Total laparoscopic clipless cholecystectomy by harmonic scalpels in patients with gall bladder stones

ABSTRACTIntroduction: Gallstones are common in western countries. Usually in minimally invasive cholecystectomy, cystic artery and duct both are separately ligated using metallic clips and then divided. Harmonic scalpel is effectual, useful, and secure instrument regarding control of blood loss and dissection especially in laparoscopic procedure for cholecystectomy. Objective: To delineate outcome of totally clipless laparoscopic cholecystectomy with harmonic scalpels in gall stones disease.Materials and Method: This research (a retrospective case study) was done at surgical department, Lahore General Hospital, Lahore for 12 months. Total 195 patients fulfilling the above mentioned inclusion criteria were enrolled. Then patients underwent surgery under general anaesthesia. During surgery, operative time, gall bladder perforation and blood loss were noted. Patients were evaluated if conversion to open surgery was required. After surgery, patients were followed-up in OPD for 7 days for assessment of infection.Results: Mean age of patients was 45.75±14.98 years. Among patients 93(47.7%) were male and 102(52.3%) were female. Mean duration of gall bladder stone was 5.02±0.80 months. Mean time for operation was 50.27±12 minutes. Mean loss of blood was 73.11±20.46 ml respectively. There were 24(12.3%) cases who had perforation. Total 35(17.9%) patients suffered from infection post operatively. Conclusion: Total laparoscopic clipless cholecystectomy by harmonic scalpels is fully safe and useful technique in surgery for gall bladder stones.Key words: Total laparoscopic clipless cholecystectomy, harmonic scalpels (HS), gall bladder stones

Cholelithiasis and its relation to body mass index and waist to hip ratio: an observational study

Background: There is increased incidence of gall stones and its variable presentations in India is a great need for a study which can provide information regarding risk factors associated with the formation of gallstones, prevalence of disease, clinical presentations and outcome of cholelithiasis. So present study done to find a relationship between body mass index (BMI) and waist to hip ratio (WHR) with cholelithiasis.Methods: The observational study was conducted in tertiary care center of SGRD Amritsar comprised of 100 patients diagnosed with pain abdomen by cholelithiasis and control comprised of 100 patients with any other cause of pain abdomen. All patients were evaluated for BMI and waist to hip ratio. BMI was calculated according to the standard formula (Quetelet’s index). The WHR was measured according to WHO protocol. Statistical tests were applied as quantitative variables were compared using unpaired t-test/Mann-Whitney test (when the data sets were not normally distributed) between the two groups. Qualitative variables were compared using chi-Square test /Fisher’s exact test.Results: A significant association of formation of gall bladder stones in female gender in comparison to their male counterpart and increased chances of formation of gall bladder stones in the patients having higher BMI and higher WHR.Conclusion: Female gender and obesity is associated with increased risk of cholelithiasis.

Bardet-Biedl syndrome presented as chronic kidney disease with rare clinical associations in a Sudanese woman (case report)

Bardet–Biedl syndrome is a rare autosomal recessive disorder falls under the spectrum of ciliopathy disorders. Its characterized by rod-cone dystrophy, renal malformations, postaxial polydactyly, learning difficulties, central obesity and hypogonadism. Hyponatremia, hepatic haemangioma, gall bladder stones and subclinical hypothyroidism rarely described in the literature as clinical presentations in BBS.

Hepatolithiasis and Surgical Approach - Experience of Hepatectomies in a Rural Medical College in North-East India

BACKGROUND Hepatolithiasis or intrahepatic stones irrespective of gall bladder stones or common bile duct stones are common in East Asian countries but rare in Western countries. Although Gall bladder stones are common in India, there is scarcity of literatures reporting hepatolithiasis from the Indian subcontinent. This study aimed to evaluate the clinical result of our first-hand experience of hepatectomies along with other standard surgical options for this low prevalence disease in a North East Indian institute catering to a rural population. METHODS 11 patients with diagnosis of hepatolithiasis operated from the period June, 2014 to June 2019 were included in this study. Pre-operative radiological and biochemical, operative & postoperative variables were assessed. Patients were followed in a planned program. RESULTS Hepatic involvement were noted as Left lobe in 7 (64 %) cases, only right lobe in one case (9 %) and bilateral in three cases (27 %). Five cases (45.5 %) were associated with extrahepatic biliary pathology; concomitant intrahepatic and extrahepatic stones were seen in four cases (36 %). Anatomical left hepatectomies (3), left lateral sectionectomies (2) choledochotomy and T-tube drainage (6 primarily or one additional) were carried out. Functional outcomes were satisfactory in all patients. Postoperative morbidity was mostly due to wound infection and there was no mortality. CONCLUSIONS Preoperative optimization of patients, relative absence of risk factors and knowledge of biliary anatomy planned with modern imaging tools makes hepatectomy a safe definitive surgical option for localised hepatolithiasis. Hepaticojejunostomy may be contemplated selectively for bilateral hepatolithiasis. Long term follow up is necessary as recurrence is associated with this disease. KEYWORDS Hepatolithiasis, Hepatectomy, Sectionectomy, Hepaticojejunostomy, Choledochotomy and T-Tube Drainage

Prevalence and incidence of biliary sludge and stones during pregnancy: A hospital based study

OBJECTIVE:-To assess the prevalence and incidence of biliary Sludge and Stones during pregnancy. METHODS AND MATERIAL: - The study was done on 100 healthy pregnant females. Gall Bladder ultrasounds were done in each trimester and 2-4weeks Postpartum. RESULTS: - The incidence of biliary sludge and gall bladder stones during pregnancy was found to be 14.58% and 8.16% respectively. The prevalence of gall stones disease increased with advancing gestational age and it was also statistically significant (p<0.001).At 2-4 weeks,postpartum gall stones have disappeared in 2 while sludge disappeared in 4. Amongst antenatal women with gall stones disease most were asymptomatic while itching was the commonest presenting symptom. A statistically significant correlation was found between gall stones disease and advanced age, high parity,prolonged breast feeding and raised BMI. CONCLUSION:- Biliary sludge and stones develops frequently during pregnancy and are usually asymptomatic.

Surgical management of gall bladder stones at tertiary care institute of Bhuj, Kutch, Gujarat

Background: Gallstones are the major cause of morbidity and mortality throughout the world. With at least 10 % of the adults have gallstones with a recent rise in the incidence due to change in the dietary factors. This study intends to know its various modes of presentation, treatment, and outcome.Methods: Fifty patients with symptoms and signs of cholelithiasis were included in the study, clinical profile, investigation, treatments, outcomes were analyzed.Results: The highest age incidence of cholelithiasis was in the 5th decade, more common in females. Pain abdomen was the most common symptom. Ultrasonography showed gallbladder stones in all patients and 52% of patients undergone open cholecystectomy, 48% of patients undergone laparoscopic cholecystectomy. The conversion rate of lap to open cholecystectomy was 4%. The operating room time and the length of post operative stay were 65 min and 7 days in open cholecystectomy and 115 min and 3 days in lap cholecystectomy.Conclusions: The result showed cholelithiasis was more common in females, 5th decade, presented most commonly with pain abdomen. Ultrasonography was the most common investigation. Laparoscopic cholecystectomy reduces the number of hospital days, pain disability.