scholarly journals Minilaparotomy Cholecystectomy: A Forgotten Art in Laparoscopic Cholecystectomy Era (Our Experience from a Peripheral Hospital in North India)

2022 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Bharath N Kumar ◽  
Rahul Pandey
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Perioperative Complications ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
North India ◽  
Incision Size ◽  
Peripheral Hospital ◽  
Conversion To Open Cholecystectomy ◽  
Average Operating Time

Background: This study aimed to report the experience of performing minilaparotomy cholecystectomy in a peripheral hospital by a single surgeon. Methods: Data collected from 50 consecutive patients undergoing minilaparotomy cholecystectomy by a single surgeon over 18 months at a peripheral hospital were reviewed and studied. The recorded data encompassed demographics, operating time, incision size, conversion rate to open cholecystectomy, perioperative complications, and hospital stay duration. Results: Fifty consecutive patients, who underwent minilaparotomy cholecystectomy for symptomatic cholelithiasis, were studied, among whom 48 patients were females. The participants’ mean age was 45 years. The length of the surgical incision was 4.5 - 6 cm, and only three patients required conversion to open cholecystectomy. The average operating time was 60 minutes; and the average postoperative hospital stay was 2.14 days. Conclusions: Minilaparotomy cholecystectomy is comparable with laparoscopic cholecystectomy in terms of postoperative morbidity, and it is ideal for peripheral hospitals lacking laparoscopic facilities.

scholarly journals A PROSPECTIVE AND OBSERVATIONAL SINGLE INSTITUTION EXPERIENCE IN LAPAROSCOPIC CHOLECYSTECTOMY

2019 ◽  
Author(s):  
Michael Lawenko ◽  
Arvyn Ilagan ◽  
Abigail Dumlao ◽  
Jesus Juan Versoza ◽  
Gerry Gonzales
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Developed Countries ◽  
The Philippines ◽  
Acute Setting ◽  
Conversion To Open Cholecystectomy ◽  
Returning To Work ◽  
The Mean

BACKGROUNDABSTRACT Laparoscopic Cholecystectomy (LC) is now the gold standard for surgical management of cholelithiasis around the world especially in developed countries, with the advantages of returning to work early, less postoperative pain, shorter hospital stay and better cosmesis. Here in the Philippines, LC has just started to pick its pace; surgeons are becoming more adept in the technique and patients have a better option with regards to the procedure to undergo.The aim of this study is to analyze our institution’s experience in laparoscopic cholecystectomy by evaluating the operative time, patients’ pain score post-operatively, hospital stay, intra-operative and post-operative complications (bleeding, bowel injury and bile duct injury) conversion rate and length of post op stay.METHODSA prospective analysis was performed on data collected during a 16-month period (January 2010 to May 2011) from 127 patients who underwent laparoscopic cholecystectomy. All of the surgeries were performed by consultants.RESULTSThe mean age was 44.7 (17-78) with whom 65.5% were females. Fifteen patients (13.6%) were operated in the acute setting. Three patients (2.7%) warranted an intraoperative cholangiogram while 5 (4.5%) underwent an Endoscopic Retrograde Cholangiopancreatography immediately prior to LC. The mean operating time was 89 (35-335 SD ±41.75) minutes. One patient had cystic duct leak which was managed with a drain and post LC ERCP. Difficulty in dissection was experienced in one case hence conversion to open cholecystectomy occurred (0.9%). Postoperatively, 101 (91.8%) received 0.5% Bupivacaine subcutaneously through the incision sites. Average VAS score was noted to be 3.05, 2.60, 2.20 at 6, 12 and 24 hours respectively. The mean post operative stay after the procedure was 36.22 (10-189 SD ±25.01) hours. No wound infection nor early incisional hernia was noted after 1 week of follow up.CONCLUSIONWith the early series of cases, it can be inferred that laparoscopic cholecystectomy is feasible and is performed safely in our institution.

scholarly journals Laparoscopic Cholecystectomy for Acute Gallbladder Disease During Index Admission- 11 the Optimum Timing for Surgery

2013 ◽  
Vol 16 (1) ◽  
pp. 11-17
Author(s):  
Md Ibrahim Siddique ◽  
Md Atiar Rahman ◽  
Md Shahadot Hossain Sheikh ◽  
Khander Manzoor Murshed ◽  
Samia Mubin ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Index Admission ◽  
Laparoscopic Procedure ◽  
Complication Rates ◽  
Financial Benefit ◽  
Conversion To Open Cholecystectomy

Background: Laparoscopic cholecystectomy, initially considered a contraindication for the treatment of acute gallbladder disease, is now being practiced for treating acute cholecystitis worldwide. The purpose of the study is to evaluate the outcome of laparoscopic procedure in the management of acute gallbladder disease during the index admission in terms of safety and feasibility, hospital stay and the rates of complications and conversion to open cholecystectomy. Methods: Between January 2009 to December 2011, 174 patients (103 female, 71 male) with median age 43.5 years (range 27-73 years) with the diagnosis of acute gallbladder disease underwent laparoscopic cholecystectomy. Diagnosis of acute cholecystitis was made from history, physical findings and ultrasound evidence of acute inflammatory changes. Results: Median time from onset of symptoms to surgery was 70 hours. Median operative time was 76.5 minutes. Conversion rate was 1.7%. Minor post-operative complications occurred in 13.5% cases of laparoscopic procedure, which did not require further intervention. Median post-operative hospital stay was 2.5 days and total length of hospital stay was median 4.4 days. There was no mortality. Conclusion: In expert hands laparoscopic cholecystectomy for acute gallbladder disease during the index admission is safe with better clinical results, shorter hospital stay and an acceptable conversion and complication rates with additional financial benefit to the patients. DOI: http://dx.doi.org/10.3329/jss.v16i1.14442 Journal of Surgical Sciences (2012) Vol. 16 (1) : 11-17

scholarly journals Three-Port versus Four-Port Laparoscopic Cholecystectomy: A Randomized Controlled Trial

2019 ◽  
Vol 21 (1) ◽  
pp. 40-43
Author(s):  
Rabin Koirala ◽  
TM Gurung ◽  
A Rajbhandari ◽  
P Rai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Controlled Trial ◽  
Open Cholecystectomy ◽  
Analgesic Requirement ◽  
Safe Alternative ◽  
Average Hospital ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

 Laparoscopic cholecystectomy (LC) is one of the most common surgery performed and is traditionally performed using four ports. With the aim of improving patient’s comfort, port numbers have been reduced to single port. But feasibility and the extra expense that comes with single and double port LC has made them less attractive. Three port LC can be a safe alternative to four port LC, and various research has shown its safety. This study compares the three port LC with the traditional four port LC with the objective of assessing feasibility and benefit of the decreased port number. We evaluated 217 patients who were randomly allocated for three port and four port LC. Both the groups were compared for operative time, assessment of postoperative pain, days of hospital stay and postoperative recovery time after discharge. The parameters were compared using Statistical Package for the Social Sciences (SPSS) version 16. Among 217 patients, 123 underwent three port LC and 94 underwent four port LC. The larger number were females (79.7%), and with comparable age group of patients. Rate of conversion to open cholecystectomy, postoperative pain scale, analgesic requirement, average hospital stay and port site infection rates were comparable in both groups of patients. The average time taken for operation was less in three port LC than the four port LC but this was not statistically significant. There is no significant difference between 3 port and 4 port LC in terms of time required for the surgery, conversion rate, complication and duration of hospital stay.

RETROSPECTIVE STUDY ON OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN THE ELDERLY AT JSS HOSPITAL, MYSURU

2021 ◽  
pp. 34-35
Author(s):  
Sudhir S. ◽  
Deepak Naik P ◽  
Deepak R. Sridhar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
The Elderly ◽  
Age Group ◽  
Elderly Age ◽  
Duration Of Hospital Stay ◽  
Wide Range ◽  
Conversion To Open Cholecystectomy ◽  
Duration Of Surgery

(a) Laparoscopic cholecystectomy is a widely performed surgery in India and across the world for a wide range of indications. It is one of the most commonly performed surgeries, and hence a study based on outcomes of Laparoscopic cholecystectomy in the elderly would go a long way in determining the safety and success of Laparoscopic cholecystectomy in the elderly, and could help in timing surgery more effectively to avoid complications and difculties. (b) Materials and methods: Out of 250 patients who underwent Laparoscopic Cholecystectomy at JSS Hospital in the period starting January 2019 onwards who were selected by randomization, 65 patients t the criteria (age > 60 years) while 185 patients were aged <60. Data regarding comorbidities, duration of surgery, duration of hospital stay, conversion to open cholecystectomy was compiled and studied. (c) Results: A signicant number of the patients in the elderly age group had associated comorbidities. Duration of surgery was prolonged by a mean duration of 9.5 minutes in the elderly. Duration of hospital stay was increased by a mean of 2.2 days in the elderly. Incidence of conversion to open cholecystectomy was also higher in the elderly. (d) Conclusions: Laparoscopic cholecystectomy is a relatively safe and easy surgery with few complications. However, one may experience difculties while operating on the elderly, viz. Adhesions, contracted gall bladder with hepatic adhesions etc., Which may result in longer duration of surgery and higher rates of conversion to open cholecystectomy.

scholarly journals GALLBLADDER CARCINOMA;

2011 ◽  
Vol 18 (01) ◽  
Author(s):  
AHMAD HASSAN KHAN ◽  
SAIFULLAH GORAYA ◽  
HAROON-UR- RASHID
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Gallbladder Carcinoma ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Chronic Cholecystitis ◽  
Surgical Department ◽  
Carcinoma Gallbladder ◽  
Average Operating ◽  
Average Operating Time

Objective: Chronic Cholecystitis is one of the commonest diseases presenting in surgical department and is subjected to cholecystectomy each time. A suspicious gall bladder on ultrasound initiates further investigations to rule out carcinoma of gall bladder yet some times a benign looking gall bladder on ultrasound turns out to be carcinoma of gall bladder on histopathology. Design: Descriptive study. Place & Duration of study: District Head Quarters Hospital, Sargodha, from September 2007 to March 2009. Patients & Methods: 200 patients who underwent both open and Laparoscopic cholecystectomy for cholelithiasis were subjected to this study. All relevant data was documented on a standardized data form. Patients were between the ages of 28-74. Patients already diagnosed as Gallbladder Carcinoma, empyema gall bladder, mucocele and gall bladder polyp were excluded from the study. Gall bladders removed after each surgery ware sent to laboratory for histopathological evaluation. Results: A total of 200 cases were studied (161 females, 39 males; M: F ratio 1:4). The mean age was 45 years (range 28-74 years). The most common presenting complaint was pain right hypochondrium with nausea and vomiting (85%).The average operating time was 50 minutes in case of open cholecystectomy and 1 hour in laparoscopic cholecystectomy. Complications included biliary leak in 2 patients (1%), Wound Infection in 3 patients (1.5%) and death in one case (0.5%). The overall rate of complications was 3%. There were a total of 5 patients of laparoscopic cholecystectomy who required extension of the incision, for Carcinoma Gallbladder. Conclusions: Carcinoma of gall bladder is a very aggressive malignancy and usually presents at a very advance stage as its symptoms mostly are marked by symptoms of cholecystitis. Detection of gall bladder carcinoma is very difficult in early stages on ultrasound. Any findings in ultrasound suggesting malignancy should be confirmed on further investigations like CT scan .Carcinoma of Gall bladder is not very common in cases of cholecystectomy for chronic Cholecystitis but once found should be dealt with extreme precision following established operating protocols. 

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 LAPAROSCOPIC CHOLECYSTECTOMY;

2019 ◽  
Vol 26 (03) ◽  
Author(s):  
Fatima Abbasi ◽  
Saeed Ahmed
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Acute Attack ◽  
P Value ◽  
Early Group ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
Late Group

Objectives: To compare the outcomes of early versus delayed laparoscopic cholecystectomy in acute calculus cholecystitis. Study Design: Randomized control study. Setting: Surgical Unit of Rawal Medical and Dental Hospital, Islamabad. Period: February 2015 to January 2016. Subjects and Methods: 100 patients with acute cholecystitis between the ages 20 years to 60 years were divided into early and late group of 50 patients each. Informed consent was taken. Data was entered into a pre designed performa. Analysis of data was done using spss version 17. T test was applied on quantitative data and chi 2 on qualitative data. p–value of less than 0.05 was taken as significant. Early group had laparoscopic cholecystectomy within 72 hours while late group had surgery 6-8 weeks after the acute attack. Results: There was increased operating time in the early group which was statistically significant (p-value 0.046). There was slightly increased rate of conversion to open cholecystectomy, increased hospital stay and intra and post operative complications but none of them were statistically significant. Also pain scores and analgesic requirements had no major difference in both groups. Conclusion: Early laparoscopic cholecystectomy is a reasonably safe and cost effective alternative to interval cholecystectomy. Although some complications are more common in early cholecystectomy mainly due to difficult anatomy of calot’s triangle like conversion to open, gall bladder perforation and wound infection, none of them proved to be statistically significant.

SP6.1.8Fundus-first laparoscopic cholecystectomy for complex gallbladders: A systematic review

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Michael El Boghdady ◽  
Hossein Arang
Keyword(s):  
Systematic Review ◽  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Scientific Evidence ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Research Quality ◽  
Cochrane Library ◽  
Conversion To Open Cholecystectomy

Abstract Aims Retrograde ‘fundus-first’ cholecystectomy is when the dissection starts from the fundus of the gallbladder to the infundibulum, in case structures of Calot's triangle cannot be identified. Although feasible in laparoscopic cholecystectomy, it remains an underutilized approach. We aimed to systematically review the fundus-first laparoscopic cholecystectomy and study its safety and feasibility. Methods A systematic review was performed in compliance with PRISMA guidelines. A literature search was performed using PubMed/MEDLINE, ScienceDirect and Cochrane-Library for articles published from 2010 to 2020. Search keywords included ‘retrograde cholecystectomy’, ‘fundus-first cholecystectomy’ and ‘fundus-down cholecystectomy’. Quality assessments were applied using the Medical Education Research Quality Instrument (MERSQI) score. The protocol was registered with PROSPERO register. Results A total of 3503 studies formed the base for evidence evaluations. 12 studies with 1978 fundus-first cholecystectomies were assessed. Three citations were scored high and 5 moderate quality. Endpoints included blood loss, rate of conversion to open, bile duct injury, gallbladders perforations, postoperative pain and hospital stay. Nine studies provided both strong and moderate scientific evidence for a positive outcome of the fundus-first approach. Conclusion The fundus-first cholecystectomy was associated with a reduced need for intraoperative cholangiography, shorter operating time, lower incidence of intra-operative complications, bile duct injury and reduced incidence of conversion to open cholecystectomy.

scholarly journals Laparoscopic Cholecystectomy- A Safe treatment option for Gangrenous Cholecystitis 48 and Empyema Gallbladder in experienced hands

2019 ◽  
Vol 19 (2) ◽  
pp. 48-51
Author(s):  
Samiron Kumar Mondal ◽  
Sharmistha Roy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Laparoscopic Procedure ◽  
Safe Procedure ◽  
Intracorporeal Suturing ◽  
Gangrenous Cholecystitis ◽  
Number Of Patients ◽  
Conversion To Open Cholecystectomy ◽  
Operative Recovery

Background: Laparoscopic cholecystectomy has become the gold standard of treatment for gall stone disease and in acute cholecystitis. But controversy persists regarding laparoscopic approach to gangrenous gallbladder and empyema gallbladder due to the risk of life threatening complications. We share our experience in a tertiary care multidisciplinary diabetic hospital where we encounter significant number of patients with empyema Gallbladder and gangrenous gallbladder because most of our patients are diabetic and hence immunocompromised. Purpose of this study was to evaluate the safety of laparoscopic procedure for the treatment of empyema of gallbladder and gangrenous gallbladder in an experienced hand. Methods & Materials: Between January 2013 and January 2015 we performed 1191 cases of laparoscopic cholecystectomy. Empyema gallbladder and gangrenous gallbladder were found per operatively in 345 and 53 cases respectively.All were managed by laparoscopic procedure except two cases, where conversion to open cholecystectomy was needed. Result: The mean operating time was 72 minutes(45-100 minutes) in empyema gallbladder. In gangrenous cholecystitismean operating time was 80 minutes(60-100 minutes). Total number of patients (including empyema gallbladder 345 and gangrenous cholecystitis 53) were 398. Among them 52 patients (13%) had excessive bleeding(>100ml) from calot’s triangle or gallbladder bed in liver. Spillage of stones occurred in 28 patients (7%). 1 patient had common bile duct injury (.25%). Gallbladder retrieval was difficult in 71 patients (18%). In the post operative period 21 patient (5%) developed minor port infection in the umbilical port. 9 patients (2%) developed chest infection, and 1 patient (.25%) developed MI. 356 patients (89%) were discharged within 72 hours of surgery. Conclusions: Innovative technique, appropriate instruments, knowledge about the possible risks and way to manage them, with expertise in intracorporeal suturing and knotting are an essential pre requisites to attempt these cases. Operating time is more but post operative recovery is prompt. Hospital stay is significantly less than open cholecystectomy. Laparoscopic cholecystectomy is a safe procedure in cases of Empyema and gangrenous gallbladder, provided the surgeon is experienced enough and has a low threshold to convert to open cholecystectomy at anypoint of time. Journal of Surgical Sciences (2015) Vol. 19 (2) : 48-51

scholarly journals Advantage of fundus first method over conventional approach in difficult laparoscopic cholecystectomy: a prospective study

2019 ◽  
Vol 6 (5) ◽  
pp. 1613
Author(s):  
Braja Mohan Mishra ◽  
Rabi Narayana Guru ◽  
Sunil Kumar Kar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Gall Stone ◽  
Antibiotic Use ◽  
Class Iii ◽  
Female Age ◽  
Conversion To Open Cholecystectomy ◽  
A Prospective Study ◽  
Difficult Cases

Background: Fundus first method is a widely accepted and practiced procedure in open cholecystectomy to deal the difficult cases but laparoscopic surgeons still have reserved opinion regarding use of fundus first approach in difficult laparoscopic cholecystectomy (DLC). As in open cholecystectomy fundus first laparoscopic cholecystectomy (FFC) can have advantages over conventional laparoscopic cholecystectomy (CLC) in DLC. So many preoperative, intraoperative, postoperative information were collected in both CLC and FFC and compared to evaluate whether FFC has any advantage over CLC in difficult laparoscopic cholecystectomy.Methods: A total 73 cases were included in the study that underwent laparoscopic cholecystectomy (LC) for gall stone diseases and intraoperatively found to be difficult cases. They were distributed into 4 classes i.e. Class I, Class II, Class III and Class IV according to the type of difficulty encountered during surgery.Results: Out of the 73 patients 24 were male and 49 were Female. Age of patient ranged from 14 to 70 years with mean age of 42.64 years. Out of 38 cases operated with FFC 6 cases (15.78%) needed conversion to open cholecystectomy as compared to 26 out of 35 (71.14%) cases that underwent CLC where conversion was done. Mean duration of hospital stay is 4.19±3.053. Mean hospital stay in FFC is 2.58±1.869 days and that of CLC is 5.14±3.143 which is clearly much higher and statistically significant (p< 0.001) than mean hospital stay in case of FFC.Conclusions: FFC has advantages over CLC in difficult LC i.e. reduced conversion rate, lesser hospital stay and less duration of antibiotic use.

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