European Journal of Molecular & Clinical Medicine

Laparoscopic surgery has now become the most accepted surgical and safe technique for a number of surgery including cholecystectomy , appendcectomy , etc .Advantages over open procedures include lesser haemorrhoage , better cosmetic results , lesser post operative pain and better results . To compare the analgesic effect of intraperitoneal application of  bupivacaine and bupivacaine with dexmedetomidine in laparoscopic cholecystectomy . To assess the quality of analgesia by visual  analgesia scale score (VAS).
Material and Method: This study was an interventional, prospective, double blind, parallel group, randomised clinical study conducted on patients undergoing laparoscopic cholecystectomy surgeries. Institutional Ethical Committee Approval was obtained and written informed consent was obtained from all the patients before the screening in the study. Total of 162 patients were selected in which 81 were randomly allocated in each group using table of randomisation. Study Duration Period 2 Sep 2020 To 2 March  2021.
Conclusion: Hence our study showed that intraperitoneal instillation of dexmedetomidine 1 µgm/kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the post-operative pain and significantly reduces the analgesic requirement in post-operative period as compared to bupivacaine 0.25% alone.

Gallstones represent a significant public health problem in
modern societies, affecting 10% to 15% of the adult population. The types of gallstones
include mixed, cholesterol and pigment stones. This study was aimed to evaluate the serum
lipid profile and common bile duct diameter in patients with gallstones pre-operatively and
post operatively and to establish the effect of cholecystectomy on lipid profile and common
bile duct dimensions.
Materials and Methods: The study was conducted in Narayana Medical College and
Hospital, Nellore, Andhra Pradesh, India. This was a prospective observational study carried
out from August 2019 to March 2020.
Results: Out of total 50 cases, 29 cases (58%) were female and remaining 21cases (42%)
were male.Highest number of cases were in the age group 30-40 years (38%) followed by
30% between 40 to 50 years of age.In the present study, there was decrease in Total
Cholesterol levels, Low density lipoprotein (LDL) and Very low density lipoprotein (VLDL)
levels 1 week after surgery, 1 and 3 months after surgery. Triglycerides (TG) levels initially
increased after 1 week and decreased significantly 1 and 3 months after surgery. Significant
increase in HDL levels are seen after 1week which continued till 3months after surgery.
The current study showed an significant increase in CBD diameter of 0.53, 0.76 and 1.07 mm
in 1week, 1month and 3 months respectively after surgery.
Conclusion: It can be concluded from this study that cholecystectomy results in
normalization of lipid levels.And also increases the diameter of Common bile duct but within
physiological limits of that age and sex group

Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system.
Gallstones are the major cause of morbidity and mortality throughout the world. With
atleast 10% of the adults have gallstones with a recent rise in the incidence due to
change in the dietary factors. This study aims to evaluate the demographic factors, its
various modes of presentation, treatment, outcome
Method: This prospective study was conducted on 100 patients in General
Surgery Ward, at Dr. D.Y. Patil Hospital and Research Centre, Pune for a period of
1 year who were diagnosed with cholelithiasis. Epidemiological aspects, Clinical
profile, investigation, treatment and outcomes were analyzed.
Result: The mean age of the patients was 36.82 years with male to female ratio
1:0.69. Pain abdomen was the most common symptom. Ultrasonography showed
gallbladder stones in all patients and 31% of patients undergone open
cholecystectomy and 65% underwent laparoscopic cholecystectomy. The
conversion rate of lap to open cholecystectomy was 4%. The average length of
post operative stay in Laparoscopic Cholecystectomy was 3 days and 7 days in
open cholecystectomy.
Conclusion: Laparoscopic cholecystectomy offers better surgical management with
reference to post operative pain, lesser number of hospital days and cosmetically
better

Background: Multiple agents are used for laparoscopic cholecystectomy since laparoscopic cholecystectomy is routinely performed surgery and desirable to have a stable intraoperative hemodynamic status by avoiding hypotension, hypertension or tachycardia. The search for ideal agent is still ongoing, alpha -2 adrenergic agonist have created interest in manner. So, the present study was conducted to compare the beneficial effect of clonidine and dexmedetomidine during laparoscopic cholecystectomy in maintain perioperative cardiovascular stability.
Methods: The present double blind randomized, prospective clinical study was carried out among patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia for a duration of 2 years. The sample size was calculated as 90 using formula: n=4pq/d² and were divided equally into groups A (control), group B (clonidine) and group C (dexmedetomidine). Preanesthetic assessment of all the selected patients were done with complete history, general examination, airway assessment, systemic examination along with laboratory investigations. During perioperative period, hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded various intervals.
Results: Increase in heart rate was statistically insignificant in all the groups at baseline (B) and just after induction (D0).After infusion of drugs, increase in heart rate was significantly lower in all the intervals in Dexmedetomidine group and Clonidine group comparing with Control group.On comparing dexmedetomidine group with clonidine group, insignificant fall (p>0.05) in DBP were observed at all intervals except at 30 minutes after pneumoperitoneum (APN30) and after reversal(DBP_AR).While comparing Dexmedetomidine group with clonidine group, insignificant fall (p>0.05) in SBP and MAP were observed at all intervals except at 50 minutes after pneumoperitoneum (APN50).While comparing Clonidine with Dexmedetomidine, significantly decrease heart rate was observed in dexmedetomidine group.
Conclusion: Creation of pneumoperitoneum in laparoscopic abdominal surgeries produces significant increase of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). During pneumoperitoneum in laparoscopic abdominal surgeries both intravenous clonidine and intravenous dexmedetomidine results to attenuate in all hemodynamic parameters (HR, SBP, DBP and MAP) During pneumoperitoneum in laparoscopic surgeries heart rate is better controlled by dexmedetomidine.

Aim: To study the conversion rate of laparoscopic cholecystectomy into open cholecystectomy in study conducted among 50 patients in our hospital.
Materials and Methods: This study was conducted in the department of General Surgery at Maharishi Markandeshwar University Solan. Patients were admitted from OPD.  History of the patient, general physical examination and clinical examination was done, ultrasound abdomen was done in 50 patients and sonographic findings were noted and posted for laparoscopic cholecystectomy. Patient with ultrasound proved symptomatic cholelithiasis, acute cholecystitis, chronic cholecystitis, empyema gall bladder, mucocele gall bladder, gall stone pancreatitis were included in this study.  Patients with gall bladder carcinoma, CBD calculus, dilated CBD with deranged LFT, history of bleeding diathesis, having severe cardiopulmonary compromise were excluded from the study.

Background and Objectives:  To evaluate the prevalence of bile duct as well as other biliary system injuries resulting after cholecystectomy in our hospital, along with the factors that contribute to the injuries and the way they are treated.
Methods: All patients between 2019 and 2021 who had an iatrogenic biliary tract injury underwent a prospective analysis. Gender, age, the presence of abnormal anatomy (extra-hepatic bile duct and vascular anatomy), the presence of gall stone pancreatitis, acute cholecystitis or cholangitis, the time between cholecystectomy and recognition of biliary tract injury, the time from injury to definite management, the type of injury, and the mode of management, such as endoscopic retrograde cholangiography, are all relevant factors for injuries sustained
Results: Injury to the bile duct occurred 2.52% of the time. Patients undergoing cholecystectomy for cholecystitis lasting longer than 72 hours tended to suffer from the majority of bile duct damage. The likelihood of bile duct injury was enhanced by elements including acute cholecystitis, cholangitis, and choledocholithiasis. Most of the injuries were discovered right after surgery. The most frequent site of injury was the common hepatic duct. The majority of BDI cases were treated with a final repair, which was aided by radiological treatments like ERCP and stenting.
Conclusion: Because of the steep learning curve of laparoscopic surgery, bile duct injury rates have been found to be higher in our institution during cholecystectomy. The best chance of recovery is provided by early detection, repair, and a multidisciplinary strategy

Background: This research aimed to determine, prior to surgery, what factors, if any, could help a surgeon anticipate a "difficult cholecystectomy" using either laparoscopic or open surgery. Consecutive patients undergoing cholecystectomies (both open and laparoscopic) for gallstone-related disorders are analysed to see which factors best predict the presence or absence of surgical complications. The goal of this study is to determine which clinical, laboratory, and radiographic criteria are most indicative of difficult dissection during cholecystectomy. To develop a scoring system prior to surgery that can accurately predict the result during the procedure.
Results: A cholecystectomy is a common surgical procedure. Those who experience symptoms from gallstone disease are increasingly likely to opt for laparoscopic cholecystectomy. The incidence of both complications and conversions are higher in patients who are already at high risk, as well as in complex cases that provide technical challenges. The current study included 123 individuals with confirmed cases of cholelithiasis who were scheduled to have surgery. The results and discoveries were recorded and scored intraoperatively. The range of possible grades was 0–15. In this case, a score of 5 or below indicated an easy task, 6–10 indicated a moderately difficult task, and 11–15 indicated a very challenging task. Two categories, "Easy" (scores of 5) and "Difficult" (scores of >6), were made for the purpose of statistical analysis. Demographic, clinical, laboratory, and imaging parameters were collected before to surgery and compared to the two intra-operative groups to identify any possible correlations.
Conclusion: 123 patients with cholelithiasis were the subjects of a prospective study. Data from these patients' demographics, imaging, and metabolic profiles, as well as their intra-operative outcomes, were compared. All 123 patients used in the study underwent laparoscopic procedures. Of the 123 cholecystectomies performed laparoscopically, 113 were successful without having to resort to open surgery. In this analysis, we find a conversion rate of 8%. It is 33.3% greater in cases of acute cholecystitis.

Aim: To establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery.

Background : Laparoscopic [LC] surgeries or minimally invasive surgeries are associated
with lesser parietal pain and haemorrhage, compared to the open surgeries. However visceral
pain persists. The effect of volume and concentration on intra-peritoneal instillation of local
anaesthetics for pain relief has not been studied . In this study we have compared the intraperitoneal
instillation of local anaesthetic with transversus abdominis plane block (TAP).
This study is aimed at assessing the superiority of effect of volume of local anaesthetic
instilled intra-peritoneally versus TAP block on post-operative pain relief in laparoscopic
cholecystectomy.

Background: The advent of Laparoscopic cholecystectomy (LC) has revolutionized the treatment of gall bladder disease. Laparoscopic cholecystectomy is preferred because of accompanying less postoperative pain, shorter hospital stay, faster recovery, improved cosmetic results, early return to work. In present study, we retrospectively analysed cases underwent laparoscopic cholecystectomy during last 4 years at our tertiary hospital.
Material and Methods: This retrospective, descriptive study was conducted among patients, who underwent laparoscopic cholecystectomy.
Results: During study period, 366 laparoscopic cholecystectomies were performed. Mean age was 40.45 ± 13.25 years, majority were female (78.69 %) as compared to male (21.31 %). Mean body weight was 58.78 ± 13.51 kgs, while mean BMI was 23.81 ± 2.23 kg/m². Various risk factors noted among cases were gall bladder contracted (18.85 %), raised bilirubin (16.12 %), acute attack (6.28 %), raised alkaline phosphates (3.55 %), previous laparotomy (3.01 %) & previous ERCP (1.64 %). Indication for surgery were Chronic calculous cholecystitis (61.75 %), Symptomatic cholelithiasis (15.30 %), Gallstone pancreatitis (13.11 %), Acute cholecystitis (6.28 %), Gall bladder mucocele (3.01 %) & Cholecystoduodenal fistula (0.55 %). Majority surgeries were done by 4 ports (88.52 %) as compared to 3 ports surgery (11.48 %). Mean duration of surgery was 77.49 ± 24.27 minutes. Drain placed in 20.22 % cases while 5.19 % cases required conversion to open cholecystectomy. Complications noted were leakage of bile (7.92 %), postoperative haemorrhage (4.10 %), subhepatic abscess (3.01 %), port site induration (2.73 %) & retained bile stone (0.55 %). Average length of stay was 2.53 ± 1.24 days.
Conclusion: Laparoscopic cholecystectomy is safe and efficacious surgery, with advantages such as shorter duration of surgery, less intra and post-operative complications, early discharge and mobilization.

Background:Humans have long known about jaundice. Obstructive jaundice is
common in general surgery. Intrahepatic or extrahepatic blockage can cause
obstructive jaundice. Most patients with suspected biliary blockage start with an
abdominal ultrasound. This study aims to determine the prevalence of obstructive
jaundice owing to choledocholithiasis in my hospital, the role of ultrasound in detecting
such cases, and the treatment options available at Princes Dusra Hospital Hyderabad.
Materials and Methods: Between June 2019 and June 2021, 24 patients with obstructive
jaundice due to choledocholithiasis were studied at Princes Esra Hospital in Hyderabad.
These patients received surgery. The proforma was used to assess these patients both
pre- and post-operatively.
Results: Obstructive jaundice due to choledocholithiasis was 0.14 percent in hospitals.
The patients were mostly female (16:4).Symptoms presented in decreasing order of
frequency. 100% jaundice, 95% abdominal pain, 50% nausea/vomiting, 50% itching
(35 percent),Fever with chills and rigours (25%) Steatorrhea (10%) and abdominal
mass (5%).Ultrasound showed stones in 16 (80%) and dilated CBD in all 24 (100%)
instances (100 percent ). 11 patients had choledocholithiasis. Four instances had
choledocholithiasis and cholelithiasis. The investigation found one incidence of
choledocholithiasis with CBD stricture. The most common surgical technique was
choledochoduodenostomy (50%) followed by choledochotomy with T-tube drainage
(40%) One case each of choledocho-jejunostomy and transduodenal sphincter. All
twenty instances had cholecystectomy. All cases were monitored for 1-6 months with no
complaints.
Conclusion:Patients with obstructive jaundice are more susceptible to infections due to
impaired liver function. It's also critical to identify specific risk factors in biliary tract
surgery patients. Our study shows that ultrasound is the cheapest, safest, and most
reliable diagnostic technique for postoperative jaundice. Despite the advent of
laparoscopic CBD exploration, open, internal, and external biliary drainage procedures
are still used successfully in areas lacking technology and experience.

Introduction: Laparoscopic cholecystectomy (LC) has been proved to be the benchmark
treatment for symptomatic cholelithiasis. The overall morbidity and mortality rate is 5–
10% and 0.1% respectively, and an open conversion rate of 5–10% is commonly
reported in the literature. Over a century, classical cholecystectomy (Open method) has
been the method of choice in the surgical management of gall bladder diseases. One of
the risk factors for cholelithiasis is obesity, the incidence of which is increasing
worldwide due to the change in lifestyle habitat. Therefore, surgeons are likely to
encounter increasing number of obese patients who require a cholecystectomy for
symptomatic cholelithiasis. Conventionally obesity has been considered as a relative
contraindication to LC, as the technical difficulties associated with this procedure in
these patients were thought to be associated with higher morbidity and mortality as well
as increased open conversion rates. The aim of this study was to investigate the safety
[peri-operative morbidity and mortality and the incidence of bile duct injuries (BDI)]
and efficacy (duration of surgery, LOS and open conversion rates) of an elective LC in
the morbid/ super obese patients (BMI > 40) compared to patients with a BMI < 26 and
a BMI 26–40.

Background: The aim of this study is to compare conventional cholecystectomy and
laparoscopic cholecystectomy.
Materials and Methods: The study subjects consisted of 40 patients with a diagnosis of
calculous cholecystitis that underwent cholecystectomy at Bhaskar Medical College and
General Hospital, yenkapally from January 2018 to June 2019. The patients will be
evaluated for detailed clinical history according to a definite proforma. All the patients
will be examined and routine blood investigations with LFT wherever necessary will be
done. Abdominal USG will be performed in all the cases.
Results: The commonest presenting complaint in both the groups was pain in the right
upper quadrant followed by vomiting, fever and dyspepsia. Majority of the patients in
both the groups had multiple stones. (15 patients in LC group and 14 patients in OC
group) The duration of LC was significantly more than for OC (median 105 min v/s
75min respectively). The intra operative blood loss and the complications were more for
the open procedure. Two patients of laparoscopic group required conversion to open
procedure. The drains were required in less number of patients of LC group and for
less number of days. Wound infection was seen in 1 of LC patient and 5 of OC patients.
One patient of OC group developed incisional hernia. The antibiotic requirement was
less in LC group (median 5days) compared to OC group (median 7days). The Visual
Analogue Scale for pain in the post op period was significantly less for LC patients
compared to OC patients (median Grade1 v/s Grade3 respectively). The duration of
pain in the LC group was significantly less (median of 2 days) compared to OC group
(median of 4 days). The analgesic requirement was significantly less in LC patients
(median for3days) compared to OC patients (median for 5 days). The LC patients
tolerated oral feeds earlier compared to OC patients (6- 8hours compared to 12-36
hours respectively). The duration of hospital stay was significantly longer for OC group
than for LC group (median 7 days versus 4 days respectively). The time to return to
normal work was delayed for OC group (median 8 days) compared to LC group
(median 5 days). The cosmetic end result was unacceptable in majority of OC patients
(14 of 20). While majority of LC patients were satisfied with the operative scar (16 of
20).
Conclusion: The laparoscopic procedure was costly compared to open procedure. But
this difference was overcome by the other costs incurred in post-operative period of
open procedure.

Aim: To evaluate the role of early Vs delayed laparoscopic cholecystectomy in mild and
moderate acute gallstone pancreatitis
Methods:This randomized prospective study conducted in the Department ofSurgery after
taking the approval of the protocol review committee and institutional ethics committee. 100
patients were included in the study. They were divided into two groups with 50 patients in
each group. Patients with mild and moderate acute gallstone pancreatitis were included in this
study.

The common etiology of conversion from LC to open cholecystectomy is uncontrollable
bleeding, adhesions, inflammation, anatomical variations, trauma of bile duct, presence of
malignant pathologies and technical failure. The conversion rate to OC remains
approximately 2-5% in most series. Patients were selected according to inclusion and
exclusion criteria after taking informed consent and reassuring them keeping confidentiality
of their data. In all the 200 patients, patients diagnosed as cholelithiasis and who underwent
laparoscopic cholecystectomy or converted to open-cholecystectomy were included in
the study. After explaining complete details of the procedure and complications to the
patients, the surgery was performed under general anesthesia. In our study out of 200
patients, age from 21-60(n=102) years have difficulty in operation with >40mins of duration
of operation with P value <0.001 and the difference is statistically highly significant by
Fisher’s exact probability test.Incidental Carcinoma of gallbladder in 1 (0.5%), Gallbladder
polyp in 1 (0.5%), CC in 136 (68%), AC in 46 (23%), AGC in 5 (2.5%) & MGB in 11
(5.5%).

Gallstones are composed predominantly of cholesterol, bilirubin and calcium salts with lesser amounts of other constituents. The most popular classification system uses the relative amount of cholesterol as the main criterion and designates gallstones as being either cholesterol or non-cholesterol. The latter are further classified as black or brown pigment stones. A thorough preoperative anaesthetic evaluation was done and patient fitness for general anaesthesia assessed. A dose of antibiotics (usually a cephalosporin) was given 30 minutes before surgery. A nasogastric tube was inserted routinely. The most common indication for open cholecystectomy was symptomatic cholelithiasis (68%). In the laparoscopic group also cholelithiasis (76%) was the most common cause.

Aim: To study the outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis:
Methods: 80 patients were included in the study. They were divided into two groups with 40 patients in each group. Group A: (40) patients who underwent laparoscopic cholecystectomy after 48 hours from day of admission. Group B: (40) patients who discharged home after resolution of the acute phase and underwent laparoscopic cholecystectomy after 6 weeks. Both groups were compared as regard: operative time, intraoperative findings and complications, conversion to open surgery, use of abdominal drains, hospital stay, post operative complications, readmission after discharge.
Results:  The mean age of patients in group A was 36.29 ± 10.33 years (range= 20-55 year) while in group B     was 37.58 ± 10.22 y (range= 20- 53 y). The majority of the patients were female. 24 patients (60%) in group A and 32 patients (80%) in group B. In group A the operative time ranged from 46 minutes to 89 minutes with a mean of 67.5±11.69 minutes, while in group B operative time ranged from 39 minutes to 76 minutes with a mean of 57.5±9.98 minutes . P value was significant 0.014. In group A 5 patients (12.5%) have intraoperative finding of acute cholecystitiswhere as none of group B express acute cholecystitisintraoperatively, with no statistically difference (p value 0.069). There was no significant difference in intraoperative complications between both groups. The difference between the two groups is significant (0% vs. 40%, p < 0.0001). 7 patients (17.5%) required hospital readmission due to severity of the symptoms. 10 patients (25%) had biliary colic, 3 patients (7.5%) developed acute cholecystitis, and 4 patients (10%) had recurrent biliary pancreatitis.
Conclusion:  We concluded that the early cholecystectomy in patients with mild acute biliary pancreatitis has no added risk of intra or post operative complications than delayed cholecystectomy. Also it significantly reduces the risk of recurrent biliary problems and length of hospital stay which has a great impact on the patients and health care resources .