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Laparoscopic cholecystectomy in empyema of gall bladder: An experience at Liaquat University Hospital, Jamshoro, Pakistan  [cached]
Malik Arshad,Laghari Abdul,Talpur K,Memon Aisha
Journal of Minimal Access Surgery , 2007,
Abstract: Objective: To find out the safety profile of laparoscopic cholecystectomy in empyema of gallbladder. Background: Empyema of gall bladder is a severe form of acute cholecystitis with superadded suppuration. It has been considered a contraindication for the laparoscopic cholecystectomy (LC) because of fear of life-threatening complications. This study aimed to determine the safety and feasibility of LC in empyema of gallbladder. Materials and Methods: LC was attempted in 67 patients of empyema of gallbladder within 24h. However in few cases there was a delay because of reluctance for surgery or delay in giving consent etc. The procedure was performed by standard four-port technique with few changes made to facilitate dissection according to situation. Results: Between April 2003 to June 2006, 970 LC performed for gallstone disease at surgical unit-1 of LUMHS by the same surgical team. Among these, 67 (6.90%) patients were diagnosed to have empyema gall bladder. LC successfully completed in 54 (80.59%) patients. In 13 (19.40%) patients the procedure was converted to open cholecystectomy (OC) due to various operative difficulties of which the most serious injuries included bleeding from cystic artery (four cases), common bile duct injury (two cases) and duodenal injury in one case. Maximum operating time was up to 160 minutes (one case). Postoperative complications occurred in 10 (18.51%) successfully operated patients. Maximum patients (n=45, 83.33%) were discharged in 48-96 hours while three patients were discharged after two weeks. Conclusion : Laparoscopic cholecystectomy can be performed in empyema of gallbladder keeping in mind a slightly increased risk of complications even in the best hands. However, the experience of the surgeon plays a key role in the overall outcome.
Effects of iatrogenic gall bladder perforations during laparoscopic cholecystectomy on postoperative pain and hospital stay  [PDF]
Mustafa Uygar Kalayc?,Bar?? Veli Ak?n,Halil Al??,Selin Kapan
Medical Journal of Bakirk?y , 2006,
Abstract: Objective: In this prospective randomized study, the effects of iatrogenic gall bladder perforations during laparoscopic cholecystectomy on postoperative pain and mean hospital stay were evaluated. Material and Methods: 100 patients of a total number of 515 patients performed laparoscopic cholecystectomy for gallstones between April 2004 and January 2005 were included in this study. Patients were divided into two groups as one group with iatrogenic gall bladder perforations during operation (n: 33) and those without perforation (n: 67). Postoperative pain was assessed by visual analog score (VAS). Students T test and Spearman’s correlation tests were used for the statistical analysis. Results: Female to male ratio of 100 patients was 83/17. Mean postoperative VAS of the perforation group was 4.76±1.458 whereas mean VAS of nonperforated group was 4.73±1.657. Mean hospital stay of perforated and non perforated groups was 1.73±0.944 and 1.82±1.435 days respectively. There was no statistically significant difference between two groups regarding these parameters (p>0.05). Conclusion: Iatrogenic gall bladder perforation during laparoscopic cholecystectomy has no effect on postoperative pain and mean hospital stay.
Laparoscopic Cholecystectomy Combined Using Miniaturised Instruments in Transgastric Gall Bladder Removal: Performed on 63 Patients  [PDF]
Florent Jurczak,Jean-Paul Pousset
Minimally Invasive Surgery , 2010, DOI: 10.1155/2010/582763
Abstract: Background. The laparoscopic cholecystectomy is a perfectly codified surgical procedure. The development of recent innovative and experimental surgical techniques Natural Orifice transluminal endoscopic surger (N.O.T.E.S.) which reduces the abdominal wall trauma leads us to develop a combined procedure of a standard dissection using miniaturised instruments already existing on the market (3 and 5?mm wide) and a gall bladder removal through a short gastrotomy Natural Orifice Specimen Extraction (N.O.S.E.). Methods. Our objective was to evaluate the safety, the feasibility, and the reproducibility of our new approach. After reviewing existing products on the market and a feasibility study, we put in place a protocol in our structure for patients on whom the procedure was performed. We carried out a gall bladder removal by a short gastrotomy, located on the anterior gastric wall, which then reduced the abdominal wall trauma and allowed them to resume normal physical activity quickly without risk of trocar site hernia. Results. We performed the procedure described in this paper on 63 patients, between April 2008 and July 2009. There were 14 men and 49 women with an average age of 46.8 years (ranging from 28 to 77) and an average BMI of 27.2. 30 patients had at least one gallstone larger than 10?mm. There was no postoperative gastric or abdominal wall complication and a fast recovery for all the patients in our study. Conclusions. This procedure is feasible, reproducible, with good results and minimal abdominal wall trauma. It is also safer than N.O.T.E.S. and endoscopic clipping and recovery, allowing normal physical activity, fast and, without risk of incisional hernia. 1. Introduction The laparoscopy became the main surgical technique for cholecystectomy with a rate of laparoscopic performances of about 99% for some French teams. The development of recent innovative and experimental surgical techniques (N.O.T.E.S.) [1–4] reduces the abdominal wall trauma and complication by using ports and removal of the gall bladder or any other abdominal organs. The risk of incisional hernia increases when using a 10?mm or more port [5, 6]. The removal of an inflamed gall bladder with or without very large gallstones usually requires enlarging one of the abdominal incisions. It will be closed of course, scrupulously [7, 8], but there is always a risk of complication (infection, bruising, incisional hernia [9–11]) and that is the same problem with the single port access surgery as it is also difficult to get back to normal physical activity quickly, without risk of
Laparoscopic cholecystectomy in-patient with situs inversus  [cached]
Shah A,Patel B,Panchal B
Journal of Minimal Access Surgery , 2006,
Abstract: In modern era, laparoscopic surgery is gold standard for gall bladder calculi. Situs inversus is a rare condition. To diagnose as well as operate any pathology in such patients is difficult. Laparoscopic cholecystectomy in such patient is a challenge but not contraindication.
Railroading removal of gall bladder in laparoscopic cholecystectomy  [cached]
Golash Vishwanath,Rahman S
Journal of Minimal Access Surgery , 2006,
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
Fikret Aksoy,G?khan Demiral,Abdullah Alp ?z?elik
Marmara Medical Journal , 2008,
Abstract: We report a case of 55 year old female with suspected chronic cholecystitis due to cholelithiasis.She was operated and found to have agenesis of gall bladder which is an extremely rare clinical condition. Standard investigative modalities which are currently used for chronic cholecystitis might be misleading and amazing. Agenesis of gall bladder should be kept in mind whenever the gall bladder is improperly visualised in routine ultrasound methods. It is difficult to diagnose gall bladder agenesis preoperatively as investigations tend to be misleading and therefore it is diagnosed intraoperatively.
Left-sided gall bladder: Report of two cases  [cached]
Chrungoo R,Kachroo S,Sharma Ashwani,Khan Arshad
Journal of Minimal Access Surgery , 2007,
Abstract: Left-sided gall bladder without situs inversus viscerum is a rare albeit recognized clinical entity. We report our experience of two cases of left-sided gall bladder in two women aged 36 and 48 who underwent laparoscopic cholecystectomy for chronic calculous cholecystitis. Left-sided gall bladder may provide an unusual surprise to the surgeons during laparoscopy as routine pre-operative studies may not always detect the anomaly. Awareness of the unpredictable confluence of the cystic duct into the common bile duct (CBD) and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual entity.
Can bile duct injuries be prevented? "A new technique in laparoscopic cholecystectomy"
Yavuz Sari, Vahit Tunali, Kamer Tomaoglu, Binnur Karag?z, Ayhan Güney?, ?brahim Karag?Z
BMC Surgery , 2005, DOI: 10.1186/1471-2482-5-14
Abstract: gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus.Between October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury.The number of bile duct injuries related to anatomic misidentification can be decreased and even vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively.Laparoscopic cholecystectomy (LC) is considered as the "golden standard" in the surgical management of symptomatic cholelithiasis. Short hospitalisation period and rapid return to normal activity, less post-operative pain, more acceptable cosmetic results and lesser morbidity and mortality rates, are the principle advantages of this technique. However, the incidence of bile duct injuries is two times greater when compared to open cholecystectomy [1-11]. Bile duct injury, either in classic open or laparoscopic cholecystectomy, may
Functional properties of laser effects on morphology of liver, gall bladder and bile ducts in cholelithiasis  [cached]
Bakhtior Shamirzaev
Medical and Health Science Journal , 2012,
Abstract: In 85 patients with calculous cholecystitis the preoperative preparation before laparoscopic cholecystectomy included irradiation of the area of gall bladder and epigastric puncture with low power magneto-infrared laser. The investigations performed revealed significant reduction of the liver and gall bladder changes both on the light optic and electron microscopic levels due to effects of low power laser irradiation.
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