EVALUATION OF CLINICO-RADIOLOGICAL FACTORS PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 63-66
Author(s):  
Wasif Mohammad Ali ◽  
Nazia Nanen ◽  
Atia Zaka Ur Rab ◽  
Syed Amjad Ali Rizvi ◽  
Mehtab Ahmad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Open Cholecystectomy ◽  
Previous History ◽  
Safe Procedure ◽  
Chi Square ◽  
Preoperative Prediction ◽  
Conversion To Open Cholecystectomy ◽  
Chi Square Test ◽  
A Prospective Study

Introduction: Laparoscopic cholecystectomy has become procedure of choice for treatment of symptomatic gallstone [1] disease . Even though it is a safe procedure occasionally it can be difcult and requires conversion to open cholecystectomy for various problems faced during surgery. Preoperative prediction of difcult laparoscopic cholecystectomy and likelihood of conversion to open cholecystectomy will avoid such complications and overall cost of treatment. Aim: To evaluate the clinico-radiological factors predicting difcult laparoscopic cholecystectomy Methods: This was a prospective study conducted from October 2018 to November 2020. Total of 101 patients meeting inclusion criteria undergoing laparoscopic cholecystectomy were included in the study. Various clinical, radiological and biochemical parameters and intraoperative difculties during surgery were recorded. The statistical analysis was done using chi-square test and ANOVA test. Results: The parameters such as sex, age, duration of disease, co-morbid disease, previous history of cholecystitis, palpable gall bladder, BMI, TLC, thickness of gall bladder, largest stone size and impacted stone are found statistically signicant in predicting difcult laparoscopic cholecystectomy and conversion to open cholecystectomy preoperatively. Conclusion: Difcult laparoscopic cholecystectomy may be predicted preoperatively even with a good clinical judgement whereas both clinical and radiological parameters provide a better preoperative prediction of difcult cholecystectomy so that the surgeon can prepared in advance for the complications.

scholarly journals Laparoscopic subtotal cholecystectomy a boon to difficult gall bladder

2020 ◽  
Vol 8 (1) ◽  
pp. 215
Author(s):  
Santosh Kumar Singh ◽  
Devendra Shukla ◽  
Pradeep Kumar Singh ◽  
Ila Katyayan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Open Procedure ◽  
Subtotal Cholecystectomy ◽  
Operative Outcomes ◽  
Conversion To Open Cholecystectomy ◽  
Hospital Stays ◽  
A Prospective Study

Background: Subtotal laparoscopic cholecystectomy has been in practice to treat difficult gall bladder for 100s of years. It keeps the benefit of being a minimally invasive and single-stage procedure. Thus, it remains a better option over conversion to open cholecystectomy as well as cholecystostomy which was a two-stage surgery practiced in earlier days.Methods: It was a prospective study focusing on indications, type and complications of subtotal laparoscopic cholecystectomy. It also compared the per-operative and post-operative outcomes of all cases of subtotal laparoscopic cholecystectomy (48) with cases of laparoscopic cholecystectomy that were converted to open procedure (30) performed over a period of 1 year. Patients were followed for 12 months post-surgery.Results: Acute cholecystitis is one of the most common indication of subtotal cholecystectomy. Also, it was associated with lesser mean operative time, postoperative hospital stays and postoperative complications when compared with conversion (to open) cholecystectomy.Conclusions: Subtotal cholecystectomy is a better option than open cholecystectomy in cases of difficult gall bladder.

scholarly journals Complications of Two Port Laparoscopic Cholecystectomy-Studyof 50 Cases

2019 ◽  
Vol 31 (1) ◽  
pp. 29-37
Author(s):  
Nasir Uddin Mahmud ◽  
Ghyas Uddin ◽  
Md Anwarul Haque ◽  
ANM Mozammel Haque ◽  
AKM Golam Kibria
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Bile Leakage ◽  
Safe Procedure ◽  
Minimal Scarring ◽  
Conversion To Open Cholecystectomy ◽  
Port Infection ◽  
Good Cosmesis

Background: For the management of Gallstone disease, laparoscopic cholecystectomy has been the the gold standard and is preferred over open cholecystectomy. As patients’ demand has increased for improved postoperative quality of life and cosmesis, surgeons have continued to decrease the number of ports for laparoscopic cholecystectomy. To meet these expectations we adopted two-port techniques at Comilla, Bangladesh. For the last three years we have selected 50 patients where two-port laparoscopic cholecystectomy was trialled. The procedure were successfully performed in 47(94%) & conversion were required in 3(6%) with some accepted complications like epigastric port infection & herniation, post cholecystectomy syndrome, reactionary haemorrhage, bile leakage & biloma, significant epigastric port pain postoperatively & stricture of CBD. The present two port technique not only overcoming specimen extraction difficulties but also contributes to good cosmesis. Objectives: To see the outcome of two port laparoscopic cholecystectomy. Methods: Consecutive 50 patients were admitted in surgery ward of Central medical college, Comilla with gallstone disease over a 3 years period. Diagnosis is confirmed by ultrasound with the assessment of operative feasibility. Data collection sheet was maintained by Microsoft Excel. Data were analyzed manually. Results: In this study 50 patients were included. Among them 34 (68%) were females and 16 (32%) were males (ratio = 2.1:1). Mean age was 35.7 years (range 20–55years).All patient were undergone two port laparoscopic cholecystectomy & successfully accomplished in 47 (94%),conversion were required in 3 (6%) patients. Most common (62%) sonological findings were cholelithiasis with normal size & shape of gall bladder. Mean operative time was 50 minutes. Among the per operative difficulties bleeding were 14%, perforation of gall bladder 10%, spillage of gallstones 6%, epigastric forceps manipulation difficulties 4%,conversion to open cholecystectomy 6%. Most of the patients(80%) admitted in hospital for 2-3 days. 4 (8%) patient had epigastric port infection & 1 (2%) patient developed this site herniation, 3 (6%) patient had post cholecystectomy syndrome,1 (2%) patient had reactionary haemorrhage, 1 (2%) bile leakage & biloma,4(8%) patient had significant epigastric port pain postoperatively, 1 (2%) patient developed delayed stricture of CBD. In all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no problem so far in 3 years follow up. Most patients (90%) returned to work within 2 weeks. Conclusion: Two-port laparoscopic cholecystectomy is a safe procedure & cosmetically rewarding. TAJ 2018; 31(1): 29-37

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

2019 ◽  
Author(s):  
Madan Goyal ◽  
R K Goel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Critical View Of Safety ◽  
Recent Onset ◽  
Conversion To Open Cholecystectomy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Collections ◽  
A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

scholarly journals SURGICAL AUDIT - LAPAROSCOPIC CHOLECYSTECTOMY IN A FREE CAMP AT PRIVATE SECTOR HOSPITAL

2020 ◽  
Vol 11 (2) ◽  
pp. 16-20
Author(s):  
Dr. Abdul Ghani Soomro
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Port Site ◽  
Bladder Injury ◽  
Safe Procedure ◽  
Trocar Site ◽  
Port Site Hernia ◽  
Surgical Audit

BACKGROUND & OBJECTIVE: Laparoscopic Cholecystectomy is usual method for the treatment of gall bladder stone disease and is practiced all over the world due to many benefits like fasten the recovery time. Furthermore, it reduced the post-operative pain and period of hospital stay. To conduct Surgical Audit and evaluate safety of Laparoscopic cholecystectomy. METHODOLGY: This prospective study was conducted in a private hospital at Hyderabad during free camps of Laparoscopic Cholecystectomy. Four camps were arranged in 2016 - 2019. Total number of 190 patients  underwent Laparoscopic Cholecystectomy during the study period. The patient's age falls between 12–65 years. A detailed history, relevant investigation and Cardiac fitness were evaluated. All patients underwent four ports Lap-Chole. Data was collected assessed and audit was performed and safety was evaluated. RESULTS: Total 190 patients operated females 88.45% and males 11.55%. 115 (60.50%)were in  the range of 30-35 years followed by 55 (28.95%)patients in the range of 40-50 years.8 (4.20%) patients were converted to open cholecystectomy, 4 due to bleeding from liver bed, 3 patients due to difficult dissection in calots triangle and 1 due to Empyema of gall bladder.10 patients (5.50%) had Trocar site bleeding, 10 patients (5.50%) had gall bladder injury, in 4 cases had spillage of stones and 72 patients (38.50%) developed umbilical port site infection 1 patient develop port site hernia. No mortality was recorded in this study. CONCLUSION: Our Surgical Audit proves that Laparoscopic Cholecystectomy is a safe procedure on the basis of only 4.2% intra operative and 5.5% postoperative complications and gaining wide spread popularity among our population due to less pain, less hospital stay. We recommend other private hospitals to extent such services to our poor population with symptomatic cholelithiasis.

scholarly journals A prospective evaluation of laparoscopic cholecystectomy in the treatment of chronic cholelithiasis: A five-year experience

2011 ◽  
Vol 64 (1-2) ◽  
pp. 77-83
Author(s):  
Veselin Stanisic ◽  
Milorad Bakic ◽  
Milorad Magdelinic ◽  
Hamdija Kolasinac ◽  
Darko Vlaovic ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Lower Cost ◽  
Average Duration ◽  
Open Cholecystectomy ◽  
Abdominal Cavity ◽  
Safe Procedure ◽  
Conversion To Open Cholecystectomy ◽  
Duration Of Hospitalization ◽  
Calculous Cholecystitis ◽  
Gallbladder Removal

Introduction. Laparoscopic cholecystectomy is a method of choice in the treatment of symptomatic cholecystolithiasis because of less postoperative pain, shorter hospitalization and lower cost of treatment. The study was aimed at analysing the outcome of laparoscopic cholecystectomy in patients surgically treated for chronic calculous cholecystitis (symptomatic cholelithiasis). Material and methods. The research was done in the period from December 2003 to December 2008. In the prospective study of 386 patients, we analyzed operative and postoperative complications, the reasons for conversion to open cholecystectomy, duration of hospitalization and mortality. Results. The average duration of laparoscopic cholecystectomy was 31.9?14.5 min: dissection of adhesions 3.2?0.7 min., elements of Calot?s triangle 9.8?3.2 min., gallbladder releasing from its bed 12.8?2.8 min., the abdominal cavity lavage and removal of gall?bladder from the abdomen 6.8?0.9 min. Some operative difficulties emerged in 22 (5.7%) patients - 4 (1%) during releasing of gallbladder adhesions from the surrounding structures, 9 (2.3%) during dissection of elements of the Calot?s triangle, 6 (1.5%) during gallbladder releasing from its bed, 3 (0.7%) during gallbladder removal from the abdomen. Some post-operative complications, single or associated, occurred in 36 (9.3%) patients: perforation of gallbladder 21 (5.4%), bleeding from gallbladder bed 18(4.6%)/, injury of extra hepatic bile ducts 1 (0.2%), 9 (2.3%) spillage of stones; 3 (0.7%) conversions were made. The average duration of preoperative and postoperative hospitalization was 1.1?0.3 and 1.4?0.5 days, respectively. The pathohistological examination revealed 2 (0.5%) adenocarcinoma of gallbladder. There were no lethal outcomes. Conclusion. Laparoscopic cholecystectomy is a safe procedure and rational choice in the treatment of biliary dyskinesia and symptomatic biliary calculosis with an acceptable rate of conversion.

scholarly journals A study on clinical and radiological factors for predicting difficult laparoscopic cholecystectomy preoperatively

2017 ◽  
Vol 4 (9) ◽  
pp. 3015
Author(s):  
Arun Prasath S. ◽  
Surag Kajoor Rathnakar ◽  
Nagaraja Anekal L.
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Open Cholecystectomy ◽  
Fluid Collection ◽  
Gall Stone ◽  
Stone Disease ◽  
Elderly Age ◽  
Conversion To Open Cholecystectomy ◽  
Upper Abdominal ◽  
A Prospective Study

Background: Laparoscopic cholecystectomy considered as the gold standard treatment for symptomatic gall stone disease has 1-13% conversion rate to an open procedure due to various reasons. Present study aims to predict difficult laparoscopic cholecystectomy preoperatively using clinical and sonological factors.Methods: This is a prospective study done on 190 patients who were posted for laparoscopic cholecystectomy from March 2015 to February 2017. Parameters taken into consideration were: age, number of previous attacks of acute cholecystitis, impacted gallstone, thickness of GB wall, pericholecystic fluid collection, history of upper abdominal surgery and obesity. All surgeries were performed by surgeons with minimum ten years of experience on laparoscopic cholecystectomy and ultrasound of the abdomen was performed by senior radiologists with experience of minimum five years.Results: Out of 190 patients, difficulty was experienced in 48 patients of which conversion to open cholecystectomy was needed for 11 patients. Elderly age, multiple attacks of pain abdomen (>2), palpable GB, impacted gallstone, thickness of GB wall >3 mm, peri-GB fluid collection, adhesions due to previous abdominal surgery and obesity were all found to be independent risk factors leading to difficult laparoscopic cholecystectomy.Conclusions: Though there is no definite scoring system to predict difficult LC, there is scope for further refinement to make the same less cumbersome and easier to handle using the above clinical and radiological factors.

scholarly journals Determination of predictive factors for difficult laparoscopic cholecystectomy

2021 ◽  
Vol 8 (2) ◽  
pp. 481
Author(s):  
Sameer Bhattarai ◽  
Ishory Bhusal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Predictive Factors ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
College Teaching ◽  
Wall Thickening ◽  
Conversion To Open Cholecystectomy ◽  
Male Sex

Background: Cholelithiasis is the most common biliary pathology, with a prevalence of 10 to 15%. It is symptomatic in approximately 1 to 2% of patients. In about 5 to 10% of laparoscopic cholecystectomy, conversion to open cholecystectomy may be needed for safe removal of gallbladder. Laparoscopic cholecystectomy (LC) may be rendered difficult by various problems encountered during surgery. The objective of this study was to predict difficulty of LC before surgery using the clinical and ultrasonographic criteria.Methods: The present study comprised of 45 cases admitted to National Medical College Teaching Hospital (NMCTH), Birgunj (Nepal) for a period of 12 months from 1st August 2013 to 30th September 2014. The cases confirmed by Ultrasonography were evaluated with following risk factors: age >50 years, male sex, BMI 25.1 to 27.5 and >27.5, previous surgery, prior hospitalization, palpable gall bladder, gall bladder wall thickening, impacted stone, pericholecystic collection and presence of adhesions. Each risk factor was given a score. The total score up to 5 predicted easy, 6 to 10 difficult and more than 10 very difficult.Results: The highest age incidence of Cholelithiasis was in the 2nd to 4th decade and was more common in females. Ultrasonography detected gallbladder stones in all patients, wall thickening in 15 and pericholecystic collection in 8. BMI >27.5 presence of adhesions, male sex and pericholecystic collection were significant predictors of difficult laparoscopic cholecystectomy.Conclusions: Numerous clinical, radiological and pre-operative features make LC sometimes difficult. Early determination of these predictive factors decreases the difficulty that we will be facing with LC.

scholarly journals Predictive factors for conversion from laparoscopic to open cholecystectomy: an institutional study

2018 ◽  
Vol 5 (8) ◽  
pp. 2894
Author(s):  
Digvijoy Sharma ◽  
Kunduru Nava Kishore ◽  
Gangadhar Rao Gondu ◽  
Venu Madhav Thumma ◽  
Suryaramachandra Varma Gunturi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Bladder Wall Thickness ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy ◽  
Gall Bladder Wall

Background: Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gallstones. However, a conversion to open surgery may be required to complete the procedure safely. The aim of this study is to identify the predictive factors of conversion from laparoscopic to open cholecystectomy in elective setting.Methods: A retrospective review of all patients underwent laparoscopic cholecystectomy electively for symptomatic gallstones from January 2016 to December 2017 was performed. Data considered for analysis were: demographic data, preoperative laboratory values of liver function tests, gall bladder wall thickness on ultrasound, preoperative ERCP, indication for surgery, history of acute cholecystitis, presence of intraoperative adhesions and frozen Calot's triangle. Conversion to open cholecystectomy was chosen as the dependent variable for both, univariate and multivariate analysis.Results: 546 patients underwent laparoscopic cholecystectomy. 333 were females (60.9%) and 213 (39.1%) males, with a mean age of 44.6 years. The most common indication for surgery was symptomatic cholelithiasis. Conversion to open cholecystectomy occurred in 48 cases (8.8%) and the most common reason for conversion was inability to define the Calot’s triangle anatomy due to inflammation/adhesions. Univariate and multivariate analyses of various variables demonstrated that male gender, gall bladder wall thickness >5 mm and presence of previous documented acute cholecystitis had statistically significant co-relation with higher rates of conversion (p<0.001).Conclusions: Presence of acute cholecystitis, gall bladder wall thickness >5mm on preoperative ultrasound and male gender were independent predictor factors for conversion from laparoscopic to open cholecystectomy. Such patients should be properly counselled about the increased risk for conversion and should be operated by surgeons experienced in laparoscopic procedures to reduce the rate of conversion and operative complications.

scholarly journals Evaluation of difficulties in laparoscopic cholecystectomy

2017 ◽  
Vol 70 (9-10) ◽  
pp. 271-276
Author(s):  
Katarina Sarcev ◽  
Dimitrije Damjanov ◽  
Dijana Kosijer ◽  
Dragomir Damjanov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Invasive Procedure ◽  
Minimally Invasive Procedure ◽  
Conversion To Open Surgery ◽  
Preoperative Prediction ◽  
Conversion To Open Cholecystectomy ◽  
Group B

Introduction. For decades, laparoscopic cholecystectomy has been the gold standard in surgical treatment of patients with cholelithiasis all over the world. The main advantage of this approach is that it is a minimally invasive procedure for patients. Although this method is a routine in our country, there are certain cases where the presumed outcome of minimally invasive procedure is not achieved, and the surgery is converted to open surgery, or a subsequent laparoscopic surgery is performed, in order to deal with the complications. The aim of this study was to establish if it was possible to create a model for preoperative prediction of difficult laparoscopic cholecystectomies. Material and Methods. Two groups of patients were analyzed. Group A included patients with cholelithiasis who were studied in order to determine parameters associated with difficult laparoscopic cholecystectomies. Out of 16 analyzed parameters, 8 showed significant correlation with difficult laparoscopic cholecystectomies. Based on these parameters, a prediction model was established, consisting of five groups: I - easy (score 1), II - laparoscopic cholecystectomy with mild difficulties (score 2), III - laparoscopic cholecystectomy with major difficulties (score 3), IV - difficult (score 4), V - conversion to open surgery is expected (score 5). This model was preoperatively applied in patients with cholelithiasis included in group B. Results. The overall predictability of the model was 82%. The greatest prediction accuracy was achieved in groups II and III (98.3% and 100%, respectively). Conversion to open cholecystectomy was predicted in 76% of patients. Conclusion. Based on certain preoperative parameters it is possible to establish a model to predict a difficult laparoscopic cholecystectomy.

scholarly journals Causes and incidence of laparoscopic cholecystectomy conversion to open cholecystectomy in Al Karama teaching hospital

2018 ◽  
Vol 5 (5) ◽  
pp. 1640
Author(s):  
Mohammed Reda Al Ghadhban ◽  
Hussein Ali Alkumasi ◽  
Mohammed Saleem Meziad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Teaching Hospital ◽  
Open Cholecystectomy ◽  
Standard Procedure ◽  
Biliary Duct ◽  
Female Patients ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy ◽  
Male Patients ◽  
A Prospective Study

Background: There is no doubt that laparoscopic cholecystectomy replaced open cholecystectomy as standard procedure for the treatment of symptomatic cholelithiasis. Conversion from laparoscopic cholecystectomy to open cholecystectomy is still required in many circumstance, this study aimed at exploring causes and incidence of conversion.  Methods: This is a prospective study of 200 cases of laparoscopic cholecystectomy cases were performed in ALKARAMA Teaching Hospital from January2009 to January 2011. All cases were followed at the time of surgery by obtaining data sheet for the patient’s age, sex, time from the introduction of ports till decision of conversion and the cause of conversion if present.Results: Out of 200 laparoscopic cholecystectomy, 12 cases were converted into open cholecystectomy (6%). The major causes were : dense adhesions (4),  bleeding (2), anatomical difficulties (2), impacted stone in Hartmann pauch (2), dilated cystic duct (1) and sever inflammation (1). Two of the conversions are males from 45 male patients underwent laparoscopic cholecystectomy, 10 cases are females from 155 female patients underwent laparoscopic cholecystectomy so the percentage of conversion for male patients is 4.44 % while for female patients is 6.45%.Conclusions: The conversion rate in this study is 6% and the most common cause for conversion is dense adhesions in the Calot’s triangle, no biliary duct injury that need conversion is found in this study and the rate for conversion is higher in female patients.

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