1702 Indian Journal of Public Health Research & Development, January 2020, Vol.DOI 11, Number: No. 01 10.37506/v11/i1/2020/ijphrd/194095 Study the Link between Laparoscopic Cholecystectomy and Abdominal Wall Paraumbilical Hernia

Mohammed Mohammud Habash

M.B.Ch, B - F.I.C.M.S, Assistant Professor in General Surgery, College of Medicine, Diyala University, Diyala, Iraq

Abstract A laparoscopic cholecystectomy is a surgery which includes the removal of gallbladder. It is a minimally invasive cholecystectomy wherein inside of the abdomen is visualize with the help of camera introduced through 4 small incisions to remove the gallbladder by using long tools. The aim of the present study is to evaluate the correlation between abdominal wall hernia (paraumbilical hernia) and laparoscopic cholecystectomy in the Iraqi patients (n=100). The age of the patients was 25 to 36 years. Before surgery, the red blood cells, white blood cells and serum urea were found to be 105.67±3.00; 13731±1940.4 and 33.48±0.47, respectively. After surgery, the red blood cells, white blood cells and serum urea were found to be 117.95±4.21; 10307.9±1057.7 and 35.25±0.46, respectively. The laparoscopic cholecystectomy with previous abdominal wall hernia is the easiest operative procedure. However, it required good experience and careful dissection.

Keywords: Abdominal wall paraumbilical hernia, Surgery, Laparoscopic cholecystectomy.

Introduction To prevent associated inflammation complications, administer conservative therapy is used which is a first Various factors such as alterations in medications, line of acute cholecystitis treatment. If patients do not hormones, diet, or rapid weight gain or loss results in respond to medication after 6 to 8 weeks of treatment, changes in concentration of bile; which helps in the laparoscopic cholecystectomy is performed. About 70% digestion into the small intestine and produced by of such patients respond to medical therapy within the the liver. Formation of gallstones occurs if the bile first 24 to 48 hours; still laparoscopic cholecystectomy composition and concentration is changed. If this is the preferred treatment for symptomatic gallstone formed gallstones migrate out of the gallbladder then disease1. it blocks bile normal flow and develops infection and inflammation. This is known as cholecystitis and its In rare cases, complications after laparoscopic symptoms are constant abdominal pain, vomiting, cholecystectomy are observed and could become serious fever and nausea1. The incidence rate of gallstones is if structures near the gallbladder are damaged. Common 10-15%. Out of these, about 35% of patients display bile duct is one of situated near gallbladder; which pores lifetime recurrence rate of symptoms or complications. bile from the gallbladder and liver into small intestine. Gallstones are three times more common in women than Biliary ducts damage or leakage leads to the barrier of men2. bile flow and develops symptoms of fever, abdominal pain, and yellowing of the skin. This is known as jaundice. Gallstone disease also showed similar Corresponding Author: symptoms along with the bleeding from a blood vessel. Mohammed Mohammud Habash Generally, bleeding stops after some time. However, if M.B.Ch, B - F.I.C.M.S, Assistant Professor in General it’s persistent for a long time, then intervention isneeded. Surgery, College of Medicine, Diyala University, Post cholecystectomy surgery, fever, nausea, worsening Diyala, Iraq pain, chills, vomiting, or jaundicealso reported by some e-mail: [email protected] authors1. Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01 1703 Another complication of laparoscopic Before surgery, the red blood cells, white blood cholecystectomy is the occurrence of port site hernia. cells and serum urea were found to be 105.67±3.00; The incidence rate of it deceits between 0.38% to 5.4% 13731±1940.4 and 33.48±0.47, respectively. After with an overall frequency of 1.7%. The incidence surgery, the red blood cells, white blood cells and serum rate is increasing with size of the trocar. The incision urea were found to be 117.95±4.21; 10307.9±1057.7 enlargement, connective tissue disorders, diabetes and 35.25±0.46, respectively (Table 1). mellitus, wound infection, type of trocar used, obesity, and defective closure of the fascial defect. These are Table 1: Blood parameters before and after surgery the major risk factors involved in the development of Blood Parameter Before After port site hernia2,3. Sometimes, peritoneal defects below Red Blood Cells 105.67±3.00 117.95±4.21* the repaired fascial layer could lead to herniation. White Blood Cells 13731±1940.4 10307.9±1057.7 Therefore, it is important to safely repair the port sites; Serum Urea 33.48±0.47 35.25±0.46 fascial as well as the peritoneal. With this background, we aim to evaluate the correlation between abdominal Discussion wall hernia (paraumbilical hernia) and laparoscopic cholecystectomy. Various studies have investigated laparoscopic cholecystectomy and associated complications such as Material and Method incisional hernia from umbilical port4-12. In the present study, we have evaluated the hematological parameters Patient Enrollment: In the present study, the and serum urea before and after hernia surgery. In a case patients (n=100) visited to the Baqubah teaching study of 55 year old female reported by Sharma et al.13an hospitalduring July 2018 to July 2019 were enrolled. anterior abdominal wall hernia was diagnosed after The age of the patients was 25 to 36 years. two days of laparoscopic cholecystectomy through the Inclusion Criteria: umbilical port. Authors have reported hernia reduction, fascial anatomical repair and peritoneal defect over the 1. All cases with symptomatic gall stone disease midline laparotomy incision13. 2. Acute cholecystitis after conservative treatment Umbilical hernia is another type of hernia 3. Diabetics patient with gall stone constituting 6% of all abdominal hernias in adults14,15. 4. A calculus cholecystitis Treatment options for umbilical hernias includes several surgical method. During laparoscopic cholecystectomy; Operative procedure: All operations are done the simultaneous occurrence of umbilical hernia and under general anesthesia, in supine position and cholelithiasis may cause technical problems in CO2 insufflation with CO2 by using Veres needles or Hason insufflations and trocar insertion. Kamer etal.16has method in patient with complicated previous abdominal explored ideal repair method among primary repair, surgery. Dissecting the calot triangle and identification mayo repair and flat mesh hernioplasty for incidentally and clippings of both cystic artery and duct. encountered umbilical hernias after laparoscopic Blood Collection: The blood was collected for the cholecystectomy. The study reported improved various biochemical assays such as hematogram analysis outcomes of the umbilical defect repair with mesh and serum urea by commercially available kits. after laparoscopic surgeries and a better technique for either obese or non-obese patients than primary suture Statistical Analysis: Results were presented as mean techniques in terms of recurrence rates16. ± standard error (SE). Dunnett multiple comparison test 17 and one way analysis of variance (ANOVA) was done to In a case control study by Uslu et al. , female estimate the statistical significance. gender, older age, higher BMI along with increased surgery duration was found to be associated with Results increased probability of a trocar site hernia formation. Thus, authors conclude that closure of trocar sites in In the present study,we examined the ­hundred obese patients above 60 years, and a longer operation patients visited to the Baqubah teaching hospital during duration could result in prevention of port site hernia July 2018 to July 2019 period. The age group of the following laparoscopic cholecystectomy17. patients was 25 to 36 years. 1704 Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01 Thus, during the follow up of patients who underwent study and review of the literature. J Laparoendosc laparoscopic cholecystectomy; after this surgery, the Adv Surg Tech A 2002;12:263-267. probability of development of port site hernia can occur. 7. Bencini L, Sanchez LJ, Scatizzi M, Farsi M, These considerations of hernia could help in providing Boffi B, Moretti R. Laparoscopic treatment of early intervention to reduce sepsis and strangulation. ventral hernias: prospective evaluation. Surg In addition, repair of both peritoneal and fascial layers LaparoscEndoscPercutan Tech 2003;13:16-19. at the port site should also be considered to avoid such 8. Courtney CA, Lee AC, Wilson C, O’Dwyer PJ. unfavorable condition at a future date. Ventral hernia repair: A study of current practice. Hernia 2003;7:44-46. Conclusion 9. Menon VS, Brown TH. Umbilical hernia in adults: The laparoscopic cholecystectomywith previous Day case local anaesthetic repair. J Postgrad Med abdominal wall hernia is the easiest operative procedure. 2003;49:132-133. However, it required good experience and careful 10. Schumacher OP, Peiper C, Lorken M, Schumpelick dissection. The red blood count gets increased after V. Long-term results after Spitzy’s umbilical hernia surgery along with serum urea. repair. Chirurg 2003;74:50-54. Ethical Clearance: Ethical clearance taken from 11. Ermilychev AA, Kravchenko VV, Popenko GA. Diyala University, Diyala, Iraq. 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