Pericholecystic Adhesions in Single <i>v</i> Multiple Gallstones and Their Consequences for Laparoscopic Cholecystectomy

Gr, Verma; Bose, Shambhunath; Wig, J D

doi:10.1089/109264201317054555

Cited by 7 publications

(15 citation statements)

References 18 publications

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“…According to our findings multiple stones were mostly present in patients of gallstones, which were in accordance with studies in the past [4,18]. Gallstones are of three varieties; most commonly they are composed of cholesterol followed by pigment and mixed stones [4].…”

Section: Discussionsupporting

confidence: 91%

Assessment of gallstone predictor: comparative analysis of ultrasonographic and biochemical parameters

Aslam¹,

Saleem²,

Edhi³

et al. 2013

Int Arch Med

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BackgroundGallstones represent a significant burden for health care systems worldwide and are one of the most common disorders presenting to emergency room. Ultrasonography, complete blood picture test and liver function tests are procedures of choice in suspected gallstones or biliary diseases. They are the most sensitive, specific, non-invasive and inexpensive tests for the detection of gallstones. Our main objective was to evaluate the relationship of ultrasonographic findings, hemolytic indices and liver function tests with gallstones.MethodologyIt was a prospective study carried out in Civil Hospital Karachi (DUHS) and Liaquat National Hospital, two largest tertiary care hospitals of Karachi, Pakistan. Duration of the study was from July 2011 to October 2012. The study was carried out on diagnosed, pre-operative and symptomatic patients of cholelithiases. Exclusion criteria were patients of gallbladder and pancreatic carcinoma, emergency operations, patients having age <12 years and non-cooperative patients, who refused to give written consent for participation in the study. Total two tests were performed on each patient after diagnosis by ultrasonography. These were complete blood count and liver function tests. All the demographic data, laboratory findings and ultrasonographic features were noted in a pre-structured Performa. Sample size was calculated by using open-epidemiological sample size calculator prevalence (p) = 35%, d = 5%, and confidence interval (CI) 95% = 350. All the data was entered and analyzed through SPSS 19.ResultThere were 454 diagnosed and pre-operative cases of gallstones present in the study. There were 120(26.4%) males and 334(73.6%) females, with a mean age of 42.80 ± 12.26 years. Most of the suspects had multiple stones 384 (84.5%) while few had single stones 70(15.4%). Fatty liver was found to be present in 144(31.7%) patients and 92(20.2%) had hepatomegaly. Splenomegaly was present in 16(3.5%) patients. Alkaline phosphatase was elevated in 186(41.0%) patients while SGPT was found to be raised in 160(35.2%). Blood urea nitrogen was found to be elevated in 186(41%) patients and serum creatinine was elevated in 46(10.1%) patients.ConclusionIn the light of findings it is recommend that all patients should go through the process of ultrasonography and all the biochemical parameters should be analyzed before surgery.

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Section: Discussionsupporting

confidence: 91%

Assessment of gallstone predictor: comparative analysis of ultrasonographic and biochemical parameters

Aslam¹,

Saleem²,

Edhi³

et al. 2013

Int Arch Med

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“…[16][17][18][19] In our study, only 23 cases had suffered from acute attack and out of this only 03(13.04%) were converted. This rate of conversion in our study may be attributed to the low incidence of acute cases and all these acute cases were operated within IST 72 hours of presentation as within this period there is edema in the tissue planes, which magnify the structures and help in dissection.…”

Section: Resultsmentioning

confidence: 96%

Laparoscopic Cholecystectomy Requires Conversion in Few Patients Only: A Prospective Study of 370 Patients

Gupta¹,

Kaur²,

Saini³

2015

jemds

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BACKGROUNDGallstone disease is a major health problem worldwide and laparoscopic cholecystectomy(LC) has become the gold standard surgical treatment of this entity. There are various complications related to this procedure which may lead to conversion into open cholecystectomy. We have done a prospective study of 370 cases in our institution to assess the reasons for conversion from LC to open cholecystectomy.

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“…They reported a conversion rate of 50% out of 78 patients with previous upper abdominal surgery. Correlation of chance of conversion with regard to stone size has been studied in various series as well 13,14 . While Saber et al 14 reported stone >1cm size to be a predictor of difficult LC, Verma et al 13 large stone size in cases of single gall stones correlated with a higher conversion rate.…”

Section: Discussionmentioning

confidence: 99%

“…Correlation of chance of conversion with regard to stone size has been studied in various series as well 13,14 . While Saber et al 14 reported stone >1cm size to be a predictor of difficult LC, Verma et al 13 large stone size in cases of single gall stones correlated with a higher conversion rate. In the present study we too observed a significantly higher rate of conversion with stone size >1.5cm.…”

Section: Discussionmentioning

confidence: 99%

Pre-Operative Predictors of Difficult Laparoscopic Cholecystectomy; Comparisons of Two Scoring Systems. A Single Center Prospective Study”

Vyas¹,

Bhandari²,

Saurabh³

et al. 2013

jemds

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INTRODUCTION:Laparoscopic Cholecystectomy has evolved as the standard of care for the treatment of Gall Stone disease over the past decade. Several patient and procedure related factors have been implicated in setting of failure to complete the procedure by minimal invasive method and various scores have been developed to precisely predict a Difficult Laparoscopic Cholecystectomy. AIMS: The present study was conducted to ascertain various patient related preoperative risk factors for conversion of laparoscopic Cholecystectomy to open method and to validate the Risk Score for conversion. SETTINGS & DESIGN: A total of 100 patients with diagnosis of Gall Stone Disease admitted to our surgical Unit between October 2011 and April 2013 were assessed for various pre-determined risk factors and were accordingly categorized into three levels of anticipated difficulty according to RSCLO and our new scoring system. The patients were then subjected to Laparoscopic Cholecystectomy by the same surgical team and the procedure was then graded as difficult or not according to the pre-defined criteria. The findings were analysed by appropriate statistical analysis. RESULTS: Presence of factors like Male sex, history of attacks of acute cholecystitis, increased GB wall thickness, presence of supra-umbilical abdominal scar, obesity and a contracted GB were associated with a significantly higher rate of conversion to open method. RSCLO was found to correlate better with the outcome in this setting than our New Scoring System. CONCLUSION: Several patient related factors may be helpful in predicting a Difficult Laparoscopic Cholecystectomy pre-operatively. RSCLO Scoring system may be useful as a pre-operative tool to predict intra-operative difficulty during LC. KEY WORDS: Difficult laparoscopic Cholecystectomy, RSCLO, pre-operative factors. INTRODUCTION:Laparoscopic Cholecystectomy has evolved as the Gold Standard procedure for treatment of Gall Stone Disease. In approximately 2-15% of the patients failure to achieve the desirous aim mandates the conversion of the procedure to Open Method 1. Various patient and procedural related factors have been implicated for this conversion. Extensive studies and various protocols have also been suggested to identify 'Difficult Laparoscopic Cholecystectomy' preoperatively. Previous attacks of acute cholecystitis, GB wall thickness, inability to delineate the anatomy and previous abdominal surgery are some of the factors that have been identified as potential risk factors for the conversion. The present study was conducted to ascertain patient related pre-operative risk factors for conversion of laparoscopic Cholecystectomy to open method and to validate the Risk Score for conversion.

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Pericholecystic Adhesions in Single v Multiple Gallstones and Their Consequences for Laparoscopic Cholecystectomy

Abstract: Dense adhesions in the porta hepatis are significantly more common in patients with single stones and are the most common reason for open conversion.

Cited by 7 publications

References 18 publications

Assessment of gallstone predictor: comparative analysis of ultrasonographic and biochemical parameters

Assessment of gallstone predictor: comparative analysis of ultrasonographic and biochemical parameters

Laparoscopic Cholecystectomy Requires Conversion in Few Patients Only: A Prospective Study of 370 Patients

Pre-Operative Predictors of Difficult Laparoscopic Cholecystectomy; Comparisons of Two Scoring Systems. A Single Center Prospective Study”

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