Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CHOLECYSTECTOMY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,297 records · Page 72Linked to original sources
PubMedDate not supplied

Deep venous thrombosis prophylaxis is not indicated for laparoscopic cholecystectomy.

OBJECTIVES: Recent publications have discussed the risk of deep venous thrombosis during laparoscopic cholecystectomy and the need for routine deep venous thrombosis (DVT) prophylaxis. The purpose of this study was to determine the incidence of clinically detectable DVT in patients undergoing laparoscopic cholecystectomy without a standard DVT prophylaxis regimen. MATERIALS AND METHODS: We performed completed laparoscopic cholecystectomy in 587 patients over a 4-year period. Eighteen of these patients received some form of perioperative DVT prophylaxis, and 569 patients did not. Routine screening with a duplex Doppler was not used. Patients were followed postoperatively for 4 weeks after discharge from the hospital. RESULTS: In an average of 4 weeks follow-up, 31 complications and 4 deaths were reported. These complications included wound infection (16), postoperative bleeding (3), persistent pain (3), pneumonia (3), retained CBD stones (2), asthma (1), papillary stenosis (1), ileus (1), and intraoperative bowel injury (1). None of the 587 patients in this study had symptoms of DVT or pulmonary embolism. DISCUSSION: Despite the fact that DVT in this patient population is rare, many reports suggest the use of routine DVT prophylaxis with sequential compression devices (SCDs) or low-molecular-weight heparin (LMWH). Because no clinically detectable evidence was found of DVT in our study group despite the lack of any perioperative DVT prophylaxis, we question whether routine DVT prophylaxis is indicated or cost effective for routine laparoscopic cholecystectomy. A large prospective trial addressing this question is needed.

Adolescent↗
PubMedDate not supplied

The advantages of preview cholangiography during laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVE: Despite the numerous and often cited benefits of routine cholangiography during laparoscopic cholecystectomy, universal application of this technique has not been realized. Surgeons who advocate selective cholangiography cite the extra cost, the low yield of unanticipated findings, and the marked increase in the duration of the operation when cholangiography is added to laparoscopic cholecystectomy. We present our experience with preview cholangiography and compare it with the transcystic-duct approach. METHODS: We attempted preview cholangiograms on 11 consecutive patients undergoing laparoscopic cholecystectomy. Successful cholangiography was determined by using established radiologic criteria. RESULTS: Preview cholangiogram was successful in all 11 patients. No complications occurred. The average time required was 110 seconds. The mean operating time was 52 minutes. These times are far better than our best accomplishments using the cystic duct cannulation method for cholangiography (mean cholangiogram time, 22 minutes, and mean operative time, 75 minutes) following the first 100 cases. CONCLUSIONS: Preview cholangiography is a safe, relatively easy, quick method for outlining the anatomy of the extrahepatic biliary tree prior to dissection necessary to remove the gallbladder with laparoscopic techniques. The ease of this approach should result in more widespread use of cholangiography during laparoscopic cholecystectomy.

Adult↗
PubMedDate not supplied

Impact of the introduction of laparoscopic cholecystectomy on the population aged 70 and over.

BACKGROUND/AIMS: Laparoscopic cholecystectomy is reported to be better tolerated than open cholecystectomy by patients aged 70 and over. We evaluate its impact on patients aged 70 and over, from one single center. METHODOLOGY: We review 427 cholecystectomies performed in one single centre, from November 1992 through November 1999. We consider 23 patients, 70 years old or older at the time of surgery. The following objective parameters were considered and compared with the younger population: length of stay in the hospital; mean preoperative stay; mean postoperative stay; incidence of risk factors; postoperative complications. A questionnaire was also mailed to all individual 427 patients. RESULTS: Length of stay in the hospital declined in both population, during the time interval considered. The incidence of risk factors, both major and minor, increases consistently with age from less than 1% below the age of 30 to about 62% in the eighth decade and over. Major postoperative complications were 4.34% in patients > or = 70 vs. 2.8% in patients < 70 years of age. Mortality was nil in both groups. Ninety percent reported complete disappearance of preoperative symptoms. CONCLUSIONS: Laparoscopic cholecystectomy in geriatric patients is safe and risks are reasonably low. Selection of patients must be done on strict indications.

Aged↗
PubMed2001

Postoperative pulmonary changes after laparoscopic cholecystectomy.

BACKGROUND: Pulmonary function tests on the day after open upper abdominal surgery and cholecystectomy show decreases of 40% to 60% compared with preoperative determinations. In this prospective, study, we evaluated the pulmonary function during and after laparoscopic cholecystectomy (LC). PATIENTS AND METHODS: Thirty patients were evaluated with preoperative and postoperative spirometry, arterial blood gas determinations and chast radiographs to quantitate the magnitude of postoperative pulmonary changes after LC. Spirometry and chast radiographs were made before and 24 h after operation. Blood gas analye were performed preoperative, and 24 h after operation. RESULTS: Forced expiratory volume in 1 s (FEV: mean +/- SD values; preoperative: 3.12 +/- 0.78; postoperative: 2.33 +/- 0.80; P < 0.05), forced vital capacity (FVC; preoperative: 3.58 +/- 0.95; postoperative: 2.93 +/- 1.05; P < 0.05), peak expiratory flow (PEF; preoperative: 5.59 +/- 1.97; postoperative: 4.27 +/- 1.60; P < 0.05) and the midexpiratory phase of forced expiratory flow (FEF25-75; preoperative: 1.98 +/- 0.93; postoperative: 1.60 +/- 0.73; P < 0.05), were reduced 20-25% on average compared with preoperative values. Clinically important changes in arterial blodd gas values did not occur. Of 30 postoperative chest films, 9 showed the development of microatetelctasis. CONCLUSION: Improved pulmonary function after laparoscopic cholecystectomy may account for the observed reduced rate of pulmonary complication after laparoscopic cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed2001

[Lessons on laparoscopic cholecystectomy (summary of the experience].

The experience of laparoscopic cholecystectomy conduction in 6524 patients with nontumoral diseases of gallbladder (chronic calculous cholecystitis, an acute calculous cholecystitis, chronic noncalculous cholecystitis, the gallbladder polyposis) was summarized. While comparing the initial seizing experience in laparoscopic cholecystectomy in the clinic the tendency was noted, trusting the skills improvement in management of laparoscopic technique, permitting to reduce the contraindications quantity for laparoscopic cholecystectomy. Several principles were elaborated, which is necessary to follow doing laparoscopic cholecystectomy for improvement of results of treatment in patients and for complications reduction.

Adolescent↗
PubMedDate not supplied

Laparoscopic cholecystectomy for acute cholecystitis in geriatric patients.

Although acute cholecystitis (AC) in many centers is routinely treated by laparoscopic cholecystectomy (LC), the outcome of LC for AC in geriatric patients (75 years or more) remains almost unstudied. All 32 geriatric patients undergoing a cholecystectomy for histologically proven AC in a teaching hospital during a six-year period were studied retrospectively. Median preoperative duration of symptoms was eight days and median preoperative hospital stay was six days. Preoperative ERCP was performed in 22 patients with successful sphincterotomy and common bile duct (CBD) stone retrieval in 11 patients. Overall twelve patients (37%) had CBD stones and 14 patients (44%) had gangrenous cholecystitis at operation. Twenty-seven patients underwent a LC with a conversion rate of 26%, a complication rate of 41% and a mortality rate of 3.7%. Five patients were judged unstable for a laparoscopic approach and underwent a straight open cholecystectomy. Although the latter were at higher risk (higher APACHE II scores), their outcome except for longer intensive care unit stays, was not different from laparoscopically treated patients. Lack of superiority of laparoscopic over open cholecystectomy in the present study seemed due to clinical characteristics of AC in geriatric patients which may lead to late diagnosis and treatment. Preoperative ERCP by further delaying surgery may contribute to loose any potential benefit of an early laparoscopic procedure. The place of preoperative ERCP and the timing of LC in geriatric patients with AC therefore may need to be redefined.

APACHE↗
PubMedDate not supplied

Laparoscopic cholecystectomy: relationship of pathology and operative time.

OBJECTIVE: Controversy exists regarding the use and timing of laparoscopic cholecystectomy in the treatment of both acute and chronic cholecystitis. Acute advocates claim to avoid fibrosis and potential dissection injuries, whereas chronic proponents avoid poor visualization due to edema and possible conversion. This study of both acute and chronic cholecystitis cases examines the relationships between pathology, operative time, and outcome of laparoscopic cholecystectomy. METHODS: A retrospective review of medical records and pathology of acute (n = 9) and chronic (n = 62) laparoscopic cholecystectomy cases, performed by 2 surgeons from 1995 to 1999 was undertaken. Using multiple regression techniques, the relationship between operative time and age, sex, race, presenting symptoms, and degree of pathologic cholecystitis was evaluated. RESULTS: One case of acute gangrenous cholecystitis required conversion. None of the chronic cases required conversion. In single variable analysis, abnormal liver function tests, chronic inflammation, wall thickness, and number of stones were each predictive of longer operative time. However, in the multiple regression, abnormal liver function tests were the only clinical factor that remained a predictor of operative time (16 minutes longer, P = 0.05). Time from presentation to operation had no effect on operative time. Twelve patients had preoperative endoscopic retrograde cholangiopancreatography, and 4 had choledocholithiasis (acute n = 1, chronic n = 3). Two chronic patients required postoperative endoscopy for a cystic duct leak (n = 1) and choledocholithiasis (n = 1). The adjusted average operative time for acute and chronic cases was similar (93 versus 74 minutes, P > 0.05). CONCLUSION: Laparoscopic cholecystectomy can be done safely for both acute and chronic cholecystitis with similar operative times. Abnormal liver function tests are associated with longer operative time. Time lapse between presentation and operation has no effect on operative time or outcome.

Adult↗
PubMedDate not supplied

Biliary mishaps in laparoscopic cholecystectomy.

AIM: To determine the incidence and types of biliary complications following laparoscopic cholecystectomy in our patients. METHODS: The clinical records of one hundred and fifty-five patients undergoing laparoscopic cholecystectomy were reviewed. RESULTS: Five patients developed biliary mishaps. The overall incidence of biliary complications was 3.2% (5/155). The incidence of major complications was 1.9% (3/155) and the incidence of minor biliary complications was 1.2% (2/155). In 3 out of 5 patients the mishap was attributed to developmental anomalies. Dense pericholecystic adhesions and cystic duct blow out were responsible for biliary complications in one patient each. Bilioenteric anastomosis was performed in two patients and restoration of continuity of the common hepatic duct over a T-tube was done in one patient. Side hole in an accessory duct was repaired over a T-tube and cystic duct blow out was managed with endoscopic biliary drainage alone. CONCLUSIONS: A high index of suspicion of developmental anomalies, cautions approach in difficult cases and readiness to consider conversion to open cholecystectomy are recommended to reduce the incidence of biliary complications in laparoscopic cholecystectomy.

Adult↗
PubMed2002

Analysis of pathogenetic mechanisms of common bile duct iatrogenic lesion during laparoscopic cholecystectomy. A review of the literature.

BACKGROUND: Laparoscopic cholecystectomy as the new gold standard for gallstone treatment has reopened the chapter of complications due to cholecystectomy. METHODS: The present work refers to the period between 1988-2001 and analyses 277,121 cholecystectomies, carried out in some European and extra-European Countries. 1,353 CBD lesions with an incidence rate of 0.48%, that almost doubles that of the laparotomic cholecystectomies, were found. Transection of CBD within <2 cm of bifurcation was the most frequent lesion. RESULTS: The mechanism and extension of CBD lesions is different when compared to that of laparotomic intervention. Actual damage is caused by a failure to recognise the anatomical structures, and also by errors in the surgical technique, learning curve and different visualisation of the operative field. CONCLUSIONS: Once the lesion has been diagnosed it is always necessary to define its type and extension accurately. A therapeutic approach that fails to take this aspect into account will expose the patient to repeated and increasingly complex surgical interventions, recurrent cholangitis episodes and a higher risk of suffering a secondary biliary cirrhosis.

Cholecystectomy, Laparoscopic↗
PubMed2002

[Digestive complications of biliary gallstone lost during laparoscopic cholecystectomy].

A patient was admitted because of an intestinal obstruction. Eight years before, he underwent a laparoscopic cholecystectomy. Abdominal ultrasonography and small bowel series showed a gallstone in the small bowel that computed tomography scan failed to identify. Laparotomy showed a Meckel's diverticula and a biliary stone in the terminal ileum. In the literature, it has been shown that gallstone lost during laparoscopic cholecystectomy may be responsible for intraperitoneal abscess. In the contact of intestine, the stone may induce an obstructive abscess, a communicating abscess, a digestive fistula or a biliary ileus. During the postoperative course of laparoscopic cholecystectomy, these patients suffer from abdominal pain and fever lasting from few days to several months. Imaging shows the biliary gallstone mechanical complications induced by the stone. To avoid such complications, biliary gallstone that falls into the peritoneum during laparoscopic cholecystectomy should be removed under laparoscopy.

Abdominal Pain↗
PubMed2002

Concomitant cholecystectomy and coronary artery bypass.

INTRODUCTION AND METHODS: Cholelithiasis is a common disorder which may be present with coronary artery disease. Concomitant cholecystectomy and coronary artery bypass grafting (CABG) was performed in selected patients and retrospective study was performed to verify the safety of the concomitant surgery. RESULTS: A total of 55 patients (41 males and 14 females, mean age 64.6 8.7 years) underwent concomitant cholecystectomy and CABG between 1992 and 2001 at the Shin-Tokyo Hospital Group. Exclusion from concomitant surgery was choledocholithiasis and/or acute cholecystitis. Cholecystectomy was performed via an upper abdominal incision extending the mid-sternal incision. In 48 patients (87.3%), the gastroepiploic artery (GEA) was used for coronary revascularization. The mean number of bypass grafts was 3.6 1.2. The mean operative time, intubation period, ICU stay, and postoperative hospital stay were 376 minutes, 15.6 hours, 3.9 days, and 23.0 days, respectively. Postoperative feeding was resumed 1 day after extubation. No intra-abdominal complications, delays in feeding, abdominal wound complications or postoperative bowel obstruction were observed. CONCLUSIONS: Concomitant surgery of cholecystectomy and CABG did not increase the postoperative complications, and it is a feasible procedure of choice.

Aged↗
PubMed2002

[What is the best timing to perform laparoscopic cholecystectomy in acute cholecystitis?].

Early laparascopic cholecystectomy within five days of onset of symptoms of acute cholecystitis has proved superior to open cholecystectomy. Feasability is well established; the conversion rate to open cholecystectomy and the post-operative morbidity are no higher than with delayed laparascopy after initial medical management. Total hospitalization is, on the other hand, significantly shorter. Only one study showed an increase in operative time with early surgery (on average 15 minutes). Both preoperative and perioperative risk factors for conversion to laparotomy were identified. Prompt laparascopic intervention avoids the complications which may arise with initial medical management, i.e., failure of medical management or biliary peritonitis. Early laparascopic cholecystectomy should be considered the gold standard for management of acute cholecystitis.

Acute Disease↗
PubMed2003

Outcome of laparoscopic cholecystectomy in acute biliary pancreatitis.

OBJECTIVE: To evaluate the efficacy, safety, and timing of laparoscopic cholecystectomy in the management of mild to moderate cases of acute biliary pancreatitis. METHODS: The medical records of 158 patients admitted to Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia (KSA) from July 1998 to December 2001 were retrospectively reviewed. Acute biliary pancreatitis was diagnosed in patients who presented with abdominal pain with serum amylase level 3 times the normal limits in the absence of hypercalcemia or hyperlipidemia and presence of gallstones on ultrasonography. Severity of the disease was assessed using Atlanta Symposium criteria. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 106 patients (74.6%) on selective basis. One hundred and eighteen patients underwent laparoscopic cholecystectomy after clinical and biochemical resolution of the attack. Standard 4 ports technique was used. Intraoperative and postoperative morbidity and mortality, and postoperative hospital stay were reported. RESULTS: Laparoscopic cholecystectomy was performed in 118 patients and it was possible in 110 cases (93.2%) after 3-8 days of admission. Preoperative ERCP was performed in 106 patients of mild to moderate acute biliary pancreatitis and common duct stones were retrieved in 19 cases (18%). The procedure was converted to open in 8 cases (6.7%). Postoperative complications were nausea and vomiting in 10, atelectasis in 8, chest infection in 3, and prolonged ileus in 2. The wound complication occurred in 4. One patient who had bile leak due to cystic duct stump avulsion at CBD junction was treated by endoscopic sphincterotomy plus stenting and another patient had partial CBD injury repaired primarily over a T-tube. Mean postoperative hospital stay was 2.4 days. One patient died due to uncontrolled arrhythmia and heart failure. CONCLUSION: Laparoscopic cholecystectomy can be safely performed for mild to moderate acute biliary pancreatitis after clinical and biochemical resolution of the attack during the same admission with acceptable morbidity and mortality rates. This strategy will lead to reducing the recurring acute biliary pancreatitis, number of admissions and hospital stay.

Acute Disease↗
PubMed2003

[Laparoscopic cholecystectomy-advantages and disadvantages].

Laparoscopic cholecystectomy becomes the most popular technique of the treatment of gallbladder lithiasis. The consequences of this procedure (including the influence of pneumoperitoneum on cardiorespiratory system, the increase of frequency of bile duct injury, shortening of hospital stay) are compared to classical cholecystectomy and minicholecystectomy. Further evaluation is necessary to choose between classical cholecystectomy, minicholecystectomy and laparoscopic cholecystectomy according to particular specificity of the patient.

Cholecystectomy, Laparoscopic↗
PubMed1992

New technology in U.S. Army health care: the role of laparoscopic cholecystectomy.

In the near future, laparoscopic cholecystectomy could become one of the most frequently performed surgical procedures in U.S. military hospitals. To determine the best way to implement this new technology in the U.S. Army Health Services Command (HSC), we have assessed the safety, efficacy, and health consequences of laparoscopic cholecystectomy. Approximately 2,800 open cholecystectomies are performed annually in HSC hospitals, 11% of them on active duty personnel. If cholecystectomies were performed using laparoscopic surgical techniques on active duty patients who meet currently accepted indications, 3,360 personnel duty days lost to convalescence and 7,048 days of limited duty (time on physical profiles) would be recouped. Applying the procedure to other beneficiaries (dependents and retired service members) would result in a potential annual savings of 11,000 hospital bed days. If implemented using stringent criteria for training and certification, these savings could be achieved with no increase in patient morbidity or mortality and with significant improvement in patient outcome.

California↗
PubMed1992

[Complications of cholecystectomy by laparoscopic approach. Apropos of 6512 cases].

6,512 laparoscopic cholecystectomies have been performed by 141 surgeons. The lithiasis was uncomplicated in 80% of cases. Conversion from laparoscopy to laparotomy was necessary in 350 cases (5.37%), for technical problems (22 cases), complications (87 cases) or surgical difficulties (241 cases): 107 cholecystitis, 68 adhesions, 14 difficulties in finding the cystic duct and 25 common bile duct stones were the principle surgical difficulties. Among the 304 complications, we have observed 35 general and 251 local complications: 58 haemorrhages, 12 common bile duct lesions (10 cases of iatrogenic trauma and 2 accidental ligations), 4 cystic duct problems and 3 cases of intestinal trauma were the principle per-laparoscopic complications. Among the 164 post-laparoscopies cholecystectomy's complications, we have observed 50 biliary fistulae with 32 requiring further surgery (damage to the common bile duct in 14 cases), 3 common bile duct strictures, 20 haemorrhages (7 requiring further surgery), 31 deep or sub-phrenic abscesses (16 requiring further surgery) and 2 peritonitis after intestinal trauma. We have had 7 deaths (0.10%). Prognostic factors are: 1) The degree of surgeon's experience; the first 50 laparoscopies cholecystectomies performed are more likely to require further surgery (P < 0.05). 2) Cholecystitis with an significantly higher rate of conversion to laparotomy (P < 0.001) and morbidity (P < 0.01). For an experienced surgeon the biliary morbidity is near to that observed in classical cholecystectomy.

Adolescent↗
PubMedDate not supplied

[Laparoscopic cholecystectomy. Analysis of 50 cases].

Biliary lithiasis is considered a significant health problem. Traditionally open cholecystectomy has been considered the gold standard procedure for symptomatic cholecystitis. Laparoscopic cholecystectomy has recently emerged as an alternative, but its usefulness in community hospitals is still being evaluated. Herein we reported our experience in 50 patients treated for 7 months (August of 1991, to February of 1992) by laparoscopic cholecystectomy. It has been necessary to convert one case into an open surgery. There has been no mortality. Seven patients developed right shoulder pain postoperative, it was controlled with minor non addictive analgesics. One had umbilical hematoma, another patient had a superficial phlebitis, and another one developed urinary retention. 43 patients (86%) had had 12 to 24 h hospital stancy, and were back to their normal activities in 7 days; during a 7 months follow-up no complications have been reported. We concluded that laparoscopic cholecystectomy is a safe procedure and can be done by the average general surgeon in community hospitals in a selected patient population. However, we strongly support a continuous monitoring of a protocol for patient management for record-keeping-purposes and as an educational tool.

Adolescent↗
PubMed1992

Postoperative respiratory function after laparoscopic cholecystectomy.

Open cholecystectomy causes changes in pulmonary function test volumes; such changes can be related to respiratory complications of hypoxemia and atelectasis. Little data is available on lung volume changes after laparoscopic cholecystectomy. We measured preoperative and postoperative vital capacity (VC), functional residual capacity (FRC), arterial PO2, and chest X-ray atelectasis in 31 patients undergoing laparoscopic cholecystectomy and found small but significant decreases (p < 0.01) in VC (13 +/- 19%) and FRC (7 +/- 17%). The PO2 decreased from 89 +/- 11 mm Hg to 82 +/- 14 mm Hg, with only one patient's PO2 less than 60 mm Hg. Three patients demonstrated new segmental lobar collapse on postoperative chest X-ray. The postoperative changes in FRC (R2 = 0.40, p < 0.04) and atelectasis (R2 = 0.46, p < 0.03) could be predicted by multiple regression of risk factors, including obesity, smoking, use of narcotics, age, and symptoms of prior respiratory disease. We conclude that the respiratory changes after laparoscopic surgery are small in comparison to those expected after open cholecystectomy.

Cholecystectomy, Laparoscopic↗