Laparoscopic Cholecystectomy

Treatments include Surgery and medications to dissolve the gallstones. Nearly all cholecystectomies are performed with laparoscopy. If tests show the gallbladder has severe inflammation, infection, or scarring from other operations, the surgeon may perform open surgery to remove the gallbladder. In some cases, open surgery is planned; however, sometimes these problems are discovered during the laparoscopy and the surgeon must make a larger incision. If gallstones

Serosanguineous drainage is expected after abdominal surgery because of incision and time needed for clotting process. It is not normal if the bandage is soaked with blood, if green or yellow drainage is coming from it, or patient have black or tarry stools, or there is blood in his stool.

The preoperative procedure of using with chlorhexidine-alcohol (CHG) before surgery has been proven to be more effective to reduce the number of surgical site infections (SSI) than the use of povidone iodine. By reducing the number of infections post surgery, it can lower patient morbidity and can reduce hospital stay time and eliminate further unnecessary costs.

Postoperative nursing care after a laparoscopic cholecystectomy includes monitoring for complications such as bleeding, making the patient comfortable, and preparing the patient for discharge. Assessment findings for poor wound healing include redness, tenderness, swelling, purulent drainage, pain, and fever. Monitoring white blood cell count is a way to see if there is a presence of a bacterial infection. Maintaining good fluid intake and nutrition promotes fast and good wound healing. The carbon dioxide can irritate the phrenic nerve

In the last five years, Enhanced Recovery After Surgery (ERAS) pathways for colorectal resection have been thrust into spotlight with evidence of expedited recovery time and improved postoperative outcomes1–5. However, there exists little uniformity in the recommendations and results of published ERAS pathways, and there is some evidence suggesting that the wrong cocktail of bundle elements can increase Surgical Site Infection (SSI) rates6. This inconsistency can be attributed to a lack of consensus on the efficacy of some common bundle elements, such as preoperative antibacterial showering, maintenance of normothermia, and high intraoperative Fraction of Inspired Oxygen (Fi02) 7–15. Such dissonance in studied ERAS efforts

Abrupt decrease in body weight. In this case, a lot of cholesterol is often excreted, which can lead to the appearance of gallstones.

Antibiotics will be prescribed to the cat to clear infections or bacterial complications that are causing the gallstones to form. Antibiotics may also be prescribed before surgery in order to prevent infection from occurring after surgery. Ursodeoxycholic acid may be prescribed twice a day in order to dissolve small gallstones that aren't blocking the bile duct. S-Adenosylmethionine, or SAMe, may also be given in order to improve bile production and function of the liver.

Table 3 shows descriptive statistics of 22,174 colectomy cases that include 4,498 partial laparoscopic colectomies, 16,689 partial open surgery colectomies and 987 total open surgery colectomies. The unadjusted average colectomy price of the sample was $20,421, which is lower than the unadjusted average colectomy price ($26,081) for Medicare patients. Age and disease severity of Medicare patients are much higher than those of privately insured patients. The mean age of the sample was 51.41 and 49.6 percent of the colectomy patients were male.

If you have gallstones or an infected gallbladder, your doctor may advise you to have surgery. Gallbladder removal is one of the many surgical procedures that can be done laparoscopically. That means recovery is usually much quicker and the hospital stay is shorter than surgeries that require a full incision. Here's a look at how laparoscopic gallbladder removal is done and what to expect as you recover from it.

This operation requires 3 to 5 small incisions be made in your lower stomach. A medical laparoscope is an instrument with a slender tube and an attached camera that the surgeon puts into one of the incisions in order to see where the damaged area is located. Your stomach is filled with gas so that the surgeon has a good view of the area where he will be working. One larger cut may be required if the surgeon needs to put a hand inside of the stomach to help remove the colon. It is not unusual to remove some lymph nodes while removing the damaged areas. The incisions will be closed with stitches or staples.

Treatment with postoperative antibiotics did not significantly reduce the risk of developing superficial SSIs, deep SSIs or organ space SSIs. The patients received postoperative antibiotics were significantly more likely to sustain a postoperative urinary tract infection (P=0.03), increased risk of Clostridium difficile infection (P =0.01) and postoperative diarrhea (P = 0.02) while showing higher rates of both readmission (P= 0.08) and reoperation (P = 0.07) (Table 3) with a significantly longer postoperative length of stay (2.6 vs 1.4 days, P = 0.001) (Table1&

Less invasive surgical technology such as laparoscopic procedures can reduce patient recovery time and allow for more low-cost outpatient procedures

The initial plan started with ordering a CBC, CMP, amylase and lipase STAT. These are all standard labs that help to rule out gallbladder pathology as well as our other differential diagnoses. Her vital signs were stable and the physical exam revealed only moderate TTP of the RUQ and epigastric region. The lab results revealed no leukocytosis, no elevation of liver enzymes, bilirubin, amylase, lipase, alk phos or any other signs of cholecystitis, cholangitis, pancreatitis or other potential signs of infection. The plan of care began with keeping the patient NPO. This is recommended as this keeps the patient from further pain secondary to food stimulating gallbladder contraction.5 It also allows the patient to be prepared for surgery if urgent cholecystectomy is required. The next step was beginning IV normal saline to keep her well hydrated. After this we began to give her medication through the IV including Zofran for her nausea. Zofran is an effective anti-emetic and there were no contraindications for use in this patient. We also gave her Morphine 2 mg IV for pain control. Opioids are an effective option for a patient with significant biliary colic.6 Although NSAIDS are another option for pain control, PUD was part of the differential diagnosis so NSAIDS were not an appropriate therapy. We ordered an abdominal ultrasound as this is the diagnostic test of choice for cholelithiasis. The ultrasound revealed multiple gallstones in the gallbladder, some mild gallbladder thickening, and some dilatation of the common bile duct. At this point we consulted GI who scheduled the patient for MRCP in the morning in order rule out choledocholithiaisis. We also consulted the surgery team who admitted the patient. The stated they would likely plan for laparoscopic

On postoperative concern that will be primarily addressed before surgery is infection control. Prior to going into the OR, the patient’s surgical site will need to be cleansed. According to a study by Webster and Osborn (2015) of the Cochrane Library “Surgical site infection is a serious complication of surgery and is usually associated with increased length of hospital stay for the patient, and also higher hospital costs. The use of an antiseptic solution for preoperative bathing or

A laparoscopic approach appears to be associated with a reduction in surgical trauma and blood loss. In addition, it is presumable that some of the benefits of minimally invasive surgery such as reduced analgesic requirements, a shorter recovery period and reduced hospital stay (Kuhry, 2005). It has become a forerunner in the quest of improving surgical results by dropping postoperative pain and lessening recovery time. Yet, the use of laparoscopic instruments can be awkward and cumbersome, thus escalating operative time and dropping dexterity, which can