scholarly journals Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

2018 ◽  
Vol 9 (4) ◽  
pp. 17-22
Author(s):  
Bikash Chandra Ghosh ◽  
Ambar Gangopadhyay
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Gall Stone ◽  
Low Pressure ◽  
Stone Disease ◽  
Care Hospital ◽  
Significant Difference ◽  
Gall Stone Disease ◽  
Standard Pressure ◽  
Symptomatic Gall Stone

Background: Laparoscopic cholecystectomy (LC), the procedure of choice for symptomatic gall stone disease. An emerging trend is to perform Low pressure pnuemoperitonium laparoscopic surgery as it has additive advantages over standard pressure to avoid complications while providing adequate working space.Aims and Objectives: The current study was designed with an aim to compare the advantage of low pressure pneumoperitoneum vs standard pressure pneumoperitoneum in laparoscopic cholecystectomy.Materials and Methods: The study was conducted in the department of General Surgery in R.G.Kar Medical College from January 2014 to June 2015. A total of 52 patients with symptomatic gall stone disease were recruited, 26 patients in each group randomly. Some intraoperative and post-operative parameters were studied.Results: All the intra-operative (IO) cardio-respiratory parameters (Pulse, Mean Arterial Pressure (MAP), End tidal CO2, spO2) were recorded just before incision, 20 minutes intra-operatively and before reversal of general anesthesia (GA). The IO parameters in our study, were found to be significant only at 20 minutes IO and before reversal of GA. The post-operative (PO) parameters (Pulse, MAP, Respiratory rate, spO2) and pain by VAS score at 6 hours, 12 hours and 24 hours post-operatively were studied. In PO period, we observed significant differences at 2 hours post-operatively in all parameters except MAP. There was significant difference in pain at 6, 12 and 24 hours when compared in both groups. The shoulder tip pain (STP) and 2 hours PO nausea and vomiting were found to be significantly higher in Standard pressure Laparoscopic cholecystectomy (SPLC) compared to Low pressure Laparoscopic cholecystectomy (LPLC). The operative time, duration of hospital stay and return to normal life after surgery though had differences but it was statisticallyinsignificant.Conclusion: Low pressure laparoscopic surgery is safe with least post operative complications when performed by experienced surgeons even in patients of ASA III.Asian Journal of Medical Sciences Vol.9(4) 2018 17-22

scholarly journals Study of persistent post laparoscopic cholecystectomy symptoms: a 6 month long follow up of 62 patients

2018 ◽  
Vol 5 (10) ◽  
pp. 3368
Author(s):  
Sagar Soitkar ◽  
Divish Saxena ◽  
Nitin Wasnik ◽  
Murtaza Akhtar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Tertiary Care ◽  
Gall Stone ◽  
Stone Disease ◽  
Complete Relief ◽  
Care Hospital ◽  
Psychiatric Illnesses ◽  
Gall Stone Disease ◽  
Symptomatic Gall Stone

Background: Majority of patient undergoing laparoscopic cholecystectomy for symptomatic gall stone disease is either cured or show improvement in their pre-operative symptoms. However, in few patients these preoperative symptoms may still persist and may continue to bother them even after surgery. The aim of this study is to evaluate and manage these patients with persistent post cholecystectomy symptoms.Methods: 62 patients of diagnosed symptomatic cholelithiasis had undergone laparoscopic cholecystectomy at a tertiary care hospital. They were evaluated with a questionnaire both before and; 3 months and 6 months after surgery. The symptoms present pre-operatively and the symptoms that persisted after laparoscopic cholecystectomy or emergence of any new symptoms were taken into consideration.Results: Out of 62 operated patients, 38 patients (61.3%) were relieved of their symptoms after cholecystectomy on follow up after 3 months whereas 24 patients (38.7%) had persistence of their symptoms. However, at 6 months follow up 16 out of these 24 patients showed improvement of their symptoms. Pain in right hypochondrium and non-specific dyspepsia were the commonest symptoms that were persistent. Thus, in this study 54 (87.1%) patients had complete relief after laparoscopic cholecystectomy and were satisfied with the treatment and in 08 (12.90%) patients the symptoms were not relieved.Conclusions: All the patients undergoing laparoscopic cholecystectomy should be evaluated in detail regarding their symptoms, psychiatric illnesses and be investigated thoroughly so as not to miss any other organic cause for their symptoms and should be counseled regarding persistence of their symptoms even after laparoscopic cholecystectomy.

scholarly journals A study on laparoscopic cholecystectomy, indications, complications and conversion to open in a tertiary care hospital

2019 ◽  
Vol 6 (11) ◽  
pp. 3942
Author(s):  
N. Chandramouli
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Tertiary Care ◽  
Gall Stone ◽  
Stone Disease ◽  
Care Hospital ◽  
Open Conversion ◽  
Calot’S Triangle ◽  
Institutional Ethics ◽  
Gall Stone Disease ◽  
A Prospective Study

Background: Disease of gall bladder, especially the stones, is one of the most common health problems leading to surgical intervention. Laparoscopic cholecystectomy is the gold standard operation for gall stone disease with a good safety profile. The aim of the study was to discuss the indications, complications encountered and open conversion rate of laparoscopic cholecystectomy in a tertiary care hospital.Methods: It was a prospective study, conducted at Sri Adichunchanagiri Hospital and Research Center, B.G. Nagara, Karnataka after the approval from institutional ethics committee (IEC). This study included 30 patients who presented to the ER or OPD with pain abdomen, from October 2018 to March 2019, and diagnosed to have gall stone disease with or without inflammation. All the patients were worked up as per standard institutional protocol. Patients clinical characteristics, ultrasonogram (USG) findings, surgical management and complications were recorded.Results: Mean age was 41.1±6.06. The indications for cholecystectomy in gall stone disease at our institute during the aforementioned timeline were symptomatic gall stones (60%) and calculus cholecystitis (40%). All underwent laparoscopy and 2 patients were converted to open surgery intra-operatively in view of difficulty in dissection of Calot’s triangle. 3 patients had post-operative complications and treated conservatively.Conclusions: Laparoscopic cholecystectomy is a standardised, efficacious procedure for the treatment of gall stone disease whether symptomatic or infected. Complications are minimal but a thorough knowledge of open procedure is also essential in case of intra-operative conversion.

scholarly journals Prediction of difficulties during laparoscopic cholecystectomy by preoperative clinical examination and ultrasonography

2017 ◽  
Vol 4 (4) ◽  
pp. 1335 ◽  
Author(s):  
Arun Kumar ◽  
Kunwar Vishal Singh ◽  
Jugendra Pal Singh Shakya ◽  
Sangita Sahu ◽  
Soniya Dhiman ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Clinical Examination ◽  
Conversion Rate ◽  
Open Cholecystectomy ◽  
Gall Stone ◽  
Stone Disease ◽  
Medical College ◽  
Preoperative Ultrasonography ◽  
Gall Stone Disease ◽  
Symptomatic Gall Stone

Background: Cholelithiasis (gall stone disease) is a well-known disease worldwide. Ultrasonography is the most common screening test for cholecystitis and cholelithiasis. Laparoscopic Cholecystectomy is considered the treatment of choice for symptomatic gall stone disease. It is important to know the different clinical, radiological parameter and specific predictor that give some prediction of difficult LC. The aim of this study was to predict the difficulty of LC and the possibility of conversion to OC before surgery using the clinical and ultrasonographic criteria in our set up.Methods: The present study was carried out in the Department of surgery, Sarojini Naidu Medical College Agra, from November 2014 to October 2016.  A total of 210 patients were enrolled for the laparoscopic cholecystectomy. All patients who were included in the study were undergone detailed history and clinical examination. A number of clinical and ultrasonographical parameters were noted.Results: Amongst the 210 patients admitted for laparoscopic cholecystectomy, 21 (10%) were male and 189 (90%) female, with age ranging from 12–60 years.  The conversion rate in our study was 4.5% (9 of 210). In our study significant pre-operative factors which increased the conversion rate to open cholecystectomy includes male gender, obesity, abdominal scar of previous surgery, contracted and thickened gall bladder and patients having stone impacted at the neck of gall bladder.Conclusions: From this study, we conclude that preoperative ultrasonography is a good predictor of difficult laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.

scholarly journals Comparative study between 3-ports and 4-ports laparoscopic cholecystectomy for the cases of gall stone disease

2016 ◽  
Vol 18 (3) ◽  
pp. 15
Author(s):  
KK Tamrakar ◽  
P Khwaunju ◽  
K Sah
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Operating Time ◽  
Wound Infection Rate ◽  
Stone Disease ◽  
Chi Square ◽  
Significant Difference ◽  
Gall Stone Disease ◽  
Chi Square Test ◽  
Operative Findings

Laparoscopic cholecystectomy is currently accepted approach for the management of patients with cholelithiasis. The standard method for removal of gall bladder in laparoscopic cholecystectomy is by using four ports. Although other techniques such as by using 3 ports or only single port are being practiced, their safety and efficacy has not been established. This study was done to assess the efficacy and safety of the use of only three ports for laparoscopic cholecystectomy.Methods: Between August 2013 and February 2014, 78 patients with the diagnosis of cholelithiasis were operated. Patients were randomized into 3-ports group and 4-ports group using random number. Operative time taken for the procedure and operative findings were noted. Postoperative pain and complications were noted in both groups. The two groups were compared using student-T test and chi square test. Results: There was no significant difference in the operating time taken for the 3-ports laparoscopic cholecystectomy and 4-ports laparoscopic cholecystectomy. However operating time was significantly higher when the cases that had dense adhesions present were compared with those who did not have. Conversion from 3-ports technique to 4-ports technique was determined mainly by the degree of adhesions and to some degree by the BMI of the patient. Postoperative wound infection rate was similar among the two groups. There was no incidence of biliary injury in both the groups.Conclusion: 3-ports laparoscopic cholecystectomy is safe and efficient approach for the selected patients who seek for lesser invasive method of laparoscopic cholecystectomy.

scholarly journals Diagnostic value of upper gastrointestinal endoscopy prior to elective laparoscopic cholecystectomy for symptomatic cholelithiasis

2017 ◽  
Vol 5 (1) ◽  
pp. 105
Author(s):  
Indira Khedkar ◽  
Dinesh Prasad ◽  
Achal Datta
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Gastrointestinal Symptoms ◽  
Stone Disease ◽  
P Value ◽  
Upper Gastrointestinal Endoscopy ◽  
Complete Relief ◽  
Gastrointestinal Lesions ◽  
Gall Stone Disease ◽  
Symptomatic Gall Stone

Background: Laparoscopic cholecystectomy is gold standard surgery for symptomatic gall stone disease which is the commonest disease needs surgical management. Present study was conducted to contribute UGI endoscopy as routine preoperative investigation and the importance of UGI endoscopy to evaluate the association between gastrointestinal symptoms with gallstones and reduce the prevalence of post cholecystectomy pain.Methods: Patients with Ultrasonography suggestive of single or multiple gall stones were included and investigated as per proforma. Upper GI Scopy was done 1 to 2 days prior to laparoscopic cholecystectomy as per inclusion and exclusion criteria. All patients above 18years, with ultrasonographically proven diagnosis of cholelithiasis and with symptoms (typical and atypical) were included.Results: In present study, author have evaluated the different OGD pathologies the most common site of pathology was stomach (72.5%) that was gastritis. Followed by oesophagitis (55%), and Hiatus hernia (16.5) The most common duodenal pathology was duodenitis (6.25%). In present study, 71 patients had pain in epigastrium at presentation which gradually subsided with no complains of pain in 3 months. Statistically significant reduction in pain was appraised at the end of first week itself (p-value <0.0001).Conclusions: Certain symptoms associated with gallstones are not alleviated by cholecystectomy itself and requires further exploration, therefore, patients presenting with symptomatic gall stone disease should undergo routine OGD prior to cholecystectomy as many gastrointestinal lesions may coexist which prevents the complete relief of the symptoms after cholecystectomy.

scholarly journals Comparative study between 3-ports and 4-ports laparoscopic cholecystectomy for the cases of gall stone disease

2017 ◽  
Vol 7 (1) ◽  
pp. 1-6
Author(s):  
Kishor Kumar Tamrakar ◽  
Pragyan Khwaunju ◽  
Keshar Bahadur Sah
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Operating Time ◽  
Wound Infection Rate ◽  
Stone Disease ◽  
Chi Square ◽  
Significant Difference ◽  
Gall Stone Disease ◽  
Invasive Method ◽  
Operative Findings

Background: Laparoscopic cholecystectomy is currently accepted approach for the management of patients with cholelithiasis. The standard method for removal of gall bladder in laparoscopic cholecystectomy is by using four ports. Although other techniques such as by using 3 ports or only single port are being practiced, their safety and efficacy has not been established. This study was done to assess the efficacy and safety of the use of only three ports for laparoscopic cholecystectomy.Methods: Between August 2013 and February 2014, 78 patients with the diagnosis of cholelithiasis were operated. Patients were randomized into 3-ports group and 4-ports group using random number. Operative time taken for the procedure and operative findings were noted. Postoperative pain and complications were noted in both groups. The two groups were compared using student-T test and chi square test.Results: There was no significant difference in the operating time taken for the 3-ports laparoscopic cholecystectomy and 4-ports laparoscopic cholecystectomy. However operating time was significantly higher when the cases that had dense adhesions present were compared with those who did not have. Conversion from 3-ports technique to 4-ports technique was determined mainly by the degree of adhesions and to some degree by the BMI of the patient. Postoperative wound infection rate was similar among the two groups. There was no incidence of biliary injury in both the groups.Conclusion: 3-ports laparoscopic cholecystectomy is safe and efficient approach for the selected patients who seek for lesser invasive method of laparoscopic cholecystectomy.

Early experience of laparoscopic cholecystectomy in acutely inflamed gallbladder

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Ali Abdul Hussein Handoz ◽  
Ahmed Kh Alsagban
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gall Stone ◽  
The Elderly ◽  
Stone Disease ◽  
Definitive Treatment ◽  
Adjacent Structures ◽  
Common Causes ◽  
Gall Stone Disease ◽  
Male To Female

Gallstones are now among the most important disease in the era of surgery. Definitive treatment of gall stone disease remains cholecystectomy. One of the common causes of emergency surgical referral is acute cholecystitis of which 50-70% cases are seen in the elderly patients.50 patients were treated with laparoscopic cholecystectomy from October 2013 to October 2015. The patient’s age was from 20 to 65 years old with a mean age of 34 ±3 years old. The patients received in the emergency unit and their attack not more than 72 hrs of acute gall stone inflammation were included in this study.From the 50 patients,15 were males (34%) and females were 35 (74%) so the ratio of 1:2of male to female. Problems and complications that facing in this study at time of laparoscopy were mainly adhesions to the adjacent structures like stomach, colon, and omentum. Adhesion into CBD also considered.Early intervention for acute cholecystitis of calculus type by laparoscopy now regarding safe and gold standard approach that should be kept in mind when dealing with such cases.

scholarly journals Evaluation of relationship of body mass index with severity of cholecystitis

2019 ◽  
Vol 6 (3) ◽  
pp. 868 ◽  
Author(s):  
Varun V. Chauhan ◽  
Bhushan A. Shah ◽  
Shivaratna J. Mahadik ◽  
Rohan P. Videkar
Keyword(s):  
Risk Factor ◽  
Open Cholecystectomy ◽  
Gall Stone ◽  
Stone Disease ◽  
Established Risk Factor ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy ◽  
Gall Stone Disease ◽  
Total Body ◽  
A Prospective Study

Background: Obesity is an established risk factor for gall stone disease. Male sex has also been recently cited as a risk factor for severe symptomatic cholelithiasis. As a possible cause of several difference in regards to the severity of cholecystitis, many physiological differences between the two sexes can be examined. Many studies have been done on the risk factors for developing the gall bladder disease explaining its polygenic nature It is postulated that the total body fat, the main value of which is significantly higher for females than males, may contribute to this sex difference. Only a couple of studies are available on BMI and its effect on severity of cholecystitis hence depicting the need for this study in our setup.Methods: This is a prospective study carried out on 70 patients for cholecystitis whose weight and height measurements had been recorded on admission. Patients were placed in either group-Obese (BMI e” 25kg/m2) or Non-Obese (BMI <25kg/m2). The association between BMI and severity of cholecystitis was investigated.Results: 18% of the laparoscopic cholecystectomy surgeries required conversion to open cholecystectomy due to reasons like severe adhesions to an adjacent organ, etc. Pain in abdomen (100%) was the commonest complaint and was present in all the patients followed by dyspepsia (44%).69% of patients were having complaints for more than 72 hours. No significant difference observed among mean BMI of different grades of severity (p=0.963).Conclusions: There is negative correlation between BMI and grade of severity of cholecystitis and BMI is not a predictor for the conversion from laparoscopic to open cholecystectomy.

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