Feasibility Of Laparoscopic Cholecystectomy Research Articles

Clinical outcomes and feasibility of laparoscopic cholecystectomy in elderly patients

Clinical outcomes and feasibility of laparoscopic cholecystectomy in elderly patients

Laparoscopic cholecystectomy - A safe and feasible procedure in patients with mild-moderate acute cholecystitis: A single center, prospective, observational study

Background/Aim: Laparoscopic cholecystectomy (LC) is the gold standard modality for treating the gallstone disease. However, it is associated with perioperative complications. Moreover, some of the patients with acute cholecystitis (AC) require conversion to open cholecystectomy (OC). Thus, the aim of this study is to assess the safety and feasibility of LC in patients with AC. Methods: This was a single center, prospective, observational study performed, over a period of 18 months (March 2019 to August 2020), in Department of General Surgery of a tertiary care center located in Central India. 96 patients fulfilling Tokyo guidelines (2018 diagnostic criteria for AC) were included. The feasibility was assessed in terms of conversion to OC, while safety was assessed in terms of postoperative complications in the first 30 days. Results: During LC, none of the patients required conversion to OC due to difficulty in dissection or anatomy. On postoperative day 1, the mean VAS score for pain was 2.1 (0.56), meaning of low pain. Mean length of hospital stay was 2.34 (0.61) days, thereby inferring shorter hospital stay. Mortality was not observed. During the follow-up period, 2 patients developed epigastric port-site infection, while other 2 reported port-site bleeding. Moreover, 2 patients had intra-abdominal collection. All the complications were managed conservatively. Conclusion: The study confirms that LC is feasible and safe in patients with AC, among the age group studied. LC can be a method of choice for AC due to decreased conversion rate, short hospital stays, reduced morbidity, and swift transition to routine.

Triple gallbladder with heterotopic gastric mucosa: a case report

BackgroundTriple gallbladder is a rare congenital anomaly of the biliary tract that can be associated with heterotopic tissue. Gallbladder triplication results from the failure of rudimentary bile ducts to regress during embryological development, and can be difficult to distinguish from Todani type II choledochal cysts and biliary duplication cysts.Case presentationA 2-year-old patient presented to our institution with intermittent abdominal pain for 1 year. She had elevated transaminases with imaging concerning for a choledochal cyst. After assessment with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography, she was diagnosed with a gallbladder multiplication and a common bile duct stricture. She underwent laparoscopic cholecystectomy, which confirmed the diagnosis of triple gallbladder. One of the three gallbladders demonstrated heterotopic gastric mucosa on final pathology, including at the cystic duct margin. Follow up testing with a technetium 99 m scan demonstrated a subtle focus of increased activity in the right upper abdomen at the expected location of the common bile duct, concerning for the presence of residual gastric mucosa. The patient remains well without abdominal pain.ConclusionsWe describe the first case of heterotopic gastric mucosa in a triple gallbladder in a young patient presenting with chronic abdominal pain. We also demonstrate the safety and feasibility of laparoscopic cholecystectomy in young children with triple gallbladder. Finally, we propose an interdisciplinary approach to the management of common bile duct strictures in the setting of ectopic acid secretion, involving a combination of medical management, endoscopic intervention, and possible salvage laparoscopic Roux-en-Y hepaticojejunostomy.

Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Upper Abdominal Surgery

Background: Previous abdominal surgery usually lead to adhesion formation, which considered as a contraindication of laparoscopic cholecystectomy (LC). However, it had been reported that, careful adhesiolysis could be performed and thus LC becomes feasible. Aim of the work: To assess the feasibility and outcome of laparoscopic cholecystectomy in patients with previous upper abdominal surgery. Patients and Methods: This study included 30 patients, who were presented by symptomatic gallstones. All participants assessed clinically. Then, a full lab profile was performed. Finally, abdominal ultrasound was done and if there was a dilatation of common bile duct, patients were submitted to magnetic resonance cholangiopancreatography. Both intra-and postoperative data were collected and any complications were documented.Results: 26 patients (86.7%) had chronic calcular cholecystitis, two had acute calcular cholecystitis and two had mucocele of gallbladder. Adhesions were grade 1 in 13.3%, grade 2 in 46.7%, grade 3 in 20% and grade 4 in 20.0%. Adhesiolysis was needed in twenty patients (66.7%). Intraoperative complications were reported in nine patients (40%). Bleeding reported in six patients and preformation of the gall bladder in three patients (10%). Three patients (10%) were converted to open surgery. Postoperatively, 12 patients (26.7%) had complications [3, 1, 2, 1 and 5 for port site wound infection, bile leakage, bleeding, and chest infection respectively). Post operative pain was mild in half of patients and moderate in other half. Conclusion: laparoscopic cholecystectomy after previous abdominal operations is relatively feasible and relatively safe, as nearly one third of patients had difficulties and complications.

Laparoscopic Cholecystectomy in Patients with Empyema of Gall Bladder

Empyema of gallbladder is a potential fatal complication of gallstone. It is characterized by suppuration superimposed on acute cholecystitis. It is considered as a common factor of difficult laparoscopic cholecystectomy. Aim of the study: to determine the safety and feasibility of laparoscopic cholecystectomy in patients with empyema of gallbladder. Patient and method:A prospective study of 800 patients suffering from gallstone diseases from 2011 to December 2014 in Azadi teaching hospital in Kirkuk-Iraq. The procedure was performed by standard three – ports technique with a few modifications made to facilitate dissection subjected to situation. Results: 800 patients with male to female ratio 1:5.25 undergone laparoscopic cholecystectomy. Among these, 50 patients (6.25%) were identified having empyema of gallbladder and were included in the study population. Laparoscopic cholecystectomy was successfully completed for 49 (98%) patients while only one (2%) patient was converted to open cholecystectomy due to uncontrolled bleeding. Conclusion: In well-trained and skillful hands of an expert, laparoscopic cholecystectomy surgery is a safe and acceptable option for patients with empyema of gallbladder.

Surgical Results of Laparoscopic Cholecystectomy for Gallbladder Torsion

Gallbladder torsion (GT) causes ischemia of the gallbladder, which potentially leads to a fatal condition. Consequently, GT requires urgent treatment. An urgent laparoscopic cholecystectomy (LC) might be the optimal approach, in view of the anatomical abnormality, "floating gallbladder," which is associated with GT. However, the feasibility of LC for GT has not been well investigated. Thus, in this study, we investigated the feasibility of LC for GT in a case series. A total of 393 patients underwent urgent LC for acute gallbladder diseases at our institution during the study period. Among these patients, six had GT (1.5%) and were enrolled in this study. We retrospectively analyzed the surgical results of LC. Of the six cases, four (66.7%) were correctly diagnosed with GT preoperatively. There were two cases of Type I and four cases of Type II, based on the Gross classification for GT. The median operation time and intraoperative bleeding volume were 64 minutes and 18 mL, respectively. No cases required conversion to open surgery. All six cases experienced an uneventful postoperative course. The median postoperative hospital stay was six days. The surgical results of LC were favorable for six cases of GT. These results showed that LC was feasible for GT.

Early versus interval cholecystectomy for acute cholecystitis: 5 years local experience.

Background. Early laparoscopic cholecystectomy for acute cholecystitis is technically demanding procedure associated with more rate of conversion to open cholecystectomy and more complications. Recently some studies demonstrate the feasibility of laparoscopic cholecystectomy for acute cholecystitis. However, many surgeons still prefer delayed laparoscopic cholecystectomy for acute cholecystitis. Our aim of this prospective randomized study was to compare the operative time, conversion rate, hospital stay, outcome and cost of early versus delayed laparoscopic cholecystectomy for acute cholecystitis Patients and Methods. Between January 2010and January 2015, 62patients with a diagnosis of acute cholecystitis underwent early laparoscopic cholecystectomy within 72 h of admission (group I). This study group was compared with a control group of 114patients of acute cholecystitis, who underwent delayed laparoscopic cholecystectomy after an initial period of conservative treatment (group II). Results. There was no significant difference in the conversion rates (3 in group I versus 2 in group II), duration of postoperative stay (2days in group I versus 3.5 days in group II) postoperative analgesia requirements and postoperative pain scores. However, duration of surgery was significantly more in group I (110 minutes versus 85 minutes in group II).No mortality was seen in either group. Total costs were higher (6450 ± 875.4 versus 8570 ± 775 Saudi Ryal; P = 0.0001) in group II patients. Conclusions. Early laparoscopic cholecystectomy for acute cholecystitis is safe, feasible, with shorter hospital stay and cost effective management of acute cholecystitis cases.

Safety and feasibility of laparoscopic cholecystectomy during pregnancy

Background/aim Symptomatic biliary diseases in pregnant women remain a great challenge to surgeons. The present study aimed to evaluate the safety and feasibility of laparoscopic cholecystectomy (LC) during pregnancy. Patients and methods This prospective, observational study was conducted on 27 pregnant women with a mean age of 27.3 ± 4.1 (range 21–36) years who presented with symptomatic gallbladder diseases (stones or cholecystitis) and underwent LC. Gestational age, operative time, and maternal and fetal outcomes were noted. Results The mean operative time was 58.7 (range 32–78.5) min. Conversion to open cholecystectomy occurred only in one patient with acute cholecystitis due to the presence of severe adhesions (3.7%). No intraoperative or postoperative complications were observed, except for mild wound infection in only one patient (3.7%) and mild uterine contractions in two patients (7.4%). All patients went on to deliver at full term with no abortion or preterm labor. Conclusion Pregnant women with repeated attacks of biliary colic and/or cholecystitis after failure of conservative treatment can undergo LC easily and safely without hazardous effects on either mothers or fetuses, especially in the second trimester.

Adenomyomatosis of the gallbladder in childhood: A systematic review of the literature and an additional case report.

To investigate the diagnostic and therapeutic assessment in children with adenomyomatosis of the gallbladder (AMG). AMG is a degenerative disease characterized by a proliferation of the mucosal epithelium which deeply invaginates and extends into the thickened muscular layer of the gallbladder, causing intramural diverticula. Although AMG is found in up to 5% of cholecystectomy specimens in adult populations, this condition in childhood is extremely uncommon. Authors provide a detailed systematic review of the pediatric literature according to PRISMA guidelines, focusing on diagnostic and therapeutic assessment. An additional case of AMG is also presented. Five studies were finally enclosed, encompassing 5 children with AMG. Analysis was extended to our additional 11-year-old patient, who presented diffuse AMG and pancreatic acinar metaplasia of the gallbladder mucosa and was successfully managed with laparoscopic cholecystectomy. Mean age at presentation was 7.2 years. Unspecific abdominal pain was the commonest symptom. Abdominal ultrasound was performed on all patients, with a diagnostic accuracy of 100%. Five patients underwent cholecystectomy, and at follow-up were asymptomatic. In the remaining patient, completely asymptomatic at diagnosis, a conservative approach with monthly monitoring via ultrasonography was undertaken. Considering the remote but possible degeneration leading to cancer and the feasibility of laparoscopic cholecystectomy even in small children, evidence suggests that elective laparoscopic cholecystectomy represent the treatment of choice. Pre-operative evaluation of the extrahepatic biliary tree anatomy with cholangio-MRI is strongly recommended.

Day-case laparoscopic cholecystectomy.

Objectives:To assess the safety and feasibility of laparoscopic cholecystectomy as a day-case procedure.Methods:All consecutive patients who were admitted to the day-surgery unit for laparoscopic cholecystectomy at the Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia from July 2009 to June 2013 were considered for this retrospective study. The medical records were reviewed for age, gender, presenting symptoms, laboratory findings, imaging studies, American Society of Anesthesiology (ASA) grade, anesthesia, conversion to open cholecystectomy, complications, the operating surgeons, pain management, nausea, and vomiting, overnight stay, readmission, morbidity, mortality, and outpatient follow up were collected and analyzed.Results:A total of 487 patients underwent laparoscopic cholecystectomy as a day case (ASA I=316, ASA II=171). Surgery was performed by high surgical trainees (HSTs) (n=417) and consultants (n=70) with conversion to open cholecystectomy in 4 patients. Twenty-two (5%) patients were admitted for overnight stay for different reasons, while 465 (95%) patients were discharged before 8 pm. Two patients (0.4 %) were re-admitted to the hospital due to abdominal pain. Five patients developed umbilical port site infection (1%). A total of 443 patients were satisfied (97%), while 14 (3%) were unsatisfied. There was no mortality or intra-abdominal septic collection.Conclusion:Day-case laparoscopic cholecystectomy is safe and feasible with optimal patient selection, education, and planned postoperative antiemetic and analgesia management.

Single-site umbilical laparoscopic cholecystectomy

Until the mid-1980s, cholecystectomy was performed through a generous right upper abdominal incision. After the early reports from Europe and the United States on the safety and feasibility of laparoscopic cholecystectomy, the minimally invasive revolution began. This revolution has continued to the current time, where surgeons are attempting to perform minimally invasive procedures with less or no visible scarring. Cholecystectomy is ideally suited for the single-site umbilical laparoscopic approach to obviate the need for epigastric and supraumbilical incisions. This article will describe the single-site umbilical laparoscopic cholecystectomy, which has been performed at Children's Mercy Hospital since 2009. Also, the literature concerning this approach in adults and in children will be discussed. Finally, a prospective randomized trial comparing the single-site cholecystectomy with the traditional 4-port laparoscopic cholecystectomy will also be described.

Laparoscopic cholecystectomy in empyema of gall bladder: An experience at Liaquat University Hospital, Jamshoro, Pakistan

Objective:To find out the safety profile of laparoscopic cholecystectomy in empyema of gallbladder.Background:Empyema of gall bladder is a severe form of acute cholecystitis with superadded suppuration. It has been considered a contraindication for the laparoscopic cholecystectomy (LC) because of fear of life-threatening complications. This study aimed to determine the safety and feasibility of LC in empyema of gallbladder.Materials and Methods:LC was attempted in 67 patients of empyema of gallbladder within 24h. However in few cases there was a delay because of reluctance for surgery or delay in giving consent etc. The procedure was performed by standard four-port technique with few changes made to facilitate dissection according to situation.Results:Between April 2003 to June 2006, 970 LC performed for gallstone disease at surgical unit-1 of LUMHS by the same surgical team. Among these, 67 (6.90%) patients were diagnosed to have empyema gall bladder. LC successfully completed in 54 (80.59%) patients. In 13 (19.40%) patients the procedure was converted to open cholecystectomy (OC) due to various operative difficulties of which the most serious injuries included bleeding from cystic artery (four cases), common bile duct injury (two cases) and duodenal injury in one case. Maximum operating time was up to 160 minutes (one case). Postoperative complications occurred in 10 (18.51%) successfully operated patients. Maximum patients (n=45, 83.33%) were discharged in 48-96 hours while three patients were discharged after two weeks.Conclusion:Laparoscopic cholecystectomy can be performed in empyema of gallbladder keeping in mind a slightly increased risk of complications even in the best hands. However, the experience of the surgeon plays a key role in the overall outcome.

Laparoscopic Cholecystectomy in Situs Inversus Totalis: A Case Report and Review of the Literature

Situs inversus is an uncommon anatomical variant characterized by transposition of the internal organs. The frequency of cholelithiasis in such patients is similar to that of the normal population. A young woman with situs inversus totalis with symptomatic gallbladder stones underwent a successful laparoscopic cholecystectomy and intraoperative cholangiogram using a mirror-image approach. Her postoperative recovery was uneventful. A review of 21 further cases in the medical literature is presented to address the feasibility of laparoscopic cholecystectomy in situs inversus.

Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases.

Laparoscopic cholecystectomy (LC) is now widely accepted as the modality of choice for the treatment of symptomatic uncomplicated cholelithiasis. The application of the laparoscopic technique in the setting of acute cholecystitis (AC) is more controversial. The precise role as well as the potential benefits of LC in the treatment of the acutely inflamed gallbladder have not been clearly established through large clinical series. The aim of our study was to assess the feasibility, safety, benefits, and specific complications of the laparoscopic approach in patients with AC. A retrospective chart analysis involving the patients admitted to two busy emergency digestive surgical units between October 1990 and December 1997 was carried out. Six hundred and nine patients meeting our criteria for AC were identified and evaluated. Overall complication rate was 15% with 12 postoperative bile leakages (1.97%) and 4 biliary tract injuries (BTI) (0.66%). The overall mortality rate was 0.66%. Local and overall complication rates were significantly correlated with the delay between the onset of acute symptoms and the operation but not the rate of general complications nor deaths. Our results demonstrate the safety and feasibility of LC in the setting of AC. Early cholecystectomy within 4 days is strongly recommended to minimize complications and increase the chances of a successful laparoscopic approach.

Laparoscopic Cholecystectomy for Gallstones: A Comparison of Outcome between Acute and Chronic Cholecystitis

Laparoscopic cholecystectomy (LC) is now a common method of treating symptomatic gallstones, and it is increasingly being requested by the informed general public. Our aim was to evaluate the role of LC for cholelithiasis and to establish its outcome and the effect of gender on the results. Between September 1994 and June 1999, all patients who underwent LC for cholelithiasis were retrospectively reviewed. They were classified as having acute or chronic cholecystitis (AC or CC). There were 791 patients with CC (633 females, 158 males) and 204 patients with AC (124 females, 80 males). Conversion to open cholecystectomy was needed in 0.76% and 11.8% of the patients with CC and AC, respectively (P<0.00). Four percent of the female patients with AC needed conversion as compared to 23.8% in the males (P<0.00). The low conversion rate in CC limited gender comparison. Median operation time in the patients with CC was 53+/-16 minutes as compared to 74.5+/-35.7 minutes in those with AC (P<0.00). Operation time in the male patients with CC and AC was significantly higher than in the female patients, even after excluding the converted cases (P<0.00). Median postoperative stay for patients with CC was 1.33+/-0.9 days as compared to 1.9+/-1.34 days in patients with AC (P<0.00). No statistical significance in the hospital stay was found between males and females (in CC and AC). There was no mortality in the series. There were three bile duct injuries in the patients with CC. In patients with successful LC, gallbladder perforation occurred in 18% and 31% of CC and AC patients, respectively (P<0.003). Missed stones occurred in 1.4% and 3.3% of the patients with successful LC for CC and AC, respectively. Bile collection, which was treated with open drainage, occurred in four patients with CC and one patient with AC. LC for symptomatic cholelithiasis is safe and feasible; it should be the first choice before resorting to open surgery. In patients with AC as compared to CC, there is an increased conversion rate, longer operation time, longer hospital stay, and higher incidence of gallbladder perforation without an increase in the incidence of bile duct injuries (BDI). Male patients have a longer operation time and higher conversion rate than female patients.

The feasibility of laparoscopic cholecystectomy in patients with previous abdominal surgery.

A retrospective study was carried in 1500 patients submitted to elective laparoscopic cholecystectomy to ascertain its feasibility in patients with previous abdominal surgery. In 411 patients (27.4%) previous infraumbilical intraperitoneal surgery had been performed, and 106 of them (7.06%) had 2 or more operations. Twenty five patients (1.66%) had previous supraumbilical intraperitoneal operations (colonic resection, hydatid liver cysts, gastrectomies, etc.) One of them had been operated 3 times. In this group of 25 patients the first trocar and pneumoperitoneum were performed by open laparoscopy. In 2 patients a Marlex mesh was present from previous surgery for supraumbilical hernias. Previous infraumbilical intraperitoneal surgery did not interfere with laparoscopic cholecystectomy, even in patients with several operations. There was no morbidity from Verres needle or trocars. In the 25 patients with supraumbilical intraperitoneal operations, laparoscopic cholecystectomy was completed in 22. In 3, adhesions prevented the visualization of the gallbladder and these patients were converted to an open procedure. In the 2 patients Marlex mesh prevented laparoscopic cholecystectomy because of adhesions to abdominal organs. We conclude that in most instances previous abdominal operations are no contraindication to laparoscopic cholecystectomy.

Clinical implication of preoperative oral cholecystogram for laparoscopic cholecystectomy.

The aim of this study was to retrospectively assess the usefulness of the preoperative oral cholecystogram (OCG) as an index to the feasibility of laparoscopic cholecystectomy (LC) and the operative pathologic findings. Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder (GB) disease. However, no definite diagnostic modality that can predict the feasibility of LC and severity of pathologic anatomy has been proposed. Retrospective data were collected on 240 consecutive patients undergoing LC at St. Vincent Hospital, Catholic University Medical College, from October 1991 until December 1993. Radiologic interpretations of OCG were standardized according to the method of Koehler and Kyaw--from grade 0 to 4. And the operative findings--pericholecystic adhesion, color of GB, and thickness of the GB wall--were evaluated simultaneously. The analysis showed that preoperative OCG can predict intraoperative GB perforation (p = 0.022), intraoperative controllable bleeding (p = 0.034), and operating time (p = 0.0001) according to the grade of visualization of GB. Grade 2- or -better visualized groups had more patients who had blue-colored GB (p = 0.000) and who had thin GB wall (p = 0.000). Preoperative oral cholecystogram may be an accurate index of the feasibility of laparoscopic cholecystectomy--represented by operating time and important intraoperative minor complications related to the operative pathological findings.