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At least 973 records · Page 54Linked to original sources
PubMed1998

Laparoscopic cholecystectomy for cholelithiasis during infancy and childhood: cost analysis and review of current indications.

Eleven consecutive laparoscopic cholecystectomies (LCs) were performed between January 1994 and June 1996 compared with seven open cholecystectomies (OCs) performed previously at King Khalid University Hospital. The comparison included surgical, clinical, and economic factors, together with a review of the literature. In the laparoscopic group the main indication for cholecystectomy was symptomatic gallstones. Other indications include mucocele of the gallbladder and chronic cholecystitis. A total of eight children in both group had sickle cell disease. The first two LCs were performed in the presence of an experienced laparoscopic surgeon. There is a learning curve to pass through with LC. The operating time for LC ranged between 65 and 135 minutes (mean +/- SD 89.81 +/- 21.89 minutes). There was no major morbidity or mortality. The average postoperative parenteral analgesia required for LC (50.45 +/- 24.57 mg) was significantly less than for OC (135.14 +/- 62.02 mg), and the mean length of hospitalization for LC was significantly shorter than that for OC (1.68 +/- 0.46 vs. 6.07 +/- 0.30) days. Although the average operative cost per LC (2522 SR) was significantly more expensive than for OC (350 SR), the ultimate cost of LC was significantly less than for OC (5790.00 +/- 787 vs. 12,343 +/- 139 SR) because the total period of hospitalization was much shorter. In conclusion, LC is safe, effective, and less expensive than OC and therefore is the approach of choice for cholecystectomy in children.

Child↗
PubMed2001

Gastrointestinal quality of life in patients with symptomatic or asymptomatic cholelithiasis before and after laparoscopic cholecystectomy.

BACKGROUND: There is an ongoing need, from both the medical and the economic perspective, for a more accurate definition of the influence of symptomatic or asymptomatic gallstone disease on gastrointestinal symptomatology, as well as on the health of the individual in general. METHODS: Using the Gastrointestinal Quality of Life Index (GIQLI), 37 symptomatic and 30 asymptomatic gallstone patients were evaluated at admission to the hospital and again 4 months after undergoing an uneventful laparoscopic cholecystectomy (LC). RESULTS: Postoperatively, significant increases in the total GIQLI score were noted in both the symptomatic group (113.42 +/- 21.9 vs 80.32 +/- 19.1 preoperatively; p < 0.05) and the asymptomatic group (96.37 +/- 14.26 vs 113.30 +/- 15.22; p < 0.05). For the subgroups of items, the core symptoms and the physical, psychological, and disease-specific items improved significantly in both groups in the postoperative period (p < 0.05 for all comparisons), but only the symptomatic group achieved a significant improvement in the subgroup of social items (p < 0.05). Negative correlations were found in both the symptomatic and asymptomatic groups between the preoperative GIQLI scores and the improvement seen after LC (r = -0.70 and r = -0.49, respectively). CONCLUSION: Gallstone disease has a profoundly negative impact on quality of life, especially in symptomatic patients with a history of biliary colic attacks and/or the complications of the disease. Although the condition is not equally distressing for the asymptomatic group of patients without such a history, uncomplicated LC improves the quality of life significantly in both groups. Gallstone patients with lower GIQLI scores are more likely to benefit from LC.

Adult↗
PubMed2003

Staged and complete laparoscopic management of cholelithiasis in a patient with gallstone ileus and bile duct calculi.

BACKGROUND: Gallstone ileus is an uncommon cause of small bowel obstruction, and its incidence peaks in elderly women. Although enterolithotomy has been accomplished laparoscopically, often using a laparoscopically assisted approach, controversy persists as to the indication, timing, and surgical approach to a cholecystectomy with closure of the cholecystoduodenal fistula. METHODS: We present the case of a 63-year-old woman with symptomatic cholecystolithiasis who presented with acute gallstone ileus and underwent an emergency laparoscopic enterolithotomy. Hypotonic duodenography during the follow-up period demonstrated a cholecystoduodenal fistula and previously unsuspected stones in the bile duct. The patient underwent an elective laparoscopic cholecystectomy with repair of the fistula, a concomitant bile duct exploration, choledocholithotomy, and primary bile duct closure. RESULTS: The patient enjoyed an uneventful recovery, and was discharged home on postoperative day 5 after her initial emergency surgery. Her recovery after the subsequent elective surgery was more expeditious, with a discharge from hospital on postoperative day 2 and a return to office employment 2 weeks later. CONCLUSION: In the good-risk patient, staged laparoscopic management of gallstone ileus and the associated cholecystoduodenal fistula is feasible and appears to be safe. In such patients, imaging of the biliary tree is essential to detect silent choledocholithiasis, which also may be managed concomitantly and safely by the laparoscopic approach.

Cholecystectomy, Laparoscopic↗
PubMed2003

Endoscopic sphincterotomy prior to laparoscopic cholecystectomy for the treatment of cholelithiasis.

BACKGROUND: We performed this study to assess the outcome of endoscopic retrograde cholangiography (ERC) before laparoscopic cholecystectomy (LC) for symptomatic gallbladder and suspected duct stones. METHODS: We performed prospective study of 310 patients with symptomatic gallstones and suspected choledocholithiasis managed by preoperative ERC with endoscopic extraction (ESE) and LC. The presence of one or more of the following criteria at hospital admission led to preoperative ERC because of suspected choledocholithiasis: jaundice for more than 72 h, ultrasonography measurement of the common bile duct > 8 mm, cholestasis, and acute biliary pancreatitis. RESULTS: ERC for suspected choledocholithiasis was performed in 310 patients. The rate of successful cannulation for ERC was 96.8%. Duct stones were found in 86%. Twelve patients had impacted duct stones cleared at open common duct exploration. The failure rate of ERC was 4.5%, and the rate of unnecessary ERC was 13.5%. LC was performed in 298 of 310 patients. Morbidity rates were 2.2% and 1.5% after ESE and LC, respectively. CONCLUSION: A total of 95.5% of patients with symptomatic gallbladder and ductal stones could be successfully managed by ERC prior to LC with a low morbidity rate.

Adolescent↗
PubMed2000

Incidental discovery of pelvic cholelithiasis on diagnostic laparoscopy.

Laparoscopic cholecystectomy, although a safe technique for removal of the gallbladder, is associated with surgery-related complications. We report a complication caused by this procedure in a young woman, in whom a diagnostic laparoscopy led to the incidental finding of retained gallstones in the pelvis. A 30-year-old woman underwent diagnostic laparoscopy for exclusion of an ectopic pregnancy. She had undergone laparoscopic cholecystectomy 3 years before presentation. Diagnostic laparoscopy ruled out ectopic pregnancy, but yellow nodules were noted in her pelvis. Removal of these nodules was not attempted because of their close proximity to the ureter. A biopsy of these lesions confirmed amorphous material suggestive of gall stones. The finding was documented in the case notes and explained to the patient after the procedure.

Adult↗
PubMed1997

Predictive factors for synchronous common bile duct stones in patients with cholelithiasis.

BACKGROUND: To determine the predictive factors of synchronous common bile duct (CBD) stones, data from 878 consecutive patients who underwent cholecystectomy in a university clinic from June 1991 to June 1996 were retrospectively analyzed. METHODS: Based on clinical, biochemical, and ultrasonographic criteria, 194 patients were selected for ERCP, 180 preoperative and 14 postoperative. RESULTS: Cannulation of CBD was successful in 192 (99%) patients. Stones were identified in 62 (32%) patients and sphincterotomy was performed in 56 (90%). Duct clearance was achieved in 43 (77%) cases. There was a high predictive value for the presence of CBD stones in patients with cholangitis, present jaundice, and dilated CBD with evidence of stones on ultrasound (75%, 72%, and 67% respectively). A dilated CBD without stone on ultrasound and elevated liver enzymes had less than 40% positive predictive value. History of previous jaundice, pancreatitis, previously raised liver enzymes, and present pancreatitis was predictive in less than 20% of the cases. Univariate analyses revealed that clinical findings of cholangitis and obstructive jaundice, elevated liver enzymes (previous and present), and ultrasonographic findings of stones in a dilated CBD were significant positive predictors. Subanalysis of each elevated liver enzyme revealed that alanine transaminase, aspartate transaminase, alkaline phosphatase, and gamma glutamyl transpeptidase were significant predictors. Both elevated conjugated and total bilirubins were also significant predictors for CBD stones. CONCLUSION: Multivariate logistic regression analysis on these significant predictors showed that cholangitis (odds ratio [OR]: 10.5), dilated CBD with evidence of stones on ultrasound (OR: 7.4), elevated aspartate transaminase (OR: 2.9), and conjugated bilirubin (OR: 5.3) were jointly significant. The likelihood of having stones in the duct without any of these predictors was 7%, but 99% when all the predictors were positive.

Adolescent↗
PubMed1978

Cholelithiasis: a frequent complication of artificial heart valve replacement.

The results of this investigation reveal that 39 per cent of patients in a study group of 46 patients with heart valve prostheses had gallstones if they survived 18 months or longer following valve replacement. In contrast, the prevalence of gallstones in a general population of autopsied rheumatic heart disease patients, including those who had been operated for severe valvular heart disease and had not survived for more than one month, was only 12 per cent. These findings suggest that gallstones are a frequent late complication of heart valve replacement.

Adult↗