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Nezami N, Jarmakani H, Arici M, Latich I, Mojibian H, Ayyagari RR, Pollak JS, Perez Lozada JCL. Selective Trans-Catheter Coil Embolization of Cystic Duct Stump in Post-Cholecystectomy Bile Leak. Dig Dis Sci 2019; 64:3314-3320. [PMID: 31123973 DOI: 10.1007/s10620-019-05677-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/16/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Percutaneous drainage is a first-line treatment for bilomas developed post-cholecystectomy in the setting of bile leak from the cystic duct stump. Percutaneous drainage is usually followed by surgical or endoscopic treatment to address the leak. AIMS This study aimed to evaluate outcome of selective coil embolization of the cystic duct stump via the percutaneously placed drainage catheters in patients with post-cholecystectomy bile leak. METHODS Seven patients with persistent bile leak after laparoscopic cholecystectomy who underwent percutaneous catheter placement for biloma/abscess formation in the region of the gallbladder fossa were followed. These patients underwent selective trans-catheter cystic duct stump coil embolization from Feb 2013 to Feb 2019. Procedural management, complications, and success rates were analyzed. RESULTS All patients underwent placement of a percutaneous catheter for drainage of biloma formation in the gallbladder fossa post-cholecystectomy. Selective coil embolization of the cystic duct was performed through the existing percutaneous tract on average 3.5 weeks after percutaneous catheter placement, resulting in resolution of the biloma. All bile leaks were immediately closed. None of the patients showed recurrent bile leak or further clinical symptoms. Coil migration to the common bile duct was diagnosed in a single case, after 2.5 years, with no bile leak reported. CONCLUSIONS Selective trans-catheter coil embolization of the cystic stump is a feasible and safe procedure, which successfully seals leaking cystic duct stumps and can circumvent the need for repeat surgical or endoscopic intervention in selected patient populations.
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Affiliation(s)
- Nariman Nezami
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Haddy Jarmakani
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Melih Arici
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Igor Latich
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Hamid Mojibian
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Rajasekhara R Ayyagari
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Jeffrey S Pollak
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Juan Carlos L Perez Lozada
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
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Pogorelić Z, Aralica M, Jukić M, Žitko V, Despot R, Jurić I. Gallbladder Disease in Children: A 20-year Single-center Experience. Indian Pediatr 2019; 56:384-386. [PMID: 30898989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Aim of this study was to examine the changes in incidence of pediatric cholecystectomies. METHODS Based on a review of hospital-records, children were divided into two groups regarding year of surgery (Group I: 1998-2007; Group II: 2008-2017) and their characteristics were compared. RESULTS Number of cholecystecomies increased from 11 to 34. Median age increased from 11 to 15.5 years and mean BMI increased from 19.2 cm/m2 to 23.0 cm/m2. Hereditary spherocytosis decreased from 63.6% to 11.8% (P=0.001) of indications for cholecystectomy, while proportion of cholesterol stones increased from 27.3% to 70.6% (P=0.006). Frequency of laparoscopic cholecystectomy increased from 36.4% to 85.3% (P=0.001). Duration of hospital stay shortened from 8 to 4 days (P=0.008). CONCLUSIONS Number of pediatric cholecystectomies has significantly increased in the last 20 years, as well as average BMI of the observed population This probably signifies a correlation between rising obesity rates and increase in frequency of symptomatic cholelithiasis in children.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Spinciceva; and University of Split, School of Medicine, Soltanska; Split, Croatia. Correspondence to: Assist. Prof. Zenon Pogorelić, Department of Pediatric Surgery, Head, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia.
| | - Maja Aralica
- University of Split, School of Medicine, Soltanska 2; Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Spinciceva, Split, Croatia
| | - Vanda Žitko
- Department of Pediatrics, University Hospital of Split, Spinciceva, Split, Croatia
| | - Ranka Despot
- Department of Pediatrics, University Hospital of Split, Spinciceva, Split, Croatia
| | - Ivo Jurić
- Department of Pediatric Surgery, University Hospital of Split, Spinciceva; and University of Split, School of Medicine, Soltanska; Split, Croatia
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Choudhary A, Barakat MT, Higgins LJ, Banerjee S. Choledochoscopic Identification of a Hepatic/Cystic Artery Pseudoaneurysm in a Patient with Hematemesis After Laparoscopic Cholecystectomy. Dig Dis Sci 2017; 62:1439-1442. [PMID: 27423886 DOI: 10.1007/s10620-016-4243-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Abhishek Choudhary
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Luke J Higgins
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA.
- , 300 Pasteur Drive Rm H0262, MC 5244, Palo Alto, CA, 94305, USA.
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Catena F, Melotti RM, Louis D, Fortuna D, Ansaloni L, Coccolini F, Di Saverio S, Sartelli M, Tarasconi A, Baiocchi G, Portolani N, Napoli J, De Simone B, Catena R, De Palma R. Cholecystectomy in Emilia-Romagna region (Italy): A retrospective cohort study based on a large administrative database. Ann Ital Chir 2017; 88:215-221. [PMID: 28874618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The aim of this study was to ascertain the variability and to identify a trend for the outcome of cholecystectomy surgery when used to treat cholelithiasis and acute cholecystitis. METHODS This was a large retrospective cohort study following patients up to 11 years post surgery, based on administrative data collected from 2002 to 2012 in the Emilia-Romagna Region (Northern Italy) and comparing the effectiveness and efficiency of surgical activity (laparoscopic (LC) and open cholecystectomy (OC)). Analyses included patient characteristics, length of hospital stay, type of admission and mortality risk. Outcomes considered were death from all causes (during the index hospital admission or thereafter), hospital readmissions with cholecystitis or cholelithiasis as principal diagnosis and time to surgery. RESULTS A total of 84,628 cholecystomies were performed from 2002 to 2012 out of 123,061 admissions with primary diagnostic category of cholecystitis or cholelitiasis. Laparoscopic procedure was used in 69,842 patients. Over time there was a rising linear statistically significant trend in the use of LC. Mortality rate at 1 year of OC treated patients showed a statistically significant difference compared to LC treated patients (using a cohorts match with propensity score). Only a small number of patients with acute cholecystitis was operated according guidelines within 72 hours. CONCLUSIONS The analysis of aggregate administrative data is a powerful tool to support regional health management, improve the quality of medical care, and assess the appropriateness of therapeutic or diagnostic approaches. It is important to stress a short hospital stay for laparoscopic cholecystectomy patients (50% less than open surgery): this shorter hospital stay leads to a significant economic advantage. Moreover, mortality is significantly higher in open surgery for acute cholecystitis. Interestingly, the same finding was confirmed after 30 days and 1 year, probably due to comorbidities that are more evident in open surgery. KEY WORDS Cholecystitis, Cholelithiasis, Delivery of health care, Disease management, Surgical.
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Kartal K, Uludag M. Can 4-port laparoscopic cholecystectomy remain the gold standard for gallbladder surgery? Ann Ital Chir 2016; 87:13-17. [PMID: 27026289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Since the first laparoscopic cholecystectomy (LC), laparoscopic approach has been the focus of surgical authorities and continued its technical revolution. With increasing surgical experience, a trend toward even more minimally invasive approaches has led to laparoscopic surgery to new inovations. Current surgical procedures are: four ports (4PLC), still the gold standart technique, three ports (3PLC), two ports (2PLC) and single port laparoscopic cholecystectomy (SPLC). Robotic cholecystectomy (RC) and natural orifice translumenal endoscopic surgery (NOTES) are the other new techniques for performing cholecystectomy. This article aims to make an objective comparision between different types of laparoscopic cholecystectomies by using available medical literature. KEY WORDS Cholecystectomy, Laparoscopic, Technique.
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Reynolds I, Bolger J, Al-Hilli Z, Hill ADK. Breaking Barriers to Successful Implementation of Day Case Laparoscopic Cholecystectomy. Ir Med J 2015; 108:202-204. [PMID: 26349348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Laparoscopic cholecystectomy is a common procedure performed in both emergency and elective settings. Our aim was to analyse the trends in laparoscopic surgery in Ireland in the public and private healthcare systems. In particular we studied the trend in day case laparoscopic cholecystectomy. National HIPE data for the years 2010-2012 was obtained. Similar datasets were obtained from the three main health insurers. 19,214 laparoscopic cholecystectomies were carried out in Ireland over the 3-year period. More procedures were performed in the public system than the private system from 2010-2012. There was a steady increase in surgeries performed in the public sector, while the private sector remained static. Although the ALOS was significantly higher in the public sector, there was an increase in the rate of day case procedures from 416 (13%) to 762 (21.9%). The day case rates in private hospitals increased only slightly from 29 (5.1%) in 2010 to 40 (5.9%) in 2012. Day case laparoscopic cholecystectomy has been shown to be a safe procedure, however significant barriers remain in place to the implementation of successful day case units nationwide.
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Fisichella PM, DeMeester SR, Hungness E, Perretta S, Soper NJ, Rosemurgy A, Torquati A, Sachdeva AK, Patti MG. Emerging Techniques in Minimally Invasive Surgery. Pros and Cons. J Gastrointest Surg 2015; 19:1355-62. [PMID: 25678255 DOI: 10.1007/s11605-015-2766-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/29/2015] [Indexed: 01/31/2023]
Abstract
New trends have emerged regarding the best minimally invasive access approaches to perform gastrointestinal surgery. However, these newer approaches are seen critically by those who demand a more strict assessment of outcomes and safety. An international panel of expert gathered at the 2014 American College of Surgeons Meeting with the goal of providing an evidence-based understanding of the real value of these approaches in gastrointestinal surgery. The panel has compared the efficacy and safety of most established approaches to gastrointestinal diseases to those of new treatment modalities: peroral esophageal myotomy vs. laparoscopic myotomy for achalasia, transgastric vs. transvaginal approach, and single-incision vs. multi-port access minimally invasive surgery. The panel found that (1) the outcome of these new approaches was not superior to that of established surgical procedures; (2) the new approaches are generally performed in few highly specialized centers; and (3) transgastric and transvaginal approaches might be safe and feasible in very experienced hands, but cost, training, operative time, and tools seem to limit their application for the treatment of common procedures such as cholecystectomy and appendectomy. Because the expected advantages of new approaches have yet to be proven in controlled trials, new approaches should be considered for adoption into practice only after thorough analyses of their efficacy and effectiveness and appropriate training.
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Affiliation(s)
- P Marco Fisichella
- Department of Surgery, Brigham and Women's Hospital and Boston VA Healthcare System, Harvard Medical School, 1400 VFW Parkway, West Roxbury, Boston, MA, 02132, USA,
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Abstract
The aim of this study was investigation of treatment results of acute cholecystitis according to suggested forms of cholecystitis by international experts in the research (Tokyo-2007). It was analyzed the immediate treatment results of 1399 patients with acute cholecystitis for the last 4 years in the Chelyabinsk Regional Hospital No3. 912 patients had acute cholecystitis I degree (easy cholecystitis), 270 patients--II (moderate) degree and 217 patients--III degree (severe cholecystitis). It was operated 1281 patients. Operating activity was 91.5%. Postoperative mortality in whole patients group was 0.78%. The authors suggested the main principles such as early, differentiated by the volume operative interventions according to graduations of investigation "Tokyo-2007". Controlled trial of treatment results of patients randomized on three degrees of acute cholecystitis observed appropriateness of allocation of these groups. It is necessary for differentiated treatment and improvement of treatment results of patients with acute cholecystitis.
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Affiliation(s)
- S A Sovtsov
- Kafedra khirurgii fakul'teta dopolnitel'nogo professional'nogo obrazovaniia Iuzhno-Ural'skogo gosudarstvennogo meditsinskogo universiteta Minzdrava RF, Cheliabinsk
| | - E V Prilepina
- Kafedra khirurgii fakul'teta dopolnitel'nogo professional'nogo obrazovaniia Iuzhno-Ural'skogo gosudarstvennogo meditsinskogo universiteta Minzdrava RF, Cheliabinsk
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Tucker JJ, Grim R, Bell T, Martin J, Ahuja V. Changing demographics in laparoscopic cholecystectomy performed in the United States: hospitalizations from 1998 to 2010. Am Surg 2014; 80:652-658. [PMID: 24987895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the clinical experience at a community hospital, younger patients appear to be receiving more laparoscopic cholecystectomy (LC). The purpose of this study was to determine if LC is increasing in the younger patient population and if obesity is associated with the increase in LC. Patients undergoing LC were identified from the Healthcare Cost Utilization Project Nationwide Inpatient Sample database. There were 4,449,643 LCs from 1998 to 2010. Patients 15 to 24 years of age had the largest increase in LC (3.2%) and obesity (10.8%) from 1998 to 2010. In the 15- to 24-year age group, the following variables were associated with obesity: female, white, private payer, nonteaching hospital, urban location, southern region, large hospital bed size, and 3+ Charlson group, all P < 0.05. Additionally in the 15- to 24-year age group, median length of stay (nonobese 2 days vs obese 3 days) and median cost (nonobese $19,170 vs obese $22,802) were both increased (P < 0.001). The percentage of younger people having LC is increasing with highest increases in the obese population. The obese youth also have longer length of stay with an increase in hospital cost. These results suggest a rising disease burden associated with obesity among people ages 15 to 24 years. Gallstone disease burden will likely increase with the increase in prevalence of obesity and would add to healthcare economic burden.
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Affiliation(s)
- James J Tucker
- Department of Surgery, York Hospital, York, Pennsylvania, USA
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10
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Ross SB, Sawangkum P, de La Vega KA, Teta A, Luberice K, Rosemurgy AS. Single-site robotic cholecystectomy (SSRC): an initial review of safety and feasibility. MINERVA CHIR 2013; 68:435-443. [PMID: 24101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM This report comprehensively reviews the findings from initial experiences with single-site robotic cholecystectomy (SSRC) across the world, and reports the feasibility of this new approach and novel platform. It attempts to be impartial in evaluating this novel robotic platform and approach. METHODS A search utilizing MEDLINE®/PubMed® and Google Scholar was undertaken to identify articles about SSRC. Eleven articles met our criteria and were reviewed. Data collected included: patient demographic, preoperative, intraoperative, and postoperative data. Data are presented as weighted means±pooled standard deviations. RESULTS Age and BMI was 46±13.1 years and 26±4.2 kg/m2, respectively. Operative time was 80±24.1 minutes; robotic console time was 38±16.9 minutes; and docking time was 7±3.1 minutes. Blood loss ranged from 0-150 mL. Ninety-eight percent of SSRC undertaken were completed robotically without the addition of other trocars/incisions, 2% of operations had additional trocars added, and three operations (<1%) were converted to "open". Postoperative hospital stay was 26 hours. Pain ratings, determined 2-3 weeks postoperatively, ranged from 0-2 on a Likert scale. CONCLUSION This study serves as an overall analysis and review of SSRC. Existing reports of initial experiences with SSRC documents the operation is safe, feasible, and easily learned by surgeons from a broad spectrum of geographic areas. However, a detailed cost analysis is necessary in order to determine what the future holds for this novel approach.
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Affiliation(s)
- S B Ross
- Southeastern Center for Digestive Disorders and Pancreatic Cancer Advanced Minimally Invasive and Robotic Surgery, Florida Hospital Tampa Tampa, FL, USA -
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Bucher P. Cholecystectomy through single access endoscopic surgery: where do we stand? MINERVA CHIR 2012; 67:97-104. [PMID: 22487912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Single access endoscopic surgery, also called laparoendoscopic single site surgery, single port access or single incision laparoscopic surgery has rapidly emerged in clinical practice for some specific indications. Among them single access cholecystectomy is rapidly diffusing in an attempt to improve cosmetic results, reduce parietal trauma, fasten recovery and answer patient's demand of this frequent surgery. While this approach is diffusing some limitations still persist in its feasibility, which have to be overcome by new development in instrumentations and refinement in techniques. And, on the other hand safety principle of minimally invasive cholecystectomy should be strictly respected to ensure our patients safe surgeries. Recent experiences and reports have shown that all these points can be respected, at least by experienced teams, while offering patients the first steps towards routine clinical scarless surgery. In this paper we will review the current status of cholecystectomy through single access endoscopic surgery regarding techniques, indications and results.
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Affiliation(s)
- P Bucher
- Department of Surgery, University Hospital Geneva, Geneva, Switzerland.
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Lai ECH, Yang GPC, Tang CN, Yih PCL, Chan OCY, Li MKW. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg 2011; 202:254-8. [PMID: 21871979 DOI: 10.1016/j.amjsurg.2010.12.009] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 12/13/2010] [Accepted: 12/13/2010] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study aimed to compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) versus conventional 4-port laparoscopic cholecystectomy (LC). METHODS From November 2009 to August 2010, 51 patients with symptomatic gallstone or gallbladder polyps were randomized to SILC (n = 24) or 4-port LC (n = 27). RESULTS Mean surgical time (43.5 vs 46.5 min), median blood loss (1 vs 1 mL) and mean hospital stay (1.5 vs 1.8 d) were similar for both the SILC and 4-port LC group. There were no open conversions and no major complications. The mean total wound length of the SILC group was significantly shorter (1.76 vs 2.25 cm). The median visual analogue pain score at 6 hours after surgery was similar (4.5 vs 4.0) but the SILC group had a significantly worse pain score on day 7 (1 vs 0). There was no difference in time to resume usual activity (mean, 5.6 vs 5.0 d). The median cosmetic score of SILC was significantly higher than at 3 months after surgery (7 vs 6). CONCLUSIONS SILC was feasible and safe for properly selected patients in experienced hands.
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Affiliation(s)
- Eric C H Lai
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Rd., Chai Wan, Hong Kong SAR, China.
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Affiliation(s)
- My Di Le
- Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC, USA
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Kohnen L, Coimbra C, Deroover A, Nsadi B, Kaba A, Lauwick S, Joris J, Maweja S, Hamoir E, Meurisse M, Honoré P, Detry O. [Image of the month. Cholecystectomy without a visible scar: laparoscopic cholecystectomy via the umbilicus]. Rev Med Liege 2010; 65:543-544. [PMID: 21128357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- L Kohnen
- Service de Chirurgie Abdominale et Transplantation, CHU de Liège, Belgique
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Abstract
BACKGROUND AND OBJECTIVES Now nearly 2 decades into the laparoscopic era, nationwide laparoscopic cholecystectomy conversion rates remain around 5% to 10%. We analyzed patient- and surgeon-specific factors that may impact the decision to convert to open. METHODS We retrospectively analyzed 2205 LCs performed at a large tertiary community hospital over a 52 month period (May 2004 through October 2008). RESULTS The overall conversion rate was 4.9%. The most common reason for conversion was adhesions, and the majority of these patients had prior abdominal surgery. Males and patients >50 years old had a significantly higher likelihood of open conversion. The conversion rate of high-volume surgeons (≥100 total cases) in comparison to low-volume surgeons (40 to 99 total cases) was significantly lower. Conversion rates were lower among surgeons with fellowship training and those who completed residency training after 1990. Interestingly, the percentage of conversions due to technical difficulty was lower among those with fellowship training but higher among those who completed training after 1990. CONCLUSION Conversion occurred in ∼5% of all laparoscopic cholecystectomies. Males, patients >50 years old, and cases performed by low-volume surgeons had a higher likelihood of conversion. Other surgeon-specific factors did not have a significant impact on conversion rate.
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Affiliation(s)
- Sujit Vijay Sakpal
- Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
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O'Bryan MC, Dutro J. Impact of laparoscopic cholecystectomy on resident training: fifteen years later. J Surg Educ 2008; 65:346-349. [PMID: 18809163 DOI: 10.1016/j.jsurg.2008.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 06/12/2008] [Accepted: 06/12/2008] [Indexed: 05/26/2023]
Abstract
Laparoscopic cholecystectomy was first introduced to our surgical community in 1989. In 1993, McKellar reviewed the impact of laparoscopic cholecystectomy on 1 specific surgical training program. Fifteen years later, the authors reexamined the implications of laparoscopic surgery on resident competency with both open and laparoscopic biliary procedures. The data reveal a statistically significant increase in the percentage of laparoscopic cholecystectomies performed when compared with total cholecystectomies (open plus laparoscopic), as well as a trend toward decreasing numbers of total common bile duct explorations performed. A review of the literature that pertains to changes in resident training as related to laparoscopic procedures is included.
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Affiliation(s)
- Meghan C O'Bryan
- Department of Surgery, Wright State University, Dayton, Ohio 45409, USA.
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Huang ZQ. [The development of biliary tract surgery]. Zhonghua Wai Ke Za Zhi 2006; 44:1585-6. [PMID: 17359681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Hobbs MS, Mai Q, Knuiman MW, Fletcher DR, Ridout SC. Surgeon experience and trends in intraoperative complications in laparoscopic cholecystectomy. Br J Surg 2006; 93:844-53. [PMID: 16671070 DOI: 10.1002/bjs.5333] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intraoperative complications, particularly bile duct injuries (BDIs), have increased since the introduction of laparoscopic cholecystectomy (LC). This excess risk is expected to decline as surgeon experience in laparoscopic surgery increases. METHODS This was a population-based study of trends in intraoperative injuries in 33 309 cholecystectomies carried out in Western Australia between 1988 and 1998, based on hospital discharge abstracts. Endpoints were identified from diagnostic and procedure codes in index or postoperative readmissions, or a register of endoscopic retrograde cholangiopancreatography procedures, and validated using hospital records. Multivariate analysis was used to estimate the risk of complications associated with potential risk factors. RESULTS Following the introduction of LC in 1991, the prevalence of all complications doubled by 1994 then stabilized, whereas that of BDI declined after 1994. The risk of complications increased with age, was higher in men, teaching and country hospitals, and was higher for LC and more complicated operations. It was lower when intraoperative cholangiography was performed and with increasing surgeon experience. Approximately 20 per cent of all complications and 30 per cent of BDIs were attributable to surgeons who had performed 200 or fewer cholecystectomies in the previous 5 years. CONCLUSION The risk of intraoperative complications declined with increasing surgical experience and use of intraoperative cholangiography.
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Affiliation(s)
- M S Hobbs
- School of Population Health, University of Western Australia, Crawley, Western Australia, Australia.
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Balaguer EJ, Price MR, Burd RS. National Trends in the Utilization of Cholecystectomy in Children. J Surg Res 2006; 134:68-73. [PMID: 16650434 DOI: 10.1016/j.jss.2006.02.053] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Revised: 02/27/2006] [Accepted: 02/28/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have suggested that indications for cholecystectomy in children have evolved over the past three decades contributing to an increased frequency of this procedure. The purpose of this study was to evaluate recent trends in utilization of cholecystectomy in children in the laparoscopic era. MATERIALS AND METHODS Children (<15 year) undergoing cholecystectomy between 1996 and 2003 were identified in the Nationwide Inpatient Sample. Underlying medical illness and related biliary tract conditions and procedures were identified using ICD-9 codes. Census data were used to calculate population-based rates stratifying by age and risk factors for cholelithiasis. Univariate and multivariate analyses were performed accounting for survey design. RESULTS During the study period, an estimated 11,823 cholecystectomies were performed nationwide. While the population frequency of children with hemolytic anemia undergoing cholecystectomy did not significantly change, the frequency of children undergoing cholecystectomy without this risk factor increased from 1.5 to 2.5 procedures/100,000 population (P = 0.03). The percentage undergoing cholecystectomy by a laparoscopic approach increased from 77 to 91% (P < 0.001), with the largest increase being observed in children <5 years old (36% versus 90%, P < 0.001). While no significant differences in in-hospital surgical complications or mortality were observed, laparoscopic cholecystectomy was associated with a 2.3 d (P < 0.001) shorter length of stay than open cholecystectomy. CONCLUSIONS The indications for cholecystectomy have continued to evolve in the laparoscopic era. While the increased use of laparoscopic cholecystectomy has been associated with decreased length of stay, this approach has not been associated with changes in in-hospital outcomes. The effect of these trends on rates of operative biliary tract injury and long-term outcome require additional study.
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Affiliation(s)
- Eric J Balaguer
- Department of Surgery, Division of Pediatric Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA
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Osborne DA, Alexander G, Boe B, Zervos EE. Laparoscopic cholecystectomy: past, present, and future. Surg Technol Int 2006; 15:81-5. [PMID: 17029166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Laparoscopic cholecystectomy is one of the most commonly undertaken procedures in General Surgery with more than 500,000 performed annually. Overall, the complication rate is less than 1.5%, and the mortality rate is less than 0.1%. As such, laparoscopic cholecystectomy was considered by most to be at its zenith since its inception in the early 1990 s. Advancements in technology and equipment have opened new doors to physicians and allowed the laparoscopic cholecystectomy to once again evolve. Traditional four-port cholecystectomy has given way to three- and even two-port techniques. Standard 12-mm ports have been replaced by 2-mm ports, and experiments have now been implemented to achieve cholecystectomy with no ports-known as the transgastric technique. The authors reviewed evolution of these techniques that included a synopsis of our experience with the three-port cholecystectomy, as well as the future direction of laparoscopic surgery.
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Affiliation(s)
- Dana A Osborne
- Department of Surgery, College of Medicine, University of South Florida, Tampa, FL, USA
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21
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Abstract
BACKGROUND The use of elective cholecystectomy has increased dramatically following the widespread adoption of laparoscopic cholecystectomy. We sought to determine whether this increase has resulted in a reduction in the incidence of severe complications of gallstone disease. METHODS We examined longitudinal trends in the population-based rates of severe gallstone disease from 1988 to 2000, using a quasi-experimental longitudinal design to assess the effects of the large increase in elective cholecystectomy rates after 1991 among people aged 18 years and older residing in Ontario. We also measured the rate of hospital admission because of acute diverticulitis, to control for secular trends in the use of hospital care for acute abdominal diseases. RESULTS The adjusted annual rate of elective cholecystectomy per 100,000 population increased from 201.3 (95% confidence interval [CI] 197.0-205.8) in 1988-1990 to 260.8 (95% CI 257.1- 264.5) in 1992-2000 (rate ratio [RR] 1.35, 95% CI 1.32- 1.38, p 0.001). An anomalously high number of elective cholecystectomies were performed in 1991. Overall, the annual rate of severe gallstone diseases (acute cholecystitis, acute biliary pancreatitis and acute cholangitis) declined by 10% (RR 0.90, 95% CI 0.88- 0.91) for 1992-2000 as compared with 1988-1991. This decline was entirely due to an 18% reduction in the rate of acute cholecystitis (RR 0.82, 95% CI 0.80-0.84). INTERPRETATION The increase in the rate of elective cholecystectomy that occurred following the introduction of laparoscopic cholecystectomy in 1991 was associated with an overall reduction in the incidence of severe gallstone disease that was entirely attributable to a reduction in the incidence of acute cholecystitis.
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Affiliation(s)
- David R Urbach
- The Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ont.
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22
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Ainsworth AP, Adamsen S, Rosenberg J. [Cholecystectomy in Denmark 1989-2003]. Ugeskr Laeger 2005; 167:2648-50. [PMID: 16014224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The aim of this study was to describe the cholecystectomy rate in Denmark in the last 15 years, since the introduction of laparoscopic cholecystectomy might have had an influence on it. MATERIALS AND METHODS An analysis was done of data from the mandatory Danish National Patient Registry, which covers all public hospitals in Denmark. All cholecystectomies performed from 1989 to 2003 in the various hospitals were registered. Open and laparoscopic operations were registered separately. In addition, the number of patients who were operated on for acute cholecystitis from 1996 to 2003 was registered. RESULTS An increase in the cholecystectomy rate was observed, from 67/100,000 inhabitants in 1989 to 143/100,000 inhabitants in 2003 (p < 0.05). The increase was due mainly to the number of laparoscopic procedures, which comprised 81% of all cholecystectomies in 2003. The proportion of patients who were operated on for acute cholecystitis decreased from 14% in 1996 to 12% in 2003 (p < 0.05). DISCUSSION The increasing cholecystectomy rate in Denmark from 1989 to 2003 is probably due to the fact that more patients are having surgery for painful gallbladder stones.
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Onders RP, Hallowell PT. The era of ultrasonography during laparoscopic cholecystectomy. Am J Surg 2005; 189:348-51. [PMID: 15792767 DOI: 10.1016/j.amjsurg.2004.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Revised: 11/23/2004] [Accepted: 11/23/2004] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- Raymond P Onders
- Department of Surgery, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106-5047, USA.
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Cai XJ. [Laparoscopic surgery in the treatment of abdominal diseases: present status and prospects]. Zhonghua Yi Xue Za Zhi 2005; 85:145-8. [PMID: 15854453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the standard operation for gallstone disease. The aim of this review was to scrutinize the advantages and benefits of this minimal invasive technique compared to the conventional operation according to the available literature. Regarding the evidence-based medicine criteria, the current status of laparoscopy in the treatment of cholecystolithiasis, cholecystitis and common bile duct stones has been worked out. METHODS A Medline, PubMed, Cochrane search. RESULTS Ten randomized controlled trials (RCTs) are available comparing laparoscopic versus open cholecystectomy. The superiority of LC in less postoperative pain, shorter recovery and hospital stay is stated. Operation time was longer in the first years of LC. 3 RCTs deal with acute cholecystitis: one paper could not find any significant advantage of LC over conventional cholecystectomy, the other two found benefits in recovery, hospital stay and postoperative pain. The range of conversion is between 5 and 7% in elective cases and increases up to 27% for acute cholecystitis. With a rate of more than 90% in Europe, the standard procedure for common bile duct stones is 'therapeutic splitting' with endoscopy and retrograde cholangiopancreatography preoperatively followed by LC. Laparoscopic bile duct clearance is effective and safe in experienced hands, however, the only proven benefit is a slightly shorter hospital stay. CONCLUSION The laparoscopic approach is preferred in elective cholecystectomy and acute cholecystitis. The minimal invasive technique has proven to be effective, gentle and safe. The main benefits are evident within the first postoperative days.
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Affiliation(s)
- Andreas Shamiyeh
- Ludwig Boltzmann Institute for Operative Laparoscopy and Second Surgical Department, Academic Teaching Hospital, Linz, Austria.
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Beburishvili AG, Bykov AV, Ziubina EN, Burchuladze NS. [Evolution of approaches to surgical treatment of complicated cholecystitis]. Khirurgiia (Mosk) 2005:43-7. [PMID: 15699968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
More than 17 thousand surgeries for calculous cholecystitis and its complications including 560 repeated surgeries on the major bile ducts were performed. Based on this experience three stages in treatment of complicated cholecystitis are distinguished. Principal changes of surgical policy are the criteria of this division. From 1993 a tendency towards mini-invasive surgery in complicated cholecystitis was developing. Optimal terms of surgery, adequate scope improved technique improve significantly results of surgical treatment of complicated cholelithiasis.
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Bakken IJ, Skjeldestad FE, Mjåland O, Johnson E. [Cholecystectomy in Norway 1990-2002]. Tidsskr Nor Laegeforen 2004; 124:2376-8. [PMID: 15467805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate cholecystectomy incidence and laparoscopy rates in Norway (1990-2002). METHODS Data were compiled from the Norwegian Patient Registry based on codes for cholecystectomy. RESULTS From 1990 to 2000-02, age-adjusted incidence rate (per 10,000 inhabitants) for cholecystectomy increased from 2.9 to 4.1 for men and from 7.0 to 11.8 for women. Incidence rates varied between counties. The proportion undergoing laparoscopic surgery increased from 1% in 1990 to 89% in 2000-02. Over the same period the length of postoperative inpatient stay decreased from 7.3 days to 3.3 days. 94% of electively admitted patients were operated by laparoscopic technique in 2000-02. Among patients admitted on an emergency basis, women below 50 were more often operated by laparoscopic technique than older women and men. CONCLUSION Substantial changes in the treatment of gallstone disease occurred in Norway over the period 1990 -2002. Increased incidence rates for cholecystectomy and reduced length of postoperative inpatient stay were observed after the introduction of cholecystectomy by laparoscopic technique.
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Abstract
Since the introduction of minimal access surgery to general surgeons in the 1980s, pediatric surgeons have been employing this innovative technology to perform surgery on children. Video technology and miniaturized instruments have brought the laboratory to the operating room; in many cases several small incisions are the only access necessary to perform complicated procedures that would otherwise require a large wound. Additional benefits of minimal access surgery may include reduced postoperative analgesic requirements, shortened length of stay, and faster resumption of normal activities. Increased operative costs offset some of these gains. The pediatric surgical community has embraced minimal access techniques for some operations; others remain controversial.
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Affiliation(s)
- Jeffrey L Zitsman
- Children's Hospital of New York Presbyterian, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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Abstract
BACKGROUND Day case cholecystectomy is increasingly becoming a management option for elective cases while "same admission" cholecystectomy is now considered a favorable option in the treatment of acute cholecystitis. To assess the advent of these changes in our surgical practice, a retrospective analysis of our experience is presented. METHODS All patients undergoing cholecystectomy between January 2000 and January 2001 were analyzed according to admission status, operation type, conversion rate, complications, and nonsurgical intervention. RESULTS 156 patients underwent cholecystectomy and 152 charts were retrieved. Laparoscopic cholecystectomy was performed on 95% of patients with a conversion rate of 9%. Morbidity for the series was 12.5%, including one common bile duct injury (0.6%). Day case and acute cholecystectomy comprised 67% of our cholecystectomy practice. CONCLUSIONS Our findings suggest that there is an increasing trend toward shortening the hospital stay of patients undergoing laparoscopic cholecystectomy. This does not appear to have had a deleterious effect on outcome.
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Affiliation(s)
- S M Johnston
- Department of Surgery, Adelaide and Meath Incorporating National Children's Hospital Tallaght, Dublin 24, Ireland.
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Bobrzyński A, Budzyński A, Strzałka M. [The decade of laparoscopic cholecystectomy]. Przegl Lek 2003; 60:180-4. [PMID: 14575022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The role of laparoscopy in the treatment of gallbladder stones has been discussed. Operative technique, intraoperative difficulties, complications and its treatment were presented. Indications, postoperative course, advantages and drawbacks of minimally invasive techniques in the treatment of cholelithiasis were discussed.
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Affiliation(s)
- Andrzej Bobrzyński
- II Katedra Chirurgii Ogólnej Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie, 31-501 Kraków, ul. Kopernika 21
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Feldman LS, Medeiros LE, Hanley J, Sigman HH, Garzon J, Fried GM. Does a special interest in laparoscopy affect the treatment of acute cholecystitis? Surg Endosc 2002; 16:1697-703. [PMID: 12098035 DOI: 10.1007/s00464-002-8514-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2002] [Accepted: 05/15/2002] [Indexed: 10/27/2022]
Abstract
BACKGROUND We tested the hypothesis that the treatment of patients with acute cholecystitis (AC) would be improved under the care of laparoscopic specialists. METHODS The records of patients undergoing cholecystectomy for AC from 1 January 1996 to 31 December 1998 were reviewed retrospectively. Of 170 patients, 48 were cared for by three laparoscopic specialists (LS group), whereas 122 were treated by nine general surgeons who perform only laparoscopic cholecystectomy (LC) (GS group). The rates of successful LC, complications, and length of hospital stay were compared. Multivariate analysis was used to control for baseline differences. RESULTS The patients in the GS group were older (median age, 63 vs 53 years; p = 0.01). In all, 31 LS patients (65%), as compared with 44 GS patients (36%), had successful laparoscopic treatment (p = 0.001). The operating time was the same (median, 70 min). The proportion of patients with postoperative complications was similar in the two groups (37% in the GS vs 31% in the LS group; p = 0.6). The median postoperative hospital stay (3 vs 5 days; p <0.01) was shorter in the LS group. On logistic regression analysis, significant predictors of a successful laparoscopic operation included LS group (p <0.01) and age (p = 0). Predictors of prolonged length of hospital stay were age (p <0.01) and comorbidity score (p <0.01), with LS group status not a significant factor (p = 0.21). CONCLUSIONS Patients with AC are more likely to undergo successful LC if cared for by a surgeon with an interest in laparoscopy. However, length of hospital stay is influenced more by patient factors in a multivariate model.
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Affiliation(s)
- L S Feldman
- Department of Surgery, McGill University, Montreal, Quebec, Canada.
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Abstract
BACKGROUND Injury to the bile ducts is the most important complication of laparoscopic cholecystectomy (LC), affecting approximately 2000 patients annually in the United States. Traditional surgical teaching fails to provide adequate extrabiliary reference points. A "person approach" of blame and shame (as distinct from a "system approach") has evidently been unsuccessful in controlling this problem. New strategies are needed. High-reliability organizations such as aviation and the nuclear power industry have well-developed system-based error prevention programs; the application to laparoscopic operations of some principles used in these programs merits evaluation. In addition, some time-honored teaching of steps to safeguard the bile duct needs to be re-examined. METHODS A review of the literature and of 34 cases of bile duct injury referred to the author was carried out. Traditional surgical teaching was evaluated to identify reasons why it has failed to prevent bile duct injury. New extrabiliary reference points were used. Error prevention strategies derived from the aviation and maritime industries were modified for application to LC. These principles have been applied in a prospective study of 2000 successive LCs carried out on 1 surgical unit, including operations by surgical trainees. RESULTS The literature and case review indicated that misidentification of biliary anatomy was the major cause of bile duct injury and the injury was unrecognized by the operating surgeon in 3 out of 4 cases, suggesting that traditional surgical teaching provides inadequate reference points to prevent duct misidentification, that spatial disorientation analogous to navigation errors occurs, and that systemic factors predisposing to error are present. Several principles used in navigation were applied. "Human factors," educational principles derived from aviation crew resource management training, were applied. No bile duct injuries occurred in the 2000 LC operations. Eight patients had biliary leakage develop but all recovered without further surgical intervention. CONCLUSIONS Laparoscopic bile duct injury continues to occur at an unacceptable rate. New strategies involving a system approach and using principles adopted by the aviation and maritime industries were applied in 2000 consecutive LCs without bile duct injury. The application in the operating room of commonly taught navigation principles, the use of extrabiliary reference points such as Rouvière's sulcus, and the introduction of human factors education for surgeons reduces the frequency of bile duct injury.
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Affiliation(s)
- Thomas B Hugh
- St Vincent's Hospital and St Vincent's Clinic, Sydney, Australia
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Maestroni U, Sortini D, Devito C, Pour Morad Kohan Brunaldi F, Anania G, Pavanelli L, Pasqualucci A, Donini A. A new method of preemptive analgesia in laparoscopic cholecystectomy. Surg Endosc 2002; 16:1336-40. [PMID: 11988800 DOI: 10.1007/s00464-001-9181-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2001] [Accepted: 01/24/2002] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although laparoscopic cholecystectomy (LC) results in less pain then open cholecystectomy, it is not a pain-free procedure. The aim of this study was to test a new method of preemptive analgesia. METHODS By simple randomization 60 patients were assigned to two groups (30 in each group). Group A, the placebo group, received 200 ml of 0.9% saline, and group B received 5 mg/kg of a local anesthetic solution (ropivacaine) in 200 ml of 0.9% saline. Local anesthetic or placebo solution were administer before creation of the pneumoperitoneum. RESULTS Pain intensity, as rated by visual analog and verbal rating scales, and stress response data were significantly less in the group receiving ropivacaine than in the placebo group. No patients in treatment group received an additional dose of analgesic, whereas two patients in placebo group needed an additional analgesic. CONCLUSIONS Our results support the clinical validity of preemptive analgesia, but the timing of intraperitoneal administration of local anesthetic is very important. Only application before creation of the pneumoperitoneum may preempt every neuronal central sensitization.
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MESH Headings
- Amides/blood
- Amides/therapeutic use
- Analgesia/methods
- Analgesia/trends
- Anesthetics, Local/blood
- Anesthetics, Local/therapeutic use
- Cholecystectomy, Laparoscopic/methods
- Cholecystectomy, Laparoscopic/trends
- Female
- Humans
- Injections, Intraperitoneal/methods
- Male
- Middle Aged
- Pain Measurement
- Pain, Postoperative/blood
- Pain, Postoperative/pathology
- Pain, Postoperative/prevention & control
- Pneumoperitoneum, Artificial/methods
- Pneumoperitoneum, Artificial/trends
- Ropivacaine
- Stress, Physiological/blood
- Stress, Physiological/pathology
- Stress, Physiological/prevention & control
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Affiliation(s)
- U Maestroni
- Department of Surgery, Anaesthsiology, and Radiology, University of Ferrara, C.so Giovecca 203, Ferrara, Italy
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Welty G, Schippers E, Grablowitz V, Lawong AG, Tittel A, Schumpelick V. Is laparoscopic cholecystectomy a mature operative technique? Surg Endosc 2002; 16:820-7. [PMID: 11997830 DOI: 10.1007/s00464-001-9019-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2001] [Accepted: 08/15/2001] [Indexed: 11/27/2022]
Abstract
BACKGROUND More than 10 years after its introduction, laparoscopic cholecystectomy has become the method of choice for the treatment of cholecystolithiasis. However intraoperative difficulties with dramatic postoperative consequences have been reported. The aim of this study was to identify what role the two-dimensional view, the surgeon's experience, the instruments, technical tools and their (time) influence exercised on the operation course in daily laparoscopic operations. METHODS The operative times for 30 laparoscopic cholecystectomies were investigated by ergonomic sequence analysis and analyzed statistically with the use of the Wilcoxon test. RESULTS Comparing experienced and less experienced surgeons, a significant difference in the duration of the operation was observed (56 +/- 24 min compared to 75 +/- 13 min p = 0,025), especially in the laparoscopic intra-abdominal phase of the operation. The prolonged duration of the operation (15-20%) was mainly due to problems with the technical tools (40%) and the use of instruments (23.5%). Visualization had a minor influence (14.4%) on the duration of the operation, and the negative effect of the two-dimensional view (0.5%) was negligible. The last two factors did not cause any complications. CONCLUSIONS The recognized difficulties still cause a loss of time and in some cases complications, which can only partly be compensated by the surgeon's experience. This leads to reluctance in the application of laparoscopic cholecystectomy in more complicated stages of the disease. Two-dimensional view satisfies the surgeon's demands for a safe procedure.
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Affiliation(s)
- G Welty
- Department of Surgery, University Hospital RWTH Aachen, Pauwelslrasse 30, D-52072 Aachen, Germany.
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Mori T, Ikeda Y, Okamoto K, Sakata K, Ideguchi K, Nakagawa K, Yasumitsu T. A new technique for two-trocar laparoscopic cholecystectomy. Surg Endosc 2002; 16:589-91. [PMID: 11972194 DOI: 10.1007/s00464-001-9090-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2001] [Accepted: 09/27/2001] [Indexed: 02/03/2023]
Abstract
BACKGROUND New techniques for laparoscopic cholecystectomy (LC) that reduce the number of trocars or use very thin instruments have been devised with the goal of further minimizing surgical invasiveness. METHODS We performed two-trocar LC using an original new technique in 70 consecutive patients. A 10-mm trocar and a 5-mm trocar were inserted in the subumbilical and epigastrium positions, respectively. A 2-mm grasper forceps was inserted directly without a trocar below the costal margin. The fundus of the gallbladder was ligated and lifted up with a folded 0 silk string and a 16-gauge vessel cannula. RESULTS The mean operative time was 73.2 +/- 23.5 min. A third trocar was added in two cases. None of the patients required conversion of the procedure to an open cholecystectomy, and there were no intraoperative complications. CONCLUSION Based on our experience, we think that this technique is as safe and effective as the classic four-trocar technique; moreover, it has a cost benefit.
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Affiliation(s)
- T Mori
- Department of Surgery, Osaka Prefectural Habikino Hospital, 3-7-1, Habikino, Habikino-City, Osaka 583-8588, Japan
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Abstract
After its debut in 1988, laparoscopic cholecystectomy rapidly became the standard of care for cholelithiasis, yet very few surgeons use minimally invasive techniques for other abdominal operations. Why do most surgeons continue to perform traditional open gastrointestinal operations? We believe that the answer to this question lies in the fact that advanced laparoscopic operations are difficult to learn, perform, and master. A number of inherent pitfalls of laparoscopy hinder the performance of these operations even after the surgeon has accumulated years of experience. These pitfalls include an unstable video camera platform, limited motion (degrees of freedom) of straight laparoscopic instruments, two-dimensional imaging, and poor ergonomics for the surgeon. Inexperienced or bored laparoscopic camera-holders move the camera frequently and rotate it away from the horizon. The long, straight laparoscopic instruments are limited in their motion by the fixation enforced by the abdominal wall trocars. Similarly, the standard two-dimensional video imaging used in most laparoscopic operations impedes the surgeon's depth perception, compounding the limitations of laparoscopic instruments. In addition, surgeons are forced to assume ergonomically awkward stances in performing many laparoscopic operations. These four factors hinder a surgeon's efforts to learn and to perform advanced laparoscopic operations, significantly lengthening the learning curve. The articles presented in this issue suggest that robotics and telerobotics offer solutions to these nagging pitfalls of laparoscopic surgery.
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Affiliation(s)
- Garth H Ballantyne
- Department of Surgery, Hackensack University Medical Center, New Jersey 07601, USA.
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Lichten JB, Reid JJ, Zahalsky MP, Friedman RL. Laparoscopic cholecystectomy in the new millennium. Surg Endosc 2001; 15:867-72. [PMID: 11443440 DOI: 10.1007/s004640080004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2000] [Revised: 10/17/2001] [Accepted: 10/17/2001] [Indexed: 12/25/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic cholelithiasis. Many authors-including investigators at our institution, who reported one of the initial experiences with laparoscopic cholecystectomy in July 1992-have documented a definite learning curve associated with this procedure. We present a follow-up study of our experience with laparoscopic cholecystectomy and compare these data to an earlier study of the initial experience with laparoscopic cholecystectomy at the Beth Israel Medical Center. METHODS We retrospectively reviewed 300 consecutive patients from March 1998 through March 1999. The patient population was epidemiologically similar to that of the original study with regard to age, sex, and American Society of Anesthesia (ASA) classification. However, whereas the initial population included only patients with chronic disease, in our study 13.7% of the patients had been admitted through the emergency room with acute stone disease of the biliary tract. RESULTS We found a 5.7% conversion rate, a 1% rate of major complication, and a 5.7% rate of minor complication rates, as compared to the initial study's rates of 12%, 4%, and 10%, respectively. Whereas none of the patients in the original study left the hospital on the day of surgery and only 49% were discharged within 1 day, in our group, 29 patients (10%) underwent ambulatory procedures and an additional 186 patients (62%) were discharged on the 1st post-operative day. The average duration of the operation was 90 min, which did not represent a statistical improvement over the time of 93 min reported in the earlier study. CONCLUSIONS Since 1992, both the conversion rate and length of stay have declined at our hospital, but operative time has remained essentially the same. These findings probably reflect a bimodal learning curve, the increase in the number of cholangiograms and additional intraoperative procedures now performed, the greater severity of gallbladder disease currently treated with laparoscopic cholecystectomy, and increases in the number of attending physicians as well as the level of residents who perform this procedure.
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Affiliation(s)
- J B Lichten
- Beth Israel Medical Center, Department of Surgery, First Avenue at 16th Street, New York, New York 10003, USA.
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Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) requires a high degree of technical ability, spatial resolution and dexterity. Assessing trainees and competent operators is an important aspect of quality assurance in patient care. Most institutions quote mean conversion rate as a method of comparing operators' performance. The purpose of the present study was to use the technique of cumulative sum (cusum) analysis to determine whether a learning curve phenomenon exists in operators performing LC. METHODS Data were obtained retrospectively by reviewing the operative records of all patients undergoing elective and acute cholecystectomy for a 30-month period coinciding with the commencement of LC at North Shore Hospital. Patients' age and gender, date and type of operative procedure, duration of operation, and name of operator were recorded. Mean and cusum-transformed data were derived for all operations as well as for four individual operators' performances. RESULTS Over the study period a total of 614 cholecystectomies was performed, with 85% attempted laparoscopically. A total of 9.8% required conversion to the open technique. Time trend analysis with the cusum technique for all surgeons revealed an inverse relationship between selection rate and conversion rate. Analysis of four individual surgeons revealed three different time trend profiles. CONCLUSION There was a direct inverse relationship between conversion rate and selection rate, in that careful selection is associated with a low conversion rate. Comparison of individual surgeons' performance showed wide variation, with only one surgeon exhibiting the phenomenon of a learning curve. Contrary to other reports, we found that performance on LC was not always related to operative experience. This highlights the need for a more objective method to analyse operator competence than operator experience alone.
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Affiliation(s)
- A Bartlett
- Division of Surgery, Faculty of Medicine and Health Science, University of Auckland, New Zealand
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Abstract
Despite the rapid development and widespread application of laparoscopic operation techniques, only laparoscopic cholecystectomy and laparoscopic fundoplication have replaced the open operations as standard techniques. Nowadays only about 10% of appendectomies and 25% inguinal hernias are performed by the laparoscopic approach. Colorectal operations are rarely performed laparoscopically. Demanding operative skills and uncertainty about the oncological quality have hindered the spread of laparoscopic colorectal resections. Studies at specialized centers have shown that it is possible to follow the principles of oncological surgery. First results of small series promise similar long-term results, but large prospective randomized trials are still unpublished. Depending on the extent of the operative procedure, laparoscopic operations result in reduced postoperative pain, fewer adhesions, shortened postoperative atonia and improved convalescence in comparison with open surgery. The direct costs of laparoscopic procedures are higher than open operations as a result of longer operation times and expensive equipment. As a result of shorter hospitalisation and quicker return to work, the overall health care costs may be reduced, but strong unbiased evidence is still lacking.
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Affiliation(s)
- A Tittel
- Chirurgische Klinik und Poliklinik, Universitätsklinikums, RWTH Aachen.
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Montori A, Boscaini M, Gasparrini M, Miscusi G, Masoni L, Onorato M, Montori J. Gallstones in elderly patients: impact of laparoscopic cholecystectomy. Can J Gastroenterol 2000; 14:929-32. [PMID: 11125183 DOI: 10.1155/2000/218531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- A Montori
- University of Rome "La Sapienza", Rome, Italy.
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Muyanga J, Ghoor FO, Modiba MC. Laparoscopic cholecystectomy in black patients at Ga-Rankuwa Hospital: a feasibility study. Cent Afr J Med 1999; 45:176-8. [PMID: 10695194 DOI: 10.4314/cajm.v45i7.8479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine feasibility and outcome of laparoscopic cholecystectomy for Black patients in Ga-Rankuwa Hospital and to analyse the type of stones harvested. DESIGN Cross sectional description study. SETTING Ga-Rankuwa Hospital/Medunsa, South Africa. SUBJECTS 79 patients who presented with cholelithiasis over a six year period. MAIN OUTCOME MEASURES Successful performance of laparoscopic cholecystectomy on the subjects. RESULTS 39 laparoscopic cholecystectomies were performed with seven conversions (18% conversion rate). Forty open cholecystectomies were also performed. Post operative stay after laparoscopic cholecystectomy averaged 3.5 days and that of the open converted group 6.9 days (p < 0.001). Two patients returned with persistence of symptoms following laparoscopic cholecystectomy. Twenty gall stones were analysed; 17 were of the cholesterol type and three of the black pigment type. CONCLUSIONS Laparoscopic cholecystectomy is feasible in the Black populace of Ga-Rankuwa Hospital. The majority of gallstones are of the cholesterol type.
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Reardon PR, Kamelgard JI, Applebaum BA, Brunicardi FC. Why mini-laparoscopic cholecystectomy? J Laparoendosc Adv Surg Tech A 1999; 9:313. [PMID: 10414553 DOI: 10.1089/lap.1999.9.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Perissat J. Laparoscopic cholecystectomy, a treatment for gallstones: from idea to reality. World J Surg 1999; 23:328-31. [PMID: 10030854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- J Perissat
- Université Victor Segalen Bordeaux 2, D.E.T.E.R.C.A., Chirurgie Laparoscopique, Bat. 3B, Rue Léo Saignat, Bordeaux F33076, France
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Budarin VN, Temnyshov SV, Bol'shakov VV, Kuz'minskiĭ VO, Startsev IL. [Laparoscopic cholecystectomy]. Khirurgiia (Mosk) 1999:58. [PMID: 10081260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Rosenberg J, Bisgaard T, Bardram L, Kehlet H. [Laparoscopic cholecystectomy at a university hospital department. Trends]. Ugeskr Laeger 1999; 161:165-8. [PMID: 9922702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- J Rosenberg
- H:S Hvidovre Hospital, kirurgisk gastroenterologisk afdeling
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Berchi García FJ. [Current status of pediatric endoscopic surgery]. Cir Pediatr 1998; 11:133-5. [PMID: 9927762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Adamsen S, Hansen OH. Laparoscopic cholecystectomy and ERCP--lessons from the Danish National Registry. Gastrointest Endosc 1998; 48:332-4; discussion 334-5. [PMID: 9744621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Schneider HT, Schell E, Wenzel F, Benninger J, Rabenstein T, Flügel H, Katalinic A, Hahn EG, Ell C. [Changes in and acceptance of surgical and noninvasive therapy procedures in cholecystolithiasis]. Med Klin (Munich) 1998; 93:457-62. [PMID: 9747100 DOI: 10.1007/bf03042594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The treatment of cholecystolithiasis has changed fundamentally in recent years due to the development of non-surgical techniques (extracorporeal shockwave lithotripsy [ESWL], oral litholysis) and the implementation of laparoscopic cholecystectomy. PATIENTS AND RESULTS Retrospective analysis of 2270 patients (1649 women, 621 men; age: 47.2 +/- 14 years) presenting with gallstone disorders in a university medical outpatients department between 1988 and 1992 in order to be instructed as to the most suitable therapy method bear witness to the rapid change in therapeutic procedure. Laparoscopic removal of the gallbladder has virtually supplanted conventional cholecystectomy, and within 5 years the proportionate role of ESWL has declined from 21 to 12%. Over the years, the proportion of patients requiring no therapeutic intervention remained constant (at about 20%). The therapeutic recommendations of the "experts" were implemented in almost 80% of cases. The majority of patients were satisfied with the chosen therapeutic approach (surgery: 93.0%, ESWL: 77.6%), although 44% of ESWL-patients and 36% of surgically managed patients reported complaints which persisted even after completion of therapy. Despite unsuccessful ESWL (residual fragments or recurrent stones) 58/95 (61%) of interviewed patients would again give preference to this non-invasive modality in the event of a renewed therapeutic decision. CONCLUSION Only a few years after its introduction, laparoscopic cholecystectomy has asserted itself as the predominant treatment option. But as far as acceptance and preference by the patient are concerned extracorporeal shockwave lithotripsy--as a non-invasive treatment modality--also enjoys high popularity and can be recommended as an alternative to surgery in suitable patients chosen according to the currently established stringent selection criteria.
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Affiliation(s)
- H T Schneider
- Medizinische Klinik I mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg
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