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PubMed1992

[Postoperative morbidity and mortality in patients undergoing additional cholecystectomy during digestive surgery].

A retrospective case-control study was carried out to assess whether additional cholecystectomy in patients undergoing digestive surgery caused increased postoperative morbidity and mortality. During the period 1983-90, 70 patients underwent cholecystectomy at the same time as other surgery (25 gastric resections, 23 colon resections, 17 total gastrectomies, 2 fundoplicatio using Nissen's technique, 2 cases of Heller's operation, 1 truncular vagotomy and pyloroplasty). These cases were matched for sex, age (+/- 5 years) and type of primary operation with 70 controls (patients without additional cholecystectomy). Complications were significantly more frequent among the former group compared to controls (28.6% vs 11.4%, p = 0.02), in particular in the group of patients undergoing colon resection (34.8% vs 8.7%, p = 0.04). The frequencies of reoperation and mortality were also higher in patients undergoing additional cholecystectomy than in controls (10% vs 1.4%), but the difference was not statistically significant (p = 0.06). In conclusion, additional cholecystectomy during digestive surgery increases the risk of postoperative complications, in particular in colorectal surgery.

Adult↗
PubMedDate not supplied

Can intraoperative cholangiography be avoided during laparoscopic cholecystectomy?

Controversy exists as to whether intraoperative cholangiography should be performed routinely or selectively during laparoscopic cholecystectomy. The aim of the present study was to assess in which circumstances intraoperative cholangiography can be avoided during laparoscopic cholecystectomy. From January 1999 to June 2002, 168 patients undergoing laparoscopic cholecystectomy for cholelithiasis without intraoperative cholangiography were prospectively evaluated at our Department. Inclusion criteria were established according to a preoperative diagnostic protocol, considering only those patients with normal liver function tests and ultrasound common bile duct diameters < or = 5 mm or > 5 mm, but with normal magnetic resonance cholangiopancreatography findings. Laparoscopic cholecystectomy was carried out without intraoperative cholangiography and postoperative results and follow-up data were recorded and analysed. No major biliary injuries were encountered and no patients had residual bile duct stones after at least a one-year postoperative follow-up. A complete preoperative diagnostic work-up proved to be of fundamental importance for decreasing the incidence of residual bile duct stones. When protocol criteria are satisfied, intraoperative cholangiography may be safely omitted during laparoscopic cholecystectomy and meticulous laparoscopic technique is the main way to reduce the incidence of iatrogenic biliary lesions to a minimum.

Adolescent↗
PubMedDate not supplied

Minilaparoscopic versus laparoscopic cholecystectomy: a randomised controlled trial.

Since its introduction in 1987, the technique of cholecystectomy has continued to undergo evolution. Surgeons have reduced the port size and number or both to achieve improvement in postoperative pain control, rapid return to activity and better cosmetic results. Therefore, this study was done to compare the standard 4 port laparoscopic cholecystectomy (LC) with the 3 port laparoscopic cholecystectomy using a 5 mm telescope instead of 10 mm telescope (mini laparoscopic cholecystectomy - MLC). Forty patients were randomised to each group. Mean operating time, intraoperative and postoperative complications, mean period to resume walking, eating and return to normal activities and mean hospital stay were similar in the two groups. The level of postoperative pain was significantly lower in the MLC group. Patients who underwent MLC required a significantly lower dose of analgesics. In conclusion mini laparoscopic cholecystectomy is a feasible and safe procedure with less postoperative pain and better cosmesis and without increased complications.

Adolescent↗
PubMed2006

A prospective study of bile leaks after laparoscopic cholecystectomy for acute cholecystitis.

Surgeons are increasingly performing laparoscopic cholecystectomy in the setting of acute cholecystitis. The acutely inflamed gallbladder poses a more technically demanding dissection with potential for an increase in bile leak rates. Clinical and subclinical bile leak rates after laparoscopic and open cholecystectomy in the elective setting are known. This study prospectively evaluates the rate of clinical and subclinical bile leaks after laparoscopic cholecystectomy in the setting of acute cholecystitis. One hundred patients underwent laparoscopic cholecystectomy for acute cholecystitis, as determined intraoperatively and by history, ultrasound, fever, or leukocytosis. On postoperative Day 1, the patients underwent cholescintigraphy (PIPIDA scan) analyzed by a board-certified radiologist for evidence of bile leaks. Postoperative cholescintigraphy revealed eight scans positive for bile leaks. Regardless of scan result, no patient experienced a clinically symptomatic bile leak. Laparoscopic cholecystectomy is a safe and effective treatment for acute cholecystitis with acceptable clinical and subclinical bile leak rates.

Adult↗
PubMed1991

Does intraoperative gallbladder perforation influence the early outcome of laparoscopic cholecystectomy?

Laparoscopic cholecystectomy is rapidly becoming the preferred therapy for symptomatic cholelithiasis. It was our impression that the necessary traction exerted on the gallbladder during this procedure would frequently lead to intraoperative perforation with bile leak. We sought to determine prospectively the incidence of gallbladder perforation during laparoscopic cholecystectomy and to ascertain whether or not intraoperative bile leak resulted in overt complications. Laparoscopic cholecystectomy was performed successfully on 250 patients between November 1989 and December 1990. Gallbladder perforation occurred in 80 patients (32%). Compared with those without a bile leak, there was a larger percentage of men (p < 0.05), and the average weight was greater (p < 0.01) in those developing a bile leak. Operating time was significantly longer in patients with gallbladder perforation (mean +/- SEM, 104 +/- 4 min) than in those without a bile leak (94 +/- 3 min, p < 0.01), presumably because of the increased time spent irrigating the abdomen and retrieving gallstones. There was no difference in postoperative serum liver enzymes, amount or type of analgesia administered, interval to return to work or to full activity, or the development of postoperative infections. A wound infection requiring antibiotic therapy developed in only one patient who had not suffered a bile leak. The incidence of bile leak during the performance of laparoscopic cholecystectomy is therefore appreciable, occurring in approximately a third of our patients. Gallbladder perforation does not lead to any other adverse complications and should not cause the surgeon to convert to an open cholecystectomy.

Adolescent↗
PubMed2006

Cholecystectomy following acute presentation to a major New Zealand metropolitan hospital: change to the timing of surgery is needed.

AIMS: To review the management and outcome of patients presenting with acute biliary pain/cholecystitis, mild acute pancreatitis, or cholangitis to a major New Zealand (NZ) metropolitan hospital. METHODS: A retrospective case note review was performed for all patients admitted acutely to Christchurch Public Hospital between 1 February 2005 and 31 September 2005, with the diagnosis of acute biliary pain/acute cholecystitis, acute pancreatitis, or cholangitis. Basic demographics, inpatient management, and subsequent outcome were recorded. RESULTS: Sixty-eight (65%) patients were admitted with acute biliary pain/cholecystitis, 23 (22%) with mild acute pancreatitis, and 13 (13%) with cholangitis. Twelve of 81 (15%) patients (who were suitable for index cholecystectomy) underwent surgery, including only 3 of the 18 patients with mild acute pancreatitis. In the remaining 69 (85%) patients, who were eligible but did not undergo cholecystectomy at the index admission, 29 (42%) subsequently represented to the emergency department. Forty-eight (70%) patients required further inpatient admission related to gallstone-related pathology within the study period. Subsequently, 42 (61%) of the 69 patients treated conservatively underwent cholecystectomy at a median (range) of 70 (1-195) days from index admission, including 6 emergency cholecystectomies due to re-presentation CONCLUSIONS: The management of acute gallstone-related disease at a major NZ metropolitan hospital fails to meet with current international standards. Few patients undergo index cholecystectomy, and a large proportion of those treated conservatively return to the health sector with ongoing problems.

Adolescent↗
PubMedDate not supplied

Combined abdominal hysterectomy, cholecystectomy and appendicectomy: a study of 25 cases in Abbottabad.

BACKGROUND: Gallstone disease is common in women. Many patients undergoing abdominal ultrasound for gynaecological diseases are found to have gallstones. This study was done to see the results of combined abdominal hysterectomy, mini-cholecystectomy and appendicectomy in a set up lacking facilities of laparoscopic surgery. METHODS: This prospective study was conducted in Ayub Teaching Hospital, Iltaf Hospital and Shahina Jamil Trust Hospital of Abbottabad from August 1998 to July 2004. All patients undergoing combined abdominal hysterectomy and mini-cholecystectomy were exclusively studied with reference to following variables. Age, Weight, Parity, Co-morbid conditions, peri-operative and post-operative complications, blood transfusion, hospital stay and mean extra time for mini-cholecystectomy and appendicectomy after abdominal hysterectomy. RESULTS: There were 25 patients in the study group. The ages ranged from 35-50 years. Mean weight was 65 Kg. There were no operative complications. Mild postoperative complications occurred in 7(28%) patients. Mean extra time for cholecystectomy was 25 minutes. Mean hospital stay was 9 days. CONCLUSIONS: In selected women, combined abdominal hysterectomy, cholecystectomy and appendicectomy is a safe, feasible and cost effective procedure.

Adult↗
PubMed1991

[Appendectomy, cholecystectomy, cholelithiasis and colorectal cancer. A retrospective case control study at the Côte-d'Or].

Several studies have shown that there might be a relationship between previous history of appendectomy or cholecystectomy and the subsequent risk of colorectal cancer. In order to investigate these hypotheses, a case-control study was set up to compare the history of appendectomy and cholecystectomy as well as the presence of cholelithiasis in patients with colorectal carcinoma vs patients with gastric carcinoma. The study was performed in the 727 patients included in the Registry of Digestive Cancers of the Côte d'Or and treated at the Dijon University Hospital during the period 1981-1987. These patients were well matched to those of the whole registry population for sex, age, stage, and residence distributions. In females, in comparison to the gastric cancer patients, a personal history of appendectomy was more commonly observed in case of right colonic cancer (odds ratio: 3.5; P less than 0.01) and a personal history of cholecystectomy in case of left colonic cancer, in particular when considering only those earlier than 10 years (odds ratio: 3.2; P less than 0.05). In contrast, the risk of rectal cancer was lower in case of a cholecystectomy performed more than 10 years earlier (odds ratio: 0.2; NS) and in case of cholelithiasis (odds ratio: 0.4; P less than 0.05). In males, there was no difference between cases and controls as for the proportion of appendectomies, cholecystectomies or cholelithiasis. These observations are consistent with the hypothesis that the appendix as a lymphoid organ plays a protective role in colon carcinogenesis, in particular in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Complications of laparoscopic cholecystectomy.

As laparoscopic cholecystectomy has become more widely practiced, the full spectrum of complications associated with this technique is being realized. We have performed 283 consecutive laparoscopic cholecystectomies with no deaths and a morbidity rate of 5.3% (15 of 283 patients; six major complications, nine minor complications). Major complications included one bile duct injury requiring laparotomy and t-tube insertion and two patients with retained stones. Symptomatic bile leakage occurred in three patients (1%). Two of these bile leaks were from accessory ducts entering the gallbladder bed; the third leak was secondary to a cystic duct leak. Eight patients (2.8%) required conversion to open cholecystectomy. Minor complications included three patients with subumbilical wound infections, two patients with urinary tract infections, one patient with costochondritis after operation, and three patients with prolonged hospital stays (more than 48 hrs) caused by ileus or fever. Several patients with life-threatening complications, including two patients who ultimately died, were transferred to our care from other centers. These included two patients with common duct injuries combined with duodenal perforations (one of whom died), one patient with a complete common duct transection, one patient with major common hepatic duct injury, and two patients with further instances of bile leakage. Laparoscopic cholecystectomy can be performed safely, and it can be associated with life-threatening complications. Prevention of complications is dependent on proper patient selection, meticulous technique, and an accepting attitude toward conversion to "open" cholecystectomy.

Adult↗
PubMed1991

[Cholecystectomy: laparoscopic or conventional?].

Cholecystectomy remains the gold standard in the treatment of cholelithiasis. With the emerging of laparoscopic techniques a new modality in the surgical therapy is available. However efficacy, morbidity and pretended advantages have to be judged in comparison to the conventional technique. Indications for cholecystectomy are not altered by the new technique. Beside some few preoperative contraindications, the definite choice of the operative procedure is determined intraoperatively according to the anatomical facts and the experience of the surgeon. The frequency of the laparoscopic approach varies between 67 and 97%. A conversion to open cholecystectomy is necessary in 3.6-4.7%. The overall complication rate is 2.6-5.1%. Outstanding from those are the iatrogenic lesions of the bile-duct, especially in the initial learning period with 1-2%. The hospital stay is dramatically reduced to 1.2-3 days as well as the postoperative recovery period with 7-14 days. Thus resulting in a cost saving up to $1200 per patient. Because of the obvious advantages of less pain, early mobilisation, less scars and an enormous cost saving the laparoscopic cholecystectomy will be the gold standard in the future. Open cholecystectomy will be restricted to complicated cases. However, in order to prevent serious injuries of the bile-duct an appropriate training in laparoscopic surgery is necessary.

Bile Ducts↗
PubMed1990

[Gallbladder cancer mortality in Chile and its relation to cholecystectomy rates. An analysis of the last decade].

Extrahepatic biliary tract cancer (mainly gallbladder cancer) mortality rates have increased from 7.84 x 100.000 to 9.6 x 100.000 in Chile during the last decade. The most significant risk factor for gallbladder cancer is gallstone disease. However, no apparent changes in the prevalence of gallstone disease has occurred during this period. In contrast, cholecystectomy rates have consistently decreased during the decade. The aim of this study was to correlate extrahepatic biliary tract cancer mortality and cholecystectomy rates of previous years during the last decade in our country. The best correlation coefficient between both variables was obtained when mortality was correlated with cholecystectomy rates two years prior to the mortality rate (r = -0.92). This finding is consistent with the hypothesis that changes in the number of cholecystectomies performed in a specific geographic area would reciprocally change gallbladder cancer mortality rate. It was estimated that increasing cholecystectomies by 12,500 per year would decrease at mortality rate from this cancer by approximately 1.0 x 100.000 two years in Chile.

Chile↗
PubMed1990

[Carcinoma of the large intestine and cholecystectomy].

The authors draw attention to the high incidence of carcinoma of the large intestine in conjunction with cholecystectomy. The increased incidence of this disease was observed in patients after cholecystectomy (17.69%). The authors processed data from a group of 260 patients with colorectal carcinoma during the ten-year period from 1979 to 1988, in 46 with cholelithiasis during previous period cholecystectomy was performed, i.e. in 17.69%. It is assumed that the stimulating effect in carcinogenesis of the large intestine are changes in the bile acid metabolism occurring after cholecystectomy. Hitherto valid indications for cholecystectomy do not change, however, but make us consider these relationships in clinical practice and call for further analyses.

Cholecystectomy↗
PubMed1990

Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms.

Cholecystectomy is standard treatment for symptomatic cholelithiasis. Long term relief from symptoms, however, has not been reported. We reviewed 671 elective cholecystectomies performed between 1982 and 1987 for biliary colic (group 1, 91 per cent), dyspepsia associated with gallstones (group 2, 5 per cent) and atypical pain syndromes (group 3, 4 per cent), to define precisely important variables for comparison with alternate methods of gallstone treatment. Cholecystectomy resulted in a mortality rate of zero per cent and an over-all morbidity rate of 4.5 per cent. The procedure-related morbidity rate was 2.2 per cent. Long term follow-up period for 81 per cent of these patients (mean of 45 months) showed that 88 per cent were free of symptoms. Patients in groups 1 and 3 were more likely to obtain relief from symptoms than those in group 2 (p = 0.10). We concluded that cholecystectomy is a definitive treatment for symptomatic cholelithiasis with minimal risk to the patient and a high degree of relief from symptoms. Alternative treatments for gallstones must compare favorably with these results of modern cholecystectomy prior to acceptance and widespread use.

Cholecystectomy↗
PubMed1989

Routine cholecystectomy in the morbidly obese.

Proven disease is generally considered a sound indication for cholecystectomy. However, incidental removal of a gallbladder with unproven pathology is controversial. The morbidly obese, however, constitute a group at especially high risk for the development of gallbladder disease, with possible greater risk immediately after weight reduction procedures. In our series of 51 consecutive patients undergoing vertical banded gastroplasty (VBG), the gallbladder was routinely removed regardless of symptomatology or results of a preoperative workup. Two patients declined cholecystectomy. Twelve patients (24.4%) had undergone cholecystectomy for symptomatic stones prior to their VBG. Of the remaining 37 subjects, there was a 73% overall incidence of disease: 11 (29.7%) had cholelithiasis, 11 (29.7%) had cholesterolosis alone, three (8.1%) had chronic cholecystitis with cholesterolosis, and two (5.4%) had chronic cholecystitis alone; only 10 (27%) had normal findings. These results, when added to evidence demonstrating a high incidence of postoperative gallbladder disease in those not receiving cholecystectomy, suggest that routine cholecystectomy be considered in all morbidly obese patients undergoing VBG or similar procedures.

Cholecystectomy↗
PubMed1989

Do colon and rectum exhibit an opposite cancer risk trend versus cholecystectomy? A case--double control study.

A case-double control study on 318 personally interviewed patients with large bowel neoplasia has been carried out to establish the possible role of cholecystectomy in the development of colorectal cancer. The dietary habits both of the cancer patients and control subjects were investigated. All controls were considered free of neoplastic lesions on the basis of a negative fecal occult blood test. Data from the study showed that the prevalence of cholecystectomy in the overall patients was similar to that of the two control groups. However, analysing the data for colon and rectum, the relative risk of colonic cancer after cholecystectomy was significantly increased in males (RR = 2.75; p less than 0.05), whereas that of rectal cancer appeared to be decreased in females (RR = 0.18; p less than 0.02). Subsite analysis demonstrated that right-sided neoplasia after long-standing cholecystectomy (greater than or equal to 10 years) was responsible for the increased colonic risk. In conclusion, the present data support the hypothesis that cholecystectomy may be considered a risk factor for right-sided colon cancer, but indicate that this operation seems to play a protective role for rectal cancer.

Aged↗
PubMed1989

[Regional differences in the use of cholecystectomy in Denmark during the period 1977-1985].

In a register-based study of all cholecystectomized patients in Denmark during the period from 1977-85 (37,048 patients) an account is given of the regional variations observed in connection with the intervention. The cholecystectomy operation is sub-divided into four types of operation dependent on whether the intervention is merely a matter of cholecystectomy or it involves the choledocus, the duodenum, the small intestine or other organs. The variation analysis is based on a division of the country into 75 areas, each primarily served by a single hospital. The method highly reflects the differences in clinical treatment strategies. The summarized rate of cholecystectomy for this period of time was 8.2 per 10,000 persons. In areas with the highest and the lowest rates of operation the figures were 12.3 per 10,000 and 5.1 per 10,000, respectively. In 18 areas, the rates of operation were significantly higher than average and in 18 other areas significantly higher than average and in 18 other areas significantly below average. SCV-score (X100) 2.19. There is no systematic correlation between the degree of specialisation in the operating department and the frequency in employing the operation. Areas with an operation index significantly above average had the same rate of more complicated operations than simple cholecystectomy as the other areas. Possible causes of national as well as international variations in the use of cholecystectomy are discussed, and the need for a radical evaluation of this kind of treatment is emphasized.

Adult↗
PubMed1986

Langenbuch's cholecystectomy, once a remarkably controversial operation.

Carl Langenbuch (1846-1901) has been appropriately designated the 'creator' of surgery of the gallbladder. In the surgical treatment of gallstone disease, Langenbuch advocated cholecystectomy in favour of cholecystostomy since he realised that the gallbladder should be removed not because it contained stones but because it originated the stones. In 1882, he successfully performed the first cholecystectomy in a 43-year-old patient. The new operation gave rise to a vehement, international discussion questioning the dispensability of the gallbladder in view of its alleged role in bile physiology. The famous abdominal surgeon Lawson Tait appeared to be a strong opponent of cholecystectomy, maintaining cholecystostomy as the procedure of choice. In the medical journals, he rejected cholecystectomy in unequivocal terms. The controversy about cholecystectomy persisted for several decades, delaying its wide acceptance.

Cholecystectomy↗
PubMed1987

Safety of cholecystectomy with abdominal aortic surgery.

Many surgeons are reluctant to remove asymptomatic gallstones during aortic reconstruction for fear of increasing the risk of graft infection. This is a review of 56 patients who underwent aortofemoral bypass or aortic aneurysm repair, with cholecystectomy, to determine if the morbidity or mortality was increased with the concomitant procedure. Follow-up averaged 25 months (range from 1 to 125 months). Three patients were lost to follow-up. Operative and postoperative hospital stay were not increased. One patient suffered a graft infection and a pseudoaneurysm; the infection was not related to the cholecystectomy since it occurred after a secondary procedure for repair of an infected false aneurysm. There were three superficial infections and three postoperative deaths, none of which specifically related to the cholecystectomy. The only related complications were three bile leaks, one liver injury due to a retractor and bleeding from the gallbladder bed in one patient who required reoperation. The authors conclude that concomitant cholecystectomy can be performed without increased risk to the patient but is advised only if the vascular procedure has been uncomplicated and the cholecystectomy appears straightforward.

Aorta↗