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.

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

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)

scholarly journals LAPAROSCOPIC CHOLECYSTECTOMY

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.

scholarly journals Correlation of shoulder tip pain in case of low pressure and standard pressure pneumoperitoneum post laparoscopic cholecystectomy

2021 ◽  
Vol 8 (5) ◽  
pp. 1522
Author(s):  
Lakshman Agarwal ◽  
Sanjay Kumawat ◽  
Sumita A. Jain ◽  
Amit Yadav ◽  
Sandeep Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Randomized Study ◽  
Visual Analogue Score ◽  
Low Pressure ◽  
P Value ◽  
Pressure Group ◽  
Group A ◽  
Standard Pressure ◽  
Group B

Background: Laparoscopic cholecystectomy is gold standard treatment for cholelithiasis now a days. Post-operative shoulder tip pain is common complain after laparoscopic cholecystectomy. The cause of this shoulder tip pain is multifactorial e.g. peritoneal stretching and diaphragmatic irritation. The main cause of this shoulder tip pain is pneumoperitoneum caused by carbon dioxide. Correlation of shoulder tip pain in case of low pressure (7-8 mmHg) and standard pressure (12-14 mmHg) pneumoperitoneum post laparoscopic cholecystectomy.Methods: A prospective randomized study was done in 100 patients of cholelithiasis in SMS hospital Jaipur Rajasthan. The patients were divided into two groups-Group A patients undergoing laparoscopic cholecystectomy at low pressure (7-8 mmHg) and group B patients undergoing laparoscopic cholecystectomy at standard pressure (12-14 mmHg). The intensity of shoulder tip pain were measured by visual analogue score at 1, 6, 12, 24 and 48 hours. In both of the group results were compared in terms of frequency of pain, intensity of pain and requirement of post-operative analgesics. The duration of hospital stay was also compared.Results: Post-operative shoulder tip was found to be less in low pressure group (group A) as compare to standard pressure group (group B). Total requirement of post-operative analgesic dose and hospital stay was also found to be less in low pressure group as compared to standard pressure group. This was statistically significant (p value<0.05).Conclusions: There is less intensity, frequency of shoulder tip pain, less post-operative analgesics requirement and less post-operative hospital stay after laparoscopic cholecystectomy done under low pressure pneumoperitoneum (7-8 mmHg).

scholarly journals Comparative Study of Conventional Electrocautery Versus Ultrasonic Dissector in Laparoscopic Cholecystectomy

2019 ◽  
Vol 8 (2) ◽  
pp. 70-73
Author(s):  
Saad Bin Anis ◽  
Pir Muneeb Rehman ◽  
Farhan Ahmad ◽  
Umar Farooq
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Bile Leakage ◽  
Minimal Invasive ◽  
P Value ◽  
Single Incision Laparoscopic Surgery ◽  
Ultrasonic Dissector ◽  
Group A ◽  
Group B

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.

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

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.

scholarly journals Kejadian Hiperbilirubinemia Ditinjau dari Berat Badan Lahir

2020 ◽  
Vol 5 (1) ◽  
pp. 36-42
Author(s):  
Yeviza Puspitasari
Keyword(s):  
Random Sampling ◽  
Statistical Tests ◽  
Univariate Analysis ◽  
Bivariate Analysis ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Study Population ◽  
Relationship Of ◽  
The Relationship

Hyperbilirubinemia is one of the clinical phenomena most often found in neonates occurring in the first week of life, which is also one of the factors causing infant death is influenced by the immature liver function of the baby to process erythrocytes (red blood cells), resulting in the accumulation of bilirubin. The purpose of this study was to determine the relationship of birth weight of infants with the incidence of hyperbilirubinemia in RSUD dr. Ibnu Soetowo Baturaja Ogan Komering Ulu Regency in 2019. This study uses analytic methods with a cross-sectional approach. The study population was all infants aged 0-7 days in the neonatal room at RSUD dr. Ibnu Soetowo Baturaja Ogan Komering Ulu Regency in 2019, with a random sampling. Data analysis uses univariate analysis and bivariate analysis using distribution tables and Chi-Square statistical tests, with a 95% confidence level. In the univariate analysis, of 203 respondents found 26.5% had hyperbilirubinemia and those without hyperbilirubinemia 72.5%, 24.6% of infants with LBW and non-LBW infants 75.4%. Bivariate analysis showed that there was an LBW relationship with the incidence of hyperbilirubinemia (p-value 0,000).

Comparison of harmonic scalpel versus Milligan Morgan technique in haemorrhoidectomy patients

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...

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

2017 ◽  
Vol 5 (1) ◽  
pp. 253 ◽  
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.

scholarly journals COMPARISON OF OUTCOMES BETWEEN EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS

2021 ◽  
Vol 71 (3) ◽  
pp. 796-800
Author(s):  
Muhammad Ismail ◽  
Nasir Mehmood Wattoo ◽  
Muhammad Qasim Butt ◽  
Fareeha Naz
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operation Time ◽  
Acute Calculous Cholecystitis ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Calculous Cholecystitis ◽  
Post Operative Complications

Objective: To compare early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of mean operative time, hospital stay, conversion rate to open surgery and post-operative complications. Study Design: Quasi experimental study. Place and Duration of Study: Army Liver Transplant Unit, Department of Surgery, Pak-Emirates Military Hospital Rawalpindi, from Jul to Dec 2018. Methodology: A total of 170 patients (85 in each group) diagnosed as a case of acute calculous cholecystitis who met the sample selection criteria were included. Group A patients underwent early laparoscopic cholecystectomy within 72 hours of admission while group B patients underwent conservative management followed by delayed laparoscopic cholecystectomy after 6 weeks. All patients were followed for operative time, hospital stay, per-operative difficulties encountered and post-operative complications. Results: Group A had a mean operation time of 43.9 ± 11.1 minutes, while group B had a mean operation time of 45.8 ± 10.1 minutes (p=0.83). The mean duration of hospitalization was 2.8 ± 1.1 days in group A and 5.3 ± 0.8 days in group B (p<0.001). Complications were measured at a frequency of 14.1% in group A and 5.9% in group B (p=0.07). Conclusion: Early laparoscopic cholecystectomy is better than delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of hospital stay and per-operative difficulties faced. The post-operative complications between the two groups are comparable.

scholarly journals HYPERLIPIDEMIC PATIENTS;

2019 ◽  
Vol 26 (03) ◽  
Author(s):  
Marium Shoukat ◽  
Hijab Batool ◽  
Faiza Javaid
Keyword(s):  
Protective Role ◽  
Lipid Lowering ◽  
Atheromatous Plaque ◽  
P Value ◽  
Cross Sectional ◽  
Apo B ◽  
Time Period ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objectives: Role of niacin in decreasing cardiovascular accidents by lowering the levels of Apo-B in hyperlipidemic patients. Background: In hyperlipidemia, there are high levels of atherogenic lipoproteins leading to higher risk of atherosclerotic cardiovascular events. Patients with dyslipidemia use statins as a mainstay of therapy over last many decades. Recent studies show that apolipoproteins play a major role in formation of atheromatous plaque, thus there is an urgent need to study the effects of lipid lowering medication on apolipoprotiens levels. Study Design: Cross sectional analytical study. Setting: Sheikh Zayed Hospital Lahore (Department of Biochemistry and Chemical Pathology). Period: 12 weeks from July to Sep 2014. Materials and Methods: Recently diagnosed hyperlipidemic patients (n=44) were selected for the study purpose and divided into two equal groups; A and B. Each group was given different medication. Group A took only statin while group B took a combination of statin and niacin. Blood samples were taken at the start of medication and then after completion of 12 week time period. Results: At the start of the treatment there was no significant difference in the Apo B cholesterol level between the two groups (p value 0.972). However, after the end of 12 week duration, there was a significant reduction in the Apo level of group B taking statin and niacin as compared to group A taking statin alone (p value 0.003). Conclusions: Niacin has cardio-protective role when used in combination with niacin.

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