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PubMed1991

Laparoscopic cholecystectomy is less expensive than open cholecystectomy.

Laparoscopic cholecystectomy (LC) is emerging as the most attractive alternative to open cholecystectomy (OC) ever offered to patients. It combines a rapid recovery time with definitive therapy for their affliction. In addition to its greater acceptance by patients, LC has the potential to be more economical than OC because of the markedly shorter hospital stay required by most patients who have undergone LC. In this article we compare the hospital charges for patients undergoing LC with a matched group of patients undergoing OC. The hospital charge was $4,070 +/- 297 (mean +/- SEM) for patients undergoing LC and $5,017 +/- 497 for patients undergoing OC. This difference arises from the mean cost of in-patient care, which was $353 +/- 40 for LC patients and $1,335 +/- 138 for OC patients. LC appeared to be a bargain, both economically and physiologically.

Adult↗
PubMed1996

[Laparoscopic cholecystectomy versus classical cholecystectomy].

The authors evaluated the results after classical (CCHE) and laparoscopic cholecystectomies (LCHE) in the period from March 16 1994 to June 30 1995. In this period they operated on 408 patients, out of which 208 were operated by the laparoscopic technique. There were no differences in postoperative morbidity. The mortality after laparoscopic surgery was 0% and the classical cholecystectomy reached the morbidity of 1.4%. Complicated patients were usually operated in the classical way. The time of hospitalisation after LCHE was 5.2 days and after CCHE 8.3 days. The results of LCHE were as follows: morbidity 10.5%, conversions 2.4%, reoperations 1.4%, and no leakage of the bile duct. We saved 40% of costs using LCHE. All these facts show that LCHE is advantageous, secure and well tolerated by patients. The patients prefer comfort after the operation, good cosmetic effect and a short hospital isation. CCHE did not lose its position, especially in complicated cases. (Tab. 5, Ref. 21.)

Adolescent↗
PubMed1997

[Changes in lung function after cholecystectomy--open versus laparoscopic cholecystectomy].

Impairment of respiratory function after open cholecystectomy may cause atelectasis and hypoxemia. Clinical experience shows evidence for easier recovery after laparoscopic operation. Postoperative respiratory function using spirometric tests was assessed in 50 patients with simple symptomatic cholecystolithiasis submitted either to open or laparoscopic cholecystectomy and revealed less impairment of respiratory function in the laparoscopic group.

Cholecystectomy↗
PubMed2005

Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies.

HYPOTHESIS: Bile duct injury (BDI) remains the most serious complication of cholecystectomy. With laparoscopic cholecystectomy (LC), the incidence has become more frequent. This study verifies the current incidence, mechanism, presentation, and treatment of BDI occurring during LC in general surgical practice. DESIGN: Anonymous retrospective multicenter survey. SETTING: Department of surgery at a university referral center, collecting data from general surgical units. PATIENTS: Data from 56 591 patients who underwent LC between January 1, 1998, and December 31, 2000, in 184 hospitals in Italy were analyzed. MAIN OUTCOME MEASURES: Current incidence, mechanism, presentation, and treatment of BDI occurring during LC in general surgical practice. RESULTS: Two hundred thirty-five BDIs were reported, with an overall incidence of 0.42%. There were no risk factors in 80.0% of the patients. Poor identification of the anatomical features of the hepatic pedicle was the most frequently reported cause (36.8%), and technical problems accounted for 27.0% of causes. The incidence of BDI was higher during cholecystitis (P<.001) and decreased with increasing number of LCs performed by the surgical teams (P<.01). There was no difference in incidence according to technique (French or US) or to routine or selective intraoperative cholangiography. One hundred eight BDIs (46.0%) were recognized intraoperatively and immediately repaired in 89.8% of patients. One hundred twenty-seven BDIs (54.0%) were diagnosed postoperatively, the dominant manifestation being biliary fistula (44.1%). CONCLUSIONS: This study confirms a higher incidence of BDI during LC. It highlights the relevance of the number of previously performed LCs and of the correct surgical technique to avoid BDI. The need for correct procedures, adequate expertise of the repairing surgeon in BDI repairs, and a multidisciplinary approach in the management of BDI is emphasized.

Abdominal Injuries↗
PubMed1991

Conventional versus laparoscopic cholecystectomy and the randomized controlled trial. Cholecystectomy Study Group.

We considered using a randomized trial to assess the value of laparoscopic cholecystectomy in the treatment of symptomatic gallstones. The pros and cons for the timing of such a trial were in favour of not beginning the trial until surgeons learned to use the new procedure safely and effectively, and until key endpoints and outcome indices could be identified and assessed using valid measures. Instead an observational study was implemented to monitor the learning curve of surgeons as they mastered the laparoscopic equipment and procedures, and to assess the responses of the patients to the procedure. In the first 100 patients, the procedure proved to be as safe and feasible to use as conventional surgery, and there were strong benefits in terms of quicker recovery of the patients with less pain, discomfort, and a reduced length of hospital stay. The responses of the surgeons and the patients to the new procedure now place ethical constraints on the planning of a randomized controlled trial. Currently, comprehensive surveillance and monitoring of laparoscopic cholecystectomy is the only realistic method with which to assess the impact of this new technology in our clinic.

Adult↗
PubMed1989

Laparoscopic laser cholecystectomy. A comparison with mini-lap cholecystectomy.

The standard treatment of cholelithiasis in the United States is surgical removal of the gallbladder, but this treatment often has a major economic impact on the patient: major surgery, lengthy hospitalization, and several weeks' absence from work. Because of this economic factor, there has been a movement toward non-invasive methods, but they, too, have their drawbacks: long-term medical therapy; a high risk of stone recurrence because the diseased gallbladder is still in place. We therefore developed a means of performing a cholecystectomy through a laparoscope using laser technology, the results of which are compared here with the results in a series of "mini-lap" cholecystectomies that we also performed during the same time period.

Adult↗
PubMed2004

Robot-assisted laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a comparative study.

BACKGROUND: The efficacy of conventional laparoscopic cholecystectomy (CLC) was compared with robot-assisted laparoscopic cholecystectomy (RLC). Surgical trainees performed the LC to avoid the surgeon's experience bias. METHODS: Two surgical trainees performed 10 CLCs and 10 RLCs at random with a Zeus-Aesop Surgical Robotic System. The primary efficacy parameters were the total time and the number of actions involved in the procedure. The secondary parameters were setup and dissection times, and the number of grasping and dissection actions. Surgical complications were evaluated. RESULTS: For CLC and RLC, respectively, the total times were 95.4 +/- 28 min and 123.5 +/- 33.3 min and the total actions were 420 +/- 176.3 and 363.5 +/- 158.2. For CLC, the times required for setup (21 +/- 10.4 min) and dissection (50.2 +/- 17.7 min) were less than for RLC (33.8 +/- 11.3 min and 72 +/- 24.3 min, respectively). The numbers of grasping and dissection actions were not significantly different: 41.4 +/- 26.5 and 378 +/- 173.7, respectively, for CLC versus 48.9 +/- 27 and 314.6 +/- 141.9, respectively, for RLC. CONCLUSION: Although feasible, RLC requires significantly more time than CLC because of slower performed actions.

Adult↗
PubMed1985

Morbidity of simple cholecystectomy and cholecystectomy with transduodenal sphincteroplasty.

Exploration of the common bile duct via transduodenal sphincteroplasty is thorough and provides an opportunity for the natural passage of retained calculi. However, this procedure destroys both the sphincter ampulla and sphincter choledochus, the sequelae of which are unknown. Fifty patients who had a transduodenal sphincteroplasty performed between 1970 and 1980 were randomly selected and compared with 50 patients who only had cholecystectomy. They were all seen in the outpatient department, assessed on a modified Visick scale and had liver function tests performed. There was no statistical difference in the subjective quality of result or in the liver function of the sphincteroplasty group when compared with the cholecystectomy patients, which suggests that destruction of the sphincters does not appear to be harmful to the patient.

Cholecystectomy↗
PubMed2006

Outpatient laparoscopic cholecystectomy: a new gold standard for cholecystectomy.

OBJECTIVE: To contribute our experience for five years in the implemetation of outpatient laparoscopic cholecystectomy (LC). PATIENTS: Between January 1999 and March 2004 we performed 504 outpatient LCs. We applied both exclusion and inclusion criteria, an anesthetic and surgical protocol, and discharge-specific criteria. Postoperative management in "fast track" regime. Postoperative period controlled by protocol, including phone calls after cholecystectomy. RESULTS: The ambulatory percentage in the global series was 88.8%, and mean hospital stay was 6.1 hours. Fifty-one patients required overnight stays (10.1%), most of them for "social" causes. Five patients required admission (between 24 and 48 hours) for different causes (conversion to laparotomy, intraoperative neumothorax, and postoperative medical complications). Six patients (1.1%) were readmitted, and we observed 11.6% postoperative complications in the global series, with abdominal parietal pain being most frequent. Phone localization by 22.00 p.m. in the same day of surgery was 100% complete for outpatient cases. Postoperative surveillance within the first month after surgery was completed in 93.9%, and within th first year in 86.7% of patients. CONCLUSIONS: Outpatient LC is safe and feasible, and probably represents a new "gold standard" in the treatment of symptomatic cholelithiasis.

Adult↗
PubMed2000

Concomitant abdominal aortic aneurysm repair and cholecystectomy. Combination of retroperitoneal aortic reconstruction and gassless laparoscopic cholecystectomy.

The coexistence of cholelithiasis and abdominal aortic aneurysm is not uncommon. However, cholecystectomy at the time of abdominal aortic reconstruction has generally been delayed because of the potential contamination of the graft. The case described here had concomitant cholelithiasis and abdominal aortic aneurysm, both of which were required to be treated, and was successfully treated with a combination of retroperitoneal abdominal aortic reconstruction and gasless laparoscopic cholecystectomy.

Aortic Aneurysm, Abdominal↗
PubMed2002

Total quality management in laparoscopic cholecystectomy. Quality of care and quality perception in ambulatory laparoscopic cholecystectomy.

OBJECTIVE: Analysis of acceptance and perception of quality in patients undergoing ambulatory laparoscopic cholecystectomy. PATIENTS: 84 consecutive patients undergoing elective laparoscopic cholecystectomy within SVS (Servei Valencia de Salut) through a special plan for waiting lists. METHODS: A prospective analysis of related variables with quality perception evaluated by a specialized nurse with no interaction with the surgical team. RESULTS: Ambulatory acceptance, 80 percent; return to work or daily activities at 72 hours after surgery, 40 percent. Extra need of medical attention was as follows: emergency general practitioner 2.7 percent, emergency room attention in 1.3 percent, extra telephone interview with the surgeon 6.0 percent. Global estimation of the procedure was very good or good by 94.7 percent. CONCLUSIONS: High acceptance rate, high quality perception. Up to 20 percent of patients would change from ambulatory to traditional surgery, possibly due to cultural factors.

Ambulatory Surgical Procedures↗
PubMed1992

[Conversion laparatomies during cholecystectomies under laparoscopy. Apropos of 285 consecutive cholecystectomies].

Retrospective analysis of a consecutive series of 285 cholecystectomies carried out by laparoscopy showed that 47 patients (17.5%) required conversion laparotomy. In 55% of these cases the conversion was due to difficulty in dissecting the gallbladder or cystic duct. Peri-operative cholangiography should be performed routinely, not only to verify the vacuity of the common bile duct (13% of the conversions) but, more particularly, to ensure the integrity of the principal biliary pathway during the dissection (8.5% of the conversions). Cholecystectomy under celioscopy is a proven and safe technique, on the condition that all stages of classical surgery can be carried out under good conditions.

Adolescent↗
PubMed2004

[Laparoscopic cholecystectomy in acute cholecystitis: predictors of conversion to open cholecystectomy and preliminar results].

Inspite of increased technical difficulties and high incidence of conversion to open procedures and complications, laparoscopic cholecystectomy is a well established treatment for acute cholecystitis. In this study we reported our results in patients with acute cholecystitis undergoing laparoscopic cholecystecomy from 1998 to 2003. We found out that laparoscopic cholecystectomy was safe and was carried out with acceptable conversion rate and low morbidity. Predictors of complications were delay of surgery more than 48 hours following the onset of symptoms, leucocytosis > 15.000 U/microl and gallbladder wall ultrasonography thickness > 7mm.

Acute Disease↗
PubMed1992

[Laparoscopic cholecystectomy versus mini-lap-cholecystectomy. Results of a prospective, randomized study].

Laparoscopic cholecystectomy (LCCE) was gaining acceptance rapidly, when several institutions could demonstrate the safety of this minimal invasive treatment modality. Nevertheless prospective randomised studies still are missing to prove the advantages of this new treatment modality in contrast to open cholecystectomy. 77 patients with symptomatic cholelithiasis were treated by LCCE (n = 40) or mini-lap CCE (n = 37) in a prospective, randomised study. As preliminary results, there were no differences in duration of anesthesia and operation time, perioperative complications or postoperative need for analgetics. Patients with LCCE had significant less postoperative pain, less restriction of total vital capacity and a shorter postoperative hospital stay as parameters of a diminished operative trauma.

Cholecystectomy↗
PubMedDate not supplied

[Morpho-functional characteristics of reflux gastritis in patients after cholecystectomy and without cholecystectomy].

The aim of this study was to evaluate some biochemical and histopathological aspects in a group of patients with a view to identifying any differences depending on whether the pathology was associated with previous cholecystectomy or idiopathic. The study involved 23 patients (8 post-cholecystectomy cases and 15 ulcer-free dyspeptic patients) with the diagnosis of duodenogastric reflux gastritis confirmed by endoscopic histopathological evaluation. The following parameters were considered: 1) pH and bile salt concentration in gastric juice; 2) histological classification of antral biopsies (Niemela's criteria); 3) dyspeptic symptoms (dyspepsia, pyrosis and epigastric pain, sense of repletion, foul-tasting mouth) graded on a scale from 0 to 4. All parameters were considered in relation to whether or not Helicobacter Pylori was found in the histological specimens. No significant differences were found between the two groups for pH and bile salt values or for Helicobacter Pylori positivity. No relationship was observed between the Helicobacter Pylori and either the severity of the histological picture, the features of the biochemical parameters or the severity of the clinical symptoms. Such findings confirm the common pathophysiological pattern of reflux gastritis regardless of any permanent biliary tract alterations and the low importance of Helicobacter Pylori infection in determining this syndrome.

Adult↗
PubMed1982

[Liver biopsy in cholecystectomy? A study on the need for liver biopsy in cholecystectomy based on the morphologic findings in both organs].

On the basis of 341 liver biopsies routinely taken during cholecystectomies using Menghini's technique the pathological changes of the liver in comparison to the degree of cholecystitis were studied. Because of the frequency of morphological changes detected in the liver tissue, the low risk of the procedure and the possibility to determine the bioptic area of the liver, biopsies are recommended to be routinely taken during cholecystectomy.

Adult↗
PubMedDate not supplied

Analysis of symptomatic patients after cholecystectomy: is the term post-cholecystectomy syndrome an anachronism?

Of 171 patients who were followed-up prospectively for 2.8 years after cholecystectomy, 31 developed postcholecystectomy symptoms, 24 of them being mild to moderate and 7 severe. Symptomatic patients mostly had functioning gall bladders preoperatively and longer duration of symptoms prior to cholecystectomy. The causes of postcholecystectomy symptoms could be identified in all of them except 9 patients who were labelled as having "essential dyspepsia". The symptoms in the latter syndrome as well as in other conditions diagnosed in the symptomatic postcholecystectomy patients appeared unrelated to the absence of gallbladder. Hence, we feel the term postcholecystectomy syndrome is an anachronism and should be redefined.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2006

Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is a matter of debate. METHODS: Data from 2,130 consecutive LCs and patients' follow-up during 9 years were collected and analyzed. During the first 4 years of the study, 800 patients underwent LC, and IOC was performed selectively (SIOC). Thereafter, 1,330 patients underwent LC, and IOC was routinely attempted (RIOC) for all. RESULTS: In the IOC group, 159 patients met the criteria for SIOC, which was completed successfully in 141 cases (success rate, 88.6%). Bile duct calculi were found in nine patients. All other patients with no criteria or failed SIOC were followed, and in nine patients retained stones were documented. Thus, the incidence of ductal stones was 1.1% and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for the detection of ductal stones were 50, 100, 98.6, and 100%, respectively. In the RIOC group, IOC was routinely attempted in 1,330 patients and was successful in 1,133 (success rate, 90.9%; p = 0.015). Bile duct stones were detected in 37 patients (including 14 asymptomatic stones). In two cases, IOC failed to reveal ductal stones (false negative). There was no false-positive IOC. Therefore, with RIOC policy, the incidence of ductal stones, sensitivity, specificity, NPV, and PPV were 3.3, 97.4, 100, 99.8, and 100%, respectively (significantly higher for success rate, incidence, sensitivity, and NPV; p < 0.05). Abnormal IOC findings were also significantly higher in the RIOC group. Common bile duct injury occurred only in the SIOC group [two cases of all 2,130 LCs (0.09%)]. CONCLUSION: RIOC during LC is a safe, accurate, quick, and cost-effective method for the detection of bile duct anatomy and stones. A highly disciplined performance of RIOC can minimize potentially debilitating and hazardous complications of bile duct injury.

Adolescent↗