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PubMed1993

Cholecystectomy and colorectal cancer.

BACKGROUND: An increased risk of large bowel cancer, especially of the right colon, following cholecystectomy has been reported in some studies but contradicted in others. The aim of this study was to settle this question by creating a cohort of cholecystectomy patients that was large enough and with a sufficient follow-up time to detect even weak associations. METHODS: A population-based cohort consisting of 62,615 patients who underwent cholecystectomy was followed up for the occurrence of colorectal cancer up to 23 years. RESULTS: There were 633 colorectal cancers versus 637.9 expected (standardized incidence ratio [SIR] = 0.99; 95% confidence interval [CI] = 0.92-1.07). Analyses of an extensive number of subgroups including sex, age at operation, duration of follow-up, underlying diagnosis, type of operation, and different cancer sites did not show any association. However, for cancer of the right colon among women, the risk was increased (SIR = 1.24; 95% CI = 1.03-1.48) most prominent 15 years or more after operation (SIR = 1.54; 95% CI = 1.03-2.22). CONCLUSIONS: Overall, there is no excess risk of colorectal cancer following cholecystectomy, but consistent with some earlier reports, we observed an increased risk among women for right-sided colon cancer 15 years or more after operation.

Adult↗
PubMed1984

Cholecystectomy stimulates hypertrophy and hyperplasia in the hamster pancreas.

Cholecystectomy may be a risk factor for carcinoma of the pancreas. In this study the morphometric and autoradiographic changes in the hamster pancreas following cholecystectomy (chole) were compared with changes observed in sham-operated controls. After operation significant increases were observed in percent acinar cell labeling with [3H]thymidine from 0.29 +/- 0.07 (controls) to 0.57 +/- 0.06 (chole) at 2 weeks and from 0.05 +/- 0.00 (controls) to 0.75 +/- 0.18 (chole) at 4 weeks. The number of labeled duct epithelial cells/mm duct length increased from 0.00 +/- 0.00 (controls) to 4.64 +/- 1.89 (chole) at 2 weeks and from 1.19 +/- 0.97 (controls) to 3.00 +/- 0.75 (chole) at 4 weeks. Duct epithelial cell height (micrometers) increased from 13.90 +/- 1.06 (controls) to 26.98 +/- 1.32 (chole) at 2 weeks and from 13.20 +/- 1.06 (controls) to 23.90 +/- 0.86 (chole) at 4 weeks. It was concluded that cholecystectomy results in hyperplasia and hypertrophy of pancreatic cell populations in the hamster. These data extend previous observations that cholecystectomy has a significant trophic effect on the pancreas.

Animals↗
PubMed1988

Association of cholecystectomy with pancreatic growth and increased plasma levels of cholecystokinin in the Syrian golden hamster.

This study examined the effect of cholecystectomy on plasma concentrations of cholecystokinin (CCK) and pancreatic growth. Seventy female Syrian golden hamsters were used in the investigation. Half the animals underwent cholecystectomy and half had a sham procedure. Following cholecystectomy, significant increases were observed in pancreatic weight (11-41%), total DNA content (8-16%), total protein content (9-19%), DNA synthesis rate (57-200%), and in random plasma CCK concentrations (12-81%) in comparison to the control group. There was no significant change in protein synthesis rate. We conclude that cholecystectomy may have a significant trophic effect on the pancreas and that this effect may be mediated by an increase in circulating levels of CCK.

Animals↗
PubMed1993

Combined cholecystectomy and radical genitourinary cancer surgery.

We have routinely performed simultaneous cholecystectomy in patients with cholelithiasis undergoing selected radical genitourinary cancer surgery. A total of 31 patients have undergone cholecystectomy at the time of radical nephrectomy (25), radical cystectomy (5), and radical prostatectomy (1). Operative time was increased twenty-five to forty-five minutes. There was no significant increase in blood loss, postoperative total bilirubin, or number of complications. No complications were directly attributable to the cholecystectomy except for 1 patient who had prolonged drainage from a closed suction drain in the gallbladder fossa. We conclude that concomitant cholecystectomy at the time of radical genitourinary cancer surgery does not significantly increase morbidity and recommend that it be performed in the presence of cholelithiasis.

Adult↗
PubMed1990

Increased cholecystectomy rates in Saudi Arabia.

Gallstones have become increasingly prevalent in Saudi Arabia, where cholecystectomy is now one of the commonest major abdominal operations. 2854 people underwent cholecystectomy in the 14 hospitals of the country's Eastern Province in the years 1977 to 1986. During this period the overall frequency of cholecystectomy increased by 978%, a finding not explained by the 67% increase in population or the 87% increase in other operations. Simultaneously, the average daily individual consumption of total calories, fat, and sugar increased by 81%, 197%, and 164%, respectively, and consumption of high-fibre grain fell by 75%. This striking increase in the frequency of cholecystectomy, which presumably reflects the incidence of gallstones, cannot be explained by demographic changes and seems more closely linked to the concomitant changes in dietary habits.

Cholecystectomy↗
PubMed1996

[Analgesia after laparoscopic cholecystectomy by intraperitoneal administration of bupivacaine].

OBJECTIVES: The aims of this study were to assess the analgesic effect of the intraperitoneal topical administration of 0.375% bupivacaine in patients undergoing laparoscopic cholecystectomy and to carry out a pharmacokinetic study of bupivacaine administered topically by intraperitoneal route. STUDY DESIGN: Randomized, double-blind controlled trial. PATIENTS AND METHODS: Twenty-four patients of ASA physical status 1 or 2, undergoing elective laparoscopic cholecystectomy, were included. Anaesthesia technique was the same for all patients. At the end of surgery, they were randomly assigned to one of two groups. Patients in group bupivacaine were administered 0.375% bupivacaine, 0.6 mL.kg-1 intraperitoneally in both subdiaphragmatic areas and the cholecystectomy wound, those of the control group were given the same volume of NaCl 0.9%. Analgesia was provided by morphine PCA. Postoperative pain, assessed on a 100 mm visual analogue pain scale (VAS), and administered morphine were recorded 30 min after extubation, and 0.5, 1, 2, 3, 6, 12, 24, 36 and 48 hours later. Blood samples were collected 2, 5, 15, 30, 60, 90, 120, 180, 300 and 480 min after the intraperitoneal administration of bupivacaine to measure bupivacaine plasma concentration. Statistics included Student t test and Chi square test. P < 0.05 was considered significant. RESULTS: There was no significant difference between the two groups with regard to VAS scores during the first 48 postoperative hours. Morphine requirements (total and at each point) were also similar. Plasma bupivacaine concentrations reached a plateau at 10-20 min, and then decreased slowly. The median plasma peak concentration was 0.94 +/- 0.47 microgram.mL-1. In one patient toxic concentrations (> 1.6 micrograms.mL-1) during the first 60 min after intraperitoneal administration were obtained, while in another patient a concentration of 1.58 micrograms.mL-1 was reached twice. CONCLUSIONS: Intraperitoneal administration of 0.6 mL.kg-1 of 0.375% bupivacaine is ineffective in reducing postoperative pain after laparoscopic cholecystectomy. Furthermore these high doses of bupivacaine may result in toxic plasma concentrations. This technique is not safe and cannot be recommended.

Adult↗
PubMed1992

Laparoscopic cholecystectomy: an analysis of 777 cases.

Born in secret in 1987 and developed in an atmosphere of scepticism throughout 1988, laparoscopic cholecystectomy triumphed in 1989 and 1990, causing a veritable revolution in the world of general surgery. The 777 consecutive cases that are reported in this chapter reflect the spirit of these various periods. From conservatively restrictive, our indications widened to include 90% of gallstone cases. For us the sclero-atrophic gallbladder still constitutes the greatest endoscopic challenge and should be reserved for the most experienced operators. The rates for mortality (0.1%) and complications (3.3%), which include three common bile duct injuries (0.4%), are comparable to, if not better than, those for traditional cholecystectomy. The quality of recovery is markedly better: near absence of pain, short hospitalization, return to normal physical activity within 10 days, rapid return to work and preservation of the abdominal musculature in sportspeople. These advantages are unavailable to the 5.5% of patients for whom an intraoperative conversion to an open procedure is necessary. Their recovery is that of traditional cholecystectomy, which itself is far from being poor. The large multicentre studies, such as those carried out in France and Belgium recently, reporting 3708 cases, have reached identical conclusions. Laparoscopic cholecystectomy is set to become the gold standard for treatment of gallstones and is the first step towards surgical techniques of the 21st century which will be performed within the musculocutaneous envelope of the intact human body.

Adolescent↗
PubMed2006

Fruit and vegetable consumption and risk of cholecystectomy in women.

PURPOSE: Many constituents of fruits and vegetables may reduce the risk for gallstones, but prospective data relating fruit and vegetable intake to gallstone disease are sparse. METHODS: We prospectively studied fruit and vegetable consumption in relation to the risk of cholecystectomy in a cohort of 77,090 women in the Nurses' Health Study, 37 to 64 years of age, who had no history of gallstone disease. Women reported on follow-up questionnaires both their consumption of fruits and vegetables and whether they had undergone cholecystectomy. RESULTS: During 1,060,033 person-years of follow-up from 1984 to 2000, participants reported 6608 cases of cholecystectomy. After adjusting for established or suspected risk factors, the relative risk for women in the highest quintile of overall consumption of fruits and vegetables was 0.79 (95% confidence interval [CI], 0.73-0.87, P for trend<.0001) compared with those in the lowest quintile. Similar results were seen for both total fruits and total vegetables separately. The composite items of fruits and vegetables including green leafy vegetables, citrus fruits, vitamin C-rich fruits and vegetables, and cruciferous vegetables also were each inversely associated with the risk. CONCLUSIONS: Our findings suggest a protective role of greater fruit and vegetable consumption against risk of cholecystectomy in women.

Adult↗
PubMed2005

The era of ultrasonography during laparoscopic cholecystectomy.

BACKGROUND: The use of ultrasound cholangiography during cholecystectomy has been well described. This study was undertaken to assess the use of the umbilical port exclusively for ultrasound and to assess its employment on the use of fluoroscopy resources. In addition, we also looked at the increased use of ultrasound from 2000 to 2004. METHODS: The use of imaging techniques during all cholecystectomies was analyzed from January 2000 to July 2001 for one surgeon and compared with that surgeon's present use from January 2004 to June 2004. Patient demographics, intraoperative finding, and postoperative results were reviewed. RESULTS: During the first study period, ultrasound was used in 29% of 189 laparoscopic cholecystectomies. During 2004, ultrasound was used in 77% of 66 laparoscopic cholecystectomies. Throughout both periods, fluoroscopy was only used during 6 laparoscopic common bile duct explorations (2.4% of all cases). There were no false-positive or -negative ultrasounds, and there were no bile duct injuries. CONCLUSIONS: As experience with ultrasound cholangiography increases, there is little indication for fluoroscopic cholangiography except for rare questions concerning anatomy and during therapeutic maneuvers for common bile duct stones.

Adolescent↗
PubMed2004

Bethanechol provocation testing does not predict symptom relief after cholecystectomy for acalculous biliary pain.

BACKGROUND: The currently accepted hypothesis to explain acalculous gallbladder pain is the lack of contractile co-ordination between the body and neck. We have previously shown that bethanechol, a muscarinic stimulant causes differential stimulation of these two regions. AIM: To evaluate the reliability of bethanechol-induced gallbladder contraction in predicting symptom relief after cholecystectomy in patients with acalculous gallbladder disease. METHODS: Fifty-one patients underwent a bethanechol provocation test together with serial ultrasound to determine gallbladder emptying. McGill pain questionnaires were completed, and patients positive for pain (bethanechol provocation test +ve) were offered cholecystectomy, and patients negative for pain (bethanechol provocation test -ve) were reassessed at 6 months and offered cholecystectomy if symptoms persisted. All patients answered pain questionnaires either 6 months after surgery or as follow-up. RESULTS: There was no difference in the percentage of gallbladder emptying between the bethanechol provocation test +ve and bethanechol provocation test -ve groups. Fifty-three percent of bethanechol provocation test +ve patients and 54% of bethanechol provocation test -ve patients still remained symptomatic 6 months after surgery. Conclusion. Gallbladder pain provoked by bethanechol does not predict symptom relief after cholecystectomy.

Adult↗
PubMed2003

A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis.

BACKGROUND: Few articles address the issue of LC in patients with cirrhosis. Existing articles are retrospective and with small sample sizes, which makes it difficult to draw conclusions about indications and complications with LC in this setting. STUDY DESIGN: An extensive search of the Medline, Embase, and Cochrane databases using the terms "laparoscopic cholecystectomy" and "cirrhosis" or "cirrhotic" was conducted. The data from each study were extracted, combined with those of similar studies, and analyzed. RESULTS: Twenty-five publications (400 patients with cirrhosis undergoing LC) from 1993 to 2001 were identified. Four articles compared LC with open cholecystectomy in patients with cirrhosis, and six compared patients with cirrhosis to patients without cirrhosis. Patients were primarily in Child-Pugh class A or B, with only six patients in Child-Pugh class C. Compared with patients without cirrhosis, patients with cirrhosis had higher conversion rates (7.06% versus 3.64%, p = 0.024), operative times (98.2 minutes versus 70 minutes, p = 0.005), bleeding complications (26.4% versus 3.1%, p < 0.001), and overall morbidity (20.86% versus 7.99%, p < 0.001). Acute cholecystitis was evident in 47% of patients with cirrhosis versus 14.7% of patients without cirrhosis (p < 0.001). When LC was compared with open cholecystectomy in patients with cirrhosis, LC was associated with less operative blood loss (113 mL versus 425.2 mL, p = 0.015), operative time (123.3 minutes versus 150.2 minutes, p < 0.042), and length of hospital stay (6 days versus 12.2 days, p < 0.001). CONCLUSIONS: Patients with cirrhosis undergo cholecystectomies for more emergent reasons and have higher morbidity. The laparoscopic approach offers advantages of less blood loss, shorter operative time, and shorter length of hospitalization in patients with cirrhosis. Prospective studies will establish which factors affect outcomes and determine the appropriateness of LC in Child's-Pugh class C cirrhosis.

Aged↗
PubMed2005

Continuous transesophageal echo-Doppler assessment of hemodynamic function during laparoscopic cholecystectomy.

STUDY OBJECTIVE: The objective of this study was to examine the utility of the transesophageal echo-Doppler device in evaluating hemodynamic changes during laparoscopic cholecystectomy. DESIGN: This was a prospective, controlled, observational open study. SETTING: The study took place in a university hospital. PATIENTS: Twenty patients with ASA physical statuses II and III undergoing laparoscopic cholecystectomy were enrolled into the study. INTERVENTIONS AND MEASUREMENTS: A standardized general anesthetic and surgical technique was used for all patients. Similar depth of hypnosis (using bispectral index monitoring) was maintained in all patients. Hemodynamic parameters including mean arterial pressure (MAP), cardiac index (CI), left ventricular (LV) ejection time interval indexed to the heart rate, maximum acceleration, peak velocity, and systemic vascular resistance (SVR) were recorded at predetermined intervals: before incision, after peritoneal CO(2) insufflation and head-up tilt, every 10 minutes thereafter, and after deflation of the abdomen and return to supine position. MAIN RESULTS: The transesophageal echo-Doppler probe placement was achieved in 3 to 5 minutes in all patients, and the probe position was maintained after creation of pneumoperitoneum and change in positioning. Induction of pneumoperitoneum and head-up tilt resulted in a significant increase in MAP and SVR (P < .05) that remained higher until deflation. The CI, LV ejection time interval indexed to the heart rate (a measure of LV filling), and maximum acceleration (a measure of contractility and global ventricular function) remained stable. CONCLUSIONS: The transesophageal echo-Doppler device can be used during laparoscopic cholecystectomy. The LV function, as determined by measurement of CI and maximum acceleration, was preserved during laparoscopic cholecystectomy despite significant increases in afterload (ie, MAP and SVR).

Adult↗
PubMed2004

Predictors of successful outcome after cholecystectomy for biliary dyskinesia.

PURPOSE: Laparoscopic cholecystectomy is accepted therapy for children with ill-defined abdominal pain and impaired gallbladder emptying (biliary dyskinesia). Follow-up shows poor clinical response in many of these patients. The purpose of this report is to identify clinical and radiographic predictors of successful outcome after cholecystectomy for biliary dyskinesia. METHODS: The authors retrospectively reviewed records of 51 children after laparoscopic cholecystectomy for biliary dyskinesia (1990 to 2003). Clinical symptoms, radiographic findings, and pathology were evaluated. Subjective clinical improvement is stratified using an established patient satisfaction score. Logistic regression analysis determines statistically independent predictors of successful outcome. RESULTS: Thirty-eight of 51 (75%) patients were available for follow-up. Twenty-seven of 38 (71%) patients reported complete resolution of symptoms. Nausea was the only symptom predictive of successful outcome by univariate analysis (odds ratio, 5.00). A cholecystokinin-stimulated, gallbladder ejection fraction less than 15% also predicts successful outcome (odds ratio, 8.00). Children with an ejection fraction greater than 15% did not have predictable resolution of symptoms. When present with pain and nausea, gallbladder emptying less than 15% has a positive predictive value of 93% and a negative predictive value of 81%. CONCLUSIONS: Together, nausea, pain, and decreased gallbladder emptying (<15%) most reliably predict which children will benefit from cholecystectomy for biliary dyskinesia.

Abdominal Pain↗
PubMed2006

A comparison of cholecystectomy and observation in children with biliary dyskinesia.

PURPOSE: The success rate of ameliorating the preoperative symptoms of biliary dyskinesia in a pediatric population has been reported to be approximately 80%. The purpose of this study was to identify patient characteristics that may help to predict successful clinical outcomes in pediatric patients with biliary dyskinesia by comparing 2 groups of pediatric patients: those who underwent cholecystectomy and those who received no surgical intervention (control group). METHODS: The medical charts of pediatric patients who had an ejection fraction of less than 35% and no other identifiable abnormalities revealed on diagnostic testing were retrospectively reviewed. Information regarding psychological diagnoses/treatment, diagnostic examination findings, histologic findings, and outcomes were collected. Patients were evaluated at 1 month and 2 years postoperatively. RESULTS: From 1995 through 2003, 55 pediatric patients were identified. All patients had an abnormal ejection fraction on hepatobiliary iminodiacetic acid scan. The patients were divided into 2 groups: those who underwent cholecystectomy (n = 35) and a control group who did not receive surgical intervention (n = 20). Of those who underwent cholecystectomy, 74% improved, whereas 75% of the control group showed improvement after 2 years. Of all patient characteristics evaluated, only weight loss was found to be significant for determining patient outcomes. CONCLUSION: When followed for a long enough period of time, outcomes were similar between the 2 groups. Of the patients whose symptoms improved, those who underwent cholecystectomy had a quicker resolution of abdominal pain than those who did not undergo surgery. With the exception of weight loss, none of the patient characteristics evaluated in this study proved to be statistically significant for predicting a positive outcome.

Adolescent↗
PubMed2006

Robotic cholecystectomy: learning curve, advantages, and limitations.

BACKGROUND: Robotic cholecystectomy is safe, feasible procedure. Initial studies showed significant set up time and operating time but no clear clinical advantage of the robotic involvement. We have investigated the learning curve, advantages and limitation of the procedure. MATERIAL AND METHODS: We reviewed all (n = 51) robotic cholecystectomies performed between July 2004 and December 2005. The surgery was performed using the da Vinci system. We recorded operative time, setup time of robotics instrumentation, conversion to laparoscopic or open cholecystectomy and complication of the procedure. RESULTS: Forty-eight of the 51 procedures (94%) were completed robotically. We did not experience any significant complications directly related to robotics surgery. The mean +/- SD operating time was 77 +/- 22.3 min. The mean setup time for robotics (from incision until robot was in place, including draping the robot) was 24 +/- 8.8 min. However, the setup time significantly improved as we gained more experience: from 30.6 +/- 10.7 min (first 16 cases) to 18.3 +/- 4.0 min (cases 33-48). The mean robotic time was 34 +/- 16.1 min. We observed no significant improvement in robotic procedure time. CONCLUSIONS: Robotic cholecystectomy offers significant advantages such as three-dimensional view, easier instrument manipulations and possibility of remote site surgery. We observed some shortcomings of robotic surgery such as need for larger and additional ports, and need for undocking the machine in case of cholangiography or change of patient position. Our data shows that the learning curve is between 16 to 32 procedures to significantly decrease the setup time and total operating time.

Adolescent↗
PubMed2005

The role of cholecystectomy in renal transplantation.

INTRODUCTION: We reviewed our clinical experience to assess the role of cholecystectomy transplant candidates pre- and posttransplantation. METHODS: Between April 1986 and December 2003, 57 (6.8%) candidates among 839 kidney transplants were found during routine pretransplant screening to show gallstones. RESULTS: Thirty nine (68.4%) symptomatic patients underwent cholecystectomy before transplantation. Among 18 (31.6%) asymptomatic patients monitored after transplantation, the 7 (39%) who developed biliary tract symptoms underwent laparoscopy or minilaparocholecystectomy without postoperative morbidity, mortality, or graft loss. CONCLUSIONS: Symptomatic gallstones have to be treated using the laparoscopic cholecystectomy or minilaparotomy technique. In asymptomatic cholelithiasis prophylactic cholecystectomy is only reserved for patients with biliary "intrinsic" risk factors. An early diagnosis and prompt surgical treatment yields good results.

Cholecystectomy↗
PubMed2005

Laparoscopic cholecystectomy for renal transplants.

The diagnosis and management of cholelithiasis in renal transplant patients are subjects of debate. The purpose of this study was to evaluate the outcomes of laparoscopic cholecystectomy in renal transplant patients with symptomatic gallstone disease. The records of 155 kidney transplant patients were reviewed, including 16 patients who, underwent laparoscopic cholecystectomy. Shortest interval time between transplantation and cholecystectomy was 2 years. Surgical morbidity were seen in two patients (12.5%) with no mortality and no graft loss. In conclusion, laparoscopic cholecystectomy can be performed safely with low morbidity in renal transplant patients who have symptomatic gallstone disease. The morbidity rate is comparable to nontransplant patients.

Cholecystectomy↗
PubMed2000

Relaparoscopy for the detection and treatment of complications of laparoscopic cholecystectomy.

BACKGROUND: Laparotomy remains the commonest intervention in patients with abdominal complications of laparoscopic surgery. Our own policy is to employ relaparoscopy to avoid diagnostic delay and unnecessary laparotomy. The results of using this policy in patients with suspected intra-abdominal complications following laparoscopic cholecystectomy are reviewed. METHODS: Data were collected from laparoscopic cholecystectomies carried out by five consultant surgeons in one center. Details of relaparoscopy for complications were analyzed. RESULTS: Thirteen patients underwent relaparoscopy within 7 days of laparoscopic cholecystectomy for intra-abdominal bleeding (2 patients) or abdominal pain (11 patients). The causes of pain were subhepatic haematoma (1), acute pancreatitis (1), small bowel injury (1), and minor bile leakage (6). In 2 patients no cause was identified. Twelve patients were managed laparoscopically and 1 patient required laparotomy. Median stay after relaparoscopy was 7 days (range 2 to 19). CONCLUSIONS: Exploratory laparotomy can be avoided by prompt relaparoscopy in the majority of patients with abdominal complications of laparoscopic cholecystectomy.

Adult↗