scholarly journals Experience of Laparoscopic Cholecystectomy at Lumbini Medical College Teaching Hospital

2013 ◽  
Vol 1 (1) ◽  
pp. 25
Author(s):  
Nabin Pokharel ◽  
Prakash Sapkota ◽  
Binay Khatri Chhetri ◽  
Rajan Shakhya ◽  
Sunil Thapa
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Teaching Hospital ◽  
Open Cholecystectomy ◽  
Significant Risk ◽  
College Teaching ◽  
Common Bile Duct Injury ◽  
Medical College ◽  
Conversion To Open Cholecystectomy ◽  
The World ◽  
Difficult Cases

  Introduction: The difficult gallbladder is the most common difficult laparoscopy being performed by generalsurgeons all over the world and the potential one that places the patient at significant risk. The present study aimed to study all the cases of laparoscopic cholecystectomy conducted in current setup at Lumbini Medical College and Teaching Hospital, to compare the results with the published literature and also analyze the complications and ways to decrease the incidence of conversion to open procedure.   Methods: Five hundred twenty five patients age 10-90 years, male:female ratio of 1:3.86 with body weight 45-65 kilogram, who had undergone laparoscopic cholecystectomy for symptomatic cholelithiasis without choledocholithiasis from April 2011 to April 2013 were studied.   Results: All the laparoscopic cholecystectomy (LC) were without major complications. Only nineteen out of five hundred twentyfive (3.6%) required conversion to open cholecystectomy (OC). Reasons for conversion included: dense omental or visceral adhesions; two (0.38%), unclear anatomy; 16 (3.04%), common bile duct injury; one (0.19%). There were 20 cases of shrunken gallbladder suspicious of malignancy but didn’t required conversion.   Conclusion: Laparoscopic cholecystectomy is the preferred method in our setup even in difficult cases.

Comparative Study of Standard Four-Port, Three Port and Single Incision Laparoscopic Cholecystectomy Performed by a Single Surgeon in Nobel Medical College Teaching Hospital, Nepal

2021 ◽  
Vol 6 (1) ◽  
pp. 1325-1329
Author(s):  
Ruslan Sulaimankulov ◽  
Gulmira Jolochieva
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Teaching Hospital ◽  
Operative Procedure ◽  
College Teaching ◽  
Operation Time ◽  
Scarless Surgery ◽  
Group Iii ◽  
Medical College ◽  
Group I ◽  
Hospital Stays

Introduction: Laparoscopic Cholecystectomy is a standard operative procedure for patients with gallbladder diseases and is the most common laparoscopic procedure performed worldwide. The aim of this study is to analyze the different methods of laparoscopic cholecystectomies done by a single surgeon at Nobel Medical College Teaching Hospital. Objectives: The objective and aim of this study are comparing 4 port classic Laparoscopic Cholecystectomy (4PLC), 3 port (3PLC) and Laparo-Endoscopic Single-Site Cholecystectomy (LESC) performed by a single surgeon and correlate worldwide experience with outcomes in our institution. Methodology: The study includes retrospective analysis of 8192 patients who underwent elective laparoscopic Cholecystectomy (LC) from October 2010 to July 2020 performed by the single surgeon. All cases divided into 3 groups depending on the type of LC (4PLC, 3PLC, LESC). The data included the type of the surgery, gender, age, operative time, conversion and complication rate and duration of hospital stay. Results: The hospital stays, operation time and conversion rate decreased from group I to group III. Female patients out numbered the male ones (M:F=1:4). The hospital stays (3.4 days), operation time (35 min), conversion (0.4%) and complications (0.7%) rate decreased from Group of 4PLC to Group of LESC (1.5 days, 13 min, 0.1% conversion, 0.4% complication respectively) which is true for almost all other similar studies. Conclusion: The advantages of LESC include a better cosmetic effect and reduced chance of infections. It has been postulated to be superior in scarless surgery with added benefits of lower pain level and reduced need for analgesics, shorter hospital stays, quicker return to work and lower financial expenses. 

scholarly journals Determination of predictive factors for difficult laparoscopic cholecystectomy

2021 ◽  
Vol 8 (2) ◽  
pp. 481
Author(s):  
Sameer Bhattarai ◽  
Ishory Bhusal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Predictive Factors ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
College Teaching ◽  
Wall Thickening ◽  
Conversion To Open Cholecystectomy ◽  
Male Sex

Background: Cholelithiasis is the most common biliary pathology, with a prevalence of 10 to 15%. It is symptomatic in approximately 1 to 2% of patients. In about 5 to 10% of laparoscopic cholecystectomy, conversion to open cholecystectomy may be needed for safe removal of gallbladder. Laparoscopic cholecystectomy (LC) may be rendered difficult by various problems encountered during surgery. The objective of this study was to predict difficulty of LC before surgery using the clinical and ultrasonographic criteria.Methods: The present study comprised of 45 cases admitted to National Medical College Teaching Hospital (NMCTH), Birgunj (Nepal) for a period of 12 months from 1st August 2013 to 30th September 2014. The cases confirmed by Ultrasonography were evaluated with following risk factors: age >50 years, male sex, BMI 25.1 to 27.5 and >27.5, previous surgery, prior hospitalization, palpable gall bladder, gall bladder wall thickening, impacted stone, pericholecystic collection and presence of adhesions. Each risk factor was given a score. The total score up to 5 predicted easy, 6 to 10 difficult and more than 10 very difficult.Results: The highest age incidence of Cholelithiasis was in the 2nd to 4th decade and was more common in females. Ultrasonography detected gallbladder stones in all patients, wall thickening in 15 and pericholecystic collection in 8. BMI >27.5 presence of adhesions, male sex and pericholecystic collection were significant predictors of difficult laparoscopic cholecystectomy.Conclusions: Numerous clinical, radiological and pre-operative features make LC sometimes difficult. Early determination of these predictive factors decreases the difficulty that we will be facing with LC.

scholarly journals Bile Duct Injuries Following Laparoscopic Cholecystectomy

2018 ◽  
Vol 15 (1) ◽  
pp. 14-19
Author(s):  
Mohammad Ibrahim Khalil ◽  
Haridas Saha ◽  
Azmal Kader Chowdhury ◽  
Imarat Hossain ◽  
AZM Mostaque Hossain
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Open Cholecystectomy ◽  
Standard Procedure ◽  
Gall Stone ◽  
Common Bile Duct Injury ◽  
Medical College ◽  
Bile Duct Injuries ◽  
Case Files

Background: Laparoscopic cholecystectomy (LC) is the gold standard procedure for the gall stone diseases.Objective: This study aimed to assess the outcome of laparoscopic cholecystectomy (LC) by determining the frequency of complications especially of bile duct injuries.Methodology: This retrospective study was conducted in the Department of surgery at Dhaka Medical College and Hospital, Dhaka, Bangladesh. The case files of all patients undergoing laparoscopic cholecystectomy (LC) from the year of 2013 to 2015 were retrospectively analyzed. The data were collected according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose resections had to be converted from laparoscopic to open surgery.Results: During the three years a total number of 336 patients were underwent LC for chronic cholecystitis (CC) of which 22(6.5%) developed complications. Among those who developed complications, two patients had major bile duct injuries (0.4%); other 43(12.8%) patients had planned laparoscopic operations converted to open cholecystectomy intra-operatively. None of the patients in this study died as a result of LC.Conclusion: The two patients who had severe common bile duct injury in this study had major anatomical anomalies that were only recognized during surgery.Journal of Science Foundation 2017;15(1):14-19

scholarly journals Study of open cholecystectomy for gallbladder disorders

2021 ◽  
Vol 8 (3) ◽  
pp. 826
Author(s):  
Sunil Kumar ◽  
T. Rudra Prasad Reddy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Clinical Judgment ◽  
Open Cholecystectomy ◽  
Standard Procedure ◽  
Demographic Data ◽  
Bile Leak ◽  
Laparoscopic Approach ◽  
Biliary Colic ◽  
Medical College ◽  
Conversion To Open Cholecystectomy

Background: Cholecystectomy is one of the most common surgeries done worldwide. Most common indication is biliary colic due to cholelithiasis. Presently most cholecystectomies are done by laparoscopic approach, however conversion to open cholecystectomy is needed in few circumstances and there are some absolute indications for open cholecystectomy where laparoscopic procedure can’t be done.Methods: This is a prospective observational study of 50 open cholecystectomies operated during March 2017 to Feb 2019 in our medical college. Various data including demographic data of patients, different indications, post-operative complications were documented and analyzed.Results: Mean age of the patients was 40.58 (16-65) years. Female patients were more in number 32 (64%) when compared with males. Maximum patients were in the age group 31-40 years accounting to 17 (34%) of study population. Pain abdomen 24 (48%) was the chief presenting complaint. Cholelithiasis 38 (76%) was the major indication for surgery. Complications like bile leak, bleeding, subphrenic abscess and infection occurred in 04 (08%) patients. Total four cases of laparoscopic cholecystectomy were converted to open cholecystectomy. Mean hospital stay was 7.48 (5-14) days.Conclusions: Even though laparoscopic cholecystectomy is the gold standard in the present era, it is important that the surgeon is also competent in doing open cholecystectomy. Certain conditions require planned open cholecystectomy as the standard procedure. In difficult laparoscopic cases, the surgeon must take timely decision to convert to the open technique. Surgeons experience and proper clinical judgment skills are important in difficult cases.

scholarly journals Causes and incidence of laparoscopic cholecystectomy conversion to open cholecystectomy in Al Karama teaching hospital

2018 ◽  
Vol 5 (5) ◽  
pp. 1640
Author(s):  
Mohammed Reda Al Ghadhban ◽  
Hussein Ali Alkumasi ◽  
Mohammed Saleem Meziad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Teaching Hospital ◽  
Open Cholecystectomy ◽  
Standard Procedure ◽  
Biliary Duct ◽  
Female Patients ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy ◽  
Male Patients ◽  
A Prospective Study

Background: There is no doubt that laparoscopic cholecystectomy replaced open cholecystectomy as standard procedure for the treatment of symptomatic cholelithiasis. Conversion from laparoscopic cholecystectomy to open cholecystectomy is still required in many circumstance, this study aimed at exploring causes and incidence of conversion.  Methods: This is a prospective study of 200 cases of laparoscopic cholecystectomy cases were performed in ALKARAMA Teaching Hospital from January2009 to January 2011. All cases were followed at the time of surgery by obtaining data sheet for the patient’s age, sex, time from the introduction of ports till decision of conversion and the cause of conversion if present.Results: Out of 200 laparoscopic cholecystectomy, 12 cases were converted into open cholecystectomy (6%). The major causes were : dense adhesions (4),  bleeding (2), anatomical difficulties (2), impacted stone in Hartmann pauch (2), dilated cystic duct (1) and sever inflammation (1). Two of the conversions are males from 45 male patients underwent laparoscopic cholecystectomy, 10 cases are females from 155 female patients underwent laparoscopic cholecystectomy so the percentage of conversion for male patients is 4.44 % while for female patients is 6.45%.Conclusions: The conversion rate in this study is 6% and the most common cause for conversion is dense adhesions in the Calot’s triangle, no biliary duct injury that need conversion is found in this study and the rate for conversion is higher in female patients.

scholarly journals Assessment of Drug Use Pattern Using WHO Prescribing Indicators

2018 ◽  
Vol 16 (3) ◽  
pp. 279-284
Author(s):  
Binaya Shrestha ◽  
Sanjaya Mani Dixit
Keyword(s):  
Drug Use ◽  
World Health Organization ◽  
Teaching Hospital ◽  
College Teaching ◽  
Brand Names ◽  
World Health ◽  
Medical College ◽  
The World ◽  
Health Organization ◽  
Drug Use Pattern

Background: In order to promote rational drug use in developing countries, assessment of drug use pattern using the World Health Organization drug use indicators is important. The aim of this study was to assess the drug prescription patterns at Kathmandu Medical College Teaching Hospital, using some of the World Health Organization core drug use indicators.Methods: A prospective cross-sectional study was carried out in order to determine current prescribing trends at Kathmandu Medical College Teaching Hospital. A total of 605 prescriptions were collected and analyzed in the study.Results: The average number of drugs per prescription was 5.85 considering the total amount of prescriptions. Furthermore, assuming each prescription as an individual patient, 64.1% of patients received antibiotics, and 71% of patients received injectable form of drugs. Among antibiotics the most common antibiotics prescribed were Ceftriaxone, Amoxicillin/Cloxacillin, Azithromycin, Cefixime, and Cloxacillin. Only 16.94% of the medicines were prescribed in generic names with the rest 83.06% of the medicines being prescribed in brand names and 47.55% of medicines prescribed were from the National List of Essential Medicines-Nepal.Conclusions: The current study revealed that polypharmacy and prescription writing using brand names were common. Prescriptions writing in generic nameneeds to be promoted and encouraged. There appears to be a crucial need for the development of prescribing guidelines when it comes to antibiotics.

scholarly journals Advantage of fundus first method over conventional approach in difficult laparoscopic cholecystectomy: a prospective study

2019 ◽  
Vol 6 (5) ◽  
pp. 1613
Author(s):  
Braja Mohan Mishra ◽  
Rabi Narayana Guru ◽  
Sunil Kumar Kar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Gall Stone ◽  
Antibiotic Use ◽  
Class Iii ◽  
Female Age ◽  
Conversion To Open Cholecystectomy ◽  
A Prospective Study ◽  
Difficult Cases

Background: Fundus first method is a widely accepted and practiced procedure in open cholecystectomy to deal the difficult cases but laparoscopic surgeons still have reserved opinion regarding use of fundus first approach in difficult laparoscopic cholecystectomy (DLC). As in open cholecystectomy fundus first laparoscopic cholecystectomy (FFC) can have advantages over conventional laparoscopic cholecystectomy (CLC) in DLC. So many preoperative, intraoperative, postoperative information were collected in both CLC and FFC and compared to evaluate whether FFC has any advantage over CLC in difficult laparoscopic cholecystectomy.Methods: A total 73 cases were included in the study that underwent laparoscopic cholecystectomy (LC) for gall stone diseases and intraoperatively found to be difficult cases. They were distributed into 4 classes i.e. Class I, Class II, Class III and Class IV according to the type of difficulty encountered during surgery.Results: Out of the 73 patients 24 were male and 49 were Female. Age of patient ranged from 14 to 70 years with mean age of 42.64 years. Out of 38 cases operated with FFC 6 cases (15.78%) needed conversion to open cholecystectomy as compared to 26 out of 35 (71.14%) cases that underwent CLC where conversion was done. Mean duration of hospital stay is 4.19±3.053. Mean hospital stay in FFC is 2.58±1.869 days and that of CLC is 5.14±3.143 which is clearly much higher and statistically significant (p< 0.001) than mean hospital stay in case of FFC.Conclusions: FFC has advantages over CLC in difficult LC i.e. reduced conversion rate, lesser hospital stay and less duration of antibiotic use.

Study on Knowledge and Prevalence of Computer Vision Syndrome among Computer Operators in Nobel Medical College Teaching Hospital, Biratnagar, Nepal

2020 ◽  
Vol 9 (2) ◽  
pp. 45-49
Author(s):  
Pramod Sharma Gautam ◽  
Uday Chandra Prakash ◽  
Subreena Dangol
Keyword(s):  
Computer Vision ◽  
Teaching Hospital ◽  
Human Life ◽  
College Teaching ◽  
Extended Period ◽  
Visual Display ◽  
Work Place ◽  
Medical College ◽  
Computer Vision Syndrome ◽  
Department Of Ophthalmology

Background: The eye and vision related problems that results from continuous use of computers and other visual display terminals for extended period of time leads to computer vision syndrome. Due to rapid digitalization in human life, the risk of developing it has also increased in many folds. So, with an aim of determining the prevalence and level of awareness of computer vision syndrome among computer users along with their attitude and practices to prevent it, this study was conducted in the office employees who use computer for a considerable period of time. Materials and Methods: A hospital based observational descriptive study was conducted in the out-patient department of Ophthalmology in Nobel Medical College and Teaching Hospital, Biratnagar, where 105 employees working in different work stations of same institution were enrolled. A questionnaire and the clinical findings were used to collect data. Results: About 80% of the employees were using computer for about (8-11) hours per day. Prevalence of computer vision syndrome noted was (92.4%) with low level of knowledge (85.7%) about it. About 45% of them wore glasses for their refractive errors but attitude and practices in work place to prevent the bad effects of using visual display terminals were found to be lacking (53.3%). Burning sensation in the eye, headache, ocular irritation and itching and neck, shoulder or back pain were the common symptoms. Around (60-70)% of the eyes tested positive for dry eye. Conclusion: Lack of awareness of computer vision syndrome and lack of personal protective measures were associated with its high level of prevalence.  

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

2019 ◽  
Author(s):  
Madan Goyal ◽  
R K Goel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Critical View Of Safety ◽  
Recent Onset ◽  
Conversion To Open Cholecystectomy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Collections ◽  
A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

Outcome of initial three years of Cranial Endoscopy at DG Khan Medical College & Teaching Hospital, Dera Ghazi Khan.

2021 ◽  
Author(s):  
Iqbal Ahmad ◽  
Ummer Farooq Raina ◽  
Muhammad Yousaf ◽  
Liaqat Jalal ◽  
Samia Saeed ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
College Teaching ◽  
Medical College ◽  
Cranial Endoscopy
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