Outcomes Of Laparoscopic Cholecystectomy Research Articles

The Impact of Postoperative COVID-19 Infection on 30-day Outcomes of Laparoscopic Cholecystectomy.

Introduction: Preoperative Coronavirus Disease 2019 (COVID-19) infections are associated with postoperative adverse outcomes. However, there is limited data on the impact of postoperative COVID-19 infection on postoperative outcomes of common general surgery procedures.Objective: To evaluate the impact of postoperative COVID-19 diagnosis on laparoscopic cholecystectomy outcomes.Methods: Patients with symptomatic cholelithiasis, acute cholecystitis, or gallstone pancreatitis who underwent laparoscopic cholecystectomy with or without intraoperative cholangiogram were identified using the 2021 National Surgical Quality Improvement Program (NSQIP) database. Patients were categorized into two groups: patients with and without a postoperative COVID-19 diagnosis. Coarsened Exact Matching was used to match the groups based on preoperative risk factors, and outcomes were compared.Results: A total of 47,948 patients were included. In the aggregate cohort, 31% were male, and mean age was 50years. Age, BMI, smoking, COPD, CHF, preoperative sepsis, and ASA class were significantly different between the two groups. After matching, there were no differences in characteristics. 30-day morbidity (OR = 2.7, 95% CI 1.4-5.1), pneumonia (OR = 5.0, 95% CI 1.7-15.0), DVT (OR = 8.22, 95% CI 1.0-66), reoperation (OR = 9.3, 95% CI 1.2-73.8), and readmission (OR = 4.8, 95% CI 2.3-10.1) continued to be significantly worse in the matched cohort.Conclusion: Postoperative COVID-19 infection was associated with worse outcomes after laparoscopic cholecystectomy. These findings suggest that even postoperative COVID-19 diagnosis increases the risk for adverse outcomes in patients recovering from laparoscopic cholecystectomy and may indicate that precautions should be taken and new COVID-19 infections even after surgery should be closely monitored.

An Observational Study on Port-site Infection and its Management in Patients Undergoing Laparoscopic Cholecystectomy

Background: With increasing number of performed laparoscopic cholecystectomies, there is an increasing number ,of port site infection, although it occurs infrequently, but it has significant influence on overall outcomes of laparoscopic cholecystectomy. The aims of the present study was to identify the causative organism involved in port-site infection (PSI) and its management and outcome after laparoscopic cholecystectomy objectives and to evaluate causative organism involved in port site infection after laparoscopic cholecystectomy.Materials & Methods: Patients who underwent laparoscopic cholecystectomy and now presenting with PSIin General Surgery OPD and Emergency of Burdwan Medical College and Hospital. Thorough clinical historytaking followed by swabs was taken for culture and sensitivity in all patients who developed port site infection after laparoscopic cholecystectomy. Tissue samples were taken for detection of mycobacterium tuberculosis by CBNAAT. All patients were followed up for 6 months post operatively. Incidence of PSI in relation to gender, pre-operative diagnosis, spillage, relation with different port sites and the type of microorganism associated was evaluated and compared with previous study.Results: In the present study 90 patients who underwent laparoscopic cholecystectomy, 19 patients reported port site infection after surgery, whereas the remaining 71 patients had uneventful post operative period. Out of the 19 infected 7 were male [25% of total male cases] and 12 were female [19% of total female cases]. Cases of port site infection were 21% of total cases. Conclusion: The incidence of PSI was higher in cases of acutely inflamed GB, biliary spillage, open port creation, avoidance of endo-bag, and in comorbidities. They were managed with either antibiotics, dressing or surgical exploration.

Outcomes of Laparoscopic Cholecystectomy in patients with Previous Upper Abdominal Surgery

Outcomes of Laparoscopic Cholecystectomy in patients with Previous Upper Abdominal Surgery

O265: Laparoscopic Cholecystectomy in Class III (Morbid) Obesity

Abstract Background High body-mass index (BMI) has been associated with increased operative-time, conversion to open surgery, and poorer perioperative outcomes. Criteria for day-surgery often includes BMI, with centers excluding patients with BMI>40kg/m2. However, as cholecystectomies are routinely performed laparoscopically with low complication rates in patients with higher BMI, this cut-off is being questioned. Objectives To examine outcomes of Laparoscopic Cholecystectomy in patients with increased BMI, particularly when comparing patients with morbid-obesity (Class-III;BMI>40 kg/m2) to those with lower BMI. Methods Data was collected between 01/01/2022 and 31/07/2023 from hospitals throughout the Aneurin-Bevan University Health-Board, South-Wales, UK. Data on BMI, surgical indication, surgical duration, length of admission, and 30-day complications, amongst others was collected. Results This study included a total of 915 patients, 77.92%female 22.08%male. Patients were placed into 5 BMI categories: BMI<25(n=98),25-29(n=255),30-34(n=253),35-39(n=176), and>40(n=133). Median BMI was 31kg/m2, median surgical duration was 79-minutes, length of stay 0-days, the complication rate was 7.3%. There were two 30-day mortalities, one in each of BMI categories <25 and 25-29. Comparing patients with BMI>40 with others showed a significantly higher surgical duration (median 90.05mins vs83.5mins;p=0.045) but no difference in complications including bile-leak (2.3%vs1.8%;p=0.1823), significant bleed (0.7%vs0.4%;p=0.4779) or bile-duct injury (0%vs0.1%;p=0.4060). Due to existing day-surgery criteria, there was significantly increased length of admission in this group (median 1vs0 days;p=0.00). Conclusion This retrospective study finds Laparoscopic Cholecystectomy safe in patients with Class-III obesity with no increased association with intraoperative or post-operative complications. Criteria for day-surgery based solely on BMI>40 appears inappropriate.

Impact of thoracic outlet diameter on surgical outcomes in laparoscopic cholecystectomy

Impact of thoracic outlet diameter on surgical outcomes in laparoscopic cholecystectomy

A Systematic Review and Meta-Analysis of the Outcomes of Laparoscopic Cholecystectomy Compared to the Open Procedure in Patients with Gallbladder Disease.

Background Conflicting evidence regarding the laparoscopic versus open cholecystectomy outcomes in scientific literature impacts the medical decision-making for patients with gallbladder disease. This study aimed to compare a range of primary and secondary outcomes between patients receiving laparoscopic cholecystectomy and those with open intervention. Methods Articles published from 1993 to 2023 were explored by utilizing advanced filters of PubMed Central/Medline, Web of Science, CINAHL, JSTOR, Cochrane Library, Scopus, and EBSCO. The gallbladder disease was determined by the presence of one or more of the following conditions: 1) Gangrenous cholecystitis, 2) acute cholecystitis, 3) chronic gallbladder diseases, and 4) cholelithiasis. The primary end-point was mortality, while the secondary outcome included (1) bile leakage, 2) common bile duct injury, 3) gangrene, 4) hospital stay (days), 5) major complications, 6) median hospital stay (days), (7) pneumonia, 8) sick leaves (days), and 9) wound infection. Results Statistically significant reductions were observed in mortality (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.30, 0.45, p < 0.00001), mean hospital stay duration (mean difference: -2.68, 95% CI: -3.66, -1.70, p < 0.00001), major complications (OR: 0.35, 95% CI: 0.19, 0.64, p = 0.0005), post/intraoperative wound infection (OR: 0.29, 95% CI: 0.16, 0.51, p < 0.0001), and sick leaves (OR: 0.34, 95% CI: 0.14, 0.80, p = 0.01) in patients who underwent laparoscopic cholecystectomy compared with those with the open intervention. No statistically significant differences were recorded between the study groups for bile leakage, common bile duct injury, gangrene, median hospital stay days, and pneumonia ( p > 0.05). Conclusions The pooled outcomes favored the use of laparoscopic cholecystectomy over the open procedure in patients with gallbladder disease. The consolidated findings indicate the higher impact of laparoscopic cholecystectomy in improving patient outcomes, including safety episodes, compared with open cholecystectomy.

Comparative Study of Clinical Outcome of Low Pressure Versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy at Birat Medical College Teaching Hospital (BMCTH)

Introduction: Laparoscopic cholecystectomy at standard pressure pneumoperitoneum ( 12-15 mmHg of Co2) is standard of practice among surgeons. The increase in intraabdominal pressure by insufflation of carbon dioxide during laparoscopy brings certain changes in function of cardiopulmonary systems and also leads to postoperative pain due to stretching of the diaphragm.&#x0D; Objective: To minimise this impact on human physiology there is increasing effort of performing laparoscopic cholecystectomy at low pressure pneumoperitoneum (8mm Hg) however its safety has not been established. This study aims to compare outcomes of laparoscopic cholecystectomy at low pressure pneumoperitoneum versus standard pressure pneumoperitoneum in people undergoing laparoscopic cholecystectomy in terms of intraoperative time, postoperative pain including shoulder tip pain and length of hospital stay.Methodology: This descriptive randomised prospective study was conducted from Feb 2023 to Aug 2023 in the department of general surgery, BMCTH in patients diagnosed with symptomatic gallstone disease meeting inclusion criteria and willing for laparoscopic cholecystectomy. All patients were prospectively randomized into two groups randomly by the lottery method. A convenient sampling method was used. Group A odd number patients underwent surgery under low pressure (LPPLC group), Group B patients at standard pressure pneumoperitoneum (SPPLC).&#x0D; Results:A total of 145 patients (114 female and 31 male) with mean age 44.99 years of presentation. 73 patients underwent surgery under LPPLC group and 72 under SPPLC group. Mean pain recorded as per VAS score at 6, 12, 24 and 36 hours postoperatively showed no significant difference in pain among two groups with p value 0.972,0.121,0.212,0.072 respectively. Shoulder tip pain and additional need of analgesia was significantly less in LPPLC group, p value 0.002 and 0.015 respectively. No significant difference was observed in terms of operating time p value 0.151.Conversion between two groups p value 0.494 suggested no significant difference between two group.&#x0D; Conclusion:LPPLC is feasible, safe and can be considered over SPPLC. LPPLC is non inferior to SPPLC in terms of postoperative pain including shoulder tip pain and additional need of analgesia.

Does previous gastrectomy history affect the surgical outcomes of laparoscopic cholecystectomy?

PurposeThis current study aimed to explore whether gastrectomy history influenced surgical outcomes while undergoing laparoscopic cholecystectomy (LC).MethodsThe PubMed, Embase, and Cochrane Library databases were searched for eligible studies from inception to April 29, 2023. The Newcastle–Ottawa Scale (NOS) was adopted to assess the quality of included studies. The mean differences (MDs) and 95% confidence intervals (CIs) were calculated for continuous variables, and the odds ratios (ORs) and 95% CIs were calculated for dichotomous variables. RevMan 5.4 was used for data analysis.ResultsSeven studies enrolling 8193 patients were eligible for the final pooling up analysis (380 patients in the previous gastrectomy group and 7813 patients in the non-gastrectomy group). The patients in the gastrectomy group were older (MD = 11.11, 95%CI = 7.80–14.41, P < 0.01) and had a higher portion of males (OR = 3.74, 95%CI = 2.92–4.79, P < 0.01) than patients in the non-gastrectomy group patients. Moreover, the gastrectomy group had longer LC operation time (MD = 34.17, 95%CI = 25.20–43.14, P < 0.01), a higher conversion rate (OR = 6.74, 95%CI = 2.17–20.26, P = 0.01), more intraoperative blood loss (OR = 1.96, 95%CI = 0.59–3.32, P < 0.01) and longer postoperative hospital stays (MD = 1.07, 95%CI = 0.38–1.76, P < 0.01) than the non-gastrectomy group.ConclusionPatients with a previous gastrectomy history had longer operation time, a higher conversion rate, more intraoperative blood loss, and longer postoperative hospital stays than patients without while undergoing LC. Surgeons should pay more attention to these patients and make prudent decisions to avoid worse surgical outcomes as much as possible.

Outcomes of laparoscopic cholecystectomy in elderly patients

Background Laparoscopic cholecystectomy (LC) is the conventional therapy for both symptomatic gallbladder stones and acute cholecystitis; nevertheless, these outcomes are representative of the overall population. Our study’s objective was to evaluate the efficacy of LC in individuals aged 60 and older. Methods This prospective research was performed on 200 elderly cases aged 60 or older who underwent LC. Cases were classified into two groups regarding the age, group (A): Cases aged greater than or equal to 70 years and group (B) Cases aged 60 −less than or equal to 69 years. Group (A) were subdivided into three groups: age from 70 to 72 years (group A1), age from 73 to 76 (group A2), and age from 77 to 80 (group A3) were the additional age categories created from the original group of patients. Results American Society of Anaesthesiologists (ASA) score increased with age in both groups. In group B, 15.5% had ASA scores greater than or equal to 3, and increased to 37.5% in group A1, 68.8% in group A2 and 80.0% in group A3. ASA classification was significantly different between both groups (P&lt;0.001). Acute cholecystitis was found in 8 (17.8%) patients in group A and 24 (15.48%) patients in group B whereas chronic cholecystitis was found in 37 (82.2%) patients in group A and 131 (84.5%) patients in group B, with no significant difference between both groups (P=0.890). The majority of surgically treated patients in all research groups were diagnosed with chronic cholecystitis. Conclusion LC in elderly patients is applicable with low mortality and morbidity rates. Despite the common prevalence of concurrent disorders involving the lung, heart, and diabetes mellitus (DM) in geriatric patients treated with LC, these medical conditions contributed slightly to the morbidity findings.

Laparoscopic cholecystectomy in the elderly: An experience at a tertiary care hospital in Eastern Nepal

Background: The prevalence of laparoscopic cholecystectomy in Nepal ranges from 2.44% to 6.45%. The prevalence of gallstones increases with age. Age is considered to be one of the major risk factors in determining the results of morbidity and mortality during laparoscopic cholecystectomy. Laparoscopic cholecystectomy is the gold standard modality for the management of gallstones. Objectives: The aim of this study was to determine the clinical outcome of laparoscopic cholecystectomy in the elderly. Methods: This was a descriptive cross-sectional observational study done after ethical clearance. Retrospective data were included of all the patients’ aged ?60 years who underwent laparoscopic cholecystectomy at Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal from 2021 July to 2022 June using convenience sampling. Data were entered in Microsoft Excel Sheet and descriptive findings are presented. Results: A total of 1688 laparoscopic cholecystectomies were performed during the study duration. Consecutively, 250 elderly patients who underwent were included in the study. The mean age of the elderly was 67.88 years. The incidence of the elderly at the institute was 26.7% (452/1688). In the present study, 95 (38%) elderly patients had some kind of comorbidities. Isolated intraoperative complications were seen in 26 (10.4%) patients. Post-operative complications were seen in 53 (21.2%) patients. The need to convert laparoscopic cholecystectomy to open cholecystectomy was observed in 3 (1.2%). Conclusion: For the elderly, laparoscopic cholecystectomy is a safe and reliable modality. They benefit from this mode of treatment without increasing the risk of surgery.

Acute cholecystitis in old adults: the impact of advanced age on the clinical characteristics of the disease and on the surgical outcomes of laparoscopic cholecystectomy

BackgroundImpact of advanced age on disease characteristics of acute cholecystitis (AC), and surgical outcomes after laparoscopic cholecystectomy (LC) has not been established.MethodsThis single-center retrospective study included patients who underwent LC for AC between April 2010 and December 2020. We analyzed the disease characteristics and surgical outcomes according to age: Group 1 (age < 60 years), Group 2 (60 ≤ age < 80 years), and Group 3 (age ≥ 80 years). Risk factors for complications were assessed using logistic regression analysis.ResultsOf the 1,876 patients (809 [43.1%] women), 723 were in Group 1, 867 in Group 2, and 286 in Group 3. With increasing age, the severity of AC and combined common bile duct stones increased. Group 3 demonstrated significantly worse surgical outcomes when compared to Group 1 and 2 for overall (4.0 vs. 9.1 vs. 18.9%, p < 0.001) and serious complications (1.2 vs. 4.2 vs. 8.0%, p < 0.001), length of hospital stay (2.78 vs. 3.72 vs. 5.87 days, p < 0.001), and open conversion (0.1 vs. 1.0 vs. 2.1%, p = 0.007). Incidental gallbladder cancer was also the most common in Group 3 (0.3 vs. 1.5 vs. 3.1%, p = 0.001). In the multivariate analysis, body mass index < 18.5, moderate/severe AC, and albumin < 2.5 g/dL were significant risk factors for serious complications in Group 3.ConclusionAdvanced age was associated with severe AC, worse surgical outcomes, and a higher rate of incidental gallbladder cancer following LC. Therefore, in patients over 80 years of age with AC, especially those with poor nutritional status and high severity grading, urgent surgery should be avoided, and surgery should be performed after sufficient supportive care to restore nutritional status before LC.

Role of mFI-5 in predicting geriatric outcomes in laparoscopic cholecystectomy

BackgroundFrailty is the age-related decline contributing to adverse outcome vulnerability. This study assesses the modified 5-factor frailty index's (mFI-5) ability to predict geriatric cholecystectomy outcomes. MethodsLaparoscopic cholecystectomy patients ages ≥65 were identified from the American College of Surgeons’ National Surgical Quality Improvement Program database (2018–2020). MFI-5 variables include hypertension, congestive heart failure, chronic obstructive pulmonary disease, diabetes, and functional status. Groups were stratified according to the number of comorbidities: mFI ​= ​0, mFI ​= ​1, mFI≥2. Results32,481 cases included 27.6% mFI ​= ​0, 46.4% mFI ​= ​1, 26.0% mFI≥2. Highest frailty correlated with increased discharges to not home (OR 1.88, p ​< ​0.01). Non-independent functional status was associated with mortality (OR 7.32), prolonged length of stay (LOS) (5.69), pneumonia (4.90), sepsis (3.78), readmission (2.60) (p ​< ​0.01). AUCs were calculated for prolonged LOS (0.89), discharges to not home (0.85), mortality (0.83), pneumonia (0.76), sepsis (0.76). ConclusionsHealthcare teams can use mFI-5 to target at-risk cholecystectomy patients and proactively intervene to avoid complications.

A Study of the Degree of Gall Bladder Wall Thickness and Its Impact on Patients Undergoing Laparoscopic Cholecystectomy.

Background The gold standard management for symptomatic gallstone disease is elective laparoscopic cholecystectomy, which has replaced open cholecystectomy. The wall thickness of the gallbladder is an indicator of cholecystitis in patients who have presented with symptoms of gallstone disease. The aim of this study was to evaluate preoperative gall bladder wall thickness by ultrasonography and assess its impact on the outcome of laparoscopic cholecystectomy, including conversion rate, complications, operative time, and postoperative hospital stay. Method This prospective study was conducted on 350 patients with symptomatic gallstone disease, those who had undergone laparoscopic cholecystectomy in Dr. Sampurnanand Medical College, Jodhpur, and attached hospitals from July 2019 to November 2021. On the basis of ultrasonography findings of gallbladder wall thickness, patients were divided into four groups: normal thickness - up to 2 mm, mild thickness - 3-4mm, moderate thickness - 5-6mm, and severe wall thickness - more than 6mm). Up to 2 millimeters thickness was considered as normal. Results The incidence of conversion rate, as well as intra or postoperative complications, were higher in moderate and severe wall thickness groups. The maximum incidence of complication rate is seen in moderately thickened group (33.33%). In severely thickened group, complication was seen in 100% of patients. Operative time, as well as postoperative hospital stay, were more in higher thickness groups. There was a statistically significant correlation between gallbladder wall thickness and conversion rate, complications operative time, and postoperative length of stay. Conclusion Increased gallbladder wall thickness causes increased intra as well as postoperative complications, more conversion to open procedure rate, increased operative time, and enhanced postoperative hospital stay. Among the total study population, 29.71% of patients had increased gallbladder wall thickness. In our study, a positive correlation was seen among gallbladder wall thickness, complication rate, conversion rate, intraoperative time, and postoperative hospital stay.

Laparoscopic cholecystectomy in super elderly (> 90 years of age): safety and outcomes

BackgroundNonagenarian patients are an age group in progressive growth. In this age group, indications for surgical procedures, including cholecystectomy, will be increasingly frequent, as biliary pathology and its complications are frequent in this population group. The main objective of this study was to analyze the safety and outcomes of laparoscopic cholecystectomy in patients older than 90 years.MethodsA retrospective observational cohort study was designed. This study involved 600 patients that were classified in 4 age groups for analysis (under 50 years, 50–69 years, 70–89 years, and over 90 years). Demographic, clinical, paraclinics, surgical, and outcome variables were compared according to age group. A multivariate analysis, which included variables considered clinically relevant, was performed to identify factors associated with mortality and complications classified with the Clavien–Dindo scale.ResultsThe patients evaluated had a median age of 65.0 (IQR 34.0) years and there was a female predominance (61.8%). A higher complication rate, conversion rate, subtotal cholecystectomy rate, and prolonged hospital stay were found in nonagenarians. The overall mortality rate was 1.6%. Mortality in the age group over 90 years was 6.8%. Regression models showed that age over 90 years (RR 4.6 CI95% 1.07–20.13), presence of cholecystitis (RR 8.2 CI95% 1.29–51.81), and time from admission to cholecystectomy (RR 1.2 CI95% 1.10–1.40) were the variables that presented statistically significant differences as risk factors for mortality.ConclusionCholecystectomy in nonagenarian patients has a higher rate of complications, conversion rate, subtotal cholecystectomy rate, and mortality. Therefore, an adequate perioperative assessment is necessary to optimize comorbidities and improve outcomes. Also, it is important to know the greatest risk for informed consent and choose the surgical equipment and schedule of the procedure.

The Outcomes of Laparoscopic Cholecystectomy in Children Compared to Adults: A Multiple Iraqi Centers Study

The Outcomes of Laparoscopic Cholecystectomy in Children Compared to Adults: A Multiple Iraqi Centers Study

Outcome of Laparoscopic Cholecystectomy in a District Level Hospital

Background: Laparoscopic cholecystectomy is a type of surgery that uses smaller incision than open cholecystectomy. LC has been performed as outpatient procedure for many years. Few studies have been conducted with primary focus on patient acceptance and preferences in terms of safety and satisfaction. We tried to explore its feasibility in otherwise healthy individuals undergoing laparoscopic cholecystectomy. The aim of the study of laparoscopic cholecystectomy is significantly affected by acute cholecystitis. Mechanical, biochemical, and bacteriological factors which are believed to participate in this inflammatory process are responsible for the different pathological processes observed in acute cholecystitis and in symptomatic cholelithiasis. Material Methods: Data from 57 patients between the age group 20 to 70 years with cholelithiasis who underwent laparoscopic cholecystectomy in a private Hospital, Madaripur, Bangladesh from April 2018 to June 2020 as ambulatory surgery (hospital stay 23 Hours) with or without overnight stay were analyzed. Complications, admissions and readmissions, patient satisfaction and treatment expenditure were assessed. Results: There were 48 (84.2%) female and 9 (15.8%) male with a median age of 42 years. Only 2.4% patients required readmission while 9.2% patients had unplanned admission. 76.4% percent patients were highly satisfied with the procedure. Treatment cost was about 15% lower than routine inpatient operation. Conclusion: Laparoscopic cholecystectomy is safe and feasible. LC can be performed as an outpatient procedure with a low rate of complications and admissions/readmissions. Patient acceptance in terms of satisfaction is high.

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

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

Impact of low- and standard-abdominal pressure on post- operative pain during laparoscopic cholecystectomy: A systematic review and meta-analysis of randomized trials

Background: This study aimed to comprehensively evaluate the impact of low- and standard-abdominal pressure on intraoperative, postoperative, and survival outcomes of Laparoscopic Cholecystectomy (LC). Methods: A literature search of the databases, PubMed, Web of Science, Embase, and Cochrane Library was performed until April 30, 2021. Studies comparing low abdominal pressure and standard abdominal pressure for LC were included. Two reviewers independently screened the studies, extracted the data of interest, and assessed the risk of bias. Meta-analysis was performed using RevMan 5.3.

A prospective cohort study of operative outcomes in laparoscopic cholecystectomy using operative difficulty grade-adjusted CUSUM analysis.

The development of a learning health system requires a shift from intermittent retrospective review of outcomes to continuous data-driven understanding of surgical processes and patient outcomes. Doing so will require the routine prospective capture of high-quality structured data. This lack of structured data has been a significant impediment to the development of surgical data science1,2. Laparoscopic cholecystectomy, a high-volume procedure, represents an opportunity to address this, but application of these data will require a paradigm shift in outcome reporting. As part of a systems-wide quality-improvement programme an end-to-end perioperative electronic workflow solution was refined and implemented at Christchurch Hospital, a tertiary referral centre, in 20133. This system allows for end-to-end data capture, including wait listing, operation booking, synoptic operation note documentation, and prospective capture of surgical complications and outcomes. Coupled with this, Christchurch Hospital has undertaken a department-wide initiative to standardize processes in laparoscopic cholecystectomy to optimize outcomes and prevent bile duct injury (BDI)4. Integration of prospective data capture into the clinical workflow allows for the possibility of real-time outcome monitoring and quality improvement.

Predicting difficulty in laparoscopic cholecystectomy preoperatively using modified Randhawa scoring system

Background: Laparoscopic cholecystectomy is a low-risk, minimally invasive operation and currently the standard for treatment of gallstone and gallbladder disease. Preoperative assessment of difficulty is required to prevent problems, ensure readiness, and ensure an effective course of surgery. Methods: In our work, we attempted to use a modified grading system developed by Randhawa et al. to preoperatively predict a difficult laparoscopic cholecystectomy. Age, gender, illness duration, history of prior GB disease, BMI, abdominal scar location (infra or supraumbilical), palpable gallbladder, and sonographic findings (gall bladder wall thickness, pericholecystic collection, and impacted stone) were assessed in patients who had been diagnosed with GB stones and required LC. Depending on the individual surgeon's assessment, a procedure is rated as easy, difficult, or very difficult. Results: On comparison of the test group difficulty level predicted with the gold standard of difficulty level intra op the test group has a sensitivity of 51.9 % and specificity of 100%. The test has a positive predictive value of 100% and Negative predictive value of 91.5%. The test and the gold standard agree on 154 out of 167 having a diagnostic accuracy of 92.21%. The Kappa value of 0.644 indicates very good agreement with a p value of &lt;0.001. Area under the curve indicates 96.1% of the difficulty is predicted by the Total score and significant with p value of &lt;0.001 Conclusions: The current modified Randhawa and Pujahari scoring method is useful and appropriate for forecasting operative outcome in laparoscopic cholecystectomy.