Preoperative factors that determine technical difficulty during laparoscopic cholecystectomy for symptomatic calcular cholecystitis

The increasing experience in laparoscopic cholecystectomy has led to more difficult cases being performed The methods to identify a potentially difficult laparoscopic cholecystectomy would be a valuable indicator for good management policies with improvement of the outcome. The aim of this study was to determine the correlation between preoperative clinical and abdominal sonographic findings in patients undergoing laparoscopic cholecystectomy for symptomatic calcular cholecystitis and the technical difficulty at operation. All consecutive patients with calcular cholecystitis undergoing laparoscopic cholecystectomy for the last 8 years [531 patients] were reviewed. The clinical preoperative factors assessed involved patient's age, sex, body weight and body mass index, of the disease, associated diabetes mellitus, the occurrence of biliary colic within the last 3 weeks, the presence of symptoms and signs of acute cholecystitis at presentation and history of acute cholecystitis. The laboratory preoperative factors assessed involved, full blood picture including total leucocytic count, liver functions including serum transaminases, serum bilirubin and prothrombin time. The preoperative abdominal sonographic findings assessed involved gallbladder size, gallbladder wall thickness, peri-cholecystic fluid, gallstones number and size and the liver condition. Laparoscopic cholecystectomy was attempted in all patients. Operative data were compared to preoperative data of all patients and statistically analyzed. It was found that the following 7 parameters are independently predictive of a difficult operation: male sex [p<0.01], the presence acute cholecystitis [p<0.01], thickening of the gallbladder wall [p<0.01], shrunken gallbladder [p<0.01], mucocele of the gallbladder [p<0.05] and enlarged liver [p<0.05] or liver cirrhosis [p<0.05]. The above-mentioned factors are important and should help to select patients for either laparoscopic or open cholecystectomy based on the expected difficulties

Effect of preoperative endoscopic biliary drainage and stenting on postoperative infection and the outcome of surgery for benign obstructive jaundice

The effect of preoperative endoscopic biliary drainage on the outcome of surgery for patients presenting with obstructive jaundice [OJ] has been studied; increase the risk of morbidity, and mortality. This work aim to studying the bile samples from those patients before and after endoscopic retrograde cholangiopancreatography [ERCP] with biliary stenting and its possible association with postoperative septic complications. The study involved 79 patients with surgically corrected benign obstructive jaundice at Thodor Bilharze Research Institute. Preoperative [ERCP] was done for all of the patients and stent insertion was made in 60 of them. Bile specimens were obtained during endoscopic cholangiography by flushing technique and intra-operatively by puncture before incising the common bile duct. Bile samples were analyzed for their bacterial spectrum and sensitivity to antibiotics. Concomitant postoperative septic complications such as wound infection and cholangitis were also assessed. Bile culture of intra-operatively obtained specimens was positive in 39/60 [65.0%] of the patients in Group II [ERGP+ biliary stent], a significantly higher incidence than that observed in group I [ERCP only], in which 7/19 [36.8%] of the patients presented positive cultures [p=0.001]. There was no significant difference in general postoperative morbidity between groups. When infective complications [cholangitis, pneumonia, wound infection] were analyzed separately, a higher incidence, although without significance was found in Group II than in Group I. Preoperative biliary drainage using the endoscopic retrograde cholangiopancreatography [ERCP] and stent insertion in patients subjected to surgery for benign obstructive jaundice could provoke biliary bacterial colonization with a possible appearance of infective complications during the postoperative period

Acute suppurative necrotizing pancholangitis. A case report

To present a case of ascending cholangitis with resulting necrosis of the biliary system with perforation. Clinical Presentation and Intervention: A 40-year-old male patient presented with upper abdominal pain, fever and jaundice assessed clinically and investigated by laboratory and radiological tests. Endoscopic retrograde cholangiogram and surgery were performed. However, because of extensive suppurative pancholangitis involving most of the intrahepatic radicles, sound surgical drainage could not be accomplished. Unfortunately, the patient died 2 days after surgery. In this case of severe cholangitis, endoscopic and surgical interventions were not successful and might have contributed to the worsening of the condition