Laparoscopic cholecystectomy: an experience at Lady Reading Hospital, Peshawar (original) (raw)
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Experience of Laparoscopic Cholecystectomy at Lumbini Medical College Teaching Hospital
Journal of Lumbini Medical College, 2013
Introduction: The difficult gallbladder is the most common difficult laparoscopy being performed by general surgeons all over the world and the potential one that places the patient at significant risk. The present study aimed to study all the cases of laparoscopic cholecystectomy conducted in current setup at Lumbini Medical College and Teaching Hospital, to compare the results with the published literature and also analyze the complications and ways to decrease the incidence of conversion to open procedure. Methods: Five hundred twenty five patients age 10-90 years, male:female ratio of 1:3.86 with body weight 45-65 kilogram, who had undergone laparoscopic cholecystectomy for symptomatic cholelithiasis without choledocholithiasis from April 2011 to April 2013 were studied. Results: All the laparoscopic cholecystectomy (LC) were without major complications. Only nineteen out of five hundred twentyfive (3.6%) required conversion to open cholecystectomy (OC). Reasons for conversion included: dense omental or visceral adhesions; two (0.38%), unclear anatomy; 16 (3.04%), common bile duct injury; one (0.19%). There were 20 cases of shrunken gallbladder suspicious of malignancy but didn't required conversion. Conclusion: Laparoscopic cholecystectomy is the preferred method in our setup even in difficult cases.
Laparoscopic cholecystectomy: experience at a tertiary level hospital
Journal of Ayub Medical College, Abbottabad : JAMC
Cholecystectomy is the most frequently performed abdominal operation and currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in 90% cases of symptomatic gallstones in USA since 1992. The aim of the study was to determine results obtained with LC at our setup. This observational case series study was conducted in department of General Surgery, Combined Military Hospital, Rawalpindi, from August 2009 to August 2011. The study participants were patients of both gender aged 14-75 years undergoing LC. Surgery was performed by consultant as well as resident surgeon. Demographic variables, intraoperative findings, mean operation time, hospital stay, conversion rate, morbidity and mortality were evaluated. Factors influencing rate of conversion were also studied. A total of 504 patients were included. Mean age was 42.64 years (range 14-75 years) with a female: male ratio of 3.9:1.2. Comorbidities were found in 36.7% patients. Main indication of surgery wa...
An Audit of Laparoscopic Cholecystectomy
Objective: To evaluate the morbidity and mortality rates in laparoscopic cholecystectomy. Material and Methods: This retrospective descriptive study was carried out in surgical "D" ward Khyber Teaching Hospital, Peshawar, from December 2012 to December 2014 in which 233 patients after fulfilling the inclusion and exclusion criteria with symptomatic gallstones disease were enrolled. Demographics, complications of surgery and conversion to open were reviewed from clinical notes and noted on a pre-designed proforma. Data were analyzed using SPSS version 16 and results compared with other studies. Results: A total of 233 patients were studied during the audit period. Of these 41(17.6%) were males and 192(82.4%) were females. Mean age of patients was 36.56±11.32 years. Mean operating time was 56.57±13.95 minutes. Complications encountered during the study include conversion to open cholecystectomy 2 (0.9%), epigastric port site bleeding 3 (1.3%) and port site infection 6(2.5%). Mean hospital stay was 3.37±2.27 days. There were no cases of umbilical port hernia, bile duct or colonic injury. No mortality was observed in our study. Conclusion: The various data collected during the audit suggest that the results of laparoscopic cholecystectomy carried in our unit are satisfactory.
International Journal of Research in Medical Sciences, 2015
Background: Laparoscopic cholecystectomy has now become a better option instead of open cholecystectomy for the treatment of cholelithiasis that is it has become a gold standard for cholelithiasis condition. Last century has been the most fruitful era for the treatment of biliary tract disease as it saw the progress from open to laparoscopic surgery with single port surgery etc. Methods: The purpose of our study is grading of Laparoscopic cholecystectomy and studying the outcome of problematic and challenging Laparoscopic cholecystectomy cases, its complication and management, to decide when to convert Laparoscopic cholecystectomy to open cholecystectomy. This study analyzes the conversion rate of laparoscopic cholecystectomy to open cholecystectomy in Navi Mumbai, India. This is a retrospective study of 100 patients conducted from October 2012 to October 2014. Results: Out of the 100 cases 98 got successfully operated by Laparoscopic cholecystectomy. Only 2 cases out of 100 got converted from Laparoscopic to open cholecystectomy and they belonged to grade E with empyema. Conclusions: Laparoscopic cholecystectomy has become the procedure of choice for management of symptomatic gall bladder. Laparoscopic cholecystectomy intra operatively for grade A to E where Grade A is very easy level of performing Gall bladder surgery to Grade E where conversion is 100% due to bad.
Pakistan Armed Forces Medical Journal, 2016
Objective: To assess the rate and causes of conversion of laparoscopic to open cholecystectomy (OC) in 450 patients who underwent laparoscopic cholecystectomy (LC) by the same surgeon in tertiary care teaching hospitals. Study Design: Descriptive study. Place and Duration of Study: The study was conducted initially at Pakistan Navalship (PNS) Shifa, Karachi and later at Combined Military Hospital, Lahore from November 2009 to June 2013. Material and Methods: All the patients of both genders and of any age group, undergoing LC for gall bladder pathology whether acute or chronic, acalculous or calculous were included in this study by convenient sampling. The exclusion criteria were choledocholithiasis, malignancy, and patients who willingly opted for open cholecystectomy. All the patients were operated by the same experienced laparoscopic surgeon. The number and sizes of the ports varied from patient to patient and was on the choice of the operating surgeon. A detailed proforma was fi...
Objective: The objective of this study is to determine the per-operative factors responsible for difficulty in performing laparoscopic cholecystectomy and lead to conversion. Study Design: Prospective analysis study. Place and Duration of study: This study was carried out in General Surgery Department of Dow University Hospital Ojha Campus and Civil Hospital Karachi, from Jan 2011 to July 2012. Methodology: This study consisted of one hundred & forty six patients with gallstone disease. All patients had full clinical examination and right hypochondrium was especially examined for assessment of murphy's sign, palpable mass and visceromegaly. Base line and specific investigations were done in all patients especially ultrasound of abdomen as diagnostic modality and for assessment of gallstone disease. Inclusion criteria was that all patients diagnosed as case of gallstone disease. LC procedure was not attempted in patients with history of abdominal surgery, pregnant ladies due to risk of foetal loss, carcinoma of gall bladder acute pancreatitis, obstructive jaundice and unfit patients for general anesthesia. Results: Out of 146 patients included in this study 133 were female (91%) and 13 male (9%); with female to male ratio of 10.2:1. The mean age was 39.21+6.20 years. Per Operative findings were adhesions in calot's triangle 24(16.43%) cases, severe & tight adhesions around gallbladder and calot's triangle 21(14.38%) cases, obscured anatomy in calot's triangle 17(11.64%) cases, intrahepatic gallbladder 11(7.53%) cases, adhesions around gallbladder 26(17.80%) cases, empyema 13(8.90%) cases, mucocele 9(6.16%) and anatomical variation 14(9.58%) cases. We observed out of 21 patients who had Severe & tight adhesions around gallbladder and calot's triangle, lead to difficulty in performing laparoscopic cholecystectomy in 11(52.38%) cases followed by 17 cases of obscured anatomy in calot's triangle and 14 cases anatomical variation also lead to performing difficult laparoscopic cholecystectomy in 6(35.29%) and 5(35.71%) cases respectively. Four (2.73%) cases out of 146 had to be converted to the open cholecystectomy procedure. Conclusions: We conclude our study revealed that various peroperative factors which make the difficult laparoscopic procedure and lead to open cholecystectomy are severe adhesions in calot's triangle, severe & tight adhesions around gallbladder and obscured anatomy in calot's triangle
Laparoscopic Cholecystectomy: An Early Experience at A Tertiary Care Hospital in Islamabad
Journal of Community Medicine and Public Health Reports, 2020
Background: Laparoscopic Cholecystectomy first introduced in 1987, is becoming more and more popular and now it has become gold standard in symptomatic gallstone disease. The current descriptive study is carried out in Department of General Surgery, Ayub Teaching hospital, Abbottabad to evaluate the result of Laparoscopic Cholecystectomy in symptomatic gallstones disease in our set up with special emphasis on complication rate, morbidity and mortality. Methods: The data of all patients who underwent Laparoscopic Cholecystectomy form January to December 2007 was entered in standardized proforma and analysed on SPSS 10. Results: Out of 60 patients, 51 (85%) were female and 9 (15%) were males; the age range from 17 to 65 years mean age being 40.30 years, majority were in age 30-40 years group. Two (3.3%) patients had bile leak, 1 (1.3%) patient developed port site wound infection 1 (1.3%) patient developed collection in pouch of Morrison and in 1 (1.3%) patient stone were recovered from the epigastric port site wound. There was no bile duct or colonic injuries. The conversion rate was 5%. There was no mortality. Conclusion: Laparoscopic cholecystectomy is a safe and effective treatment for gall stone disease and is up to the accepted standard in our set up as compared to national and international data.
Today Laparoscopic cholecystectomy has replaced open cholecystectomy as the 'gold standard' in treatment of patients with symptomatic cholelithiasis. Advantages being relatively less pain, early ambulation, shorter hospital stay and lower incidence of incisional hernia. The condition of the patient, the level of experience of the surgeon, and technical factors all can play a role in the decision for conversion. This study was conducted in an effort to determine the conversion rate and also identify the factors responsible for conversion of laparoscopic cholecystectomy to open cholecystectomy. Hence, these findings will allow us to preoperatively discuss the higher risk of conversion and allow for an earlier judgement and decision on conversion if intra-operative difficulty is encountered. This was a prospective clinical study consisting of 112 patients undergoinglaparoscopic cholecystectomy. All patients were admitted in Bankura Sammilani Medical College and Hospital from June 2014 to May 2015. Data was collected by meticulous history taking, careful clinical examination, appropriate radiological, haematological investigation, operative findings and follow-up of the cases. In conclusion, laparoscopic cholecystectomy is a safe and minimally invasive technique, with only low conversion rate and the commonest cause of conversion in this study was the presence of dense adhesions at Calot's triangle
Laparoscopic Cholecystectomy: An Initial Clinical Experience at Faridpur District
Journal of Current and Advance Medical Research, 2015
Background: Laparoscopic cholecystectomy quickly emerged as an alternative to open cholecystectomy. However its safety, efficacy, and morbidity have yet to be fully evaluated. Objective: The purpose of the present study was to determine the efficacy and safety of laparoscopic cholecystectomy Procedure in the removal of gall bladder stones at Faridpur district-one of the remote district of Bangladesh. Methodology: A prospective, nonrandomized, open label Consecutive study was carried out at Faridpur district using laparoscopic cholecystectomy (LC) procedure for the symptomatic treatment of Gall bladder stones. For this purpose a total number of 145 patients having conclusively diagnosed as gall bladder stones were enrolled. LC procedure was performed by North American technique-a well established and standard procedure described earlier for the purpose. The key variables studied were average operating room time, condition of the gall bladder, the presence or absence of stones, the character of stones, post-operative complicates and duration of hospital stay. Result: The study revealed that among 145 patients 83.4% were female with an average age of 40.3 years. The average operating time required was 130 minutes. Gall bladder was thickened but was free from adhesion in 96.5% cases and stones' only 3.45% patients needed open method due to fibrosis and adhesion of the gall bladder with omentum and gut. The duration of hospital or clinic stay following LC was 3.5 days. Evidence of infection like fever, pain etc. was seen only in 2.75% cases. Bleeding was present in 2.06% cases. This was corrected after blood transfusion. No injury to the common bile duct or any of the bile duct or any of the blood vessels was observed. Similarly no evidence of malignancy was seen in any of the gall bladder removed. Conclusion: The present study concludes that laparoscopic cholecystectomy is a safe, minimal invasive, cost-effective and safe procedure for the symptomatic treatment of gall bladder stones.
Pakistan Armed Forces Medical Journal, 2020
Objective: To compare the morbid anatomy and iatrogenic problems and complications encountered during laparoscopic cholecystectomy (LC) in both genders. Study Design: A cross sectional analytical study. Place and Duration of Study: The study was conducted at Pakistan Air Force Hospital, Islamabad, from May 2017 to Jan 2019. Methodology: All patients who underwent LC during our study period were included in the study. A predesigned proforma was used to record data. The cases were divided into two groups based on gender. The parameters studied for each group included appearance of gallbladder, intra operative bile leakage, requirement of hemostatic procedure, spillage of stones, multiplicity of stones i.e. single vs. multiple, operative time and need of drain placement. Results: A total of 120 patients were included in the study. There were 21 (17.5%) male and 99 (82.5%) female subjects. The mean age was 43.66 ± 13.8 years with range of 11-74 years. Normal looking gallbladder was more...