Cholecystectomy In Patients Research Articles

Comparative study of ropivacaine and ropivacaine with dexmedetomidine in ultrasound-guided transversus abdominis plane (TAP) block for post operative analgesia in laparoscopic cholecystectomies

Background and aims: TAP block is an effective way to provide postoperative analgesia .TAP block using ropivacaine alone has not been consistently proven to be effective in alleviating pain after laparoscopic surgeries. The study aimed to compare the combination of dexmedetomidine and ropivacaine to ropivacaine alone in TAP block for laparascopic cholecystectomy patients for post operative analgesia. Materials and Methods: 60 patients of ASA health status I or II, were divided equally into 2 groups. Groups R received bilateral US- TAP blocks with 20 mL 0.375% Ropivacaine and Group RD received, 20 ml 0.375% ropivacaine with 50μg dexmedetomidine. Each patient was assessed in the PACU for first 24 hr for pain duration of analgesia,and need for rescue analgesic. Results: The mean of VAS pain score was least in group RD compared to group R and statistically significant (P < 0.05).The total rescue analgesia ( tramadol ) consumption in 24 h after surgery was (116.6±37.9) mg in group RD against (160±67.4) mg in group R, which was also statistically significant (P < 0.05). Duration of analgesia was greater in group RD (7.7 ± .53) compared to group R (4.5 ± .56).

Clinical Significance of Intraoperative Nursing Cooperation on Complications of Minimally Invasive Cholecystectomy Patients

Clinical Significance of Intraoperative Nursing Cooperation on Complications of Minimally Invasive Cholecystectomy Patients

SP8.1.2 Group and Saves for Laparoscopic Cholecystectomies: An Unnecessary Expense?

Abstract Aims The aim of this study was to analyse the necessity of routine group and saves (G+S) in patients undergoing laparoscopic cholecystectomies and to establish whether it would be safe to cease this practice. In doing so, we aim to reduce financial burden and workload, whilst maintaining safe clinical outcomes. Methods This was a retrospective study into all consecutive patients that underwent an elective or emergency laparoscopic cholecystectomy in Royal Hampshire County Hospital (RHCH) from May 2019 - May 2021. IT systems and clinical notes were analysed to identify the quantity of pre-operative G+S samples sent, and the proportion of patients that required a postoperative blood transfusion. Results Over 24 months, 427 laparoscopic cholecystectomies were performed in RHCH, 70% of which were elective. In total, 682 G+S samples were processed (1.6/patient), resulting in a cost of £16504. Two patients received a postoperative blood transfusion (0.5%). One of these patients presented with an UGI bleed, whilst the other presented with a haemolytic crisis. They were therefore predictable, pre-operative conditions, for which a post-operative transfusion had been planned prior to surgery. Conclusion In conclusion, this study suggests that performing routine G+S for all laparoscopic cholecystectomy patients has created an unnecessary workload and financial burden on this small DGH. Furthermore, during this 24 months, this practice had no clinical advantage. We therefore advise that sending pre-operative G+S samples should be a clinical decision made on a case by case basis, rather than a default for all patients.

Metagenomic Sequencing of the Gallbladder Microbiome: Bacterial Diversity Does Not Vary by Surgical Pathology

IntroductionAlterations in the microbiome contribute to the pathogenesis of many gastrointestinal diseases. However, the composition of the microbiome in gallbladder disease is not well described. MethodsWe aimed to characterize the biliary microbiome in cholecystectomy patients. Bile and biliary stones were collected at cholecystectomy for a variety of surgical indications between 2017 and 2019. DNA was extracted and metagenomic sequencing was performed with subsequent taxonomic classification using Kraken2. The fraction of bacterial to total DNA reads, relative abundance of bacterial species, and overall species diversity were compared between pathologies and demographics. ResultsA total of 74 samples were obtained from 49 patients: 46 bile and 28 stones, with matched pairs from 25 patients. The mean age was 48 years, 76% were female, 29% were Hispanic, and 29% of patients had acute cholecystitis. The most abundant species were Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pasteurianus. The bacterial fraction in bile and stone samples was higher in acute cholecystitis compared to other non-infectious pathologies (p < 0.05). Neither the diversity nor differential prevalence of specific bacterial species varied significantly between infectious and other non-infectious gallbladder pathologies. Multivariate analysis of the non-infectious group revealed that patients over 40 years of age had increased bacterial fractions (p < 0.05). ConclusionsMetagenomic sequencing permits characterization of the gallbladder microbiome in cholecystectomy patients. Although a higher prevalence of bacteria was seen in acute cholecystitis, species and diversity were similar regardless of surgical indication. Additional study is required to determine how the microbiome can contribute to the development of symptomatic gallbladder disease.

3D Magnetic Resonance Cholangiopancreatography (MRCP) in Symptomatic Post Cholecystectomy Patients: Ideal Imaging Plane of Source Volume Images

Objectives: The purpose of our study was to find out the ideal 3D-MRCP acquisition plane among coronal and axial source datasets for bile duct assessment in patients with persistent post cholecystectomy pain. Methods: This was a cross sectional analytical study carried out in Radiology department of a teaching hospital from 1st January 2016 to 30 May 2017. 78 symptomatic patients for MRCP in the duration were included. Age range was 20 to 70 years and patients had persistent or recurrent post cholecystectomy symptoms like abdominal pain, vomiting or jaundice. Data was collected retrospectively from the hospital’s database so the need of informed consent was waivered off by permission from hospital’s ethical committee. MRCP was performed for all patients on 1.5 tesla GE MRI machine with breath-hold multi-slice acquisition using dedicated multichannel surface coils covering the abdomen. Both 2D and 3D MRCP were done. Coronal MIP was reconstructed based on each dataset. Data was analyzed using Microsoft excel and SPSS version 22. Results were compared for the ideal 3D plane to assess pancreatic and biliary ducts. Results: The encountered post cholecystectomy biliary findings were strictures (48%), retained biliary stones (35.8%), which were located either intrahepatic or extra-hepatic, most commonly in distal CBD causing obstructive jaundice and rest of the patients had either cholangiocarcinoma at hilum, pancreatitis or post op complications like complete bile duct transaction, bile duct ligation etc. The most common finding was biliary stricture. CHD and proximal CBD were better assessed for presence of strictures and stones on 3D coronal (P value &lt;0.05) as compared to the axial images. Peri-ampullary, distal CBD, intrahepatic and hilar confluence duct strictures were better visualized on 3D axial (P value &lt;0.05). 3D axial was also better than coronal raw data sets regarding visualization of calculi in distal CBD, intrahepatic biliary ducts, GB remnant, cystic duct and hilar biliary confluence. 3D coronal was better for post op ligature whereas 3D axial was more helpful deciding the level of duct injury and to assess the site of biliary leakage. Conclusion: The results of our study suggest that 3D axial primary dataset of MRCP is preferable for visualization and evaluation of distal CBD, ampulla and hilar confluence whereas for overall evaluation of bile ducts status, coronal reconstructions with MIP are preferred. Most common finding in our study was biliary strictures.

Anesthesia Effect of Remifentanil Combined with Propofol in Laparoscopic Cholecystectomy and Its Impact on Postoperative Cognitive Recovery.

Objective To investigate the anesthesia effect of remifentanil combined with propofol for laparoscopic cholecystectomy and its impact on postoperative cognitive recovery. Methods A total of 120 patients who underwent laparoscopic cholecystectomy in our hospital from February 2019 to June 2021 were recruited and assigned into either control group or experimental group at a ratio of 1 : 1 via the random number table method. The patients in the control group were anesthetized with fentanyl combined with propofol, and the patients in the experimental group were anesthetized with remifentanil combined with propofol. The clinical basic indicators (extubation time, recovery time, breathing recovery time, and orientation recovery time), and observer's assessment of awareness/sedation (OAA/S) scores and complications were compared between the two groups. Results There was no significant difference in extubation time between the two groups (P > 0.05). The postoperative wake-up time, respiratory recovery time, and orientation recovery time of the experimental group were significantly better than those of the control group (P < 0.05). The OAA/S scores of the patients in the experimental group were significantly higher than those in the control group immediately after surgery, 1 h after surgery, and 3 h after surgery (P < 0.05). There was no significant difference in the OAA/S scores between the two groups on the 1st day after operation (P > 0.05). The incidence of complications in the experimental group was significantly lower than that in the control group (P < 0.05). Conclusion Remifentanil + propofol for laparoscopic cholecystectomy patients has a significant anesthesia effect. This strategy effectively shortens the extubation, awakening, respiratory recovery, orientation recovery time of patients, and OAA/S score, suggest a minor impact on the postoperative cognitive function and state of consciousness. It has a high safety profile and thus is worthy of clinical application.

Comparative Study between Fat Restriction and Normal Diet on Post Laparoscopic Cholecystectomy Patients in Early Postoperative Period

Comparative Study between Fat Restriction and Normal Diet on Post Laparoscopic Cholecystectomy Patients in Early Postoperative Period

Comparative Risk of Surgical Site Infection With Open Cholecystectomy Vs Laparoscopic Cholecystectomy

OBJECTIVES: This study aimed to compare the risk of surgical site infection with open vs laparoscopic cholecystectomy. METHODOLOGY: This randomized control trial was done at the Department of Surgery, Hayatabad Medical Complex, Peshawar, for 12 months from 11/5/2018 to 11/5/2019. 116 patients were recruited for this study, 58 for each group randomly allocated to a group by lottery method and concealed Allocation. Patients in Group A underwent laparoscopic cholecystectomy, while patients in group B underwent open cholecystectomy. According to ward protocol, post-operative analgesia &amp; antibiotics were given to patients in both groups. Expert consultant general surgeons did all the evaluation &amp; procedures; all the patients were followed up to 30 days after the procedure &amp; any surgical site infections, if found, were noted. RESULTS: The mean age was 36 years ± 12.19 SD and 38 years ± 11.88 SD in laparoscopic and open cholecystectomy, respectively. In laparoscopic cholecystectomy, 28% of patients were male, and 72% of patients were female, while in open cholecystectomy, 29% of patients were male, and 71% of patients were female. 07% of laparoscopic and 26% of open cholecystectomy patients had surgical site infections. CONCLUSION: Our study concludes that the frequency of surgical site infection was found less in laparoscopic cholecystectomy than in open cholecystectomy.

Cholecystectomy prior to short bowel syndrome does not alter nutritional prognosis

BackgroundPrevious cholecystectomy is common in patients with short bowel syndrome (SBS). An intact gallbladder is beneficial in preventing cirrhosis in SBS patients, but the nutritional consequences of cholecystectomy are largely unknown. Our aim was to evaluate the effect of pre-SBS cholecystectomy on need for chronic parenteral nutrition (PN). MethodsWe reviewed 485 adults with SBS: 267 underwent cholecystectomy prior to SBS and 218 patients had an intact gallbladder. Demographic data, intestinal anatomy, and nutritional outcome were compared. ResultsPre-SBS cholecystectomy patients were more likely to have had postoperative SBS and BMI >35. Intestinal remnant length and anatomy type and performance of surgical rehabilitation procedures within the first year were similar.Overall, there was no significant difference in the need for PN > 1year between the two groups. There was also no significant difference in the need for PN > 1year in any specific subgroup of intestinal remnant length or intestinal anatomy. ConclusionsCholecystectomy performed prior to the development of SBS does not influence the nutritional prognosis of SBS, regardless of the intestinal remnant length and anatomy type.

Efficacy of ringer’s solution and 5% dextrose in preventing post-operative nausea and vomiting score in laparoscopic cholecystectomy

Background: Post-operative nausea and vomiting (PONV) is the most common problem after anaesthesia and surgery, with a prevalence of about 30%. The present study assessed efficacy of dextrose in preventing PONV in laparoscopic cholecystectomy patients. Materials &amp; Methods: 120 patients scheduled for LC under general anesthesia were divided into 2 groups. In group I, patients received an infusion of 500 cc lactated Ringer’s solution and in group II, patients received 5% dextrose in lactated Ringer’s solution over a period of 30 minutes. Nausea and vomiting intensity was recorded using the verbal rating scale immediately at post‑anaesthesia care unit arrival; 60 and 120 minutes after arriving at the PACU and 12 and 24 hours after surgery. Results: Group I received lactated Ringer’s solution and group II received 5% dextrose. There were 25 males and 35 females in group I and 20 males and 40 females in group II. Nausea score at 60 minutes (N1) was 5.5 in group I and 1.2 in group II, N2 was 4 in group I and 0.83 in group II, N3 was 2.56 in group I and 1.36 in group II and N4 was 0.1 in group I and 0.2 in group I.

Clinical outcome of subtotal cholecystectomy for difficult gallbladder

When the Calot triangle structures cannot be found and a critical evaluation of patient safety cannot be achieved, surgeons perform a subtotal cholecystectomy (SC). objective Evaluation and analysis of the outcomes of subtotal cholecystectomy at the GIT and Hepatology teaching Hospital is to be conducted. Retrospective analysis of patient data and research methodologies thirteen hundred and eighty onsecutive cholecystectomy patients at GIT &amp; Hepatology Hospital (Oct.2017 to Apr.2020). 53 of the 1380 people investigated underwent a partial cholecystectomy. Routine laparoscopic or open cholecystectomy patients (13.27) could not be included in the study. An individual patient's medical history is mined for information on their preoperative features. Results 53 individuals had subtotal cholecystectomy, with 29 males (55.7%) and 24 women (24.8%) both undergoing the procedure (45.2 percent ). Patients in the research, who ranged in age from 20 to 69, had an average age of 43.5 years. The bulk of the 45 patients (87.2%) had elective surgery, whereas only 8 (15%) had emergency surgery. There were 33 cases of laparoscopic subtotal cholecystectomy and only 20 cases of open subtotal cholecystectomy in this study (6 patients had conversion subtotal cholecystectomy).

Effect of Pranayama (Ancient Indian Breathing Techniques) in Laparoscopic Cholecystectomy Patients: A Prospective Randomized Control Trial

Pranayama is an art of prolongation and control of breath, which helps the person to bring his consciousawareness in breathing; to reshape his breathing habits and patterns these in turn produce variousbiochemical and physiological changes in the body milieu which need no proof.Materials and Methods: A total of 40 patients having cholelithiasis which consisted 34 females and6 males (All were nonsmoker) with age varying from 18years to 82years were recruited from ourhospital, Uttar Pradesh University of Medical sciences, Saifai. Etawah.Results: In our study we found that the mean alertness level at 1 hour post op in subject groups was 7.2in respect to 5.8 in the control group, which has a significant value.

The Therapeutic Antiemetic and Hemodynamic Effects of Dexmedetomidine, Ephedrine, and Dexamethasone in Combination with Midazolam on Laparoscopic Cholecystectomy Patients: A Randomised Clinical Trial.

Objective:The objective was to compare the hemodynamic and antiemetic effects of the combination of midazolam with ephedrine, dexamethasone, and dexmedetomidine in laparoscopic cholecystectomy surgical patients.Materials and Methods:This randomised, parallel-group, double-blind clinical trial was conducted by enrollment of 96 patients who were referred for laparoscopic cholecystectomy. Patients assigned into three equal-sized intervention arms having received anaesthesia induction with midazolam-ephedrine, midazolam-dexamethasone, and midazolam-dexmedetomidine using a block randomisation method. Frequency and severity of nausea and vomiting were observed from recovery to 24 h later, adverse events, and sedation on Ramsay sedation scale at recovery, 1, 2, and 4 h postoperatively. Data were recorded and analysed at a significance level lower than 0.05 in SPSS software.Results:The clinical parameters including mean blood pressure at all times and heart rate in 60–90 min were lower in the dexmedetomidine group when compared with other groups. The lowest severity of postsurgery nausea occurrence was observed in the midazolam-dexamethasone group and those receiving midazolam-dexmedetomidine from 4 to 24 h. In addition, vomiting scores were lower throughout recovery up to postoperative 4 h in the dexamethasone and dexmedetomidine groups (all P < 0.05). The highest sedation score was observed in the dexmedetomidine group during recovery up to 2 h (P = 0.001), reflecting a more clinically superior effect than dexamethasone (P = 0.01).Conclusions:A positive implication of dexmedetomidine was observed in attenuating postoperative nausea and vomiting and potentiating sedation. Nevertheless, it is providing a drop in the blood pressure and heart rate. Lending support to the potent adjuvant efficacy of dexamethasone following dexmedetomidine, consequently, a hypothesis can be put forward, stating that the dexmedetomidine and dexamethasone as adjuvants to midazolam are expected to bring the advantages of avoiding the adverse events and improving postoperative sedation.

Does "Sludge" Require Cholecystectomy?

Biliary sludge is a subjective, ill-defined term. Surgery is often consulted for laparoscopic cholecystectomy, regarded as a low risk procedure.After IRB approval, a word search was used to identify "sludge" in all ultrasounds performed in 2016. The number of patients undergoing cholecystectomy, complications, pathologic findings, and risk factors were identified. Non-operative patients were evaluated for subsequent symptoms and studies or procedures related to biliary pathology.2769 patients underwent RUQ US; 253 patients were found to have sludge. Of 48 (19%) cholecystectomy patients, 9 had cholelithiasis. No deaths occurred in the cholecystectomy group. Two surgical complications occurred. Fifty (24.4%) of the 205 non-operative patients underwent subsequent US imaging: 44% residual sludge, 28% normal, 18% stones, and 10% other.Sludge may resolve 28% of the time. Repeat ultrasound is prudent before proceeding with cholecystectomy. If an abnormality is seen on repeat imaging and risk factors persist, cholecystectomy may be reasonable.

Incidence of Various Types of Gallstones in Association with Age

Aim: Gallstones are responsible for many hospitalizations and surgical interventions in our local population. Our main goal was to evaluate the relationship between age and gallstones as a risk factor in our local population. Methods: Cross-sectional study of all cholecystectomy patients with prior informed consent was conducted in the department of Surgery at Sheikh Khalifa Bin Zaid Hospital (PGMI), Quetta and Bacha Khan Medical Complex, Swabi for the duration of 06 months from 15th March 2021 to 15th August 2021. The stones are divided into 3 groups according to their colour: light yellow and whitish like a cholesterol stone, black and black-brown like a pigment stone, and laminated brownish or greenish yellow as mixed stones. The collected data was statistically processed using SPSS version 21. The types of stones were correlated with the age groups of the patients using the student’s test and / or the Chi-square test as appropriate. The confidence level was defined as 95% CI and p values below 0.05 were considered statistically significant. Results: The study included 100 patients 14(14%) men and 86 (86% women) with a female to male ratio of 13.2: 1, chi-square = 1190.70, p &lt; 0.0001 and their mean age was 46.2 years (SD ± 9.4) (Range, 30 to 75 years). The most common pigment stones were found in 44 (44%). The highest incidence of gallstones was found in the age groups 41-50 and 31-40, 44% and 26%, respectively (p &lt;0.05). Conclusion: From the study it can be concluded that age has an influence on the occurrence of gallstone disease. Keywords: Gallstone (GS); Pigment stones (PS); Mixed stones (MS); Cholesterol stones (CS);

Ascending Cholangitis Secondary to Choledocholithiasis In Post Cholecystectomy Patient: A Diagnostic Dilemma

Choledocholithiasis is the presence of stones in the common bile duct (CBD). Choledocholithiasis in post-cholecystectomy is rare. Nonetheless, this is a report of a 40-year-old woman who was presented with severe epigastric pain with high-grade fever, tea-coloured urine, pale stool, and jaundice. She had a history of pangastritis and had cholecystectomy two years ago.This case report describes the significant diagnostic dilemma of the choledocholithiasis, particularly in a post-cholecystectomy patient who had pangastritis and was presented with severe epigastric pain. The diagnosis of choledocholithiasis was missed as the early symptoms of choledocholithiasis are similar to those of pangastritis. Therefore, treatment for choledocholithiasis was delayed. A high index of suspicion for diagnosis of choledocholithiasis must be emphasized among primary care practitioners even in a post-cholecystectomy patient. This will enable early treatment for the patient and prevent complications such as ascending cholangitis and sepsis. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 458-462

Assessment of postoperative pain intensity after laparoscopic cholecystectomy: Comparative analysis of three rating scales in terms of scores and patient preferences

Objective: To compare three rating scales in assessment of postoperative pain intensity after laparoscopic cholecystectomy Methods: A total 102 patients who underwent elective laparoscopic cholecystectomy surgery were participated on a voluntary basis in this cross-sectional questionnaire survey. The questionnaire form elicited items on sociodemographic characteristics of patients, pain characteristics and the pain intensity assessment via three scales including Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Descriptor Scale (VDS). Results: Mean(SD) VAS, VDS and NRS scores were 4.7(1.3), 2.8(0.7) and 4.5(1.2), respectively. VDS (67.6%) was the most commonly preferred scale by patients, as followed by VAS (23.5%) and NRS (8.8%). Positive significant correlations were noted between each scale (r: ranged from 0.809 between VAS and VDS to 0.865 between VDS and NRS, p&lt;0.001 for each). There was a high level of inter-scale concordance overall (Cronbach's alpha: 0.910), including VAS x VDS (Cronbach's alpha: 0.820), VAS x NRS (Cronbach’s alpha=0.906) and VDS x NRS (Cronbach’s alpha=0.868). Conclusion: In conclusion, our findings demonstrate that all three scales (VAS, NRS, VDS) provide reliable and valid data with strong correlations and a high level of inter-scale concordance in assessing postoperative pain intensity in laparoscopic cholecystectomy patients. However, VDS appears to be the best scale in assessing pain intensity after laparoscopic cholecystectomy surgery with respect to patient preference rates as well as its strong correlation with other scales, particularly the NRS.

Bacteriological profile of bile in cholecystectomy patients in tertiary care center

Bacteriological profile of bile in cholecystectomy patients in tertiary care center

Hepatic abscess, an unusual complication in a postoperative cholecystectomy patient: Case report

The hepatic abscess is a rare complication related to multiple causes, mostly of biliary origin. Its etiology can be classified on amoebic or pyogenic origin, being more frequent with the bacterial etiology. The development of a hepatic abscess is related in 4.8% to 15% of patients with acute cholecystitis and 21.9% of patients having a biliary disease. The clinical presentation is usually non-specific; it needs to be complemented with an imaging study to make the timely diagnosis. Its management varies according to its evolution and size; both percutaneous drainage and surgical drainage provide adequate management for medium and large abscess with a favorable prognosis. We presented the case of a patient with hepatic abscess formation after a laparoscopic cholecystectomy for acute Lithia sic cholecystitis.

Surgical Treatment of Acute Cholecystitis in Patients over 80 Years: 10-Year Experience

The prevalence of gallstones ranges from 20% to 30% in patients ≥ 60 years of age whereas it is higher in individuals ≥ 90 years of age. Elderly patients with gallstones tend to develop more complications such as gallbladder hydrops, empyema or perforation. Although perioperative morbidity and mortality is slightly high in elderly patients with acute cholecystitis, cholecystectomy is successfully performed for acute cholecystitis with regard to improvement in patients care. In this study, we aimed to evaluate the results of patients over 80 years of age who had cholecystectomy. The data of the 196 patients over 80 years of age who underwent cholecystectomy for acute cholecystitits between Jan 2011and August 2020 were retrospectively reviewed. The age of the patients in this study ranged from 80 to 97 years. The number of female patients was 111 and male patients was 85. 109 patients underwent laparoscopic cholecystectomy and 77 patients underwent open cholecystectomy. 10 patients converted from laparoscopic to open surgery. One patient who underwent open cholecystectomy died. We observed more wound infection in open cholecystectomy group. Laparoscopic cholecystectomy patients were discharged earlier. Age is not a contraindication for cholecystectomy in patients with acute cholecystitits. Cholecystectomy is a safe procedure in elderly patients with accepted morbidity.