Laparoscopic Cholecystectomy For Chronic Cholecystitis Research Articles

TAKING INTO ACCOUNT THE MORPHO-FUNCTIONAL CHANGES IN THE COMPONENTS OF THE TRIANGLE OF CALLO IN ACUTE CHOLECYSTITIS AND THEIR INFLUENCE ON THE FEATURES OF THE LAPAROSCOPIC CHOLECYSTECTOMY

At the acute cholecystitis of loud speaker of infl ammatory process in a hepatobiliary one quickly acquires the dangerous display of the infi ltration-used for setting fi re character. Such changes in the zone of triangle of Callot’s predetermine the increase of risk of sub- and postoperative complications.Research aim: to learn the features of infl uence of anatomic changes in the zone of triangle of Callot’s at a sharp destructive cholecystitis and to defi ne the optimal list of operative- technic’s assures at implementation of cholecystectomy.Material and methods. From 2018 to 2023, in the surgical department of the Storozhynets Multidisciplinary Hospital for Intensive Care studied 89 (100 %) patients who were operated on for acute cholecystitis.Resalts. In the course of treatment and examination, the infl uence of the infl ammatory process in acute cholecystitis on the nature of anatomical changes in the area of the Callot’s triangle was studied. In order to avoid suboperative complications during laparoscopic cholecystectomy, 18 step-by-step operational and technical measures were identifi ed, which served as criteria for the safe performance of laparoscopic cholecystectomy in acute cholecystitis. It was established that the optimal variant of laparoscopic cholecystectomy for chronic cholecystitis according to the method of Stephen Strasberg (1992), Gary G. Wind (1999), in case of destructive changes in the area of the Callot’s triangle, is inferior to the «elephant trunk» method, which is more practical in such circumstances.Conclusion. Suboperative consideration of the step-by-step implementation of certain tactical and therapeutic measures made it possible to avoid postoperative complications in all operated patients 89 (100 %). Observance of such techniques during laparoscopic cholecystectomy creates conditions for its eff ective implementation, both in chronic and acute cholecystitis.

Clinical effect of laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones

ABSTRACT Chronic cholecystitis is a common disease that causes inflammation in the gallbladder and is usually associated with gallstones. Laparoscopic cholecystectomy has been widely used as a minimally invasive surgical technique to treat this condition. However, the clinical effect of laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones needs further investigation. This study aimed to investigate the clinical effect of laparoscopic cholecystectomy in treating chronic cholecystitis with gallstones. 90 patients with chronic cholecystitis and gallstones were randomly divided into control and research groups. The control group underwent traditional open cholecystectomy, while the research group received laparoscopic cholecystectomy. Perioperative indexes, oxidative stress indexes, serum inflammatory factors, liver function indexes and the incidence of complications were observed and compared. Results showed that laparoscopic cholecystectomy significantly reduced the operation time, blood loss, anal exhaust time, abdominal pain duration, and hospital stay compared to traditional open cholecystectomy (P < 0.05). Moreover, laparoscopic cholecystectomy significantly reduced the levels of oxidative stress indexes (GSH-Px), inflammatory factors (IL-6, TNF-α, and CRP), and liver function indexes (TBIL, AST, and ALT) compared to traditional open cholecystectomy. Moreover, the complication rate of the research group was significantly lower than that of the control group (P < 0.05). In conclusion, laparoscopic cholecystectomy for chronic cholecystitis with gallstones is a safe and effective procedure that reduces the perioperative stress response and promotes the rapid recovery of the postoperative body. The findings of this study provide a basis for the clinical promotion of laparoscopic cholecystectomy as the preferred surgical treatment for chronic cholecystitis with gallstones.

A patient with cystic duct remnant calculus treated by laparoscopic surgery combined with near-infrared fluorescence cholangiography

BackgroundThe recurrence of symptoms present before cholecystectomy may be caused by a cystic duct remnant. The resolution of cystic duct remnant syndrome may require surgical resection, but identification of the duct remnant during laparoscopic surgery may be difficult because of adhesions following the previous procedure. Open surgery, which is more invasive than laparoscopic surgery, is frequently chosen to avoid bile duct injury.Case presentationThe patient was a 24-year-old woman with previous laparoscopic cholecystectomy for chronic cholecystitis and repeated attacks of biliary colic. The postoperative course was uneventful, but computed tomography revealed a remnant cystic duct calculus. Ten months after surgery, the patient returned to our department for right hypochondriac pain. Laparoscopic remnant cystic duct resection was performed with intraoperative near-infrared (NIR) fluorescence cholangiography to visualize the common bile duct and remnant cystic duct. The postoperative course was uneventful and the patient was discharged on day 3 after surgery. At the 6-month follow-up, she had no recurrence of pain.ConclusionLaparoscopic surgery with NIR cholangiography is a safe and effective alternative for the removal of a cystic duct remnant calculus after cholecystectomy.

Transumbilical single-port laparoscopic cholecystectomy for chronic cholecystitis with cholecystolithiasis

Objective To study the feasibility, safety and aesthetics of laparoscopic cholecystectomy using a single-port through the umbilicus in patients with chronic cholecystitis with cholecystolithiasis. Methods From Jan 2007 to Jun 2017, the clinical data of 4790 patients who underwent single-port, 4 426 patients conventional three-ports, and 3 304 patients two-ports laparoscopic cholecystectomy were retrospectively studied. Results There were no death in all the three groups. There were no significant differences in the incidences of postoperative bleeding, bile leakage, biliary tract injury and other significant short-term complications (all P>0.05). The operation time of transumbilical single-port laparoscopic cholecystectomy was significantly longer than that of two-ports and three-ports laparoscopic cholecystectomy [(35.3±9.0)min vs. (28.4±7.2)min vs. (23.3±6.4)min, P 0.05). There were no significant differences among the three groups in intraoperative blood loss, first postoperative passing of flatus, postoperative pain, and length of hospital stay (all P>0.05). The satisfaction score of surgical scar in the single-port group was higher than that in the two-ports and three-ports groups [(9.6±1.6) vs. (7.6±1.9) vs. (6.7±2.0), P<0.05]. Conclusions Transumbilical single-port laparoscopic cholecystectomy was safe and feasible, with good aesthetics and other advantages. It was more difficult than the traditional laparoscopic technique. After the learning curve, the operation time could be comparable to the three-ports technique. Key words: Cholecystectomy, laparoscopic; Cholecystolithiasis; Cholecystitis; Transumbilical single-port laparoscopy

Conversion to open surgery in the era of laparoscopic cholecystectomy: Changing rates and reasons in geriatric patients

Objective: Compared to open surgery; laparoscopic cholecystectomy has become the standard of care for the treatment of cholelithiasis at any age over the last two decades. In the present study, the aim was to identify and to compare the rates and reasons involved in conversion to open procedure in elective surgery for cholelithiasis in geriatric patients over the course of fourteen years. Methods: To assess the possible differences in the conversion rates and reasons over time, 207 patients over 65 years of age undergoing elective laparoscopic cholecystectomy for chronic cholecystitis were analyzed in two groups - the first ten years (n=141) and the last four years (n=66). Acute cholecystitis, gallbladder malignancy and/or polyps were excluded. Demographic characteristics, comorbidities, history of previous abdominal surgery, preoperative endoscopic retrograde cholangiopancreatography (ERCP) and the reasons and rates involved in conversion to open cholecystectomy were all analyzed. Results: In male and female patients, the conversion rate was 18.8% and 5.07 %, respectively (p=0.02). In the first ten years, the conversion rate was 11.3%, while in last four years, it was 6.1% (p=0.230). In first ten years, 62.5% of the reason for conversion was found to be dense pericholecystic adhesions related, but in last four years, this rate decreased notably to 25%. Conclusions: Although there was no statistical significance, in last four years, surgeons seemed to more easily overcome difficult cholecystectomies.

ROLE OF MALE GENDER IN LAPAROSCOPIC CHOLECYSTECTOMY OUTCOME

Laparoscopic cholecystectomy (LC) is one of the most commonly performed laparoscopic procedures. Problems occurring during laparoscopic cholecystectomy include bile duct injury, conversion to open operation, and other postoperative complications. Male gender is a risk factor for LC conversion rate.Our goal is to determine the effect of male gender on the outcome of laparoscopic cholecystectomy for Chronic Cholecystitis. We have done that through a retrospective clinical trial was carried out at our Hospital to evaluate the sex difference as predictor for difficult laparoscopic cholecystectomy. From a total number of 638 patients, who underwent laparoscopic cholecystectomy for Chronic Cholecystitis from 1st January 2012 to 1st of January 2015) two hundred and seventeen patients were excluded according to exclusion criteria and the remaining 421 patients were included.All the operation were done according to standard four-port technique through an open method was used, with first entry port in the periumblical region. 1 Anesthetic technique and perioperative management were the same for all patients during the study period. Results: Patients who were candidates for elective cholecystectomy , were mostly females with (F:M ratio= 4/1), mean age 40 years (range 13-101 years) with mean age of 45 years(range 20-78 years) for the males, 40years (range 13-100 years) for the females. There were more difficult cholecystectomies in males in comparison to female patients for chronic cholecystitis. The outcome of this study is male gender is a predictor for difficult laparoscopy for symptomatic gallstones presented as chronic cholecystitis

Intraoperative fluorescent imaging using indocyanine green for liver mapping and cholangiography

Preoperative imaging is widely used and extremely helpful in hepatobiliary surgery. However, transfer of preoperative data to a intraoperative situation is very difficult. Surgeons need intraoperative anatomical information using imaging data for safe and precise operation in the field of hepatobiliary surgery. We have developed a new system for mapping liver segments and cholangiograms using intraoperative indocyanine green (ICG) fluorescence under infrared light observation. The imaging technique for mapping liver segments and cholangiogram based on ICG fluorescence used an infrared-based navigation system. Eighty one patients with liver tumors underwent hepatectomy from 2006, January to 2009, March. In liver surgery, 1 ml of ICG was injected via the portal vein under observation by the fluorescent imaging system. Fourteen patients were underwent laparoscopic cholecystectomy for chronic cholecystitis with gallstones. In laparoscopic cholecystectomy, 5 ml of ICG was administered intravenously just before operation and the bile duct was observed using the infrared-based navigation system. This new technique successfully identified stained subsegments and segments of the liver in 73 of 81 patients (90.1%). Moreover, clear mapping of liver segments was obtained even against a background of liver cirrhosis. Fluorescent cholangiography clearly showed the common bile duct and cystic duct in 10 of 14 patients (71.4%). No adverse reactions to the ICG were encountered. Application of this technique allows intraoperative identification of anatomical landmark in hepatobiliary surgery.

Predictive Factors for Difficult Surgery in Laparoscopic Cholecystectomy for Chronic Cholecystitis

Introduction: Conversion rate in laparoscopic cholecystectomy is still 1.5-19%. Our aim was to look for various factors and to make a predictive index which can predict the chances of conversion. Methods: We included 536 patients with laparoscopic cholecystectomy during July 2002 to April 2006. A total of 64 patients needed conversion. Twenty four patients who underwent conversion because of non-surgical reasons were excluded. Criteria of exclusion were: history of jaundice, cholangitis, raised alkaline phosphatase, dilated common bile duct (CBD) and patients with CBD stones. Patients were evaluated in terms of clinical, hematological, biochemical and ultrasonographic parameters. Results: Overall conversion rate was 7.81%. Univariate analysis showed that body mass index (BMI), fever at the time of attack, number of stones, number of attacks, previous history of acute cholecystitis, presence of tenderness, gall bladder wall thickness on ultrasonography (USG) and raised total leucocyte counts (TLC) were significant for conversion. Stepwise logistic regression showed that only number of attacks, TLC & wall thickness were significant. Probability of prediction: P = ey/(1+ey) and Y = -9.2015 + (0.3623 × Number of Attacks) + (0.0003 x TLC) + (0.8633 × Wall Thickness), where 'e' is the exponential constant -2.7182, number of attacks is '1' if > 5 and '0' for 11,000/cu.mm and '0' if within normal range, and wall thickness is '1' if > 4 mm and '0' for < 4 mm on USG. Conclusion: Yes, it is possible to predict the risk of conversion and patients can be informed preoperatively.

Laparoscopic cholecystectomy for chronic cholecystitis in Jamaican patients with sickle cell disease: preliminary experience

Laparoscopic cholecystectomy, with its advantages of reduced postoperative pain and shorter hospitalization is the accepted standard of care for patients with symptomatic cholelithiasis. A retrospective study was done to assess the outcome of laparoscopic cholecystectomy in patients with sickle cell disease, a group known for its high postoperative morbidity. The study sample comprised of patients seen at the University Hospital of the West Indies during the period 1999 to 2004. Twelve patients were females and four were males. Their mean age was 28.5 years (range 13-43 years). Fifteen underwent elective cholecystectomy for recurrent episodes of cholecystitis while one patient required an emergency procedure. All patients underwent endoscopic retrograde cholangiopancreatography, which successfully removed common bile duct stones which were present in 25% of the cases. There were four conversions to open cholecystectomy as a result of obscure anatomy due to scarring and adhesions. The duration of surgery ranged from 70-150 minutes. Six patients developed postoperative complications, four of whom had acute chest syndrome. This resulted in death in one patient. The mean postoperative hospitalization period was 5.5 days. This report indicates that patients with sickle cell disease remain a high risk group with the potential for significant morbidity even when subjected to minimal access surgery.

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.

A technique for laparoscopic retraction of the acutely inflamed thick-walled gallbladder.

Utilizing the described technique, we have been able to obtain adequate cephalad retraction of the acutely inflamed, tense, and thick-walled gallbladder with minimal trauma. This has made it possible to more adequately identify key anatomical landmarks and to more safely perform the dissection in this area. We believe that the benefits of a shorter hospital stay, decreased postoperative pain, and earlier return to normal activity that patients realize when having an elective laparoscopic cholecystectomy for chronic cholecystitis can be made available as well to more patients presenting with acute cholecystitis.