316 research outputs found
A prospective randomised control trial to study the role of intra-peritoneal instillation of ropivacaine versus normal saline irrigation in reduction of post-operative pain in patients undergoing laparoscopic cholecystectomy.
The study was done to compare the effect of intra-peritoneal instillation of ropivacaine versus normal saline irrigation on post operative abdominal pain and shoulder pain in laparoscopic cholecystectomy. Ninety patients with symptomatic gall stones disease undergoing laparoscopic cholecystectomy were randomized in three groups. In study group A (n=30 patients) 0.5% of 30 ml (150 mg) of ropivacaine was instilled at gall bladder bed, and in study group B (n=30) 0.9% of 25 – 30 ml/kg of normal saline irrigation was done at gall bladder bed and sub-diaphragmatic space or control group C (n=30) none of above two intervention was done. Pain abdomen is worse during first 24 hours after laparoscopic cholecystectomy. At 6 hours pain abdomen was significantly less in group A compared to group B (p<.035). At 12 hours pain abdomen was less in group A and group B compared to control group. Intensity of shoulder tip pain was almost similar in group A and group B. Group A experienced significantly reduced shoulder tip pain at 6hours and 12 hours as compared to group C. Group B experienced less shoulder tip pain during first postoperative day as compared to control group. Intra-peritoneal instillation of ropivacaine is more effective than normal saline irrigation at early post-operative hours in reducing post-operative pain abdomen after laparoscopic cholecystectomy. However, intra-peritoneal instillation of ropivacaine and normal saline irrigation are comparable in its effect on shoulder tip pain
Laparoscopic cholecystectomy conversion rate and associated factors
Objective: To identify risk factor/s for conversion to open cholecystectomy. Methodology A retrospective records review was carried out. Records of all patients who underwent laparoscopic cholecystectomy from January 2008 till December 2009 in Hospital Raja Perempuan Zainab II (HRPZ II), Kota Bharu, Kelantan were reviewed and all risk factors were documented. Risks factors for conversion were analysed. Results Of 82 records reviewed, 11 (13.4%) require conversion to open cholecystectomy. Age, gender, co-morbidity and history of prior abdominal surgery were not statistically significant to the conversion rate. Fever, pancreatitis and ultrasound findings of thickened gallbladder wall or pericholecystic fluid collection were not associated with significant risk of conversion. There were significant associations between acute cholecystitis (p-value=0.06, adjusted OR=13.365) and stone in the common bile duct (p-value=0.07, adjusted OR=9.278) with conversion to open cholecystectomy. Conclusion Acute cholecystitis and presence of stone in the common bile duct were associated with higher incidence of conversion to open cholecystectom
Laparoscopic cholecystectomy at the Aga Khan Hospital, Nairobi
Objective: To evaluate our experience of laparoscopic cholecystectomies at the Aga Khan Hospital, Nairobi over a three-year period from the inception of the technique, and to assess its value and advantages to the patients.Design: A prospective case series study.Setting: The Aga Khan Hospital, Nairobi.Patients: One hundred and thirty five cases operated from February 1996 to April 1999. All patients were subjected to the American method of laparoscopic cholecystectomy, which is described in detail in this paper. Main outcome measures: Clinical presentation, age and sex demographics, average hospital stay, intraoperative and postoperative complications and outcome.Results: There was a female preponderance with a female to male ratio of 5:1. Mean age was forty nine years. Majority of patients suffered from chronic cholecystitis. The conversion rate to an open procedure was five per cent. There were two cases of significant bile leakage which required laparotomy. No mortality was reported in this series.Conclusion: This technique was found to have distinct advantages such as shorter hospital stay, lesser postoperative pain and very good cosmesis. It is a safe procedure if performed by a well trained surgeon
Gall bladder specimen histopathological findings after cholecystectomy
Background: Cholecystitis is a generally widespread problem in adult population. Multiple finding has been found in gross and microscopic examination of gallbladder. Existence of stones is one of the known causative factors that lead to histopathological changes in gallbladder. It is also responsible for the development of gallbladder carcinoma. The purpose of this study was to find out the histopathology of gall bladder specimens following surgical intervention.
Methods: This observational study included 116 patients admitted in the department of general surgery, PMCH, Patna with acute or chronic cholecystitis from August 2018 to July 2019. Written and informed consent was taken from all the participants. Data was analyzed using SPSS version 20.
Results: A total of 116 gallbladder specimens that presented for histopathological examination during the study period were included into the study, with male to female ratio of 1:3. The highest prevalence was found in the age group of 31-50 years. The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 93 (80.1%), acute cholecystitis in 17 (14.6%), and dysplasia was found in 5 (4.3%) patients, and gall bladder carcinoma was detected in 1 (0.8%) patients. On morphological analysis, the commonest gall stones were made up of cholesterol and the most common lesion was chronic cholecystitis by histopathology.
Conclusions: This study concludes that the chronic calculus cholecystitis was dominant in our population. It is assumed that routine histopathological examination following cholecystectomies essential for all gallbladder specimens even in the non-existence of macroscopic signs of carcinoma, which was the case in our patients
Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment
Epidemiological and clinical studies have found that gallstone prevalence is twice as high in women as in men at all ages in every population studied. Hormonal changes occurring during pregnancy put women at higher risk. The incidence rates of biliary sludge (a precursor to gallstones) and gallstones are up to 30 and 12%, respectively, during pregnancy and postpartum, and 1-3% of pregnant women undergo cholecystectomy due to clinical symptoms or complications within the first year postpartum. Increased estrogen levels during pregnancy induce significant metabolic changes in the hepatobiliary system, including the formation of cholesterol-supersaturated bile and sluggish gallbladder motility, two factors enhancing cholelithogenesis. The therapeutic approaches are conservative during pregnancy because of the controversial frequency of biliary disorders. In the majority of pregnant women, biliary sludge and gallstones tend to dissolve spontaneously after parturition. In some situations, however, the conditions persist and require costly therapeutic interventions. When necessary, invasive procedures such as laparoscopic cholecystectomy are relatively well tolerated, preferably during the second trimester of pregnancy or postpartum. Although laparoscopic operation is recommended for its safety, the use of drugs such as ursodeoxycholic acid (UDCA) and the novel lipid-lowering compound, ezetimibe would also be considered. In this paper, we systematically review the incidence and natural history of pregnancy-related biliary sludge and gallstone formation and carefully discuss the molecular mechanisms underlying the lithogenic effect of estrogen on gallstone formation during pregnancy. We also summarize recent progress in the necessary strategies recommended for the prevention and the treatment of gallstones in pregnant women
Cholecystectomy for Gallstone: Types and Findings
Gall stone disease remains a common and significant cause of suffering in most parts of the world. Gallstones are the most common biliary pathology. A descriptive study covered 80 patients underwent surgical treatment for gallstone diseases. Ultrasound study and plain abdominal X-ray were done to confirm the presence of gallstone. More than half of the sample 58.8% were in the oldest age group 50-69 year. Female were 68(85%) and the remaining 12(15%) patients were male. Most of patients 60(75.0%) operated upon by open cholecystectomy, laparoscope used in 18(22.5%). The main finding on exploring the abdomen was inflammatory adhesion in 54(67.5%) of the patients, thick wall gallbladder came next in 12 (15%) patients. Many complications and clinical findings associated with gallstone, some of them are serious other are even fatal. That is why cholecystectomy is highly indicated even for silent gallstone. Keywords: Gallstone, Jaundice, Cholecystitis, Surgery, Laparoscopy DOI: 10.7176/JHMN/71-09 Publication date: February 29th 202
Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy
Background: Laparoscopic cholecystectomy (LC) has been the favored technique for treating symptomatic cholelithiasis. LC has several benefits over the normal open cholecystectomy: negligible traumas, reduced pains, shorter hospitalization, acceptable cosmetic outcomes, rapid recovery, and back to work.Aim and objectives: The aim of this study was to identify the predictors of safe LC.Patients and methods: This prospective study was performed among 500 patients underwent LC who was attending to Al-Hussein Hospital, Al-Azhar University from January 2019 to June 2021. Cases with cholecystitis either acute or chronic, patients with age equal or more than 18 years old, and both sexes were included. While patients with age lower than 18 years old, patients with common bile duct (CBD) stone, pregnancy or patients with bleeding tendency history were excluded.Results: Upon assessing factors associated with postoperative complications of laparoscopic cholecystectomy, the male gender was statistically significantly correlated with complications while a non-significant change was found among complications and other sociodemographic variables. A significant association was found among WBCs, total bilirubin, ALT, AST, and complications while a non-significant association was found among gall bladder thickness and complications.Conclusion: In conclusion, this study evaluated the parameters that expect the complications in LC. Patient factors included male sex, leukocytic count, ALT and AST
Pre-operative predictors of difficult laparoscopic cholecystectomy and its correlation with post-cholecystectomy syndrome and its impact on quality of life in North Indian population
Background: Laparoscopic cholecystectomy (LC) is the most preferable surgical procedure worldwide. LC is not completely risk-free and 2 to 15% of attempted LC procedures have to be converted to open cholecystectomy. The aim of the study was to assess the predictors of difficult LC procedures and for knowing the impact of difficult LC procedures on post-cholecystectomy syndrome and quality of life of patients.Methods: A prospective observational study was conducted on patients who underwent LC. Clinical, demographic, radiological and biochemical parameters along with detailed history of patients were documented. Laparoscopic cholecystectomy was then done on patients using standard technique. Level of difficulty in LC procedure was assessed and graded. Occurrence of post-cholecystectomy syndrome was investigated and quality of patient’s life was assessed using SF-36 inventory.Results: The difficulty rate in LC procedure was observed to be 17.4%. The clinical predictors of difficult LC procedures were old age and prior history of abdominal surgery. Contracted gall bladder, peripancreatic fluid and thick gallbladder wall were radiological predictors and presence of adhesions, longer duration of surgery and conversion to open procedures were intraoperative predictors of difficult LC procedures. Early PCS was affected by difficult LC procedures; though with passage of time it reduced. Post-operative quality of life was affected more by PCS incidence than the difficult LC procedure.Conclusions: The findings of the study would help in anticipating predictors of difficult LC procedures and in understanding the phenomenology and determinants of PCS along with its relationship with operative difficulty and quality of life of patients
Fundus first laparoscopic cholecystectomy in patients with gall stone disease and the Fitz-Hugh-Curtis syndrome
Background: To present this experience using the fundus-first technique during laparoscopic cholecystectomy for the management of symptomatic gall stone disease with an intra-operative finding of Fitz-Hugh-Curtis syndrome.Methods: This is a prospective review of patients who had the fundus-first dissection during laparoscopic cholecystectomy. The study was carried out at the Jos University Teaching Hospital (JUTH), and FOMAS hospital, both of which are tertiary hospitals located in Jos. Patients were recruited from January 2017 - January 2019. All patients undergoing laparoscopic cholecystectomy who had an intraoperative diagnosis of Fitz-Hugh-Curtis syndrome, and who had the fundus-first dissection, were included in the study. Patients who had fundus-first dissection for indications other than Fitz-Hugh-Curtis syndrome, were excluded from the study. Demographic and clinical information of patients included age, sex, duration of surgery, complications, and duration of hospital stay. Descriptive statistics were applied.Results: A total of 76 patients had elective laparoscopic cholecystectomies over the study period. Of that number, 17 (22.4%) patients had an intra- operative diagnosis of Fitz-Hugh-Curtis syndrome, and had the fundus-first dissection. The mean patient age was 46.3 years (SD = 11.7 years). All patients were female. The mean operating time was 70 minutes (SD = 23 minutes). The duration of hospital stay was 24 hours. There was one conversion due to uncontrollable intraoperative bleeding.Conclusions: This study revealed that the fundus-first dissection is suitable for removing the gall bladder during laparoscopic cholecystectomy in patients with gall stone disease, and an intraoperative finding of Fitz-Hugh-Curtis syndrome
Cholecystitis in Pregnancy
Biliary tract disease is a relatively uncommon, heterogenous disease in pregnancy. Specifically,
acute cholecystitis can be especially difficult to recognize in pregnancy. However, once diagnosed,
the initial management plan should be conservative and include antibiotic therapy. Subsequent
management depends on the gestational age at diagnosis. Surgical therapy, when indicated,
should not be delayed and a planned intervention during the second trimester appears to offer a
better outcome than surgery performed under emergent conditions
- …