Print ISSN: 1683-3589

Online ISSN: 2409-501X

Keywords : Cholecystectomy


8- LAPAROSCOPIC CHOLECYSTECTOMY IN SICKLE CELL DISEASE: IS IT A SAFE PROCEDURE?

Hashim S Alkhayat; Jassim H Salim; Mohammad M Mohammad; Salim M Albassam

Basrah Journal of Surgery, 2011, Volume 17, Issue 1, Pages 0-0
DOI: 10.33762/bsurg.2011.55121

Salim M Albassam*, Mohammad M Mohammad@, Jassim H Salim@&
Hashim S Alkhayat@
*Department of surgery, Basrah Medical College, Iraq. @Department of surgery, Basrah General
Hospital, Iraq.
Correspondence to: Dr. Salim M Albassam, e-mail: albassamsalim@yahoo.ca
Abbreviation: Hb= Hemoglobin. ACS = Acute Chest Syndrome. ASA = American Society of Anesthesiologists
Abstract
The aim of this trial is to determine the safety of laparoscopic cholecystectomy for treatment of
gall bladder stones in patients with sickle cell anemia (a controversial issue). Sixty patients from
both sexes, between 19-35 years old with sickle cell anemia, all of them having gall bladder
stones were included in this study in Endosurgery Center in Basrah General Hospital. The
patients were divided into three groups, group one (19 patients) were selected for laparoscopic
cholecystectomy on random preoperative background, the same thing was applied in group two
(21 patients) whose patients were subjected to open cholecystectomy while patients in group
three (20 patients) were selected for laparoscopic cholecystectomy on conditioned selection.
Three mortalities and two serious morbidities were encountered in the group one and one mild
morbidity seen in group two and no mortalities or morbidities in group three. Laparoscopic
cholecystectomy in sickle cell patients is a debatable issue, an increasing controversy about
serious perioperative and postoperative morbidity were mentioned. The procedure itself was
accused and an entirely opposed results were emerged from different studies all are debatable.
In this study we noticed the big influence of the risk factors, preparation of patients for surgery
and the adherence to the principle anesthetic rules on the outcome after laparoscopic
cholecystectomy in patients with sickle cell disease. This influence was limited in open
procedure. The controversy in the different trials lies on wither the problem is confined to the
disease itself or to the surgical method used for cholecystectomy or both.
According to the results obtained from our study we believe that both the severity of the disease
and the surgical procedure affecting the results, application of intra and post operative protocol
(blood transfusion if Hb less than 9gm/dI, rehydration, oxygenation and respecting general
anesthesia rules are mandatory for the safety of the patients.

10- SPILLED GALL STONES DURING LAPAROSCOPIC CHOLECYSTECTOMY : A PROSPECTIVE STUDY

Mushtaq Ch. Abu-Alhail; Mazin A Abdulla; Jasim D Saud

Basrah Journal of Surgery, 2011, Volume 17, Issue 1, Pages 0-0
DOI: 10.33762/bsurg.2011.55131

Jasim D Saud#, Mazin A Abdulla@ & Mushtaq Ch. Abu-Alhail*
*#MBChB, CABS, Specialist Surgeon, Basrah General Hospital, Basrah, Iraq. @MBChB, CABS,
Consultant Surgeon, Department of Surgery, College of Medicine, University of Basrah, Basrah, Iraq.
ABSTRACT
This study assesses the impact of spilled gall stones during laparoscopic cholecystectomy (LC)
and it's clinically significant complications resulting from stones left in the peritoneum.
This is a prospective analysis of laparoscopic cholecystectomies performed at The Surgical
Unit in Basrah General Hospital from 1st January 2006 to 31st December 2010. There were 678
patients in the study who underwent LC. The inclusion criteria for LC were: patients of all ages
and both genders, symptomatic gallstone disease, recurrent attack while waiting for interval LC,
normal values of blood complete picture & liver function tests and ultrasound examination of
abdomen demonstrating gallstone disease.
There were 73 cases of gallbladder perforation, i.e. a frequency of 10.7%. In 34 of these
patients gallstones spillage also occurred in a frequency of 5%. An effort was made in each
case to remove the spilled stones laparoscopically but in 25 patients unretrieved stones were
left (frequency of 3.6%). Eight patients (1.17%) developed complications, one patient developed
ileus which was thought to be the result of irritation from a gallstone that had been shown on US
examination. The free fluid in the Douglas pouch resolved with medical management. Two
patients developed sub-hepatic abscess, presenting with right hypochondrial & shoulder tip pain
and fever post operatively; which confirmed by abdominal sonograph, one patient responded
well to medical treatment while the other one required ultrasound guided drainage and broadspectrum
antibiotics. Three patients developed epigastric port site infection; two were treated
successfully by daily wound care and appropriate antibiotics after culture and sensitivity. One
developed persistent epigastric sinus, and a gallstone was retrieved on exploration. Two
patients developed sub-hepatic and right sub-phrenic abscess respectively in the seventh post
operative day and required open drainage. There was no mortality and long-term morbidity.
In conclusion, complications arising from spillage of gall stones during laparoscopic
cholecystectomy are rare. They can present months after the cholecystectomy with septic
complications. The patients should be informed preoperatively that spillage of bile and
gallstones are possible. The surgeon should take utmost care to prevent spillage of stones and
attempt to remove all visible stones at the time of surgery. If spillage occurred it should be
recorded clearly in the operative notes and such patients should be kept under close follow up
to aid in the early diagnosis of later complications. There is no indication for routine conversion
to open surgery.

11- LAPAROSCOPIC CHOLECYSTECTOMY, TRUE OUTPATIENT PROCEDURE (Is it possible to shorten the hospital stay?)

Hamid Boserwel; Salim M ALBassam; Abdulhadi Mossa Mohamad

Basrah Journal of Surgery, 2009, Volume 15, Issue 1, Pages 67-71
DOI: 10.33762/bsurg.2009.55389

Laparoscopic cholecystectomy is currently considered the gold standard for the managment of
gallbladder stones. Many hospitals have employed short stay wards for monitoring patients after
surgery. The meaning of the early discharge as true outpatient surgery is controversial. To
achieve this objective there is a need to shorten the hours of hospital stay by: Appropriate
selection criteria and discharge protocol, Peroperative technical modification and manipulation,
Procedures to control pain, nausea and vomiting. This study was carried at Endosurgery
Centre, Ibensena University Hospital, Sirte, libya.

4- CAUSES AND INCIDENCE OF LAPAROSCOPIC CHOLECYSTECTOMY CONVERSION

Adnan Y Abdulwahab; Safwan A Taha; Salam T Mutlak

Basrah Journal of Surgery, 2009, Volume 15, Issue 1, Pages 20-24
DOI: 10.33762/bsurg.2009.55258

Four hundred cases of laparoscopic cholecystectomy candidates were
prospectively followed at the time of surgery by obtaining a data sheet for the
patient’s age, sex, time from the introduction of ports till decision of conversion
and the cause of conversion if present in two years (2006 & 2007) period.
From 400 laparoscopic cholecystectomy, 20 conversions were obtained and the
causes were; wide cystic duct, empyema of the gall bladder, severe obesity, liver
tumor, abnormal position of gall bladder, vascular variation and dense adhesions
with disturbed anatomy. The percentage of conversion was 5%. Eight conversion
cases were males from the total 45 male patients underwent laparoscopic
cholecystectomy. Twelve cases were females out of 355 female patients
underwent laparoscopic cholecystectomy. The percentage of conversion for male
patients was 17.7% while in female patients was 3.3%. Our results showed that
the conversion rate in this study was 5% and the most common cause for
conversion is dense adhesions. No biliary duct injury or severe bleeding that
need conversion is found in this study and the rate for conversion is higher in
male patients.