Laparoscopic Cholecystectomy Procedures Research Articles

Real-time artificial intelligence validation of critical view of safety in laparoscopic cholecystectomy

BackgroundCritical View of Safety (CVS) is the accepted strategy to avoid bile duct injury during Laparoscopic Cholecystectomy (LC). In this study, we sought to investigate the accuracy and performance of a trained Artificial Intelligent (AI) model in validation of the CVS achievement during elective LC in a real time operating room setting. Study designA deep learning neural network which was previously trained on annotated segments of 700 LC videos to identify the CVS criteria, was integrated into the operating room laparoscopic video system, for continuous monitoring and real-time validation of CVS achievement during elective LC procedures. The system's feedback and surgeon's report were recorded and compared, as well as the overall rate of CVS achievement. ResultsOf 40 consecutive LC, CVS was reported by the surgeons in 34 (85 %). In all the 6 cases where CVS was not achieved due to severe inflammation or anatomy distortion, the AI model agreed with surgeon's report and did not identify CVS. Out of the 34 cases where CVS was achieved, the AI model identified 33. Thus, the AI model detected the CVS achievement with a specificity of 100 % [95%-CI 98.1 %, 100 %] and sensitivity of 97 % [95%-CI 96.1 %, 98.2 %]. ConclusionsA trained AI model can identify CVS during elective LC with very high accuracy in a real time OR setting. Additionally, its use may result in high rates of CVS achievement, thereby improving LC procedure's safety and outcome.

Impact of an AI-Based laparoscopic cholecystectomy coaching program on the surgical performance: a randomized controlled trial.

Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic gallstones but carries inherent risks like bile duct injury (BDI). While critical view of safety (CVS) is advocated to mitigate BDI, its real-world adoption is limited. Additionally, significant variations in surgeon performance impede procedural standardization, highlighting the need for a feasible, innovative, and effective training approach. The aim of this study is to develop an Artificial Intelligence (AI)-assisted coaching program for LC to enhance surgical education and improve surgeon's performance. We conducted a multi-center, randomized controlled trial from May 2022 to August 2023 to assess the impact of an AI-based coaching program, SmartCoach, on novice performing LC. Surgeons and patients meeting specific inclusion criteria were randomly assigned to either a coaching group with AI-enhanced feedback or a self-learning group. The primary outcome was assessed using the Laparoscopic Cholecystectomy Rating Form (LCRF), with secondary outcomes including surgical safety, efficiency, and adverse events. Statistical analyses were performed using SPSS, with significance set at P-value less than 0.05. Between May 2022 and August 2023, 22 surgeons were initially enrolled from 10 hospitals, with 18 completing the study. No demographic differences were noted between coaching and self-learning groups. In terms of surgical performance (LCRF scores), the coaching group showed significant improvement over time (31 to 40, P=0.008), outperforming the self-learning group by study end (40 vs 38, P=0.032). Significant improvements in CVS achievement were also noted in the coaching group (11% to 78%, P=0.021). Overall, the coaching program was well-received, outpacing traditional educational methods in both understanding and execution of CVS and participants in the intervention group expressed strongly satisfaction with the program. The AI-assisted surgical coaching program effectively improved surgical performance and safety for novice surgeons in LC procedures. The model holds significant promise for advancing surgical education.

Evaluation of the impact of prospective payment systems on cholecystectomy: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the impact of prospective payment systems (PPSs) on cholecystectomy. A comprehensive literature review was conducted, examining studies published until December 2023. The review process focused on identifying research across major databases that reported critical outcomes such as length of stay (LOS), mortality, complications, admissions, readmissions, and costs following PPS for cholecystectomy. The studies were specifically selected for their relevance to the impact of PPS or the transition from fee-for-service (FFS) to PPS. The study analyzed six papers, with three eligible for meta-analysis, to assess the impact of the shift from FFS to PPS in laparoscopic and open cholecystectomy procedures. Our findings indicated no significant changes in LOS and mortality rates following the transition from FFS to PPS. Complication rates varied and were influenced by the diagnosis-related group categorization and surgeon cost profiles under episode-based payment. There was a slight increase in admissions and readmissions, and mixed effects on hospital costs and financial margins, suggesting varied responses to PPS for cholecystectomy procedures. The impact of PPS on cholecystectomy is nuanced and varies across different aspects of healthcare delivery. Our findings indicate a need for adaptable, patient-centered PPS models that balance economic efficiency with high-quality patient care. The study emphasizes the importance of considering specific surgical procedures and patient demographics in healthcare payment reforms.

Effect of preoperative oral carbohydrates on insulin resistance in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

PurposeThe present research seeks to clarify the consequences of two specific preoperative oral carbohydrate (POC) amounts on insulin resistance (IR) and stomach evacuation in laparoscopic cholecystectomy (LC) patients.MethodsA total of 129 patients set for elective LC procedures were randomly assigned to a control group (C, n = 45), a 200 mL POC group (P1, n = 42), and a 400 mL POC group (P2, n = 42). The C group was fasted from midnight until surgery, whereas the P1 and P2 groups received their respective carbohydrate volumes 2–4 h before anesthesia. Fasting blood glucose, insulin, and glucagon concentrations were measured at three junctures. IR metrics were derived by employing the homeostasis model assessment. Gastric volume was measured before anesthesia using gastric ultrasound. Inter-group comparisons included IR indicators, subjective comfort scores, and hemodynamic data.ResultsAt T2, the C group exhibited reduced glucose concentrations compared to the P2 group (4.73 ± 0.64 vs. 5.26 ± 1.02 mmol/L, p < 0.05). The Perlas grading indicated that grade 1 was more prevalent in the P2 group than in the P1 and C groups (18 [42.9%] vs. 6 [14.3%] and 1 [2.2%], p < 0.05). Additionally, thirst and hunger metrics for the P2 group were notably reduced compared to the C group at both T2 and T3.ConclusionAdministering either 200 mL or 400 mL of carbohydrates 2–4 h pre-surgery had no detectable impact on IR or gastric volume in LC patients.Trial registrationChiCTR, ChiCTR2200065648. Registered January 13, 2023, http://www.chictr.org.cn.

Active gas aspiration in reducing pain after laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials.

Postoperative pain is a common issue following laparoscopic cholecystectomy. This meta-analysis aimed to determine if active gas aspiration is more effective than passive gas aspiration in reducing postoperative pain and analgesic requirements. The study conducted a systematic search of various databases, including Embase, Medline, and Cochrane Central Register of Controlled Trials (CENTRAL) via Ovid. It also searched trial registries and reference lists of included studies, with no date restrictions but limited to English language, up to December 21, 2022. The study included all randomized clinical trials that had documented elective laparoscopic cholecystectomy procedure and reported at least one relevant outcome. Articles that included subdiaphragmatic drain, intraperitoneal normal saline infusion, or pulmonary recruitment maneuver were excluded from the analysis. Two reviewers independently and in duplicate assessed the eligibility of studies and extracted data. The study reported findings according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The risk of bias of the included trials was assessed using the Revised Cochrane Risk of Bias Assessment Tool. The study used a random-effects model to pool data. This meta-analysis included 5 randomized clinical trials with 367 participants and found that active gas aspiration resulted in significantly lower residual gas volume and total analgesia requirements compared to passive gas aspiration. Active gas aspiration also led to significantly lower shoulder pain scores at 24h postoperatively. However, no significant differences were observed in hospital stay duration or abdominal pain scores. The study found that active gas aspiration can be effective in reducing postoperative shoulder pain and analgesic requirements after laparoscopic cholecystectomy, which has important implications for patient care and healthcare costs. Importantly, this intervention does not impose any additional time or financial burden. However, further research is needed to evaluate its impact on other laparoscopic procedures.

A novel comparison of erector spinae plane block and paravertebral block in laparoscopic cholecystectomy.

Erector spinae plane block is an updated method than paravertebral block, possessing a lower risk of complications. This study aimed to compare erector spinae plane and paravertebral blocks to safely reach the most efficacious analgesia procedure in laparoscopic cholecystectomy cases. The study included 90 cases, aged 18-70 years, classified as American Society of Anesthesiologists I-II, who underwent an laparoscopic cholecystectomy procedure. They were randomly separated into three groups, namely, Control, erector spinae plane, and paravertebral block. No block procedure was applied to Control, and a patient-controlled analgesia device was prepared containing tramadol at a 10 mg bolus dose and a 10-min locked period. The pain scores were recorded with a visual analog scale for 24 h postoperatively. The visual analog scale values at 1, 5, 10, 20, and 60 min at rest and 60 min coughing were found to be significantly higher in Control than in paravertebral block. A significant difference was revealed between Control vs. paravertebral block and paravertebral block vs. erector spinae plane in terms of total tramadol consumption (p=0.006). Total tramadol consumption in the first postoperative 24 h was significantly reduced in the paravertebral block compared with the Control and erector spinae plane groups. Sonography-guided-paravertebral block provides sufficient postoperative analgesia in laparoscopic cholecystectomy surgery. Erector spinae plane seems to attenuate total tramadol consumption.

Preoperative predictive factors of difficult laparoscopic cholecystectomy

Background Laparoscopic cholecystectomy is a routine start-up procedure for any surgeon interested in the field of laparoscopy. However, one may encounter complex cases that may increase the risk of perioperative complications. It is crucial to identify these cases preoperatively for better surgical planning. Herein, we studied preoperative risk factors for difficult cholecystectomy procedures in our Egyptian tertiary care center. Methodology One hundred patients were enrolled in our study, and their cholecystectomy procedures were classified as easy, difficult, or very difficult based on two parameters; preoperative scoring system and intraoperative findings. Results There was a significant agreement between preoperative difficulty prediction score and intraoperative findings (k=0.858, P&lt;0.001). Procedure difficulty was associated with patient hospitalization (P&lt;0.001), previous supraumbilical surgeries (P=0.004), previous acute cholecystitis (P&lt;0.001), previous jaundice (P=0.049), previous endoscopic biliary clearance (P=0.022), increased gallbladder wall thickness (P=0.001), and pericholecystic fluid collection (P=0.014). Conversion to the open approach was needed in 6 cases (6%). Age, sex, BMI, and impacted stone did not significantly impact procedure difficulty (P&gt;0.05). Conclusion Multiple preoperative parameters have been significantly associated with the increased difficulty of the laparoscopic cholecystectomy procedure. Properly identifying these parameters and their inclusion into a scoring system would be greatly helpful in determining difficult cases during the preoperative period.

Post-cholecystectomy iatrogenic bile duct injuries: Emerging role for endoscopic management.

Post-cholecystectomy iatrogenic bile duct injuries (IBDIs), are not uncommon and although the frequency of IBDIs vary across the literature, the rates following the procedure of laparoscopic cholecystectomy are much higher than open cholecystectomy. These injuries caries a great burden on the patients, physicians and the health care systems and sometime are life-threatening. IBDIs are associated with different manifestations that are not limited to abdominal pain, bile leaks from the surgical drains, peritonitis with fever and sometimes jaundice. Such injuries if not witnessed during the surgery, can be diagnosed by combining clinical manifestations, biochemical tests and imaging techniques. Among such techniques abdominal US is usually the first choice while Magnetic Resonance Cholangio-Pancreatography seems the most appropriate. Surgical approach was the ideal approach for such cases, however the introduction of Endoscopic Retrograde Cholangio-Pancreatography (ERCP) was a paradigm shift in the management of such injuries due to accepted success rates, lower cost and lower rates of associated morbidity and mortality. However, the literature lacks consensus for the optimal timing of ERCP intervention in the management of IBDIs. ERCP management of IBDIs can be tailored according to the nature of the underlying injury. For the subgroup of patients with complete bile duct ligation and lost ductal continuity, transfer to surgery is indicated without delay. Those patients will not benefit from endoscopy and hence should not do unnecessary ERCP. For low-flow leaks e.g. gallbladder bed leaks, conservative management for 1-2 wk prior to ERCP is advised, in contrary to high-flow leaks e.g. cystic duct leaks and stricture lesions in whom early ERCP is encouraged. Sphincterotomy plus stenting is the ideal management line for cases of IBDIs. Interventional radiologic techniques are promising options especially for cases of failed endoscopic repair and also for cases with altered anatomy. Future studies will solve many unsolved issues in the management of IBDIs.

Factors causing conversion in laparoscopic cholecystectomy

Introduction and purpose: Laparoscopic cholecystectomy (LC) is the gold standard surgical procedure in the treatment symptomatic gall bladder disease. Conversion is not a failure or complication. It is only a step taken to ensure patient safety and to avoid complications. The objective of our study was to investigate the rate and the causative preoperative and intraoperative factors of conversion and to help surgeons have an idea about potential intraoperative challenges. Materials and methods: Laparoscopic cholecystectomy procedures performed on 4433 patients with signs and symptoms of cholelithiasis-cholecystitis who were diagnosed with abdominal ultrasonography were retrospectively reviewed. The patients were grouped on the basis of age, gender, length of hospitalization, history of preoperative endoscopic retrograde cholangiopancreaticography (ERCP), diabetes mellitus (DM), chronic fibrotic cholecystitis, gall bladder polyps, and urgent-elective surgery. The rate and causative factors of conversion were investigated. Statistical analyses were carried out using IBM SPSS for Windows, version 17.0 (IBM statistics for Windows version 17, IBM Corparation, Armonk, New York, United States) software package. Result: In our study, the conversion rate was 0.85%. Male gender, advanced age, increased length of hospitalization, history of preoperative ERCP, urgent surgery (acute-hydropic cholecystitis), and chronic fibrotic cholecystitis were the significant risk factors for conversion. DM had no effect on conversion. Conclusion: Conversion should not be necessarily regarded as a complication in laparoscopic cholecystectomy. Identifying patients with significant risk factors for conversion can significantly minimize the complications of the laparoscopic procedure. This may assist in identifying high-risk patients and reviewing surgical strategy in this patient group.

Safety and Feasibility of SAB in Otherwise Healthy Individuals Undergoing Laparoscopic Cholecystectomy

Background: The safety and feasibility of utilizing SAB as the sole anesthetic technique in otherwise healthy individuals undergoing laparoscopic cholecystectomy have been increasingly recognized. SAB offers potential advantages in terms of reduced complications, improved pain control, and avoidance of general anesthesia-related risks. Objective: To assess safety and feasibility of SAB in otherwise healthy individuals undergoing laparoscopic cholecystectomy. Method: The study included a cohort of 40 patients who underwent elective laparoscopic cholecystectomy and met specific inclusion criteria. All patients received a subarachnoid block (SAB) with 3 ml of 0.5% bupivacaine and 25 micrograms of fentanyl at the L2-L3 level. The laparoscopic cholecystectomy procedure was performed using a standard 4-port technique, while maintaining a low intra-abdominal pressure of 9-10 mm Hg through CO2 pneumoperitoneum. The patients were followed up at various time points, including 30 minutes, 4 hours, the time of discharge, and on the 7th day after the operation. Any voluntary or involuntary movements or exaggerated diaphragmatic excursions during the operation were carefully monitored. The study recorded parameters such as operation time, duration of operating room occupancy, length of hospital stay, post-operative pain levels, analgesic requirements, occurrences of nausea, vomiting, headache, right shoulder pain, wound-related complications, and patient satisfaction. Results: SAB demonstrated efficacy in all 40 patients undergoing surgery. Conversion to general anesthesia was required in two cases due to persisting low oxygen saturation. Hypotension occurred in 23.7% of patients, while 10.5% experienced right shoulder pain. The average operating time was 37.3 minutes, ranging from 21 to 77 minutes. Awkward movements and exaggerated respiratory excursions were observed in 23.7% and 18.4% of cases, respectively. Only two cases required conversion to general anesthesia. The mean hospital stay duration was 29.3 hours. No major complications were reported during the study. Conclusion: These findings suggest that SAB can be successfully and effectively used for laparoscopic cholecystectomy in healthy patients, providing a safe alternative to general anesthesia.

WTP3.4 Improvement of biliary service in hospital by altering the management of suspected or confirmed bile duct stones. Confirmed bile duct stones can be managed by single-stage procedure of laparoscopic cholecystectomy (LC) plus common bile duct exploration (CBDE). Intra-operative cholangiogram (IOC) can be used to avoid delays waiting for MRCP

Abstract Background Significant delays can follow the process of emergency admissions with biliary problems in hospitals. Routine pathway for gallstones and abnormal liver functions tests (LFTs) is ultrasound (US) followed by MRCP. Pathway for confirmed common bile duct (CBD) stones has been routinely an ERCP followed by LC either as inpatient or outpatient. Significant delays take place awaiting MRCP considering that there is no out-of-hours or weekend service, while ERCP lists only occur twice weekly for both emergency and elective which can lead to unnecessary delays. Methods An audit was performed for 2 months period from 1st October 2022 to 30th November 2022 to assess how patients were managed in the department. Results A total of 16 emergency LCs were done in this period. 3 of them had ERCP prior to operation while 5 had MRCP prior to exclude CBD stones. Average length of stay (LOS) for these 8 patients was 7 days. It was estimated that LOS for these patient would have been reduced to 4 days if IOC +/- CBDE were done. A total of 37 ERCPs were done in the same period. 22 of them were done as emergency of which 12 were for CBD stones, 7 for cancers and 3 for bile leak. 7 of the 12 emergency ERCPs for CBD stones would have benefited from one stage procedure of LC + CBDE reducing their LOS and leaving space for other cases in ERCP lists. Conclusion A dedicated weekly IOC/CBDE list was proposed to overcome this problem.

Management of concomitant umbilical hernia with laparoscopic cholecystectomy

Background: During laparoscopic cholecystectomy (LC) procedures, umbilical abnormalities may present technical challenges for general surgeons and increase the risk of incisional hernia. Objective was to identify the best repair technique to go along with LC for known or incidentally discovered umbilical hernias. Methods: In this study, retrospective review of the medical records of patients who had concurrent LC and umbilical hernia repair was done. Between January 2020 and January 2023, our institution performed LC on 600 patients, 65 (10.5%) of whom also underwent simultaneous UHR and LC. The analysis included 65 (10.5%) patients who met the inclusion requirements. Patients with umbilical hernias were identified during the preoperative phase by a clinical examination. Results: Mean age of 65 qualifying patients who underwent LC+UHR was 54.7±14.9 years (range 23-81 years) Men and women comprised 41 (65.6%) and 24 (34.4%) of these 65 patients, respectively. Median VAS pain scores measured on the first, second and seventh days were higher in group 3 compared with those of the other two groups. There were statistically significant differences between different days in groups 1, 2 and 3 (p=0.01). Conclusions: The outcomes of the UHR with mesh after laparoscopic surgeries appear to be better for either obese or non-obese patients than primary suture techniques in recurrence rates.

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.

Can the parkland grading scale predict the difficulty of laparoscopic cholecystectomy? A new approach to validation

BackgroundThe Parkland Grading Scale (PGS) is an intraoperative grading scale to stratify gallbladder disease severity during laparoscopic cholecystectomy (LC). We evaluated the usefulness of the PGS in predicting the difficulty levels of LC procedures using a novel approach.MethodsA total of 261 patients diagnosed with cholelithiasis and cholecystitis who underwent LC were assessed. The PGS and the surgical difficulty grading system were used to evaluate surgical procedures by reviewing the operation videos. Clinical baseline characteristics and post-treatment outcomes were also recorded. Differences between the five PGS grades in terms of surgical difficulty scores were analyzed using the Jonckheere-Terpstra test. The relationship between PGS grades and surgical difficulty scores was assessed using Spearman’s Rank correlation. Finally, the linear trends between morbidity scores and PGS grades were evaluated using the Mantel-Haenszel test.ResultsThere was a significant difference in the surgical difficulty scores for the five PGS grades (p < 0.001). In pairwise comparison, each grade (1–5) was significantly different from the others (p < 0.05) in terms of surgical difficulty, except Grade 2 vs. 3 (p = 0.07) and Grade 3 vs. 4 (p = 0.08). There was a significant correlation between PGS grades and surgical difficulty scores (rs = 0.681, p < 0.001). There was also a significant linear association between morbidity and PGS grades (p < 0.001). Spearman’s R value was 0.176 (p = 0.004).ConclusionThe PGS can accurately assess the surgical difficulty level of LC. The precision and conciseness of the PGS make it suitable for use in future research.

Outcomes of early and interval laparoscopic cholecystectomy for acute cholecystitis at a teaching hospital in Kerala: A prospective observational comparative study

Timing of laparoscopic cholecystectomy, a widely used treatment modality for acute cholecystitis remains controversial. This prospective observational comparative study investigated patient outcomes for early (ELC) and interval laparoscopic cholecystectomy (ILC) in patients with acute cholecystitis admitted to the General Surgery Department at a tertiary care centre in Thrissur, Kerala, between December 2018 and June 2020. Of 67 patients, 34 were assigned to ELC and 33 to ILC groups and followed up for 2 weeks post-surgery. Patient characteristics, clinical features, investigations, intra operative details and post operative outcomes were tabulated. Comparison of age was statistically analyzed using student’s ‘t’ test, demographics and morbidity data using Fisher’s exact test/ Chi-square test and length of hospital stay using Mann Whitney U test. Mean age was significantly higher in the ILC group. 66% of study participants were females with a higher proportion of females observed in the ILC group. Post-surgical complications were not significantly higher in ELC group compared to ILC group. Total length of hospital stay was significantly longer in the ILC group than in ELC group (10.2 ±4.5 vs. 7.1 ±3.0) days, p value: 0.001). Duration of hospital stay for the laparoscopic cholecystectomy procedure taken separately, was longer in ELC group comparatively, 7 ±3.01 versus 4 ±-2.38, (p value: &lt;0.001). There was no mortality. It was observed in the present study that ELC is preferable to ILC for acute cholecystitis with added benefit of shorter hospital stay. Further large randomized trials would be valuable to make recommendations for future management. Keywords: acute cholecystitis; laparoscopic cholecystectomy; hospital stay; conversion rate

Rouviere’s Sulcus: A Guide to Safe Laparoscopic Cholecystectomy

Purpose: Rouviere’s sulcus (RS) serves as an important anatomical landmark to avoid bile duct injuries during a laparoscopic cholecystectomy. However, there is significant paucity in literature regarding its surgical importance during laparoscopic surgeries. The aim of this study was to identify cases where RS was identified before dissection of the Calot’s triangle.Methods: For this retrospective observational study, 500 patients who underwent a laparoscopic cholecystectomy at our hospital and who were operated on between September 2017 to August 2022 were reviewed. Identification of RS and its types were analyzed.Results: Among all 500 cases, RS was present in 465 (93%) cases whereas it was absent in only 35 (7%) cases. RS was present in different forms of cholelithiasis. Open, closed, slit like, and scar type of RS was found in 75.29%, 12.90%, 3.21%, and 8.20%, respectively. Identification of RS along with achieving a critical view of safety in antero-superior direction to RS resulted in no injury to the bile duct in all 465 cases.Conclusion: Identification of RS along with achieving a critical view of safety should be the aim in all laparoscopic cholecystectomy procedures. The RS is as an important landmark to reduce biliary tract injuries.

Implications of routine cholangiography during laparoscopic cholecystectomy on postoperative testing: Review of more than 2,300 cases in a community-based practice

BackgroundWe hypothesized that routine cholangiography during laparoscopic cholecystectomy may increase use of postoperative imaging and invasive testing. MethodsA retrospective review was performed of laparoscopic cholecystectomy cases at 6 community hospitals from 2017 through 2020. For surgeons performing routine vs selective cholangiography, we compared primary outcomes of operative time, 30-day complications, and postoperative imaging or procedures. ResultsIn total, 2359 laparoscopic cholecystectomy procedures were performed. Eighteen surgeons performed routine cholangiography (1125 cases), and 13 performed selective (1234 cases). Mean operative time was longer in the routine group (125.3 vs 98.7 min, P < .001). Between groups, 30-day complications were similar. Two common bile duct injuries were identified in the routine group. Postoperatively, the routine group underwent 2.5 times more imaging and invasive testing (P < .001). ConclusionsIn community hospitals, laparoscopic cholecystectomy can be performed safely by surgeons using cholangiography routinely or selectively. Routine cholangiography resulted in more postoperative imaging and invasive testing.

To Compare Isobaric Thoracic Spinal Anesthesia Versus General Anesthesia in Laparascopy Cholecystectomy

Background: The laparoscopic cholecystectomy procedure is typically carried out under general anesthesia, but regional techniques, such as low thoracic isobaric spinal anesthesia, have been used to manage patients with significant medical problem like coexisting systemic disease, who are deemed to be high risk in general anesthesia. Segmental spinal anesthesia has great outcomes in terms of post-operative discomfort, the need for analgesics, relatively fewer complications, and shorter hospital stays. Thus the aim of this study to avoid and minimize the risk of general anesthesia who does not have any significant comorbidity. So it might be a substitute for a standard laparoscopic cholecystectomy. Material and Methods: Total 60 adult patient with ASA1 &amp; I I, 18-60 years, with normal coagulation profile, is divided into 2 groups. Group IS (Isobaric) - given 2.5 ml of isobaric preservative free bupivacaine 0.5% (levobupivacaine) + 0.5 mg of Fentanyl at T9-T10/T10-T11 into sub arachnoid space. Group GA – given general anesthesia using propofol, fentanyl citrate and atracurium besylate. After intubation, ventilation was controlled and balanced anesthesia was continued with isoflurane. After completion, neuromuscular block was anatagonized neostigmine methylsulfate and glycopyrrolate at the end of surgery. Results: Isobaric spinal anesthesia showed good control in intraoperative as well as postoperative pain control as compared to general anesthesia. In few patients, there were minor degrees of nausea, vomiting, abdominal pain, shoulder pain, patient anxiety or itchng which were treated with standard medication like fentanyl and midazolam. All patients can resume oral intake on the day of surgery. Conclusions: In conclusion, this study provide evidence that segmental spinal anesthesia can be used in place of general anesthesia in healthy individuals also.

Comparison of Accuracy Scores between CLOC and RSCLO Scoring Systems in Predicting the Risk of Preoperative Laparoscopic Cholecystectomy Conversion at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Background: Cholecystectomy is a surgical therapy for cholelithiasis which can be performed by open cholecystectomy or laparoscopic cholecystectomy. Not all laparoscopic cholecystectomy procedures work properly. Sometimes it requires conversion from laparoscopic cholecystectomy to open cholecystectomy. A risk factor scoring system has been developed and validated using a large prospective cholecystectomy database and can accurately predict the likelihood of conversion with the conversion from laparoscopic to open cholecystectomy (CLOC) score and risk score for conversion from laparoscopic to open cholecystectomy (RSCLO). This study aimed to compare the accuracy value between CLOC and RSCLO in predicting the risk of preoperative laparoscopic cholecystectomy conversion at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.&#x0D; Methods: This study was an observational study with a cross-sectional approach. A total of 183 research subjects participated in this study. Observation of CLOC and RSCLO scores was carried out in this study. Univariate and bivariate data analysis was carried out using SPSS. The analysis of the value of sensitivity, specificity, positive predictive value, and negative predictive value were carried out using Medcalc software.&#x0D; Results: A CLOC score &gt; 5.5 has a greater conversion risk than a CLOC score ≤ 5.5. Meanwhile, an RSCLO score &gt;-2 has a greater conversion risk than an RSCLO score ≤ -2. Sensitivity value CLOC for the prediction of preoperative conversion from laparoscopic cholecystectomy to open cholecystectomy obtained 75% and a specificity of 74.85%, with value negative predictive value, which is higher than a positive predictive value and 74.86% accuracy. The sensitivity value RSCLO for the prediction of preoperative conversion from laparoscopic cholecystectomy to open cholecystectomy was obtained at 75% and a specificity of 77.78%. With value negative predictive value, which is higher than the positive predictive value and 74.86% accuracy.&#x0D; Conclusion: The CLOC and RSCLO scores were equally accurate in predicting preoperative conversion from laparoscopic cholecystectomy to open cholecystectomy.

Laparoscopic Cholecystectomy in Cases of Acute Cholecystitis

Objective: To evaluate the laparoscopic cholecystectomy procedure in cases of acute cholecystitis. Study Design: Cohort study Place and Duration of Study: Department of Surgery, Surgical Unit-1, SIMS/Services Hospital Lahore from 1st January 2021 to 30th June 2022. Methodology: One hundred and ninety eight cases which suffered from acute cholecystitis were enrolled. The age of the cases was within 35-60 years. The cases were divided into 3 groups; group A, group B and group C. The group selection was dependent on the interval period (between the onset of acute attack and the time of presentation for treatment). Group A was the one where interval period was &lt;3 days, Group B has 3 to 7 days while it was &gt;7 days in group C. The laparoscopic cholecystectomy was performed and operative outcomes were evaluated. Results: The mean age of the patients was 40.66±1.5 years with more females in each group than males. The cases of gall bladder empyema/mucocele were presented at the highest 68.8%. This was followed by the cases having Gall Bladder phlegmon identified in 24.74% of the cases. The rate of complication was highest in Group B while operation time and post-operative hospital stay was highest in Group A. The conversion rate from Laparoscopic to open cholecystectomy was measured as 3.03%. Conclusion: Laparoscopic cholecystectomy is a procedure which can be successfully achieved in acute cholecystitis cases with reduced conversion rate and complication attained through surgical expertise. Keywords: Laparoscopic cholecystectomy, Acute cholecystitis, Conversion rate