Laparoscopic cholecystectomy in an adult patient with a ventriculoperitoneal shunt system

Adult patients with a ventriculoperitoneal shunt valve (VDVP) are not exempt from suffering from gastrointestinal diseases. Nowadays, with technological advances, it would be contradictory not to offer them the benefits of minimally invasive surgery. The case of a laparoscopic cholecystectomy of a 40-year-old male patient with VDVP who presented clinical signs of cholecystitis is presented. The patient's evolution was satisfactory and he was discharged home 72 hours after surgery. Currently, there are significant studies that demonstrate the benefit of minimally invasive surgery in patients with VDVP as a treatment for abdominal surgical pathologies, including biliary pathology. Therefore, in our experience and with the published cases, we conclude that patients with VDVP do benefit from minimally invasive surgery for any abdominal surgical pathology, including pathology of biliary origin.

Laparoscopic cholecystectomy under spinal-epidural anesthesia versus general anaesthesia: a prospective randomized study

Background: The choice between spinal-epidural anesthesia and general anesthesia for laparoscopic cholecystectomy depends on various factors, including patient characteristics, surgical team expertise, and institutional guidelines. While both techniques have their advantages and disadvantages, spinal-epidural anesthesia offers an alternative to general anesthesia, potentially reducing complications and improving patient outcomes. Objective of the study was to compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy in healthy patients. Methods: This study was conducted at Sheikh Hasina Medical College, Hobiganj, Bangladesh. In this prospective comparative study, we enrolled one hundred patients diagnosed with symptomatic gallstone disease and classified as American Society of Anesthesiologists (ASA) status I or II. These patients were subjected to randomization, with fifty of them assigned to undergo laparoscopic cholecystectomy under spinal anesthesia, while the remaining fifty received general anesthesia. Subsequently, we conducted a comprehensive assessment, comparing various intraoperative parameters, postoperative pain levels, incidence of complications, recovery rates, and patient satisfaction during the follow-up period, with the aim of evaluating the differences between these two anesthesia methods. Results: All the procedures were completed by the allocated method of anesthesia, as there were no conversions from spinal to general anesthesia. Pain was significantly less at 4 hours (p<0.001), 8 hours (p<0.001), 12 hours (p<0.001), and 24 hours (p=0.02) after the procedure for the spinal anesthesia group compared with those who received general anesthesia. There was no difference between the 2 groups regarding complications, hospital stay, recovery, or degree of satisfaction at follow-up. Conclusions: Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesthesia without limiting recovery.

Effect of acetaminophen combined with ketorolac tromethamine on analgesia after laparoscopic chol-ecystectomy / 临床麻醉学杂志

Objective To investigate the effectiveness and safety of acetaminophen combined with ketorolac tromethamine in pain management early after laparoscopic cholecystectomy(LC).Methods Ninety patients with LC under general anesthesia,42 males and 48 females,aged 18-78 years,BMI 18-28 kg/m2,ASA physical statusⅠorⅡ,were selected and randomly divided into two groups by random num-ber table method:the acetaminophen combined with ketorolac tromethamine group(group AK)and the nal-buphine group(group NA),45 patients in each group.Group AK received 500 mg(diluted to 50 ml)of acetaminophen injection and 30 mg of ketorolac tromethamine(diluted to 10 ml)injection pumped 15 mi-nutes before induction of anesthesia,and group NA received 50 ml of NS injection and 0.2 mg/kg of nalbu-phine(diluted to 10 ml)injection pumped at the same time.Postoperative pain was recorded 0.5,3,6,12,and 24 hours after surgery using VAS pain scores(the non-inferiority boundary Δ = 1.0 score).The sleep quality score on the night of surgery,the number of remedial analgesia cases within 24 hours after sur-gery,the Ramsay sedation score 0.5,3,and 6 hours after surgery,the occurrence of adverse reactions such as nausea and vomiting within 24 hours after surgery,and the overall satisfaction of patients were recorded.Results Compared with group NA,the VAS pain scores 0.5 hour after surgery was reduced in group AK(P＜0.05).The sleep quality score and overall satisfaction in group AK were significantly higher than those in group NA(P＜0.05).There were no significant differences in the rate of remedial analgesia,the score of Ramsay sedation at different time points and the incidence of nausea and vomiting within 24 hours after surgery between the two groups.Conclusion Acetaminophen combined with ketorolac tromethamine is not less effective than nalbuphine in relieving early postoperative pain after laparoscopic cholecystectomy without increasing the incidence of nausea and vomiting.Patients receiving acetaminophen combined with ketorolac tromethamine have higher sleep quality scores on the night of surgery and overall satisfaction.

Effect of right stellate ganglion block on shoulder pain after laparoscopic cholecystectomy / 临床麻醉学杂志

Objective To investigate the effect of right stellate ganglion block(SGB)on postoper-ative shoulder pain in patients receiving laparoscopic cholecystectomy(LC).Methods A total of 104 pa-tients scheduled for LC from April to August 2022,32 males and 72 females,aged 18-64 years,ASA phys-ical status Ⅰ orⅡ,were selected and randomized into two groups:the stellate ganglion block group(group S,n = 51)and the control group(group C,n = 53).Immediately after intubation,0.2%ropivacaine 4 ml was used for ultrasound-guided right SGB in group S,and saline 4 ml was injected at the same site in group C.The number of cases of post-laparoscopic shoulder pain(PLSP)and the duration of PLSP were re-corded within 48 hours after operation.The VAS pain scores of PLSP were recorded to assess the level of PLSP immediately after operation(T1),2 hours after operation(T2),6 hours after operation(T3),12 hours after operation(T4),24 hours after operation(T5),and 48 hours after operation(T6).The number of effective compressions of the PCIA pump and the salvage analgesia were recorded.The adverse reactions such as nausea,vomiting,and abdominal distension were recorded.Results The incidence of PLSP and the rate of patients with PLSP lasting more than 10 hours in group S was significantly lower than those in group C(P＜0.05),and the degree of PLSP in group S was significantly lower than that in group C at T3-T5(P＜0.05).The number of effective compressions of the PCIA pump and the salvage analgesia rate in group S was significantly lower than those in group C(P＜0.05).The incidence of nausea in group S was significantly lower than that in group C(P＜0.05).Conclusion Right stellate ganglion block can reduce the incidence of PLSP in patients receiving LC,relieve the pain degree of PLSP,and reduce the incidence of adverse reactions.

Efficacy of electroacupuncture on the recovery of gastrointestinal function after laparoscopic cholecystectomy:a systematic review / 针灸推拿医学（英文版）

Objective:To evaluate the efficacy of electroacupuncture(EA)in enhancing the recovery of gastrointestinal function after laparoscopic cholecystectomy(LC). Methods:Randomized controlled trials(RCTs)of EA treatment in the postoperative period of patients undergoing LC were searched.Studies were obtained from Excerpta Medica Database(EMBASE),PubMed,Cochrane Library,Wanfang Academic Journal Full-text Database(Wanfang),China National Knowledge Infrastructure(CNKI),China Biology Medicine Disc(CBM),and Chongqing VIP Database(CQVIP)from inception to December 10th,2022.RevMan 5.4.1 was used to perform the meta-analysis.The Cochrane tool was used to assess the risk of bias.Mean difference(MD)and confidence interval(CI)were used for statistical descriptions. Results:A total of 7 studies were included in the meta-analysis.The meta-analysis found that the EA group had a shorter time to the first flatus[P<0.001,MD=-5.32,95%CI(-6.42,-4.21)],bowel movement recovery[P<0.001,MD=-6.22,95%CI(-8.11,-4.34)],and the first defecation(P<0.001,MD=-11.08,95%CI(-15.78,-6.39)]than the control group. Conclusion:EA treatments can promote the recovery of gastrointestinal function after LC.

The role of virtual reality simulation training in laparoscopic skills training for young physicians / 中华医学教育探索杂志

Objective:To explore the significance of laparoscopic virtual reality simulation training by analyzing the learning curve of laparoscopic cholecystectomy among young general surgeons who had participated in laparoscopic skills training at our hospital.Methods:Fifty young surgeons were divided into two groups, with the intervention group participating in virtual reality simulation training and the control group participating in traditional laparoscopic clinical training. After completion of the training, 30 laparoscopic cholecystectomies were performed under the supervision of highly qualified surgeons with extensive laparoscopic experience. CUSUM analysis was applied to plot the trainees' surgical learning curve based on the completion rate, surgical score and operative time. " x" is the number of surgical cases and " k" is the slope. The value of x when k=0 was calculated and the surgical learning curves and intraoperative scores of the 2 groups of trainees were compared. SPSS 23.00 was performed for t-test and Chi-square test. Results:The intervention and control groups crossed the surgical learning curve at x=19.24±0.39 and x=21.72±0.73 respectively, with significant differences ( P<0.01); the intervention and control groups scored (10.82±2.73) and (9.71±2.69) for gallbladder exposure ( t=4.61, P<0.01), (12.59±3.12) and (8.87±2.99) for gallbladder dissection triangle ( t=6.21, P<0.01), and (10.69±3.38) and (8.80±3.55) for gallbladder dissection ( t=3.10, P<0.01). Conclusions:Virtual reality simulation training can facilitate the translation of basic laparoscopic training skills into clinical skills and can promote the growth of young general surgeons.

A novel comparison of erector spinae plane block and paravertebral block in laparoscopic cholecystectomy

SUMMARY OBJECTIVE: Erector spinae plane block is an updated method than paravertebral block, possessing a lower risk of complications. This study aimed to compare erector spinae plane and paravertebral blocks to safely reach the most efficacious analgesia procedure in laparoscopic cholecystectomy cases. METHODS: The study included 90 cases, aged 18-70 years, classified as American Society of Anesthesiologists I-II, who underwent an laparoscopic cholecystectomy procedure. They were randomly separated into three groups, namely, Control, erector spinae plane, and paravertebral block. No block procedure was applied to Control, and a patient-controlled analgesia device was prepared containing tramadol at a 10 mg bolus dose and a 10-min locked period. The pain scores were recorded with a visual analog scale for 24 h postoperatively. RESULTS: The visual analog scale values at 1, 5, 10, 20, and 60 min at rest and 60 min coughing were found to be significantly higher in Control than in paravertebral block. A significant difference was revealed between Control vs. paravertebral block and paravertebral block vs. erector spinae plane in terms of total tramadol consumption (p=0.006). Total tramadol consumption in the first postoperative 24 h was significantly reduced in the paravertebral block compared with the Control and erector spinae plane groups. CONCLUSION: Sonography-guided-paravertebral block provides sufficient postoperative analgesia in laparoscopic cholecystectomy surgery. Erector spinae plane seems to attenuate total tramadol consumption.

Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy

SUMMARY OBJECTIVE: A new block, namely, modified thoracoabdominal nerves block through perichondrial approach, is administered below the costal cartilage. We sought to compare the analgesic efficacy of the modified thoracoabdominal nerves block through perichondrial approach block with local anesthetic infiltration at the port sites in an adult population who underwent laparoscopic cholecystectomy. METHODS: Patients who will undergo laparoscopic cholecystectomy were randomized to receive bilateral ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach blocks or local anesthetic infiltration at the port insertion sites. The primary outcome was the total amount of tramadol used in the first 12 h postoperatively. The secondary outcomes were total IV tramadol consumption for the first postoperative 24 h and visual analog scale scores. RESULTS: The modified thoracoabdominal nerves block through perichondrial approach group had significantly less tramadol use in the first 12 h postoperatively (p<0.001). The modified thoracoabdominal nerves block through perichondrial approach group's visual analog scale scores at rest (static) and with movement (dynamic) were significantly lower compared with the port infiltration group (p<0.05). CONCLUSION: Patients who received modified thoracoabdominal nerves block through perichondrial approach block had significantly less analgesic consumption and better pain scores than those who received port-site injections after laparoscopic cholecystectomy.

Port site tuberculosis and retained gall stone after laparoscopic cholecystectomy

Laparoscopic cholecystectomy is one of the most common general surgical procedures performed. Port site infection is common surgical site infection. However, tuberculosis of port sites is very uncommon. We report a case of a 36-year-old lady who was presented to our center with complaint of swelling at midclavicular port and seropurulent discharge from epigastrium port site for one month after laparoscopic cholecystectomy done outside. Patient underwent wide local excision with stone retrieval and histopathology of specimen was suggestive of chronic inflammation. Following excision patient again develop swelling at scar site and FNAC from swelling reveal feature of tuberculosis, subsequently patient was started on anti-tubercular drug therapy and follow-up after 2 months show healthy suture line with no sinus or discharge or swelling. Port site tuberculosis in absence of tuberculosis of gall bladder and abdominal is most likely due to contamination of instrument or dressing by mycobacterium tuberculosis. Diagnosis is made by ZN staining or FNAC or biopsy. Management includes incision and drainage or debridement or wide local excision with anti-tuberculosis medication. Following standardized sterilization procedure is essential for prevention.

Lidocaína en infusión transoperatoria para control de dolor: un estudio aleatorizado / Intraoperative intravenous lidocaine pain control: a randomized study

Resumen: Introducción: contar con una analgesia efectiva en el postoperatorio es fundamental para evitar complicaciones asociadas a dolor, en pacientes sometidos a colecistectomía laparoscópica. Objetivos: evaluar la efectividad de la lidocaína en infusión transoperatoria para el control de dolor postoperatorio en pacientes sometidos a colecistectomía laparoscópica. Material y métodos: se realizó un estudio experimental, aleatorizado, ciego simple, en pacientes sometidos a colecistectomía laparoscópica en el Hospital General Regional No. 1 en Obregón. Se dividieron en dos grupos de forma aleatoria, al grupo L se le aplicó lidocaína 1.5 mg/k en infusión, al grupo P se le aplicó placebo. Se realizó un análisis estadístico en SPSS v. 22 y se consideró significativa una p < 0.05. Resultados: se observó un adecuado manejo del dolor en los pacientes del grupo L a su ingreso a la Unidad de Recuperación Postanestésica (URPA) (p = 0.002), menor consumo de fentanyl transoperatorio sin diferencia estadística contra placebo (p = 0.086), menor uso de analgesia de rescate postquirúrgica (p = 0.045). Conclusiones: la infusión de lidocaína es efectiva para el manejo del dolor postquirúrgico inmediato, así como disminución de consumo de opioides y dosis de rescate analgésico, con una baja incidencia de náuseas y vómito, pero se asoció a hipotensión transoperatoria.

Abstract: Introduction: having an effective analgesia in the postoperative period is essential to avoid complications associated with pain in patients undergoing laparoscopic cholecystectomy. Objectives: test the effectiveness of intravenous lidocaine for postoperative pain in cholecystectomized patients by laparoscopy. Material and methods: an experimental, randomized, single-blind study was carried out in patients who underwent laparoscopic cholecystectomy at the No. 1 Regional General Hospital in Obregon, Sonora. They were divided into two groups randomly: group L to whom we applied lidocaine 1.5 mg/k in infusion and group P to whom placebo was applied. A statistical analysis was performed in SPSS v. 22 and a p < 0.05 was considered significant. Results: adequate pain management was observed in patients of group L upon admission to PACU (p = 0.002), lower consumption of transoperative fentanyl without statistical difference against placebo (p = 0.086), lower use of post-surgical rescue analgesia (p = 0.045), but higher incidence of adverse effects such as hypotension and bradycardia (p = 0.024). Conclusions: the infusion of lidocaine is effective for the management of immediate postsurgical pain; as well it decreases opioid consumption and analgesic rescue dose, with a low incidence of nausea and vomiting, but associated with hypotension after surgery.

The effects of positive end-expiratory pressure (PEEP) application on optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy: a randomized trial

Abstract Background: Positive end-expiratory pressure (PEEP) can overcome respiratory changes that occur during pneumoperitoneum application in laparoscopic procedures, but it can also increase intracranial pressure. We investigated PEEP vs. no PEEP application on ultrasound measurement of optic nerve sheath diameter (indirect measure of increased intracranial pressure) in laparoscopic cholecystectomy. Methods: Eighty ASA I-II patients aged between 18 and 60 years scheduled for elective laparoscopic cholecystectomy were included. The study was registered in the Australian New Zealand Clinical Trials (ACTRN12618000771257). Patients were randomly divided into either Group C (control, PEEP not applied), or Group P (PEEP applied at 10 cmH20). Optic nerve sheath diameter, hemodynamic, and respiratory parameters were recorded at six different time points. Ocular ultrasonography was used to measure optic nerve sheath diameter. Results: Peak pressure (PPeak) values were significantly higher in Group P after application of PEEP (p = 0.012). Mean respiratory rate was higher in Group C at all time points after application of pneumoperitoneum (p < 0.05). The mean values of optic nerve sheath diameters measured at all time points were similar between the groups (p > 0.05). The pulmonary dynamic compliance value was significantly higher in group P as long as PEEP was applied (p = 0.001). Conclusions: During laparoscopic cholecystectomy, application of 10 cmH2O PEEP did not induce a significant change in optic nerve sheath diameter (indirect indicator of intracranial pressure) compared to no PEEP application. It would appear that PEEP can be used safely to correct

Factores asociados con la conversión a técnica abierta en la colecistectomía laparoscópica / Factors associated with conversion to open technique in laparoscopic cholecystectomy

Introducción. La colecistectomía laparoscópica es el estándar de oro para el manejo de la patología de la vesícula biliar con indicación quirúrgica. Durante su ejecución existe un grupo de pacientes que podrían requerir conversión a técnica abierta. Este estudio evaluó factores perioperatorios asociados a la conversión en la Clínica Central OHL en Montería, Colombia. Métodos. Estudio observacional analítico de casos y controles anidado a una cohorte retrospectiva entre 2018 y 2021, en una relación de 1:3 casos/controles, nivel de confianza 95 % y una potencia del 90 %. Se caracterizó la población de estudio y se evaluaron las asociaciones según la naturaleza de las variables, luego por análisis bivariado y multivariado se estimaron los OR, con sus IC95%, considerando significativo un valor de p<0,05, controlando variables de confusión. Resultados. El estudio incluyó 332 pacientes, 83 casos y 249 controles, mostrando en el modelo multivariado que las variables más fuertemente asociadas con la conversión fueron: la experiencia del cirujano (p=0,001), la obesidad (p=0,036), engrosamiento de la pared de la vesícula biliar en la ecografía (p=0,011) y un mayor puntaje en la clasificación de Parkland (p<0,001). Conclusión. La identificación temprana y análisis individual de los factores perioperatorios de riesgo a conversión en la planeación de la colecistectomía laparoscópica podría definir qué pacientes se encuentran expuestos y cuáles podrían beneficiarse de un abordaje mínimamente invasivo, en búsqueda de toma de decisiones adecuadas, seguras y costo-efectivas

Introduction. Laparoscopic cholecystectomy is the gold standard for the management of gallbladder pathology with surgical indication. During its execution, there is a group of patients who may require conversion to the open technique. This study evaluated perioperative factors associated with conversion at the OHL Central Clinic in Montería, Colombia. Methods. Observational analytical case-control study nested in a retrospective cohort between 2018 and 2021, in a 1:3 case/control ratio, 95% confidence level and 90% power. The study population was characterized and the associations were evaluated according to the nature of the variables, then the OR were estimated by bivariate and multivariate analysis, with their 95% CI, considering a value of p<0.05 significant, controlling for confounding variables. Results. The study included 332 patients, 83 cases and 249 controls, showing in the multivariate model that the variables most strongly associated with conversion were: the surgeon's experience (p=0.001), obesity (p=0.036), gallbladder wall thickening on ultrasonography (p=0.011), and a higher score in the Parkland classification (p<0.001). Conclusions. Early identification and individual analysis of the perioperative risk factors for conversion in the planning of laparoscopic cholecystectomy could define which patients are exposed, and which could benefit from a minimally invasive approach, in search of making safe, cost-effective, and appropriate decisions

A study of port site infections in patients underwent laparoscopic cholecystectomy and its prevention and management

Background: Rapid growths in health care technology have given the surgeon the power of not only treating diseases surgically but also limiting surgical invasiveness. Methods: It is an institution based non-randomized, prospective, analytical study at Burdwan Medical College and Hospital. Results: As far as our study is concerned all the hospitals from where patients came were using “activated di-aldehyde” solution for sterilization of laparoscopic instruments; it may be a strong possibility that there might have been a growth of atypical mycobacteria in this solution, as four out of the five cases reported here found to be seropositive for tuberculosis. Conclusions: Port site infection (PSI), although infrequent, can be a frustrating complication in minimal access surgery (MAS), both for the patient as well as the operating surgeon. After the surgery, all the instruments should be dismantled completely. Cleaning and washing the instruments should be done under running water.

Thoracic segmental spinal anaesthesia vs general anaesthesia for laparoscopic cholecystectomy: a comparative study

Background: Regional anaesthesia techniques are now being preferred over General anaesthesia in patients with major medical problems and those at high risk for GA. Thoracic segmental spinal anaesthesia has recently gained popularity because of its safety and efficacy in procedures like laparoscopic cholecystectomy, breast surgeries etc. Methods: A comparative study involving 50 patients of ASA grade I & II of both genders with age group of 25-55 years, weighing between 50-85 kg posted for lap. Cholecystectomy in GGH, Kakinada for a study period of 5 months. 50 Patients were divided into Group A & Group B with 25 patients in each group. After taking informed & written conscent, Group A patients were given Thoracic Segmental Spinal Anaesthesia at T10 level with Inj.0.5% isobaric Levo-bupivacaine 1.75 ml (13.75 mg) with Inj. Fentanyl 0.25 ml (25 mcg) and Group B patients were given GA with fentanyl, propofol, sevoflurane, succinylcholine and vecuronium. Results: conscious patients with less hemodynamic variability, greater duration of post operative analgesia, greater duration for first rescue analgesia were observed in Group A. Whereas greater hemodynamic variability, intubation response, more requirement of intraoperative opioid, less duration of post operative analgesia, lesser time for first rescue analgesia were observed in Group B. Conclusions: TSSA is safe alternative as it provides excellent analgesia. With TSSA, GA can be avoided in patents with comorbidities.

Unusually large number of gall stones removed through laparoscopic cholecystectomy from a single patient- A case report

Gallstone disease is characterized by the formation of calculi in the gall bladder or the biliary tract. It may be asymptomatic or present as biliary colic or with complicated disease. Laparoscopic cholecystectomy is the mainstay of treatment for symptomatic gall stones. We describe a case of Gallstone disease in a 43-year-old female, where over seven thousand stones were removed through a Laparoscopic procedure. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Changes in liver function tests in laparoscopic cholecystectomy versus open cholecystectomy in a tertiary care center

Background: Gallstone disease is a major health problem worldwide particularly in the adult population. The traditional open cholecystectomy (OC) has been replaced by laparoscopic cholecystectomy (LC), with LC becoming the gold standard for management of gall stone disease. Elevation in the levels of liver enzymes following LC is a major cause of concern. Hence the present study determines and compares the changes in liver function tests following Laparoscopic cholecystectomy with open cholecystectomy, as well the significance of these changes is studied. Methods: A total of 100 patients with symptomatic cholelithiasis were selected in the study from October 2020 to October 2022. The cases were randomly divided into two groups, Group LC and Group OC. The blood samples were collected for Liver Function Tests (LFT)-Pre-operatively, Post-operative Day (POD)-1, POD-2 and POD-7 and enzyme alterations were studied. Results: The study demonstrated increase in levels of Serum AST, ALT, ALP in LC group on POD-1 and POD-2 with p<0.001, while the levels returned to reference values on POD-7. In OC group the increase in levels of Serum AST, ALT, ALP were observed on POD-1 only with p<0.05 and the levels returned to normal values by POD-2 of majority of patients. The changes in LFT were higher in LC group compared to OC group (where the changes were slight). Conclusions: Cholecystectomy especially laparoscopic, leads to transient significant hepatic enzyme alterations which can be attributed to CO2 pneumoperitoneum, surgical manipulations, diathermy and arterial injury. These derangements at times may be of concern to surgeons for its implication to the integrity of biliary tract.

Changes in liver function tests in laparoscopic cholecystectomy versus open cholecystectomy in a tertiary care center

Background: Gallstone disease is a major health problem worldwide particularly in the adult population. The traditional open cholecystectomy (OC) has been replaced by laparoscopic cholecystectomy (LC), with LC becoming the gold standard for management of gall stone disease. Elevation in the levels of liver enzymes following LC is a major cause of concern. Hence the present study determines and compares the changes in liver function tests following Laparoscopic cholecystectomy with open cholecystectomy, as well the significance of these changes is studied. Methods: A total of 100 patients with symptomatic cholelithiasis were selected in the study from October 2020 to October 2022. The cases were randomly divided into two groups, Group LC and Group OC. The blood samples were collected for Liver Function Tests (LFT)-Pre-operatively, Post-operative Day (POD)-1, POD-2 and POD-7 and enzyme alterations were studied. Results: The study demonstrated increase in levels of Serum AST, ALT, ALP in LC group on POD-1 and POD-2 with p<0.001, while the levels returned to reference values on POD-7. In OC group the increase in levels of Serum AST, ALT, ALP were observed on POD-1 only with p<0.05 and the levels returned to normal values by POD-2 of majority of patients. The changes in LFT were higher in LC group compared to OC group (where the changes were slight). Conclusions: Cholecystectomy especially laparoscopic, leads to transient significant hepatic enzyme alterations which can be attributed to CO2 pneumoperitoneum, surgical manipulations, diathermy and arterial injury. These derangements at times may be of concern to surgeons for its implication to the integrity of biliary tract.

Efectividad de la colecistectomía laparoscópica de puerto único asistida con imanes bajo anestesia espinal

Objetivo: Determinar la efectividad de la colecistectomía laparoscópica de puerto único asistida por imanes bajo anestesia espinal en el tratamiento quirúrgico de la colecistopatía litiásica crónica. Material y Métodos: Estudio prospectivo de cohorte en 51 pacientes entre octubre de 2019 y febrero de 2021. 17 pacientes fueron sometidos a colecistectomía laparoscópica de puerto único asistida por imanes y 34 a colecistectomía laparoscópica convencional por un mismo equipo quirúrgico. Se aplicó la técnica quirúrgica descrita por Dominguez et al y SAGES, bajo anestesia espinal. Se realizó estadística descriptiva e inferencial, analizando el dolor postoperatorio a las 3, 6, 12, 24 y 72 h y la satisfacción de los pacientes. Resultados: Se encontró diferencia significativa en el dolor postoperatorio en el grupo de estudio a las 6 h (p = 0,022), 12 h (p = 0,039), 24 h (p = 0,025) y 72 h (p < 0,001). En la satisfacción se encuentra un RR de 3 (p = 0,001), sin diferencia significativa en el tiempo operatorio y horas de hospitalización postquirúrgicas. Conclusiones: La colecistectomía laparoscópica de puerto único asistida por imanes, bajo anestesia espinal, ha demostrado efectividad en la reducción importante del dolor postoperatorio a partir de las 6 h, y en la superación de las expectativas en los intervenidos, sin aumento significativo de tiempo operatorio ni estancia hospitalaria.

Aim: To determine the effectiveness of magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia in surgical treatment of chronic lithiasic cholecystopathy. Materials and Method: Prospective cohort study in 51 patients between October 2019 and February 2021. 17 patients underwent magnet-assisted single-port laparoscopic cholecystectomy and 34 underwent conventional laparoscopic cholecystectomy by the same surgical team. The surgical technique described by Dominguez and SAGES was used, under spinal anesthesia. Descriptive and inferential statistics were performed, analyzing postoperative pain at 3, 6, 12, 24 and 72 hours and patient satisfaction. Results: A significant difference in postoperative pain was found in the study group at 6 h (p = 0.022), 12 h (p = 0.039), 24 h (p = 0.025) and 72 h (p < 0.001). In satisfaction, there is an RR of 3 (p = 0.001), with no significant difference in operative time and postoperative hospitalization hours. Conclusions: Magnet-assisted single-port laparoscopic cholecystectomy under spinal anesthesia has shown effectiveness in significantly reducing postoperative pain after 6h, associated with significantly exceeding expectations in those operated on, without a significant increase in operative time or hospital stay.

Colecistectomía laparoscópica en una paciente con situs inversus totalis. Reporte de un caso y revisión de la literatura

Introducción: El situs inversus totalis es una condición congénita en la cual los órganos torácicos y abdominales se encuentran en posición contraria a la posición habitual. En la literatura quirúrgica internacional se encuentran publicados no más de 55 casos de colecistectomía en pacientes con situs inversus totalis. La resolución laparoscópica de una paciente en nuestra Institución nos permite revisar esta particular condición patológica. Caso Clínico: Paciente femenino de 43 años de edad hospitalizada por una colecistitis aguda la cual es resuelta por vía laparoscópica sin incidentes. Material y Método: Se resume la literatura actual mediante una extensa revisión en PubMed de los reportes más relevantes. Considerando que todos los artículos publicados son casos clínicos o pequeñas series de casos, se presentan los resultados de esta revisión en tablas con estadística descriptiva básica. Discusión: Se discuten las características generales de estos pacientes, la presentación clínica, diagnóstico y técnica quirúrgica. Conclusión: La colecistectomía laparoscópica constituye el estándar de oro en pacientes con situs inversus y patología biliar, la cual debe ser realizada por un cirujano experimentado acomodando los trocares apropiadamente, debido a las dificultades técnicas que se encuentran en estos pacientes por las anomalías anatómicas propias de esta condición. El diagnóstico radiológico actual permite la planificación del abordaje y del procedimiento quirúrgico apropiado para cada paciente.

Introduction: Situs inversus totalis is a congenital condition in which the thoracic and abdominal organs are in the opposite position from normal anatomy. We found no more than 55 cases of cholecystectomy in patients with situs inversus totalis published in the international surgical literature. The laparoscopic resolution of a patient in our Institution allows us to review this particular pathological condition. Clinical Case: A 43-year-old female patient was admitted for acute cholecystitis and was resolved laparoscopically without any incidents. Material and Method: We summarized the current literature through an extensive PubMed review of the most relevant reports. Considering that all published articles are clinical cases or small case series, we present the results of this review in a table with basic descriptive statistics. Discussion: We discuss the general characteristics of these patients, clinical presentation, diagnosis, and surgical technique. Conclusions: Laparoscopic cholecystectomy is the gold standard in patients with situs inversus and biliary pathology, which must be performed by an experienced surgeon, properly accommodating the trocars due to the technical difficulties in these patients secondary to anatomical anomalies typical of this condition. Current radiological diagnosis allows planning the appropriate approach and surgical procedure for each patient.

Outcome of Laparoscopic Cholecystectomy in a District Level Hospital

Background: Laparoscopic cholecystectomy is a type of surgery that uses smaller incision than open cholecystectomy. LC has been performed as outpatient procedure for many years. Few studies have been conducted with primary focus on patient acceptance and preferences in terms of safety and satisfaction. We tried to explore its feasibility in otherwise healthy individuals undergoing laparoscopic cholecystectomy. The aim of the study of laparoscopic cholecystectomy is significantly affected by acute cholecystitis. Mechanical, biochemical, and bacteriological factors which are believed to participate in this inflammatory process are responsible for the different pathological processes observed in acute cholecystitis and in symptomatic cholelithiasis. Material & Methods: Data from 57 patients between the age group 20 to 70 years with cholelithiasis who underwent laparoscopic cholecystectomy in a private Hospital, Madaripur, Bangladesh from April 2018 to June 2020 as ambulatory surgery (hospital stay 23 Hours) with or without overnight stay were analyzed. Complications, admissions and readmissions, patient satisfaction and treatment expenditure were assessed. Results: There were 48 (84.2%) female and 9 (15.8%) male with a median age of 42 years. Only 2.4% patients required readmission while 9.2% patients had unplanned admission. 76.4% percent patients were highly satisfied with the procedure. Treatment cost was about 15% lower than routine inpatient operation. Conclusion: Laparoscopic cholecystectomy is safe and feasible. LC can be performed as an outpatient procedure with a low rate of complications and admissions/readmissions. Patient acceptance in terms of satisfaction is high.