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PubMed2000

Persistent occurrence of bradycardia during laparoscopic cholecystectomies in low-risk patients.

BACKGROUND/AIMS: A debate has arisen about the use of carbon dioxide to distend the abdomen because of certain negative effects on venous return to the heart, and declining cardiac output. We previously reported 4 cases of bradycardia that occurred during 725 laparoscopic cholecystectomies. Now, we describe 6 cases of bradycardia that occurred in a 1-year period (May 31, 1997 to June 1, 1998) during CO(2) pneumoinsufflation at the beginning of planned, elective laparoscopic cholecystectomies. These patients appeared not to be at any special cardiac risk. To determine the frequency, and possible underlying common denominators, we reviewed the laparoscopic cholecystectomies. METHODS: We completely reviewed the patients' records to find any common denominators. Also, we calculated the frequency of bradycardia during laparoscopic cholecystectomies. RESULTS: Six patients experienced bradycardia during laparoscopic cholecystectomies. None had known cardiac disease or symptoms. These cases occurred during the year's 127 laparoscopic cholecystectomies (4.7% approximately). There were no common denominators between the patients. CONCLUSIONS: Although cardiac changes were noted during laparoscopic gynecologic surgery approximately 20 years ago, only in the last few years have cardiovascular changes been noted during laparoscopic cholecystectomies. Surgeons should be prepared to encounter such cardiovascular changes even with low-risk patients as it appears that bradycardia is a persistent occurrence during laparoscopic cholecystectomies.

Adult↗
PubMed2004

Biliary ascariasis as a cause of post-cholecystectomy syndrome in an endemic area.

BACKGROUND: Post-cholecystectomy syndrome encompasses numerous biliary, pancreatic and other entities. Biliary ascariasis is a common cause of adult biliary disease in an endemic area. Post-cholecystectomy biliary ascariasis, a cause of post- cholecystectomy syndrome although not yet defined is frequently seen in this part of the world. METHOD: Between Jan. 1990 and Jan. 2001, 104 cases of post-cholecystectomy biliary ascariasis were seen. Ultrasonography was found to be an excellent tool for diagnosing and monitoring of the worms inside the biliary tract. Endoscopic retrograde cholangiopancreatography had both diagnostic and therapeutic value. RESULTS: The majority (68.2%) of patients responded to conservative treatment. Surgical treatment was advocated in 18.2%, which included 2 patients with liver abscesses. Endoscopic extraction of worms was successful in 48.2%. CONCLUSION: Post-cholecystectomy biliary ascariasis as a cause of post-cholecystectomy syndrome needs to be included in the list of causes for post-cholecystectomy syndrome. Although the majority of patients respond to conservative treatment but endoscopic extraction or surgical intervention may be needed. Routine deworming of patients undergoing cholecystectomy both preoperatively and postoperatively should be done in all patients in endemic areas of ascariasis. Although this entity is rare in Europe and United States, due to population migration and increased travel, it is necessary for surgeons in these countries to be aware of this condition.

Adolescent↗
PubMed2004

Is routine cholecystectomy required during laparoscopic gastric bypass?

BACKGROUND: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of our study was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric bypass (LRYGBP). METHODS: 289 LRYGBP were performed between November 1999 and May 2002. 60 patients (21%) who had prior cholecystectomy were excluded. If gallstones were identified by intra-operative ultrasound (IOUS), simultaneous cholecystectomy was performed. Patients without gallstones were prescribed ursodiol for 6 months and scheduled for follow-up with transabdominal ultrasound. RESULTS: During LRYGBP, gallstones were detected in 40 patients using IOUS (14%) and simultaneous cholecystectomy was performed. Of 189 patients with no stones identified by IOUS, 151 patients (80%) had a postoperative ultrasound after 6 months. 39 patients developed gallstones (22%) and 12 developed sludge (8%), as demonstrated by ultrasound at the time of follow-up. 11 patients had gallstone-related symptoms and subsequently underwent cholecystectomy (7%). 106 patients (70%) were gallstone-free at the time of ultrasound follow-up. Ursodiol compliance was found to be significantly lower for patients developing stones than for gallstone-free patients (38.9% vs 58.3%, z =-2.00, P = 0.045). CONCLUSIONS: There is a low incidence of symptomatic gallstones requiring cholecystectomy after LRYGBP. Prophylactic ursodiol is protective. Routine IOUS and selective cholecystectomy with close patient follow-up is a rational approach in the era of laparoscopy.

Adolescent↗
PubMed2004

Is routine cholecystectomy required during laparoscopic gastric bypass?

BACKGROUND: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of this study was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric bypass (LRYGBP). METHODS: 289 LRYGBP were performed between November 1999 and May 2002. 60 patients (21%) who had prior cholecystectomy were excluded. If gallstones were identified by intra-operative ultrasound (IOUS), simultaneous cholecystectomy was performed. Patients without gallstones were prescribed ursodiol for 6 months and scheduled for follow-up with transabdominal ultrasound. RESULTS: During LRYGBP, gallstones were detected in 40 patients using IOUS (14%) and simultaneous cholecystectomy was performed. Of 189 patients with no stones identified by IOUS, 151 patients (80%) had a postoperative ultrasound after 6 months. 33 patients developed gallstones (22%) and 12 developed sludge (8%) as demonstrated by ultrasound at the time of follow-up. 11 patients had gallstone-related symptoms and subsequently underwent cholecystectomy (7%). 106 patients (70%) were gallstone-free at the time of ultrasound follow-up. Ursodiol compliance was found to be significantly lower for patients who developed stones than for gallstone-free patients (38.9% vs 58.3%, z =-2.00, P = 0.045). CONCLUSIONS: There is a low incidence of symptomatic gallstones requiring cholecystectomy after LRYGBP. Prophylactic ursodiol is protective. Routine IOUS and selective cholecystectomy with close patient follow-up is a rational approach in the era of laparoscopy.

Adolescent↗
PubMed1991

Laparoscopic cholecystectomy: evolution, early results, and impact on nonsurgical gallstone therapies.

Laparoscopic cholecystectomy, a surgical technique first performed in France, has gained widespread acceptance among surgeons in the United States. The abdominal cavity is inflated by carbon dioxide, a video monitor is inserted via a laparoscope placed periumbilically, and the gallbladder is freed and removed from the liver bed by using small subcostal ports for access and dissection. Intraoperative cholangiography is routinely performed, but uncertainty exists about how best to manage choledocholithiasis. Compared with traditional cholecystectomy, initial reports describing laparoscopic cholecystectomy cite shorter recovery times because no large incisions are made, thus potentially reducing the cost and morbidity of cholecystectomy. A survey of 614 early cases supports these claims, with a reported complication rate of 1.5% and quick resumption of normal activities by patients. Because of its promise for reduced morbidity, laparoscopic cholecystectomy is challenging open cholecystectomy as the therapeutic gold standard for symptomatic cholelithiasis. Thus, the standard to which the nonsurgical gallstone therapies, such as lithotripsy and contact dissolution, will be compared may shift to laparoscopic cholecystectomy. As the laparoscopic complications are similar to those of traditional cholecystectomy, such as abscesses and bile leaks, their percutaneous treatment should not change.

Cholecystectomy↗
PubMed1999

Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy.

BACKGROUND: Gangrenous cholecystitis occurs in up to 30% of patients admitted with acute cholecystitis. Factors predicting gangrenous disease in patients with acute cholecystitis remain poorly defined, making preoperative diagnosis difficult. Identification of these factors and early diagnosis of gangrenous cholecystitis will indicate more aggressive treatment, earlier operation, and a lower threshold for conversion of laparoscopic to open cholecystectomy. METHODS: We reviewed our experience with acute cholecystitis during the 2-year period of 1995 to 1996. Admitting history, physical examination, operative report, laboratory and radiology data, and pathology report were analyzed for each patient. Acute cholecystitis and its gangrenous complication were diagnosed by both gross and microscopic examination. RESULTS: One hundred fifty-four patients were admitted to the hospital with acute cholecystitis and underwent cholecystectomy; gallbladder gangrene was found in 27 (18%) of these patients. Four patients with gallbladder gangrene underwent open cholecystectomy and 23 patients underwent laparoscopic cholecystectomy, of which 15 (65%) were completed laparoscopically and 8 (35%) had open conversion as a result of severe inflammation. Risk factors for gallbladder gangrene included male gender, age older than 50 years, history of cardiovascular disease, and leukocytosis greater than 17,000 white blood cells/mL. CONCLUSIONS: Older male patients (age older than 50 years) with history of cardiovascular disease, leukocytosis greater than 17,000 white blood cells/mL, and acute cholecystitis have increased risk of gallbladder gangrene and conversion of laparoscopic cholecystectomy to open cholecystectomy. Urgent laparoscopic cholecystectomy with low threshold for conversion to open cholecystectomy should be considered in these patients at high risk for gallbladder gangrene.

Acute Disease↗
PubMed2003

[Laparoscopic cholecystectomy--accessory bile ducts].

INTRODUCTION: Modern medical technology (ultrasonography, intraoperative radiologic contrast methods, ERC, CT and NMR) help in performing laparoscopic cholecystectomy and operative procedures on bile ducts. The safe performance of these operative procedures requires good knowledge of clinical anatomy. In spite of excellent laparoscopic visualization, perioperative lesions of vascular structures or extrahepatic (especially accessory) bile ducts during laparoscopic cholecystectomy are a frequent cause of intra- and postoperative complications. Therefore, we wish to point to the potential risk of running into accessory bile ducts on dissection within or around the cystohepatic triangle, which may entail some overlooked and untreated lesions. PATIENTS AND METHOD: Accessory bile ducts originate from the liver parenchyma and may enter a large bile duct or gallbladder at any location, or can directly enter the intestine. The accessory bile ducts encountered on cholecystectomy or bile duct procedure call for special attention. We found accessory bile ducts in 13 (0.52%) patients during the procedure of laparoscopic cholecystectomy. There are three groups of 'risky' accessory bile ducts that can be encountered during laparoscopic cholecystectomy. Group I includes accessory bile ducts encountered on gallbladder removal from its support: 1) Luschka's subvesical accessory bile duct was found in six (46.1%) patients. A lesion to these ducts was intraoperatively observed in three (23.1%) patients, whereas in another three (23.1%) patients it was only detected and treated on reoperation; 2) the hepatocystic bile duct enters gallbladder directly from liver parenchyma, in the area of the gallbladder lobe. A hepatocystic accessory bile duct was identified during one (7.7%) laparoscopic cholecystectomy, when the duct lumen was observed on the gallbladder removal from the lobe, and another one (7.7%) was only identified on reoperation. Group II comprises accessory bile ducts encountered during dissection in the cystohepatic triangle, between the two hepatovesical plicae: 1) the hepatocystic accessory bile duct runs from liver parenchyma into the cystic duct within the cystohepatic triangle. Bile leak from a bile duct approaching the cystic duct immediately below the clip was observed on reoperation in one (7.7%) patient; 2) the hepatohepatic accessory bile duct drains a part of the liver and runs into the common hepatic duct within the cystohepatic triangle. During one (7.7%) dissection, another delicate bile duct originating from liver parenchyma was detected upon cystic duct clipping. Bile leak from a bile duct running into the common bile duct before entering the properly occluded cystic duct was observed on one (7.7%) reoperation; 3) anastomotic accessory bile ducts connect cystic duct with the common hepatic duct, or connect gallbladder, which has its own cystic duct, with the common hepatic duct or right hepatic duct. In our laparoscopic practice, we did not encounter this type of accessory bile ducts. Group III includes accessory bile ducts observed in the laparoscopic operative field, beyond the cystohepatic triangle, during cholecystectomy and bile duct procedures: 1) the hepatocystic accessory bile duct leaves liver parenchyma and enters the gallbladder at various sites. Stumps of two such accessory bile ducts (15.4%) were detected on reoperation. One entered the gallbladder below the cystic duct entry, and the other approached the gallbladder from above. RESULTS: Reoperation following laparoscopic cholecystectomy was required in 15 (0.6%) patients. In eight (53.3%) of these, the reason for reoperation was untreated lesion of accessory bile duct in eight (53.3%), other untreated minor lesions of the cystic duct in five (33.3%), and lesions of the hepatocystic duct in two (13.3%) patients. Out of the eight patients reoperated on for untreated lesion of accessory bile duct, reoperation was indicated by external biliary secretion by drain for more than 7 days in three (37.5%), and by the development of biliary peritonitis with the symptom of pain in five (62.5%) patients. Right-sided shoulder pain and elevated body temperature were recorded in two (40.0%) patients each, whereas abdominal distension with pronounced local defense and hyperbilirubinemia were observed in four (80.0%) patients each. A combination of these symptoms was present in the majority of patients. The prevalence of symptoms was consistent with literature reports. Of the eight patients reoperated on for lesions of accessory bile ducts, the lesion was managed by repeat laparoscopy procedure in five (62.5%) and by laparotomy in three (37.5%) patients. There was no mortality. CONCLUSION: Besides technical skill and experience, good knowledge of the clinical anatomy of accessory bile ducts is required to reduce the incidence of postoperative biliary secretion. Based on our own experience, lesions to accessory bile ducts are the most common cause of postoperative complications.

Bile Ducts↗
PubMedDate not supplied

[Cholecystectomy via video laparoscopy: the whys of a choice].

The management of calculous disease of the gallbladder has undergone significant change during the last decade. Recent years have seen the development of alternative methods for the treatment of biliary stones including dissolution therapy, endoscopic and percutaneous extraction, extracorporeal shock wave lithotripsy. Yet, despite these technologic advances, most surgeons have continued to consider cholecystectomy the safest, most effective and the only curative procedure. Open cholecystectomy, performed in the same fashion for more than a century has demonstrated low morbidity and minimal mortality rates. However, the operation does incur sizable expense in terms of hospitalization, cosmetic appearance and time lost from work. Laparoscopic cholecystectomy quickly emerged as an alternative to open cholecystectomy. The authors report their experience of laparoscopic cholecystectomy performed at the Surgical Department of Montecchio Maggiore Hospital (VI). Twenty-eight patients were operated on: in all but one laparoscopic cholecystectomy was successfully completed; in one case a fistula between gallbladder and the common bile duct led to T-tube drainage insertion via a laparotomy. In one patient laparoscopic cholecystectomy was performed after an endoscopic retrograde cholangio-sphincterotomy for associated stones of the common bile duct. Mean operative time was 69 minutes (range 46-210). Morbidity and mortality were 0%; maximal hospital stay was 48 hours. These data confirm that laparoscopic cholecystectomy may be considered the treatment of choice for stone disease of the gallbladder and it should enter into the cultural and technical background of a general surgeon.

Adult↗
PubMed1992

Complications of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy with lasers or cautery is a feasible, effective, and worthwhile operative procedure that is subject to morbidity and mortality. There is unequivocal evidence that the complication incidence is directly related to the training and experience of the surgeon, applicability of basic principles of gallbladder and common duct surgery, and preventive measures toward iatrogenic injuries in gallbladder surgery. Continued and sustained investigation in laparoscopic cholecystectomy, technological developments in equipment, and the continued education of the surgeon in the applicability and use of laparoscopic cholecystectomy, intraoperative cholangiography, and choledocholithotomy are essential. At the St Francis Medical Center, Pittsburgh, Pennsylvania 1009 laparoscopic cholecystectomies with lasers or cautery were performed between March 1989 and October 1991. There were 32 (3%) abandoned laparoscopic cholecystectomies with alternative open cholecystectomy. There were six extrahepatic ductal injuries and a complication incidence of 10.9%. The mortality rate was 0.38%. The average length of stay was 2 days. In comparison with standard cholecystectomy, laparoscopic cholecystectomy is a competitive and superior procedure in selected circumstances.

Bile Ducts↗
PubMed1992

Electrosurgical laparoscopic cholecystectomy.

Though laparoscopic cholecystectomy has become widespread, questions remain as to its success rate, its role in acute cholecystitis, the role of cholangiography, and whether laser use is necessary. To attempt to answer these questions, the first 100 patients undergoing laparoscopic cholecystectomy at Emory University using electrosurgical diathermy were reviewed. Patients underwent cholecystectomy for biliary colic (87), gallstone pancreatitis (1), and acute cholecystitis (12). The average length of hospital stay was 29 hours (range: 12 hours to 5 days). Laparoscopic cholecystectomy was not possible in 7 patients because of gangrenous cholecystitis (2), adhesions from previous surgery (2), equipment failure (2), and choledochoduodenal fistula found at surgery (1). Two patients developed bile leaks from accessory bile ducts that healed spontaneously. There were no other complications. The average time required to complete the laparoscopic cholecystectomy was 115 minutes (range: 45 to 238 minutes) and was not significantly different in those patients undergoing intraoperative cholangiography (117 minutes) versus those without (109 minutes). Common duct stones were uncommon in this series. Thirty-three patients underwent intraoperative cholangiogram. One patient was found to have a common duct stone, which was pushed into the duodenum using a Fogarty catheter (American Edwards Laboratories; Anasco, Puerto Rico) inserted through the cystic duct at the time of laparoscopic cholecystectomy. Twelve patients with acute cholecystitis underwent an attempt at laparoscopic cholecystectomy that was successful in nine. These procedures were difficult and lengthy (mean of 143 minutes). Causes for failure were gangrenous cholecystitis (2) and equipment failure (1). In conclusion, laparoscopic cholecystectomy can be performed with a high success rate (93%) and low morbidity (2%). No complications seemed attributable to electrosurgical dissection.

Adolescent↗
PubMed2004

[Actual status of laparoscopic cholecystectomy].

INTRODUCTION: Since the first laparoscopic cholecystectomy in 1988, the management of gall-bladder disease has changed importantly. This technique was rapidly popularized in the U.S. as well as in Europe. Multiple studies have proved its feasibility, safeness and great advantages. OBJECTIVE: Analyze usefulness and recent advances of endoscopic surgery in the management of gallbladder disease. METHODS: We did a review of the recent medical literature to determine the actual status of laparoscopic cholecystectomy. RESULTS: Laparoscopic cholecystectomy is the most common surgical procedure performed in the digestive tract. During the year 2001, 1,100,000 cholecystectomies were done in the U.S., 85% were done laparoscopically. In Mexico cholecystectomy in government hospitals is done laparoscopically in 50% of the cases, while in private hospitals it reaches 90%. There are multiple prospective controlled studies showing superiority of laparoscopic cholecystectomy in times of recovery, costs, return to normal activity, pain, morbidity, esthetics among other advantages. CONCLUSIONS: Laparoscopic cholecystectomy is the gold standard for the treatment of the great majority of cases of gallbladder disease, nevertheless in developing countries open cholecystectomy is still done frequently.

Cholecystectomy, Laparoscopic↗
PubMed2005

Natural history of asymptomatic bile duct stones at time of cholecystectomy.

OBJECTIVES: There is little data on the natural history of asymptomatic bile duct stones and hence there is uncertainty on the management of asymptomatic bile duct stones discovered incidentally at the time of laparoscopic cholecystectomy. We retrospectively reviewed a group of patients who had previously underwent laparoscopic cholecystectomy, but who did not have a pre-operative suspicion of intra-ductal stones, to determine if any biliary complications had subsequently developed. A group of patients who had no pre-operative suspicion of intra-ductal stones, but routinely underwent intraoperative cholangiogram (IOC) at time of cholecystectomy, served as the control group. METHODS: A telephone questionnaire was completed by each patient's family practitioner in 59 of 79 (75%) patients who underwent laparoscopic cholecystectomy. In the remaining 20 patients additional information was obtained from hospital records and from the central services agency (CSA). These patients had no pre-operative suspicion of bile duct stones and therefore did not undergo an IOC or ERCP. The control group (73 patients) had no pre-operative suspicion of bile duct stones but had a routine IOC performed to define the biliary anatomy. RESULTS: 59 patients were followed up for an average of 57 months (range 30-78 months) after laparoscopic cholecystectomy. None of these patients developed pancreatitis, jaundice, deranged liver function tests (LFT's), or required ERCP or other biliary intervention. In the additional 20 patients where no information was available from the family practitioner, 11 patients had follow up appointments with no documentation of biliary complications or abnormal LFT's. 19 of 20 patients were traceable through the CSA and were all alive. Only 1 patient was untraceable and therefore unknown if biliary complications had developed. In the control group, 4 of 73 (6%) patients had intraductal stones detected and extracted. Thus the prevalence of asymptomatic bile duct stones during the time of cholecystectomy in our population was 6%. CONCLUSIONS: Asymptomatic bile duct stones discovered at the time of cholecystectomy do not appear to cause any biliary complications over a 5-year follow up. Incidental bile duct stones found in patients undergoing laparoscopic cholecystectomy may not need to be removed.

Adult↗
PubMed1985

Is there an increased risk of colorectal cancer after cholecystectomy?

The incidence of cholecystectomy was not higher in 525 colorectal cancer patients than in subjects without colorectal cancer of the same age and sex living in the same region. If we did not include the persons who underwent cholecystectomy 1 or 2 years before the diagnosis or the examination was made, the number of cholecystectomy patients was the same in both groups. Right-sided and left-sided localizations of colon cancer after cholecystectomy did not differ from those without cholecystectomy. The tendency to right-sided colon cancer in women who have undergone cholecystectomy was not significant. Patients after cholecystectomy have no higher risk of colorectal cancer than persons without cholecystectomy.

Adult↗
PubMed1984

Lack of relationship between cholecystectomy and colorectal cancer. A case control autopsy study in a defined population.

To study the postulated relationship between prior cholecystectomy and occurrence of subsequent colorectal cancer, we examined the prevalence of cholecystectomy in all patients with histologically confirmed colorectal cancer registered during 1966-75 in the city of Malmö. In addition, we studied the frequency of colon cancer in all females autopsied in 1978-79 with a previous cholecystectomy. Of all 1061 cases of colon cancer diagnosed during the 1966-75 period, 94 (8.9%) had undergone cholecystectomy, as compared with 106 (10.0%) in the age-matched controls. In the female subgroup (n = 503) the corresponding figure for cholecystectomy was 58 (11.5%), as compared with 70 (13.9%) in the controls. The incidence of right-sided colon cancer among the 58 females with previous cholecystectomy did not differ from that of age-matched controls (28.6 and 28.1%, respectively). The incidence of colon cancer among 305 females with a prior cholecystectomy autopsied during 1978-79 was 24 (7 right-sided), as compared with 22 (8 right-sided) in age-matched controls without gallbladder disease. Gastric cancer was more frequent (p less than 0.01) in cholecystectomized women than in controls. These results refute the suggested relationship between cholecystectomy and development of colon cancer in any location.

Autopsy↗
PubMed1983

Cholecystectomy with intraperitoneal drain.

The effects of prophylactic intraperitoneal drainage after cholecystectomy were studied in 389 patients operated upon with elective and in 68 patients operated upon with acute cholecystectomy. The drainage fluid and the duration of drainage were measured and related to clinical variables and postoperative morbidity. The amount of drainage fluid varied from 0 to 1075 ml after elective cholecystectomy and from 5 to 4500 ml after acute cholecystectomy, but there was no statistically significant difference between electively and acutely operated patients. Increased amounts of drainage fluid were significantly more often found in patients with not dry operative field at the end of the operation compared to patients with dry operative field. The maximum daily discharge of drainage fluid occurred during the first and second postoperative day in most patients. The incidence of postoperative morbidity was significantly higher in patients operated upon with acute cholecystectomy. After elective cholecystectomy the postoperative morbidity was significantly increased in patients who drained greater than 150 ml of fluid and also in patients who were drained for three days or more. Relaparotomies because of intraperitoneal hemorrhage and bile leakage or abscess were in spite of intraperitoneal drain performed in six patients after elective cholecystectomy and in one patient after acute cholecystectomy.

Adolescent↗
PubMed1993

[Traditional open cholecystectomy].

During the past 5 years, traditional open cholecystectomy was performed on 344 patients with gallbladder stones at our hospital. Using the data obtained, we studied the indications and results of traditional open cholecystectomy. In the cases of gallbladder stones with a history of cholecystitis, cholecystectomy was performed as a rule by laparoscopic cholecystectomy. However, traditional open cholecystectomy was chosen in cases which were complicated by perforation, pericholecystic abscess, internal biliary fistra, cirrhosis, or suspicious carcinoma of gallbladder. Investigation of the time of operation revealed that early operation tended to be performed easily. However, cases with gallbladder stones were often complicated with carcinoma of alimentary tracts, therefore before operation we must examine the alimentary tract. Cases in which gallbladder could not be visualized under ERCP, and those accompanied by pericholecystic abscess under US were difficult to operate on by laparoscopic cholecystectomy. Thus many cases required laparotomy. Postoperative complications of open cholecystectomy were rare, it was concluded that traditional cholecystectomy is one of the most valuable procedures for the treatment of gallbladder stones.

Aged↗
PubMedDate not supplied

Incidental cholecystectomy in the over-70 age group. A 19-year retrospective, comparative study.

OBJECTIVES: To analyse the outcome of incidental cholecystectomy in the over 70 age-group during surgery for gastrointestinal malignancies. DESIGN: Nineteen-year retrospective, comparative study. SETTING: Department of Surgery B, Belinson Campus, Rabin Medical Center. SUBJECTS: The hospitalization records of 4,072 patients who underwent cholecystectomy between 1975 and 1994 were reviewed. The incidental cholecystectomy cases for this period were identified and those performed during surgery for gastrointestinal malignancy were analysed separately. A sex- and age-matched control group was identified for comparison. MAIN OUTCOME MEASURES: Postoperative complications, overall morbidity and mortality, postoperative hospitalization days. Statistical differences in gallbladder-related complications and mortality among groups. RESULTS: Mortality and overall morbidity were significantly increased in the no-cholecystectomy group. Hospitalization days were increased significantly in the group not under-going cholecystectomy and although it didn't reach statistical significance, there was a clear trend for increased number of pulmonary complication in this same group. Sepsis and multiorgan failure, as an expression of acutely, postoperative symptomatic gallbladder were the major cause of death in the no-incidental-cholecystectomy group. CONCLUSIONS: Incidental cholecystectomy is safe and should be considered in every case of abdominal surgery, regardless of the age of the patient. In the over 70 age group, complication and mortality rates increase significantly and dreadfully when the gallbladder is left in situ after surgery for gastrointestinal tumors. Incidental cholecystectomy is not warranted in patients undergoing palliative procedures or in whom life expectancy is less than 6 months.

Age Factors↗
PubMedDate not supplied

Anatomical limit of extended cholecystectomy for gallbladder carcinoma involving the neck of the gallbladder.

BACKGROUND: Extended cholecystectomy is the common operation for gallbladder carcinoma. When extended cholecystectomy is performed, the liver bed can be generously resected from the fundus to the body of the gallbladder; however, the thickness of the liver parenchyma to be removed is limited to the neck of the gallbladder. There have been few reports providing convincing data with regard to how thick the liver can be anatomically resected by extended cholecystectomy. METHODS: The thickness of the liver tissue actually resected at the time of extended cholecystectomy and that potentially resected by extended cholecystectomy were measured in 24 clinical and 25 autopsy cases, respectively, to assess the anatomical limit of extended cholecystectomy. RESULTS: The mean anatomical distances from the neck of the gallbladder to the right hepatic duct and to the bifurcation of the anterior and posterior branch of the right hepatic duct were only 1.6 and 5.9 mm, respectively. The distance from the gallbladder to the bifurcation of the superior and inferior branch of the right anterior hepatic duct, and to the root of the right anterior inferior hepatic duct were 11.2 mm2, and 12.8 mm3, respectively (123:p < 0.05). The actual width of the liver excised by extended cholecystectomy was 5.2 mm at the neck, 11.7 mm at the body, and 8.1 mm at the fundus of the gallbladder, respectively. These results indicate that the neck of the gallbladder is anatomically close to the hepatic hilum including the right hepatic duct and portal vein. CONCLUSIONS: Surgical strategy for gallbladder carcinoma should be considered to rely not only upon the depth of invasion but also upon the site of gallbladder tumor. When gallbladder carcinoma involves the muscle layer or further at the neck of the organ, more extensive hepatectomy than extended cholecystectomy should be considered.

Adult↗