A Common Bile Duct Stone formed by Suture Material after Open Cholecystectomy

The use of non-absorbable suture materials for cystic duct ligation after cholecystectomy can expose patients to the risk of recurrent stone formation in the common bile duct (CBD). However, in Korea suture materials have rarely been found to act as a nidus for common bile duct calculus formation. Recently, we experienced a case in which suture material, that had migrated from a previous cholecystectomy site into the CBD, probably served as a nidus for common bile duct stone formation. The stone was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) and removed successfully using a basket. The authors report a case of surgical suture migration and discuss its subsequent role as a stone forming nucleus within the CBD in a patient who underwent open cholecystectomy; and include a review of the literature

A prospective comparative study on laparoscopic cholecystectomy vs open cholecystectomy

INTRODUCTION: Gall stone disease is common in India, that too affecting mostly middle age group men and women. The classical open cholecystectomy and the minimally invasive laparoscopic cholecystectomy are two alternative operations for removal of the gallbladder. There are no significant differences in mortality and complications between the laparoscopic and the open techniques. The laparoscopic operation has advantages over the open operation regarding duration of hospital stay and convalescence. With the advent of laparoscopic cholecystectomy the scenario of surgical management of cholelithiasis has changed drastically. It has opened new horizons in the management of gallstones. Theoretical benefits of laparoscopic approach include reduced hospitalization and cost, decreased pain, avoidance of large incision with improved cosmetic purpose and reduced post-operative recovery time with an early return to work. AIM OF THE STUDY: 1. To compare time taken for surgery. 2. To compare and discuss the various operative complications in both the surgery. 3. To compare the postoperative complications. 4. To compare postoperative hospital stay. 5. To compare pain duration in both surgeries. MATERIALS AND METHODS: My study is a prospective randomized study included 88 patients with gallstones, who were admitted to Thanjavur medical college and hospital from September 2016 to September 2017. The selection of procedure of open cholecystectomy or laparoscopic was decided depending up on the inclusion and exclusion criteria, exception when patient consent was not given for a particular procedure. Information was collected from the patients after a written valid informed consent from them. The study was approved by IEC. Patients between 20 years to 60 years with acute cholecystitis, or chronic cholecystitis and gall stones without pain abdomen, were included in the study. Patient’s written valid informed consent for the particular procedure was taken. Patients less than 20 years and more than 60 years or those with Gall bladder cancer and Choledocholithiasis were excluded. This study involved preoperative assessment, intraoperative practice and post-operative management and follow up till 3 months. All the patients were studied with reference to duration of surgery, post-operative analgesia, post-operative stay and morbidity, intra operative and post-operative complications. CONCLUSION: Minimally invasive surgery is better than open cholecystectomy in terms of postoperative pain, analgesic requirement, early return to work. However open cholecystectomy is preferred method for surgeons in beginning of their career and in case of difficult dissection and bleeding

Cystic Artery Variations and Associated Vascular Complications in Laparoscopic Cholecystectomy

Substantial knowledge of the arterial supply and its anatomical variations of the gall bladder and liver are important in all the hepatobiliary surgical procedures. The arterial supply of gallbladder called cystic artery (CA) is a vital structure required to get ligated or clipped in the path of laparoscopic cholecystectomy. The possible concerns like intra-operative bleeding or adjoining accidental injuries will almost always be focused on the research consisting of dissection and clipping with cystic artery. Pseudoaneurysm of the cystic artery has additionally been belonging to the presence of acute cholecystitis or pancreatitis. An original supply of CA is usually assessed depending on the existence of hepatic artery variants. Laparoscopic cholecystectomy is really a recent and arduous noninvasive procedure and might even result in substantial unintended effects possibly iatrogenic or in the form of post-procedural complications. The perfect knowledge of anatomy in addition to feasible variation of cystic artery is mandatory. An efficient operative strategy and consciousness are probably the key components with all the results and marginal likelihood of complications, which often can be ultimately attainable. Within this chapter, we have attempted to explore some variations of cystic artery, complications and management

Comprehensive Analysis of Complications and Outcome of Laparoscopic Cholecystectomy in K.A.P.V. Government Medical College & Hospital

INTRODUCTION: Gall stone disease is common in India, that too affecting mostly middle age group men and women. The classical open cholecystectomy and the minimally invasive laparoscopic cholecystectomy are two alternative operations for removal of the gallbladder in recent era. In my study I choose this topic as we post graduates and young surgeons of Government K.A.P.V Medical College who are in laparoscopic learning curve, under the guidance of professors and associate professors doing laparoscopic cholecystectomy and proposed for a comprehensive analysis of complications and outcome of Laparoscopic cholecystectomy and comparing the results with existing study. AIM OF THE STUDY: Our aim of the study is to analyse the complications and outcome of laparoscopic cholecystectomy in our teaching institution. Parameters discussed here are : 1. Technique of surgery, 2. Duration of surgery, 3. Complications of surgery, 4. Post-operative morbidity, 5. Analgesic and antibiotic requirements, 6.Hospital stay& 7. Return to work. METHODOLOGY: My study is a prospective randomized study included 60 patients with gallstones, who were admitted to K.A.P.V Medical College & Hospital within the period of 15 months. The selection of procedure was decided depending up on the inclusion and exclusion criteria, exception when patient consent was not given for a particular procedure. The study was approved by Ethical Committee. Duration of study: One year. Study design : Prospective study. Sample Size: 60 cases. Inclusion Criteria: Age between 25 to 70 years. USG confirmation of GB calculus without obstructive features. Cholelithiasis without choledocholithiasis or complications. Cholelithiasis without anomalous biliary tract. Exclusion Criteria: Age 70 years. Features of obstructive jaundice. Patient presenting with cholelithiasis and choledocholithiasis. Patient presenting with gallbladder Malignancy. Patient presenting with anomalous biliary tract. After proper pre-operative workup following the proposed guidelines, patients were studied with reference to duration of surgery, post-operative analgesia, post-operative stay and morbidity, intra operative and post-operative complications. CONCLUSION: As per the study data the laparoscopic cholecystectomy has advantages regarding duration of hospital stay and convalescence. Benefits of laparoscopic approach include reduced hospitalization, decreased pain, avoidance of large incision with improved cosmetic purpose and reduced post-operative recovery time with an early return to work

Controversial issues and new trends in elective laparoscopic cholecystectomy

Aims: The incidence of bile duct injuries (BDI) and symptomatic residual bile duct stones in patients undergoing elective laparoscopic cholecystectomy (LC) without routine use of intraoperative cholangiography (IOC) were studied. The appropriateness and long-term results of elective LC in the treatment of gallstone disease in the elderly patients were analyzed. The rate of abdominal symptom persistence after elective LC along with its dependence from preoperative symptom severity in uncomplicated gallstone patients was clarified. In addition, the feasibility and applicability of single incision laparoscopic cholecystectomy (SILC) in small-volume community hospitals were assessed. Patients and methods: Patient records of all 1,101 patients (mean age 53 years, range 15 - 89 years, 874 females and 227 males) who had elective LC for gallstone disease in Turku City Hospital for Surgery between 1992 - 2001 were retrospectively studied. Data concerning long-term outcomes were obtained with questionnaire sent to the available patients in 2004. Short- and long-term results of elderly patients (age ≥ 75 years, n = 80) were compared with the two younger age groups (< 65 years and 65 - 74 years, n = 80 in each). Recurrence rates of abdominal symptoms in patients who have had uncomplicated gallstone disease with severe (n = 380) and mild (n = 287) preoperative symptoms, were compared. The details and outcome of SILC in 51 consecutive patients were recorded and analyzed. Results: The incidence of BDIs was 0.5% (n = 5) and symptomatic residual bile duct stones 0.9% (n = 10). The mean hospitalization time and the rate of complications increased with the age of the patients. Eighty percent of patients aged ≥ 75 years were satisfied or very satisfied with the long-term results of the procedure. Thirty-seven percent of patients continued to have abdominal symptoms postoperatively (41% of patients with mild preoperative symptoms and 33% with severe symptoms, p = 0.052). Eighty-two percent of SILCs succeeded without conversion to multi-port or open surgery. No major intra- or postoperative complications occurred in SILC patients, but 10% of patients had postoperative wound infection. Conclusions: Both the incidence of BDIs and symptomatic postoperative bile duct stones remain low without the routine use of IOC. Also in elderly, elective LC seems safe and feasible operation with good long-term results. More than one third of the patients with uncomplicated gallstone disease experienced persistent symptoms after elective LC. Patients with mild preoperative symptoms may have more recurrences. SILC can be adopted without major complications in small-volume hospitals but the rate of wound infections seems to increase with the introduction of SILC.Kiistanalaisia kysymyksiä ja uusia suuntauksia elektiivisessä sappirakon tähystysleikkauksessa Tavoitteet: Tutkimuksessa selvitettiin sappitievaurioiden ja oireisten sappitiehyeiden jäännöskivien esiintyvyyttä potilailla, joille elektiivinen laparoskooppinen kolekystektomia oli tehty ilman rutiininomaista leikkauksenaikaista kolangiografiaa. Tutkimuksessa analysoitiin myös elektiivisen laparoskooppisen kolekystektomian soveltuvuutta ja pitkäaikaistuloksia iäkkäiden potilaiden sappikivitaudin hoidossa. Sen lisäksi selvitettiin vatsan alueen oireiden uusiutumista komplisoitumatonta sappikivitautia sairastavilla potilailla elektiivisen laparoskooppisen kolekystektomian jälkeen. Lisäksi, tutkimuksessa arvioitiin yhden portin kautta tehtävän laparoskooppisen kolekystektomian käyttökelpoisuutta ja sovellettavuutta aluesairaaloissa. Aineisto ja menetelmät: Tähän retrospektiiviseen tutkimukseen otettiin mukaan kaikki 1101 potilasta (keski-ikä 53 vuotta, vaihteluväli 15 - 89 vuotta, 874 naista ja 227 miestä), joiden sappikivitautia oli hoidettu elektiivisellä laparoskooppisella kolekystektomialla Turun kaupungin Kirurgisessa sairaalassa vuosina 1992 - 2001. Toimenpiteen pitkäaikaistuloksia selvitettiin vuonna 2004 lähetetyllä kyselyllä. Iäkkäämpien potilaiden (ikä ≥ 75 vuotta, n = 80) lyhyt- ja pitkäaikaistuloksia verrattiin kahteen nuorempaan ikäryhmään (ikä < 65 vuotta ja ikä 65 - 74 vuotta, n = 80 molemmissa ryhmissä). Komplisoitumatonta sappikivitautia sairastaneiden potilaiden vatsaoireiden uusiutumista sappileikkauksen jälkeen selvitettiin vertaamalla kahta potilasryhmää, joista toisessa ryhmässä leikkausta edeltäneet oireet olivat olleet voimakkaita (n = 380) ja toisessa lieviä (n = 278). Yhden portin kautta tehtävän laparoskooppisen kolekystektomian hoitotuloksia selvitettiin yksityiskohtaisesti 51:n peräkkäisen potilaan otoksella. Tulokset: Sappitievaurioiden esiintyvyys tutkimusryhmässä oli 0.5% (n = 5) ja oireisten sappitiehyeiden jäännöskivien esiintyvyys oli 0.9% (n = 10). Iäkkäämmillä potilailla keskimääräinen sairaalassaoloaika oli pidempi sekä komplikaatioiden määrä suurempi. Kuitenkin 75 vuoden ikäisistä tai sitä vanhemmista potilaista 80% oli tyytyväisiä tai erittäin tyytyväisiä toimenpiteen pitkäaikaistulokseen. Komplisoitumatonta sappikivitautia sairastaneilla potilailla vatsaoireet jatkuivat sappileikkauksen jälkeen 37%:lla potilaista (leikkausta edeltävästi lieviä tai voimakkaita oireita kokeneiden potilasryhmien välillä ei ollut tilastollista eroa). Yhden portin tekniikalla aloitetuista leikkauksista 82% onnistuttiin toteuttamaan ilman lisäporttien laittamista tai konversiota avoleikkaukseksi. Yhden portin menetelmällä hoidetuilla potilailla ei esiintynyt vakavia leikkauksenaikaisia tai leikkauksen jälkeisiä komplikaatioita, mutta 10%:lla näistä potilaista todettiin leikkauksen jälkeinen haavainfektio. Johtopäätökset: Sekä sappitievaurioiden että leikkauksen jälkeisten oireisten sappitiehyeiden jäännöskivien esiintyvyys pysyvät alhaisina ilman rutiininomaista leikkauksenaikaista kolangiografiaa. Iäkkäillä potilailla laparoskooppinen kolekystektomia vaikuttaa turvalliselta ja käyttökelpoiselta toimenpiteeltä, jolla saavutetaan myös hyvät pitkäaikaistulokset. Komplisoitumatonta sappikivitautia sairastavista yli kolmasosalla vatsaoireet eivät häviä elektiivisen sappileikkauksen jälkeen. Pysyviä oireita saattaa esiintyä enemmän potilailla, joilla leikkausta edeltävät vatsaoireet ovat olleet enimmäkseen lieviä. Yhden portin kautta tehtävä laparoskooppinen kolekystektomia soveltuu käytettäväksi aluesairaaloissa, eikä menetelmän käyttöönottoon liity vaikeita komplikaatioita vaikkakin haavainfektioiden määrä tuntui yhden portin tekniikka käytettäessä kasvavan.Siirretty Doriast

A comparative study between laparoscopic and open cholecystectomy in Chengalpattu Medical College

BACKGROUND: Gallstones occurrence is one of the commonest disease processes treated by general surgeon. In 1882 Carl Langenbuch performed the first cholecystectomy, enunciating a principal that the gall bladder needs to be removed not because it contains stones, but because it forms them. Over the years cholecystectomy has been the gold standard in the treatment of gall stone disease. Open cholecystectomy which had been performed unchallenged for over a century now faces an abrupt end with advent of laparoscopic cholecystectomy. In 1985 Philipe Mouret from France performed the first Human Lap Cholecystectomy. Patient acceptance, preference and demand for laparoscopic cholecystectomy is logical since this procedure gives less pain , need for less medication, far shorter hopitalisation and most important it permits an early return to family and normal work and activity. As an added bonus it has an excellent cosmetic result. Laparoscopic cholecystectomy further offers the long term benefit of negligible incidence of wound infection, incisional hernia, nerve entrapment and post operative adhesions. In the field of laparoscopy, laparoscopic cholecystectomy has been the first major surgery performed and has paved the path for laparoscopic intervention for other varied intra abdominal pathologies. So we will study both the techniques and their standing in present scenario. With the background of experience in open cholecystectomy we will commence our work on laparoscopic cholecystectomy. OBJECTIVES OF THE STUDY: 1. Comparative study of the duration of Surgery in both groups. 2. Comparative study of post operative hospital stay, drugs used, Time taken for return to work and Study of conversion rate to open surgery. 3. Comparative study of post-operative complications mortality and morbidity in both groups. MATERIALS AND METHODS: Source of data: Study is a prospective type which includes all patients admitted in Chengalpattu Medical College for elective cholecystectomy. Method of collection of data (including sampling procedure if any: Definition of a study subject: Patients admitted to Department of Surgery, Chengalpattu Medical College for Elective Cholecystectomy. The method of study consists of;- • Detail history taking & clinical examination as per the proforma. • Investigations after taking written informed consent. • Patients will be explained about types of surgeries available-laparoscopic or open cholecystectomy. • Intraoperatively careful note will be made about • Time latent for the procedure • Documentation of any complication encountered during procedure. • If laproscopic procedure converted to open cholecystectomy, reason for the same. • Post operative period will be divide into immediate or in hospital stay and follow up period during in hospital stay, following data will be collected: • Drain removal ,if put. • Post operative hospital stay. • Any complication if occurred. • Patients of both groups will be followed regularly up to 3 months. • Note will made of any complications, time taken to return to work and patients satisfaction. Inclusion criteria: 1. Patients with symptomatic gallbladder diseases 2. Symptomatic gallstones. 3. Acute or Chronic cholecystitis. 4. Mucocele/ Pyocele of gallbladder. Exclusion criteria: 1. Pregnancy. 2. Major bleeding disorder. 3. Cirrhosis with portal hypertension. 4. Generalised peritonitis. 5. Patient not fit for general anaesthesia. 6. Suspected gall bladder malignancy The following investigations will be done after taking written informed consent:- 1. Routine Investigations for General Surgical Procedure Blood Investigation and Urine Investigations :Hb%, TC , DC, Peripheral smear, ESR, Renal function tests, Liver function tests, Lipid profile, FBS/PPBS, HIV, HBsAg, , Urine for albumin, sugars, ketone bodies, microscopy, BT CT. Other investigations : X-ray of the chest, X-ray Erect Abdomen, Ultrasonogram of Abdomen, Serum amylase. In selected cases MRCP, ERCP, CT Abdomen CONCLUSION: The above study is to evaluate the superiority of laparascopic cholecystectomy over open cholecystectomy in Chengalpattu Medical College Hospital during the period September 2015 to October 2016

A prospective analytical study about common bile duct stones in Government Rajaji Hospital

Calculus disease of the biliary tract is one of the most common problems affecting the digestive tract .It accounts for more than 95% of calculus disease which include cholelithiasis and choledocholithiasis. Choledocholithiasis is associated in 10-15% of patients with cholelithiasis. Its incidence in India is increasing, due to the change in lifestyle and dietary modifications. Primary bile duct stones are of brown pigment type . Secondary bile duct stones are those migrating from the gall bladder and its major component is cholesterol variety. Clinically CBD stones present as biliary colic,jaundice,fever due to cholangitis and pancreatitis. AIMS & OBJECTIVES: To evaluate age,sex, incidence, various clinical presentations,various modes of management in our institution. MATERIALS & METHODS: Patients admitted in various surgical units of GRH, Madurai between September 2010- Nov.2011 encompass the materials of this study.A total of 58 patients with CBD stones included. They were subjected to detailed history, clinical examination ,LFT,USG abdomen. In selected patients, CT& MRCP done. Patients were managed surgically. They were followed for 6 months

A Clinical study and Management of Cholelithiasis

INTRODUCTION: Among the many distinguished names in Hindu medicine is that of SUSHRUTA, The Father of Indian surger. He compiled the surgical knowledge of his time in his classic ―Sushrata Samhitha. It is believed that this classic was compiled between 800 B.C. and 400 A.D. He described jaundice as-pitta-ashmarijanya‖ meaning a jaundice caused by stone in bile.1It was also known that such jaundice could be caused by wrong diet. 6% of prevelance gall stone was found in India. Diagnosis of gallstone is by proper history and physical examination and combining it with appropriate investigations. With the help of ultrasound we can easily identify gall stones. Because of increase incident of Gall stones and its variable presentations in there is a need for study which can provide prevalence, clinical presentations and management outcomes. AIM OF THE STUDY: 1. To study the age and sex distribution. 2. To study the various modes of presentation. 3. To study safety and efficacy of laparoscopic cholecystectomy in patients of cholelithiasis by comparing with results of open cholecystectomy by comparing use of post-operative analgesia, post-operative hospital stay, wound infection. METHODOLOGY: This dissertation titled as “A clinical study and management of cholelithiasis” is going to conduct at Govt. Royapettah Hospital, KMCH, Chennai-10 for a period of January 2018 to June 2018. About 53 consecutive cases will admit, examine, investigate and operate during the period of January 2018 to June 2018. Detailed history of all the 53 cases will take according to the profoma approved by the guide. Detailed history and examination and relevant investigations done. Risk and complications of the condition as well as surgery has been explain to the patients, concern will take. Preoperative antibiotics will give. In this study sum of the patients undergone open cholecystectomy and some of the patients undergone lap cholecystectomy. Postoperative pain were assessed by VAS. Patients who undergone lap cholecystectomy discharge on the 7th day and open cholecystectomy discharge on the 11th day. Unless any complications. All Patients advise regarding diet, rest and to visit the surgical OPD for regular follow up. In the follow up period attention were given to subject to improvement of the patients with regard to symptoms as well as examination of the operative scar. OBSERVATION: The age incidence of cholelithiasis was more in the 3rd, 4th & 5th decade, with peak incidence in 4th decade of life. 60.4% (32 Patients) were female and 39.6 % (21 Patients) were male. The female to male ratio was 1.52:1. Pain was the commonest presenting symptom presenting in 98% patients. Tenderness in the right hypochondrium was the most common sign present in 100%. The most common complication of cholelithiasis was chronic cholecystitis 80% .LC versus OC (18 cases in open and 35 cases in lap) and found that the mean operating room time was 104 min for OC and 88 min for LC. The conversion rate was 10.5%. The mean duration of hospital stay was 11 days for OC and 8 days for LC. The amount and period of analgesia were significantly less in the LC group. Patients recovered significantly faster after LC. CONCLUSION: The highest age incidence of cholelithiasis was in the 4th decade, even though no age group was exempt from the disease process. The incidence of cholelithiasis was more in females. The commonest symptom was pain and commonest sign was tenderness. The most common complication presenting with symptomatic gall stones was chronic cholecystitis. Laparoscopic cholecystectomy is a safe and effective treatment for most patients with symptomatic gallstones