scholarly journals Intraoperative scoring system for grading severity of cholecystitis at laparoscopic cholecystectomy

2021 ◽  
Vol 9 (1) ◽  
pp. 75
Author(s):  
Shefa Tanwir Ansari ◽  
Karamjot Singh Bedi ◽  
Shantanu Kumar Sahu
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Scoring System ◽  
Open Cholecystectomy ◽  
Grading System ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Conversion To Open Surgery ◽  
Carcinoma Gall Bladder ◽  
Tertiary Center ◽  
Operative Findings

Background: Various studies had been carried out to evaluate the risk of preoperative conversion in laparoscopic cholecystectomy. However, there was no grading or scoring of operative findings during surgery at present, making it difficult to compare the publications citing outcomes, including the conversion to open surgery. Sugrue in 2015 devised a scoring system based upon the intraoperative findings in Laparoscopic cholecystectomy. Aim of the study was to grade the severity of cholecystitis during laparoscopic cholecystectomy using intraoperative scoring system, to evaluate the spectrum of cholecystitis in cases of laparoscopic cholecystectomy in a tertiary center using the grades of intraoperative scores and to validate the scoring system devised by Michael Sugrue.Methods: This prospective cross sectional observatory study of 200 patients admitted for laparoscopic cholecystectomy was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India over a period of 12 months. All patients directly planned for open cholecystectomy and carcinoma gall bladder were excluded from the study. Patients were subjected to the intra operative grading system for cholecystitis severity as devised by Micheal Sugrue and the grades were classified with a score of <2 - mild; 2 to 4 -moderate, 5– 7- severe and 8 to 10 – extreme.Results: The operative grading system showed a positive correlation with the severity of cholecystitis.Conclusions: Use of this intra-operative scoring system will help us to provide a trigger for a prompt early conversion to avoid intra-operative complications associated with difficult laparoscopic cholecystectomy.

scholarly journals THE STUDY OF CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN CHOLECYSTECTOMY IN THE TREATMENT OF ACUTE CHOLECYSTITIS.

2019 ◽  
pp. 1-3
Author(s):  
Dug Tariq Hassan ◽  
Rayees Ahmad Bhat ◽  
Liyaqat Nazir ◽  
Shabir Ahmad Dar ◽  
Mohammad Zakiuddin
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Medical Sciences ◽  
Preoperative Risk ◽  
Conversion To Open Surgery ◽  
Preoperative Risk Factors ◽  
Risk Scoring

BACKGROUND: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion.However,there is a need to devise a risk-scoring system based on the identified risk factors to (a) predict the risk of conversion preoperatively for selected patients, (b) prepare the patient psychologically, (c) arrange operating schedules accordingly, and (d) minimize the procedure-related cost and help overcome financial constraints,which is a significant problem in developing countries. AIM: This study was aimed to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy in our setting. MATERIALS AND METHODS:A case control study of patients who underwent laparoscopic surgery from May 2016 to April 2017 at Shere Kashmir Institute of Medical Sciences, Srinagar. All those patients who were converted to open surgery (n = 73) were enrolled as cases.Two controls who had successful laparoscopic surgery (n = 146) were matched with each case for operating surgeon and closest date of surgery. RESULTS:The final multivariate model identified two risk factors for conversion:ultrasonography signs of inflammation (adjusted odds ratio [aOR] = 8.5;95% confidence interval [CI]:3.3,21.9) and age > 60 years (aOR = 8.1;95% CI:2.9,22.2) after adjusting for physical signs,alkaline phosphatase and BMI levels. CONCLUSION: Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors is important for understanding the characteristics of patients at a higher risk of conversion

scholarly journals Determinants for Predicting the Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy - A Prospective Study

2020 ◽  
Vol 7 (50) ◽  
pp. 3006-3009
Author(s):  
Sandeep Kumar Goyal ◽  
Gopal Singhal ◽  
Bhanu Pratap Sharma ◽  
Dinesh Mohan ◽  
Savita Savita ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Scoring System ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Age Groups ◽  
Successful Outcome ◽  
Difficulty Level ◽  
Scoring Method ◽  
Conversion Rates ◽  
Group 3

BACKGROUND Laparoscopic surgery is a kind of minimal access surgery that obviates various complications which are encountered during open method, but the outcome of procedure varies according to condition of the patient. Knowledge of these factors may be used for the preoperative counselling of the patients regarding the successful outcome of the surgery as well as to herald the risk of conversion before undertaking patients. We wanted to evaluate the various preoperative factors for conversion of laparoscopic cholecystectomy to open cholecystectomy.c METHODS A total of 100 patients of both sexes, from all age groups and socio-economic status was included in the study. All routine investigations and USG (Ultrasonography) were done. Risk factors assessed were age, sex, abdominal tenderness, gall bladder wall thickness, any history of para-umbilical surgery. Clinical evaluation was done for each included patient and score was given according to their signs and symptoms. Patients were categorised subsequently into mild (group 1 & 2), moderate (group 3 & 4) and severe (group 5) difficulty as per scoring method. RESULTS The mean age was 46.21 ± 13.36, ranging between 20 years to 80 years (95 % CI 43.56 to 48.86) with 89 females and 11 males. Among the converted group, 3 (18.75 %) participants were > 60 years of age and 2 (2.38 %) participants were of age < 60 years. According to patient's expected level of difficulty in laparoscopic cholecystectomy and according to scoring system, patients were categorised as mild, moderate and severe. A total of 81 patients were categorised as mild, 17 as moderate and 2 as severe. Conversion rate is 0 % in mild difficulty group, 17.64 % in moderate difficulty group and 100 % in severe difficulty group. CONCLUSIONS Difficulty and conversion risk may be predicted accurately by using the scoring system. Surging scores indicated marked increase in difficulty levels intraoperatively and thus affects the conversion rates. Thus, it can be concluded that the scoring system accurately assessed the conversion rates of laparoscopic cholecystectomy preoperatively to open surgery. Higher scores indicated increase in difficulty level. KEYWORDS Laparoscopic Cholecystectomy, Open Cholecystectomy, Determinants

scholarly journals Preoperative prediction of difficult laparoscopic cholecystectomy using a scoring system

2017 ◽  
Vol 4 (10) ◽  
pp. 3388 ◽  
Author(s):  
Ashish K. Khetan ◽  
Meenakshi Yeola
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Scoring System ◽  
Improve Patient Safety ◽  
Gallbladder Disease ◽  
Bladder Wall ◽  
Previous History ◽  
Conversion To Open Surgery ◽  
Preoperative Prediction ◽  
Gall Bladder Wall ◽  
History Of

Background: Laparoscopic cholecystectomy (LC) has become gold standard for the surgical treatment of gallbladder disease. 2% to 15% of patients require conversion to open surgery for various reasons. Pre-operative prediction of “difficult laparoscopic cholecystectomy” may not only improve patient safety but also be useful in reducing the overall cost of therapy. The aim of this study is to study the factors determining the preoperative predictability of difficult laparoscopic cholecystectomy.Method: 30 cases of laparoscopic cholecystectomy operated by a single experienced surgeon. There are total 15 score from history, clinical and sonological findings. They were evaluated and scored on the basis of scoring system of Randhawa and Pujahari. Score up to 5 is defined as easy, 6-10 as difficult and 11-15 as very difficult.Result: Previous history of hospitalization for cholecystitis and increased gall bladder wall thickness were found statistically significant in predicting difficult LC.Conclusion: The scoring system had a positive prediction value for easy prediction of 81.9% and for difficult prediction of 75%. 

scholarly journals Pilot epidemiological study of cleft lip and/or palate inh Kota Kinabalu, Sabah

2013 ◽  
Vol 4 (3) ◽  
pp. 86-91
Author(s):  
Chai Siew Cheng ◽  
SKL Jimeno ◽  
R Sasidaran ◽  
A Sergius
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cross Sectional Study ◽  
Queen Elizabeth Hospital ◽  
Sectional Study ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Secondary Palate ◽  
Male Patients

Objective: To identify number of cases and the type of cleft lip and/or palate managed in government tertiary center (Queen Elizabeth Hospital) in Kota Kinabalu; and to analyze the associative factors of cleft lip and/or palate. Methods: A retrospective cross-sectional study carried out in Hospital Queen Elizabeth, Kota Kinabalu, Sabah from January 2011 to December 2012. Data from 162 new cases, which were referred for cleft lip and/or palate, were included in the study. Result: Cleft lip and palate was the most common type. While cleft lip with or without palate had higher preponderance towards male patients, secondary palate however was more common among female patients. These results were statistically significant. Conclusion: Further and larger scale study need to be carried out to identify the incidence of cleft lip and/or palate in Sabah, and its associated genetic and environmental risk factors. Early identification and intervention for cleft lip and palate need to be emphasized. DOI: http://dx.doi.org/10.3126/ajms.v4i3.8170   Asian Journal of Medical Sciences 4(2013) 86-91

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.

scholarly journals National Trends in the Adoption of Laparoscopic Cholecystectomy over 7 Years in the United States and Impact of Laparoscopic Approaches Stratified by Age

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Anahita Dua ◽  
Abdul Aziz ◽  
Sapan S. Desai ◽  
Jason McMaster ◽  
SreyRam Kuy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Elderly Patients ◽  
Open Cholecystectomy ◽  
Age Groups ◽  
The United States ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Discharge Disposition ◽  
Open Versus ◽  
National Trends

Introduction. The aim of this study was to characterize national trends in adoption of laparoscopic cholecystectomy and determine differences in outcome based on type of surgery and patient age.Methods. Retrospective cross-sectional study of patients undergoing cholecystectomy. Trends in open versus laparoscopic cholecystectomy by age group and year were analyzed. Differences in outcomes including in-hospital mortality, complications, discharge disposition, length of stay (LOS), and cost are examined.Results. Between 1999 and 2006, 358,091 patients underwent cholecystectomy. In 1999, patients aged ≥80 years had the lowest rates of laparoscopic cholecystectomy, followed by those aged 65–79, 64–50, and 49–18 years (59.7%, 65.3%, 73.2%, and 83.5%, resp.,P<0.05). Laparoscopic cholecystectomy was associated with improved clinical and economic outcomes across all age groups. Over the study period, there was a gradual increase in laparoscopic cholecystectomy performed among all age groups during each year, though elderly patients continued to lag significantly behind their younger counterparts in rates of laparoscopic cholecystectomy.Conclusion. This is the largest study to report trends in adoption of laparoscopic cholecystectomy in the US in patients stratified by age. Elderly patients are more likely to undergo open cholecystectomy. Laparoscopic cholecystectomy is associated with improved clinical outcomes.

scholarly journals Laparoscopic cholecystectomy: Conversion rate and complcation

2016 ◽  
Vol 18 (3) ◽  
pp. 43
Author(s):  
BR Malla ◽  
HN Joshi ◽  
N Rajbhandari ◽  
YR Shakya ◽  
B Karki ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conversion Rate ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Conversion To Open Surgery ◽  
Calot’S Triangle ◽  
Conversion Rates ◽  
Conversion To Open Cholecystectomy ◽  
Previous Laparotomy ◽  
History Of

Introduction and Objective: Laparoscopic Cholecystectomy is the standard surgical treatment for gallbladder disease. However, conversion to open surgery is not the complication. Different centers have reported different conversion rates and post operative complications. The objective of this study is to identify conversion rate and post operative complication of laparoscopic cholecystectomyMaterials and Methods: This retrospective study included all laparoscopic cholecystectomies attempted in Dhulikhel hospital during the year 2015. Files of all patients were reviewed to find out the demography of the patients and the indication of Laparoscopic cholecystectomy. The rate of conversion to open cholecystectomy, the underlying reasons for conversion and postoperative complications were analyzed.Results: Out of 324 cases attempted laparoscopic cholecystetomies, two cases with the history of previous laparotomy were excluded to rule out the bias in the result. Out of 322 cases 226(70.18%)were female and 96(29.81%) were male . The mean age was 38 years. Over all conversion rate to open cholecystetomy was 1.86% with frozen calot’s triangle as the most common reason for conversion. The over all postoperative complication was 1.24% with no major bile duct injury.Conclusion: Laparoscopic cholecystectomy can safely be done with low conversion rate and complication.

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