Predicting factors for conversion of laparoscopic cholecystectomy to open one

Laparoscopic cholecystectomy has now replaced open cholecystectomy for the treatment of gallbladder diseases. However, certain cases still require conversion to open procedures. So, there is a need to identify risk factors for [a] predicting the probability of conversion preoperatively for selected patients, [b] preparing those patients psychologically, [c] arranging operating schedules accordingly, and [d] minimizing the procedure-related cost, which is a significant problem in developing countries. This study aimed to identify and evaluate risk factors that may predict conversion of laparoscopic cholecystectomy to an open procedure. 200 patients undergoing Laparoscopic cholecystectomy were included in the study. Sonographic findings like gall bladder wall thickness, adhesions around gall bladder and anatomy of Calot's triangle as well as gender, obesity, state of the liver and intra operative findings and/or complications which may supervene were analyzed. Of the 200 patients in whom laparoscopic cholecystectomy was attempted, 17 cases [8.5%] required conversion to open surgery. The most common reasons for conversion were dense adhesions around gall bladder [8cases] representing 47.05% of converted cases and 4% of total cases and gall bladder wall thickness>3mm [3 cases] accounting for 17.64% of total conversion and 1.5% of all cases .Significantly independent predictive factors for conversion were male gender, old age, obesity and liver cirrhosis. Patient factors, disease related factors, preoperative ultrasonography findings, operative findings and of no doubt surgeon's experience, all contribute to predict the possibility of conversion of laparoscopic cholecystectomy. Knowledge of these factors may help in pre-information to patient for psychological preparations for conversion and an experienced surgeon to operate on these patients

Perioperative pulmonary function in laparoscopic cholecystectomy versus open cholecystectomy, with preemptive intercostal nerve block

Background: the purpose of this study was to assess the efficacy of open cholecystectomy with right intercostal nerve block as an equivalent or substitute to laparoscopic cholecystectomy as regarding to the effect on the postoperative pulmonary function

Methods: forty female patients included in the study, were allocated randomly into two groups [20 patients in each] group [I] undergone laparoscopic cholecystectomy, while group [II] was subjected for open cholecystectomy with preemptive right intercostal nerve block. VC, FVC, FEVI, PEFR, and ABG were assessed

Results: all measured parameters of pulmonary function were markedly depressed early postoperative with some improvements noticed 4 hours later but still far from the preoperative values. These reductions in pulmonary function were less marked in open cholecystectomy with intercostals nerve block [II] than in laparoscopic cholecystectomy [I]. The operative time and total required dose of meperidine were significantly lower in group [II] than group [I]. There were no changes in AGS between groups or within the same group

Conclusion: open cholecystectomy with preemptive light intercostal nerve block can be less deterious or at least equivalent to laparoscopic cholecystectomy as regards the effect on postoperative pulmonary function and the total 24 hour requirement of meperidine

Primary gallbladder carcer in Saudi Arabia

Gallbladder carcinoma [GBC] is rare neoplasm. Very little information is available in the literature regarding the pattern of this cancer in the kingdom of Saudi Arabia [KSA]. The objective of this is to review all the cases of GBC and to review the epidemiological, clinical, and pathological features of GBC in two major institutions in KSA. We retrospectively reviewed the records of the pathology department at king Abdulaziz university hospital [1997-2005] and king Faisal specialist hospital and research center, Jeddah [200-2005]. All the primary gallbladder carcinomas were included in the study. Only twenty eight cases of primary GBC were identified. The age ranged between 30 and 90 years. Mean age was 64 years. There were 22 female and 6 male female ratio was 1: 3.7. The patients presented clinically with symptoms of cholecystitis. Polypoid lesions have been seen in 12 cases, wall thickening in 14 cases and ulcerative lesions in 2 cases. The tumor size ranged between 1 and 7 cm. Microscopic evaluation revealed well differentiated carcinoma in 9 cases, moderately differentiated in 15 cases and poorly differentiated in 4 cases. The tumor invaded the serosa in 7 cases, muscle in 20 cases and only case limited to the lamina propria. GBC is a rare neoplasm in Saudi population. Careful pathoiogical examination of an the gallbladders resected for either inflammation or because gallstone is very important. Well sampling of any abnormal areas is recommended to detect incidental carcinoma in cases, which are not suspected clinically

Role of surgery in asymptomatic gall stones

The present study included 30 patients with asymptomatic gall stones detected accidentally on ultrasonography for another abdominal complaint unrelated to gall stone symptoms. All of them had oral cholecystography and cholecystectomy. The gall bladder specimens subjected to histopathology. The cholecystography showed non functioning gall bladder in 80% of cases and the pathological findings showed a picture of chronic cholecystitis in 90% of cases

Duodenogastric reflux before and after simple cholecystectomy in patients with gallstone disease

20 gallstone patients were investigated for the occurrence of duodenogastric reflux [DGR] before and after cholecystectomy and compared their results with 20 control subjects. DGR was found in 35% of the control group compared to 70% of the gallstone patients, and the mean bile acid [BA] concentration in the gastric juice of the control group was 1.86 mu mol/hour compared to 7.93 mu mol/hour for gallstone patients before operation and 26.49 mu mol/hour after cholecystectomy. None of the gallstone patients without DGR developed reflux after cholecystectomy. However, in those with DGR, the reflux increased significantly after cholecystectomy. This may be due to the presence of great amount of BA in the duodenum after cholecystectomy which leads to greater reflux through the previously incompetent pyloric sphincter

Colecistectomía por video laparoscopia en colecistitis aguda / Cholecystectomy by video laparoscopy in acute cholecystitis

Desde finales de los años 80 la Colecistectomía por Video Laparoscopia ha reemplazado a la colecistectomia tradicional como el método terapéutico de elección en casos electivos con Litiasis Vesicular Sintomática. Como resultado de esta experiencia, se ha comenzado a emplear esta técnica no sólo para los electivos sino para Colecistitis aguda; aunque, obviamnete, el procedimiento puede ser más difícil y requiere más experiencia y el uso rutinario de la colangiografía operatoria. Presentamos nuestros primeros 65 casos de Colecistitis Aguda operados por Video Laparoscopia en el Hospital de Clínicas Caracas. En esta evidencia una muy baja morbilidad, tiempo de hospitalización promedio de 2 días y período de convalescencia de 11/2 semanas, lo cual es muy inferior a lo esperado para los resueltos mediante la técnica de colecistectomía tradicional. El procedimiento fue exitoso en el 97% de los casos con un porcentaje de conversión a laparatomía de apenas 3%, por las siguientes razones: Un caso por necrosis del conducto cístico, otro por obscesos perivesiculares y gangrena de la vesícula y el tercero debido a que la vesícula estaba firmemente adosado al conducto hepático común y derecho. Recomendamos intentar la técnica por video laparoscopia aún en colecistitis aguda, siempre y cuando el grupo de cirujanos a cargo de el caso tenga un entrenamiento depurado en cirugía laparoscópica y una amplia experiencia en colecistectomía por video laparoscopia en casos no agudos