“Clinico-morphoradiological factors predicting Difficult Laparoscopic Cholecystectomy in viral marker positive and negative patients-A Hospital Based Comparative Study”
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 10
Abstract
At times Laparoscopic Cholecystectomy becomes difficult. Laparoscopic Cholecystectomy may be rendered difficult by various problems encountered during surgery. Aims and Objective: To study preoperatively, the Clinical, biochemical and radiological parameters in predicting difficult laparoscopic cholecystectomy. Material and Methods:This prospective study was conducted on patients of Gallbladder stone disease in the Department of General Surgery of subharti medical college admitted through surgery OPD and emergency or transferred from other department after taking informed consent and clearance from University Ethical Committee on 200 patients out of which 90 are viral marker positive and 110 are viral marker negative. Finally 84 positive and 90 viral negative patients satisfying the inclusion criteria were included in the study (n=174). Patients with Acute (within 72 hours operated) & Chronic Cholecystitis with Cholelithiasis underwent laparoscopic cholecystectomy or conversion to open approach were studied during September 2015 to July 2017 (n = 174, Laparoscopic cholecystectomy = 164 and Open conversion = 10). Statistical analysis: Univariate analysis was performed using Chi-Square test to determine the factors that are associated with difficult laparoscopic cholecystectomy using SPSS software. Next, a correlation matrix was developed to evaluate correlation between individual parameters. Results: age (>65 years), obesity (BMI>30), male gender, fever, past history of upper abdominal pain (acute cholecystitis/ pancreatitis), post ercp status, leukocytosis, abnormal LFT and amylase level, increased CRP levels ,ultrasound whole abdomen parameters like thickened gallbladder wall ,gallbladder excessive distension or fibrosed gallbladder, calculi size and numbers, pericholecystic fluid ,hepatomegaly ,cirrhosis of liver, portal hypertension etc. are predictive markers of Difficult Laparoscopic Cholecystectomy both in viral marker positive( HBsAg, HCV, HIV) and negative patients. In 51.72% cases (90 patients) (n=174) laparoscopic cholecystectomy was difficult, out of these 40% (36 patients, n= 90) were viral marker positive patients.
Authors and Affiliations
Dr Mishra Shashank, Dr Kansal Sumit, Dr Vishnoi Anshul, Dr Bansal Rani, Dr Tyagi Ruchi, Dr Kumar Dhanesh
Keywords
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- EP ID EP239207
- DOI 10.9790/0853-1610024559
- Views 101
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