Laparoscopic Cholecystectomy In Patients Research Articles

Comparison of analgesic efficacy of ultrasound-guided erector spinae block with port site infiltration following laparoscopic cholecystectomy

ABSTRACT Background One of the foremost common medical reasons for delayed discharge following ambulatory surgery is pain. Erector spinae plane block (ESPB) is a comparatively new technique utilized for intra‑ and post‑operative analgesia. We aimed to compare the analgesic efficacy of ESPB with port site infiltration in laparoscopic cholecystectomy (LC) patients. Methods Forty-four patients 18–60 years old with body mass index (BMI) of 18–35 kg/m2 who were scheduled for laparoscopic cholecystectomy were randomized into two groups (22 patients each) either to obtain an ultrasound‑guided Bilateral ESPB (group A) or port‑site infiltration of local anesthetic (group B) after anesthesia induction. The primary outcome was the total postoperative nalbuphine consumption in the first 24 h. Results The overall amount of rescue analgesia was significantly lower in group A (8.27 ± 1.12 mg for nalbuphine as first-line rescue analgesic and 10 patients needed ketorolac as second line rescue analgesic) than in group B (15.92 ± 2.11 mg for nalbuphine as first-line rescue analgesic and 22 patients needed ketorolac as second-line rescue analgesic) during the first 24 h postoperatively. The time to first analgesic request showed statistically significant difference between the two groups with longer time in group A (p value < 0.001). The numerical rate score at rest and when coughing was significantly lower in group A than group B. Conclusion Erector spinae plane block was superior to port site infiltration regarding decrease in analgesic consumption and prolongation in time of postoperative rescue analgesia in patients undergoing laparoscopic cholecystectomy.

A Possible Role of Interleukin-18 Binding Protein in Immune Regulation of Postoperative Pain: A Prospective Randomized Clinical Trial.

A possible role of interleukin-18 binding protein (IL-18BP) in immune regulation of pain and analgesics following surgery is rarely studied. The aim of this study was to investigate serum IL-18BP values in a cohort of laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) patients and to establish their relationship with other cytokines and number of analgesic doses (NAD) of LC and MC patients postoperatively. Blood levels of IL-18BP, six other interleukins (IL-18, IL-1ra, IL-6, IL-10, IL-1β, and IL-8) and high-sensitivity C-reactive protein were measured before operation (PRE), immediately after operation (POP1), and six hours after operation (POP2) in 114 patients with cholelithiasis. Following surgery, the mean serum IL-18BP values correlated significantly to numeric rating scale (NRS) pain scores at 24 hours (r=0.194, p=0.009). In addition, the mean serum IL-18BP values correlated significantly to NAD (r=0.254, p<0.001). IL-18BP, a soluble antagonist of IL-18, correlates to NRS and NAD in LC and MC patients, which may support a possible role of IL-18BP in immune regulation of postoperative pain.

Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for patients with gallbladder and common bile duct stones a meta-analysis of randomized controlled trials.

This study aimed to compare the efficacy and safety of laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) to determine which one provides a better outcome for patients with gallbladder and common bile duct stones. An electronic literature search was undertaken using Embase, Medline, PubMed, and Cochrane Library databases up to April 2022. For quality assessment of included studies, randomized controlled trials (RCTs) were assessed by utilizing the Jadad scale. The primary outcome includes surgical success rate, retained stone rate, stone clearance rate, major morbidity, and mortality. The second outcome includes conversion to open surgery rate, postoperative pancreatitis, bile leakage, cholangitis, hemorrhage, pneumonia, and surgical-site infection. 14 randomized controlled trials with 2,181 patients were included. No significant difference was seen between the two groups in terms of surgical success, stone clearance, retained stones, operation time, and total morbidity. LC-LCBDE had higher rate of bile leakage [relative risk (RR): 4.52; 95% confidence interval (CI): 2.19-9.31] and lower rate of postoperative pancreatitis (RR: 0.25; 95% CI: 0.13-0.46), cholangitis (RR: 0.17; 95% CI: 0.05-0.67), and hemorrhage (RR: 0.18; 95% CI: 0.07-0.42). Both LC+LCBDE and LC+ERCP are safe, effective, and minimal-invasive treatments for concomitant gallbladder and CBD stones. LC-LCBDE was associated with comparable effects compared with LC+ERCP in terms of surgical success rate, stone clearance rate, retained stones rate, operation time, and total morbidity. At the same time, LC-LCBDE had a higher rate of bile leakage and a lower rate of postoperative pancreatitis, cholangitis, and hemorrhage.

Evaluating opioid prescribing patterns following discharge from elective surgical procedures: a worrying trend during the 'opioid crisis' - an audit of elective surgical procedures.

The 'opioid crisis' has reached epidemic proportions globally. Importantly, 30% of opioid dependency stem from opioids obtained on hospital discharge prescriptions. The aim of this study is to evaluate opioid prescription patterns on discharge of post-operative patients in an Irish Hospital. A retrospective cohort study was undertaken in a single institution during the 5year eligibility period (January 2017-October 2021). Comparisons in opioid prescription patterns following minor (inguinal hernia repair (IHR), intermediate (laparoscopic cholecystectomy (LC)) and major (colonic resection (CR)) were made. Descriptive statistics were performed using SPSS version 26.0 RESULTS: In total, 300 patients were included in this study with mean age 59.6years (range: 20-92). Of these, 112 patients underwent IHR (37.3%), 116 patients underwent LC (38.7%), and 72 patients underwent CR (24.0%). The mean age at diagnosis was 61years, 53years and 58years for IHR, LC and CR, respectively (P < 0.001). Patients undergoing CR were more likely to have greater comorbidity burden (3.1 vs. 1.2 (IHR) vs. 1.8 (LC) respectively (P = 0.030). On discharge, 27.8% of CR patients received opioids (20/72) compared to 24.1% of IHR (28/116) and 15.9% of LC (18/113) patients, respectively (P = 0.126). We observed considerable variability in opioid prescribing patterns following minor, intermediate and major operations in our centre. Care is required when prescribing opioids in the post-operative setting, and opioid prescription guidelines are required to both tackle and prevent an escalation of this 'opioid crisis'.

Pre-emptive Effects of Preoperative Diclofenac Suppository on Pain Management in Patients Undergoing Laparoscopic Cholecystectomy: a Case-Control Study

Introduction: Postoperative pain following laparoscopic cholecystectomy is common in abdominal surgeries. Opioids and non-steroidal anti-inflammatory drugs are used in the management of postoperative pain. The current clinical study was undertaken to evaluate the efficacy of a preemptive diclofenac suppository for the alleviation of post-surgery pain and opioid consumption in laparoscopic cholecystectomy patients.&#x0D; Methods: A total of eighty patients aged 18 to 65 who underwent laparoscopic cholecystectomy in Sina Hospital of Maragheh University of Medical Sciences were included in this prospective, matched case-control study and were randomly allocated to two groups of 40 each. Subjects received 100 mg diclofenac suppository or placebo within 2 h before surgery. The pain score and analgesic consumption data were recorded up to 24 h postoperatively. An Independent t-test was utilized for the analysis of results.&#x0D; Results: Visual Analogue Scale (VAS) scores in the diclofenac group were statistically lower at 2, 4, 8, and 12 hours compared to the placebo-controlled group. Opioid consumption was statistically significantly reduced in the treatment group compared to the control group (20.0 ± 3.48 vs 54.7 ± 3.63 ml, respectively. Rescue analgesia usage was significantly higher in the control group. Half of the patients in the diclofenac group did not need any opioid drug. Besides, postoperative side effects and hospital staying duration were decreased in the diclofenac group in comparison to the control group.&#x0D; Conclusion: Current study demonstrates that preemptive diclofenac 100 mg administration could be taken into consideration to alleviate postoperative pain and is a valuable addition to the standard treatment following cholecystectomy pain management.

Safety of laparoscopic cholecystectomy in patients with a cerebrospinal fluid shunt in the peritoneal cavity.

The management of patients with a cerebrospinal fluid (CSF) shunt located in the peritoneal cavity undergoing laparoscopic surgery is an issue that has not yet been settled. These patients are at risk of increased intracranial pressure caused by peritoneal insufflation, shunt dysfunction, and shunt infection/retrograde meningitis. This study aimed to determine the need for perioperative shunt intervention in CSF shunt patients undergoing laparoscopic cholecystectomy. We reviewed and analyzed five shunt patients who underwent laparoscopic cholecystectomy in our institution between 2012 and 2022, as well as 17 patients described in previous reports. Among the 22 patients, shunt type was ventriculoperitoneal in 14 and lumboperitoneal in eight. The most common indication for CSF shunt was hydrocephalus caused by cerebral vascular accident (50.0%). Laparoscopic cholecystectomy was performed for cholecystolithiasis in 13 patients (59.1%), acute cholecystitis in eight (36.4%), and gallbladder polyp in one (4.5%). Shunt clamping or externalization was performed in six patients. Two patients in the group that did not undergo shunt clamping or externalization experienced complications (intra abdominal abscess and subcutaneous emphysema). However, the incidence of short-term complications (both overall and shunt-related) and median length of hospital stay did not significantly differ between the two groups. Routine shunt clamping, externalization, or removal might not be necessarily required in patients with a ventriculoperitoneal or lumboperitoneal shunt undergoing laparoscopic cholecystectomy.

Retaining the epigastric trocar, until rest all ports closed decreases post-operative shoulder pain in laparoscopic cholecystectomy patients

Background: Laparoscopic cholecystectomy has become the mainstay of treatment for gallstone disease cases due to its lower morbidity and pain compared to open techniques. Unfortunately, the use of carbon dioxide to insufflate the abdomen is the main contributor to post-operative shoulder pain. Aims and Objectives: The aim of the study was to evaluate the effectiveness of retaining the epigastric port trocar in position until rest all ports closed after completion of lap cholecystectomy in decreasing the post-operative shoulder pain. Materials and Methods: A prospective, randomized, and clinical trial was done in AIIMS hospital, Bhubaneswar, on 102 patients who have undergone laparoscopic cholecystectomy. The patients were alternatively selected, one in the study group (52) and the other in the control group (50). For those patients in the study group, after the completion of the surgery, the epigastric port trocar is retained in position until the rest of all ports were closed. In the control group, all trocars were removed and port closure was done. The patients were evaluated for the next 24 h for post-operative shoulder pain. A numerical rating scale (NRS) was used to assess shoulder pain on patient arrival to the ward, at 4, 6, 12, and 24 h postoperatively. One hundred and two patients were included in the final data analysis. Results: NRS pain scores were significantly lower in the study group at 6, 12, and 24 h post-laparoscopic cholecystectomy compared to the control group with no additional requirement of IV analgesics. Conclusion: Retaining the epigastric trocar in position is an easy way that is beneficial in reducing post-operative shoulder pain post laparoscopic cholecystectomy surgery.

Preventive analgesia with pregabalin in laparoscopic cholecystectomy post-operated patients.

Preventive analgesia is the administration of an analgesic drug with the aim of attenuating post-operative pain, hyperalgesia and allodynia. Its use is justified in order to offer analgesia and reduce anxiety in patients undergoing laparoscopic procedures. To evaluate if pregabalin in a dose of 1 mg/kg of weight is effective as preventive analgesia in post-operated laparoscopic cholecystectomy patients. A single-blind controlled clinical trial was conducted, which included 60 patients scheduled for laparoscopic cholecystectomy randomly divided into 2 groups, where Group 1 received placebo and Group 2 received pregabalin a daily dose 72 h prior to surgical intervention. The intensity of pain was assessed using the numeric analog scale at 1, 2, 6, 12 and 24 post-operative h, as well as the level of presurgical anxiety with the Hamilton scale. Pain reduction was demonstrated in patients in the pregabalin group from the 1st h (p = 0.002), later the decrease in pain was more noticeable compared to patients who were given placebo (p < 0.001), the same happened with the anxiety level evaluated with the Hamilton scale (p < 0.005). The use of pregabalin as preventive analgesia turns out to be effective in the post-operative period and the pre-operative anxiety with minimal adverse effects in the post-operated patients of laparoscopic cholecystectomy.

Scope of Laparoscopic Cholecystectomy in Patients with Previous Upper Abdominal Surgery

Background: Laparoscopic cholecystectomy has become the treatment of choice for symptomatic gallstones. Previous upper abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy.This study specifically examined the effect of previous upper abdominal surgery on the feasibility and safety of laparoscopic cholecystectomy.&#x0D; Methods: A number of 50 patients of adult age group (25 to 60 years) who were admitted suffering from gall bladder pathology and having history of previous upper abdominal surgery in the surgery units of a tertiary level hospitalwithin the time period of September, 2013 to August, 2014 were included in this prospective observational study. With the consent of the patients, laparoscopic cholecystectomy was chosen as the surgical procedure. All these data were analyzed to find out the feasibility and safety of laparoscopic cholecystectomy in the patients with previous upper abdominal surgery.&#x0D; Results: The patients were classified into 3 groups: group 1, patients with no adhesions, group 2, patients with minimum adhesions and group 3, patients with moderate dense adhesions. The 3 groups were similar with respect to age and sex (P&gt;0.05). Conversion to laparotomy was required in 5 (10%) patients (1 in group 1, 2 in group 2, and 3 in group 3). No statically significant difference was noted among groups with respect to the conversion rate (P&gt;0.05). No per-operative complications occurred in any of the groups. The post-operative complication rates among groups were not statistically different (P&gt;0.05).&#x0D; Conclusion: Previous upper abdominal surgery is not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with an increased need for adhesiolysis, a chance for open conversion and a prolonged operation time.&#x0D; AKMMC J 2021; 12(1) : 11-15

Comparison of metoclopramide–dexamethasone combination and metoclopramide alone for prophylaxis of postoperative nausea vomiting in laparoscopic cholecystectomy

BACKGROUND &amp; OBJECTIVE: Post operative nausea and vomiting (PONV) is an important concern in laparoscopic surgeries. Aim of this study is to identify the role of metoclopramide dexamethasone combination for prophylactic management of post laparoscopic cholecystectomy nausea and vomiting in comparison to metoclopramide alone.&#x0D; METHODOLOGY: The study group comprised of 150 patients. These were the patients with symptomatic gallstones for whom elective laparoscopic cholecystectomy was planned. Study was conducted from 15-04-2018 to 15-07-2019. Non-probability consecutive sampling technique was used.Two groups were generated by simple random method. Group M was given injection metoclopramide only, whereas patients in Group D+M were injected with both dexamethasone and metoclopramide, intravenously, before induction of anesthesia. Parameters observed for 24 hours during postoperative period included; nausea, episodes of vomiting, requirement for rescue antiemetic drugs and total duration of hospital stay after the surgical procedure.&#x0D; RESULTS: In Group D+M (dexamethasone+metoclopramide), out of total 75 patients, 8% developed nausea while 5.33% had both nausea along with emesis. While in group M (metoclopramide), 16% out of the total 75 patients had nausea only but 18.7% patients had complaints of nausea and emesis. Three patients out of 75, that is 4% from group (D+M) had extended duration of in hospital admission (&gt; 24 hours), while in groupM, this percentage was 13.33% (n=10) patients.&#x0D; CONCLUSION: A combination of metoclopramide with dexamethasone for prophylaxis against PONV in laparoscopic cholecystectomy patients is preferred to metoclopramide alone.

One-step laparoscopic cholecystectomy with common bile duct exploration and stone extraction versus two-step endoscopic retrograde cholangiography with stone extraction plus laparoscopic cholecystectomy for patients with common bile duct stones: a randomised feasibility and pilot clinical trial—the preGallStep trial

BackgroundEndoscopic retrograde cholangiography (ERC) with stone extraction and papillotomy with subsequent laparoscopic cholecystectomy—the two-step approach—is the standard treatment of common bile duct stones in many countries. However, ERC is associated with a high risk of complications and more than half of patients require multiple ERCs. Meta-analyses of randomised clinical trials find no major differences of the two-step approach in comparison with laparoscopic cholecystectomy with intraoperative laparoscopic stone clearance—the one-step approach. Currently, there are insufficient data to ascertain superiority.MethodsThe preGallstep trial is an investigator-initiated, multicentre randomised feasibility and pilot clinical trial with blinded outcome assessment. Eligible patients are patients with common bile duct stones (identified by magnetic resonance cholagiopancreatography), age 18 years or above with the possibility to perform both interventions within a reasonable time. We intent to randomise 150 participants allocated 1:1. The experimental intervention is the one-step approach. This consists of laparoscopic common bile duct exploration plus laparoscopic cholecystectomy. The control intervention is the two-step approach which consists of ERC plus sphincterotomy (first step) and subsequent laparoscopic cholecystectomy (second step). Feasibility outcomes include the proportion of eligible patients not wanting to participate, reasons for rejection to participate, difficulties during the informed consent procedure, difficulties with randomisation, difficulties with data management, difficulties with blinding patient charts and forms and difficulties with maintaining blinding for the outcome assessors. The primary pilot outcome is the proportion of participants with at least one postoperative complication according to the Clavien-Dindo score grade II and above until 90 days after randomisation. This outcome will be used for a future sample size calculation of a larger pragmatic trial. Further, a range of clinical explorative outcomes will be assessed.DiscussionAs no sample size is estimated in this trial, there is a risk of wrongly assessing the effect on the patient-related outcome. The surgical procedures cannot be blinded. However, blinding will be employed in all other aspects of the trial, including the establishment of a blinded outcome adjudication committee with three independent assessors. Heterogeneity in screening, randomisation, diagnostics, treatment procedures, interventions and follow-up across trial sites may cause challenges in conducting a larger pragmatic trial. To monitor inter-site differences, we have implemented a central data monitoring scheme.Trial registrationClinicalTrials.gov identification: NCT04801238, Registered on 16 March 2021

Scope of Laparoscopic Cholecystectomy in Patient with History of Previous Upper Abdominal Surgery

Introduction: In recent years, laparoscopy's role in treating benign gallbladder and biliary tract diseases has been well confirmed. Objective: The main objective of the study is to find the scope of laparoscopic cholecystectomy in patient with history of previous upper abdominal surgery. Material and methods: This retrospective study was conducted in khyber medical center Peshawar during June 2022 to December 2022. An informed consent was obtained from each patient included in the study. The primary outcomes of the current study involves incidence rate of intraoperative biliary injury and the secondary outcome of the study includes postoperative strictures, bile leaks, hernia, infections, postoperative need for reoperation or drainage. Results: A total of 316 cholecystectomies were performed. Out of these 28 were performed with other hepatobiliary or bariatric operations. The remaining subjects 288, out of which 212 did not show severe cholecystitis and the remaining 76 had severe cholecystitis. 51 patients with severe cholecystitis had LC and 22 were treated with LSC out of those 3 went through open cholecystectomy and were excluded from the study. Practical Implication: This study will helps us in hospitals in Laparoscopic cholecystectomy because it’s a safe method and procedure. Conclusion: It is concluded that Laparoscopic cholecystectomy is a feasible and safe treatment for symptomatic gallstone disease in selected patients with previous upper abdominal surgery history. Keywords: Laparoscopic cholecystectomy, Procedure, Patients, Abdominal

Outcomes of Early Vs. Delayed Laparoscopic Cholecystectomy in Acute Biliary Stone-Induced Pancreatitis a Prospective Observational Study

Objective: This study aims to compare the outcomes of early and delayed laparoscopic cholecystectomy in patients with acute biliary stone-induced pancreatitis Methods: this prospective observational stusy conducted in department of surgery hmc Peshawar From January 2015 to December 2019, 200 patients (100) (50%) male and 100(50%) female) with acute biliary stone-induced pancreatitis underwent laparoscopic cholecystectomy. Hospital E.M.R.s provided patient data. Laparoscopic cholecystectomy was performed early (before 72 hours) or delayed (beyond 72 hours). Complications and death were crucial outcomes. Recovery, hospitalization, and postoperative discomfort were secondary outcomes. Chi-square and t-tests analyzed data. Results: 200 patients were evaluated with a median age of 45 (IQR=35-56) years. 43 (21.5%) patients had difficult dissection. The median operative time was 46 (IQR=37-55) minutes, while the median hospital stay was 8 (IQR=5-8) days. 65(32.5%) patients had drain placement. Only minor complications were seen in 22 (11%) patients. Furthermore, most of the patients in the gallbladder group, i.e., 90.5%, had complete recovery, while the mortality rate was also meager, i.e., 0.45%. Early laparoscopic cholecystectomy had a reduced incidence of complications (p&lt;0.05), shorter inpatient time (p&lt;0.001), and quicker recovery time than delayed surgery. Both groups had similar death rates (p=0.070). Early laparoscopic cholecystectomy reduced discomfort (p&lt;0.001). Conclusion: This research suggests that early laparoscopic cholecystectomy for acute biliary stone-induced pancreatitis is safe and effective. Early laparoscopic cholecystectomy reduces postoperative discomfort, hospitalization, and complications. Keywords: Early Laparoscopic Cholecystectomy, Acute Biliary Stone, Delayed Laparoscopic Cholecystectomy, Pancreatitis, Biliary Tract Diseases.

Comparison of Open vs Laparoscopic Cholecystectomy in patients of Cholelithiasis having Previous Abdominal Surgeries

Background: Most of the surgeons in our setups perform open cholecystectomy (OC) in patients of cholelithiasis having previous abdominal surgery. This is the era of laparoscopic and robotic surgery and laparoscopic cholecystectomy (LC) should be the preferred treatment for these patients as well. Aim: To observe the effect of previous abdominal surgeries on laparoscopic cholecystectomy. Study design: Randomized, controlled and multicenter experimental study. Place and duration of study: Department of Surgery, Central Park Teaching Hospital, Lahore, Noor Hospital, Kot Radha Kishan and Bilquees Hospital, Kasur from 1st January 2020 to 31st December 2021. Methodology: Fifty eight patients were allocated into 2 groups (29 in each group) not considering age and sex. Both types of surgeries were analyzed on the basis of operating time, post-operative pain (VAS) and complications. Complications were noted i.e. wound infection, bile leakage from cystic duct/CBD injury, gut injury and per operative bleeding). Type of previous surgery was also noted. Data of conversion to open cholecystectomy from laparoscopic cholecystectomy was also recorded. Results: Mean age of patients in group A was 45.99±13.42 years while mean age of patients in group B was 41.87±14.65 years and p-value 0.105. 75.2% patients in group A were female while 82.1% patients in group B were female (p-value 0.185). Operative time in group A was 45.51±8.32 minutes while operative time in group B was 70.33±13.40 minutes (p-value 0.001). VAS score was 7.34±1.80 in group A while it was 5.24±1.93 in group B (p-value 0.001). 4 patients (13.79%) in group A developed wound infection while 1 patient (3.45%) from group B developed wound infection (p-value 0.005). Bile leakage and gut injury were not seen in any of the patient from both groups. Peroperative bleeding (more than 50ml) was seen in 2 patients of group A (6.90%) while it was seen in 8 patients of group B (27.59%) p-value 0.001. Type of previous surgeries were 24 cases were of mesh hernioplasty (41.38%), 16 cases of herniorrhaphy (27.59%), 10 laparotomies for peritonitis/intestinal obstruction (17.24%) and 8 cases of laparotomies for gynecological problems (13.79%). No case of laparoscopic cholecystectomy was converted to open cholecystectomy. Conclusion: Laparoscopic cholecystectomy is a safe and excellent option in patients of cholelithiasis having previous abdominal surgery. Even though LC takes more time due to adhesions but this issue does not out weights the benefits of laparoscopic cholecystectomy over open cholecystectomy. Keywords: Laparoscopic cholecystectomy, Cholelithiasis

Comparison between percutaneous transhepatic gallbladder drainage and upfront laparoscopic cholecystectomy in patients with moderate-to-severe acute cholecystitis: a propensity score-matched analysis.

In the Tokyo Guidelines 2018 (TG18), emergency laparoscopic cholecystectomy is recognized as a crucial early treatment option for acute cholecystitis. However, early laparoscopic intervention in patients with moderate-to-severe acute cholecystitis or those with severe comorbidities may increase the risk of complications. Therefore, in the present study, we investigated the association between early laparoscopic cholecystectomy and percutaneous transhepatic gallbladder drainage (PTGBD) in moderate-to-severe acute cholecystitis patients. We retrospectively analyzed 835 TG18 grade II or III acute cholecystitis patients who underwent laparoscopic cholecystectomy at 4 tertiary medical centers in the Republic of Korea. Patients were classified into 2 groups according to whether PTGBD was performed before surgery, and their short-term postoperative outcomes were analyzed retrospectively. The patients were divided into 2 groups, and 1:1 propensity score matching was conducted to establish the PTGBD group (n = 201) and the early laparoscopic cholecystectomy group (n = 201). The PTGBD group experienced significantly higher rates of preoperative systemic inflammatory response syndrome (24.9% vs. 6.5%, P < 0.001), pneumonia (7.5% vs. 3.0%, P = 0.045), and cardiac disease (67.2% vs. 57.7%, P = 0.041) than the early operation group. However, there was no difference in biliary complication (hazard ratio, 1.103; 95% confidence interval, 0.519-2.343; P = 0.799) between the PTGBD group and early laparoscopic cholecystectomy group. In most cases of moderate-to-severe cholecystitis, early laparoscopic cholecystectomy was relatively feasible. However, PTGBD should be considered if patients have the risk factor of underlying disease when experiencing general anesthesia.

Retracted: Effectiveness of Laparoscopic Cholecystectomy in Patients with Gallbladder Stones with Chronic Cholecystitis.

[This retracts the article DOI: 10.1155/2022/1434410.].

Rouviere’s Sulcus: An Important Anatomical Landmark in Laparoscopic Cholecystectomy

Introduction: Though laparoscopic cholecystectomy is a gold standard treatment for symptomatic cholelithiasis, safe dissection of Calot's triangle is important to avoid major complications like injury to bile duct, vessels and nearby organs.&#x0D; Aims: This study was designed to determine the frequency, description of Rouviere’s sulcus and its role in safe laparoscopic cholecystectomy.&#x0D; Methods:This prospective cross-sectional study was conducted at the Department of Surgery, Karuna Hospital, Nepal from January 2022 to September 2022. Patients who underwent laparoscopic cholecystectomy, presence of Rouviere’s sulcus were identified and classified, kept in Group A and absent in Group B. If the common bile duct outline visualized, its relation with Rouviere’s sulcus was noted and used as reference point for gall bladder dissection. The perioperative complications, conversion to open procedure, operative time and hospital stay were recorded.&#x0D; Results: Among 100 patients, the Rouviere’s sulcus was present in 79% and absent in 21%. Type I is the most common (65.82%). It was found above the level of common bile duct line in 84.81%. Cystic artery injury was present in 1.26% (Group A) and 14.28% (Group B). Bile/stone spillage 1.26% (Group A) and 9.52% (Group B), port hematoma 2.52% (Group A) and 9.52% (Group B), operative time 43.17±8.57 minutes (Group A) and 61.29±12.07 minutes (Group B), conversion to open procedure was none in Group A and 9.52% (Group B) and hospital stay 1.23±0.59 days in group A and 3.16±1.16 days in Group B.&#x0D; Conclusion: Rouviere’s sulcus is an important extrabiliary anatomical landmark, seen in majority of patients for safe laparoscopic cholecystectomy.

Complications in Laparoscopic Cholecystectomy: Experiences from A Study of 1425 Cases

Objective: To evaluate the complications of laparoscopic cholecystectomy in the symptomatic cholelithiasis and other benign gall bladder diseases. Methods: This descriptive observational study was carried out at CMH Dhaka and CMH Jashore from March 2016 to Jun 2022, to evaluate the frequency and outcome of management of all the complications in laparoscopic cholecystectomy. A total of 1425 patients of laparoscopic cholecystectomy were included in this study. Patients were followed up for a period of three months after operation. The complications in laparoscopic cholecystectomy observed in this study were divided into (i) Access related (ii) Intraoperative (biliary and extrabiliary) and (iii) Postoperative. Results: The incidence of access-related, intraoperative or procedure-related biliary, extrabiliary and postoperative complications were 3.64%, 2.95%, 4.98% and 1.96% respectively. Access related complications were extraperitoneal insufflations 1.40%, port site bleeding 1.19%, small bowel laceration 0.21% and transverse colon injury 0.07%.Procedural biliary complications included common bile duct (CBD) injury 0.14%, common hepatic duct (CHD) injury 0.07% and iatrogenic gall bladder perforation with bile leakage 2.74%. Procedural extrabiliary complications were Liver injury 0.56%, duodenal perforation 0.07%, colon perforation 0.07%, bleeding through cystic artery 0.49% and bleeding from gall bladder fossa 1.12%. Two colonic perforations and one duodenal perforation were the major complications encountered in this series. Two colonic perforations required conversion to open procedure but duodenal perforation was managed laparoscopically by intracorporeal suturing. Total nine (0.63%) patients required conversion to open procedure. Postoperative complications included port site infection (PSI) 1.05%, port site hernia 0.56%, major sepsis 0.14% and ischemic stroke 0.07%. There was no retained stone, biliary stricture and mortality reported in this series. Conclusion: Complications in laparoscopic cholecystectomy are mainly due to access related and intraoperative and have their own characteristics.. CBD transaction, CHD injury, Colonic perforations and duodenal perforations were the major complications requiring conversion to open procedure except duodenal perforation which was dealt laparoscopically. Conversion to open procedure should not be considered as a complication. J Bangladesh Coll Phys Surg 2023; 41: 75-81

Laparoscopic Cholecystectomy Lower Thoracic Spinal Anesthesia. A retrospective Study with 505 Patients

Background: In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a retrospective study with patients undergoing laparoscopic cholecystectomy under thoracic spinal anesthesia. Methods: A total of 505 laparoscopic cholecystectomy patients operated under spinal anesthesia were included in this study. Spinal anesthesia was between T8 to T11, with a 27G cutting point or pencil tip in lateral or sitting. Spinal anesthesia was performed with two doses of 0.5% bupivacaine hyperbaric plus 25 µg of fentanyl, until reaching the sensitive level of T3. We evaluated the demographics, analgesia, and degree of motor block, incidence of paresthesia, bradycardia, hypotension, anesthesia success and neurological complications. Results: All 505 patients developed spinal. Neither the dose of hyperbaric solution of 0.5% bupivacaine nor the addition of fentanyl affected the onset of sensory block. The duration of sensory block was greater than the motor block with hyperbaric solution. Bradycardia occurred in 16 (3.1%) patients, and was not correlated with the level of thoracic puncture. Hypotension occurred in 82 (16.2%), with no significant association with the dose of local anesthetic. None of the 505 patients had the maximum degree of lower limb motor block, with significant difference in terms of dose. Paresthesia was observed in 28 (5.5%) without significant difference between needles. All paresthesias were transient and without residual sequelae. Conclusion: The beginning of the block is fast regardless of the solution used. By providing a sensory block of longer duration than the motor block hyperbaric bupivacaine is reflected in a better indication. Thoracic spinal anesthesia provides excellent anesthesia for lower limb orthopedic surgery, without neurological sequelae.

Evaluation of early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis: a prospective, randomized study.

Uncertainty exists about whether early laparoscopic cholecystectomy (LC) is an appropriate surgical treatment for acute calculous cholecystitis. This study aimed to compare early vs. late LC for acute calculous cholecystitis regarding intraoperative difficulty and postoperative outcomes. This was a prospective randomized study carried out between December 2015 and June 2017; 60 patients with acute calculous cholecystitis were divided into two groups (early and delayed groups), each comprising 30 patients. Thirty patients treated with LC within 3 to 5 days of arrival at the hospital were assigned to the early group. The other 30 patients were placed in the delayed group, first treated conservatively, and followed by LC 3 to 6 weeks later. The conversion rates in both groups were 6.7% and 0%, respectively (p = 0.143). The operating time was 56.67 ± 11.70 minutes in the early group and 75.67 ± 20.52 minutes in the delayed group (p = 0.001), and both groups observed equal levels of postoperative complications. Early LC patients, on the other hand, required much fewer postoperative hospital stay (3.40 ± 1.99 vs. 6.27 ± 2.90 days, p = 0.006). Considering shorter operative time and hospital stay without significant increase of open conversion rates, early LC might have benefits over late LC.