Complications of Laproscopic Cholecystectomy in Patients of Acute Cholecystitis

Objective: To determine the complications of laparoscopic cholecystectomy in patients of acute cholecystitis. Study Design: Prospective study. Place & Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from January 2020 to June 2020. Methods: Total 120 patients of both genders with ages 20 to 60 years were included in this study. Patients’ detailed demographics were recorded after taking written consent. Patients with history of abdominal surgery were excluded. All the patients underwent laparoscopic cholecystectomy for gall bladder diseases. Post-operative pain was analyzed by VAS. Complications were recorded at 5th postoperative day. Data was analyzed by SPSS 24.0. Results: Out of 120 patients 30 (25%) patients were males and 75% patients were females. Most of the patients 50 (41.67%) were in the age group 31 to 40 years followed by 37 (30.83%) patients were ages between 41 to 50 years. 70 (58.33%) patients had surgical size port incision was 5mm and 50 (41.67%) patients had 10mm. Mean pain score was 2.24+1.1 at 5th postoperative day. Wound infection was found in 10 (8.33%). Port site hernia was found in 12 (10%). Conclusion: Laparoscopic cholecystectomy is safe and effective treatment procedure with no major complications. Keywords: Laparoscopic Cholecystectomy, Acute Cholecystitis, Wound Infection, Port Site Hernia, Pain

ASSESSMENT OF RISK FACTORS AND COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY

Cholecystectomy is one of the most common abdominal surgical procedures in developed countries. 74 patients of cholecystectomy of both genders were enrolled. was recorded. A thorough clinical examination was done. Lipid profile, Etiology and complications were recorded. Common etiology found to be cholestasis in 38, hyperlipidemia in 24, hereditary spherocystosis and idiopathic cases. The difference was significant (P< 0.05). Complications were intraoperative bleeding, biliary peritonitis, intra-abdominal collections bile duct injury, ligation of CBD, bile leakage, SSI, and retained CBD stones cases. The difference was significant (P< 0.05). Authors found that common etiology found to be cholestasis, hyperlipidemia, hereditary spherocystosis and idiopathic.

Retrospective analysis of complications in 3600 patients of laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy results in specific complications which occur frequently as compared to open cholecystectomy. Several aspects of these complications and their treatment modalities were analyzed.Methods: 3600 cases of laparoscopic cholecystectomy performed by a single surgeon at various private hospitals in Jammu (Jammu and Kashmir), India during the period of 18 years from March 2002 to March 2020 were analyzed for the complications and their management.Results: Complications of laparoscopic cholecystectomy occurred in 14.5% of the patients. The most common complication was haemorrhage. Conversion to open cholecystectomy was necessary in 41 (1.13%) patients due to obscure anatomy as a result of adhesions and acute inflammation. In the study, 6 deaths (0.16%) were recorded.Conclusions: Laparoscopic surgeon should remain highly vigilant to detect major complications like injury to small gut at the time of entry into the peritoneal cavity or bile duct injury during laparoscopic cholecystectomy at an earliest and should timely manage such cases to save the life of the patient.

The impact of surgical experience on complications of laparoscopic cholecystectomy

Objective: Laparoscopic cholecystectomy (LC) is the gold standard option for the surgical treatment of cholecystitis. Meanwhile, experience of surgical center and operator play central role in adequate management of patients with gallbladder disorders. The aim of this study is to analyze complications and conversion rates of laparoscopic cholecystectomy at various periods of implication of the method in a single center. Methods: We retrospectively analyzed early complications of 6381 patients operated due to various forms of cholecystitis according to periods of implication of LC in Kyrgyz National Center of General Surgery (1996-2019). Patients were divided into 3 groups: first group of patients were operated from 1996 to 2004 during first implementation of technique (n=1446); second group patients underwent operation between 2005-2008, when operators concentrated on technical skills (n=1225); third group of patients operated between 2009 and 2019, when surgical team concentrated on prevention of complications. Results: Both complication and conversion cases represented strong association with surgical experience. The highest complications (4.8% vs 1.5% and 0.4%, respectively, p&lt;0.001) and conversion to surgical cholecystectomy (11.2% vs 1.5% and 0.1%, respectively, p=0.001) rates were detected in group 1 as compared to groups 2 and 3. Conclusion: Occurrence of complications and conversion to conventional surgical cholecystectomy reduced over time, depending on surgical experience of operating team and practice of operator.

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

Complications of laparoscopic cholecystectomy performed by junior surgeon in resource-restricted settings

Background: The aims of this audit were to determine the rate of complications of laparoscopic cholecystectomy performed by a junior surgeon, to identify changes that can be made to reduce the complications, and to re-audit the complication rate after the changes have been made.Methods: Laparoscopic cholecystectomies performed by the surgeon between August and November, 2018 were assessed retrospectively. Data was collected from electronic records and operation notes and entered in the format as enclosed within. A re-audit was conducted between December 15th, 2018 and June 15th, 2019.Results: In the initial audit, the complication rate of laparoscopic cholecystectomy was 40% and the incidence of bile leaks was 6%. The re-audit showed a significant reduction in the overall complication rate to 24% with no incidence of bile leaks.Conclusions: The learning curve of surgeons for laparoscopic procedures is steep and cases should be chosen carefully depending on the current skill set and comfort level of the surgeon. Recommended standard practices should be followed in all situations, and all the team members should be involved in identifying risks during the surgery.