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Article
ATROPINE IN LAPAROSCOPIC CHOLECYSTECTOMY: IS IT SIGNIFICANT?

Authors: Mazin H AL-Hawaz --- Mohammed H AL-Hijaji --- Anna W Krikor
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2014 Volume: 20 Issue: 2 Pages: 75-80
Publisher: Basrah University جامعة البصرة

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Abstract

Bradycardia is a known problem in laparoscopic cholecystectomy especially during pneumoperitoneum and gall bladder dissection which might necessitate the use of intravenous atropine. The clinical significance of the latter as prophylactic issue in laparoscopic cholecystectomy has not been studied much to clarify its importance and to know how and when it could be used. We conducted a prospective study to evaluate the significance of preoperative intravenous atropine sulphate to reduce bradycardia during laparoscopic cholecystectomy. One hundred and forty patients were analyzed in a prospective study; seventy of them were atropine group and another seventy were non atropine group. Heart rate changes were studied in both groups in respect to preoperative, pneumoperitoneum and postoperative period. As well as the heart rate changes were evaluated separately in each group in concern of preoperative and pneumoperitoneum period. The results showed that age, sex, body mass index, duration of surgery and previous operations were comparable in both groups. Significant bradycardia was seen in non-atropine group during pneumoperitoneum as compared to atropine group (p<0.05), while insignificant heart rate changes were observed in both groups across preoperative and postoperative period (p>0.05). In conclusion, this work shows that a preoperative intravenous dose of atropine sulphate might be of value in preventing bradycardia during laparoscopic cholecystectomy.


Article
SONOGRAPHY TO PREDICT CONVERSION IN LAPAROSCOPIC CHOLECYSTECTOMY

Authors: Gazwan M Khadim --- Zaki A Al-Faddagh
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 2 Pages: 26-37
Publisher: Basrah University جامعة البصرة

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Abstract

Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomaticcholelithiasis. Several preoperative variables have been identified as risk factors that are helpfulin predicting the probability of conversion to laparotomy for safe and successful removal of thegallbladder.This study aimed to look for the various sonographic findings and to make a predictive index forpatients who are candidates for laparoscopic cholecystectomy, operative difficulties andconversion to open cholecystectomy.This is a prospective study conducted in the Department of Surgery of Al-Mawani GeneralHospital, Al-Mousawi Private Hospital in Basrah, Iraq, between May 2005 and October 2008.Abdominal Sonography performed in 105 consecutive patients before laparoscopiccholecystectomy (the sonographic signs are: gallbladder wall thickness, pericholecystic fluid,sonographic Murphy's sign, shrunken gallbladder, number and size of gallstones). Patientsexcluded are those with history of jaundice, abnormal liver function test, upper abdominalsurgery, co-morbid illnesses, extreme obesity, dilated intrahepatic or extrahepatic biliary ducts orthose with CBD stones.The surgeon re-evaluates the results of ultrasound with the results obtained during surgery.One hundred and five patients included in the study, 103 patients with gallstones, the other 2patients having polyps. Ultrasound was accurate 100% in detecting gallstones and polyps, 99patients (94.3%) have their cholecystectomies via the laparoscope, 75 patient (75.8%) fromthem show easy procedure, while 24 patients (24.2%) suffered from difficulties.Six patients (5.7%) needed conversion to open cholecystectomy to complete the operationsafely.In conclusion, there are many sonographic signs that we can be depend on them to give us anidea about the possibility of conversion to open cholecystectomy, the most specific one ispericholecystic fluid. Secondly gallbladder wall thickness more than 3mm, thirdly, sonographicMurphy's sign, fourthly, shrunken gallbladder, fifthly single gall stone. The other signs are of lessspecificity like size and multiplicity of gall stones.


Article
7-CAN CYSTIC ARTERY CAUTERIZATION BE SAFELY PRACTICED IN LAPAROSCOPIC CHOLECYSTECTOMY?

Authors: Falih M Ali --- Safwan A Tahasam --- Adnan Y Al-Adab
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 2 Pages: 45-48
Publisher: Basrah University جامعة البصرة

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Abstract

This study aimed to evaluate the safety and efficacy of cystic artery cauterization inlaparoscopic cholecystectomy (Lap.Chole.) and to outline possible complications and limitationsthat might arise from adoption of such approach.Cauterization of the cystic artery was adopted as the principal mean of securing the cysticartery in the course of standard lap.chole. The technique was applied on 46 cases oflaparoscopic cholecystectomy. Patients with adhesions in the triangle of Calot and/or very shortcystic arteries were excluded from the study. All patients were followed up for 2-3 weeks.We didn't get any serious complication in form of: major bile duct injury, right hepatic arteryinjury, post operative hematoma.Mean operative time was 35 minutes. Out of the 46 patients who had cystic artery cauterizationwe had the following complications: one patient developed intra-operative bleeding from thecystic artery in the course of its skeletonization which was controlled by prompt clipping, anotherpatient developed rather severe bleeding from a torn cystic artery and we converted him toopen cholecystectomy.Forty one patients were females (age range 18-48 years) and 5 were males (age range 33-49years). Complications occurred exclusively in females.Apart from conversion due to other causes, the incidence rate of conversion due to bleedingfrom cystic artery during clipping and cauterization was 1.5%, 2% respectively.


Article
Predictive Factors For Conversion Of Laparoscopic Cholecystectomy To Open Procedure
العوامل التنبؤية لتحويل استئصال المرارة بالمنظار إلى طريقة الفتح

Authors: Zanko Sherko --- Sirwan Hama Shareef --- Taher Abdullah Hawrame
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2010 Volume: 14 Issue: 1 Pages: 1-8
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objectives: Laparoscopic cholecystectomy is the gold stander surgery for gallbladder diseases, especially symptomatic gall stone disease. to identify the factors that causes the conversion of planed laparoscopic cholecystectomy to an open procedure. Identifying these predictive factors will predict the conversion rate and eventually will help the surgeon, the patient and the hospital in planning the surgery.Methods: Retrospective study. Between October 2003 and December 2004 hundred and fifty patients with symptomatic gallstone underwent laparoscopic cholecystectomy in Department of Surgery, Sulaimaniyah Teaching HospitalResults: ages of the patients were between 11-70 years with a mean of 40, female to male were 5/1, and in 47% the symptoms were present for more than two years. Conversion incidence was 8.7.Conclusions: The predictive factors for conversion in our study accordingly were duration of the symptoms, abnormal intra-abdominal findings, concurrent illnesses, and intra-operative complications

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