Comparative study of ondansetron, granisetron and granisetron with dexamethasone for prevention of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy

An assortment of drugs are being used for managing postoperative nausea and vomiting after laparoscopic surgeries. Combination anti-emetic therapy using 5HT3 antagonists with dexamethasone as an adjunct is being tried owing to its improved efficacy for prevention or treatment of PONV. This was a prospective, randomized, double blind, comparative study conducted on 150 patients aged between 18 to 65 years scheduled for laparoscopic cholecystectomy. Group O received 0.1 mg/Kg IV ondansetron upto a maximum dose of 8 mg, Group G received 0.04 mg/kg IV granisetron upto a maximum dose of 3mg, Group G+D will receive 0.04mg/kg IV granisetron and 8mg Dexamethasone. The three groups were comparable in terms of demographic data. Our results showed that the patients who had received combination of granisetron and Dexamethasone showed a better complete response as compared to patients who received ondansetron and patients who received granisetron alone. This was seen in all three time periods of 2-6 hours, 6-12 hours and 12-24 hours postoperatively with a p value less than 0.001 making it statistically significant. : Combination therapy with granisetron and dexamethasone IV used as prophylactic antiemetic is better than granisetron or ondansetron given IV alone. IV granisetron and dexamethasone combination has fewer side effects compared to ondansetron or granisetron. Need for the rescue antiemetic was least in the patients receiving granisetron and dexamethasone combination as compared to in patient receiving ondansetron and granisetron alone.

Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy

<b>OBJECTIVE</b><b> </b> <p>To evaluate the effect of preoperative blood glucose (POBG) level on hospital length of stay (LOS) in patients undergoing appendectomy or laparoscopic cholecystectomy. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>We conducted a retrospective cohort study of patients aged ≥18 years who had undergone either appendectomy or laparoscopic cholecystectomy procedures between 2005 and 2016 at a tertiary medical center in Taiwan. The association between POBG level and LOS was evaluated using a multivariable quasi-Poisson regression with robust variance. Multiple imputations were performed to replace missing values.</p> <p><b>RESULTS</b></p> <p>We included a total of 8,291 patients; 4,025 patients underwent appendectomy (appendectomy group) and 4,266 underwent laparoscopic cholecystectomy (laparoscopic cholecystectomy group). In the appendectomy group, patients with POBG levels of ≥123 mg/dL (adjusted relative risk [aRR], 1.19; 95% CI, 1.06–1.33) had a 19% higher risk of having a LOS of >3 days than did those with POBG levels of <106 mg/dL. In the laparoscopic cholecystectomy group, patients with POBG levels of ≥128 mg/dL also had a significantly higher risk of having a LOS of >3 days (aRR, 1.17; 95% CI, 1.07–1.29) than did those with POBG levels of <102 mg/dL. A positive dose–response curve between POBG and an adjusted risk of a LOS of >3 days was observed, despite the curve starts to flatten at a POBG level of approximately 130 mg/dL.</p> <p><b>CONCLUSIONS</b></p> <p>We demonstrated that a higher POBG level was significantly associated with a prolonged LOS for patients undergoing appendectomy and laparoscopic cholecystectomy. The optimal POBG level may be lower than that commonly perceived.</p>

Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy

<b>OBJECTIVE</b><b> </b> <p>To evaluate the effect of preoperative blood glucose (POBG) level on hospital length of stay (LOS) in patients undergoing appendectomy or laparoscopic cholecystectomy. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>We conducted a retrospective cohort study of patients aged ≥18 years who had undergone either appendectomy or laparoscopic cholecystectomy procedures between 2005 and 2016 at a tertiary medical center in Taiwan. The association between POBG level and LOS was evaluated using a multivariable quasi-Poisson regression with robust variance. Multiple imputations were performed to replace missing values.</p> <p><b>RESULTS</b></p> <p>We included a total of 8,291 patients; 4,025 patients underwent appendectomy (appendectomy group) and 4,266 underwent laparoscopic cholecystectomy (laparoscopic cholecystectomy group). In the appendectomy group, patients with POBG levels of ≥123 mg/dL (adjusted relative risk [aRR], 1.19; 95% CI, 1.06–1.33) had a 19% higher risk of having a LOS of >3 days than did those with POBG levels of <106 mg/dL. In the laparoscopic cholecystectomy group, patients with POBG levels of ≥128 mg/dL also had a significantly higher risk of having a LOS of >3 days (aRR, 1.17; 95% CI, 1.07–1.29) than did those with POBG levels of <102 mg/dL. A positive dose–response curve between POBG and an adjusted risk of a LOS of >3 days was observed, despite the curve starts to flatten at a POBG level of approximately 130 mg/dL.</p> <p><b>CONCLUSIONS</b></p> <p>We demonstrated that a higher POBG level was significantly associated with a prolonged LOS for patients undergoing appendectomy and laparoscopic cholecystectomy. The optimal POBG level may be lower than that commonly perceived.</p>

COMPARATIVE STUDY OF SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY AND CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY

Background Single Incision Laparoscopic Surgery, is an alternative to conventional multi-port laparoscopic surgeries with the aim to reduce complications associated with multiple incisions and increase cosmesis. In this study we aim to compare the single incision approach vs the conventional approach for laparoscopic cholecystectomy. Materials We conducted a prospective cohort study at a tertiary care set up, comparing 30 patients each undergoing conventional laparoscopic cholecystectomy and single incision laparoscopic cholecystectomy. Data recorded included demographics, intra-operative and post-operative course, duration of hospital stay, hospital cost and expenditure. Results We found out that single incision laparoscopic cholecystectomy is associated with longer operative time (65 mins vs 55 mins), a longer hospital stay (5 days vs 2.5 days) and higher hospital expenditure. Intraoperative complications like bleeding and inadvertent gall bladder perforation were more in the single incision group (10% vs 3.3%), and on follow up, 2 patients from the single incision group had surgical site infection and port site herniation compared to none from the conventional laparoscopy group. The patients reported better cosmetic outcome in the single incision laparoscopic cholecystectomy group. Conclusion Single incision laparoscopic cholecystectomy is better than conventional laparoscopic cholecystectomy with regards to final cosmesis and quality of life parameters, however, it comes with higher economic burden, longer operative times and untoward intra-operative and post-operative events.

Comparison of 3-port with standard 4-port laparoscopic cholecystectomy: A clinical trial

Introduction: Since the laparoscopic cholecystectomy was introduced first in 1990, the 4-port laparoscopic cholecystectomy was the gold standard. The 4-port (lateral) is used to hold gallbladder fundus and observe Calot's triangle. It is discussed that the 4-port technique is not required in many patients. Therefore, this study aimed to make a comparison between 3-port and 4-port laparoscopic cholecystectomy methods in the treatment of gallstone disease. Methods: A double-blind clinical trial was performed on patients admitted to Imam Reza Hospital, Birjand, Iran. The patients with gallstone disease (n=60) were randomly assigned into the case (3-port) and control (4-port) groups using balanced block randomization and underwent 3- or 4-port laparoscopic cholecystectomy. Postoperative pain was measured by a visual analog scale four h after surgery. The amount of pain-killer, duration of surgery, as well as length of stay and scars were measured in this study. Data were analyzed statistically in SPSS software (version 18) through the Chi-square test and t-test. A p-value less than 0.05 was considered statistically significant. Results: The groups were compared in terms of demographic characteristics. There were 24 females (80%) and 6 males (20%) in the control group and 25 females (83.4%) and 5 males (16.7%) in the case group (P=0.739). Moreover, the mean ages of the control and case groups were 59.823±7.8 and 61.10±4.7, respectively, and there was no significant difference between the groups in this regard (P=0.348). Furthermore, length of operation (P=0.001) and analgesic consumption (P=0.001) in the 3-port laparoscopic cholecystectomy group were lower than those in the 4-port group; however, the hospital stay (P=0.896) was the same in both groups. Conclusions: The 3-port laparoscopic cholecystectomy is a safe, reliable, and cost-effective method in patients who underwent laparoscopic cholecystectomy.

Timing of Cholecystectomy after Emergent Endoscopic Retrograde Cholangiopancreatography for Cholangitis

Debate remains regarding the timing of laparoscopic cholecystectomy after emergent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis. We hypothesized that patients undergoing early laparoscopic cholecystectomy would have fewer operative complications and a lower conversion rate. This study is a retrospective review of an ERCP database from 2012 to 2016 of adults with a diagnosis of cholangitis secondary to choledocholithiasis who underwent ERCP followed by a laparoscopic cholecystectomy. Patient demographics, ERCP details, timing of operation (<72 hours vs >72 hours after ERCP), complications, and mortality were recorded. Analysis included chi-square, Fisher's exact, and Wilcoxon rank-sum tests, where appropriate. In the 127 patients (65 per cent male; median age, 67 years; 48 (38%) early surgery), there were no differences in demographics, BMI, vital signs, or laboratory values. Patients in the late surgery group were more likely to have a Charlson Comorbidity Index > 3 ( P = 0.002), require pre-operative endoscopic sphincterotomy ( P < 0.002), need pre-operative insertion of a ductal stent ( P < 0.03), and had more postoperative complications ( P = 0.04). Patients in the late laparoscopic cholecystectomy group had more comorbidities and suffered more complications.

Single port laparoscopic cholecystectomy compared to the standard laparoscopic cholecystectomy

Background: Efforts to improve outcomes of laparoscopic cholecystectomy heralded the advent of single incision laparoscopic cholecystectomy. The objective of this study was to evaluate and compare single port laparoscopic cholecystectomy to the standard laparoscopic cholecystectomy with respect to time required for surgery, postoperative pain, morbidity and complications.Methods: This comparative randomized study was conducted in M.L.B. Medical College, Jhansi among 124 patients. 74 patients were included in the three port laparoscopic cholecystectomy group and 50 in the single port laparoscopic cholecystectomy group. Informed consent was taken. All patients were operated under general anesthesia. Statistical analysis was using independent t-test and chi- square test.Results: The mean operative time was slightly longer in SILC (group I) as compared to CLC/SLC (group II). Postoperative pain on VAS scale in group I after 6 hours (1st day score) was 2.44 in group I and 2.73 in group II (CLC/SLC). But on 2nd day in SILC 1.40 and in CLC/SLC it was 1.81. In SILC (group I) 4 patients out of 50 (8%) developed seroma and 2 patients out of 50 (4%) developed Biliary peritonitis due to the slipped dip. And in SLC/CLC (group II) 3 patients out of 74 (4.05%) developed seroma.Conclusions: SILC can be an effective alternative to traditional CLC/SLC, with the added benefit of minimized scarring and a shorter length of stay. This technique can be performed safely for patients with a multitude of gallbladder diseases without resulting in additional complications.

LAPAROSCOPIC CHOLECYSTECTOMY;

Objectives: Toevaluate the outcome of laparoscopic cholecystectomy as compared with open cholecystectomy in compensated cirrhotic patients. Study Design: Prospective randomized study. Setting: Department of Surgery, Liaquat University Hospital, Jamshoro. Liaquat University Hospital is Tertiary Care Hospital in the region of Hyderabad and Jamshoro. Period: Three years from January 2011 to December 2014. Patients and Method: Total 172 patients presentedwithsymptomatic gall stone disease and compensated cirrhosis were randomly divided in to two groups, open cholecystectomy group and laparoscopic cholecystectomy group. Study variables were age, sex, cause of cirrhosis, surgical time, blood loss during and after surgery, hospital stay and postoperative complications. After inform consent, data was collected on preformed proforma. For statically analysis SPSS 16 were used, statically significance were defined a P value < 0.05. Results: In patients for open cholecystectomy group cirrhosis was developed due to secondary infection hepatitis C in 56 (65.88%), hepatitis B in 21 (24.70%) and hepatitis B & C in 08 (9.42%). In laparoscopic cholecystectomy group patients cirrhosis was developed due secondary infection with hepatitis C in 62 (71.26%), hepatitis B in 15 (17.24%) and hepatitis B & C in 10 (11.5%). Laparoscopic cholecystectomy was done on 79 (90.80%) and eight (9.20%) patients converted in to open cholecystectomy due to difficult dissection in three patients and bleeding developed into five patients. The time of surgery was shorter in laparoscopic cholecystectomy group (60.15±15 min) as compared to 75.10±15 minutes in open cholecystectomy group. Oral diet was started early (08-18H) after laparoscopic cholecystectomy as compared to open cholecystectomy (24-12) hours. Hospital stay was also shorter in laparoscopic cholecystectomy group (1.5±1) days versus 03±01 day in open cholecystectomy group. Conclusion: Laparoscopic cholecystectomy is safe, more feasible, needless operative time and less postoperative complicationsin compensated cirrhotic patient as compare to open cholecystectomy but laparoscopic cholecystectomy needs more expertise and availability of instruments.

BILE DUCT INJURIES

Objective: To find out frequency of bile duct injuries during cholecystectomyprocedures either open or laparoscopic. Study design: Prospective observational study. Placeand duration of study: This study was conducted at Surgical department, Liaquat UniversityHospital Jamshoro and Dow International Hospital Karachi, from July 2012 to December2013. Methodology: This study consisted of hundred patients. Patients were divided in twogroups. Group A for open cholecystectomy (OC) comprising of 50 patients who underwentelective open cholecystectomy. Group B for Laparoscopic cholecystectomy (LC) comprisingof 50 patients who underwent elective Laparoscopic cholecystectomy. Inclusion criteria wereall patients diagnosed case of gallstones on the basis of ultrasound abdomen, any age andboth gender. Exclusion criteria included not willing for surgery, General anesthesia problem,pregnant ladies due to risk of foetal loss, carcinoma of gall bladder, stone in CBD and obstructivejaundice. Results: Out of 100 cases of gallstone were operated for either laparoscopic / opencholecystectmy. In open cholecystectomy group 20(40 % ) were male and 30(60 %) female.Ratio male: female ratio of 1:1.5. In laparoscopic cholecystectomy group 11(22 % ) were maleand 39(78 %) female with male: female ratio of 1:3.5. There was wide variation of age rangingfrom a minimum of 10 year to 70 year in both group. The mean age was 41.28+12.30 yearsfor OC group and 38.44+13.50 years for LC group (p 0.02). Common bile duct injury wereoccurred 2(4%) patients in laparoscopic cholecystectomy group while 3(6%) patients observedin open cholecystectomy group. Conclusions: We conclude that found bile duct injury 2(4%)patients in laparoscopic cholecystectomy group while 3(6%) patients observed in opencholecystectomy group

Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a comparative study

Background: Laparoscopic cholecystectomy is now the procedure of choice for patient presenting with acute cholecystitis unless it is contraindicated for technical reason or safety. An attempt was made to compare the outcome and postoperative complications of early vs delayed laparoscopic cholecystectomy in acute cholecystitis.Methods: Fifty patients aged 18 to 64 years having acute cholecystitis admitted for laparoscopic cholecystectomy were included. They were divided into two groups, early (less than 72 hours) and delayed (more than 72 hours up to 6 weeks) laparoscopic cholecystectomy. The patients were followed for three months after the surgery. The primary outcome measures were conversion to open surgery and postoperative complications whereas secondary outcome measures were hospital stay and return to full activity. Comparison of quantitative variables and qualitative variables was done using unpaired student’s “t” test and chi-square test/ Fisher’s exact test respectively.Results: Conversion to open cholecystectomy (p = 0.007) and post-operative complications (p = 0.032) were significantly less in early laparoscopic cholecystectomy group compared to delayed laparoscopic cholecystectomy group. Mean days of hospital stay (4.9 versus 7.4 with p = 0.001) and mean days of return to full activities (12.6 vs 16.3 days with p = 0.001) was significantly less in early laparoscopic surgery group compared to delayed laparoscopic cholecystectomy group. Mean duration of surgery was significantly less in early laparoscopic surgery group as compared to delayed laparoscopic surgery group (69.3 versus 108.5 minutes, with p = 0.001).Conclusions: Early laparoscopic cholecystectomy is better choice than delayed laparoscopic cholecystectomy in acute cholecystitis.