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PubMed2000

["Acute cholecystitis"--laparoscopic cholecystectomy is often possible. Results of a multicenter study by the East German Study Group for Performance Assessment and Quality Assurance in Surgery].

With the introduction of laparoscopic cholecystectomy (LCE) the method became very fast successful in clinical practice. To describe the actual situation we initiated in 1994/95 a clinical multicenter study with the name CESAQ. 29 hospitals participated in the study. 4,675 cholecystectomies were performed, a total number of 2,960 patients were operated upon with the laparoscopic and 1,468 with the conventional technique. Furthermore, conversion to open cholecystectomy was necessary in 247 cases. One part of the study focused on the results achieved for patients with acute cholecystitis. 9.4% of the laparoscopic but 37.3% of the conventional cholecystectomies were performed due to acute cholecystitis. We differentiated a simple (adhesions to gallbladder, hydrops) and complicated form (empyema, gangrenous gallbladder) of acute cholecystitis. Treating acute cases the incidence of intraoperative (simple 8.3%, complicated 12.1%) and specific postoperative complications (simple 9.2%, complicated 6.9%) was higher compared to elective procedures (intraoperative 4.6%, specific postoperative 3.7%). This is well known from the experience of open surgery. Nevertheless there were lower general complication rates (simple 5.5%, complicated 5.2%) and no mortality in acute cholecystitis when LCE was performed. Considering an early conversion to open cholecystectomy in cases of severe acute cholecystitis the indication for LCE can be made generously. Great surgical experience in LCE is a requirement for the laparoscopic management of acute cholecystitis.

Acute Disease↗
PubMed2002

[Hormonal and hyperglycemic response in laparoscopic and open cholecystectomy].

The aim of the study is to evaluate the intensity of the operative trauma during laparoscopic and open cholecystectomy measured by hormonal (cortisol level) and metabolic (blood sugar level) response. Prospective randomized study was conducted in seventy patients with cholelithiasis. They were divided in two groups: thirty five underwent laparoscopic cholecystectomy and thirty five underwent open cholecystectomy (control group). Mean cortisol concentration and glucose concentration were measured preoperatively and postoperatively after 2, 4, 8, 12, 24 and 48 hours. The examined groups were comparable in age and sex. Preoperative plasma cortisol concentration was within normal range in both groups. Postoperatively plasma cortisol level increased in the laparoscopically operated group, and peak level occurred eight hours after surgery (692.6 +/- 27.2 nmol/L). Peak plasma cortisol level in control group developed 8 hours postoperatively (841.1 +/- 33.2 nmol/L). The mean cortisol concentration was significantly higher (p < 0.05) following open procedure between fourth and 48th postoperative hour. Mean plasma glucose concentrations after laparoscopic and open cholecystectomy were significantly higher (p < 0.05) than preoperative values. The mean glucose concentration during the initial 24 hours was significantly higher (p < 0.05) following open cholecystectomy.

Adult↗
PubMed2002

[Laparoscopic and classic cholecystectomy in patients with liver cirrhosis].

BACKGROUND: The prevalence of gallstones is increased in patients with cirrhosis. However the presence of cirrhosis has been generally considered a relative contraindication to cholecystectomy. AIM: To investigate the complications and the outcomes of laparoscopic and open cholecystectomy in patients with cirrhosis. PATIENTS AND METHODS: Sixty seven patients with gallstones with well-documented cirrhosis undergoing cholecystectomy (laparoscopic cholecystectomy (LC) in 35 and open cholecystectomy (OC) in 32), were studied. The mean age was 57.7 + 10.3 years for LC and 58.9 + 11.6 years for OC. In the LC group, 26 were classified as Child-Pugh class A, 8 as Child's B class and 1 as Child's class C. In the OC group, 12 were classified as Child's class A, 15 as Child's B and 5 as Child's C. RESULTS: Complications occurred in 4 of 35 (12.3%) LC patients (1 patients was Child A and 3 were B). In the OC group 14 of 32 patients had complications (4 Child A, 7 B and 3 C, 43.7% p < 0.05 as compared with LC group). Three patients in the OC group died (9.4%). Mean hospital stay was 2.8 + 1.9 and 13 + 12 days in LC and OC patients, respectively (p < 0.05). CONCLUSIONS: LC has a lower rate of complications than OC and is a reasonable option for Child's class A and B patients with cirrhosis and gallstones.

Adult↗
PubMed2004

Laparoscopic cholecystectomy for acute cholecystitis. Can preoperative factors predict conversion?

OBJECTIVE: To determine if preoperative clinical, laboratory and radiology data can predict conversion of laparoscopic cholecystectomy for acute cholecystitis to open procedure. METHODS: Retrospective analysis of 44 laparoscopic cholecystectomies were performed for acute cholecystitis between August 2000 and July 2002 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Data related to age and sex of patients, maximum body temperature, white blood cell count, gallbladder wall thickness on ultrasonography and timing of surgery from onset of symptoms were collected. RESULTS: The procedure was converted from laparoscopic to open cholecystectomy in 10 patients (23%). Conversion rate was significantly high (33% versus zero; p=0.01) if the gallbladder wall was thickened. Conversion rate was significantly low (zero versus 32%: p=0.01) if the procedure was performed within 48 hours from the onset of symptoms. The data related to age, sex, white blood cell count and body temperature did not reliably predict conversion of laparoscopic cholecystectomy for acute cholecystitis to open procedure. There was no mortality or major morbidity. CONCLUSION: Laparoscopic cholecystectomy is a safe modality of treatment for acute cholecystitis. Factors associated with increased conversion rate are thickened gallbladder wall on ultrasonography and delay in surgery for more than 48 hours from the onset of symptoms.

Adolescent↗
PubMed2004

[Cholecystectomy in Norway 1990-2002].

BACKGROUND: The purpose of this study was to investigate cholecystectomy incidence and laparoscopy rates in Norway (1990-2002). METHODS: Data were compiled from the Norwegian Patient Registry based on codes for cholecystectomy. RESULTS: From 1990 to 2000-02, age-adjusted incidence rate (per 10,000 inhabitants) for cholecystectomy increased from 2.9 to 4.1 for men and from 7.0 to 11.8 for women. Incidence rates varied between counties. The proportion undergoing laparoscopic surgery increased from 1% in 1990 to 89% in 2000-02. Over the same period the length of postoperative inpatient stay decreased from 7.3 days to 3.3 days. 94% of electively admitted patients were operated by laparoscopic technique in 2000-02. Among patients admitted on an emergency basis, women below 50 were more often operated by laparoscopic technique than older women and men. CONCLUSION: Substantial changes in the treatment of gallstone disease occurred in Norway over the period 1990 -2002. Increased incidence rates for cholecystectomy and reduced length of postoperative inpatient stay were observed after the introduction of cholecystectomy by laparoscopic technique.

Adult↗
PubMed2005

[Complaints before and after cholecystectomy].

BACKGROUND: It may be difficult to decide whether a patient's discomfort is related to known gallbladder stones. MATERIAL AND METHODS: A questionnaire regarding pre- and postoperative complaints and satisfaction with treatment was sent to 211 patients a median 51 months after they had undergone cholecystectomy at Rana district hospital during the May 1993 to March 2001 period. RESULTS: 97% of the patients returned our questionnaire. 80% had experienced sudden bursts of pain; in 91% of them the pain was relieved. 71% reported no complaints after cholecystectomy, 26% still had some discomfort after the operation. Two thirds of these had experienced discomfort for several years. 22% reported new or different symptoms. After surgery our patients reported a significant reduction in symptoms like sudden pain, constant pain, nausea/vomiting and bloating. 94% were very satisfied or satisfied with the outcome; 1% regretted having undergone the procedure. INTERPRETATION: Sudden attacks of pain are likely to be relieved after cholecystectomy. Our patients also experienced a number of different types of discomfort both before and after the cholecystectomy. Similar complaints also are reported by persons without gallstones, hence it is difficult to interpret the relief or worsening of these symptoms in relation to the cholecystectomy.

Abdominal Pain↗
PubMed2005

[Cost-effect evaluation of different variants of cholecystectomies].

Short-term results of treatment and cost-effect rates were analyzed in three groups of patients undergone traditional cholecystectomy, laparoscopic cholecystectomy and cholecystectomy through minilaparotomy. It was demonstrated that frequency of complications was less after operations through laparoscopy and minilaparotomy. Traditional approach had the most costs due to more number of postoperative complications, hospital stay after surgery and more number of analgesics. Cholecystectomy through minilaparotomy is most cost-effective due to high clinical effectiveness, short hospital stay and rare complications. This procedure does not require expensive devices and can be performed with regional anesthesia only. It is concluded that minimally invasive methods of cholecystectomy must be used more widely.

Cholecystectomy↗
PubMedDate not supplied

[Intestinal and systemic endotoxaemia after laparotomic or laparoscopic cholecystectomy].

Since laparoscopic cholecystectomy (LC) is widely recognised as being a "mild" or minimally invasive kind surgery, the aim of this prospective non-randomised study was to investigate the effect of intestinal manipulation on intestinal permeability and endotoxaemia in patients undergoing elective cholecystectomy, comparing the laparoscopic and laparotomic approaches. The intestine is susceptible to operations at remote locations, and the barrier function is altered during intestinal manipulation, leading to bacterial or endotoxin translocation into the systemic circulation. Fifty-three patients undergoing elective cholecystectomy were divided into two groups on the basis of laparotomic (n = 27) or laparoscopic (n = 26) approach. Intestinal permeability was measured preoperatively, and on day 1 and day 3 after surgery using the lactulose/mannitol absorption test. Serial venous samples were taken at 0, 30, 60, 90, 120 and 180 minutes, and at 12, 24 and 48 hours after surgery, for endotoxin measurement using the chromogenic limulus amoebocyte lysate assay. Intestinal permeability was significantly increased on day 1 [0.106 +/- 0.0005 (mean +/- S.E.M.)] in the laparotomic group compared to the preoperative level (0.019 +/- 0.005, p < 0.05) and to the laparoscopic group on day 1 (0.019 +/- 0.005, p < 0.05) which showed no change in comparison with the preoperative level. A significantly higher concentration of systemic endotoxin was detected intraoperatively in the laparotomic group of patients in comparison with the laparoscopic group (p < 0.05). There was significant positive correlation between systemic endotoxaemia and intestinal permeability (rs = 0.958; p = 0.001). An increase in intestinal permeability and degree of systemic endotoxaemia are observed during laparotomic cholecystectomy. This suggets that intestinal manipulation may impair the mucosal barrier function of the gut and contribute to the systemic inflammatory response seen in open cholecystectomy.

Adult↗
PubMed1995

Normal inspiratory muscle strength is restored more rapidly after laparoscopic cholecystectomy.

Respiratory complications after laparotomy cholecystectomy may result from generalised muscle weakness and fatigue, or from reduced respiratory muscle function secondary to an upper abdominal incision. In a prospective study we compared maximal inspiratory effort (Pimax/mmHg) and dominant hand grip strength (kPa) (expressed as a percentage of zero hour value) in patients undergoing open cholecystectomy (OC) (n = 12), laparoscopic cholecystectomy (LC) (n = 25) and a control group of patients undergoing lower limb surgery (n = 12). Of the 12 OC patients, three suffered respiratory complications: two had atelectasis and one a chest infection, compared with no such complications in the other two groups (P < 0.05). Pimax decreased postoperatively in all groups (P < 0.05) and had returned to normal by 48 h in the LC and control groups. In contrast, in the OC group Pimax fell from 112.5 +/- 17.8 mmHg to as low as 81.3 +/- 16.5 mmHg at 72 h and only returned to preoperative levels at 120 h. The hand grip strength fell significantly in all groups at 24 h (P < 0.05) but normal levels were achieved again by 48 h in all groups, and there was no significant difference in the hand grip strength between the groups over the 5 days. These results suggest that generalised muscle fatigue after surgery is similar after open and laparoscopic cholecystectomy. Open cholecystectomy does, however, cause a more prolonged reduction in respiratory muscle function and this is likely to contribute to the higher incidence of respiratory complications in this group of patients.

Adult↗
PubMedDate not supplied

[Risk factors in laparoscopic cholecystectomy].

In this report the authors have analysed the various risk factors of the laparoscopy cholecystectomy, proving that those are not different from the ones of standard open cholecystectomy. It has been underlined that laparoscopy cholecystectomy offers significant advantages over open cholecystectomy and moreover the possibility to convert laparoscopy cholecystectomy when it is necessary.

Age Factors↗
PubMed1994

Laparoscopic cholecystectomy in Leicester: an audit of 555 patients.

Laparoscopic techniques have revolutionised the surgical approach to cholecystectomy, even though there have been no published randomised controlled trials to demonstrate the safety of this approach. We present an audit of 555 patients offered laparoscopic cholecystectomy. In all, 54 patients (9.7%) were converted to an open procedure. Peroperative cholangiography (POC) was attempted in 190 cases (34.2%) and achieved in 141 (25.4%). Major complications occurred in 26 cases (4.7%) including 5 (0.9%) deaths, two of whom had major pre-existing morbidity. There was one common bile duct (CBD) injury (0.18%). There were 30 patients (5.4%) found to have CBD stones, 27 of which were cleared at ERCP, and three converted to open exploration. Cholecystectomy by any route is a major operation and we conclude that careful case selection remains imperative. However, morbidity is favourable compared with open cholecystectomy, and comparable with other reports using the laparoscopic technique. Our experience of CBD injury (0.18%) is also acceptable compared with the risk of injury during open cholecystectomy. There were 312 patients (56.2%) who did not undergo perioperative CBD imaging with ERCP or POC and three of these developed early symptomatic retained stones. This group requires further follow-up.

Adolescent↗
PubMed1994

[Conventional or laparoscopic cholecystectomy in treatment of acute cholecystitis?].

Elective laparoscopic cholecystectomy has become established as the procedure of choice for the treatment of symptomatic cholecystolithiasis while the application of this method for acute cholecystitis has been propagated with restrainment. In a prospective study 114 conventional (right subcostal incision) and 102 laparoscopic cholecystectomies for this indication were compared. The overall complication rate amounted 10.7% for conventional cholecystectomy and 8.9% for laparoscopic cholecystectomy. The rate of conversion was 9.2%. Due to the fact that intraoperative cholangiography was carried out in 60% of conventional cholecystectomies and in only one of laparoscopic procedures the arithmetic advantage of minimally invasive technique with respect to blood loss and operating time does not allow final conclusions. These patients however recovered clearly faster and could be discharged after an average of 5.2 +/- 4.2 postoperative days, while the hospitalisation after conventional operations amounted to 7.6 +/- 3.8 days (p < 0.001).

Acute Disease↗
PubMed1993

Laparoscopic and open cholecystectomy. A prospective, randomized study.

OBJECTIVE: To compare laparoscopic with open cholecystectomy. DESIGN: Prospective random control trial. SETTING: Central Hospital of Akershus, Nordbyhagen, Norway. SUBJECTS: 74 consecutive patients due to undergo elective cholecystecomy between October 1990 and June 1991. INTERVENTIONS: Two patients were excluded from randomisation, and two were withdrawn after randomisation. The remaining 70 were randomly allocated to open or laparoscopic cholecystectomy (n = 35 in each group). MAIN OUTCOME MEASURES: Duration of operation and postoperative stay in hospital, amount of postoperative pain, incidence of complications, and duration of convalescence and sick leave. RESULTS: Laparoscopic cholecystectomy took twice as long as open (median [range] 100 [52-180] minutes compared with 50 [15-115], p < 0.01), but patients stayed in hospital half the time (2 [1-9] days compared with 4 [2-22], p < 0.01); required less opiate analgesia (4 [0-20] doses compared with 6 [0-13], p = 0.02; took less sick leave (11 [4-267] days (n = 18) compared with 34 [20-48] (n = 22), p < 0.01); and spent less time in convalescence (8 [3-40] days (n = 17) compared with 49 [10-247] (n = 12), p < 0.01). There were six complications in the laparoscopy group and seven in the open cholecystectomy group. CONCLUSION: Because of the significant differences between laparoscopic and open cholecystectomy we have now adopted the laparoscopic method as our standard, but we think that we can improve our results further by refining our operative techniques and giving our patients more information.

Adult↗
PubMed1993

The physiology of laparoscopic surgery: pulmonary function after laparoscopic cholecystectomy.

Changes in pulmonary function were studied via standard spirometry in 30 patients after laparoscopic cholecystectomy (LC) and compared with those in nine patients after traditional open cholecystectomy (OC). Studies performed presurgery and the morning after surgery included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and forced expiratory flow (FEF25%-75%). Age (43.9 +/- 2.6 years for LC and 42.3 +/- 3.2 for OC), sex, reasons for cholecystectomy, and smoking history were similar in both groups. The mean FVC decreased 23% after LC (3.57 +/- 0.18 L presurgery, range 0.56-5.62, versus 2.68 +/- 0.17 postsurgery, range 0.65-5.14) and 35.2% after OC (mean 3.52 +/- 0.29 presurgery, range 2.38-4.99, versus 2.24 +/- 0.24, range 1.23-3.49 postsurgery). FEV1 showed similar changes, with LC decreasing pulmonary function by 24.3% (2.76 +/- 0.14 L presurgery versus 2.01 +/- 0.12 postsurgery) compared with a 36.2% reduction in FEV1 after OC (2.86 +/- 0.29 L presurgery versus 1.81 +/- 0.21 L postsurgery). Forced expiratory flow decreased by 24.3% after LC and 40% after OC. Laparoscopic cholecystectomy provides less decrement in pulmonary function than traditional open cholecystectomy.

Adult↗
PubMed1993

Intraoperative cholangiography for laparoscopic cholecystectomy.

Intraoperative cholangiography in the course of laparoscopic cholecystectomy is not only valuable to detect common bile duct stones, but also to delineate the anatomy of the biliary ducts, facilitate the dissection, avoid injuries to the biliary tract and identify other abnormalities, such as fistulas, cysts and tumors of the biliary system. Most surgeons use a variation of the transcystic injection of contrast. We describe herein a technique of cholangiography through the gallbladder, performed before starting any dissection in the cystic duct area, which has resulted in a rate of 92 percent of adequate cholangiograms and has proved to be easier, by far, and safer than the transcystic technique. A comparison was made between 405 instances of open cholecystectomies and 200 laparoscopic cholecystectomies with transcystic cholangiograms and 105 laparoscopic cholecystectomies with cholangiograms done through the gallbladder. All instances were done for symptomatic chronic or acute calculous cholecystitis. Satisfactory cholangiograms were obtained in 95 percent of open cholecystectomies and in only 68 percent of transcystic laparoscopic attempts. Complications and false-positive findings were seen in transcystic laparoscopic procedures in five and six instances, respectively. Cholangiography performed through the gallbladder was 100 percent successful among 73 patients with chronic cholecystitis and in 66 percent of 32 patients with acute calculous cholecystitis. For optimal visualization of the bile ducts, it is essential to exert pressure on the gallbladder after the injection of contrast to advance the contrast through the cystic duct. This is greatly facilitated by the use of a double-balloon catheter to avoid leak at the site of the gallbladder puncture.

Catheterization↗
PubMed1996

Impact of laparoscopic cholecystectomy on surgical training.

All cholecystectomies in a single health district were studied during a 5-year period spanning the introduction of laparoscopic cholecystectomy (LC). The number of LCs increased from 2 (1.3%) in year 3 to 86 (56%) in year 5. The number of operative cholangiograms and explorations of the common bile duct performed both fell substantially. The age distribution did not change significantly during the study period, but the percentage of females undergoing cholecystectomy increased. The percentage of trainee operations remained constant in those Firms performing only open cholecystectomy (OC), but fell from 67% to 9% in those adopting LC. An increase in annual cholecystectomy rate was seen with the laparoscopic surgeons, with a corresponding fall for those surgeons performing only OC. There was a threefold increase in the percentage of operations performed privately from years 2 to 5, with 73% being laparoscopic in year 5. The consequences for training of the introduction of LC must be addressed.

Adolescent↗
PubMed1996

The impact of laparoscopic cholecystectomy on the management and outcome of biliary tract disease in North Carolina: a statewide, population-based, time-series analysis.

BACKGROUND: Laparoscopic cholecystectomy (LC) has had a major impact on the treatment of patients with biliary tract disease, but the magnitude and the details of its effects on biliary surgery remain incompletely described. The purpose of this study was to perform a statewide, population-based, time-series analysis of the effects of LC on biliary surgery. STUDY DESIGN: Patient data were obtained from the statewide hospital discharge database that collects data from all 157 hospitals in the state of North Carolina. All patients with hospital admissions for biliary tract disease from 1988 through 1993 were selected for analysis. RESULTS: The use of open cholecystectomy (OC) dropped from 100 percent of all cholecystectomies in 1988 to 32.3 percent in 1993, while LC increased from eight cases in 1988 to over 7,800 per year in 1993. The increase in the rate of LC was not associated with an increase in the overall rate of cholecystectomy. Bile duct (BD) repairs increased from 13 in 1988 to a high of 36 in 1992. There was a strong, statistically significant correlation between the rate of LCs and the rate of BD repairs (R = 0.89, p = 0.0001). Hospital charges and component charges were lower for patients having elective LC compared to those having elective OC (p = 0.001). This remained true after stratification by age and type of gallbladder disease. Hospital stays were shorter for patients having LC than for those having OC (p = 0.001 for all). Surgeons in smaller hospitals were slower at adopting LC. Younger and board certified surgeons adopted LC more rapidly than older and non-board certified surgeons. CONCLUSIONS: In North Carolina, LCs progressed from nonexistent to the dominant approach for managing patients with cholelithiasis in a matter of a few years. Associated with this change were shorter hospitalizations and lower charges. Contrary to other published reports, North Carolina did not experience an increase in the overall rate of cholecystectomy with the adoption of LC. There was a highly correlated increase in the rate of bile duct repairs in the first years of the study.

Adolescent↗
PubMed1996

[laparoscopic cholecystectomy and acute cholecystitis--feasibility and morbidity].

This quality control study was devised to establish, wether laparoscopic cholecystectomy is recommendable for acute cholecystitis. Of 314 prospectively recorded laparoscopic cholecystectomies 59 were done for histologically proven acute cholecystitis within 3 years. 29 cases (49.2%) were converted to open cholecystectomy due to unsatisfactory exposure and recognition of anatomical structures or haemorrhage. Morbidity with laparoscopic cholecystectomy without conversion was 16.6% (5/30 patients), mortality zero. There were no common bile duct injuries. Our results show that, if the operation is performed by an experienced laparoscopic surgeon or under one's supervision, laparoscopic cholecystectomy for acute cholecystitis is safe. A low threshold for converting to open laparotomy must be observed particularly when anatomical structures are not clearly identified.

Acute Disease↗