Background: In laparoscopic cholecystectomy, gall bladder extraction via different ports has always been a matter of concern for the surgeons. This study is designed so as to determine the difference in the rate of pain and infection in gall bladder extraction via umbilical and epigastric port.Methods: A prospective randomized study was done from January 2015 to December 2015 at S. N. Medical College, Agra in which 200 patients of cholelithiasis were considered. The patients were randomly selected in the operation theatre for gall bladder extraction via epigastric port (designated as Group-A with n = 100 patients) and gall bladder extraction via umbilical port (designated as Group-B with n = 100 patients).Results: Post-operative pain at 24 hours, in terms of VAS was 3.67±1.42 in Group-A while 2.47±1.17 in Group-B with 10 being the worst pain. The p-value was calculated as .000048. The result is significant at p< .05. A total of eight patients out of two hundred patients suffered port site infections amongst which five were from Group-A (5%) and three were from Group-B (3%).Conclusions: This study thus indicates that in laparoscopic cholecystectomy, gall bladder retrieval through the umbilical port is a better alternative to gall bladder extraction via epigastric port in terms of post-operative pain and port site infection. Our study recommends gall bladder extraction via umbilical port rather than epigastric port.

Background: Traditionally laparoscopic common bile duct exploration is followed by T-tube placement because of which patients suffer problems related to T-tube thereby increasing the morbidity of patients. Primary closure of CBD following laparoscopic choledocholithotomy is now being considered as an alternative superior to the traditional method. This study is designed to analyse the outcome of primary CBD repair in terms of mean operation time, duration of hospital stay and post-operative morbidity.Methods: A prospective randomized study was done in which 40 patients at our institute and associated hospitals were divided into two groups to compare the results of primary closure to T-tube placement following laparoscopic choledocholithotomy.Results: 40 patients were included in this study. The mean operating time was observed to be 65±14.05 mins in Group A (primary closure) patients while that in case of Group B (T-tube drainage) patients was 95.25±9.66 mins with a p-value 0.0001 which is considered statistically significant. The average duration of hospital stay in Group A (primary closure) was 8.2 days which was much shorter than that of Group B (T-tube drainage) patients which was of 15.7 days. The post-operative complication was observed in 1 patient of Group A (primary closure) while post-operative complication occurred in 3 patients of Group B (T-tube drainage).Conclusions: This study indicates that primary repair following laparoscopic choledocholithotomy is a safer and more effective method than T-tube drainage and we strongly recommend this procedure in clinical practice.

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Background: Cholelithiasis (gall stone disease) is a well-known disease worldwide. Ultrasonography is the most common screening test for cholecystitis and cholelithiasis. Laparoscopic Cholecystectomy is considered the treatment of choice for symptomatic gall stone disease. It is important to know the different clinical, radiological parameter and specific predictor that give some prediction of difficult LC. The aim of this study was to predict the difficulty of LC and the possibility of conversion to OC before surgery using the clinical and ultrasonographic criteria in our set up.Methods: The present study was carried out in the Department of surgery, Sarojini Naidu Medical College Agra, from November 2014 to October 2016.  A total of 210 patients were enrolled for the laparoscopic cholecystectomy. All patients who were included in the study were undergone detailed history and clinical examination. A number of clinical and ultrasonographical parameters were noted.Results: Amongst the 210 patients admitted for laparoscopic cholecystectomy, 21 (10%) were male and 189 (90%) female, with age ranging from 12–60 years.  The conversion rate in our study was 4.5% (9 of 210). In our study significant pre-operative factors which increased the conversion rate to open cholecystectomy includes male gender, obesity, abdominal scar of previous surgery, contracted and thickened gall bladder and patients having stone impacted at the neck of gall bladder.Conclusions: From this study, we conclude that preoperative ultrasonography is a good predictor of difficult laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.

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