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.

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 EPIGASTRIC VS. UMBILICAL PORT FOR RETRIEVAL IN LAPAROSCOPIC CHOLECYSTECTOMY : WHICH IS BETTER

2020 ◽  
pp. 1-2
Author(s):  
Zayd Ashok ◽  
Priyanka pant
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Standard Treatment ◽  
Single Incision ◽  
Technical Difficulty ◽  
Port Site ◽  
Post Operative Pain ◽  
Port Site Hernia ◽  
Day By Day ◽  
Site Pain

Background and aim - Cholilithiasis is most common cause for cholecystectomy. These days laparoscopic cholecystectomy is the standard treatment for cholilithiasis. Extraction of gall bladder is an important cause for post operative pain after cholecystectomy. Laparoscopic cholecystectomy is still evolving, the number of ports are being reduced day by day. From standard four port to single incision and using natural orifices (NOTES). This study was done to determine whether the patients undergoing gall bladder retrieval via umbilical port was associated with more complications than epigastric port in a standard four port laparoscopic cholecystectomy. Method - 400 patients were selected for the study and were randomly allocated into 2 groups. Postoperatively, port-site pain score assessed at 2, 6, 12, and 24 hours by visual analog scale (VAS) score both for the epigastric and umbilical ports in all the patients and other variables are assesed accordingly and the collected data were analyzed by using SPSS version 22. Result - The postoperative pain and spillage was more in retrieval via epigastric port with only mild technical difficulty and relatively higher incidence of port site hernia from the retrieval port in retrieval via umbilical port.

scholarly journals An Unusual Incarcerated Port Site Hernia due to retained partial gall bladder with stones - A case report.

KYAMC Journal ◽  
2013 ◽  
Vol 3 (2) ◽  
pp. 309-311
Author(s):  
Mohd. Farid Hossain ◽  
Md. Rakib Uddin ◽  
Raihanul Islam Emon ◽  
Md. Manhbur Rashid Sarkar
Keyword(s):  
Emergency Department ◽  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Gall Bladder ◽  
Port Site ◽  
Primary Surgery ◽  
Incomplete Removal ◽  
Port Site Hernia ◽  
Early Features

A 50 years old lady presented to the Emergency department with what appeared to be a strangulated infraumbilical hernia. She was explored and found to have an unexpected, unusual diagnosis -- incarcerated port site hernia with early features of strangulation. There was fundic part of gall bladder loaded with stones in the center of hernial contents. Gall bladder was surrounded by inflammed pad of omentum. The defect and the mass was approximately 6-8 cm below the umbilical port site incision scar of laparoscopic cholecystectomy, performed 13 years back. Excision of the inflammed hernial contents and Herniorraphy was performed. Patient recovered completely. Complications related to introduction of ports and incomplete removal of gall bladder may present in various ways and sometimes many years after the primary surgery. Methods of reducing the risk of such complications and pathogenesis of hernia in this case are discussed. KYAMC Journal Vol. 3, No.-2, January 2013, Page 309-311 DOI: http://dx.doi.org/10.3329/kyamcj.v3i2.15174

scholarly journals Complications of Laparoscopic Cholecystectomy

2019 ◽  
Vol 17 (2) ◽  
pp. 73-79
Author(s):  
ABM Khurshid Alam ◽  
Mashrur Akbar Khan ◽  
Rashed Uz Zaman ◽  
Md Ali Akbar ◽  
Md Abul Bashar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallbladder Disease ◽  
Gallstone Disease ◽  
Gall Stone ◽  
Bile Leakage ◽  
Port Site ◽  
Trocar Site ◽  
College Hospital ◽  
Port Site Hernia ◽  
Complications Of Laparoscopic Cholecystectomy

Background: laparoscopic cholecystectomy is now regarded as the "Gold Standard" treatment option for benign gallbladder disease. But it is not free of procedure related complications. Objective: To review the complications of laparoscopic cholecystectomy for gall stone disease. Materials & Method: A prospective observational study was carried out over a period of 9 years beginning from 1st of July 2003 till 30th of June 2012 in Comilla Medical College Hospital and several private hospitals of Comilla. A total of 946 patients who underwent laparoscopic cholecystectomy for symptomatic and asymptomatic gallstone disease as confirmed by ultrasound scan were included. Patient having cirrhosis of liver, ischaemic heart disease, suspected carcinoma of gall bladder were excluded from the study. The outcome including the complications was analyzed. Result: Out of 946 patients 632 (66.80%) were females and 314 (33.19%) were males. Most (92.3%) of them were between 21-50 years of age. The commonest immediate complication was bleeding from liver bed (9.40%), from vascular injury in Callot's triangle (5.17%) and from the trocar site (4%). There was spillage of gallstones in 104(10.99%) cases. Bowel injury was seen in only one (0.10%) case. Bile leakage was observed in 4(.42%) cases that also include CBD injury .in 3 cases. The procedure was converted to open surgery in 11(1.17%) cases. Port site infection was seen in 43 (4.54%) cases. Late complications include port site hernia in 6 (0.63%) cases, port site keloid in 1 (.1%) case and CBD stricture in 5 (0.54%) cases. Mortality was unavoidable in in 2(0.21%) cases. Conclusion: With increasing experience laparoscopic cholecystectomy can be a safe and effective procedure for most patients with cholelithiasis. Proper training and sound knowledge of possible complications can yield favorable results and lesser complications. Journal of Surgical Sciences (2013) Vol. 17 (2) :73-79

scholarly journals Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain

2018 ◽  
Vol 5 (2) ◽  
pp. 500 ◽  
Author(s):  
R. S. Gupta ◽  
A. Rai ◽  
Vikram Vasuniya ◽  
Devendra Choudhary
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Port Site ◽  
Control Group ◽  
Narcotic Analgesics ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Group 3

Background: Laparoscopic cholecystectomy (LC) is now the gold standard technique for the treatment of gallstones disease. Although pain after LC is less intense than after open cholecystectomy, some patients still experience considerable discomfort during early postoperative hours. The aim of this study is to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in early postoperative period following LC.Methods: This is a randomized, prospective analytical study among patients subjected to elective laparoscopic cholecystectomy. Patients were divided into 3 groups as; Group 1 was control, Group 2 was assigned to receive portside infiltration of bupivacaine, while group 3 received combined port site and intraperitoneal instillation of bupivacaine. The evaluation of postoperative pain was done according to the visual analog scale and the dosage of narcotic analgesics consumed and duration of hospital stay was also recorded.Results: At 1st post-operative hour, minimum VAS score was in group 3 (p=0.003). At 4th post-operative hour, Minimum VAS score was in group 3(p=0.015). At 8th post-operative hour, Minimum VAS score was in group 3, (p=0.044). Patients in group 3 received a lower total amount of rescue analgesia and they also had the shortest hospital stay after LC, compared to the patients in the other groups. As regarding the incidence of right shoulder pain, group 3 has minimal no of patients experienced rt shoulder tip pain.Conclusions: Infiltration of bupivacaine into port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective LC.

scholarly journals OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH GALLSTONE DISEASE AT A SECONDARY LEVEL CARE HOSPITAL

2018 ◽  
Vol 31 (1) ◽  
Author(s):  
Ahmed TAKI-ELDIN ◽  
Abd-Elnaser BADAWY
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Care Hospital ◽  
Biliary Leakage ◽  
Port Site Hernia ◽  
Conversion To Open Cholecystectomy ◽  
Secondary Hospital

ABSTRACT Background: Laparoscopic cholecystectomy is the most commonly performed operation of the digestive tract. )It is considered as the gold standard treatment for cholelithiasis. Aim: To evaluate the outcome of it regarding length of hospital stay, complications, morbidity and mortality at a secondary hospital. Methods: Data of 492 patients who underwent laparoscopic cholecystectomy were retrospectively reviewed. Patients’ demographics, co-morbid diseases, previous abdominal surgery, conversion to open cholecystectomy, operative time, intra and postoperative complications, and hospital stay were collected and analyzed from patients’ files. Results: Out of 492 patients, 386 (78.5%) were females and 106 (21.5%) males. The mean age of the patients was 49.35±8.68 years. Mean operative time was 65.94±11.52 min. Twenty-four cases (4.9%) were converted to open surgery, four due to obscure anatomy (0.8%), 11 due to difficult dissection in Calot’s triangle (2.2%) and nine by bleeding (1.8%). Twelve (2.4%) cases had biliary leakage, seven (1.4%) due to partial tear in common bile duct, the other five due to slipped cystic duct stables. Mean hospital stay was 2.6±1.5 days. Twenty-one (4.3%) developed wound infection. Port site hernia was detected in nine (1.8%) patients. There was no cases of bowel injury or spilled gallstones. There was no mortality recorded in this series. Conclusions: Laparoscopic cholecystectomy is a safe and effective line for management of gallstone disease that can be performed with acceptable morbidity at a secondary hospital.

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

scholarly journals Laparoscopic cholecystectomy for gall stone disease. A single center experience.

2020 ◽  
Vol 27 (09) ◽  
pp. 1983-1988
Author(s):  
Shehzad Ahmad Qamar ◽  
Munawar Jamil ◽  
Kokab Salim
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Demographic Data ◽  
Gall Stone ◽  
Major Complication ◽  
Stone Disease ◽  
Safe Procedure ◽  
Trocar Site ◽  
Single Center Experience ◽  
Gall Stone Disease

Objectives: Laparoscopic cholecystectomy has turned into the gold standard for patients with symptomatic cholelithiasis. But still this procedure is not complication free. Many a time’s laparoscopic cholecystectomy needs to be converted to open cholecystectomy. Study Design: Observational study. Setting: Civil Hospital Bahawalpur. Period: 3 years from July 2015 to June 2018. Material & Methods: Carried out to review the frequency of complications encountered in laparoscopic cholecystectomy by assessing 400 cases of laparoscopic cholecystectomies. Performa was intended to incorporate important demographic data, history of illness, examination and investigations. Results: The major complication of our procedure was bleeding. Bleeding from the trocar site happened in 11 cases (2.75%), vascular damage in the callots triangle in 2 (0.5%) and from liver bed in 19 (4.75%) cases, followed by biliary leak that happened in 20 (5%) cases. Spilled gallstones were seen in 8(2%), Port site infection in 24 (6%) cases. Common bile channel stricture was accounted for in 5 patients, 14 (3.5%) out of 400 patients were converted to open surgery. Mortality was low for our situation I.e. 1 patient. Conclusion: Laparoscopic cholecystectomy is becoming a safe procedure in terms of complications.

scholarly journals Factors influencing conversion of laparoscopic cholecystectomy into open cholecystectomy

2019 ◽  
Vol 6 (11) ◽  
pp. 4017
Author(s):  
Ankur Dutt Tripathi ◽  
Imran Qazi ◽  
Shashank Shekhar Tripathi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Gall Bladder ◽  
Epigastric Pain ◽  
Open Cholecystectomy ◽  
Univariate Analysis ◽  
Bladder Injury ◽  
Stone Size ◽  
Increased Risk

Background: Laparoscopic cholecystectomy may be rendered difficult by various problems encountered during surgery, such as difficulty in accessing the peritoneal cavity, creating a pneumoperitonium, dissecting the gall bladder, pericholecystic adhesions and adhesions between the common bile duct the cystic duct and the cystic artery (calot’s triangle) or extracting the excised gall bladder, injury to common bile duct, bowel and iliac vessels. These conditions may lead surgeons to perform conventional open cholecystectomy.Methods: The general biodata was collected. A detailed history was taken with special reference to duration of right upper quadrant pain or epigastric pain, its periodicity, its aggravation by fatty meals and relief by oral or parental analgesics. Fever, jaundice or any previous attacks of cholecystitis. A relevant general physical examination and systemic examination was done and findings recorded, routine laboratory investigation was done. All cases were then subjected to ultrasound examination with 2-5MHz curvilinear array transducer with an aim to assess.Results: The univariate analysis sex proved to be significantly predictive of conversion in the present study. Execution of ERCP before the intervention proved associated with an increased risk for conversion in our study. Stone position as significant factor for conversion while stone size was not significant. No significant association between fever and conversion our study.Conclusions: Male gender, GB wall thickness, stone position, stone size, ultrasound signs of pericholecystitis, acute cholecystitis, were significantly associated with conversion.

scholarly journals Laparoscopic Cholecystectomy: An Initial Clinical Experience at Faridpur District

2015 ◽  
Vol 2 (2) ◽  
pp. 30-33
Author(s):  
PK Saha ◽  
Ratna Rani Roy ◽  
Nukul Sarkar ◽  
Jahangir Alam
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Gall Bladder ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Symptomatic Treatment ◽  
Safe Procedure ◽  
Bladder Stones ◽  
Average Operating ◽  
Gall Bladder Stones

Background: Laparoscopic cholecystectomy quickly emerged as an alternative to open cholecystectomy. However its safety, efficacy, and morbidity have yet to be fully evaluated.Objective: The purpose of the present study was to determine the efficacy and safety of laparoscopic cholecystectomy Procedure in the removal of gall bladder stones at Faridpur district-one of the remote district of Bangladesh.Methodology: A prospective, nonrandomized, open label Consecutive study was carried out at Faridpur district using laparoscopic cholecystectomy (LC) procedure for the symptomatic treatment of Gall bladder stones. For this purpose a total number of 145 patients having conclusively diagnosed as gall bladder stones were enrolled. LC procedure was performed by North American technique-a well established and standard procedure described earlier for the purpose. The key variables studied were average operating room time, condition of the gall bladder, the presence or absence of stones, the character of stones, post-operative complicates and duration of hospital stay.Result: The study revealed that among 145 patients 83.4% were female with an average age of 40.3 years. The average operating time required was 130 minutes. Gall bladder was thickened but was free from adhesion in 96.5% cases and stones' only 3.45% patients needed open method due to fibrosis and adhesion of the gall bladder with omentum and gut. The duration of hospital or clinic stay following LC was 3.5 days. Evidence of infection like fever, pain etc. was seen only in 2.75% cases. Bleeding was present in 2.06% cases. This was corrected after blood transfusion. No injury to the common bile duct or any of the bile duct or any of the blood vessels was observed. Similarly no evidence of malignancy was seen in any of the gall bladder removed.Conclusion: The present study concludes that laparoscopic cholecystectomy is a safe, minimal invasive, cost-effective and safe procedure for the symptomatic treatment of gall bladder stones.Journal of Current and Advance Medical Research, 2015;2(2):30-33

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