scholarly journals A PROSPECTIVE STUDY OF LAPAROSCOPIC CHOLECYSTECTOMY WITH PARTICULAR REFERENCE TO CONVERSION RATE

2020 ◽  
Vol 4 (10) ◽  
Author(s):  
Sunil Kaval ◽  
Piyush Kumar Saini ◽  
Vishal Agarwal ◽  
Anuj Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gold Standard ◽  
Conversion Rate ◽  
Standard Procedure ◽  
Gall Stone ◽  
Stone Disease ◽  
Daily Routine ◽  
Female Ratio ◽  
Early Return ◽  
Gall Stone Disease

Background: Laparoscopic Cholecystectomy is established as the primary procedure for the vast majority of patients with benign gall bladder disease .1st laparoscopic cholecystectomy record in medical literature was performed in March 1987 by Phillip Mouret, in France and in 1992 accepted as new gold standard procedure across world despite of few complications. Aims and Objectives: To determine the causes of conversion of laparoscopic cholecystectomy to open cholecystectomy. Material and methods: From September 2018 to September 2019, total 85 patients were diagnosed as cholelithiasis admitted in respective unit postings of SVBP hospital Meerut and 53 cases selected for study of laparoscopic cholecystectomy. Workup of patients done with proper history, clinical examination, blood investigations and ultrasonography abdomen. Observations and Results: We performed laparoscopic cholecystectomy in 53 cases with male: female ratio of 1:4.9.Conversion  rate was 7.5% .Most common cause of conversion was frozen calot’s with adhesions ,several other factors aid in conversion like age more than 45 years, male gender and acute phase of cholecystitis. Conclusion:  In our study, we found that laparoscopic cholecystectomy when performed in properly selected patients is very much effective in treatment of symptomatic gall stone disease in term of less complication, less duration of operation and anaesthesia related complication ,cost effectiveness ,early return on work and daily routine activity .Thus laparoscopic cholecystectomy is gold standard procedure for gall stone disease despite of few complications and unavoidable conversion. Keywords: Cccl, BMI

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 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.

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 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 one-year study of cholelithiasis at a tertiary care hospital of South India

2018 ◽  
Vol 5 (7) ◽  
pp. 2444
Author(s):  
Ramalinga Reddy Rachamalla ◽  
Kishore Kumar Markapuram ◽  
Sreeram Satish
Keyword(s):  
Gall Stone ◽  
Stone Disease ◽  
Hormonal Contraceptives ◽  
Care Hospital ◽  
Mixed Diet ◽  
Female Ratio ◽  
Gall Stones ◽  
Increased Risk ◽  
Gall Stone Disease ◽  
One Year

Background: Gall stone disease is a chronic recurrent disease of hepatobiliary system characterised by formation of gall stones due to impaired metabolism of bile acids, cholesterol and bilirubin. The prevalence of cholelithiasis is variable and has been reported as 2-29% in India with differences in interstate and interregions. The objective of the present study was mainly focuses on the total clinical study with surgical management and their outcome.Methods: A prospective study for a period of one year was done after approval from ethical committee. The socio-demographic factors, clinical history, physical examination, laboratory investigations with ultrasound abdomen were done in all the cases. Surgical repair by Laparoscopic and open cholecystectomy was done.Results: Females were more predominant with male: female ratio of 1:1.97. Mean age of study population was 34.12±6.2 years and was more common during 5th decade of life. Pain in the hypochondrium was most common sign. Mixed stones were most common and mostly observed in cases of mixed diet. Laparoscopic cholecystectomy was most commonly performed with zero conversion rate. Wound infection was the most common post-operative complication in both the types of repair.Conclusions: To conclude, from the present study females were more commonly affected by cholelithiasis than males with a ratio of 1:1.97. Females are more prone during fertile age and reasons are multifactorial due to hormones, parity and hormonal contraceptives. Gall stone disease is more common during fourth and fifth decade of life in both males and females. Mixed diet (non-vegetarian) is associated with increased risk of developing gall stones than vegetarian diet.

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 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 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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