• Journal of Trauma and Injury
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• v.36 no.3
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• pp.295-297
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• 2023

Penetrating gallbladder injuries are uncommon in the pediatric population. The treatment varies according to the severity of the injury and the patient's hemodynamics. We present the case of an 11-year-old male with an accidental pellet gunshot wound to the right upper abdomen that resulted in a grade III liver laceration and damage to the anterior gallbladder wall. The patient underwent laparoscopic cholecystectomy with drain placement. Postoperative radiography of the surgical specimen confirmed the presence of the pellet in the gallbladder. The patient recovered uneventfully and was discharged home on postoperative day 3. Laparoscopic cholecystectomy is a feasible treatment option for penetrating gallbladder injuries in hemodynamically stable patients.

• The Korean Journal of Pain
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• v.22 no.2
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• pp.130-134
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• 2009

Background: The advances in surgical technology, anesthesia and perioperative care have made it possible to perform laparoscopic cholecystectomy on an outpatient basis. This study was conducted to assess the analgesic effect and the adverse events of different dosing methods when using transdermal fentanyl patches (TDFPs) after laparoscopic cholecystectomy. Methods: Sixty patients who were to undergo laparoscopic cholecystectomy under general anesthesia were divided into two groups. Group 1: 2 TDFPs that released $12{\mu}g/h$ were applied after the induction of anesthesia and these 2 patches were removed after 24 hours. Group 2: 2 TDFPs that released $12{\mu}g/h$ were applied after the induction of anesthesia and one patch was removed after 7 hours and the other patch was removed after 24 hours. The intensity of the postoperative pain was assessed by using a visual analogue scale (VAS) and assessing the adverse events, including dizziness, pruritus and nausea/vomiting, were recorded for 48 hours postoperatively. Results: The VAS score of postoperative pain was not significantly different between the two groups at all times. The incidence of dizziness in groups I and II was 10 and 3, respectively, and the incidence of nausea/vomiting in group I and II was 4 and 0, respectively. The incidences of dizziness and nausea/vomiting in group II were significantly lower than those of group I (P<0.05). Conclusions: A dosing method that removes half of the TDFPs ($24{\mu}g/h$) after 7 hours of application caused a lower incidence of dizziness and nausea/vomiting without any significant difference of postoperative analgesic efficacy, as compared to leaving on both the TDFPs (24$\mu$g/h) for 24 hours after laparoscopic cholecystectomy.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2007.10a
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• pp.567-567
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• 2007

• The Korean Journal of Pain
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• v.26 no.4
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• pp.361-367
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• 2013

Background: Nefopam is a centrally acting analgesic that is used to control pain. The aim of this study was to find an appropriate dose of nefopam that demonstrates an analgesic effect when administered in continuous infusion with fentanyl at the end of laparoscopic cholecystectomy. Methods: Ninety patients scheduled for laparoscopic cholecystectomy were randomly assigned to receive analgesia with fentanyl alone (50 ${\mu}g$, Group 1, n = 30), or with fentanyl in combination with nefopam 20 mg (Group 2, n = 30) or in combination with nefopam 40 mg (Group 3, n = 30) at the end of surgery. Pain and side effects were evaluated at 10 minutes, 30 minutes, 1 hour, 2 hours, 6 hours, and 12 hours after arrival in the post-anesthesia care unit (PACU). Results: Pain was statistically significantly lower in Groups 2 and 3 than in Group 1 at 10 minutes, 2 hours, and 6 hours after arrival in the PACU. Nausea was statistically significantly lower in Group 2 than in Groups 1 and 3 at 10 minutes after arrival in the PACU. Shivering was statistically significantly lower in Groups 2 and 3 than in Group 1 at 10 minutes after arrival in the PACU. Conclusions: Nefopam is a drug that can be safely used as an analgesic after surgery, and its side effects can be reduced when fentanyl 50 ${\mu}g$ is injected with nefopam 20 mg.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.3
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• pp.301-306
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• 2023

Backgrounds/Aims: Postoperative delirium (POD) is a common complication that increases mortality and morbidity in older patients. This study aimed to evaluate the clinical significance of post-cholecystectomy delirium in older patients. Methods: This retrospective study included 201 patients aged > 75 years who underwent cholecystectomy for acute or chronic cholecystitis between January 2016 and December 2019. Patients were divided into the POD (n = 21) and non-POD (n = 180) groups, and their demographic features and clinical results were compared. Results: The mean patient age was 78.88 years; the female/male ratio was 44.8%/55.2%. Laparoscopic surgery was performed in 93.5% of patients. The univariate analysis showed that lower body mass index (BMI), immobilized admission status, neuropsychiatric disease history, preoperative intervention (percutaneous drainage), high C-reactive protein, hypoalbuminemia, neutrophilia, hypo-/hyperkalemia, and longer operative time were more frequently observed in the POD group. The multivariate analysis showed that lower BMI (odds ratio [OR], 2.796; p = 0.024), neuropsychiatric disease history (OR, 3.019; p = 0.049), hyperkalemia (OR, 5.972; p = 0.007), and longer operative time (OR, 1.011; p = 0.013) were significant risk factors for POD. Conclusions: POD was associated with inflammation degree, general condition, poor nutritional status, electrolyte imbalance, and stressful conditions. Recognizing risk factors requiring multidisciplinary team approaches is important to prevent and treat POD.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.5
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• pp.3315-3318
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• 2013

Gall bladder carcinoma is the most common cancer of biliary tree, characterized by rapid progression and a very high mortality rate. Detection at an early stage, however, is indicative of a very good prognosis and prolonged survival. The practice of histopathological examination of gall bladder specimens removed for clinically benign conditions and its usefulness has been a subject of controversy. The present prospective study was carried out over a period of four years in order to find out the incidence of unsuspected gallbladder carcinoma in cholecystectomy specimens received in our histopathology laboratory and to analyze their clinico-pathological features. A total of 4,115 cases were examined. Incidentally detected cases comprised 0.44%, which accounted for 72% of all gall bladder carcinomas detected. The majority were in an early, surgically resectable stage. From the results of this study we recommend that in India and other countries with relatively high incidences of gall bladder carcinoma, all cholecystectomy specimens should be submitted to histopathology laboratory, as this is the only means by which malignancies can be detected at an early, potentially curable stage.

• Journal of Korean Academy of Nursing
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• v.40 no.5
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• pp.714-723
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• 2010

Purpose: The purpose of this study was to examine the effects of using gauze frozen with normal saline or ice on thirstrelief and oral condition of laparoscopic cholecystectomy patients. Methods: A quasi-experimental nonequivalent control group, pretest-posttest design was used. Participants (n=53) received either gauze frozen with normal saline (n=17), ice (n=18) or wet gauze (n=18) for thirst-relief. The subjective thirst level and oral condition of the participants were assessed before the intervention, 15 min after the first intervention and 15 min after the second intervention. Results: After oral care was provided twice, there were significant differences in thirst level among the groups. When oral care was provided twice, the oral condition of tongue, saliva, mucosal membrane, and gingiva was improved in patients receiving gauze frozen with normal saline or ice. Conclusion: Gauze frozen with normal saline and ice can be effective for oral care in reducing the thirst level and improving the condition of the oral cavity.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.22 no.3
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• pp.287-296
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• 2015

Purpose: The purpose of this study was to examine the effects of forced air warming on intraoperative and postoperative body temperature, postoperative shivering and pain in patients undergoing laparoscopic cholecystectomy. Methods: A quasi-experimental design with nonequivalent control group was utilized. Fifty eight patients scheduled for laparoscopic cholecystectomy were recruited and assigned to the experimental group (n=29) or control group (n=29). For the experimental group, forced air warming was applied from right after induction and up to one hour after surgery. Body temperature, shivering score and pain score were measured in both groups at 15 minute intervals. Data were collected from September, 2013 to April, 2014. Data were analyzed using t-test, Bonferroni test and repeated measures ANOVA. Results: The experimental group showed higher body temperature than the control group during surgery. After surgery the experimental group showed higher body temperature, lower shivering and less pain compared to the control group. Conclusion: Results show that forced air warming is effective in enhancing body temperature and reducing shivering and pain. Therefore, forced air warming is recommended as an operative nursing intervention.

• Korean Journal of Transplantation
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• v.28 no.3
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• pp.160-164
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• 2014

Background: In solid organ transplantation patients, complications of cholelithiasis may run a fulminant course, resulting in high morbidity and mortality under immunosuppression and may even result in rejection. Here, we reviewed medical records of 66 patients in order to determine the outcome of management approach for asymptomatic gallstones in renal transplantation patients. Methods: We retrospectively reviewed clinical courses of 66 cases of renal transplantation performed between 2000 and 2012 at Kosin University Gospel Hospital. Results: Among 66 cases, eight had gallstones before transplantation. Three of these cases had undergone previous cholecystectomy for symptomatic gallstones, one had a simultaneous laparoscopic cholecystectomy and renal transplantation, and four were observed by regular abdominal ultrasonography. One patient was found to have cholangitis, and endoscopic retrograde biliary drainage was performed, resulting in alleviation of symptoms. Among 58 cases without preoperative gallstones, three developed gallstones after transplantation. One patient had cholecystitis, and the symptoms subsided after conservative treatment. Conclusions: For patients with asymptomatic gallstones who are awaiting renal transplantation, expectant management should be considered.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.1
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• pp.63-69
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• 2023

Methods: Patients who underwent cholecystectomy were classified into two groups according to their GBWT status (GBWT+ vs. GBWT-). Results: Among 1,211 patients who underwent cholecystectomy, GBWT+ was seen in 177 (14.6%). The GBWT+ group was significantly older with more males, higher ASA score, higher alkaline phosphatase level, higher international normalized ratio, and lower albumin level than the GBWT- group. On ultrasound, GBWT+ patients had larger stone size, more pericholecystic fluid, more common bile duct stone, and more biliary pancreatitis. Compared with the GBWT- group, the GBWT+ group had more urgent surgeries (12.4% vs. 3.2%, p = 0.001), higher conversion rate (4.5% vs. 0.3%, p = 0.001), prolonged operative time (67 ± 38 vs. 54 ± 29 min; p = 0.001), more bleeding (3.4% vs. 0.5%, p = 0.002), and more need of drain (21.5% vs. 10.5%, p = 0.001). By multivariate analysis, factors associated with increased length of hospital stay were GBWT+ (HR: 1.97, 95% CI: 1.19-3.25, p = 0.008), urgent surgery (HR: 10.2, 95% CI: 4.07-25.92, p = 0.001), prolonged surgery (HR: 1.01, 95% CI: 1.0-1.02, p = 0.001), and postoperative drain (HR: 11.3, 95% CI: 6.40-20.0, p = 0.001). Conclusions: Variables such as GBWT ≥ 5 mm, urgent prolonged operation, and postoperative drains are independent predictors of extended hospital stay. GBWT+ patients are twice likely to stay in hospital for more than 72 hours and more prone to develop complications than GBWT- patients.