scholarly journals Revisiting Mini-Cholecystectomy in Laparoscopic Era – A Retrospective Study

2020 ◽  
Vol 7 (45) ◽  
pp. 2617-2620
Author(s):  
Phungreikan Ningshen ◽  
Khumallambam Ibomcha Singh ◽  
Ningombam Minita Devi ◽  
Malem Devi M ◽  
Yumkhaibam Sabir Ahmed ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Hospital Stay ◽  
Resource Constraints ◽  
Operating Time ◽  
Rectus Muscle ◽  
Normal Activity ◽  
Incision Length ◽  
American Society ◽  
American Society Of Anesthesiologists

BACKGROUND Mini-cholecystectomy (MC), with its varied incision length, has long been considered feasible with comparable results to laparoscopic cholecystectomy (LC) 1-6,7 We undertook this study, driven by resource-constraints, by well-experienced surgeons, using 3 - 5 cm incision length, in our patients with low BMI. The aim of this study is to compare the results and outcomes between MC and LC. METHODS In this retrospective study of a prospectively maintained database, first 50 patients each were selected for MC and LC respectively. Operative time, pain-score, SSI (Surgical Site Infection), hospital stay, return to normal activity and complications were compared. RESULTS Both groups were matched for age, sex, BMI (Body Mass Index) and American Society of Anesthesiologists (ASA) grading. The mean operating time for MC was 43 minutes and for LC, 64 minutes. Hospital stay for MC was 1.9 days and for LC was 1.8 days, which was statistically not significant. Return to normal activity was 8 days for MC and 6.6 days for LC. In a subset analysis of eight lean and thin patients using 3 - 3.5 cm length incision with rectus muscle splitting, the return to normal activity was 6.9 days which is comparable to LC patients. CONCLUSIONS Mini-cholecystectomy and laparoscopic cholecystectomy produce comparable patient outcomes. In lean and thin patient, MC may be slightly more advantageous than LC in terms of less operating time. KEYWORDS Mini-Cholecystectomy, Laparoscopic Cholecystectomy, Outcome, Lean and Thin Patient

Three-Port, Two Located on the Pfannenstiel Line, Laparoscopic Cholecystectomy Comparison with Traditional Laparoscopic Cholecystectomy

2017 ◽  
Vol 83 (3) ◽  
pp. 260-264
Author(s):  
Musa Akoglu ◽  
Erdal Birol Bostanci ◽  
Muhammet Kadri Colakoglu ◽  
Erol Aksoy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Postoperative Results ◽  
Conversion To Open Surgery ◽  
Included Patient ◽  
History Of ◽  
Abdominal Operations ◽  
American Society ◽  
American Society Of Anesthesiologists

Laparoscopic cholecystectomy (LC) is seen as a gateway to minimally invasive surgery. We defined a new three-port technique with different port sites and compared the postoperative results with traditional four-port LC procedure in a case-match study. Between June 2012 and May 2013, 104 consecutive patients underwent three-port LC by same experienced surgeon. In the same center, 2963 consecutive patients underwent four-port LC, and of these 2963 patients, a matched group of 104 patients was selected. Data included patient age, gender, body mass index, American Society of Anesthesiologists score, history of abdominal operations, intraoperative data about operating time and conversion to open surgery, and postoperative data about length of hospital stay and postoperative complications were recorded prospectively. We concluded that our new three-port technique with different port sites is as feasible and safe as traditional four-port technique.

Timing of Laparoscopic Cholecystectomy for Acute Cholecystitis: Evidence to Support a Proposal for an Early Interval Surgery

2007 ◽  
Vol 73 (11) ◽  
pp. 1188-1192 ◽  
Author(s):  
Jee K. Low ◽  
Paul Barrow ◽  
Anas Owera ◽  
Basil J. Ammori
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Operating Time ◽  
Cost Effective ◽  
Delayed Surgery ◽  
Urgent Surgery ◽  
Bile Duct Injuries ◽  
Total Hospital Stay ◽  
Interval Surgery

We evaluated the safety and feasibility of delayed urgent laparoscopic cholecystectomy (LC) performed beyond 72 hours to overcome the logistical difficulties in performing early urgent LC within 72 hours of admission with acute cholecystitis (AC), and to avoid earlier readmission with recurrent AC in patients awaiting delayed interval. Patients admitted with AC were scheduled for urgent LC. Patients who underwent early urgent LC were compared with those who had delayed urgent surgery. Fifty consecutive patients underwent urgent LC for AC within 2 weeks of admission. There were no conversions and no bile duct injuries. Delayed surgery (n = 36) neither prolonged operating time (90 vs 85 minutes), nor increased operative morbidity (9.7% vs 7.7%) or mortality (2.4% vs 7.7%) compared with early surgery (n = 14). Although delayed surgery was associated with shorter postoperative hospital stay (1 vs 2 days, P = 0.029), it prolonged total hospital stay (9 vs 5 days, P < 0.0001). Delay of LC beyond 72 hours neither increases operative difficulty nor prolongs recovery. It might be more cost effective to schedule patients who could not undergo early urgent LC but are responding to conservative treatment for an early interval LC within 2 weeks of presentation with AC.

Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery

2005 ◽  
Vol 103 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Vadim Nisanevich ◽  
Itamar Felsenstein ◽  
Gidon Almogy ◽  
Charles Weissman ◽  
Sharon Einav ◽  
...  
Keyword(s):  
Body Weight ◽  
Hospital Stay ◽  
Fluid Management ◽  
Postoperative Outcome ◽  
Protocol Group ◽  
Number Of Patients ◽  
Secondary Endpoints ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
The Impact

Background The debate over the correct perioperative fluid management is unresolved. Methods The impact of two intraoperative fluid regimes on postoperative outcome was prospectively evaluated in 152 patients with an American Society of Anesthesiologists physical status of I-III who were undergoing elective intraabdominal surgery. Patients were randomly assigned to receive intraoperatively either liberal (liberal protocol group [LPG], n = 75; bolus of 10 ml/kg followed by 12 ml x kg(-1) x h(-1)) or restrictive (restrictive protocol group [RPG], n = 77; 4 ml x kg(-1) x h(-1)) amounts of lactated Ringer's solution. The primary endpoint was the number of patients who died or experienced complications. The secondary endpoints included time to initial passage of flatus and feces, duration of hospital stay, and changes in body weight, hematocrit, and albumin serum concentration in the first 3 postoperative days. Results The number of patients with complications was lower in the RPG (P = 0.046). Patients in the LPG passed flatus and feces significantly later (flatus, median [range]: 4 [3-7] days in the LPG vs. 3 [2-7] days in the RPG; P &lt; 0.001; feces: 6 [4-9] days in the LPG vs. 4 [3-9] days in the RPG; P &lt; 0.001), and their postoperative hospital stay was significantly longer (9 [7-24] days in the LPG vs. 8 [6-21] days in the RPG; P = 0.01). Significantly larger increases in body weight were observed in the LPG compared with the RPG (P &lt; 0.01). In the first 3 postoperative days, hematocrit and albumin concentrations were significantly higher in the RPG compared with the LPG. Conclusions In patients undergoing elective intraabdominal surgery, intraoperative use of restrictive fluid management may be advantageous because it reduces postoperative morbidity and shortens hospital stay.

scholarly journals Dexmedetomidine use during epiduroscopy reduces fentanyl use and postoperative nausea and vomiting: A single-center retrospective study

2018 ◽  
Vol 6 ◽  
pp. 205031211875680 ◽  
Author(s):  
Takashi Suzuki ◽  
Ryota Inokuchi ◽  
Kazuo Hanaoka ◽  
Machi Suka ◽  
Hiroyuki Yanagisawa
Keyword(s):  
Retrospective Study ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Anesthesia Care ◽  
Low Back ◽  
Monitored Anesthesia Care ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

Objectives: Minimally invasive epiduroscopy has recently been reported as an effective treatment procedure for chronic and intractable low back pain. However, no study has determined safe anesthetics for monitored anesthesia care during epiduroscopy. We aimed to compare and evaluate conventional monitored anesthesia care drugs with dexmedetomidine. Methods: A retrospective study including all patients who underwent epiduroscopy at the JR Tokyo General Hospital from April 2011 to March 2016 was designed. The epiduroscopy procedures were performed under anesthesia with dexmedetomidine plus fentanyl (dexmedetomidine group) or droperidol plus fentanyl (neuroleptanalgesia group). Patients who received analgesics other than fentanyl, another analgesic combined with fentanyl, any sedative other than dexmedetomidine or droperidol, or who had incomplete data were excluded. We compared (1) the type and dose of medication during the epiduroscopy and (2) the incidence of postoperative nausea and vomiting. Results: We identified 45 patients (31 and 14 in the dexmedetomidine and neuroleptanalgesia groups, respectively) with a mean age of 69.0 years. The two groups had comparable characteristics, such as age, sex, body mass index, the American Society of Anesthesiologists Physical Status, analgesics used in the clinic, comorbidities, history of smoking, and the duration of anesthesia. The dexmedetomidine group received a significantly lower fentanyl dose during surgery (126 ± 14 vs 193 ± 21 µg, mean ± standard deviation, p = 0.014) and exhibited a significantly lower incidence of postoperative nausea and vomiting (1 vs 3, p = 0.047) than the neuroleptanalgesia group. Conclusion: This study involved elderly patients, and the use of dexmedetomidine in monitored anesthesia care during epiduroscopy procedures in these patients may reduce the required fentanyl dose during surgery and the incidence of postoperative nausea and vomiting. This strategy may help prevent respiratory depression and aspiration.

scholarly journals Evaluation of Outcome Between Excisional Haemorrhoidectomy and Longo's Technique (PPH)

2019 ◽  
Vol 17 (2) ◽  
pp. 66-72
Author(s):  
Md Atiar Rahman ◽  
Md Shahidul Lslam ◽  
Md Shahadot Hossain Sheikh ◽  
Md Ibrahim Siddique ◽  
Md Ahsan Ullah ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Operating Time ◽  
Normal Activity ◽  
Controlled Study ◽  
Anal Stenosis ◽  
Recurrent Prolapse ◽  
Time Frequency ◽  
Early Return ◽  
Rapid Healing

Objective: The introduction of a Longo’s technique for the treatment of haemorrhoids has the potential for less postoperative pain, a short operating time, rapid healing and an early return to full activity. The outcome of Longo’s technique was compared with that of current standard surgery in a randomized controlled study, and followed up two years. Methods: In a prospective randomized study, 140 patients requiring surgical treatment for haemorrhoids grade 2, 3 and 4 were assigned to either MMF (Milligan-Morgan, Park Ferguson) or PPH (Procedure for prolapse and haemorrhoids) 70 each. Operating time, frequency of postoperative analgesic intake, hospital stay, time to return to normal activity and postoperative complications were also recorded. Results: The Longo’s group had a shorter operating time, less frequent postoperative analgesia intake, and earlier return to normal activity. Postoperative pain at rest and during defecation was less important after PPH if no resection of external piles or skin tags was associated. After a mean follow-up of 24 months (12-46), recurrent haemorrhoidal symptoms, mostly mild and temporary, were reported after both MMF and PPH (Table-3). Four patients (5.71 %) complained of recurrent prolapse and/or external swelling after PPH, requiring re-do surgery in 3 of them between 18 to 32 months. Recurrent prolapse or external piles were also observed in 5 patients (7.14%) after MMF and re-do surgery was needed in 3 of them between 14 and 41 months. Long term patient's satisfaction after PPH was more or less same like after MMF. None of the patients had anal stenosis, incontinence, fecal urgency or sepsis. Conclusions: Postoperative pain is less after PPH. This advantage disappears if any resection is associated with the stapling. Use of a Longo's technique in the treatment of haemorrhoidal disease promotes rapid healing, shorter hospital stay and early return to normal activities. Journal of Surgical Sciences (2013) Vol. 17 (2) :66-72

scholarly journals Fundus first laparoscopic cholecystectomy in patients with gall stone disease and the Fitz-Hugh-Curtis syndrome

2020 ◽  
Vol 8 (6) ◽  
pp. 2062
Author(s):  
Alexander F. Ale ◽  
Mercy W. Isichei ◽  
Danaan J. Shilong ◽  
Solomon D. Peter ◽  
Andrew H. Shitta ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Gall Stone ◽  
Operating Time ◽  
Stone Disease ◽  
Duration Of Hospital Stay ◽  
Duration Of Surgery ◽  
Gall Stone Disease ◽  
The Mean ◽  
Fitz Hugh Curtis Syndrome

Background: To present this experience using the fundus-first technique during laparoscopic cholecystectomy for the management of symptomatic gall stone disease with an intra-operative finding of Fitz-Hugh-Curtis syndrome.Methods: This is a prospective review of patients who had the fundus-first dissection during laparoscopic cholecystectomy. The study was carried out at the Jos University Teaching Hospital (JUTH), and FOMAS hospital, both of which are tertiary hospitals located in Jos. Patients were recruited from January 2017 - January 2019. All patients undergoing laparoscopic cholecystectomy who had an intraoperative diagnosis of Fitz-Hugh-Curtis syndrome, and who had the fundus-first dissection, were included in the study. Patients who had fundus-first dissection for indications other than Fitz-Hugh-Curtis syndrome, were excluded from the study. Demographic and clinical information of patients included age, sex, duration of surgery, complications, and duration of hospital stay. Descriptive statistics were applied.Results: A total of 76 patients had elective laparoscopic cholecystectomies over the study period. Of that number, 17 (22.4%) patients had an intra- operative diagnosis of Fitz-Hugh-Curtis syndrome, and had the fundus-first dissection. The mean patient age was 46.3 years (SD = 11.7 years). All patients were female. The mean operating time was 70 minutes (SD = 23 minutes). The duration of hospital stay was 24 hours. There was one conversion due to uncontrollable intraoperative bleeding.Conclusions: This study revealed that the fundus-first dissection is suitable for removing the gall bladder during laparoscopic cholecystectomy in patients with gall stone disease, and an intraoperative finding of Fitz-Hugh-Curtis syndrome.

Single Incision Laparoscopic Cholecystectomy Performed via the “Marionette” Technique Shows Equivalence in Outcome and Cost to Standard Four Port Laparoscopic Cholecystectomy in a Selected Patient Population

2015 ◽  
Vol 81 (10) ◽  
pp. 1015-1020 ◽  
Author(s):  
Maryam N. Saidy ◽  
Sunal S. Patel ◽  
Mark W. Choi ◽  
Mohammed Al-Temimi ◽  
Deron J. Tessier
Keyword(s):  
Multivariate Analysis ◽  
Laparoscopic Cholecystectomy ◽  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Single Incision ◽  
Univariate Analysis ◽  
Operating Time ◽  
Complication Rates ◽  
Single Incision Laparoscopic Cholecystectomy

The aim of our study is to compare single incision laparoscopic cholecystectomy (SILC) performed using the “marionette” technique (m-SILC), to the standard four-port technique [four-port laparoscopic cholecystectomy (4PLC)]. Patient information was extracted from a prospectively maintained database (n = 188). Our primary endpoint was operative costs (determined by operating time and instruments used). Secondary endpoints were length of stay, operative time, blood loss, and postoperative complication rates. Univariate and adjusted multivariate analysis was used to compare the outcomes. There were a total of 188 patients for this study. Gender, body mass index, American Society of Anesthesiologists class, and resident participation were similar. Patients undergoing m-SILC were younger (43.8 vs 49.8 years old), less likely to have cholangiogram (32% vs 54%), and were more likely to undergo cholecystectomy for chronic cholecystitis (73.3% vs 52%). In univariate analysis, cholecystectomy performed by the “marionette method” as compared with the 4PLC was associated with shorter operative time (67 vs 59 minutes respectively) and shorter hospital stay (1.2 vs 2.08 days respectively). In multivariate analysis, SILC was associated with shorter hospital stay and comparable operative time, blood loss, and postoperative complications. Instrumentation cost was less in SILC (by $94). SILC done by an experienced surgeon with the “marionette” technique on a carefully selected population shows a statistically significant cost benefit while maintaining clinically comparable outcomes to the standard 4PLC.

Surgical Management of Complex Bile Duct Injuries in Specialized Hepatopancreatobiliary (HPB) Unit

2021 ◽  
Vol 15 (7) ◽  
pp. 1700-1702
Author(s):  
Muhammad Khawar Shahzad ◽  
Tariq Ali Bangash ◽  
Amer Latif ◽  
Hussam Ahmed ◽  
Muhammad Asif Naveed ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Bile Duct ◽  
Hospital Stay ◽  
Surgical Management ◽  
Bile Duct Injury ◽  
Surgical Repair ◽  
Open Cholecystectomy ◽  
Tube Placement ◽  
Bile Duct Injuries

Objective: To describe the surgical management of complex bile duct injuries in a specialized hepatopancreatobiliary unit. Design of the Study: It was a retrospective study. Study Settings: This study was carried out at Department of Anaesthesia and Hepatobiliary Unit, Sheikh Zayed Hospital Lahore from August 2017 to August 2019. Material and Methods: This retrospective study includes 80 patients of bile duct injury who underwent surgical correction of bile duct injury at specialized Hepatopancreatobiliary [HPB] and liver transplant department of Shaikh Zayed Hospital Lahore. All the subjects were evaluated by retrospectively. The information regarding primary operative procedure, drain placement, T-tube placement, presentation, hospital stay, Liver Function Tests [LFTs], level of biliary tract injury and type of surgical procedure obtained from patients records. Results of the Study: During the study period 80 patients – 65 females and 15 male were operated for bile duct injury. Mean age was 39.89 years range 21 to 65 years. Hospital stay ranges from 9 to 36 days with mean of 16.18 days. Patients underwent open cholecystectomy, 43.8% laparoscopic cholecystectomy and in 3 patients procedure was converted from laparoscopic to open. 52.5% patients underwent open cholecystectomy, 43.8 laparoscopic cholecystectomy and in 3 patient’s procedure was converted from laparoscopic to open. Conclusion: It is concluded that the correct long lasting and physiological method to treat injuries of bile duct is only surgical repair. Although, surgical repair of bile duct must be operated by skilled hepatopancreaticobiliary surgeons. A practical method which is selected appropriately and implemented successfully has surely improved surgical outcome without any problem faced during the operation. Keywords: Hepatopancreatobiliary, Bile Duct Injury, Surgical Management

scholarly journals Laparoscopic Cholecystectomy Performed by Residents: A Retrospective Study on 569 Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Dario Pariani ◽  
Stefano Fontana ◽  
Giorgio Zetti ◽  
Ferdinando Cortese
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Postoperative Hospital Stay ◽  
Daily Activities ◽  
Safe Procedure ◽  
Duration Of Surgery ◽  
Junior Residents

Introduction. Aim of this study was to evaluate the safety of laparoscopic cholecystectomy performed by residents.Materials and Methods. We retrospectively reviewed 569 elective laparoscopic cholecystectomies.Results. Duration of surgery was84±39min for residentsversus  66±47 min for staff surgeons,P<0.001. Rate of conversion was 3.2% for residentsversus2.7% for staff surgeons,P=0.7. There was no difference in the rates of intraoperative and postoperative complications for residents (1.2% and 3.2%)versusstaff surgeons (1.5% and 3.1%),P=0.7andP=0.9. Postoperative hospital stay was3.3±1.8days for residentsversus  3.4±3.2days for staff surgeons,P=0.6. One death in patients operated by residents (1/246) and one in patients operated by staff surgeons (1/323) were found,P=0.8. No difference in the time to return to normal daily activities between residents (11.3±4.2days) and staff surgeons (10.8±5.6days) was found,P=0.2. Shorter duration of surgery when operating the senior residents (75±31minutes) than the junior residents (87±27minutes),P=0.003.Conclusion. Laparoscopic cholecystectomy performed by residents is a safe procedure with results comparable to those of staff surgeons.

scholarly journals Study of efficacy of combination of dexamethasone and ondansetron versus ondansetron alone using SAMBA guidelines for postoperative nausea and vomiting in laparoscopic cholecystectomy.

2020 ◽  
Vol 27 (09) ◽  
pp. 1839-1844
Author(s):  
Ali Arslan Munir ◽  
Abeera Zareen ◽  
Sumbal Rana
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Memory Loss ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Military Hospital ◽  
Significance Level ◽  
American Society ◽  
Group B ◽  
Post Operative Nausea ◽  
American Society Of Anesthesiologists

Objectives: Comparing the effectiveness of combining ondansetron and dexamethasone vs ondansetron unaided in amounts suggested by SAMBA strategies for stoppage of post-operative nausea and vomiting in laparoscopic cholecystectomy patients. Study Design: Randomized Control trial. Setting: Department of Anaesthesia, Combined Military Hospital, Rawalpindi. Period: Six months (April 2015–October 2015). Material & Methods: A sum of 160 patients were experimented by taking 80 in every group. Group A: of ondansetron. Group B: ondansetron plus dexamethasone. Significance level: 5% Test power: 80% Proportion of the projected population A is 72%1. Foreseen population percentage B is 88%1. Besides successive non-probability specimen system was taken for sample gathering. Patients who were selected were American society of anesthesiologists 1 & 2 while ones with struggle in communiqué e.g. psychologic issues, memory loss, loss of speech etc, pregnant and menstruating ladies3, known of PONV, motion disease, ear problems and vertigo, on long term steroid use3, anguished from diabetes mellitus, hiatal hernia were excluded. The frequency of side effects were duly scribed down and doses of drugs wrote down. Rescue anti vomiting was secondhand for ones of PONV. Results: We deduced that mixture of ondansetron & dexamethasone was effectual in averting post-operative nausea & vomiting equated to Ondansetron unaided. Conclusion: There is variance in incidence of PONV in mutual clusters with combination remedy of ondansetron plus dexamethasone being safer as equated to Ondansetron unaided.

Sign in / Sign up

Export Citation Format

Share Document