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Article
Preoperative Prediction of Difficult Laparoscopic Cholecystectomy by Clinical Assessment and Ultrasonagraphy

Author: Mohamed Salih Younis
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 196-201
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: Laparoscopic cholecystectomy(LC) has now replaced open cholecystectomy(OC) for the treatment ofgallbladder diseases. However, LC may be rendered difficult by various problems encountered duringsurgery, such as difficulties in accessing the peritoneal cavity, dissecting the Calot’s triangle and gallbladder, or extracting the excised gall bladder.OBJECTIVE:Of this prospective study: is to determine whether preoperative clinical parameter and Ultrasonagraphycan predict difficult LC. PATIENT AND METHODS: 100 patients underwent LC in Al-Jamhuri Teaching Hospital, all had gallstone disease. Prospectiveanalyses of different preoperative clinical and ultrasonic parameters contributing to difficult LC wereperformed. These included: age, gender, BMI (Body Mass Index), previous upper abdominal surgery,previous attack of acute cholecystitis , gall bladders size , gall stones size and numbers. The outcomesincluded the following operative parameters: access to peritoneal cavity, adhesion and difficultdissection, bleeding during surgery, bile leak, and conversion to OC. RESULTS: Of 100 patients with LC 41 patients (41%) developed difficulties during operation .Factors contributedto difficult LC were male sex, previous upper abdominal surgery ,previous attack of acute cholecystitis, BMI more than 35 and gall stones that were more than (1 cm) in diameters . The most common typeof difficulties was intraoperative bile leak (14%) and the least frequent difficulty was conversion to OC(1%).CONCLUSION: Clinical and ultrasonographic findings can help to predict difficult LC .This information may be usefulto both the patients and surgeons in being better prepared for the intra-operative risk includingconversion to OC


Article
Evaluation of Clinical Parameters that Predict Difficulties During Laparoscopic Cholecystectomy

Authors: Karam Kamal Younis --- Layth Qassid Al-Harbawi --- Omar Abbas Ashoor
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 175-180
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: Laparoscopic cholecystectomy(LC) may be rendered ‘difficult’ by various problems encounteredduring surgery e.g accessing the peritoneal cavity, dissecting the gall bladder … etc. OBJECTIVE:To identify certain preoperative clinical parameters to predict technical difficulties during (LC) .SETTING: Surgical wards of Al-Jamhoori Teaching Hospital between October 2009 to October 2010. METHODS: A prospective analysis of150 patients who underwent (LC). Prospective analysis of differentpreoperative data including patient's age, gender, weight, height, previous abdominal surgery andprevious attack of acute cholecystitis were done. The dependent variables (outcomes) included theduration of operation, bleeding, difficult accessing, bile leak, difficult dissection of gall bladder, andconversion to open cholecystectomy. Surgeons who performed the operations had operative experienceof more than 50 (LC) RESULTS: The difficulties were met in 57(38%) patients. The mean duration of surgery was 79·83 ± 1·30 minutes.Factors contributed to difficult (LC) were; male gender, previous upper abdominal surgery and BMI >35. CONCLUSION: Preoperative clinical patient's factors including male gender, BMI > 35 and history of previous upperabdominal surgery are significant predictive preoperative parameters for difficult (LC). Knowledge ofthese parameters preoperatively can predict difficulties during (LC).


Article
Morbidity and mortality Post laparoscopic Cholecystectomy in cirrhotic patients

Author: Hayder Al. Zobaidy
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 4 Pages: 385-387
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Cholecystectomy in cirrhotic patients is commonly followed by high morbidity and mortality, the incidence of hepatic cirrhosis has increased since last decade as well as the occurrence of complication such as liver failure, portal hypertension, and biliary disorders.Patients and methods: laparoscopic Cholecystectomy was performed in 24 cirrhotic patients (18 child A and 6 child B) in an effort to obtain lower complications and mortality rates. The mean age of the group was 51.8 years, ten of the 24 patients were men and 14 female.Results: intraoperative complications such as bleeding, dense adhesion and long operative time were recorded.Conclusion: laparoscopic Cholecystectomy was safe and will tolerated by selected cirrhotic patients (child A and B) with clear indication for surgery.


Article
An ‘early interval ' (Delayed Urgent) laparoscopic cholecystectomy for acute cholecystitis: evidence to support a safe surgical procedure.

Author: Imad F. Sakran عماد فارس سكران
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2011 Volume: 53 Issue: 2 Pages: 142-146
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Delayed interval cholecystectomy can be performed to overcome the logistical difficulties in performing ‘early urgent’ laparoscopic cholecystectomy (LC) within 72 hours of admission with acute cholecystitis (AC), and to avoid earlier re-admission with recurrent AC in patients waiting ‘delayed interval’ cholecystectomyObjectives: To evaluate the safety and feasibility of ‘delayed urgent’ LC performed beyond 72 hours.
Methods: Patients admitted with AC were scheduled for urgent LC. Patients who underwent ‘early urgent’ LC were compared with those who had ‘delayed urgent’ surgery.
Results: Fifty consecutive patients underwent urgent LC for AC within 2 weeks of admission. There were no conversions and no bile duct injuries. Delayed surgery (n=36) neither prolonged operating time (90 vs. 85 minutes) nor increased operative morbidity (9.7% vs. 7.7%) or mortality (2.4% vs. 7.7%) compared with early surgery (n=14). Although delayed surgery was associated with shorter postoperative hospital stay (1 vs. 2 days, p=0.029), it prolonged total hospital stay (9 vs. 5 days, p<0.0001).
Conclusions: Delay of LC beyond 72 hours neither increases operative difficulty nor prolongs recovery. It might be more cost effective to schedule patients who could not undergo ‘early urgent’ LC but are responding to conservative treatment for an ‘early interval’ LC within 2 weeks of presentation with


Article
THE CONVERSION RATE IN LAPORASCOPIC CHOLECYSTECTOMY IN PATIENTS COMPLAINING OF ACUTE AND CHRONIC CHOLECYSTITIS

Author: Saad AR Al-Shammari سعد علي رشيد الشمري
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 2 Pages: 153-158
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Laparoscopic cholecystectomy is the gold standard in the treatment of cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy for several factors.Objective:To estimate the conversion rate and evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy.Methods:140 laparoscopic cholecystectomies were carried out from January 2008 to January 2011 at Al-Kindy Teaching Hospital. Preoperative clinical, laboratory and radiographic parameters for these patients assessed and analyzed prospectively.Results:Conversion to open cholecystectomy was needed in 30 patients (21.4%). Multivariate analysis identified male sex, with positive Murphy's sign, gall bladder wall thickness > 3 mm, a history of acute cholecystitis and time from the onset of symptoms till the time of surgery > 3 days as independent predictors of conversion rate to open cholecystectomy.Conclusion:The identification of certain risk factors for conversion from laporascopic to open cholecystectomy preoperatively such as male gender, age more than 40 years, onset of symptoms, gallbladder wall thickness can help the surgeon to plan and counsel the patients about the conversion rate.Keywords:Acute cholecystitis, laporascopic cholecystectomy, open cholecystectomy


Article
Conversion Rate in Laparoscopic Cholecystectomy: A Review of 300 Cases

Authors: Abbas A. Al-Jubori --- Fadhil A. Al-Janabi --- Raad S. Al-Saffar
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2010 Volume: 3 no.1 Issue: 6 Pages: 772-778
Publisher: Kerbala University جامعة كربلاء

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Abstract


background : Prediction of a difficult laparoscopic cholecystectomy (LC) can help the patient as well as the surgeon to be better prepared for the intra-operative risk and the risk of conversion to open cholecystectomy. The difficult gallbladder is the most common 'difficult' laparoscopic surgery being performed by general surgeons all over the world and the potential one that places the patient at significant risk. We present our experience of 300 cases since September 2007 to December 2009 in a single center with respect to conversion to open cholecystectomy.
AIM: evaluation of difficult laparoscopic cholecystectomy and conversion rate in different 300 cases of cholelithiasis.
Methods: Patients who underwent laparoscopic cholecystectomy (LC) from September 2007 to December 2009 were analyzed. The cases were analyzed in relation to conversion rate to open surgery; factors affecting pulmonary disease were not included in the study.
Results: Out of 300 cases, 52 patients (17.33%) were identified as difficult cases. Laparoscopic cholecystectomy was successfully completed in 295 patients with a completion rate of 98.33%. Laparoscopic procedure had to be converted to the open procedure in 5 patients with a conversion rate of 1.66% of the total LCs performed and 9.6% of the difficult cases. Conversion had been done due to several reasons.
Conclusion: It can be reliably concluded that LC is the preferred method even in the difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.
Key words: conversion, laparoscopy, cholecystectomy.


Article
Cystic Artery Pseudoaneurysm: A Rare but Serious Complication after Cholecystectomy Report of Three cases

Authors: Talib A. Majid*,Raafat R. Ahmad --- Ahmed R. Jawad --- Akeil H. Eissa --- Akeel S. Mahmmod
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 2 Pages: 164-168
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

Cholecystectomy is the most common major abdominal procedure (1). Pseudo-aneurysm of the cystic artery is a well documented rare but serious complication that might follow an open or laparoscopic cholecystectomy (LC). It may be seen in isolation or in association with bile duct injury (2). It represents a technical failure and can be avoided by adopting a standardized procedure.We present three cases of cystic artery pseudoaneurysm, one following an open and two following laparoscopic cholecystectomy. All of them presented with hemobilia but with different scenario. These patients required laparotomy to control their problem, two of them were emergencies and one was elective laparotomy.


Article
8- LAPAROSCOPIC CHOLECYSTECTOMY IN SICKLE CELL DISEASE: IS IT A SAFE PROCEDURE?

Authors: Hashim S Alkhayat --- Jassim H Salim --- Mohammad M Mohammad --- Salim M Albassam
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2011 Volume: 17 Issue: 1 Pages: 54
Publisher: Basrah University جامعة البصرة

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Abstract

Salim M Albassam*, Mohammad M Mohammad@, Jassim H Salim@&Hashim S Alkhayat@*Department of surgery, Basrah Medical College, Iraq. @Department of surgery, Basrah GeneralHospital, Iraq.Correspondence to: Dr. Salim M Albassam, e-mail: albassamsalim@yahoo.caAbbreviation: Hb= Hemoglobin. ACS = Acute Chest Syndrome. ASA = American Society of AnesthesiologistsAbstractThe aim of this trial is to determine the safety of laparoscopic cholecystectomy for treatment ofgall bladder stones in patients with sickle cell anemia (a controversial issue). Sixty patients fromboth sexes, between 19-35 years old with sickle cell anemia, all of them having gall bladderstones were included in this study in Endosurgery Center in Basrah General Hospital. Thepatients were divided into three groups, group one (19 patients) were selected for laparoscopiccholecystectomy on random preoperative background, the same thing was applied in group two(21 patients) whose patients were subjected to open cholecystectomy while patients in groupthree (20 patients) were selected for laparoscopic cholecystectomy on conditioned selection.Three mortalities and two serious morbidities were encountered in the group one and one mildmorbidity seen in group two and no mortalities or morbidities in group three. Laparoscopiccholecystectomy in sickle cell patients is a debatable issue, an increasing controversy aboutserious perioperative and postoperative morbidity were mentioned. The procedure itself wasaccused and an entirely opposed results were emerged from different studies all are debatable.In this study we noticed the big influence of the risk factors, preparation of patients for surgeryand the adherence to the principle anesthetic rules on the outcome after laparoscopiccholecystectomy in patients with sickle cell disease. This influence was limited in openprocedure. The controversy in the different trials lies on wither the problem is confined to thedisease itself or to the surgical method used for cholecystectomy or both.According to the results obtained from our study we believe that both the severity of the diseaseand the surgical procedure affecting the results, application of intra and post operative protocol(blood transfusion if Hb less than 9gm/dI, rehydration, oxygenation and respecting generalanesthesia rules are mandatory for the safety of the patients.


Article
SURGICAL SITE INFECTIONS AFTER LAPAROSCOPIC CHOLECYSTECTOMY 87

Authors: Jasim D Saud --- Mushtaq Ch AbuAl-Hail
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 1 Pages: 87-90
Publisher: Basrah University جامعة البصرة

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Article
4- CAUSES AND INCIDENCE OF LAPAROSCOPIC CHOLECYSTECTOMY CONVERSION

Authors: Adnan Y Abdulwahab --- Safwan A Taha --- Salam T Mutlak
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 1 Pages: 20-24
Publisher: Basrah University جامعة البصرة

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Four hundred cases of laparoscopic cholecystectomy candidates wereprospectively followed at the time of surgery by obtaining a data sheet for thepatient’s age, sex, time from the introduction of ports till decision of conversionand the cause of conversion if present in two years (2006 & 2007) period.From 400 laparoscopic cholecystectomy, 20 conversions were obtained and thecauses were; wide cystic duct, empyema of the gall bladder, severe obesity, livertumor, abnormal position of gall bladder, vascular variation and dense adhesionswith disturbed anatomy. The percentage of conversion was 5%. Eight conversioncases were males from the total 45 male patients underwent laparoscopiccholecystectomy. Twelve cases were females out of 355 female patientsunderwent laparoscopic cholecystectomy. The percentage of conversion for malepatients was 17.7% while in female patients was 3.3%. Our results showed thatthe conversion rate in this study was 5% and the most common cause forconversion is dense adhesions. No biliary duct injury or severe bleeding thatneed conversion is found in this study and the rate for conversion is higher inmale patients.

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