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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]

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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]

Background: Even with all the advantages that come with having a laparoscopic cholecystectomy, like quicker recovery times and shorter hospital stays, there is still a significant rate of postoperative nausea, vomiting, and pain, which lowers patient satisfaction. The purpose of this research was to evaluate the effectiveness of ondansetron versus intravenous or intraperitoneal dexamethasone in preventing pain, nausea, and vomiting following laparoscopic cholecystectomy. Methods: This comparative prospective randomized double-blinded clinical trial was conducted at the Anesthesia, Intensive Care, and Pain Management Department of Zagazig University Hospitals. The study included 120 Patients undergoing laparoscopic cholecystectomy randomly allocated into four groups: Group A (control group, n=30) received no ondansetron or dexamethasone; Group B (intravenous Ondansetron group, n=30); Group C (intraperitoneal dexamethasone, n=30); and Group D (intravenous dexamethasone, n=30). Results: Both ondansetron and dexamethasone, either intraperitoneal or intravenous effectively showed comparable effect to reduce postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. But regarding postoperative pain, both intraperitoneal and intravenous dexamethasone, offers superior postoperative pain management compared to ondansetron and saline controls. Conclusions: Intraperitoneal dexamethasone may be a promising alternative for preventing postoperative complications and improving patient outcomes following laparoscopic cholecystectomy. [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 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 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]

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: 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]

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]

Background: Previous upper abdominal surgery was considered a contraindication to laparoscopic cholecystectomy; Patients who have had surgery in the upper abdomen were advised against having laparoscopy due to the creation of adhesions and the challenge of seeing the gallbladder. This raises the risk of harm to the bowel or blood vessels caused by the first trocar. This study aims to evaluate the possibility and results of laparoscopic cholecystectomy in patients who had previously had surgery in the upper abdomen. Subjects and Methods: This prospective study was conducted at the General Surgery Department of Zagazig University Hospital. Thirty patients with gallstone disease (13 males and 17 females), aged 30-62 years with a mean age of 47.03±7.61 years, all of whom had a previous upper abdominal incision and were subjected to laparoscopic cholecystectomy. Results: In our study, laparoscopic cholecystectomy was feasible and completed safely in 27 patients, while in 3 patients, it was converted to open cholecystectomy due to intra-abdominal adhesions; we failed to create pneumoperitoneum in one of the converted cases; in another patient, there were dense adhesions in the periportal area, and the last patient to be converted was due to small intestine injury, which was managed by direct repair of the injury. Conclusion: Patients with previous upper abdominal surgeries reported difficulties during their procedure of laparoscopic cholecystectomy, but only those who had prior major abdominal surgery and incisions near the cholecystectomy laparoscopic area reported longer operating times, higher rates of conversion, high-grade adhesions, and longer hospital stays. [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]

Objectives: To provide a comprehensive review of post-cholecystectomy complications, including their classification, diagnostic approaches, and clinical management, with a focus on imaging modalities and their role in improving patient outcomes. Design: This review integrates current evidence from relevant studies and clinical guidelines to categorize and describe early and late complications after cholecystectomy. Imaging findings, management strategies, and multidisciplinary considerations are emphasized. Setting: Data were synthesized from peer-reviewed literature and case studies involving postcholecystectomy patients in diverse clinical settings. Participants: Patients undergoing laparoscopic or open cholecystectomy and subsequently presenting with complications such as bile duct injuries, bile leaks, vascular injuries, or stone-related conditions. Methods: A systematic approach was employed to identify common and rare complications. Each complication was categorized by anatomical location, timing of presentation, and severity. The diagnostic utility of imaging modalities, including ultrasound, computed tomography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography was critically evaluated. Results: Post-cholecystectomy complications significantly impact morbidity. Early complications include bile duct injuries, bile leaks, vascular injuries, and infectious processes. Late complications, such as bile duct strictures, retained stones, and Mirizzi syndrome are associated with higher diagnostic complexity. Imaging modalities play a crucial role in early detection and management, with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography offering superior diagnostic and therapeutic potential. Conclusion: Post-cholecystectomy complications require timely recognition and multidisciplinary management. Imaging studies are indispensable for accurate diagnosis and treatment planning. This review highlights key complications and their imaging characteristics, aiding clinicians in optimizing patient outcomes. [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: 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]

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 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]

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]

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]

Chronic cholecystitis is a common disease that causes inflammation in the gallbladder and is usually associated with gallstones. Laparoscopic cholecystectomy has been widely used as a minimally invasive surgical technique to treat this condition. However, the clinical effect of laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones needs further investigation. This study aimed to investigate the clinical effect of laparoscopic cholecystectomy in treating chronic cholecystitis with gallstones. 90 patients with chronic cholecystitis and gallstones were randomly divided into control and research groups. The control group underwent traditional open cholecystectomy, while the research group received laparoscopic cholecystectomy. Perioperative indexes, oxidative stress indexes, serum inflammatory factors, liver function indexes and the incidence of complications were observed and compared. Results showed that laparoscopic cholecystectomy significantly reduced the operation time, blood loss, anal exhaust time, abdominal pain duration, and hospital stay compared to traditional open cholecystectomy (P < 0.05). Moreover, laparoscopic cholecystectomy significantly reduced the levels of oxidative stress indexes (GSH-Px), inflammatory factors (IL-6, TNF-α, and CRP), and liver function indexes (TBIL, AST, and ALT) compared to traditional open cholecystectomy. Moreover, the complication rate of the research group was significantly lower than that of the control group (P < 0.05). In conclusion, laparoscopic cholecystectomy for chronic cholecystitis with gallstones is a safe and effective procedure that reduces the perioperative stress response and promotes the rapid recovery of the postoperative body. The findings of this study provide a basis for the clinical promotion of laparoscopic cholecystectomy as the preferred surgical treatment for chronic cholecystitis with gallstones. [ABSTRACT FROM AUTHOR]

Background: The pain following a laparoscopic cholecystectomy is multifaceted; Therefore, it can be controlled by multimodal methods such as Transmuscular Quadratus Lumborum Block (TQLB) and analgesics. Objectives: Determine the effectiveness of TQLB using Bupivacaine or Bupivacaine-Dexamethasone in improving the quality of analgesia after laparoscopic cholecystectomy procedures. Methods: Under general anesthesia, ninety patients, ranging in age from eighteen to sixty, were scheduled for elective laparoscopic cholecystectomy surgery. Three groups of patients (30 patients in each) were randomly assigned who underwent bilateral ultrasound guided TQLB injected with 21 ml of the drug on each side. The Bupivacaine group (B) received (20 ml Bupivacaine hydrochloride 0.25% + 1 mL 0.9% normal saline); the Dexamethasone-Bupivacaine group (D) received (20 ml Bupivacaine hydrochloride 0.25% + 1 mL dexamethasone 4 mg); and the Control group (C) received (21 ml 0.9% normal saline). Results: The initial analgesic request was significant longer in group D (18 h) more than B (14 h), and C (0.8 h). The total analgesic requirements were increased in group C. The visual Analogue Score at rest and movement always revealed no significant distinctions between groups B and D. However, all values were raised in the control group more than in the other groups. The percentage of patients who were satisfied with the technique was greater in groups B and D than in group C. Conclusions: Ultrasound guided TQLB is a useful technique for raising patient satisfaction and analgesic quality. Furthermore, the addition of dexamethasone can prolong the duration of analgesia and decrease the postoperative Analgesia requirement. [ABSTRACT FROM AUTHOR]

Background: To explore the effect of right stellate ganglion block (RSGB) during laparoscopic cholecystectomy (LC) for control of intraoperative arrhythmia during CO2 pneumoperitoneum and postoperative pain relief Methods: Forty patients undergoing LC in our hospital were selected as the subjects and were randomly divided into group S (20 cases) and group C (20 cases), all patients received RSGB, 10 mL of lidocaine 2% under ultrasound guidance to compare the incidence of arrhythmia (1ry outcome), changes of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MBP) in different time points and postoperative visual analogue scale (VAS) was reported in the 1st, 6th, and 12th hours, respectively, with time to first analgesia request. Results: Intraoperative arrhythmias was significantly lower in group S rather than group C (P = 0.037); postoperative pain profile revealed that there was a significant difference between the 2 groups presented as longer duration for first time to request analgesia (P = 0.015) and lower VAS scores specially at the 1st and 6th postoperative hours in group S compared to group C (P < 0.001 and 0.004); changes in heart rate and blood pressure, there was a significant difference between the 2 groups in values of both parameters 5 minutes following CO2 insufflation, group S showed significantly lower HR, SBP, and MBP at this time point than group C. Conclusion: Patients received RSGB before laparoscopic cholecystectomy can experience lower incidence of arrhythmia, better intraoperative hemodynamics, and effective pain control postoperatively. [ABSTRACT FROM AUTHOR]

Intraperitoneal (IP) bupivacaine instillation for postoperative analgesia after laparoscopic cholecystectomy (LC) has been reported in many studies as either diluted or non-diluted, with conflicting results and no standard recommendations. Objective: Our study aims to compare the analgesic efficacy of intraperitoneal instillation of diluted versus non-diluted bupivacaine after laparoscopic cholecystectomy. Methods: In this prospective, single-blinded, controlled and randomized study, we included 50 patients undergoing LC. They were randomly divided into two groups, with 25 patients each. At the end of surgery, the first group received intraperitoneal 20 ml bupivacaine 0.5% (100 mg), added to 480 ml normal saline, diluted bupivacaine group (DBG) and the second group received intraperitoneal 20 ml bupivacaine 0.5% (100 mg); non-diluted bupivacaine group (NBG). Pain was assessed and recorded using the visual analog scale (VAS) for 24 h. Time to the first analgesic request, total analgesic consumption in 24 h, incidence of negative effects after LC, such as nausea, vomiting and shoulder pain, any side effects due to local anesthetic used as hypotension, bradycardia or respiratory depression and hemodynamic parameters were also recorded. Results: Postoperative VAS values were significantly lower in DBG than NBG in the 1st 24 h (P value ≤ 0.003). The duration of analgesia (the 1st time analgesic request) was significantly longer in DBG (20.16 ± 3.52 h) than that in NBG (6.19 ± 2.93 h) (P value = 0.0001). Also, the total amount of postoperative analgesic consumption (tramadol) was less in DBG (7.2 ± 19.9 mg) than NBG (63 ± 31.16 mg) (P value = 0.0001). In relation to negative effects after LC, side effects due to analgesic drugs and hemodynamic parameters, the results were comparable in both groups. Conclusion: Intraperitoneal instillation of diluted bupivacaine at the end of laparoscopic cholecystectomy decreases postoperative pain, delays request for rescue analgesia and reduces the amount of analgesics in the 1st 24 h postoperatively, more than non-diluted bupivacaine, with comparable results in incidence-negative effects after LC, side effects due to analgesic drugs and comparable hemodynamic parameters. [ABSTRACT FROM AUTHOR]

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Abstract 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.

Background: Honeycomb gallbladder (GB) is a rare condition characterized by multiple septations in the GB wall, giving it a honeycomb appearance. First described by Knetsch in 1952, this anomaly is typically congenital but can also be acquired. Patients with a honeycomb GB often present with a variety of symptoms, the most common being abdominal pain. Case Description: We present the case of a 62-year-old female with a history of symptomatic chronic calculus cholecystitis. She underwent a laparoscopic cholecystectomy, which resolved her symptoms. Preoperative ultrasound imaging showed no evidence of multiple septations; however, post-operative examination revealed a multiseptated gallbladder. Conclusions: Honeycomb GB is an unusual presentation. Among the theories explaining multiseptated GB, one suggests that chronic calculus cholecystitis leads to extensive denudation of the epithelial lining, causing fibrosis and calcification beneath, which results in contraction. Our case supports this theory, as these pathological changes likely contributed to the honeycomb appearance. While medical management typically focuses on symptomatic relief, cholecystectomy has been shown to completely resolve symptoms.

The aim of this study was to assess the impact of the external oblique intercostal block (EOIB) on early postoperative pain in patients who underwent laparoscopic cholecystectomy.

Background: Understanding the basics of embryologic development and the structure of the gallbladder can help identify and detect various abnormalities. This study aims to identify anatomical variations and congenital anomalies of the gallbladder in Sudanese patients observed during laparoscopic cholecystectomy. Methods and Results: A retrospective study included 345 patients diagnosed with cholelithiasis who underwent laparoscopic cholecystectomy. The study patients’ ages ranged from 14 to 71, with a mean age of 45.59±13.29 years. Of 345 cases of cholelithiasis, 83.2% were females, and 16.8% were males, with a female-to-male ratio of 4.95:1. Preoperative ultrasound examination revealed chronic cholecystitis in 99.7% of patients. Among the operated patients, the majority (99.13%) underwent laparoscopic cholecystectomy and 0.87% open cholecystectomy. A normal anatomy of the biliary system was found in 82.9% of all patients who underwent laparoscopic cholecystectomy. Among 59 patients with anomalies of the biliary system, gallbladder anomalies were detected in 19(32.2%) cases and included buried gallbladder (11.9%), floating gallbladder (1.7%), double gallbladder (3.4%), bilobed gallbladder (8.5%), and diverticulum of the gallbladder (6.8%). Conclusion: During laparoscopic cholecystectomy, surgeons must identify anomalies to prevent unintended intraoperative injury and bleeding, thereby improving postoperative outcomes.

Bile duct injury rates in laparoscopic cholecystectomy remain higher than during open cholecystectomy. Intraoperative injuries are mostly the result of a misinterpretation of anatomical structures due to severe inflammation or topographical variations. Standard laparoscopic cholecystectomy requires proper dissection of Calot’s triangle to achieve the critical view of safety (CVS). The CVS is the end product of dissection, and bile duct injuries occur before the conclusion of that process. The CVS cannot always be achieved in cases of severe cholecystitis because of technical difficulties. A complete strategy of safety should therefore include early recognition of difficulties and identification of cholecystectomies, when the CVS cannot be achieved, in order to utilize new intraoperative technologies to clarify the anatomy. Fixed anatomical landmarks can help in proper orientation to ascertain the surgical anatomy correctly during surgery. Encompassed within the review are insights into identifying critical landmarks for assessing the positioning of vital structures in compromised anatomical conditions.