RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE
AND ADDRESS: (IN BLOCK
LETTERS) / DR. SAFARULLA SH
Muhammadiya Manzil, Maheshwari Nagar,
Sakaleshpura, Hassan Dist, Karnataka-573134
2. / NAME OF THE INSTITUTION / DR. B. R AMBEDKAR MEDICAL
COLLEGE AND HOSPITAL.
BANGALORE
3. / COURSE AND SUBJECT / M.S GENERAL SURGERY
4. / DATE OF ADMISSION / 31/05/ 2012
5. / TITLE OF THE
DISSERTATION / THE STUDY OF CHOLECYSTECTOMY (OPEN/ LAP) IN ACUTE CALCULOUS CHOLECYSTITIS
6. / BRIEF RESUME OF INTENDED WORK
6.1 NEED FOR STUDY:
·  Biliary diseases constitute a major portion of digestive tract disorder. Among these gall stone disease is the most common biliary pathology.
·  Optimal surgical timing and operative technique in the treatment of acute cholecystitis are of major importance and are still debatable issues.
·  The pathological changes in the surgical target begin with increasing rapidity, to present a troublesome challenge to the surgeon, making laparoscopic cholecystectomy for acute cholecystitis more difficult and less safe than when performed earlier.
·  We intend with this study to clarify further the timing of surgery for acute cholecystitis, its complications, the cause and predictive factors for conversion to open cholecystectomy. All this information will help in reducing the morbidity, mortality associated with the disease in addition to reducing the hospital stay.
6.2 REVIEW OF LITERATURE:
The Greek physician Trallianus described calculi within the hepatic radicles of a
human liver (Glenn and Grafe, 1966). By the 16th century, Vesalius and Fallopius
described gallstones found in the gallbladders of dissected human bodies (Schwartz,
1981). These observations suggested a clear recognition of the phenomenon of
cholelithiasis; however , pathogenesis and clinical significance of gallstones were
seldom referred to. In the late 19th century, Langenbuch (1882) widened the
understanding of gallstone pathology by performing the first cholecystectomy.1
Laparoscopic cholecystectomy was first performed by Muhe in 1985. The first series
of laparoscopic cholecystectomies was first published by Dubois et al, 1989.
Essenhigh was the first to advocate early operation for an acutely inflamed
gallbladder, in 1966.1. In 1983, Lukichev and colleagues described laparoscopic
cholecystostomy as treatment for acute cholecystitis. Several authors since then have
reported performing laparoscopic cholecystectomy in the face of acute inflammation
with success, but with a higher conversion rate than for elective laparoscopic
cholecystectomy (Cooperman, 1990; Hermann, 1990; Rattner et al, 1993 etc.).2-4.
Since then multiple prospective randomized trials have shown that early
cholecystectomy is the preferred treatment of acute cholecystitis.1
6.3 OBJECTIVES OF STUDY:
1. To study complications associated with emergency cholecystectomy for acute calculous cholecystitis.
2. To study conversion rates in surgeries for acute calculous cholecystitis (laparoscopy to open or open to cholecytostomy).
3. To study the effect of timing of surgery on the outcome of surgery for acute calculous cholecystitis (within 72hrs or after 72hrs till 7 days).
7. / MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
The data will be obtained from all the patients admitted with the diagnosis of
acute cholecystitis in DR B.R AMBEDKAR MEDICAL COLLEGE AND HOSPITAL
from a period between October 2012 to November 2014.
7.2 METHODOLOGY OF COLLECTION OF DATA:
This prospective clinical study will be conducted in the Department of
Surgery, DR B.R AMBEDKAR MEDICAL COLLEGE AND HOSPITAL from
October 2012 to November 2014.
Inclusion criteria:
 Age 18 yrs and older
 Cholecystectomy for acute calculous cholecystitis documented by clinical
features, radiology, intra-operative findings and/or pathology.
Exclusion criteria:
 Patient with common bile duct stones and/or cholangitis
 Cholecystectomy for acalculous cholecystitis
 Significant co-morbidities needing ICU care before surgery(e.g. recent cardiac
surgery, sepsis unrelated to cholecystitis)
 Presence of symptoms for more than 7days or surgery after 7 days of onset of
symptoms
Proforma
Name: Age: Sex: IP/OP No.:
Address:
Date of admission: Date of surgery:
Date of discharge: Total duration of stay:
Presenting complaints with duration:
H/o pain abd: H/o nausea and vomiting:
H/o fever: H/o jaundice:
Other complaints:
Past history: Pain abdomen: Asso. Fever:
Jaundice:
H/o previous hospitalization:
Co-morbid conditions:
DM: HTN: Heart disease:
Others:
O/E: Temp: PR: BP: RR:
CVS:
RS:
P/A: Tenderness: Gaurding:
Organomegaly: BS:
Investigations: Hb: TC: N: L:
LFT: Total bilirubin:
Direct bilirubin:
Total proteins: Albumin:
AST: ALT:
Alkaline phosphatase:
PT: INR: APTT:
USG Abd & Pelvis: GB:
Pericystic fluid collection:
Wall thickening:
Surgery performed:
Intra-op findings:
Duration of surgery:
Complications- Intra-op:
Post-op:
Duration of stay post surgery:
HPE Report:
7.4 Has ethical clearance been obtained from your institution?
YES/NO
8. / LIST OF REFERENCES
1. Leslie H. Blumgart. Surgery of the Liver, Biliary Tract and Pancreas. 4th Edition.
New York: Elsevier; 2006
2. Rattner D, Ferguson C, Warshaw A. Factors associated with successful
laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1993;217:233-236.
3. Pitt HA, King W, Mann LL, et al. Increased risk of cholelithiasis with prolonged
total parenteral nutrition. Am J Surg. 1983;145:106–12.
4. S.Das. A concise textbook of surgery. 5th Edition. Kolkata: S.Das; 2008
9. / SIGNATURE OF THE CANDIDATE
10. / REMARKS OF THE GUIDE
11. / 1. NAME AND
DESIGNATION OF THE
GUIDE / DR B. S Ramesh
PROFESSOR
DEPARTMENT OF GENERAL SURGERY
DR B.R AMBEDKAR MEDICAL COLLEGE
BANGALORE
2. SIGNATURE
3. CO-GUIDE / NO
5. HEAD OF THE
DEPARTMENT / DR V KRISHNA RAO
PROFESSOR AND HEAD
DEPARTMENT OF GENERAL SURGERY
DR B.R AMBEDKAR MEDICAL COLLEGE
BANGALORE
6. SIGNATURE
12. / 1. REMARKS OF THE
CHAIRMAN AND
PRINCIPAL
2. SIGNATURE