scholarly journals A COMPARATIVE STUDY BETWEEN ROUTINE INSERTIONS OF SUBHEPATIC DRAIN VERSUS NO DRAIN AFTER ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

2020 ◽  
pp. 1-3
Author(s):  
Subhadip Sarkar
Keyword(s):  
Abdominal Pain ◽  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Wound Infection ◽  
Statistical Tests ◽  
Abdominal Drain ◽  
Symptomatic Cholelithiasis ◽  
Standard Laparoscopic Cholecystectomy ◽  
Drain Group ◽  
Operative Wound

Introduction: Laparoscopic cholecystectomy is the mainstay of treatment in symptomatic cholelithiasis. Surgeons are still following the old habit of routine Subhepatic drainage following laparoscopic cholecystectomy (LC). However, routine drainage after LC is still a debatable issue. This study aims at evaluating the effects of Subhepatic drainage after standard laparoscopic cholecystectomy in terms of various post-operative parameters. Materials & methods: The study was conducted at the department of General Surgery, ESIC-PGIMSR, Joka, Kolkata from January 2018 to March 2020. We selected 120 patients with symptomatic cholelithiasis & divided them into 2 groups; each having 60 patients, with drain & without drain respectively. Age & sex distribution of the patients, post-operative abdominal pain & right shoulder tip pain, post-operative wound infection, subhepatic collection (24 & 72 hrs after surgery) & post-surgical hospital stay were measured in both groups. Data were analyzed by appropriate statistical tests. Results: We found the incidence of laparoscopic cholecystectomy was highest in the 5th decade & more common in women. The incidence of post-surgical abdominal pain & subhepatic collection were greater in the group of patients with drain in situ which was statistically significant also. Moreover, inserting drain showed increased incidence of post operative wound infection & hospital stay, though these were statistically insignificant. More patients in the non drain group showed post-operative right shoulder tip pain in comparison to the drain group but that was also statistically insignificant. Conclusion: The decision of inserting drain should be taken judiciously on the basis of individual case scenario. The generalized approach of putting abdominal drain after every standard laparoscopic cholecystectomy is not at all beneficial.

scholarly journals A comparative study of laparoscopic cholecystectomy with and without abdominal drain

2018 ◽  
Vol 6 (11) ◽  
pp. 3639
Author(s):  
Udit I. Gadhvi ◽  
Dhaval A. Bhimani ◽  
Jaivik Waghela ◽  
Darshil K. Rajgor
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Fluid Collection ◽  
Gall Stone ◽  
Stone Disease ◽  
Abdominal Drain ◽  
Lower Pain ◽  
Drain Group ◽  
The Difference ◽  
Operative Recovery

Background: Laparoscopic surgery has several advantages when compared to open surgery, including faster post-operative recovery and lower pain scores. Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Routine drainage after laparoscopic cholecystectomy is an issue of considerable debate.Methods: Study was randomized, prospective, observational and longitudinal including 100 patients, selected according to inclusion criteria.Results: The sub hepatic fluid collection on first ultrasound at 24hrs was higher in drained group than in non-drained groups. Further, the difference became insignificant on subsequent ultrasound at 72hrs. Incidence of post-operative drain site pain was present in 25% of patients with drain (more at drain site). Incidence drain site infection was present in 16.6% of patients in drain group. Majority of the patients with drain group (n=24) required hospital stay for ≥3 days, while for majority of patients without drain group (n=20), required hospital stay was 1 day.Conclusions: An uncomplicated gall stone disease can be treated by laparoscopic cholecystectomy without need for drain with reasonable safety by an experienced surgeon. With no usage of drain, it is significantly advantageous in terms of post-operative pain, use of analgesics and hospital stay.

scholarly journals Predictive Factors for a Long Hospital Stay in Patients Undergoing Laparoscopic Cholecystectomy

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Wasana Ko-iam ◽  
Trichak Sandhu ◽  
Sahattaya Paiboonworachat ◽  
Paisal Pongchairerks ◽  
Anon Chotirosniramit ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Predictive Factors ◽  
Rating Scale ◽  
Open Cholecystectomy ◽  
Multivariable Analysis ◽  
Numeric Rating Scale ◽  
Antiemetic Drug ◽  
Abdominal Drain ◽  
Analgesia Requirement

Background. Although the advantages of laparoscopic cholecystectomy (LC) over open cholecystectomy are immediately obvious and appreciated, several patients need a postoperative hospital stay of more than 24 hours. Thus, the predictive factors for this longer stay need to be investigated. The aim of this study was to identify the causes of a long hospital stay after LC. Methods. This is a retrospective cohort study with 500 successful elective LC patients being included in the analysis. Short hospital stay was defined as being discharged within 24 hours after the operation, whereas long hospital stay was defined as the need for a stay of more than 24 hours after the operation. Results. Using multivariable analysis, ten independent predictive factors were identified for a long hospital stay. These included patients with cirrhosis, patients with a history of previous acute cholecystitis, cholangitis, or pancreatitis, patients on anticoagulation with warfarin, patients with standard-pressure pneumoperitoneum, patients who had been given metoclopramide as an intraoperative antiemetic drug, patients who had been using abdominal drain, patients who had numeric rating scale for pain > 3, patients with an oral analgesia requirement > 2 doses, complications, and private ward admission. Conclusions. LC difficulties were important predictive factors for a long hospital stay, as well as medication and operative factors.

scholarly journals Laparoscopic cholecystectomy in hepatitis C liver cirrhosis patients: “to drain or not to drain: impact on postoperative pain”

2019 ◽  
Vol 6 (8) ◽  
pp. 2708
Author(s):  
Ahmed Mohamed Abdelaziz Hassan ◽  
Magdy M. A. Elsebae ◽  
Mohamed Abbas ◽  
Hussien Ezzat ◽  
Mohamed Z. Ali ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Laparoscopic Cholecystectomy ◽  
Hepatitis C ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Nausea And Vomiting ◽  
Analgesic Requirement ◽  
Group I ◽  
Duration Of Surgery ◽  
Drain Group

Background: When cirrhotic patients with symptomatic gallstones require laparoscopic cholecystectomy (LC), the drainage tube is supposed to prevent postoperative abdominal radiating to the right shoulder, nausea and vomiting due to pneumoperitoneum using carbon dioxide gas. Aim of this work is to evaluate the effect of placing of drains on the incidence of postoperative pain, nausea and vomiting in those patients.Methods: sixty-four patients with uncomplicated chronic calcular cholecystitis and liver cirrhosis were recruited for the study during the period from February 2017 to February 2019. They electively operated upon at the department of general surgery of Theodor Bilharz Research Institute (TBRI) using laparoscopic technique. Patients were subdivided into two equal groups Group-I (n=32); suction drains were placed in the sub-hepatic region (Morison’s pouch) and Group-II (n=32), no drains were placed. Duration of surgery, postoperative shoulder tip pain and vomiting and analgesics requirement were evaluated and recorded.Results: Operative time's difference was not statistically significant between the two groups. Drain group had a significant lower shoulder tip pain and analgesic requirement at post-operative 6 and 12 hours but that was higher After 12 hours, than group without drain. The overall incidence of nausea/vomiting was significantly higher statistically in group without drain than in drain group. Patients in drain group had a significantly longer hospital stay as compared to group without drain that was statistically significant.Conclusions: Although the incidence of pain and nausea/vomiting are less in early  post-operative period after LC  with abdominal drain in hepatitis C liver cirrhosis patients; its routine use is not justified because post-operative pain and analgesic requirement  after 12 hours is higher and hospital stay is longer. 

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

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.

scholarly journals Wound infections after surgery in a modern operating suite: clinical, bacteriological and epidemiological findings

1979 ◽  
Vol 83 (1) ◽  
pp. 41-58 ◽  
Author(s):  
Stellan Bengtsson ◽  
Anna Hambraeus ◽  
Gunnar Laurell
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Wound Infection Rate ◽  
Wound Infections ◽  
Staph Aureus ◽  
Air Contamination ◽  
Operating Theatres ◽  
A Prospective Study ◽  
Operating Suite ◽  
Operative Wound

SUMMARYA prospective study of 2983 operations in general and orthopaedic surgery during 3 years performed in four operating theatres in a modern operating suite was carried out in order to evaluate the importance of airborne infection. Weekly nose-and-throat samples were taken from the surgical staff and pre-operative samples were taken from the nose, throat, skin and perineum of the patients. The air contamination was followed by using settle plates, which showed low mean counts of total bacteria of between 9 and 15 c.f.u./m2/min, with mean counts of Staph. aureus of between 0.03 and 0.06 c.f.u./m2/min. No correlation was found between the total number of bacteria and the incidence of post-operative infections or between the amount of Staph. aureus in the air and post-operative Staph. aureus infections. It was concluded that further increases in ventilation could, at best, only marginally affect the incidence of post-operative infection.The post-operative wound-infection rate was 9.0%. In various types of surgery, the infection rates varied from 5.3% in clean operations to 47.6% in dirty surgery. About one third of the infections were classified as moderate or severe.Adverse patient factors, such as immunodeficiency, steroid treatment, intensive care, etc., increased the rate to 15.0%; in ‘normal’ patients it was 3.8%.Among the bacteria isolated, gram-negative bacilli (31% of wounds), often together with other bacteria, and Staph. aureus (28%) predominated, but in 25% no specimens were taken.Of 76 post-operative Staph. aureus infections, 32 were caused by the patients' own strains, and of the remaining 44 infections, 22, or 8% of all infections, could be traced to strains present in the air and/or the respiratory tracts of staff during the operation.The length of pre-operative hospital stay had no influence on the carrier rate of Staph. aureus in patients. The incidence of post-operative wound infection was significantly higher in patients carrying Staph. aureus and was even higher if these bacteria were found on the skin.Patients with wound infections stayed, on an average, 15 days longer than patients without infections. In serious infections the increase in duration of stay was > 20 days. Although infections were commoner in older patients, the average additional hospital stay of infected patients did not increase with age. If the post-operative infections studied in a concurrent retrospective study are taken into account more than 12 000 bed-days were due to post-surgical wound infections in the period studied or, in other words, some 12 beds (corresponding to 5.5% of the total) were always occupied by infected patients.

scholarly journals Single dose Intraoperative Antibiotics versus Postoperative Antibiotics for Patient Undergoing Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis

2017 ◽  
pp. 5
Author(s):  
Sagun Bahadur Thapa ◽  
Yashwant Ramakrishan Kher ◽  
Yashwant Gajanan Tambay
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Single Dose ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Prophylactic Antibiotic ◽  
College Teaching ◽  
Intravenous Dose ◽  
Site Infection ◽  
Symptomatic Cholelithiasis ◽  
The Difference

  Introduction: Surgical site infection is a common complication shown in literature following cholecystectomies. Smaller incision and use of trocars in laparoscopic cholecystectomy lessen the contamination resulting in less chances of surgical site infection. However, in fear of postoperative infection, many opt for the prolonged postoperative use of antibiotic and there is growing consensus against it. Antibiotics not only increases the cost and hospital stay duration but it aids in emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial to see whether a single prophylactic dose of antibiotic at the time of induction of anesthesia for laparoscopic cholecystectomy was equally effective in controlling post-operative infection as multi-dose antibiotics during and post-operative period.   Methods: The study was conducted at the department of general surgery, Lumbini Medical College Teaching Hospital, from November  2015 to October 2016. All cases with symptomatic cholelithiasis subjected for laparoscopic cholecystectomy were enrolled. Patients were randomized into two groups; Group SD received single dose of an intravenous dose of amikacin 500 mg, at induction of anesthesia and Group MD received multiple intravenous dose of amikacin, during and postoperatively for two days. Complications, hospital stay, and treatment cost in two groups were compared and analyzed.   Results: There were a total of 240 patients in the study, 118 in Group SD and 122 in Group MD. Post-operative infection rate was 4.2% (n= 5, N=118) in Group SD and 3.3% (n=4, N=122) in Group MD; the difference was not significant (p=0.75). Hospital stay was prolonged and cost was higher significantly in Group MD.   Conclusion: Single dose of prophylactic antibiotic, administered at induction of anesthesia, is equally effective as multiple doses of post surgical antibiotics to prevent post-operative infection in patients undergoing elective laparoscopic cholecystectomy for uncomplicated cholelithiasis.

scholarly journals Single dose Intraoperative Antibiotics versus Postoperative Antibiotics for Patient Undergoing Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis

2017 ◽  
Vol 5 (1) ◽  
pp. 13
Author(s):  
Sagun Bahadur Thapa ◽  
Yeshwant Ramakrishna Kher ◽  
Yashwant Gajanan Tambay
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Single Dose ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Prophylactic Antibiotic ◽  
College Teaching ◽  
Intravenous Dose ◽  
Site Infection ◽  
Symptomatic Cholelithiasis ◽  
The Difference

Introduction: Surgical site infection is a common complication shown in literature following cholecystectomies. Smaller incision and use of trocars in laparoscopic cholecystectomy lessen the contamination resulting in less chances of surgical site infection. However, in fear of postoperative infection, many opt for the prolonged postoperative use of antibiotic and there is growing consensus against it. Antibiotics not only increases the cost and hospital stay duration but it aids in emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial to see whether a single prophylactic dose of antibiotic at the time of induction of anesthesia for laparoscopic cholecystectomy was equally effective in controlling post-operative infection as multi-dose antibiotics during and post-operative period. Methods: The study was conducted at the department of general surgery, Lumbini Medical College Teaching Hospital, from November  2015 to October 2016. All cases with symptomatic cholelithiasis subjected for laparoscopic cholecystectomy were enrolled. Patients were randomized into two groups; Group SD received single dose of an intravenous dose of amikacin 500 mg, at induction of anesthesia and Group MD received multiple intravenous dose of amikacin, during and postoperatively for two days. Complications, hospital stay, and treatment cost in two groups were compared and analyzed. Results: There were a total of 240 patients in the study, 118 in Group SD and 122 in Group MD. Post-operative infection rate was 4.2% (n= 5, N=118) in Group SD and 3.3% (n=4, N=122) in Group MD; the difference was not significant (p=0.75). Hospital stay was prolonged and cost was higher significantly in Group MD. Conclusion: Single dose of prophylactic antibiotic, administered at induction of anesthesia, is equally effective as multiple doses of post surgical antibiotics to prevent post-operative infection in patients undergoing elective laparoscopic cholecystectomy for uncomplicated cholelithiasis.

scholarly journals Day case Laparoscopic Cholecystectomy

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Munir Ahmad Rathore ◽  
Muhammad Mansha ◽  
Brown M G
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Admission Rate ◽  
Day Case ◽  
Symptomatic Cholelithiasis ◽  
Suction Drain ◽  
Direct Admission ◽  
The Usa ◽  
Wound Pain ◽  
Standard Laparoscopic Cholecystectomy ◽  
The Uk

Background: Day case laparoscopic cholecystectomy (DC-LC) is being practised in the USA and at sporadic centres in the UK including our department. The aim was to evaluate the initial experience of DC-LC at the unit. Patients & methods: Prospectively collected data was analysed retrospectively. The case notes of all patients were retrieved from the medical records and reviewed individually. Standard laparoscopic cholecystectomy was performed. All patients had anti-DVT prophylaxis (pneumatic compression and enoxaparin), per-operative antibiotic, oro-gastric tube, paracetamol suppository and local anaesthetic to all wounds. They were discharged the same day. The end point was 6-week follow-up (86% overall). Results: Over a 32-month period, 164 consecutive patients with symptomatic cholelithiasis and ASA score of III or less were included. M:F was 1:5 and median age 43y. There were two conversions. The direct admission rate (DAR) was 26/164 (14%). The indication for direct admission included observation alone (7/26), wound pain (6/26), nausea (3/26), suction drain (2/26) and operation in the afternoon (2/26). Six (3.6%) required re-admission. One had a cystic artery pseudo-aneurysm presenting with colonic bleeding and anot her with an injury to CBD. One had post-op mild pancreatitis and three had wound pain and bruising. Conclusion DC-LC is safe and feasible in non-acute patients with symptomatic cholelithiasis

Efficacy of Thiol disulfide Homeostasis and Ischemia Modified Albumin Values in Estimating the Degree of Difficulty for Laparoscopic Cholecystectomy

2020 ◽  
Vol 23 ◽  
Author(s):  
Gökhan Akkurt ◽  
Burcu Akkurt ◽  
Emel Alptekın ◽  
Birkan Birben ◽  
Mehmet Keşkek ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Demographic Data ◽  
Previous History ◽  
Significant Negative Correlation ◽  
White Blood Count ◽  
Ischemia Modified Albumin ◽  
Total Thiol ◽  
Duration Of Surgery ◽  
History Of

Aim: The aim of this study is to investigate the efficacy of thiol disulfide homeostasis and Ischemia Modified Albumin (IMA) values in predicting the technical difficulties that might be encountered during laparoscopic cholecystectomy. Materials and Methods: The study included 65 patients who underwent laparoscopic cholecystectomy due to cholelithiasis at the General Surgery Clinic of Ankara Numune Training and Research Hospital. All patients’ demographic data, previous history of cholecystitis, a history of chronic illness, preoperative white blood count (WBC), liver function tests (AST, ALT), amylase and lipase levels, intra-operative adhesion score, the ultrasonographic appearance of gallbladder, duration on hospital stay, duration of operation, thiol disulfide and IMA values were evaluated. Results: Native thiol and total thiol averages were higher in patients without a history of cholecystitis, on the other hand, disulfide, disulfide/native thiol rate, disulfide/total thiol rate, native thiol/total thiol rate and IMA averages were higher in patients with a history of cholecystitis. While there was a statistically significant negative correlation between native and total thiol values and age, duration of surgery and duration of hospital stay; IMA, disulfide, disulfide/Total thiol, Native/Total thiol and disulfide/Native thiol rates were higher in older patients with a longer duration of surgery and hospital stay. In addition, preoperative IMA, disulfide, disulfide/Total thiol, Native/Total thiol and disulfide/Native thiol were observed to increase as the degree of intraoperative pericholecystic adhesion increased. Conclusion: We believe that the evaluation of thiol disulfide homeostasis and IMA parameters prior to laparoscopic cholecystectomy can be used as an effective method for predicting intraoperative difficulties.

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