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Article
The benefit and feasibility of early laparoscopic cholecystectomy

Author: Haqqi I. Razzouki
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 2 Pages: 40-45
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Acute cholecystitis is a common disease. The best managementin early cases is surgical, but the optimal timing for surgery remainscontroversial. With advances and increased experience in laparoscopicsurgery, laparoscopic cholecystectomy is increasingly being used in themanagement of acute cholecystitis.Aims: To determine the best time to operate in acute cholecytitis (early vs.delayed) and to compare the results of laparoscopic approach with those ofopen surgery in the treatment of acute cholecystitis .Patients and Methods: This was a prospective study done at al‐Yarmoukteaching hospital, Baghdad from Sep. 1st 2012 to Sep. 2nd 2013. All patientsadmitted with a proved diagnosis of acute cholecystitis were included. Thepatients were divided into two groups, the first group had earlycholecystectomy, laparoscopic (LC) or open (OC). The second group wastreated conservatively and delayed cholecystectomy was done. Detailedclinical, investigative and imaging data were recorded. The details of theoperative findings, procedures and early post‐operative complications, weredocumented.Results: There were 146 patients, 82.2% female and 17.8% male. The mean agewas 40±2 years. Early surgery was done for 32.8% of patients, 58.4% as alaparoscopic procedure, and 41.6% as an open procedure. Delayedcholecystectomy was done in 67.2% of cases. In the early group,the difficultywas minimal in 27.2%, moderate in 39.5%, marked in 25 % and very difficult withconversion done in 8.3%. Early complications were noticed in 4.2% in the earlyLC group, and 8.3% in the early OC. For delayed LC, 8.1% had earlycomplications vs. 6.1% for delayed OC.Conclusions: Early laparoscopic cholecystectomy is a safe and feasibleapproach to the management of acute cholecystitis.


Article
Early Laparoscopic Versus OpenCholecystectomy for Acute Cholecystitis

Author: Mumtaz K. H. AL-Nasir
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2007 Volume: 4 Issue: 1 Pages: 76-81
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Acute cholecystitis is common surgical problem, which was treated previously by conservative treatment .Later early open has been introduced as an alternative to interval for treatment of acute cholecystitis. Early open was found to be a safe, successful with comparable postoperative complication rate. With the advent of laparoscopy laparoscopic have been used for chronic cholecystitis and became the first line of treatment. New reports have shown that laparoscopic can be used as an alternative to open for surgical treatment of acute cholecystitis.
Objectives: to compare the success, safety of early laparoscopic versus early open as a primary treatment of acute cholecystitis.
Methods: out of 68 patients were treated for clinical acute cholecystitis between January 2002 and February 2004 in the department of surgery, at Al – Kindy teaching hospital. A total of 62 patients underwent early for acute cholecystitis as soon as possible after diagnosis. The preferred preoperative imaging technique was ultrasound. 30 (48.3%) of the operations were attempted laparoscopically, whereas the remaining 32 patients (51.7%) underwent initial open .
Results: The mean operative time for the open cases was 75 minutes versus 60 minutes for the laparoscopic group. There was no perioperative mortality in either group. The incidence of conversion to open was 10% (3 patients). Surgical complications related to laparoscopic and open occurred in 2 (6.6%) and 3 (9.3%) cases, respectively. There was no difference between the open and laparoscopic groups in regard to the major postoperative complications.
Conclusion: The current study shows that early (whether performed by open or laparoscopically) is a safe and effective treatment for acute cholecystitis. Low conversion rates can be maintained with strict guidelines for appropriate patient selection, adequate experience, and proper laparoscopic technique.
Key Words: Acute cholecystitis– Conversion rate – Laparoscopic .


Article
EARLY LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS AT AL-KADHIMIYA TEACHING HOSPITAL

Authors: Osama M. Alabid اسامه محمد علي العبد --- Hassan A. Hassan حسن احمد حسن
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2014 Volume: 12 Issue: 1 Pages: 37-43
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Despite the well-accepted success of laparoscopic cholecystectomy (LC) in the elective treatment of symptomatic gallstone, the safety and the efficacy of this technique has been subjected to some debate in the setting of acute cholecystitis (AC).Objective:To evaluate our institution’s experience with early LC and to evaluate the safety and effectiveness of LC in the treatment of AC.Methods:Eighty nine patients were diagnosed as having AC based on the clinical, laboratory and ultrasound findings; 80 patients were divided randomly into two equal groups.Group 1 included 40 patients who had early LC for AC within one week from onset of the symptoms and group 2 included 40 patients who had late LC around 6 weeks from onset of symptoms as interval LC after conservative treatment. Results:No significant difference in the conversion rate (in early group 8 patients (20%) versus delayed group 6 patients (15%). Complication rate was insignificant (in early group 4 patients (10%) versus delayed group 3 patients (7.5%). The delayed group had a significantly shorter operative time (early group = 128±53.5 min versus delayed group = 107±50.1 min) and significantly shorter postoperative stay (early = 2.4±3.2 days versus delay = 1.4±1.4 days). The early group had a significantly shorter total hospital stay (early = 5.5±3.1 days versus delay = 8.5±4.5 days). The male gender had a significant higher conversion rate in both groups.Conclusion:Early LC can be performed safely in most patients with AC and it is considered as effective treatment, allows significantly shorter total hospital stay with no significant differences in conversion rate or complications compared with delayed LC, in the hands of a safe and well trained surgeon.Keywords:Early laparoscopic cholecystectomy, acute cholecystitis.


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: PISSN: 00419419 / EISSN: 24108057 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
Outcome of laparoscopic cholecystectomy in acute and chronic cholecystitis

Author: Omar S. Khattab
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2010 Volume: 52 Issue: 3 Pages: 262-265
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: laparoscopic cholecystectomy is standard treatment in gallbladder disease. Acute cholecystitis has been relative contraindication of laparoscopic cholecystectomy. With the accumulation of experience in laparoscopic surgery, laparoscopic cholecystectomy is being gradually applied for the treatment of acute cholecystitis .Objective: to evaluate and compare the outcome of laparoscopic cholecystectomy in acute and chronic cholecystitis in terms of complications, conversion rates, reason of conversion, need for special modifications of the operative technique, and hospital stay.
Methods: A prospective study done Between April 2007 and January 2010, in the department of general surgery, medical city teaching hospital, Baghdad. Evaluation of all patients admitted with symptomatic gall bladder disease, who underwent laparoscopic cholecystectomy were included in this study. They were classified as group A (having acute cholecystitis) and group B (having chronic cholecystitis), The diagnosis of AC was based on clinical, ultrasonographic, and operative finding; also histological diagnosis.
Results: A total of 197 patients. 46 (23%) had acute cholecystitis (group A) while 151 patients (76.6%) had chronic cholecystitis (group B). In group A, Gall bladder decompression was required in 4 (8.7%) patients. One patient (2.2%) had wound infection, and one patient (2.2%) developed a subhepatic biliary collection. While epigastric port hernia occurs in one patient (2.2%). In group B, One patient (0.7%) had wound infection, and one patient (0.7%) had umbilical port hernia. Conversion rate was 3(6.5%) for group A and 0% for group B. There was no procedure related mortality in either group. The hospital stay (6-24 hours) was the same for both groups (group A; mean 9.13±6.89 hours, group B; mean 15.77±8.99 hours).
Conclusion: laparoscopic cholecystectomy is safe in all patients presented with symptomatic gall bladder disease.


Article
Early and late Biliary Complications of Laparoscopic Cholecystectomy in Acute Cholecystitis

Author: Omar Salem Khattab عمر سالم خطاب
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 2 Pages: 131-136
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Laparoscopic cholecystectomy has become the standard of care for the elective management of cholelithiasis. Little information exists, however, regarding the appropriateness of this procedure in the setting of acute symptomatology. Objective: This study was designed to evaluate the outcome of laparoscopic cholecystectomy in acute and severe acute cholecystitis based on early and late biliary complications, their incidence and management, and conversion rates to open surgery. Methods: A prospective study done between April 2007 and November 2010, in the department of general surgery, medical city teaching hospital, Baghdad. Includes patients with acute cholecystitis admitted for laparoscopic cholecystectomy; they were divided into two groups, (group 1) including patients with acute cholecystitis; (group 2) including patients with severe acute cholecystitis. Results: 306 patients were admitted for laparoscopic cholecystectomy, 71 (23.2%) of them with acute cholecystitis and was involved in this study; they were divided into two groups, (group 1) patients with acute cholecystitis 61(85.9%), (group 2) patients with severe acute cholecystitis 10 (14%); including gangrenous gallbladder 3(30%), and empyematous gallbladder 7(70%). Patients in group 2 were significantly older than in group 1. Female sex was more significant in group 1, while male sex was more significant in group. There was no procedure related mortality. Conclusion: laparoscopic cholecystectomy for acute cholecystitis is safe and associated with a low morbidity, mortality, and a low conversion rate.


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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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
Early and delayed laparoscopic cholecystectomy in patients with acute cholecystitis

Author: Tariq E.Alaubaidi طارق العبيدي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2011 Volume: 53 Issue: 1 Pages: 40-43
Publisher: Baghdad University جامعة بغداد

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Article
Effect of early laparoscopic Cholecystectomy in Acute Cholecystitis

Author: Abdulhameed J. Ali*, Arkan A. AL-Ogali**, Hala I. Salih**, Abdalrahman H. Turfa
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2014 Volume: 10 Issue: 2 Pages: 41-44
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Laparoscopic cholecystectomy (LC) has become the treatment of choice for elective cholecystectomy.Objectives: To evaluate the safety and feasibility of early LC for AC and to compare the results with delayed LC.Methods: A prospective study done from April 2011 to October 2013, 88 patients with diagnosis of AC were divided randomly into two groups according to the mode of treatment; (early group n=40) treated by early LC within first 72 hours or (delayed group, n=48) initial conservative treatment for 4-6 weeks, followed by delayed LC.Results: There was no difference between the two groups (early & delayed LC), operating time (early 80min, delayed70min), conversion rate (early 7.5%, delayed 6.25%),postoperative complications (early 20%, delayed 14.58%),However, the early group had shorter mean hospital stay(early 2.5 days, delay 5 days).Conclusion: early laparoscopic cholecystectomy appears to be reliable, safe, and cost effective treatment modality for acute cholecystitis, offering the additional benefits of a shorter hospital stay.Keywords: Acute cholecystitis, early LC, delayed LC.


Article
COMPARISON OF EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS: EXPERIENCE FROM TWO CENTERS IN BASRAH

Authors: Habeeb Flayyih Hussein --- Rafid Abduljabbar Mohammed --- Mushtaq C Abu-Al-Hail --- Omran S Habib
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2018 Volume: 24 Issue: 1 Pages: 39-46
Publisher: Basrah University جامعة البصرة

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Abstract

COMPARISON OF EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS: EXPERIENCE FROM TWO CENTERS IN BASRAH Habeeb Flayyih Hussein@, Rafid Abduljabbar Mohammed$, Mushtaq C Abu-Al-Hail#, & Omran S Habib% @MB,ChB, CABS, General and Laparoscopic Surgeon, Alsadr Teaching Hospital. $MB,ChB, CABS, MRCS, General Surgeon and Lecturer at Basrah College of Medicine. #MB,ChB, CABS, Consultant General and Laparoscopic Surgeon, Basrah Teaching Hospital. %PhD, Professor of Epidemiology and Health Care, Department of Community Medicine, Basrah College of Medicine, Basrah, IRAQ. Abstract Calculous cholecystitis is a major and common health problem, and nowadays laparoscopic cholecystectomy is the preferred approach for its surgical management but timing of surgery is a matter of debate especially in presence of acute inflammation of the gall bladder. The aim of this study is to compare the outcome of early and delayed laparoscopic cholecystectomy for acute cholecystitis. This retrospective comparative study was done in two tertiary hospitals in Basrah from July 2010 to July 2017. It involved 122 cases (98 females 80.3% and 24 males 19.7 %). Forty two (34.5%) underwent early laparoscopic cholecystectomy within 4 days of symptoms and 80 patients (65.5%) underwent delayed operation within 6-12 weeks of first presentation. The two groups were comparable in regard to demographic and clinical points of view. The age of studied patients lies between 20-65 years. The operative time was not identical for the two groups (P=0.004), early treated cases tended to take longer operative time. Hospital stay was significantly longer in early cases as compared to delayed cases (p=0.000). Bile leak happened in only one case (2.4%) of the early group and was managed successfully and discharged well. Bleeding and respiratory infection were extremely rare in both groups. Conversion rate was 4.8% and 5% for the early and delayed group respectively and the difference was statistically not significant (p value 0.661). In conclusion, early laparoscopic cholecystectomy in acute cholecystitis is safe and feasible in selected patients with no difference in morbidity and mortality if it done during the 1st four days of beginning of symptoms, but the operative time is longer than delayed operation.

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