European Journal of Molecular & Clinical Medicine

Background:The advanced instruments like harmonic shears have made laparoscopic cholecystectomy (LC) a safe option. The present study determined twoyearsexperience of patients after laparoscopic cholecystectomy in cirrhosis patients.
Methods: A total of 50 cirrhotic patients underwent LC from August 2020 to February 2022. The type of surgery performed was laparoscopic cholecystectomy. The parameters recorded were,presence of adhesions,use ofharmonic devices, amount of bleeding during surgery,rate of conversion to open surgery and the reasons thereof, operative time in minutes, plasma and platelet transfusion postoperatively and duration of hospital stay .
Results:Majority of the patients were of Child-Pugh class A. The cause of cirrhosis was hepatitis C virus (HCV) in most of the patients. Biliary colic was found to be the most common presentation. Higher CTP, model for end-stage liver disease (MELD) scores, higher mean international normalization ratio (INR) value, lower mean platelet count, higher operative bleeding, higher blood, and plasma transfusion rates, longer mean operative time and postoperative hospital stays were found to be statistically significantand  correlated well with 30-day morbidities and mortalities.
Conclusion: LC could be a better surgery performed in patients with cirrhosis. However, higher CTP and MELD scores, greater operative bloodloss, largerno of  blood and plasma transfusion in units, longer operative time, lower platelet count, and higher INR values can be considered factors resulting in poor outcome. 

Background: Laparoscopic surgery has rapidly gained wide spread acceptance for the
last couple of decades, yet it is marred with the occurrence of post-operative port site
infections. One of the better ways of tackling port site infection is its prevention. Hence
the present study was conducted to compare the efficacy of single dose antibiotic
prophylaxis vis conventional multidose antibiotic therapy in patients of low risk elective
laparoscopic cholecystectomy.
Materials and Methods: The patients were divided in two groups, Group A and Group
B with 34 and 36 patients respectively. Patients were assessed for any post-operative
fever at frequent intervals for 24-48 hours and noted down and port sites were assessed
for any induration, discharge, erythema or tenderness.
Results: The age of the patients ranged from 19-55 years and 15-55 years in group A
and group B respectively. Three patients in each group developed low grade fever in the
post-operative period (day 1) that settled with paracetamol and didn’t merit further
evaluation. Two patients developed port site discharge with mild gaping at the
epigastric port site in group A. One patient developed port site discharge in group B.
The difference was statistically insignificant.
Conclusion: Hence, it is concluded that the efficacy of the single dose antibiotic
prophylaxis is the same as the conventional multiple dose antibiotic prophylaxis
therapy.

Background: Laparoscopic cholecystectomy (LC) has become the gold standard for treatment of benign Gall Bladder disease. Pain after laparoscopic surgery though primarily visceral, often affecting the sub diaphragmatic region and often referred to the right shoulder region, also has a parietal component which occurs at the trocar site. The present study was planned to evaluate the effect of combined port site levobupivacaine administration before and after surgery for patients who underwent Laparoscopic cholecystectomy.
Material & Methods: This was a hospital based prospective randomized double blind comparative study done on 100 patients undergoing elective laparoscopic cholecystectomy surgery at Jawahar Lal Nehru Hospital, Ajmer, after approval from ethical committee. The study population were randomly divided into two groups A (Preincisional) and B (Post incisional) with 50 patients in each group using computer generated tables of random numbers. The primary outcome variable was to compare pain (visual analogue scale [VAS]) score. The intensity of post-operative pain was recorded for all the patients using VAS score at 3, 6, 12, 24 h after surgery (mean of all VAS scores).
Results: Our study showed that mean age of patients in group A was 43.20 years and 41.16 years in group B, which was statistical non-significant (P=0.435). There was significant difference in the mean VAS scores between the two groups up to 12^th hour postoperatively. There was statistically lower VAS score in group A as compared to group B postoperatively up to 12 hour at 24^th postoperative hour there was no significant difference in VAS score in both groups. The mean duration of analgesia was 164.94 ± 27.37 min in group A with a range of 95 to 210 min., while in group B, the mean duration of analgesia was 121.42 ± 14.81 min. with a range of 85 to 145 min, which was statistically longer in Group A as compared to Group B, (p value < 0.0001). Mean number of doses required in group A was 1.70 ± 0.46 and in group B was 2.38 ± 0.49, which was statistically higher in group B (p value <0.0001). In group A total amount of tramadol required in 24 hours was 170.00 ± 46.29 mg in comparison to group B where it was 238.00 ± 49.03 mg (p value <0.0001).
Conclusion: We concluded thatlevobupivacaine can be safely used as local anesthetic infiltration for postoperative pain relief following laparoscopic cholecystectomy surgery.

Background: Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. As it gained worldwide popularity, it has become one of the most common operations performed in general surgical practice. In this study we aimed to investigate to determine changes in liver function tests after laparoscopic cholecystectomy.
Material & Methods: A prospective observational study done on 100 patients who underwent elective laparoscopic cholecystectomy were taken up for the study in the department of General surgery at JLN medical college and hospital, Ajmer, Rajasthan, India during period between January 2020 to December 2021. All patients who gave consent for the study underwent a standard clinical and laboratory evaluation including USG. Pre-operative investigations included liver function tests i.e. prothrombin time, bilirubin (total and direct), alanine transaminase, aspartate transaminase, alkaline phosphatase, total proteins, serum albumin, GGT, and LDH. The subjects under inclusion criteria have taken up for the study. The liver function tests have repeated 24 hours, 3^rd day, 7^th days, 10^th days after the operation and compared.
Result: The mean age of the study population was 43.3 years with a standard deviation of 13.35 yrs. A negative t-STAT shows that the value of serum total protein, serum albumin was falling after the laparoscopic procedure. A statistically significant increase in the bilirubin(total and direct), SGOT, SGPT, GGT, LDH, and serum alkaline phosphatase levels were noted after laparoscopic cholecystectomy and no statistical significance in prothrombin time.
Conclusion: We concluded that statistically significant increase in the bilirubin (total and direct), SGOT, SGPT, GGT, LDH, and serum alkaline phosphatase levels after Laparoscopic cholecystectomy. There was a decrease in total protein and albumin and no change for prothrombin time. However, further studies with larger sample sizes and multi-center trials would yield more definite results, along with meta-analyses. We strongly suggest the consideration of confounding factors such ascomorbidities, duration of surgery, CO2 pressure, utilized anesthetic agents, and also longer period follow-ups. 

Background: Laparoscopic cholecystectomy is a minimally invasive surgical procedure for removal of a diseased gallbladder. Rapid recovery after laparoscopic cholecystectomy and increasing experience with its post operative course has led to progressively shorter post operative period and the recent trend of day care surgery without an overnight stay at hospital. Now due to advances in anesthesia and surgical techniques, day surgery is the standard pathway of care for many complex patients and procedures traditionally treated through inpatient pathways. The purpose of present study is to evaluate feasibility and outcome of day care laparoscopic cholecystectomy in JLN Medical College & Hospital, Ajmer.
Material & Methods: This is a hospital based prospective study done on 50 patients undergoing laparoscopic cholecystectomy in Department of General Surgery at JLN HOSPITAL, Ajmer, Rajasthan from January 2020 to June 2021. Assessment of the post operative symptoms like nausea, vomiting, post operative pain was done in the recovery room itself. The discharged patients were followed up in surgical outpatient department on 2nd, 5th and 10th post operative day. Student’s t test, Fisher’s exact test were applied appropriately as per distribution of data. P-value<0.05 were considered statistically significant.
Results: Our study showed that the mean age of all the patients was 39.46 ± 10.06 years. 30% of all the patients were male, while 70% were female. Mean height was calculated to be 167.28 ± 6.89 cm. Mean weight was calculated to be 67.52 ± 10.47 kg and the mean BMI of the sample size was calculated to be 24.03 ± 2.69 kg/m². It was found that the mean nausea & vomiting score was highest post-operatively than at discharge at least on 2^nd day follow up (p value<0.05). The difference between the percentage of patients discharged and those not discharged was statistically significant (p value<0.05).
Conclusion: After undergoing the extensive research, collecting the data for the study purpose, analyzing the data, we could conclude that day-case laparoscopic cholecystectomy is feasible and safe and effective treatment for symptomatic gallstones

Introduction: Laparoscopic cholecystectomy may be performed using spinal anaesthesia instead of
general anaesthesia (LC). In-depth investigation on the feasibility of laparoscopic cholecystectomy
Spinal anaesthesia is administered. Aside from general anaesthesia, regional anaesthesia has been
documented as a solo approach for executing LC (spinal/epidural/combined spinal epidural).
Material and Methods: The American Society of Anaesthesiologists anesthesiologists provided SA to
12 patients who had elective laparoscopic cholecystectomy with physical status I or II. Throughout the
perioperative phase, only drugs for anxiety, pain reduction, nausea/vomiting alleviation, hypotension
therapy, and adverse event management were administered. The operating table tilt was kept to a
minimum and the CO2 pneumoperitoneum pressure was less than 10 mm Hg during the LC procedure.
Several studies were undertaken to examine postoperative complications as well as the duration of
hospitalisation and patient feedback.
Results: Everyone had a successful spinal anaesthetic procedure and the maximum degree of sensory
blocking was reached at T4. Only one patient had GA for surgery, and that patient was not able to have
surgery with SA. Four patients (33.33%) complained of right shoulder discomfort after surgery, and
Fentanyl was administered to two of them. There was no additional discomfort during or after the
procedure. Midazolam was prescribed to two individuals for anxiety. One patient needed ephedrine
because she was hypotensive, despite intraoperative crystalloid infusions of 1460 (SD 138) ml.
Conclusion: As a standard technique, a laparoscopic cholecystectomy may be performed under spinal
anaesthesia. This is both feasible and safe. In hospitals with limited resources, such as those in developing
countries, laparoscopic cholecystectomy may be done under spinal anaesthesia

Background:Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical
procedures worldwide is accepted as the gold standard in the treatment of symptomatic gallstones.
The present study was conducted to assess incidence of CBD injury who underwent LC.
Materials & Methods:180 patients who underwent laparoscopic cholecystectomy of both genders
were included. Predictors of CBD injury were assessed based on grading of degree of difficult LC and
visualization of critical view of safety (CVS). BDI was classified according to Strasberg
classification.
Results: Out of 180, males were 110 and females were 70. Diagnosis was acute cholecystitis in 90,
chronic cholecystitis in 40, empyema gall bladder in 30 and mucocele gall bladder in 20 cases. Degree
of difficulty was mild in 46, moderate in 84, severe in 28 and extreme in 22. CVS was seen in 160.
The difference was significant (P< 0.05). Type of bile duct injury was type A in 5, type B in 1, type D
in 2 and type E4 in 3 patients. The difference was significant (P< 0.05).
Conclusion: Majority of bile duct injuries, results mainly from the surgeon’s inexperience,
misinterpretation of anatomy and poor surgical technique.

Background: The stress response to surgery is an unconscious response to tissue injury and
refers to autonomic, hormonal and metabolic changes that follow injury or trauma. Excessive
intraoperative stress evoked by surgical nociceptive stimulation may influence patient’s
outcome, length of hospital stay and overall costs of hospital care. Traditionally, clinical signs
like somatic or autonomic responses are used to evaluate whether analgesia is adequate. It has
been proved to be unreliable demonstrating low specificity. In the present study
hemodynamic changes are correlated with changes in surgical plethysmographic index (SPI)
and entropy at the time of stress.
Methods: A prospective non-randomised observational study was conducted in the patients
posted for elective laparoscopic cholecystectomy. Hundred ASA physical status I and II
patients aged between 18 to 60 years belonging to both the gender scheduled for elective
laparoscopic cholecystectomy were enrolled in the study.
Results: According to the correlation coefficient values SPI values are correlating with
changes in heart rate, systolic blood pressure and diastolic blood pressure at the time points of
5 min after intubation, 10 mins after intubation and before inflation. Entropy values does not
correlate with SPI as entropy indicates hypnosis level where as SPI is based on sympathetic
and parasympathetic stimulation. State entropy correlates with changes in systolic and
diastolic blood pressure at the time points of before inflation, 30 min after inflation and
deflation. However state and response entropy correlates with each
Other. Response entropy correlates with changes in systolic and diastolic blood pressure at
the time points of 5 mins after intubation and before inflation.

Background:Laparoscopic cholecystectomy is considered the gold standard for gallbladder
removal and is the most common laparoscopic procedure worldwide. The present study was
conducted to compare high and low-pressure carbon dioxide in patients undergoing
laparoscopic cholecystectomy.
Materials & Methods:86 patients undergoing laparoscopic cholecystectomy of both
genders were classified into 2 groups of 43 each. Group I comprised of high-pressure
carbon dioxide and group II low pressure carbon dioxide. In both groups, abdominal pain,
nausea and vomiting were evaluated on the verbal rating scale (VRS) at 1, 3, 6, 12, and 24
hours.
Results: The mean nausea/vomiting score at 1 hour, 3 hours, 6 hours, 12 hours and 24
hours in group I and II was 5.6, 5.0, 4.5, 3.8 and 3.2 and 4.2, 3.4, 3.0, 2.6 and 2.0
respectively. The mean abdominal pain in group I was 7.5, 6.5, 6.0, 5.4 and 4.6 and in
group II was 6.8, 4.6, 5.2, 3.6 and 2.2 in group I. The mean shoulder tip pain was 6.2, 5.4,
4.6, 3.8 and 2.4 in group I and 6.0, 4.8, 4.4, 3.6 and 1.8 in group II respectively. The mean
pre- operative ALT level in group I was 20.5 and post- operative level was 40.5 and in
group II was 20.4 and 45.6. AST level found to be 21.4 and 38.2 and in group II was 20.4
and 45.3, ALP level was 185.4 and 170.5, BILLT level was 0.62 and 0.70 in group I and
0.61 and 0.69 in group II, BILLD level was 0.21 and 0.34 in group I and 0.23 and 0.35 in
group II respectively. The difference was significant (P< 0.05).
Conclusion: Low pressure group had less pain score and nausea and vomiting score as
compared to high pressure group. Hence, it can be considered as treatment of choice in
patients undergoing laparoscopic cholecystectomy.

The first open cholecystectomy was performed by Langenbuch in1882 in Berlin. The first laparoscopic cholecystectomy was performed by Muhe in 1985. However the first laparoscopic cholecystectomy recorded in medical literature was performed in March 1987 by Mouret in Lyon, France. The technique was perfected a year later in March 1988 by Dubois in Paris. Preoperatively patient’s history was assessed with special reference to pain, fever, nausea, vomiting, dyspepsia, jaundice, mass per abdomen, weight loss and decreased appetite. A careful emphasis was made to record the physical findings particularly icterus tenderness in right hypochondrium and gallbladder mass. Laboratory testing and USG of gallbladder and CBD was done. CBD stone was ruled out by USG. Mean patient satisfaction score is significantly less in Group OPEN with P =0.009.Significant number of patients responded with good to excellent grading (80%) in LAP group when compared to those patients in group OPEN (44%).For statistical analysis purpose we combined excellent+good as above average, and average+poor as below average satisfaction. Significant numbers of patients are satisfied with laparoscopic surgery when compared with open surgery.

Background: Gallstone disease (GSD or Cholelithiasis) is a significant health problem
both worlds over (in both developing and developed nations). The main objective is
Laparoscopic cholecystectomy has rapidly become established as the popular alternative to
open cholecystectomy, but it should have a safety profile better than of open procedure.
Aims and objectives: The aim of this study was to compare conventional cholecystectomy
and laparoscopic cholecystectomy with respect to duration of procedure, complications,
postoperative pain, analgesic requirement and period of hospital stay.
Materials and Methods: This study consists of 52 patients who have undergone gallbladder
removal in GMC Budaun. 26 patients who have undergone laparoscopic cholecystectomy
and 26 patients who have undergone open cholecystectomy for a study period of one year
have been taken into the study In method 52 consecutive patients below 70 years presenting
with calculous cholecystitis with no evidence of CBD stones were randomized to undergo
open and laparoscopic cholecystectomy.
Results: 9 patients of LC and 10 patients of OC were males. Among LC 16 patients were
females and among OC group 15 were females, 28% of patients who underwent open
surgery had complications and 16% of patients who underwent laparoscopic surgery had
complications. The overall percentage of complications is lesser in laparoscopic surgery
than open surgery, The VAS was median grade 2 in LC group as compared to median
grade 4 in LC group. The NSAID’S were used for more days in OC group compared to LC
group, 23 patients who underwent laparoscopic cholecystectomy were discharged before 5
days. All patients who underwent OC stayed >5 days in hospital.
Conclusion: Herewe conclude in results, the duration of pain, rate of complications and
hospital stay were significantly lower in laparoscopic group. However the main advantages
of LC were reduced postoperative pain with less duration of analgesic intake, more rapid
recovery, reduced hospital stay and early return to normal work.

- Baquba Teaching Hospital – Diyala – Iraq, from January 2017 to December 2019. A total of 2749 patients of all age groups and both sexes who were found to have symptomatic gallstones were included in the study. Operative findings, causes of conversion and postoperative complications were recorded.
Result: Out of the 2749 patients who were included in this study, successful laparoscopic cholecystectomy was completed in 2711 patients, while conversion to open procedure was required in 38 patients (1.38 %). Among those who were converted to open surgery, the most common cause of conversion was dense adhesions around the gallbladder representing 42.1 % of causes of conversion.The next common cause of conversion was obscure anatomy at Calot's triangle in 31.58 % patients. Instrument failure was responsible for 10.53 % of conversions. Massive bleeding that could not be controlled laparoscopically was the cause of conversion in 7.89 % of patients and visceral injury was the cause in 5.26 % while the least common cause of conversion was wide cystic duct in 2.63% which was difficult to clip laparoscopically.
Conclusion: The risk of conversion to open surgery is always present and the decision about when to convert to laparotomy is an individual one, often subjective, made by the surgeon in the course of the procedure. The conversion rate in the present study was 1.38 % which is in the lower limit as compared to other studies, with causes similar to or approximating many national and international literatures.