Online ISSN: 2515-8260

Keywords : Cholecystectomy


A Comparative Study of Intraperitoneal Instillation of Different Volumes and Concentrations of Bupivacaine Versus Transversus Abdominis Plane Block (Tap) for Post-Operative Analgesia in Laparoscopic Cholecystectomy

Dr Megha A, Dr Malavika, Dr Sindhu A P

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 459-470

Background : Laparoscopic [LC] surgeries or minimally invasive surgeries are associated
with lesser parietal pain and haemorrhage, compared to the open surgeries. However visceral
pain persists. The effect of volume and concentration on intra-peritoneal instillation of local
anaesthetics for pain relief has not been studied . In this study we have compared the intraperitoneal
instillation of local anaesthetic with transversus abdominis plane block (TAP).
This study is aimed at assessing the superiority of effect of volume of local anaesthetic
instilled intra-peritoneally versus TAP block on post-operative pain relief in laparoscopic
cholecystectomy.

A Comparative Study Between Open and Laparoscopic Cholecystectomy

Srikanth Jukuru

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1217-1225

Background: The aim of this study is to compare conventional cholecystectomy and
laparoscopic cholecystectomy.
Materials and Methods: The study subjects consisted of 40 patients with a diagnosis of
calculous cholecystitis that underwent cholecystectomy at Bhaskar Medical College and
General Hospital, yenkapally from January 2018 to June 2019. The patients will be
evaluated for detailed clinical history according to a definite proforma. All the patients
will be examined and routine blood investigations with LFT wherever necessary will be
done. Abdominal USG will be performed in all the cases.
Results: The commonest presenting complaint in both the groups was pain in the right
upper quadrant followed by vomiting, fever and dyspepsia. Majority of the patients in
both the groups had multiple stones. (15 patients in LC group and 14 patients in OC
group) The duration of LC was significantly more than for OC (median 105 min v/s
75min respectively). The intra operative blood loss and the complications were more for
the open procedure. Two patients of laparoscopic group required conversion to open
procedure. The drains were required in less number of patients of LC group and for
less number of days. Wound infection was seen in 1 of LC patient and 5 of OC patients.
One patient of OC group developed incisional hernia. The antibiotic requirement was
less in LC group (median 5days) compared to OC group (median 7days). The Visual
Analogue Scale for pain in the post op period was significantly less for LC patients
compared to OC patients (median Grade1 v/s Grade3 respectively). The duration of
pain in the LC group was significantly less (median of 2 days) compared to OC group
(median of 4 days). The analgesic requirement was significantly less in LC patients
(median for3days) compared to OC patients (median for 5 days). The LC patients
tolerated oral feeds earlier compared to OC patients (6- 8hours compared to 12-36
hours respectively). The duration of hospital stay was significantly longer for OC group
than for LC group (median 7 days versus 4 days respectively). The time to return to
normal work was delayed for OC group (median 8 days) compared to LC group
(median 5 days). The cosmetic end result was unacceptable in majority of OC patients
(14 of 20). While majority of LC patients were satisfied with the operative scar (16 of
20).
Conclusion: The laparoscopic procedure was costly compared to open procedure. But
this difference was overcome by the other costs incurred in post-operative period of
open procedure.

Analysis of Safety and Efficacy of a Laparoscopic Cholecystectomy in the Morbid and Super Obese Patients at a Tertiary Care Centre

Gopal, Sharad Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1339-1343

Introduction: Laparoscopic cholecystectomy (LC) has been proved to be the benchmark
treatment for symptomatic cholelithiasis. The overall morbidity and mortality rate is 5–
10% and 0.1% respectively, and an open conversion rate of 5–10% is commonly
reported in the literature. Over a century, classical cholecystectomy (Open method) has
been the method of choice in the surgical management of gall bladder diseases. One of
the risk factors for cholelithiasis is obesity, the incidence of which is increasing
worldwide due to the change in lifestyle habitat. Therefore, surgeons are likely to
encounter increasing number of obese patients who require a cholecystectomy for
symptomatic cholelithiasis. Conventionally obesity has been considered as a relative
contraindication to LC, as the technical difficulties associated with this procedure in
these patients were thought to be associated with higher morbidity and mortality as well
as increased open conversion rates. The aim of this study was to investigate the safety
[peri-operative morbidity and mortality and the incidence of bile duct injuries (BDI)]
and efficacy (duration of surgery, LOS and open conversion rates) of an elective LC in
the morbid/ super obese patients (BMI > 40) compared to patients with a BMI < 26 and
a BMI 26–40.

A Clinical Study of Obstructive Jaundice Secondary to Choledocholithiasis

Mohammed Shazad Ahmed, Syed Mohammed Sajjad Husayni, Mohammed Naqi Zain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5048-5054

Background:Humans have long known about jaundice. Obstructive jaundice is
common in general surgery. Intrahepatic or extrahepatic blockage can cause
obstructive jaundice. Most patients with suspected biliary blockage start with an
abdominal ultrasound. This study aims to determine the prevalence of obstructive
jaundice owing to choledocholithiasis in my hospital, the role of ultrasound in detecting
such cases, and the treatment options available at Princes Dusra Hospital Hyderabad.
Materials and Methods: Between June 2019 and June 2021, 24 patients with obstructive
jaundice due to choledocholithiasis were studied at Princes Esra Hospital in Hyderabad.
These patients received surgery. The proforma was used to assess these patients both
pre- and post-operatively.
Results: Obstructive jaundice due to choledocholithiasis was 0.14 percent in hospitals.
The patients were mostly female (16:4).Symptoms presented in decreasing order of
frequency. 100% jaundice, 95% abdominal pain, 50% nausea/vomiting, 50% itching
(35 percent),Fever with chills and rigours (25%) Steatorrhea (10%) and abdominal
mass (5%).Ultrasound showed stones in 16 (80%) and dilated CBD in all 24 (100%)
instances (100 percent ). 11 patients had choledocholithiasis. Four instances had
choledocholithiasis and cholelithiasis. The investigation found one incidence of
choledocholithiasis with CBD stricture. The most common surgical technique was
choledochoduodenostomy (50%) followed by choledochotomy with T-tube drainage
(40%) One case each of choledocho-jejunostomy and transduodenal sphincter. All
twenty instances had cholecystectomy. All cases were monitored for 1-6 months with no
complaints.
Conclusion:Patients with obstructive jaundice are more susceptible to infections due to
impaired liver function. It's also critical to identify specific risk factors in biliary tract
surgery patients. Our study shows that ultrasound is the cheapest, safest, and most
reliable diagnostic technique for postoperative jaundice. Despite the advent of
laparoscopic CBD exploration, open, internal, and external biliary drainage procedures
are still used successfully in areas lacking technology and experience.

To Evaluate The Role Of Early Vs Delayed Laparoscopic Cholecystectomy In Mild And Moderate Acute Gall stone Pancreatitis

Dr Sandip kumar Chaudhari, Dr Nayan Pancholi, Dr Latif Bagwan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 54-59

Aim: To evaluate the role of early Vs delayed laparoscopic cholecystectomy in mild and
moderate acute gallstone pancreatitis
Methods:This randomized prospective study conducted in the Department ofSurgery after
taking the approval of the protocol review committee and institutional ethics committee. 100
patients were included in the study. They were divided into two groups with 50 patients in
each group. Patients with mild and moderate acute gallstone pancreatitis were included in this
study.

Clinical profile of patients treated with cholecystectomy at a tertiary care hospital

Dr.SadiqHusainKachavi, Dr.CG Sunil, Dr.Sandeep Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 428-432

Gallstones are composed predominantly of cholesterol, bilirubin and calcium salts with lesser amounts of other constituents. The most popular classification system uses the relative amount of cholesterol as the main criterion and designates gallstones as being either cholesterol or non-cholesterol. The latter are further classified as black or brown pigment stones. A thorough preoperative anaesthetic evaluation was done and patient fitness for general anaesthesia assessed. A dose of antibiotics (usually a cephalosporin) was given 30 minutes before surgery. A nasogastric tube was inserted routinely. The most common indication for open cholecystectomy was symptomatic cholelithiasis (68%). In the laparoscopic group also cholelithiasis (76%) was the most common cause.

A study to analyze pre-operative parameters with intraoperative and histopathological findings in cholelithiasis

Dr.BalaMurali Krishna Mudiyam MS, Dr.M Lakshman Kumar Yadav, Dr. J Mayur Kumar,Dr. M Gururaj

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 1250-1257

The common etiology of conversion from LC to open cholecystectomy is uncontrollable
bleeding, adhesions, inflammation, anatomical variations, trauma of bile duct, presence of
malignant pathologies and technical failure. The conversion rate to OC remains
approximately 2-5% in most series. Patients were selected according to inclusion and
exclusion criteria after taking informed consent and reassuring them keeping confidentiality
of their data. In all the 200 patients, patients diagnosed as cholelithiasis and who underwent
laparoscopic cholecystectomy or converted to open-cholecystectomy were included in
the study. After explaining complete details of the procedure and complications to the
patients, the surgery was performed under general anesthesia. In our study out of 200
patients, age from 21-60(n=102) years have difficulty in operation with >40mins of duration
of operation with P value <0.001 and the difference is statistically highly significant by
Fisher’s exact probability test.Incidental Carcinoma of gallbladder in 1 (0.5%), Gallbladder
polyp in 1 (0.5%), CC in 136 (68%), AC in 46 (23%), AGC in 5 (2.5%) & MGB in 11
(5.5%).

Outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis: A randomised prospective study

Dr. Abu Noaman, Dr. Mahesh Choudhary, Dr.Balkeshwarkumar Suman

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1860-1867

Aim: To study the outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis:
Methods: 80 patients were included in the study. They were divided into two groups with 40 patients in each group. Group A: (40) patients who underwent laparoscopic cholecystectomy after 48 hours from day of admission. Group B: (40) patients who discharged home after resolution of the acute phase and underwent laparoscopic cholecystectomy after 6 weeks. Both groups were compared as regard: operative time, intraoperative findings and complications, conversion to open surgery, use of abdominal drains, hospital stay, post operative complications, readmission after discharge.
Results:  The mean age of patients in group A was 36.29 ± 10.33 years (range= 20-55 year) while in group B     was 37.58 ± 10.22 y (range= 20- 53 y). The majority of the patients were female. 24 patients (60%) in group A and 32 patients (80%) in group B. In group A the operative time ranged from 46 minutes to 89 minutes with a mean of 67.5±11.69 minutes, while in group B operative time ranged from 39 minutes to 76 minutes with a mean of 57.5±9.98 minutes . P value was significant 0.014. In group A 5 patients (12.5%) have intraoperative finding of acute cholecystitiswhere as none of group B express acute cholecystitisintraoperatively, with no statistically difference (p value 0.069). There was no significant difference in intraoperative complications between both groups. The difference between the two groups is significant (0% vs. 40%, p < 0.0001). 7 patients (17.5%) required hospital readmission due to severity of the symptoms. 10 patients (25%) had biliary colic, 3 patients (7.5%) developed acute cholecystitis, and 4 patients (10%) had recurrent biliary pancreatitis.
Conclusion:  We concluded that the early cholecystectomy in patients with mild acute biliary pancreatitis has no added risk of intra or post operative complications than delayed cholecystectomy. Also it significantly reduces the risk of recurrent biliary problems and length of hospital stay which has a great impact on the patients and health care resources .