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Sample records for ignoring acute cholecystectomy

  1. Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy.

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    Acar, Turan; Kamer, Erdinç; Acar, Nihan; Atahan, Kemal; Bağ, Halis; Hacıyanlı, Mehmet; Akgül, Özgün

    2017-01-01

    Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstones. The common opinion about treatment of acute cholecystitis is initially conservative treatment due to preventing complications of inflamation and following laparoscopic cholecystectomy after 6- 8 weeks. However with the increase of laparoscopic experience in recent years, early laparoscopic cholecystectomy has become more common. We aimed to compare the outcomes of the patients to whom we applied early or late cholecystectomy after hospitalization from the emergency department with the diagnosis of AC between March 2012-2015. We retrospectively reviewed the files of totally 66 patients in whom we performed early cholecystectomy (within the first 24 hours) (n: 33) and to whom we firstly administered conservative therapy and performed late cholecystectomy (after 6 to 8 weeks) (n: 33) after hospitalization from the emergency department with the diagnosis of acute cholecystitis. The groups were made up of patients who had similar clinical and demographic characteristics. While there were no statistically significant differences between the durations of operation, the durations of hospitalization were longer in those who underwent early cholecystectomy. Moreover, more complications were seen in the patients who underwent early cholecystectomy although the difference was not statistically significant. Early cholecystectomy is known to significantly reduce the costs in patients with acute cholecystitis. However, switching to open surgery as well as increase of complications in patients who admitted with severe inflammation attack and who have high comorbidity, caution should be exercised when selecting patients for early operation.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  3. Pain and dyspepsia after elective and acute cholecystectomy

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

    1998-01-01

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

  4. Pain and dyspepsia after elective and acute cholecystectomy

    DEFF Research Database (Denmark)

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

    1998-01-01

    . Complaints of abdominal pain and dyspepsia were found with similar frequencies in the acute cholecystitis and gallstone groups. Women had abdominal pain more often than men (42% versus 29%) (P = 0.01). Although more than one-third complained of abdominal pain after cholecystectomy, 93% had improved or were...

  5. Pain and dyspepsia after elective and acute cholecystectomy

    DEFF Research Database (Denmark)

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

    1998-01-01

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

  6. Emergent laparoscopic cholecystectomy for acute acalculous cholecystitis revisited.

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    Ueno, Daisuke; Nakashima, Hiroshi; Higashida, Masaharu; Yoshida, Koji; Hino, Keisuke; Irei, Isao; Moriya, Takuya; Matsumoto, Hideo; Hirai, Toshihiro; Nakamura, Masafumi

    2016-03-01

    To compare the safety of emergent laparoscopic cholecystectomy for acute acalculous cholecystitis (AAC) with surgery for acute calculous cholecystitis (ACC). We retrospectively reviewed the perioperative records of 111 patients who underwent emergent laparoscopic cholecystectomy for acute cholecystitis under the care of the Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, between January 2010 and April 2014. Patients were divided into the AAC group (27 patients) and the ACC group (84 patients), and their perioperative outcomes were compared. Patients in the AAC group had significantly higher disease severity and American Society of Anesthesiologists physical status scores (p = 0.001 and 0.037, respectively), lower blood hemoglobin and albumin concentrations (p = 0.0005 and 0.017, respectively), and lower hematocrit and platelet count (p < 0.0001 and 0.040, respectively) than those in the ACC group. When we compared perioperative outcomes, we also found that patients in the AAC group were more likely to have received a blood transfusion (p = 0.002) and to have required conversion to open surgery (p = 0.008). There were no significant differences in morbidity, mortality or length of hospital stay. Early laparoscopic cholecystectomy is safe in acute acalculous as well as acute calculous cholecystitis.

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

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    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.

  8. Multimodal Preincisional Premedication to Prevent Acute Pain After Cholecystectomy

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    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.

  9. Early cholecystectomy in acute cholecystitis: experience at DHQ Hospital Abbottabad.

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    Saeed, Asif; Nawaz, Muhammad; Noreen, Aysha; Ahmad, Sarfraz

    2010-01-01

    Cholelithiasis is a common disorder affecting the females more commonly. Most of the population carrying the gallstones remains asymptomatic, however biliary colic and acute cholecystitis is a common complication. Most surgeons agree that early cholecystectomy is safe and should be the procedure of choice in acute cholecystitis. Objective of this study was to determine the frequency of patients with acute cholecystitis, and morbidity and mortality in such cases. A prospective study, conducted at DHQ Hospital Abbottabad, and Yahya Welfare Hospital, Haripur simultaneously on 162 patients having symptomatic gall stones. All patients were admitted on presentation and surgical intervention done within 72 hours on patients fit for surgery. Patients with cardiac problem, HCV positive, and with radiologic evidence of Common Bile Duct (CBD) stones were excluded. Ultrasonography abdomen was the main investigation. Postoperative complications, hospital stay and return to routine activities was evaluated. The postoperative complications were seroma formation in 3 cases (1.9%), liver trauma resulting in bleeding and prolonged hospital stay in 1 case (0.6%). In 1 patient stones slipped into CBD resulting in CBD exploration. Early cholecystectomy with upper right transverse incision and muscle retraction in acute cholecystitis is a safe, and cost effective procedure with fewer complications, better cosmesis and early return to work.

  10. Laparoscopic cholecystectomy for acute cholecystitis: clinical analysis of 216 cases

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    DAI Juntao

    2014-07-01

    Full Text Available ObjectiveTo investigate the clinical experience of laparoscopic cholecystectomy (LC for acute cholecystitis. MethodsA retrospective analysis was performed on the clinical records of 216 patients with acute cholecystitis who underwent LC in Qingpu Branch of Zhongshan Hospital, Fudan University from January 2010 to January 2013. LC was performed under intubation general anaesthesia, with three holes conventionally and four holes if necessary. After operation, the drainage tube was placed for 1-3 d, and antibiotics were administered for 3-5 d. The time of operation, length of postoperative hospital stay, and incidence of postoperative complications were determined. All patients were followed up for at least 0.5 year after operation. ResultsLC was successfully performed in 188 (87.0% of all patients; 28 (13.0% of all patients were converted to open surgery. The mean time of operation was 62.00±11.27 min; the mean length of hospital stay was 4.60±2.16 d; the incidence of postoperative complications was 2.3%(5/216. All patients were cured and discharged. During follow-up, no patients developed other complications and all recovered well. ConclusionLC is safe and feasible in the treatment of acute cholecystitis. Correct manipulation of the Calot's triangle and proper abdominal drainage are the key to successful operation.

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

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    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.

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

    DEFF Research Database (Denmark)

    Gurusamy, K; Samraj, K; Gluud, C

    2010-01-01

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

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

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

    2011-04-01

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

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

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

    2016-01-01

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

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

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    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.

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

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    Agnieszka Popowicz

    2016-01-01

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

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

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

    2006-01-01

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

  18. Influence of delayed cholecystectomy after acute gallstone pancreatitis on recurrence: consequences of lack of resources

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    Natalia Bejarano-González

    Full Text Available Introduction: Acute pancreatitis is often a relapsing condition, particularly when its triggering factor persists. Our goal is to determine the recurrence rate of acute biliary pancreatitis after an initial episode, and the time to relapse, as well as to identify the risk factors for recurrence. Material and method: We included all patients admitted for a first acute gallstone pancreatitis event during four years. Primary endpoints included readmission for recurrence and time to relapse. Results: We included 296 patients admitted on a total of 386 occasions. The incidence of acute biliary pancreatitis in our setting is 17.5/100,000 population/year. In all, 19.6% of pancreatitis were severe (22.6% of severe acute pancreatitis for first episodes versus 3.6% for recurring pancreatitis, with an overall mortality of 4.4%. Overall recurrence rate was 15.5%, with a median time to relapse of 82 days. In total, 14.2% of patients relapsed after an acute pancreatitis event without cholecystectomy or endoscopic retrograde cholangio-pancreatography. Severe acute pancreatitis recur in 7.2% of patients, whereas mild cases do so in 16.3%, this being the only risk factor for recurrence thus far identified. Conclusions: Patients admitted for pancreatitis should undergo cholecystectomy as soon as possible or be guaranteed priority on the waiting list. Otherwise, endoscopic retrograde cholangio-pancreatography with sphincterotomy may be an alternative to surgery for selected patients.

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

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    Eva Barreiro-Alonso

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

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

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    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

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

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    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.

  2. 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

  3. Small Gallstone Size and Delayed Cholecystectomy Increase the Risk of Recurrent Pancreatobiliary Complications After Resolved Acute Biliary Pancreatitis.

    Science.gov (United States)

    Kim, Sung Bum; Kim, Tae Nyeun; Chung, Hyun Hee; Kim, Kook Hyun

    2017-03-01

    Acute biliary pancreatitis (ABP) is a severe complication of gallstone disease with considerable mortality, and its recurrence rate is reported as 50-90% for ABP patients who do not undergo cholecystectomy. However, the incidence of and risk factors for recurrent pancreatobiliary complications after the initial improvement of ABP are not well established in the literature. The aims of this study were to determine the risk factors for recurrent pancreatobiliary complications and to compare the outcomes between early (within 2 weeks after onset of pancreatitis) and delayed cholecystectomy in patients with ABP. Patients diagnosed with ABP at Yeungnam University Hospital from January 2004 to July 2016 were retrospectively reviewed. The following risk factors for recurrent pancreatobiliary complications (acute pancreatitis, acute cholecystitis, and acute cholangitis) were analyzed: demographic characteristics, laboratory data, size and number of gallstones, severity of pancreatitis, endoscopic sphincterotomy, and timing of cholecystectomy. Patients were categorized into two groups: patients with recurrent pancreatobiliary complications (Group A) and patients without pancreatobiliary complications (Group B). Of the total 290 patients with ABP (age 66.8 ± 16.0 years, male 47.9%), 56 (19.3%) patients developed recurrent pancreatobiliary complications, of which 35 cases were acute pancreatitis, 11 cases were acute cholecystitis, and 10 cases were acute cholangitis. Endoscopic sphincterotomy and cholecystectomy were performed in 134 (46.2%) patients and 95 (32.8%) patients, respectively. Age, sex, BMI, diabetes, number of stone, severity of pancreatitis, and laboratory data were not significantly correlated with recurrent pancreatobiliary complications. The risk of recurrent pancreatobiliary complications was significantly increased in the delayed cholecystectomy group compared with the early cholecystectomy group (45.5 vs. 5.0%, p gallstone less than or equal to 5

  4. Clinical efficacy of transumbilical single-port laparoscopic cholecystectomy in treatment of acute cholecystitis

    Directory of Open Access Journals (Sweden)

    LIU Chao

    2015-10-01

    Full Text Available ObjectiveTo evaluate the clinical efficacy of transumbilical single-port laparoscopic cholecystectomy in patients with acute cholecystitis and the effect of this surgical procedure on the postoperative recovery of gastrointestinal function. MethodsThis study enrolled 74 patients who were diagnosed with acute cholecystitis at Yanan University Affiliated Hospital, Shaanxi Province, China, from January 2013 to February 2014. The patients received either transumbilical laparoscopic surgery (treatment group or conventional laparoscopic treatment (control group. Differences in operative time, intraoperative blood loss, rate of postoperative complications, time to first bowel sound, time to first flatus, time to ambulation, and hospital costs were compared between the two groups. Categorical data were compared using the χ2 test and continuous data were compared using the t test. ResultsNo significant difference was noted between the treatment group and the control group in terms of operative time (P>0.05. However, the treatment group had significantly lower blood loss (10.5±1.5 L, rate of postoperative complications (10.8%, and hospital costs (8218±389 yuan and significantly less time to first bowel sound (2.5±0.3 h, time to first flatus (1.6±4.1 h, and time to ambulation (9.7±5.8 h than the control group (all P<0.05. ConclusionTransumbilical single-port laparoscopic cholecystectomy is a safe and feasible procedure for the treatment of acute cholecystitis as it offers minimal trauma and fast recovery of gastrointestinal function after surgery, which warrants its greater use in clinical practice.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Same admission laparoscopic cholecystectomy for acute cholecystitis: is the "golden 72 hours" rule still relevant?

    Science.gov (United States)

    Tan, Jarrod K H; Goh, Joel C I; Lim, Janice W L; Shridhar, Iyer G; Madhavan, Krishnakumar; Kow, Alfred W C

    2017-01-01

    Studies have shown that same admission laparoscopic cholecystectomy (SALC) is superior to delayed laparoscopic cholecystectomy for acute cholecystitis (AC). While some proposed a"golden 72-hour" for SALC, the optimal timing remains controversial. The aim of the study was to compare the outcomes of SALC in AC patients with different time intervals from symptom onset. A retrospective analysis of 311 patients who underwent SALC for AC from June 2010-June 2015 was performed. Patients were divided into three groups based on the time interval between symptom onset and surgery: 7 (L-SALC). The mean duration of symptoms was 2(1-3), 5(4-7) and 9 (8-13) days for E-SALC, M-SALC and L-SALC, respectively (p < 0.001). Conversion rates were higher in the L-SALC group [E-SALC, 8.2% vs M-SALC, 9.6% vs L-SALC, 21.4%] (p = 0.048). The total length of stay was longer in patients with longer symptom duration [E-SALC, 4 (2-33) vs M-SALC, 2 (2-23) vs L-SALC, 7 (2-49)] (p < 0.001). Patients with AC presenting beyond 7 days of symptoms have higher conversion rates and longer length of stay associated with SALC. However, patients with less than a week of symptoms should be offered SALC. Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

  7. 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.

  8. Postoperative infection in laparoscopic cholecystectomy in treatment of acute cholecystitis complicated by choleperitonitis

    Directory of Open Access Journals (Sweden)

    YANG Yalin

    2017-01-01

    Full Text Available ObjectiveTo investigate the influence of laparoscopic cholecystectomy (LC versus open cholecystectomy (OC on postoperative systemic infection and immune response in patients with acute cholecystitis complicated by choleperitonitis. MethodsA prospective randomized controlled trial was performed for 45 patients who had a definite diagnosis of acute calculous cholecystitis complicated by choleperitonitis in Shanghai Liqun Hospital from January 2014 to June 2016. According to surgical procedures, the patients were randomized into LC group (23 patients and OC group (22 patients. The length of hospital stay, postoperative complications, and deaths were evaluated in both groups. Blood samples were collected from all patients before surgery and at 1, 3, and 6 days after surgery to compare the changes in neutrophil count, serum levels of C-reactive protein (CRP and interleukin-6 (IL-6, and erythrocyte sedimentation rate (ESR, as well as the incidence of endotoxemia.  The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThe LC group had a significantly shorter length of hospital stay than the OC group (5.4±2.7 d vs 10.2±3.5 d, t= -5.46, P<0.001. One patient (4.3% in the LC group and 6 (27.3% in the OC group experienced peritoneal abscess after surgery, and there was a significant difference in the incidence rate of complications between the two groups (χ2=4.77, P=0.03. In all patients, the mortality rate was 17.8% (8/45, with 1 (4.3% in the LC group and 7 (31.8% in the OC group, and there was a significant difference between the two groups (χ2= 5.16, P=0.02. Of all patients in the OC group, 4 died of peritoneal abscess, 1 died of pulmonary embolism, and 1 died of myocardial infarction; of all patients in the LC group, 1 died of myocardial infarction. There were no significant differences in inflammatory markers before surgery between the two

  9. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  11. [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.

  12. Organizational Ignorance

    DEFF Research Database (Denmark)

    Lange, Ann-Christina

    2016-01-01

    This paper provides an analysis of strategic uses of ignorance or not-knowing in one of the most secretive industries within the financial sector. The focus of the paper is on the relation between imitation and ignorance within the organizational structure of high-frequency trading (HFT) firms...... and investigate the kinds of imitations that might be produced from structures of not-knowing (i.e. structures intended to divide, obscure and protect knowledge). This point is illustrated through ethnographic studies and interviews within five HFT firms. The data show how a black-box structure of ignorance...... is replicated within the organizational setting of these firms and re-enacted by the traders. Towards the end of the paper the politics of the relationship between imitation and ignorance is discussed....

  13. Ignorance Management

    Directory of Open Access Journals (Sweden)

    John ISRAILIDIS

    2013-05-01

    Full Text Available This paper identifies an alternative perspective on Knowledge Management (KM in multinational organisations by definition of the concept of Ignorance Management.Furthermore, this paper discusses the dificulties employees face in understanding and comprehending what they need to know to do their jobs, and what implications this can have within global technology intensive environments. The focus is given in particular on multinational organisations where innovation and new knowledge is essential to both shortterm opportunistic value capture and long-term business sustainability. Hence, this paper discusses why managing ignorance is essential for maintaining a strategic knowledge sharing culture within multinational organisations. Furthermore, it develops a novel theory on the nature of knowledge and ignorance while making the distinction between knowns and unknowns as well as between consciousness and ignorance. The theoretical findings have been applied to technology intensive and innovative environments. A case study is explored within the paper, based on findings from one of the largest military contractors in the world, which employs over 100,000 people across the globe. The paper adopts an interpretative philosophy, using the primary strategy of qualitative research. In addition, due to the complexity of the topic, a mixed methods approach has been used for the data collection process. Moreover, participatory action research is undertaken to study individuals’ actions in a particular context and improve organisational strategies and KM practices. The study shows that managing ignorance and adaptiveness in multinational organisations is becoming increasingly important. Thus, the critical question is not just managing what is known but also trying to find ways to manage the unknown. This viewpoint of acknowledging ignorance, if successfully incorporated within a company’s KM strategy, will not only facilitate and enhance knowledge storage

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

    Science.gov (United States)

    Kortram, Kirsten; van Ramshorst, Bert; Bollen, Thomas L; Besselink, Marc G H; Gouma, Dirk J; Karsten, Tom; Kruyt, Philip M; Nieuwenhuijzen, Grard A P; Kelder, Johannes C; Tromp, Ellen; Boerma, Djamila

    2012-01-12

    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. 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. 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. Netherlands Trial Register (NTR): NTR2666.

  15. 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

  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. The Varieties of Ignorance

    DEFF Research Database (Denmark)

    Nottelmann, Nikolaj

    2016-01-01

    This chapter discusses varieties of ignorance divided according to kind (what the subject is ignorant of), degree, and order (e.g. ignorance of ignorance equals second-order ignorance). It provides analyses of notions such as factual ignorance, erotetic ignorance (ignorance of answers to question...

  18. The Value of Abdominal Drainage After Laparoscopic Cholecystectomy for Mild or Moderate Acute Calculous Cholecystitis: A Post Hoc Analysis of a Randomized Clinical Trial.

    Science.gov (United States)

    Prevot, Flavien; Fuks, David; Cosse, Cyril; Pautrat, Karine; Msika, Simon; Mathonnet, Muriel; Khalil, Haitham; Mauvais, François; Regimbeau, Jean-Marc

    2016-11-01

    Although the preoperative management of mild and moderate (Grade I-II) acute calculous cholecystitis (ACC) has been standardized, there is no consensus on the value of abdominal drainage after early cholecystectomy. In a post hoc analysis of a randomized controlled trial (NCT01015417) focused on the value of postoperative antibiotic therapy in patients with ACC, we determined the value of abdominal drainage in patients having undergone laparoscopic cholecystectomy for Grades I-II ACC. All postoperative complications were analyzed after using a propensity score. A post hoc test was used to assess the statistical robustness of our results. Of the 414 enrolled patients, 178 did not have abdominal drainage (forming the no-drainage group) and 236 had drainage (the drainage group). After matching on PS, the deep incisional site infection was 1.1 versus 0.8 %, p = 0.78. This result is similar for the superficial incisional site infections; the distant infections; the overall morbidity, and the readmission rate. Only the hospital length of stay was significantly longer in the drainage group (3.3 vs. 5.1 days, p = 0.003). Neither abdominal drainage nor the absence of postoperative antibiotic therapy was found to be a risk factor for deep incisional site infections. The use of abdominal drainage depends on the surgeon's personal preferences but is often used in high-risk populations. However, abdominal drainage does not appear to be of any benefit (in terms of postoperative outcomes) and may even compromise recovery in patients having undergone early laparoscopic cholecystectomy for mild or moderate ACC.

  19. Laparoscopic cholecystectomy due to acute calculouscholecystitis in 16 weeks′ in vitro fertilization and embryo transfer pregnancy: Report of the first case

    Directory of Open Access Journals (Sweden)

    G Augustin

    2012-01-01

    Full Text Available The most common casues of acute abdomen during pregnancy are acute appendicitis followed by acute cholecystitis. The case presented is a 33-year-old patient in 16 weeks′ in vitro fertilization and embryo transfer pregnacy who developed acute cholecystitis. Previously there were two unsuccessful cycles, one complicated with ovarian hyperstimulation syndrome. Due to clinical deterioration during intravenous antibiotic therapy laparoscopic cheolecystecomy was performed and acute cholecystitis found. The postoperative course was uneventful. During the first 24 h tocolysis with intravenous fenoterol in addition to peroral atenolol 2 Χ 50 mg was administered. Postoperative course was uneventuful with further normal pregnancy. Elective cesarean section was made in term pregnancy (39 weeks with singleton with Apgar 10/10. Current guidelines do not recommend prophylactic tocolysis in pregnant population with acute abdomen but there is no mention of the IVF-ET subpopulation of patients. Also, there are no guidelines for thromboprophylaxis in such patients with increased risk of thromboembolic accidents. To our knowledge this is the first case report of a laparoscopic cholecystectomy during IVF-ET gestation.

  20. The Sin of Science: Ignorance of Ignorance.

    Science.gov (United States)

    Ravetz, Jerome R.

    1993-01-01

    Considers the idea of ignorance of ignorance in the scientific culture. Topics discussed include a historical background of ignorance in science, including the ideas of Socrates, Galileo, Descartes, and Bacon; teaching and practice; and philosophical reconstruction and the relationship between knowledge and ignorance. (Contains six references.)…

  1. The Application of Laparoscopic Cholecystectomy on Elderly Patients with Acute Cholecystitis%腹腔镜胆囊切除术在老年急性胆囊炎中的应用

    Institute of Scientific and Technical Information of China (English)

    姚时伟

    2013-01-01

    目的:研究腹腔镜胆囊切除术在老年人急性胆囊炎病人中的应用价值。方法:回顾性分析我院2009年9月~2013年2月开展的42例65岁以上老年急性胆囊炎行腹腔镜胆囊切除术的临床资料。结果:42例65岁以上老年人急性胆囊炎成功的完成了腹腔镜胆囊切除术40例,有2例中转开腹手术。结论:经过精心的术前准备与手术风险评估后,腹腔镜胆囊切除术适宜于老年人急性胆囊炎胆囊切除术,也能取得安全、有效、创伤小、恢复快的优点。%Objective:to research the applied value of laparoscopic cholecystectomy on elderly patients with acute cholecystitis .Meth-ods:To retrospectively analyse the clinical data of 42 cases of laparoscopic cholecystectomy on elderly patients over age 65 with acute cho-lecystitis from Sep.2009 to Feb.2013.Results:40 cases elderly patients over age 65 with acute cholecystitis were implemented Successful by the laparoscopic cholecystectomy , 2 cases were converted laparoscopic cholecystectomy to laparotomy .Conclusion:After careful preop-erative preparation and operation risk assessment , laparoscopic cholecystectomy was Suitable for the elderly with acute cholecystitis and was safe,effective,less injury, rapid recovery.

  2. 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.

  3. Diarrhea after laparoscopic cholecystectomy: Associated factors and predictors

    OpenAIRE

    Tuan-Pin Yueh; Fong-Ying Chen; Tsyr-En Lin; Mao-Te Chuang

    2014-01-01

    Background: Diarrhea is part of the postlaparoscopic cholecystectomy syndrome, but is not well defined. Published reports have ignored possible associated factors such as the preoperative excretion pattern, gastrointestinal disorders, personality disorders, the effect of drugs, unsanitary food, and high-fat diets. Purpose: The aim of this study was to define the associated factors and predictors of postlaparoscopic cholecystectomy diarrhea (PLCD) at different time intervals after the opera...

  4. 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.

  5. 三孔法腹腔镜胆囊切除术治疗急性胆囊炎%Three Holes Method Laparoscopic Cholecystectomy for Acute Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    赵言明; 李永明

    2012-01-01

      目的:探讨三孔法腹腔镜胆囊切除术治疗急性胆囊炎的应用价值。方法:2003年2月-2012年1月笔者所在医院对150例急性胆囊炎患者尝试三孔法腹腔镜胆囊切除,观察疗效。结果:145例患者顺利完成 LC,2例患者因胆囊周围严重粘连,肝外胆管难以辨认,1例患者胆囊横结肠瘘,2例术中快速病检提示胆囊癌中转开腹。术后住院3~5 d,无结肠,十二指肠及胃损伤,无胆管损伤及腹腔出血,剑突下切口感染5例,门诊换药治愈。结论:三孔法腹腔镜胆囊切除术治疗急性胆囊炎能迅速缓解患者剧烈腹痛及呕吐,终止患者痛苦,降低了发生胆囊穿孔、胆汁性腹膜炎及腹腔脓肿的风险,缩短了住院时间,降低了单病种的治疗费用,降低了并发症的发生及科室的医疗纠纷,减轻了医护人员的劳动强度及心理压力。%  Objective :To investigate three holes method laparoscopic cholecystectomy for acute cholecystitis in application value.Methods :In our hospital from Feb 2003 to Jan 2012150 cases of acute cholecystitis patients try three holes method laparoscopic cholecystectomy.Results :145 patients successfully completed LC,2 patients with gallbladder surrounding severe adhesions,extrahepatic bile duct illegible in 1 cases,gallbladder transverse colon fistula,2 cases of rapid intraoperative pathological examination revealed gallbladder carcinoma laparotomy.The postoperative hospital stay of 3-5 days,without colonic, duodenal and gastric injury,no bile duct injury and intraperitoneal hemorrhage,subxiphoid incision infection in 5 cases,clinic medicine changing cured. Conclusion :Three holes method laparoscopic cholecystectomy for acute cholecystitis can relieve the patient of severe abdominal pain and vomiting,termination of patient pain,reduces the incidence of perforation of the gallbladder,biliary peritonitis and peritoneal abscess risks,shorten hospitalization time,reduce the single disease

  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. Patients' experiences with cholecystitis and a cholecystectomy.

    Science.gov (United States)

    Lindseth, Glenda N; Denny, Dawn L

    2014-01-01

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

  8. 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....

  9. Ignorability for categorical data

    DEFF Research Database (Denmark)

    Jaeger, Manfred

    2005-01-01

    We study the problem of ignorability in likelihood-based inference from incomplete categorical data. Two versions of the coarsened at random assumption (car) are distinguished, their compatibility with the parameter distinctness assumption is investigated and several conditions for ignorability...

  10. Spontaneous bilateral adrenal hemorrhage following cholecystectomy.

    Science.gov (United States)

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

    2016-06-01

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

  11. Cholecystectomy vs. percutaneous cholecystostomy for the management of critically ill patients with acute cholecystitis: a protocol for a systematic review

    OpenAIRE

    Ambe, Peter C; Kaptanis, Sarantos; Papadakis, Marios; Weber, Sebastian A.; Zirngibl, Hubert

    2015-01-01

    Background Acute cholecystitis is a common diagnosis. However, the heterogeneity of presentation makes it difficult to standardize management. Although surgery is the mainstay of treatment, critically ill patients have been managed via percutaneous cholecystostomy. However, the role of percutaneous cholecystostomy in the management of such patients has not been clearly established. This systematic review will compare the outcomes of critically ill patients with acute cholecystitis managed wit...

  12. Elective cholecystectomy reduces morbidity of cholelithiasis in pediatric sickle cell disease.

    Science.gov (United States)

    Goodwin, Emily F; Partain, Paige I; Lebensburger, Jeffrey D; Fineberg, Naomi S; Howard, Thomas H

    2017-01-01

    Cholelithiasis is a frequent complication in pediatric sickle cell disease (SCD). Though it is standard practice to perform a cholecystectomy in pediatric SCD patients with symptoms of cholelithiasis, the use of elective cholecystectomy for asymptomatic patients remains controversial. Records of 191 pediatric sickle cell patients with cholelithiasis who underwent cholecystectomy were retrospectively reviewed. Patients classified as follows: (i) elective-no preoperative symptoms, cholelithiasis on screening ultrasound, comprehensive preoperative plan; (ii) symptomatic-preoperative symptoms of cholelithiasis on diagnostic ultrasound, comprehensive preoperative plan; or (iii) emergent-hospitalization for acute cholecystitis symptoms, cholelithiasis on diagnostic ultrasound, limited preoperative preparation. We compared the morbidity of cholecystectomy by examining pre- and post-cholecystectomy hospital admission days, length of stay for cholecystectomy, and surgical complications. Patients with SCD underwent a total of 191 cholecystectomies over a 10-year period: 51 elective, 110 symptomatic, and 30 emergent. Patients who required emergent cholecystectomy had a longer postoperative hospitalization time than elective or symptomatic cholecystectomy (7.3 vs 4.3, P cholelithiasis and cholecystectomy in SCD to date. These data strongly suggest that elective cholecystectomy decreases morbidity associated with emergent cholecystectomy. The overall outcomes for symptomatic and elective patients are favorable. However, our study indicates the need for prospective studies to identify clinical indicators for those emergent patients. © 2016 Wiley Periodicals, Inc.

  13. Comparative Analysis of the Clinic Effect Between Laparoscopic Cholecys-tectomy and Open Cholecystectomy on Acute Cholecystitis%腹腔镜与传统开腹式治疗急性胆囊炎的临床效果对比分析

    Institute of Scientific and Technical Information of China (English)

    蔡建平

    2014-01-01

    目的:比较分析腹腔镜与传统开腹术治疗急性胆囊炎的临床效果。方法收集该院收治的524例急性胆囊炎患者资料作为分析对象,其中285例行腹腔镜胆囊切除术,239例行传统开腹胆囊切除术。比较两组患者的术中指标:如切口长度、术中出血量、术中引流量、手术时间;术后各项恢复指标,如肠鸣音恢复时间、疼痛视觉模拟评分、止痛药使用例数、术后下床时间和住院时间;以及并发症情况。结果腹腔镜胆囊切除术治疗急性胆囊炎的术中各项指标:切口长度、术中出血量、术中引流量、手术时间分别为(3.5±0.7) cm,(45.2±8.4) mL,(63.8±12.9) mL,(52.7±15.3) mL,均低于于传统开腹胆囊切除术的(11.2±2.7)cm,(89.1±16.6) mL,(97.6±14.2) mL,(85.1±14.6) mL;两组间差异有统计学意义(P<0.05)。同时,术后各项恢复指标,如肠鸣音恢复时间、疼痛评分、止痛药使用例数、术后下床时间和住院时间分别为(23.2±3.5) h,(2.3±0.6)分,203例,(27.1±4.2)h,(5.0±1.5)d,差异有统计学意义(P<0.05)低于于传统开腹胆囊切除术的(43.6±6.8) h,(4.7±1.4) h,236例,(48.3±7.5) h,(12.5±4.0) d。同时,腔镜胆囊切除术患者的并发症发生率(3.5%)显著低于传统开腹式(11.3%)(P<0.05)。结果腹腔镜胆囊切除术治疗急性胆囊炎的术中各项指标、术后各项恢复指标均显著优于传统开腹胆囊切除术(P<0.05)。同时,腔镜胆囊切除术患者的并发症发生率显著低于传统开腹式(P<0.05)。结论腹腔镜胆囊切除术是一种治疗急性胆囊炎的安全、有效的手术方式,值得在临床上推广。%Objective To compare and analyze the clinic effect between laparoscopic cholecystectomy and open cholecystectomy on acute cholecystitis. Methods The clinical data of 524 patients with acute

  14. 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.

  15. 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。

  16. The most appropriate timing for selective laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute severe cholecystitis aged above 60 years

    Directory of Open Access Journals (Sweden)

    ZHAO Hongguang

    2017-04-01

    Full Text Available ObjectiveTo investigate the clinical effect of selective laparoscopic cholecystectomy (LC after percutaneous transhepatic gallbladder drainage (PTGD in the treatment of elderly patients with acute severe cholecystitis, as well as the most appropriate timing for selective operation. MethodsA total of 90 patients with acute severe cholecystitis aged above 60 years who were admitted to Department of Hepatobiliary Surgery in The First Hospital of Jilin University from January 2015 to June 2016 were enrolled, and according to the time of selective LC, they were divided into group A (with 2 months, group B (2-4 months, and group C (>4 months, with 30 patients in each group. The clinical effects of PTGD and selective LC were observed. The t-test was used for comparison of continuous data between two groups, an analysis of variance was used for comparison between three groups, and LSD-t test was used for comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. ResultsAll the patients underwent successful PTGD, and the time to abdominal pain remission was 2.52±0.76 hours. Body temperature returned to normal with 24-72 hours after surgery, and there were significant improvements in laboratory markers (white blood cell count, neutrophil count, and liver function (all P<005. No patient experienced complications such as bile leakage, hematobilia, pneumothorax, and colon perforation caused by puncture, and there was no case of PTGD after the tube was detached. There were significant differences between the three groups in gallbladder wall thickness before LC(F=8.029, P<0.001, time of operation (F=24.674, P<0.001, intraoperative blood loss (F=12.864, P<0.001, length of hospital stay (F=22.844, P<0.001, rate of conversion to laparotomy (χ2=12.345, P=0.002, and incidence rate of complications (χ2=8.750, P=0.013. Compared with group A, groups B and C had significantly lower gallbladder

  17. 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.

  18. 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....

  19. 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....

  20. 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。

  1. 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。

  2. 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.

  3. The impact of timing of cholecystectomy following gallstone pancreatitis.

    Science.gov (United States)

    Johnstone, Marianne; Marriott, Paul; Royle, T James; Richardson, Caroline E; Torrance, Andrew; Hepburn, Elizabeth; Bhangu, Aneel; Patel, Abhilasha; Bartlett, David C; Pinkney, Thomas D

    2014-06-01

    Current guidelines for the management of acute gallstone pancreatitis recommend cholecystectomy as definitive treatment during primary admission or within 2 weeks of discharge, with the aim of preventing recurrent pancreatitis. However, cholecystectomy during the inflammatory phase may increase surgical complication rates. This study aimed to determine whether adherence to the guidelines prevents recurrent pancreatitis while minimising surgical complications. Multi-centre review of seven UK hospitals, indentifying patients presenting with their first episode of gallstone pancreatitis between 2006 and 2008. A total of 523 patients with gallstone pancreatitis were identified, of which 363 (69%) underwent cholecystectomy (72 during the primary admission or within 2 weeks of discharge; 291 following this). Overall, 7% of patients had a complication related to cholecystectomy of which a greater proportion occurred when cholecystectomy was performed within guideline parameters (13% vs 6%; p = 0.07). 11% of patients were readmitted with recurrent pancreatitis prior to surgery, with those undergoing cholecystectomy outside guideline parameters being most at risk (p = 0.006). This study suggests cholecystectomy within guideline parameters significantly reduces recurrence of pancreatitis but may increase the risk of surgical complications. A prospective randomised study to assess the associated morbidity is required to inform future guidelines. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  4. 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

  5. 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.

  6. Strategic Self-Ignorance

    DEFF Research Database (Denmark)

    Thunström, Linda; Nordström, Leif Jonas; Shogren, Jason F.

    We examine strategic self-ignorance—the use of ignorance as an excuse to overindulge in pleasurable activities that may be harmful to one’s future self. Our model shows that guilt aversion provides a behavioral rationale for present-biased agents to avoid information about negative future impacts...... of such activities. We then confront our model with data from an experiment using prepared, restaurant-style meals — a good that is transparent in immediate pleasure (taste) but non-transparent in future harm (calories). Our results support the notion that strategic self-ignorance matters: nearly three of five...... subjects (58 percent) chose to ignore free information on calorie content, leading at-risk subjects to consume significantly more calories. We also find evidence consistent with our model on the determinants of strategic self-ignorance....

  7. Strategic self-ignorance

    DEFF Research Database (Denmark)

    Thunström, Linda; Nordström, Leif Jonas; Shogren, Jason F.

    2016-01-01

    We examine strategic self-ignorance—the use of ignorance as an excuse to over-indulge in pleasurable activities that may be harmful to one’s future self. Our model shows that guilt aversion provides a behavioral rationale for present-biased agents to avoid information about negative future impacts...... of such activities. We then confront our model with data from an experiment using prepared, restaurant-style meals—a good that is transparent in immediate pleasure (taste) but non-transparent in future harm (calories). Our results support the notion that strategic self-ignorance matters: nearly three of five...... subjects (58%) chose to ignore free information on calorie content, leading at-risk subjects to consume significantly more calories. We also find evidence consistent with our model on the determinants of strategic self-ignorance....

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

  9. Clash of Ignorance

    Directory of Open Access Journals (Sweden)

    Mahmoud Eid

    2012-06-01

    Full Text Available The clash of ignorance thesis presents a critique of the clash of civilizations theory. It challenges the assumptions that civilizations are monolithic entities that do not interact and that the Self and the Other are always opposed to each other. Despite some significantly different values and clashes between Western and Muslim civilizations, they overlap with each other in many ways and have historically demonstrated the capacity for fruitful engagement. The clash of ignorance thesis makes a significant contribution to the understanding of intercultural and international communication as well as to the study of inter-group relations in various other areas of scholarship. It does this by bringing forward for examination the key impediments to mutually beneficial interaction between groups. The thesis directly addresses the particular problem of ignorance that other epistemological approaches have not raised in a substantial manner. Whereas the critique of Orientalism deals with the hegemonic construction of knowledge, the clash of ignorance paradigm broadens the inquiry to include various actors whose respective distortions of knowledge symbiotically promote conflict with each other. It also augments the power-knowledge model to provide conceptual and analytical tools for understanding the exploitation of ignorance for the purposes of enhancing particular groups’ or individuals’ power. Whereas academics, policymakers, think tanks, and religious leaders have referred to the clash of ignorance concept, this essay contributes to its development as a theory that is able to provide a valid basis to explain the empirical evidence drawn from relevant cases.

  10. 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

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    Blake Geoffrey

    2005-03-01

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

  13. Diarrhea after laparoscopic cholecystectomy: associated factors and predictors.

    Science.gov (United States)

    Yueh, Tuan-Pin; Chen, Fong-Ying; Lin, Tsyr-En; Chuang, Mao-Te

    2014-10-01

    Diarrhea is part of the postlaparoscopic cholecystectomy syndrome, but is not well defined. Published reports have ignored possible associated factors such as the preoperative excretion pattern, gastrointestinal disorders, personality disorders, the effect of drugs, unsanitary food, and high-fat diets. The aim of this study was to define the associated factors and predictors of postlaparoscopic cholecystectomy diarrhea (PLCD) at different time intervals after the operation and to identify the possible associated factors and predictors of PLCD. We also aimed to determine the effectiveness of a low-fat diet in these patients and to educate the patients about their diet after the operation. Data were obtained from clinical records and preoperative interviews with patients, who were also interviewed or contacted by telephone 1 week after the operation, and then surveyed by telephone 3 months later using standardized questionnaires. A total of 125 consecutive patients who were adequately informed and who had assented to accepting a prescription of a low-fat diet after undergoing laparoscopic cholecystectomy participated in this prospective study. Thirty-eight patients (25.2%) had diarrhea 1 week after laparoscopic cholecystectomy and seven patients (5.7%) had diarrhea 3 months after laparoscopic cholecystectomy. The important predictors of PLCD at 1 week were a low-fat diet (B = -0.177, p = 0.000) and a high score on a preoperative diarrhea scale (B = 0.311, p = 0.031). There was no predictor for PLCD 3 months after laparoscopic cholecystectomy. We advise patients who have undergone laparoscopic cholecystectomy to follow a low-fat diet for at least 1 week to reduce the possibility of diarrhea, especially when they are ≤45 years of age, of male sex, and had a high preoperative tendency for diarrhea. Copyright © 2014. Published by Elsevier B.V.

  14. The challenges of ignorance

    CSIR Research Space (South Africa)

    Barnard, E

    2009-11-01

    Full Text Available as ignorance models, and point out the need for a framework that allows for prior probabilities to be constructed in a more principled fashion. Such a framework is proposed for the task of supervised learning, based on the trend of the Bayes error as a function...

  15. In Praise of Ignorance

    Science.gov (United States)

    Formica, Piero

    2014-01-01

    In this article Piero Formica examines the difference between incremental and revolutionary innovation, distinguishing between the constrained "path finders" and the unconstrained "path creators". He argues that an acceptance of "ignorance" and a willingness to venture into the unknown are critical elements in…

  16. Cost-effectiveness of same-admission versus interval cholecystectomy after mild gallstone pancreatitis in the PONCHO trial.

    Science.gov (United States)

    da Costa, D W; Dijksman, L M; Bouwense, S A; Schepers, N J; Besselink, M G; van Santvoort, H C; Boerma, D; Gooszen, H G; Dijkgraaf, M G W

    2016-11-01

    Same-admission cholecystectomy is indicated after gallstone pancreatitis to reduce the risk of recurrent disease or other gallstone-related complications, but its impact on overall costs is unclear. This study analysed the cost-effectiveness of same-admission versus interval cholecystectomy after mild gallstone pancreatitis. In a multicentre RCT (Pancreatitis of biliary Origin: optimal timiNg of CHOlecystectomy; PONCHO) patients with mild gallstone pancreatitis were randomized before discharge to either cholecystectomy within 72 h (same-admission cholecystectomy) or cholecystectomy after 25-30 days (interval cholecystectomy). Healthcare use of all patients was recorded prospectively using clinical report forms. Unit costs of resources used were determined, and patients completed multiple Health and Labour Questionnaires to record pancreatitis-related absence from work. Cost-effectiveness analyses were performed from societal and healthcare perspectives, with the costs per readmission prevented as primary outcome with a time horizon of 6 months. All 264 trial participants were included in the present analysis, 128 randomized to same-admission cholecystectomy and 136 to interval cholecystectomy. Same-admission cholecystectomy reduced the risk of acute readmission for recurrent gallstone-related complications from 16·9 to 4·7 per cent (P = 0·002). Mean total costs from a societal perspective were €234 (95 per cent c.i. -1249 to 738) less per patient in the same-admission cholecystectomy group. Same-admission cholecystectomy was superior to interval cholecystectomy, with a societal incremental cost-effectiveness ratio of -€1918 to prevent one readmission for gallstone-related complications. In mild biliary pancreatitis, same-admission cholecystectomy was more effective and less costly than interval cholecystectomy. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

  17. 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.

  18. Presentation and management of gallbladder remnant after partial cholecystectomy.

    Science.gov (United States)

    Jayant, Mayank; Kaushik, Robin

    2013-01-01

    Partial cholecystectomy is usually performed with the aim of preventing bile duct injury and/or vascular injuries in situations where there is difficulty in performing cholecystectomy. Occasionally, such patients can become symptomatic due to recurrence or persistence of disease in the gallbladder remnant and may require further treatment. A case series of various presentations and follow up of seven patients who had undergone open partial cholecystectomy for symptomatic gallstone disease in the past. Of 7 patients, 6 were symptomatic, and each of them was found to have a remnant of the gallbladder (with calculi in the remnant in 4 patients). Three patients who presented with recurrent biliary symptoms were re-operated and the gallbladder remnant was removed, with resolution of the symptoms. Two patients refused further operation-one patient with acute pancreatitis who underwent endoscopic retrograde cholangiopancreatography (ERCP) for removal of common bile duct stones, and another who presented with acute cholecystitis. The other 2 patients (one with transient jaundice and the other who is asymptomatic) remain on follow-up. Although partial cholecystectomy is an accepted, safe option in difficult cases, these patients must be counselled regarding the recurrence of symptoms, and must be kept on follow-up. If symptoms develop, completion of cholecystectomy to remove the remnant provides symptomatic relief.

  19. 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...

  20. Association between cholecystectomy with vs without intraoperative cholangiography and risk of common duct injury.

    Science.gov (United States)

    Sheffield, Kristin M; Riall, Taylor S; Han, Yimei; Kuo, Yong-Fang; Townsend, Courtney M; Goodwin, James S

    2013-08-28

    Significant controversy exists regarding routine intraoperative cholangiography in preventing common duct injury during cholecystectomy. To investigate the association between intraoperative cholangiography use during cholecystectomy and common duct injury. Retrospective cohort study of all Texas Medicare claims data from 2000 through 2009. We identified Medicare beneficiaries 66 years or older who underwent inpatient or outpatient cholecystectomy for biliary colic or biliary dyskinesia, acute cholecystitis, or chronic cholecystitis. We compared results from multilevel logistic regression models to the instrumental variable analyses. Intraoperative cholangiography use during cholecystectomy was determined at the level of the patients (yes/no), hospitals (percentage intraoperative cholangiography use for all cholecystectomies at the hospital), and surgeons (percentage use for all cholecystectomies performed by the surgeon). Percentage of use at the hospital and percentage of use by surgeon were the instrumental variables. Patients with claims for common duct repair operations within 1 year of cholecystectomy were considered as having major common duct injury. Of 92,932 patients undergoing cholecystectomy, 37,533 (40.4%) underwent concurrent intraoperative cholangiography and 280 (0.30%) had a common duct injury. The common duct injury rate was 0.21% among patients with intraoperative cholangiography and 0.36% among patients without it. In a logistic regression model controlling for patient, surgeon, and hospital characteristics, the odds of common duct injury for cholecystectomies performed without intraoperative cholangiography were increased compared with those performed with it (OR, 1.79 [95% CI, 1.35-2.36]; P < .001). When confounding was controlled with instrumental variable analysis, the association between cholecystectomy performed without intraoperative cholangiography and duct injury was no longer significant (OR, 1.26 [95% CI, 0.81-1.96]; P

  1. Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy.

    Science.gov (United States)

    Legorreta, A P; Silber, J H; Costantino, G N; Kobylinski, R W; Zatz, S L

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

  2. Risk Factors for Surgical Site Infection After Cholecystectomy.

    Science.gov (United States)

    Warren, David K; Nickel, Katelin B; Wallace, Anna E; Mines, Daniel; Tian, Fang; Symons, William J; Fraser, Victoria J; Olsen, Margaret A

    2017-01-01

    There are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy. A retrospective cohort of commercially insured persons aged 18-64 years was assembled using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded. Surgical site infections within 90 days after cholecystectomy were identified by ICD-9-CM diagnosis codes. A Cox proportional hazards model was used to identify independent risk factors for SSI. Surgical site infections were identified after 472 of 66566 (0.71%) cholecystectomies; incidence was higher after open (n = 51, 4.93%) versus laparoscopic procedures (n = 421, 0.64%; P infection, laparoscopic approach with acute cholecystitis/obstruction (hazards ratio [HR], 1.58; 95% confidence interval [CI], 1.27-1.96), open approach with (HR, 4.29; 95% CI, 2.45-7.52) or without acute cholecystitis/obstruction (HR, 4.04; 95% CI, 1.96-8.34), conversion to open approach with (HR, 4.71; 95% CI, 2.74-8.10) or without acute cholecystitis/obstruction (HR, 7.11; 95% CI, 3.87-13.08), bile duct exploration, postoperative chronic anemia, and postoperative pneumonia or urinary tract infection. Acute cholecystitis or obstruction was associated with significantly increased risk of SSI with laparoscopic but not open cholecystectomy. The risk of SSI was similar for planned open and converted procedures. These findings suggest that stratification by operative factors is important when comparing SSI rates between facilities.

  3. Ignorance and Science: Dilemmas, Perspectives, and Prospects.

    Science.gov (United States)

    Smithson, Michael

    1993-01-01

    Discusses scientific ignorance and uncertainty. Highlights include approaching knowledgeable ignorance, including a taxonomy of ignorance and uncertainty frameworks and measures; social constructivism, subjectivity, and scientific realism; strategies for working with scientific ignorance; and frameworks for ignorance representation. (Contains 43…

  4. 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.

  5. Cholelithiasis, cholecystectomy, and liver disease.

    Science.gov (United States)

    Ioannou, George N

    2010-06-01

    Cholelithiasis and fatty liver disease share some important risk factors, such as central obesity, insulin resistance, and diabetes. We sought to determine whether persons with cholelithiasis or a history of cholecystectomy were more likely to have elevated serum liver enzymes or to develop cirrhosis. We used cohort data from the first National Health and Nutrition Examination Survey (NHANES), to determine whether persons with a self-reported history of cholecystectomy at baseline (n=466) had a higher incidence of hospitalization or death due to cirrhosis than persons without a history of cholecystectomy (n=8,691) during up to 21 years of follow-up. We also used cross-sectional data from the third NHANES conducted between the years 1988 and 1994 to determine whether persons with cholelithiasis (n=833) or previous cholecystectomy (n=709), as determined by ultrasonography, were more likely to have elevated serum alanine aminotransferase (ALT) or gamma-glutamyl transferase (GGT) than persons without cholecystectomy or cholelithiasis (n=8,027). Persons with previous cholecystectomy were two times more likely to be hospitalized for or die of cirrhosis (adjusted hazard ratio 2.1, 95% confidence interval (CI) 1.1-4.0) and were more likely to have elevated serum ALT (adjusted odds ratio 1.8, 95% CI 1.3-2.5) or GGT (adjusted odds ratio 1.7, 95% CI 1.1-2.6) than persons without cholecystectomy. We did not identify an independent association between cholelithiasis and serum ALT or GGT levels. Cholecystectomy is a predictor of the development cirrhosis and is associated with elevated serum liver enzymes. Cholelithiasis is not independently associated with serum liver enzyme levels; whether cholelithiasis is associated with the development of cirrhosis remains to be determined.

  6. Sleep after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

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

    1996-01-01

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

  7. Epistemologies of Ignorance in Education

    Science.gov (United States)

    Malewski, Erik; Jaramillo, Nathalia

    2011-01-01

    Epistemologies of Ignorance provide educators a distinct epistemological view on questions of marginalization, oppression, relations of power and dominance, difference, philosophy, and even death among our youth. The authors of this edited collection challenge the ambivalence--ignorance--found in the construction of curriculum, teaching practices,…

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

    Science.gov (United States)

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

    1994-06-11

    identification of resistant type 6 P. aeruginosa. Antibiotics were adapted and administered iv with no clinical improvement. Selective catheterism of the hepatic artery via the femoral access was performed to allow intra-hepatic antibiotic delivery. Three weeks later clinical situation remained unchanged when acute respiratory distress highly suggestive of pulmonary embolism led to death. Autopsy was not performed. In both of these rare cases of infectious complications due to P. aeruginosa after laparoscopic cholecystectomy, the source of contamination remained unknown. Nosocomial infection was suspected.

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

    DEFF Research Database (Denmark)

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

    1995-01-01

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

  11. Use of MRI and MRCP in preoperative evaluation of patients undergoing laparoscopic cholecystectomy for acute cholecystitis%MRI及MRCP在急性胆囊炎腹腔镜胆囊切除术前评估中的应用

    Institute of Scientific and Technical Information of China (English)

    汪建初; 浦涧; 宋斌; 陆涛; 马日海; 吴贤建; 卓臣义; 路远; 王存川

    2015-01-01

    目的 探讨MRI及MRCP在急性胆囊炎腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术前评估中的作用.方法 前瞻性搜集我院收治的术前行MRI检查的159例急性胆囊炎资料,记录LC中暴露胆囊三角、胆囊三角解剖、胆囊床剥离所需时间,分析MR表现如胆囊壁厚度、胆囊大小、胆囊壁连续性、胆囊周围积液、胆囊管与肝总管角度等与手术时间关系.结果 手术时间> 90 min的有98例(98/159,61.64%);胆囊壁厚度≥5 mm的患者,胆囊三角解剖及胆囊自胆囊床剥离所需时间较多(P =0.001);胆囊≥4 cm及胆囊黏膜断裂的患者在暴露胆囊三角、胆囊三角解剖、胆囊自胆囊床剥离所需时间均较长(P=0.001),胆囊周围有积液的患者,在暴露胆囊三角、胆囊三角解剖、胆囊床剥离阶段所需时间均较长(P =0.001).胆囊管与肝总管角度<60.的患者,在解剖胆囊三角方面所占时间较长(P =0.001).在暴露胆囊三角方面,胆囊≥4 cm、胆囊黏膜断裂、胆囊周围积液等所需时间较长(P =0.001);全组无中转开腹病例,1例胆总管误夹,无其他严重并发症.结论 MRI及MRCP检查可以预测急性胆囊炎LC手术难度,为急性胆囊炎LC提供指导.%Objective To study MRI and MRCP in preoperative evaluation of laparoscopic cholecystectomy for acute cholecystitis.Methods This is a prospective study,159 acute cholecystitis cases with MRI preoperative evaluation between May 2011 and May 2014 were treated by laparoscopic cholecystectomy (LC).Time required for exposing gallbladder triangle,dissecting gallbladder triangle,and resection of gallbladder was recorded.The relationship between MRI finding and thickness and size of gallbladder wall,gallbladder effusion,and the angle between hepatic duct and cystic duct < 60° was analyzed.Results The time length for LC was more than 90 minutes in 98 out of the 159 cases; In cases with gallbladder wall thickness ≥ 5 mm the time required

  12. 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.

  13. 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

  14. Gallstone Ileus Post-cholecystectomy.

    Science.gov (United States)

    Månsson, C; Norlén, O

    2015-01-01

    Gallstone ileus is a rather rare condition and in most cases it involves a cholecysto-enteric fistula, through which a gallstone passes into the bowel. If the gallstone is large enough it may obstruct the bowel and a gallstone ileus emerges. In the presented case, the patient was subjected to a cholecystectomy over 40 years ago, but despite this, he developed a gallstone ileus. A gallstone that obstructed the small bowel was suspected with computed tomography and confirmed with exploratory laparotomy. Although a few cases of gallstone ileus after cholecystectomy are described in the literature, our case describes a unique pathogenic mechanism.

  15. Therapy of umbilical hernia during laparoscopic cholecystectomy.

    Science.gov (United States)

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

    2013-09-01

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

  16. Optimal timing of cholecystectomy in children with gallstone pancreatitis.

    Science.gov (United States)

    Badru, Faidah; Saxena, Saurabh; Breeden, Robert; Bourdillon, Maximillan; Fitzpatrick, Colleen; Chatoorgoon, Kaveer; Greenspon, Jose; Villalona, Gustavo

    2017-07-01

    Little data exist regarding the recurrence of pancreatitis in pediatric patients with gallstone pancreatitis awaiting cholecystectomy. This study evaluates the recurrence rate of pancreatitis after acute gallstone pancreatitis based on the timing of cholecystectomy in pediatric patients. A retrospective chart review of all patients admitted with gallstone pancreatitis from 2007 to 2015 was performed. Children were divided into the following five groups. Group 1 had surgery during the index admission. Group 2 had surgery within 2 wk of discharge. Group 3 had surgery between 2 and 6 wk postdischarge. Group 4 had surgery 6 wk after discharge, and group 5 patients had no surgery. The recurrence rates of pancreatitis were calculated for all groups. Forty-eight patients with gallstone pancreatitis were identified in this study. The 19 patients in group 1 had no recurrence of their pancreatitis. Of the remaining 29 patients, nine (31%) had recurrence of pancreatitis or required readmission for abdominal pain prior to their cholecystectomy. In group 2, two of the eight patients (25%) had recurrent pancreatitis. In group 3, three of eight patients (37.5%) developed recurrent pancreatitis. In group 4, three of five patients (60%), and in group 5, one of eight. No children in group 5 had demonstrable gallstones at presentation, only sludge in their gallbladder. Cholecystectomy during the index admission is associated with no recurrence or readmission for pancreatitis. Therefore, we recommend that cholecystectomy be performed after resolution of an episode of gallstone pancreatitis during index admission. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    NARCIS (Netherlands)

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

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Abdulrahman S Al-Mulhim

    2011-01-01

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

  19. Theories of Knowledge and Ignorance

    NARCIS (Netherlands)

    Thijsse, E.; van der Hoek, W.; Jaspars, J.; Rahman, S.; Gabbay, G.; Symons, J.; Bendegem, J.P.

    2004-01-01

    What does it mean to say that an agent only knows a particular fact,i.e., knowing that fact and not more than that? The problem of describing so-called minimal knowledge has been discussed in the literature since 1985, when Halpern and Moses published a paper on Knowledge and Ignorance.The present c

  20. Laparoscopic cholecystectomy in sickle cell patients in Niger

    Directory of Open Access Journals (Sweden)

    Abarchi Habibou

    2009-12-01

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

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

    DEFF Research Database (Denmark)

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

    1992-01-01

    of the patient's residential area was not associated with mortality. As regards early mortality, it is concluded that simple elective cholecystectomy is a safe procedure before the age of 50 to 60 years. Acute admissions and more than one diagnosis at discharge were associated with an increased mortality......This paper assesses the risk of dying within 30 days of admission among 13,854 women who had a cholecystectomy performed as the principal operation from 1977 to 1981. The overall crude mortality rate was 1.2%. Women who had a simple elective cholecystectomy performed had a mortality rate similar...... to women who had a simple hysterectomy. The mortality was significantly higher than in the general female population (p less than 0.05). Increased age, acute admission, admissions to hospital within 3 months prior to the index admission, the number of discharge diagnoses, and the geographical region were...

  2. [Simple cholecystectomy without drainage. A dilemma?].

    Science.gov (United States)

    Macellari, G; Baraldi, U; Giustina, A; David, P; Parigi, M; De Angelis, E

    1980-04-30

    A retrospective study was carried out to show the uselessness of the routine employment of the drainage after simple cholecystectomy. 1425 patients underwent cholecystectomy because for cholelithiasis; of these 164 (13%) were drained because of adhesions, concomitant pancreatitis, inadvertent damage, empiema, gangrena and perforation of the gallbladder. In no case of the 1261 patients without drainage it has been possible to demonstrate the presence of one of those complications for which the use of a drainage after simple cholecystectomy is commonly advised.

  3. Relationship between ultrasonic features of acute cholecystitis and conversion from laparoscopic to open cholecystectomy%急性胆囊炎术前超声征象与腹腔镜胆囊切除术转开腹的关系

    Institute of Scientific and Technical Information of China (English)

    于爱军; 赵洪涛; 赵鲁文; 史华宁; 张学军; 刘金龙

    2011-01-01

    Objective To explore the relationship between preopertive abdominal ultrasonic features of acute cholecystitis and conversion from laparoscopic to open cholecystectomy. Methods A total of 226 patients with acute cholecystitis received ultrasonic examination before LC. The parameters measured pre-operatively included the gallbladder volume, cholecystic wall thickness, gallbladder fossa fluid, stone impaction in gallbladder neck,adhesions of gallbladder to arourd tissue or adhensions of Calot's triangle. The relationship between the imaging results and conversion to laparotomy in LC were analyzed. Results LC was successfully performed in 208 patients, but 18 were converted to open surgery. Univariate analysis showed that enlarged gallbladder,cholecystic wall thickness, stone impaction in gallbladder neck and adhesions of Calot's triangle were significantly correlated with the conversion to open cholecystectomy ( P < 0. 05 ). Multivariate analysis showed that cholecystic wall thickness and adhesion of Calot's triangle were independent risk factors for conversion from laparoscopic cholecystectomy to open surgery. Conclusions Preoperative ultrasonography for predicting conversion from laparoscopic to open cholecystectomy in acute cholecystitis is simple, and has important significance for selection of laparoscopic operation in acute cholecystitis.%目的 探讨急性胆囊炎术前腹部超声检查征象与腹腔镜胆囊切除术(laparosccpic cholecystectomy,LC)中转开腹的关系.方法 对226例急性胆囊炎LC患者术前行腹部超声检查,记录胆囊容积,胆囊壁厚度,胆囊窝有无积液,胆囊颈管是否有结石嵌顿,胆囊与周围粘连,胆囊三角粘连情况.分析超声显像与LC转开腹的关系.结果 208例成功完成LC,18例中转开腹.单因素分析显示超声检查胆囊容积增大,胆囊壁增厚,胆囊颈管结石嵌顿,胆囊颈粘连是中转开腹的危险因素(P<0.05).多因素回归分析显示胆囊壁增

  4. Ninety-day readmissions after inpatient cholecystectomy: A 5-year analysis

    Science.gov (United States)

    Manuel-Vázquez, Alba; Latorre-Fragua, Raquel; Ramiro-Pérez, Carmen; López-Marcano, Aylhin; Al-Shwely, Farah; De la Plaza-Llamas, Roberto; Ramia, José Manuel

    2017-01-01

    AIM To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. METHODS We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomy-related complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies. RESULTS We analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of 4.99%. Sixty-four point seven nine percent occurred after elective surgery (cholelithiasis or vesicular polyps) and 35.21% after emergency surgery (acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d. CONCLUSION The use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure. PMID:28522915

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

    Directory of Open Access Journals (Sweden)

    Mahesh

    2015-12-01

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

  6. 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...

  7. No-visible-scar cholecystectomy

    Directory of Open Access Journals (Sweden)

    Tadeusz M. Wróblewski

    2010-12-01

    Full Text Available Introduction: Single incision laparoscopic surgery (SILS is a laparoscopic method providing a good cosmetic effect,but requiring the application of special ports and instruments enabling the surgeon to perform the procedure.We report three-ports cholecystectomy through umbilical and suprapubic incisions performed with typical laparos -copic instruments which calls no-visible-scar cholecystectomy (NVSC.Material and methods: Twenty patients with symptomatic cholelithiasis were qualified for NVSC. Typical CO2 pneumoperitoneumwas done after umbilical skin incision. Two ports of 5 mm were inserted in the maximum externaledges of this incision. After cystic duct and cystic artery dissection the right one was exchanged for a port of 11 mm.The second incision for the 11-mm trocar for the laparoscope was done in the suprapubic median line within the hairarea.Results: Cholecystectomies were performed without any conversion to classical laparoscopic cholecystectomy (LCHor open surgery. They were not technically identical due to the gradual improvement in the access and manipulationof instruments. The time of the intervention ranged from 2 hours during the introduction of the new method to 50 minfor the last procedures. No postoperative complications were observed and all patients were discharged not later thanafter conventional LCH.Conclusions: NVSC is a three-port laparoscopic intervention performed with typical laparoscopic instruments. It ismore convenient for the surgeon than single incision LCH, because the placement of the optic in the suprapubic regiongives more space for the instruments. It also provides a very good cosmetic effect of the intervention. The describedprocedure is easy to learn and in case of technical problems additional ports can be applied (as in typical LCH.

  8. Timing of the laparoscopic cholecystectomy after PTGD for acute cholecystitis%急性胆囊炎经皮经肝胆囊穿刺引流术后手术时机的选择

    Institute of Scientific and Technical Information of China (English)

    邱明; 吴向未; 杨宏强; 刘国起; 马杰; 张示杰

    2014-01-01

    Objective To investigate thetiming offurtheroperative opportunity for the treatmentofpercutaneous transhepatic gallbladder drainage (PTGD)in patients with acute cholecystitis. Methods Theclinical data of 77 patients with acute cholecystitis who received laparoscopic cholecystectomy after PTGD wereanalyzed retrospectively. According to the interval, Seventy-seven cases weredivided into 3 groups. The patientsin the first (n = 11), second (n = 36), third (n = 30) group performed LC were within 2 m, during 2 ~ 4 m,and beyond 4 m, retrospectively. The rate of conversion to surgery, intraoperative blood, operation time andhospital stay were compared among the three groups. Results There was significant difference in the thicknessof gallbladder wall before LC, conversion to open surgery, intraoperative blood, operation time, hospital stayandpostoperative complications among 3 groups (P < 0.05). Conclusion The timing for LC in patients withacute cholecystitis should be within the 2 ~ 4 mintervalafter PTGD, the thickness of gallbladder wall less than0.42 cm and stable condition. On average LC appearsafe and effective with short operation time , less blood loss,low rate of conversion to open surgery and postoperative complications , reduced hospital stay, and results inbetter quality of life.%目的:探讨急性胆囊炎患者行经皮经肝胆囊穿刺引流术后的进一步手术治疗的时机。方法:回顾性分析我院77例急性胆囊炎患者行经皮经肝胆囊穿刺引流术(percutaneous transhepatic gallbladder drainage,PTGD)后联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床资料。按 PTGD 与 LC 的间隔时间分为三组,组1为 PTGD 后2个月内行 LC 的病例(n =11),组2为 PTGD 后2~4个月内行 LC的病例(n =36),组3为 PTGD 后间隔4个月以上行 LC 的病例(n =30)。比较三组中转率、术中出血量、手术时间、术后住院时间等。结果:三组间,LC

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

    Directory of Open Access Journals (Sweden)

    Mauro Neiva Fernandes

    2008-05-01

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

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

    Science.gov (United States)

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

    2008-05-24

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

  11. Abdominal lift for laparoscopic cholecystectomy.

    Science.gov (United States)

    Gurusamy, Kurinchi Selvan; Koti, Rahul; Davidson, Brian R

    2013-08-31

    Laparoscopic cholecystectomy (key-hole removal of the gallbladder) is now the most often used method for treatment of symptomatic gallstones. Several cardiopulmonary changes (decreased cardiac output, pulmonary compliance, and increased peak airway pressure) occur during pneumoperitoneum, which is now introduced to allow laparoscopic cholecystectomy. These cardiopulmonary changes may not be tolerated in individuals with poor cardiopulmonary reserve. To assess the benefits and harms of abdominal wall lift compared to pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2013. We included all randomised clinical trials comparing abdominal wall lift (with or without pneumoperitoneum) versus pneumoperitoneum. We calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis with both the fixed-effect and the random-effects models using the Review Manager (RevMan) software. For abdominal wall lift with pneumoperitoneum versus pneumoperitoneum, a total of 130 participants (all with low anaesthetic risk) scheduled for elective laparoscopic cholecystectomy were randomised in five trials to abdominal wall lift with pneumoperitoneum (n = 53) versus pneumoperitoneum only (n = 52). One trial which included 25 people did not state the number of participants in each group. All five trials had a high risk of bias. There was no mortality or conversion to open cholecystectomy in any of the participants in the trials that reported these outcomes. There was no significant difference in the rate of serious adverse events between the two groups (two trials; 2/29 events (0.069 events per person) versus 2/29 events (0.069 events per person); rate ratio 1.00; 95% CI 0

  12. The use of intraoperative cholangiogram during laparoscopic double cholecystectomy

    Directory of Open Access Journals (Sweden)

    Gustavo E. Guajardo-Salinas

    2010-09-01

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

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

    Directory of Open Access Journals (Sweden)

    J. Bueno Lledó

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

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

    Science.gov (United States)

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

    2001-01-01

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

  15. 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.

  16. SIMPLIFIED LAPAROSCOPIC CHOLECYSTECTOMY WITH TWO INCISIONS

    Science.gov (United States)

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

    2014-01-01

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

  17. Knowledge, responsibility, decision making and ignorance

    DEFF Research Database (Denmark)

    Huniche, Lotte

    2001-01-01

    a closer look at genetic knowledge, responsibility and decision making, because these seem to be important issues in my field of study. I have added ignorance to the list in order to discuss a further aspect of dealing with hereditary disease. Interestingly, ignorance (understood both as being ignorant...

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

    DEFF Research Database (Denmark)

    Harboe, Kirstine Moll; Bardram, Linda

    2011-01-01

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

  19. Endoscopic removal of common bile duct stones without subsequent cholecystectomy.

    Science.gov (United States)

    Olaison, G; Kald, B; Karlqvist, P A; Lindström, E; Anderberg, B

    1987-09-01

    Good results from endoscopic sphincterotomy (EST) for removing choledochal stones following cholecystectomy, have led to increasing use of the method when the gallbladder is in situ. The need for cholecystectomy after successful EST has been questioned. As cholecystectomy in elderly patients involves substantial risk, we routinely defer cholecystectomy in such patients while they remain asymptomatic. Experience of 40 cases is reported. Thirty-four were discharged without cholecystectomy and one underwent elective cholecystectomy at his own request. The remaining 33 patients were followed up for 6-53 (mean 21.5) months. Four died from causes unrelated to gallstone disease. Symptoms requiring cholecystectomy arose in two cases (6%). We found no problems due to refraining from routine elective cholecystectomy following EST for common bile duct stones. The rarity of later symptoms appears to justify a "wait and see" attitude to post-EST cholecystectomy.

  20. Prophylactic laparoscopic cholecystectomy in adult sickle cell disease patients with cholelithiasis: A prospective cohort study.

    Science.gov (United States)

    Muroni, Mirko; Loi, Valeria; Lionnet, François; Girot, Robert; Houry, Sidney

    2015-10-01

    Prophylactic laparoscopic cholecystectomy remains controversial and has been discussed for selected subgroups of patients with asymptomatic cholelithiasis who are at high risk of developing complications such as chronic haemolytic conditions. Cholelithiasis is a frequent condition for patients with sickle cell disease (SCD). Complications from cholelithiasis may dramatically increase morbidity for these patients. Our objective was to evaluate the effectiveness of prophylactic cholecystectomy in SCD patients with asymptomatic gallbladder stones. From January 2000 to June 2014, we performed 103 laparoscopic cholecystectomies on SCD patients. Fifty-two patients had asymptomatic cholelithiasis. The asymptomatic patients were prospectively enrolled in this study, and all underwent a prophylactic cholecystectomy with an intraoperative cholangiography. The symptomatic patients were retrospectively studied. Upon admission, all patients were administered specific perioperative management including intravenous hydration, antibiotic prophylaxis, oxygenation, and intravenous painkillers, as well as the subcutaneous administration of low-molecular-weight heparin. During the same period, 51 patients with SCD underwent a cholecystectomy for symptomatic cholelithiasis. We compared these 2 groups in terms of postoperative mortality, morbidity, and hospital stay. There were no postoperative deaths or injuries to the bile ducts in either group. In the asymptomatic group, we observed 6 postoperative complications (11.5%), and in the symptomatic group, there were 13 (25.5%) postoperative complications. Regarding the SCD complications, we observed 1 case (2%) of acute chest syndrome in an asymptomatic cholelithiasis patient, while there were 3 cases (6%) in the symptomatic group. Vaso-occlusive crisis was observed in 1 patient (2%) with asymptomatic cholelithiasis, and in 4 patients (8%) in the other group. The mean hospital stay averaged 5.8 (4-17) days for prophylactic cholecystectomy

  1. Critical view of safety during laparoscopic cholecystectomy.

    Science.gov (United States)

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

    2011-01-01

    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 usually contain arterial or biliary anomalies and is therefore ideal for a safe dissection, even in less experienced hands. We applied and compared the critical view of safety triangle approach with the infundibular approach in a retrospective cohort study. We divided 174 patients into 2 groups, with a similar case-mix (cholelithiasis, chronic cholecystitis, and acute cholecystitis). Results of operations performed by a young surgeon using critical view of safety dissection were compared to results of the infundibular approach performed by an experienced surgeon. Outcome values and operative times were examined with univariate analysis (Student t test). No difference occurred in terms of morbidity (even though comparison for biliary injuries is inconclusive because of insufficient power) and outcome; significant differences were found in operative time, favoring the critical view of safety approach in every stage of gallbladder disease, with minor significance for acute cases. We suggest this technique as the gold standard for resident teaching, because it has a similar rate of biliary and hemorrhagic complications but has a shorter operative time, builds self-confidence, and is a simple standardized method both for complicated and uncomplicated gallbladder lithiasis.

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

    Science.gov (United States)

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

    2017-01-01

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

  3. Single-Port Robotic Cholecystectomy in Pediatric Patients: Single Institution Experience.

    Science.gov (United States)

    Rosales-Velderrain, Armando; Alkhoury, Fuad

    2017-04-01

    Modifications to conventional laparoscopic cholecystectomy are aimed to decrease abdominal pain and improve cosmetic results. Single-port robotic cholecystectomy is a safe and feasible approach that has been reported in adults, though reports are limited in children. This study aims to report our experience with single-port robotic cholecystectomy in children, and to evaluate the safety, feasibility, and outcomes of this approach. After single-port robotic approach was available at our institution, we prospectively followed our patients who underwent a single-port robotic cholecystectomy from March 2013 to May 2015 in our children's hospital. There were 14 patients [female 11 (79%) versus male 3 (21%)], the average age was 12.20 ± 4.97 years, with a mean body mass index of 28.01 ± 8.57 m/kg(2). Of the 14 patients, 4 (29%) had cholelithiasis with choledocolithiasis and had undergone an endoscopic retrograde cholangiopancreatography before the operation, 6 (43%) had symptomatic cholelithiasis, and 4 (28%) had acute cholecystitis. The median operative room time was 125 minutes (range 60-202), the median time of operation was 77.5 minutes (range 64-169), the median estimated blood loss was 2 mL (range 2-25), and a median length of stay was 1 day (range 0-2). There were no conversions to another approach. The median follow-up was 7 months (range 3-22). One patient (7%) developed an umbilical port site seroma, which was managed conservatively, no other complications occurred. Single-port robotic cholecystectomy is a feasible and safe approach for cholecystectomy in the pediatric population. More studies are required to compare it to different approaches.

  4. Gallstone ileus after laparoscopic cholecystectomy.

    Science.gov (United States)

    Ivanov, I; Beuran, M; Venter, M D; Iftimie-Nastase, I; Smarandache, R; Popescu, B; Boştină, R

    2012-09-15

    Gallstone ileus represents a rare complication (0,3-0,5%) of a serious, but common disease-gallstones, which affect around 10% of the population in the USA and Western Europe. Associated diseases (usually severe), elderly patients, delayed diagnosis and therapy due to late presentation to the hospital, account for the morbidity and mortality rates described in literature. We present the case of a patient with partial colon obstruction due to a large gallstone that was "lost" during an emergency laparoscopic cholecystectomy. The calculus eroded the intestinal wall, partially occluding the lumen, triggering recurrent Kerwsky-like, subocclusive episodes. The intraperitoneal abscess has spontaneously drained through the subhepatic drain and once the tube has been removed, a persistent intermittent fistula became obvious.

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

    Directory of Open Access Journals (Sweden)

    Sinha

    2014-12-01

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

  6. Laparoscopic cholecystectomy at the Nairobi hospital: a personal ...

    African Journals Online (AJOL)

    Background: Laparoscopic cholecystectomy is a recent entry in the treatment of gall ... in Kenya and in general if this surgery should be promoted in this country. ... There were three conversions to open cholecystectomy for various reasons, but ...

  7. 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

  8. Laparoscopic cholecystectomy in patients with empyematous cholecystitis: an outcome analysis.

    Science.gov (United States)

    Simopoulos, Constantinos; Botaitis, Sotirios; Polychronidis, Alexandros; Trypsianis, Grigorios; Perente, Sebachedin; Pitiakoudis, Michail

    2009-10-01

    Laparoscopic cholecystectomy (LC), the procedure of choice for elective cholelithiasis, is now also used in the management of acute cholecystitis. Empyema of the gallbladder is unexpectedly encountered in a proportion of these patients. This paper describes our experience with LC in the treatment of patients with empyema of the gallbladder. From May 1992 to July 2007, 315 patients with a clinical diagnosis of acute cholecystitis underwent LC. Operative and histopathology reports were used to identify patients with empyema of the gallbladder, to which retrospective chart reviews were applied. Factors associated with conversion and complications were assessed to determine their predictive power. Being male and having high levels of aspartate transaminase (AST), alanine transaminase (ALT), and white blood cells significantly influenced the prediction of empyema. The conversion rate was significantly higher for empyema and acute cholecystitis, but the complication rate did not differ significantly between these conditions. Previous abdominal surgery was an independent risk factor for conversion and complications. Also, temperature >37.5°C, AST >60 IU/l, and ALT >60 IU/l were associated with higher conversion rates. The hospital stay was longer in patients with empyema, while the operation time did not differ between the two groups. Empyema of the gallbladder can be encountered in patients with presumed acute cholecystitis. Preoperatively differentiating between simple acute cholecystitis and empyema is difficult, if not impossible. The conversion rate is expected to be higher when empyema is approached laparoscopically than for simple acute cholecystitis or symptomatic cholelithiasis.

  9. Histological evaluation of 400 cholecystectomy specimens

    Directory of Open Access Journals (Sweden)

    H Kumar

    2015-09-01

    Full Text Available Background: A majority of gallbladder specimens show changes associated with chronic cholecystitis; however few harbour a highly lethal carcinoma. This study was conducted to review the significant histopathological findings encountered in gallbladder specimens received in our laboratory.Materials and Methods: Four hundred cholecystectomy specimens were studied over a period of five years (May, 2002 to April, 2007 received at department of pathology, Kasturba Medical College, Mangalore, India. Results: Gallstones and associated diseases were more common in women in the 4th to 5th decade as compared to men with M: F ratio of 1:1.33. Maximum number of patients (28.25% being 41 to 50 years old. Histopathologically, the most common diagnosis was chronic cholecystitis (66.75%, followed by chronic active cholecystitis (20.25%, acute cholecystitis (6%, gangrenous cholecystitis (2.25%,xanthogranulomatous cholecystitis (0.50%, empyema (1%, mucocele (0.25%, choledochal cyst (0.25%, adenocarcinoma gallbladder (1.25% and  normal  gallbladders (1%.Conclusion: All lesions were found more frequently in women except chronic active cholecystitis. Gallstones were present in (80.25% cases, and significantly associated with various lesions (P value 0.009. Pigment stones were most common, followed by cholesterol stones and mixed stones. Adequate  sectioning  is  mandatory  in  all  cases  to  assess  epithelial changes arising from cholelithiasis and chronic cholecystitis as it has been known to progress to malignancy in some cases.

  10. 腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿并急性化脓性胆囊炎的疗效%Research on the curative effect of laparoscopic cholecystectomy in the treatment of calculi incarcerated in neck of gallbladder and acute suppurative cholecystitis

    Institute of Scientific and Technical Information of China (English)

    李文彬

    2015-01-01

    Objective:To observe the curative effect of laparoscopic cholecystectomy in the treatment of calculi incarcerated in necK of gallbladder and acute suppurative cholecystitis .Methods:80 cases of calculi incarcerated in necK of gallbladder and acute suppurative cho-lecystitis were divided into observation group and control group according to the difference in therapeutic methods ,40 cases in each group .The observation group received laparoscopic cholecystectomy ,and the control group accepted conventional open operation ,with the time of operation ,intraoperative blood loss ,the time of hospital stay and complication between the two groups compared .Results:There were significant differences in the time of operation ,intraoperative blood loss ,the time of hospitalization ,and the complication rate between the two groups .The time of operation and hospitalization in the observation group was shorter than those in the control group , and intraoperative blood loss in the former group was less than that in the latter group ( P <0 .05) .Conclusion:Laparoscopic cholecys-tectomy in the treatment of calculi incarcerated in necK of gallbladder and acute suppurative cholecystitis is of better clinical effect ,and higher treatment security ,which can help patients recover quicKly .%目的:观察腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿合并急性化脓性胆囊炎的疗效.方法:80 例胆囊颈部结石嵌顿并急性化脓性胆囊炎患者 ,按照治疗方法的差异分为观察组与对照组 ,每组各40例.其中观察组患者以腹腔镜胆囊切除术进行治疗 ,对照组患者以常规开腹手术进行治疗 ,对比两组患者的手术时间、术中出血量、住院时间及并发症等. 结果:两组患者在手术时间、术中出血量、住院时间、并发症发生率等指标上比较 ,差异有统计学意义 ,观察组患者的手术时间、住院时间均短于对照组 ,术中出血量也少于对照组( P <0 .05 ).结论:腹腔镜

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  12. 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

  13. 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

  14. 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.

  15. From dissecting ignorance to solving algebraic problems

    Energy Technology Data Exchange (ETDEWEB)

    Ayyub, Bilal M

    2004-09-01

    Engineers and scientists are increasingly required to design, test, and validate new complex systems in simulation environments and/or with limited experimental results due to international and/or budgetary restrictions. Dealing with complex systems requires assessing knowledge and information by critically evaluating them in terms relevance, completeness, non-distortion, coherence, and other key measures. Using the concepts and definitions from evolutionary knowledge and epistemology, ignorance is examined and classified in the paper. Two ignorance states for a knowledge agent are identified: (1) non-reflective (or blind) state, i.e. the person does not know of self-ignorance, a case of ignorance of ignorance; and (2) reflective state, i.e. the person knows and recognizes self-ignorance. Ignorance can be viewed to have a hierarchal classification based on its sources and nature as provided in the paper. The paper also explores limits on knowledge construction, closed and open world assumptions, and fundamentals of evidential reasoning using belief revision and diagnostics within the framework of ignorance analysis for knowledge construction. The paper also examines an algebraic problem set as identified by Sandia National Laboratories to be a basic building block for uncertainty propagation in computational mechanics. Solution algorithms are provided for the problem set for various assumptions about the state of knowledge about its parameters.

  16. Disagreement behind the veil of ignorance

    NARCIS (Netherlands)

    Muldoon, Ryan; Lisciandra, Chiara; Colyvan, Mark; Martini, Carlo; Sillari, Giacomo; Sprenger, Jan

    2014-01-01

    In this paper we argue that there is a kind of moral disagreement that survives the Rawlsian veil of ignorance. While a veil of ignorance eliminates sources of disagreement stemming from self-interest, it does not do anything to eliminate deeper sources of disagreement. These disagreements not only

  17. 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.

  18. [Laparoscopic cholecystectomy with three-port and 25 millimeters long incision.

    Science.gov (United States)

    Gómez Tagle-Morales, Enrique David

    2013-01-01

    Background: three-port and 25 mm total incision laparoscopic cholecystectomy has shown benefits compared to conventional laparoscopy. The aim was to examine the safety and feasibility of this technique. Methods: a three-port laparoscopic cholecystectomy trial was conducted through Cinvestav metasearcher, Seriunam and Rencis. The eligibility criteria were: three port laparoscopic cholecystectomy, 25 mm total incision, and score = 17 on Data Review System. Trials which employed instruments smaller than 5 mm in diameter were excluded. The comparative variables were documented and results obtained in the selected trials were described. Results: four trials were selected, comprising 1767 cases (1329 females and 438 males), average age was 44.3 years. Chronic cholecystitis was documented in 84.3 %, and acute cholecystitis in 14.7 %. Average surgical time was 54.5 minutes. An additional port was required in 4.8 % and 1.4 % was converted to open technique. Bile duct injury was presented in 0.11 %. The success rate was 94.9 %. Conclusions: three port and 25 mm total incision in laparoscopic cholecystectomy is safe and feasible.

  19. On the Rationality of Pluralistic Ignorance

    DEFF Research Database (Denmark)

    Bjerring, Jens Christian Krarup; Hansen, Jens Ulrik; Pedersen, Nikolaj Jang Lee Linding

    2014-01-01

    Pluralistic ignorance is a socio-psychological phenomenon that involves a systematic discrepancy between people’s private beliefs and public behavior in cer- tain social contexts. Recently, pluralistic ignorance has gained increased attention in formal and social epistemology. But to get clear...... on what precisely a formal and social epistemological account of pluralistic ignorance should look like, we need answers to at least the following two questions: What exactly is the phenomenon of pluralistic ignorance? And can the phenomenon arise among perfectly rational agents? In this paper, we propose...... and social interactive aspects of the phenomenon. Second, given our characterization of pluralistic ignorance, we argue that the phenomenon can indeed arise in groups of perfectly rational agents. This, in turn, ensures that the tools of formal epistemology can be fully utilized to reason about pluralistic...

  20. Evolution and current challenges of laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    XU Dahua.

    2013-03-01

    Full Text Available Since its introduction at the end of the 20th century, laparoscopic cholecystectomy has evolved into a safe and convenient minimally invasive surgical method, which is now the gold standard therapy for cholelithiasis worldwide. Physicians have continued to improve upon the procedure, creating methods that further minimize the related scarring and pain, such as the laproendoscopic single-site cholecystectomy and the gasless-lift laparoscopy. Additionally, the primary challenge of limited operative space in these procedures remains a key feature requiring improvement. In this review, the development and progression of laparoscopic cholecystectomy over the past 26 years is discussed, highlighting the current advantages and disadvantages that need to be addressed by practicing physicians to maximize the clinical value of this important therapy.

  1. LAPAROSCOPIC VS. OPEN SURGERY FOR CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Preetham

    2016-03-01

    Full Text Available INTRODUCTION Cholecystectomy in a layman language is the surgical removal of the bile duct. There is a plethora of pathologies of gall bladder in which the main mode of treatment is cholecystectomy. In an economy like India the Laparoscopic surgery may not be economic taking into consideration of the cost factor. The main aim of the study is to find out the pros and cons for each method used in cholecystectomy. The best way to operate is the laparoscopic. But the conventional open access surgery has to be used whenever the need arises. The cost effectiveness of the laparoscopic surgery has to be worked out for the better usage of the procedure

  2. Constructing and Reconstructing Scientific Ignorance: Ignorance Claims in Science and Journalism.

    Science.gov (United States)

    Stocking, S. Holly; Holstein, Lisa W.

    1993-01-01

    Describes distinctions between ignorance and knowledge and examines scientists' use of ignorance claims in the construction of science and in science for public policy based on an interdisciplinary approach. Ignorance claims in journalism are also examined, including journalists' coverage of the claims of formal scientific discourse and of public…

  3. Pain and convalescence after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Bisgaard, T; Kehlet, H; Rosenberg, J

    2001-01-01

    Pain and speed of convalescence are the two main problems after uncomplicated laparoscopic cholecystectomy. We therefore identified interventional and descriptive studies in electronic databases and supplemented them with manual searches. Pain and interventional analgesic studies were analysed......, 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...... treatment in combination with short, standardised instructions to resume work and normal activity....

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

    Science.gov (United States)

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

    1993-01-01

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

  5. Indications of laparoscopic cholecystectomy based on preoperative imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Wakizaka, Yoshitaka; Sano, Syuichi; Nakanishi, Yoshimi; Koike, Yoshinobu; Ozaki, Susumu; Iwanaga, Rikizo (Sapporo City General Hospital (Japan)); Uchino, Junichi

    1994-03-01

    We studied the indications for laparoscopic cholecystectomy (LC) and values of preoperative imaging findings in 82 patients who underwent preoperative imaging diagnostic tests (abdominal echogram, abdominal CAT scan, ERCP). We analyzed mainly patients who were considered to be indicated for LC but whose gallbladders could be removed by open laparotomy, or whose gallbladders were removed by open laparotomy but were considered indicated for LC from retrospective study. We found the following results. LC could be easily performed in patients with a history of severe acute cholecystitis if they had no findings of a thickened wall or negative gallbladder signs. Abdominal echogram and CAT scan were the best preoperative imaging tests for determining the gallbladder's state, especially for obstruction of the cystic duct. These results are important today when the operative indications of LC are extremely indefinite because of the accumulation of operative experience and technological improvements. (author).

  6. Many College Women Ignore Indoor Tanning's Risks

    Science.gov (United States)

    Skip navigation U.S. National Library of Medicine Menu ... Ignore Indoor Tanning's Risks 7 out of 10 surveyed overlook connection to skin cancer To use the sharing features on this page, please enable ...

  7. Does Employee Ignorance Undermine Shared Capitalism?

    OpenAIRE

    John W. Budd

    2008-01-01

    The potential of shared capitalism to improve individual and organizational performance through financial incentives depends on employees knowing about and participating in compensation plans that link rewards to performance. This paper therefore analyzes a survey of employees from multiple companies to assess the extent to which employees are ignorant about company, group, and individual-based incentive pay plans and ESOPs. The findings reveal significant amounts of employee ignorance in bot...

  8. Is Ignorance of Climate Change Culpable?

    Science.gov (United States)

    Robichaud, Philip

    2016-11-28

    Sometimes ignorance is an excuse. If an agent did not know and could not have known that her action would realize some bad outcome, then it is plausible to maintain that she is not to blame for realizing that outcome, even when the act that leads to this outcome is wrong. This general thought can be brought to bear in the context of climate change insofar as we think (a) that the actions of individual agents play some role in realizing climate harms and (b) that these actions are apt targets for being considered right or wrong. Are agents who are ignorant about climate change and the way their actions contribute to it excused because of their ignorance, or is their ignorance culpable? In this paper I examine these questions from the perspective of recent developments in the theories of responsibility for ignorant action and characterize their verdicts. After developing some objections to existing attempts to explore these questions, I characterize two influential theories of moral responsibility and discuss their implications for three different types of ignorance about climate change. I conclude with some recommendations for how we should react to the face of the theories' conflicting verdicts. The answer to the question posed in the title, then, is: "Well, it's complicated."

  9. Coagulation and fibrinolysis during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

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

    1999-01-01

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

  10. 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.

  11. 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.

  12. PRINCIPLES OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Tomaž Benedik

    2003-12-01

    Full Text Available Background. After more than decade of routine use of laparoscopic cholecystectomy for treatment of symptomatic gallbladder stones, the incidence of biliary injuries, which are potentially life threatening and cause prolonged hospitalization and major morbidity, seems to be increased in laparoscopic cholecystectomy compared with open operation. Injury rate was from some reports 2.5 to 4 times higher than with open operation. There are many proposed classifications of types of biliary injuries.The most frequent direct causes of laparoscopic biliary injury are misidentification of the common bile duct, cautery injuries to the bile duct and improper application of clips to the cystic duct.Conclusions. To avoid misidentification of ducts one should conclusively identify cystic duct and artery, the structures to be divide, in every laparoscopic cholecystectomy. To achieve that goal, Calot’s triangle must be dissected free of fat and fibrous – tissue and the lower end of the gallbladder must be dissected of the liver bed. The only two structures entering the gallbladder should be visible – cystic duct and artery. With avoidance of blind application of cautery and clips to control bleeding one should avoid injury of bile duct. Low cautery settings should be used in portal dissections to prevent arc.With meticulous care in dissection and conclusive identification of cystic duct and artery we can prevent injuries of bile duct, which still have impermissible high incidence. In the article 504 laparoscopic cholecystectomies performed at the Department of abdominal surgery in BPD in 2002 were analysed. We follow priciples of safety in laparoscopic cholecystectomy. There were no biliary injuries reports.

  13. Knowledge, responsibility, decision making and ignorance

    DEFF Research Database (Denmark)

    Huniche, Lotte

    2001-01-01

    This article is concerned with the question of how to argue about morality and ethics in relationto a severe and deadly hereditary disease. It is inspired by the uneasiness I have felt on a number of ocations when "right and wrong" is being discussed by persons at risk, professionals and in parti......This article is concerned with the question of how to argue about morality and ethics in relationto a severe and deadly hereditary disease. It is inspired by the uneasiness I have felt on a number of ocations when "right and wrong" is being discussed by persons at risk, professionals...... a closer look at genetic knowledge, responsibility and decision making, because these seem to be important issues in my field of study. I have added ignorance to the list in order to discuss a further aspect of dealing with hereditary disease. Interestingly, ignorance (understood both as being ignorant...

  14. A case series of cholecystectomy in Jamaican sickle cell disease patients - The need for a new strategy

    Directory of Open Access Journals (Sweden)

    Pierre-Anthony Leake

    2017-03-01

    Full Text Available High morbidity rates related to cholecystectomy in sickle cell disease (SCD patients have been previously reported in the region. This study serves to assess the current outcomes related to cholecystectomy in a Jamaican SCD population. METHODS: A retrospective chart review of SCD patients undergoing elective cholecystectomy at the University Hospital of the West Indies over a 6-year period was performed providing relevant information for analysis. Patients were grouped on an intention-to-treat basis into an open and laparoscopic group. RESULTS: A total of 27 patients were included (18 laparoscopic and 9 open. Both groups were matched for age, gender and steady state hemoglobin. Only one patient (in the open group received preoperative blood transfusion. The conversion rate for laparoscopy was 28%. Operative time was significantly longer in the open group (175.3 ± 62.1 vs. 125.9 ± 54.4 min, p = 0.0355. Bile duct exploration was undertaken in 66.7% of patients in the open group compared to 0% in the laparoscopic group. There was no significant difference between groups with respect to hospital stay, morbidity or mortality. The overall 30-day morbidity was 48.1% with acute chest syndrome being diagnosed in 6 patients and pneumonia in 7 patients. CONCLUSION: Morbidity rates related to cholecystectomy in the Jamaican SCD population remain high. Further studies to evaluate the factors contributing to such high morbidity in this population are warranted, with particular focus on laparoscopic cholecystectomy. Strategies such as preoperative transfusion and prophylactic cholecystectomy also need to be evaluated and considered in this patient group.

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

    Directory of Open Access Journals (Sweden)

    Ritima Dhir

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    DEFF Research Database (Denmark)

    Harboe, Kirstine M; Bardram, Linda

    2011-01-01

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

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

    Science.gov (United States)

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

    1991-01-01

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

  19. Mexico, A Neighbor not to be Ignored.

    Science.gov (United States)

    1988-04-01

    election fraud in Puebla , Mexico’s fourth largest city, resulted in an editor being fired. (5:27) A similar case in Mazatlan was totally ignored and a...president, Lazaro Cardenas (1934- 1940 ), and an experienced, well respected PAN candidate, Senor Clouthier, could prove to be important. The elder Cardenas

  20. 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.

  1. 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

  2. Laparoscopic cholecystectomy in children with sickle cell anemia and the role of ERCP.

    Science.gov (United States)

    Al-Salem, Ahmed Hassan; Issa, Hussain

    2012-04-01

    Patients with sickle cell anemia (SCA) have a high incidence of cholelithiasis and choledocholithiasis. This report is an analysis of our experience with laparoscopic cholecystectomy (LC) for children with SCA and the role of endoscopic retrograde cholangiopancreatography (ERCP). The records of children with SCA who had cholecystectomy were retrospectively reviewed for age, sex, hemoglobin level, hemoglobin electrophoresis, indication for cholecystectomy, operative time, hospital stay, and postoperative complications. They were divided into 2 groups, open cholecystectomy (OC) group and LC group, and the 2 were compared in terms of operative time, hospital stay, and postoperative complications. Over a period of 15 years (January 1995 and December 2009), 94 children with SCA had cholecystectomy. Thirty-five (19 males and 16 females) had OC, 52 (28 males and 24 females) had LC, and 7 (4 males and 3 females) had LC and splenectomy. Their age ranged from 4 to 15 years (mean, 11.4 y). The indications for cholecystectomy were biliary dyspepsia and biliary colic (55), acute cholecystitis (7), obstructive jaundice (17), asymptomatic (12), and biliary pancreatitis (3). All those who had OC underwent intraoperative cholangiogram, 9 of them (25.7%) had common bile duct (CBD) exploration and 2 transduodenal sphincterotomy. Of those who had LC, 13 (25%) underwent preoperative ERCP, which was normal in 1, showed dilated CBD with no stones in 2, and dilated CBD with stones in 7. In 3, ERCP showed dilated CBD with enlarged, inflammed papilla suggestive of recent stone passage. Nine underwent endoscopic sphincterotomy and stone extraction followed by LC. There was no mortality; 1 (2.1%) required conversion to OC and another underwent postoperative exploration because of bleeding from an accessory cystic artery. In the LC group, 4 (7.7%) developed minor postoperative complications, whereas 8 (22.9%) in the OC group developed complications. With proper perioperative management, LC is

  3. Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy.

    Science.gov (United States)

    Gurusamy, Kurinchi Selvan; Koti, Rahul; Davidson, Brian R

    2013-09-03

    Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Drains are used after laparoscopic cholecystectomy to prevent abdominal collections. However, drain use may increase infective complications and delay discharge. The aim is to assess the benefits and harms of routine abdominal drainage in uncomplicated laparoscopic cholecystectomy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2013. We included all randomised clinical trials comparing drainage versus no drainage after uncomplicated laparoscopic cholecystectomy irrespective of language and publication status. We used standard methodological procedures defined by The Cochrane Collaboration. A total of 1831 participants were randomised to drain (915 participants) versus 'no drain' (916 participants) in 12 trials included in this review. Only two trials including 199 participants were of low risk of bias. Nine trials included patients undergoing elective laparoscopic cholecystectomy exclusively. One trial included patients undergoing laparoscopic cholecystectomy for acute cholecystitis exclusively. One trial included patients undergoing elective and emergency laparoscopic cholecystectomy, and one trial did not provide this information. The average age of participants in the trials ranged between 48 years and 63 years in the 10 trials that provided this information. The proportion of females ranged between 55.0% and 79.0% in the 11 trials that provided this information. There was no significant difference between the drain group (1/840) (adjusted proportion: 0.1%) and the 'no drain' group (2/841) (0.2%) (RR 0.41; 95% CI 0.04 to 4.37) in short-term mortality in the ten trials with 1681 participants reporting on this outcome. There was no significant difference between the drain group (7/567) (adjusted proportion: 1.1%) and the 'no drain' group (3/576) (0.5%) in the

  4. 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...

  5. 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

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

    Institute of Scientific and Technical Information of China (English)

    Sheng-Bing Huang; Shi-Lian Chen

    2016-01-01

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

  7. Imaging of the complications of laparoscopic cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Lohan, Derek; Walsh, Sinead; McLoughlin, Raymond; Murphy, Joseph [University College Hospital, Department of Radiology, Galway (Ireland)

    2005-05-01

    Laparoscopic cholecystectomy has, in recent years, emerged as the gold standard therapeutic option for the management of uncomplicated symptomatic cholelithiasis. Each year, up to 700,000 of these procedures are performed in the United States alone. While the relative rate of post-procedural complications is low, the popularity of this method of gallbladder removal is such that this entity is not uncommonly clinically encountered, and therefore must be borne in mind by the investigating physician. By way of pictorial review, we explore the radiological appearances of a variety of potential complications of laparoscopic cholecystectomy. The radiological appearances of each shall be illustrated in turn using several imaging modalities, including ultrasound, computed tomography, MR cholangiography and radio-isotope scintigraphy. From calculus retention to portal vein laceration, bile duct injury to infected dropped calculi, we illustrate numerous potential complications of this procedure, as well as indicating the most suitable imaging modalities available for the detection of these adverse outcomes. As one of the most commonly performed intra-abdominal surgeries, laparoscopic cholecystectomy and the complications thereof are not uncommonly encountered. Awareness of the possible presence of these numerous complications, including their radiological appearances, makes early detection more likely, with resultant improved patient outcome. (orig.)

  8. Open Cholecystectomy for Surgical Treatment of Gallstones

    Directory of Open Access Journals (Sweden)

    Jorge Luis Estepa Pérez

    2015-02-01

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

  9. 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.

  10. 术前超声检查预测急性胆囊炎腹腔镜手术难度的受试者工作特征曲线分析%Evaluation of Ultrasonic Predicting Difficulty of Laparoscopic Cholecystectomy in Acute Cholecystitis by Receiver Operator Characteristic Curve

    Institute of Scientific and Technical Information of China (English)

    赵鲁文; 赵洪涛; 于爱军; 史华宁; 张学军; 刘金龙

    2012-01-01

    目的 探讨术前超声检查对急性胆囊炎行腹腔镜手术难度的预测价值.方法 对235例急性胆囊炎腹腔镜胆囊切除术(LC)患者术前行腹部超声检查,记录胆囊容积,胆囊壁厚度,胆囊窝有无积液,胆囊颈管是否有结石嵌顿,胆囊与周围粘连,胆囊三角粘连情况.应用χ2检验单因素分析筛选出导致手术困难的危险因素,再对危险因素进行Logistic多元回归分析,并分别赋值,建立术前超声预测急性胆囊炎LC难度评分表,进行受试者工作特征(receiver operator characteristic,ROC)曲线分析.结果 胆囊容积增大、胆囊壁增厚、胆囊颈管结石嵌顿和胆囊颈粘连是影响急性胆囊炎腹腔镜手术难度的独立危险因素.应用4项指标建立术前超声预测急性胆囊炎LC难度评分表.经ROC曲线分析,曲线下面积为0.945,与完全随机情况下获得的曲线下面积(0.5)进行比较,差异有统计学意义(P<0.05).结论 术前超声检查可以较好地预测急性胆囊炎行腹腔镜手术的难易程度,对手术适应证的选择有重要指导意义.%Objective To explore the predictive value of ultrasonic appearance for difficulty of laparoscopic cholecystectomy ( LC ) in acute cholecystitis. Methods A total of 235 patients with acute cholecystitis received ultrasonic examination before LC. The parameters were measured pre - operation including the volume of gallbladder, cholecystic wall thickness, gallbladder fossa fluid, stone incarceration and adhesion of gallbladder or Calot's triangle. The risk factors associated with difficult LC was selected by Chi - square test, then multivariable analysis with Logistic regression was performed for the selected risk factors and given scores which formed a scoring system for ultrasonic appearance in acute cholecystitis, predicting technical difficulties during LC. Receiver operator characteristic ( ROC ) curve was then applied to analyze the scoring system. Results Multivari

  11. Genetic ignorance, moral obligations and social duties.

    Science.gov (United States)

    Takala, T; Häyry, M

    2000-02-01

    In a contribution to The Journal of Medicine and Philosophy, Professor Rosamond Rhodes argues that individuals sometimes have an obligation to know about their genetic disorders, because this is required by their status as autonomous persons. Her analysis, which is based on Kant's concept of autonomy and Aristotle's notion of friendship, is extended here to consequentialist concerns. These are of paramount importance if, as we believe and Professor Rhodes herself implies, the Kantian and Aristotelian doctrines can be helpful only in the sphere of private morality, not in the public realm. Better tools for assessing the right to genetic ignorance as an issue of public policy can, we contend, be found in Mill's ideas concerning liberty and the prevention of harm. Our own conclusion, based on the Millian way of thinking, is that individuals probably do have the right to remain in ignorance in the cases Professor Rhodes presents as examples of a duty to know.

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

    DEFF Research Database (Denmark)

    Harboe, Kirstine M; Bardram, Linda

    2011-01-01

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

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

    DEFF Research Database (Denmark)

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

    1999-01-01

    BACKGROUND: After cholecystectomy for symptomatic gallstone disease 20%-30% of the patients continue to have abdominal pain. The aim of this study was to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. METHODS: One hundred and two patients w...

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

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

    NARCIS (Netherlands)

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

    2006-01-01

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

  16. The veil of ignorance can favour biological cooperation.

    Science.gov (United States)

    Queller, David C; Strassmann, Joan E

    2013-01-01

    Lack of information is a constraint but ignorance can sometimes assist the evolution of cooperation by constraining selfishness. We discuss examples involving both ignorance of role or pay-off and ignorance of relatedness. Ignorance can favour cooperative traits like grouping and warning coloration and reduce conflicts from meiotic drive, imprinting, greenbeards and various forms of nepotism.

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

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2016-01-01

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

  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. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy

    Science.gov (United States)

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

    2013-01-01

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

  20. 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

  1. Ignored Aspects of Islamic Banking and Finance

    Directory of Open Access Journals (Sweden)

    Seyed Hadi Arabi

    2014-06-01

    Full Text Available Purpose: In the past several decades of Islamic banking and fi nance (IBF activity in many countries, notable literature on this topic has been produced all over the world. By analyzing this IBF literature, this study investigates and highlights some ignored aspects of IBF activities. Methodology: Academic IBF literature includes defending the plausibility of IBF as a part of Islamic economics; theoretical analysis regarding some advantages of IBF compared with conventional systems, suggesting some methods for performing IBF; and concentration on introducing fi nancial instruments and innovations in Islamic financial markets. After reviewing them, they are classifi ed as high ranking journal papers and graduate dissertations that were written on Islamic economics in I.R. Iran during the past three decades. Then they are analyzed via analytical methods and descriptive statistics to investigate the ignored aspects of IBF. Findings: Through this systemic study of Islamic banking, real and not skeletal adaptation of Islamic contracts, Islamic goals of Islamic economy, Islamic and ethical values, and justice and poverty reduction are some of the more important neglected aspects in IBF activities. Research Implications: Focusing on these areas in future research could improve the performance of IBF as part of the Islamic economic system and guide IBF activities to the real nature of Islam (Islamicity. Originality: Besides reviewing and classifying the academic literature on IBF, the study is unique in focusing on the neglected aspects of IBF because it is very important and infl uential to distinguish IBF from non-IBF activities.

  2. 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

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

    Science.gov (United States)

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

    2010-07-01

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

  4. [Asymptomatic or paucisymptomatic CBD dilatation on US after cholecystectomy: management].

    Science.gov (United States)

    Pilleul, F

    2006-04-01

    In western countries, 10-15% of the population has gallbladder stones with 46,000 cholecystectomies performed in France in 2003. So, daily ultrasonography of the abdomen performed in patients without gallbladder is a routine exam. However, identification of an enlarged common bile duct is frequent and the normal nature of this finding remains uncertain. The purpose of this article is to perform a literature review of the impact of cholecystectomy on the diameter of the common bile duct. Furthermore, it is important not to dismiss common bile duct dilatation after cholecystectomy because it may be the result of post operative complication or secondary to a congenital disease of bile duct.

  5. Synchronous presentation of acute acalculous cholecystitis and appendicitis: a case report

    LENUS (Irish Health Repository)

    Sahebally, Shaheel M

    2011-11-14

    Abstract Introduction Acute acalculous cholecystitis is traditionally associated with elderly or critically ill patients. Case presentation We present the case of an otherwise healthy 23-year-old Caucasian man who presented with acute right-sided abdominal pain. An ultrasound examination revealed evidence of acute acalculous cholecystitis. A laparoscopy was undertaken and the dual pathologies of acute acalculous cholecystitis and acute appendicitis were discovered and a laparoscopic cholecystectomy and appendectomy were performed. Conclusion Acute acalculous cholecystitis is a rare clinical entity in young, healthy patients and this report describes the unusual association of acute acalculous cholecystitis and appendicitis. A single stage combined laparoscopic appendectomy and cholecystectomy is an effective treatment modality.

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

    Directory of Open Access Journals (Sweden)

    V. N. Klimenko

    2014-04-01

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

  7. Why epidemiologists cannot afford to ignore poverty.

    Science.gov (United States)

    Krieger, Nancy

    2007-11-01

    Epidemiologists cannot afford to ignore poverty. To do so would, first, wrongly obscure the devastating impact of poverty on population health, and, second, undercut our commitment to scientific rigor. At issue is doing correct science, not "politically correct" science. Blot poverty and inequity from view, and not only will we contribute to making suffering invisible but our understanding of disease etiology and distribution will be marred. To make this case, I address current debates about the causal relationships between poverty and health, and provide examples of how failing to consider the impact of socioeconomic position has biased epidemiologic knowledge and harmed the public's health. By definition, the people we study are simultaneously social beings and biologic organisms-and we cannot study the latter without taking into account the former. It is the responsibility of all epidemiologists, and not only social epidemiologists, to keep in mind the connections between poverty and health.

  8. Ignorability in Statistical and Probabilistic Inference

    CERN Document Server

    Jaeger, M

    2011-01-01

    When dealing with incomplete data in statistical learning, or incomplete observations in probabilistic inference, one needs to distinguish the fact that a certain event is observed from the fact that the observed event has happened. Since the modeling and computational complexities entailed by maintaining this proper distinction are often prohibitive, one asks for conditions under which it can be safely ignored. Such conditions are given by the missing at random (mar) and coarsened at random (car) assumptions. In this paper we provide an in-depth analysis of several questions relating to mar/car assumptions. Main purpose of our study is to provide criteria by which one may evaluate whether a car assumption is reasonable for a particular data collecting or observational process. This question is complicated by the fact that several distinct versions of mar/car assumptions exist. We therefore first provide an overview over these different versions, in which we highlight the distinction between distributional an...

  9. [Comparative study of ambulatory laparoscopic cholecystectomy versus management of laparoscopic cholecystectomy with conventional hospital stay].

    Science.gov (United States)

    Lezana Pérez, María Ángeles; Carreño Villarreal, Guillermo; Lora Cumplido, Paola; Alvarez Obregón, Raúl

    2013-01-01

    To analyse the effectiveness and quality of ambulatory laparoscopic cholecystectomy (CLCMA) versus management of laparoscopic cholecystectomy with conventional hospital stay (CLEST). A retrospective study was conducted on all patients ASA I-II, who had a laparoscopic cholecystectomy (LC) over a period of 6 years. The patients were divided into 2 groups: group CLCMA (n = 141 patients) and group CLEST (n = 286 patients). The effectiveness was analysed by evaluating morbidity, further surgery, re-admission and hospital stay. The quality analysis was performed using CLCMA group satisfaction surveys and subsequent assessment by indicators of satisfaction. There was no significant differences between groups (CLEST vs. CLCMA) in morbidity (5.24 vs 4.26), further surgery (2.45 vs. 1.42) or re-admissions (1.40 vs. 3.55). There was no postoperative mortality. In the CLCMA group 82% of patients were discharged on the same day of surgery, with a mean stay of 1.16 days, while in the CLEST group the mean hospital stay was 2.94 days (P=.003).The overall satisfaction rate was 82%, and the level of satisfaction of care received was 81%, both above the previously set standard. CLCMA is just as effective and safe as hospital based CLEST, with a good level of perceived quality. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  10. On strategic ignorance of environmental harm and social norms

    DEFF Research Database (Denmark)

    Thunström, Linda; van 't Veld, Klaas; Shogren, Jason

    Are people strategically ignorant of the negative externalities their activities cause the environment? Herein we examine if people avoid costless information on those externalities and use ignorance as an excuse to reduce pro-environmental behavior. We develop a theoretical framework in which pe...... norm, namely the share of air travelers who buy carbon offsets. We find evidence that some people use ignorance as an excuse to reduce pro-environmental behavior—ignorance significantly decreases the probability of buying carbon offsets....

  11. 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.

  12. Spilled gallstones mimicking a retroperitoneal sarcoma following laparoscopic cholecystectomy.

    Science.gov (United States)

    Kim, Bum-Soo; Joo, Sun-Hyung; Kim, Hyun-Cheol

    2016-05-07

    Laparoscopic cholecystectomy has become a standard treatment of symptomatic gallstone disease. Although spilled gallstones are considered harmless, unretrieved gallstones can result in intra-abdominal abscess. We report a case of abscess formation due to spilled gallstones after laparoscopic cholecystectomy mimicking a retroperitoneal sarcoma on radiologic imaging. A 59-year-old male with a surgical history of a laparoscopic cholecystectomy complicated by gallstones spillage presented with a 1 mo history of constant right-sided abdominal pain and tenderness. Computed tomography and magnetic resonance imaging demonstrated a retroperitoneal sarcoma at the sub-hepatic space. On open exploration a 5 cm × 5 cm retroperitoneal mass was excised. The mass contained purulent material and gallstones. Final pathology revealed abscess formation and foreign body granuloma. Vigilance concerning the possibility of lost gallstones during laparoscopic cholecystectomy is important. If possible, every spilled gallstone during surgery should be retrieved to prevent this rare complication.

  13. 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...

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

    DEFF Research Database (Denmark)

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

    1999-01-01

    BACKGROUND: After cholecystectomy for symptomatic gallstone disease 20%-30% of the patients continue to have abdominal pain. The aim of this study was to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. METHODS: One hundred and two patients...... and sonography evaluated gallbladder motility, gallstones, and gallbladder volume. Preoperative variables in patients with or without postcholecystectomy pain were compared statistically, and significant variables were combined in a logistic regression model to predict the postoperative outcome. RESULTS: Eighty...

  15. 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...

  16. Increased ERCP rate following the introduction of laparoscopic cholecystectomy.

    Science.gov (United States)

    Legorreta, A P; Brooks, R J; Staroscik, R N; Xuan, Y; Costantino, G N; Zatz, S L

    1995-10-01

    Over the past 5 years there has been a remarkable change in the manner in which symptomatic gallstones are surgically managed. In this study we reviewed the experience of a large HMO to determine the relationship between the rate of increase of ERCP and that of cholecystectomy. All individuals enrolled in US Healthcare's HMO-PA, in the region of southeastern Pennsylvania from 1988 through 1993, were included in the analysis. Using the HMO claims database, patients who underwent an open or laparoscopic cholecystectomy during the study period were identified. We then identified those patients who had a pre- or post- operative ERCP. Over the study period, there has been a substantial increase in cholecystectomies per 1000 members-from 1.37 in 1988 to 2.16 (p < 0.0001) in 1993. In our study population there were 1261 ERCPs performed in 979 patients with an average of 1.3 ERCPs per patient during the study period. The ERCP rate per 1000 members has increased from 0.16 to 0.56 (p < 0.0001) from 1988 to 1993, at the same time that the cholecystectomy rate was substantially increasing. The correlation for the ERCP and cholecystectomy rates from 1988 to 1993 was 0.994 (p < 0.0001). Since the introduction of laparoscopic cholecystectomy in 1989-1990, many more ERCPs are now being performed. It is necessary to determine the implications related to the rapid diffusion of laparoscopic cholecystectomy, including the effect that this technology has had on other older and stable technologies such as ERCP. Our results describe the dramatic effect that laparoscopic cholecystectomy has had on the utilization of ERCPs.

  17. Climate Change Ignorance: An Unacceptable Legacy

    Science.gov (United States)

    Boon, Helen J.

    2015-01-01

    Climate change effects will be most acutely felt by future generations. Recent prior research has shown that school students' knowledge of climate change science is very limited in rural Australia. The purpose of this study was to assess the capacity of preservice teachers and parents to transmit climate change information and understanding to…

  18. Climate Change Ignorance: An Unacceptable Legacy

    Science.gov (United States)

    Boon, Helen J.

    2015-01-01

    Climate change effects will be most acutely felt by future generations. Recent prior research has shown that school students' knowledge of climate change science is very limited in rural Australia. The purpose of this study was to assess the capacity of preservice teachers and parents to transmit climate change information and understanding to…

  19. 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.

  20. Association of cholecystectomy with metabolic syndrome in a Chinese population.

    Directory of Open Access Journals (Sweden)

    Chao Shen

    Full Text Available An association between cholecystectomy and metabolic syndrome has not been fully established. Here we analyzed the association between cholecystectomy and metabolic syndrome in a Chinese population of 5672 subjects who undergone annual health checkups at the First Affiliated Hospital, College of Medicine, Zhejiang University between January 2011 and December 2012. The prevalences of gallstones, cholecystectomy and metabolic syndrome were 6.0%, 3.6%, and 32.5%, respectively. The prevalence of metabolic syndrome was significantly higher in subjects with a history of cholecystectomy (63.5% than in those with gallstones (47.0% or in those without gallstone disease (30.3%; P<0.01 for both. Multivariate logistic regression analysis showed that cholecystectomy was significantly associated with increased risk of metabolic syndrome (OR = 1.872; 95% CI: 1.193-2.937. However, the association of gallstones with metabolic syndrome was not statistically significant (OR = 1.267; 95% CI: 0.901-1.782. Altogether, our results suggest that cholecystectomy significantly increases the risk of metabolic syndrome.

  1. 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.

  2. Laparoscopic cholecystectomy and the Peter Pan syndrome.

    Science.gov (United States)

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

    2000-08-01

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

  3. Bias and ignorance in demographic perception.

    Science.gov (United States)

    Landy, D; Guay, B; Marghetis, T

    2017-08-31

    When it comes to knowledge of demographic facts, misinformation appears to be the norm. Americans massively overestimate the proportions of their fellow citizens who are immigrants, Muslim, LGBTQ, and Latino, but underestimate those who are White or Christian. Previous explanations of these estimation errors have invoked topic-specific mechanisms such as xenophobia or media bias. We reconsidered this pattern of errors in the light of more than 30 years of research on the psychological processes involved in proportion estimation and decision-making under uncertainty. In two publicly available datasets featuring demographic estimates from 14 countries, we found that proportion estimates of national demographics correspond closely to what is found in laboratory studies of quantitative estimates more generally. Biases in demographic estimation, therefore, are part of a very general pattern of human psychology-independent of the particular topic or demographic under consideration-that explains most of the error in estimates of the size of politically salient populations. By situating demographic estimates within a broader understanding of general quantity estimation, these results demand reevaluation of both topic-specific misinformation about demographic facts and topic-specific explanations of demographic ignorance, such as media bias and xenophobia.

  4. Beyond risk and ambiguity: deciding under ignorance.

    Science.gov (United States)

    Pushkarskaya, Helen; Liu, Xun; Smithson, Michael; Joseph, Jane E

    2010-09-01

    In this study, we examined the neural basis of decision making under different types of uncertainty that involve missing information: ambiguity (vague probabilities) and sample space ignorance (SSI; unknown outcomes). fMRI revealed that these two different types of uncertainty recruit distinct neural substrates: Ambiguity recruits the left insula, whereas SSI recruits the anterior cingulate cortex, bilateral inferior parietal cortex, and the lateral orbitofrontal cortex. The finding of unique activations for different types of uncertainty may not necessarily be predicted within the reductive approach of modern theories of decision making under uncertainty, because these theories purport that humans reduce more complicated uncertain environments to subjectively formed less complicated ones (i.e., SSI to ambiguity). The predictions of the reductive view held only for ambiguity-averse individuals and not for ambiguity-tolerant individuals. Consequently, theories of decision making under uncertainty should include individual tolerance for missing information and how these individual differences modulate the neural systems engaged during decision making. Supplemental materials for this article may be downloaded from http://cabn.psychonomic-journals.org/content/supplemental.

  5. Aspiring to Spectral Ignorance in Earth Observation

    Science.gov (United States)

    Oliver, S. A.

    2016-12-01

    Enabling robust, defensible and integrated decision making in the Era of Big Earth Data requires the fusion of data from multiple and diverse sensor platforms and networks. While the application of standardised global grid systems provides a common spatial analytics framework that facilitates the computationally efficient and statistically valid integration and analysis of these various data sources across multiple scales, there remains the challenge of sensor equivalency; particularly when combining data from different earth observation satellite sensors (e.g. combining Landsat and Sentinel-2 observations). To realise the vision of a sensor ignorant analytics platform for earth observation we require automation of spectral matching across the available sensors. Ultimately, the aim is to remove the requirement for the user to possess any sensor knowledge in order to undertake analysis. This paper introduces the concept of spectral equivalence and proposes a methodology through which equivalent bands may be sourced from a set of potential target sensors through application of equivalence metrics and thresholds. A number of parameters can be used to determine whether a pair of spectra are equivalent for the purposes of analysis. A baseline set of thresholds for these parameters and how to apply them systematically to enable relation of spectral bands amongst numerous different sensors is proposed. The base unit for comparison in this work is the relative spectral response. From this input, determination of a what may constitute equivalence can be related by a user, based on their own conceptualisation of equivalence.

  6. Ignorance as an under-identified social problem.

    Science.gov (United States)

    Ungar, Sheldon

    2008-06-01

    This paper examines the persistence and intensification of ignorance in the ostensible knowledge society. Given the ubiquity of ignorance, it focuses on research and observations dealing with functional knowledge deficits that challenge the ideal of the well-informed citizen. These developments are traced back to the contradictory dynamics of the knowledge society, specifically information explosions in the knowledge economy and the resultant knowledge-ignorance paradox. The theoretical unfolding of this paradox in terms of entry and speech barriers suggests that pockets of observed public knowledge - rather than ignorance - are exceptional and require specific explanation. While ignorance among individuals, as well as experts and organizations, is a serious social problem with potentially deadly consequences, ignorance remains relatively unrecognized since it has major liabilities as a marketable issue. The conclusion points to the importance of future research on the cultural and institutional production of ignorance.

  7. [Enterolithotomy and early cholecystectomy, an application of damage control surgery for patients with gallstone ileus].

    Science.gov (United States)

    Martín-Pérez, Jesica; Delgado-Plasencia, Luciano; Bravo-Gutiérrez, Alberto; Lorenzo-Rocha, Nieves; Burillo-Putze, Guillermo; Medina-Arana, Vicente

    2015-01-01

    Recurrent gallstone ileus is an uncommon mechanical intestinal obstruction secondary to occlusion of the intestine by an intraluminal biliary calculus. Female, 75 years old, ischaemic heart disease (stent), arrived in our department complaining of abdominal pain and vomiting. Computed tomography showed gallstone ileus. The patient underwent an enterotomy with gallstone removal. Three months later, the patient came back with the same clinical symptoms and signs. A new computed tomography highlighted a gallstone ileus again. Enterolithotomy and gallstone removal, cholecystectomy and closure of cholecystoduodenal fistula were performed. The patient had a prolonged hospital stay due to the development of congestive heart failure. Case 2. Male, 71 years old, ischaemic heart disease and aortocoronary bypass, seen in our department complaining of vomiting. Computed tomography showed aerobilia and gallstone ileus. The patient underwent an urgent enterolithotomy. Seven months later, the patient came back with the same clinical symptoms and signs. Computed tomography showed a new gallstone ileus. An enterotomy and gallstone removal, cholecystectomy and closure of cholecystoduodenal fistula were performed. The patient died due to multi-organ failure in post-surgery period. In the elderly patients with concomitant medical illnesses with the risk of a second laparotomy, it is justifiable to reconsider the definitive repair in the treatment of gallstone ileus. The enterolithotomy in acute phase followed by early cholecystectomy (4-8 weeks) may be a safe method for eliminating, not only the possibility of recurrent gallstone ileus, and probably the need for a second laparotomy, but also the exceptional possibility of developing a gallbladder carcinoma. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  8. Perioperative music may reduce pain and fatigue in patients undergoing laparoscopic cholecystectomy.

    Science.gov (United States)

    Graversen, M; Sommer, T

    2013-09-01

    Acute post-operative pain is a predictor in the development of chronic pain after laparoscopic cholecystectomy. Music has been shown to reduce surgical stress. In a randomized, clinical trial, we wanted to test the hypothesis that perioperative and post-operative soft music reduces pain, nausea, fatigue and surgical stress in patients undergoing laparoscopic cholecystectomy as day surgery. The study was performed in otherwise healthy Danish patients eligible for day surgery. Ninety-three patients were included and randomized to either soft music or no music perioperatively and post-operatively. Using visual analog score pain, nausea and fatigue at baseline, 1 h, 3 h, 1 day and 7 days after surgery were recorded. C-reactive protein and cortisol were sampled before and after surgery. Music did not lower pain 3 h after surgery, which was the main outcome. The music group had less pain day 7 (P = 0.014). Nausea was low in both groups and was not affected by music. The music group experienced less fatigue at day 1 (P = 0.042) and day 7 (P = 0.015). Cortisol levels decreased during surgery in the music group (428.5-348.0 nmol/l), while it increased in the non-music group (443.5-512.0 nmol/l); still, the difference between the two groups were only significant using general linear models as post-hoc analysis. Soft music did not affect C-reactive protein levels. Soft music did not reduce pain 3 h after laparoscopic cholecystectomy. Soft music may reduce later post-operative pain and fatigue by decreasing the surgical stress response. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  9. Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial

    NARCIS (Netherlands)

    Costa, D.W. da; Bouwense, S.A.; Schepers, N.J.; Besselink, M.G.; Santvoort, H.C. van; Brunschot, S. van; Bakker, O.J.; Bollen, T.L.; Dejong, C.H.; Goor, H. van; Boermeester, M.A.; Bruno, M.J.; Eijck, C.H. van; Timmer, R.; Weusten, B.L.; Consten, E.C.; Brink, M.A.; Spanier, B.W.; Bilgen, E.J.; Nieuwenhuijs, V.B.; Hofker, H.S.; Rosman, C.; Voorburg, A.M.; Bosscha, K.; Duijvendijk, P. van; Gerritsen, J.J.; Heisterkamp, J.; Hingh, I.H. de; Witteman, B.J.; Kruyt, P.M.; Scheepers, J.J.; Molenaar, I.Q.; Schaapherder, A.F.; Manusama, E.R.; Waaij, L.A. van der; Unen, J. van; Dijkgraaf, M.G.; Ramshorst, B. van; Gooszen, H.G.; Boerma, D.

    2015-01-01

    BACKGROUND: In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission

  10. Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO) : A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Da Costa, David W.; Bouwense, Stefan A.; Schepers, Nicolien J.; Besselink, Marc G.; van Santvoort, Hjalmar C.|info:eu-repo/dai/nl/304821721; Van Brunschot, Sandra; Bakker, Olaf J.|info:eu-repo/dai/nl/314099050; Bollen, Thomas L.; Dejong, Cornelis H.; Van Goor, Harry; Boermeester, Marja A.; Bruno, Marco J.; Van Eijck, Casper H.; Timmer, Robin; Weusten, Bas L.; Consten, Esther C.; Brink, Menno A.; Spanier, B. W Marcel; Bilgen, Ernst Jan Spillenaar; Nieuwenhuijs, Vincent B.; Hofker, H. Sijbrand; Rosman, Camiel; Voorburg, Annet M.; Bosscha, Koop; Van Duijvendijk, Peter; Gerritsen, Jos J.; Heisterkamp, Joos; De Hingh, Ignace H.; Witteman, Ben J.; Kruyt, Philip M.; Scheepers, Joris J.; Molenaar, I. Quintus|info:eu-repo/dai/nl/239093976; Schaapherder, Alexander F.; Manusama, Eric R.; Van Der Waaij, Laurens A.; Van Unen, Jacco; Dijkgraaf, Marcel G.; Van Ramshorst, Bert; Gooszen, Hein G.; Boerma, Djamila

    2015-01-01

    Background In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission

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

    Directory of Open Access Journals (Sweden)

    Leila Sadati

    2014-07-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    NARCIS (Netherlands)

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

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  15. 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

  16. Forgotten biliary stents: ignorance is not bliss.

    Science.gov (United States)

    Kumar, Saket; Chandra, Abhijit; Kulkarni, Rugved; Maurya, Ajeet Pratap; Gupta, Vishal

    2017-06-22

    Endoscopic biliary stenting is a common procedure in routine gastroenterology practice. Plastic stents are the most common type of stents used and are indicated mainly for short-term biliary drainage. Prolonged indwelling plastic stents can result in disastrous complications. We conducted a retrospective analysis of patients who presented with complications of forgotten biliary stents in a tertiary care hospital during January 2010 to October 2016. All patients were managed either by endoscopic or surgical means. Details of these patients were obtained from departmental patient database, endoscopy records, and surgical register. A total of 21 cases of retained biliary stents were managed in the study period and their outcome was analyzed. The median age was 47 years (range 17-70 years) and 17 (80.9%) patients were female. Primary indication of biliary stenting was stone disease in 76.2% (n = 16), while benign biliary stricture accounted for 19% of cases (n = 4). Mean duration at presentation to hospital after ERCP stenting was 3.53 years (range 1-14 years), with cholangitis being the most common presentation (66.67%). Definitive endoscopic treatment for forgotten stent and its associated complication was possible only in five patients (23.8%); in remaining 16 (76.2%) cases, surgical exploration was required. Despite life-threatening complications and major surgical interventions, no mortality was recorded. Instances of forgotten biliary stents presenting with serious complications are not uncommon in Indian setup. Patients either ignore advice for timely stent removal or are unaware of the presence of endoprosthesis or need for removal. Adequate patient counseling, information, and proper documentation are essential to avoid this condition.

  17. Laparoscopic cholecystectomy in acute cholecystitis: An analysis of ...

    African Journals Online (AJOL)

    reactions make dissection difficult and increase the risk of serious complications. However ... variables were expressed as means (standard deviation (SD)), while non-normally ..... more rapid return to normal activity for patients. With patience,.

  18. 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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  20. 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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  2. 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.

  3. 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.

  4. 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.

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Residual gallbladder stones after cholecystectomy: A literature review

    Science.gov (United States)

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

    2015-01-01

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

  9. Residual gallbladder stones after cholecystectomy: A literature review

    Directory of Open Access Journals (Sweden)

    Pradeep Chowbey

    2015-01-01

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

  10. On strategic ignorance of environmental harm and social norms

    DEFF Research Database (Denmark)

    Thunström, Linda; van’t Veld, Klaas; Shogren, Jason. F.

    2014-01-01

    Are people strategically ignorant of the negative externalities their activities cause the environment? Herein we examine if people avoid costless information on those externalities and use ignorance as an excuse to reduce pro-environmental behavior. We develop a theoretical framework in which...... on their harm to the environment, and that they use ignorance as an excuse to engage in less pro-environmental behavior. It also predicts that the cost of ignorance increases if people can learn about the social norm from the information. We test the model predictions empirically using an experiment combined...

  11. On strategic ignorance of environmental harm and social norms

    DEFF Research Database (Denmark)

    Thunström, Linda; van 't Veld, Klaas; Shogren, Jason

    and an option to buy offsets for the flight’s carbon footprint. More than half (53 percent) of the subjects choose to ignore information on the carbon footprint alone before deciding their offset purchase, but ignorance significantly decreases (to 29 percent) when the information additionally reveals the social...... norm, namely the share of air travelers who buy carbon offsets. We find evidence that some people use ignorance as an excuse to reduce pro-environmental behavior—ignorance significantly decreases the probability of buying carbon offsets....

  12. Laparoscopic cholecystectomy for cholelithiasis in children

    Directory of Open Access Journals (Sweden)

    Gowda Deepak

    2009-01-01

    Full Text Available Aim: To evaluate the role of laparoscopic cholecystectomy (LC in the management of cholelithiasis in children. Methods: A retrospective review of our experience with LC for cholelithiasis at our institution, between April 2006 and November 2008, was done. Data included patient demographics, clinical history, hematological investigations, imaging studies, operative technique, postoperative complications, postoperative recovery, and final histopathological diagnosis. Results: During the study period of 32 months, 18 children (8 males and 10 females with cholelithiasis were treated by LC. The mean age was 9.4 years (range 3-18. Seventeen children had symptoms of biliary tract disease and 1 child had incidentally detected cholelithiasis during an ultrasonography of abdomen for unrelated cause. Only 5 (27.8% children had definitive etiological risk factors for cholelithiasis and the remaining 13 (75.2% cases were idiopathic. Sixteen cases had pigmented gallstones and 2 had cholesterol gallstones. All the 18 patients underwent LC, 17 elective, and 1 emergency LC. The mean operative duration was 74.2 min (range 50-180. Postoperative complications occurred in 2 (11.1% patients. The average duration of hospital stay was 4.1 days (range 3-6. Conclusion: Laparoscopic chloecystectomy is a safe and efficacious treatment for pediatric cholelithiasis. The cause for increased incidence of pediatric gallstones and their natural history needs to be further evaluated.

  13. Percutaneous transhepatic gallbladder drainag sequential laparoscopic cholecystectomy in the treatment of acute cholecystitis in elderly patients with high risk%经皮经肝胆囊穿刺置管引流序贯手术治疗老年高危患者的临床研究

    Institute of Scientific and Technical Information of China (English)

    祁军安; 江奎; 王涛; 卢振华; 杨彦伟; 罗冬根; 郑又侨; 吴林; 马晓阳

    2016-01-01

    目的 探讨老年高危患者急性结石性胆囊炎行经皮经肝胆囊穿刺置管引流术(PTGD)的适应证,及其序贯腹腔镜胆囊切除术(LC)的临床优势、手术时机、临床意义.方法 分析440例老年高危患者急性结石性胆囊炎行PTGD的临床资料,其中395例择期序贯LC术,并与同期390例老年急诊行LC术患者对照分析;分析在PTGD术后2~4周、4~8周、8~12周三种不同时段序贯行LC术的临床资料.结果 440例患者PTGD术后1d,379例(86.1%)患者症状得到明显缓解,术后3d,体温、白细胞计数、C-反应蛋白、血清降钙素原均得到明显好转,术后7d,胆囊大小、胆囊壁厚度明显改善,差异有统计学意义.395例PTGD序贯LC组与同期390例急诊LC组对照,两组并发症发病率、中转开腹率、手术时间、手术出血量、术后腹腔引流总量及术后住院天数差异有统计学意义.395例PTGD术后2~4周、4~8周、8~12周三种不同时段序贯行LC术,三组随着时间段延长胆管感染次数增加,手术并发症、手术时间、中转开腹率、手术出血量、术后住院天数之间差异均无统计学意义.结论 对于老年高危急性结石性胆囊炎患者,通过先行PTGD,待炎症得到有效控制,经围手术期准备后,2~4周择期序贯行LC术,疗效显著.%Objective To study clinical advantages,operative opportunity and clinical significance in high-risk elderly patients with acute calculous cholecystitis underwent Percutaneous transhepatic gallbladder drainage (PTGD)sequential Laparoscopic cholecystectomy (LC).Methods Analysis of 440 cases of elderly and high risk patients with acute calculous cholecystitis underwent PTGD,including 395 patients underwent sequential LC clinical data,and compared with 390 cases of emergency LC in the same period.Comparative analysis in PTGD postoperative 2-4 weeks,4-8 weeks,8-12 weeks,three time sequential LC patient data.Results 440 cases of elderly patients with

  14. COMPARATIVE ANALYSIS OF TRAUMA REDUCTION TECHNIQUES IN LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Anton Koychev

    2017-02-01

    Full Text Available Nowadays, there is no operation in the field of abdominal surgery, which cannot be performed laparoscopically. Both surgeons and patients have at their disposal an increasing number of laparoscopic techniques to perform the surgical interventions. The prevalence of laparoscopic cholecystectomy is due to its undeniable advantages over the traditional open surgery, namely small invasiveness, reducing the frequency and severity of perioperative complications, the incomparably better cosmetic result, and the so much better medical and social, and medical and economic efficiency. Single-port laparoscopic techniques to perform laparoscopic cholecystectomy are acceptable alternative to the classical conventional multi-port techniques. The security of the laparoscopic cholecystectomy requires precise identification of anatomical structures and precise observing the diagnostic and treatment protocols, and criteria for selection of patients to be treated surgically by these methods.

  15. Laparoscopic cholecystectomy in a patient with situs inversus totalis

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  16. A focus on acute cholecystitis and acute cholangitis

    Directory of Open Access Journals (Sweden)

    Massimo Sartelli

    2012-01-01

    Full Text Available Biliary infections are very common intra-abdominal infections. Laparoscopic cholecystectomy for acute cholecystitis and endoscopic retrograde management of acute cholangitis play important roles in the treatment of biliary infections. Also antimicrobial therapy is nevertheless important in the overall management of biliary infections. A multidisciplinary team of physicians, including surgeons trained in laparoscopic techniques, interventional gastroenterologists, and interventional radiologists may improve outcomes of patients with biliary infections. This review focuses the clinical presentation, diagnosis, and state of the art management of acute cholecystitis and acute cholangitis.

  17. A focus on acute cholecystitis and acute cholangitis

    Institute of Scientific and Technical Information of China (English)

    Massimo Sartelli; Cristian Tranà

    2012-01-01

    Biliary infections are very common intra-abdominal infections. Laparoscopic cholecystectomy for acute cholecystitis and endoscopic retrograde management of acute cholangitis play important roles in the treatment of biliary infections. Also antimicrobial therapy is nevertheless important in the overall management of biliary infections. A multidisciplinary team of physicians, including surgeons trained in laparoscopic techniques, interventional gastroenterologists, and interventional radiologists may improve outcomes of patients with biliary infections. This review focuses the clinical presentation, diagnosis, and state of the art management of acute cholecystitis and acute cholangitis.

  18. On strategic ignorance of environmental harm and social norms

    DEFF Research Database (Denmark)

    Thunström, Linda; van’t Veld, Klaas; Shogren, Jason. F.

    2014-01-01

    decreases (to 29 percent) when the information additionally reveals the share of air travelers who buy carbon offsets. We find evidence that some people use ignorance as an excuse to reduce pro-environmental behavior—ignorance significantly decreases the probability of buying carbon offsets....

  19. Hearing or Ignoring Audience: the Dilemma of the Freshman Writer.

    Science.gov (United States)

    Wenner, Barbara

    Students work most productively when they feel free to move back and forth from ignoring audience to addressing it. Students should consider audience as they begin a writing task. Then they should get away from it all and simply write. If they find an audience inhibiting, they should feel free to ignore the idea of audience altogether or alter…

  20. Regional variations in cholecystectomy rates in Sweden: impact on complications of gallstone disease.

    Science.gov (United States)

    Noel, Rozh; Arnelo, Urban; Enochsson, Lars; Lundell, Lars; Nilsson, Magnus; Sandblom, Gabriel

    2016-01-01

    There are considerable variations in cholecystectomy rates between countries, but it remains unsettled whether high cholecystectomy rates prevent future gallstone complications by reducing the gallstone prevalence. The aims of this study were to investigate the regional differences in cholecystectomy rates and their relation to the incidence of gallstone complications. Nation-wide registry-based study of the total number of cholecystectomies in Sweden between 1998 and 2013. Data were obtained from the Swedish Inpatient Registry covering the entire population and subdivided for by the 21 different counties. Indications for the procedure were prospectively collected during the years 2006-2013 in the National Registry for Gallstone Surgery and ERCP. The detailed demography of the total number of patients undergoing cholecystectomy and its relation to the respective indications were analysed by linear regression. The annual rates of cholecystectomy in the Swedish counties ranged from 100 to 207 per 100,000 inhabitants, with a mean of 157 (95% CI 145-169). The majority of cholecystectomies were done in females based on the indication biliary colic, with a peak incidence in younger ages. Cholecystectomies performed due to gallstone complications, pancreatitis and cholecystitis, were mainly carried out in the older age groups. No significant relationship could be demonstrated between cholecystectomy rates in the different regions and the respective incidences of gallstone complications. There are wide regional variations in cholecystectomy rates in Sweden. The present study does not give support that frequent use of cholecystectomy in uncomplicated gallstone disease prevents future gallstone complications.

  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. Acute Paraplegia After General Anesthesia

    Directory of Open Access Journals (Sweden)

    Gholam Hossein Ghaedi

    2011-08-01

    Full Text Available Acute paraplegia is a rare but catastrophic complication of surgeries performed on aorta and corrective operations of vertebral column. Trauma to spinal cord after spinal anesthesia and ischemia of spinal cord also may lead to acute paraplegia. Acute paraplegia as a complication of general anesthesia in surgeries performed on sites other than aorta and vertebral column is very rare. Here we present a 56 year old woman with acute paraplegia due to spinal cord infarction after laparoscopic cholecystectomy under general anesthesia probably caused by atherosclerosis of feeding spinal arteries and ischemia of spinal cord after reduction of blood flow possibly due to hypotension during general anesthesia.

  4. [Use of percutaneous needles in the feasability of single-port laparoscopic cholecystectomy].

    Science.gov (United States)

    Dávila, Fausto; Tsin, Daniel; González, Gloria; Dávila, M Ruth; Lemus, José; Dávila, Ulises

    2014-04-01

    The usefulness of percutaneous needles (PN) to replace traditional assistance ports in mini-invasive techniques with a single port is analyzed and their feasibility for conducting a single port laparoscopic cholecystectomy (SPLC) is demonstrated. A retrospective, linear and descriptive study covering 2,431 patients with a diagnosis of acute and non-acute gallbladder disease has been conducted. The patients underwent a single port laparoscopic cholecystectomy using some type of PNs, replacing the assisting ports used in traditional laparoscopic cholecystechtomy (TLC). Based on the progressive use of PNs-reins (R), hooked needles (HN) and passing suture needles (PSN)-to carry out the SPLC technique, 3 groups have been established: A, B and C. The results were compared using a Student T test, odds ratio and CI and were analyzed by means of the SPSS software v. 13.0. The use of PNs showed an increased feasibility for the laparoscopic procedure, as they were included in the surgical technique. The R were useful when carrying out the SPLC in 78% of the cases and when the HK were added, the results increased to 88%. When using the 3 types (R, HN and PSN), the results increased by 96%. Statistical significance was obtained with these values: chi 2=67.13 and P<.001; odds ratio and 95% CI became significant when comparing the B/C, A/C, and A-B/C groups. The PNs, replacing the assisting ports in laparoscopy, make it possible to attain a feasibility of the process in 96% of the cases. This percentage was similar to what is achieved with the TLC, which places the one port laparoscopy surgery technique as an advantageous and economic alternative. This application of the PNs could be made extensive to other single-port techniques, with a multi-valve platform and natural orifice surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  5. Diarrhea after laparoscopic cholecystectomy: Associated factors and predictors

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    Tuan-Pin Yueh

    2014-10-01

    Conclusion: We advise patients who have undergone laparoscopic cholecystectomy to follow a low-fat diet for at least 1 week to reduce the possibility of diarrhea, especially when they are ≤45 years of age, of male sex, and had a high preoperative tendency for diarrhea.

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

    DEFF Research Database (Denmark)

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

    1999-01-01

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

  7. 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.

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

    NARCIS (Netherlands)

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

    1998-01-01

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

  9. Reconstruction of major bile duct injuries after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Holte, Kathrine; Bardram, Linda; Wettergren, André

    2010-01-01

    Bile duct injury (BDI) after cholecystectomy remains a serious complication with major implications for patient outcome. For most major BDIs, the recommended method of repair is a hepaticojejunostomy (HJ). We conducted a retrospective review aiming to examine the perioperative and the long...

  10. Risk Assessment in Cholelithiasis: Is Cholecystectomy Always to be Preferred?

    Science.gov (United States)

    Mertens, Marlies C.; Roukema, Jan A.; Scholtes, Vincent P. W.

    2010-01-01

    Background As many patients with gallstone disease do not benefit from cholecystectomy, preoperative recognition of such high-risk patients is important. The aim of the study is to identify predictors of persisting symptoms at 6 months after cholecystectomy for patients with different preoperative symptomatology. Method Participants in this prospective study were consecutive patients (n = 172), age 18–65 years, with symptomatic cholelithiasis, undergoing a laparoscopic cholecystectomy. Predictors were identified using uni- and multivariate regression analyses. Results At 6 months postcholecystectomy, patients with only preoperative biliary symptoms were most often free of symptoms (62.5%). Patients with only dyspeptic symptoms most often reported persistence of preexisting symptoms (63.2%). Preoperative non-specific symptoms predicted the report of postoperative biliary and/or dyspeptic symptoms (OR = 4.5–6.1). Persistence of preexisting pattern of symptoms was predicted by the use of psychotropic medication (OR = 5.3) and dyspeptic symptoms (OR = 4.5). Postoperative biliary symptoms were predicted by High Trait Anxiety (HTA) (OR = 10.6). Conclusion Surgeons should take account of individual risks of patients in the management of cholelithiasis. Instead of cholecystectomy, expectative management should be the first choice in patients with non-specific symptoms, with dyspeptic symptoms only, with HTA and in patients using psychotropic medication. PMID:20502977

  11. Laparoscopic cholecystectomy in situs inversus totalis: A review article

    Directory of Open Access Journals (Sweden)

    Sunder Goyal

    2016-09-01

    Conclusions: Without doubt, laparoscopic cholecystectomy in these patients is technically more demanding but still feasible and should be performed by trained and experienced laparoscopic surgeons. Difficulty is encountered in skeletonizing the structures in Calot's triangle, which usually requires extra time than in patients with a normally located gall bladder. [Arch Clin Exp Surg 2016; 5(3.000: 169-176

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  13. Assessment of Requirement of Routine Intraoperative Cholaniography at Cholecystectomy

    Directory of Open Access Journals (Sweden)

    M Shiryazdi

    2013-12-01

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

  14. The difficult gallbladder: technical tips for laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Rosenberg, J; Bisgaard, T

    2000-01-01

    in the 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...

  15. Hydro-dissection - A simple Solution in Difficult Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Lubna, H; Masoom, M R

    2015-07-01

    This Quasi-experimental study was done to assess the effectiveness of hydro-dissection in difficult laparoscopic cholecystectomies in Hamdard University Hospital, Karachi, Pakistan, from April 2012 to March 2014. All consecutive patients who presented with cholelithiasis and planned for laparoscopic cholecystectomy were enrolled in this study. Per-operatively the degree of difficulty of the operation was assessed by Cuschieri's scale after grading; Grade II, III and IV cholecystectomies were included in this study. Hydro dissection with saline jet through 5mm simple irrigation and suction probe was used, Operative findings and the total number of patients, in whom anatomy of calot's triangle was clearly displayed with hydro-dissection, was recorded. A total 55 patients were included in the study after assessing the degree of difficulty per operatively by Cuschieri Scale. Thirty one (31) patients were in Group II, 22 in Group III and 02 were included in group IV of Cuschieri scale in which hydro-dissection was used. This method cleared the obscure anatomy in all patients in Group II but in 3 patients of Group III, dense adhesions required sharp dissection to clear the operative field. Two patients, in whom conversion was required, were grouped in Cuschieri's scale IV. Methods of dissection in difficult cholecystectomies are of paramount importance to avoid iatrogenic injuries. Hydro-dissection using suction irrigation probe is a safe and effective technique to clear the difficult anatomy.

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

    Directory of Open Access Journals (Sweden)

    Ravi Vasupalli

    2016-09-01

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

  17. Cholecystectomy in Sweden 2000 – 2003: a nationwide study on procedures, patient characteristics, and mortality

    Directory of Open Access Journals (Sweden)

    Stenlund Hans

    2007-08-01

    Full Text Available Abstract Background Epidemiological data on characteristics of patients undergoing open or laparoscopic cholecystectomy are limited. In this register study we examined characteristics and mortality of patients who underwent cholecystectomy during hospital stay in Sweden 2000 – 2003. Methods Hospital discharge and death certificate data were linked for all patients undergoing cholecystectomy in Sweden from January 1st 2000 through December 31st 2003. Mortality risk was calculated as standardised mortality ratio (SMR i.e. observed over expected deaths considering age and gender of the background population. Results During the four years of the study 43072 patients underwent cholecystectomy for benign biliary disease, 31144 (72% using a laparoscopic technique and 11928 patients (28% an open procedure (including conversion from laparoscopy. Patients with open cholecystectomy were older than patients with laparoscopic cholecystectomy (59 vs 49 years, p Conclusion Laparoscopic cholecystectomy is performed on patients having a lower mortality risk than the general Swedish population. Patients with open cholecystectomy are more sick than patients with laparoscopic cholecystectomy, and they have a mortality risk within 90 days of admission for cholecystectomy, which is four times that of the general population. Further efforts to reduce surgical trauma in open biliary surgery are motivated.

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

    Science.gov (United States)

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

    2010-09-01

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

  19. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Mittalgodu Anantha Krishna Murthy Vivek

    2014-01-01

    Full Text Available Context: Laparoscopic cholecystectomy (LC is the gold standard cholecystectomy. LC is the most common difficult laparoscopic surgery performed by surgeons today. The factors leading to difficult laparoscopic cholecystectomy can be predicted. Aims: To develop a scoring method that predicts difficult laparoscopic cholecystectomy. Settings and Design: Bidirectional prospective study in a medical college setup. Materials and Methods: Following approval from the institutional ethical committee, cases from the three associated hospitals in a medical college setup, were collected using a detailed proforma stating the parameters of difficulty in laparoscopic cholecystectomy. Study period was between May 10 and June 12. Preoperative, sonographic and intraoperative criteria were considered. Statistical Analysis Used: Chi Square test and Receiver Operater Curve (ROC analysis. Results: Total 323 patients were included. On analysis, elderly patients, males, recurrent cholecystitis, obese patients, previous surgery, patients who needed preoperative Endoscopic retrograde cholangiopancreatography (ERCP, abnormal serum hepatic and pancreatic enzyme profiles, distended or contracted gall bladder, intra-peritoneal adhesions, structural anomalies or distortions and the presence of a cirrhotic liver on ultrasonography (USG were identified as predictors of difficult LC. A scoring system tested against the same sample proved to be effective. A ROC analysis was done with area under receiver operator curve of 0.956. A score above 9 was considered difficult with sensitivity of 85% and specificity of 97.8%. Conclusions: This study demonstrates that a scoring system predicting the difficulty in LC is feasible. There is scope for further refinement to make the same less cumbersome and easier to handle. Further studies are warranted in this direction.

  20. 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

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

    Directory of Open Access Journals (Sweden)

    Sangeeta Tiwari

    2013-01-01

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

  2. Color Doppler flow imaging in acute cholecystitis to predict technical difficulties during laparoscopic cholecystectomy%急性胆囊炎腹腔镜胆囊切除术前彩色多普勒超声对其难度的预测价值

    Institute of Scientific and Technical Information of China (English)

    王川予; 蒋文莉; 马娜

    2010-01-01

    Objective To evaluate the value of preoperative color Doppler flow imaging findings for predicting possible difficuulties encountered during laparoscopic cholecystectomy (LC).Methods Eighty-six Datients with acute cholecystitis underwent color Doppler flow imaging examination were divided into operation difficult group(67 cases)and operation easy group(19 cases)according to the diffculty score.The parameters were measured pre-operation including the volume of gallbladder,the thickness of the gallbladder wall,the condition of arterial flow in the gallbladder wall,the conditions of gallbladder cavity and gallbladder fossa and the intra-and extra-hepatic bile duet.The relationships among imaging results,operation difficulties and operation findings were investigated.Results Gallbladder volume,gallbladder wall thickness.the presence rates of plentiful arterial flow in the gallbladder wall,adhesion of gallbladder and stone incarceration In operation difficult group were significantly different from those in operation easy group [(52.6±14.6)mm~3 vs(32.6±10.4)mm~3,(9.7±4.1)mm vs(3.8±0.9)mm,89.5%(17/19)vs 17.9%(12/67),78.9%(15/19)vs 11.9%(8/67),10.5%(2,19)vs 0(0/67)](P<0.05 or<0.01).The accurate rate was 94.2%(81/86)in predicting.Conclusion Preoperative color Doppler flow imaging is helpful in predicting difficulties of LC.%目的 探讨术前彩色多普勒超声检查对急性胆囊炎腹腔镜胆囊切除术难度的预测价值.方法 86例急性胆囊炎腹腔镜胆囊切除术患者,根据术中实际难度评分分为困难组(67例)和容易组(19例),比较两组术前行彩色多普勒超声检查指标,包括胆囊容积、胆囊壁厚度及血流、胆囊腔、胆囊床和肝内外胆管情况,评价术前超声检测指标与手术难度之间的关系.结果 困难组与容易组超声检测胆囊容积分别为(52.6 4±14.6)mm~3和(32.6±10.4)mm~3,胆囊壁厚度分别为(9.7±4.1)mm和(3.8±0.9)mm,胆囊壁血流信号丰富的发生率分别为89

  3. DMPD: TLR ignores methylated RNA? [Dynamic Macrophage Pathway CSML Database

    Lifescience Database Archive (English)

    Full Text Available 16111629 TLR ignores methylated RNA? Ishii KJ, Akira S. Immunity. 2005 Aug;23(2):111-3. (.png) (.svg) (.html... SVG File (.svg) HTML File (.html) CSML File (.csml) Open .csml file with CIOPlay

  4. Empirical likelihood method for non-ignorable missing data problems.

    Science.gov (United States)

    Guan, Zhong; Qin, Jing

    2017-01-01

    Missing response problem is ubiquitous in survey sampling, medical, social science and epidemiology studies. It is well known that non-ignorable missing is the most difficult missing data problem where the missing of a response depends on its own value. In statistical literature, unlike the ignorable missing data problem, not many papers on non-ignorable missing data are available except for the full parametric model based approach. In this paper we study a semiparametric model for non-ignorable missing data in which the missing probability is known up to some parameters, but the underlying distributions are not specified. By employing Owen (1988)'s empirical likelihood method we can obtain the constrained maximum empirical likelihood estimators of the parameters in the missing probability and the mean response which are shown to be asymptotically normal. Moreover the likelihood ratio statistic can be used to test whether the missing of the responses is non-ignorable or completely at random. The theoretical results are confirmed by a simulation study. As an illustration, the analysis of a real AIDS trial data shows that the missing of CD4 counts around two years are non-ignorable and the sample mean based on observed data only is biased.

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  6. The ignoring paradox: cueing distractor features leads first to selection, then to inhibition of to-be-ignored items.

    Science.gov (United States)

    Moher, Jeff; Egeth, Howard E

    2012-11-01

    Observers find a target item more quickly when they have foreknowledge of target-defining attributes, such as identity, color, or location. However, it is less clear whether foreknowledge of nontarget attributes can also speed search. Munneke, Van der Stigchel, and Theeuwes Acta Psychologica 129:101-107, (2008) found that observers found the target more quickly when they were cued to ignore a region of space where a target would not appear. Using a similar paradigm, we explored the effects of cueing nontarget features on search. We found that when we cued observers to ignore nontarget features, search was slowed. The results from a probe-dot detection task revealed that this slowing occurred because, paradoxically, observers initially selected an item appearing in the to-be-ignored color. Finally, we found that cueing nontarget features sped search when placeholders matching the location of the to-be-ignored color preceded presentation of the search display by at least 800 ms; thus, it appears that some limited inhibition of to-be-ignored items occurs following selection. Taken together, these results suggest that observers are unable to explicitly avoid selection of items matching known nontarget features. Instead, when nontarget features are cued, observers select the to-be-ignored feature or the locations of objects matching that feature early in search, and only inhibit them after this selection process.

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

    Directory of Open Access Journals (Sweden)

    R Barani Selvan

    2012-01-01

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

  8. 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.

  9. 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

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

    DEFF Research Database (Denmark)

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

    2001-01-01

    was present 1 week after laparoscopy and 4 weeks after laparotomy. CONCLUSIONS: After laparotomy, total sleep time increased and there was a change in diurnal sleep distribution. These sleep alterations were less pronounced after laparoscopic cholecystectomy. Thus, sleep architecture was disturbed for ?4......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 days...... before until 4 weeks after surgery. RESULTS: Following laparoscopic surgery, total sleep time increased during the 1st week after the operation compared with preoperative values (p = 0.02), whereas sleep duration during weeks 2, 3, and 4 did not differ from the times reported preoperatively. Following...

  11. Rules, praise, and ignoring: elements of elementary classroom control.

    Science.gov (United States)

    Madsen, C H; Becker, W C; Thomas, D R

    1968-01-01

    An attempt was made to vary systematically the behavior of two elementary school teachers to determine the effects on classroom behavior of Rules, Ignoring Inappropriate Behaviors, and showing Approval for Appropriate Behavior. Behaviors of two children in one class and one child in the other class were recorded by observers, as were samples of the teachers' behavior. Following baseline recordings, Rules, Ignoring, and Approval conditions were introduced one at a time. In one class a reversal of conditions was carried out. The main conclusions were that: (a) Rules alone exerted little effect on classroom behavior, (b) Ignoring Inappropriate Behavior and showing Approval for Appropriate Behavior (in combination) were very effective in achieving better classroom behavior, and (c) showing Approval for Appropriate Behaviors is probably the key to effective classroom management.

  12. The veil of ignorance and health resource allocation.

    Science.gov (United States)

    Soto, Carlos

    2012-08-01

    Some authors view the veil of ignorance as a preferred method for allocating resources because it imposes impartiality by stripping deliberators of knowledge of their personal identity. Using some prominent examples of such reasoning in the health care sector, I will argue for the following claims. First, choice behind a veil of ignorance often fails to provide clear guidance regarding resource allocation. Second, regardless of whether definite results could be derived from the veil, these results do not in themselves have important moral standing. This is partly because the veil does not determine which features are morally relevant for a given distributive problem. Third, even when we have settled the question of what features to count, choice behind a veil of ignorance arguably fails to take persons seriously. Ultimately, we do not need the veil to solve distributive problems, and we have good reason to appeal to some other distributive model.

  13. Laryngeal mask airway protector™: Advanced uses for laparoscopic cholecystectomies

    Directory of Open Access Journals (Sweden)

    Leng Zoo Tan

    2017-01-01

    Full Text Available The laryngeal mask airway (LMA Protector™ is a second-generation perilaryngeal sealer type supraglottic airway device recently introduced into clinical practice. We describe our initial experiences with the use of the LMA Protector™ in three patients undergoing laparoscopic cholecystectomies. In all patients, we found the LMA Protector™ to have acceptable placements on the first attempt, adequate oropharyngeal leak pressures and ventilation adequacy.

  14. [Warming up with endotrainer prior to laparoscopic cholecystectomy].

    Science.gov (United States)

    Troncoso-Bacelis, Alicia; Soto-Amaro, Jaime; Ramírez-Velázquez, Carlos

    Laparoscopic cholecystectomy is a safe and effective treatment and remains the gold standard in patients with benign disease. However it presents difficulties such as: the limited movement range of the instruments, the loss of depth perception, haptic feedback and the fulcrum effect. Previous training can optimize surgical performance in patients to master basic skills. Assess the effectiveness of surgeons warming up with an endotrainer before performing laparoscopic cholecystectomy. Single-blind controlled clinical trial with 16 surgeons who performed 2 laparoscopic cholecystectomies, the first according to standard practice and the second with warm-up comprising 5 MISTELS system exercises. Patient and surgeon demographics were recorded, in addition to findings and complications during and after surgery for each procedured. We found a decrease in surgical time of 76.88 (±18.87) minutes in the group that did not warm up to prior to surgery compared with 72.81 (±35.5) minutes in the group with warm-up (p=0.0196). In addition, increased bleeding occurred in the procedures performed with warm-up 31.25 (±30.85) ml compared with the group that had no warm-up 23.94 (±15.9) (p=0.0146). Performing warm up on a MISTELS system endotrainer before performing laparoscopic cholecystectomy reduces the operating time of surgery for all surgeons. Surgery bleeding increases in operations performed by surgeons with less experience in laparoscopic surgery. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  15. Residual gallbladder stones after cholecystectomy: A literature review

    OpenAIRE

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

    2015-01-01

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

  16. 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.

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

    OpenAIRE

    Ahmet Serdar Karaca

    2013-01-01

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

  18. 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 ...

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  3. Consensus statement of the consortium for LESS cholecystectomy.

    Science.gov (United States)

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

    2012-10-01

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

  4. 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

  5. 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.

  6. 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.

  7. Intercostal neuroma pain after laparoscopic cholecystectomy: diagnosis and treatment.

    Science.gov (United States)

    Dellon, A Lee

    2014-03-01

    Chest wall or abdominal pain after laparoscopic cholecystectomy is perceived as residual gastrointestinal problems. Some patients will have tenderness at the laparoscopic portal site(s), representing injury to one or more intercostal nerves. The author describes this patient population for the first time, outlining a diagnostic and therapeutic algorithm. Inclusion criteria included (1) right chest wall or abdominal pain persisting more than 1 year after laparoscopic cholecystectomy, (2) relief of that pain with intercostal nerve block, (3) resection of intercostal nerves identified by nerve block, and (4) at least a 6-month postoperative follow-up by telephone. Review from 2009 through 2011 identified one man and seven women meeting these criteria. Mean age was 44 years (range, 18 to 74 years). Mean interval between cholecystectomy and intercostal neurectomy was 44.3 months (range, 13 to 72 months). Two intercostal nerves were resected in two patients, three in four patients, four in one patient, and five in one patient, most commonly intercostal nerves T6, T7, and T8. Proximal nerves were implanted into the serratus or latissimus dorsi. At a mean period of 18.3 months after surgery, the preoperative mean visual analogue score of 8.9 (range, 7 to 10) decreased to 3.6 (range, 0 to 6) (p intercostal nerve injury. Diagnostic blocks are essential to confirm diagnosis. Nerve resection and implantation of the proximal ends into muscle can give good to excellent results in most patients. Therapeutic, IV.

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

    Science.gov (United States)

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

    2017-01-01

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

  9. Laparoscopic cholecystectomy: an audit of our training programme.

    Science.gov (United States)

    Lim, Swee Ho; Salleh, Ibrahim; Poh, Beow Kiong; Tay, Khoon Hean

    2005-04-01

    Laparoscopic cholecystectomy is a commonly performed procedure in general surgical practice but it also has an inherently steep learning curve. The training of surgeons in this procedure presents a challenge to teaching hospitals, which essentially have to strike a balance between effective training and safety of the patient. The present study aims first to assess the safety of the structured training programme for this procedure at the Department of Surgery, Changi General Hospital, Singapore. Secondly, it seeks to audit the conversion and bile duct injury rates among the laparoscopic cholecystectomies performed by the department, and the factors which influence these. Notes of all patients who underwent laparoscopic cholecystectomy in the department over an 18-month period were reviewed retrospectively and the relevant data prospectively collected. Demographics, as well as details of cases of conversion to open operation and of bile duct injury were identified and the reasons for each recorded. A total of 443 patients underwent laparoscopic cholecystectomy in the 18-month period. The most common indication for surgery was biliary colic/dyspepsia (61.4%), followed by cholecystitis, cholangitis, pancreatitis and common bile duct stone. The overall conversion rate was 11.5%. Three hundred and fifty-five patients were operated on by consultant surgeons, while 88 were by registrars who had been through the structured training programme. There was no statistically significant difference found in the conversion rates between these two groups (P = 0.284). Twenty-two of the 268 female (8.2%) patients had conversion to open operation, while 29 of the 175 male patients (16.6%) underwent conversion (P = 0.007). Amongst cases of cholecystitis and cholangitis, the conversion rate for patients operated on within 7 days of onset of symptoms was 35%, while those operated on 8 or more days later had a conversion rate of 29.7% (P = 0.639). There was a solitary case of bile duct

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

    Directory of Open Access Journals (Sweden)

    Nik Kholgh A

    2000-09-01

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

  11. Variational symmetries as the existence of ignorable coordinates

    CERN Document Server

    del Castillo, G F Torres

    2016-01-01

    It is shown that given a Lagrangian for a system with a finite number of degrees of freedom, the existence of a variational symmetry is equivalent to the existence of coordinates in the extended configuration space such that one of the coordinates is ignorable.

  12. [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.

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

    Directory of Open Access Journals (Sweden)

    Hari Gopal

    2013-10-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  16. Abdominal Wall Sinus: A Late Complication of Gallstone Spillage During Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Michael D. Graham

    1997-01-01

    Full Text Available Long term complications of laparoscopic cholecystectomy are uncommon. However, as experience with this procedure accumulates, sporadic reports of non-biliary complication have been published. We report a case of abdominal wall sinus formation secondary to gallbladder perforation and stone spillage occurring during laparoscopic cholecystectomy.

  17. 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...

  18. 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

  19. 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.

  20. Diagnostic Limitations of 13C-Mixed Triglyceride Breath Test in Patients after Cholecystectomy

    Directory of Open Access Journals (Sweden)

    V.I. Rusyn

    2014-09-01

    Full Text Available The results of a comprehensive examination of 136 patients after cholecystectomy are provided. High efficiency and informativeness of the 13C-mixed triglyceride breath test for determining exocrine pancreatic insufficiency at its early stages was noted in patients after cholecystectomy.

  1. 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.

    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

  2. Acute calculous cholecystitis

    OpenAIRE

    Angarita, Fernando A.; University Health Network; Acuña, Sergio A.; Mount Sinai Hospital; Jimenez, Carolina; University of Toronto; Garay, Javier; Pontificia Universidad Javeriana; Gömez, David; University of Toronto; Domínguez, Luis Carlos; Pontificia Universidad Javeriana

    2010-01-01

    Acute calculous cholecystitis is the most important cause of cholecystectomies worldwide. We review the physiopathology of the inflammatory process in this organ secondary to biliary tract obstruction, as well as its clinical manifestations, workup, and the treatment it requires. La colecistitis calculosa aguda es la causa más importante de colecistectomías en el mundo. En esta revisión de tema se resume la fisiopatología del proceso inflamatorio de la vesículabiliar secundaria a la obstru...

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

    Directory of Open Access Journals (Sweden)

    Samba Binagi

    2015-01-01

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

  4. Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9

    Directory of Open Access Journals (Sweden)

    Shuji Akimoto

    2016-08-01

    Full Text Available Serum carbohydrate antigen 19-9 (CA 19-9, a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET-computed tomography (CT findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The C-reactive protein (CRP level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3 without tumor shadows in the liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy.

  5. Population-based study of the need for cholecystectomy after obesity surgery.

    Science.gov (United States)

    Plecka Östlund, M; Wenger, U; Mattsson, F; Ebrahim, F; Botha, A; Lagergren, J

    2012-06-01

    Weight loss following obesity surgery is associated with gallstone formation, but there is limited evidence on whether prophylactic cholecystectomy is indicated during obesity surgery. The aim of this study was to clarify the need for cholecystectomy following obesity surgery. A Swedish nationwide, population-based cohort study was conducted during the 22-year interval 1987-2008. Need for later cholecystectomy for gallstone disease was assessed in patients who had undergone obesity surgery in comparison with the general population of corresponding age, sex and calendar year. This need was also compared with the need for cholecystectomy in cohorts of patients who had undergone antireflux surgery and appendicectomy. Standardized incidence ratios (SIRs) with 95 per cent confidence intervals (c.i.) were calculated to estimate the relative risk. In the obesity surgery cohort of 13 443 patients, the observed number of cholecystectomies (1149, 8·5 per cent) exceeded the expected number by over fivefold (SIR 5·5, 95 per cent c.i. 5·1 to 5·8). The observed need for imperative cholecystectomy (for cholecystitis, cholangitis, pancreatitis, or jaundice; 427, 3·2 per cent) was also greater than expected (SIR 5·2, 4·7 to 5·7). The SIR peaked 7-24 months after obesity surgery and decreased with longer follow-up. The SIRs for cholecystectomy after antireflux surgery and appendicectomy were 2·4 (2·2 to 2·6) and 1·7 (1·6 to 1·7) respectively. An increased need for cholecystectomy after obesity surgery was confirmed, but was probably partly due to an increased detection of gallbladder disease only because of the surgery; the individual's risk of imperative cholecystectomy was low. Therefore, prophylactic cholecystectomy might not be recommended during obesity surgery. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  6. Word-identification priming for ignored and attended words

    Science.gov (United States)

    Stone, M.; Ladd, S. L.; Vaidya, C. J.; Gabrieli, J. D.

    1998-01-01

    Three experiments examined contributions of study phase awareness of word identity to subsequent word-identification priming by manipulating visual attention to words at study. In Experiment 1, word-identification priming was reduced for ignored relative to attended words, even though ignored words were identified sufficiently to produce negative priming in the study phase. Word-identification priming was also reduced after color naming relative to emotional valence rating (Experiment 2) or word reading (Experiment 3), even though an effect of emotional valence upon color naming (Experiment 2) indicated that words were identified at study. Thus, word-identification priming was reduced even when word identification occurred at study. Word-identification priming may depend on awareness of word identity at the time of study.

  7. Mismatch negativity during attend and ignore conditions in Alzheimer's disease.

    Science.gov (United States)

    Kazmerski, V A; Friedman, D; Ritter, W

    1997-09-01

    Mismatch negativities (MMNs) of the event-related potential to deviant tones and environmental sounds were recorded during active and ignore oddball sequences in young and elderly controls and patients with probable Alzheimer's disease (PAD). MMNs were smaller in the PAD waveforms compared to those of the controls, suggesting a degraded sensory memory trace in these subjects; however, under ignore conditions, environmental sounds elicited robust MMNs in the PAD group along with N2b and novelty P3 components in similar fashion to controls. As N2b and P3 are usually elicited by attended stimuli, these data suggest that in the PAD subjects, the highly deviant events involuntarily captured attention, perhaps reflecting the activation of an attentional switching mechanism. Because this passive switching is thought to reflect activation of a mechanism located in the frontal lobes, the data suggest that this putative frontal lobe mechanism is relatively intact in the early stages of the disease.

  8. Word-identification priming for ignored and attended words

    Science.gov (United States)

    Stone, M.; Ladd, S. L.; Vaidya, C. J.; Gabrieli, J. D.

    1998-01-01

    Three experiments examined contributions of study phase awareness of word identity to subsequent word-identification priming by manipulating visual attention to words at study. In Experiment 1, word-identification priming was reduced for ignored relative to attended words, even though ignored words were identified sufficiently to produce negative priming in the study phase. Word-identification priming was also reduced after color naming relative to emotional valence rating (Experiment 2) or word reading (Experiment 3), even though an effect of emotional valence upon color naming (Experiment 2) indicated that words were identified at study. Thus, word-identification priming was reduced even when word identification occurred at study. Word-identification priming may depend on awareness of word identity at the time of study.

  9. On uncertainty in information and ignorance in knowledge

    Science.gov (United States)

    Ayyub, Bilal M.

    2010-05-01

    This paper provides an overview of working definitions of knowledge, ignorance, information and uncertainty and summarises formalised philosophical and mathematical framework for their analyses. It provides a comparative examination of the generalised information theory and the generalised theory of uncertainty. It summarises foundational bases for assessing the reliability of knowledge constructed as a collective set of justified true beliefs. It discusses system complexity for ancestor simulation potentials. It offers value-driven communication means of knowledge and contrarian knowledge using memes and memetics.

  10. Information Pluralism and Some Informative Modes of Ignorance

    Directory of Open Access Journals (Sweden)

    Erkki Patokorpi

    2011-01-01

    Full Text Available In this paper information concepts will be roughly divided into two categories: The cybernetic and the semiotic-pragmatic. They are further divided into three and four subcategories, respectively. The cybernetic conception of information, which comprises both the mathematical-statistic and the logical-semantic approaches, misses some aspects of information and knowing, that are important in economics and technology studies, among others. The semiotic-pragmatic approach presumes the existence of several modes of being of information, as well as connects certainty and ambiguity to information in a different way from how the cybernetic approach does. These two general approaches to information and knowing are strikingly different, especially in their analysis of ignorance or incomplete knowledge. None of the cybernetic conceptions, and only some conceptions within the semiotic-pragmatic approach, can vindicate the elusive intuition of the potential positive role of ignorance. This comparative, philosophical discussion of the modes of ignorance may be taken as a challenge for cybernetics and computational philosophy to make better sense of incomplete knowledge.

  11. Could ICG-aided robotic cholecystectomy reduce the rate of open conversion reported with laparoscopic approach? A head to head comparison of the largest single institution studies.

    Science.gov (United States)

    Gangemi, A; Danilkowicz, R; Elli, F E; Bianco, F; Masrur, M; Giulianotti, P C

    2017-03-01

    Comparative studies between robotic and laparoscopic cholecystectomy (LC) focus heavily on economic considerations under the assumption of comparable clinical outcomes. Advancement of the robotic technique and the further widespread use of this approach suggest a need for newer comparison studies. 676 ICG-aided robotic cholecystectomies (ICG-aided RC) performed at the University of Illinois at Chicago (UIC) Division of General, Minimally Invasive and Robotic Surgery were compiled retrospectively. Additionally, 289 LC were similarly obtained. Data were compared to the largest single institution LC data sets from within the US and abroad. Statistically significant variations were found between UIC-RC and UIC-LC in minor biliary injuries (p = 0.049), overall open conversion (p ≤ 0.001), open conversion in the acute setting (p = 0.002), and mean blood loss (p advantages associated with the robotic platform may significantly decrease the rate of open conversion in both the acute and non-acute setting. The sample size discrepancy and the non-randomized nature of our study do not allow for drawing definitive conclusions.

  12. 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.

  13. 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.

  14. 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

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

    Science.gov (United States)

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

    2008-01-01

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

  16. Syndrome of inappropriate antidiuretic hormone secretion related to Guillain-Barré syndrome after laparoscopic cholecystectomy.

    Science.gov (United States)

    Çakırgöz, Mensure Yılmaz; Duran, Esra; Topuz, Cem; Kara, Deniz; Turgut, Namigar; Türkmen, Ülkü Aygen; Turanç, Bülent; Dolap, Mustafa Önder; Hancı, Volkan

    2014-01-01

    Guillain-Barré Syndrome is one of the most common causes of acute polyneuropathy in adults. Recently, the occurrence of Guillain-Barré Syndrome after major and minor surgical operations has been increasingly debated. In Guillain-Barré syndrome, syndrome of inappropriate antidiuretic hormone secretion and dysautonomy are generally observed after maximal motor deficit. A 44-year-old male patient underwent a laparoscopic cholecystectomy for acute cholecystitis. After the development of a severe headache, nausea, diplopia, and attacks of hypertension in the early postoperative period, a computer tomography of the brain was normal. Laboratory tests revealed hyponatremia linked to syndrome of inappropriate antidiuretic hormone secretion, the patient's fluids were restricted, and furosemide and 3% NaCl treatment was initiated. On the second day postoperative, the patient developed numbness moving upward from the hands and feet, loss of strength, difficulty swallowing and respiratory distress. Guillain-Barré syndrome was suspected, and the patient was moved to intensive care. Cerebrospinal fluid examination showed 320 mg/dL protein, and acute motor-sensorial axonal neuropathy was identified by electromyelography. Guillain-Barré syndrome was diagnosed, and intravenous immune globulin treatment (0.4 g/kg/day, 5 days) was initiated. After 10 days in the intensive care unit, at which the respiratory, hemodynamic, neurologic and laboratory results returned to normal, the patient was transferred to the neurology service. Our case report indicates that although syndrome of inappropriate antidiuretic hormone secretion and autonomic dysfunction are rarely the initial characteristics of Guillain-Barré syndrome, the possibility of postoperative syndrome of inappropriate antidiuretic hormone secretion should be kept in mind. The presence of secondary hyponatremia in this type of clinical presentation may delay diagnosis. Copyright © 2013 Sociedade Brasileira de Anestesiologia

  17. Syndrome of inappropriate antidiuretic hormone secretion related to Guillain-Barré syndrome after laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Mensure Yilmaz Çakirgöz

    2014-06-01

    Full Text Available Background and objectives: Guillain-Barré Syndrome is one of the most common causes of acute polyneuropathy in adults. Recently, the occurrence of Guillain-Barré Syndrome after major and minor surgical operations has been increasingly debated. In Guillain-Barré syndrome, syndrome of inappropriate antidiuretic hormone secretion and dysautonomy are generally observed after maximal motor deficit. Case report: A 44-year-old male patient underwent a laparoscopic cholecystectomy for acute cholecystitis. After the development of a severe headache, nausea, diplopia, and attacks of hypertension in the early postoperative period, a computer tomography of the brain was normal. Laboratory tests revealed hyponatremia linked to syndrome of inappropriate antidiuretic hormone secretion, the patient's fluids were restricted, and furosemide and 3% NaCl treatment was initiated. On the second day postoperative, the patient developed numbness moving upward from the hands and feet, loss of strength, difficulty swallowing and respiratory distress. Guillain-Barré syndrome was suspected, and the patient was moved to intensive care. Cerebrospinal fluid examination showed 320 mg/dL protein, and acute motor-sensorial axonal neuropathy was identified by electromyelography. Guillain-Barré syndrome was diagnosed, and intravenous immune globulin treatment (0.4 g/kg/day, 5 days was initiated. After 10 days in the intensive care unit, at which the respiratory, hemodynamic, neurologic and laboratory results returned to normal, the patient was transferred to the neurology service. Conclusions: Our case report indicates that although syndrome of inappropriate antidiuretic hormone secretion and autonomic dysfunction are rarely the initial characteristics of Guillain-Barré syndrome, the possibility of postoperative syndrome of inappropriate antidiuretic hormone secretion should be kept in mind. The presence of secondary hyponatremia in this type of clinical presentation may

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

    Directory of Open Access Journals (Sweden)

    Abu Lais Mustaque

    2016-04-01

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

  19. [Natural history of cholelithiasis and incidence of cholecystectomy in an urban and a Mapuche rural area].

    Science.gov (United States)

    Pérez-Ayuso, Rosa María; Hernández, Verónica; González, Berta; Carvacho, Claudia; Navarrete, Carlos; Alvarez, Manuel; González, Robinson; Marshall, Guillermo; Miquel, Juan Francisco; Nervi, Flavio

    2002-07-01

    Cholelithiasis is the second cause of hospital admissions in Chile. To study the prevalence of symptomatic gallstone disease and opportunity of cholecystectomy in La Florida, Santiago and among Mapuche Indians in Huapi Island. In the period 2000-2001, we contacted to 71% (1127 subjects) and to 61% (145 subjects) patients of La Florida and Huapi Island, respectively, that had previously participated in an epidemiological study on cholelithiasis in 1993. We defined symptomatic gallstone patients as those with a history of biliary colic. Each patient was subjected to gallbladder ultrasound. In 1993, 30-35% of gallstone patients were symptomatic (approximately 70% women). During the lapse 1993-2001, only 50% of subjects from La Florida and 25% of patients from Huapi Island were cholecystectomized (p Mapuche Indians from Huapi, cholecystectomy was indicated in 2001. After five months of the indication, only one of these subjects had been operated. Laparoscopic cholecystectomy represented 40% of all cholecystectomies performed in the National Health Service Hospitals. This study demonstrates an unacceptable high prevalence of symptomatic gallstone patients remaining non-operated in both the urban and rural communities. This reciprocally correlates with the high frequency of emergency cholecystectomies and the high incidence of gallbladder cancer among Chileans. This study contrasts negatively with the situation of Scotland, where 73.5% of cholecystectomies were laparoscopic in 1998-1999. To reach Scotland standards, the Chilean Public Health System should increase the number of cholecystectomies from 27,000 in 2001 to 57,510

  20. Cancer risk in patients with cholelithiasis and after cholecystectomy: a nationwide cohort study.

    Science.gov (United States)

    Chen, Yen-Kung; Yeh, Jiann-Horng; Lin, Cheng-Li; Peng, Chiao-Ling; Sung, Fung-Chang; Hwang, Ing-Ming; Kao, Chia-Hung

    2014-05-01

    This study examined the association of cholelithiasis post-cholecystectomy with subsequent cancers and evaluated the risk of cancer in patients with both cholelithiasis and cholecystectomy. The Taiwanese National Health Insurance Research Database was used to identify 15545 newly diagnosed cholelithiasis patients from 2000 to 2010, and 62180 frequency-matched non-cholelithiasis patients. A total of 5850 (37.6 %) with cholelithiasis patients received a cholecystectomy. The risk of developing cancer after cholecystectomy was measured using the Cox proportional-hazards model. The incidence of developing cancer in the cholelithiasis cohort was 1.52-fold higher than that in the comparison cohort (p cholelithiasis, respectively. After a cholecystectomy, the HR for developing stomach and colorectal cancer was 1.81-fold and 1.56-fold, respectively. The incidence rate ratio was higher for the first 5 years and over 5 years (5.05 and 4.46, respectively) (95 % confidence interval 4.73-5.39 and 4.11-4.84, respectively) in proximal colon and stomach cancer patients with cholecystectomies. Cholelithiasis patients have a higher risk of gastrointestinal cancer, particularly of gallbladder and extrahepatic bile duct cancer. Post-cholecystectomy patients have a risk of colorectal and stomach cancer within the first 5 years and persisting after 5 years, respectively. This paper proposes strategies for preventing gastrointestinal cancer.

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    Krishn Kant Rawal

    2017-01-01

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

  3. Role of laryngeal mask airway in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  4. 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.

  5. Early visceral pain predicts chronic pain after laparoscopic cholecystectomy.

    Science.gov (United States)

    Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus; Licht, Peter B; Toft, Palle

    2014-11-01

    Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1 week postoperatively, and 3, 6, and 12 months postoperatively for pain, psychological factors, and signs of hypersensitivity. Overall pain, incisional pain (somatic pain component), deep abdominal pain (visceral pain component), and shoulder pain (referred pain component) were registered on a 100-mm visual analogue scale during the first postoperative week. Nine patients developed chronic unexplained pain 12 months postoperatively. In a multivariate analysis model, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained chronic pain 12 months postoperatively. There were no consistent signs of hypersensitivity in the referred pain area either pre- or postoperatively. There were no significant associations to any other variables examined. The risk of chronic pain after laparoscopic cholecystectomy is relatively low, but significantly related to the visceral pain response during the first postoperative week. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  7. 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

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

    Science.gov (United States)

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

    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 disease-free 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

  9. Determining health care rights from behind a veil of ignorance.

    Science.gov (United States)

    Korobkin, R

    1998-01-01

    Should our society establish positive rights to health care that each citizen could claim, as many health policy analysts believe? Or should it provide only background rules of contract and property law and leave the provision of health care to the free market, as Richard Epstein advocates in Mortal Peril? In this article, Professor Korobkin argues that this question should be addressed from the Rawlsian "veil of ignorance" perspective. That is, the question should be answered by asking what kind of society would individuals agree to form if they had no knowledge of their individual skills or endowments; if they did not know whether they were rich or poor, healthy or sick, weak or strong. Professor Korobkin contends that individuals behind such a veil of ignorance would balance their inherent risk aversion (which favors a safety net of "rights") against the inefficient incentives created by rights regimes that would reduce net social wealth (which favors a free market). Whether they would choose to establish rights to health care or not is ultimately an empirical question that turns on how inefficient any particular right would be. The question thus requires a case-by-case analysis of proposed rights. The article then considers the policy issues of (1) community rating of private health insurance and (2) the mandated provision of emergency medical care. It concludes that in these cases the inefficient incentives created by establishing rights are probably smaller and/or controllable enough to lead individuals behind the veil of ignorance to favor a regime of positive rights.

  10. Magnetic Fields are not ignorable in the dynamics of disks

    CERN Document Server

    Battaner, E; Guijarro, A

    2000-01-01

    Magnetic fields are considered to be dominant when $\\epsilon_{B}\\geq\\epsilon_{K}$, being $\\epsilon_{B}=B^{2}/8\\pi$ the magnetic energy density and $\\epsilon_{K}=1/2 \\rho\\theta^{2}$ the rotation energy density, for a conventional moderate B= 1 $\\mu$G. They are considered to be negligible when $\\epsilon_{B}<\\epsilon_{K}$ for $B\\sim 10 \\mu$G. With no assumption and no theoretical calculation, we show that magnetic fields cannot be ignored in the outer parts of a galaxy like the Milky Way and in the whole disk of a dwarf galaxy.

  11. The ACA from behind the "Veil of Ignorance".

    Science.gov (United States)

    Dentzer, Susan

    2017-01-01

    John Rawls posited that we could determine the nature of justice if we imagined ourselves observing conditions in society from behind a hypothetical "veil of ignorance." Not knowing how or where we would end up-rich, poor, empowered, disabled-we would choose governing principles that did not leave one disadvantaged because of his or her circumstances. Rawls's concepts are implicitly embedded in the Affordable Care Act, which guarantees that vastly more Americans can obtain health insurance. The law effectively closed down the de facto lottery that awarded coverage to most but left out millions of others. © 2017 The Hastings Center.

  12. Preferences for equity in health behind a veil of ignorance.

    Science.gov (United States)

    Andersson, F; Lyttkens, C H

    1999-08-01

    Individual attitudes to distributions of life years between two groups in a society are explored by means of an experiment. Subjects are asked to place themselves behind a veil of ignorance which is specified in terms of risk (known probabilities) for some subjects and in terms of uncertainty (unknown probabilities) for some subjects. The latter is argued to be the appropriate interpretation of Rawls' notion. It is found that subjects exhibit convex preferences over life years for the two groups, and that preferences do not differ between the risk and the uncertainty specifications.

  13. The retroverted uterus: ignored to date but core to prolapse.

    Science.gov (United States)

    Haylen, Bernard T

    2006-11-01

    The retroverted uterus has been largely ignored in urogynaecological research to date. The prevalence of the retroverted uterus is 79% more common in the urogynaecological patient population (34%) than in the general gynaecological population (19%). Its diagnosis requires the use of (a) transvaginal ultrasound with (b) an empty bladder. Recent data demonstrate that the prevalence of grade 2-4 uterine prolapse for a retroverted uterus is 4.5 times that for an anteverted uterus. Alternatively, 69% grade 2-4 uterine prolapse involves the retroverted uterus. The retroverted uterus, when diagnosed by transvaginal ultrasound (bladder empty), is far more common in urogynecology patients due to their higher incidence of prolapse.

  14. Ignorància i saber en Nicolau de Cusa

    Directory of Open Access Journals (Sweden)

    Jesús Mansilla Navarro

    2004-01-01

    Full Text Available Después de un acercamiento al pensamiento de Nicolás de Cusa, este artículo profundiza en su obra Idiota de sapientia (1450. A partir de su estudio, el autor plantea la paradoja que se establece en torno a la noción de verdad ya que, de acuerdo con la tradición socrática, la ignorancia a la que se refiere Nicolás de Cusa no consiste en la obscuridad del no-saber sino en una ignorancia sapiencial que constituye un punto de partida para el estudio de cualquier realidad aceptando la humildad como actitud intelectual. ____________________________________________________________________________________________________________________________________________________________ Après une approche de la pensée de Nicolas de Cusa, cet article approfondit l’étude de son oeuvre Idiota de sapientia (1450. À partir de son étude, l’auteur propose le paradoxe qui est posé autour de la notion de vérité. En effet, conformément à la tradition socratique, l’ignorance à laquelle se réfère Nicolas de Cusa ne consiste pas en l’obscurité du nonsavoir sinon en une ignorance sage, qui constitue un point de départ pour l’étude de n’importe quelle réalité en acceptant l’humilité comme attitude intellectuelle.Following a review of the thinking of Nicholas of Cusa, this article undertakes a detailed study of his work, Idiota de Sapientia (1450. From this study, the author discusses the paradox that has grown up around the notion of truth since, in accordance with the Socratic tradition, the ignorance to which Nicholas of Cusa refers does not consist of the darkness of not knowing but rather of a learned ignorance that constitutes a starting point for the study of any reality accepting humility as an intellectual attitude.Después de un acercamiento al pensamiento de Nicolás de Cusa, este artículo profundiza en su obra Idiota de sapientia (1450. A partir de su estudio, el autor plantea la paradoja que se establece en torno a la noci

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

  16. The Marley hypothesis: denial of racism reflects ignorance of history.

    Science.gov (United States)

    Nelson, Jessica C; Adams, Glenn; Salter, Phia S

    2013-02-01

    This study used a signal detection paradigm to explore the Marley hypothesis--that group differences in perception of racism reflect dominant-group denial of and ignorance about the extent of past racism. White American students from a midwestern university and Black American students from two historically Black universities completed surveys about their historical knowledge and perception of racism. Relative to Black participants, White participants perceived less racism in both isolated incidents and systemic manifestations of racism. They also performed worse on a measure of historical knowledge (i.e., they did not discriminate historical fact from fiction), and this group difference in historical knowledge mediated the differences in perception of racism. Racial identity relevance moderated group differences in perception of systemic manifestations of racism (but not isolated incidents), such that group differences were stronger among participants who scored higher on a measure of racial identity relevance. The results help illuminate the importance of epistemologies of ignorance: cultural-psychological tools that afford denial of and inaction about injustice.

  17. The end of ignorance multiplying our human potential

    CERN Document Server

    Mighton, John

    2008-01-01

    A revolutionary call for a new understanding of how people learn. The End of Ignorance conceives of a world in which no child is left behind – a world based on the assumption that each child has the potential to be successful in every subject. John Mighton argues that by recognizing the barriers that we have experienced in our own educational development, by identifying the moment that we became disenchanted with a certain subject and forever closed ourselves off to it, we will be able to eliminate these same barriers from standing in the way of our children. A passionate examination of our present education system, The End of Ignorance shows how we all can work together to reinvent the way that we are taught. John Mighton, the author of The Myth of Ability, is the founder of JUMP Math, a system of learning based on the fostering of emergent intelligence. The program has proved so successful an entire class of Grade 3 students, including so-called slow learners, scored over 90% on a Grade 6 math test. A ...

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

    Directory of Open Access Journals (Sweden)

    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. [Apropos of a case of gas gangrene of the abdominal wall after cholecystectomy].

    Science.gov (United States)

    Mohammadine, E; Benamr, S; Abbassi, A; Serhane, K; Essadel, A; Lahlou, M K; Taghy, A; Chad, B; Zizi, A; Belmahi, A

    1996-01-01

    The authors report a new case of gas gangrene following cholecystectomy with a fatal outcome. Mode of infection and principles of diagnosis and therapy are discussed together with a review of the literature.

  20. Value of EGD in patients referred for cholecystectomy: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Lamberts, M.P.; Kievit, W.; Ozdemir, C.; Westert, G.P.; Laarhoven, C.J.H.M. van; Drenth, J.P.H.

    2015-01-01

    BACKGROUND: As many as 33% of patients with symptomatic cholelithiasis report persisting abdominal pain after cholecystectomy, suggesting alternative causes of these symptoms. EGD may serve as a tool to identify additional symptomatic abdominal disorders beforehand to avoid unnecessary gallbladder s

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Niranjan Kumar Verma

    2016-08-01

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

  4. 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.

  5. 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....

  6. Cholelithiasis, cholecystectomy and risk of hepatocellular carcinoma: a meta-analysis.

    Science.gov (United States)

    Guo, Lingyun; Mao, Jie; Li, Yumin; Jiao, Zuoyi; Guo, Jiwu; Zhang, Junqiang; Zhao, Jun

    2014-01-01

    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.

  7. 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...

  8. Gallstone obstructive ileus 3 years post-cholecystectomy to a patient with an old ileoileal anastomosis.

    Science.gov (United States)

    Papavramidis, T S; Potsi, S; Paramythiotis, D; Michalopoulos, A; Papadopoulos, V N; Douros, V; Pantoleon, A; Foutzila-Kalogera, A; Ekonomou, I; Harlaftis, N

    2009-12-01

    The present case is one of gallstone obstructive ileus due to gallstones 3 yr after laparoscopic cholecystectomy. It is interesting because of the sex of the patient, the fact that ileus occurred 3 yr after cholecystectomy and that the localization of the obstruction was an old side-to-side ileoileal anastomosis due to a diverticulectomy following intussusception of Meckels' diverticulum at the age of 3.

  9. LAPAROSCOPIC CHOLECYSTECTOMY VERSUS MINILAPAROTOMY IN CHOLELITHIASIS: SYSTEMATIC REVIEW AND META-ANALYSIS

    Science.gov (United States)

    CASTRO, Paula Marcela Vilela; AKERMAN, Denise; MUNHOZ, Carolina Brito; do SACRAMENTO, Iara; MAZZURANA, Mônica; ALVAREZ, Guines Antunes

    2014-01-01

    Introduction A introdução da técnica laparoscópica em 1985 foi um fator importante na colecistectomia por representar técnica menos invasiva, resultado estético melhor e menor risco cirúrgico comparado ao procedimento laparotômico. Aim To compare laparoscopic and minilaparotomy cholecystectomy in the treatment of cholelithiasis. Methods A systematic review of randomized clinical trials, which included studies from four databases (Medline, Embase, Cochrane and Lilacs) was performed. The keywords used were "Cholecystectomy", "Cholecystectomy, Laparoscopic" and "Laparotomy". The methodological quality of primary studies was assessed by the Grade system. Results Ten randomized controlled trials were included, totaling 2043 patients, 1020 in Laparoscopy group and 1023 in Minilaparotomy group. Laparoscopic cholecystectomy dispensed shorter length of hospital stay (pcholelithiasis, laparoscopic cholecystectomy is associated with a lower incidence of postoperative pain and infectious complications, as well as shorter length of hospital stay and time to return to work activities compared to minilaparotomy cholecystectomy. PMID:25004295

  10. 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.

  11. 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.

  12. Fluorescence versus X-ray cholangiography during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

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

    2016-01-01

    ). The primary outcome is visualisation of the junction between the cystic duct, the common hepatic duct and the common bile duct. CONCLUSION: The present study may show that fluorescent cholangiography is as valid for visualisation of important structures of the extrahepatic biliary tract as conventional X......INTRODUCTION: Intraoperative fluorescent cholangiography is a novel non-invasive imaging technique to visualise the extrahepatic biliary tract during laparoscopic cholecystectomy. It has been proven feasible, fast and cost effective. Never-theless, there is only sparse data on the capacity...... of fluorescent cholangiography to visualise the biliary anatomy. METHODS: Based on a non-inferiority design, patients with complicated gallstone disease are randomised to either -intraoperative conventional X-ray cholangiography (reference group, n = 60) or intraoperative fluorescent cholangiography (n = 60...

  13. Laparoscopic cholecystectomy performed by residents at a University Hosp

    Directory of Open Access Journals (Sweden)

    M. N. Brito Viglione

    2015-04-01

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

  14. Clinical outcome of routine drainage in simple laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    LIANG Zongchao

    2013-03-01

    Full Text Available ObjectiveTo retrospectively review outcomes of elective laparoscopic cholecystectomy (LC to evaluate the benefit of routine drainage in uncomplicated surgeries. MethodsTwo-hundred-and-ninety-five patients with cholecystolithiasis or gallbladder polyps who underwent LC with drainage (n=145 and or without drainage (n=150 between 2009 and 2011 were enrolled in the study. The decision for drainage was randomized. ResultsThe LC without drainage group had significantly shorter time to first flatus and shorter length of postoperative hospital stay than the LC with drainage group. One patient in the drainage group developed an intra-abdominal abscess, but there was no significant difference between the two LC groups with respect to overall postoperative complication rate. ConclusionApplication of a peritoneal drainage tube after simple elective, uncomplicated LC did not provide any clinical benefit to the patients, and should be considered according to the operating physician′s judgment on a case-by-case basis.

  15. Fluorescence versus X-ray cholangiography during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Lehrskov, Lars Lang; Larsen, Søren Schytt; Kristensen, Billy Bjarne

    2016-01-01

    INTRODUCTION: Intraoperative fluorescent cholangiography is a novel non-invasive imaging technique to visualise the extrahepatic biliary tract during laparoscopic cholecystectomy. It has been proven feasible, fast and cost effective. Never-theless, there is only sparse data on the capacity...... of fluorescent cholangiography to visualise the biliary anatomy. METHODS: Based on a non-inferiority design, patients with complicated gallstone disease are randomised to either -intraoperative conventional X-ray cholangiography (reference group, n = 60) or intraoperative fluorescent cholangiography (n = 60......). The primary outcome is visualisation of the junction between the cystic duct, the common hepatic duct and the common bile duct. CONCLUSION: The present study may show that fluorescent cholangiography is as valid for visualisation of important structures of the extrahepatic biliary tract as conventional X...

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  17. 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.

  18. Characteristics and prediction of early pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Bisgaard, T; Klarskov, B; Rosenberg, J

    2001-01-01

    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...... dominated in incidence and intensity compared with visceral pain, which in turn dominated over shoulder pain. In a multivariate analysis model, preoperative neuroticism, sensitivity to cold pressor-induced pain, and age were identified as independent risk factors for early postoperative pain. Our results......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...

  19. Giant ameloblastoma mortality; a consequence of ignorance, poverty and fear.

    Science.gov (United States)

    Etetafia, Mabel Okiemute; Arisi, Andrew Arotuah; Omoregie, Osawe F

    2014-05-22

    Ameloblastoma is a benign tumour of odontogenic origin. Although locally invasive, delay in treatment can lead to severe disfiguring of the facial region. In this report, we present two cases, a man and a woman, of a large ameloblastoma that presented with the typical radiographic features of variably sized radiolucent loculations. Patients presented initially with relatively small tumours but due to fear of surgery, ignorance and possibly poverty, tumour growth became enormous. The female patient died while awaiting consent for surgery and the male patient died at home due to complications closely associated with fear and growth of tumour. Literatures on mortality of ameloblastoma are reviewed. The need for more public enlightenment on the nature and treatment of facial tumours is highlighted. 2014 BMJ Publishing Group Ltd.

  20. Exploit and ignore the consequences: A mother of planetary issues

    Science.gov (United States)

    Moustafa, K.

    2016-07-01

    Many environmental and planetary issues are due to an exploitation strategy based on exploit, consume and ignore the consequences. As many natural and environmental resources are limited in time and space, such exploitation approach causes important damages on earth, in the sea and maybe soon in the space. To sustain conditions under which humans and other living species can coexist in productive and dynamic harmony with their environments, terrestrial and space exploration programs may need to be based on 'scrutinize the consequences, prepare adequate solutions and then, only then, exploit'. Otherwise, the exploitation of planetary resources may put the environmental stability and sustainability at a higher risk than it is currently predicted. (C) 2016 Elsevier B.V. All rights reserved.

  1. An ignored variable: solution preparation temperature in protein crystallization.

    Science.gov (United States)

    Chen, Rui-Qing; Lu, Qin-Qin; Cheng, Qing-Di; Ao, Liang-Bo; Zhang, Chen-Yan; Hou, Hai; Liu, Yong-Ming; Li, Da-Wei; Yin, Da-Chuan

    2015-01-19

    Protein crystallization is affected by many parameters, among which certain parameters have not been well controlled. The temperature at which the protein and precipitant solutions are mixed (i.e., the ambient temperature during mixing) is such a parameter that is typically not well controlled and is often ignored. In this paper, we show that this temperature can influence protein crystallization. The experimental results showed that both higher and lower mixing temperatures can enhance the success of crystallization, which follows a parabolic curve with an increasing ambient temperature. This work illustrates that the crystallization solution preparation temperature is also an important parameter for protein crystallization. Uncontrolled or poorly controlled room temperature may yield poor reproducibility in protein crystallization.

  2. Period After The Role of Ignorant Companions Poetry

    Directory of Open Access Journals (Sweden)

    Osman Nedim Yektar

    2015-12-01

    Full Text Available  Companions changed the bad aspects in the poetry of ignorance era.  Therefore, they are not totally opposed to the poetry. Poems were evaluated in accordance with the meaning of the words in them. They didn’t read the poems in which bad words were found and didn’t let them to be read. Companions who had engaged with poetry before being Muslims, used that for jihad or for different charities in Islam. During the allegiance to the Prophet in front of him, during the war, during the request for assistance and in sadness, did they read poems without saying any words which mean ‘sin’.

  3. Quality of information available over internet on laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Jayaweera Muhandiramge Uthpala Jayaweera

    2016-01-01

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

  4. Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial.

    Science.gov (United States)

    da Costa, David W; Bouwense, Stefan A; Schepers, Nicolien J; Besselink, Marc G; van Santvoort, Hjalmar C; van Brunschot, Sandra; Bakker, Olaf J; Bollen, Thomas L; Dejong, Cornelis H; van Goor, Harry; Boermeester, Marja A; Bruno, Marco J; van Eijck, Casper H; Timmer, Robin; Weusten, Bas L; Consten, Esther C; Brink, Menno A; Spanier, B W Marcel; Bilgen, Ernst Jan Spillenaar; Nieuwenhuijs, Vincent B; Hofker, H Sijbrand; Rosman, Camiel; Voorburg, Annet M; Bosscha, Koop; van Duijvendijk, Peter; Gerritsen, Jos J; Heisterkamp, Joos; de Hingh, Ignace H; Witteman, Ben J; Kruyt, Philip M; Scheepers, Joris J; Molenaar, I Quintus; Schaapherder, Alexander F; Manusama, Eric R; van der Waaij, Laurens A; van Unen, Jacco; Dijkgraaf, Marcel G; van Ramshorst, Bert; Gooszen, Hein G; Boerma, Djamila

    2015-09-26

    In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission cholecystectomy is poor, and concerns exist about an increased risk of cholecystectomy-related complications with this approach. In this study, we aimed to compare same-admission and interval cholecystectomy, with the hypothesis that same-admission cholecystectomy would reduce the risk of recurrent gallstone-related complications without increasing the difficulty of surgery. For this multicentre, parallel-group, assessor-masked, randomised controlled superiority trial, inpatients recovering from mild gallstone pancreatitis at 23 hospitals in the Netherlands (with hospital discharge foreseen within 48 h) were assessed for eligibility. Adult patients (aged ≥18 years) were eligible for randomisation if they had a serum C-reactive protein concentration less than 100 mg/L, no need for opioid analgesics, and could tolerate a normal oral diet. Patients with American Society of Anesthesiologists (ASA) class III physical status who were older than 75 years of age, all ASA class IV patients, those with chronic pancreatitis, and those with ongoing alcohol misuse were excluded. A central study coordinator randomly assigned eligible patients (1:1) by computer-based randomisation, with varying block sizes of two and four patients, to cholecystectomy within 3 days of randomisation (same-admission cholecystectomy) or to discharge and cholecystectomy 25-30 days after randomisation (interval cholecystectomy). Randomisation was stratified by centre and by whether or not endoscopic sphincterotomy had been done. Neither investigators nor participants were masked to group assignment. The primary endpoint was a composite of readmission for recurrent gallstone-related complications (pancreatitis, cholangitis

  5. [Mini-invasive technologies in treatment of acute cholecystitis in patients with high operational and anesthetic risk].

    Science.gov (United States)

    Ermolov, A S; Guliaev, A A; Ivanov, P A; Samsonov, V T; Rogal', M L; Timerbaev, V Kh; Trofimova, E Iu; Kudriashova, N E; Tlibekova, M A

    2014-01-01

    The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.

  6. Handling Uncertainty and Ignorance in Databases: A Rule to Combine Dependent Data

    NARCIS (Netherlands)

    Choenni, R.S.; Blok, H.E.; Leertouwer, Erik; Lee, Mong Li; Tan, Kian-Lee; Wuwongse, Vilas

    In many applications, uncertainty and ignorance go hand in hand. Therefore, to deliver database support for effective decision making, an integrated view of uncertainty and ignorance should be taken. So far, most of the efforts attempted to capture uncertainty and ignorance with probability theory.

  7. What Is Hospitality in the Academy? Epistemic Ignorance and the (Im)possible Gift

    Science.gov (United States)

    Kuokkanen, Rauna

    2008-01-01

    The academy is considered by many as the major Western institution of knowledge. This article, however, argues that the academy is characterized by prevalent "epistemic ignorance"--a concept informed by Spivak's discussion of "sanctioned ignorance." Epistemic ignorance refers to academic practices and discourses that enable the continued exclusion…

  8. Experiences of Being Ignored by Peers during Late Adolescence: Linkages to Psychological Maladjustment

    Science.gov (United States)

    Bowker, Julie C.; Adams, Ryan E.; Fredstrom, Bridget K.; Gilman, Rich

    2014-01-01

    In this study on being ignored by peers, 934 twelfth-grade students reported on their experiences of being ignored, victimized, and socially withdrawn, and completed measures of friendship and psychological adjustment (depression, self-esteem, and global satisfaction). Peer nominations of being ignored, victimized, and accepted by peers were also…

  9. What Is Hospitality in the Academy? Epistemic Ignorance and the (Im)possible Gift

    Science.gov (United States)

    Kuokkanen, Rauna

    2008-01-01

    The academy is considered by many as the major Western institution of knowledge. This article, however, argues that the academy is characterized by prevalent "epistemic ignorance"--a concept informed by Spivak's discussion of "sanctioned ignorance." Epistemic ignorance refers to academic practices and discourses that enable the continued exclusion…

  10. Reclaiming the Body: Teaching Modern Poetry by Ignoring Meaning.

    Science.gov (United States)

    Hansen, Tom

    Many students think of poetry as a meaning to be figured out, a puzzle to be solved--as if poets were forever doomed to write only what they never quite mean and to mean what they never actually write. The struggle to discover meaning becomes acute with that distinctly modern poetry created by T. S. Eliot, Ezra Pound, Wallace Stevens, and their…

  11. Incidence of Gallstone Formation and Cholecystectomy 10 Years After Bariatric Surgery.

    Science.gov (United States)

    Melmer, Andreas; Sturm, Wolfgang; Kuhnert, Bernhard; Engl-Prosch, Julia; Ress, Claudia; Tschoner, Alexander; Laimer, Markus; Laimer, Elisabeth; Biebl, Matthias; Pratschke, Johann; Tilg, Herbert; Ebenbichler, Christoph

    2015-07-01

    Rapid weight loss is a risk factor for gallstone formation, and postoperative treatment options for gallstone formation are still part of scientific discussion. No prospective studies monitored the incidence for gallstone formation and subsequent cholecystectomy after bariatric surgery longer than 5 years. The aim of the study was to determine the incidence of gallstone formation and cholecystectomy in bariatric patients over 10 years. One hundred nine patients were observed over 10 years after laparoscopic gastric banding or gastric bypass/gastric sleeve. The incidence of gallstone formation and cholecystectomy was correlated to longitudinal changes in anthropometric parameters. In total, 91 female and 18 male patients were examined. Nineteen patients had postoperative gallstone formation, and 12 female patients required cholecystectomy. The number needed to harm for gallstone formation was 7.1 and 2.3 cases in the banding group and gastric bypass/gastric sleeve group, respectively. The number needed to harm for cholecystectomy was 11.6 and 2.5 cases in the banding group and the gastric bypass/gastric sleeve group, respectively. Weight loss was higher in patients requiring subsequent cholecystectomy. Mean follow-up to cholecystectomy was 21.5 months with the latest operation after 51 months. Female gender and rapid weight loss were major risk factors for postoperative cholelithiasis. Ultrasound examinations within 2 to 5 years are recommended in every patient, independent of bariatric procedure. Pharmacologic treatment should be considered in high risk patients within 2 to 5 years to prevent postoperative cholelithiasis. This helps to optimize patient care and lowers postoperative morbidity.

  12. Getting started with robotics in general surgery with cholecystectomy: the Canadian experience

    Science.gov (United States)

    Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M.

    2009-01-01

    Background The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Methods Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. Results There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Conclusion Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it

  13. Methotrexate Hepatotoxicity; the Danger Not to Be Ignored

    Directory of Open Access Journals (Sweden)

    M Baghbanian

    2013-06-01

    Full Text Available Introduction: Methotrexate is used increasingly for treatment of some diseases such as rheumatoid arthritis, psoriasis and Crohn. Bone marrow suppression, mucocutaneous lesions, pneumonitis, and hepatotoxicity are major side effects of this drug. Since methotrexate toxicity is dose dependent and is usually administered with low dose via a weekly regimen, its side effects are not commonly seen. But due to long term prescription of this drug over the recent years especially for rheumatoid arthritis, growing cases of methotrexate hepatotoxicity are referred to Gastroenterologist. High dose of drug, high age, alcohol consumption, renal failure and preexisting liver disease are main risk factors for this toxicity. In this study, in addition to presenting two cases with cirrhosis and two cases with hepatitis linked to methotrexate, the clinical aspects on this field are discussed. Conclusions: Methotrexate hepatotoxicity is not a theoretical issue that can be ignored because it can lead to cirrhosis and liver failure. We can prevent the onset of this growing side effect with appropriate patient selection and investigating the patients’ liver function before and during Methotrexate therapy. Periodic testing the liver enzymes is used for monitoring the liver condition, but because interpretation of these tests is sometimes difficult, liver biopsy is needed in particular cases.

  14. Jets launched at magnetar birth cannot be ignored

    CERN Document Server

    Soker, Noam

    2016-01-01

    I question models for powering super energetic supernovae (SESNe) with a magnetar central engine that do not include jets that are expected to be launched by the magnetar progenitor. I show that under reasonable assumptions the outflow that is expected during the formation of a magnetar can carry an amount of energy that does not fall much below, and even surpasses, the energy that is stored in the newly born spinning neutron star (NS). The rapidly spinning NS and the strong magnetic fields attributed to magnetars require that the accreted mass onto the newly born NS possesses high specific angular momentum and strong magnetic fields. These ingredients are expected, as in many other astrophysical objects, to form collimated oputflows/jets. I argue that the bipolar outflow in the pre-magnetar phase transfers a substantial amount of energy to the supernova (SN) ejecta, and it cannot be ignored in models that attribute SESNe to magnetars. I conclude that jets launched by accretion disks and accretion belts are m...

  15. Should we ignore U-235 series contribution to dose?

    Science.gov (United States)

    Beaugelin-Seiller, Karine; Goulet, Richard; Mihok, Steve; Beresford, Nicholas A

    2016-01-01

    Environmental Risk Assessment (ERA) methodology for radioactive substances is an important regulatory tool for assessing the safety of licensed nuclear facilities for wildlife, and the environment as a whole. ERAs are therefore expected to be both fit for purpose and conservative. When uranium isotopes are assessed, there are many radioactive decay products which could be considered. However, risk assessors usually assume (235)U and its daughters contribute negligibly to radiological dose. The validity of this assumption has not been tested: what might the (235)U family contribution be and how does the estimate depend on the assumptions applied? In this paper we address this question by considering aquatic wildlife in Canadian lakes exposed to historic uranium mining practices. A full theoretical approach was used, in parallel to a more realistic assessment based on measurements of several elements of the U decay chains. The (235)U family contribution varied between about 4% and 75% of the total dose rate depending on the assumptions of the equilibrium state of the decay chains. Hence, ignoring the (235)U series will not result in conservative dose assessments for wildlife. These arguments provide a strong case for more in situ measurements of the important members of the (235)U chain and for its consideration in dose assessments.

  16. Jets launched at magnetar birth cannot be ignored

    Science.gov (United States)

    Soker, Noam

    2016-08-01

    I question models for powering super energetic supernovae (SESNe) with a magnetar central engine that do not include jets that are expected to be launched by the magnetar progenitor. I show that under reasonable assumptions the outflow that is expected during the formation of a magnetar can carry an amount of energy that does not fall much below, and even surpasses, the energy that is stored in the newly born spinning neutron star (NS). The rapidly spinning NS and the strong magnetic fields attributed to magnetars require that the accreted mass onto the newly born NS possesses high specific angular momentum and strong magnetic fields. These ingredients are expected, as in many other astrophysical objects, to form collimated outflows/jets. I argue that the bipolar outflow in the pre-magnetar phase transfers a substantial amount of energy to the supernova (SN) ejecta, and it cannot be ignored in models that attribute SESNe to magnetars. I conclude that jets launched by accretion disks and accretion belts are more likely to power SESNe than magnetars are. This conclusion is compatible with the notion that jets might power all core collapse SNe (CCSNe).

  17. Measuring the health of populations: the veil of ignorance approach.

    Science.gov (United States)

    Pinto-Prades, José-Luis; Abellán-Perpiñán, José-María

    2005-01-01

    We report the results from two surveys designed to explore whether an application of Harsanyi's principle of choice form behind a veil of ignorance (VEI) can be used in order to measure the health of populations. This approach was tentatively recommended by Murray et al. (Bull. World Health Organ 2000; 78: 981-994; Summary Measures of population health: Concepts, Ethics, Measurement and Applications, WHO, 2002.) as an appropriate way of constructing summary measures of population health (SMPH) for comparative purposes. The operationalization of the VEI approach used in this paper was suggested by Nord (Summary Measures of Population Health: Concepts, Ethics, Measurement and Applications, WHO, 2002.). We test if VEI and person trade-off (PTO) methods generate similar quality-of-life weights. In addition, we compare VEI and PTO weights with individual utilities estimated by means of the conventional standard gamble (SG) and a variation of it we call double gamble. Finally, psychometric properties like feasibility, reliability, and consistency are examined. Our main findings are next: (1) VEI and PTO approaches generate very different weights; (2) it seems that differences between PTO and VEI are not due to the 'rule of rescue'; (3) the VEI resembled more a DG than a classical SG; (4) PTO, VEI, and DG exhibited good feasibility, reliability and consistency.

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

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    Ming G Tian

    2013-01-01

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

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

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    Mirsharifi Rasoul

    2008-06-01

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

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

    Science.gov (United States)

    Imbelloni, Luiz Eduardo

    2014-01-01

    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 CO2. 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 T3. 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 T3, 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. Satisfaction occurred in 99% of

  1. 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

  2. Inverse association between coffee consumption and risk of cholecystectomy in women but not in men.

    Science.gov (United States)

    Nordenvall, Caroline; Oskarsson, Viktor; Wolk, Alicja

    2015-06-01

    There is conflicting epidemiologic evidence on whether coffee consumption reduces the risk of gallstone disease. We examined the association between coffee consumption and risk of cholecystectomy (as a proxy for symptomatic gallstone disease) in a prospective cohort study. We collected data from 30,989 women (born 1914-1948) and 40,936 men (born 1918-1952) from the Swedish Mammography Cohort and the Cohort of Swedish Men. Baseline information on coffee consumption was collected by using a food-frequency questionnaire; subjects were followed up for procedures of cholecystectomy from 1998 through 2011 by linkage to the Swedish Patient Register. Hazard ratios (HRs) were estimated by using Cox proportional hazard models. During a total follow-up period of 905,933 person-years, we identified 1057 women and 962 men who had undergone a cholecystectomy. After adjustment for potential confounders, the HR of cholecystectomy was 0.58 (95% confidence interval [CI], 0.44-0.78) for women who drank ≥6 cups of coffee/day compared with women who drank coffee consumption and risk of cholecystectomy in women who were premenopausal or used HRT but not in other women or in men. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

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

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    J. Diez

    1998-01-01

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

  4. 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.

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

    NARCIS (Netherlands)

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

    1997-01-01

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

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

    OpenAIRE

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

    2013-01-01

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

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

    NARCIS (Netherlands)

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

    1997-01-01

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

  8. Double jeopardy and the veil of ignorance--a reply.

    Science.gov (United States)

    Harris, J

    1995-06-01

    This paper discusses the attempt in this issue of the journal by Peter Singer, John McKie, Helga Kuhse and Jeff Richardson, to defend QALYs against the argument from double jeopardy which I first outlined in 1987. In showing how the QALY and other similar measures which combine life expectancy and quality of life and use these to justify particular allocations of health care resource, remain vulnerable to the charge of double jeopardy I am able to clarify some of the central issues concerning the value of life. In particular, the idea that the value of a life varies with its life expectancy and with its quality, understood in terms of its richness, variety, success etc, is subjected to special examination. It is shown how defenders of QALYs are committed to the view that so far from all lives being of equal value, all lives are necessarily of subtly different value. The paper then analyses the use to which the notorious 'veil of ignorance' has been put both by Singer et al and by others and shows how this device of John Rawls's cannot do the work so often assigned to it. The paper then considers the issue of hypothetical consent and the role that it can play in justifying disposing of the lives of people who have not in fact consented to their lives being disposed of in particular ways. Finally, the paper makes some points about the comprehensive nature of the data collection and storage which would be required by QALY advocates and points out the independent problems attaching to licensing such comprehensive collection and use of personal data.

  9. Covert Laparoscopic Cholecystectomy: A New Minimally Invasive Technique

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    Hu,Hai

    2011-10-01

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

  10. Consequences of Lost Gallstones During Laparoscopic Cholecystectomy: A Review Article.

    Science.gov (United States)

    Jabbari Nooghabi, Azadeh; Hassanpour, Masoumeh; Jangjoo, Ali

    2016-06-01

    Laparoscopic cholecystectomy (LC) has become a popular and widespread procedure for the treatment of gallstone disease. There is still an increasing concern about specific complications of LC due to gallbladder perforation and spillage of bile and stones. Although unretrieved intraperitoneal gallstones rarely become symptomatic, their infective complications may cause serious morbidities even after a long interval from LC. We performed a review of the literature on the diagnosis, prevention, consequences, and management of lost gallstones. All studies with a focus on lost gallstones or perforated gallbladder were analyzed to evaluate the postoperative complications. Between 1991 and 2015, >250 cases of postoperative complications of spilled gallstones were reviewed in the surgical literature. The most common complications are intraperitoneal abscesses and fistulas. Confusing clinical pictures due to gallstones spreading in different locations makes diagnosis challenging. Even asymptomatic dropped gallstones may masquerade intraperitoneal neoplastic lesions. Every effort should be made to prevent gallbladder perforation; otherwise, they should be retrieved immediately during laparoscopy. In cases with multiple large spilled stones or infected bile, conversion to open surgery can be considered. Documentation in operative notes and awareness of patients about lost gallstones are mandatory to early recognition and treatment of any complications.

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

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

    2002-05-01

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

  12. Is intraoperative cholangiography necessary during laparoscopic cholecystectomy for cholelithiasis?

    Science.gov (United States)

    Ding, Guo-Qian; Cai, Wang; Qin, Ming-Fang

    2015-02-21

    To determine the efficacy and safety benefits of performing intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) to treat symptomatic cholelithiasis. Patients admitted to the Minimally Invasive Surgery Center of Tianjin Nankai Hospital between January 2012 and January 2014 for management of symptomatic cholelithiasis were recruited for this prospective randomized trial. Study enrollment was offered to patients with clinical presentation of biliary colic symptoms, radiological findings suggestive of gallstones, and normal serum biochemistry results. Study participants were randomized to receive either routine LC treatment or LC+IOC treatment. The routine LC procedure was carried out using the standard four-port technique; the LC+IOC procedure was carried out with the addition of meglumine diatrizoate (1:1 dilution with normal saline) injection via a catheter introduced through a small incision in the cystic duct made by laparoscopic scissors. Operative data and postoperative outcomes, including operative time, retained common bile duct (CBD) stones, CBD injury, other complications and length of hospital stay, were recorded for comparative analysis. Inter-group differences were statistically assessed by the χ2 test (categorical variables) and Fisher's exact test (binary variables), with the threshold for statistical significance set at Pcholelithiasis does not improve rates of CBD stone retainment or bile duct injury but lengthens operative time.

  13. Obesity Increases Operative Time in Children Undergoing Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Pandian, T K; Ubl, Daniel S; Habermann, Elizabeth B; Moir, Christopher R; Ishitani, Michael B

    2017-03-01

    Few studies have assessed the impact of obesity on laparoscopic cholecystectomy (LC) in pediatric patients. Children who underwent LC were identified from the 2012 to 2013 American College of Surgeons' National Surgical Quality Improvement Program Pediatrics data. Patient characteristics, operative details, and outcomes were compared. Multivariable logistic regression was utilized to identify predictors of increased operative time (OT) and duration of anesthesia (DOAn). In total, 1757 patients were identified. Due to low rates of obesity in children obese). Among obese children, 80.6% were girls. A higher proportion of obese patients had diabetes (3.0% versus 1.0%, P obesity was an independent predictor of OT >90 (odds ratio [OR] 2.02; 95% confidence interval [95% CI] 1.55-2.63), and DOAn >140 minutes (OR 1.86; 95% CI 1.42-2.43). Obesity is an independent risk factor for increased OT in children undergoing LC. Pediatric surgeons and anesthesiologists should be prepared for the technical and physiological challenges that obesity may pose in this patient population.

  14. Analgesic Effect of Preoperative Pentazocine for Laparoscopic Cholecystectomy

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ahmet Serdar Karaca

    2013-10-01

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

  16. 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.

  17. LAPAROSCOPIC TREATMENT OF ACUTE CHOLECYSTITIS

    Institute of Scientific and Technical Information of China (English)

    Davaadorj Nyamkhuu MD; Nyamkhuu Gonchigsenghe MD; Albert Holly Rusher MD

    2003-01-01

    Objctive: To assess the current treatment of AC in a single institution in the series,which the best treatment modality for acute cholecystitis (AC) is still under debate, whereas early cholecystectomy is accepted as the optimal timing for surgery. Methods: From December 1996 to December 2001,138 (102 women and 36 men) patients underwent laparoscopic cholecystectomy for acute cholecystitis confirmed by histopathological examination. The patients ranged in age from 21 to 85 years of age ( mean age:45.3 years). Patients were divided into 2 groups (similar in age and ASA classification): group 1 (98 patients) underwent LC within 3 days after the onset of symptoms of acute cholecystitis and group 2 (40 patients) underwent LC after 3 days. Results: Approximately one half of the cases were uncomplicated, 26 % were empyema, 13 % had gangrenous changes and 7% had hydrops of the gallbladder. Conversion to open cholecystectomy was required in 21 (15.2%) cases. The principal reason for conversion was anatomic uncertainty (14 cases), uncontrolled bleeding (7 cases). The conversion rates in patients who underwent surgery before and after the onset of symptoms were respectively 6:15. There was no significant difference in operative time (122.0 min in 1 group versus 124.0 min in 2 group) and postoperative stay ( 5.1 days in group 1 vs 6.8 days in group 2). The hepatorenal space was drained in 78 (56.5 % ), and the drain is removed in 3rd postoperative days. Twenty six patients (18.8%) had undergone previous abdominal surgery. Thirty seven patients (26.8%) had spillage of bile and/or stones during the procedure. There were no deaths and major complications. Conclusions: LC for acute cholecystitis should be done immediately after the diagnosis is established because delaying surgery allows inflammation to become more intense,thus increasing the technical difficulty of LC. Intraoperative spillage of bile and stones does not lead to an increase in early complications. LC is safe and

  18. Reversibility of central neuronal changes in patients recovering from gallbladder stones or acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Daniel W Kjaer; Marek Stawowy; Lars Arendt-Nielsen; Asbjφrn Mohr Drewes; Peter Funch-Jensen

    2006-01-01

    AIM: To investigate the referred pain area in patients 2-7 years after cholecystectomy in order to test the hypothesis that neuroplastic changes could give rise to post cholecystectomy pain.METHODS: Forty patients were tested. Twenty five were cholecystectomized due to uncomplicated gallbladder stones and 15 because of acute cholecystitis. Sensitivity to pinprick, heat, cold, pressure and single and repeated electrical stimulation was studied both in the referred pain area and in the control area on the contra lateral side of the abdomen.RESULTS: Five patients still intermittently suffered from pain. But in the objective test of the 40 patients, no statistical significant difference was found between the referred pain area and the control area.CONCLUSION: This study does not support the hypothesis that de novo neuroplastic changes could develop several years after cholecys-tectomy.

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

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    Muammer Bilici

    2016-03-01

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

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

    DEFF Research Database (Denmark)

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

    2001-01-01

    , after insufflation or traction, 30 min after introduction of the laparoscope, 10 min after exsufflation of carbon dioxide or traction, 4 h after extubation and 24 h after operation. RESULTS: The two groups were comparable with respect to age, sex, body mass index and duration of operation. Plasma levels......BACKGROUND: Carbon dioxide pneumoperitoneum may be an important pathophysiological factor stimulating the coagulation system during conventional laparoscopic cholecystectomy. The aim of this study was to test the hypothesis that gasless laparoscopy produces smaller changes in the coagulation...... and fibrinolytic system than carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. METHODS: Fifty patients were allocated randomly to conventional (n = 26) or gasless (n = 24) laparoscopic cholecystectomy. Blood samples were obtained on admission, after induction of anaesthesia...

  1. 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.

  2. Histological assessment of cholecystectomy specimens performed for symptomatic cholelithiasis: routine or selective?

    Science.gov (United States)

    de Silva, WMM

    2013-01-01

    Traditionally, all cholecystectomy specimens resected for symptomatic cholelithiasis were sent for histological evaluation. The objectives of such evaluation are to confirm the clinicoradiological diagnosis, identification of unsuspected findings including incidental gallbladder malignancy, audit and research purposes, and quality control issues. Currently, there is a developing trend to consider selective histological evaluation of surgical specimens removed for clinically benign disease. This article discusses the need for routine or selective histopathological evaluation of gallbladder specimens following cholecystectomy. Although several retrospective studies have suggested selective histological evaluation of cholecystectomy specimens performed for symptomatic cholelithiasis, the evidence is not adequate at present to recommend selective histological evaluation globally. However, it may be appropriate to consider selective histological evaluation on a regional basis in areas of extremely low incidence of gallbladder cancer only after unanimous agreement between the governing bodies of surgical and histopathological expertise. PMID:23838492

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

    Directory of Open Access Journals (Sweden)

    Mariana Correia

    2016-04-01

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

  4. Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Gramatica, L; Brasesco, O E; Mercado Luna, A; Martinessi, V; Panebianco, G; Labaque, F; Rosin, D; Rosenthal, R J; Gramatica, L

    2002-03-01

    Laparoscopic cholecystectomy has been successfully performed using epidural anesthesia. We evaluated our experience with this surgical approach in high-risk patients. We present the results of 29 patients with gallstones who, between 1998 and 1999, underwent laparoscopic cholecystectomy with epidural anesthesia. All but 1 patient had chronic obstructive pulmonary disease. All 29 surgeries were successfully completed via laparoscopy and with the patients under epidural anesthesia. No patient required endotracheal intubation during surgery or pain medication afterward. Postoperatively, 1 patient developed a wound infection and 3 patients developed urinary retention. At last follow-up (12 months postop), all patients were in good health. In this series, laparoscopic cholecystectomy was feasible under epidural anesthesia and it eliminated the need for postoperative analgesia. We believe that this approach should be considered for patients who require biliary surgery but who are not good candidates for general anesthesia due to cardiorespiratory problems.

  5. A Case of Concomitant Perforated Acute Cholecystitis and Pancreatitis

    Directory of Open Access Journals (Sweden)

    Marlon Perera

    2013-01-01

    Full Text Available Introduction. Concomitant cholecystitis and gallstone pancreatitis is an infrequent clinical encounter, reported sparsely in the literature. Concurrent acute cholecystitis and pancreatitis complicated by gall bladder perforation has not been reported before. Presentation of Case. We report a 39-year-old female presenting with concomitant cholecystitis and acute pancreatitis, complicated by gallbladder perforation. Discussion. There is much controversy surrounding the timing of cholecystectomy following gallstone pancreatitis, with the recent literature suggesting that “early” operation is safe. In the current case, gallbladder perforation altered the “routine” management of gallstone pancreatitis and posed as a management dilemma. Conclusion. Clinical judgement dictated timing of operative management and ultimately cholecystectomy was performed safely.

  6. Are we meeting the British Society of Gastroenterology guidelines for cholecystectomy post-gallstone pancreatitis?

    Science.gov (United States)

    Creedon, Lee R; Neophytou, Chris; Leeder, Paul C; Awan, Altaf K

    2016-12-01

    The aim of this study was to audit the current management of patients suffering with gallstone pancreatitis (GSP) at a university teaching hospital for compliance with the British Society of Gastroenterology (BSG) guidelines regarding cholecystectomy post-GSP. Data were collected on all patients identified via the hospital coding department that presented with GSP between January 2011 and November 2013. Patients with alcoholic pancreatitis were excluded. The primary outcome was the length of time in days from diagnosis of GSP to cholecystectomy. Secondary outcomes included readmission with gallstone-related disease prior to definitive management and admitting speciality. One hundred and fifty-eight patients were identified with a presentation of GSP during the study period. Thirty-nine patients were treated conservatively. One hundred and six patients underwent laparoscopic cholecystectomy a median (interquartile range) interval of 33.5 days (64 days) post-admission. Patients with a severe attack as classified by the Glasgow severity score (n = 16) waited a median of 79.5 days (71.5) for cholecystectomy. Only 32% (n = 34) of patients with mild disease underwent cholecystectomy during the index admission or within 2 weeks. When grouped by admitting speciality, patients admitted initially under hepatobiliary surgery waited significantly fewer days for definitive treatment compared with other specialities (P gallstone-related pathology prior to undergoing cholecystectomy. Only 32.1% were treated as per BSG guidelines. About 19.8% (n = 21) of the patients suffered further morbidity as a result of a delayed operation and there is a clear difference between admitting speciality and the median time to operation. © 2014 Royal Australasian College of Surgeons.

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    Anahita Dua

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  10. Long-term risk of pancreatitis and diabetes after cholecystectomy in patients with cholelithiasis but no pancreatitis history: a 13-year follow-up study.

    Science.gov (United States)

    Tsai, Ming-Shian; Lin, Cheng-Li; Hsu, Yao-Chun; Lee, Hui-Ming; Kao, Chia-Hung

    2015-09-01

    Patients with biliary pancreatitis are suggested to undergo cholecystectomy to prevent the recurrence of pancreatitis. However, it remains controversial whether cholecystectomy is associated with reduced risks of pancreatitis and diabetes in patients with cholelithiasis and no history of pancreatitis. From Taiwan's National Health Insurance Research Database, we identified the following cohorts and analyzed the long-term risks of pancreatitis and diabetes in each cohort: 1) cholecystectomy cohort: cholelithiasis patients who had no history of pancreatitis and diabetes and underwent cholecystectomy; and 2) comparison cohort: cholelithiasis patients who had no history of pancreatitis and diabetes and did not undergo cholecystectomy. The cholecystectomy group and the comparison group had similar distributions of age, sex, and comorbidities, except for hyperlipidemia. The proportion of patients in the cholecystectomy group who underwent endoscopic cholangiographic procedures was higher than that in the comparison group. Cholecystectomy was associated with a reduced risk of pancreatitis (adjusted hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.36-0.68). Age-specific analyses showed that pancreatitis risk was decreased in patients younger than 50 and older than 65years. Both men and women exhibited reduced risks of pancreatitis after cholecystectomy. However, cholecystectomy was not associated with changes in the risk for diabetes. Cholecystectomy for cholelithiasis is associated with a reduced risk of pancreatitis, but not of diabetes, in patients without previous history of pancreatitis and diabetes. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  11. 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...

  12. 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.

  13. POSSIBILITIES OF EARLY REHABILITATION OF PATIENTS WITH CHOLELITHIASIS AFTER ENDOSCOPIC CHOLECYSTECTOMY

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    S. I. Marsheva

    2013-01-01

    Full Text Available The aim of the clinical test was to develop a method for combined rehabilitation of patients after endoscopic cholecystectomy at the early stage with the use of magnetic-laser therapy, UHF therapy, and mineral waters.The analysis of obtained results has indicated that the combined rehabilitation of cholelithiasis patients after endoscopic cholecystectomy with the use of natural and и preformed physical factors favored the improvement of indices of functional activity of the hepatobiliary system, psychoemotional state, and adaptability of the organism, not causing their stress.

  14. 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....

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

    Directory of Open Access Journals (Sweden)

    Gaurav Gupta

    2015-11-01

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

  16. 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

  17. Laparoscopic cholecystectomy: What is the price of conversion?

    Science.gov (United States)

    Lengyel, Balazs I; Panizales, Maria T; Steinberg, Jill; Ashley, Stanley W; Tavakkoli, Ali

    2012-08-01

    Laparoscopic cholecystectomy (LC) is the gold standard procedure for gallbladder removal. Conversion to an open procedure is sometimes deemed necessary, especially in complex cases in which a prolonged laparoscopic operative time is anticipated. A prolonged LC case is thought to be associated with increased complications and cost and therefore generally discouraged. The purpose of this study was to test this assumption, and compare outcomes and cost of converted and prolonged LC cases. By using institutional National Surgical Quality Improvement Program and financial databases, we retrospectively reviewed and compared prolonged laparoscopic cases (Long-LC) with converted (CONV) procedures. Surgical times, length of stay (LOS), 30-day complications, operative room, and total hospital charges were compared between the 2 groups. A total of 101 Long-LC and 66 CONV cases met our inclusion criteria. Long-LC cases were 19 minutes longer than CONV cases (123 vs 104 min; P .05). When Poisson regression was used, we found that LOS was significantly shorter in the Long-LC compared with CONV group (1 day vs 4 days; P < .01). Long-LC cases had greater operative charges ($15,278 vs $13,128; P < .01). However, hospital charges for Long-LC cases were 26% less than for CONV cases ($23,946 vs $32,446; P < .01). Conversion is associated with a 3-day increase in LOS. Long-LC cases have greater operative room charges, but overall hospital charges were 26% less than CONV cases. Our data suggest that decision making regarding conversion should focus on safety and not time considerations. Copyright © 2012 Mosby, Inc. All rights reserved.

  18. Virtual Reality Training Versus Blended Learning of Laparoscopic Cholecystectomy

    Science.gov (United States)

    Nickel, Felix; Brzoska, Julia A.; Gondan, Matthias; Rangnick, Henriette M.; Chu, Jackson; Kenngott, Hannes G.; Linke, Georg R.; Kadmon, Martina; Fischer, Lars; Müller-Stich, Beat P.

    2015-01-01

    Abstract This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program. Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks. Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires. The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group. VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches. PMID:25997044

  19. 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

  20. Dissection by Ultrasonic Energy Versus Monopolar Electrosurgical Energy in Laparoscopic Cholecystectomy

    Science.gov (United States)

    2010-01-01

    Introduction: Laparoscopic cholecystectomy is the gold standard for management of symptomatic gallstones. Electrocautery remains the main energy form used during laparoscopic dissection. However, due to its risks, search is continuous for safer and more efficient forms of energy. This review assesses the effects of dissection using ultrasonic energy compared with monopolar electrocautery during laparoscopic cholecystectomy. Methods: A literature search of the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, and EMBASE was performed. Studies included were trials that prospectively randomized adult patients with symptomatic gallstone disease to either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Data were collected regarding the characteristics and methodological quality of each trial. Outcome measures included operating time, gallbladder perforation rate, bleeding, bile leak, conversion rate, length of hospital stay and sick leave, postoperative pain and nausea scores, and influence on systemic immune and inflammatory responses. For metaanalysis, the statistical package RevMan version 4.2 was used. For continuous data, Weighted Mean Difference (WMD) was calculated with 95% confidence interval (CI) using the fixed effects model. For Categorical data, the Odds Ratio (OR) was calculated with 95% confidence interval using fixed effects model. Results: Seven trials were included in this review, with a total number of 695 patients randomized to 2 dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. No mortality was recorded in any of the trials. With ultrasonic dissection, operating time is significantly shorter in elective surgery (WMD −8.19, 95% CI −10.36 to −6.02, P>0.0001), acute cholecystitis (WMD −17, 95% CI −28.68 to −5.32, P=0.004), complicated cases (WMD −15, 95% CI −28.15 to −1.85, P=0.03), or if surgery was performed by trainee

  1. [The pneumoperitoneum course forecasting and surgery tactic in the group of patients with acute and chronic cholecystitis and concomitant pathology of cardiovascular system].

    Science.gov (United States)

    Korotkyĭ, V M; Soliaryk, S O; Tsyganok, A M; Sysak, O M

    2012-01-01

    The share of elderly and senile patients with acute cholecystitis concomitant cardiovascular pathology whom the laparoscopic cholecystectomy has been provided is increased. The heightened intraabdominal pressure has negative influence at the cardiovascular system, so the alternative ways for treatment of this group of patients are used in clinic. We propose the pneumoperitoneum model using the pneumatic belt which is fixed at the abdomen in preoperative period in patients with an acute and chronic cholecystitis. This model is useful to forecast cardiovascular disorders during future laparoscopic cholecystectomy. The arterial pressure level, pulse score and ECG are monitored during the test (90 min). Myocardial ischemia appearance seems that the risk of laparoscopic cholecystectomy with pneumoperitoneum is high. The alternative method of surgery in such group of patients (no pneumoperitoneum is applied) is laparoscopic assisted cholecystectomya from miniaccess. This method allows to reducing frequency of intra- and postoperative complications connected with pneumoperitoneum negative influence at the patients with concomitant pathology of cardiovascular system.

  2. 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.

  3. Neurophysiological Signals of Ignoring and Attending Are Separable and Related to Performance during Sustained Intersensory Attention

    Science.gov (United States)

    Lenartowicz, Agatha; Simpson, Gregory V.; Haber, Catherine M.; Cohen, Mark S.

    2017-01-01

    The ability to attend to an input selectively while ignoring distracting sensations is thought to depend on the coordination of two processes: enhancement of target signals and attenuation of distractor signals. This implies that attending and ignoring may be dissociable neural processes and that they make separable contributions to behavioral outcomes of attention. In this study, we tested these hypotheses in the context of sustained attention by measuring neurophysiological responses to attended and ignored stimuli in a noncued, continuous, audiovisual selective attention task. We compared these against responses during a passive control to quantify effects of attending and ignoring separately. In both sensory modalities, responses to ignored stimuli were attenuated relative to a passive control, whereas responses to attended stimuli were enhanced. The scalp topographies and brain activations of these modulatory effects were consistent with the sensory regions that process each modality. They also included parietal and prefrontal activations that suggest these effects arise from interactions between top–down and sensory cortices. Most importantly, we found that both attending and ignoring processes contributed to task accuracy and that these effects were not correlated—suggesting unique neural trajectories. This conclusion was supported by the novel observation that attending and ignoring differed in timing and in active cortical regions. The data provide direct evidence for the separable contributions of attending and ignoring to behavioral outcomes of attention control during sustained intersensory attention. PMID:24666167

  4. The Consequences of Ignoring Multilevel Data Structures in Nonhierarchical Covariance Modeling.

    Science.gov (United States)

    Julian, Marc W.

    2001-01-01

    Examined the effects of ignoring multilevel data structures in nonhierarchical covariance modeling using a Monte Carlo simulation. Results suggest that when the magnitudes of intraclass correlations are less than 0.05 and the group size is small, the consequences of ignoring the data dependence within the multilevel data structures seem to be…

  5. Neurophysiological signals of ignoring and attending are separable and related to performance during sustained intersensory attention.

    Science.gov (United States)

    Lenartowicz, Agatha; Simpson, Gregory V; Haber, Catherine M; Cohen, Mark S

    2014-09-01

    The ability to attend to an input selectively while ignoring distracting sensations is thought to depend on the coordination of two processes: enhancement of target signals and attenuation of distractor signals. This implies that attending and ignoring may be dissociable neural processes and that they make separable contributions to behavioral outcomes of attention. In this study, we tested these hypotheses in the context of sustained attention by measuring neurophysiological responses to attended and ignored stimuli in a noncued, continuous, audiovisual selective attention task. We compared these against responses during a passive control to quantify effects of attending and ignoring separately. In both sensory modalities, responses to ignored stimuli were attenuated relative to a passive control, whereas responses to attended stimuli were enhanced. The scalp topographies and brain activations of these modulatory effects were consistent with the sensory regions that process each modality. They also included parietal and prefrontal activations that suggest these effects arise from interactions between top-down and sensory cortices. Most importantly, we found that both attending and ignoring processes contributed to task accuracy and that these effects were not correlated--suggesting unique neural trajectories. This conclusion was supported by the novel observation that attending and ignoring differed in timing and in active cortical regions. The data provide direct evidence for the separable contributions of attending and ignoring to behavioral outcomes of attention control during sustained intersensory attention.

  6. Modelling non-ignorable missing-data mechanisms with item response theory models

    NARCIS (Netherlands)

    Holman, Rebecca; Glas, Cees A.W.

    2005-01-01

    A model-based procedure for assessing the extent to which missing data can be ignored and handling non-ignorable missing data is presented. The procedure is based on item response theory modelling. As an example, the approach is worked out in detail in conjunction with item response data modelled us

  7. The Mathematical Miseducation of America's Youth: Ignoring Research and Scientific Study in Education.

    Science.gov (United States)

    Battista, Michael T.

    1999-01-01

    Because traditional instruction ignores students' personal construction of mathematical meaning, mathematical thought development is not properly nurtured. Several issues must be addressed, including adults' ignorance of math- and student-learning processes, identification of math-education research specialists, the myth of coverage, testing…

  8. Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy.

    Science.gov (United States)

    Nickkholgh, A; Soltaniyekta, S; Kalbasi, H

    2006-06-01

    Routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is a matter of debate. Data from 2,130 consecutive LCs and patients' follow-up during 9 years were collected and analyzed. During the first 4 years of the study, 800 patients underwent LC, and IOC was performed selectively (SIOC). Thereafter, 1,330 patients underwent LC, and IOC was routinely attempted (RIOC) for all. In the IOC group, 159 patients met the criteria for SIOC, which was completed successfully in 141 cases (success rate, 88.6%). Bile duct calculi were found in nine patients. All other patients with no criteria or failed SIOC were followed, and in nine patients retained stones were documented. Thus, the incidence of ductal stones was 1.1% and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for the detection of ductal stones were 50, 100, 98.6, and 100%, respectively. In the RIOC group, IOC was routinely attempted in 1,330 patients and was successful in 1,133 (success rate, 90.9%; p = 0.015). Bile duct stones were detected in 37 patients (including 14 asymptomatic stones). In two cases, IOC failed to reveal ductal stones (false negative). There was no false-positive IOC. Therefore, with RIOC policy, the incidence of ductal stones, sensitivity, specificity, NPV, and PPV were 3.3, 97.4, 100, 99.8, and 100%, respectively (significantly higher for success rate, incidence, sensitivity, and NPV; p Common bile duct injury occurred only in the SIOC group [two cases of all 2,130 LCs (0.09%)]. RIOC during LC is a safe, accurate, quick, and cost-effective method for the detection of bile duct anatomy and stones. A highly disciplined performance of RIOC can minimize potentially debilitating and hazardous complications of bile duct injury.

  9. Single-incision cholecystectomy in a patient with situs inversus totalis presenting with cholelithiasis: A case report.

    Science.gov (United States)

    Deguchi, Yoshio; Mitamura, Keitaro; Omotaka, Shunsuke; Eguchi, Jun-ichi; Sakuma, Dai; Sato, Masashi; Nomura, Norihiro; Ito, Takayoshi; Grimes, Kevin Lawrence; Inoue, Haruhiro

    2015-08-01

    Laparoscopic cholecystectomy has become the gold standard for the treatment of cholelithiasis, and many reports of single-incision laparoscopic cholecystectomy have been published in the past few years. Situs inversus totalis is a very rare condition, but the variant anatomy should not preclude a minimally invasive approach to surgery. We report a case of successful single-port laparoscopic cholecystectomy in a patient with situs inversus totalis, describe the technical advantages, and review the literature. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  10. The concept of ignorance in a risk assessment and risk management context

    Energy Technology Data Exchange (ETDEWEB)

    Aven, T., E-mail: terje.aven@uis.n [University of Stavanger (Norway); Steen, R. [University of Stavanger (Norway)

    2010-11-15

    There are many definitions of ignorance in the context of risk assessment and risk management. Most refer to situations in which there are lack of knowledge, poor basis for probability assignments and possible outcomes not (fully) known. The purpose of this paper is to discuss the ignorance concept in this setting. Based on a set of risk and uncertainty features, we establish conceptual structures characterising the level of ignorance. These features include the definition of chances (relative frequency-interpreted probabilities) and the existence of scientific uncertainties. Based on these structures, we suggest a definition of ignorance linked to scientific uncertainties, i.e. the lack of understanding of how consequences of the activity are influenced by the underlying factors. In this way, ignorance can be viewed as a condition for applying the precautionary principle. The discussion is also linked to the use and boundaries of risk assessments in the case of large uncertainties, and the methods for classifying risk and uncertainty problems.

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

    Institute of Scientific and Technical Information of China (English)

    Cheng-Gang Li

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  13. 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.

  14. 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.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  16. Clinical characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy: a report of 40 cases.

    Science.gov (United States)

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

    2006-04-28

    To summarize the performing essentials and analyze the characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy. 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. 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 post-operative hospital stay were 30.6 +/- 10.2 mL and 2.8 +/- 0.8 d, respectively. Camera clearing times and time used for operative field adjustment were 1.1+/- 1.0 min and 2.0 +/- 0.8 min, respectively. The operative error was 7.5%. 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. Shortened preoperative fasting for prevention of complications associated with laparoscopic cholecystectomy: a meta-analysis.

    Science.gov (United States)

    Xu, Duo; Zhu, Xuejiao; Xu, Yuan; Zhang, Liqing

    2017-02-01

    Objective Routine fasting (12 h) is always applied before laparoscopic cholecystectomy, but prolonged preoperative fasting causes thirst, hunger, and irritability as well as dehydration, low blood glucose, insulin resistance and other adverse reactions. We assessed the safety and efficacy of a shortened preoperative fasting period in patients undergoing laparoscopic cholecystectomy. Methods We searched PubMed, Embase and Cochrane Central Register of Controlled Trials up to 20 November 2015 and selected controlled trials with a shortened fasting time before laparoscopic cholecystectomy. We assessed the results by performing a meta-analysis using a variety of outcome measures and investigated the heterogeneity by subgroup analysis. Results Eleven trials were included. Forest plots showed that a shortened fasting time reduced the operative risk and patient discomfort. A shortened fasting time also reduced postoperative nausea and vomiting as well as operative vomiting. With respect to glucose metabolism, a shortened fasting time significantly reduced abnormalities in the ratio of insulin sensitivity. The C-reactive protein concentration was also reduced by a shortened fasting time. Conclusions A shortened preoperative fasting time increases patients' postoperative comfort, improves insulin resistance, and reduces stress responses. This evidence supports the clinical application of a shortened fasting time before laparoscopic cholecystectomy.

  19. [Features of vegetative dysfunction development in patients with cholelithiasis before and after cholecystectomy].

    Science.gov (United States)

    Taiutina, T V; Bagmet, A D; Ruban, A P; Nedoruba, E A; Kobzar', O N

    2014-01-01

    The aim of the present study was a comprehensive study of the features autonomic nervous system in cholelithiasis before and after cholecystectomy. 88 patients aged 40 to 60 years. 55 patients with cholelithiasis before and after laparoscopic cholecystectomy (CE). Control group consisted of 33 patients of similar age and gender. To investigate the function of the autonomic nervous system were evaluated themes complaint history, physical examination data, and used less Tod mathematical analysis of cardiac rhythm by Baevsky RM using the author's computer-related programs "Korveg" with the definition of heart rate variability and table--Solovevoj Wayne. The study of autonomic provision in rest and during exercise were increased sympathetic activity, exceeding those in the control group. Studies indicate a tendency to sympathicotonia patients with gall stones before and after cholecystectomy, which is enhanced adaptive compensatory mechanisms to maintain homeostasis in the body. Identify logical connections between clinical and autonomic indicators will predict flow pattern cholelithiasis before and after cholecystectomy, as well as pick individual therapy for each patient taking into account the autonomic features that can be widely used in practical medicine--not.

  20. 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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  2. How to proceed in patients with carcinoma detected after laparoscopic cholecystectomy.

    Science.gov (United States)

    Frauenschuh, D; Greim, R; Kraas, E

    2000-12-01

    Carcinoma of the gallbladder is a rare disease. Gallbladder carcinoma is detected in less than 1% of all gallstone operations. With the introduction of laparoscopic surgery and the higher acceptance of this technique, gallbladders are now removed much earlier than they used to be. With the increase of cholecystectomies, the diagnosis of unexpected gallbladder carcinoma became more frequent. We report on how to proceed in patients with a diagnosis of gallbladder carcinoma and discuss the additional problems that have arisen since laparoscopic cholecystectomy became established. From June 1990 to December 1999, we performed 6230 cholecystectomies in the surgical department of Moabit Hospital in Berlin. Of these, 42 (0.6%) were identified as carcinoma. There were 37 women and five men, and the mean age was 69 years. In 16 patients (39%), there was a preoperative suspicion of malignancy. In 26 patients (61%), malignancy was suspected intraoperatively or diagnosed postoperatively after pathologic examination of the resected gallbladder. In these patients, an open repeat operation was necessary in seven cases to achieve an adequate curative resection and staging. This involved additional liver bed resection and lymph node dissection of the hepatoduodenal ligament. Abdominal wall (port site) recurrence in the absence of distant metastasis was present only in two patients. We recommend removal using a bag in all gallbladders with wall thickening, irregularities, or scleroatrophic calcified gallbladder area. In stage Tis or T1, laparoscopic cholecystectomy is sufficient. In stage T2 and T3, we perform a repeat operation with liver bed resection and lymphadenectomy.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  4. 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.

  5. Global sea-level rise is recognised, but flooding from anthropogenic land subsidence is ignored around northern Manila Bay, Philippines.

    Science.gov (United States)

    Rodolfo, Kelvin S; Siringan, Fernando P

    2006-03-01

    Land subsidence resulting from excessive extraction of groundwater is particularly acute in East Asian countries. Some Philippine government sectors have begun to recognise that the sea-level rise of one to three millimetres per year due to global warming is a cause of worsening floods around Manila Bay, but are oblivious to, or ignore, the principal reason: excessive groundwater extraction is lowering the land surface by several centimetres to more than a decimetre per year. Such ignorance allows the government to treat flooding as a lesser problem that can be mitigated through large infrastructural projects that are both ineffective and vulnerable to corruption. Money would be better spent on preventing the subsidence by reducing groundwater pumping and moderating population growth and land use, but these approaches are politically and psychologically unacceptable. Even if groundwater use is greatly reduced and enlightened land-use practices are initiated, natural deltaic subsidence and global sea-level rise will continue to aggravate flooding, although at substantially lower rates.

  6. A COMPARATIVE STUDY OF POST-CHOLECYSTECTOMY COMPLICATIONS AMONG PATIENTS WITH AND WITHOUT DRAIN

    Directory of Open Access Journals (Sweden)

    Anindita Bhar

    2016-06-01

    Full Text Available BACKGROUND The disease of gallbladder is one of the most common abdominal ailment encountered by the surgeons since ancient times for which cholecystectomy is the most commonly performed operation. In the late 19 th century, first successful open cholecystectomy was performed by Carl Langenbuch using aseptic technique, thereafter in the last 100 years, open cholecystectomy has remained the gold standard for definitive management of symptomatic cholelithiasis. It was a common practice to give a routine drain in each and every case of cholecystectomy, but Spivak and many other authors have advocated operation without drain which has dramatically reduced postoperative morbidity and hospital stay. AIM The aim of the study was to compare the postoperative complications such as pain, wound infection, respiratory complications, and incidence of postoperative thrombophlebitis, subhepatic collection and length of hospital stay in patients who have undergone open cholecystectomy with drain with those without drain. DESIGN This is a prospective longitudinal interventional study. MATERIALS AND METHODS This study was done in 70 patients admitted for cholecystectomy operation in Surgery Department of Midnapore Medical College. 35 of them selected randomly were assigned as Group A who were given a postoperative drain and rest 35 patients assigned Group B were without drain. The presence of postoperative complications such as pain, wound infection, respiratory complications (cough, breathing difficulty, pneumonitis, and pulmonary embolism, thrombophlebitis, subhepatic collection and length of hospital stay were compared between the two groups. RESULT 91.42% patients of Group A had a significant pain compared to 51.42% patients of Group B. Wound infection and respiratory complications were present in 14.28% cases of Group A as against 5.71% cases in Group B. Fever was present in 42.85%, thrombophlebitis in 25.71% and subhepatic collection in 28.57% of patients

  7. STUDY OF CHANGES IN COAGULATION PROFILE OF PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY USING CARBON DIOXIDE PNEUMOPERITONEUM

    Directory of Open Access Journals (Sweden)

    Vasuki Rajam

    2017-04-01

    Full Text Available BACKGROUND Laparoscopic cholecystectomy is now the gold standard procedure and with over 5,00,000 procedures being done annually, laparoscopic cholecystectomy assumes a great significance in general surgical specialty. This study aims to study the effects of carbon dioxide pneumoperitoneum on the coagulation system of patients undergoing laparoscopic cholecystectomy and make the surgeon aware of the detrimental effects. MATERIALS AND METHODS A prospective clinical observational study of 50 patients selected by systematic sampling method from January 2015 to September 2015 at our institution was conducted to determine the results of changes in coagulation profile of patients undergoing laparoscopic cholecystectomy using carbon dioxide pneumoperitoneum. RESULTS The mean prothrombin time of the patients before surgery is 11.83 seconds. The standard deviation was 1.008 and standard error of mean was 0.143. The mean of prothrombin time 6 hours after surgery was 11.7 seconds. The standard deviation was 0.898 and the standard error of mean being 0.127. The difference in the mean between the two groups was 0.130. The p-value was 0.0109 (<0.05. Hence, the value was statistically extremely significant. The values for D-dimer were analysed. The mean value of D-dimer before surgery is 129.78. The standard deviation was 21.01 and standard error of mean was at 2.97. In the D-dimer values after surgery, mean was calculated to be 350.22 with the standard deviation at 73.21 and standard error of mean at 10.35. CONCLUSION Our study concluded that there is activation of both coagulation and fibrinolytic systems post laparoscopic cholecystectomy.

  8. 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.

  9. 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.

  10. 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.

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

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    Prasad A

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Po-Nien Chen

    2016-01-01

    Full Text Available 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.

  13. Preliminary experience with laparoscopic cholecystectomy in a nigerian teaching hospital.

    Science.gov (United States)

    Afuwape, O O; Akute, O O; Adebanjo, A T

    2012-01-01

    Presently many centers have facilities for laparoscopic surgery in Nigeria, but the practice is just evolving in most of these centers. This article presents the preliminary experience of the endoscopic surgery unit (general surgery) at the University College Hospital Ibadan Nigeria. The University College Hospital is the premier Nigerian teaching hospital and is located in the south-western part of the country. All the patients who had laparoscopic cholecystectomy at the University College Hospital between June 2009 and January 2011 were included in this study. The patients' demographic data, diagnosis, results of investigations and intra-operative findings were obtained from the records. Additional information extracted from the records was the duration of surgery, complications, outcome and discharge periods. There were thirteen patients over the twenty month period consisting of twelve females and one male. The age range was twenty six to sixty seven years with a mean of 44.6 years. The duration of surgery ranged from 90 to 189 minutes with a mean of 124 minutes. There were two complications. These were adhesive bowel obstruction and common bile duct injury. The duration of admission ranged from four to thirty two days with a mean of 7.53SD ± 8.5 days. There was one conversion to open surgery due to intra-operative gallbladder perforation with consequent dispersal of multiple gall stones within the peritoneal cavity. The common bile duct injury was diagnosed four days following surgery for which a choledochojejunostomy was done after initial conservative treatment. There was no mortality. Laparoscopic surgery is feasible in Nigeria and is likely to show increasing popularity among patients and surgeons. A careful patient selection protocol is necessary for an acceptable success rate with minimal complications. Our protocol of patient selection eliminated the need for intra-operative common bile duct exploration which requires expensive instruments. However, to

  14. Surgical management of acute cholecystitis. Results of a nation-wide survey among Spanish surgeons.

    Science.gov (United States)

    Badia, Josep M; Nve, Esther; Jimeno, Jaime; Guirao, Xavier; Figueras, Joan; Arias-Díaz, Javier

    2014-10-01

    There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals.

  15. Liver Involvement with Acute Myeloid Leukemia

    Directory of Open Access Journals (Sweden)

    Emily Mathews

    2008-03-01

    Full Text Available Liver involvement with acute myeloid leukemia (AML is rarely reported. The majority of published cases suggest a cholestatic picture and obstructive jaundice at presentation. On the contrary, our patient presented with transaminitis without cholestasis. Elevated liver function tests persisted in our patient despite cholecystectomy; however, they normalized with chemotherapy administration, suggesting that AML was the causative effect of the hepatitis-like picture. Our review of the literature revealed that most reported cases of AML with liver involvement had short-lived remissions and an overall ominous prognosis. In our opinion, patients who have liver involvement with AML should be offered alternative investigational therapies with a low hepatic toxicity profile.

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  17. Left-sided gallbladder (Sinistroposition encountered during laparoscopic cholecystectomy: A rare case report and review of the literature

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    Menelaos Zoulamoglou

    2017-01-01

    Conclusion: Surgeons, by placing the patient to left-side up position, are able to expose the Calot’s triangle and possible accompanying anatomical anomalies and thus perform a safe laparoscopic cholecystectomy without difficult surgical modifications.

  18. Increased Risk of Pancreatic Cancer Related to Gallstones and Cholecystectomy: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Fan, Yonggang; Hu, Jie; Feng, Bing; Wang, Wei; Yao, Guoliang; Zhai, Jingming; Li, Xin

    2016-04-01

    To investigate the potential roles of gallstones and cholecystectomy in pancreatic carcinogenesis, we performed the first meta-analysis of all currently published studies by pooling relative risks (RRs) with 95% confidence intervals (95% CIs). Stratified analysis by ethnicity, study design, and common adjusted factors were also conducted. Individuals with a history of gallstones and cholecystectomy were at increased risk of pancreatic cancer (RR, 1.39; 95% CI, 1.28-1.52; P pancreatic cancer, respectively (for gallstones: RR, 1.70; 95% CI, 1.30-2.21; P pancreatic cancer was independent of confounders including diabetes, obesity, smoking, and follow-up years of postcholecystectomy. A history of gallstones and cholecystectomy is a robust risk factor for pancreatic cancer. Gallstone disease or cholecystectomy alone is also an independent risk factor for pancreatic carcinogenesis.

  19. Anesthetic management of patient with systemic lupus erythematosus and antiphospholipid antibodies syndrome for laparoscopic nephrectomy and cholecystectomy

    Science.gov (United States)

    Khokhar, Rashid Saeed; Baaj, Jumana; Al-Saeed, Abdulhamid; Sheraz, Motasim

    2015-01-01

    We report a case of a female having systemic lupus erythematosus and antiphospholipid antibodies syndrome, who was on immunosuppressant therapy. We discussed the preoperative evaluation and perioperative management who underwent nephrectomy and cholecystectomy. PMID:25558207

  20. Anesthetic management of patient with systemic lupus erythematosus and antiphospholipid antibodies syndrome for laparoscopic nephrectomy and cholecystectomy

    Directory of Open Access Journals (Sweden)

    Rashid Saeed Khokhar

    2015-01-01

    Full Text Available We report a case of a female having systemic lupus erythematosus and antiphospholipid antibodies syndrome, who was on immunosuppressant therapy. We discussed the preoperative evaluation and perioperative management who underwent nephrectomy and cholecystectomy.

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

    Science.gov (United States)

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

    2016-09-01

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

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

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    Theodoros Mariolis-Sapsakos

    2017-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Uivaroşan Diana

    2015-07-01

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

  4. Acute Calculous Cholecystitis: What is new in diagnosis and therapy?

    Directory of Open Access Journals (Sweden)

    Dirk J. Gouma

    1992-01-01

    Full Text Available The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce.

  5. Effects of aging on the novelty P3 during attend and ignore oddball tasks.

    Science.gov (United States)

    Friedman, D; Kazmerski, V A; Cycowicz, Y M

    1998-09-01

    The effects of attention were assessed on novelty P3 amplitude and scalp distribution elicited by environmental sounds in young and elderly volunteers who participated in either actively attended or ignored oddball conditions. For the young, novelty P3 amplitude decreased with time on task during both attend and ignore sequences. Amplitude decrements were greatest at frontal sites during the attend condition, but at all sites during the ignore condition. A reliable amplitude decrement was not observed for the elderly in either the attend or ignore oddball series. The data suggest that attention differentially activates multiple generators that contribute to scalp-recorded novelty P3 activity. The lack of novelty P3 habituation seen in the elderly is consistent with changes in frontal lobe function as age increases.

  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. Cholecystocolonic fistula mimicking acute cholecystitis diagnosed unequivocally by computed tomography.

    Science.gov (United States)

    Chick, Jeffrey Forris Beecham; Chauhan, Nikunj Rashmikant; Paulson, Vera Ashley; Adduci, Alexander J

    2013-12-01

    Cholecystocolonic fistula is an uncommon potential complication of cholecystitis found intraoperatively in 0.06-0.14 % of patients undergoing cholecystectomy and 0.1-0.5 % of autopsy series. Although cholecystocolonic fistula is the second most common cholecystoenteric fistula, second only to cholecystoduodenal fistula, it is diagnosed preoperatively in only 7.9 % of patients. Failure to preoperatively diagnose cholecystocolonic fistula places surgeons in precarious positions, as they may be forced to convert a seemingly routine cholecystectomy to a more sophisticated procedure coupled with adhesiolysis, colonic suturing, or colonic resection. We report a young patient who presented to the emergency department with complaints indicative of acute cholecystitis; however, preoperative ultrasound was suggestive of a cholecystoenteric fistula. Computed tomography and pathology were pathognomonic with clear visualization of the cholecystocolonic fistulous tract.

  8. Laparoscopic Cholecystectomy for Acute Cholecystitis: The Evolving Trend in an Institution

    Directory of Open Access Journals (Sweden)

    Chun Han Chau

    2006-07-01

    Conclusion: LC for AC is safe and effective and associated with a low incidence of complications when routinely applied by surgical residents. The conversion rate is related to operators' surgical experience.

  9. Acute and chronic pancreatitis: surgical management.

    Science.gov (United States)

    Dzakovic, Alexander; Superina, Riccardo

    2012-08-01

    Pancreatitis is becoming increasingly prevalent in children, posing new challenges to pediatric health care providers. Although some general adult treatment paradigms are applicable in the pediatric population, diagnostic workup and surgical management of acute and chronic pancreatitis have to be tailored to anatomic and pathophysiological entities peculiar to children. Nonbiliary causes of acute pancreatitis in children are generally managed nonoperatively with hydration, close biochemical and clinical observation, and early initiation of enteral feeds. Surgical intervention including cholecystectomy or endoscopic retrograde cholangiopancreatography is often required in acute biliary pancreatitis, whereas infected pancreatic necrosis remains a rare absolute indication for pancreatic debridement and drainage via open, laparoscopic, or interventional radiologic procedure. Chronic pancreatitis is characterized by painful irreversible changes of the parenchyma and ducts, which may result in or be caused by inadequate ductal drainage. A variety of surgical procedures providing drainage, denervation, resection, or a combination thereof are well established to relieve pain and preserve pancreatic function.

  10. Cholecystectomy During the Weekend Increases Patients' Length of Hospital Stay

    DEFF Research Database (Denmark)

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

    2016-01-01

    30 days between week time and weekend time. A longer postoperative length of stay was observed for patients operated on Fridays and Saturdays even though surgical complication rates were alike between weekdays. Patients with acute cholecystitis had a longer length of stay on Saturdays. CONCLUSION: We...

  11. 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

  12. 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

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

  13. 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.

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

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    Kamil Gulpinar

    2011-01-01

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

  15. 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.

  16. [THE REMOTE RESULTS OF SIMULTANEOUS LAPAROSCOPIC CORRECTION OF CHRONIC DUODENAL OBSTRICTION AND CHOLECYSTECTOMY IN CHOLELITHIASIS].

    Science.gov (United States)

    Isayev, H; Hachverdiyev, B

    2016-05-01

    The aim of the research was to investigate the remote results of surgical treatment of 75 patients with cholelithiasis combined with chronic duodenal obstruction. Control group was composed of 40 patients who underwent laparoscopic cholecystectomy. Compensated stage of cholelithiasis with chronic duodenal obstruction was detected in 16 (21.3%) patients, subcompensated in 37 (49.3%) and decompensated stage in 17 (22.7%) patients. In 14 patients (18.7%) with cholelithiasis combined with chronic duodenal obstruction laparoscopic cholecystectomy was conducted due to the positive results of preoperative conservative treatment. In the long-term quality of life after surgery in the main group of patients were average 35.4% higher than in the control group; in the main group postcholecystectomical syndrome was diagnosed in one case (2,1%) and in 13 (32,2%) cases in the control group.

  17. 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

    performed in all patients, and stone extraction was successfully performed in 29 patients (93%) with 2 failures (7%) due to impacted stones. In 8 patients (26%), the laparoscopic procedure was converted to open cholecystectomy because of dense adhesions or unclear anatomy. Two patients (7%) developed mild......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...

  18. 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....

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

    Directory of Open Access Journals (Sweden)

    Grigoris Chatzimavroudis

    2012-01-01

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

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

    Science.gov (United States)

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

    2001-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Tian-Xue Wen; Hao Wang

    2016-01-01

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

  2. Porcine cadaver organ or virtual-reality simulation training for laparoscopic cholecystectomy: a randomized, controlled trial.

    Science.gov (United States)

    Van Bruwaene, Siska; Schijven, Marlies P; Napolitano, Daniel; De Win, Gunter; Miserez, Marc

    2015-01-01

    As conventional laparoscopic procedural training requires live animals or cadaver organs, virtual simulation seems an attractive alternative. Therefore, we compared the transfer of training for the laparoscopic cholecystectomy from porcine cadaver organs vs virtual simulation to surgery in a live animal model in a prospective randomized trial. After completing an intensive training in basic laparoscopic skills, 3 groups of 10 participants proceeded with no additional training (control group), 5 hours of cholecystectomy training on cadaver organs (= organ training) or proficiency-based cholecystectomy training on the LapMentor (= virtual-reality training). Participants were evaluated on time and quality during a laparoscopic cholecystectomy on a live anaesthetized pig at baseline, 1 week (= post) and 4 months (= retention) after training. All research was performed in the Center for Surgical Technologies, Leuven, Belgium. In total, 30 volunteering medical students without prior experience in laparoscopy or minimally invasive surgery from the University of Leuven (Belgium). The organ training group performed the procedure significantly faster than the virtual trainer and borderline significantly faster than control group at posttesting. Only 1 of 3 expert raters suggested significantly better quality of performance of the organ training group compared with both the other groups at posttesting (p groups at retention testing. The virtual trainer group did not outperform the control group at any time. For trainees who are proficient in basic laparoscopic skills, the long-term advantage of additional procedural training, especially on a virtual but also on the conventional organ training model, remains to be proven. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Sonal S Khatavkar

    2016-01-01

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

  4. Effect of Clonidine on Hemodynamic Responses During Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Zhang, Yi; Zhang, Xi; Wang, Yu; Zhang, Jiefeng

    2017-10-01

    Clonidine might be beneficial to the patients undergoing laparoscopic cholecystectomy. This meta-analysis focused on the influence of clonidine on hemodynamic responses in patients undergoing laparoscopic cholecystectomy. We searched several databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases. This meta-analysis included randomized controlled trials regarding the influence of clonidine versus placebo on laparoscopic cholecystectomy. The primary outcomes were mean arterial pressure (MAP) and heart rate (HR) at pneumoperitoneum. The random-effect model was applied for this study. Compared with control intervention, clonidine intervention was found to significantly reduce the MAP at pneumoperitoneum [standard mean difference=-2.58; 95% confidence interval (CI),-4.63 to -0.53; P=0.01), HR at pneumoperitoneum (standard mean difference=-3.67; 95% CI, -6.57 to -0.76; P=0.01), MAP at intubation (standard mean difference=-2.40; 95% CI, -4.75 to -0.06; P=0.04), HR at intubation (standard mean difference=-3.39; 95% CI, -5.75 to -1.02; P=0.005), propofol requirement (standard mean difference=-2.25; 95% CI, -4.01 to -0.48; P=0.01), as well as postoperative nausea and vomiting (risk ratio, 0.35; 95% CI, 0.19-0.63; P=0.0005). Compared with control intervention, clonidine intervention was found to significantly reduce MAP and HR at pneumoperitoneum and intubation, propofol requirement, as well as postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.

  5. Safety of laparoscopic adjustable gastric banding with concurrent cholecystectomy for symptomatic cholelithiasis.

    Science.gov (United States)

    Obeid, Nabeel R; Kurian, Marina S; Ren-Fielding, Christine J; Fielding, George A; Schwack, Bradley F

    2015-05-01

    The prevalence of cholelithiasis correlates with obesity. Patients often present for bariatric surgery with symptomatic cholelithiasis. There is a concern of cross-contamination when performing laparoscopic adjustable gastric banding (LAGB) with concurrent cholecystectomy. The primary goal of this study is to address the safety and feasibility of this practice. A retrospective cohort study was designed from a prospectively collected database. All LAGB patients from July 2005 to April 2013 were included. Patients undergoing LAGB with concurrent cholecystectomy comprised the study group (LAGB/chole). The control group (LAGB) consisted of patients undergoing LAGB alone, and was selected using a 3:1 (control:study) case-match based on demographic and comorbidity data. The primary outcome was overall complication rate, with secondary outcomes including operating room (OR) time, length of stay (LOS), 30-day readmission/reoperation, erosion, infection, and band/port revisional surgery. There were 4,982 patients who met criteria. Of these, 28 patients had a LAGB with concurrent cholecystectomy, comprising the LAGB/chole (study) group. The remaining 4,954 patients were eligible controls, of which 84 were selected for the LAGB (control) group. Demographic and comorbidity data, along with mean follow-up time, were similar between the two groups. OR time was longer in the LAGB/chole group, but LOS was the same. The overall complication rate in the LAGB/chole group was 21 (n = 6) versus 20% (n = 17) in the LAGB group (p = 0.893). Thirty-day readmission and reoperation were similar. There was also no difference in port site, wound, and intra-abdominal infections. There were no band erosions in either group. Performing a concurrent cholecystectomy at the time of LAGB does not result in increased immediate or delayed morbidity. Although longer to perform, this safe operation would avoid a second surgery for a patient already diagnosed with symptomatic cholelithiasis.

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

    OpenAIRE

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2012-11-01

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

  8. Multimedia article. The fear of transgastric cholecystectomy: misinterpretation of the biliary anatomy.

    Science.gov (United States)

    Perretta, Silvana; Dallemagne, Bernard; Donatelli, Gianfranco; Mutter, Didier; Marescaux, Jacques

    2011-02-01

    Prevention of injury during cholecystectomy relies on accurate dissection of the cystic duct and artery and avoidance of major biliary and vascular structures. The advent of natural orifice translumenal surgery (NOTES) has led to a new look into the biliary anatomy, especially Calot's triangle. Here we show the clinical case of a NOTES transgastric cholecystectomy for uncomplicated cholelithiasis, in which misinterpretation of the biliary anatomy occurred. A 5-mm port was introduced at the umbilicus to ascertain the feasibility of transgastric cholecystectomy and to ensure safe gastrotomy creation and closure. Transgastric access was obtained using a percutaneous endoscopic gastrostomy (PEG)-like technique on the anterior mid body of the stomach to pass a 12-mm gastroscope (Karl Storz, Tuttlingen, Germany). The laparoscope was switched to a grasper for gallbladder retraction. Dissection was started close to the gallbladder using the endoscope at the junction between the infundibulum and what was thought to be the cystic duct. During dissection, the size and the orientation of the cystic duct appeared to be unclear. The decision was made to switch to a laparoscopic view to reorient the dissection plane and clarify the anatomy. At laparoscopy, dissection of the triangle of Calot, although started close to the gallbladder, appeared far too low. The common bile duct had been mistaken for the cystic duct. Once the biliary anatomy was clarified, the vision was switched back to the endoscope, but an additional 2-mm grasper was introduced to improve exposure while cholecystectomy was performed in a standard fashion. Specific anatomic distortions due to NOTES technique together with the lack of exposure provided by current methods of retraction tend to distort Calot's triangle by flattening it rather than opening it out. At this stage, whenever the anatomy of the biliary tract is unclear, a temporary "conversion" to a laparoscopic view, more familiar to the surgeon's eye

  9. 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

  10. 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...

  11. Passionate ignorance

    DEFF Research Database (Denmark)

    Hyldgaard, Kirsten

    2006-01-01

    , it is what makes education not work or at least what comes as a fundamental surprise, what makes plans, methods, ideas about ‘best practice', ideas about ‘what works' powerless.  This also implies a correspondence between distinguishing analysis and therapy on the one hand and distinguishing pedagogy...... be a science, rather, a question of and for philosophy; any scientific theory excludes the possibility of thinking the question of what is a subject. However, the question of the subject is not the exclusive province of philosophy. Being a theory of the subject, and as a clinical practice its purpose is to let...... the subject speak, psychoanalysis allows us to identify the essential distinction between pedagogy on the one hand and educational, didactical theory on the other hand. Psychoanalysis and pedagogical philosophy may contribute to the analysis of why educational practice is and always will be haunted...

  12. Ignorance Radicalized

    Directory of Open Access Journals (Sweden)

    Gergo Somodi

    2009-12-01

    Full Text Available The aim of this paper is twofold. I criticize Michael Devitt's linguistic---as opposed to Chomsky's psychological---conception of linguistics on the one hand, and I modify his related view on linguistic intuitions on the other. I argue that Devitt's argument for the linguistic conception is in conflict with one of the main theses of that very conception, according to which linguistics should be about physical sentence tokens of a given language rather than about the psychologically real competence of native speakers. The basis of this conflict is that Devitt's view on language, as I will show, inherits too much from the criticized Chomskian view. This is also the basis of Devitt's strange claim that it is the linguist, and not the ordinary speaker, whose linguistic intuition should have an evidential role in linguistics. I will argue for the opposite by sketching a view on language that is more appropriate to the linguistic conception. That is, in criticizing Devitt, I am not defending the Chomskian approach. My aim is to radicalize Devitt's claims.

  13. Passionate ignorance

    DEFF Research Database (Denmark)

    Hyldgaard, Kirsten

    2006-01-01

    the subject speak, psychoanalysis allows us to identify the essential distinction between pedagogy on the one hand and educational, didactical theory on the other hand. Psychoanalysis and pedagogical philosophy may contribute to the analysis of why educational practice is and always will be haunted...

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

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    Hüseyin Özer

    2013-07-01

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

  15. 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

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

    Science.gov (United States)

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

    1995-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Del monaco Pamela

    2009-11-01

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

  18. Extra-biliary complications during laparoscopic cholecystectomy: How serious is the problem?

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    Malik Arshad

    2008-01-01

    Full Text Available Objective: To deteremine the incidence, nature and management of extra-biliary complications of laparoscopic cholecystectomy. Materials and Methods: This study presents a retrospective analysis of extra-biliary complications occuring during 1046 laparoscopic cholecystectomies performed from August 2003 to December 2006. The study population included all the patients with symptomatic gallstone disease in whom laparoscopic cholecystectomy was performed. The extra-biliary complications were divided into two distinct categories: (i Procedure related and (ii Access related. Results: The incidence of access-related complications was 3.77% and that of procedure-related complications was 6.02%. Port-site bleeding was troublesome at times and demanded a re-do laparoscopy or conversion. Small bowel laceration occurred in two patients where access was achieved by closed technique. Five cases of duodenal and two of colonic perforations were the major complications encountered during dissection in the area of Calot′s triangle. In 21 (2% patients the procedure was converted to open surgery due to different complications. Biliary complications occurred in 2.6% patients in the current series. Conclusion: Major extra-biliary complications are as frequent as the biliary complications and can be life-threatening. An early diagnosis is critical to their management.

  19. [Reduction of omalgia in laparoscopic cholecystectomy: clinical randomized trial ketorolac vs ketorolac and acetazolamide].

    Science.gov (United States)

    Figueroa-Balderas, Lorena; Franco-López, Francisco; Flores-Álvarez, Efrén; López-Rodríguez, Jorge Luis; Vázquez-García, José Antonio; Barba-Valadez, Claudia Teresa

    2013-01-01

    Laparoscopy cholecystectomy for the surgical treatment of cholelithiasis has been considered the gold standard. The referred pain to the shoulder (omalgia) may be present to 63% of the patients and limits outpatient management. The study was to evaluate the usefulness of acetazolamide associated with ketorolac for reduction of the omalgia to minimally invasive treatment. We performed a clinical trial, randomized, double blind in patients undergoing laparoscopic cholecystectomy to assess the reduction of post-operative omalgia comparing ketorolac and ketorolaco+acetazolamida. 31 patients in each group were studied. The study group: 250 mg of acetazolamide before anesthetic induction and 30 mg of ketorolac in the immediate postoperative period. one tablet of placebo prior to the anesthetic induction and 30 mg of ketorolac in the immediate postoperative. The presence of omalgia was assessed using the analog visual scale. The variables recorded included: age, sex, flow of carbon dioxide intra-abdominal pressure, surgical time, urgent or elective surgery, omalgia, severity of pain evaluated by analog visual scale, addition analgesia. Both groups were homogeneous and statistical analysis showed no differences in the variables studied. The omalgia in the study group was presented at 9.67% and in the group control was the 58.06% (p < 0.001). 250 mg oral acetazolamide associated 30 mg of ketorolac reduces significantly the development of omalgia in patients undergoing laparoscopic cholecystectomy.

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

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    M. G. Clarke

    2011-01-01

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