scholarly journals Nondrainage after Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis Does Not Increase the Postoperative Morbidity

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Jianguo Qiu ◽  
Ming Li
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Postoperative Recovery ◽  
End Points ◽  
Acute Calculous Cholecystitis ◽  
Vas Score ◽  
Estimated Blood Loss ◽  
Number Of Patients ◽  
Significant Difference ◽  
Calculous Cholecystitis

Background. It is now established that prophylactic drainage is not needed after laparoscopic cholecystectomy (LC) for chronic calculous cholecystitis. However, the benefit of drains versus their potential harm for acute calculous cholecystitis (ACC) following laparoscopic LC has been questioned. Therefore, we conducted a comparative study to assess the need for drainage.Methods. Between January 2014 and October 2016, 212 patients with ACC undergoing LC undergo either drainage (n= 106) or no drainage (n= 106). The primary end points were the number of patients with postoperative drain-related complications, early and late Visual Analogue Scale (VAS) score, and hospital stay. Secondary end points included estimated blood loss, postoperative recovery, analgesia requirement, and cosmetic satisfaction result.Results. There was no bile duct injury and mortality in both groups. The overall complication rate was 12.5% with no significant difference between those with or without drainage (P=0.16). Normal activity resumption was significantly faster and the postoperative hospital stay was slightly shorter in the nondrainage group (P=0.03 andP= 0.04, respectively). The early VAS score in the drainage group was significantly higher (p<0.05). There were no significant differences between the two groups in postoperative hematology test, late VAS score, and patient satisfaction of cosmetic outcome.Conclusion. Routine drainage for patients with ACC after LC may not be justified with similar drain-related complications compared with nondrainage group.

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 COMPARISON OF OUTCOMES BETWEEN EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS

2021 ◽  
Vol 71 (3) ◽  
pp. 796-800
Author(s):  
Muhammad Ismail ◽  
Nasir Mehmood Wattoo ◽  
Muhammad Qasim Butt ◽  
Fareeha Naz
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operation Time ◽  
Acute Calculous Cholecystitis ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Calculous Cholecystitis ◽  
Post Operative Complications

Objective: To compare early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of mean operative time, hospital stay, conversion rate to open surgery and post-operative complications. Study Design: Quasi experimental study. Place and Duration of Study: Army Liver Transplant Unit, Department of Surgery, Pak-Emirates Military Hospital Rawalpindi, from Jul to Dec 2018. Methodology: A total of 170 patients (85 in each group) diagnosed as a case of acute calculous cholecystitis who met the sample selection criteria were included. Group A patients underwent early laparoscopic cholecystectomy within 72 hours of admission while group B patients underwent conservative management followed by delayed laparoscopic cholecystectomy after 6 weeks. All patients were followed for operative time, hospital stay, per-operative difficulties encountered and post-operative complications. Results: Group A had a mean operation time of 43.9 ± 11.1 minutes, while group B had a mean operation time of 45.8 ± 10.1 minutes (p=0.83). The mean duration of hospitalization was 2.8 ± 1.1 days in group A and 5.3 ± 0.8 days in group B (p<0.001). Complications were measured at a frequency of 14.1% in group A and 5.9% in group B (p=0.07). Conclusion: Early laparoscopic cholecystectomy is better than delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of hospital stay and per-operative difficulties faced. The post-operative complications between the two groups are comparable.

scholarly journals Post-procedural Drainage versus no Drainage in Laparoscopic Cholecystectomy at DHQ Hospital Charsadda, Pakistan

2021 ◽  
Vol 10 (2) ◽  
pp. 105-109
Author(s):  
Muhammad Bilal ◽  
Viqar Aslam ◽  
Zaheer ud din ◽  
Waqas Jan ◽  
Inamullaha ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Drainage Tube ◽  
Duration Of Hospital Stay ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group A

Background: Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic gall stones but controversy regarding the routine use of drainage after elective LC still exists. The objective of this study was to determine the efficacy of post-procedural drainage versus no drainage after simple laparoscopic cholecystectomy. The postoperative complications were also evaluated in both groups after the LC procedure.Material and Methods: This Randomized controlled trial (RCT) was conducted in patients who underwent Laparoscopic cholecystectomy according to a pre-set inclusion criterion. Ninety-three patients were randomly assigned into group A (with drainage tube) and group B (without drainage tube) using sealed opaque envelopes containing computer‐generated random numbers. Primary (like duration of hospital stay, Postoperative pain) and secondary outcomes (like postoperative complications) were noted in both groups. Chi-square, Fischer exact test and Mann witney U test were applied as appropriate and statistical significance was established at P < .05.Results: The number of patients with hospital stay exceeding two days were more in group A (n=23; 51.1%) than B (n=13; 28.8%) (P < .05). Group A presented with more postoperative complications but differences between the two groups were statistically non-significant. Both Groups experienced a high level of pain at six hours of surgery followed by progressive decrease in severity at 24 and 48 hours, respectively (P=.06).Conclusions: Post-procedural drain placement after laparoscopic cholecystectomy has no advantages as there is no significant difference in post-operative complications and duration of hospital stay in drainage versus no drainage groups.

The timing of laparoscopic cholecystectomy and nano-ligation clip for acute calculous cholecystitis under guidance of Tokyo guidelines 2018 (multi-center retrospective analysis)

2021 ◽  
Vol 11 (10) ◽  
pp. 1681-1690
Author(s):  
Hongsheng Wu ◽  
Keqiang Ma ◽  
Lei Yu ◽  
Weili Gu ◽  
Yong Yan ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Statistical Difference ◽  
Operation Time ◽  
Postoperative Hospital Stay ◽  
Optimum Time ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Group A ◽  
Calculous Cholecystitis

Laparoscopic cholecystectomy (LC) has been recognized as the standard surgical method for cholecystectomy. A nano-absorbable ligation clip. The material used in the ligation clip is composed of basic materials (poly(p-dioxanone), poly trimethylene carbonate or polycaprolactone) and nano-short fibers (Polyglycolide acid or polylactide). The short nano-fibers maintain the crystalline form evenly dispersed in the base material. The diameter of short nano-fibers is 300–500 nm and the length is 20–50 µm. The nano-absorbable ligation clip has strong closing force and will not cause closure failure. However, there are still some controversies about the optimum time for LC treatment of acute calculous cholecystitis (ACC) patients, and the optimum time for performing LC based on evidence-based medicine has not been unanimously recognized. Here, we explore LC timing for ACC treatment under the guidance of the Tokyo Guidelines for Acute Cholecystitis 2018 (TG18). We retrospectively analyzed the data of 3,147 ACC cases undergoing LC in eight hospitals in China. According to the time from the onset of the patient’s symptoms to the operation, they were divided into the following three groups: Group A (onset to operation time of ≤3 days), Group B (onset to operation time of 4–7 days), and Group C (onset to operation time of >7 days). There was no obvious statistical difference in preoperative indicators, such as gender ratio, history of hypertension, diabetes, and abdominal operation; ASA Classification; and TG18 Classification between the three groups. Similarly, the results of preoperative laboratory indices (e.g., white blood cell, C-reactive protein, procalcitonin, platelet, serum creatinine, and international normalized ratio) showed no obvious statistical difference between the three groups. The comparison of gallbladder characteristics under B-ultrasound showed no significant statistical difference between the three groups. However, the conversion rate in Group C was significantly higher than that in Groups A and B, the incidence of complications (e.g., bile leakage, bile duct injury, and wound infection) was significantly higher in Group C than that in Groups A and B, and the postoperative hospital stay was significantly shorter in Group A than that in Groups B and C. A comprehensive analysis of patients’ medical records in multiple medical centers confirms that it is safe and feasible to perform early LC 7 days before the onset of ACC, which can significantly decrease postoperative complications and shorten the postoperative hospital stay for ACC patients. Performing early LC for ACC patients under the TG18 guidelines is safe and feasible. Additionally, since TG18 has obvious practicability and guidance for the clinical practice of hepatobiliary surgery, it is worthy of popularization and application in China.

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

2020 ◽  
pp. 000313482097338
Author(s):  
Elizabeth McCarthy ◽  
Benjamin L. Gough ◽  
Michael S. Johns ◽  
Alexandra Hanlon ◽  
Sachin Vaid ◽  
...  
Keyword(s):  
Postoperative Recovery ◽  
Logistic Regression Models ◽  
Community Institution ◽  
Physical Status Classification ◽  
Estimated Blood Loss ◽  
Comparative Review ◽  
Significant Difference ◽  
American Society ◽  
The Individual ◽  
American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

scholarly journals Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

2021 ◽  
Vol 8 (1) ◽  
pp. 37-42
Author(s):  
Hasan Ghandhari ◽  
◽  
Ebrahim Ameri ◽  
Mohsen Motalebi ◽  
Mohamad-Mahdi Azizi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Obese Group ◽  
Obese Patients ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

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