Outcomes Of Laparoscopic Cholecystectomy Research Articles

Is gender a determinant for the outcome of laparoscopic cholecystectomy?

Background: Currently, laparoscopic cholecystectomy is one of the most desirable procedures to treat symptomatic gallstone disease. Yet, various risk factors govern its conversion to open surgery. The impact of male sex as a risk factor for conversion has been a questionable issue. The study aimed to evaluate the role of male sex on outcomes of laparoscopic cholecystectomy.Methods: As per inclusion and exclusion criteria, medical records of all the patients aged 18-70 years who underwent elective LC for a period of 14 months were accessed retrospectively. Data related to patients’ demographic details, intra-operative and post-operative findings was recorded and subjected to analysis.Results: Out of 232 selected cases, 17.67% were males and 82.32% were females. Mean age in both gender groups was similar (p=0.139). Body mass index was also found to be similar in both the groups (p=0.232). There was no significant difference (p=0.85) in the mean operative time between men (29.37±9.29) and women (28.88±15.66). Conversion to open surgery was seen only in female group (1.57%) but it is not significantly from the male group (p=0.42). No significant difference was observed in both groups regarding unwanted intra-operative events (p=0.231) and post-operative complications (p=0.70) and post- operative stay (p=0.50).Conclusions: This study suggests that male gender may not be considered as an independent risk factor for outcome of laparoscopic cholecystectomy. However, extensive research in future may cast further light on this issue.

Quality of life and surgical outcomes of laparoscopic cholecystectomy in patients over the age of 80: a retrospective study

Background: As the United Kingdom’s population ages an increasing number of patients undergoing elective cholecystectomy are over the age of eighty. The current literature base focuses on a younger patient cohort and fails to consider quality of life benefit from the intervention. Assessing quality of life benefit as well as operative morbidity and post-operative complications together is important in the assessment of whether patients of this age should be managed surgically or conservatively.Methods: A retrospective study was conducted on all patients above the age of eighty undergoing elective cholecystectomy between January 2017 to January 2019 at a tertiary care centre in London. Intra-operative morbidity and post-operative complications were obtained from inpatient notes and quality of life was measured using the gastrointestinal quality of life questionnaire (GIQLI) pre and post operatively.Results: 120 patients over the age of eighty underwent laparoscopic cholecystectomy in the three-year timeframe. 11% experienced post-operative complications. A statistically significant improvement in GIQLI score was noted post-operatively across all domains including social function, gastrointestinal symptoms, physical function and emotional function.Conclusions: Post-operative complication rates were higher amongst this cohort compared to series studying a younger cohort of patients. However, quality of life significantly benefited from the intervention for patients over the age of 80. Hence, amongst carefully selected patients, laparoscopic cholecystectomy remains a viable treatment option and can greatly benefit the individual.

Fluorescent cholangiography significantly improves patient outcomes for laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) is the most common elective abdominal surgery in the USA, with over 750,000 performed annually. Fluorescent cholangiography (FC) using indocyanine green dye (ICG) permits identification of extrahepatic biliary structures to facilitate dissection without requiring cystic duct cannulation. Achieving the "critical view of safety" with assistance of ICG cholangiogram may support identification of anatomy, safely reduce conversion to open procedures, and decrease operative time. We assess the utility of FC with respect to anatomic visualization during LC and its effects on patient outcomes. A retrospective review of a prospectively maintained database identified patients undergoing laparoscopic cholecystectomy at a single academic center from 2013 to 2019. Exclusion criteria were primary open and single incision cholecystectomy. Patient factors included age, sex, BMI, and Charlson Comorbidity Index. Outcomes included operative time, conversion to open procedure, length of stay (LOS), mortality rate, and 30-day complications. A multivariable logistic regression was performed to determine independent predictors for open conversion. A total of 1389 patients underwent laparoscopic cholecystectomy. 69.8% were female; mean age 48.6years (range 15-94), average BMI 29.4kg/m2 (13.3-55.6). 989 patients (71.2%) underwent LC without fluorescence and 400 (28.8%) underwent FC with ICG. 30-day mortality detected 2 cases in the non-ICG group and zero with ICG. ICG reduced operative time by 26.47min per case (p < 0.0001). For patients with BMI ≥ 30kg/m2, operative duration for ICG vs non-ICG groups was 75.57 vs 104.9min respectively (p < 0.0001). ICG required conversion to open at a rate of 1.5%, while non-ICG converted at a rate of 8.5% (p < 0.0001). Conversion rate remained significant with multivariable analysis (OR 0.212, p = 0.001). A total of 19 cases were aborted (1.35%), 8 in the ICG group (1.96%) and 11 in the non-ICG group (1.10%), these cases were not included in LC totals. Average LOS was 0.69 vs 1.54days in the ICG compared to non-ICG LCs (p < 0.0001), respectively. Injuries were more common in the non-ICG group, with 9 patients sustaining Strasberg class A injuries in the non-ICG group and 2 in the ICG group. 1 CBDI occurred in the non-ICG group. There was no significant difference in 30-day complication rates between groups. ICG cholangiography is a non-invasive adjunct to laparoscopic cholecystectomy, leading to improved patient outcomes with respect to operative times, decreased conversion to open procedures, and shorter length of hospitalization. Fluorescence cholangiography improves visualization of biliary anatomy, thereby decreasing rate of CBDI, Strasberg A injuries, and mortality. These findings support ICG as standard of care during laparoscopic cholecystectomy.

Nursing perspective of patient in post operative outcome of laparoscopic cholecystectomy versus open cholecystectomy: A prospective study from a tertiary care hospital in Guwahati, Asssam

Nursing perspective of patient in post operative outcome of laparoscopic cholecystectomy versus open cholecystectomy: A prospective study from a tertiary care hospital in Guwahati, Asssam

Surgical Outcome of Laparoscopic Cholecystectomy in Patients With a History of Gastrectomy.

Although laparoscopic cholecystectomy (LC) has been applied to patients with a history of abdominal surgery, we lack data on the surgical outcome of LC in patients with a history of gastrectomy. Here, we assessed the outcomes of LC and investigated predictive factors for conversion from laparoscopic to open surgery in patients with a gastrectomy history. We retrospectively compared the surgical outcomes of LC between patients with and without a history of gastrectomy. We performed multivariate regressions to identify independent predictive factors for open conversion during an LC. Among 2235 patients who underwent LCs, 39 (1.7%) had undergone a previous gastrectomy (29 men, 10 women; mean age, 72 y; 34 with distal gastrectomy and 5 with total gastrectomy). The operation time, intraoperative bleeding, postoperative hospital stays, and conversion rate were significantly worse in patients with, compared with those without the history of gastrectomy. Conversion during an LC in the cases with a history of gastrectomy was significantly correlated with age and the type of gastrectomy. These results suggested that LC in patients with a history of gastrectomy exhibited worse outcomes in terms of operation time, intraoperative bleeding, postoperative hospital stay, and conversion rate than those without it. Furthermore, it was also implied that age and the type of gastrectomy were significant predictive factors for conversion during an LC in patients with a history of gastrectomy.

Utility of Tokyo guidelines and intraoperative safety steps in improving the outcome of laparoscopic cholecystectomy in complex acute calculus cholecystitis: a prospective study

Laparoscopic cholecystectomy (LC) in complicated acute calculus cholecystitis (ACC) poses multiple challenges. This prospective, observational study assessed the utility and safety of a set protocol and intraoperative steps in LC for complex ACC. All cases of ACC from 2008 to 2018 were graded asper Tokyo guidelines; moderate and severe ACC were termed as 'complex ACC (CACC).' Patients were subjected to upfront LC or percutaneous drainage (PCD) followed by LC. Seven intraoperative safety steps were used to achieve critical view of safety (CVS). Use of safety steps, duration of surgery, and length of hospital stay were compared between moderate and severe ACC; complications were classified using Clavien-Dindo classification. We analyzed 145 patients with moderate (74.5%) and severe (25.5%) ACC. There were significantly more male (p = 0.0059) and older (p = 0.0006) patients with severe ACC. Upfront LC was performed in 81.4%; PCD required in 6.9%. Timing of LC from symptom onset was < 1week (53.1%), 2-5weeks (28.3%), and ≥ 6weeks (18.6%). CVS was achieved in 97.2%, subtotal cholecystectomy performed in 2.8%, conversion rate was 1.4%, major postoperative complications (Clavien-Dindo Grade IIIa and IIIb) were seen in 4.1%, no bile duct injury, and mortality was 0.7%. The outcomes were similar irrespective of timing of intervention. The study concludes that preoperative assessment by Tokyo guidelines, algorithmic plan of treatment and use of intraoperative safety steps results in favorable outcome of LC in ACC.

Association of hospital and surgeon operative volumes and surgeon pediatric subspecialization with pediatric laparoscopic cholecystectomy outcomes: A population-based cohort study

BackgroundMost pediatric cholecystectomies are performed by adult general surgeons, but it is unclear whether outcomes differ by surgeon pediatric subspecialization, hospital procedure volume, or surgeon procedure volume. We aimed to determine whether higher hospital or surgeon laparoscopic cholecystectomy (LC) volume or surgeon pediatric subspecialization is associated with better outcomes after LC in children. MethodsWe performed a retrospective cohort study using statewide hospital discharge databases from the states of Florida, Georgia, and Iowa. We included children aged 4–18 years who underwent inpatient or outpatient LC for acute or chronic gallbladder disease in January 2010–August 2015.Propensity score weighting was used to estimate relationships between operative volumes or surgeon pediatric subspecialization and rates of readmission or emergency department (ED) visit within 30 days. ResultsA total of 5391 children were included (mean age 15.9 years, 81.6% female). Children operated on by surgeons with high LC volumes in hospitals with high LC volumes were less likely to experience a readmission or ED visit within 30 days (10.8% vs. 13.7%, p = 0.04). Additionally, children operated on by adult general surgeons in hospitals with high LC volumes were less likely to experience a readmission or ED visit within 30 days (10.9% vs. 13.8%, p = 0.03). ConclusionsChildren are less likely to be readmitted to the hospital or present to the ED after laparoscopic cholecystectomy if they receive their care from adult general surgeons at hospitals that frequently perform this procedure in both adults and children. Level of evidenceIII

Does the Surgeon's Caseload Affect the Outcome in Laparoscopic Cholecystectomy for Acute Cholecystitis?

This study investigated how annual caseloads and the surgeon's previous experience influence the outcome in laparoscopic cholecystectomy (LCC) for acute cholecystitis. A total of 892 patients treated in Helsinki University Hospital in 2013-2016 were retrospectively analyzed. Surgeons were compared regarding volume-over 5 LCCs for acute cholecystitis a year versus 5 or fewer LCCs a year, and experience-attendings versus residents. High-volume surgeons (n=14) operated faster than low-volume surgeons (n=62) (91 vs. 108 min, P<0.001). Examining only procedures with an attending present, high-volume attendings (n=7) converted less (14.9% vs. 32.0%, P<0.001) and operated faster (95 vs. 110 min, P<0.001) compared with low-volume attendings (n=41). The results of residents did not significantly differ from the results of attendings. Attending surgeons, performing >5 LCCs for acute cholecystitis a year, have shorter operative times and lower conversion rates.

Effect modification of resident autonomy and seniority on perioperative outcomes in laparoscopic cholecystectomy.

Resident operative involvement is an integral aspect of general surgery residency training. However, current data examining the effect of resident autonomy on perioperative outcomes remain limited. Patient and operator-specific data were collected from 344 adult laparoscopic cholecystectomies at a tertiary academic institution and its regional affiliates between 2018 and 2019. Multivariate modeling compared postoperative outcomes between cases completed with or without resident involvement and its effect modification by resident seniority and autonomy per Zwisch scale. Outcomes include 30-day postoperative complications, hospital readmission rate, and operative time. Multivariate analysis revealed resident involvement in laparoscopic cholecystectomy did not significantly change odds of 30-day postoperative complications (OR 2.52, p=0.185, 95% CI 0.64-9.92) or hospital readmission (OR 1.61, p=0.538, 95% CI 0.36-7.23). Operative time is significantly increased compared to faculty-only cases (IRR 1.37, p<0.001, 95% CI 1.26-1.48). While accounting for case difficulty and resident performance evaluated by SIMPL criteria, stratification by resident autonomy measured by Zwisch scale or seniority reveal no effect modification on 30-day postoperative complications, readmissions, or operative time. The effect of resident involvement on longer relative rates of operative time loses its significance in supervision-only cases (IRR 1.18, p=0.069, 95% CI 0.99-1.41). While resident involvement and autonomy are associated with significantly longer operative times in laparoscopic cholecystectomy, their lack of significant effect on postoperative outcomes argues strongly for continued resident involvement and supervised operative independence.

Đánh giá kết quả phẫu thuật nội soi điều trị viêm túi mật cấp do sỏi đã dẫn lưu túi mật

Tóm tắt Đặt vấn đề: Xác định tỷ lệ phẫu thuật nội soi (PTNS) thành công và một số yếu tố liên quan của PTNS cắt túi mật (TM) sau dẫn lưu túi mật (DLTM) qua da xuyên gan hoặc DLTM qua da trong viêm túi mật cấp (VTMC) do sỏi. Phương pháp nghiên cứu: Nghiên cứu cắt ngang người bệnh (NB) được PTNS cắt TM sau DLTM do VTMC do sỏi tại Bệnh viện Trưng Vương từ tháng 01/2013 đến tháng 6/2019. Kết quả: 72 NB được DLTM, 35 nam, 37 nữ, tỉ lệ nam/nữ 0,94. Tuổi trung bình là 57,8 ± 14,3. DLTM thành công 100%. Tỉ lệ chuyển mổ mở của PTNS cắt TM sau DLTM là 1,4 % (1 NB). Kết luận: DLTM trong VTMC do sỏi là kỹ thuật dễ thực hiện, an toàn, tỉ lệ thành công cao (100%), không có tai biến, và biến chứng nghiêm trọng. PTNS cắt TM sau DLTM thành công cao (98,6%), tỉ lệ chuyển mổ mở thấp, tai biến, biến chứng không đáng kể. DLTM là phương pháp điều trị tạm thời hiệu quả để chuẩn bị cho PTNS cắt TM sau đó. Abstract Introduction: Identification of successful rate of laparoscopic cholecystectomy (LC) and analysis of factors related to results of LC for post-percutaneous transhepatic gallbladder drainage or percutaneous gallbladder drainage (PTGBD) in acute calculous cholecystitis (ACC). Materials and Methods: Cross-sectional study. The patients with cholecystostomy due to ACC underwent LC at Trung Vuong hospital from January 2013 to June 2019 enrolled. Results: 72 patients had PTGBD including 35 male and 37 female, male/ female ratio was 0.94. The mean age was 57.8 ± 14.3 years old. The success rate of PTGBD was 100%. The LC has performed successfully for PTGBD and conversion rate to open surgery was 1,4% (1 patient). Conclusion: PTGBD for ACC is a feasilble and safe technique, high rate of success (100%) without any serious accidents and complications. LC after PTGBD has conducted successfully at high rate (98,6%), very low conversion rate and minimal complications. PTGBD is an effective temporary management for preparation of subsequent laparoscopic cholecystectomy Keywords: Cholecystitis, Percutaneous Transhepatic Gallbladder Drainage.

A Clinical Practice Audit of Laparoscopic Cholecystectomy at our Institute

ABSTRACT Background: Laparoscopic cholecystectomy has replaced open surgery in the treatment of symptomatic cholecystolithiasis. Objective: To evaluate the clinical practices and outcome of laparoscopic cholecystectomy at our institute. Methodology: This was a cross sectional study, conducted at Surgical Unit II, Sheikh Zayed Hospital, Rahim yar khan, from November 2018 to October 2019. Sample size: 100 patients undergoing standard laparoscopic cholecystectomy selected by non probability sampling. All the patients of laparoscopic cholecystectomy during the study period having a clinical diagnosis of acute and chronic cholecystitis were included, whereas patients who had previously undergone midline abdominal operations, ventral hernias, with evidence of common bile duct pathology, having bleeding disorders and hepatitis were excluded. Study variables were operating time, duration of hospital stay, frequency of operative and post-operative complications. Results: There were 85 females and 15 males. Mean age was 40 ± 1.2 years. In this study, 68% patients were having chronic cholecystitis due to cholelithiasis whereas 32% were having acute cholecystitis. Abdominal ultrasound showed multiple stones in 82% and single stone in 18% patients. Adhesions in 30%, Mucocele in 1% and empyema in 2% patients was reported. Gall bladder was perforated in 12% patients and 8% patients converted to open procedure. The mean operative time for laparoscopic cholecystectomy was 71.2+ 2.6 minute. The post operative complications were; wound infection in 4%, shoulder pain 1% and surgical emphysema 1%. The mean hospital stay was 1.38 days. Conclusion: Laparoscopic Cholecystectomy proved a safe procedure in term of operative and post operative complications in our setup.

Gall Bladder Wall Thickness: Sonographic Accuracy and Laparoscopic Cholecystectomy Conversion Rate, Evaluated by Histopathology

Background: Preoperative prediction of a difficult laparoscopic cholecystectomy can help the patient as well as the surgeon to prepare better for intraoperative risk and the risk of conversion to open Cholecystectomy. Aim of study: Evaluation the impact of gall bladder wall thickness, on the outcome of laparoscopic cholecystectomy and conversion rate to open cholecystectomy assessed by sonography preoperative and postoperative measurement of gall bladder wall thickness by histopathology. Patients and Methods: A prospective study conducted in the surgical unit, Department of surgery, Baghdad Teaching Hospital between November 2010 and November 2011. Abdominal Sonography performed in 110 consecutive patients before laparoscopic cholecystectomy. The surgeon re-verified sonographic finding in operative room, and postoperatively, the gall bladder specimens were sent for histopathological measurement of wall thickness. Results: Out of 110 patients with cholecystolithiasis on sonography, we encountered easy laparoscopic cholecystectomy in 80 patients (72.7%), difficult laparoscopic cholecystectomy in 24 (21.8%) and the procedure was converted to open cholecystectomy in six patients (5.5%). The difference between Sonographic and histological measurement was within 1 mm in 102 patients (92.7%), and the other 8 patients was with 1.5 mm (7.3%) with sensitivity of (100%), specificity of (83.3%) and accuracy of (97%). Conclusion: An accurate preoperative diagnostic sonography is mandatory for planned laparoscopic gall bladder surgery to provide information for the selection of the most appropriate approach and avoid intraoperative difficulties and surprises. On sonography gall bladder wall thickening is the most sensitive indicator of technical difficulties during laparoscopic cholecystectomy. Such difficulties may require conversion to laparotomy.

Patterns of complications and outcome of laparoscopic cholecystectomy

Background: Cholelithiasis is known to be one of the most common biliary pathologies. Laparoscopic cholecystectomy is the gold standard for the removal of the gallbladder, because of its cosmetic benefit, short stay, cost-effective and lesser side effects. But no procedure is immune to complications and other procedure-related side effects. The present study was conducted to study the patterns of complications and outcome of laparoscopic cholecystectomy.Methods: the present study was conducted prospectively on patients undergoing laparoscopic cholecystectomy for symptomatic gall bladder pathology. the patients undergoing laparoscopic cholecystectomy were distributed and analysed on various parameters i.e. age, sex, ultrasound abdomen findings, complications related to access, per-operative condition of gallbladder, per-operative and postoperative complication.Results: In our study cases major complication rate 1% leading to biliary stricture for which hepaticojejunostomy was done, minor complication rate 11% and conversion to open cholecystectomy rate 2%.Conclusions: It is concluded that laparoscopic cholecystectomy is the safe and standard procedure for the laparoscopic cholecystectomy and its major complication are preventable by strictly following the basic principles of laparoscopic cholecystectomy and keeping a low level of the threshold for converting to open cholecystectomy.

Is Specialisation Needed in Laparoscopic Cholecystectomy? A Retrospective Cohort Study of 5122 Patients

Background: Gallstone disease is a common problem and laparoscopic cholecystectomy (LC) is a common elective procedure. This operation was performed by a general surgeon, colorectal surgeons, breast and vascular surgeons according to the largest UK's audit (CholeS study). Objectives: To compare the outcomes of laparoscopic cholecystectomy performed by a specialist upper gastrointestinal (UGI) surgeon to that of CholeS and large international studies. Our hypothesis is: UGI specialist is producing better outcomes for LC patients. Methods: All patient who underwent LC between 1999 and 2019 at one hospital by an UGI consultant and 2014-2019 at another hospital by another UGI consultant surgeon were included. The inclusion criteria were LC performed by UGI surgeon. Lost to follow up, procedures done by trainees and gallbladder cancer patients were excluded. The outcome measures of bile leak, bile duct injuries, bleeding, infectious complications, bowel injuries, vascular injuries and pseudoaneurysms, neuralgia, port site hernia, mesenteric haematoma, 30-day mortality and conversion to open were reported. Statistical tests were used to assess the significant differences, the confidence interval was 95% and the p-value was taken as 0.05. Results: Two UGI specialists performed 5122 LC, 4396 (86%) were female and 715 (14%) male. The age was 13-93 year (median of 48 years). 3681 (72 %) was done as a day surgery case. 1431(28%) as an inpatient and 287 (5.6%) emergency LC. There was no death in the 30 days periods of surgery, 8 (0.15%) biliary leak from the duct of Luschka, 4 (0.19%) common bile duct (CBD) injuries, 9(0.02%) conversions and 17(0.33%) procedures were abandoned. There were significant differences in the above complications between our study and the CholeS report. Conclusions: Laparoscopic cholecystectomy is associated with acceptable outcomes, low risk of bile duct injury and no mortality when performed by a specialist upper GI surgeon.

Predicting morbidity and mortality in laparoscopic cholecystectomy: Preoperative serum albumin still matters

BackgroundThis study examined the association of preoperative serum albumin with outcomes for laparoscopic cholecystectomy. MethodsThe American College of Surgeons National Surgical Quality Improvement Program was retrospectively analyzed from 2005 to 2016 for adult patients undergoing laparoscopic cholecystectomy. Patients were stratified into four groups: <3.0 g/dL (Severe Malnutrition), 3.0-<3.5 (Moderate Malnutrition), 3.5-<4.0 (Mild Malnutrition), and ≥4.0 g/dL (Normal Nutrition). The primary outcome of 30-day mortality was evaluated with multivariable regression. ResultsOf 131,855 patients, 14.0% had Severe, 22.8% Moderate, and 29.7% Mild Malnutrition, with 33.5% classified as Normal Nutrition. Adjusted multivariable regressions demonstrated that relative to Normal Nutrition, mortality risk was increased for Severe (OR = 3.09 [95% Confidence Interval: 2.09–4.56]) and Moderate (OR = 1.83 [1.24–2.72]) Malnutrition. Severe (OR = 2.45 [1.67–3.61]) and Moderate (OR = 1.52 [1.04–2.24]) Malnutrition were also associated with increased risk of postoperative septic shock. ConclusionsEven in less invasive laparoscopic cholecystectomy, reduced preoperative serum albumin is strongly associated with increased morbidity and mortality.

Impact of Residents on Safety Outcomes in Laparoscopic Cholecystectomy.

New training programs face quality concern by faculty who believe resident involvement in operative management may lead to poorer outcomes. This study aims to understand the impact of resident surgeons on outcomes in a specific common surgical procedure. We obtained a retrospective review of 1216 laparoscopic cholecystectomy cases between June 2012 and June 2017 at a community teaching hospital. Data reviewed included patient demographics, operative time, length of stay, 30-day outcomes. An initial analysis comparing outcomes with/without resident participation was undertaken. A subset analysis comparing junior (PGY 1-2) and senior (PGY 3-5) groups was also performed. We found the resident group participated in higher-risk patient (ASA > 3, 47.5% vs 39.8%, p = 0.04 more acute disease (59.8% vs 37.5%, p < 0.0001) and emergent surgery (59.7% vs 37.5%, p < 0.0001). Resident involvement in severe cases was not a significant factor in the odds of morbidity, mortality, conversion rate or length of stay. Resident participation did increase the odds of having longer OR time (OR 12.54, 95% CI 7.74-17.34, p < 0.0001). Resident participation is associated with increased operative times but not complications. This study confirms resident participation in the operating room in difficult and challenging cases is safe.

A study of factors determining difficult surgery among patients undergoing laparoscopic cholecystectomy

Background: With widespread use of laparoscopic cholecystectomy and its applicability in many difficult situation, the chances of complication and difficulty during surgery have increased. This study was done to determine the factors which could preoperatively predict difficulty undergoing laparoscopic cholecystectomy.Methods: The data were obtained from the patients admitted to in wards of General Surgery, JN Medical Collage, Aligarh Muslim University, and Aligarh, India undergoing laparoscopic cholecystectomy. The difficult laparoscopic cholecystectomy was defined as procedures exceeded 70 minutes in duration or those which were converted to open procedure. Dependent variable included demographic factors, clinical and sonographic findings. P value was kept at 0.05.Results: During the study duration, 200 patients were included in the study undergoing for the laparoscopic cholecystectomy and out of this 85 had difficult outcome procedure. High BMI, hypertension, previous upper abdomen surgery, deranges AST and serum creatinine along sonographic findings of gall balder wall thickening and pericholecytsic edema were found to be significantly associated with difficult LC.Conclusions: This study demonstrates that presence of various factors can predict the difficult outcome of laparoscopic cholecystectomy. This can help in minimizing the complication and council the patients regarding difficult procedure and need for conversion to open cholecystectomy, especially relevant for funds-limited settings like India.

The impact of dementia on surgical outcomes of laparoscopic cholecystectomy for symptomatic cholelithiasis and acute cholecystitis: A retrospective study.

The aim of this study was to clarify the impact of dementia on surgical outcomes of laparoscopic cholecystectomy for symptomatic cholelithiasis and acute cholecystitis. We reviewed medical data of 96 patients who underwent laparoscopic cholecystectomy for symptomatic cholecystitis and acute cholecystitis. The patients were divided into the dementia group (n = 18) and non-dementia group (n = 78). Clinical features of the patients and surgical outcomes were compared between the two groups. Mean age and rates of The American Society of Anesthesiologists Physical Status classification score > 2 in the dementia group were significantly higher than those of the non-dementia group (P < .001, P = .008, respectively). Incidences of acute cholecystitis and the rate of percutaneous transhepatic gallbladder drainage in the dementia group were significantly higher than those of the non-dementia group (P = .009, P = .01, respectively). The rates of conversion to laparotomy and non-surgical complications in the dementia group were higher than those in the non-dementia group (P = .02, P = .03, respectively). Postoperative hospital stay in the dementia group was significantly longer than that in the non-dementia group (15.2 ± 9.3 vs 8.2 ± 3.2 days, P = .009). Subgroup analysis of patients with acute cholecystitis showed postoperative hospital stay in the dementia group to be significantly longer than that in the non-dementia group (18.7 ± 10.7 vs 10.3 ± 4.2 days, P = .03). Patients with dementia who underwent laparoscopic cholecystectomy have a high incidence of acute cholecystitis and a high rate of percutaneous transhepatic gallbladder drainage, which may result in increased rates of conversion to laparotomy and prolong the postoperative hospital stay.

Laparoscopic Cholecystectomy with Single Port Access System in 15 Dogs

To evaluate the outcome of laparoscopic cholecystectomy performed with a single port access system (SPAS) in dogs. Retrospective study. Fifteen client-owned dogs with nonobstructive gallbladder disease. Medical records were reviewed for signalment, clinical signs, diagnostic imaging, surgical findings, and outcome until suture removal. The SPAS was placed 1 cm caudal to the umbilicus. The procedure was completed with the SPAS alone in two cases. An additional cannula was added in 12 cases. In the last 10 cases, the additional cannula was placed at the beginning of the procedure. Dissection began at the cystic duct in 11 dogs (73%). In three cases (20%), the SPAS procedure was converted to a laparotomy; two of these conversions were elective, and one was emergent. The risk of conversion was affected by the experience of the surgeon (odds ratio = 0.53; P = .0105), and the rate of conversion was reduced when a cannula was added at the beginning of the procedure (P = .022). Fourteen dogs were discharged from the hospital. One dog died after being discharged due to severe cholangiohepatitis, and another dog died due to leakage of a gastrostomy tube. The use of SPAS for cholecystectomy in dogs has an acceptable outcome. The experience gained by the surgeon and the addition of a cannula reduced the risk of conversion. Laparoscopic cholecystectomy can be performed with a SPAS. The placement of an additional cannula at the beginning of the procedure is highly recommended.

Outcome of Laparoscopic Cholecystectomy as Ambulatory Surgery: Experience of 250 Cases

Background: Laparoscopic cholecystectomy 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.&#x0D; Methods: Data from 250 patients with cholelithiasis who underwent laparoscopic cholecystectomy in BIRDEM General Hospital from April 2017 to June 2018 as ambulatory surgery (hospital stay d”23 Hours) with or without overnight stay were analyzed. Complications, admissions and readmissions, patient satisfaction and treatment expenditure were assessed.&#x0D; Results: Mean duration of hospital stay was 17.3 hours. Two patients had complications (deep port site infection) on 5th post-operative day after surgery. Only 2.4% patients required readmission while 9.2% patients had unplanned admission. Seventy six point four percent patients were highly satisfied with the procedure. Treatment cost was about 15% lower than routine inpatient operation.&#x0D; Conclusion: Laparoscopic cholecystectomy can be performed as an outpatient procedure with a low rate of complications and admissions/readmissions. Patient acceptance in terms of satisfaction is high.&#x0D; Birdem Med J 2019; 9(2): 157-161