Is it Safe to Perform Laparoscopic Cholecystectomy for Acute Calculus Cholecystitis within 7 Days Following Symptom Onset?

Introduction: Although operation within “golden 72 hours” from the onset of symptoms has been suggested for acute calculus cholecystitis, such early surgery is hardly possible in clinical practice because of variable timing of presentation. The aim of this study is to compare the outcomes of patients undergoing laparoscopic cholecystectomy within 72 hours of symptom onset with patients undergoing surgery after 72 hours up to 7 days of symptom onset for acute calculus cholecystitis.Methods: This is a descriptive cross-sectional study carried out from November 2016 to July 2018. Patients with acute calculus cholecystitis were divided in two groups according to the onset of symptoms. Main outcomes measured were conversion rate, duration of surgery, length of hospital stay and intraoperative complications.Results: Total 64 patients were evaluated. Among which 18 (28.1%) underwent surgery within 72 hours of onset of symptom. Around 46 (71.9%) underwent surgery after 72 hours of symptom onset. On bivariate analysis there were no significant differences in mean duration of surgery, hospital stay and conversion to open surgery between two groups. Conclusions: Early laparoscopic cholecystectomy is a safe procedure when done within 7 days of symptom onset. There were no significant difference in conversion rate, operative time, hospital stay, morbidity and mortality.

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Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective, Randomized Study

International Surgery ◽

10.9738/intsurg-d-13-00068.1 ◽

2014 ◽

Vol 99 (1) ◽

pp. 56-61 ◽

Cited By ~ 29

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.

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Laparoscopic Cholecystectomy Performed by Residents: A Retrospective Study on 569 Patients

Surgery Research and Practice ◽

10.1155/2014/912143 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Dario Pariani ◽

Stefano Fontana ◽

Giorgio Zetti ◽

Ferdinando Cortese

Keyword(s):

Laparoscopic Cholecystectomy ◽

Retrospective Study ◽

Postoperative Complications ◽

Hospital Stay ◽

Postoperative Hospital Stay ◽

Daily Activities ◽

Safe Procedure ◽

Duration Of Surgery ◽

Junior Residents

Introduction. Aim of this study was to evaluate the safety of laparoscopic cholecystectomy performed by residents.Materials and Methods. We retrospectively reviewed 569 elective laparoscopic cholecystectomies.Results. Duration of surgery was84±39min for residentsversus 66±47 min for staff surgeons,P<0.001. Rate of conversion was 3.2% for residentsversus2.7% for staff surgeons,P=0.7. There was no difference in the rates of intraoperative and postoperative complications for residents (1.2% and 3.2%)versusstaff surgeons (1.5% and 3.1%),P=0.7andP=0.9. Postoperative hospital stay was3.3±1.8days for residentsversus 3.4±3.2days for staff surgeons,P=0.6. One death in patients operated by residents (1/246) and one in patients operated by staff surgeons (1/323) were found,P=0.8. No difference in the time to return to normal daily activities between residents (11.3±4.2days) and staff surgeons (10.8±5.6days) was found,P=0.2. Shorter duration of surgery when operating the senior residents (75±31minutes) than the junior residents (87±27minutes),P=0.003.Conclusion. Laparoscopic cholecystectomy performed by residents is a safe procedure with results comparable to those of staff surgeons.

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Single Setting ERCP and Laparoscopic Cholecystectomy is a Safe Procedure in Patients with Cholecysto-Choledocholithiasis: A Prospective Study in a Peripheral-Level Hospital

Nepal Medical College Journal ◽

10.3126/nmcj.v22i1-2.30038 ◽

2020 ◽

Vol 22 (1-2) ◽

pp. 73-81

Author(s):

Nabin Pokhrel ◽

G Katwal

Keyword(s):

Laparoscopic Cholecystectomy ◽

Prospective Study ◽

Hospital Stay ◽

Safe Procedure ◽

Open Procedure ◽

Significant Difference ◽

Setting Approach ◽

A Prospective Study ◽

Level Hospital ◽

Cbd Exploration

The ideal management of cholecysto-choledocholithiasis is an open cholecystectomy (OC) with the common bile duct (CBD) exploration worldwide. The single setting 2-stage approach- endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST), and CBD clearance followed by laparoscopic cholecystectomy (LC) offers an advantage, mainly by reducing the hospital stay, the cost, and the morbidity. The Objective of the study is to compare the ERCP+LC single setting approach with an OC+CBD exploration for the treatment of cholecysto-choledocholithiasis. This is an interim analysis of 160 patients with 83 (51.9%) patients in ERCP+LC and 77 (48.1%) in an open procedure (OC+CBD exploration) group respectively. We did a prospective study in patients admitted for the management of the cholecysto-choledocholithiasis in the Department of Surgery at the Lumbini Medical College and Teaching Hospital from November 2012–October 2015. They underwent 2-stage ERCP+LC in a single setting and we compared them with 2-stage OC+CBD exploration in a single setting approach. The patients with the open procedure were our control group. All the included cases in the study were elective. The procedure was feasible in our hospital. Similarly, the hospital stay was significantly shorter in the ERCP+LC group; 3.92±0.719 days vs 10.30±1.557 days, p <0.05. There was a significant difference in the total morbidity of ERCP+LC group 7 (8.4%) vs 14 (18.2%), p <0.05. Here, wound infection in the ERCP+LC group was 2 (2.4%) vs 4 (5.2%) and there was one case of abdominal collection 1 (1.2%) which was managed symptomatically. The incidence of retained CBD stone in the ERCP+LC was 3 (1.2%) which was managed successfully with ERCP. In all the cases, post- ERCP amylase value was found to be within the normal limit. The result of our study suggests, single setting ERCP+LC at the peripheral-level hospital is feasible in terms of cost, length of hospital stay, morbidity and stone clearance.

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Harmonic scalpel versus titanium clips and l-hook in the ligation of cystic duct and artery and gall bladder dissection in laparoscopic cholecystectomy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175075 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5145

Author(s):

Anand Vijayvargiya ◽

S. K. Jain ◽

Varsha Soni

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Hospital Stay ◽

Cystic Duct ◽

Harmonic Scalpel ◽

P Value ◽

Duration Of Hospital Stay ◽

Significant Difference ◽

Conversion To Open Cholecystectomy ◽

Duration Of Surgery

Background: Laparoscopic cholecystectomy is a gold standard for gall bladder stone surgery. The Aim and objective of study was to compare the total duration of surgery, intraoperative complication like bile leak from cystic duct stump, spillage of bile from gallbladder and post op pain and abdomen distension and jaundice.Methods: Study was carried out in dept. of gen Surgery, Govt medical college Kota in yr. 2015-16 in a total of 50 patients with cholelithiasis with cholecystitis. Patient were equally divided randomly into two groups (a) Harmonic scalpel group and (b) Titanium Clip and L hook group. All patients with medical comorbidities, Concomitant CBD calculi, cirrhosis and portal HT were excluded from study. Intraoperatively adhesions, bile spillage from GB and cystic duct stump noted Postoperatively complain like pain abdomen, Jaundice, and fever were noted. Duration of hospital stay was observed. All results were statistically analyzed using Chi square and ANOVA test.Results: Both groups were comparable on the basis of age and sex distribution, as no statistically difference was noted (P value 0.867 and 0.999 respectively). Intraoperative findings were adhesions 5 in clip group and 7 in harmonic group. Spillage from gall bladder was 2 in Clip group and 3 in harmonic group. Mean duration of surgery was 65.20 min in clip group and 63.68 in harmonic group with no statistically significant difference in both the group (P Value 0.727). Average duration of hospital stay was similar in both the groups with a mean of 2.6 days. Postoperative complication was fever, abdomen pain and distension were 3,1,1 were respectively in the clip group and 3,2,2 respectively in harmonic group with the P value of 0.999 which was statistically insignificant. No CBD injury was noted in any case. Conversion to open cholecystectomy was not done in any case. On 1week and 1 month follow up 2 cases in clip group and 1 in HS group had collection in gall bladder fossa and none at I month.Conclusions: Harmonic scalpel offers an effective, alternative and safe method to cystic duct division and Gallbladder dissection from liver bed.

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Optimal timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography

International Surgery Journal ◽

10.18203/2349-2902.isj20174101 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3504 ◽

Cited By ~ 1

Author(s):

Rasmiranjan Sahoo ◽

Debasish Samal ◽

A. Pradhan ◽

Rima Sultana ◽

Nabakishore Nayak ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Conversion Rate ◽

Open Cholecystectomy ◽

Secondary Outcome ◽

Optimal Timing ◽

Endoscopic Retrograde ◽

Early Laparoscopic Cholecystectomy ◽

Group I ◽

Significant Difference ◽

Group Ii

Background: Nowadays in patients with cholelithiasis with choledocholithiasis, the ideal treatment is endoscopic retrograde cholangiopancreatographic (ERCP) removal of duct stone and laparoscopic cholecystectomy. But when to do and whether we can do it simultaneously or one after another and what interval should be there, that is always controversial. The purpose was an optimal gap for cholecystectomy after ERCP.Methods: We have done a comparison study in 60 patients within a duration of 2 year who had already done ERCP. Group 1, those patients who had laparoscopic cholecystectomy within 72 hours compared with group 2 who had laparoscopic cholecystectomy after an interval of 6 week. Primary outcome was the conversion rate from lap to open cholecystectomy. Secondary outcome was duration of operation, intra-operative difficulties, postoperative morbidity and hospital stay.Results: Of 60 consecutive patients 30 were in group I and 30 were in group II. There is no difference in demographics, laboratory or ultrasonographic findings. The hospital stays in group I is significantly shorter than group II and conversion rate; operative time is higher in group II. No statistically significant difference in post-operative morbidity between both groups.Conclusions: Early laparoscopic cholecystectomy within 72 hr is better than interval (6 week) cholecystectomy after ERCP with shorter hospital stay and less intraoperative difficulties.

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Three-port versus four-port laparoscopic cholecystectomy: a comparative study at a tertiary care centre in North India

International Surgery Journal ◽

10.18203/2349-2902.isj20180014 ◽

2018 ◽

Vol 5 (2) ◽

pp. 426

Author(s):

Peeyush Kumar ◽

Anil K. S. Rana

Keyword(s):

Laparoscopic Cholecystectomy ◽

Return To Work ◽

Hospital Stay ◽

Tertiary Care ◽

Gall Stone ◽

North India ◽

Duration Of Hospital Stay ◽

Conversion Rates ◽

Significant Difference ◽

Duration Of Surgery

Background: Improvement of Laparoscopic Cholecystectomy (LC) technique in terms of reduction in size and number of ports is being tried to improve patient satisfaction and outcome. Present study was conducted to evaluate and compare the safety outcome and advantages of three-port and four-port LC. Methods: This prospective study included 90 patients presenting with symptomatic gall stone disease or gall bladder polyp more than 1cm at base. Patients with jaundice and choledocholithiasis were excluded. Patients were divided into two groups: A and B, who underwent three-port and four-port LC respectively. Outcomes of the two groups were assessed and compared in terms of duration of surgery, intra-operative and post-operative variables including rate and nature of complications, conversion rates, post-operative pain, duration of hospital stay, return to work and cosmetic outcome.Results: Statistically significant difference was found between the two groups in terms of Visual Analogue Score for pain at 6 and 24 hours, analgesic requirement, duration of hospital stay and return to work; all being less in the three- port LC group. Cosmetic outcome as perceived by patients was also better in the three-port group. Results of other variables were comparable in the two groups. Conclusions: Three-port procedure is safe and appears to be more cost effective than four-port LC. If LC is performed by an experienced surgeon, it can be started with three ports, if required, a fourth port can be inserted.

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Retrospective Study of Three-port versus Standard Four-port Laparoscopic Cholecystectomy: A Single Surgical Unit Experience of 1456 Patients

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44484.13826 ◽

2020 ◽

Author(s):

Vivek Srivastava ◽

Mumtaz Ahmad Ansari ◽

Vijay Kumar Shukla ◽

Somprakas Basu

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Complications ◽

Hospital Stay ◽

Postoperative Period ◽

Conversion Rate ◽

Operating Time ◽

Chronic Cholecystitis ◽

Early Recovery ◽

Significant Difference ◽

The Mean

Introduction: Although laparoscopic surgeries have proven beyond doubt their benefit in terms of early recovery, better patient care and cost-effectiveness, the quest for reduction in either the size or number of ports still continues. Aim: To compare the safety, outcome, and advantages between three-port versus four-port Laparoscopic Cholecystectomy (LC) in acute and chronic cholecystitis. Materials and Methods: Medical records of 1456 patients that underwent LC (three- or four-port) for acute and chronic cholecystitis from January 2015 to December 2019 (60 months) were retrospectively analysed. All patients were given the same anaesthetic drugs for induction and maintenance, with standard anaesthetic protocol. The results were compared for both the techniques in terms of operating time, conversion rate, intraoperative complications, immediate postoperative complications, pain score, analgesic requirement and hospital stay. Results: Total 1456 patients underwent LC; 1282 were female and 174 were male. The mean age of the patients was 39.2 years (range 18-70 years). The three-port LC technique was performed on 816 (56.04%) patients, while the traditional four-port LC technique was performed on 640 (43.96%) patients. Visual Analog Score (VAS) in the postoperative period at six hour was 2.11±0.82 in three-port group versus 3.17±1.12 in four-port group, this suggests that there was a significant difference in pain in these two groups in the early postoperative period (p<0.001). In three-port group, the requirement of analgesic drug was significantly less as compared to four-port group (2.86±0.98 versus 3.22±0.87; p<0.001). There was no statistically significant difference in the mean operating time, duration of hospital stay, intra and postoperative complications, days to return to normal activity, satisfaction score and conversion rate (p=0.087, p=0.061, p=0.578, p=0.555, p=0.572 and p=0.145, respectively). Conclusion: Three-port LC is a feasible, effective and safe technique that further enhances the surgical outcome in terms of postoperative pain, fewer needs for analgesic medication.

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LAPAROSCOPIC CHOLECYSTECTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.02.2059 ◽

2011 ◽

Vol 18 (02) ◽

pp. 237-242

Author(s):

AWAIS SHUJA ◽

ABID BASHIR ◽

ABID RASHID

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Complication Rate ◽

Conversion Rate ◽

Gall Stone ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

The Impact

Laparoscopic cholecystectomy is the gold standard treatment for patients presenting with acute gall stone disease necessitating hospital admission. Objective: To assess the impact of timing of laparoscopic cholecystectomy on conversion rate, hospital stay and morbidity. Period: Jan 2008-2010. Setting: Department of Surgery, Independent University Hospital, Faisalabad. Study Design: Experimental study. Material & Methods: The subjects were included by consecutive sampling technique. 81 cases were divided into 3 groups. Group A (Surgery within 72 hrs of onset symptoms). Group B (surgery between 72hrs to 96 hours of onset of symptoms). Group C (surgery after 96 hours of onset of symptoms). Results: The mean age was 41-95 years. Female to male ratio was 4.5:1. The overall complication rate was 12.69%. Mean hospital stay was 2.85 days. The open conversion rate was 8.64%. In group A the complication rate was 6%, group B 11.5% and group C 12.8&. The mean hospital stay and conversion rate had no significant difference. Conclusions: The timing of laparoscopic cholecystectomy has no significant impact on the conversion rate and length of hospital stay in cases with acute cholecystitis. However the complication rate was higher when surgery performed after 72 hours of onset of symptoms.

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PROPHYLACTIC ANTIBIOTICS. ROLE STILL TO BE DEFINED IN ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.02.187 ◽

2019 ◽

Vol 26 (02) ◽

Author(s):

Shiraz Shaikh

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Surgical Site Infections ◽

Prophylactic Antibiotics ◽

Low Risk ◽

University Hospital ◽

Superficial Infection ◽

Cross Sectional ◽

Significant Difference ◽

Surgery Duration

ABSTRACT… Objective: The purpose of this study was to find out the role of prophylactic antibiotics in preventing surgical site infections in patients underwent low risk elective laparoscopic cholecystectomytrauma of abdomen. MATERIALS AND METHOD: All low risk patients those underwent laparoscopic cholecystectomy at Surgical Unit – III, Liaquat University Hospital Jamshoro from 1st January 2015 to 31st December 2016 were enrolled prospectively for this cross-sectional comparative study. Overall 150 cases were enrolled within the study as well as were categorized into A-Group (n=77), and B-Group (n=73). A-Group was offered prophylactic antibiotic’s single dose at induction of anesthesia, and B-Group was offered without any antibiotic. Groups were recorded for, surgery duration, gender, age and hospital stay. All subjects were followed-up for one month on weekly basis and data was recorded regarding surgical site in addition to intra-abdominal infection. RESULTS: There was no significant difference among both groups regarding surgery duration, sex, age, and hospital stay duration. Complications in both the groups were compared. Rate of superficial infection was 6.49% (n=5) and 6.84% (n=6) respectively in group A and B. On statistical analysis these differences were not significant. Rate of deep infection and seroma formation were 0% (n=0) in both the groups. Conclusion: It was concluded that, the application of prophylactic antibiotics does not significantly lower the rates of postoperative infective complication and is not essential among cases undergoing laparoscopic cholecystectomy with low risk.

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Early versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective Randomized Trial

ISRN Minimally Invasive Surgery ◽

10.1155/2013/486107 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 9

Author(s):

Sushant Verma ◽

P. N. Agarwal ◽

Rajandeep Singh Bali ◽

Rajdeep Singh ◽

Nikhil Talwar

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Initial Period ◽

Control Group ◽

Early Group ◽

Early Laparoscopic Cholecystectomy ◽

Delayed Laparoscopic Cholecystectomy ◽

Conversion Rates ◽

Significant Difference ◽

Duration Of Surgery

Introduction. Very few studies demonstrate the feasibility of laparoscopic cholecystectomy for acute cholecystitis. However, most surgeons prefer to delay surgery in the acute phase. The aim of this prospective randomized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis. Materials and Methods. Between August 2010 and March 2012, 30 patients with a diagnosis of acute cholecystitis underwent early laparoscopic cholecystectomy within 72 h of admission. This study group was compared with a control group of 30 patients of acute cholecystitis, who underwent delayed laparoscopic cholecystectomy after an initial period of conservative treatment. Results. There was no significant difference in the conversion rates (3 early versus 2 delayed), postoperative analgesia requirements, postoperative pain scores, or duration of postoperative stay (1.67 days early versus 1.47 days delayed). However, duration of surgery was significantly more in the early group (65.78 minutes early versus 56.83 minutes delayed). Surgery was abandoned in 2 patients from the early group because of difficult anatomy. No complications and mortality were seen in either group. Conclusions. Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible, offering the additional benefit of a shorter hospital stay. It should be offered to patients with acute cholecystitis, provided the surgery is performed within 72 h from the onset of symptoms.

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