European Journal of Cardiovascular Medicine

Background:   Bactibilia, or the presence of bacteria in bile from the gallbladder, may contribute to the development of septic complications. It has been related to increased rates of surgical site infection after cholecystectomy. Laparoscopic cholecystectomy is the definitive treatment for cholelithiasis and cholecystitis. Advanced age, acute cholecystitis, ERCP, and gallstones are important risk factors for the development of bactibilia. This study aims at showing the effect of bactibilia on the course of laparoscopic cholecystectomy. Materials and methods: This are a prospective case-control study to be conducted at Govt. General Hospital, Vijayawada at Dept. of General Surgery over 1 year on 50 patients. Patients with asymptomatic Cholelithiasis of age 18-60 are included in the study and patients with hemoglobin < 10 gm%, hypoalbuminemia < 2.5 gm/dL, patients in acute sepsis, patients with HbA1c >6.5%, hypertension (>139/89 mm of Hg) and BMI > 30 and patients in an emergency setting and patients who have not consented for the study were excluded from the study. None of the patients received pre-operative antibiotics. Intra-operatively, bile is collected from the gall bladder and sent for microbiological culture in aerobic and anaerobic media for 3-5 days. Patients are divided into: Group A - Microbiological culture positive for microbes and Group B - Microbiological culture sterile. Both groups will be analyzed for the duration of hospitalization after surgery, post-operative wound infection, and any other complications encountered. Results: Out of the 50 patients, 32 were males and 18 were females. The mean age of the patients was 43.5 ∓ 9.6 years. The mean BMI was 27.1 ∓ 4.7. Of the total 25 samples positive for bile culture, 11 were E.coli, 7 were Klebsiella, 3 were Enterobacter spp., 2 were Acinetobacter spp., and the remaining were 2 Viridans streptococci. All the bacteria were sensitive to Amikacin. All except Acinetobacter were sensitive to gentamycin and imipenem. All except one case of E.coli were susceptible to ciprofloxacin. The incidence of port site infection, prolonged fever, intra-abdominal abscess, pneumonia, wound healing duration, and hospital stay were significantly higher in group A compared to group b (p-value < 0.05). Conclusion: Bactibilia affects the outcomes of laparoscopic cholecystectomy in terms of prolonged hospital stay, increased incidence of wound infection, duration of wound healing, and fever.

Material & Methods: Study Design: Hospital based prospective observational study.Study area:Department of Obstetrics & Gynecology, Mayo institute of Medical Sciences,Barabanki, Uttar Pradesh.Study Period:April 2022 toMarch 2023. Study population:All patients presenting with jaundice to Department of Obstetrics & Gynecologyin antepartum or intrapartum period.Sample size: Study consisted a total of 55 subjects.Sampling Technique:  Simple Random technique. Results: In 29% (n=16) of cases, jaundice is due to obstetric cholestasis, who are mostly presented with pruritis and abnormal LFT’s in their third trimester, In 27% (n=15)it is due to HELLP syndrome which is associated with preeclampsia in 14%, In 12.7%(n=7) cases jaundice is due to sickle cell anemia and Hepatitis B each, haemolytic anemia due to blood transfusion is seen in 5.45% (3), in 3.6%(n=2) cases cause is AFLP who presented with hepatic encephalopathy and hypoglycemia , cirrhosis is the cause of jaundice in 3.6%(n=2) who presented in their first and second trimester,1.8%(n=1) cases are due to malaria, cholelithiasis and autoimmune hepatitis each. So in nearly half of the cases the cause of jaundice is pregnancy specific causes. Conclusion:Jaundice in pregnancy is a dreadful condition resulting in high maternal and fetal mortality. Even though the blood bank facilities has increased, due to their advanced disease state at admission few patients could not be survived. So early referrals are helpful.Team effort is needed in the management of jaundice , team should constitute obstetrician , physician, gastroenterologist, anaesthetist and neonatologist, so that identification and treatment throughout antepartum, intrapartum and postpartum period prevent and reduce maternal and perinatal morbidity and mortality.

Laparoscopic Cholecystectomy is one of the widely performed elective surgeries worldwide and is the gold standard method for patients with symptomatic gallstones. It was a common practice earlier, to use prophylactic antibiotics before an operative procedure; but recent studies show evidence againsttheuseofprophylacticantibioticsinlow-riskpatientsundergoingelective laparoscopic cholecystectomy. In our study we included 200 patients diagnosed with symptomatic cholelithiasis and divided them into 2 groups of 100 patients each. All were planned for elective laparoscopic cholecystectomy, in which, group (A) underwent surgery without any prophylactic antibiotics and the other group (B) got the routine antibiotic prophylaxis preoperatively. At 95% confidence level, there is no significant difference in the fever, port site infection and raised TLC (Leucocytosis) during hospital stay, at the time of discharge and on1-weekfollow-upof the patients in both the study groups. We concluded that there is no need for routine antibiotic prophylaxis in patients undergoing an elective uncomplicated laparoscopic cholecystectomy for symptomatic gallstone disease.

Background: In the recent era, laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. The aim of this study is to find out the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy in a tertiary care centre in Central India. Method: It is a descriptive cross-sectional study done among 200 patients at the Department of Surgery of a tertiary care centre from June, 2022 to May, 2024. Successive patients who underwent elective laparoscopic cholecystectomy during the study period were included. Standard 4 port laparoscopic technique was used for the laparoscopic cholecystectomy and sub-costal Kocher incision was used for the open cholecystectomy respectively. After data collection, entry and analysis were done in Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 200 patients, the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy was 5 (2.5%) (0.65-4.11 at 95% Confidence Interval).Conclusion: This study showed that the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy was lower when compared to similar studies conducted in similar settings.

Background: Cholelithiasis, or gallstone disease, is a prevalent digestive disorder affecting approximately 20 million individuals in the U.S., with a rising prevalence in India due to changing dietary habits. It is characterized by episodic biliary colicky pain and can lead to serious complications in 20–25% of cases. While open cholecystectomy was the traditional treatment, laparoscopic cholecystectomy (LC) has become the preferred method due to its advantages, including reduced surgical trauma and quicker recovery. However, challenges such as prolonged operative time and potential complications necessitate understanding predictive factors to enhance surgical outcomes and patient safety.  Objectives: To explore the epidemiological trends, clinical manifestations, and therapeutic advancements in cholelithiasis while emphasizing the importance of understanding predictive variables that influence the difficulty of laparoscopic cholecystectomy. Materials & methods: The present study was a prospective study conducted at the Government Medical College, Patiala, involving 75 cases who were admitted for elective LC. Informed written consent was obtained from all participants. A comparison of preoperative factors and intraoperative difficulty levels was conducted to enhance understanding of surgical outcomes. Data analysis was performed using SPSS software to interpret the results. Results: This study evaluated laparoscopic cholecystectomy difficulty among 75 participants, revealing that 54.7% underwent "Easy" procedures, 30.7% "Difficult," and 14.7% "Very Difficult." Key factors influencing surgical complexity included older age, male gender, prolonged pain, and recent acute attacks. Ultrasound findings showed significant associations with gallbladder condition, stone characteristics, and wall thickness affecting difficulty levels. The majority had normal gallbladders, and most surgeries lasted under an hour, with a minimal conversion rate to open surgery (8%). Recognition of these factors aids in optimizing surgical approaches and enhancing patient outcomes. Conclusion: The study revealed significant correlations between surgical difficulty in laparoscopic cholecystectomy and factors such as older age, male gender, prolonged mild pain, and recent acute attacks. Ultrasound findings indicated that over-distended gallbladders, single large stones, stones in the neck, and increased gallbladder wall thickness contributed to surgical challenges. Recognizing these factors can aid surgeons in optimizing their approach, potentially reducing operative times and complications, thus improving patient outcomes.

Background: Cholelithiasis with associated common bile duct (CBD) stones is a frequent indication for endoscopic retrograde cholangiopancreatography (ERCP) followed by cholecystectomy. However, residual CBD stones despite ERCP may contribute to postoperative complications. This study evaluates the impact of residual CBD stones on postoperative outcomes in patients undergoing cholecystectomy after ERCP. Materials and Methods: This retrospective cohort study included 180 patients who underwent laparoscopic cholecystectomy following ERCP for CBD stones at a tertiary care hospital. Patients were categorized into two groups: Group A (n=90) with confirmed clearance of CBD stones post-ERCP and Group B (n=90) with residual CBD stones identified intraoperatively or postoperatively. Postoperative complications, including biliary leakage, pancreatitis, wound infection, and length of hospital stay, were recorded and analyzed using SPSS v26. Chi-square and t-tests were employed for statistical comparisons, with p<0.05 considered significant. Results: Residual CBD stones were associated with significantly higher postoperative complications. Biliary leakage occurred in 14.4% of Group B compared to 3.3% in Group A (p=0.01). Postoperative pancreatitis was observed in 11.1% of Group B versus 2.2% in Group A (p=0.02). Mean hospital stay was prolonged in Group B (6.7 ± 2.1 days) compared to Group A (4.3 ± 1.6 days) (p<0.001). Wound infections were slightly more frequent in Group B (8.9%) than in Group A (4.4%), though not statistically significant (p=0.19). Conclusion: The presence of residual CBD stones following ERCP significantly increases the risk of postoperative complications, including biliary leakage, pancreatitis, and prolonged hospitalization. Thorough CBD clearance verification during ERCP is crucial to optimize outcomes post-cholecystectomy.