scholarly journals Laparoscopic Cholecystectomy in Patients with Emphysematous and Gangrenous Cholecystitis: An Experience at Khwaja Yunus Ali Medical College & Hospital, Enayetpur, Sirajgonj.

KYAMC Journal ◽  
2017 ◽  
Vol 5 (2) ◽  
pp. 519-523
Author(s):  
Mohd Farid Hossain ◽  
Sailendra Nath Biswas ◽  
Masudur Rahman ◽  
Tanvir Ahmed ◽  
Apu Karmaker
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Operating Time ◽  
Severe Form ◽  
College Hospital ◽  
Open Procedure ◽  
Early Laparoscopic Cholecystectomy ◽  
Calot’S Triangle ◽  
Gangrenous Cholecystitis ◽  
Surgical Technical

Objective- To look for the feasibility and safety of laparoscopic cholecystectomy in patients with emphysematous and gangrenous cholecystitis.Back ground- Emphysematous and gangrenous cholecystitis are severe form of acute cholecystitis. They are considered as contraindication of laparoscopic cholecystectomy due to peri operative life threatening complications, surgical technical difficulties, frequent conversion to open procedure. This study describe our experience in terms of feasibility and safety with laparoscopic cholecystectomy in patients with emphysematous and gangrenous cholecystitis.Materials and methods- From January 2012 to December 2014,total 37 patients with clinical diagnosis of severe acute cholecystitis under went laparoscopic cholecystectomy within 72 hours of admission. Operative findings and histopathological reports were used to identify patients of emphysematous and gangrenous cholecystitis.Results- 35(94.59%)among 37 patient's laparoscopic cholecystectomy were performed successfully.29 case were emphysematous and 8 cases were gangrenous cholecystitis. Two patient's laparoscopic procedure were converted to open procedure due to various operative difficulties, of which the most common was distorted calot's triangle. Maximum operating time was up to 130 minutes(one case),Post operative major complications occurred in 2 cases(5.40%).maximum patients were discharged by 48 to72 hours. There was no mortality.Conclusion- laparoscopic cholecystectomy is feasible and safe in emphysematous and gangrenous cholecystitis. However the experience of the surgeon and his patience during surgery play key role in over all out come. Based on our experience we recommend an early laparoscopic cholecystectomy for these group of patients, provided expertise & gadgets are available.KYAMC Journal Vol. 5, No.-2, Jan 2015, Page 519-523

scholarly journals EARLY CHOLECYSTECTOMY

2018 ◽  
Vol 21 (01) ◽  
pp. 010-015
Author(s):  
Muhammad Sajid ◽  
Khalid Azim ◽  
Sajid Rehman ◽  
Khurram Saqib
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Bile Leak ◽  
Early Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Major Bleed ◽  
Calot’S Triangle ◽  
Symptomatic Gallstones ◽  
Safe Technique

Background: This study was conducted to evaluate results of earlycholecystectomy in acute cholecystitis in terms of procedural safety. Methods: In this study 50consecutive cases of acute cholecystitis who underwent early laparoscopic cholecystectomy(within 03 days of attack) were included. Patients with symptoms of more than 03 days durationor those with associated diseases were excluded. Evaluation of results was done by analyzingthe data in SPSS V-17. Results: Out of 50 patients operated 46 (92%) were female and 4 (8%)were male. Most of the patients were received within 24 hours after the onset of symptoms. Theage of patients ranged from 30-70 years with the median age of 45 years. Ultrasound revealedoedematous gall bladder with pericholecystic fluid in 38 (76%) patients. In 8 (16%) patients, gallbladder was small, shrunken and thick walled, there was empyema in 2 (4%) patients &mucocele with stone impacted at hartmann’s pouch in 2 (4%) patients. Average operation timewas 40 minutes. All patients were operated within 72 hours of onset of symptoms. Per operativelysevere inflammation was noted in 32 (64%) patients, adhesions with colon/stomach/omentum in10 (20%) patients, adhesions with CBD in 3 (6%) patients, distorted anatomy at Calot’s triangle in5 (10%) patients. 6 (12%) patients had bleeding from liver bed, but controlled with diathermy. In46 (92%) patients laparoscopic cholecystectomy was completed successfully. In 4 (8%) patients,laparoscopic procedure was converted to open cholecystectomy. Reasons of conversion wereacute cholecystitis with severe adhesions which caused bleeding in 2 (4%) patients, obscureanatomy of Calot's triangle in 2 (4%) patients. Post operatively, there was bile leak in 1 (2%)patient which was due to minor injury of CBD, which required re-exploration & suturing of defect.No patient developed post operative jaundice. There was no major bleed post operatively. 3 (6%)patients developed wound infection. Conclusions: Laparoscopic cholecystectomy is aneffective and safe technique of treating symptomatic gallstones even in cases of acutecholecystitis because of accelerated recovery couple with less postoperative pain and shorthospital stay.

scholarly journals EARLY LAPAROSCOPIC CHOLECYSTECTOMY

2008 ◽  
Vol 15 (01) ◽  
pp. 162-167
Author(s):  
THAKUR K. HINDUJA ◽  
SHER MOHAMMAD SHAIKH ◽  
MALICK HUSSAIN JALBAN ◽  
Nisar Ahmed Shaikh ◽  
Ishaque Soomro
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Related Complication ◽  
College Hospital ◽  
Female Ratio ◽  
Early Laparoscopic Cholecystectomy ◽  
Medical College ◽  
Surgical Units

To assess the clinical out come of laparoscopic Cholecystectomyfor management of acute cholecystitis and to evaluate its safety, frequency of complications. Design: Observationalstudy. Setting: Surgical Units II and III Of Chandka Medical College Hospital Larkana.. Period: From 01.09.2003 upto 31.12.2007 Patients & Methods: A total of 100 consecutive cases of, acute cholecystitis confirmed subsequentlyby abdominal ultrasound scanning, who were admitted for early laparoscopic cholecystectomy. Results: There wasfemale preponderance with male to Female ratio of 1:4.5. Mean age was 45.75, SD 11.99, and most of patients werereceived with in 24 hours from the onset of symptoms. In 51 patients ultrasound reveals Edematous GB in 24(24%),Empyma 8(8%), Contracted 10(10%), Perforated 5(5%) and Gangrenous GB in 4(4%) while 49(49%) have acutecholecystitis with cholelithiasis. The conversion rate was 6%; The minimum time taken during the procedure was 50minutes. No mortality was reported in this series. Conclusion: Emergency / early cholecystectomy is reliable and safemodality cost effective, and timely surgery with modern conception in themanagement of acute cholecysttitis, becauseof accelerated recovery, negligible wound infection or related complication, and less postoperative pain. So Lap Choleshould be preferred technique now days for the treatment of acute cholecystitis at our Institute.

scholarly journals EARLY LAPAROSCOPIC CHOLECYSTECTOMY;

2008 ◽  
Vol 15 (01) ◽  
pp. 162-167
Author(s):  
THAKUR K. HINDUJA ◽  
SHER MOHAMMAD SHAIKH ◽  
MALICK HUSSAIN JALBANi ◽  
Nisar Ahmed Shaikh ◽  
Ishaque Soomro
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Related Complication ◽  
College Hospital ◽  
Female Ratio ◽  
Early Laparoscopic Cholecystectomy ◽  
Medical College ◽  
Surgical Units

 To assess the clinical out come of laparoscopic Cholecystectomyfor management of acute cholecystitis and to evaluate its safety, frequency of complications. Design: Observationalstudy. Setting: Surgical Units II and III Of Chandka Medical College Hospital Larkana.. Period: From 01.09.2003 upto 31.12.2007 Patients & Methods: A total of 100 consecutive cases of, acute cholecystitis confirmed subsequentlyby abdominal ultrasound scanning, who were admitted for early laparoscopic cholecystectomy. Results: There wasfemale preponderance with male to Female ratio of 1:4.5. Mean age was 45.75, SD 11.99, and most of patients werereceived with in 24 hours from the onset of symptoms. In 51 patients ultrasound reveals Edematous GB in 24(24%),Empyma 8(8%), Contracted 10(10%), Perforated 5(5%) and Gangrenous GB in 4(4%) while 49(49%) have acutecholecystitis with cholelithiasis. The conversion rate was 6%; The minimum time taken during the procedure was 50minutes. No mortality was reported in this series. Conclusion: Emergency / early cholecystectomy is reliable and safemodality cost effective, and timely surgery with modern conception in themanagement of acute cholecysttitis, becauseof accelerated recovery, negligible wound infection or related complication, and less postoperative pain. So Lap Choleshould be preferred technique now days for the treatment of acute cholecystitis at our Institute.  

scholarly journals Outcome of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for patients with acute cholecystitis

2020 ◽  
Vol 7 (4) ◽  
pp. 1212 ◽  
Author(s):  
Zahid Mohd Rather ◽  
Nighat Ara Majid ◽  
Mohd Nazrull Islam ◽  
Raja Waseem Mohd
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Operating Time ◽  
Total Hospital ◽  
Average Hospital ◽  
Early Laparoscopic Cholecystectomy ◽  
Total Hospital Stay ◽  
Delayed Laparoscopic Cholecystectomy ◽  
The Cost

Background: This prospective randomized study was undertaken to to assess the outcomes of early versus delayed cholecystectomy for patient’s acute cholecystitis.Methods: 70 patients with acute cholecystitis were prospectively randomized to either an early laparoscopic cholecystectomy (n=35) or a delayed laparoscopic cholecystectomy group (n=35). The mean operative time, conversion rate, total hospital stay, intra-operative and post-operative complications, average hospital cost were evaluated between the two groups.Results: A total of 70 patients were enrolled, 35 patients in each group. There was no significant difference in the conversion rates (early, 8.57% vs delayed, 5.71%) and postoperative complications (early, 25% vs delayed, 20%). At the cost of an increased operating time (early, 81 minutes vs delayed, 78 minutes) and blood loss (early, 180.33ml vs delayed, 108.00 ml), early laparoscopic cholecytectomy significantly shortened the total hospital stay (early, 1.5 days vs. delayed, 7.95 days) and  average hospital cost (early 9240 INR vs delayed, 12251 INR).Conclusions: The safety and efficacy of early and delayed laparoscopic cholecystectomy for acute cholecystitis were comparable in terms of morality, morbidity and conversion rate. However early laparoscopic cholecystectomy allows significantly shorter  total hospital stay and reduction in days away from work at the cost of  longer operating time and blood loss and offers definitive treatment at initial admission. Moreover it avoids repeated admissions for recurrent symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

2021 ◽  
pp. 004947552110100
Author(s):  
Shamir O Cawich ◽  
Avidesh H Mahabir ◽  
Sahle Griffith ◽  
Patrick FaSiOen ◽  
Vijay Naraynsingh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gold Standard ◽  
Standard Treatment ◽  
Gallstone Disease ◽  
Acute Attack ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Surgery ◽  
Delayed Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

SP3.2.10 Establishing an Emergency Surgical Ambulatory Care (ESAC) pathway for acute laparoscopic cholecystectomies: a single centre experience from a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Neil Donald ◽  
Lavanya Varatharajan ◽  
Kumaran Ratnasingham ◽  
Shashi Irukulla
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Ambulatory Care ◽  
Operating Time ◽  
District General Hospital ◽  
Gallstone Pancreatitis ◽  
Early Laparoscopic Cholecystectomy ◽  
Patient Demographics ◽  
Day Range ◽  
Cost Efficiencies

Abstract Aims Early laparoscopic cholecystectomy is the gold standard for acute cholecystitis and gallstone pancreatitis. In order to deliver this service, a local Emergency Surgical Ambulatory Care (ESAC) pathway with a dedicated ESAC theatre list was established. The aim of this audit was to determine whether ESAC was associated with (1) improved length of stay and (2) cost efficiencies. Methods Consecutive patients who underwent an emergency laparoscopic cholecystectomy between October 2018 to October 2019 were identified. Data related to patient demographics, operating time, complications length of stay (LOS), reason for inpatient stay and re-admissions were collected. A dedicated ESAC service was introduced in July 2020. Outcomes were re-audited (July – December 2020). Results Prior to the introduction of ESAC, 142 patients (42% male, mean age 51 years (range 14 -82 years)) underwent an acute cholecystectomy, of which 13% were discharged on the same day. Median pre-operative LOS was 2 days (range 0-12 days) and median post-operative LOS was 1 day (range 1-16 days). Following the introduction of ESAC, 78 patients (32% male, mean age 49 years (range 22 – 89 years)) underwent an acute cholecystectomy, of which 76% were discharged on the same day and 90% within 1 day. Median pre-operative LOS was 0 days (range 0 to 7 days) and median post-operative LOS was 0 days (range 0-16 days). Conclusions Our results show that the introduction of a dedicated ESAC pathway improved both pre- and post-operative LOS. This subsequently saves approximately £80,000 per annum in hospital bed days.

scholarly journals INDOCYANINE GREEN ENHANCED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE PATIENTS: DO WE NEED A REVISION OF THE SAFETY PARADIGMS?

2017 ◽  
Vol 64 (2) ◽  
pp. 151-154
Author(s):  
Catalin Alius ◽  
◽  
Eugen-Sebastian Gradinaru ◽  
Adriana Elena Nica ◽  
◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Augmented Reality ◽  
Surgical Technique ◽  
Indocyanine Green ◽  
Near Infrared ◽  
Fluorescent Dyes ◽  
Operating Time ◽  
Biliary Anatomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Small Cohort

Introduction. Rapid developments in medical technology have allowed the incorporation of Indocyanine green (ICG) fluorescent cholangyography in the surgical technique armamentarium. The visualization of the biliary anatomy with augmented reality devices during surgery reduces complications and offer the perspective of challenging the safety paradigms which prohibited surgery in certain acute biliary conditions. Materials and methods. 43 consecutive patients were enrolled in a prospective interventional study and randomly divided into a cohort of 19 patients who had ICG injected prior to laparoscopic cholecystectomy and a cohort of 23 patients who received no fluorescent dye prior to surgery. In the ICG lot a Near Infrared Fluorescent System was used for the acquisition of fluorescent data in order to produce real time augmented reality imaging (ICG fluorescent cholangiography). The surgical technique and the indications for surgery were the same for the same in both cohorts of patients. Results and discussion. The cohort of patients receiving ICG had no complications and the mean operating time was 10 minutes less. The biliary anatomy was identified immediately in the ICG cohort with a specificity of 89.4% for the common bule duct and 73.6% for the cystic duct. In the non ICG cohort 21% of the CBDs and 43.4% of the cystic ducts were identified with difficulty during the procedure. Conclusion. We demonstrated in a small cohort of patients that early laparoscopic cholecystectomy is safe and can be performed quicker with the aid of fluorescent dyes. In order to challenge the safety paradigms around the early laparoscopic cholecystectomy a larger study is necessary.

scholarly journals LAPAROSCOPIC CHOLECYSTECTOMY;

2013 ◽  
Vol 20 (02) ◽  
pp. 313-318
Author(s):  
MOHAMMAD ADNAN NAZEER ◽  
HASAAN IMTIAZ ◽  
HARUN MAJID DAR ◽  
Zulfiqar Ali ◽  
Asma Samreen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Controlled Trial ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Cholecystectomy ◽  
Laparoscopic Cholecystectomy Group ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Delayed Group ◽  
Group 2 ◽  
Group 1

Introduction: The role of laparoscopic cholecystectomy in treatment of acute cholecystitis is still controversial. Objective:The objective of this prospective randomized controlled trial was to evaluate the outcomes of early laparoscopic cholecystectomy foracute cholecystitis and to compare the results with delayed cholecystectomy. Setting: Sheikh Zayed Hospital, Lahore. Period: 1st Feb,2012 to 31st July 2012. Materials & Methods: 60 diagnosed patients of acute cholecystitis were randomly allocated to two groups,Group 1 underwent early laparoscopic cholecystectomy (Group 1, n = 30) and Group 2 to initial conservative treatment followed bydelayed laparoscopic cholecystectomy, 6 to 12 weeks later (Group 2 , n = 30). Results: The overall complication rate was 3.3% (01) inearly group and 16.7% (05) in the delayed group. There was no common bile duct injury in both groups. The complications includedwound infection and intraperitoneal collection. Conclusions: According to the results our study we concluded that early laparoscopiccholecystectomy can safely be carried out for acute cholecystitis as the complications for early laparoscopic cholecystectomy are lessas compared to delayed laparoscopic cholecystectomy. Early laparoscopic cholecystectomy has also an edge over delayed because ofsingle hospital stay.

scholarly journals Comparison of Early and Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

2021 ◽  
Vol 15 (1) ◽  
pp. 91-94
Author(s):  
Muhammad Nasir ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Female Patients ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
Group A ◽  
Male Patients ◽  
Group B

Background: Laparoscopic Cholecystectomy is now accepted as being safe for acute cholecystitis. However, it has not become routine, because the exact timing and approach to the surgical management remains ill define. Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe Laparoscopic Cholecystectomy. Objective: To compare the early and delayed Laparoscopic Cholecystectomy in the acute phase in terms of frequency of conversion to open cholecystectomy. Study Design: Randomized clinical trial. Settings: Department of Surgery, Divisional Headquarter Hospital, Faisalabad. Punjab Medical College, Faisalabad Pakistan. Duration: Study was carried out over a period of six months from June 2018 to May 2019. Methodology: A total of 152 cases (76 cases in each group) were included in this study. All patients were randomly allocated to either group i.e., group -A early Laparoscopic Cholecystectomy and group-B delayed Laparoscopic Cholecystectomy. Results: Mean age was 39.09 + 8.8 and 37.05+ 8.5 years in group- A and B, respectively. In group-A, male patients were 48 (63.2%) and female patients were 28 (36.8%). Similarly, in group-B, male patients were 41 (53.9%) and female patients were 35 (46.1%). Conversion to open cholecystectomy was required in 6 patients (7.9%) of group-A and 16 patients (21.0%) of group – B. Significant difference between two groups was observed (P= 0.021). Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible in terms of less frequency of conversion to open cholecystectomy.

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