scholarly journals Anaotmical variability in the position of cystic artery and its affect on surgical approach during laparoscopic cholecystectomy

2020 ◽  
Author(s):  
Muhammad Samir Irfan Wasi ◽  
Omer Fateh ◽  
Syed Muhammad Abdullah Bukhari
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Learning Curve ◽  
Cystic Duct ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Cystic Artery ◽  
Care Hospital ◽  
Open Approach ◽  
Safe Area ◽  
History Of

Abstract Background: The laparoscopic view of extrahepatic biliary tract and cystic artery is different anatomically from open approach. Consequently iatrogenic injuries due to inadverent damage to cystic artery are not uncommon. These complications can be prevented by careful dissection in Calots triangle and better knowledge of laparoscopic anatomy of cystic artery and its variations. The aim of this study is to establish the prevalence of variation in position of cystic artery in relation to cystic duct in Asia’s largest slum area. This will help identify the safe area for dissecting peritoneum in Calots triangle and thus help young surgeons overcome the long learning curve associated with laparoscopy.Methods: During a 2 year period from 2018-2019, 192 laparoscopic cholecystectomies that were performed at a tertiary care hospital were studied. Patients above the age of 70 years, pregnant females, patients with history of previous abdominal surgery and the cases of conversion from laparoscopic to open cholecystectomy were excluded from the study. Cystic artery was divided into four groups based on its relative position to cystic duct. It includes superomedial, superolateral, anterior and absent cystic artery relative to the cystic duct.Results: Out of 192 cases of laparoscopic cholecystectomy 174 (90.62%) patients had cystic artery superomedial to cystic duct and 10 (5.208%) had a cystic artery at superolateral position to cystic duct. In 5 (2.6%) patients it was found anterior to cystic duct and in 3 (1.56%) patients it was absent.Conclusions: As the least common position of cystic artery was found to be anterior to cystic duct in our study, it is concluded that blind dissection from anterior side is the safest approach to avoid injury to cystic artery. This technique can help young surgeons overcome the long learning curve associated with laparoscopy.

scholarly journals Anaotmical variability in the position of cystic artery during laparoscopic visualization

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Omer Fateh ◽  
Muhammad Samir Irfan Wasi ◽  
Syed Abdullah Bukhari
Keyword(s):  
Cystic Duct ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cystic Artery ◽  
Care Hospital ◽  
Open Approach ◽  
Iatrogenic Injuries ◽  
Safe Area ◽  
Common Position ◽  
History Of

Abstract Background The laparoscopic view of extrahepatic biliary tract and cystic artery is different anatomically from open approach. Consequently iatrogenic injuries due to inadverent damage to cystic artery are not uncommon. These complications can be prevented by careful dissection in Calots triangle and better knowledge of laparoscopic anatomy of cystic artery and its variations. The aim of this study is to establish the prevalence of variation in position of cystic artery in relation to cystic duct. This will help identify the safe area for dissecting peritoneum in Calots triangle and thus help young surgeons overcome the long learning curve associated with laparoscopy. Materials and methods During a 10 year period from January 2009 to January 2019, 1850 laparoscopic cholecystectomies that were performed at a tertiary care hospital were studied. Patients with history of previous abdominal surgery were excluded from the study. Cystic artery was divided into four groups based on its relative position to cystic duct. It includes superomedial, superolateral, anterior and absent cystic artery relative to the cystic duct. Results Out of 1850 cases of laparoscopic cholecystectomy 1676 (90.59%) patients had cystic artery superomedial to cystic duct and 96 (5.19%) had a cystic artery at superolateral position to cystic duct. In 48 (2.59%) patients it was found anterior to cystic duct and in 30 (1.62%) patients it was absent. Conclusions It is concluded that the most common position of cystic artery is superomedial while the least common position was found to be anterior to cystic duct. Hence it is postulated that blind dissection from anterior side is the safest approach to avoid injury to cystic artery.

scholarly journals Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study

2020 ◽  
Vol 27 (4) ◽  
pp. E202043
Author(s):  
Aamir Hussain Hela ◽  
Haseeb Mohammad Khandwaw ◽  
Rahul Kumar ◽  
Mir Adnan Samad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Bile Duct ◽  
Surgical Site Infection ◽  
Tertiary Care Hospital ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Care Hospital ◽  
Site Infection ◽  
The Mean

Introduction: Laparoscopic cholecystectomy is the most commonly performed surgical procedure of digestive tract. It has replaced open cholecystectomy as gold standard treatment for cholelithiasis and inflammation of gallbladder.  It is estimated that approximately 90% of cholecystectomies in the  United States are performed using a laparoscopic approach.  The aim of this study was to evaluate the outcome of Laparoscopic cholecystectomy in context to its complications, morbidity and mortality in a tertiary care hospital.  Methods: This retrospective study was conducted on 1200 patients, who underwent laparoscopic cholecystectomies, during the period from January 2019 to December 2019, at Government Medical College Jammu J & K, India and necessary data was collected and reviewed. Results: In our study, a total of 1200 patients were studied including 216 males (18%) and 984 females (82%). The mean age of the patients was 43.35±8.61. The mean operative time in our study was 55.5±10.60 minutes with range of 45 – 90 minutes. Conversion rate was 2.6%. 2 patients were re-explored. Bile duct injury was found in 6 patients (0.5%).  Conclusions: Gallstone disease is a global health problem. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first choice of treatment for gallstones. Gall stone diseases is most frequently encountered in female population. The risk factors for conversion to open cholecystectomy include male gender, previous abdominal surgery, acute cholecystitis, dense adhesions and fibrosis in Calot’ s triangle, anatomical variations, advanced age, comorbidity, obesity, suspicion of common bile duct stones, jaundice, and decreased surgeon experience. The incidence of surgical site infection has significantly decreased in laparoscopic cholecystectomy compared to open cholecystectomy. In our study we could not find any case of surgical site infection.

scholarly journals Assessment of different stress responses after laparoscopic and open cholecystectomy in patients attending tertiary care hospital, Bhuj, Gujarat, India: a prospective study

2017 ◽  
Vol 4 (5) ◽  
pp. 1575
Author(s):  
Bhavin Kothari ◽  
Gyaneshwar Rao
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Stress Responses ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Serum Cortisol ◽  
The Body ◽  
Surgical Trauma ◽  
Care Hospital ◽  
C Reactive Protein ◽  
Reactive Protein

Background: Surgical trauma by incision and dissection of tissue stimulates the body to respond proportionately to the extent of injury. This study was conducted with an aim to compare metabolic and inflammatory responses after laparoscopic and open cholecystectomy namely serum cortisol and C-reactive protein levels before and after operation at Bhuj, Kutch, India.Methods: Present study was non-randomized, and comparative study carry out in the General Surgery Department at Gujarat Adani prospective institute of Medical Science, Bhuj, Kutch, Gujarat, India for an era of two years. One hundred and two patients were included in this study and were divided into two groups of open and laparoscopic cholecystectomy. Out of these 102 patients, 41 undergo open cholecystectomy and 61 laparoscopic cholecystectomy. Preoperative, intraoperative, postoperative and anesthetic medications were consistent in all the patients.Results: It was found that metabolic responses like serum cortisol were significantly higher after open procedure 6 hours and 48 hours postoperatively. Similarly, inflammatory response indicator C-reactive protein was raised significantly higher 48 hours after open as compared to laparoscopic cholecystectomy.Conclusions: Open cholecystectomy caused further tissue responses as compared to its laparoscopic alternative.

scholarly journals Clinical study of patients with inguinal hernia at a tertiary care hospital

2017 ◽  
Vol 4 (6) ◽  
pp. 2042
Author(s):  
Pradeep Kumar J. ◽  
Suresh Kadli ◽  
Kailas C. T. ◽  
Sowmya Kadli
Keyword(s):  
Inguinal Hernia ◽  
Tertiary Care ◽  
College Teaching ◽  
Teaching Hospitals ◽  
Abdominal Muscles ◽  
Care Hospital ◽  
Open Approach ◽  
Medical College ◽  
Strenuous Work ◽  
History Of

Background: The history of hernia is the history of surgery. Historically hernia causative was attributed to a mechanical disparity between visceral pressure and the resistance of the musculature.Methods: 100 cases of inguinal hernia admitted in Medical College Teaching Hospitals were selected on the basis of the nonprobability (purposive) sampling method. All patients with uncomplicated direct and indirect hernias treated by open approach surgeries were included. The age/sex incidence, mode of presentation, precipitating factors, surgical treatment, postoperative complications were all evaluated and compared with standard published literature. A predesigned proforma was used to collect this information for individual case.Results: The incidence of hernia was common in younger,18-40-year age group (33%), people engaged in agriculture (42%), labourers (33%). 52% patients presented with swelling and 48% with pain and swelling. Right indirect hernia was the most common (41%), right direct hernia (23%), pantaloon (7%) and bilateral in 8%. 32% patients had strenuous work as a precipitating factor, 35 % had smoking as associated factors. Abdominal tone was poor in 8% cases.Conclusions: Strenuous work is often responsible for development of hernia. Heavy work, especially lifting weights, puts a great strain on the abdominal muscles. If there is an underlying weakness already present, hernia may develop. The patient relates the onset of the hernia to a particular event.

scholarly journals Outcome of laparoscopic cholecystectomy in terms of intraoperative complications in a tertiary care hospital.

2021 ◽  
Vol 29 (01) ◽  
pp. 19-25
Author(s):  
Muhammad Sayyar ◽  
Yousaf Jan ◽  
Shaukat Hussain
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Intraoperative Complications ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Abdominal Ultrasound ◽  
International Studies ◽  
Care Hospital ◽  
Research Committee ◽  
Conversion To Open Cholecystectomy ◽  
Operative Complications

Objectives: The main objective was to evaluate the outcome of laparoscopic cholecystectomy in terms of intra-operative complications and the rate and reasons of conversion to open cholecystectomy. Study Design: Descriptive Study. Setting: Hayatabad Medical Complex, Peshawar. Period: June 2018 to May 2019. Material & Methods: After taking consent of Hospital ethical & research committee, patients admitted with clinical diagnosis of cholelithiasis and chronic cholecystitis, confirmed by abdominal ultrasound, undergoing laparoscopic cholecystectomy fulfilling inclusion criteria were selected. Results: A total of 150 were included in the study. Mean age was 39.2yrs with female to male ratio of 9.75:1. Laparoscopic cholecystectomy was successfully accomplished in 98% cases. In 2% (3 patients) converted cases the most common cause of conversion observed was dense adhesions in the calots triangle. Intra-operative complications were noted in 1.4% patients, those included bile duct injury and leakage from the gallbladder bed. However other complications such as bowel injury, blood vessel injury, and post operative hemorrhage did not occur. Overall morbidity was 1.4% with no mortality. Conclusion: Laparoscopic cholecystectomy is a safe and effective procedure in our setup to the accepted standards, as evident by the national and international studies. And it can be accomplished with minimal morbidity and low rate of conversion with the increasing surgeon’s experience.

scholarly journals Intra-operative factors responsible for conversion of laparoscopic cholecystectomy to open cholecystectomy in a tertiary care center

2020 ◽  
Vol 7 (5) ◽  
pp. 1467
Author(s):  
Anam Saeed ◽  
Mohammed Salim ◽  
Devi Singh Kachhawa ◽  
Renuka Chaudhary
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Care Center ◽  
Tertiary Care ◽  
Open Approach ◽  
Visceral Injury ◽  
Critical View Of Safety ◽  
Symptomatic Cholelithiasis ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis and has multiple advantages over open approach. With increasing skills and techniques over the years, the contra-indications to laparoscopic cholecystectomy have reduced. Even after careful selection of appropriate candidates for laparoscopic cholecystectomy, it sometimes becomes necessary to convert into an open cholecystectomy to prevent complications. This study was undertaken so as to identify the intra-operative factors necessitating conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: In this study conducted at S. P. Medical College and P. B. M. Hospital, Bikaner, over a period of 1 year, 100 consecutive patients with symptomatic cholelithiasis, planned for laparoscopic cholecystectomy were included. Laparoscopic cholecystectomy was performed and cases which could not be completed laparoscopically were converted to open cholecystectomy via right subcostal incision. Intra-operative factors necessitating conversion were observed and analyzed.Results: The incidence of conversion was found to be 7%. The most common intra-operative factor for conversion was dense adhesions at the Calot’s triangle (71.43%) followed by obscure anatomy (42.86%). Uncontrolled bleeding and CBD stones also led to conversion. The identification and appearance of CBD and achievement of critical view of safety were significant factors for conversion to open cholecystectomy (p=0.0001).Conclusions: The rate of conversion to open cholecystectomy was 7% which is comparable to similar studies. Conversion is not a failure or complication but actually a safer alternative to ensure completion of the procedure without any real complications of laparoscopic cholecystectomy- biliary or visceral injury, haemorrhage, etc.

scholarly journals Incidence and Management of Post Cholecystectomy Biliary Fistula at Tertiary Care Hospital

2021 ◽  
pp. 203-208
Author(s):  
Ahtesham-Ul- Haq ◽  
Sohail Ahmed Memon ◽  
Riaz Ahmad Memon ◽  
Bilal Rasool ◽  
Shahnawz Khatti ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Tertiary Care Hospital ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Health Sciences ◽  
Biliary Fistula ◽  
Care Hospital ◽  
One Year ◽  
A Prospective Study ◽  
Surgery Department

Objective: To determine the incidence and management of post cholecystectomy biliary fistula at tertiary care Hospital.  Methodology: This was a prospective study which was conducted at general surgery department of Liaquat University of Medical and health Sciences, during one year from March 2017 to February 2018. All the patients those underwent laparoscopic cholecystectomy or open cholecystectomy, age more than15 years and either of gender were included. All the patients were evaluated for developed biliary fistula after cholecystectomies. All the patients of biliary fistula were managed conservatively and surgically and their management outcome was recorded. After operation most of patients were followed up to 6 months. The data was collected via study designed proforma. Data was analyzed by using SPSS version 20. Results: Out of 318 patients, 280 patients underwent laparoscopic cholecystectomies, 38 patients underwent open cholecystectomies. Mean age of the patients was 41.34+8.23 years. Females were in majority 233(73.3%) and males were 95(29.7%). Out of all post-cholecystectomy biliary fistula was seen in 10(3.14%) patients. Incidence of post-cholecystectomy biliary fistula was insignificantly associated with types of cholecystectomies (p=0.425), while it was highly prevalent in females (p=0.001). Conclusion: In the conclusion of this study the post cholecystectomy biliary fistula was observed to be 3.14% and mostly patients were manged via conservative treatment.

scholarly journals Safe Completion of Laparoscopic Cholecystectomy and Its Conversion Rate in a Tertiary Care Hospital

2017 ◽  
Vol 23 (2) ◽  
Author(s):  
Muhammad Shahid Farooq ◽  
Rabia Altaf ◽  
Ahmad Uzair Qureshi ◽  
Fatima Naumeri ◽  
Abrar Ashraf Ali
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Conversion Rate ◽  
Tertiary Care Hospital ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Self Awareness ◽  
Safe Procedure ◽  
Care Hospital ◽  
Public Sector Hospital

AbstractObjectives:  Laparoscopic cholecystectomy is a very good and safe procedure for the removal of gall bladder. The objective of our study was to see the conversion rate of laparoscopic cholecystectomy in our unit.Methods:  This is a retrospective descriptive study. We conducted this study on 167 patients who under-went gall bladder removal in our unit at a Public sector hospital of Lahore.Results:  Our study showed that 163 (97.6%) out of 167 patients had safe complete laparoscopic cholecystectomy while 4 (2.4%) had to be converted to open cholecystectomy. About 40% of the procedures completed by laparoscope were difficult. Approximately 98% were completed by consultants and 42% weresafely performed by the senior registrars.Conclusion:  Gall bladder surgery can be safely completed with laparoscope with good team effort and self-awareness of team.

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