Comparative Study of Conventional Electrocautery Versus Ultrasonic Dissector in Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy (LC) is very commonly performed for removal of gallstones. In routine, ultrasonic devices are used for laparoscopy involving the deeper operating fields, while electrosurgical devices are preferred for LC. However, nowadays both of these devices are used for LC. The objective of this study was to compare the surgical outcomes of ultrasonic dissector over conventional electrocautery in patients planned for LC. Material and Methods: This non-randomized clinical trial was conducted in general surgery unit, Jinnah hospital Lahore. The study duration was 15th January 2015 to 31st December 2016. In group A (n=100), patients were operated through three-port standard laparoscopic cholecystectomy and conventional electrosurgical cautery was used for dissection. While in group B (n=50), patients were operated through single incision laparoscopic surgery (SILS) and Harmonic dissector was used for sealing of cystic artery and cystic duct. SPSS version 23 was used for data analysis. Complications between electrocautery and ultrasonic dissector were compared using chi-square test/Fischer exact test and operative time was compared using student’s t-test with p-value ≤ 0.05 considered as statistically significant.Results: Out of 150 patients planned for laparoscopic cholecystectomy, 33 (22%) were males and 117 (78%) females. The mean age was 40±6.45 years with an age range of 12-80 years. In group A, intraoperative gall bladder perforation was found in 5 patients whereas in group B, there was only one patient with perforation. A total of 4 cases were converted to open cholecystectomy in group A due to difficult dissection in Calot’s triangle as compared to 1 case in group B. In group A, 3 cases had postoperative bile leakage in the drain. In two patients it settled over a period of 3 days. About 03 cases had wound infection in group A and 1 in group B. Mean operative time in group A was 42.2±8.93 minutes versus 35.7±4.85 minutes in group B (p-value 0.001).Conclusion: In this study, the rate of post-operative complications was similar between the two groups, but operative time was significantly shorter in the group B. Harmonic dissector enabled easy dissection of tissues with good hemostasis and less trafficking of instrument, avoiding use of clips and sutures during minimal invasive surgery.

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DOES EARLY LAPAROSCOPIC CHOLECYSTECTOMY AFTER ERCP OFFERS SIGNIFICANT BENEFIT IN SURGICAL OUTCOME? A COMPARATIVE STUDY BETWEEN EARLY AND LATE GROUPS

10.36106/ijsr/3225443 ◽

2021 ◽

pp. 59-61

Author(s):

Anshul Mathur ◽

Ketan Patel ◽

Jitendra Kumar Mangtani ◽

K.K. Dangayach

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Operative Time ◽

Open Cholecystectomy ◽

Endoscopic Retrograde ◽

Endoscopic Retrograde Cholangiopancreaticography ◽

Early Laparoscopic Cholecystectomy ◽

Conversion Rates ◽

Group A ◽

Group B

Introduction:- Endoscopic retrograde cholangiopancreaticography (ERCP) prior to Laparoscopic Cholecystectomy(LC) is most commonly practiced strategy worldwide for management of co-existing cholelithiasis with choledocholithiasis. The time interval between Endoscopic Retrograde Cholangiopancreaticography (ERCP) and Laparoscopic cholecystectomy (LC) is questionable and varies from 1 day to 6 weeks in different studies. Aims and objectives:- To compare two groups of patients managed with laparoscopic cholecystectomy (after ERCP), EARLY(24 to 72 hours), and LATE(> 6weeks) in terms of mean operative time in minutes, intraoperative difculties, conversion rates to open cholecystectomy, conversion rates to open cholecystectomy, drain insertion required or not, postoperative complications, and duration of hospital stay. Materials and methods:- A prospective randomized comparative study was conducted on 70 patients who presented with concomitant cholelithiasis with choledocholithiasis over a period of January 2019 to June 2020 at the Department of General Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur. After ERCP and stone retrieval patients were randomised into 2 groups using sealed envelope method. Group A underwent early laparoscopic cholecystectomy (24 to 72hours) and Group B underwent late laparoscopic cholecystectomy (after 6 weeks). Data collected, statistical analysis done, results and observations concluded. Result:- We found that mean operative time, intraoperative difculties, post operative complications and mean hospital stay in days were signicantly higher in Group B as compared to Group A. Though the conversion rates to open procedure and requirement of drain insertion were comparatively higher in Group B but were found to be statistically non signicant. Conclusion:- We hereby conclude that early laparoscopic cholecystectomy (24 to 72 hours) after Endoscopic Retrograde Cholangiopancreaticography (ERCP) is better as compared to late laparoscopic cholecystectomy (>6 weeks) after ERCP in patients of cholelithiasis with coexisting choledocholithiasis. So, we recommend performing early Laparoscopic Cholecystectomy (24-72hours) after Endoscopic Retrograde Cholangiopancreaticography (ERCP)

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BENEFITS OF EARLY POST-ERCP LAPAROSCOPIC CHOLECYSTECTOMY: A SINGLE CENTRE PROSPECTIVE STUDY

Journal of University Medical & Dental College ◽

10.37723/jumdc.v12i3.567 ◽

2021 ◽

Vol 12 (3) ◽

Author(s):

Farhan javed ◽

Saira Saleem ◽

Ayesha Rehman ◽

Faiza Wattoo ◽

Nadia Bano ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Operative Time ◽

Statistical Tests ◽

P Value ◽

Cross Sectional ◽

Increased Risk ◽

Group A ◽

Study Population ◽

Group B

ABSTRACT: BACKGROUND & OBJECTIVE: Laparoscopic cholecystectomy (LC) following Endoscopic retrograde cholangiopancreatography (ERCP) is associated with an increased risk of complications. ERCP is associated with increased incidence of complications during LC. Surgery may be performed in same anesthesia with ERCP or up to 6 weeks later. We aimed to determine the benefits of performing LC within 72hrs of ERCP. METHODOLOGY: After institutional ethical approval this prospective cross-sectional study was performed at Madinah Teaching Hospital Faisalabad from April 2019 to June 2020. By performing convenience sampling, all patients undergoing LC after uneventful ERCP in our hospital were included. Study population was divided based on interval between ERCP and Cholecystectomy; Group-A had LC within 72hrs of ERCP, Group B had LC in same hospital stay after 72hrs and Group-C patients were discharged after ERCP and readmitted for LC. Data was collected using custom designed questionnaire, tabulated using Microsoft Excel 2016 and subjected to statistical tests to compare outcomes. Primary outcome was incidence of complications, while operative time, hospital stay and cost were considered as secondary outcomes. p-value of <0.05 was considered significant. RESULTS: Total 75 patients were included in study, 32 in Group-A, 20 in Group-B and 23 in Group-C. Average age was 44.987 ± 14.819 and study population was predominantly female (86.67%). Complication rate, duration of hospital stay and average cost were less in Group A as compared to other groups (p<0.05). Mean operative time in 3 groups was similar. CONCLUSION: LC within 72hrs after ERCP provides superior results in terms of fewer complications, shorter hospital stays and lesser cost.

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LAPAROSCOPIC CHOLECYSTECTOMY

The Professional Medical Journal ◽

10.29309/tpmj/18.4838 ◽

2018 ◽

Vol 25 (10) ◽

pp. 1503-1509

Author(s):

Mudassar Jabeen ◽

Bushra Jamil ◽

Shehzad Amjad Khan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Operative Time ◽

Standard Procedure ◽

P Value ◽

Randomized Controlled ◽

Surgeon Experience ◽

Widespread Acceptance ◽

Group A ◽

Elective Laparoscopic Cholecystectomy ◽

Group B

Introduction: Since the first laparoscopic cholecystectomy (LC) was reportedin 1990, it has widespread acceptance as a standard procedure using four trocars. The fourth(lateral) trocar is used to grasp the fundus of the gall bladder to expose calot`s triangle. Withincreasing surgeon experience, LC has undergone many refinements including reductionin port number and size. Three port LC has been reported to be safe and feasible in manyclinical trials. Objectives: To compare the operative time and of three ports versus four portlaparoscopic cholecystectomy. Study Design: Randomized Controlled Trials. Setting: SurgicalDepartments, Allied & Civil Hospitals Faisalabad. Period: 15-09-2010 to 15-03-2011. Materialand Methods: 132 Patients who underwent elective laparoscopic cholecystectomy wererandomized to undergo either the 4-port. (Group A) or the 3-port LC (group B).66 patients ineach group. Results: Mean Operative time was 25.14±4.19 minutes in group A and 25.35±4.34in group B. (p value-0.774). Mean VAS score at 12th postoperative hour was 5.37±0.993 ingroup A and 4.52±0.986 in group B. (p value <0.0001). Conclusion: Three port Laparoscopiccholecystectomy did not affect, operative time. However it resulted in less early postoperativepain in three port LC.

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Safety and feasibility of three port procedure in laparoscopic cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20192063 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1975

Author(s):

Vipin Gupta ◽

Shailendra Pal Singh ◽

Somendra Pal Singh ◽

Anil Kumar Keshari ◽

Anil Kumar Erry ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Operative Time ◽

Open Cholecystectomy ◽

Standard Technique ◽

Post Operative Pain ◽

Conversion To Open Cholecystectomy ◽

Operative Complications ◽

Group A ◽

The Mean ◽

Group B

Background: Laparoscopic cholecystectomy is widely accepted gold standard technique for management of cholelithiasis and has undergone many refinements including decrease in size and number of ports. Many researchers have claimed that three-port laparoscopic cholecystectomy is safe and feasible method for management of cholelithiasis but still it is not performed widely by the surgeons. Objective of our study was to assess the safety and feasibility of three-port laparoscopic cholecystectomy by comparing the various defined parameters with the standard four-port laparoscopic cholecystectomy.Methods: The study included 100 patients and was divided equally in 2 groups. Patients in Group A underwent laparoscopic cholecystectomy by three-port technique and in Group B were operated by four-port technique. Patients in both the groups were compared in terms of operative time, intra-operative complications, post-operative pain, post-operative complications and cosmesis outcome.Results: The mean operative time was similar in both groups. Intra-op and post-op complications were also similar. 3 patients in Group A needed fourth port and 1 patient in both group required conversion to open cholecystectomy. Mean pain score and requirement of parentral analgesia was found to be lower in Group A. Duration of hospital was similar in both the groups. Patients in group A had slightly better cosmetic outcome.Conclusions: Three-port laparoscopic cholecystectomy is a minimally invasive, safe and feasible technique and is not difficult to master than other advanced techniques. In experienced hands, laparoscopy cholecystectomy can be initially started with three-ports and can be converted to four-port if rarely necessary.

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975 Outcome of Low Verus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomized Trial

British Journal of Surgery ◽

10.1093/bjs/znab135.051 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

H Anwaar ◽

R Ahmed ◽

Z Hashmi ◽

Q Qavi ◽

T Zafar

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Randomized Trial ◽

Operative Time ◽

Low Pressure ◽

P Value ◽

Group A ◽

Standard Pressure ◽

Group B

Abstract Introduction Recent studies have shown that patients may experience considerable pain after laparoscopic cholecystectomy as well. Hence, this study was done to compare results on post op pain with low pressure pneumoperitoneum compared with standard pneumoperitoneum. Method 100 patients were selected for study and equally divided in two groups randomized into Low pressure (n = 50) and Standard pressure (n = 50). Operative time (min), postoperative pain (VAS) and frequency of Shoulder Tip Pain was noted in both groups Results A total of 100 patients were enrolled for this study. Patients were divided into two groups i.e. Group-A (Standard pressure) and Group-B (Low pressure). In group-A, there were 35(70%) males and 15(30%) females, while in group-B, there were 41(82%) males and 9(18%) females. Mean age of group-A patients was 42.0±7.0 years and 44.5±8.1 years in group-B. In group-A, 18(36%) patients had shoulder tip pain, while 4(8%) patients had had shoulder tip pain in group-B patients with a p-value of 0.001, which is statistically significant. Conclusions Laparoscopic cholecystectomy using low pressure pneumoperitoneum is feasible and results in less post-operative shoulder tip pain.

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Comparison of Early and Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

Annals of Punjab Medical College ◽

10.29054/apmc/2021.1099 ◽

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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Comparison of harmonic scalpel versus Milligan Morgan technique in haemorrhoidectomy patients

Journal of the Pakistan Medical Association ◽

10.47391/jpma.03-1303 ◽

2021 ◽

Author(s):

Muhammad Ahmad ◽

Syed Tatheer Abbas ◽

Amna Javaid ◽

Naveed Arshad ◽

Falak Shair

Keyword(s):

Wound Healing ◽

Operative Time ◽

Harmonic Scalpel ◽

Controlled Trial ◽

P Value ◽

Randomized Controlled ◽

Group A ◽

The Mean ◽

Complete Wound Healing ◽

Group B

Objectives: To assess the comparison of harmonic scalpel versus Milligan Morgan technique in patients undergoing haemorrhoidectomy. Methodology: This randomized controlled trial study was conducted at General Hospital, Lahore, from March 2019 to September 2019. Informed consent was obtained from eligible 60 patients. Patients were randomly divided into two equal groups. In group-A, haemorrhoidectomy was conducted according to the harmonic scalpel method. In group-B, open haemorrhoidectomy was performed by the Milligan Morgan procedure. Data was assembled through a designed questionnaire and investigated via SPSS version 25. Data were stratified for descriptive statistics, level of haemorrhoids and period of haemorrhoids. Post-stratification, independent sample t-test was used. Results: Mean age of both groups patients were 44.6±7.6 and 43.8±8.2 years, respectively. In group-A, mean operative time was 20.8±2.8 minutes, while 26.5±2.8 minutes in group-B, which was statistically significant with p-value of 0.001. In group-A, mean convalescence period was 9.7±2.9 days, while 13.4±3.7 days in group-B, which was statistically significant with p-value of 0.001. The mean convalescence period with harmonic scalpel method was 7.4 days (range 5–14, SD 3.6) versus 18.6 days (range 7–30, SD 5.4) with Milligan Morgan technique (P?0.001). This research observed that harmonic scalpel method required almost six weeks for complete wound healing, whereas in Milligan Morgan technique, complete wound healing was achieved after three months (P<0.05). Conclusion: Harmonic scalpel haemorrhoidectomy found an advantageous method when assessing the operative time and convalescence period. Hence, Harmonic scalpel haemorrhoidectomy can be adapted as a safe and effective alternative method for treating symptomatic haemorrhoids. Continuous...

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A comparative study of open cholecystectomy and laparoscopic cholecystectomy in patients with cholelithiasis

International Surgery Journal ◽

10.18203/2349-2902.isj20175905 ◽

2017 ◽

Vol 5 (1) ◽

pp. 253 ◽

Cited By ~ 1

Author(s):

Pramod Singh ◽

Sumit Kumar Gupta ◽

Mukesh Kumar

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Site Infection ◽

Hospital Stay ◽

Open Cholecystectomy ◽

City Hospital ◽

Site Infection ◽

First Choice ◽

Duration Of Surgery ◽

Group A ◽

Group B

Background: Cholelithiasis is a major cause of morbidity among Indians with a female preponderance. Most of the cases of gallstones are asymptomatic. For a long time, open cholecystectomy (OC) used to be the surgical treatment for cholelithiasis. But with the advent of laparoscopic cholecystectomy (LC) there has been a gradual shift in the treatment with most surgeons preferring LC over OC. Apart from the benefits of decreased hospital stay, lesser postoperative pain and earlier return to normal activity LC are also cosmetically better as compared to OC. Longer operative time and increased incidence of biliary leakage are some pitfalls of LC in initial phase of surgical practice.Methods: A prospective study of 100 patients was carried out in the department of surgery in IQ city medical college and Durgapur city hospital, Durgapur between January 2017 and August 2017 with the aim of comparing open cholecystectomy with laparoscopic cholecystectomy. The patients were randomly assigned into two groups. Group A consisted of patients who underwent laparoscopic surgery while Group B patients underwent open surgery for cholelithiasis.Results: Duration of surgery was longer in OC than LC (72.4min versus 44.7min.). Mean duration of post-operative pain was 18.3hrs in group A as compared to mean duration of 30.7hrs in group B patients. The mean period of post-operative hospital stay was 1.8 days in group A and 4.8 days in group B. Post-operative resumption of normal diet was possible in 2.1 days in OC while it took lesser time (1.2 days) in LC. The rate of surgical site infection was higher in OC as compared to LC.Conclusions: Laparoscopic cholecystectomy can be recommended as first choice operative treatment for patients with cholelithiasis as it provides better cosmetic results, lesser pain, lesser post-operative hospital stay and fewer incidence of surgical site infection.

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Comparison of laparoscopic cholecystectomy using harmonic scalpel with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.10.4327 ◽

2020 ◽

Vol 27 (10) ◽

pp. 2050-2055

Author(s):

Muhammad Asif ◽

Muhammad Faheem Anwer ◽

Muhammad Hasan Anwaar ◽

Shahbaz Ahmad ◽

Muhammad Kamran ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Loss ◽

Operative Time ◽

Harmonic Scalpel ◽

Conventional Group ◽

P Value ◽

Conventional Laparoscopic Cholecystectomy ◽

Conventional Laparoscopic ◽

Symptomatic Gallstones ◽

Group B

Objectives: To compare the laparoscopic cholecystectomy using harmonic scalpel with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones in terms of mean operative time and mean intra-operative blood loss. Study Design: Randomized Control trial. Setting: Department of Surgical at Allied Hospital Faisalabad. Period: 6 months Oct 2017 to Mar 2018. Material & Methods: Eighty (80) patients (forty in one group) divided randomly into A (harmonic scalpel group) and B (conventional) group, done under general anesthesia. Total time of operation and blood loss during procedure was noted. Results: Our study showed that mean operative time in Harmonic group (A) was 38.07+5.28 minutes and in Conventional group (B) 63.75+7.62 minutes, (p-value = 0.0001), blood loss in Harmonic group (A) 32.93+8.86ml and 55.53+8.96ml in Conventional group (B), (p-value = 0.0001). Conclusion: It is concluded that the laparoscopic cholecystectomy using harmonic scalpel is significantly better when compared with conventional laparoscopic cholecystectomy in patients of symptomatic gallstones in terms of mean operative time and mean intra-operative blood loss.

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Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain

Journal of Shifa Tameer-e-Millat University ◽

10.32593/jstmu/vol2.iss2.47 ◽

2019 ◽

Vol 2 (2) ◽

pp. 47-51

Author(s):

Sania Waseem ◽

Humera Naz Altaf ◽

Sehrish Latif ◽

Omar Shahzad Altaf ◽

Fareeha Farooqui ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Cavity ◽

Low Pressure ◽

Intraabdominal Pressure ◽

P Value ◽

Reduced Pressure ◽

Quasi Experimental ◽

Group A ◽

Standard Pressure ◽

Group B

Laparoscopic cholecystectomy is now gold standard and depends on good exposure of the peritoneal cavity. It is achieved by insufflation of the abdominal cavity with CO2. Operating at lower intraabdominal pressure (<12 -15mmHg) has been associated with fewer pulmonary and hemodynamic complications and lesser postoperative pain. Objective: To ascertain the advantages of low pressure pneumoperitoneum over standard pressure pneumoperitoneum Methods: Our study was quasi experimental study conducted at KRL Hospital, Islamabad over period of 3years from 2013 to 2016. SPSS version 20 was used to calculate p value. Results: A total of 456 patients of gallstones were equally divided in two groups assigned to undergo low pressure (7-8mm of Hg) pneumoperitoneum or standard pressure (12-14mm of Hg) pneumoperitoneum laparoscopic cholecystectomy The average age of patients was 46.2+/-13.6yrs in group A compared to 43.5 +/- 12.9 in group B. There were 60 (26.3%) male and 168 (73.7%) female patients in group A compared to 53 (23.2% and 175 (76.85) in group B respectively. It was found that group A 14 (6.1%) had no pain, 26 (11.4%) had VAS between 1 – 7 and 188 (82.5%) had VAS of 8 – 10 where as in group B 164 (72.6%) patients reported no shoulder tip pain postoperatively, 42 (18.6%) had VAS of 1 – 7 and 20 (8.8%) had VAS OF 8 – 10. The difference was statistically significant (p-value = <0.001). Conclusions: reduced pressure of pneumoperitoneum to 7 – 8 mm of Hg produce lower incidence of postoperative shoulder tip pain.

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