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.

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 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.

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 A study on clinical and radiological factors for predicting difficult laparoscopic cholecystectomy preoperatively

2017 ◽  
Vol 4 (9) ◽  
pp. 3015
Author(s):  
Arun Prasath S. ◽  
Surag Kajoor Rathnakar ◽  
Nagaraja Anekal L.
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Open Cholecystectomy ◽  
Fluid Collection ◽  
Gall Stone ◽  
Stone Disease ◽  
Elderly Age ◽  
Conversion To Open Cholecystectomy ◽  
Upper Abdominal ◽  
A Prospective Study

Background: Laparoscopic cholecystectomy considered as the gold standard treatment for symptomatic gall stone disease has 1-13% conversion rate to an open procedure due to various reasons. Present study aims to predict difficult laparoscopic cholecystectomy preoperatively using clinical and sonological factors.Methods: This is a prospective study done on 190 patients who were posted for laparoscopic cholecystectomy from March 2015 to February 2017. Parameters taken into consideration were: age, number of previous attacks of acute cholecystitis, impacted gallstone, thickness of GB wall, pericholecystic fluid collection, history of upper abdominal surgery and obesity. All surgeries were performed by surgeons with minimum ten years of experience on laparoscopic cholecystectomy and ultrasound of the abdomen was performed by senior radiologists with experience of minimum five years.Results: Out of 190 patients, difficulty was experienced in 48 patients of which conversion to open cholecystectomy was needed for 11 patients. Elderly age, multiple attacks of pain abdomen (>2), palpable GB, impacted gallstone, thickness of GB wall >3 mm, peri-GB fluid collection, adhesions due to previous abdominal surgery and obesity were all found to be independent risk factors leading to difficult laparoscopic cholecystectomy.Conclusions: Though there is no definite scoring system to predict difficult LC, there is scope for further refinement to make the same less cumbersome and easier to handle using the above clinical and radiological factors.

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 The Impact of Patient-Controlled Analgesia on Laparoscopic Cholecystectomy

2007 ◽  
Vol 89 (4) ◽  
pp. 374-378 ◽  
Author(s):  
S Sinha ◽  
V Munikrishnan ◽  
J Montgomery ◽  
SJ Mitchell
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Pain Management ◽  
Stone Disease ◽  
Patient Controlled Analgesia ◽  
Open Operation ◽  
Symptomatic Gallstones ◽  
Elective Laparoscopic Cholecystectomy ◽  
The Impact

INTRODUCTION Laparoscopic cholecystectomy has revolutionised the management of symptomatic gallstones and is increasingly performed as a day-case procedure. The aim of this study was to assess the impact of opioid patient-controlled analgesia (PCA) on elective laparoscopic cholecystectomy. PATIENTS AND METHODS In a prospective, non-randomised, observational study, 76 consecutive patients who underwent elective in-patient laparoscopic cholecystectomy were reviewed. Six patients with complicated gall stone disease and four patients who converted from laparoscopic to an open operation were excluded. RESULTS Of the 66 remaining in the study group, 25 patients received morphine-PCA and, of these, 9 were fit for discharge. In contrast, 41 patients did not receive PCA and, of these, 27 were fit for discharge (P < 0.05). Median Aldrete score in the PCA group was 16 and in the non-PCA group 18 (P < 0.05). Postoperative nausea and vomiting were more common in patients receiving a morphine-based PCA and with in those with higher anti-emetic requirement (10/25 in PCA and 7/41 non-PCA groups; P < 0.05). CONCLUSIONS Routine postoperative opioid PCA prolongs the recovery and in-patient stay following elective laparoscopic cholecystectomy. Its role in postoperative pain management in routine laparoscopic cholecystectomy should be questioned.

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 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 Diagnosis of Helicobacter pylori in cholelithiasis and cholecystitis: by histology and serological association

2019 ◽  
Vol 6 (11) ◽  
pp. 3986
Author(s):  
Srinivasan Doraiswamy ◽  
Dharmendra Kumar ◽  
P. N. Sreeramulu ◽  
Suresh .
Keyword(s):  
Helicobacter Pylori ◽  
Open Cholecystectomy ◽  
Gall Stone ◽  
Stone Disease ◽  
Marked Rise ◽  
Female Ratio ◽  
Gall Stone Disease ◽  
Calculus Disease ◽  
Set Up ◽  
Calculous Cholecystitis

Background: Biliary calculus disease is one of the most common disorders affecting the gastrointestinal tract. It is an important cause of morbidity. There has been marked rise in the incidence of gall stone disease in the west. In India, it is more common in northern states than in South India. Incidence of gallstones increases with age with a male to female ratio of 1:4. About 50% of these patients are asymptomatic.Methods: An analytical prospective study on patients diagnosed with cholecystitis and/or cholelithiasis was conducted in R. L. Jalappa Hospital Tamaka, Kolar. 58 patients were included in the study between June 2018 and May 2019. Data was collected and analysed using SPSS 22 version software. Categorical data was represented in the form of frequencies and proportions.Results: The age incidence was found to be highest between 31 to 40 years. The incidence of cholelithiasis was more in females. All patients presented with pain abdomen. Calculous cholecystitis was the most common mode of presentation. Open cholecystectomy was commonly done for cholelithiasis in our set up. Chronic calculous cholecystitis is the commonest histopathology.Conclusions: According to our findings evidence of recent and chronic infection Helicobacter pylori as shown by demonstration of IgM and IgG class of antibodies respectively to the organism was found in most of patients and histological evidence of the patients with cholecystitis and cholelithiasis. Thus, the frequency of helicobacter infection seems to be low in the patient population studied.

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