Outcomes Of Laparoscopic Cholecystectomy Research Articles

Lessons learned from implementing laparoscopic common bile duct exploration at a safety net hospital

BackgroundMounting evidence favors one-stage laparoscopic cholecystectomy with common bile duct exploration over endoscopic retrograde cholangiopancreatography with cholecystectomy for choledocholithiasis. However, laparoscopic cholecystectomy with common bile duct exploration remains underused. In 2020, our center initiated a laparoscopic cholecystectomy with common bile duct exploration program for choledocholithiasis. This study compares the experience and outcomes of laparoscopic cholecystectomy with common bile duct exploration compared with endoscopic retrograde cholangiopancreatography with cholecystectomy at a safety net hospital. MethodsThis single-center, retrospective study analyzed data from 179 patients admitted with choledocholithiasis from 2019 to 2023. Demographics, preoperative investigations, intraoperative details, and postoperative outcomes were evaluated. ResultsThe study included 179 patients (55.6 ± 21.0 years, 66% female) with American Society of Anesthesiologists Physical Status Classification System score III (II–III) and body mass index 29 kg/m2 (25.8–35.5 kg/m2). Of these, 148 underwent endoscopic retrograde cholangiopancreatography with cholecystectomy and 31 underwent laparoscopic cholecystectomy with common bile duct exploration. Demographic and preoperative data were similar between groups. Laparoscopic cholecystectomy with common bile duct exploration achieved a 74.2% success rate. Laparoscopic cholecystectomy with common bile duct exploration’s average operative time was 180 (139–213) minutes, with a 3.2% postoperative bile leak and 35.4% requiring postoperative ERCP. Median lengths of stay were 3 (1–4) for laparoscopic cholecystectomy with common bile duct exploration and 4 days (3–7) for endoscopic retrograde cholangiopancreatography with cholecystectomy (Z = –3.16, P = .002). The number of readmissions were 1.2 ± 0.4 for laparoscopic cholecystectomy with common bile duct exploration and 1.9 ± 1.3 for endoscopic retrograde cholangiopancreatography with cholecystectomy (t = 1.43, P = .08). Additional procedures for choledocholithiasis were performed in 36% of laparoscopic cholecystectomy with common bile duct exploration and 79% of ERCP + LC cases (χ2 = 21.7, P < .0001). ConclusionThe study highlights challenges in implementing laparoscopic cholecystectomy with common bile duct exploration at a safety net hospital. Results support laparoscopic cholecystectomy with common bile duct exploration over endoscopic retrograde cholangiopancreatography, with cholecystectomy, with shorter stays, fewer readmissions, and fewer additional procedures reported. Laparoscopic cholecystectomy with common bile duct exploration remains underused, with only 17.3% of patients who underwent one-stage laparoscopic cholecystectomy with common bile duct exploration. Further research is needed for laparoscopic cholecystectomy with common bile duct exploration’s expansion as the superior choledocholithiasis treatment.

Worse cholecystectomy outcomes during the COVID-19 pandemic: were staff shortages or a change in patient case-mix the culprit?

The COVID-19 pandemic has profoundly impacted the field of surgery, mostly through infectious risks, staff shortages, reduced hospital capacities, and changed patient pathways. Prompted by an increase in wound complications, we performed an in-depth analysis of an example surgical procedure. A consecutive cohort of 195 patients undergoing laparoscopic cholecystectomy was studied retrospectively. Data of patients receiving cholecystectomy before, during, and after the peak of the pandemic were compared. The potential influence of patient characteristics, pandemic phase, and staffing level (surgeons and nurse assistants) was analyzed statistically. In the primary analyses, the composite measure of a 'textbook outcome' was examined, which was defined as no relevant complication, hospital stay < 5days, and no readmission. During the COVID-19 phase, acute biliary disease was more common than in the pre-COVID-19 phase (62% vs. 30%). In 35% of cases, no qualified operating room nurse was available. Intraoperative features and postoperative complication rates were increased (bile spillage in 46%, wound complications in 24%). A 59-year-old male admitted with acute cholecystitis during COVID-19 died of wound-related septic shock. Multivariate analysis confirmed the acuity of gallbladder inflammation (odds ratio 5.3) and old age (2.6) as risk factors for a non-textbook outcome. The absence of qualified nursing staff was clearly associated with a non-textbook outcome (odds ratio 3.3). The fact that laparoscopic cholecystectomy outcomes were worse during COVID-19 can be partly attributed to a change in patient case-mix, but the shortage of qualified nursing staff in the operating room also had a strong negative influence.

Outcomes of Laparoscopic Cholecystectomy in Elderly Patients

Background: Laparoscopic cholecystectomy (LC) is the standard treatment for both symptomatic gallstones and acute cholecystitis. Laparoscopic cholecystectomy is the surgical procedure to remove the gallbladder. While historically challenging in cases of acute cholecystitis, advancements in laparoscopic techniques have made it a viable and preferred treatment option for this condition. Objective: Our study’s objective was to evaluate the efficacy of LC in elderly individuals. Methods: This prospective observational study was conducted at the general surgical department of Mymensingh Medical College Hospital from January 2023 to December 2023. A total number of 70 elderly patients who had acute cholecystitis (symptomatic gallstone disease) were included in this study. Based on physical examination, general conditions, laboratory investigation, and radiographic results, gallstone disease was diagnosed. All cases provided a signed, informed consent form. The research was done after approval of the ethical committee. Results: Among the 70 patients the majority of patients (87.14%) fall within the 60-69 years age range. A smaller proportion of older patients: A smaller percentage (12.86%) of patients are aged 70 years or older. The majority of the patients (68.30%) were male and (32.70%) were female. Hypertension is the most prevalent comorbidity among the patients, approximately 15.6% of the patients. Diabetes mellitus follows as the second most common comorbidity, with 11.1% of patients Cardiac disease is the third most frequent comorbidity, present in 6.7% of the patients. Peripheral vascular disease is the least common comorbidity among those presented, affecting 4.4% of the patients. Regarding the symptoms and clinical presentation, patients exhibited a variety of the usual gallbladder disease symptoms, including epigastric pain (51.30%), fatty food intolerance (37.14%), nausea and vomiting (24.29%), Murphy’s sign (14.29%), biliary colic (32.86%), right upper ......

The Impact of Intra-abdominal Pressure on Perioperative Outcomes in Laparoscopic Cholecystectomy.

Intra-abdominal pressure (IAP) is a critical factor in laparoscopic cholecystectomy, potentially affecting various perioperative outcomes. Understanding the impact of different IAP levels can guide clinical practice to optimize patient safety and recovery. This study aimed to evaluate the effects of low, moderate, and high IAPs on perioperative outcomes in patients undergoing laparoscopic cholecystectomy. A total of 150 patients were categorized into three groups based on IAP: Low Pressure (8-10 mmHg, n=50), Moderate Pressure (10-15 mmHg, n=70), and High Pressure (>15 mmHg, n=30). Primary outcomes measured included operative time, intraoperative complications, postoperative pain scores at six hours, length of hospital stay, and return to normal activity. Secondary outcomes included postoperative complications and analgesic consumption. Operative time increased significantly with higher IAP, averaging 80.4 ± 12.7 minutes in the Low Pressure group, 85.6 ± 15.3 minutes in the Moderate Pressure group, and 90.1 ± 14.2 minutes in the High Pressure group (p=0.03). Intraoperative complications occurred in 10%, 15%, and 23% of patients in the Low, Moderate, and High Pressure groups, respectively (p=0.12). Postoperative pain scores, length of hospital stay, and recovery time showed no significant differences between groups. Higher IAP is associated with longer operative times but does not significantly affect other perioperative outcomes, suggesting that careful consideration of IAP levels is important in laparoscopic cholecystectomy.

The incidence of complications in Laparoscopic Cholecystectomy in Acute Cholecystitis in tertiary Care Setup

Abstract Laparoscopic cholecystectomy is the procedure usually performed in our setups for both acute &amp; chronic Cholecystitis and simple gall stone disease. Objective Find the outcomes of laparoscopic cholecystectomy in acute cholecystitis in our hospital setup. Methods This prospective cross sectional study was conducted in Hazrat Bari Sarkar Hospital Islamabad on 10th Nov 2022 to 30 June 2023. The patients from above 10 year age with both genders were included by convenient sampling. All Diagnosed cases of gall stone disease with acute cholecystitis, acute on chronic cholecystitis, abscess, and empyema or mucocele gall bladder were included in this study. SPSS 22 was used for data analysis that was recorded on a performa. Results This study included 77 laparoscopic cholecystectomies done for Acute Cholecystitis. 53 female &amp; 24 male patients with female to male ratio of 2.2:1 undergoing laparoscopic cholecystectomies were included in the study. The mean age of patients was 47.6 years + 11.6 SD. The mean operative time was around 90min + 13.5 SD and the mean hospital stay was 2.23 days + 0.77 SD with a range of 1-4 days. Conversion rate to open cholecystectomy was noted in 8 cases. The operative complications were bleeding in 2 cases, minor bile duct injury in 2 cases, surgical site infection 15 cases, retained stone in 2 cases. Conclusion Laparoscopic cholecystectomy for acute cholecystitis has better results in patient outcomes as regards post-operative recovery &amp; length of hospital stay &amp; safety.

ThP6.1 - Revisiting outcomes of laparoscopic cholecystectomy in an elderly population

Abstract Aims Laparoscopic cholecystectomy in the elderly patient is a challenging operation with variable outcomes. We evaluate the outcome of patients who underwent laparoscopic cholecystectomy in a hospital that serves a large ageing population. Methods Retrospective analysis of 53 patients over the age of 70 years who underwent cholecystectomy between January and December 2023. Outcomes were compared between elective vs emergency procedures, indications, age groups (70-74, 75-79, 80-84, 85+) and Charlson comorbidity index (CCI). Results The mean age was 77±4.9 years, and the mean CCI was 4±1. Of 53 procedures performed, 30.2% (n=16) were emergency and 69.8% (n=37) were elective. 6.3% (n=1) was converted to open. 11.3% (n=6) of patients underwent Rendezvous ERCP. Emergency patients had increased length of stay (LOS) (5.1±2.8 vs 1.6±4.1, p=0.04). The indication for surgery was noted to have a significant influence on LOS (p=0.003), however, age groups and CCI did not influence LOS. Non-biliary complications occurred in 13.2% (n=7) of patients. 7.5% (n=4) of patients had readmission within 30 days. 3.75% (n=2) had retained CBD stone and underwent postoperative ERCP. No significant differences between age groups in relation to complications were identified. Conclusions Emergency cholecystectomy in patients over the age of 70 is associated with a longer LOS. Rates of complications are not influenced by age or CCI. Laparoscopic Cholecystectomy can be safely offered to a diverse elderly population.

Correlation of G-10 Scoring &amp; Per Operative Outcomes in Laparoscopic Cholecystectomy: A Tertiary Care Centre Experience

Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide and has only recently achieved a perioperative predictive score. This study aims to document our experience as a tertiary care hospital regarding the use of the same. 250 patients were considered in a prospective observational study, subsequently recording the intraoperative findings and postoperative complications based on G10 scoring put forward by the WSES based on the Sugrue study. They were classified as easy, moderate, difficult, and extremely difficult. The mean operative time was 48.58 min (range 30 to 190). The conversion rate was 2%. A p value of &lt;0.0001 shows G10 scoring is significantly related to open conversion. Overall, 19 (7.60%) patients were found to have a difficult or extreme degree of operative difficulty as judged by a G10 score of 5 or greater. A significant relationship was found with respect to bile duct injury, biliary fistula, vessel injury, abscess formation, and readmission in view of G10-based scoring difficulty. Validation and widespread adaptation may provide a standard for understanding and improving care and enable more standardization in global comparisons of care for cholecystectomy. This study is a single institution experience validating the significance of intraoperative scoring for biliary disease management.

654 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 outcomes. Criteria for day surgery often includes BMI, with centres excluding patients with BMI&amp;gt;40kg/m2 . However, as cholecystectomies are routinely performed laparoscopically with low complication rates in patients with higher BMI, this cut-off is being reviewed. Aim To examine outcomes of Laparoscopic Cholecystectomy in patients with increased BMI, particularly when comparing patients with morbid obesity (Class-III;BMI&amp;gt;40 kg/m2) to those with lower BMI. Method 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, operative duration, length of admission and 30-day complications, amongst others, was collected. Results This study included a total of 1007 patients (77.92% female, 22.08% male). Patients were placed into 5 BMI categories: BMI&amp;lt;25(n=117),25-29(n=284),30-34(n=285),35-39(n=193), and&amp;gt;40(n=135). The median BMI was 31kg/m2 and overall complication-rate 5.36%. There were three 30-day mortalities, one in BMI category &amp;lt;25(p=0.19) and two in 25-29(p=0.06). When comparing patients with BMI&amp;gt;40 to those with lower BMI there was no significant difference in complications including bile-leak (0%vs1.79%;p=0.35), significant bleed (0.10%vs0.20%;p=0.41) or bile-duct injury (0%vs0.1%;p=0.71). The duration of surgery was increased, almost reaching statistical significance (83.5vs78mins;p=0.05). Due to existing Health board admission criteria, length of admission was significantly raised for BMI&amp;gt;40 (median1vs0days;p=0.00). Conclusions 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&amp;gt;40 appears inappropriate.

Laparoscopic cholecystectomy with or without drainage: a systematic review and meta-analysis

Background. The abdominal drainage with a prophylactic purpose was used by surgeons for decades because of the possibility to detect early signs of postoperative complications. However, the real value of routine drainage after abdominal surgery is still debated. There are discrepancies between studies supporting the drain placement only in patients with intraoperative complications and works showing a beneficial effect of prophylactic abdominal drainage on postoperative pain, nausea, and vomiting. However, there is still a lack of evidence on the use of routine abdominal drainage following laparoscopic cholecystectomy and its clinical value. Current guidelines do not mention the role of drainage after laparoscopic cholecystectomy. Objective: to evaluate whether conventional postoperative drainage is more effective than no drainage in patients with non-complicated benign gallbladder disease after laparoscopic cholecystectomy. Materials and methods. A search in the electronic databases MEDLINE, Scopus, Cochrane Library was conducted for randomized controlled trials reporting outcomes of laparoscopic cholecystectomy with and without an abdominal drainage until January 2024. The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis — using fixed and random effects models. Odds ratio (OR) with confidence interval (CI) for qualitative variables and mean difference (MD) with CI for continuous variables were calculated using IBM SPSS Statistics 29.0.2.0. Results. Forty-four randomized controlled trials invol­ving 5,185 patients (2,592 with drains vs 2,593 without them) were included in the meta-analysis. There were no statistically significant differences in the incidence of intra-abdominal fluid accumulation (OR = 0.87; 95% CI: 0.64–1.19; p = 0.39) between two groups. Abdominal drains did not reduce the overall incidence of nausea and vomiting (OR = 1.51; 95% CI: 0.85–2.70; p = 0 .16) or shoulder pain (OR = 0.90; 95% CI: 0.58–1.41; p = 0.65). The abdominal drain group reported significantly higher pain scores (MD = 0.67; 95% CI: 0.37–0.98; p &lt; 0.001) than patients without drains. Abdominal drainage increased operative time (MD = 3.82; 95% CI: 1.93–5.70; p &lt; 0.001) but not the length of hospital stay after surgery (MD = 0.42; 95% CI: –0.02–0.85; p = 0.06). Wound infection (OR = 3.26; 95% CI: 2.35–4.51; p &lt; 0.001), fever (OR = 4.40; 95% CI: 2.57–7.8554; p &lt; 0.001) and pneumonia (OR = 4.74; 95% CI: 2.25–9.97; p &lt; 0.001) were found to be associated with the use of abdominal drains. Conclusions. Currently, there is no evidence to support the use of routine drainage after laparoscopic cholecystectomy in non-complicated benign gallbladder disease. No drainage after laparoscopic cholecystectomy is safe and associated with fewer complications. Postoperative recovery is improved if drain is not used. Further well-designed randomized clinical trials are required to confirm this finding.

The effects of previous abdominal surgery and the utilisation of modified access techniques on the operative difficulty and outcomes of laparoscopic cholecystectomy and bile duct exploration

BackgroundEarly reports suggested that previous abdominal surgery was a relative contraindication to laparoscopic cholecystectomy (LC) on account of difficulty and potential access complications. This study analyses different types/systems of previous surgery and locations of scars and how they affect access difficulties. As modified access techniques to minimise risk of complications are under-reported the study details and evaluates them.MethodProspectively collected data from consecutive LC and common bile duct explorations (LCBDE) performed by a single surgeon over 30 years was analysed. Previous abdominal surgery was documented and peri-operative outcomes were compared with patients who had no previous surgery using Chi-squared analysis.ResultsOf 5916 LC and LCBDE, 1846 patients (31.2%) had previous abdominal surgery. The median age was 60 years. Those with previous surgery required more frequent duodenal (RR 1.07; p = 0.023), hepatic flexure (RR 1.11; p = 0.043) and distal adhesiolysis (RR 3.57; p < 0.001) and had more access related bowel injuries (0.4% vs. 0.0%; p < 0.001). Previous upper gastrointestinal and biliary surgery had the highest rates of adhesiolysis (76.3%), difficult cystic pedicles (58.8%), fundus-first approach (7.2%), difficulty grades (64.9% Grades 3–5) and utilisation of abdominal drains (71.1%). Previous open surgery resulted in longer operative time compared to previous laparoscopic procedures (65vs.55 min; p < 0.001), increased difficulty of pedicle dissection (42.4% vs. 36.0%; p < 0.05) and required more duodenal, hepatic flexure and distant adhesiolysis (p < 0.05) and fundus-first dissection (4% vs 2%; p < 0.05). Epigastric and supraumbilical access and access through umbilical and other hernias were used in 163 patients (8.8%) with no bowel complications.ConclusionThe risks of access and adhesiolysis in patients with previous abdominal scars undergoing biliary surgery are dependent on the nature of previous surgery. Previous open, upper gastrointestinal and biliary surgery carried the most significant risks. Modified access techniques can be adopted to safely mitigate these risks.Graphical abstract

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 &amp; 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&amp;gt;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&amp;gt;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&amp;lt;25(n=98),25-29(n=255),30-34(n=253),35-39(n=176), and&amp;gt;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 &amp;lt;25 and 25-29. Comparing patients with BMI&amp;gt;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&amp;gt;40 appears inappropriate.

Clinical evolution of gallstones following percutaneous cholecystostomy in patients with severe acute calculous cholecystitis: a single-center analysis of 102 cases.

Percutaneous cholecystostomy (PC) is effective in controlling sepsis in patients with severe acute calculous cholecystitis (ACC). The long-term treatment of this group is still debated. We aimed to assess the clinical evolution of gallstones after severe ACC and the outcomes of laparoscopic cholecystectomy (LC) and conservative management, following PC. This was a retrospective analysis of the rate of readmissions due to recurrent biliary disease and all-cause mortality in subjects who underwent a PC for severe ACC. We compared results between patients who underwent interval LC and those who received conservative management. Readmissions and late mortality were assessed using the Kaplan-Meier method and multivariate regression analysis. A total of 102 patients were included, of whom 30 underwent interval LC and 72 PC only. Overall, 51.6% were readmitted with recurrent biliary events and the rate did not differ between groups (P=0.583). The probability of recurrent gallstone events was higher in the first 30 weeks after PC; in the surgical cohort, 77.8% of them developed before LC. Late deaths occurred in 46.2% of patients: 13.3% LC vs. 61.9% conservative (P<0.001). Three years after PC, the estimated survival was 75% LC vs. 38% conservative (P=0.014). High-grade comorbidities and severity of ACC were positive predictors of all-cause mortality (P=0.004 and P=0.027), whereas LC was a negative predictor (P=0.003). Recurrent biliary events were common following PC for ACC. Interval LC was associated with lower rates of readmissions and all-cause late mortality.

Impact of thoracic outlet diameter on surgical outcomes in laparoscopic cholecystectomy

Impact of thoracic outlet diameter on surgical outcomes in laparoscopic cholecystectomy

Outcomes of laparoscopic cholecystectomy in pediatric population (NIS 1998- 2018)

Outcomes of laparoscopic cholecystectomy in pediatric population (NIS 1998- 2018)

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 analysis of laparoscopic cholecystectomy outcomes in acute calculous cholecystitis: importance of indocyanine green, optimal dosing regimen

To show the effectiveness of the indocyanine green application in laparoscopic cholecystectomy of any complexity. Our study used a domestically produced drug, namely indocyanine green, lyophilisate, which was diluted in water for injections. In addition, 4K equipment with the possibility of fluorescence of different manufacturers (Arthrex, ELEPS, KARL STORZ) was used. The study group included 117 patients who were urgently hospitalized with acute calculous cholecystitis diagnosis. All patients were additionally examined in the preoperative period according to the recommendations of the Ministry of Health of the Russian Federation. The control group included 109 patients. A retrospective analysis of the medical records for 2023 was carried out. The advantages of using indocyanine green in the performance of laparoscopic cholecystectomy of any complexity were confirmed. The drug application promotes the extrahepatic biliary tracts navigation, thus allowing to avoid the injuries of extrahepatic bile ducts and the consequences of these injuries. In addition, its implementation increases the possibility of early training of young professionals and residents on the technique of safe laparoscopic cholecystectomy. The application of optimal dosages of indocyanine does not cause visual discomfort during the operation, significantly reduces the duration of the surgery, thus allowing to reduce the time spent in the hospital in the postoperative period.

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.