Citation Information :
Sharma B, Agarwal N. Intraoperative Findings and Technique Modification in Acute Cholecystitis in Early and Delayed Groups of Laparoscopic Cholecystectomies: A Randomized Control Prospective Study. J Mahatma Gandhi Univ Med Sci Tech 2017; 2 (3):114-117.
Cholecystectomy is the most common surgery performed. The invention of laparoscopic cholecystectomy has made it extremely convenient and safe, but still the question of when to perform the surgery persists. This study attempts to compare the intraoperative findings of acute cholecystitis patients of the early and delayed group and its impact in surgery.
Materials and methods
Institutional-based prospective randomized control study was done on two groups of patients who were diagnosed and admitted to the General Surgery outpatient department (OPD) of Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India from November 2015 to November 2017. The early group was operated within 7 days of the appearance of symptoms and the delayed group was operated after 6 weeks. Intraoperative findings and modification of technique were duly noted in both and analysis done by applying the chi-square test.
Acute complications are found to be more in an early group like turbid bile or pus with distended gallbladder in the early group, but adhesions are much more in the delayed group. Technique modification is more required in early as compared with the delayed group.
An early cholecystectomy is a convenient option for a patient with a nonsignificant technique modification to manage the intraoperative complications.
How to cite this article
Agarwal N, Sharma BK. Intraoperative Findings and Technique Modification in Acute Cholecystitis in Early and Delayed Groups of Laparoscopic Cholecystectomies: A Randomized Control Prospective Study. J Mahatma Gandhi Univ Med Sci Tech 2017;2(3):114-117.
Janzon L, Aspelin P, Eriksson S, Hildell J, Trell E, Ostberg H. Ultrasonographic screening for gallstone disease in middle-aged women. Detection rate, symptoms, and biochemical features. Scand J Gastroenterol 1985 Aug;20(6):706-710.
Jorgensen T, Teglbjerg JS, Wille-Jorgensen P, Bille T, Thorvaldsen P. Persisting pain after cholecystectomy. A prospective investigation. Scand J Gastroenterol 1991 Jan;26(1):124-128.
NIH Consensus Statement. Gallstones and laparoscopic cholecystectomy. Bethesda (MD): NIH; 1992. [cited 2006 Aug 10]. Available from: http://consensus.nih.gov/1992/1992GallstonesLaparoscopy090html.htm.
Muhrbeck O, Sahlin S, Ahlberg J. Rise and fall in the number of cholecystectomies: Stockholm 1932-1993. Eur J Surg 1996 Apr;162(3):199-204.
Halldestam I, Enell EL, Kullman E, Borch K. Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg 2004 Jun;91(6):734-738.
Sharma, AK. Gallstone disease more prevalent North India. 2017. [cited 2017 Nov 25]. Available from: https://www.linkedin.com/pulse/gallstone-disease-more-prevalent-north-india-sharma-avsm.
Bakken IJ, Skjeldestad FE, Mjåland O, Johnson E. Cholecystectomy in Norway 1990-2002. Tidsskr Nor Laegeforen 2004 Sep;124(18):2376-2378.
Cheema S, Brannigan AE, Johnson S, Delaney PV, Grace PA. Timing of laparoscopic cholecystectomy in acute cholecystitis. Ir J Med Sci 2003 Jul;172(3):128-131.
Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 2004 Sep;188(3):205-211.
Peng WK, Sheikh Z, Nixon SJ, Paterson-Brown S. Role of laparoscopic cholecystectomy in the early management of acute gallbladder disease. Br J Surg 2005 May;92(5):586-591.
Williams, NS.; Bulstrode, CJ.; O'Connell, PR.; editors. Bailey & Love's short practice of surgery. 26th ed.Boca Raton (FL): CRC Press; 2013.
Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1998 Apr;227(4):461-467.
Riaz M, Bhasin SK, Hussain T, Parvez M. Early vs late laparoscopic cholecystectomy and effect of time on clinical severity, pathology, and surgical outcome in patients of acute cholecystitis a prospective study. J Evol Med Dent Sci 2015 Nov;4(92):15786-15790.
Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Seenu V. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 2004 Sep;18(9):1323-1327.
Ganio E Altomare DF Gabrielli F Milito G Canuti S Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy. Br J Surg 2001 May;885669674
Shalaby R Desoky A Randomised clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg 2001 Aug;88810491053
Yang L, Jiang L, Bi M, Jia X, Wang Y, He C, Yao Y, Wang J, Wang Z. High dose of maternal folic acid supplementation is associated to infant asthma. Food Chem Toxicol 2015 Jan;75:88-93.
Fodinger M, Horl WH, Sunder-Plassmann G. Molecular biology of 5,10-methylenetetrahydrofolate reductase. J Nephrol 2000 Jan-Feb;13(1):20-33.
Varga EA, Sturm AC, Misita CP, Moll S. Cardiology patient pages. Homocysteine and MTHFR mutations: relation to thrombosis and coronary artery disease. Circulation 2005 May;111(19):e289-e293.
Houghton LA, Sherwood KL, Pawlosky R, Ito S, O'Connor DL. [6S]-5-Methyltetrahydrofolate is at least as effective as folic acid in preventing a decline in blood folate concentrations during lactation. Am J Clin Nutr 2006 Apr;83(4):842-850.
Lamers Y, Prinz-Langenohl R, Moser R, Pietrzik K. Supplementation with [6S]-5-methyltetrahydrofolate or folic acid equally reduces plasma total homocysteine concentrations in healthy women. Am J Clin Nutr 2004 Mar;79(3):473-478.
Obeid R, Holzgreve W, Pietrzik K. Is 5-methyltetrahydrofolate an alternative to folic acid for the prevention of neural tube defects? J Perinat Med 2013 Sep;41(5):469-483.
NFHS-3. National Nutrition Monitoring Bureau Survey (NNMBS), 2006.
Ezzati M, Lopez AD, Rodgers A, Murray CJL. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization; 2004.
Lone FW, Qureshi RN, Emanuel F. Maternal anaemia and its impact on perinatal outcome. Trop Med Int Health 2004 Apr;9(4):486-490.
Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, Ota E, Gilmour S, Shibuya K. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr 2016 Feb;103(2):495-504.
National Iron + Initiative. Guidelines for Control of Iron Deficiency Anemia. Adolescent Division Ministry of Health and Family Welfare Government of India; 2013.
Berger J, Thanh HT, Cavalli-Sforza T, Smitasiri S, Khan NC, Milani S, Hoa PT, Quang ND, Viteri F. Community mobilization and social marketing to promote weekly iron-folic acid supplementation in women of reproductive age in Vietnam: impact on anemia and iron status. Nutr Rev 2005 Dec;63(12 Pt 2):S95-S108.
Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, Joshi SR, Sadikot S, Gupta R, Gulati S, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009 Feb;57:163-170.
Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001 Aug;25(8):1175-1182.
Kumari P, Gupta M, Kahlon P, Malviya S. Association between high maternal body mass index (BMI) and feto-maternal outcome. J Obes Metab Res 2014;3:143-144.
Forsum E, Brantsaeter AL, Olafsdottir AS, Olsen SF, Thorsdottir I. Weight loss before conception: a systematic literature review. Food Nutr Res 2013;57.
Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 2006 Sep;368(9542):1164-1170.
Glazer NL, Hendrickson AF, Schellenbaum GD, Mueller BA. Weight change and the risk of gestational diabetes in obese women. Epidemiology 2004 Nov;15(6):733-737.
Kjaer MM, Nilas L. Pregnancy after bariatric surgery—a review of benefits and risks. Acta Obstet Gynecol Scand 2013 Mar;92(3):264-271.
Dornhorst A, Paterson CM, Nicholls JS, Wadsworth J, Chiu DC, Elkeles RS, Johnston DG, Beard RW. High prevalence of gestational diabetes in women from ethnic minority groups. Diabet Med 1992 Nov;9(9):820-825.
Seshiah V, Balaji V, Balaji MS, Sanjeevi CB, Green A. Gestational diabetes mellitus in India. J Assoc Physicians India 2004 Sep;52:707-711.
Wahabi HA, Esmaeil SA, Fayed A, Al-Shaikh G, Alzeidan RA. Pre-existing diabetes mellitus and adverse pregnancy outcomes. BMC Research Notes 2012;5:496.
Murphy HR, Roland JM, Skinner TC, Simmons D, Gurnell E, Morrish NJ, Soo SC, Kelly S, Lim B, Randall J, et al. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Diabetes Care 2010 Dec;33(12):2514-2520.
Unnikrishnan AG, Kalra S, Sahay RK, Bantwal G, John M, Tewari N. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J Endocrinol Metab 2013 Jul-Aug;17(4):647-652.
El Baba KA, Azar ST. Thyroid dysfunction in pregnancy. Int J Gen Med. 2012;5:227-230.
Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999 Aug;341(8):549-555.
Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet 2010 Feb;281(2):215-220.
Kriplani A, Buckshee K, Bhargava VL, Takkar D, Ammini AC. Maternal and perinatal outcome in thyrotoxicosis complicating pregnancy. Eur J Obstet Gynecol Reprod Biol 1994 May;54(3):159-163.
Luewan S, Chakkabut P, Tongsong T. Outcomes of pregnancy complicated with hyperthyroidism: a cohort study. Arch Gynecol Obstet 2011 Feb;283(2):243-247.
Spencer L, Bubner T, Bain E, Middleton P. Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. Cochrane Database Syst Rev 2015 Sep;9:CD011263.
Li M, Yao Q, Xing A. A clinical analysis of 188 cases of pregnancy complicated with critical heart disease. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2014 Nov;39(11):1145-1150.
Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, Talwar KK. Cardiac disease in pregnancy. Int J Gynaecol Obstet 2003 Aug;82(2):153-159.
Gelson E, Curry R, Gatzoulis MA, Swan L, Lupton M, Steer P, Johnson M. Effect of maternal heart disease on fetal growth. Obstet Gynecol 2011 Apr;117(4):886-891.
Arora N, Kausar H, Jana N, Mandal S, Mukherjee D, Mukherjee R. Congenital heart disease in pregnancy in a low-income country. Int J Gynaecol Obstet 2015 Jan;128(1):30-32.
Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000 Jul;183(1):S1-S22.
Agency for Healthcare Research and Quality. Management of chronic hypertension during pregnancy. Evidence Report/Technology Assessment no.14. AHRQ publication no. 00-E011. Rockville, MD: Agency for Healthcare Research and Quality; 2000.
Ferrer RL, Sibai BM, Mulrow CD, Chiquette E, Stevens KR, Cornell J. Management of mild chronic hypertension during pregnancy: a review. Obstet Gynecol 2000 Nov;96(5 Pt 2):849-860.
Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India. Epilepsia 1999 May;40(5):631-636.
Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, McCorry D, Bagary M, Mignini L, Khan KS, Zamora J, Thangaratinam S, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet 2015 Nov;386(10006):1845-1852.
Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 2010 Nov;5(11):2060-2068.
Hazes JM, Coulie PG, Geenen V, Vermeire S, Carbonnel F, Louis E, Masson P, De Keyser F. Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use. Rheumatology (Oxford) 2011 Nov;50(11):1955-1968.
Velu PP, Gravett CA, Roberts TK, Wagner TA, Zhang JS, Rubens CE, Gravett MG, Campbell H, Rudan I. Epidemiology and aetiology of maternal bacterial and viral infections in low- and middle-income countries. J Glob Health 2011 Dec;1(2):171-188.
UNAIDS: UNAIDS report on the global AIDS epidemic. 2010. Available from http://www.unaids.org/globalreport/Global_report.htm
Ioannidis JP, Abrams EJ, Ammann A, Bulterys M, Goedert JJ, Gray L, Korber BT, Mayaux MJ, Mofenson LM, Newell ML, et al. Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/ml. J Infect Dis 2001 Feb;183(4):539-545.
Anglemyer A, Rutherford GW, Horvath T, Baggaley RC, Egger M, Siegfried N. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev 2013 Apr;4:CD009153.
Rimoin DL, Connor JM, Pyeritz RE, Korf BR. Emery and Rimoin's principles and practice of medical genetics. Churchill Livingstone Elsevier; 2007.
Verma IC, Puri RD. Global burden of genetic disease and the role of genetic screening. Semin Fetal Neonatal Med 2015 Oct;20(5):354-363.
White SJ, Boldt KL, Holditch SJ, Poland GA, Jacobson RM. Measles, mumps, and rubella. Clin Obstet Gynecol 2012 Jun;55(2):550-559.
American College of Obstetricians and Gynecologists. ACOG educational bulletin: viral hepatitis in pregnancy. Int J Gynaecol Obstet 1998 Nov;63:195-202.
Geeta MG, Riyaz A. Prevention of mother to child transmission of hepatitis B infection. Indian Pediatr 2013;50:189-192.
Swamy GK, Beigi RH. Maternal benefits of immunization during pregnancy. Vaccine 2015 Nov;33(47):6436-6440.
Sukumaran L, McCarthy NL, Kharbanda EO, McNeil MM, Naleway AL, Klein NP, Jackson ML, Hambidge SJ, Lugg MM, Li R, et al. Association of Tdap vaccination with acute events and adverse birth outcomes among pregnant women with prior tetanus-containing immunizations. JAMA 2015 Oct;314(15):1581-1587.
Singru SA, Tilak VW, Gandham N, Bhawalkar JS, Jadhav SL, Pandve HT. Study of susceptibility towards Varicella by screening for the presence of IgG antibodies among nursing and medical students of a Tertiary Care Teaching Hospital in Pune, India. J Glob Infect Dis 2011 Jan-Mar;3(1):37-41.
Nathwani D, Maclean A, Conway S, Carrington D. Varicella infections in pregnancy and the newborn. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect 1998;36 (Suppl 1):59-71.
Michaan N, Amzallag S, Laskov I, Cohen Y, Fried M, Lessing JB, Many A. Maternal and neonatal outcome of pregnant women infected with H1N1 influenza virus (swine flu). J Matern Fetal Neonatal Med 2012 Feb;25(2):130-132.
Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006 Jul;55(RR-10):1-42.