BACKGROUNDLaparoscopic cholecystectomy has been extensively accepted since Mouret first successfully introduced the procedure in 1987. During this procedure the cystic artery can be controlled using surgical clips, harmonic scalpel and ligature or monopolar cautery. The extensive use of surgical clips in laparoscopic surgery has led to a variety of complications. Monopolar electrocoagulation can be used to control the cystic artery as it is cheap and universally available. Hence in this study, we compared monopolar electrocautery with clip application for securing haemostasis and to identify the safest and least complicated way for haemostasis of the cystic artery in laparoscopic cholecystectomy.
BACKGROUND Hepatolithiasis or intrahepatic stones irrespective of gall bladder stones or common bile duct stones are common in East Asian countries but rare in Western countries. Although Gall bladder stones are common in India, there is scarcity of literatures reporting hepatolithiasis from the Indian subcontinent. This study aimed to evaluate the clinical result of our first-hand experience of hepatectomies along with other standard surgical options for this low prevalence disease in a North East Indian institute catering to a rural population. METHODS 11 patients with diagnosis of hepatolithiasis operated from the period June, 2014 to June 2019 were included in this study. Pre-operative radiological and biochemical, operative & postoperative variables were assessed. Patients were followed in a planned program. RESULTS Hepatic involvement were noted as Left lobe in 7 (64 %) cases, only right lobe in one case (9 %) and bilateral in three cases (27 %). Five cases (45.5 %) were associated with extrahepatic biliary pathology; concomitant intrahepatic and extrahepatic stones were seen in four cases (36 %). Anatomical left hepatectomies (3), left lateral sectionectomies (2) choledochotomy and T-tube drainage (6 primarily or one additional) were carried out. Functional outcomes were satisfactory in all patients. Postoperative morbidity was mostly due to wound infection and there was no mortality. CONCLUSIONS Preoperative optimization of patients, relative absence of risk factors and knowledge of biliary anatomy planned with modern imaging tools makes hepatectomy a safe definitive surgical option for localised hepatolithiasis. Hepaticojejunostomy may be contemplated selectively for bilateral hepatolithiasis. Long term follow up is necessary as recurrence is associated with this disease. KEYWORDS Hepatolithiasis, Hepatectomy, Sectionectomy, Hepaticojejunostomy, Choledochotomy and T-Tube Drainage
Introduction: Laparoscopic cholecystectomy has become the gold standard for the treatment of cholelithiasis. It has many advantages such as better cosmetic, shorter hospitalization time, minimal postoperative pain, early return to normal life. However carbon dioxide pneumoperitoneum may cause alteration in the coagulation system and moreover the reverse Trendelenburg position adopted diring surgery can induce blood stagnation in the lower limbs leading to a hypercoagulable state. The aim Objective: of the study was to record the effect of carbon dioxide pneumoperitoneum on coagulation factors and brinolysis response during laparoscopic cholecystectomy and to assess if there is any risk of postoperative thromboembolic complications following laparoscopic cholecystectomy. Methods: The hospital based descriptive study of 50 patients undergoing elective laparoscopic cholecystectomy was designed to study alteration in Clotting time, Prothrombin time(PT), Activated partial thrombin time(aPTT), Fibrinogen and D-dimer, which were measured preoperatively and 6 hour postoperatively. Out of 50 Results: patients operated 38 were female and 12 were male. Signicant decrease in PT and aPTT suggested activation of coagulation pathways while signicant increase in d-dimer and brinogen suggested activation of brinolytic systems. None of the patients had any postoperative thromboembolic complications. From the study we found that there was activati Discussions: on of coagulation and brinolysis after laparoscopic cholecystectomy leading to a hypercoagulable state which may be either due to carbon dioxide pneumoperitoneum or due to increased intraabdominal pressure. Although none of the patients had any thromboembolic complications postoperatively, however there may be the need to use prophylactic measures for thrombosis in high risk patients.
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