Top PDF A comparative study between open and Laparoscopic cholecystectomy in gallstone disease

A comparative study between open and Laparoscopic cholecystectomy in gallstone disease

A comparative study between open and Laparoscopic cholecystectomy in gallstone disease

Knowledge of relevant anatomy is important for the safe execution of any operative procedure. Specifically, in the context of a cholecystectomy, it has been recognized since long that misinterpretation of normal anatomy as well as the presence of anatomical variations contribute to the occurrence of major postoperative complications especially biliary injuries. Such injuries in turn can cause significant morbidity and occasionally even mortality. They are also one of the commonest causes of litigation against abdominal surgeons in the developed world. There is now a fair amount of data to suggest that the acceptance of laparoscopic cholecystectomy (LC) as the standard procedure, has led to an increase in bile duct injuries. This seems partly related to the different anatomical exposure of the area around the gallbladder especially the Calot's triangle during the laparoscopic procedure as opposed to the open procedure.
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A comparative study between open and laparoscopic cholecystectomy in K.A.P. Viswanatham Government Medical College, Trichy

A comparative study between open and laparoscopic cholecystectomy in K.A.P. Viswanatham Government Medical College, Trichy

This is to certify that this dissertation titled “A COMPARATIVE STUDY BETWEEN OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY IN KAPV GOVT MEDICAL COLLEGE, TRICHY” is a bonafide work of Dr. INDRA PRIYADHARSINI. P.., Post Graduate in M.S. General Surgery, Department of General Surgery, K.A.P.V. Government Medical College, Trichy and has been prepared by him under our guidance. This has been submitted in partial fulfilment of regulations of The Tamil Nadu Dr. M.G.R. Medical University, Chennai -32 for the award of M.S. Degree in General Surgery (Branch- I)
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Comparative Study of Laparoscopic Cholecystectomy Versus Open Cholecystectomy in Elderly Patients: An Observational Comparative Study

Comparative Study of Laparoscopic Cholecystectomy Versus Open Cholecystectomy in Elderly Patients: An Observational Comparative Study

Gallstone disease is one of the most common surgical encounters. According to world literature, it occurs among 3-20% of the world population (1). A gallstones survey suggested that the incidence of gallbladder (GB) stones is 7 times more common in Northern Indian than in Southern Indian population. Laparoscopic cholecystectomy (LC) is accepted as the gold standard treatment for this disorder (1). Surgery for cholelithiasis is more common in elderly patients as the incidence of gallstones increases with age. The use of a laparoscopic approach in aging patients may pose problems because the comorbid conditions that are concomitant with advanced age thereby increasing the post-operative LC complications and the frequency of conversion to open surgery (2). Cholecystectomy is the most frequent abdominal operation, and its employment in the elderly varies between 8.3% and
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Comparative study of morbidity of laparoscopic versus open cholecystectomy in complicated gallstone disease

Comparative study of morbidity of laparoscopic versus open cholecystectomy in complicated gallstone disease

In our study the majority of cases (88%) of OC group felt moderate to severe pain and late recovery as compare to LC group where 31% felt mild to moderate pain (p=0.005) with quick re- covery and early mobilization and therefore was less need of postoperative analgesia in LC group. In other studies laparoscopic cholecystectomy have minimum surgical stress, less postoperative pain, fast recovery 25 and early gut motility and feed-

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A prospective comparative study on laparoscopic cholecystectomy vs open cholecystectomy

A prospective comparative study on laparoscopic cholecystectomy vs open cholecystectomy

Out of 88 patients in the study 56 patients did not present with pain abdomen. They are diagnosed in USG for the complaints of vague abdominal symptoms like epigastric fullness, early satiety, vomiting after fatty meal. 12 patients presented with features suggestive of acute cholecystitis that includes emphysematous cholecystitis. 20 patients were diagnosed earlier who had few episodes of acute cholecystitis and were treated elsewhere.

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A Comparative Study on Elective Laparoscopic Cholecystectomy With and Without Antimicrobial Therapy

A Comparative Study on Elective Laparoscopic Cholecystectomy With and Without Antimicrobial Therapy

The common bile duct runs between the layers of the lesser omentum, lying anterior to the portal vein and to the right of the hepatic artery. Passing behind the first part of the duodenum in a groove on the back of the head of the pancreas, it enters the second part of the duodenum. The duct runs obliquely through the posterior-medial wall, usually joining the main pancreatic duct to form the Ampulla of Vater (1720). The ampulla makes the mucous membrane bulge inwards to form an eminence: the duodenal papilla. In about 10-15% of subjects the bile and pancreatic ducts open separately into theduodenum.
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A comparative study of laparoscopic versus open cholecystectomy in Coimbatore Medical College and Hospital, Coimbatore

A comparative study of laparoscopic versus open cholecystectomy in Coimbatore Medical College and Hospital, Coimbatore

¾ Traditional major open abdominal operations have potent effects on the immune system. Surgical trauma induces an inflammatory state characterized by the release of proinflammatory cytokines IL-1B, IL-6, IL-8, TNFalpha and acute phase proteins such as C-reactive protein are typically transiently increased. Surgical manipulation also depresses cell mediated immunity by alteration in recruitment, activation and function of circulating lymphocytes, monocytes and other immune cells. After open cholecystectomy, higher post operative plasma levels of CRP, TNFalpha, IL-1B, IL-6 and higher leukocyte counts relative to laparoscopic cholecystectomy. 17 This was the probable reasons for early recovery, less pain and early ambulance in laparoscopic cholecystectomy patients.
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Laparoscopic cholecystectomy under spinal anesthesia: comparative study between conventional-dose and low-dose hyperbaric bupivacaine

Laparoscopic cholecystectomy under spinal anesthesia: comparative study between conventional-dose and low-dose hyperbaric bupivacaine

and no major adverse intraoperative events occurred. There was no need to convert to open surgery in any patient. Twenty patients had dense adhesions of the omentum to the anterior abdominal wall, all of which were dissected successfully. Local washing of the right diaphragm with lidocaine solution 1% 10 mL was successful in preventing pain in 112 patients. Intravenous fentanyl 50 µ g was needed in 22 patients due to severe right shoulder pain; surgery was continued and com- pleted uneventfully after administration of rescue analgesic in all cases.

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Factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy

Factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy

In 1985 Sauerbruch was the first to apply the application of extracorporeal shock-wave lithotripsy to gallstone disease.Diminishing the surface-to-volume ratio of a stone is the rationale behind this, thereby increasing the efficacy of oral dissolution. This in turn decreases stone size and allows it and the debris to pass directly unhindered from the gallbladder into the intestine. It involves delivery of focused high-pressure sound waves to the gallstones. Passage of the shock wave causes cavitation at the anterior surface of the stone by liberating compressive and tensile forces on the stone, thereby leading to stone fragmentation. Size, architecture and microcrystalline structure are the factors that influence fragmentation.
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A comparative study of laparoscopic (LC) vs. open cholecystectomy (OC) in a medical school of Bihar, India

A comparative study of laparoscopic (LC) vs. open cholecystectomy (OC) in a medical school of Bihar, India

Patients were admitted a day prior to surgery in case of elective cholecystectomy from OPD. Some patients were admitted from emergency department of hospital as they had presented with acute abdominal pain. A detailed clinical history was taken from all patients. Physical examination was done with the help of a common proforma. Full range of investigations like chest X-ray, ECG, CBC (Complete Blood Count), LFT (Liver Function Test), KFT (Kidney Function Test), serum electrolytes and viral markers were done on all patients. Medical and anesthetic fitness were assessed preop. Gas and relaxant general anesthesia were used on all. Patients were randomly allocated into two groups. Group I (n = 100) who underwent laparoscopic cholecystectomy (LA) and group II (n = 100) being patients who underwent open cholecystectomy (OC). Patients were informed and detailed about both the procedures in native language. Patients were randomized in the operating theatre and standard anesthetic technique and pain-control measures were taken.
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Costs and quality of life of small-incision open cholecystectomy and laparoscopic cholecystectomy - an expertise-based randomised controlled trial

Costs and quality of life of small-incision open cholecystectomy and laparoscopic cholecystectomy - an expertise-based randomised controlled trial

Several reasons necessitate a discussion of cost- effectiveness in treatment of gallstone disease. The increasing population age in industrialized countries escalates health care costs [24]. Sphincterotomy has separated treatment of bile duct stones and gallblad- der stones [25, 26], although SIOC, with choledochot- omy, and primary closure of the common bile duct during cholecystectomy is safe, effective and inexpen- sive when performed by trained surgeons [27]. The decline in training in open surgery for residents [28] is of concern for the treatment of gallstone disease [29, 30]. After appropriate training, SIOC is an alter- native to LC wherever the health-care budget is lim- ited, not only in the third world [31].
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Open cholecystectomy for all patients in the era of laparoscopic surgery – a prospective cohort study

Open cholecystectomy for all patients in the era of laparoscopic surgery – a prospective cohort study

The main advantage of using small-incision open chole- cystectomy for all patients is its general applicability and elimination of double learning curves. Nationwide stud- ies have shown that after the introduction of laparoscopic cholecystectomy 20 to 30% of all gallbladder operations are completed openly, and that patients thus treated are older and have more co-morbidities than patients under- going laparoscopic cholecystectomy [32-34]. From 1995 through 1999, 82% of Swedish patients over the age 70 treated for acute gallstone disease and 43% of those treated for chronic gallstone disease had an open opera- tion[35]. The limited exposure to open biliary surgery cre- ates a dilemma for training of residents[36,37]. The surgical community has to develop strategies to meet the growth of workload accompanying the increasing age of populations in the western world[38]. The present cohort study indicates that small-incision open cholecystectomy is an attractive alternative for elderly patients, with their high incidence of acute cholecystitis and common bile duct stones[39]. We agree with Syrakos et al[8] that com- missioners of health care should question whether lapar- oscopic gallbladder surgery gives value for the cost. Further cost-utility studies comparing mini-laparotomy cholecystectomy and laparoscopic cholecystectomy are necessary, ideally performed as expertise based ran- domised controlled trials[40]. As pointed out earlier, reg- ister studies with their inherent difficulties in controlling for patient characteristics are unlikely to answer questions concerning relative merits cholecystectomy techiques[35,41].
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Ondansetron and palanosetron for prevention of post-operative nausea and vomiting in laparoscopic cholecystectomy: a comparative study

Ondansetron and palanosetron for prevention of post-operative nausea and vomiting in laparoscopic cholecystectomy: a comparative study

Today laparoscopic cholecystectomy is one of the most commonly performed procedures in general surgery. It is considered the "gold standard" for the surgical treatment of gallstone disease, with more than 5,00,000 procedures performed annually in the world. 11 Various studies reported that post-operative period was associated with variable incidence of nausea and vomiting depending on the duration of surgery 12,13 , the type of anesthetic agents used (dose, inhalational drugs, opioids) 14,15 , smoking habit 16 etc. The incidence of PONV was 20- 30% after general anesthesia with volatile anesthetics and up to 70% to 80% in high risk patients such as abdominal, gynaecologic, eye, ear, nose and throat and breast surgery, any surgery lasting over 30 minutes 13,17 ,female, young age, history of motion sickness, history of prior postoperative nausea and vomiting, non- smoker, family history of PONV. 16,18
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A comparative study between laparoscopic and open cholecystectomy in Chengalpattu Medical College

A comparative study between laparoscopic and open cholecystectomy in Chengalpattu Medical College

mechanism involves temporary elevation of pancreaticductal pressures, causing a secondary inflammation of the pancreaticparenchyma. Even a temporary elevation of intraluminal pressurecan cause significant injury to the pancreas. As opposed to the gallbladder, in which relief of the obstruction is accompaniedby pain resolution, the symptoms in pancreatitis continue in spiteof passage of the stone. With the diagnosis of pancreatitis in whichthe cause is unclear, ultrasound will help identify gallstones andmay show choledocholithiasis or a dilated bile duct. The offendingstone usually passes spontaneously but may still cause severe pancreatitis.In most cases of gallstone pancreatitis, the pancreatitis isself-limited. If, by clinical assessment, the pancreatitis is severe,early ERCP to remove a stone that may not have passed is indicatedand has been shown to reduce the morbidity of the episodeof pancreatitis.To prevent a future episode of gallstone pancreatitis, a laparoscopic cholecystectomy is warranted; this is generallyrecommended during the same hospitalization, just beforedischarge. Given the suspicion of choledocholithiasis, intraoperativecholangiography should be performed if no other imaginghas been performed to confirm the passage of the gallstone.
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Study on preoperative factors predicting the conversion of laparoscopic cholecystectomy to open cholecystectomy

Study on preoperative factors predicting the conversion of laparoscopic cholecystectomy to open cholecystectomy

“Cholelithiasis is a common disease throughout the Western world. Gallstones can be found in 10% to 20% of the western population at some stage of life. In both sexes the prevalence increases with age; however, overall gallstones are more common in females than in males with a ratio of 4:1. Obesity and family history are also significant risk factors. The prevalence of gallstones is related to many factors like age, gender, ethnicity. Many factors predispose to the development of gallstones. They include obesity, pregnancy, dietary factors, Crohn's disease, terminal ileal resection, gastric surgery, hereditary spherocytosis, sickle cell disease, and thalassemia”.
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Morpho-functional gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease

Morpho-functional gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease

The study has provided so far, since January 2010, the enrollment of 62 patients. Of these, 31 completed the follow-up to 6 months, 19 were lost at follow-up, 12 patients have yet to complete the follow-up. Nineteen of 62 patients (30.64%) did not return for the post-opera- tive follow-up ,maybe for the scant willingness to undergo an invasive follow-up endoscopy, especially if the purpose is the finding of a bile reflux gastritis, a condition that can occur without symptoms and who’s long term risks are unknown. Patients who did not undergo the postoperative examination were excluded from the study.
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Outcomes of Laparoscopic Cholecystectomy in Patients with End Stage Renal Disease

Outcomes of Laparoscopic Cholecystectomy in Patients with End Stage Renal Disease

Purpose: In this study, we aimed to discuss the laparoscopic cholecystectomy in patients with end stage renal disease compared to the general population. Materials and Methods: We retrospec- tively evaluated a group of patients with (n = 45) and without (n = 90) end-stage renal disease undergoing laparoscopic cholecystectomy. The groups were compared in terms of length of sur- gery; duration of hospitalization after surgery; use of blood derivatives; mortality rates; and perio- perative, postoperative, and postdischarge complications. Results: Patients with end-stage renal disease exhibited a higher frequency of associated diseases; lower hemoglobin levels; and ele- vated alkaline phosphatase, blood urea nitrogen, and creatinine values. Statistically significant differences were found between the two groups regarding length of surgery (83.6 ± 14.88 vs. 71.7 ± 11.42 minutes; p < 0.001); duration of hospitalization (1.7 ± 0.47 vs. 1.4 ± 0.31 days; p < 0.001). In the group of patients with end-stage renal disease had significantly higher perioperative (p = 0.011), postoperative (p < 0.001), and postdischarge complication (p = 0.011) rates. Among all pa- tients with end-stage renal disease, 12 (26.7%) were converted to an open procedure (p < 0.001). Conclusion: Despite higher complication rates of laparoscopic cholecystectomy in end-stage renal disease patients, laparoscopic cholecystectomy could be performed safely in patients with end- stage renal disease with low levels of complications and no associated mortality.
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To Study the Drain versus No Drain in Laparoscopic Cholecystectomy

To Study the Drain versus No Drain in Laparoscopic Cholecystectomy

Gallstone disease is the pathologic state of stones or calculi within the gallbladder lumen and biliary tree. This is a common digestive disorder worldwide, with occurrence varying from 6- 20%. [1] The definitive management of symptomatic gallstones is surgical. The two surgical approaches are conventional and laparoscopic. First successful removal of gallbladder was done by Carl Langenbuch in 1882 for stone disease. [2]

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COMPARATIVE STUDY BETWEEN LAPAROSCOPIC TOTAL HYSTERECTOMY AND OPEN ABDOMINAL HYSTERECTOMY IN ALDIWANIYAH TEACHING HOSPITAL

COMPARATIVE STUDY BETWEEN LAPAROSCOPIC TOTAL HYSTERECTOMY AND OPEN ABDOMINAL HYSTERECTOMY IN ALDIWANIYAH TEACHING HOSPITAL

Hysterectomy is one of the most common gynecological procedures performed worldwide. Approximately 600,000 hysterectomies are performed annually in the United States the majority of which are performed for benign indications. [1] Hysterectomy can be performed Trans abdominally, Transvaginally, laparoscopic ally with or without robot-assisted facilities or a combination of 2 of the above mentioned approaches. [2] Choosing route of hysterectomy is influenced by many factors as shape and size of the uterus and pelvis, surgical indications, presence or absence of adnexal pathology, extensive pelvic adhesive disease, surgical risks, hospitalization and recovery length, hospital resources, and surgeon expertise are all weighed once hysterectomy is planned. Each approach carries distinct advantages and disadvantages, and should be discussed with the
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