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PubMed1993

Cholecystectomy and colorectal cancer: evidence from a cohort study on diet and cancer.

The association between cholecystectomy and subsequent risk for colorectal carcinoma was investigated in a prospective cohort study on diet and cancer (n = 120,852), which is being conducted in the Netherlands from 1986 onwards among 120,852 men and women, aged 55 to 69. After a follow-up period of 3.3 years, 478 incident cases of colorectal cancer (258 men and 220 women) were identified in the cohort, 64 of whom reported at baseline to have undergone previous gall-bladder surgery (21 men and 43 women). After adjustment for age and familial history of large-bowel cancer, the relative rate (RR) for colorectal cancer in subjects who had undergone cholecystectomy compared with those who had not was 1.81 in men (p = 0.02) and 1.47 in women (p = 0.05). Additional adjustment for parity. Quetelet index, alcohol intake and other dietary variables resulted in a RR of 1.78 in men and 1.51 in women. In women, the highest RR was detected in the right colon (RR = 1.89), whereas in men, no site within the large bowel accounted specifically for the increased relative rate. In both men and women, the rate appeared to increase from approximately 6 years after cholecystectomy onward. According to the TNM stage of the disease, cholecystectomized patients were not detected at an earlier stage than the other patients. It is concluded that in this study the positive association between colorectal cancer and cholecystectomy cannot be explained by detection bias or ascertainment bias and is not confounded by risk factors for gallstone disease or dietary factors.

Aged↗
PubMed1985

Questionable relationship between cholecystectomy and colon cancer.

The relationship between prior cholecystectomy and right-sided colon cancer was evaluated in a case-control study. The study population comprised 267 women with right-sided colon cancer (cases) and 268 women with left-sided colon cancer (controls). All patients were white females, aged between 40 and 69 years, and registered at The University of Texas M.D. Anderson Hospital and Tumor Institute between 1970 and 1982. Thirty cases (11.2%) and 21 controls (7.8%) had documented prior cholecystectomy (odds ratio 1.49, 95% confidence limits 0.83, 2.67). The temporal relationship between cholecystectomy and colon cancer and the presence of diabetes were also evaluated. The authors conclude that there is no significant relationship between prior cholecystectomy and the development of right-sided colon cancer.

Adult↗
PubMed1989

The relationship between cholecystectomy and colon cancer: an Iowa study.

The relationship between cholecystectomy and subsequent development of colon cancer was investigated in a case-control study of 165 patients with histologically proven adenocarcinoma of the colon. These patients were from a community in Iowa where incidence of colon cancer was considered to be higher than average in the United States. The relative risk of developing colon cancer after cholecystectomy was shown to be 2.11 (P = .009) for the entire series and 2.91 (P = .002) for the female group. There was a difference of frequency in developing colon cancer after cholecystectomy between the right- and left-sided colons; the relative risk of the right versus the left colon cancer was 2.31 (P = .019). The other factors, including blood group, red cell indices, obesity, serum cholesterol, colonic diverticula, and co-existence of hyperplastic or adenomatous polyp disclosed no significant relation to colon cancer developed after cholecystectomy.

Adenocarcinoma↗
PubMed1993

[Is cholecystectomy a risk factor for colorectal cancer? A meta-analysis].

The number of patients subjected to cholecystectomy has increased since the introduction of laparoscopic methods. Therefore, the question of an association between colorectal cancer (CR-Ca) and cholecystectomy (CHE) is again topical. Several studies have been performed investigating the possibility of a link between cholecystectomy and large bowel cancer. The findings recorded in these studies have been varied and in some cases contradictory. In meta-analyses of the different types of studies (prospective and retrospective) the main question, "Is the risk of colorectal cancer higher after cholecystectomy?" was examined. In prospective matched-pairs studies, 1158 patients who had undergone CHE were compared with 1222 controls. The relative risk (RR) was 1.48, and this result was not significant. The four prospective cohort studies compared the frequency of CR-Ca of 22,783 CHE patients with the expected frequency in the population (RR = 0.99). The retrospective studies compared the frequency of previous CHE in 11,797 patients with CR-Ca with the frequency in 33,940 controls without CR-Ca. The calculated odds ratio (O. R.) of the meta-analysis was 1.15, a significant but not clinically relevant increase in risk. Similar results was shown for evaluation of sex difference both in the prospective studies, with an RR of 0.99 for women and 1.00 for men, and in the retrospective studies, with a RR of 1.17 (p < 0.05) for women and 1.09 (n.s.) for men. The results for different location of the tumour show no significant risk differences in prospective studies either for the colon or for the rectum.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholecystectomy↗
PubMed1991

[Technique of laparoscopic cholecystectomy].

A new technique for laparoscopic cholecystectomy is described which regards as far as possible the conventional approach to cholecystectomy. Positioning of the operating team is identical to normal cholecystectomy, and the surgeon is able to use both hands to operate since the camera is handled by the assistant. Dissection of the infundibulum is performed in the socalled "tease-and-tear" technique. The peritoneal layer is opened by coagulation. The cystic duct and artery are bluntly dissected by a commercially available dissector. Fat and connective tissue are gently torn off from both structures. After closure of cystic duct and artery by clips, the gallbladder is cut out by thermocoagulation. 178 operations were performed by 8 surgeons; mean duration of the operation was 60 min. A change to open cholecystectomy was necessary in 2.5%. Three complications occurred, requiring reoperation in one case of insufficiency of the cystic duct and another one with intestinal perforation. In the third case, bile leakage from an aberrant bile-duct occurred but dried up spontaneously after a few days. No death occurred nor were there any lesions of the common bile-duct. Conclusively, this new technique seems to be safe and simple to teach due to its approximity to the conventional technique and is recommended as a standard procedure.

Cholecystectomy↗
PubMed1994

Delayed gallstone abscess following laparoscopic cholecystectomy.

Delayed infectious complications following elective laparoscopic cholecystectomy have not been well delineated in the medical literature. Irretrievable spillage of gallbladder contents at the time of laparoscopic cholecystectomy is not rare, and has generally been felt to be of little consequence, particularly in the nonacute setting. The case presented documents an instance of delayed gallstone abscess formation after elective laparoscopic cholecystectomy. While rare, such cases highlight the need for refined techniques to prevent gallbladder, perforation during this procedure and to allow laparoscopic recovery of small gallstones spilled at the time of cholecystectomy.

Abscess↗
PubMed1996

The impact of laparoscopic cholecystectomy on the treatment of symptomatic cholelithiasis.

BACKGROUND: There has been a debate about the cost-effectiveness of laparoscopic cholecystectomy (LC), as well as a concern regarding its possible overutilization and changes in the indication for surgery. METHODS: A retrospective analysis of all cholecystectomies performed at UCDMC from 1988 to 1994 was done. The annual rate of cholecystectomy increased by 50% in 1990 when LC was introduced but has since stabilized at a rate 11% higher than the rate before LC. The disease status and severity did not change. RESULTS: The incidence of nonelective surgery remained stable at 31.2% to 37.5%. Elective cholecystectomy had lower mortality (0.16% vs 1.8%, P = 0. 029), morbidity (2.6% vs 11.2%, P = 0.0001), and conversion rate (2. 6% vs 16%, P = 0.0001) and a shorter length of stay (2.1 days vs 5.4 days), compared with nonelective procedure. CONCLUSIONS: The indication for surgery in cholelithiasis has not changed since the introduction of LC. In patients with symptomatic gallstones, early elective surgery is recommended and may be more cost-effective.

Adult↗
PubMedDate not supplied

Common bile duct caliber following cholecystectomy: a two-year sonographic survey.

The aim of this study was to evaluate the size of the common bile duct (CBD) in patients with gallstones, before and after cholecystectomy. Ten female patients (22-61 years) were examined in whom gallstones were shown by ultrasound. The caliber of CBD was measured before cholecystectomy and then 6, 12, 18, and 24 months after cholecystectomy. No significant change of CBD caliber in each interval prior to or following cholecystectomy was observed.

Adult↗
PubMed1994

Laparoscopic cholecystectomy. The early experience of surgical attendings compared with that of residents trained by apprenticeship.

During our first year of laparoscopic surgery, all cases were performed by attending surgeons; resident involvement was confined to camera work and occasionally to acting as first assistant. These residents were PGY3 or -4. During our second year, these same residents, who had learned the craft in the traditional apprenticeship method, on promotion to senior resident functioned as the primary surgeon in laparoscopic cholecystectomy cases, but under very close guidance by the credentialed attending. Ninety-two cases were attempted in the first year and 100 in the second. There were no differences in age, gender, or preoperative symptoms. More than half the patients had at least one co-morbidity in addition to their gallbladder disease. More women had laparoscopic cholecystectomy soon after pregnancy in the second year, but the percent of the patients with previous surgery declined from 21.4% to 5%. There was a threefold increase in the percent of cases performed in less than two hours and there was a significant reduction in hospital length of stay in the second year. Complication rates were similar in the first and second years. Training residents to do laparoscopic cholecystectomy can be done in a traditional residency program provided the attendings are adequately trained. However, the residents need a higher level of skill at this time than was necessary for open cholecystectomy and have to be further advanced in their training in order to perform this operation laparoscopically.

Adult↗
PubMed1995

Complications of laparoscopic cholecystectomy in HIV and AIDS patients.

We retrospectively evaluated the results of laparoscopic cholecystectomy in patients infected with the human immunodeficiency virus (HIV) with and without acquired immunodeficiency syndrome (AIDS). One thousand one hundred twenty-seven consecutive patients underwent laparoscopic cholecystectomy by our surgical group. Eighteen of these patients were known to be infected with the HIV virus; 6 were asymptomatic and 12 had AIDS. We reviewed the medical records of all HIV-positive individuals with regard to morbidity, mortality, and postoperative outcome following laparoscopic cholecystectomy. In the six HIV-patients without AIDS, five (83%) had improvement of symptoms postoperatively. There was one minor complication (17%). In contrast, only one of the 12 patients with AIDS had postoperative improvement of symptoms and eight (66%) had complications after surgery. There were four deaths (33%) within 30 days of surgery in this group. Only a small percentage of AIDS patients benefit from laparoscopic cholecystectomy. There is a significantly morbidity and mortality following this procedure in this group. Strategies to improve outcome are presented.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Cholecystectomy in the peritoneal dialysis patient. Unique advantages to the laparoscopic approach.

Laparoscopic cholecystectomy has proven to be a safe and effective treatment for symptomatic gallstone disease. Several subsets of patients, however, may not be candidates for the laparoscopic approach, including patients with morbid obesity, acute cholecystitis, and previous abdominal surgery. Because of peritoneal thickening and abdominal adhesions secondary to peritoneal dialysis, the applicability of laparoscopic cholecystectomy in patients maintained on chronic peritoneal dialysis is also unclear. We performed laparoscopic cholecystectomy on three peritoneal dialysis patients without intraoperative complications. We have noted several unique advantages to laparoscopic surgery in this patient population and advocate this approach in peritoneal dialysis patients requiring cholecystectomy.

Adult↗
PubMed1992

Effect of cholecystectomy on gallbladder bile composition.

Human bile samples are commonly used in biliary research; however, the optimal sampling technique is not known. The current study examines whether bile obtained prior to operative manipulation of the gallbladder differs in composition from samples obtained after cholecystectomy. Gallbladder bile samples were obtained from 26 patients undergoing cholecystectomy. An initial sample was obtained prior to manipulation or devascularization of the gallbladder, and a second sample was obtained after the removal of the gallbladder from the operative field. Gallbladder bile pH and total protein were significantly increased in the postcholecystectomy samples. Bile obtained after cholecystectomy also contained significantly less phospholipid. Gallbladder bile cholesterol, total bile acids, bilirubin, ionized and total calcium, cholesterol saturation index, and total lipids were similar between techniques. These results indicate that manipulation of the gallbladder during cholecystectomy produces alterations in gallbladder bile composition. These results also emphasize the need for consistent sampling technique when obtaining samples for biliary research.

Bile↗
PubMed1984

Cholecystectomy as a risk factor for gastric cancer. A cohort study.

Epidemiological findings suggest that gallstone disease and some frequent human cancers share common risk factors. In the present historical prospective cohort study, comprising 16,773 patients who had undergone cholecystectomy 12-15 years previously, the risk of developing gastric cancer was investigated. The total number of observed gastric cancers (89) was very close to the expected number (88), giving a relative risk (RR) of 1.01. A significantly increased risk (P less than 0.01; RR = 2.67) of developing gastric cancer was found during the first year after cholecystectomy, and this increase was judged to be due to cancers that were present but overlooked at the time of cholecystectomy. Subgrouping according to age at surgery revealed a tendency towards a lower risk in patients operated on before the age of 70 years. It is concluded that our data do not support the hypothesis that there are common risk factors for gallstones and cancer, and cholecystectomy does not seem to be associated with an increased risk of gastric cancer within 15 years after this operation.

Adult↗
PubMedDate not supplied

Bile duct injury during laparoscopic cholecystectomy: mechanism of injury, prevention, and management.

Although several studies have shown a low incidence of bile duct injuries during laparoscopic cholecystectomy, concerns remain because of the sustained increase in the number of referrals for biliary reconstruction after the procedure. Twenty-one patients have been referred to our institution because of major bile duct injuries after laparoscopic cholecystectomy. The injury was recognized during the laparoscopic procedure in only 6 of the 21 (29%). Nineteen patients underwent hepaticojejunostomy at least once, one patient required hepaticojejunostomy and repair of a choledochoduodenal fistula, and one patient needed repair of a biliary colonic fistula. Hepaticojejunostomy above the bifurcation was required in 10 patients (50%), at the bifurcation in 3, and below the bifurcation in 7. Nine of the eleven patients in whom the initial repair was performed at the local hospital presented with early stricture (median 7 months). The common denominator of the development of bile duct injuries during laparoscopic cholecystectomy is the failure to identify the structures of the triangle of Calot. Specific steps during laparoscopic cholecystectomy to avoid bile duct injuries are described. Expertise in hepatobiliary surgery appears to optimize results of biliary reconstruction.

Adolescent↗
PubMedDate not supplied

Management of bile duct injuries and strictures following cholecystectomy.

During 7057 conventional cholecystectomies (1972-1991), 16 bile duct injuries occurred, amounting to a risk of 0.22%. A total of 1022 laparoscopic cholecystectomies were performed without such a complication since April 1990. In a retrospective study, 64 patients (16 of our patients and 48 referrals) with an injury or stricture due to conventional cholecystectomy were investigated. In 14 of our 16 patients the injury was recognized and immediately repaired with a good long-term result of 93%, including one successful repair of a subsequent stricture. Two cases of unrecognized injury were managed by nonoperative means. The group of 48 referred patients comprised 10 early postoperative complications (21%) and 38 strictures after an "uneventful" cholecystectomy. Of the 64 total patients, 10 (16%) underwent nonoperative treatment, and 54 required surgery. The mean follow-up period after surgery was 7.4 +/- 4.9 years. Most cases (93%) were repaired by bilioenteric anastomosis (i.e., foremost hepaticojejunostomy) with an 18% restricture rate. Including second and third repairs for restricture, a total of 60 operations (14 primary and 46 secondary reconstructions) were performed without hospital mortality. A good long-term result after stricture repair was achieved in 75% of the patients, whereas 17% had a poor outcome owing to restricture or death (10% had related mortality within 10 years). The other 8% had a moderate result due to recurrent cholangitis. Thus immediate repair of a bile duct injury offers the better chance of a favorable prognosis compared to secondary stricture repair.

Adult↗
PubMed1988

Relative risk of colorectal cancer after cholecystectomy. A multicentre case-control study.

The relative risk of developing colorectal cancer after cholecystectomy was assessed retrospectively in 493 patients with colorectal cancer (239 women, 254 men). The results were compared with a control group of patients matched for sex and age. The overall relative risk was 0.7 (90% confidence interval, 0.7-0.8). However, when the data were analysed for site significant differences were seen. In the caecum and ascending colon the relative risk of developing colorectal cancer after cholecystectomy was 2.8 (90% confidence interval, 1.0-9.4). In the rectum the relative risk was only 0.3 (90% confidence interval, 0.2-0.6) in both sexes. The results suggest a relative increased risk of developing right-sided colon cancer after cholecystectomy in women. However, they only partially support the hypothesis that prior cholecystectomy increases the relative risk of developing colorectal cancer in view of the data relating to the rectum.

Aged↗
PubMedDate not supplied

Routine versus selective intra-operative cholangiography during laparoscopic cholecystectomy.

Opinion is divided whether intra-operative cholangiography should be performed routinely or on a selective basis during laparoscopic cholecystectomy. We therefore performed the first prospective randomized trial of static cholangiography in patients who did not have indications for cholangiograms. Laparoscopic cholecystectomy was attempted on 164 consecutive patients, of whom 49 (30%) patients were excluded from the trial due to indications for or against cholangiography. In the remaining 115 (70%) patients, 56 were randomized to the cholangiography group while 59 patients did not receive cholangiograms. Duration of postoperative hospitalization and interval to return to full activity were identical in the two groups. Static cholangiograms added 16 +/- 1 min (mean +/- SEM) to the procedures (p < 0.01). Cholangiography increased the total charges for the operation by almost $700 (p < 0.01). Cholangiograms were performed successfully in 94.6% of the patients and changed the operative management in 4 (7.5%) patients. There was 1 (1.9%) false negative study. Intra-operative cholangiography did not reveal aberrant bile ducts at risk of injury from the operative dissection. There was no mortality or cholangiogram-related morbidity in either group. In follow-up ranging from 2-12 months, there has been no clinical evidence of bile duct injury or retained common bile duct stones. In summary, in patients without indications for cholangiography, the performance of static cholangiograms markedly increased the operative time and cost of laparoscopic cholecystectomy. The operative management of a minority of patients was changed by the information obtained, but laparoscopic cholecystectomy may be performed safely in the absence of cholangiograms with little risk of injury to the major ductal system or retained calculi.

Adult↗
PubMedDate not supplied

Evaluation of the laparoscopic cholecystectomy on patients with simple and complicated cholecystolithiasis.

Laparoscopic cholecystectomy is now a well described method for the treatment of cholelithiasis. The purpose of this paper is to define its implementation, limits, risks and indications. Following a prospective method, the results of this treatment were compared in 187 patients with simple cholelithiasis and 75 patients with complicated cholelithiasis. Cholecystectomy was performed with a straight optic introduced through the paraumbilical region, and coupled with video camera. Two, 3, or 4 other trocars were inserted and placed as required by anatomic conditions. In the group with simple cholelithiasis, laparoscopic cholecystectomy was performed in 99% of the patients while in the group with complicated cholelithiasis the procedure was achieved in 75% of the patients. Immediate laparotomy was done in 1% and 25% of cases respectively in both groups. No interventional mortality occurred. Postoperative complications have been acceptable (1.6% and 2.7%), with no late complications reported. Our study shows that laparoscopic cholecystectomy is feasible in the majority of cases of complicated cholelithiasis and that the main advantages of this method were retained.

Adult↗