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Sample records for cholecystectomy

  1. Cholecystectomy for the elderly

    DEFF Research Database (Denmark)

    Nielsen, Liv Bjerre Juul; Harboe, Kirstine Moll; Bardram, Linda

    2014-01-01

    The number of Danish inhabitants older than 65 years is increasing, and cholecystectomy is one of the most common surgical procedures performed for this age group. This study aimed to analyze the role of age as an independent predictor of outcome for elderly cholecystectomy patients.......The number of Danish inhabitants older than 65 years is increasing, and cholecystectomy is one of the most common surgical procedures performed for this age group. This study aimed to analyze the role of age as an independent predictor of outcome for elderly cholecystectomy patients....

  2. Cholecystectomy in children

    DEFF Research Database (Denmark)

    Ainsworth, Alan Patrick; Axelsen, Anne Reiss; Rasmussen, Lars

    2010-01-01

    It is recommended that children with typical clinical signs of biliary colic should be offered surgery if gallstones are present. The aim of this study was to describe a population of children having undergone cholecystectomy.......It is recommended that children with typical clinical signs of biliary colic should be offered surgery if gallstones are present. The aim of this study was to describe a population of children having undergone cholecystectomy....

  3. Sex differences in laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Thesbjerg, Simon E; Harboe, Kirstine Moll; Bardram, Linda

    2010-01-01

    Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document the relations...

  4. MODIFIED LAPAROSCOPIC CHOLECYSTECTOMY

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    To furtherly reduce the subxiphoid port site pain,improve the cosmetic result and patient satisfaction,and increase the safety for patients underwent laparoscopic cholecystectomy by advanced laparoscopic knotting skill.Methods:Among our 1500 patients underwent laparoscopic cholecystectomy since 1991,120 cases of modified laparoscopic cholecystectomy (MLC) were performed with three 5-mm ports and one 10-mm port(for laparoscope and sepcien withdrawn).There were 25 male and 95 female patients with an average age of 55 years (24~77years).The indications for MLC included polypoid lesions of gallbladder (21),simple cholecystitis(3),cholecystolithiasisi with chronic cholecystitis(84),with acute suppurative cholecystitis(7),with atrophic cholecystitis(5).Results:There were 5 patients underwent combined laparoscopic appendectomy(3),fenestration of hepatic cyst(1),and drainge for liver abscess(1).The average operative time for MLC was 55 minutes(30~150min),blood loss was 10ml(3~50ml),and postoperative stay was 3 days(1~5days).There were no conversion from MLC to either LC or open surgery,without mortality.Complications were limited to two patients(1.7%).One was retained common bile duct stone and another was port site bleeding after operation.They were treated by transduodenal endoscopic stone retrieval and simple suture ligation,respecrtively.Conclusions:The advantages of MLC conducted mainly by advanced laparoscopic knotting techniques were no more laparoscope (either 2-mm or 5-mm)needed,no sacrifice of good illumination and laproscopic image.Most of all,its costeffective and operative safety were all improved furtherly.

  5. Outpatientversusinpatientlaparoscopic cholecystectomy:asinglecenterclinicalanalysis

    Institute of Scientific and Technical Information of China (English)

    Wu Ji; Kai Ding; Ling-Tang Li; Dan Wang; Ning Li; Jie-Shou Li

    2010-01-01

    BACKGROUND: Outpatient laparoscopic cholecystectomy (OPLC) developed in the United States and other developed countries as one of the fast-track surgeries performed in ambulatory centers. However, this practice has not been installed as a routine practice in the major general hospitals and medical centers in China. We designed this case-control study to evaluate the feasibility, beneifts, and safety of OPLC. METHODS: Two hundred patients who had received laparo-scopic cholecystectomy for various benign gallbladder pathologies from April 2007 to December 2008 at Jinling Hospital of Nanjing University School of Medicine were classiifed into two groups:OPLC group (100 patients), and control group (100), who were designated for inpatient laparoscopic cholecystectomy (IPLC). Data were collected for age, gender, indications for surgery, American Society of Anesthesiology (ASA) class, operative time, blood loss during surgery, length of hospitalization, and intra- and post-operative complications. The expenses of surgery and in-hospital care were calculated and analyzed. The operative procedures and instrumentation were standardized for laparo-scopic cholecystectomy, and the procedures were performed by two attending surgeons specialized in laparoscopic surgery. OPLC was selected according to the standard criteria developed by surgeons in our hospital after review. Reasons for conversion from laparoscopic to open cholecystectomy were recorded and documented. RESULTS:One hundred patients underwent IPLC following the selection criteria for the procedure, and 99% completed the procedure. The median operative time for IPLC was 24.0 minutes, blood loss was 16.2 ml, and the time for resuming liquid then soft diet was 10.7 hours and 22.0 hours, respectively. Only one patient had postoperative urinary infection. The mean hospital stay for IPLC was 58.2 hours, and the cost for surgery and hospitalization was 8770.5 RMB yuan on average. Follow-up showed that 90% of the

  6. Sleep after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Rosenberg-Adamsen, S; Skarbye, M; Wildschiødtz, G

    1996-01-01

    The sleep pattern and oxygenation of 10 patients undergoing laparoscopic cholecystectomy were studied on the night before operation and the first night after operation. Operations were performed during general anaesthesia and postoperative analgesia was achieved without the administration...... of opioids. There were no significant changes in the total time awake or the number of arousals on the postoperative night compared with the night before operation. During the postoperative night, we found a decrease (P = 0.02) in slow wave sleep (SWS) with a corresponding increase in stage 2 sleep (P = 0.......01). SWS was absent in four of the patients after operation, whereas in six patients it was within the normal range (5-20% of the night). The proportion of rapid eye movement (REM) sleep was not significantly changed after operation. There were no changes in arterial oxygen saturation on the postoperative...

  7. OUTCOME FOLLOWING OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY

    OpenAIRE

    Anmol; Lakshminarayan; Manohar; Avadhani Geeta; Abinash

    2014-01-01

    : Laparoscopic cholecystectomy has rapidly become established as the popular alternative to open cholecystectomy, but it should have a safety profile similar to or better than that of open procedure. The aim of this study was to compare conventional cholecystectomy and laparoscopic cholecystectomy with respect to duration of procedure, complications, postoperative pain, analgesic requirement, antibiotic requirement, resumption of normal diet and period of hospital stay.50 ...

  8. Therapy of umbilical hernia during laparoscopic cholecystectomy.

    Science.gov (United States)

    Zoricić, Ivan; Vukusić, Darko; Rasić, Zarko; Schwarz, Dragan; Sever, Marko

    2013-09-01

    The aim of this study is to show our experience with umbilical hernia herniorrhaphy and laparoscopic cholecystectomy, both in the same act. During last 10 years we operated 89 patients with cholecystitis and pre-existing umbilical hernia. In 61 of them we performed standard laparoscopic cholecystectomy and additional sutures of abdominal wall, and in 28 patients we performed in the same act laparoscopic cholecystectomy and herniorrhaphy of umbilical hernia. We observed incidence of postoperative herniation, and compared patients recovery after herniorrhaphy combined with laparoscopic cholecystectomy in the same act, and patients after standard laparoscopic cholecystectomy and additional sutures of abdominal wall. Patients, who had in the same time umbilical hernia herniorrhaphy and laparoscopic cholecystectomy, shown better postoperative recovery and lower incidence of postoperative umbilical hernias then patients with standard laparoscopic cholecystectomy and additional abdominal wall sutures.

  9. Timing of cholecystectomy after mild biliary pancreatitis: a systematic review.

    NARCIS (Netherlands)

    Baal, M.C.P.M. van; Besselink, M.G.; Bakker, O.J.; Santvoort, H.C. van; Schaapherder, A.F.; Nieuwenhuijs, V.B.; Gooszen, H.G.; Ramshorst, B. van; Boerma, D.

    2012-01-01

    OBJECTIVES: To determine the risk of recurrent biliary events in the period after mild biliary pancreatitis but before interval cholecystectomy and to determine the safety of cholecystectomy during the index admission. BACKGROUND: Although current guidelines recommend performing cholecystectomy earl

  10. Sexual function after transvaginal cholecystectomy

    DEFF Research Database (Denmark)

    Donatsky, Anders M; Jørgensen, Lars N; Meisner, Søren;

    2014-01-01

    INTRODUCTION: Despite several benefits, patients are concerned that transvaginal cholecystectomy has a negative impact on sexual health. The objective of this systematic review was to assess the impact of transvaginal cholecystectomy on postoperative dyspareunia and sexual function. METHOD......: A literature search was performed in the PubMed and EMBASE databases. Papers reporting on postoperative dyspareunia, vaginal pain or discomfort, and sexual function were included. RESULTS: Seventeen papers reported on dyspareunia and vaginal pain or discomfort. Two papers reported a rate of de novo dyspareunia...... of 3.8% and 12.5%, respectively. One study reported a nonsignificant reduction in painful sexual intercourse and the remaining 14 reported no incidents of dyspareunia. Eight papers reported on sexual function. One paper using a nonvalidated questionnaire found impaired sexual function. The papers...

  11. Outpatient laparoscopic cholecystectomy: A new gold standard for cholecystectomy?

    Directory of Open Access Journals (Sweden)

    J. Bueno Lledó

    Full Text Available Objective: to contribute our experience for five years in the implemetation of outpatient laparoscopic cholecystectomy (LC. Patients: between January 1999 and March 2004 we performed 504 outpatient LCs. We applied both exclusion and inclusion criteria, an anesthetic and surgical protocol, and discharge-specific criteria. Postoperative management in "fast track" regime. Postoperative period controlled by protocol, including phone calls after cholecystectomy. Results: the ambulatory percentage in the global series was 88.8%, and mean hospital stay was 6.1 hours. Fifty-one patients required overnight stays (10.1%, most of them for "social" causes. Five patients required admission (between 24 and 48 hours for different causes (conversion to laparotomy, intraoperative neumothorax, and postoperative medical complications. Six patients (1.1% were readmitted, and we observed 11.6% postoperative complications in the global series, with abdominal parietal pain being most frequent. Phone localization by 22.00 p.m. in the same day of surgery was 100% complete for outpatient cases. Postoperative surveillance within the first month after surgery was completed in 93.9%, and within th first year in 86.7% of patients. Conclusions: outpatient LC is safe and feasible, and probably represents a new "gold standard" in the treatment of symptomatic cholelithiasis.

  12. SIMPLIFIED LAPAROSCOPIC CHOLECYSTECTOMY WITH TWO INCISIONS

    Science.gov (United States)

    ABAID, Rafael Antoniazzi; CECCONELLO, Ivan; ZILBERSTEIN, Bruno

    2014-01-01

    Background Laparoscopic cholecystectomy has traditionally been performed with four incisions to insert four trocars, in a simple, efficient and safe way. Aim To describe a simplified technique of laparoscopic cholecystectomy with two incisions, using basic conventional instrumental. Technique In one incision in the umbilicus are applied two trocars and in epigastrium one more. The use of two trocars on the same incision, working in "x" does not hinder the procedure and does not require special instruments. Conclusion Simplified laparoscopic cholecystectomy with two incisions is feasible and easy to perform, allowing to operate with ergonomy and safety, with good cosmetic result. PMID:25004296

  13. Patients' experiences with cholecystitis and a cholecystectomy.

    Science.gov (United States)

    Lindseth, Glenda N; Denny, Dawn L

    2014-01-01

    Nurses commonly care for patients with cholecystitis, a major health problem with a growing prevalence. Although considerable research has been done to compare patient outcomes among surgical approaches for cholecystitis, few studies have examined the experiences of patients with cholecystitis and the subsequent cholecystectomy surgery. A qualitative study with a phenomenological approach was initiated to better understand the experience of hospitalized patients with cholecystitis through their cholecystectomy surgery. Face-to-face semistructured interviews were conducted with patients diagnosed with cholecystitis and scheduled for a cholecystectomy at a rural, Midwestern hospital in the United States. Postoperative interviews were then conducted with the patients who experienced an uneventful cholecystectomy. Giorgi's technique was used to analyze postoperative narratives of the patients' cholecystectomy experiences to determine the themes. Following analysis of interview transcripts from the patients, 5 themes emerged: (a) consumed by discomfort and pain, (b) restless discomfort interrupting sleep, (c) living in uncertainty, (d) impatience to return to normalcy, and (e) feelings of vulnerability. Informants with acute cholecystitis described distressing pain before and after surgery that interfered with sleep and family responsibilities. Increased awareness is needed to prevent the disruption to daily life that can result from the cholecystitis and resulting cholecystectomy surgery. Also, nurses can help ease the unpredictability of the experience by providing relevant patient education, prompt pain relief, and an attentive approach to the nursing care.

  14. Laparoscopic retrograde (fundus first cholecystectomy

    Directory of Open Access Journals (Sweden)

    Kelly Michael D

    2009-12-01

    Full Text Available Abstract Background Retrograde ("fundus first" dissection is frequently used in open cholecystectomy and although feasible in laparoscopic cholecystectomy (LC it has not been widely practiced. LC is most simply carried out using antegrade dissection with a grasper to provide cephalad fundic traction. A series is presented to investigate the place of retrograde dissection in the hands of an experienced laparoscopic surgeon using modern instrumentation. Methods A prospective record of all LCs carried out by an experienced laparoscopic surgeon following his appointment in Bristol in 2004 was examined. Retrograde dissection was resorted to when difficulties were encountered with exposure and/or dissection of Calot's triangle. Results 1041 LCs were carried out including 148 (14% emergency operations and 131 (13% associated bile duct explorations. There were no bile duct injuries although conversion to open operation was required in six patients (0.6%. Retrograde LC was attempted successfully in 11 patients (1.1%. The age ranged from 28 to 80 years (mean 61 and there were 7 males. Indications were; fibrous, contracted gallbladder 7, Mirizzi syndrome 2 and severe kyphosis 2. Operative photographs are included to show the type of case where it was needed and the technique used. Postoperative stay was 1/2 to 5 days (mean 2.2 with no delayed sequelae on followup. Histopathology showed; chronic cholecystitis 7, xanthogranulomatous cholecystitis 3 and acute necrotising cholecystitis 1. Conclusions In this series, retrograde laparoscopic dissection was necessary in 1.1% of LCs and a liver retractor was needed in 9 of the 11 cases. This technique does have a place and should be in the armamentarium of the laparoscopic surgeon.

  15. A COMPARATIVE STUDY BETWEEN OPEN CHOLECYSTECTOMY AND LAPAROSCOPIC CHOLECYSTECTOMY IN RURAL MEDICAL COLLEGE SET UP

    Directory of Open Access Journals (Sweden)

    Sinha

    2014-12-01

    Full Text Available laparoscopic cholecystectomy has established itself as the gold standard for cholecystectomy replacing decades old open cholecystectomy. This study compared open cholecystectomy and lap chole in a medical college in rural setup and consisted of 40 patients with a diagnosis of gall stone disease, that underwent Cholecystectomy at M V J Medical College and Research Hospital from Nov 2011 T0 Oct 2013 to compare the advantages and disadvantages of both the methods. Patients with cholelithiasis proven by USG with at least one attack of upper abdominal pain were included in the study. Patients with CBD stones and aged above 70 yrs were excluded from the study. The main advantages of LC were the reduced post-operative pain with less duration of analgesic intake, more rapid recovery and reduced hospital stay

  16. Single-incision and NOTES cholecystectomy, are there clinical or cosmetic advantages when compared to conventional laparoscopic cholecystectomy? A case-control study comparing single-incision, transvaginal, and conventional laparoscopic technique for cholecystectomy

    NARCIS (Netherlands)

    Boezem, P.B. van den; Velthuis, S.; Lourens, H.J.; Cuesta, M.A.; Sietses, C.

    2014-01-01

    BACKGROUND: The aim of the present study was to compare the clinical and cosmetic results of transvaginal hybrid cholecystectomy (TVC), single-port cholecystectomy (SPC), and conventional laparoscopic cholecystectomy (CLC). Recently, single-incision laparoscopic surgery and natural orifice translumi

  17. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis

    NARCIS (Netherlands)

    Keus, F.; de Jong, J. A. F.; Gooszen, H. G.; van Laarhoven, C. J. H. M.

    2006-01-01

    Background Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Laparoscopic cholecystectomy was introduced in the 1980s. Objectives To compare the beneficial and harmful effects of laparoscopic versus open cholecyste

  18. Cost assessment of instruments for single-incision laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Henriksen, Nadia A; Al-Tayar, Haytham; Rosenberg, Jacob;

    2012-01-01

    Specially designed surgical instruments have been developed for single-incision laparoscopic surgery, but high instrument costs may impede the implementation of these procedures. The aim of this study was to compare the cost of operative implements used for elective cholecystectomy performed...... as conventional laparoscopic 4-port cholecystectomy or as single-incision laparoscopic cholecystectomy....

  19. Application of FTS in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Yan-Ying Zhang

    2016-01-01

    Objective:To explore the application value of FTS in laparoscopic cholecystectomy.Methods:A total of 120 patients who were admitted in our hospital for laparoscopic cholecystectomy from July, 2013 to June, 2015 were included in the study and randomized into the observation group and the control group. The patients in the observation group were given laparoscopic cholecystectomy in the guidance of FTS, while the patients in the control group were performed with conventional laparoscopic cholecystectomy. The situation of the operations, the postoperative recovery, and the postoperative complications in the groups were observed. Results:The white blood cell count and the neutrophils percentage the 1st day and 3rd day after operation in the observation group were significantly lower than those in the control group (P<0.05). The various recovery time after operation in the observation group was significantly shorter than that in the control group (P<0.05). The occurrence rate of the postoperative complications in the observation group was significantly lower than that in the control group (P<0.05).Conclusions: Application of FTS in laparoscopic cholecystectomy can effectively improve the patients’ psychological state, accelerate the postoperative recovery, reduce the occurrence of complications, and enhance the postoperative living qualities; therefore, it deserves to be widely recommended in the clinic.

  20. Pseudoaneur ysm following laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Mansoor Ahmed Madanur; Narendra Battula; Harsheet Sethi; Rahul Deshpande; Nigel Heaton; Mohamed Rela

    2007-01-01

    BACKGROUND: Laparoscopic cholecystectomy (LC) is the operation of choice for removal of the gallbladder. Unrecognized bile duct injuries present with biliary peritonitis and systemic sepsis. Bile has been shown to cause damage to the vascular wall and therefore delay the healing of injured arteries leading to pseudoaneurysm formation. Failure to deal with bile leak and secondary infection may result in pseudoaneurysm formation. This study was to report the incidence and outcomes of pseudoaneurysm in patients with bile leak following LC referred to our hospital. METHODS:A retrospective analysis of our prospectively maintained liver database using key words pseudoaneurysm, bile leak and bile duct injury following laparoscopic cholecystectomy from January 2000 to December 2005 was performed. RESULTS:A total of 86 cases were referred with bile duct injury and bile leak following LC and of these, 4 patients (4.5%) developed hepatic artery pseudoaneurysm (HAP) presenting with haemobilia in 3 and massive intra-abdominal bleed in 1. Selective visceral angiography conifrmed pseudoaneurysm of the right hepatic artery in 2 cases, cystic artery stump in one and an intact but ectatic hepatic artery with surgical clips closely applied to the right hepatic artery at the origin of the cystic artery in the fourth case. Effective hemostasis was achieved in 3 patients with coil embolization and the fourth patient required emergency laparotomy for severe bleeding and hemodynamic instability due to a ruptured right hepatic artery. Of the 3 patients treated with coil embolization, 2 developed late strictures of the common hepatic duct (CHD) requiring hepatico-jejunostomy and one developed a stricture of left hepatic duct. All the 4 patients are alive at a median follow up of 17 months (range 1 to 65) with normal liver function tests. CONCLUSIONS:HAP is a rare and potentially life-threatening complication of LC. Biloma and subsequent infection are reported to be associated with

  1. Pain and convalescence after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Bisgaard, T; Kehlet, H; Rosenberg, J

    2001-01-01

    rather than other pain components. Early pain after cholecystectomy is reduced by minimising residual pneumoperitoneum and by giving incisional local anaesthetics, epidural analgesia, and non-steroidal anti-inflammatory drugs. There are inconclusive data about type and pressure of pneumoperitoneum......, the use of intraperitoneal local anaesthetics, and the type of general anaesthesia. Pain and medico-cultural traditions are the main factors responsible for prolonged convalescence after laparoscopic cholecystectomy. To minimise pain and the duration of convalescence, we recommend multi-modal analgesic...

  2. Laparoscopic cholecystectomy. Leave no (spilled) stone unturned.

    Science.gov (United States)

    Wilton, P B; Andy, O J; Peters, J J; Thomas, C F; Patel, V S; Scott-Conner, C E

    1993-01-01

    Stones are sometimes spilled at the time of cholecystectomy. Retrieval may be difficult, especially during laparoscopic cholecystectomy. Little is known about the natural history of missed stones which are left behind in the peritoneal cavity. We present a case in which a patient developed an intraabdominal abscess around such a stone. The abscess recurred after drainage and removal of the stone was needed for resolution. This case suggests that care should be taken to avoid stone spillage, and that stones which are spilled into the abdomen should be retrieved.

  3. Laparoscopic cholecystectomy in adult cystic fibrosis.

    LENUS (Irish Health Repository)

    McGrath, D S

    2012-02-03

    Two female patients with Cystic Fibrosis, attending the Adult Regional Cystic Fibrosis centre at the Cork University Hospital, were investigated for upper abdominal pain and found to have gallstones at ultrasonography. Laparoscopic cholecystectomy was performed successfully and, without complication, in both patients.

  4. Coagulation and fibrinolysis during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Rahr, H B; Fabrin, K; Larsen, J F;

    1999-01-01

    Laparoscopic surgery appears to be less traumatic to the patient than open surgery, but its influence upon coagulation and fibrinolysis is incompletely elucidated. Our aim was to measure markers of coagulation and fibrinolysis before, during. and after laparoscopic cholecystectomy (LC). Blood...

  5. Spontaneous bilateral adrenal hemorrhage following cholecystectomy.

    Science.gov (United States)

    Dahan, Meryl; Lim, Chetana; Salloum, Chady; Azoulay, Daniel

    2016-06-01

    Postoperative bilateral adrenal hemorrhage is a rare but potentially life-threatening complication. This diagnosis is often missed because the symptoms and laboratory results are usually nonspecific. We report a case of bilateral adrenal hemorrhage associated with acute primary adrenal insufficiency following laparoscopic cholecystectomy. The knowledge of this uncommon complication following any abdominal surgery allows timey diagnosis and rapid treatment.

  6. New minimally invasive approaches for cholecystectomy: Review of literature

    Institute of Scientific and Technical Information of China (English)

    Martin; Gaillard; Hadrien; Tranchart; Panagiotis; Lainas; Ibrahim; Dagher

    2015-01-01

    Laparoscopic cholecystectomy is the most commonlyperformed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy(SILC), minilaparoscopic cholecystectomy(MLC) and natural orifice transluminal endoscopic surgery(NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment.

  7. OUTCOME FOLLOWING OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Anmol

    2014-12-01

    Full Text Available : Laparoscopic cholecystectomy has rapidly become established as the popular alternative to open cholecystectomy, but it should have a safety profile similar to or better than that of open procedure. The aim of this study was to compare conventional cholecystectomy and laparoscopic cholecystectomy with respect to duration of procedure, complications, postoperative pain, analgesic requirement, antibiotic requirement, resumption of normal diet and period of hospital stay.50 patients with symptoms and signs of acute acalculous/calculous cholecystitis, selected randomly, were included in this study. Clinical profile, investigations, treatments, outcomes were analyzed. The highest age incidence was in the 5th decade, more common in females. Pain in the RUQ of abdomen was the most common symptom. Ultrasonography showed gallbladder stones in almost all patients. The duration of LC (120min was more than for OC (90min. The conversion rate of LC to OC was 8%. Post- operative morbidity was more in case of LC. The antibiotic and analgesic requirements were less in LC group. The resumption of normal diet was 2 days earlier in LC compared to OC group, and the hospital stay was 4 days less in LC group. The result showed the incidence of acute calculous/acalculous cholecystitis more in females, 5th decade, presented more commonly with pain abdomen. Ultrasonography was the most common investigation. Laparoscopic cholecystectomy reduces the number of antibiotic and analgesic requirement, hospital days, pain disability, wound infection, and with better cosmesis, except for the prolonged operative time, which can be minimized in due course of time as the learning curve progresses.

  8. Nationwide quality improvement of cholecystectomy: results from a national database

    DEFF Research Database (Denmark)

    Harboe, Kirstine M; Bardram, Linda

    2011-01-01

    To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones....

  9. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function.

    Science.gov (United States)

    Frazee, R C; Roberts, J W; Okeson, G C; Symmonds, R E; Snyder, S K; Hendricks, J C; Smith, R W

    1991-01-01

    Upper abdominal surgery is associated with characteristic changes in pulmonary function which increase the risk of lower lobe atelectasis. Sixteen patients undergoing open cholecystectomy and 20 patients undergoing laparoscopic cholecystectomy were prospectively evaluated by pulmonary function tests (forced vital capacity [FVC], forced expiratory volume [FEV-1], and forced expiratory flow [FEF] 25% to 75%) before operation and on the morning after surgery to determine if the laparoscopic technique lessens the pulmonary risk. Fraction of the baseline pulmonary function was calculated by dividing the postoperative pulmonary function by the preoperative pulmonary function and multiplying by 100%. Postoperative FVC measured 52% of preoperative function for open cholecystectomy and 73% for laparoscopic cholecystectomy (p = 0.002). Postoperative FEV-1 measured 53% of baseline function for open cholecystectomy and 72% for laparoscopic cholecystectomy (p = 0.006). Postoperative FEF 25% to 75% measured 53% for open cholecystectomy and 81% for laparoscopic cholecystectomy (p = 0.07). It is concluded that laparoscopic cholecystectomy offers improved pulmonary function compared to the open technique. PMID:1828139

  10. The study of laparoscopic cholecystectomy and its conversion to open cholecystectomy: analysis of 100 cases in Navi Mumbai, India

    Directory of Open Access Journals (Sweden)

    Nandkishor Narwade

    2015-12-01

    Results: Out of the 100 cases 98 got successfully operated by Laparoscopic cholecystectomy. Only 2 cases out of 100 got converted from Laparoscopic to open cholecystectomy and they belonged to grade E with empyema. Conclusions: Laparoscopic cholecystectomy has become the procedure of choice for management of symptomatic gall bladder. Laparoscopic cholecystectomy intra operatively for grade A to E where Grade A is very easy level of performing Gall bladder surgery to Grade E where conversion is 100% due to bad. [Int J Res Med Sci 2015; 3(12.000: 3586-3590

  11. Laparoscopic cholecystectomy: Rate and predictors for conversion

    Directory of Open Access Journals (Sweden)

    Merdad Adnan

    1999-01-01

    Full Text Available Laparoscopic cholecystectomy (LC was attempted in 847 patients, 823 (97.2% were completed laparoscopically and 24 (2.8% had to be converted to open cholecystectomy (OC. Acute cholecystitis was the commonest reason for conversion (13 out of 24 patients. Patients who had acute cholecystitis are five times at risk for conversion to open than other patients with non-acute cholecystitis (p< 0.00I . Age and sex were not statistically significant predictors for conversion. There were no mortalities and no major bile duct injuries in our series. These data confirms the safety of LC, identify factors which predicts conversion to OC and may be helpful in selecting patients for day care ambulatory LC.

  12. Sepsis from dropped clips at laparoscopic cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Hussain, Sarwat E-mail: sarwathussain@hotmail.com

    2001-12-01

    We report seven patients in whom five dropped surgical clips and two gallstones were visualized in the peritoneal cavity, on radiological studies. In two, subphrenic abscesses and empyemas developed as a result of dropped clips into the peritoneal cavity during or following laparoscopic cholecystectomy. In one of these two, a clip was removed surgically from the site of an abscess. In two other patients dropped gallstones, and in three, dropped clips led to no complications. These were seen incidentally on studies done for other indications. Abdominal abscess secondary to dropped gallstones is a well-recognized complication of laparoscopic cholecystectomy (LC). We conclude that even though dropped surgical clips usually do not cause problems, they should be considered as a risk additional to other well-known causes of post-LC abdominal sepsis.

  13. Effect of laparoscopic cholecystectomy and open cholecystectomy on liver function and immune function in patients

    Institute of Scientific and Technical Information of China (English)

    Sheng-Bing Huang; Shi-Lian Chen

    2016-01-01

    Objective:To investigate the effect of laparoscopic cholecystectomy and open cholecystectomy on liver function and immune function in patients.Methods:The clinical data of 100 cases of cholecystectomy in our hospital from November 2013 to November 2015 were retrospectively analyzed. According to the operation method was divided into OC group (laparoscopic cholecystectomy) and LC group (laparoscopic cholecystectomy), two groups were in general anesthesia, tracheal intubation, 1D, 1D, 5D fasting peripheral venous blood collection, serum total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (GGT), IgA, IgG, IgM, CD4+, CD8+, CD3+, and calculated CD4+/CD8+ ratio AST.Results:preoperative TBIL, ALT, GGT, AST no statistical significance (1D), postoperative indicators were significantly higher than preoperative levels, the index basically recovered to preoperative level, but the two groups were not statistically significant (1D) IgG two groups IgM each index level were lower than preoperative OC group, postoperative 5D indicators have recovered, LC group, CD8+, 1D, CD4+, two groups CD3+, 1D, 5D groups, 1D, 1D groups, OC, 1D two groups, IgA LC, CD4+/CD8+ no statistical significance, postoperative 1D two group CD3+, CD4+, CD4+/CD8+ compared with preoperative 1D decreased, CD8+ increased, there was statistical significance (P<0.05), postoperative 5D index LC There was no statistical significance between the group and the preoperative 1D, but the OC group had statistical significance.Conclusion:LC cholecystectomy is a minimally invasive surgery with little trauma, little impact on the body, fast recovery and so on, which reflects the advantages of minimally invasive surgery, it is worthy of clinical application.

  14. Open Cholecystectomy for Surgical Treatment of Gallstones

    Directory of Open Access Journals (Sweden)

    Jorge Luis Estepa Pérez

    2015-02-01

    Full Text Available Background: cholecystectomy is one of the surgical procedures that are still practiced despite the passing of time. It remains the appropriate method to perform in the absence of advanced technology. Objective: to describe the results of the open cholecystectomy in the treatment of gallstones. Methods: a descriptive study was conducted in patients operated on for gallstones in 2012 in the María G. Guerrero Ramos Comprehensive Diagnostic Center in the Capital District, Bolivarian Republic of Venezuela. The information was obtained from medical records and a data collection model. The variables analyzed were: age, sex, associated diseases, signs and symptoms, results of the surgical treatment, outcome and complications. Results: a total of 147 patients underwent surgery; the 41-60 year age group and female patients predominated; right hypochondrial pain and intolerance to fatty foods and grains were the major signs and symptoms. Cefazolin was the most widely used antibiotic. Patients recovered satisfactorily, complications were minimal. Conclusions: open cholecystectomy remains useful for the treatment of gallstones in the absence of advanced technology.

  15. Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis

    NARCIS (Netherlands)

    Keus, F.; de Jong, J. A. F.; Gooszen, H. G.; van Laarhoven, C. J. H. M.

    2006-01-01

    Background Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Small-incision cholecystectomy is a less frequently used alternative. Laparoscopic cholecystectomy was introduced in the 1980s. Objectives To compare the

  16. Systematic review: open, small-incision or laparoscopic cholecystectomy for symptomatic cholecystolithiasis

    DEFF Research Database (Denmark)

    Keus, F; Gooszen, H G; Van Laarhoven, C J H M

    2009-01-01

    Laparoscopic cholecystectomy has become the method of choice for gallbladder removal, although evidence of superiority over open and small-incision cholecystectomy is lacking.......Laparoscopic cholecystectomy has become the method of choice for gallbladder removal, although evidence of superiority over open and small-incision cholecystectomy is lacking....

  17. Cholecystectomy in Danish children--a nationwide study

    DEFF Research Database (Denmark)

    Langballe, Karen Oline; Bardram, Linda

    2014-01-01

    BACKGROUND: An increase in the frequency of cholecystectomy in children has been described during the last decades. Part of the reason is that more cholecystectomies in children are performed for dyskinesia of the gallbladder and not only for gallstone disease. We conducted the first nationwide s...

  18. Nationwide quality improvement of cholecystectomy: results from a national database

    DEFF Research Database (Denmark)

    Harboe, Kirstine M; Bardram, Linda

    2011-01-01

    To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones.......To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones....

  19. Chylous ascites post open cholecystectomy after severe pancreatitis.

    LENUS (Irish Health Repository)

    Cheung, Cherry X

    2012-05-01

    Chylous ascites a rare complication post cholecystectomy. There are to our knowledge only 3 reported cases in the literature. We describe a case of chylous ascites post open cholecystectomy in a patient with recent severe pancreatitis. We propose a potential relationship between acute biliary pancreatitis and the development of chylous ascites.

  20. Preemptive analgesia with ketamine for laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Harsimran Singh

    2013-01-01

    Full Text Available Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy.

  1. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy

    Science.gov (United States)

    Singh, Harsimran; Kundra, Sandeep; Singh, Rupinder M; Grewal, Anju; Kaul, Tej K; Sood, Dinesh

    2013-01-01

    Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy. PMID:24249984

  2. Laparoscopic cholecystectomy perioperative management: an update

    Directory of Open Access Journals (Sweden)

    Sellbrant I

    2015-07-01

    Full Text Available Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no firm evidence for best anesthetic technique, further high quality studies assessing short as well as more protracted outcomes are needed. Preventive multi-modal analgesia, combining non-opioid analgesics, paracetamol, nonsteroidal anti-inflammatory drugs or coxib, and local anesthesia, has a long history. Local anesthesia improves postoperative pain and facilitates discharge on the day of surgery. Whether transversus abdominis plane-block has clinically important advantages compared to local infiltration analgesia needs further studies. Single intravenous dose steroid, dexamethasone, reduces postoperative nausea and vomiting, pain, and enhances the recovery process. Multi-modal analgesia is reassuringly safe thus having a positive benefit versus risk profile. Adherence to modern guidelines avoiding prolonged fasting and liberal intravenous fluid regime supports rapid recovery. The effects of CO2 insufflation must be acknowledged and low intra-abdominal pressure should be sought in order to reduce negative cardiovascular/respiratory effects. There is no firm evidence supporting heating and humidification of the insufflated gas. The potential risk for CO2/gas entrainment into vasaculture, gas emboli, or subcutaneous/intra-thoracic into the pleural space must be kept in mind. Laparoscopic cholecystectomy in ASA 1-2 patients following a multi-modal enhanced recovery protocol promotes high success rate for discharge on the day of surgery. Keywords: laparoscopic

  3. [Celioscopic cholecystectomy. 2 cases of infectious complications].

    Science.gov (United States)

    Caron, F; Fayeulle, V; Peillon, C; Roullée, N; Koning, E; Bénozio, M; Testart, J; Humbert, G

    1994-06-11

    Despite the low morbidity and mortality of laparoscopic cholecystectomy, trauma and infection have been reported. Such complications can produce a misleading clinical picture, as in two cases we observed. Case 1. A symptomatic 56-year-old female patient underwent laparoscopic cholecystectomy. During the operation, the gall bladder ruptured and the contents had to be aspirated from the abdominal cavity. The patient complained of hepatalgia 2 weeks after the operation, then was not seen again for more than 1 year when fever and hepatalgia did not respond to symptomatic treatment. An inter-hepato-renal collection (6 cm in diameter) was punctured under echography. Aspirate culture yielded Pseudomonas aeruginosa. Adapted antibiotic therapy was unsuccessful and surgery was required to empty the abscess then remove a fibrous conjunctive tissue formation. Case 2. A 55-year-old female patient with a history of complete remission after mammectomy for breast cancer underwent laparoscopic cholecystectomy in 1991. Two days after the operation, fever (39 degrees C) was accompanied by abdominal defence. Biliary peritonitis due to imperfect suture of the bile duct was repaired followed by peritoneal lavage-drainage. Per-operative blood samples revealed type 6 Pseudomonas aeruginosa. Despite adapted parenteral antibiotics, fever persisted at 39 degrees C and intense jaundice was observed. A second laparoscopy 14 days later showed inflammatory narrowing of the main bile duct which was drained into a small bowel loop. Eight days later computed tomography revealed multiple abscess in the liver. Transparietal cholangiography was performed and showed that the contrast medium entered the abscesses via the biliary canals. The state of sepsis persisted, jaundice worsened and hepatic encephalopathy developed with obnubilation and flapping tremor. After 1 month of general antibiotherapy, no improvement was seen on computed tomography images and needle biopsy of an abscess led to the

  4. Predictors of adverse postoperative course of cholecystectomy in mini-incision access and laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    V. N. Klimenko

    2014-04-01

    Full Text Available Background. Shift from laparotomy to laparoscopy qualitatively changed surgery aggressiveness, allowed to reduce the number and severity of postoperative complications. New methods of minimally invasive interventions introduction have generated a number of legitimate questions relating to the desirability, safety, possible range of applications, the effectiveness of interventions. However, no studies in the literature devoted to the development of criteria for predicting the likely complications of surgical data and adverse postoperative course. Aim of the study - to identify the most significant predictors of adverse postoperative course of the laparoscopic cholecystectomy and laparotomy cholecystectomy from the minimum access. Material and methods. Retrospective study included 102 patients with cholelithiasis who routinely were performed cholecystectomy. Cholecystectomy from minimum laparotomy access was performed in 48 (47,1% patients. 54 (52,9% patients underwent laparoscopic cholecystectomy. The groups were comparable by age, sex, height, weight, body mass index. Statistical processing of the material was carried out with software package Statistica 6.0. and MedCalc10.2.0.0. Parametric (t-test for dependent and independent variables, ANOVA ANOVA, paired Pearson correlation and nonparametric (Wald-Wolfowitz runs test, Kolmogorov-Smirnov two-sample test, Mann-Whitney U test, correlation Spearman statistic methods were used. Differences considered statistically significant at a value of p <0,05. Method for constructing operating characteristic curves (ROC-analysis was used for the risk of adverse postoperative course assess. Predictors of adverse postoperative period were measured with Cox proportional hazard model. Independent indicators of adverse postoperative course were built with multivariable Cox proportional hazard model, the variables included reverse stepwise method. Results. Positive prognostic value had the follow: initial ESR 20

  5. Laparoscopic cholecystectomy: A report from a single center

    Institute of Scientific and Technical Information of China (English)

    Konstantinos Vagenas; Stavros N Karamanakos; Charalambos Spyropoulos; Spyros Panagiotopoulos; Menelaos Karanikolas; Michalis Stavropoulos

    2006-01-01

    AIM: To review and evaluate our experience in laparoscopic cholecystectomy.METHODS: A retrospective analysis was performed on data collected during a 13-year period (1992-2005)from 1220 patients who underwent laparoscopic cholecystectomy.RESULTS: Mortality rate was 0%. The overall morbidity rate was 5.08% (n = 62), with the most serious complications arising from injuries to the biliary tree and the cystic artery. In 23 (1.88%) cases, cholecystectomy could not be completed laparoscopically and the operation was converted to an open procedure. Though the patients were scheduled as day-surgery cases, the average duration of hospital stay was 2.29 d, as the complicated cases with prolonged hospital stay were included in the calculation.CONCLUSION: Laparoscopic cholecystectomy is a safe,minimally invasive technique with favorable results for the patient.

  6. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis

    DEFF Research Database (Denmark)

    Gurusamy, Kurinchi Selvan; Davidson, Christopher; Gluud, Christian;

    2013-01-01

    Gallstones are present in about 10% to 15% of the adult western population. Between 1% and 4% of these adults become symptomatic in a year (the majority due to biliary colic but a significant proportion due to acute cholecystitis). Laparoscopic cholecystectomy for acute cholecystitis is mainly...... performed after the acute cholecystitis episode settles because of the fear of higher morbidity and of need for conversion from laparoscopic to open cholecystectomy. However, delaying surgery exposes the people to gallstone-related complications....

  7. Abdominal drainage following cholecystectomy: high, low, or no suction?

    OpenAIRE

    McCormack, T T; Abel, P D; Collins, C. D.

    1983-01-01

    A prospective trial to assess the effect of suction in an abdominal drain following cholecystectomy was carried out. Three types of closed drainage system were compared: a simple tube drain, a low negative pressure drain, and a high negative pressure drain: 120 consecutive patients undergoing cholecystectomy were randomly allocated to one of the three drainage groups. There was no significant difference in postoperative pyrexia, wound infection, chest infection, or hospital stay. This study f...

  8. Health-related quality of life outcomes after cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Amedeo Carraro; Dania EI Mazloum; Florian Bihl

    2011-01-01

    Gallbladder diseases are very common in developed countries. Complicated gallstone disease represents the most frequent of biliary disorders for which surgery is regularly advocated. As regards, cholecystectomy represents a common abdominal surgical intervention; it can be performed as either an elective intervention or emergency surgery, in the case of gangrene, perforation, peritonitis or sepsis. Nowadays, the laparoscopic approach is preferred over open laparotomy. Globally, numerous cholecystectomies are performed daily; however, little evidence exists regarding assessment of post-surgical quality of life (QOL) following these interventions. To assess post-cholecystectomy QOL, in fact, documentation of high quality care has been subject to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years. However, there has been little research published regarding QOL outcomes following cholecystectomy; in addition, much of the current literature lacks systematic data on patient-centered outcomes. Then, although several tools have been used to measure QOL after cholecystectomy, difficulty remains in selecting meaningful parameters in order to obtain reproducible data to reflect postoperative QOL. The aim of this study was to review the impact of surgery for gallbladder diseases on QOL. This review includes Medline searches of current literature on QOL following cholecystectomy. Most studies demonstrated that symptomatic patients profited more from surgery than patients receiving an elective intervention. Thus, the gain in QOL depends on the general conditions before surgery, and patients without symptoms profit less or may even have a reduction in QOL.

  9. Laparoscopic cholecystectomy and the Peter Pan syndrome.

    Science.gov (United States)

    Orlando, G; Bellini, P; Borioni, R; Pace, A

    2000-08-01

    We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy (LC). This condition was due to the rupture of a pseudo-aneurysm of the right hepatic artery in the common bile duct, probably caused by a clip erroneously fired during LC on the lateral right wall of the vessel. It also caused the formation of multiple liver abscesses and the onset of sepsis. This life-threatening complication led to melena, fever, epigastric pain, pancreatitis, liver dysfunction, and severe anemia, requiring urgent hospitalization and operation. In the operating theater, the fistula was closed, the liver abscesses drained, and a Kehr tube inserted. Thereafter, the patient's general condition improved, and she is now well. LC is often considered to be the gold standard for the management of symptomatic cholelithiasis. However, recent data have undermined that opinion. The apparent advantages offered by LC in the short term (less pain, speedier recovery, shorter hospital stay, and lower costs) have been overwhelmed by the complications that occur during long-term follow-up. When the late downward trend in the bile duct and the vascular injury rate are taken into consideration, the learning curve is prolonged. Therefore, LC should be regarded as the surgical equivalent of a modern Peter Pan-i.e., it is like a young adult who should make definitive steps toward becoming an adult but does not succeed in doing so. We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy. Based on the facts in this case, we argue that the endoscopic procedure still needs to be perfected and cannot yet be considered the gold standard for selected cases of gallstone disease.

  10. Ambulatory laparoscopic cholecystectomy: A single center experience

    Directory of Open Access Journals (Sweden)

    Cagri Tiryaki

    2016-01-01

    Full Text Available Aim: To evaluate the demographic and clinical parameters affecting the outcomes of ambulatory laparoscopic cholecystectomy (ALC in terms of pain, nausea, anxiety level, and satisfaction of patients in a tertiary health center. Materials and Methods: ALC was offered to 60 patients who met the inclusion criteria. Follow-up (questioning for postoperative pain or discomfort, nausea or vomiting, overall satisfaction was done by telephone contact on the same day at 22:00 p.m. and the first day after surgery at 8: 00 a.m. and by clinical examination one week after operation. STAI I and II data were used for proceeding to the level of anxiety of patients before and/or after the operation. Results: Sixty consecutive patients, with a mean age of 40.6 ± 8.1 years underwent ALC. Fifty-five (92% patients could be sent to their homes on the same day but five patients could not be sent due to anxiety, pain, or social indications. Nausea was reported in four (6.7% cases and not associated with any demographic or clinical features of patients. On the other hand, pain has been reported in 28 (46.7% cases, and obesity and shorter duration of gallbladder disease were associated with the increased pain perception (P = 0.009 and 0.004, respectively. Preopereative anxiety level was significantly higher among patients who could not complete the ALC procedure (P = 0.018. Conclusion: Correct management of these possible adverse effects results in the increased satisfaction of patients and may encourage this more cost-effective and safe method of laparoscopic cholecystectomy.

  11. Hybrid transvaginal cholecystectomy, clinical results and patient-reported outcomes of 50 consecutive cases

    NARCIS (Netherlands)

    Boezem, P.B. van den; Velthuis, S.; Lourens, H.J.; Samlal, R.A.; Cuesta, M.A.; Sietses, C.

    2013-01-01

    OBJECTIVE: The aim of this study was to report the clinical and cosmetic results of transvaginal hybrid cholecystectomy (TVC). BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) has been developed as a minimal invasive alternative for conventional laparoscopic cholecystectomy. Altho

  12. Effect of preoperative education on recovery time of laparoscopic cholecystectomy: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Leila Sadati

    2014-07-01

    Conclusion: Preoperative education of patients can significantly decrease the recovery time after laparoscopic cholecystectomy surgery. Therefore, it is strongly recommended to include the preoperative education in routine care of laparoscopic cholecystectomy patients for better surgical outcomes.

  13. Laparoscopic vs. small incision cholecystectomy : Implications for pulmonary function and pain. A randomized clinical trial

    NARCIS (Netherlands)

    Keus, F.; Ali, U. Ahmed; Noordergraaf, G. J.; Roukema, J. A.; Gooszen, H. G.; Van Laarhoven, C. J. H. M.

    2008-01-01

    Background: Upper abdominal surgery, including laparoscopic cholecystectomy (LC), is associated with post-operative pulmonary dysfunction. LC has, by consensus, become the treatment of choice for symptomatic cholecystolithiasis. The small-incision cholecystectomy (SIC), a procedure which does not re

  14. The quality of cholecystectomy in Denmark has improved over 6-year period

    DEFF Research Database (Denmark)

    Rothman, Josephine Philip; Burcharth, Jakob; Pommergaard, Hans-Christian;

    2015-01-01

    PURPOSE: The Danish Cholecystectomy Database (DCD) was a nationwide quality database that existed from 2006 to 2011. The main goal (indicators) for the database was to increase the quality of cholecystectomy in Denmark by (1) reducing the number of primary open cholecystectomies, (2) increasing t...

  15. Systematic review: open, small-incision or laparoscopic cholecystectomy for symptomatic cholecystolithiasis.

    NARCIS (Netherlands)

    Keus, F.; Gooszen, H.G.; Laarhoven, C.J.H.M. van

    2009-01-01

    BACKGROUND: Laparoscopic cholecystectomy has become the method of choice for gallbladder removal, although evidence of superiority over open and small-incision cholecystectomy is lacking. AIM: To compare the effects of open, small-incision and laparoscopic cholecystectomy techniques for patients wit

  16. Systematic review : open, small-incision or laparoscopic cholecystectomy for symptomatic cholecystolithiasis

    NARCIS (Netherlands)

    Keus, F.; Gooszen, H. G.; Van Laarhoven, C. J. H. M.

    2009-01-01

    Laparoscopic cholecystectomy has become the method of choice for gallbladder removal, although evidence of superiority over open and small-incision cholecystectomy is lacking. To compare the effects of open, small-incision and laparoscopic cholecystectomy techniques for patients with symptomatic cho

  17. Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Feza Y Karakayali; Aydincan Akdur; Mahir Kirnap; Ali Harman; Yahya Ekici and Gökhan Moray

    2014-01-01

    BACKGROUND: In low-risk patients with acute cholecystitis who  did  not  respond  to  nonoperative  treatment,  we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy. METHODS: In 91 patients (American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis ≥72 hours at hospital admission and who did not respond to nonoperative treatment (48 hours), 48 patients were treated with emergency laparoscopic  cholecystectomy  and  43  patients  were  treated with delayed cholecystectomy at ≥4 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average (range 7-29). RESULT: Compared  with  the  patients  who  had  emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy  had  a  lower  frequency  of  conversion  to open surgery [19 (40%) vs 8 (19%); P=0.029], a frequency of intraoperative bleeding ≥100 mL [16 (33%) vs 4 (9%); P=0.006], a mean postoperative hospital stay (5.3±3.3 vs 3.0±2.4 days; P=0.001), and a frequency of complications [17 (35%) vs 4 (9%); P=0.003]. CONCLUSION: In  patients  with  acute  cholecystitis  who presented to the hospital ≥72 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic chole-cystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.

  18. Single-port laparoscopic cholecystectomy vs standard laparoscopic cholecystectomy:A non-randomized,agematched single center trial

    Institute of Scientific and Technical Information of China (English)

    Yoen; TK; van; der; Linden; Koop; Bosscha; Hubert; A; Prins; Daniel; J; Lips

    2015-01-01

    AIM: To compare the safety of single-port laparoscopic cholecystectomies with standard four-port cholecystectomies.METHODS: Between January 2011 and December 2012 datas were gathered from 100 consecutive patients who received a single-port cholecystectomy. Patient baseline characteristics of all 100 single-port cholecystectomies were collected(body mass index, age, etc.) in a database. This group was compared with 100 age-matched patients who underwent a conventional laparoscopic cholecystectomy in the same period. Retrospectively, per- and postoperative data were added. The two groups were compared to each other using independent t-tests and χ2-tests, P values below 0.05 were considered significantly different.RESULTS: No differences were found between both groups regarding baseline characteristics. Operating time was significantly shorter in the total single-port group(42 min vs 62 min, P < 0.05); in procedures performed by surgeons the same trend was seen(45 min vs 59 min, P < 0.05). Peroperative complications between both groups were equal(3 in the single-port group vs 5 in the multiport group; P = 0.42). Although not significant less postoperative complications were seen in the single-port group compared with the multiport group(3 vs 9; P = 0.07). No statistically significant differences were found between both groupswith regard to length of hospital stay, readmissions and mortality. CONCLUSION: Single-port laparoscopic cholecystectomy has the potential to be a safe technique with a low complication rate, short in-hospital stay and comparable operating time. Single-port cholecystectomy provides the patient an almost non-visible scar while preserving optimal quality of surgery. Further prospective studies are needed to prove the safety of the single-port technique.

  19. Biliary leaks after laparoscopic cholecystectomy:timetostentortimetodrain

    Institute of Scientific and Technical Information of China (English)

    Haim Pinkas; Patrick G. Brady

    2008-01-01

    BACKGROUND: Endoscopic retrograde cholangiopan-creatography (ERCP) with placement of a biliary stent or nasobiliary (NB) drain is the procedure of choice for treatment of post-cholecystectomy bile duct leaks. The aim of this study was to compare the effect of NB drainage versus internal biliary stenting on rates of leak closure, time elapsed until drain or stent removal, length of hospital stay and number of required endoscopic procedures. METHODS: Charts were reviewed on 20 patients who underwent laparoscopic cholecystectomy complicated by Luschka or cystic duct leak. Ten patients were treated with NB drains connected to low intermittent suction and repeat NB cholangiograms were performed until leak closure was observed. Ten patients were treated with internal biliary stents. Biliary sphincterotomies were performed for stone extraction or a presumed papillary stenosis. Large bilomas were drained percutaneously prior to stenting. RESULTS: In all 20 patients, a cholangiogram and successful placement of a NB drain or internal stent was achieved. Four patients (20%) were found to have bile duct stones, which were extracted following a sphincterotomy. Sixteen patients required percutaneous drains to evacuate large bilomas prior to biliary instrumentation. Fifteen cystic duct leaks and 5 Luschka duct leaks were reviewed. There were no complications related to ERCP. Closure of the leak was documented within 2 to 11 days (mean 4.7±0.9 days) in patients receiving a NB drain. The drains were removed non-endoscopically following leak closure. The internal stent group required stenting for 14 to 53 days (mean 29.1±4.4 days). The stent was then removed endoscopically after documentation of leak closure. Bile leaks following laparoscopic cholecystectomy closed rapidly after NB drainage and did not require repeat endoscopy for removal of the NB drain, resulting in fewer ERCPs required for treatment of biliary leaks. Internal biliary stents were in place longer owing

  20. Residual gallbladder stones after cholecystectomy: A literature review

    Science.gov (United States)

    Chowbey, Pradeep; Sharma, Anil; Goswami, Amit; Afaque, Yusuf; Najma, Khoobsurat; Baijal, Manish; Soni, Vandana; Khullar, Rajesh

    2015-01-01

    BACKGROUND: Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. MATERIALS AND METHODS: Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up. RESULTS: Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct. CONCLUSION: Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic) is the most common treatment modality reported in the literature for the management of residual gallbladder stones. PMID:26622110

  1. Residual gallbladder stones after cholecystectomy: A literature review

    Directory of Open Access Journals (Sweden)

    Pradeep Chowbey

    2015-01-01

    Full Text Available Background: Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. Materials And Methods: Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up. Results: Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct. Conclusion: Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic is the most common treatment modality reported in the literature for the management of residual gallbladder

  2. Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis

    Directory of Open Access Journals (Sweden)

    Miguel Sánchez-Carrasco

    2016-01-01

    Full Text Available Objective. To evaluate if early cholecystectomy (EC is the most appropriate treatment for acute cholecystitis compared to delayed cholecystectomy (DC. Patients and Methods. A retrospective cohort study of 1043 patients was carried out, with a group of 531 EC cases and a group of 512 DC patients. The following parameters were recorded: (1 postoperative hospital morbidity, (2 hospital mortality, (3 days of hospital stay, (4 readmissions, (5 admission to the Intensive Care Unit (ICU, (6 type of surgery, (7 operating time, and (8 reoperations. In addition, we estimated the direct cost savings of implementing an EC program. Results. The overall morbidity of the EC group (29.9% was significantly lower than the DC group (38.7%. EC demonstrated significantly better results than DC in days of hospital stay (8.9 versus 15.8 days, readmission percentage (6.8% versus 21.9%, and percentage of ICU admission (2.3% versus 7.8%, which can result in reducing the direct costs. The patients who benefited most from an EC were those with a Charlson index > 3. Conclusions. EC is safe in patients with acute cholecystitis and could lead to a reduction in the direct costs of treatment.

  3. Laparoscopic Cholecystectomy: An Experience of 200 cases

    Directory of Open Access Journals (Sweden)

    Sanjay K. Bhasin, J.G. Langer.

    2004-04-01

    Full Text Available The surgical management of gallstones has been revolutionized after the advent of laparoscopiccholecystectomysince 1985/87. This minimally invasive technique has virtually become the goldstandard in the management of cholelithiasis. We share our experience of 200 cases of laparoscopiccholecystectomyperformed in symptomatic cholelithiasis over a period of five years from 1998 to2002 in Govt. Medical College, Jammu. There were 32 males and 168 females in the study group.Maximum age of the patients was 65-yr and minimum 17-yr. Patients with high-risk medical problems;deranged LFT, CBD stones and acute cholecystitis were excluded from this study. Average operationtime was 61.3 minute (40-130 mt, post-operative analgesic used were 3.02 doses per patient (2-15doses, post-operative hospital stay was 4.34 days (2-26 days and time to return to work was 13.2days (10-40 days. Rate of conversion to conventional-cholecystectomy was 4%. There was nomortality and negligible/acceptable morbidity. No complications were observed in the follow up periodranging from 2 weeks to 6 months. The patients were quite satisfied with the outcome of the procedure.

  4. [Laparoscopic cholecystectomy in elderly and old patients].

    Science.gov (United States)

    Galashev, V I; Zotikov, S D; Gliantsev, S P

    2001-01-01

    The results of cholecystectomy from mini-approach (CEMA) in 111 elderly and old patients with acute and chronic cholecystitis living in European North of Russia were analyzed, and also 84 patients were operated by traditional approach (TCE). Duration of CEMA was less than TCE (75 +/- 3.2 and 95.2 +/- 4.6 min respectively; p CEMA were removed on day 8.4 +/- 1.2 (after TCE--on day 13.8 +/- 2.4, p CEMA was 11.4 +/- 2.1 days vs. 18.8 +/- 3.5 days after TCE (p CEMA were seen in 1.8% patients, after TCE--in 5.0%. Lethality was 0.9% after CEMA and 3.5% after TCE. The main advantages of CEMA are: reduction of surgery time, early activation of patients, decrease of postoperative complications number and reduction of postoperative treatment time (11.4 +/- 2.1 days after CEMA and 18.8 +/- 3.5 days after TCE, p < 0.05).

  5. Laparoscopic cholecystectomy in situs inversus totalis: a case report

    Directory of Open Access Journals (Sweden)

    Blake Geoffrey

    2005-03-01

    Full Text Available Abstract Background Laparoscopic cholecystectomy is one of the commonest surgical procedures carried out in the world today. Occasionally patients present with undiagnosed situs inversus and acute cholecystitis. We discuss one such case and outline how the diagnosis was made and the pitfalls encountered during surgery and how they were overcome. Case presentation A 32 year old female presented to our department with epigastric pain radiating through to the back. A diagnosis of acute cholecystitis in a patient with situs inversus totalis was made following clinical examination and radiological investigation. Laparoscopic cholecystectomy was subsequently performed and the patient made an uneventful recovery. Conclusion Situs inversus presenting with acute cholecystitis is very rare. The surgeon must appreciate that care should be taken to set up the operating theatre in the mirror image of the normal set-up for cholecystectomy, and that right handed surgeons must modify their technique to adapt to the mirror image anatomy.

  6. Pain and dyspepsia after elective and acute cholecystectomy

    DEFF Research Database (Denmark)

    Middelfart, H V; Kristensen, J U; Laursen, C N;

    1998-01-01

    and dyspepsia 5-10 years after cholecystectomy in 345 (222 women, 123 men) patients cholecystectomized for acute cholecystitis and in a control group of 296 (213 women, 83 men) patients cholecystectomized for uncomplicated symptomatic gallbladder stones. RESULTS: Of 641 questionnaires, 534 (83%) were completed....... Complaints of abdominal pain and dyspepsia were found with similar frequencies in the acute cholecystitis and gallstone groups. Women had abdominal pain more often than men (42% versus 29%) (P = 0.01). Although more than one-third complained of abdominal pain after cholecystectomy, 93% had improved or were...... cured. CONCLUSION: The outcome after cholecystectomy seems to be independent of the underlying gallbladder disease (acute cholecystitis or elective operations for gallstones)....

  7. Laparoscopic cholecystectomy in a patient with situs inversus totalis

    Institute of Scientific and Technical Information of China (English)

    Unal Aydin; Omer Unalp; Pinar Yazici; Baris Gurcu; Murat Sozbilen; Ahmet Coker

    2006-01-01

    Currently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon? We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone.Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies.Laparoscopic cholecystectomy was safely performed,despite of difficulties of situs inversus. The patient was discharged on postoperative day 1.It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery.

  8. Fluorescence versus X-ray cholangiography during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Lehrskov, Lars Lang; Larsen, Søren S; Kristensen, Billy B;

    2016-01-01

    INTRODUCTION: Intraoperative fluorescent cholangiography is a novel non-invasive imaging technique to visualise the extrahepatic biliary tract during laparoscopic cholecystectomy. It has been proven feasible, fast and cost effective. Never-theless, there is only sparse data on the capacity......-ray cholangiography. This may lead to the introduction of online imaging of the extrahepatic tract during dissection of the gallbladder during cholecystectomy. FUNDING: none. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov (No. NCT02344654), with the National Committee on Health Research Ethics...

  9. Pain and dyspepsia after elective and acute cholecystectomy

    DEFF Research Database (Denmark)

    Middelfart, H V; Kristensen, J U; Laursen, C N;

    1998-01-01

    BACKGROUND: Postcholecystectomy pain occurs in 20-30%. The main cause of this pain remains unclear. Whether the underlying gallbladder disease influences the outcome after cholecystectomy is not fully established. METHODS: A multicenter questionnaire study comparing the occurrence of abdominal pain....... Complaints of abdominal pain and dyspepsia were found with similar frequencies in the acute cholecystitis and gallstone groups. Women had abdominal pain more often than men (42% versus 29%) (P = 0.01). Although more than one-third complained of abdominal pain after cholecystectomy, 93% had improved or were...

  10. Endoscopic management of biliary leaks after laparoscopic cholecystectomy.

    Science.gov (United States)

    Rustagi, Tarun; Aslanian, Harry R

    2014-09-01

    Laparoscopic cholecystectomy has become the procedure of choice for management of symptomatic cholelithiasis. Although it has distinct advantages over open cholecystectomy, bile leak is more common. Endoscopic retrograde cholangiopancreatography is the diagnostic and therapeutic modality of choice for management of postcholecystectomy bile leaks and has a high success rate with the placement of plastic biliary stents. Repeat endoscopic retrograde cholangiopancreatography with placement of multiple plastic stents, a covered metal stent, or possibly cyanoacrylate therapy may be effective in refractory cases. This review will discuss the indications, efficacy, and complications of endoscopic therapy.

  11. EXPERIMENTAL STUDY OF CHEMICAL CHOLECYSTECTOMY: OBSERVATION OF PATHOLOGICAL CHANGES

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: TO verify through animal experiment the validity of chemical cholecystectomy . Methods: The experimental objects seven healthy juvenile pigs,hardener was infused into the gallbladder,after infusion the samples were collected by pathoiogical examination , according to the different duration under anesthestize. Reslts:The mucous destructive and digestive process remained with one week, the inflammatory reacton in two weeks,the chronic inflatoy reaction compained a a great deal of granu lation tissue and scar formation occurred in 4th-8th week,10 weeks latter,the inflmmatory reaction reduced ,and scar tissue formed. Conclusion: Chemical cholecystectomy is safe and reliable in clinical.

  12. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones

    DEFF Research Database (Denmark)

    Borly, L; Anderson, I B; Bardram, L

    1999-01-01

    patients completed all questionnaires. Twenty-one patients continued to have abdominal pain after the operation. Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score, 'irritating' abdominal pain, and an introverted personality...

  13. Assessment of Requirement of Routine Intraoperative Cholaniography at Cholecystectomy

    Directory of Open Access Journals (Sweden)

    M Shiryazdi

    2013-12-01

    Conclusion: According to above statistically significant relation, we recommend that in patients who are candidate for cholecystectomy, if elevated preoperative serum alkaline phosphatase or elevated preoperative serum bilirubin or abnormal ultrasound findings were observed, more diagnostic evaluation should be done for them including MRC and ERC.

  14. Can sonographic signs predict conversion of laparoscopic to open cholecystectomy?

    NARCIS (Netherlands)

    van der Velden, JJ; Berger, MY; Bonjer, HJ; Brakel, K; Lameris, JS

    1998-01-01

    Background: The aim of this study was to determine whether sonographic signs can predict the risk for conversion of laparoscopic (LC) to open cholecystectomy (OC). Methods: All 346 patients who underwent LC at our institution between January 1, 1993, and March 1, 1996, were studied retrospectively.

  15. The outcome of laparoscopic cholecystectomy by ultrasonic dissection.

    LENUS (Irish Health Repository)

    Sasi, Walid

    2010-04-01

    Electrocautery remains the main energy form used for dissection in laparoscopic cholecystectomy. However, due to its many risks the search continues for safer and more efficient forms of energy. This chapter assesses the outcomes of dissection using ultrasonic energy as compared to monopolar electrocautery during laparoscopic cholecystectomy. Studies included are trials of prospectively randomized adult patients with symptomatic gallstone disease subject either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Seven trials were included in this review, with a total patient number of 695 randomized to two dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. Ultrasonic dissection is shown to be superior to monopolar electrocautery in laparoscopic cholecystectomy. Disadvantages include a difficult maneuvering technique and overall cost. Appropriate training programs may be implemented to overcome the first disadvantage, and it might be argued that given the combined cost of factors associated with standard clip and cautery technique, cost issues may be outweighed by the benefits of ultrasonic dissection. However, this necessitates further cost-benefit analysis.

  16. Validation of data and indicators in the Danish Cholecystectomy Database

    DEFF Research Database (Denmark)

    Harboe, Kirstine Moll; Anthonsen, Kristian; Bardram, Linda

    2009-01-01

      OBJECTIVES: In The Danish Cholecystectomy Database quality indicators are derived from clinical data in combination with administrative data from the National Patient Registry. The indicators "Length of postoperative stay £ 1 day and no readmission", "Length of stay > 3 days and/or readmission...

  17. Laparoscopic cholecystectomy causes less sleep disturbance than open abdominal surgery

    DEFF Research Database (Denmark)

    Gögenur, I; Rosenberg-Adamsen, S; Kiil, C;

    2001-01-01

    BACKGROUND: The aim of this study was to examine subjective sleep quality before and after laparoscopic vs open abdominal surgery. METHODS: Twelve patients undergoing laparoscopic cholecystectomy and 15 patients undergoing laparotomy were evaluated with the aid of a sleep questionnaire from 4 day...

  18. Video. Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy.

    Science.gov (United States)

    Bessler, Marc; Gumbs, Andrew A; Milone, Luca; Evanko, John C; Stevens, Peter; Fowler, Dennis

    2010-09-01

    Enthusiasm for natural orifice transluminal endoscopic surgery (NOTES) has been partly tempered by the reality that most NOTES procedures to date have been laparoscopically assisted. After safely performing transvaginal cholecystectomy in an IACUC-approved porcine model, the authors embarked on an institution review board (IRB)-approved protocol for ultimate performance of pure NOTES cholecystectomy in humans. They describe their experience performing a true NOTES transvaginal cholecystectomy after safely accomplishing three laparoscopically assisted or hybrid procedures in humans. One of the patients was a 35-year-old woman presenting with symptoms of biliary colic. Ultrasound confirmed gallstones, and her liver enzymes were normal. Pneumoperitoneum to 15 mmHg was obtained via a transvaginal trocar placed through a colpotomy made under direct vision. A double-channel endoscope then was advanced into the abdomen. To overcome the retracting limitations of currently available endoscopes, the authors used an extra-long 5-mm articulating retractor placed into the abdomen via a separate colpotomy made under direct vision using the flexible endoscope in a retroflexed position. Endoscopically placed clips were used for control of both the cystic duct and the artery. These techniques obviated the need for any transabdominally placed instruments or needles. This patient was the first to undergo a completely NOTES cholecystectomy at the authors' institution, and to their knowledge, in the United States. She was discharged on the day of surgery and at this writing has not experienced any complication after 1 month of follow-up evaluation. Performance of NOTES transvaginal cholecystectomy without aid of laparoscopic or needleoscopic instruments is feasible and safe for humans. Additional experience with this technique are required before studies comparing it with standard laparoscopy and hybrid techniques are appropriate.

  19. Helicobacter pylori in Cholecystectomy Specimens-Morphological and Immunohistochemical Assessment

    Science.gov (United States)

    Reddy, Venkatarami; Jena, Amitabh; Gavini, Siva; Thota, Asha; Nandyala, Rukamangadha; Chowhan, Amit Kumar

    2016-01-01

    Introduction Helicobacter pylori (H.pylori) is associated with gastritis, peptic ulcer, gastric carcinoma and gastric lymphoma. Current literature describes presence of H.pylori in various extra-gastric locations and its association with many diseases. Apart from the conventional location of gastric and duodenal mucosa, H.pylori have been isolated and cultured from gallbladder. Aim Analysis of cholecystectomy specimens to detect H.pylori by means of immunohistochemical staining. Materials and Methods There were a total of 118 cholecystectomy specimens received in the Department of Pathology in three months duration. We have performed immunostaining for H.pylori in 45 consecutive cases of cholecystectomy specimen. Clinical and other investigational information were retrieved from the medical records department. For each case, routine Haematoxylin and Eosin stain was studied. Immunohistochemistry (IHC) was done using purified polyclonal Helicobacter pylori antiserum. Results Majority of the patients had undergone laparoscopic cholecystectomy for the presenting complaint of right hypochondrial pain. Multiple pigmented stones were present in majority (27/45) of them. Immunostain for H.pylori was positive in ten cases. Six of these cases had pigmented gall stones, two had stones not specified and in two of the cases there were no stones. Conclusion Helicobacter pylori is present in gall bladder and is commonly seen in association with stones. A more detailed study of cholecystectomy cases (both neoplastic and non-neoplastic) with serological, culture and molecular data of H.pylori is desirable to study the pathogenesis of cholecystitis, its association with gall stones and other gall bladder disorders. PMID:27437221

  20. Laparoscopic cholecystectomy under spinal anaesthesia: A prospective, randomised study

    Directory of Open Access Journals (Sweden)

    Sangeeta Tiwari

    2013-01-01

    Full Text Available Context: Spinal anaesthesia has been reported as an alternative to general anaesthesia for performing laparoscopic cholecystectomy (LC. Aims: Study aimed to evaluate efficacy, safety and cost benefit of conducting laparoscopic cholecystectomy under spinal anaesthesia (SA in comparison to general anaesthesia(GA Settings and Design: A prospective, randomised study conducted over a two year period at an urban, non teaching hospital. Materials and Methods: Patients meeting inclusion criteria e randomised into two groups .Group A and Group B received general and spinal anaesthesia by standardised techniques. Both groups underwent standard four port laparoscopic cholecystectomy. Mean anaesthesia time, pneumoperitoneum time and surgery time defined primary outcome measures. Intraoperative events and post operative pain score were secondary outcome measure. Statistical Analysis Used: The Student t test, Pearson′s chi-square test and Fisher exact test. Results: Out of 235 cases enrolled in the study, 114 cases in Group A and 110 in Group B analysed. Mean anaesthesia time appeared to be more in the GA group (49.45 vs. 40.64, P = 0.02 while pneumoperitoneum time and corresponding the total surgery time was slightly longer in the SA group. 27/117 cases who received SA experienced intraoperative events, four significant enough to convert to GA. No postoperative complications noted in either group. Pain relief significantly more in SA group in immediate post operative period (06 and 12 hours but same as GA group at time of discharge (24 hours. No late postoperative complication or readmission noted in either group. Conclusion: Laparoscopic cholecystectomy done under spinal anaesthesia as a routine anaesthesia of choice is feasible and safe. Spinal anaesthesia can be recommended to be the anaesthesia technique of choice for conducting laparoscopic cholecystectomy in hospital setups in developing countries where cost factor is a major factor.

  1. Cholecystectomy under segmental thoracic epidural block in a patient with twin gestation

    Directory of Open Access Journals (Sweden)

    R Barani Selvan

    2012-01-01

    Full Text Available Cholecystectomy represents the second most common surgery during pregnancy. Both general and regional anesthetic techniques have been successfully used for cholecystectomy in pregnant patients. Authors present here a case of a pregnant patient carrying twin gestation who underwent cholecystectomy, which is not frequently encountered by the anesthesiologists. This report enumerates the perioperative issues relating to anesthesia given to a pregnant patient in addition to emphasizing the importance of multidisciplinary approach when such a case is encountered.

  2. The effect of oral tizanidine on postoperative pain relief after elective laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Reihanak Talakoub

    2016-01-01

    Conclusion: Oral administration of 4 mg tizanidine before laparoscopic cholecystectomy reduces postoperative pain, opioid consumption, and consequence of the duration of stay in recovery room without any complication.

  3. Changes in T-Lymphocytes' Viability After Laparoscopic Versus Open Cholecystectomy

    Science.gov (United States)

    Gomatos, Ilias P.; Alevizos, Leonidas; Kalathaki, Olga; Kantsos, Harilaos; Kataki, Agapi; Leandros, Emmanuel; Zografos, George; Konstantoulakis, Manousos

    2015-01-01

    Laparoscopic surgery results in decreased immune and metabolic stress response compared to open surgery. Our aim was to evaluate the suspension of host immune defense in terms of apoptosis, necrosis, and survival of peripheral T-lymphocytes in patients undergoing laparoscopic versus open cholecystectomy. Apoptosis, necrosis and viability of peripheral T-lymphocytes were measured preoperatively and postoperatively by means of flow cytometry in 27 patients undergoing laparoscopic cholecystectomy and 25 undergoing open cholecystectomy. White cell count, CRP, and serum glucose levels were also measured. Viable peripheral T-lymphocytes were significantly decreased in open cholecystectomy (P = 0.02), while their late apoptotic as well as the overall necrotic rate were significantly increased (P = 0.01 and P < 0.01, respectively). Open cholecystectomy was also associated with lower levels of surviving circulating T-lymphocytes (P = 0.01) and higher percentage of necrotic T lymphocytes (P = 0.03) 24 hours postoperatively compared to laparoscopic cholecystectomy. Serum CRP was increased 24 hours after open cholecystectomy (P = 0.04). All differences failed to sustain more than 48 hours postoperatively. Increased viability and decreased necrosis of circulating T-lymphocytes were observed in laparoscopic cholecystectomy. Necrosis (and not apoptosis) seems to be the predominant pathway of T-lymphocyte death in open cholecystectomy, in a process reaching its peak at 24 hours and further attenuating 48 hours postoperatively. PMID:25875553

  4. Randomized study of coagulation and fibrinolysis during and after gasless and conventional laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Larsen, J F; Ejstrud, P; Svendsen, F;

    2001-01-01

    BACKGROUND: Carbon dioxide pneumoperitoneum may be an important pathophysiological factor stimulating the coagulation system during conventional laparoscopic cholecystectomy. The aim of this study was to test the hypothesis that gasless laparoscopy produces smaller changes in the coagulation...... and fibrinolytic system than carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. METHODS: Fifty patients were allocated randomly to conventional (n = 26) or gasless (n = 24) laparoscopic cholecystectomy. Blood samples were obtained on admission, after induction of anaesthesia...... increased significantly in both groups (P coagulation and fibrinolysis associated with laparoscopic cholecystectomy. The coagulation and fibrinolytic systems are activated during and after gasless as well...

  5. Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Bouwense, S.A.W.; Besselink, M.G.; Brunschot, S. van; Bakker, O.J.; Santvoort, H.C. van; Schepers, N.J.; Boermeester, M.A.; Bollen, T.L.; Bosscha, K.; Brink, M.A.; Bruno, M.J.; Consten, E.C.; Dejong, C.H.; Duijvendijk, P. van; Eijck, C.H. van; Gerritsen, J.J.; Goor, H. van; Heisterkamp, J.; Hingh, I.H.J.T. de; Kruyt, P.M.; Molenaar, I.Q.; Nieuwenhuijs, V.B.; Rosman, C.; Schaapherder, A.F.; Scheepers, J.J.; Spanier, M.B.; Timmer, R.; Weusten, B.L.; Witteman, B.J.; Ramshorst, B. van; Gooszen, H.G.; Boerma, D.; for the Dutch Pancreatitis Study, G.; Verbeek, A.L.

    2012-01-01

    ABSTRACT: BACKGROUND: After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. Dur

  6. Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial) : Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Bouwense, Stefan A.; Besselink, Marc G.; van Brunschot, Sandra; Bakker, Olaf J.; van Santvoort, Hjalmar C.; Schepers, Nicolien J.; Boermeester, Marja A.; Bollen, Thomas L.; Bosscha, Koop; Brink, Menno A.; Bruno, Marco J.; Consten, Esther C.; Dejong, Cornelis H.; van Duijvendijk, Peter; van Eijck, Casper H.; Gerritsen, Jos J.; van Goor, Harry; Heisterkamp, Joos; de Hingh, Ignace H.; Kruyt, Philip M.; Molenaar, I. Quintus; Nieuwenhuijs, Vincent B.; Rosman, Camiel; Schaapherder, Alexander F.; Scheepers, Joris J.; Spanier, Marcel B. W.; Timmer, Robin; Weusten, Bas L.; Witteman, Ben J.; van Ramshorst, Bert; Gooszen, Hein G.; Boerma, Djamila

    2012-01-01

    Background: After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. During this w

  7. Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    S.A.W. Bouwense (Stefan); M.G. Besselink (Marc); S. van Brunschot (Sandra); O.J. Bakker (Olaf ); H.C. van Santvoort (Hjalmar); N.J. Schepers (Nicolien); M.A. Boermeester (Marja); T.L. Bollen (Thomas); K. Bosscha (Koop); M.A. Brink (Menno); M.J. Bruno (Marco); E.C. Consten (Esther); C.H. Dejong (Cees); P. van Duijvendijk (Peter); C.H.J. van Eijck (Casper); J.J. Gerritsen (Jos); H. van Goor (Harry); J. Heisterkamp (Joos); I.H.J.T. de Hingh (Ignace); Ph.M. Kruyt (Philip); I.Q. Molenaar (I.Quintus); V.B. Nieuwenhuijs (Vincent); C. Rosman (Camiel); A.F.M. Schaapherder (Alexander); J.J. Scheepers (Joris); B.W.M. Spanier (Marcel); R. Timmer (Robin); B.L. Weusten (Bas); B.J.M. Witteman (Ben); B. van Ramshorst (Bert); H.G. Gooszen (Hein); D. Boerma (Djamila)

    2012-01-01

    textabstractBackground: After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. D

  8. Anaesthesiological considerations in small-incision and laparoscopic cholecystectomy in symptomatic cholecystolithiasis : implications for pulmonary function. A randomized clinical trial

    NARCIS (Netherlands)

    Keus, F.; Ali, U. Ahmed; Noordergraaf, G. J.; Roukema, J. A.; Gooszen, H. G.; van Laarhoven, C. J. H. M.

    2007-01-01

    Background: Upper abdominal surgery, including laparoscopic cholecystectomy (LC), is associated with post-operative pulmonary dysfunction. LC has, by consensus, become the treatment of choice for symptomatic cholecystolithiasis. Small-incision cholecystectomy (SIC), a procedure that does not require

  9. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Bjerrum, Flemming; Gögenür, Ismayil

    2013-01-01

    BACKGROUND: Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholecystolithiasis. Despite the many advantages over open surgery, many patients complain about referred pain to the shoulder during the postoperative course. The purpose of this review was to evaluate...... different intraoperative surgical methods to minimize shoulder pain (SP). METHODS: A search of the literature was conducted using PubMed, Excerpta Medica Database (EMBASE), and Cochrane database of systematic reviews. Eligibility criteria were: randomized clinical trials or meta-analysis evaluating...

  10. The First Trocar Entry in the Laparoscopic Cholecystectomy, Which Technique?

    OpenAIRE

    Ahmet Serdar Karaca

    2013-01-01

    Aim: We planned a comparison of veress needle (VN) and direct trocar (DT) insertion techniques, which have been commonly used in laparoscopic surgical procedures, via a prospective randomized clinical study. Material and Method: 400 patients who had undergone laparoscopic cholecystectomy were included to the present prospective randomized clinical study. SPSS 17.0 (SPSS Inc., Chicago, IL) was used for the statistical analysis. Insufflation-related technical complications were investigated in ...

  11. Residual gallbladder stones after cholecystectomy: A literature review

    OpenAIRE

    Pradeep Chowbey; Anil Sharma; Amit Goswami; Yusuf Afaque; Khoobsurat Najma; Manish Baijal; Vandana Soni; Rajesh Khullar

    2015-01-01

    Background: Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. Materials And Methods: Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-ch...

  12. Characteristics and prediction of early pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Bisgaard, T; Klarskov, B; Rosenberg, J

    2001-01-01

    by ice water (cold pressor test), neuroticism, dyspepsia, patient history of biliary symptoms, intraoperative factors, and demographic information in 150 consecutive patients undergoing uncomplicated laparoscopic cholecystectomy for their influence on early postoperative pain. During the first...... dominated in incidence and intensity compared with visceral pain, which in turn dominated over shoulder pain. In a multivariate analysis model, preoperative neuroticism, sensitivity to cold pressor-induced pain, and age were identified as independent risk factors for early postoperative pain. Our results...

  13. Biliary-colonic fistula caused by cholecystectomy bile duct injury

    Institute of Scientific and Technical Information of China (English)

    Francisco Igor B Macedo; Victor J Casillas; James S Davis; Joe U Levi and Danny Sleeman

    2013-01-01

     Biliary-colonic  fistula  is  a  rare  complication after laparoscopic cholecystectomy. We present a case of post-cholecystectomy  iatrogenic  biliary  injury  that  resulted  in  a fistula  between  the  common  hepatic  duct  and  large  bowel. Magnetic  resonance  cholangiopancreatography  provided good  visualization  of  injury  even  with  concurrent  normal level of alkaline phosphatase. Radiologic findings and surgical management of this condition are discussed in detail.

  14. Laparoscopic cholecystectomy in sickle cell patients in Niger

    Directory of Open Access Journals (Sweden)

    Abarchi Habibou

    2009-12-01

    Full Text Available BACKGROUND: We report the results of our experience on laparoscopic cholecystectomy in sickle cell disease patients in Niger, which is included in the sickle cell belt. METHODS: A prospective study covering a period of 45 months, from July 2004 to March 2008. We included all sickle cell disease patients that underwent laparoscopic cholecystectomy. Blood transfusion was done for patients with haemoglobin (Hb levels less than 9g/dl. Homozygous and composite heterozygous patients were admitted in intensive care unit for 24 hours or plus post operatively. RESULTS:The series included 47 patients operated by the same surgeon, 31 females (66% and 16 males (34% (Ratio: 0.51. The average age was 22.4 years (range: 11 to 46 years and eleven (23.4% of them were aged less than 15 years. The types of sickle cell disease found were 37 SS, 2 SC, 1 S beta-thalassemia and 7 AS. Indications for surgery were biliary colic in 29 cases (61.7% and acute cholecystitis in 18 cases (38.3%. The mean operative time was 64 min (range: 42 to 103 min. Conversion to open cholecystectomy in 2 cases (4.2 % for non recognition of Calot‘s triangle structures. The postoperative complications were: four (4 cases of vaso-occlusive crisis and one case of acute chest syndrome. The mean postoperative hospital stay was 3,5days (range: 1 to 9 days. No mortality was encountered. CONCLUSION: Laparoscopic cholecystectomy is a safe procedure in sickle cell patients. It should be a multidisciplinary approach and involve a haematologist, an anaesthesiologist and a surgeon.

  15. Gastrointestinal bleeding 30 years after a complicated cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Thorsten; Brechmann; Wolff; Schmiegel; Volkmar; Nicolas; Markus; Reiser

    2010-01-01

    Gastrointestinal bleeding from small-bowel varices is a rare and difficult to treat complication of portal hypertension. We describe the case of a 79-year-old female patient with recurrent severe hemorrhage from smallbowel varices 30 years after a complicated cholecystectomy. When double balloon enteroscopy was unsuccessful to reach the site of bleeding, a rendezvous approach was favored with intraoperative endoscopy. Active bleeding from varices within a biliodigestive anastomosis was found and controlled ...

  16. Single-Incision Cholecystectomy in about 200 Patients

    Directory of Open Access Journals (Sweden)

    Roland Raakow

    2011-01-01

    Full Text Available Background and Aims. We describe our experience of performing transumbilical single-incision laparoendoscopic cholecystectomy as standard procedure for acute and chronic gallbladder diseases. Methods. Between September 2008 and March 2010, 220 patients underwent laparoscopic single-incision surgery. A single port was used for 196 patients and two conventional 5 mm and one 10 mm port in 24 cases. All operations were performed with straight instruments. Results. Single-incision surgery was successfully performed in 215 patients (98%. Three patients (1.4% required conversion to a three-port technique and two patients (0.9% to an open procedure. Average age of 142 women (65% and 78 men (35% was 47 years (range: 15–89, average ASA status 2 (range: 1–3 and BMI 28 (range: 15–49. Mean operative time was 62 minutes (range: 26–174 and 57 patients (26% had histopathological signs of acute cholecystitis. Eleven patients (5% developed to surgery-related complications and nine (4% of these required a reoperation. The mean followup was 331.5 (range: 11–590 days. Conclusion. Transumbilical single-incision cholecystectomy is a feasible and safe new approach for routine cholecystectomy. After a short learning curve, operation time and complication rate are comparable with standard multiport operation. In addition, most cases of acute cholecystitis can be performed with this technique.

  17. Consensus statement of the consortium for LESS cholecystectomy.

    Science.gov (United States)

    Ross, Sharona; Rosemurgy, Alexander; Albrink, Michael; Choung, Edward; Dapri, Giovanni; Gallagher, Scott; Hernandez, Jonathan; Horgan, Santiago; Kelley, William; Kia, Michael; Marks, Jeffrey; Martinez, Jose; Mintz, Yoav; Oleynikov, Dmitry; Pryor, Aurora; Rattner, David; Rivas, Homero; Roberts, Kurt; Rubach, Eugene; Schwaitzberg, Steven; Swanstrom, Lee; Sweeney, John; Wilson, Erik; Zemon, Harry; Zundel, Natan

    2012-10-01

    Many surgeons attempting Laparo-Endoscopic Single Site (LESS) cholecystectomy have found the operation difficult, which is inconsistent with our experience. This article is an attempt to promote a standardized approach that we feel surgeons with laparoscopic skills can perform safely and efficiently. This is a four-trocar approach consistent with the four incisions utilized in conventional laparoscopic cholecystectomy. After administration of general anesthesia, marcaine is injected at the umbilicus and a 12-mm vertical incision is made through the already existing anatomical scar of the umbilicus. A single four-trocar port is inserted. A 5-mm deflectable-tip laparoscope is placed through the trocar at the 8 o'clock position, a bariatric length rigid grasper is inserted through the trocar at the 4 o'clock position (to grasp the fundus), and a rigid bent grasper is placed through the 10-mm port (to grasp the infundibulum). This arrangement of the instruments promotes minimal internal and external instrument clashing with simultaneous optimization of the operative view. This orientation allows retraction of the gallbladder in a cephalad and lateral direction, development of a window between the gallbladder and the liver which promotes the "critical view" of the cystic duct and artery, and provides triangulation with excellent visualization of the operative field. The operation is concluded with diaphragmatic irrigation of marcaine solution to minimize postoperative pain. Standardization of LESS cholecystectomy will speed adoption, reduce intraoperative complications, and improve the efficiency and safety of the approach.

  18. Patients' quality of life after laparoscopic or open cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    CHEN Li; TAO Si-feng; XU Yuan; FANG Fu; PENG Shu-you

    2005-01-01

    Objective: This study was aimed at evaluating and comparing the quality of life in patients who underwent laparoscopic and open cholecystectomy for chronic cholecystolithiasis. Methods: The study included 25 patients with laparoscopic cholecystectomy (LC group) and 26 with open cholecystectomy (OC group). The quality of life was measured with the Gastrointestinal Quality of Life Index (GLQI) preoperatively, thereafter regularly at 2, 5, 10 and 16 weeks after the operation. Results:The mean preoperative overall GLQI scores were 112.5 and 110.3 in LC and OC group respectively (P>0.05). In the LC group, the mean overall GLQI score reduced slightly to 110.0 two weeks after the operation (P>0.05). The LC group showed significant improvement in overall score and in the aspects of symptomatology, emotional and physiological status from 5 to 16 weeks postoperatively. In the OC group, the GLQI score reduced to 102.0 two weeks after surgery (P0.05). The patients experienced significant improvements of GLQI sixteen weeks after OC operation (P<0.01~0.05). Within the 10 postoperative weeks, the LC group had significantly higher GLQI scores than the OC group (P<0.05). Conclusions: LC can improve the quality of life postoperatively better and more rapidly than OC. The assessment of quality of life assessment is a valid method for measuring the effects of surgical treatment.

  19. Multimodal Preincisional Premedication to Prevent Acute Pain After Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Dawood Aghamohammadi

    2012-09-01

    Full Text Available Introduction: Postoperative pain as an important medical concern is usually treated by opioids which also are of various inevitable side effects. The aim of this study was to assess the efficacy of multimodal preincisional premedication on preventing post-cholecystectomy acute pain. Methods: In a randomized clinical trial, sixty patients undergoing open cholecystectomy were randomized into two groups. Before anesthesia induction, Diclofenac suppository (100 mg and oral Clonidine (0.2 mg were administered in the first group. Immediately before operation, patients received Ketamine (1 mg/kg IV while the control group received placebo. The site of incision was infiltrated by the surgeon with 20 mL Bupivacaine 0.25% in both groups. Anesthesia induction and maintenance were similar in both groups. The severity of pain was recorded 2, 4, 6, 12, 24 and 48 hours after operation according to Visual Analogue Scale. Results: The severity of pain at two defined stages (6 and 12 hours later was significantly less in the intervention group than the control group (P<0.005. The average pain severity score was less than the control group (P<0.005. Conclusion: In our study, the administration of Clonidine, Diclofenac and Ketamine and bupivacaine infiltration to the site of incision, altogether was associated with a significant decrease in pain score and opioid requirement after cholecystectomy in comparison to bupivacaine infiltration to the site of incision.

  20. Microlaparoscopic vs conventional laparoscopic cholecystectomy: a prospective randomized double-blind trial

    DEFF Research Database (Denmark)

    Bisgaard, T; Klarskov, B; Trap, R;

    2002-01-01

    BACKGROUND: Downsizing the port incisions may reduce pain after laparoscopic cholecystectomy. METHODS: In a double-blind controlled study, 60 patients were randomized to undergo either microlaparoscopic cholecystectomy using one 10-mm and three 3.5-mm trocars (3.5-mm LC) or traditional laparoscopic...

  1. Risk factors for a prolonged operative time in a single-incision laparoscopic cholecystectomy

    OpenAIRE

    Sato, Norihiro; Yabuki, Kei; Shibao, Kazunori; Mori, Yasuhisa; Tamura, Toshihisa; Higure, Aiichiro; Yamaguchi, Koji

    2013-01-01

    Background: A prolonged operative time is associated with adverse post-operative outcomes in laparoscopic surgery. Although a single-incision laparoscopic cholecystectomy (SILC) requires a longer operative time as compared with a conventional laparoscopic cholecystectomy, risk factors for a prolonged operative time in SILC remain unknown.

  2. Ergonomic assessment of the French and American position for laparoscopic cholecystectomy in the MIS Suite

    NARCIS (Netherlands)

    Kramp, Kelvin H.; van Det, Marc J.; Totte, Eric R.; Hoff, Christiaan; Pierie, Jean-Pierre E. N.

    2014-01-01

    Cholecystectomy was one of the first surgical procedures to be performed with laparoscopy in the 1980s. Currently, two operation setups generally are used to perform a laparoscopic cholecystectomy: the French and the American position. In the French position, the patient lies in the lithotomy positi

  3. Surgical Space Conditions During Low-Pressure Laparoscopic Cholecystectomy with Deep Versus Moderate Neuromuscular Blockade

    DEFF Research Database (Denmark)

    Staehr-Rye, Anne K; Rasmussen, Lars S.; Rosenberg, Jacob;

    2014-01-01

    described, but deep neuromuscular blockade may be beneficial. We investigated if deep muscle relaxation would be associated with a higher proportion of procedures with "optimal" surgical space conditions compared with moderate relaxation during low-pressure (8 mm Hg) laparoscopic cholecystectomy. METHODS...... with surgical space conditions that were marginally better than with moderate muscle relaxation during low-pressure laparoscopic cholecystectomy....

  4. Immediate Postoperative Pain: An Atypical Presentation of Dropped Gallstones after Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Samba Binagi

    2015-01-01

    Full Text Available Cholecystectomy is one of the most commonly performed surgical procedures in the United States. A common complication is dropped gallstones, and the diversity of their presentation poses a substantial diagnostic challenge. We report the case of a 58-year-old man presenting with chronic right upper quadrant hours status post cholecystectomy. Imaging demonstrated retained gallstones in the perihepatic space and symptoms remitted following their removal via laparoscopic operation. Gallstones are lost in roughly 1 in 40 cholecystectomies and are usually asymptomatic. The most common presentations are months or years status post cholecystectomy due to fistula, abscess, or sinus tract formation. We report this case hoping to bring light to a rare presentation for dropped gallstones and provide advice on the management of this common complication of cholecystectomy.

  5. The use of intraoperative cholangiogram during laparoscopic double cholecystectomy

    Directory of Open Access Journals (Sweden)

    Gustavo E. Guajardo-Salinas

    2010-09-01

    Full Text Available ouble gallbladder is a rare finding in patients with symptomatic cholelithiasis or acute cholecystitis. The incidence has been described as 1 in every 4000-5000 patients during autopsy. To identify the gallbladder (GB duplication prior to surgical removal of the GB is of upmost importance. It is not unusual to identify this diagnosis intraoperatively, but by using US, ERCP or MRCP more than 50% of the cases are diagnosed preoperatively. The use of intraoperative cholangiogram helps to identify the anatomy and confirm the diagnosis during laparoscopic cholecystectomy in patients with gallbladder duplication.

  6. Gallstone ileus one quarter of a century post cholecystectomy.

    Science.gov (United States)

    Saedon, Mahmud; Gourgiotis, Stavros; Salemis, Nikolaos S; Majeed, Ali W; Zavos, Apostolos

    2008-01-01

    Gallstone ileus is a rare but potentially serious complication of cholelithiasis. It is usually preceded by history of biliary symptoms. It usually occurs as a result of a large gallstone creating and passing through a cholecysto-enteric fistula. Most of the time, the stone will pass the GI tract without any problems, but large enough stones can cause obstruction. The two most common locations of impaction are the terminal ileum and the ileocaecal valve because of the anatomical small diameter and less active peristalsis. We present an unusual case of small bowel obstruction secondary to gallstone ileus 24 years after an open cholecystectomy.

  7. Twenty-five years of ambulatory laparoscopic cholecystectomy.

    Science.gov (United States)

    Bueno Lledó, José; Granero Castro, Pablo; Gomez I Gavara, Inmaculada; Ibañez Cirión, Jose L; López Andújar, Rafael; García Granero, Eduardo

    2016-10-01

    It is accepted by the surgical community that laparoscopic cholecystectomy (LC) is the technique of choice in the treatment of symptomatic cholelithiasis. However, more controversial is the standardization of system implementation in Ambulatory Surgery because of its different different connotations. This article aims to update the factors that influence the performance of LC in day surgery, analyzing the 25 years since its implementation, focusing on the quality and acceptance by the patient. Individualization is essential: patient selection criteria and the implementation by experienced teams in LC, are factors that ensure high guarantee of success.

  8. Virtual reality training versus blended learning of laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Nickel, Felix; Brzoska, Julia Anja; Gondan, Matthias;

    2015-01-01

    Objective: This study compared virtual reality (VR) training with low cost blended learning (BL) in a structured training program. Background: Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks. Methods: Laparoscopy-naïve medical students...... were randomized in two groups stratified for gender. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, USA). Each group trained 3×4 hours...

  9. EXPERIMENTAL STUDY OF CHEMICAL CHOLECYSTECTOMY OF PATHOLOGIC OBSERVATION

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective:To verify through animal experiment the validity of chemical cholecystectomy.Mothods:The expermental objects seven healthy juvenile pigs,hardener was infused into the gallbladder,after infusion the sapmles were collected by pathological examination,according to the different duration under anesthestize.Results:The mucous destructive and digestive process remained with one week,the inflammatory reaction in two weeks,the chronic inflammatory reaction compained a great deal of granulation tissue and scar formation occurred in 4th-8th week,10 weeks latter,the inflammatory reaction reduced,and scar tissue formed.Conlusion:Chemical cholecystecomy is safe and reliable in clinic.

  10. Focal fatty change in the liver that developed after cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Akinobu; Osame; Toshimichi; Mitsufuji; Shinichi; Kora; Kengo; Yoshimitsu; Daisuke; Morihara; Hideo; Kunimoto

    2014-01-01

    Focal fatty change of the segment IV of the liver has been attributed to local systemic venous inflow replacing the portal venous supply, which could develop or be accentuated after gastrectomy. However, focal fatty change due to aberrant pancreaticoduodenal vein that developed after cholecystectomy has never been reported. We report a 30-year-old man with such a rare lesion, which was initially misdiagnosed as a hepatocellular carcinoma, but was confirmed on computed tomography during selective gastroduodenal arteriography. The lesion disappeared 12 mo later without any intervention.

  11. Carcinoid of the Appendix During Laparoscopic Cholecystectomy: Unexpected Benefits

    Science.gov (United States)

    Haluck, Randy; Cooney, Robert N.; Minnick, Kathleen E.; Ruggiero, Francesco; Smith, J. Stanley

    1999-01-01

    Carcinoid tumors of the midgut arise from the distal duodenum, jejunum, ileum, appendix, ascending and right transverse colon. The appendix and terminal ileum are the most common location. The majority of carcinoid tumors originate from neuroendocrine cells along the gastrointestinal tract, but they are also found in the lung, ovary, and biliary tracts. We report the first case of elective laparoscopic cholecystectomy in which we found a suspicious lesion at the tip of the appendix and proceeded to perform a laparoscopic appendectomy. The lesion revealed a carcinoid tumor of the appendix. PMID:10323177

  12. EFFECT OF ORAL CLONIDINE PREMEDICATION ON HAEMODYNAMIC CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY - A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Abu Lais Mustaque

    2016-04-01

    Full Text Available BACKGROUND Laparoscopic surgeries are the recent advances in the field of surgery and are the essence of today’s surgical practice. Laparoscopic cholecystectomy has revolutionised gall bladder surgeries and has become the treatment of choice for cholelithiasis. This procedure has minimised the numbers of open cholecystectomy performed these days. AIMS AND OBJECTIVES To study the effect of oral clonidine premedication on haemodynamic changes during laparoscopic cholecystectomy. MATERIALS & METHODS The present study was conducted in the Department of Anaesthesiology of Assam Medical College, Dibrugarh for a period of one year from July 2012 to June 2013 on patients undergoing laparoscopic cholecystectomy at operation theatre of Department of General Surgery of Assam Medical College and Hospital, Dibrugarh. A total of 150 adult patients of either sex between the age group of 18 to 40 years of ASA-1 and ASA-2 undergoing elective laparoscopic cholecystectomy were divided randomly into two groups of 75 patients each. RESULTS With the present study that oral premedication with Tab. Clonidine 150 mcg administered 90 minutes before surgery was able to prevent adverse haemodynamic changes during elective laparoscopic cholecystectomy under general anaesthesia. CONCLUSION Hence, from the findings of this study, we can reasonably recommend oral premedication with Tab. Clonidine 150 mcg in otherwise healthy patients undergoing laparoscopic cholecystectomy

  13. Randomized clinical trial comparing oral prednisone (50 mg) with placebo before laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Bisgaard, Thue; Schulze, S.; Hjortso, N.C.;

    2008-01-01

    cholecystectomy. Methods In a double-blind placebo-controlled study, 200 patients were randomized to oral administration of prednisone (50 mg) or placebo 2 h before laparoscopic cholecystectomy. Patients received a similar standardized anaesthetic, surgical, and analgesic treatment. The primary outcome was pain......-h pain, fatigue or malaise scores or any other variables were found (P > 0.05). Conclusion There is no important clinical gain of preoperative oral steroid administration compared with placebo in patients undergoing laparoscopic cholecystectomy Udgivelsesdato: 2008/2...

  14. A portable fluorescence microscopic imaging system for cholecystectomy

    Science.gov (United States)

    Ye, Jian; Yang, Chaoyu; Gan, Qi; Ma, Rong; Zhang, Zeshu; Chang, Shufang; Shao, Pengfei; Zhang, Shiwu; Liu, Chenhai; Xu, Ronald

    2016-03-01

    In this paper we proposed a portable fluorescence microscopic imaging system to prevent iatrogenic biliary injuries from occurring during cholecystectomy due to misidentification of the cystic structures. The system consisted of a light source module, a CMOS camera, a Raspberry Pi computer and a 5 inch HDMI LCD. Specifically, the light source module was composed of 690 nm and 850 nm LEDs, allowing the CMOS camera to simultaneously acquire both fluorescence and background images. The system was controlled by Raspberry Pi using Python programming with the OpenCV library under Linux. We chose Indocyanine green(ICG) as a fluorescent contrast agent and then tested fluorescence intensities of the ICG aqueous solution at different concentration levels by our fluorescence microscopic system compared with the commercial Xenogen IVIS system. The spatial resolution of the proposed fluorescence microscopic imaging system was measured by a 1951 USAF resolution target and the dynamic response was evaluated quantitatively with an automatic displacement platform. Finally, we verified the technical feasibility of the proposed system in mouse models of bile duct, performing both correct and incorrect gallbladder resection. Our experiments showed that the proposed system can provide clear visualization of the confluence between the cystic duct and common bile duct or common hepatic duct, suggesting that this is a potential method for guiding cholecystectomy. The proposed portable system only cost a total of $300, potentially promoting its use in resource-limited settings.

  15. Role of laryngeal mask airway in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    José; M; Bele?a; Ernesto; Josué; Ochoa; Mónica; Nú?ez; Carlos; Gilsanz; Alfonso; Vidal

    2015-01-01

    Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway(LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low.

  16. Open versus laparoscopic cholecystectomies in patients with or without type 2 diabetes mellitus in Spain from 2003 to 2013

    Institute of Scientific and Technical Information of China (English)

    José M de Miguel-Yanes; Manuel Méndez-Bailón; Rodrigo Jiménez-García; Valentín Hernández-Barrera; Napoleón Pérez-Farinós; Fernando Turégano; Nuria Muñoz-Rivas; Ana López-de-Andrés

    2016-01-01

    BACKGROUND: This study aimed to compare the rates of open and laparoscopic cholecystectomies and outcomes in patients with or without type 2 diabetes mellitus (T2DM) in Spain from 2003 to 2013. METHODS: We collected all cases of open and laparoscopic cholecystectomies using national hospital discharge data and evaluated the annual cholecystectomy rates stratiifed by T2DM status. We analyzed tendency for in-hospital mortality (IHM). We also analyzed the impact of T2DM on IHM in patients who underwent cholecystectomies. RESULTS: We identiifed 611 533 cholecystectomies (71.3%laparoscopic) in the patients, in whom 78 227 (12.8%) patients had T2DM. The rates of open cholecystectomies were 3-fold higher (130.0/105 vs 41.1/105) in patients with T2DM than in those without T2DM, and the rate of laparoscopic cholecys-tectomies was almost 2-fold higher (195.2/105 vs 111.8/105) in patients with T2DM. The annual rate of laparoscopic pro-cedures showed an 11-year relative increase of 88.3% (from 117.0/105 to 220.3/105) in T2DM and 49.2% (from 79.2/105 to 118.2/105) in patients without T2DM (P CONCLUSION: The rate of cholecystectomy was higher in patients with T2DM, and laparoscopic cholecystectomy was popularized in the past 11 years both in selective and emer-gency cholecystectomies.

  17. Incidental gallbladder cancer during laparoscopic cholecystectomy: Managing an unexpected finding

    Institute of Scientific and Technical Information of China (English)

    Andrea Cavallaro; Gaetano Piccolo; Vincenzo Panebianco; Emanuele Lo Menzo; Massimiliano Berretta; Antonio Zanghì; Maria Di Vita; Alessandro Cappellani

    2012-01-01

    AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively reviewed.Gallbladder pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography (CT)].Patients with gallbladder cancer (GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and survival.Incidental GBC was compared with suspected or preoperatively diagnosed GBC.The primary endpoint was diseasefree survival (DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.RESULTS:Nineteen patients (11 women and eight men) were found to have GBC.The male to female ratio was 1∶1.4 and the mean age was 68 years (range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed postoperatively.One was suspected intraoperatively and confirmed by frozen sections.The ratio between incidental and nonincidental cases was 9/19.The tumor node metastasis stage was:pTis (1),pT1a (2),pT1b (4),pT2 (6),pT3 (4),pT4 (2); five cases with stage Ⅰa (T1 a-b); two with stage Ⅰb (T2 N0); one with stage Ⅱa (T3 N0); six with stage Ⅱb (T1-T3 N1); two with stage Ⅲ (T4 Nx Nx); and one with stage Ⅳ (Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage (≤ Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT (nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum (one case),porcelain gallbladder (one case),gallbladder adenoma (one case),and chronic cholelithiasis (eight cases

  18. Evaluation of Operative Notes Concerning Laparoscopic Cholecystectomy: Are Standards Being Met?

    NARCIS (Netherlands)

    Wauben, L.S.G.L.; Goossens, R.H.M.; Lange, J.F.

    2010-01-01

    Background - Laparoscopic cholecystectomy (LC) is the most performed minimal invasive surgical procedure and has a relatively high complication rate. As complications are often revealed postoperatively, clear, accurate, and timely written operative notes are important in order to recall the procedur

  19. Acute Cholangitis following Intraductal Migration of Surgical Clips 10 Years after Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Natalie E. Cookson

    2015-01-01

    Full Text Available Background. Laparoscopic cholecystectomy represents the gold standard approach for treatment of symptomatic gallstones. Surgery-associated complications include bleeding, bile duct injury, and retained stones. Migration of surgical clips after cholecystectomy is a rare complication and may result in gallstone formation “clip cholelithiasis”. Case Report. We report a case of a 55-year-old female patient who presented with right upper quadrant pain and severe sepsis having undergone an uncomplicated laparoscopic cholecystectomy 10 years earlier. Computed tomography (CT imaging revealed hyperdense material in the common bile duct (CBD compatible with retained calculus. Endoscopic retrograde cholangiopancreatography (ERCP revealed appearances in keeping with a migrated surgical clip within the CBD. Balloon trawl successfully extracted this, alleviating the patient’s jaundice and sepsis. Conclusion. Intraductal clip migration is a rarely encountered complication after laparoscopic cholecystectomy which may lead to choledocholithiasis. Appropriate management requires timely identification and ERCP.

  20. Robotic Single-Port Laparoscopic Cholecystectomy Is Safe but Faces Technical Challenges

    NARCIS (Netherlands)

    Van Der Linden, Yoen T K; Brenkman, Hylke J F; van der Horst, Sylvia; van Grevenstein, Wilhelmina M U; Van Hillegersberg, Richard; Ruurda, Jelle P.

    2016-01-01

    Background: For cholecystectomy, multiport laparoscopy is the recommended surgical approach. Single-port laparoscopy (SPL) was introduced to reduce postoperative pain and provide better cosmetic results, but has technical disadvantages. Robotic SPL (RSPL) was developed to overcome these disadvantage

  1. Survival until 6 years after cholecystectomy: female population of Denmark, 1977-1983

    DEFF Research Database (Denmark)

    Andersen, T F; Brønnum-Hansen, H; Jørgensen, T;

    1995-01-01

    admissions had a relative risk (RR) of about 1.5. Cholecystectomy patients had a significantly increased mortality when compared to hysterectomy patients, RR = 1.3 (1.1-1.6), and to the population sample. Heart diseases and cancer occurred significantly more often as causes of death among cholecystectomy......It has been a prevailing assumption that cholecystectomy patients by and large follow a pattern of survival similar to that of the normal population. This paper presents a population-based study of the long-term survival after cholecystectomy in order to reassess this assumption. Based on data...... to both hysterectomy patients and a sample of the female population. Adjusting for age and other covariates, patients with psychiatric hospital admissions prior to surgery experienced a threefold risk of dying within 6 years after surgery. Patients with prior somatic admissions and patient with acute...

  2. Do height and weight affect the feasibility of single-incision laparoscopic cholecystectomy?

    OpenAIRE

    Meillat, Hélène; Birnbaum, David Jérémie; FARA, Régis; Mancini, Julien; Berdah, Stéphane; BEGE, Thierry

    2015-01-01

    Laparoscopic cholecystectomy is the gold standard for gallbladder removal and the most common laparoscopic procedure worldwide. Single-incision laparoscopic surgery has recently emerged as a less invasive potential alternative to conventional three- or four-port laparoscopy. However, the feasibility of single-incision laparoscopic cholecystectomy (SILC) remains unclear, and there are no rigorous criteria in the literature. Identifying patients at risk of failure of this new technique is essen...

  3. The beneficial effect of transversus abdominis plane block after laparoscopic cholecystectomy in day-case surgery

    DEFF Research Database (Denmark)

    Petersen, Pernille Lykke; Stjernholm, Pia; Kristiansen, Viggo B;

    2012-01-01

    Laparoscopic cholecystectomy is associated with postoperative pain of moderate intensity in the early postoperative period. Recent randomized trials have demonstrated the efficacy of transversus abdominis plane (TAP) block in providing postoperative analgesia after abdominal surgery. We hypothesi...... hypothesized that a TAP block may reduce pain while coughing and at rest for the first 24 postoperative hours, opioid consumption, and opioid side effects in patients undergoing laparoscopic cholecystectomy in day-case surgery....

  4. Laparoscopic modified subtotal cholecystectomy for difficult gall bladders: A single-centre experience

    Science.gov (United States)

    Harilingam, Mohan Raj; Shrestha, Ashish Kiran; Basu, Sanjoy

    2016-01-01

    AIM: Laparoscopic cholecystectomy (LC) is considered the ‘gold standard’ intervention for gall bladder (GB) diseases. However, to avoid serious biliovascular injury, conversion is advocated for distorted anatomy at the Calot's triangle. The aim is to find out whether our technique of laparoscopic modified subtotal cholecystectomy (LMSC) is suitable, with an acceptable morbidity and outcome. PATIENTS AND METHODS: A retrospective analysis of prospectively collected data of 993 consecutive patients who underwent cholecystectomy was done at a large District General Hospital (DGH) between August 2007 and January 2015. The data are as follows: Patient's demographics, operative details including intra- and postoperative complications, postoperative stay including follow-up that was recorded and analysed. RESULTS: A total of 993 patients (263 males and 730 female) were included. The median age was 52*(18-89) years. Out of the 993 patients, 979 (98.5%) and 14 (1.5%) were listed for laparoscopic and open cholecystectomy, respectively. Of the 979 patients, 902 (92%) and 64 (6.5%) patients underwent LC ± on-table cholangiography (OTC) and LMSC ± OTC, respectively, with a median stay of 1* (0-15) days. Of the 64 patients, 55 (86%) had dense adhesions, 22 (34%) had acute inflammation, 19 (30%) had severe contraction, 12 (19%) had empyema, 7 (11%) had Mirizzi's syndrome and 2 (3%) had gangrenous GB. The mean operative time was 120 × (50-180) min [Table 1]. Six (12%) patients required endoscopic retrograde cholangiopancreatography (ERCP) postoperatively, and there were four (6%) readmissions in a follow-up of 30 × (8-76) months. The remaining 13 (1.3%) patients underwent laparoscopic cholecystectomy converted to an open cholecystectomy. The median stay for open/laparoscopic cholecystectomy converted to open cholecystectomy was 5 × (1-12) days. CONCLUSION: Our technique of LMSC avoided conversion in 6.5% patients and believe that it is feasible and safe for difficult GBs

  5. Cholelithiasis, cholecystectomy and risk of hepatocellular carcinoma: A meta-analysis

    Directory of Open Access Journals (Sweden)

    Lingyun Guo

    2014-01-01

    Full Text Available Available evidence of the relationship between cholelithiasis, cholecystectomy, and risk of liver cancer and hence we conducted a meta-analysis to investigate the relationships. PubMed, EMBASE, and ISI Web of Knowledge were searched to identify all published cohort studies and case-control studies that evaluated the relationships of cholelithiasis, cholecystectomy and risk of liver cancer and single-cohort studies which evaluated the incidence of liver cancer among patients who understood cholecystectomy (up to February 2013. Comprehensive meta-analysis software was used for meta-analysis. A total of 11 observational studies (six cohort studies and five case-control studies were included in this meta-analysis. The result from meta-analysis showed that cholecystectomy (risk ratio [RR]: 1.59, 95% confidence interval [CI]: 1.01-2.51, I2 = 72% and cholecystolithiasis (RR: 5.40, 95% CI: 3.69-7.89, I2 = 93% was associated with more liver cancer, especially for intrahepatic cholangiocarcinoma (ICC (cholecystectomy: RR: 3.51, 95% CI: 1.84-6.71, I2 = 26%; cholecystolithiasis: RR: 11.06, 95% CI: 6.99-17.52, I2 = 0%. The pooled standardized incidence rates (SIR of liver cancer in patients who understood cholecystectomy showed cholecystectomy might increase the incidence of liver cancer (SIR: 1.57, 95% CI: 1.13-2.20, I2 = 15%. Based on the results of the meta-analysis, cholecystectomy and cholecystolithiasis seemed to be involved in the development of liver cancer, especially for ICC. However, most available studies were case-control studies and short-term cohort studies, so the future studies should more long-term cohort studies should be well-conducted to evaluate the long-term relationship.

  6. LAPAROSCOPIC CHOLECYSTECTOMY UNDER SPINAL ANAESTHESIA: STUDY IN 100 CASES

    Directory of Open Access Journals (Sweden)

    Niranjan Kumar Verma

    2016-08-01

    Full Text Available BACKGROUND Laparoscopic cholecystectomies are generally performed under general anaesthesia. Trials for spinal anaesthesia were not satisfactory. My experience on 100 cases with a modified technique provided very good results, where Bupivacaine and Clonidine were administered by subarachnoid route combined with peritoneal insufflation and local infiltration of Ropivacaine. METHOD One hundred ASI grade 1 and grade 2 patients undergoing elective laparoscopic cholecystectomy opting for spinal anaesthesia were given 1 mL (150 mcg of clonidine in L1-L2 interspace followed by 3 mL (15 mg of 0.5% heavy bupivacaine in the same interspace by separate syringes, 15 degrees head down tilt, intra-peritoneal insufflation of 0.5% Ropivacaine just after pneumoperitoneum and cannula insertion and lastly local infiltration of 0.5% Ropivacaine 2 mL at each incision at the time of skin closure. Preemptive 10-15 mg of Mephentermine IM was given to each patient. Recordings of vital parameters, pain experienced by patients, especially excruciating shoulder pain, any difficulty experienced by surgeons, need for analgesia, level of consciousness, respiratory depression, hypotension, bradycardia, pruritus were recorded at frequent intervals during operation and later in the ICU for prompt managements. RESULTS None of the patients experienced any pain in the peri- and post-operative period, analgesia was excellent for 12-16 hours postoperatively. No respiratory depression, severe bradycardia, hypotension or pruritus was noticed. Incidence of post-operative nausea and vomiting were negligible. CONCLUSION Clonidine as adjuvant with hyperbaric Bupivacaine in spinal anaesthesia combined with intraperitoneal infiltration of 20 mL of 0.5% Ropivacaine just after insertion of cannula through an irrigation cannula and 2 mL of 0.5% Ropivacaine injected at each port site at the time of skin stitches, when given in proper way can be a very good alternative to general anaesthesia for

  7. Outcome of laparoscopic cholecystectomy at a secondary level of care in Saudi Arabia

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    Abdulrahman S Al-Mulhim

    2011-01-01

    Full Text Available Background/Aim: The first option for gallbladder surgery is laparoscopic cholecystectomy. The aim of this study is to analyze the outcomes for all patients who underwent laparoscopic cholecystectomy at a secondary level of care. Patients and Methods: Between 2005 and 2008, 968 consecutive laparoscopic cholecystectomies were performed at King Fahad Hospital. We collected and analyzed data including age, gender, body mass index (kg/m 2 , the American Society of Anesthesiologists (ASA class, mode of admission (elective or emergency, indication for LC (chronic or acute cholecystitis [AC], co-morbid disease, previous abdominal surgery, conversion to open cholecystectomy, complications, operation time, and length of postoperative hospital stay. Results : Nine hundred and sixty-eight patients had laparoscopic cholecystectomy at the center. There were 824 females and 144 males; the age range was 15-64 (mean 32.9± 12.7 years. The operating time was 45 to 180 min (median 85 min; the complication rate was 4.03% (39 patients. Conclusion: Laparoscopic cholecystectomy could be performed safely in the majority of patients with cholelithiasis, by an experienced surgical team at a secondary level of care.

  8. Changes of gastrointestinal myoelectric activity and bile acid pool size after cholecystectomy in guinea pigs

    Institute of Scientific and Technical Information of China (English)

    Xue-Mei Zhang; Lei Dong; Li-Na Liu; Bi-Xia Chang; Qian He; Qian Li

    2005-01-01

    AIM: To investigate the bile acid pool size after cholecystectomy whether or not correlated to the gastrointestinal migrating myoelectric complex (MMC) in guinea pigs.METHODS: Gallbladder motilities were assessed before cholecystectomy. Furthermore, we continuously monitored interdigestive gastrointestinal motilities using bipolar electrodes in conscious guinea pigs before and after surgery at 4 wk in standard diet group and high cholesterol diet (cholesterol gallstone) group. Total bile acid pool sizes were measured by isotope dilution method at meantime.RESULTS: After cholecystectomy, there were parallel falls in duration of phase Ⅰ, Ⅱ, Ⅲ and MMC cycle duration but increase in amplitude in the guinea pigs with normal gallbladder function, and in the guinea pigs with cholesterol stones. However, There were not significantly differences. On the other hand, the bile acid pool was definitely small in the GS guinea pigs compared to normal guinea pigs and became slightly smaller after cholecystectomy. Similarly, bile acid in gallbladder bile, fecal bile acid was slightly increased in GS guinea pigs after cholecystectomy, to the same degree as normal. These differences, however, were not significant.CONCLUSION: It is concluded that in the guinea pigs with normal gallbladder function, and in the guinea pigs with cholesterol stones: (1) Cholecystectomy produce a similar but less marked trend in bile acid pool; and (2) MMC are linked to enterohepatic circulation of bile acids, rather than surgery, which is consistent with changes of the bile acid pool size. As a result, gastrointestinal dyskinesia is not involved in occurrence of postcholecystectomy syndrome.

  9. Vascular emergencies in cholelithiasis and cholecystectomy:our experience with two cases and literature review

    Institute of Scientific and Technical Information of China (English)

    Narasimhaiah Srinivasaiah; Maneesh Bhojak; Ralph Jackson; Sean Woodcock

    2008-01-01

    BACKGROUND: Complications from gallstones and laparoscopic cholecystectomy can be serious and fatal if there is a delay in recognition and treatment. We aim to present two unusual, life threatening vascular complications as a result of gallstones and laparoscopic cholecystectomy. Their management is highlighted with a brief review of literature. METHODS: Data for the article were gathered from clinical case note review. Radiology database was used for images. A brief literature review was undertaken using Pubmed search. The keywords used included hemobilia, pseudoaneurysm, arterio-biliary ifstula and laparoscopic cholecystectomy. RESULTS: The article highlights two individual case reports. The ifrst case constitutes an 81-year woman who had cystic arterial erosion causing hematemesis, while the second patient was a 57-year man who presented with hemobilia from a pseudoaneurysm of right hepatic artery (RHA) following laparoscopic cholecystectomy. Cystic arterial erosion was treated with subtotal cholecystectomy with duodenal defect closure while the pseudoaneurysm underwent radiological intervention. CONCLUSIONS: Cystic artery erosion and pseudoaneurysm causing arteriobiliary ifstula are rare vascular complications related to the biliary tree. A high index of suspicion and timely intervention is important. Trauma to arteries should be avoided during laparoscopic cholecystectomy.

  10. Small cell cervical cancer: an unusual finding at cholecystectomy.

    LENUS (Irish Health Repository)

    Boyle, Emily

    2012-02-01

    BACKGROUND: Small cell carcinoma of the cervix is a rare cancer, comprising less than 3% of all cervical neoplasms. It uniformly has a poor prognosis, and has a high mortality even with early stage disease. It can metastasise rapidly and metastatic sites include lung, liver, brain, bone, pancreas and lymph nodes. CASE: Here, we report the case of a 60-year-old woman with no symptoms of cervical pathology who developed post-renal failure following a laparoscopic cholecystectomy. The cause was bilateral ureteric obstruction from metastatic small cell cervical cancer and metastases were subsequently found on her gallbladder specimen. CONCLUSION: This is an unusual presentation of small cell cervical cancer and demonstrates the aggressive nature of this disease.

  11. Laparoscopic cholecystectomy performed by residents at a University Hosp

    Directory of Open Access Journals (Sweden)

    M. N. Brito Viglione

    2015-04-01

    Full Text Available The aim of this paper was to evaluate the results of laparoscopic cholecystectomy (CL in patients operated on by residents, reviewing morbidity and conversion to laparotomy surgery. A cross-sectional retrospective study was performed selecting patients admitted to the database service, operated by residents of CL in a period from 1/1/11 to 6/30/13. 363 CL were made by residents, presenting a 1.4% conversion, 2.7% of postoperative complications and 1.4% of readmissions. In this series there were no bile duct injury. CL is a safe procedure with low morbidity when performed by residents in an academic institution, when it has adequate supervision.

  12. No effect of melatonin on oxidative stress after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Kücükakin, B.; Klein, M.; Lykkesfeldt, Jens

    2010-01-01

    Background Melatonin, an endogenous circadian regulator, also has antioxidant and anti-inflammatory properties. The aim of this study was to evaluate the antioxidative effect of melatonin in patients undergoing laparoscopic cholecystectomy. Methods Patients were randomized to receive 10 mg...... melatonin or placebo during surgery. Blood samples for analysis of malondialdehyde (MDA), ascorbic acid (AA), total ascorbic acid (TAA) dehydroascorbic acid (DHA) and C-reactive protein (CRP) were collected pre-operatively and at 5 min, 6 h and 24 h after operation. Results Twenty patients received...... melatonin and 21 patients received placebo during surgery. No significant differences were observed between the groups in the oxidative stress variables MDA, TAA, AA and DHA or in the inflammatory variable CRP (repeated-measures ANOVA, P > 0.05 for all variables). Conclusions Administration of 10 mg...

  13. Quality of information available over internet on laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Jayaweera Muhandiramge Uthpala Jayaweera

    2016-01-01

    Full Text Available Background: The purpose of this study was to evaluate the quality of information available on the internet to patients undergoing laparoscopic cholecystectomy. Materials and Methods: The sources of information were obtained the keyword 'laparoscopic cholecystectomy', from internet searches using Google, Bing, Yahoo!, Ask and AOL search engines with default settings. The first 50 web links were evaluated for their accessibility, usability and reliability using the LIDA tool (validation instrument for healthcare websites by Minervation.The readability of the websites was assessed by using the Flesch Reading Ease Score (FRES and the Gunning Fog Index (GFI. Results: Of the 250 links, 90 were new links. Others were repetitions, restricted access sites or inactive links. The websites had an average accessibility score of 52/63 (83.2%; range 40-62, a usability score of 39/54 (73.1%; range 23-49 and a reliability score of 14/27 (51.6%; range 5-24. Average FRES was 41.07 (4.3-86.4 and average GFI was 11.2 (0.6-86.4. Discussion and Conclusion: Today, most people use the internet as a convenient source of information. With regard to health issues, the information available on the internet varies greatly in accessibility, usability and reliability. Websites appearing at the top of the search results page may not be the most appropriate sites for the target audience. Generally, the websites scored low on reliability with low scores on content production and conflict-of-interest declaration. Therefore, previously evaluated references on the World Wide Web should be given to patients and caregivers to prevent them from being exposed to commercially motivated or inaccurate information.

  14. Effect of intravenous esmolol on analgesic requirements in laparoscopic cholecystectomy

    Science.gov (United States)

    Dhir, Ritima; Singh, Mirley Rupinder; Kaul, Tej Kishan; Tewari, Anurag; Oberoi, Ripul

    2015-01-01

    Background and Aims: Perioperative beta blockers are also being advocated for modulation of acute pain and reduction of intraoperative anesthetic requirements. This study evaluated the effect of perioperative use of esmolol, an ultra short acting beta blocker, on anesthesia and modulation of post operative pain in patients of laproscopic cholecystectomy. Material and Methods: Sixty adult ASA I & II grade patients of either sex, scheduled for laparoscopic cholecystectomy under general anesthesia, were enrolled in the study. The patients were randomly allocated to one of the two groups E or C according to computer generated numbers. Group E- Patients who received loading dose of injection esmolol 0.5 mg/kg in 30 ml isotonic saline, before induction of anesthesia, followed by an IV infusion of esmolol 0.05 μg/kg/min till the completion of surgery and Group C- Patients who received 30 ml of isotonic saline as loading dose and continuous infusion of isotonic saline at the same rate as the esmolol group till the completion of surgery. Results: The baseline MAP at 0 minute was almost similar in both the groups. At 8th minute (time of intubation), MAP increased significantly in group C as compared to group E and remained higher than group E till the end of procedure. Intraoperatively, 16.67% of patients in group C showed somatic signs as compared to none in group E. The difference was statistically significant. 73.33% of patients in group C required additional doses of Inj. Fentanyl as compared to 6.67% in group E. Conclusions: We conclude that intravenous esmolol influences the analgesic requirements both intraoperatively as well as postoperatively by modulation of the sympathetic component of the pain i.e. heart rate and blood pressure. PMID:26330719

  15. Effect of intravenous esmolol on analgesic requirements in laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Ritima Dhir

    2015-01-01

    Full Text Available Background and Aims: Perioperative beta blockers are also being advocated for modulation of acute pain and reduction of intraoperative anesthetic requirements. This study evaluated the effect of perioperative use of esmolol, an ultra short acting beta blocker, on anesthesia and modulation of post operative pain in patients of laproscopic cholecystectomy. Material and Methods: Sixty adult ASA I & II grade patients of either sex, scheduled for laparoscopic cholecystectomy under general anesthesia, were enrolled in the study. The patients were randomly allocated to one of the two groups E or C according to computer generated numbers. Group E- Patients who received loading dose of injection esmolol 0.5 mg/kg in 30 ml isotonic saline, before induction of anesthesia, followed by an IV infusion of esmolol 0.05 μg/kg/min till the completion of surgery and Group C- Patients who received 30 ml of isotonic saline as loading dose and continuous infusion of isotonic saline at the same rate as the esmolol group till the completion of surgery. Results: The baseline MAP at 0 minute was almost similar in both the groups. At 8th minute (time of intubation, MAP increased significantly in group C as compared to group E and remained higher than group E till the end of procedure. Intraoperatively, 16.67% of patients in group C showed somatic signs as compared to none in group E. The difference was statistically significant. 73.33% of patients in group C required additional doses of Inj.Fentanyl as compared to 6.67% in group E. Conclusions: We conclude that intravenous esmolol influences the analgesic requirements both intraoperatively as well as postoperatively by modulation of the sympathetic component of the pain i.e. heart rate and blood pressure.

  16. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

    DEFF Research Database (Denmark)

    Gurusamy, K; Samraj, K; Gluud, C

    2010-01-01

    BACKGROUND:: In many countries laparoscopic cholecystectomy for acute cholecystitis is mainly performed after the acute episode has settled because of the anticipated increased risk of morbidity and higher conversion rate from laparoscopic to open cholecystectomy. METHODS:: A systematic review...

  17. Premedication with clonidine versus fentanyl for intraoperative hemodynamic stability and recovery outcome during laparoscopic cholecystectomy under general anesthesia

    OpenAIRE

    Gupta, Kumkum; Lakhanpal, Mahima; Prashant K.Gupta; Krishan, Atul; Rastogi, Bhawna; Tiwari, Vaibhav

    2013-01-01

    Background: Laparoscopic cholecystectomy under general anesthesia induced intraoperative hemodynamic responses which should be attenuated by appropriate premedication. The present study was aimed to compare the clinical efficacy of clonidine and fentanyl premedication during laparoscopic cholecystectomy for attenuation of hemodynamic responses with postoperative recovery outcome. Subjects and Methods: In this prospective randomized double blind study 64 adult consented patients of either sex ...

  18. Cholecystectomy in sickle cell anemia patients : Perioperative outcome of 364 cases from the national preoperative transfusion study

    NARCIS (Netherlands)

    Haberkern, CM; Neumayr, LD; Orringer, EP; Earles, AN; Robertson, SM; Abboud, MR; Koshy, M; Idowu, O; Vichinsky, EP; Black, D.

    1997-01-01

    Cholecystectomy is the most common surgical procedure performed in sickle cell anemia (SCA) patients. We investigated the effects of transfusion and surgical method on perioperative outcome. A total of 364 patients underwent cholecystectomy: group 1 (randomized to aggressive transfusion) 110 patient

  19. Randomized Controlled Trial of Conventional Carbon Dioxide Pneumoperitoneum versus Gasless Technique for Laparoscopic Cholecystectomy

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    Nikhil Talwar, Rahul Pusuluri, Mohinder Paul Arora, Mridula Pawar

    2006-04-01

    Full Text Available Concerns about pathophysiologic changes and disadvantages associated with carbon dioxidepneumoperitoneum during laparoscopic cholecystectomy have led to the introduction of gasless laparoscopyemploying abdominal wall lifting (AWL method. However, AWL has been criticized for its complexityand technical difficulty. We have used AWL method for gasless laparoscopic cholecystectomy and comparedit with laparoscopic cholecystectomy with respect to operation performance, postoperative course, andpathophysiologic changes. During a four-month period, 40 consecutive patients with symptomatic gallstoneswere randomly assigned to receive laparoscopic cholecystectomy with conventional CO2 pneumoperitoneum(PP group; N=20 or the AWL method (AWL group; N=20. Operative results and operative time wererecorded. Cardiopulmonary and ventilatory functions were assessed during the surgery. Postoperativepain and presence of nausea and vomiting were assessed for 48 hours after surgery. Postoperative time torecovery of flatus, tolerance to a full oral diet, and full activity were also determined. The intraoperativecardiopulmonary and ventilatory functions deteriorated significantly less in the AWL group. The preparationtime for surgery and total operative time were significantly greater in the AWL group. None of the patientsin either group required conversion to open surgery. Technique related morbidity was minimal and therewas no mortality in either group. Although AWL method required a longer operation time, our resultssuggest that the technique is valuable in high-risk patients with cardiorespiratory disease. AWL techniqueof laparoscopic cholecystectomy is a feasible, safe and effective alternative to CO2 pneumoperitoneum. Itprobably costs less and is therefore, more useful in developing countries.

  20. LAPAROSCOPIC CHOLECYSTECTOMY REQUIRES CONVERSION IN FEW PATIENTS ONLY: A PROSPECTIVE STUDY OF 370 PATIENTS

    Directory of Open Access Journals (Sweden)

    Mahesh

    2015-12-01

    Full Text Available BACKGROUND Gallstone disease is a major health problem worldwide and laparoscopic cholecystectomy(LC has become the gold standard surgical treatment of this entity. There are various complications related to this procedure which may lead to conversion into open cholecystectomy. We have done a prospective study of 370 cases in our institution to assess the reasons for conversion from LC to open cholecystectomy. MATERIAL AND METHODS 370 cases of symptomatic gallstones were admitted in surgical unit of Rama Medical College Hospital & Research Centre, Kanpur, U.P and all of them had undergone LC. The study was done prospectively from September 2013 to August 2015. All the patients with symptomatic gallstone disease including acute cholecystitis were included in this study and the reasons for conversion were recorded. RESULTS In our study we had to convert only 9(2.43% cases out of 370 into open cholecystectomy and the most common reason found was dense adhesions and acutely inflamed gallbladder with a very low incidence of bile duct injury. CONCLUSIONS Despite of good selection of cases and experience of the operating surgeon few cases of laparoscopic cholecystectomy may require conversion into the open procedure.

  1. The Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    J. Diez

    1998-01-01

    Full Text Available A retrospective study was carried in 1500 patients submitted to elective laparoscopic cholecystectomy to ascertain its feasibility in patients with previous abdominal surgery. In 411 patients (27.4% previous infraumbilical intraperitoneal surgery had been performed, and 106 of them (7.06% had 2 or more operations. Twenty five patients (1.66% had previous supraumbilical intraperitoneal operations (colonic resection, hydatid liver cysts, gastrectomies, etc. One of them had been operated 3 times. In this group of 25 patients the first trocar and pneumoperitoneum were performed by open laparoscopy. In 2 patients a Marlex mesh was present from previous surgery for supraumbilical hernias. Previous infraumbilical intraperitoneal surgery did not interfere with laparoscopic cholecystectomy, even in patients with several operations. There was no morbidity from Verres needle or trocars. In the 25 patients with supraumbilical intraperitoneal operations, laparoscopic cholecystectomy was completed in 22. In 3, adhesions prevented the visualization of the gallbladder and these patients were converted to an open procedure. In the 2 patients Marlex mesh prevented laparoscopic cholecystectomy because of adhesions to abdominal organs. We conclude that in most instances previous abdominal operations are no contraindication to laparoscopic cholecystectomy.

  2. Early laparoscopic cholecystectomy is the appropriate management for acute gangrenous cholecystitis.

    Science.gov (United States)

    Choi, Sae Byeol; Han, Hyung Joon; Kim, Chung Yun; Kim, Wan Bae; Song, Tae-Jin; Suh, Sung Ock; Kim, Young Chul; Choi, Sang Yong

    2011-04-01

    Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications. We determined whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. The medical records of 116 patients with acute gangrenous cholecystitis admitted to the Korea University Guro Hospital between January 2005 and December 2009 were reviewed. The early operation group, those patients who had cholecystectomies within 4 days of the diagnosis, was compared with the delayed operation group, who had cholecystectomies 4 days after the diagnosis. Of the 116 patients, 57 were in the early operation group and 59 were in the delayed operation group. There were no statistical differences between the groups with respect to gender, age, body mass index, operative methods, major complications, duration of symptoms, mean operative time (98 vs 107 minutes), or postoperative hospital stay. However, the total hospital stay was significantly longer in the delayed operation group. More patients underwent preoperative percutaneous cholecystostomy in the delayed operation group (3.5 vs 15.3%). Early laparoscopic cholecystectomy for acute gangrenous cholecystitis is safe and feasible. There is no advantage to postponing an urgent operation in patients with acute gangrenous cholecystitis.

  3. Spinal anesthesia for laparoscopic cholecystectomy: Thoracic vs. Lumbar Technique

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2014-01-01

    Full Text Available Aims: In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a prospective study with all patients undergoing LC under spinal anesthesia in our department since 2007. Settings and Design: Prospective observational. Materials and Methods: From 2007 to 2011, 369 patients with symptoms of colelithiasis, laparoscopic cholecystectomy were operated under spinal anesthesia with pneumoperitoneum and low pressure CO 2. We compared 15 mg of hyperbaric bupivacaine and lumbar puncture with 10 or 7.5 mg of hyperbaric bupivacaine thoracic puncture, all with 25 μg fentanyl until the sensory level reached T 3 . Intraoperative parameters, post-operative pain, complications, recovery, patient satisfaction, and cost were compared between both groups. Statistical Analysis Used: Means were compared by ANOVA or Kruskal-Wallis test, the percentages of the Chi-square test or Fisher′s exact test when appropriate. Time of motor and sensory block in spinal anesthesia group was compared by paired t test or Mann-Whitney test. Differences were considered significant when P ≤ 0.05, and for comparisons of mean pain visual scale, we employed the Bonferroni correction applied to be considered significant only with P ≤ 0.0125 Results: All procedures were completed under spinal anesthesia. The use of lidocaine 1% was successful in the prevention of shoulder pain in 329 (89% patients. There were significant differences in time to reach T 3 , obtaining 15 mg > 10 mg = 7.5 mg. There is a positive correlation between the dose and the incidence of hypotension. The lowest doses gave a decrease of 52.2% in the incidence of hypotension. There was a positive correlation between the dose and duration of sensory and motor block. Sensory block was almost twice the motor block at all doses. With low doses, 60% of patients went from table to stretcher

  4. Factors associated with time to laparoscopic cholecystectomy for acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Chris N Daniak; David Peretz; Jonathan M Fine; Yun Wang; Alan K Meinke; William B Hale

    2008-01-01

    AIM:To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis.METHODS:A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted.Data collected included demographic data,co-morbidities,symptoms and physical findings at presentation,laboratory and radiological investigations,length of stay,complications,and admission service (medical or surgical).Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis.Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures,presenting signs,and admitting service with time to surgery.RESULTS:Seventy cases met inclusion and exclusion criteria,among which 12 were admitted to the medical service and 58 to the surgical service.Mean±SD time to surgery was 39.3±43 h,with 87% of operations performed within 72 h of hospital arrival.In the adjusted models,longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP,P=0.01) as well with admission to medical service without adjustment for ERCP (P<0.05).Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery.Patients admitted to the surgical versus medical service underwent surgery earlier (30.4±34.9 vs 82.7±55.1 h,P<0.01),had less postoperative complications (12% vs 58%,P<0.01),and shorter length of stay (4.3±3.4 vs 8.1±5.2 d,P<0.01).CONCLUSION:Admission to the medical service and performance of numerous diagnostic procedures,ERCP,or MRCP combined with CT scan were associated with longer time to surgery.Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.

  5. Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial: study protocol for a randomized controlled trial

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    Bouwense Stefan A

    2012-11-01

    Full Text Available Abstract Background After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. During this waiting period, the patient is at risk of recurrent biliary events. In current clinical practice, surgeons usually postpone cholecystectomy for 6 weeks due to a perceived risk of a more difficult dissection in the early days following pancreatitis and for logistical reasons. We hypothesize that early laparoscopic cholecystectomy minimizes the risk of recurrent biliary pancreatitis or other complications of gallstone disease in patients with mild biliary pancreatitis without increasing the difficulty of dissection and the surgical complication rate compared with interval laparoscopic cholecystectomy. Methods/Design PONCHO is a randomized controlled, parallel-group, assessor-blinded, superiority multicenter trial. Patients are randomly allocated to undergo early laparoscopic cholecystectomy, within 72 hours after randomization, or interval laparoscopic cholecystectomy, 25 to 30 days after randomization. During a 30-month period, 266 patients will be enrolled from 18 hospitals of the Dutch Pancreatitis Study Group. The primary endpoint is a composite endpoint of mortality and acute re-admissions for biliary events (that is, recurrent biliary pancreatitis, acute cholecystitis, symptomatic/obstructive choledocholithiasis requiring endoscopic retrograde cholangiopancreaticography including cholangitis (with/without endoscopic sphincterotomy, and uncomplicated biliary colics occurring within 6 months following randomization. Secondary endpoints include the individual endpoints of the composite endpoint, surgical and other complications, technical difficulty of cholecystectomy and costs. Discussion The PONCHO trial is designed to show that early

  6. The First Trocar Entry in the Laparoscopic Cholecystectomy, Which Technique?

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    Ahmet Serdar Karaca

    2013-10-01

    Full Text Available Aim: We planned a comparison of veress needle (VN and direct trocar (DT insertion techniques, which have been commonly used in laparoscopic surgical procedures, via a prospective randomized clinical study. Material and Method: 400 patients who had undergone laparoscopic cholecystectomy were included to the present prospective randomized clinical study. SPSS 17.0 (SPSS Inc., Chicago, IL was used for the statistical analysis. Insufflation-related technical complications were investigated in two groups. The cases requiring open surgery (mesenteric laceration, bleeding, organ perforation, solid organ injury and blood vessel injuries were determined as major complications. Minor complications (subcutaneous emphysema, phison and extraperitoneal insufflation were established as factors not changing the length of hospital stay. Results: Mortality was not observed in both groups. There was no difference between the groups with respect to mean age, male to female ratio, BMI and duration of surgery. 33 minor complications were detected. 27 of these complications were observed in the VN group, whereas the number of minor complications seen in the DT group was 6. Major complications seen in the VN and DT groups were respectively 3 and 1. Discussion: If pneumoperitoneum is established by close method, there is no safety-related significant difference between the insertion of DT and VN.

  7. Analgesic Effect of Preoperative Pentazocine for Laparoscopic Cholecystectomy

    Science.gov (United States)

    Wang, Na; Wang, Lei; Gao, Yang; Zhou, Honglan

    2016-01-01

    Objective: To assess whether preoperative pentazocine can reduce intraoperative hemodynamic changes and postoperative pain. Methods: Fifty patients undergoing laparoscopic cholecystectomy were randomized into two groups. Group P received intravenous 0.5 mg/kg pentazocine 10 min before surgery, and Group C received normal saline as a placebo. A standardized general anesthesia was conducted in all patients. Mean blood pressure (MBP), heart rate (HR), and visual analog scale (VAS) scores at various time points were recorded. The tramadol consumption during the study period was recorded. Results: Group P had lower VAS scores at two, four, and eight hours postoperatively compared with Group C. MBP and HR rose significantly because of pneumoperitoneum within Group C, and no significant changes were detected in MBP and HR within Group P. Tramadol doses given were statistically fewer in Group P. Conclusion: Preoperative intravenous pentazocine can decrease intraoperative hemodynamic changes and postoperative pain. PMID:28168126

  8. Will intraoperative cholangiography prevent biliary duct injury inlaparoscopic cholecystectomy?

    Institute of Scientific and Technical Information of China (English)

    Li Bo Li; Xiu Jun Cai; Jun Da Li; Yi Ping Mu; Yue Dong Wang; Xiao Ming Yuan; Xian Fa Wang; Urs Bryner; Robert K.Finley Jr

    2000-01-01

    AIM To evaluate the role of intraoperative cholangiogram (IOC) in preventing biliary duct injury duringlaparoscopic cholecystectomy.METHODS Injury location, mechanism, time of detection, treatment outcome, and whether anintraoperative cholangiogram was performed were evaluated in 31 cases of bile duct injuries.RESULTS Cholangiograms were done in 22 cases, but they were misinterpreted in 3 of them. In 12 of 19misidentified cases, the cholangiogram was interpreted correctly, and the injury detected intraoperatively.Primary laparoscopic repair or open repair and T-tube drainage solved the problem. No long-termcomplications occurred. However, in 3 of the 19 cases the cholangiogram was misinterpreted and in 4 of the19 cases no cholangiogram was performed. Three of the seven patients required a cholangioentericanastomosis. In 2 cases the diagnosis was delayed and one of these required a two-stage procedure. Morbiditywas increased. Three cases of clim impingement of the common duct had delayed diagnoses, and two of themhad injuries. Thermal injury developed in 4 cases who had cholangiograms.CONCLUSION Routine IOC plays no role in inducing, preventing, detecting, or minimizing any of theinjuries due to clips, lacerations, or electrocautery, IOC does not prevent injuries due to ductmisidentification either. Careful interpretation of IOC would prevent injuries and avoid an open operation.

  9. Covert Laparoscopic Cholecystectomy: A New Minimally Invasive Technique

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    Hu,Hai

    2011-10-01

    Full Text Available To further improve our developed transumbilical endoscopic surgery (TUES, we developed a completely covert laparoscopic cholecystectomy (LC. Twelve cases of LC were recruited for this new approach. First, a 10-mm trocar was placed above the umbilicus for inserting the laparoscope. Two 5-mm trocars were then placed near the right and left ends of the superior margin of the suprapubic hair. After the 5-mm 30° laparoscope was shifted to the left suprapubic trocar, the harmonic scalper, electric hook, and grasper were inserted either through the 10-mm umbilical trocar or through the right suprapubic trocar. All gallbladders were successfully removed without intraoperative complications. The mean operating time was 28.5±5.7min (range 20-45min. All patients felt well after surgery and did not need postoperative analgesia. They resumed free oral intake 6h after the procedure. All patients were satisfied with the appearance of the incisions, which were completely hidden in the umbilicus and suprapubic hair. The approach we developed has overcome both external instrument interference around the umbilicus and the loss of triangulation in the operative field. It is relatively simpler than a typical TUES and offers better cosmetic results.

  10. Efficacy of cholangiography under helical computed tomography for laparoscopic cholecystectomy

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    Takeuchi, Motoya; Hishiyama, Houhei [Asahikawa Red Cross Hospital, Hokkaido (Japan); Kondo, Satoshi; Katoh, Hiroyuki [Hokkaido Univ., Sapporo (Japan). Graduate School of Medicine

    2002-05-01

    Although laparoscopic cholecystectomy (LC) is known to be safe, the optimal imaging technique for examining the common bile duct and cystic duct prior to laparoscopic intervention remains controversial. The objective of this study was to evaluate the efficacy of cholangiography under helical computed tomography (helical CT cholangiography) for LC. We studied 53 consecutive patients who underwent LC carried out by the same surgeon. The data of 23 of these patients who had undergone LC before the introduction of helical CT were used as the reference standard. Among the 53 patients, 28 were prospectively randomized for preoperative biliary tract evaluation with versus without helical CT cholangiography, into a CT/+ group (n=13) and a CT/- group (n=15), respectively. Two patients were excluded from the study preoperatively. There were no significant differences in age or laboratory findings, including liver function tests or the serum amylase level before or after surgery, between the two groups. In the CT/- group, endoscopic retrograde cholangiography-related pancreatitis developed in one patient, and one patient required conversion to open surgery. In contrast, in the CT/+ group, there were no preoperative complications and no patient required conversion to open surgery. The mean operative time was significantly shorter in the CT/+ group than in the CT/- group (P=0.0137). These findings provide evidence to support the advantages of helical CT cholangiography in relation to operative time, conversion, and procedure-related preoperative complications. (author)

  11. Laparoscopic cholecystectomy under continuous spinal anesthesia in a patient with Steinert's disease

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    Mariana Correia

    2016-04-01

    Full Text Available ABSTRACT Steinert's disease is an intrinsic disorder of the muscle with multisystem manifestations. Myotonia may affect any muscle group, is elicited by several factors and drugs used in general anesthesia like hypnotics, sedatives and opioids. Although some authors recommend the use of regional anesthesia or combined anesthesia with low doses of opioids, the safest anesthetic technique still has to be established. We performed a continuous spinal anesthesia in a patient with Steinert's disease undergoing laparoscopic cholecystectomy using 10 mg of bupivacaine 0.5% and provided ventilatory support in the perioperative period. Continuous spinal anesthesia was safely used in Steinert's disease patients but is not described for laparoscopic cholecystectomy. We reported a continuous spinal anesthesia as an appropriate technique for laparoscopic cholecystectomy and particularly valuable in Steinert's disease patients.

  12. Clips migration to duodenum as a rare complication of laparoscopic cholecystectomy

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    Muammer Bilici

    2016-03-01

    Full Text Available Endoclip migration into the duodenum is an extremely rare complication of laparoscopic cholecystectomy. The patients usually present with bleeding ulcer. Here we report a 65-year-old female patient with a complaint of abdominal pain and dyspepsia due to clip migration into the duodenum after laparoscopic cholecystectomy secondary to symptomatic cholelithiasis 15 months previously. Ultrasonography and liver function tests were normal. Endoscopy showed metal clips in the second part of duodenum. The clips were removed endoscopically. No active bleeding was noted. In this case report, we present diagnosis and management of clips migration into wall of duodenum as a complication of laparoscopic cholecystectomy. [Cukurova Med J 2016; 41(0.100: 71-74

  13. Early endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy can strain the occurrence of trocar site hernia.

    Science.gov (United States)

    Sumer, Fatih; Kayaalp, Cuneyt; Yagci, Mehmet Ali; Otan, Emrah; Kocaaslan, Huseyin

    2014-11-16

    This study reports a 69-year-old, obese, female patient presenting with a biliary leakage after laparoscopic cholecystectomy for cholelithiasis. Closure of the umbilical trocar site had been neglected during the laparoscopic cholecystectomy. Early, on postoperative day five, endoscopic retrograde cholangiopancreatography (ERCP) requirement after laparoscopic cholecystectomy resolved the biliary leakage problem but resulted with a more complicated clinical picture with an intestinal obstruction and severe abdominal pain. Computed tomography revealed a strangulated hernia from the umbilical trocar site. Increased abdominal pressure during ERCP had strained the weak umbilical trocar site. Emergency surgical intervention through the umbilicus revealed an ischemic small bowel segment which was treated with resection and anastomosis. This report demonstrates that negligence of trocar site closure can result in very early herniation, particularly if an endoscopic intervention is required in the early postoperative period.

  14. National Trends in the Adoption of Laparoscopic Cholecystectomy over 7 Years in the United States and Impact of Laparoscopic Approaches Stratified by Age

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    Anahita Dua

    2014-01-01

    Full Text Available Introduction. The aim of this study was to characterize national trends in adoption of laparoscopic cholecystectomy and determine differences in outcome based on type of surgery and patient age. Methods. Retrospective cross-sectional study of patients undergoing cholecystectomy. Trends in open versus laparoscopic cholecystectomy by age group and year were analyzed. Differences in outcomes including in-hospital mortality, complications, discharge disposition, length of stay (LOS, and cost are examined. Results. Between 1999 and 2006, 358,091 patients underwent cholecystectomy. In 1999, patients aged ≥80 years had the lowest rates of laparoscopic cholecystectomy, followed by those aged 65–79, 64–50, and 49–18 years (59.7%, 65.3%, 73.2%, and 83.5%, resp., P<0.05. Laparoscopic cholecystectomy was associated with improved clinical and economic outcomes across all age groups. Over the study period, there was a gradual increase in laparoscopic cholecystectomy performed among all age groups during each year, though elderly patients continued to lag significantly behind their younger counterparts in rates of laparoscopic cholecystectomy. Conclusion. This is the largest study to report trends in adoption of laparoscopic cholecystectomy in the US in patients stratified by age. Elderly patients are more likely to undergo open cholecystectomy. Laparoscopic cholecystectomy is associated with improved clinical outcomes.

  15. National Trends in the Adoption of Laparoscopic Cholecystectomy over 7 Years in the United States and Impact of Laparoscopic Approaches Stratified by Age

    Science.gov (United States)

    Aziz, Abdul; Desai, Sapan S.; McMaster, Jason

    2014-01-01

    Introduction. The aim of this study was to characterize national trends in adoption of laparoscopic cholecystectomy and determine differences in outcome based on type of surgery and patient age. Methods. Retrospective cross-sectional study of patients undergoing cholecystectomy. Trends in open versus laparoscopic cholecystectomy by age group and year were analyzed. Differences in outcomes including in-hospital mortality, complications, discharge disposition, length of stay (LOS), and cost are examined. Results. Between 1999 and 2006, 358,091 patients underwent cholecystectomy. In 1999, patients aged ≥80 years had the lowest rates of laparoscopic cholecystectomy, followed by those aged 65–79, 64–50, and 49–18 years (59.7%, 65.3%, 73.2%, and 83.5%, resp., P < 0.05). Laparoscopic cholecystectomy was associated with improved clinical and economic outcomes across all age groups. Over the study period, there was a gradual increase in laparoscopic cholecystectomy performed among all age groups during each year, though elderly patients continued to lag significantly behind their younger counterparts in rates of laparoscopic cholecystectomy. Conclusion. This is the largest study to report trends in adoption of laparoscopic cholecystectomy in the US in patients stratified by age. Elderly patients are more likely to undergo open cholecystectomy. Laparoscopic cholecystectomy is associated with improved clinical outcomes. PMID:24790759

  16. Role of preoperative sonography in predicting conversion from laparoscopic cholecystectomy to open surgery

    Energy Technology Data Exchange (ETDEWEB)

    Tosun, Alptekin, E-mail: tosun_alptekin@yahoo.com [Giresun University Hospital, Department of Radiology (Turkey); Hancerliogullari, Kadir Oymen [Giresun University Hospital, Department of Pediatric Surgery (Turkey); Serifoglu, Ismail [Bulent Ecevit University Hospital, Department of Radiology (Turkey); Capan, Yavuz [Gaziantep Primer Hospital, Department of Surgery (Turkey); Ozkaya, Enis [Dr. Sami Ulus Maternity and Children' s Health Training and Research Hospital, Department of Obstetrics and Gynecology (Turkey)

    2015-03-15

    Highlights: •The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. The study may be a guide for the surgeon to prefer laparoscopic or open surgery. -- Abstract: Background: Laparoscopic cholecystectomy is the first step treatment in cholelithiasis. The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. Methods: This study included 176 patients who had undergone laparoscopic cholecystectomy. Preoperative ultrasonographic findings were assessed and we gave points to each finding according to results from correlation analysis. After the scoring we investigated the relationship between ultrasonographic findings and conversion from laparoscopic cholecystectomy to open surgery. Results: Scoring significantly predicted failure in laparoscopic approach (AUC = 0.758, P = 0.003,). Optimal cut off score was found to be 1.95 with 67% sensitivity and 78% specificity. Score > 1.95 was a risk factor for failure in laparoscopic approach [odds ratio = 7.1(95% CI,2-24.9, P = 0.002)]. There were 8 subjects out of 36(22%) with high score underwent open surgery while 4 out of 128 (3%) subjects with low score needed open surgery (p = 0.002). Negative predictive value of 128/132 = 97%. Mean score of whole study population was 1.28 (range 0–8.8) and mean score of subjects underwent open surgery was 3.6 while it was 1.1 in successful laparoscopic approach group (p < 0.001). Mean Age and BMI were similar between groups (p > 0.05). Sex of subjects did not affect the success of surgery (p > 0.05). Conclusion: The contribution of preoperative ultrasonography is emphasized in many studies. Our study suggests quantitative results on conversion from laparoscopic cholecystectomy to open surgery. We believe that radiologists have to indicate the risk of conversion in their ultrasonography reports.

  17. Three-Port Laparoscopic Cholecystectomy in a Brazilian Amazon Woman with Situs Inversus Totalis: Surgical Approach

    Directory of Open Access Journals (Sweden)

    Mauro Neiva Fernandes

    2008-05-01

    Full Text Available Situs inversus totalis (SIT is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT.

  18. Three-port laparoscopic cholecystectomy in a brazilian Amazon woman with situs inversus totalis: surgical approach.

    Science.gov (United States)

    Fernandes, Mauro Neiva; Neiva, Ivan Nazareno Campos; de Assis Camacho, Francisco; Meguins, Lucas Crociati; Fernandes, Marcelo Neiva; Meguins, Emília Maíra Crociati

    2008-05-24

    Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT.

  19. Pain after microlaparoscopic cholecystectomy. A randomized double-blind controlled study

    DEFF Research Database (Denmark)

    Bisgaard, T; Klarskov, B; Trap, R;

    2000-01-01

    BACKGROUND: Laparoscopic cholecystectomy (LC) is traditionally performed with two 10-mm and two 5-mm trocars. The effect of smaller port incisions on pain has not been established in controlled studies. METHODS: In a double-blind controlled study, patients were randomized to LC or cholecystectomy......: The study was discontinued after inclusion of 26 patients because five of the 13 patients (38%) randomized to micro-LC were converted to LC. In the remaining 21 patients, overall pain and incisional pain intensity during the first 3 h postoperatively increased in the LC group (n = 13) compared...

  20. Pre and per operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters

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    Gaurav Gupta

    2015-11-01

    Methods: In 50 consecutive patients who underwent LC during 2013 to 2014 patient's characteristics, clinical history, laboratory data, ultrasonography results and intraoperative details were prospectively analyzed to determine predictors of difficult LC. Results: Of 50 patients 3 (06% required conversion to open cholecystectomy. Significant predictors of conversion were obscured anatomy of Calot's due to adhesions, sessile gall bladder, male gender and gall bladder wall thickness >3 mm. Conclusions: With preoperative clinical and ultrasonographic parameters, proper patient selection can be made to help predict difficult LC and a likelihood of conversion to open cholecystectomy. [Int J Res Med Sci 2015; 3(11.000: 3342-3346

  1. Left-sided gallbladder discovered during laparoscopic cholecystectomy in a patient with dextrocardia.

    Science.gov (United States)

    Sadhu, Sagar; Jahangir, Tarshid A; Roy, Manas K

    2012-04-01

    Left-sided gallbladder, a rare congenital anomaly, is often associated with transposition of single or multiple viscera of thorax and/or abdomen. Clinical features and routine presurgical ultrasonography could miss the anomalous position thereby producing unnecessary anxiety during surgery. Here we are reporting a patient with left-sided gallbladder, known to have dextrocardia with multiple intracardiac anomalies, and detected incidentally in a series of 1258 consecutive laparoscopic cholecystectomies. Laparoscopic cholecystectomy was performed successfully in this patient with port site modification and careful dissection. Some degree of abdominal visceral situs inversus is to be anticipated in patients with dextrocardia.

  2. Quality of information available over internet on laparoscopic cholecystectomy

    Science.gov (United States)

    Jayaweera, Jayaweera Muhandiramge Uthpala; De Zoysa, Merrenna Ishan Malith

    2016-01-01

    BACKGROUND: The purpose of this study was to evaluate the quality of information available on the internet to patients undergoing laparoscopic cholecystectomy. MATERIALS AND METHODS: The sources of information were obtained the keyword ‘laparoscopic cholecystectomy’, from internet searches using Google, Bing, Yahoo!, Ask and AOL search engines with default settings. The first 50 web links were evaluated for their accessibility, usability and reliability using the LIDA tool (validation instrument for healthcare websites by Minervation). The readability of the websites was assessed by using the Flesch Reading Ease Score (FRES) and the Gunning Fog Index (GFI). RESULTS: Of the 250 links, 90 were new links. Others were repetitions, restricted access sites or inactive links. The websites had an average accessibility score of 52/63 (83.2%; range 40-62), a usability score of 39/54 (73.1%; range 23-49) and a reliability score of 14/27 (51.6%; range 5-24). Average FRES was 41.07 (4.3-86.4) and average GFI was 11.2 (0.6-86.4). DISCUSSION AND CONCLUSION: Today, most people use the internet as a convenient source of information. With regard to health issues, the information available on the internet varies greatly in accessibility, usability and reliability. Websites appearing at the top of the search results page may not be the most appropriate sites for the target audience. Generally, the websites scored low on reliability with low scores on content production and conflict-of-interest declaration. Therefore, previously evaluated references on the World Wide Web should be given to patients and caregivers to prevent them from being exposed to commercially motivated or inaccurate information. PMID:27609327

  3. Effect of surgical methods of cholecystectomy on immunity and stress reaction in patients with gallstones

    Institute of Scientific and Technical Information of China (English)

    Cheng-Gang Li

    2016-01-01

    Objective:To observe the effect of the selection of surgical methods of cholecystectomy on the immunity and stress reaction in patients with gallstones.Methods:A total of 150 patients with gallstones merged with cholecystitis who were admitted in our hospital from February, 2013 to May, 2015 for cholecystectomy were included in the study and divided into LC group and MC group with 75 cases in each group. The patients in LC group were performed with laparoscopic cholecystectomy, while the patients in MC group were performed with mini-incision cholecystectomy. The related indicators of immunological function and stress reaction in the two groups were compared.Results:The immunological functions 1d after operation in the two groups were reduced, and the reduced degree of CD3+ and CD4+ in MC group was more significant (P0.05).Conclusions:LC and MC have their own advantages and disadvantages. The two surgical methods have small effects on the immunological function, but MC has a great effect on the postoperative stress reaction; therefore, during the treatment process, the surgical method should be selected according to the patients practical physical conditions.

  4. Evaluation of operative notes concerning laparoscopic cholecystectomy: Are standards being met?

    NARCIS (Netherlands)

    L.S.G.L. Wauben; R.H.M. Goossens (Richard); J.F. Lange (Johan)

    2010-01-01

    textabstractBackground Laparoscopic cholecystectomy (LC) is the most performed minimal invasive surgical procedure and has a relatively high complication rate. As complications are often revealed postoperatively, clear, accurate, and timely written operative notes are important in order to recall th

  5. Blunt Dissection: A Solution to Prevent Bile Duct Injury in Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Xiu-Jun Cai; Han-Ning Ying; Hong Yu; Xiao Liang; Yi-Fan Wang; Wen-Bin Jiang; Jian-Bo Li

    2015-01-01

    Background: Laparoscopic cholecystectomy (LC) has been a standard operation and replaced the open cholecystectomy (OC) rapidly because the technique resulted in less pain, smaller incision, and faster recovery.This study was to evaluate the value of blunt dissection in preventing bile duct injury (BDI) in laparoscopic cholecystectomy (LC).Methods: From 2003 to 2015, LC was performed on 21,497 patients, 7470 males and 14,027 females, age 50.3 years (14-84 years).The Calot's triangle was bluntly dissected and each duct in Calot's triangle was identified before transecting the cystic duct.Results: Two hundred and thirty-nine patients (1.1%) were converted to open procedures.The postoperative hospital stay was 2.1 (0-158) days, and cases (46%) had hospitalization days of 1 day or less, and 92.8% had hospitalization days of 3 days or less;BDI was occurred in 20 cases (0.09%) including 6 cases of common BDI, 2 cases of common hepatic duct injury, 1 case of right hepatic duct injury, 1 case of accessory right hepatic duct, 1 case of aberrant BDI 1 case ofbiliary stricture, 1 case of biliary duct perforation, 3 cases ofhemobilia, and 4 cases of bile leakage.Conclusion: Exposing Calot's triangle by blunt dissection in laparoscopic cholecystectomy could prevent intraoperative BDI.

  6. Less surgical experience has no impact on mortality and morbidity after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Rothman, Josephine P; Burcharth, Jakob; Pommergaard, Hans-Christian;

    2015-01-01

    BACKGROUND: The number of cholecystectomies required to be fully educated as a surgeon has not yet been established. The European Association for Endoscopic Surgery, however, claims that inadequate experience is a risk factor for bile duct injury. The objective was to investigate surgical experie...

  7. Risk factors for conversion during laparoscopic cholecystectomy - experiences from a general teaching hospital.

    NARCIS (Netherlands)

    Steeg, H.J.J. van der; Alexander, S.; Houterman, S.; Slooter, G.D.; Roumen, R.M.

    2011-01-01

    BACKGROUND AND AIMS: Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic cholelithiasis. Conversion, however, is sometimes necessary. The aim of this study was to determine predictive factors of conversion in patients undergoing LC for various indications in elective and

  8. Case Report: Modified Laparoscopic Subtotal Cholecystectomy: An Alternative Approach to the “Difficult Gallbladder”

    Science.gov (United States)

    Segal, Michael S.; Huynh, Richard H.; Wright, George O.

    2017-01-01

    Patient: Male, 56 Final Diagnosis: Acute cholecystitis Symptoms: Abdominal pain Medication:— Clinical Procedure: Laparoscopic subtotal cholecystectomy Specialty: Surgery Objective: Unusual clinical course Background: Laparoscopic cholecystectomy is a commonly performed surgical procedure. In certain situations visualization of the Callot triangle can become difficult due to inflammation, adhesions, and sclerosing of the anatomy. Without being able to obtain the “critical view of safety” (CVS), there is increased risk of damage to vital structures. An alternative approach to the conventional conversion to an open cholecystectomy (OC) would be a laparoscopic subtotal cholecystectomy (LSC). Case Report: We present a case of a 56-year-old male patient with acute cholecystitis with a “difficult gallbladder” managed with LSC. Due to poor visualization of the Callot triangle due to adhesions, safe dissection was not feasible. In an effort to avoid injury to the common bile duct (CBD), dissection began at the dome of the gallbladder allowing an alternative view while ensuring safety of critical structures. Conclusions: We discuss the potential benefits and risks of LSC versus conversion to OC. Our discussion incorporates the pathophysiology that allows LSC in this particular circumstance to be successful, and the considerations a surgeon faces in making a decision in management. PMID:28220035

  9. Randomized clinical trial of single- versus multi-incision laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Jørgensen, Lars Nannestad; Rosenberg, J; Al-Tayar, H;

    2014-01-01

    BACKGROUND: There are no randomized studies that compare outcomes after single-incision (SLC) and conventional multi-incision (MLC) laparoscopic cholecystectomy under an optimized perioperative analgesic regimen. METHODS: This patient- and assessor-blinded randomized three-centre clinical trial c...

  10. Clinical characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy: A report of 40 cases

    Institute of Scientific and Technical Information of China (English)

    Han-Xin Zhou; Yue-Hua Guo; Xiao-Fang Yu; Shi-Yun Bao; Jia-Lin Liu; Yue Zhang; Yong-Gong Ren; Qun Zheng

    2006-01-01

    AIM: To summarize the performing essentials and analyze the characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy.METHODS: Robot-assisted laparoscopic cholecystectomy was performed in 40 patients between May 2004 and July 2005. The operating procedures and a variety of clinical parameters were recorded and analyzed.RESULTS: Forty laparoscopic cholecystectomy procedures were successfully completed with Zeus robotic system. And there were no post-operative complications. Total operating time, system setup time and performing time were 100.3±18.5 min, 27.7±8.8 min and 65.6±18.3 min, respectively. The blood loss and postoperative hospital stay were 30.6±10.2 mL and 2.8±0.8d, respectively. Camera clearing times and time used for operative field adjustment were 1.1 ± 1.0 min and 2.0± 0.8min, respectively. The operative error was 7.5%.CONCLUSION: Robot-assisted laparoscopic cholecystectomy following the principles of laparoscopic operation has specific performing essentials. It preserves the benefits of minimally invasive surgery and offers enhanced ability of controlling operation field, precise and stable operative manipulations.

  11. Randomized clinical trial of small-incision and laparoscopic cholecystectomy in patients with symptomatic cholecystolithiasis

    NARCIS (Netherlands)

    Keus, Frederik; Werner, Johanna E. M.; Gooszen, Hein G.; Oostvogel, Henk J. M.; van Laarhoven, Cornelis J. H. M.

    2008-01-01

    Objective: To evaluate the primary and clinical outcomes in laparoscopic and small-incision cholecystectomy. Design: Blinded randomized single-center trial emphasizing methodologic quality and generalizability. Setting: General teaching hospital in the Netherlands Patients: A total of 257 patients u

  12. Intent at day case laparoscopic cholecystectomy in Owerri, Nigeria: Initial experiences

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    Christopher Nonso Ekwunife

    2013-01-01

    Full Text Available Background and Objective: Laparoscopic cholecystectomy has been the default operation for cholelithiasis at Federal Medical Centre, Owerri for the past 2 years and the outcomes have been good. The duration of post operative stay has been decreasing. We therefore initiated a preliminary 2-year prospective study in May 2010 to determine the feasibility of carrying out day case laparoscopic cholecystectomy in our hospital. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were included in the study if they satisfied the following criteria: Age < 65 years, body mass index < 35 kg/m 2 , American Society of Anaesthesiology physical status class I and II, patient residence within 20 km radius of the hospital, patient acceptance of the procedure and absence of previous complicated upper abdominal surgery. Results: Twelve patients (10 females, 2 males were worked up with the intent of achieving same-day discharge of the patients. Five of the patients (41.7% were discharged on the day of operation. The reasons for overnight stay included inadequate pain control, insertion of drain and patient wishes. There was no conversion to open surgery, no major complications and no case of readmission to the hospital. Conclusions: Day case laparoscopic cholecystectomy in our environment could be safely promoted but will depend on improved facilities and patient enlightenment.

  13. Biohumoral and endocrine parameters in assessment of surgical trauma in open and laparoscopic cholecystectomy

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    Radunović Miodrag

    2013-01-01

    Full Text Available Background/Aim. Every surgical procedure causes metabolic, endocrine, and hemodynamic stress in the organism. The aim of this work was to assess the extent of trauma following each of the two types of cholecystectomy (traditional/open and laparoscopic by measuring palette of biochemical parameters. Methods. This prospective, single- center study included 120 patients subjected to elective cholecystectomy during the period of one year. Sixty patients were treated laparoscopically and 60 traditionally. Biohumoral and endocrine parameters were determined from 24-hour urine and blood. We measured adrenaline, noradrenaline, metabolites of corticosteroid hormones (17-hydroxyl and 17-keto steroids, C-reactive protein (CRP, albumin, glycemia, creatine-phosphokinase (CPK, lactate-dehydrogenase (LDH, red blood cells sedimentation and serum concentration of potassium. Results. We observed significantly lower levels of adrenaline (p < 0.01, noradrenaline (p < 0.05, dopamine (p < 0.01, 17-hydroxyl (p < 0.01 and 17-keto steroids (p < 0.01, glycemia (p < 0.01, CPK (p < 0.01, LDH (p < 0.01 and red blood cells sedimentation (p < 0.01 following laparoscopic cholecystectomy compared to traditional one. Significant increase in CRP levels was recorded postoperatively in both groups (p < 0.05, as well as significant decrease in serum albumin values (p < 0.05. Duration of the hospitalization following laparoscopic cholecystectomy was significantly shorter (p < 0.01. Conclusion. The intensity of organism response is proportional to the intensity of surgical trauma. Metabolic, tissue and neuroendocrine response of organism to trauma has lower intensity after laparoscopic cholecystectomy.

  14. Desflurane reinforces the efficacy of propofol target-controlled infusion in patients undergoing laparoscopic cholecystectomy.

    Science.gov (United States)

    Chen, Po-Nien; Lu, I-Cheng; Chen, Hui-Ming; Cheng, Kuang-I; Tseng, Kuang-Yi; Lee, King-Teh

    2016-01-01

    Whether low-concentration desflurane reinforces propofol-based intravenous anesthesia on maintenance of anesthesia for patients undergoing laparoscopic cholecystectomy is to be determined. The aim of this study was to investigate whether propofol-based anesthesia adding low-concentration desflurane is feasible for laparoscopic cholecystectomy. Fifty-two patients undergoing laparoscopic cholecystectomy were enrolled in the prospective, randomized, clinical trial. Induction of anesthesia was achieved in all patients with fentanyl 2 μg/kg, lidocaine 1 mg/kg, propofol 2 mg/kg, and rocuronium 0.8 mg/kg to facilitate tracheal intubation and to initiate propofol target-controlled infusion (TCI) to effect site concentration (Ce: 4 μg/mL with infusion rate 400 mL/h). The patients were then allocated into either propofol TCI based (group P) or propofol TCI adding low-concentration desflurane (group PD) for maintenance of anesthesia. The peri-anesthesia hemodynamic responses to stimuli were measured. The perioperative psychomotor test included p-deletion test, minus calculation, orientation, and alert/sedation scales. Group PD showed stable hemodynamic responses at CO2 inflation, initial 15 minutes of operation, and recovery from general anesthesia as compared with group P. There is no significant difference between the groups in operation time and anesthesia time, perioperative psychomotor functional tests, postoperative vomiting, and pain score. Based on our findings, the anesthetic technique combination propofol and desflurane for the maintenance of general anesthesia for laparoscopic cholecystectomy provided more stable hemodynamic responses than propofol alone. The combined regimen is recommended for patients undergoing laparoscopic cholecystectomy.

  15. Postoperative pain after cholecystectomy: Conventional laparoscopy versus single-incision laparoscopic surgery

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    Prasad A

    2011-01-01

    Full Text Available Background: This study was undertaken to compare the postoperative pain after cholecystectomy done by single-incision laparoscopic surgery (SILS versus conventional four-port laparoscopy [conventional laparoscopic surgery (CLS]. SILS is a feasible and a promising method for cholecystectomy. It is possible to do this procedure without the use of special equipments. While there are cosmetic advantages to SILS, it is not clear whether or not the pain is also reduced. Methods: Patients undergoing cholecystectomy for symptomatic gallstones were offered the choice of the two methods and the first 100 consecutive patients from each group were included in this observational study. Only conventional instruments were used to keep the cost of surgery comparable. Pain scores were checked 8 hours after the surgery using visual analogue score. Student′s t test was done to check the statistical significance. Results: We observed no significant difference in the pain score between the CLS and SILS (2.78 versus 2.62. The operative time (OT was significantly lower in the CLS group (28 versus 67 minutes. Comparing the OTs of the first 50 patients undergoing SILS with the second 50 patients showed a significantly lower OT (79 versus 54 minutes. We also compared the pain score between these three groups. The second half of SILS group had a significantly lower pain score compared to the first half (2.58 versus 2.84. This group also had a lower pain score compared to conventional laparoscopy group but the difference was not statistically significant (2.58 versus 2.78. Conclusion: Although there was no significant difference in the overall postoperative pain as OT decreases with surgeon′s experience in single-incision laparoscopic cholecystectomy, postoperative pain at 8 hours appears to favour this method over conventional laparoscopic cholecystectomy.

  16. MONOPOLAR ELECTROCAUTERY VS SURGICAL CLIPS IN CONTROL OF CYSTIC ARTERY IN LAPAROSCOPIC CHOLECYSTECTOMY: A COMPARATIVE STUDY

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    Ridipta Sekha

    2016-04-01

    Full Text Available BACKGROUND Laparoscopic cholecystectomy has been extensively accepted since Mouret first successfully introduced the procedure in 1987. During this procedure the cystic artery can be controlled using surgical clips, harmonic scalpel and ligature or monopolar cautery. The extensive use of surgical clips in laparoscopic surgery has led to a variety of complications. Monopolar electrocoagulation can be used to control the cystic artery as it is cheap and universally available. Hence in this study, we compared monopolar electrocautery with clip application for securing haemostasis and to identify the safest and least complicated way for haemostasis of the cystic artery in laparoscopic cholecystectomy. METHODS A retrospective analysis of 201 patients were done who were planned for laparoscopic cholecystectomy. Among them 3 were converted to open cholecystectomy due to intraoperative bleeding. The rest 198 patients underwent successful laparoscopic cholecystectomy. In 42 patients the cystic artery was ligated using Ligaclip 300, while in 156 patients the artery was coagulated using monopolar cautery with hook. The patients were observed for any incidences of post-operative haemorrhage and bile leak, difference in length of hospital stay and post-operative complications. RESULTS The mean age was 40.26 years with M:F ratio 1:4. About 86% (135 and 88% (37 patients, respectively in electrocautery and Ligaclip group were discharged on the first post-operative day itself. Only 3 (1.5% patients, 2 in electrocautery and 1 in Ligaclip group developed post-operative port site infection. These differences were not statistically significant. CONCLUSION We conclude that monopolar electrocautery can be used as a safer alternative to surgical clips in control of cystic artery, especially in developing countries.

  17. Laparoscopic cholecystectomy for acute cholecystitis: early or delayed?

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    Song, Guo-Min; Bian, Wei; Zeng, Xian-Tao; Zhou, Jian-Guo; Luo, Yong-Qiang; Tian, Xu

    2016-01-01

    Abstract The laparoscopic cholecystectomy (LC) is an important approach of treating acute cholecystitis and the timing of performing this given treatment is associated with clinical outcomes. Although several meta-analyses have been done to investigate the optimal timing of implementing this treatment, the conflicting findings from these meta-analyses still confuse decision-making. And thus, we performed this systematic review to assess discordant meta-analyses and generate conclusive findings to facilitate informed decision-making in clinical context eventually. We electronically searched the PubMed, Cochrane Library, and EMBASE to include meta-analysis comparing early (within 7 days of the onset of symptoms) with delayed LC (at least 1 week after initial conservative treatment) for acute cholecystitis through August 2015. Two independent investigators completed all tasks including scanning and appraising eligibility, abstracting essential information using prespecified extraction form, assessing methodological quality using Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR) tool, and assessing the reporting quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), as well as implementing Jadad algorithm in each step for the whole process. A heterogeneity degree of ≤50% is accepted. Seven eligible meta-analyses were included eventually. Only one was Level I of evidence and remaining studies were Level II of evidence. The AMSTAR scores varied from 8 to 11 with a median of 9. The PRISMA scores varied from 19 to 26. The most heterogeneity level fell into the desired criteria. After implementing Jadad algorithm, 2 meta-analyses with more eligible RCTs were selected based on search strategies and implication of selection. The best available evidence indicated a nonsignificant difference in mortality, bile duct injury, bile leakage, overall complications, and conversion to open surgery, but a significant

  18. Laparoscopic single site (LESS) and classic video-laparoscopic cholecystectomy in the elderly: A single centre experience.

    Science.gov (United States)

    Aprea, Giovanni; Rocca, Aldo; Salzano, Andrea; Sivero, Luigi; Scarpaleggia, Mauro; Ocelli, Prisida; Amato, Maurizio; Bianco, Tommaso; Serra, Raffaele; Amato, Bruno

    2016-09-01

    Laparoscopic cholecystectomy (LC) is the gold-standard surgical method used to treat gallbladder diseases. Recently Laparoendoscopic single site surgery (LESS) has gained greater interest and diffusion for the surgical treatment of several pathologies. In elderly patients, just few randomized controlled trials are present in the literature that confirm the clinical advantages of LESS compared with the classic laparoscopic procedures. We present in this paper the preliminary results of this randomized prospective study regarding the feasibility and safety of LESS cholecystectomy versus classic laparoscopic technique. We demonstrated that LESS technique compared with traditional technique show some advantages like: acceptable operative times, lower post-operative discomfort and sometimes reduction added complications. In addition we also demonstrate that fewer incisions and less scarring which mean less pain, and fewer parietal complications are related to this surgical procedure. In conclusion in the elderly LESS cholecystectomy technique is to be considered a suitable alternative to traditional three-port cholecystectomy.

  19. Randomized clinical trial of small-incision and laparoscopic cholecystectomy in patients with symptomatic cholecystolithiasis: primary and clinical outcomes.

    NARCIS (Netherlands)

    Keus, F.; Werner, J.E.; Gooszen, H.G.; Oostvogel, H.J.M.; Laarhoven, C.J.H.M. van

    2008-01-01

    OBJECTIVE: To evaluate the primary and clinical outcomes in laparoscopic and small-incision cholecystectomy. DESIGN: Blinded randomized single-center trial emphasizing methodologic quality and generalizability. SETTING: General teaching hospital in the Netherlands. PATIENTS: A total of 257 patients

  20. Aberrant subvesical bile ducts identified during laparoscopic cholecystectomy: A rare case report and review of the literature

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    Theodoros Mariolis-Sapsakos

    2017-01-01

    Conclusion: Aberrant subvesical bile ducts are associated with a high risk of surgical bile duct injury. Nevertheless, meticulous operative technique combined with surgeons’ perpetual awareness concerning this peculiar anatomical aberration leads to a safe laparoscopic cholecystectomy.

  1. THE ECONOMIC IMPACT OF THE DIGESTIVE DISEASES ACROSS THE EU MEMBER STATES. THE COSTS ANALYSIS IN CHOLECYSTECTOMY

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    Uivaroşan Diana

    2015-07-01

    Full Text Available United European Gastroenterology provide wide studies and researches on the economic impact of the digestive diseases across the countries that are members of the European Union, very useful in planning health services, in making the case for investment in research where there are clear gaps in knowledge, and in reflecting the economic differences across the EU member states in the funding available to support health services. These studies reflect that there are important disparities in the accessibility to high-quality healthcare even among the industrialized countries. Out of all the digestive diseases, the gallstone disease is one of the most common and expensive of the health problems, in industrialized countries, like those of the European Union are. In general, symptomatic or complicated gallstone disease is treated by cholecystectomy, with surgical removal of the gallbladder. The advent of laparoscopic cholecystectomy has revolutionized the management of the gallstone disease, causing an increase in the rate of cholecystectomies. This study represents an analysis of the hospitalization costs involved by two surgical treatment options: laparoscopic cholecystectomy and open cholecystectomy. The investigation of the costs was done according to the type of intervention chosen and comprised the direct costs of hospitalization, including diagnostic tests and general expenses of medical assistance, pharmaceutical and medical supplies. The results are based on the analysis of the costs of cholecystectomies in the surgical department of the Emergency County Hospital Oradea for the year 2014 (781 cases. The average cost per hospitalized patient was 1.970 RON, lower in patients with laparoscopic cholecystectomy (1.579 RON. The average cost per patient with open cholecystectomy was 55% higher than for laparoscopic surgery (2.442 RON. Even if the laparoscopic operation cost is higher because of the equipment it uses, the reduction of the number of

  2. A review on the status of natural orifice transluminal endoscopic surgery (NOTES cholecystectomy: techniques and challenges

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    Michael C Meadows

    2010-09-01

    Full Text Available Michael C Meadows1,3, Ronald S Chamberlain1,2,31Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; 2Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA; 3Saint George’s University, School of Medicine, West Indies, GrenadaIntroduction: The evolution of techniques for the performance of a cholecystectomy over the last 25 years has been swift. The laparoscopic approach is now the gold standard for removal of the gall bladder and is the most frequently performed minimally invasive procedure globally. Currently in its infancy stage, natural orifice transluminal endoscopy surgery, or NOTES, is purported to be the next leap forward in minimally invasive approaches. The safety, feasibility, and effectiveness of this procedure, as well as the significance of potential benefits to patients beyond current surgical approaches are yet undetermined.Methods: A comprehensive literature search was conducted using PubMed, a search engine ­created by the National Library of Medicine. Keywords used in the search included “natural orifice transluminal endoscopic surgery”, “NOTES”, “cholecystectomy”, “transcolonic”, “transvaginal”, and “transgastric”. The accumulated literature was critically analyzed and reviewed.Results: One-hundred and eighty-six cases of NOTES cholecystectomies have been published to date. Of these, 174 have been performed through a transvaginal approach. The remainder of the procedures were performed transgastrically. There are no published reports of ­transcolonic cholecystectomies performed in humans. Four of 186 cases (2.15% were converted to traditional laparoscopy due to intraoperative complications. No significant complications or mortalities have been reported.Conclusion: NOTES cholecystectomy appears to be a feasible procedure. However, technical, safety, and ethical issues remain relatively unresolved. Besides improved cosmesis, whether additional

  3. Pulmonary thromboembolism following laparoscopic cholecystectomy in a patient with preexisting risk factors for deep venous thrombosis

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    Jyotsna A Goswami

    2007-01-01

    Full Text Available We report a case of a forty-five year old male who was admitted fifteen days prior with biliary pancreatitis. He developed pulmonary thromboembolism (PTE after uneventful laparoscopic cholecystec-tomy. He was initially treated with intravenous (IV heparin and inferior vena cava (IVC filter. Later on he underwent emergency pulmonary embolectomy due to haemodynamic deterioration. There is less incidence of PTE after laparoscopic cholecystectomy, but it becomes high-risk for postoperative thromboembolic complications when it is associated with other risk factors. The purpose of this report is to highlight that preoperative detection of risk factors and thromboprophylaxis in indicated cases can prevent this complication. We also review the incidence of PTE, risk factors and thromboprophylaxis.

  4. FACTORS AFFECTING CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN SURGERY IN A TERTIARY HOSPITAL IN SOUTH INDIA

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    Suresh Kumar

    2016-01-01

    Full Text Available BACKGROUND Laparoscopic Cholecystectomy (LC is most commonly performed hepatobiliary minimally access surgery worldwide. Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallstone diseases. However, there still is a substantial proportion of patients in whom laparoscopic cholecystectomy cannot be successfully performed and for whom conversion to open surgery is required. The NIH postulated that the outcome of LCs would be greatly influenced by surgeon-specific factors such as training, experience, skill and judgment.(1 In addition numerous patient and disease-related factors, such as male gender, obesity, old age (>65, prior abdominal surgery, acute cholecystitis, choledocholithiasis and anomalous anatomy have been reported as significant risk factors for conversion to the open procedure.(2-5 Although the rate of conversion to open surgery and the complication rate are low in experienced hands, the surgeon should not enter the Operating Room with idea of opening the abdomen in difficult case as failure or insult to the surgeon. Various preoperative factors can help in deciding the difficult gallbladder and conversion to open cholecystectomy. The aim of this study is to predict the difficulty of laparoscopic cholecystectomy and the possibility of conversion to open cholecystectomy before and during surgery using the clinical and ultrasonographic criteria in our setup. MATERIALS AND METHODS A prospective study was performed in SRM Medical College and Hospital of all patients who underwent LC during (May 2013 to October 2015 was performed. The LCs were performed by 12 trained certified surgeons. The decision to convert to open was made by the individual surgeon and the reason for conversion was extracted from the patient’s medical record (operative report prospectively. The inclusion and exclusion criteria defined. All operations were performed with the patient under general anesthesia with endotracheal intubation

  5. Single Incision Laparoscopic Cholecystectomy by Using a 2 mm Atraumatic Grasper without Trocar

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    Kamil Gulpinar

    2011-01-01

    Full Text Available Purpose. We present our experience in single incision laparoscopic cholecystectomy by using a grasper directly without using a trocar in five patients. Methods and Results. The technique involves the use of Karl Storz 27290F grasper in order to perform gallbladder retraction in single port cholecystectomy. The grasper was introduced directly into the skin through abdominal wall without using any trocar and used to mobilize gallbladder whenever needed during surgery without causing any perforation or leakage of the gallbladder. There were no intraoperative and postoperative complications in 5 patients with the advantages of shorter operation time and almost invisible postoperative skin scar formation. Conclusion. We claim that the use of this instrument in SILS surgery might be advantageous than the conventional placement of sutures for the gallbladder mobilization.

  6. The best management for 'crescendo biliary colic' is urgent laparoscopic cholecystectomy.

    Science.gov (United States)

    Robertson, G S; Wemyss-Holden, S A; Maddern, G J

    1998-11-01

    Gallbladder disease due to stones is well recognised as falling into two categories, presenting with either chronic symptoms or developing acute cholecystitis or other complications. We describe an intermediate group of 14 patients (11 women, three men, median age 31 years) presenting with 4-14 days of at least daily attacks of resolving biliary colic, who underwent early laparoscopic cholecystectomy within 24 hours of presentation. None had any evidence of acute inflammation, either at laparoscopy or on histology. Their surgery was straightforward with operating times ranging from 35-80 minutes and no complications. Patients with 'crescendo biliary colic' are often young women who can rarely afford invalidity. Rather than the current practice of analgesia for each attack and elective surgery weeks later, they are optimally managed by urgent laparoscopic cholecystectomy, preventing the development of complications and minimising the need for further medical involvement.

  7. Retroperitoneal Abscess Formation as a Result of Spilled Gallstones during Laparoscopic Cholecystectomy: An Unusual Case Report

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    Grigoris Chatzimavroudis

    2012-01-01

    Full Text Available One of the complications of laparoscopic cholecystectomy for gallstone disease that seems to exceed that of the traditional open method is the gallbladder perforation and gallstone spillage. Its incidence can occur in up to 40% of patients, and in most cases its course is uneventful. However in few cases an abdominal abscess can develop, which may lead to significant morbidity. Rarely an abscess formation due to spilled and lost gallstones may occur in the retroperitoneal space. We herein report the case of a female patient who presented with clinical symptoms of sepsis six months following laparoscopic cholecystectomy. Imaging investigations revealed the presence of a retroperitoneal abscess due to retained gallstones. Due to patient’s decision to refuse abscess’s surgical drainage, she underwent CT-guided drainage. The 24-month followup of the patient has been uneventful, and the patient remains in good general condition.

  8. Effect Observation on Heat-sensitive Moxibustion for Abdominal Distension Following Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Fei Hua-hua

    2014-01-01

    Objective: To observe the clinical effect of heat-sensitive moxibustion on abdominal distension following laparoscopic cholecystectomy. Methods: A total of 240 cases were randomly allocated into an observation group and a control group according to their admission sequence, 120 in each group. Cases in the observation group were treated with conventional care, glycerol enema and heat sensitive moxibustion, whereas cases in the control group were only treated with conventional care and glycerol enema. Then the passage of gas by anus within 24 h and improvement of abdominal distension were observed in both groups. Results: There were statistical differences in the emergence time of bowel sounds and the initial passage of gas by anus between the two groups (bothP Conclusion: Heat-sensitive moxibustion has reliable effect for abdominal distension following laparoscopic cholecystectomy.

  9. Early postoperative mortality following cholecystectomy in the entire female population of Denmark, 1977-1981

    DEFF Research Database (Denmark)

    Bredesen, J; Jørgensen, T; Andersen, T F;

    1992-01-01

    to women who had a simple hysterectomy. The mortality was significantly higher than in the general female population (p less than 0.05). Increased age, acute admission, admissions to hospital within 3 months prior to the index admission, the number of discharge diagnoses, and the geographical region were...... significantly associated with increased mortality. Exploration of the common bile duct was associated with higher mortality in the bivariate analysis, but the association disappeared when the number of discharge diagnoses was taken into account. Type of hospital and the population based cholecystectomy rate...... of the patient's residential area was not associated with mortality. As regards early mortality, it is concluded that simple elective cholecystectomy is a safe procedure before the age of 50 to 60 years. Acute admissions and more than one diagnosis at discharge were associated with an increased mortality...

  10. Absence of analgesic effect of intravenous melatonin administration during daytime after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Andersen, Lars Peter Holst; Kücükakin, Bülent; Werner, Mads U

    2014-01-01

    STUDY OBJECTIVE: To investigate whether melatonin administered intraoperatively reduced pain following laparoscopic cholecystectomy. DESIGN: Randomized, placebo-controlled, double-blinded study. SETTING: Two surgical departments in Copenhagen. PATIENTS: 44 women between 18 and 70 years of age, who...... mg of intravenous (IV) melatonin or placebo were administered at the time of surgical incision. MEASUREMENTS: Pain was assessed by a set of questionnaires documenting "pain at rest" using a visual analog scale (VAS). The use of rescue medication was recorded. Sleep quality and general well-being were...... between the two groups in the postoperative period. The use of postoperative rescue medication did not differ between the groups. CONCLUSIONS: The use of 10mg of IV melatonin administered during laparoscopic cholecystectomy did not affect postoperative pain or use of analgesic medication....

  11. The effect of melatonin on sleep quality after laparoscopic cholecystectomy: a randomized, placebo-controlled trial

    DEFF Research Database (Denmark)

    Gögenur, Ismail; Kücükakin, Bülent; Bisgaard, Thue

    2009-01-01

    BACKGROUND: In this study, we investigated whether melatonin administration could improve postoperative subjective sleep quality and reduce discomfort. METHODS: One hundred twenty-one patients scheduled for elective ambulatory laparoscopic cholecystectomy were randomized to oral 5 mg melatonin (n...... = 60) or placebo (n = 61) for 3 nights after surgery. Subjective sleep quality, sleep duration, sleep timing, and subjective discomfort (fatigue, general well-being, and pain) were measured. RESULTS: Sleep latency was significantly reduced in the melatonin group (mean [sd] 14 min [18]) compared...... with placebo (28 min [41]) on the first postoperative night (P = 0.015). The rest of the measured outcome variables did not differ between groups. CONCLUSIONS: Melatonin did not improve subjective sleep quality or discomfort compared with placebo after laparoscopic cholecystectomy....

  12. Readmissions due to acute biliary edematous pancreatitis in patients without cholecystectomy

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    Eva Barreiro-Alonso

    Full Text Available Objectives: Analyzing the readmission of patients with acute biliary edematous pancreatitis (ABEP without cholecystectomy despite a previous episode of mild acute gallstone pancreatitis or lithiasic cholecystitis. Calculating the health costs associated with the non-performance of cholecystectomy. Materials and methods: Prospective observational study conducted at a tertiary hospital (Hospital de Cabueñes. Gijón, Asturias. Spain from July to November 2014. The study has consecutively included inpatients suffering from ABEP who: a had suffered a previous episode of mild acute gallstone pancreatitis or cholecystitis at least 2 weeks before readmission; and b had not undergone cholecystectomy despite the lack of contraindications. Results: During the research period, 9 patients (7 females and 2 males with a mean age of 65.3 years (standard deviation [SD] 19.2 were readmitted. The median number of days between the previous episode of ABEP or cholecystitis and the readmission was 114 days (interquartile range [IQR] 111.0. Reported median overall length of hospital stay was 10 days (IQR = 2.0. Patients underwent a mean of 2.8 (SD = 1.2 ultrasound scans, 1.3 (SD = 0.9 abdominal and pelvic CT, 0.8 (SD = 1.0 MRCP and 0.2 (SD = 0.4 ERCP. The mean cost per patient for each readmission, including hospital stay (143.0 €/day, Emergency Service (332.31 € and tests performed was 2,381.70 €/patient. Conclusions: Not performing a cholecystectomy within two weeks after a first episode of mild ABEP or cholecystitis contributes to patient readmission due to recurrent pancreatitis, resulting in avoidable treatment costs.

  13. Single-Incision Laparoscopic Cholecystectomy - can we Afford that? Cost Comparison of Different Surgical Techniques

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    Matyja Maciej

    2014-04-01

    Full Text Available One of the most commonly performed surgeries in general surgery wards with laparoscopic technique as a method of choice is gall-bladder excision. In addition to -the commonly used conventional laparoscopic cholecystectomy single incision laparoscopic cholecystectomy is getting more and more attention. Despite many works and studies comparing these methods, there is still a shortage of results assessing efficiency of this new surgical technique. The aim of the study was to evaluate cost-effectiveness of this method in Polish financial reality. We have analyzed costs of three different surgical techniques: conventional (multi- incision laparoscopic cholecystectomy, SILC and ‘no -port’ SILC. Material and methods. We conducted a retrospective study that compared three groups of patients who underwent treatment with conventional laparoscopic cholecystectomy (n=20, SILC (n=20 and no-port SILC (n=20. These groups were matched by age, sex and BMI. Following parameters were analyzed: complication rate, operative time, operative costs, length of hospital stay, hospitalization costs. The SILC cases were performed with one of the three-trocar SILC ports available on the market. The ‘no- port’ SILC cases were performed by single skin incision in the umbilicus, insertion of one 10 mm trocar for the operating instrument, another instrument and scope were inserted directly thorough small incisions in the aponeurosis without a dedicated port Results. The average operative cost was significantly higher in the SILC group comparing to the conventional laparoscopy group and the no-port SILC group. There was no significant difference in complication rate, operative time, length of hospital stay, or hospitalization costs between the three groups Conclusions. Currently the cost of the dedicated SILC port does not allow a regular use of this procedure in Polish financial reality. According to our experience improved cosmesis is the only advantage of the single

  14. Anesthetic management of a case with hereditary spherocytosis for splenectomy and open cholecystectomy

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    Sonal S Khatavkar

    2016-01-01

    Full Text Available Hereditary spherocytosis (HS is a familial hemolytic disorder with marked heterogeneity of clinical features ranging from asymptomatic condition to a fulminant hemolytic anemia. HS is characterized by the strong family history of anemia, jaundice, splenomegaly and cholelithiasis. Anesthetic Management of HS with liver dysfunction is very challenging since most of the anesthetic drugs are metabolized by the liver. Hereby, we report anesthetic management in a case of HS with splenomegaly and gall stones for elective splenectomy and cholecystectomy.

  15. One-stop cholecystectomy clinic: an application of lean thinking--can it improve the outcomes?

    Science.gov (United States)

    Siddique, Khurram; Elsayed, Sameh Effat Abd; Cheema, Raza; Mirza, Shirin; Basu, Sanjoy

    2012-11-01

    Lean thinking principles were utilised to set up 'One-stop cholecystectomy clinics' at which patients underwent the surgical and the preoperative assessment during the same visit. The main aims were to reduce the number of patient hospital visits, preoperative admissions and the waiting time to surgery. The results showed a significant reduction in the number of patient visits as well as the waiting time to surgery thus highlighting that patientcare can be improved by good team working and lean management.

  16. Delayed assessment and eager adoption of laparoscopic cholecystectomy:Implications for developing surgical technologies

    Institute of Scientific and Technical Information of China (English)

    Alexander; C; Allori; I; Michael; Leitman; Elizabeth; Heitman

    2010-01-01

    Despite the prevailing emphasis in the medical literature on establishing evidence,many changes in the practice of surgery have not been achieved using proper evidence-based assessment.This paper examines the adoption of laparoscopic cholecystectomy(LC)into regular use for the treatment of cholecystitis and the process of its acceptance,focusing on the limited role of technology assessment in its appraisal.A review of the published medical literature concerning LC was performed.Approximately 3000 studies of...

  17. Colovesical fistula due to a lost gallstone following laparoscopic cholecystectomy: report of a case.

    Science.gov (United States)

    Daoud, F; Awwad, Z M; Masad, J

    2001-01-01

    We report the case of a 74-year-old man with a colovesical fistula caused by a gallstone that was lost during a laparoscopic cholecystectomy 7 months earlier. The patient was cured after undergoing colonoscopic removal of the stone. To our knowledge this is the first case report of such a complication in the English literature. The report reviews the outcome and complications of retained intraperitoneal gallstones.

  18. Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared With Traditional Laparoscopic Cholecystectomy

    OpenAIRE

    Zhang, Yang; Peng, Jian; Li, Xiaoli; Liao, Mingmei

    2016-01-01

    The study aimed to compare the application values of endoscopic-laparoscopic cholecystolithotomy (ELC) and laparoscopic cholecystectomy (LC) for patients with cholecystolithiasis. It did a retrospective analysis of 107 patients with cholecystolithiasis who underwent ELC and 144 patients with cholecystolithiasis who underwent LC. There is no significant difference in operating time and expenses when comparing ELC with LC (P>0.05). ELC showed significantly less blood loss during operation compa...

  19. Effect of laparoscopic cholecystectomy on inflammatory factors and immunoglobulin in elderly chronic cholecystitis complicated with cholecystolithiasis

    Institute of Scientific and Technical Information of China (English)

    Tian-Xue Wen; Hao Wang

    2016-01-01

    Objective:To investigate the effect of laparoscopic cholecystectomy on inflammatory factors and immunoglobulin in elderly chronic cholecystitis complicated with cholecystolithiasis. Methods: A total of 80 senile chronic cholecystitis complicated with cholecystolithiasis patients were randomly divided into observation group (n=40) and control group (n=40). The observation group was were treated with laparoscopic cholecystectomy while the control group was were treated with open cholecystectomy. Using nephelometry to detect the serum CRP, IgA, IgG and IgM levels, using enzyme-linked immunosorbent assay to detect the IL-6 level. The levels of inflammatory factors (CRP, IL-6) and immunoglobulin indexes (IgA, IgG and IgM) were compared before and after operation between the two groups.Results:Compared with before operation, the inflammatory factors (CRP, IL-6) had no significant difference in observation group, the inflammatory factors (CRP, IL-6) were increased significantly in control group, and there was significant difference on inflammatory factors (CRP, IL-6) in two groups after operation; compared with before operation, the levels of immunoglobulin indexes (IgA, IgG and IgM) had no significant difference in observation group, the levels of IgA, IgG and IgM were decreased significantly in control group, and the levels of IgA, IgG and IgM had significant difference after treatment between the two groups.Conclusion: Laparoscopic cholecystectomy had almost no effect on inflammatory factors and immune function in elderly chronic cholecystitis complicated with cholecystolithiasis.

  20. EFFECT OF ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA ON PLASMA CATECHOLAMINE CONTENT IN CHOLECYSTECTOMY PATIENTS

    Institute of Scientific and Technical Information of China (English)

    Li Changgen; Peng Xiaoyun; Xu Mingyu; Wang Zhongcheng

    2001-01-01

    Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods:33 cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia (A) group (n = 11), acupoint-skin electrical stimulation combined with epidural anesthesia (B) group (n= 11 ) and simple epidural anesthesia (C) group (n= 11). Acupoints used were bilateral Zusanli (ST 36) and Neiguan (PC 6) and stimulated with parameters of frequency 2/15 Hz, intermittent waves, electric current 2~3 mA for group A and 13mA for group B. Extradural anesthetic administered was 1.5% Lidocaine 5 mL. Venous blood samples were collected one day before,NE of group A and B lowered in comparison with pre-operation, particularly group A (P <0.01), while in group C,plasma NE level increased slightly; plasma E of group A and B increased significantly compared with pre-operation (P levels recovered basically in comparison with those of one day before operation. It indicates that acupuncture or acupoint-skin electrical stimulation is capable of regulating sympathetic activity during epidural anesthesia. The anesthetic effec t has a closer relation with changes of plasma NE level rather than changes of plasma E or DA levels. C_onclusion:Acupuncture or acupoint-surface electrical stimulation combined with epidural anesthesia may be of reducing or releasing surgical operation generated stress response during cholecystectomy.

  1. Acute cholecystitis – early laparoskopic surgery versus antibiotic therapy and delayed elective cholecystectomy: ACDC-study

    Directory of Open Access Journals (Sweden)

    Büchler Markus W

    2007-10-01

    Full Text Available Abstract Background Acute cholecystitis occurs frequently in the elderly and in patients with gall stones. Most cases of severe or recurrent cholecystitis eventually require surgery, usually laparoscopic cholecystectomy in the Western World. It is unclear whether an initial, conservative approach with antibiotic and symptomatic therapy followed by delayed elective surgery would result in better morbidity and outcome than immediate surgery. At present, treatment is generally determined by whether the patient first sees a surgeon or a gastroenterologist. We wish to investigate whether both approaches are equivalent. The primary endpoint is the morbidity until day 75 after inclusion into the study. Design A multicenter, prospective, randomized non-blinded study to compare treatment outcome, complications and 75-day morbidity in patients with acute cholecystitis randomized to laparoscopic cholecystectomy within 24 hours of symptom onset or antibiotic treatment with moxifloxacin and subsequent elective cholecystectomy. For consistency in both arms moxifloxacin, a fluorquinolone with broad spectrum of activity and high bile concentration is used as antibiotic. Duration: October 2006 – November 2008 Organisation/Responsibility The trial was planned and is being conducted and analysed by the Departments of Gastroenterology and General Surgery at the University Hospital of Heidelberg according to the ethical, regulatory and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989 and the Good Clinical Practice guideline (GCP. Trial Registration ClinicalTrials.gov NCT00447304

  2. A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy

    Directory of Open Access Journals (Sweden)

    Del monaco Pamela

    2009-11-01

    Full Text Available Abstract Background Cholecystectomy has been the treatment of choice for symptomatic gallstones, but remains the greatest source of post-operative biliary injuries. Laparoscopic approach has been recently preferred because of short hospitalisation and low morbidity but has an higher incidence of biliary leakages and bile duct injuries than open one due to a technical error or misinterpretation of the anatomy. Even open cholecystectomy presents a small number of complications especially if it was performed in urgency. Hemobilia is one of the most common cause of upper gastrointestinal bleeding from the biliary ducts into the gastrointestinal tract due to trauma, advent of invasive procedures such as percutaneous liver biopsy, transhepatic cholangiography, and biliary drainage. Methods We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage. Conclusion The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.

  3. RESEARCH OF NUTRITIONAL AND IMMUNE STATUS IN PATIENTS WITH GALLBLADDER CARCINOMA RADICAL CHOLECYSTECTOMY

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To inquire the nutritional and immune status in patients with gallbladder carcinoma before and after radical cholecystectomy.Methods The nutritional and immune status in patients with gallbladder carcinoma were assessed in 1 week before surgery, and on 3rd day, 7th day, 14th day and 21st day after operation, respectively.Results All of the nutritional parameters but the serum level of iron, TIBC and transferrin recovered within 3 week after operation. Remarkable decrease of serum IgG, IgA, IgM and C3, C4 complement, IL-2, CD4, CD4/CD8 ratio, and the remarkable increase of serum SIL-2R and CD8(P<0.01) on 3rd day after operation.Conclusion Adequate iron should be supplemented after the radical cholecystectomy for gallbladder carcinoma in the third postoperative week. Radical cholecystectomy with complete resection of the tumor and removal of lymph nodes played the important roles in the recovery of immune function.

  4. An Effective Approach to Improving Day-Case Rates following Laparoscopic Cholecystectomy

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    M. G. Clarke

    2011-01-01

    Full Text Available Background. Day-case laparoscopic cholecystectomy (LC is a safe and cost-effective treatment for gallstones. In 2006, our institution recorded an 86% laparoscopic, 10% day-case, and 5% readmission rate. A gallbladder pathway was therefore introduced in 2007 with the aim of increasing daycase rates. Methods. Patients with symptomatic gallstones, proven on ultrasound, were referred to a specialist-led clinic. Those suitable for surgery were consented, preassessed, and provided with a choice of dates. All defaulted to day case unless deemed unsuitable due to comorbidity or social factors. Results. The number of cholecystectomies increased from 464 in 2006 to 578 in 2008. Day-case rates in 2006, 2007, 2008, and June 2009 were 10%, 20%, 30%, and 61%, respectively. Laparoscopic and readmission rates remained unchanged. Conversion rates for elective cholecystectomy fell from 6% in 2006 to 3% in 2009. Conclusions. Development of a gallbladder pathway increased day-case rates sixfold without an associated increase in conversion or readmission rates.

  5. Elimination of biliary stones through the urinary tract: a complication of the laparoscopic cholecystectomy

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    Castro Maurício Gustavo Bravim de

    1999-01-01

    Full Text Available The introduction and popularization of laparoscopic cholecystectomy has been accompanied with a considerable increase in perforation of gallbladder during this procedure (10%--32%, with the occurrence of intraperitoneal bile spillage and the consequent increase in the incidence of lost gallstones (0.2%--20%. Recently the complications associated with these stones have been documented in the literature. We report a rare complication occurring in an 81-year-old woman who underwent laparoscopic cholecystectomy and developed cutaneous fistula to the umbilicus and elimination of biliary stones through the urinary tract. During the cholecystectomy, the gall bladder was perforated, and bile and gallstones were spilled into the peritoneal cavity. Two months after the initial procedure there was exteriorization of fistula through the umbilicus, with intermittent elimination of biliary stones. After eleven months, acute urinary retention occurred due to biliary stones in the bladder, which were removed by cystoscopy. We conclude that efforts should be concentrated on avoiding the spillage of stones during the surgery, and that no rules exist for indicating a laparotomy simply to retrieve these lost gallstones.

  6. Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-Pressure Pneumoperitoneum - Prospective Study of 150 Cases

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    Sunder Goyal

    2012-08-01

    Materials and Methods: In a private rural medical college, 150 patients were selected prospectively for laparoscopic cholecystectomy, under low-pressure (8mmHg pneumoperitoneum and under spinal anesthesia over a span of one and a half years. Injection bupivacaine (0.5% was used for spinal anesthesia. All ports were made in a head-down position to avoid hypotension. Shoulder pain was managed by reassurance as well as by diverting the attention and sedation in a few cases. Results: We successfully performed the operations in 145 patients without major complications. Spinal anesthesia was converted to general anesthesia in five patients due to severe shoulder pain. Age varied between 21 and 75 years. Duration of operation time (skin to skin was between 40 and 80 minutes. Twenty-nine patients complained of right shoulder pain. Most of them were managed by reassurance from the anesthetist and a few needed an injection of fentanyl along with midazolam. Conclusion: Laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum is feasible and safe under spinal anesthesia. Incidence of postoperative shoulder pain and complications are comparable with laparoscopic cholecystectomy under general anesthesia. [Arch Clin Exp Surg 2012; 1(4.000: 224-228

  7. The Effect of Cholecystectomy on the Histology of Antrum and Helicobacter Pylori Colonization

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    Hüseyin Özer

    2013-07-01

    Full Text Available Aim: Notwithstanding cholecystectomy’s being the standard cure for symptomatic gallbladder stones, it might as well trigger changes that result in the increase of duodenogastric reflux and the emergence of relevant clinic and laboratorial data. The aim of this thesis is to explore the effect of cholecystectomy on the duodenogastric reflux, histopathologic changes in the antral mucosa and Helicobacter pylori colonization. Material and Method: This prospective research is based upon data collected from 45 patients (28 of them being female and 17 of them being male patients with an average age of 50.9, who would undergo cholecystectomic surgery. Upper gastrointestinal endoscopy has been performed on patients before the operation and at least two months after the operation in order to examine the existence of bile in the stomach. The tissues removed from the antrum during these endoscopic biopsies have been examined to spot the histopathologic changes and the existence of Helicobacter pylori in the mucosa (chronic gastritis, activation findings, and intestinal metaplasia. Results: Duodenogastric reflux, chronic gastritis, and intestinal metaplasia have been observed to increase significantly after cholecystectomy (p<0.001 for duodenogastric reflux and chronic gastritis, p<0.05 for intestinal metaplasia. On the other hand, no significant data have been attained in terms of activation findings and the existence of H.pylori before and after the operation. Discussion: Although cholecystectomy cause duodenogastric reflux and histopathologic changes in the antrum, it does not affect  H.pylori colonization.

  8. Extensive subcutaneous emphysema and hypercapnia during laparoscopic cholecystectomy: two case reports.

    Science.gov (United States)

    Abe, H; Bandai, Y; Ohtomo, Y; Shimomura, K; Nayeem, S A; Idezuki, Y

    1995-06-01

    We report two cases of marked hypercapnia of more than 60 mm Hg (PaCO2) and extensive subcutaneous emphysema noted during laparoscopic cholecystectomy. The first case, a 55-year-old man was diagnosed as having cholecystolithiasis and had hypercapnia up to 83.5 mm Hg (PaCO2) during laparoscopic cholecystectomy. The patient resumed spontaneous respiration under controlled ventilation accompanied by persistent bigeminal pulse. Soon after deflation, CO2 returned to normal range, and extensive subcutaneous emphysema was detected in the recovery room. The second patient, a 53-year-old woman, had cholecystolithiasis and also underwent laparoscopic cholecystectomy. Both hypercapnia rising to 61.1 mm Hg (PaCO2) and extensive subcutaneous emphysema appeared just before completion of resection of the gallbladder. Mild hypercapnia during pneumoperitoneum of about 50 mm Hg (PaCO2) has been reported previously. As compared with cases in the literature, the present cases suggest that hypercapnia is due to extensive subcutaneous emphysema. The large absorption surface area in the subcutaneous tissue and the large difference in the partial pressure cause the extensive gaseous interchange of CO2 between subcutaneous tissue and blood perfusing into it at the moment between peritoneal cavity and blood perfused the peritoneum.

  9. Timing of laparoscopic cholecystectomy for acute cholecystitis: A prospective non randomized study

    Institute of Scientific and Technical Information of China (English)

    George Tzovaras; Dimitris Zacharoulis; Paraskevi Liakou; Theodoros Theodoropoulos; George Paroutoglou; Constantine Hatzitheofilou

    2006-01-01

    AIM: To study the timing of laparoscopic cholecystectomy for patients with acute cholecystitis.METHODS: Between January 2002 and December 2005,all American Society of Anesthesiologists classification (ASA) Ⅰ ,Ⅱand Ⅲ patients with acute cholecystitiswere treated laparoscopically during the urgent (index) admission. The patients were divided into three groups according to the timing of surgery: (1) within the first 3 d, (2) between 4 and 7 d and (3) beyond 7 d from the onset of symptoms. The impact of timing on the conversion rate, morbidity and postoperative hospital stay was studied.RESULTS: One hundred and twenty-nine patients underwent laparoscopic cholecystectomy for acute cholecystitis during the index admission. Thirty six were assigned to group 1, 58 to group 2, and 35 to group 3. The conversion rate and morbidity for the whole cohort of patients were 4.6% and 10.8%, respectively. There was no significant difference in the conversion rate, morbidity and postoperative hospital stay between the three groups.CONCLUSION: Laparoscopic cholecystectomy for acute cholecystitis during the index admission is safe, regardless of the time elapsed from the onset of symptoms. This policy can result in an overall shorter hospitalization.

  10. The role of hepatobiliary scintigraphy and oral cholecystography in predicting the performance of laparoscopic cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Won, Kyoung Sook [Kangnung Hospital, Kangnung (Korea, Republic of); Ryu, Jin Sook; Moon, Dae Hyuk [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)] [and others

    1997-03-01

    Laparoscopic cholecystectomy can be performed safely in most patients with symptomatic cholelithiasis. Preoperative evaluation should assess the potential problems that affect the performance of laparoscopic cholecystectomy. Hepatobiliary scintigraphy or oral cholecystography can assess the gallbladder function and nonvisualization of gallbladder usually indicates acute or severe chronic cholecystitis. The purpose of this study was to evaluate the role of preoperative hepatobiliary scintigraphy or oral cholecystography in predicting the performance of laparoscopic cholecystectomy. The study group consists of 176 patients who underwent both hepatobiliary scintigraphy with Tc-99m DISIDA and oral choelcystography within one month before laparoscopic cholecystectomy. Nonvisualization of gallbladder was defined as persistent nonvisualization of gallbladder until 4 hours on hepatobiliary scintigraphy or 12 hours on oral cholecystography. Among 176 patients, gallbladder was not visualized in 38 patients on hepatobiliary scintigraphy and 41 patients on oral cholecystography. Concordance rate between hepatobiliary scintigraphy and oral cholecystography was 89.2%. The conversion rate to open cholocystectomy was significantly higher in patients with nonvisualization of gallbladder than in patients with gallbladder higher in patients with nonvisualization of gallbladder visualization (15.8% vs 2.9% on hepatobiliary scintigraphy, 12.2% vs 3.7% on oral cholecystography: p<0.01 and p<0.05 respectively). The operative complication rate was also significantly higher in patients with nonvisualization of gallbladder (13.2% vs 2.9% on hepatobiliary scintigraphy, 14.6% vs 2.2% on oral cholecystography : p<0.01 and p<0.001, respectively). Similarly, operation time was significantly prolonged in patients with nonvisualization of gallbladder (88.8{+-}41.9 min vs 62.5{+-}23.6 min on hepatobiliary scintigraphy : p<0.001, 89.4{+-}41.3 min vs 61.8{+-}22.8 min on oral cholecystography :p<0

  11. EFFECT OF PREMEDICATION WITH INTRAVENOUS CLONIDINE ON HAEMODYNAMIC CHANGES IN LAPAROSCOPIC CHOLECYSTECTOMY: A RANDOMISED STUDY

    Directory of Open Access Journals (Sweden)

    Sudheer

    2015-03-01

    Full Text Available BACKGROUND: Laparoscopic cholecystectomy offers many benefits but significant hemodynamic changes are observed, which can be detrimental especially in elderly and hemodynamically compromised patients. Clonidine was found to inhibit the release of catecholamines and v asopressin and thus modulate the haemodynamic changes induced by pneumoperitoneum. AIM AND OBJECTIVES OF THE STUDY: To assess the efficacy of intravenous clonidine premedication in prevention of adverse haemodynamic changes during laparoscopic cholecystec tomy. The following parameters were studied. Heart rate and Blood pressure response to induction, intubation and pneumoperitoneum . Requirements of intra - op analgesia like Fentanyl . Incidence of post - op nausea and vomiting Incidence of shivering . METHODS: 100 patients undergoing elective laparoscopic cholecystectomy were randomly assigned to one of the two groups to receive either clonidine 4 micrograms per kg or equivalent quantity of normal saline The primary outcome was to assess the efficacy of intrave nous clonidine premedication in prevention of adverse haemodynamic changes during laparoscopic cholecystectomy. STATISTICAL METHODS : Student t test (two tailed, independent has been used to find the significance of study parameters (HR, SBP, DBP on conti nuous scale between two groups (Inter group analysis and to test the homogeneity samples based on age (continuous parameters. Chi - square test was used to test the homogeneity of samples based on parameters on categorical scale between two groups. P<0.05 was considered as statistically significant . The statistical software namely SPSS 15.0, Stata 8.0, Med Calc 9.0.1 and Systat 11.0 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc. RESULTS: The result showed that Blood Pressure (SBP, DBP, MAP and HR in study group fell significantly to lower level within 10 minutes after starting clonidine infusion and

  12. Cholecystectomy and sphincterotomy in patients with mild acute biliary pancreatitis in Sweden 1988 - 2003: a nationwide register study

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    Stenlund Hans C

    2009-10-01

    Full Text Available Abstract Background Gallstones represent the most common cause of acute pancreatitis in Sweden. Epidemiological data concerning timing of cholecystectomy and sphincterotomy in patients with first attack of mild acute biliary pancreatitis (MABP are scarce. Our aim was to analyse readmissions for biliary disease, cholecystectomy within one year, and mortality within 90 days of index admission for MABP. Methods Hospital discharge and death certificate data were linked for patients with first attack acute pancreatitis in Sweden 1988-2003. Mortality was calculated as case fatality rate (CFR and standardized mortality ratio (SMR. MABP was defined as acute pancreatitis of biliary aetiology without mortality during an index stay of 10 days or shorter. Patients were analysed according to four different treatment policies: Cholecystectomy during index stay (group 1, no cholecystectomy during index stay but within 30 days of index admission (group 2, sphincterotomy but not cholecystectomy within 30 days of index admission (group 3, and neither cholecystectomy nor sphincterotomy within 30 days of index admission (group 4. Results Of 11636 patients with acute biliary pancreatitis, 8631 patients (74% met the criteria for MABP. After exclusion of those with cholecystectomy or sphincterotomy during the year before index admission (N = 212, 8419 patients with MABP remained for analysis. Patients in group 1 and 2 were significantly younger than patients in group 3 and 4. Length of index stay differed significantly between the groups, from 4 (3-6 days, (representing median, 25 and 75 percentiles in group 2 to 7 (5-8 days in groups 1. In group 1, 4.9% of patients were readmitted at least once for biliary disease within one year after index admission, compared to 100% in group 2, 62.5% in group 3, and 76.3% in group 4. One year after index admission, 30.8% of patients in group 3 and 47.7% of patients in group 4 had undergone cholecystectomy. SMR did not differ

  13. Advantages and Disadvantages of 1-Incision, 2-Incision, 3-Incision, and 4-Incision Laparoscopic Cholecystectomy: A Workflow Comparison Study.

    Science.gov (United States)

    Bartnicka, Joanna; Zietkiewicz, Agnieszka A; Kowalski, Grzegorz J

    2016-08-01

    A comparison of 1-port, 2-port, 3-port, and 4-port laparoscopic cholecystectomy techniques from the point of view of workflow criteria was made to both identify specific workflow components that can cause surgical disturbances and indicate good and bad practices. As a case study, laparoscopic cholecystectomies, including manual tasks and interactions within teamwork members, were video-recorded and analyzed on the basis of specially encoded workflow information. The parameters for comparison were defined as follows: surgery time, tool and hand activeness, operator's passive work, collisions, and operator interventions. It was found that 1-port cholecystectomy is the worst technique because of nonergonomic body position, technical complexity, organizational anomalies, and operational dynamism. The differences between laparoscopic techniques are closely linked to the costs of the medical procedures. Hence, knowledge about the surgical workflow can be used for both planning surgical procedures and balancing the expenses associated with surgery.

  14. Post-operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime

    DEFF Research Database (Denmark)

    Jensen, K; Kehlet, H; Lund, Claus

    2007-01-01

    BACKGROUND: Laparoscopic cholecystectomy is now often an ambulatory procedure, but dependent on short-term post-operative complaints of pain and post-operative nausea and vomiting (PONV). The efficacy of post-anaesthesia care units (PACUs) is therefore important to facilitate return to normal...... functions. We investigated the feasibility and efficacy of a standardized, evidence-based anaesthesia/analgesic regime to identify residual problems in the early post-operative phase. METHODS: One hundred and thirty-four consecutive patients admitted for elective laparoscopic cholecystectomy at Hvidovre...... to discharge (mean, 88 min). There were on average 2.7 treatment interventions (range, 0-11) before discharge. CONCLUSION: An evidence-based, multimodal approach to the anaesthetic/analgesic management in laparoscopic cholecystectomy is feasible and advantageous in the early post-operative phase. Pain and PONV...

  15. Laparoscopic Cholecystectomy for Gallbladder Calculosis in Fibromyalgia Patients: Impact on Musculoskeletal Pain, Somatic Hyperalgesia and Central Sensitization.

    Science.gov (United States)

    Costantini, Raffaele; Affaitati, Giannapia; Massimini, Francesca; Tana, Claudio; Innocenti, Paolo; Giamberardino, Maria Adele

    2016-01-01

    Fibromyalgia, a chronic syndrome of diffuse musculoskeletal pain and somatic hyperalgesia from central sensitization, is very often comorbid with visceral pain conditions. In fibromyalgia patients with gallbladder calculosis, this study assessed the short and long-term impact of laparoscopic cholecystectomy on fibromyalgia pain symptoms. Fibromyalgia pain (VAS scale) and pain thresholds in tender points and control areas (skin, subcutis and muscle) were evaluated 1week before (basis) and 1week, 1,3,6 and 12months after laparoscopic cholecystectomy in fibromyalgia patients with symptomatic calculosis (n = 31) vs calculosis patients without fibromyalgia (n. 26) and at comparable time points in fibromyalgia patients not undergoing cholecystectomy, with symptomatic (n = 27) and asymptomatic (n = 28) calculosis, and no calculosis (n = 30). At basis, fibromyalgia+symptomatic calculosis patients presented a significant linear correlation between the number of previously experienced biliary colics and fibromyalgia pain (direct) and muscle thresholds (inverse)(pfibromyalgia pain significantly increased and all thresholds significantly decreased at 1week and 1month (1-way ANOVA, pFibromyalgia pain and thresholds returned to preoperative values at 3months, then pain significantly decreased and thresholds significantly increased at 6 and 12months (pfibromyalgia patients undergoing cholecystectomy thresholds did not change; in all other fibromyalgia groups not undergoing cholecystectomy fibromyalgia pain and thresholds remained stable, except in fibromyalgia+symptomatic calculosis at 12months when pain significantly increased and muscle thresholds significantly decreased (pfibromyalgia symptoms and that laparoscopic cholecystectomy produces only a transitory worsening of these symptoms, largely compensated by the long-term improvement/desensitization due to gallbladder removal. This study provides new insights into the role of visceral pain comorbidities and the effects of

  16. The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database

    DEFF Research Database (Denmark)

    Harboe, Kirstine Moll; Bardram, Linda

    2011-01-01

    included 20,307 patients (82% of all cholecystectomies). The conversion rate was 7.6%. Male sex, acute cholecystitis, and previous upper abdominal surgery were risk factors for conversion, with respective odds ratios of 1.50, 4.61, and 3.54. The mean LOS was 1.5 days, and 37.3% of the patients had same...... conversion rate and a high frequency of short admissions without readmission. Acute cholecystitis and open procedure are important risk factors for poorer outcomes.The results of this study analyzing a large, unbiased population can be used to benchmark outcomes of cholecystectomy....

  17. Single-Incision Laparoscopic Cholecystectomy: Is It a Plausible Alternative to the Traditional Four-Port Laparoscopic Approach?

    Directory of Open Access Journals (Sweden)

    Juan Pablo Arroyo

    2012-01-01

    Full Text Available The current standard-of-care for treatment of cholecystectomy is the four port laparoscopic approach. The development of single incision/laparoendoscopic single site surgery (SILC/LESS has now led to the development of new techniques for removal of the gallbladder. The use of SILC/LESS is now currently being evaluated as the next step in treatment of cholecystectomy. This review is an attempt to consolidate the current knowledge and analyze the feasibility of world-wide implementation of SILC/LESS.

  18. SUMMARY OF CLINICAL STUDY ON ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA FOR CHOLECYSTECTOMY

    Institute of Scientific and Technical Information of China (English)

    秦必光; 刘颖涛; 李长根; 任亚川; 张兰英; 艾中立; 彭小云; 白占勇

    2001-01-01

    Objective: To study clinical effect and anesthetic method of acupuncture anesthesia combined with epidural administration of smadose of anesthetic for cholecystectomy. Methods: A total of 194 cases of cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia group (group A, n=66), acupoint-skin electrical stimulation combined with epidural anesthesia group (group B, n = 63) and simple epidural anesthesia group (group C, n=65). Observations were conducted using single-bland method. Bilateral Neiguan (PC 6) and Zusanli (ST 36) were punctured and stimulated electrically in group A and only stimulated electrically via cutaneous electrodes in group B. Epidural anesthetic used was 1.5% Lidocaine and the anesthetic level was controlled to reach T4~11. Results: The class-I (excellent) rates of group A, B and C were 75.76%, 60.32% and 13.85% respectively, showing significant differences between group A and C and group B and C ( P < 0. 001 ). The initial dose, doses of every hour and every case of group A and B were lower than those of group C. The dose of every hour of group C was 36.23% and 3.75 % higher than group A and B respectively ( P < 0. 001 ), suggesting that acupuncture or acu-point-skin electrical stimulation could strengthen anesthetic effect and reduce the dose of epidural anesthetic. During operation, indexes of the life signs as HR, MAP, RR, TV, MV, SpO2 and ECG kept basically stable and all patients in group A passed surgical operation safely. Conclusion: Acupuncture or acupoint-skin electrical stimulation combined with epidural anesthesia can be used as one of the anesthetic methods for cholecystectomy.

  19. Effect of mechanical pressure-controlled ventilation in patients with disturbed respiratory function during laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Šurbatović Maja

    2013-01-01

    Full Text Available Background/Aim: Laparoscopic cholecystectomy is considered to be the gold standard for laparoscopic surgical procedures. In ASA III patients with concomitant respiratory diseases, however, creation of pneumoperitoneum and the position of patients during surgery exert additional negative effect on intraoperative respiratory function, thus making a higher challenge for the anesthesiologist than for the surgeon. The aim of this study was to compare the effect of intermittent positive pressure ventilation (IPPV and pressure controlled ventilation (PCV during general anesthesia on respiratory function in ASA III patients submitted to laparoscopic cholecystectomy. Methods. The study included 60 patients randomized into two groups depending on the mode of ventilation: IPPV or PCV. Respiratory volume (VT, peak inspiratory pressure (PIP, compliance (C, end-tidal CO2 pressure (PETCO2, oxygen saturation (SpO2, partial pressures of O2, CO2 (PaO2 and PaCO2 and pH of arterial blood were recorded within four time intervals. Results. There were no statistically significant differences in VT, SpO2, PaO2, PaCO2 and pH values neither within nor between the two groups. In time interval t1 there were no statistically significant differences in PIP, C, PETCO2 values between the IPPV and the PCV group. But, in the next three time intervals there was a difference in PIP, C, and PETCO2 values between the two groups which ranged from statistically significant to highly significant; PIP was lower, C and PETCO2 were higher in the PCV group. Conclusion. Pressure controlled ventilation better maintains stability regarding intraoperative ventilatory parameters in ASA III patients with concomitant respiratory diseases during laparoscopic cholecystectomy.

  20. Post-cholecystectomy symptoms were caused by persistence of a functional gastrointestinal disorder

    Institute of Scientific and Technical Information of China (English)

    Malte Schmidt; Karl S(o)ndenaa; John A Dumot; Steven Rosenblatt; Trygve Hausken; Maria Ramnefjell; Gro Nj(o)lstad

    2012-01-01

    AIM:To classify gallstone disease as a basis for assessment of post-cholecystectomy symptoms.METHODS:One hundred and fifty three patients with a clinical and ultrasonographic diagnosis of gallstones filled out a structured questionnaire on abdominal pain symptoms and functional gastrointestinal disorder (FGID) before and at six months after cholecystectomy.Symptom frequency groups (SFG) were categorized according to frequency of pain attacks.According to certain pain characteristics in gallstone patients,a gallstone symptom score was accorded on a scale from one to ten.A visual analogue scale was used to quantify pain.Operative specimens were examined for size and magnitude of stone contents as well as presence of bacteria.Follow-up took place after six months with either a consultation or via a mailed questionnaire.Resuits were compared with those obtained pre-operatively to describe and analyze symptomatic outcome.RESULTS:SFG groups were categorized as severe (24.2%),moderate (38.6%),and mild (22.2%) attack frequency,and a chronic pain condition (15%).Pain was cured or improved in about 90% of patients and two-thirds of patients obtained complete symptom relief.Patients with the most frequent pain episodes were less likely to obtain symptom relief.FGID was present in 88% of patients pre-operatively and in 57% postoperatively (P =0.244).Those that became asymptomatic or improved with regard to pain also had most relief from FGID (P =0.001).No pre-operative FGID meant almost complete cure.CONCLUSION:Only one third of patients with FGID experienced postoperative relief,indicating that FGID was a dominant cause of post-cholecystectomy symptoms.

  1. Modified port placement and pedicle first approach for laparoscopic concomitant cholecystectomy and splenectomy in children

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    Pal Kamalesh

    2010-01-01

    Full Text Available Aim : Laparoscopy is becoming the preferred modality for concomitant cholecystectomy and splenectomy (CAS. Usually, six to seven ports are employed for CAS, and spleen is removed by classical lateral approach or anterior approach. We report here our modified five-port and pedicle first approach for CAS in children to minimize the intraoperative bleeding and maximize the access. Materials and Methods : Twenty-one children underwent laparoscopic CAS with this new approach and their data were recorded prospectively. Following cholecystectomy (with ports 1-4, left side was elevated by 30°. The spleen was lifted by a grasper/fan retractor through port no. 5. The pedicle was dissected and splenic vessels were divided by ligasure (vessels < 8 mm, and for bulkier pedicle, vascular endo-GIA stapler was used. Short gastric and gastrosplenic ligament, lower pole and phrenico-colic attachments and upper pole attachments were dissected by ligasure in that sequence. Spleen was placed in endosac and delivered by digital fracture technique. Occasionally, lower transverse incision was made to deliver a massive spleen. Results : There were 12 males and 9 females with an average age of 8 years. Fourteen had sickle cell disease (SCD and 7 had SCD and beta thalassemia. All CAS were completed successfully without any complication. Total duration was 160 minutes. Cholecystectomy took an average of 35 minutes. Average blood loss was 140 ml. The mean splenic weight was 900 g and mean length was 20 cm. Duration of hospitalization was 3-4 days. Conclusion : CAS can be successfully performed by five ports. The pedicle first approach is extremely helpful in moderate to massive spleens as it reduces splenic size, vascularity and bleeding from capsular adhesions or inadvertant lacerations.

  2. Effect on liver function, immune function and inflammatory factors of laparoscopic and open cholecystectomy in patients

    Institute of Scientific and Technical Information of China (English)

    Lun Yu; Jun Zhang; Yong Jiao; Peng Yong

    2016-01-01

    Objective:To observe the effect on liver function, immune function and inflammatory factors of laparoscopic and open cholecystectomy in patients.Methods:A total of 113 patients who would experience cholecystectomy were chosen as research objects. According to their own willingness, these patients were randomly divided into LC group (67 cases) and OC group (46 cases). LC group was treated with laparoscopic cholecystectomy (LC). OC group was treated with traditional open cholecystectomy (OC). Changes of liver function (ALT, AST,γ-GT, ALP, TBIL), immune function (IgA, IgM, CD3, CD4, CD8) and inflammatory factors (CRP, IL-6, IL-8) were observed 1 and 7 d after surgery.Results: Comparison of liver function: exceptγ-GT showed no significant difference before and after surgery, the levels of ALT, AST and TBIL were significantly increased, while the level of ALP was significantly decreased 1 d after surgery in the two groups (P<0.05); the levels of ALT, AST, TBIL and ALP 7 d after surgery were comparable with preoperative levels in the two groups; furthermore, there were no significant differences referring to these indexes between the two groups at the same time points, say, 1 and 7 d after surgery. Comparison of immune function: the levels of CD3 and CD4 were significantly decreased 1 d after surgery compared with before surgery in the two groups (P<0.05); but 7 d after surgery, the levels of CD3 and CD4 were comparable with preoperative levels in the two groups; furthermore, there were no significant differences referring to the levels of CD3 and CD4 between the two groups at the same time points; As for the levels of IgA, IgM and CD8, no significant changes were observed in the two groups before and after surgery. Comparison of inflammatory factors: the levels of CRP, IL-6 and IL-8 were significantly increased 1 d after surgery compared with before surgery in the two groups (P<0.05); these mentioned levels of inflammatory factors 7 d after surgery were still higher

  3. ANAESTHETIC MANAGEMENT OF A CASE OF HEREDITARY SPHEROCYTOSIS FOR SPLENECTOMY AND CHOLECYSTECTOMY.

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    Jyotsna

    2012-11-01

    Full Text Available ABSTRACT: We report successful anaesthetic management of a pat ient with hereditary spherocytosis who underwent laproscopic splenectomy, ch olecystectomy and appendioectomy. Hereditary spherocytosis is a familial hemolytic di sorder with marked heterogeneity of clinical features, ranging from asymptomatic condition to a f ulminant hemolytic anaemia. Commonly recommended perioperative management in these patien ts includes preemptive erythrocyte transfusion, aggressive hydration and avoidance of hypoxia, aplastic crisis, hypothermia and acidosis. The management of such a case is challeng ing from anaesthetic point of view because of sickling oriented anaesthetic approach. Key words: Hereditary spherocytosis, splenectomy, cholecystectomy, perioperative management.

  4. Risk factors for prolonged operative time in single-incision laparoscopic cholecystectomy

    OpenAIRE

    Cheon, Seong Uk; Moon, Ju Ik; Choi, In Seok

    2015-01-01

    Purpose We performed 3-channel single incision laparoscopic cholecystectomy (SILC) in earlier period of this study and modified our method to 4-channel SILC using a snake retractor for better operative field in later period. This study has been designed to evaluate the risk factors for prolonged operative time in SILC. Methods From April 2010 to August 2014, 323 cases of 3-channel SILC (Konyang standard method [KSM] group) and 399 cases of 4-channel SILC (modified KSM [mKSM] group) using a sn...

  5. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy

    OpenAIRE

    2012-01-01

    Objective: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy. Material and Methods: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. Results: Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH20; P-LMA, 27.0±4.7 cmH20; p=0.42) and did not change...

  6. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy

    OpenAIRE

    2012-01-01

    Objective: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy.Material and Methods: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. Results: Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH20; P-LMA, 27.0±4.7 cmH20; p=0.42) and did not change during the induction of and throughout pneumoperit...

  7. Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared With Traditional Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Zhang, Yang; Peng, Jian; Li, Xiaoli; Liao, Mingmei

    2016-10-01

    The study aimed to compare the application values of endoscopic-laparoscopic cholecystolithotomy (ELC) and laparoscopic cholecystectomy (LC) for patients with cholecystolithiasis. It did a retrospective analysis of 107 patients with cholecystolithiasis who underwent ELC and 144 patients with cholecystolithiasis who underwent LC. There is no significant difference in operating time and expenses when comparing ELC with LC (P>0.05). ELC showed significantly less blood loss during operation compared with LC (PLC (PLC. The contractile function of gallbladder was close to normal (Pthickness of gallbladder wall significantly decreased (PLC.

  8. Iatrogenic gall bladder perforations in laparoscopic cholecystectomy: an audit of 200 cases.

    Science.gov (United States)

    Zubair, M; Habib, L; Mirza, M R; Channa, M A; Yousuf, M

    2010-07-01

    This study was done to evaluate the frequency of iatrogenic gall bladder perforation (IGBP) in laparoscopic cholecystectomy and to determine its association with gender, adhesions in right upper quadrant and types of gall bladder. This retrospective descriptive study included 200 patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis at Jamal Noor Hospital and Hamdard University Hospital, Karachi from January 2007 to January 2009. Video recording of all 200 laparoscopic cholecystectomies were analyzed for the IGBP. The different factors; sex of the patient, type of gall bladder, presence of adhesions in the right upper quadrant, timing of perforation, site of perforation, cause of perforation and spillage of stones were recorded. Data was entered and analyzed on SPSS 15. Pearson Chi Square test was applied to check the significance of these factors in IGBP where applicable. In this study there were 173 females and 27 male patients. IGBP occurred in 51 patients (25.5%) and among them 40(23.12%) were females and 11(40.74%) males. Statistical analysis failed to prove male gender a significant factor in the IGBP (p=0.051). Spillage of stones occurred in 23 patients (11.5% in total study population). In 32(18.49%) patients with chronic calculus cholecystitis IGBP occured while in other cluster of 27 patients suffering from acute cholecystitis, empyema & mucocele, 19(70.37%) had IGBP. Hence the condition of gall bladder (acute cholecystitis, empyema and mucocele) was proved statistically a significant factor in IGBP (p=0.000). Adhesiolysis in right upper quadrant was required in 109 patients in whom 31 patients (28.44%) had IGBP while in 91 patients in whom no adhesiolysis was required, 20 patients (21.98%) had IGBP. Statistically no significant difference was present regarding this factor (p=0.296). In total of 51 patients of IGBP, fundus of gall bladder was the commonest site of perforation in 21(41.18%), followed by body of gall bladder in

  9. Diaphragmatic injury caused by an endo-retractor during laparoscopic cholecystectomy

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    Chih-Yang Hsiao

    2016-01-01

    Full Text Available Endo-retractors are convenient devices for exposure and traction during minimally invasive surgery and are widely used in laparoscopic cholecystectomy (LC. Complications associated with the use of this device are rare. We present a patient with symptomatic gallstones who underwent LC and developed a diaphragmatic laceration as a result of the inappropriate use of an endo retractor. Although the incidence of complications with endo retractors is low, this report indicates the potential risk of diaphragmatic injury while using the retractors for exposure and traction during minimally invasive surgery.

  10. Prospective Observational Study of Single-Site Multiport Per-umbilical Laparoscopic Endosurgery versus Conventional Multiport Laparoscopic Cholecystectomy: Critical Appraisal of a Unique Umbilical Approach

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    Priyadarshan Anand Jategaonkar

    2014-01-01

    Full Text Available Purpose. This prospective observational study compares an innovative approach of Single-Site Multi-Port Per-umbilical Laparoscopic Endo-surgery (SSMPPLE cholecystectomy with the gold standard—Conventional Multi-port Laparoscopic Cholecystectomy (CMLC—to assess the feasibility and efficacy of the former. Methods. In all, 646 patients were studied. SSMPPLE cholecystectomy utilized three ports inserted through three independent mini-incisions at the umbilicus. Only the day-to-day rigid laparoscopic instruments were used in all cases. The SSMPPLE cholecystectomy group had 320 patients and the CMLC group had 326 patients. The outcomes were statistically compared. Results. SSMPPLE cholecystectomy had average operative time of 43.8 min and blood loss of 9.4 mL. Their duration of hospitalization was 1.3 days (range, 1–5. Six patients (1.9% of this group were converted to CMLC. Eleven patients had controlled gallbladder perforations at dissection. The Visual Analogue Scores for pain on postoperative days 0 and 7, the operative time, and the scar grades were significantly better for SSMPPLE than CMLC. However, umbilical sepsis and seroma outcomes were similar. We had no bile-duct injuries or port-site hernias in this study. Conclusion. SSMPPLE cholecystectomy approach complies with the principles of laparoscopic triangulation; it seems feasible and safe method of minimally invasive cholecystectomy. Overall, it has a potential to emerge as an economically viable alternative to single-port surgery.

  11. Effects of combined perioperative epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine on postoperative pain, pulmonary, and endocrine-metabolic function after minilaparotomy cholecystectomy

    DEFF Research Database (Denmark)

    Dahl, J B; Hjortsø, N C; Stage, J G

    1994-01-01

    cholecystectomy improves pain relief in the immediate postoperative period, compared to intramuscular morphine. Pulmonary and endocrine-metabolic function is not changed to such degree after minicholecystectomy that epidural analgesia can be demonstrated to have beneficial effects.......BACKGROUND AND OBJECTIVES. The study investigates the effects of combined perioperative continuous epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine, compared with intermittent systemic morphine, ibuprofen, and incisional bupivacaine, on postoperative pain, respiratory...... function, and endocrine-metabolic alterations associated with minilaparotomy cholecystectomy. METHODS. Thirty-two patients scheduled for cholecystectomy, performed through a minilaparotomy, were randomized to receive general anesthesia with pre- and postoperative thoracic (T7-9) epidural analgesia...

  12. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial

    DEFF Research Database (Denmark)

    Bisgaard, Thue; Klarskov, Birthe; Kehlet, Henrik

    2003-01-01

    OBJECTIVE: To determine the effects of preoperative dexamethasone on surgical outcome after laparoscopic cholecystectomy (LC). SUMMARY BACKGROUND DATA: Pain and fatigue are dominating symptoms after LC and may prolong convalescence. METHODS: In a double-blind, placebo-controlled study, 88 patient...

  13. Cholecystostomy as Bridge to Surgery and as Definitive Treatment or Acute Cholecystectomy in Patients with Acute Cholecystitis

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    Agnieszka Popowicz

    2016-01-01

    Full Text Available Purpose. Percutaneous cholecystostomy (PC has increasingly been used as bridge to surgery as well as sole treatment for patients with acute cholecystitis (AC. The aim of the study was to assess the outcome after PC compared to acute cholecystectomy in patients with AC. Methods. A review of medical records was performed on all patients residing in Stockholm County treated for AC in the years 2003 and 2008. Results. In 2003 and 2008 altogether 799 and 833 patients were admitted for AC. The number of patients treated with PC was 21/799 (2.6% in 2003 and 50/833 (6.0% in 2008. The complication rate (Clavien-Dindo ≥ 2 was 4/71 (5.6% after PC and 135/736 (18.3% after acute cholecystectomy. Mean (standard deviation hospital stay was 11.4 (10.5 days for patients treated with PC and 5.1 (4.3 days for patients undergoing acute cholecystectomy. After adjusting for age, gender, Charlson comorbidity index, and degree of cholecystitis, the hospital stay was significantly longer for patients treated with PC than for those undergoing acute cholecystectomy (P<0.001 but the risk for intervention-related complications was found to be significantly lower (P=0.001 in the PC group. Conclusion. PC can be performed with few serious complications, albeit with a longer hospital stay.

  14. POST-OPERATIVE VENTRICULAR TACHYCARDIA LEADING TO CARDIAC ARREST IN AN ASAG- I PATIENT OF CHOLECYSTECTOMY: A CASE REPORT

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    Pradip

    2014-03-01

    Full Text Available We here present our experience with ventricular tachycardia (VT leading to cardiac arrest in a patient with American Society of Anesthesiologists grade-I (ASA-I 11 hours after cholecystectomy. Excessive fluid overload and hypoxemia due to lung congestion may lead to cardiac arrest in this case. Immediate diagnosis and appropriate intervention saved the life of the patient.

  15. Is mini-laparoscopic cholecystectomy any better than the gold standard?: A comparative study

    Science.gov (United States)

    Shaikh, Haris R.; Abbas, Asad; Aleem, Salik; Lakhani, Miqdad R.

    2017-01-01

    BACKGROUND: Mini-laparoscopic cholecystectomy (MLC) has widened the horizons of modern laparoscopic surgery. Standard four port laparoscopic cholecystectomy (SLC), which has long been established as the “Gold Standard” for gall bladder diseases, is under reconsideration following the advent of further minimally-invasive procedures including MLC. Our study aims to provide a comparison between MLC and SLC and assesses whether MLC has any added benefits. MATERIALS AND METHODS: Patients with symptomatic gall bladder disease undergoing MLC or SLC during the 2.5-month period were included in the study. Thirty-two patients underwent MLC while SLC was performed on 40 patients by the same surgeon. Data was collected prospectively and analysed retrospectively using a predesigned questionnaire. RESULTS: In our study, both the groups had similar age, body mass index (BMI) and gender distribution. No cases of MLC required insertion of additional ports. The mean operative time for MLC was 38.2 min (33-61 min), which is longer than SLC; but it was not statistically significant. There was no significant difference in mean operative blood loss, postoperative pain, analgesia requirement and mobilization. Patients who underwent MLC were able to return to normal activity earlier than patients undergoing SLC (P cosmetic results. Further large scale trials are required to prove any additional benefit of MLC. PMID:27251827

  16. Intraincisional vs intraperitoneal infiltration of local anaesthetic for controlling early post-laparoscopic cholecystectomy pain

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    Gouda M El-labban

    2011-01-01

    Full Text Available Background: The study was designed to compare the effect of intraincisional vs intraperitoneal infiltration of levobupivacaine 0.25% on post-operative pain in laparoscopic cholecystectomy. Materials and Methods: This randomised controlled study was carried out on 189 patients who underwent laparoscopic cholecystectomy. Group 1 was the control group and did not receive either intraperitoneal or intraincisional levobupivacaine. Group 2 was assigned to receive local infiltration (intraincisional of 20 ml solution of levobupivacaine 0.25%, while Group 3 received 20 ml solution of levobupivacaine 0.25% intraperitoneally. Post-operative pain was recorded for 24 hours post-operatively. Results: Post-operative abdominal pain was significantly lower with intraincisional infiltration of levobupivacaine 0.25% in group 2. This difference was reported from 30 minutes till 24 hours post-operatively. Right shoulder pain showed significantly lower incidence in group 2 and group 3 compared to control group. Although statistically insignificant, shoulder pain was less in group 3 than group 2. Conclusion: Intraincisional infiltration of levobupivacaine is more effective than intraperitoneal route in controlling post-operative abdominal pain. It decreases the need for rescue analgesia.

  17. SPINAL ANAESTHESIA VERSUS GENERAL ANAESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY - A PROSPECTIVE RANDOMIZED CONTROLLED STUDY

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    Prasad

    2014-02-01

    Full Text Available INTRODUCTION: Combining minimal invasive surgical and lesser invasive anesthesia technique reduces morbidity and mortality. The aim of the study is to compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy. MATERIALS & METHODS: 60 healthy patients were randomized under spinal anesthesia (n=30 & General Anesthesia (n=30 . Hyperbaric 3ml bupivacaine plus 25mcg fenta nyl was administered for spinal group and conventional general anesthesia for GA group. Intraoperative parameters and post - operative pain and recovery were noted. Under spinal group any intraoperative discomfort were taken care by reassurance , drugs or con verted to GA. Questionnaire forms were provided for patients and surgeons to comment about the operation. RESULTS: None of the patients had significant hemodynamic and respiratory disturbance except for transient hypotension and bradycardia. Operative time was comparable. 6patients under spinal anesthesia had right shoulder pain , 2 patients were converted to GA and 4 patients were managed by injection midazolam and infiltration of lignocaine over the diaphragm. There was significant post - operative pain reli ef in spinal group. All the patients were comfortable and surgeons satisfied. CONCLUSION: Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesth esia without limiting recovery , but require cooperative patient , skilled surgeon , a gentle surgical technique and an enthusiastic anesthesiologist

  18. Effect of gender on pain perception and analgesic consumption in laparoscopic cholecystectomy: An observational study

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    Aziza M Hussain

    2013-01-01

    Full Text Available Background: Evidence regarding gender affecting the response to pain and its treatment is inconsistent in literature. The objective of this prospective, observational study was to determine the effect of gender on pain perception and postoperative analgesic consumption in patients undergoing laparoscopic cholecystectomy. Materials and Methods: We recruited 60 male and 60 female patients undergoing elective laparoscopic cholecystectomy. Patients were observed for additional intraoperative and postoperative analgesia. Numerical rating scale was documented at 10 min interval for 1 h in post-anesthesia recovery room and at 4, 8, and 12 h postoperatively. Boluses of tramadol given as rescue analgesia were also noted. There were no dropouts. Results: The mean pain scores were significantly higher in female patients at 20 and 30 min following surgery. Mean dose of tramadol consumption was significantly higher in female patients for the first postoperative hour (P = 0.002, but not in the later period. Conclusion: Female patients exhibited greater intensity of pain and required higher doses of analgesics compared to males in in the immediate postoperative period in order to achieve a similar degree of analgesia.

  19. Predictive Factors for a Long Hospital Stay in Patients Undergoing Laparoscopic Cholecystectomy

    Science.gov (United States)

    Ko-iam, Wasana; Sandhu, Trichak; Paiboonworachat, Sahattaya; Pongchairerks, Paisal; Chotirosniramit, Anon; Chotirosniramit, Narain; Chandacham, Kamtone; Jirapongcharoenlap, Tidarat

    2017-01-01

    Background. Although the advantages of laparoscopic cholecystectomy (LC) over open cholecystectomy are immediately obvious and appreciated, several patients need a postoperative hospital stay of more than 24 hours. Thus, the predictive factors for this longer stay need to be investigated. The aim of this study was to identify the causes of a long hospital stay after LC. Methods. This is a retrospective cohort study with 500 successful elective LC patients being included in the analysis. Short hospital stay was defined as being discharged within 24 hours after the operation, whereas long hospital stay was defined as the need for a stay of more than 24 hours after the operation. Results. Using multivariable analysis, ten independent predictive factors were identified for a long hospital stay. These included patients with cirrhosis, patients with a history of previous acute cholecystitis, cholangitis, or pancreatitis, patients on anticoagulation with warfarin, patients with standard-pressure pneumoperitoneum, patients who had been given metoclopramide as an intraoperative antiemetic drug, patients who had been using abdominal drain, patients who had numeric rating scale for pain > 3, patients with an oral analgesia requirement > 2 doses, complications, and private ward admission. Conclusions. LC difficulties were important predictive factors for a long hospital stay, as well as medication and operative factors. PMID:28239497

  20. The Influence of Kinesio Taping on the Effects of Physiotherapy in Patients after Laparoscopic Cholecystectomy

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    Marcin Krajczy

    2012-01-01

    Full Text Available Physiotherapy in patients after laparoscopic cholecystectomy (CHL is impeded by postoperative pain which causes a decline in patients’ activity, reduces respiratory muscles’ function, and affects patients’ ability to look after themselves. The objective of this work was to assess the influence of Kinesio Taping (KT on pain level and the increase in effort tolerance in patients after CHL. The research included 63 patients after CHL. Test group and control group included randomly selected volunteers. Control group consisted of 32 patients (26 females, 6 males, test group consisted of 31 patients (22 females, 9 males. Both groups were subjected to complex physiotherapy, and control group had additional KT applications. Before surgery, during and after physiotherapy, patients were given the following tests: 100-meter walk tests, subjective pain perception assessment, and pain relief medicines intake level assessment. The level of statistical significance for all tests was established at <0.05. Statistical analysis showed a significant decrease in the time required to cover a 100-meter distance and a decrease in pain perception presented by significantly lower painkillers' intake in the test group in comparison with the control group. The improvement in clinical condition observed in the research indicates the efficiency of KT as a method complementing physiotherapy in patients after laparoscopic cholecystectomy.

  1. Peritoneal Nebulization of Ropivacaine during Laparoscopic Cholecystectomy: Dose Finding and Pharmacokinetic Study

    Science.gov (United States)

    Allegri, Massimo; Ornaghi, Martina; Meghani, Yash; Calcinati, Serena; Lovisari, Federica; Radhakrishnan, Krishnaprabha; Cusato, Maria; Scalia Catenacci, Stefano; Somaini, Marta; Fanelli, Guido; Ingelmo, Pablo

    2017-01-01

    Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain and morphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150 mg of ropivacaine 1% by peritoneal nebulization through a nebulizer. Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery. The pharmacokinetics of ropivacaine was evaluated using high performance liquid chromatography. Results. Nebulization of 50 mg of ropivacaine had the same effect of 100 or 150 mg in terms of postoperative morphine consumption, shoulder pain, postoperative nausea and vomiting, activity resumption, and hospital discharge timing (>0.05). Plasma concentrations did not reach toxic levels in any patient, and no significant differences were observed between groups (P > 0.05). Conclusions. There is no enhancement in analgesic efficacy with higher doses of nebulized ropivacaine during laparoscopic cholecystectomy. When administered with a microvibration-based aerosol humidification system, the pharmacokinetics of ropivacaine is constant and maintains an adequate safety profile for each dosage tested.

  2. COMPARATIVE STUDY O F I TRAVENOUS NITROGLYCERINE AND CLONIDINE ON HAEMODYNAMIC STABILITY IN LAPROSCOPIC CHOLECYSTECTOMY

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    Omar

    2013-05-01

    Full Text Available ABSTRACT: Clonidine has been shown to reduce perioperative haemodynamic instability. The aim of the study was to investigate the clinical efficiency of intravenous clonidine premedication with nitroglycerine infusion in prev ention of haemodynamic response associated with pneum o peritoneum . Sixty adult patients of ASA physical status I& II, scheduled for elective laparoscopic cholecystectomy were recruited for a prospective randomized, double - blinded comparative study. They w ere randomly allocated to one of the two groups to receive either nitrog lycerine infusion (Group I or i.v. clonidine 2mg (Group II, before induction of anaesthesia. Significant rise in heart rate was observed following pneumoperitoneum in Group I as comp ared to Group II (99.23±14.02 Vs 81.26±8.40 bpm. Similarly, while systolic arterial pressure, diastolic arterial pressure and mean arterial pressure changes were insignificant in both the groups following pneumoperitoneum. Nitroglycerine drip was started in 2 patients in Group II to control intraoperative hypertension. Incidence of postopera tive nausea - vomiting and shivering was less in Group II. To conclude, clonidine premedication provides better perioperative haemodynamic stability, hence it can be reco mmended as a routine premedication for laparoscopic cholecystectomy .

  3. The microbiological and clinical characteristics of invasive salmonella in gallbladders from cholecystectomy patients in kathmandu, Nepal.

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    Sabina Dongol

    Full Text Available Gallbladder carriage of invasive Salmonella is considered fundamental in sustaining typhoid fever transmission. Bile and tissue was obtained from 1,377 individuals undergoing cholecystectomy in Kathmandu to investigate the prevalence, characteristics and relevance of invasive Salmonella in the gallbladder in an endemic area. Twenty percent of bile samples contained a Gram-negative organism, with Salmonella Typhi and Salmonella Paratyphi A isolated from 24 and 22 individuals, respectively. Gallbladders that contained Salmonella were more likely to show evidence of acute inflammation with extensive neutrophil infiltrate than those without Salmonella, corresponding with higher neutrophil and lower lymphocyte counts in the blood of Salmonella positive individuals. Antimicrobial resistance in the invasive Salmonella isolates was limited, indicating that gallbladder colonization is unlikely to be driven by antimicrobial resistance. The overall role of invasive Salmonella carriage in the gallbladder is not understood; here we show that 3.5% of individuals undergoing cholecystectomy in this setting have a high concentration of antimicrobial sensitive, invasive Salmonella in their bile. We predict that such individuals will become increasingly important if current transmission mechanisms are disturbed; prospectively identifying these individuals is, therefore, paramount for rapid local and regional elimination.

  4. Complications of laparoscopic cholecystectomy (L.C in Imam Reza hospital in Kermanshah (2006-2012

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    Ezatollah Sadeghi

    2014-01-01

    Full Text Available Background: laparoscopic cholecystectomy has become a technique of choice for treatment and removal of gallbladder problems. Various studies have been done on its effectiveness & complications. The most common complications are bile duct injuries, bile leakage, wound infection and bile peritonitis. Methods: This study retrospectively analysed the total number of laparoscopic cholecystectomy cases performed in Imam Reza hospital (2006-2012. According to the patient's profile, we tried to determine the actual incidence of complications after L.C. Results: Total of 1380 patients were studied, from whom 1074 cases were female (77.8%. The average age of the participants was 48.11(0/7%. The most common complications were bile duct injuries and bile leakage. The most common location of biliary damage was CBD (61%. Cystic duct injuries and other accessory bile ducts were categorized as following priorities. Incidence of collections after surgery was 15 cases (1.08%. The majority of bile duct injuries were surgically treated (81%, using biliary-enteric anastomosis procedure. Conclusion: The most common and challenging complications of L.C were bile duct injury and bile leakage that occur for patients due to tragic consequences. The most common surgical repair method for bile injuries is biliary-enteric anastomosis and insertion of T.Tube. The alternative method is percutaneous drainage for small leakages.

  5. Laparoscopic Cholecystectomy of Patients with Cardiac Disease in Our Clinic; Retrospective Study

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    Ömer Faruk Şavluk

    2013-03-01

    Full Text Available Introduction: The application of laparoscopic cholecystectomy is investigated to effected on patients with cardiac surgery or examination of patients that were identified with cardiac problem.Patients and Methods: Between 2008-2010 total of 233 patients with laporoscopiccholecystectomy were retrospectively analyzed follow up papers. Systolic blood pressure, diastolic blood pressure, heart rate, X-rays and ECGs were evaluated in preoperative examination in all patients. ECG, SpO2 monitoring was performed to all patients in the operating room. In all patients systolic blood pressure, diastolic blood pressure, heart rate and SpO2 values before the operation and during the operation were recorded. End-tidal CO2 was monitored during the operation. Additional disease duration of surgery, duration of intubation, preoperative, perioperative and postoperative need to inotropic support were recorded. Results: One hundred and one (43% patients were men and 132 (57% female. Forty five of 233 patients with cardiac problems are sick. Twenty five patients of these patients had coronary bypass surgery and eight patients underwent prosthetic valve surgery. As a result of preoperative transthoracic echocardiography in 12 patients were diagnosed with valve insufficiency. Demographic characteristics were similar than between the two groups. The mean operation time, insuflation time, extubation time, staying hospital time and hemodynamic data were similar than between the two groups. Conclusion: Laparoscopic cholecystectomy safely and easily can apply for application of the balanced anesthesia, low-pressure pneumoperitoneum after being stable cardiac status in patients with cardiac problem.

  6. Original single-incision laparoscopic cholecystectomy for acute inflammation of the gallbladder

    Institute of Scientific and Technical Information of China (English)

    Kazunari Sasaki; Goro Watanabe; Masamichi Matsuda; Masaji Hashimoto

    2012-01-01

    AIM:To investigate the safety and feasibility of our original single-incision laparoscopic cholecystectomy (SILC) for acute inflamed gallbladder (AIG).METHODS:One hundred and ten consecutive patients underwent original SILC for gallbladder disease without any selection criteria and 15 and 11 of these were diagnosed with acute cholecystitis and acute gallstone cholangitis,respectively.A retrospective review was performed not only between SILC for AIG and non-AIG,but also between SILC for AIG and traditional laparoscopic cholecystectomy (TLC) for AIG in the same period.RESULTS:Comparison between SILC for AIG and nonAIG revealed that the operative time was longer in SILC for AIG (97.5 min vs 85.0 min,P =0.03).The open conversion rate (2/26 vs 2/84,P =0.24) and complication rate (1/26 vs 3/84,P =1.00) showed no differences,but a need for additional trocars was more frequent in SILC for AIG (5/24 vs 3/82,P =0.01).Comparison between SILC for AIG and TLC for AIG revealed no differences based on statistical analysis.CONCLUSION:Our original SILC technique was adequately safe and feasible for the treatment of acute cholecystitis and acute gallstone cholangitis.

  7. Risk Factors for Recurrence of Symptomatic Common Bile Duct Stones after Cholecystectomy

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    Ju Hyun Oak

    2012-01-01

    Full Text Available Purpose. The recurrence of CBD stone is still observed in a considerable number of patients. The study was to evaluate the risk factors for recurrence of symptomatic CBD stone in patients who underwent cholecystectomy after the removal of CBD stone. Methods. The medical records of patients who underwent removal of CBD stone with subsequent cholecystectomy were reviewed. The risk factors for the recurrence of symptomatic CBD stone were compared between the recurrence and the nonrecurrence group. Results. The mean follow-up period was 40.6 months. The recurrence of symptomatic CBD stones was defined as the detection of bile duct stones no sooner than 6 months after complete clearance of CBD stones, based on symptoms or signs of biliary complication. 144 patients (68 males, 47.2% were finally enrolled and their mean age was 59.8 (range: 26~86 years. The recurrence of CBD stone occurred in 15 patients (10.4%. The mean period until first recurrence was 25.9 months. The presence of type 1 or 2 periampullary diverticulum and multiple CBD stones were the independent risk factors. Conclusion. For the patients with type 1 or 2 periampullary diverticulum or multiple CBD stones, careful followup is needed for the risk in recurrence of symptomatic CBD stone.

  8. SILC for SILC: Single Institution Learning Curve for Single-Incision Laparoscopic Cholecystectomy

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    Chee Wei Tay

    2013-01-01

    Full Text Available Objectives. We report the single-incision laparoscopic cholecystectomy (SILC learning experience of 2 hepatobiliary surgeons and the factors that could influence the learning curve of SILC. Methods. Patients who underwent SILC by Surgeons A and B were studied retrospectively. Operating time, conversion rate, reason for conversion, identity of first assistants, and their experience with previous laparoscopic cholecystectomy (LC were analysed. CUSUM analysis is used to identify learning curve. Results. Hundred and nineteen SILC cases were performed by Surgeons A and B, respectively. Eight cases required additional port. In CUSUM analysis, most conversion occurred during the first 19 cases. Operating time was significantly lower (62.5 versus 90.6 min, P = 0.04 after the learning curve has been overcome. Operating time decreases as the experience increases, especially Surgeon B. Most conversions are due to adhesion at Calot’s triangle. Acute cholecystitis, patients’ BMI, and previous surgery do not seem to influence conversion rate. Mean operating times of cases assisted by first assistant with and without LC experience were 48 and 74 minutes, respectively (P = 0.004. Conclusion. Nineteen cases are needed to overcome the learning curve of SILC. Team work, assistant with CLC experience, and appropriate equipment and technique are the important factors in performing SILC.

  9. ANESTHETIC MANAGEMENT OF A PATIENT WITH SITUS INVERSUS POSTED FOR LAPAROSCOPIC CHOLECYSTECTOMY

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    Sudhir

    2014-04-01

    Full Text Available Situs inversus totalis is a congenital visceral malrotation anomaly that results from disturbances in establishment of left-right asymmetry and it is characterized by total transposition of thoracic and abdominal viscera, and the predicted incidence is one in 10, 000 among the general population. In a patient with situs inversus totalis, not just the diagnosis of any acute abdomen pathology is difficult but equally challenging is the anesthetic management during the respective surgical procedure. We are reporting a patient who had situs inversus totalis and was operated for laparoscopic cholecystectomy under general anesthesia with I-gel, a new supraglottic airway device as an airway conduit. Though the problems related to such patients are mainly of surgical feasibility, an anesthesiologist must be aware of the associated problems of both, situs inversus and the laparoscopy. The present case report lays an emphasis on the potential difficulties during anesthetic management and its various implications. To the best of our knowledge, we report the first case in India of a successful laparoscopic cholecystectomy in a patient with situs inversus totalis with use of I-gel.

  10. The microbiological and clinical characteristics of invasive salmonella in gallbladders from cholecystectomy patients in kathmandu, Nepal.

    Science.gov (United States)

    Dongol, Sabina; Thompson, Corinne N; Clare, Simon; Nga, Tran Vu Thieu; Duy, Pham Thanh; Karkey, Abhilasha; Arjyal, Amit; Koirala, Samir; Khatri, Nely Shrestha; Maskey, Pukar; Poudel, Sanjay; Jaiswal, Vijay Kumar; Vaidya, Sujan; Dougan, Gordon; Farrar, Jeremy J; Dolecek, Christiane; Basnyat, Buddha; Baker, Stephen

    2012-01-01

    Gallbladder carriage of invasive Salmonella is considered fundamental in sustaining typhoid fever transmission. Bile and tissue was obtained from 1,377 individuals undergoing cholecystectomy in Kathmandu to investigate the prevalence, characteristics and relevance of invasive Salmonella in the gallbladder in an endemic area. Twenty percent of bile samples contained a Gram-negative organism, with Salmonella Typhi and Salmonella Paratyphi A isolated from 24 and 22 individuals, respectively. Gallbladders that contained Salmonella were more likely to show evidence of acute inflammation with extensive neutrophil infiltrate than those without Salmonella, corresponding with higher neutrophil and lower lymphocyte counts in the blood of Salmonella positive individuals. Antimicrobial resistance in the invasive Salmonella isolates was limited, indicating that gallbladder colonization is unlikely to be driven by antimicrobial resistance. The overall role of invasive Salmonella carriage in the gallbladder is not understood; here we show that 3.5% of individuals undergoing cholecystectomy in this setting have a high concentration of antimicrobial sensitive, invasive Salmonella in their bile. We predict that such individuals will become increasingly important if current transmission mechanisms are disturbed; prospectively identifying these individuals is, therefore, paramount for rapid local and regional elimination.

  11. Prediction of Hemodynamic Reactivity during Sevoflurane Remifentanyl Anesthesia for Laparoscopic Cholecystectomy Using Analgesia Nociception Index

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    Ali Şefik Köprülü

    2016-12-01

    Full Text Available Aim: Pneumoperitoneum may cause serious side effects in high-risk patients during laparoscopic cholecystectomy. Perioperative analgesic sufficiency has been measured by the Analgesia Nociception index (ANI in recent years. We examine the possibility of predicting hemodynamic reactivity by observing sudden changes in ANI during operation. Methods: In this retrospective study, recorded hemodynamic parameters (including heart rate, systolic/ diastolic blood pressure values and ANI values, before and after intubation, nasogastric tube application, intraperitoneal gas insufflation, and surgical incision in 31 patients who were applied laparoscopic cholecystectomy were compared by paired t-test. Additionally, an increment or decrement of 20% in ANI and 15% in hemodynamic parameters with respect to basal observation values were called “sudden changes”. Correlation of these parameters with sudden changes in ANI values was examined either. Results: There was a statistically significant difference in parameters after premedication and intubation. After induction, a statistically significant decrement was detected only in heart rate and systolic/diastolic blood pressure values. There was no significant change after nasogastric tube insertion. During pneumoperitoneum and surgical incision, there was no change in heart rate and systolic/diastolic blood pressure values, but a statistically significant decrement was observed in ANI. No correlation was detected between sudden changes in ANI values and hemodynamic parameters. Conclusion: We assume that use of ANI in analgesia evaluation under general anesthesia at perioperative period is suitable, however, it is not reliable in predicting hemodynamic interaction.

  12. EFFECT OF PREEMPTIVE MAGNESIUM SULPHATE ON PAIN RELIEF AFTER LAPAROSCOPIC CHOLECYSTECTOMY

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    Ravi Vasupalli

    2016-09-01

    Full Text Available BACKGROUND The concept of preemptive analgesia was introduced by C. J. Woolf et al demonstrating that a post-injury hypersensitivity results via a central mechanism. The effect of magnesium on perioperative analgesic requirements was first evaluated by Koinig and his colleagues in patients with identical levels of surgical stimulation. Magnesium Sulphate is an antagonist of Nmethyl-D-aspartate (NMDA receptors and its associated channels and regulation of calcium influx into the cell. Magnesium causes modulation of acute pain reducing postsurgical pain intensity and dosage of analgesics. Seyhan et al have reported that magnesium sulphate boluses were effective for postoperative pain relief after gynaecological surgery. Fucs-Budder et al, Kussman B et al used continuous infusion (15 mg/kg/hr. in addition to initial bolus (50 mg/kg of magnesium sulphate in their studies, which caused bradycardia and delayed extubation time, which can be attributed to the infusion of Iva Bacak Kochman et al studied effect of low dose MgSO4 (7.5 mg/kg as analgesic agent after induction in patients undergoing laparoscopic cholecystectomy. This bolus dose of MgSO4 given for control of sympathetic response during intubation also reduced early postoperative pain. Study conducted by O Mentes et al on postoperative analgesic efficacy of single dose MgSO4 (50 mg/kg after laparoscopic cholecystectomy measured significantly less VAS scores. On this background, our study was done to evaluate the postoperative analgesic efficacy of single dose of magnesium sulphate (50 mg/kg as preemptive analgesic and measured after laparoscopic cholecystectomy. In addition to VAS scores, total tramadol consumption and time for first rescue analgesia, postoperative haemodynamic parameters and side effects if any were evaluated. METHODS After obtaining Institutional Ethical committee clearance and written informed consent from the patients, a randomised prospective study was conducted at King

  13. Antibiotic prophylaxis in elective cholecystectomy: protocol adequacy and related outcomes in a retrospective single-centre analysis

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    Gil Rodríguez-Caravaca

    2016-01-01

    Full Text Available Background: Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection. Methods: This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis. Results: The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%, followed by the moment of initiating its administration (8.9%. The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6. No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0, nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1. Conclusions: The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%. No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found.

  14. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis: An overview of Cochrane Hepato-Biliary Group reviews (Review)

    NARCIS (Netherlands)

    Keus, F.; Gooszen, H.G.; Laarhoven, C.J.H.M. van

    2010-01-01

    BACKGROUND: Patients with symptomatic cholecystolithiasis are treated by three different techniques of cholecystectomy: open, small-incision, or laparoscopic. There is no overview on Cochrane systematic reviews on these three interventions. OBJECTIVES: To summarise Cochrane reviews that assess the e

  15. Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

    DEFF Research Database (Denmark)

    Philip Rothman, Josephine; Burcharth, Jakob; Pommergaard, Hans-Christian;

    2016-01-01

    BACKGROUND: Preoperative risk factors for the conversion of laparoscopic cholecystectomy to open surgery have been identified, but never been explored systematically. Our objective was to systematically present the evidence of preoperative risk factors for conversion of laparoscopic cholecystecto...... cholecystitis were risk factors for the conversion of laparoscopic cholecystectomy to open surgery. Furthermore, there was no association between diabetes mellitus or white blood cell count and conversion to open surgery....

  16. Cholecystectomy in patients with normal gallbladder function did not alter characteristics in duodenal motility which was not correlated to size of bile acid pool

    DEFF Research Database (Denmark)

    Andersen, P V; Mortensen, J; Oster-Jørgensen, E;

    1999-01-01

    Nine gallstone patients with normal gallbladder function as assessed by hepatobiliary scintigraphy were included. Fasting and postprandial duodenal motility were studied before and one month after an uncomplicated laparoscopic cholecystectomy. An ambulatory continuous pressure recording was obtai......Nine gallstone patients with normal gallbladder function as assessed by hepatobiliary scintigraphy were included. Fasting and postprandial duodenal motility were studied before and one month after an uncomplicated laparoscopic cholecystectomy. An ambulatory continuous pressure recording...

  17. THE LMA PROSEAL: AN EFFECTIVE ALTERNATIVE TO TRACHEAL INTUBATION FOR LAPAROSCOPIC CHOLECYSTECTOMY

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    Sanchita Sarma

    2015-12-01

    Full Text Available An Anaesthesiologist has the fundamental responsibility to maintain a patent airway during surgical procedures. Although the tracheal tube is considered ideal for laparoscopic procedures, there is consistent flow of reports highlighting the safety of LMA ProSeal in laparoscopic surgeries. The aim of this study was to compare the effects of insertion and removal of LMA ProSeal and Endotracheal tube on haemodynamic responses, to evaluate the efficacy and safety of use of LMA ProSeal as an airway device for Laparoscopic cholecystectomy and to note other observations, if any. Sixty patients undergoing elective Laparoscopic Cholecystectomy of 35-45 minutes duration were randomly divided into two groups comprising of 30 patients in each. Group E: Patients receiving EndoTracheal Tube (ETT. Group P: Patients receiving LMA ProSeal (LMA-PS. A standard General Anaesthesia protocol and routine monitoring was applied in all patients. Monitoring of Heart Rate (HR, Systolic Blood Pressure (SBP, Diastolic Blood Pressure (DBP, Mean Arterial Blood Pressure (MAP and SPO2 preoperatively (As baseline, after intubation or placement of LMA-PS, at 1min, 3mins, 5mins and every 5mins thereafter till the reading at removal and after 5mins of removal of ETT or LMA-PS. For both the groups, baseline value for ETCO2 was taken from connection of ETCO2 cable following placement of airway devices (ETT/LMA-PS.All data were analyzed by specific statistical methods applicable to the various sets of data. Tests employed were Student T test, Fisher’s exact test which were performed on SPSS software. Microsoft Word and Excel have been used to generate graphs, tables etc. SpO2 was well maintained in both the groups throughout the procedure. On statistical analysis, it was found that the increase in HR,SBP,DBP, MAP were highly significant after instrumentation, at 1 min and 3 mins with Group E showing a greater rise than Group P. It became insignificant at 5 mins and there after

  18. Early endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy can strain the occurrence of trocar site hernia

    Institute of Scientific and Technical Information of China (English)

    Fatih; Sumer; Cuneyt; Kayaalp; Mehmet; Ali; Yagci; Emrah; Otan; Huseyin; Kocaaslan

    2014-01-01

    This study reports a 69-year-old, obese, female patientpresenting with a biliary leakage after laparoscopiccholecystectomy for cholelithiasis. Closure of the um-bilical trocar site had been neglected during the lapa-roscopic cholecystectomy. Early, on postoperative dayfive, endoscopic retrograde cholangiopancreatography(ERCP) requirement after laparoscopic cholecystectomyresolved the biliary leakage problem but resulted with amore complicated clinical picture with an intestinal ob-struction and severe abdominal pain. Computed tomog-raphy revealed a strangulated hernia from the umbilicaltrocar site. Increased abdominal pressure during ERCPhad strained the weak umbilical trocar site. Emergencysurgical intervention through the umbilicus revealed anischemic small bowel segment which was treated withresection and anastomosis. This report demonstratesthat negligence of trocar site closure can result in veryearly herniation, particularly if an endoscopic interven-tion is required in the early postoperative period.

  19. Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy

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    Arshad Rashid

    2015-01-01

    Full Text Available Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47% patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot’s triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries.

  20. Role of laparoscopic subtotal cholecystectomy in the treatment of complicated cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Wu Ji; Ling-Tang Li; Jie-Shou Li

    2006-01-01

    BACKGROUND:Laparoscopic cholecystectomy (LC) has become the "gold standard" in treating benign gallbladder diseases. Increasing laparoscopic experience and techniques have made laparoscopic subtotal cholecystectomy (LSC) a feasible option in more complex procedures. In recent years, few studies with a few cases of LSC have reported good results in patients with various types of cholecystitis. This study was designed to evaluate the feasibility, indications, characteristics and beneifts of LSC in patients with complicated cholecystitis. METHODS:Altogether, 3485 patients were scheduled to receive LC during the past 4 years at our institute. Among them, 168 patients with various complicated forms of cholecystitis were treated by LSC. Meanwhile, the other 3317 patients who received standard LC were enrolled as the control group. Perioperative data from the two groups were collected and retrospectively analyzed. RESULTS:In the LSC group, 135 patients suffered from acute calculic cholecystitis, 18 from chronic calculic cholecystitis with cirrhotic portal hypertention, and 15 from chronic calculic atrophy cholecystitis with severe ifbrosis. These patients constituted 4.8% of the total patients who underwent LC (168/3485) in the same period at our institute. In 122 patients, the cystic duct and artery were clipped before division. In another 46 patients, the gallbladder was initially incised at Hartmann's pouch. Five patients (3.0%) were converted to open subtotal cholecystectomy. The median operation time for LSC was 65.5±15.2 minutes, estimated operative blood loss was 71.5±15.5 ml, and the time to resume diet was 20.4±6.3 hours. Thirteen patients (7.7%) had local complications. The mean postoperative hospital stay was 4.2±2.6 days. In the LC group, 2887 had chronic calculic cholecystitis, 312 had acute calculic cholecystitis, 47 had chronic calculic atrophy cholecystitis, and 71 had polypus. Seventeen patients (0.5%) were converted to open cholecystectomy. The

  1. Technical modifications for laparoscopic cholecystectomy by the left-handed surgeon.

    Science.gov (United States)

    Herrero-Segura, Antonio; López-Tomassetti Fernández, Eudaldo M; Medina-Arana, Vicente

    2007-10-01

    There is a complete paucity of literature for left-handed surgeons. Some studies revealed that left-handed surgical residents have lesser operating skills and some surgeons have considered leaving surgery at some point in their career owing to laterality-related frustrations. Most important, whereas minimally invasive surgical techniques have had a profound impact on the treatment of diseased gallbladder, these procedures do not eliminate laterality related to the discomfort of left-handed surgeons. Usually, left-handed surgeons must teach themselves a procedure. They must make modifications and learn some technical tips to make a more comfortable, convenient, and safe intervention. The aim of this study was to describe some modifications made by a left-handed surgeon to perform 52 safe laparoscopic cholecystectomies with standard right-handed instruments in our hospital. These surgical steps could be used in a reproducible way to minimize the recurring difficulties of left-handed learners in a surgical residency program.

  2. Laparoscopic Cholecystectomy for a Patient with a Lumboperitoneal Shunt: A Rare Case.

    Science.gov (United States)

    Rumba, Roberts; Vanags, Andrejs; Strumfa, Ilze; Pupkevics, Andrejs; Pavars, Maris

    2016-01-01

    A rare factor that can complicate the perioperative course of laparoscopic cholecystectomy is previous placement of a lumboperitoneal (LP) shunt. Thus far, only two articles describing this situation have been published. Here, we report on a 41-year-old female patient with gallstone disease and a LP shunt placement in the preceding year due to idiopathic intracranial hypertension. It is a syndrome of increased intracranial pressure without any known cause that mainly affects young obese women. The patient was operated upon using standard port placement and peritoneal insufflation. The postoperative period was uneventful and the patient was discharged shortly after the procedure. Due to the increasing incidence and prevalence of obesity, the number of general surgical patients with a LP shunt will likely increase. Based on our experience and evidence in the literature, we conclude that performing a laparoscopy for a patient with a LP shunt is safe.

  3. "Extended" radical cholecystectomy for gallbladder cancer:Long-term outcomes, indications and limitations

    Institute of Scientific and Technical Information of China (English)

    Yoshio Shirai; Jun Sakata; Toshifumi Wakai; Taku Ohashi; Katsuyoshi Hatakeyama

    2012-01-01

    AIM:To delineate indications and limitations for "extended" radical cholecystectomy for gallbladder cancer:a procedure which was instituted in our department in 1982.METHODS:Of 145 patients who underwent a radical resection for gallbladder cancer from 1982 through 2006,52 (36%) had an extended radical cholecystectomy,which involved en bloc resection of the gallbladder,gallbladder fossa,extrahepatic bile duct,and the regional lymph nodes (first-and second-echelon node groups).A retrospective analysis of the 52 patients was conducted including at least 5 years of follow up.Residual tumor status was judged as no residual tumor (R0) or microscopic/macroscopic residual tumor (R1-2).Pathological findings were documented according to the American Joint Committee on Cancer Cancer Staging Manual (7th edition).RESULTS:The primary tumor was classified as pathological T1 (pT1) in 3 patients,pT2 in 36,pT3 in 12,and pT4 in 1.Twenty-three patients had lymph node metastases; 11 had a single positive node,4 had two positive nodes,and 8 had three or more positive nodes.None of the three patients with pT1 tumors had nodal disease,whereas 23 of 49 (47%) with pT2 or more advanced tumors had nodal disease.One patient died during the hospital stay for definitive resection,giving an in-hospital mortality rate of 2%.Overall survival (OS) after extended radical cholecystectomy was 65% at 5 years and 53% at 10 years in all 52 patients.OS differed according to the pT classification (P < 0.001)and the nodal status (P =0.010).All of 3 patients with pT1 tumors and most (29 of 36) patients with pT2 tumors survived for more than 5 years.Of 12 patients with pT3 tumors,8 who had an R1-2 resection,distant metastasis,or extensive extrahepatic organ involvement died soon after resection.Of the remaining four pT3 patients who had localized hepatic spread through the gallbladder fossa and underwent an R0 resection,2 survived for more than 5 years and another survived for 4 years and 2 mo

  4. No effect of melatonin on oxidative stress after laparoscopic cholecystectomy: a randomized placebo-controlled trial

    DEFF Research Database (Denmark)

    Kucukakin, B.; Klein, M.; Lykkesfeldt, Jens

    2010-01-01

    Background Melatonin, an endogenous circadian regulator, also has antioxidant and anti-inflammatory properties. The aim of this study was to evaluate the antioxidative effect of melatonin in patients undergoing laparoscopic cholecystectomy. Methods Patients were randomized to receive 10 mg...... melatonin or placebo during surgery. Blood samples for analysis of malondialdehyde (MDA), ascorbic acid (AA), total ascorbic acid (TAA) dehydroascorbic acid (DHA) and C-reactive protein (CRP) were collected pre-operatively and at 5 min, 6 h and 24 h after operation. Results Twenty patients received...... melatonin and 21 patients received placebo during surgery. No significant differences were observed between the groups in the oxidative stress variables MDA, TAA, AA and DHA or in the inflammatory variable CRP (repeated-measures ANOVA, P > 0.05 for all variables). Conclusions Administration of 10 mg...

  5. Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study

    Science.gov (United States)

    Erdem, Vuslat Muslu; Uzman, Sinan; Yildirim, Dogan; Avaroglu, Huseyin; Ferahman, Sina; Sunamak, Oguzhan

    2017-01-01

    Purpose Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC. Methods Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups. Results Anesthesia procedures and surgeries for all patients were successfully completed. After the organization of pneumoperitoneum in CSEA group, 3 patients suffered from shoulder pain (12.5%) and 4 patients suffered from abdominal discomfort (16.6%). All these complaints were recovered with IV fentanyl administration. Only 1 patient developed hypotension which is recovered with fluid replacement and no need to use vasopressor treatment. Postoperative shoulder pain was significantly less observed in CSEA group (25% vs. 60%). Incidence of postoperative nausea and vomiting (PONV) was less observed in CSEA group but not statistically significant (4.2% vs. 20%). In the group of CSEA, 3 patients suffered from urinary retention (12.5%) and 2 patients suffered from spinal headache (8.3%). All postoperative pain parameters except 6th hour, were less observed in CSEA group, less VAS scores and less need to analgesic treatment in CSEA group comparing with GA group. Conclusion CSEA can be used safely for laparoscopic cholecystectomies. Less postoperative surgical field pain, shoulder pain and PONV are the advantages of CSEA compared to GA.

  6. Is it worth offering a routine laparoscopic cholecystectomy in developing countries? A Thailand case study

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    Teerawattananon Yot

    2005-10-01

    Full Text Available Abstract Objective The study aims to investigate whether laparoscopic cholecystectomy (LC is a cost-effective strategy for managing gallbladder-stone disease compared to the conventional open cholecystectomy(OC in a Thai setting. Design and Setting Using a societal perspective a cost-utility analysis was employed to measure programme cost and effectiveness of each management strategy. The costs borne by the hospital and patients were collected from Chiang Rai regional hospital while the clinical outcomes were summarised from a published systematic review of international and national literature. Incremental cost per Quality Adjusted Life Year (QALY derived from a decision tree model. Results The results reveal that at base-case scenario the incremental cost per QALY of moving from OC to LC is 134,000 Baht under government perspective and 89,000 Baht under a societal perspective. However, the probabilities that LC outweighed OC are not greater than 95% until the ceiling ratio reaches 190,000 and 270,000 Baht per QALY using societal and government perspective respectively. Conclusion The economic evaluation results of management options for gallstone disease in Thailand differ from comparable previous studies conducted in developed countries which indicated that LC was a cost-saving strategy. Differences were due mainly to hospital costs of post operative inpatient care and value of lost working time. The LC option would be considered a cost-effective option for Thailand at a threshold of three times per capita gross domestic product recommended by the committee on the Millennium Development Goals.

  7. Comparing efficacy of preemptively used dexketoprofen and tramadol for postoperative pain in patients underwent laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Süreyya Özkan

    2015-03-01

    Full Text Available Objective: In our study, we aimed to compare effects of preoperative dexketoprofen and tramadol administered by intravenous route on intraoperative and postoperative analgesic consumption, postoperative pain, durations of hospital stay and patient satisfaction in patients, undergoing laparoscopic cholecystectomy. Methods:After approval of ethic committee and written consent of patients were obtained, 60 patients between 18-70 years old with ASA I-II were included in the study. After routine monitorization and 20 minutes before induction of anesthesia, dexketoprofen 50 mg in 100 cc 0.9% NaCl was administered in Dexketoprofen Group and tramadol 100 mg in 100 cc 0.9% NaCl in Tramadol Group as intravenous infusion during 20 minutes. Intraoperative hemodynamic parameters, analgesic-anesthetic consumptions and complications of patients, on whom standard general anesthesia was applied, were recorded. Pain severity, degree of sedation, morphine consumptions and hemodynamic parameters were recorded at postoperative 30 th minute, and 4 th, 8th, 12th and 24 th hours. Additional analgesia requirement, times for requiring first analgesia, duration of hospital stay, postoperative complications and patient satisfactions were recorded. Results: Intraoperative analgesic-anesthetic consumptions, postoperative visual analogue scale (VAS scores, sedation degrees, intravenous patient controlled analgesia (PCA and morphine consumptions, times for requiring first analgesic, durations of hospital stay, intraoperative-postoperative complications developed and patient satisfactions were similar in both groups. Consequently, postoperative analgesic efficacy of pre-emptive dexketoprofen intravenous 50 mg and tramadol intravenous 100 mg administered was found to be similar in cases, who had laparoscopic cholecystectomy operation. Conclusion:Because VAS scores were low in our patients, morphine consumptions with intravenous PCA were similar in both groups, and there wasn

  8. Hemodynamic stress response during laparoscopic cholecystectomy: Effect of two different doses of intravenous clonidine premedication

    Directory of Open Access Journals (Sweden)

    Deepshikha C Tripathi

    2011-01-01

    Full Text Available Background : Clonidine has emerged as an attractive premedication desirable in laparoscopic surgery wherein significant hemodynamic stress response is seen. The minimum safe and effective dose of intravenous clonidine to attenuate the hemodynamic stress response during laparoscopic surgery has however not yet been determined. Materials and Methods : This prospective, randomized, double-blind controlled study was conducted on 90 adults of ASA physical status I and II, scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were randomized to one of the three groups (n= 30. Group I received 100 ml of normal saline, while groups II and III received 1 μg/ kg and 2 μg/ kg of clonidine respectively, intravenous, in 100 ml of normal saline along. All patients received glycopyrrolate 0.004 mg/kg and tramadol 1.5 mg/kg intravenously, 30 min before induction. Hemodynamic variables (heart rate, systolic, diastolic, mean arterial pressure, SpO2, and sedation score were recorded at specific timings. MAP above 20% from baseline was considered significant and treated with nitroglycerine. Results : In group I, there was a significant increase in hemodynamic variables during intubation pneumoperitoneum and extubation (P<0.001. Clonidine given 1 μg/kg intravenous attenuated hemodynamic stress response to pneumoperitoneum (P<0.05, but not that associated with intubation and extubation. Clonidine 2 μg/kg intravenous prevented hemodynamic stress response to pneumoperitoneum and that associated with intubation and extubation (P<0.05. As against 14 and 2 patients in groups I and II respectively, no patient required nitroglycerine infusion in group III. Conclusions : Clonidine, 2 μg/ kg intravenously, 30 min before induction is safe and effective in preventing the hemodynamic stress response during laparoscopic cholecystectomy.

  9. Management of postlaparoscopic cholecystectomy major bile duct injury: Comparison of MRCP with conventional methods

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    Abou El-Ella Khalid

    2004-01-01

    Full Text Available Background: Postlaparoscopic cholecystectomy bile duct injury remains one of the devastating complications seen in current surgical practice. Aim of Study: This study describes the diagnostic role of magnetic resonance cholangiopancreatography (MRCP in such injuries compared with conventional methods. Patients and Methods: Eighteen patients referred to the Division of Hepatobiliary Surgery, King Khalid University Hospital from July 1998 to September 2000 were retrospectively studied. The technique of the repair was by utilizing Roux-en-Y hepaticojejunostomy with establishment of mucosa-to-mucosa anastomosis.The study included presentation, age and gender. Results: The presentation of patients were variable and frequently included pain, jaundice with or without cholangitis in 13 patients, bile leakage with development of biliary peritonitis in three, and development of external biliary fistula in two patients. Besides lower incidence of complication, MRCP was more diagnostic and informative in planning surgery by mapping both ducts proximal and distal to site of injury or stricture in 14 out of 18 patients. The Bismuth level of bile duct injuries were type I in one, type 11 in five, type III in 11 and type IV in one patient. All patients are alive, well and no complications occurred in the immediate postoperative period. Only two patients developed stricture within four months after surgery, one of them treated conservatively with repeated dilatation and stenting was done for the other. Conclusion: Hepaticojejunostomy is the procedure of choice for repair of bile duct injuries and provides adequate bilairy drainage. MRCP is an ideal diagnostic test when bile duct injury is suspected following laparoscopic cholecystectomy

  10. PLMA vs. I-gel: A Comparative Evaluation of Respiratory Mechanics in Laparoscopic Cholecystectomy

    Science.gov (United States)

    Sharma, Bimla; Sehgal, Raminder; Sahai, Chand; Sood, Jayashree

    2010-01-01

    Background: Supraglottic airway devices (SADs), such as ProSealTM laryngeal mask airway (PLMA), which produce high oropharyngeal seal pressure (OSP) and have the facility for gastric decompression have been used in laparoscopic procedures. i-gel is a new SAD which shares these features with the PLMA. This study was designed to compare the respiratory mechanics of these two devices during positive pressure ventilation in anaesthetised adult patients undergoing laparoscopic cholecystectomy. Patients & Methods: The study included 60 ASA I-II adult patients scheduled for laparoscopic cholecystectomy. The patients were randomized to two groups of 30 each, with either PLMA or i-gel as their airway device. Anaesthesia and premedication were standardized for both the groups. In addition to routine monitoring, neuromuscular monitoring with TOF ratio, OSP and respiratory mechanics monitoring (dynamic compliance, resistance, work of breathing, measured minute ventilation and peak airway pressures) were employed. Fibreoptic evaluation of positioning of the devices and adverse events related to them were also compared. Results: The OSP (cm H2O) were higher for PLMA (38.9 vs. 35.6, P=0.007). The respiratory mechanics parameters using the two devices were comparable apart from the dynamic compliance, which was significantly higher with i-gel (P < 0.05). Malrotation was higher with i-gel than with PLMA (15 vs. 5, P = 0.006). Conclusion: The PLMA formed a better seal while the dynamic compliance was higher with the i-gel. Both devices provided optimal ventilation and oxygenation and the adverse events were also comparable. PMID:21547168

  11. A COMPARATIVE STUDY SHOWING EFFICACY OF PREEMPTIVE INTRAVENOUS PARACETAMOL IN REDUCING POSTOPERATIVE PAIN AND ANALGESIC REQUIREMENT IN LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Aftab Ahmad

    2015-07-01

    Full Text Available A double blind, prospective, randomized study was conducted on 60 patients of ASA I and II undergoing laparoscopic cholecystectomy to evaluate the efficacy of pre - emptive IV paracetamol [PCM] in reducing postoperative pain and analgesic requirement. Patien ts were randomly assigned in two groups, group A and group B of which group A received pre - emptive IV PCM 10 minutes before skin incision. It was observed that time to first analgesic required was significantly longer in group A as compared to group B and group A had significantly lower total analgesic consumption and visual analogue scores (VAS as compared to group B. We concluded that pre - emptive use of IV PCM (Paracetamol in laparoscopic cholecystectomy significantly decreases postoperative pain and a nalgesic requirement.

  12. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

    DEFF Research Database (Denmark)

    Wilson, E; Gurusamy, K; Gluud, C

    2010-01-01

    BACKGROUND:: A recent systematic review found early laparoscopic cholecystectomy (ELC) to be safe and to shorten total hospital stay compared with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis. The cost-effectiveness of ELC versus DLC for acute cholecystitis is unknown. METHODS......:: A decision tree model estimating and comparing costs to the UK National Health Service (NHS) and quality-adjusted life years (QALYs) gained following a policy of either ELC or DLC was developed with a time horizon of 1 year. Uncertainty was investigated with probabilistic sensitivity analysis, and value......-of-information analysis estimated the likely return from further investment in research in this area. RESULTS:: ELC is less costly (approximately - pound820 per patient) and results in better quality of life (+0.05 QALYs per patient) than DLC. Given a willingness-to-pay threshold of pound20 000 per QALY gained...

  13. Laparoscopic Cholecystectomy for Severe Acute Cholecystitis in a Patient with Situs Inversus Totalis and Posterior Cystic Artery

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    Theodoros E. Pavlidis

    2008-01-01

    Full Text Available Situs inversus totalis is an inherited condition characterized by a mirror-image transposition of thoracic and abdominal organs. It often coexists with other anatomical variations. Transposition of the organs imposes special demands on the diagnostic and surgical skills of the surgeon. We report a case of a 34-year-old female patient presented with left upper quadrant pain, signs of acute abdomen, and unknown situs inversus totalis. Severe acute cholecystitis was diagnosed, and an uneventful laparoscopic cholecystectomy was performed. A posterior cystic artery was identified and ligated. Laparoscopic cholecystectomy is feasible in patients with severe acute calculus cholecystitis and situs inversus totalis; however, the surgeon should be alert of possible anatomic variations.

  14. [Adverse hemodynamic changes during laparoscopic cholecystectomy and their possible suppression with clonidine premedication. Comparison with intravenous and intramuscular premedication].

    Science.gov (United States)

    Málek, J; Knor, J; Kurzová, A; Lopourová, M

    1999-06-01

    Laparoscopic cholecystectomies have adverse haemodynamic effects which limit their use in risk patients with heart disease. This applies in particular to significant hypertension. The etiology is analysed in detail in a review of the literature. The authors confirmed in their work involving 21 patients the incidence of these effects and tried to suppress them by premedication with clonidine (CATAPRESAN, Boehringer). 21 patients were given 0.15 mg clonidine in an infusion 15 minutes before operation and 21 patients 0.15 mg clonidine by the i.m. route 60-90 min. before operation. Standard anaesthesia was administered. A highly significant drop in the incidence of hypertension was recorded during operation for systolic pressure (p premedication). Premedication with intravenous clonidine can be recommended as a routine procedure before laparoscopic cholecystectomies.

  15. Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes

    DEFF Research Database (Denmark)

    McCloy, R.; Randall, D.; Schug, S.A.;

    2008-01-01

    cosmetic result (largely patient rated). There was a significantly greater likelihood of conversion to conventional LC or to open cholecystectomy in the MLC group than there was of conversion to open cholecystectomy in the conventional LC group [OR 4.71 (95% confidence interval 2.67-8.31), p ... using MEDLINE and EmBASE. Only randomized controlled trials in English, investigating minilaparoscopic versus conventional LC (total size of trocar incision > or = 25 mm) and reporting pain scores were included. Quantitative analyses (meta-analyses) were performed on postoperative pain scores and other...... patient outcomes from more than one study where feasible and appropriate. Qualitative analyses consisted of assessing the number of studies showing a significant difference between the techniques. RESULTS: Thirteen trials met the inclusion criteria. There was a trend towards reduced pain with MLC compared...

  16. A COMPARATIVE STUDY OF LEVOBUPIVACAINE WITH CLONIDINE AND LEVOBUPIVACAINE WITH DEXMEDETOMIDINE IN THORACIC EPIDURAL BLOCK FOR LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Aditya Kumar

    2016-02-01

    Full Text Available Laparoscopic cholecystectomy has traditionally been performed under general anaesthesia, regional anaesthetic techniques like spinal and epidural anaesthesia has emerged as a more suitable alternative for the minimally invasive laparoscopic cholecystectomy. We conducted a clinical study comparing levobupivacaine with clonidine and a combination of levobupivacaine with dexmedetomidine in thoracic epidural anaesthesia for laparoscopic cholecystectomy as sole anaesthetic. MATERIAL AND METHODS After taking approval from Institutional Ethical Committee, 100 adult patients of ASA grade I and II were divided into two groups; Group 1 where levobupivacaine 0.5% (2mg/kg with 1.5µg/kg clonidine was given and in Group 2 levobupivacaine 0.5% (2mg/kg with 0.5μg/kg of dexmedetomidine. Thoracic epidural was given at the T10-T11 interspace to obtain a sensory block of T4-L2 dermatome, which was judged every minute by pinprick method till complete sensory block was established. Hemodynamic parameters like heart rate, non-invasive blood pressure, electrocardiogram, oxygen saturation were monitored and readings were recorded initially then at every 5 mins after administration of drug intraoperatively. RESULT Duration of block was longer in group 2 patients, onset of block was comparable in both the groups. Also fall in blood pressure and heart rate was greater in group 2 patients. Less incidence of shoulder pain was found in group 2 patients. Oxygen saturation (Spo2 was comparable in both the groups and no respiratory distress was seen. More post-operative analgesia was required in group 1. Also no complications were seen postoperatively in both the groups. CONCLUSION Levobupivacaine with dexmedetomidine provides better anaesthesia than levobupivacaine with clonidine in thoracic epidural for laparoscopic cholecystectomy.

  17. A comparative study of efficacy of epidural versus interpleural bupivacaine for post operative analgesia after open cholecystectomy

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    RK Yadav

    2014-04-01

    Full Text Available Background The conventional methods of administering the prescribed doses of intramuscular or intravenous analgesics at fixed time intervals results in widely fluctuating and inadequate plasma level leads to poor post operative pain relief. Despite all advances made in the field of medicine, this symptom called “Pain” has not been combated well. Objective The present study was carried out to compare the efficacy of epidural verses interpleural administration of bupivacaine(0.5% with adrenaline for post operative pain relieve in patients undergoing open cholecystectomy. Methods We prospectively randomized and compared the post operative pain relieve with the reference of visual analog score (VAS in patients undergoing elective open cholecystectomy in college of medical sciences-teaching hospital, Bharatpur, Chitwan. Forty adult patients undergoing elective cholecystectomy were divided into two groups. Twenty patients in each group were subjected to a different technique of post-operative analgesia, namely thoracic epidural and interpleural instillation of 0.5% bupivacaine. These two groups were then compared in relation to changes produced in the pain scores, vital parameters and complication and side effects associated with the two techniques. The study was conducted for 24 hour postoperatively. Observation: Both thoracic epidural and interpleural instillation of 0.5% bupivacaine compared favorably with regard to analgesia in the present study. In general, the pain relief following thoracic epidural was more complete compared to interpleural but this was not clinically significant. Conclusion The present study shows that both the techniques are equally effective in providing analgesia following cholecystectomy. However, neither technique rendered the patients completely pain free at all times during first 24 hours. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 15-23 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10232

  18. Effects of lidocaine and esmolol infusions on hemodynamic changes, analgesic requirement, and recovery in laparoscopic cholecystectomy operations

    OpenAIRE

    Serpil Dagdelen Dogan; Faik Emre Ustun; Elif Bengi Sener; Ersin Koksal; Yasemin Burcu Ustun; Cengiz Kaya; Fatih Ozkan

    2016-01-01

    ABSTRACT OBJECTIVE: We compared the effects of lidocaine and esmolol infusions on intraoperative hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery in laparoscopic cholecystectomy surgery. METHODS: The first group (n = 30) received IV lidocaine infusions at a rate of 1.5 mg/kg/min and the second group (n = 30) received IV esmolol infusions at a rate of 1 mg/kg/min. Hemodynamic changes, intraoperative and postoperative analgesic requirements, and rec...

  19. Transvaginal/Transumbilical Hybrid—NOTES—Versus 3-Trocar Needlescopic Cholecystectomy: Short-term Results of a Randomized Clinical Trial

    Science.gov (United States)

    Knuth, Jürgen; Cerasani, Nicola; Sauerwald, Axel; Lefering, Rolf; Heiss, Markus Maria

    2015-01-01

    Objective: For cholecystectomy, both the needlescopic cholecystectomy (NC) 3-trocar technique using 2 to 3 mm trocars and the umbilical-assisted transvaginal cholecystectomy (TVC) technique have found their way into clinical routine. This study compares these 2 techniques in female patients who are in need of an elective cholecystectomy. Background: Natural orifice transluminal endoscopic surgery (NOTES) is a surgical concept permitting scarless intra-abdominal operations through natural orifices, such as the vagina. Because of the lack of an adequately powered trial, we designed this first randomized controlled study for the comparison of TVC and NC. Methods: This prospective, randomized, nonblinded, single-center trial evaluates the safety and effectiveness of TVC (intervention), compared with NC (control) in female patients with symptomatic cholecystolithiasis. The primary endpoint was intensity of pain until the morning of postoperative day (POD) 2. Secondary outcomes were among others intra- and postoperative complications, procedural time, amount of analgesics used, pain intensity until POD 10, duration of hospital stay, satisfaction with the aesthetic result, and quality of life on POD 10 as quantified with the Eypasch Gastrointestinal Quality of Life Index (GIQLI). Results: Between February 2010 and June 2012, 40 patients were randomly assigned to the interventional or control group. All patients completed follow-up. Procedural time, length of postoperative hospital stay, and the rate of intra- and postoperative complications were similar in the 2 groups. However, significant advantages were found for the transvaginal access regarding pain until POD 2, but also until POD 10 (P = 0.043 vs P = 0.010) despite significantly less use of peripheral analgesics (P = 0.019). In the TVC group, patients were significantly more satisfied with the aesthetic result (P < 0.001) and had a significantly better GIQLI (P = 0.028). Conclusions: Although comparable in terms of

  20. EFFECT OF INTRAOPERATIVE ESMOLOL INFUSION ON POSTOPERATIVE ANALGESIA IN LAPAROSCOPIC CHOLECYSTECTOMY PATIENTS: A RANDOMISED CONTROLLED TR IAL

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    Shreya

    2015-10-01

    Full Text Available BACKGROUND: Laparoscopic cholecystectomy, gaining worldwide popularity, can be performed on a short stay basis if postoperative pain is adequately addressed. Our present study determines the effect of intraoperative infusion of intravenous esmolol primarily in terms of postoperative analgesia and intraoperative haemodynamic stability. METHODS: 60 ASAPS 1 and 2 patients undergoing elective laparoscopic cholecystectomy were included in this randomi s ed, prospective, placebo - controlled clinical study. Patients were alloca ted into two groups to receive intraoperative intravenous esmolol (Group A, n=30 or normal saline (Group B, n=30 over a period of 10 minutes before induction. Intraoperative heart rate, mean arterial pressure and postoperative fentanyl requirement ( D uri ng first 6 postoperative hours were recorded. RESULTS: Postoperative requirement of fentanyl was significantly lower (92.73±17.42mcg in group A compared to 117.32±19.22mcg in group B, p value 0.05. CONCLUSION: Intravenous esmolol effectively reduces postoperative fentanyl requirement, thereby is a safe adjunct in the fie ld of postoperative analgesia for laparoscopic cholecystectomy.

  1. Transumbilical single-port laparoscopic cholecystectomy using traditional laparoscopic instruments: a report of thirty-six cases

    Institute of Scientific and Technical Information of China (English)

    Li-ping CAO; Ri-sheng QUE; Fan ZHOU; Guo-ping DING; De-xi JING

    2011-01-01

    Objective:To evaluate the feasibility and safety of the operation of transumbilical single-port laparoscopic cholecystectomy (TSPLC) by traditional laparoscopic instruments and summarize the initial experience.Methods:Sixty subjects with cholelithiasis were divided into two groups.One group (36 cases) underwent TSPLC and the control group (24 cases) underwent traditional three-port laparoscopic cholecystectomy (LC).Postoperative complications were observed and operation time,hospital days,visual analogue scale (VAS) after 6 and 24 h of operation,and subject satisfaction score were measured.Results:TSPLC and traditional LC were performed successfully in the two groups.The operation time in the TSPLC group was significantly longer than that in the control group.There was no statistically significant difference in hospital stay and VAS between the TSPLC and control groups.The subject satisfaction score in the TSPLC group was 91.2,significantly higher than that in the control group (P<0.01).All subjects recovered from the operation and no postoperative complication occurred during the period of two weeks after operation.Conclusions:TSPLC is a feasible and safe method for cholecystectomy,although it may be more time-consuming.However,it is welcomed by patients who are more concerned with cosmetic outcomes.Future studies are needed to confirm its disadvantages and contraindications.

  2. A PROSPECTIVE, RANDOMIZED CONTROL STUDY EVALUATING THE POSTOPERATIVE ANALGESIA USING RECTAL DICLOFENAC IN PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY SURGERIES

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    Padmaja

    2015-05-01

    Full Text Available BACKGROUND: To assess the efficacy of rectal diclofenac suppository in patients undergoing elective laparoscopic cholecystectomy surgeries in management of postoperative pain, in reduction of intra operative opioid requirement and in prolongation of postoperative anal gesic initiation time. OBJECTIVES: This prospective randomized single blinded clinical trial evaluates the efficacy of rectal diclofenac suppository for the management of postoperative pain. MATERIALS AND METHODS: 100 patients undergoing elective laparosco pic cholecystectomy surgeries were randomized into two groups, Group 1 patients receiving 100mg diclofenac rectal suppository after induction of general anaesthesia, Group 2 patients does not receive any diclofenac rectal suppository. Intra operative hemod ynamic monitoring, post - operative VAS score and adverse reactions were recorded over period of 24 hrs. Intra operative opioid (fentanyl was repeated when heart rate and blood pressure variability of more than 20% from base line are noted. Post operatively if VAS score is more than 4 rescue analgesia with inj. Tramadol is given intramuscularly. RESULTS: Administration of single dose of rectal diclofenac had statistically significant reduction in VAS score post operatively compared to control group, reduced requirement of intra operative opioids (fentanyl. Post - operative rescue analgesia initiation time is prolonged in group 1 mean 9.56 hrs compared to group 2, mean 0.72 hrs (p - 0.000. CONCLUSION: Rectal Diclofenac used in laparoscopic cholecystectomy cases provide adequate, effective prolonged analgesia in the post - operative period with good safety profile

  3. Effect of oral clonidine premedication on perioperative haemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy.

    Science.gov (United States)

    Singh, Shivinder; Arora, Kapil

    2011-01-01

    Clonidine has anti-hypertensive properties and augments the effects of anaesthesia, hence we considered it to be an ideal agent to contain the stress response to pneumoperitoneum. We studied the clinical efficacy of oral clonidine premedication in patients undergoing laparoscopic cholecystectomies. Fifty patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia were randomly allocated to receive premedication with either oral clonidine 150 μg (Group I, n = 25) or placebo (Group II, n = 25) 90 minutes prior to induction. The patients were managed with a standard general anaesthetic. The two groups were compared with respect to haemodynamic parameters, isoflurane concentration, pain and sedation scores, time to request of analgesic and cumulative analgesic requirements. Oral clonidine was found to be significantly better in terms of maintaining stable haemodynamics, having an isoflurane sparing effect and having a prolonged time interval to the first request of analgesia postoperatively compared to the control group. Administration of oral clonidine 150 μg as a pre-medicant in patients undergoing laparoscopic cholecystectomy results in improved perioperative haemodynamic stability and a reduction in the intra-operative anaesthetic and post-operative analgesic requirements.

  4. Effect of oral clonidine premedication on perioperative haemodynamic response and post-operative analgesic requirement for patients undergoing laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Shivinder Singh

    2011-01-01

    Full Text Available Clonidine has anti-hypertensive properties and augments the effects of anaesthesia, hence we considered it to be an ideal agent to contain the stress response to pneumoperitoneum. We studied the clinical efficacy of oral clonidine premedication in patients undergoing laparoscopic cholecystectomies. Fifty patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia were randomly allocated to receive premedication with either oral clonidine 150 μg (Group I, n = 25 or placebo (Group II, n = 25 90 minutes prior to induction. The patients were managed with a standard general anaesthetic. The two groups were compared with respect to haemodynamic parameters, isoflurane concentration, pain and sedation scores, time to request of analgesic and cumulative analgesic requirements. Oral clonidine was found to be significantly better in terms of maintaining stable haemodynamics, having an isoflurane sparing effect and having a prolonged time interval to the first request of analgesia postoperatively compared to the control group. Administration of oral clonidine 150 μg as a pre-medicant in patients undergoing laparoscopic cholecystectomy results in improved perioperative haemodynamic stability and a reduction in the intra-operative anaesthetic and post-operative analgesic requirements.

  5. A COMPARATIVE EVALUATION OF ISOFLURANE VS HALOTHANE TO ATTENUATE HAEMODYNAMIC RESPONSE DUE TO CO 2 PNEUMOPERI- TONEUM DURING LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Chavi

    2013-03-01

    Full Text Available ABSTRACT: BACKGROUND: Laparoscopic cholecystectomy is a relatively new sur gical procedure which is enjoying ever increasing popularit y and presenting new anesthetic challenges. Volatile anesthetics play an important ro le in the management of haemodynamic changes due to CO2 pneumoperitoneum during laparoscopi c surgeries. The aim of the study is to evaluate Isoflurane Vs Halothane as an adjunct t o obtund haemodynamic response due to CO2 pneumoperitoneum. MATERIALS & METHODS: 50 patients aged 20-60 yrs of either sex belonging to ASA grade I & II scheduled for electiv e laparoscopic cholecystectomy admitted in MLB Medical College, Jhansi were randomly divided i nto two group. Group I – O 2 : N 2 O + Inhalational agent (Isoflurane 1.5-2% Group II – O 2 : N 2 O + Inhalational agent (Halothane 1.5-2% RESULTS : Hypertensive response due to CO 2 pneumoperitoneum was well suppressed by Isoflurane (1.5-2% {Group-I} which maintained pulse rate at a relatively higher side than halothane, (1.5-2%{Group II} decreased mean arteria l pressure more significantly than halothane without any difference in arterial oxygen saturation (SPO 2 and end tidal CO 2 concentration (E T CO 2 . CONCLUSION : This can be concluded from the study that Isoflur ane (Group-I more effectively attenuated the haemodyna mic response due to CO 2 pneumoperitoneum during laparoscopic cholecystectomy as compared to Halothane (Group-II under balanced anesthetic technique.

  6. Successful outcome of sphincterotomy and 7 French pigtail stent insertion in the management of post-cholecystectomy bile leaks.

    LENUS (Irish Health Repository)

    Donnellan, Fergal

    2009-06-01

    BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used to manage post-cholecystectomy bile leaks. However, the best endoscopic intervention remains controversial. We investigated the success of a 7 French double pigtail stent following sphincterotomy in the management of such bile leaks. METHODS: Between July 1998 and June 2008, 48 patients were referred for ERCP for presumed post-cholecystectomy bile leaks. Leaks were confirmed at ERCP and managed by a combination of sphincterotomy and stent insertion unless contraindicated. RESULTS: Bile duct cannulation was successful in 44 (91.7%) patients. A leak of the cystic duct was demonstrated in 19 (43.2%) patients, the duct of Luschka in 11 (25.0%), and the common hepatic duct in 5 (11.4%). Complete transection of the common bile duct occurred in 4 patients. The remaining patients had no cholangiographic evidence of a leak. Sphincterotomy was performed in 34 patients. A 7 French double pigtail plastic stent was placed in all 35 patients with cholangiographic evidence of a bile leak. No bile leaks were demonstrated at a follow-up of 8-16 weeks and all stents were removed successfully. CONCLUSION: The combination of sphincterotomy and insertion of a 7 French double pigtail stent results in excellent outcomes in the management of post-cholecystectomy bile leaks.

  7. Colecistectomía transvaginal (NOTES combinada con minilaparoscopia Transvaginal cholecystectomy (NOTES combined with minilaparoscopy

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    C. Dolz

    2007-12-01

    Full Text Available Objetivo: comunicar la primera colecistectomía transvaginal realizada en humanos en nuestro país. Pacientes y métodos: mujer de 35 años de edad con historia de cólicos hepáticos de repetición de etiología litiásica. La intervención la realizó un equipo multidisciplinar constituido por cirujanos, gastroenterólogos y ginecólogos. Consistió en crear un neumoperitoneo mediante una aguja de Veres colocada en el fondo umbilical con posterior colocación de un trócar de 5 mm. Se colocó un segundo trócar de 3 mm en el hipocondrio derecho. Se realizó una colpotomía y colocación de un trócar vaginal de 12 mm que permitió el paso de un videogastroscopio que alcanzó el hilio hepático. Resultados: se realizó la colecistectomía mediante la acción conjunta de instrumentos de trabajo que pasaron por las puertas de entrada de la minilaparoscopia y por el videogastroscopio. La extracción de la vesícula se realizó por vía transvaginal mediante el videogastroscopio. No aparecieron complicaciones postoperatorias siendo la paciente dada de alta al cabo de 24 horas. Conclusiones: la colecistectomía transvaginal mediante la acción conjunta de un equipo multidiscliplinar es posible y segura. La cirugía endoscópica transluminal a través de orificios naturales (NOTES, es una modalidad emergente que intenta ser menos invasiva, mejor tolerada y más respetuosa con el daño estético que la cirugía laparoscópica y probablemente será la puerta de entrada de innovaciones médicas y tecnológicas de gran trascendencia durante los próximos años.Objective: to report on the first transvaginal cholecystectomy performed on a human being in Spain. Patients and methods: a 35-year-old female with a history of recurrent bouts of biliary pain resulting from gallstones. A surgical procedure was performed by a multidisciplinary team composed of surgeons, gastroenterologists, and gynecologists. It involved creating a pneumoperitoneum by placing a

  8. 经脐单孔腹腔镜胆囊切除术%Transumbilical single-port laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    梁平; 黄小兵; 左国华; 李靖; 丁生才; 王细文

    2010-01-01

    目的 探讨经脐单孔腹腔镜胆囊切除术临床应用的安全性及疗效.方法 回顾性分析2008年1月至2010年5月第三军医大学新桥医院完成的16例行经脐单孔腹腔镜胆囊切除术患者的临床资料.取紧邻脐孔右侧缘行约1.5 cm的切口,入腹后置入连接好2个5 mm Trocar和1个10 mm Trocar所形成的三通道防漏气操作装置,制造气腹,以10 mm Trocar进入腹腔镜镜头,自2个5 mm Trocar各进入一把腹腔镜器械和5 mm超声刀,按常规腹腔镜操作方法完成胆囊切除术.结果 16例患者手术均获成功,手术时间为50~150 min,未放置引流管,术后无出血及胆汁漏等并发症发生.患者恢复良好,脐部无明显手术瘢痕.结论 经脐单孔腹腔镜胆囊切除术切口美观,安全可行.但操作难度较传统LC大,进一步完善脐部操作装置及手术器械,可望在一定程度上取代传统LC.%Objective To evaluate the safety and efficacy of transumbilical single port laparoscopic cholecystectomy. Methods The clinical data of 16 patients who received transumbilical single port laparoscopic cholecystectomy at Xinqiao Hospital from January 2008 to May 2010 were retrospectively analysed. An incision with a length of 1.5 cm was made adjacent to the umbilicus, and then two 5 mm trocars and one 10 mm trocar were installed. After the establishment of pneumoperitoneum, a laparoscopic camera was placed via the 10 mm trocar,and laparoscopic instruments and a 5 mm ultrasonic scalpel were placed via the two 5 mm trocars, respectively.Cholecystectomy was performed in the same manner as for the conventional laparoscopic procedure. Results All the operations were successfully carried out. The operation time was 50-150 minutes. No drainage tube was inserted,and no complications such as bleeding or bile leakage were observed after the operation. Patients recovered well,and no scarring was observed around the umbilicus. Conclusions Transumbilical single-port laparoscopic

  9. A randomized controlled trial of laparoscopic versus open cholecystectomy in patients with cirrhotic portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Wu Ji; Ling-Tang Li; Zhi-Ming Wang; Zhu-Fu Quan; Xun-Ru Chen; Jie-Shou Li

    2005-01-01

    AIM: To evaluate the characters, risks and benefits of laparoscopic cholecystectomy (LC) in cirrhotic portal hypertension (CPH) patients.METHODS: Altogether 80 patients with symptomatic gallbladder disease and CPH, including 41 Child class A,32 Child class B and 7 Child class C, were randomly divided into open cholecystectomy (OC) group (38 patients) and LC group (42 patients). The cohorts were well-matched for number, age, sex, Child classification and types of disease.Data of the two groups were collected and analyzed.RESULTS: In LC group, LC was successfully performed in 36 cases, and 2 patients were converted to OC for difficulty in managing bleeding under laparoscope and dense adhesion of Calot's triangle. The rate of conversion was 5.3%. The surgical duration was 62.6±15.2 min. The operative blood loss was 75.5±15.5 mL. The time to resume diet was 18.3±6.5 h. Seven postoperative complications occurred in five patients (13.2%). All patients were dismissed after an average of 4.6±2.4 d. In OC group, the operation time was 60.5±17.5 min. The operative blood loss was 112.5±23.5 mL. The time to resume diet was 44.2±10.5 h.Fifteen postoperative complications occurred in 12patients (30.0%). All patients were dismissed after an average of 7.5±3.5 d. There was no significant difference in operation time between OC and LC group. But LC offered several advantages over OC, including fewer blood loss and lower postoperative complication rate, shorter time to resume diet and shorter length of hospitalization in patients with CPH.CONCLUSION: Though LC for patients with CPH is difficult, it is feasible, relatively safe, and superior to OC.It is important to know the technical characters of the operation, and pay more attention to the meticulous perioperative managements.

  10. Spontaneous tension pneumothorax during laparoscopic cholecystectomy secondary to congenital diaphragm defects

    Institute of Scientific and Technical Information of China (English)

    Zhengnian Ding; Qinhai Zhou; Bo Gui

    2009-01-01

    A 67-year-old woman with chronic cholecystitis was scheduled to have laparoscopic cholecystectomy under general anesthesia. About 5~10 min after the CO2 intraperitoneal insufflation, the peak airway pressure gradually increased from 15 cmH2O to 27 cmH2O, the end-tidal CO2(EtCO2) from 32 mmHg to 56 mmHg. The SpO2 decreased from 100% to 96%, and blood pressure from 135/80 mmHg to 80/ 52 mmHg. A fight side tension pneumothorax was confirmed and a drainage tube was placed in the fight pleura] cavity. As the continuous gas leakage from the drainage tube was noted, even as ventilation was withheld, the diaphragm was carefully examined and a porous diaphragm was found. These defects were then patched with biomedical materials. The operation was finished uneventfully. It was concluded that in a patient with a tension pneumothorax during laparoscopic surgery, a diaphragm defect should be taken into consideration.

  11. Perioperative plasma concentrations of stable nitric oxide products are predictive of cognitive dysfunction after laparoscopic cholecystectomy.

    LENUS (Irish Health Repository)

    Iohom, G

    2012-02-03

    In this study our objectives were to determine the incidence of postoperative cognitive dysfunction (POCD) after laparoscopic cholecystectomy under sevoflurane anesthesia in patients aged >40 and <85 yr and to examine the associations between plasma concentrations of i) S-100beta protein and ii) stable nitric oxide (NO) products and POCD in this clinical setting. Neuropsychological tests were performed on 42 ASA physical status I-II patients the day before, and 4 days and 6 wk after surgery. Patient spouses (n = 13) were studied as controls. Cognitive dysfunction was defined as deficit in one or more cognitive domain(s). Serial measurements of serum concentrations of S-100beta protein and plasma concentrations of stable NO products (nitrate\\/nitrite, NOx) were performed perioperatively. Four days after surgery, new cognitive deficit was present in 16 (40%) patients and in 1 (7%) control subject (P = 0.01). Six weeks postoperatively, new cognitive deficit was present in 21 (53%) patients and 3 (23%) control subjects (P = 0.03). Compared with the "no deficit" group, patients who demonstrated a new cognitive deficit 4 days postoperatively had larger plasma NOx at each perioperative time point (P < 0.05 for each time point). Serum S-100beta protein concentrations were similar in the 2 groups. In conclusion, preoperative (and postoperative) plasma concentrations of stable NO products (but not S-100beta) are associated with early POCD. The former represents a potential biochemical predictor of POCD.

  12. A case report of incisional hernia through a 5 mm lateral port site following laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Audrius Dulskas

    2011-01-01

    Full Text Available Introduction: Less than 10 mm port-site herniation is a rare complication after laparoscopic surgery. We report a case of complicated herniation through the 5-mm lateral trocar port site. Case Report: A 63-year old obese female was admitted due to intestinal obstruction. She has undergone the laparoscopic cholecystectomy 1 year ago. On examination, abdomen was bloated and roughly 10 cm size mass was palpable on the right subcostal area. Plane radiogram of the abdomen showed signs of intestinal obstruction. Since conservative treatment was ineffective, the patient was operated on. The laparotomy revealed a protrusion of a part of right large intestine and greater omentum into the subcutaneous space through the abdominal wall defect below right subcostal margin. There was a dilatation of intestines proximally incarcerated colon. It was released and a part of omentum was resected. The peritoneum and fascia-muscular defect was closed by interrupted vicryl sutures. Conclusion: Acute herniation through a 5 mm size most lateral trocar port site is a rare complication of laparoscopic surgery requiring prompt differential diagnosis.

  13. A comparison of lightwand and laryngoscopic intubation techniques in patients undergoing laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Chenglan Xie; Congjin Ju; Jiawen Cheng; Xuejun Yan; Dengquan Guo

    2009-01-01

    Objective:To assess the effects of lightwand and laryngoscopic intubation techniques in patients undergoing laparoscopic cholecystectomy (LC). Methods: 300 ASA physical status Ⅰ and Ⅱ patients, undergoing LC, were randomly assigned to two groups, with 150 cases in each group. Patients in the LS group underwent endotracheal intubation using a standard direct-suspension laryngoscopic technique. Patients in the LW group were intubated by using transillumination with a lightwand. Mean arterial pressure and heart rate were recorded before induction, and at 1, 3 and 5 min after intubation. The incidence and of sore throat, hoarseness, and dysphagia was assessed twenty-four hours after surgery. Results: This study demonstrated no clinically significant difference in cardiovascular variables between the two techniques. Patients had a significantly lower incidence of sore throat, hoarseness, and dysphagia when the lightwand was used for intubation. Conclusion: This study suggests that lightwand intubation may decrease the incidence of postoperative sore throat, hoarseness,and dysphagia, thereby potentially increasing satisfaction in surgical patients. Therefore, more frequent use of the lightwand is recommended for endotracheal intubation.

  14. Update on Instrumentations for Cholecystectomies Performed via Transvaginal Route: State of the Art and Future Prospectives

    Directory of Open Access Journals (Sweden)

    Elia Pulvirenti

    2010-01-01

    Full Text Available Natural Orifice Transluminal Endoscopic Surgery (NOTES is an innovative approach in which a flexible endoscope enters the abdominal cavity via the transesophageal, transgastric, transcolonic, transvaginal or transvescical route, combining the technique of minimally invasive surgery with flexible endoscopy. Several groups have described different modifications by using flexible endoscopes with different levels of laparoscopic assistance. Transvaginal cholecystectomy (TVC consists in accessing the abdominal cavity through a posterior colpotomy and using the vaginal incision as a visual or operative port. An increasing interest has arisen around the TVC; nevertheless, the most common and highlighted concern is about the lack of specific instruments dedicated to the vaginal access route. TVC should be distinguished between “pure”, in which the entire operation is performed through the transvaginal route, and “hybrid”, in which the colpotomy represents only a support to introduce instruments and the operation is performed mainly by the classic transabdominal-introduced instruments. Although this new technique seems very appealing for patients, on the other hand it is very challenging for the surgeon because of the difficulties related to the mode of access, the limited technology currently available and the risk of complications related to the organ utilized for access. In this brief review all the most recent advancements in the field of TVC's techniques and instrumentations are listed and discussed.

  15. Migration of Surgical Clips into the Common Bile Duct after Laparoscopic Cholecystectomy

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    Krishn Kant Rawal

    2017-01-01

    Full Text Available Laparoscopic cholecystectomy (LC is currently the treatment of choice for symptomatic gallstones. Associated complications include bile duct injury, retained common bile duct (CBD stones, and migration of surgical clips. Clip migration into the CBD can present with recurrent cholangitis over a period of time. Retained CBD stones can be another cause of recurrent cholangitis. A case of two surgical clips migrating into the common bile duct with few retained stones following LC is reported here. The patient had repeated episodes of fever, pain at epigastrium, jaundice, and pruritus 3 months after LC. Liver function tests revealed features of obstructive jaundice. Ultrasonography of the abdomen showed dilated CBD with few stones. In view of acute cholangitis, an urgent endoscopic retrograde cholangiopancreatography was done, which demonstrated few filling defects and 2 linear metallic densities in the CBD. A few retained stones along with 2 surgical clips were removed successfully from the CBD by endoscopic retrograde cholangiopancreatography after papillotomy using a Dormia basket. The patient improved dramatically following the procedure.

  16. Clinical Study on Application of Chinese Herbs during the Perioperative Period of Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    LI Rong-xiang; ZHOU Ying; LI Jin-long; LI Jin; CHEN Sheng-gui; CHEN Yong

    2007-01-01

    Objective:To explore the effect of Chinese herbs during the perioperative period of laparoscopic cholecystectomy (LC).Methods:Three hundred and sixty patients of chronic lithic cholecystitis (LCCT) were randomly assigned to two groups by lottery,180 patients in each group.During the peri-operative period,the control group was treated with conventional Western medicine and placebo.The treated group was given the same conventional Western medicine and Chinese herbal decoctions,with Shitong mixture No.1 (石通1号) added before LC,and Liujunzi decoction (六君子汤) added after LC for three days.The operation time,body temperature after LC,white blood cell count,wind-breaking time after operation,as well as the changes of tongue coating in the first three post-operative days were recorded.Results:There was no significant difference between the two groups in operation time (P>0.05),while the improvement in body temperature recovery,wind-breaking time and changes of tongue coating in the treated group were better than those in the control group (P<0.01).Conclusion:Applying Chinese herbs during perioperative period of LC could effectively benefit early recovery in such patients.

  17. The efficacy of laparoscopic cholecystectomy without discontinuation in patients on antithrombotic therapy

    Science.gov (United States)

    Yun, Jong Hyuk; Jung, Hae Il; Lee, Hyoung Uk; Baek, Moo-Jun

    2017-01-01

    Purpose Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries in the world today. However, there is no consensus regarding whether LC can be performed in patients with acute cholecystitis while on antithrombotic therapy. The objective of our study was to describe postoperative outcomes of patients who underwent emergent LC without interruption to antithrombotic therapy. Methods We performed a retrospective review of patients who underwent LC for acute cholecystitis while on antithrombotic therapy from 2010 to 2015 at Soonchunhyang Universtiy Cheonan Hospital. Patients were divided into 2 groups as underwent emergent LC and elective LC. Results A total of 67 patients (emergent group, 22; elective group, 45) were included in the analysis. Elective group had significantly longer duration between the admission and operation (8 [7–10] days vs. 2 [1–3] days, P < 0.001) and longer duration of antithrombotic drugs discontinuation (7 days vs. 1 [0–3] days, P < 0.001). Emergent group had significantly more postoperative anemia (6 patients vs. 0 patient, P = 0.001) and 3 of 6 patients received packed RBC transfusion in postoperative period. However, there was no significant difference in length of postoperative stays, length of intensive care unit stays and mortality rates. Conclusion Emergent LC without interruption to antithrombotic therapy was relatively safe and useful. A well-designed multicenter study is needed to confirm the safety and efficacy of LC without suspension of antithrombotic therapy and to provide a simple guideline. PMID:28289668

  18. Laparoscopic cholecystectomy in patient with situs inversus totals: Diagnostic and treatment pitfalls

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    Roberto Marcellus de Barros Sena

    2016-06-01

    Full Text Available Situs inversus totalis, a rare congenital recessive autosomal malformation described in humans by Fabricius, in 1600, is characterised by the viscera's transposition. It presents the incidence of approximately one case to each 10.000-20.000 newborns. The main etiology is still unknown and when the abdominal and thoracic visceral commitment is associated, including dextrocardia, it is described as situs inverses totalis. We report the case of a female patient, 16-years-old, who came to the Digestive Surgical Department, in hospital Therezinha de Jesus, Juiz de Fora and ndash; MG and ndash; Brazil, complaining of pain in the left hypochondrium, associated to nauseas and vomiting. The patient mentioned that she had been suffering for 4 months and that the pain worsened in the previous 2 days. At the general clinical examination, she presented a cardiac focus ausculta in the right hemithorax, however, without abnormalities. The abdomen was flat, without surgical scars, ventral or inguinal hernias. There was hyperthermia, pain in the deep palpation on the left hypochondrium, associated guarding and rebound tenderness. The patient told that she had a previous diagnosis of situs inversus totalis. The aim of this case report is to describe a patient with cholecystitis associated with situs inversus totalis, who was previously aware of her congenital abnormality. Moreover, we review some aspects for the correct diagnosis, and propose recommendations for a safe laparoscopic cholecystectomy. [Arch Clin Exp Surg 2016; 5(2.000: 124-127

  19. Triple non-invasive diagnostic test for exclusion of common bile ducts stones before laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To evaluate the impact of a preoperative "triple non-invasive diagnostic test" for diagnosis and/or exclusion of common bile duct stones.METHODS: All patients with symptomatic gallstone disease, operated on by laparoscopic cholecystectomy from March 2004 to March 2006 were studied retrospectively. Two hundred patients were included and reviewed by using a triple diagnostic test including:patient's medical history, routine liver function tests and routine ultrasonography. All patients were followed up 2-24 mo after surgery to evaluate the impact of triple diagnostic test.RESULTS: Twenty-five patients were identified to have common bile duct stones. Lack of history of stones,negative laboratory tests and normal ultrasonography alone was proven to exclude common bile duct stones in some patients. However, a combination of these three components (triple diagnostic), was proven to be the most statistically significant test to exclude common bile duct stones in patients with gallstone disease.CONCLUSION: Using a combination of routinely used diagnostic components as triple diagnostic modality would increase the diagnostic accuracy of common bile duct stones preoperatively. This triple non-invasive test is recommended for excluding common bile duct stones and to identify patients in need for other investigations.

  20. Effect of implanting fibrin sealant with ropivacaine on pain after laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Jian-Zhu Fu; Jie Li; Ze-Li Yu

    2009-01-01

    AIM: To investigate the safety and efficacy of implanting fibrin sealant with sustained-release ropivacaine in the gallbladder bed for pain after laparoscopic cholecystectomy (LC). METHODS: Sixty patients (American Society of Anesthesiologists physical status was Ⅰ or Ⅱ and underwent LC) were randomly divided into three equal groups: group A (implantation of fibrin sealant in the gallbladder bed), group B (implantation of fibrin sealant carrying ropivacaine in the gallbladder bed), and group C (normal saline in the gallbladder bed). Postoperative pain was evaluated, and pain relief was assessed by visual analog scale (VAS) scoring. RESULTS: The findings showed that 81.7% of patients had visceral pain, 50% experienced parietal, and 26.7% reported shoulder pain after LC. Visceral pain was significantly less in group B patients than in the other groups ( P < 0.05), and only one patient in this group experienced shoulder pain. The mean VAS score in group B patients was lower than that in the other groups. CONCLUSION: Visceral pain is prominent after LC and can be effectively controlled by implanting fibrin sealant combined with ropivacaine in the gallbladder bed.

  1. Routine testing of liver function before and after elective laparoscopic cholecystectomy: is it necessary?

    LENUS (Irish Health Repository)

    Ahmad, Nasir Zaheer

    2012-01-31

    BACKGROUND AND OBJECTIVES: Liver function tests (LFTs) include alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and bilirubin. The role of routine testing before and after laparoscopic cholecystectomy was evaluated in this study. PATIENTS AND METHODS: A total of 355 patients were retrospectively analyzed by examining the LFTs the day before, the day after, and 3 weeks after the surgery. The Wilcoxon signed-rank test and Student t test were performed to determine statistical significance. RESULTS: Alterations in the serum AST, ALT, and GGT were seen on the first postoperative day. Minor changes were seen in bilirubin and ALP. An overall disturbance in the LFTs was seen in more than two-thirds of the cases. Repeat LFTs performed after 3 weeks on follow-up were found to be within normal limits. CONCLUSION: Mild-to-moderate elevation in preoperative LFTs may not be associated with any deleterious effect, and, in the absence of clinical indications, routine preoperative or postoperative liver function testing is unnecessary.

  2. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study

    DEFF Research Database (Denmark)

    Bisgaard, T; Klarskov, B; Kristiansen, V B;

    1999-01-01

    Pain is the dominant complaint after laparoscopic cholecystectomy. No study has examined the combined effects of a somato-visceral blockade during laparoscopic cholecystectomy. Therefore, we investigated the effects of a somato-visceral local anesthetic blockade on pain and nausea in patients...... undergoing elective laparoscopic cholecystectomy. In addition, all patients received multi-modal prophylactic analgesic treatment. Fifty-eight patients were randomized to receive a total of 286 mg (66 mL) ropivacaine or 66 mL saline via periportal and intraperitoneal infiltration. During the first 3...... postoperative h, the use of morphine and antiemetics was registered, and pain and nausea were rated hourly. Daily pain intensity, pain localization, and supplemental analgesic consumption were registered the first postoperative week. Ropivacaine reduced overall pain the first two hours and incisional pain...

  3. [THE IDENTIFICATION OF ALTERATIONS IN THE AREA OF GREAT DUODENAL PAPILLA AND MICRO-CHOLELITHIASIS AS A TECHNIQUE OF PREVENTION OF POST-CHOLECYSTECTOMY SYNDROME AFTER MINI-INVASIVE CHOLECYSTECTOMY].

    Science.gov (United States)

    Leontiev, A S; Korotevich, A G; Repnikova, R V; Merzliakov, M V; Safronova, G A; Arkhipova, S V; Faiev, A A

    2015-06-01

    The article presents the results of endoscopic and laboratory analyses of bile in 90 patients after mini-invasive cholecystectomy The significant amount of endoscopic diagnosed alterations in the area of major duodenal papilla that amounted to 64.4% of examined patients and also occurrence of micro-cholelithiasis and insoluble precipitates in analyzed bile of 83.3% of patients. The derived data testifies necessity of application of pre-operational endoscopic diagnostic of alterations in the area of major duodenal papilla and in post-operative period as well completing it by analysis of native bile preparation.

  4. 单切口与传统腹腔镜胆囊切除术的随机对比研究%A randomized comparative trial of single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    耿良元; 白剑峰; 孙跃明; 陆文熊; 傅赞; 石毅

    2012-01-01

    Objective: To compare the short-term outcomes of single-incision laparoscopic cholecystectomy (SILC) versus conventional 4-port laparoscopic cholecystectomy ( LC). Methods:Between Jun. and Aug. 2011,40 qualified patients with gallstone or gallbladder polyps were selected and randomly assigned to SILC (n =20) and LC (ra =20) groups. General data,operative time,blood loss,hospital stay, incision length, pain score, complications and C-reactive protein (CRP) were compared between SILC and LC groups. Results;No significant difference was detected between two groups in age,gender, ASA,body mass index and CRP before surgery. Operative time, blood loss, hospital stay, complications and postoperative CRP were similar ( P > 0.05 ). Incision of SILC was shorter and the pain score was lower. Conclusions; SILC is feasible and safe for selected patients. The advantages of SILC are less wound and lower pain scores.%目的:对比分析单切口腹腔镜胆囊切除术(single-incision laparoscopic cholecystectomy,SILC)与传统四孔法腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的近期疗效.方法:2011年6月至8月将40例胆囊结石和胆囊息肉患者随机分为SILC组(n=20)和LC组(n=20).对比分析两组患者一般资料、手术时间、术中出血量、术后住院时间、并发症、切口长度、疼痛程度和C反应蛋白量( C-reactive protein,CRP).结果:两组患者年龄、性别、ASA分期、体重指数和术前CRP无明显差别,手术时间、术中出血量、术后住院时间、并发症、术后CRP差异无统计学意义,但SILC组切口更小,术后疼痛更轻微.结论:适当把握手术适应证,SILC安全可行,具有切口长度小、术后疼痛轻等优点.

  5. The Effects of Different Insufflation Pressures on Liver Functions Assessed with LiMON on Patients Undergoing Laparoscopic Cholecystectomy

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    H. Barıs Eryılmaz

    2012-01-01

    Full Text Available Purpose. Laparoscopic cholecystectomy has been accepted as an alternative to laparotomy, but there is still controversy regarding the effects of pneumoperitoneum on splanchnic and hepatic perfusion. We assessed the effects of different insufflation pressures on liver functions by using indocyanine green elimination tests (ICG-PDR. Methods. We analyzed 43 patients who were scheduled for laparoscopic cholecystectomy. The patients were randomly allocated to two groups. In Group I, the operation was performed using 10 mmHg pressure pneumoperitoneum. In Group II, 14 mmHg pressure pneumoperitoneum was used. The ICG-PDR measurements were made after induction (ICG-PDR 1 and after the end of the operation (ICG-PDR 2. Serum aspartate aminotransferase (AST, alanine aminotransferase (ALT, and total bilirubin levels were all recorded preoperatively, 1 hour, and postoperative 24 hours after surgery. Results. The ICG-PDR 1 values for Groups I and II were as follows: 26.78±4.2% per min versus 26.01±2.4% per min (>0.05. ICG-PDR 2 values were found to be 25.63±2.1% per min in Group I versus 19.06±2.2% per min in Group II (0.05. Conclusion. In conclusion, the results show that 14 mmHg pressure pneumoperitoneum decreased the blood flow to the liver and increased postoperative 1st-hour serum AST and ALT levels. We think that 10 mmHg pressure pneumoperitoneum is superior to 14 mmHg pressure pneumoperitoneum in laparoscopic cholecystectomy.

  6. Oral premedication with pregabalin or clonidine for hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy: A comparative evaluation

    Directory of Open Access Journals (Sweden)

    Kumkum Gupta

    2011-01-01

    Full Text Available Background: Hemodynamic responses of laryngoscopy and laparoscopy should be attenuated by the appropriate premedication, smooth induction, and rapid intubation. The present study evaluated the clinical efficacy of oral premedication with pregabalin or clonidine for hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy. Methods: A total of 180 healthy adult consented patients aged 35 to 52 years with American Society of Anesthesiologist (ASA physical status I and II of both gender, who met the inclusion criteria for elective laparoscopic cholecystectomy, were randomized to receive placebo Group I, pregabalin (150 mg Group II, or clonidine (200 μg Group III, given 75 to 90 minutes before surgery as oral premedication. All groups were compared for preoperative sedation and anxiety level along with changes of heart rate and mean arterial pressure prior to premedication, before induction, after laryngoscopy, pneumoperitoneum, release of carbon dioxide, and extubation. Intraoperative analgesic drug requirement and any postoperative complications were also recorded. Results: Pregabalin and clonidine proved to have sedative and anxiolytic effects as oral premedicants and decreased the need of intraoperative analgesic drug requirement. Clonidine was superior to pregabalin for attenuation of the hemodynamic responses to laryngoscopy and laparoscopy, but it increased the incidence of intra-and postoperative bradycardia. No significant differences in the parameters of recovery were observed between the groups. None of the premedicated patient has suffered from any postoperative side effects. Conclusion: Oral premedication with pregabalin 150 mg or clonidine 200 μg causes sedation and anxiolysis with hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy, without prolongation of recovery time and side effects.

  7. Comparison of hemodynamic and metabolic stress responses caused by endotracheal tube and Proseal laryngeal mask airway in laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Handan Güleç

    2012-01-01

    Full Text Available Background: We aimed to compare hemodynamic and endocrine alterations caused by stress response due to Proseal laryngeal mask airway and endotracheal tube usage in laparoscopic cholecystectomy. Materials and Methods: Sixty-three ASA I-II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated into two groups of endotracheal tube and Proseal laryngeal mask airway. Standard general anaesthesia was performed in both groups with the same drugs in induction and maintenance of anaesthesia. After anaesthesia induction and 20 minutes after CO 2 insufflations, venous blood samples were obtained for measuring adrenalin, noradrenalin, dopamine and cortisol levels. Hemodynamic and respiratory parameters were recorded at the 1 st , 5 th , 15 th , 30 th and 45 th minutes after the insertion of airway devices. Results: No statistically significant differences in age, body mass index, gender, ASA physical status, and operation time were found between the groups (p > 0.05. Changes in hemodynamic and respiratory parameters were not statistically significant when compared between and within groups (p > 0.05. Although no statistically significant differences were observed between and within groups when adrenalin, noradrenalin and dopamine values were compared, serum cortisol levels after CO 2 insufflation in PLMA group were significantly lower than the ETT group (p = 0.024. When serum cortisol levels were compared within groups, cortisol levels 20 minutes after CO 2 insufflation were significantly higher (46.1 (9.5-175.7 and 27.0 (8.3-119.4 in the ETT and PLMA groups, respectively than cortisol levels after anaesthesia induction (11.3 (2.8-92.5 and 16.6 (4.4-45.4 in the ETT and PLMA groups, respectively in both groups (p = 0.001. Conclusion: PLMA usage is a suitable, effective and safe alternative to ETT in laparoscopic cholecystectomy patients with lower metabolic stress.

  8. EFFECT OF ORAL MOXONIDINE IN THE ATTENUATION OF THE HEMODYNAMIC RESPONSES SEEN DURING LAPAROSCOPIC CHOLECYSTECTOMY: A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Raghuram

    2014-04-01

    Full Text Available BACKGROUND: Pneumoperitoneum required for laparoscopic surgeries results in various pathophysiologic changes in the body, especially in the cardiovascular system. Moxonidine is a selective Imidazoline I1-receptor agonist with an I1:α2 affinity ratio of 40:1 to 70:1. Through an action in the Rostral Ventrolateral Medulla (RVLM, where the I1 receptors are situated, it reduces sympathetic outflow and lowers peripheral vascular resistance. BP reduction is not accompanied by any significant change in heart rate or cardiac output. AIMS AND OBJECTIVES: The aim of our study was to evaluate effect of orally administered Moxonidine in attenuating the hemodynamic responses that occur during laparoscopic cholecystectomy. MATERIALS AND METHODS: 50 adult ASA I and II patients scheduled for elective laparoscopic cholecystectomy were selected for this prospective randomized double blinded comparative study. They were randomly allocated to two groups; Moxonidine group and Placebo group. Moxonidine group received oral Moxonidine 0.3 mg at 8 PM the day before surgery and at 8 AM on the day of surgery. Placebo group received a placebo at the same timing as that of the Moxonidine group. RESULTS: When vital parameters were compared significant rise in heart rate, systolic, diastolic and mean blood pressure was noted in the Placebo group following pneumoperitoneum, where as in Moxonidine group the rise was not more than 20% of baseline. CONCLUSION: In conclusion, Moxonidine when administered preoperatively provides perioperative hemodynamic stability in ASA I and II patients undergoing laparoscopic cholecystectomy. It’s other benefits such as absence of reflex tachycardia, preservation of hepatic and renal function makes it a good choice for laparoscopic procedure.

  9. Anesthetic Considerations in Patient with Wolff-Parkinson-White Syndrome for Laparoscopic Cholecystectomy: Role of Perioperative Dexmedetomidine

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    Mridu Paban Nath

    2015-04-01

    Full Text Available Wolff-Parkinson-White (WPW syndrome is a cardiac disorder having abnormal electrical communication between atria and ventricles. It is an uncommon disorder may be asymptomatic or present with symptoms like palpitation. Intraoperatively these patients may present with serious cardiac emergencies like paroxysmal supraventricular tachyarrythmias (PSVT and atrial fibrillation (AF. We report a case of 35 years old female posted for elective laparoscopic cholecystectomy under general anesthesia with the use of dexmedetomidine in the perioperative period. Perioperative management of these patients under general anesthesia is a real challenge for the anesthesiologists particularly under general anesthesia.

  10. The indications and contraindications of laparoscopic cholecystectomy and its conversion to open rate in Imam Hospital, 1372-77

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    Nik Kholgh A

    2000-09-01

    Full Text Available Since its introduction in 1988, laparoscopic cholecystectomy (LC has become the procedure of choice in the management of gallstone disease. It has well established advantages compared to its traditional open counterpart such as reduction in hospital stay and related costs, more rapid return to work, and reduction in pain and cosmetic problems. LC, like any other procedure, has its own indications and contraindications that have been modified due to the improvement in laparoscopic technics and surgical skills. The goal of this article is to review these indications and contraindications in surgical wards 1 and 5-Imam Khomeini medical center-Tehran. In a retrospective descriptive case-series, patient records of all cholecystectomies from 1993 till 1998 were studied. Patients age and sex, diagnosis at admission, sonographic and/or other radiologic findings, lab data, indication of cholecystectomy, co-existent clinical situation, history of abdominal operation and/or malignancy, type of operation (LC, open, converted to open and its cause, intra-operative findings, pathologic findings, days from operation to discharge, and early mortality rate were reviewed. 343 cholecystectomies were studied, among which 121 were laparoscopic. In the laparoscopic group, there were 117 (96.6% women and 4 (3.3% men. Age range was 14 to 84 with the median of 45. The most common indications for LC in this center are: 1 Recurrent biliary colic (88.4%, 2 Non-specific manifestations of gallstone (5.8% and 3 Asymptomatic gallstone (1.7%. Contraindications for LC are: 1 Acute cholecystitis 2 CBD stone and/or dilatation, 3 Gallbladder cancer, 4 Intra-abdominal malignancies, 5 The need for other elective abdominal operation, 6 History of upper abdominal, laparatomy, 7 Sepsis, 8 Ileus, 9 Peritonitis, 10 Pancreatitis and 11 Morbid obesity. Compensated cirrhosis of the liver is not a contraindication to LC. LC in cardiac and respiratory patients requires exact evaluations and

  11. Single-port versus multi-port cholecystectomy for patients with acute cholecystitis:a retrospective comparative analysis

    Institute of Scientific and Technical Information of China (English)

    DietmarJacobandRol; Raakow

    2011-01-01

    BACKGROUND: Trans-umbilical single-port laparoscopic cholecystectomy for chronic gallbladder disease is becoming increasingly accepted worldwide. But so far, no reports exist about the challenging single-port surgery for acute cholecystitis. The objective of this study was to describe our experience with single-port cholecystectomy in comparison to the conventional laparoscopic technique. METHODS: Between August 2008 and March 2010, 73 patients with symptomatic gallbladder disease and histopathological signs of acute cholecystitis underwent laparoscopic cholecystec-tomy at our institution. Thirty-six patients were operated on with the single-port technique (SP group) and the data were compared with a control group of 37 patients who were treated with the multi-port technique (MP group). RESULTS: The mean age in the SP group was 61.5 (range 21-81) years and in the MP group was 60 (range 21-94) (P=0.712). Gender, ASA status and BMI were not significantly different. The number of white blood cells was different before [SP:9.2 (range 2.8-78.4); MP: 13.2 (range 4.4-28.6); P=0.001] and after the operation [SP: 7.8 (range 3.5-184.8); MP: 11.1 (range 5-20.8); P=0.002]. Mean operating time was 88 (range 34-174) minutes in the SP group vs 94 (range 39-209) minutes in the MP group (P=0.147). Four patients (5%) required conversion to an open procedure (SP: 1; MP: 3; P=0.320). During the follow-up period of 332 (range 29-570) days in the SP group and 428 (range 111-619) days in the MP group (P=0.044), eleven (15%) patients developed postoperative complications (P=0.745) and two patients in the SP group required reoperation (P=0.154). CONCLUSIONS: Trans-umbilical single-port cholecystectomy for beginning acute cholecystitis is feasible and the complication rate is comparable with the standard multi-port operation. In spite of our good results, these operations are difficult to perform and should only be done in high-volume centers for laparoscopic surgery with

  12. Comparison of the minimally invasive surgical methods of the cholelithiasis treatment: single-port and four-port laparoscopic cholecystectomy

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    V. N Klymenko

    2015-08-01

    Full Text Available Aim and methods. In this paper, a comparative analysis of the results obtained in the performance of single-port laparoscopic surgery (SILS and the traditional four-port laparoscopic cholecystectomy was presented. Average duration of surgery, intra and postoperative complications, duration of pain, hyperthermia, a cosmetic effect were assessed and compared. Results. SILS technique reduces the duration and intensity of post-operative discomfort associated with pain in the wound; achieve early almost complete physical and social adaptation, and return to the normal rhythm of life; get the best cosmetic result.

  13. Comparisons of prediction models of quality of life after laparoscopic cholecystectomy: a longitudinal prospective study.

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    Hon-Yi Shi

    Full Text Available BACKGROUND: Few studies of laparoscopic cholecystectomy (LC outcome have used longitudinal data for more than two years. Moreover, no studies have considered group differences in factors other than outcome such as age and nonsurgical treatment. Additionally, almost all published articles agree that the essential issue of the internal validity (reproducibility of the artificial neural network (ANN, support vector machine (SVM, Gaussian process regression (GPR and multiple linear regression (MLR models has not been adequately addressed. This study proposed to validate the use of these models for predicting quality of life (QOL after LC and to compare the predictive capability of ANNs with that of SVM, GPR and MLR. METHODOLOGY/PRINCIPAL FINDINGS: A total of 400 LC patients completed the SF-36 and the Gastrointestinal Quality of Life Index at baseline and at 2 years postoperatively. The criteria for evaluating the accuracy of the system models were mean square error (MSE and mean absolute percentage error (MAPE. A global sensitivity analysis was also performed to assess the relative significance of input parameters in the system model and to rank the variables in order of importance. Compared to SVM, GPR and MLR models, the ANN model generally had smaller MSE and MAPE values in the training data set and test data set. Most ANN models had MAPE values ranging from 4.20% to 8.60%, and most had high prediction accuracy. The global sensitivity analysis also showed that preoperative functional status was the best parameter for predicting QOL after LC. CONCLUSIONS/SIGNIFICANCE: Compared with SVM, GPR and MLR models, the ANN model in this study was more accurate in predicting patient-reported QOL and had higher overall performance indices. Further studies of this model may consider the effect of a more detailed database that includes complications and clinical examination findings as well as more detailed outcome data.

  14. Two-port laparoscopic cholecystectomy with modified suture retraction of the fundus: A practical approach

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    Ming G Tian

    2013-01-01

    Full Text Available Context: Although transumbilical single incision laparoscopic cholecystectomy (SILC has been demonstrated to be superior cosmetic, it is only limited to simple cases at present. In complex cases, the standard four- or three-port LC is still the treatment of choice. Aim: To summarize the clinical effect of a modified technique in two-port LC. Settings and Design: A consecutive series of patients with benign gallbladder diseases admitted to the provincial teaching hospital who underwent LC in the past 4 years were included. A modified two-port LC was the first choice except for those requiring laparoscopic common bile duct exploration (LCBDE. Materials and Methods: The operation was done with suture retraction of the fundus by a needle-like retractor. The patients′ data, including the operative time, time consumed by gallbladder retraction, operative bleeding, conversion rate, rate of adding trocars, and postoperative complications were recorded. Statistical Analysis: Data were expressed as percentage and mean with standard deviation. Results: Total 107 patients with chronic calculous cholecystitis (N = 61, acute calculous cholecystitis (N = 43, and cholecystic polyps (N = 3 received two-port LC. The procedure was successful in 99 out of 107 cases (success rate, 92.5%, and a third trocar was added in the remaining 8 cases (7.5% due to severe pathological changes. The operative time was 47.2 (±13.21 min. There was no conversion to open surgery. Conclusion: Two-port LC using a needle-like retractor for suture retraction of the gallbladder fundus is a practical approach when considering the safety, convenience, and indications as well as relatively minimal invasion.

  15. Transumbilical single incision laparoscopic cholecystectomy with conventional instruments: A continuing study

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    Rajeev Sinha

    2014-01-01

    Full Text Available Introduction: The feasibility of the single incision, multiport transumbilical approach(SILC for the treatment of symptomatic gallbladder calculus disease has been established. Aims: The study examines both short and long term morbidity of the SILC approach. Materials and Methods: All the 1338 patients were operated by the same surgeon through a transversely placed umbilical incision in the upper third of the umbilicus.Three conventional ports,10,5 and 5 mm were introduced through the same skin incision but through separate transfascial punctures.The instruments were those used for standard laparoscopic cholecystectomy(SLC.Patients with acute cholecystitis and calculous pancreatitis were included,while those with choledocholithiasis were excluded.Results were compared with those of SLC. Results: Forty patients had difficult gall bladders, 214 had acute cholecystitis, and 16 had calculous pancreatitis.The mean operating time was 24.7 mins as compared to 18.4 mins in SLC. Intracorporeal knotting was required in four patients. Conversion to SLC was required in 12 patients.Morrisons pouch drain was left in 3 patients.Injectable analgesics were required in 85% vs 90% (SILC vs SLC on day 1 and 25% vs 45% on day 2 and infection was seen in 6(0. 45% patients.Port site hernia was seen in 2 patients. The data was compared with that of SLC and significance calculated by the student ′t′ test. A p value less than 0.05 was considered as significant. Conclusions: Trans umbilical SILC gives comparable results to SLC, and is a superior alternative when cosmesis and postoperative pain are considered, but the operative time is significantly more.

  16. Laparoscopic cholecystectomy accompanied by simultaneous umbilical hernia repair: A retrospective study

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    Kamer E

    2007-01-01

    Full Text Available Background : Umbilical defects may cause technical problems for general surgeons in patients during laparoscopic cholecystectomy (LC operations and may increase the incidence of incisional hernia. Aim : The objectives of this study were to determine the optimal repair method for umbilical hernias that already exist or are encountered incidentally and to present data regarding potential problems that may occur during LC. Settings and Design : Medical records of patients who had received simultaneous umbilical hernia repair (UHR with LC were investigated retrospectively. Materials and Methods : Cholelithiasis was accompanied by umbilical hernia in 64 (8.6% out of 745 patients who underwent LC and UHR simultaneously in our hospital between 2000 and 2004. Statistical Analysis Used : The Mann-Whitney U, Chi-square, One-Way Anova, Kaplan-Meier survival analysis, the log-rank test and t test were used for statistical analyses. Results : LC was followed by UHR using primary suture (Group 1, Mayo repair (Group 2 and flat mesh-based repair (Group 3 in 32 (50%, 18 (28.1% and 14 (21.9% patients, respectively. Mean body mass indexes (BMI of patients were 26.6 kg/m 2 , 29.2 kg/m 2 and 39.9 kg/m 2 in Groups 1, 2 and 3, respectively. Recurrence rates were 9.4%, 5.6% and none (0% in Groups 1, 2 and 3, respectively. Recurrence was observed in three (7.0% out of 43(67.2% patients with BMI≥30 kg/m 2 while umbilical hernia recurred in one (4.8% out of 21 (32.8% patients with BMI< 30 kg/m 2 . Overall morbidity and mortality rates were 14.1% and 0%, respectively. Conclusions : The outcomes of the UHR with mesh after laparoscopic surgeries appear to be better for either obese or non-obese patients than primary suture techniques in recurrence rates.

  17. Influence of preemptive analgesia on pulmonary function and complications for laparoscopic cholecystectomy.

    Science.gov (United States)

    Şen, Meral; Özol, Duygu; Bozer, Mikdat

    2009-12-01

    Pain and diaphragmatic dysfunction are the major reasons for postoperative pulmonary complications after upper abdominal surgery. Preoperative administration of analgesics helps to reduce and prevent pain. The objective of this study was first to research the rate of pulmonary complications for laparoscopic cholecystectomy (LC) and then analyze the influence of preemptive analgesia on pulmonary functions and complications. Seventy patients scheduled for elective LC were included in our double-blind, randomized, placebo-controlled, prospective study. Randomly, 35 patients received 1 g etofenamate (group 1) and 35 patients 0.9% saline (group 2) intramuscularly 1 h before surgery. All patients underwent physical examination, chest radiography, lung function tests, and pulse oxygen saturation measurements 2 h before surgery and postoperatively on day 2. Atelectasis was graded as micro, focal, segmental, or lobar. With preemptive analgesia, the need for postoperative analgesia decreased significantly in group 1. In both groups mean spirometric values were reduced significantly after the operation, but the difference and proportional change according to preoperative recordings were found to be similar [29.5 vs. 31.3% reduction in forced vital capacity (FVC) and 32.9 vs. 33.5% reduction in forced expiratory volume in 1 s (FEV(1)) for groups 1 and 2, respectively]. There was an insignificant drop in oxygen saturation rates for both groups. The overall incidence of atelectasia was similar for group 1 and 2 (30.2 vs. 29.2%). Although the degree of atelectesia was found to be more severe in the placebo group, the difference was not statistically significant. We concluded that although preemptive analgesia decreased the need for postoperative analgesia, this had no effect on pulmonary functions and pulmonary complications.

  18. Operative stress response and energy metabolism after laparoscopic cholecystectomy compared to open surgery

    Institute of Scientific and Technical Information of China (English)

    Kai Luo; Jie-Shou Li; Ling-Tang Li; Kei-Hui Wang; Jing-Mei Shun

    2003-01-01

    AIM: To determine the least invasive surgical procedure by comparing the levels of operative stress hormones, responsereactive protein (CRP) and rest energy expenditure (REE)after laparoscopic (LC) and open cholecystectomy (OC).METHODS: Twenty-six consecutive patients with noncomplicated gallstones were randomized for LC (14) and OC (12). Plasma concentrations of somatotropin, insulin, cortisol and CRP were measured. The levels of REE were determined.RESULTS: In the third postoperative day, the insulin levels were lower compared to that before operation (P<0.05).Tn the first postoperative day, the levels of somatotropin and cortisol were higher in OC than those in LC. After operation the parameters of somatotropin, CRP and cortisol increased, compared to those in the preoperative period in the all patients (P<0.05). In the all-postoperative days,the CRP level was higher in OC than that in LC (7.46±0.02;7.38±0.01, P<0.05). After operation the REE level all increased in OC and LC (P<0.05). In the all-postoperative days, the REE level was higher in OC than that in LC (1438.5±A18.5;1222.3±L80.8, P<0.05).CONCLUSION: LC results in less prominent stress response and smaller metabolic interference compared to open surgery. These advantages are beneficial to the restoration of stress hormones, the nitrogen balance, and the energy metabolism. However, LC can also induce acidemia and pulmonary hypoperfusion because of the penumoperitonium it uses during surgery.

  19. A rare condition: Ectopic liver tissue with its unique blood supply encountered during laparoscopic cholecystectomy

    Science.gov (United States)

    Bal, Ahmet; Yilmaz, Sezgin; Yavas, Betul Demirciler; Ozdemir, Cigdem; Ozsoy, Mustafa; Akici, Murat; Kalkan, Mustafa; Ersen, Ogun; Saripinar, Baris; Arikan, Yuksel

    2015-01-01

    Introduction Developmental abnormalities of liver including ectopic liver tissue (ELT) are rare conditions. Few cases presenting ELT have been reported in literature till now. Even though the most common area seen is gallbladder, it is detected both abdominal and thoracic sites. There is a relationship between HCC and ectopic liver that necessitates the removal. Presentation of case A 51-year-old female was hospitalized because of abdominal pain. Gallstone and bile duct dilatation were determined during ultrasonographic (USG) evaluation. The patient was operated for cholecystectomy following a successful endoscopic retrograde cholangiopancreatography (ERCP). During operation, a mass located on gallbladder with its unique vascular support was identified and resected together with gallbladder. The mass had a separate vascular stalk arising from liver parenchyma substance and it was clipped with laparoscopic staples. The histopathological examination revealed that the mass adherent to gallbladder was ectopic liver confirming the intraoperative observation. The postoperative course of patient was uneventfull and she was discharged at the second day after the operation. Discussion Ectopic liver tissue is incidentally found both in abdominal and thoracic cavity. ELT can rarely be diagnosed before surgical procedures or autopsies. It can be overlooked easily by radiological techniques. Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction. ELT also has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed. Conclusion Although ELT is rarely seen, it should be removed when recognized in order to prevent the complications and malignant transformation. PMID:25723748

  20. Outcome of laparoscopic cholecystectomy is not influenced by chronological age in the elderly

    Institute of Scientific and Technical Information of China (English)

    Hyung Ook Kim; Jung Won Yun; Jun Ho Shin; Sang Il Hwang; Yong Kyun Cho; Byung Ho Son; Chang Hak Yoo; Yong Lai Park; Hungdai Kim

    2009-01-01

    AIM: To evaluate the outcome of laparoscopic cholecystectomy (LC) in patients aged 80 years and older. METHODS: A total of 353 patients aged 65 to 79 years (group 1) and 35 patients aged 80 years and older (group 2) underwent LC. Patients were further classified into two other groups: those with uncomplicated gallbladder disease (group A) or those with complicated gallbladder disease (group B). RESULTS: There were no significant differences between the age groups (groups 1 and 2) with respect to clinical characteristics such as age, gender, comorbid disease, or disease presentation. Mean operative time, conversion rate, and the incidence of major postoperative complications were similar in groups 1 and 2. However, the percentage of high-risk patients was significantly higher in group 2 than in group 1 (20.0% vs 5.7%, P < 0.01). Group A comprised 322 patients with a mean age of 71.0 ± 5.3 years, and group B comprised 51 patients with a mean age of69.9 ± 4.8 years. In group B, mean operative time (78.4 ± 49.3 min vs 58.3 ± 35.8 min, P < 0.01), mean postoperative hospital stay (7.9 ± 6.5 d vs 5.0 ± 3.7 d, P < 0.01), and the incidence of major postoperative complications (9.8% vs 3.1%, P < 0.05) were significantly greater than in group A. The conversion rate tended to be higher in group B, but this difference was not significant. CONCLUSION: Perioperative outcomes in elderly patients who underwent LC seem to be influenced by the severity of gallbladder disease, and not by chronologic age. In octogenarians, LC should be performed at an earlier, uncomplicated stage of the disease whenever possible to improve perioperative outcomes.

  1. Surgical options in the management of cystic duct avulsion during laparoscopic cholecystectomy

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    Mirsharifi Rasoul

    2008-06-01

    Full Text Available Abstract Background Avulsion of cystic duct during laparoscopic cholecystectomy (LC is not a common intraoperative complication, but may be encountered by any laparoscopic surgeon. Surgeons are rarely familiar with management of this condition. Methods Patients with gall stone related problems who were scheduled for LC at the minimal invasive surgery unit of a tertiary referral hospital during a 5 years period (April 2002–April 2007 were prospectively enrolled. Results 12 cases were identified (incidence: 1.15%. All 12 patients had gallbladder inflammation. Five patients had acute and seven patients had chronic cholecystitis. The avulsed cystic duct (ACD was managed by clipping in 4, intracorporeal suturing in 3, converting to open surgery with suture ligation in 2, and lonely external drainage in 3 patients. Bile leakage had ceased within 3 days in 2, 14 days in one, and 20 days in the other patient. Bile volume increased gradually in one of the patients, which stopped only after endoscopic sphincterotomy (ES at 25th postoperative day. No major late complication or mortality occurred. Conclusion ACD during LC is a rare complication. Almost all standard methods of treatment yield to successful outcomes with low morbidity. According to the situation, ACD may be successfully managed laparoscopically. Available cystic stump remnant was clipped. Intracorporeal suture ligation was performed when short length of stump precluded clipping. Deeply retracted cystic duct with active bile leak led to conversion to open surgery. With minimal or no bile leak at ACD stump, closed tube drainage of sub-hepatic area was attempted. Persistent bile leak was assumed to be controlled by ES, successfully accomplished in one patient.

  2. Comparison between transumbilical single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy%经脐单孔与传统腹腔镜胆囊切除术的比较研究

    Institute of Scientific and Technical Information of China (English)

    程晓剑; 章安庆; 叶显道; 侯亚峰; 吴袁生; 何宗全; 吴新刚; 方磊

    2013-01-01

    Objective To analyze the curative effect and safety of single -incision laparoscopic cholecystectomy and conventional laparoscop -ic cholecystectomy. Methods We analyzed retrospectively the clinical data of the transumbilical single -incision laparoscopic cholecystecto -my ( observation group, n = 28 ) or the conventional laparoscopic cholecystectomy ( control group, n = 29 ) for treatment of 57 patients with chronic cholecystitis polypoid lesions or gallbladder stone in Tongling People's Hospital from January 2010 to November 2010. Results The time for taking the gallbladder, degree of pain, pain time, pain relievers used, and satisfaction in the observation group were significantly bet -ter than those in the control group. However, the operation time in the observation group was significantly higher than that in the control group. There were no significant differences in blood loss ,postoperative eating time ,bed activity time,length of hospital stay ,and postoperative complications. Conclusions Transumbilical single incision laparoscopic cholecystectomy not only shows the advantages of conventional laparoscopic cholecystectomy ,but also has a better cosmetic results and less invasion than the conventional one .%目的 分析经脐单孔与传统腹腔镜胆囊切除术的疗效和安全性.方法 对2010年1月-2012年11月10月间收治的57例慢性胆囊炎伴有息肉样病变或胆囊结石患者,分别采用经脐单孔腹腔镜胆囊切除术(观察组,n=28)或传统腹腔镜胆囊切除术(对照组,n=29),对比分析两组患者临床资料.结果 观察组患者的取胆囊时间、疼痛度、疼痛时间、镇痛药应用和满意度都显著地优于对照组患者,但是观察组患者的手术时间显著地大于对照患者,两组患者的出血量、术后进食时间、术后下床活动时间、住院时间和并发症无显著地差异.结论 经脐单孔腹腔镜胆囊切除术,治疗效果和安全性与传统腹腔镜胆囊切除术相

  3. Effects of thoracic paravertebral block with bupivacaine versus combined thoracic epidural block with bupivacaine and morphine on pain and pulmonary function after cholecystectomy

    DEFF Research Database (Denmark)

    Bigler, D; Dirkes, W; Hansen, R;

    1989-01-01

    Twenty patients undergoing elective cholecystectomy via a subcostal incision were randomized in a double-blind study to either thoracic paravertebral blockade with bupivacaine 0.5% (15 ml followed by 5 ml/h) or thoracic epidural blockade with bupivacaine 7 ml 0.5% + morphine 2 mg followed by 5 ml...

  4. A comparative study between ProSeal laryngeal mask airway and endotracheal tube for ease of insertion and haemodynamic changes in patients undergoing laparoscopic cholecystectomy under general anaesthesia

    Directory of Open Access Journals (Sweden)

    Veena Patodi

    2016-12-01

    Conclusions: ProSeal LMA proved to be a suitable alternative to endotracheal tube for airway management with stable haemodynamics in patients undergoing laparoscopic cholecystectomy under general anaesthesia. [Int J Res Med Sci 2016; 4(12.000: 5334-5340

  5. Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy: A prospective,randomized study

    Institute of Scientific and Technical Information of China (English)

    Thawatchai Akaraviputh; Charay Leelouhapong; Varut Lohsiriwat; Somkiat Aroonpruksakul

    2009-01-01

    AIM: To determine the efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy.METHODS: A prospective, double-blind, randomized,placebo-controlled study was conducted on 70 patients who underwent elective laparoscopic cholecystectomy under general anesthesia at Siriraj Hospital, Bangkok,from January 2006 to December 2007. Patients were randomized to receive either 20 mg parecoxib infusion 30 min before induction of anesthesia and at 12 h after the first dose (treatment group), or normal saline infusion, in the same schedule, as a placebo (control group). The degree of the postoperative pain was assessed every 3 h in the first 24 h after surgery, and then every 12 h the following day, using a visual analog scale. The consumption of analgesics was also recorded.RESULTS: There were 40 patients in the treatment group, and 30 patients in the control group. The pain scores at each time point, and analgesic consumption did not differ between the two groups. However,there were fewer patients in the treatment group than placebo group who required opioid infusion within the first 24 h (60% vs 37%, P = 0.053).

  6. "EFFECTIVENESS OF ABDOMINAL WALL ELEVATOR IN REDUCING INTRA-ABDOMINAL PRESSURE AND CO2 VOLUME DURING LAPAROSCOPIC CHOLECYSTECTOMY"

    Directory of Open Access Journals (Sweden)

    A. Yaghoobi Notash

    2004-06-01

    Full Text Available Since CO2 pneumoperitoneum is the dominant method of laparoscopic exposure due to facility and good view, its physiologic effects are most relevant to the surgeons. CO2 pneumoperitoneum may affects hemodynamics by increased intra-abdominal pressure (IAP and the physiologic effects of absorbed CO2. The adverse effects of both mechanisms relate directly to the duration of the pneumoperitoneum and the elevation of IAP. Gasless laparoscopy involves obtaining exposure for laparoscopy by placing an internal retracting device through a small incision and lifting the anterior abdominal wall. We designed and made a mechanical wall elevator and used it in 24 patients, compared with a control group (52 cases using a conventional laparoscopic cholecystectomy. A prospective trial was undertaken in Sina Hospital, Tehran University of Medical Sciences from 1998 to 2000. The patients were assigned randomly to two groups. There was a significant decrease in IAP and CO2 consumption in the group using mechanical wall elevator as compared to conventional laparoscopic cholecystectomy, (mean IAP of 3.5 mmHg compared to 11.4 mmHg in the control group, mean CO2 volume 17 liters compared to 73 liters in the control group. We recommend this semigasless method in laparoscopy due to safety in performance and significant reduction in IAP through the surgery. This method provides a satisfactory view and easy performance without any increase in time or complications. The hospital stay and costs did not increase.

  7. Evaluation of Transcutaneous Electroacupoint Stimulation with the Train-of-four Mode for Preventing Nausea and Vomiting after Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    LIU Yu-yong; DUAN Shan-e; CAI Ming-xue; ZOU Peng; LAI Yong; LI Ya-lan

    2008-01-01

    Obiectve:To evaluate the efficacy of transcutaneous electroacupoint stimulation with a train-of-four(TOF)mode for the prevention of postoperative nausea and vomiting(PONV)in the patients undergoing laparoscopic cholecystectomy.Methods:Ninety-six ASA Grade Ⅰ-Ⅱ patients scheduled for laparoscopic cholecystectomy were randomized into Neiguan(P6)electroacupoint stimulation group(treated group)and a placebo control group(placement of electrodes without electroacupoint stimulation).The anesthetic regimen was standardized by needling at Neiguan on the left side and connecting the TOF peripheral nerve stimulator.The incidence of nausea,vomiting,severity,antiemetic dosage and the degree of pain were assessed at 0,60,120 min,and 24 h after surgery.Results:The incidence of nausea and vomiting,the dose of antiemetics and the occurrence of severe nausea were all significantly lower in the treated group compared with the control group and the score for pain was obviously reduced in patients of the treated group at 24 h post-operation (P<0.05 or P<0.01).Conclusion:Transcutaneous electroacupoint stimulation at P6 with the TOF mode could reduce the incidence and severity of nausea and vomiting with analgesic effects.

  8. Effect of remifentanil combined with propofol anesthesia on stress response, blood gas index in patients with laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Yan-Dong Jiang; Su-Min Zhao

    2016-01-01

    Objective:To observe the effect of remifentanil combined with propofol anesthesia on stress response, blood gas index in patients with laparoscopic cholecystectomy. Methods:A total of 88 patients with laparoscopic cholecystectomy were randomly divided into the observation group (46 cases) and the control group (42 cases). After anesthesia induction,the observation group was given remifentanil combined with propofol intravenous anesthesia for continuous anesthesia, and control group was given isoflurane and propofol. Stress response (TNF-αα, CRP, BG, COGT), blood gas index (PaO2, PCO2, PH value) before surgery, before anesthesia maintained, and after surgery between two groups were compared. Results: Before anesthesia maintained and after surgery, PaO2 and PCO2 levels of the two groups increased with before surgery (P0.05). pH value of the two groups showed no change before and after surgery. Before anesthesia maintained and after surgery, TNF-αα, CRP, BG, COGT of the two groups increased with before surgery (P0.05) at before anesthesia maintained. While to the end of surgery, these index of the control group was significantly higher than that in the observation group (P<0.05). Conclusions:Remifentanil combined with propofol anesthesia can make blood gas index stable as well as isoflurane combined with propofol anesthesia, but inhibit stress response more significantly.

  9. [Celioscopic cholecystectomy. A survey of the French Society of Endoscopic Surgery and Operative Radiology. Apropos of 937 cases].

    Science.gov (United States)

    Collet, D

    1992-01-01

    Twenty-eight surgeons, members of the Société Française de Chirurgie Endoscopique et de Radiologie Opératoire, took part in this multicenter study, carried out between March 1989 and January 1991. Nine hundred and thirty-seven patients were entered into the study, 934 of whom presented with biliary lithiasis and 3 with gallbladder polyps. Biliary colic was found in 918 (98 percent) of patients. One hundred and twenty-five patients (13.3 percent) presented with acute cholecystitis. Laparoscopic cholecystectomy had to be converted to traditional laparotomy in 50 cases (5.3 percent). The most frequent causes of conversion were the presence of cholecystitis (34 percent) and the occurrence of hemorrhage which could not be controlled laparoscopically (18 percent). There was one death (mortality rate: 0.1 percent) and there were 37 postoperative complications (morbidity rate: 3.9 percent) which required reoperation in 11 instances: 4 laparatomies, 5 laparoscopies and 2 ultrasonography guided drainages. The mean duration of postoperative hospital stay for patients without complications or conversion was 3.8 days. These results show both the limits and the advantages of laparoscopic cholecystectomy. This new technique is now well established and should be added to other therapies used in the treatment of patients with biliary lithiasis.

  10. A new method of preventing bile duct injury in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Fang Xu; Cheng-Gang Xu; De-Zheng Xu

    2004-01-01

    AIM: Of all the complications of laparoscopic cholectecystomy,bile duct injury (BDI) is the most serious complication.The prevention of injury to the common bile duct (CBD) remains a significant concern in laparoscopic cholecystectomy (LC).Different kinds of methods have been advanced to avoid this injury but no single method has gained wide acceptance.Because of various limitations of current methodologies we began a study using cold light illumination of the extrahepatic biliary system (light cholangiography LCP) to better visualize this area and thereby reduce the risk of bile duct injury.METHODS: Thirty-six patients with cholelithiasis were divided into two groups.Group Ⅰ (16 cases) received LCP and group Ⅱ (20 cases) received methelenum coeruleum cholangiography (MCCP).In group Ⅰ cold light was used to illuminate the common bile duct by leading an optical fiber into the common duct with a duodenoscope at the time of LC.The light coming from the fiber in the CBD could clearly illuminate the location of CBD and hepatic duct establishing its location relative to the cystic duct.This method was compared with the dye injection technique using methelenum coeruleum.RESULTS: In group Ⅰ thirteen cases were successfully illuminated and three failed.The cause of three failed cases was due to the difficulty in inserting the fiber into the ampulla of Vater.No complications occurred in the thirteen successful cases.In each of these successful cases the location of the common and hepatic ducts was clearly seen differentiating the ductal system from surrounding anatomy.In ten cases both the left and right hepatic ducts could be seen and in three only the right hepatic ducts were seen.In four of the thirteen cases,cystic ducts were also seen.In group Ⅱ,eighteen of the twenty cases were successful.The location of extrahepatic ducts became blue differentiating the ductal system from surrounding anatomy.Two cases failed due to a stone obstructing the cystic duct

  11. 经脐单孔腹腔镜与传统腹腔镜胆囊切除术的比较研究%Comparative Study of the Transumbilical Single Port Laparoscopic Cholecystectomy and the Conventional Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    钱毅; 顾元龙; 李建平

    2011-01-01

    Objective To evaluate the safety, feasibility and advantages of transumbilical single port laparoscopic cholecystectomy. Methods Retrospective study was achieved on the length of operation time, intraoperative hemorrhage, pain levels, intestinal function recovery time, length of hospital stay between the transumbilical single port laparoscopic cholecystectomy (group A,16 cases) and the conventional laparoscopic cholecystectomy ( group B ,20 cases). Results In the group A and B, it showed significant differences ( P < 0.05 ) in the operation time of (63.1 ± 11.2 ) min vs. (52.9 ± 13.1 ) min respectively, and the visual analogue scale(VAS)of (1.2 ±1.0) vs. (2.5 ± 1.2) respectively. But there was no difference in the intraoperative hemorrhage volnume, the intestinal function recovery time, and the length of hospital stay (P > 0.05 ). Conclusion Transumbilical single port laparoscopic cholecystectomy is safe and feasible with similar clinical outcomes comparing to the conventional laparoscopic choleeysteetomy.%目的 评价经脐单孔腹腔镜胆囊切除术的安全性、可行性及优势.方法回顾性分析经脐单孔腹腔镜胆囊切除术组(A组,16例)及传统四孔法腹腔镜胆囊切除术组(B组,20例)临床资料,A组采用脐孔上缘20 mm圆弧形切口,切口中间穿刺置入直径10 mm穿刺鞘,观察镜进入; 两侧分别置入两个5 mm的穿刺鞘,放置操作器械,器械摆放呈"三角"状,各穿刺鞘之间由腹壁组织相间隔.经右锁骨中线肋缘下穿刺置入直径1 mm的克氏针,以克氏针钝头辅助牵引暴露术野,完成手术操作.结果 A组与B组比较,手术时间分别为(63.1±11.2)min vs.(52.9±13.1)min,术后疼痛评分为(1.2±1.0) vs.(2.5±1.2),均有统计学差异(P0.05).结论现阶段的经脐单孔腹腔镜胆囊切除术是安全可行的,且更具有微创、美容的优势.

  12. 经脐单孔腹腔镜与传统腹腔镜胆囊切除术的对比研究%Comparative study on transumbilical single port laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    张海江; 闫军; 王赢凯; 杨波; 王建忠

    2012-01-01

    Objective To compare the clinical efficacy of transumbilical single port laparoscopic cholecystectomy(TUSPLC) and conventional laparoscopic cholecystectomy ( LC) ,and to explore the safety,feasibility and characteristics of transumbilical single port laparoscopic cholecystectomy. Methods Fifty patients undergoing transumbilical single port laparoscopic cholecystectomy (single port group) ,and fifty patients undergoing traditional laparoscopic cholecystectomy by the same surgeon (control group) ,were enrolled in this study. The operation time,the operative bleeding volume,the side injury during operation,the degree of postoperative pain,the postoperative intestinal function recovery time, the postoperative complications and the postoperative hospitalized day were recorded and compared. Results All patients successfully completed the surgery. In single port group and control group the operation time was (65.20±28.75)and(61.50±21.00)min,respectively(f'>0.05).Intraoperative blood loss,postoperative hospital stay were also not statistically different between 2 groups (P > 0.05 ). The postoperative intestinal function recovery time in single port group was significantly shorter than in control group [ (22.76 ±4.22)h vs(28.02 ±5.04)h,P<0.05].The degree of postoperative pain was lower in single port group than that of control group (P <0. 05). No side injury, postoperative bleeding and complications were found in two groups. Conclusion Transumbilical single port laparoscopic cholecystectomy is a safe,feasible and more minimally invasive way,with the advantages of less postoperative pain,quicker recovery,and no obvious abdominal scar.%目的 比较经脐单孔腹腔镜胆囊切除术(TUSPLC)与传统腹腔镜胆囊切除术(Lc)的手术疗效,探讨经脐单孔腹腔镜胆囊切除术的安全性、可行性及特点.方法 选择山西医科大学第一临床医学院普外科近期施行的经脐单孔腹腔镜胆囊切除术50例为单孔组,同一医师施行的

  13. Comparative study of open tension-free and laparoscopic inguinal hernia repair in hernioplasty and simultaneous laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    JIANG Dao-zhen; QIU Ming; ZHENG Xiang-min; LU Lei; DONG Zhi-tao; HE Yan-fei; JIANG Hang

    2006-01-01

    Objective: To evaluate the clinical value of laparoscopic inguinal hernia repair in hernioplasty and simultaneous cholecystectomy. Methods: Twenty-eight patients with symptomatic chronic calculous cholecystitis and synchronous unilateral primary inguinal hernia were performed combined surgery between October 2001 and March 2005. Of them, 10 cases underwent laparoscopic totally extraperitoneal mesh hernia repair (TEP) and laparoscopic cholecystectomy (LC), 3 cases underwent laparoscopic transabdominal preperitoneal mesh hernia repair (TAPP) and LC, and 15 cases underwent LC and open tension-free hernia repair. Results: All the procedures were performed successfully, 2 patients occurred urinary retention in LC+open group and 1 patient occurred scrotum seroma in LC+TEP procedures. During the 6 to 24 months' follow-up, no hernia recurrences occurred in all patients. There were 6 Patients (40%) in LC +open group had discomfort pain in the inguinal region and lasted 1 to 3 months. The operating time was longer in the totally laparoscopic group (TEP+LC and TAPP+LC) (104±31 min) than in the LC+open group (80±28 min) (P<0.05). The intensity of postoperative pain at rest was greater in the LC+open group at 24 h (P<0.05) and 48 h (P<0.05). No differences between the 2 groups were found in the mean operating costs and oral intake of the postoperative period. But the time resume to walking (2.9 vs 1. 8 d) (P<0.01) and the mean hospital stay (8.2 vs 4.6 d) (P<0. 001) was longer in the LC+open group than in the totally laparoscopic group. Conclusion: In the same operating costs, the totally laparoscopic precedure has more advantages of low postoperative pain, quicker resume to walking and less hospital stay than open tension-free hernia repair in hernioplasty and simultaneous LC. Thus, the totally laparoscopic approach is considered to be advantage of the hernioplasty and simultaneous LC.

  14. Comparison of palanosetron with ondansetron for postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anesthesia

    Directory of Open Access Journals (Sweden)

    Jyoti Bhalla

    2015-01-01

    Full Text Available Background: Post-operative nausea and vomiting (PONV is a ′big little′ problem especially after laparoscopic surgeries. Palanosetron is a new potent 5 hydroxy tryptamine 3 antagonists. In this randomized double blind clinical study we compared the effects of i.v. ondansetron and palanosetron administered at the end of surgery in preventing post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anesthesia. Materials and Methods: A total of 100 subjects between 18-60 years with Apfel score ≥2, were randomly assigned into one of the two groups, containing 50 patients each. Group A received ondansetron 4 mg i.v. and Group B received palanosetron 0.07 5mg i.v. both as bolus before induction. The incidence of nausea, retching and vomiting, incidence of total PONV, requirement of rescue antiemetics and adverse effects were evaluated during the first 24 h following end of surgery. Results: The incidence of nausea was significantly lower in patients who had received palanosetron (16% as compared to ondansetron (24%. Need of rescue antiemetics was significantly higher in patients receiving ondansetron (32% as compared to palanosetron (16%. The incidence of total PONV was also significantly lower in group receiving palanosetron (20% as compared to ondansetron (50%. Among the side effects, headache was noted significantly higher with ondansetron (20% as compared to palanosetron (6%. Conclusion: Palanosetron has got better anti-nausea effect, less need of rescue antiemetics, favourable side effect profile and a decrease in the incidence of total PONV as compared to ondansetron in 24 h post operative period in patients undergoing laproscopic cholecystectomy under general anesthesia.

  15. Effects of lidocaine and esmolol infusions on hemodynamic changes, analgesic requirement, and recovery in laparoscopic cholecystectomy operations

    Directory of Open Access Journals (Sweden)

    Serpil Dagdelen Dogan

    2016-04-01

    Full Text Available ABSTRACT OBJECTIVE: We compared the effects of lidocaine and esmolol infusions on intraoperative hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery in laparoscopic cholecystectomy surgery. METHODS: The first group (n = 30 received IV lidocaine infusions at a rate of 1.5 mg/kg/min and the second group (n = 30 received IV esmolol infusions at a rate of 1 mg/kg/min. Hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery characteristics were evaluated. RESULTS: In the lidocaine group, systolic arterial blood pressures values were lower after the induction of anesthesia and at 20 min following surgical incision (p < 0.05. Awakening time was shorter in the esmolol group (p < 0.001; Ramsay Sedation Scale scores at 10 min after extubation were lower in the esmolol group (p < 0.05. The modified Aldrete scores at all measurement time points during the recovery period were relatively lower in the lidocaine group (p < 0.05. The time to attain a modified Aldrete score of ≥9 points was prolonged in the lidocaine group (p < 0.01. Postoperative resting and dynamic VAS scores were higher in the lidocaine group at 10 and 20 min after extubation (p < 0.05, p < 0.01, respectively. Analgesic supplements were less frequently required in the lidocaine group (p < 0.01. CONCLUSION: In laparoscopic cholecystectomies, lidocaine infusion had superiorities over esmolol infusions regarding the suppression of responses to tracheal extubation and postoperative need for additional analgesic agents in the long run, while esmolol was more advantageous with respect to rapid recovery from anesthesia, attenuation of early postoperative pain, and modified Aldrete recovery (MAR scores and time to reach MAR score of 9 points.

  16. Is intra-operative cholangiography necessary during laparoscopic cholecystectomy? A multicentre rural experience from a developing world country

    Institute of Scientific and Technical Information of China (English)

    Iqbal Saleem Mir; Mir Mohsin; Omar Kirmani; Tafazul Majid; Khurshid Wani; Mehmood-ul Hassan; Javed Naqshbandi; Mohammed Maqbool

    2007-01-01

    AIM: To evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in non-teaching ruralhospitals of a developing country without intra-operative cholangiography (IOC). To evaluate the possibility of reduction of costs and hospital stay for patients undergoing LC.METHODS: A prospective analysis of patients with symptomatic benign diseases of gall bladder undergoing LC in three non-teaching rural hospitals of Kashmir Valley from Jan 2001 to Jan 2007. The cohort represented a sample of patients requiring LC, aged 13 to 78 (mean 47.2) years. Main outcome parameters included mortality, complications, re-operation, conversion to open procedure without resorting to IOC, reduction in costs borne by the hospital, and the duration of hospital stay.RESULTS: Twelve hundred and sixty-seven patients (976 females/291 males) underwent laparoscopic cholecystectomy. Twenty-three cases were converted to open procedures; 12 patients developed port site infection, nobody died because of the procedure. One patient had common bile duct (CBD) injury, 4 patients had biliary leak, and 4 patients had subcutaneous emphysema. One cholecystohepatic duct was detected and managed intraoperatively, 1 patient had retained CBD stones, while 1 patient had retained cystic duct stones. Incidental gallbladder malignancy was detected in 2 cases. No long-term complications were detected up to now.CONCLUSION: LC can be performed safely even in nonteaching rural hospitals of a developing country provided proper equipment is available and the surgeons and other team members are well trained in the procedure.It is stressed that IOC is not essential to prevent biliary tract injuries and missed CBD stones. The costs to the patient and the hospital can be minimized by using reusable instruments, intracorporeal sutures, and condoms instead of titanium clips and endobags.

  17. The evaluation of efficacy and safety of paravertebral block for perioperative analgesia in patients undergoing laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Anil Agarwal

    2012-01-01

    Full Text Available Background: Paravertebral block is a popular regional anesthetic technique used for perioperative analgesia in multiple surgical procedures. There are very few randomized trials of its use in laparoscopic cholecystectomy in medical literature. This study was aimed at assessing its efficacy and opioid-sparing potential in this surgery. Methods: Fifty patients were included in this prospective randomized study and allocated to two groups: Group A (25 patients receiving general anesthesia alone and Group B (25 patients receiving nerve-stimulator-guided bilateral thoracic Paravertebral Block (PVB at T6 level with 0.3 ml/kg of 0.25% bupivacaine prior to induction of general anesthesia. Intraoperative analgesia was supplemented with fentanyl (0.5 μg/kg based on hemodynamic and clinical parameters. Postoperatively, patients in both the groups received Patient-Controlled Analgesia (PCA morphine for the first 24 hours. The efficacy of PVB was assessed by comparing intraoperative fentanyl requirements, postoperative VAS scores at rest, and on coughing and PCA morphine consumption between the two groups. Results: Intraoperative supplemental fentanyl was significantly less in Group B compared to Group A (17.6 μg and 38.6 μg, respectively, P =0.001. PCA morphine requirement was significantly low in the PVB group at 2, 6, 12, and 24 hours postoperatively compared to that in Group A (4.4 mg vs 6.9 mg, 7.6 mg vs 14.2 mg, 11.6 mg vs 20.0 mg, 16.8 mg vs 27.2 mg, respectively; P <0.0001 at all intervals. Conclusion: Pre-induction PVB resulted in improved analgesia for 24 hours following laparoscopic cholecystectomy in this study, along with a significant reduction in perioperative opioid consumption and opioid-related side effects.

  18. Cosmesis and body image after single-port laparoscopic or conventional laparoscopic cholecystectomy: a multicenter double blinded randomised controlled trial (SPOCC-trial

    Directory of Open Access Journals (Sweden)

    Vonlanthen René

    2011-09-01

    Full Text Available Abstract Background Emerging attempts have been made to reduce operative trauma and improve cosmetic results of laparoscopic cholecystectomy. There is a trend towards minimizing the number of incisions such as natural transluminal endoscopic surgery (NOTES and single-port laparoscopic cholecystectomy (SPLC. Many retrospective case series propose excellent cosmesis and reduced pain in SPLC. As the latter has been confirmed in a randomized controlled trial, patient's satisfaction on cosmesis is still controversially debated. Methods/Design The SPOCC trial is a prospective, multi-center, double blinded, randomized controlled study comparing SPLC with 4-port conventional laparoscopic cholecystectomy (4PLC in elective surgery. The hypothesis and primary objective is that patients undergoing SPLC will have a better outcome in cosmesis and body image 12 weeks after surgery. This primary endpoint is assessed using a validated 8-item multiple choice type questionnaire on cosmesis and body image. The secondary endpoint has three entities: the quality of life 12 weeks after surgery assessed by the validated Short-Form-36 Health Survey questionnaire, postoperative pain assessed by a visual analogue scale and the use of analgesics. Operative time, surgeon's experience with SPLC and 4PLC, use of additional ports, conversion to 4PLC or open cholecystectomy, length of stay, costs, time of work as well as intra- and postoperative complications are further aspects of the secondary endpoint. Patients are randomly assigned either to SPLC or to 4PLC. Patients as well as treating physicians, nurses and assessors are blinded until the 7th postoperative day. Sample size calculation performed by estimating a difference of cosmesis of 20% (alpha = 0.05 and beta = 0.90, drop out rate of 10% resulted in a number of 55 randomized patients per arm. Discussion The SPOCC-trial is a prospective, multi-center, double-blind, randomized controlled study to assess cosmesis and body

  19. “PRE - OPERATIVE PREDICTORS OF DIFFICUL T LAPAROSCOPIC CHOLECYSTECTOMY; COMPARIS ONS OF TWO SCORING SYSTEMS. A SINGLE CENTER PROSPECTIVE STUDY”

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    Hari Gopal

    2013-10-01

    Full Text Available ABSTRACT: INTRODUCTION: Laparoscopic Cholecystectomy has evolved as the standard of care for the treatment of Gall Stone disease over the past decade. Several patient and procedure related factors have been impli cated in setting of failure to complete the procedure by minimal invasive method and various scores have been developed to precisely predict a Difficult Laparoscopic Cholecystectomy. AIMS: The present study was conducted to ascertain various patient relate d pre - operative risk factors for conversion of l apar o scopic Cholecystectomy to open method and to validate the Risk Score for conversion . SETTINGS & DESIGN: A total of 100 patients with diagnosis of Gall Stone Disease admitted to our surgical Unit between October 2011 and April 2013 were assessed for various pre - determined risk factors and were accordingly categorized into three levels of anticipated difficulty according to RSCLO and our new scoring system. The patients were then subjected to Laparoscopic C holecystectomy by the same surgical team and the procedure was then graded as difficult or not according to the pre - defined criteria. The findings were analysed by appropriate statistical analysis. RESULTS: Presence of factors like Male sex, history of att acks of acute cholecystitis, increased GB wall thickness, presence of supra - umbilical abdominal scar, obesity and a contracted GB were associated with a significantly higher rate of conversion to open method. RSCLO was found to correlate better with the ou tcome in this setting than our New Scoring System. CONCLUSION: Several patient related factors may be helpful in predicting a Difficult Laparoscopic Cholecystectomy pre - operatively. RSCLO Scoring system may be useful as a pre - operative tool to predict intr a - operative difficulty during LC.

  20. [Comparative analysis of application of highly intensive laser irradiation and electrocoagulation during laparoscopic cholecystectomy performed for destructive forms of an acute calculous cholecystitis].

    Science.gov (United States)

    Nichitayio, M Yu; Bazyak, A M; Klochan, V V; Grusha, P K; Goman, A V

    2015-02-01

    Comparative analysis of results of the laser diode (the wave length 940 nm) and elec- trocoagulation application while performing laparoscopic cholecystectomy was con- ducted. For an acute calculous cholecystitis 52 patients were operated, in whom instead of electrocoagulation the laser was applied, provide for reduction of thermal impact on tissues, the complications absence, reduction of the patients stationary treatment duration postoperatively from (5.2 ± 1.2) to (4.9 ± 0.6) days.

  1. Acute liver failure due to concomitant arterial, portal and biliary injury during laparoscopic cholecystectomy: is transplantation a valid life-saving strategy? A case report

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    Goldaracena Nicolas

    2009-09-01

    Full Text Available Abstract Background Combined iatrogenic vascular and biliary injury during cholecystectomy resulting in ischemic hepatic necrosis is a very rare cause of acute liver failure. We describe a patient who developed fulminant liver failure as a result of severe cholestasis and liver gangrene secondary to iatrogenic combine injury or the hepatic pedicle (i.e. hepatic artery, portal vein and bile duct during laparoscopic cholecystectomy. Case presentation A 40-years-old woman underwent laparoscopic cholecystectomy for acute cholecystitis. During laparoscopy, a severe bleeding at the liver hilum motivated the conversion to open surgery. Many sutures were placed across the parenchyma for bleeding control. After 48 hours, she rapidly deteriorated with encephalopathy, coagulopathy, persistent hypotension and progressive organ dysfunction including acute renal failure requiring hemodialysis and mechanical ventilation. An angiography documented an occlusion of right hepatic artery and right portal vein. In the clinical of acute liver failure secondary to liver gangrene, severe coagulopathy and progressive secondary multi-organ failure, the patient was included in the waiting list for liver transplantation. Two days later, the patient was successfully transplanted with initial adequate liver graft function. However, she developed bilateral pneumonia and severe gastrointestinal bleeding and finally died 24 days after transplantation due to bilateral necrotizing pneumonia. Conclusion The occurrence of acute liver failure due to portal triad injury during laparoscopic cholecystectomy is a catastrophic complication. Probably, the indication of liver transplantation as a life-saving strategy in patients with late diagnosis, acute liver failure, severe coagulopathy and progressive secondary multi-organ failure could be considered but only minimizing immunosuppressive regimen to avoid postoperative infections.

  2. Prophylactic gabapentin for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: A randomized, double-blind, placebo-controlled study

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    Pandey Chandra

    2006-01-01

    Full Text Available Background: Gabapentin is an antiepileptic drug. Its antiemetic effect is demonstrated in chemotherapy-induced acute and delayed onset of nausea and vomiting in breast cancer patients. Aim: To evaluate the antiemetic effect of gabapentin on incidence and severity of postoperative nausea and vomiting in laparoscopic cholecystectomy. Settings and Design: Double-blind, randomized, placebo-controlled study. Materials and Methods: Two hundred and fifty patients of ASA physical status I and II, scheduled for laparoscopic cholecystectomy were randomly assigned into two equal groups to receive 600 mg gabapentin or matching placebo two hours before surgery. Standard anaesthesia technique was used. Fentanyl was used as rescue postoperative analgesic. Ondansetron 4 mg was used intravenously as rescue medication for emesis. The total number of patients who had nausea or vomiting, and its severity and total fentanyl consumption in the first 24 hours were recorded. Statistical Analysis: "Z test" was used to test the significance of severity of post-operative nausea and vomiting between groups. Fentanyl consumed in each group (Mean±SD within 24 hrs was compared using student t test. P value< 0.05 was considered significant. Results: There were no demographic difference between the two groups. Incidence of post-operative nausea and vomiting within 24 hrs after laparoscopic cholecystectomy was significantly lower in gabapentin group (46/125 than in the placebo group (75/125 (37.8% vs 60%; P =0.04. There was a significantly decreased fentanyl consumption in gabapentin group (221.2±92.4 µg as compared to placebo group (505.9±82.0 µg; P =0.01. Conclusion: Gabapentin effectively suppresses nausea and vomiting in laparoscopic cholecystectomy and post-operative rescue analgesic requirement.

  3. Comparative study between transumbilical single-port laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy%经脐单孔与传统腹腔镜胆囊切除术的比较研究

    Institute of Scientific and Technical Information of China (English)

    张正东; 国维克

    2012-01-01

    Objective To study feasibility, security of transumbilical single-port laparoscopic cholecystectomy by traditional instrument and to summarize the initial experience. Methods The data of 60 patients with laparoscopic cholecystectomy in our department from May 2010 to August 2011 were analyzed retrospectively. 36 patients underwent TSPLC. 24 patients underwent LC. The diagnosis of chronic cholecystitis were made by ultrasound and CT. Surgical indications include: (1)Non-acute inflammation time cholecysti-tus or cholecystolithiasis. (2)Gallbladder polyp. (3)Non-acute inflammation time gallbladder benign disease. The BMI,associated disease, operating time, intraoperative blood loss, pain scores at 6h and 24h, shoulder and back pain rate, time taken for resumption of oral intake, postoperative hospital stay and wound complications were noted and retrospective analysis was conducted. Results All the operations were successfully completed. The mean operating time was longer in the TSPLC group than in the LC group( P 0. 05 ) . However patient satisfaction was higher in the TSPLC group than in the LC group ( P < 0. 05 ) . No setting at the abdominal cavity drainage tube, no surgical complications such as hemorrhage, cholerrhagia and Biliary duct damage. The average in hospital time is 3 days. Postoperatively from 1 to 3months following up adominal wall scar was not obvious in the TSPLC group. Conclusions Transumbilical single-port laparoscopic cholecystectomy by traditional instrument is technically safe and feasible. It appears to be cosmetically superior compared to standard LC. But it's more difficult to manipulate. Beginners need to go through a certain amount of practice can only master.%目的 探讨传统器械经脐入路单孔腹腔镜胆囊切除术(Transumbilical single-port laparoscopic cholecystectomy,TSPLC)的可行性、安全性并总结初步经验.方法 回顾性分析我院2010年5月~2011年8月行腹腔镜胆囊切除术(laparoscopic cholecystectomy

  4. Clinical experience of the single umbilical port of laparoscopic cholecystectomy.%经脐单孔腹腔镜胆囊切除的临床应用

    Institute of Scientific and Technical Information of China (English)

    马良; 李捷; 王家兴; 何永; 林龙英

    2011-01-01

    Objective To investigate the single umbilical port laparoscopic cholecystectomy feasibility and safety. Methods Retrospectively analyzed clinical data of observation group and control group from December 2008 to December 2009, there were 229 eases which adopted the single port umbilical laparoscopic cholecystectomy as observation group, and 192 cases which adopted the conventional laparoscopic cholecystectomy as control group. Operarive time, blood lost, postoperative complications, hospital stay and abdominal wall aesthetic satisfaction were compared by t-test and χ2 in two groups. Results 215 patients in observation group were successful by the single umbilical port laparoscopic cholecysteetomy, 13 patients by conventional four-hole cholecystectomy, 1 patient by laparotomy. There was no significant difference of operative time, blood lost, postoperative eomplieation, hospital stay between two groups. The abdominal wall aesthetic satisfaction of observation group gained an advantage over control group. Conclusion The single umbilical port laparoscopic cholecystectomy was safe and feasible, had less surgical trauma and higher degree of postoperative appearance, suitable for clinical practice.%目的 探讨经脐单孔腹腔镜胆囊切除术的可行性和安全性.方法 回顾分析我院2008年12月至2009年12月229例经脐单孔腹腔镜胆囊切除患者(观察组)和同期进行的192例常规腹腔镜胆囊切除患者的临床资料(对照组),采用t检验和X2检验比较两组手术时间、术中出血量、术后并发症、术后住院时间和术后腹壁美观满意度.结果 观察组229例,完成经脐单孔腹腔镜胆囊切除215例,转常规四孔法完成胆囊切除13例,中转开腹1例.两组手术时间、术中出血、术后并发症和术后住院时间均无显著差异,观察组术后腹壁美观程度明显优于对照组.结论 经脐单孔腹腔镜胆囊切除安全可行,手术创伤更小,术后美观程度更高,适合临床推广.

  5. Comparison of transumbilical and conventional laparoscopic cholecystectomy%经脐入路与传统腹腔镜胆囊切除术的比较

    Institute of Scientific and Technical Information of China (English)

    李潇娴; 朱江帆; 忻颖; 马颖璋

    2012-01-01

    目的 评价经脐入路腹腔镜胆囊切除术的安全性、可行性及潜在的优势.方法 60例胆囊疾患患者分别行经脐入路(TUES组,n=30)和传统腹腔镜胆囊切除术(LC组,n=30),比较两组手术时间、术中出血量、手术中转率、并发症、术后疼痛评分、手术美容满意度和总费用.结果 60例手术均成功.TUES组3例转LC,LC组1例中转开腹.无手术并发症发生.LC组手术时间较TUES组缩短(P<0.05),TUES组美容满意度明显优于LC组(P<0.05),其他指标差异均无统计学意义(P>0.05).结论 TUES胆囊切除术安全可行,能够取得和LC相同的临床结果,并且美容效果更好,患者满意度更高.%Objective To evaluate the efficacy, safety and feasibility of transumbilical laparoscopic cholecystectomy in comparison of conventional modality. Methods Sixty patients underwent transumbilical laparoscopic cholecystectomy ( TUES group, n = 30) or conventional laparoscopic cholecystectomy ( LC group, n = 30). Operation time, blood loss, length of hospital stay, surgical complications, total costs and cosmetic results were compared between two groups. Results All operations were successful without major surgical complications in both groups. There were no significant differences in blood loss, complications rates,length of hospital stay or the total costs. The patients undergoing transumbilical cholecystectomy showed better cosmetic results (P < 0. 05) and longer operative time (P <0.05). Conclusion Transumbilical laparoscopic cholecystectomy is a safe and feasible surgical modality, however, multicenter randomized clinical trials are necessary to further elucidate the safety and efficiency of this new technique.

  6. Effect of Endoscopic Sphincterotomy for Suspected Sphincter of Oddi Dysfunction on Pain-Related Disability Following Cholecystectomy

    Science.gov (United States)

    Cotton, Peter B.; Durkalski, Valerie; Romagnuolo, Joseph; Pauls, Qi; Fogel, Evan; Tarnasky, Paul; Aliperti, Giuseppe; Freeman, Martin; Kozarek, Richard; Jamidar, Priya; Wilcox, Mel; Serrano, Jose; Brawman-Mintzer, Olga; Elta, Grace; Mauldin, Patrick; Thornhill, Andre; Hawes, Robert; Wood-Williams, April; Orrell, Kyle; Drossman, Douglas; Robuck, Patricia

    2015-01-01

    IMPORTANCE Abdominal pain after cholecystectomy is common and may be attributed to sphincter of Oddi dysfunction. Management often involves endoscopic retrograde cholangiopancreatography (ERCP) with manometry and sphincterotomy. OBJECTIVE To determine whether endoscopic sphincterotomy reduces pain and whether sphincter manometric pressure is predictive of pain relief. DESIGN, SETTING, AND PATIENTS Multicenter, sham-controlled, randomized trial involving 214 patients with pain after cholecystectomy without significant abnormalities on imaging or laboratory studies, and no prior sphincter treatment or pancreatitis randomly assigned (August 6, 2008-March 23, 2012) to undergo sphincterotomy or sham therapy at 7 referral medical centers. One-year follow-up was blinded. The final follow-up visit was March 21, 2013. INTERVENTIONS After ERCP, patients were randomized 2:1 to sphincterotomy (n = 141) or sham (n = 73) irrespective of manometry findings. Those randomized to sphincterotomy with elevated pancreatic sphincter pressures were randomized again (1:1) to biliary or to both biliary and pancreatic sphincterotomies. Seventy-two were entered into an observational study with conventional ERCP managemeny. MAIN OUTCOMES AND MEASURES Success of treatment was defined as less than 6 days of disability due to pain in the prior 90 days both at months 9 and 12 after randomization, with no narcotic use and no further sphincter intervention. RESULTS Twenty-seven patients (37%; 95%CI, 25.9%-48.1%) in the sham treatment group vs 32 (23%; 95%CI, 15.8%-29.6%) in the sphincterotomy group experienced successful treatment (adjusted risk difference, −15.6%; 95% CI, −28.0% to −3.3%; P = .01). Of the patients with pancreatic sphincter hypertension, 14 (30%; 95% CI, 16.7%-42.9%) who underwent dual sphincterotomy and 10 (20%; 95% CI, 8.7%-30.5%) who underwent biliary sphincterotomy alone experienced successful treatment. Thirty-seven treated patients (26%; 95% CI,19%-34%) and 25 patients

  7. STUDY OF PREEMPTIVE ANA L GESIC EFFECTS OF INTRAVENOUS PARACETAMOL IN REDUCING DOSES OF MORPHINE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Aftab Ahmad

    2015-05-01

    Full Text Available Paracetamol is primarily thought to be a cyclo - oxygenase inhibitor acting through central nervous system. Indirect effects of paracetamol are through serotonergic system as a non - opioid analgesic. We studied intravenous paracetamol 1 gram preoperatively to assess its intraoperative and post - operative analgesic e ffects, in reducing intraoperative morphine requirements, to reduce the requirement of postoperative analgesia, enable early recovery from anaesthesia and to reduce postoperative nausea and vomiting. One hundred patients from either sex classified in ASA C lass I and II scheduled for laparoscopic cholecystectomy were randomly allocated into two groups of 50 patients each. Group I ( S tudy group received paracetamol 1 gram infusion prior to induction with 50μg/kg morphine diluted with normal saline to a total volume of 5ml. Group II ( C ontrol group received l00μg/kg morphine diluted with normal saline to a total volume of 10ml at induction. We observed that there was significant increase in mean time for rescue analgesia from induction of anaesthesia in Group I (study group w as 11.25±1.827 hours and Group II ( C ontrol group w as 6.98±4.568 hours (p value < 0.001. The median value of visual analogue score was lower at all - time points in group I when compared to group II at each interval and it was statistically significant (p value < 0.001. A significant decrease in mean number of administered doses of rescue analgesia during 24 hours was seen in the study group (0.52±0.505 as compared to the control group (1.3±0.463 with a p value of < 0.001. Mean modified A ldrete score in the study group was 9.78±0.465 and in control group it was 8.1±1.15. It was statistically significant p value of <0.001. The mean number episodes of nausea and vomiting in group I were 0.74±0.633 and in group II 0.94±0.652 and was statistic ally in significant with p value of 0. 3 61 . CONCLUSION: Administration of intravenous paracetamol and 50

  8. Effect of thoracic epidural etidocaine 1.5% on somatosensory evoked potentials, cortisol and glucose during cholecystectomy

    DEFF Research Database (Denmark)

    Dahl, J B; Rosenberg, J; Kehlet, H

    1992-01-01

    The effect of thoracic (T7-8) epidural etidocaine 1.5%, 9 ml, and continuous per- and postoperative epidural infusion of etidocaine 1.5%, 4 ml/h, on early (less than 500 ms) somatosensory evoked potentials (SEPs), and cortisol and glucose in plasma during cholecystectomy, was examined in ten...... stimulation at the L1, T10 or T6 dermatomal level (P greater than 0.09). SEPs were abolished in only two patients at T6, and no patient had SEPs abolished at T10 or L1. The plasma concentrations of cortisol and glucose were significantly increased 20 min after surgical incision and remained increased...... throughout the study. No correlation was found between the block-induced decrease in the peak-to-peak amplitude at T6 or T10 and increase in plasma cortisol, except for a negative correlation at T10 and the initial increase in cortisol (Rs = 0.72, P = 0.03). In conclusion, thoracic epidural administration...

  9. Role of ERCP in the era of laparoscopic cholecystectomy for the evaluation of choledocholithiasis in sickle cell anemia

    Institute of Scientific and Technical Information of China (English)

    Hussain Issa; Ahmed H Al-Salem

    2011-01-01

    AIM: To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis in patients with sickle cell anemia (SCA) in the era of laparoscopic cholecystectomy (LC).METHODS: Two hundred and twenty four patients (144 male, 80 female; mean age, 22.4 years; range, 5-70 years) with SCA underwent ERCP as part of their evaluation for cholestatic jaundice (CJ).The indications for ERCP were: CJ only in 97, CJ and dilated bile ducts on ultrasound in 103, and CJ and common bile duct (CBD) stones on ultrasound in 42.RESULTS: In total, CBD stones were found in 88 (39.3%) patients and there was evidence of recent stone passage in 16.Fifteen were post-LC patients.These had endoscopic sphincterotomy and stone extraction.The remaining 73 had endoscopic sphincterotomy and stone extraction followed by LC without an intraoperative cholangiogram.CONCLUSION: In patients with SCA and cholelithiasis, ERCP is valuable whether preoperative or postoperative, and in none was there a need to perform intraoperative cholangiography.Sequential endoscopic sphincterotomy and stone extraction followed by LC is beneficial in these patients.Endoscopic sphincterotomy may also prove to be useful in these patients as it may prevent the future development of biliary sludge and bile duct stones.

  10. Analgesic effect of parecoxib and flurbiprofen axetil for patients undergoing laparoscopic cholecystectomy and their influences on platelet aggregation

    Institute of Scientific and Technical Information of China (English)

    JI Fu-hai; JIN Xin; YANG Jian-ping; ZAN Li-li

    2010-01-01

    It is known that opioids produce postoperative analgesia,while it can also cause, especially in large doses, side effects like nausea, vomiting, constipation, syncope, skin itching, urinary retention and even respiratory inhibition.These factors have all greatly limited its clinical use for treating postoperative pain. Meanwhile, non-steroidal anti-inflammatory drags (NSAIDs) play an increasingly important role in postoperative analgesia. Some studies suggest that NSAIDS may be neural protective in cerebral ischemic conditions.1 Flurbiprofen axetil, which utilizes a lipid microsphere drag delivery system, may promote accumulation of flurbiprofen granular at inflammatory lesion sites and absorption by inflammatory cells,2 both factors which help to effectively target therapy. Parecoxib is the first selective cyclooxygenase-2 (COX-2) inhibitor available for intravenous injection, which is beneficial to patients susceptible to NSAIDs3 and those prone to gastrointestinal disturbances like perforation, ulcers, and bleeding.4 This investigation assesses the analgesic effect of parecoxib and flurbiprofen axetil for patients undergoing laparoscopic cholecystectomy and their influence on platelet aggregation in order to offer some guidance for clinic practice.

  11. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency.

    Science.gov (United States)

    Mehta, Nandita; Gupta, Sunana; Sharma, Atul; Dar, Mohd Reidwan

    2015-01-01

    Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency.

  12. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

    Directory of Open Access Journals (Sweden)

    Mehta N

    2015-12-01

    Full Text Available Nandita Mehta, Sunana Gupta, Atul Sharma, Mohd Reidwan Dar Department of Anesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India Abstract: Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency. Keywords: geriatric anesthesia, bupivacaine, segmental anesthesia, laparoscopic surgery

  13. Universal safe procedure of laparoscopic cholecystectomy standardized by exposing the inner layer of the subserosal layer (with video).

    Science.gov (United States)

    Honda, Goro; Hasegawa, Hiroshi; Umezawa, Akiko

    2016-09-01

    An incorrect approach to the critical view of safety can cause bile duct and/or vascular injury. However, only superficial anatomical features have been proposed as surgical landmarks to initiate laparoscopic cholecystectomy (LC) safely in previous reports. Accordingly, we have proposed a novel surgical anatomical definition of the gallbladder wall, in which the subserosal (SS) layer is divided into the inner layer of the SS (SS-Inner) layer consisting of vasculature and fibrous tissue, and the outer layer of the SS (SS-Outer) layer consisting of abundant fat tissue. By dissecting the gallbladder along the SS-Inner layer after exposure at a safe region, bile duct and/or vascular injury can be avoided, even in cholecystitis cases. Furthermore, recognition of this surgical anatomy reveals several aspects. In cholecystitis cases associated with severe fibrotic change, completion of LC by dissecting along the SS-Inner layer is impossible, resulting in abandonment of regular LC. An abscess in the liver bed associated with acute cholecystitis usually forms in the SS-Outer layer, thus, the gallbladder can be dissected easily. In the dome-down technique, the right hepatic duct is endangered by whole-layer dissection, in which the SS-Outer layer is also removed. The proposed procedure should become the universal standard for LC.

  14. Comparison of the Prophylactic Antiemetic Efficacy of Aprepitant Plus Palonosetron Versus Aprepitant Plus Ramosetron in Patients at High Risk for Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy: A Prospective Randomized-controlled Trial.

    Science.gov (United States)

    Choi, Eun Kyung; Kim, Dong Gyeong; Jeon, Younghoon

    2016-10-01

    We compared the antiemetic efficacy of aprepitant plus palonosetron versus aprepitant plus ramosetron in patients after laparoscopic cholecystectomy. A total of 88, nonsmoking, female patients undergoing laparoscopic cholecystectomy were randomly allocated to 2 groups of 44 each who received palonosetron 0.075 mg (aprepitant plus palonosetron group) and ramosetron 0.3 mg (aprepitant plus ramosetron group) after induction of anesthesia. All patients received aprepitant 80 mg 2 hours before surgery. The incidence of postoperative nausea and vomiting (PONV), use of rescue antiemetic, pain severity, and any side effects were assessed for 24 hours after surgery. The incidence of PONV and use of rescue antiemetic were less in aprepitant plus palonosetron group than in aprepitant plus ramosetron group for 24 hours after surgery (Pplus palonosetron significantly prevents PONV, compared with aprepitant plus ramosetron in patients at high risk for PONV after laparoscopic cholecystectomy.

  15. Clinical countermeasures of acute gangrenous cholecystitis by laparoscopic cholecystectomy%腹腔镜下急性坏疽性胆囊炎处理对策

    Institute of Scientific and Technical Information of China (English)

    李旭; 郭鑫; 郭志民

    2015-01-01

    Objective:To analyze the risk factors of the acute gangrenous cholecystitis and discuss the surgical techniques used in laparoscopic treatment of acute gangrenous cholecystitis.Methods:The clinical data of 158 patients with acute gangrenous cholecysti-tis treated with laparoscopic cholecystectomy in People’s Hospital of Yilong County from February 2006 to February 2014 were re-viewed.Results:Among the cases,31 cases had complete resection by conventional cholecystectomy;102 cases had retrograde chole-cystectomy;34 cases had subtotal cholecystectomy and 13 cases converted to open surgey actively.The average operation time was (120.4 ±61 .5)minutes.The average amount of bleeding was (100.5 ±40.9)mL during the operation,and duration of postopera-tive hospital stay was (7.3 ±3.4)days.There was no bile duct damage,gastric duodenal injury,colon injury,postoperative intra-ab-dominal hemorrhage,secondary common bile duct stones and death among 158 cases of patients.Conclusion:To master the risk factors of acute gangrenous cholecystitis,do surgical intervention as soon as possible and apply different methods,such as complete resection, retrograde cholecystectomy,subtotal cholecystectomy and active converting to open surgery,can reduce bile duct injury and other oper-ative complication.%目的:分析急性坏疽性胆囊炎发生的危险因素,并探讨腹腔镜胆囊切除术治疗急性坏疽性结胆囊炎的手术方法和手术技巧。方法:回顾性分析2006年2月至2014年2月我院行急性坏疽性胆囊炎胆囊切除术患者158例患者临床资料。结果:顺行胆囊完整切除31例,逆行胆囊完整切除102例,胆囊大部分切除34例,主动中转开腹13例。平均手术时间(120.4±61.5)min,术中平均出血量(100.5±40.9)mL,术后平均住院时间(7.3±3.4)d。全组158例患者无胆总管损伤、胃十二指肠损伤、结肠损伤,术后腹腔出血、继发性胆总管结石及死亡等

  16. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study

    Directory of Open Access Journals (Sweden)

    Mefkur Bakan

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: Intraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. METHODS: 80 Anesthesiologists I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF. All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6 h after surgery. The primary outcome variable was postoperative fentanyl consumption. RESULTS: Fentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75 ± 59 µg and 120 ± 94 µg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. CONCLUSION: Opioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting.

  17. Study on Clinical Nursing of Laparoscopic Cholecystectomy%腹腔镜胆囊切除术临床护理路径研究

    Institute of Scientific and Technical Information of China (English)

    刘影

    2015-01-01

    目的:研究临床护理路径在腹腔镜胆囊切除术中的作用。方法收集腹腔镜胆囊切除术的患者,分为临床路径组和对照组。临床路径组予临床路径规范护理,对照组常规护理,数据统计学分析比较住院天数、术后恢复状况、患者满意度的差异。结果与对照组比较,临床路径组患者住院天数缩短、术后恢复更快、患者满意度提高,有统计学意义。结论对于腹腔镜胆囊切除术的患者按照临床路径规范护理非常必要。%Objective Study on clinical nursing of laparoscopic cholecystectomy. Methods We selected feasible laparoscopic cholecystectomy patients to study who were divided into two groups,clinical nursing pathway group and paral el control group. According to clinical nursing pathway schedule,the clinical pathway group implemented the treatment table process. The paral el control group completed the treatment according to traditional customs. The data was statistical analyzed to compare the differences between two groups of patients hospitalized in length of hospital stay,health care quality and patient satisfaction. Results Compared with the control group,patients in the clinical pathway group hospitalization daysshorter,faster recovery after surgery,patient satisfaction increased,and results had a statistical significance. Conclusion Laparoscopic cholecystectomy for patients,accordingto clinical nursing path specification,is necessary.

  18. Colecistectomia videolaparoscópica por trocarte único (SITRACC®: uma nova opção Laparoscopic cholecystectomy by single trocar access(SITRACC®: a new option

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Dantas de Campos Martins

    2009-04-01

    Full Text Available OBJETIVO: Apresentar uma nova abordagem cirúrgica para realização de colecistectomia videolaparoscópica. MÉTODO: Em outubro de 2008 realizamos a primeira colecistectomia videocirúrgica por acesso transumbilical único, em humano, com a utilização do equipamento denominado SITRACC® - Single Trocar Access. A operação foi realizada em paciente do sexo feminino e constituiu dos passos clássicos da colecistectomia videolaparoscópica, com a utilização de instrumental flexível especial. RESULTADOS: O tempo operatório foi de 64 minutos, não sendo necessária a introdução de trocárteres adicionais. A evolução pós-operatória ocorreu de maneira satisfatória, sem nenhuma intercorrência. CONCLUSÃO: A colecistectomia por acesso umbilical único, com uso do SITRACC, mostro-se plenamente viável em humanos. Com o avançar tecnológico do instrumental, novas cirurgias poderão ser realizadas por esse método.BACKGROUND: To present a new device for the execution of Laparoscopic Cholecystectomy. METHODS: In October 2008 was performed the first human Single Trocar Acess - Sitracc Cholecystectomy, in a female patient. The operation consisted in the classical steps of a laparoscopic cholecystectomy, using special flexible instruments and a 5 mm optical device. RESULTS: The operative time was 64 minutes. There were no important complications at the post-operative phase. CONCLUSION: The cholecistectomy by the Single Trocar Access method is feasible in humans. With the improvement of the instruments and the multichannel trocar, new surgeries could be perform by this method, adding a new weapon in a continuous fight to benefit our patients.

  19. Objective ergonomic risk assessment of wrist and spine with motion analysis technique during simulated laparoscopic cholecystectomy in experienced and novice surgeons

    Science.gov (United States)

    Dabholkar, Twinkle Yogesh; Yardi, Sujata Sudhir; Oak, Sanjay Narahari; Ramchandani, Sneha

    2017-01-01

    INTRODUCTION: There is a rise in prevalence of work-related musculoskeletal disorders in surgeons performing laparoscopic surgeries due to lack of ergonomic considerations to the minimal access surgical environment. The objective of this study was to assess the physical ergonomics in experienced and novice surgeons during a simulated laparoscopic cholecystectomy. METHODOLOGY: Thirty-two surgeons participated in this study and were distributed in two groups (experienced and novices) based on the inclusion criteria. Both groups were screened for the spinal and wrist movements on the orientation sensor-based, motion analysis device while performing a simulated laparoscopic cholecystectomy. Simultaneous video recording was used to estimate the other joint positions. The RULA (Rapid Upper Limb Assessment) ergonomic risk scores were estimated with the acquired data. RESULTS: We found that surgeons in both novice and experienced groups scored a high on the RULA. Limited awareness of the influence of monitor position on the postural risk caused surgeons to adopt non-neutral range cervical postures. The thoracolumbar spine is subjected to static postural demand. Awkward wrist postures were adopted during the surgery by both groups. There was no statistically significant difference in the RULA scores between the novice and experienced, but some differences in maximum joint excursions between them as detected on the motion analysis system. CONCLUSION: Both experienced and novice surgeons adopted poor spinal and wrist ergonomics during simulated cholecystectomy. We concluded that the physical ergonomic risk is medium as estimated by the RULA scoring method, during this minimally invasive surgical procedure, demanding implementation of change in the ergonomic practices. PMID:28281476

  20. COMPARATIVE EVALUATION OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS V/S NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS FOR POSTOPERATIVE PAIN MANAGEMENT IN OPEN CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Hans Raj

    2016-06-01

    Full Text Available Pain is not only an unpleasant sensation but also increases morbidity of any operation like atelectasis, ileus, requirement of intensive care and increase in hospital stay. By neuro-modulation based on the gate control theory, we can achieve the similar results as with pharmaceutics without their side effects. Aim of this study was to compare the Non-Steroidal Anti-Inflammatory Drug (NSAID with Transcutaneous Nerve Stimulation (TENS in terms of postoperative pain and duration of pain relief by using a visual analogue scale. MATERIAL AND METHODS Our study included open cholecystectomy patients, 25 patients in each group (Groups I with NSAID, group II with TENS use. The lower limit of age was 20 years. All patients who underwent open cholecystectomy and above 20 years of age without any comorbidities were included in the study. Data was analysed by using SPSS software version 16. RESULTS In TENS therapy group, patient’s acceptance was 84%. Patients in group I had a higher VAS score and less duration of pain relief than group II at 24 and 48 hours (VAS = 4 v/s 2, duration of pain relief = 8.0 and 8.8 hours v/s 10.8 and 11.2 hours. Average numbers of application for the group I was higher than group II (3 v/s 2.1. Both showed no complications of pain equal physiologic parameters like pulse and blood pressure, so both modalities were effective in controlling pain. CONCLUSION TENS can be used without analgesic for the postoperative pain of cholecystectomy with good patient acceptance and effectiveness.

  1. Outpatient laparoscopic cholecystectomy: A new gold standard for cholecystectomy? Colecistectomía laparoscópica ambulatoria: ¿El nuevo "gold standard" de la colecistectomía?

    Directory of Open Access Journals (Sweden)

    J. Bueno Lledó

    2006-01-01

    Full Text Available Objective: to contribute our experience for five years in the implemetation of outpatient laparoscopic cholecystectomy (LC. Patients: between January 1999 and March 2004 we performed 504 outpatient LCs. We applied both exclusion and inclusion criteria, an anesthetic and surgical protocol, and discharge-specific criteria. Postoperative management in "fast track" regime. Postoperative period controlled by protocol, including phone calls after cholecystectomy. Results: the ambulatory percentage in the global series was 88.8%, and mean hospital stay was 6.1 hours. Fifty-one patients required overnight stays (10.1%, most of them for "social" causes. Five patients required admission (between 24 and 48 hours for different causes (conversion to laparotomy, intraoperative neumothorax, and postoperative medical complications. Six patients (1.1% were readmitted, and we observed 11.6% postoperative complications in the global series, with abdominal parietal pain being most frequent. Phone localization by 22.00 p.m. in the same day of surgery was 100% complete for outpatient cases. Postoperative surveillance within the first month after surgery was completed in 93.9%, and within th first year in 86.7% of patients. Conclusions: outpatient LC is safe and feasible, and probably represents a new "gold standard" in the treatment of symptomatic cholelithiasis.Objetivo: aportar nuestra experiencia durante cinco años en la implantación de la colecistectomía laparoscópica (CL en un programa de cirugía mayor ambulatoria (CMA. Pacientes: entre enero de 1999 y marzo de 2004, se realizaron 504 CL consecutivas en régimen ambulatorio. Se aplicaron criterios de exclusión e inclusión, un procedimiento anestésico-quirurgico protocolizado, y criterios específicos al alta hospitalaria. El manejo postoperatorio se realizó en régimen de "fast track" o de recuperación rápida. Seguimiento postoperatorio estricto mediante protocolo de revisiones, incluido localizaci

  2. Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?

    Institute of Scientific and Technical Information of China (English)

    Hongyi Cui

    2011-01-01

    Single incision laparoscopic surgery (SILS) is a novel minimally invasive surgical technique that is gaining popularity around the world.One of the most commonly performed procedures is single incision laparoscopic cholecystectomy (SILC).Most reported techniques utilize special purpose-made access port and articulating instruments,rendering the procedure costly and difficult to learn.This article provides a stepwise description of SILC technique using all straight instruments without the need for a special port.It aims to shorten the learning curve for surgeons wishing to adopt a safe and cost-effective SILC technique to their practice.

  3. 3D 腹腔镜胆囊切除术36例报告%Application of 3D Laparoscopic Cholecystectomy:a Report of 36 Cases

    Institute of Scientific and Technical Information of China (English)

    徐安书; 傅朝春; 孙勇; 杨晓宾; 张世博; 许永平; 李洁

    2015-01-01

    Objective To investigate the clinical value of 3D laparoscopic cholecystectomy. Methods From June to October 2014, 36 cases of gallbladder disease, including 31 cases of gallbladder stones and 5 cases of gallbladder polyps, were treated by 3D laparoscopic cholecystectomy.The operation was performed by using the three ports technique, which was similar to conventional laparoscopic cholecystectomy. Results The operative time was 12-91 min ( average, 27.5 ±16.6 min) , and the blood loss was 5-120 ml (average, 45.0 ±26.9 ml).Two patients were given abdominal drainage, and the remaining patients required no drainage. No bile leakage, bleeding and other complications occurred.Postoperative follow-ups for 1-5 months ( average, 2 months) in 36 cases showed no discomfort. Conclusion 3D laparoscopic cholecystectomy is feasible and safe.As compared with 2D surgery, it is easier to operate and has more intuitive surgical vision.%目的:探讨3D腹腔镜胆囊切除术的临床应用价值。方法2014年6~10月我院对31例胆囊结石和5例胆囊息肉样病变施行3D腹腔镜胆囊切除术( laparoscopic cholecystectomy,LC),采用上腹部三孔法切除胆囊,建立腹腔镜操作通道,并维持气腹完成胆囊切除(手术方法同一般胆囊切除术)。结果手术时间12~91 min,(27.5±16.6) min;术中出血5~120 ml,(45.0±26.9) ml。2例由于炎症重放置引流管,其余未放引流管,无胆漏、出血等并发症。36例术后随访1~5个月,平均2个月,患者无不适。结论3D腹腔镜胆囊切除术是安全可行的,较2D腹腔镜易操作,更直观。

  4. STUDY OF THE ROLE OF ORAL CLONIDINE PREMEDICATION ON HAEMODYNAMIC CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANAESTHESIA WITH ENDOTRACHEAL INTUBATION

    Directory of Open Access Journals (Sweden)

    Subhrajyoti Chattopadhyay

    2016-07-01

    Full Text Available BACKGROUND Laparoscopic cholecystectomy (LC is known to produce Exaggerated Haemodynamic Responses (HDR owing to pneumoperitoneum. Different pharmacological agents like opioids, benzodiazepines, lignocaine, beta blockers, nitroglycerine, etc. are being used to alleviate HDR. Clonidine at doses varying from 2 to 6 mcg per kg body weight or a fixed dose of 150 or 200 mcg have been tested either through intravenous or oral routes with varying results thus creating confusion. Hence, we have designed to observe the effect of oral premedication with 200 mcg clonidine in attenuating HDR in patients undergoing LC under GA. METHODS Sixty adults aged between 18 and 60 years of either sex of American Society of Anaesthesiologists (ASA physical status I or II, undergoing LC under GA were randomly allocated to receive orally either tablet clonidine 200 mcg (Group 1, n=30 or multivitamin tablets (Group 2, n=30 about 60-90 minutes before induction of GA. Heart rate, mean arterial pressure (MAP, SpO2, and EtCO2 were recorded at different perioperative time points. The level of sedation was also noted using Ramsay Sedation Scale. Postoperatively, the incidence of shivering was recorded. RESULTS The surge in heart rate and MAP after intubation, 15 and 30 min after pneumoperitoneum, after release of CO2, and after extubation were found lower in the study group (p=0.0001. Patients receiving oral clonidine premedication showed a deeper level of sedation before induction (p=0.001 and in the postoperative period (p <0.001, better control of postoperative shivering (p=0.038, nausea (p=0.038 and vomiting (p=0.036. CONCLUSION Oral premedication with 200 mcg clonidine is effective in achieving better perioperative haemodynamic stability, deeper level of sedation, and reduced incidences of postoperative shivering, nausea, and vomiting compared with placebo. With such dose, clonidine does not produce any harmful changes in observed parameters like SpO2, EtCO2, or ECG.

  5. Nursing care of patients undergoing laparoscopic cholecystectomy%腹腔镜胆囊切除术的护理

    Institute of Scientific and Technical Information of China (English)

    周燕娥; 张宏; 曾茹英

    2010-01-01

    目的 探讨腹腔镜胆囊切除术(LC)的护理.方法 对165例腹腔镜胆囊切除术患者术前心理状况、术后并发症的观察等护理措施做回顾性分析.结果 本组患者通过系统的精心的护理措施干预,消除了患者的焦虑和抑郁的心理障碍,使其能较好的配合手术,痊愈出院.结论 依据患者的不同状况和进行腹腔镜专业知识进行系统的护理措施干预,能显著减轻患者的心理负担,为术后的护理工作提供有力的保障.%Objective To explore nursing care of patients undergoing laparoscopic cholecystectomy ( LC ). Methods The nursing intervention including observation of psychological state and postoperative complications were retrospectively analyzed in 165 patients undergoing LC. Results The general nursing intervention could relieve anxiety and depression in those patients. The procedure was successfully perfomed in all the patients and they were discharged with full recovery. Conclusions Nursing intervention based on the patients with different physical conditions and the expertise of laparoscopy can markedly lower psychologic burden in patients and provid great guarantee for postoperative nursing care.

  6. Sphincter of Oddi Dysfunction and the Formation of Adult Choledochal Cyst Following Cholecystectomy: A Retrospective Cohort Study.

    Science.gov (United States)

    Xia, Hong-Tian; Wang, Jing; Yang, Tao; Liang, Bin; Zeng, Jian-Ping; Dong, Jia-Hong

    2015-11-01

    To determine the causes underlying the formation of adult choledochal cyst.Anomalous pancreaticobiliary junction is the most widely accepted theory regarding the etiology of choledochal cyst. However, choledochal cysts have been found in patients in the absence of this anomaly. Because the number of adult patients with choledochal cyst is increasing, it is important to address this controversy.Bile amylase levels in the cysts of 27 patients (8 males and 19 females) who had undergone cholecystectomy were retrospectively evaluated.The average age of the 27 patients was 45.8 ± 10.1 years and the majority (85.2%) were diagnosed with Todani type I cysts. None of the patients had dilatation of the common bile duct prior to surgery. There were 6 (22.2%) patients with anomalous pancreaticobiliary junction. However, amylase levels did not significantly differ between patients with and without this anomaly (P = 0.251). According to bile amylase levels, pancreatobiliary reflux was present in 21 (77.8%) patients. The mean amylase level significantly differed in patients with pancreatobiliary reflux (23,462 ± 11,510 IU/L) and those without (235 ± 103 IU/L) (P < 0.001). In patients with pancreatobiliary reflux, only 4 patients had anomalous pancreaticobiliary junction. That is, the majority of patients (17/21, 81%) having pancreatobiliary reflux did not have an anomalous junction of the pancreatic and biliary ducts.Since the only explanation for pancreatobiliary reflux in patients with a normal pancreaticobiliary junction is sphincter of Oddi dysfunction, we proposed that the formation of adult choledochal cyst is mainly due to sphincter of Oddi dysfunction.

  7. 三孔法腹腔镜胆囊切除术与传统开腹胆囊切除术的临床疗效比较%Comparison of the clinical efficacy between laparoscopic cholecystectomy with three holes and traditional open cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    梁金龙; 冯金发; 杨勇; 马春雷; 李欣

    2011-01-01

    Objective: To observe and compare the efficacy and safety of surgery between laparoscopic cholecystectomy with three holes and conventional open cholecystectomy, and for providing further guidance basis.Methods: 76 cases with cholecystectomy patients from January 2008 to January 2010 in our hospital were divided into A group Oaparoscopic cholecystectomy with three holes) and B group (traditional open cholecystectomy), each 38 cases according to the different surgical methods, and ovserved and compared the average incision length, the average operation time, mean blood loss, average length of stay and complications (wound infection wound bleeding, bile leakage, radiating pain bile duct injury).Results:38 patients applied laparoscopic cholecystectomy with three holes were discharged after 2-6 d, no death.And the averagelength of incision, the average operation time, mean blood loss.average stay of A group were significantly shorter than those of B group (P<0.05).The complications such as wound infection, wound hleeding.bile leakage, radiating pain of A group were significartly lower than those of B group, the difference was statistically signiricant (P<0.05).Conclusion: Laparoscopic cholecystectomy with three holes than traditional surgery group has less surgical time, less blood loss, less occurrence of incisional bleeding, infection, bile leakage and other complications, and it should be applied to primary hospital.%目的:观察三孔法腹腔镜胆囊切除术的手术疗效及安全性,并与传统开腹胆囊切除术的临床疗效作比较,旨在为临床治疗胆囊疾病提供进一步的指导依据.方法:选择我院外科2008年1月~2010年1月住院的接受胆囊切除术的76例患者,根据手术方法的不同随机分为A组(三孔法腹腔镜胆囊切除术)和B组(传统开腹胆囊切除术)各38例,观察比较两组平均切口长度、平均手术时间、术中平均出血量、平均住院时间及术后并发症(切口感染、切

  8. 三孔法腹腔镜胆囊切除术与传统开腹胆囊切除术的临床效果分析%Analysis of the clinical effect of laparoscopic cholecystectomy three hole method and conventional cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    闫雨龙

    2014-01-01

    Objective:To explore the clinical effect of laparoscopic cholecystectomy three hole method and conventional cholecystectomy.Methods:98 cases with cholecystectomy were selected from January 2013 to December 2013.They were divided into two groups according to the different operation style.43 cases of the observation group were treated with laparoscopic cholecystectomy three hole method.55 cases of the control group were treated with conventional cholecystectomy.The intranperative conditions,postoperative conditions and complications of two groups were compared.Results:The average operation incision of the observation group was 1.84±0.14cm.The average operation time was 69.53±3.62 minutes.The average amount of bleeding was 35.16±15.11ml.The average postoperative getting out of bed time was 3.25±0.16 hours.The average wound healing time was 5.28 ± 1.34 days.The pain degree was 2.08 ± 1.13.The average hospitalization time was 2.34 ± 0.14 days.The complications rate was 6.98% .Compared with the control group.The observation group was better than the control group.The difference was statistically significant.Conclusion:The laparoscopic cholecystectomy three hole method has less time,short incision, less bleeding,less pain,faster healing,fewer complications.It is superior to the conventional cholecystectomy.It is worthy of popularization and application.%目的:探讨三孔法腹腔镜胆囊切除术与传统开腹胆囊切除术的临床疗效。方法:2013年1月-12月收治胆囊切除患者98例,按照术式的不同分为两组,观察组43例采用三孔法腹腔镜胆囊切除术,对照组55例采用传统开腹胆囊切除术,比较两组术中、术后情况和并发症情况。结果:观察组手术切口平均1.84±0.14cm,手术时间平均69.53±3.62分钟,术中出血量平均35.16±15.11ml,术后离床时间平均3.25±0.16小时,切口愈合时间平均5.28±1.34天,疼痛程度2.08±1.13分,住院时间平均2.34±0.14

  9. A comparison of the effects of droperidol and the combination of droperidol and ondansetron on postoperative nausea and vomiting for patients undergoing laparoscopic cholecystectomy.

    LENUS (Irish Health Repository)

    Awad, Imad T

    2012-02-03

    STUDY OBJECTIVES: To compare the prophylactic antiemetic efficacy of the combination of ondansetron and droperidol with that of droperidol alone in patients undergoing elective laparoscopic cholecystectomy. DESIGN: Randomized, double-blind controlled trial. University affiliated teaching hospital after induction of standardized general anesthesia. PATIENTS: 64 ASA physical status I or II patients aged 18 to 80 years, undergoing elective laparoscopic cholecystectomy. INTERVENTION: Following induction of general anesthesia, patients received either droperidol 1.25 mg intravenously (IV; n = 30; Group D) or the combination of droperidol 1.25 mg IV and ondansetron 4 mg IV (n = 34; Group D+O). MEASUREMENTS: Number and severity of nausea episodes, number of emetic episodes, total analgesic consumption, and rescue antiemetic administration were assessed at 1, 3, and 24 hours after admission to the recovery room. Data were analyzed using Fisher\\'s Exact test and unpaired Student\\'s t-test; a p-value <0.05 was considered significant. RESULTS: The proportions of patients who experienced nausea (70% and 53% for D and D+O groups, respectively) and vomiting (30% and 19% for D and D+O groups, respectively) were similar in the two groups. The frequency of moderate and severe nausea (requiring administration of antiemetic) was less in group D + O (7%) compared with group D (19%; p < 0.05). CONCLUSIONS: Patients who received the combination of droperidol and ondansetron experienced less severe nausea compared with patients who received droperidol alone.

  10. 超声刀在腹腔镜胆囊切除术中的应用%Application of ultrasonic harmonic scalpel in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    孙雪峰; 王军

    2009-01-01

    Objective To summarized the experiences and superiority of ultrasonic harmonic scalpel in laparoscopic cholecystectomy(LC).Methods The method was same as conventional LC. Ductus cysticus was cut off after it was closed. And then arteria cysticus and bed cysticus were separated, stripped,coagulated and cut off by ultrasonic harmonic scalpel.Results Two hundred and ninety eight patients have been cured, 2 patients were converted to open surgery.Conclusion The application of ultrasonic harmonic scalpel in laparoscopic cholecystectomy has the followingadvantages such as good-to-excellent effects on stopping bleeding, accurate cut, safe to the patients, short operation time.%目的 总结超声刀在腹腔镜胆囊切除术(LC)中的应用方法、技巧及注意事项.方法 基本同常规LC方法,夹闭胆囊管后将其切断,胆囊动脉及胆囊床组织用超声刀分离、剥离、凝固、切割止血.结果 本组298例均痊愈出院,其中中转开腹2例.结论 在LC手术中超声刀的应用具有以下优越性:①止血效果好;②切割精确;③安全性高;④手术时间短.

  11. Comparative evaluation of the effects of propofol and sevoflurane on cognitive function and memory in patients undergoing laparoscopic cholecystectomy: A randomised prospective study

    Directory of Open Access Journals (Sweden)

    Upasana Goswami

    2015-01-01

    Full Text Available Background and Aims: General anaesthesia (GA may cause post-operative impairment of cognition and memory. This is of importance where time to discharge after anaesthesia is short as after laparoscopic cholecystectomy. This study was conducted to compare the effects of propofol and sevoflurane on cognitive function in the post-operative period. Methods: After approval of the Ethical Committee, 80 female patients posted for laparoscopic cholecystectomy to be performed under GA were randomly divided into two groups. Propofol was used in Group P and sevoflurane in Group S. Data analysis was done with California verbal learning test (CVLT, digit span test (DST, Rivermead behavioural memory test (RBMT, mini mental state examination (MMSE score, and semantic memory tests. Aldrete recovery scoring system and visual analogue scale for pain were assessed post-operatively. The level of statistical significance was set at P < 0.05. Results: There was no significant difference in demographic and haemodynamic data. Cognition and explicit memory were affected more in the propofol group in the immediate post-operative period. With majority of tests, such as semantic memory test, MMSE score, DST and RBMT, the difference was insignificant at 2 and 4 h post-operatively. But CVLT values were found to be statistically significant between groups even at 4 h. Conclusion: Propofol was associated with significant impact on cognitive functions in comparison to sevoflurane in the immediate post-operative period. Sevoflurane anaesthesia might be a better option in day care surgeries.

  12. 小切口胆囊切除术在基层医院的可行性研究%Feasibility research of small incision cholecystectomy in the primary hospital

    Institute of Scientific and Technical Information of China (English)

    刘叔云; 梅飞; 刘朝阳

    2014-01-01

    目的:探讨基层医院开展小切口胆囊切除术的可行性研究。方法:2008年1月-2012年1月收治小切口胆囊切除术患者43例与常规胆囊切除术患者38例,对两组进行比较。结果:小切口胆囊切除成功41例(95.35%),术中延长手术切口2例(4.65%);小切口组切口一期愈合42例(97.67%),平均住院(5.5±0.6)d,常规胆囊切除组切口一期愈合32例(84.21%),平均住院(10.2±0.4)d。结论:小切口胆囊切除术切口一期愈合率、平均住院天数等均显著优于常规胆囊切除术,值得在基层医院推广。%Objective:To explore the feasibility research of launching small incision cholecystectomy in the primary hospital. Methods:43 cases with small incision cholecystectomy and 38 cases with routine cholecystectomy were selected from January 2008 to January 2012.The patients in two groups were compared.Results:Small incision cholecystectomy was successful in 41 cases(95.35%);the operative incision was extension during operation in 2 cases(4.65%).42 cases(97.67%) of incision were primary healing in the small incision group;the average hospitalization was (5.5±0.6) days.32 cases(84.21%) of incision were primary healing in the routine cholecystectomy group;the average hospitalization was (10.2±0.4) days.Conclusion:The primary healing rate of incision and average hospitalization days of small incision cholecystectomy are significantly better than those of the routine cholecystectomy.It is worth to be popularized in primary hospital.

  13. Experience on Laparoscopic Cholecystectomy for Complicated Cholecystolithiasis: with A Report of 75 Cases%复杂性胆囊结石腹腔镜治疗体会

    Institute of Scientific and Technical Information of China (English)

    王崇高; 蔡永东; 胡昇庠; 赵新潮; 江秋生; 郑后珍; 刘福生

    2012-01-01

    目的 总结复杂性胆囊结石的腹腔镜手术治疗体会,探讨其安全性和可行性. 方法 对2009年5月~2012年5月行腹腔镜胆囊切除术的75例复杂性胆囊结石患者的临床资料进行回顾性分析.其中,急性胆囊炎48例,坏疽性胆囊炎12例,萎缩性胆囊炎5例,合并肝硬化5例,胆囊十二指肠瘘1例,Mirizzi综合征1例,合并腹部手术史3例. 结果 本组手术时间52~180 min,平均(67.5±35.5) min;术中出血量50~ 140 ml,平均(75.3±55.5)ml;术后住院时间5~30 d,平均(6.5±2.0)d.完成腹腔镜手术73例,其中腹腔镜下顺行胆囊切除术67例,顺逆结合胆囊切除4例,胆囊大部分切除2例.中转开腹2例,1例为胆总管损伤,行开腹胆囊切除加胆总管T管引流,另1例为右肝管和胆囊管并行过长解剖不清同时合并术中出血;术后并发急性脑梗塞1例.无术后大出血、胆瘘、腹腔脓肿、肠梗阻等并发症发生. 结论 充分的术前准备,术中仔细操作,及时中转开腹,以及认真细致地术后处理,腹腔镜治疗复杂性胆囊结石是安全可行的.%Objective To summarize the experience of laparoscopic cholecystectomy for complicated gallstone and to discuss its safety and feasibility. Methods The clinical data of 75 cases of complicated gallstone admitted from May 2009 to May 2012 were retrospectively analyzed. All patients were performed laparoscopic cholecystectomy. Results The average operation time was 67. 5 ± 35. 5 minutes ( ranged from 52 to 180 minutes) , the average blood loss was 75. 3 ±55. 5 ml( ranged from 50 to 140ml) , and the average postoperative hospitalization was 6.5 ±2.0 days (ranged from 5 to 30 days). A total of 73 cases accomplished the laparoscopic cholecystectomy, including anterograde gallbladder resection in 67 cases, anterograde and retrograde gallbladder resection in 4 cases and greater partial cholecystectomy in 2 cases. Another 2 cases were conversed to open surgery because of biliary duct

  14. 腹腔镜胆囊切除中转开腹的危险因素分析%Risk factors for conversion of laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    李晶

    2013-01-01

    Objective To analyze the risk factors of laparoscopic cholecystectomy converted to open management. Methods Collecting the patients undergoing cholecystectomy in our center,according to conversion to open management or not, we divided the patients in laparoscopic cholecystectomy( LC )group and laparoscopic to open cholecystectomy( LOC ) group. The single factor analysis would be performed with age, gender, diabetes, cardiovascular disease, arteriosclerosis, previous upper abdominal surgery, body mass index( BMI), gallbladder wall thickness, count of white blood cells, drinking, gallbladder enlargement and impacted stones and serum total bilirubin, then we enrolled those with statistical difference in the binary logistic regression model, and evaluated which was the independent risk factor. Results A total of 260 patients were enrolled. There were statistical differences in age, gender, diabetes, arteriosclerosis, previous upper abdominal surgery, BMI, gallbladder wall thickness, count of white blood cells and serum total bilirubin. After the logistic regression, we found that gender, BMI,gallbladder wall thickness and count of white blood cells could be treated as the independent risk factor. The operation time of LOC was higher than LC[ ( 83.48 ±7.25 )min vs( 42.77 ± 10.37 )min,t = 19. 54,P <0.01 ]. Conclusion LC is a safe and effective management for gallbladder disease but it is technically demanding. Patients with elder age,gender as man,obesity, gallbladder wall thickening and high WBC count prefer to have open cholecystectomy directly.%目的 分析影响腹腔镜胆囊切除中转开腹的相关因素,以进一步指导临床.方法 选取该院近5年行胆囊切除的患者,对其相关指标进行单因素及Logistic回归分析,从而找出相关危险因素或独立危险因素.结果 共260例患者纳入本次研究,经单因素分析显示中转组和非中转组年龄、性别、糖尿病、动脉硬化、上腹部手术史、BMI、胆囊壁厚

  15. Comparative Analysis of the Clinic Effect Between Laparoscopic Cholecys-tectomy and Open Cholecystectomy on Acute Cholecystitis%腹腔镜与传统开腹式治疗急性胆囊炎的临床效果对比分析

    Institute of Scientific and Technical Information of China (English)

    蔡建平

    2014-01-01

    目的:比较分析腹腔镜与传统开腹术治疗急性胆囊炎的临床效果。方法收集该院收治的524例急性胆囊炎患者资料作为分析对象,其中285例行腹腔镜胆囊切除术,239例行传统开腹胆囊切除术。比较两组患者的术中指标:如切口长度、术中出血量、术中引流量、手术时间;术后各项恢复指标,如肠鸣音恢复时间、疼痛视觉模拟评分、止痛药使用例数、术后下床时间和住院时间;以及并发症情况。结果腹腔镜胆囊切除术治疗急性胆囊炎的术中各项指标:切口长度、术中出血量、术中引流量、手术时间分别为(3.5±0.7) cm,(45.2±8.4) mL,(63.8±12.9) mL,(52.7±15.3) mL,均低于于传统开腹胆囊切除术的(11.2±2.7)cm,(89.1±16.6) mL,(97.6±14.2) mL,(85.1±14.6) mL;两组间差异有统计学意义(P<0.05)。同时,术后各项恢复指标,如肠鸣音恢复时间、疼痛评分、止痛药使用例数、术后下床时间和住院时间分别为(23.2±3.5) h,(2.3±0.6)分,203例,(27.1±4.2)h,(5.0±1.5)d,差异有统计学意义(P<0.05)低于于传统开腹胆囊切除术的(43.6±6.8) h,(4.7±1.4) h,236例,(48.3±7.5) h,(12.5±4.0) d。同时,腔镜胆囊切除术患者的并发症发生率(3.5%)显著低于传统开腹式(11.3%)(P<0.05)。结果腹腔镜胆囊切除术治疗急性胆囊炎的术中各项指标、术后各项恢复指标均显著优于传统开腹胆囊切除术(P<0.05)。同时,腔镜胆囊切除术患者的并发症发生率显著低于传统开腹式(P<0.05)。结论腹腔镜胆囊切除术是一种治疗急性胆囊炎的安全、有效的手术方式,值得在临床上推广。%Objective To compare and analyze the clinic effect between laparoscopic cholecystectomy and open cholecystectomy on acute cholecystitis. Methods The clinical data of 524 patients with acute

  16. The Application of Laparoscopic Cholecystectomy on Elderly Patients with Acute Cholecystitis%腹腔镜胆囊切除术在老年急性胆囊炎中的应用

    Institute of Scientific and Technical Information of China (English)

    姚时伟

    2013-01-01

    目的:研究腹腔镜胆囊切除术在老年人急性胆囊炎病人中的应用价值。方法:回顾性分析我院2009年9月~2013年2月开展的42例65岁以上老年急性胆囊炎行腹腔镜胆囊切除术的临床资料。结果:42例65岁以上老年人急性胆囊炎成功的完成了腹腔镜胆囊切除术40例,有2例中转开腹手术。结论:经过精心的术前准备与手术风险评估后,腹腔镜胆囊切除术适宜于老年人急性胆囊炎胆囊切除术,也能取得安全、有效、创伤小、恢复快的优点。%Objective:to research the applied value of laparoscopic cholecystectomy on elderly patients with acute cholecystitis .Meth-ods:To retrospectively analyse the clinical data of 42 cases of laparoscopic cholecystectomy on elderly patients over age 65 with acute cho-lecystitis from Sep.2009 to Feb.2013.Results:40 cases elderly patients over age 65 with acute cholecystitis were implemented Successful by the laparoscopic cholecystectomy , 2 cases were converted laparoscopic cholecystectomy to laparotomy .Conclusion:After careful preop-erative preparation and operation risk assessment , laparoscopic cholecystectomy was Suitable for the elderly with acute cholecystitis and was safe,effective,less injury, rapid recovery.

  17. Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during laparoscopic cholecystectomy.

    Science.gov (United States)

    Sen, Oznur; Umutoglu, Tarik; Aydın, Nurdan; Toptas, Mehmet; Tutuncu, Ayse Cigdem; Bakan, Mefkur

    2016-01-01

    Pressure-controlled ventilation (PCV) is less frequently employed in general anesthesia. With its high and decelerating inspiratory flow, PCV has faster tidal volume delivery and different gas distribution. The same tidal volume setting, delivered by PCV versus volume-controlled ventilation (VCV), will result in a lower peak airway pressure and reduced risk of barotrauma. We hypothesized that PCV instead of VCV during laparoscopic surgery could achieve lower airway pressures and reduce the systemic stress response. Forty ASA I-II patients were randomly selected to receive either the PCV (Group PC, n = 20) or VCV (Group VC, n = 20) during laparoscopic cholecystectomy. Blood sampling was made for baseline arterial blood gases (ABG), cortisol, insulin, and glucose levels. General anesthesia with sevoflurane and fentanyl was employed to all patients. After anesthesia induction and endotracheal intubation, patients in Group PC were given pressure support to form 8 mL/kg tidal volume and patients in Group VC was maintained at 8 mL/kg tidal volume calculated using predicted body weight. All patients were maintained with 5 cmH2O positive-end expiratory pressure (PEEP). Respiratory parameters were recorded before and 30 min after pneumoperitonium. Assessment of ABG and sampling for cortisol, insulin and glucose levels were repeated 30 min after pneumoperitonium and 60 min after extubation. The P-peak levels observed before (18.9 ± 3.8 versus 15 ± 2.2 cmH2O) and during (23.3 ± 3.8 versus 20.1 ± 2.9 cmH2O) pneumoperitoneum in Group VC were significantly higher. Postoperative partial arterial oxygen pressure (PaO2) values are higher (98 ± 12 versus 86 ± 11 mmHg) in Group PC. Arterial carbon dioxide pressure (PaCO2) values (41.8 ± 5.4 versus 36.7 ± 3.5 mmHg) during pneumoperitonium and post-operative mean cortisol and insulin levels were higher in Group VC. When compared to VCV mode, PCV mode may improve compliance during pneumoperitoneum

  18. Comparison between general anesthesia and spinal anesthesia in attenuation of stress response in laparoscopic cholecystectomy: A randomized prospective trial

    Directory of Open Access Journals (Sweden)

    Writuparna Das

    2015-01-01

    Full Text Available Background: Laparoscopy though minimally invasive produces significant hemodynamic surge and neuroendocrine stress response. Though general anesthesia (GA is the conventional technique, now-a-days, regional anesthesia has been accepted for laparoscopic diagnostic procedures, and its use is also being extended to laparoscopic surgeries. Objective: The aim was to compare the hemodynamic surge and neuroendocrine stress response during laparoscopic cholecystectomy (LC under GA and spinal anesthesia (SA in American Society of Anesthesiologists (ASA PS 1 patients. Materials and Methods: Thirty ASA physical status I patients, aged 18-65 years were randomly allocated into two equal groups of 15 each. Group A received GA with controlled ventilation. Patients were preoxygenated for 5 min with 100/5 oxygen, premedicated with midazolam 0.03 mg/kg intravenous (i.v, fentanyl 2 mcg/kg i.v; induction was done with thiopentone 3-5 mg/kg i.v; intubation was achieved after muscle relaxation with 0.5 mg/kg atracurium besylate i.v. Anesthesia was maintained with 1-2% sevoflurane and N2O:O2 (60:40 and intermittent i.v injection of atracurium besylate. Group B SA with 0.5% hyperbaric bupivacaine and 25 μg fentanyl along with local anesthetic instillation in the subdiaphragmatic space. Mean arterial pressure, heart rate (HR, oxygen saturation, end tidal carbon-dioxide were recorded. Venous blood was collected for cortisol assay before induction and 30 min after pneumoperitoneum. All data were collected in Microsoft excel sheet and statistically analyzed using SPSS software version 16 (SPSS Inc., Chicago, IL, USA. All numerical data were analyzed using Student′s t-test and paired t-test. Any value <0.05 was taken as significant. Results: Mean arterial pressure and mean HR and postpneumoperitoneum cortisol level were lower in group B than group A though the difference was not statistically significant in hemodynamic parameters but significant in case of cortisol

  19. Analysis of the effect contrast of laparoscopic cholecystectomy and conventional open cholecystectomy in the treatment of patients with acute cholecystitis%腹腔镜胆囊切除和传统开腹胆囊切除治疗急性胆囊炎的效果对比

    Institute of Scientific and Technical Information of China (English)

    高国强; 戴季蓬

    2015-01-01

    目的:对比分析腹腔镜胆囊切除术和传统开腹胆囊切除术治疗急性胆囊炎的临床疗效。方法:收治急性胆囊炎患者160例,随机分成两组,腹腔镜组采取腹腔镜胆囊切除术治疗,传统组采取传统开腹胆囊切除术治疗,比较两组治疗效果。结果:腹腔镜组术中出血量、术中引流量均少于传统组;手术时间、切口长度、住院时间、术后下床时间、肠鸣音恢复时间均短于传统组;疼痛评分低于传统组;并发症发生率明显低于传统组,差异有统计学意义(P<0.05)。结论:腹腔镜手术相较于传统开腹手术不仅疗效具有优势,也使患者术后恢复更快。%Objective:To analyze the contrastive effect of laparoscopic cholecystectomy and conventional open cholecystectomy in the treatment of patients with acute cholecystitis.Methods:160 patients with acute cholecystitis were selected.They were randomly divided into the two groups.Patients in the laparoscopic group treated with laparoscopic cholecystectomy.Patients in the traditional group were taken the conventional open cholecystectomy treatment.We compared the treatment effect of the two groups.Results:The intraoperative blood loss and intraoperative lead flow of the laparoscopic group were less than those of the traditional group. The operation time,incision length,hospitalization time,postoperative ambulation time,recovery time of bowel sounds were shorter than those of the traditional group.The pain score was lower than the traditional group.The complication rate was significantly lower than that of the traditional group,and the difference was statistically significant(P<0.05).Conclusion: Laparoscopic operation not only has the efficacy advantages compared to the traditional open surgery,but it also can make the patients recover faster.

  20. The effect of dexketoprofen pre-emptively administered on the consumption of tramadol and the incidence of nausea and vomiting after laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Costea D.

    2014-05-01

    Full Text Available The aim of our study has been to assess the comparative use of the two NSAIDs, dexketoprofen and ketoprofen, for postoperative analgesia after laparoscopic cholecystectomy mainly following: the quality of the analgesia, the incidence of potential adverse effects (for example, postoperative nausea and vomiting and the rescue analgesics consumption (tramadol. This prospective, randomized, double-blind study included 90 patients undergoing laparoscopic cholecystectomy under general anaesthesia. Patients were randomly assigned into 2 groups: group D (n = 45 - patients that have received dexketoprofen 50 mg in dilution with10 ml saline solution iv., 30 minutes before the induction and group K (n = 45 - patients that have received ketoprofen 100 mg in dilution with 10 ml saline solution iv., 30 minutes before the induction (preemptive analgesia. Surgical interventions were conducted under general anaesthesia, with identical protocol for the two groups of study. Post-surgery analgesic regime consisting in 4 g of paracetamol administered for example in the first 24 hours, was started immediately after surgery. Boluses of tramadol of 100 mg (until 400 mg /daily have been used as rescue analgesia. The main objectives of our study have been: post-surgery analgesia (VAS at mobilization, 0-100 mm at 0, 2, 6, 12 and 24 hours after the surgery,the consumption of tramadol, incidence of PONV and the length of hospitalization period (LOS. Secondary objectives of the study have been: the incidence of gastrointestinal symptoms and the incidence of postsurgery blood losses. In the two study groups there have not been any differences concerning demographic data, post-surgery gastro-intestinal symptoms, postsurgery loss of blood and the hospitalization period. VAS was significantly lower in group D vs. K, at 0 and 6 hours after the surgery (p <0,05. The incidence of PONV was lower in the group of patients who received preemptive analgesia with dexketoprofen (p <0

  1. Nursing Analysis on Patients With Bile Leakage After Laparoscopic Cholecystectomy%腹腔镜胆囊切除术后胆漏护理分析

    Institute of Scientific and Technical Information of China (English)

    方丽梅

    2015-01-01

    Objective Nursing method and its effect on patients with bile leakage after laparoscopic cholecystectomy are to be studied.Methods Chose 68 patients with bile leakage who were diagnosed and operated with laparoscopic cholecystectomy in hospital from December 2013 to August 2015 and separated them into one group that were given conventional nursing(35 cases) and another group that were given comprehensive nursing(35 cases)at random.Then observed and compared nursing effects between two groups.Results Patients'satisfaction rate in group that were given comprehensive nursing was much higher than group that were given conventional nursing,besides,patients'drainage-tube removal time and their hospitalization days in group that were given comprehensive nursing were much shorter than group that were given conventional nursing. There was differential between two groups and such a differential had statistic value(P<0.05). Conclusion Comprehensive care is of great efficacy for patients with bile leakage after laparoscopic cholecystectomy,and it is significant to improve patients'recovery and increase their satisfaction with treatment.%目的 分析腹腔镜胆囊切除术后胆漏的护理措施以及护理效果.方法 选取于2013年12月~2015年8月经临床确诊并且在我院接受治疗的腹腔镜胆囊切除术后胆漏患者68例,并随机分为常规护理组(33例)和综合干预组(35例),对以上两种护理措施进行对照研究.结果 综合干预组患者的护理满意度评分高于常规护理组,引流管拔除时间以及住院时间均短于常规护理组,组间差异有统计学意义(P<0.05).结论 腹腔镜胆囊切除术后胆漏患者应用综合护理的效果确切,能够促进患者痊愈以及提高护理满意度.

  2. 腹腔镜胆囊切除术243例护理分析%Nursing Analysis of 243 Laparoscopic Cholecystectomy Cases

    Institute of Scientific and Technical Information of China (English)

    王岩

    2015-01-01

    目的:探讨围手术期护理干预对腹腔镜胆囊切除术患者的临床意义。方法选择本院收治的需进行腹腔镜胆囊切除术的患者243例,随机分为对照组与观察组,对照组采用常规护理模式,观察组采用整体护理干预进行护理,对比观察两组患者的护理满意度,及手术时间、术中出血量和住院时间情况。结果观察组护理满意度显著高于对照组,差异有统计学意义(P<0.05);与对照组相比,观察组的手术时间、术中出血量、患者住院时间均具有明显优势,差异具有显著性(P<0.05)。结论完整的围术期护理干预模式可以降低腹腔镜胆囊切除术手术时间,提高患者康复速度,且减少并发症,患者满意度普遍较高。%Objective To study the clinical significance of nursing operation in peri-operation in patients with laparoscopic cholecystectomy.Methods Choose 243 patients who were treated with laparoscopic cholecystectomy in our hospital, randomly divided into control group and observation group, control group adopted the conventional care, observation group were treated with the whole nursing operation in peri-operation, observed patients satisfaction with nursing, the operation time, peri-operative bleeding and length of hospital stay.Results Compared with control group, the observation group had significantly advantage in clinical nursing satisfaction, the operation time, peri-operative bleeding and length of hospital stay. The difference was statistically significant(P<0.05).Conclusion Complete perioperative nursing intervention mode can reduce the operation time of laparoscopic cholecystectomy, improve patient recovery rate, reduce the complications, and improve patient satisfaction.

  3. Laparoscopic management of Mirrizzi syndrome during laparoscopic cholecystectomy%腹腔镜胆囊切除术时Mirrizzi综合征的处理

    Institute of Scientific and Technical Information of China (English)

    董云生; 佟强; 赵刚

    2013-01-01

    Objective: To explore the oprate treatment of Mirrizzi syndrome in laparoscopic cholecystectomy (LC). Methods: LC in patients with diagnosis of Mirrizzi syndrome was performed in 12 cases,4 cases are prospected to have Mirrizzi syndrome preoperatively and the rest were found in LC. Patients who scored Sherry type Ⅰ underwent laparoscopic cholecystectomy while type Ⅱ with gallbladder excision plus repair of bile duct or R-Y entrerobiliary anastomosis. By means of curettage and aspiration technique in separation of Calot triangle is recommended. Results: 8 cases of Sherry Ⅰ underwent cholecystectomy. In Type Ⅱ ,2 of 4 cases received bile duct repair procedure and other 2 with enterobiliary anastomosis. All cases recovered well and had no severe complications after the operations. Conclusion; Mirrizzi syndrome is often encountered during LC. Operative methods are associated with different classification. Application of curettage and aspiration technique in separating Calot triangle can enhance the identifying of the disease and educe bile duct injury.%目的:探讨腹腔镜胆囊切除术时Mirrizzi综合征的处理.方法:腹腔镜胆囊切除术诊断Mirrizzi综合征患者12例,术前明确诊断者4例,其余均在术中发现.Sherry Ⅰ型患者采用腹腔镜胆囊切除术,Ⅱ型患者采用胆囊切除胆管修补成型术和胆肠吻合术,术中全部采用刮吸解剖技术分离处理胆囊三角.结果:Sherry分型Ⅰ型8例采用胆囊切除术;Ⅱ型4例中2例采用胆囊切除胆管修补成型术,2例采用胆囊切除胆肠吻合术.全部病例手术顺利,术后恢复良好,无严重并发症.结论:Mirrizzi综合征多在腹腔镜胆囊切除术中发现,术中应根据不同类型选择不同的术式.应用刮吸解剖技术分离处理胆囊三角可提高本病的发现率并减轻胆管损伤.

  4. Analysis the Clinical Effect of Laparoscopic Cholecystectomy and Laparotomy in Treatment of Gallstone%腹腔镜胆囊切除术和开腹手术治疗胆结石的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    李志超

    2015-01-01

    Objective To investigate the clinical efficacy of laparoscopic cholecystectomy and conventional open cholecystectomy in treatment of the gallstones.Methods Selected 120 patients with gallstones from May 2014 to May 2015 were randomly divided into the control group and the observation group, each group had 60 cases. The control group was given conventional open cholecystectomy, the observation group was treated by laparoscopic cholecystectomy, and compared the clinical treatment effect of two groups.Results Compared with the control group ,the observation group of patients’ average operation time was ( 55.24±4.65 ) mins and the average bleeding volume ( 42.16±10.63 ) ml were decreased, and the incidence of postoperative complications was 13.33% lower than the control group 40.00%,P<0.05, had difference statistically signiifcance.Conclusion Compared with the conventional open cholecystectomy in the treatment of gallstones, laparoscopic cholecystectomy has more clinical advantages.%目的:探讨腹腔镜胆囊切除术和开腹手术用于治疗胆结石的临床疗效并进行比较分析。方法选取2014年5月~2015年5月于我院就诊的胆结石患者120例,将患者随机分为观察组和对照组,各60例,对照组入院之后给予开腹手术治疗,观察组采用腹腔镜胆囊切除手术进行治疗,比较两组患者的临床治疗效果。结果观察组平均手术时间(55.24±4.65)min及手术平均出血量(42.16±10.63)ml均减少,术后并发症发生率为13.33%低于对照组40.00%,P<0.05,差异具有统计学意义。结论与传统的开腹手术治疗胆结石相比,腹腔镜胆囊切除术具有缩减手术时间、减少手术出血量以及降低术后并发症发生率的临床疗效,更具有临床优势。

  5. 完全经脐单孔腹腔镜胆囊切除术的手术方法及技术改进%Operative method and technique improvement of transumbilical single-port laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    杨富财; 王霞; 朵萍; 魏永俭; 任恒宽; 李建忠; 张志; 徐兴彦

    2011-01-01

    目的:探讨完全经脐单孔腹腔镜胆囊切除术(1aparoscopic cholecystectomy,LC)的手术方法及技术改进.方法:回顾分析在钟世镇院士提出的胆囊替代定位点理论指导下,开展完全经脐LC94例的手术方法及技术改进,并复习总结国內相关文献.结果:94例患者中1例因可疑胆囊癌中转开腹,3例因腹腔粘连、肥胖等因素,未明确找到Rouviere沟无法确定胆囊替代定位点而增加戮孔行常规LC.90例顺利完成手术.术后患者均获随访,无胆漏、梗阻性黄疸等并发症发生.患者术后恢复良好,治疗及美容效果满意.结论:经脐单孔LC在技术上是安全可行的,但与传统LC相比,操作难度增加.术者遵循正确的操作原则,操作困难及时增加戳孔或中转开腹,此术式可广泛开展.%Objective: To investigate the operative method and technique improvement of transumbilical single-port laparoscopic cholecystcctomy. Methods: The clinical data of 94 patients who underwent transumbilical single-port laparoscopic cholecystectomy were retrospectively analyzed. Results: One patient was converted to open surgery because of suspicious gallbladder cancer,3 underwent classic laparoscopic cholecystectomy because of undetected Rouviere groove. 90 patients successfully underwent transumbilical single-port laparoscopic cholecystectomy according to the principle of gallbladder substitution anchor point,these patients were all followed up,no complications occurred,such as bile leakage or obstructive jaundice. All patients recovered well and were satisfied with therapeutic and cosmetic result. Conclusions: Transu mhilical single-port laparoscopic cholecystectomy is safe and feasible,but difficult when compared with traditional laparoscopic cholecystectomy. Surgeons should follow correct operative principle, increase port or convert to laparotomy when the procedure is hard to continue. The operation can be widely applied in clinic.

  6. Transumbilical single incision laparoscopic cholecystectomy in 51 cases%经脐单孔腹腔镜胆囊切除术51例分析

    Institute of Scientific and Technical Information of China (English)

    李健; 陈红兵; 李解生; 李学远

    2013-01-01

    目的 探讨经脐单孔腹腔镜胆囊切除术的可行性及安全性.方法 回顾分析51例胆囊结石及胆囊息肉病变患者经脐单孔腹腔镜胆囊切除术的临床资料,并与同期38例传统腹腔镜胆囊切除术患者的手术疗效进行比较.结果 观察组与对照组术后住院天数分别为(3.0±1.2)d、(5.7±1.6)d,VAS评分(1.2±1.0)、(2.5±1.2)分,腹壁创口满意度96.08%、22.68%,差异均有统计学意义(P<0.05或0.01),手术时间、术中出血量、并发症情况差异均无统计学意义(均P >0.05).结论 经脐单孔腹腔镜胆囊切除术治疗胆囊良性疾病安全有效,且更具微创性,美容效果更佳,有待于推广.%Objective To explore the feasibility and safety of laparoscopic cholecystectomy through a transumbilical single incision.Methods The clinical data of 51 patients with gallbladdder calculi or polyps who underwent transumbilical single incision laparoscopic cholecystectomy were retrospectively analyzed,and compared with the clinical efficiency of 38 patients with gallbladdder calculi or polyps who underwent conventional laparoscope cholecystectomy.Results In the observation group and control group,it showed significant differences (P<0.05 or 0.01) in the length of hospital stay of (3.0 ± 1.2) d vs (5.7 ± 1.6) d,and the VAS score of (1.2 ± 1.0) vs (2.5 ± 1.2),the abdominal wound satisfaction of 96.08% vs 22.68%,there was no difference in the operation time,the peri-operative bleeding and the complications situation (all P<0.05).Conclusion Transumbilical single incision laparoscopic cholecystectomy is a minimally invasive,safe and effective procedure for benign diseases of the gallbladdder with excellent cosmetic results,and deserves to generalize in clinic.

  7. 微型腹腔镜胆囊切除术临床疗效观察%Effect of mini laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    吴国庆; 王国范; 周晓娜

    2015-01-01

    Objective To compare the clinical curative effect between mini laparoscopic cholecystectomy (MLC) and conventional laparoscopic cholecystectomy (LC).Methods Using random number table method to divide the patients into conventional laparoscopic cholecystectomy group (30 cases) and mini laparoscopic cholecystectomy group (27 cases).Compared the operation time,bleeding volume,VAS score,postoperative hospital stay,complications.Results No conversion to laparotomy and serious complications,but each group has 6 cases from the three holes increase to four holes,and 4 cases of MLC group were converted to traditional LC.MLC group and LC group,average operation time (57.5 ± 17) min and (50 ± 15) min (P > 0.05);the average postoperative hospital stay was (2.5 ± 1.4) d and (3.1 ± 1.5) d (P > 0.05);postoperative pain degree of MLC group of 6 h and 12 hrespectively (4.8±2.6) and (3.5±1.1),LC group were (5.5 ±2.7) and (5.0±2.1) points (P< 0.05).Conclusion Postoperative pain of MLC is lighter than LC,in appropriate cases,is a safe and effective treatment method.%目的 通过随机对照方法比较微型腹腔镜胆囊切除术(MLC)与传统腹腔镜胆囊切除术(LC)的临床疗效.方法 将拟行LC的57例患者用随机数字表法分为传统腹腔镜胆囊切除术组(30例)和微型腹腔镜胆囊切除术组(27例).对比其手术时间、出血量、VAS评分、术后住院天数、并发症.结果 两组患者均无中转开腹及严重并发症出现,但各有6例从三孔L增加至四孔L,且MLC组中有4例转为传统LC.MLC组和LC组手术时间平均(57.5 ±17) min和(50±15) min(P>0.05);术后平均住院时间为(2.5±1.4)d和(3.1 ±1.5) d(P>0.05);术后疼痛程度MLC组6h和12 h分别为(4.8±2.6)分和(3.5±1.1)分,LC组分别为(5.5±2.7)分和(5.0±2.1)分(P<0.05).结论 MLC术后疼痛较LC更轻,对适合的病例,是一种安全有效的治疗方式.

  8. Colecistectomía videolaparóscopica: cirugía de invasión mínima Videolaparoscopic cholecystectomy: minimal invasion surgery

    Directory of Open Access Journals (Sweden)

    Nelson Ramírez B.

    1994-03-01

    Full Text Available El desarrollo de la colecistectomía videolaparoscópica constituye uno de los avances quirúrgicos más importantes de los últimos tiempos y abre nuevos horizontes en el tratamiento de las enfermedades torácicas y abdominales. Se presenta un breve recuento histórico del desarrollo de esta técnica, la forma de practicarla, sus indicaciones, complicaciones y beneficios.

     

    The development of laparoscopic cholecystectomy is one of the most important surgical advances of recent years; it opens new horizons for the treatment of thoracic and abdominal diseases. The technique and a historical account of its development are briefly described; its indications, complications and benefits are summarized.

     

  9. 小切口胆囊切除术359例临床分析%The analysis of 359 cases of minilaparotomy cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    唐鸿云; 黄秀珍

    2009-01-01

    Objective To investigate the miuilaparotomy cholceystectomy (MC) value in clinical application.Methods 359 cases of minilaparotomy cholecystectomy were retrospectively analyzed,summarized the advantages and the main point of surgery and operation of the minilaparotomy cholecystectomy.Results 359 cases of minilaparotomy cholecystectomy were successfully completed,after the operation,there were 172 cases without using the painkiller,accounting for 47.9%.Within 24 hours all recovered to take food and have out-of-bed activity,non-accidental bleeding,none of the incisions had infection.241 cases of the patients discharged from the hospital within 7d after operations,accounting for 67.1%,the longest length of stay was 11d.The shortest operation time was 38 minutes,and the longest one was 135 minutes,the average time was 52 minutes,there were 349 cases have the out-of-bed with 7-24 hours after the operations,and 252 cases were without postoperative analgesia.The discharged time was within 4~20d,the average time of follow-up visit was 6 months.there was none of eomplications.Conclusions The minilaparotomy cholecystectomy was safe,little painful,with short operative time,quick recovery,short hospitalization time,small sear,and easy to grasp the main points of its operation,as long as the master of the indications for MC.Rule out the serious edema of Calot triangle,adhesion patients,majority of patients can be MC linesurgery.Operators can do skilifully.h is worth for extending.%目的 探讨小切口胆囊切除术的临床应用价值.方法 对359例病例的小切口胆囊切除术资料进行回顾性分析,总结小切口胆囊切除术的手术优点和手术操作要点.结果 359例小切口胆囊切除术均顺利完成,术后未用止痛药物的172例,占47.9%,24h内均恢复进食并下床活动,无意外出血,无1例切口感染;术后7 d内出院的241例,占67.1%,住院时间最长者11d,手术时间最短38min,最长135min,平均52min,术后349例7~24h

  10. Laparoscopic repair of Morgagni hernia and cholecystectomy in a 40-year-old male with Down's sindrome. Report of a case.

    Science.gov (United States)

    De Paolis, P; Mazza, L; Maglione, V; Fronda, G R

    2007-06-01

    Morgagni-Larrey hernia (MH) is an unusual diaphragmatic hernia of the retrosternal region. Few cases of MH, treated laparoscopically, associated with Down's syndrome (DS) have been reported in literature. On October 2004, a DS 40-year-old male was admitted to our Department with mild abdominal pain and nausea. Hematochemical tests were within the normal range. Ultrasonography showed biliary sludge and multiple gallstones. Chest X-ray revealed a right-sided paracardiac mass that appeared as MH after a thoraco-abdominal computed tomography (CT). Four trocars were placed as a routinary cholecystectomy. Abdominal exploration confirmed the presence of a voluminous hernia through a wide diaphragmatic defect (12 cm) on the left side of the falciform ligament, containing the last 20 cm ileal loops and right colon with the third lateral of transverse. After retrograde cholecystectomy and reduction of the herniated ileo-colonic tract from multiple adherences, the defect was repaired with an interrupted 2/0 silk suture and then a running 2/0 polypropylene suture. Postoperative course was complicated by pulmonary edema but subsequently the patient was discharged without further complications and has no recurrence after 2 years. In conclusion, surgery is necessary for symptomatic MH and to prevent possible severe complications. We preferred laparoscopy for the reduced morbidity compared to laparotomy, even if in our case the postoperative course was not uneventful. There are still few comparative data about the modality of closure of the defect between primary repair with nonabsorbable suture material, in case of small defects, or continuous monofilament suture or prosthesis in case of large defects.

  11. 使用普通腹腔镜器械行经脐腹腔镜胆囊切除术%Transumbilical Laparoscopic Cholecystectomy with Routine Laparoscopic Instruments

    Institute of Scientific and Technical Information of China (English)

    丁轶人; 江涌; 颜海; 赵伟; 葛玮; 谭梦志

    2015-01-01

    本文报道2010年2月~2014年4月122例单纯胆囊良性疾病使用普通腹腔镜器械行经脐腹腔镜胆囊切除术。脐周呈倒三角形置入3个trocar,使用30°腹腔镜和普通腹腔镜抓钳、电钩、钛夹完成胆囊切除术,不留置引流。手术均获成功,手术时间35~80 min,(45.0±9.3) min,术后脐部切口隐蔽、美观。全组术后随诊1~12个月,(6.3±1.2)月,无胆漏、胆道狭窄及残石、脐疝等并发症。%[Summary] Clinical data of 122 patients who underwent transumbilical laparoscopic cholecystectomy with routine laparoscopic instruments from Febrary 2010 to April 2014 were analyzed retrospectively.Three trocars were introduced periumbilically at the sites of apexes of an inverted triangle.By using a 30°laparoscope and laparoscopic forceps, electric hook, and titanium clips, the cholecystectomy was completed without indwelling drainage.All the operations were successfully performed.The mean operative time was (45.0 ±9.3) min (range, 35-80 min).Umbilical scar wasn’t obvious.The cases were followed up for 1-12 months (6.3 ± 1.2 months) , during which no biliary leakage, residual stones, biliary stenosis, or umbilical hernia occurred.

  12. 单孔腹腔镜与非单孔腹腔镜胆囊切除术安全性及有效性的荟萃分析%Meta-analysis of the Transumbilical Single-incision Laparoscopic Cholecystectomy and the Conventional Laparoscopic Cholecystectomy in Efficacy and Safety

    Institute of Scientific and Technical Information of China (English)

    顾钧; 刘颖斌; 穆嘉盛; 毕建威; 李茂岚; 吴文广; 董平; 陆建华; 丁琦晨; 张林; 杨佳华; 吴向嵩

    2012-01-01

    Objective To evaluate the safety,feasibility and advantages of transumbilical single-incision laparoscopic cholecystectomy. Methods PubMed and Wanfang database were reviewed using meta-analysis. Randomized controlled trials (RCT) describing the length of operation time,pain levels, postoperative complications and postoperative beauty score between the transumbilical single-incision laparoscopic cholecystectomy and the conventional laparoscopic cholecystectomy were collected. Cochrane review methodology was used for assessing the trial quality and efficacy. Results Only 4 clinical studies were selected and 236 eligible patients were included in the systematic review. Meta-analysis showed that there were no differences between two groups in the risk of postoperative complications (OR 1.47; 95% CI 0.73 ~ 2.97; P = 0.28). But it showed significant difference in postoperative beauty score( SMD 0.70; 95% CI 0.40 ~ 0.99; P <0.00001). Conclusions Transumbilical single-incision laparoscopic cholecystectomy is safe with better cosmetic effect comparing to the conventional laparoscopic cholecystectomy. However, it still need a large number of randomized and controlled study for e-valuation of the other advantages and disadvantages of these two operation methods.%目的 系统评价单孔腹腔镜与非单孔腹腔镜胆囊切除术安全性及有效性. 方法 计算机检索Pubmed和万方数据库中有关单孔腹腔镜与非单孔腹腔镜胆囊切除术的随机对照实验(RCT)文献,依据Cochrane评价手册评价偏倚风险,并提交手术时间、术后疼痛评分、术后并发症发生率及术后美容评分等的相关数据进行荟萃分析. 结果 纳入4篇RCT文献,共236例患者.荟萃分析结果显示相比非单孔腹腔镜胆囊切除术,单孔腹腔镜技术不会显著性影响手术并发症的发生(OR 1.47; 95%CI 0.73~2.97;P=0.28),且具有更高的术后美容评分(SMD 0.70; 95% CI 0.40 ~0.99;P<0.00 001).结论 单孔腹腔镜

  13. 经脐单孔腹腔镜胆囊切除术15例临床分析%Transumbilical single-port laparoscopic cholecystectomy: an analysis of 15 cases

    Institute of Scientific and Technical Information of China (English)

    孙琳; 史炼钢; 于镜泊; 肖在鹏

    2011-01-01

    目的 总结经脐单孔腹腔镜胆囊切除术的手术经验.方法 回顾性分析2010年5-10月实施的经脐单孔腹腔镜胆囊切除术15例患者的临床资料.结果 15例患者手术时间30~85(45±16)min,术后住院时间(2.5±1.1)d,术后无一例发生出血、胆瘘等并发症.术后腹部瘢痕隐蔽,美容效果佳.结论 经脐单孔腹腔镜胆囊切除术安全可行,术后恢复快,美容效果好,但较传统腹腔镜胆囊切除术难度增加,早期开展经脐单孔腹腔镜胆囊切除术适应证选择很关键.%Objective To summarize the operative experience of transumbilical single-port laparoscopic cholecystectomy. Method The clinical data of 15 patients underwent transumbilical singleport laparoscopic cholecystectomy between May to October in 2010 was reviewed. Results The operative time was 30-85(45±16) min,hospitalization time was (2.5 ± 1.1 ) d. No surgical complications such as bile leak or uncontrolled hemorrhage occurred postoperatively. All the incision were healed well and the surgical scar was virtually concealed whithin the umbilicus. Conclusions Transumbilical single-port laparoscopic cholecystectomy is feasible and safe when patients are well selected. Comparing with conventional laparoscopic cholecystectomy, it's more manipulatively difficult.

  14. Preoperative evaluation of the cystic duct for laparoscopic cholecystectomy: comparison of navigator-gated prospective acquisition correction- and conventional respiratory-triggered techniques at free-breathing 3D MR cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Itatani, Ryo [Kumamoto Chuo Hospital, Department of Radiology, Kumamoto (Japan); Kumamoto University, Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto (Japan); Namimoto, Tomohiro; Sakamoto, Fumi; Yamashita, Yasuyuki [Kumamoto University, Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto (Japan); Kajihara, Hiroo; Yoshimura, Akira; Katahira, Kazuhiro [Kumamoto Chuo Hospital, Department of Radiology, Kumamoto (Japan); Nasu, Jiro [Kumamoto Chuo Hospital, Department of Digestive Surgery, Kumamoto (Japan); Matsushita, Ikuo [Kumamoto Chuo Hospital, Department of Gastroenterological Medicine, Kumamoto (Japan); Kidoh, Masafumi [Amakusa Medical Center, Department of Diagnostic Radiology, Amakusa, Kumamoto (Japan)

    2013-07-15

    To evaluate the quality of magnetic resonance cholangiopancreatography (MRCP) images obtained with a three-dimensional navigator-gated (NG) technique and compare findings with conventional respiratory-triggered (RT) images in pre-laparoscopic cholecystectomy patients. Turbo-spin-echo (TSE) RT-MRCP (average 242 s) and balanced turbo-field-echo (bTFE) NG-MRCP (average 263 s) were acquired at 1.5-T MRI for 49 pre-laparoscopic cholecystectomy patients. Two radiologists independently assessed image quality, visibility of anatomical structures, common bile duct (CBD) stones, and signal-to-noise ratios (SNRs). Interobserver agreement was also evaluated. The anatomical details of the cystic duct were clearly demonstrated in 33 (67.3 %, reader A) and 35 (71.4 %, reader B) patients on RT-MRCP, and in 45 (91.8 %) and 44 (89.7 %) patients on NG-MRCP. On NG-MRCP, visualisation of the cystic duct (3.22/3.12), its origin (3.57/3.55), and the gallbladder(3.61/3.59) was statistically better than on RT-MRCP (2.90/2.78, 3.29/3.12, 2.98/2.88, respectively). The overall image quality was statistically better on NG-MRCP than RT-MRCP. Each technique identified the presence of CBD stones in all affected patients. The SNR was significantly higher on NG-MRCP (CHD 22.40, gallbladder 17.13) than RT-MRCP (CHD 17.05, gallbladder 9.30). Interobserver agreement was fair to perfect. Navigator-gated MRCP is more useful than respiratory-triggered MRCP for evaluating the gallbladder and cystic duct in patients scheduled for laparoscopic cholecystectomy. circle Magnetic resonance cholangiopancreatography (MRCP) provides important cystic duct information before laparoscopic cholecystectomy. (orig.)

  15. Clinical analysis of laparoscopic cholecystectomy with improved trocar position in 247 cases%改良戳卡位置腹腔镜胆囊切除术247例临床分析

    Institute of Scientific and Technical Information of China (English)

    范智峰

    2015-01-01

    目的:探讨改良戳卡位置腹腔镜胆囊切除术的临床效果.方法:收治胆囊疾病患者247例,采用改良戳卡位置腹腔镜胆囊切除术治疗,观察治疗效果.结果:所有患者均顺利完成手术,术后恢复迅速,无严重并发症.结论:改良戳卡位置腹腔镜胆囊切除术的临床效果显著.%Objective:To explore the clinical effect of laparoscopic cholecystectomy with improved trocar position trocar.Methods:247 patients with gallbladder disease were selected.They were treated by laparoscopic cholecystectomy with improved trocar position.We observed the effect of treatment.Results:The operation of all patients were successfully completed.The postoperative recovery was rapid.There was no serious complications.Conclusion:The clinical effect of laparoscopic cholecystectomy with improved trocar position trocar was significant.

  16. 心脏瓣膜病16例腹腔镜胆囊切除术的临床分析%Clinical analysis of laparoscopic cholecystectomy for valvular heart disease in 16 cases

    Institute of Scientific and Technical Information of China (English)

    朱勇; 蔡茂庆; 秦湧; 张林

    2011-01-01

    目的 探讨心脏瓣膜病变及心脏瓣膜置换术后患者行腹腔镜胆囊切除术(LC)围手术处理.方法 回顾分析16例心脏瓣膜病变及心脏瓣膜置换术后患者行LC的临床资料.结果 所有患者都顺利完成LC.结论 心脏瓣膜病变及心脏瓣膜置换术后患者经正确的围手术期处理,可安全完成LC.%Objective To explore the perioroperative handling of laparoscopic cholecystectomy in the patients with valvular heart disease or after cardiac valvular replacemental surgery. Methods The clinical data of laparoscopic cholecystectomy in 16 patients with valvular heart disease or after cardiac valvular replacemental surgery were retrospectively analyzed. Results The operation was successful in all 16 cases. Conclusion The correct perioroperative treatment is the key of success for laparoscopic cholecystectomy in the patients with valvular heart disease or after cardiac valvular replacemental surgery.

  17. 改良腹壁吊线经脐单孔腹腔镜胆囊切除术%Transumbilical single-port laparoscopic cholecystectomy by improved abdomen wall traction stitch

    Institute of Scientific and Technical Information of China (English)

    戴小明; 黄秋林; 贺更生; 罗加兴; 韩东

    2012-01-01

    [Objective] To summarize the experience of transumbilical single-port laparoscopic cholecystectomy by improved abdomen wall traction stitch, and explore its feasibility. [Methods] 20 patients were retrospectively analyzed, 14 of which with chronic calculous cholecystitis, and 6 cases of gallbladder polypoid lesions treated by transumbilical single-port laparoscopic cholecystectomy with conventional instruments and improved abdomen wall traction stitch, postoperative follow-up in 6 months. [Results] 19 cases of laparoscopic cholecystectomy were performed successfully by transumbilical single-port. Operative time was 32 to 90 min, an average of 55 min, bleeding volume in operation was 2 to 10 mL, an average of 5 mL. The other case was converted to laparoscopic cholecystectomy with 2 ports by adding one trocar through subxyphoid approach because of local tissue density adhesions and difficult anatomy in gallbladder triangular. No one cases had complications in the short-term after operation. [Conclusions ] Transumbilical single-port laparoscopic cholecystectomy with conventional instruments by improved means of abdomen wall traction stitch is feasible, with excellent cosmetic outcomes, but indications should be strictly controlled.%目的 总结改良腹壁吊线经脐单孔腹腔镜胆囊切除术经验,探讨其可行性.方法 回顾分析该院2009年7月~2010年12月20例改良腹壁吊线常规器械经脐单孔腹腔镜胆囊切除术患者临床资料,其中慢性结石性胆囊炎14例,胆囊息肉6例,术后随访6个月.结果 除1例因局部致密粘连,胆囊三角解剖困难,于剑突下增加1个操作通道改为吊线二孔法外,其余19例均获成功.手术时间42~90 min,平均55 min;术中出血2~8mL,平均5mL;术后无近期并发症,腹壁几乎见不到疤痕.结论 改良腹壁吊线经脐单孔腹腔镜胆囊切除术是可行的,并有较好的美容效果,但需严格掌握适应证.

  18. 腹腔镜胆囊切除术中Rouviere沟解剖定位及其应用价值研究%Role of Rouviere's sulcus as anatomic landmark in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    蔡华杰; 叶百亮; 韩宇; 暨玲; 屠金夫; 郑晓风; 蒋飞照

    2012-01-01

    Objective To explore the role of Rouviere's sulcus as extrabiliary reference point in laparoscopic cholecystectomy. Methods The clinical data of 584 patients performed laparoscopic cholecystectomy from March 2010 to April 2011 in the Department of Endoscopic Surgery, the First Affiliated Hospital of Wenzhou Medical College were analyzed. Frequency and type of Rouviere's sulcus were documented and Rouviere's sulcus was used to guide the commencement of dissection in hepatobiliary triangle in laparoscopic cholecystectomy. Results A total of 584 patients who underwent laparoscopic cholecystectomy were included in the study. Open type of Rouviere's sulcus was visualized in 346 patients and fused type of Rouviere's sulcus was visualized in 102 patients. Hence in a total of 448 (76.7%) patients had Rouviere's sulcus. There was no bile duct injury or mortality. Three patients were converted to open operation (0.5%) and all patients recovered well. Conclusion Rouviere's sulcus is an important extrabiliary landmark and identifiable in majority of patients. Its identification before commencement of Calot' s triangle dissection may help in preventing the bile duct injury in laparoscopic cholecystectomy and should be applied widely.%目的 探讨Rouviere沟作为肝外胆管参照点在腹腔镜胆囊切除术中的作用.方法 自2010年3月至2011年4月温州医学院附属第一医院腔镜外科连续实施腹腔镜胆囊切除术584例,术中记录Rouviere沟的出现率及分型,并采用以Rouviere沟为导向的胆囊三角区解剖方法.结果 584例中,开放型Rouviere沟346例,融合型Rouviere沟102例,共448例(76.7%)存在Rouviere沟.全组未发生胆管损伤及手术死亡,3例(0.5%)中转开腹,所有病例恢复良好.结论 Rouviere沟是重要的肝外胆管解剖标志,出现于大多数人中.以Rouviere沟为导向的胆囊三角区解剖方法可以预防腹腔镜胆囊切除术中胆管损伤,值得推广应用.

  19. 经脐部三孔法腹腔镜胆囊切除术%Transumbilical Laparoscopic Cholecystectomy with Three Trocars

    Institute of Scientific and Technical Information of China (English)

    孙明生; 周启旭; 何平

    2011-01-01

    目的 探讨经脐三孔腹腔镜胆囊切除术(transumbilical laparoscopic cholecystectomy, TULC)的可行性. 方法 取脐下缘10 mm、脐右上缘3 mm及脐左上缘5 mm穿剌孔,分别置入Storz 10 mm 30°腔镜及直线型刚性器械,超声刀或电凝钩进行组织分离,应用腔镜下结扎缝合技术处理胆囊管和(或)胆囊动脉. 结果 160例行胆囊切除术,3例因胆囊炎症水肿严重、胆囊三角解剖困难行胆囊部分切除术.无中转常规腹腔镜手术或开腹手术.联合肝囊肿开窗术1例,联合胆囊十二指肠瘘修补术2例.手术时间20~250 min,平均65 min.术中无不可控制出血,术后无出血、胆漏、感染等并发症.141例随访1~15个月,平均10.6月.术后右上腹部轻微隐痛不适2例,复查B超无残余胆囊、胆囊窝积液及胆总管结石等发生;慢性腹泻1例,经饮食调节2个月后痊愈;其余病例均无明显自觉症状. 结论 经脐缘三点穿刺入路的TULC安全可行.%Objective To investigate the feasibility of transumbilical cholecystectomy with laparoscopy with three trocars.Methods Three trocars were placed at 10 mm below and 3 mm above the umbilicus, and 5 mm to the left upper edge of the umbilicus. Storz 10 mm 30° laparoscope and rigid instruments were used. Ultrasonic scalpel or electrocoagulation was employed to separate the tissues, and then the cystic duct and/or cystic artery were sutured under the laparoscope. Results Totally 160 patients received the operation; none of them were converted to conventional laparoscopy or open surgery. Partial chotecystectomy was carried out in three of the patients because of severe inflammation of the cyst. Hepatic cyst fenestration was carried out in 1 case, and cholecystocolonic fistulectomy was performed on two patients. The operation time in this series ranged from 20 to 250 minutes ( the mean time for fenestration was 65 minutes). No uncontrollable bleeding, bile leakage, or infections occurred in the

  20. 三孔法腹腔镜胆囊切除术治疗急性胆囊炎%Three Holes Method Laparoscopic Cholecystectomy for Acute Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    赵言明; 李永明

    2012-01-01

      目的:探讨三孔法腹腔镜胆囊切除术治疗急性胆囊炎的应用价值。方法:2003年2月-2012年1月笔者所在医院对150例急性胆囊炎患者尝试三孔法腹腔镜胆囊切除,观察疗效。结果:145例患者顺利完成 LC,2例患者因胆囊周围严重粘连,肝外胆管难以辨认,1例患者胆囊横结肠瘘,2例术中快速病检提示胆囊癌中转开腹。术后住院3~5 d,无结肠,十二指肠及胃损伤,无胆管损伤及腹腔出血,剑突下切口感染5例,门诊换药治愈。结论:三孔法腹腔镜胆囊切除术治疗急性胆囊炎能迅速缓解患者剧烈腹痛及呕吐,终止患者痛苦,降低了发生胆囊穿孔、胆汁性腹膜炎及腹腔脓肿的风险,缩短了住院时间,降低了单病种的治疗费用,降低了并发症的发生及科室的医疗纠纷,减轻了医护人员的劳动强度及心理压力。%  Objective :To investigate three holes method laparoscopic cholecystectomy for acute cholecystitis in application value.Methods :In our hospital from Feb 2003 to Jan 2012150 cases of acute cholecystitis patients try three holes method laparoscopic cholecystectomy.Results :145 patients successfully completed LC,2 patients with gallbladder surrounding severe adhesions,extrahepatic bile duct illegible in 1 cases,gallbladder transverse colon fistula,2 cases of rapid intraoperative pathological examination revealed gallbladder carcinoma laparotomy.The postoperative hospital stay of 3-5 days,without colonic, duodenal and gastric injury,no bile duct injury and intraperitoneal hemorrhage,subxiphoid incision infection in 5 cases,clinic medicine changing cured. Conclusion :Three holes method laparoscopic cholecystectomy for acute cholecystitis can relieve the patient of severe abdominal pain and vomiting,termination of patient pain,reduces the incidence of perforation of the gallbladder,biliary peritonitis and peritoneal abscess risks,shorten hospitalization time,reduce the single disease

  1. Effect of respiratory muscle training in patients undergoing cholecystectomy Efeito do treinamento muscular respiratório em pacientes submetidos à colecistectomia

    Directory of Open Access Journals (Sweden)

    Claudiane Pedro Rodrigues

    2010-12-01

    Full Text Available The upper abdominal surgeries such as cholecystectomy, tend to evolve postoperatively with restrictive ventilatory disorders. The aim of this study was to evaluate the evolution of inspiratory muscle strength after training the respiratory muscles through the use of linear load device with pressure in patients undergoing conventional cholecystectomy. We studied 10 female patients with indication for cholecystectomy who underwent assessment of inspiratory muscle strength by means of the Maximal Inspiratory Pressure (MIP. Of these, six were evaluated preoperatively and postoperatively (G1 - group 1 and conducted Respiratory Muscle Training (RMT using the Theshold ® (twice a day on the 1st and 2nd postoperative day using 40% MIP and four patients were observed in the post-surgery as a control group (G2 - group 2. The results indicate that despite the decrease in MIP postoperatively, there was recovery of inspiratory muscle strength on the first day of RMT, from 36.7 ± 13.7 cmH2O to 48.0 ± 13.7 cmH2O, and this increase was statistically significant (p As cirurgias abdominais altas, como as colecistectomias, tendem a evoluir no pós operatório com distúrbios ventilatórios restritivos. O objetivo deste trabalho foi avaliar a evolução da força muscular inspiratória após o treinamento da musculatura respiratória, por meio do uso de aparelho com carga linear pressórica em pacientes submetidos à colecistectomia convencional. Foram estudados 10 pacientes do sexo feminino, com indicação de colecistectomia, e elas realizaram avaliação da força muscular inspiratória através da medida da Pressão Inspiratória Máxima (PImáx. Deles, seis foram avaliados no pré e pós-operatório (G1 – grupo 1 e realizaram o Treinamento Muscular Respiratório (TMR com uso do Theshold® (2 vezes ao dia no 1º e no 2º pós-operatório utilizando 40% da PImáx, e quatro pacientes foram acompanhados no pós-operátorio como grupo controle (G2 – grupo 2

  2. 186 cases of postoperative nursing of laparoscopic cholecystectomy%腹腔镜胆囊切除术186例术后综合护理观察

    Institute of Scientific and Technical Information of China (English)

    曾翠祥

    2014-01-01

    目的:观察腹腔镜胆囊切除术后采用综合护理模式的疗效。方法:本组186例患者随机分为综合组和常规组各93例。常规组采用一般护理、引流管的观察与护理、腹部的观察与护理、并发症的观察与护理等措施进行护理;综合组在常规组的基础上加强了健康教育和心理护理等措施。比较两组的术后平均住院时间和患者满意度。结果:综合组的术后平均住院时间短于常规组,患者满意率高于常规组,不满意率低于常规组,具有显著性差异(P<0.05)。结论:采用综合护理模式对腹腔镜胆囊切除术的术后临床护理效果明显优于常规护理模式。%Objective:To observe the curative effect of laparoscopic cholecystectomy after the comprehensive nursing mode. Methods:186 cases of patients were divided into group and the control group with 93 cases in each. The conventional group with general nursing, observation and nursing of drainage tube, the belly of the observation and nursing, observation and nursing of complications and other measures of nursing;comprehensive group to strengthen the health education and psychological nursing on the basis of conventional group. The average hospitalization of the two groups were compared after operation time and patient satisfaction. Results:the average postoperative hospitalization time was shorter than the conventional group, patients satisfaction rate higher than the conventional group, not satisfied with the rate is lower than the control group, with significant difference (P<0.05). Conclusion:the comprehensive nursing on laparoscopic cholecystectomy clinical nursing effect was better than the routine nursing mode.

  3. Needlescopic versus laparoscopic cholecystectomy: a prospective study of 60 patients Colecistectomia agulhascópica versus colecistectomia laparoscópica: um estudo prospectivo de 60 pacientes

    Directory of Open Access Journals (Sweden)

    Pedro Henrique Oliveira Cabral

    2008-12-01

    Full Text Available PURPOSE: To test the hypothesis that needlescopic cholecystectomies (NC offer superior outcomes in comparison to common laparoscopic cholecystectomies (LC. METHODS: Sixty consecutive patients with gallbladder disease undergoing either LC or NC were evaluated with respect to differences in operative time, frequency of per-operative incidents, post-operative pain, late postoperative symptoms, length of scars and level of postoperative satisfaction. RESULTS: Mean operative time was similar in both groups. Most of the patients, irrespective of the technique, informed mild postoperative pain. NC patients had lower levels of pain on the 7th postoperative day (PO7 (pOBJETIVO: Testar a hipótese de que colecistectomias agulhascópicas oferecem resultados superiores aos da colecistectomia laparoscópica usual (CL. MÉTODOS: Sessenta pacientes consecutivos com colecistopatia submetidos à CA ou CV foram avaliados quanto ao tempo operatório, freqüência de acidentes peroperatórios, dor pós-operatória, sintomas pós-operatórios tardios, comprimento das cicatrizes e grau de satisfação. RESULTADOS: O tempo operatório médio foi semelhante em ambos os grupos. A maioria dos pacientes, independentemente da técnica, relataram dor pós-operatória leve. Aqueles operados por CA tiveram menores níveis de dor no 7º dia de pós-operatório (PO7 (p<0.01 e menor necessidade de analgesia adicional. Menor freqüência de dor epigástrica foi observada no grupo CA até o PO4 (p<0.01. O resultado estético foi amplamente superior após CA (comprimento total das cicatrizes menor que a metade após CL. Não houve diferença quanto ao grau de satisfação entre os grupos. CONCLUSÕES: As duas técnicas foram seguras e eficazes, apresentando tempos operatórios semelhantes e baixos níveis de dor pós-operatória. A redução dos portais para 2-3 mm associou-se a menor freqüência de dor pós-operatória apenas na incisão epigástrica até o PO4. O resultado est

  4. Gasless iaparoendoscopic single-site cholecystectomy with abdominal wall iift:a trial compared with conventional laparoscopic cholecystectomy%悬吊式经脐单孔腹腔镜胆囊切除术与传统腹腔镜胆囊切除术的对比研究

    Institute of Scientific and Technical Information of China (English)

    刘南; 张光永; 胡三元

    2011-01-01

    目的:对比分析免气腹悬吊式经脐单孔腹腔镜胆囊切除术(gasless laparoendoscopic single-site cholecystectomy,GLESC)和传统腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的优缺点.方法:2009年6月至2010年7月为34例患者行GLESC,为35例患者行传统LC.观察两组患者的体重指数(BMI)、合并症、手术时间、出血量、中转开腹率、C反应蛋白(C-reactive protein,CRP)水平、疼痛指数、肩背部疼痛发生率、恢复进食时间、术后住院时间及切口并发症等.结果:GLESC组2例患者因BMI过高显露欠佳,改行悬吊合并低气腹单孔腹腔镜手术,32例成功施行GLESC,35例成功实施LC.术后随访48~174d,平均120d.平均手术时间GLESC组[(78.91±24.59)min]长于LC组[(46.84±9.60)min](P<0.05).两组术后6h疼痛指数相似[GLESC组为(4.96±0.98),LC组为(5.42±1.17)].术后24h疼痛指数GLESC组(3.39±1.12)明显低于LC组(4.84±1.42)(P=0.001).GLESC组肩背部疼痛发生率低于LC组(P=0.009).两组术中出血量、CRP水平、住院时间均相似,差异无统计学意义.两组均无切口并发症发生.结论:对大多数胆囊疾病患者而言,GLESC是安全、有效、可行的,具有优于传统腹腔镜手术的美容效果及术后疼痛轻、康复快等优点.对于一定BMI和身高的患者,术野显露满意,手术入路简单有效.GLESC可在将来成为标准的、可普遍施行的手术.%Objective:On the request to make laparoscopic surgery even more minimally invasive,laparoscopic single-site surgeries have been described. A novel technique of gasless [aparoendoscopic single-site surgery with abdominal wall lift (AWL) was presented for cholecystectomy. This study aimed to compare the outcome and morbidity parameters of gasless laparoendoscopic single-site cholecystectomy (GLESC) and standard laparoscopic cholecystectomy (LC). Methods: Data from 34 patients who underwent GLESC and 35 patients who underwent LC between Jun. 2009 and Jul. 2010

  5. Quality of life (GIQLI) and laparoscopic cholecystectomy usefulness in patients with gallbladder dysfunction or chronic non-lithiasic biliary pain (chronic acalculous cholecystitis) Calidad de vida (GIQLI) y utilidad de la colecistectomía laparoscópica en pacientes con disfunción vesicular o dolor crónico biliar alitiásico (colecistitis crónica alitiásica)

    OpenAIRE

    M. Planells Roig; J. Bueno Lledó; A. Sanahuja Santafé; R. García Espinosa

    2004-01-01

    Objective: the aim of this study was to evaluate the incidence, clinical features and role of laparoscopic cholecystectomy (LC) in patients with chronic acalculous cholecystitis (CAC) in comparison with a control group of patients who underwent cholecystectomy for chronic calculous cholecystitis (CCC). Material and methods: prospective evaluation of 34 patients with CAC in contrast with 297 patients with CCC. Outcome measures: clinical presentation, quality of life using the Gastrointestinal ...

  6. Gallbladder carcinoma in the "Hospital de Clinicas" of Uruguay: 1998-2002. A clinicopathologic study of five cases in 802 cholecystectomies.

    Science.gov (United States)

    Barcia, Juan José; Rodríguez, Ana; Siri, Leonardo; Masllorens, Ana; Szwebel, Patricia; Acosta, Gisĕle

    2004-02-01

    Five cases of primary carcinoma of the gallbladder are presented. The cases were identified after a study of 802 cholecystectomies in a period of 5 years. The patients are three women and two men between the ages of 43 and 60 years (mean, 55.8 years). In three cases the clinical diagnosis was that of carcinoma, while in two other patients the clinical diagnosis was that of acute cholecystitis. Grossly, all cases were characterized by a gray-white diffuse or focal plaque-like thickening of the gallbladder wall, with loss of the normal velvety mucosal surface and fibrosis of the organ. Histologically, four cases belong to moderately to poorly differentiated adenocarcinoma and were characterized by infiltrative, irregularly shaped and sized glands, islands, nests, and cords. The cells showed pleomorphic nuclei with clumped chromatin and frequent single nucleoli. One case was a mucinous adenocarcinoma characterized by large pools of mucoid material with neoplastic glands and cells "floating" within. Pathologic staging was pT3 in three cases; pT2 in one case; and pT2N1 in one other case. The present study highlights the importance of careful gross and histopathologic evaluation of gallbladders otherwise removed with the history of chronic or acute cholecystitis. In addition, it highlights the incidence of gallbladder carcinoma in a particular institution.

  7. Results of laparoscopic cholecystectomy in a third-level university hospital after 17 years of experience Resultados de la colecistectomía laparoscópica en un hospital universitario de tercer nivel tras 17 años de experiencia

    OpenAIRE

    2009-01-01

    Objective: the aim of the study is to determine the results obtained with laparoscopic cholecystectomy at Ramón y Cajal Hospital after 17 years of experience, comparing current results with those at the beginning of the experience. Material and methods: between 1991 and December 2007, 3,933 laparoscopic cholecystectomies were performed at the "Ramón y Cajal Hospital"; 1,849 patients were operated on between 1991 and 2000, and 2,084 between 2001 and 2007. Patients studied included 69.8% of wom...

  8. Clinical analysis and experience of single-incision laparoscopic cholecystectomy%单切口腹腔镜胆囊切除术的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    宋平; 唐滔; 陶绪雄; 阎玉矿

    2012-01-01

    Objective To discuss the feasibility of single incision laparoscopic cholecystectomy and its clinical application through analyzing the method,effect and experience of single incision laparoscopic surgery.Methods All 25 cases of cholecystitis and cholelithiasis patients with umbilical single incision laparoscopic cholecystectomy from September 2009 to April 2011 were enrolled.Results Twenty five patients with single incision laparoscopic cholecystectomy patients were completed surgery successfully,no transit conventional laparoscopy or laparotomy happened.The operation time was from 50 to 90 min.the average blood loss was 3 ml,and all patients were not placed abdominal drainage tube.Get out of bed and the liquid diet within 24 hours after surgery,the hospitalization time was 2-4 d,without special uncomfortable symptoms after operation,with no cases of wound infection,complications such as bleeding,bile duct injury did not occure,all patients were cured and discharged,and back to normal work and lives.Conclusions Single incision laparoscopic cholecystectomy is technically secure and viable,it is the combination of minimally invasive surgery and cosmetic surgery method.Compared to the traditional laparoscopic cholecystectomy,the operation of single incision laparoscopic surgery is difficult,and the operation time has been prolonged,while can achieved the same clinical effect as conventional laparoscopic cholecystectomy with three holes technique,and scar is hidden,cosmetic effect is very good.%目的 分析单切口腹腔镜胆囊切除术的手术方法及临床效果,探讨单切口腹腔镜胆囊切除术的可行性及临床应用前景.方法 总结我院2009年9月至2011年4月对25例胆囊炎并结石患者行单切口腹腔镜胆囊切除术治疗效果.结果 25例单切口腹腔镜胆囊切除术患者均顺利完成手术,无中转常规腹腔镜或开腹手术.患者手术时间50~90 min,平均出血量3ml,均未放置腹腔引流管.术后1d以内

  9. COMPARATIVE EVALUATION OF ORALLY DISINTEGRATING FILM OF ONDANSETRON VERSUS INTRAVENOUS GRANISETRON IN PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE, RANDOMIZED DOUBLE - BLIND PLACEBO - CONTROLLED STUDY

    Directory of Open Access Journals (Sweden)

    Snehalatha

    2015-05-01

    Full Text Available BACKGROUND : Ondansetron and granisetron are first generation 5 - hydroxytry - ptamine - 3 (5 - HT3 receptor antagonists widely used in the prophylaxis of postoperative nausea and vomiting (PONV. Orally Disintegrating Film (ODF formulations are novel and advanced oral drug delivery systems used in management of (PONV. We aimed to study the efficacy of ODF of Ondansetron in the prophylaxis of PONV and to compare it with intravenous Granisetron and placebo in patients undergoing Laparoscopic cholecystectomy . MATERIALS AND METHODS : In this prospective, randomized double - blind placebo - controlled study, 120 consented adult patients of ASA grade I and grade II, aged between 25 - 55 years of both genders, undergoing elective Laparoscopic cholecystectomy , w ere randomized into 3 groups of 40 patients each as Placebo, intravenous Granisetron 2mg and ODF of Ondansetron 8mg (ODF8 g roups. Study drugs were administered just before induction of Anaesthesia. Standardized anesthetic technique was used, and data was collected. Incidence of PONV was assessed and the number of patients suffering from nausea and vomiting at 0 - 6, 7 - 14, and overall 0 - 24 hours post - operatively was evaluated in all the groups and need for rescue anti - emetic noted. RESULTS : Data was analysed using one - way ANOVA test, Chi ‑ square test and Mann – Whitney test. The incidence and severity of nausea and vomiting at different time intervals in Group G and ODF Group was significantly lower when compared with Placebo Group ( p=0.000 . But there was no significant difference in between the ODF and in travenous groups. There was no significant difference in the incidence of side effects in between the three groups. CONCLUSION : orally disintegrating film of Ondansetron is a safe, simple and cost - effective, novel formulation , equally effective to intraven ous Granisetron in preventing PONV in patients undergoing laparoscopic cholecystectomy.

  10. Descoberta simultânea de carcinomatose disseminada e carcinoma de cólon, após colecistectomia laparoscópica Unsuspected colon adenocarcinoma revealed after laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    João Luiz M. C. Azevedo

    2000-08-01

    Full Text Available A particularly rapid and fatal outcome has been noted in cases of malignant soft-tissue metastases occurring after cancer surgery. Abdominal wall metastases occurring in scars after laparotomy for cancer resection show a similar poor outcome. On the other hand, neoplasm seeding at trocar sites after laparoscopy has been reported with an increasing frequency. A case is presented of a 68-years-old woman with metastatic seeding of non-diagnosed colon cancer at the umbilical trocar site used for a laparoscopic cholecystectomy. The gallbladder was extracted through the umbilical incision. Pathological examination confirmed chronic cholecystitis. Eight months latter, the patient was seen with a tender umbilical mass protruded through a 4,5 cm the umbilical incision site. Biopsies of this tissue were taken and histopathological examination showed metastatic adenocarcinoma, probably of a gastrointestinal origin. A colonoscopy performed at the same time revealed a 2-cm lesion at the hepatic flexur which was shown to be a differentiated adenocarcinoma. An 8.0 x 6.0 x 6.0-cm pelvic mass without signs of liver metastases was identified by computerised tomography. Diagnostic laparoscopy showed a diffuse peritoneal carcinomatosis. The pelvis could not be approached, except for simple biopsy, and no surgical procedure was performed. It is presumed that the primary colon cancer existed prior to cholecystectomy. Laparoscopy is the procedure of choice to perform cholecystectomy and fundoplication. It has also been increasingly used to diagnose, resect and perform the staging of malignant tumours. As in any relatively new technique, questions arising about its safety and risk of complications must be extensively studied. Many questions about the specific features of laparoscopy promoting cancer growth remain unanswered.

  11. Clinical Observation of 50 Cases of Acute Cholecystitis Treated With Laparoscopic Cholecystectomy%腹腔镜胆囊切除术治疗急性胆囊炎50例疗效观察

    Institute of Scientific and Technical Information of China (English)

    崔磊; 瞿建国; 党胜春; 张清; 谢嵘; 黄润生

    2015-01-01

    Objective To investigate the clinical effect of laparoscopic cholecystectomy for acute cholecystitis. Methods 50 cases of acute cholecystitis treated by laparoscopic cholecystectomy were set as the observation group, 50 cases treated with conventional open surgery were set as the control group, and the treatment effect of the two groups was compared. Results The operation time, bleeding volume, postoperative pain score, anal exhaust time, defecation time, hospitalization time and complications in the observation group were statistically significant with the control group (P<0.05). Conclusion Laparoscopic cholecystectomy for acute cholecystitis is beneifcial to postoperative recovery.%目的:探讨腹腔镜胆囊切除术治疗急性胆囊炎的临床疗效。方法将50例采用腹腔镜胆囊切除术治疗的急性胆囊炎患者设为观察组,将同期收治的50例采用常规开腹手术治疗的急性胆囊炎患者设为对照组,比较两组的治疗效果。结果观察组的手术时间、术中出血量、术后疼痛评分、肛门排气时间、排便时间、住院时间、并发症少于对照组,差异有统计学意义(P<0.05)。结论腹腔镜胆囊切除术治疗急性胆囊炎有利于患者的术后康复。

  12. 复杂胆囊结石患者行腹腔镜胆囊次全切除术的临床疗效观察%Clinical curative effect observation of laparoscopic subtotal cholecystectomy in patients with complicated gallstone

    Institute of Scientific and Technical Information of China (English)

    邓强

    2015-01-01

    Objective:To explore the clinical effect of laparoscopic subtotal cholecystectomy in patients with complicated gallstone.Methods:40 patients with complicated gallstone were selected.They were randomly divided into two groups.The control group were given conventional operation treatment,and the observation group were given laparoscopic subtotal cholecystectomy. The clinical effects of two groups were compared.Results:The operation time,intraoperatve blood soss and hospitalization time of the observation group were better than those of the control group(P<0.05).Conclusion:The patients with complicated gallstone are given laparoscopic subtotal cholecystectomy in clinic.It can not only shorten the hospitalization time,reduce the intraoperatve blood soss,but also can improve the treatment effect,and improve the life quality of patients.%目的:探析复杂胆囊结石患者行腹腔镜胆囊次全切除术的临床效果。方法:收治复杂胆囊结石患者40例,随机分为两组,对照组给予常规手术治疗,观察组给予腹腔镜胆囊次全切术,对比两组治疗效果。结果:观察组的手术时间、术中出血量以及住院时间均优于对照组(P<0.05)。结论:临床上对复杂胆囊结石患者行腹腔镜胆囊次全切术,不仅可以缩短住院时间、降低术中出血量,还能提高治疗效果,改善患者的生活质量。

  13. To Investigate the Clinical Efficacy of LMA Laryngeal Mask Airway in Laparoscopic Cholecystectomy%探讨LMA喉罩应用在腹腔镜胆囊切除术中的临床有效性

    Institute of Scientific and Technical Information of China (English)

    李海良

    2016-01-01

    目的:分析探讨LMA喉罩应用在腹腔镜胆囊切除术中的临床有效性。方法选取在我院接受腹腔镜下胆囊切除术的90例患者,采用随机分组的方式将其分为44例对照组和46例观察组,对照组行气管插管通气,观察组行LMA喉罩通气。结果两组患者在T0、T1、T2、T3时的HR、MAP指标相比,观察组低于对照组(P<0.05);两组的并发症发生率相比,差异有统计学意义(P<0.05)。结论在腹腔镜胆囊切除术中行LMA喉罩通气,具有较好的通气效果和较高的安全性。%Objective To investigate the clinical effcacy of LMA laryngeal mask airway in laparoscopic cholecystectomy.Methods 90 patients with laparoscopic cholecystectomy using randomized were chosen in our hospital, divided into 44 cases in the control group and 46 cases in the observation group, control group underwent tracheal intubation observed group received LMA ProSeal mask ventilation.Results The two groups in T0, T1, T2, T3, HR, MAP indicators compared to the observation groupwas significantly lower than the control group (P<0.05), the incidence of complications of the two groups was significantly different (P<0.05). Conclusion LMA laryngeal mask airway ventilation in laparoscopic cholecystectomy has better ventilation effect and higher safety.

  14. Effect observation of dexmedetomidine to prevent nausea and vomiting after laparoscopic cholecystectomy%右美托咪定预防腹腔镜胆囊切除术后恶心呕吐效果观察

    Institute of Scientific and Technical Information of China (English)

    朱玉梅; 汤海俊; 张红; 夏晶

    2016-01-01

    目的:观察右美托咪定预防腹腔镜胆囊切除术后恶心呕吐的临床效果。方法选择择期全麻下拟行腹腔镜胆囊切除术患者40例,将患者随机分为治疗组和对照组,每组20例,观察术后24h 出现恶心呕吐的情况。结果治疗组恶心呕吐发生率为15.0%明显低于对照组的55.0%,差异有统计学意义(P <0.05)。结论右美托咪定复合麻醉可显著降低腹腔镜胆囊切除术后恶心呕吐的发生率,值得临床推广使用。%Objective To observe the effects of dexmedetomidine to prevent nausea and vomiting after laparoscopic cholecystectomy. Methods 40 cases of patients undergoing laparoscopic cholecystectomy under general anesthesia were select-ed and randomly divided into treatment group and control group,with 20 cases in each group. The occurrence of nausea and vomiting was observed during 24 hours after operation. Results The incidence of nausea and vomiting in the treatment group (15. 0%)was significantly lower than that of the control group(55. 0%),the difference was statistically significant(P <0. 05). Conclusion Dexmedetomidine can reduce incidence of nausea and vomiting after laparoscopic cholecystectomy,and worthy of clinical use.

  15. Clinical Study of Auricular Plaster Therapy for Post-laparoscopic Cholecystectomy Nausea and Vomiting%耳穴压豆缓解腹腔镜胆囊切除术后恶心、呕吐的临床研究

    Institute of Scientific and Technical Information of China (English)

    费华华; 贾丽萍

    2015-01-01

    目的:观察耳穴压豆缓解腹腔镜胆囊切除术后恶心、呕吐的效果。方法将240例腹腔镜胆囊切除术患者随机分为治疗组和对照组,每组120例。两组均采用常规护理,治疗组在此基础上给予耳穴压豆治疗。观察两组恶心、呕吐发生情况。结果治疗组恶心、呕吐发生率为46.7%,对照组为60.8%,两组比较差异具有统计学意义(P<0.05)。结论耳穴压豆法能缓解腹腔镜胆囊切除术后患者恶心、呕吐症状。%Objective To investigate the efficacy of auricular plaster therapy for post-laparoscopic cholecystectomy nausea and vomiting. Methods Two hundred and forty laparoscopic cholecystectomy patients were randomly allocated to treatment and control groups, 120 cases each. Both groups received routine nursing care. In addition, the treatment group received auricular plaster therapy. The incidence of nausea and vomiting was observed in the two groups.Results The incidence of nausea and vomiting was 46.7% in the treatment group and 60.8% in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusion Auricular plaster therapy can relieve postoperative nausea and vomiting in laparoscopic cholecystectomy patients.

  16. Guard against "block phenomenon" for inferior vena cava being in compression during open cholecystectomy%警惕开腹胆囊切除手术过程中下腔静脉"阻断现象"

    Institute of Scientific and Technical Information of China (English)

    刘国英; 康彤; 姚世民; 陈金明

    2009-01-01

    Objective To explore the existence of "block phenomenon" of the inferior vena cava being in compression during open cholecystectomy.Methods A total of 30 patients receiving open cholecystectomy under the general anesthesia and epidural anesthesia in our hospital were selected.The right internal jugular vein and femoral vein catheterization was performed after the anesthesia induction and intubation to continuously monitor CVP and the inferior vena cava pressure (IVCP).Meanwhile, the changes in CVP, MAP, HR, IVCP before abdominal opening,upon pulling gallblad-der as well as 5 min, 10 min and 15 minutes after the opening of deep retractors were observed, recor-ded and compared.Results The HR of patients during cholecystectomy did not changed significantly (P>0.05) but MAP and CVP were decreased markedly (P0.05),而MAP、CVP均不同程度下降(P0.05).结论 开腹胆囊切除手术过程中确实不同程度地存在下腔静脉受压,静脉回流受阻,即"下腔静脉阻断现象",是导致病人血流动力学变化的主要原因之一.要求麻醉医生在麻醉管理中加快补液速度,同时提醒手术医生在血压下降时注意改变拉钩的姿势和力量,以减轻对下腔静脉的压迫.

  17. 经脐入路腹腔镜无疤痕胆囊切除术33例报告%Transumbilical laparoscopic cholecystectomy without visible scar: a report of 33 cases

    Institute of Scientific and Technical Information of China (English)

    路春雷; 张海峰

    2011-01-01

    目的:探讨经脐入路腹腔镜无疤痕胆囊切除术的可行性.方法:33例患者均于脐下穿刺5mm Trocar,置入30°腹腔镜,脐上缘做l5 mm切口,穿刺10mm Trocar作为主操作孔,于其右侧穿刺5mm Trocar后拔出Trocar,置入无创抓钳,完成胆囊切除术.结果:33例手术均获成功,无中转传统腹腔镜手术.手术时间平均55 min(40~85 min),平均出血量平均12ml(820ml).术中均未放置腹腔引流管,无并发症发生,术后2~3d出院.术后随访1~4个月,腹壁无可见疤痕.结论:使用传统腹腔镜器械施行经脐入路腹腔镜胆囊切除术是安全可行的,可达到腹壁无可见手术疤痕的美容效果.%Objective :To discuss the feasibility and clinical application of transumbilical laparoscopic cholecystectomy without visible scar. Methods:The 33 well-selected patients underwent transumbilical laparoscopic cholecystectomy without visible scar. A 5mm incision was made at the lower border of umbilicus and the abdominal cavity was explored with a 5mm 30° laparoscope. A 15mm incision was made at the upper border of umbilicus and a 10mm Trocar was introduced through it. Then the grasper was introduced to the right of the l0mm Trocar. Laparoscopic cholecystectomy was performed and the gallbladder was taken out through the 10mm incision.Results :All operations were performed successfully. The mean operation time was 55min(range,40-85min) and the mean blood loss was 12ml(range,8-20ml). No drainage tube was placed and no complications occurred. The postoperative hospital stay ranged from 2 to 3 days. The follow-up period ranged from 1 to 4 months and there was no visible scar on the abdominal wall. Conclusions: Transumbilicai laparoscopic cholecystectomy using conventional instruments is safe and technically feasible and without obvious abdominus scar.

  18. 免气腹悬吊式与传统气腹式腹腔镜胆囊切除术比较分析%Clinical comparison of gasless laparoscopy using abdominal wall lifting and conventional laparoscopic for cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    吴金柱; 胡江; 梁鲁; 蔡卫华

    2013-01-01

    Objective To analyze the clinical value of gasless laparoscopic cholecystectomy (GLC). Methods The clinical data of 60 patients suffered from cholecystolithiasis, gall bladder polypi or chronic cholecystitis between July 2009 and March 2010 in Baotou center hospital were analyzed. All the patients were divided into GLC group (30 patients) and convention laparoscopic cholecystectomy (CLC) group (30 patients) in randomly. Patients intraoperative data, postoperative recovery, postoperative complications, hospitalized time and related costs were recorded. Results Compared with CLC, the effects were very significant in GLC, which included less adverse effects of intraoperative and postoperative respiratory cycle, faster postoperative recovery time, getting out of bed earlier, lower incidence of postoperative nausea and vomiting (PONV), neck and shoulder pain, lower hospitalization costs. Conclusion GLC can avoid affecting to the respiratory and circulatory function, thus it can avoid the harmful effects of CO2 pneumoperitoneum on the human body and increase operative safety.%目的 分析悬吊式免气腹腹腔镜胆囊切除术(gasless laparoscopic cholecystectomy,GLC)的临床应用价值.方法 对2009年7月至2010年3月包头市中心医院普通外科60例腹腔镜胆囊切除术的临床资料进行分析.将60例慢性胆囊炎、胆囊结石或胆囊息肉病人随机分为GLC组及传统气腹式腹腔镜胆囊切除术(convention laparoscopic cholecystectomy,CLC)组,每组30例,记录术中、术后情况,对比分析并发症的发生率、住院时间及相关费用.结果 GLC对术中、术后呼吸循环和术后恢复的影响较小,具有术后胃肠功能恢复快,术后下床活动早,术后恶心呕吐发生率低,颈肩痛轻,住院费用低的优点.结论 选择GLC避免了对呼吸、循环系统的影响,从而避免了二氧化碳(CO2)气腹对人体的不良影响,增加了手术安全性.

  19. 腹腔镜胆囊切除术在急性胆囊炎治疗中的临床价值分析%Analysis Clinical Value of Laparoscopic Cholecystectomy in Treatment of Acute Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    卜德永

    2016-01-01

    Objective Analysis clinical value of laparoscopic cholecystectomy in Treatment of acute cholecystitis.MethodsRandomly selected patients with cholecystitis in our hospital,to differentiate operative time 60 patients were divided into two groups,30 patients in each group,laparotomy cholecystectomy applied to the conventional group,The laparoscopic cholecystectomy applied research group,then the two groups of patients as well as treatment incidence of adverse reactions were compared. ResultsTreatment of patients with disease study group was signiifcantly higher effciency,while the complication rate is lower than the control group,statisticsP<0.05, signiifcant difference.Conclusion Patients with acute cholecystitis laparoscopic cholecystectomy for treatment can improve disease treatment,reduce the incidence of complications,with extensive use value.%目的:研究在急性胆囊炎的治疗中使用腹腔镜胆囊切除术的效果。方法对我院收治的胆囊炎患者进行随机抽取,以手术时间的差异将60例患者分为两组,每组30例,常规组应用开腹胆囊切除术,研究组应用腹腔镜下胆囊切除术,对比两组患者治疗效果以及不良反应发生率。结果研究组疾病治疗有效率高于对照组,同时并发症发生率比对照组低,P<0.05,差异具有统计学意义。结论对急性胆囊炎患者实施腹腔镜胆囊切除术进行治疗能够提高疾病治疗效果,减少并发症的发生。

  20. 腹腔镜胆囊切除术治疗老年急性胆囊炎临床观察%Clinical observation of laparoscopic cholecystectomy in the treatment of elderly cases with acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    陈锟; 沙拉衣丁·沙力克江

    2014-01-01

    目的:探讨针对老年急性胆囊炎患者采取腹腔镜胆囊切除术的临床治疗效果。方法:2011年5月-2013年5月收治老年胆囊炎患者80例,随机分为观察组和对照组,每组40例。对照组采取传统的胆囊切除手术治疗,观察组采取腹腔镜胆囊切除术。比较分析两组术中出血量、手术时间、术后成功率、并发症情况和肠道恢复时间。结果:和对照组比较,观察组在各项指标上都有着更好的疗效,差异具有统计学意义(P<0.05)。结论:腹腔镜胆囊切除术治疗老年人急性胆囊炎,疗效较好,值得临床推广。%Objective:To investigate the clinical effect of laparoscopic cholecystectomy in the treatment of acute cholecystitis in the elderly cases.Methods:80 elderly cases with cholecystitis were selected from May 2011 to May 2013.They were randomly divided into the observation group and the control group with 40 cases in each.The control group adopted conventional cholecystectomy operation treatment,while the observation group adopt laparoscopic cholecystectomy.We compared the amount of bleeding in operation,the operation time,the success rate of operation,the concurrent and intestinal recovery time of the two groups. Results:The curative effect of all indexes of the observation group were better than those of the control group,and the difference is statistically significant(P<0.05).Conclusion:The effect of laparoscopic cholecystectomy in the treatment of elderly cases with acute cholecystitis is better,so it is worth clinical application.

  1. 经脐单孔腹腔镜胆囊切除术的临床应用及安全性探讨%Clinical application of transumbilical single port laparoscopic cholecystectomy and its safety

    Institute of Scientific and Technical Information of China (English)

    赵雷

    2015-01-01

    Objective To explore the clinical efficacy of transumbilical single port laparoscopic cholecystectomy and its safety. Methods Patients admitted to our hospital and underwent cholecystectomy from July 2012 to July 2014 were divided into trial group (n = 40) treated with transumbilical single port laparoscopic cholecystectomy and control group (n = 40) treated with conven-tional laparoscopic cholecystectomy. Comparison was done between the two groups. Results The operative time, blood loss, post-operative hospital stay of the trial group and the control group were (64. 23 ± 28. 81) minutes vs (61. 77 ± 21. 02) minutes, (14. 62 ± 3. 59) ml vs (13. 39 ± 3. 90) ml, (3. 39 ± 0. 85) minutes vs (3. 37 ± 0. 84) days. There were no statistically signifi-cant differences between the two groups (t = 1. 34, P > 0. 05; t = 1. 57,P > 0. 05; t = 1. 29, P > 0. 05). In the trial group,postop-erative intestinal function recovery time was (22. 76 ± 4. 23) hours, and postoperative pain score was (2. 29 ± 1. 46); in the con-trol group, the counterparts were (28. 16 ± 5. 06) hours and (5. 19 ± 1. 64). There were statistically significant differences be-tween the two groups (t = 2. 98, P 0.05;t =1.57,P >0.05;t =1.29,P >0.05)。实验组术后肠功能恢复时间为(22.76±4.23) h、术后疼痛评分为(2.29±1.46)分,对照组术后肠功能恢复时间为(28.16±5.06) h、术后疼痛评分为(5.19±1.64)分,组间比较有统计学意义(t =2.98,P <0.05;t =3.32,P <0.05)。结论采用经脐单孔腹腔镜胆囊切除术,不仅手术时间短,术中出血量少,且术后住院时间短,疼痛较轻,是一种微创、安全的手术方法。

  2. Laparoscopic cholecystectomy for the treatment of gallbladder stone effect analysis%腹腔镜胆囊切除术对胆囊结石治疗效果分析

    Institute of Scientific and Technical Information of China (English)

    陈建平

    2015-01-01

    目的:分析腹腔镜胆囊切除术对胆囊结石的临床治疗效果。方法:选择了2013年7月-2014年7月在我院接受治疗的60例胆囊结石患者作为研究对象,将所有患者随机分为对照组和实验组,对照组患者给予常规开腹胆囊切除术治疗,而实验组患者给予腹腔镜胆囊切除术治疗,然后对两组患者的治疗效果进行观察和对比。结果:实验组患者的术中出血量、手术时间、肛门排气时间、住院时间、镇痛药使用等情况均明显优于对照组,两组患者之间的差异具有统计学意义(P<0.05)。结论:对胆囊结石患者采取腹腔镜胆囊切除术治疗,其治疗效果明显优于常规开腹胆囊切除治疗,而且手术时间短,术后并发症少,有效改善了患者的生活质量。%ObjectiveAnalysis the clinical therapeutic effect of gall bladder calculi of laparoscopic cholecystectomy. Methods Chose July 2013 - July 2014 in our hospital for treatment of 60 patients with gallbladder stone as the research object, all the patients were randomly divided into control group and experimental group, control group given conventional laparotomy cholecystectomy in patients with treatment, the experimental group patients give treatment of laparoscopic cholecystectomy.Results Experimental group patients with intraoperative blood loss, operative time, length of hospital stay, anal exhaust time, analgesic use, and so on and so forth were significantly better than the control group, the differences between the two groups have statistical significance (P < 0.05).Conclusions Treated with laparoscopic cholecystectomy in patients with gallstones, gallbladder excision with its treatment effect is superior to the conventional laparotomy, and shorter operation time, less postoperative complications, effectively improve the patient's quality of life.

  3. 腹腔镜下胆囊切除术的手术室临床护理与配合分析%To Analyze the Clinical Nursing and Cooperation of Laparoscopic Cholecystectomy in the Operating Room

    Institute of Scientific and Technical Information of China (English)

    陈慧燕

    2013-01-01

      目的:分析腹腔镜下胆囊切除术的手术室临床护理和配合。方法:回顾性分析50例需要进行腹腔镜下胆囊切除手术的患者的资料,探讨腹腔镜下胆囊切除术的手术室临床护理和配合。结果:术前给予患者临床护理能够减轻患者的心理压力;术中做好手术准备,医护人员做好协助工作能够缩短手术的时间,保证手术顺利完成;术后做好出院指导,能够减少术后并发症的发生率和复发率。结论:腹腔镜下胆囊切除术中手术室良好的护理和配合是保证手术顺利完成的关键,在提高护理质量的同时能够提高手术成功率。%Objective: To analyze the clinical nursing and cooperation of laparoscopic cholecystectomy in the operating room. Meth-ods: Retrospective analysis of data of 50 cases of patients in need of laparoscopic cholecystectomy, to explore the clinical nursing and cooperation of laparoscopic cholecystectomy in the operating room. Results: Clinical nursing given to patients before surgery to reduce the patient's psychological pressure. Well prepared for surgery and the medical staff do the assist work can shorten the time of the surgery, to ensure the successful completion of the surgery. Made the discharge guidance well after surgery can reduce the inci-dence of postoperative complications and recurrence rate. Conclusion: Clinical nursing and cooperation of laparoscopic cholecystec-tomy in the operating room is the key to ensuring the successful completion of the surgery, while improving the quality of nursing can improve the success rate of surgery.

  4. Transumbilical single-port laparoscopic cholecystectomy: 22 cases report%经脐单孔腹腔镜胆囊切除术22例报告

    Institute of Scientific and Technical Information of China (English)

    王建球; 杨廷燕; 朱堃; 周海华; 史佩东; 王建平; 陈跃宇

    2011-01-01

    目的:总结经脐单孔腹腔镜胆囊切除术的可行性和应用前景.方法:2009年10月至2010年6月,上海市嘉定区中心医院应用普通腹腔镜器械行经脐单孔腹腔镜胆囊切除术22例(单孔组),与同期常规腹腔镜胆囊切除术22例(四孔组)进行分析和比较.结果:手术时间:单孔组(52.3±8.1) min,四孔组(47.4±5.3) min,P<0.05.术中出血量:单孔组(11.9±1.3) mL,四孔组(11.5±1.2) mL,P>0.05;术后住院时间:单孔组(3.5±-0.7)d,四孔组(3.4±0.6)d,P>0.05;术后疼痛评分采用Prince-Henry5级评分法:单孔组(3.2±0.7),四孔组(3.4±0.7),p>0.05.两组差异除平均手术时间外,其他均无统计学意义.无并发症发生,脐部瘢痕隐蔽.结论:经脐单孔腹腔镜胆囊切除术操作难度大;有技术条件的医院,可在慎重选择病例的基础上开展.%Objective To summarize the feasibility of transumbilical single-port laparoscopic cholecystectomy (TUSPLC). Methods From Oct 2009 to Jun 2010, the Central Hospital of Jiading District, Shanghai, by using the ordinary laparoscopic instruments, performed TUSPLC in 22 cases, and conventional laparoscopic cholecystectomy in 22 cases; the two methods were compared. Results The operation time: single-hole group (52.3±8.1) min, 4-hole group (47.4± 5.3) min, P0.05; Postoperative hospital stay: single-hole group (3.5±0.7) d, 4-hole group (3.4±0.6) d, P>0.05. Postoperative pain score by Prince-Henry 5 class score method: single-hole group (3.2±0.7), 4-hole group (3.4±0.7), ft>0.05. The difference in operative time in the 2 groups was statistically significant, while in other respects they were not There were no complications, and the umbilical scars were not outstanding in both groups. Conclusions Since TUSPLC is more difficult to perform, surgeons can choose it in patients carefully selected in qualified hospitals.

  5. Necrose do coto do ducto cístico após colecistectomia videolaparoscópica Post-videolaparoscopy cholecystectomy necrosis of the cystic duct

    Directory of Open Access Journals (Sweden)

    Daniel Santos Maia

    2010-03-01

    Full Text Available INTRODUÇÃO: Lesões das vias biliares, embora não frequentes, podem ser visualizadas ou percebidas no ato operatório. Porém, as derivadas de necrose por manipulação são tardias e não reconhecíveis durante a operação. RELATO DO CASO: Paciente submetida à colecistectomia videolaparoscópica apresentou coleperitônio no pós-operatório. Em re-operação observou-se ducto cístico fistuloso no local da clipagem dupla. Realizada drenagem intra-cística. Evoluiu com bilioma associado que necessitou também de drenagem por aspiração. Evoluiu satisfatoriamente e com cura em um mês. CONCLUSÃO: Por ser uma situação rara, ainda não existe consenso sobre suas principais causas e incidência.BACKGROUND: Biliary iatrogenic lesions in cholecistectomies are not frequent, but can be treated at the same procedure, if recognized. Necrotic lesion, by the other hand, no. CASE REPORT: Woman submitted to videolaparoscopic cholecystectomy presented, on early follow-up, acute peritonitis due to necrosis of cystic duct on the clips site. Was operated to drain the duct through the introduction of a nasogastric tube inserted in cystic ostium in the necrotic area. Drainage of a bilioma in the epigastrium was also needed after one week, guided by ultrasound. The case had good evolution in one month. CONCLUSION: Due to the rare condition, the management of biliary fistula in necrotic area remains controversial.

  6. Prospective survey to study factors which could influence same-day discharge after elective laparoscopic cholecystectomy in a tertiary care hospital of a developing country.

    Science.gov (United States)

    Ismail, Samina; Ahmed, Aliya; Hoda, Muhammad Qamarul; Sohaib, Muhammad; Zia-Ur-Rehman

    2016-12-01

    All laparoscopic cholecystectomy (LC) patients in our hospital setting are admitted overnight. This article assesses the contribution of factors like postoperative nausea and vomiting (PONV), postoperative pain and surgical complications to overnight stay after elective LC. This 1-year observational study included patients having normal liver functions undergoing elective LC before 1400 h. The collected data included patient demographics, co-morbidities, PONV, pain scores, complications, surgical time, anesthesia technique, use of prophylactic antiemetics, analgesics, patient satisfaction and desire to have this surgery as day case or in-patient procedure. From 930 LC done per annum, 45.2 % (430/950) patients were included in this study. Prophylactic antiemetic was given in 91.6 %, intraoperative narcotics in 94.2 % patients and multimodal analgesia in 85.3 %. The mean pain score in the recovery and ward was maintained to <4. In the ward, 99.1 % patients were able to start oral fluids after 6 h and were started on oral non-steroidal anti-inflammatory drugs and paracetamol, and none required parental opioid. The PONV score of more than 2 was observed in only 3.2 % of patients in the ward requiring parenteral antiemetic. Surgical complications in the form of bleeding, visceral injury and bile duct leak were observed in 2 % of patients, which was treated intra-operatively. Satisfaction was observed in 99.3 % and desire to stay overnight in 87.4 % of patients. Factors like postoperative pain, PONV and surgical complications were well managed and were not associated with significant morbidity to justify routine overnight admission. However, majority of the patients desired to stay overnight, which could be improved by counseling and education.

  7. 三维技术在腹腔镜胆囊切除术的应用探讨%Application of three -dimensional technique in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    陈光彬; 刘丹峰; 刘昌阔; 章新桥; 孙荣能; 孙礼侠

    2014-01-01

    Objective To explore the feasibility of three-dimensional (3D) laparoscopic system in laparoscopic cholecystectomy. Methods Three patients with benign gallbladder disease with a history of abdominal pain were selected to undergo the surgery. All the operations were performed with Viking 3D HD laparoscopic system. Results The 3 operations were completed successfully with no conversion to laparotomy. The operation time and intraoperative bleeding volume were quite equal to the conventional laparoscopy. All of them recovered successfully and were discharged 3 days postoperatively. Conclusion Three-dimensional technique can well reveal the tissue anatomy in the operative field,allows more precise operation with reduced complications and is suitable for more complex laparoscopic surgery.%目的:探讨三维(3D)技术应用于腹腔镜胆囊切除术的可行性及临床经验。方法临床筛选3例胆囊良性疾病患者,既往有右上腹疼痛病史,术中应用 Viking 3D 高清腹腔镜系统完成腹腔镜胆囊切除术。结果3例患者均顺利完成手术,无中转开腹,手术时间、术中出血量与传统腹腔镜相当;患者术后均恢复顺利,术后72 h 出院。结论3D 腹腔镜下纵深感明显、解剖层次感强、操作空间位置感明确,因此手术操作更加精准,有助于减少手术并发症、完成更为复杂的腹腔镜手术。

  8. Application of B-mode Ultrasound before Laparoscopic Cholecystectomy%B超在腹腔镜胆囊切除术前的应用

    Institute of Scientific and Technical Information of China (English)

    房月明; 李德才; 杨晓

    1995-01-01

    According to the ultrasonic manifestations of the gall bladder before laparoscopic cholecystectomy(LC),including size,morphology,wall thickness,presence or absence of gallstone,congenital anomaly of biliary duct,surrounding adhesion and state of common bile duct,tbe patients Werc dividcd into 4 groups:A.Most suitable for LC,B.Sitable for LC,C.Relatively suitable for LC. D.Not suitable for LC.This provided clinicians the basis for patient selection.Comparing with the sur.gical findings,the coincidence rate of B-mode ultrasonography was 97.8%.Preoperative B-mode ul-trasonography of gall bladder has significant clinical value to relieve the patients from pain,decrease the operative risk and conversion rate of LC.%本文根据腹腔镜胆囊切除术(LC)前病人胆囊的大小、形态、胆囊壁厚薄,胆周有无粘连,胆囊结石及胆总管情况,胆道有无先天性畸形.将患者分为A(最适合组)、B(适合组)、 C(相对适合组);D(不适合组)四个组,为临床提供了较为全面的选择依据.与手术对照,B超爷合率97.8,6.对于减轻病人痛苦,减少手术风险,降低LC手术中转率具有重要临床价值.

  9. MUTIRÕES DE COLECISTECTOMIA POR VIDEOLAPAROSCOPIA EM REGIME DE CIRURGIA AMBULATORIAL INTENSIVE PROGRAM OF VIDEOLAPAROSCOPY CHOLECYSTECTOMY ON AN AMBULATORY SURGERY BASIS

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    J.S. Santos

    2001-01-01

    Full Text Available Introdução: As listas de espera para colecistectomia, associadas à elevada demanda dos leitos e salas cirúrgicas dos Hospitais Universitários, são incentivos para adoção de novos programas de assistência. Objetivo: Avaliar o processo de organização e os resultados clínicos dos Mutirões de Colecistectomia por Videolaparoscopia, em regime de Cirurgia Ambulatorial. Pacientes e Métodos: Dentre os 314 pacientes portadores de colelitíase sintomática que aguardavam cirurgia no HCFMRP-USP, 160 foram selecionados para tratamento em regime ambulatorial. Uma equipe multiprofissional, formada por cirurgiões, anestesistas, enfermeiros e assistentes sociais, programou 4 mutirões para serem realizados em fins de semana, em função da disponibilidade do bloco cirúrgico e da sala de recuperação pós-anestésica. Mediante avaliação retrospectiva, foram analisados 79 prontuários dos pacientes operados nos Mutirões I e II (Grupo A e 79 dos 80 operados nos Mutirões III e IV (Grupo B. Análise estatística: teste de Wilcoxon e exato de Fisher (pIntroduction: The growing list of patients awaiting cholecystectomy, together with the great demand for beds and operating rooms at University Hospitals have encouraged the adoption of different solutions. Objective: To evaluate the process of organization and the clinical results of intensive programs of cholecystectomy by videolaparoscopy on an ambulatory surgery basis. Methods: Among the 314 patients with symptomatic cholelithiasis who were waiting for surgery at HCFMRP-USP, 160 were selected for treatment on an ambulatory basis. A multiprofessional team consisting of surgeons, anesthesiologists, nurses and social workers scheduled 4 intensive programs to be performed on weekends according to the availability of the surgical block and of the post-anesthesia recovery room. In a retrospective evaluation, the authors analyzed 79 medical records of patients operated upon in the intensive programs I

  10. 免气腹悬吊式腹腔镜与常规腹腔镜胆囊切除术术后呕吐的研究%A Comparative Study of Vomiting after Gasless Laparoscopic Cholecystectomy of Abdominal Wall Lifting and Conventional Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    王淑贤; 于跃利; 陈彪; 董玉红

    2014-01-01

    Objective:To compare and analyse the patients′ state of postoperative nausea and vomiting(PONV)after gas-less laparoscopic cholecystectomy of abdominal wall lifting(GLC)and convention laparoscopic cholecystectomy(CLC). Meth-ods:60 patients hospitalized for chronic cholecystitis,cholecystolithiasis and gall bladder polypi in the First Affiliated Hospital of Baotou Medical College from July 2009 to March 2010 were randomly divided into GLC group(group A)and CLC group(group B),with 30 patients in each group. Results:The incidence of PONV went down with time in two groups. The incidence of PONV in group B was higher than that in group A at various stages. There was significant difference( P ﹤ 0. 05)in the incidence of nausea within 24 hours after the operation,and significant difference( P ﹤ 0. 05)in the incidence of vomiting within 12 hours after the operation,between the two groups. Conclution:Compared with that in CLC,The incidence of PONV was lower in GLC.%目的:研究悬吊式免气腹腹腔镜胆囊切除术术后发生恶心、呕吐的情况。方法:随机选择包头医学院第一附属医院2009年5月至2010年5月患有胆囊炎、胆囊结石或胆囊息肉入院的患者,随机分为免气腹腹腔镜胆囊切除术组(A 组)30例、传统腹腔镜胆囊切除术组(B 组)30例。结果:术后两组恶心、呕吐发生率随时间而降低,B 组各时间段恶心、呕吐发生率均高于 A 组,在术后24 h 内两组恶心发生率差异均有统计学意义( P ﹤0.05),在术后12 h 内两组呕吐发生率差异均有统计学意义( P ﹤0.05)。结论:免气腹腹腔镜胆囊切除术恶心、呕吐发生率低于传统腹腔镜胆囊切除术。

  11. 腹腔镜下胆囊切除术与常规开腹胆囊切除术治疗胆结石的临床效果研究%Research of clinical effects of laparoscopic cholecystectomy and conventional open cholecystectomy in the treatment of cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    贺志敬

    2015-01-01

    目的:比较腹腔镜下胆囊切除术与常规开腹胆囊切除术治疗胆结石的临床效果。方法90例胆结石患者,随机分为观察组(45例)与对照组(45例),观察组行腹腔镜下胆囊切除术治疗,对照组行常规开腹胆囊切除术治疗,比较两种术式手术时间、术中出血量、排气时间、下床时间、住院时间及并发症发生情况。结果观察组手术时间(53.35±5.11)min、术中出血量(43.85±12.64)ml、排气时间(11.34±5.30)h、下床时间(11.62±3.67)h、住院时间(6.28±2.67)d低于对照组(77.68±11.54)min、(75.20±18.32)ml、(19.65±7.43)h、(25.60±4.35)h、(8.85±1.30)d,差异均具有统计学意义(P lower operation time (53.35±5.11) min, intraoperative bleeding volume (43.85±12.64) ml, evacuation time (11.34±5.30) h, off-bed time (11.62±3.67) h, and hospital stay (6.28±2.67) d than those of the control group as (77.68±11.54) min, (75.20±18.32) ml, (19.65±7.43) h, (25.60±4.35) h, and (8.85±1.30) d, and their differences all had statistical significance (P<0.05). The total incidence of complications of the observation group as 4.44% (2/45) was lower than 17.78% (8/45) of the control group, and the difference had statistical significance (P<0.05).Conclusion Laparoscopic cholecystectomy has minimally invasive features, and it provides better indexes than conventional open cholecystectomy. This method contains high value in clinical application.

  12. 两孔法与三孔法腹腔镜胆囊切除术的临床比较研究%Comparative Study of Two-Port and Three-Port Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    冯轲; 李姿健; 杨永辉; 王琳

    2011-01-01

    Objective To compare and analyse the effects of two-port laparoscopic cholecystectomy and three-port laparoscopic cholecystectomy. Methods 102 patients who underwent laparoscopic cholecystectomy in Yui People's Hospital from Dec. 2008 to Jan. 2011 were randomly selected to receive either the two-port or the three -port technique. All patients were blinded to the type of operation they underwent. The length of the operation, bleeding amount, postoperative pain, postoperative complication, postoperative stay, and satisfaction of the patients score on scars were compared between two groups. Results In the two-port group, two cases had to be shifted to three-port LC due to severe adhesion. LC was successfully performed in all of the cases without conversion to laparotomy. In two-port group, the operative time was shorter than that of three port group (34.45 ± 6.56) min vs (48.8 ± 13.5) min, and there was a statistically significant difference ( P<0.05). Postoperative pain and postoperative satisfaction was significantly different ( P<0.05). Other parameters including bleeding amount, hospital stay and postoperative complication were similar between the two groups. Conclusion Two-port laparoscopic cholecystectomy is safe and feasible with a higher patient satisfaction score and lighter postoperative pain than the conventional three -port laparoscopic cholecystectomy.%目的 比较两孔法和三孔法腹腔镜胆囊切除术的方法和效果.方法 同 期(2008年12月至2011年1月)102例患者,手术由同一有丰富腹腔镜操作技术的医师进行腹腔镜胆囊切除术,随机分为两孔法腹腔镜切除术组(50例)或三孔法腹腔镜胆囊切除组(52例),比较手术时间、术中失血、术后疼痛、术后住院天数、术后并发症和患者对术后切口疤痕的满意度.结果 两孔法组2例患者因胆囊炎症及粘连严重而改为三孔法并顺利的完成手术.无中转开腹手术,比较两组病例,两孔法组

  13. 体位和残留二氧化碳对腹腔镜胆囊切除术后肩痛的影响%Effects of Body Position and Residual Carbon Dioxide Shoulder Pain after Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    蒙炯; 万智恒

    2015-01-01

    Objective To study the upper limb position and residual CO2 effects on shoulder pain after laparoscopic cholecystectomy. Methods In our hospital from 2014 January to 2014 june were treated 120 patients underwent laparoscopic cholecystectomy in a different position or not the degree of tilt and CO2 gas, randomly divided into A,B,C,D group, 30 cases in each group,with the same set of laparoscopic equipment,cholecystectomy,postoperative visual analogue scale method is used to evaluate four groups of patients of postoperative shoulder pain degree,compare the degree of postoperative pain. Results Compared with groupB and groupA, compared to patients with residual CO2 and postoperative pulled out, two groups of postoperative shoulder pain level was statistically significant (P≤0.05) or less, pulled out of postoperative shoulder pain of patients with residual CO2 gas loss; Group A compared with groupC, two groups of postoperative shoulder pain level was statistically significant (P≤0.05), the degree of postoperative shoulder pain in patients with groupC than in groupA. Conclusion laparoscopic cholecystectomy when take different upper position and whether or not the operation at the end of the residual CO2 gas discharge all affect the postoperative shoulder pain for patients. Laparoscopic cholecystectomy, the upper limb abducent angles should be at 60~70o,drawn and postoperative abdominal residual CO2,can reduce the degree of postoperative patients with shoulder pain.%目的:研究上肢体位和残留CO2对腹腔镜胆囊切除术后肩痛的影响。方法将该院于2014年1月-2014年6月收治的120例行腹腔镜胆囊切除术的患者按照体位倾斜程度以及CO2气体与否放入不同,随机分为A、B、C、D组,每组30例,用同一套腹腔镜设备,行胆囊切除术,术后采用视觉模拟评分法评估4组患者术后肩部疼痛程度,比较术后疼痛程度。结果A组与B组比较,术后抽出残留CO2气体与不抽出患者

  14. 腹腔镜胆囊切除术治疗急性发作期胆囊炎的临床分析%Clinical Analysis of Laparoscopic Cholecystectomy in the Treatment of Acute Exacerbation of Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    马振刚

    2015-01-01

    目的:探讨腹腔镜胆囊切除术治疗急性发作期胆囊炎的临床效果,为临床诊疗提供依据。方法:选取2012年1月至2014年1月我院收治的80例急性发作期胆囊炎患者为临床研究资料,随机分组获得对照组和观察组,各40例,观察组接受腹腔镜胆囊切除手术,对照组接受传统开腹胆囊切除术,对比分析两组治疗效果及并发症等。结果:观察组40例患者中38例完成腹腔镜胆囊切除手术,2例中转开腹,其中1例为Mirizzi综合征,1例因胆囊三角粘连紧密,均于于术中及时中转开腹以治疗。观察组和对照组在有效率、并发症和手术时间方面,两组比较均存在差异统计学意义(P<0.05),观察组治疗效果优于对照组。结论:腹腔镜胆囊切除术治疗急性发作期胆囊炎的临床较好,安全可行,可有效降低手术意外发生率,提高手术成功率。%Objective: To investigate the treatment of laparoscopic cholecystectomy in acute cholecystitis exacerbation of clinical results,that provide the basis for clinical diagnosis and treatment.Methods:80 cases of cholecystitis patients with acute exacerbation of clinical research data in our hospital from January 2012 toJanuary 2014,randomized to the control group and the observation group to get all 40 cases,the observation group underwent laparoscopic cholecystectomy, the control group received conventional open cholecystectomy, comparative analysis of the effect of treatment, and complications.Results:40 patients of the observation group, 38 cases of laparoscopic cholecystectomy,two cases laparotomy, including one case of Mirizzi syndrome, one case of gallbladder triangle close adhesion, both in laparotomy in patients with timely treatment. The observation group and the control group in an efficient,complications and operative time, the two groups were statistically significant differences (P<0.05), the observation group than the

  15. Colecistectomia laparoscópica: estruturação de um modelo de trabalho Laparoscopic cholecystectomy: structure of a working model

    Directory of Open Access Journals (Sweden)

    Henrique Walter Pinotti

    2000-04-01

    Full Text Available São apresentados os resultados de 1772 colecistectomias videolaparoscópicas, sendo 1.700 consecutivas sem mortalidade e baixa morbidade e rápida recuperação pós-operatória. Salienta-se a importância da sistematização técnica adotada para tais resultados, bem como do uso de instrumentos especiais de dissecção. É apresentada a estruturação de um modelo de trabalho para formação do cirurgião em cirurgia laparoscópica do aparelho digestivo, de maneira progressiva e sistematizada. O modelo implantado de formação e preparo do cirurgião, com rigor, profundidade e seriedade, é certamente responsável pelos resultados do nível de excelência obtidos.The authors showed the results of 1772 laparoscopic cholecystectomies, 1700 of them consecutevely without mortality and low morbidity and fast post-operative recovery. From the 1772 patients, 12,4% were over 70 years old; 49% of them had associated diseases. Surgical risk were evaluated from ASA I to IV. Chronic cholecystitis were present in 94,8% of the patients while, 3,6% had acute cholecystitis, and 0,2% gallblader cancer. Intraoperative cholangiography was performed in 83% of the cases. There were 67 patients with choledocolithiasis, 29 of them with no pre-operative clinical suspection. Conversion rate was less than 1%. Operative technique was standartized, beginning with the patient position in operative bed, trocars positioning, gallblader presentation with the graspers, as well as the timing of the structures dissection. The importance of the technical sistematization utilized is underlined, as well as the use of special instruments for dissection. It is presented a working model for surgical formation on alimentary tract laparoscopic surgery, in a progressive and sistematized way. It begins with the organization of a motivated surgical team, working together in order to improve the laparoscopic surgery methodology. The model for surgical formation of is responsible for the

  16. Nursing for patients with laparoscopic approach to postoperative abdominal bleeding after laparoscopic cholecystectomy%腹腔镜胆囊切除术后腹腔出血再次腹腔镜探查患者的护理

    Institute of Scientific and Technical Information of China (English)

    何月红; 王建华; 刘维

    2013-01-01

    Objective To explore the perioperative nursing for the patients with laparoscopic approach to abdominal bleeding after laparoscopic cholecystectomy.Methods Clinical materials of 7 patients with laparoscopic approach to abdominal bleeding after laparoscopic cholecystectomy were analyzed retrospectively.Results Among the 7 patients,2 patients had Trocar bleeding,2 patients had vascular bleeding of omental adhesion stripped surface,one patient had posterior bleeding of cystic artery and 2 patients had staxis in gallbladder bed.All the patients underwent operations successfully,and the duration of operation time was 40 to 90 minutes.No complications such as rehaemorrhagia,bile leakage and infection were observed after operation.Conclusion After laparoscopic cholecystectomy,the related work such as rigorous observation on abdominal bleeding,placement of drainage tube in postoperative period,nursing for patients with rehabilitation of gastrointestinal function and mental nursing should be well arranged and implemented.%目的 探讨腹腔镜手术后腹腔出血的观察及再行腹腔镜探查术的围术期护理.方法 回顾性分析7例腹腔镜胆囊切除术后腹腔出血再次腹腔镜探查术患者的临床资料.结果 7例患者中,2例为Trocar戳孔出血,2例大网膜粘连剥离面血管出血,1例胆囊动脉后支出血,2例胆囊床渗血.7例患者再次手术均顺利,手术时间为40~80 min,无术后再出血、胆漏、感染等并发症.结论 腹腔镜胆囊切除术后应严密观察,腹腔出血再次手术后必须做好引流管、胃肠功能恢复护理及心理护理.

  17. Application of dynamic intraoperative cholangiography using the C-arm X-ray machine during cholecystectomy%C型臂X线机下动态术中胆道造影在胆囊切除术中的应用

    Institute of Scientific and Technical Information of China (English)

    储文军; 刘峰; 韩江

    2012-01-01

    目的 探讨C型臂X线机下动态术中胆道造影在胆囊切除术中的应用价值.方法 对2006-2010年我科利用C型臂X线机对126例开腹胆囊切除术病例行动态术中胆道造影的资料进行回顾性分析.结果 造影成功122例,成功率96.8%.造影发现结石11例,其中胆总管结石8例,左肝管结石1例,右肝管结石2例,均行胆总管切开,胆道镜下取石,T管引流术.胆管损伤1例,行胆管修补.副肝管1例,Mirizzi综合征1例.均采取相应方法予以正确处理,一期愈合出院.全组无假阳性发生.平均耗时6.25min.结论 C型臂X线机下动态术中胆道造影法在胆囊切除术中是一种有效方法,省时,省力,显影清楚,值得推广.%Objective To evaluate the clinical value of dynamic intraoperative cholangiography using the C-arm X-ray machine during the process of cholecystectomy. Methods One hundred and twenty-six dynamic intraoperative eholangiography were retrospectively analyzed using the C-arm X-ray machine in cases of open cholecystectomy from 2006 to 2010 . Results 122 cases were successful imaging, the success rate was 96.8%. Biliary tract lithiasis were found in 1 1 cases, in whom 8 cases were common bile duct stones, 1 case left hepatic duct stones, 2 cases right hepatic duct, Choledochotomy, choledochoscope and T-tube drainage were performed in all cases , One case of bile duct injury which accepted bile duct repair was found. One case of bile duct variation and 1 case of Mirizzi suydrome was found. No false positive was found in this group. The average cholangiography time was 6.25 min. Conclusion Dynamic intraoperative cholangiography using the C-arm X-ray machine during cholecystectomy is fast, effective, and safe.

  18. 腹腔镜下胆囊切除术的手术室护理配合对策探讨%Discussion on the Countermeasures of Nursing Cooperation in the Operation Room of the Patients Undergoing Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    李洁

    2016-01-01

    目的:探析腹腔镜下胆囊切除术的手术室护理配合对策。方法选取2014年1月~2015年12月我院行腹腔镜下胆囊切除术的患者264例,随机分成两组:对照组与观察组,各组132例。对照组施行常规围手术期护理,观察组在对照组的基础上加强手术室护理配合,对两组护理效果予以观察对比。结果观察组患者的并发症发生率、手术时间、术中出血量均要少于对照组(P <0.05)。结论在腹腔镜下胆囊切除术治疗中,加强手术室护理配合,可以减少并发症的发生,缩短手术时间,减少术中出血量。%Objective To analyze the countermeasures of nursing cooperation in the operation room of the patients undergoing laparoscopic cholecystectomy. Methods 264 cases of laparoscopic cholecystectomy patients from January 2014 to December 2015 in our hospital were selected and were randomly divided into two groups: control group and observation group, 132 cases in each group. Control group received conventional perioperative nursing, the observation group on the basis of the control group strengthen the operating room nursing, the nursing effect of two groups was observed. Results The occurrence rate of complications, the operative time and the volume of intraoperative blood loss of observation group were less than that of control group (P<0.05). Conclusion In the treatment of laparoscopic cholecystectomy, strengthening the operating room nursing cooperation can significantly shorten the operation time and reduce the occurrence rate of complications and the volume of intraoperative blood loss.

  19. 预氧无正压通气在悬吊式腹腔镜胆囊切除术中的应用%Application of preoxygenation without positive-pressure ventilation in the suspended laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    王文明; 郭茂

    2011-01-01

    Objective:To investigate the application of preoxygenation without positive-pressure ventilation during rapid sequence induction of anesthesia and operation in suspended laparoscopic cholecystectomy. Methods: Forty patients who were scheduled for elective suspended laparoscopic cholecystectomy were randomly divided into two groups: preoxygenation group ( group A, n = 20 )and conventional induction group( group B,n = 20) ,SpO2 ,heart rate ( HR),blood pressure (BP) and electrocardiogram ( ECG) were monitored before induction and after intubation. Trachea intubation time and stomach tube utilization ratio were recorded. Results:There was no significant difference between 2 groups in general situation, HR, BP before and after intubation, and trachea intubation time.SpO2 dropped slightly after trachea intubation in group A, but it was still safe. Stomach tube utihzation ratio obviously increased in group B. Conclusions: Application of preoxygenation without positive-pressure ventilation in suspended laparescopic cholecystectomy is safe,and reduces the utilization rate of stomach tube.%目的:探讨预氧无正压通气在悬吊式腹腔镜胆囊切除术全麻快速诱导及术中的应用.方法:随机将40例行择期悬吊式腹腔镜胆囊切除术的患者分为A组(预氧组)和B组(常规诱导组),每组20 例,记录诱导前及插管后血氧饱和度(SpO2)、心率(heart rate,HR)、血压(blood pressure,BP)、心电图(electrocardiogram,ECG)及插管时间、胃管使用率.结果:两组患者一般情况、插管前后HR、BP及插管时间差异无统计学意义.A组SpO2轻度下降,但在安全范围内.B组胃管使用率明显增加.结论:预氧无正压通气用于悬吊式腹腔镜胆囊切除术是安全的,同时减少了胃管的使用.

  20. 腹腔镜胆囊切除术治疗急性发作期胆囊炎的临床治疗体会%Clinical experience of laparoscopic cholecystectomy for treatment of acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    顾伟勇

    2015-01-01

    目的:探讨腹腔镜胆囊切除术在急性发作期胆囊炎患者中的治疗效果。方法:收治胆囊炎急性发作期患者48例,随机分为对照组和试验组,试验组采用腹腔镜胆囊切除术治疗,对照组采用常规开腹手术治疗,比较两组的治疗效果。结果:试验组手术时间长于对照组,但术中出血量明显少于对照组(P<0.05)。试验组并发症发生率4.2%,明显低于对照组的25%(P<0.05)。结论:腹腔镜胆囊切除术治疗急性发作期胆囊炎患者效果满意,能减少患者并发症发生率。%Objective:To explore the clinical effect of laparoscopic cholecystectomy for treatment of acute cholecystitis.Methods:48 patients with acute cholecystitis were selected.They were randomly divided into the control group and the experimental group. The experimental group were treated with laparoscopic cholecystectomy.The control group were treated with conventional laparotomy.We compared the treatment effect of the two groups.Results:In the experimental group,the operation time was longer than that of the control group,but the amount of bleeding during the operation was significantly less than that of the control group(P<0.05).In the experimental group,the complication rate of 4.2% was significantly lower than 25% t in the control group(P<0.05).Conclusion:The clinical effect of laparoscopic cholecystectomy for treatment of acute cholecystitis is significant.It can reduce the incidence of complications in patients.

  1. Transumbilical Single-Port Laparoscopic Cholecystectomy Using Conventional Laparoscopic Instrumentation%常规腹腔镜器械下经脐单孔腹腔镜胆囊切除术

    Institute of Scientific and Technical Information of China (English)

    杜贻豹; 韩晓东; 狄建忠; 张弘玮; 周玉龙; 张频

    2012-01-01

    Objective: A prospective case series of transumbilical single-port laparoscopic cholecystectomy (TUSPLC) using conventional laparoscopic instrument is described. Methods: Eighteen selected patients with gallbladder pathologies underwent TUSPLC between March 2009 and July 2009. Three trocars via a single small umbilical incision and conventional laparoscopic instrument were used to perform the cholecystectomy. Results: This series of 18 patients (5 men and 13 women) had no conversion to standard multiport laparoscopy or open surgery. The patients had an average age of 39 years (range, 25-53 years). The average operating time was 69 min (range, 45-115 min). No significant blood loss or complications occurred. The mean postoperative hospital stay was 1.7 (range, 1.0-3.0) days. All of the patients were pleased with their results. At the 2-week follow-up, the umbilical incisions were nearly invisible, even to the patients. Conclusions: TUSPLC using conventional laparoscopic instrument is feasible. It can be performed without specialized instrumentation and at no extra cost. Additional studies randomizing standard laparoscopic cholecystectomy and TUSPLC are necessary for defining the exact role of this procedure.%目的:前瞻性分析常规腹腔镜器械下的经脐单孔腹腔镜胆囊切除术.方法:2009年3月至2009年7月,入选18例胆囊疾病患者行经脐单孔腹腔镜胆囊切除术.该手术使用常规腹腔镜器械及经脐部同一小切口的三个穿刺套管.结果:18例患者(男性5人,女性13人)均没有中转为常规多孔腹腔镜或开放手术.患者平均年龄39岁(25-53岁),平均手术时间69 min(45-115 min).无明显失血或并发症发生.患者平均术后住院天数为1.7天(1-3天).术后患者满意度为100%.术后2周,患者脐部切口几乎不可见.结论:常规腹腔镜器械下经脐单孔腹腔镜胆囊切除术是可行的.它能够在没有专门器械及额外费用的情况下实施.

  2. Application of Fast Track Surgery Idea in Laparoscopic Cholecystectomy%加速康复外科理念在腹腔镜胆囊切除术中的应用

    Institute of Scientific and Technical Information of China (English)

    黄河; 王钢; 熊怡南

    2014-01-01

    [Objective] To observe the clinical efficacy of fast-track surgery (FTS) idea used in laparoscopic cholecystectomy .[Methods] Totally 106 patients undergoing laparoscopic cholecystectomy were chosen and randomly divided into FTS group( n=53) and conventional treatment group( n=53) .The postoperative first exhaust time ,eating time ,postoperative ambulation time ,the incidence of nausea ,vomiting and surgical com-plications ,length of stay ,hospitalization cost and other indicators were compared between two groups .[Re-sults]Compared with the control group ,the first exhaust time after operation was shortened ,and postopera-tive eating and ambulation time were ahead ,and the length of stay was shortened ,and the hospitalization cost was reduced in FTS group .There was no significant different in the incidence of postoperative nausea ,vomi-ting and operation complications between two groups .[Conclusion] FTS can be widely used in laparoscopic cholecystectomy .%[目的]探讨加速康复外科(FTS)理念在腹腔镜胆囊切除术中的应用效果。[方法]选取106例腹腔镜胆囊切除手术患者,随机分为快速康复组(FTS组)53例和常规治疗组(对照组)53例。比较两组术后的首次排气时间、进食时间、术后下床时间及恶心呕吐和手术并发症的发生率、住院时间、住院费用等指标。[结果]与对照组比较,FTS组术后首次排气时间缩短,术后进食和下床活动时间均提前,住院时间缩短,住院费用降低(P<0.01或 P<0.05)。两组术后恶心、呕吐发生率及手术并发症的发生率差异无统计学意义(P>0.05)。[结论]加速康复外科可广泛应用于腹腔镜胆囊切除。

  3. Analysis of comfort care in laparoscopic complete cholecystectomy rehabilitation%腹腔镜胆囊完全切除术康复中的舒适护理分析

    Institute of Scientific and Technical Information of China (English)

    宗晓洁; 薛晓洁

    2015-01-01

    Objective:To discuss the effect of comfort care in laparoscopic complete cholecystectomy rehabilitation.Methods:118 patients with laparoscopic cholecystectomy were selected.They were randomly divided into the observation group and the control group,59 cases in each.The control group received routine nursing,and the observation group was given comfort care system.We analyzed nursing effect of the two groups.Results:In the observation group the physiological factors was superior to the control group,and the length of time to be shorter than that of the control group(P<0.05).The observation group on nursing satisfaction was higher than that of the control group(P<0.05).Conclusion:Using comfort care in laparoscopic complete cholecystectomy rehabilitation can significantly improve the patient's physiological and psychological state.It is helpful to postoperative recovery.%目的:探讨对腹腔镜胆囊完全切除术康复期的患者实施舒适护理的临床成效。方法:收治行腹腔镜胆囊完全切除术患者118例,随机分为观察组和对照组,各59例。对照组实施常规的护理干预,观察组进行系统的舒适护理。分析统计两组的护理成效。结果:观察组的生理状态要优于对照组,住院时间要短于对照组(P<0.05);观察组对护理的满意度高于对照组(P<0.05)。结论:对腹腔镜胆囊完全切除术康复期的患者实施舒适护理能够显著改善患者的生理和心理状态,有利于患者术后恢复。

  4. 针刺内关穴预防腹腔镜胆囊切除术后恶心呕吐的疗效观察%Effect of Acupuncture at“Neiguang”in Preventing Nausea and Vomiting after Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    Objective To observe the effect of acupuncture at“Neiguan”in preventing nausea and vomiting after laparoscopic cho-lecystectomy. Methods 178 cases for selective laparoscopic cholecystectomy were randomly divided into 3 groups: control group (n=60), metoclopramide group (n=58) and acupuncture at“Neiguan”group (n=60); the curative effects at the time point of 4h, 8h, 12h and 24h after surgery were observed and compared. Results The occurrence of nausea and vomiting within 8 hours after surgery in metoclo-pramide group and acupuncture at“Neiguan”group was lower than that in control group and the scores of Nausea Visual Analog Scale (NVAS) in acupuncture at“Neiguan”group was lower than that in control group. Conclusions Acupuncture at“Neiguan”is effective in preventing the occurrence of nausea and vomiting after laparoscopic cholecystectomy, it shares the same effect with metoclopramide, and can decrease the severity of nausea.%  目的观察针刺内关穴预防术后恶心呕吐(PONV)的疗效。方法行腹腔镜胆囊切除手术患者178例,随机分为对照组(60例)、甲氧氯普胺组(58例)及针刺内关穴组(60例),于术后4h、8h、12h、24h随访,进行疗效对比。结果在术后8h内甲氧氯普胺组和针刺内关穴组恶心呕吐发生率均较对照组低,针刺内关穴组恶心程度的视觉模拟评分(NVAS)较对照组低。结论针刺内关穴可预防腹腔镜胆囊切除术后恶心呕吐,与甲氧氯普胺等效,还可降低恶心程度。

  5. PROSPECTIVE, RANDOMIZED, DOUBLE BLIND STUDY TO COMPARE THE EFFICACY AND SAFETY OF GRANISETRON VERSUS ONDANSETRON IN PREVENTION OF POST OPERATIVE NAUSEA AND VOMITING IN PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANAESTHESIA

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    Vijayalakshmi

    2015-09-01

    Full Text Available OBJECTIVE : To compare the efficacy and safety of Granisetron versus Ondansetron in prevention of post - operative nausea and vomiting in patients undergoing elective Laparoscopic Cholecystectomy under general anaesthesia. MATERIALS AND METHODS: After the approval from IEC, the study was started and conducted over a period of two years i.e., from 2010 - 2012. Data was c ollected from 100 ASA I and II patients scheduled for laparoscopic cholecystectomy aged between 20 - 60 years at Government General Hospital, Kakinada. Both the study groups were selected from these patients. Written informed consent was taken from all patie nts . Preanesthetic medication was given with Ranitidine 150mg and Lorazepam 1mg, the night before and morning of surgery. Patients were randomly allocated into 2 groups. Group A - R eceived Inj. Ondansetron 8mg diluted in 5ml of normal saline . Group B - R ec eived Inj. Granisetron 1mg diluted in 5ml of normal saline . INJ. Glycopyrolate 0.01mg/kg & INJ. Fentanyl (1 - 2μ/Kg given intravenously 5min prior to induction of anaesthesia. All the vital data values recorded before & throughout surgery at 15 min interval for 2 hours. Patients were observed at 0 - 2hrs, 2 - 6hrs, 6 - 12hrs post operatively for episodes of PONV. RESULTS: At the end of the study , a complete response i.e., no PONV and no need for another rescue antiemetic was attained in 92 % of patients who received Granisetron and 68% of patients who received Ondansetron. No differences in adverse events were observed in the two groups. CONCLUSION: The incidence of PONV after laparoscopic cholecystectomy is large. In view of the proven advan tage of serotonin antagonists, we decided to study the antiemetic efficacy of Granisetron. After premedication, patients were administered the study drugs intravenously prior to the induction and balanced general anaesthesia was administered. Patients were observed for nausea and vomiting after the procedure at 0 - 2hrs, 2 - 6

  6. 复方阿嗪米特肠溶片对胆囊切除术后消化不良的临床疗效%Complex Azintamide Enteric-coated Tablet on the Clinical Efifcacy of Indigestion After Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    宋传芳

    2015-01-01

    目的:观察探究复方阿嗪米特针对胆囊切除手术后患者消化不良的临床疗效。方法选取我院收治的50例胆囊切除手术后消化不良的患者。将患者随机分为观察组和对照组,每组25例,对照组患者行常规治疗使用复方消化酶胶囊,观察组则使用复方阿嗪米特肠溶片,对比两组患者治疗情况。结果两组患者在治疗后均有好转迹象,且观察组总有效率高于对照组,两组有效率比较具有明显差异(P<0.05)。结论复方阿嗪米特对治疗胆囊切除术后产生的消化不良有明显疗效,且安全性较高。%Objective To observe and study the clinical curative effect of compound azintamide for cholecystectomy after operation in patients with dyspepsia.MethodsSelect our hospital 50 cases of cholecystectomy after operation patients with dyspepsia. The patients were randomly divided into observation group and control group, 25 cases in each group, the use of control Compound Digestive Enzyme Capsules group underwent routine treatment, the observation group was used Compound Azintamide Enteric-coated Tablets, compared two groups of patients with treatment. ResultsThe two groups of patients had signs of improved after treatment, and the total effective rate of observation group is obviously higher than that in control group. Two groups of efifciency compared with signiifcant difference (P<0.05).Conclusion Compound azintamide has obvious curative effect on the treatment of post cholecystectomy have indigestion, and higher security, has a positive effect on the clinical treatment.

  7. Laparoscopic Cholecystectomy for Acute Suppurative Cholecystitis:a Report of 452 Cases%腹腔镜治疗急性化脓性胆囊炎452例

    Institute of Scientific and Technical Information of China (English)

    毕保洪; 李华; 李伟; 张朝永

    2014-01-01

    目的:探讨腹腔镜胆囊切除术( laparoscopic cholecystectomy, LC)治疗急性化脓性胆囊炎的处理方法及并发症的预防措施。方法2003年10月~2013年6月我院采用四孔法LC治疗急性化脓性胆囊炎452例,因胆囊三角水肿和(或)粘连严重而无法分离,采用逆行腹腔镜胆囊部分切除术( laparoscopic partial cholecystectomy,LPC),胆囊管不能常规夹闭,采用缝扎或胆囊管开口处直接放置引流管引流,术后均常规放置腹腔引流管引流。结果3例因解剖困难中转开腹手术,382例成功完成LC,67例行LPC。 LC手术时间(55±20) min,术中出血量(80±10) ml;LPC手术时间(61±15) min,术中出血量(75±15) ml。术后胆漏21例,其中19例保守治疗成功,2例开腹治疗成功;切口感染致延期愈合18例。术后住院3~15 d,平均6.5 d。成功实施腹腔镜手术的449例,术后随访6~24个月(平均14个月),21例因其他疾病死亡,余428例无并发症发生。结论 LC治疗急性化脓性胆囊炎是一种安全可靠的方法,但及时中转开腹手术仍是手术医师最明智的选择。%Objective To investigate the management methods and complication prevention of laparoscopic cholecystectomy ( LC) for acute suppurative cholecystitis. Methods From October 2003 to June 2013, we performed 4-port LC on 452 patients with acute suppurative cholecystitis.The patients were given laparoscopic partial cholecystectomy ( LPC) by retrograde dissection because of serious edema and ( or ) adhesion of gallbladder triangle.Because the cystic ducts could not be clipped by conventional methods, primary suture or drainage tube placement was performed near the opening of the cystic duct.An abdominal cavity drainage tube was placed in all the cases. Results Among the 452 patients, LC was performed successfully in 382 patients, conversions to open surgery because of exposure difficulties were

  8. Alterações funcionais respiratórias na colecistectomia por via laparoscópica Functional respiratory changes in laparoscopic cholecystectomy

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    LUCIANA DIAS CHIAVEGATO

    2000-04-01

    Full Text Available Objetivo: Estudar as alterações da ventilação e volumes pulmonares e da força muscular respiratória no pós-operatório de colecistectomia por via laparoscópica. Tipo de estudo: Estudo prospectivo. Material e métodos: Foram avaliados 20 pacientes provenientes da enfermaria de gastrocirurgia da Unifesp, com média de idade 42,7 anos, sendo 7 (35% homens e 13 (65% mulheres. No período pré-operatório todos foram submetidos a um questionário clínico, exame físico, radiografia de tórax, espirometria. No pré e no pós-operatório foram obtidas as medidas da força muscular respiratória (pressões inspiratória e expiratória máximas, da ventilação pulmonar (volume corrente e volume minuto, da capacidade vital, a oximetria de pulso e o índice diafragmático (ID. Este índice é capaz de refletir o movimento toracoabdominal, determinado pelas mudanças nas dimensões ântero-posteriores da caixa torácica (CT e do abdome (AB e foi calculado utilizando-se a seguinte fórmula: ID = D AB/D AB + D CT. Resultados: Observou-se que os pacientes evoluíram no primeiro dia de pós-operatório com diminuição média significante de 26% do volume corrente, de 645ml ± 220ml para 475ml ± 135ml; 20% do volume minuto, de 15,0L ± 4,5L para 11,9L ± 3,6L; 36% da capacidade vital, de 2,7L ± 0,6L para 1,74L ± 0,7L; 47% da pressão inspiratória máxima, de -75 ± -22cm/H2O para -40 ± 17cm/H2O; 39% da pressão expiratória máxima, de +90 ± 28cm/H2O para +55 ± 28cm/H2O e 36% do índice diafragmático, de 0,60 ± 0,10 para 0,39 ± 0,14 (p Objective: The aim of this study was to measure the changes in lung volume, pulmonary ventilation, maximum respiratory muscle strength, and the incidence of pulmonary complications in patients undergoing elective laparoscopic cholecystectomy. Type of study: Prospective study. Material and methods: Twenty patients (7 men and 13 women with mean age of 42.7 years with normal respiratory function were studied. All

  9. 单孔腹腔镜与传统腹腔镜胆囊切除术治疗效果比较%A prospective randomized controlled trial: single-incision laparoscopic cholecystectomy vs.traditional three-port laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    吴万庆; 傅聿铭; 郭晓磊; 郭魁元; 崔小兵

    2015-01-01

    Objective To evaluate the clinical efficacy and safety of single-incision laparoscopic cholecystectomy (SILC) compared with conventional three-port laparoscopic cholecystectomy (3PLC).Methods Fifty-four patients diagnosed with biliary deases were included in this study at our institution.The patients were randomized into two groups:3PLC group (n =28) and SILC group (n =26).Data including gender,age,weight,height,body mass index,operative duration,pain scores,percentage of conversion during the operation and vancouver scar scale were prospectively collected and analyzed.Patients were prospectively collected and analyzed.Patients were followed up for 12 months.Results There were no significant differences between the two groups with respect to gender,age,weight,height and body mass index.The operation time in SILC group was significantly longer than that in 3PLC group [(56.9 ± 15.8) min vs.(35.2 ± 8.7) min,P < 0.01].On the first day after operation,the pain scores were higher for SILC with the application of equal narcotic drugs.There were no statistically signiicnat differences between the two groups in terms of total pain scores.Wound complications were severer in SILC,but there was no significant difference in incidence of incision hernia between the two groups.Cosmetic scores were favored for SILC (11.7 ± 0.8 vs.10.1 ± 1.2,P < 0.05).Conclusion This prospective randomized controlled study showed that SILC is safe and feasible in treating patients with simple biliary diseases compared with 3PLC.%目的 探讨单孔腹腔镜(SILC)与传统腹腔镜两种术式的安全性和可行性.方法 选取胆囊疾病患者54例随机分为SILC组(n=26)和三通道腹腔镜胆囊切除术(3PLC)组(n=28).收集患者年龄、体质量、身高、体质量指数(BMI)、手术时间、疼痛分数、中途转换手术率、切口满意度评分等临床资料,并进行了12个月的随访.结果 两组患者在性别、年龄、体质量、身高和BMI方面比

  10. Comparison between Transumbilical Single-incision Minilaparoscopic Cholecystectomy and Conventional Laparoscopic Cholecystectomy%经脐单切口微型腔镜胆囊切除术与传统腹腔镜胆囊切除术的比较

    Institute of Scientific and Technical Information of China (English)

    彭毅; 何立锐; 钟立明

    2012-01-01

    Objective To compare the efficacy of transumbilical single-incision minilaparoscopic cholecystectomy (mini-LC) with conventional LC, and the feasibility of transumbilical single-incision mini-LC with regular instruments. Methods Since June to November 2010, 60 patients with gallbladder disease were assigned to transumbilical single-incision mini-LC ( n = 30) or conventional LC ( n = 30) based on the date of the surgery. The two procedures were carried out by a same group of surgeons. All the instruments used in the mini-LC group were exactly the same as the conventional LC group except for the urethroscope, which was a 3-mm one. The operation time, intraoperative blood loss, postoperative pain score and complications, total hospital cost, and postoperative hospital stay were compared between the two groups. Results Without conversion to open surgery nor postoperative complications, the procedures were completed successfully in both the groups. Compared with the conventional group, mini-LC group showed longer operation time [ (62. 6 ± 30. 6) min vs. (47. 7 ± 21. 6 ) min, t = 2. 179, P = 0. 033 ] , but comparable intraoperative blood loss, postoperative pain score and hospital stay, total hospital cost, the other indicators showed no significant differences (all P>0.05). Conclusion Transumbilical single-incision mini-LC not only shows the advantages of traditional LC, but also has a better cosmetic results and less invasion than the conventional one.%目的 比较微型腔镜下经脐单切口胆囊切除术与传统腹腔镜胆囊切除术( laparoscopic cholecystectomy,LC)的临床效果,探讨应用常规器械行经脐单切口微型腔镜胆囊切除的可行性.方法 2010年6~11月60例胆囊良性疾病按手术日分为2组,由同一手术组医师分别施行经脐单切口微型腔镜胆囊切除术与传统LC,前者除换用3 mm尿道镜外,余均使用同样的设备和操作器械,比较2组手术时间、术中出血量、术后疼痛评分、术

  11. Morbimortalidade da colecistectomia em pacientes idosos, operados pelas técnicas laparotômica, minilaparotômica e videolaparoscópica Morbimortality of elderly patients submitted to cholecystectomy by laparotomy, minilaparotomy or videolaparoscopy

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    José Guilherme Minossi

    2007-06-01

    Full Text Available RACIONAL: A colelitíase é uma das doenças mais freqüentes do aparelho digestivo, acometendo 20% da população adulta. A idade tem sido considerada importante fator preditivo de complicações após a colecistectomia. OBJETIVO: Avaliar a morbimortalidade da colecistectomia em pacientes idosos operados por técnica laparotômica, minilaparotômica e videolaparoscópica. MÉTODO: Foram analisados retrospectivamente 557 pacientes submetidos à colecistectomia associada ou não a outros procedimentos sobre as vias biliares no período de julho de 1985 a dezembro de 2003. Desses, 152 pacientes (27,3% tinham 60 ou mais anos e 120 (79% eram do sexo feminino. Noventa e dois doentes foram operados por laparotomia, 46 por videolaparoscopia e 14 por minilaparotomia. RESULTADOS: As complicações ocorreram com mais freqüência e gravidade nos pacientes mais idosos e operados por laparotomia, sendo que estes apresentaram maior índice de infecção urinária, da ferida cirúrgica e maior tempo de permanência hospitalar. Houve três casos de óbito, sendo dois após laparotomia e outro após videolaparoscopia, todos acima de 70 anos de idade. CONCLUSÃO: A idade é importante fator preditivo de complicações após a colecistectomia, tanto pela incidência aumentada da doença do trato biliar complicada, como pela maior morbimortalidade da operação no idoso, em decorrência de doenças associadas.BACKGROUND: Cholelithiasis is one of the most frequent diseases regarding the digestive system. It is present in about 20% of the adult population, being age an important predictive factor for complications after cholecystectomy. AIM: To evaluate the morbimortality rates concerning elderly patients who underwent cholecystectomy and who are submitted to conventional practices, minilaparotomy and laparoscopy. METHODS: Five hundred and fifty seven patients submitted to cholecystectomy, associated or not to other procedures on the biliary tract, were observed

  12. 开腹及腹腔镜手术切除胆囊治疗结石性胆囊炎对比观察%Comparison observation laparotomy and laparoscopic cholecystectomy treating calculous cholecystitis

    Institute of Scientific and Technical Information of China (English)

    仲杨

    2016-01-01

    ABSTRAC:Objective To compare the effect of open and laparoscopic cholecystectomy in the treatment of gallstone cholecystitis. Methods in our hospital in January 2013 and 2015 January 100 cases of calculus cholecystitis patients were studied with different surgery were randomly divided into open surgery grouPand the laparoscopic group, there were 50 cases of patients in the laparotomy grouPunderwent conventional open cholecystectomy surgery, the laparoscopic grouPunderwent laparoscopic cholecystectomy, of two groups of patients with operation time, incision length, intraoperative bleeding and hospitalization time and other factors compared. Results compared with the open group, the operation time, incision length, blood loss and postoperative pain time of the laparoscopic grouPwere more ideal,P< 0.05, the difference was statistically significant. And, the proportion of complications of open surgery grouPwas 24%, compared with the open group, the probability of complications of laparoscopic grouPwas 12%, significantly lower,P< 0.05, the difference between the two groups was statistically significant.Conclusion laparoscopic cholecystectomy for gallstone cholecystitis can achieve good clinical results, it is worthy of clinical application in the future.%目的:将开腹及腹腔镜手术切除胆囊治疗结石性胆囊炎的效果进行对比。方法选取本院2013年1月至2015年1月收治的100例结石性胆囊炎患者进行研究,以手术方式的不同随机分为开腹组与腹腔镜组,两组均有50例患者,开腹组行传统开腹胆囊切除手术,腹腔镜组行腹腔镜胆囊切除术,对两组患者的手术时间、切口长度、术中出血量以及住院时间等因素进行比较。结果与开腹组相比,腹腔镜组的手术时间、切口长度、术中出血量以及术后疼痛时间等更为理想,P<0.05,差异具有统计学意义。并且,开腹组并发症所占比例为24.0%,与开腹组相比,腹

  13. 腹腔镜胆囊切除术与开腹胆囊切除术疗效比较%Clinical effect of laparoscopic cholecystectomy and laparotomy surgical treatment with cholecystolithiasis

    Institute of Scientific and Technical Information of China (English)

    张全轴

    2015-01-01

    目的:比较腹腔镜胆囊切除术与开腹胆囊切除术的临床治疗效果。方法收治胆囊结石患者102例,其中采取四孔法腹腔镜胆囊切除术(腔镜组)50例,采取传统开腹胆囊切除术(对照组)52例,比较两组患者的手术时间、术中出血量、术后首次下床时间、术后通气时间、引流管拔除时间、术后住院时间以及术后并发症发生率。结果腔镜组手术时间平均(61.36±10.23) min,术中出血量(21.04±5.44)ml,术后通气时间(1.70±0.64) d,引流管拔除时间(2.26±0.44) d,术后平均住院时间(3.26± 0.44)d。对照组手术时间平均为(80.08±8.44) min,术中出血量为(76.12±7.43) ml,术后通气时间为(3.08±0.75)d,腔镜组上述指标均优于对照组,差异均有统计学意义(P<0.05)。结论在具备良好的腹腔镜手术技术的基础上行腹腔镜胆囊切除术是安全有效的,值得在基层医院推广。%Objective To compare the clinical effect of laparoscopic cholecystectomy and laparotomy surgical treatment with cholecystolithiasis.Methods A total of 102 patients diagnosed as gallbladder stone in our hospital were selected and randomly divided into experimental group and control group.50 cases in experimental group were treated with four-hole laparoscopic cholecystectomy, 52 cases in control group were received conventional open cholecystectomy.The clinical effect were observed and compared by the two groups.Results In the experimental group, the mean operative time (61.36 ±10.23) min, the bleeding amount (21.04 ±5.44) ml, postoperative ventilation time (1.70 ±0.64) d, drainage tube removal time (2.26 ±0.44) d, the mean postoperative hospital stay time (3.26 ±0.44) d, the results were better than the control group, the difference was statistically significant(P<0.05).Postoperative complications had no statistically significant

  14. 胆囊癌腹腔镜胆囊切除术的疗效和安全性分析%Efficacy and safety of laparoscopic cholecystectomy for gallbladder carci-noma

    Institute of Scientific and Technical Information of China (English)

    罗钢; 淦勤

    2015-01-01

    目的:评价和分析胆囊癌腹腔镜胆囊切除术的疗效和安全性。方法我院从2011年5月~2013年12月接诊的90例胆囊癌患者,根据患者的意愿分为治疗组和观察组。治疗组50例,观察组40例,治疗组的患者行腹腔镜胆囊切除术治疗,观察组的患者行传统开腹胆囊切除术治疗。将两组患者的手术时间、术后恢复相关指标、安全性、术后并发症及术后一年的复发状况的结果统计并进行对比。结果治疗组患者在术后恢复的相关指标包括切口长度、术后疼痛、排气时间、下床时间、住院天数、术后引流量及引流天数明显的低于观察组的患者,差异有统计学意义(P<0.05);治疗组患者的手术时间、术后并发症及术后一年的复发状况明显的低于观察组的患者,差异有统计学意义(P<0.01)。结论腹腔镜胆囊切除手术,不仅切口安全美观,减轻了患者的痛苦,而且有效地降低了手术时间、术后恢复期、术后并发症以及术后一年的并发状况,值得临床上加以推广和应用。%Objective To evaluate and analyze the efficacy and safety of laparoscopic cholecystectomy for gallbladder carcinoma. Methods 90 cases of patients with gallbladder cancer were selected in our hospital from May 2011 to De-cember 2013, according to the wishes of patients,they were divided into the treatment group and observation group. There were 50 cases in the treatment group and 40 cases in the observation group.Patients in treatment group were treated with cholecystectomy,the observation group was treated with conventional open cholecystectomy.The operation time and postoperative recovery of the two groups were compared with the results of one year after operation. Results The postoperative recovery index included incision length,postoperative pain,exhaust time, bed time,hospital stay,post-operative drainage and drainage days of patients in the treatment group was

  15. Clinical study on the maintenance of general anesthesia in elderly patients undergoing laparoscopic cholecystectomy%老年患者腹腔镜胆囊切除术全麻维持的临床研究

    Institute of Scientific and Technical Information of China (English)

    李仕明; 杨小英; 郑燕萍

    2016-01-01

    目的:探讨老年患者腹腔镜胆囊切除术全麻维持的临床研究。方法:选取70岁以上行腹腔镜胆囊切除术老年患者80例随机分为A、B两组各40例:A组使用右美托咪定+瑞芬太尼麻醉维持,B组采用丙泊酚+瑞芬太尼麻醉维持。观察记录患者不同时间点的心率(HR)、平均动脉压(MAP)和脑电双频指数值(BIS)值。术后对两组患者进行改良OAA/S评级及Steward苏醒评分并观察记录苏醒时间、不良反应情况。结果:两组患者BIS在不同时间点差异无统计学意义;在各时间点A组患者的HR、MAP明显低于B组,且相邻两个时间点A组患者HR、MAP变化幅度小于B组(P<0.05);术后两组患者改良OAA/S评级、Steward苏醒评分及苏醒时间比较差异无统计学意义。结论:老年患者行腹腔胆囊切除术时采用右美托咪定取代丙泊酚作为麻醉镇静剂,对患者术中麻醉维持时血流动力学影响小,安全性好,效果显著。%Objective: To investigate the clinical study on laparoscopic cholecystectomy in elderly patients undergoing laparoscopic cholecystectomy. Methods:Eighty cases of elderly patients over 70 years old underwent laparoscopic cholecystectomy were randomly divided into group A (dexmedetomidine+remifentanil) and B (propofol+remifentanil) with 40 cases each. Heart rate (HR), mean arterial pressure (MAP) and bispectral index (BIS) at different time points were investigated. The patients were assessed by the modiifed OAA/S rating and Steward recovery score and the recovery time and the adverse reaction were observed after the operation. Results: The comparison of BIS at different time points showed no statistical significance. HR and MAP were significantly slower or lower in group A than group B and the changes of HR and MAP at two adjacent time points were less in group A than group B (P<0.05). After the operation, there were no signiifcant differences between the two

  16. 影响腹腔镜胆囊切除术胆管损伤的相关危险因素研究%Research on correlated risk factors of bile duct injury induced by laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    龙胜林; 杨华; 顾超; 唐海静; 舒易超

    2015-01-01

    Objective To explore the correlated risk factors of bile duct injury induced by laparoscopic cholecystectomy ,and to reduce the rate of bile duct injury companied with LC and improved patients condition after LC .Methods One thousand two hun‐dred and forty four patients who had been done the laparoscopic cholecystectomy in our hospital were searched from December 2003 to December 2013 for their case notes .The relationship between rate of bile duct injury induced by laparoscopic cholecystectomy and gender ,age ,time of LC surgery ,pathology ,gallbladder wall thickness ,liver function levels ,the existence of the gallbladder triangle anatomical anomalies and physician experience were analyzed by logistic regression method .Results Logistic regression analysis showed that patients did LC surgery at early time ,with acute cholecystitis ,with gallstones combined effusion ,with gallbladder wall thicker than 4 mm and with gallbladder triangle anatomical anomalies were likely to have bile duct injury induced by LC (P<0 .05) .And doctor′s experience on LC is another important factor as well (P<0 .05) .Conclusion According to the correlated risk factors of bile duct injury caused by laparoscopic cholecystectomy ,methods should be employed to reduce the bile duct injury .And sharing experience between doctors and learning new techniques could be helpful ,too .%目的:探讨腹腔镜胆囊切除术并发胆管损伤的相关危险因素,以减少胆管损伤的发生率,改善患者预后。方法察看2003年12月至2013年12月在该院行腹腔镜胆囊切除手术的1244例患者的病历及病程记录。对患者性别、年龄、行LC术时间、病理、胆囊壁厚度、术前肝功水平、是否存在胆囊三角解剖异常情况和医师经验等因素与LC并发胆管损伤的相关性进行Logistic回归分析。结果LC手术时间早、急性胆囊炎患者、合并胆囊积液的胆结石患者、胆囊壁厚度大于4mm、胆囊三角解剖存在

  17. Serum oxidative stress is increased in patients with post cholecystectomy bile duct injury Aumento del estrés oxidativo en el suero de pacientes con lesiones de vías biliares postcolecistectomía

    Directory of Open Access Journals (Sweden)

    A. G. Miranda-Díaz

    2010-06-01

    Full Text Available Background: post-cholecystectomy bile duct injuries are identified by the onset of jaundice as well as elevated bilirubin and alkaline phosphatase levels during the peri-operative period. It is unknown how serum oxidative stress markers are modified in patients with post-cholecystectomy bile duct injuries. Objective: to determine serum oxidative stress marker levels (lipid peroxidation by-products, nitrites/nitrates and total antioxidant capacity in patients with post-cholecystectomy bile duct injuries. Patients and methods: a prospective, transversal and analytical study was designed with two groups. Group 1: 5 healthy volunteer subjects. Group 2: 52 patients with post-cholecystectomy bile duct injuries (43 female and 9 male. An elective bilio-digestive reconstruction was performed at week 8. The serum oxidative stress marker levels were quantified by colorimetric method. Results: patients with bile duct injuries had a significant increased serum lipid peroxides (malondialdehyde and 4-hydroxy-alkenals and nitric oxide metabolites (nitrites/nitrates levels compared to the control group. In contrast, total antioxidant capacity in patients with bile duct injuries remained similar compared to healthy controls. Conclusions: the results show that oxidative stress is usually associated to bile duct injury.Introducción: las lesiones de las vías biliares postcolecistectomía se establecen por la aparición de ictericia, elevación de las bilirrubinas y de la fosfatasa alcalina durante el periodo perioperatorio. Se desconoce cómo se modifican los marcadores de estrés oxidativo en el suero de los pacientes con lesiones de las vías biliares postcolecistectomía. Objetivo: determinar los marcadores de estrés oxidativo (productos de peroxidación de lípidos, catabolitos del óxido nítrico y capacidad antioxidante total en el suero de pacientes con lesiones de las vías biliares. Pacientes y métodos: se realizó un estudio prospectivo transversal

  18. The efficacy and safety of intravenous parecoxib analgesia for laparoscopic cholecystectomy%帕瑞昔布钠超前镇痛用于腹腔镜胆囊切除术的临床效果评价

    Institute of Scientific and Technical Information of China (English)

    陈江山; 杨孟昌; 牟玲; 兰志勋

    2012-01-01

    Objective To evaluate the efficacy and safety of intravenous parecoxib analgesia for laparoscopic chole-cystectomy. Methods 60 patients ASA I ~ II grade aged(20)-(56) undergoing laparoscopic cholecystectomy were randomly divided into two groups(n= 30): Group I, the tramadol group and group 2, the parecoxib group. The tramadol group were given a bolus of 200mg tramadol 30 minutes before operation while the parecoxib group were given abolus of 40mg parecoxib 30 minutes before operation. The blood pressure, heart rate, pain scores VAS (visual analog scale), Prince Henry score (PHS), Ramsay sedation score, nausea, vomiting, itching, urinary retention and other adverse reactions were recorded in 4,8,12,16,20 and 24 hour postoperation respectively. Results There were no significant differences of the VAS and PHS score between the two groups. In group I,Ramsay sedation score were higher group II at the 4 hour postoperation and 8 hour postoperation and 12 hour postoperation. The complaint of nausea, vomiting and dizziness in group I were higher than group H. Conclusion There were no differences in analgesic effect between tramadol and parecoxib during laparoscopic cholecystectomy. Parecoxib was safer in analgesia without excessive sedation and lower nausea and vomiting and dizziness during laparoscopic cholecystectomy.%目的 评价静脉注射帕瑞昔布钠超前镇痛用于腹腔镜胆囊切除术的效果与安全性.方法 对60例ASAⅠ~Ⅱ级,择期行腹腔镜胆囊切除术的患者随机分为2组:曲马多组(Ⅰ组,n=30),术前30分钟静脉注射200mg曲马多;帕瑞昔布钠组(Ⅱ组,n=30),术前30分钟静脉注射40mg帕瑞昔布纳(特耐).分别于术后4、8、12、16、20、24 h观察BP、HR、疼痛评分VAS(视觉模拟评分法)、Prince Henry评分(PHS)、Ramsay镇静评分及恶心、呕吐、瘙痒、尿潴留等不良反应.结果 VAS、PHS评分两组患者无显著性差异(P>0.05);Ramsay镇静评分在4、8、12h时,Ⅰ组高于Ⅱ

  19. Analysis the Curative Effect of Laparoscopic Cholecystectomy for Acute Cholecystitis%探析腹腔镜胆囊切除术治疗急性胆囊炎的疗效

    Institute of Scientific and Technical Information of China (English)

    许兴; 黄照果

    2015-01-01

    Objective To analyze the application of laparoscopic resection of acute cholecystitis treated effect. Methods in our hospital 35 cases of patients with acute cholecystitis laparoscopic excision, the other 35 cases patients with acute cholecystitis with conventional open cholecystectomy operation, comparison of two kinds of operation mode effect. Results the curative effect is better than traditional open operation group used laparoscopic resection in the treatment of acute cholecystitis, operation time and bleeding volume less than traditional laparotomy group, there is statistical signiifcance. Treatment of acute cholecystitis resection is safe and reliable, the conclusion of laparoscopic cholecystectomy and exact curative effect, it is worth in clinical application.%目的:分析急性胆囊炎应用腹腔镜切除术进行治疗的疗效。方法对我院收治的急性胆囊炎患者35例应用腹腔镜进行切除,另外35例急性胆囊炎患者应用常规的开腹手术切除胆囊,比较两种手术方式的效果。结果应用腹腔镜切除术治疗急性胆囊炎的疗效优于传统开腹手术组,手术时间与出血量也比传统开腹组少,有显著的统计学意义。结论腹腔镜胆囊切除术治疗急性胆囊炎安全可靠,疗效确切,值得在临床推广应用。

  20. 曲马多超前镇痛在腹腔镜胆囊切除术中的应用%Tramadol Analgesia in Advance in the Application of Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    李灵玲

    2013-01-01

    目的:探讨曲马多超前镇痛对腹腔镜胆囊切除术患者的影响。方法选择全麻患者60例,随机分为c组(对照组,n=30)、T组(曲马多组,n=30)。术中切实补足血容量。试验组手术前l5min静脉注射曲马多l00mg(10ml),对照组注射生理盐水l0ml作为对照。记录术后1、2、4、6、12和24h视觉模拟评分(vAs)。结果试验组VAS明显低于对照组(P<0.05)。结论曲马多超前镇痛对腹腔镜胆囊切除术患者产生较好的镇痛效果。%Objective to investigate tramadol advanced analgesic ef ect on patients with laparoscopic cholecystectomy. Methods select 60 cases patients with general anesthesia, were randomly divided into group c (control group, n=30), group T (tramadol group, n=30). Intraoperative supplement blood capacity. Patients before surgery l5min intravenous tramadol lOOmg (10 ml) and control group injected physiological saline lOml as controls. Record postoperative 1, 2, 4, 6, 12 and 24 h visual analogue scale (vAs). Results VAS trial group was lower than that in control group (P< 0.05). Conclusion tramadol analgesia in advance bet er analgesic ef ects of laparoscopic cholecystectomy patients.

  1. 腹腔镜胆囊切除术后胆漏的诊治体会(附34例报告)%Diagnosis and treatment of biliary leakage after laparoscopic cholecystectomy with a report of 34 cases

    Institute of Scientific and Technical Information of China (English)

    余同辉; 黄峻松; 黄奕江; 侯金华; 高显清

    2012-01-01

    Objective:To investigate the cause and treatment of biliary leakage after laparoscopic cholecystectomy. Methods: The clinical data of 34 patients who suffered from biliary leakage after LC between Feb. 2000 and Feb. 2012 were analyzed retrospectively. Results: Open surgery were conducted in 3 patients, B ultrasound-guided percutaneous cholecystostomy were executed in 6 patients,25 patients received conservative treatment. All patients were cured with no stenosis of bile duct, cholangitis, recurrence, or peritoneal abscess occurred. Conclusions: A strict control of operation indication as well as meticulous management of Calots triangle can help to reduce incidence of postoperative biliary leakage. It is necessary to place abdominal drainage when Calot s triangle can not be fully dissected.%目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后胆漏的原因及诊治措施.方法:回顾分析2000年2月至2012年2月LC术后34例患者发生胆漏的临床资料.结果:开腹手术治疗3例,B超引导下穿刺引流6例(引流管引流不畅所致),保守治疗25例.患者治疗后均痊愈,无胆管狭窄、胆管炎、再次胆漏及腹腔脓肿等严重并发症发生.结论:术前严格掌握手术适应证,术中精细解剖胆囊三角,以减少术后胆漏的发生;术中胆囊三角解剖不清时,放置引流是必须的.

  2. 超声检查对腹腔镜胆囊切除术难度的预测价值%Value of preoperative sonography in predicting difficulties of laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    王晶明; 沈君礼; 白新艳; 丁蓉; 袁雪红

    2011-01-01

    Objective:To discuss the value of preoperative ultrasound in predicting possible difficulties of laparoscopic cholecystectomy( LC ). Methods:A total of 793 patients with chronic cholecystitis received ultrasonography examination. Before LC, the gallbladders were comprehensively examined to observe the contour, gallbladder necks, wall thickness, wall echoes, intra-cyst echoes in these patients. Preoperative data and intraoperative data were compared to access pericholecystic and Calot triangular area adherence. Results:Sensitivity,specificity and accuracy of preoperative sonography for predicting the difficulty of LC was 91.32% ,97.51% and 95.08%, respectively. Conclusions:Preoperative ultrasonography is valuable for predicting difficulties during LC.%目的:评价术前超声检查对预测慢性胆囊炎患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)难度的应用价值.方法:793例患者因慢性胆囊炎行LC,术前超声检查对胆囊轮廓、胆囊颈部、囊壁厚度、囊壁回声、囊内回声情况进行综合分析,评估胆囊周围、Calot三角区的粘连程度,并与手术病理进行对照.结果:超声检查综合评估胆囊与周围组织粘连程度的敏感性为91.32%,特异性97.51%,准确性95.08%.结论:术前超声检查对预测慢性胆囊炎患者施行LC的难度有较高的临床价值.

  3. Population Preferences for Various Approaches of Cholecystectomy%不同人群对胆囊切除手术方式的选择

    Institute of Scientific and Technical Information of China (English)

    李潇娴; 朱江帆; 忻颖

    2012-01-01

    Objective To evaluate population perception of various ways of cholecystectomy, ao that to understand patients' demands, which is a base for further clinical trials, surgical training, and innovation of technology and equipment. Methods Since June 2010 through March 2011, an anonymous questionnaire was given to patients, doctors and nurses, who were requested to select the preferred approach among open surgery (OS), laparoscopic surgery ( LS) , transumbilical endoscopic surgery (TUES), and natural orifice transluminal endoscopic surgery ( NOTES). Results Totally 198 questionnaires were valid among the 200, including 128 from patients (65% ) , and 35 ( 18% ) from doctors and nurses. LS was the most popular approach, which was accepted by 96 people (49% ) , followed by TUES, chosen by 84 people (42% ). Only 12 people (6% ) chose NOTES, and six people (3% ) chose OS. Conclusions As the "gold standard", LS has been accepted by most people. TUES, as a new technology, is accepted by female and young people, due to its good cosmetic outcomes. NOTES is still not an ideal option for safety, feasibility and other potential reasons.%目的 研究不同人群对不同胆囊切除手术方式的选择,明确患者对新技术的需求,从而能够据此结果进行相关的临床试验、手术训练以及技术、器械的革新. 方法 2010年6月~2011年3月,在不同人群中进行无记名问卷调查,将开腹手术(open surgery,OS)、腹腔镜手术(laparoscopic sugery,LS)、经脐内镜手术(transumbilical endoscopic surgery,TUES)、经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)4种胆囊切除手术方式供医生、护士、住院患者选择.结果 200份问卷中,有效问卷198份.其中患者128人(65%),医生及护士各35人(18%).LS是最受欢迎的术式,被96人(48%)接受,其次是TUES 84人(42%),只有12人(6%)选择NOTES,6人(3%)选择开腹手术. 结论 LS作为胆囊切除的“金标准”,较之传

  4. 两孔腹腔镜胆囊切除术的探讨%Clinical Application of Two-Port Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    赵建国; 孙力; 邱斌; 蔡兵

    2012-01-01

    Objective To discuss the safety, feasibility, and advantages of two-port laparoscopic cholecystec-tomy (LC). Methods The clinical data of 114 patients underwent LC from June 2008 to October 2010 were retrospectively analyzed, of which 46 underwent two-port LC (two-port LC group, n=46) and 68 underwent three-port LC (three-port LC group, n=68). The operation time, intraoperative blood loss, postoperative feeding time, postoperative pain, postoperative hospital stay, and hospitalization expenses were compared between two groups. Results All the operations were successful, no postoperative complications occurred in both groups. The operation time in the two-port LC group was longer than that in the three-port LC group (P0. 05). The hospitalization expenses in the two-port group was less than that in the three-port group (P < 0. 05). Conclusions Two-port LC is a safe and feasible operation in the simple gallstone patients. It is cautious in those patients with acute cholecystitis because of the restricted vision and operation.%目的 探讨两孔腹腔镜胆囊切除术(LC)的安全性、可行性及优势.方法 回顾性分析2008年6月至2010年10月期间无锡市人民医院开展的两人两孔LC(两孔LC组,n=46)及同期完成的两人三孔LC(三孔LC组,n=68)胆囊结石患者的临床资料,比较2组的手术时间、术中出血量、术后进食时间、术后疼痛评分、术后住院时间及总住院费用.结果 114例患者手术均获成功,术中、术后无并发症发生.两孔LC组的手术时间明显长于三孔LC组(P<0.05);2组的术中出血量、术后进食时间、术后疼痛评分及术后住院时间比较差异均无统计学意义(P>0.05);两孔LC组的住院费用明显低于三孔LC组(P<0.05).结论 两人两孔LC在单纯胆囊结石病例安全、可行,总住院费用低于两人三孔LC;在胆囊结石合并急性胆囊炎病例,因视野及操作均受限,应谨慎开展.

  5. Influence of Pneumoperitoneum on Liver Function after Operation in Diabetic Patients with Laparoscopic Cholecystectomy%腹腔镜胆囊切除术气腹对糖尿病患者术后肝功能的影响

    Institute of Scientific and Technical Information of China (English)

    张小斌; 周毅; 张将; 赵俊; 杜强

    2015-01-01

    Objective:To investigate the influence of CO2 pneumoperitoneum on liver function in diabetic patients who received laparoscopic cholecystectomy.Method:60 patients who received cholecystectomy in our hospital from January 2013 to December 2014 were selected as the research objects.They were all with gallbladder stones, chronic cholecystitis and diabetes mellitus.They were divided into group Ⅰ,group Ⅱ and group Ⅲ according to the intra-abdominal pressures of CO2 pneumoperitoneum,with each group 20 cases.Group Ⅰ and group Ⅱ were given laparoscopic cholecystectomy with pneumoperitoneum pressures 12 and 15 mm Hg respectively.Group Ⅲ was given open cholecystectomy.1 day before operation and 1,24,48 and 72 hours after operation,venous blood was collected to determine the concentrations of ALT,AST and TBIL in serum.Result:1,24 and 48 hours after operation,the levels of ALT,AST and TBIL in group Ⅰ and group Ⅱ were significantly higher than those before operation and those in group Ⅲ.72 hours after operation,the levels of ALT,AST and TBIL in group Ⅱ were significantly higher than those before operation and those in group Ⅲ.The differences above were all statistically significant(P<0.01).After operation,the levels of ALT,AST and TBIL in group Ⅲ were higher than those before operation,but only 24 hours after operation,the differences were statistically significant(P<0.05).The levels of ALT,AST,and TBIL in group Ⅱ were significantly higher than those in group Ⅰ at all times after operation,the differences were statistically significant(P<0.05). Conclusion:Diabetic patients who use conventional pneumoperitoneum pressure in laparoscopic cholecystectomy have less abnormal liver function than high pneumoperitoneum pressure.%目的:探讨腹腔镜胆囊切除术CO2气腹对于糖尿病患者术后肝功能的影响.方法:选择2013年1月-2014年12月于本院行胆囊切除术的胆囊结石伴慢性胆囊炎合并糖尿病的患者60

  6. 经脐单孔腹腔镜与传统腹腔镜胆囊切除术的疗效对比观察%Efficacy of umbilical hole laparoscopic and conventional laparoscopic cholecystectomy:a comparative study

    Institute of Scientific and Technical Information of China (English)

    卢茂松; 黄钲焘; 曾鹏飞

    2011-01-01

    OBJECTIVE To comparatively study of laparoscopic and conventional single hole through umbilical laparoscopic cholecystectomy patients. METHODS A total of selective 139 cases with cholecystectomy surgical indications were randomly divided into treatment group (82 cases )and control group (57 cases), were carried out by the umbilical hole laparoscopic cholecystectomy with conventional laparoscopic; of the operation timet blood loss, get active time, postoperative hospital stay (d) and complication ratesi the satisfaction of the patients with abdominal wounds were investigated after 1 month and statistically analyzed. RESULTS The operation time (min) , blood loss (ml), get active time (h) , postoperative hospital stay (d) and complication rates were (52. 1±6. 7) and (33. 8±7. 2),(39. 2±l2. 5) and (42. 7±11.9), (14. 3±6. 5) and (12. 6±6. 7), (5. 7±1.3 )and (5. 2±1. 1), the incidence rates of the complications were 2. 44% and 1. 75% which showed significant difference on the treatment group increased operative time (P0. 05) ; 1-month follow-up two patients after abdominal wounds were very satisfied with the degree of 96. 34% and 8. 77% > the difference between them was statistically significant (P<0. 05). CONCLUSION The clinical efficacy of the umbilical hole laparoscopic cholecystectomy is similar to conventional laparoscopic cholecystectomy except the increased operation time with the good wound healing and scars hidden ? Which can make the abdominal wall wounds actually achieve the beautiful effect.%目的 对照研究经脐单孔腹腔镜与传统腹腔镜胆囊切除术的疗效.方法 选择具有择期胆囊切除术手术指征者139例随机分治疗组82例、对照组57例,分别进行经脐单孔腹腔镜与传统腹腔镜胆囊切除术;分析其手术时间、术中出血量、下床活动时间、术后住院天数及并发症发生率;1个月后对患者进行腹壁创口满意度调查;并进行统计分析.结果治疗者与对

  7. Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a Meta-analysis of randomized controlled trials%单孔与传统腹腔镜胆囊切除术的比较:随机对照试验的Meta分析

    Institute of Scientific and Technical Information of China (English)

    邝学军; 彭钊; 胡志立; 王建钧

    2013-01-01

    Objective: To evaluate the efficiency and safety of single-incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC). Methods: The literature of randomized controlled trials (RCTs) concerning SILC versus CLC was retrieved by searching the electronic databases from their inception date to November 2012. Methodological quality of the included trials was assessed using the Cochrane Reviewers' Handbook criteria, and data were extracted and combined into a Meta-analysis by using RevMan 5.1 analysis software. Results: Seventeen studies were finally selected after screening, with a total of 1 267 patients, of whom, 654 cases underwent SILC and 613 cases underwent CLC. Meta-analysis results demonstrated that the operative time in SILC group was longer than that in CLC group (WMD=13.02, 95%CI=7.95-18.09, P<0.00l); the scores for the postoperative appearance of incision and patient-satisfaction in SILC group were higher than those in CLC group (WMD=1.21, 95%CI=0.70-1.72, P<0.001; WMD=0.76, 95%CI=0.53-1.00, P<0.001); the postoperative complications, postoperative pain scores and lengths of hospital stay between the two group showed no statistical difference (RR=1.13, 95%CI=0.87-1.48, P=0.35; WMD=0.03, 95%CI=-0.82-0.88, P=0.95; WMD=-0.06,95%CI=-0.40-0.28, P=0.73). Conclusion: For uncomplicated cases of benign gallbladder disease, SILC is a safe and effective surgical procedure with the advantages of a good cosmetic incision and high patient satisfaction.%目的:评价单孔腹腔镜胆囊切除术(SILC)与传统腹腔镜胆囊切除术(CLC)的安全性和有效性.方法:计算机检索各数据库中有关SILC与CLC的前瞻性随机对照试验.检索时限均为建库至2012年1 1月.按Cochrane系统评价员手册对纳入文献的方法学质量进行评价后,提取数据,采用RevMan 5.1统计软件行Meta分析.结果:筛选后最终纳入17个研究,共1 267例患者,其中SILC组654例,CLC组613例.Meta分析结果显示

  8. Videocirurgia robótica: estudo clínico prospectivo na colecistectomia laparoscópica Robotic surgery for laparoscopic cholecystectomy: a prospective study

    Directory of Open Access Journals (Sweden)

    Ricardo Zorrón

    2005-08-01

    videocirurgia robótica à distância.BACKGROUND: Robotic surgery is a new clinical and technological advance in its e