Introduction Of Laparoscopic Cholecystectomy Research Articles

The Conversion Rate of Laparoscopic Cholecystectomy to Open Cholecystectomy at King Abdulaziz Medical City, Jeddah, Saudi Arabia: Prevalence and Causes.

Introduction Laparoscopic cholecystectomy has emerged as the preeminent surgical technique for cholecystectomy. However, in exceptional circumstances, surgeons may encounter significant obstacles that necessitate reverting to the traditional open approach, which has more undesirable complications. In this study, we aimed to identify the factors underlying conversion and to quantify its prevalence in the medical setting of King Abdulaziz Medical City (KAMC) in Jeddah to lower the rate of conversion. Methodology In this retrospective cross-sectional study, a non-probability consecutive sampling technique was utilized to include all patients over 16 years of age who underwent cholecystectomy at KAMC, Jeddah, between January 2009 and June 2022, excluding any patients with missing data. Results The total number of patients operated for cholecystectomy was 2,632, of which 1924 were female (73.1%) and 708 were males (26.9%). Of these patients, only 69 were converted to open (2.62%). Among them, 32 patients were in the age group >60, with the highest conversion rate (7.80%). The leading causes were adhesions in 55 cases (79.71%) and distorted anatomy in 31 cases (44.92%). Conclusion This study shows distorted anatomy and adhesions to be the leading causes of conversion from laparoscopic cholecystectomy to open approach at KAMC with a conversation rate of 2.62%. Furthermore, this article includes a higher number of patients in a longer period compared to other similar literature, which may give more accountable results that help reduce the conversion rate and complications.

Comparative Analysis of Monopolar Electrocautery and Ultrasonic Activated Scalpel in Laparoscopic Cholecystectomy: A Comprehensive Evaluation Using Clinical, Laboratory, and Imaging Techniques.

Introduction Laparoscopic cholecystectomy has long been the cornerstone of gallstone treatment. Both monopolar cautery and ultrasonically activatedscalpel(UAS, also known as harmonic scalpel) have been employed in the dissection of the gallbladder from its fossa during laparoscopic cholecystectomy. Material and methods The prospective study was conducted in the Department of Surgery at Vivekananda Institute of Medical Sciences including 200 patients equally divided among the monopolar cautery and harmonic scalpel group. Patients were observed for 48 hours post-surgery, during which temperature and pain assessment were done. Acute phase reactants were measured during this period and compared with preoperative values. On the seventh day ultrasonography was done to look for the inflammatory changes. Results In a study involving 200 patients, the majority fell within the age bracket of 31 to 50 years, with females constituting the predominant demographic. Notably, patients who underwent surgery with a harmonic scalpel exhibited a reduced need for analgesics. Furthermore, the use of harmonic scalpels led to noteworthy alterations in acute phase reactants, including a significant decrease in the total leucocyte count (TLC) (p=0.03), neutrophils (p=0.005), and lymphocytes (p=0.02). Additionally, patients in the UAS group experienced a significantly lesser increase in erythrocyte sedimentation rate(ESR) and C-reactive protein (CRP) values (p=0.0001). Conversely, ultrasound imaging conducted on the seventh day post-surgery did not reveal any significant differences between the two groups. Conclusion Laparoscopic cholecystectomy performed with a harmonic scalpel is associated with a reduced tissue response and less tissue damage compared to the monopolar group.

CVS: An Effective Strategy to Prevent Bile Duct Injury

Background: Bile duct injuries have been substantially increased after the introduction of laparoscopic cholecystectomy (LC). These are accompanied by major morbidity and mortality. Studies have shown varying degrees of success in the reduction of bile duct injury (BDI) using the Critical View of Safety (CVS) technique. The aim of this study was to see the efficacy of the CVS technique as the sole method of dissection in laparoscopic cholecystectomy. Methods: 1647 cases of LC were done between January 2012 and January 2022 for a period of 10 years in two hospitals. All were operated by the CVS dissection technique and none by the infundibular technique. Cases included acute cholecystitis, chronic cholecystitis, gangrenous cholecystitis, empyema, and Gallbladder (GB) polyp. Results: The average operating time was 42 minutes and the range was 13 to 80 minutes. In 92% of cases, all 3 criteria of CVS were achieved. In the remaining 8% cases were either converted to open or operated by a division of GB or subtotal cholecystectomy was done. There was only one case of cystic duct stump leak requiring drainage and common bile duct stenting. Conclusion: The excellent outcome of our study suggests that the CVS method will be the gold standard technique in the dissection of the gallbladder in LC. Further dissemination of the technique is necessary to improve safety in LC.

Risk Factors and Prevalence Associated With Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Tertiary Care Hospital Experience in Western Mexico.

Introduction Laparoscopic cholecystectomy (LC) is a common procedure used for the treatment of different pathologies caused by gallstones in the gallbladder, and one of the most common indications is acute cholecystitis. The definitive treatment for acute cholecystitis is surgery, and LC is the gold standard. Nevertheless, transoperative complications (like intraoperative bleeding, anatomical abnormalities of the gallbladder, etc.) of LC and some other preoperative factors (like dilatation of bile duct, increased gallbladder wall thickness, etc.) can cause or be a risk factor for conversion to open cholecystectomy (OC). The objective of this study was to determine the risk factors and prevalence associated with the conversion from LC to OC in patients with gallbladder pathology and the indication for LC. Materials and methods This was a prospective cohort study. We included patients of both sexes over 18 years of age with gallbladder disease. To determine the risk factors associated with conversion, we performed a bivariate analysis and then a multivariate analysis. Results The rate of conversion to OC was 4.54%. The preoperative factors associated with conversion, in the bivariate analysis, were common bile duct dilatation (p=0.008), emergency surgery (p=0.014), and smoking (p=0.001); the associated intraoperative variables were: laparoscopic surgery duration (p <0.0001), Calot triangle edema (p=0.033), incapacity to hold the gallbladder with atraumatic laparoscopic tweezers (p=0.036), and choledocholithiasis (p=0.042). Laparoscopic Surgery duration was the only factor with a significant association in the multivariate analysis (p=0.0036); we performed a receiver operating characteristic (ROC) curve analysis and found a cut-off point of 120 minutes for the duration of laparoscopic surgery with a sensitivity and a specificity of 67 and 88%, respectively. Conclusion The prevalence of conversion from LC to OC is similar to that reported in the international literature. The risk factors associated with conversion to OC, in this study, should be confirmed in future clinical studies, in this same population, with a larger sample size.

Impact of Resident Post-Graduate Year on Laparoscopic Cholecystectomy Outcomes.

Introduction Laparoscopic cholecystectomy is a minimal access procedure in which the gallbladder is removed by laparoscopic techniques. Effective training for laparoscopic surgery should focus on not only understanding the anatomy and procedural steps but also acquiring the specific gestures and techniques of this type of surgery that may differ from those used in traditional open surgery. The aim of our study was to analyze whether the laparoscopic cholecystectomy performed by surgeons in training is a safe procedure. Material and methods This is a retrospective review of 433 patients who were divided into two groups: laparoscopic cholecystectomies performed by trainees and those performed by senior surgeons. Results Around 66% of surgeries were performed by resident surgeons. There was no demographic difference between residents and senior surgeons. Operative time was significantly longer in the residents' group compared to senior surgeons' group (96 minutes vs 61 minutes; p<0.001). The overall intra- and post-operative complication rates were 3.1% and 2.5%, respectively, with no significant difference between the two groups (p=0.368 and p=0.223). Conversion to open laparotomy was required in 8% of cases in each group (p=0.538). The mean length of hospital stay after surgery was significantly longer in patients operated by residents (p<0.001). We did not notice any case of mortality in both groups.

Rising incidence of iatrogenic bile duct injuries following cholecystectomy: a cause of worry

Inaccurate learning and understanding of biliary anatomy mainly lead to iatrogenic bile duct injuries (IBDI) and such complications are mostly the postoperative result of laparoscopic cholecystectomy. Minor bile leakage of aberrant ducts and complete occlusion of the main duct or a branch (often an aberrant right duct) are possibilities for many IBDIs. In addition, bile duct strictures and biliary leakages are severe long-term complications after laparoscopic cholecystectomy1. A well-established thought is that any postoperative change observed after laparoscopic cholecystectomy suggests possible damage to the biliary tract. Injuries related to the biliary tract are associated with high morbidity, death rate, and prolonged hospitalization. Bile duct injury with an estimated incidence of 0.4%–1.5% is a dangerous complication of cholecystectomy2. and with the introduction of laparoscopic cholecystectomy as the surgical treatment of choice for symptomatic cholelithiasis, the incidence of IBDI—which represents the most dramatic complications after open or laparoscopic cholecystectomy increased3. Comparing the incidence of IBDI in open cholecystectomy and laparoscopic cholecystectomy, despite increasing experience, IBDI incidence is still elevated in LC which is up to 3% compared with the rate of clinically relevant bile leaks after conventional open cholecystectomy ranging between 0.1 and 0.54–6. According to studies, the incidence of bile duct injuries after laparoscopic cholecystectomy hiked as high as 1% with a conservative estimate being 1 in 1000 cases (0.1%)7. Successful treatment is characterized by early diagnosis, control of the intra-abdominal fluid collection and infection, nutritional balance, multidisciplinary approach, and surgical repair by an experienced surgeon in biliary reconstruction. The top most recommended strategies to classify and initially diagnose and treat IBDI are endoscopic techniques, for example biliary stent placement, biliary sphincterotomy, and nasobiliary drainage. Surgical intervention, precisely Roux-en-Y hepaticojejunostomy, is the most feasible treatment for patients with complete dissection or obstruction of the bile duct. Even though eventually most bile duct injuries require surgical reconstruction but the role of the interventional radiologist in the initial diagnosis, classification, and management of IBDIs is often crucial for achieving a successful outcome. Long-term results are most important in the assessment of the effectiveness of IBDI treatment. Apart from that, adequate diagnosis and treatment of IBDI may avoid many serious complications and improve the quality of life of our patients, therefore, management of these injuries often requires an experienced multidisciplinary team (including interventional radiology, gastroenterology, and surgery), they are best handled in a tertiary referral center. Ethical approval None. Sources of funding None. Author contribution O.H.S., S.I.A., R.M.A., and M.K.: wrote the manuscript. ,O.H.S. and S.I.A.: review editing, formatting, and referencing, Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Maham Khan.

STUDY OF FACTORS RESPONSIBLE FOR DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

Introduction: Cholecystectomy remains the most effective treatment for gallbladder disease when symptomatic. Since the introduction of laparoscopic cholecystectomy, this approach has replaced the traditional open cholecystectomy. Laparoscopic Cholecystectomy was rst reported in Germany (1985) and France (1987). Although not immediately universally adopted, laparoscopic cholecystectomy has revolutionized minimally invasive surgery. Now Laparoscopic cholecystectomy has rapidly become the procedure of choice for gallbladder disease patients and is currently the most commonly performed major abdominal procedure worldwide. Aims: The aim of this study is to assess the preoperative and intraoperative predictors of difcult laparoscopic cholecystectomy. Materials and method: This Study was conducted for one and a half year at Department of General Surgery, AIMSR, Bathinda. 100 patients were included in this study. Result: The study showed that, most of the patients had no Conversion to open [93 (93.0%)] it was statistically signicant (p&lt; .00001.). (Z=12.1622) and we also found that, higher number of patients had POD2 Drain removal [60 (60.0%)] it was statistically signicant (p&lt; .00001.). (Z=5.0064). Conclusion: In this study, most of the patients had E Lap cholecystectomy. However, D Lap cholecystectomy followed by VD Lap cholecystectomy and lower number of patients had Conversion to open which was statistically signicant

Iatrogenic bile duct injuries after laparoscopic cholecystectomy: evaluation by MRCP before management

BackgroundIatrogenic bile duct injuries are unusual but possibly associated with fatal complications with increased incidence since the introduction of laparoscopic cholecystectomy. Appropriate estimation of these injuries is essential for proper management. Imaging is vital for the initial diagnosis, extent assessment and consequently, treatment guidance of bile duct injury with an ideal outcome. In this study, MRCP was carried out in 37 cases (28 females and 9 males, age range from 19 to 58 years) with suspected BDI following laparoscopic cholecystectomy. MRCP images were assessed for bile duct transection injury, strictures, biliary leakage, and intrahepatic biliary radicles (IHBR) dilatation. In positive cases, Strasberg classification system was used with the definitive diagnosis was done regarding the surgical findings and/or findings on endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC).ResultsOur study includes 37 cases with biliary injuries. On MRCP our cases were stratified regarding the Strasberg-Bismuth classification into five types (A to E). Most BDIs were type E2 (29.7%), followed by type E1 (18.9%), type A (16.2%), type E3 (10.8%), type E4 (8.2%), type C (5.4%), and type D and finally type E5 and B injuries with each one representing 2.7%. Twenty cases presented with biliary leakage and seventeen with bile duct obstruction, whether duct ligation or stricture.ConclusionMRCP is an essential imaging modality for assessment of iatrogenic BDIs enabling the radiologists to classify these injuries and helps to govern the management.

Definition and outcomes of postoperative biliary fistula after bile duct injury repair surgery

Background: Bile duct injury remains constant since the introduction of laparoscopic cholecystectomy. In many instances, the placement of a stent is the treatment of choice. Otherwise, a bilioenteric anastomosis is required. Postoperative biliary fistula is a recognized complication of the procedure. The evolution of the leak is variable, it is quite common in the very early postoperative period, and in most cases no more procedures will be necessary. In some instances, on the contrary the leak persists, often requiring the placement of intrahepatic drains to control the fistula. Perpetuation of the leak is an adverse situation for the final result of the anastomosis, and until now there is no definition that adequately refers the volume of output or number of days needed to become a clinically relevant fistula. The aim of this study is to analyze the frequency, management, and outcome in patients with postoperative biliary fistula according to our definition in a high-volume bile duct repair center.

Novel Application of Hydrodissection in Laparoscopic Cholecystectomy for Gangrenous Gallbladders

IntroductionLaparoscopic cholecystectomy (LC) for gangrenous gallbladders (GGBs) can be challenging and represent a significant number of LC cases, necessitating more efficacious surgical techniques. Currently, the standard treatment for GGBs is blunt dissection which can have high iatrogenic complication rates. To our knowledge, this is the first large retrospective study conducted on the novel application of hydrodissection (HD) in LCs for GGBs. MethodsIn this retrospective study of 386 LCs, data were collected for patient demographics, medical comorbidities, operating time (OT), anesthesia time (AT), length of stay (LOS), estimated blood loss, conversion to open procedures, 30-day readmissions, and mortality. Patients were categorized into four groups: (1) Vyas employing HD for GGBs (VHG), (2) non-Vyas group of five surgeons not employing HD for GGBs (NVG), (3) Vyas treating non-GGBs, and (4) non-Vyas group of five surgeons treating non-GGBs. Control groups were age-matched and sex-matched. Statistical analysis used descriptive statistics, Mann–Whitney U testing, and chi-squared testing (α = 0.05). ResultsThis study demonstrated significantly decreased (P < 0.05) OT (P = 0.001), AT (P < 0.001), LOS (P = 0.015), and conversion to open procedures (P = 0.047) between the VHG and NVG groups, with HD reducing OT by 35.5% compared to blunt dissection. This study did not demonstrate significantly decreased (P > 0.05) estimated blood loss (P = 0.185) and 30-day readmissions (P = 0.531) between the VHG and NVG groups, but they were trending toward significant. There were no mortalities in this study. ConclusionsHD is associated with improved surgical outcomes of LCs for GGBs demonstrated by reduced OT, AT, LOS, and conversion to open procedures. Further multi-institutional studies are needed to validate HD implementation and further dissemination.

IATROGENIC INJURIES OF SUBVESICAL BILE DUCT - CASE REPORT AND LITERATURE REVIEW

With the rise of laparoscopic cholecystectomy as the gold standard for treating gallbladder calculi andpolyps, subvesical bile ducts are gaining increased clinical importance. With the introduction of electrocautery insurgery, a large part of these tubular structures, although with interrupted continuity, do not show extravasation ofbile content postoperatively. Decreased bile production during general anesthesia and increased intraperitonealpressure also make diagnosis of injuries difficult. Surgeons who frequently operate in the right upper quadrant haveto understand the anatomy of the biliary tree and its tendency for structural variation. The work of laparoscopicsurgeons should be conceptualized around three main goals: to enable safe identification of key anatomicalstructures, usually by providing a critical point of safety (Critical View of Safety), to make a decision at the rightmoment not to proceed with laparoscopic surgery when working conditions become too dangerous and there is nopossibility of identification of structures and to end the laparoscopic surgery with subtotal cholecystectomy whenidentification of structures is impossible. Controversy among authors on the naming of the various subvesicalstructures causes confusion in their identification and description. In order to overcome these challenges, there was aneed to establish classification systems for post-cholecystectomy lesions of the biliary tract. But due to theindividual shortcomings of all these systems, in June 2011, during the 19th meeting of the European Association forEndoscopic Surgery in Turin, Italy, a conference was held to reach a consensus to establish a uniform classificationof iatrogenic bile duct injuries that will have two primary goals: first, to take into account changes in the type ofinjuries with the introduction of laparoscopic cholecystectomy, and second, to combine all existing classificationsystems and integrate them into one, universally accepted classification system. As part of the new inclusiveclassification system for iatrogenic injuries of the biliary ducts, the following systems are considered: Bismuth,Strasberg et al., McMahon et al., AMA, Neuhaus et al., Csendes et al., Steward et al., Hanover, Lau and Lai ,Siewert et al., Cannon et al., Kapoor., Sandha et al.. In the new system a total of fifteen classifications areincorporated using semantic connotations and grouped into three categories that will allow easy memorization bysurgeons. A (anatomy) for anatomy, To (time of) for time/moment of observation and M (mechanism) for themechanism of occurrence of the injury. By enabling a more precise classification of each of the injuries, the surgicalcommunity will have the opportunity to develop recommendations for prevention, treatment and prognosis for theiroutcome.

Robotic assisted cholecystectomy – A retrospective cohort study of experience of 106 first robotic cholecystectomies in versius robotic platform

IntroductionLaparoscopic cholecystectomy is currently the standard of care for symptomatic cholelithiasis as well as for chronic and acute cholecystitis. The incidence of bile duct injury in laparoscopic cholecystectomy is still higher than that in open surgery. Surgical robots aim to bridge this gap. With the greater availability of surgical robots and cheaper alternatives to the Da Vinci system, surgeons can take advantage of the better manoeuvrability and better vision that a surgical robot offers. This is likely to make robotic assisted cholecystectomy a very safe option. Here, we present our early data on the robotic procedures performed by the Versius robotic system by CMR (Cambridge Medical Robotics). MethodsIt is a retrospective study, with data collected from our prospectively maintained database at Swagat Super Speciality Surgical Institute and NH, maintained collectively by CMR and our surgical residents. The first consecutive 106 planned robotic cholecystectomies that were performed by a single surgeon were included in the study. ResultsOut of 106 serial planned robotic assisted cholecystectomies (101 robotic assisted cholecystectomies + 5 combined with other procedures), no bile duct injury was reported, with a mean console time of 54.16 min and a mean setup time of 9.29 min. One procedure had to be converted to open for malignancy, and another patient had to be converted to laparoscopy due to dense adhesions with the duodenum. Three chronic liver disease (CLD) patients underwent partial cholecystectomy. A total of 70.75% of patients had no pain – visual analogy scale (VAS) pain score of 0 at POD 1 with minimal blood loss in most of the procedures. No learning curve for robotic assisted cholecystectomy was seen. ConclusionAlthough robotic assisted cholecystectomy was mostly chosen for patients in whom difficult cholecystectomy was clinically anticipated, it fared quite well. The learning curve was essentially non-existent. Robotic assisted cholecystectomy is a safe and feasible option in both simple and difficult cases of gallbladder disease.

Laparoscopic Cholecystectomy in the Time of Coronavirus: A Level-1 Trauma Center's Experience.

Laparoscopic cholecystectomy (LC), one of the most common surgical procedures performed in the U.S., offers a window into the effects of the COVID-19 pandemic on routine surgical care. The purpose of our study was to analyze the effects of the COVID-19 pandemic at a Level-1 trauma center on the performance rate of non-elective LC over time. A retrospective chart review from July 2019 to December 2020 identified all non-elective LC cases performed at a level-1 trauma center. Patients were categorized into 4 temporal phases along the course of the pandemic based on statewide incidence data on COVID-19: pre-pandemic, peak 1, recovery, and peak 2. We compared the phases based on demographic information and outcomes. In total, 176 patients were reviewed. The performance rate in cases/day varied as follows: pre-pandemic .61, 1st peak .34, recovery .44, and 2nd peak .53. The complication rate was highest in the 2nd peak (16%) (P < .05). Compared to the pre-pandemic period, the intra-pandemic period had a higher incidence of complicated gallbladder disease (P < .05). In the non-elderly subgroup, complicated gallbladder disease was significantly more prevalent in the intra-pandemic period compared to the pre-pandemic period (25% vs 10%, P < .05). Our data suggests a learning curve throughout the course of the pandemic, reflecting a stepwise increase in the performance rate of LC. The higher incidence of complicated gallbladder disease in the intra-pandemic period may imply patient hesitancy to seek routine surgical care, especially among younger patients.

Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review.

Hepatic surgery is a rapidly expanding component of abdominal surgery and is performed for a wide range of indications. The introduction of laparoscopic cholecystectomy in 1987 was a major change in abdominal surgery. Laparoscopic surgery was widely and rapidly adopted throughout the world for cholecystectomy initially and then applied to a variety of other procedures. Laparoscopic surgery became regularly applied to hepatic surgery, including segmental and major resections as well as organ donation. Many operations progressed from open surgery to laparoscopy to robot-assisted surgery, including colon resection, pancreatectomy, splenectomy thyroidectomy, adrenalectomy, prostatectomy, gastrectomy, and others. It is difficult to prove a data-based benefit using robot-assisted surgery, although laparoscopic and robot-assisted surgery of the liver are not inferior regarding major outcomes. When laparoscopic surgery initially became popular, many had concerns about its use to treat malignancies. Robot-assisted surgery is being used to treat a variety of benign and malignant conditions, and studies have shown no deterioration in outcomes. Robot-assisted surgery for the treatment of malignancies has become accepted and is now being used at more centers. The outcomes after robot-assisted surgery depend on its use at specialized centers, the surgeon’s personal experience backed up by extensive training and maintenance of international registries. Robot-assisted hepatic surgery has been shown to be associated with slightly less intraoperative blood loss and shorter hospital lengths of stay compared to open surgery. Oncologic outcomes have been maintained, and some studies show higher rates of R0 resections. Patients who need surgery for liver lesions should identify a surgeon they trust and should not be concerned with the specific operative approach used. The growth of robot-assisted surgery of the liver has occurred in a stepwise approach which is very different from the frenzy that was seen with the introduction of laparoscopic cholecystectomy. This approach allowed the identification of areas for improvement, many of which are at the nexus of engineering and medicine. Further improvements in robot-assisted surgery depend on the combined efforts of engineers and surgeons.

Rouviere's sulcus - An anatomical landmark for safe laparoscopic cholecystectomy: A cross-sectional study

IntroductionLaparoscopic cholecystectomy (LC) has been established as the gold standard treatment for symptomatic gallstones, however surgeons face the risk of injuring bile ducts and vessels due to the inherent limitations of laparoscopy. MethodsThis is a cross-sectional study done in the Department of Surgery, Shree Birendra Hospital (SBH) on patients who were posted for LC. The study period was through April 2021 to September 2021. During LC, the anatomy of RS was noted and classified into Group A (RS present) or Group B (RS absent). Data analyses were performed considering a p-value of <0.05 as statistically significant. ResultsRS was present in 169 (93.9%) out of 180 cases. The open sulcus type was found in 114 cases (67.5%), followed by closed type in 26 (15.4%), slit sulcus type in 22 (13.0%), and scar type in 7 (4.1%) cases. Injury to cystic artery occurred in one case (0.15%) of Group A while in two cases (18.18%) of Group B (p-value = 0.001). The adjusted operative time in Group A and Group B were 50.61 ± 10.33 min and 69.86 ± 15.28 min respectively (p-value = 0.005). There was significant difference between Group A and Group B in conversion to open surgery - 01 (0.59%) and 04 (36%) respectively (p-value < 0.001). Surgical Site Infection (SSI) was detected in nine (5.33%) cases among Group A and in three (27.2%) cases among Group B (p-value = 0.028). ConclusionRS can be considered as an important anatomical landmark for safer LC with fewer injuries to cystic artery, SSI, conversion to open surgery and shorter operative time.

Comparison Between Single Dose Versus Multiple Doses Antibiotics in Laparoscopic Cholecystectomy

Introduction Laparoscopic cholecystectomy is clean-contaminated surgery. Prophylactic antibiotics are used to reduce SSI but there is still controversy regarding use of antibiotics in postoperative period. The aim of this study is to compare the effect of single dose versus multiple doses of antibiotics in terms of wound infection. Methods This prospective study was carried out in department of surgery of National Medical College and Teaching Hospital, Birgunj from March 2020 to March 2021. Patients with diagnosis of symptomatic cholelithiasis were divided using lottery method in single dose (SD) group and multiple doses (MD) group. SD group were given injection ceftriaxone 1gm at the time of induction of anaesthesia and MD group received injection ceftriaxone 1gm at the time induction of anaesthesia and followed by continuation of same dose twice a day for 2 days. Results A total of 249 patients completed the study among which 127 patients were included in the (SD) group and 122 patients in (MD) group. The mean age of patient was 37.37±14.30 years. In single dose (SD) group, 4(3.1%) patients developed wound infection and 3(2.5%) patients in multiple (MD) group developed wound infection which was not statistically significant (p=0.437). Conclusions Single dose antibiotic was found to be as effective as multiple doses of antibiotics in terms of wound infection in laparoscopic cholecystectomy.

Three Port Laparoscopic Cholecystectomy by a Modified Technique

Introduction:Since the introduction of laparoscopic cholecystectomy (LC) several modifications have been introduced to its procedure. Main aim of these modifications is to improve cosmesis &amp; reduce pain. Several institutes are routinely performing conventional 3 ports laparoscopic. In modified 3 ports LC, the third port was moved from right hypochondrium to umbilicus, to conceal it in the umbilical scar, thereby giving the three port comfort to the surgeon and two port benefits to the patient. Methods: This observational study was conducted in the Department of Surgery of Shaheed Suhrawardy Medical College &amp; Hospital from September 2015 to October 2016. After taking valid consent a total 45 patients were selected for modified 3 ports LC. Here we tried to see the safety and benefit of this modified technique by assessing operating time, intra-operative complications, open conversion rate, postoperative wound infection, post-operative hospital stay, pain score and satisfaction with cosmetic outcome. Results: 3 patients were excluded from study due to different reasons. So, among total 42 (N) patients 30 (71.4%) were female &amp; 12 (28.6%) were male. Operative time was 58.48 ± 32.52 minutes (range 34 to 180 minutes). 2 patients required conversion to open surgery. Pain score was 2.07 ±1.71 and cosmetic score was 8.67 ± 1.99. Conclusion: Modified 3 port laparoscopic cholecystectomy can be performed safely with a higher cosmetic satisfaction in selected cases by expert surgeon. J Shaheed Suhrawardy Med Coll 2020; 12(2): 90-94

Laparoscopic Cholecystectomy: Evaluation of Web-Based Information.

IntroductionLaparoscopic cholecystectomy (LC), the gold standard treatment for symptomatic gallstone disease, is the most common procedure performed by general surgeons worldwide. The internet remains to be a popular source of medical information. Our aim was to evaluate the quality and readability of information available on the web for patients undergoing LC and to compare the information provided by the National Health Service (NHS) and non-NHS websites. MethodsWe searched for the keywords ‘laparoscopic cholecystectomy’ using the three most popular search engines (Google, Yahoo and MSN) and looked at the first 50 websites only. The readability of each document was assessed using the Flesch Reading Ease (FRE) score. We checked Health on the Net Foundation Code of Conduct (HONcode) certification status, whether the sites had been checked by an expert and when the information was last updated.ResultsFifty-five of the possible 150 sites were analysed thus excluding repetitions (n=65), irrelevant content (n=26) or inaccessible links (n=3). Only seven of those were HONcode-certified. The mean FRE score was 46 (range 0-68, SD=16.13). There were 13 NHS sites and 42 non-NHS sites. The mean FRE score for the NHS sites was significantly better compared to the non-NHS sites [58.31 (SD=5.01) vs 42.21 (SD=16.35); p=0.001]. Fifty-four per cent (54%) of the analysed websites had been checked by a medical expert and 22% were updated within the last year.ConclusionsThis study highlights the poor quality and readability of information on medical websites. The information provided by NHS sites have significantly better readability compared to non-NHS sites.

Pattern of Presentation of Iatrogenic Biliary Injury Following Laparoscopic Cholecystectomy

Background: Cholecystectomy is one of the most now common abdominal surgeries performed every day. The incidence of bile duct injury (BDI) following open cholecystectomy is only 0.1% - 0.2%. After the introduction of laparoscopic cholecystectomy, the incidence has gone up to 0.4% - 0.7%. The present study is a prospective analysis of all patients with bile duct injury who were admitted to Dhaka Medical College Hospital during or at a variable period following cholecystectomy. Methods: To determine the pattern of presentation of iatrogenic biliary injury following cholecystectomy in the department of surgery of Dhaka Medical College Hospital, a total of 30 patients were purposively selected from May 2018 to November 2018. Patient particulars, records of physical and clinical evaluation, and operative details were collected by individual researchers. Data analysis was done by SPSS for windows version 21. Results: BDI was found very common among the age group 21 - 30 yrs (36%) and female dominant (60%). Majority of the patients presented with abdominal pain (96%), intra-abdominal collection (88%), biliary peritonitis (68%), cholangitis (60%), and obstructive jaundice (40%), and biliary fistula (40%). Laparoscopic cholecystectomy (84%) was the principal cause of biliary injury in our study. 48% of patients experienced clinical features within 7 days post-cholecystectomy. Per-operative diagnosis was done in only 12% of cases. 44% of patients in this study were recognized as Bismuth grade-3, followed by 36%, grade-2 patients. Management outcomes included wound infection (41.66%), minor bile leak (25%), peritonitis (8.33%), and renal impairment (8.33%). Conclusion: The effect of BDI is an extremely distressful clinical condition for the patients and their family members, hence proper care and management protocol should be followed.

Comparative study of open cholecystectomy versus laparoscopic cholecystectomy

Background: After the introduction of laparoscopic cholecystectomy it has become the procedure of choice for the removal of gall bladder. The advantages of laparoscopic cholecystectomy cited were the avoidance of large incision, shortened hospital stay and earlier return to work. This study was conducted in an effort to determine if these proposed advantages could be achieved in practice. Objectives: To assess safety and efficacy of laparoscopic cholecystectomy in comparison to open cholecystectomy and to compare laparoscopic cholecystectomy versus open cholecystectomy in terms of duration of operation, hospital stay, post-operative recovery, complications and patient satisfaction. Methods: This was a Retrospective clinical study consisting of 50 patients undergoing cholecystectomy randomised in two groups-25 patients in group LAP (Laparoscopic cholecystectomy) and 25 patients in group OPEN (Open cholecystectomy). Results: There was a preponderance of cases in the 3rd and 5th decades of life in both groups with a female preponderance. The most common indication for cholecystectomy was cholelithiasis. The duration of the procedure was less in the group LAP when compared to the group OPEN. Overall complications were more in group OPEN. Pain was less in group LAP. Resumption of oral intake was significantly earlier in group LAP. Also the duration of hospital stay was shorter with earlier return to normal work in group LAP. Conclusion: Females were the main sufferers of gallbladder disease in our study. The duration of surgery was lesser in group LAP in our study. Over all complication were more in group OPEN. The postoperative pain was less and patients tolerated oral feeds earlier in laproscopic cholecystectomy group when compared to open surgery. The patients undergoing laparoscopic cholecystectomy were discharged earlier and resumed their normal work earlier when compared to open cholecystectomy group. In conclusion, the study supports the view that laparoscopic cholecystectomy is safe and efficacious and offers definitive advantages over open cholecystectomy and should be the available option for all patients requiring elective cholecystectomy.