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PubMed2004

Gastric electrical activity in patients with cholelithiasis undergoing laparoscopic cholecystectomy: a prospective controlled study.

BACKGROUND: The aim of the present study was to evaluate the effect of gallstone disease (GD) and laparoscopic cholecystectomy on gastric electrical activity of slow waves, which was recorded via transcutaneous electrogastrography (EGG). METHODS: Twenty-one consecutive patients (M/F: 12/9, 52.7 +/- 15 years old) with GD and no previous history of abdominal operations or known disease affecting gastrointestinal motility were studied. The EGG was performed for 30 min prior to and 90 min after a standard meal, during a 4-6 month period prior to and after laparoscopic cholecystectomy. The percentile proportion of the three spectra of gastric slow waves frequency was studied, defined as follows: bradygastria, 1-2.1 cycles per min (c.p.m.); normogastria, 2.2-3.9 c.p.m.; and tachygastria, 4-9 c.p.m. The findings were compared to those of nine healthy subjects (M/F: 5/4, 49.5 +/- 14.8 years old). RESULTS: No statistically significant difference was found in percentile distribution of bradygastria, normogastria and tachygastria, pre- or post-prandially, neither before or after laparoscopic cholecystectomy, nor between patients and controls. CONCLUSIONS: Patients with GD do not exhibit differences in gastric electrical activity of slow waves in comparison to normal subjects and laparoscopic cholecystectomy does not alter gastric electrical activity. These findings suggest that cholelithiasis does not seem to cause dyspeptic symptoms due to gastric dysrythmias.

Adult↗
PubMed1988

Gallstones at autopsy and cholecystectomy: a comparative study.

An examination of 613 post-mortems gave a prevalence of biliary disease at autopsy of 36.5%, higher than reported previously in Australia. This consisted of an asymptomatic gallstone prevalence of 18.9%, with a further 5.7% of the autopsies having granular biliary sludge and 11.9% having had a previous cholecystectomy. Although the rate of occurrence of cholesterol gallstones was approximately half that of the pigment gallstones and pigment biliary sludge combined, no significant association between the sex of the postmortems and stone type was observed at autopsy (chi 2(1) = 0.1: P greater than 0.05). The ratio of biliary disease between females and males was approximately 2:1. Gallstones and biliary sludge from 310 cholecystectomy patients showed that cholesterol gallstones were approximately twice as common in men, and approximately six times as common in women than pigment gallstones. In this group of patients there was a significant association between the sex of the patient and the rate of occurrence of stone type. The rate of occurrence of cholesterol gallstones was significantly higher than pigment gallstones in both the males and females at cholecystectomy (chi 1(2) = 18.97; P less than 0.0001). A female to male ratio of approximately 2:1 was also observed. A statistically significant higher rate of pigmented biliary disease was observed at autopsy than at cholecystectomy. (chi 2 = 101.0; P less than 0.0001). Analyses on biliary sludge, a filterable, fine granular pigmented material in bile, suggest that it may be the direct precursor for a number of different gallstone types.

Adult↗
PubMed1994

Laparoscopic management of complications following laparoscopic cholecystectomy.

Laparoscopic cholecystectomy has rapidly become the treatment of choice for symptomatic cholelithiasis. Although published morbidity and mortality rates compare favourably with open cholecystectomy, bile duct injuries occur far more frequently and technical complications unique to the laparoscopic approach account for a significant number of postoperative deaths. The majority of these complications are dealt with by laparotomy. Two technical complications encountered in a series of 170 patients undergoing laparoscopic cholecystectomy and their subsequent management are presented. One patient suffered a diathermy injury to the common hepatic duct and postoperative bile leak. This was managed successfully by repeat laparoscopy and peritoneal lavage combined with endoscopic retrograde cholangiopancreatography (ERCP) and stenting of the hepatic duct. Another patient sustained a perforated duodenum complicated by peritonitis, subcutaneous wound infection and generalized sepsis. The perforation was repaired at a second laparoscopy using intracorporeal suturing and Tissucol. It is demonstrated that it is possible to deal with some of the technical complications of laparoscopic cholecystectomy with a combination of minimally invasive techniques, sparing the patient from the additional risk of laparotomy.

Adult↗
PubMed1995

A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy.

The aims of this study were to see if laparoscopic cholecystectomy is associated with a similar postoperative pain pattern to gynaecological laparoscopy and to see whether the use of a suprahepatic suction drain makes recovery from laparoscopic cholecystectomy more comfortable. After routine laparoscopic cholecystectomy and insertion of a suprahepatic suction drain, patients were randomized to suction or no suction on the drain. The time course of the severity of wound, abdominal and shoulder tip pain was assessed by visual analogue scales administered in the morning and afternoon of the first 3 postoperative days. The control group had a high incidence of shoulder tip pain similar to that after gynaecological laparoscopy. Patients in the treatment group reported significantly less shoulder tip pain than the control group (O.R. 0.16, 95% CI, 0.06-0.40). There was a tendency for the treatment group to report reduced abdominal and, to a lesser extent, wound pain. The authors recommend suprahepatic suction as a simple and more effective way to improve patient comfort after laparoscopic cholecystectomy.

Abdominal Pain↗
PubMedDate not supplied

Cholecystectomy and endometrial cancer: a marker of long-term elevated estrogen exposure?

Excess hormones, both endogenous and exogenous, are implicated in the etiology of endometrial cancer. We considered whether having had gallstones or a cholecystectomy (surgery to remove the gallbladder), which are more common in women who are obese and who use exogenous hormones, might be a marker for high lifetime levels of estrogen. We conducted a population-based study of endometrial cancer cases and community controls in women aged 40-79 years. Participants completed an interviewer-administered questionnaire that elicited exposures prior to diagnosis or reference date, including history of gallstones and cholecystectomy, as well as reproductive history, lifetime body mass, smoking, postmenopausal hormone (PMH) use, and other risk factors. Compared to controls, cholecystectomy was associated with a 50% increased risk of developing endometrial cancer (odds ratio = 1.5 [1.1-2.0]). The relationship appeared to depend upon PMH user status; the association was observed only among never hormone users. Body mass index did not appear to modify this relationship. Having a diagnosis of gallstones was also associated with endometrial cancer, although to a lesser magnitude. Although other etiologic factors may play a role in the relation between cholecystectomy and endometrial cancer, the current analysis suggests that this association is attributable, at least in part, to the sharing of hormonal risk factors.

Adult↗
PubMed2004

Long-term intake of dietary fiber and decreased risk of cholecystectomy in women.

BACKGROUND: Epidemiologic studies on the relationship between dietary fiber and gallstone disease are inconclusive, and the effects of different types of dietary fiber are not clear. METHODS: We examined the association between long-term intake of dietary fiber as well as fiber from different sources and risk of cholecystectomy in a cohort of 69,778 women who were aged from 35 to 61 years in 1984 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every two years both their fiber intake and whether they had undergone cholecystectomy. RESULTS: During 16 yr of follow-up, we documented 5,771 cases of cholecystectomy. After adjusting for age and other known or suspected risk factors in a multivariate model, compared with women in the lowest quintile of total dietary fiber intake, the relative risk of choleystectomy for those in the highest quintile was 0.87 (95% CI, 0.78-0.96, p for trend = 0.005). For a 5-g increase in total fiber intake, the multivariate relative risk was 0.94 (95% CI, 0.90-0.98). Insoluble fiber, taking soluble fiber into account in the multivariate model, was significantly associated with a reduced risk. The multivariate relative risk was 0.83 (95% CI, 0.73-0.94, p for trend = 0.009) for insoluble fiber, and was 1.01 (95% CI, 0.89-1.15, p for trend = 0.9) for soluble fiber, when extreme quintiles were compared. For a 5-g increase in intake, the relative risk was 0.90 (95% CI, 0.84-0.97) for insoluble fiber, and was 1.01 (95% CI, 0.83-1.23) for soluble fiber. CONCLUSIONS: Our results suggest that increased long-term consumption of dietary fiber, particularly insoluble fiber, can reduce risk of cholecystectomy in women.

Adult↗
PubMed2004

Recurrence of acute gallstone pancreatitis and relationship with cholecystectomy or endoscopic sphincterotomy.

OBJECTIVES: To determine the prevalence of recurrence of gallstone pancreatitis, its clinical features, and the presence of prognostic factors of recurrence. METHODS: From January 1, 2000 to August 31, 2003, 233 patients admitted with acute gallstone pancreatitis (AGP) were prospectively studied. Patients were divided into two groups: recurrent and nonrecurrent group. Clinical, analytical, radiological, prognostic parameters, and severity (Atlanta criteria) were assessed, along with the performance of cholecystectomy or endoscopic sphincterotomy (ES). Clinical features of recurrence were analyzed. Univariate (chi(2), Student's t-test) and multivariate tests were performed. Statistical significance was assumed if p < 0.05. RESULTS: Two hundred and eighty-six attacks were identified. Forty-two patients (18.2%) recurred, suffering 53 recurrent attacks, which took place within 30 days in 23.3%. Patients who did not undergo surgery after the first attack had 31-fold risk of recurrence (OR = 31.5%, CI = 95%[7.22-137.84], p < 0.001). In patients not operated, recurrence was more frequent if ES was not performed (37.04%vs 0%, p= 0.019). Among patients with surgical risk, none who recurred underwent ES, compared with 27.9% of those who did not recur. Patients in the nonrecurrent group underwent cholecystectomy within the first 30 days or ES more frequently (31.2%vs 7.3%, p= 0.001). CONCLUSIONS: Recurrence of gallstone pancreatitis is a frequent event. Delay of cholecystectomy implies an increased risk of recurrence. ES could be an acceptable option to prevent recurrence in patients who are not candidates for surgery or who do not desire to undergo cholecystectomy.

Acute Disease↗
PubMed2005

Small gallstones are associated with increased risk of acute pancreatitis: potential benefits of prophylactic cholecystectomy?

OBJECTIVES: Pancreatitis is a severe complication of gallstone disease with considerable mortality. Small gallstones may increase the risk of pancreatitis. Our aims were to evaluate potential association of small stones with pancreatitis and potential beneficial effects of prophylactic cholecystectomy. METHODS: Stone characteristics were determined in patients with biliary pancreatitis (115), obstructive jaundice due to gallstones (103), acute cholecystitis (79), or uncomplicated gallstone disease (231). Sizes and numbers of gallbladder and bile duct stones were determined by ultrasonography and endoscopic retrograde cholangiopancreatography, respectively. Effects of prophylactic cholecystectomy were assessed by decision analyses with a Markov model and Monte Carlo simulations. RESULTS: Patients with pancreatitis or obstructive jaundice had more and smaller gallbladder stones than those with acute cholecystitis or uncomplicated disease (diameters of smallest stones: 3 +/- 1, 4 +/- 1, 8 +/- 1, and 9 +/- 1 mm, respectively, p < 0.01). Bile duct stones were smaller in case of pancreatitis than in obstructive jaundice (diameters of smallest stones: 4 +/- 1 vs 8 +/- 1, p < 0.01). Multivariate analysis identified old age and small stones as independent risk factors for pancreatitis. Decision analysis in a representative group of patients with small (<or=5 mm) gallstones (5,000 patients, 67% females, 45 yr old, 10-yr follow-up) indicates that life-years may be gained or lost by cholecystectomy, depending on incidence and mortality of pancreatitis. CONCLUSIONS: Small gallstones are associated with pancreatitis. Prophylactic cholecystectomy may lead to gain or loss of life-years in patients with small stones, depending on incidence and mortality of pancreatitis.

Age Factors↗
PubMed1977

Wound sepsis after cholecystectomy: effect of incidental appendicectomy.

The records of a consecutive series of 224 patients were analysed to discover the effect of incidental appendicectomy on the wound sepsis rate after cholecystectomy. One hundred and five patients had had a cholecystectomy alone and 119 cholecystectomy with incidental appendicectomy. The incidence of wound sepsis in patients not given adequate antibiotic prophylaxis was significantly lower (16-1%) when cholecystectomy alone was carried out than when the appendix was removed as well (41-1%).

Adult↗
PubMed2006

Central adiposity, regional fat distribution, and the risk of cholecystectomy in women.

PURPOSE: Whether central adiposity contributes independently of total adiposity to the risk for gall stones is inconclusive. We examined prospectively indicators of central adiposity in relation to the occurrence of gall stone disease. METHODS: We evaluated the relationship between abdominal circumference and waist to hip ratio and risk of cholecystectomy in a cohort of women who had no history of gall stone disease. As part of the Nurses' Health Study, the women reported on questionnaires their weights, heights, and waist and hip circumferences, and the occurrence of cholecystectomy. A total of 42,312 women, aged 39-66 years in 1986, who were free of prior gall stone disease, provided complete waist and hip circumference measurements in 1986. RESULTS: We documented 3197 cases of cholecystectomy during 514,283 person years of follow up. After adjusting simultaneously for regional (waist circumference or waist to hip ratio) and total adiposity (body mass index) measures as well as for other risk factors of gall stone disease, women with a height adjusted waist circumference of 36 inches or larger had a relative risk (RR) of 1.96 (95% confidence interval (CI) 1.53-2.51; p trend < 0.0001) compared with women with a height adjusted waist circumference of less than 26 inches. Waist to hip ratio was directly associated with the risk, with an RR of 1.39 (95% CI 1.16-1.66; p trend < 0.0001) for women with a waist to hip ratio of 0.86 or higher compared with women with a waist to hip ratio of less than 0.70. CONCLUSION: Abdominal circumference and waist to hip ratio were associated with an increased risk of cholecystectomy, independently of body mass index in women.

Adult↗
PubMed1999

Effect of cholecystectomy on bowel function: a prospective, controlled study.

BACKGROUND: Published estimates of the prevalence of postcholecystectomy diarrhoea derive from retrospective or uncontrolled data. They ignore functional bowel syndromes and possible changes in diet and drug use. AIMS: To determine prospectively whether and how often cholecystectomy leads to changes in bowel function and bowel symptoms, especially to liquid stools, over and above any non-specific effect of laparoscopic surgery. SUBJECTS PATIENTS: 106 adults undergoing laparoscopic cholecystectomy (85 women, 21 men). CONTROLS: 37 women undergoing laparoscopic sterilisation. METHODS: Before and 2-6 months after surgery patients were administered questionnaires about bowel frequency, bowel symptoms, diet, and drugs, and kept records of five consecutive defecations with assessment of stool form or appearance on a seven point scale. RESULTS: In cholecystectomised women, stated bowel frequency increased, on average by one movement a week, and fewer subjects felt that they became constipated. However, records showed no consistent change in bowel frequency, stool form, or defecatory symptoms. Six women reported diarrhoea after the operation but in only one was it clearly new and in her it was mild. Change in dietary fibre intake did not associate with change in bowel function but stopping constipating drugs did in a minority. In women being sterilised there was no consistent change in bowel function. In men having cholecystectomy no consistent changes were observed. CONCLUSIONS: In women, cholecystectomy leads to the perception of less constipation and slightly more frequent defecations but short term recordings show no consistent change in bowel function. Clinical diarrhoea develops rarely and is not severe.

Adult↗
PubMed2001

Risk of pancreatic cancer after cholecystectomy: a cohort study in Sweden.

BACKGROUND: Although some experimental studies have indicated that cholecystectomy may increase the risk of pancreatic cancer, data from epidemiological studies are conflicting. AIMS: We conducted a register based retrospective cohort study to explore the relationship between cholecystectomy and pancreatic cancer. SUBJECTS: The cohort included 87 263 men and 181 049 women with a documented cholecystectomy for cholelithiasis between 1965 and 1997. METHODS: By record linkage to the nationwide and virtually complete registers of Cancer, Emigration, and Causes of Death, the cohort was followed up until the occurrence of any cancer, emigration, death, or the end of follow up, 31 December 1997, whichever came first. Relative risk was estimated by standardised incidence ratio (SIR) using the Swedish nationwide sex, age, and calendar year specific cancer incidence rates as reference. RESULTS: During the period of observation, 1053 cases of pancreatic cancer were found, among which 231 (22%) occurred within 12 months after operation. After excluding cases and person years accrued during the first two years of follow up, we observed a non-significant 6% excess risk for pancreatic cancer (95% confidence interval (CI) -2 to 14%). The relative risk did not increase with increasing follow up duration, with a SIR equal to 0.98 (95% CI 0.79-1.20) 20 years or more after operation. Patients with a comorbidity of diabetes or chronic pancreatitis had higher relative risks (SIR=1.79, 95% CI 1.39-2.28; SIR=3.17, 95% CI 1.37-6.24, respectively). After excluding patients with recorded diabetes or chronic pancreatitis, the relative risk was close to unity (SIR=1.01, 95% CI 0.94-1.09). CONCLUSIONS: Our findings do not support the hypothesis that cholecystectomy increases the subsequent risk of pancreatic cancer.

Adult↗
PubMed1995

Comparison of short term outcomes of open and laparoscopic cholecystectomy.

OBJECTIVE: To compare the three month outcome of open and laparoscopic cholecystectomy. DESIGN: Prospective assessment of outcome for a series of patients encompassing the introduction of the laparoscopic technique. SETTING: One teaching hospital. PATIENTS: 269 patients admitted for open cholecystectomy between January 1989 and March 1992 and 122 admitted for laparoscopic cholecystectomy between January 1991 and March 1992. MAIN MEASURES: Patients' reported symptoms and self assessed scores with the Nottingham health profile before operation and at three month follow up. Incidence of complications and adverse events after discharge. RESULTS: Similar improvements in symptom rates and health scores were seen regardless of surgical technique. A lower rate of postoperative complications was seen in the patients given laparoscopic surgery (6/95(6%) v 45/235(19%)), and their mean length of stay was lower (4.5 v 9.8 days). Similar results were obtained when the analysis was restricted to a subset of fairly uncomplicated cases (patients aged 60 or less without other illnesses on admission who were not undergoing emergency or urgent surgery), which constituted a larger proportion of the group given laparoscopy (35/95(37%) v 40/235(17%)). Between these two groups no significant difference was seen in the frequency of relevant readmissions to hospital or visits to general practitioners or accident and emergency departments. CONCLUSION: Ideally, a new surgical technique would be evaluated in a randomised trial. In the absence of such a trial, this observational study provides some evidence that the switch from open to laparoscopic cholecystectomy has brought benefits, particularly in terms of reduced length of stay in hospital. A range of clinical and patient derived indicators suggests that these gains have not been associated with a reduction in the quality of the outcome at three months.

Cholecystectomy↗
PubMed1996

Subtotal cholecystectomy.

Subtotal cholecystectomy has been carried out in 34 patients from 1972 to 1992. In the same period 1620 total cholecystectomies were performed. The indications were severe inflammation and/or severe fibrosis in 31 patients, and Mirizzi syndrome type 1 in 3 patients. The morbidity was insignificant, but one patient died, due to severe sepsis. In follow up studies ranging from 6 months to 9 years, there was one patient with retained stones in the common bile duct. No other post cholecystectomy sequelae were noticed in the remaining 32 patients. Subtotal cholecystectomy is a safe, feasible and definitive operation in patients for whom the standard operation could be dangerous. This operation is less burdensome to the patient, and is accompanied by fewer complications than ordinary cholecystostomy.

Adult↗
PubMed1997

Postoperative intravenous drip infusion is not required after minilaparotomy cholecystectomy.

OBJECTIVE: To determine if drip infusion should be discontinued after full recovery of the patient from anaesthesia after minilaparotomy cholecystectomy in uncomplicated cases. DESIGN: A randomised controlled clinical trial on 60 patients, from the waiting list, of cholelithiasis/cholecystitis operated by minilaparotomy cholecystectomy between November 1995 to March 1996. 30 patients did not receive postoperative i.v. drip infusion and in 30 patients 12-24 hours of standard drip transfusion was continued according to the current practice. SETTING: Single Surgical Unit, SS Hospital, Banaras Hindu University, Varanasi, India. MAIN OUTCOME MEASURE: Recognition of clinical indication for continuation of i.v. drip infusion after full recovery from anaesthesia. RESULTS: In the cohorts of 30 patients each who were or were not given i.v. drip infusion after full recovery from anaesthesia following minilaparotomy cholecystectomy the observations on pulse rate, blood pressure, time to first voiding of urine and time to start first oral intake of fluids were identical. However postoperative urinary retention occurred in 6 (20%) patients in whom the IV drip infusion was given. CONCLUSION: There is no clinical indication to continue IV drip infusion after full recovery from anaesthesia in patients operated for minilaparotomy cholecystectomy.

Adult↗
PubMed2000

Gallstones in elderly patients: impact of laparoscopic cholecystectomy.

The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.2%) were attempted on elderly patients, 11 (35%) of which were on an emergency basis because of acute cholecystitis, cholangitis or acute biliary pancreatitis. Ten per cent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0%. Associated gallbladder and common bile duct stones were found in five (16%) patients (four preoperative LC endoscopic sphincterotomy and one transcystic approach). The success rate in both of these cases was 100%, overall morbidity was 29% and there was no mortality. These results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists' class III because an excessive duration of operation is the most common reason for converting to an open cholecystectomy.

Aged↗
PubMed1999

Laparoscopic cholecystectomy in two patients with symptomatic cholelithiasis and situs inversus totalis.

BACKGROUND: Situs inversus viscerum is a rare condition with a genetic predisposition. We report 2 patients with situs inversus totalis and symptomatic cholelithiasis successfully treated via laparoscopic cholecystectomy. PATIENTS AND METHODS: The first patient was a 61-year-old female presenting with pain in the left upper quadrant associated with fever, chills, nausea and vomiting. The abdomen was tender with guarding and rebounding pain in the same region. Abdominal ultrasound and CT scan confirmed the diagnosis of gallstones as well as situs inversus with the liver and gallbladder on the left side and the spleen on the right. The second patient was a 37-year-old male with known situs inversus who presented with biliary colic due to cholelithiasis. In both patients cholecystectomy was performed laparoscopically in a reverse fashion. RESULTS: Laparoscopic cholecystectomy was carried out successfully despite the reversed anatomic relationships and both patients made a smooth recovery. CONCLUSION: Cholelithiasis occurring with situs inversus totalis is rare and may present a diagnostic problem. Laparoscopic cholecystectomy can be safely and effectively applied in the setting of situs inversus, although attention must be paid to the details of left-right reversal.

Adult↗
PubMed2001

Laparoscopic cholecystectomy in cirrhotic patients.

BACKGROUND/AIMS: Laparoscopic cholecystectomy has become the procedure of choice for symptomatic cholelithiasis. A study to evaluate the benefits and risks of laparoscopic cholecystectomy in cirrhotic patients was performed. METHODS: Between January 1994 and December 2000, 1,100 laparoscopic cholecystectomies for symptomatic gallbladder diseases were performed. There were 24 cirrhotic patients (group A) and 72 age- and sex-matched controls (group B). All patients had well-compensated cirrhosis (Child's class A or B). RESULTS: There was no operative mortality in either group and the postoperative complication rates were 20.8 and 9.72% in groups A and B, respectively (p < 0.000001). Operative time in group A was 89.16 vs. 68.41 min in group B (p < 0.000001). The estimated intraoperative blood loss in group A was 106.25 vs. 37.08 ml in group B (p < 0.000001). The average transfusion requirement was 0.155 and 0.0 units in groups A and B, respectively (p < 0.025). The hospital stay in groups A and B was 4.7 and 3.61 days, respectively (p < 0.0500). CONCLUSION: Laparoscopic cholecystectomy in patients with compensated cirrhosis is safe and should be the treatment of choice for these patients. Laparotomy should be applied only if the surgeon considers the operation inadequate to be continued laparoscopically.

Adult↗