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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...... the relationship of gender to conversion rate and length of hospital stay after laparoscopic cholecystectomy in a national cohort of patients....

  4. 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...

  5. 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.

  6. 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

  7. Sleep after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

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

    1996-01-01

    .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...... compared with the preoperative night. Comparison of our results with previous studies on SWS and REM sleep disturbances after open laparotomy, suggests that the magnitude of surgery or administration of opioids, or both, may be important factors in the development of postoperative sleep disturbances.......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...

  8. 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 ...

  9. 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...

  10. Comparison of open cholecystectomy with laparoscopic cholecystectomy using latest variables of pulmonary functions as parameters

    International Nuclear Information System (INIS)

    Comparison of open cholecystectomy with laparoscopic cholecystectomy using latest variables of pulmonary functions as parameters To compare open holecystectomy with laparoscopic cholecystectomy using latest variables of pulmonary functions as parameters. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Surgery, CMH Rawalpindi from May 2010 to Nov 2010. Patients and Methods: Patients with symptomatic cholelithiasis subjected to elective cholecystectomy were studied. The patients were divided into two groups. Open Cholecystectomy was performed on patients in group I, and laparoscopic cholecystectomy was performed in patients in group II. Respiratory function tests were performed preoperatively and on the morning of the 1st post-operative day. Results: Preoperative pulmonary function tests were normal and did not differ significantly between the two groups. After operation a significant reduction in the FEV1 (Forced Expiratory Volume in first second), FEV6 (Forced expiratory volume in first six seconds) and their ratio FEV1/FEV6 occurred after both open and laparoscopic cholecystectomy. However, mean reductions in FEV1, FEV6 and FEV1/FEV6 in the laparoscopic cholecystectomy group were significantly (p<0.05) less as compared with those after open holecystectomy. Conclusion: Laparoscopic cholecystectomy causes less impairment of lung function than cholecystectomy performed through a subcostal incision. (author)

  11. 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.

  12. 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

  13. 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

  14. 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

  15. 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.

  16. 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...

  17. Cardiopulmonary function and laparoscopic cholecystectomy.

    Science.gov (United States)

    Wahba, R W; Béïque, F; Kleiman, S J

    1995-01-01

    This review analyzes the literature dealing with cardiopulmonary function during and pulmonary function following laparoscopic cholecystectomy in order to describe the patterns of changes in these functions and the mechanisms involved as well as to identify areas of concern and lacunae in our knowledge. Information was obtained from a Medline literature search and the annual meeting supplements of Anesthesiology, Anesth Analg, Br J Anaesth, and Can J Anaesth. The principal findings were that changes in cardiovascular function due to the insufflation are characterized by an immediate decrease in cardiac index and an increase in mean arterial blood pressure and systemic vascular resistance. In the next few minutes there is partial restoration of cardiac index and resistance but blood pressure and heart rate do not change. The pattern is the result of the interaction between increased abdominal pressure, neurohumoral responses and absorbed CO2. Pulmonary function changes are characterized by reduced compliance without large alterations in PaO2, but tissue oxygenation can be adversely affected due to reduced O2 delivery. A major difficulty in maintaining normocarbia is due to the abdominal distention reducing pulmonary compliance and to CO2 absorption. End tidal CO2 tension is not a reliable index of PaCO2, particularly in ASA III-IV patients. The pattern of lung function following LC is characterized by a transient reduction in lung volumes and capacities with a restrictive breathing pattern and the loss of the abdominal contribution to breathing. Atelectasis also occurs. These changes are qualitatively similar to but of a lesser magnitude than those following "open" abdominal operations. It is concluded that the changes in cardiopulmonary function during laparoscopic upper abdominal surgery lead us to suggest judicious invasive monitoring and careful interpretation in ASA III-IV patients. Lung function following extensive procedures in sick patients has not been

  18. 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.

  19. 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.

  20. 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.

  1. Influencing factors on postoperative hospital stay after laparoscopic cholecystectomy

    OpenAIRE

    Chong, Jae Uk; Lee, Jin Ho; Yoon, Young Chul; Kwon, Kuk Hwan; Cho, Jai Young; Kim, Say-Jun; Kim, Jae Keun; Kim, Sung Hoon; Choi, Sae Byeol; Kim, Kyung Sik

    2016-01-01

    Backgrounds/Aims Laparoscopic cholecystectomy can reduce postoperative pain and recovery time. However, some patients experience prolonged postoperative hospital stay. We aimed to identify factors influencing the postoperative hospital stay after laparoscopic cholecystectomy. Methods Patients (n=336) undergoing laparoscopic cholecystectomy for gallbladder pathology at 8 hospitals were enrolled and divided into 2 groups: 2 or less and more than 2 days postoperative stay. Perioperative factors ...

  2. Laparoscopic cholecystectomy--can conversion be predicted?

    Science.gov (United States)

    Sikora, S S; Kumar, A; Saxena, R; Kapoor, V K; Kaushik, S P

    1995-01-01

    The possibility of conversion to open cholecystectomy (OC) always exists while performing a laparoscopic cholecystectomy (LC). This study has been performed with the aim of identifying factors predicting conversion to OC. From October 1992-April 1994, LC was attempted in 150 patients and conversion to OC was required in 29 (19%) patients. Ten preoperative factors were analyzed retrospectively to identify parameters significantly correlating with conversion to OC. Preoperative factors analyzed were age, sex, duration of symptoms, BMI (Body Mass Index), past history of jaundice, previous abdominal surgery, associated medical risk factors, palpable lump on clinical examination, USG, and OCG findings. Univariate and multiple stepwise regression analysis identified male sex, USG finding of contracted/thick-walled gall bladder, and a palpable gall bladder lump on examination as significant preoperative factors predicting conversion to OC. PMID:8553679

  3. Sepsis from dropped clips at laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    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

  4. [Laparascopic cholecystectomy in patients with acute cholecystitis].

    Science.gov (United States)

    Tokin, A N; Chistiakov, A A; Mamalygina, L A; Zheliabin, D G; Osokin, G Iu

    2008-01-01

    Experience of diagnostics and treatment of 758 patients with acute cholecystitis was summarized. Authors attach the main importance to evaluation of ultrasound data and functional condition of respiratory and cardio-vascular sistem choosing the method of surgical treatment. Sparse use of laparoscopic cholecystectomy in treatment of acute cholecystitis compared with chronic may be explouned by presence of complications in patients which make problems in differentiation of tubular structures during the operation. Authors offered to use ultrasound dissection for clear identification of tubular structures and argon coagulation for hemostasis and safe mobilization of gall bladder. Stick to suggested tactics authors practically doubled the amount of performed laparoscopic cholecystectomies reducing at the same time the frequency of complications. PMID:19301492

  5. Traumatic Gallbladder Rupture Treated by Laparoscopic Cholecystectomy

    Science.gov (United States)

    Egawa, Noriyuki; Ueda, Junji; Hiraki, Masatsugu; Ide, Takao; Inoue, Satoshi; Sakamoto, Yuichiro; Noshiro, Hirokazu

    2016-01-01

    Abstract Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy. PMID:27462188

  6. Laparoscopic Cholecystectomy During Abdominoplasty: Case Report

    Directory of Open Access Journals (Sweden)

    Kazim DUMAN

    2013-04-01

    Full Text Available We aimed to present the phenomenon of laparoscopic cholecystectomy and abdominoplasty which we diagnosed at the same period the abdominal laxation, diastase of rectum and cholelithiasis that we think in the literature the first samples without leaving any trocar entrance mark.A 58 year old female patient has consulted to the polyclinic of plastic surgery due to prolapsus on the abdominal region. Gall bladder multiplestones were ascertained through abdominal ultrasonograpy. On request and to provide minimal cosmetic failure to the patient, cholecystectomy and abdominoplasty is performed at the same session. Patients with abdominal pathologies that may occur after operations requiring surgery such as abdominoplasty very serious impact on cosmetics. Concordantly, we strongly suggest to take abdominal USG, even if there is no additional complaints especially before the plastic surgery operations and abdominoplasty, for ascertain the existent patologies. [Cukurova Med J 2013; 38(2.000: 319-324

  7. 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.

  8. 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.

  9. 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

  10. Laparoscopic cholecystectomy perioperative management: an update

    OpenAIRE

    Jakobsson, Jan

    2015-01-01

    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 fir...

  11. Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    The authors describe a hepatic pseudoaneurysm following laparoscopic cholecystectomy in a child. It arose from a hepatic artery that was ligated during surgery and was supplied by collaterals from the superior right branch. Because of the risk of hepatic infarction and recanalization of the pseudoaneurysm by new collaterals, the authors decided not to occlude the superior right branch, but to embolize the aneurysm itself with cyanoacrylate. Since the intra-arterial approach was not feasible, a transhepatic puncture was successfully performed. (orig.)

  12. Budd–Chiari Syndrome Following Laparoscopic Cholecystectomy

    OpenAIRE

    Amarapurkar, Pooja D.; Parekh, Sunil J.; Sundeep, Punamiya; Amarapurkar, Deepak N.

    2013-01-01

    Patients with thrombophilic disorder while undergoing intra-abdominal surgery may develop splanchnic vein thrombosis which can have dire consequences. Here we report a case of a 38-year-old female who developed acute Budd–Chiari syndrome after a laparoscopic cholecystectomy. She had polycythemia vera which was not diagnosed before surgery. In this report we want to highlight presurgical evaluation of routine biochemical tests and ultrasonography suggestive of myeloproliferative disorders were...

  13. Critical View of Safety During Laparoscopic Cholecystectomy

    OpenAIRE

    Vettoretto, Nereo; Saronni, Cristiano; Harbi, Asaf; Balestra, Luca; Taglietti, Lucio; Giovanetti, Maurizio

    2011-01-01

    Background and Objectives: Laparoscopic cholecystectomy has a 0.3% to 0.5% morbidity rate due to major biliary injuries. The majority of surgeons have routinely performed the so-called “infundibular” technique for gallbladder hilar dissection since the introduction of laparoscopy in the early nineties. The “critical view of safety” approach has only been recently discussed in controlled studies. It is characterized by a blunt dissection of the upper part of Calot's space, which does not usual...

  14. Laparoscopic Cholecystectomy by Sectorisation of Port Sites

    International Nuclear Information System (INIS)

    Objectives: To evaluate the results of 160 consecutive laparoscopic cholecystectomy using sectorisation based port site selection to improve ergonomics for surgeons. Design: Descriptive study. Place and Duration of study: PNS Shifa Karachi, Pakistan from Feb 2011 to Feb 2012. Patients and Methods: In this prospective study, 160 consecutive patients had undergone laparoscopic cholecystectomy in a tertiary care hospital using sectorisation for trocar placement. All patients with symptomatic gallstones, acute calculous cholecystitis and empyema gallbladder were included. Patients with choledocholithiasis were excluded from the study. The collected data included age, sex, diagnosis, history of previous surgery, conversion to open surgery and its reasons, operative time, post-operative hospital stay, complications and laparoscopy related complications to the surgeon such as shoulder pain, wrist stress and pain, finger joint pain and stress exhaustion. Result: One hundred and sixty patients underwent laparoscopic cholecystectomy with mean age 45 +- 12.9 years. Female to male ratio was 7.8:1. A total of 110 patients had chronic cholecystitis / biliary colic, 34 patients were with acute cholecystitis and 16 patients had diagnosis of empyema gallbladder. The mean operative time was 35.3+-14.6 min. Conversion rate to open surgery was 1.2%. Complications included bleeding from cystic artery (n=1) and injury to common hepatic duct (CHD) (n=1). One patient developed port site hernia post operatively. There was no incidence of laparoscopy related complications in surgeon such as pain shoulder, strains on the wrist joint, stress exhaustion and hand-finger joint pain. Conclusion: Sectorisation technique can be used in laparoscopic cholecystectomy in order to avoid the physical constraints of laparoscopic shoulder, hand finger joint pain, tenosynovitis, stress exhaustion, and hand muscle injury without increasing any morbidity to the patients. (author)

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. Bacteriological analysis of bile in cholecystectomy patients

    Directory of Open Access Journals (Sweden)

    Pratik M. Parekh

    2015-11-01

    Methods: The study was a prospective study carried out in SSG Hospital. A total of 78 patients undergone cholecystectomy who met the inclusion criteria were included in the study. 3cc bile was aspirated from all patients, this collected bile from gallbladder before cholecystectomy was transported to the laboratory in sterile test-tube. The specimen was evaluated to find out whether it is sterile or has any bacteria present. The types of bacteria are determined and whether the amount of isolate is significant or not. And sensitivity to antibacterial agents against antibiotics was determined. Results: 19 patients showed positive bile culture in which Escherichia coli was the most common isolated bacteria (63.16% among positive bile culture and 15.38% among all patients and bile was sterile in 59 patients (75.64%. Other organisms isolated were Pseudomonas (3.85%, Klebsiella (2.56%, coagulase negative Staphylococcus and Staphylococcus viridans (1.28%. Positive bile culture was a more common finding (50% of patients were bile culture positive in patients with acute cholecystitis in this study. Post-operative wound infection is more common (15.79% in group of patients with isolated organism from bile. There is a strong correlation between bile culture and wound culture (75%. Conclusions: It was found that sensitivity to third- and fourth-generation cephalosporins was higher as compared to aminoglycoside in acute as well as chronic cholecystitis. In this study levofloxacin also shows good sensitivity against isolated organism from bile. Piperacilin and tazobactum also shows good sensitivity against isolated organism from bile and they are more effective against pseudomonas. The resistance to second-generation cephalosporins and aminoglycoside has increased. For preoperative prophylaxis third and fourth-generation cephalosporins and levofloxacin show better promise and may be used as the first line of preoperative prophylaxis in operations for acute and chronic

  20. [Complicated course of a laparoscopic cholecystectomy].

    Science.gov (United States)

    Dralle, H; Neu, J; Köckerling, F; Klee, F; Büchler, M W

    2015-09-01

    The case presented deals with the complicated course of a laparoscopic cholecystectomy in a 45-year-old female patient due to cholecystolithiasis. The patient complained that during the operation an injury to the small intestine occurred, which was only operatively treated at midday of the despite massive pain and insufficient pain treatment. The intervention was claimed to have resulted in mental and physical suffering. The case is assessed by two independent experts in the sense of a "scientifically founded comment" with respect to the decision of the arbitration board and taking the surgical standards into consideration. PMID:26315012

  1. Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment

    Science.gov (United States)

    Udachan, Tejaswini V; Sasnur, Prasad; Baloorkar, Ramakanth; Sindgikar, Vikram; Narasangi, Basavaraj

    2015-01-01

    Introduction Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open for various reasons. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. But there is no clear consensus among the laparoscopic surgeons regarding the parameters predicting the difficult dissection and conversion to open cholecystectomy. Aim To assess the clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion. Materials and Methods This was a prospective study conducted from October 2010 to October 2014. Total of 180 patients meeting the inclusion criteria undergoing LC were included in the study. Four parameters were assessed to predict the difficult LC. These parameters were: 1) Gallbladder wall thickness; 2) Pericholecystic fluid collection; 3) Number of attacks; 4) Total leucocyte count. The statistical analysis was done using Z-test. Results Out of 180 patients included in this study 126 (70%) were easy, 44 (24.44%) were difficult and 3 (5.56%) patients required conversion to open cholecystectomy. The overall conversion rate was 5.6%. The TLC>11000, more than 2 previous attacks of cholecystitis, GB wall thickness of >3mm and Pericholecystic collection were all statistically significant for predicting the difficult LC and its conversion. Conclusion The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, WBC count, Gall bladder wall thickness and Pericholecystic collection. PMID:26816942

  2. Increased Risk of Depressive Disorder following Cholecystectomy for Gallstones.

    Directory of Open Access Journals (Sweden)

    Ming-Chieh Tsai

    Full Text Available Prior studies indicate a possible association between depression and cholecystectomy, but no study has compared the risk of post-operative depressive disorders (DD after cholecystectomy. This retrospective follow-up study aimed to examine the relationship between cholecystectomy and the risk of DD in patients with gallstones in a population-based database.Using ambulatory care data from the Longitudinal Health Insurance Database 2000, 6755 patients who received a first-time principal diagnosis of gallstones at the emergency room (ER were identified. Among them, 1197 underwent cholecystectomy. Each patient was then individually followed-up for two years to identify those who were later diagnosed with DD. Cox proportional hazards regressions were performed to estimate the risk of developing DD between patients with gallstone who did and those who did not undergo cholecystectomy.Of 6755 patients with gallstones, 173 (2.56% were diagnosed with DD during the two-year follow-up. Among patients who did and those who did not undergo cholecystectomy, 3.51% and 2.36% later developed depressive disorder, respectively. After adjusting for the patient's sex, age and geographic location, the hazard ratio (HR of DD within two years of gallstone diagnosis was 1.43 (95% CI, 1.02-2.04 for patients who underwent cholecystectomy compared to those who did not. Females, but not males, had a higher the adjusted HR of DD (1.61; 95% CI, 1.08-2.41 for patients who underwent cholecystectomy compared to those who did not.There is an association between cholecystectomy and subsequent risk of DD among females, but not in males.

  3. Postoperative Care of Patients Undergoing Same-Day Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Brenner, Patricia; Kautz, Donald D

    2015-07-01

    Elective laparoscopic cholecystectomies are common outpatient surgical procedures. After briefly discussing cholecystectomy and its indications, best practices in phase I, phase II, and phase III recovery are discussed. Typical pharmaceutical regimens for controlling pain and postoperative nausea and vomiting are summarized. By implementing best practices, nurses can prevent and recognize complications. The criteria for discharge, extended recovery, and inpatient admission are discussed, along with the required patient discharge teaching using the teach-back technique, as well as patient and family teaching needs in the immediate postoperative period. Nurses can optimize the patient's surgical experience and promote safety by implementing best practices in all phases of recovery from laparoscopic cholecystectomy. PMID:26119606

  4. The outcomes of SILS cholecystectomy in comparison with classic four-trocar laparoscopic cholecystectomy

    OpenAIRE

    Kurpiewski, Waldemar; Pesta, Wiesław; Kowalczyk, Marek; Głowacki, Leszek; Juśkiewicz, Wit; Szynkarczuk, Rafał; Snarska, Jadwiga; Stanowski, Edward

    2012-01-01

    Introduction General approval of laparoscopy as well as persistent urge to minimize operative trauma with still existing difficulties in putting natural orifice transluminal endoscopic surgery (NOTES) into practice have contributed to the introduction of laparoscopic operations through one incision in the umbilicus named single incision laparoscopic surgery (SILS). Aim The main aim of this study was to assess the benefits to patients of applying SILS cholecystectomy as a method of gallbladder...

  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. 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...

  7. Large Subcapsular Liver Hematoma Following Single-Incision Laparoscopic Cholecystectomy

    OpenAIRE

    Hansen, Adam J.; Augenstein, Julie; Ong, Evan S

    2011-01-01

    Background and Objectives: Many laparoscopic surgeons are now transitioning from standard multiple-port laparoscopic cholecystectomy to single-incision laparoscopic surgery (SILS) in an attempt to improve cosmetic outcomes and decrease postoperative morbidity. However, little has been published regarding the potential complications of SILS operations. Methods: We report the case of a patient undergoing SILS cholecystectomy who developed the complication of a large hepatic hematoma, resulting ...

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

    OpenAIRE

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

    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 anes...

  9. Cholecystectomy in situs inversus totalis: a laparoscopic approach

    Directory of Open Access Journals (Sweden)

    Dan Eisenberg

    2009-10-01

    Full Text Available Dan EisenbergDepartment of Surgery, Palo Alto VA Health Care System and Stanford School of Medicine, Palo Alto, CA, USAPurpose: To report and describe a safe approach to laparoscopic cholecystectomy in patients with situs inversus totalis.Methods: We present the case of a 61-year-old male who was diagnosed with gallstones and situs inversus totalis during work-up for epigastric pain. Laparoscopic cholecystectomy was performed in mirror-image to the standard approach, with the surgeon standing on the patient’s right side. In order to maintain orientation and safety during the operation, anatomical structures were spatially related to each other in a “medial” and “lateral” manner, which are preserved in situs inversus; rather than “left” and “right” which are reversed.Results: The duration of the operation was 85 minutes, which is slightly longer than our standard laparoscopic cholecystectomy. Nonetheless, the patient was discharged on the morning following surgery, which is comparable to other patients undergoing laparoscopic cholecystectomy. He was seen in follow-up on postoperative day 14 and was doing very well. There were no postoperative complications.Conclusion: Laparoscopic cholecystectomy can be performed safely in patients with situs inversus totalis. Careful attention to unfamiliar anatomic relationships is important. Approaching the anatomy in terms of medial and lateral structures, a relationship that is preserved, is helpful to complete the procedure safely.Keywords: cholecystectomy, laparoscopic, situs inversus, mirror-image

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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 the...... patients treated with cholecystectomy in the period from 2006 to 2011. The indicators were analyzed over time as a measure of quality of cholecystectomy and analyzed using chi-square statistics. RESULTS: A total of 37,317 patients were included in the study. The registration rate in the DCD was around 90...

  20. A Case of Persistent Hiccup after Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Elisa Grifoni

    2013-01-01

    Full Text Available A 79-year-old man, with history of recent laparoscopic cholecystectomy, came to our attention for persistent hiccup, dysphonia, and dysphagia. Noninvasive imaging studies showed a nodular lesion in the right hepatic lobe with transdiaphragmatic infiltration and increased tracer uptake on positron emission tomography. Suspecting a malignant lesion and given the difficulty of performing a percutaneous transthoracic biopsy, the patient underwent surgery. Histological analysis of surgical specimen showed biliary gallstones surrounded by exudative inflammation, resulting from gallbladder rupture and gallstones spillage as a complication of the previous surgical intervention. This case highlights the importance of considering such rare complication after laparoscopic cholecystectomy.

  1. 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.

  2. 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.

  3. A STUDY OF PREDICTIVE FACTORS IN LAPAROSCOPIC CHOLECYSTECTOMY DETERMINING CONVERSION TO OPEN CHOLECYSTECTOMY WITH SPECIAL REFERENCE TO BODY MASS INDEX

    Directory of Open Access Journals (Sweden)

    Gaurav

    2015-09-01

    Full Text Available Laparosco pic cholecystectomy is regarded /considered as the gold standard treatment for symptomatic gall stone disease. Beside the advantages of decreased postoperative pain, better cosmetic results, decreased length of hospital stay, early return to work and decreased total hospital cost; the pr ocedure is also associated with a definitive learning curve. There are many preoperative factors that can predict a difficult laparoscopic cholecystectomy which includes both clinical (Increasing age, male sex, history of acute pancreatitis and ultrason ological factors (Contracted gall bladder, thickened gall bladder wall, impacted stone at neck of gall bladder. In today ’ s world due to sedentary life style we are coming across patients with higher BMI even in socioecono mically weaker class which is a co nstrain in a successful laparoscopic surgery. We studied the correlation of Body Mass Index (BMI with performance of laparoscopic cholecystectomy.

  4. Cholecystectomy in Danish children--a nationwide study

    DEFF Research Database (Denmark)

    Langballe, Karen Oline; Bardram, Linda

    2014-01-01

    into the secure Web site by the surgeon immediately after the operation. In the present analysis, we have included children ≤ 15 years from the five year period January 1, 2006, to December 31, 2010. RESULTS: In the study period 35,444 patients were operated with a cholecystectomy. Of these, 196 (0.5%) were ≤ 15...

  5. Transumbilical single-port laparoscopic cholecystectomy: a case report

    Institute of Scientific and Technical Information of China (English)

    GUO Wei; ZHANG Zhong-tao; HAN Wei; LI Jian-she; JIN Lan; LIU Jun; ZHAO Xiao-mu; WANG Yu

    2008-01-01

    @@ Recently,scarless surgery has become a widely used surgical technique,which has made considerable progress owing to extensive animal model studies and clinical trials.Here,we report the first case of transumbilical single-port laparoscopic cholecystectomy in mainland China,on 28th May,2008.

  6. 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.

  7. ICG-loaded microbubbles for multimodal billiary imaging in cholecystectomy

    Science.gov (United States)

    Qin, Ruogu; Melvin, Scott; Xu, Ronald X.

    2012-12-01

    A dual-mode imaging technique has been developed for intraoperative imaging of bile ducts and real-time identification of iatrogenic injuries in cholecystectomy. The technique is based on ultrasound (US) and fluorescence (FL) imaging of a dual-mode microbubble (MB) agent comprising a poly (lactic-co-glycolic acid) (PLGA) shell and a core of Indocyanine Green. During cholecystectomy, a clinical US probe is used to localize the bile duct structure after bolus injection of dual-mode MBs. As the surrounding adipose tissue is removed and the Calot's triangle is exposed, FL imaging is used to identify the MB distribution and to determine the potential bile duct injury. The contrast-enhanced bile duct imaging technique has been demonstrated in both a surgical simulation model and an ex vivo porcine tissue model under two surgical scenarios. The first scenario simulates the correct procedure where the cystic duct is clipped. The second scenario simulates the incorrect procedure where the common bile duct is clipped, leading to consequent bile duct injury. Benchtop experiments in both the phantom and the ex vivo models show that the dual-mode imaging technique is able to identify the potential bile duct injury during cholecystectomy. A phantom system has also been established for future device calibration and surgical training in image-guided cholecystectomy. Further in vivo animal validation tests are necessary before the technique can be implemented in a clinical setting.

  8. 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...

  9. The difficult gallbladder: technical tips for laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Rosenberg, J; Bisgaard, T

    2000-01-01

    gallbladder, use of the Endo Paddle Retract (United States Surgical Corp., Norwalk, CT, USA) to depress abdominal viscera, and subtotal cholecystectomy). These methods may be used in situations in which there is no operative risk for complications, such as bile duct injury, but technical aspects of the...

  10. 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.

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

    DEFF Research Database (Denmark)

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

    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...

  12. Lost Stone During Laparoscopic Cholecystectomy: Retrieval Using a Condom

    OpenAIRE

    Chung, S C S; Li, M K W; Li, A. K. C.

    1993-01-01

    Laparoscopic cholecystectomy is becoming increasingly popular for the treatment of gall stone disease. In this technique, the gall bladder is dissected free under laparoscopic vision and then extracted. We report an interesting complication that occurred during extraction of a gall bladder containing a large stone and a novel method of overcoming the problem.

  13. 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.

  14. 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

  15. Comparing the Impact of Intraperitoneal Hydrocortisone With Bupivacaine on Postoperative Pain After Laparoscopic Cholecystectomy

    OpenAIRE

    Amini, Shahram; Sabzi Sarvestani, Amene

    2014-01-01

    Background: Postoperative pain is a major complaint following laparoscopic cholecystectomy. Objectives: The aim of this study was to compare the impact of intraperitoneal hydrocortisone with intraperitoneal bupivacaine on pain relief after laparoscopic cholecystectomy Patients and Methods: In a double blind clinical trial, 63 candidates for laparoscopic cholecystectomy were randomly allocated to receive intraperitoneal instillation of either 100 mg bupivacaine in 250 mL normal saline (n = 32)...

  16. 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

  17. 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.

  18. Characteristics and prediction of early pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Bisgaard, T; Klarskov, B; Rosenberg, J;

    2001-01-01

    Small-scale studies have suggested a large inter-individual variation in early postoperative pain after laparoscopic cholecystectomy, emphasizing the need for improved analgesic treatment and valid predictors. We investigated prospectively the association between a preoperative nociceptive stimulus...... 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...... postoperative week patients registered overall pain, incisional, visceral, and shoulder pain on a visual analogue scale and verbal rating scale, and daily analgesic requirements were noted. Throughout the first postoperative week overall pain showed a pronounced inter-individual variability. Incisional pain...

  19. 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

  20. 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

  1. 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

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

    OpenAIRE

    Hearing, S; Thomas, L.; HEATON, K; Hunt, L.

    1999-01-01

    BACKGROUND—Published estimates of the prevalence of postcholecystectomy diarrhoea derive from retrospective or uncontrolled data. They ignore functional bowel syndromes and possible changes in diet and drug use.
AIMS—To determine prospectively whether and how often cholecystectomy leads to changes in bowel function and bowel symptoms, especially to liquid stools, over and above any non-specific effect of laparoscopic surgery.
SUBJECTS—Patients: 106 adults undergoing laparoscopic cholecystecto...

  3. 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...

  4. Transvaginal NOTES cholecystectomy in my partner? No way!

    OpenAIRE

    Kobiela, Jarek; Stefaniak, Tomasz; Dobrowolski, Sebastian; Makarewicz, Wojciech; Łachiński, Andrzej J.; Śledziński, Zbigniew

    2011-01-01

    Introduction Natural orifice transluminal endoscopic surgery (NOTES) transvaginal cholecystectomy is being intensively studied. A few studies have been recently published evaluating patients’ attitude towards NOTES with its individual accesses. However, the choice of a transvaginal access with its potential influence on sex life and fertility is not restricted entirely to women. The sexual partner would at least give his opinion or decide together with the woman. Aim The aim of the study was ...

  5. 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 ...

  6. 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.

  7. Effect of chewing gum on the bowel motility after cholecystectomy

    Directory of Open Access Journals (Sweden)

    Khadije Yazdi

    2011-07-01

    Full Text Available Background: Postoperative ileus is common after cholecystectomy, causes gas retension, distention, nausea, vomiting, and even pain. Chewing gum is a type of sham feeding that may reduce the duration of postoperative ileus. This study determines the effect of chewing gum in the immediate postoperative period to facilitate ileus recovery following cholecystectomy. Material & Methods: This is a randomized controlled trial in 2009. Twenty-four patients undergoing cholecystectomy and they divided in to two equal groups (n=12. Patients in group A chewed sugarless gum there time after surgery, each time 20 miniutes in 4, 10 and 18 hours after finishing sugery. Demographics, intraoperative, and postoperative care data did not reveal any significant difference between two groups. The data resending the first passage of flatus, defecation and bowel sound in every 2 hours for each patient completed in questioning. Data were analyzed using SPSS software version-13.5 and student t-test. Results: The first bowel sound heard 3 ±1.3 and 2.8 ±1.3 hours post-operatively in cases and controls, respectively. The above findings were not significant between two groups. Furthermore gas passing reported at 18.3±10.5 and 36.28±12.6 hours post-operation in case and control groups respectively. The first defecation was occured at 36.8 ±21.7 and 69.5 ±19.2 hours after operation in case and control groups, respectively

  8. 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.

  9. 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.

  10. 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.

  11. Intraperitoneal hydrocortisone for pain relief after laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Amene S Sarvestani

    2013-01-01

    Full Text Available Background: Laparoscopic cholecystectomy is associated with shorter hospital stay and less pain in comparison to open surgery. The aim of this study was to evaluate the effect of intraperitoneal hydrocortisone on pain relief following laparoscopic cholecystectomy. Methods: Sixty two patients were enrolled in a double-blind, randomized clinical trial. Patients randomly received intraperitoneal instillation of either 250 ml normal saline (n=31 or 100 mg hydrocortisone in 250 ml normal saline (n=31 before insufflation of CO2 into the peritoneum. Abdominal and shoulder pain were evaluated using VAS after surgery and at 6, 12, and 24 hours postoperatively. The patients were also followed for postoperative analgesic requirements, nausea and vomiting, and return of bowel function. Results: Sixty patients completed the study. Patients in the hydrocortisone group had significantly lower abdominal and shoulder pain scores (10.95 vs 12.95; P<0.01. The patients were similar regarding analgesic requirements in the recovery room. However, those in the hydrocortisone group required less meperidine than the saline group (151.66 (±49.9 mg vs 61.66 (±38.69 mg; P=0.00. The patients were similar with respect to return of bowel function, nausea and vomiting. No adverse reaction was observed in either group. Conclusion: Intraperitoneal administration of hydrocortisone can significantly decrease pain and analgesic requirements after laparoscopic cholecystectomy with no adverse effects.

  12. Two-port mini laparoscopic cholecystectomy compared to standard four-port laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Sreenivas S

    2014-01-01

    Full Text Available Introduction: Two-port mini laparoscopic cholecystectomy (LC has been proposed as a safe and feasible technique. However, there are limited studies to evaluate the effectiveness of the procedure. This study is a prospective randomised trial to compare the standard four-port LC with two-port mini LC. Materials and Methods: A total of 116 consecutive patients undergoing LC were randomised to four-port/two-port mini LC. In two-port mini LC, a 10-mm umbilical and a 5-mm epigastric port were used. Outcomes measured were duration and difficulty of operation, post-operative pain, analgesia requirements, post-operative stay, complications and cosmetic score at 30 days. Results: Out of 116 patients, the ratio of M:F was 11:92, with mean age 40.79 ± 12.6 years. Twelve patients (nine in four-port group and three in two-port group were lost to follow-up. The mean operative time were similar (P = 0.727. Post-operative pain was significantly low in the two-port group at up to 24 hrs (P = 0.023. The overall analgesia requirements (P = 0.003 and return to daily activity (P = 0.00 were significantly lower in two-port group. The cosmesis score of the two-port group was better than four-port group (P = 0.00. However, the length of hospital stay (P = 0.760 and complications (P = 0.247 were similar between the two groups. Conclusion: Two-port mini LC resulted in reduced pain, need for analgesia, and improved cosmesis without increasing the operative time and complication rates compared to that in four-port LC. Thus, it can be recommended in selected patients.

  13. 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

  14. 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...

  15. Laparoscopic cholecystectomy: evolution, early results, and impact on nonsurgical gallstone therapies.

    Science.gov (United States)

    Brandon, J C; Velez, M A; Teplick, S K; Mueller, P R; Rattner, D W; Broadwater, J R; Lang, N P; Eidt, J F

    1991-08-01

    Laparoscopic cholecystectomy, a surgical technique first performed in France, has gained widespread acceptance among surgeons in the United States. The abdominal cavity is inflated by carbon dioxide, a video monitor is inserted via a laparoscope placed periumbilically, and the gallbladder is freed and removed from the liver bed by using small subcostal ports for access and dissection. Intraoperative cholangiography is routinely performed, but uncertainty exists about how best to manage choledocholithiasis. Compared with traditional cholecystectomy, initial reports describing laparoscopic cholecystectomy cite shorter recovery times because no large incisions are made, thus potentially reducing the cost and morbidity of cholecystectomy. A survey of 614 early cases supports these claims, with a reported complication rate of 1.5% and quick resumption of normal activities by patients. Because of its promise for reduced morbidity, laparoscopic cholecystectomy is challenging open cholecystectomy as the therapeutic gold standard for symptomatic cholelithiasis. Thus, the standard to which the nonsurgical gallstone therapies, such as lithotripsy and contact dissolution, will be compared may shift to laparoscopic cholecystectomy. As the laparoscopic complications are similar to those of traditional cholecystectomy, such as abscesses and bile leaks, their percutaneous treatment should not change. PMID:1830188

  16. 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.

  17. The use of laparoscopic subtotal cholecystectomy in a case with a cholecystohepatic duct

    OpenAIRE

    Naonori Kawakubo; Yoshio Zaizen; Yukiko Goto; Shizu Miura

    2015-01-01

    A cholecystohepatic duct is a rare biliary anomaly that is identified by the drainage of the hepatic duct into the gallbladder. We herein report on the case of a 2-year-old boy diagnosed as this anomaly. Laparoscopic subtotal cholecystectomy was successfully performed, and this is the first report of a case with a cholecystohepatic duct treated using a laparoscopic subtotal cholecystectomy.

  18. Gallbladder Fossa Abscess Masquerading as Cholecystitis After Cholecystectomy.

    Science.gov (United States)

    Rodrigue, Paul; Fakhri, Asif; Baumgartner, Andrew

    2015-12-01

    We present a case of a 59-y-old woman who had undergone cholecystectomy and was subsequently found to have an abscess within the gallbladder fossa. A hepatobiliary scan using (99m)Tc-diisopropyliminodiacetic acid demonstrated the characteristic rim sign, a photopenic defect surrounded by a rim of mildly increased activity immediately adjacent to the gallbladder fossa. The rim sign was thought to be the result of reactive inflammation in the hepatic tissue adjacent to a postoperative abscess within the gallbladder fossa. PMID:26111711

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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

  5. 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...

  6. 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.

  7. 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

    Background Intravenous administration of dexamethasone 90 min before laparoscopic cholecystectomy improves surgical outcome but may be impractical. The objective of this study was to assess the clinical efficacy of oral self-administration of prednisone 2 h before ambulatory laparoscopic...

  8. COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY IN RESPECT OF POSTOPERATIVE RECOVERY AND HOSPITAL STAY

    Directory of Open Access Journals (Sweden)

    Ajay

    2014-01-01

    Full Text Available Gall stones are one of the major causes of morbidity and mortality all over the world. Differences in primary outcomes like mortality and complication proportions [particularly bile duct injuries] are important reasons to choose one of the two operative te chniques open or laparoscopic Cholecystectomy. The study consists of 100 patients with a diagnosis of calculus cholecystitis that underwent Cholecystectomy. Laparoscopic cholecystectomy is a considerable advancement in the treatment of gall bladder disease , technically the dissection of the cystic artery and cystic duct is very precise and bleeding is easily controlled with less per operative blood loss. LC is associated with less chances of wound infection and there is no risk of wound dehiscence. The only disadvantage of the laparoscopic Cholecystectomy over the open procedure is the duration of operating time which is significantly longer.

  9. 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....

  10. An Evaluation of the Effect of Hypnosis on Postoperative Analgesia following Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Joudi, Marjan; Fathi, Mehdi; Izanloo, Azra; Montazeri, Omid; Jangjoo, Ali

    2016-01-01

    Little attention has been paid to the effectiveness of hypnosis in improving the results of surgery in Iran. One hundred and twenty patients scheduled for laparoscopic cholecystectomy were randomly divided into either control (standard care) or experimental (hypnosis) groups. Prior to surgery and again after surgery, abdominal pain, nausea, and vomiting were assessed. The results suggest that hypnosis could effectively reduce pain after laparoscopic cholecystectomy and significantly reduce hospitalization time. PMID:27267679

  11. 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.

  12. 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

  13. Evaluation of the response of cortisol, corticotropin and blood platelets kinetics after laparoscopic and open cholecystectomy

    OpenAIRE

    Crema Eduardo; Ribeiro Elisangela Neto; Hial Ana Marcela; Alves Júnior Juverson Terra; Pastore Ricardo; Silva Alex Augusto

    2005-01-01

    PURPOSE: To compare the behavior of serum cortisol and ACTH levels and platelet kinetics after laparoscopic and open cholecystectomy. METHODS: In this prospective study, 31 patients with symptomatic cholelithiasis submitted to elective cholecystectomy, 17 by the laparoscopic route and 14 by the open route, were compared. Peripheral blood samples were collected on admission of the patient, during anesthetic induction, and 2, 6, 12, 24 and 48 hours after the surgical incision. Platelets were co...

  14. Prophylactic Antiemetic Therapy with Ondansetron,Granisetron and Metoclopramide in Patients Undergoing Laparoscopic Cholecystectomy Under GA

    OpenAIRE

    Vishal Gupta, Renu Wakhloo, Anjali Mehta, Satya Dev Gupta; Renu Wakhloo; Anjali Mehta; Satya Dev Gupta

    2008-01-01

    The aim of the present study was to compare the antiemetic effect of intravenous Granisetron, Ondansetron& Metoclopramide in a randomized blinded study for prophylaxis of post operative nausea and vomiting(PONV) in patients undergoing laparoscopic cholecystectomy under general anaesthesia. 60 patients(ASA I & II) undergoing laparoscopic cholecystectomy under general anaesthesia were randomly allocatedinto three equal groups (n=20). Emetic episodes in first 24 hours were recorded and compared ...

  15. 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...

  16. The analgesic effect of the ultrasound-guided transverse abdominis plane block after laparoscopic cholecystectomy

    OpenAIRE

    Ra, Yoon Suk; Kim, Chi Hyo; Lee, Guie Yong; Han, Jong In

    2010-01-01

    Background Several methods are performed to control the pain after a laparoscopic cholecystectomy. Recently, the transverse abdominis plane block has been proposed to compensate for the problems developed by preexisting methods. This study was designed to evaluate the effect of the ultrasound-guided transverse abdominis plane block (US-TAP block) and compare efficacy according to the concentration of local analgesics in patients undergoing laparoscopic cholecystectomy. Methods Fifty-four pati...

  17. MR imaging of upper abdomen following cholecystectomy: normal and abnormal findings

    Energy Technology Data Exchange (ETDEWEB)

    Haakansson, K. [Kalmar Hospital, (Sweden). Dept. of Radiology; Leander, P.; Ekberg, O. [Malmoe Univ. Hospital (Sweden). Dept. of Radiology; Haakansson, H.O. [Kalmar Hospital, (Sweden). Dept. of Surgery

    2001-03-01

    To describe the normal MR appearance after cholecystectomy and the findings in patients with postoperative complications using fast pulse sequences in abdominal MR imaging. Material and methods: In a prospective study of 119 patients, 64 were examined with MR after cholecystectomy. In total, 56 patients with uncomplicated cholecystectomy were examined with MR 1-5 days (mean 1.6 days) after cholecystectomy. Nine patients had an abdominal postoperative complication and 8 of these were examined with MR after the complication commenced 1-12 days after the cholecystectomy. Results: Oedema in the gallbladder fossa was the only finding in 39 patients (61%), all with uneventful recovery. Small fluid collections in an area consistent with the gallbladder fossa were seen in 9/64 (14%) patients, of which 3 had surgical complications: 1 bleeding and 2 bile duct leakage. Twenty-two (34%) patients had small locally situated fluid collections adjacent to the liver, 14 were uneventful and 8 showed postoperative surgical complications. Seven patients had fluid in the rest of the abdomen of which 5 had surgical complications; 4 due to bile duct leakage and 1 acute pancreatitis. One patient had a postoperative bleeding not seen on MR images. Conclusion: MR is very sensitive in detecting fluid collections. Early MR findings following cholecystectomy are normally only subtle changes, mainly in the gallbladder fossa. Fluid collections diagnosed elsewhere than in the gallbladder fossa usually indicate a surgical complication and a surgical complication is unlikely if MR fails to show a fluid collection.

  18. LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS DUE TO CHOLELITHIASIS IN GERIATRIC PATIENTS

    Directory of Open Access Journals (Sweden)

    D. Vasincu

    2007-07-01

    Full Text Available This study is focused on the results of laparoscopic cholecystectomy for acute cholecystitis due to cholelithiasis in geriatric patients. The records of all patients from „St. Joan” Emergency Hospital Iaşi from January 2001 to December 2005 and from General Surgery Clinic in S. Orsola - M. Malpighi Hospital Bologna – Italia from January 2003 to December 2004 who undergo cholecystectomy were reviewed. The entire series consists of 557 patients. This report identifies 161 patients who were aged 65 years or older at the time of laparoscopic cholecystectomy. The results are reported in three progressive age groups: 65 to 74, 75 to 84, and over 85 years. At 101 geriatric patients was practiced laparoscopic cholecystectomy. Gallstones were present in all patients. In this series of laparoscopic cholecystectomy, 32.6% had an emergency procedure and the remainder had an elective or semielective procedure. The conversion rate was 5.6%. 74.2% of the patients were discharged home after 3-5 days of postoperative observation. Laparoscopic cholecystectomy is a safe procedure and should be recommended for all geriatric patients who have acute cholecystitis due to cholelithiasis before the development of complications.

  19. 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.

  20. 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.

  1. Laparoscopic cholecystectomy performed by residents at a University Hosp

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    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.

  2. 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.

  3. The Efficacy and Safety of Different Kinds of Laparoscopic Cholecystectomy: A Network Meta Analysis of 43 Randomized Controlled Trials

    OpenAIRE

    Lun Li; Jinhui Tian; Hongliang Tian; Rao Sun; Quan Wang; Kehu Yang

    2014-01-01

    BACKGROUND AND OBJECTIVE: We conducted a network meta analysis (NMA) to compare different kinds of laparoscopic cholecystectomy [LC] (single port [SPLC], two ports [2PLC], three ports [3PLC], and four ports laparoscopic cholecystectomy [4PLC], and four ports mini-laparoscopic cholecystectomy [mini-4PLC]). METHODS: PubMed, the Cochrane library, EMBASE, and ISI Web of Knowledge were searched to find randomized controlled trials [RCTs]. Direct pair-wise meta analysis (DMA), indirect treatment co...

  4. Quality of information available over internet on laparoscopic cholecystectomy

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    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.

  5. Single-access surgery laparoscopic cholecystectomy and appendectomy.

    Science.gov (United States)

    Mofid, Hamid; Zornig, Carsten

    2010-04-01

    The objective of this study was to achieve an ideal cosmetic result and minimize the access trauma to the abdominal wall. The authors developed a technique to perform cholecystectomies and appendectomies with only one incision in the umbilicus. With the upcoming idea of Natural Orifice Transluminal Endoscopic Surgery (NOTES) in the recent years and noticing the lack of feasibility of the technique for the daily routine beside the technique described by these authors, another development was raising the interest of the surgeons around the world. The single-access surgery through the umbilicus is a technique, that can be used in the daily routine and provides the best cosmetic results. Furthermore, injury of the abdominal wall is located at only one site, which might reduce the rate of trocar hernias and abdominal wall infections. Two 5.5-mm trocars were inserted through an incision at the upper edge of the umbilicus. After perforation of the abdominal wall with a stylet of a 5.5-mm trocar, a curved grasper was inserted, without the use of a trocar, into the abdominal cavity. The use of curved instruments facilitates better triangulation and instrument handling. No gas leakage was observed due to the nonexistence of a trocar. Dissection of the Calot' s triangle or appendix vessels can be done with standard instruments. The curved grasper allows retraction of the gallbladder or appendix. The specimen can be removed through the umbilical incision. The authors present a single-access surgery technique for cholecystectomies and appendectomies using curved instruments. The single-access surgery with parallel inserted curved instruments is feasible. No additional complications are related to this modification other than those known to be associated with laparoscopic surgery. This method offers an almost scarless surgery. Whether other advantages such as less trocar hernias, wound infections, and/or a faster recovery can be achieved, it has not yet to be proven. PMID

  6. Prevention of common bile duct injury during laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Zhi-Bing Ou; Jian-Ping Gong; Sheng-Wei Li; Chang-An Liu; Bing Tu; Chuan-Xin Wu; Xiong Ding; Zuo-Jin Liu; Ke Sun; Hu-Yi Feng

    2009-01-01

    BACKGROUND: Since the widespread adoption of laparoscopic cholecystectomy (LC) in the late 1980s, a rise in common bile duct (CBD) injury has been reported. We analyzed the factors contributing to a record of zero CBD injuries in 10 000 consecutive LCs. METHODS: The retrospective investigation included 10 000 patients who underwent LC from July 1992 to June 2007. LC was performed by 4 teams of surgeons. The chief main surgeon of each team has had over 10 years of experience in hepatobiliary surgery. Calot's triangle was carefully dissected, and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identiifed. A clip was applied to the cystic duct at the neck of the gallbladder and the duct was incised with scissors proximal to the clip. The cystic artery was dissected by the same method. Then, the gallbladder was dissected from its liver bed. A drain was routinely left at the gallbladder bed for 1-2 days postoperatively. RESULTS: No CBD injuries occurred in 10 000 consecutive LCs, and there were 16 duct leaks (0.16%). Among these, there were 10 Luschka duct leaks (0.1%) and 6 cystic duct leaks (0.06%). Four hundred thirty cases were converted to open cholecystectomy (OC), giving a conversion rate of 4.3%. After a mean follow-up of 17.5 months (range 6-24 months), no postoperative death due to LC occurred, and good results were observed in 95% of the patients. CONCLUSIONS: In our 10 000 LCs with zero CBD injuries, the techniques used and practices at our department have been successful. Surgeon's expertise in biliary surgery,preoperative imaging, precise operative procedures, and conversion from LC to OC when needed are important measures to prevent CBD injuries.

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

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    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.

  8. Radiation diagnosis of the biliary system before laparascopic cholecystectomy (a review of literature). Part 2: Non-ultrasonic techniques

    International Nuclear Information System (INIS)

    The paper is defined as a review of literature on radiation diagnostic of biliary tract. High-quality intraoperative cholangiogramms securing is actual now. The role of selective cholangiography with laproscopic cholecystectomy, a review of 737 consecutive cases of intraoperative cholangiography in laproscopic cholecystectomy, the abilities of spiral computed tomographic cholangiography before laproscopic cholecystectomy are under consideration. Magneto-resonance cholangiopancreatography as a new method of diagnosis of biliary system diseases is analysed in certain papers. The problem of indications to conducting some diagnostic methods as well as sequences their use (algorithm) touches upon all scientific investigations devoted tactics of medical examinations of patients before laproscopic cholecystectomy

  9. Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease.

    Science.gov (United States)

    Parmar, Abhishek D; Coutin, Mark D; Vargas, Gabriela M; Tamirisa, Nina P; Sheffield, Kristin M; Riall, Taylor S

    2014-09-01

    Our objective was to determine the probability threshold for recurrent symptoms at which elective cholecystectomy compared to observation in older patients with symptomatic cholelithiasis is the more effective and cost-effective option. We built a decision model of elective cholecystectomy versus observation in patients >65 presenting with initial episodes of symptomatic cholelithiasis that did not require initial hospitalization or cholecystectomy. Probabilities for subsequent hospitalization, emergency cholecystectomy, and perioperative complications were based on previously published probabilities from a 5 % national sample of Medicare patients. Costs were estimated from Medicare reimbursements and from the Healthcare Cost and Utilization Project. Utilities (quality-adjusted life years, QALYs) were obtained from established literature estimates. Elective cholecystectomy compared to observation in all patients was associated with lower effectiveness (-0.10 QALYs) and had an increased cost of $3,422.83 per patient at 2-year follow-up. Elective cholecystectomy became the more effective option when the likelihood for continued symptoms exceeded 45.3 %. Elective cholecystectomy was both more effective and less costly when the probability for continued symptoms exceeded 82.7 %. An individualized shared decision-making strategy based on these data can increase elective cholecystectomy rates in patients at high risk for recurrent symptoms and minimize unnecessary cholecystectomy for patients unlikely to benefit. PMID:24919433

  10. 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.

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

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    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

  12. 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.

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

    OpenAIRE

    Shreya; Sabyasachi; Sekhar Ranjan

    2015-01-01

    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, prospec...

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  15. Indocyanine-green-loaded microballoons for biliary imaging in cholecystectomy

    Science.gov (United States)

    Mitra, Kinshuk; Melvin, James; Chang, Shufang; Park, Kyoungjin; Yilmaz, Alper; Melvin, Scott; Xu, Ronald X.

    2012-11-01

    We encapsulate indocyanine green (ICG) in poly[(D,L-lactide-co-glycolide)-co-PEG] diblock (PLGA-PEG) microballoons for real-time fluorescence and hyperspectral imaging of biliary anatomy. ICG-loaded microballoons show superior fluorescence characteristics and slower degradation in comparison with pure ICG. The use of ICG-loaded microballoons in biliary imaging is demonstrated in both biliary-simulating phantoms and an ex vivo tissue model. The biliary-simulating phantoms are prepared by embedding ICG-loaded microballoons in agar gel and imaged by a fluorescence imaging module in a Da Vinci surgical robot. The ex vivo model consists of liver, gallbladder, common bile duct, and part of the duodenum freshly dissected from a domestic swine. After ICG-loaded microballoons are injected into the gallbladder, the biliary structure is imaged by both hyperspectral and fluorescence imaging modalities. Advanced spectral analysis and image processing algorithms are developed to classify the tissue types and identify the biliary anatomy. While fluorescence imaging provides dynamic information of movement and flow in the surgical region of interest, data from hyperspectral imaging allow for rapid identification of the bile duct and safe exclusion of any contaminant fluorescence from tissue not part of the biliary anatomy. Our experiments demonstrate the technical feasibility of using ICG-loaded microballoons for biliary imaging in cholecystectomy.

  16. Nefopam Vs Fentanyl in Female Patients Undergoing Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Ki Hwa Lee

    2014-05-01

    Full Text Available Nefopam is a non-opioid drug that inhibits reuptake of serotonin, norepinephrine, and dopamine. Nafopam is equipotent with opioids (morphine andmeperidine and can decrease postoperative nausea and vomiting (PONV by morphine sparing effect. So, we compared postoperative painand PONV between female patients who received nefopam and fentanyl after laparoscopic cholecystectomy (LC. Methods Patients were randomly assigned to two groups: those who received fentanyl 1 μg/kg at skin closure (Group F, n=31 and those who received nefopam 30 mg mixed with normal saline 500 ml for 30 minutes during surgery (Group N, n=31. General anesthesia was induced with lidocaine 40 mg, propofol 2 mg/kg, and rocuronium 0.6 mg/kg and was maintained with desflurane and remifentanil 0.5 -1.5 μg/kg/min. Postoperative pain is assessed using visual analogue scale (VAS. VAS, rescue analgesics (fentanyl and ketorolac doses, and PONV were evaluated for 0-2 hr, 2-6 hr, 6-12 hr, and 12-24 hr after surgery. Results Age-adjusted VAS significantly decreased during the four assessment time periods in both groups (p< .0001. There were no significant differences between the two groups in fentanyl (p =0 .163 and ketorolac (p = 0.676 doses and PONV. Conclusion The analgesic effects of nefopam and fentanyl administered after LC in female patients were not significantly different. Nefopam is not inferior to fentanyl for pain control of LC.

  17. 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.

  18. 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.

  19. Instrumental detection of cystic duct stones during laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Amir Kambal; Tomos Richards; Harsha Jayamanne; Zeyed Sallami; Ashraf Rasheed and Taha Lazim

    2014-01-01

     Residual  cystic  duct  stones  (CDSs)  after cholecystectomy  have  been  recognized  as  a  cause  of  post-cholecystectomy pain. This study was undertaken to determine the incidence of CDSs during laparoscopic cholecystectomy (LC). A cohort of 330 consecutive patients (80 males and 250 females) undergoing LC between November 2006 and May 2010 was studied. Their age ranged between 16 and 88 years (median 50, IQR: 36.62). The data were prospectively collected of preoperative liver function tests, imaging, the presence of intraoperative CDSs, and common bile duct stones at on-table cholangiogram. CDSs were detected intraoperatively in 64 of the 330 patients (19%). Ultrasound failed to detect CDSs in any of these cases. Deranged liver function tests were noted in 73% of the patients with CDSs and in 57% without CDSs. Common bile duct stones were detected in 9% (29) of the 330 patients. CDSs occur commonly at routine cholecystectomy, and preoperative investigations are not helpful in their diagnosis. As CDSs may lead to postoperative morbidity, they should be actively sought out during surgery if present.

  20. Ambulatory laparoscopic cholecystectomy: Is it safe and cost effective?

    Directory of Open Access Journals (Sweden)

    Ali Athar

    2009-01-01

    Full Text Available Background : Laparoscopic cholecystectomy (LC is the most commonly performed minimal invasive surgery. However, practice of its use as an ambulatory surgery in our hospital settings is uncommon. Objective : To evaluate safety and cost effectiveness of LC as an ambulatory day care surgery. Study Design : Quasiexperimental. Setting : Department of surgery, Aga Khan University Hospital, Karachi, Pakistan. Materials and Methods : Patients with uncomplicated symptomatic gallstones were selected for Ambulatory LC. They were admitted electively on the same day and operated on in the morning hours and discharged after a check by the surgeon 6-8 hrs later. Results : Of fifty (n = 50 patients selected for ambulatory LC, 92% were discharged successfully after 6-8 hrs observation. No significant perioperative complications were noted. Unplanned admission and readmission rate was 8 and 2%, respectively. Cost saving for the daycare surgery was Rs. 6,200, Rs. 13,300, and Rs.22,800 per patient as compared to in patient general, semiprivate, and private ward package, respectively. Conclusion : Practice ambulatory LC is safe and cost-effective in selected patients with uncomplicated symptomatic gallstones.

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

    Directory of Open Access Journals (Sweden)

    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

  2. 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. PMID:25400872

  3. 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.

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

    International Nuclear Information System (INIS)

    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

  5. 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...

  6. 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.

  7. Endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy is safe and effective

    DEFF Research Database (Denmark)

    Jakobsen, Henrik Loft; Vilmann, Peter; Rosenberg, Jacob

    2011-01-01

    Management strategy for common bile duct (CBD) stones is controversial with several treatment options if stones in the CBD are recognized intraoperatively. The aim of this study was to report our experience with same-session combined endoscopic-laparoscopic treatment of gallbladder and CBD stones....... We retrospectively evaluated 31 patients with cholecystolithiasis and CBD stones undergoing same-session combined endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and endoscopic stone extraction and laparoscopic cholecystectomy. Same-session ERCP and sphincterotomy were...... pancreatitis postoperatively and no other morbidity or mortality. In conclusion, same-session ERCP with stone extraction and laparoscopic cholecystectomy seems to be a safe and effective treatment strategy for CBD stones....

  8. An Option of Conservative Management of a Duodenal Injury Following Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    MA Modi

    2014-01-01

    Full Text Available Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

  9. 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

  10. Cholecystectomy is associated with higher risk of early recurrence and poorer survival after curative resection for early stage hepatocellular carcinoma.

    Science.gov (United States)

    Li, Tao; Wang, Shu-Kang; Zhi, Xu-Ting; Zhou, Jian; Dong, Zhao-Ru; Zhang, Zong-Li; Sun, Hui-Chuan; Ye, Qing-Hai; Fan, Jia

    2016-01-01

    Although cholecystectomy has been reported to be associated with increased risk of developing hepatocellular carcinoma (HCC), the association between cholecystectomy and prognosis of HCC patients underwent curative resection has never been examined. Through retrospective analysis of the data of 3933 patients underwent curative resection for HCC, we found that cholecystectomy was an independent prognostic factor for recurrence-free survival (RFS) of patients at early stage (BCLC stage 0/A) (p = 0.020, HR: 1.29, 95% CI: 1.04-1.59), and the 1-, 3-, 5-year RFS rates for patients at early stage were significantly worse in cholecystectomy group than in non-cholecystectomy group (80.5%, 61.8%, 52.0% vs 88.2%, 68.8%, 56.8%, p = 0.033). The early recurrence rate of cholecystectomy group was significantly higher than that of non-cholecystectomy group for patients at early stage (59/47 vs 236/333, p = 0.007), but not for patients at advanced stage (BCLC stage C) (p = 0.194). Multivariate analyses showed that cholecystectomy was an independent risk factor for early recurrence (p = 0.005, HR: 1.52, 95% CI: 1.13-2.03) of early stage HCC, but not for late recurrence (p = 0.959). In conclusion, cholecystectomy is an independent predictor for early recurrence and is associated with poorer RFS of early stage HCC. Removal of normal gallbladder during HCC resection may be avoided for early stage patients. PMID:27320390

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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...

  13. 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.

  14. A Multimodal Approach in Coil Embolization of a Bile Leak Following Cholecystectomy

    International Nuclear Information System (INIS)

    Bile leak is a well-known complication of cholecystectomy. Endoscopic drainage and decompression of the biliary system including temporary insertion of a biliary stent is generally considered the treatment of choice. We report the successful obliteration of a bile leak using fibered platinum coils placed under fluoroscopic guidance after stent treatment had failed

  15. MODIFIED THREE PORT LAP A ROSCOPIC CHOLECYSTECTOMY: HOW WE DO IT DIFFERENTLY?

    Directory of Open Access Journals (Sweden)

    Prasad

    2013-12-01

    Full Text Available ABSTRACT : The modified three port laparoscopic cholecystectomy technique has the same comfort and feasibility to the surgeon similar to regular three or four port surgery along with added advantage of less pain and better cosmetic appearance to the patient. The procedure is simple and can be conducted in acute and chronic cholecystits in any laparoscopic centre practicing laparoscopy.

  16. 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.

  17. 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

  18. Obstructive jaundice as a complication of a right hepatic artery pseudoaneurysm after laparoscopic cholecystectomy

    OpenAIRE

    Chih-Yang Hsiao; Ting-Chun Kuo; Hong-Shiee Lai; Ching-Yao Yang; Yu-Wen Tien

    2015-01-01

    A hepatic artery pseudoaneurysm is a rare, but a potentially life-threatening complication after laparoscopic cholecystectomy (LC). Obstructive jaundice owing to a hepatic artery pseudoaneurysm after LC has never been reported. We report a patient with a hepatic artery pseudoaneurysm after LC who presented with tarry stools, bloody drainage and obstructive jaundice.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Outpatient laparoscopic cholecystectomy: A new gold standard for cholecystectomy? Colecistectomía laparoscópica ambulatoria: ¿El nuevo "gold standard" de la colecistectomía?

    OpenAIRE

    J. Bueno Lledó; M. Planells Roig; C. Arnau Bertomeu; A. Sanahuja Santafé; M. Oviedo Bravo; R. García Espinosa; R. Martí Obiol; A. Espí Salinas

    2006-01-01

    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...

  4. Assessment of Risk Factors for Conversion from Difficult Laparoscopic to Open Cholecystectomy - A Hospital Based Prospective Study

    Directory of Open Access Journals (Sweden)

    Roman Kidwai

    2016-07-01

    Full Text Available Background: Laparoscopic cholecystectomy is the gold standard in the treatment of gallstones. It has proved to be an effective and safe procedure both in elective and emergency conditions; however, conversion to open surgery is inevitable in some cases. Hence the present study was carried out to identify various factors which can predict the difficult laparoscopic cholecystectomy so that an early conversion to open cholecystectomy can be considered. Material and Methods: A prospective st st study was conducted from 1 February 2011 to 31 January 2012 that included 63 patients of all age groups and both sexes who were found to have symptomatic gallstones and were scheduled for laparoscopic cholecystectomy at Nepalgunj Medical College and Teaching Hospital, Nepal. Age, sex, body mass index, previous abdominal surgery and past history of acute attack of cholecystitis of the patients were recorded. A pre-operative ultrasound was performed just prior to surgery, and three ultrasonographic parameters were analyzed, namely gall bladder wall thickness, number of stones and stone impacted in Hartmann's pouch. Intra-operative causes for difficult laparoscopic cholecystectomy like adhesions in Calot's triangle and gall bladder perforation with bile leak were also evaluated. Results: Total number of patients in this study was 63; out of which difficult laparoscopic cholecystectomy was seen in 25(39.7 patients and 7(11.1 patients required conversion to open cholecystectomy. Ultrasonography was good at predicting difficulty in each component with exception of gall bladder wall thickness which was not statistically significant. Conclusion: BMI, ultrasonographic finding of presence of multiple stone or stones impacted in Hartmann's pouch, adhesion in Calot's triangle and gall bladder perforations are predictors of difficult laparoscopic cholecystectomy.

  5. A randomized controlled trial to compare a restrictive strategy to usual care for the effectiveness of cholecystectomy in patients with symptomatic gallstones (SECURE trial protocol)

    OpenAIRE

    de Reuver, P. R.; van Dijk, A. H.; Wennmacker, S. Z.; Lamberts, M. P.; Boerma, D.; Den Oudsten, B. L.; Dijkgraaf, M G W; Donkervoort, S. C.; Roukema, J.A.; Westert, G.P.; Drenth, J.P.H.; van Laarhoven, C. J. H.; Boermeester, M A

    2016-01-01

    Background Five to 22 % of the adult Western population has gallstones. Among them, 13 to 22 % become symptomatic during their lifetime. Cholecystectomy is the preferred treatment for symptomatic cholecystolithiasis. Remarkably, cholecystectomy provides symptom relief in only 60-70 % of patients. The objective of this trial is to compare the effectiveness of usual (operative) care with a restrictive strategy using a standardized work-up with stepwise selection for cholecystectomy in patients ...

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

    Directory of Open Access Journals (Sweden)

    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

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Prophylactic Antiemetic Therapy with Ondansetron,Granisetron and Metoclopramide in Patients Undergoing Laparoscopic Cholecystectomy Under GA

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    Vishal Gupta, Renu Wakhloo, Anjali Mehta, Satya Dev Gupta

    2008-04-01

    Full Text Available The aim of the present study was to compare the antiemetic effect of intravenous Granisetron, Ondansetron& Metoclopramide in a randomized blinded study for prophylaxis of post operative nausea and vomiting(PONV in patients undergoing laparoscopic cholecystectomy under general anaesthesia. 60 patients(ASA I & II undergoing laparoscopic cholecystectomy under general anaesthesia were randomly allocatedinto three equal groups (n=20. Emetic episodes in first 24 hours were recorded and compared in differentstudy groups. Results were analyzed. Minimal emetic episodes were observed in early post-operativeperiod (1-12hrs in patients who had received intravenous granisetron in comparison to ondansetron andmetoclopramide. However, after 12 hours emesis free periods were statistically insignificant betweengroup A and B while patients in group C had no antiemetic effect.

  10. Tromboprofilaxia na colecistectomia videolaparoscópica Thromboprofilaxis for videolaparoscopic cholecystectomy

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    Renato Maciel

    2004-10-01

    Full Text Available Inspirados no caso de um paciente que desenvolveu tromboembolia pulmonar três dias após a realização de uma colecistectomia videolaparoscópica, mesmo tendo feito uso de heparina não fracionada no pré e nas primeiras 24hs de pós-operatório.Os autores analisaram a ocorrência de tromboembolia venosa na colecistectomia videolaparoscópica , os fatores de risco, as medidas de tromboprofilaxia e sugerem a conduta a ser adotada neste tipo de procedimento.Based in a case of a patient who developed pulmonary embolism three days after a laparoscopic cholecystectomy in spite of using unfrationated heparin starting before surgery and mantained in the first 24hs postoperatively. The authors have analysed the risk factors and the rate of VTE in laparoscopic cholecystectomy , the use of thromboprofilaxis and suggested procedures that should be adopted

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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....

  14. 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......). RESULTS: Optimal surgical space conditions during the entire procedure were observed in 7 of 25 patients allocated to deep neuromuscular blockade and in 1 of 23 patients allocated to moderate blockade (P = 0.05) with an absolute difference of 24% between the groups (95% confidence interval, 4......%-43%). Laparoscopic cholecystectomy was completed at pneumoperitoneum 8 mm Hg in 15 of 25 and 8 of 23 patients in the deep and moderate group, respectively (95% confidence interval, -2% to 53%; P = 0.08). Surgical space conditions during dissection of the gallbladder assessed by use of the numeric rating scale were...

  15. Abnormal right hepatic artery injury resulting in right hepatic atrophy: diagnosed by laparoscopic cholecystectomy

    OpenAIRE

    Martino Valter; Ferrarese Alessia; Bindi Marco; Marola Silvia; Gentile Valentina; Rivelli Matteo; Ferrara Yuri; Enrico Stefano; Berti Stefano; Solej Mario

    2015-01-01

    An intact hepatic artery is the gateway to successful hepato-biliary surgery. Introduction of laproscopic cholecystectomy (LC) has stimulated a renewed interest in the anatomy of hepatic artery. In this case report we have highlighted importance of variations of right hepatic artery in terms of origin and course We present a rare asymptomatic case of liver atrophy due to an intraoperative lesion of right hepatic artery. We also performed a literature review about surgical vascular lesions and...

  16. Detection and treatment of an aneurysma spurium of the arteria hepatica dextra after laparoscopic cholecystectomy

    OpenAIRE

    Kirschberg, Oliver; Scheding, Andreas; Saers, Thomas; Krakamp, Bernd

    2013-01-01

    Background Massive upper gastrointestinal hemorrhage can be the dominant symptom of decompensated liver cirrhosis, varices and ulcerations in the upper gastrointestinal tract. Postoperative complications are known to lead to these bleedings. Commonly, emergency endoscopy will be performed. Here we report of a patient with extensive bleeding caused by an aneurysma spurium of the arteria hepatica dextra induced by a laparoscopic cholecystectomy. The condition was diagnosed by the Doppler ultras...

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

    Directory of Open Access Journals (Sweden)

    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

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

    OpenAIRE

    Marcin Krajczy; Katarzyna Bogacz; Jacek Luniewski; Jan Szczegielniak

    2012-01-01

    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 vol...

  19. 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...

  20. Role of flupirtine as a preemptive analgesic in patients undergoing laparoscopic cholecystectomy

    OpenAIRE

    Yadav, Ghanshyam; Behera, Shailaja Shankar; Das, Saurabh Kumar; Jain, Gaurav; Choupoo, Sujali; Raj, Janak

    2015-01-01

    Background and Aims: Postsurgical pain is the leading complaint after laparoscopic cholecystectomy that may delay the postoperative recovery and hence we undertook a prospective randomized trial to analyze the role of flupirtine as a preemptive analgesic for postoperative pain relief in patients undergoing above surgery. Material and Methods: A total of 66 cases were randomly assigned to two groups to receive capsule flupirtine (200 mg) or capsule vitamin B complex administered orally, 2 h be...

  1. [Endoscopic cholecystectomy. Experience of the surgical team at the Saint-Charles hospital].

    Science.gov (United States)

    Abousleiman, C; Husseini, H; Cherfane, M; Baaklini, J; Rouhana, G; Saad, H

    1993-01-01

    The laparoscopic cholecystectomy has been a major event in the progress of surgical techniques during the last few years and becomes more and more present every day in the surgeon's life. We present our experience with our 26 first patients. The results are similar to those already published in the literature. No procedure was converted to laparotomy. No major complications were noted. The team work is stressed upon and advised to our Lebanese colleagues. PMID:8057331

  2. Risk Factors for Development of Biliary Stricture in Patients Presenting with Bile Leak after Cholecystectomy

    OpenAIRE

    Lokesh, Hosur Mayanna; Pottakkat, Biju; Prakash, Anand; Singh, Rajneesh Kumar; Behari, Anu; Kumar, Ashok; Kapoor, Vinay Kumar; Saxena, Rajan

    2013-01-01

    Background/Aims This study was aimed at determining the factors associated with the development of benign biliary stricture (BBS) in patients who had sustained a bile duct injury (BDI) at cholecystectomy and developed bile leaks. Methods A retrospective analysis of 214 patients with BDI who were referred to our center between January 1989 and December 2009 was done. Results One hundred fifty-three (71%) patients developed BBS (group I), and 61 (29%) were normal (group II). By univariate analy...

  3. Migrated endoclip and stone formation after cholecystectomy: A new danger of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Endoclip migration into the common bile duct following laparoscopic cholecystectomy (LC) is an extremely rare complication. Migrated endoclip into the common bile duct can cause obstruction, serve as a nidus for stone formation, and cause cholangitis. We report a case of obstructive jaundice and acute biliary pancreatitis due to choledocholithiasis caused by a migrated endoclip 6 mo after LC. The patient underwent early endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and stone extraction.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Cholecystectomy by single incision laparoscopic surgery (SILS): early experience and technique standardization.

    Science.gov (United States)

    Ceci, F; Di Grazia, C; Cipriani, B; Nicodemi, S; Corelli, S; Pecchia, M; Martellucci, A; Costantino, A; Stefanelli, F; Salvadori, C; Napoleoni, A; Parisella, M; Spaziani, E; Stagnitti, F

    2012-01-01

    Single Incision Laparoscopic Surgery (SILS) is a recent surgical technique, first described in the 1990s. Its aim is to optimize the esthetic result offered by laparoscopy by minimizing the number of abdominal incisions. Various preliminary studies have been carried out on the application of SILS, especially in cholecystectomy and appendectomy. This study evaluates the preliminary results of cholecystectomy by SILS (SILS™ Port) conducted between October 2009 and February 2011 on 21 patients (4 men and 17 women) with a mean age of 49.9 years and a mean Body Mass Index (BMI) of 22.8. All patients were treated by the same team, which had previously undergone six months' simulator training. There were two main selection criteria, both evaluated intraoperatively: absence of adhesions and of significant inflammatory sequelae from previous cholecystitis; and suitable distance between gallbladder and SILS access port. Conversion to traditional laparoscopy was necessary in just two cases, while an accessory trocar was introduced in another two cases. Conversion to open surgery was not necessary in any case. One case of SILS cholecystectomy was complicated by postoperative bile leakage, which was treated conservatively, as the fistula had a low output. The mean duration of hospitalization was 3.6 days. This preliminary experience led us to conclude that SILS is safe and highly satisfactory in the postoperative phase, thanks to the reduced need for painkillers and the improved esthetic result. PMID:23017290

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  9. Intravenous Versus Oral Antibiotic Prophylaxis Efficacy for Elective Laparoscopic Cholecystectomies: a Prospective Randomized Controlled Trial.

    Science.gov (United States)

    Karaca, A Serdar; Gündoğdu, Haldun; Özdoğan, Mehmet; Ersoy, Eren

    2015-12-01

    The aim of the present prospective randomized controlled trial is to compare the effectiveness of intravenous and oral antibiotic prophylaxis for cost and surgical site infection in elective laparoscopic cholecystectomy. Three hundred twenty patients were split into two groups as to include 160 patients in each, and they were evaluated in a prospective and randomized fashion. While one group was subjected to 1 g cefazolin via intravenous route during anesthesia induction, other group received 1 g cephalexin monohydrate via oral route 1 h prior to the operation. Demographic findings and operation results of the patients were compared by analyses. Our 320 patients (278 females and 42 males) received elective cholecystectomy and were followed up for a period of 6-26 months. Each group had 160 patients. Both groups were similar with regard to demographic characteristics and inclusion criteria. Among all, only five (1.5 %) cases demonstrated postoperative surgical site infection. Surgical site infection at postoperative period was determined in three (1.8 %) cases of intravenous prophylaxis group and two (1.2 %) cases of oral prophylaxis group. There was no statistically significant difference between the groups in terms of surgical site infection. Oral antibiotic prophylaxis can be used in elective laparoscopic cholecystectomy prophylaxis due to its cost-effective, reliable nature, and low surgical site infection rate. PMID:26730079

  10. 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

  11. Port site and distant metastases of gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography

    Institute of Scientific and Technical Information of China (English)

    Jian-Bin Hu; Xiao-Nan Sun; Jing Xu; Chao He

    2008-01-01

    We report port site and distant metastases of unsuspected gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography (PET) in two patients. Patient 1, a 72-year-old woman was diagnosed as cholelithiasis and cholecystitis and received laparoscopic cholecystectomy. Unsuspected gallbladder cancer was discovered with histological result of well-differentiated squamous cell carcinoma of the gallbladder infiltrating the entire wall. A PET scan using F-18-fluorodeoxygluccee (FDG-PET) before radical resed:ion revealed residual tumor in the gallbladder fossa and recurrence at port site and metastases in bilateral hilar lymph nodes. Patient 2, a 69-year-old woman underwent laparoscopic cholecystectomy more than one year ago with pathologically confirmed unsuspected adenosquamous carcinoma of stage pTlb. At 7-mo follow-up after surgery, the patient presented with nodules in the periumbilical incision. Excisional biopsy of the nodule revealed adenosquamous carcinoma. The patient was examined by FDG-PET, demonstrating increased FDG uptake in the right lobe of the liver and mediastinal lymph nodes consistent with metastatic disease. This report is followed by a discussion about the utility of FDG-PET in the gallbladder cancer.

  12. Predictive factors of difficult procedure in octogenarians undergoing elective laparoscopic cholecystectomy: a single center experience

    Science.gov (United States)

    GUIDA, F.; MONACO, L.; SCHETTINO, M.; PORFIDIA, R.; IAPICCA, G.

    2016-01-01

    Aim To assess the feasibility and safety of laparoscopic cholecystectomy (LC) in very elderly patients with particular attention to the predicitive factors of difficulty. Patients and methods All patients aged ≥ 80 undergoing elective LC for lithiasis at our institution since 1st January 2015 to 31st December 2015 were included in the study. Exclusion criteria were: a) acute cholecystitis; b) biliary pancreatitis; c) biliary tract neoplasms; d) urgent procedure. Pre-, intra- and postoperative data were recorded. Results During the study period, we performed 72 LC and we enrolled 17 patients aged ≥ 80 with a M:F = 5:12. Of these, 10 patients had a “difficult” cholecystectomy. In seven cases an intraoperative cholangiography (IOC) was performed. Postoperative course was regular but in two patients we had an Oddian spasm in 1st postoperative day. Female sex (p=0.03) and preoperative high level of serum amylase (p= 0.02) were significantly associated to difficult cholecystectomy in elderly patients. Conclusion LC in octogenarians is feasible and safe. However, sex and serum amylase can help the surgeon to predict a more difficult procedure in elective LC. In this group of patients an approach based on the individual risk is desirable and the patient could be referred to a multidisciplinary approach. PMID:27381691

  13. 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

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

    International Nuclear Information System (INIS)

    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<0.001). It is

  15. 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

  16. 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. PMID:27438171

  17. 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.

  18. 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

  19. 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

    BACKGROUND: In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision ... return to activity), but an evidence-based approach has been lacking. The current systematic review was undertaken to evaluate the importance of total size of trocar incision in improving surgical outcomes in adult laparoscopic cholecystectomy (LC). METHODS: The literature was systematically reviewed...... 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...

  20. Abscesso intrabdominal tardio pós colecistectomia laparoscópica Late intrabdominal abscess after laparoscopic cholecystectomy

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    Júlio Cezar Uili Coelho

    2003-04-01

    Full Text Available Perforation of the gallbladder during laparoscopic cholecystectomy may be associated with intraperitoneal gallstone spillage. Several complications secondary to lost gallstones in the abdominal cavity have been described. We report a rare complication of abdominal abscess secondary to two gallstones left in the abdominal cavity. A 75-year-old female presented with spontaneous drainage of pus through the umbilicus five years after laparoscopic cholecystectomy. An ultrasonographic evaluation of the abdomen revealed a solid mass of 56x26 mm of diameter, with acoustic shadow, localized distal to the umbilicus. At laparotomy, an abscess with two biliary calculi was drained. The patient had good recovery, with no complication.

  1. 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.

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

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    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.

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Endoscopic retrograde cholangiopancreatography, endoscopic esphinterotomy and laparoscopic cholecystectomy in a patient with choledocolitiasis and cholelitiasis

    International Nuclear Information System (INIS)

    The case report of a 30 year-old presumably healthy patient, who attended the Gastroenterology Department from 'Dr Juan Bruno Zayas Alfonso' Teaching General Hospital in Santiago de Cuba, and suffering from biliary cholic, ictero, choluria, nausea, vomit and loss of appetite is presented. The complementary examinations confirmed the choledocolitiasis and cholelitiasis diagnosis, reason why it was necessary to carry out a endoscopic retrograde cholangiopancreatography, endoscopic esphinterotomy and ambulatory laparoscopic cholecystectomy, in a single anesthetic injection. The postoperative clinical course was favorable and she was discharged without complications 24 hours before the intervention

  6. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  8. 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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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.

  13. 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.

  14. 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.

  15. Radiological investigation in laparoscopic compared with conventional cholecystectomy--an early assessment.

    Science.gov (United States)

    McLoughlin, R F; Gibney, R G; Mealy, K; Hyland, J

    1992-04-01

    The implications of laparoscopic cholecystectomy (LC) for radiology were assessed by comparing imaging investigations in 48 LC and 48 conventional cholecystectomy (CC) patients. In addition, we attempted to identify findings on pre-operative ultrasound (US) which predicted operative difficulties at LC. There were no per-operative or T-tube cholangiograms in the LC patients, but otherwise the pattern of investigation was similar in both groups. Forty of the 48 CC patients underwent cholangiography (per-operative cholangiography in 36, endoscopic retrograde cholangiopancreatography (ERCP) in two, and both in two) demonstrating calculi in eight (16.7%) cases. Only four LC patients had cholangiography (ERCP in all cases) demonstrating common bile duct (CBD) calculi in one (2.1%) case. Ultrasound failed to identify the gall-bladder with certainty in three of the five failed LC cases. Neither gall-bladder wall thickness, contraction nor calculus size on pre-operative US served as predictors of other per-operative difficulties. Our results indicate that there may be some patients with retained CBD calculi in the LC group. The role of pre-operative US in predicting operative difficulties needs further assessment in a prospective study. PMID:1395385

  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. 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.

  19. 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 .

  20. 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.

  1. Laparoscopic cholecystectomy: is it a conscious preference among Turkish patients with symptomatic gallstones?--prospective study.

    Science.gov (United States)

    Cingi, Asim; Düşünceli, Fikret; Güllüoğlu, Bahadir M; Yeğen, Cumhur; Aktan, A Ozdemir; Yalin, Rifat

    2004-10-01

    Laparoscopic cholecystectomy (LC) has the advantages of early return to full daily activity, early return to work, and better cosmetic result, as well as quickly resolving pain. Yet how this information about the procedure influences a patient's attitude toward laparocopy is not known. In this study we analyzed the factors that play role in the decision-making process of patients who choose laparoscopic surgery, and we also evaluated patients' knowledge of laparoscopy and their expectations. A questionnaire was used in evaluating 98 patients suffering from symptomatic cholelithiasis scheduled for elective laparoscopic cholecystectomy between January 2001 and January 2002. Females constituted 81% of the study population. Most of the patients (56%) were housewives. While 45% of the patients had an educational status of primary school degree only, 14% had graduated from a university. Forty-three patients described their level of knowledge about laparoscopy as "low" (had only heard about laparoscopy). In 61% of the patients the surgeon was the sole decision maker about the type of the operation. Almost none of the patients had a preference for the time of discharge from the hospital after surgery, and only three of the actively working patients offered a time interval for return to work. From this study we concluded that most patients have inadequate information about laparoscopic surgery, that the type of operation is dictated mostly by the surgeon, and that early discharge and early return to work are not important for many patients. PMID:15573265

  2. Prediction of Patients with Acute Cholecystitis Requiring Emergent Cholecystectomy: A Simple Score

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    Wael N. Yacoub

    2010-01-01

    Full Text Available The objective was to develop a score, to stratify patients with acute cholecystitis into high, intermediate, or low probability of gangrenous cholecystitis. The probability of gangrenous cholecystitis (score was derived from a logistic regression of a clinical and pathological review of 245 patients undergoing urgent cholecystectomy. Sixty-eight patients had gangrenous inflammation, 132 acute, and 45 no inflammation. The score comprised of: age > 45 years (1 point, heart rate > 90 beats/min (1 point, male (2 points, Leucocytosis > 13,000/mm3 (1.5 points, and ultrasound gallbladder wall thickness > 4.5 mm (1 point. The prevalence of gangrenous cholecystitis was 13% in the low-probability (0–2 points, 33% in the intermediate-probability (2–4.5 points, and 87% in the high probability category (>4.5 points. A cutoff score of 2 identified 31 (69% patients with no acute inflammation (PPV 90%. This scoring system can prioritize patients for emergent cholecystectomy based on their expected pathology.

  3. 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

    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...... 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....

  4. 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.

  5. 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.

  6. 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 cholecystectomy...... to open surgery. METHODS: PubMed and Embase were searched systematically in March 2014. Observational studies evaluating preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery in patients with gallstone disease were included. The outcome variables extracted were patient...... demographics, medical history, severity of gallstone disease, and preoperative laboratory values. RESULTS: A total of 1,393 studies were screened for eligibility. We found 32 studies, including 460,995 patients operated with laparoscopic cholecystectomy, eligible for the systematic review. Of these, 10 studies...

  7. 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

  8. 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...

  9. 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.

  10. 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.

  11. 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.

  12. "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

  13. 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.

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

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    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

  15. 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...... intra-operatively, and in the PACU on demand (prn) administration of sufentanil, morphine, paracetamol, ondansetron, droperidol, oral fluids and oxygen (if SpO(2) < 93%) with PACU discharge using a modified Aldrete score. RESULTS: Protocol violations were moderate and occurred unsystematically, 8% had...

  16. Colecistectomia videolaparoscópica em paciente submetido a transplante cardíaco Laparoscopic cholecystectomy in heart transplant patient

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    Flávio Heuta Ivano

    2000-10-01

    Full Text Available Cardiac transplant has been performed with an increased frequency as the treatment for end-stage cardiac disease. Although cholelithiasis is more frequent in both pretransplant and posttransplant patients, no standard management approach exists. Pretransplant patients are well recognized for cardiac events, and posttransplant immunossupressed patients are at a considerable risk for septic complications. Because the first presentation of gallstones in this population is often acute cholecystitis, asymptomatic calculi cannot be considered benign and it seems reasonable to recommend pretransplant screening and posttransplant surveillance for gallstones. Prophylatic laparoscopic cholecistectomy should be undertaken in the stable patient to avoid the substantial mortality associated with postoperative acute cholecystitis and urgent cholecystectomy. In this case report we present a 44 year-old male with acute cholecystitis after cardiac transplantation who was submitted to a safe laparoscopic cholecystectomy one year and seven months later.

  17. Laparoscopic Resection of Cholecystocolic Fistula and Subtotal Cholecystectomy by Tri-Staple in a Type V Mirizzi Syndrome

    Science.gov (United States)

    Yetişir, Fahri; Şarer, Akgün Ebru; Acar, Hasan Zafer; Parlak, Omer; Basaran, Basar; Yazıcıoğlu, Omer

    2016-01-01

    The Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann's pouch that mechanically obstructs the common bile duct (CBD). We would like to report laparoscopic subtotal cholecystectomy (SC) and resection of cholecystocolic fistula by the help of Tri-Staple™ in a case with type V MS and cholecystocolic fistula, for first time in the literature. A 24-year-old man was admitted to emergency department with the complaint of abdominal pain, intermittent fever, jaundice, and diarrhea. Two months ago with the same complaint, ERCP was performed. Laparoscopic resection of cholecystocolic fistula and subtotal cholecystectomy were performed by the help of Tri-Staple. At the eight-month follow-up, he was symptom-free with normal liver function tests. In a patient with type V MS and cholecystocolic fistula, laparoscopic resection of cholecystocolic fistula and SC can be performed by using Tri-Staple safely. PMID:26904324

  18. 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.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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

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

    OpenAIRE

    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 1wee...

  2. 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...

  3. Epidural anesthesia for laparoscopic cholecystectomy in a patient with sickle cell anemia, beta thalassemia, and Crohn's disease -A case report-

    OpenAIRE

    Baş, Sema Şanal; Özlü, Onur

    2012-01-01

    A 37-year-old woman diagnosed with sickle cell anemia (SCA), beta (+) thalassemia, Crohn's disease, and liver dysfunction was scheduled for laparoscopic cholecystectomy (LC) due to acute cholecystitis with gall bladder. Regional anesthesia was performed. An epidural catheter was inserted into the 9-10 thoracal epidural space and then 15 ml of 0.5% bupivacaine was injected through the catheter. The level of sensorial analgesia tested with pinprick test reached up to T4. Here we describe the fi...

  4. 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.

  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. 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.

  7. Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases.

    Science.gov (United States)

    Basak, F; Hasbahceci, M; Canbak, T; Sisik, A; Acar, A; Yucel, M; Bas, G; Alimoglu, O

    2016-04-01

    Introduction Cholecystectomy for benign gallbladder diseases can lead to previously undiagnosed gallbladder cancer during histopathological evaluation. Despite some controversy over its usefulness, histopathological evaluation of all gallbladder specimens is common in most hospitals. We evaluated the results of routine pathology of the gallbladder after cholecystectomy for benign gallbladder diseases with regard to unexpected primary gallbladder cancer (UPGC). Methods Patients undergoing cholecystectomy because of benign gallbladder diseases between 2009 and 2013 were enrolled in this study. All gallbladder specimens were sent to the pathology department, and histopathological reports were examined in detail. The impact of demographic features on pathological diagnoses and prevalence of UPGC assessed. Data on additional interventions and postoperative survival for patients with UPGC were collected. Results We enrolled 1,747 patients (mean age, 48.7±13.6 years). Chronic cholecystitis was the most common diagnosis (96.3%) and was associated significantly with being female (p=0.001). Four patients had UPGC (0.23%); one was stage T3 at the time of surgery, and the remaining three cases were stage T2. Conclusions Routine histopathological examination of the gallbladder is valuable for identification of cancer that requires further postoperative management. PMID:26924485

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

    Directory of Open Access Journals (Sweden)

    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

  9. 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.

  10. Comparison of efficacy of Ondansetron and Dexamethasone combination and Ondansetron alone in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Objective: To compare the efficacy of ondansetron alone and combination of ondansetron and dexamethasone in preventing post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Methods: The randomised control trial was conducted from April 23 to August 22, 2009, at the Liaquat National Hospital, Karachi, and comprised 100 American Society of Anaesthesiology I and II patients undergoing laparoscopic cholecystectomy. Half of the subjects comprised Group A and received ondansetron alone, while Group B received combination of ondansetron and dexamethasone. They were randomised by opaque envelope method. Group A received ondansetron 4mg while Group B received ondansetron 4mg with dexamethasone 8mg, 1 minute before induction. Post-operatively patients were observed for six hours for any episode of nausea or vomiting, or whether the patients required any rescue anti emetic. SPSS 19 was used for statistical analysis. Results: Patients receiving ondansetron alone showed 14(28%) with incidence of nausea or vomiting while the other group showed 6(12%). This difference was statistically significant (p<0.046). Conclusion: Combination of ondansetron and dexamethasone was more efficacious compared to ondansetron alone in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. (author)

  11. 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

  12. LAPAROSCOPIC CHOLECYSTECTOMY AT THE PATIENTS WITH THE ASSOCIATE PATHOLOGY AND DIFFICULT SURGICAL TECHNIQUES

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    A. Lesco

    2006-01-01

    Full Text Available This paper present an analysis made on 1210 cases of laparoscopic cholecystectomies (LC. From these, 88 patients had associated pathology. The age of the patients was 11 – 82 yo. The indication for LC was large. In the study group (88 cases, the Acid-Base Balance (ABB, blood gasses, blood pressure, the central venous pressure (CVP, intra-cranial pressure (ICP, inspiratory resistance, temperature changes and also peritoneal biopsy were analysed. Methods: The multilateral study clinic-instrumental examinations of associate pathology in preoperative period were determined. Determination of the risk group and patients for LC has been allowed. Results: The CO2 pneumoperitoneum (PP (7-12 mmHg determines changes of the: 1 ABB (intra operator blood pH was 7.37 before and 7.25 after the procedure; 2 partial carbon dioxide (before 40, after 47; 3 blood pressure; 4 mean CVP (before operation - 6.67±0.17 and 10.73±0.29 after procedure (p<0.01; 5 ICP (8.65±0.19 mm, p<0.01; 6 inspiratory resistance; 7 temperature changes (due to the CO2 temperature. The conversion rate was (0,41%: complicated acute cholecystites (1, dense multiple adhesions (1, the incidence of significant hemorrhage (2, bile duct injury (1. The postoperative mortality were 0,33% (4 cases due to pulmonary artery tromboemboly. Billiary lesions during LC occur with a frequency of 0,41% (5 patients: four bile duct injuries and leaks and one case – right billiary accessory duct, were solved following another operation three days after the initial procedure. Wound infection was more frequently, occurring in 21 cases (1,74%. The other complications (14 cases include: subcutaneous emphysema and insufflations of the pro-peritoneal space, omentum, or mesentery. Conclusions: LC is a safety technique even in the patients with associated pathology, but the morbidity and mortality are high. No presumed ductal or vascular structure should be divided until its anatomical features have been completely

  13. 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.

  14. Laparoscopic cholecystectomy for gallstones: A comparison of outcomebetween acute and chronic cholecystitis

    International Nuclear Information System (INIS)

    Laparoscopic cholecystectomy (LC) is now a common method of treatingsymptomatic gallstones and it is increasingly being requested by the informedgeneral public. Our aim was to evaluate the role of LC for cholelithiasis andto establish its outcome and the effect of gender on the results. BetweenSeptember 1994 and June 99, all patients who underwent LC for cholelithiasiswere retrospectively reviewed. They were classified as having acute orchronic cholecystitis (AC or CC). There were 791 patients with CC (633females, 158 males) and 204 patients with AC (124 females, 80 males).Conversion to open cholecystectomy was needed in 0.76% and 11.8% of thepatients with CC and AC, respectively (P<0.00). Four percent of the femalepatients with AC needed conversion as compared to 23.8% in the males(P<0.00). The low conversion rate in CC limited gender comparison. Medianoperation time in the patients with CC was 53+-16 minutes as compared to74.5+-35.7 minutes in those with AC (P<0.00). Operation time in the malepatients with CC and AC was significantly higher than in the female patients,even after excluding the converted cases (P<0.00). Median postoperative stayfor patients with CC was 1.33+-0.9 days as compared to 1.9+-1.34 days inpatients with AC (P<0.00). No statistical significance in the hospital staywas found between males and females (in CC and AC). There was no mortality inthe series. There were three bile duct injuries in the patients with CC. Inpatients with successful LC, gallbladder perforation occurred in 18% and 31%of CC and AC patients, respectively, (P<0.003). Missed stones occurred in1.4% and 3.3% of the patients with successful LC for CC and AC, respectively.Bile collection, which was treated with open drainage, occurred in fourpatients with CC and one patient with AC. LC for symptomatic cholelithiasisis safe and feasible; it should be the first choice before resorting to opensurgery. In patients with AC as compared to CC, there is an increasedconversion rate

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. Perioperative Continuous Ropivacaine Wound Infusion in Laparoscopic Cholecystectomy: A Randomized Controlled Double-blind Trial.

    Science.gov (United States)

    Fassoulaki, Argyro; Vassi, Emilia; Korkolis, Dimitrios; Zotou, Marianna

    2016-02-01

    Wound infusion with local anesthetics has been used for postoperative pain relief with variable results. This randomized, controlled, double-blind clinical trial examines the effect of ropivacaine infusion on pain after laparoscopic cholecystectomy. A total of 110 patients were randomly assigned to 2 groups. After induction of anesthesia a 75-mm catheter was inserted subcutaneously and connected to an elastomeric pump containing either 0.75% ropivacaine (ropivacaine group) or normal saline (control group) for 24 hours postoperatively. Before skin closure, each hole was infiltrated with 2 mL of 0.75% ropivacaine or normal saline according to randomization. Pain at rest, pain during cough, and analgesic consumption were recorded in the postanesthesia care unit and at 2, 4, 8, 24, and 48 hours postoperatively. Analgesic requirements and pain scores were recorded 1 and 3 months after surgery. The ropivacaine group reported less pain during cough (P=0.044) in the postanesthesia care unit (P=0.017) and 4 hours postoperatively (P=0.038). Ropivacaine wound infusion had no effect on late and chronic pain. PMID:26679680

  5. Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography

    International Nuclear Information System (INIS)

    Purpose: To assess the diagnostic value of MR cholangiography (MRC) for detecting common bile duct (CBD) stones in candidates for laparoscopic cholecystectomy (LC). Material and Methods: A series of 95 selected patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and/or CBD size 6.5 mm at US) were referred to our institution for MRC, before LC. MRC was performed on a 0.5 T magnet through a non-breath-hold, respiratory-triggered, fat-suppressed, thin-slab, heavily T2-weighted fast spin-echo sequence and through a breath-hold, thick-slab, single-shot T2-weighted sequence in the coronal plane. Axial T1- and T2-weighted sequences were first obtained. Two observers in conference reviewed source images and maximum intensity projections to determine the presence or absence of choledocholithiasis. MR findings were compared with endoscopic retrograde cholangiography and intraoperative cholangiography (IOC); IOC was always performed during LC. Results: CBD calculi (single or multiple) were identified in 41 out of 95 patients (43%). Two false-positive and 4 false-negative cases were found on MRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRC for choledocholithiasis were 90%, 96%, 94%, 95%, and 93%, respectively. Conclusion: MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC Bile ducts gallbladder calculi stenosis or obstruction MR imaging

  6. 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.

  7. Imaging patients with 'post-cholecystectomy syndrome': an algorithmic approach

    Energy Technology Data Exchange (ETDEWEB)

    Terhaar, O.A. [Department of Academic Radiology, Beaumont Hospital and Royal College of Surgeons Medical School, Beaumont Road, Dublin (Ireland); Abbas, S. [Department of Academic Radiology, Beaumont Hospital and Royal College of Surgeons Medical School, Beaumont Road, Dublin (Ireland); Thornton, F.J. [Department of Academic Radiology, Beaumont Hospital and Royal College of Surgeons Medical School, Beaumont Road, Dublin (Ireland); Duke, D. [Department of Academic Radiology, Beaumont Hospital and Royal College of Surgeons Medical School, Beaumont Road, Dublin (Ireland); O' Kelly, P. [Department of Academic Radiology, Beaumont Hospital and Royal College of Surgeons Medical School, Beaumont Road, Dublin (Ireland); Abdullah, K. [Department of Academic Radiology, Beaumont Hospital and Royal College of Surgeons Medical School, Beaumont Road, Dublin (Ireland); Varghese, J.C. [Department of Academic Radiology, Beaumont Hospital and Royal College of Surgeons Medical School, Beaumont Road, Dublin (Ireland); Lee, M.J. [Department of Academic Radiology, Beaumont Hospital and Royal College of Surgeons Medical School, Beaumont Road, Dublin (Ireland)]. E-mail: mlee@rcsi.ie

    2005-01-01

    AIM: To assess the role of ultrasound (US), magnetic resonance cholangiopancreatography (MRCP) and liver function tests (LFTs) in the evaluation of selected patients presenting with late post-cholecystectomy syndrome (PCS) who were referred for endoscopic retrograde cholangiopancreatography (ERCP) MATERIALS AND METHODS: In a retrospective study a final group of 42 patients with PCS referred for diagnostic ERCP underwent MRCP and abdominal US. ERCP and MRCP images were assessed for bile duct diameters and the presence of strictures and stones. A common bile duct (CBD) diameter of <10 mm was considered normal, whereas {>=}10 mm was considered abnormal on US. Findings were correlated to LFTs with contingency table results performed for single techniques and combination of methods. RESULTS: In total 14 stones and one stricture were seen. US had a high negative predictive value (86.4%). MRCP had a sensitivity of 100% and specificity of 88.0%. ERCP is the most accurate test but failed in 11 patients, five of whom had a stone. The accuracy of US and LFTs increases to 93.8% if test results agree in either negative or positive outcome. CONCLUSION: US and LFTs are first-line tests in PCS. If the CBD on US is {>=}10 mm, but no cause is identified, MRCP should be performed. If US and LFTs are normal then MRCP is not necessary. The availability of LFTs raises the diagnostic value of imaging.

  8. Development of bile duct bezoars following cholecystectomy caused by choledochoduodenal fistula formation: a case report

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    Adibnejad Soheil

    2006-01-01

    Full Text Available Abstract Background The formation of bile duct bezoars is a rare event. Its occurrence when there is no history of choledochoenteric anastomosis or duodenal diverticulum constitutes an extremely scarce finding. Case presentation We present a case of obstructive jaundice, caused by the concretion of enteric material (bezoars in the common bile duct following choledochoduodenal fistula development. Six years after cholecystectomy, a 60-year-old female presented with abdominal pain and jaundice. Endoscopic retrograde cholangiopancreatography demonstrated multiple filling defects in her biliary tract. The size of the obstructing objects necessitated surgical retrieval of the stones. A histological assessment of the objects revealed fibrinoid materials with some cellular debris. Post-operative T-tube cholangiography (9 days after the operation illustrated an open bile duct without any filling defects. Surprisingly, a relatively long choledochoduodenal fistula was detected. The fistula formation was assumed to have led to the development of the bile duct bezoar. Conclusion Bezoar formation within the bile duct should be taken into consideration as a differential diagnosis, which can alter treatment modalities from surgery to less invasive methods such as more intra-ERCP efforts. Suspicions of the presence of bezoars are strengthened by the detection of a biliary enteric fistula through endoscopic retrograde cholangiopancreatography. Furthermore, patients at a higher risk of fistula formation should undergo a thorough ERCP in case there is a biliodigestive fistula having developed spontaneously.

  9. 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.

  10. 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...... 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...... for the first three postoperative hours (P nausea was reduced in the ropivacaine group (P

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

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    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.

  12. Massive right hemothorax as the source of hemorrhagic shock after laparoscopic cholecystectomy - case report of a rare intraoperative complication

    Directory of Open Access Journals (Sweden)

    Federico Biolchini

    2011-05-01

    Full Text Available Abstract A 62-year old man was referred to our institution in hemorrhagic shock after a laparoscopic cholecystectomy for acute cholecystitis, performed at an outside hospital. A chest X-ray revealed a right-sided massive pleural effusion. Urgent surgical exploration was performed through a video-assisted mini-thoracotomy which revealed active bleeding from a pleural adherence. Successful hemostasis was achieved intraoperatively and the patient had an uneventful recovery. In absence of intra-abdominal hemorrhage, a hemothorax should be considered as a potential source of major bleeding in patients who develop symptoms of hypovolemia after laparoscopic surgery.

  13. 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.

  14. 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

  15. 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

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. 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.

  19. Laparoscopic cholecystectomy: device-related errors revealed through a national database.

    Science.gov (United States)

    Panesar, Sukhmeet S; Salvilla, Sarah A; Patel, Bhavesh; Donaldson, Sir Liam

    2011-09-01

    Laparoscopic techniques represent a key milestone in the development of modern surgery, offering a step change in quality of care, patient satisfaction and efficiency in use of health service resources. Laparoscopy is most widely used for gall bladder surgery. As would be expected with the introduction of any new technology, the early phase of development was accompanied by complications in its use. Arguably some of these should have been anticipated, but nevertheless standards and training programs were subsequently put in place to secure a more consistent standard of care across the UK. Now that this early learning curve has largely been negotiated, we wanted to examine the nature of the errors associated with laparoscopic gall bladder surgery, particularly in relation to equipment. We used data from the largest error-reporting system in the world to examine the problem of equipment-related incidents amongst patients who had laparoscopic cholecystectomy. Over the 6-year period 2004-2010, the number of such reports increased 15-fold, whilst the growth in use of the procedure itself increased 1.3-fold. The majority of the increase was in device-related errors. User-related errors constituted a smaller proportion of errors. Whilst most surgeons appear to carry out laparoscopic surgery with a low level of harm to their patients, problems with their equipment remains a risk for many procedures. In some ways, this is an easier problem to address than one associated with competency. A risk associated with faulty, substandard or misused equipment is one that should be minimized in a 21st Century surgical service. PMID:22026620

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    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. 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.

  4. 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.

  5. Evolution of SILS Cholecystectomy in the Caribbean: The Direct Transfascial Puncture Technique Using Conventional Instruments without Working Ports

    Directory of Open Access Journals (Sweden)

    Shamir O. Cawich

    2014-01-01

    Full Text Available Introduction. Single incision laparoscopic cholecystectomy (SILC has become accepted as an alternative to conventional multiport cholecystectomy. However, SILC is still limited in applicability in low resource centres due to the expense associated with specialized access platforms, curved instruments, and flexible scopes. Presentation of Case. We present three cases where a modified SILC technique was used with conventional instruments and no working ports. The evolution of this technique is described. Discussion. In order to contain cost, we used conventional instruments and three transfascial ports placed in an umbilical incision, but we noted significant instrument clashes that originated at the port platforms. Therefore, we modified our technique by omitting ports for the working instruments. The technique allowed us to exchange instruments as necessary, maximized ergonomics, and prevented collisions from the bulky port platforms. Finally, the puncture left by the instrument alone did not require fascial closure at the termination of the procedure. Conclusion. The direct transfascial puncture using conventional laparoscopic instruments without working ports is a feasible option that minimizes cost and increases ergonomics.

  6. [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.

  7. 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).

  8. Comparison of the effects of continuous intrapleural vs epidural administration of 0.5% bupivacaine on pain, metabolic response and pulmonary function following cholecystectomy

    DEFF Research Database (Denmark)

    Scott, N B; Mogensen, T; Bigler, D;

    1989-01-01

    Twenty patients undergoing elective cholecystectomy were prospectively randomised to receive either intrapleural (bolus 20 ml followed by 10 ml/h) or thoracic epidural (bolus 9 ml followed by 5 ml/h) bupivacaine 0.5% for 8 h postoperatively to assess the effect of these two techniques on pain, pu...

  9. 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...

  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. 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 patients...... were randomized to intravenous dexamethasone (8 mg) or placebo 90 minutes before LC. Patients received a similar standardized anesthetic, surgical, and multimodal analgesic treatment. All patients were recommended 2 days postoperative duration of convalescence. The primary endpoints were fatigue and...... drug. Dexamethasone significantly reduced postoperative levels of CRP (P = 0.01), fatigue (P = 0.01), overall pain, and incisional pain during the first 24 postoperative hours (P < 0.05) and total requirements of opioids (P < 0.05). In addition, cumulated overall and visceral pain scores during the...

  14. 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.

  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. 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.

  17. Is C-reactive protein the single most useful predictor of difficult laparoscopic cholecystectomy or its conversion? A pilot study

    Directory of Open Access Journals (Sweden)

    Kam Wa Jessica Mok

    2016-01-01

    Full Text Available Introduction: Both converted and difficult laparoscopic cholecystectomies (LC have impact on operating time and training of juniors. The aim of this study is to evaluate parameters that predict difficult LC or conversion (C, and find predictive values for different cut-off points of C-reactive protein (CRP for conversion. Materials and Methods: A retrospective cohort study of cholecystectomies performed from January 2011 to December 2012 at NHS trust was undertaken. Association of intra-operative difficulties or conversion with the following factors was studied: Age, gender, CRP, white blood cell count (WBC, history of pancreatitis, and endoscopic retrograde cholangiopancreatography (ERCP. Results: Two hundred and ninety one patients were analysed (222 laparoscopic, 45 difficult LC and 24 C. Only 141 patients had a recorded CRP. Median CRP was highest for patients who were converted (286.20 compared to those who had difficult LC (67.40 or LC (7.05. Those patients who did not have preoperative CRP (8/150, 5.3% had less chance of conversion than those who had CRP (16/141, 11.34% (P = 0.063. Patients with CRP of ≤220 (3/91, 3.2% had significantly less chance of conversion than those with CRP >220 (13/21, 61.9% (P < 0.001. High preoperative CRP, WBC count and ERCP, were predictors of conversion. These factors were only marginally better than CRP alone in predicting conversion. Conclusion: CRP can be a strong predictor of conversion of LC. Further validation of the results is needed.

  18. 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.

  19. 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

  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. 62例急性胆囊炎的腹腔镜胆囊切除术%62 cases of clinical analysis of laparoscopic cholecystectomy for acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    杜愚贱; 胡立光; 李俊国

    2012-01-01

      目的:总结急性胆囊炎的腹腔镜切除术临床治疗.方法:回顾性分析本院62例实施腹腔镜胆囊切除术的急性胆囊炎患者的临床资料.结果:62例患者均进行腹腔镜胆囊切除术,手术时间30min-1.5h,其中有10例中转开腹,无一例发生肝外胆管损失及肝漏等并发症,无死亡病例.结论:急性胆囊炎进行腹腔镜胆囊切除术针对性好、创伤小、伤口愈合快、不易出现并发症,广为外科医生及患者所接受.%  Objective To summarize the clinical treatment of laparoscopic cholecystectomy for acute cholecystitis. Methods Retrospective analysis of the implementation of 62 cases of laparoscopic cholecystectomy for acute cholecystitis in patients with clinical data. Results 62 cases of laparoscopic cholecystectomy in patients with, operation 30min-1.5h, of which 10 have been converted to open, without a case of extrahepatic bile duct loss and liver complications, such as leakage, no deaths. Conclusion Targeted well in laparoscopic cholecystectomy for acute cholecystitis, small wounds, wound healing, and is less prone to complications, widely accepted by surgeons and patients.

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

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    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

  3. Effect of intraoperative esmolol infusion on anesthetic, analgesic requirements and postoperative nausea-vomitting in a group of laparoscopic cholecystectomy patients

    OpenAIRE

    Necla Dereli; Zehra Baykal Tutal; Munire Babayigit; Aysun Kurtay; Mehmet Sahap; Eyup Horasanli

    2015-01-01

    PURPOSE: Postoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV. METHODS: Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows;...

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. Treatment of bile ducts injury in cholecystectomy%胆囊切除致胆管损伤的诊治

    Institute of Scientific and Technical Information of China (English)

    何宗全; 叶显道

    2013-01-01

    Objective To investigate the reasons and preventive measures and treatments of bile ducts injury in cholecystectomy. Methods Clinical data of 27 cases of bile ducts injury caused by cholecystectomy during 7 years were retrospectively analyzed. These 27 cases received a total of 34 sessions procedures, choledochojejunal Roux-en-Y anastomosis in 19 sessions procedures, abdominal cavity drainage in 2 sessions procedures, bile duct neoplasty in 2 sessions procedures, end-to-end anastomosis of bile duct with T-tube pedestal drainage in 3 sessions procedures, bile duct neoplasty with T tube pedestal drainage in 3 sessions procedures, ENBD in 1 case, bile duct reconstruction with pedicled umbilical vain graft in 1 case. Results In short-term,20 cases( 74. 1% )achieved good effect,fair in 6 cases ( 22.2% ),died in 1 case( 3. 7% ). In 20 cases undergoing average 3-year follow-up, achieved good 15 cases( 75. 0% ),fair 4 cases (20.0% )and bad 1 case( 5.0% ). In non-death cases of illness, choledochojejunal Roux-en-Y anastomosis 15 cases, good 11 cases ( 73. 3% ) ,fair 3 cases( 20. 0% ) ,bad 1 case( 6. 7% ). Conclusions Iatrogenic dile duct injury is prone to occur during cholecystectomy. The main reason of bile duct damage is unsuitable modus operandi for three basic factors including pathology, anatomy and human factor. Bile duct damages will obtain good treatment results, the key to is which prompt discovery and correct and timely treatment. Choledochojejunal Roux-en-Y anastomosis technique is an effective method for most of the injury of bile duct and biliary stricture cases.%目的 探讨胆囊切除致胆管损伤的原因及防治措施.方法 回顾性分析近7年收治27例胆囊切除致胆管损伤的临床资料.27例胆囊切除致胆管损伤中,实施手术34例次.胆肠Roux-en-Y吻合术19例次,腹腔引流术2例次,胆管修补术2例次,胆管对端吻合、T管支撑引流术3例次,胆管修补、T管支撑引流术3例

  9. 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

  10. 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.

  11. 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. PMID:27515579

  12. Comparison of ramosetron and ondansetron for control of post-operative nausea and vomiting following laparoscopic cholecystectomy

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    Maulana M Ansari

    2010-01-01

    Full Text Available Background: Post-operative nausea and vomiting (PONV is common. 5HT 3 receptor antagonists are commonly used drugs for its prevention. A study was designed to compare the efficacy and safety of ramosetron and ondansetron in patients undergoing laparoscopic cholecystectomy (lap chole. Materials and Methods: A prospective randomized case controlled study was conducted at J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India, in patients who underwent lap chole following intravenous administration of ondansetron (4mg or ramosetron (0.3mg at the end of surgery, and efficacy as well as side effects of ondansetron and ramosetron was documented and compared. Results: One hundred and thirty adult females undergoing lap chole were studied - 65 patients in each of the two groups. In first 24 h after surgery, complete response (No PONV was observed in 28 patients of the ondansetron group and in 32 patients of the ramosetron group (P>0.05. Complete response in the second 24 h after surgery was observed in 30 patients of the ondansetron group and in 45 patients of the ramosetron group (P0.05. Conclusion: Ramosetron was found safe and more effective antiemetic than ondansetron in patients undergoing lap chole.

  13. 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.

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. Trial sequential analyses of meta-analyses of complications in laparoscopic vs. small-incision cholecystectomy: more randomized patients are needed

    DEFF Research Database (Denmark)

    Keus, Frederik; Wetterslev, Jørn; Gluud, Christian;

    2010-01-01

    Conclusions based on meta-analyses of randomized trials carry a status of "truth." Methodological components may identify trials with systematic errors ("bias"). Trial sequential analysis (TSA) evaluates random errors in meta-analysis. We analyzed meta-analyses on laparoscopic vs. small-incision ......Conclusions based on meta-analyses of randomized trials carry a status of "truth." Methodological components may identify trials with systematic errors ("bias"). Trial sequential analysis (TSA) evaluates random errors in meta-analysis. We analyzed meta-analyses on laparoscopic vs. small......-incision cholecystectomy regarding different outcome measures for the occurrence of type I errors....

  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. 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.

  5. Injection dexamethasone in preventing postoperative nausea and vomiting: a comparison with placebo in the patients undergoing laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    To determine the efficacy of intravenous dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy (lap-chole) and comparing it with normal saline (placebo). After the approval of the hospital's ethical committee, the study was conducted on 60 patients who were randomly divided into two groups, each group containing 30 patients. All belonged to A.S.A-I and A.S.A-II. Randomization was done by envelope draw method. Injections dexamethasone (8 mg in 2mls) and normal saline ( 2 mls ) were given intravenously to respective groups just before induction of anesthesia. Fisher's exact test was applied to compare proportion of PONV between two groups for the recovery room data, while Chi-square test was applied to compare the proportion of PONV between two groups during first 12 hours and second 12 hours. The p-value was calculated at the level of significance chosen as 0.05. In the recovery room where the patient stayed for one hour 10% of patients in the dexamethasone group in comparison with 33% of the patients in the placebo group experienced PONV (p=0.028). In the ward, during first 12 hours observation period, 27% of the patients in the dexamethasone group in comparison with 43% of the patients in the placebo group experienced PONV (p=0.176). During the second 12 hours observation period, 30% of the patients in the dexamethasone in comparison with 80% of the patients in the placebo group experienced PONV (p<0.001). (author)

  6. 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

  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

  8. Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial: Study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kortram Kirsten

    2012-01-01

    Full Text Available Abstract Background Laparoscopic cholecystectomy in acute calculous cholecystitis in high risk patients can lead to significant morbidity and mortality. Percutaneous cholecystostomy may be an alternative treatment option but the current literature does not provide the surgical community with evidence based advice. Methods/Design The CHOCOLATE trial is a randomised controlled, parallel-group, superiority multicenter trial. High risk patients, defined as APACHE-II score 7-14, with acute calculous cholecystitis will be randomised to laparoscopic cholecystectomy or percutaneous cholecystostomy. During a two year period 284 patients will be enrolled from 30 high volume teaching hospitals. The primary endpoint is a composite endpoint of major complications within three months following randomization and need for re-intervention and mortality during the follow-up period of one year. Secondary endpoints include all other complications, duration of hospital admission, difficulty of procedures and total costs. Discussion The CHOCOLATE trial is designed to provide the surgical community with an evidence based guideline in the treatment of acute calculous cholecystitis in high risk patients. Trial Registration Netherlands Trial Register (NTR: NTR2666

  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. 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.

  11. 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.

  12. A Prospective Blinded Study Evaluating the Role of Endoscopic Ultrasound before Endoscopic Retrograde Cholangiopancreatography in the Setting of "Positive" Intraoperative Cholangiogram during Cholecystectomy.

    Science.gov (United States)

    Luthra, Anjuli K; Aggarwal, Vipul; Mishra, Girish; Conway, Jason; Evans, John A

    2016-04-01

    During laparoscopic cholecystectomy, intraoperative cholangiography (IOC) is used to identify common bile duct (CBD) stones. In patients whose IOC is suspicious for stones, endoscopic retrograde cholangiopancreatography (ERCP) is the modality of choice for stone removal. However, IOC has a false positive rate of 30 to 60 per cent, and ERCP adverse events may occur in 11 per cent of patients. Endoscopic ultrasound (EUS) may serve as a noninvasive means of diagnosing suspected CBD stones. This study sought to assess the role of EUS in predicting the likelihood of choledocholithiasis at ERCP in patients found to have a positive IOC. This was a prospective blinded study of EUS before ERCP in patients with a positive IOC. Recruited subjects who underwent cholecystectomy and had an IOC with suspicion for obstruction were referred for ERCP within one month of their procedure. In patients with a positive IOC, EUS had a positive predictive value of 95 per cent in detecting choledocholithiasis. IOC with single or multiple filling defects more often correlated to the presence of CBD stones. At ERCP, choledocholithiasis was present in 65 per cent of patients who had an IOC suspicious for CBD stones. EUS should be used as a noninvasive method to correctly identify retained CBD stones in low-to-moderate risk patients with a positive IOC. PMID:27097628

  13. Comparison of Postoperative Events between Spinal Anesthesia and General Anesthesia in Laparoscopic Cholecystectomy: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Wang, Xian-Xue; Zhou, Quan; Deng, Hui-Wei; Zhou, Ai-Guo; Guo, Hua-Jing; Huang, Fu-Rong

    2016-01-01

    Background. Laparoscopic cholecystectomy is usually carried out under general anesthesia. There were a few studies which have found spinal anesthesia as a safe alternative. We aimed to evaluate the postoperative events between spinal anesthesia and general anesthesia in patients undergoing laparoscopic cholecystectomy. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to January 2016) for eligible studies. The primary outcome was the visual analogue scale score. Secondary outcomes included postoperative nausea and vomiting and urine retention 24 hours postoperatively. We calculated pooled risk ratios and 95% confidence interval using random- or fixed-effects models. Results. Eight trials involving 723 patients were listed. Meta-analysis showed that patients in spinal anesthesia groups have lower visual analogue scale score 24 hours postoperatively. There were significant decreases in the occurrence of postoperative nausea and vomiting in spinal anesthesia group when compared with general anesthesia group (odds ratios: 0.38, 95% confidence interval: 0.19–0.76; P = 0.006) with heterogeneity accepted (I2 = 13%; P = 0.33), while urine retention rate was increased in patients with spinal anesthesia (odds ratios: 4.95, 95% confidence interval: 1.24–19.71; P = 0.02) without any heterogeneity (I2 = 0%; P = 0.98). Conclusions. Spinal anesthesia may be associated with less postoperative pain and postoperative nausea and vomiting compared with general anesthesia. PMID:27525282

  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. Natural orifice translumenal endoscopic cholecystectomy: Animal model%经自然管壁内镜手术胆囊切除术动物实验

    Institute of Scientific and Technical Information of China (English)

    孙刚; 李闻; 孙国辉; 王向东; 孟江云; 杜红; 杨云生

    2011-01-01

    Objective To study the manipulation, feasibility and safety of natural orifice translumenal endoscopic cholecystectomy in animal models. Methods Ten mongrel dogs were involved in this study. Endoscopic gastrostomy, laparoscopy, transumbilical single orifice endoscopic cholecystectomy were performed. The incision on gastric wall was closed and antibiotics were routinely used. The animals were fed with semi-liquid diet. Two weeks after operation, the animals were sacrificed to observe the changes occurred after cholecystectomy. Results Of the 10 dogs, 8 survived for 2 weeks after operation with a success rate of 80%(8/10), 1 died during operation, and 1 died 1 week after operation due to abdominal abscess. The average operation time was 80 min(range 40-150min). Hemostasis was performed 4 times with electric coagulation and once with clips for liver bleeding during the operation. Leakage occurred in the residual end of gallbladder and cystic ducts and was closed with clips. The incision was completely healed with no abdominal abscess in those that survived for 2 weeks after operation. Conclusion Mongrel dogs can be used as the model of translumenal cholecystectomy in humans. Transumbilical single orifice endoscopic cholecystectomy is feasible and relatively safe. Surgical instruments cannot meet its requirements and remain to be developed.%目的 探讨单孔腹腔镜辅助下自然管壁内镜手术(NOTES)胆囊切除术的操作方法、可行性及安全性.方法 采用成年杂种犬模型10只.先后完成内镜下胃造口术、腹腔探查、经脐单孔腹腔镜辅助下胆囊暴露及内镜下胆囊切除术.术后钛夹闭合胃壁切口,常规应用抗生素3d,半流食饲养.2周后处死模型解剖,观察胆囊切除术后改变.结果 8只模型胆囊切除术后存活2周,1只实验中死亡,1只存活1周后死于腹腔脓肿,成功率80%(8/10).平均用时80min/例次(40-150min),术中肝脏出血应用电凝止血4次,钛夹闭合1次;

  16. 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

  17. 腹腔镜胆囊次全切除术在困难性胆囊切除中的应用%Application of laparoscopic subtotal cholecystectomy for complicated laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    高君; 孙文兵; 张延峰; 柯山; 丁雪梅

    2010-01-01

    Objective To evaluate the application of laparoscopic subtotal cholecystectomy (LSC) for complicated laparoscopic cholecystectomy(LC).Methods From June,2006 to February,2009,40 patients with complicated cholecystitis underwent LSC in our hospital were admitted.9 were operated by leaving the posterior wall intact with the liver (LSC Ⅰ),18 were operated by leaving the cystic duct(LSC Ⅱ),13 with a combination of LSC Ⅰ and LSC Ⅲ(LSC Ⅲ).According to rules of same sex.similar inflammation and complicated degree,40 cases were selaparoscopy successfully,none was converted to laparotomy and damaged the bile duct.Intraoperative bleeding in LSC group(73±26)ml increased significantly than those in LC group(41±12)ml(t=4.183,P0.05).In LSC group,operators were mostly the laparoscopie surgeon with five to ten years experience(32/8),whereas in LC group,mostly were with above ten years experience(7/33)(χ~2=34.690,P0.05).All patients were cured,and no complications occurred.Conclusions LSC is a safe and effective procedure in LC with complicated cholecystitis,without incurring of laparotomy.%目的 探讨腹腔镜胆囊次全切除术(LSC)在困难性胆囊切除中的应用效果.方法 2006年6月至2009年2月,我院对40例解剖困难的胆囊结石患者行LSC.根据局部病理情况,采取3种LSC术式.其保留部分胆囊床(LSC Ⅰ式)9例,保留部分胆囊壶腹(LSC Ⅱ式)18例,保留部分胆囊床和壶腹(LSC Ⅲ式)13例.并在同期行腹腔镜胆囊切除术(LC)的384例病例中,按照性别相同,年龄、炎症类型、手术难度相近的原则,选择40例与LSC组一一配对,作为对照组.对比观察临床疗效.结果 LSC组和LC组均顺利在腹腔镜下完成手术,无中转开腹和胆道损伤发生.术中出血量LSC组[(73±26)ml]多于LC组[(41±12)ml],差异有统计学意义(t=4.183,P0.05).住院天数LSC组[(6±6)d]与LC组[(7±5)d]比较,差异无统计学意义(t=0.616,P>0.05).LSC组的术者主要为腔镜经验5~10年(5

  18. Antibioticoprofilaxia na colecistectomia videolaparoscópica eletiva: estudo prospectivo randomizado e duplo cego Antibiotic prophylaxis in elective laparoscopic cholecystectomy: a prospective, randomized and double blind study

    Directory of Open Access Journals (Sweden)

    Hamilton Petry de Souza

    2008-06-01

    Full Text Available OBJETIVO: Identificar a necessidade de profilaxia antibiótica em colecistectomias videolaparoscópicas eletivas. MÉTODO: Estudo prospectivo, randomizado e duplo-cego, em pacientes submetidos à colecistectomia videolaparoscópica eletiva, durante o período de Junho de 2003 a Julho de 2007, com alocação de 163 pacientes em dois grupos: A (n=82, recebeu profilaxia com cefoxitina 2g intravenoso na indução anestésica; B (n=81, recebeu solução salina 2 mililitros intravenoso. A equipe e a técnica cirúrgica utilizadas foram as mesmas. O desfecho avaliado foram complicações infecciosas de sítio cirúrgico, isto é, infecção de ferida operatória e abscessos superficiais e/ou profundos. Os pacientes foram revisados em sete e 28 dias pós-operatório. Os dados foram analisados pelo Teste exato de Fisher (pBACKGROUND: To identify the need for antibiotic prophylaxis usage in routine laparoscopic cholecystectomy. METHODS: A prospective, randomized double-blind study was done in patients submitted to routine laparoscopic cholecystectomy from June 2003 to July 2007, with 163 patients divided in two groups: Group A (n=82 received antibiotic prophylaxis with Cefoxitin 2g IV at anesthesia induction; Group B (n=81 received 2 mL of isotonic sodium chloride solution at same time. Surgical technique and team were the same. The purpose of this study was to search the outcome for surgical site infections and superficial or deep abscesses. The patients were examined at 7 and 28 days after surgery. Data were analyzed by Fisher's exact test. RESULTS: This study showed infection complication rates of 4.76% in group A and 6.17% in group B. There were no statistical significant differences (p = 0.746 for infection complication rates in both groups. The groups were homogeneous and comparable. CONCLUSIONS: Patients submitted to routine laparoscopic cholecystectomy with low surgical risk do not need antibiotic prophylaxis, because it will not result in lower

  19. The effects of 10 cmH 2 O positive end-expiratory pressure on arterial oxygenation, respiratory mechanics and hemodynamic parameters in laparoscopic cholecystectomy operations

    Directory of Open Access Journals (Sweden)

    Fatma Çiçek

    2014-09-01

    Full Text Available Objective: The effects of 10cmH2O Positive End-expiratory Pressure (PEEP on respiratory mechanics, arterial oxygenation and hemodynamics in laparoscopic cholecystectomy operation were investigated. Methods: The study was planned on ASA I-II, 18-65 years old, forty patients scheduled for laparoscopic cholecystectomy under general anesthesia. The patients were divided into two groups which PEEP implemented Group 0 and 10 cmH2O PEEP applied Group P (Group 0, n=20; Group P, n=20. Heart rate, Mean arterial blood pressure, arterial oxygen saturation (SpO2, partial pressure of end-tidal carbon dioxide (PEtCO2, Peak inspiratory pressure (PİP, plato pressure (Pplato, partial pressure of oxygen in arterial blood (PaO2, partial pressure of carbon dioxide in arterial blood (PaCO2 values were evaluated at 5 minutes after induction, 5 minutes after CO2 insufflation, after the head-up position and the right side in the 10th and 30th minutes, After 10 minutes desufflation and in the recovery room. The Alveolar–arterial oxygen pressure gradient (P(A-a O2, the ratio of physiologic dead space over tidal volume (VD/VT, Arterial to End Tidal CO2 gradient (P(a-et CO2, static compliance (CS, dynamic compliance (CD were assessed same times. Results: The assessment between the groups, there were not statistical differences about mean blood pressure, heart rate, SpO2, PetCO2, PaO2, plateau pressure, and P (A-a values (p>0.05. Peak inspiratory pressure was higher in Group P (p<0.05. Peak inspiratory pressure and plateau pressure increased with CO2 insufflation in both groups. PaCO2 and P(a-et CO2 were higher statistically significantly in Group 0 (p<0.05. There was no difference between the groups in terms of the PetCO2 values. VD/VT ratios were statistically significantly lower in the Group P (p<0.05. There was no difference at static compliance values between the groups, dynamic compliance was lower in Group P. According to the initial values, there was a decrease in

  20. 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.

  1. 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.

  2. 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.

  3. Evaluation of the response of cortisol, corticotropin and blood platelets kinetics after laparoscopic and open cholecystectomy Avaliação da resposta do cortisol, da corticotropina e da cinética das plaquetas após colecistectomias laparoscópica e aberta

    OpenAIRE

    Eduardo Crema; Elisangela Neto Ribeiro; Ana Marcela Hial; Juverson Terra Alves Júnior; Ricardo Pastore; Alex Augusto Silva

    2005-01-01

    PURPOSE: To compare the behavior of serum cortisol and ACTH levels and platelet kinetics after laparoscopic and open cholecystectomy. METHODS: In this prospective study, 31 patients with symptomatic cholelithiasis submitted to elective cholecystectomy, 17 by the laparoscopic route and 14 by the open route, were compared. Peripheral blood samples were collected on admission of the patient, during anesthetic induction, and 2, 6, 12, 24 and 48 hours after the surgical incision. Platelets were co...

  4. 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.

     

  5. 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.

  6. 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.

  7. 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。

  8. 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.

  9. Comparison of ultrasound-guided transversus abdominis plane block with bupivacaine and ropivacaine as adjuncts for postoperative analgesia in laparoscopic cholecystectomies

    Directory of Open Access Journals (Sweden)

    Shradha Sinha

    2016-01-01

    Full Text Available Background and Aims: Transversus abdominis plane (TAP block is a popular technique for post-operative analgesia in abdominal surgeries. The aim of the study was to evaluate the relative efficacy of bupivacaine versus ropivacaine for post-operative analgesia using ultrasound-guided TAP block in laparoscopic cholecystectomies. Methods: Sixty adults undergoing elective laparoscopic cholecystectomy were randomised to receive ultrasound-guided TAP block at the end of the surgical procedure with either 0.25% bupivacaine (Group I, n = 30 or 0.375% ropivacaine (Group II, n = 30. All patients were assessed for post-operative pain and rescue analgesic consumption at 10 min, 30 min, 1 h, 4 h, 8 h, 12 h and 24 h time points. Means for normally distributed data were compared using Student′s t-test, and proportions were compared using Chi-square or Fisher′s exact test whichever was applicable. Results: Patients receiving ultrasound-guided TAP block with ropivacaine (Group II had significantly lower pain scores when compared to patients who received the block with bupivacaine (Group I at 10 min, 30 min and 1 h. However, both the drugs were equivalent for post-operative analgesia and 24 h cumulative rescue analgesic requirement (median [interquartile range] (75.00 [75.00-75.00] in Group I vs. 75.00 [75.00-93.75] in Group II, P = 0.366. Conclusion: Ultrasound-guided TAP block with ropivacaine provides effective analgesia in the immediate post-operative period up to 1 h as compared to bupivacaine. However, both the drugs are similar in terms of 24 h cumulative rescue analgesic requirement.

  10. Pain related to robotic cholecystectomy with lower abdominal ports: effect of the bilateral ultrasound-guided split injection technique of rectus sheath block in female patients

    Science.gov (United States)

    Kim, Jin Soo; Choi, Jong Bum; Lee, Sook Young; Kim, Wook Hwan; Baek, Nam Hyun; Kim, Jayoun; Park, Chu Kyung; Lee, Yeon Ju; Park, Sung Yong

    2016-01-01

    Abstract Background: Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients. Methods: We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study). Results: Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups. Conclusions: After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB. PMID:27495072

  11. 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. PMID:17519846

  12. 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.

  13. 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

  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. 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

    International Nuclear Information System (INIS)

    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.)

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. 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

  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. 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

  4. “Hook and Roll Technique” Using an Articulating Hook Cautery to Provide a Critical View during Single-incision Laparoscopic Cholecystectomy

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    Kin,Hitoshi

    2013-08-01

    Full Text Available We describe a new simple and easy technique called the "Hook and roll technique" (HRT that uses an articulating hook cautery to provide a critical view during single incision laparoscopic cholecystectomy (SILC. A 2-cm incision is made at the umbilicus to insert three 5-mm trocars or a multichannel port. After dissection of the serosa of the dorsal and ventral sides of the gall bladder, including Calot's triangle, the angled tip of the hook cautery is inserted between the cystic artery and duct with its tip placed dorsally. The tip is then rotated in a clockwise manner to avoid bile duct injury, allowing the connective tissue between them to be hooked, coagulated and cut. This procedure is repeated several times, followed by dissection between the cystic artery and the liver bed to achieve a critical view. From December 2008 to May 2011, 121 patients underwent SILC using HRT in our hospital without any serious complications. This technique is suitable for SILC, as it is consists of simple procedures that can be performed safely and easily, even by left hand in a cross-over approach, and it allows complete dissection of Calot's triangle to achieve a critical view without using any dissector under dangerous in-line viewing.

  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. 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

  7. Descoberta simultânea de carcinomatose disseminada e carcinoma de cólon, após colecistectomia laparoscópica Unsuspected colon adenocarcinoma revealed after laparoscopic cholecystectomy

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    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.

  8. 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.

  9. The HAC Trial (Harmonic for Acute Cholecystitis Study. Randomized, double-blind, controlled trial of Harmonic(H versus Monopolar Diathermy (M for laparoscopic cholecystectomy (LC for acute cholecystitis (AC in adults

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    Coccolini Federico

    2009-05-01

    Full Text Available Abstract Background In the developmental stage of laparoscopic cholecystectomy (LC it was considered 'unsafe' or 'technically difficult' to perform laparoscopic cholecystectomy for acute cholecystitis (AC. With increasing experience in laparoscopic surgery, a number of centers have reported on the use of laparoscopic cholecystectomy for acute cholecystitis, suggesting that it is technically feasible but at the expense of a high conversion rate, which can be up to 35 per cent and common bile duct lesions. The HARMONIC SCALPEL(R (H is the leading ultrasonic cutting and coagulating surgical device, offering surgeons important benefits including: minimal lateral thermal tissue damage, minimal charring and desiccation. Harmonic Scalpel technology reduces the need for ligatures with simultaneous cutting and coagulation: moreover there is not electricity to or through the patient Harmonic Scalpel has a greater precision near vital structures and it produces minimal smoke with improved visibility in the surgical field. In retrospective series LC performed with H was demonstrated feasible and effective with minimal operating time and blood loss: it was reported also a low conversion rate (3.9%. However there are not prospective randomized controlled trials showing the advantages of H compared to MD (the commonly used electrical scalpel in LC. Methods/Design Aim of this RCT is to demonstrate that H can decrease the conversion rate compared to MD in LC for AC, without a significant increase of morbidity. The patients will be allocated in two groups: in the first group the patient will be submitted to early LC within 72 hours after the diagnosis with H while in the second group will be submitted to early LC within 72 hours with MD. Trial Registration ClinicalTrials.gov Identifier: NCT00746850

  10. 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。

  11. 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。

  12. 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.

  13. 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.

  14. 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.

  15. 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。

  16. 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.

  17. 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。

  18. 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.

  19. 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.

  20. 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.

  1. Necrose do coto do ducto cístico após colecistectomia videolaparoscópica Post-videolaparoscopy cholecystectomy necrosis of the cystic duct

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    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.

  2. Effect of intraoperative esmolol infusion on anesthetic, analgesic requirements and postoperative nausea-vomitting in a group of laparoscopic cholecystectomy patients

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    Necla Dereli

    2015-04-01

    Full Text Available PURPOSE: Postoperative pain and nausea/vomitting (PNV are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV. METHODS: Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; I - Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil, II - Only propofol and remifentanil was used during maintenance, III - Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil, IV - Only desflurane and remifentanil was used during maintenance. They have been followed up for 24 h for PNV and analgesic requirements. Visual analog scale (VAS scores for pain was also been evaluated. RESULTS: VAS scores were significantly lowest in group I (p = 0.001-0.028. PNV incidence was significantly lowest in group I (p = 0.026. PNV incidence was also lower in group III compared to group IV (p = 0.032. Analgesic requirements were significantly lower in group I and was lower in group III compared to group IV (p = 0.005. Heart rates were significantly lower in esmolol groups (group I and III compared to their controls (p = 0.001 however blood pressures were similar in all groups (p = 0.594. Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (p = 0.024-0.03. CONCLUSION: Using esmolol during anesthetic maintenance significantly decreases anesthetic-analgesic requirements, postoperative pain and PNV.

  3. Operation Nursing and Experience of Laparoscopic Cholecystectomy%腹腔镜胆囊切除术的手术护理配合与体会

    Institute of Scientific and Technical Information of China (English)

    范晓勇; 晁晓霞; 张晓红

    2014-01-01

    Objective Discuss the surgical nursing cooperation of laparoscopic cholecystectomy(LC). Methods Constantly summarize and optimize the proficiency and mastery of LC through the 212 cases of LC surgical nursing cooperation during January-December 2012. Results Sum up that the key points to surgical nursing cooperation are skillfully mastering the performance and use method of LC instruments and equipment with adequate preoperative preparation. Conclusions Perfect surgical nursing cooperation of LC can effectively shorten the operation time, reduce the surgical risks of patients, ensure the operation successful and make the patients spend the operative period peacefully.%目的:探讨腹腔镜胆囊切除术的手术配合。方法通过2011年1月至2012年12月份212例腹腔镜胆囊切除术的手术配合,不断的总结和完善对此技能的熟练与掌握。结果总结出熟练的掌握腹腔镜设备及器械的性能,使用方法及充足的术前准备是手术配合的关键。结论完善的腹腔镜胆囊切除术的手术护理配合可有效的缩短手术时间,降低患者的手术危险性,保障手术顺利进行,使患者平安度过手术期。

  4. 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。

  5. RAMOSETRON: PREVENTION FOR POST OPERATIVE NAUSEA AN D VOMITING AFTER LAPAROSCOPIC CHOLECYSTECTOMY- A PROS PECTIVE, RANDOMIZED, DOUBLE-BLIND COMPARISION WITH ONDASETRO N

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    Anjan

    2013-05-01

    Full Text Available ABSTRACT: BACKGROUND: Postoperative nausea and vomiting (PONV frequently hampers implementation of laparoscopic surgery in spite of so many antiemetic drugs and regimens. This study was to compare the efficacy of Ramosetron and Ondansetron in (PONV after Laparoscopic Cholecystectomy. MATERIALS & METHODS : 124 adult patients of either sex, of ASA physical status I and II, scheduled for Laparoscopic Cholecystectom y operation, were randomly allocated into Group A (n=62 patients received IV Ondansetron 4mg and Group B (n=62 patients received IV Ramosetron (0.3 mg. Drug was administered prior to induction of GA. Episodes of PONV were compared between the groups at 4 hrs,4.5 hrs,5 hrs, 5.5 hrs and 6 hrs post- operatively. STATISTICAL ANALYSIS: The raw data analyzed by SPSS Ⓡ ⓇⓇ Ⓡ statistical package version 18.0 (SPSS Inc., Chicago, IL, USA. Numerical variables were c ompared by independent sample t test. Chi square test, Officers exact test and Fischer’s exac t test were used to compare categorical variables between groups. All analysis were two tailed and a P<0.05 was considered statistically significant RESULTS: Statistically significant difference between groups A and B (P <0.05, was found showing that Ramosetron was superior than Ondansetron in an tiemetic efficacy and Ramosetron emerged as a better antiemetic than Ondansetron in 1st12 hr s post-operative period. The post-operative mean Visual Analogue Scale( VAS scoring for the s everity of PONV between the two study groups at 4 hrs and 6 hrs post operative period, revealed that there was statistically significant difference between the two groups , showing that severity of nausea was more in case of Ondansetron than Ramosetron.

  6. Application of B-mode Ultrasound before Laparoscopic Cholecystectomy%B超在腹腔镜胆囊切除术前的应用

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    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.

  7. The Effect of Warm Water Intake on Bowel Movements in the Early Postoperative Stage of Patients Having Undergone Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

    Science.gov (United States)

    Çalişkan, Nefise; Bulut, Hülya; Konan, Ali

    2016-01-01

    This study was aimed at determining the effect of oral administration of warm water during the postoperative initial stage on the time of first flatus in patients who had undergone laparoscopic cholecystectomy. In the literature, it is emphasized that warm water has favorable effects on intestinal movements such as "reliving gastrointestinal spasms and helping peristalsis return." This randomized controlled trial and experimental study was conducted in a university hospital between May and December 2011. In the study sample, we included a total of 60 patients; 30 were in the experimental group (drank warm water), while the other 30 composed the control group. Patients were randomized through a simple random sampling method. The experimental group was provided with 200 ml of warm water at 98.6°F (37°C) in the fourth postoperative hour and were made to drink it within 15 minutes. Patients received no oral intake other than warm water until the eighth postoperative hour. The oral feeding of both groups started in the eighth postoperative hour with fluids and soft food. They shifted to the normal diet as tolerated. In the analysis of the data and percentage numbers, chi-square test and Fisher's exact test, Student's t test, Mann-Whitney U test, Kruskal-Wallis variance, and correlation analysis were used. The results of the data were considered reliable and statistically significant when they were in the reliability interval of 95% and p .05). Groups were homogeneously distributed. Flatus expulsion in the experimental group was 11 ± 4.2 hours and was determined to be 18.6 ± 6 hours for patients in the control group (p .05). It was determined that warm water intake in the fourth postoperative hour significantly decreased the first flatus expulsion period and had a favorable impact on intestinal movements. PMID:27684632

  8. MUTIRÕES DE COLECISTECTOMIA POR VIDEOLAPAROSCOPIA EM REGIME DE CIRURGIA AMBULATORIAL INTENSIVE PROGRAM OF VIDEOLAPAROSCOPY CHOLECYSTECTOMY ON AN AMBULATORY SURGERY BASIS

    Directory of Open Access Journals (Sweden)

    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

  9. 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。

  10. 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.

  11. 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

  12. 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

  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. Stepwise approach to curative surgery using percutaneous transhepatic cholangiodrainage and portal vein embolization for severe bile duct injury during laparoscopic cholecystectomy: a case report.

    Science.gov (United States)

    Honmyo, Naruhiko; Kuroda, Shintaro; Kobayashi, Tsuyoshi; Ishiyama, Kohei; Ide, Kentaro; Tahara, Hiroyuki; Ohira, Masahiro; Ohdan, Hideki

    2016-12-01

    Laparoscopic cholecystectomy (LC) has been recently adapted to acute cholecystitis. Major bile duct injury during LC, especially Strasberg-Bismuth classification type E, can be a critical problem sometimes requiring hepatectomy. Safety and definitive treatment without further morbidities, such as posthepatectomy liver failure, is required. Here, we report a case of severe bile duct injury treated with a stepwise approach using (99m)Tc-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT)/CT fusion imaging to accurately estimate liver function.A 52-year-old woman diagnosed with acute cholecystitis underwent LC at another hospital and was transferred to our university hospital for persistent bile leakage on postoperative day 20. She had no jaundice or infection, although an intraperitoneal drainage tube discharged approximately 500 ml of bile per day. Recorded operation procedure showed removal of the gallbladder with a part of the common bile duct due to its misidentification, and each of the hepatic ducts and right hepatic artery was injured. Abdominal enhanced CT revealed obstructive jaundice of the left liver and arterial shunt through the hilar plate to the right liver. Magnetic resonance cholangiopancreatography revealed type E4 or more advanced bile duct injury according to the Bismuth-Strasberg classification. We planned a stepwise approach using percutaneous transhepatic cholangiodrainage (PTCD) and portal vein embolization (PVE) for secure right hemihepatectomy and biliary-jejunum reconstruction and employed (99m)Tc-GSA SPECT/CT fusion imaging to estimate future remnant liver function. The left liver function rate had changed from 26.2 % on admission to 26.3 % after PTCD and 54.5 % after PVE, while the left liver volume rate was 33.8, 33.3, and 49.6 %, respectively. The increase of liver function was higher than that of volume (28.3 vs. 15.8 %). On postoperative day 63, the curative operation, right

  15. Alterações funcionais respiratórias na colecistectomia por via laparoscópica Functional respiratory changes in laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    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

  16. 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

  17. 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。

  18. 氟比洛芬酯用于腹腔镜胆囊切除术超前镇痛的Meta分析%THE META-ANALYSIS OF THE EFFECTS OF FLURBIPROFEN AXETIL PREEMPTIVE ANALGESIA ON LAPAROSCOPIC CHOLECYSTECTOMY

    Institute of Scientific and Technical Information of China (English)

    姚志文; 赵振龙; 古妙宁

    2012-01-01

    Objective: To evaluate the effects of flurbiprofen axetil preemptive analgesia on laparosco-pic cholecystectomy with Meta-analysis. Methods: We searched on Wanfang database and CNKI database and VIP database and PubMed database to get the random-control trials on the effects of flurbiprofen axetil preemptive analgesia on laparoscopic cholecystectomy. According to the data being extracted, the effects of flurbiprofen axetil preemptive analgesia and the adverse reactions were comprehensively evaluated by Meta-analysis. Results: There were 14 studies with 702 cases enrolled in this Meta-analysis. The results of the Meta-analysis showed that the effects of flurbiprofen axetil preemptive analgesia at 2 h, 4 h, 8 h,12 h after operation were better than that of control. There was no significant difference in adverse reaction of nausea and vomiting between the two groups. Conclusion: Flurbiprofen axetil preemptive analgesia has a better effect on laparoscopic cholecystectomy without increasing the incidence of adverse reactions.%目的:用Meta分析的方法综合评价氟比洛芬酯用于腹腔镜下胆囊切除术的超前镇痛效果.方法:检索万方数据库、CNKI数据库、维普数据库及PubMed数据库,以查找所有公开发表的关于氟比洛芬酯用于腹腔镜下胆囊切除术超前镇痛效果的随机对照试验,提取数据后用Meta分析的方法综合评价氟比洛芬酯的术后镇痛效果及不良反应情况.结果:Meta分析共纳入14篇文献,累计病例702人.结果表明术后2h,4h,8h及12h的氟比洛芬酯超前镇痛效果明显,具有统计学意义(P<0.001),并且恶心呕吐的不良反应和对照组没有统计学差异(P=0.59).结论:氟比洛芬酯用于腹腔镜下胆囊切除术的超前镇痛效果明确,且不增加不良反应的发生情况.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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。

  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

    Directory of Open Access Journals (Sweden)

    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. 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

  7. 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

  8. Transumbilical Triple-hole Approach Laparoscopic Cholecystectomy Combined with Appendectomy:a Report of 42 Cases%脐周三孔法腹腔镜胆囊联合阑尾切除术42例

    Institute of Scientific and Technical Information of China (English)

    王家兴; 林龙英; 李萍; 李捷

    2014-01-01

    Objective-To-evaluate-the-feasibility-of-the-transumbilical-triple-hole-laparoscopic-cholecystectomy-combined-with-appendectomy-.-Methods-From-March-2012-to-December-2012,-a-total-of-42-cases-subject-to-transumbilical-triple-hole-laparoscopic-cholecystectomy-combined-with-appendectomy-in-this-hospital-were-retrospectively-analyzed-.Under-general-anesthesia-,-the-patients-were-maintained-at-recumbent-position-,-with-a-pneumoperitoneum-pressure-of-12-14-mm-Hg.With-the-navel-as-the-center-,-10-mm,-5-mm,-and-10-mm-trocars-were-introduced-at-5,-8,-and-1-o’-clock-direction-along-the-circumference-of-periumbilical-skin-fold-,-respectively-.After-observation-and-exploration-,-cholecystectomy-and-appendectomy-were-successively-performed-.-Results-All-the-patients-were-successfully-treated,-without-any-complications.The-operation-time-was-60-130-min-(mean,-78-min).A-follow-up-observation-for-2--12-month-(-mean,-7-month-)-was-conducted-in-40-cases.No-obvious-scars-or-complications-were-noted-.-Conclusions-Transumbilical-triple-hole-laparoscopic-cholecystectomy-combined-with-appendectomy-is-a-safe-and-feasible-operation-.-This-method-can-be-carried-out-at-large-scale-in-hospitals-as-improved-alternative-of-cholecystectomy-combined-with-appendectomy-.%目的:探讨脐周三孔法腹腔镜胆囊联合阑尾切除术的可行性。方法2012年3~12月行脐周三孔腹腔镜胆囊联合阑尾切除术42例。全身麻醉。采用平卧位,气腹压力12~14 mm Hg(1 mm Hg=0.133 kPa)。以脐为中心,沿脐周皮肤皱褶线画圆,从5、8、1点方向分别置入10、5、10 mm trocar,入镜观察胆囊和阑尾情况,先行胆囊切除后再行阑尾切除术。结果42例采用普通腹腔镜器械经脐周行三孔胆囊切除联合阑尾切除术取得成功。手术时间60~130 min,平均78 min。40例术后随访2~12个月(平均7个月),腹壁瘢痕不明显,无并发症发生。结论脐周三孔腹腔镜胆囊联合阑尾切除术

  9. 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

  10. 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

  11. 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

  12. 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

  13. Repercussão respiratória funcional após colecistectomia com incisão subcostal: efeito analgésico da morfina Functional respiratory repercussion in opened subcostal cholecystectomy: morphine effect analgesic

    Directory of Open Access Journals (Sweden)

    Gilson Cassem Ramos

    2009-04-01

    Full Text Available OBJETIVO: Avaliar a função pulmonar pós-colecistectomias subcostais abertas de pacientes sob ação da morfina no pós-operatório imediato. MÉTODOS: Tratou-se de um estudo prospectivo, onde se avaliaram espirometrias pós-operatórias de 15 pacientes submetidas à colecistectomias abertas subcostais, que receberam dose única de morfina peridural na anestesia. Os dados pós-operatórios foram comparados aos pré-operatórios pelo teste t-Student emparelhado. Um valor de p OBJECTIVE: To evaluate pulmonary function after open subcostal cholecystecomy under action of the morphine in the immediate post-operative. METHODS: This was a prospective study, in which the post-operative spirometries of fifteen patients who underwent open subcostal cholecystectomies which received peridural morphine anesthesia. Post- and pre-operative data were compared using a paired student-t test. A value of p < 0,05 was considered statistically significant. RESULTS: Significant differences existed for the Forced Vital Capacity variable (p = 0,007 and Forced Expiratory Volume in the first second (p = 0,008 between pre- and immediate post-operative, indicating restrictive ventilatory disturbances. All of the patients presented normal espirometries in the third day of post-operative. CONCLUSION: Even under action morphine peridural analgesia, in the immediate post-operative, light restrictive post-cholecystectomy ventilatory disturbances were observed. However, it was observed abbreviated recovery of pulmonary function, which may lower post-operative pulmonary morbidity.

  14. 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。

  15. 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.

  16. 腹腔镜胆囊切除术后胆总管残余结石的危险因素分析%Risk factors for retained common bile duct stones of laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    崔宏力; 周长宇; 刘建东; 安宏超; 李华志; 徐宏征; 吴永哲

    2014-01-01

    目的 探讨导致腹腔镜胆囊切除术术后胆管残余结石的相关危险因素,为预防术后胆管残余结石提供科学依据.方法 分析2002年1月-2013年6月于北京市垂杨柳医院行腹腔镜胆囊切除术的654例胆囊结石患者,按术后是否存在胆总管结石残留,分为残余结石组(27例)及非残余结石组(627例).分别观察两组的黄疸胰腺炎病史、胆总管内径(B超)≥8 mm、急性胆囊炎、急诊手术、胆囊切除顺序、胆囊三角粘连、泥沙样结石、结石颈部嵌顿、充满型结石、胆囊管增粗、胆囊管保留≥1 cm、结石最小直径≤5 mm、胆囊结石数量≥5个、脓性胆汁等相关指标.采用统计软件IBM SPSS 20.0进行统计学分析.结果 经Logistic回归分析,按照影响度高低排序,本研究发现以下因素为LC术后残余结石的独立危险因素:胆总管内径(B超)≥8 mm、胆囊切除顺序(逆切)、黄疸胰腺炎病史、胆囊管保留长度≥1 cm、泥沙样结石.结论 有黄疸胰腺炎病史、胆总管内径(B超)≥8 mm、胆囊切除顺序(逆切)、泥沙样结石、胆囊管保留长度≥1 cm,是LC术后胆管残余结石的独立危险因素,在行LC术前及术中应特别注意上述因素并采取相应的措施,有助于避免术后胆管残余结石的发生.%Objective To investigate the related risk factors caused the retained common bile duct (CBD)stones after laparoscopic cholecystectomy,to provide the evidence for preventing from retained common bile duct stones of laparoscopic cholecystectomy.Methods Selected 654 cases of laparoscopic cholecystectomy patients as the objects whom hospitalized in Beijing Chuiyongliu Hospital from January 2002 to June 2013.All cases were divided into the group of retained CBD stones (27cases) and the group of non-retained CBD stones (627 cases).Collected the potentially relevant factors of two groups with the retained CBD stones,including medical history of jaundice and pancreatitis

  17. Comparative analysis the postoperative complications after laparoscopic cholecystectomy%腹腔镜胆囊切除术术后并发症的比较分析

    Institute of Scientific and Technical Information of China (English)

    周海波

    2014-01-01

    目的:探讨腹腔镜胆囊切除术术后并发症的发生率及发生因素。方法:筛选收治的腹腔镜胆囊切除术的患者120例,作为研究对象。所有患者均应用腹腔镜行胆囊切除术进行治疗,其中胆囊结石86例,胆囊息肉20例,急慢性胆囊炎14例,对所有患者的术后并发症及术中治疗措施、患者自身实际情况进行调查分析,统计腹腔镜胆囊切除术术后各类并发症的发生率,并总结其发生因素。结果:发生术后综合征2例,术后出血6例,胆漏5例,胆管损伤4例,结石残余5例,切口感染1例,腹泻2例;调查并发症发生的原因发现患者的生理特异性和医疗操作是造成术后并发症的主要因素,差异具有统计学意义( P <0.05)。结论:加强术前检查,规范医生手术方案及加强技术水平能够有效降低腹腔镜胆囊切除术术后并发症的发生率,使患者及早康复,减少痛苦。%Objective To investigate the incidence and factors of postoperative complications after laparoscopic cholecystectomy(LC). Method 120 cases with LC were as research subjects. All patients were treated with LC,where 86 cases of gallstones,20 cases of gallblad-der polyps,14 cases of acute and chronic cholecystitis. We analyzed postoperative complications,surgery treatment,and the patient's own actual situation to count the incidence of postoperative complications after LC and summarizes the factors. Results There were 2 cases of postoperative syndrome,6 cases of postoperative bleeding,5 cases of bile leakage,4 cases of bile duct injury,5 cases of residual stones,and 1 cases of wound infection,2 cases of diarrhea. It was the main reason of postoperative complications that the patient's physiological speci-ficity and medical operations. The results were statistically significant(P < 0. 05). Conclusion It can effectively reduce the incidence of postoperative complications after LC that Strengthening

  18. 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.

  19. Granulomatous Peritonitis After Laparoscopic Cholecystectomy

    OpenAIRE

    Famularo, Giuseppe; Remotti, Daniele; Galluzzo, Michele; Gasbarrone, Laura

    2012-01-01

    Background: Granulomatous peritonitis may indicate a number of infectious, malignant, and idiopathic inflammatory conditions. It is a very rare postoperative complication, which is thought to reflect a delayed cell-mediated response to cornstarch from surgical glove powder in susceptible individuals. This mechanism, however, is much more likely to occur with open abdominal surgery when compared with the laparoscopic technique. Methods: We report a case of sterile granulomatous peritonitis in ...

  20. 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

  1. 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

  2. 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

  3. Videocirurgia robótica: estudo clínico prospectivo na colecistectomia laparoscópica Robotic surgery for laparoscopic cholecystectomy: a prospective study

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    Ricardo Zorrón

    2005-08-01

    videocirurgia robótica à distância.BACKGROUND: Robotic surgery is a new clinical and technological advance in its early stage of development. The possibility of solosurgery brings up a discussion of feasibility and safety of robotic procedures in abdominal surgery. A prospective study was designed to test the learning curve and results of the new technique for cholecystectomy using robotic assistance with AESOP 3000. METHODS: Fifteen patients were prospective documented and submitted to laparoscopic robotic assisted surgery, using the robotic camera system AESOP 3000 with voice control and a fixed mechanical arm, allowing the execution of the procedures under the general concept of solo-surgery (without assistants. The camera was positioned at the umbilical port, adjusted to receive voicecontrol by the HERMES system, allowing the memorization of key positions. A fixed traction arm was connected to the operating table to retract organs when necessary. RESULTS: Operations succeed normally, and there were no need for converting to open surgery. Disconnection of the AESOP System for manual camera control was necessary in one case. Operating time was longer for robotic procedures, and time needed for adjusting the system alone was 21,9 minutes. Mean postoperative hospital stay was short, with most patients being discharged up to 48hs (86.7%. There were no local or systemic postoperative complications. Grade of satisfaction by the surgical teams was 3.94 for robotic assistance. CONCLUSIONS: Robotic surgery is a new evolving method. Potential advantages of AESOP 3000 and telerobotic systems were confirmed by the study. A short learning curve is necessary for the technique, which was easily learned by training doctors. With longer operative time than standard laparoscopic procedure, robotic surgery shows a great precision and camera stability, suggesting an early step for telerobotic surgery.

  4. SLIPA喉罩与气管插管麻醉在腹腔镜胆囊切除手术的应用比较%Compare with application of SLIPA larygneal mask and tracheal intubation to laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    洪黎霞; 王坚

    2010-01-01

    Objective To compare the changes of circulation and respiration parameters and the complications of the patients undergoing laparoscopic cholecystectomy with SLIPA larygneal mask and tracheal intubation, and explore appropriate methods of nursing care for it. Methods A total of 60 patients undergoing laparoscopic cholecystectomy were randomly allocated into two groups: SLIPA group(n = 30) and tracheal intubation group ( n = 30). Two groups of patients with intubation were recorded before and after intubation in terms of HR, SBP, DSP, and the minute ventilation, tidal volume, peak airway pressure (Ppeak), PETCO2. The incidence of complications such as reflux and aspiration in the operation, bucking when the operation finished,sore throat, hoarseness, nausea, vomiting, lung infection after operation and were observed. Results The minute ventilation (MV), tidal volume (TV), peak airway pressure (Ppeak), and PETCO2 at 15 minute after positive pressure ventilation and pneumoperitoneum were significantly different between the two groups. The incidence of postoperative complications of SLIPA (group L) was significantly lower than that of tracheal intubation group.Conclusions SLIPA laryngeal mask airway for laparoscopic cholecystectomy is superior to tracheal intubation. It can maintain hemodynamic stable and low complications. Nursing care on patients used laryngeal mask anesthesia and tracheal intubation have different emphases, the former focused on the preoperative nursing assessment and prevention of intraoperative displacement, and the latter focused on tracheal nursing care and prevention of infection and other complications.%目的 比较SLIPA喉罩与气管插管全麻对腹腔镜胆囊切除手术患者循环和呼吸参数的变化及并发症的情况,探讨相应的护理方法.方法 60例择期腹腔镜胆囊切除手术患者随机分为SLIPA喉罩组和气管插管组,记录两组患者插管前后心率、血压、每分通气量(MV)、潮气量(TV)、

  5. Benefícios da cinesioterapia respiratória no pós-operatório de colecistectomia laparoscópica Benefits of postoperative respiratory kinesiotherapy following laparoscopic cholecystectomy

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    AC Gastaldi

    2008-04-01

    Full Text Available INTRODUÇÃO: Alterações da função pulmonar após cirurgia abdominal levam à redução do volume pulmonar, prejudicando as trocas gasosas. OBJETIVO: Avaliar os efeitos da cinesioterapia respiratória sobre a função pulmonar e a força muscular respiratória em pacientes submetidos à colecistectomia laparoscópica. MATERIAIS E MÉTODOS: Em estudo prospectivo, 20 mulheres e 16 homens (idade: 48,4 ± 9,55 anos, submetidos à colecistectomia laparoscópica, foram divididos aleatoriamente: 17 realizaram exercícios respiratórios (respiração diafragmática, sustentação máxima da inspiração e inspiração fracionada e 19 participaram como Grupo Controle. Todos realizaram avaliação das pressões respiratórias máximas (PImax e PEmax, pico de fluxo expiratório (PFE e espirometria, medindo capacidade vital (CV, capacidade vital forçada (CVF, volume expiratório no primeiro segundo (VEF1, relação VEF1/CVF no pré-operatório e diariamente até o sexto pós-operatório (PO. RESULTADOS: Os valores de pré-operatório não foram estatisticamente diferentes entre os dois grupos. Ambos os grupos apresentaram diminuição de todas as variáveis no 1º PO (pINTRODUCTION: Pulmonary function changes following abdominal surgery lead to reduced pulmonary volume, thus compromising gas exchanges. OBJECTIVE: To evaluate the effects of respiratory kinesiotherapy on pulmonary function and respiratory muscle strength in patients who underwent laparoscopic cholecystectomy. METHODS: Twenty women and 16 men (age 48.4 ± 9.55 years who underwent laparoscopic cholecystectomy were prospectively studied. They were randomly divided as follows: 17 subjects performed breathing exercises (diaphragmatic respiration, maximum sustained inspiration and fractional inspiration and 19 participated as a Control Group. All of them underwent evaluations of maximal inspiratory and expiratory pressures (MIP and MEP, peak expiratory flow (PEF and spirometry, with

  6. Study on clinical application of esmolol in general anesthesia in senile patients with laparoscopic cholecystectomy.%艾司洛尔在老年患者全麻腹腔镜胆囊切除术的临床研究

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    施燕飞; 王晓军; 刘如葵; 徐连生; 李雪刚; 汤荣兴; 张努

    2011-01-01

    目的 探讨艾司洛尔对老年患者全麻腹腔镜胆囊切除术的有效性和安全性.方法 选择60例美国麻醉师协会(ASA) I~II全麻腹腔镜胆囊切除术老年患者,麻醉诱导前静脉注射艾司洛尔0.5 mg/kg,然后以25 μg/(kg·min)持续静脉输注,监测麻醉诱导前(T0)、插管前(T1)、插管后(T2)、插管后5 min(T3)、插管后10 min(T4)、拔管前(T5)、拔管后5 min(T6)的收缩压(SBP)、舒张压(DBP)、心率(HR)及术后苏醒情况、麻醉并发症.结果 插管后、插管后5 min、插管后10 min、拔管前、拔管后5 min的收缩压、舒张压、心率与插管前比较差异均无统计学意义(P>0.05);术中无心律失常,术后24 h内随访无麻醉相关并发症.结论 艾司洛尔可安全有效的用于老年患者全麻腹腔镜胆囊切除术,血流动力学稳定,术后苏醒快.%Objective To study the efficacy and safety of esmolol applied in general anesthesia for senile patients with laparoscopic cholecystectomy. Methods The application of loading dosage of esmolol 0.5mg/kg before induction of anaesthesia and followed by infusion of 25 μg/ ( kg · min ) was carried out during the operation, laparoscopic cholecystectomy under ASA Ⅰ to Ⅱ general anesthesia was carried out in 60 senile patients, their systolic blood pressure ( SBP ), diastolic blood pressure ( DBP ) and heart rate ( HR ) were recorded before induction of anaesthesia,immediately after intubation, 5 and 10 minutes after intubation, before and 5 minutes after extubation. At the same time, monitoring postoperative recovery situation and complications at 24 hornrs after anesthesia was also observed. Results There were no statistically significant difference ( P> 0.05 ) observed immediately after intubation, 5 and 10 minutes after intubation, before and 5 minutes after extubation among systolic blood pressure, diastolic blood pressure and heart rate as compared with those before intubation; and there were no arrhythmia and

  7. 瑞芬太尼与芬太尼在腹腔镜胆囊手术中应用的效果比较%Comparison of the application effect of remifentanil and fentanyl in laparoscopic cholecystectomy

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    张红

    2014-01-01

    目的:比较瑞芬太尼与芬太尼在腹腔镜胆囊手术中应用的临床效果。方法:选择腹腔镜胆囊手术患者52例,随机均分为瑞芬太尼组与芬太尼组,分别采用瑞芬太尼与芬太尼麻醉,比较两组患者术中血液动力学变化及临床效果。结果:瑞芬太尼组的术中血液动力学稳定性较芬太尼组平稳,芬太尼组气腹2 min与插管5 min时临床指标变化,差异具有统计学意义(P<0.05);术后自主呼吸时间、呼之睁眼时间、拔除导管时间及定向力恢复时间进行比较,瑞芬太尼组均优于芬太尼组(P<0.05)。结论:腹腔镜胆囊手术时采用瑞芬太尼与芬太尼麻醉均有效,但前者血液动力学稳定性较后者平稳,术后恢复也优于后者,应作为首选麻醉方案。%Objective:To compare the clinical effect of the application of remifentanil and fentanyl in laparoscopic cholecystectomy.Methods:52 patients with laparoscopic cholecystectomy were selected.They were randomly divided into the remifentanil group and the fentanyl group.They were respectively given remifentanil and fentanyl anesthesia.The intraoperative hemodynamic changes and clinical effects of patients in two groups were compared.Results:The intraoperative hemodynamic stability of the remifentanil group was more smooth than that of the fentanyl group.At pneumoperitoneum 2 minutes and intubation 5 minutes,the differences between the clinical indicator changes of the fentanyl group were statistically significant(P<0.05).The postoperative spontaneous breathing time,called eye opening time,catheter removal time and directional force recovery time were compared,and the remifentanil group were better than those of the fentanyl group(P<0.05).Conclusion:Laparoscopic cholecystectomy using remifentanil and fentanyl are effective,but the hemodynamic stability of the former is more smooth than that of the latter,and postoperative recovery is also better than that of

  8. 胆囊颈部结石嵌顿实施腹腔镜胆囊切除术的临床探析%Clinical analysis of laparoscopic cholecystectomy in the treatment of gallbladder neck calculi incarceration

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    赵宇

    2016-01-01

    Objective:To analyze the clinical effect of laparoscopic cholecystectomy in the treatment of gallbladder neck calculi incarceration.Methods:92 patients with gallbladder neck calculi incarceration were divided into the control group and the experimental group with 46 cases in each.The control group was given conventional open cholecystectomy treatment.The experimental group was given laparoscopic surgery treatment.The operation time,intraoperative blood loss,postoperative recovery feeding time,hospitalization time and complications were compared in two groups.Results:The two groups were successfully completed surgery.The experimental group had no transfer laparotomy cases.The operation time,intraoperative blood loss, postoperative recovery feeding time,hospitalization time of the experimental group were significantly less than those of the control group(P<0.05).The incidence rate of postoperative complication in the experimental group was significantly lower than that of the control group(P<0.05).Conclusion:Laparoscopic cholecystectomy in the treatment of gallbladder neck calculi incarceration has exact effect.It has the advantages of less trauma, less bleeding,high safety.It is beneficial to the rapid recovery of patients.%目的:分析胆囊颈部结石嵌顿实施腹腔镜胆囊切除术治疗的临床效果。方法:将92例胆囊颈部结石嵌顿患者分为对照组和试验组各46例,对照组给予常规开腹胆囊切除术治疗,试验组给予腹腔镜手术治疗,比较两组患者手术耗时、术中失血量、术后恢复进食时间、住院时间以及并发症等。结果:两组均顺利完成手术,试验组无中转开腹病例;试验组手术耗时、术中失血量、术后恢复进食时间以及住院时间明显少于对照组(P<0.05);试验组术后并发症发生率明显低于对照组(P<0.05)。结论:胆囊颈部结石嵌顿实施腹腔镜胆囊切除术治疗效果确切,且具

  9. 腹腔镜胆囊切除术治疗胆囊癌的疗效和安全性分析%Efficacy and Safety of Laparoscopic Cholecystectomy on Treatment of Gallbladder Carcinoma

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    司义龙; 李天驷; 孙翔宇

    2015-01-01

    Objective To compare the clinical effect of laparoscopic cholecystectomy and gallbladder carcinoma on treatment of gallbladder carcinoma. Methods 70 cases of gallbladder cancer patients admitted in our hospital from February 2010 to May 2015 were selected as the research object. They were divided into observation group and control group by using random number table method, with 35 cases in each group, control group underwent conventional open radical resection of gallbladder carcinoma, observation group underwent laparoscopic cholecystectomy, compared two groups’ postoperative complications and clinical indexes. Recorded two groups’ survival rate after 1 year and 5 years.Results Observation group’s bleeding, postoperative exhaust time, surgery, digestive function recovery time, hospitalization time were lower than control group, observation group’s postoperative complications and adverse reactions occurred were significantly lower than control group (P<0.05); observation group’s postoperative recurrence rate was higher than control group, but postoperative 5 years survival rate was higher than control group (P<0.05).Conclusion Laparoscopic cholecystectomy surgery has exact effect on treatment of gallbladder cancer exactly, it has low injury and low rate of postoperative complications. It is worthy of application and popularization with its high operation safety and high survival rate.%目的:对比腹腔镜下胆囊切除术与胆囊癌根治手术治疗胆囊癌的临床疗效。方法筛选2010年2月至2015年5月我院收治的胆囊癌患者70例为研究对象。采用随机数表法将其分为观察组与对照组,每组35例。对照组常规开放胆囊癌根治术,观察组腹腔镜胆囊切除术,比较患者术后并发症发生情况及一般临床指标,并统计两组患者术后1年、5年生存率。结果观察组术中出血量、术后排气时间、手术用时、消化功能恢复时间、住院时间等均低于对照组

  10. Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit? Colecistectomía laparoscópica en el tratamiento de la litiasis biliar: ¿cirugía mayor ambulatoria o corta estancia?

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    A. Martínez Vieira

    2004-07-01

    Full Text Available Objective: analysis of clinical and surgical factors in a series of patients subjected to laparoscopic cholecystectomy in an outpatient unit and their relationship with time of discharge and patient acceptance. Patients and method: eighty one consecutive patients underwent to elective laparoscopic cholecystectomy during year 2002 within S.A.S. (Andalusian Health Service from a surgical waiting list. Retrospective and comparative study between two groups: group A includes patients discharged between 24 and 48 hours after intervention; group B includes patients discharged in less than 24 hours. We analyse the clinical and surgical characteristics and post-operative outcome of both groups of patients. Results: group A was composed of 53 patients and group B of 28 patients. Factors of clinical significance which determined discharge after 24 hours included: early post-surgical incidences or complications (p = 0.017, inability to tolerate oral diet (p = 0.002, and doubts and feelings insecurity of patients regarding discharge by traditional means 62.3% (p = 0.0003. Conclusions: outpatient laparoscopic cholecystectomy is a safe and reliable procedure with a high acceptance rate and few complications. Perhaps traditional culture has to be changed to obtain better results.Objetivo: analizar los factores clínicos y quirúrgicos que en una serie de pacientes sometidos a colecistectomía laparoscópica ambulatoria influyeron en la decisión del momento del alta y cuál fue la aceptación de los pacientes al alta. Pacientes y método: en este estudio fueron incluidos 81 pacientes consecutivos procedentes de la lista de espera quirúrgica en quienes se realizó una colecistectomía laparoscópica electiva a lo largo del año 2002. Es un estudio retrospectivo y comparativo que incluye dos grupos de pacientes: los del grupo A fueron dados de alta entre 24 a 48 horas tras la intervención; los del grupo B lo fueron en menos de 24 horas. Analizamos las caracter

  11. 电凝法处理胆囊动脉在腹腔镜胆囊切除术中的应用%Electrocoagulation of Gallbladder Artery in Laparoscopic Cholecystectomy

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    程鑫; 陈心怡; 甘有均

    2014-01-01

    Objective To investigate the safety and feasibility of electrocoagulation of gallbladder artery in laparoscopic cholecystectomy ( LC) . Methods A total of 376 patients with gallbladder benign diseases underwent LC in our hospital from May 2004 to September 2013.The gallbladder artery was treated by electrocoagulation . Results Because of unclear gallbladder triangle due to abdominal adhesion , conversion to laparotomy was performed in 9 patients.In the remaining 367 patients, three-port LC with electrocoagulation of the gallbladder artery was conducted successfully .Laparoscopic appendectomy was conducted simultaneously in 12 patients.An additional fenestration and drainage of the left renal cyst was performed in 1 patient.Postoperatively, a secondary bile duct exploration was conducted in 1 patient because of bile duct obstruction caused by common bile duct stones . Conclusion The electrocoagulation of gallbladder artery is safe and feasible in LC for the treatment of gallbladder benign diseases .%目的:探讨电凝法处理胆囊动脉在腹腔镜胆囊切除( laparoscopic cholecystectomy ,LC)术中的安全性、可行性。方法我院2004年5月~2013年9月采用电凝法处理胆囊动脉行三孔法LC 376例。结果中转开腹9例(腹腔粘连致胆囊三角解剖不清),其余367例在腹腔镜下完成手术,均以电凝法处理胆囊动脉,12例同期行腹腔镜阑尾切除术,1例行左肾囊肿开窗引流术。术后1例因胆总管结石致胆道梗阻行二次手术胆总管切开取石。结论胆囊良性疾病行LC时,电凝法处理胆囊动脉是安全、可行的。

  12. 经脐单孔腹腔镜胆囊切除术20例报告%The transumhilical single port laparoscopic cholecystectomy :a report or 20 cases

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    孙凯; 李杰; 田虎; 徐宗珍; 刘锋

    2011-01-01

    Objective:To discuss the clinical application of transumbilical single port laparoscopic surgery. Methods:The clinical data of 20 patients with gallbladder and appendix diseases undergoing transumbiiical single port laparoscopic surgery from Jul. 2010 to Jan.2011 were analyzed retrospectively. Results: All the operations were successfully performed. 18 patients underwent eholecystecto-my ,2 patients accepted cholecystectomy and appendectomy. None of them experienced conversion to open surgery or conventional laparoscopic surgery. The operating time ranged from 15 to 70 min,the blood loss was little without drainage tube. No complications occurred, postoperative hospital slay was 2-4 d. The abdominal wall scar was not obvious in follow-up of one month. Conclusions: Transumbiiical single port laparoscopic cholecystectomy and appendectomy is safe and feasible. Compared with the routing laparoscopic surgery, it has more mini-invasive advantages,less pain and abdominal wall scar,but the operation is difficult to perform. This surgery can be applied in qualified hospital with suitable indication.%目的:探讨经脐单孔腹腔镜手术的应用价值.方法:回顾分析2010年7月至2011年1月为20例患者行经脐单孔腹腔镜手术的临床资料,结果:18例行胆囊切除术,2例同时切除胆囊及阑尾,手术均获成功,无中转开腹或常规腹腔镜手术,手术时间15~70 min,术中出血少,均未放置引流管,无并发症发生,术后2~4 d出院,随访1个月腹部瘢痕不明显.结论:经脐单孔腹腔镜胆囊及阑尾切除术安全可行,比常规腹腔镜手术更微创,具有患者疼痛轻、腹壁瘢痕不明显等优点.但手术操作相对困难,对术者技术水平要求高,可在有条件的医院选择适合病例开展.

  13. The clinical application of harmonic scalpel in laparoscopic cholecystectomy in patients with cirrhosis%超声刀在肝硬化患者腹腔镜胆囊切除术中的应用价值

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    徐琳; 王峰; 宗光全; 刘仁民; 张宇飞

    2013-01-01

    Objective:To investigate the clinical application value of harmonic scalpel in laparoscopic cholecystectomy (LC) for patients with cirrhosis. Methods:From Apr. 2008 to Apr. 2012,48 patients who suffered from cholecystolithiasis and cirrhosis were randomly divided into harmonic saclpel group and conventional electric coagulation group. The related indices of perioperative period were comparatively analyzed between 2 groups. Results;LC was successfully performed in harmonic scalpel group,and 3 patients in conventional electric coagulation griup were converted to laparotomy. The use of the harmonic scalpel was associated with a statistically significant shorter operative time,less estimated intraoperative blood loss,less postoperative abdominal drainage and shorter postoperative hospital stay. No statistically significant difference was found between both groups as regards the conversion rate and the incidence of postoperative complications. Conclusions:The harmonic scalpel provides a superior alternative in terms of shorter operative time,less intraoperative blood loss,and lower incidence of deterioration of liver function in LC for patients with cirrhosis. This procedure is safe and effective,can avoid the injury of bile duct,and has better clinical application value.%目的:研究超声刀在肝硬化患者腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的临床应用价值.方法:选取2008年4月至2012年4月收治的48例胆囊结石合并肝硬化患者,随机分为超声刀组与常规电凝组,对比分析两组患者围手术期相关指标.结果:超声刀组均顺利完成LC,常规电凝组3例中转开腹.超声刀组手术时间、术中出血量、术后腹腔引流量及术后住院时间均明显低于常规电凝组,差异有统计学意义;中转率及术后并发症发生率超声刀组优于电凝组,但差异无统计学意义.结论:肝硬化患者LC术中应用超声刀可有效缩短手术时间、减少手术出血量、保

  14. Transumbilical Single-port Laparoscopic Cholecystectomy and Appendectomy:Report of 16 Cases%经脐单孔腹腔镜胆囊阑尾联合切除术16例报告

    Institute of Scientific and Technical Information of China (English)

    刘宝胤; 骆成玉; 段煜飞; 李鑫

    2012-01-01

    目的 探讨经脐单孔腹腔镜胆囊阑尾联合切除术的临床应用价值. 方法 回顾性分析我院2010年7月~2012年1月16例经脐单孔腹腔镜胆囊阑尾联合切除术的临床资料.经脐置入多孔道trocar,曲线形腹腔镜器械先切除胆囊并使用推结器丝线打结结扎胆囊动脉及胆囊管,然后行阑尾切除,4例由脐孔行拖出式阑尾切除,12例应用常规腹腔镜器械切除阑尾并使用推结器丝线打结结扎阑尾动脉及阑尾根部. 结果 16例均获成功,未放置引流.手术时间60~150 min,平均80.4 min,无并发症发生. 结论 使用专用器械行经脐单孔腹腔镜胆囊阑尾联合切除术安全、可行,但较传统腹腔镜手术操作困难,需要有一个学习曲线.%Objective To investigate the efficacy of transumbilical laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA) with a single port and free clips. Methods The clinical data of 16 patients, who received transumbilical single-port LC plus LA in our hospital from July 2010 to January 2012, were analyzed retrospectively. A multi-channel trocar was inserted through the umbilicus, and then cholecystectomy were performed with curved laparoscopic instruments. After the cystic artery and duct were ligated with a knot pusher, LA was carried out. The appendix was pulled out through the umbilicus in 4 patients, and in the other 12 patients, appendectomy was made with conventional laparoscopic instruments, and the appendix artery and stump were ligated with a knot pusher. Results The procedure was completed in all the 16 patients without placing drainage tube. The operation time ranged from 60 to 150 minutes with a mean of 80. 4 min. No patient had complications. Conclusions Transumbilical single-port LC and LA are feasible and safe, but more difficult than conventional laparoscopic procedure. A learning curve is expected.

  15. Comparison of the Effect of Pre-operative Single Oral Dose of Tramadol and Famotidine on Gastric Secretions pH and Volume in Patients Scheduled for Laparoscopic Cholecystectomy

    International Nuclear Information System (INIS)

    Objective: To evaluate and compare the effects of pre-operative single oral dose of tramadol and famotidine on gastric secretions pH and volume in patients electively scheduled for laparoscopic cholecystectomy. Study Design: Randomized control trial. Place and Duration of Study: Department of Anaesthesia, King Saud University Riyadh, Saudi Arabia, from August 2011 to June 2013. Methodology: Ninety adult, ASA-I and II patients scheduled for laparoscopic cholecystectomy were included in the study. Patients were randomly assigned to receive pre-operatively either placebo (Group-C, n=30), oral tramadol 100 mg (Group-T, n=30) or famotidine 40 mg (Group-F, n=30). After induction of general anaesthesia, gastric fluid was aspirated through orogastric tube. The gastric secretions volume and pH was measured using pH meter. Results:There was no statistically difference between groups in age, weight and gender. The gastric secretions mean pH was 2.06 ± 0.22,2.04 ± 0.20, 5.79 ± 0.77 and volume was 0.59 ± 0.17, 0.59 ± 0.14 and 0.28 ± 0.16 ml/kg in Group-C, Group-T and Group-F respectively. There was a significant statistical difference in the mean pH values between Group-C vs. Group-F (p greater than 0.001) and Group-Tvs. Group-F (p greater than 0.001). Statistically significant difference was also found in the mean gastric secretions volume between Group - C vs. Group-F (p greater than 0.001) and Group-Tvs. Group-F (p greater than 0.001). There was no significant difference in the mean gastric fluid pH values (p=0.99) and mean gastric secretions volume (p=0.99) between Group-Tand Group-C. Conclusion:As compared to famotidine, pre-operative single oral dose of tramadol was unable to elevate the desired level of gastric fluid pH (less than 2.5) and decrease in gastric secretions volume (greater than 0.4ml/kg). (author)

  16. Preliminary evaluation of pericholecystic adhesions before cholecystectomy by ultrasonography%腹腔镜胆囊切除术前超声评估胆囊周围粘连的初步研究

    Institute of Scientific and Technical Information of China (English)

    钟洁愉; 宫琳; 张蒂荣; 胡正明

    2011-01-01

    目的 探讨腹腔镜胆囊切除术前超声预测胆囊周围粘连的可行性和应用价值.方法 选择188例因胆囊结石拟行腹腔镜胆囊切除术的患者,术前超声对可能与胆周粘连程度相关的因素进行评估;与术中情况比较,分析导致胆周粘连的各相关危险因素的优势比.结果 与胆周粘连程度相关的超声观察项目:胆周异常回声、囊壁异常声像、胆囊增大、胆囊缩小伴填充型结石、胆囊颈部结石嵌顿、胆囊折叠及胆囊壁厚.其中,胆周异常回声的优势比最高,与胆周严重粘连密切相关.以囊壁厚度≥5.0 mm作为评估胆周重度粘连的临界值,灵敏度和特异度分别为63%和92%.结论 超声可以较准确地预测胆周粘连的程度,对腹腔镜胆囊切除术有一定的临床指导意义.%Objective To explore the feasibility and diagnostic value of ultrasonography in predicting pericholecystic adhesions before cholecystectomy. Methods One hundred and eighty - eight patients with cholecystolithiasis were examined by ultrasonography before surgery, and the relevant parameters of pericholecystic adhesions were recorded. Compared with the condition in surgery, the risk factors were analyzed, and the diagnostic value was evaluated. Results The ultrasonic factors related to the degree of pericholecystic adhesions were pericholecystic abnormal echo, gallbladder wall abnormal imaging,enlarged gallbladder. contractible gallbladder with packing stones, incarcerated stone in gallbladder neck, folded gallbladder,thickened gallbladder wall. Among them, pericholecystic abnormal echo was the most important positive factor correlated to dense pericholecystic adhesions. Numerical value as equal or greater than 5.0 mm of gallbladder wall thickness was set as cutoff value to diagnose pericholecystic dense adhesions, the sensitivity and specificity were 63% and 92% , respectively. Conclusion Pericholecystic adhesions before laparoscopic cholecystectomy

  17. The clinical analysis of laparoscopic cholecystectomy for preoperative ultrasound diagnosis%腹腔镜胆囊切除术术前超声诊断临床分析

    Institute of Scientific and Technical Information of China (English)

    陈言; 桑玉顺; 姥义; 吴晓燕

    2015-01-01

    Objective:To analyze the clinical effect of ultrasonography before laparoscopic cholecystecto‐my. Methods :retrospective analysis of our hospital from 2013 March to 2014 March received preoperative ultra‐sound diagnosis of 128 cases underwent laparoscopic cholecystectomy in patients with ultrasound examination and postoperative pathologic data. Results :the ultrasound assessment of patients with difficult operation in 45 cases, the actual operation was determined with difficulty of operation in 43 cases, the coincidence rate reached 95. 56%. In ad‐dition, difficult operation group and non operation group, the rate of difficult to abdominal complication, gallbladder wall thickness were significant differences (P<0. 05). Conclusion:ultrasound diagnosis before operation can effec‐tively predict the difficulty of laparoscopic cholecystectomy to reduce operation complication, which has important clinical value, improve the rate of conversion to open.%目的:探讨腹腔镜胆囊切除术术前超声诊断的临床效果。方法:对128例术前超声诊断后行腹腔镜胆囊切除术患者的超声检查结果及术后病理资料进行对比分析。结果:超声评估手术困难患者45例,实际手术中手术困难患者43例,其符合率达95.56%。此外,手术困难组与非手术困难组转开腹率、并发症率、胆囊壁厚度等参数均存在显著性差异(P<0.05)。结论:术前超声诊断可有效预测腹腔镜胆囊切除术的施术难度,对降低手术并发症,改善转开腹率具有重要临床价值。

  18. Clinical Study on Transumbilical Single Port Laparoscopic Cholecystectomy Comparing with Conventional Laparoscopic Cholecystectomy%经脐单孔腹腔镜胆囊切除术与常规腹腔镜胆囊切除术的临床疗效比较

    Institute of Scientific and Technical Information of China (English)

    王广伟; 顾元龙; 吴兴桂; 翟年宽; 刘敏丰

    2011-01-01

    目的 比较经脐单孔腹腔镜胆囊切除术(LC)与常规LC的的优、缺点.方法 回顾性分析2009年11月至2010年11月期间45例行择期胆囊切除患者,分别行经脐单孔 LC(经脐LC组,n=20)和常规LC(常规LC组,n=25).比较2组患者的手术时间、术后3d肝功能评分、术后3d应用止痛药频率、术后首次下床时间、术后住院时间、术中失血量及术后1个月慢性疼痛情况.结果除常规LC组1例由于Mirizzi综合征而中转开腹外,余均顺利完成手术.术后3d内应用止痛药频率和术后住院时间,经脐LC组优于常规LC组(P<0.05);而术后1个月内手术区域慢性疼痛及肝功能评分方面,经脐LC组与常规LC组比较差异无统计学意义(P>0.05);手术时间和术中失血量方面常规LC组优于经脐LC组(P<0.05,P<0.0l).结论经脐单孔LC具有伤口小、疼痛轻及恢复快的优点.%Objective To compare the advantages and disadvantages of transumbilical single port (TUSP) and conventional laparoscopic cholecystectomy (LC). Methods The clinical data of 45 patients underwent elective LC were analyzed, 20 patients with TUSP LC (TUSP-LC group), 25 patients with conventional LC (conventional LC group). The operation time, Child-Pugh score and painkiller application frequency within three days after operation, the first time of out of bed and hospital stay after operation, intraoperative blood loss, chronic pain within one month after surgery were compared between two groups. Results All cases were operated successfully except one patient in the conventional LC group. The frequency of painkiller application within three days after operation and postoperative hospital stay in the TUSP-LC group were better than those in the conventional LC group (P0. 05). The operation time and intraoperative blood loss in the conventional LC group were less than those in the TUSP-LC group (P<0. 05, P<0. 01). Conclusion TUSP LC has the advantages of small wound, slight pain

  19. 高原地区和非高原地区腹腔镜胆囊切除术的比较%Comparison of Laparoscopic Cholecystectomy between the Highland and Non-highland Area

    Institute of Scientific and Technical Information of China (English)

    黄韬; 罗彪; 刘佳; 杜景平

    2011-01-01

    Objective To explore the characteristics of patients undergoing laparoscopic cholecystectomy in highland area, in order to carry out better perioperative management. Methods We collected and analyzed the general information, preoperative diagnosis and complications of 367 patients living in highland area and 167 patients living in inland between February 2009 and May 2010. There was no significant difference between the two groups in sex, age and course of disease (P>0. 05). Cholecystolithiasis was the main disease followed by gallbladder polyps, and there was no difference between them in the kind of diseases (P>0. 05). The incidence of hypertension, coronary heart disease, hereditary persistence of fetal hemoglobin and sinus bradycardia was higher in patients in highland area than that in patients in non-highland area (P0. 05). Conventional laparoscopic cholecystectomy was conducted in both two groups. Comparative analysis of treatment outcome and postoperative complications was done. Results The rate of conversion from laparoscopic surgery to laparotomy in Tibetan patients (7. 1%) was higher than that in patients in non-highland area (2. 4%) (P 0.05). Conclusions Laparoscopic cholecystectomy for patients in highlardarea should be converted to laparotomy when necessary. Appropriate perioperative management is helpful in reducing the incidence of postoperative complications.%目的 探讨高原地区腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者的特点,以便更好地进行围手术期处理.方法 对2009年2月-2010年5月收治的长期生活在西藏高原地区的患者(高原组)367例和非高原地区患者(非高原地区组)167例的一般资料、术前诊断、合并症情况进行回顾性分析,两组患者性别、年龄及病程比较,差异无统计学意义(P>0.05),有可比性.两组患者诊断均以胆囊结石为主,其次为胆囊息肉,诊断构成比较,差异无统计学意义(P>0.05);两组患者合并症比较,

  20. Learning curve of transumbilical single-site laparoscopic cholecystectomy with conventional devices%常规器械经脐腹腔镜胆囊切除术学习曲线分析

    Institute of Scientific and Technical Information of China (English)

    吴庆华; 包皙婷; 孔雷; 刘玉祥; 陈勇; 王赭; 项明

    2016-01-01

    目的:评估常规器械经脐单部位腹腔镜胆囊切除术(transumbilical single-site laparoscopic cholecystectomy, TUSSLC)的阶段疗效,分析其学习曲线。方法:回顾性分析2014年3月至2015年1月笔者应用自创的常规器械“两trocar两切口”TUSSLC 100例。按手术顺序将病例分为6组,即A组、B组、C组、D组、E组各15例与F组25例。比较各组在性别、年龄、体质量指数、病种及手术时间、术中失血量、手术并发症、术后住院时间方面的差异。绘制学习曲线。结果:各组在性别、年龄、体质量指数及病种方面无统计学差异(P>0.05)。所有病例均顺利完成常规器械TUS-SLC,无术中中转,无术后腹腔内出血、胆道损伤等并发症发生。A组手术时间(59.7±16.7) min大于其余各组(P<0.05)。各组在术中失血量、术后住院时间方面无统计学差异(P>0.05)。术后随访6~9个月,随访率100%。无腹痛、发热、黄疸等术后胆道并发症发生,病人对脐部切口恢复的美容效果均满意。结论:常规器械TUSSLC安全可行,学习期估计为11例。掌握此术式特有的操作要点,可能有助于进一步缩短其学习期。%Objective To investigate the effect and learning curve of transumbilical single-site laparoscopic chole-cystectomy with conventional devices. Methods A retrospective analysis was made to 100 enrolled patients undergoing transumbilical single-site laparoscopic cholecystectomy with conventional devices by a self-created method so called “sin-gle site two trocars and two incisions” from Mar 2014 to Jan 2015. These consecutive cases were divided into six groups as group A (n=15), group B (n=15), group C (n=15), group D (n=15), group E (n=15) and group F (n=25). Demographic da-ta such as gender, age, body mass index and disease entity and surgical data such as operating time, operative blood loss, complications and postoperative hospital stay among the

  1. 常规器械下经脐入路腹腔镜胆囊切除术156例经验总结%Experience of Transumbilical Single-site Laparoscopic Cholecystectomy with Conventional Devices: A Report of 156 Cases

    Institute of Scientific and Technical Information of China (English)

    吴庆华; 刘玉祥; 陈勇; 陈一伟; 束一鸣

    2013-01-01

    目的 探讨常规器械下经脐入路单一部位腹腔镜胆囊切除术(transumbilical single-site laparoscopic cholecystectomy,TUSLC)的安全性和可行性.方法 2010年6月~2012年9月应用常规器械行TUSLC 156例.围手术期处理及手术基本操作原则同传统LC.脐旁10 mm trocar,置入腹腔镜探查腹腔,在10 mm trocar左旁直接戳孔后置入5 mm直径操作钳,在10 mm trocar右旁置入10 mm trocar作为主操作孔.左右手器械交叉操作,顺逆结合切除胆囊.结果 5例为胆囊与周围组织粘连严重,探查后即中转为传统三孔 LC.余151例平均手术时间49.3 min(30 ~ 90 min),术中出血量25.7 ml(5 ~70 ml),肠功能恢复时间平均1.3 d(1~2d),术后住院时间平均2.3 d(1~3 d).156例术后随访1~24个月,平均10.8月,均无发热、腹痛、黄疸等术后胆道相关疾病症状,患者对脐部切口恢复的美容效果均满意.结论 常规器械下TUSLC安全可行.%Objective To investigate the safety and feasibility of transumbilical single-site laparoscopic cholecystectomy with conventional devices.Methods The study enrolled 156 patients undergoing transumbilical single-site laparoscopic cholecystectomy with conventional devices from June 2010 to September 2012 in Shanghai Armed Police Force Hospital.Perioperative treatments and basic surgical procedures were in accordance with traditional laparoscopic cholecystectomy.We inserted laparoscope into paraumbilical 10-mm trocar for abdominal exploration,then inserted 5-mm trocar and 10-mm trocar on the left and right of umbilicus for operation forceps of 5 mm in diameter and main procedures.Anterograde combined with retrograde cholecystectomy was performed.Results Of the 156 cases,5 cases were converted to conventional LC due to severe tissue adhesion.The operation time,intra-operative blood loss,bowel function recovery time and postoperative hospital stay of the rest cases were 49.3 min (range,30-90 min),25.7 ml (range,5-70 ml),1.3 days

  2. 两孔法腹腔镜胆囊切除术与传统四孔法胆囊切除术的近期疗效对比研究%Comparative study of the short-term effects of two-port and four-port laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    陈云端; 佘勇; 何修林

    2013-01-01

    目的 比较两孔法腹腔镜胆囊切除术与传统四孔法胆囊切除术治疗结石性胆囊炎的近期疗效.方法 选取我院86例结石性胆囊炎患者,采用随机数字表法将其分为两孔法腹腔镜胆囊切除术组(简称观察组)和传统四孔法胆囊切除术组(简称对照组),比较两组手术时间、切口长度、术中出血量、肛门排气时间、住院时间、住院费用及切口感染情况;比较两组患者术后6h、12h、24h疼痛程度.结果 观察组患者在手术切口长度上明显短于对照组,差异具有统计学意义(P<0.05);两组的手术时间、术中出血量、肛门排气时间、切口感染等差异均无统计学意义(P>0.05);对照组患者在术后12h、24 h疼痛评分上明显高于观察组患者,差异具有统计学意义(P<0.05);两组患者在术后6h疼痛评分上差异无统计学意义(P>0.05).结论 对于传统四孔法胆囊切除术,两孔法腹腔镜胆囊切除术在治疗结石性胆囊炎上有术后疼痛轻、切口短等优点,值得临床推广.%Objective To compare and analyze the short-term effects of two-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy.Methods Eighty-six patients who had calculous cholecystitis were selected in our hospital and randomly divided into the observation group (treated by two-port laparoscopic cholecystectomy)and the control group (treated by four-port laparoscopic cholecystectomy).The operation duration,length of the cut,bleeding amount,anus exhausting time,length of hospital stay,hospitalization costs,and incision infection were compared between the two groups.Results In the observation group,the length of the cut was significantly shorter than that of the control group (P<0.05).The operation duration,bleeding amount,anus exhausting time,and incision infection showed no statistically significant difference between the two groups (P>0.05).The pain score 12 h,24 h after operation in the

  3. 帕洛诺司琼联合地塞米松预防腹腔镜胆囊切除术后恶心呕吐的临床观察%Clinical observation of palonosetron combined with dexamethasone in prevention of postoperative nausea and vomiting in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    洪叶; 唐祖芝; 蔡萍

    2015-01-01

    Objective To observe effect by palonosetron combined with dexamethasone in prevention of postoperative nausea and vomiting (PONV) in laparoscopic cholecystectomy.Methods A total of 120 patients receiving laparoscopic cholecystectomy were randomly divided into palonosetron group, dexamethasone group, and combined group, with 40 cases in each group. Incidences of nausea and vomiting within 24 h after operation were observed.Results Incidence of postoperative nausea and vomiting was obviously lower in the combined group than in palonosetron group and dexamethasone group. Their difference had statistical significance (P<0.05). Conclusion Combination of palonosetron and dexamethasone is more effective than single drug in prevention of postoperative nausea and vomiting in laparoscopic cholecystectomy. This method is worth promoting and applying.%目的 观察帕洛诺司琼联合地塞米松预防腹腔镜胆囊切除术后恶心呕吐(PONV)的效果.方法 120 例择期行腹腔镜胆囊切除术患者随机分为帕洛诺司琼组、地塞米松组、联合组, 每组40 例.观察手术后24 h内恶心呕吐发生率.结果 联合组术后恶心呕吐的发生率显著低于帕洛诺司琼组和地塞米松组, 差异有统计学意义(P<0.05).结论 帕洛诺司琼联合地塞米松预防腹腔镜胆囊切除术后恶心呕吐较单药更为有效, 值得临床推广应用.

  4. 针刺穿线胆囊悬吊在经脐单孔腹腔镜胆囊切除术中的临床对照研究%Controlled Clinical Studies Of Transumbilical Single Port Laparoscopic Cholecystectomy With The Needle Threading Gallbladder Suspended

    Institute of Scientific and Technical Information of China (English)

    李祺

    2012-01-01

      Objective To observe the therapeutic effect of acupuncture threading gallbladder suspension and conventional Transumbilical single port laparoscopic cholecystectomy. Methods 60 patients with gallbladder stones, gallbladder polyps(met the inclusion criteria), were randomly divided into the 30 cases(observation group) who were treated by transumbilical single port laparoscopic cholecystectomy with acupuncture threading gallbladder, the 30 cases(control group) were surgeried by transumbilical single port laparoscopic cholecystectomy with the the routine. The operative time, blood loss, hospital stay, pain index, shoulder pain, C-reactive protein(C-reactive protein, CRP), blood clotting function were obsevered to evaluate the therapeutic effect of the two surgical techniques. Results The operative time, blood loss, hospital stay, pain index, shoulder pain, CRP comparison were a statistically significant difference. In two groups of patients before and after surgery(P0.05). Athese index in control group were a statistically significant difference(P0.05),对照组凝血功能异常,与治疗前比有显著的统计学差异(P<0.05,P<0.01,P<0.001).结论针刺穿线胆囊悬吊经脐单孔腹腔镜胆囊切除术胆囊三角显露良好,传统器械处理起来简单方便,切口小术后不易察觉起到了美容效果,患者术后凝血功能正常,避免了腹腔镜术后患者静脉、肺栓塞的问题.

  5. Colecistectomía videolaparoscópica II : evaluación prospectiva de los primeros 328 casos en Medellín Veideolaparoscopic cholecystectomy: experience with 328 cases in Medellín, Colombia

    Directory of Open Access Journals (Sweden)

    Juan J. Uribe

    1994-03-01

    Full Text Available Se presenta la experiencia de los primeros 328 casos de colecistectomía laparoscópica en Medellín, realizados entre septiembre 18 de 1991 y mayo 18 de 1993, por el grupo CIGLA (cirujanos laparoscopistas de Antioquia. El grupo de pacientes estuvo formado por 252 mujeres (76.8% y 76 hombres (23.2% con edades comprendidas entre 14 y 85 aíios. Se intervinieron 274 casos (83.5% como cirugía programada y 54 de urgencia por colecistitis aguda (16.5%. Fue necesario convertir el procedimiento a cirugía abierta en 5 pacientes (1.5%; dos de ellos tenían adherencias firmes, anatomía confusa y fístulas colecistoduodenales; otros dos presentaban inflamación aguda y marcado edema y el último sufrió una lesión iatrogénica de las vías biliares; sólo se presentaron 6 casos de complicación mayor (1.8%: una colección sub hepática infectada que requirió drenaje quirúrgico, una lesión del conducto hepático derecho, dos casos de litiasis residual y dos de pancreatitis postoperatoria. El tiempo quirúrgico fue en promedio 46.6 minutos en los casos electivos y 63.3 en los urgentes. La hospitalización duró menos de un día en 280 pacientes (85.3%. Se concluyó que, también en nuestro medio, la colecistectomía videolaparoscópica es el tratamiento de elección de la litiasis vesicular.

    We report on our experience with 328 cases of laparoscopic cholecystectomy performed between September 18, 1991 and May 18, 1993 by a specialized surgical team in Medellín, Colombia. The patients were 252 women (76.8% and 76 men (23.2%, with ages between 14 and 85 years. The surgical procedure was elective in 274 of them (83.5% while 54 (16.5% were emergencies due to acute cholecystitis. In 5 cases (1.5% it became necessary to convert the procedure to open surgery: 2 of them had strong adherences, obscure anatomy and cholecystoduodenal fistula; in two there was acute inflammation and marked

  6. 氟比洛芬酯应用于腹腔镜胆囊切除术超前镇痛的临床研究%Clinical Study of Flurbiprofen Axetil Used in Preemptive Analgesia of Laparoscopic Cholecystec-tomy

    Institute of Scientific and Technical Information of China (English)

    代莉; 潘道波; 陈安基; 周爱国; 孟哲贤

    2014-01-01

    [Objective] To study the efficacy of preemptive analgesia with flurbiprofen axetil on reducing postoperative pain and adverse reaction of propofol combined with remifentanil for total intravenous anesthesia , and to explore administration method ,time and dosage of preemptive analgesia with flurbiprofen axetil .[Meth-ods] Totally 40 patients undergoing laparoscopic cholecystectomy were chosen and randomly divided into group A( n=20) and group B( n =20) .Group A received intravenous flurbiprofen axetil 100mg before skin inci-sion ,while group B received intravenous flurbiprofen axetil 100mg immediately at pneumoperitoneum .Double blind method was used to observe VAS score 2h(T1 ) ,6h(T2 ) and 24h(T3 ) after operation .Blood pressure (BP) ,heart rate(HR) ,SpO2 ,agitation ,cough during the extubation and Ramsay sedation score 10min after extubation were observed .[Results]VAS scores in group A at T1 were lower than those in group B ( P 0 .05) .[Conclusion] Flurbiprofen axetil can effectively relieve the pain after laparoscopic cholecystectomy .The analgesic efficacy of preoperative administration is better than postoperative administration .Preoperative administration can maintain satisfactory sedative effect .%[目的]研究氟比洛芬酯超前镇痛对减少异丙酚复合瑞芬太尼全凭静脉麻醉术后疼痛及不良反应的效应。探讨氟比洛芬酯超前镇痛的给药方式、时间、剂量。[方法]选择期腹腔镜胆囊切除术患者40例,随机分为A、B两组,每组20例。A组切皮前静脉注射氟比洛芬酯100mg;B组气腹后即刻注射氟比洛芬酯100mg。双盲法观察患者术后2h(T1)、6h(T2)、24h(T3)的VAS评分。观察围拔管期的血压(BP)、心率(HR)、脉搏血氧饱和度(SpO2)以及躁动、呛咳、拔管后10min的Ramsay镇静评分情况。[结果]VAS评分于T1时A组低于B组(P<0.05)。两组患者不良反应及拔管后Ramsay评分差异无统计学意义(P>0.05

  7. 腹腔镜胆囊切除术的手术室护理干预效果观察%To Observe the Effect of Nursing Intervention in the Operation Room of Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    宋王蓓

    2016-01-01

    Objective To analyze the effect of nursing intervention in clinical operation room of laparoscopic cholecystectomy.MethodsA total of 100 cases of laparoscopic cholecystectomy patients as the research object, according to the randomized single blind method divided into normal group and intervention group, each of 50 cases, conventional group take routine method of surgical nursing, the intervention group on the basis of routine nursing implementation of comprehensive nursing intervention, compared two groups of patients with operation time, intraoperative bleeding, emergence agitation and patient satisfaction.Results Theoperation time, blood loss, recovery agitation rate were significantly less than that in the conventional group, the rate of nursing satisfaction of the intervention group was significantly higher than that of the conventional group, the two groups had significant difference. Conclusion Laparoscopic gallbladder resection were performed in the operating room quality nursing intervention, not only can effectively accelerate the process of the operation, shorten operation time, reduce the amount of bleeding in operation, to protect the success rate of surgery, and to avoid postoperative emergence agitation, to improve patient satisfaction, promote rehabilitation has great signiifcance.%目的:分析腹腔镜胆囊切除术的临床手术室护理干预效果。方法选取100例腹腔镜胆囊切除术患者作为研究对象,按随机单盲法分为常规组和干预组各50例,常规组采取常规方法进行手术护理,干预组在常规护理的基础上实施综合护理干预,比较两组患者手术时间、术中出血、苏醒躁动情况及患者满意度。结果干预组患者手术时间、术中出血量、苏醒躁动发生率均少于常规组,干预组患者护理满意率高于常规组,两组比较差异具有统计学意义。结论临床腹腔镜胆囊切除术患者行手术室优质护理干预,不仅能有效

  8. 单孔腹腔镜与传统腹腔镜胆囊切除术安全性的荟萃分析%Single-incision versus conventional laparoscopic cholecystectomy: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    张正东; 国维克

    2013-01-01

    目的 评价单孑L腹腔镜胆囊切除术(SILC)的安全性和有效性.方法 收集2010年至2012年公开发表的SILC和传统腹腔镜胆囊切除术(LC)治疗胆囊良性疾病的中文和英文文献,对SILC组和LC组的术后并发症情况、术后恢复情况及术中情况进行荟萃分析.结果 筛选出符合纳入标准的研究11项共859例患者,SILC组449例,LC组410例.与LC组相比,SILC组术后美容效果更好,差异有统计学意义(Ⅳ=0.95,95%CI:0.56 ~ 1.34,Z=4.76,P=0.00),但在手术时间上SILC组明显长于LC组,差异有统计学意义(Ⅳ=16.66,95%CI:9.60 ~ 23.72,Z=4.62,P=0.00);两组患者术中出血量、术中中转率、术后6 ~24 h疼痛情况、住院时间及术后并发症方面的差异则无统计学意义(P>0.05).结论 SILC是安全可行的,具有优于LC的美容效果;但手术操作难度较大,手术时间长,有一定经验的医师方能施行.%Objective To study feasibility and security of single-incision laparoscopic cholecystectomy (SILC).Methods Clinical trials comparing SILC with conventional laparoscopic cholecystectomy (LC) for benign gallbladder disease published from 2010 to 2012 were retrieved.A metaanalysis was conducted to evaluate operative time,blood loss,conversion rate,post-operative pain,wound satisfaction score,post-operative hospital stay and post-operative complications between SILC group and LC group.A fixed effect model or random effect model was established to collect the data.Results Eleven random clinical trials on 859 patients qualified for the meta-analysis,449 patients being allocated to SILC and 410 patients to LC.There was no significant difference between SILC group and LC group for blood loss,conversion rate,post-operative pain,post-operative hospital stay and post-operative complications.However,operative time was significantly longer in SILC group than LC group (Ⅳ =16.66,95% CI:9.60-23.72,Z =4.62,P =0.00).Furthermore,wound satisfaction score was

  9. 经脐单孔腹腔镜与传统腹腔镜胆囊切除术安全性Meta分析%Safety of transumbilical single-incision laparoscopic cholecystectomy versus conventional laparoscopic holecystectomy: a meta analysis

    Institute of Scientific and Technical Information of China (English)

    王晔飞; 沈艾; 刘波; 王洪林

    2012-01-01

    Objective To evaluate the safety of transumbilical single-incision laparoscopic cholecystectomy. Methods Cochrane library (No.l 2011), PubMed (1978-2011), EMBase (1978-2011) and CNKI (1978-2011) were searched for randomized controlled trials on the efficacy of transumbilical singleincision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic holecystectomy (CLC) for the treatment of benign gallbladder disease. According to the inclusion criteria, eight studies were selected. Two authors cited the details about the designs of the trials, identities of the participants and the outcomes from the studies included independently. The data were analyzed by Revman 5.1 software. Results Operating time in the SILS group was longer than that in the CLC group significantly (weighted mean difference =8.03, 95% confidence interval (6.02, 10.03) , P<0.01). There was no signi fi cant difference in the introoperative blood loss [weighted mean difference=2.41, 95% confidence interval ( 5.66, 0.83) , P=(X15], postoperative hospital stay [weighted=0.15, 95% confidence interval ( -0.06, 0.37) , P=0.16] and the postoperative complications incidence [relative risk=1.21, 95% confidence interval (0.53, 2.78),P=0.69] between the two groups. Conclusion SILC is a safe procedure for the treatment of uncomplicated gallstone disease, especially for cosmetic purpose.%目的 探讨经脐单孔腹腔镜胆囊切除术(SILC)的安全性.方法 计算机检索Cochrane图书馆(2011年第1期)、PubMed(1978-2011年)、EMBase(1978-2011年)、CNKI(1978-2011年)有关SILC与传统腹腔镜胆囊切除术(CLC)的随机对照试验.按照入选标准,有8项临床试验纳入本研究,由2名作者各自独立地对入选研究中有关试验设计、研究对象的特征、研究结果等内容进行摘录,并用RevMan5.1软件进行分析.结果 与CLC相比较,SILC除手术时间延长外[MD=8.03,95%CI(6.02,10.03),P<0.01],术中出血量[MD=-2.41,95%可信区间为(-5.66,0.83),P=0

  10. Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones:Results of a retrospective,single center study between 1996-2002

    Institute of Scientific and Technical Information of China (English)

    Gabor Mester; Gyorgy Reti; Attila Nagy; Peter Laszlo Lakatos

    2004-01-01

    AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).METHODS: Patients undergoing preoperative ERCP (≤90 dbefore laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1st of January 1996 to the 31st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct (≥8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCP.RESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%,for three 72.5%, for four or more 91.4%.CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients).Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g.skill of the endoscopist, other diagnostic tools).

  11. 超声检查在急性胆囊炎腹腔镜胆囊切除术前的应用价值%Value of preoperative ultrasonography for acute cholecystitis patients undergoing laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    王晶明; 丁蓉; 白新艳; 袁雪红; 李霞

    2011-01-01

    Objective To observe the value of preoperative ultrasound in predicting possible difficulties of laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. Methods A total of 180 patients with acute cholecystitis received ultrasonography before LC. The gallbladders were comprehensively examined to observe the contour, gallbladder necks, wall thickness, wall echoes and intracyst echoes. Preoperative data and intraoperative data were compared for accessing the grade of adherence in the pericholecystic and Calot triangular area. Results The sensitivity, specificity and accuracy of preoperative ultrasonography for predicting the grade of adherence between the gallbladder and the tissue around it was 92. 78% (90/97), 93.98% (78/83) and 93. 33% (168/180), respectively. Conclusion Preoperative ultrasonography is valuable for predicting difficulties during LC in patients with acute cholecystitis.%目的 评价术前超声检查对预测腹腔镜胆囊切除术(Lc)治疗急性胆囊炎难度的价值.方法 对180例因急性胆囊炎接受LC的患者,术前超声检查综合分析胆囊轮廓、胆囊颈部、囊壁厚度、囊壁回声、囊内回声情况,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 超声检查综合性评估胆囊与周围组织粘连程度的敏感度为92.78%(90/97),特异度为93.98%(78/83),准确率为93.33%(168/180).结论 术前超声检查对预测LC治疗急性胆囊炎的难度有重要价值.

  12. 全程整体护理对腹腔镜胆囊切除患者身心康复的影响%Influence of holistic nursing on the physical and mental health of patients with laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    周国秀; 黄冬枚

    2013-01-01

    Objective To explore the influence of holistic nursing on the physical and mental health of patients with laparoscopic cholecystectomy,and to provide references for the implement of the holistic nursing model in hospitals.Methods Totals of 80 patients with laparoscopic cholecystectomy were randomly divided into observation group and control group,with 40 cases in each group.The patients in control group received the ordinary routine nursing,while the patients in observation group received holistic nursing.The two groups were compared in anxiety levels,the first postoperative ambulation time,anal exhaust time and the number of days of hospitalization.Results In the score of SAS,baseline data of two groups was similar [(47.17 ± 2.67) vs (46.20 ± 2.16) ; t =1.795,P > 0.05].The score of SAS (42.43 ± 2.89),the first postoperative ambulation time (14.78 ± 4.06) h,postoperative anal exhaust time (27.83 ± 2.74) h and the number of days in hospital (3.68 ± 0.53) d in observation group was lower than that in control group [(45.10 ± 1.48),(24.00 ± 6.21) h,(35.33 ± 3.62) h,(5.00 ± 0.56) d,respectively] after intervention,and the difference was statistically significant (t =-5.209,-7.863,-10.457,-10.966 ; P < 0.01).Conclusions Holistic nursing for patients provided comprehensive,specialized service.The implementation of holistic nursing can reduce physical and physiological suffering for patients with laparoscopic cholecystectomy,and promote the patient' s physical and psychological recovery.The application of holistic nursing should be widely applied in hospitals.%目的 探讨全程整体护理对腹腔镜胆囊切除患者身心康复的影响,为开展全程整体护理模式提供参考依据.方法 选择行腹腔镜胆囊切除术患者80例,随机分为观察组和对照组各40例,对照组采取择期手术普通常规护理,观察组采取责任包干制全程整体护理,比较两组患者焦虑程度、术后第1次下床活动时间、术后肛门

  13. 术前超声预测腹腔镜胆囊切除术手术难度的分析%Analysis of preoperative ultrasound in predicting difficulty of laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    李琴; 韩晓东; 张弘玮; 张频

    2013-01-01

    目的:根据术前超声资料建立预测腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)手术难度的评分表,并评价其科学性.方法:连续选择1 078例接受LC的患者,随机分为两组,训练样本960例,验证样本118例.采用自身前后对照试验方案,术前应用超声检测胆囊大小、胆囊壁厚度、胆囊颈结石嵌顿情况、胆囊结石数量与最大长径,以及脐孔、胆囊颈、胆囊底有无粘连;观察手术时间、术中出血量、中转开腹、引流管放置情况、并发症及术后住院时间、切口疼痛、胃肠道反应、肛门排气等指标.根据960例训练样本LC的实际难度分为容易与困难两组,应用t检验、x2检验筛选有统计学意义的超声检测指标,建立术前超声预测LC手术难度的评分表.进行受试者工作特征曲线(receiver operating characteristic curve,ROC)分析.结果:胆囊大小、胆囊壁厚度、单枚胆囊结石最大径、胆囊颈结石嵌顿、胆囊颈粘连、胆囊底粘连6项检测指标在LC容易与困难两组间差异有统计学意义(P<0.05).应用6项指标建立术前超声预测LC难度评分表.经ROC分析,曲线下面积为0.948,与完全随机情况下获得的曲线下面积(0.5)相比,差异有统计学意义(P<0.05).经118例检验样本前瞻性误判概率评估,结果显示术前超声预测LC难度误判率约4.2%.结论:术前超声预测LC手术难度的评分表可正确预测手术难度,对手术适应证的选择具有重要意义.%Objective;To establish and evaluate a scoring system that predicts the difficulty of laparoscopic cholecystectomy ( LC ) based on preoperative ultrasonic data. Methods: With self-controlled trial, 1 078 consecutive patients undergoing LC were divided into two groups:960 in training group, 118 in testing group. Preoperative ultrasonic examination parameters including the size of gallbladder, thickness of gallbladder wall,incarcerated stone in neck of gallbladder

  14. Clinical Observation of Propacetamol Hydrochloride Applied in Preemptive Analgesia of Laparoscopic Cholecystectomy%丙帕他莫超前镇痛用于腹腔镜胆囊切除术的临床观察

    Institute of Scientific and Technical Information of China (English)

    曾东; 古军; 何东江; 陈余

    2015-01-01

    目的:观察丙帕他莫超前镇痛用于腹腔镜胆囊切除术的临床效果和安全性。方法90例ASA I~Ⅱ级拟行腹腔镜胆囊切除术患者随机分为A组、B组和C组,每组30例。麻醉诱导前15 min,A组将盐酸丙帕他莫2g溶入100 ml生理盐水静脉滴入;B组按照布托啡诺20μg/kg计算用量,用生理盐水稀释至100 ml静脉滴入;C组静脉滴注生理盐水100 ml。观察并记录术后患者自主呼吸恢复时间、麻醉苏醒时间、拔管时间。采用视觉模拟镇痛评分法(VAS)评价三组患者术后1h、2h、4h、8h和24 h疼痛程度,同时观察嗜睡、烦躁、恶心呕吐、呼吸抑制等不良反应。结果与B组比较,A组和C组的苏醒时间、拔管时间均明显缩短(P<0.05),A组与C组间比较无统计学意义(P>0.05);与C组比较,A组和B组患者在术后2h、4h、8h和24h的VAS评分明显降低(P<0.05);A组和C组术后嗜睡例数明显少于B组(P<0.05),三组均未发生呼吸抑制,烦躁、恶心呕吐不良反应发生率无统计学意义(P>0.05)。结论丙帕他莫超前镇痛用于腹腔镜胆囊切除术具有显著的术后镇痛作用,且不影响患者的苏醒质量,不增加术后不良反应。%Objective To observe the clinical effect and the safety of propacetamol hydrochloride applied in preemptive analgesia of laparoscopic cholecystectomy. Methods 90 cases to receive laparoscopic cholecystectomy with ASA grading from I to II were ran-domly divided into 3 groups:Group A, Group B and Group C, 30 cases in each;15 minutes before anesthesia, infusion of propacetamol hydrochloride (2g diluted in 100ml saline) was made to cases in Group A, infusion of butorphanol with the dosage calculation of 20μg/kg diluted in 100ml saline was made to cases in Group B and infusion of 100ml saline was made to cases in Group C;the recovery time of spontaneous respiration after operation, the anesthesia awaking time and

  15. Usefulness of magnetic resonance cholangiography in the diagnosis of biliary tract lesions in patients with suspected complication following cholecystectomy; Valor da colangiopancreatografia por ressonancia magnetica no diagnostico de lesoes das vias biliares em pacientes com suspeita de complicacao pos-colecistectomia

    Energy Technology Data Exchange (ETDEWEB)

    Cecin, Alexandre de Oliveira [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil); Goldman, Suzan Menasce; Caetano, Simone; Rosas, George de Queiroz; Coelho, Rafael Darahem de Souza [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem; Lobo, Edson Jose [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Gastroenterologia Cirurgica; Abdalla, Nitamar; Szejnfeld, Jacob [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem

    2005-01-15

    Objective: to determine the usefulness of magnetic resonance cholangiopancreatography (MRCP) in the diagnoses of bile duct injuries following cholecystectomy. Material and method: MRCP was retrospectively evaluated in 40 patients with suspected bile duct injury after laparoscopic or conventional cholecystectomy. Eight of these patients had been submitted to biliary reconstruction. All patients were symptomatic (jaundice, fever and chills, weight loss and abdominal pain). The scans were independently reviewed by two radiologists. The results were confirmed by surgery, percutaneous drainage, endoscopic retrograde cholangiopancreatography and clinical follow-up. The level and severity of bile duct injury were rated according to the Bismuth classification. Results: in a total of 40 symptomatic patients, 10 (25%) had normal findings on MRCP; Postoperative complications were seen in 29 (72.5%) patients, seven of them with more than one finding. Pancreatic head neoplasia was diagnoses in one patient. The most frequent finding was sclerosing (41.4%) followed by biliary duct stenosis (34.5%), residual or recurrent biliary stones (31.0%) and fluid collections (17.2%). The images obtained by MRCP were considered of good quality. Conclusion: MRCP is an effective method for the evaluation of patients with suspected postcholecystectomy biliary tract complications. (author)

  16. Relativity Between the Constitution of Factors and Pain after Laparoscopic Cholecystectomy%体质因素与腹腔镜胆囊切除术后疼痛的相关性研究

    Institute of Scientific and Technical Information of China (English)

    郝文立; 王帅; 周振理; 王玲; 丁娜; 孙志萍

    2015-01-01

    目的::探讨体质因素与腹腔镜胆囊切除术后疼痛的相关性。方法:总结分析622例腹腔镜胆囊切除术患者体质分布情况以及这些患者的VAS评分,研究不同体质因素与VAS之间的相关性。结果:胆囊结石患者中构成比占前三位的中医体质分别为痰湿质(35.85%)、气虚质(23.79%)和湿热质(19.61%)。3组数据两两比较,术后疼痛VAS(12 h和24 h)评分结果提示气虚质明显高于痰湿质和湿热质(P<0.05),而痰湿质和湿热质两组之间未见明显差别(P>0.05)。结论:气虚质的胆囊结石患者于围手术期应更注重止痛和心理治疗。%Objective To evaluate the relativity between the constitution of factors and the pain after lapa⁃roscopic cholecystectomy. Methods The distribu⁃tion of different physical factors and visual analogue scales of 622 patients following laparoscopic cholecys⁃tectomy with LC were summarized and analyzed. Results The top three physical factors were phlegm damp constitution(35.85%),Qi deficiency constitution(23.79%), and damp heat constitution(19.61%). Paired-comparisons showed that VAS (post-operation 12 h and 24 h) in Qi deficiency constitution were signifi⁃cantly higher than those in the other two constitution factors (P0.05). Conclusion For the Qi de⁃ficiency constitution patients with gallbladder stones more attentions should be paid to perioperative period pain and psychological therapy.

  17. 胆囊切除术后患者胆道Ⅲ型Oddi括约肌功能障碍的治疗%Therapy for patients with bile duct Ⅲ of sphincter of Oddi dysfunction after cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    翁坚军; 关亚萍; 朱峰

    2016-01-01

    Objective To study the therapeutic effect of pinaverium bromid and oryz-aspergillus enzyme and pancreatin tablet on patients with bile duct Ⅲ of sphincter of Oddi dysfunction (SOD) after cholecystectomy.Methods 72 patients who had a diagnosis consistent with bile duct Ⅲ of SOD seen from February 2010 to February 2013 in our hospital were randomly divided into the control group and the treatment group.Patients in the control group were given pinaverium bromid for 3 months while patients in the treatment group were,in addition to pinaverium bromid,given oryz-aspergillus enzyme and pancreatin tablet.Relief of abdominal pain,abdominal distention and recurrence of the above symptoms after drug withdrawal were studied.Results The scores on abdominal pain in the treatment group before and after treatment were 7.5 ± 1.1 and 3.0 ± 1.6 (P < 0.05) while the scores in the control group were 7.4 ± 1.1 and 5.0 ± 1.4 (P < 0.05),respectively.Alleviation of abdominal pain in the treatment group was superior to the control group (P < 0.05).The scores on abdominal distention in the treatment group before and after treatment were 5.4 ± 0.6 and 1.6 ± 0.5 (P < 0.05) while the scores in the control group were 5.2 ± 0.5 and 4.7 ± 0.8 (P > 0.05),respectively.Alleviation of abdominal distention in the treatment group was superior to the control group (P <0.05).The scores of abdominal pain and distention in half year after 3 months' therapy in the treatment group were 3.1 ± 1.7 and 1.7 ± 1.1,respectively,which obviously were lower than the control group (5.4 ± 1.4 and 5.0 ± 0.6,P < 0.05).Conclusions Pinaverium bromid and oryz-aspergillus enzyme and pancreatin tablet could effectively alleviate abdominal pain and distention in patients with bile duct Ⅲ of SOD after cholecystectomy and the recurrence rates of symptoms were significantly lower.%目的 观察匹维溴铵联合米曲菌胰酶片治疗胆囊切除术后患者胆道Ⅲ型Oddi括约肌功能

  18. Reducing effect of pulmonary recruitment on laparoscopic cholecystectomy-induced upper abdominal pain, shoulder pain, and incision pain%膨肺对腹腔镜胆囊切除术后疼痛的影响

    Institute of Scientific and Technical Information of China (English)

    李振杰; 刘虎

    2015-01-01

    Objective Abdominal pain, shoulder pain, and incision pain after laparoscopic cholecystectomy ( LC) are com-mon complaints of the patients.This study was to observe the effects of pulmonary recruitment ( PR) in reducing post-LC abdominal pain, shoulder pain, and incision pain. Methods A total of 138 patients treated by LC were randomly assigned to a PR ( n=67) and a control group (n=71).The former underwent postoperatively five 5-second-long manual inflations of the lungs by positive pres-sure ventilation with 40 cmH2 O to discharge CO2 from the abdominal cavity, while the latter received traditional passive deflation of CO2 .At 6, 12, 24, and 48 h after surgery, we recorded the incidences of abdominal pain, shoulder pain, and incision pain and as-sessed the pain intensity using the visual analogue scale ( VAS) . Results Compared with the control group at 12 and 24 h after sur-gery, the PR group showed significant decreases in the incidence rate of upper abdominal pain (90.14%vs 74.63%and 91.55%vs 73.13%, both P0.05). Conclusion Pulmonary recruitment can re-duce the incidence rates and severity of upper abdominal pain and shoulder pain, but has no effect in alleviating incision pain following laparoscopic cholecystectomy.%目的:腹腔镜胆囊切除术后上腹痛、肩痛及切口痛是造成患者术后不适的常见原因。文中观察腹腔镜胆囊切除术后实施膨肺策略对患者上腹痛、肩痛及切口痛的影响。方法选取2010年1月至2013年12月实行腹腔镜胆囊切除术138例患者,随机分为干预组( n=67)和对照组( n=71)。干预组在术后实施连续5次不超过40 cmH2 O的人工正压力通气,每次持续时间为5 s,促使腹腔内的CO2排出;对照组术后腹腔内的CO2通过腹壁孔道被动排除。在术后6、12、24 h及48 h评估上腹痛、肩痛及切口疼痛发生率,并通过视觉模拟评分法( visual analogue scale, VAS)评分确定疼痛严重程度。结果与对

  19. Clinical report of 186 patients accepted PCIA with oxycodone after laparoscopic cholecystectomy%盐酸羟考酮在腹腔镜胆囊切除术后镇痛效果研究

    Institute of Scientific and Technical Information of China (English)

    何双亮; 甘建辉; 于虹

    2015-01-01

    Objective To explore application effect that using PCIA with oxycodone after laparoscopic cholecystectomy.Methods A total of 186 cases were included in this study,the average packet after patients were divided into A,B groups.During the maintenance of anesthesia drugs remifentanil +propofol +cis acid at-racurium,then extubation,open PCIA pump.PCIA pump recipe A group of oxycodone hydrochloride 100mg in-jection 5mg tropisetron added,increase the amount to 100 mL of normal saline;group B 100 mg of morphine sul-fate Gato alkyl granisetron 5mg,increase the amount to 100 mL of normal saline.Mian outcome:oxycodone and morphine analgesic efficacy and side effects.Record into the recovery room,wake time,extubation and cardio-vascular system parameters 5 minutes later,the pain visual analog scale,PCIA pump and whether the number of presses,vomiting,respiratory depression,nausea,or under different time points after surgery complications ac-company.Results Patients with mean arterial pressure when entering the recovery room and little difference between heart rate,immediate extubation and after extubation 5min differences in mean arterial pressure and heart rate is not the same,the difference was not statistically significant ( P >0.05).VAS scores slightly differ-ent at different times,but the difference was not statistically significant( P >0.05).All patients were awake in about 16 minutes,the average number of pressing CIA pump five times less,but the difference was not statisti-cally significant( P >0.05);the patients in group A deputy reaction rates lower than group B,and there was statistically significant ( P <0.05).Conclusion Oxycodone and morphine analgesic effect similar,effective at treating pain after laparoscopic cholecystectomy application oxycodone.%①目的探讨盐酸羟考酮在腹腔镜胆囊切除术后镇痛治疗中的应用效果。②方法选择接受腹腔镜胆囊切除术的患者186例,分为 A、B 两组。手术后拔除气管插管,开启

  20. Comparative analysis of modified instruments and conventional instruments in transumbilical single-pore laparoscopic cholecystectomy%改良器械和常规器械经脐入路单孔腹腔镜胆囊切除术的对比分析

    Institute of Scientific and Technical Information of China (English)

    王林安; 邓斗兴; 李玉民

    2016-01-01

    Objective To analyze the effect of clinical application of transumbilical single-pore laparoscopic cholecystectomy with modified instruments and conventional instruments. Methods Fifty transumbilical single-pore laparoscopic cholecystectomy patients with conventional instruments (conventional instruments group) and 50 transumbilical single-pore laparoscopic cholecystectomy patients with modified instruments (modified instruments group) were selected. The operation time, recovery satisfaction degree of navel incision, intraoperative bleeding, postoperative complication, change rate of surgical procedure, length of hospital stay and hospitalization expenses were compared between 2 groups. Results The operation time and change rate of surgical procedure in modified instruments were significantly lower than those in conventional instruments, and the recovery satisfaction degree of navel incision was significantly higher than that in conventional instruments:(43.5 ± 12.0) min vs. (60.0 ± 2.2) min, 2.0% (1/50) vs. 12.0% (6/50) and (4.5 ± 0.2) scores vs. (3.2 ± 1.2) scores, and there were statistical differences (P0.05). Conclusions The transumbilical single-pore laparoscopic cholecystectomy with modified instruments can obviously reduce the operation time and the change rate of surgical procedure, improve the recovery satisfaction degree of navel incision, reduce the operation difficulty of performer and shorten the time of learning curve.%目的:探讨改良器械和常规器械经脐入路单孔腹腔镜胆囊切除术的临床应用效果。方法选取行常规器械和改良器械经脐入路单孔腹腔镜胆囊切除术患者各50例(常规器械组和改良器械组),比较两组手术时间、脐部戳口恢复满意度、术中出血、术后并发症、手术方式更改率、住院时间及住院费用。结果改良器械组手术时间、手术方式更改率低于常规器械组,脐部戳口恢复满意度高于常规器械组[(43.5±12.0

  1. 十二指肠镜联合腹腔镜手术治疗老年胆囊结石合并胆总管结石124例%Duodenoscopy and laparoscopic cholecystectomy in the treatment of cholecyslithiasis complicated with choledocholithiasis in 124 aged patients

    Institute of Scientific and Technical Information of China (English)

    尹小军; 张荣春; 王向平; 郭学刚

    2012-01-01

    目的 探讨十二指肠镜联合腹腔镜续贯治疗老年患者胆囊结石合并肝外胆管结石的疗效.方法 回顾分析2010年1月至12月246例老年患者(年龄大于等于60岁)胆囊结石合并肝外胆管结石的临床资料,按手术方式的不同分为微创组和传统手术组.微创组(n=124)采用十二指肠镜下内镜乳头括约肌切开术(EST)取石再行腹腔镜胆囊切除术(LC),传统手术组(n=122)采用传统开腹胆囊切除术胆总管切开取石T管引流术,对比两组住院时间、并发症和结肠功能恢复时间等.结果 微创组与传统手术组比较,住院时间短、并发症低和术后结肠功能恢复时间短,差异均有明显的统计学意义(P<0.01);两组手术时间无统计学差异(P>0.05).结论 十二指肠镜联合腹腔镜续贯治疗老年胆囊结石合并肝外胆管结石具有微创、安全、疗效良好等优点.%Objective To evaluate the efficacy of duodenoscopy and laparoscopic cholecystectomy in the treatment of cholecyslithiasis complicated with choledocholithiasis and to discuss its clinical significance. Methods The clinical data of 246 aged patients with cholecyslithiasis complicated with choledocholithiasis ( age ≥ 60 years) from January 2010 to December 2010 were retrospectively analyzed. The patients were divided into the minimally invasive group (n =124) and the conventional surgery group (n = 122). The patients in the minimally invasive group were underwent duodenoscopy,endoscopic sphincterotomy (EST) and laparoscopic cholecystectomy (LC) while those in the conventional surgery group (n = 122) were experienced traditional open cholecystectomy,choledocholithotomy and T-tube drainage. The hospital stay, complications and recovery time of the colon function were compared between the two groups. Results The hospital stay was shorter in the minimally invasive group compared with that in the conventional therapy group,P 0. 05 ) . Conclusion consecutive treatment of

  2. Acupuncture at Daimai Point and Zusanli Poi nt for Improving Gastrointestinal Functional Recovery of Elder Patients fater Laparoscopic Cholecystectomy%针刺带脉穴和足三里促进老年患者腹腔镜胆囊切除术后胃肠功能恢复的临床观察

    Institute of Scientific and Technical Information of China (English)

    孙更新; 杨兴武

    2015-01-01

    Objective:To observe the effect of acupuncturing at Zusanli(ST 36) and Daimai(GB 26) points on the day before laparoscopic cholecystectomy and the first day after the laparoscopic cholecystectomy to shorten the time about the first time of exhaustion and defecation,and to explore a simple,effective and practical meth-od.Methods:90 cases with laparoscopic cholecystectomy of elderly patients were randomly divided into 3 groups:Blank group, Control group and Observation group,with 30 cases in each group.The blank group only received conventional treatment method.On the basis of routine treatment, the Control group was acupunctured at Zusanli point (ST 36)and Zhigou point (SJ 6),and the Observation group was acupunctured at Zusanli point (ST 36)and Daimai(GB 26) point.Analyze and compare the time of patients'first anal exhaustion and defeca-tion in three groups.Results:The time in Observation group for patients'first exhaustion and defecation was su-perior to that in the Control group and the Blank group, and there was a statistically significant difference( P<0.05).Conclusion:Daimai(GB 26) point has a positive significance to promote the gastrointestinal function re-covery after laparoscopic cholecystectomy,and with Zusanli ( ST 36) ,the effect will be more obvious.The selec-tion of acupoints is little and the clinical operation is simple and easy.%目的:观察在腹腔镜胆囊切除术前1天和术后第1天针刺带脉穴和足三里对缩短患者肛门首次排气排便时间的效果,以探索简便、有效、实用的方法。方法:选取行腹腔镜下胆囊切除术的老年患者90例,随机分成3组,空白组、对照组和观察组各30例。空白组对患者施行术前术后的常规治疗方法,对照组在常规治疗基础上给予针刺双侧足三里、支沟穴,观察组在常规治疗的基础上针刺双侧带脉穴、足三里;均每日两次。分析比较3组患者的肛门首次排气、排便时间。结果:观察组

  3. Technical difficulties and avoidance of complications in delayed laparoscopic cholecystectomy for acute cholecystitis%急性胆囊炎“延期”腹腔镜胆囊切除的手术技巧及并发症预防

    Institute of Scientific and Technical Information of China (English)

    朱斌; 张展志; 张能维; 宫轲; 路夷平; 王岩; 阿民布和; 李凯; 王桐生

    2011-01-01

    Objective To investigate the technical difficulties and the avoidance of complications in delayed laparoscopic cholecystectomy (LC) for acute cholecystitis (AC).Methods The results of LC carried out on 133 consecutive patients with AC between February 2004 and August 2008 were retrospectively studied.The outcomes were compared between patients who received LC for AC within 72 hours (the early group) and those after 72 hours (the delayed group).There were 34 patients in the early group and 99 in the delayed group.During LC,Calot's triangle was carefully dissected,and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified.Retrograde cholecystectomy in 2 patients was used when the Calot's triangle was poorly identified.Laparoscopic subtotal cholecystectomy was carried out in 4 patients whose inflammation or fibrosis precluded dissection of the Calot's triangle.Results There was no conversion to open cholecystectomy,biliary tract injury,biliary leak,or any other intraoperative or postoperative complications.There was no 30day readmission in the 2 groups.Patients who received delayed LC had a significantly longer operation time [(44.1±5.32) vs (66.4±3.05)rnin,P<0.01].There was no significant difference in wound infection rates in the 2 groups (1/34 2.94 % vs 2/99 2.02 %,P>0.05).Conclusions Delayed LC was as feasible and safe as early LC in the treatment of AC.Delayed LC was technically more demanding than early LC.%目的 探讨急性胆囊炎延期腹腔镜胆囊切除术(LC)的手术技巧及并发症预防.方法 将2004年2月至2008年8月收治的133例急性胆囊炎行LC患者,按急性胆囊炎发作后手术治疗的时间分为两组:急性发作72 h内手术的为早期组(34例)和急性发作72 h后手术的延期组(99例).手术技巧是沿胆囊壶腹分离胆囊管,尽量充分“掏空”、显露Calot三角,顺行切除胆囊;如Calot三角粘连紧密,解剖关系不清,可逆性切除胆囊或自

  4. 腹腔镜胆囊切除术后促进胃肠道功能恢复的中医护理进展%Nursing progress on traditional Chinese medicine on the recovery of gastrointestinal function in promoting after lap-aroscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    姜颖; 王芳; 蒋慧; 张丹; 肖红

    2015-01-01

    It expounded the mechanism of influencing the recovery of gastrointestinal function of patients after surgery laparoscopic cholecystectomy (LC).It reviewed the progress on TCM nursing of the recovery of gastro-intestinal function of patients after laparoscopic cholecystectomy.It pointed out that the TCM nursing method didn't pass through the digestive tract,which can avoid the decomposition of drugs by the liver,a variety of di-gestive enzymes and digestive fluid,so as to make up for the lack of drug treatment.In the future it is to strengthen the comprehensive regulation of traditional Chinese medicine and more routes of administration,in order to promote the recovery of gastrointestinal function and relieve symptoms.%阐述影响腹腔镜胆囊切除术(LC)术后胃肠道功能恢复的机制,综述促进腹腔镜胆囊切除术后胃肠道功能恢复的中医护理研究进展。指出中医护理方法不经过消化道,可避免肝脏及各种消化酶、消化液对治疗药物的分解破坏,从而弥补药物内治的不足。今后可加强中医药整体综合调节、多途径给药的研究,以促进胃肠道功能恢复、缓解不适症状等。

  5. 对比分析腹腔镜胆囊切除术与传统开腹切除术治疗胆结石的临床效果%The Clinical Effect of Laparoscopic Cholecystectomy and Conventional Open Surgery in the Treatment of Gallstones

    Institute of Scientific and Technical Information of China (English)

    杨贵江; 胡晓芳

    2016-01-01

    Objective To analyze laparoscopic cholecystectomy and conventional open surgery of the effect of surgery in the treatment of cholelithiasis.Methods126 cases of cholelithiasis patients were divided into two groups,observation group,and control group(63 cases) respectively, in the implementation of peritoneoscope gallbladder excision and traditional open cholecystectomy. The effect and recovery situation of the two groups were compared.ResultsIn the observation group of treatment efficiency(96.8%)and control group(81.0%),compared with significant difference(P<0.05). The operation time,hospitalization time,complications rates of the observation group were lower than that of the control group(P<0.05).Conclusion Laparoscopic gallbladder resection surgery in the treatment of patients with gallstones has significantly effect.%目的:分析腹腔镜胆囊切除术与传统开腹切除术治疗胆结石的效果。方法将胆结石患者126例分为两组,观察组、对照组(各63例)分别实施腹腔镜胆囊切除术与传统开腹切除术,比较两组疗效及恢复情况。结果观察组患者治疗有效率(96.8%)与对照组(81.0%)相比差异有统计学意义(P<0.05)。观察组手术时间、住院时间、并发症发生率均低于对照组(P<0.05)。结论腹腔镜胆囊切除术治疗胆结石患者效果满意。

  6. 上腹部手术史患者行三孔法腹腔镜胆囊切除术的临床分析%Clinical analysis of three-trocar laparoscopic cholecystectomy for patients with history of upper abdominal operation

    Institute of Scientific and Technical Information of China (English)

    李坚; 辜天慧; 袁伟; 李全; 张志勇; 彭煜; 谢见平

    2011-01-01

    目的 探讨上腹部手术史患者行三孔法腹腔镜胆囊切除术(LC)的可行性和特点.方法 回顾性分析该院97例上腹部手术史后腹腔粘连患者行三孔法LC的临床资料.结果 97例患者中,三孔法及四孔法LC分别成功完成93例及2例,LC成功率为97.9%,中转开腹手术2例.手术时间28~129 min,平均45 min,术中平均出血20 mL.结论 上腹部手术史后腹腔粘连患者行三孔法LC是安全、可行的,三孔法可以作为常规方式选择.%Objective To discuss the feasibility and characteristics of three-trocar laparoscopic cholecystectomy(LC) for patients with history of upper abdominal operation. Methods The clinical data of 97 patients with celiac adhesion after upper abdominal operation who accepted three-trocar LC were retrospectively analyzed. Results Among 97 cases of LC,three-trocar and four-trocars LC were successfully performed in 93 and 2 patients,respectively, with the LC success rate of 97. 9% ,2 patients shifted from laparoscopic to open cholecystectomy. The operation time was 28-129 min with the mean time of 45 min and the mean intraoperative bleeding of 20 ml.. Conclusion Three-trocar LC is safe and feasible for patients with celiac adhesion after upper abdominal operation, which can be selected as a conventional method.

  7. 腹膜内用药在腹腔镜下胆囊切除术后镇痛中的应用%Application of intraperitoneal administration in the treatment of postoperative pain after laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    史艳欣; 岳子勇

    2016-01-01

    Laparoscopic cholecystectomy (LC) patients showed mild to moderate pain, non steroidal anti-inflammatory drugs (NSAIDS), opioids and antiepileptic drugs are used in routine treatment of postoperative pain in clinic. Although these drugs worked quickly, their adverse effects, such as drowsiness, post-operative nausea and vomiting (PONV), constipation and respiratory inhibition can lead to delayed discharge. Therefore, many researchers study the replacement treatment of postoperative pain. Pain after LC can be divided into superficial incision pain, deep visceral pain and shoulder referred pain. The species of drug are local anesthetics, steroid, tramadol and dexmedetomidine. There are 3 main types intraperitoneal administration time: before the establishment of pneumoperitoneum, at the time of pneumoperitoneum and immediately after removal of the gallbladder. Intraperitoneal administration is often applied to the fossa of gallbladder, liver diaphragm, liver and diaphragm gap or the sites near the hepatoduodenal ligament. The main methods of intraperitoneal administration are instillation, infiltration, spraying and flushing. Based on many studies, it is beneficial to use intraperitoneal administration in terms of pain reduction in the early stage after LC. The use of intraperitoneal administration could reduce the amount of analgesic and mitigate the associated complications.%腹腔镜胆囊切除术(LC)术后呈轻至中度疼痛,临床上常规应用非甾体抗炎药(NSAIDS)、阿片类药物、抗癫痫药物等治疗术后疼痛.虽然这些药物起效快,但它们的不良反应,如嗜睡、术后恶心呕吐(PONV)、便秘以及呼吸抑制等可导致出院延迟.因此,许多学者研究LC术后镇痛的替代治疗方法.LC术后疼痛主要包括浅表切口痛,深部内脏痛和肩部牵涉痛三部分.药物种类有局部麻醉剂、类固醇、曲马多、右美托咪啶等.腹膜内应用药物的时间主要有三种:建立气腹前、建立气腹

  8. Nursing interventions of time-limited timing fasting for the patients with laparoscopic cholecystectomy%对行腹腔镜胆囊切除术患者择时禁食禁饮的护理研究

    Institute of Scientific and Technical Information of China (English)

    何冉

    2012-01-01

    Objective To observe the effects of nursing interventions on the complications of time - limited timing fasting such as thirst,hunger,hypoglycemia,anxiety for the patients with laparoscopic cholecystectomy ( LC ) operation.Methods According to the different fasting time operation the patients with LC were randomly divided into observation group and control group.The control group only received routine preoperative instruction,and the observation group took active nursing intervention and management measures according to the operation schedule.Solid food ( not including fried food and meat) and semi - liquid diet were forbidden respectively 8 h and 6 h before operation in the observation group.The patients of two groups were surveyed by the questionnaire to collect data and carry on statistical analysis.Results The time of preoperative fasting and water - deprivation in the control group was longer than that in the observation group.There was no intraoperative aspiration,postoperative nausea,vomiting in two groups.Two groups had significant difference (P <0.01 ).Conclusions Nursing intervention can improve the correct understanding for preoperative fasting and water - deprivation,improve preoperative comfort,the tolerance and the perioperative safety.%目的 观察护理干预管理对腹腔镜胆囊切除(LC)手术患限时择时禁食、禁饮并发症如口渴、饥饿、低血糖反应、焦虑等的影麻响.方法 根据不同禁食、禁饮时限随机将LC手术病人按入院的先后顺序分为对照组和观察组,对照组在术前仅给予常规的术前指导,观察组根据手术时间安排采取积极的护理干预管理措施,观察组术前禁固体食物(不包括油炸食物和肉类)8h,禁半流质饮食6h,两组均在术后2d进行问卷调查,收集资料并进行统计学处理.结果 对照组比观察组术前禁食、禁饮的时间长,两组患者均无术中误吸、术后恶心、呕吐发生,两组比较有显著性差异(P<0

  9. 两种不同处理方式对腹腔镜胆囊切除术后肩部疼痛的影响%Effect of two methods on postoperative shoulder pain following laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    张涛; 王磬; 吴微庆; 施海华

    2015-01-01

    目的 观察改善腹腔镜胆囊切除术(LC)后肩部疼痛发生的防治方法.方法 将99例行LC的患者随机分为A、B、C组,每组33例.A组为对照组,B组为术后右膈下留置负压引流管2h,C组术中右膈下温热生理盐水冲洗,观察3组术后1、3、6、12、24、48、72 h肩痛的发生率和疼痛程度视觉模拟评分(VAS).结果 72 h内出现肩痛B组(6例)、C组(1例)肩痛发生率明显低于A组(14例),而C组处理方式对改善肩痛效果最明显,组间比较差异有统计学意义(x2=2.733,P=0.004),而且B组(术后24h为1.02±0.27、48 h为0.72±0.26)、C组术后(24 h为0.15±0.02、48 h为0.08±0.21)肩痛程度VAS均低于A组(术后24 h为2.25±1.23、48 h为2.09±0.74),C组程度最轻(P<0.05).结论 温热生理盐水右膈下冲洗,可能阻断了引起肩痛的多种机制,明显降低了肩痛的发生,值得临床上推广.%Objective To investigate the effect of two methods on postoperative shoulder pain following laparoscopic cholecystectomy (LC).Methods A total of 99 patients undergoing LC were prospectively divided into three groups (33 patients in each group):Patients in group A underwent LC were control group,those in group B were inserted negative pressure drainage tube under the right inferior phrenic after LC,and patients in group C accepted warm and normal saline flush during operation under the right inferior phrenic.Shoulder pain occurrence and shoulder pain levels (visual analogue pain scale-VAS) were recorded on 1,3,6,24,48,72 h after operation.Results Postoperative shoulder pain occurrence was significantly higher in group A (14/33) than those in group B (6/33) and group C (1/33),and group C had the best effect (x2 =2.733,P =0.004) among the 3 groups.For shoulder pain levels,same result was achieved with group C had the best effect (P < 0.05).Conclusion Warm and normal saline flush during operation under the right inferior phrenic could help to obviously reduce the occurrence of post LC

  10. The treatment about modified mini-laparoscopic cholecystectomy by using silk tie%丝线打结改良迷你腹腔镜胆囊切除术疗效分析

    Institute of Scientific and Technical Information of China (English)

    何海清; 伍华飞

    2011-01-01

    Objective To explore the security and feasibility of modified mini-laparoscopic cholecystectomy dealed with cystic duct and cystic artery by silk ties instead clips. Methods 458 patients of LC surgery during 2008 January ~ May 2011, were divided into two groups: 112 cases (22.45%) using modified mini-laparoscopy, treatment of cystic duct with a silk tie and successful complete the cystic artery surgery;The others 346 patients using conventional rabbit clip. Compare the rate of convert to open operation, operative time, blood loss, drainage tube placed time and complications. Results In conventional group, 3 cases (0.87%) convert to open operation; and in modified mini-laparoscopic group, 1 case (0.89%) convert to open operation. There were no significant difference in the two groups from the operative time, blood loss, drainage tube placed time. Patients hadn't complications such as bleeding, bile leakage and intra-abdominal infection. Follow-up of 402 cases (modified group of 80 patients, conventional group 322 cases) ,there were no patients have abdominal pain, jaundice and fever and other symptoms. Modified group and the conventional are no significant clinical differences (P> 0.05), and achieve a good cosmetic effect P <0.05. Conclusion Modified mini-laparoscopic by using silk tie and ultrasonic surgical knife in treatment of cystic duct and cystic artery is a reliable, safe , and can effectively avoid the complications of the clip, the patient's surgery is more beautiful.%目的:探讨改良迷你腹腔镜胆囊切除术(LC)中用丝线打结替代夹子处理胆囊管和胆囊动脉的安全性和可行性.方法:2008年1月~2011年5月458例LC手术中,112例(22.45%)采用改良迷你腹腔镜,用丝线打结处理胆囊管及胆囊动脉顺利完成手术中,346例常规方法(兔夹子处理),对比两组转开腹手术比率、手术时间、术中出血量及放置引流管时间、术后并发症的差异.结果:常规LC组术转开腹手术3例(0

  11. Transumbilical single incision laparoscopic cholecystectomy for gallbladder benign diseases:A report of 80 cases%经脐单孔腹腔镜下胆囊切除术应用体会(附80例报告)

    Institute of Scientific and Technical Information of China (English)

    江弢; 孙晶; 岑刚; 裘正军

    2011-01-01

    Objective To investigate a single surgeon' s learning curve of transumbilical single incision laparoscopic cholecystectomy ( SILC ) in the treatment of gallbladder benign diseases. Methods Eighty patients with gallbladder benign disease accepted SILC operated by a single experienced laparoscopic surgeon. The operation was performed following the routine LC procedure. The perioperative data were recorded and the learning curve was defined by the operation time. Results Eighty patients accepted SILC successfully,including 56 cases of gallbladder stones, 16 cases of cholesterol polyps,3 cases of adenomatous polyp, 1 case of adenomyomatosis and 4 cases of complex diseases. No patients were converted to conventional LC or open surgery. The average operative duration was 46.9 ± 14.6 min. The average postoperative hospital stay was 1.8 ± 1.3 days. There was no perioperative complication. The learning curve of the SILC procedures indicated the first 40 cases as a learning phase for an experienced laparoscopic surgeon.Conclusion SILC is an easy and safe procedure for experienced laparoscopic surgeons. There are significant benefits as milder pain,lower incidence of port - related complications, better cosmetology and faster recovery. SILC may become another option for the treatment of gallbladder benign diseases.%目的 了解