A PROSPECTIVE AND OBSERVATIONAL SINGLE INSTITUTION EXPERIENCE IN LAPAROSCOPIC CHOLECYSTECTOMY

BACKGROUNDABSTRACT Laparoscopic Cholecystectomy (LC) is now the gold standard for surgical management of cholelithiasis around the world especially in developed countries, with the advantages of returning to work early, less postoperative pain, shorter hospital stay and better cosmesis. Here in the Philippines, LC has just started to pick its pace; surgeons are becoming more adept in the technique and patients have a better option with regards to the procedure to undergo.The aim of this study is to analyze our institution’s experience in laparoscopic cholecystectomy by evaluating the operative time, patients’ pain score post-operatively, hospital stay, intra-operative and post-operative complications (bleeding, bowel injury and bile duct injury) conversion rate and length of post op stay.METHODSA prospective analysis was performed on data collected during a 16-month period (January 2010 to May 2011) from 127 patients who underwent laparoscopic cholecystectomy. All of the surgeries were performed by consultants.RESULTSThe mean age was 44.7 (17-78) with whom 65.5% were females. Fifteen patients (13.6%) were operated in the acute setting. Three patients (2.7%) warranted an intraoperative cholangiogram while 5 (4.5%) underwent an Endoscopic Retrograde Cholangiopancreatography immediately prior to LC. The mean operating time was 89 (35-335 SD ±41.75) minutes. One patient had cystic duct leak which was managed with a drain and post LC ERCP. Difficulty in dissection was experienced in one case hence conversion to open cholecystectomy occurred (0.9%). Postoperatively, 101 (91.8%) received 0.5% Bupivacaine subcutaneously through the incision sites. Average VAS score was noted to be 3.05, 2.60, 2.20 at 6, 12 and 24 hours respectively. The mean post operative stay after the procedure was 36.22 (10-189 SD ±25.01) hours. No wound infection nor early incisional hernia was noted after 1 week of follow up.CONCLUSIONWith the early series of cases, it can be inferred that laparoscopic cholecystectomy is feasible and is performed safely in our institution.

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Minilaparotomy Cholecystectomy: A Forgotten Art in Laparoscopic Cholecystectomy Era (Our Experience from a Peripheral Hospital in North India)

Journal of Archives in Military Medicine ◽

10.5812/jamm.116265 ◽

2022 ◽

Vol In Press (In Press) ◽

Author(s):

Bharath N Kumar ◽

Rahul Pandey

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Perioperative Complications ◽

Open Cholecystectomy ◽

Operating Time ◽

North India ◽

Incision Size ◽

Peripheral Hospital ◽

Conversion To Open Cholecystectomy ◽

Average Operating Time

Background: This study aimed to report the experience of performing minilaparotomy cholecystectomy in a peripheral hospital by a single surgeon. Methods: Data collected from 50 consecutive patients undergoing minilaparotomy cholecystectomy by a single surgeon over 18 months at a peripheral hospital were reviewed and studied. The recorded data encompassed demographics, operating time, incision size, conversion rate to open cholecystectomy, perioperative complications, and hospital stay duration. Results: Fifty consecutive patients, who underwent minilaparotomy cholecystectomy for symptomatic cholelithiasis, were studied, among whom 48 patients were females. The participants’ mean age was 45 years. The length of the surgical incision was 4.5 - 6 cm, and only three patients required conversion to open cholecystectomy. The average operating time was 60 minutes; and the average postoperative hospital stay was 2.14 days. Conclusions: Minilaparotomy cholecystectomy is comparable with laparoscopic cholecystectomy in terms of postoperative morbidity, and it is ideal for peripheral hospitals lacking laparoscopic facilities.

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Laparoscopic Cholecystectomy for Acute Gallbladder Disease During Index Admission- 11 the Optimum Timing for Surgery

Journal of Surgical Sciences ◽

10.3329/jss.v16i1.14442 ◽

2013 ◽

Vol 16 (1) ◽

pp. 11-17

Author(s):

Md Ibrahim Siddique ◽

Md Atiar Rahman ◽

Md Shahadot Hossain Sheikh ◽

Khander Manzoor Murshed ◽

Samia Mubin ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Acute Cholecystitis ◽

Open Cholecystectomy ◽

Gallbladder Disease ◽

Index Admission ◽

Laparoscopic Procedure ◽

Complication Rates ◽

Financial Benefit ◽

Conversion To Open Cholecystectomy

Background: Laparoscopic cholecystectomy, initially considered a contraindication for the treatment of acute gallbladder disease, is now being practiced for treating acute cholecystitis worldwide. The purpose of the study is to evaluate the outcome of laparoscopic procedure in the management of acute gallbladder disease during the index admission in terms of safety and feasibility, hospital stay and the rates of complications and conversion to open cholecystectomy. Methods: Between January 2009 to December 2011, 174 patients (103 female, 71 male) with median age 43.5 years (range 27-73 years) with the diagnosis of acute gallbladder disease underwent laparoscopic cholecystectomy. Diagnosis of acute cholecystitis was made from history, physical findings and ultrasound evidence of acute inflammatory changes. Results: Median time from onset of symptoms to surgery was 70 hours. Median operative time was 76.5 minutes. Conversion rate was 1.7%. Minor post-operative complications occurred in 13.5% cases of laparoscopic procedure, which did not require further intervention. Median post-operative hospital stay was 2.5 days and total length of hospital stay was median 4.4 days. There was no mortality. Conclusion: In expert hands laparoscopic cholecystectomy for acute gallbladder disease during the index admission is safe with better clinical results, shorter hospital stay and an acceptable conversion and complication rates with additional financial benefit to the patients. DOI: http://dx.doi.org/10.3329/jss.v16i1.14442 Journal of Surgical Sciences (2012) Vol. 16 (1) : 11-17

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Fundus first laparoscopic cholecystectomy in patients with gall stone disease and the Fitz-Hugh-Curtis syndrome

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20202244 ◽

2020 ◽

Vol 8 (6) ◽

pp. 2062

Author(s):

Alexander F. Ale ◽

Mercy W. Isichei ◽

Danaan J. Shilong ◽

Solomon D. Peter ◽

Andrew H. Shitta ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Gall Stone ◽

Operating Time ◽

Stone Disease ◽

Duration Of Hospital Stay ◽

Duration Of Surgery ◽

Gall Stone Disease ◽

The Mean ◽

Fitz Hugh Curtis Syndrome

Background: To present this experience using the fundus-first technique during laparoscopic cholecystectomy for the management of symptomatic gall stone disease with an intra-operative finding of Fitz-Hugh-Curtis syndrome.Methods: This is a prospective review of patients who had the fundus-first dissection during laparoscopic cholecystectomy. The study was carried out at the Jos University Teaching Hospital (JUTH), and FOMAS hospital, both of which are tertiary hospitals located in Jos. Patients were recruited from January 2017 - January 2019. All patients undergoing laparoscopic cholecystectomy who had an intraoperative diagnosis of Fitz-Hugh-Curtis syndrome, and who had the fundus-first dissection, were included in the study. Patients who had fundus-first dissection for indications other than Fitz-Hugh-Curtis syndrome, were excluded from the study. Demographic and clinical information of patients included age, sex, duration of surgery, complications, and duration of hospital stay. Descriptive statistics were applied.Results: A total of 76 patients had elective laparoscopic cholecystectomies over the study period. Of that number, 17 (22.4%) patients had an intra- operative diagnosis of Fitz-Hugh-Curtis syndrome, and had the fundus-first dissection. The mean patient age was 46.3 years (SD = 11.7 years). All patients were female. The mean operating time was 70 minutes (SD = 23 minutes). The duration of hospital stay was 24 hours. There was one conversion due to uncontrollable intraoperative bleeding.Conclusions: This study revealed that the fundus-first dissection is suitable for removing the gall bladder during laparoscopic cholecystectomy in patients with gall stone disease, and an intraoperative finding of Fitz-Hugh-Curtis syndrome.

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Three-Port versus Four-Port Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Nepal Medical College Journal ◽

10.3126/nmcj.v21i1.24849 ◽

2019 ◽

Vol 21 (1) ◽

pp. 40-43

Author(s):

Rabin Koirala ◽

TM Gurung ◽

A Rajbhandari ◽

P Rai

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Hospital Stay ◽

Controlled Trial ◽

Open Cholecystectomy ◽

Analgesic Requirement ◽

Safe Alternative ◽

Average Hospital ◽

Significant Difference ◽

Conversion To Open Cholecystectomy

Laparoscopic cholecystectomy (LC) is one of the most common surgery performed and is traditionally performed using four ports. With the aim of improving patient’s comfort, port numbers have been reduced to single port. But feasibility and the extra expense that comes with single and double port LC has made them less attractive. Three port LC can be a safe alternative to four port LC, and various research has shown its safety. This study compares the three port LC with the traditional four port LC with the objective of assessing feasibility and benefit of the decreased port number. We evaluated 217 patients who were randomly allocated for three port and four port LC. Both the groups were compared for operative time, assessment of postoperative pain, days of hospital stay and postoperative recovery time after discharge. The parameters were compared using Statistical Package for the Social Sciences (SPSS) version 16. Among 217 patients, 123 underwent three port LC and 94 underwent four port LC. The larger number were females (79.7%), and with comparable age group of patients. Rate of conversion to open cholecystectomy, postoperative pain scale, analgesic requirement, average hospital stay and port site infection rates were comparable in both groups of patients. The average time taken for operation was less in three port LC than the four port LC but this was not statistically significant. There is no significant difference between 3 port and 4 port LC in terms of time required for the surgery, conversion rate, complication and duration of hospital stay.

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RETROSPECTIVE STUDY ON OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN THE ELDERLY AT JSS HOSPITAL, MYSURU

10.36106/ijsr/0225150 ◽

2021 ◽

pp. 34-35

Author(s):

Sudhir S. ◽

Deepak Naik P ◽

Deepak R. Sridhar

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Open Cholecystectomy ◽

The Elderly ◽

Age Group ◽

Elderly Age ◽

Duration Of Hospital Stay ◽

Wide Range ◽

Conversion To Open Cholecystectomy ◽

Duration Of Surgery

(a) Laparoscopic cholecystectomy is a widely performed surgery in India and across the world for a wide range of indications. It is one of the most commonly performed surgeries, and hence a study based on outcomes of Laparoscopic cholecystectomy in the elderly would go a long way in determining the safety and success of Laparoscopic cholecystectomy in the elderly, and could help in timing surgery more effectively to avoid complications and difculties. (b) Materials and methods: Out of 250 patients who underwent Laparoscopic Cholecystectomy at JSS Hospital in the period starting January 2019 onwards who were selected by randomization, 65 patients t the criteria (age > 60 years) while 185 patients were aged <60. Data regarding comorbidities, duration of surgery, duration of hospital stay, conversion to open cholecystectomy was compiled and studied. (c) Results: A signicant number of the patients in the elderly age group had associated comorbidities. Duration of surgery was prolonged by a mean duration of 9.5 minutes in the elderly. Duration of hospital stay was increased by a mean of 2.2 days in the elderly. Incidence of conversion to open cholecystectomy was also higher in the elderly. (d) Conclusions: Laparoscopic cholecystectomy is a relatively safe and easy surgery with few complications. However, one may experience difculties while operating on the elderly, viz. Adhesions, contracted gall bladder with hepatic adhesions etc., Which may result in longer duration of surgery and higher rates of conversion to open cholecystectomy.

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

Kathmandu University Medical Journal ◽

10.3126/kumj.v7i1.1759 ◽

1970 ◽

Vol 7 (1) ◽

pp. 16-20 ◽

Cited By ~ 16

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

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

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/281 ◽

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

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OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH GALLSTONE DISEASE AT A SECONDARY LEVEL CARE HOSPITAL

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020180001e1347 ◽

2018 ◽

Vol 31 (1) ◽

Cited By ~ 2

Author(s):

Ahmed TAKI-ELDIN ◽

Abd-Elnaser BADAWY

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Operative Time ◽

Open Cholecystectomy ◽

Gallstone Disease ◽

Care Hospital ◽

Biliary Leakage ◽

Port Site Hernia ◽

Conversion To Open Cholecystectomy ◽

Secondary Hospital

ABSTRACT Background: Laparoscopic cholecystectomy is the most commonly performed operation of the digestive tract. )It is considered as the gold standard treatment for cholelithiasis. Aim: To evaluate the outcome of it regarding length of hospital stay, complications, morbidity and mortality at a secondary hospital. Methods: Data of 492 patients who underwent laparoscopic cholecystectomy were retrospectively reviewed. Patients’ demographics, co-morbid diseases, previous abdominal surgery, conversion to open cholecystectomy, operative time, intra and postoperative complications, and hospital stay were collected and analyzed from patients’ files. Results: Out of 492 patients, 386 (78.5%) were females and 106 (21.5%) males. The mean age of the patients was 49.35±8.68 years. Mean operative time was 65.94±11.52 min. Twenty-four cases (4.9%) were converted to open surgery, four due to obscure anatomy (0.8%), 11 due to difficult dissection in Calot’s triangle (2.2%) and nine by bleeding (1.8%). Twelve (2.4%) cases had biliary leakage, seven (1.4%) due to partial tear in common bile duct, the other five due to slipped cystic duct stables. Mean hospital stay was 2.6±1.5 days. Twenty-one (4.3%) developed wound infection. Port site hernia was detected in nine (1.8%) patients. There was no cases of bowel injury or spilled gallstones. There was no mortality recorded in this series. Conclusions: Laparoscopic cholecystectomy is a safe and effective line for management of gallstone disease that can be performed with acceptable morbidity at a secondary hospital.

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LAPAROSCOPIC CHOLECYSTECTOMY;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.03.3256 ◽

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.

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Factors resulting in conversion of laparoscopic cholecystectomy to open cholecystectomy-institution based study

International Surgery Journal ◽

10.18203/2349-2902.isj20175882 ◽

2017 ◽

Vol 5 (1) ◽

pp. 132 ◽

Cited By ~ 1

Author(s):

Naseer Ahmad Awan ◽

Firdous Hamid ◽

Irfan Nazir Mir ◽

Mir Mujtaba Ahmad ◽

Ajaz Ahmad Shah ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Open Cholecystectomy ◽

Operating Time ◽

Average Hospital ◽

Visceral Injury ◽

Female Ratio ◽

Open Conversion ◽

Number Of Patients ◽

The Mean ◽

Cbd Injury

Background: Laparoscopic surgery has revolutionized the way it is performed for an increasing number of patients. In this study, we determined the various reasons for conversion of laparoscopic cholecystectomy in our setup.Methods: This was a descriptive study, conducted at Government Medical College Srinagar, Frommay 2015 to June 2017. The study included 450patients with symptomatic cholelithiasis, who underwent laparoscopic cholecystectomy. All patients were operated by experienced laparoscopic surgeons with experience of more than 300 Laparoscopic cholecystectomies. Cases that required conversion from laparoscopic to open surgery were analyzed and the factors possible for such conversion were studied.Results: The mean age of patients was 45.6 years and male to female ratio 1:3.8. The mean operating time was 49 minutes and average hospital stay was 2 days. Out of 450 patients, 26(5.8%) required open conversion. Factors responsible for open conversion were dense adhesions in 12(2.7%), obscure anatomy at clot’s triangle in 6, (1.3%), significant intra-operative bleeding 5 (1.1), CBD injury 1(0.2%), visceral injury 1 (0.2%), and instrument failure in 1(0.2%) conversions.Conclusions: Open conversion rate of laparoscopic cholecystectomy in this study was 5.8%. The commonest cause of conversion was dense adhesions around the gall-bladder. Preventable factors like instrument failure or power breakdown can be addressed by a reliable back up.

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