 90 underwent laparoscopic subtotal cholecystectomy (LSC group). There was no significant difference in male to female ratio, age, cases performed on an elective or emergency basis, hospital length of stay or initial operative findings. There were 5 patients with detected intraoperative biliary injury in LC group only. Postoperative bile leaks were significantly higher in the LSC (11.1%) than in the LC group (3.9%). Postoperative collections which needed percutaneous aspiration were also significantly higher in the LSC group (18.9%) than in the LC group (7.4%). Reoperation for collection was required in 8 patients in LC group and in 5 patients in LSC group. The rates of retained common bile duct stones, port site hernia, wound infections, and total complications were not significantly different between the two groups (28.1% v. 45.6%).Conclusions: Our study demonstrated that laparoscopic subtotal cholecystectomy is a safe procedure which reduces the risk of bile duct injury and is comparable to laparoscopic cholecystectomy in patients with severe cholecystitis with unclear anatomy.

scholarly journals Laparoscopic cholecystectomy: an experience of university hospital in eastern Nepal

2012 ◽  
Vol 10 (2) ◽  
pp. 134-136
Author(s):  
A Bajracharya ◽  
S Adhikary ◽  
C S Agrawal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
University Hospital ◽  
Biliary Colic ◽  
Female Ratio ◽  
Open Operation ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
History Of

Introduction: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall stones disease. Objective of this study to assess the safety of this procedure, to audit the conversion and bile duct injury rates and the factors which influence these. Methods: A total of 346 laparoscopic cholecystectomy over a six months period (15 April 2010 to 14 October 2010) with their demographics and ethnic group, conversion to open operation and bile duct injury were recorded. Pre operative, operative and the relevant data were collected prospectively. A chi squire test was done to determine significance of any differences between subgroups. Results: Male to female ratio was 1:4. The most common indication for surgery was biliary colic/dyspepsia (51%),cholecystitis (chronic- 49.4%, acute- 12%), pancreatitis, gallbladder polyp, history of recurrent attacks 16.5%,obesity 19.1%. 128 were operated by consultant, 170 by junior consultants, 48 were by senior residents. There was no statistically significant difference found in the duration of surgery between consultants and junior consultants (P=0.264), however significance between consultants and senior residents (P=<0.001)was observed. Conclusion: Despite limited resources, laparoscopic cholecystectomy is feasible and safe for gallstones disease even in developing country like Nepal.DOI: http://dx.doi.org/10.3126/hren.v10i2.6582 Health Renaissance 2012; Vol 10 (No.2); 134-136 

scholarly journals Laparoscopic cholecystectomy: an experience of university hospital in eastern Nepal

1970 ◽  
Vol 10 (1) ◽  
pp. 46-48
Author(s):  
A Bajracharya ◽  
S Adhikary ◽  
CS Agrawal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Injury Rate ◽  
University Hospital ◽  
Biliary Colic ◽  
Female Ratio ◽  
Open Operation ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall stones disease. Objective: To assess the safety of this procedure, to audit the conversion and bile duct injury rates and the factors which influence these. Methods: Demographics and ethnic group, conversion to open operation and bile duct injury recorded. Pre operative, operative and the relevant data collected prospectively. The X2 test to determine significance of any differences between subgroups. Results: A total of 346 laparoscopic cholecystectomy over a six months period (15 April 2010- 14October 2010), male to female ratio 1:4. The most common indication for surgery was biliary colic/dyspepsia (51%),cholecystitis (chronic- 49.4%, acute-12%), pancreatitis, gallbladder polyp, history of recurrent attacks 16.5%,obesity 19.1%. 128 were operated by consultant, 170 by junior consultants, 48 were by senior residents. There were no statistically significant difference found in the duration of surgery between consultants and junior consultants (P=0.264), however significant between consultants and senior residents (P=<0.001). Over all open conversion rate 2.9%, there was a single case of bile duct injury equating to a bile duct injury rate 0.3%. Conclusion: Despite limited resources, laparoscopic cholecystectomy is feasible and safety procedure for gallstones disease even in developing country like Nepal. DOI: http://dx.doi.org/10.3126/hren.v10i1.6007 HREN 2012; 10(1): 46-48

scholarly journals BILE DUCT INJURIES

2018 ◽  
Vol 21 (05) ◽  
pp. 841-844
Author(s):  
Sadia Sana ◽  
Muhammad Jawed ◽  
Ubedullah Shaikh ◽  
Shazia Ubed Shaikh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Open Cholecystectomy ◽  
Female Ratio ◽  
Surgical Department ◽  
Bile Duct Injuries ◽  
Laparoscopic Cholecystectomy Group ◽  
Male Female Ratio ◽  
Group B

Objective: To find out frequency of bile duct injuries during cholecystectomyprocedures either open or laparoscopic. Study design: Prospective observational study. Placeand duration of study: This study was conducted at Surgical department, Liaquat UniversityHospital Jamshoro and Dow International Hospital Karachi, from July 2012 to December2013. Methodology: This study consisted of hundred patients. Patients were divided in twogroups. Group A for open cholecystectomy (OC) comprising of 50 patients who underwentelective open cholecystectomy. Group B for Laparoscopic cholecystectomy (LC) comprisingof 50 patients who underwent elective Laparoscopic cholecystectomy. Inclusion criteria wereall patients diagnosed case of gallstones on the basis of ultrasound abdomen, any age andboth gender. Exclusion criteria included not willing for surgery, General anesthesia problem,pregnant ladies due to risk of foetal loss, carcinoma of gall bladder, stone in CBD and obstructivejaundice. Results: Out of 100 cases of gallstone were operated for either laparoscopic / opencholecystectmy. In open cholecystectomy group 20(40 % ) were male and 30(60 %) female.Ratio male: female ratio of 1:1.5. In laparoscopic cholecystectomy group 11(22 % ) were maleand 39(78 %) female with male: female ratio of 1:3.5. There was wide variation of age rangingfrom a minimum of 10 year to 70 year in both group. The mean age was 41.28+12.30 yearsfor OC group and 38.44+13.50 years for LC group (p 0.02). Common bile duct injury wereoccurred 2(4%) patients in laparoscopic cholecystectomy group while 3(6%) patients observedin open cholecystectomy group. Conclusions: We conclude that found bile duct injury 2(4%)patients in laparoscopic cholecystectomy group while 3(6%) patients observed in opencholecystectomy group

scholarly journals P-EGS21 The impact of COVID-19 on operative difficulty and outcomes of laparoscopic cholecystectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Alisha Pati-Alam ◽  
Paul Vulliamy ◽  
Dipanker Mukherjee ◽  
Samrat Mukherjee
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Hospital Stay ◽  
Bile Duct Injury ◽  
Complication Rate ◽  
Bile Leak ◽  
Length Of Hospital Stay ◽  
Subtotal Cholecystectomy ◽  
Operative Difficulty ◽  
The Impact

Abstract Background The COVID-19 pandemic resulted in substantial delays to surgery among patients with symptomatic gallstones due to cessation of elective surgical procedures. As this exposed patients to a longer period of time during which complications from gallstones could develop, we hypothesised that the operative difficulty and complication rate of laparoscopic cholecystectomy (LC) increased following the first wave of the pandemic. Methods This was a retrospective cohort study of patients receiving emergency or elective LC at a single NHS trust comprising three sites. We included patients undergoing surgery in the pre-pandemic period (July-September 2019) and after resumption of elective surgical services following the first wave of the pandemic (July-September 2020). We compared data on operative duration, length of hospital stay, complications (bile leak, bile duct injury and mortality) and need for subtotal cholecystectomy. Categorical data are reported as n(%) and were compared with Fisher’s exact test. Continuous data are reported as median with interquartile range and compared with Mann-Whitney U Test. Results 220 patients were included; 106 in the pre-pandemic group and 114 in the pandemic group. There were no significant differences in median operative times between the pre-pandemic (91 (71-121 minutes) and post-first wave (86 (69-114) minutes) groups (p = 0.48).  The proportion of prolonged operations (over two hours) was similar in the pre-pandemic and pandemic groups (50% versus 46%, respectively, p = 0.59). Median length of hospital stay was 0 days for both groups (pre-pandemic 0 (0-1) days; pandemic 0 (0-1) days, p = 0.42)). There were no significant differences in the rates of bile leak, bile duct injury, mortality, or the conversion to subtotal cholecystectomy. Conclusions Interruption of elective surgery following the first wave of the COVID-19 pandemic did not result in a discernible change in the technical difficulty or complication rate of LC at our centre. Longer term studies are required to assess the effect of prolonged delays to surgery and the impact of subsequent waves of the pandemic.

CONCOMITANT GALLSTONES AND COMMON BILE DUCT STONES: SHOULD SINGLE-STEP LAPAROSCOPIC CHOLECYSTECTOMY IMMEDIATELY AFTER THE ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY?

2018 ◽  
Vol 8 (6) ◽  
pp. 99-104
Author(s):  
Vy Pham Trung ◽  
Hiep Pham Nhu ◽  
Vu Pham Anh ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Single Step ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Female Ratio ◽  
Cbd Stones ◽  
Study Results

Purpose: To evaluate results from treatment of concomitant gallstones and common bile duct (CBD) stones by ERCP and laparoscopic cholecystectomy. Analysis of single-step or separated-step characteristics. Object: During the 3 years (2015-2017), 285 patients CBD stones concomitant or not gallstones underwent ERCP, 68 patients concomitant gallstones and CBD suitable criteria for inclusion at Hue Central Hospital. Retrospective clinical descriptive study. Results: Average age 52.2±12.5 (24-90), male/female ratio of 0.7/1 (27/41). Abdominal pain was the most common symptom 91.2%, jaundice 51.5%, direct bilirubin increased 27.3±15.6μmol/l (2.2-165). The diameter of CBD stone is 12.4±3.2mm (6-20), gallstones size 11.3±6.2mm (536). The first time CBD stones 95.6%, recurrence CBD stones 4.4%. ERCP and laparoscopic cholecystectomy (LC) 34patients, ERCP 1.4±2.5times and secondary LC. Single-step ductal clearance 76.5%, separatestep ductal clearance 94.1% (p=0.041). Length of hospital stay 6.5±4.3days and 13.6±2.2days (p<0.0001). Conclusions: The percentage of ductal clearance in the separate-step patients group was higher than that single-step patients group with p=0.041. The indication of cholecystectomy immediately endoscopic retrograde cholangio pancreatography should be based on the patient status, the ductal clearance as well as the complications. Key words: Common bile duct stones, Endoscopic retrograde cholangio pancreatography

scholarly journals Early Re- Laparoscopy in Suspected Bile Duct Injuries after Laparoscopic Cholecystectomy

2021 ◽  
Vol 6 (1) ◽  
pp. 1396-1400
Author(s):  
Roshan Ghimire ◽  
Dhiresh Maharjan ◽  
Prabin Thapa
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Bile Leak ◽  
Early Postoperative Period ◽  
Female Ratio ◽  
Medical College ◽  
Bile Duct Injuries ◽  
Definitive Repair ◽  
Operative Findings

Introduction: Management of patients with suspected bile leak or bile duct injury after laparoscopic cholecystectomy is challenging. Early laparoscopy in these groups of patients will benefit in terms of diagnostic as well therapeutic purpose. Objective: This study is done to assess utility of early re-laparoscopy in suspected bile duct injury in early postoperative period following laparoscopic cholecystectomy. Methodology: It is a descriptive study of all consecutive patients who underwent diagnostic as well therapeutic re-laparoscopy when required in suspected bile duct injury in early postoperative laparoscopic cholecystectomy that is within 72 hours of presentation. Study was conducted over a period from June 2019 to December 2020 at Kathmandu medical College, Sinamangal, Kathmandu, Nepal. Relaparoscopic operative findings and therapeutic intervention done were recorded. Result: The mean age at presentation was 34.6 years and male to female ratio was 1:1.8. During the study period, eleven patients underwent re-laparoscopy out of which one had no bile leak. Six out of ten were managed definitely in the same time of re-laparoscopy. However, four patients underwent definitive biliary reconstruction as they had already undergone arteriography in CT scan. Conclusions: Early re-laparoscopy may be beneficial prior to detail radiological investigations in suspected bile leak patients. Early re-laparoscopy can be an effective diagnostic as well therapeutic tool; and also it can help in planning for definitive repair in later date. 

scholarly journals Gallstones in Elderly Patients: Impact of Laparoscopic Cholecystectomy

2000 ◽  
Vol 14 (11) ◽  
pp. 929-932 ◽  
Author(s):  
A Montori ◽  
M Boscaini ◽  
M Gasparrini ◽  
G Miscusi ◽  
L Masoni ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Common Bile Duct Stones ◽  
Safe Procedure ◽  
Bile Duct Stones ◽  
Class Iii

The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.2%) were attempted on elderly patients, 11 (35%) of which were on an emergency basis because of acute cholecystitis, cholangitis or acute biliary pancreatitis. Ten per cent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0%. Associated gallbladder and common bile duct stones were found in five (16%) patients (four preoperative LC endoscopic sphincterotomy and one transcystic approach). The success rate in both of these cases was 100%, overall morbidity was 29% and there was no mortality. These results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists’ class III because an excessive duration of operation is the most common reason for converting to an open cholecystectomy.

scholarly journals Iatrogenic Bile Duct Injuries: An Overview and A Review of Literature

2021 ◽  
Vol 07 (01) ◽  
pp. 037-043
Author(s):  
Vinoth M. ◽  
Abhijit Joshi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Surgical Procedures ◽  
Surgical Repair ◽  
Review Of Literature ◽  
Bile Duct Injuries ◽  
Iatrogenic Bile Duct Injury

Abstract​ Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures worldwide. Iatrogenic bile duct injury (IBDI) is a serious complication of LC and has an incidence of 0.3 to 0.7%. Since it is associated with a significant and potentially lifelong morbidity as well as mortality, diagnosing IBDI as early as possible is of paramount importance. Management of bile duct injuries and prognosis of their surgical repair depend on the timing of its recognition, type and the extent of the injury. In this paper, we present a case of IBDI and attempt to discuss all its dimensions.

Iatrogenic Bile Duct Injury. A Significant Surgical Problem. Assessment of Treatment Outcomes in the Department's Own Material

2015 ◽  
Vol 86 (12) ◽  
Author(s):  
Adam Bobkiewicz ◽  
łukasz Krokowicz ◽  
Tomasz Banasiewicz ◽  
Tomasz Kościński ◽  
Maciej Borejsza-Wysocki ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Retrospective Analysis ◽  
Bile Duct Injury ◽  
Clinical Symptoms ◽  
Open Cholecystectomy ◽  
Multidisciplinary Treatment ◽  
Laparoscopic Technique ◽  
Primary Surgery ◽  
Iatrogenic Bile Duct Injury

AbstractIatrogenic bile duct injuries (BDI) are still a challenging diagnostic and therapeutic problem. With the introduction of the laparoscopic technique for the treatment of cholecystolithiasis, the incidence of iatrogenic BDI increased.was a retrospective analysis of 69 patients treated at the department due to iatrogenic BDI in the years 2004-2014.. In this paper, we presented the results of a retrospective analysis of 69 patients treated at the Department due to iatrogenic BDI in the years 2004-2014. The data were analysed in terms of age, sex, type of biliary injury, clinical symptoms, the type of repair surgery, the time between the primary surgery and the BDI management, postoperative complications and duration of hospital stay.. 82.6% of BDI occurred during laparoscopic cholecystectomy, 8.7% occurred during open cholecystectomy, whereas 6 cases of BDI resulted from surgeries conducted for other indications. In order to assess the degree of BDI, Bismuth and Neuhaus classifications were used (for open and laparoscopic cholecystectomy respectively). 84.1% of patients with confirmed BDI, were transferred to the Department from other hospitals. The average time between the primary surgery and reoperation was 6.2 days (SD 4). The most common clinical symptom was biliary fistula observed in 78.3% of patients. In 28 patients, unsuccessful attempts to manage BDI were made prior to the admission to the Department in other centres. The repair procedure was mainly conducted by laparotomy (82.6%) and by the endoscopic approach (15.9%). Hepaticojejunostomy was the most common type of reconstruction following BDI (34.7%).. The increase in the rate of iatrogenic bile duct injury remains a challenging surgical problem. The management of BDI should be multidisciplinary treatment. Referring patients with both suspected and confirmed iatrogenic BDI to tertiary centres allows more effective treatment to be implemented.

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