scholarly journals STUDY OF PREOPERATIVE CLINICAL AND INVESTIGATIVE FACTORS PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

2020 ◽  
Vol 8 (3) ◽  
pp. 207-213
Author(s):  
Deepak Verma ◽  
Ratan ◽  
Nemi Chand
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Wall Thickness ◽  
Past History ◽  
Anatomical Variation ◽  
Cost Effective ◽  
Liver Function Tests ◽  
Early Return ◽  
Post Operative Pain ◽  
History Of

Background: Laparoscopic cholecystectomy is one of the most commonly performed surgical procedure with the advantage of short hospital stay, cosmetic, less post-operative pain and early return to work and thus ultimately cost effective. However, certain factors can make the procedure difficult and such patients many do not enjoy benefit of laparoscopic procedure particularly longer hospital stay. Aim: To determine various factors on clinical, pathological and radiological grounds to predict difficult laparoscopic cholecystectomy. Material and Method: 200 patients admitted in surgical ward with a diagnosis of Chronic Calculus cholecystitis to be selected for laparoscopic cholecystectomy were subject of this study. Age, Sex, BMI, number of previous attack, previous abdominal surgery, past history of pancreatitis and jaundice, signs of acute cholecystitis, leucocytosis, CRP, Liver function tests, serum amylase and lipase, GB wall thickness,  presence of pericholecystic fluid , status of  GB and anatomical variation were various factors studied. Results: Age > 50 years, male sex, BMI>30, more than 4 attacks, signs of cholecystitis, leucocytosis > 11,000/cu mm, increased GB wall thickness, presence of pericholecystic fluid and overdistended or contracted gall bladder are associated with difficult laparoscopic cholecystectomy.

Efficacy of Thiol disulfide Homeostasis and Ischemia Modified Albumin Values in Estimating the Degree of Difficulty for Laparoscopic Cholecystectomy

2020 ◽  
Vol 23 ◽  
Author(s):  
Gökhan Akkurt ◽  
Burcu Akkurt ◽  
Emel Alptekın ◽  
Birkan Birben ◽  
Mehmet Keşkek ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Demographic Data ◽  
Previous History ◽  
Significant Negative Correlation ◽  
White Blood Count ◽  
Ischemia Modified Albumin ◽  
Total Thiol ◽  
Duration Of Surgery ◽  
History Of

Aim: The aim of this study is to investigate the efficacy of thiol disulfide homeostasis and Ischemia Modified Albumin (IMA) values in predicting the technical difficulties that might be encountered during laparoscopic cholecystectomy. Materials and Methods: The study included 65 patients who underwent laparoscopic cholecystectomy due to cholelithiasis at the General Surgery Clinic of Ankara Numune Training and Research Hospital. All patients’ demographic data, previous history of cholecystitis, a history of chronic illness, preoperative white blood count (WBC), liver function tests (AST, ALT), amylase and lipase levels, intra-operative adhesion score, the ultrasonographic appearance of gallbladder, duration on hospital stay, duration of operation, thiol disulfide and IMA values were evaluated. Results: Native thiol and total thiol averages were higher in patients without a history of cholecystitis, on the other hand, disulfide, disulfide/native thiol rate, disulfide/total thiol rate, native thiol/total thiol rate and IMA averages were higher in patients with a history of cholecystitis. While there was a statistically significant negative correlation between native and total thiol values and age, duration of surgery and duration of hospital stay; IMA, disulfide, disulfide/Total thiol, Native/Total thiol and disulfide/Native thiol rates were higher in older patients with a longer duration of surgery and hospital stay. In addition, preoperative IMA, disulfide, disulfide/Total thiol, Native/Total thiol and disulfide/Native thiol were observed to increase as the degree of intraoperative pericholecystic adhesion increased. Conclusion: We believe that the evaluation of thiol disulfide homeostasis and IMA parameters prior to laparoscopic cholecystectomy can be used as an effective method for predicting intraoperative difficulties.

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.

scholarly journals Laparoscopic cholecystectomy in Jordan

2001 ◽  
Vol 7 (4-5) ◽  
pp. 838-840
Author(s):  
A. Al Raymoony
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Return To Work ◽  
Hospital Stay ◽  
Operative Time ◽  
Safe Procedure ◽  
Short Hospital Stay ◽  
Early Return ◽  
The Mean ◽  
Mean Time

This study was conducted on 100 patients with symptomatic gallbladder stones, aged 22-81 years with a mean of 51.5 years, who underwent cholecystectomy in Zarqa city, Jordan between July 1998 and July 1999. The success rate was 87% and the procedure was completed using the conventional method in 13 patients. The mean operative time was 60 minutes, complication rate was 5% and there were no deaths. The mean hospital stay was 1 day and mean time to return to work was 10 days. This study showed that laparoscopic cholecystectomy is a safe procedure with reasonable operative time, less postoperative pain, a short hospital stay, early return to work, and a low morbidity and mortality rate.

Feasibility of Laparoscopic Intraoperative Cholangiogram in Patients with Intermediate Risk for Choledocholithiasis

2021 ◽  
Vol 8 (02) ◽  
pp. 108-114
Author(s):  
Adithya G.K. ◽  
Satya Prakash Jindal ◽  
Varun Madaan ◽  
Vachan Hukkeri ◽  
Rigved Gupta ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Liver Function ◽  
Liver Function Tests ◽  
Filling Defect ◽  
Primary Objective ◽  
Intermediate Risk ◽  
Intraoperative Cholangiogram ◽  
History Of ◽  
Technical Issues

BACKGROUND Intra-Operative Cholangiogram (IOC) is a procedure carried out during cholecystectomy with the primary objective of clearly delineating the biliary anatomy. Over decades, routine IOC became selective IOC and now it is being overtaken by less invasive investigations like MRCP and EUS. Role of IOC remains only to intraoperatively confirm or rule out bile duct injury in difficult cases. Laparoscopic IOC is a skilful procedure which requires training and extra added time during laparoscopic cholecystectomy. Once mastered it can be used in many situations for either anatomical reasons or to detect CBD pathology. METHODS All patients getting admitted for laparoscopic cholecystectomy with intermediate risk for choledocholithiasis were enrolled in the study from 2016 to 2019. Procedure was carried out with all necessary consents and precautions. All cases were performed by an experienced GI surgeon and followed up with proper protocol. RESULTS Fifty patients with known intermediate risk for choledocholithiasis underwent laparoscopic cholecystectomy with laparoscopic IOC. Procedure was successfully done in all patients except two, where cystic duct was very thin and cannulation was not possible. Forty-one (82%) patients had deranged liver function test and 9 patients (18%) had history of acute pancreatitis in the past as indications for the procedure. Two patients had dilated CBD (>6 mm) on ultrasound along with deranged liver function tests. An average of 12 minutes was taken to perform the procedure (range: 8 - 15 min). In cases where IOC took longer time was mainly due to technical issues (operability of C-arm). No IOC related complications occurred in any of the patients. Hospital stay was not prolonged in any of the patients due to IOC. None of the patients had any filling defect in CBD. All cases followed till date are asymptomatic. CONCLUSIONS It is a technically feasible procedure that can be performed with limited addition to OT time, minimal failure rate, and complications. All patients with limited criteria for intermediate risk of choledocholithiasis had a normal IOC with no evidence of biliary obstruction in follow up. KEYWORDS Laparoscopic Intraoperative Cholangiogram, Intermediate Risk, CBD Stones

PREVALENCE OF OSTEOPOROSIS IN SUB-URBAN POPULATION OF CHENNAI USING QUS (QUANTITATIVE ULTRASOUND) OF CALCANEUM -A CROSS SECTIONAL STUDY

2021 ◽  
pp. 43-44
Author(s):  
S. Balameena ◽  
R Agavendra ◽  
Karthikeyan Karthikeyan ◽  
Sujatha Sujatha ◽  
Sabarish Sabarish ◽  
...  
Keyword(s):  
Screening Test ◽  
Past History ◽  
Age Groups ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Health Concern ◽  
Cross Sectional ◽  
Study Results ◽  
History Of ◽  
Ultrasound Score

Background:Burden of Osteoporosis and its related fractures are enormous and growing public health concern. Worldwide, an estimated 200 million adults suffer from osteoporosis. Vertebral and non-vertebral fractures are the most clinically relevant osteoporotic fracture because they are expensive to treat and have severe consequences for middle aged and elderly population.(1 ,2) The purpose of our study was to assess calcaneal ultrasound score as a screening test for osteoporosis. Material and Methods: Fifty patients above the age of 40 years who attended a health checkup camp conducted by our institute in a suburban population base of Chennai,Tamilnadu was subjected for noninvasive QUS of calcaneum bone as a screening test for osteoporosis. They were divided into different age groups ,co-morbid conditions noted and BMD scores from QUS was assessed. Statistical method were used with SPSS Version .It was a cross sectional descriptive study. Results: A total of 50 patients underwent QUS of calcaneum bone in our study , all of them above the age of 40 years. 33(66%) of them were females and 17(34%) were males. Eight patients( 16% ) had T score < -2.5 out of which 1 was male. 26 patients(52%) had T scores in the osteopenic range (-1>Tscore>-2.5).16 patients(32%) had T scores in the normal range. 40 % of patients had associated osteoarthritis and four patients had diabetes. 2 patients who underwent screening had past history of nontraumatic fractures. Conclusion: QUS of calcaneum is a good screening tool for assessing bone density in our country since its cost effective and can be used in various screening camps. The machine is portable and can be used with minimal training making it easier for the primary caregiver. It has reasonably good sensitivity and fair specicity when using Tscore of -2.5 as the cut off point. However DEXAis the gold standard for treatment and followup of patients with osteoporosis.

scholarly journals A Curious Case of Iron-Deficiency Anemia

2016 ◽  
Vol 2016 ◽  
pp. 1-2
Author(s):  
Seth Shaffer ◽  
Mayur Brahmania ◽  
Hemant Shah
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Past History ◽  
Digital Rectal Examination ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
Chronic Liver ◽  
Deficiency Anemia ◽  
Sessile Polyp ◽  
History Of

A 49-year-old Brazilian male presented to the emergency department with a five-day history of abdominal pain, dark stools, and syncope. Physical examination did not reveal any melena on digital rectal examination and there were no stigmata of chronic liver disease. Laboratory results showed hemoglobin of 47 g/L, MCV of 80 fL, and ferritin of 6 ng/mL. Liver enzymes and liver function tests were normal. Abdominal ultrasound showed a cirrhotic liver with splenomegaly and varices suggestive of portal hypertension. His past history was significant for cirrhosis based on a previous variceal bleed but a workup for chronic liver disease was negative and a liver biopsy did not show steatosis, fibrosis, or cirrhosis. A gastroscopy in this admission showed large esophageal varices without high-risk stigmata and no overt bleeding was seen. A colonoscopy was subsequently completed to the terminal ileum and was normal aside from a 5 mm sessile polyp in the descending colon.

scholarly journals Complications of Laproscopic Cholecystectomy in Patients of Acute Cholecystitis

2021 ◽  
Vol 15 (8) ◽  
pp. 2477-2479
Author(s):  
Haseena Rehman ◽  
Gul Lalley ◽  
Gul Sharif ◽  
Asim Shafi ◽  
Asif Mehmood ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Wound Infection ◽  
Acute Cholecystitis ◽  
Port Site ◽  
Treatment Procedure ◽  
Post Operative Pain ◽  
Port Site Hernia ◽  
Complications Of Laparoscopic Cholecystectomy ◽  
Bladder Diseases ◽  
History Of

Objective: To determine the complications of laparoscopic cholecystectomy in patients of acute cholecystitis. Study Design: Prospective study. Place & Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from January 2020 to June 2020. Methods: Total 120 patients of both genders with ages 20 to 60 years were included in this study. Patients’ detailed demographics were recorded after taking written consent. Patients with history of abdominal surgery were excluded. All the patients underwent laparoscopic cholecystectomy for gall bladder diseases. Post-operative pain was analyzed by VAS. Complications were recorded at 5th postoperative day. Data was analyzed by SPSS 24.0. Results: Out of 120 patients 30 (25%) patients were males and 75% patients were females. Most of the patients 50 (41.67%) were in the age group 31 to 40 years followed by 37 (30.83%) patients were ages between 41 to 50 years. 70 (58.33%) patients had surgical size port incision was 5mm and 50 (41.67%) patients had 10mm. Mean pain score was 2.24+1.1 at 5th postoperative day. Wound infection was found in 10 (8.33%). Port site hernia was found in 12 (10%). Conclusion: Laparoscopic cholecystectomy is safe and effective treatment procedure with no major complications. Keywords: Laparoscopic Cholecystectomy, Acute Cholecystitis, Wound Infection, Port Site Hernia, Pain

scholarly journals Stitch less, clip less, three ports laparoscopic cholecystectomy: experience of 300 cases

2019 ◽  
Vol 7 (8) ◽  
pp. 2899
Author(s):  
Ritvik Resutra ◽  
Neha Mahajan ◽  
Rajive Gupta
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Operative Time ◽  
Normal Activity ◽  
Duration Of Hospital Stay ◽  
Bile Duct Injuries ◽  
Early Return ◽  
Routine Work ◽  
Better Than

Background: 300 cases of cholelithiasis were operated by stitch less, clip less, three ports laparoscopic cholecystectomy at Maxx lyfe Hospital, near Bathindi morh, Sunjwan road, Jammu with effect from August 2017 to May 2019. The outcome measures in the form of safety of the technique, postoperative pain, need of postoperative analgesia, number of OT assistants needed, duration of hospital stay, recovery and return to routine work, cosmetic satisfaction of the patient were taken into consideration and were found to be better than in conventional four ports technique of laparoscopic cholecystectomy.Methods: In three port laparoscopic cholecystectomy, first 10 mm umbilical, second 5 mm subxyphoid and third 5 mm subcostal ports are used and telescope is passed into the peritoneal cavity through the umbilical port. Retraction of the gallbladder is done by the long grasping forceps through the 5 mm subcostal port, whereas dissection is accomplished through the subxyphoid port. The gallbladder is retrieved through the subxyphoid port.Results: Mean operative time was 40 minutes and mean duration of postoperative stay in the hospital was 18 hours. Days to return to normal activity was 4 days at an average.Conclusions: The 3-port laparoscopic cholecystectomy  technique is safe and has better outcomes in the form of less postoperative pain, less duration of hospital stay, early return to routine work and more cosmetic satisfaction as compared to the conventional 4-port technique, with no obvious increase in bile duct injuries and it can be a viable alternative in the field of minimally invasive surgery.

scholarly journals Comparison of low pressure versus standard pressure pneumoperitoneum for elective laparoscopic cholecystectomy in a tertiary care institute of western India

2018 ◽  
Vol 5 (5) ◽  
pp. 1776
Author(s):  
Ajit Gohil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Gall Stone ◽  
Low Pressure ◽  
Western India ◽  
Average Hospital ◽  
Post Operative Pain ◽  
Surgeon Experience ◽  
Standard Pressure

Background: Laparoscopic cholecystectomy has proven beyond doubt to be the gold standard in the management of symptomatic cholelithiasis and other gall stone diseases. The aim of this study was to compare the use of the low-pressure pneumoperitoneum (defined as 7-9 mm Hg) with the use of standard pressure pneumoperitoneum (defined as 14 mm Hg) in patients undergoing laparoscopic cholecystectomy in a prospective randomized manner.Methods: This randomized prospective study was carried out in the Department of General Surgery in a tertiary care PDU hospital, in Rajkot, India, from July 2014 to October 2016, with a sample size of 50 patients. Patients were randomized into two groups, one group with 25 patients was undergone laproscopic cholcystectomy with standard pressure pneumoperitoneun at 14 mm hg (SPLC) while the other group with 25 patients was undergone laproscopic cholecystectomy with low pressure pneumoperitoneum at 7-9 mm hg (LPLC).Results: Incidence and intensity of post-operative pain were significantly lower in LPLC group compared to SPLC group. The average change in systolic BP and diastolic BP in patients who underwent LPLC and SPLC was not statistically significant. Average hospital stay for LPLC group are 1.92 days and for SPLC group its 2.48 days.Conclusions: Though surgeon experience quite more difficulty in dissection during low pressure pneumoperitoneum and operative time is quite high, it is significantly advantageous in terms of post-operative pain, use of analgesics, less shoulder tip pain and hospital stay. It is feasible and safe. There was no significant change in SBP and DBP in both groups.

scholarly journals Diagnostic hystero-laparoscopy in work-up of female infertility

2017 ◽  
Vol 6 (7) ◽  
pp. 2852
Author(s):  
Amrita Rai ◽  
Manju G. Mishra
Keyword(s):  
Past History ◽  
Cost Effective ◽  
Pelvic Surgery ◽  
Infertile Couple ◽  
Secondary Infertility ◽  
Cost Effective Method ◽  
History Of ◽  
Work Up ◽  
Infertile Patients

Background: Infertility is a growing concern of the society. In many cases the exact cause of infertility may not be elucidated, whether it is tubal, ovarian, uterine, or a combination of factors. This paper aims to understand the role of diagnostic hystero-laparoscopy in evaluation of cases of infertility.Methods: This prospective study included 200 infertile women and it was conducted at department of Obstetrics and Gynaecology, MGM Hospital, during the period between January 2016 to December 2016. All the infertile patients either with primary or secondary infertility were included after thorough evaluation.Results: Out of 200 cases, 118(59%) patients had primary infertility and 82(41%) had secondary infertility. While laparoscopy detected abnormalities in 49% of the cases, significant hysteroscopy findings were noted in only 23.5% of cases. The most common laparoscopic abnormalities were endometriosis (32%) and unilateral tubal lockage (24%). On hysteroscopy, periosteal adhesions were the commonest abnormality in both the groups.Conclusions: Diagnostic hystero-laparoscopy is a safe and cost-effective method and should be considered when there are abnormal HSG results, a past history of pelvic infection, pelvic surgery and /or unexplained secondary infertility during management of infertile couple. Evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies which are usually missed by other imaging modalities, can be diagnosed as well as managed in some cases by hystero-laparoscopy.

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