Acute Calculous Cholecystitis, Gallbladder Empyema, Gallbladder Mucocele
Conditions
Keywords
Acute Calculous Cholecystitis, Gallbladder Empyema, Gallbladder Mucocele, Distended gallbladder, Intra-operative aspiration
Brief summary
Laparoscopic cholecystectomy (LC) is a standard procedure for gallstones and the standard surgical approach for acute calcular cholecystitis, superseding open cholecystectomy for gallbladder (GB) pathologies. Despite this progress, mortality rates in high-risk cohorts remain substantial, ranging between 3.7% and 41.0%. Moreover, the recommended modality for mucocele which is defined as distension and marked dilatation of the GB associated with dysfunction is LC. The routine aspiration showed significant less percentage of GB perforation during surgery with similarity for other factors . However, routine aspiration of the GB during uncomplicated LC is considered an unnecessary intervention and therefore not recommended as a routine practice. Accidental GB perforation occurs in about 20% of laparoscopic cholecystectomies, and bile contamination in the abdominal cavity can cause SSI and lead to the formation of a residual abscess or wound infection. Grasping a thick and distended GB is one of the most common technical difficulties of laparoscopic cholecystectomy in acute cholecystitis. If the GB is distended it should be decompressed it to avoid conversion to open due to bile duct injury or perforation with spillage of bile and gallstones previously, authors had advocated conversion if iatrogenic perforation occurred.
Detailed description
This study was conducted on patients with symptomatic calcular cholecystitis presented to Aswan university hospital. The following parameters were measured intraoperative difficulty. * Operative time * Incidence of biliary tree injury * Higher surgeon consultation * Conversion into open surgery All groups were followed up for 30 days period for post-operative complication clinically and by sonar. * Wound infection * Liver bed bleeding * Collection in the liver bed * Peritonitis * Hospital stays.
Interventions
PROCEDURELaparoscopic needle
During classic LC, either with preoperative or accidently intra-operative overdistended GB using a laparoscopic needle to decompress the GB and make the operation much easier
Sponsors
Aswan University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Participants agreed to participate in the study and undergo the LC
Intervention model description
comparing the efficacy of intra-operative Gallbladder content aspiration in overdistended cases with completion of the operation without aspiration
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patient with calcular cholecystitis, GB mucocele or GB empyema * Distended gallbladder: shiny, over distended, long, difficult to grasp and manipulate gallbladder. * Acute or chronic calcular cholecystitis
Exclusion criteria
* Obstructive jaundice * Non distended gallbladder * Previous upper abdomen operations * Pregnant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difficulty of the operation | 30 days | the difficulty will be assessed by the following Operative time, Incidence of biliary tree injury, Higher surgeon consultation and Conversion to open chole |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Liver bed bleeding | 30 days | checking post procedures and postoperative through the drain |
| 30-day mortality | 30 days | follow-up the patient in the outpatient and by phone |
| Hospital stays. | 30 days | total stay in the hospital |
| Peritonitis | 30 days | incidence of peritonitis in the first week of the operation |
Countries
Egypt
Contacts
PRINCIPAL_INVESTIGATORAli H Abdelaal
Faculty of Medicine, Aswan University
Outcome results
None listed