scholarly journals EARLY CHOLECYSTECTOMY

2018 ◽  
Vol 21 (01) ◽  
pp. 010-015
Author(s):  
Muhammad Sajid ◽  
Khalid Azim ◽  
Sajid Rehman ◽  
Khurram Saqib
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Bile Leak ◽  
Early Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Major Bleed ◽  
Calot’S Triangle ◽  
Symptomatic Gallstones ◽  
Safe Technique

Background: This study was conducted to evaluate results of earlycholecystectomy in acute cholecystitis in terms of procedural safety. Methods: In this study 50consecutive cases of acute cholecystitis who underwent early laparoscopic cholecystectomy(within 03 days of attack) were included. Patients with symptoms of more than 03 days durationor those with associated diseases were excluded. Evaluation of results was done by analyzingthe data in SPSS V-17. Results: Out of 50 patients operated 46 (92%) were female and 4 (8%)were male. Most of the patients were received within 24 hours after the onset of symptoms. Theage of patients ranged from 30-70 years with the median age of 45 years. Ultrasound revealedoedematous gall bladder with pericholecystic fluid in 38 (76%) patients. In 8 (16%) patients, gallbladder was small, shrunken and thick walled, there was empyema in 2 (4%) patients &mucocele with stone impacted at hartmann’s pouch in 2 (4%) patients. Average operation timewas 40 minutes. All patients were operated within 72 hours of onset of symptoms. Per operativelysevere inflammation was noted in 32 (64%) patients, adhesions with colon/stomach/omentum in10 (20%) patients, adhesions with CBD in 3 (6%) patients, distorted anatomy at Calot’s triangle in5 (10%) patients. 6 (12%) patients had bleeding from liver bed, but controlled with diathermy. In46 (92%) patients laparoscopic cholecystectomy was completed successfully. In 4 (8%) patients,laparoscopic procedure was converted to open cholecystectomy. Reasons of conversion wereacute cholecystitis with severe adhesions which caused bleeding in 2 (4%) patients, obscureanatomy of Calot's triangle in 2 (4%) patients. Post operatively, there was bile leak in 1 (2%)patient which was due to minor injury of CBD, which required re-exploration & suturing of defect.No patient developed post operative jaundice. There was no major bleed post operatively. 3 (6%)patients developed wound infection. Conclusions: Laparoscopic cholecystectomy is aneffective and safe technique of treating symptomatic gallstones even in cases of acutecholecystitis because of accelerated recovery couple with less postoperative pain and shorthospital stay.

Unusual fistula demonstrating the need for an early cholecystectomy

2020 ◽  
Vol 13 (9) ◽  
pp. e235795
Author(s):  
Gregory Harrison ◽  
Roland Fernandes
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Early Cholecystectomy ◽  
Calot’S Triangle ◽  
Initial Episode ◽  
Laparoscopic Assisted ◽  
Definitive Management ◽  
Active Disease

A 79-year-old man developed a spontaneous cholecystocutaneous fistula 12 months after an initial episode of acute cholecystitis. A laparoscopic cholecystectomy procedure was twice abandoned due to extensive adhesions and active disease, limiting safe dissection of Calot's triangle. Abdominal collections formed and a spontaneous cholecystocutaneous fistula developed. Imaging revealed an 11 cm calculus and erosion of the fundus of the gall bladder through the sheath. Definitive management was achieved with a laparoscopic assisted open cholecystectomy.

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 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. 

scholarly journals Predictive factors for conversion from laparoscopic to open cholecystectomy: an institutional study

2018 ◽  
Vol 5 (8) ◽  
pp. 2894
Author(s):  
Digvijoy Sharma ◽  
Kunduru Nava Kishore ◽  
Gangadhar Rao Gondu ◽  
Venu Madhav Thumma ◽  
Suryaramachandra Varma Gunturi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Bladder Wall Thickness ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy ◽  
Gall Bladder Wall

Background: Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gallstones. However, a conversion to open surgery may be required to complete the procedure safely. The aim of this study is to identify the predictive factors of conversion from laparoscopic to open cholecystectomy in elective setting.Methods: A retrospective review of all patients underwent laparoscopic cholecystectomy electively for symptomatic gallstones from January 2016 to December 2017 was performed. Data considered for analysis were: demographic data, preoperative laboratory values of liver function tests, gall bladder wall thickness on ultrasound, preoperative ERCP, indication for surgery, history of acute cholecystitis, presence of intraoperative adhesions and frozen Calot's triangle. Conversion to open cholecystectomy was chosen as the dependent variable for both, univariate and multivariate analysis.Results: 546 patients underwent laparoscopic cholecystectomy. 333 were females (60.9%) and 213 (39.1%) males, with a mean age of 44.6 years. The most common indication for surgery was symptomatic cholelithiasis. Conversion to open cholecystectomy occurred in 48 cases (8.8%) and the most common reason for conversion was inability to define the Calot’s triangle anatomy due to inflammation/adhesions. Univariate and multivariate analyses of various variables demonstrated that male gender, gall bladder wall thickness >5 mm and presence of previous documented acute cholecystitis had statistically significant co-relation with higher rates of conversion (p<0.001).Conclusions: Presence of acute cholecystitis, gall bladder wall thickness >5mm on preoperative ultrasound and male gender were independent predictor factors for conversion from laparoscopic to open cholecystectomy. Such patients should be properly counselled about the increased risk for conversion and should be operated by surgeons experienced in laparoscopic procedures to reduce the rate of conversion and operative complications.

A Prospective Study of Bile Leaks after Laparoscopic Cholecystectomy for Acute Cholecystitis

2006 ◽  
Vol 72 (3) ◽  
pp. 265-268 ◽  
Author(s):  
Edward P. Dominguez ◽  
Dave Giammar ◽  
John Baumert ◽  
Oscar Ruiz
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Prospective Study ◽  
Acute Cholecystitis ◽  
Effective Treatment ◽  
Open Cholecystectomy ◽  
Bile Leak ◽  
Elective Setting ◽  
A Prospective Study ◽  
Bile Leaks

Surgeons are increasingly performing laparoscopic cholecystectomy in the setting of acute cholecystitis. The acutely inflamed gallbladder poses a more technically demanding dissection with potential for an increase in bile leak rates. Clinical and subclinical bile leak rates after laparoscopic and open cholecystectomy in the elective setting are known. This study prospectively evaluates the rate of clinical and subclinical bile leaks after laparoscopic cholecystectomy in the setting of acute cholecystitis. One hundred patients underwent laparoscopic cholecystectomy for acute cholecystitis, as determined intraoperatively and by history, ultrasound, fever, or leukocytosis. On postoperative Day 1, the patients underwent cholescintigraphy (PIPIDA scan) analyzed by a board-certified radiologist for evidence of bile leaks. Postoperative cholescintigraphy revealed eight scans positive for bile leaks. Regardless of scan result, no patient experienced a clinically symptomatic bile leak. Laparoscopic cholecystectomy is a safe and effective treatment for acute cholecystitis with acceptable clinical and subclinical bile leak rates.

scholarly journals ACUTE CHOLECYSTITIS

2009 ◽  
Vol 16 (04) ◽  
pp. 489-491
Author(s):  
MUHAMMAD FAISAL BILAL LODH ◽  
SUMERA KANWAL ◽  
MUHAMMAD AKRAM
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Operative Time ◽  
Early Group ◽  
Total Hospital ◽  
Effective Technique ◽  
Early Laparoscopic Cholecystectomy ◽  
Total Hospital Stay ◽  
Symptomatic Gallstones ◽  
Late Group

Laparoscopic cholecystectomy has been accepted as the treatment of choice for symptomatic gallstones. Its efficacy and timingin cases of acute cholecystitis is still under debate. This study was undertaken to evaluate our experience with early cholecystectomy as a safe,effective treatment of acute cholecystitis. M a t e r i a l s a n d m e t h o d s : Record of all the patients who had undergone laparoscopic cholecystectomy for the diagnosis of acute cholecystitis was reviewed. Patients were divided into two groups on the bases of onset of symptoms to surgical intervention: less than 72 hours in the early group (n = 15) and more than 72 hours in the late group (n = 25). Results: Conversion to openprocedure was insignificantly less (3 out of 15 in early group and 8 out Of 25 in late group) (20% versus 32%) in the early treated patients (pvalue0.411). Furthermore, the operative time (75 versus 95 minutes) postoperative hospitalization (2 versus 4 days) and total hospital stay (4versus 6 days) were significantly reduced in patients undergoing early laparoscopic cholecystectomy. C o n c l u s i o n : Laparoscopiccholecystectomy is a safe, effective technique for acute cholecystitis in experienced hands with lower conversion rate, shorter operative timeand reduced hospitalization.

scholarly journals Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis revised: Protocol of a systematic review and meta-analysis of results

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Giuseppe Borzellino ◽  
Safi Khuri ◽  
Michele Pisano ◽  
Subhi Mansour ◽  
Niccolò Allievi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Laparoscopic Cholecystectomy ◽  
Early Intervention ◽  
Conservative Treatment ◽  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Early Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Pooled Data ◽  
Delayed Cholecystectomy

Abstract Background Early laparoscopic cholecystectomy has been adopted as the treatment of choice for acute cholecystitis due to a shorter hospital length of stay and no increased morbidity when compared to delayed cholecystectomy. However, randomised studies and meta-analysis report a wide array of timings of early cholecystectomy, most of them set at 72 h following admission. Setting early cholecystectomy at 72 h or even later may influence analysis due to a shift towards a more balanced comparison. At this time, the rate of resolving acute cholecystitis and the rate of ongoing acute process because of failed conservative treatment could be not so different when compared to those operated with a delayed timing of 6–12 weeks. As a result, randomised comparison with such timing for early cholecystectomy and meta-analysis including such studies may have missed a possible advantage of an early cholecystectomy performed within 24 h of the admission, when conservative treatment failure has less potential effects on morbidity. This review will explore pooled data focused on randomised studies with a set timing of early cholecystectomy as a maximum of 24 h following admission, with the aim of verifying the hypothesis that cholecystectomy within 24 h may report a lower post-operative complication rate compared to a delayed intervention. Methods A systematic review of the literature will identify randomised clinical studies that compared early and delayed cholecystectomy. Pooled data from studies that settled the early intervention within 24 h from admission will be explored and compared in a sub-group analysis with pooled data of studies that settled early intervention as more than 24 h. Discussion This paper will not provide evidence strong enough to change the clinical practice, but in case the hypothesis is verified, it will invite to re-consider the timing of early cholecystectomy and might promote future clinical research focusing on an accurate definition of timing for early cholecystectomy for acute cholecystitis.

scholarly journals Determinants of conversion during laparoscopic cholecystectomy among a sample of Iraqi patients

2018 ◽  
Vol 5 (7) ◽  
pp. 2455
Author(s):  
Abutalib B. Alluaibi ◽  
Bahaa K. Hassan ◽  
Alaa H. Ali ◽  
Ahmed A. Muhsen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Male Gender ◽  
Visceral Injury ◽  
Previous Abdominal Surgery ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy

Background: Laparoscopic cholecystectomy has become a standard technique for gall bladder surgery of symptomatic cholelithiasis. However, conversion to open cholecystectomy is sometimes necessary. The aim of the present study was to assess the predictive factors that increase the possibility of conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: A total of 621 laparoscopic cholecystectomies were attempted at AL-Mawanee General Hospital and AL-Sader Teaching Hospital in Basrah, IRAQ from June 2012 till June 2016.Of these,43 had to be converted to open cholecystectomies. Patients assessed according to different factors, including age, sex, acute cholecystitis, adhesions of gallbladder and calot's triangle, obesity, previous abdominal surgery, anatomical variation of gallbladder and Calot's triangle and intraoperative complications (bleeding, bile duct injury, visceral injury).Results: Conversion to open cholecystectomy was performed in 43 patients (6.92%). The significant factors for conversions were adhesions of gallbladder and Calot's triangle(39.53%) followed by acute cholecystitis(34.88%). Rate of conversion in other factors are as the following i.e., isolated male gender (0%), age (0%), previous abdominal surgery (9.3%), obesity (2.33%), anatomical variations of gall bladder and calot's triangle (2.33%), intra operative complications including bleeding (4.65%), bile duct injury (4.65%), visceral injury (2.33%) were insignificant factors for conversion.Conclusions: Adhesions of gallbladder and calot's triangle is the most common predictive factor and cause for conversion from laparoscopic cholecystectomy to open cholecystectomy. Acute cholecystitis found to be the strongest factor for conversion despite its incidence is lower than adhesions of gall bladder and calots triangle. Male gender and age more than fifty years are not direct predictive factors for conversions.

scholarly journals Laparoscopic Cholecystectomy in Patients with Emphysematous and Gangrenous Cholecystitis: An Experience at Khwaja Yunus Ali Medical College & Hospital, Enayetpur, Sirajgonj.

KYAMC Journal ◽  
2017 ◽  
Vol 5 (2) ◽  
pp. 519-523
Author(s):  
Mohd Farid Hossain ◽  
Sailendra Nath Biswas ◽  
Masudur Rahman ◽  
Tanvir Ahmed ◽  
Apu Karmaker
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Operating Time ◽  
Severe Form ◽  
College Hospital ◽  
Open Procedure ◽  
Early Laparoscopic Cholecystectomy ◽  
Calot’S Triangle ◽  
Gangrenous Cholecystitis ◽  
Surgical Technical

Objective- To look for the feasibility and safety of laparoscopic cholecystectomy in patients with emphysematous and gangrenous cholecystitis.Back ground- Emphysematous and gangrenous cholecystitis are severe form of acute cholecystitis. They are considered as contraindication of laparoscopic cholecystectomy due to peri operative life threatening complications, surgical technical difficulties, frequent conversion to open procedure. This study describe our experience in terms of feasibility and safety with laparoscopic cholecystectomy in patients with emphysematous and gangrenous cholecystitis.Materials and methods- From January 2012 to December 2014,total 37 patients with clinical diagnosis of severe acute cholecystitis under went laparoscopic cholecystectomy within 72 hours of admission. Operative findings and histopathological reports were used to identify patients of emphysematous and gangrenous cholecystitis.Results- 35(94.59%)among 37 patient's laparoscopic cholecystectomy were performed successfully.29 case were emphysematous and 8 cases were gangrenous cholecystitis. Two patient's laparoscopic procedure were converted to open procedure due to various operative difficulties, of which the most common was distorted calot's triangle. Maximum operating time was up to 130 minutes(one case),Post operative major complications occurred in 2 cases(5.40%).maximum patients were discharged by 48 to72 hours. There was no mortality.Conclusion- laparoscopic cholecystectomy is feasible and safe in emphysematous and gangrenous cholecystitis. However the experience of the surgeon and his patience during surgery play key role in over all out come. Based on our experience we recommend an early laparoscopic cholecystectomy for these group of patients, provided expertise & gadgets are available.KYAMC Journal Vol. 5, No.-2, Jan 2015, Page 519-523

scholarly journals Bile Leak Following Laparoscopic Cholecystectomy

2019 ◽  
Vol 4 (5) ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Open Cholecystectomy ◽  
Bile Leak ◽  
Signs And Symptoms ◽  
Bile Leakage ◽  
The Other ◽  
Symptomatic Gallstones ◽  
Cbd Injury ◽  
Dangerous Condition

Bile leakage is a very dangerous condition after laparoscopic cholecystectomy and may lead to fatal complications and serious care should be taken to diagnose the cause as early as possible because it may be sign of bile duct injury which is a major concern to the surgeons as if it is not diagnosed early, it will lead to dangerous complications such as biliary peritonitis, hepatic failure and even death. Early diagnosis is important to decrease morbidity and mortality. This study aimed to determine the incidence of bile leakage, its types of management and the outcome in patients with gallstone who are submitted to laparoscopic cholecystectomy. This prospective study was done in Basrah Al-Sadr Teaching Hospital in a two-year period from October 2013 to October 2015 on 560 patients; they were 378 females and 182 males. All of them have symptomatic gallstones and underwent laparoscopic cholecystectomy. All converted cases to open cholecystectomy were excluded. From the total number of 560 patients, nine patients developed bile leak in early post-operative period, 6 of them have drains, the other three have no drain, and they were presented with signs and symptoms of intra-abdominal collection. The causes of leak were common bile duct (CBD) injury in 2 cases, accessory duct in 3 patients, leak from the gall bladder bed in 3 cases and one case iatrogenic from intra-hepatic drain. All the patients were treated conservatively except the two patients with CBD injury who were treated; one with the aid endoscopic retrograde cholangio-pancreatography (ERCP) and the other by re-exploration. In conclusion, bile leak is a serious complication after laparoscopic cholecystectomy, although it is not common but it is important to identify the site of leak and should be tre

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