Percutaneous Cholecystostomy in Acute Calculus Cholecystitis: Current Management | Chapter 8 | An Overview of Disease and Health Research Vol. 9

 

Percutaneous cholecystostomy is an interventional radiological procedure that entails the insertion of a catheter into the gallbladder lumen for bile drainage. This procedure can be executed via either a transhepatic or transperitoneal approach. It is indicated for patients with severe acute calculus cholecystitis, serving to stabilise them prior to a subsequent laparoscopic cholecystectomy. Percutaneous cholecystostomy is considered a safe procedure, with the most prevalent complications being bleeding, perforation, and bile leakage. This chapter examined the role of percutaneous cholecystostomy in the management of acute calculus cholecystitis. Percutaneous cholecystostomy was compared with laparoscopic cholecystectomy as a definitive treatment for acute calculus cholecystitis, and the duration and timing of percutaneous cholecystostomy removal were explored. The study concluded that percutaneous cholecystostomy is a valuable, minimally invasive interim procedure for patients with severe acute calculus cholecystitis who are deemed unsuitable for surgical intervention.

 

 

Author(s) Details

Kumar Hari Rajah
School of Medicine Clinical Campus, Taylor’s University, 4700 Sg Buloh, Selangor, Malaysia.

 

Please see the book here :- https://doi.org/10.9734/bpi/aodhr/v9/7032

 

Serum Mucin1 and Cholesterol Ester Transfer Protein (CETP) Levels in Bangladeshi Cholelithiasis Patients and the Impact of Laparoscopic Cholecystectomy | Chapter 3 | Medical Science: Recent Advances and Applications Vol. 7

Background: Cholelithiasis, i.e., gallstone disease (GSD), is one of the most common gastrointestinal disorders. apolipoprotein A1 (ApoA1), In other studies, ApoE, Mucin1 and cholesterol ester transfer protein (CETP) were implicated with cholelithiasis. However, these results were variable and needed confirmation by further research.

 

Objective: This study evaluates the associations of Mucin1 and cholesterol ester transfer protein (CETP) between normal control subjects (NCs) and Cholelithiasis, i.e. gallstone disease (GSD) patients (Pts) preoperatively (I0) and postoperatively (II0) with laparoscopic cholecystectomy.

 

Methods: Adult Pts (N=55, Gender: 10 males, 45 females; Age range: 25-65 years, Mean age±SD: 45.5 ± 12.2 years) were those reported in our previous case-control prospective interventional studies carried out from October 2016 to March 2018 at MRU, MHWT, Uttara, Dhaka, Bangladesh. The patients with GSD were diagnosed as having cholelithiasis according to standard clinical and laboratory criteria as practised in the hospital. The lipid profile (TG, TC, LDL-C, HDL-C), Lp (a), ApoA1, ApoB100, ApoE, Mucin1 and CETP status in serum of NCs and Pts (I0, II0) and Pts-Bile (I0) were made by standard clinical laboratory methods using research/diagnostics kits from reputed companies and reported in the recent past. Recently, further advanced statistical analyses on these data were made according to the objectives of the present article, i.e. to obtain information regarding associations (correlations) between serum Mucin1 and CETP status among NCs and Pts (I0, II0) by using the SPSS programme version 26.

 

Results: Regarding associations (correlations) between Mucin1 and CETP status among NCs (I0) and Pts (I0) and Pts (II0), significant Pearson correlations were found for Pts-Mucin1 (I0) vs Pts-CETP (I0) (r=0.316, p=0.019), Pts-Mucin1 (Bile-I0) vs Pts-CETP (Bile-I0) (r=0.441, p=0.005), Pts-Mucin1 (II0) vs Pts-CETP (I0) (r=0.398, p=0.007), Pts-Mucin1 (I0) vs Pts-CETP (II0) (r=0.335, p=0.017) and NCs-Mucin1 (I0) vs Pts-CETP (Bile-10) (r=0.375, p=0.048). No significant correlations were observed between any of the other groups compared (P>0.05).

 

Conclusions: The observations on associations between Mucin1 and CETP among NCs and Pts (I0, II0) suggested their probable involvement in the aetiopathogenesis of the disease. Since GSD is one of the most prevalent diseases in gastroenterology, an appropriate diagnostic approach and management in clinical practice, such as medical treatment and surgical intervention depending on the patient’s condition, should be adopted. Considering the complexity of the molecular mechanisms in the formation of gallstones, further studies on GSD are certainly warranted, particularly involving a larger number of Bangladeshi patients in the future.

 

Author(s) Details

A. S. M. Giasuddin
Impulse Hospital, ImHS&RC Ltd, 304/E, Tejgaon Industrial Area, Dhaka-1208, Bangladesh.

 

K. A. Jhuma
Dhaka Medical College, Dhaka-1000, Bangladesh.

 

M. A. M. Choudhury
Department of Surgery, MCW&H, MHWT, Plot-4, Road-8/9, Sector-1, Uttara Model Town, Dhaka-1230, Bangladesh.

 

A. M. M. Haq
Department of Internal Medicine, MCW&H and Chairman of MRU, MCN&H, MHWT, Uttara, Dhaka-1230, Bangladesh.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v7/5598

 

Managing Gall Bladder Perforation in the Setting of Percutaneous Nephrolithotomy – Challenges and Clinical Insights | Chapter 7 | Newer Frontiers in Urology

The preferred treatment for patients with big and complex renal calculi is percutaneous nephrolithotomy (PCNL). Rarely, this surgery can result in visceral damage. Injuries from needle punctures are more likely to occur in a gall bladder (GB) which borders the kidney on the right side. A worse outcome is predicted by GB damage that results in peritonitis. A GB perforation case was described that followed an otherwise unremarkable PCNL and received prompt intraoperative laparoscopic cholecystectomy treatment. The treating surgeon was alerted when the first puncture produced a straw-coloured, gelatinous aspirate. After PCNL, a diagnostic laparoscopy was performed. A bile leak and damage to the gall bladder were discovered. Cholecystectomy was performed electively. The postoperative period was uneventful other than a brief period of paralytic ileus. The patient recovered well and was discharged from the hospital on the third postoperative day. Since early identification can avoid mortality associated with peritonitis and sepsis due to GB perforation during PCNL, it is imperative to be aware of this potentially fatal consequence and to have a high index of suspicion for prompt timely treatment.

 

Author (s) Details

Nakul Aher
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Subash Kaushik TG
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

Please see the book here:- https://doi.org/10.9734/bpi/mono/978-93-49238-86-2/CH7

Comparison of Postoperative Analgesic Effects of Bilateral Erector Spinae Plane Block Guided by Ultrasonography with Traditional Intravenous Opioids in Elective Laparoscopic Cholecystectomy: A Randomized Controlled Study | Chapter 11 | Achievements and Challenges of Medicine and Medical Science Vol. 10

 Background: Spinal anesthesia is associated with intraoperative hypotension so it is unsuitable for hemodynamically unstable patients. Intraoperative gas insufflation, artificial pneumoperitoneum compression and diaphragmatic displacement increase intrathoracic pressure and reduce preload. Postoperative analgesia in laparoscopic cholecystectomy has seen a recent uptick in popularity after the introduction of the Erector Spinae Plane Block. One main way that local anesthetics work is by physically spreading and diffusing to neuronal structures in the fascial plane, which in turn affects the erector spinae muscles and other tissue compartments. By using ultrasound, regional blocks may be performed more quickly, with fewer needle pricks, and with a shorter onset time.

Aims: The purpose of this study is to evaluate the efficacy of standard intravenous opioids vs an ultrasound-guided bilateral erector spinae plane block in elective laparoscopic cholecystectomies for postoperative pain management.

Materials and Methods: This is a Randomized controlled trial done in the Department of Anesthesiology, conducted at NKPSIMS and RC and LMC, Nagpur, a tertiary care center, patients undergoing elective laparoscopic cholecystectomies under general anesthesia from November 2022 to May 2024. A total consecutive sample of 56 participants fulfilling eligibility criteria was selected by convenience sampling method. Using Pearson's chi-square test, the percentages of two sets of qualitative criteria were compared. All comparisons were deemed statistically significant when the P value was less than 0.05.

Results: Most of the patients come under 51-60 years of age. Group B: Ages 22-66 years, mean 44.96 years, SD 13.52 years. Group O: Ages 20-66 years, mean 42.54 years, SD 12.32 years. Group B: 42.86% males, 57.14% females. Group O: 39.29% males, 60.71% females. Patients are not statistically significant with respect to height, weight and BMI. ASA Classification, Group B: 57.14% Grade I, 42.86% Grade II Group O: 53.57% Grade I, 46.43% Grade II. Duration of Pneumoperitoneum Group B: Range 1.25-3 hours, mean 2.05 hours, SD 0.43 hours Group O: Range 1.5-3 hours, mean 2.25 hours, SD 0.45 hours. Duration of Anesthesia Group B: Range 2-3.5 hours, mean 2.59 hours, SD 0.4 hours. Group O: Range 2-3.5 hours, mean 2.77 hours, SD 0.44 hours. There is no statistical significance respected to intraoperative hemodynamic events. Significant differences in intraoperative hemodynamic events, additional treatment requirements, rescue analgesia, and side effects underscore the importance of advanced analgesic techniques in improving patient outcomes. These comparative insights provide valuable context for our results and suggest avenues for future research and clinical practice improvements.

Conclusion: Group B significantly outperformed Group O in terms of intraoperative hemodynamic stability, and they needed less supplemental therapy and rescue analgesia overall. “There was a marked decrease in postoperative nausea and vomiting in Group B. The results of this study highlight the need to include ESP Blocks in the pain management plans of patients undergoing laparoscopic cholecystectomy procedures. When it comes to elective laparoscopic cholecystectomy, the ultrasound-guided bilateral erector spinae plane block seems to be a great way to improve perioperative outcomes, provide better hemodynamic stability, lessen the need for postoperative pain medication, and decrease the occurrence of postoperative complications. The technique could potentially enhance patient comfort and satisfaction, leading to better overall surgical outcomes.

 

Author (s) Details

 

Ketaki Marodkar
Department of Anesthesiology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra- 440019, India.

 

Ankita Agrawal
Department of Anesthesiology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra- 440019, India.

 

Rutuja Chati
Department of Anesthesiology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra- 440019, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v10/3631