scholarly journals Comparison of Early and Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

2021 ◽  
Vol 15 (1) ◽  
pp. 91-94
Author(s):  
Muhammad Nasir ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Female Patients ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
Group A ◽  
Male Patients ◽  
Group B

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.

scholarly journals Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Aly Saber ◽  
Emad N. Hokkam
Keyword(s):  
Patient Satisfaction ◽  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Patient’S Satisfaction ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Operative Outcome ◽  
Group A ◽  
Group B

Introduction. Early laparoscopic cholecystectomy is usually associated with reduced hospital stay, sick leave, and health care expenditures. Early diagnosis and treatment of acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies.Objectives. To compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction.Patients and Methods. Patients with acute cholecystitis were divided into two groups, early (A) and delayed (B) cholecystectomy. Diagnosis of acute cholecystitis was confirmed by clinical examination, laboratory data, and ultrasound study. The primary end point was operative and postoperative outcome and the secondary was patient’s satisfaction.Results. The number of readmissions in delayed treatment group B was three times in 10% of patients, twice in 23.3%, and once in 66.7% while the number of readmissions was once only in patients in group A and the mean total hospital stays were higher in group B than in group A. The overall patient’s satisfaction was92.66±6.8in group A compared with75.34±12.85in group B.Conclusion. Early laparoscopic cholecystectomy resulted in significant reduction in length of hospital stay and accepted rate of operative complications and conversion rates when compared with delayed techniques.

scholarly journals Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective, Randomized Study

2014 ◽  
Vol 99 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Alper Bilal Özkardeş ◽  
Mehmet Tokaç ◽  
Ersin Gürkan Dumlu ◽  
Birkan Bozkurt ◽  
Ahmet Burak Çiftçi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Operation Time ◽  
Early Laparoscopic Cholecystectomy ◽  
Laparoscopic Cholecystectomy Group ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

Abstract We aimed to compare the clinical outcome and cost of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Sixty patients with acute cholecystitis were randomized into early (within 24 hours of admission) or delayed (after 6–8 weeks of conservative treatment) laparoscopic cholecystectomy groups. There was no significant difference between study groups in terms of operation time and rates for conversion to open cholecystectomy. On the other hand, total hospital stay was longer (5.2 ± 1.40 versus 7.8 ± 1.65 days; P = 0.04) and total costs were higher (2500.97 ± 755.265 versus 3713.47 ± 517.331 Turkish Lira; P = 0.03) in the delayed laparoscopic cholecystectomy group. Intraoperative and postoperative complications were recorded in 8 patients in the early laparoscopic cholecystectomy group, whereas no complications occurred in the delayed laparoscopic cholecystectomy group (P = 0.002). Despite intraoperative and postoperative complications being associated more with early laparoscopic cholecystectomy compared with delayed intervention, early laparoscopic cholecystectomy should be preferred for treatment of acute cholecystitis because of its advantages of shorter hospital stay and lower cost.

scholarly journals Early versus late laparoscopic cholecystectomy in the management of acute cholecystitis: a retrospective study

2019 ◽  
Vol 6 (11) ◽  
pp. 3897
Author(s):  
Deepu Thiyagarajan ◽  
Prince Deva Ruban
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Demographic Data ◽  
Late Complications ◽  
Aged Patients ◽  
Early Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
Duration Of Surgery

Background: Early laparoscopic cholecystectomy (LC) is a life-saving procedure in the management of acute cholecystitis as it helps in prevention of late complications like development of adhesions, haemorrhage and sepsis. The study aims at comparing the outcomes of early versus late laparoscopic cholecystectomy in the management of acute cholecystitis.Methods: A retrospective study was done by analyzing the past 5 years medical records of 250 patients admitted to the emergency department with diagnosis of acute cholecystitis established according to the Tokyo criteria. The relevant clinio-social demographic data of the patients, clinical and radiological parameters, intra-operative and post-operative findings and follow-up data were compared between early and late LC group of patients.Results: The study included 125 middle aged patients who underwent early LC (within 24 hours) and 125 patients who underwent late LC (after 24 4hours). The complication rate, conversion to open cholecystectomy and duration of surgery showed no significant differences between early and late laparoscopic cholecystectomy except for an increased duration of stay among the late LC group.Conclusions: Early LC is an efficient procedure for acute cholecystitis but it has risks of complications which can be minimized by careful selection of patients after clear clinical and radiological evaluation. 

DOES EARLY LAPAROSCOPIC CHOLECYSTECTOMY AFTER ERCP OFFERS SIGNIFICANT BENEFIT IN SURGICAL OUTCOME? A COMPARATIVE STUDY BETWEEN EARLY AND LATE GROUPS

2021 ◽  
pp. 59-61
Author(s):  
Anshul Mathur ◽  
Ketan Patel ◽  
Jitendra Kumar Mangtani ◽  
K.K. Dangayach
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Endoscopic Retrograde ◽  
Endoscopic Retrograde Cholangiopancreaticography ◽  
Early Laparoscopic Cholecystectomy ◽  
Conversion Rates ◽  
Group A ◽  
Group B

Introduction:- Endoscopic retrograde cholangiopancreaticography (ERCP) prior to Laparoscopic Cholecystectomy(LC) is most commonly practiced strategy worldwide for management of co-existing cholelithiasis with choledocholithiasis. The time interval between Endoscopic Retrograde Cholangiopancreaticography (ERCP) and Laparoscopic cholecystectomy (LC) is questionable and varies from 1 day to 6 weeks in different studies. Aims and objectives:- To compare two groups of patients managed with laparoscopic cholecystectomy (after ERCP), EARLY(24 to 72 hours), and LATE(> 6weeks) in terms of mean operative time in minutes, intraoperative difculties, conversion rates to open cholecystectomy, conversion rates to open cholecystectomy, drain insertion required or not, postoperative complications, and duration of hospital stay. Materials and methods:- A prospective randomized comparative study was conducted on 70 patients who presented with concomitant cholelithiasis with choledocholithiasis over a period of January 2019 to June 2020 at the Department of General Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur. After ERCP and stone retrieval patients were randomised into 2 groups using sealed envelope method. Group A underwent early laparoscopic cholecystectomy (24 to 72hours) and Group B underwent late laparoscopic cholecystectomy (after 6 weeks). Data collected, statistical analysis done, results and observations concluded. Result:- We found that mean operative time, intraoperative difculties, post operative complications and mean hospital stay in days were signicantly higher in Group B as compared to Group A. Though the conversion rates to open procedure and requirement of drain insertion were comparatively higher in Group B but were found to be statistically non signicant. Conclusion:- We hereby conclude that early laparoscopic cholecystectomy (24 to 72 hours) after Endoscopic Retrograde Cholangiopancreaticography (ERCP) is better as compared to late laparoscopic cholecystectomy (>6 weeks) after ERCP in patients of cholelithiasis with coexisting choledocholithiasis. So, we recommend performing early Laparoscopic Cholecystectomy (24-72hours) after Endoscopic Retrograde Cholangiopancreaticography (ERCP)

scholarly journals Early versus Delayed Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis in Southern Odisha - A Prospective Comparative Study

2021 ◽  
Vol 8 (20) ◽  
pp. 1484-1488
Author(s):  
Manoj Kumar Sethy ◽  
Siva Rama Krishna M ◽  
Jagannath Subudhi S ◽  
Biswa Ranjan Pattanaik ◽  
Manita Tamang ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conservative Treatment ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Morbidity And Mortality ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
The Mean ◽  
Antibiotic Coverage

BACKGROUND Acute cholecystitis is a pathology of inflammatory origin, usually associated with cholelithiasis, with a high incidence in the world. Its treatment involves an important socioeconomic impact. There are two surgical therapeutic options: early laparoscopic cholecystectomy (ELC) done within 72 hours of onset of pain or delayed laparoscopic cholecystectomy (DLC) done after 6 weeks of conservative treatment. The present study intends to compare between the effectiveness of ELC vs DLC in the management of acute cholecystitis in a tertiary care setup. METHODS The study sample included 65 patients who were clearly documented and radiologically proven cases of acute calculous cholecystitis, met the inclusion criteria, admitted to the surgery department of MKCG MCH, Berhampur, between August 2018 and July 2020. Out of 65 patients, 33 and 32 patients were selected randomly for ELC and DLC respectively. In ELC group surgery was done within 72 hours of the onset of pain while in DLC group surgery was done after 6 weeks of initial conservative treatment. The study was conducted using a case record proforma, prepared in their local language. The questionnaire included timing of cholecystectomy, duration of antibiotic coverage, mean duration of hospital stay, number of intraoperative and postoperative complications, conversion to open cholecystectomy, and follow-up. The data was compiled and tabulated in MS ® Excel and statistically analysed using IBM ® SPSS 22.0. RESULTS The overall morbidity and mortality were less in ELC compared to DLC. The mean duration of surgery was less in ELC (47.36 minutes) compared to DLC (65.75 minutes). The mean duration of antibiotic coverage was lesser in ELC (3.58 days) compared to DLC (5.50 days).The mean hospital stay was less in ELC (4.67 days) to DLC (6.50 days). The overall morbidity and mortality were less in ELC. CONCLUSIONS ELC is considered to be a safe modality of treatment in patients with acute cholecystitis and leads to an economical treatment. KEYWORDS Acute Calculus Cholecystitis, Early Laparoscopic Cholecystectomy, Delayed Laparoscopic Cholecystectomy

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 LAPAROSCOPIC CHOLECYSTECTOMY;

2019 ◽  
Vol 26 (03) ◽  
Author(s):  
Fatima Abbasi ◽  
Saeed Ahmed
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Acute Attack ◽  
P Value ◽  
Early Group ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
Late Group

Objectives: To compare the outcomes of early versus delayed laparoscopic cholecystectomy in acute calculus cholecystitis. Study Design: Randomized control study. Setting: Surgical Unit of Rawal Medical and Dental Hospital, Islamabad. Period: February 2015 to January 2016. Subjects and Methods: 100 patients with acute cholecystitis between the ages 20 years to 60 years were divided into early and late group of 50 patients each. Informed consent was taken. Data was entered into a pre designed performa. Analysis of data was done using spss version 17. T test was applied on quantitative data and chi 2 on qualitative data. p–value of less than 0.05 was taken as significant. Early group had laparoscopic cholecystectomy within 72 hours while late group had surgery 6-8 weeks after the acute attack. Results: There was increased operating time in the early group which was statistically significant (p-value 0.046). There was slightly increased rate of conversion to open cholecystectomy, increased hospital stay and intra and post operative complications but none of them were statistically significant. Also pain scores and analgesic requirements had no major difference in both groups. Conclusion: Early laparoscopic cholecystectomy is a reasonably safe and cost effective alternative to interval cholecystectomy. Although some complications are more common in early cholecystectomy mainly due to difficult anatomy of calot’s triangle like conversion to open, gall bladder perforation and wound infection, none of them proved to be statistically significant.

scholarly journals Short term outcomes of three dimensional versus two-dimensional laparoscopic cholecystectomy

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Abdul Razaque Shaikh ◽  
Aaijaz Ahmed Shaikh ◽  
Mujib Rehman Abbasi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Three Dimensional ◽  
Port Site ◽  
Two Dimensional ◽  
Short Term ◽  
Term Outcome ◽  
Conversion To Open Cholecystectomy ◽  
Group A ◽  
Group B

Objective: To compare the short-term outcomes of three dimensional (3D) versus two dimensional (2D) laparoscopic procedures used for cholecystectomy. Methods: This study was conducted at minimally invasive surgery center of Liaquat University of Medical Health and Sciences (LUMHS) Jamshoro Pakistan, between 15th May 2017 to 16th December 2017 after taking informed consent. All patients were diagnosed cases of cholelithiasis without any complications. Patients having risk factors for inability to get access to gall bladder via laparoscope and in whom the chances of conversion to open cholecystectomy were greater were not included as part of study. One group of patients underwent cholecystectomy under 3D laparoscopy while other group underwent 2D laparoscopy. Surgeons included in the study were all well-trained. The short-term outcome noted were intraoperative and postoperative complications, conversion to open, operative time, mortality and hospital stay. Visual strain and headache for the surgeon in three D laparoscopic cholecystectomy. Results: A total of one hundred forty patients were included in the study. Group-A consists of sixty two females and eleven males whereas Group-B comprised of fifty eight females and fifteen males. Eight percent of patients in Group-A whereas in Group-B two percent had gallbladder rupture. Fifteen percent of patients in Group-A whereas 5.4% from Group-B had bleeding from liver bed. One patient from Group-A had CBD (Common Bile Duct) injury. Post-operatively two (2.73%) patients from Group-A had port site bleeding. Six (8.21%) patients had port site infection in Group-A. Conclusion: Three dimensional was found to have low incidence of intra-operative and post-operative complications compared to 2D laparoscopic cholecystectomy. doi: https://doi.org/10.12669/pjms.37.1.3721 How to cite this:Shaikh AR, Shaikh AA, Abbasi M. Short term outcomes of three dimensional versus two-dimensional laparoscopic cholecystectomy. Pak J Med Sci. 2021;37(1):162-166. doi: https://doi.org/10.12669/pjms.37.1.3721 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Safety and feasibility of three port procedure in laparoscopic cholecystectomy

2019 ◽  
Vol 6 (6) ◽  
pp. 1975
Author(s):  
Vipin Gupta ◽  
Shailendra Pal Singh ◽  
Somendra Pal Singh ◽  
Anil Kumar Keshari ◽  
Anil Kumar Erry ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Standard Technique ◽  
Post Operative Pain ◽  
Conversion To Open Cholecystectomy ◽  
Operative Complications ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Laparoscopic cholecystectomy is widely accepted gold standard technique for management of cholelithiasis and has undergone many refinements including decrease in size and number of ports. Many researchers have claimed that three-port laparoscopic cholecystectomy is safe and feasible method for management of cholelithiasis but still it is not performed widely by the surgeons. Objective of our study was to assess the safety and feasibility of three-port laparoscopic cholecystectomy by comparing the various defined parameters with the standard four-port laparoscopic cholecystectomy.Methods: The study included 100 patients and was divided equally in 2 groups. Patients in Group A underwent laparoscopic cholecystectomy by three-port technique and in Group B were operated by four-port technique. Patients in both the groups were compared in terms of operative time, intra-operative complications, post-operative pain, post-operative complications and cosmesis outcome.Results: The mean operative time was similar in both groups. Intra-op and post-op complications were also similar. 3 patients in Group A needed fourth port and 1 patient in both group required conversion to open cholecystectomy. Mean pain score and requirement of parentral analgesia was found to be lower in Group A. Duration of hospital was similar in both the groups. Patients in group A had slightly better cosmetic outcome.Conclusions: Three-port laparoscopic cholecystectomy is a minimally invasive, safe and feasible technique and is not difficult to master than other advanced techniques. In experienced hands, laparoscopy cholecystectomy can be initially started with three-ports and can be converted to four-port if rarely necessary.

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.

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