A Retrospective Study Determining the Association between Echocardiographic LVFP Parameter, VMT Score and Clinical Outcomes of HFpEF
Authors/Creators
- 1. Senior Resident (Academic), Department of Cardiology, IGIMS, PATNA, Bihar, India
- 2. Additional Professor, Department of Cardiology, IGIMS, PATNA, Bihar, India
Description
Background: Choledocholitiasis develops in about 10–15% of patients with gallbladder stones. For patients with cholelithiasis and choledocholithiasis open exploration of the bile duct was the principal treatment for almost 100 years. But with advancement in endoscopic instrumentation and expertise, endoscopic retrograde cholangiopancreatography has evolved as the primary choice of treatment for biliary stones and it is successful in more than 90% of patients. Currently, the most accepted protocol in these cases involves endoscopic clearance of CBD followed at a later date by laparoscopic cholecystectomy. But there is no consensus regarding the exact time gap between these two procedures. Faced with the frequent problem of a ‘difficult’ laparoscopic cholecystectomy in these cases, the current study was undertaken to attempt to define the ideal time gap between the two procedures for the best possible outcome. Methods: In this study, 30 patients underwent ERCP with or without sphincterotomy followed at various intervals by elective laparoscopic cholecystectomy. According to these intervals, the patient’s data were assigned to one of the two groups : group A (<3 weeks) or group B (>3 weeks). A prospective comparative study was conducted to compare intra-operative parameters and post-operative outcomes of laparoscopic cholecystectomy done at different intervals after endoscopic retrograde cholangiopancreatography to decide upon the optimal timing for the surgery. Results: Overall rate of partial or subtotal cholecystectomy including all patients was 16.7% with significantly higher in delayed group B. Need for a drain was significantly higher as the interval between ERCP and LC progressed (p value 0.014). The mean duration of surgery for group A was 91.75 min and for group B was 127.78 min and this difference was statistically significant at p value < 0.05. A lower incidence of post-operative jaundice, bleeding, bile leak and wound infection was observed in group A than in the group B. Overall, statistically significant higher complication rates were observed in late period group B than in the early period group A. Patients in group B had more prolonged post-operative hospital stay with a mean of 5.0 days (SD 3.08). Conclusion: We recommend early laparoscopic cholecystectomy after ERCP for common bile duct disease could well be an answer in reducing rate of subtotal or partial cholecystectomy, duration of surgery, post-operative complications and post-operative hospital stay.
Abstract (English)
Background: Choledocholitiasis develops in about 10–15% of patients with gallbladder stones. For patients with cholelithiasis and choledocholithiasis open exploration of the bile duct was the principal treatment for almost 100 years. But with advancement in endoscopic instrumentation and expertise, endoscopic retrograde cholangiopancreatography has evolved as the primary choice of treatment for biliary stones and it is successful in more than 90% of patients. Currently, the most accepted protocol in these cases involves endoscopic clearance of CBD followed at a later date by laparoscopic cholecystectomy. But there is no consensus regarding the exact time gap between these two procedures. Faced with the frequent problem of a ‘difficult’ laparoscopic cholecystectomy in these cases, the current study was undertaken to attempt to define the ideal time gap between the two procedures for the best possible outcome. Methods: In this study, 30 patients underwent ERCP with or without sphincterotomy followed at various intervals by elective laparoscopic cholecystectomy. According to these intervals, the patient’s data were assigned to one of the two groups : group A (<3 weeks) or group B (>3 weeks). A prospective comparative study was conducted to compare intra-operative parameters and post-operative outcomes of laparoscopic cholecystectomy done at different intervals after endoscopic retrograde cholangiopancreatography to decide upon the optimal timing for the surgery. Results: Overall rate of partial or subtotal cholecystectomy including all patients was 16.7% with significantly higher in delayed group B. Need for a drain was significantly higher as the interval between ERCP and LC progressed (p value 0.014). The mean duration of surgery for group A was 91.75 min and for group B was 127.78 min and this difference was statistically significant at p value < 0.05. A lower incidence of post-operative jaundice, bleeding, bile leak and wound infection was observed in group A than in the group B. Overall, statistically significant higher complication rates were observed in late period group B than in the early period group A. Patients in group B had more prolonged post-operative hospital stay with a mean of 5.0 days (SD 3.08). Conclusion: We recommend early laparoscopic cholecystectomy after ERCP for common bile duct disease could well be an answer in reducing rate of subtotal or partial cholecystectomy, duration of surgery, post-operative complications and post-operative hospital stay.
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References
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