Laparoscopic Cholecystectomy-Analgesia Research Papers - Academia.edu (original) (raw)

2025, Journal of the Egyptian Society of Parasitology

Laparoscopic cholecystectomy is the "gold standard" in the treatment of symptomatic gallbladder lithiasis. Nevertheless, some pitfalls are associated with the use of the monopolar hook, such as the risk of thermal injuries and biliary complications. The present study assessed the efficacy of the Liga-Sure Vessel Sealing System (LVSS) when used for cystic duct closure during laparoscopic cholecystectomy. The laparoscopic cholecystectomy was done beginning with visualization of Calot's triangle, and dissection of Calot's triangle was achieved using a monopolar cautery device. Once the cystic duct was exposed, sealing was performed and divided using the LVSS. The records were compared with those of patients undergoing laparoscopic cholecystectomy with closure of the cystic duct with clips during the same period. The results showed that during the study period, 218 laparoscopic cholecystectomies were performed; 82 of these were performed with the Liga-Sure. The work was experienced a single case of bile leakage from the cystic duct due to missed stone in the common bile duct that was managed using ERCP.

2025, BioMed Research International

Background. Postoperative nausea and vomiting (PONV) is one of common complications in patients undergoing laparoscopic cholecystectomy (LC). Aim of this study was to compare the efficacy of subhypnotic (1 mg/kg/h) infusion of propofol with dexamethasone on PONV in patients undergoing LC.Methods. A total of 120 patients were included in this randomized, double-blind, placebo-controlled study. Patients were randomly assigned to 3 groups; patients of group dexamethasone (group D) were administrated 8 mg dexamethasone before induction of anesthesia, patients of group propofol (group P) were infused to subhypnotic (1 mg/kg/h) propofol during operation and patients of group control (group C) were applied infusion of 10% intralipid. The incidence of PONV and needs for rescue analgesic and antiemetic were recorded in the first 24 h postoperatively.Results. In the 0–24 h, the incidence of PONV was significantly lower in the group D and group P compared with the group C (37.5%, 40%, and 72.5...

2025, Turkish Journal of Surgery

2025, Journal of Hepatology and Gastrointestinal disorders

Introduction: Bile stone is the main cause of acute pancreatitis (AP) and one of the few etiologies that can benefit from specific and curative treatment. The purpose of our work is to evaluate our experience of endoscopic treatment of acute biliary pancreatitis. Retrospective study performed in the hepatogastroenterology "C" department of Ibn Sina hospital in Rabat, we included patients who had acute biliary pancreatitis and endoscopically treated. We included 42 patients, the women/man sex ratio=3.2, the mean age was 51.5 years. A history of acute pancreatitis (AP) was reported in 8 cases and cholecystectomy in 15 cases. Arguments for retaining biliary origin were cytolysis greater than 3 times normal in 18 cases, presence of retentional jaundice in 4 cases, cholangitis in 3 patients, primary biliary stone on ultrasound in 8 cases and choledochal dilatation without obstacle image in 15 cases. Bili-MRI was performed in 6 patients with confirmation of biliary origin in 2 patients. The degree of severity of AP was Balthazar stage A in 14 cases, stage B in 7 cases, stage C in 4 cases and E in 6 cases. In 7 cases severity was not specified. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stone image in 17 cases, dilatation of the bile duct in 31 cases. Stone extraction was successful in 38 patients. Sphincterotomy was performed in 34 cases, of which 4 cases benefited from placement of pancreatic or biliary prosthesis. Immediate complications are marked by a minor bleeding stopped spontaneously. In patients with gallbladders in place, a cholecystectomy was scheduled in the subsequent ERCP. The endoscopic treatment of acute biliary pancreatitis in our experience, proved its efficacy without added morbidity.

2025, The American Surgeon

Chylous ascites is a rare complication after many abdominal procedures. It has never been reported after laparoscopic cholecystectomy. We describe a 31-year-old female who presented 2 weeks postoperatively after laparoscopic cholecystectomy with abdominal distention and pain. A percutaneously drained abdominal fluid collection revealed chylous ascites. Lymphoscintigraphy demonstrated extravasation at the level of the hepatic fossa. At laparoscopic exploration, a chylous leak within the gallbladder fossa was controlled with suture ligation and fibrin glue with immediate resolution of the leak. This demonstrates a novel, minimally invasive technique for control of a previously unreported complication after laparoscopic cholecystectomy.

2025, Texila International Journal of Public Health

Laparoscopic cholecystectomy (LC) is the preferred surgical approach for treating gallstone disease; however, there are cases that pose significant challenges, often leading to a switch to open surgery. This study aims to identify preoperative indicators that suggest a difficult laparoscopic cholecystectomy (LC), focusing on demographic factors, inflammatory markers, and intraoperative challenges. A prospective study was performed on patients diagnosed with acute or chronic cholecystitis, examining factors such as gender, age, diabetes mellitu), CRP, ESR, and TC. The findings revealed a strong association between male gender, older age, and diabetes mellitus with surgical complications (p = 0.001). CRP, ESR, and TLC were significantly linked to intraoperative challenges and the need for conversion to open surgery. The severity grade of the Tokyo Guidelines (TG-13) was substantially associated with surgical difficulty (p = 0.001). These findings points out the significance of preoperative evaluation in recognising high-risk patients, facilitating enhanced surgical planning and improved patient outcomes. Nevertheless, constraints such as a single-center design and retrospective data collecting require more multi-center prospective research to improve predictive accuracy and investigate sophisticated imaging and biochemical indicators for enhanced risk stratification.

2025, Archives of Pediatrics & Adolescent Medicine

Abdominal ultrasonography was performed on 305 children with sickle cell disease (SCD) (285 SS and 20 S-beta-thalassemia) to establish the prevalence of cholelithiasis in Saudi children with SCD. Their ages ranged from 1 to 18 years (mean 10.45 years). Gallstones were demonstrated in 60 children, giving a prevalence of 19.7%. An additional 50 patients (16.4%) had only biliary sludge. The youngest patient with gallstones was 3 years old. There was a correlation between the presence of gallstones and increasing age. Patients with gallstones were also found to have higher serum bilirubin levels, but their hemoglobin, hematocrit, reticulocyte count, hemoglobin S, and hemoglobin F levels were not significantly different from those of patients without gallstones.

2025, Journal of Ayub Medical College, Abbottabad : JAMC

The aim of this study was to determine the financial costs to institution on patients waiting for gall bladder disease surgery and suggest measures to reduce them. This multi-centre prospective descriptive survey was performed on all patients who underwent an elective cholecystectomy by three consultants at secondary care hospitals in Pakistan between Jan 2010 to Jan 2012. Data was collected on demographics, the duration of mean waiting time, specific indications and nature of disease for including the patients in the waiting list, details of emergency re-admissions while awaiting surgery, investigations done, treatment given and expenditures incurred on them during these episodes. A total of 185 patients underwent elective open cholecystectomy. The indications for listing the patients for surgery were biliary colic in 128 patients (69%), acute cholecystitis in 43 patients (23%), obstructive jaundice in 8 patients (4.5%) and acute pancreatitis in 6 patients (3.2%). 146 (78.9%) and 3...

2025

Introduction: Laparoscopic cholecystectomy at the time of cesarean section is novel in medicine. It is safe, feasible, and cost-effective. Case reports: A 29-year-old G3P2+0 woman had two previous cesarean sections. She was pregnant at 32 weeks. The fetus had anencephaly. She had acute cholecystitis. Laparoscopic cholecystectomy done at the time of termination of pregnancy by cesarean section Discussion: Laparoscopic surgery seems to be safe at the time of a cesarean section. It enables the surgeon to perform surgery through small incisions, lowering the risks of surgical infection, blood loss, and incisional hernia. Conclusion: As long as the surgeon is highly qualified and experienced, the combination of laparoscopic cholecystectomy immediately post cesarean section in a critical period as acute cholecystitis is effective.

2025

Despite the benefits of laparoscopic cholecystectomy, the incidence of bile duct injury has increased significantly over the years from a range of 0.1 to 0.2% during the era of open cholecystectomy to a range of 0.4 to 0.6 % in the era of laparoscopic cholecystectomy and 0.72% per year in single-port cholecystectomy. Mostly interventions of prevention or safety alone have failed to achieve adequate implementation and results in terms of injury to the line biliary tract have remained almost unchange. Nothing is further from reality that aims to reestablish infallible formulas for the prevention of surgical injuries to the bile duct. Perhaps one of the most important principles is to keep in mind that any surgeon can present them. Only from this premise, the recommendations of the high security and the 7 intraoperative manuevers can be useful for a secure cholecystectomy, it is certain that together with a structured and competency-based teaching-learning process, the rate of surgical disruption of the bile duct can further decrease.

2025, Pakistan Armed Forces Medical Journal

Objective: To observe the effects of topical Gentamycin as a prophylactic measure to control post-operative port site infection after bile spillage during gall bladder retrieval in patients undergoing laparoscopic cholecystectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi, from Feb to Aug 2019. Methodology: The study population comprised 80 patients (divided into two groups) diagnosed with cholelithiasis and underwent elective laparoscopic cholecystectomy. Seven surgeries were converted into open cholecystectomies, and bile spillage was recorded in 42 patients who underwent uneventful surgery. These patients were then examined for 30 days to evaluate port site infection. Results: It was seen that EPSI was more common in patients in the fourth decade of their life even after Gentamicin prophylaxis 6 (14.29%). A deeper analysis of the study showed that EPSI was more common in patients with Class-I obesity and their ...

2025, British Journal of Surgery

BackgroundThe optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a ‘delayed’ operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease.MethodsUsing data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost–utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impac...

2025, Cirugía Española

Colecistectomı ´a laparosco ´pica Puerto u ´ nico Cirugı ´a sin huella Agujas percuta ´neas Laparo endoscopic single site Cirugı ´a endosco ´pica transluminal a trave ´s de orificios naturales r e s u m e n Introduccio´n: Se analiza la utilidad de agujas percuta ´neas (AP) sustituyendo puertos de asistencia tradicionales en te ´cnicas miniinvasivas de puerto u ´ nico, mostrando su factibilidad al realizar colecistectomı ´a laparosco ´pica con un puerto (CL1P). Material y me´todos: Estudio retrospectivo, lineal y descriptivo de 2.431 pacientes intervenidos de CL1P, por enfermedad vesicular aguda y no aguda utilizando algu ´ n tipo de AP, sustituyendo los puertos asistenciales usados en colecistectomı ´a laparosco ´pica tradicional (CLT). Basado en el uso progresivo de AP: riendas (R), aguja-gancho (AG) y aguja pasa hilos (APH) al desarrollar la te ´cnica CL1P, dividimos 3 grupos: A, B y C. Se compararon resultados utilizando T de student, odds ratio e IC, analiza ´ndolos mediante SPSS 13.0. Resultados: El uso de las AP mostro ´incremento en la factibilidad del procedimiento laparosco ´pico, conforme se integraron en la te ´cnica quiru ´ rgica. Las R tuvieron factibilidad de realizar CL1P en 78% de los casos, integrando AG aumento ´a 88% y utilizando R, AG y APH en 96%. Hubo significacio ´n estadı ´stica con valores: Ji 2 de 67,13 y p < 0,001; odds ratio e IC (95%) obtuvieron significacio ´n comparando grupos B/C, A/C y A-B/C. Conclusiones: Las AP, sustituyendo puertos asistenciales, permiten alcanzar factibilidad del procedimiento en el 96% de los casos, semejante al que se logra con la CLT, lo cual coloca a la te ´cnica CL1P como una alternativa ventajosa y econo ´mica. Esta aplicacio ´n de las AP podrı ´a ser extensiva a otras te ´cnicas de puerto u ´ nico, con plataforma multivalvular, y a la cirugı ´a por orificios naturales.

2025

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. Conversion to an open procedure is necessary in 5-10% of patients. The aim of work: The present study was to illustrate the incidence of conversion of laparoscopic cholecystectomy to open cholecystectomy & to validate the efficacy of "CLOC" (Conversion from Laparoscopic to open cholecystectomy) risk scoring system on the patients included in the study. Patients and methods: The present observational prospective study was conducted in EL-Demerdash Teaching Hospital (January 2019-January 2020). The study included (100) symptomatic cholelithiasis patients. Patients were divided into two groups, firstly those who completed laparoscopic cholecystectomy and secondly those who were converted into open cholecystectomy. Preoperative variables included patient demographics, indications for surgery, ASA grade, admission type, ultrasound findings and preoperative endoscopic retrograde cholangiopancreatography (ERCP). Validation of the "CLOC" scoring system was applied to all patients. Operative data were gathered prospectively, and the difficulty of the procedure was graded using the Nassar scale (grades 1-4). Results: (24%) of patients recorded difficult total score; open surgery was conducted in (5%). There was statistically significant relation between CLOC risk scoring level and age (p<0.001); indication (p=0.002); ASA (p=0.002); gallbladder wall thickness. (p<0.001) and preoperative ERCP patients (p=0.003). There was statistically significant increase in difficulty in male compared to female. (p=0.019). There was actual conversion according to groups with 'high risk scoring >7 and conversions in the' low risk >6 easy' group below. (p=0.042); highly statistically significant increase of mean in difficult group compared to essay group (p<0.001). The difficult group complications rate was higher than the easy group (75% versus 10.5%); gallbladder rupture was mostly reported in (37.5% and 2.6%) of difficult group and easy group cases, respectively. Receiver operating characteristics (ROC) curve sensitivity was 92%; specificity was 98.7%. Age, gender, indication, ASA, gallbladder wall and Pre-Operative ERCP have a significant effect on the difficulty. Conclusion: The present study could conclude that parameters as older age, male gender, cholecystitis, ASA, thick wall GB, preoperative ERCP are predictors for difficult LC. Meanwhile these

2025

Název: Ventilačně-respirační změny a difuze plynů v simulované sněhové lavině. Cíle práce: Cílem této práce bylo sledování různých ventilačně-respiračních parametrů při dýchání v simulované sněhové lavině se vzduchovou kapsou a bez ní. Metoda: Intervenční, dvojitě zaslepená randomizovaná studie se zkříženým designem byla provedena u 12 mužů, studentů Vojenského oboru při Fakultě tělesné výchovy a sportu University Karlovy. Měření probíhala v Krkonoších od 14. do 18. 1. 2013, v nadmořské výšce 762 m.n.m. Každý z dobrovolníků, který se zúčastnil studie, byl v náhodném pořadí podroben dvěma fázím experimentu: 1. fáze "AP" - dýchání do vzduchové kapsy s objemem 1 L a 2. fáze "NP" - dýchání do sněhu bez vzduchové kapsy. V průběhu experimentu byly zaznamenávány různé fyziologické parametry, zejména frakce vdechovaného a vydechovaného O2 a CO2, periferní saturace krve kyslíkem a dechová práce (WoB), vyjádřená pomocí Pressure-Time Product (PTP). Výsledky: Přítomnost vzdu...

2025, IJSR

MIS has rapidly evolved as a major speciality since laparoscopic cholecystectomy was rst performed in March, 1985 by
Prof. Muhe, in Germany1. Although it offered many advantages over laparotomy, new concerns arose regarding the effects of a pneumoperitoneum
onvarious organ systems. Renal venous pressure, hydrostatic pressure and glomerular ltration rate was adversely affected by
pneumo-peritoneum. However, expansion of the extracellular volume can be benecial to renal function2,3,4. This study is a cross-sectional
prospective study, conducted in a series of 60 cases of chronic calculus cholecystitis admitted at Rajendra Institute of Medical Sciences, Ranchi.
Aim of the study : To observe preoperative and post operative renal functional status in patients undergoing laparoscopic cholecystectomy and
evaluate the usual time required for return of deranged renal function , if any, to normal levels.
It was observed that the amount of urine output was distinctly less in LC during pneumo-peritoneum. However diuresis commenced soon after
deation of pneumo-peritoneum and normal urine output was resumed within 2 hours of postoperative period. These observations can also be
appreciated in a study carried out byAnna –Maria koivusalo et al which showed decrease in urine output during pneumoperitoneum and diuresis
started about 60 minutes after deation5.

2025, Revista Mexicana de Pediatría

niños generalmente es médico, pero en ocasiones es necesario recurrir a la cirugía. A este respecto la cirugía laparoscópica aún no se ha considerado que sea el tratamiento de elección en los niños, aunque es una buena opción, con ventajas respecto a la cirugía convencional. 4,5 Aquí se informa el caso de una niña de cuatro años de edad que presentó un hidrocolecisto como complicación inmediata de un reimplante ureteral, la que fue tratada por laparoscopía. CASO CLÍNICO La niña tenía en su historia médica que padecía de pie equino varo, que fue corregido mediante varias inter-RESUMEN El hidrocolecisto es una variedad anátomo-clínica de la colecistitis, rara en niños. Sus manifestaciones clínicas son principalmente: dolor abdominal en el cuadrante superior derecho, hipersensibilidad abdominal generalizada, vómitos, masa palpable y fiebre. Predomina en el sexo masculino y se encuentra desde recién nacido hasta la adolescencia. El ultrasonido es el procedimiento electivo de diagnóstico y con éste generalmente se confirma este padecimiento en los niños. Su manejo es médico, pero hay casos que requiere cirugía. La cirugía laparoscópica colecistectomía es una buena opción de tratamiento por su seguridad y los resultados: por disminuir la respuesta neuroendocrina al trauma quirúrgico, el dolor, el miedo del paciente y su familia a la intervención: por permitir el reinicio temprano de la vía oral, una mejor recuperación postoperatoria y menor tiempo de estancia hospitalaria. En el año 2005 publicamos nuestra experiencia en un caso de hidrocolecisto en un preescolar, que fue tratado por laparoscopía, en esta ocasión presentamos otro caso similar tratado con éxito por una vía mini-invasiva, pero con distintas características clínicas: por haber presentado un hidrocolecisto como complicación inmediata de un reimplante ureteral.

2025, JPMA. The Journal of the Pakistan Medical Association

To evaluate the outcome of undertaking out-patient laparoscopic cholecystectomy (OLC) and identifying its predictive failures. One hundred and forty-nine consecutive patients with symptomatic cholelithiasis scheduled for preplanned elective laparoscopic cholecystectomy (LC) from August 2004 to December 2006 were included in the study. Patients with associated severe diseases, ASA class III and IV who would have required post operative surgical care, residents of remote areas and other surgical reasoning were entered in Inpatient's Laparoscopic Cholecystectomy (ILC) group (n = 57) and others were enrolled in OLC group (n = 87). Five patients converted to open surgery and thus were excluded from the study. All patients were recruited during the initial outpatient visit and the full preoperative details were explained to them. All of the related factors of OLC were recorded in every visit. Significant differences were evaluated using Chi-square and fisher exact test. Eighty seven p...

2025, West Indian Medical Journal

The first world witnessed a laparoscopic revolution in the 1990s. At the start, laparoscopic surgery was heavily criticized and ridiculed. Despite this, the specialty has blossomed where almost any procedure can be done laparoscopically with the now obvious tremendous benefit to the patients. The objective of this paper is to examine where the Caribbean is placed relative to the rest of the world in terms of laparoscopic surgery and to understand why we are here. The literature written on laparoscopy in the region was reviewed and contributions were taken from key surgeons in three main islands, Trinidad and Tobago, Barbados and Jamaica. Results: Though the first laparoscopic cholecystectomy in the Caribbean, in most islands, took place in the early 1990s like the rest of the world, there was relative dormancy for at least a decade in Trinidad and Tobago and even longer in other islands with regards to implementing advanced procedures or increasing case volumes. Reasons for this included lack of funding, lack of operating time in public facilities, lack of information of the public and the medical fraternity but most importantly lack of trained laparoscopic surgeons. This last factor was proven to be the key one in Trinidad and Tobago in 2003, Jamaica 2005 and Barbados 2011/12, when the return of trained personel engineered the transition from basic to advanced laparoscopy. Conclusion: Despite the delay of approximately 10 years in Trinidad and Tobago and 15 years in other islands, the return of trained surgeons has seen a rapid increase in case variety and volumes in laparoscopy. The wheels of motion of the laparoscopic revolution in the Caribbean have finally begun.

2025, Uva Clinical Research Lab 2025 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198

Open cholecystectomy, once the cornerstone of gallbladder surgery, has been largely supplanted by laparoscopic techniques. However, the open approach remains a critical surgical competency, particularly in complex or emergent situations where anatomical distortion, inflammation, or malignancy preclude safe minimally invasive dissection. This comprehensive review explores the contemporary role of open cholecystectomy, focusing on indications, detailed operative technique, intraoperative decision-making, complication profiles, and strategies for enhancing interprofessional collaboration. The procedure involves a right subcostal (Kocher) or upper midline incision, careful identification of Calot’s triangle, and safe dissection of the cystic structures under direct vision. Specific intraoperative challenges such as bile duct injuries, difficult exposure, and severe inflammation are addressed through surgical judgment and advanced “bailout” strategies. While the procedure is associated with higher morbidity compared to laparoscopic cholecystectomy, proper patient selection and multidisciplinary management can significantly improve outcomes. Open cholecystectomy also plays a vital pedagogical role, offering trainees essential exposure to hepatobiliary anatomy, surgical dissection principles, and complication management. This article underscores the enduring clinical relevance of open cholecystectomy in modern surgical practice.

2025, JSLS : Journal of the Society of Laparoendoscopic Surgeons

Background: The indications and benefits of laparoscopic cholecystectomy (LC) in patients with liver cirrhosis and symptomatic cholelithiasis have not been satisfactorily documented. The aim of this study was to investigate its efficacy and safety in such patients. Methods: Medical records of 38 patients with liver cirrhosis (stages Child-Pugh A and B) who underwent LC were retrospectively reviewed. Demographic characteristics and other parameters including initial presentation, conversion rate, complication rate, mortality, and duration of hospital stay were investigated and compared with noncirrhotic patients' parameters in our database. Results: Cirrhotic patients who underwent LC were older than noncirrhotic patients (P=0.021). Both the conversion rate (15.78%) and the duration of hospital stay were increased in the cirrhotic group, but without significant differences. Major complications occurred more often in the cirrhotic group (P=0.027), increasing morbidity; however, th...

2025, British Journal of Surgery

2025

Choledocholithiasis or common bile duct stones (CBDS) is a common problem noted during the evaluation of abdominal pain of biliary origin. Other than biliary colic, CBDS is usually diagnosed during the evaluation of pancreatitis, cholecystitis, obstructive jaundice, or at times incidentally during abdominal imaging for unrelated illnesses. [1] Risk factors for CBDS are the same as cholelithiasis, however, additional etiology could be biliary obstruction due to benign or malignant biliary stricture and at times forgotten biliary stents. The incidence of choledocholithiasis varies from 5% to 15%. [2] With advancements in endoscopic technology and increasing availability of expertise, ERCP has evolved as the standard of care for CBDS. During ERCP, stones are extracted by a balloon extractor after sphincterotomy. In case of large or complicated CBDS, additional modalities such as balloon sphincteroplasty,

2025, Annals of Punjab Medical College

of local anesthesia either intra-peritoneal or in the wound. Theoretically peripheral blockage of pain stimuli with local anesthetic agent is more effective than treating pain. For this purpose, Bupivacaine has been recently used to be injected at port sites. Objective: To evaluate the pain and requirement of injectable anti-inflammatory drug (inj. Ketorolac 30mg) after port site infiltration of inj. bupivacaine in laparoscopic cases. Study Design: Prospective randomized study of elective laparoscopic procedures. Settings: Surgical Unit-IV, DHQ Teaching Hospital Faisalabad, Medical University Faisalabad Pakistan. Duration: November 2015 to May 2017. Methodology: Two hundred and sixty patients included in the study were divided into two groups with equal number in each group. Results: In the study group(A), 103(79.3%) patients were females of 27(20.7%) patients were males. All female patients in the study group underwent LC and among males, 26(96.3%) patients underwent TAPP and 1(3.7%) patient underwent LC. In the control group(B) 97(74.6%) patients were females, 33(25.4%) patients were male. All female patients (100%) underwent LC and among the males, 30 patients (90.9%) underwent TAPP, 3(9.1%) patients underwent LC. In the study group, the mean VAS in the study group at 2 hours, 6 hours, 12 hours after surgery was 1.6, 1.7, 1.6 with standard deviation 1.6, 1.7, 1.8 respectively while in the control group VAS was 2.9, 3.1, 2.6 with standard deviation 2.1, 1.8, 1.9 respectively. In the study group the mean of anti-inflammatory drug injections (Ketorolac) needed was 1.0000 with standard deviation 0.7 and in control group, the same was 1.3 with standard deviation 70.8. The previous was less than 0.05. Conclusion: Infiltration of local anesthetic agent i.e., Bupivacaine results in almost total painless procedure in laparoscopic surgery, the timing and anatomical site of injection should be investigated further.

2025, Annali italiani di chirurgia

Anatomic unexpected variations in biliary tree may be discovered during laparoscopic cholecystectomy. A 57-year-old man was admitted for abdominal pain, vomiting and mild jaundice. Abdominal ultrasonography revealed a gallbladder containing multiple stones and biliary sludge. All pre-operative investigations showed no anatomical variations in extrahepatic biliary tree. During surgical intervention an accessory extrahepatic duct, connecting the IV segment of the liver to the fundus of gallbladder, was discovered. Pre-operative routine investigations for gall stones diseases may not reveal anatomic variations of biliary tree.

2025, JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons

Laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in the management of the acute biliopancreatic pathology. Nevertheless, controversy remains about the appropriate timing for retrograde cholangiopancreatography. A retrospective study was undertaken on a consecutive series of 117 patients with acute biliary-pancreatic pathology, who underwent laparoscopic cholecystectomy between April 1995 and April 1999. Criteria for preoperative endoscopic retrograde cholangiopancreatography were defined, and the patients were divided into 3 groups based on the presence or absence of a preoperative retrograde cholangiopancreatography indication: (1) ERCP+LC group: patients with retrograde cholangiopancreatography indicated and performed (n = 30); (2) LC group: patients without retrograde cholangiopancreatography criteria treated only by LC (n = 47); (3) LC-ERCP group: patients with retrograde cholangiopancreatography criteria ...

2025, Intensive Care Medicine

Objective: To evaluate the efficacy of the urine column (UC) measurement compared to the intravesicular pressure (IVP) measurement as an estimation of intraabdominal pressure (IAP) in patients with IAP up to 30 mmHg. Methods: Fifteen patients undergoing a laparoscopic cholecystectomy were studied. All patients were catheterized. IVP measurements were performed using a pressure transducer connected to the culture aspiration port. UC measurements were done by holding up the tubing against a measuring rod. The symphysis pubis was used as the zero-reference. IAP was raised from 0 to 30 mmHg using increments of 5 mmHg, during which first the IVP and then UC measurement series were recorded endexpiratory. Fifty and 100 ml of saline were used as a priming volume. Results: The IVP and UC measurements showed a significant correlation with IAP. Comparing IVP and UC showed a correlation of 0.91 (p \ 0.001) for 50 ml and 0.87 (p \ 0.001) for 100 ml of saline as a priming volume. Using 50 ml of saline, UC was 0.68 mmHg higher than IVP (95% CI -7.21 to ?5.85 mmHg). For 100 ml of saline, UC was 1.23 mmHg lower than IVP (95% CI -7.41 to ?9.87 mmHg). Conclusion: UC measurement shows significant correlation to IVP measurement as an estimation of the IAP. Further study needs to be done to conclude whether UC measurement is a reliable clinical alternative to IVP measurement.

2025, Archives of Surgery

The combined endoscopic and laparoscopic approach is safe and effective in managing gallstone cholangitis in the era of laparoscopic cholecystectomy (LC). Design: Retrospective case series. Setting: University teaching hospital. Patients: One hundred eighty-four consecutive patients with gallstone cholangitis treated between January 1995 and December 1998. The main treatments were endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) followed by interval LC. Open or laparoscopic common bile duct exploration (OCBDE or LCBDE) was used when ERCP or ES failed. Main Outcome Measures: Success of various interventions, morbidity and mortality, and long-term incidence of recurrent biliary symptoms. Results: Endoscopic retrograde cholangiopancreatography was successful in 175 patients (95%), with bile duct stones found in 147 (84%). Endoscopic stone clearance by ES was achieved in 132 patients (90%). Morbidity rate after ERCP or ES was 4.0% (n = 7), and overall mortality rate from cholangitis was 1.6% (n=3). After bile duct stone clearance, 82 patients underwent LC with a conversion rate of 9.8% (n=8) and a morbidity rate of 3.6% (n=3). Eighteen patients underwent OCBDE with a morbidity rate of 33% (n = 6), and 3 underwent LCBDE with 1 conversion and no morbidity. There was no operative mortality. Seventy-eight patients were managed conservatively after endoscopic clearance of bile duct stones. Follow-up data were available in 101 patients with cholecystectomy and 73 patients with gallbladder in situ. During a median follow-up of 24 months, recurrent biliary symptoms occurred in 5.9% (n = 6) and 25% (n=18), respectively (P=.001). In both groups, the most common recurrent symptom was cholangitis (n=5 and n=14, respectively). Gallbladder in situ (risk ratio, 4.16; 95% confidence interval, 1.39-12.50; P=.01) and smallsize papillotomy (risk ratio, 2.94; 95% confidence interval, 1.07-8.10; P = .04) were significant risk factors for recurrent biliary symptoms. Conclusions: Endoscopic sphincterotomy for biliary drainage and stone removal, followed by interval LC, is a safe and effective approach for managing gallstone cholangitis. Patients with gallbladder left in situ after ES have an increased risk of recurrent biliary symptoms. Laparoscopic cholescystectomy should be recommended after endoscopic management of cholangitis except in patients with prohibitive surgical risk.

2025, Archives of Surgery

2025

Objective: To determine the frequency of prolonged hospital stay and its associated factors in patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis at Tertiary Care Hospital, Karachi. Methods: After the ethical approval from College of Physicians and Surgeons Pakistan, this descriptive study, was conducted at Department of Surgery, Civil Hospital, Karachi, from 08-06-2021 till 08-01-22. Data was prospectively collected from patients after taking a verbal consent. 88 patients who met the diagnostic criteria were included. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables was presented as frequency and percentages. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification chi square test was applied taking p-value of ≤0.05 as significant
Results: A total of 88 patients who met the inclusion and exclusion criteria were included in this study. Mean age, duration of surgery, BMI, height and weight in our study was 50.14±10.49 years, 75.25±20.87 minutes, 29.66±2.56 kg/m2, and 152.3±10.28 cm and 76.9±8.87 kg. Out of 88 patients, 26 (29.5%) and 62 (70.5%) had and did not have prolonged hospital stay.
Conclusion:It is possible to shorten the length of time spent in the hospital after surgery if the patient is carefully evaluated beforehand, the operation is performed with precision, and the patient is well cared for afterward.

2025, HPB Surgery

Choledochoduodenostomy (CDD) has been reported as a more effective treatment of CBD stones than T-tube drainage but it is regarded as a last resort or obsolete therapeutic method due to fears of higher mobidity, cholangitis, “sump” syndrome and liver dysfunction. We aimed to assess the aforementioned issues analyzing prospectively our experience from 1976 through Dec.92.Methods: CDD was performed in 89 females and 36 males, aged 60.2±8.7 years, 26 during repeat surgery. Duct stones were the indication in 94, Sphincter of oddi (SO) dysfunction in 23 and obstructive pancreatitis nodule in 8. Peroperative liver biopsies were obtained in 44 patients. The “follow-up” schedule (> 2.5 years in 110) included clinical interview and LFT's on an yearly basis. Ultra sound (USG) was obtained every one or two years. ERC was done in 10 symptomatic patients and in 25 others for protocul purposes. Liver biopsies were taken four to nine years post surgery in 11 patients-five at relaparotomy fo...

2025, Uva Clinical Research Lab - Endoscopic Retrograde Cholangiopancreatography (ERCP)

Abstract: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a hybrid endoscopic and fluoroscopic procedure that facilitates both the diagnosis and treatment of various biliary and pancreatic ductal disorders. Initially introduced as a diagnostic modality, ERCP has evolved into a predominantly therapeutic tool used for interventions such as biliary stone extraction, stent placement, sphincterotomy, and pancreatic drainage. The procedure involves cannulation of the major duodenal papilla under fluoroscopic guidance after endoscopic visualization of the ampulla of Vater. Despite its clinical benefits, ERCP is associated with a significant risk of complications, including post-ERCP pancreatitis, infections, hemorrhage, and perforation. Proper patient selection, procedural technique, perioperative anesthesia planning, and post-procedural monitoring are essential for minimizing risks. Multidisciplinary collaboration among endoscopists, anesthesiologists, radiologists, and nursing staff is critical in optimizing outcomes. This article provides a comprehensive overview of the anatomical considerations, procedural techniques, indications, contraindications, complications, anesthetic considerations, and interprofessional strategies essential for safe and effective ERCP practice.

2025, Akinik publication

Background: Diabetes mellitus (DM) is a known risk factor for gallstone formation and associated complications. However, its impact as an independent risk factor for complications during laparoscopic cholecystectomy (LC) remains debated. This study aimed to evaluate the surgical outcomes of laparoscopic cholecystectomy in diabetic versus non-diabetic patients. Methods: This hospital-based comparative study included 60 patients (30 diabetics and 30 nondiabetics) undergoing elective laparoscopic cholecystectomy. Preoperative, intraoperative, and postoperative parameters were compared between the two groups, including operative time, intraoperative difficulties, and conversion rate to open surgery, postoperative complications, and length of hospital stay. Results: Both groups were comparable regarding age, gender, and BMI. Intraoperatively, diabetic patients exhibited significantly higher rates of adhesions (83.3% vs 46.7%, p<0.01), difficulty during surgery (46.7% vs 10.0%, p<0.01), and longer operative time (77.96 vs 68.50 minutes, p<0.01). Conversion to open surgery was required in 13.3% of diabetic patients versus none in non-diabetics (p=0.038). Although postoperative complications including fever (16.7% vs 6.7%), surgical site infections (26.7% vs 10.0%), and bile leak (10.0% vs 0.0%) were more frequent in diabetics, these differences were not statistically significant. Hospital stay was significantly longer in diabetic patients (6.19 vs 4.73 days, p<0.01). Conclusion: Diabetes mellitus is associated with increased intraoperative difficulties, higher conversion rates to open surgery, and longer hospital stay in patients undergoing laparoscopic cholecystectomy. Surgeons should anticipate these challenges when operating on diabetic patients and take appropriate measures to optimize outcomes in this high-risk population.

2025, Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

Background: Transvaginal cholecystectomy encourages researchers to develop new hybrid or pure techniques for natural orifice surgery. We present an approach that combines flexible endoscopes, rigid instruments, and percutaneous needles. Methods: A 26-year-old female patient with cholelithiasis underwent a single-port culdolaparoscopy cholecystectomy at "Hospital Regional Poza Rica" (Poza Rica, Mexico) on July 2008. The surgery was performed with only 1 transvaginal 16 mm in diameter by 32 cm in length port. The instruments included a gastroscope, laparoscopic 5 mm in diameter by 43 cm in length instruments, percutaneous reins, and hook needle. The patient was discharged 24 hours after surgery, which is customary for the hospital, without pain or visible scars. Conclusions: Single transvaginal port cholecystectomy using a gastroscope and laparoscopic 5 mm instruments in a parallel path is a feasible procedure in selected patients. This technique requires no abdominal ports assistance.

2025, Uva Clinical Research Lab - Laparoscopic cholecystectomy

Laparoscopic cholecystectomy has become the gold standard for the surgical management of symptomatic cholelithiasis and related gallbladder pathologies due to its minimal invasiveness, faster recovery, and lower complication rates compared to open cholecystectomy. This article provides an in-depth review of the essential equipment, operative personnel, preparation, surgical technique, and postoperative care. Particular focus is given to potential complications such as hemorrhage, bile duct injury, bile leaks, infection, and the rare but necessary conversion to open surgery. Clinical implications of gallbladder disease are also explored, emphasizing the pathophysiology, symptomatology, and appropriate diagnostic modalities including ultrasound, MRCP, ERCP, and HIDA scanning. Additionally, the article outlines the significance of interdisciplinary collaboration among surgeons, primary care providers, radiologists, and hepatobiliary specialists in improving patient outcomes. This comprehensive overview serves to enhance surgical planning, patient counseling, and postoperative management for healthcare professionals involved in biliary surgery.

2025, Journal of Veterinary Internal Medicine

BackgroundBiliary sludge (BS) frequently is identified on ultrasonographic examination and is described as incidental. It is hypothesized that biliary stasis and hypersecretion play a role in both BS and gallbladder mucocele (GBM) formation. Recent studies have documented similarities in composition of BS and GBM, and there are several examples of progression from BS to GBM in the veterinary literature.ObjectivesTo assess the relationship between the presence of BS and later development of GBM in dogs, over time periods >12 months.AnimalsA total of 154 dogs with BS and ultrasonographic follow‐up >12 months.MethodsMedical records were retrospectively collected from 9 UK‐based referral centers for all available time points. A semiobjective scoring system was used to track volume of BS within the gall bladder (GB) over time.ResultsTwenty dogs developed GBM during the study period. Shetland Sheepdogs (odds ratio [OR], 40.99; 95% confidence interval [CI], 3.61‐465.95; P = .003) and...

2025, Open veterinary Journal

The liver is one of the largest glands in the digestive system and performs 13 various functions, including the secretion of hormones and enzymes. The gallbladder serves as a storage reservoir for secretions before they are released into the digestive system through the duodenum. The bile ducts branch from the liver's lobes and ultimately connect to the digestive system, making this structure significant and distinct among different animal species. This review focuses on the differences between dogs and cats, highlighting the importance of these differences from both health and pathological perspectives. After conducting a detailed scientific review of the biliary tree in dogs and cats, we concluded that cats are more susceptible to the disease than dogs. We recommend conducting extensive radiological studies to determine which species experience cases of this disease more frequently. Additionally, it would be beneficial to explore crossbreeding with another species with a biliary tree structure that offers protection against certain diseases affecting the liver and bile.

2025, Surgical Endoscopy and Other Interventional Techniques

Background A high incidence of problems with the technical equipment is known to occur during routine laparoscopic procedures. Use of a structured checklist of preparatory measures could help to prevent these problems. This study aimed to determine the extent to which a checklist reduced the number of incidents with technical laparoscopic equipment. Methods A 28-item checklist was developed based on frequently occurring laparoscopic equipment problems during 30 laparoscopic cholecystectomies (the control group). A further 30 procedures were conducted with the checklist (the checklist group). The number and type of incidents with the technical equipment were compared between the groups. All the procedures were recorded using a special audio-video system (black-box). Results In the checklist group, the total number of incidents per procedure was 53% lower than in the control group (23/30 versus 49/30). The checklist led to fewer incidents of wrong positioning (9/30 versus 22/30), and wrong settings and connections (7/30 versus 12/30) of the equipment. Defects or malfunctions decreased from 15/30 in the control group to 7/30 in the checklist group. One or more incidents with the equipment occurred in 47% (14/ 30) of the checklist procedures compared with 87% (26/30) of the control procedures. Median time taken to complete the checklist items was 3.3 min (range 1.0-8.3 min). Conclusions Use of a checklist was feasible and helped to reduce problems with the laparoscopic equipment in the operating room. Future research should aim to implement checklists for different procedures and investigate their effects.

2025

Despite of being a relatively rare disease in horses, cholelithiasis is the most common cause of biliary obstruction in this species. Simultaneous intrahepatic and extrahepatic gallstones are the most frequent presentation. Usually, there are no clinical signs associated with this condition, although biliary obstruction could occur as a consequence. Two cases of cholelithiasis in horses, including gross and histopathological findings are described. In one of the cholelithiasis cases there was no association with clinical signs or cause of death, but in the other one, chronic loss of weight may have been caused by cholelithiasis.

2025

Objective: To determine the frequency of CBD stone on ERCP in gall stone pancreatitis with deranged liver function. If decrease frequency of CBD stone found then recommendations can be made to reduce the unnecessary ERCP and it's... more

2025, Journal of health organization and management

Purpose Length of stay (LOS) in hospital after surgery varies for each patient depending on surgeon's decision that considers criticality of the surgery, patient's conditions before and after surgery, expected time to recovery and experience of the surgeon involved. Decision on patients' LOS at hospital post-surgery affects overall healthcare performance as it affects both cost and quality of care. The purpose of this paper is to develop a model for deriving the most appropriate LOS after surgical interventions. Design/methodology/approach The study adopts an action research involving multiple stakeholders (surgeon, patients/patients' relatives, hospital management and other medics). First, a conceptual model is developed using literature and experts' opinion. Second, the model is applied in three surgical interventions in a public hospital in Malta to demonstrate the effectiveness of the model. Third, the policy alternatives developed are compared to a selection...

2025

Today laparoscopic cholecystectomy (LC) is the gold standard treatment
of gallbladder diseases all over the world. Patients undergoing laparoscopic cholecystectomy must be the focus when planning a hospital discharge process by giving them effective practical discharge guidelines that will increase their confidence in managing their care at home, so that, Aim: The aim of the present study was to develop discharge guidelines for patients undergoing laparoscopic cholecystectomy. Design: A descriptive exploratory design was utilized in this study. Setting: The study was conducted at the surgical departments and outpatient` clinics of the Gastroenterology Center at Mansoura University. Sample: A purposive sample of 200 adult patients, from both genders, underwent laparoscopic cholecystectomy in the above-mentioned setting within 6 months. Tools for data collection: 1) A structured interviewing questionnaire sheet to assess patients` knowledge. 2) An observational checklist to assess patients' practices at the pre- and postoperative periods. 3) Health condition assessment sheet to assess patients` health condition on the 1st follow-up visit at the outpatient clinic. Results: The mean age of the studied patients was 43.25 ± 11.01. More than half (62.0%) of studied patients had an unsatisfactory level of knowledge as regards laparoscopic cholecystectomy surgery (pre/post-operative care and discharge instructions). Most (90.5%) of them had unsatisfactory level of practices (pre/postoperative practices) added to poor health condition assessment for more than half (60.0%) of the studied sample Conclusion: There was a statistically significant relation between patients` total knowledge scores and the total practice scores as regards their sociodemographic characteristics. Moreover, a highly positive correlation was indicated between patients` knowledge & practices and their health condition assessment. Recommendations: Further research studies are needed to focus on studying factors affecting quality of life for patients undergoing laparoscopic cholecystectomy.
Keywords: Laparoscopic cholecystectomy, patients' healthrelated knowledge & practices, Patients` discharge guidelines

2025, Journal of Nepal Health Research Council

The reported prevalence of biliary tract disruption following laparoscopic cholecystectomy has ranged from 0% to 7% in early reports. Bile leaks are the most common biliary complication of laparoscopic cholecystectomy. Total 530 patients who had undergone laparoscopic cholecystectomy from January 2004 to November 2006 at Kathmandu Medical College Teaching Hospital were studied for biliary complications after laparoscopic cholecystectomy. We reviewed 500 laparoscopic cholecystectomies performed at our institution and found 13 cases of bile extravasation and/or biloma formation and/or bile duct injuries (prevalence, 2.6%). One bile duct transection was acutely recognized and treated with hepaticojejunostomy. Three lateral bile duct injuries were also acutely recognized, two of them were managed with primary repair of CBD without T tube and the other was managed with repair and T-tube drainage. Two patients had postoperative generalized biliary peritonitis, one of whom was undergone ex...

2025, Kathmandu University Medical Journal

Background: Laparoscopic cholecystectomy is a gold standard treatment for gall stone diseases. Early surgical intervention in acute calculus cholecystitis is feasible and duration of onset of symptoms does not influence the conversion rate. Objective: To compare the safety and feasibility between urgent and delayed laparoscopic cholecystectomy in patients with acute calculus cholecystitis. Materials and methods: This is a comparative study conducted in Department of Surgery, Kathmandu Medical College, during the period of January 2006 to January 2008. Altogether, 436 patients were analysed out of which 55 were selected as urgent laparoscopic cholecystectomy and were included in the study. Among 55 patients presented with acute calculus cholecystitis were divided into two groups. Group 1 underwent laparoscopic cholecystectomy within 72 hours of onset of pain abdomen and Group 2 after 72 hours of onset of pain abdomen. Results: Conversion rate in Group 1 was 19.44% whereas it was 263%...

2025, Annals of Surgery

gallstone-induced pancreatitis occurs with some frequency in patients without enzyme elevation or gallstones, and a cholecystectomy, in this case, will present a high risk/benefit ratio. In addition, surgeons should be wary of the patients who have gallstones on ultrasonography but do not have increased liver enzymes on day 1 because the recurrence rate was 23%. When presented with these 2 scenarios, surgeons often proceed with cholecystectomy because the alternative is to assign the diagnosis of idiopathic pancreatitis and have few therapeutic options for the patient. The results of this study strongly suggest that further evaluation, especially immediately, during repeated attacks of pancreatitis is warranted. Patients should present to their physicians immediately when symptoms arise so liver enzymes can be tested to determine which patients may benefit from cholecystectomy. These data add a new dimension to our treatment of patients with gallstone-induced pancreatitis and suggest that continued refinement of management algorithms is useful. K. E. Behrns, MD Laparoendoscopic Rendezvous Versus Preoperative ERCP and Laparoscopic Cholecystectomy for the Management of Cholecysto-Choledocholithiasis: Interim Analysis of a Controlled Randomized Trial Tzovaras G, Baloyiannis I, Zachari E, et al (

2025, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

Background: Pre-emptive use of paracetamol has been shown to reduce the need for postoperative analgesia in many patient groups; however, evidence supporting its role in laparoscopic surgery is lacking. To determine the effect of Pre-emptive paracetamol on post-operative Aim: analgesia requirement in patients undergoing laparoscopic surgery. The randomised control trial was conducted at Dr.