Management of major postcholecystectomy biliary injuries: An analysis of surgical results in 62 patients

Background: Management of injuries sustained during cholecystectomy requires expertise and involves a patient who is troubled, usually drained of personal resources. There has been an increase in incidence with laparoscopic cholecystectomy. The standard surgical management done for major biliary injuries is Roux-en-Y Hepaticojejunostomy (R-en-Y HJ). Materials and Methods: Patients managed surgically for definitive management of biliary injuries in the form of R-en-Y HJ were included. Data were collected from prospectively maintained records and through outpatient follow-up. Demographic data, early and late surgical complications, long-term outcomes, and follow-up results were analyzed. Results: Among the 62 patients, 26 were males, with a mean age of 37.4 ± 13.5 years. A total of 24 patients presented with ongoing biliary fistula. The Strasberg­Bismuth type of injury included types E1 in 8 (13%), E2 in 31 (50%), E3 in 19 (30.6%), and E4 in four patients (6.4%). There were no postoperative mortality and morbidity in 27.4% of patients. Atrophy­hypertrophy complex was seen in four patients, vascular injury in six patients, and an internal fistulisation with duodenum in two patients. Presence of comorbidities (P = 0.05), male gender (P = 0.03), tobacco use (P = 0.04), low albumin (P = 0.016), and more proximal (E4-E1) type of injury (P = 0.008) were independent predictors of postoperative morbidity (P < 0.05). The mean duration of patient follow-up was 26.2 ± 21.1 months. Conclusion: Optimization of preoperative nutrition, avoidance of intraoperative blood transfusion, proper timing of repair, and tension-free R-en-Y HJ draining all the ducts which is done at an experienced hepatobiliary center provide the best outcome

An evaluation of mini-laparotomy cholecystectomy in the laparoscopic era: a rural experience

Background: Laparoscopic cholecystectomy (LC) is the gold standard for the management of symptomatic cholelithiasis and complications of gallstone disease. Mini laparotomy cholecystectomy (MOC) may be a more appropriate option in the resource constrained rural setting due to its widespread applicability and comparable outcome with LC. The study aimed toprovide an epidemiological analysis of gallstone disease in the rural population and to evaluate the outcome of MOC in a rural hospital.Methods: A retrospective chart analysis of 248 patients undergoing cholecystectomy in a rural regional referral hospital in KwaZulu-Natal from January 2009 to December 2013 was undertaken.Results: Of the 248 patients, the majority were females (n = 211, [85%]). The most frequent indications for cholecystectomy included: biliary colic (n = 115, [46.3%]); acute cholecystitis (n = 80, [32.3%]); gallstone pancreatitis (n = 27, [10.8%]). Forty cases (16.1%) were converted to open cholecystectomy (OC). The median operative time was 40 minutes (range18­57). Twenty-three morbidities (9.3%) occurred including: bile leaks (n = 6, [2.4%]); bleeding from drain site (n = 1, [0.4%]), incisional hernia (n = 8 [3.2%]) and wound sepsis (n = 8 [3.2%]). The median length of hospital stay in patients who underwent MOC was 48 hours (range: 24­72 hours) and the median time to return to work was 10 days (range: 4­14 days). There was one mortality in the entire cohort.Conclusion: MOC is a safe and feasible operation for symptomatic cholelithiasis when cholecystectomy is indicated. The low operative morbidity and mortality in the context of a high risk patient profile and complicated gallstone disease makes this procedure an alternative to LC where LC is inaccessible

Trend over time for cholecystectomy following the introduction of laparoscopy in a Nigerian tertiary hospital

Background: There still exist some concerns about the desirability of laparoscopic surgery in lower-middle income countries. We recently adopted laparoscopy for common general surgical procedures and observed many benefits. This study aims to describe the changing rate of cholecystectomy before and after the introduction of laparoscopy in our hospital. Methods: We reviewed the records of cholecystectomies performed before and after the introduction of laparoscopic cholecystectomy (LC) in 2009 in a single general surgery unit of the Ife Hospital Unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Cholecystectomy was reviewed as a percentage of general procedures performed, and postoperative length of stay was calculated. Results: A total of 173 cholecystectomies were performed in the hospital between January 2005 and December 2015. The yearly number rose from 7 in 2005 to 31 in 2015 corresponding to 2.7% of total elective major general surgery procedures in 2005 and 9.1% in 2015. A marked progressive increase was observed in the number and rate of cholecystectomies from 2009 following introduction of LC. From 0% in 2005, LC rose to 90% of all cholecystectomies in 2015. The mean postoperative length of stay of patients undergoing cholecystectomy declined from 5.2 days in 2005 to 3 days in 2009 and 1.8 days in 2015. Conclusion: This study demonstrates an increased rate of cholecystectomy following the introduction of LC in our setting. We recommend increased adoption of laparoscopy and other forms of minimally invasive surgery across the country

Laparoscopic Cholecystectomy at the Korle Bu Teaching Hospital; Accra; Ghana: an Initial Report

BACKGROUND: Laparoscopic cholecystectomy (LC) the preferred treatment for gallstones was not available in Ghana until 2005. OBJECTIVE: To report experience from Ghana of laparoscopic cholecystectomy in the treatment of galestones. METHODS: In a prospective study of patients with gallstones; information was obtained on demography; duration of various stages of the operation; analgesia and complication of patients with gallstones. All patients had general anaesthesia using endotracheal intubation; muscle relaxant and intermittent positive pressure ventilation. A standard four-trocar technique and maximum pneumoperitoneum pressure of 14mmHg were maintained during surgery. RESULTS: There were 50 women and two men aged 17-72 years (mean 44.2 years). All had symptomatic gallstones treated by interval LC. The main indications were biliary colic 23(44) and previous cholecystitis 15(29). There were scars from previous abdominal surgery in 22 (42); mainly pfannenstiel. The Verres needle was used to obtain pneumoperitoneum in 40 (77). Only one patient (1.9) had the operation converted to open cholecystectomy. Most patients; 47/51 (92); were discharged in 24 hours. The mean durations of various stages were: anaesthesia (110 minutes); pneumo-peritoneum (67.5 minutes) and reverse trendelenburg (47.8 minutes). The mean operating time reduced from 81 to 68 minutes in the last 20 patients. Complications were sore throat 11(21.6); infection of the umbilical wound 3(5.9); right shoulder tip pain (3; 5.9) and bile leak 1(2). There was no peri-operative mortality. CONCLUSION: Elective laparoscopic cholecystectomy can be performed with good results in patients with symptomatic gallstones in Accra

Surgical Management of Common Bile Duct Stones at Saint Paul's Hospital; Addis Ababa; Ethiopia

Background: This study was aimed at evaluating the trend and outcome of surgical management of choledocholithiasis in St. Paul Teaching Hospital Addis Ababa; Ethiopia. Methods: This was a clinical based retrospective analysis. The operation register was used to identify the cases that were operated for biliary lithiasis. Their clinical records were obtained from the record office of the hospital and data collected and recorded on a predesigned format. Data was analyzed by SPSS statistical software. Pearson's chi-square test was used for statistical analysis. P-value 0.05 was considered significant. Results: A total of 1230 underwent open cholecystectomy over 5 year period of which 98 patients where found to have choledocholithiasis constituting 7. Of the 98 patients who underwent common bile duct (CBD) exploration; the records of 78 patients were found and made the basis of this analysis. Fifty-nine (75.6) patients were females and 19(24.4) were males; with a male to female ratio 1: 3. The mean age was 49.15 years. The most common symptoms were right upper quadrant pain and jaundice. The most frequent physical findings was right upper quadrant tenderness. Choledocholithotomy with T-tube insertion was done in 39 patients; side to side choledochoduodenostomy in 34 patients; and hepaticojejunostomy in 5 patients. Twenty-four (71.6) choledochoduodenostomy patients were discharged in less than ten days after operation while 36(87.1) of those with T-tube were discharged after 10 days (p0.019). The re-operation rate was 12.8for the T-tube insertion group and 2.9for choledochoduodenostomy patients. There were 3(8.8) deaths in the former and 1(2.9) in the group of choledochoduodenostomy. The overall complication rate was 11 (30.6) for the T-tube insertion and 3 (8.8) for the choledochoduodenostomies. Conclusion: Choledochoduodenostomy is a better option than Choledocholithotomy with T-tube insertion in the treatment of choledocholithiasis in African setting. We recommend choledochoduodenostomy (CD) for multiple CBD calculi; big calculi in the CBD; much dilated CBD (2cm); primary CBD stones; hepatic stones; recurrent stones; and elderly patients where the size of the CBD is 15mm and above

Cholecystectomy: Indications at University of Calabar Teaching Hospital; Calabar; Nigeria

Background/objective: The relative rarity of gallbladder disease has been documented in various parts of Africa. Recently the incidence has been reported as rising in some African countries. We undertook this study to evaluate the indications for cholecystectomy in our center and compare with others. Methods: This is a retrospective study of 18 open cholecystectomies in 10 years. Results: The ages ranged from 13 and 65 years (mean 39.2years). There were 15 females and 3 males (F: M=ratio 5:1). Calculous cholecystitis 9(50) in patients; acalculous cholecystitis 8(44.4) and a patient with carcinoma of the gallbladder were offered cholecystectomy. The commonest stone was mixed multiple stones. Conclusion: The numbers of cholecystectomies attest to the rarity of gallbladder disease in this environment. This may be due to the high fiber and low cholesterol diet predominant in this costal population in southern Nigeria

Cholecystectomy: Indications at University of Calabar Teaching Hospital; Calabar; Nigeria

Background/objective: The relative rarity of gallbladder disease has been documented in various parts of Africa. Recently the incidence has been reported as rising in some African countries. We undertook this study to evaluate the indications for cholecystectomy in our center and compare with others. Methods: This is a retrospective study of 18 open cholecystectomies in 10years. Results: The ages ranged from 13 and 65 years (mean 39.2years). There were 15 females and 3 males (F: M=ratio 5:1). Calculous cholecystitis 9(50) in patients; acalculous cholecystitis 8(44.4) and a patient with carcinoma of the gallbladder were offered cholecystectomy. The commonest stone was mixed multiple stones. -Conclusion: The numbers of cholecystectomies attest to the rarity of gallbladder disease in this environment. This may be due to the high fiber and low cholesterol diet predominant in this costal population in southern Nigeria

Gallbladder Carcinoma Unassociated with Cholelithias

Carcinoma of the gallbladder is a rare and often over looked cause of right upper abdominal quadrant pain. Diagnostic delay is common as the clinical features are confused with those of chronic cholecystitis. We report two cases of gallbladder carcinoma not associated with gallstones occurring in two middle-aged women. To our knowledge this is the first report in Nigeria of gallbladder carcinoma unassociated with cholelithiasis. We conclude that there should be a high index of suspicion in patients presenting with weight loss and chronic cholecystitis syndrome

Endoscopic Laser Cholecystectomy: Report of 300 Cases

From April 1989 to February 1991; the author performed endoscopic laser cholecystectomy in 300 patients (236 women and 64 men; who ranged from 19 to 86 years of age). The operation was undertaken with the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in 275 cases; the argon laser in 13 cases; the potassium titanyl phosphate (KTP) laser in 1 case; and the holmium:YAG laser in 11 cases. The average operative time was 34 minutes. Four endoscopic procedures (1.3) were converted to open cholecystectomies because of poor visualization of the operative field. Reoperation was necessary for bile leakage in 1 case and for haemorrhage in another case; both patients recovered satisfactorily. Postoperative discomfort was controlled with an average of 235 mg of demerol. Twenty-six patients were discharged from the hospital on the day of surgery; and 248 remained in the hospital only overnight; the other patients were treated early in the series and had slightly longer hospitalization times. Unrestricted activity was resumed within 3 to 8 days

Bilan de quatre annees de chirurgie laparoscopique a Abidjan

La chirurgie laparoscopique fait partie integrante de l'arsenal therapeutique en chirurgie digestive. Les auteurs font le bilan de quatre annees d'experience a propos de 494 patients operes par cette methode a Abidjan; Cote d'Ivoire. Si les indications essentielles sont representees par les cholecystectomies et les appendicectomies; le champ d'application de la coeliochirurgie est interessant en Afrique Noire tant en chirurgie reglee (exploration laparoscopique des douleurs abdominales chroniques et des cancers digestifs) qu'en chirurgie d'urgence (peritonite; contusion abdominale)