scholarly journals Laparoscopic cholecystectomy in elderly patients

2009 ◽  
Vol 56 (2) ◽  
pp. 87-91
Author(s):  
V. Stanisic ◽  
M. Bakic ◽  
M. Magdelinic ◽  
H. Kolasinac ◽  
M. Miladinovic

Laparoscopic cholecystectomy (LC ) is the method of choice of surgical treatment of gallbladder diseases. Operations in elderly people over 65 years because of chronic diseases, are often associated with high operative and postoperative morbidity and mortality. The aim of this study was to analyze the outcome of LC in the treatment of cholelithiasis in patients older than 65 years. For evaluation of LC effectiveness and security in old patients, we did this prospective analysis of 81 patients surgically treated because of symptomatic cholelithiasis . We had analyzed associated diseases, operative and postoperative complications, the reasons of conversion to open cholecystectomy. The research points to the small percentage of operative and postoperative complications, short hospital stay, less postoperative pain, quick recovery and savings in treatment. The age can not be contraindication for LC in older patients. In uncomplicated symptomatic cholelithiasis in elderly people, LC is a successful and safe procedure. Complicated symptomatic cholelithiasis, because of longer duration of operations is looking for a good assessment of general condition and associated diseases for LC.

2021 ◽  
pp. 63-66
Author(s):  
Wasif Mohammad Ali ◽  
Nazia Nanen ◽  
Atia Zaka Ur Rab ◽  
Syed Amjad Ali Rizvi ◽  
Mehtab Ahmad

Introduction: Laparoscopic cholecystectomy has become procedure of choice for treatment of symptomatic gallstone [1] disease . Even though it is a safe procedure occasionally it can be difcult and requires conversion to open cholecystectomy for various problems faced during surgery. Preoperative prediction of difcult laparoscopic cholecystectomy and likelihood of conversion to open cholecystectomy will avoid such complications and overall cost of treatment. Aim: To evaluate the clinico-radiological factors predicting difcult laparoscopic cholecystectomy Methods: This was a prospective study conducted from October 2018 to November 2020. Total of 101 patients meeting inclusion criteria undergoing laparoscopic cholecystectomy were included in the study. Various clinical, radiological and biochemical parameters and intraoperative difculties during surgery were recorded. The statistical analysis was done using chi-square test and ANOVA test. Results: The parameters such as sex, age, duration of disease, co-morbid disease, previous history of cholecystitis, palpable gall bladder, BMI, TLC, thickness of gall bladder, largest stone size and impacted stone are found statistically signicant in predicting difcult laparoscopic cholecystectomy and conversion to open cholecystectomy preoperatively. Conclusion: Difcult laparoscopic cholecystectomy may be predicted preoperatively even with a good clinical judgement whereas both clinical and radiological parameters provide a better preoperative prediction of difcult cholecystectomy so that the surgeon can prepared in advance for the complications.


2011 ◽  
Vol 64 (1-2) ◽  
pp. 77-83
Author(s):  
Veselin Stanisic ◽  
Milorad Bakic ◽  
Milorad Magdelinic ◽  
Hamdija Kolasinac ◽  
Darko Vlaovic ◽  
...  

Introduction. Laparoscopic cholecystectomy is a method of choice in the treatment of symptomatic cholecystolithiasis because of less postoperative pain, shorter hospitalization and lower cost of treatment. The study was aimed at analysing the outcome of laparoscopic cholecystectomy in patients surgically treated for chronic calculous cholecystitis (symptomatic cholelithiasis). Material and methods. The research was done in the period from December 2003 to December 2008. In the prospective study of 386 patients, we analyzed operative and postoperative complications, the reasons for conversion to open cholecystectomy, duration of hospitalization and mortality. Results. The average duration of laparoscopic cholecystectomy was 31.9?14.5 min: dissection of adhesions 3.2?0.7 min., elements of Calot?s triangle 9.8?3.2 min., gallbladder releasing from its bed 12.8?2.8 min., the abdominal cavity lavage and removal of gall?bladder from the abdomen 6.8?0.9 min. Some operative difficulties emerged in 22 (5.7%) patients - 4 (1%) during releasing of gallbladder adhesions from the surrounding structures, 9 (2.3%) during dissection of elements of the Calot?s triangle, 6 (1.5%) during gallbladder releasing from its bed, 3 (0.7%) during gallbladder removal from the abdomen. Some post-operative complications, single or associated, occurred in 36 (9.3%) patients: perforation of gallbladder 21 (5.4%), bleeding from gallbladder bed 18(4.6%)/, injury of extra hepatic bile ducts 1 (0.2%), 9 (2.3%) spillage of stones; 3 (0.7%) conversions were made. The average duration of preoperative and postoperative hospitalization was 1.1?0.3 and 1.4?0.5 days, respectively. The pathohistological examination revealed 2 (0.5%) adenocarcinoma of gallbladder. There were no lethal outcomes. Conclusion. Laparoscopic cholecystectomy is a safe procedure and rational choice in the treatment of biliary dyskinesia and symptomatic biliary calculosis with an acceptable rate of conversion.


2010 ◽  
Vol 63 (5-6) ◽  
pp. 404-408 ◽  
Author(s):  
Veselin Stanisic ◽  
Milorad Bakic ◽  
Milorad Magdelinic ◽  
Hamdija Kolasinac ◽  
Igor Babic

Introduction. Laparoscopic cholecystectomy is a method of choice for surgical treatment of diseases of gallbladder. Although most surgeons today use laparoscopic cholecystectomy in treatment of severe acute cholecystitis, most surgeons still consider acute cholecystitis a relevant contraindication for laparoscopic cholecystectomy because of ?confused? anatomy and ?severe? pathology. Aim of the study was to analyze laparoscopic cholecystectomy outcomes in treatment of acute cholecystitis. Material and methods. A prospective analysis included 78 patients operated for acute calculose cholecystitis from Jan 2007 to Dec 2008. We analyzed clinical characteristics of the course of disease, associated diseases, duration of operation, operative and postoperative complications, reasons for conversion into open cholecystectomy. Results. The study indicated a low percentage of operative and postoperative complications, short stay in hospital, quick recovery and saving in treatment. The length of preoperative and postoperative hospitalization was 1.4?0.5 days and 2.5?1.6 days, respectively. 25 (32%) patients were operated within 72 hours from the onset of symptoms, some operative difficulties were present in 56 (71%) patients, light identification of artery and ductus cysticus in 30 (38.5%) patients, intraoperative lesion of ductus choledohus in 1 (1.3%); in 6 (7.7%) patients conversion into open cholecystectomy was done, the average duration of laparascopic cholecystectomy was 58.1?26.2 min. There were no lethal outcomes. Conclusion. Laparoscopic cholecystectomy is an efficient and reliable operative procedure in treatment of acute cholecystitis. It is much easier to select patients for laparoscopic cholecystectomy when preoperative risk factors predicting difficulties during the operation are known. An early conversion into open cholecystectomy is a rational choice of any surgeon when anatomy is not clear and in cases of advanced inflammatory process in order to decrease operative and postoperative morbidity.


1970 ◽  
Vol 6 (2) ◽  
pp. 74-77
Author(s):  
SK Biswas ◽  
JC Saha ◽  
ASMT Rahman ◽  
ASMZ Rahman ◽  
MM Rahman

Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversion to open cholecystectomy and postoperative complications are still inevitable in certain cases. Knowledge of the rate and underlying reasons for conversion and postoperative complications could help surgeons during preoperative assessment and improve the informed consent of patients. We decide to review the rate and causes of conversion and postoperative complications of our LC series. This study included 760 consecutive laparoscopic cholecystectomies from July 2006 to June 2011 at Faridpur Central Hospital and Faridpur Medical College Hospital. All patients had surgery performed by same surgeon. Conversion to open cholecystectomy required in 19 (2.5%) patients. The most common reasons for conversion were severe adhesions at calot's triangle (6, 0.83%) and acutely inflamed gallbladder (5, 0.66%). The incidence of postoperative complications was 1.58%. The most common complication was wound infection, which was seen in 5 (0.66%) patients followed by biliary leakage in 3 (0.40%) patients. Delayed complications seen in our series is port site incisional hernia (2, 0.26%). LC is the preferred method even in difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands, the surgeons should keep a low threshold for conversion to open surgery and it should not be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon. Key words: Laparoscopic cholecystectomy (LC); Open cholecystectomy; Conversion; Complications; Calot's triangle DOI: http://dx.doi.org/10.3329/fmcj.v6i2.9204 FMCJ 2011; 6(2): 74-77


2019 ◽  
Vol 31 (1) ◽  
pp. 29-37
Author(s):  
Nasir Uddin Mahmud ◽  
Ghyas Uddin ◽  
Md Anwarul Haque ◽  
ANM Mozammel Haque ◽  
AKM Golam Kibria

Background: For the management of Gallstone disease, laparoscopic cholecystectomy has been the the gold standard and is preferred over open cholecystectomy. As patients’ demand has increased for improved postoperative quality of life and cosmesis, surgeons have continued to decrease the number of ports for laparoscopic cholecystectomy. To meet these expectations we adopted two-port techniques at Comilla, Bangladesh. For the last three years we have selected 50 patients where two-port laparoscopic cholecystectomy was trialled. The procedure were successfully performed in 47(94%) & conversion were required in 3(6%) with some accepted complications like epigastric port infection & herniation, post cholecystectomy syndrome, reactionary haemorrhage, bile leakage & biloma, significant epigastric port pain postoperatively & stricture of CBD. The present two port technique not only overcoming specimen extraction difficulties but also contributes to good cosmesis. Objectives: To see the outcome of two port laparoscopic cholecystectomy. Methods: Consecutive 50 patients were admitted in surgery ward of Central medical college, Comilla with gallstone disease over a 3 years period. Diagnosis is confirmed by ultrasound with the assessment of operative feasibility. Data collection sheet was maintained by Microsoft Excel. Data were analyzed manually. Results: In this study 50 patients were included. Among them 34 (68%) were females and 16 (32%) were males (ratio = 2.1:1). Mean age was 35.7 years (range 20–55years).All patient were undergone two port laparoscopic cholecystectomy & successfully accomplished in 47 (94%),conversion were required in 3 (6%) patients. Most common (62%) sonological findings were cholelithiasis with normal size & shape of gall bladder. Mean operative time was 50 minutes. Among the per operative difficulties bleeding were 14%, perforation of gall bladder 10%, spillage of gallstones 6%, epigastric forceps manipulation difficulties 4%,conversion to open cholecystectomy 6%. Most of the patients(80%) admitted in hospital for 2-3 days. 4 (8%) patient had epigastric port infection & 1 (2%) patient developed this site herniation, 3 (6%) patient had post cholecystectomy syndrome,1 (2%) patient had reactionary haemorrhage, 1 (2%) bile leakage & biloma,4(8%) patient had significant epigastric port pain postoperatively, 1 (2%) patient developed delayed stricture of CBD. In all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no problem so far in 3 years follow up. Most patients (90%) returned to work within 2 weeks. Conclusion: Two-port laparoscopic cholecystectomy is a safe procedure & cosmetically rewarding. TAJ 2018; 31(1): 29-37


2020 ◽  
Vol 7 (5) ◽  
pp. 1467
Author(s):  
Anam Saeed ◽  
Mohammed Salim ◽  
Devi Singh Kachhawa ◽  
Renuka Chaudhary

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.


2019 ◽  
Vol 19 (2) ◽  
pp. 48-51
Author(s):  
Samiron Kumar Mondal ◽  
Sharmistha Roy

Background: Laparoscopic cholecystectomy has become the gold standard of treatment for gall stone disease and in acute cholecystitis. But controversy persists regarding laparoscopic approach to gangrenous gallbladder and empyema gallbladder due to the risk of life threatening complications. We share our experience in a tertiary care multidisciplinary diabetic hospital where we encounter significant number of patients with empyema Gallbladder and gangrenous gallbladder because most of our patients are diabetic and hence immunocompromised. Purpose of this study was to evaluate the safety of laparoscopic procedure for the treatment of empyema of gallbladder and gangrenous gallbladder in an experienced hand. Methods & Materials: Between January 2013 and January 2015 we performed 1191 cases of laparoscopic cholecystectomy. Empyema gallbladder and gangrenous gallbladder were found per operatively in 345 and 53 cases respectively.All were managed by laparoscopic procedure except two cases, where conversion to open cholecystectomy was needed. Result: The mean operating time was 72 minutes(45-100 minutes) in empyema gallbladder. In gangrenous cholecystitismean operating time was 80 minutes(60-100 minutes). Total number of patients (including empyema gallbladder 345 and gangrenous cholecystitis 53) were 398. Among them 52 patients (13%) had excessive bleeding(>100ml) from calot’s triangle or gallbladder bed in liver. Spillage of stones occurred in 28 patients (7%). 1 patient had common bile duct injury (.25%). Gallbladder retrieval was difficult in 71 patients (18%). In the post operative period 21 patient (5%) developed minor port infection in the umbilical port. 9 patients (2%) developed chest infection, and 1 patient (.25%) developed MI. 356 patients (89%) were discharged within 72 hours of surgery. Conclusions: Innovative technique, appropriate instruments, knowledge about the possible risks and way to manage them, with expertise in intracorporeal suturing and knotting are an essential pre requisites to attempt these cases. Operating time is more but post operative recovery is prompt. Hospital stay is significantly less than open cholecystectomy. Laparoscopic cholecystectomy is a safe procedure in cases of Empyema and gangrenous gallbladder, provided the surgeon is experienced enough and has a low threshold to convert to open cholecystectomy at anypoint of time. Journal of Surgical Sciences (2015) Vol. 19 (2) : 48-51


2019 ◽  
Author(s):  
Madan Goyal ◽  
R K Goel

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.


2020 ◽  
Vol 11 (2) ◽  
pp. 16-20
Author(s):  
Dr. Abdul Ghani Soomro

BACKGROUND & OBJECTIVE: Laparoscopic Cholecystectomy is usual method for the treatment of gall bladder stone disease and is practiced all over the world due to many benefits like fasten the recovery time. Furthermore, it reduced the post-operative pain and period of hospital stay. To conduct Surgical Audit and evaluate safety of Laparoscopic cholecystectomy. METHODOLGY: This prospective study was conducted in a private hospital at Hyderabad during free camps of Laparoscopic Cholecystectomy. Four camps were arranged in 2016 - 2019. Total number of 190 patients  underwent Laparoscopic Cholecystectomy during the study period. The patient's age falls between 12–65 years. A detailed history, relevant investigation and Cardiac fitness were evaluated. All patients underwent four ports Lap-Chole. Data was collected assessed and audit was performed and safety was evaluated. RESULTS: Total 190 patients operated females 88.45% and males 11.55%. 115 (60.50%)were in  the range of 30-35 years followed by 55 (28.95%)patients in the range of 40-50 years.8 (4.20%) patients were converted to open cholecystectomy, 4 due to bleeding from liver bed, 3 patients due to difficult dissection in calots triangle and 1 due to Empyema of gall bladder.10 patients (5.50%) had Trocar site bleeding, 10 patients (5.50%) had gall bladder injury, in 4 cases had spillage of stones and 72 patients (38.50%) developed umbilical port site infection 1 patient develop port site hernia. No mortality was recorded in this study. CONCLUSION: Our Surgical Audit proves that Laparoscopic Cholecystectomy is a safe procedure on the basis of only 4.2% intra operative and 5.5% postoperative complications and gaining wide spread popularity among our population due to less pain, less hospital stay. We recommend other private hospitals to extent such services to our poor population with symptomatic cholelithiasis.


2021 ◽  
Vol 15 (1) ◽  
pp. 91-94
Author(s):  
Muhammad Nasir ◽  

Background: Laparoscopic Cholecystectomy is now accepted as being safe for acute cholecystitis. However, it has not become routine, because the exact timing and approach to the surgical management remains ill define. Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe Laparoscopic Cholecystectomy. Objective: To compare the early and delayed Laparoscopic Cholecystectomy in the acute phase in terms of frequency of conversion to open cholecystectomy. Study Design: Randomized clinical trial. Settings: Department of Surgery, Divisional Headquarter Hospital, Faisalabad. Punjab Medical College, Faisalabad Pakistan. Duration: Study was carried out over a period of six months from June 2018 to May 2019. Methodology: A total of 152 cases (76 cases in each group) were included in this study. All patients were randomly allocated to either group i.e., group -A early Laparoscopic Cholecystectomy and group-B delayed Laparoscopic Cholecystectomy. Results: Mean age was 39.09 + 8.8 and 37.05+ 8.5 years in group- A and B, respectively. In group-A, male patients were 48 (63.2%) and female patients were 28 (36.8%). Similarly, in group-B, male patients were 41 (53.9%) and female patients were 35 (46.1%). Conversion to open cholecystectomy was required in 6 patients (7.9%) of group-A and 16 patients (21.0%) of group – B. Significant difference between two groups was observed (P= 0.021). Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible in terms of less frequency of conversion to open cholecystectomy.


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