Cholecystectomy Research Articles

Evaluation of fundus first laparoscopic cholecystectomy in an obscured calot triangle: outcomes

Background: A fundus first laparoscopic cholecystectomy when performed by an experienced surgeon, provides the same level of safety and durability as an open cholecystectomy. When Calot's triangle cannot be safely dissected during laparoscopic cholecystectomy a rescue treatment is advised. Current revisions stress the importance of intraoperative observations in helping surgeons make a rescue decision and minimize additional harm. Objective: To examines the fundus-first strategy in laparoscopic cholecystectomy in an indistinct Calot's triangle and the patient's clinical outcome. Patients and Methods: This is a prospective study that was done in Rizgary Teaching Hospital from January 1st, 2020 to December 31st, 2022, on 68 cases who underwent laparoscopic cholecystectomy where Calot’s triangle was difficult to distinguish during the operation. Fundus: first dissection of the gall bladder down to the infundibulum and after safe ligation of the gall bladder stump and good hemostasis of the liver bed, the gallbladder is removed via a 10-mm port. This research looked at the duration of operation, postoperative pain, rate of conversion to open surgery and duration of the hospital stay. Results: Among 68 cases of fundus first laparoscopic cholecystectomy most of the patients were female 45(66.17%) and 23(33.82%) were male, majority of cases were between 31 and 50 years old, with a mean age of 39±10.44, and the majority of patients were complaining of inflammation with fibrosis at the site of the cystic duct. The duration of operation ranged from 45-60 minutes in 16(23.52%) and 60-80 minutes in 20(29.41%) cases and 130-140 minutes in 2(2.94%) cases. The majority of our cases remained in the hospital and ambulated on day 3-5, and the main hospital stay was 4.68±1.8 days. There was statistical significance in the age distribution with a P-value 0.04. Conclusion: Fundus first laparoscopic cholecystectomy remains a feasible and safe procedure. Surgeon experience and judgement affects the operative time, conversion rate, morbidity and hospital stay in difficult and obscured Calot’s triangle.

Endoscopic Findings of a Patient Having Cholelithasis in SOMCH, Sylhet, Bangladesh

Introduction: Cholelithiasis is one of the most frequently encountered disease and one of the major causes of abdominal morbidity throughout world [1]. Cholelithiasis is one of the most common and costly of all digestive diseases. Common causes of upper abdominal symptoms are peptic ulcer, acute and chronic gastritis and gallstones. Objective: To assess the endoscopic findings of a patient having cholelithasis in SOMCH. Methods: This was Retrospective Hospital based study conducted at Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January to December 2022 were (One hundred patients were included). All patients underwent OGD after being diagnosed as having cholelithiasis proved by Endoscopic. All patients above 18 years of age presenting with upper abdominal pain, dyspepsia with or without jaundice diagnosed ultrasonically as cholelithiasis and choledocholithiasis with cholelithiasis were included in the study and patients managed conservatively, patients with primary choledocholithiasis and with asymptomatic gallstones were excluded from the study. Results: Out of 100 subjects evaluated during the study period, 58 were females and 42 males. The most common age group affected was between 31-50 years (65%), followed by less than 30 years of age being 18% and more than 50 years being 17%. It should also be noted the higher rate of incidence (65%) in the age group of 31-50 years. Associated symptoms with cholelithiasis were pain in abdomen, which was observed in all the patients (100%). Of these, 74 patients (74%) presented with chronic upper abdominal pain and 26 patients (26%) presented with acute upper abdominal pain. Remaining 56% of the subjects had positive endoscopic findings. Endoscopic findings were positive in 56 had hiatus hernia, duodinitis, duodenal ulcer or other positive findings. Among patients with positive findings 14 had both oeophagitis as well as gastritis while 12 had both gastritis as well as gastric ulcer. All the 56 patients (100%) underwent surgery. Forty patients (71.4%) underwent laparoscopic cholecystectomy, 14 (25.0%) open cholecystectomy and 2 cholecystostomy for empyema gall bladder. Of the 56 patients 40 patients (71.4%) patient had chronic cholecystitis, 9 patients (16.07%) had acute cholecystitis, 4 patients (7.14%) had carcinoma gall bladder, 2 (3.57%) had xanthogranulomatous cholecystitis and 1(1.78%) had cholesterolosis of gallbladder. Of the 4 patients diagnosed of carcinoma gallbladder, 1 patient had carcinoma confined to muscularis mucosa with negative margins and no metastasis, hence no further surgical management was advised and the rest of the 3 patients had either metastasis or positive margins which were managed as per standard guidelines. Conclusion: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Endoscopy the most common finding was gastritis, oesophagitis and gastric ulcer in decreasing order. There was no hiatus hernia, duodinitis or duodenal ulcer in our study. Patients presenting with dyspepsia and gall-stones in rural setup should be directly treated surgically. Multiple gallstones are common and Laparoscopic cholecystectomy offers best surgical management with 6.57% of conversion rate to open cholecystectomy, with lesser complications.

Investigation and Comparison of Preoperative Symptoms in Patients With Appendicitis and Cholecystitis Before Appendectomy and Cholecystectomy Surgeries

Investigation and Comparison of Preoperative Symptoms in Patients With Appendicitis and Cholecystitis Before Appendectomy and Cholecystectomy Surgeries

Optimal treatment strategies for gallbladder disease in pregnancy: a systematic review with dual network meta-analyses.

This study sought to determine the optimal treatment strategy and timing for cholecystectomy in managing gallbladder diseases during pregnancy. It evaluated the effectiveness of conservative management (CM), laparoscopic cholecystectomy (LC), and open cholecystectomy (OC) in pregnancy and compared cholecystectomy outcomes across three trimesters. Studies comparing CM, LC, and OC or evaluating cholecystectomy outcomes across trimesters were included in a literature search until February 2024. Studies included were required to have at least 10 cases per treatment group and perform statistical comparisons. Two Bayesian network meta-analyses (NMAs) were conducted, and surface under cumulative ranking area (SUCRA) values, risk ratio (RR), mean difference (MD), and 95% credible intervals (CrIs) were calculated for outcomes of interest. Our study included 17 studies with 63,523 pregnant patients. The first NMA included data from 12 studies involving 29,052 pregnant women, revealing that LC had the lowest risk for preterm delivery, significantly lower than CM (RR: 0.23, 95% CrI: 0.07-0.55). LC also had a significantly reduced risk of fetal complications (RR: 0.42, 95% CrI: 0.16-0.57) and maternal complications (RR: 0.44, 95% CrI: 0.15-0.50) compared to OC. LC was associated with a significantly shorter length of stay than OC (MD: -2.77, 95% CrI: -8.37 to -2.87). The second NMA analyzed data from five population-based studies with 34,471 pregnant patients, finding no significant differences in preterm delivery and abortion rates across the three trimesters following cholecystectomy. Cholecystectomy performed in the third trimester significantly increased the risk of maternal complications, with relative risks compared to first (RR: 0.48, 95% CrI: 0.22-1.00) and second trimesters (RR: 0.42, 95% CrI: 0.21-0.93). LC is deemed the optimal treatment for gallbladder diseases during pregnancy. While cholecystectomy is safe to be performed across all trimesters, careful deliberation is recommended during the third trimester due to an increased risk of maternal complications.

Is the trocar through which the gallbladder is removed during cholecystectomy important for potential complications?

Objective: Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallstone disease and complications can develop at trocar sites following laparoscopic cholecystectomy. This study aims to evaluate the impact of extracting the gallbladder through either the umbilical or epigastric ports during laparoscopic cholecystectomy on the complications observed after gallbladder extraction. Methods: Symptomatic cholelithiasis patients who had four port laparoscopic cholecystectomy included to the study. Individuals were divided into two groups based on gallbladder removal site: umbilical or epigastric. Medical records were reviewed for post-surgical complications within 30 days and incisional hernias within one year. The age, gender, operation duration, BMI and the largest stone dimentions of the patients were also noted. Results: A total of 112 patients were included in the study, with 45 patients in the umbilical group and 67 patients in the epigastric group. No significant differences were observed in age, gender, body mass index and stone dimentions between groups. Port site hernia and port site infection developed more frequently but not significantly in umblical group. When examined the stone dimention and BMI based on the presence of a port site hernia and port site infection, BMI and stone dimention were significantly higher in port site infection and hernia patients. Conclusion: Using umbilical port for removing gallbladder, carried a higher risk of infection and hernia development. Additionally, regardless of which trocar is used, patients with a high BMI and large stone dimensions have a higher risk of port site infection and hernia. Patients should be informed about these risks during the preoperative period.

Bailout for the Difficult Gallbladder: Subtotal vs. Open Cholecystectomy-A Retrospective Tertiary Care Center Experience.

Background and Objectives: A difficult gallbladder anatomy augments the risk of bile duct injuries (BDIs) and other complications during a laparoscopic cholecystectomy. This study compares the outcomes of a laparoscopic subtotal cholecystectomy (LSTC) and open total cholecystectomy (OTC) for difficult cholecystectomies. Materials and Methods: This retrospective analysis of gallbladder procedures (LSTC or OTC) from 2016 to 2023 examined patient demographics, surgical details, and postoperative results. The primary outcome was the incidence of a BDI. Secondary outcomes included operative duration, blood loss, and postoperative complications. Results: Seventy-one patients were included in the study. Of them, 59.2% (n = 42) underwent an LSTC and 44.6% (n = 29) underwent an OTC. The LSTC cohort was more likely to have a day-surgery case with a same-day discharge (33.3% vs. 0%, p = 0.009), less blood loss (71.4 ± 82.26 vs. 184.8 ± 234.86, p = 0.009), and a shorter operative duration (187.86 ± 68.74 vs. 258.62 ± 134.52 min, p = 0.008). Furthermore, BDI was significantly lower in the LSTC group (2.4% vs. 17.2%, p = 0.045). However, there were no significant differences between the two groups concerning intraoperative drain placement, peri-cholecystic fluid collection, bile leak, and other complications (p > 0.05). Conclusions: LSTC is a safe and effective alternative to OTC for challenging gallbladder cases. Further studies with larger sample sizes and longer follow-up periods as well as different study designs are warranted.

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Background: Gallstones are a common gastrointestinal disorder often requiring cholecystectomy. Laparoscopic cholecystectomy, the gold standard for gallbladder removal, involves pneumoperitoneum (PNP) using carbon dioxide (CO2) for better visibility and access. However, postoperative shoulder pain remains a frequent complication, largely attributed to CO2 insufflation. This study compares the incidence and severity of postoperative shoulder pain between low-pressure pneumoperitoneum (LPP) and standard-pressure pneumoperitoneum (SPP) during laparoscopic cholecystectomy. Materials and Methods: A prospective interventional study was conducted at SMS Hospital, Jaipur, including 80 patients with gallstone disease undergoing elective laparoscopic cholecystectomy. Patients were divided into two groups: LPP (8–10 mm Hg) and SPP (12–14 mm Hg), each comprising 40 patients. Pain was assessed using the Verbal Rating Scale (VRS) at 2, 6, 12, 24, and 48 hours postoperatively. Data were analyzed using the unpaired two-tailed t-test, with a P value < 0.05 considered statistically significant. Results: The incidence of shoulder pain was significantly lower in the LPP group (10%) compared to the SPP group (40%) (P = 0.00). Mean VAS scores at 2, 6,12,24, and 48 hours post-surgery were consistently lower in the LPP group, with significant differences noted at each time point. At 12 hours, the LPP group had a mean VAS score of 0.62 ± 0.34 compared to 2.92 ± 1.4 in the SPP group (P = 0.00). By 48 hours, no LPP patients reported shoulder pain, whereas the SPP group still reported a mean VAS score of 0.62 ± 0.21 (P = 0.00). Conclusion: LPP is associated with significantly lower incidence and severity of postoperative shoulder pain compared to SPP in laparoscopic cholecystectomy. These findings suggest that LPP could be a better option for reducing patient discomfort and improving postoperative outcomes

Effects of Footbath on Pain, Anxiety, Sleep, and Comfort Levels in Patients With Postlaparoscopic Cholecystectomy: A Randomized Controlled Study.

The aim of the study is to determine the effect of of hot footbaths on the pain, anxiety, sleep, and comfort levels of patients who underwent laparoscopic cholecystectomy. The study is a randomized controlled designed. This study was conducted in surgery clinic of a university hospital between January 2022 and November 2022. The research was completed with 54 patients in the experimental group and 54 patients in the control group. The mean state anxiety score and VAS-Sleep score of the patients in the experimental group 120 minutes after the application was 31.07±4.70 and 612.62±82.37, respectively, which was statistically significantly lower than that of the patients in the control group ( P <0.05). On the other hand, at the 120th minutes after the application, the mean VAS-Comfort scores of the patients in the experimental group were statistically significantly higher than those of the patients in the control group ( P <0.05). A positive relationship was found between the mean VAS-Pain and VAS-Sleep scores of the patients in the experimental group, and a significant negative relationship was found between the mean VAS-Comfort and state anxiety scores. Foot bath is effective in reducing the pain and anxiety levels of patients undergoing laparoscopic cholecystectomy surgery.

Management of Symptomatic Gallstones in Pregnancy

Gallstones, also known as cholelithiasis, are crystalline forms that occur in the gallbladder or biliary tract. Pregnancy causes various physiological changes that raise the chance of gallstone formation, which can lead to difficulties for both the mother and the fetus. Objective: To examine the safety and outcomes of conventional and interventional treatment in pregnant women with symptomatic gallstones. Methods: The study was longitudinal study. This study was conducted in Khairpur Medical College Civil Hospital Khairpur Mirs. The duration of this study was one Year, from Jan 2023 to Dec 2023. A total number of participant was (N=250) in this study. The age of participants was 18-35 years. There were included two treatment conventional and interventional. Results: The mean age of patients was 35.5 years. This study included 250 patients, had experienced gallstone symptoms. The intervention treatment group had the most participants (76%), followed by the conservative treatment group (24%). The cholecystitis participants had conservative treatment (76.3%), followed by laparoscopic treatment (53.3%). The majority participants was (66.6%) got laparoscopic therapy in the second trimester and indicate significant outcomes as compared to third trimester. The pregnant women was experienced no mortality, miscarriage during intervention therapy. Conclusions: This study supported prior findings that laparoscopic cholecystectomy can be performed safely during pregnancy, particularly in the second trimester. However, the third trimester brings additional obstacles, as seen by the higher prevalence of open cholecystectomy.

Exploring the correlation among genetic variants, cholecystectomy and gut microbiome: A Mendelian randomization study.

This Mendelian randomization (MR) study aims to explore the relationship between gut microbiota and the occurrence of cholelithiasis, as well as the impact of cholecystectomy on the gut microbiota. This study leverages data on exposures and outcomes from the GWAS database, employing the inverse variance weighting (IVW) method to obtain primary causal estimates. Heterogeneity is assessed using Cochran Q and Rücker Q tests through both IVW and MR-Egger methods. Pleiotropy is evaluated using the Egger-intercept method, while sensitivity analyses are conducted via leave-one-out tests. Additionally, the F-statistic is calculated to assess the presence of weak instrument bias. Finally, the MR-PRESSO method is utilized to validate the findings concerning the relationship between gut microbiota and the incidence of cholelithiasis, as well as the impact of cholecystectomy on gut microbiota composition. The genera Butyricicoccus (ID: 2055), Solibacillus (ID: 11348), Anaerotruncus (ID: 2054), Allisonella (ID: 2174), and Howardella (ID: 2000) have been found to decrease the genetically predicted probability of cholelithiasis. Reverse MR analysis indicates that the occurrence of cholelithiasis reduces the levels of gut microbiota such as Blautia (ID: 1992), Anaerofilum (ID: 2053), Howardella (ID: 2000), Butyricicoccus (ID: 2055), Solibacillus (ID: 11348), Allisonella (ID: 2174), Anaerotruncus (ID: 2054), and Firmicutes (ID: 1672). Additionally, the genera Odoribacter (ID: 952), and Holdemanella (ID: 2157) increase the genetically predicted risk of cholecystectomy. Reverse MR results show that post-cholecystectomy reduces the levels of gut microbiota such as Blautia (ID: 1992), Butyricicoccus (ID: 2055), Alistipes (ID: 11296), Oxalobacteraceae (ID: 2966), and Ruminococcaceae UCG010 (ID: 11367). Conversely, post-cholecystectomy increases the levels of gut microbiota such as Odoribacter (ID: 952), an unknown family (ID: 1000001214), an unknown genus (ID: 1000001215), Aeromonadales (ID: 1591), Holdemanella (ID: 2157), Phascolarctobacteria (ID: 1589), and Eggerthella (ID: 819). All study results show no horizontal pleiotropy, and the MR-PRESSO validation results are consistent with the MR analysis findings. This study elucidates the relationship between gut microbiota and the occurrence of cholelithiasis, as well as the impact of cholecystectomy on the gut microbiota. These findings have clinical significance for diagnosing disease onset and understanding digestive function changes following gallbladder removal, providing theoretical support for further investigation into the molecular mechanisms underlying cholelithiasis.

Pre-Operative Evaluation of Risk Factors for Difficult Laparoscopic Cholecystectomy

Cholelithiasis or the gallstone disease is the most common biliary pathology. 10-15% population of western world is estimated to be affected by gallstone disease, of which majority remains asymptomatic (&gt;80%) and 1-2 % of these asymptomatic patients will develop symptoms needing surgery per year. In this prospective study, 77 patients years undergoing elective Laparoscopic Cholecystectomy (LC) and meeting all inclusion criteria in Department of General Surgery, Nepal Medical College and Teaching Hospital over period of 1 year. History, detailed clinical examination and laboratory investigations were performed as per the working proforma. Operative time and conversion to open cholecystectomy were recorded. The association between clinical, laboratory and sonographic factors with difficult laparoscopy were obtained. Data analysis was done using SPSS-17 version. Out of 77 patients, 63 were females. Body mass index (BMI) above 30 representing obese population were 33.2% with p value 0.0004. Also, 41.5% patients had history of acute cholecystitis while 12.9% patients had previous history of abdominal surgery and 70.1% patients had history of recurrent abdominal pain. Total of 19.4% patients had increased leucocyte count. On ultrasonography thickened GB wall of &gt;3 mm was seen in 42.8%, distended GB was seen in 41.5%, stone size of &gt;1 cm was seen in 70.1% patients and multiple stones were seen in 84.4%. Similarly, duration of surgery was &gt;90 mins in 31.1% and 7.04% patients underwent conversion to open cholecystectomy both of which were considered difficult laparoscopy. Our study reveled that clinical factors like age, BMI, history of acute cholecystitis, previous history of recurrent abdominal pain and past history of abdominal surgery had significant association in prediction of difficult LC.

A Comparative Study of Postoperative Outcomes: Open Cholecystectomy versus Laparoscopic Cholecystectomy

Background: Surgery is usually necessary to treat gallstones, or cholelithiasis. Because laparoscopic cholecystectomy is less intrusive than open cholecystectomy, it is now the treatment of choice. Objectives: To evaluate and compare the postoperative results of open and laparoscopic cholecystectomies with regard to duration of hospital stay, complication rates, and amount of discomfort experienced during the procedure. Methods: A prospective comparative study was conducted on one hundred patients with symptomatic cholelithiasis who were to undergo elective cholecystectomy. Patients were randomized into two groups: Among the patients, 50 patients were operated for Laparoscopic Cholecystectomy and 50 for Open Cholecystectomy. The data on the postoperative results of the operation, including the time spent during the operation, as well as the time spent on pain, the length of stay in the hospital, and complications were collected and compared using statistical methods with the chosen level of significance equals to p ≤0.05. Results: The mean operative time of Laparoscopic Cholecystectomy was less than Open Cholecystectomy (48. 5 ± 12. 4 vs. 68. 5 ± 15. 3 minutes; p≤0.05). The overall postoperative pain was less in patients who undertook Laparoscopic Cholecystectomy with the mean pain period of (18. 3 ± 5.2) hours compared with 30. 7 ± 7. For Open Cholecystectomy patients the time taken was 1 hours. The length of the hospital stay was also lesser in Laparoscopic Cholecystectomy group which was (1.8 ± 1.2) days compared to Open Cholecystectomy group of (4.8 ± 1.5) days. Also, the Laparoscopic Cholecystectomy group had less complication rate at 12% compared to the Open Cholecystectomy at 38% with p ≤0.05 Conclusion: Laparoscopic Cholecystectomy is shown to be more beneficial in terms of postoperative results than Open Cholecystectomy in terms of the operating time, pain, hospital stay, and complications. Thus, these results shows Laparoscopic Cholecystectomy as the most appropriate surgical management for patients with symptomatic cholelithiasis; however, Open Cholecystectomy will still be required for cases that are not suitable for Laparoscopic Cholecystectomy.

Unplanned hospital readmission after cholecystectomy in adults with cerebral palsy.

Adults with cerebral palsy (CP) are a largely understudied, growing population with unique health care requirements. We sought to establish a deeper understanding of the surgical risk in adults with CP undergoing a common general surgical procedure: cholecystectomy. Data were obtained from the State Inpatient Database developed for the Healthcare Cost and Utilization Project. Inclusion criteria included patients ≥ 18years with CP and a primary ICD-9 procedure code indicating open or laparoscopic cholecystectomy. Demographics, procedure-related factors, and comorbid conditions were analyzed, and unplanned 30 and 90day readmission rates calculated for each variable. Reasons for readmission based on ICD-9 diagnosis codes were grouped into relevant categories. Univariate analysis identified factors significantly associated with readmission rates. A total of 802 patients with CP met the inclusion criteria. Unplanned 30 and 90day readmission rates after laparoscopic cholecystectomy were 11.4% and 18.1%, respectively. Average length of stay (LOS) after laparoscopic cholecystectomy was 7.1days. After open cholecystectomy, 30 and 90day readmission rates were 16.9% and 30.3% with an average LOS of 14.6days. Infection was the most common cause for 30 and 90day readmission. Factors associated with 30day readmission included type of cholecystectomy, LOS, discharge to skilled nursing facility, and comorbid diabetes and malnutrition. Factors associated with 90day readmission included type of cholecystectomy, LOS, discharge to skilled nursing facility, and comorbid heart failure, renal disease, epilepsy, and malnutrition. Unplanned readmission rates after open and laparoscopic cholecystectomy in adult patients with CP are much higher than previously demonstrated rates in the general population. These patients frequently suffer multiple comorbid conditions that significantly complicate their surgical care. As more and more of these patients live longer into adulthood, further study is warranted to grasp the perioperative risk of simple and complex surgical procedures.

Patient and hospital factors influence surgical approach in treatment of acute cholecystitis.

Minimally invasive (MIS) cholecystectomies have become standard due to patient and hospital advantages; however, this approach is not always achievable. Acute and gangrenous cholecystitis increase the likelihood of conversion from MIS to open cholecystectomy. This study aims to examine patient and hospital factors underlying differential utilization of MIS vs open cholecystectomies indicated for acute cholecystitis. This is a retrospective, observational cohort study of patients with acute cholecystitis who underwent a cholecystectomy between 2016 and 2018 identified from the California Office of Statewide Health Planning and Development database. Univariate analysis and multivariable logistic regression models were used to analyze patient, geographic, and hospital variables as well as surgical approach. Our total cohort included 53,503 patients of which 98.4% (n = 52,673) underwent an initial minimally invasive approach and with a conversion rate of 3.3% (n = 1,759). On multivariable analysis advancing age increased the likelihood of either primary open (age 40 to < 65 aOR 2.17; ≥ 65 aOR 3.00) or conversion to open cholecystectomy (age 40 to < 65 aOR 2.20; ≥ 65 aOR 3.15). Similarly, male sex had higher odds of either primary open (aOR 1.70) or conversion to open cholecystectomy (aOR 1.84). Hospital characteristics increasing the likelihood of either primary open or conversion to open cholecystectomy included teaching hospitals (aOR 1.37 and 1.28, respectively) and safety-net hospitals (aOR 1.46 and 1.33, respectively). With respect to cholecystectomy, it is well-established that a minimally invasive surgical approach is associated with superior patient outcomes. Our study focused on the diagnosis of acute cholecystitis and identified increasing age as well as male sex as significant factors associated with open surgery. Teaching and safety-net hospital status were also associated with differential utilization of open, conversion-to-open, and MIS. These findings suggest the potential to create and apply strategies to further minimize open surgery in the setting of acute cholecystitis.

The incidence of complications in Laparoscopic Cholecystectomy in Acute Cholecystitis in tertiary Care Setup

Abstract Laparoscopic cholecystectomy is the procedure usually performed in our setups for both acute &amp; chronic Cholecystitis and simple gall stone disease. Objective Find the outcomes of laparoscopic cholecystectomy in acute cholecystitis in our hospital setup. Methods This prospective cross sectional study was conducted in Hazrat Bari Sarkar Hospital Islamabad on 10th Nov 2022 to 30 June 2023. The patients from above 10 year age with both genders were included by convenient sampling. All Diagnosed cases of gall stone disease with acute cholecystitis, acute on chronic cholecystitis, abscess, and empyema or mucocele gall bladder were included in this study. SPSS 22 was used for data analysis that was recorded on a performa. Results This study included 77 laparoscopic cholecystectomies done for Acute Cholecystitis. 53 female &amp; 24 male patients with female to male ratio of 2.2:1 undergoing laparoscopic cholecystectomies were included in the study. The mean age of patients was 47.6 years + 11.6 SD. The mean operative time was around 90min + 13.5 SD and the mean hospital stay was 2.23 days + 0.77 SD with a range of 1-4 days. Conversion rate to open cholecystectomy was noted in 8 cases. The operative complications were bleeding in 2 cases, minor bile duct injury in 2 cases, surgical site infection 15 cases, retained stone in 2 cases. Conclusion Laparoscopic cholecystectomy for acute cholecystitis has better results in patient outcomes as regards post-operative recovery &amp; length of hospital stay &amp; safety.

Risk factors for persistent postoperative opioid use: an entity distinct from chronic postsurgical pain

Despite a decline in opioid prescriptions over the past decade, patients commonly receive opioid analgesics as a treatment for postoperative pain in the USA. One complication that patients may experience...

EP361 - Left Sided Gall Bladder: A Surgical Surprise

Abstract Laparoscopic cholecystectomy is a minimally invasive surgical procedure used for the removal of a diseased gallbladder. Since the early 1990s, this technique has largely replaced the open technique for cholecystectomies. We present a unique incident where a left-sided gallbladder was incidentally discovered during a laparoscopic cholecystectomy, posing a technical challenge for the surgeon. Our patient was a 34-year-old female who visited our hospital with complaints of right upper abdominal pain and postprandial nausea lasting for three months. Ultrasound examination revealed two gallstones measuring 16mm and 13mm in the neck of the gallbladder. During the routine laparoscopic cholecystectomy, the surgeon encountered a left-sided gallbladder. To ensure a safe and effective dissection, an additional port was required during the surgical procedure. The prevalence of this rare congenital anomaly, known as a left-sided gallbladder, ranges from 0.1% to 0.7%. It is characterized by the gallbladder being located on the left side of the ligamentum teres and falciform ligament, with the cystic artery passing in front of the common bile duct from right to left. This anatomical variation is often associated with abnormalities in the biliary tree and the porto-venous system. Failing to recognize these variations can lead to serious complications, particularly in hepatobiliary surgery. Discovering a left-sided gallbladder during surgery is an infrequent finding that can increase the complexity and morbidity rate of the procedure.

ThP5.5 - Outcomes Of Laparoscopic Common Bile Duct Exploration And Laparoscopic Cholecystectomy; A Single Centre Review From A District General Hospital In Northern Ireland

Abstract Aim Laparoscopic cholecystectomy with laparoscopic common bile duct exploration is a one-stage therapeutic option for patients presenting with choledocholithiasis. This is a review of outcomes for patients who underwent this procedure in a district general hospital setting in Northern Ireland over a two-year period. Method This is a retrospective review of prospectively collected data concerning all patients who underwent laparoscopic cholecystectomy and laparoscopic common bile duct exploration between October 2021 and October 2023. Data were reviewed to include pre-operative liver function, pre-operative imaging, rate of conversion to open procedure, length of stay, and readmission rate due to complications. Results 106 patients were included in the review. The average length of stay was 2.7 days (with a median of 1 day) and readmission rate was 7.5%. 87.7% of patients had deranged liver function tests on the morning of surgery, and 100% had proven choledocholithiasis on cross-sectional imaging prior to proceeding to theatre. Only two patients required conversion to open cholecystectomy. No patients developed postoperative pancreatitis. The complication rate was 11.3%, with most complications being of Clavien-Dindo Grade I or II. Conclusions Laparoscopic common bile duct exploration at the time of laparoscopic cholecystectomy represents a safe and effective method for management of choledocholithiasis. It can be considered as an alternative to endoscopic retrograde cholangiopancreatography as a therapeutic option in an appropriately selected patient group.

A Comparative Study of Laparoscopic Versus Robotic Cholecystectomies Based on the Parkland Grading Scale.

Background Cholecystectomy, the surgical removal of the gallbladder, is a common procedure performed to treat conditions like gallstone disease and cholecystitis. Among the various techniques available, laparoscopic cholecystectomy (LC) and robotic cholecystectomy (RC) are minimally invasive methods, while open cholecystectomy (OC) involves a more extensive incision and is reserved for cases where less invasive options are unsuitable. This study focuses on evaluating and comparing the safety and efficacy of LC and RC across different grades of cholecystitis, categorized by the Parkland Grading Scale. The goal is to determine whether RC provides significant benefits over LC, particularly in cases of higher-grade cholecystitis. Methodology This ambispective observational case-control study was conducted from January to June 2024 at Manipal Hospitals, Vijayawada, India. It included patients aged 18 or older with acute cholecystitis who underwent LC or OC. Exclusions were made for chronic cholecystitis, prior surgeries affecting the procedure, incomplete records, or severe complications. Data, including demographics, preoperative symptoms, intraoperative details, and postoperative outcomes, were extracted from electronic medical records. Laparoscopic procedures used standard techniques, while robotic procedures employed the da Vinci surgical system. Outcomes measured included operative time, complications, conversion rates, length of stay, and readmission rates. Results There was no significant difference in pre-operative parameters like age, white blood cell (WBC) count, total bilirubin, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), or history of previous surgery according to the Parkland Grading Scale. However, differences were noted in the Parkland Grading Scale regarding the thickness of the gallbladder wall, incidence of pericholecystic collection, and history of acute cholecystitis (p < 0.05). The most common complication was bleeding during the operation, which was more frequent in LC and was significant. Other complications, such as bile duct injury and vascular injury, were not observed in either procedure. Conclusion This study highlights that RC provides notable benefits compared to LC, especially for higher grades of cholecystitis, as per the Parkland Grading Scale. Although robotic procedures have longer operative times, they result in fewer intraoperative and postoperative complications, reduced conversion rates, and lower readmission rates. These advantages make RC a promising choice for treating complex cases of cholecystitis.

Current situation of surgical treatment of gallbladder polyps and some problems that should be paid attention to

Gallbladder polyp is a common disease of gallbladder, the incidence of gallbladder polyp in China is about 5%~10%, and the trend is increasing year by year. The patients with gallbladder polyps had no obvious clinical symptoms, which was more than that found by ultrasonography during physical examination. At present, the diameter of gallbladder polyps>10 mm is still used by clinicians as the main surgical indication for cholecystectomy. According to the data, about 80% to 90% of gallbladder polyps are cholesterol type polyps and benign gallbladder polyps. For these patients whose gallbladder is removed due to benign gallbladder polyps, we consider that we can continue to observe or retain the gallbladder, without having to bear the adverse consequences that may be caused by gallbladder removal. Based on the literature analysis at home and abroad, this paper discusses the surgical treatment of gallbladder polyps and the results of postoperative pathological diagnosis, and reminds the majority of clinicians to be careful when removing gallbladder polyps.