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Male gender is not a risk factor for the outcome of laparoscopic cholecystectomy: A single surgeon experience  [cached]
Al-Mulhim Abdulmohsen
Saudi Journal of Gastroenterology , 2008,
Abstract: Background/Aim: Previous studies regarding the outcome of laparoscopic cholecystectomy (LC) in men have reported inconsistent findings. We conducted this prospective study to test the hypothesis that the outcome of LC is worse in men than women. Materials and Methods: Between 1997 and 2002, a total of 391 consecutive LCs were performed by a single surgeon at King Fahd Hospital of the University. We collected and analyzed data including age, gender, body mass index (kg/m 2 ), the American Society of Anesthesiologists (ASA) class, mode of admission (elective or emergency), indication for LC (chronic or acute cholecystitis [AC]), comorbid disease, previous abdominal surgery, conversion to open cholecystectomy, complications, operation time, and length of postoperative hospital stay. Results: Bivariate analysis showed that both genders were matched for age, ASA class and mode of admission. The incidences of AC ( P = 0.003) and comorbid disease ( P = 0.031) were significantly higher in men. Women were significantly more obese than men ( P < 0.001) and had a higher incidence of previous abdominal surgery ( P = 0.017). There were no statistical differences between genders with regard to rates of conversion ( P = 0.372) and complications ( P = 0.647) and operation time ( P = 0.063). The postoperative stay was significantly longer in men than women ( P = 0.001). Logistic regression analysis showed that male gender was not an independent predictor of conversion (Odds ratio [OR] = 0.37 and P = 0.43) or complications (OR = 0.42, P = 0.42). Linear regression analysis showed that male gender was not an independent predictor of the operation time, but was associated with a longer postoperative stay ( P = 0.02). Conclusion: Male gender is not an independent risk factor for satisfactory outcome of LC in the experience of a single surgeon.
The Professional Medical Journal , 2011,
Abstract: Laparoscopic cholecystectomy is the gold standard treatment for patients presenting with acute gall stone disease necessitatinghospital admission. Objective: To assess the impact of timing of laparoscopic cholecystectomy on conversion rate, hospital stay and morbidity.Period: Jan 2008-2010. Setting: Department of Surgery, Independent University Hospital, Faisalabad. Study Design: Experimental study.Material & Methods: The subjects were included by consecutive sampling technique. 81 cases were divided into 3 groups. Group A (Surgerywithin 72 hrs of onset symptoms). Group B (surgery between 72hrs to 96 hours of onset of symptoms). Group C (surgery after 96 hours of onsetof symptoms). Results: The mean age was 41-95 years. Female to male ratio was 4.5:1. The overall complication rate was 12.69%. Meanhospital stay was 2.85 days. The open conversion rate was 8.64%. In group A the complication rate was 6%, group B 11.5% and group C 12.8&.The mean hospital stay and conversion rate had no significant difference. Conclusions: The timing of laparoscopic cholecystectomy has nosignificant impact on the conversion rate and length of hospital stay in cases with acute cholecystitis. However the complication rate was higherwhen surgery performed after 72 hours of onset of symptoms.
Laparoscopic cholecystectomy in acute cholecystitis: An analysis of the risk factors
S Botaitis, M Pitiakoudis, S Perente, G Tripsianis, A Polychronidis, C Simopoulos
South African Journal of Surgery , 2012,
Abstract: Background and aim: Laparoscopic cholecystectomy (LC) is increasingly being used as the initial surgical approach in patients with acute cholecystitis (AC). We describe our experience with LC in the treatment of AC. Materials and methods: In this study 2 412 patients underwent LC, in 315 cases for AC. The diagnosis was based on clinical, laboratory and intra- operative findings. Rates of conversion, complications, length of hospital stay, operating times, and factors associated with conversion or morbidity were analysed. Results: Conversion to open cholecystectomy was necessary in 60 patients (19.04%) with AC. Factors associated with conversion were age >65 years, male gender, presence of empyema, previous abdominal surgery, and fever (temperature >37.5oC). There were no deaths, and the complication rate was 6.4%. The only risk factor for morbidity was a bilirubin level of >20.52 μmol/l. The operating time and hospital stay were significantly longer in AC than in elective cases. Conclusions: LC for AC is technically demanding but safe and effective. With patience, experience, careful dissection and identification of vital structures, the laparoscopic approach is safe in the majority of cases.
What necessitates the conversion to open cholecystectomy? A retrospective analysis of 5164 consecutive laparoscopic operations
Genc, Volkan;Sulaimanov, Marlen;Cipe, Gokhan;Basceken, Salim Ilksen;Erverdi, Nezih;Gurel, Mehmet;Aras, Nusret;Hazinedaroglu, Selcuk M;
Clinics , 2011, DOI: 10.1590/S1807-59322011000300009
Abstract: objective: laparoscopic cholecystectomy (lc) has become the gold standard for the surgical treatment of gallbladder disease, but conversion to open cholecystectomy is still inevitable in certain cases. knowledge of the rate and impact of the underlying reasons for conversion could help surgeons during preoperative assessment and improve the informed consent of patients. we decided to review the rate and causes of conversion from laparoscopic to open cholecystectomy. method: this study included all laparoscopic cholecystectomies due to gallstone disease undertaken from may 1999 to june 2010. the exclusion criteria were malignancy and/or existence of gallbladder polyps detected pathologically. patient demographics, indications for cholecystectomy, concomitant diseases, and histories of previous abdominal surgery were collected. the rate of conversion to open cholecystectomy, the underlying reasons for conversion, and postoperative complications were also analyzed. results: of 5382 patients for whom lc was attempted, 5164 were included this study. the overall rate of conversion to open cholecystectomy was 3.16% (163 patients). there were 84 male and 79 female patients; the mean age was 52.04 years (range: 26-85). the conversion rates in male and female patients were 5.6% and 2.2%, respectively (p<0.001). the most common reasons for conversion were severe adhesions caused by tissue inflammation (97 patients) and fibrosis of calot's triangle (12 patients). the overall postoperative morbidity rate was found to be 16.3% in patients who were converted to open surgery. conclusion: male gender was found to be the only statistically significant risk factor for conversion in our series. lc can be safely performed with a conversion rate of less than 5% in all patient groups.
Conversion Rate of Laparoscopic Cholecystectomy to Open Surgery at Al Karamah Teaching Hospital, Iraq  [PDF]
Basim Jasim Abdulhussein, Yarub Fadhil Hussein, Abdulsalam Hatem Nawar, Redhwan Ahmed Al-Naggar
Surgical Science (SS) , 2015, DOI: 10.4236/ss.2015.65034

Background: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall bladder disease. However, there still a substantial proportion of patients in whom Laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. Method: In this study, 1600 laparoscopic cholecystectomy performed at Al karamah teaching hospital from January 2010 to January 2015, were prospectively analyzed. The patients studied included 1600, 1245 where females (78.4%) and 346 where males (21.6%) with a mean age of 41.2 years. From the data collected, only factors available to surgeon preoperatively were considered for analysis. These factors included: age, gender, history of acute Cholecystitis, jaundice, previous abdominal surgery, obesity and concomitant disease, ultrasound preoperatively & ERCP. Results: Of the 1600 patients in whom Laparoscopic cholecystectomy was attempted 56 patients (3.5%) required conversion to open surgery. The most common reason for conversion was difficult to define anatomy in patients with inflamed, contracted gall bladder (n = 42). Significant predictor factors for conversion were male gender, previous abdominal surgery, acute Cholecystitis, and obesity. Conclusion: An appreciation for these predictors for conversion will allow appropriate planning by the patient, the institution and the surgeon.

The Professional Medical Journal , 2003,
Abstract: Background: Postoperative shoulder tip pain occurs frequently following laparoscopic cholecystectomy. The aim of thisrandomized clinical trial was to evaluate the efficacy of a low pressure carbon dioxide pneumoperitoneum during laparoscopicsurgery in reducing the incidence of postoperative shoulder tip pain. Material & Methods: Ninety consecutive patients undergoinglaparoscopic cholecystectomy were randomized prospectively into low pressure (group A) and normal pressure (group B)laparoscopic cholecystectomy groups. Patients in group A (n=46) underwent laparoscopic cholecystectomy with 10 mm Hg carbondioxide pneumoperitoneum during most of the operation and those in group B (n=44) had laparoscopic cholecystectomy with 14mmHg pneumoperitoneum. Shoulder tip pain was recorded on a visual analogue pain scale 1,3,6,12, 24 and 48 hours afteroperation. Results: The low pressure pneumoperitoneum did not increase the duration of surgery. There were no significantintraoperative or postoperative complications in either group. Fourteen patients (32%) in group B and five (11%) in group Acomplained of shoulder pain. Mean shoulder tip pain scores at 12 and 24 hours and postoperative analgesia requirements werealso significantly lower in the low pressure laparoscopic cholecystectomy group. Conclusion: A carbon dioxidepneumoperitoneum pressure lower than that usually utilized to perform laparoscopic surgery reduces both the frequency andintensity of shoulder tip pain following laparoscopic cholecystectomy.
The Professional Medical Journal , 2009,
Abstract: Objective: To determine the frequency of bleeding, surgical site infection and common bile duct injury after laparoscopic Cholecystectomy in patients with co-morbidity. Study design: Descriptive study. (Case series). Setting: Department of Allied & D.H.Q hospital Faisalabad. Period: July 2006 to December 2007. Patients and Methods: It comprised of 30 consecutive patients of cholelithiasis with co-morbidity presenting in surgical department. Patients having uncontrolled hypertension, chronic obstructive airway disease and malignancy were excluded. Detailed history and physical examination was carried out as per protocol. It was followed up by relevant investigations. All the cases underwent laparoscopic cholecstectomy. Results: The age of the patients ranged from 23-68 y, with mean age of 40-56 y. Among these 14 cases were having D.M (46.66 %), 06 patients were cirrhotic (20%), 06 patients had acute cholecystitis (20%), 02 patients were having H.T.N (6.6%), and 02 patients were >70 years (6.6%). All the patients were females. Out of diabetic patients undergoing laparoscopic cholecystectomy, SSI was noted in 02 ( 6.66%) patients. While mild postoperative bleeding was noted in 01 (16.6%) of cirrhotic patients after laparoscopic cholecystectomy. No untoward event was noted in patients with H.T.N ac. Cholecystitis & advanced age. Conclusion: In high risk patients undergoing laparoscopic cholecystectomy, very few complications were noted. Postoperatively. Morbidity following above procedure was quite low as compared to conventional one. Laparoscopic cholecystectomy should be the preferred option in high risk patients for better outcome.
The Professional Medical Journal , 2009,
Abstract: Objective: To determine if intraoperative instillation of bupivacaine into gall bladder fossa would decrease early postoperative pain after laparoscopic cholecystectomy, Design: Double-blind, randomized, controlled trial. Setting: Surgical Unit-I, Holy Family Hospital, Rawalpindi and Surgical Unit-1, Benazir Bhutto Hospital, Duration: Two year study. Patients: Fifty patients underwent laparoscopic cholecystectomy group-A. They were compared with a control group of fifty patients who had laparoscopic cholecystectomy but did not receive bupivacaine Group-B. Intervention: Instillation of 10 ml of 0.5% bupivacaine into gall bladder fossa intra operatively after removal of gall bladder. Main Outcome Measures: Visual analogue scale (VAS) pain scores assessed 3 times post operatively, at 1, 6 & 24 hours, using similar peroperative and postoperative analgesics in both groups. Main Outcome Measure: Mean VAS pain scores (range 0 [no pain] to 10 [severe pain]) at 1 hour and at 6 hours after surgery were 6.5 and 4.2 respectively, in the bupivacaine group (Group-A) compared with 6.2 and 4.5 respectively, in the control group(Group-B) (p =.085 and 0.078,sd=.919 and.495). VAS scores at 24 hours postoperatively did not differ between the two groups (2.4 VS 2.5)(p=.282,sd=.636). Conclusion: Instillation of bupivacaine into gall bladder fossa has no effect on post operative pain control in elective laparoscopic cholecystectomy
The Professional Medical Journal , 2010,
Abstract: Objective: To determine the frequency of common bile duct (CBD) injury in laparoscopic cholecystectomy in our settings, in mylast 500 cases, after going through the learning curve associated CBD injuries. Design: Descriptive study. Place and Duration of Study:Surgical Unit-I, Rawalpindi General Hospital and the author’s Surgical Clinics from January 2003 to December 2008. Patients and Methods:Five hundred patients undergoing laparoscopic cholecystectomy by the same surgeon were included. The important variables includeddemographic data, intra operative time and findings, frequency of CBD injury and post operative hospital stay. Results: There were 419(83.8%)females and 81(16.2%) males with mean age 45.04±11.03 years. 294(58.8% )patients had chronic cholecystitis with Cholelithiasis and were admitted through Out Patient Department whereas 206(41.2%) were admitted through Accident and Emergency Department with acutecholecystitis. Abdominal ultrasound showed multiple calculi in 351(70.2%) patients and 149(29.8%) patients had single calculus preoperatively. Empyema was found in 97(19.4%) cases whereas adhesions were present in 182( 36.4%) patients. In our study frequency of CBD injury was 1%. Mean operating time was 35 minutes. 96.8 % of the patients were discharged within 48 hrs of operation. Conclusion: Laparoscopic Cholecystectomy in our set up proved to be a safe procedure, having frequency of CBD injury of only 1% and a short hospital stay 493(96.8% )being discharged in less than 2 days.
Paediatric gallstones and laparoscopic cholecystectomy  [PDF]
D. G. Samuel, N. N. Naguib, A. Y. Izzidien
Health (Health) , 2010, DOI: 10.4236/health.2010.21011
Abstract: Introduction: Gall stones disease is a rare oc-currence in paediatric patients and the diagno-sis is often overlooked. Patients often present with non-specific symptoms of abdominal pain and the classic features of gallstones are some-times absent [1]. The aim of our study is to in-crease the awareness of cholecystitis and acute pancreatitis being a possible occurrence in the paediatric age group and should therefore be in the differential diagnosis of acute abdominal pain in children. We undertook a retrospective analy- sis of all the paediatric patients recorded as hav- ing had a laparoscopic Cholecystectomy per-formed at Prince Charles Hospital. 8 paediatric patients underwent Laparoscopic cholecysteco- my between 2000 and 2008 consisting of 5 fe-male patients and 3 male patients. The average age of the cohort was 14.1 years [12-16]. Pre- morbid obesity was a feature in 4 patients and all patients reported high fat diet. Abdominal Ul- trasound used to assess all 8 patients who pre- sented with acute abdomen showed gallstones to be present in all. 7 patients underwent an ele- ctive procedure 3-6 months after the initial di-agnosis was made and 1 patient had laparosco- pic Cholecystectomy within 72 hours of initial presentation. 1 patient was found to have an in- herited haematological disorder and 2 of the pa- tients were sisters with a family history of gall- stone disease. 2 patients presented with acute pancreatitis. Gallstone related cholecystitis is a rare occurrence amongst paediatric patients and is often overlooked as a differential diagnosis. We report 8 patients over an 8 year period. Con- clusion: It is important that clinicians include cholecystitis and biliary colic in the differential diagnosis of patients presenting with acute ab-domen in childhood not explained by other di-agnoses. Laparoscopic Cholecystectomy is the treatment of choice and has minimal complica-tions.
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