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.

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.

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 Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective, Randomized Study

2014 ◽  
Vol 99 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Alper Bilal Özkardeş ◽  
Mehmet Tokaç ◽  
Ersin Gürkan Dumlu ◽  
Birkan Bozkurt ◽  
Ahmet Burak Çiftçi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Operation Time ◽  
Early Laparoscopic Cholecystectomy ◽  
Laparoscopic Cholecystectomy Group ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

Abstract We aimed to compare the clinical outcome and cost of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Sixty patients with acute cholecystitis were randomized into early (within 24 hours of admission) or delayed (after 6–8 weeks of conservative treatment) laparoscopic cholecystectomy groups. There was no significant difference between study groups in terms of operation time and rates for conversion to open cholecystectomy. On the other hand, total hospital stay was longer (5.2 ± 1.40 versus 7.8 ± 1.65 days; P = 0.04) and total costs were higher (2500.97 ± 755.265 versus 3713.47 ± 517.331 Turkish Lira; P = 0.03) in the delayed laparoscopic cholecystectomy group. Intraoperative and postoperative complications were recorded in 8 patients in the early laparoscopic cholecystectomy group, whereas no complications occurred in the delayed laparoscopic cholecystectomy group (P = 0.002). Despite intraoperative and postoperative complications being associated more with early laparoscopic cholecystectomy compared with delayed intervention, early laparoscopic cholecystectomy should be preferred for treatment of acute cholecystitis because of its advantages of shorter hospital stay and lower cost.

scholarly journals COMPARISON OF ONDANSETRON AND METOCLOPRAMIDE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANESTHESIA.

2019 ◽  
Vol 26 (07) ◽  
pp. 1197-1202
Author(s):  
Hajra Shuja ◽  
Mehmood Ali Shah ◽  
Sadaf Bokhari
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Controlled Trial ◽  
Study Groups ◽  
P Value ◽  
Significant Difference ◽  
High Incidence ◽  
Group A ◽  
Group B ◽  
Trial Setting

Background: Laparoscopic cholecystectomy is a standard treatment for cholelithiasis. It is a safe and effective treatment in many cases. General anesthesia has a high incidence for PONV. But anti-emetic drugs can help in preventing PONV. Objectives: To compare the efficacy of ondansetron and metoclopramide in patients undergoing laparoscopic cholecystectomy under general anesthesia. Study Design: Randomized controlled trial. Setting: Department of Anaesthesia, Sheikh Zayed Hospital, Lahore. Period: 6 months i.e. from 15-2-2017 to 15-8-2017. Material & Methods: The patients were divided into two groups. Ondansetron was given to group A patients within 15 minutes of induction, and metoclopramide to group B patients within 15 minutes of induction. Then patients were shifted to the ward after surgery and followed-up for 24 hours for assessment of PONV. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients in group A was 38.40±12.07 years and in group B was 42.63±11.77 years. The efficacy achieved in 53 were from group A and 39 were from group B Statistically significant difference was found between the study groups i.e. p-value=0.003. Conclusion: Ondansetron showed significantly better efficacy than metoclopramide in preventing PONV after laparoscopic cholecystectomy under general anesthesia.

scholarly journals Three-Port versus Four-Port Laparoscopic Cholecystectomy: A Randomized Controlled Trial

2019 ◽  
Vol 21 (1) ◽  
pp. 40-43
Author(s):  
Rabin Koirala ◽  
TM Gurung ◽  
A Rajbhandari ◽  
P Rai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Controlled Trial ◽  
Open Cholecystectomy ◽  
Analgesic Requirement ◽  
Safe Alternative ◽  
Average Hospital ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

 Laparoscopic cholecystectomy (LC) is one of the most common surgery performed and is traditionally performed using four ports. With the aim of improving patient’s comfort, port numbers have been reduced to single port. But feasibility and the extra expense that comes with single and double port LC has made them less attractive. Three port LC can be a safe alternative to four port LC, and various research has shown its safety. This study compares the three port LC with the traditional four port LC with the objective of assessing feasibility and benefit of the decreased port number. We evaluated 217 patients who were randomly allocated for three port and four port LC. Both the groups were compared for operative time, assessment of postoperative pain, days of hospital stay and postoperative recovery time after discharge. The parameters were compared using Statistical Package for the Social Sciences (SPSS) version 16. Among 217 patients, 123 underwent three port LC and 94 underwent four port LC. The larger number were females (79.7%), and with comparable age group of patients. Rate of conversion to open cholecystectomy, postoperative pain scale, analgesic requirement, average hospital stay and port site infection rates were comparable in both groups of patients. The average time taken for operation was less in three port LC than the four port LC but this was not statistically significant. There is no significant difference between 3 port and 4 port LC in terms of time required for the surgery, conversion rate, complication and duration of hospital stay.

scholarly journals 1379. Comparison of Inpatient Tuberculosis Screening Methods and Their Effect on Patient Duration in Airborne Isolation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S501-S501
Author(s):  
Mary Katherine. Theoktisto ◽  
Delvina Ford ◽  
Omar Khan ◽  
Kelly R Reveles ◽  
Jose Cadena
Keyword(s):  
Statistical Significance ◽  
Nucleic Acid Amplification ◽  
Health Concern ◽  
Smear Microscopy ◽  
Screening Methods ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Crude Analysis

Abstract Background Tuberculosis (TB) remains a significant public health concern, and exposure in healthcare settings is prevalent. Current guidelines recommend testing for TB by acid-fast bacilli (AFB) smear microscopy with 3 sputum samples and/or using nucleic acid amplification test (NAAT), and mycobacterium culture. The purpose of this project is to compare how different TB diagnostic tests affect the duration of stay in respiratory isolation. Methods This study was conducted at the Veteran Affairs South Texas hospital, which includes a total of 437 beds. Data were collected retrospectively from medical records. Eligibility included patients admitted to the hospital and placed in airborne isolation for TB screening and diagnosis, had 3 sputum samples collected 8 hours apart and/or had 2 PCR MTB/RIF. Patients were excluded if they had TB or were not undergoing evaluation for TB. Three time periods analyzed included, 3 AFB sputum samples analyzed in-house from December 2012 to January 2014 (Group A), 3 AFB sputum samples analyzed at outside facility during 2013 to 2014 as well as 2 months in 2012 (Group B), and 2 MTB PCR/RIF in house during 2017 and 2018 (Group C). Duration of isolation was compared between groups using the Kruskal–Wallis test. A total number of 815 patients were screened, leaving 105 patients for analysis after exclusion. There were 49 patients analyzed from Group A, 28 from Group B, and 28 from Group C. Results Crude analysis of the data showed numerical differences in the total number of days and hours in isolation between the 3 groups. The average (mean) days in isolation were 4.2 for Group A, 7.4 for Group B, and 5.5 for Group C. There was no statistically significant difference in either days or hours of airborne precautions by “rule out” method. Days of isolation in airborne precautions (median IQR) was 4 for all groups (P = 0.3313). Likewise, hours of airborne precautions had a median IQR of 96 for all groups P = 0.4347. Conclusion Although there was no statistical significance between the groups, crude analysis did show a numerical difference in the mean total airborne days and hours. Lack of statistical difference may be due to low number of patients, timing of order placement for in-house PCR, and longer than expected stay in airborne precautions. Disclosures All authors: No reported disclosures.

scholarly journals Harmonic scalpel versus titanium clips and l-hook in the ligation of cystic duct and artery and gall bladder dissection in laparoscopic cholecystectomy

2017 ◽  
Vol 5 (12) ◽  
pp. 5145
Author(s):  
Anand Vijayvargiya ◽  
S. K. Jain ◽  
Varsha Soni
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Hospital Stay ◽  
Cystic Duct ◽  
Harmonic Scalpel ◽  
P Value ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy ◽  
Duration Of Surgery

Background: Laparoscopic cholecystectomy is a gold standard for gall bladder stone surgery. The Aim and objective of study was to compare the total duration of surgery, intraoperative complication like bile leak from cystic duct stump, spillage of bile from gallbladder and post op pain and abdomen distension and jaundice.Methods: Study was carried out in dept. of gen Surgery, Govt medical college Kota in yr. 2015-16 in a total of 50 patients with cholelithiasis with cholecystitis. Patient were equally divided randomly into two groups (a) Harmonic scalpel group and (b) Titanium Clip and L hook group. All patients with medical comorbidities, Concomitant CBD calculi, cirrhosis and portal HT were excluded from study. Intraoperatively adhesions, bile spillage from GB and cystic duct stump noted Postoperatively complain like pain abdomen, Jaundice, and fever were noted. Duration of hospital stay was observed. All results were statistically analyzed using Chi square and ANOVA test.Results: Both groups were comparable on the basis of age and sex distribution, as no statistically difference was noted (P value 0.867 and 0.999 respectively). Intraoperative findings were adhesions 5 in clip group and 7 in harmonic group. Spillage from gall bladder was 2 in Clip group and 3 in harmonic group. Mean duration of surgery was 65.20 min in clip group and 63.68 in harmonic group with no statistically significant difference in both the group (P Value 0.727). Average duration of hospital stay was similar in both the groups with a mean of 2.6 days. Postoperative complication was fever, abdomen pain and distension were 3,1,1 were respectively in the clip group and 3,2,2 respectively in harmonic group with the P value of 0.999 which was statistically insignificant. No CBD injury was noted in any case. Conversion to open cholecystectomy was not done in any case. On 1week and 1 month follow up 2 cases in clip group and 1 in HS group had collection in gall bladder fossa and none at I month.Conclusions: Harmonic scalpel offers an effective, alternative and safe method to cystic duct division and Gallbladder dissection from liver bed.

Comparative Analysis of Early versus Late Enteral Feeding after Gastrointestinal Surgeries

2021 ◽  
Vol 15 (8) ◽  
pp. 2050-2053
Author(s):  
Amnah Ilyas Khan ◽  
Nazish Masood ◽  
Usman Ilyas ◽  
Zahra Raza ◽  
Jehangaiz Khan
Keyword(s):  
Enteral Nutrition ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Enteral Feeding ◽  
Controlled Trial ◽  
Gastrointestinal Surgery ◽  
Early Enteral Nutrition ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B

Background: Despite of widespread belief, clinical studies and animal experiments have suggested that initiation of early feeding after surgery has many advantages. Present study was planned for comparing outcomes of early and late enteral feeding in patients who were undergoing gastrointestinal surgeries in our settings. This would help the surgeons to select better option for earlier recovery after surgery Objective: To compare the outcome of early versus late enteral feeding in patients undergoing gastrointestinal surgeries. Design: It was a randomized controlled trial. Study Settings: The study was conducted at Department of General Surgery, PIMS Islamabad for a period of six months w.e.f 20-12-2017 to 19-06-2018. Patients and Methods: A total of two hundred (n=200) patients of both gender between age 15-70 years, who had been scheduled for elective or emergency gastrointestinal surgery were enrolled in the study. Patients were randomized early (Group A, <24 hours after surgery) and late enteral feeding (Group B, <24 hours after surgery). Outcomes were estimated in terms of infection, anastomotic leak and duration of hospital stay in both groups. Results: Mean age of the patients was 36.8±11.2. There were total 85 females and 115 males with female to male ratio of 1:1.35. Mean duration of hospital stay was 2.62 days ± 0.71 in group A and it was 6.55 days ± 0.71 2.93SD in groups B (P=0.001). Wound infection rate (8% vs 33%, P=0.001) and anastomotic leak rate (0% vs 10%, P=0.001) was also significantly lower in group A when compared with group B. Conclusion: Initiation of early enteral feeding (within 24 hours post operatively) in patients undergoing gastrointestinal surgeries has an immediate advantage of caloric intake and results in faster recovery with fewer complications. Similar results are found in the literature. We recommend early initiation (within 24 hours after surgery) of enteral feeding in patients undergoing gastrointestinal surgeries. Keywords: Anostomotic leak, early enteral nutrition (EEN), late enteral nutrition (LEN).

scholarly journals Three-port versus four-port laparoscopic cholecystectomy: a comparative study at a tertiary care centre in North India

2018 ◽  
Vol 5 (2) ◽  
pp. 426
Author(s):  
Peeyush Kumar ◽  
Anil K. S. Rana
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Return To Work ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Gall Stone ◽  
North India ◽  
Duration Of Hospital Stay ◽  
Conversion Rates ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Improvement of Laparoscopic Cholecystectomy (LC) technique in terms of reduction in size and number of ports is being tried to improve patient satisfaction and outcome. Present study was conducted to evaluate and compare the safety outcome and advantages of three-port and four-port LC. Methods: This prospective study included 90 patients presenting with symptomatic gall stone disease or gall bladder polyp more than 1cm at base. Patients with jaundice and choledocholithiasis were excluded. Patients were divided into two groups: A and B, who underwent three-port and four-port LC respectively. Outcomes of the two groups were assessed and compared in terms of duration of surgery, intra-operative and post-operative variables including rate and nature of complications, conversion rates, post-operative pain, duration of hospital stay, return to work and cosmetic outcome.Results: Statistically significant difference was found between the two groups in terms of Visual Analogue Score for pain at 6 and 24 hours, analgesic requirement, duration of hospital stay and return to work; all being less in the three- port LC group. Cosmetic outcome as perceived by patients was also better in the three-port group. Results of other variables were comparable in the two groups. Conclusions: Three-port procedure is safe and appears to be more cost effective than four-port LC. If LC is performed by an experienced surgeon, it can be started with three ports, if required, a fourth port can be inserted. 

scholarly journals COMPARATIVE STUDY BETWEEN STANDARD AND TUBELESS PERCUTANEOUS NEPHROLITHOTOMY PROCEDURES FOR SURGICAL MANAGEMENT OF KIDNEY STONES.

2020 ◽  
pp. 1-2
Author(s):  
Rahul Goel ◽  
Dalvir Singh ◽  
Shivangi Middha ◽  
Jyoti Yadav
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Statistical Significance ◽  
Randomised Trial ◽  
Standard Group ◽  
Residual Stone ◽  
Analgesic Requirement ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
Duration Of Surgery

Introduction: Percutaneous Nephrolithotomy (PCNL) is an effective treatment for renal stone. Due to significant pain and morbidity after standard PCNL because of nephrostomy tubes, various modifications of PCNL are being performed. We report a randomised trial comparing these modalities. Material and method: 50 patients were randomised in two groups of 25 each: standard PCNL with nephrostomy tubes (Group 1) and tubeless PCNL with ureteric stent and no nephrostomy (Group 2). At the end of procedure randomisation was done for those patients satisfying the inclusion criteria based on duration of surgery, single puncture tract, intraoperative bleeding, stone burden, intact pelvicalyceal system and no residual stone at end of procedure. Hb drop, haemorrhage, need for blood transfusion, pyrexia, urine leak, pain score, analgesic requirement and duration of hospital stay were measured. Results: No significant difference in haemorrhage was observed. Urinary leak was only seen in one patient of standard group. Duration of hospital stay and analgesic requirement attained statistical significance in favour of tubeless group compared to standard. Conclusion: Tubeless is effective and safe method for management of renal stones. It reduces postoperative pain and morbidity compared to standard group.

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