scholarly journals Mini-Incision Versus Laparoscopic Cholecystectomy

HPB Surgery ◽  
1997 ◽  
Vol 10 (5) ◽  
pp. 338-340 ◽  
Author(s):  
Charles J. Yeo
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Control ◽  
Operating Time ◽  
Wound Dressings ◽  
Control Methods ◽  
Small Incision ◽  
Significant Difference ◽  
American Society ◽  
Mini Incision ◽  
Back To Work

Background: We report a prospective randomised comparison between laparoscopic and small-incision cholecystectomy in 200 patients which was designed to eliminate bias for or against either technique.Methods: Patients were randomised in the operating theatre and anaesthetic technique and pain-control methods were standardised. Four experienced surgeons did both types of procedure. Identical wound dressings were applied in both groups so that carers could be kept blind to the type of operation.Findings: There was no significant difference between the groups for age, sex, body mass index, and American Society of Anaesthesiologists grade. Laparoscopic cholecystectomy took significantly longer than small-incision cholecystectomy (median 65 [range 27-140] min vs 40 [18-142] min, p<0.001). The operating time included operative cholangiography which was attempted in all patients. We found no significant difference between the groups for hospital stay (postoperative nights in hospital, median 3.0 [1-17] nights for laparoscopic vs 3.0 [1-14] nights for small-incision, p=0.74), time back to work for employed persons (median 5.0 weeks vs 4.0 weeks; p=0.39), and time to full activity (median 3.0 weeks vs 3.0 weeks; p=0.15).Interpretation: Laparoscopic cholecystectomy takes longer to do than small-incision cholecystectomy and does not have any significant advantages in terms of hostital stay or 13 ostoperative recovery.

scholarly journals Effects of Dexmedetomidine on Intraoperative Hemodynamic Responses in Patients Undergoing Laparoscopic Cholecystectomy: A Randomised Double Blind Trial

2021 ◽  
Author(s):  
Dhanashree Dongare ◽  
Smita Gharde
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Base Line ◽  
Loading Dose ◽  
Double Blind Trial ◽  
Hemodynamic Responses ◽  
Double Blind ◽  
Significant Difference ◽  
Group A ◽  
American Society ◽  
Group B

Background: Dexmedetomidine is selective alpha 2 agonist with sedative sympatholytic, analgesic properties and is used as an anaesthetic adjuvant. We have evaluated the effect of dexmedetomidine on various hemodynamic responses to incidences such as laryngoscopy, endotracheal intubation, exubation and pneumoperitoneum in patients who were undergoing surgeries like laparoscopic cholecystectomy. We have used loading dose of 0.5mcg/kg of inj. Dexmedetomidine given over 10 minutes followed by infusion of a dose of 0.3mcg/kg/hour for the control of hemodynamic response to laparoscopy. Methods: Patient of either sex aged between 18-50 yrs, belongs to ASA I and II (AMERICAN SOCIETY OF ANAESTHESIOLOGY) posted for laparoscopic cholecystectomy were included. Institutional ethical committee clearance was obtained prior to study. After enrolment and valid written consent was taken. 60 patients were enrolled written valid informed consent was taken. Patients were divided into two groups 30 each with computerized randomization. Base line parameters were noted. Observer and patient was blinded for the content of syringe. Group A received injection dexmedetomidine and group B received bolus and infusion of normal saline at same rate. Routine general anaesthesia was instituted. Parameters were noted after induction, after intubation, after co2 insufflation, after 20 min, after 40 min, after co2 deflation, after extubation, after 1 and 2 hrs post-extubation. Results: Group A showed significantly less rise in HR and MAP than Group B. Requirement of intraoperative propofol was more in Group B. There was no significant difference for time taken to awakening in both groups. Conclusion: We found Injection Dexmedetomidine in given doses gave good hemodynamic control with minimal undesired effects during laparoscopy.

scholarly journals Does the male gender govern conversion of laparoscopic cholecystectomy?

2019 ◽  
Vol 6 (1) ◽  
pp. 14-20
Author(s):  
Kishor Manandhar ◽  
Sujita Manandhar
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Laparoscopic Cholecystectomy ◽  
Operating Time ◽  
Male Gender ◽  
Female Group ◽  
Emergency Visit ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy ◽  
Upper Abdominal

Introductions: Laparoscopic cholecystectomy (LC) occasionally demands conversion to open cholecystectomy (OC) because of multiple risk factors. This study was conducted to find out whether male gender is a stand-alone risk factors for conversion of LC to OC. Methods: This was a comparative analysis of conversion of LC to OC in patients operated for symptomatic cholelithiasis during June 2017 to May 2018 at Bir hospital, National Academy of Medical Sciences, Kathmandu, Nepal. The patients were divided into two groups: male (group 1) and female (group 2). Study variables included gender, America Society of Anesthesiologist class, history of upper abdominal pain within six weeks prior to surgery, upper abdominal surgery, emergency department visit due to upper abdominal pain, adhesion of gallbladder to adjacent structure and body mass index. Binominal logistic regression analysis of risk factors for conversion was conducted. Odds ratio (95% CI) was calculated. The p value ≤ 0.05 was considered statistically significant. Results: Among 151 patients (male 39, female 112), 7 (4.6%, male 3 and female 4) had conversion from LC to OC. Male gender itself as an isolated risk factor had no significant association to conversion (p=0.303). There was no significant difference found for age, operating time and hospital stay. Previous emergency visit (p=0.020) and adhesion (p<0.030) were associated with conversion. Conclusions: Male gender had no significant association for conversion of LC to open. Previous emergency visit due to upper abdominal pain and adhesion of gallbladder were associated risk factors for conversion.

scholarly journals Comparison Of Transversus Abdominis Plan Block And Quadratus Lumborum Block For Postoerative Pain Control Following Laparoscopic Cholecystectomy

2020 ◽  
Author(s):  
Merve Kacan ◽  
Handan Gulec ◽  
berrin kosar ◽  
seda ilhan ◽  
Eyup Horasanli
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Control ◽  
Transversus Abdominis ◽  
Morphine Consumption ◽  
Consumption Values ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Significant Difference ◽  
Elective Laparoscopic Cholecystectomy ◽  
Effective Analgesia

Abstract BACKGROUND To compare Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane (TAP) blocks for postoperative pain control following laparoscopic cholecystectomy. Study and Design Prospective randomized head-to-head clinical trial. Methods A total of 60 patients who were set to undergo elective laparoscopic cholecystectomy were randomly separated into two groups. QLB was preoperatively applied to 30 patients and TAP block was also applied to 30 patients. A record was made of the intraoperative additional fentanyl dose, and at postoperative 0-1-2-4-6-12-24 hours, records were made of cumulative morphine consumption, number of morphine requests, VAS values, shoulder pain, heartrate, systolic and diastolic blood pressure, SpO2, sedation score (Ramsey scale), itching, nausea and vomiting, respiratory depression, and other complications. Results In the examination of intraoperative additional fentanyl use, there was no requirement for additional fentanyl in 86.7% of the QLB group, while in 60% of the TAP group, there was seen to be at least one dose of additional fentanyl required. At all timepoints between 0 and 24 hours postoperatively, the cumulative morphine requests and morphine consumption values were significantly lower in the QLB group than in the TAP group. No statistically significant difference was determined between the groups with respect to nausea, vomiting, sedation, and itching as morphine-related side effects. Conclusion Morphine consumption was significantly lower in patients who underwent QLB procedure at 6, 12, 24, and 48 hours compared to the TAP group. In general, effective analgesia was provided by both methods, but more effective analgesia was determined to have been provided in the QLB group compared to the TAP group, and thus QLB can be preferable to TAP.

scholarly journals Revisiting Mini-Cholecystectomy in Laparoscopic Era – A Retrospective Study

2020 ◽  
Vol 7 (45) ◽  
pp. 2617-2620
Author(s):  
Phungreikan Ningshen ◽  
Khumallambam Ibomcha Singh ◽  
Ningombam Minita Devi ◽  
Malem Devi M ◽  
Yumkhaibam Sabir Ahmed ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Hospital Stay ◽  
Resource Constraints ◽  
Operating Time ◽  
Rectus Muscle ◽  
Normal Activity ◽  
Incision Length ◽  
American Society ◽  
American Society Of Anesthesiologists

BACKGROUND Mini-cholecystectomy (MC), with its varied incision length, has long been considered feasible with comparable results to laparoscopic cholecystectomy (LC) 1-6,7 We undertook this study, driven by resource-constraints, by well-experienced surgeons, using 3 - 5 cm incision length, in our patients with low BMI. The aim of this study is to compare the results and outcomes between MC and LC. METHODS In this retrospective study of a prospectively maintained database, first 50 patients each were selected for MC and LC respectively. Operative time, pain-score, SSI (Surgical Site Infection), hospital stay, return to normal activity and complications were compared. RESULTS Both groups were matched for age, sex, BMI (Body Mass Index) and American Society of Anesthesiologists (ASA) grading. The mean operating time for MC was 43 minutes and for LC, 64 minutes. Hospital stay for MC was 1.9 days and for LC was 1.8 days, which was statistically not significant. Return to normal activity was 8 days for MC and 6.6 days for LC. In a subset analysis of eight lean and thin patients using 3 - 3.5 cm length incision with rectus muscle splitting, the return to normal activity was 6.9 days which is comparable to LC patients. CONCLUSIONS Mini-cholecystectomy and laparoscopic cholecystectomy produce comparable patient outcomes. In lean and thin patient, MC may be slightly more advantageous than LC in terms of less operating time. KEYWORDS Mini-Cholecystectomy, Laparoscopic Cholecystectomy, Outcome, Lean and Thin Patient

scholarly journals A comparison of outcomes of four ports versus three ports laparoscopic cholecystectomy

2018 ◽  
Vol 4 (1) ◽  
pp. 66-71
Author(s):  
K. Koirala ◽  
G. Simkhada ◽  
N. Adhikari ◽  
R. Mukhia ◽  
S. Shakya
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Teaching Hospital ◽  
Operating Time ◽  
Acute Calculous Cholecystitis ◽  
Significant Difference ◽  
Surgeon Experience ◽  
Operative Complications ◽  
Calculous Cholecystitis ◽  
Post Operative Complications

Background: Conventional laparoscopic cholecystectomy is performed using four ports. With increasing surgeon experience, there is a trend towards performing it using three ports. The aim of this study was to compare the three-port laparoscopic cholecystectomy with the conventional four-port technique in terms of safety, benefits and feasibility in a teaching hospital and private hospital setups.Materials & Methods: A retrospective review of medical records was performed on patients who underwent laparoscopic cholecystectomy at KIST Medical College and Teaching Hospital and Om Hospital & Research Center P. Ltd by a single laparoscopic surgeon. The review included demographics, operating time, analgesics requirement, post- operative hospital stay and intra-operative and post-operative complications. The data were tabulated in MS-Excel and statistically analyzed using SPSS statistics software, version 21.Results: There were 150 patients included in this study with 75 patients in each three and four-port groups. The demographics were comparable in both groups. 7.3% were diagnosed with acute calculous cholecystitis, 76.7% with chronic calculous cholecystitis and 3.3 % were gall bladder polyps. Four-port technique was generally required for the acute calculous cholecystitis which was statistically significant. The three-port group had a shorter mean operative time than the four-port group. There was no statistically significant difference in the doses of analgesics requirement and mean post-operative hospital stay in both groups. There were no major intra and post-operative complications in both groups. Four-port technique was commonly done in teaching hospital and the three-port in private hospital.Conclusions: There is significant number of laparoscopic cases being performed using three ports and we concluded that the three-port laparoscopic cholecystectomy is safe and feasible in experienced hand although there is no significant benefit. The study also showed an increasing use of four-port technique in the teaching institution which is better to clearly visualize the anatomy of the Calot’s triangle. So we recommend using the four-port technique for teaching the beginners and as the experience is gained, we can gradually shift to three-port technique and at the same time we shouldn’t hesitate to convert to four-port in difficult cases.JMMIHS.2018;4(1):66-71

scholarly journals TWO-PORT LAPAROSCOPIC APPENDECTOMY IS MORE BENEFECIAL THAN OPEN APPENDECTOMY IN EARLY ACUTE APPENDICITIS

2017 ◽  
Vol 52 (2) ◽  
pp. 131
Author(s):  
Vicky S Budipramana
Keyword(s):  
Acute Appendicitis ◽  
Wound Infection ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
Operation Time ◽  
T Test ◽  
Small Incision ◽  
Post Operative Pain ◽  
Significant Difference

Open appendectomy has already commonly been performed to treat acute appendicitis, but the relatively more painful and longer incision scar becomes a cosmetical problem. Two port laparoscopic appendectomy can be performed safely, less painful and leaving only two small incision scars. The aim of the study was to evaluate the benefit of two-port laparoscopic appendectomy and that of with open appendectomy in the case of early acute appendicitis. An observational study was conducted from 2012 to 2014; to compare the operating time, post operative pain and wound infection in early acute appendicitis, performed with two-port laparoscopic appendectomy and with open appendectomy. The statistical analysis in this study uses t-test. There were 114 patients (73 men and 41 women) divided into two groups based on the choice made by the patients themselves. The number of samples performed with two-port laparoscopic appendectomy was 64 and that with open appendectomy was 46. Four patients were excluded from this study. In analysis using t-test, we found that the two-port laparoscopic appendectomy was more beneficial than open appendectomy. There was a significant difference between the two groups, the length of operation time was 37.22 minute in two-port laparoscopic appendectomy and 43.83 minute in open appendectomy (p=0.00), VAS pain score was 1.58 in two-port laparoscopic appendectomy and 2.30 in open appendectomy (p=0.00) and no post operative wound infection in both two groups. The conclusion is two-port laparoscopic appendectomy technique is faster and less painful and the same risk of wound infection than open appendectomy in early acute appendicitis.

scholarly journals Study of laparoscopic cholecystectomy in gallstones induced pancreatitis

2018 ◽  
Vol 5 (4) ◽  
pp. 1319
Author(s):  
Abhinav Bisht ◽  
Babar Rehmani
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Operating Time ◽  
Acute Attack ◽  
Additional Risk ◽  
Significant Difference ◽  
Increase Risk ◽  
Complications Of Surgery ◽  
General Surgeons ◽  
Timing Of Cholecystectomy

Background: Many general surgeons still harbor a notion that laparoscopic cholecystectomy in patients with acute gallstone induced pancreatitis has a higher morbidity. The timing of cholecystectomy in these patients is a matter of debate. Aim of the study was to assess the degree of difficulty, the timing of laparoscopic cholecystectomy (LC), and the complications of surgery in patients of gall stone pancreatitis subjected to laparoscopic cholecystectomy.Methods: 69 patients were diagnosed with gall stone induced pancreatitis over a period of 12 months and 46 underwent laparoscopic cholecystectomy. After an acute attack of pancreatitis the procedure was performed on index admission or was delayed for an interval of 3 to 4 weeks, thereby dividing the study sample into two on the basis of timing of surgery. The severity of pancreatitis was graded according to the Revised Atlanta criteria.Results: All the patients who underwent laparoscopic cholecystectomy had either mild or moderate severity of pancreatitis. Comparing the two groups with regard to timing of cholecystectomy, no statistically significant difference was noted in operating time, difficulty in surgery, conversion rate to open procedure or post-operative stay.Conclusions: Laparoscopic cholecystectomy in patients with gallstone induced pancreatitis does not attribute any additional risk and does not have increased morbidity nor is there any increase risk of conversion.

scholarly journals Retrospective Study of Three-port versus Standard Four-port Laparoscopic Cholecystectomy: A Single Surgical Unit Experience of 1456 Patients

2020 ◽  
Author(s):  
Vivek Srivastava ◽  
Mumtaz Ahmad Ansari ◽  
Vijay Kumar Shukla ◽  
Somprakas Basu
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Postoperative Period ◽  
Conversion Rate ◽  
Operating Time ◽  
Chronic Cholecystitis ◽  
Early Recovery ◽  
Significant Difference ◽  
The Mean

Introduction: Although laparoscopic surgeries have proven beyond doubt their benefit in terms of early recovery, better patient care and cost-effectiveness, the quest for reduction in either the size or number of ports still continues. Aim: To compare the safety, outcome, and advantages between three-port versus four-port Laparoscopic Cholecystectomy (LC) in acute and chronic cholecystitis. Materials and Methods: Medical records of 1456 patients that underwent LC (three- or four-port) for acute and chronic cholecystitis from January 2015 to December 2019 (60 months) were retrospectively analysed. All patients were given the same anaesthetic drugs for induction and maintenance, with standard anaesthetic protocol. The results were compared for both the techniques in terms of operating time, conversion rate, intraoperative complications, immediate postoperative complications, pain score, analgesic requirement and hospital stay. Results: Total 1456 patients underwent LC; 1282 were female and 174 were male. The mean age of the patients was 39.2 years (range 18-70 years). The three-port LC technique was performed on 816 (56.04%) patients, while the traditional four-port LC technique was performed on 640 (43.96%) patients. Visual Analog Score (VAS) in the postoperative period at six hour was 2.11±0.82 in three-port group versus 3.17±1.12 in four-port group, this suggests that there was a significant difference in pain in these two groups in the early postoperative period (p<0.001). In three-port group, the requirement of analgesic drug was significantly less as compared to four-port group (2.86±0.98 versus 3.22±0.87; p<0.001). There was no statistically significant difference in the mean operating time, duration of hospital stay, intra and postoperative complications, days to return to normal activity, satisfaction score and conversion rate (p=0.087, p=0.061, p=0.578, p=0.555, p=0.572 and p=0.145, respectively). Conclusion: Three-port LC is a feasible, effective and safe technique that further enhances the surgical outcome in terms of postoperative pain, fewer needs for analgesic medication.

Three-Port, Two Located on the Pfannenstiel Line, Laparoscopic Cholecystectomy Comparison with Traditional Laparoscopic Cholecystectomy

2017 ◽  
Vol 83 (3) ◽  
pp. 260-264
Author(s):  
Musa Akoglu ◽  
Erdal Birol Bostanci ◽  
Muhammet Kadri Colakoglu ◽  
Erol Aksoy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Postoperative Results ◽  
Conversion To Open Surgery ◽  
Included Patient ◽  
History Of ◽  
Abdominal Operations ◽  
American Society ◽  
American Society Of Anesthesiologists

Laparoscopic cholecystectomy (LC) is seen as a gateway to minimally invasive surgery. We defined a new three-port technique with different port sites and compared the postoperative results with traditional four-port LC procedure in a case-match study. Between June 2012 and May 2013, 104 consecutive patients underwent three-port LC by same experienced surgeon. In the same center, 2963 consecutive patients underwent four-port LC, and of these 2963 patients, a matched group of 104 patients was selected. Data included patient age, gender, body mass index, American Society of Anesthesiologists score, history of abdominal operations, intraoperative data about operating time and conversion to open surgery, and postoperative data about length of hospital stay and postoperative complications were recorded prospectively. We concluded that our new three-port technique with different port sites is as feasible and safe as traditional four-port technique.

scholarly journals Comparative study between 3-ports and 4-ports laparoscopic cholecystectomy for the cases of gall stone disease

2016 ◽  
Vol 18 (3) ◽  
pp. 15
Author(s):  
KK Tamrakar ◽  
P Khwaunju ◽  
K Sah
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Stone ◽  
Operating Time ◽  
Wound Infection Rate ◽  
Stone Disease ◽  
Chi Square ◽  
Significant Difference ◽  
Gall Stone Disease ◽  
Chi Square Test ◽  
Operative Findings

Laparoscopic cholecystectomy is currently accepted approach for the management of patients with cholelithiasis. The standard method for removal of gall bladder in laparoscopic cholecystectomy is by using four ports. Although other techniques such as by using 3 ports or only single port are being practiced, their safety and efficacy has not been established. This study was done to assess the efficacy and safety of the use of only three ports for laparoscopic cholecystectomy.Methods: Between August 2013 and February 2014, 78 patients with the diagnosis of cholelithiasis were operated. Patients were randomized into 3-ports group and 4-ports group using random number. Operative time taken for the procedure and operative findings were noted. Postoperative pain and complications were noted in both groups. The two groups were compared using student-T test and chi square test. Results: There was no significant difference in the operating time taken for the 3-ports laparoscopic cholecystectomy and 4-ports laparoscopic cholecystectomy. However operating time was significantly higher when the cases that had dense adhesions present were compared with those who did not have. Conversion from 3-ports technique to 4-ports technique was determined mainly by the degree of adhesions and to some degree by the BMI of the patient. Postoperative wound infection rate was similar among the two groups. There was no incidence of biliary injury in both the groups.Conclusion: 3-ports laparoscopic cholecystectomy is safe and efficient approach for the selected patients who seek for lesser invasive method of laparoscopic cholecystectomy.

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