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 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.

Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

2021 ◽  
pp. 004947552110100
Author(s):  
Shamir O Cawich ◽  
Avidesh H Mahabir ◽  
Sahle Griffith ◽  
Patrick FaSiOen ◽  
Vijay Naraynsingh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gold Standard ◽  
Standard Treatment ◽  
Gallstone Disease ◽  
Acute Attack ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Surgery ◽  
Delayed Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

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 RESULTS OF EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH AN ACUTE CALCULUS CHOLECYSTITIS AND ISCHEMIC HEART DISEASE

2018 ◽  
Vol 13 (3-4) ◽  
pp. 15-21
Author(s):  
V.G. Mishalov ◽  
S.O. Kondratenko ◽  
L.Yu. Markulan
Keyword(s):  
Heart Disease ◽  
Laparoscopic Cholecystectomy ◽  
Ischemic Heart Disease ◽  
Open Cholecystectomy ◽  
Group Versus ◽  
Ischemic Heart ◽  
Acute Calculous Cholecystitis ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
Calculous Cholecystitis

Relevance. Determination of the optimal time for laparoscopic cholecystectomy (LCE) in patients with acute calculous cholecystitis (ACC) and ischemic heart disease (IHD) is still an actual and unresolved issue. Objective: to evaluate the results early versus delayed LCE in patients with ACC and IHD. Materials and methods. The study involved 107 patients with ACC and IHD: 56 (47,7 %) women and 51 (52,3 %) men aged 55 to 82 years, an average 70,2±0,6 years. The group with early LCE (ELCE) included 48 patients with LCE – up to 72 hours from the beginning of ACC (on average 41,9±2,1 hours), the group with delayed LCE (DLCE) – 59 patients, who were LCE for more than 72 hours (in average 90,2±1,6 hours) from the beginning of ACC. Groups of patients were representative according to the functional classes of heart failure, angina pectoris, severity and the histological form of ACC. All patients had a Charlson comorbidity index from 0 to 2 points. The endpoint of the study were: the frequency of conversion to open cholecystectomy, cardiac events in the intra – and early postoperative periods, the incidence of complications according to the Clavien-Dindo classification. Data analysis was performed using IBM SPSS Statistics. Results.  The duration of LCE in the DLCE group was 45,2±2,1 minutes, in the ELCE group it was 40,9±1,4 min (p=0,115). Conversion to open cholecystectomy was required in 8 (13,6 %) patients of the DLCE group versus one (2,1 %) in the ELCE group, p=0,033. During the operation, myocardial ischemia occurred in 17 (28,8 %) patients of the DLCE group versus 6 (12,5%) the ELCE group, p=0,041, and a systolic blood pressure decrement lower than 70 mm hg. art. – in 24 (40,7 %) against 8 (16,7 %), p=0,007; saturation reduction episodes – in 33 (55,9 %) against 17 (35,4 %), p=0,034, respectively. In the early postoperative period, an increasing of HF class according to NYHA was observed in 12 (20,3 %) patients of the DLCE group versus one (2,1 %) in the ELCE group, p=0.004; the number of patients with complications according to Clavien-Dindo classification – 40 (67,8 %) versus 23 (47,9 %), p=0,038; pneumonia occurred in 26 (44,1 %) against 6 (12,5 %), p=0,001; exudative pleurisy – in 28 (47,5 %) against 9 (18,8 %), p=0,002, respectively. There were no lethal cases in the period up to 7 days in both groups. Conclusion. ELCE is a priority method of treatment patients with an acute calculous cholecystitis (ACC) and ischemic heart disease (IHD) with a different functional class (according to NYHA). Compared with DLCE, it is associated with reliable reduce of conversion (2,1 %), against 8 (13,6 %), intra- and  early postoperative complications of the cardiovascular system and complications according to Clavien-Dindo classification – 23 (47,9 %) patients against 40 (67,8 %).

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 A study of factors determining difficult surgery among patients undergoing laparoscopic cholecystectomy

2019 ◽  
Vol 6 (9) ◽  
pp. 3322
Author(s):  
Mohhamad Sadik Akhtar ◽  
Parwez Alam ◽  
Yasir Alvi ◽  
Syed Amjad Ali Rizvi ◽  
Mohhmad Habib Raza
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Wall Thickening ◽  
P Value ◽  
Difficult Situation ◽  
Open Procedure ◽  
Conversion To Open Cholecystectomy ◽  
Difficult Procedure ◽  
Upper Abdomen ◽  
High Bmi

Background: With widespread use of laparoscopic cholecystectomy and its applicability in many difficult situation, the chances of complication and difficulty during surgery have increased. This study was done to determine the factors which could preoperatively predict difficulty undergoing laparoscopic cholecystectomy.Methods: The data were obtained from the patients admitted to in wards of General Surgery, JN Medical Collage, Aligarh Muslim University, and Aligarh, India undergoing laparoscopic cholecystectomy. The difficult laparoscopic cholecystectomy was defined as procedures exceeded 70 minutes in duration or those which were converted to open procedure. Dependent variable included demographic factors, clinical and sonographic findings. P value was kept at 0.05.Results: During the study duration, 200 patients were included in the study undergoing for the laparoscopic cholecystectomy and out of this 85 had difficult outcome procedure. High BMI, hypertension, previous upper abdomen surgery, deranges AST and serum creatinine along sonographic findings of gall balder wall thickening and pericholecytsic edema were found to be significantly associated with difficult LC.Conclusions: This study demonstrates that presence of various factors can predict the difficult outcome of laparoscopic cholecystectomy. This can help in minimizing the complication and council the patients regarding difficult procedure and need for conversion to open cholecystectomy, especially relevant for funds-limited settings like India.

scholarly journals Evaluation of Early versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Rati Agrawal ◽  
K. C. Sood ◽  
Bhupender Agarwal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Randomized Study ◽  
Group Versus ◽  
Operation Time ◽  
Early Group ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Delayed Group

Background. The role of early laparoscopic cholecystectomy for acute cholecystitis with cholelithiasis is not yet established. The aim of our prospective randomized study was to evaluate the safety and feasibility of early LC for acute cholecystitis and to compare the results with delayed LC.Methods. Between March 2007 to December 2008, 50 patients with diagnosis of acute cholecystitis were assigned randomly to early group,n=25(LC within 24 hrs of admission), and delayed group,n=25(initial conservative treatment followed by delayed LC, 6–8 weeks later).Results. We found in our study that the conversion rate in early LC and delayed LC was 16% and 8%, respectively, Operation time for early LC was 69.4 min versus 66.4 min for delayed LC, postoperative complications for early LC were 24% versus 8% for delayed LC, and blood loss was 159.6 mL early group versus 146.8 mL for delayed group. However early LC had significantly shorter hospital stay (4.1 days versus 8.6 days).Conclusions. Early LC for acute cholecystitis with cholelithiasis is safe and feasible, offering the additional benefit of shorter hospital stay. It should be offered to the patients with acute cholecystitis, provided that the surgery is performed within 96 hrs of acute symptoms by an experienced surgeon.

scholarly journals A comparative study of early vs. delayed laparoscopic cholecystectomy in acute cholecystitis

1970 ◽  
Vol 7 (1) ◽  
pp. 16-20 ◽  
Author(s):  
RP Yadav ◽  
S Adhikary ◽  
CS Agrawal ◽  
B Bhattarai ◽  
RK Gupta ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Total Leukocyte Count ◽  
Early Group ◽  
Duration Of Symptoms ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Delayed Group ◽  
The Mean

Aims and Objectives: To compare the outcome in early vs. delayed laparoscopic cholecystectomy in terms of frequency of intra-operative and postoperative complications and to determine the rate and reasons for conversion. Materials and methods: A prospective randomized clinical trial was performed in the Department of Surgery at BP Koirala Institute of Health Sciences from February 2003 to June 2004 in all patients with the diagnosis of acute calculus cholecystitis. Results: Out of 145 cases, 50 cases were included in our study where 12 (24%) patients were males and 38 (76%) were females (M:F=1:3.16). The mean (SD) age of patients in early and delayed groups were 42.68 yrs. (14.18) and 40.26 yrs. (11.62) respectively. The mean (SD) duration of symptoms in early successful and converted groups were 109.24 hrs. (43.66) and 132 hrs. (49.96) respectively and the mean (SD) duration of symptoms in delayed successful and converted groups were 15.36 months (13.88) and 41 months (40.73) respectively. In early group, 17 (68%) patients had total leukocyte count more than 10,000/cmm and they had ultrasound findings suggestive of acute cholecystitis. Out of 25 patients in early group, seven had jaundice and ten had deranged liver function in the preoperative period. In early group 4 (16%) patients; and in delayed group 3 (12%) had to be converted to open cholecystectomy (P=1.00). In early group 10 (40%) and in delayed 5 (20 %) cases had intra-operative complications (P=0.122). The total hospital stay was longer in the delayed group. The postoperative hospital stay in early and delayed converted groups were higher than early and delayed successful group (P=0.081, P=0.082). Conclusion: Both early and delayed laparoscopic cholecystectomy is possible and safe in the treatment of acute cholecystitis. Key words: Acute cholecystitis, Laparoscopic cholecystectomy, Conversion doi: 10.3126/kumj.v7i1.1759       Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 16-20   

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 An evaluation of early and delayed laparoscopic cholecystectomy for acute cholecystitis

2019 ◽  
Vol 6 (9) ◽  
pp. 3147
Author(s):  
M. Zaid Imbisat ◽  
S. A. A. Rizvi ◽  
Imad Ali
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gall Stone ◽  
Gallbladder Perforation ◽  
Early Group ◽  
Early Laparoscopic Cholecystectomy ◽  
Total Hospital Stay ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Duration Of Surgery ◽  
Delayed Group

Background: Acute cholecystitis is one of the hepatopancreatobiliary emergencies. With more and more experience in the laparoscopic cholecystectomy studies are being carried out evaluating the effectiveness and feasibility of early laparoscopic cholecystectomy in acute cholecystitis.Methods: Fifty patients presenting with acute cholecystitis were included in this study and randomized using chit in the box method into two groups- early group and delayed group.Results: Mean duration of surgery in the early group is 42.28±5.99 mins and in the delayed group is 39.12±5.55 mins (p=0.06). Gallbladder perforation was reported in 4 patients (16%) in early group and in 2 patients (8%) in delayed group (p=0.67). Gall stone spillage was reported in 3 patients (12%) in early group and in 2 patients (8%) in delayed group (p=1.00). At 6th hr mean VAS (visual analogue scale) score in the early group was 4.0±0.41 and in the delayed group it was 3.6±0.58 (p=0.01). At 12th hr mean VAS score in the early group was 3.4±0.51 and in the delayed group it was 3.3±0.48 (p=0.39). Mean duration of postoperative stay was 2.24±0.60 days in early group and in the delayed group it was 2.08±0.57 days (p=0.34).Conclusions: It has been found that early laparoscopic cholecystectomy is safe and feasible in the setting of acute cholecystitis with added advantage of shorter total hospital stay.

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