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 955 records · Page 53Linked to original sources
PubMedDate not supplied

Laparoscopic cholecystectomy in patients with hepatic cirrhosis: a five-year experience.

Our institution is a tertiary referral center that specializes in hepatobiliary surgery. To evaluate the safety, efficacy, and conversion rate of laparoscopic cholecystectomy in patients with hepatic cirrhosis, we conducted a retrospective analysis of all cirrhotic patients undergoing attempted laparoscopic cholecystectomy during the period from 1991 to 1996. The diagnosis of cirrhosis was made on the basis of either a preoperative history, a liver biopsy, or the surgeon's operative description of the liver. All patients had early, well-compensated cirrhosis (Child's class A or B). A total of 30 patients underwent attempted laparoscopic cholecystectomy and five patients were converted to an open procedure (17%). The conversion rate for elective cases was 5% compared with 36% for urgent procedures. Two patients were converted because of varices and three because of unclear anatomy. No patients were converted because of bleeding. There were no operative deaths. The complication rate for elective procedures was 16%, with an average length of stay of 2.1 days, compared with 36% and 4.8 days, respectively, for urgent cases. Laparoscopic cholecystectomy in patients with early, well-compensated cirrhosis is safe and should be the treatment of choice for these patients.

Blood Loss, Surgical↗
PubMed2004

Somatosensory changes in the referred pain area in patients with acute cholecystitis before and after treatment with laparoscopic or open cholecystectomy.

BACKGROUND: Visceral pain can lead to hypersensitivity in the referred pain area. In patients with chronic visceral pain this somatic hypersensitivity can persist for years. As 25%-40% of patients continue to have symptoms after cholecystectomy, whereof no explanation for pain can be offered in up to 30%, it could be hypothesized that altered sensory characteristics induced by acute cholecystitis could persist in some patients and thus be responsible for postcholecystectomy pain. The aim of this study was to investigate the somatosensory sensitivity in the referred pain area in patients with acute cholecystitis before and after cholecystectomy. METHODS: Patients with acute cholecystitis were studied before (n = 30) and after (n = 18) treatment. Sensitivity to pinprick, heat, cold, pressure and single and repeated electrical stimulation was studied in the referred pain area and in the control area on the contralateral side of the abdomen. RESULTS: Significant hypersensitivity in the referred pain area was detected in patients with acute cholecystitis. The somatic sensitivity was normalized after cholecystectomy. CONCLUSIONS: Acute cholecystitis leads to hypersensitivity in the referred pain area. Persistent hypersensitivity, as earlier reported after chronic visceral pain, was not seen aftiser cholecystectomy, indicating that this mechanism may not play a major role in patients with postcholecystectomy pain syndrome. The possible role in patients operated on for chronic gallstone pain has still to be investigated.

Abdominal Pain↗
PubMed1998

Pulmonary function and complications after laparoscopic cholecystectomy.

OBJECTIVE: To investigate the impairment of pulmonary function and complications after laparoscopic compared with open cholecystectomy through an upper midline incision. DESIGN: Prospective randomised trial. SETTING: Teaching hospital, Spain. SUBJECTS: 40 patients, 20 in each group. INTERVENTIONS: Clinical examination, spirometry, arterial blood gas analysis, and chest radiographs before and after operation. RESULTS: 48 hours postoperatively FVC and FEV1 had decreased to 56.7% and 53%, respectively, in the patients who had had open cholecystectomy, compared with 85.3% and 84.8% in the laparoscopic group (p < 0.0001). The mean (SD) postoperative percentage reductions in both PaO2 (86.1 (11.1) compared with 98.3 (11.3)) and SatO2 (98.6 (1.3) compared with 100 (1.5)) were also greater in the open group (p < 0.005 in both cases). CONCLUSIONS: Laparoscopic cholecystectomy causes less impairment of lung function than cholecystectomy through an upper midline incision.

Cholecystectomy↗
PubMed1997

Longitudinal cholecystectomy study: patterns of care in a total community experience.

The purpose of this study was to determine outcomes and safety of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) in a community setting at multiple open staff hospitals with multiple surgeons. This second-year study retrospectively examined all cholecystectomy records in one city at each of five hospitals over a 1-year period beginning in April 1991 through March 1992. All charts were examined for type of surgery, rate of conversion to open procedure, sex, weight, previous abdominal surgery, surgeon, hospital, preoperative workup, operative time, antibiotic prophylaxis, cholangiograms, concurrent procedures, drains, hospital stay, common duct stones and their follow-up, pathology, reoperations, complications, and mortality. One thousand eight hundred one gallbladders were removed. One thousand three hundred four (72.4%) were successfully removed at LC. One hundred eighty-three (10.2%) others were attempted laparoscopically and converted to open cholecystectomy (CC), which represented 12.3% of the attempted LCs. Three hundred fourteen (17.4%) were removed via a standard OC. The mean operative times were 72.3 minutes for LC, 100.1 minutes for CC, and 86.2 minutes for OC. Cholangiography was attempted in 916 (70.3%) LCs, 144 (78.7%) CCs, and 250 (79.6%) OCs, with similar operative times, except in LC, when done via the GB, operative time was 65.2 versus 73.4 minutes when done via the cystic duct. Diagnosis of acute cholecystitis occurred in 306 (23.5%) LCs, 119 (65.0%) CCs, and 145 (46.2%) OCs. Complications requiring reoperation occurred in 30 (2.3%) LCs, 5 (2.7%) CCs, and 5 (1.6%) OCs. Common bile duct (CBD) injuries occurred in 5 (34%) LCs, with 4 converted to CC and 1 repaired 5 days later. Trocar site hernias occurred in 11 (0.8%) LCs. Thirty-nine surgeons participated in the study with mean numbers of 33.4 LC cases, 5.5 CC cases, and 7.2 OC cases, with ranges of 1 to 165 LC cases, 1 to 17 CC cases, and 1 to 24 OC cases. Death occurred in 12 (0.9%) LC cases, 4 (2.2%) CC cases, and 25 (8.0%) OC cases. The mean hospital stay was 39.6 hours for LC, 156.5 hours for CC, and 198.3 hours for OC.

Cholangiography↗
PubMed1994

Metabolic responses to cholecystectomy: open vs. laparoscopic approach.

Laparoscopic cholecystectomy is considered a minor surgical procedure. In a prospective, randomized study, we compared the metabolic responses to surgery in two groups of patients submitted to open or laparoscopic cholecystectomy. The aim of the study was to verify if the latter caused less metabolic changes. Blood samples were drawn before the operation (basal), 1 h and 2 h after skin incision, and on the first and second postoperative days. The following parameters were studied: cortisol, renin, and leukocytes, including subpopulations. The mean values for age, weight, height, basal neutrophil and lymphocyte counts, basal values of cortisol and renin of patients, and sex distribution of group 1 patients (open, n = 20) matched with those for group 2 (laparoscopic, n = 20), with the exception of age (p < 0.05). No differences were detected between the two groups in terms of cortisol and renin values. However, the neutrophil count 1 h after skin incision was statistically significantly higher with the laparoscopic approach (p < 0.05). The lymphocyte count on the second postoperative day was also statistically significantly higher in group 2 (p < 0.05). We conclude that when a cholecystectomy is performed, the laparoscopic approach has no advantage over the open approach from the standpoint of the metabolic responses we studied. It appears that leukocytes have a more rapid return to normal values after laparoscopic cholecystectomy. Although pneumoperitoneum is known to be responsible for important cardiorespiratory changes, no worse response was found in the laparoscopic group than in the open group.

Adult↗
PubMed1995

Comparison of outcomes and complications for open and laparoscopic cholecystectomy in Mexico.

A retrospective analysis of the outcome and surgical complications of two groups of patients undergoing cholecystectomy was performed. Group I consisted of 253 patients who underwent laparoscopic cholecystectomy between 1991 and 1994, and group II was formed by 292 patients who met the same preoperative criteria than patients of group I and underwent open cholecystectomy between 1986 and 1990, prior to the introduction of laparoscopic cholecystectomy in our hospital. General characteristics and associated clinical conditions were similar for both groups. Intraoperative cholangiography was used more frequently in group II whereas preoperative ERCP was performed more frequently in group I patients. There was no operative mortality in any of the groups. There were no statistically significant differences between both groups in terms of type and number of complications.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1996

Outpatient laparoscopic cholecystectomy feasibility.

One-hundred nineteen elective cholecystectomies were performed at Kern Medical Center over a 20-month period from October 1992 to May 1994 and were retrospectively reviewed. Eight males and 111 females ranged in age from 16 to 70. Laparoscopic cholecystectomy was attempted in 116 patients and converted to open in 8 (7%). Of the elective procedures, 108 (91%) were planned as outpatient procedures. Of the 108 planned outpatient procedures, 73 (68%) were successfully completed as outpatients. Of the 35 patients who required unplanned admission, 21 were discharged in less than 24 h. In total, 101 (87%) of the 116 elective cholecystectomies begun laparoscopically were discharged in less than 24 h. Subsequent to this data analysis, our institution is developing a 23.9 h "day hospital" for postanesthesia observation. With extended postoperative monitoring and observation, patients with short-term problems such as nausea, vomiting, pain, and even patients with medical conditions requiring close observation and control should be able to avoid admission. This retrospective study indicates that with development of a 23.9 h postanesthesia care unit, the majority of elective cholecystectomies can be attempted and completed laparoscopically on an outpatient basis.

Adolescent↗
PubMed1996

A case-control study of postoperative pulmonary complications after laparoscopic and open cholecystectomy.

Postoperative pulmonary complications (PPC) are common after upper abdominal surgery. The objective of this case-control study was to compare the incidence of PPC after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) within a tertiary care center. Patients were accrued from two sequential clinical trials that evaluated the role of incentive spirometry in the prevention of PPC after abdominal surgery. Included for study were patients with gallstones undergoing elective surgery who had an American Society of Anesthesiologists (ASA) classification < 3. All patients included in the study were encouraged to use an incentive spirometer at least 10 times each hour while awake. Patients with chronic bronchitis were excluded from study, as were patients who received other forms of physical therapy. OC was performed through either a transverse or an oblique incision. There was an equitable dispersion of putative risk factors for PPC between the groups at baseline. PPC were defined as clinical features consistent with collapse/consolidation, an otherwise unexplained temperature above 38 degrees C, plus either confirmatory chest radiology or positive sputum microbiology. The incidence of PPC was 2.7% (1/37) after LC and 17.2% (10/58) after OC (p < 0.05). It is concluded that PPC are less common after laparoscopic cholecystectomy than after open cholecystectomy.

Abdomen↗
PubMed1998

Indications for and outcomes of cholecystectomy: a comparison of the pre and postlaparoscopic eras.

PURPOSE: Examine changing patient characteristics and surgical outcomes for patients undergoing cholecystectomy at five community hospitals in 1989 and 1993. PROCEDURES: In a retrospective chart review, data were gathered regarding gallstone disease severity, type of admission, patient age, number of comorbidities, American Society of Anesthesiologists (ASA) Physical Status Classification, length of stay, and multiple outcomes of surgery. MAIN FINDINGS: The volume of nonincidental cholecystectomies increased 26%, from 1611 in 1989 to 2031 in 1993. Nearly all of the increase occurred among patients with uncomplicated cholelithiasis and with elective admissions. In 1993, lengths of stay were significantly shorter and percentages of complications were significantly lower for infectious, cardiac, pulmonary, and gastrointestinal complications when controlling for patient case-mix characteristics. There were more major intraoperative complications (unintended wounds or injuries to the common bile duct, bowel, blood vessel(s), or other organs) in 1993. CONCLUSIONS: Different types of patients underwent cholecystectomy in 1993 compared with patients in 1989, which supports the hypothesis of changing thresholds. Statements supporting the safety of cholecystectomy in the laparoscopic era were borne out when controlling for differences in patient characteristics.

Adult↗
PubMed1992

Laparoscopic versus conventional cholecystectomy. Use of biliary scintigraphy.

Laparoscopic cholecystectomy has become a popular alternative to traditional open cholecystectomy for uncomplicated, acute cholecystitis. At some centers, laparoscopic cholecystectomy is already the more frequently performed procedure. The presence or suspicion of common bile duct (CBD) stones or obstruction may necessitate conventional surgery or additional procedures. This report describes a patient with acute cholecystitis for whom the surgical management changed based on biliary scintigraphy. The demonstration of an unsuspected CBD obstruction by biliary imaging allowed the surgeon to change the initial plan for laparoscopic cholecystectomy to conventional open surgery. Stones in the common bile duct were removed.

Acute Disease↗
PubMed1994

Outpatient laparoscopic cholecystectomy.

Outpatient Laparoscopic Cholecystectomy was attempted in 98 patients selected from 266 patients presenting for elective cholecystectomy (37%). Two patients required admission following conversion to "open" Cholecystectomy, one patient was admitted for observation because of a technically difficult Laparoscopic Cholecystectomy and 16 patients were admitted because of refractory nausea and vomiting in the early post-operative period. Seventy-nine patients (81%) were able to be discharged home within 4 to 6 hours of surgery, with only one patient requiring readmission to hospital because of the onset of nausea and vomiting. There were no post-operative complications attributable to the outpatient experience. We believe this approach to elective gallbladder pathology can be safely accomplished in selected patients and will be increasingly utilized in the future.

Adult↗
PubMedDate not supplied

Antimicrobial prophylaxis in laparoscopic and conventional cholecystectomy . Conclusions of a large prospective multicenter quality assurance study in Germany.

BACKGROUND: Postoperative infection following cholecystectomy poses a significant threat to recovery, with major cost repercussions. Though antimicrobial prophylaxis is commonly practiced, its value - particularly in laparoscopic cholecystectomy - has not yet been adequately documented. METHOD: In a prospective multicenter quality assurance study in 28 German hospitals, an analysis of data collected on 4,477 patients undergoing conventional (n = 1,349) or laparoscopic (n = 3,128) cholecystectomy was performed; 2,217 patients received and 2,260 did not obtain perioperative antibiotic cover. RESULTS: Postoperative infections occurred in a total of 136 patients, with infection rates of 5.0% in those without prophylaxis, 0.8% in those on ceftriaxone, and 1.2% in those on other antibiotic regimens. Patients receiving prophylaxis fared significantly better than those with no prophylaxis in terms of the rate of postoperative wound infections, chest infections, other complications, reoperation and mortality. CONCLUSION: Neither laparoscopic nor conventional open cholecystectomy should be performed without adequate perioperative antimicrobial prophylaxis in future, especially since such measures also reduce hospital stay and hence the costs.

Adult↗
PubMed1996

Effects of laparoscopic cholecystectomy on global respiratory muscle strength.

Laparoscopic cholecystectomy has a better postoperative outcome than the traditional open technique, which has been shown to significantly affect respiratory muscle function. The aim of this study was to investigate the effects of laparoscopic surgery on respiratory function, and particularly that of the respiratory muscles. Respiratory muscle strength was assessed in 26 patients who underwent laparoscopic cholecystectomy and in 25 who underwent open cholecystectomy by measuring mouth pressure during maximum static inspiratory (PImax) and expiratory (PEmax) efforts. PImax, PEmax, and blood gases were measured 24 h preoperatively (-24 h) as well as 24 h (+24 h) and 48 h (+48 h) postoperatively. FEV1 and FVC were measured at -24 h and +48 hr, and the ratio of FEV1 to FVC (FEV1/FVC) was calculated. PImax decreased at +24 h and +48 h in both groups, but this decrease was significantly greater in the patients who had open surgery, (p < 0.01, and p < 0.005, respectively). Similarly, PEmax was significantly smaller in the open- than in the laparoscopic-surgery group (p < 0.0001) at +48 h. Spirometric indices showed a more severe restrictive defect at +48 h after open surgery than after laparoscopy (p = 0.01). The arterial oxygen tension (PaO2) was significantly greater in the laparoscopic- than in the open-surgery group at +24 h (p < 0.007). Laparoscopic cholecystectomy caused smaller decreases in respiratory muscle strength than did open surgery. This accords with the hypothesis of phrenic nerve inhibition during open surgery. The results are of clinical importance, since they may explain the different outcomes with the two techniques.

Adult↗
PubMed1995

Laparoscopic and open cholecystectomy outcomes in Medicare beneficiaries in member states of the Large State PRO Consortium.

To determine the incidence of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) and some of their possible outcomes (complications, mortality, 30-day readmission) in the general population of senior citizens, we examined Medicare claims data for beneficiaries 65 years and older in eight states. Billing data for all cholecystectomies (ICD9-CM 51.22, 51.23) performed on an inpatient basis in those states on Medicare beneficiaries age 65 and older during fiscal year 1992 were examined. The incidence of LC in each state ranged from 2.1 to 3.2/1,000, whereas the incidence of OC ranged from 2.2 to 3.5/1,000. Eleven and one-half percent of LC patients suffered at least one perioperative complications, as did 21.5% of OC patients. There was considerable interstate variation in complication rates. In-hospital mortality was about five times greater of OC (4.5%) than for LC (0.9%). Patients who underwent OC were more likely (9.2%) to be readmitted within 30 days than were LC patients (7.0%). LC seems to be at least as safe as OC in the elderly population. Analyzing Medicare claims data can be useful in uncovering geographic variations in cholecystectomy practice.

Aged↗
PubMed2006

A comparison of open and laparoscopic cholecystectomy done by a surgeon in training.

Laparoscopic cholecystectomy has virtually replaced conventional open cholecystectomy as the gold standard for symptomatic cholelithiasis. The laparoscopic approach brings numerous advantages at the expense of higher complication rates, especially in training facilities. This comparative 18-month review examines the outcomes of 52 cholecystectomies performed by a single surgical resident at the University Hospital of the West Indies--a teaching hospital in Jamaica. The advantages of laparoscopic cholecystectomy have been demonstrated and it has been found to be safe and effective in this training facility.

Adolescent↗
PubMedDate not supplied

Laparoscopic versus open cholecystectomy: effect on pulmonary function tests.

BACKGROUND/AIMS: Operations often cause impairment in respiration due to pain. This study was designed to compare the changes in pulmonary function tests after open and laparoscopic cholecystectomy. METHODOLOGY: Two groups of 35 patients were randomly set up. Each patient had 3 pulmonary function tests performed and 2 postero-anterior grid chest roentgenograms taken. All of these data were evaluated by the same group of investigators. RESULTS: After taking into consideration the difference between pulmonary function tests, values were not significant (P < or = 0.05). All pulmonary function test values decreased significantly on the 1st postoperative day (P < or = 0.05). When postero-anterior chest roentgenograms were compared no clinically evident atelectasis except 3 lineary was seen in the laparoscopic cholecystectomy group, whereas 5 lineary, 7 focal, and 3 segmentary atelectasia were encountered in the open cholecystectomy group (P < or = 0.05). CONCLUSIONS: We believe that laparoscopic cholecystectomy has more advantages when speaking of postoperative pulmonary function tests and atelectasia.

Adult↗
PubMed2001

[Complications of cholecystectomy before and after introduction of laparoscopic surgery].

OBJECTIVES: In the University Department of Surgical Gastroenterology, Arhus University Hospital, the frequency of complications to acute and elective cholecystectomy was investigated before and after introduction of laparoscopic cholecystectomy. MATERIAL AND METHODS: A retrospective survey turned up 1768 patients in the period of conventional open surgery (1974-1985) and 1432 patients in the laparoscopic period (1991-1998). All patients with exploration of the common bile duct were excluded. RESULTS: In the open period 12 patients (0.68%) had lesions of the common bile duct requiring reconstruction. In patients operated on with laparoscopic cholecystectomy, lesions of the common bile duct were found in three patients (0.21%) (p = 0.06). Lesions of the cystic duct or an aberrant bile duct occurred in 14 patients (0.79%) during the open period and in 24 patients (1.7%) (p < 0.05) operated on with the laparoscopic technique. Infectious and cardiopulmonary complications were seen in significantly more patients operated on with the open technique. DISCUSSION: It is concluded that laparoscopic cholecystectomy offers a safe procedure, although the technique can still be improved, especially with respect to decreasing leakage from the cystic duct.

Adult↗
PubMedDate not supplied

Complications of cholecystectomy in the era of laparoscopic surgery.

Both open and laparoscopic cholecystectomy are highly safe and effective procedures for patients with symptomatic cholelithiasis. Today, adverse outcomes after open cholecystectomy are limited to the elderly patients with comorbid conditions and complicated biliary tract disease. Though underreported, major biliary tract complications still occur, more so with laparoscopic cholecystectomy and continue to be the main cause of morbidity after cholecystectomy.

Cholecystectomy↗