Abstract

Laparoscopic cholecystectomy is the treatment of choice for gall bladder stone disease. Difficult cholecystectomy is associated with serious complications and a high conversion rate. The aim of this study was to review the current strategies to manage difficult cholecystectomy. Bile duct injuries were analysed in a prospective study of 1,250 cases of laparoscopic cholecystectomy. The aim of the study was to identify the incidence and causes of bile duct injuries in the course of laparoscopic cholecystectomy, and to recommend the possible ways to avoid this serious complication. All injuries were attributed to distortion of Calot’s triangle and failure to clearly identify the anatomy. A recent history of acute cholecystitis, a history of jaundice, pancreatitis and repeated or technically difficult endoscopic retrograde cholangio-pancreatography (ERCP) were associated with local inflammatory changes that had possibly contributed to the distorted anatomy at Calot’s triangle and consequently to the injury. All injuries were detected during surgery and immediately repaired. Major bile duct injuries were repaired by choledocho-enterotomy, while minor injuries were treated by simple sutures around the T tube in the common bile duct. All patients were asymptomatic with normal liver function tests on follow-up for a period up to 3 years after surgery. Conclusions: The incidence of bile duct injuries in laparoscopic cholecystectomy is comparable to open surgery. Patients with a clinical history of acute cholecystitis, or a recent history of jaundice and repeated ERCP should be considered for operative cholangiography in order to help reduce the chances of bile duct injuries. Materials and Methods: A Pre-experimental and one group pretest and posttest design was used to assess the knowledge on early ambulation of 50 patients on Laparoscopic Cholecystectomy. A structured questionnaire was developed to assess the knowledge of the patients. The study started with the pretest followed by structured teaching program and posttest. Results: The post test showed a significant improvement in the knowledge regarding Early Ambulation of laparoscopic Cholecystectomy patients. In the pretest 20 patients had good level of knowledge and 30 had average level of knowledge. The post test revealed that 40 patients had Very good knowledge and 10 had good level of knowledge. Paired t-test value of knowledge and practice was 2.06 and 1.47 respectively, which was higher than the table value 2.66* at p <0.05 hence the structured teaching program was found to be effective in improving the knowledge of the patients. Conclusion: Patients acquired knowledge laparoscopic cholecystectomy. Also have an improvement in diet, exercise to prevent other complications.