Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CHOLECYSTECTOMY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 595 records · Page 33Linked to original sources
PubMed2006

Feasibility of same day discharge after mini-laparotomy cholecystectomy -- a simulation study in a rural teaching hospital.

OBJECTIVE: Open cholecystectomy is still widely practised, more so in the developing countries, due to the high cost of laparoscopic cholecystectomy. However, the long traditional postoperative stay (7-8 days) prevents rapid turnover and adds to the waiting list. The aim of this study was to evaluate whether mini-laparotomy cholecystectomy (MLC) can be done as a day surgery or extended day surgery in a rural setting. METHODS: A nonrandomized, uncontrolled study was done prospectively at the North Bengal Medical College and Hospital. The subjects underwent mini-laparotomy cholecystectomy under general or epidural anesthesia. Postoperatively they were encouraged to be ambulant early and to accept oral fluids. In the evening they were assessed, by preset criteria, for fitness for discharge. None were actually discharged but were observed overnight and reassessed the next morning, by the same criteria, for any adverse effects that could have occurred had they actually been discharged on the same day. They were discharged after removal of stitches. Any complications of the surgery were also noted. RESULTS: Thirty-two patients (26 females, 6 males) formed the study group. General anesthesia was given in 19 cases and epidural in 13. Using the scoring system, 25 (78.1%) patients were considered fit for discharge on the evening of surgery. The most prominent reasons for non discharge were vomiting and pain. Re-evaluation on the following morning showed that 30 (93.75%) patients were in a position to be discharged. None showed any complication that would have required readmission. There were no significant complications pertaining to the procedure itself. CONCLUSION: Mini-laparotomy cholecystectomy as day surgery or extended day surgery is feasible and a safe, well tolerated procedure in a wide range of age groups. It may be a good alternative to laparoscopic cholecystectomy in developing countries, where resources are limited and waiting lists are long.

Ambulatory Surgical Procedures↗
PubMed2006

Laparoscopic cholecystectomy: past, present, and future.

Laparoscopic cholecystectomy is one of the most commonly undertaken procedures in General Surgery with more than 500,000 performed annually. Overall, the complication rate is less than 1.5%, and the mortality rate is less than 0.1%. As such, laparoscopic cholecystectomy was considered by most to be at its zenith since its inception in the early 1990 s. Advancements in technology and equipment have opened new doors to physicians and allowed the laparoscopic cholecystectomy to once again evolve. Traditional four-port cholecystectomy has given way to three- and even two-port techniques. Standard 12-mm ports have been replaced by 2-mm ports, and experiments have now been implemented to achieve cholecystectomy with no ports-known as the transgastric technique. The authors reviewed evolution of these techniques that included a synopsis of our experience with the three-port cholecystectomy, as well as the future direction of laparoscopic surgery.

Cholecystectomy, Laparoscopic↗
PubMed1991

Laparoscopic cholecystectomy: a hundred consecutive cases.

Laparoscopic cholecystectomy is a new, minimaly invasive technique for removing the gallbladder which has several advantages over the traditional laparotomy cholecystectomy. We reviewed our initial experience with 100 consecutive patients in whom laparoscopic cholecystectomy was attempted. The indications for operation were biliary colic, chronic cholecystitis, acute gallbladder and gallstone pancreatitis. Laparoscopic cholecystectomy was successfully performed in 87 patients. Anaesthesia time was 144 +/- 52 min. There was no mortality while overall morbidity was 14%. One patient had a retained common bile duct stone. Postoperative hospital stay was 4.1 +/- 2.2 days and the mean time to full activity in a random sample of 25 patients was 13.7 +/- 11.7 days. Laparoscopic cholecystectomy is a safe effective procedure which removes the gallbladder. We suggest that this technique be considered in all patients undergoing cholecystectomy.

Adolescent↗
PubMed1991

[Early vs delayed cholecystectomy for acute cholecystitis].

The timing of cholecystectomy in acute cholecystitis is still controversial. A marked change toward early surgery has been noted in the past decade. In a retrospective study of 197 patients we evaluated the results of cholecystectomy in 117 who underwent elective cholecystectomy, and in 80 operated on during the acute phase of cholecystitis. The diagnosis of acute cholecystitis was by isotope scan (HIDA) or ultrasound. There was no case of misdiagnosis. 3 patients died postoperatively: 2 in the early operation group (1 had emergency cholecystectomy) and 1 in the elective group. Postoperative complications were more frequent in the early surgery group (p = 0.06). The highest morbidity was in early cholecystectomy in those older than 60 years who had cardiovascular disease (p less than 0.0002). Hernia in the scar was a unique complication of the early operation. According to most studies reviewed, early operation eliminates the need for emergency operation when conservative treatment fails, without increasing morbidity or mortality. Therefore, early operation during the acute phase of cholecystectomy is advised. For patients older than 60 years who have cardiovascular disease, we recommend delaying surgery until the acute inflammation subsides. The waiting period before surgery should be as short as possible in order to reduce the risk of recurrent cholecystitis and its complications.

Acute Disease↗
PubMed1990

Hepatobiliary compensation for the loss of gallbladder function after cholecystectomy. An experimental study in the cat.

The side effects of the removal of a functioning gallbladder are surprisingly few, and it has been suggested, but never demonstrated, that the hepatobiliary tract then adjusts to compensate for the loss of gallbladder function. In this study the effects of cholecystectomy on bile acid kinetics, bile flow, and biliary clearance of mannitol were studied in cats 6-8 weeks after cholecystectomy. An enhanced recycling rate of a diminished bile acid pool was found. The bile flow was reduced and the bile acid concentration in hepatic bile was increased, but fasting bile acid secretion rate was not changed. Both when the bile acid secretion rate was reduced by drainage via an acute bile fistula and when it was enhanced by intravenous infusion of glycocholic acid, there was a lower bile acid-independent flow in the cholecystectomy group. This reduced bile flow after cholecystectomy was not explained by the higher proportion of deoxycholic acid present in the bile of the cholecystectomized animals. Biliary clearance of mannitol, which is supposed to reflect the canalicular inflow, was not reduced, indicating that the reduction in bile flow is explained by a reduced fluid secretion or an enhanced fluid reabsorption in the bile ductules and ducts after cholecystectomy. In this manner the bile ducts compensate for the loss of the absorptive function of the gallbladder after cholecystectomy.

Animals↗
PubMed1990

[Early cholecystectomy for acute cholecystitis; effect of length of symptoms on morbidity and mortality].

In this retrospective study the results of "early' cholecystectomy for acute cholecystitis were analysed, especially the influence of duration of symptoms on morbidity and mortality. During a 4-year period 122 patients underwent early cholecystectomy for acute cholecystitis. The mean age was 64 years (range 20-101). Cholecystectomy was performed in 93 patients, 25 underwent cholecystectomy and common bile duct exploration and the remaining 4 patients cholecystostomy. The mortality was 1.6% (2 patients 88 and 89 years of age). Biliary surgery related complications and wound infection occurred in 14 and 11 patients respectively. There was no significant difference in morbidity and mortality according to duration of symptoms (2 days versus 2-7 days). The duration of symptoms is not a major contraindication to early cholecystectomy. Early cholecystectomy appears to be a safe procedure for acute cholecystitis for patients within 7 days after onset of symptoms.

Acute Disease↗
PubMedDate not supplied

Obesity and cholecystectomy among women: implications for prevention.

Almost all studies of the association of body mass with the risk of gallbladder disease have found that risk increases with obesity. Some studies report a nonlinear relationship of body mass to gallbladder disease risk, and some report that the association of excess body mass with increased risk of gallbladder disease is confined to younger women. We examined the association of body mass with the risk of cholecystectomy based on data from 14 years of follow-up of 16,638 women. The cholecystectomy rate was much greater in the highest quintile of Quetelet's body mass index than in other quintiles. The striking association of high rates of cholecystectomy with the highest quintile of Quetelet's body mass index was observed in each age group studied. The low incidence of cholecystectomy in young, thin women made the relative risk of cholecystectomy in women in the fifth quintile of body mass highest in women under 25 years of age. The observation that cholecystectomy rates are not linearly associated with obesity suggests that women in the highest quintiles of body mass could be considered a reasonable group in which strategies for prevention of gallbladder disease might be tested.

Adult↗
PubMed1984

Bile reflux to the stomach and gastritis before and after cholecystectomy.

Thirty-four patients with gallstone disease were examined with cholescintigraphy and gastroscopy before and after cholecystectomy. Sixteen patients had a functioning and 23 a non-functioning gallbladder at cholescintigraphy. At scintigraphy 99Tcm-activity was found over the gastric fundus in 28% before and in 22% after cholecystectomy and there was no difference between the groups with and without a functioning gallbladder regarding bile reflux. Before cholecystectomy bile-stained contents in the stomach was significantly more often found among those with a non-functioning gallbladder (87%) than in those with a functioning gallbladder (44%). After cholecystectomy the number of patients with bile-stained contents in the stomach was high in both groups (92% and 82% respectively). No correlation could be found between the two methods to detect bile in the stomach. Before cholecystectomy patients with a functioning gallbladder had inflammatory changes in the antral as well as the fundic mucosa in 31%. Patients with a nonfunctioning gallbladder had inflammatory changes in the antral mucosa in 47% and in the fundic mucosa in 56%. These differences were however not statistically significant. No correlation could be found between bile-stained contents in the stomach and chronic gastritis or scintigraphically detected bile in the stomach and chronic gastritis. The degree and distribution of chronic gastritis was virtually unchanged one year after cholecystectomy.

Adult↗
PubMedDate not supplied

[Quantitative evaluation of the duodenogastric reflux after cholecystectomy and transduodenal sphincteroplasty: experimental study in dogs].

The role of cholecystectomy and transduodenal sphincteroplasty on duodenogastric reflux (DGR) is still controversial. PURPOSE--To assess the effect of cholecystectomy alone, transduodenal sphincteroplasty alone and cholecystectomy combined with transduodenal sphincteroplasty on bile reflux into the stomach. METHODS--40 dogs were divided into four groups: control group (C) (n = 12), cholecystectomy group (Co) (n = 10), transduodenal sphincteroplasty group (Es) (n = 10) and cholecystectomy plus transduodenal sphincteroplasty group (Co+Es) (n = 8). A quantitative index of DGR was obtained in each case by determining the percentage of the intravenously injected 99m Technetium-DISIDA that was recovered in the gastric juice. RESULTS--The DGR was significantly higher in Co+Es group (mean: 2.26 +/- 2.69%) than in the C group (mean: 0.23 +/- 0.26%), and the Co group (mean: 1.52 +/- 1.77%) and the Es group (mean: 1.23 +/- 1.23%) (p < 0.05). The DGR did not differ significantly between C, Co and Es groups (p > 0.05). CONCLUSION--The results shows that only cholecystectomy plus sphincteroplasty increases duodenogastric reflux.

Animals↗
PubMed1995

Comparison of initial laparoscopic cholecystectomy at a community hospital versus a teaching hospital.

OBJECTIVE: To compare the initiation of laparoscopic cholecystectomy at a community hospital versus a tertiary-care teaching hospital. DESIGN: Retrospective chart review. SETTINGS: A general community hospital in Prince George, BC, and a tertiary-care teaching hospital in Vancouver. PATIENTS: One hundred and eighty-two patients in the community hospital and 318 patients in the tertiary-care centre. INTERVENTION: Laparoscopic cholecystectomy for symptomatic gallbladder disease. MAIN OUTCOME MEASURES: Preparation of surgeons for the new technique, complication rates, operating time, conversion rates to open cholecystectomy and duration of hospitalization. RESULTS: All community surgeons took didactic and laboratory courses in preparation for the new procedure and assisted each other for their first 10 cases, but surgeons at the teaching hospital had more varied preparation that included additional extensive laboratory work and preceptorships with surgeons experienced with the procedure. The rates of major complications of laparoscopic cholecystectomy were 6.5% at the community hospital compared with 5% at the tertiary-care centre. The rates of minor complications were 5.5% at community hospital and 5.3% at the tertiary-care centre. The rates of conversion to open cholecystectomy were 6.6% for the community hospital versus 4.7% for teaching hospital. The mean (and standard deviation) operating time was shorter at the community hospital than at the teaching hospital: 72.3 (30) minutes versus 106 (32) minutes (p < 0.0001). The mean (SD) length of stay was 2.5 (1.8) days at the community hospital and 3.4 (1.9) days at the teaching hospital. CONCLUSIONS: The introduction of laparoscopic cholecystectomy during a 2-year period was achieved safely at both hospitals. The complication rates were similar. The length of stay and operating times were shorter in the community hospital.

Adult↗
PubMed1995

Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladder.

BACKGROUND: Early case reports suggest more frequent and rapid recurrences of carcinoma of the gallbladder after laparoscopic cholecystectomy (LC) than after open cholecystectomy. This cancer has a poor prognosis and occurs in 1 percent of patients who undergo cholecystectomies. STUDY DESIGN: A recent community hospital series of gallbladder carcinoma (GBC) was reviewed and the total reported experience of GBC after LC was compiled. Diagnostic findings were compared for patients with GBC and a consecutive series of 24 patients who had LC for benign disease. RESULTS: Nine patients with GBC were found among 928 patients who had undergone cholecystectomy (0.97 percent incidence). Compared to patients without GBC, patients with carcinoma were older, had thicker gallbladder walls, and had more abnormalities detected intraoperatively (all p < or = 0.05). Recurrence of GBC occurred more rapidly after LC, and in diffuse peritoneal and port sites when compared with recurrence patterns after open cholecystectomy. CONCLUSIONS: In patients with GBC, LC may be sufficient when the disease is confined to the gallbladder mucosa and the gallbladder is excised intact without bile spillage. However, patients whose gallbladders are torn during dissection or patients who have invasive tumors should undergo laparotomy and local reexcision. In situ GBC can be implanted if the organ is torn during dissection. When gallbladders with suspicious wall thickening or adhesions are noted at LC, especially in older patients, the procedure should be converted to open cholecystectomy.

Aged↗
PubMed1995

[Special complications of cholecystectomy performed by micro- and modern mini-laparotomy].

There is no data on the special complications of micro (less than 4 cm incision) and modern mini laparotomy cholecystectomies (4.1-6 cm incision). Out of 710 non selected patients, 643 micro laparotomy cholecystectomies were performed and 61 modern mini laparotomies due to choledocholithiasis. On three occasions, conventional mini (6.1-10 cm) laparotomy was performed and in another three, conventional laparotomy (over 10 cm incision) was executed. Intraoperative bleeding was encountered in 15 cases (2.1%) while accidental hepatic duct clipping occurred in one case (0.1%). Damage to the bile duct did not occur in any case reported. Postoperative bleeding was reported in 8 cases (1.1%) and delayed bile leakage was reported in 10 cases (1.4%). Special complications reported as a result of pathological alteration in the bile tract as follows: Intraoperative bleeding encountered during simple cholecystectomy-1% but cholecystectomy due to obstructive cholecystitis 3.8%, also caused by intraoperative bleeding. Delayed bile leakage in simple cholecystectomy was not observed, but after cholecystectomy for obstructive cholecystitis it encountered in 3.4%. Special complications resulted in four early reoperations (0.5%). Two other patients were re-operated within three weeks, independent of special complications. The percentage of both intra and postoperative complication was significantly higher in obstructive cholecystitis with an operative delay of 11 or more days.

Adolescent↗
PubMed1995

Laparoscopic cholecystectomy in the treatment of acute cholecystitis.

BACKGROUND: Laparoscopic cholecystectomy has several advantages over traditional cholecystectomy, which make it the treatment of choice for patients with uncomplicated biliary lithiasis. However, in patients with acute cholecystitis, the role of this technique remains controversial and some clinicians regard this condition as a contraindication to laparoscopic cholecystectomy. STUDY DESIGN: Between June, 1991 and July, 1993, a total of 259 patients with cholelithiasis underwent laparoscopic cholecystectomy at the "Virgen de la Arrixaca" University Hospital. Of these patients, 60 underwent laparoscopic cholecystectomy for acute cholecystitis. RESULTS: Conversion to laparotomy was necessary in eight patients (13 percent). Mean operating time was 83 minutes (range, 45 to 180 minutes). Overall mean hospital stay (laparoscopy and conversions) was 3.1 days (range, one to nine days). There was no mortality or injury to the common bile duct in our series. CONCLUSIONS: We believe that laparoscopic cholecystectomy in patients with acute cholecystitis is a safe and effective procedure, in which the patient can benefit from the advantages of laparoscopic surgery without an increase in mortality and morbidity rates.

Acute Disease↗
PubMed1995

The impact of state approval requirements on elective cholecystectomy patients.

A total of 215 cholecystectomies were performed at Kern Medical Center over a 20-month period from 10/92 to 5/94 and were retrospectively reviewed. Twenty-four males and 191 females ranged in age from 15-70 years. Of the total 215 cholecystectomies, 119 were performed electively and were separated into two groups. Group 1 (79) consisted of patients awaiting state authorization for cholecystectomy. Group 2 (40) consisted of patients who did not require state authorization. Date of diagnosis was defined as the date when the positive gallbladder ultrasound was completed which, in context with the clinical presentation, confirmed the need for cholecystectomy. The average number of days between diagnosis and cholecystectomy differed significantly between Group 1 and 2 (116 vs 23 respectively, P < .01). The average number of preoperative emergency room (ER) visits differed significantly between Group 1 and 2 (1.48 vs 0.76 respectively, P < .01). The average number of preoperative surgery clinic visits also differed between the two groups (2.88 vs 1.96 in Group 1 and 2 respectively, P < .01). Patients with symptomatic cholelithiasis requiring state approval for cholecystectomy had to wait longer for their operation, and preoperatively visited the ER and outpatient surgery clinic more often. Delay increases patient discomfort and adds additional strain to an already overcrowded ER and clinic. Finally, the economic impact is most likely significant as lost work hours, and additional ER and clinic visits cost taxpayers money.

Adolescent↗
PubMed1995

[Cholecystectomy performed by macro- and modern mini-laparotomy].

The conventional and laparoscopic cholecystectomy is as already every day utilized method, the operation procedure is well developed and the instruments used allow a reliable operation. The cholecystectomy performed by minilaparotomy is not yet a widespread procedure, since there is no established method and the instruments needed are not readily available, as well as the fact that special complications' rates is not yet well known. In order to further elaborate on the procedure and to demonstrate it's true value, 710 micro- and modern minilaparotomies, without exclusion or selection, were analyzed and the operation procedures were then summarized. The operations were completed with microlaparotomy (smaller than 4 cm incisions) in 643 cases (90.6%) with modern minilaparotomies (4.1-6 cm) in 61 cases (8.6%), with conventional mini (6.1-10 cm), and the incisions longer than 10 cm with conventional laparotomies in 3-3 instances (0.4-0.4%). We performed a complete cholecystectomy in 97.2%, a longer cystic stumps was left in 1.7%, subtotal and partial cholecystectomies in 0.7% and 0.3% respectively. In 69 of the cases (9.7%) simultaneous choledocholithiasis was discovered and resolved. 21.2% of the operations were termed as difficult. 2/3 of the intra and postoperative complications as well as early reoperations occured in cases where they followed a delayed operation of obstructive cholecystitis. One patient was lost (0.14%) due to non-surgical complication. These experiences show that cholecystectomy performed by micro and modern minilaparotomy is a realistic alternatives to the conventional and laparoscopic cholecystectomies.

Adolescent↗
PubMed1993

Laparoscopic cholecystectomy: the Springfield experience.

Laparoscopic cholecystectomy has become an accepted alternative to open cholecystectomy. The purpose of this paper is to review the first 150 laparoscopic cholecystectomies performed at our institution. Hospital and clinic charts were reviewed to obtain demographic information. Anesthesia time and length of hospital stay were recorded. The incidence of intraoperative cholangiogram and laser use were calculated. The type and overall rate of complications were determined, as were complication rates for specific patient subsets. Learning curves by individual surgeons were plotted and hospital costs recorded. Six staff surgeons performed or attempted laparoscopic cholecystectomy on 150 (118 female, 32 male) symptomatic patients. The average age was 43.9 years (range, 18-77). Sixty-five patients (43.3%) had undergone previous abdominal surgery. The average duration of anesthesia was 120.8 min (SD +/- 43.5). Eighteen patients (12.0%) had intraoperative cholangiograms, and 16 procedures (10.7%) employed the laser for dissection. Ten procedures (6.7%) were converted to open cholecystectomy at the discretion of the individual surgeon. Three patients (2.0%) were found to have acute cholecystectomy. Average hospitalization was 1.4 days (SD +/- 1.64). The overall complication rate was 9.3%. Complication rate by age was 7.2% (age < 50 years) versus 13.2% (age > or = 50 years). The complication rate in overweight patients was 15.52% compared with a rate of 5.43% for those not overweight (overweight was arbitrarily defined as > 175 lb for women, > 200 lb for men). The complication rate in patients who had previous abdominal surgery was 8.5% compared with 9.9% in patients who had not had previous abdominal surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Conventional cholecystectomy in elderly patients.

One hundred and seventy two consecutive patients of 70 years or older undergoing cholecystectomy at laparotomy for gallbladder stone disease during a five-year period in Tampere University Hospital were studied to evaluate the present safety of "conventional" cholecystectomy in the elderly. One hundred and six (62%) underwent emergency or urgent cholecystectomy for acute cholecystitis and 66 (33%) elective cholecystectomy. The mortality was zero per cent in elective operations as compared to 5% in emergency/urgent operations (P < 0.001). The complication rate was 8% in elective operations compared to 25% in emergency/urgent operations (P < 0.001). These results suggest that conventional cholecystectomy is a very safe operation in the elderly, when performed electively. The development of new methods to treat gallbladder stone disease, such as laparoscopic cholecystectomy, must be undertaken from this background.

Age Factors↗
PubMed1994

Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function.

BACKGROUND: Upper abdominal surgery is associated with severe postoperative pain and a concomitant reduction in pulmonary function and oxygen saturation. Laparoscopic cholecystectomy is said to result in less postoperative pain compared with open cholecystectomy. METHODS: In a pragmatic, randomized trial, postoperative pain, opiate analgesic consumption, oxygen saturation, and pulmonary function (forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow rate) were assessed after laparoscopic (n = 67) and minilaparotomy (n = 65) cholecystectomy. RESULTS: Compared with minilaparotomy cholecystectomy, laparoscopic cholecystectomy was associated with lower linear analogue pain scores (median 40 vs 59, p < 0.001), lower patient-controlled morphine consumption (median 22 vs 40 mg, p < 0.001), a smaller reduction in postoperative pulmonary function (mean peak expiratory flow rate 64% of preoperative value vs 49%, p < 0.001), and better oxygen saturation (mean 92.9% vs 91.2%, p = 0.008). CONCLUSIONS: This study confirms that the postoperative pain and pulmonary changes associated with upper abdominal surgery are significantly reduced by the laparoscopic technique. These findings suggest that laparoscopic cholecystectomy may result in a reduced risk of postoperative pulmonary complications.

Adult↗