scholarly journals Effect of dexmedetomidine as an adjuvant to 0.25% bupivacaine for local infiltration of port site in laparoscopic cholecystectomy in terms of quality and duration of post-op analgesia

2019 ◽  
Author(s):  
Venkatesh Selvaraj ◽  
Rajkumaran Kamaraj
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Port Site ◽  
Local Infiltration

Assessment of Effect of Port Site and Intraperitoneal Instillation of Bupivacaine in Reduction of Post-Operative Pain After Laparoscopic Cholecystectomy

2020 ◽  
Author(s):  
Nippun Roy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Assessment ◽  
Pain Control ◽  
Port Site ◽  
Controlled Study ◽  
Control Group ◽  
Local Infiltration ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Intraperitoneal Instillation

Aim: Effective postoperative pain control is an essential component for care of surgical patients. Inadequate pain control may result in increased morbidity or mortality. Analgesic effects of periportal infiltration of local anesthetics, infiltration of periportal parietal peritoneum, intraperitoneal spraying at subdiaphragmatic space and subhepatic space covering the area of hepatoduodenal ligament have been reported. The present controlled study aimed at assessing the effect of port site injection and intraperitoneal instillation of bupivacaine in reduction of post-operative pain after laparoscopic cholecystectomy. Methods: The present study was conducted among a group of 180 patients diagnosed to have symptomatic cholelithiasis and who underwent elective laparoscopic cholecystectomy under general anesthesia. In group 1, pre-incisional local infiltration of 20ml 0.5% bupivacaine at the port sites; and in group 2, local infiltration of 20ml 0.5% bupivacaine at the port sites with intraperitonial installation. In group 3, no local infiltration was done and treated as control group. Pain assessment is based on a Universal Pain Assessment Tool. Analysis of our study was performed one-way ANOVA & Post HOC test (Scheffe's HSD) & Chi square tests as and when indicated. Results: Mean pain scores at 30 minutes were significantly lower in groups 1 & 2 compared to control group; but however, the values were not significantly different when compared to each other. Similarly, the mean pain scores at 4th, 8th, 16th and 24th hours for the preincisional and preclosure groups, didn't signify any inter-group advantage. Therefore, bupivacaine provides a substantial reduction of pain intensity up to 24 hours postoperatively; and was found to be statistically significant. However, timing of anesthesia was found to be statistically insignificant in terms of preclosure vs pre incisional of the port sites. Conclusion: Instillation of bupivacaine at the port sites in laparoscopic cholecystectomy irrespective of the timing of instillation is an effective method of achieving pain control in the post-operative period as long as 24 hours after surgery. There was no statistically significant reduction of post-operative pain between the pre-incisional and pre-closure groups.

scholarly journals COMPARATIVE STUDY OF POST OPERATIVE PAIN RELIEF IN LAPAROSCOPIC CHOLECYSTECTOMY WITH PORT SITE AND INTRAPERITONEAL INSTILLATION OF 0.5% BUPIVACAINE WITH ADRENALINE AND PLACEBO

2021 ◽  
pp. 24-25
Author(s):  
Vivek Agrawal ◽  
Parikshit Bishnoi ◽  
Anand Nagar ◽  
Shireesh Gupta ◽  
Anshul Mathur ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Comparative Study ◽  
Local Anaesthetic ◽  
Anaesthetic Agent ◽  
Port Site ◽  
Local Infiltration ◽  
Early Return ◽  
Post Operative Pain ◽  
Intraperitoneal Instillation ◽  
Improve Cost

Introduction : Postoperative pain is variable in intensity,character,duration and is the main factor delaying discharge of patients undergoing day-care procedures including laparoscopy and hence adding to hospital cost and stay. Optimal management has a potential for shortening of hospital stay and for speeding up of recovery.AIM :Comparing the effect of port site and intraperitoneal instillation of 0.5% bupivacaine with adrenaline versus saline for post-operative analgesia in laparoscopic cholecystectomy. To assess the need of rescue analgesics in post- operative period in both groups.Material & Method :A comparative study to be performed on 50 cases receive 40 mls of 0.5% bupivacaine as intraperitoneal infiltration and local infiltration of 20 mls of 0.5% bupivacaine in the port sites (5 ml infiltration in each port) versus 50 cases receive 40 ml of normal saline intraperitoneally Discussion :Reduction in post-operative pain with better cosmesis and early return to work have been the goals to improve cost effectiveness and patient satisfaction. Conclusion : We conclude that instillation of local anaesthetic drug intraperitonialy & Port site local anaesthetic agent injection has added benefits in post operative pain

Late-type port-site recurrence of unexpected gallbladder carcinoma 11 years after laparoscopic cholecystectomy

2014 ◽  
Vol 7 (4) ◽  
pp. 304-307 ◽  
Author(s):  
Eiji Tsujita ◽  
Yasuharu Ikeda ◽  
Nao Kinjo ◽  
Ippei Uezu ◽  
Junko Matsuyama ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallbladder Carcinoma ◽  
Port Site ◽  
Late Type ◽  
Port Site Recurrence

Frequency of port site infection following gall bladder removal through Epigastric vs Umbilical port.

2021 ◽  
Vol 28 (03) ◽  
pp. 277-281
Author(s):  
Bushra Shaikh ◽  
Imamuddin Baloch ◽  
Azhar Ali Shah ◽  
Abdul Sami Mirani ◽  
Parkash Lal Lund ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wound Infection ◽  
Port Site ◽  
Site Infection ◽  
College Hospital ◽  
Medical College ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Objective: To compare the frequency of port site wound infection following gall bladder removal through umbilical and epigastric port in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Surgical Unit 2, Ghulam Muhammad Mahar Medical College, hospital Sukkur. Period: 1st November 2019 to 30th October 2020. Material & Methods: All cases who underwent four port laparoscopic cholecystectomy were enrolled in two groups. All procedures were performed under general anesthesia. As the last event of surgery gall bladder was retrieved in a glove bag through umbilical port in group A and through epigastric port in group B, both under direct camera vision. Wound infection was considered if there was 3 to 5 grade of wound according to Southampton wound grading system (Figure-1) on 5th postoperative day. All demographics and outcome variables were recorded. Results: Age ranged from 20 to 60 years with mean age of 38.875±8.11 years, BMI 29.973±5.12 Kg/m2, duration of surgery 50.656±8.41 mins and Southampton score was 1.044±1.07 in Group A and mean age of 38.560±6.23 years, BMI 27.437±5.04 Kg/m2, duration of surgery 48.920±8.67 mins and Southampton score was 0.856±0.92 in Group B. In group A, 18 (5.7%)patients developed port site wound infection in contrast to 5 (1.6%) patients in group B (P= 0.006). Conclusion: We conclude that epigastric port retrieval of gall bladder following laparoscopic cholecystectomy results in less port site infection.

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.

Frequency of Port Site Wound Infection with and Without End Gloves Techniques of Retrieval of Gallbladder in Pouch

2021 ◽  
Vol 15 (12) ◽  
pp. 3399-3401
Author(s):  
Naeem Ahmed ◽  
Maryum Saleem Raha ◽  
Uzma Shamim Seth ◽  
Mohammad Taha Kamal ◽  
Anum Nawazish Al ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wound Infection ◽  
General Surgery ◽  
Port Site ◽  
Medical Institute ◽  
Conventional Laparoscopic Cholecystectomy ◽  
Conventional Laparoscopic ◽  
Group I ◽  
Significant Difference

Background: The gallbladder is a hollow organ that sits just beneath the right lobe of the liver. Chief functioning of gallbladder is to store gall, also known as bile that is required for digestion of food. Removing gallbladder through small incision in the abdomen is called laparoscopic cholecystectomy. Among benefits of cholecystectomy are decreased need for postoperative analgesia, decreased postoperative pain and shortened hospital stay from 1 week to less than 24 hours. Objective: To compare the frequency of port site wound infection with and without endogloves techniques of retrieval of gallbladder in pouch after laparoscopic cholecystectomy for chronic calculus cholecystitis. Design: It was a randomized controlled trial. Study Settings: This study was conducted at Department of General Surgery, Midland Doctors Medical Institute Tandali Muzaffarabad from July 2019 to July 2021 Material and Methods: A total of 260 cases who fulfilled inclusion criteria were enrolled in the study through wards of Department of General Surgery. Written informed consent was obtained from all the patients. Two groups were made by random division of patients. Conventional laparoscopic cholecystectomy was performed in patients of group I. Through umbilical port gall-bladder was retrieved in these patients, exactly spot on by a sterile surgical hand glove endobag. Vicryl “O” with J-shaped needle was used to close 10mm umbilical port (fascial defect) and 5mm ports were conventionally closed. In patients of group II, conventional laparoscopic cholecystectomy was performed and gall-bladder was retrieved as in patients of group I but without using surgical sterile hand glove endobag. Results: The mean age of the patients in study group was 48.09±15.402 years and in control group it was 47.51±16.48 years. Male to female ratio was 1.06:1. The post-op wound infection was found in 11 (4.23%) patients. Statistically significant difference was found in groups (P<0.05). Conclusion: The use of endoglove technique of retrieval of gallbladder in pouch after laparoscopic cholecystectomy for chronic calculus cholecystitis is safe, cheap, simple and potentially reduces significant port site wound infection compared to without endogloves. Keywords: Laparoscopic Cholecystectomy, Endoglove, Gallbladder (GB).

Metastasis of missed cholangiocarcinoma in the left lobethrough abdominal wall laparoscopic port-site and umbilicus after laparoscopic cholecystectomy: case report and literature review

2020 ◽  
Author(s):  
Lesheng Huang ◽  
Hongyi Li ◽  
Jun Chen ◽  
Jinghua Jiang ◽  
Wanchun Zhang ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Wall ◽  
Malignant Tumor ◽  
Malignant Tumors ◽  
Abdominal Cavity ◽  
Left Lobe ◽  
Port Site ◽  
Laparoscopic Port ◽  
Missed Diagnosis ◽  
Upper Abdominal

Abstract Introduction: Laparoscopic cholecystectomy (LC) has been widely used by surgeons. However, a serious but rare condition may be happened, which is the missed diagnosis of intraperitoneal malignant tumor. If the malignancy exists, the changes of the abdominal environment or the laparoscopic operation might brought the cancer cells to the abdominal cavity or the abdominal wall. The missed laparoscopic malignant tumors are prone to metastasis, especially at the laparoscopic port-site. More extreme condition will be located in the navel, which is known as Sister Mary Joseph’s nodule(SMJN).Case presentation: A 63-year-old female who had undergone cholecystectomy and choledocholithotomy ten months ago was hospitalized for upper abdominal pain. Laboratory examination indicated that the most of tumor markers were increased. CT scan revealed that there was a diffused irregular and progressively enhanced mass around the left lobe bile duct, multiple enlarged lymph nodes in the abdominal cavity and multiple nodular lesions were found under the costal margin of the right upper abdominal wall, right lower abdominal wall and the umbilicus. Biopsy of the nodules under the original surgical scar showed an infiltrative or metastatic middle differentiated adenocarcinoma. So the diagnosis was left lobe cholangiocarcinoma of the liver, multiple lymph nodes metastasis in the abdominal cavity and multiple implant metastasis in abdominal wall laparoscopic port-site and umbilical.Conclusion: In laparoscopic cholecystectomy, surgeons should not only focus on the local lesions, like gallstone in biliary system, but also look around other the tissues and organs to avoid missing the abdominal malignant tumor or other lesions. When atypical symptoms or abnormalities have been found pre-operation, all abdominal organs should be evaluated in detail to avoid missed diagnosis of potential malignant tumors. On the other hand, when there is a nodule in the umbilicus, all the organs and tissues in abdomen should be examined to find the potential malignant tumor. Finally, multiple cholelithiasis in the left lobe of the liver should be regarded as a high risk factor for cholangiocarcinoma.

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