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At least 19 recordsLinked to original sources
PubMed1997

[The comparison of conventional open cholecystectomy, laparoscopic cholecystectomy and minor-incision cholecystectomy].

To study the clinical value of minor incision for cholecystectomy, compared conventional open cholecystectomy (300 patients, group A), alparoscopic cholecytectomy (300 patients, group B), and minor-incision cholecystectomy (300 patients, group C) with regard to duration (day) of operation, amount of intraoperative bleeding, complications, time (day) of gastrointestinal function recovery, intravenous infusion, and expense and time (day) of hospitalization. The results showed that the operating time, amount of bleeding, duration of intravenous infusion, time of gastrointestinal function recovery and hospitalization in group A were significantly different from those in group B and C (P < 0.05), but the incidence in group A was lower than that in group B. The operating time, amount of intraoperative bleeding, and the time of gastrointestinal function recovery and intravenous infusion in group B were similar to those in group C, but there was a high rate of intraoperative and postoperative complication in group B (1.66%). There was no complication in group C (P < 0.05). Comparison of the effects among group A, B and C showed that it was superior in group C to those in group A and B.

Adolescent↗
PubMed1993

Retrospective comparison of outcome of 100 consecutive open cholecystectomies and 100 consecutive laparoscopic cholecystectomies.

If laparoscopic cholecystectomy is to be a viable option for community surgeons and their patients, it should have a safety profile similar to or better than that of open cholecystectomy. Morbidity and mortality from 100 consecutive open cholecystectomies were compared to morbidity and mortality from 100 consecutive laparoscopic cholecystectomies. All procedures were done at Davis Community Hospital (Statesville, NC, population 25,000). Open cholecystectomies were done by seven staff surgeons from July 1987 to March 1990. Laparoscopic cholecystectomies were done by three staff surgeons from February 1990 to August 1990. Cholangiography during open cholecystectomy was selective. After an initial learning experience of 11 cases, cholangiography was routine during laparoscopic cholecystectomy. Patients having cholecystectomy coincidental to a planned common duct exploration for stones or neoplasia were excluded. For open cholecystectomy, morbidity was 13% and mortality, 2%. For laparoscopic cholecystectomy, morbidity was 9% and mortality, 1%. One death after open cholecystectomy was due to pulmonary embolus. The other two deaths in the series were due to underlying severe cardiopulmonary disease. Complications related directly to cholecystectomy were bleeding requiring transfusion (open 2, laparoscopic 1), bile leak (open 1, laparoscopic 1), wound infection (open 1), and prolonged back pain (laparoscopic 2). In two patients, the laparoscopic procedure was converted to open cholecystectomy. There were no common bile duct injuries in either group of patients. Results of this study suggest that laparoscopic cholecystectomy can be done as safely as open cholecystectomy, even in smaller community hospitals.

Adolescent↗
PubMed1992

Comparison of laparoscopic cholecystectomy versus elective open cholecystectomy.

Laparoscopic cholecystectomy has essentially replaced open cholecystectomy as the procedure of choice for gallbladder disease. This rapid shift to laparoscopic cholecystectomy, however, has resulted more from marketing forces than from prospective clinical trials. To evaluate the safety and efficacy of laparoscopic cholecystectomy, the first 486 laparoscopic cholecystectomies at two institutions were studied. These results were then compared to the results of the last 6 months of elective open cholecystectomy cases prior to the introduction of laparoscopic surgery. The age, sex, height, and weight were similar in both groups. The mean operative time was 78.8 +/- 1.8 min for laparoscopic cholecystectomy and 62.7 +/- 2.6 min for open cholecystectomy (p < 0.01). The mean time for tolerating a regular diet was 1.23 +/- 0.04 days in the laparoscopic group versus 2.44 +/- 0.07 days in the open group (p < 0.01). Laparoscopic cholecystectomy patients required only oral pain medications by a mean of 1.22 +/- 0.03 days postoperatively compared to 2.55 +/- 0.07 days postoperatively for those undergoing open cholecystectomy (p < 0.01). The mean length of hospitalization was 1.58 +/- 0.07 days for laparoscopic patients and 3.55 +/- 0.11 days for open patients (p < 0.01). Thirty-one patients undergoing laparoscopic cholecystectomy were converted to open cholecystectomy (6.4%). The most common reasons for conversion to open cholecystectomy were acute inflammation, adhesions, and bleeding. For the laparoscopic patients, the morbidity rate was 8.4% and the mortality rate 0.2% (1 death). In the open cholecystectomy group the morbidity rate was 8.0% and there were no deaths. The most troublesome complication in laparoscopic cholecystectomies continues to be bile leaks and bile duct injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1994

Prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland. West of Scotland Laparoscopic Cholecystectomy Audit Group.

Although laparoscopic cholecystectomy has rapidly developed in the treatment of gall bladder disease in the absence of controlled clinical trial data its outcome parameters compared with open cholecystectomy remain unclear. A prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland over a two year period was carried out to attempt to assess this new procedure. A total of 45 surgeons in 19 hospitals performing laparoscopic cholecystectomy submitted prospective data from September 1990-1992. A total of 2285 cholecystectomies were audited (a completed data collection rate of 99%). Laparoscopic cholecystectomy was attempted in 1683 (74%) patients and completed in 1448 patients (median conversion rate to the open procedure 17%). The median operation time in the completed laparoscopic cholecystectomy patients was 100 minutes (range 30-330) and overall hospital stay three days (1-33). There were nine deaths (0.5%) after laparoscopic cholecystectomy although only two were directly attributable to the laparoscopic procedure. In the laparoscopic cholecystectomy group there were 99 complications (5.9%), 53 (3%) of these were major requiring further invasive intervention. Forty patients (2.4%) required early or delayed laparotomy for major complications such as bleeding or bile duct injuries. There were 11 (0.7%) bile duct injuries in the laparoscopic cholecystectomy series, five were noted during the initial procedure and six were recognised later resulting from jaundice or bile leaks. Ductal injuries occurred after a median of 20 laparoscopic cholecystectomies. In conclusion laparoscopic cholecystectomy has rapidly replaced open cholecystectomy in the treatment of gall bladder disease. Although the overall death and complication rate associated with laparoscopic cholecystectomy is similar to open cholecystectomy, the bile duct injury rate is higher.

Adolescent↗
PubMedDate not supplied

Falling cholecystectomy thresholds since the introduction of laparoscopic cholecystectomy.

OBJECTIVES: To determine whether cholecystectomy rates among the elderly increased following the introduction of laparoscopic cholecystectomy in 1989, and to assess whether changes in rates were accompanied by lower clinical thresholds for performing cholecystectomy. DESIGN: Time-series quasi-experimental design based on quarterly observations from 1986 to 1993. Data were obtained from Medicare hospital discharge files for Pennsylvania. PATIENTS: Medicare patients aged 65 years or older who resided in Pennsylvania, did not have end-stage renal disease, and underwent cholecystectomy in Pennsylvania from 1986 to 1993. MAIN OUTCOME MEASURES: Cholecystectomy rates per 1000 elderly Medicare beneficiaries, stage of gallstone disease (uncomplicated vs complicated) at cholecystectomy, type of admission (elective vs urgent/emergent), patient age and comorbidities, and 30-day postoperative mortality. RESULTS: Cholecystectomy rates increased 22% from 1989 to 1993. The proportions of cholecystectomy patients with uncomplicated gallstone disease and with elective admissions declined from 1986 to 1989 but then increased rapidly after laparoscopic cholecystectomy was introduced. In contrast, the age distribution and comorbidities of cholecystectomy patients did not change during the study period. Postoperative mortality rates were stable from 1986 to 1989 but decreased thereafter. CONCLUSIONS: Growth in cholecystectomy rates following the introduction of laparoscopic cholecystectomy was accompanied by evidence of lower clinical thresholds for performing surgery. The normative, or prescriptive, implications of lower cholecystectomy thresholds require further analyses that consider lower direct medical costs and indirect costs and reduced postoperative morbidity after laparoscopic cholecystectomy.

Age Distribution↗
PubMed1999

Increased rate of cholecystectomy after introduction of laparoscopic cholecystectomy in Saudi Arabia.

A rapid increase in the rate of cholecystectomy was reported in eastern Saudi Arabia between 1977 and 1986. The aim of this study was to determine whether the rate of cholecystectomy in the same region was still rising after the introduction of laparoscopic cholecystectomy. From 1987 to 1995 a total of 24 hospitals in eastern Saudi Arabia were surveyed using a questionnaire. During the 9-year study period, the rate of total cholecystectomy (open and laparoscopic) increased by 91%. Whereas the cholecystectomy rate decreased by 4% per annum from 1987 to 1990, it increased by 63.7% from 1991 to 1995 after the introduction of laparoscopic cholecystectomy. The increase in the rates of cholecystectomy was observed in all age groups and both sexes. Cholecystectomy was, however, most frequent among the age group 45-64 years followed by the age group 25-44 years. Young and female patients were more likely to undergo laparoscopic cholecystectomy than the open procedure. The rise in cholecystectomy rate deserves further evaluation with regard to the following: reasons for the increased rate of cholecystectomy, cholecystectomy-related morbidity and mortality, and the total costs of cholecystectomy.

Adolescent↗
PubMed1992

Open cholecystectomy: a control group for comparison with laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is rapidly becoming accepted as the best method for the treatment of symptomatic cholelithiasis. Randomized clinical trials comparing laparoscopic cholecystectomy with open cholecystectomy are unlikely to be performed. In order to compare these two operations, surgeons need an historical control group of patients who have undergone a conventional open cholecystectomy. The aim of this study was to document a control group of patients having an open cholecystectomy and compare them with patients having a laparoscopic cholecystectomy. This was achieved by a retrospective study of all patients who had an open cholecystectomy from January 1985 to December 1989. Four hundred and fifty-seven patients, 345 women and 112 men, had a cholecystectomy. Exploration of the common bile duct (ECBD) was performed in 59 (12.5%) cases. The mean operative duration was 73 min for cholecystectomy and 118 min for cholecystectomy and ECBD. The shortest mean postoperative stay was for an elective cholecystectomy (5.3 days) and the longest mean postoperative stay was for urgent admissions requiring ECBD (12.0 days). Operative dissection was difficult in 14.1% of elective cases and 51.8% of urgent cases. Ninety-seven (19.5%) patients had an additional procedure, unrelated to cholelithiasis, at the same operation; 44 did not require laparotomy, 31 had interval appendectomies, and 22 other cases required laparotomy in order to perform the additional procedure. All but one patient required postoperative narcotic analgesia. The mean duration of narcotic analgesia was 2.3 days. The complication rate was 35.2% for cholecystectomy and 62.5% for ECBD. If pulmonary atelectasis is excluded as a complication, these complication rates fell to 6.8% and 20.1%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

How do bile duct injuries sustained during laparoscopic cholecystectomy differ from those during open cholecystectomy?

BACKGROUND AND PURPOSE: Bile duct injuries sustained during laparoscopic cholecystectomy differ from those of open cholecystectomy. The authors conducted a retrospective analysis of their experience with 124 major bile duct injuries to identify these differences. PATIENTS AND METHODS: Biliary injury in 83 patients (67%) was sustained during open cholecystectomy, while in 41 patients (33%), it occurred during laparoscopic cholecystectomy. Intraoperative recognition was possible in 21 patients (25%) in the former group and in 14 patients (34%) in the latter (P < 0.05). RESULTS: The median time of presentation after laparoscopic cholecystectomy was 37 days v 240 days after open cholecystectomy (P < 0.001). Twenty-eight patients presented with external biliary fistulae in both groups. Spontaneous closure of these fistulae occurred in 21 patients (75%) in the open cholecystectomy group and in only 10 patients (36%) in the laparoscopic group (P < 0.01). Bismuth type III or IV injuries were the commonest type in the laparoscopic cholecystectomy group (N = 25; 61%) while Bismuth type I or II were the usual injuries in open cholecystectomy (N = 57; 69%) (P < 0.01). After hepaticojejunostomy, over a mean follow-up period of 3.4 years, stenosis of the hepaticojejunostomy was seen in two patients in both groups. CONCLUSION: Compared with open cholecystectomy, biliary injuries sustained during laparoscopic cholecystectomy are more likely to present earlier, are more often associated with persistent bile leaks, and are usually high injuries. However, the results of surgical repair do not appear to be different in these two groups.

Adolescent↗
PubMed2003

Timing of cholecystectomy for acute biliary pancreatitis: outcomes of cholecystectomy on first admission and after recurrent biliary pancreatitis.

Biliary stones are the leading cause of acute pancreatitis. Although cholecystectomy and selective endoscopic retrograde cholangiography (ERC) comprise the current treatment in patients with acute biliary pancreatitis (ABP), the time of intervention is still controversial. In this study we evaluated the outcomes of cholecystectomy on first admission for ABP and in patients with recurrent biliary pancreatitis. A series of 43 patients with ABP between January 1997 and November 2000 were evaluated retrospectively. Patients were classified into two groups. Group I included 27 patients who underwent cholecystectomy on first admission before discharge from the hospital. Group II comprised 16 patients who had recurrent biliary pancreatitis and then underwent cholecystectomy. The severity of the pancreatitis was determined by Ranson's criteria. Age, gender, length of hospital stay, severity of pancreatitis, amylase level, and complications of cholecystectomy were evaluated in both groups. Patients in group I underwent cholecystectomy during the original hospital admission and patients in group II during an admission for a recurrence. There were 24 patients with a Ranson's score </= 3 in group I and 12 in group II. The mean hospital stays were 15.29 days (range 4-48 days) and 36.66 days (range 15-123 days) in groups I and II, respectively ( p = 0.006). Morbidity was 11% without mortality in group I and 43% with one mortality in group II ( p = 0.023). Definitive treatment of ABP can be accomplished effectively and safely by cholecystectomy following clinical improvement, with selective ERC performed during the first admission (delayed cholecystectomy). Waiting to perform cholecystectomy (interval cholecystectomy) may result in recurrent biliary pancreatitis, which may increase morbidity and the length of the hospital stay.

Acute Disease↗
PubMed2002

Laparoscopic cholecystectomy versus open cholecystectomy in children.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is well accepted as the standard cholecystectomy only in adult patients. However, the advantages of LC over open cholecystectomy have never been proved in pediatric patients because the number of pediatric cholecystectomies is limited as well as the faster ability of pediatric patients to resume their normal activity. MATERIAL AND METHOD: Retrospective study of 42 pediatric cholecystectomies (laparoscopic cholecystectomy (n = 8) (LCs), open cholecystectomy alone (n = 8) (OCs) and open cholecystectomy concomitant with splenectomy (n = 26)(OCs + S)) done in Siriraj University Hospital, Bangkok, Thailand between 1992 and 2000 was conducted. RESULTS: Statistical comparison revealed that LC was superior to OC in regard to diet resumption. LCs resumed soft diet on 1.38 days, whereas OCs and OCs + S could resume soft diet on 3.38 and 3.35 days respectively. The average length of hospitalization following LCs was significantly shorter than OCs' and OCs + S' ones (3.00 vs 8.38 and 4.85 days respectively). There was no morbidity and mortality in LCs, whereas two OCs and three OCs + S had complications. CONCLUSION: In this preliminary study, laparoscopic cholecystectomy is a preferred method of cholecystectomy in children because it has a shorter post-operative interval of diet resumption and shortens hospitalization with minimal morbidity. However, this study has a limited number of patients and further study is still required to conclude the benefits of LC.

Adolescent↗
PubMed1995

Randomized trial of laparoscopic cholecystectomy and mini-cholecystectomy.

Three hundred and ten patients having elective cholecystectomy were randomized to either laparoscopic cholecystectomy or mini-cholecystectomy. There were 155 patients in each group. Conversion to open cholecystectomy was significantly more common with laparoscopic cholecystectomy (13 versus 4 per cent) and complications were significantly more frequent with laparoscopic cholecystectomy (9 versus 3 per cent). If laparoscopic cholecystectomy was successful, hospital stay was significantly shorter than for mini-cholecystectomy (2 versus 3 days respectively), but overall the hospital stay was not significantly different. Postoperative analgesia requirements were reduced and return to normal activities and to work were faster after laparoscopic cholecystectomy. There was no significant cost difference between the two procedures.

Adolescent↗
PubMed2001

C-reactive protein (CRP) as a response to postoperative stress in laparoscopic cholecystectomy using the abdominal wall lift, with performed pneumoperitoneum (CO2), and in open cholecystectomy.

The first laparoscopic cholecystectomy was performed thirteen years ago and rapidly became the preferred way of operation in patients suffering from cholelithiasis. The pneumoperitoneum can be responsible for haemodynamic disorders. The abdominal wall lift is an alternative way for pneumoperitoneum during laparoscopic cholecystectomy. The aim of this study was the comparative analysis of operative trauma response in the patients treated by laparoscopic cholecystectomy using abdominal wall lift and in cases which underwent open cholecystectomy or laparoscopic operation using pneumoperitoneum. The concentration of C-reactive protein was measured in patient serum before and twice after surgery. The obtained data underwent a statistic analysis. In all cases the surgery caused the marked changes of CRP-concentration. The mean level of CRP was higher three times in patients after open cholecystectomy than in cases treated by laparoscopic cholecystectomy with the use of abdominal wall lift or with performed pneumoperitoneum. During the experiment the statistically significant different between laparoscopic surgery with the use of the laparolift and laparoscopic with earlier performed pneumoperitoneum was observed. The stress and inflammatory response in cholecystectomy using abdominal wall lift was significant but smaller than the response noted in open cholecystectomy and similar to the response observed after pneumoperitoneum. The replacement of pneumoperitoneum by abdominal wall lift does not change the operative stress in laparoscopic cholecystectomy.

Adult↗
PubMedDate not supplied

Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy.

OBJECTIVE: To examine if overall cost savings may fail to result from laparoscopic ("closed") cholecystectomy if it also results in an increased total rate of cholecystectomies or generates additional costs unassociated with the open procedure. OUTCOME MEASURES: Inpatient and outpatient expenditures, incidence rates, and length of inpatient stay data for 6909 health maintenance organization enrollees with gallbladder complaints were analyzed from 1988 through 1992 using claims data from a large, private practice-based health maintenance organization. RESULTS: The incidence of cholecystectomy and total health maintenance organization expenditures on gallbladder disease have increased since the introduction of laparoscopic closed cholecystectomy. The rate of cholecystectomy procedures per 1000 enrollees increased from 1.35 in 1988 to 2.15 in 1992 (P < .001). Total annual medical expenditures on gallbladder disease per 1000 enrollees (in 1992 dollars) rose 11.4% during the study period (P < .001), despite a concurrent 25.1% decline in the unit cost (physician and hospital cost) for cholecystectomy procedures (P < .001). During the same study period, no significant change was noted in the rate of appendectomy per 1000 enrollees (0.76 in 1988 to 0.73 in 1992), which is a measure of nonelective surgical care, or in the inguinal hernia repair rate (2.01 in 1988 to 2.19 in 1992), which has a physician and patient discretionary component similar to that of cholecystectomy. CONCLUSIONS: The introduction of laparoscopic gallbladder surgery resulted in rising rates of cholecystectomy for a population of patients in a private, independent practice-based health maintenance organization. Such a rise was not seen for hernia repair surgery or appendectomy. It seems that the use of laparoscopic cholecystectomy, a new technology touted as reducing health care costs, may result in an increased consumption of health care resources due to changes in the indications for gallbladder surgery.

Cholecystectomy↗
PubMed1993

Laparoscopic cholecystectomy. A statewide experience. The Connecticut Laparoscopic Cholecystectomy Registry.

The explosion in laparoscopic cholecystectomy has posed many questions about its safety compared with the "gold standard" of open cholecystectomy. A statewide database was established in Connecticut to study these issues. Thirty-three (97%) of 34 hospitals in Connecticut participated in the study, which began at the inception of the laparoscopic procedure. Four thousand six hundred forty laparoscopic cholecystectomies were performed between May 1, 1990, and September 30, 1991. The overall conversion rate to open cholecystectomy was 6.9%. Conversions were more frequent with acute cholecystitis, in the elderly, and early in a surgeon's experience. The overall technical complication rate was 4.7%; common bile duct injuries occurred in 15 patients (0.3%). Complications decreased with increasing experience, to 0.98% after a surgeon's 75th procedure. Six patients (0.13%) died following laparoscopic cholecystectomy. The overall mortality rate associated with cholecystectomy fell during the study period. The frequency of cholecystectomy in Connecticut increased 29% with the advent of the laparoscopic procedure. The introduction of laparoscopic cholecystectomy has resulted in an increased frequency of surgery without an increase in surgical mortality. The incidence of common bile duct injuries was low. The decreasing incidence of technical complications demonstrates the learning curve for the procedure.

Adult↗
PubMed2000

Laparoscopic cholecystectomy: a good buy? A cost comparison with small-incision (mini) cholecystectomy.

OBJECTIVES: To compare inpatient costs for laparoscopic and small-incision cholecystectomy. DESIGN: Retrospective analysis using results of a single blind prospective randomised trial. SETTING: Teaching hospital, UK. SUBJECTS: 200 patients having elective cholecystectomy. INTERVENTIONS: Standard laparoscopic cholecystectomy with conversion to open cholecystectomy if necessary. Small-incision cholecystectomy using high right transverse epigastric incision, enlarged if necessary for safe exposure. MAIN OUTCOME MEASURES: Providers inpatient costs. RESULTS: Small-incision cholecystectomy cost Pound Sterling 995 and was 29% less expensive than the laparoscopic procedure which cost Pound Sterling 1397. Costs of equipment and operations themselves accounted for most of the difference. Results also suggest that costs to patients and society from time lost away from work may be lower for mini-cholecystectomy. CONCLUSIONS: The national health service could be spending over Pound Sterling 10m a year by encouraging laparoscopic rather than small-incision operations for cholecystectomy. Commissioners of health care should question whether the benefits of laparoscopic surgery justify the additional costs.

Cholecystectomy↗
PubMed1996

Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy in Scotland.

This survey determined the effect of the introduction of laparoscopic cholecystectomy on the rates of cholecystectomy (total and laparoscopic) in Scotland. From 1977 to 1990, the Scottish cholecystectomy rate fell by an average of almost 1% per annum. With the advent of laparoscopic cholecystectomy, the total cholecystectomy rate (open and laparoscopic) rose considerably--by 18.7% from 1989-93 (p < 0.05). The largest increase (25%) was observed in the 45-64 years age group but it was also particularly evident (19%) in elderly patients (65-74 years). Subjects were more likely to undergo laparoscopic cholecystectomy than open cholecystectomy if they were young and female. The increased cholecystectomy rate observed merits careful scrutiny and health economic evaluation.

Adolescent↗