Laparoscopic Cholecystectomy Group Research Articles

Ultrasound-Guided Transversus Abdominis Plane Block Versus Intraperitoneal Instillation of Bupivacaine after Laparoscopic Cholecystectomy – A Randomized Control Trial

Background: Postoperative pain prolongs hospital stay after laparoscopic cholecystectomy and remains a major challenge during the postoperative period. Effective pain control encourages early ambulation, which significantly reduces postoperative complications. In recent years, multimodal analgesia has been recommended with fewer adverse effects and more effective analgesia. The primary objective of this study was to compare the efficacy of analgesia between Transversus Abdominis Plane Block (TAP) Block and intraperitoneal instillation of bupivacaine by comparing the meantime of the first dose of rescue analgesia in either group and the total supplementary analgesia required. Methods: This retrospective observational study was conducted on 150 patients who underwent laparoscopic cholecystectomy Group 1 comprised of patients who had received Intraperitoneal Bupivacaine for analgesia and Group 2 received TAP Block for pain relief. Results: Time of the first dose of analgesia after surgery was observed earlier in Group 1 as compared to Group 2 (Time – hours: 9.2 ± 2 vs. 12.3 ± 1.6; p = 0.0001. The Total dose of analgesic was higher in the Intra Peritoneal Bupivacaine Group as compared to the TAP group. Conclusion: AP block provided for a better quality of analgesia as assessed by the reduced requirement of intravenous supplementary analgesia which was less in patients who were given TAP Block as compared to local instillation of Bupivacaine. Keywords: Cholecystectomy, Bupivacaine, Transversus abdominis plane block

Can gallbladder wall thickness and systemic inflammatory index values predict the possibility of conversion from laparoscopy to open surgery?

This study aims to develop an objective marker that predicts the risk of conversion from laparoscopy to open surgery using gallbladder wall thickness and inflammatory index values. A total of 2,920 cholecystectomy patients were screened, including those whose operations were converted to open and those who underwent laparoscopy. A total of 700 cholecystectomy patients who met the study criteria were included in the study. The same team of surgeons performed all operations. The conversion probability from laparoscopic to open cholecystectomy was calculated using the ratio obtained by evaluating inflammatory markers and gallbladder wall thickness (K). The preoperative complete blood count and abdominal ultrasound data of the patients were obtained from our university patient registry system. Age, neutrophil count, gallbladder wall thickness, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), KxNLR, and KxPLR values were all significantly higher in the conversion from laparoscopy to open surgery group compared with the laparoscopic cholecystectomy group. According to the ROC analysis performed on the gallbladder wall thickness values according to the probability of conversion to open surgery, the cutoff value was determined as >3 mm. Gallbladder wall thickness >KxPLR >KxNLR was defined as the diagnostic value order according to the area under the curve. The results of this study showed that gallbladder wall thickness effectively determines the probability of conversion from laparoscopy to open cholecystectomy and multiplying the gallbladder wall thickness (mm) by NLR increased the sensitivity.

COMPARISON OF SAFETY OF MINILAPAROSCOPIC AND CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY

Abstract. Aim: to assess the safety of mini-laparoscopic cholecystectomy (MLC) compared to traditional laparoscopic cholecystectomy (LC) based on a critical view of safety (CVS).
 Materials and methods: an analysis of 46 video recordings of MLC surgeries and 156 LC surgeries performed for chronic calculous cholecystitis and gallbladder polyps between 2015 and 2022 was conducted, using the concept of CVS and the quality of its achievement. An analysis of anatomical variations was also performed.
 Results and discussion: the average age was 38.5 years in the MLC group and 53.8 years in the LC group, with an average operation time of (59.4±2.13) minutes and (63.01±2.01) minutes, respectively. CVS was achieved in 97.8 % of cases in MLC and 93.0 % in LC. Anatomical variations were present in 31.1 % of cases in MLC and 30.1% in LC. There were no complications of MLC, conversions from MLC to LC, or open surgery.
 Conclusions: The frequency of achieving CVS in MLC was higher than in LHE (97.8 % vs. 93.0 %). Anatomical variations of the biliary system should always be considered for the safe cholecystectomy. MLC is a safe technique that is not inferior to standard LCE in elective surgery in patients with a normal BMI, and at the same time has better cosmetic results.

The first experience of using the "Senhance" robotic surgical system during cholecystectomy

The aim of our study was to evaluate the differences in intra­operative and postoperative outcomes of cholecystectomy using the Senhance robotic platform and laparoscopic cholecystectomy. A retrospective analysis of medical cases history of patients who underwent cholecystectomy from December 2021 to February 2022 was conducted. The treatment outcomes of patients with chronic calculous cholecystitis who underwent robotic cholecystectomy (RC) were compared with those who underwent laparoscopic cholecystectomy (LC). Robotic cholecystectomy was performed using the Senhance robotic platform. The RC and LC groups were matched for age, sex, body mass index and compared for the duration of the operation and hospital stay. For normally distributed data, the mean and standard deviation, determined using the Shapiro-Wilk test (p-value>0.05), were applied. Median and interquartile range (IQR) were also used. Difference between cohorts - 95% confidence interval (95% Confidence Interval) were estimated for normally distributed data. Data analysis was performed using standard summary statistics on the Jamovi 2.2.5 platform. Data were processed using application program packages. All surgical procedures were performed by two surgeons from Odesa National Medical University. Robotic cholecystectomy was performed on 18 pa­tients and laparoscopic cholecystectomy was performed on 20 patients. There were no statistically significant differences between the groups in terms of length of hospital stay, blood loss or complications. There were no bile duct injuries, intra­operative complications, or conversions in either group. The only statistically significant difference was the total time under anesthesia (p>0.05), which was longer in the robotic cholecystectomy group. Cholecystectomy using the Senhance robotic platform was found to be safe, with an average operative time of 35.2±5.0 minutes, while the duration of laparoscopic cholecystectomy was 32.2±3.3 minutes. The study results showed that robotic cholecystectomy using the Senhance system is safe and effective. The use of robotic systems can improve precision and control during surgery, reduce blood loss and complications.

Early versus delayed laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: A meta-analysis.

Patients with cholecysto- and choledocholithiasis usually undergo endoscopic retrograde cholangiopancreatography (ERCP)/-endoscopic sphincterotomy followed by laparoscopic cholecystectomy (LC). However, differences in the timing of LC after the ERCP may alter the post-operative outcomes. The aim of this study was to compare the effect of early (≤3 days) or delayed LC (>3 days) following ERCP on the post-operative outcomes. A comprehensive search of the 3 databases PubMed, EMBASE and the Cochrane Library was performed. Articles related to LC at different time-points after ERCP were retrieved. Dichotomous and continuous outcomes were analyzed by risk ratio (RR) and mean difference, and RevMan was used to analyze each group. A total of 7 studies, including 5 randomized controlled studies and 2 retrospective studies, involved a total of 711 patients. There were 332 patients in early LC group and 379 in delayed LC group. The conversion rate was lower in the early LC group compared to the delayed LC group (RR 0.38, 95% confident interval 0.19 to 0.74, P = .005, I2 = 0%). Early LC resulted in a shorter operation time (RR -6.2, 95% CI -27.2 to -5.2, P = .004, I2 = 97%) and fewer complications (RR 0.48, 95% CI 0.29 to 0.79, P = .004, I2 = 17%). Subgroup analysis found that there were no significant differences in the conversion rate (RR 0.61, 95% CI 0.25 to 1.45, P = .26, I2 = 0%) or complications between the early LC group and the delayed group who underwent LC after 1 month. Early LC after ERCP is the preferred treatment for patients with concurrent cholecysto- and choledocholithiasis due to improved clinical outcomes as compared to those who undergo delayed LC.

557 Laparoscopic versus robotic cholecystectomy: a meta-analysis to differentiate between postoperative outcomes

Abstract Objective Robotic cholecystectomy (RC) may be an option to replace conventional laparoscopic cholecystectomy (LC) due to several reported advantages. The objective of this study is to compare the postoperative surgical outcomes in patients undergoing RC versus LC. Materials and methods RCTs reporting postoperative outcomes in patients undergoing RC versus LC were selected from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results Two RCTs on 196 (113 patients in RC group and 83 patients in LC group) patients were found suitable for meta-analysis according to the inclusion criteria. In the random effects model analysis, the duration of operation [standardised mean difference -15.83, 95%, CI (-22.99, -8.67), Z = 4.33, p < 0.0001] was shorter in the LC group. However, the risk of bile leak [standardised mean difference 3.15, 95%, CI (0.69, 14.44), Z = 1.48, p = 0.14] and postoperative complications [standardised mean difference -0.48, 95%, CI (0.10, 2.33), Z =0.91, p = 0.36] were statistically similar between RC and LC groups. There was no heterogeneity (Tau 2 = 0.09; Chi 2 = 1.06, df = 1; (p = 0.30; I 2 = 6 %) between included RCTs. Conclusion RC failed to prove any clinical advantage over LC for postoperative outcomes including longer duration of operation. These findings are insufficient to draw a stronger conclusion due to the paucity of RTCs and a major multicentre RCT is required to strengthen the existing evidence.

FTP5.13 Laparoscopic cholecystectomy is more cost effective than robotic cholecystectomy: a systematic review of published studies

Abstract Objective Robotic cholecystectomy (RC) has been proven safe and postoperative outcomes have also been quoted to be equivalent to conventional laparoscopic cholecystectomy (LC). The objective of this review to evaluate the cost effectiveness of RC compared to LC. Materials and methods All types of comparative studies reporting the cost of RC versus LC were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.4. Results Four comparative studies (one randomised trial and 3 retrospective studies) on 817 patients undergoing RC versus LC were found and deemed suitable for analysis. There were 559 patients in the LC group and 258 patients in the RC group. In the random effects model analysis, LC was associated with the reduced cost [standardised mean difference -5.39, 95%, CI (-8.97, -1.81), Z = 2.95, P=0.003] compared to RC. However, there was significant heterogeneity (Tau2 = 13.06; Chi2 = 583.52, df = 3; (p < 0.00001; I2 = 99%) among included studies. Conclusion The LC seems to be more cost effective compared to RC in terms of procedural cost. However, due to statistically significant heterogeneity among included studies and paucity of the randomised, controlled trials, these findings should be taken cautiously. A Major multicentre randomised, controlled trial is needed to validate these findings.

A comparative study of umbilical port versus epigastric port for gall bladder extraction in laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis. Postoperative pain is important factor that decide requirement of injectable analgesics and post-operative hospital stay. Gall bladder (GB) can be extracted from umbilical or epigastric port. Excessive manipulation during GB extraction can cause postoperative pain. Methods: Study was carried out in 60 patients between January 2022 to December 2022, including patients who have symptomatic gall bladder stone and required laparoscopic cholecystectomy. Patients with perforated GB and required emergency laparoscopic cholecystectomy and patient having GB carcinoma and required elective laparoscopic radical cholecystectomy and patients requiring laparoscopy converted to open cholecystectomy were not included in the study. In this study, patients were randomly allocated in two groups: group A (n=30) includes laparoscopic cholecystectomy with GB retrieval from epigastric port and group B (n=30) includes laparoscopic cholecystectomy with GB retrieval from umbilical port. Author have compared two groups in terms of intraoperative time, postoperative pain, wound infection and port site hernia development. Results: This study shows that there is no significant difference in intraoperative time, wound infection and port site hernia development between two groups but there is significant less postoperative pain in group B patients with GB retrieval from umbilical port. Conclusions: In laparoscopic cholecystectomy, there is no significant difference in GB retrieval from umbilical port and epigastric port in terms of intraoperative time, wound infection and port site hernia development. But GB retrieval from umbilical port reduce post-operative pain in comparison to epigastric port GB retrieval.

Lower abdominal approach in laparoscopic cholecystectomy: A propensity score-matching analysis and prospective cohort study

BackgroundClassic laparoscopic cholecystectomy) using multiple ports is a widely used method with excellent surgical outcomes. However, the resulting wounds do not meet the cosmetic needs of patients. Therefore, this study aimed to find a new minimally invasive surgical method for invisible wounds while maintaining surgical safety through a new port site. MethodsIn this prospective cohort study, we used propensity score matching analysis to evaluate the perioperative outcomes of multiport laparoscopic cholecystectomy using articulating devices with the lower abdominal approach. We performed a propensity score matching analysis of prospectively maintained data from 228 patients who underwent classic laparoscopic cholecystectomy using straight instruments and laparoscopic cholecystectomy with a lower abdominal approach using articulating devices between January and October 2022. A single surgeon performed all operations included in the study. We evaluated several perioperative outcomes. ResultsNo differences were found in potential confounding factors, such as sex, age, admission type, previous abdominal surgery, and medical comorbidities, between the 2 groups after propensity score matching. In the classic laparoscopic cholecystectomy group, the mean operation time was shorter (43.73 ± 23.71 vs 50.60 ± 9.75 min; P < .04). No significant difference was noted in the 2 groups’ numerical rating scale scores for pain, body mass index, and incidence of postoperative complications. The mean length of hospital stay was longer for patients who underwent classic laparoscopic cholecystectomy (4.27 vs 2.07 days; P = .064). The lower abdominal laparoscopic cholecystectomy group had delayed defecation after surgery. ConclusionRegarding surgical outcomes and minimal invasiveness, lower abdominal laparoscopic cholecystectomy is a feasible cholecystectomy method.

Outcomes of an enhanced recovery after surgery (ERAS) program to limit perioperative opioid use in outpatient minimally invasive GI and hernia surgeries.

Perioperative pain management is important for patient satisfaction while returning to homeostasis in the safest way possible. Studies show that patients don't require as much opioids as once thought. The benefits of ERAS pathways extend beyond enhancement of patients' perioperative experience, and include reducing opioid prescriptions in the face of the ongoing nationwide opioid crisis and evidence of prescription opioids as a contributor. We performed a retrospective cohort study of patients undergoing same day minimally invasive surgery (MIS) procedures for GI and hernia disease using a minimal-opioid ERAS protocol at two community hospitals between January 2020 and May 2022. We included elective laparoscopic cholecystectomy (LC), laparoscopic appendectomy (LA) for acute appendicitis without perforation, and minimally invasive (laparoscopic and robotic) inguinal and ventral hernia repair or abdominal wall reconstruction (AWR). Primary outcome was postoperative opioid use. A total of 509 patients were included, undergoing procedures of MIS hernia repair (52.5%), LC (43.6%), and LA (7.9%). Only 9.4% of patients received opioid prescriptions at discharge, with no difference between groups. Among the patients receiving a prescription at discharge, there was a significant difference in morphine milligram equivalents (MME) prescribed (25.0 ± 0.0 in the LA group, 65.0 ± 41.4 in the LC group, 100.6 ± 46.2 in the MIS hernia/AWR group; P = 0.015). Nine percent of patients called with pain management concerns postoperatively. ASA score ≥ 3 was associated with increased odds for postoperative opioid prescription (OR 2.084; P = 0.014). We demonstrate that an opioid-sparing ERAS program effectively manages pain for patients undergoing multiple outpatient MIS GI/hernia procedures, and suggests generalizability across a diverse range of operations. Therefore, the use of ERAS may safely and effectively expand beyond inpatient MIS and open surgeries that target reduced length of stay to also minimize opioids for outpatient procedures.

Short- and long-term outcomes of laparoscopic radical gallbladder resection for gallbladder carcinoma: A multi-institutional retrospective study in Japan.

Laparoscopic resection of gallbladder carcinomas remains controversial. This study aimed to evaluate the surgical and oncological outcomes of laparoscopic procedures for suspected gallbladder carcinoma (GBC). In this retrospective study, data regarding suspected GBC treated with laparoscopic radical cholecystectomy before 2020 in Japan, was included. Patient characteristics, surgical procedure details, surgical outcomes, and long-term outcomes were analyzed. Data of 129 patients with suspected GBC who underwent laparoscopic radical cholecystectomy were retrospectively collected from 11 institutions in Japan. Among them, 82 patients with pathological GBC were included in the study. Laparoscopic gallbladder bed resection was performed in 114 patients and laparoscopic resection of segments IVb and V was performed in 15 patients. The median operation time was 269 min (range: 83-725 min), and the median intraoperative blood loss was 30 mL (range: 0-950 mL). The conversion and postoperative complication rates were 8% and 2%, respectively. During the follow-up period, the 5-year overall survival rate was 79% and the 5-year disease-free survival rate was 87%. Recurrence was detected in the liver, lymph nodes, and other local tissues. Laparoscopic radical cholecystectomy is a treatment option with potential favorable outcomes in selected patients with suspected GBC.

Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients

Aim: To assess which treatment modality, Patients with AC who are at a high risk should have a cholecystectomy performed using or percutaneous catheter drainage. Methodology: Sixty people were included in this study because they got diagnosed with acute calculous cholecystitis. Both the procedure of laparoscopic cholecystectomy and percutaneous catheter drainage were offered to them at random. Results: In terms of the need for further surgery, there was a statistically significant difference between the groups as there were 2 (6.7%) who needed re-intervention in laparoscopic cholecystectomy group and 14 (46.7%) in percutaneous catheter drainage group (p=0.001*), recurrent biliary disease as there were 2 (6.7%) in laparoscopic cholecystectomy group and 17 (56.7%) in percutaneous catheter drainage group (p&lt;0.001*) and total length of hospital stay as the mean of laparoscopic cholecystectomy group was 4.9 (±2.77 SD) while in percutaneous catheter drainage group was 10.67 (±6.62 SD).Conclusion: Cholecystectomy with laparoscopic is favored over percutaneous drainage for high-risk individuals with acute cholecystitis. When compared to percutaneous catheter drainage, laparoscopic cholecystectomy decreased significant complications but did not affect fatality rates.

Comparison of laparoscopic radical cholecystectomy and open radical cholecystectomy for stage III gallbladder cancer

Comparison of laparoscopic radical cholecystectomy and open radical cholecystectomy for stage III gallbladder cancer

LAPAROSCOPIC CHOLECYSTECTOMY VS OPEN CHOLECYSTECTOMY IN THE TREATMENT OF ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY CONDUCTED AT ONE OF THE TERTIARY CARE CENTRES IN NOTHRERN INDIA.

Background: Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no denitive data on its use in AC has been published. To Objective: compare the results of laparoscopic cholecystectomy (LC) with those of open cholecystectomy (OC) in the treatment of acute cholecystitis. Materials and Methodology: A prospective study was conducted among 30 patients who have taken surgical treatment for acute cholecystitis by taking their prior consents at Surgery Department, Career Institute OF Medical Sciences, Lucknow for 1 year. The patients underwent surgery within 72 hours of the onset of symptoms. The pa tients were selected for LC or OC depending on the surgeon's experience in laparoscopic surgery. Operating time, rate of con- version from LC to OC, complications, and length of hos pital stay were the main outcomes which were noted in both procedures. Conversion from LC to OC was necessary in 15% of the patients. The Results: mean operating time was 77 minutes for the OC group and 88 minutes for the LC group (P&lt;.001). Complications occurred in 14% of the patients in the LC group and in 23% of the patients in the OC group, with no signicant differences between the 2 groups (P=.06). The number of moderate or severe com- plications was similar in both groups, whereas mild com- plications were more common in the OC group (P&lt;.02). The length of the hospital stay averaged 8.1 days for the OC group and 3.3 days for the LC group (P&lt;.001). Laparoscopic cholecystectomy is a s Conclusions: afe, valid alternative to OC in patients with acute cholecystitis. The technique has a low rate of complications, implies a shorter hospital stay, and offers the patient a more comfortable postoperative period than OC

Evaluation of the Common bile duct (CBD) Diameter After Laparoscopic Cholecystectomy (LC) and Laparoscopic Common Bile Duct Exploration (LCBDE): A Retrospective Study.

Common Bile duct (CBD) measurement is a crucial aspect in the evaluation of the biliary tree. Whether the CBD undergoes any compensatory change in diameter after laparoscopic cholecystectomy or laparoscopic common bile duct exploration is still up for discussion. The aim of this study was to investigate CBD diameter changes after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) on magnetic resonance cholangiopancreatography (MRCP). Our retrospective study is divided into 2 sections. The first part assessing CBD diameter changes after laparoscopic cholecystectomy due to gallstones or gallbladder polyps, involved 85 patients, who underwent MRCP procedures. These patients aged between 30 and 85 were divided into an interval LC group (group A, n=56) and a remote LC group (group B, n=29). In group A, the common CBD diameters were measured at their widest portions on MRCP obtained before and after laparoscopic cholecystectomy. Measurements of the CBD diameters were repeated on MRCP obtained twice after the surgery in group B.Section 2 consisted of 38 patients who had choledocholithiasis and were treated with laparoscopic CBD exploration and T-tube placement. These patients aged 26 to 86 formed the interval LCBDE group (group C). The CBD widest diameters were measured on MRCP before LCBDE and after T-tube cholangiography for these individuals.Patients in groups A and C were further divided into 5 and those in group B into 4 age-related subgroups to facilitate statistical analysis. The Pearson correlation test was performed to find any relationship between CBD diameters and age in groups A and B. Paired sample T test was used to compare the significant difference between the 2 sets of CBD diameters in each study group and their subgroups. In the interval LC group, the post-LC mean CBD diameter was significantly wider when compared with the preoperative mean diameter (P<0.05). There was a significant difference between the first and second post-LC means CBD diameter in the remote LC group (P<0.05). In group C, the mean CBD diameter measured on T-tube cholangiography after LCBDE was significantly smaller than the preoperative dilated mean diameter (P<0.05). This study demonstrated significant dilation occurring in the common bile duct diameter after laparoscopic cholecystectomy. Furthermore, our remote LC group also supported that claim by showing significant dilation between the first and second post-cholecystectomy CBD diameter values. And lastly, our interval LCBDE sample's initial dilation of the CBD diameters was reduced after surgery and stone extraction.

Association of Laparoscopic Methods and Clinical Outcomes of Cholecystolithiasis Plus Choledocholithiasis: A Cohort Study.

This cohort study retrospectively included patients who underwent laparoscopic surgery for cholecystolithiasis plus choledocholithiasis at our hospital (January 2017 to March 2021). The primary outcome was bile leakage. Totally 127 patients were enrolled. The time to get out of bed and the indwelling duration of the abdominal drainage tube in the patients who underwent laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage were higher than the endoscopic retrograde cholangiopancreatography+laparoscopic cholecystectomy group, without differences in the laparoscopic common bile duct exploration group (all P < .05). All indexes decreased in the 3 groups after surgery (all P < .01). On the first day after surgery, only white blood cells (P < .001) and gamma-glutamyl transferase (P = .045) showed significant differences among the different surgical methods. The incidence of biliary leakage (P = .001) was higher in laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, while the occurrence of hyperamylasemia was higher with endoscopic retrograde cholangiopancreatography+laparoscopic cholecystectomy (P = .001). Compared with laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, laparoscopic common bile duct exploration was associated with fewer bile leakage (RR = 0.03, 95% CI: 0.003-0.37). Compared with laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, laparoscopic common bile duct exploration was associated with bile leakage.

ADVANTAGES OF LAPAROSCOPIC SURGERY IN CALCULOUS CHOLECYSTITIS

Purpose: The aim of the study is the comparative analysis of the operating time, blood loss during surgery, postoperative discomfort, and pain, hospital stay, cost-effectiveness, and patient satisfaction in patients undergoing laparoscopic cholecystectomy and conventional cholecystectomy in UMHATEM "N.I.Pirogov". Material and Methods: For a one-year period (from 01.01.2018 to 01.01.2019) 512 patients with calculous cholecystitis were operated on the Department of General, Visceral, and Emergency surgery on UMHATEM "Pirogov". In 487 of these cases, laparoscopic cholecystectomy was performed (group I), the remaining 25 cases were treated with conventional cholecystectomy (group II). Women with laparoscopic cholecystectomy (group I) were 392 (75.82%), men 95 (24.18%). From the open surgery cohort (group II), women were 19 (75.41%), men 6 (24.59%). The age in this retrospective analysis varied from 18 to 83 years (average 52.7 years). Results: From group I (lap. cholecystectomy), women were 392 (80.49%), men 95 (19.51%). In group II (open cholecystectomy), women were 19 (76%), men 6 (24%). Age in this retrospective analysis ranged from 18 to 83 years (average 52.7 years) for both groups. There was no significant difference between demographic variables in the two groups. The operating time varied between 23 and 165 min (average 39.4 min) for group I and 35 to 104min (average 44.6min) for group II respectively. The hospital stay was recorded from 48 hours to 7 days (2.7 days on average) for group I and 3 to 9 days (average 4.5 days) for group II respectively. Surgical morbidity included 12 patients (operative wound suppuration, ileus, postoperative hernia, jaundice), 7 from group I (1.44%) and 5 from group II (20%), which was considered a significant difference. Conclusion: Laparoscopic cholecystectomy is an easy intervention, reduced time-consuming procedure, with shortened complication rates compared to open cholecystectomy. It completely debates an advantage of a decreased hospital stay and early return to work compared to open surgery.

Minimally invasive radical cholecystectomy as a safe alternative to open radical cholecystectomy

Background: Gallbladder cancer today accounts for an estimated 1.2% of all new cancer diagnoses worldwide. For localized stage T1b gallbladder cancer and above, the treatment of choice is a radical cholecystectomy with negative gross and histologic margins. This procedure involves removal of the gallbladder and a portion of the liver, with or without concurrent resection of the bile duct and regional lymph nodes. In the past, performing this resection laparoscopically has been contraindicated due to fears of increased metastasis and inadequate lymph node sampling. With the advancement of laparoscopic techniques, however, minimally invasive radical cholecystectomies have the potential to be as safe and effective as the classic, open approach. This study seeks to use the current available literature to compare outcomes between an open and a laparoscopic radical cholecystectomy.

Emergency versus elective cholecystectomy: Experience at a university hospital in the Eastern Province, Saudi Arabia.

Laparoscopic cholecystectomy (LC), the procedure of choice for treating most gallbladder pathology, has become the most trusted elective procedure for treating gallstone disease because of its effectiveness and safety. While the timing is an important factor in those cases, our aim in this study was to compare emergency and elective LC, determine the differences in postoperative complications, and assess the conversion rate to open cholecystectomy. This study included a total of 627 patients who had undergone laparoscopic cholecystectomy during 2017-2019 at King Fahd Hospital of the University (KFHU). Records of both emergency and elective cases were reviewed from Quadra-med (software package). All demographic data of the patients, presenting complaint, laboratory and inflammatory marker, type of the operation, intraoperative complications, procedure time, conversion rate from laparoscopic to open cholecystectomy, postoperative period, length of hospital stay, and pathological diagnosis were entered into an Excel sheet. The data was analyzed using SPSS 23.0. Qualitative variables were described as frequencies and percentages, and continuous variables were summarized with mean and standard deviation (SD). Chi-square test, t-test, and the Mann-Whitney U-test were applied to test for statistical significance at P ≤ 0.05. The mean age for patients undergoing elective LC was 39.94 years (SD=13.56) whereas, mean age of patients undergoing emergency LC was 40.64 years (SD=13.02). About 71% of cases in elective LC group were females compared to 55% in the emergency LC group. There was a significant difference in C-reactive protein (CRP) in relation to the type of surgery where P < 0.05. Twelve (1.9%) patients had subtotal cholecystectomy and two cases converted from LC to open. There was a significant association between postoperative complication and the type of surgery. The length of hospital stay (LOS) was also found to be significantly more in patients having emergency LC (6.0 vs. 4.5 d; P < 0.05). The relation between conversion to an open procedure and type of surgery (elective or emergency) in our study was nonsignificant. There was a significant association between preoperative CRP, postoperative complication, length of hospital stay, and type of surgery. Further multicenter studies are required for further investigation.

Serum cholecystokinin levels can be a predictive factor for difficult cholecystectomy: Decreased cholecystokinin receptor levels.

Laparoscopic cholecystectomy (LC) is being performed frequently in general surgery practice. Estimation of difficult cholecystectomy is very important to take precautions against complications. Cholecystokinin (CCK) is an important enzyme for gall-bladder motility. CCK receptor is the target for CCK. Fibrosis and emptying problems of gallbladder are related with difficult cholecys-tectomies. We aimed to evaluate the association between plasma CCK and difficult cholecystectomy and try to explain the mechanism. Prospective cross-sectional study was conducted on a group of patients with cholelithiasis Patients who underwent elective cholecystectomy were classified into easy, difficult and very difficult preoperatively using LC difficulty scores. Pre-operative gallbladder empting ratios were measured by ultrasonography. Serum C-reactive protein, and postprandial serum CCK and pancreas polypeptide levels were measured before the operation. Operation data including operation times, adhesion scores, and complications were collected. Tissue CCK receptor levels and tissue fibrosis scores were obtained. Easy, difficult, and very difficult LC (DLC) groups were consisted of 34, 28, and 8 patients, respectively. Gallbladder emp-tying was 60% in easy LC group, but 15% in very DLC group. Plasma CCK levels in easy group (37.4 pg/ml) were significantly lower than plasma CCK levels of difficult (58.6 pg/ml), and very difficult groups (66.23 pg/ml). Tissue CCK receptor levels of easy, difficult, and very difficult were 372.4, 178.3, and 144.1 ng/100 mg, respectively. Adhesion scores and fibrosis scores of very difficult group were significantly higher than other groups. Operation times were significantly longer in very difficult group. There were two conversions to open in very DLC group (25%). CCK is a reliable parameter for determining the difficulty of LC. Decreased CCK receptor levels with fibrosis of gallbladder are the probably responsible mechanism.