Cholecystectomy Research Articles

Clinical outcomes of minimally invasive (laparoscopic and robotic) versus open extended cholecystectomy: A multicenter propensity score matched study.

This multicenter study aimed to compare the clinical outcomes of minimally invasive extended cholecystectomy (MI-EC) versus open EC (O-EC) for patients with gallbladder cancer (GBC). Patients who underwent EC (cholecystectomy, wedge resection of the liver bed, and regional lymphadenectomy) for GBC between 2010 and 2020 in three centers were included in the study. The clinicopathological data were compared after propensity score matching. Additional subgroup analysis on laparoscopic and robotic EC (L-EC and R-EC) was performed. A total of 377 patients were included: 308 for O-EC and 69 for MI-EC, respectively. The MI-EC group had a longer operative time (188.9 vs. 238.1 min, p < .001) and shorter hospital stay (9.0 vs. 7.2 days, p = .007), although no differences were found in operative blood loss, complication rate and survival outcome. In subgroup analysis, L-EC patients had a longer operative time (264.4 vs. 202.0 min, p = .001), compared to R-EC patients with comparable perioperative and survival outcomes. Although patients with MI-EC had a longer operation time and higher medical costs, the advantages were enhanced recovery with comparable short- and long-term outcomes. The operation time was less for R-EC patients than for L-EC patients, though the high cost still remains. The surgery type for EC can be selected according to the patient's condition, social status and surgeon's preference.

Zinc Transporter ZnT1 mRNA Expression Is Negatively Associated with Leptin Serum Concentrations but Is not Associated with Insulin Resistance or Inflammatory Markers in Visceral Adipose Tissue.

The aim of this study was to evaluate the relationship between biomarkers of chronic inflammation, insulin resistance, and zinc transporter ZnT1 expression in human visceral adipose tissue. Visceral adipose tissue obtained from 47 adults undergoing laparoscopic surgery for cholecystectomy was used to analyze ZnT1 mRNA expression by RT-qPCR. ZnT1 mRNA levels were compared between subjects with normal weight, overweight, and obesity. A significantly lower ZnT1 expression was observed in overweight and obesity compared with normal-weight subjects (p = 0.0016). Moreover, subjects with normal weight had significantly higher serum zinc concentration (97.7 ± 13.1mg/L) than subjects with overweight (87.0 ± 12.8mg/L) and obesity (83.1 ± 6.6mg/L) (p = 0.002). Pearson test showed a positive correlation between serum zinc concentrations and ZnT1 mRNA expression in visceral adipose tissue (r = 0.323; p = 0.031) and a negative correlation with body mass index (r = - 0.358; p = 0.013). A linear regression model was used to analyze the associations between ZnT1 mRNA expression and serum zinc levels, insulin resistance (HOMA2-IR), serum adipokines (leptin and adiponectin), and serum inflammation biomarkers (tumor necrosis factor alpha, interleukin-6, and C-reactive protein). Interestingly, leptin concentrations were negatively associated with ZnT1 mRNA expression (p = 0.012); however, no significant associations were found for the rest of the analyzed variables. Future research is needed to analyze the causality of negative association between ZntT1 expression in visceral adipose tissue and leptin.

Subtotal cholecystectomy; A substandard bail-out technique?

Introduction: While the open approach was previously mandated as the salvage procedure in difficult cholecystectomies, subtotal cholecystectomy has since been implemented. While this technique may prevent biliary duct injury intraoperatively, it comes with major pitfalls. Case Series: We present a series of four cases where a subtotal cholecystectomy was previously performed, in which further gallstone-related complications occurred. Conclusion: We aim to increase awareness toward recurrent symptoms that may require further evaluation and repeat procedures in patients with previous cholecystectomy; and drawbacks relating to performing subtotal cholecystectomies—opting instead for open cholecystectomy, recruitment of another senior or specialist hepatobiliary surgeon and/or transfer to a tertiary center with the appropriate facilities.

Subtotal cholecystectomy as an approach to preventing injury in the left-sided gallbladder in the emergency surgery setting: A case study

A left-sided gallbladder is an unusual anatomic variation that makes gallbladder surgery challenging. Two systematic reviews on surgery for left-sided gallbladder highlighted high iatrogenic bile duct injury rates of 4.4% and 7.3%. This paper reports a female in her 40s with symptoms of acute calculous cholecystitis admitted to a secondary health-care center. After inserting four ports through standard sites for conventional gallbladder surgery, laparoscopic inspection revealed a phlegmonous left-sided gallbladder. No discordant situs of abdominal viscera was noted. Laparoscopic surgery was converted to open subtotal closed-tract cholecystectomy. No post-operative complications related to the surgical site were observed. A left-sided gallbladder affected by severe inflammation and infection is an extraordinary condition that should be considered as a risk factor. If an inflamed left-sided gallbladder is encountered, emergency subtotal cholecystectomy is an alternative to total cholecystectomy when the circumstances to adopt the strategies of a culture of safety in cholecystectomy for complete removal of the gallbladder are unfavorable. Relevance for Patients: Subtotal cholecystectomy in patients with left-sided gallbladder reduces the risk for bile duct injuries, outweighing the potential side effects stemming from this surgical approach.

The Nassar Scale as an Instrument for Predicting Conversionof Laparoscopic to Open Cholecystectomy

Background: Difficult cholecystectomy, often associated with a heightened risk of complications, poses a significant surgical dilemma. Risk factors, such as patient age, increased body weight, the presence of gallstones, acute cholecystitis, and prior abdominal surgeries, can complicate laparoscopic cholecystectomy and necessitate conver- sion to an open procedure for safety. The aim of our study was to assess the applicability of the Nassar scale in predicting the need for conversion from laparoscopic to open cholecystectomy.Material and methods: In our prospective cohort study, we included 85 patients who underwent either emergency or elective laparoscopic cholecystectomy between December 2021 and October 2023. The Nassar scale was used to assess the complexity of laparoscopic cholecystectomy, incorporating parameters such as ‘Gallbladder,’ ‘Cystic pedicle,’and ‘Adhesions’ to determine a final score ranging from 1 to 5. Statistical analysis involved descriptive and analytical methods, with the significance threshold set at p &lt; 0.05.Results: ANOVA analysis revealed a statistically significant difference in the duration of operative procedures with different Nassar grades (p &lt; 0.001). An increase in the Nassar grade by 1 was associated with a statistically significant6.23-fold increase in the odds of conversion to an open procedure (p &lt; 0.001). Receiver Operating Characteristic (ROC) analysis demonstrated a highly significant association (p &lt; 0.001) between the Nassar grade and the conversion event, with an Area Under the Curve (AUC) of 0.881 (95% CI 0.79,0.96). The optimal cutoff value, identified as &gt;2.5, struck a balance between sensitivity (0.86) and 1-specificity (0.23). Conclusion: Our study underscores the utility of the Nassar scale in surgical practice. It provides valuable insights into assessing the severity of operations, facilitating informed decision-making, and optimizing treatment outcomes for patients undergoing laparoscopic cholecystectomy at our institution.

Bailout Surgery for Difficult Gallbladders: Surgical Approach and Outcomes.

Inflammation in acute cholecystitis may cause a cholecystectomy to be more challenging. Due to the difficult dissection, conversion to subtotal cholecystectomy via laparoscopic or open procedure may be required. This is done to reduce the risk of bile duct injury and hemorrhage. We sought to describe the incidence and risk factors, safety, morbidity, and outcomes associated with bailout procedures. A single academic center, retrospective review of laparoscopic cholecystectomies that resulted in bailout procedures performed between January 2015 and December 2020. Data collected from the chart review included demographics, comorbidities, length of presenting symptoms, vital signs, laboratory and imaging, intraoperative findings, length of surgery, and outcome. A total of 1892 cholecystectomies were performed with 147 bailout procedures. For bailout 92 (63.4%) were converted to open, with 66% resulting in complete cholecystectomy. Hypertension and diabetes were the most common comorbidities. The median duration of symptoms was 4days. Difficult anatomy in the hepatocystic triangle (66%) and dense adhesions (31%) were the most common reasons for bailout. The mean duration of surgery was 145.76 (SD 102.94) minutes. There were 2 bile duct injuries, both in open total cholecystectomy subgroup. Bile leak occurred in 23.8% with majority in subtotal cholecystectomy group. There was no difference in hospital length of stay, surgical site infection, or mortality among different bailout procedures. Subtotal cholecystectomy represents a safe alternative to total cholecystectomy during challenging cases to avoid damaging surrounding structures. The choice of laparoscopic or open subtotal approach is dependent on the surgeons' expertise.

Gender variation in operative findings and outcome in patients undergoing laparoscopic cholecystectomy at Birat Medical College Teaching Hospital

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis. Despite advancement in surgical instrument and operating technique, conversion to open cholecystectomy is still worrisome concern to surgeons. There are various preoperative factors impacting on conversion. Male gender as an independent risk factor for conversion is still debatable. Ojectives: This study aims to study the role of male gender, its impact on operative findings and conversion.Methodology: A total number of 131 patients diagnosed as symptomatic cholelithiasis and who fulfilled the inclusion criteria underwent laparoscopic cholecystectomy. Data related to patients demographics like age sex, intraoperative complications like bleeding, bile leak, duration of surgery, conversion if any was noted. Reason for conversion was also noted. Postoperative complications like pain, surgical site infection and duration of hospital stay was noted. Results: In this study, A total of 130 patients participated in this study of which 64 (51.70%) were male (M) and 66 (44.89%) were female (F). Mean age of presentation was 48.25 years, youngest being 23 years and elder being 78 years of age. Mean operating time was 40.66 minutes. Bile leak was seen in 2 patients in male (M) group while no such event was observed in the female group (p value 0.240). There was no organ injury observed in either group. 1 patient in the female (F) group had postoperative pancreatitis (p value 1.00). Postoperative obstructive jaundice was noted in 2 patients in female group (F), p value 0.496. It was observed that 7 male patients had conversion to open during the procedure while only 3 cases were converted in the female gender group, p value of 0.203. Bile duct injury was seen in 1 patient in male (M) gender group, p value 0.492. However, this injury was not seen in the conversion group. All cases undergoing conversion had mean operating time of 75.3 minutes and this was more in male (M) group. Conclusion: Laparoscopic cholecystectomy is difficult in male (M) gender group compared to females and operating time is also longer, however male gender is not an independent risk factor for conversion.

The Impact of Ultrasound-Guided Subcostal Transversus Abdominis Plane (SCTAP) Block on Postoperative Pain Relief in a Patient Undergoing Cholecystectomy: A Case Report

Introduction: Handling post-operative pain in cholecystectomy requires several considerations, especially in terms of pain management. Various multimodal analgesia strategies to optimize postoperative pain control include epidural catheter placement, intravenous opioids, and the recently introduced ultrasonography (USG)-guided subcostal transversus abdominis plane (SCTAP) block. This case report aims to describe the postoperative analgesic effectiveness of ultrasound-guided SCTAP block in a patient undergoing open cholecystectomy.&#x0D; Case presentation: A 57 year old female patient with a diagnosis of multiple cholelithiasis, cholecystitis, was planned to undergo cholecystectomy, under general anesthesia and SCTAP block, with an ultrasound probe placed under the costal margin, the transversus abdominis muscle fascia was identified and local anesthetic infiltration laterally with bupivacaine plain 0.25 % 20 ml each on the left and right sides. Postoperatively, the patient returned to the room and received oral analgesics without opioids for pain management.&#x0D; Conclusion: Ultrasound-guided SCTAP blocks provide effective postoperative analgesia, reduce the need for postoperative analgesics, while supporting recovery after open cholecystectomy.

A COMPARISON OF INTRAPERITONEAL INSTILLATION OF ROPIVACAINE AND ROPIVACAINE WITH DEXMEDETOMIDINE FOR POSTOPERATIVE ANALGESIA FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE STUDY

Objective: laparoscopic cholecystectomy surgeries are having advantages over open cholecystectomy with less pain and quick recovery. Intraperitoneal route of administration of a local anaesthetic is a cheap, easy and non-invasive method of reducing the intensity of post laparoscopic pain. This study compared the postoperative analgesic effect of intraperitoneal instillation of ropivacaine 0.5% and ropivacaine 0.5% with dexmedetomidine (1µg/kg) in patients undergoing laparoscopic cholecystectomy under general anaesthesia.&#x0D; Methods: Total 86 patients were divided equally in 2 groups. Patients in group R received 20 ml 0.5% isobaric ropivacaine hydrochloride+5 ml NS where in Group RD, patients received 20 ml 0.5% isobaric ropivacaine hydrochloride with 1µg/kg dexmedetomidine hydrochloride. Solution was diluted with normal saline to make a total volume 25 ml. Hemodynamic parameters were noted during surgery Postoperatively, patient was assessed for pain using the visual analogue scale (VAS) at 30 min, then 2,4,8,12 and 24 h. Total analgesic consumption in the first 24 h also compared.&#x0D; Results: Baseline demographic profile of study participants were similar. Mean duration of analgesia was significantly higher in group RD (10.05±6.916 h) as compared to group R (5.59±6.8) (p=0.003). Mean dose of rescue analgesia was significantly higher in group R (130.81±61.44) as compared to group RD (75±36.6) (p&lt;0.001). VAS score was significantly higher in group R as compared to group RD at different time intervals.&#x0D; Conclusion: We concluded that intraperitoneal Ropivacaine with Dexmedetomidine produced postoperative analgesia better than ropivacaine alone.

Safety and Efficacy of Early Cholecystectomy in Acute Biliary Pancreatitis

Objective: This study was done to assess the safety and efficacy of early Cholecystectomy in mild to moderate Acute Biliary pancreatitis in own surgical setup.&#x0D; Methodology: This descriptive study was done in surgical unit 1, Fauji Foundation Hospital Rawalpindi from 1st January 2019 to 31st December 2022. Total 70 patients diagnosed as having mild or moderate acute biliary pancreatitis were included in study. Patients having severe acute biliary pancreatis, multi-organ dysfunction syndrome and pre-existing severe medical co-morbidity were excluded from study. After informed consent early cholecystectomy either laparoscopic or open was performed by senior consultant surgeon within 2-4 days of admission. Post-operatively patient subjective feeling of pain, intravenous analgesia and hospital stay were recorded. Post-operative complications were documented. Data were analyzed on SPSS version 26.&#x0D; Results: The age range was from 28 to 72 years with a mean of 45.2 ± 11.86 years. Majority of patients were of mild severity 44(62.9%), while 26(37.1%) cases were of moderate severity. Laparoscopic cholecystectomy was performed 28(40%) cases and open cholecystectomy was done in 38(54.28%) cases. Post-operative pain numerical scale mean was 4.31 ± 1.55. The duration of requirement of post-operative intravenous analgesia was mean 37.02 ± 18.12 hrs. Mean hospital stay of patients was 5.95 ± 1.39 days. Among post-operative complications, the most frequent was post prandial dyspepsia 10(14.3%) cases followed by surgical site infection 6(8.6%) cases, recurrent pancreatitis 4(5.7%) cases, pseudocyst formation 2(2.9%) cases, lobar pneumonia 1(1.4%) case and recurrent biliary sepsis in 1(1.4%) case.&#x0D; Conclusion: Early cholecystectomy is a safe surgical procedure in mild to moderate biliary pancreatitis. It shortens the course of illness, prevents complications and reduces hospital stay.&#x0D; KEYWORDS: Cholelithiasis, Acute biliary pancreatitis, cholecystectomy, safety, Efficacy.

Surgical Safety Checklist as an optimal organizational model in ensuring the maximum degree of preparedness for intraoperative incidents (case report)

Objective. The use of checklists for quality and safety control of medical care is an effective tool for reducing the frequency of errors, dangers and complications in any section of medical practice.The aim is to demonstrate the possibilities of minimizing and leveling the potential risks accompanying surgical intervention using the example of routine application of the surgical safety checklist.Object and methods. Patient A., 55 years old, was admitted to the emergency department of Samara City Clinical Hospital №1 named after N.I. Pirogov on 24.04.2023. with complaints of pain in the right upper abdomen, nausea, vomiting, general weakness. The diagnosis was Cholelithiasis, acute calculous cholecystitis with the formation of a perivesical abscess. It required laparoscopic cholecystectomy operation. While filling in the surgical safety checklist (SSC) and analyzing possible intraoperative incidents, the attending physician executed an informed voluntary consent for transfusion of donor blood components. The corresponding components were ordered. Having weighted up the potential intraoperative risks specified in the part "Before anesthesia" of SSC, the anesthesiologist installed a catheter into one of the central veins and performed the urine bladder catheterization. Surgical intervention was complicated by bleeding, which required conversion of surgical approach. Upper median laparotomy, cholecystectomy, surgical hemostasis were performed. Total blood loss was 1000 ml, plasma and red blood cell were donated to the patient. The operation was completed by drainage of the subhepatic space and suturing of surgical wounds.Results. The clinical case describes the importance of a team approach at the stage before the operation, as well as the role of all specialists provided life support and medical care for the patient. It results from attentive work with the checklist which shows a clear liability for each member of the operating team at different stages of preparation and treatment of a surgical patient.Conclusions. The development of a culture of surgical safety is an important way to minimize the risks associated with surgical intervention for each individual patient and for the institution by optimizing the work of operating units.

The effects of pks+ Escherichia coli and bile acid in colorectal tumorigenesis among people with cholelithiasis or cholecystectomy.

Patients with cholelithiasis (CL) or cholecystectomy (CE) would have more chances of getting colorectal adenoma (CRA) or cancer (CRC). We aimed to figure out the effects of gut microbiota and bile acid on colorectal neoplasm in CL and CE patients. This was a retrospective observational study that recruited 514 volunteers, including 199 people with normal gallbladders (normal), 152 CL, and 163 CE patients. Discovery cohort was established to explore the difference in gut microbiota through 16S rRNA and metagenomics sequencing. Validation cohort aimed to verify the results through quantitative polymerase chain reaction (qPCR). Significant enrichment of Escherichia coli was found in patients with cholelithiasis or cholecystectomy both in the discovery cohort (16S rRNA sequencing, PNormal-CL=0.013, PNormal-CE=0.042; metagenomics sequencing, PNormal-CE=0.026) and validation cohort (PNormal-CL<0.0001, PNormal-CE<0.0001). Pks+ E.coli was found enriched in CL and CE patients through qPCR (in discovery cohort: PNormal-CE=0.018; in validation cohort: PNormal-CL<0.0001, PNormal-CE<0.0001). The differences in bile acid metabolism were found both through Tax4Fun analysis of 16S rRNA sequencing (Ko00120, primary bile acid biosynthesis, PNormal-CE=0.014; Ko00121, secondary bile acid biosynthesis, PNormal-CE=0.010) and through metagenomics sequencing (map 00121, PNormal-CE=0.026). The elevation of serum total bile acid of CE patients was also found in validation cohort (PNormal-CE<0.0001). The level of serum total bile acid was associated with the relative abundance of pks+ E.coli (r=0.1895, P=0.0012). E.coli, especially pks+ species, was enriched in CL and CE patients. Pks+ E.coli and bile acid metabolism were found associated with CRA and CRC in people after cholecystectomy.

ROBOtic Care Outcomes Project for acute gallbladder pathology.

Robotic cholecystectomy is being increasingly used for patients with acute gallbladder disease who present to the emergency department, but clinical evidence is limited. We aimed to compare the outcomes of emergent laparoscopic and robotic cholecystectomies in a large real-world database. Patients who received emergent laparoscopic or robotic cholecystectomies from 2020 to 2022 were identified from the Intuitive Custom Hospital Analytics database, based on deidentified extraction of electronic health record data from US hospitals. Conversion to open or subtotal cholecystectomy and complications were defined using ICD10 and/or CPT codes. Multivariate logistic regression with inverse probability treatment weighting (IPTW) was performed to compare clinical outcomes of laparoscopic versus robotic approach after balancing covariates. Cost analysis was performed with activity-based costing and adjustment for inflation. Of 26,786 laparoscopic and 3,151 robotic emergent cholecystectomy patients being included, 64% were female, 60% were ≥45 years, and 24% were obese. Approximately 5.5% patients presented with pancreatitis, and 4% each presenting with sepsis and biliary obstruction. After IPTW, distributions of all baseline covariates were balanced. Robotic cholecystectomy decreased odds of conversion to open (odds ratio, 0.68; 95% confidence interval, 0.49-0.93; p = 0.035), but increased odds of subtotal cholecystectomy (odds ratio, 1.64; 95% confidence interval, 1.03-2.60; p = 0.037). Surgical site infection, readmission, length of stay, hospital acquired conditions, bile duct injury or leak, and hospital mortality were similar in both groups. There was no significant difference in hospital cost. Robotic cholecystectomy has reduced odds of conversion to open and comparable complications, but increased odds of subtotal cholecystectomy compared with laparoscopic cholecystectomy for acute gallbladder diseases. Further work is required to assess the long-term implications of these differences. Therapeutic/Care Management; Level IV.

The effect of previous endoscopic retrograde cholangiopancreatography on subsequent laparoscopic cholecystectomy: The retrospective analysis of 1500 patients.

Laparoscopic cholecystectomy (LC) is the gold standard for patients with acute cholecystitis at early period. However, 15%-20% of patients with acute cholecystitis develop obstructive jaundice, cholangitis and bile duct stones ultimately requiring endoscopic retrograde cholangiopancreatography (ERCP). In such cases, a two-session approach is usually recommended, first ERCP followed by LC thereafter. However, the effect of prior ERCP on the difficulty of subsequent LC is unknown. Hence, the aim of the present study is to determine the effects of previous ERCP on the results of LC. In this study, the files of 1500 patients who underwent LC were reviewed retrospectively. The patients were divided into three groups (500 patients for each group). The patients undergoing LC for asymptomatic cholelithiasis were assigned to the L-e group. The patients who underwent LC for acute cholecystitis were assigned to the L-c group. The patients with acute cholecystitis who underwent ERCP first and then LC were assigned to the L-ercp group. The rates of conversion to open cholecystectomy, operation times, complication rates and hospital stays of the three groups were compared. The results of LC performed after ERCP are similar to the results of LC for cholecystitis without ERCP in terms of operation time, hospital stay, conversion and complications. Previous ERCP does not affect the safety and effectiveness of early LC in patients with acute cholecystitis.

Post-cholecystectomy bile duct injuries: a retrospective cohort study

BackgroundBile duct injury (BDI) is still a major worrisome complication that is feared by all surgeons undergoing cholecystectomy. The overall incidence of biliary duct injuries falls between 0.2 and 1.3%. BDI classification remains an important method to define the type of injury conducted for investigation and management. Recently, a Consensus has been taken to define BDI using the ATOM classification. Early management brings better results than delayed management. The current perspective in biliary surgery is the laparoscopic role in diagnosing and managing BDI. Diagnostic laparoscopy has been conducted in various entities for diagnostic and therapeutic measures in minor and major BDIs.Methods35 cases with iatrogenic BDI following cholecystectomy (after both open and laparoscopic approaches) both happened in or were referred to Alexandria Main University Hospital surgical department from January 2019 till May 2022 and were analyzed retrospectively. Patients were classified according to the ATOM classification. Management options undertaken were mentioned and compared to the timing of diagnosis, and the morbidity and mortality rates (using the Clavien-Dindo classification).Results35 patients with BDI after both laparoscopic cholecystectomy (LC) (54.3%), and Open cholecystectomy (OC) (45.7%) (20% were converted and 25.7% were Open from the start) were classified according to ATOM classification. 45.7% were main bile duct injuries (MBDI), and 54.3% were non-main bile duct injuries (NMBDI), where only one case 2.9% was associated with vasculobiliary injury (VBI). 28% (n = 10) of the cases were diagnosed intraoperatively (Ei), 62.9% were diagnosed early postoperatively (Ep), and 8.6% were diagnosed in the late postoperative period (L). LC was associated with 84.2% of the NMBDI, and only 18.8% of the MBDI, compared to OC which was associated with 81.3% of the MBDI, and 15.8% of the NMBDI. By the Clavien-Dindo classification, 68.6% fell into Class IIIb, 20% into Class I, 5.7% into Class V (mortality rate), 2.9% into Class IIIa, and 2.9% into Class IV. The Clavien-Dindo classification and the patient’s injury (type and time of detection) were compared to investigation and management options.ConclusionManagement options should be defined individually according to the mode of presentation, the timing of detection of injury, and the type of injury. Early detection and management are associated with lower morbidity and mortality. Diagnostic Laparoscopy was associated with lower morbidity and better outcomes. A proper Reporting checklist should be designed to help improve the identification of injury types.

CONVERSION OF LAPAROSCOPIC TO OPEN CHOLECYSTECTOMY

Background: Globally, gallstone disease (GS) is a significant health issue, especially for adults although cholecystitis is common, there is an evidence of variance in its diagnosis and course of therapy, including surgery. In place of open cholecystectomy, laparoscopic cholecystectomy is now the preferred course of treatment for symptomatic cholelithiasis. In situations where laparoscopic cholecystectomy is dangerous; a surgeon may be forced to change from laparoscopy to an open procedure. The aim of the study was to clarify the benefits and role of minimally invasive surgery in comparison to the open conventional method of cholecystectomy, with a focus on the postoperative phase and to compare the ratio of Laparoscopic and open cholecystectomy between male and female genders. Methods: 185 Patients of cholecystitis aged between 10 years to 80 years (86.5% males and 13.5% females) were presented to Zawia Medical Center during the period from March 2005 till April 2006 that randomly get an open or laparoscopic cholecystectomy. They were divided into open and laparoscopic Cholecystectomy group. Results: In this study, a total of 185 patients were included: 160 females (86.5% of the total) and 25 males (13.5% of the total). Whereas, 86 females (53.7%) were operated on by laparoscopic cholecystectomy, and 74 females (46%) were operated on by open cholecystectomy. In comparison, of a total of 25 males, 12 (48%) underwent laparoscopic cholecystectomy and 13 (52%) underwent open cholecystectomy. The conversion rate was eight cases (8.2%) due to technical, bleeding, or massive adhesion. Conclusion: From this study, we concluded that the laparoscopic cholecystectomy versus open cholecystectomy ratio (female: male ratio) was 86.5% to 13.5% of the total 185 patients, and laparoscopic cholecystectomy appears to be a safe procedure with quick recovery, early discharge from the hospital, and less postoperative pain as compared to open cholecystectomy.

Medical nutrition after cholecystectomy

Cholecystectomy (CE) is one of the most frequently performed surgical interventions and the main method of symptomatic gallstone disease treatment. Despite the widespread implementation of minimally invasive surgery techniques, significant proportion of patients develop spectrum of symptoms after CE. These manifestations require correction with different approaches including medical nutrition. The aim of the research was to perform structured review of recently published data related to diet therapy and nutritional support of patients after CE. Material and methods. A literature search was performed in PubMed/MEDLINE, EMBASE, Cyberleninka, eLibrary databases using the keywords "Cholecystectomy" in combination with "Diet", "Medical nutrition", "Nutritional support" and their Russianlanguage equivalents for the relevant databases. Correct description of interventions, analyzed outcomes, statistical processing and found effects where necessary for the inclusion to the analysis. Duplicate publications were excluded. Results and discussion. A review of the recommendations on nutritional support after CE has been conducted, including handbooks and clinical guidelines, results of relevant clinical trials evaluating the efficacy of different measures of nutritional support. The rational of traditionally used dietary approaches for the correction of symptoms that develop after CE has been assessed, as well as recently published data on the effectiveness of nutritional support methods. Conclusion. Disturbed regulation of bile secretion in the early CE postoperative period may support the need for limitation of fat consumption. Impaired circulation of bile acids and possible changes in the balance of intestinal microbiota may support the need for the use of prebiotics (like dietary fiber), as well as probiotics, especially when antibiotic treatment was administrated for the patient. These interventions may be important from the viewpoint of prevention of late complications after CE.

Comparative Analysis of Haemodynamic and Capnographic Changes in Laparoscopic Cholecystectomy and Open Cholecystectomy: A Randomised Clinical Study

Introduction: Laparoscopic cholecystectomy is now preferred over the open procedure due to advantages such as reduced blood loss and shorter hospital stays. However, concerns have been raised regarding the potential for increased Intra-abdominal Pressure (IAP) during laparoscopic procedures, which may impact haemodynamic stability and respiratory parameters. However, there is a lack of comprehensive analysis directly comparing both surgical approaches from both haemodynamic and capnographic perspectives. Aim: To compare the haemodynamic and capnographic changes between laparoscopic and open cholecystectomy. Materials and Methods: This randomised clinical study was conducted at Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam, India from May 2021 to June 2022. The study included 300 patients scheduled for cholecystectomy, divided into two groups: Laparoscopic Cholecystectomy (LC) Group I (n=150) and Open Cholecystectomy (OC) Group II (n=150). Haemodynamic parameters, including Pulse Rate (PR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Oxygen Saturation (SpO2 ), were recorded. Capnographic parameters, such as End-Tidal Carbon Dioxide (EtCO2 ) levels, were also measured at regular intervals. Data analysis was performed using the student’s t-test and Chi-square test with Statistical Package for Social Sciences (SPSS) version 21.0 software and Microsoft excel. Results: There were no significant differences in age, body weight, and sex distribution between Group I and Group II. However, significant differences were observed in PR and SBP at 15 minutes (PR: 101.46 and 95.86; SBP: 148.57 and 140.97), 30 minutes (PR: 104.52 and 99.82; SBP: 141.28 and 136.07), and 45 minutes (PR: 102.52 and 97.70; SBP: 140.59 and 133.95) (p-value &lt;0.01). Highly significant differences were observed in MAP and EtCO2 postinsufflation at 15 minutes (MAP: 118.38 and 108.61; EtCO2: 36.48 and 33.89), 30 minutes (MAP: 111.11 and 106.01; EtCO2: 41.02 and 36.15), 45 minutes (MAP: 110.73 and 103.48; EtCO2: 42.65 and 38.36), and 60 minutes (MAP: 106.08 and 101.45; EtCO2: 41.10 and 38.21) (p-value &lt;0.01). DBP showed high significance at 15 minutes (103.21 and 93.23), 30 minutes (96.74 and 92.57), and 60 minutes (93.14 and 86.92) (p-value &lt;0.01), and significant (p-value=0.01) at 45 minutes (95.53 and 87.59). Oxygen saturation showed significance (p-value &lt;0.05) at 15 minutes (99.93 and 100). Conclusion: The present study demonstrated a significant increase in both haemodynamic and capnographic parameters, even in American Society of Anaesthesiologists (ASA) Grade-I and Grade-II patients undergoing laparoscopic cholecystectomy compared to the open surgical technique. These findings emphasise the need for careful monitoring during laparoscopic procedures.

External Oblique Intercostal Plane Block for Open Cholecystectomy - A Novel Technique

Abstract The conversion of laparoscopic to open cholecystectomy with a large oblique subcostal incision may be associated with severe pain, leading to basilar atelectasis, delayed post-operative recovery and respiratory failure. Various techniques like thoracic epidural block, paravertebral blocks, erector spine block, transverse abdominis plane blocks and anterior quadratus lumboram plane block can be practised to alleviate the pain. In this particular case, we describe an External Oblique Intercostal Block which was given for postoperative analgesia after open cholecystectomy.

A comparative study of low-pressure pneumoperitoneum versus standard-pressure pneumoperitoneum in laparoscopic cholecystectomy in tertiary care center

Background: Laparoscopic cholecystectomy is the gold standard management of symptomatic cholelithiasis. We try to use low-pressure pneumoperitoneum (LPP) to study the effect of pneumoperitoneum in the duration of surgery, field of visualization with providing sufficient work space for surgeon, and post-operative shoulder pain and hospital stay in laparoscopic cholecystectomy. Aims and Objectives: The aims and objectives of the study are to compare outcomes in LPP versus standard-pressure pneumoperitoneum (SPP) with respect to duration of surgery, CO2 consumption, field of visualization, and surgical difficulties to convert SPP or open cholecystectomy and post-operative shoulder pain and hospital stay. Materials and Methods: The prospective randomized study was conducted in tertiary care center, Government Medical College, Banda, Uttar Pradesh from July 2021 to October 2022. All consented 100 patients after randomization were allotted into two groups. Results: In our study, the mean duration of surgery surgical difficulties to convert open and standard pressure and difficulty in field visualization insignificant is more in LPP as compared to SPP but CO2 consumption, post-operative shoulder pain, and mean hospital stay is less in LPP as compared to SPP. Conclusion: Laparoscopic cholecystectomy in LPP is safe and feasible. Field visualization, conversion rate, and duration of surgery are affected non-significantly because depend on the expertise of surgeon but shoulder pain, CO2 consumption, and hospital stay are less in LPP.