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PubMedDate not supplied

[Inflammatory markers after laparoscopy versus laparotomy cholecystectomy].

OBJECTIVE: The study is carried out to determine whether the level of IL-6 is altered and in what way after surgery as well as if such a change could be an indicator of increased morbidity after surgical treatment. MATERIALS OF THE STUDY: Chemiluminesence immunoeassay system was used in order to establish IL-6 level in blood samples of 71 patients that underwent abdominal surgery, 36 Laparoscopic Cholecystectomy (LC) and 35 Open Cholecystectomy (OC) at time 0 (before the operation), 1 h, 2 h, 3 h, 6 h, 24 h and 48 h after the operation. RESULTS: Plasma IL-6 levels are significantly increased after OC; we observed 3 cases of post-operative infections, in which IL-6 returned to normal levels 6 days after surgery. Analogous variation to the IL-6 levels was noted for the C-reactive protein levels. DISCUSSION: Laparoscopic cholecystectomy, a so called mini-invasive surgical procedure, is associated to a small increase of IL-6 serum levels and provides better post-operative conditions to the patients by reducing surgical stress and the infectious complications correlated to the surgical procedure. CONCLUSIONS: During OC there is a significant higher elevation of IL-6 serum levels than after laparoscopic cholecystectomy. Variation of C-reactive protein serum levels after surgery is analogous to variation of IL-6 levels.

Adult↗
PubMedDate not supplied

Efficacy and safety of elective laparoscopic cholecystectomy in elderly: a case-controlled comparison with the open approach.

BACKGROUND: Minimally invasive laparoscopic surgery is the method of choice for the surgical treatment of gallbladder disease. However, surgery of the biliary tract in the elderly is often associated with high morbidity and mortality. PATIENTS AND METHOD: To evaluate the efficacy and safety of the laparoscopic cholecystectomy in the elderly with symptomatic, uncomplicated gallbladder disease, we retrospectively compared the records of 24 consecutive patients over 70 years of age with symptomatic uncomplicated gallbladder disease, who underwent elective laparoscopic cholecystectomy, with a similar cohort of patients who underwent elective open cholecystectomy for the same indications. RESULTS: In the laparoscopic group we found a significantly low incidence of postoperative complications, low analgesics and antibiotics administration, rapid recovery, short length of stay and considerable cost savings. CONCLUSION: We conclude that elective laparoscopic cholecystectomy in elderly with uncomplicated gallbladder disease is safe and effective and we suggest that it may become the surgical procedure of choice.

Age Factors↗
PubMedDate not supplied

[Antibiotic prophylaxis in laparotomic and laparoscopic cholecystectomy].

Antibiotic prophylaxis in biliary surgery, when correctly used, has led to the minimisation of postoperative infections. Conventional cholecystectomy, and particularly laparoscopic cholecystectomy give rise to a very complicated issue concerning the use of antimicrobial prophylaxis, especially in relation to low-risk patients. The authors describe their experience with the use of short-term prophylaxis in biliary surgery based on a hundred consecutive laparoscopic cholecystectomies. In addition, the literature on this topic strengthens the authors' conviction that antimicrobial prophylaxis may be indicated in all surgical cholecystectomy procedures, also in view of the difficult management of postoperative infection risk factors.

Adolescent↗
PubMed2005

Elevation of serum liver enzymes after laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy (LC) has been accepted as an alternative to laparotomy, and has become the standard treatment of benign gallbladder diseases. However, it has been noticed that (following LC) the serum level of certain liver enzymes raises markedly in patients who had preoperatively normal liver enzyme values. METHODS: We measured serum values of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamyl transferase, bilirubin, and international normalized ratio (INR) in 72 consecutive patients who underwent laparoscopic cholecystectomy and 36 consecutive patients who underwent open cholecystectomy (OC). During laparoscopic surgery, the intra-abdominal pressure was maintained at 14 mmHg of CO2. To assess liver function, serum liver enzymes were measured before operations and at 1,3,7, and 10 days postoperation. RESULTS: Mortality was nil. Twenty-four hours after the procedure, ALT and AST increased statistically significantly in the LC group (ALTLC24: 87.1+/-24.2 U/L P<0.001; ASTLC24:82.8+/-19.1 U/L, p<0.001)--whereas in the OC group, 24 hours after the procedure, the serum value of ALT and AST was above the upper normal limits in only in one patient. A further increase in serum ALT and AST value was observed in the LC group (ALTLC72: 99.3+/-19.5 U/L, p<0.001; ASTLC72H: 103.5+/-21.6 U/L, p<0.001) 72 hours after the operation. The mean value of ALT and AST in the OC group was within normal limits 72 hours after the procedure. Slow return to normality occurred 7-10 days after the procedure in the LC group. CONCLUSION: Alterations in hepatic function occur after laparoscopic cholecystectomy and appear to be clinically insignificant. CO2 pneumoperitoneum seems to be the main reason for theses changes but other factors may also contribute. We also measured the values of ALP, GGT, INR and bilirubin. No statistically significant increase was noticed in any groups between the preoperative and postoperative values of these enzymes.

Adult↗
PubMedDate not supplied

Sex as a factor in conversion from laparoscopic cholecystectomy to open surgery.

OBJECTIVES: Although laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder diseases, conversion to open surgery is required in a substantial proportion of patients. In this study, we attempted to clarify whether male sex carries an increased risk for conversion to open surgery during laparoscopic cholecystectomy. METHODS: This study comprised 80 patients (41 females, 39 males) with symptomatic gallbladder stones. Average age was 39.2 years, and all female patients were of reproductive age. Patients were excluded from the study if they had acute cholecystitis, previous abdominal surgery, systemic or connective tissue diseases, or were using tobacco, alcohol, or medications that affect wound healing or inflammation. Tissue samples were obtained from the same sites in each gallbladder wall and pericholecystic tissue for the measurement of tissue hydroxyproline (HP) and collagen. Samples were examined under light microscopy for histopathology. Findings in male and female patients were compared by using the Student t test. RESULTS: All patients except 3 males received laparoscopic cholecystectomy. Conversion to open cholecystectomy was necessary in those 3 because of intense pericholecystic fibrosis. In male patient samples, macrophages were twice as numerous as in female samples, whereas mast cells in the men were 4 times more numerous, and eosinophils were 6 times more numerous (P<0.01). In men, HP levels in the gallbladder wall and pericholecystic tissue were 23.4+/-14.9 microg/mg dry tissue and 25.2+/-13.1 microg/mg dry tissue, respectively. The corresponding values in women were 13.1+/-9.4 microg/mg dry tissue and 14.5+/-8.1 microg/mg dry tissue. This higher level of tissue HP in men was statistically significant (P<0.015). Tissue collagen levels both in the submucosal area of the gallbladder wall and in pericholecystic tissue were significantly higher in men than in women (P<0.05). CONCLUSION: Our data suggest that in the context of symptomatic gallbladder stones, inflammation and fibrosis are more extensive in men than in women. These findings may help explain why the rate of conversion to open surgery is higher in men than in women.

Adult↗
PubMed1991

[Laparoscopic cholecystectomy as evolution of traditional cholecystec- tomy. Comparative evaluation].

Laparoscopic cholecystectomy (LC) is a minimally invasive method of removing the gallbladder that has become an accepted procedure all over the world. Authors performed 200 LC and compare the results of first 70 procedures with a matched group of patients who have undergone traditional cholecystectomy (TC) to evaluate its safety and efficacy. The average length of operation in the LC group was 64.5 +/- 26.3 min as compared to 68.5 +/- 22.5 min in the TC group. The difference between the incidence of postoperative complications in the 2 group was not statistically significant. The average length of stay in the LC group was 2.3 +/- 1.9 days versus 5.2 +/- 1.4 in the TC group. The difference is statistically significant. The comparison between the 2 methods shows less discomfort for LC patients during postoperative course. Pain was minimal, bowel evacuation was early and spontaneous, urinary retention only occurred in 2 patients versus 21 in TC group. The difference is statistically significant. Our results confirm laparoscopic cholecystectomy is a safe, effective and cost-efficient alternative to open cholecystectomy.

Adult↗
PubMed1994

[Laparoscopic cholecystectomy makes difficult the analysis of gallbladder mucosa. Morphometric study].

Laparoscopic gallbladder surgery damages gallbladder mucosa, impeding an adequate histological examination. We studied gallbladder samples coming from 56 conventional and 44 laparoscopic cholecystectomies performed in patients with chronic cholecystitis without signs of acute inflammation. The length of each examined sample and the length of the portion where superficial epithelia was not found was measured. No differences in sample length was found between both types of cholecystectomy. However; the segment with superficial mucosa was significantly shorter in the samples coming from laparoscopic surgery. Seventeen samples did not contain mucosa at all and 14 of these (82%) came from laparoscopic procedures. Eighty six percent of samples coming from laparoscopic surgery were considered inadequate for histological study compared to 36% of samples coming from conventional cholecystectomy. It is concluded that laparoscopic cholecystectomy hampers the study of gallbladder mucosa and may have an impact on the diagnosis of neoplastic gallbladder lesions.

Cholecystectomy↗
PubMed1993

Minilaparotomy cholecystectomy.

Cholecystectomy was performed through a 3-5 cm minilaparotomy incision in 80 consecutive patients with stones confined to the gall bladder, with 97.5% success rate. The procedure was converted to the conventional method in two (2.5%) patients only, both with chronic empyema of the gall bladder. The mean operation time was 36 min. Cholecystectomy through this mini-exposure was facilitated by the use of an illuminated retractor and a metal clip applicator. There was no mortality or major duct injury in this series. Choleperitoneum occurred, early in the series, in two (2.5%) patients and was treated successfully by percutaneous aspiration and temporary stenting of the sphincter of Oddi. Minor complications occurred in 10 patients (12.5%). Ninety per cent of patients were ready for discharge within 2 days of their surgery and 80 were fit to return to work within 10 days. Compared with laparoscopic cholecystectomy, the minilaparotomy approach, similarly, offers the patient an improved cosmetic result, shorter hospitalization and early return to work. Moreover, minilaparotomy cholecystectomy has the advantages of a much shorter operation time and probably a smaller risk of major complications. In addition it does not require sophisticated expensive technology or additional specialized skills and, therefore, can become available in any general hospital.

Adult↗
PubMed1994

[Effectiveness of laparoscopic cholecystectomy using various surgical techniques].

The study compares two groups, both in number of 100 patients subdued to laparoscopic cholecystectomy. In each group a different surgical technique was performed. The comparison study regarded duration of surgical performance, incidence of postoperative complications, surgical morbidity and mortality, as well as duration of hospitalization and return to full activity. The surgical interventions were performed at two distinct workplaces. Neither of the mentioned parameters yielded significant differences in dependence on the utilized operation technique. The entire group of 200 cholecystectomic performances was thereafter compared with a comparable group of classical cholecystectomies which had been performed at the identical hospitals. The mentioned parameters yield statistically significant differences in postoperative morbidity, hospitalization duration and return to full professional activity. The results speak in favour of laparoscopic cholecystectomy. The duration of surgical performance, number of postoperative complications requiring reoperation, and mortality do not yield significant differences. The comparison of the observed parameters in relation to age categories presents laparoscopic cholecystectomy as the method suitable also for older patients above 65 years of age. (Tab. 2, Fig 2, Ref. 6).

Adult↗
PubMed1995

The laparoscopic approach reduces the endocrine response to elective cholecystectomy.

The purpose of this study was to prospectively determine and compare the effect of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) on the neuroendocrine response to surgical trauma. Twenty-three evenly matched patients were assigned to either OC (11) or LC (12). Plasma concentrations of norepinephrine (NEPI), epinephrine (EPI), dopamine (DOPA), total catecholamine (TCAT), cortisol, and glucose were measured before and up to 9 hours after skin incision. Compared with preoperative values, significant (P < 0.05) increases in the plasma concentrations of catecholamines, cortisol, and glucose occurred shortly after skin incision following both LC and OC. Compared to post-incision values for OC patients, the increases in NEPI (3-9 hrs), EPI (2-9 hrs), DOPA (1-9 hrs), cortisol (4-9 hrs) and glucose (4-9 hrs) were significantly (P < 0.05) less following LC. Levels of these stress indicators returned to baseline by 4-5 hrs after LC but remained elevated for 9 hrs after OC. The laparoscopic approach results in a significantly reduced neuroendocrine response to surgical trauma following cholecystectomy. The laparoscopic technique may be the best surgical approach in critically ill patients requiring cholecystectomy or other intraabdominal procedures.

Adult↗
PubMed1994

Complications of cholecystectomy. Incidence, clinical manifestations, and diagnosis.

Both open cholecystectomy and laparoscopic cholecystectomy are highly safe and effective procedures for the treatment of patients with symptomatic cholelithiasis. Today, adverse outcomes after open cholecystectomy are largely limited to elderly patients with co-morbid conditions and complicated biliary tract disease. Although infrequent, major biliary complications still occur and have been slightly more common in the initial experience with laparoscopic cholecystectomy. Diagnosis of these potentially serious problems is founded on recognition of their early clinical manifestations and accurate cholangiographic definition on which definitive therapy is predicated.

Biliary Tract Diseases↗
PubMedDate not supplied

Cholecystectomies: from laparotomy to laparoscopy.

Retrospective study of a series of 397 consecutive cholecystectomies among which 289 by laparotomy, 100 by coelioscopy and 8 by coelioscopy first and laparotomy in a second time (conversion rate 8/108 = 7.4%). The results of the whole series are comparable to those of the literature (mortality: 0.7% and morbidity: 8.5%). The results of the first 100 cholecystectomies completely performed by laparoscopy are comparable to the last 100 cholecystectomies performed by laparotomy (no mortality and low morbidity). The coelioscopic approach can reasonably be proposed when indication for cholecystectomy exists, with the exception of undissectable adhesions, a Mirizzi's syndrome or a very acute cholecystitis, and providing a good preoperative imagery of the biliary ducts. In our series, we did not observed wounds of the main biliary duct. We recommend a systematic subhepatic drainage.

Adolescent↗
PubMed1994

[Respiratory exchange during laparoscopic and laparotomic cholecystectomy].

The utility of laparoscopic cholecystectomy in reducing postoperative pain and patient's hospital discharge is already known. Nevertheless peritoneal gas insufflation required by surgical procedure can modify respiratory homeostasis during general anesthesia. The aim of this study was to evaluate the effect of laparoscopic cholecystectomy on pulmonary dead spaces and alveolar gas exchange during inhalation anesthesia compared with traditional laparotomic cholecystectomy. With the approval of Hospital Ethical Committee, thirty-one patients undergoing isoflurane general anesthesia for laparoscopic (CL-S, n = 16) and open (CL-T, n = 15) cholecystectomy were prospectively evaluated in order to asses modifications in physiological (VDphy/VT), anatomical (VDan/VT) and alveolar (VDalv/VT) dead space to tidal volume ratio, arterial to end-tidal carbon dioxide partial pressure difference [P(a-Et)CO2] and alveolar to arterial oxygen partial pressure difference (A-aDO2). Patients, 21-64 years-old, ASA I-II, had no cardiopulmonary diseases. The CL-S group required peritoneal insufflation of carbon dioxide with an intraabdominal pressure (IAP) of about 10-14 mmHg and antitrendelenburg positioning (15-20 degree). Expired gas measurements and arterial blood gas sample for pulmonary dead spaces and arterial to alveolar CO2 and O2 gradient calculation were performed 20 min after a steady state condition. VDphy/VT, VDalv/VT, P(a-Et)CO2 and A-aDO2 increased significantly in the CL-S compared to the CL-T group (p < 0.05). No differences were found in the VDan/VT. These results can be explained by analteration of the ventilation to perfusion ratio (VA/Q) with an increase of high VA/Q regions due to the antitrendelenburg positioning with a redistribution of blood flow towards basal zones.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

How minimally invasive is laparoscopic cholecystectomy?

To determine the extent of surgical stress induced by open (n = 20) and laparoscopic (n = 20) cholecystectomy, postoperative serum cortisol, growth hormone, and insulin responses were determined for each group. The groups were similar regarding age, sex distribution, and duration of the surgical procedures. The open cholecystectomy group had significant elevations of serum cortisol, growth hormone, and insulin levels 8 h after surgery (p < 0.05). The increased cortisol and growth hormone levels returned to preoperative control values 48 h after surgery. In the laparoscopically operated group, although all hormones increased after surgery, only the increase in growth hormone was statistically significant (p < 0.05). Serum cortisol and growth hormone levels gradually returned to control values 48 h after surgery, but the increased serum insulin levels remained significantly high in both groups 24 and 48 h after surgery (p < 0.05). It is concluded that acute surgical stress induced by open cholecystectomy is more severe than that induced by laparoscopic surgery as reflected by serum hormone determinations. However, the hormonal convalescence rate was similar for both groups. It appears that laparoscopic cholecystectomy is "minimally invasive" concerning the hormonal responses.

Cholecystectomy↗
PubMed1994

Comparative study of pain level and analgesic requirement after laparoscopic and open cholecystectomy.

The laparoscopic technique of cholecystectomy leads to shorter hospitalization, faster recuperation, and earlier return to economic activity. Although reduction in pain is considered a major factor, no objective clinical trial has confirmed this assumption. This prospective trial compared the pain level of laparoscopic (n = 28) and conventional (n = 11) cholecystectomy. The level of pain was determined by an independent observer using the visual analog scale (VAS). Intramuscular pethidine or oral naproxen was given intermittently on demand. Patients who underwent the laparoscopic procedure had significantly less pain on the day of operation (mean VAS score 3.8 vs 7.7) and on the first postoperative day (mean VAS score 2.8 vs 6.2) (p < 0.05). The proportion of patients requiring intramuscular pethidine was correspondingly less in the laparoscopy group. On the second and third postoperative day, the level of pain was not statistically different. All patients who had conventional cholecystectomy required at least one dose of analgesia (pethidine or naproxen), whereas only 53.6% of patients who had the laparoscopic procedure required analgesia (p < 0.05). This study verifies that pain reduction is an important advantage of laparoscopic cholecystectomy.

Analgesia↗
PubMed1993

[Alternatives to minimally invasive cholecystectomy].

Open endoscopic minimally invasive cholecystectomy procedures were developed as alternatives to laparoscopic as well as conventional cholecystectomy. The procedures: 1. Open endoscopic microsurgical removal of gallbladder (with or without laser) a 2-2.5 centimeters verticular median incision between the xiphoid and umbilicus. 118 operations with this technique has been performed. 2. Open endoscopic minimally invasive removal of gallbladder with 2.6-4 cms verticular median incision (63 patients) and 4.1-6 cms verticular median incision. Eighteen operations with this technique have been performed (7 choledocholithiasis, 4 accessory bile duct to the right liver lobe etc). Since 1990 we performed 200 consecutive open endoscopic minimally invasive cholecystectomy with no death and a morbidity rate of 1%. There were 161 women and 39 men (19 to 82 years). All gallbladder diseased patients are candidates for this procedures including patients with acute cholecystitis, empyema of the gallbladder, choledocholithiasis, large gallstones or previous abdominal surgery. These procedures are designed as safe, less expensive alternatives to laparoscopic or conventional cholecystectomy.

Adult↗
PubMed1996

[Laparoscopic cholecystectomy in acute cholecystitis].

We performed 417 laparoscopic cholecystectomies, including 58 for acute cholecystitis, between September 1991 and April 1995,. All operations were successful, with no mortality or complications. In about 10%, the laparoscopic approach failed and we converted to open cholecystectomy. Average post-operative hospitalization was 24 hours. We also performed primary open cholecystectomies in 55 patients with acute cholecystitis, because of limitations of operating room and staff availability for unscheduled laparoscopic surgery. In these patients, hospital stay was longer and rate of complications higher. In our opinion laparoscopic cholecystectomy is safe and the preferred approach in acute cholecystitis.

Acute Disease↗
PubMedDate not supplied

Bile duct injury in laparoscopic cholecystectomy.

Bile duct injuries in laparoscopic cholecystectomy are briefly reviewed. The Norwegian National Cholecystectomy Registry was started on April 1, 1993, to collect data from most Norwegian surgical departments. in the period April 1, 1993-May 31, 1995, common bile duct (CBD) injuries necessitating treatment were reported in 0.61% of 2,612 laparoscopic cholecystectomies and in 0.74% of 674 open cholecystectomies. Early diagnosis is mandatory and the treatment is then simple. Delayed diagnosis is dangerous and the treatment may then be difficult. This field seems to show a difference between publications and the real world.

Adult↗