Cholecystectomy For Symptomatic Gallstones Research Articles

Predicting Conversion from Laparoscopic to Open Cholecystectomy Using a Perioperative Gallbladder Scoring System

Background: Gallstones and associated consequences are a leading cause of elective and emergency laparoscopic and open surgical procedures. Since the first laparoscopic Cholecystectomy in 1985, laparoscopic Cholecystectomy has been the gold standard for treating symptomatic gallstones. Several pre-operative scoring systems can tell you if a laparoscopic cholecystectomy for gall bladder surgery will be difficult based on different anatomical, imaging, and laboratory findings. However, few intraoperative scoring systems can tell if the surgery will be complicated. Some authors recently considered the most prominent essentials confronting surgeons during laparoscopic Cholecystectomy. Aim of the study: This study attempted a planned assessment of a recently reported intra-operative gallbladder scoring framework (G10) to decide if it might predict the result of surgery, essentially the ability to complete the operation laparoscopically. Patient and methods: Eight hundred thirty-seven patients admitted to laparoscopic Cholecystectomy for symptomatic gall stones were enrolled in this prospective study from 1st January 2018 to 31st 2021, performed in Rizgary and Hawler Teaching hospitals in Erbil, Iraq. Results: Among 837 patients, the mean age was 42.3 (range 14–71), 581 (69.4%) were female, and 256 (30.6%) were male. The mean operation time was 32.7 minutes, ranging from 15 to 150 minutes, and 63 (7.6%) patients were converted to open Cholecystectomy because of intraoperative difficulties. The most significant correlations were found with distended and/or contracted gall bladders, the inability to grasp the wall with traumatic forceps, an impacted stone in the Hartman's pouch, and pus or bile outside the gall bladder. Conclusion: New intraoperative scoring systems are valuable in predicting difficulties and preventing increased operation time and possible injuries; the main points of difficulties are distended or contracted gallbladder, large stone impaction, difficulty grasping the wall of the gall bladder, and the presence of bile or pus outside the gall bladder.

Hydro-dissection: An Effective Intra-Operative Technique for Difficult Laparoscopic Cholecystectomies

Hydrodissection, a technique used to treat nerve entrapments, involves injecting an anaesthetic, saline, or 5% dextrose in water to separate the nerve from the surrounding tissue. Objectives: To assess the efficacy of this technique in all patients undergoing difficult laparoscopic cholecystectomy in terms of operative time, haemorrhage, and intra-operative complications. Methods: A multicenter observational study was conducted at the department of surgery, PAF Faisal Hospital and Anis Bantva Trust Hospital Karachi. A total of 219 patients were included in this study who underwent laparoscopic cholecystectomy for symptomatic gall stones, with age ranging from 18-70 years, with intra-operative Cuschieri classification >1, using a non-probability sampling method. Results: This study included 219 patients from hospital records categorized as per intra-operative difficulty grading of Cuschieri from grade II-IV. The mean age of patients was 40.46 ±12.50 years, with an average duration of symptoms of 16.95 ± 8.73 days. There were 160 (73.1%) males and 59 (26.9%) females. About two-thirds of patients were admitted through the emergency department. The pre-operative and intraoperative diagnosis of patients was symptomatic cholelithiasis 76 (34.7%), acute on chronic cholecystitis (27.9%), chronic cholecystitis 57 (26.0%), empyema and mucocele gallbladder 11 (5%) each, and Gangrenous gallbladder 3 (1.4%) were recorded. Conclusion: This study showed a clear association of intra-operative complicated anatomy during laparoscopic cholecystectomy to its conversion to open cholecystectomy. Techniques of dissection are of significant importance to minimize injuries to vital structures

The Final Illness of Herbert Hoover.

Herbert Hoover, the archetypal self-made man, was the 31st president of the United States. His term in office was overwhelmed by the Great Depression and he was defeated by Franklin Delano Roosevelt in the 1932 November presidential election. His post-presidential years were spent writing and serving 4 subsequent presidents. Near the end of his life, he underwent a cholecystectomy for symptomatic gallstones and a colectomy for colon cancer. His health care was complicated by the development of cirrhosis and recurrent gastrointestinal bleeding. After his 90th birthday, he died in October 1964 from massive bleeding due to a Dieulafoy lesion of the gastric cardia. This manuscript will review the details of his health and the physicians who cared for Hoover during his final years.

Morphological and Biochemical Analysis of Gallstones in Lahore, Pakistan.

Introductions: Gallstones are formed within the gallbladder or in biliary tract. They can be termed as cholesterol stones whose major constituent is cholesterol or pigment stones which mainly are composed of bilirubin or there can be calcium and oxalate stones too. The aim of this study was to establish the composition of stones found within the gallbladder after cholecystectomy for symptomatic gallstones. Material and Methods: This study was conducted in a tertiary care hospital (Services Hospital Lahore) from 1st August-2017 to 30th June-2018. After examining the physical characteristics of the stones (color, number, shape and surface) were analyzed by semi- quantitative colorimetric analysis. Demographic data, morphology of stones and the percentage different chemical components were noted on pre-established performa and analyzed by SPSS software version 22. Results: A total 200 people were recruited in the study. The mean age of the patients was 37.82 ± 11.67 years. 90% patients were female and 10% patients were males. 10% cases had solitary stone while 90% cases had multiple stones. 25% patients had light brown stones, 30% had dark brown stones, 35% had gray stones and 10% had black stones. 85% cases had mixed stones whereas 15% had cholesterol stones. The mean percentages by weight of calcium, cholesterol, iron, phosphorus and bilirubin were 50± 10.59%, 27.45± 11.57%, 14.3± 6.28%, 13.25± 8.36% and 5.1± 2.46% respectively. Conclusion: It is concluded that gallstone disease is common in third decade of life and mixed stones is the most frequent variety of gallstones and calcium is the most abundant substrate of the gallstone

EFFICACY OF LIVER FUNCTION TEST IN PATIENTS WITH SYMPTOMATIC GALL STONE DISEASE

Background: Cholelithiasis is a common clinical problem in surgical practice all over the world. Liver function tests (LFT’s) are routinely performed in patients undergoing cholecystectomy for symptomatic gall stones.
 Objective: To evaluate the effectiveness of routine LFTs in patients with symptomatic gall stones attending Shridev Suman Subharti Medical College attached with Dr. K.K. Bhatnagar Memorial Subharti Hospital, Dehradun, Uttarakhand, India
 Material and Methods: The present prospective observational study was conducted from December 2016 to November 2017 in the Dept. of Surgery in collaboration with Dept. of Biochemistry at Shridev Suman Subharti Medical College attached with Dr. K.K. Bhatnagar Memorial Subharti Hospital, Dehradun, Uttarakhand, India. All patients clinically diagnosed with symptomatic cholelithiasis were included in the study. Patients with past and present history of jaundice, pancreatitis, cholangitis and abnormal calibre common bile duct on ultrasonography (more than 8mm) were excluded from the study. Data regarding relevant history, clinical examination findings, LFT’s and ultrasound examination findings were analyzed and noted in pre-designed proforma.
 Results: Study composed of 120 patients comprising 100(83.33%) female and 20(16.67%) male with the mean age of 45±25 years. Out of 120 patients, 85(70.83%) presented as chronic calculous cholecystitis, 29(24.17%) as biliary colic and 6(5.00%) with acute calculous cholecystitis. The LFT’s were within normal range in 107(89.16%) patient, which labeled as group A. In group A, 80(74.76%) patients were presented as chronic calculous cholecystitis, 24 (22.42%) as biliary colic and 3(2.8%) as acute calculous cholecystitis. The levels of LFT’s were found abnormal in 13 patients (8.33%) which is labeled as group B. In group B, clinical presentation of 2 (40.00%) patients were as chronic calculous cholecystitis, 8(30.00%) patients as biliary colic & 3(30.00%) patients as acute calculous cholecystitis. Parameters of LFTs, Bilirubin were elevated in 2, AST in 3 and ALP in 8 patients. All patients from either group had normal Common Bile Duct (CBD) caliber on preoperative ultrasound examination and per operatively (in open surgery), no CBD dilatation or palpable calculi.
 Conclusion: Routine LFT’s in preoperative assessment of symptomatic cholelithiasis usually reveals normal findings and is not recommended as a good predictive marker for the detection of silent CBD calculi.
 Keywords: Cholelithiasis, Choledocholithiasis, Common bile duct (CBD), LFT, Cholecystectomy, Laparoscopic

Pain after cholecystectomy for symptomatic gallstones

Pain after cholecystectomy for symptomatic gallstones

Double Cystic Duct Not Detected by Imaging But Diagnosed on Intraoperative Dissection in Laparoscopic Cholecystectomy: A Case Report, Hatwan Hospital-Sulaimani Province-Kurdistan-Iraq

The incidence rate of bile duct injury during laparoscopic cholecystectomy has not been changed for many years. This may be because of biliary tree abnormalities, as variation in cystic duct anatomy is quite common. One of the extremely rare anomalies is a double cystic duct. An old lady underwent laparoscopic cholecystectomy for symptomatic gallstones. Without any clue for this anomaly in preoperative checkup, we found two cystic ducts during the laparoscopy. Operation completed laparoscopically, with smooth early and later postoperative checkups till now.

Risk stratification and preoperative evaluation of the patient with known or suspected liver disease

Surgical risk for patients with liver disease increases in those with advanced portal hypertension and acute liver injury. Although a general approach is shown in Figure ​Figure1,1, risk stratification should be individualized. Improved prognostication with tools such as the MELD score and preoperative optimization can help guide a discussion of the risks and benefits to help patients make educated decisions about invasive procedures. Open in a separate window Figure 1 Recommended approach for preoperative risk assessment. Abbreviation: OR, operating room.

When Heart Failure has to do with Past Abdominal Surgery

A 70-year-old woman, with a past medical history of permanent atrial fibrillation, cholecystectomy for symptomatic gallstones and obesity (54 kg/m² body mass index), was admitted to the hospital for rapidly increasing dyspnea (NYHA class III). At admission, heart rate was 110 beats per minute (bpm) and blood pressure was 125/73 mmHg. Physical examination revealed clinical signs of right heart failure including major peripheral oedema, hepatomegaly, bilateral pleural effusion, and ascites with no signs of portal hypertension or hepatocellular insufficiency.

Neuroendocrine tumor of gallbladder: a case report in maharaj nakorn chiang mai hospital

Introduction Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) originate from neuroendocrine cells which distribute along the entire gastrointestinal tract and pancreas. The site of predilection is the stomach and the tumors are mostly graded as G1 NETs; however, gallbladder NETs are extremely rare, showing only 0.5% of all NETs with unfavorable prognosis. Case presentation A 68-year-old woman underwent open cholecystectomy for symptomatic gallstones, and the gallbladder was diagnosed as poorly differentiated adenocarcinoma. Two months later, two liver metastases were detected in segment 4a and 5. Hepatic segmentectomy (segment 4a and 5) was done. The liver pathology revealed infiltration of small round tumor cells containing small nuclei with fine granular chromatin and inconspicuous nucleoli. The tumor cells were immunoreactive for chromogranin A; therefore, metastatic small cell carcinoma was diagnosed. The gallbladder lesion was reviewed and the diagnosis was revised to neuroendocrine carcinoma grade 3. The patient was sent to the provincial hospital for further chemotherapeutic treatment. Conclusion Neuroendocrine tumors of gallbladder are uncommon and indistinguishable from carcinoma of gallbladder clinically and surgically. Features from radiographic investigation and histopathological features are essential for making the diagnosis. Moreover, the prognosis of gallbladder neuroendocrine tumor is poor and the 5-year survival rate is worse than neuroendocrine tumor from other locations.

MAGNETIC RESONANCE CHOLANGIOGRAPHY–AN OVERUSED INVESTIGATION IN PATIENTS WITH SYMPTOMATIC GALLSTONES?

IntroductionThe incidence of choledocholithiasis with symptomatic gallstones has been estimated to be 10–15%. Pre-magnetic resonance cholangiography (MRC), the common bile duct (CBD) was selectively imaged with intra-operative cholangiogram in patients...

Comparison of early and delayed laparoscopic cholecystectomy for acute cholecystitis: Experience from a single center

Background:Cholecystectomy for symptomatic gallstones is mainly performed after the acute cholecystitis episode settles because of the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis.Aims:To evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy.Materials and Methods:This was a prospective and randomized study. For patients assigned to early group, laparoscopic cholecystectomy was performed as soon as possible within 72 hours of admission. Patients in the delayed group were treated conservatively and discharged as soon as the acute attack subsided. They were subsequently readmitted for elective laparoscopic cholecystectomy 6-12 weeks later.Results:There was no significant difference in the conversion rates, postoperative analgesia requirements, or postoperative complications. However, the early group had significantly more blood loss, more operating time, and shorter hospital stay.Conclusion:Early laparoscopic cholecystectomy within 72 hours of onset of symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

Accidental finding of a toothpick in the porta hepatis during laparoscopic cholecystectomy: a case report

IntroductionUnintentional ingestion of a toothpick is not an uncommon event. Often the ingested toothpicks spontaneously pass through the gut without sequelae. However, serious complications can happen when these sharp objects migrate through the gastrointestinal wall.Case presentationIn the current report, we describe the case of a 37-year-old Caucasian woman with an incidental finding of a toothpick in the porta hepatis during laparoscopic cholecystectomy for symptomatic gall stones.ConclusionToothpick ingestion is not an uncommon event and can predispose patients to serious complications. In this particular case, the toothpick was only discovered at the time of unrelated surgery. Therefore, it was important during surgery to exclude any related or missed injury to the adjacent structures by this sharp object.

Post Operative Pain after Cholecystectomy: Conventional Laparoscopy Versus Single Incision Laparoscopic Surgery (SILS)

Background This study was done to compare postoperative pain after cholecystectomy done by single incision laparoscopic surgery (SILS) versus conventional four port laparoscopy. Methods 100 patients undergoing cholecystectomy for symptomatic gall stones who were willing to be part of this comparison were included in the study. Patients were randomized into two groups of 50 each. Only conventional instruments were used in both groups to keep the cost of surgery same. No special ports, roticulating instruments or flexible telescopes were used. Pain score was checked after 6 hours of surgery using a visual analogue score. Results We observed that there was no statistically significant difference in overall post operative pain. But on further analysis, we found significant difference in post operative pain score in latter half of our series of SILS when compared to conventional laparoscopic cholecystectomy and also the first half of the SILS group. There was also significant difference between operative times in earlier and latter half of SILS. Conclusion Single incision laparoscopic surgery is a feasible and a promising method for cholecystectomy. It is possible to do this procedure with out using special equipment. Although there was no significant difference in overall postoperative pain, there is a possibility that after the initial learning curve, when the operative time reduces, the postoperative pain may also decrease. More studies are needed.

Agenesia del lóbulo hepático derecho. ¿Dónde está la vesícula?

Anomalies of the liver are infrequent. Agenesis of the right hepatic lobe is an uncommon, usually asymptomatic, entity that is diagnosed through new imaging techniques or during surgery. We present the case of a 51-year-old woman with right hepatic lobe agenesis who underwent technically difficult cholecystectomy for symptomatic gallstones. We discuss the diagnosis and technical difficulties that can be encountered during cholecystectomy when there is right hepatic lobe agenesis.

Minilaparotomy cholecystectomy or laparoscopic cholecystectomy for symptomatic gallstones?

Minilaparotomy cholecystectomy or laparoscopic cholecystectomy for symptomatic gallstones?

Sténose post-opératoire de la voie biliaire principale due à un névrome d’amputation post-cholécystectomie

Amputation neuroma of the common bile duct after surgery is a rare and mostly asymptomatic lesion. A 60-year old patient presented with obstructive jaundice three months after a cholecystectomy for symptomatic gallstones. Imaging investigations showed common extrahepatic bile duct stenosis. Surgical resection of the stricture with biliodigestive anastomosis was performed. Histological examination of the surgical specimen revealed an amputation neuroma. Despite its rarity, amputation neuroma of the common bile duct should be considered in patients with post-cholecystectomy syndrome following liver or extrahepatic bile duct surgical procedures.

Cholecystectomy in Jamaican children with homozygous sickle-cell disease.

Twenty-seven children aged 18 years and under with homozygous sickle-cell disease had open cholecystectomy for symptomatic gallstones over the 12-year period 1985-1997. Emergency procedures (done during period of acute exacerbation of symptoms) were performed on 16 patients. Four with haemoglobin levels greater than 1 g/dl below their steady state received a simple blood transfusion preoperatively designed to raise haemoglobin levels to 10 g/dl. All had acute or acute on chronic cholecystitis based on histological examination of gallbladder specimens. Twelve had common bile duct stones. In two patients calculi were missed intraoperatively but these subsequently passed into the duodenum after a period saline irrigation via an in-situ t-tube. Six developed the acute chest syndrome (aetiology not determined) and this progressed to multi system failure and death in one. This high level of postoperative mobility and mortality may in part be due to the high proportion of emergency procedures.

Preoperative Prediction Model of Outcome after Cholecystectomy for Symptomatic Gallstones

Background: After cholecystectomy for symptomatic gallstone disease 20%-30% of the patienrs continue to have abdominal pain. The aim of this study was to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. Methods: One hundred and two patients were referred to elective cholecystectomy in a prospective study. Median age was 45 years; range, 20-81 years. A preoperative questionnaire on pain, symptoms, and history was completed, and the questions on pain and symptoms were repeated 1 year postoperatively. Preoperative cholescintigraphy and sonography evaluated gallbladder motility, gallstones, and gallbladder volume. Preoperative variables in patients with or without postcholecystectomy pain were compared statistically, and significant variables were combined in a logistic regression model to predict the postoperative outcome. Results: Eighty patients completed all questionnaires. Twenty-one patients continued to have abdominal pain after the operation. Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score, 'irritating' abdominal pain, and an introverted personality and by the absence of 'agonizing' pain and of symptoms coinciding with pain (P < 0.000001). In a constructed logistic regression model 15 of 18 predicted patients had postoperative pain (PVpos = 0.83). Of 62 patients predicted as having no pain postoperatively, 56 were pain-free (PVneg = 0.90). Overall accuracy was 89%. Conclusion: From this prospective study a model based on preoperative symptoms was developed to predict postcholecystectomy pain. Since intrastudy reclassification may give too optimistic results, the model should be validated in future studies.