scholarly journals An observational study to assess male gender as an isolated risk factor in the laparoscopic cholecystectomy

2021 ◽  
Vol 8 (8) ◽  
pp. 2382
Author(s):  
Bhupen Songra ◽  
Amit Kumar ◽  
Mohit Jain ◽  
Gaurav Jalendra
Keyword(s):  
Risk Factor ◽  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wall Thickness ◽  
Bladder Wall ◽  
Male Gender ◽  
P Value ◽  
Bladder Wall Thickness ◽  
Gall Bladder Wall ◽  
Difficult Cholecystectomy

Background: Laparoscopic cholecystectomy is the procedure of choice for majority of patients with gall bladder disease. The aim of the study was to investigate the role of male gender as an isolated risk factor responsible for the increased peri-operative morbidity of laparoscopic cholecystectomy by excluding associated risk factors.Methods: This was a prospective observational descriptive study 60 cases of elective laparoscopic cholecystectomy admitted to the S. M. S. Hospital from July 2019 to May 2020 were included.Results: The most common age group in male was 41-50 years and in female was 51-60 years. Impacted stones and gall bladder wall thickness >4 mm was causes of difficult cholecystectomy and evenly distributed in both sexes. Operative time (p value=0.268), visual analogue score on day 1 (p value=0.307) and hospital stay (p value=0.376) was more in male group but not statistically significant.Conclusions: Impacted stone and gall bladder wall thickness >4 mm were only factors associated with difficult laparoscopic cholecystectomy and excludes male gender as an isolated risk factor for difficult cholecystectomy however large-scale studies may provide different results.

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 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 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.

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.

scholarly journals Predicting difficulty in laparoscopic cholecystectomy preoperatively using a scoring system

2019 ◽  
Vol 6 (3) ◽  
pp. 957 ◽  
Author(s):  
Mohammed Raza ◽  
Venkata Rajeev M.
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wall Thickness ◽  
Scoring System ◽  
Bladder Wall ◽  
Preoperative Assessment ◽  
P Value ◽  
Operative Outcome ◽  
Gall Bladder Wall ◽  
Impacted Stone

Background: Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures worldwide. Preoperative assessment of difficulty is needed for frequent procedures such as LC in order to avoid complications, preparedness and to guarantee an efficient course of surgery. But there is no scoring system available to predict the difficulty preoperatively.Methods: In our study we have tried to predict a difficult LC preoperatively using a modified scoring system proposed by Randhawa et al. Patients diagnosed to have GB stones requiring LC were evaluated with following factors age, gender, duration of illness, h/o previous GB disease, underwent ERCP, BMI, abdominal scar whether infra umbilical or supraumbilical, palpable gallbladder, sonographic findings - gall bladder wall thickness, pericholecystic collection, impacted stone. Various clinical and radiological and intra-operative parameters were scored. Procedure is graded based on individual surgeon’s opinion as easy/difficult/very difficult. The parameters were analyzed to find their correlation to predicting difficult LC. Degree of difficulty was analyzed.Results: Preoperative scoring system proposed by Randhawa et al that we modified was found to be appropriate for predicting operative outcome in LC, having overall p value for the scoring system of <0.001, with sensitivity of 90.9, specificity of 73.1% and area under RoC of 0.876. In present study, palpable gall bladder, history of previous cholecystitis, and the radiological parameters i.e. GB wall thickness, pericholecystic fluid and impacted stone to be statistically significant.Conclusions: Present modified Randhawa and Pujahari scoring system is valuable and appropriate for predicting operative outcome in laparoscopic cholecystectomy. This, in turn, facilitates better preparedness.

scholarly journals Gall Bladder Wall Thickness as a Predictor for Laparoscopic Cholecystectomy Difficulties in Gadarif, Eastern Sudan

2021 ◽  
Vol 2 (3) ◽  
pp. 158-163
Author(s):  
Sami E. E. Salah ◽  
Hawa Yahia
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wall Thickness ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Bladder Wall Thickness ◽  
Conversion To Open Cholecystectomy ◽  
Gall Bladder Wall ◽  
History Of

Background: Laparoscopic cholecystectomy is a revolutionary change in the treatment of patients with gallbladder stones. Multiple studies have identified factors that are predictive of surgical difficulties including preoperative ultra-sonographic findings. Objective: To determine the effectiveness of sonographic measurement of gall bladder wall thickness as a predictive factor for laparoscopic cholecystectomy difficulties in Gadarif Teaching Hospital, Sudan. Patients and methods: This are a prospective, observational, analytical cross-sectional hospital-based study in which all patients who underwent laparoscopic cholecystectomy for gall stones disease and had a pre-operative sonographic measurement for GBWT in GTH in the year 2019 were included. Results: 110 cases were studied. The male to female ratio was 0.2: 1, the mean age was 35±3.8 years. Past history of the acute attack reported in 54 (48.2%) of the patients, history of ERCP was reported in 2 (1.8%) and the majority of patients 71 (64.5%) has no associated medical condition. Abdominal examination was normal in 69 (62.7%) of the patients, 35 (31.8%) patients showed positive Murphy's sign or other signs. Gall bladder thickening, as a predictor of difficulty, was normal of ≤ 3 mm in 69 (62.7%), mild (4-5 mm) in 34 (30.9%), moderate (6-7 mm) in 5 (4.5%), and severe > 7 in 2 (1.8%) of the patients. A significant association was found between GBWT and: duration of symptoms, the number of attacks, operative time and hospital stay, postoperative complication, and conversion to open cholecystectomy. Operative time was found to be associated with the experience of the operator (P-value < 0.05). Conclusion: Pre-operative sonographic increasing gall bladder wall thickness is associated with difficult laparoscopic cholecystectomy in terms of postoperative complications, prolonged operative time, and conversion to open cholecystectomy even in expert hands.

scholarly journals Assessment of a Scoring System to Predict Difficult Laparoscopic Cholecystectomy

2020 ◽  
Vol 42 (3) ◽  
pp. 71-75
Author(s):  
Prem R Sigdel ◽  
Nirajan Subedi ◽  
Suman Phuyal ◽  
Ashik Pokharel ◽  
Bikal Ghimire ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Gall Bladder ◽  
Wall Thickness ◽  
Bladder Wall ◽  
Bladder Wall Thickness ◽  
Previous Abdominal Surgery ◽  
Gall Bladder Wall ◽  
History Of ◽  
Impacted Stone

Introduction Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. It would be useful to have some reliable predictive factors for conversion in LC. Our aim is to predict difficult laparoscopic cholecystectomy preoperatively by using a scoring system. MethodsA total of 136 patients were included. The parameters considered for this study were old age, male sex, history of hospitalization, obesity, abdominal surgery scar, palpable gall bladder, gall bladder wall thickness, pericholecystic collection and impacted stone. ResultsAmong 136 cases, 70.6% were easy, 24.3% were difficult and 5.1% were very difficult intraoperatively. The factors like age >50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness >4mm and impacted stone were found statistically significant in predicting difficult LC. The preoperative scoring is statistically and clinically a good test for predicting the difficult LC (area under the curve = 0.824) with sensitivity of the test being 82.3% and specificity 72.7%. Conversion rate was 3.67%. ConclusionThe factors like age >50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness >4 mm and impacted stone are the preoperative predictors of difficult LC.

scholarly journals Study of the degree of gall bladder wall thickness and its impact on outcomes following laparoscopic cholecystectomy in JSS Hospital

2018 ◽  
Vol 5 (4) ◽  
pp. 1417
Author(s):  
Sharath Chandra B. J. ◽  
Rahul Bose
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Gall Bladder ◽  
Wall Thickness ◽  
Gallstone Disease ◽  
Bladder Wall ◽  
Bladder Wall Thickness ◽  
Conversion Rates ◽  
Increased Risk ◽  
Gall Bladder Wall

Background: Elective laparoscopic cholecystectomy (LC) is presently the gold standard for management of symptomatic gall stone disease, replacing open cholecystectomy. The objective of this study was to measure gall bladder wall thickness preoperatively on ultrasound in patients with symptomatic gallstone disease and to establish its role as a prognostic indicator for complications during or following laparoscopic cholecystectomy.Methods: Gall bladder wall thickness was measured by ultrasonography in 151 patients who presented with Gallstone disease and underwent laparoscopic cholecystectomy for gallstone disease in the JSS Hospital in the given time period. They were then divided into 4 groups depending upon the wall thickness. Normal (upto 2 mm), mildly thickened (>2 to 4 mm), moderately thickened (>4 to 6mm), severely thickened (>6 mm). The incidence of intra and post-operative complications were monitored and compared between the four groups.Results: The incidence of complications was found to be significantly higher in patients with mildly and moderately thickened gall bladder walls (53.1% and 83.3% respectively) as compared to gall bladders with normal wall thickness (10.5%). Average postoperative length of stay in hospital was significantly higher in patients with thickened walls as compared to patients with normal thickness.Conclusions: With wall thickness of greater than 2 mm, the complication and conversion rates are extremely high. An increase in the thickness of the gall bladder wall leads to an increased risk of complications and conversions as well as an increased length of stay in hospital post operatively. Patients with thickened gall bladder walls accounted for only 30% of the study population but they experienced the maximum number of complications (72.5%) and conversions to open (71.4%).

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