scholarly journals Laparoscopic Cholecystectomy, A single Surgeon experience at Teaching Hospital Biratnagar, Nepal

2017 ◽  
Vol 6 (1) ◽  
pp. 1-5
Author(s):  
Ashok Koirala ◽  
Dipendra Thakur ◽  
Sunit Agrawal ◽  
Kamal Raj Pathak ◽  
Manoj Bhattarai ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hepatic Duct ◽  
Gall Stone ◽  
Age Groups ◽  
Biliary Tree ◽  
Anatomical Variations ◽  
Stone Disease ◽  
Symptomatic Cholelithiasis ◽  
Surgeon Experience ◽  
Gall Stone Disease

Background :Laparoscopic cholecystectomy (LC) is a treatment of choice for symptomatic gall stone disease and is commonly done all over the country in general surgical practice. The aim of this study is to show the results of LC in our medical college.Material and Methods: A retrospective analysis of the patients underwent laparoscopic cholecystectomy from July 2015 to September 2016 was carried out in NMCTH, Biratnagar. A total of 391 patients admitted through OPD of our Hospital underwent laparoscopic cholecystectomy were studied. All age groups and both sex were included.Results: Out of 391 patients with symptomatic cholelithiasis, 385(98.46%) patients underwent successful laparoscopic cholecystectomy. Age range of patients in the study varied between 12-84 years and maximum patients (30.69%) were found in the age group of 31-40 years. There were 333(82.58%) female and 58(17.41%)male patients. Mean age of the patients was 39.61 years. Indication for surgery was symptomatic cholelithiasis. Conversion was done in 6(1.53%) cases due to unclear anatomy. A rare congenital anomaly, Accessory right hepatic duct with cystic duct continuous with it was encountered in 12-yearboy; LC was done safely without injuring biliary tree. As postoperative complications, one patient developed biliary peritonitis which was managed by drainage tube.Conclusion: Laparoscopic cholecystectomy is successfully being done for last 5 years in our institute. The results are comparable with those of published series. Anatomical variations and complications may present, for which care must be taken. Journal of Nobel Medical CollegeVolume 6, Number 1, Issue 10 (January-June, 2017), page: 1-5

scholarly journals An evaluation of open versus laparoscopic cholecystectomy in tertiary centre

2019 ◽  
Vol 6 (8) ◽  
pp. 2797
Author(s):  
Kanwar Singh Goel ◽  
Sapna Goel ◽  
Sham L. Singla ◽  
Pawan Tiwari
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Age Groups ◽  
Stone Disease ◽  
Average Hospital ◽  
Medical College ◽  
Tertiary Centre ◽  
Gall Stone Disease ◽  
Open Versus ◽  
Surgery Department

Background: Cholecystectomy is a method of treatment for acute or chronic cholecystitis with cholelithiasis or any other diseases of gall bladder. The diagnosis of gall stone disease depends on an accurate history, physical examination, supporting lab investigations and a proper ultrasound of abdomen. After the advent of lap cholecystectomy there is revolution in minimally invasive surgery. Because of better technological innovations, the lap cholecystectomy has become gold standard presently.Methods: This prospective observational study was performed in Surgery Department in SGT Medical College, Budhera, Gurugram, over a period of 2 years from January 2017 to January 2019. Patients were taken from both sexes and all age groups from different units of surgery. A total of 100 patients were taken for study who underwent cholecystectomy.Results: Mean age of patients in our study was 38.64 years. Most patients were females. Procedure adopted was open in 18% patients and lap cholecystectomy in 74% patients. Conversion from laparoscopic to open was done in 8% patients. In 8% patients there were operative complications. Average hospital stay was much less for lap cholecystectomy.Conclusions: After the advent of laparoscopic cholecystectomy, most of the surgeons are performing more and more of laparoscopic cholecystectomy. Here incision is small, pain is less, and hospitalization is shorter. Even in acute cholecystitis, in experienced hand, lap cholecystectomy can be performed safely. The author’s inclination is totally in favour of lap cholecystectomy, except the cases where lap cholecystectomy is contraindicated. 

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 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 Bacteriological analysis of bile in laparoscopic cholecystectomy patients

2018 ◽  
Vol 7 (1) ◽  
pp. 41-44
Author(s):  
Ashok Koirala ◽  
Dipendra Thakur ◽  
Sunit Agrawal ◽  
Abhilasha Sharma
Keyword(s):  
Escherichia Coli ◽  
Laparoscopic Cholecystectomy ◽  
Bacterial Colonization ◽  
Gall Stone ◽  
Age Groups ◽  
Stone Disease ◽  
Klebsiella Species ◽  
Bile Culture ◽  
A Prospective Study ◽  
Preoperative Prophylaxis

Background: Laparoscopic cholecystectomy is commonly performed operation for symptomatic gall stone disease. The presence of stones within the biliary system is associated with the bacterial colonization of the bile. The aim of this study is to evaluate the bacteriological profile of the bile and to determine appropriate antibiotics for preoperative prophylaxis in laparoscopic cholecystectomy patients. Material & Methods: A prospective study was carried out in NMCTH, Biratnagar from June2017- May 2018. A total of 100 patients admitted through OPD of our hospital for laparoscopic cholecystectomy were studied. About 5ml of bile aspirated from gall bladder was transported to laboratory in sterile syringe for culture and sensitivity. All age groups and both sex were included. Results: Bile culture was positive in 16 patients. The most common organisms isolated from bile was Escherichia coli (50%) followed by Klebsiella species (25%). Histopathological report of all 16 cases revealed chronic cholecystitis. Wound infection was seen in 5% cases and all were bile culture positive. Most sensitive drug was found to be aminoglycoside group followed by piperacilin and tazobactam. Conclusion: Most common organism isolated from bile culture was Escherichia coli. Aminoglycoside group of drugs was found to be more promising compared to other group of drugs. It can be considered as a first line drug for preoperative prophylaxis for patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 41-44

scholarly journals Prevalence of undiagnosed hypothyroidism in patients with gall bladder stones in Belagavi

2021 ◽  
Vol 9 (1) ◽  
pp. 124
Author(s):  
Ramesh S. Koujalagi ◽  
Vinod Karagi ◽  
Abhijit S. Gogate ◽  
Athira C.
Keyword(s):  
Subclinical Hypothyroidism ◽  
Gall Stone ◽  
Age Groups ◽  
Thyroid Function Test ◽  
Gallstone Formation ◽  
Stone Disease ◽  
Biliary Calculus ◽  
Gall Stone Disease ◽  
Study Population ◽  
And Gender

Background: Contribution of hypothyroidism to gallstone formation is debated over years. With this background, the study intended to analyze the prevalence of undiagnosed hypothyroidism in patients with cholelithiasis. The aim is to understand the prevalence of hypothyroidism in patients with gallstones.Methods: A prospective, hospital-based study was done on 100 patients admitted for the management of gall stone disease in Belagavi. After initial screening, a detailed history was obtained with special reference to symptomatology and the risk factors as per proforma from patients meeting selection criteria. Thyroid function test was done on all eligible patients. Patients were divided into three groups of Euthyroid, Subclinical hypothyroid and clinical hypothyroidism. Statistical analysis used. Percentage of gall stones in different age groups and gender of the study population was calculated followed by prevalence of hypothyroidism and subclinical hypothyroidism in all the patients included.Results: Among the study population, 40% were male and 60% were female. 23 of them have subclinical hypothyroidism and 6 of them were diagnosed with hypothyroidism. Majority of subclinical hypothyroid patients (39.13%) were aged 41-60 years. Hypothyroid symptoms were shown by the study population with unknown thyroid status.Conclusions: The prevalence of hypothyroidism in cholelithiasis is 29% in the study and is significant. The study demands further studies to consider hypothyroidism as a cause /risk factor for biliary calculus.

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

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.

scholarly journals Can Laparoscopic Cholecystectomy be a Feasible Standard in a Rural set up too? - An Experience of 348 cases from a Peripheral set up of Western Nepal

2017 ◽  
Vol 13 (2) ◽  
pp. 130-133
Author(s):  
A.L. Shrestha ◽  
P. Shrestha ◽  
D. Brown
Keyword(s):  
Socioeconomic Status ◽  
Laparoscopic Cholecystectomy ◽  
Rural Population ◽  
Gall Stone ◽  
Stone Disease ◽  
Uneventful Recovery ◽  
Conversion To Open Cholecystectomy ◽  
Gall Stone Disease ◽  
Set Up ◽  
The Impact

Background Gall stone disease is a common reason for admissions in both acute and elective situations and bears significant morbidity in the rural population of western Nepal. The earlier conventional open method of treatment for the same seems to have been largely seeded by the laparoscopic approach owing to its numerous benefits.Objective To study the clinical profile of patients with symptomatic gall stones with respect to demography and to assess the feasibility of using Laparoscopic cholecystectomy as the next standard in this set up too as guided by the outcome in terms of complications, conversion rates and potential impact it bears on the health and socioeconomic status in this group.Method A retrospective analysis of all the patients undergoing an attempted laparoscopic cholecystectomy from 1st Jestha 2068 to 30th Jestha 2070 was done. Relevant medical records were reviewed to study demography, various indications for operations, intra operative events including conversions and complications.Result Of 348 patients 293(84.19%) were females and 55(15.80%) were males. The mean age was 38.46 years (range 15-76 years). Most of the patients belonged to the Palpa district of Lumbini zone and many were from other surrounding areas. Gall stone disease was commonest in people of Brahmin ethnicity. The operating time was <2 hours for most and most had an uneventful recovery with a mean hospital stay of 3.8 days. The rate of conversion to open cholecystectomy was 6.9% (24 out of 348 patients). Post operative complications were noted in 5 patients (1.42%). Of these 1 sustained a major bile duct injury (0.28%) requiring immediate conversion and repair, 3 had post operative bilioma and 1 had diffuse bleeding from the gall bladder fossa all requiring re explorations. There was no mortality in this study.Conclusion Laparoscopic cholecystectomy is a safe, reliable and a promising option even in the rural peripheral set up. Due to its well known advantages and superiority over the open conventional method and considering the impact that it holds on the overall outcome, morbidity, health and socioeconomic status of the rural population, it can be recommended as an acceptable feasible standard in rural peripheral set up.

scholarly journals Nassar operative grade and ultrasonography prediction for difficult laparoscopic cholecystectomy

2021 ◽  
Author(s):  
Samir Paruthy ◽  
Shivani B. Paruthy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Stone Disease ◽  
Surgical Interventions ◽  
Open Method ◽  
Early Return ◽  
Gall Stone Disease ◽  
Difficult Cholecystectomy ◽  
Grade 3 ◽  
Challenging Situation

Background: ‘Gold standard’ for symptomatic cholelithiasis is laparoscopic cholecystectomy (LC) with advantagesof minimal access surgery, early return to activity with cosmetic scar. However, this may not always holdtrue in all cases. Conversion to open procedure in challenging circumstances would be in better interest of the patient even after the learning curve of the surgeon has surpassed several years. Methods: Forty patients undergoing symptomatic gall stone disease without any acute episode in past six weeks were investigated. All cases were evaluated with clinical examinations, biochemical parameters and preoperative ultrasonography done a day prior for prediction of difficult LC. All cases correlated with preoperative USG parameters and Nassar per operative grade (1-4 and 5) and analyzed for prediction to open method in difficult challenging situations. Complications associated with in 30 day of surgical interventions were also recorded. Results: Difficult cholecystectomy was anticipated with USG parameters in 20 cases, and Nassar operative grading of difficulty (Grade-3, 4 and 5) predicted in 13 cases; the latter was correlated with conversion to open methods. p<0.05 in USG parameters and Nassar grading of operative difficulty was considered significant. There were no complications nor any surgical interventions required during 30 days interval.Conclusions: Per operative Nassar grading and prior USG parameters for prediction of likelihood of difficult cholecystectomy helps in guiding surgeon in challenging situation to safely proceed to complete cholecystectomy procedure either by laparoscope or open method in the better interest of the patient.  

scholarly journals Multiple port sites metastasis after laparoscopic cholecystectomy: a case report

2017 ◽  
Vol 4 (12) ◽  
pp. 4096
Author(s):  
Farhanul Huda ◽  
Sudhir K. Singh ◽  
Arvind Gupta ◽  
Navin Kumar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Radical Surgery ◽  
Histopathological Examination ◽  
Gall Stone ◽  
Stone Disease ◽  
Rare Occurrence ◽  
Port Site Metastasis ◽  
Gall Stone Disease ◽  
Incidental Gallbladder Cancer

Laparoscopic cholecystectomy is a surgical procedure of choice for gall stone disease. Incidental gallbladder cancer is found in about 0.25-3% of patients after routine cholecystectomy. Depending on the stage of tumour, additional radical surgery may be required. In recent years, several reports of port site metastasis have been published. Here, we report a case of a 55-year-old female patient who presented to us with simultaneous multiple port sites metastasis after an interval of 15 months of laparoscopic cholecystectomy for gall stone disease. We recommend the routine use of specimen bag for the retrieval of gall bladder during laparoscopic cholecystectomy and also to send the gall bladder for histopathological examination. To the best of our knowledge, metastasis to more than one port is a very rare occurrence.

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