Gall stone disease is a common gastrointestinal surgical problem and symptomatic patients needs appropriate and timely treatment in the form of cholecystectomy else the disease process becomes complicated because of recurrent chronic infection, dislodgement of stone to common bile duct, acute infection and more severe complications like perforation of gall bladder. In recent years, Laparoscopic Cholecystectomy is considered as gold standard treatment for symptomatic as well as for few categories of asymptomatic cholelithiasis. Reduced postoperative pain, early return of mobility and to work, cosmetic results and brief hospital stay are distinct advantages of the procedure. Laparoscopic Cholecystectomy becomes difficult in patients with male sex, age above 50 years, obese, history of previous hospitalization due to attacks, previous abdominal surgery scar, palpable gall bladder, impacted stone, overdistended/contracted gall bladder. Various scoring systems have been reported to predict difficult laparoscopic cholecystectomy preoperatively. These difficult cases required longer operating time and hospital stay. The incidence of postoperative complications are also higher as compared to easy Laparoscopic Cholecystectomy Of the total 430 cases included in this study, 200 (46.5%) cases were difficult cases. For performing Laparoscopic Cholecystectomy in these patients successfully i.e. with minimum conversion to open, certain modifications in the classical four-port technique were done. As a result, conversion rate in difficult laparoscopic cholecystectomy could be limited to 7% only. Postoperative complication were pyrexia (21.5%), paralytic ileus (9.5%), bile stained subhepatic discharge (6.5%), port site infection (8%) and respiratory complications (8%). Late complication was port-site hernia (0.5%). Operating time 58.7+12.4 minutes in difficult laparoscopic cholecystectomy as compared to 36.5+9.2 minutes in easy cases and postoperative hospital stay was of 6.9+1.8 days against 2.3+0.8 days as compared to easy cases. Unclear anatomy (3%), haemorrhage (4%), dense adhesions (2%) and anaesthesia issue (1%) were the reasons of conversion to open cholecystectomy. It is concluded from this study that preoperative difficult laparoscopic cholecystectomy can be predicted and modifications of the steps of four-port cholecystectomy can be done to minimize the conversion rate.
| Published in | Journal of Surgery (Volume 8, Issue 4) |
| DOI | 10.11648/j.js.20200804.14 |
| Page(s) | 118-122 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Cholelithiasis, Cholecystectomy, Difficult Laparoscopic Cholecystectomy, Conversion to Open Cholecystectomy
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APA Style
Deepak Verma, Nemi Chand, Sarthak Sharma, Mahesh Malani, Parul Yadav. (2020). Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate. Journal of Surgery, 8(4), 118-122. https://doi.org/10.11648/j.js.20200804.14
ACS Style
Deepak Verma; Nemi Chand; Sarthak Sharma; Mahesh Malani; Parul Yadav. Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate. J. Surg. 2020, 8(4), 118-122. doi: 10.11648/j.js.20200804.14
AMA Style
Deepak Verma, Nemi Chand, Sarthak Sharma, Mahesh Malani, Parul Yadav. Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate. J Surg. 2020;8(4):118-122. doi: 10.11648/j.js.20200804.14
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Download@article{10.11648/j.js.20200804.14,
author = {Deepak Verma and Nemi Chand and Sarthak Sharma and Mahesh Malani and Parul Yadav},
title = {Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate},
journal = {Journal of Surgery},
volume = {8},
number = {4},
pages = {118-122},
doi = {10.11648/j.js.20200804.14},
url = {https://doi.org/10.11648/j.js.20200804.14},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200804.14},
abstract = {Gall stone disease is a common gastrointestinal surgical problem and symptomatic patients needs appropriate and timely treatment in the form of cholecystectomy else the disease process becomes complicated because of recurrent chronic infection, dislodgement of stone to common bile duct, acute infection and more severe complications like perforation of gall bladder. In recent years, Laparoscopic Cholecystectomy is considered as gold standard treatment for symptomatic as well as for few categories of asymptomatic cholelithiasis. Reduced postoperative pain, early return of mobility and to work, cosmetic results and brief hospital stay are distinct advantages of the procedure. Laparoscopic Cholecystectomy becomes difficult in patients with male sex, age above 50 years, obese, history of previous hospitalization due to attacks, previous abdominal surgery scar, palpable gall bladder, impacted stone, overdistended/contracted gall bladder. Various scoring systems have been reported to predict difficult laparoscopic cholecystectomy preoperatively. These difficult cases required longer operating time and hospital stay. The incidence of postoperative complications are also higher as compared to easy Laparoscopic Cholecystectomy Of the total 430 cases included in this study, 200 (46.5%) cases were difficult cases. For performing Laparoscopic Cholecystectomy in these patients successfully i.e. with minimum conversion to open, certain modifications in the classical four-port technique were done. As a result, conversion rate in difficult laparoscopic cholecystectomy could be limited to 7% only. Postoperative complication were pyrexia (21.5%), paralytic ileus (9.5%), bile stained subhepatic discharge (6.5%), port site infection (8%) and respiratory complications (8%). Late complication was port-site hernia (0.5%). Operating time 58.7+12.4 minutes in difficult laparoscopic cholecystectomy as compared to 36.5+9.2 minutes in easy cases and postoperative hospital stay was of 6.9+1.8 days against 2.3+0.8 days as compared to easy cases. Unclear anatomy (3%), haemorrhage (4%), dense adhesions (2%) and anaesthesia issue (1%) were the reasons of conversion to open cholecystectomy. It is concluded from this study that preoperative difficult laparoscopic cholecystectomy can be predicted and modifications of the steps of four-port cholecystectomy can be done to minimize the conversion rate.},
year = {2020}
}
TY - JOUR T1 - Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate AU - Deepak Verma AU - Nemi Chand AU - Sarthak Sharma AU - Mahesh Malani AU - Parul Yadav Y1 - 2020/07/04 PY - 2020 N1 - https://doi.org/10.11648/j.js.20200804.14 DO - 10.11648/j.js.20200804.14 T2 - Journal of Surgery JF - Journal of Surgery JO - Journal of Surgery SP - 118 EP - 122 PB - Science Publishing Group SN - 2330-0930 UR - https://doi.org/10.11648/j.js.20200804.14 AB - Gall stone disease is a common gastrointestinal surgical problem and symptomatic patients needs appropriate and timely treatment in the form of cholecystectomy else the disease process becomes complicated because of recurrent chronic infection, dislodgement of stone to common bile duct, acute infection and more severe complications like perforation of gall bladder. In recent years, Laparoscopic Cholecystectomy is considered as gold standard treatment for symptomatic as well as for few categories of asymptomatic cholelithiasis. Reduced postoperative pain, early return of mobility and to work, cosmetic results and brief hospital stay are distinct advantages of the procedure. Laparoscopic Cholecystectomy becomes difficult in patients with male sex, age above 50 years, obese, history of previous hospitalization due to attacks, previous abdominal surgery scar, palpable gall bladder, impacted stone, overdistended/contracted gall bladder. Various scoring systems have been reported to predict difficult laparoscopic cholecystectomy preoperatively. These difficult cases required longer operating time and hospital stay. The incidence of postoperative complications are also higher as compared to easy Laparoscopic Cholecystectomy Of the total 430 cases included in this study, 200 (46.5%) cases were difficult cases. For performing Laparoscopic Cholecystectomy in these patients successfully i.e. with minimum conversion to open, certain modifications in the classical four-port technique were done. As a result, conversion rate in difficult laparoscopic cholecystectomy could be limited to 7% only. Postoperative complication were pyrexia (21.5%), paralytic ileus (9.5%), bile stained subhepatic discharge (6.5%), port site infection (8%) and respiratory complications (8%). Late complication was port-site hernia (0.5%). Operating time 58.7+12.4 minutes in difficult laparoscopic cholecystectomy as compared to 36.5+9.2 minutes in easy cases and postoperative hospital stay was of 6.9+1.8 days against 2.3+0.8 days as compared to easy cases. Unclear anatomy (3%), haemorrhage (4%), dense adhesions (2%) and anaesthesia issue (1%) were the reasons of conversion to open cholecystectomy. It is concluded from this study that preoperative difficult laparoscopic cholecystectomy can be predicted and modifications of the steps of four-port cholecystectomy can be done to minimize the conversion rate. VL - 8 IS - 4 ER -
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