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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.
A. Yaghoobi Notash,Sh. Bahrpeyma M. H. Modaghegh
Acta Medica Iranica , 2004,
Abstract: Since CO2 pneumoperitoneum is the dominant method of laparoscopic exposure due to facility and good view, its physiologic effects are most relevant to the surgeons. CO2 pneumoperitoneum may affects hemodynamics by increased intra-abdominal pressure (IAP) and the physiologic effects of absorbed CO2. The adverse effects of both mechanisms relate directly to the duration of the pneumoperitoneum and the elevation of IAP. Gasless laparoscopy involves obtaining exposure for laparoscopy by placing an internal retracting device through a small incision and lifting the anterior abdominal wall. We designed and made a mechanical wall elevator and used it in 24 patients, compared with a control group (52 cases) using a conventional laparoscopic cholecystectomy. A prospective trial was undertaken in Sina Hospital, Tehran University of Medical Sciences from 1998 to 2000. The patients were assigned randomly to two groups. There was a significant decrease in IAP and CO2 consumption in the group using mechanical wall elevator as compared to conventional laparoscopic cholecystectomy, (mean IAP of 3.5 mmHg compared to 11.4 mmHg in the control group, mean CO2 volume 17 liters compared to 73 liters in the control group). We recommend this semigasless method in laparoscopy due to safety in performance and significant reduction in IAP through the surgery. This method provides a satisfactory view and easy performance without any increase in time or complications. The hospital stay and costs did not increase.
Cardiac arrest during laparoscopic cholecystectomy under general anaesthesia: A study into four cases  [PDF]
B Gautam,BR Shrestha
Kathmandu University Medical Journal , 2009, DOI: 10.3126/kumj.v7i3.2738
Abstract: Laparoscopic cholecystectomy (LapChole) has virtually superseded the more conventional open abdomen approach for the surgical treatment of symptomatic cholelithiasis. LapChole is however not a risk free procedure and serious, potentially fatal intra-operative complications can occur. Here we present case reports of four patients who suffered from intra-operative cardiac arrest during LapChole. All four recovered without residual morbidity and three of them underwent successful surgery in the same setting. No definite cause could be identified in any of the patients. We outline several possible mechanisms that could have been involved and discuss these events in face of published reports describing similar incidences. We infer that the creation of carbon-dioxide (CO2) pneumoperitoneum was involved in the causation of the cardiac arrest because all four incidences occurred within minutes thereafter. Although rare, such complications can be fatal and are thus demanding to the anaesthesiologist.
Radiological evaluation of patients after laparoscopic cholecystectomy  [cached]
Al Shehri Mohammad
Saudi Journal of Gastroenterology , 1999,
Abstract: The objective of this study is to describe the normal, abdominal radiological findings after laparoscopic cholecystectomy that could be confused with a pathological process. Thirty-one patients, who had laparoscopic cholecystectomy were prospectively studied. They underwent supine and erect abdominal X-rays, on the first and second postoperative days. In 19 patients (61 %) no residual free intraperitoneal gas was seen. In 12 patients (39%) small amounts of free gas were noticed 24 hours postoperatively, and in six (19%), some free intraperitoneal gas was seen after 48 hours. Distention of the colon was noticed in 17 (55%), and was mainly in the hepatic flexure area in nine of these patients (29%). Eight patients complained of shoulder pain. This study shows that pneumoperitoneum tends to disappear within 48 hours of laparoscopic cholecystectomy. When present, there is usually no cause for alarm as long as patients show no evidence of clinical disturbance.
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.
Effects of Laparoscopic Cholecystectomy on Intraocular Pressure  [PDF]
Alaa Mohammed Ibrahem Khalil, Waled Mahdy Nada
Open Journal of Ophthalmology (OJOph) , 2017, DOI: 10.4236/ojoph.2017.71005
Abstract: Purpose: To evaluate the effects of laparoscopic cholecystectomy in patients with gall stones under general anesthesia using carbon dioxide (CO2) insufflations on the intraocular pressure (IOP). Methods: The study was an observational case series, involved 24 non-glaucomatous patients with gall stones who underwent laparoscopic cholecystectomy surgery under general anesthesia using (CO2) insufflations in the period from January 2016 to April 2016 in Zagazig University Hospitals. IOP was measured preoperatively, intra-operatively and shortly postoperatively. Interpretation of the results was performed. Results: The study revealed that IOP was elevated significantly during laparoscopic cholecystectomy surgery (P < 0.001), as the mean preoperative IOP was (15.21 ± 1.61 mmHg) compared to intra-operative (24.55 ± 6.28 mmHg) and nearly returned to the normal level after 8 hours postoperatively (16.13 ± 2.44 mmHg). Conclusion: Laparoscopic cholecystectomy surgery elevated IOP significantly which is not favorable for glaucoma or ocular hypertension patients, especially for the old.
Laparoscopic Trainer with Pneumoperitoneum  [PDF]
José L. Ortiz Simón, Arturo Minor Martínez, Neftalí Prado Coronado, Ricardo Ordorica Flores
Surgical Science (SS) , 2012, DOI: 10.4236/ss.2012.310099
Abstract: The development of skills and abilities in laparoscopy is directly related to the use of trainers. The trainer should model the patient with all its natural complexities as closely as possible. In this article we propose a system for training the establishment of pneumoperitoneum executing the basic tasks to create the workspace in the trainer, the insertion of primary umbilical trocar and simulate some of the everyday problems in surgery. Materials and Methods. A group of electrical with biomedical engineers and laparoscopic surgeons developed a physical trainer that allows implementing the pneumoperitoneum. The system uses pneumatic electro valves that are controlled with a dedicated microprocessor. The user can program the system to set the parameters of the pneumoperitoneum. Results. This new trainer facilitated the programming of right values of parameters to distend the abdominal cavity according a specific clinical case. The model developed enables the trainee to consolidate his knowledge on establishing the parameters required within clinical practice, as well as the entry techniques. Conclusions. A new physical model for laparoscopic training was designed. The system enables the laparoscopic surgeon to set the parameters for establishing the workspace according to the clinical case. The trainer allows the surgeon to train in the Hasson technique for the introduction of the first trocar, as well as the placement of the rest of surgical instruments with video assistance. We think this new trainer system will help minimize entry-related injuries.
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.
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.
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