The impact of laparoscopic cholecystectomy on the treatment of symptomatic cholelithiasis

1996 ◽  
Vol 10 (7) ◽  
pp. 746-750 ◽  
Author(s):  
H. S. Ho ◽  
K. A. Mathiesen ◽  
B. M. Wolfe
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Symptomatic Cholelithiasis ◽  
The Impact

scholarly journals 709 Covid-19 Pandemic: Audit on The Management of Acute Cholecystitis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Asarbakhsh ◽  
N Lazarus ◽  
P Lykoudis
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Readmission Rate ◽  
Adverse Outcomes ◽  
Management Option ◽  
Management Guidelines ◽  
Theatre Staff ◽  
The Impact ◽  
Definitive Management ◽  
Upper Gastrointestinal

Abstract Background The definitive management of acute cholecystitis is laparoscopic cholecystectomy on the same admission if the patient is fit. As the Covid-19 pandemic emerged, evidence suggested adverse outcomes for asymptomatic Covid positive patients undergoing surgery, including increased mortality risk. Risks to theatre staff were also highlighted. This prompted changes in acute cholecystitis management guidelines. Method The audit aim was to assess the impact of guideline change on clinical outcomes and readmission rate for acute cholecystitis. The revised Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) guidelines were the gold standard. All inpatient admissions for acute cholecystitis during the 4-week peak of the pandemic (17/04/2020 – 14/05/2020) were included. Result 24 patients were admitted with acute cholecystitis. 10 patients (41.7%) were managed with antibiotics alone, 4 patients (16.6%) underwent cholecystostomy. 12 patients (50%) were discharged within 3 days. Lack of clinical progress/ongoing symptoms was the indication for laparoscopic cholecystectomy in 5 cases (20.8%). 5 conservatively managed patients (20.8%) were readmitted with ongoing cholecystitis or pancreatitis. Conclusions 19 patients (80%) were managed non-surgically in accordance with AUGIS guidelines. However conservative management was not always appropriate. We recommend that laparoscopic cholecystectomy should remain a management option for acute cholecystitis during the ongoing Covid-19 pandemic.

The Impact of Prophylactic Dexamethasone on Nausea and Vomiting After Laparoscopic Cholecystectomy

2008 ◽  
Vol 248 (5) ◽  
pp. 751-762 ◽  
Author(s):  
Paul J. Karanicolas ◽  
Shona E. Smith ◽  
Bilge Kanbur ◽  
Edward Davies ◽  
Gordon H. Guyatt
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Nausea And Vomiting ◽  
The Impact

scholarly journals Is Nighttime Really Not the Right Time for a Laparoscopic Cholecystectomy?

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Anna C. M. Geraedts ◽  
Meindert N. Sosef ◽  
Jan Willem M. Greve ◽  
Mechteld C. de Jong
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Morbidity ◽  
Time Of Day ◽  
Outcome Data ◽  
Emergency Procedure ◽  
Out Of Hours ◽  
Increased Risk ◽  
The Right ◽  
The Impact ◽  
Univariate Analyses

Purpose. The impact of an out-of-hours laparoscopic cholecystectomy on outcome is controversial. We sought to determine the association between an out-of-hours procedure and postoperative complications within 90 days. Methods. Between 2014 and 2016, 1553 laparoscopic cholecystectomies were performed. Therapeutic, operative, and outcome data were prospectively collected and analyzed. We defined out of hours as during weekends, national holidays, and daily between 5PM and 8AM. Results. Most patients operated on were female (n=988; 63.6%) and the majority of procedures were electives (n=1341; 86.3%). Although all procedures were performed with a laparoscopic intent, 42 (2.7%) were converted to open procedure. In total, 145 (9.3%) procedures were out of hours, all nonelective, and in most cases for acute cholecystitis (n=111; 7.1%). Overall, there were 212 complications in 191 patients (12.3%), most (n=153; 9.9%) classified as minor. The conversion rate in the out-of-hours group was significantly higher (9.7% vs 2.0%; p<0.001). While univariate analyses revealed out-of-hours procedure (OR=1.83; p=0.008) to be associated with an increased risk of complications, when controlling for confounding factors by multivariate analysis, this association was not found. However, operation by surgical staff (OR=1.71) and conversion to laparotomy (OR=3.74) were found to be independently associated with an increased risk of complications (both p<0.05), while an emergency procedure tended to be associated with postoperative morbidity (OR=1.82; p=0.069). Conclusion. An out-of-hours laparoscopic cholecystectomy was not found to be an independent risk factor for developing postoperative morbidity and time of day should therefore only be a relative contraindication.

scholarly journals A prospective observational study to study and correlate the clinical and microbiological profile of bile cultures in patients with symptomatic cholelithiasis

2020 ◽  
Vol 7 (5) ◽  
pp. 1566
Author(s):  
Ramakrishnan Shankaran ◽  
Chaminda Amarasekara
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Gallstone Disease ◽  
Significant Proportion ◽  
Antibiotic Sensitivity ◽  
Klebsiella Species ◽  
Duration Of Symptoms ◽  
Symptomatic Cholelithiasis ◽  
Bile Culture ◽  
Symptomatic Gallstone Disease

Background: Biliary infection has been reported in a significant proportion of patients developing gallstones. Many studies have found biliary microflora in 20% to 46% patients with a post-operative infection rate of 7% to 20% in those who undergo cholecystectomy for symptomatic gallstone disease. Various antibiotics are also used empirically as prophylaxis against post-operative infection. The study was conducted in order to determine the bacteriology and to test its sensitivity to commonly used antibiotics of aspirated bile samples taken during laparoscopic cholecystectomy, and to correlate it with the clinical profile recorded in patients with symptomatic cholelithiasis.Methods: A total of 266 patients who underwent laparoscopic cholecystectomy were included in the study over a two year period. Intra operatively, bile was aspirated from gall bladder and sent for culture and antibiotic sensitivity testing.Results: 14.66% (39 out of 266) patients had positive growth with Escherichia coli most commonly isolated in 9.77% (26/266) patients, followed by the Klebsiella species in 4.89% (13 out of 266) patients. All the cultures were sensitive to amikacin and meropenem, 97.44% to imipenem, and only 43.39% were sensitive to ampicillin. A statistically significant correlation was observed between a positive bile culture with the duration of symptoms (p=0.01874) and gall bladder thickness (p<0.0001). No correlation was seen between bile culture and history of acute cholecystitis, number or size of calculi.Conclusions: The results of this study can help develop local guidelines and recommendations based on Indian data to ensure the rational use of prophylactic antibiotics in patients with symptomatic cholelithiasis.

scholarly journals Porta Hepatis Injury during Laparoscopic Cholecystectomy

2020 ◽  
Vol 14 (1) ◽  
pp. 234-241
Author(s):  
Reem Shammout ◽  
Raiean Al Habbal ◽  
Fadi Rayya
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Treatment Strategy ◽  
Surgical Complication ◽  
Operative Procedure ◽  
Porta Hepatis ◽  
Mortality And Morbidity ◽  
Hepatic Lobe ◽  
The Right ◽  
Vasculobiliary Injury ◽  
The Impact

Iatrogenic porta hepatis injury is a rare but devastating surgical complication of laparoscopic cholecystectomy. There are no systematic studies examining the best treatment strategy in patients with this injury. We present a case of a 23-year-old woman with a large abscess in the right hepatic lobe due to an extreme vasculobiliary injury after laparoscopic cholecystectomy. Although rare, the impact of vasculobiliary injuries after cholecystectomy highlights the need for constant alertness and prompt management in order to minimize mortality and morbidity usually associated with the routine operative procedure.

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