Candidates For Laparoscopic Cholecystectomy Research Articles

Comparison of the Stress Responses Following TAP Block and Epidural Anesthesia in Patients Undergoing Elective Laparoscopic Cholecystectomy Under General Anesthesia: Randomized Clinical Trial.

Major surgeries and the accompanied acute stress response are associated with poor immune system function and extensive immunological changes. This study was done to compare post-surgery stress responses following TAP blocks and epidural anesthesia in patients undergoing laparoscopic cholecystectomy under general anesthesia. Sixty patients who were candidates for laparoscopic cholecystectomy were enrolled in this RCT. After randomly assigning patients into two groups (30 patients in epidural anesthesia and 30 patients in the TAP block group), the degree of pain and stress responses (serum level of blood glucose, CRP, IL-1, TNF-α, cortisol) of patients were measured preoperatively and at 6 and 24 hours after surgery. Mean blood glucose, serum cortisol, CRP, and WBC decreased significantly 6 and 24 hours after the intervention in both groups and differed significantly between the two groups (P-value <0.05). The proportion of patients with a pain score greater than 3 at 6 and 12 hours after surgery was significantly higher in the Epidural group compared with the TAP block group, although this figure was significantly higher in the TAP block group 24 hours after surgery. A significant decrease in the mean blood sugar, serum cortisol, CRP, and WBC in both groups at 6 and 24 hours after the surgery was noted. The pain score decreased 24 hours after surgery in the epidural anesthesia group and increased in the TAP block group.

Effect of 30 mg Oral Dextromethorphan and Placebo on Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy

Background and Objective: Laparoscopic cholecystectomy is considered a global standard procedure for the surgical treatment of gallstones. The present study aimed to compare the effect of dextromethorphan and oral placebo on postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: This double-blind clinical trial study was performed on 114 ASA I and II patients who were candidates for laparoscopic cholecystectomy. Two hours before the induction of anesthesia, the intervention group was administered 30 mg of plain dextromethorphan syrup, and the control group was given 2 cc of placebo of an oral syrup. Pain intensity, systolic and diastolic blood pressure, heart rate, and SPO2 at the time of recovery, 1, 6, and 12 hours after surgery, and the amount of pethidine were recorded. Data were analyzed in SPSS software (version 24) at a significance level of 0.05. Results: The mean pain intensity was statistically significant in the control and intervention groups. The mean pain intensity in the intervention group was lower than that in the control group (P&lt;0.05). Diastole blood pressure, heart rate, and SPO2 in the two groups did not have a statistically significant difference (P&gt;0.05), while systolic blood pressure statistically differed (P&lt;0.05). The amount of pethidine consumption in the intervention group was higher than that in the control group. Conclusion: As evidenced by the obtained results, low-dose dextromethorphan (30 mg) is effective in postoperative analgesia for patients undergoing laparoscopic cholecys-tectomy and reduces opioid use.

A Comparison of effect of preemptive versus postoperative use of ultrasound-guided bilateral transversus abdominis plane (TAP) block on pain relief after laparoscopic cholecystectomy

Nowadays, there are various methods to manage pain after laparoscopic cholecystectomy. The aim of this study was to compare the effectof preemptive versus postoperative use of ultrasound-guided transversus abdominis plane (USG-TAP) block on pain relief after laparoscopic cholecystectomy. In this single-blinded randomized clinical trial, the patients who were candidates for laparoscopic cholecystectomy were randomly divided into the two groups (n = 38 per group). In the preemptive group (PG) after the induction of anesthesia and in the postoperative group (POG) after the end of surgery and before the extubation, bilateral ultrasound-guided transversus abdominis plane (TAP) block was performed on patients using 20 cc of ropivacaine 0.25%. Both groups received patient controlled IV analgesia (PCIA) containing Acetaminophen (20 mg/ml) plus ketorolac (0.6 mg/ml) as a standard postoperative analgesia and meperidine 20 mg q 4 h PRN for rescue analgesia. Using the numerical rating scales (NSR), the patients’ pain intensity was assessed at time of arrival to the PACU and in 2th, 4th, 8th, 12th, 24th h. Primary outcome of interest is NSR at rest and coughing in the PACU and in 2th, 4th, 8th, 12th, 24th h. Secondary outcomes of interests were the time to first post-surgical rescue analgesic and level of patients’ pain control satisfaction in the first 24 h. The USG-TAP block significantly decreased pain score in the POG compared to the PG, and also the pain was relieved at rest especially in 8 and 12 h (p value ≤ 0.05) after the surgery. Pain score after coughing during recovery at 2, 8 and 12 h after the operation were significantly decreased. (p value ≤ 0.05) The patient satisfaction scores in the POG were significantly higher in all times. There was a statistically significant difference between the two groups in terms of rate of postoperative nausea and vomiting (PONV), indicating that patients in the POG had significantly lower incidences of the PONV compared tothe PG. The time to first analgesic request was significantly shorterin the POG, which was statistically significant (p value = 0.089). There was no statistically significant difference between the two groups in terms of consumption of analgesics. The postoperative TAP block could offer better postoperative analgesia than preepmtive TAP block.

The Effect of Preoperative Electronic Education on Anxiety of Patients Undergoing General Surgery

Background: Preoperative anxiety is a common problem of surgical patients because it causes a range of emotional, psychological and physical problems. Numerous pharmacological and non-pharmacological methods have been used to reduce the level of anxiety in patients undergoing general surgery. Objectives: The aim of this study was to evaluate the effect of electronic education on preoperative anxiety in patients undergoing laparoscopic cholecystectomy (LC). Methods: The present study was a randomized controlled trial on 88 patients who were candidates for LC in two intervention and control groups in one of the Kermanshah hospitals. Patients in the intervention group received electronic education before surgery. The Visual Analog Scale Anxiety (VAS-A) questionnaire was used to measure anxiety before surgery in the study. Data analysis was performed using SPSS statistical software. Results: The results showed that there was no significant difference in the level of basic anxiety between the intervention and control groups. In second VAS-A evaluation, a significant mean difference was observed between the two groups so that the anxiety of the intervention group was calculated as 26.1 ± (SD = 16) vs. the control group as 45 ± (SD = 21). The mean of post-intervention anxiety compared to pre-intervention anxiety significantly decreased in the intervention group. Conclusions: Our findings highlight that electronic-based education can reduce the preoperative anxiety level in LC patients. Therefore, it's recommended to medical staff for delivering pre-surgery electronic educational interventions for LC surgical patients in order to reduce the level of preoperative anxiety.

Intra-operative factors responsible for conversion of laparoscopic cholecystectomy to open cholecystectomy in a tertiary care center

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis and has multiple advantages over open approach. With increasing skills and techniques over the years, the contra-indications to laparoscopic cholecystectomy have reduced. Even after careful selection of appropriate candidates for laparoscopic cholecystectomy, it sometimes becomes necessary to convert into an open cholecystectomy to prevent complications. This study was undertaken so as to identify the intra-operative factors necessitating conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: In this study conducted at S. P. Medical College and P. B. M. Hospital, Bikaner, over a period of 1 year, 100 consecutive patients with symptomatic cholelithiasis, planned for laparoscopic cholecystectomy were included. Laparoscopic cholecystectomy was performed and cases which could not be completed laparoscopically were converted to open cholecystectomy via right subcostal incision. Intra-operative factors necessitating conversion were observed and analyzed.Results: The incidence of conversion was found to be 7%. The most common intra-operative factor for conversion was dense adhesions at the Calot’s triangle (71.43%) followed by obscure anatomy (42.86%). Uncontrolled bleeding and CBD stones also led to conversion. The identification and appearance of CBD and achievement of critical view of safety were significant factors for conversion to open cholecystectomy (p=0.0001).Conclusions: The rate of conversion to open cholecystectomy was 7% which is comparable to similar studies. Conversion is not a failure or complication but actually a safer alternative to ensure completion of the procedure without any real complications of laparoscopic cholecystectomy- biliary or visceral injury, haemorrhage, etc.

Examination of the sedative and analgesic effects of gabapentin and dexmedetomidine in patients undergoing laparoscopic cholecystectomy surgery: A randomized controlled trial.

Introduction:At present, laparoscopic surgery is a very common method, especially for the removal of the gallbladder, because pain and anxiety following surgery is a major problem in surgical operations. Various studies have demonstrated the effectiveness of gabapentin and dexmedetomidine in reducing pain intensity after surgery. The present study is aimed at examining the sedative and analgesic effects of gabapentin and dexmedetomidine in patients undergoing laparoscopic cholecystectomy.Methods:This was a double-blinded clinical trial involving 40 patients who were candidates for laparoscopic cholecystectomy. The patients were randomly allotted in two groups of dexmedetomidine (n = 20) and gabapentin (n = 20). Then, pain intensity based on the visual analog scale (VAS) and sedation level based on the Ramsay Sedation Scale (RSS) were measured at the curtained times. As the data were not normally distributed, the Mann–Whitney U test was used to analyze the data, and the significance level was set at 0.05.Results:Across the follow-up points, more reduction in pain intensity was observed in the dexmedetomidine group as compared with the gabapentin group. The available dissimilarities between these two groups in pain decrement at the recovery room and 3 h after being discharged from the recovery room were not significant (P ≥ 0.414). In addition, across all the time points, there was considerable growth in sedation in the dexmedetomidine group in comparison with the gabapentin group (P < 0.024). This finding indicated that dexmedetomidine was more effective than gabapentin in creating sedation.Conclusion:Compared with gabapentin, dexmedetomidine leads to more pain reduction after surgery and better sedation during and after surgery.

How I do it: laparoscopic treatment of common bile duct stones

The standard treatment for patients with symptomatic gallstones is laparoscopic cholecystectomy (LC). In patients undergoing LC the prevalence of common bile duct (CBD) stones ranges between 8% and 15% and it increases with advancing age, reaching up to 60% in elderly patients. Every patient who is candidate for LC should be evaluated for the presence of CBD stones and these should be treated if the diagnosis is confirmed. In the literature, the procedure of choice for CBD stones treatment is still debated. In many centers, pre- or postoperative endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) and LC (two-stage endo-laparoscopic management) is considered standard practice instead of open choledocholithotomy and cholecystectomy. Laparoscopic single-stage management of gallstones and CBD stones has demonstrated equivalent outcomes to the two-stage endo-laparoscopic approach in randomized controlled trials but with shorter hospital stay and fewer interventions. Moreover, the two-stage endo-laparoscopic management of CBD stones and gallstones may be associated with a higher additional procedures rate, and possibly increased costs, as compared to single-stage laparoscopic management. Another option is single-stage endo-laparoscopic management of gallstones and CBD stones, performing ERCP/ES during the same LC anesthesia (so called, “Rendez-Vous” procedure). Excluding patients with cholangitis, who should be managed by emergency ERCP with ES and stones removal, in the elective setting the ultimate choice for one procedure or the other largely depends on the local resources and expertise that are available in the individual center, notwithstanding the scientific evidence in favour of single-stage laparoscopic management. The authors report the surgical techniques that they follow during LC for CBD exploration and stones’ removal by laparoscopic trans-cystic or choledochotomy approach.

Comparison of Arterial Oxygenation Following Head-Down and Head-Up Laparoscopic Surgery.

BackgroundRegarding the role of gas entry in abdomen and cardiorespiratory effects, the ability of anesthesiologists would be challenged in laparoscopic surgeries. Considering few studies in this area and the relevance of the subject, this study was performed to compare the arterial oxygen alterations before operation in comparison with after surgery between laparoscopic cholecystectomy and ovarian cystectomy.MethodsIn this prospective cohort, 70 consecutive women aged from 20 to 60 years who were candidate for laparoscopic cholecystectomy (n = 35) and ovarian cystectomy (n = 35) with reverse (20 degrees) and direct (30 degrees) Trendelenburg positions, respectively, with ASA class I or II were enrolled. After intubation and before operation, for the first time, the arterial blood gas from radial artery in supine position was obtained for laboratory assessment. Then, the second blood sample was collected from radial artery in supine position and sent to the lab to be assessed with the same device after 30 minutes from surgery termination. The measured variables from arterial blood gas were arterial partial pressure of oxygen (PaO2) and Oxygen saturation (SpO2) alterations.ResultsTotal PaO2 was higher in the first measurement. The higher values of PaO2 in cholecystectomy (upward) than in ovarian cystectomy (downward) were not significant in univariate (P = 0.060) and multivariate analysis (P = 0.654). Furthermore, higher values of SpO2 in cholecystectomy (upward) than in ovarian cystectomy (downward) were not significant in univariate (P = 0.412) and multivariate analysis (P = 0.984).ConclusionsIn general, based on the results of this study, the values of PaO2 in cholecystectomy (upward) were not significantly higher than the values in cystectomy (downward) in laparoscopic surgeries when measured 30 minutes after surgery.

Effects of preoperative administration of ginger (Zingiber officinale Roscoe) on postoperative nausea and vomiting after laparoscopic cholecystectomy

One of the most common postoperative problems is nausea and vomiting. Although using some anesthetic materials has been considered as the mainstay of this phenomenon, the exact factors are not known. Because of several morbidities associated with postoperative nausea and vomiting (PONV), its prevention and treatment has been a challenge for physicians, so several drugs have been recommended for this purpose. Based on the documented antiemetic specificity of ginger, we evaluated and compared the effects of preoperative administration of ginger on PONV with ondansetron administration as the standard medication. The participants included 100 patients with cholelitiasis who were candidate for laparoscopic cholecystectomy. Patients were divided into two groups: group A comprised 50 patients who received 500 mg oral ginger 1 h before surgery, and group B included 50 patients who received 4 mg intravenous ondansetron before completion of surgery. Antiemetic efficacy was assessed by visual analogue scale scores of nausea intensity at 0, 4, 8, 16, and 24 h after surgery and frequency of vomiting during the evaluation period. Although multifactor analysis showed that nausea severity was significantly lower in the ginger group, the data indicated that except 16 h after operation, the differences between two groups in the frequency of vomiting was not significant. In conclusion, though complementary studies are needed to have a strong suggestion, based on this study, we recommend administration of oral ginger 1 h before operation to control the severity of PONV in patients undergoing laparoscopic cholecystectomy.

Role of Tranexamic Acid on Blood Loss in Laparoscopic Cholecystectomy.

Context:Nonsurgical uses of tranexamic acid include the management of bleeding associated with leukemia, ocular bleeding, recurrent hemoptysis, menorrhagia, hereditary angioneurotic edema, and numerous other medical problems. However, there is hardly any documentation of the use of tranexamic acid in laparoscopic cholecystectomy.Aims:This study was conducted to evaluate the role of tranexamic acid in limiting blood loss in laparoscopic cholecystectomy and to evaluate the effect of blood loss on morbidity in terms of hospital stay and mortality of the patient.Subjects and Methods:The study was conducted on sixty patients admitted with gallstones, candidates for laparoscopic cholecystectomy. Thirty patients received an intravenous 20 mg/kg bolus dose of tranexamic acid at induction of anesthesia (Group A), and another thirty did not receive the aforementioned drug at induction (Group B).Statistical Analysis:The two groups were compared, and the data collected were entered and tabulated using Microsoft Office Excel and analyzed using appropriate statistical tests.Results:The mean postoperative hospital stay (2.4 vs. 2.63, P = 0.4147), drain fluid hemoglobin (Hb) (0.83 vs. 0.90, P = 0.2087), drain fluid hematocrit (0.2434 vs. 0.2627, P = 0.3787), mean drain output (85 vs. 87.23, P = 0.9271), mean pulse rate at the start of surgery (74.2 vs. 75, P > 0.999), mean pulse rate 24 h after surgery (75.9 vs. 76.4, P = 0.5775), and mean change in Hb (0.240 vs. 0.266, P = 0.2502) in both the groups were not significant.Conclusions:There is no active role of tranexamic acid in elective laparoscopic cholecystectomy.

Perception and knowledge of patients candidates for laparoscopic cholecystectomy in a teaching hospital: a study to evaluate and optimize the informed consent

Perception and knowledge of patients candidates for laparoscopic cholecystectomy in a teaching hospital: a study to evaluate and optimize the informed consent

Intraperitoneal bupivacaine effect on postoperative nausea and vomiting following laparoscopic cholecystectomy.

Background:Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC) has multifactorial etiology. Pain and use of opioids are among the important factors.Objectives:The present study aimed to evaluate the efficacy of intrapritoneal (IP) injection of bupivacaine on PONV.Patients and Methods:This was a double-blind randomized clinical trial, conducted on 66 patients aged 20-60, ASA I or II, candidates for LC. Patients were randomly assigned to two groups. Bupivacaine group received 20 mL bupivacaine 0.25% in the gallbladder bed, before and after cholecystectomy and the control group did not. The incidence of nausea and postoperative pain intensity was measured with Visual analogue scale (VAS) at 1, 2, 3 and 4 hours after operation, at rest and when coughing and changing positions. Nausea and vomiting occurrence were assessed at the same times.Results:There were no demographic data differences between groups. No differences were found between the two groups, in terms of incidence of nausea and vomiting. Furthermore, both groups were similar with respect to opioid consumption, during four hours post-operation.Conclusions:Intraperitoneal bupivacaine administration at the beginning and end of laparoscopic cholecystectomy reduced only visceral and shoulder pains at the 4th postoperative hour, but had no effect on reducing neither PONV, nor opioid demand, during the first four postoperative hours.

Effect of preoperative nursing visit on preoperative anxiety and postoperative complications in candidates for laparoscopic cholecystectomy: a randomized clinical trial

Despite progress in surgery and anaesthesia techniques, anxiety remains an important problem that imposes tremendous barriers to postoperative recovery for surgery patients. In this study, we investigated the effects of preoperative nursing visits on anxiety and postoperative complications in candidates for laparoscopic cholecystectomy. One hundred consecutive patients were randomly assigned into two equal groups of 50 patients each. Anxiety was evaluated in both groups using a translated and validated Spielberger State-Trait Anxiety Inventory. Patients in the control group received routine nursing care. Patients in the intervention group received two preoperative interviews, one on the day before surgery and one just before entering the operating room. Pain, nausea, vomiting and other postoperative complications were compared. Pain was measured using a visual analogue scale. All patients were women with a mean ± standard deviation age of 46.8 ± 10.6 years. At admission, state and trait anxiety measurements in the intervention and control groups were approximately 56 and 55 in both groups. Just before entering the operating room, these values reduced to 40.30 and 39.04 in the intervention group, with no significant change in the control group (p > 0.05). Mean time to reach an Aldrete consciousness score of 9, frequency of nausea and vomiting in the recovery room, level of postoperative pain, vital sign stabilization and time interval to get out of bed all improved significantly in the intervention group. Our study showed that preoperative nursing visits could decrease the level of preoperative anxiety and postoperative complications in this patient population.

Intravenous paracetamol for postoperative analgesia in laparoscopic cholecystectomy.

BackgroundAlthough opioids are the main choice for acute postoperative pain control, many side effects have been reported for them. NSAIDs and paracetamol have been used extensively as alternatives, and it seems that they are more effective for minor to moderate pain control postoperatively when have been used alone or in combination with opioids. As laparoscopic cholecystectomy poses moderate pain postoperatively, this study was planned to assess whether paracetamol is able to provide effective analgesia as a sole analgesic at least in the first few hours post operatively.ObjectivesWe evaluated the effect of intravenous Paracetamol on postoperative pain in patients undergoing laparoscopic cholecystectomy.Patients and MethodsThis is a randomized double- blind clinical trial study. 30 patients ASA class I, aged 18 to 50 years, candidate for laparoscopic cholecystectomy were recruited, and randomly divided into two equal groups. Group A (paracetamol group) received 1 gr paracetamol and group B received placebo ten minutes after the induction of anesthesia. 0.1 mg/Kg Morphine was administered intravenously based on patients compliant and pain score >3. Pain score and the opioids consumption were recorded in the first six hours postoperative. Patient's pain was measured by the VAS (Visual Analog Scale).ResultsThe pain score was lower in group A (P= 0.01), but the morphine consumption showed no significant difference between the groups (P= 0.24) during the first 6 hours postoperatively.ConclusionsAlthough paracetamol (1gr) has caused a better pain relief quality but it is not a suitable analgesic for moderate pain control in acute phase after surgery alone.

Granisetron Versus Dexamethasone in Prophylaxis of Nausea and Vomiting After Laparoscopic Cholecystectomy

Background: Post-operative nausea and vomiting (PONV) is one of the common problems after laparoscopic cholecystectomy. Objectives: The current study aimed to compare Dexamethasone effect with that of Granisetron in prevention of PONV. Patients and Methods: In the current study 104 patients aged 20-60 with ASA class I or II who were candidates for laparoscopic cholecystectomy were included in the study. Patients were randomly divided into two groups of A and B. 15 minutes before anesthesia induction, in group a patients 3 mg Granisetron and in group B patients 8 mg Dexamethasone was intravenously injected. Then both groups underwent general anesthesia with similar medications. After operation the prevalence of nausea and vomiting was assessed at three time intervals (0-6 hours, 6-12 hours and 12-24 hours after consciousness). SPSS software version 16 was employed to analyze data. T test, chi-square test and Fischer exact test were performed level of significance was P < 0.05. Results: There was no significant difference between age, gender proportion, weight, height, and body mass index (BMI) of patients in the two groups. In Dexamethasone group, seven patients experienced nausea and three patients had vomiting, and in Granisetron group, five patients experienced nausea and three patients had vomiting after consciousness. Statistical analysis indicated no significant difference between the two groups in this regard. Conclusions: Intravenous injection of 8 mg Dexamethasone or 3 mg Granisetron before anesthesia induction had similar effects in prophylaxis of nausea and vomiting after laparoscopic cholecystectomy.

Granisetron Versus Dexamethasone in Prophylaxis of Nausea and Vomiting After Laparoscopic Cholecystectomy

BackgroundPost-operative nausea and vomiting (PONV) is one of the common problems after laparoscopic cholecystectomy.ObjectivesThe current study aimed to compare Dexamethasone effect with that of Granisetron in prevention of PONV.Patients and MethodsIn the current study 104 patients aged 20-60 with ASA class I or II who were candidates for laparoscopic cholecystectomy were included in the study. Patients were randomly divided into two groups of A and B. 15 minutes before anesthesia induction, in group a patient’s 3 mg Granisetron and in group B patients 8 mg Dexamethasone was intravenously injected. Then both groups underwent general anesthesia with similar medications. After operation the prevalence of nausea and vomiting was assessed at three time intervals (0-6 hours, 6-12 hours and 12-24 hours after consciousness). SPSS software version 16 was employed to analyze data. T test, chi-square test and Fischer exact test were performed level of significance was P < 0.05.ResultsThere was no significant difference between age, gender proportion, weight, height, and body mass index (BMI) of patients in the two groups. In Dexamethasone group, seven patients experienced nausea and three patients had vomiting, and in Granisetron group, five patients experienced nausea and three patients had vomiting after consciousness. Statistical analysis indicated no significant difference between the two groups in this regard.ConclusionsIntravenous injection of 8 mg Dexamethasone or 3 mg Granisetron before anesthesia induction had similar effects in prophylaxis of nausea and vomiting after laparoscopic cholecystectomy.

SONOGRAPHY TO PREDICT CONVERSION IN LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion to laparotomy for safe and successful removal of the gallbladder. This study aimed to look for the various sonographic findings and to make a predictive index for patients who are candidates for laparoscopic cholecystectomy, operative difficulties and conversion to open cholecystectomy. This is a prospective study conducted in the Department of Surgery of Al-Mawani General Hospital, Al-Mousawi Private Hospital in Basrah, Iraq, between May 2005 and October 2008. Abdominal Sonography performed in 105 consecutive patients before laparoscopic cholecystectomy (the sonographic signs are: gallbladder wall thickness, pericholecystic fluid, sonographic Murphy's sign, shrunken gallbladder, number and size of gallstones). Patients excluded are those with history of jaundice, abnormal liver function test, upper abdominal surgery, co-morbid illnesses, extreme obesity, dilated intrahepatic or extrahepatic biliary ducts or those with CBD stones. The surgeon re-evaluates the results of ultrasound with the results obtained during surgery. One hundred and five patients included in the study, 103 patients with gallstones, the other 2 patients having polyps. Ultrasound was accurate 100% in detecting gallstones and polyps, 99 patients (94.3%) have their cholecystectomies via the laparoscope, 75 patient (75.8%) from them show easy procedure, while 24 patients (24.2%) suffered from difficulties. Six patients (5.7%) needed conversion to open cholecystectomy to complete the operation safely. In conclusion, there are many sonographic signs that we can be depend on them to give us an idea about the possibility of conversion to open cholecystectomy, the most specific one is pericholecystic fluid. Secondly gallbladder wall thickness more than 3mm, thirdly, sonographic Murphy's sign, fourthly, shrunken gallbladder, fifthly single gall stone. The other signs are of less specificity like size and multiplicity of gall stones.

Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography

To assess the diagnostic value of MR cholangiography (MRC) for detecting common bile duct (CBD) stones in candidates for laparoscopic cholecystectomy (LC). A series of 95 selected patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and/or CBD size > or = 6.5 mm at US) were referred to our institution for MRC, before LC. MRC was performed on a 0.5 T magnet through a non-breath-hold, respiratory-triggered, fat-suppressed, thin-slab, heavily T2-weighted fast spin-echo sequence and through a breath-hold, thick-slab, single-shot T2-weighted sequence in the coronal plane. Axial T1- and T2-weighted sequences were first obtained. Two observers in conference reviewed source images and maximum intensity projections to determine the presence or absence of choledocholithiasis. MR findings were compared with endoscopic retrograde cholangiography and intraoperative cholangiography (IOC); IOC was always performed during LC. CBD calculi (single or multiple) were identified in 41 out of 95 patients (43%). Two false-positive and 4 false-negative cases were found on MRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRC for choledocholithiasis were 90%, 96%, 94%, 95%, and 93%, respectively. MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC.

Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography.

To assess the diagnostic value of MR cholangiography (MRC) for detecting common bile duct (CBD) stones in candidates for laparoscopic cholecystectomy (LC). A series of 95 selected patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and/or CBD size > or = 6.5 mm at US) were referred to our institution for MRC, before LC. MRC was performed on a 0.5 T magnet through a non-breath-hold, respiratory-triggered, fat-suppressed, thin-slab, heavily T2-weighted fast spin-echo sequence and through a breath-hold, thick-slab, single-shot T2-weighted sequence in the coronal plane. Axial T1- and T2-weighted sequences were first obtained. Two observers in conference reviewed source images and maximum intensity projections to determine the presence or absence of choledocholithiasis. MR findings were compared with endoscopic retrograde cholangiography and intraoperative cholangiography (IOC); IOC was always performed during LC. CBD calculi (single or multiple) were identified in 41 out of 95 patients (43%). Two false-positive and 4 false-negative cases were found on MRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRC for choledocholithiasis were 90%, 96%, 94%, 95%, and 93%, respectively. MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC.

Sonography for selecting candidates for laparoscopic cholecystectomy: a prospective study.

We assessed the value of sonography in predicting intraoperative difficulties for patients undergoing laparoscopic cholecystectomy and in identifying indicators for conversion to conventional cholecystectomy. Upper abdominal sonography was performed (according to a checklist) in 75 consecutive patients before laparoscopic cholecystectomy. Sonographic findings were verified by the surgeon in the operating room. Conversion from laparoscopic surgery to laparotomy was performed in five patients (6.7%). Of 75 patients, 19 had sonograms revealing gallbladder wall thickening (>4 mm); surgical preparation difficulties in 16 of these patients led to laparotomy in four patients. Sensitivity, specificity, positive predictive value, and accuracy of wall thickening as an indicator of technical difficulties were 66.7%, 94.1%, 84.2%, and 85.3%, respectively. Sensitivity, specificity, positive predictive value, and accuracy of wall thickening as an indicator of surgical conversion were 80.0%, 78.6%, 21.1%, and 78.7%, respectively. Technical difficulties at laparoscopy occurred in all five patients with pericholecystic fluid on sonography (sensitivity, 20.8%; specificity, 100%; positive predictive value, 100%; accuracy, 74.7%) and led to laparotomy in three patients (sensitivity 60.0%, specificity 97.1%, positive predictive value 60%, accuracy 94.7%). The accuracy of sonography for cholecystolithiasis was 100%. On sonography, gallbladder wall thickening is the most sensitive indicator and pericholecystic fluid is the most specific indicator of technical difficulties during laparoscopic cholecystectomy. Such difficulties may require conversion to laparotomy.