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Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Minimally invasive treatments for cholelithiasis have gained popularity. The complexity of diagnosing and treating choledocholithiasis offers multiple surgical options, including laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+LC) and endoscopic retrograde cholangiopancreatography and/or endoscopic sphincterotomy plus laparoscopic cholecystectomy (ERCP/EST+LC). Objective: To compare outcomes in patients with typical signs, symptoms, laboratory, and imaging features of cholelithiasis combined with common bile duct stones, we retrospectively analyzed the short-term outcomes of LCBDE+LC and ERCP/EST+LC. Methods: We analyzed 318 patients with gallbladder stones treated between January 2022 and May 2024. Of these, 152 underwent LCBDE+LC, and 166 underwent ERCP/EST+LC. We compared patients' baseline characteristics, perioperative outcomes, and short-term complications between the two groups. The primary outcome was the effectiveness of choledochal stone removal, while secondary outcomes included length of stay, hospitalization costs, and patient satisfaction. Results: Patients' baseline characteristics were similar between the LCBDE+LC and ERCP/EST+LC groups. Stone clearance rates were comparable (97.37% versus 95.18%, P =.306), with a slight advantage in the LCBDE+LC group. The length of hospitalization was significantly shorter in the LCBDE+LC group (6.49 ± 1.18 days versus 6.77 ± 1.11 days, P <.05). The LCBDE+LC group also had lower total hospitalization costs ($5188.78 ± 861.26 versus $6498.76 ± 1190.58 P <.01). Additionally, the incidence of pancreatitis was lower in the LCBDE+LC group (0.66% versus 6.02%, P <.01). There were no significant differences between the groups in other short-term complications such as abdominal infection, cholangitis, biliary bleeding, or bile leakage. Postoperative follow-up indicated higher patient satisfaction and acceptance in the LCBDE+LC group (SSQ-8, 85.84 ± 4.31 points versus 81.20 ± 4.54 points, P <.01). Conclusion: Our findings suggest that the LCBDE+LC holds promise as a safe and efficacious approach for the management of cholelithiasis combined with common bile duct stones. However, further prospective clinical trials are essential to corroborate these results and confirm their broader applicability. [ABSTRACT FROM AUTHOR]

Background: The surgical difficulty of laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) and the risk of bile duct injury (BDI) depend on the degree of fibrosis and scarring caused by inflammation; therefore, understanding these intraoperative findings is crucial to preventing BDI. Scarring makes it particularly difficult to perform safely and increases the BDI risk. This study aimed to develop an artificial intelligence (AI) system to indicate intraoperative findings of scarring in LC for AC. Materials and methods: An AI system was developed to detect scarred areas using an algorithm for semantic segmentation based on deep learning. The training dataset consisted of 2025 images extracted from LC videos of 21 cases with AC. External evaluation committees (EEC) evaluated the AI system on 20 cases of untrained data from other centers. EECs evaluated the accuracy in identifying the scarred area and the usefulness of the AI system, which were assessed based on annotation and a 5-point Likert-scale questionnaire. Results: The average DICE coefficient for scarred areas between AI detection and EEC annotation was 0.612. The EEC's average detection accuracy on the Likert scale was 3.98 ± 0.76. AI systems were rated as relatively useful for both clinical and educational applications. Conclusion: We developed an AI system to detect scarred areas in LC for AC. Since scarring increases the surgical difficulty, this AI system has the potential to reduce BDI. [ABSTRACT FROM AUTHOR]

Organ and tool detection and segmentation in real time during surgery have been significant challenges in the development of robotic surgery. Most existing detection methods are unsuitable for the surgical environment, where the lighting conditions, occlusions, and anatomical structures can vary significantly. This study presents an organ and surgical tool segmentation and detection algorithm using a manually annotated dataset based on YOLOv8 (You Only Look Once), a state-of-the-art object detection framework. The YOLOv8 deep learning neural network is trained to detect and segment organs and tools during laparoscopic cholecystectomy using a manually annotated dataset of frames taken from actual surgeries. After four experiments using combinations of small and extra-large model sizes and the original and a modified dataset, the resulting algorithm is evaluated and tested in real time on a new surgical video. The method shows it can provide real-time feedback to the surgeon by accurately locating and segmenting the target organs displayed in the surgical video. The method outperforms the baseline methods, with a "bounding box" mean average precision (mAP50) and precession (P) of (50.2%, 51.6%), (52.8%, 76.9%), (83.2%, 81.1%), and (86.3%, 85.7%) for the first, second, third, and fourth experiments, respectively, and a "masking segment" of mAP50 and precession of (50.5%, 51.8%), (54.3%, 76.1%), (82.6%, 80.4%), (86.0%, 85.4%) for the first, second, third, and fourth experiments, respectively. The best-performing model has a speed of around 13.1 ms per frame. This novel application could be a stepping stone in future work, such as developing an algorithm to display the results to the surgeon in a heads-up-display (HUD) to help navigate the scenes or even be implemented in robotic surgeries. [ABSTRACT FROM AUTHOR]

Background: There is still controversy regarding the treatment strategy for moderate acute cholecystitis (AC). Percutaneous transhepatic gallbladder drainage (PTGBD) followed laparoscopic cholecystectomy (LC) has shown advantages compared to emergency LC (ELC). However, the results are controversial. Therefore, we conducted this updated meta-analysis to clarify this issue. Materials and Methods: A comprehensive literature search for relevant studies comparing the PTGBD + LC and ELC for moderate AC was performed. The statistical analysis was conducted using Stata. Results: A total of 14 studies were included. The pooled analysis revealed that PTGBD + LC group had a shorter operation time (SMD = −1.07, 95%CI = −1.19 to −0.95), lower amount of intraoperative bleeding (SMD = −0.93, 95%CI = −1.07 to −0.79), lower conversion rate (OR = 0.28, 95% CI = 0.17-0.44), lower postoperative complications (OR = 0.45, 95% CI = 0.23-0.88) shorter postoperative hospital stay (SMD = −1.20, 95%CI = −1.33 to −1.07), lower wound infection rate (OR = 0.41, 95%CI = 0.23-0.74) and higher hospitalization expenses (SMD = 1.13, 95%CI = 0.96 to 1.29) compared with ELC group. There was no significant difference in the incidence of bile leak, bile duct injury and total hospital stay. Conclusion: This meta-analysis suggested that PTGBD + LC has significant advantages over ELC for moderate AC patients, including lower surgical difficulty, lower conversion rate, fewer postoperative complications, and shorter hospital stay. [ABSTRACT FROM AUTHOR]

Background: Patients with prior abdominal surgeries are at higher risk of intra-peritoneal adhesions near the trocar entry site, increasing the likelihood of organ injury during laparoscopic cholecystectomy (LC). This study evaluates a novel technique where the epigastric trocar is inserted first, after creating pneumoperitoneum, to allow safe dissection of adhesions under direct vision before placing the umbilical trocar. Methods: This prospective study included 244 patients with symptomatic uncomplicated gallstone disease and a history of previous abdominal surgeries extending to the umbilicus. Patients were randomly assigned to two groups: Group I (n = 98) underwent traditional umbilical trocar-first LC using the Hasson technique, while Group II (n = 146) received LC using the epigastric trocar-first approach. Operative time, complications, and conversion rates were analyzed. Results: There was no significant difference in the demographics between both groups. The epigastric trocar-first approach significantly reduced total operative time (41.6 ± 7.7 min vs. 46.8 ± 8.8 min, p = 0.031) and small bowel injury rates (p = 0.006). Otherwise, intraoperative complications were comparable. Conversion to open surgery was lower in Group II (2.1% vs. 8.2%, p = 0.012). Postoperative pain at 6 h was significantly lower in Group II (p = 0.001). Conclusions: The epigastric trocar-first approach, offers a safer alternative for patients with prior abdominal surgeries when undergoing LC. This approach is safe; minimizes bowel injury risk, reduces conversion rates, and enhances patient recovery. This approach may also be beneficial in other laparoscopic procedures requiring safe entry in patients with prior abdominal surgeries. Further studies are recommended to validate its broader clinical application. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of transversus abdominis plane (TAP) block under direct vision with acupoint injection on the rapid recovery of patients after laparoscopic cholecystectomy. Methods: Ninety-three patients undergoing laparoscopic cholecystectomy at Hangzhou Hospital of Traditional Chinese Medicine from January 2023 to December 2023 were selected and divided into control, TAP block under direct vision (TAP-DV), and TAP-DV with acupoint injection (TAP-DVA) groups using a random number table method. Postoperative VAS, Ramsay score, IL-6, CRP, and postoperative rehabilitation indices were compared among the three groups. Results: The VAS pain score at 6 h after surgery was significantly lower in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05). The VAS pain score at 24 h after surgery was significantly lower in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05) and was significantly lower in the TAP-DVA group than in the TAP-DV group (P < 0.05). The VAS pain score 48 h after surgery was significantly lower in the TAP-DVA group than in the control and TAP-DV groups (P < 0.05). The mean IL-6 level was significantly lower in the TAP-DVA and TAP-DV groups than in the control group (P < 0.05). The postoperative nausea and vomiting rate was significantly lower in the TAP-DVA group than in the control group (P < 0.05). The postoperative exhaust time was earlier in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05) and was earlier in the TAP-DVA group than in the TAP group (P < 0.05). The postoperative hospitalization days and total cost were significantly lower in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05). Conclusion: TAP-DVA has a stable and good analgesic effect and can promote rapid recovery after laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy for acute cholecystitis carries an increased risk of biliovascular injuries. Fluorescence cholangiography (FC) is a valuable diagnostic tool for identifying extrahepatic bile ducts (EHBD). The objective of this study was to evaluate the efficacy of FC in delineating EHBD anatomy, both before and after dissection, based on the critical view of safety (CVS) principles. Methods: Urgently admitted patients were prospectively stratified into two groups, depending on whether they had mild or moderate acute cholecystitis, in accordance with the 2018 Tokyo guidelines. All patients were scheduled for an early laparoscopic cholecystectomy using FC and were administered a fixed dose of indocyanine green (ICG) intravenously 12 h prior to the surgical procedure. Results: A total of 108 patients—75 patients with mild acute cholecystitis and 33 patients with moderate acute cholecystitis—were included. More than four CVS steps were performed in 101 patients (93.5%). Less than four CVS steps were performed only in seven patients—three (2.5%) patients with mild acute cholecystitis and four (4%) patients with moderate acute cholecystitis. The achievement of the CVS principles and the visualization rate using FC significantly increased in both patient groups, ranging from 3% before CVS to 100% after CVS (p < 0.001). In both groups, the cystic duct was visualized in most patients after CVS and FC, followed by the common bile duct and the common hepatic duct. Conversely, even after using CVS and FC, the visualization of the confluence of the cystic and common hepatic ducts remained less likely and challenging in both groups (57.3% in mild patients vs. 33.3% in moderate patients; p = 0.022). Background liver fluorescence disturbance was observed equally in both patient groups (6–11%), but it did not reach statistical significance. The median operative time was 60 ± 25 min in patients with mild acute cholecystitis compared to 85 ± 37 min in patients suffering from moderate acute cholecystitis (p < 0.001). No postoperative complications or biliovascular injuries were observed. Conclusions: FC is a convenient, safe, and efficacious procedure for attaining CVS principles and identifying the EHBD anatomy in most patients. The procedure showed superior results in mild acute cholecystitis patients in comparison to moderate acute cholecystitis patients. [ABSTRACT FROM AUTHOR]

Background: High-frequency, high-intensity transcutaneous electrical nerve stimulation (HFHI TENS, i.e. 80 Hz and 40–60 mA) is an effective, fast-acting pain relief modality after elective surgery, offering pain relief within 5 min. Few studies have explored patients' perspectives on using TENS in the post-anesthesia care unit. This study investigates patients' experiences and perceptions of TENS as a complementary approach to traditional pharmacological pain management in postoperative care. Method: Patients undergoing elective laparoscopic cholecystectomy were offered TENS as an alternative to conventional pain treatment with IV opioids. Twenty participants attended telephone semi-structured telephone interviews a median of 12 days after surgery. Data were analysed using a thematic analysis according to Braun and Clark. Results: Participants expressed that TENS provided reassurance and relaxation, calmed them, and gave them a sense of control over their pain. Participants perceived a greater degree of autonomy as TENS could be administered independently. They conveyed a preference for TENS, which they experienced as a safe and fast-acting alternative to opioids, despite its limitations in managing severe pain and rapid offset upon discontinuation. Conclusion: To our knowledge, this is the first study that describes patients' views on managing postoperative pain using TENS in the post-anesthesia care unit. This study indicates that patients desire alternatives to drugs for pain control in the postoperative setting. TENS has advantages, such as a rapid onset and offset and supporting patient autonomy, as well as drawbacks, such as being ineffective when pain is too severe. TENS could be included within the routine multimodal analgesia framework for person-centred postoperative pain management. Trial registration: The participants in the current study were retrospectively registered and recruited from a randomized controlled trial (RCT; registered at ClinicalTrials.gov: NCT04114149). [ABSTRACT FROM AUTHOR]

Background: Cholecystectomy remains the definitive treatment for complicated gallbladder disease, with laparoscopic (LC) and open cholecystectomy (OC) as primary surgical approaches. Objective: To compare recovery trajectories and complication rates between laparoscopic and open cholecystectomy in patients with complicated gallbladder disease. Method: A randomized controlled trial was conducted at Veer Surendra Sai Institute of Medical Sciences And Research (VIMSAR), Sambalpur, Odisha, from 2021 to 2024. A total of 300 patients diagnosed with complicated gallbladder disease were randomly assigned to undergo either LC (n=150) or OC (n=150). Recovery metrics, including time to ambulation, length of hospital stay, and return to normal activities, were assessed. Complication rates, such as bile duct injury, infection, and hemorrhage, were recorded. Statistical analyses involved chi-square tests for categorical variables and t-tests for continuous variables, with significance set at p<0.05. Additionally, multivariate regression was utilized to adjust for potential confounders, and cost-effectiveness was evaluated based on hospital expenses and patient recovery times. Result: Among the 300 patients, the LC group exhibited a significantly shorter hospital stay (mean 3.2 days vs. 6.8 days, p<0.001) and faster ambulation (mean 12 hours vs. 24 hours, p<0.001) compared to the OC group. Return to normal activities was expedited in the LC group (mean 7 days) versus the OC group (mean 14 days, p<0.001). Complication rates were markedly lower in LC (15%) compared to OC (30%, p=0.002). Specifically, bile duct injuries occurred in 2% of LC patients versus 5% of OC patients, infections in 5% versus 12%, and hemorrhages in 3% versus 13%. Multivariate analysis confirmed that LC was independently associated with reduced hospital stay (β=-3.6, p<0.001) and lower overall complications (OR=0.45, 95% CI: 0.28-0.72, p=0.001). Cost analysis revealed that LC incurred an average cost of INR 50,000 compared to INR 70,000 for OC, indicating a 28.5% cost reduction. Additionally, the conversion rate from LC to OC was 10%, primarily due to severe inflammation and anatomical variations. Conclusions: Laparoscopic cholecystectomy significantly enhances recovery times and reduces complication rates compared to open cholecystectomy in patients with complicated gallbladder disease. These findings support the preferential use of LC as the standard surgical approach in such clinical scenarios. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy is the preferred method for treating acute cholecystitis. Although the incidence of postoperative infections in laparoscopic cholecystectomy is low, serious postoperative surgical site infections are still reported. Hepatic abscesses, particularly fungal, can occur post-cholecystectomy leading to significant mortality and morbidity. We report a case of a 58-year-old female who underwent laparoscopic cholecystectomy and subsequently developed fever, jaundice, and right upper quadrant pain. Laboratory results showed deranged liver function tests with raised inflammatory markers. Radiographic investigations, including CT and MRI, revealed an irregular hilar lesion with periportal changes suggestive of an abscess with portal vein thrombosis. Histopathological examination of the biopsy obtained from the hilar lesion showed a fungal hepatic infection, and particularly conidiobolomycosis. To our best knowledge, this is the first case that reports this fungal infection as a complication of laparoscopic cholecystectomy. The patient was managed with a combination of intravenous antibiotics and antifungals, which yielded mild improvement. Unfortunately, the patient decided to leave the hospital against medical advice, limiting the information on the disease course. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy (LC) is the preferred surgical procedure for treating symptomatic gallstone (GS) disease. Objectives: This study aimed to evaluate and compare the outcomes of emergent and elective LC, focusing on complications, conversion rates, duration of surgery (DOS), length of hospital stay, and post-operative pain. Methods: A total of 166 patients who underwent LC surgery at Baqiyatallah Hospital, Tehran, Iran, between 2021 and 2022 were included in the study. Of these, 64 patients underwent emergent LC, and 102 underwent elective LC. The groups were compared for complications, conversion rates, DOS, length of hospital stay, and post-operative pain. Results: The study revealed that while intraoperative complications did not differ significantly between the two groups (P = 0.14), there was a significant difference in the conversion of surgical methods from three to four trocars (P = 0.007). Additionally, more patients in the emergent group required drain insertion during surgery (P = 0.003). Regarding post-operative outcomes, no significant differences were observed between the emergent and elective LC groups in terms of local (P = 0.77) and systemic complications (P = 0.37). However, patients in the elective LC group experienced a significantly shorter post-operative hospital stay (P = 0.002). Pain levels one day (1.02 ± 0.80) and one week (0.14 ± 0.43) after surgery were lower in the elective LC group. Furthermore, patients in the elective group returned to daily activities earlier (3.77 ± 1.21 days). Conclusions: The findings of this study indicate that emergent LC is as safe as elective LC. However, patients undergoing elective LC may benefit from a shorter recovery period and reduced post-operative pain. Overall, LC remains a low-risk and safe option for managing emergent gallstone cases. [ABSTRACT FROM AUTHOR]

Background and Aims: Ondansetron and dexamethasone combination is effective for prophylaxis against postoperative nausea and vomiting (PONV). Ondansetron, when compared to dexamethasone, is known to cause more adverse effects and is relatively expensive. The present study evaluated the efficacy of standard dose and low dose ondansetron, i.e. 100 μg/kg and 50 μg/kg, respectively, with dexamethasone 8 mg for PONV prophylaxis in laparoscopic cholecystectomy (LC). Material and Methods: After the approval from the Institutional Ethics Committee-Human Research [IEC-HR] and prospective CTRI registration, this randomized, double-blind interventional study was conducted following informed consent from each participant. Patients aged 18–65 years of either sex, with ASA physical status I or II, undergoing LC under general anesthesia, were included and divided into groups C and L. Patients in groups C and L received 100 μg and 50 μg of ondansetron, respectively, in combination with 8 mg dexamethasone. The incidence of PONV in first 6 hrs, PONV score, rescue antiemetic consumption, rescue analgesia, and hemodynamic parameters were recorded. Results: A total of 110 patients were included with 55 in each group. Incidence of PONV in the first 6 hours was found to be higher in 1–2 hour- and 2–3-hour time intervals in group L; but was significant only at 1–2-hour time interval (P < 0.05). Proportion of patients needing rescue antiemetic in the first 6 hours was higher in group L but was not statistically significant. Conclusion: We observed that 50 μg/kg combination of ondansetron was associated with higher incidence of post operative nausea in the immediate postoperative period than 100 μg/kg dose; however, no significant difference was observed in incidence of post-operative vomiting between two doses following LC. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy is a minimally invasive surgery which most often is associated with post-operative pain. Pre-emptive administration of ketamine and diclofenac in combination reduces post-operative pain. Aims and Objectives: In patients undergoing laparoscopic cholecystectomy, the aim of this study was to evaluate the efficacy of preemptively administered ketamine and diclofenac and their combination on post-operative pain. Materials and Methods: A total of 90 patients, with American Society of Anesthesiologists physical grading I and II, were recruited for the study. Patients were allocated randomly into the following groups: Group I was administered 100 mL isotonic saline intravenous (IV) 20 min before the induction of anesthesia and 0.15 mg/kg ketamine IV diluted in 5-mL isotonic saline before skin incision; Group II received diclofenac in the dose of 1 mg/kg diluted in 100-mL isotonic saline IV 20 min before the induction of anesthesia and 5-mL isotonic saline IV before skin incision; Group III was administered a combination of diclofenac 1 mg/kg diluted in 100-mL isotonic saline IV 20 min before the induction of anesthesia and 0.15 mg/kg ketamine diluted in 5-mL isotonic saline IV before skin incision. Time for rescue analgesia, post-operative Visual Analog Scale score, hemodynamic changes, and adverse effects were evaluated. Results: Post-operative analgesia was longer in Group III as compared to Group II and Group I at 2, 4, and 6 h (P<0.05). The mean time to receive rescue analgesia was significantly higher in Group III (6.950±0.6208) and Group II (5.633±0.7184) as compared to Group I (2.833±0.6205). Significantly higher heart rate and blood pressure were noted in Group I as compared to Group II and Group III at 2, 4, and 6 h postoperatively. Conclusion: Administration of ketamine and diclofenac preemptively in the patients undergoing laparoscopic cholecystectomy has a definitive role in providing postoperative analgesia without any adverse side effects whereas ketamine alone when given preemptively did not produce any benefit in post-operative pain relief. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy is one of the most common surgical procedures. Several techniques of ligating the cystic duct have been compared in randomized trials, but data on comparative effectiveness are missing. Our aim was to systematically review the literature and, if appropriate, synthesize the available evidence. Methods: A systematic search of PubMed, Scopus, Ovid, and Cochrane Library was conducted to identify randomized studies comparing different ligation techniques of the cystic duct in laparoscopic cholecystectomy. Network meta-analysis synthesized evidence from all available techniques. Techniques compared were metal (MC), absorbable (AC), or polymer clips (PC), suture ligation (SL), and ultrasonic shears (US). Results: Twenty-three randomized studies with 2851 patients were included in our study. A well-connected network was formed for bile leak and a star-shaped network for operative time, with MC as the common comparator. No difference was found when SL, AC, US, or PC were compared for bile leak. Operative time was statistically significantly reduced when US were compared to MC (mean difference [MD] = −14.32 [−19.37, −9.28]), SL MD = −20.16 (−10.84, −29.47), and AC MD = −18.32 (−1.25, −35.39). The remaining techniques had similar operative times. PC had the highest probability of being the best technique P = 41.8, and SL had the highest probability P = 46.1 of being the second best for bile leak. US had a 98.1% chance of being the best technique for operative time. Conclusions: Given that all techniques demonstrate similar efficacy, the decision should be based on cost, familiarity with the technique, and environmental factors. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic Cholecystectomy (LC) is the Gold Standard procedure for symptomatic gallstones. With the development of laparoscopic procedure, surgical interest in the Rouviere's sulcus and cystic lymph node in relation to the right portal pedicle and prevention of bile duct injury has increased recently. This prospective study aimed at safety landmarks for avoiding Bile Duct Injuries during surgery and reducing the number of intraoperative and postoperative complications in laparoscopic cholecystectomy. The aim of the study is to compare the frequency of bile duct injury in conventional method of dissection versus the frequency of bile duct injury by delineating rouviere's sulcus and cystic lymph node as safety landmark in laparoscopic cholecystectomy. Material and Method: A comparative study was conducted on 60 patients of cholelithiasis who underwent laparoscopic cholecystectomy at our institution in two-year period. All patients were evaluated in terms of clinical, biochemical, haematological and ultrasonographic parameters and randomised in two groups. Patients were allocated group A and B depending upon Ticket picked by them. Group A patient: Rouviere's sulcus and cystic lymph node was identified intraoperatively and an imaginary line (R4U) that passed from the sulcus across the base of segment 4 to the umbilical fissure drawn and cystic line is an imaginary line running through cystic lymph node and parallel to hepatoduodenal ligament was drawn and dissection superolateral to intersection of these lines along with achievement of CVS. Group B patients: Underwent conventional method of dissection (calot's Triangle dissection with critical view of safety achievement). Patients were followed up after 7 days and assessment was done. Conclusion: The study concluded that before commencement of calot's triangle dissection identification of Rouviere's sulcus [RS] and cystic lymph node of lund is an extra biliary, easily accessible and reliable anatomical land mark from where we can draw two imaginary line [R4U and cystic line] and dissection start above and lateral to intersection of these line and no injury was observed and one bile duct injury was noted during convention method of dissection. So it can help us as an additional safe reference point to avoid bile duct injury and dissection in safe area close to gall bladder in laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Copyright of Zagazig University Medical Journal is the property of Association of Arab Universities and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Acute cholecystitis (AC) is an acute inflammatory disease of the gallbladder and one of the most frequent causes of acute abdominal pain. Early cholecystectomy is recommended for mild cholecystitis. However, the optimal surgical timing for moderate-to-severe cholecystitis requiring percutaneous transhepatic gallbladder drainage (PTGBD) remains unclear. We hypothesized that early elective surgery after PTGBD would reduce surgical morbidity. Methods: A retrospective analysis was performed on adult patients who underwent elective surgery for AC after PTGBD at our hospital between January 2011 and December 2020. Patient demographics, perioperative findings, and postoperative morbidity and mortality rates were also investigated. The patients were divided into two groups based on postoperative morbidity, and univariable analysis was performed for preoperative factors. Multivariable logistic regression analysis was performed for the potential independent variables. Results: A total of 891 patients were screened for eligibility, and 259 were included in the analysis. Among these patients, 32 developed postoperative morbidity; however, there was no postoperative mortality. Multivariable analysis revealed that the time from PTGBD to surgery was an independent predictor of surgical morbidity (odds ratio, 1.05; 95% confidence interval: 1.01–1.10). Conclusion: In early elective surgery for moderate-to-severe AC requiring PTGBD, a shorter interval from biliary drainage to surgery may decrease surgical morbidity. [ABSTRACT FROM AUTHOR]

Over the last 40 years, the role of endoscopic ultrasound (EUS) has evolved from being diagnostic to therapeutic. EUS-guided gallbladder drainage (EUS-GBD) and EUS-guided gastroenterostomy (EUS-GE) are emerging techniques in recent years; however, there are limited studies and inconsistent results regarding these techniques. In addition, EUS has become a more common alternative to traditional interventions due to its super minimally invasive nature, but the mobility of both the gallbladder and intestine makes it challenging to introduce stents. An increasing number of researchers are dedicating themselves to solving this problem, leading to the development of various assisted technologies. Consequently, this review focused on the comparison of EUS-GBD and EUS-GE with other alternative approaches and explored the various assisted techniques employed for EUS-GBD and EUS-GE. Plain language summary: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and endoscopic ultrasound-guided gastroenterostomy (EUS-GE) have emerged as novel, minimally invasive endoscopic interventional techniques in recent years, have become the increasingly popular alternative to conventional surgical and percutaneous interventions. However, the superiority of endoscopic ultrasound-guided interventional therapy remains controversial topics in the medical literature. Additionally, the mobility of gallbladder and intestine reduces technical success rate. Therefore, this article comprehensively compares EUS-GBD, EUS-GE and other alternative methods, as well as the assisted methods of them. [ABSTRACT FROM AUTHOR]

Introduction: Gallstone disease is a prevalent condition, affecting over 10% of the population, and acute cholecystitis (AC) remains a frequent cause of emergency gastrointestinal admissions. The Tokyo Guidelines (TG18/TG13) provide criteria for assessing the severity of AC and guide treatment decisions. This study aims to identify factors associated with mortality and prolonged hospitalization in elderly patients undergoing laparoscopic cholecystectomy (LC) for AC. Materials and Methods: This retrospective study included patients aged 70 and older who underwent LC for TG18/TG13 grade 1-2 AC between 2016 and 2023. Patients with recurrent AC, organ dysfunction, or a history of ERCP were excluded. Data on demographics, comorbidities (Charlson Comorbidity Index (CCI)), ASA (American Society of Anesthesiologists) scores, CRP/Albumin ratio (CAR), POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity) scores, postoperative outcomes, and length of hospital stay were collected. Statistical analyses were performed to evaluate the correlation between clinical factors and outcomes, including mortality and hospitalization duration. Results: A total of 52 patients, with a mean age of 74 years, were included. Mortality occurred in 4 patients (7.6%). Higher ASA, CCI, and POSSUM scores were significant predictors of mortality. CAR and serum albumin levels showed borderline significance. The timing of surgery and Tokyo severity scores were not associated with mortality. A positive correlation was found between the timing of surgery and length of hospital stay. The POSSUM score had higher specificity and sensitivity compared to CCI in predicting mortality. Conclusion: The POSSUM score was superior to CCI and ASA in predicting mortality in elderly patients undergoing LC for AC. The CAR ratio also showed potential as a predictive factor. These scores may help in optimizing treatment decisions and outcomes in this high-risk population. [ABSTRACT FROM AUTHOR]

Introduction: The elderly population is at high risk for perioperative morbidity and mortality due to their disease profiles. This study aimed to evaluate the results of laparoscopic cholecystectomy (LC) performed in a single center in terms of young and elderly patients. Materials and Methods: Patients who underwent LC between January 2022 and March 2023 were evaluated retrospectively. Two hundred and eighty-three patients were included in the study. Patients were divided into two groups: ≥65 years and <65 years, and perioperative findings were compared. Results: Patients aged ≥65 had higher rates of heart disease, lung disease, kidney disease, and neurological disease; American Society of Anesthesiologists Score II-III; longer length of hospital stay (LOS); and longer length of intensive care unit (ICU) stay than patients aged <65. In addition, patients aged ≥65 had lower levels of hematocrit, hemoglobin, platelets, and albumin than patients aged <65, and patients aged ≥65 had higher levels of urea, creatinine, and total bilirubin than patients aged <65. High white blood cell count, C-reactive protein, aspartate transferase, and bilirubin values, as well as low hematocrit, hemoglobin, and albumin values, were associated with longer LOS and ICU stay. In addition, high aspartate transferase, alanine aminotransferase, alkaline phosphatase, direct bilirubin, and total bilirubin values were associated with increased development of complications. No mortality was observed during the study period. Conclusion: LC is a safe method and has acceptable mortality and morbidity rates, even in patients with high comorbidities in elective conditions. [ABSTRACT FROM AUTHOR]

Copyright of Diyala Journal of Medicine is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The most common therapy for gallstones is laparoscopic cholecystectomy (LC). How to help young residents avoid bile duct injuries (BDI) during surgery and grasp LC seems to be a paradox. Methods: We retrospectively reviewed 145 cases of LC operated by two residents under indocyanine green (ICG)–guided mode or normal LC procedures to illustrate the role of ICG mode in boosting the LC learning curve. The clinic data were analyzed by logistic regression, receiver operator curve tests, Cumulative Sum (CUSUM), and Risk-Adjusted Cumulative Sum (RA-CUSUM) analysis. Results: The operation failure rate is similar. However, operation time under ICG mode is shorter than that under normal mode. The peak at the 49th case represented the normal resident's complete mastery of the surgery, while the peak point of ICG mode appeared at the 36th case in the fitting curve. The most significant cumulative risk (peak point) of operation failure of LC was at the 35th case in ICG LC mode, while it appeared in the 49th in normal LC mode. Conclusions: Owing to the advantage of real-time imaging and the stable success rate of cholangiography, ICG-guided LC helps residents shorten the operation time, boost the learning curve, and manage to control the operation failure rate. [ABSTRACT FROM AUTHOR]

Background: Technological advances have made the laparoscopy procedure popular for simultaneous cholecystectomy and bile duct exploration. We aimed to assess the implementation of a structured mentorship program for training in laparoscopic common bile duct exploration (LCBDE). We explored the effectiveness thereof in facilitating the learning of LCBDE as a single-stage treatment of common bile duct stones (CBD) with gallbladder in situ. Methods: The surgical databases of a mentor (experienced in LCBDE) and a mentee (new to LCBDE) were analyzed. The analysis retrospectively compared the mentor's first 100 cases (MF) with the mentee's first 100 (MEF) cases, and the mentor's last 100 cases (ML) with the mentee's initial cases. Data included demographics, technical details, and postoperative outcomes. Results: A total of 300 patients underwent LCBDE. For MF vs. MEF (both n = 100), MF had a lower transcystic approach rate (5% vs. 70%; p < 0.001) than MEF. Postoperative median hospital stay was significantly shorter in the MEF group compared to the MF group (2 vs 5, p < 0.001). No mortality or significant complications were observed in either group. For ML (n = 100) vs. MEF, the ML group had a higher transcystic rate (87% vs. 70%; p = 0.005). No differences in mortality or conversion were observed between the groups. Bile leak was lower in the ML (3% vs. 6%, p = 0.498) group than the MEF group. Postoperative median hospital stay did not significantly differ between the ML and MEF group (1 vs 2 days, p = 0.952). Conclusions: Structured mentorship significantly influenced the successful adoption of LCBDE by the mentee, shortening the learning curve to provide outcomes in the first 100 cases, comparable to highly experienced centers. These results support the implementation of structured training and continuous mentoring to facilitate the learning curve of laparoscopic bile duct exploration. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic cholecystectomy is one of the most frequently performed procedures by general surgeons. Strategies for minimizing bile duct injuries including use of the critical view of safety method, as outlined by the SAGES Safe Cholecystectomy Program, are not always possible. Subtotal cholecystectomy has emerged as a safe "bail-out" maneuver to avoid iatrogenic bile duct injury in these difficult cases. Strasberg and colleagues defined two main types of subtotal cholecystectomies: reconstituting and fenestrating. As there is a paucity of studies comparing the two subtypes of laparoscopic subtotal cholecystectomy (LSC), we performed a systematic review and meta-analysis comparing the reconstituting and fenestrating techniques for managing the difficult gallbladder. Methods: A search of PubMed, Embase, and Cochrane databases was conducted to identify prospective and retrospective studies comparing fenestrating and reconstituting LSC. The outcomes of interest were bile leak, reoperation, readmissions, completion cholecystectomy, postoperative ERCP, and retained CBD stones. Results: We screened 2855 studies and included 13 studies with a total population of 985 patients. Among them, 330 patients (33.5%) underwent reconstituting LSC and 655 patients (55.5%) underwent fenestrating LSC. Twelve studies were retrospective, and one was prospective. Notably, reconstituting STC was associated with decreased incidence of bile leak (OR 0.29; CI 95% 0.16–0.55; p = 0.0002; I2 = 36%). We also noted increased rates of postoperative ERCP with fenestrating STC in sensitivity analysis (OR 0.32; CI 95% 0.16–0.64; p = 0.001; I2 = 31%). In addition, there was no difference between the two techniques regarding the rates of completion of cholecystectomy, reoperation, readmission, and retained CBD stones. Conclusions: Fenestrating LSC leads to a higher incidence of postoperative bile leakage. In addition, our sensitivity analysis revealed that the fenestrating technique is associated with a higher incidence of postoperative ERCP. Further randomized trials and studies with longer-term follow-up are still necessary to better understand these techniques in the difficult gallbladder cases. [ABSTRACT FROM AUTHOR]

Port site infection causes significant morbidity in patients undergoing laparoscopic cholecystectomy. The umbilicus, the most common location for creating pneumoperitoneum, frequently harbours resident microflora, which can render a patient susceptible to subsequent port site infections. Umbilical hygiene and its role in preventing surgical site infections have not yet been studied. Our study aimed to bridge this gap by proposing a method for umbilical hygiene. Five hundred two patients planned for laparoscopic cholecystectomy were randomised. In the intervention arm, the umbilicus was cleaned with 2–3 drops of coconut oil and patients were instructed to take a bath, with an emphasis on umbilicus cleaning. Patients in the control group were asked to bathe before surgery, without applying coconut oil. In both arms, the abdomen was painted using chlorhexidine, and a standard laparoscopic cholecystectomy was done with the gall bladder being extracted through the epigastric port. Eight (or 1.5%) of the 480 patients had port site infections. Five of them had infections at the umbilical port site, of which four (p = 0.200) belonged to the control group. Our study showed no statistically significant association between preoperative umbilical hygiene and port site infection. This might be due to the fact that patients in both arms bathed prior to the surgery and had their abdomen painted and deep cleaned with chlorhexidine. Hence, we would like to emphasise the significance of deep cleaning of the umbilicus with chlorhexidine during the painting of the abdomen. Further studies with a larger sample size are needed. [ABSTRACT FROM AUTHOR]

Background: The gold standard treatment of acute cholecystitis is early laparoscopic cholecystectomy (LC), as indicated in the Tokyo Guidelines (TG). However, the definition of "early" is still unclear. In 2013, TG suggested surgical intervention within 72 h from the onset of the symptoms; however, according to the 2018 revision, LC must be performed as soon as possible, regardless of symptom onset. Therefore, the optimal timing for surgery is still debated. In order to avoid any complications, surgeons need to know all the surgical strategies for safety in case of a difficult cholecystectomy. Methods and Materials: Starting from January 2023 at Cittiglio Hospital (Italy), the following strategies were implemented: LC within 72 h from the onset of symptoms, systematic intraoperative use of indocyanine green fluorescence cholangiography, systematic identification of the Critical View of Safety (CVS), and subtotal cholecystectomy when the CVS was impossible to identify. We retrospectively analyzed a cohort of patients who underwent LC in our surgical department, subdividing them into two groups: Group 1 (G1) included patients operated on in 2022, and Group 2 (G2) included patients operated on in 2023. End points were length of stay and in-hospital postoperative complications, with particular interest in biliary duct injury. Results: Overall, 210 LC have been performed (97 in G1 and 113 in G2). After the introduction of the new safety strategy, the median length of stay (3 days in G1 vs. 2 in G2), BDI rate (2 in G1 vs. 0 in G2), and conversion rate to open procedure (5 in G1 vs. 1 in G2) were decreased. Conclusions: Our data are promising, highlighting that LC with the standardization of new safety strategies, especially in case of acute cholecystitis, immediately improves surgical outcomes in terms of length of stay and complications. [ABSTRACT FROM AUTHOR]

Copyright of Zagazig University Medical Journal is the property of Association of Arab Universities and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Objectives: Acute cholecystitis (AC) presents a significant burden in emergency surgical settings. Early laparoscopic cholecystectomy (ELC) is the standard of care for AC, yet its implementation varies. This study aims to assess the impact of preoperative waiting time (WT) on postoperative length of stay (LOS) in patients undergoing urgent cholecystectomy. Methods: From June 2021 to September 2022, data on patients undergoing urgent cholecystectomy for AC or pancreatitis were collected from two university hospitals. Patients were categorized into early (ELC) or delayed (DLC) cholecystectomy groups based on WT. The primary outcome was the assessment of the variables influencing LOS via univariate and multivariate analyses. Results: This study included 170 patients, predominantly female, with a median age of 64.50 years. ELC was performed in 58.2% of cases, with a median WT of 0 days, while DLC was performed in 41.8%, with a median WT of 3 days. Postoperative complications occurred in 21.8% of cases, with LOS being significantly shorter in the ELC group (median 5 days vs. 9 days; p = 0.001). Multivariate analysis confirmed that WT (OR 8.08 (1.65–77.18; p = 0.033)) was the most important predictor of LOS. Conclusions: ELC is associated with a shorter LOS and with DLC, aligning with the WSES recommendations. Earlier surgery reduces the risk of complications and overall hospital costs. An extended WT contributes to a prolonged LOS, underscoring the importance of timely access to operating theaters for acute biliary pathologies. [ABSTRACT FROM AUTHOR]

Background: The gold standard for treating acute cholecystitis is an early laparoscopic cholecystectomy. However, whether this still applies for a > 7-day existing cholecystitis remains heavily debated. Therefore, this systematic review investigates the safety of early laparoscopic cholecystectomy for a > 7-day existing cholecystitis. Methods: PubMed and Embase were systematically searched for all studies comparing early laparoscopic cholecystectomy in patients with 0–7 versus > 7-day existing cholecystitis at time of surgery. Meta-analyses were performed on dichotomous and continuous outcomes with risk difference (RD) and mean difference (MD) as measures of effect. Results: A total of 3007 studies were screened, resulting in the inclusion of 13 non-randomised studies comprising 5481 patients. Of these, 4690 received cholecystectomy within 7 days, and 791 after 7 days. Operating times (MD -11.8 min; 95% CI [-18.4; -5.2]) and total hospital stay (MD -2.7 days; 95% CI [-4.0; -1.4]) were longer in the > 7-day group. However, no significant risk difference was found for combined major complications: bile duct injury/leakage and bowel injury (RD -1.0%; 95% CI [-2.3; 0.3]), for complications graded Clavien-Dindo ≥ 3 (RD -0.3%; 95% CI [-2.5; 1.9]), or for conversions (RD -1.5%; 95% CI [-3.9; 0.9]). Conclusion: Early laparoscopic cholecystectomy for cholecystitis after the 7-day barrier might be harder, as reflected by longer operating times. However, a significant increase in complications or conversions was not found. Due to the risk of bias and lack of well-powered studies directly comparing early cholecystectomy after 7 days with alternative strategies, strong recommendations cannot be made. Meanwhile, it is advised to carefully weigh the treatment options in case of a > 7-day existing cholecystitis, based on patient's characteristics and surgeon's experience. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy with ultrasonic dissection presents a compelling alternative to conventional electrocautery. The evidence for elective cholecystectomy supports the adoption of ultrasonic dissection, citing advantages such as reduced operating time, diminished bleeding, shorter hospital stays and decreased postoperative pain and nausea. However, the efficacy of this procedure in emergency surgery and patients diagnosed with acute cholecystitis remains uncertain. The aim of this study was to compare outcomes of electrocautery and ultrasonic dissection in patients with acute cholecystitis. Methods: A randomized, parallel, double-blinded, multicentre controlled trial was conducted across eight Swedish hospitals. Eligible participants were individuals aged ≥ 18 years with acute cholecystitis lasting ≤ 7 days. Laparoscopic cholecystectomy was performed in the emergency setting as soon as local circumstances permitted. Random allocation to electrocautery or ultrasonic dissection was performed in a 1:1 ratio. The primary endpoint was the total complication rate, analysed using an intention-to-treat approach. The primary outcome was analysed using logistic generalized estimated equations. Patients, postoperative caregivers, and follow-up personnel were blinded to group assignment. Results: From September 2019 to March 2023, 300 patients were enrolled and randomly assigned to electrocautery dissection (n = 148) and ultrasonic dissection (n = 152). No significant difference in complication rate was observed between the groups (risk difference [RD] 1.6%, 95% confidence interval [CI], − 7.2% to 10.4%, P = 0.720). No significant disparities in operating time, conversion rate, hospital stay or readmission rates between the groups were noted. Haemostatic agents were more frequently used in electrocautery dissection (RD 10.6%, 95% CI, 1.3% to 19.8%, P = 0.025). Conclusions: Ultrasonic dissection and electrocautery dissection demonstrate comparable risks for complications in emergency surgery for patients with acute cholecystitis. Ultrasonic dissection is a viable alternative to electrocautery dissection or can be used as a complementary method in laparoscopic cholecystectomy for acute cholecystitis. Trial registration: The trial was registered prior to conducting the research on http://clinical.trials.gov, NCT03014817. [ABSTRACT FROM AUTHOR]

Background: The benefits of low-pressure laparoscopic cholecystectomy (LPLC) in patients with cardiopulmonary comorbidities remain unclear. This study aimed to explore the feasibility and pulmonary effects of LPLC in patients with cardiopulmonary comorbidities. Methods: This was a multicenter, parallel, double-blind, randomized controlled trial. Eligible patients included patients with cardiac or pulmonary comorbidities, who were randomly assigned (1:1) to undergo LPLC (10 mmHg) or standard-pressure laparoscopic cholecystectomy (SPLC) (14 mmHg). The primary outcome was postoperative partial pressure of carbon dioxide (CO2). Surgical safety variables, patient recovery, pulmonary function parameters, and surgeon comfort were also compared between groups. Results: This study enrolled 144 participants, with 124 participants extracted for the final analysis (62 in LPLC and 62 in SPLC group, respectively). The median postoperative PaCO2 was similar in the LPLC (43.3 mmHg) and SPLC (43.0 mmHg) groups (p = 0.988). Pulmonary parameters including postoperative pH, PaCO2, HCO3, and lactate levels were similar between the two groups. Postoperative base excess was significantly higher in the LPLC group (− 0.6 mmol/L [− 6.9 ~ 7.5] vs. −1.9 mmol/L [− 6.6 ~ 5.4]; p = 0.031). There was no between-group difference regarding intraabdominal operative time, rate of intraoperative bile spillage, blood loss, surgeon comfort during surgery, and conversion rate. Moreover, postoperative major complication rates, the median time to the first flatus, postoperative hospital stay, or mean postoperative visual analog scale score for pain were similar in both groups. Conclusions: This study found no reduction of partial pressure of CO2 with LPLC compared with SPLC for patients with cardiopulmonary comorbidities. LPLC with a pneumoperitoneum pressure of 10 mmHg may be safe and feasible for these patients when performed by experienced surgeons, although it does not improve pulmonary parameters. Registration: The trial is retrospectively registered at ClinicalTrials.gov (NCT04670952) on December 17, 2020. [ABSTRACT FROM AUTHOR]

Background: Volvulus of gallbladder is defined as a rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. Many factors are postulated to be the causes such as anatomical, mechanical, physiological, and hormonal risk factors but the presence of a distended gallbladder with a redundant mesentery is thought to be an important cause. Case presentation: A 68‐year‐old woman presented with right hypochondrial pain and vomiting for 2 days that was radiated to the interscapular region and associated with nausea and vomiting. The patient had no jaundice and the abdominal examination showed severe tenderness with guarding during palpation of the right upper abdomen with no palpable mass. The WBCs were elevated, with normal liver enzymes, bilirubin, and alkaline phosphatase. The ultrasound showed a single gallstone with increased wall thickness. There was no significant clinical improvement with antibiotics and analgesics. During laparoscopy, volvulus of the gallbladder was discovered causing gangrene of the gallbladder. Laparoscopic detorsion and successful laparoscopic cholecystectomy were performed. The patient was discharged on the third postoperative day with dramatic improvement with no postoperative complications. Conclusion: Gall bladder volvulus is an acute surgical emergency that is usually seen in the elderly population. It required a high index of suspicion especially in the absence of gallstones and must be differentiated from acalculous cholecystitis. Most cases are discovered at surgery. It must be managed with immediate detorsion and cholecystectomy, and the prognosis is excellent in most cases after an appropriate surgical intervention. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy is a popular abdominal surgery and the most common problem for patients undergoing laparoscopic cholecystectomy is the postoperative pain, and associated side effects due to opioids use for pain management and multimodal analgesia is suggested to reduce postoperative pain and need for postoperative opioids. This controlled clinical trial compares the effects of multimodal analgesia and pregabalin as unimodal analgesia on postoperative pain management, postoperative opioids consumption, and reduction of opioids accompanied adverse effects in patients undergoing laparoscopic cholecystectomy where large multicenter studies evaluating specific analgesic combinations are lacking. Method: This comparison randomized controlled trial between multimodal analgesia approach and pregabalin as unimodal analgesia included 95 laparoscopic cholecystectomy patients that were randomly allocated to three groups using a simple randomization method where multimodal and pregabalin groups included 30 patients in each and the drugs was administered orally one hour before the incision and control group included 35 patients that did not receive any preoperative analgesia. Multimodal analgesic therapy included acetaminophen 1 g, pregabalin 150 mg and celecoxib 400 mg while pregabalin group received pregabalin 150 mg only. Results: Multimodal group showed a significantly lower need for total opioid analgesics mean ± SD (1.33 ± 1.918) as compared to the control group mean ± SD (3.31 ± 2.784) with p-value 0.014. Pregabalin and multimodal groups showed significantly lower postoperative visual analogue scale used for pain assessment mean ± SD (3.50 ± 2.543) and mean ± SD (3.70 ± 2.231), respectively, compared to the control group mean ± SD (5.89 ± 2.857) with p-value 0.001. Conclusion: Multimodal analgesia reduced postoperative opioids consumption more than pregabalin alone when used preoperatively in laparoscopic cholecystectomy and consequently reduced opioids associated adverse effects, but they have the same efficacy in reducing postoperative pain, so pregabalin can be used alone preoperatively in patients with contraindications for using some analgesics included in multimodal analgesia protocol. The study was registered retrospectively in clinical trials; Trial registration ID: NCT05547659. [ABSTRACT FROM AUTHOR]

Minimally invasive laparoscopic cholecystectomy is among the most frequently performed abdominal surgeries. Bile duct injury is a significative complication that occurs in about 0.2–0.3% of open procedures and 0.5% of laparoscopic surgeries, with concomitant vasculobiliary injuries in 12–61% of cases. Most of these lesions occurs during challenging severe cholecystitis where the intense inflammation obscures the hepatocystic anatomy. In this case a bailout strategy such as a subtotal cholecystectomy should be considered. Subtotal cholecystectomy is a surgical technique performed to remove a portion of the gallbladder while leaving part of it behind. In such complex cholecystectomies, surgeons should be aware of this technique, and subtotal cholecystectomy should be part of their surgical armamentarium. We aim to familiarize surgeons with bailout techniques like subtotal cholecystectomy and gallbladder emptying for challenging acute cholecystectomy cases to reduce the risk of vasculobiliary injury. This multimedia article provides, a comprehensive step-by-step overview of the different possible minimally invasive subtotal cholecystectomy procedures, we outline five distinct techniques for conducting subtotal cholecystectomy, including some tips and tricks and demonstrates the usefulness of a minimally invasive approach. Finally, we emphasize the importance of carefully choosing between laparoscopic and robotic approaches and suggests using adjunctive tools, such as preoperative indocyanine green, to better identify common bile duct anatomy. [ABSTRACT FROM AUTHOR]

Objective: The transversus abdominis plane (TAP) block and local anaesthetic infiltration (LAI) of port sites provide adequate analgesia after laparoscopic cholecystectomy (LC). Little is known if the two techniques affect the day-case (DC) rate of LC. We tested the appropriateness of the research design in view of a larger randomised controlled trial (RCT) – laparoscopic-assisted right subcostal TAP block plus local anaesthetic wound infiltration (STALA) versus LAI. Subjects and Methods: Sixty patients having DC LC were randomised into STALA and LAI. Participants received bupivacaine 0.5% 30 mL. Pain scores were evaluated with the Visual Analogue Scale (VAS) score, at 1 h post-surgery and at discharge. Need of postoperative intravenous (IV) opioids, DC rate, and Quality of Recovery-15 questionnaires were compared between groups and were considered as measures of efficacy of the interventions and follow-up in a definitive trial. Results: Twenty-nine participants were randomised to STALA, and 31 to LAI. Subjects in LAI group were all women (p = 0.0007) and younger (43.8 vs. 37.7 years, p = 0.023). Median VAS scores were 0 versus 1 at 1 h (p = 0.60), 0 versus 1.5 at discharge (p = 0.55). The need of IV opioids was 15/29 (51.7%) versus 13/31 (41.9%; p = 0.60). The DC rate was 93.1% versus 93.5% (p = 0.39). Fifty (83.3%) participants responded the questionnaires. Conclusions: The laparoscopically guided right subcostal TAP block provided no additional benefit to LAI on pain control after LC and DC rate. Despite the appropriate design, our findings do not support a larger RCT. [ABSTRACT FROM AUTHOR]

Background and Objectives: Laparoscopic cholecystectomy constitutes the current "gold standard" treatment of symptomatic gallstone disease. In order to avoid intraoperative vasculobiliary injuries, it is mandatory to establish the "critical view of safety". In cases of poor identification of the cystic duct and artery leading to a missed intraoperative injury, patients present with elevated liver function tests (LFTs) or increased bilirubin postoperatively. The aim of this study is to present a series of patients of our institute with elevated liver enzymes and bilirubin after laparoscopic cholecystectomy in the absence of intraoperative injury or any other obvious etiology and to provide a possible explanation of this finding. Materials and Methods: From 2019 to 2023, 200 patients underwent elective laparoscopic cholecystectomy at the Papageorgiou General Hospital and at the European Interbalkan Medical Center of Thessaloniki utilizing the "critical view of safety" method. We retrospectively collected the intraoperative reports, and the pre- and postoperative imaging and laboratory studies of the patients included in this series. Postoperative LFTs and bilirubin levels were extracted and the reason for their transient elevation was examined. Results: From 200 cases of laparoscopic cholecystectomy, elevated LFTs and bilirubin were found in six patients on the first postoperative day, which is suggestive of a missed intraoperative injury. All patients were asymptomatic. During the investigatory workup, a triple-phase CT of the liver and/or an MRCP were ordered, but no pathological findings, such as biliary injury, hepatic artery injury or choledocholithiasis, were found. On postoperative day 3, LFTs and bilirubin levels decreased or normalized without any intervention. No postoperative complications were reported. Conclusions: In select cases, a transient increase in LFTs and/or bilirubin may be observed in the early postoperative period after elective laparoscopic cholecystectomy in the absence of an obvious etiology. A possible interpretation of these findings could involve the pneumoperitoneum or the anesthesia regimens used intra- or perioperatively. The specific cause, however, remains undetermined and yet to be examined by future studies. [ABSTRACT FROM AUTHOR]

Background: Single-incision laparoscopic cholecystectomy (SILC) is a minimally invasive procedure designed to minimize the number and size of the incisions needed for cholecystectomy. Titanium clips are traditionally used to close the cystic duct and artery. Although it is considered safe, dislodgement can result in bleeding and biliary leakage. Using LigaSure for duct sealing is still controversial. The aim of this study was to evaluate the safety and feasibility of using LigaSure to close the cystic duct during SILC. Methods: A prospective study over two years was conducted at the General Surgery Department, Mansoura University Hospital, on 102 patients, 51 in each group. They underwent SILC using LigaSure (Group 1) or titanium clips (Group 2) to control the cystic duct and artery. Results: The data analyzed included demographic data, operative time, intra- and postoperative complications, postoperative pain, and hospital stay. The operative time was significantly shorter in LigaSure group (68.5 ± 9.8 versus 72.9 ± 10.6 minutes in the clips group, P.03). There was no significant difference between the two groups regarding postoperative bile leak or bleeding. However, two cases in Group 1 and four cases in Group 2 were converted to multiple port laparoscopic cholecystectomy; this was statistically nonsignificant. Postoperative pain and hospital stay showed no significant difference between the two groups. Two patients in each group developed port-site incisional hernia. Conclusions: Clipless SILC using LigaSure is a feasible and safe procedure with acceptable morbidity with shorter operative time than SILC using clips. Nevertheless, the risk of port-site incisional hernia should be explained to the patients. [ABSTRACT FROM AUTHOR]

Purpose: Laparoscopic cholecystectomy for a benign disease is often the initial endoscopic surgery performed by trainee surgeons. However, a lack of surgical experience is associated with prolonged operative times, which may increase the risk of postoperative complications and poor outcomes. This study aimed to identify the factors associated with prolonged operative times for laparoscopic cholecystectomy performed by inexperienced surgeons. Methods: This retrospective single-center study was conducted between January 2018 and December 2023. We performed a multivariate analysis to identify the factors associated with prolonged operative time by analyzing elective cases of laparoscopic cholecystectomy performed by surgeons with limited experience. Results: The study included 323 patients, subjected to a median operative time of 89 min. Multivariate analysis identified that patient characteristics such as male sex, increased body mass index, and a history of conservative treatment for cholecystitis, as well as operating surgeon's post-graduation years (< 4 years), and an attending surgeon without endoscopic surgical skill certification from the Japan Society of Endoscopic Surgery, were independent risk factors for a prolonged operative time. Conclusion: Our findings suggest that endoscopic surgical skill-certified attending surgeons have excellent coaching skills and mitigate the operative time for elective cholecystectomy. [ABSTRACT FROM AUTHOR]

Purpose: Recently, bail-out cholecystectomy (BOC) during laparoscopic cholecystectomy to avoid severe complications, such as vasculobiliary injury, has become widely used and increased in prevalence. However, current predictive factors or scoring systems are insufficient. Therefore, in this study, we aimed to test the validity of existing scoring systems and determine a suitable cutoff value for predicting BOC. Methods: We retrospectively assessed 305 patients who underwent laparoscopic cholecystectomy and divided them into a total cholecystectomy group (n = 265) and a BOC group (n = 40). Preoperative and operative findings were collected, and cutoff values for the existing scoring systems (Kama's and Nassar's) were modified using a prospectively maintained database. Results: The BOC rate was 13% with no severe complications. A logistic regression analysis revealed that the Kama's score (odds ratio, 0.93; 95% confidence interval 0.91–0.96; P < 0.01) was an independent predictor of BOC. A cutoff value of 6.5 points gave an area under the curve of 0.81, with a sensitivity of 87% and a specificity of 67%. Conclusions: Kama's difficulty scoring system with a modified cutoff value (6.5 points) is effective for predicting BOC. [ABSTRACT FROM AUTHOR]

Background: While single-incision laparoscopic cholecystectomy (SILC) has gained more popularity in recent years, its application to elderly patients needs further evaluation. Few SILC studies regarded this rapidly growing vulnerable population, and single-incision laparoscopic common bile duct exploration (SILCBDE) was never mentioned. We conducted an observational study of 146 routine SILCBDE to address this issue. Methods: One hundred forty-six consecutive patients underwent SILCBDE with concomitant cholecystectomies during a period of 6 years (July 2012–June 2016 and July 2018–July 2020). Forty patients with an age of 65 years or older were the study target. Characteristics and operative outcomes were compared with the remaining 106 younger patients by retrospective chart review. The primary outcomes include complications and mortality, while the secondary outcomes contain intraoperative blood loss, operative time, procedural conversions, postoperative length of hospital stay, and bile duct stone recurrence. Results: There was no mortality. The bile duct stone clearance rate was 98.6%. The elderly group had higher American Society of Anesthesiologists (ASA) scores, higher comorbidity rate, higher acute cholangitis rate, lower completion intraoperative cholangiography (IOC) rate, longer operative time, more blood loss, longer postoperative hospital stay (p <.001), longer total hospital stay (p <.001), higher procedural conversion rate (p <.05), higher complication rate (p <.001), and the exclusive open conversion (2.5%). The difference in complications derived from Clavien–Dindo grade I. Conclusion: Routine SILCBDE with concomitant cholecystectomy by experienced surgeons is safe and efficacious for elderly patients as for younger patients. Randomized controlled trials are anticipated. [ABSTRACT FROM AUTHOR]

Background and Objectives: Laparoscopic Cholecystectomy is a minimally invasive surgery for or conducting gallbladder removal, providing faster recovery times and fewer complications compared to conventional open surgery. This study aims to evaluate and compare the standard of post-operative nursing care provided to patients who undergo Laparoscopic Cholecystectomy procedures in surgical units at teaching hospitals and understand statistical tools' performance in evaluating care quality. Methods: A cross-sectional descriptive study design, involving fifty nurses via nonprobability (purposive) sampling technique, who had been working in the surgical unit. The data were collected through the use of the observational checklist, which consisted of two parts; the first part includes information about the socio-demographic characteristics of respondents, and the second part is about the assessment of Postoperative nurses' care items consisting of five main domains. The data were collected from October -2023 to February -2024 after approval of the proposal by the Ethical Committee, using statistical tools to analyze the data. Result: The finding of the study showed that most study items responding to the questionnaire showed significant differences and that there is insufficient provision of highquality postoperative nurse interventions for patients undergoing Laparoscopic cholecystectomy at surgical wards at Erbil City teaching hospitals. Conclusion: This study concludes that several demographic factors, such as age, marital status, and level of education, among nursing staff significantly correlate with the quality of nursing care provided in surgical wards. Despite their educational background, many nurses lacked adequate professional skills and training in postoperative nursing interventions for care. [ABSTRACT FROM AUTHOR]

Background Percutaneous cholecystostomy (PC) is effective in controlling sepsis in patients with severe acute calculous cholecystitis (ACC). The long-term treatment of this group is still debated. We aimed to assess the clinical evolution of gallstones after severe ACC and the outcomes of laparoscopic cholecystectomy (LC) and conservative management, following PC. Methods This was a retrospective analysis of the rate of readmissions due to recurrent biliary disease and all-cause mortality in subjects who underwent a PC for severe ACC. We compared results between patients who underwent interval LC and those who received conservative management. Readmissions and late mortality were assessed using the Kaplan-Meier method and multivariate regression analysis. Results A total of 102 patients were included, of whom 30 underwent interval LC and 72 PC only. Overall, 51.6% were readmitted with recurrent biliary events and the rate did not differ between groups (P=0.583). The probability of recurrent gallstone events was higher in the first 30 weeks after PC; in the surgical cohort, 77.8% of them developed before LC. Late deaths occurred in 46.2% of patients: 13.3% LC vs. 61.9% conservative (P<0.001). Three years after PC, the estimated survival was 75% LC vs. 38% conservative (P=0.014). High-grade comorbidities and severity of ACC were positive predictors of all-cause mortality (P=0.004 and P=0.027), whereas LC was a negative predictor (P=0.003). Conclusions Recurrent biliary events were common following PC for ACC. Interval LC was associated with lower rates of readmissions and all-cause late mortality. [ABSTRACT FROM AUTHOR]

Background: To potentially lessen injuries and associated complications, fluorescence cholangiography has been suggested as a technique for enhancing the visualization and identification of extrahepatic biliary anatomy. The most popular way to administer indocyanine green (ICG) is intravenously, as there is currently little data on ICG injections directly into the gallbladder. In order to visualize extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC), we compared the two different ICG administration techniques. We also examined variations in visualization time, as well as the effectiveness, benefits, and drawbacks of each modality. Methods: In this prospective randomized clinical study, 60 consecutive adult patients with chronic and acute gallbladder disease were included. Our study conducted from 2022 to 2024 in Surgical Department of Theodor Bilharz Research Institute. Thirty patients underwent LC with intravenous ICG administration (IV-ICG), thirty patients received a direct injection of gallbladder through transhepatic ICG (IC-ICG) and Preoperative, intraoperative, and postoperative patient data were examined. Results: In terms of their perioperative and demographic features, the groups were similar. Without a statistically significant difference, the IV-ICG group's total operating time was less than that of the IC-ICG group (p 0.140). Compared to the transhepatic IC-ICG method, IV-ICG was more accurate in identifying the duodenum and the common hepatic duct (p = 0.029 and p = 0.016, respectively). In the transhepatic IC-ICG and IV-ICG groups, the cystic duct could be identified prior to dissection in 66.6% and 73.3% of cases, respectively, and this increased to 86.6% and 93.3% following dissection. In the transhepatic IC-ICG group, the common bile duct was visible in 93.3% of cases; in the IV-ICG group, it was visible in 90% of cases. Two cases in the IC-ICG group and every case following IV-ICG administration had liver fluorescence (6.6% versus 100%; p < 0.001). Conclusion: The current study shows that for both administration methods, ICG-fluorescence cholangiography can be useful in identifying the extrahepatic biliary anatomy during Calot's triangle dissection. By avoiding hepatic fluorescence, the transhepatic IC-ICG route can increase the bile duct-to-liver contrast with less expense and no risk of hypersensitivity reactions than the intravenous ICG injection method. We recommend to use both techniques in case of acute cholecystitis with cystic duct obstruction. In cases of liver cirrhosis, we recommend transhepatic IC-ICG as IV-ICG is limited. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy (LC) is now the gold standard treatment of symptomatic gallstones. Our study aims to assess the prevalence of port-site infection in laparoscopic cholecystectomies, associated factors, and the most common organism causing port-side infections. Materials and Methods: This is a retrospective institute-based study including all laparoscopic cholecystectomies in our institute during two years period from 1 May 2022 to 30 April 2024. This study includes a total of 847 laparoscopic cholecystectomies. Patients who developed PSI swabs were taken for culture and sensitivity in all. Excisional biopsies for chronic discharging sinuses were done and sent for histopathological studies. Results: PSI was found in 27/847 patients (3.19%). According to the site of port infection, 22 patients (81.48%) developed an infection at the epigastric port, 4 patients (14.81%) developed an infection at the umbilical port and only 1 patient (3.70%) developed an infection at the lateral port. About the results of swab culture and histopathology of tissue samples, 16 patients (59.26%) were infected by Gram-ve bacteria, 3 patients (11.11%) were infected by Gram +ve bacteria, 8 patients (29.63%) with no growth. In the patients with deep infection, tissue was sent for histopathology out of six patients 3 showed granulomatous lesion (11.11%) and 3 with inflammatory lesion. Conclusion: Port site infection is very problematic It is important that instruments should be cleaned thoroughly after each surgery and should be sent for ethylene trioxide sterilization It is important to prevent any spillage during retrieval of gallbladder. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy represents a minimally invasive surgical approach for the excision of a pathological gallbladder. Dexmedetomidine is commonly used in anesthesia practice as well. Nalbuphine belongs to mixed agonist-antagonist class of opioids (ĸ-agonist and µ-antagonist) with better features such as prolonged duration of analgesia while avoiding the side effects. Hence, the present study was conducted for assessing and comparing the efficacy of intraperitoneal administration of dexmedetomidine and nalbuphine as adjuncts to ropivacaine for post-operative pain relief in patient undergoing laparoscopic cholecystectomy. Materials and Methods: Present study was conducted in Department of Anaesthesiology, Maharshi Vishwamitra Autonomous State Medical College, Ghazipur, Uttar Pradesh, India. A total of 45 patients who were scheduled to undergo elective laparoscopic cholecystectomy under general anesthesia were enrolled. The participants were randomly divided into three groups, each consisting of 10 individuals. In Group 1, patients were administered a 50 ml solution containing 49 ml of 0.25% ropivacaine combined with 1 mcg/kg of dexmedetomidine. Group 2 received a 50 ml solution comprising 49 ml of 0.25% ropivacaine along with 5 mg of nalbuphine, while Group 3 was given a 50 ml solution that included 0.25% ropivacaine and 10 mg of nalbuphine. Postoperative pain was evaluated using the Visual Analog Scale (VAS). All data were analyzed using SPSS software. Chi-square test and ANOVA test were used for evaluation of level of significance. Results: Mean age of the patients of group 1, group 2 and group 3 was 43.2 years, 40.9 years and 41.7 years respectively. Mean BMI among patients of group 1, group 2 and group 3 was 23.7 Kg/m2, 24.1 Kg/m2, and 23.9 Kg/m2 respectively. Group 2 was associated with maximum pain as assessed by VAS. Comparing the VAS among three study groups at 2 hours and 4 hours, significant results were obtained. Conclusion: The administration of 0.25% ropivacaine combined with dexmedetomidine at a dosage of 1 mcg/kg in comparison to nalbuphine yielded the most favorable outcomes in patients. [ABSTRACT FROM AUTHOR]

Introduction: Although laparoscopic cholecystectomy has replaced the open surgery for management of gall bladder stones, however, bile duct stones or choledocholithiasis remains to be a challenging task. Bile duct stones are seen in almost every 7th to 10th patient having gall bladder stonesi. There is controversy regarding the ideal approach for management of common bile duct (CBD) gallstones, more so, in view of availability of multiple options. Until the laparoscopic and endoscopic modalities came into picture, open cholecyststectomy was the only procedure for CBD exploration. Materials and methods: Prospective Study was done in all patients with a diagnosis of choledocholithiasis in OPD in surgery department at Era's Lucknow Medical College and hospital posted for elective surgery. All the patients above 18 years of age presenting with uncomplicated choledocholithiasis undergoing elective CBD exploration were included. Patients with cholangitis, gall stone pancreatitis, abnormal liver enzymes (greater than thrice the upper limit of normal), immunocompromised patient were excluded. All patients with a diagnosis of choledocholithiasis in surgery OPD at ELMCH were chosen by SNOSE technique for open and laparoscopic CBD exploration. Demographic information was obtained. Blood specimen were obtained for hematological and biochemical assessment. Pre-operative sonographic assessment was also done and stone size was assessed. All patients received preoperative parental broad spectrum antibiotics. All procedures were operated by the same experienced surgical team, under general anesthesia. Results: Out of a total of 88 patients enrolled in the study, a total of 44 (50%) underwent CBD exploration using laparoscopic procedure and comprised the Group 1 of study whereas remaining 44 (50%) patients underwent CBD exploration using open procedure and comprised the Group 2 of study. Majority of patients in both the groups were female. Proportion of males was 36.4% and 34.1% respectively in Groups 1 and 2. Overall, there were 31 (35.2%) males and 57 (64.8%) females. On comparing the data statistically, no significant difference was observed between the two groups with respect to sex of the patients (p=0.823). Mean neutrophil, lymphocyte eosinophil and monocyte count was 68.45±7.19, 26.45±7.51, 4.23±1.79 and 0.82±1.02% respectively in Group 1 as compared to 68.30±7.61, 27.32±7.69, 3.95±1.82 and 0.61±1.10% respectively in Group 2. For none of these variables, the difference between two groups was significant (p>0.05). Mean prothrombin time and INR were 12.12±1.62 seconds and 0.70±0.14 respectively in Group 1 as compared to 12.20±1.47 seconds and 0.68±0.11 respectively in Group 2. Statistically, there was no significant difference between two groups for both these parameters (p>0.05). Conclusion: The findings of the study show that except for a slightly longer duration of procedure, laparoscopic procedure was associated with fewer complications (intraoperative blood loss, post-operative infection, wound dehiscence, residual stones and Incisional hernia), shorter duration of post-operative hospital stay and cheaper overall cost. Thus laparoscopic exploration of CBD offered a better clinical outcome with fewer outcomes and could be recommended as the preferred modality for exploration of CBD. [ABSTRACT FROM AUTHOR]

Background This study compares the outcomes of gallbladder removal using epigastric versus umbilical port placements in laparoscopic cholecystectomy. The objective is to evaluate differences in surgical efficacy, patient recovery, and cosmetic results between these two port locations. Methods A retrospective analysis was conducted involving 200 patients who underwent laparoscopic cholecystectomy with either an epigastric or umbilical port placement for gallbladder extraction. Patient demographics, postoperative pain, scarring, postoperative infection, port site hernia, requirement of analgesia, retrieval difficulty and cosmetic outcomes were assessed. The epigastric port group involved placing the extraction port in the epigastric region, while the umbilical port group utilized the umbilicus for gallbladder removal. Results The study included a total of 200 patients, with 100 patients in each group. The analysis revealed that both techniques were effective in performing laparoscopic cholecystectomy with similar operative times and low conversion rates. Data from both the groups were collected and analyzed. The average age of the patients was 44.52 years in group A and 44.52 years in group B with male to female ratio of approximately 1:2 in both groups. The visual analog scale (VAS) for pain showed an average of 2.3 in group A and 4.3 in group B with post-operative port site infections which were observed to be 1% in group A and 3% in group B. The incidence of port site hernia was found to be 1% in group A and 4% in group B. In 64% of patient of group A and 88% of patients in group B there was no scarring noted post operatively. Cosmetic outcomes were better in group B with 97% being satisfied as compared to only 90% of the patients in group A. Requirement of analgesia was found to be higher in group A than group B. There was a higher retrieval difficulty in the cases of umbilical port(group B). Conclusion Gallbladder removal via the epigastric port in laparoscopic cholecystectomy offers advantages over the umbilical port approach in terms of postoperative pain, surgical site infection, port site hernia, retrieval time, and patient satisfaction. Both techniques are safe and effective; however, the umbilical port placement may provide superior results in minimizing visible scars and cosmetic outcomes. Future studies with larger sample sizes and long-term follow-up are recommended to confirm these findings and further evaluate the benefits of port placement techniques. [ABSTRACT FROM AUTHOR]

Background: The transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. This study investigated whether the subcostal transversus abdominis block was superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Aim and Objectives: To investigated whether the subcostal transversus abdominis block is superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Materials and Methods: All patients were randomly assigned to two equal groups (n=30) using computer-generated randomization. Patients in Group 1 (TAP group) received a TAP block by administration of 10 mL of 0.5% bupivacaine on each side just before completion of surgery, and patients in Group 2 (local wound infiltration [LWI] group) received 10 mL of 0.5% bupivacaine as a local infiltrate at the local site just before completion of surgery. The pain was measured using a Visual Analog Scale (VAS) at intervals of 30 min to 24 h after the procedure. Results: The mean VAS score was significantly lower in group 1 as compared to group 2 at 2 h and 4 h. Whereas the VAS score was not significantly different post-operative 30 min, 6 h, 12 h, and 24 h. The mean first rescue analgesia was significantly more in Group 1 than in Group 2 (P<0.001). Conclusion: The TAP block patients had significant VAS scores at 2 and 4 h postoperatively compared to the LWI patients. The TAP group had a significantly longer median time to first emergency analgesia compared to the LWI group, with a higher proportion of patients requiring only one dose of emergency analgesia. [ABSTRACT FROM AUTHOR]

Introduction: Surgery and anaesthesia are uncomfortable experiences for patients, often causing stress and anxiety that can impede the intended therapeutic outcomes. Increased stress and anxiety may have a deleterious impact on post-operative analgesic use and pain perception. Advancements in anaesthesia extend anesthesiologists’ role beyond the surgery, allowing for an anaesthesia in diverse procedures, and raising patient expectations for comfortable treatment. (1) At least two days before the operation, anxiety affects a majority of patients scheduled for surgery. Materials And Methods: After obtaining institutional ethics committee approval (SGRD/IEC/2022-163 dated 13.12.2022) and the patient’s informed consent, this prospective semi-experimental randomised single-blind controlled study was conducted to investigate the effect of music (the independent variable) on cortisol levels, VAS-A scores and VAS pain scores (the dependent variables). The study was conducted in 100 patients of either sex in the age group between 18 to 60, with ASA classification I and II, undergoing Laparoscopic Cholecystectomy from January 2023 to December 2023.Results: The demographic characteristics of the study participants were analysed and there were no statistically significant differences in the mean values of all the characteristics. (Table 1) As shown in Table 2 on comparing mean VAS-A scores among the three groups, the difference at the baseline was statistically not significant (p-value 0.77) but when the three groups were compared after the respective interventions, the scores before surgery were significantly lower in group A than in groups B and C (p-value 0.037) additionally, scores of group B were significantly lower than group C. Similar findings were seen when the three groups were compared after surgery (p-value 0.02).Conclusion: Music therapy especially listening to music of choice is a safe and effective non-invasive non-pharmacological intervention with several benefits for surgical patients. It reduces the need for pain medication during the postoperative period without causing any side effects. It also hinders the increase of blood cortisol levels. Additionally, music therapy helps lower anxiety enhancing the overall surgical experience for patients. [ABSTRACT FROM AUTHOR]