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Sample records for laparoscopic subtotal cholecystectomy

  1. 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

  2. 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

  3. Sex differences in laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

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

    2010-01-01

    Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document...... the relationship of gender to conversion rate and length of hospital stay after laparoscopic cholecystectomy in a national cohort of patients....

  4. 复杂胆囊结石患者行腹腔镜胆囊次全切除术的临床疗效观察%Clinical curative effect observation of laparoscopic subtotal cholecystectomy in patients with complicated gallstone

    Institute of Scientific and Technical Information of China (English)

    邓强

    2015-01-01

    Objective:To explore the clinical effect of laparoscopic subtotal cholecystectomy in patients with complicated gallstone.Methods:40 patients with complicated gallstone were selected.They were randomly divided into two groups.The control group were given conventional operation treatment,and the observation group were given laparoscopic subtotal cholecystectomy. The clinical effects of two groups were compared.Results:The operation time,intraoperatve blood soss and hospitalization time of the observation group were better than those of the control group(P<0.05).Conclusion:The patients with complicated gallstone are given laparoscopic subtotal cholecystectomy in clinic.It can not only shorten the hospitalization time,reduce the intraoperatve blood soss,but also can improve the treatment effect,and improve the life quality of patients.%目的:探析复杂胆囊结石患者行腹腔镜胆囊次全切除术的临床效果。方法:收治复杂胆囊结石患者40例,随机分为两组,对照组给予常规手术治疗,观察组给予腹腔镜胆囊次全切术,对比两组治疗效果。结果:观察组的手术时间、术中出血量以及住院时间均优于对照组(P<0.05)。结论:临床上对复杂胆囊结石患者行腹腔镜胆囊次全切术,不仅可以缩短住院时间、降低术中出血量,还能提高治疗效果,改善患者的生活质量。

  5. MODIFIED LAPAROSCOPIC CHOLECYSTECTOMY

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

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

  6. 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...

  7. 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...

  8. Therapy of umbilical hernia during laparoscopic cholecystectomy.

    Science.gov (United States)

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

    2013-09-01

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

  9. 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 ...

  10. Laparoscopic subtotal colectomy for colonic inertia.

    Science.gov (United States)

    Sample, Cliff; Gupta, Rohit; Bamehriz, Fahad; Anvari, Mehran

    2005-01-01

    Colonic inertia is an uncommon condition, usually occurring in women in the third decade of life. Severity of symptoms may lead some patients to a surgical consultation. This is a retrospective review of 14 patients who underwent laparoscopic subtotal colectomy for colonic inertia, performed by a single surgeon from August 1993 to November 2002. The mean age of the patients was 38.5 years (range 26-50 years); 93% of the patients were women. The common presenting symptoms included abdominal pain (93%), bloating (100%), constipation (100%), and nausea (57%). Median duration of symptoms before surgery was 4.5 years (range 1-30 years). Subtotal colectomy was completed laparoscopically in 13 patients. There was one conversion (7%) because of adhesions. Eleven patients (78.6%) had undergone previous abdominal surgery. The mean operating room time was 153 minutes (range 113-210 minutes). The median time to full bowel action was 2 days. One patient developed postoperative small bowel obstruction that required open exploration. Complete follow-up was available for 11 patients at a median follow-up of 18 months (range 2-96 months). Ninety-one percent of the patients reported excellent satisfaction with surgery, and their bowel movement frequency changed from 1.2 (+/-0.2) per week preoperatives to 17.2 (+/-2.9) per week postoperatively (P relief in patients with colonic inertia who do not respond to medical measures.

  11. Laparoscopic retrograde (fundus first cholecystectomy

    Directory of Open Access Journals (Sweden)

    Kelly Michael D

    2009-12-01

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

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. 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...

  17. 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....

  18. 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.

  19. 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

  20. 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

  1. 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....

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. Clinical effect of laparoscopic surgery in treatment of common bile duct stones after subtotal gastrectomy

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    LEI Ting

    2017-08-01

    Full Text Available ObjectiveTo investigate the safety and feasibility of laparoscopic surgery in the treatment of common bile duct stones after subtotal gastrectomy. MethodsA retrospective analysis was performed for the clinical data of 46 patients with gallstones and common bile duct stones after subtotal gastrectomy who underwent surgical treatment in Luoyang Central Hospital Affiliated to Zhengzhou University from January 2010 to October 2016. Among these patients, 25 underwent laparoscopic cholecystectomy+common bile duct exploration (laparoscopic group, and 21 underwent open cholecystectomy+common bile duct exploration (open group. The surgical conditions and postoperative complications were compared between the two groups. 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. ResultsNo patients died during the perioperative period and 2 patients (8.0% in the laparoscopic group were converted to open surgery. There were significant differences between the laparoscopic group and the open group in time to ambulation after surgery (1.2±0.6 d vs 2.4±1.2 d, t=4.395, P<0.001, time to passage of gas by anus after surgery (1.8±0.5 d vs 2.8±0.8 d, t=5.168, P<0.001, and length of postoperative hospital stay (5.2±1.1 d vs 7.5±2.3 d, t=4.439, P<0.001. There were no significant differences between the two groups in time of operation, intraoperative blood loss, hospital costs, T tube placement, and rate of residual stones (all P>0.05. After surgery, 2 patients (8.0% in the laparoscopic group and 3 (14.3% in the open group experienced complications, and there was no significant difference between the two groups (P=0.495. ConclusionLaparoscopic surgery is safe and feasible in the treatment of common bile duct stones after subtotal gastrectomy and has the advantages of minimally invasive surgery.

  7. 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 ...

  8. 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.

  9. Laparoskopisk subtotal kolecystektomi ved kompliceret galdestenssygdom

    DEFF Research Database (Denmark)

    Semenisina, Galina; Rosenberg, Jacob; Gögenur, Ismail

    2010-01-01

    In laparoscopic cholecystectomy conversion to open surgery occurs. Patients who would otherwise need conversion can benefit from laparoscopic subtotal cholecystectomy (LSC). We present a review of studies in which outcome after LSC has been investigated. The results show reduced conversion rates,...

  10. 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.

  11. 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.

  12. Laparoscopic cholecystectomy: Rate and predictors for conversion

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    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.

  13. Critical View of Safety During Laparoscopic Cholecystectomy

    OpenAIRE

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

    2011-01-01

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

  14. 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.)

  15. 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

  16. 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

  17. 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

  18. Laparoscopic Cholecystectomy During Abdominoplasty: Case Report

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    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

  19. Preemptive analgesia with ketamine for laparoscopic cholecystectomy

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    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.

  20. 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

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

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    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.

  2. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Chia-Jen Wu

    2015-02-01

    Full Text Available According to a nation-wide population-based study in Taiwan, along with the expanding concepts and surgical techniques of minimally invasive surgery, laparoscopic supracervical/subtotal hysterectomy (LSH has been blooming. Despite this, the role of LSH in the era of minimally invasive surgery remains uncertain. In this review, we tried to evaluate the perioperative and postoperative outcomes of LSH compared to other types of hysterectomy, including total abdominal hysterectomy (TAH, vaginal hysterectomy, laparoscopic-assisted vaginal hysterectomy, and total laparoscopic hysterectomy (TLH. From the literature, LSH has a better perioperative outcome than TAH, and comparable perioperative complications compared with laparoscopic-assisted vaginal hysterectomy. LSH had less bladder injury, vaginal cuff bleeding, hematoma, infection, and dehiscence requiring re-operation compared with TLH. Despite this, LSH has more postoperative cyclic menstrual bleeding and re-operations with extirpations of the cervical stump. LSH does, however, have a shorter recovery time than TAH due to the minimally invasive approach; and there is quicker resumption of coitus than TLH, due to cervical preservation and the avoidance of vaginal cuff dehiscence. LSH is therefore an alternative option when the removal of the cervix is not strictly necessary or desired. Nevertheless, the risk of further cervical malignancy, postoperative cyclic menstrual bleeding, and re-operations with extirpations of the cervical stump is a concern when discussing the advantages and disadvantages of LSH with patients.

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

    Science.gov (United States)

    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.

  4. COMPARATIVE ANALYSIS OF TRAUMA REDUCTION TECHNIQUES IN LAPAROSCOPIC CHOLECYSTECTOMY

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    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.

  5. [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.

  6. 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.

  7. 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.

  8. 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...

  9. 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....

  10. 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...

  11. Ambulatory laparoscopic cholecystectomy: A single center experience

    Directory of Open Access Journals (Sweden)

    Cagri Tiryaki

    2016-01-01

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

  12. 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.

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

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    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.

  14. 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.

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

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    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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  17. Laparoskopisk subtotal kolecystektomi ved kompliceret galdestenssygdom

    DEFF Research Database (Denmark)

    Semenisina, Galina; Rosenberg, Jacob; Gögenur, Ismail

    2010-01-01

    In laparoscopic cholecystectomy conversion to open surgery occurs. Patients who would otherwise need conversion can benefit from laparoscopic subtotal cholecystectomy (LSC). We present a review of studies in which outcome after LSC has been investigated. The results show reduced conversion rates,......, shorter hospital stay, minimal complications and mortality rates. Acute cholecystitis, cirrhosis, Mirrizi syndrome type I are the indications for LSC. Randomized prospective trials are needed to investigate safety and long-term effects....

  18. 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

  19. Biliary leaks after laparoscopic cholecystectomy:timetostentortimetodrain

    Institute of Scientific and Technical Information of China (English)

    Haim Pinkas; Patrick G. Brady

    2008-01-01

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

  20. 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.

  1. 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.

  2. 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.

  3. Laparoscopic and open subtotal colectomies have similar short-term results

    NARCIS (Netherlands)

    Hoogenboom, Froukje J.; Bosker, Robbert J. I.; Groen, Henk; Meijerink, Wilhelmus J. H. J.; Lamme, Bas; Pierie, Jean Pierre E. N.

    2013-01-01

    Background: Laparoscopic subtotal colectomy (STC) is a complex procedure. It is possible that short-term benefits for segmental resections cannot be attributed to this complex procedure. This study aims to assess differences in shortterm results for laparoscopic versus open STC during a 15year

  4. Acceptable short-term outcome of laparoscopic subtotal colectomy for inflammatory bowel disease

    DEFF Research Database (Denmark)

    Frid, Natalie Lassen; Bulut, Orhan; Pachler, Jørn

    2013-01-01

    Laparoscopic colectomy for both benign and malignant disease, including inflammatory bowel disease (IBD), has recently been shown to have many advantages compared with open surgery. This study aimed to compare the effect of laparoscopic versus open subtotal colectomy (STC) for IBD on overall...

  5. Acceptable short-term outcome of laparoscopic subtotal colectomy for inflammatory bowel disease

    DEFF Research Database (Denmark)

    Frid, Natalie Lassen; Bulut, Orhan; Pachler, Jørn

    2013-01-01

    Laparoscopic colectomy for both benign and malignant disease, including inflammatory bowel disease (IBD), has recently been shown to have many advantages compared with open surgery. This study aimed to compare the effect of laparoscopic versus open subtotal colectomy (STC) for IBD on overall...

  6. 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

  7. 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...

  8. 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 ...

  9. 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.

  10. 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

  11. 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

  12. Diarrhea after laparoscopic cholecystectomy: Associated factors and predictors

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

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

    NARCIS (Netherlands)

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

    1998-01-01

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

  15. 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.

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

    NARCIS (Netherlands)

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

    2006-01-01

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

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. 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

  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. 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.

  4. 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.

  5. 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.

  6. [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.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. Emergent laparoscopic cholecystectomy for acute acalculous cholecystitis revisited.

    Science.gov (United States)

    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.

  12. Intraperitoneal hydrocortisone for pain relief after laparoscopic cholecystectomy

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    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.

  13. 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.

  14. 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...

  15. 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

  16. 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...

  17. 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.

  18. 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....

  19. 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.

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

    DEFF Research Database (Denmark)

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

    2002-01-01

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

  1. Laparoscopic cholecystectomy in sickle cell patients in Niger

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    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.

  2. 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.

  3. 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

  4. 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

  5. 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.

  6. 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.

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

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    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

  8. [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).

  9. 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.

  10. Minilaparoscopy-assisted transumbilical laparoscopic cholecystectomy

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    GERALDO JOSÉ DE SOUZA LIMA

    2016-06-01

    Full Text Available ABSTRACT The role of laparoscopy in the modern surgery era is well established. With the prospect of being able to improve the already privileged current situation, new alternatives have been proposed, such as natural orifice endoscopic surgery (NOTES, the method for single transumbilical access (LESS - Laparo-endoscopic single-site surgery and minilaparoscopy (MINI. The technique proposed by the authors uses a laparoscope with an operative channel like the flexible endoscope used in NOTES. All operative times are carried out through the umbilical trocar as in LESS, and assisted by a minilaparoscopy grasper. This new technic combines, and results from, the rationalization of technical particularities and synergy of these three approaches, seeking to join their advantages and minimize their disadvantages.

  11. 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.

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

    Science.gov (United States)

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

    2016-10-01

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

  13. 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.

  14. 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

  15. 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

  16. 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

  17. 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

  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.

    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

  19. Covert Laparoscopic Cholecystectomy: A New Minimally Invasive Technique

    Directory of Open Access Journals (Sweden)

    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.

  20. 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....

  1. 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

  2. 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.

  3. 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...

  4. 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.

  5. 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.

  6. 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).

  7. 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...

  8. 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...

  9. 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...

  10. 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.

  11. 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.

  12. 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...

  13. 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...

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. 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)

  19. 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.

  20. 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.

  1. 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.

  2. 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....

  3. 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.

  4. 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

  5. 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...

  6. 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.

  7. 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

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

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    Ritima Dhir

    2015-01-01

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

  9. 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

  10. 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 ...

  11. 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

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. 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

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

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2014-01-01

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

  16. 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

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. 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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

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

    2014-11-16

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

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

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    Mariana Correia

    2016-04-01

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

  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. 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.

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

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    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.

  7. 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.

  8. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  11. 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.

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

    Science.gov (United States)

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

    2011-04-01

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

  13. 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

  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. [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.

  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. 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

  20. 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

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    Juan Pablo Arroyo

    2012-01-01

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

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

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    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.

  4. 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.

  5. 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.

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

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    Ridipta Sekha

    2016-04-01

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

  7. 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.

  8. Two-Port Laparoscopic Cholecystectomy: 18 Patients Human Experience Using the Dynamic Laparoscopic NovaTract Retractor.

    Science.gov (United States)

    Sucandy, Iswanto; Nadzam, Geoffrey; Duffy, Andrew J; Roberts, Kurt E

    2016-08-01

    The concept of reducing the number of transabdominal access ports has been criticized for violating basic tenets of traditional multiport laparoscopy. Potential benefits of reduced port surgery may include decreased pain, improved cosmesis, less hernia formation, and fewer wound complications. However, technical challenges associated with these access methods have not been adequately addressed by advancement in instrumentations. We describe our initial experience with the NovaTract™ Laparoscopic Dynamic Retractor. A retrospective review of all patients who underwent two-port laparoscopic cholecystectomy between 2013 and 2014 using the NovaTract retractor was performed. The patients were equally divided into three groups (Group A, B, C) based on the order of case performed. Eighteen consecutive patients underwent successful two-port laparoscopic cholecystectomy for symptomatic cholelithiasis. Mean age was 39.9 years and mean body mass index was 28.1 kg/m(2) (range 21-39.4). Overall mean operative time was 65 minutes (range 42-105), with Group A of 70 minutes, Group B of 65 minutes, and Group C of 58 minutes (P = .58). All cases were completed laparoscopically using the retraction system, without a need for additional ports or open conversion. No intra- or postoperative complications were seen. All patients were discharged on the same day of surgery. No mortality found in this series. The NovaTract laparoscopic dynamic retractor is safe and easy to use, which is reflected by acceptable operative time for a laparoscopic cholecystectomy using only two ports. The system allows surgical approach to mimic the conventional laparoscopic techniques, while eliminating or reducing the number of retraction ports.

  9. 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...

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

    Science.gov (United States)

    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

  11. 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

  12. 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.

  13. 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.

  14. 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...

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

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    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.

  16. 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.

  17. 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.

  18. 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

  19. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  3. 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.

  4. 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

  5. Total versus subtotal Laparoscopic Hysterectomy: A comparative study in Arash Hospital

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    Samiei H

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Over the past 50 years, subtotal or supracervical hysterectomy has come to be viewed as a suboptimal procedure reserved for those rare instances in which when concern over blood loss or anatomic distortion dictates limiting the extent of dissection, the aim of this study was to compare total and subtotal laparoscopic hysterectomy. "n"nMethods: The patients who were candidates for hysterectomy with benign disease, with no contraindication for laparoscopic surgery entered the study in Arash Hospital, from March 2007 to April 2009. By simple randomization 45 patients (25 for TLH and 20 for SLH were selected. Demographic Details and intra and post operative complications, were recorded by the staff and were compared between two groups."n"nResults: The average time for TLH operations look significantly longer than SLH operation (148.6±29.7 minutes; 128.5±25.64 minutes, p=0.03. Although, the hemoglobin (gr/dl drop in TLH was significantly higher than SLH (1.54 Versus 0.9, p<0.05 Blood transfusion were common in SLH (1 case Versus 3 Cases. The total length of hospital stay, was significantly shorter after SLH than TLH (3.6±1.47 day and 2.85±0.59, p=0.04. The drug requirements to

  6. A COMPARATIVE STUDY OF EPIDURAL VS. GENERAL ANAESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY

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    Jayadheer D

    2016-07-01

    Full Text Available BACKGROUND Laparoscopic cholecystectomy has many benefits for patients including reduced postoperative pain, postoperative stay, and fewer wound-related complications. Specifically, obese patients and patients with severe respiratory diseases are benefited with laparoscopic procedures. The procedure is normally performed under general anaesthesia. But off late, this procedure was tried under regional successfully especially under epidural anaesthesia. Various reports in the literature suggest the safety of the use of spinal, epidural, and combined spinal-epidural anaesthesia in laparoscopic procedures. The advantages of regional anaesthesia include: Prevention of airway manipulation, an awake and spontaneously breathing patient intraoperatively, minimal nausea and vomiting, effective postoperative analgesia, and early ambulation and recovery. However, regional anaesthesia maybe associated with a few side effects such as the requirement of a higher sensory level, more severe hypotension, shoulder discomfort due to diaphragmatic irritation, and respiratory embarrassment caused by pneumoperitoneum. Further studies maybe required to establish the advantage of regional anaesthesia over general anaesthesia for its eventual global use in different patient populations. METHODS 40 patients with the ASA (American Society of Anaesthesiologists class I and II were enrolled after taking prior written consent for laparoscopic cholecystectomy at King George Hospital, Visakhapatnam. These 40 patients were divided into two groups of equal size and randomised using random numbers. One group was given general anaesthesia and in the other group procedures were performed under epidural anaesthesia. Two patients in the epidural group required general anaesthesia. RESULTS 40 patients were divided and studied of which the results proved that general anaesthesia was better over epidural anaesthesia except for the disadvantages namely cost factor, PONV, and high risk of

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

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    Priyadarshan Anand Jategaonkar

    2014-01-01

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

  8. 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

  9. 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...

  10. 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.

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

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    Jyotsna A Goswami

    2007-01-01

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

  12. [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.

  13. 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.

  14. 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....

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

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    Grigoris Chatzimavroudis

    2012-01-01

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

  16. [Comparison of oncology outcomes and anal function among laparoscopic partial, subtotal and total intersphincteric resection for low rectal cancers].

    Science.gov (United States)

    Zhang, Bin; Liu, Quanlong; Zhao, Yujuan; Zhuo, Guangzuan; Yin, Shuhui; Zhu, Jun; Zhao, Ke; Ding, Jianhua

    2017-08-25

    To compare the oncology outcomes and anal function among laparoscopic partial, subtotal and total intersphincteric resection(ISR) for low rectal cancers. From June 2011 to February 2016, a total of 79 consecutive patients with low rectal cancers underwent laparoscopic ISR with hand-sewn coloanal anastomosis at our department. According to the distal tumor margin, partial ISR (internal sphincter resection at the dentate line) was used to treat tumors with distance anal sphincter (n=28), subtotal ISR was adopted for the tumors locating between the dentate line and intersphincteric groove (n=34), and total ISR (resection at the dentate line) was applied in the treatment of intra-anal tumors (n=17). Anal function was evaluated by a standardized gastrointestinal questionnaire, Wexner incontinence score and Kirwan's classification. Metaphase oncological results and postoperative anal function were compared among three groups, and. Other than the distance of tumor low margin to dentate line (P=0.000) and serum CEA level (P=0.040), no significant differences were noted in baseline data among 3 groups (all P>0.05). The median follow up was 21(8-61) months. The 3-year disease-free survival rates in laparoscopic partial, subtotal and total ISR groups were 91.1%, 88.9%, 88.2% (P=0.901) and the 3-year local relapse-free survival rates were 91.1%, 72.9%, 80.2%(P=0.658), whose all differences were not significant. Thirty-eight patients who did not receive neoadjuvant chemoradiotherapy and underwent ileostomy closure for at least 24 months completed the evaluation of anal function, including 14 cases in partial group, 15 cases in subtotal group and 9 cases in total group. Of 38 patients, 73.7%(28/38) was classified as good function (Wexner incontinence score ≤10) and no patient adopted a colostomy because of severe fecal incontinence(Kirwan classification=grade 5). Furthermore, there were no significant differences in Wexner incontinence score and Kirwan classification among 3

  17. 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...

  18. 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.

  19. 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.

  20. 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...

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

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    Sudheer

    2015-03-01

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

  2. General anesthesia versus segmental thoracic or conventional lumbar spinal anesthesia for patients undergoing laparoscopic cholecystectomy

    Science.gov (United States)

    Yousef, Gamal T.; Lasheen, Ahmed E.

    2012-01-01

    Background: Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. Objective: This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction. Materials and Methods: A total of 90 patients undergoing elective laparoscopic cholecystectomy, between January 2010 and May 2011, were randomized into three equal groups to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under segmental thoracic (TSA group) or conventional lumbar (LSA group) spinal anesthesia or general anesthesia (GA group). To achieve a T3 sensory level we used (hyperbaric bupivacaine 15 mg, and fentanyl 25 mg at L2/L3) for LSAgroup, and (hyperbaric bupivacaine 7.5 mg, and fentanyl 25 mg at T10/T11) for TSAgroup. Propofol, fentanyl, atracurium, sevoflurane, and tracheal intubation were used for GA group. Intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction were compared between the three groups. Results: All procedures were completed laparoscopically by the allocated method of anesthesia with no anesthetic conversions. The time for the blockade to reach T3 level, intraoperative hypotensive and bradycardic events and vasopressor use were significantly lower in (TSA group) than in (LSA group). Postoperative pain scores as assessed throughout any time, postoperative right shoulder pain and hospital stay was lower for both (TSA group) and (LSA group) compared with (GA group). The higher degree of patients satisfaction scores were recorded in patients under segmental TSA. Conclusion: The present

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

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    Sunder Goyal

    2012-08-01

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

  4. 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.

  5. 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.

  6. 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.

  7. 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.

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

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    Arshad Rashid

    2015-01-01

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

  9. Anomalous middle hepatic artery in laparoscopic cholecystectomy: Wolf in sheep's clothing

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    Johnrose John Grifson

    2017-01-01

    Full Text Available Laparoscopic cholecystectomy is a simple but dangerous operation. The complex anatomy and frequent anomalies of the hepatic arterial and biliary system are often a shocking surprise to the laparoscopic surgeon. When these vital structures cannot be identified correctly, potentially crippling serious vascular and biliary injury can occur. A very rare case of middle hepatic artery encountered in the Calot's coursing over the gall bladder and travelling extraparenchymal into segment IV is reported. Identification and preservation of the middle hepatic artery is essential to prevent the possibility of hepatic artery thrombosis and to avoid ischemic cholangiopathy of segment IV duct. A comprehensive understanding of the hepatic arterial and biliary anatomy of the liver will empower laparoscopic surgeons to avoid crippling vascular and biliary injury.

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

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    Suresh Kumar

    2016-01-01

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

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

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    Šurbatović Maja

    2013-01-01

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

  12. The anatomy of Rouviere's sulcus as seen during laparoscopic cholecystectomy: A proposed classification

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    Mohinder Singh

    2017-01-01

    Full Text Available Introduction: Although Rouviere's sulcus is being increasingly mentioned as the first landmark to be seen so as to begin dissection during laparoscopic cholecystectomy to prevent bile duct injuries, the anatomy of the sulcus has not been described in clear and simple terms. Objectives: To define the detailed anatomy of Rouviere sulcus as seen during laparoscopic surgery in simple terms for the surgeons to refer to and begin their dissection from this, always staying above this sulcus in order to eliminate bile duct injury. Methods: 100 recordings of laparoscopic cholecystectomy were analysed to define the anatomy of the Rouviere's sulcus. Results: Majority of the sulci (71 were seen as a deep sulcus and were labelled as simply the 'sulcus'. This was further seen to be of two types – open (60 or closed (11. Some of the sulci (23 were small and so narrow and shallow as to be labelled as a 'slit'. Rarely, the sulcus was found to be fused and represented by a white fusion line (6 cases, and this was simply labelled as a 'scar'. Conclusions: The Rouviere's sulcus can now be defined in three simple terms – a deep sulcus, or a slit or a scar. We recommend that as a first step in laparoscopic cholecystectomy, the surgeon must look for this reference point (whether it is in the form of a scar, or a slit or a real sulcus which will be the plane of the main bile duct, and thus avoid any dissection below this point in order to eliminate any danger to the bile duct during surgery.

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

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

    1997-03-01

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

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

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    Castro Maurício Gustavo Bravim de

    1999-01-01

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

  15. [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.

  16. Virtual reality training versus blended learning of laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

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

    2015-01-01

    Objective: This study compared virtual reality (VR) training with low cost blended learning (BL) in a structured training program. Background: Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks. Methods: Laparoscopy-naïve medical students...

  17. Virtual reality training versus blended learning of laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

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

    2015-01-01

    Objective: This study compared virtual reality (VR) training with low cost blended learning (BL) in a structured training program. Background: Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks. Methods: Laparoscopy-naïve medical students...

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

    Science.gov (United States)

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

    2016-08-01

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

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

    DEFF Research Database (Denmark)

    Jensen, K; Kehlet, H; Lund, Claus

    2007-01-01

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

  20. 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

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

    Directory of Open Access Journals (Sweden)

    Kamil Gulpinar

    2011-01-01

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

  2. Structural deteriorations of the human peritoneum during laparoscopic cholecystectomy. A transmission electron microscopic study.

    Science.gov (United States)

    Tarhan, Omer Ridvan; Barut, Ibrahim; Ozogul, Candan; Bozkurt, Serkan; Baykara, Basak; Bulbul, Mahmut

    2013-08-01

    In previous studies, changes in the surface of the peritoneum during laparoscopic surgery are well defined. Nevertheless, almost all of these studies were performed on rodents via scanning electron microscopy. In the present study, structural alterations of the mesothelial cells of peritoneum were examined during laparoscopic cholecystectomy using transmission electron microscopy. Twenty patients with symptomatic cholelithiasis were included in the study. Peritoneal biopsy was performed immediately after CO2 pneumoperitoneum creation and at the end of surgery just before gallbladder removal. Biopsies were taken from the right upper quadrant, i.e., apart from operative manipulation. Peritoneal sample cross-sections were compared using transmission electron microscopy. The carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy caused deteriorations of the peritoneal mesothelium. Apoptosis were developed in mesothelial cells. Bulging of mesothelial cells, irregular cell junctions, focal intercellular clefts, apical cell membrane degeneration, deep nuclear invaginations, and lipid droplets in the cytoplasm of the mesothelial cells were other remarkable findings. Mesothelial edema also was determined. As seen in previous studies, basement membrane nudity appeared after carbon dioxide pneumoperitoneum could be attributable to mesothelial cell apoptosis, deterioration of the cell structure, and cell organelles.

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

    Science.gov (United States)

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

    2017-01-01

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

  4. Day case laparoscopic cholecystectomy in children: A review of 11 cases

    Directory of Open Access Journals (Sweden)

    Prakash Agarwal

    2014-01-01

    Full Text Available Aim: The aim of this paper is to study the outcome of day case laparoscopic cholecystectomy (DCLC in children. Materials and Methods: A clinical pathway for day care laparoscopic cholecystectomy was followed with emphasis on the analgesia, post-operative nausea and vomiting (PONV, feeding, mobilization, pain scoring and patient satisfaction. Demographic and clinical data were recorded prospectively from March 2013 to November 2013. The setup allowed easy access to an overnight stay if needed. Hospital stay, complications, the need for medical advice after discharge, convalescence and patients satisfaction were analyzed. Results: We admitted 11 children with symptomatic cholelithiasis for day case laparoscopic surgery. There were no intra- or post-operative complications. The incidence of PONV was 0/11. There was no readmission. 4/11 patients complained of shoulder tip pain on follow-up next day. There was no overnight stay. Conclusions: Adoption of a DCLC pathway is feasible and safe for children. Emphasis on adequate pain management and avoidance of PONV results in a high rate of day case surgery equivalent to that achieved in adult practice.

  5. Magnetically anchored cautery dissector improves triangulation, depth perception, and workload during single-site laparoscopic cholecystectomy.

    Science.gov (United States)

    Arain, Nabeel A; Cadeddu, Jeffrey A; Hogg, Deborah C; Bergs, Richard; Fernandez, Raul; Scott, Daniel J

    2012-09-01

    This study evaluated operative outcomes and workload during single-site laparoscopy (SSL) using a magnetically anchored cautery dissector (MAGS) compared with a conventional laparoscopic hook cautery (LAP). Each cautery was used to perform six SSL porcine cholecystectomies. For MAGS, the cautery device was inserted through the umbilical incision, magnetically coupled, and deployed; two graspers and a laparoscope were used. For LAP, two percutaneous retraction sutures, one grasper, a hook cautery dissector, and a laparoscope were used. Operative outcomes, surgeon ratings (scale, 1-5; 1 = superior), and workload (scale, 1-10; 1 = superior) were evaluated. No significant differences were detected for operative outcomes and surgeon ratings, however, trends were detected favoring MAGS. Surgeon workload ratings were significantly better for MAGS (2.6 ± 0.2) vs. LAP (5.6 ± 1.1; p triangulation were excellent and the safe handling protocol was followed with no complications. For LAP, the parallelism of instruments and lack of triangulation hindered depth perception, caused instrument conflicts, and resulted in two minor complications (one superficial liver laceration and one inadvertent burn to the diaphragm). These data suggest that using the MAGS device for SSL cholecystectomy results in equivalent (or better) operative outcomes and less workload compared with LAP.

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

    Mini-laparoscopic cholecystectomy (MLC) has widened the horizons of modern laparoscopic surgery. Standard four port laparoscopic cholecystectomy (SLC), which has long been established as the "Gold Standard" for gall bladder diseases, is under reconsideration following the advent of further minimally-invasive procedures including MLC. Our study aims to provide a comparison between MLC and SLC and assesses whether MLC has any added benefits. Patients with symptomatic gall bladder disease undergoing MLC or SLC during the 2.5-month period were included in the study. Thirty-two patients underwent MLC while SLC was performed on 40 patients by the same surgeon. Data was collected prospectively and analysed retrospectively using a predesigned questionnaire. In our study, both the groups had similar age, body mass index (BMI) and gender distribution. No cases of MLC required insertion of additional ports. The mean operative time for MLC was 38.2 min (33-61 min), which is longer than SLC; but it was not statistically significant. There was no significant difference in mean operative blood loss, postoperative pain, analgesia requirement and mobilization. Patients who underwent MLC were able to return to normal activity earlier than patients undergoing SLC (P < 0.01). Our experience suggests that MLC can safely be used as an alternative to SLC. Compared to SLC, it has the added benefit of an early return to work along with excellent cosmetic results. Further large scale trials are required to prove any additional benefit of MLC.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  9. COMPARATIVE ANALYSIS OF IMMUNOLOGICAL PROFILES IN WOMEN UNDERGOING CONVENTIONAL AND SINGLE-PORT LAPAROSCOPIC CHOLECYSTECTOMY.

    Science.gov (United States)

    Borges, Marisa de Carvalho; Takeuti, Tharsus Dias; Terra, Guilherme Azevedo; Ribeiro, Betânia Maria; Rodrigues-Júnior, Virmondes; Crema, Eduardo

    2016-01-01

    Surgical trauma triggers an important postoperative stress response characterized by significantly elevated levels of cytokines, an event that can favor the emergence of immune disorders which lead to disturbances in the patient's body defense. The magnitude of postoperative stress is related to the degree of surgical trauma. To evaluate the expression of pro-inflammatory (TNF-α, IFN-γ, IL-1β, and IL-17) and anti-inflammatory (IL-4) cytokines in patients submitted to conventional and single-port laparoscopic cholecystectomy before and 24 h after surgery. Forty women with symptomatic cholelithiasis, ranging in age from 18 to 70 years, participated in the study. The patients were divided into two groups: 21 submitted to conventional laparoscopic cholecystectomy and 19 to single-port laparoscopic cholecystectomy. Evaluation of the immune response showed no significant difference in IFN-γ and IL-1β levels between the groups or time points analyzed. With respect to TNF-α and IL-4, serum levels below the detection limit (10 pg/ml) were observed in the two groups and at the time points analyzed. Significantly higher postoperative expression of IL-17A was detected in patients submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels (p=0.0094). Significant postoperative expression of IL-17 was observed in the group submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels, indicating that surgical stress in this group was higher compared to the conventional laparoscopic cholecystectomy. O trauma cirúrgico induz resposta de estresse pós-operatório significativo, evidenciado pelos níveis elevados de citocinas, podendo favorecer o surgimento de distúrbios imunológicos. A magnitude de estresse está relacionada ao grau do trauma cirúrgico. Avaliar a expressão das citocinas pró-inflamatórias (TNF-α, IFN-γ, IL-1β, IL-17) e da anti-inflamatória (IL-4) no pré e pós-operatório de pacientes

  10. 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.

  11. 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

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

    OpenAIRE

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Chih-Yang Hsiao

    2016-01-01

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

  14. Effect of intravenous clonidine premedication in patients undergoing laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    S. K. Gvalani

    2016-09-01

    Results: Data was analysed by Pearson's chi-square test. Clonidine significantly attenuated the rise in heart rate, and the blood pressure. The incidence of postoperative nausea and vomiting was less in the clonidine group. It also reduced shivering. Conclusions: 2 microgm/kg of clonidine iv can be reasonably recommended as a premedicant for laparoscopic procedures in otherwise healthy patients. However further study is required to test its efficacy in patients with compromised cardiovascular function. [Int J Res Med Sci 2016; 4(9.000: 3806-3811

  15. Integration of Hands-On Team Training into Existing Curriculum Improves Both Technical and Nontechnical Skills in Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Caskey, Robert C; Owei, Lily; Rao, Raghavendra; Riddle, Elijah W; Brooks, Ari D; Dempsey, Daniel T; Morris, Jon B; Neylan, Christopher J; Williams, Noel N; Dumon, Kristoffel R

    2017-05-26

    Nontechnical skills are an essential component of surgical education and a major competency assessed by the ACGME milestones project. However, the optimal way to integrate nontechnical skills training into existing curricula and then objectively evaluate the outcome is still unknown. The aim of this study was to determine the effect laparoscopic team-based task training would have on the nontechnical skills needed for laparoscopic surgery. 9 PGY-1 residents underwent an established training curriculum for teaching the knowledge and technical skills involved in laparoscopic cholecystectomy. Initial training involved a didactic session, expert-led practice on a porcine model in a simulated operating room and laparoscopic skills practice on a virtual reality trainer. Residents then performed a laparoscopic cholecystectomy on the same porcine model as a preintervention test. Three to four months following this, residents were subjected to specific nontechnical skills training involving 2 simple team-based laparoscopic tasks. They then practiced a further 4 to 6 hours on the virtual reality trainer. A repeat postintervention laparoscopic cholecystectomy was then performed 3 to 4 months after nontechnical skills training. Both the preintervention and postintervention laparoscopic cholecystectomies were audiovisually recorded and then evaluated by 2 independent surgeons in a blinded fashion. Technical skills were assessed using objective structured assessment of technical skills (OSATS) and a technique specific rating scale (TRS) that we developed for laparoscopic cholecystectomy. Nontechnical skills were assessed using nontechnical skills for surgeons (NOTSS). Residents also completed a survey at the beginning and end of the training. Tertiary care, university based teaching institution. A total of 9 general surgery residents at the intern level. The mean OSATS score improved from 13.7 ± 1.24 to 26.7 ± 0.31 (p skills training for laparoscopic cholecystectomy that was

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sanchita Sarma

    2015-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Deepshikha C Tripathi

    2011-01-01

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

  19. [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.

  20. 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.

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

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

    2017-03-01

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

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

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    Ezatollah Sadeghi

    2014-01-01

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

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

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    Aziza M Hussain

    2013-01-01

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

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

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    Ömer Faruk Şavluk

    2013-03-01

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

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

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    Marcin Krajczy

    2012-01-01

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

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

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    Sudhir

    2014-04-01

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

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

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    Chee Wei Tay

    2013-01-01

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

  8. Intraperitoneal local anaesthetics after laparoscopic cholecystectomy: effects on postoperative pain, metabolic responses and lung function.

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    Rademaker, B M; Kalkman, C J; Odoom, J A; de Wit, L; Ringers, J

    1994-03-01

    We have compared the efficacy of 0.9% NaCl 20 ml (n = 15), 0.25% bupivacaine 20 ml (n = 15) and 0.5% lignocaine 20 ml (n = 15), administered i.p., in reducing postoperative pain and opioid requirements, and modifying the metabolic response to surgery and postoperative lung function after laparoscopic cholecystectomy. There were no differences in postoperative pain scores (visual analogue scale and verbal rating scale) between the three groups in the first 4 h after operation and in analgesic requirements during the first 24 h. In all groups, forced vital capacity, peak expiratory flow and forced expiratory volume in 1 s decreased 2 h after surgery (P < 0.001). Ventilatory values recovered only partially in the first 2 days after operation (P < 0.05), with no significant differences between groups. Plasma concentrations of glucose and cortisol increased after surgery (P < 0.05). Cortisol concentrations returned to baseline 48 h after operation. There were no significant differences between the groups in any measured variable. These data suggest that the administration of 20 ml of local anaesthetics i.p. is not effective in reducing postoperative pain, improving lung function, or attenuating the metabolic endocrine response after laparoscopic cholecystectomy.

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

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    Prasad

    2014-02-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Kazunari Sasaki; Goro Watanabe; Masamichi Matsuda; Masaji Hashimoto

    2012-01-01

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

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

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    Gouda M El-labban

    2011-01-01

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

  12. Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective randomized study.

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    El-Awadi, Saleh; El-Nakeeb, Ayman; Youssef, Tamer; Fikry, Amir; Abd El-Hamed, Tito M; Ghazy, Hosam; Foda, Elyamany; Farid, Mohamed

    2009-02-01

    Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy (LC) feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy (OC) versus LC in compensated cirrhosis. A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group (55 patients) and LC group (55 patients). There was no operative mortality. In LC group 4 (7.33%) patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group (96.13+17.35 min versus 76.13+15.12) P<0.05, associated with significantly higher intraoperative bleeding in OC group (P<0.01), necessitating blood transfusions to 7 (12.72%) patients in OC group. The time to resume diet was 18.36+8.18 h in LC group which is significantly earlier than in OC group 47.84+14.6h P<0.005. Hospital stay was significantly longer in OC group than LC group (6+1.74 days versus 1.87+1.11 days) P<0.01 with low postoperative morbidity. LC in cirrhotics is still complicated and highly difficult which associates with significant morbidity compared with that of patients without cirrhosis. However, it offers lower morbidity, shorter operative time; early resume dieting with less need for blood transfusion and reducing hospital stay than OC.

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

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    Ali Şefik Köprülü

    2016-12-01

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

  14. Fluorescent Imaging With Indocyanine Green During Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury

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    Ankersmit, M.; Dam, D.A. van; Rijswijk, A.S. van; Tuynman, J.B.; Meijerink, W.J.H.J.

    2017-01-01

    BACKGROUND: Although rare, injury to the common bile duct (CBD) during laparoscopic cholecystectomy (LC) can be reduced by better intraoperative visualization of the cystic duct (CD) and CBD. The aim of this study was to establish the efficacy of early visualization of the CD and the added value of

  15. Effectiveness of a barbed suture in the repair of bile duct injury during laparoscopic cholecystectomy: Report of two cases

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    Yusuke Takahashi

    2016-01-01

    Conclusion: We believe that the V-Loc™ device is an effective and appropriate option for bile duct injuries that occur during laparoscopic cholecystectomies, particularly around the gallbladder bed, and it is especially useful for surgeons unfamiliar with intracorporeal knot tying.

  16. Role of Rouviere′s sulcus as anatomical landmark in laparoscopic cholecystectomy: a report of 750 cases

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    WANG Shoujun

    2014-08-01

    Full Text Available ObjectiveTo explore the role of Rouviere′s sulcus as the anatomical landmark for the cystic duct in laparoscopic cholecystectomy. MethodsThe clinical data of 750 patients who underwent laparoscopic cholecystectomy operated by one beginner from October 2012 to March 2014 in the Affiliated Santai Hospital of North Sichuan Medical College were analyzed. The frequency of appearance of Rouviere′s sulcus was recorded during operation, and the Rouviere′s sulcus was used as the anatomical landmark for the cystic duct in laparoscopic cholecystectomy. ResultsOf the 750 patients, 705 had Rouviere′s sulcus. There was no mortality during operation. Bile duct injury occurred in one case (0.13%, whose Rouviere′s sulcus was not seen during operation. Among the first 300 cases, the three-hole method was used in 35 cases, and 30 cases (10% were converted to open surgery. Among the succeeding 450 cases, the three-hole method was used in 387 cases, and 15 cases (3.3% were converted to open surgery. ConclusionRouviere′s sulcus is an important anatomical landmark for the cystic duct. Its identification before Calot′s triangle dissection may help in preventing the bile duct injury in laparoscopic cholecystectomy for beginners. It has great clinical significance and should be applied widely.

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

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    Ravi Vasupalli

    2016-09-01

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

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

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    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.

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

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    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

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

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

    2010-01-01

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

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

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    Haris R Shaikh

    2017-01-01

    Full Text Available Background: Mini-laparoscopic cholecystectomy (MLC has widened the horizons of modern laparoscopic surgery. Standard four port laparoscopic cholecystectomy (SLC, which has long been established as the “Gold Standard” for gall bladder diseases, is under reconsideration following the advent of further minimally-invasive procedures including MLC. Our study aims to provide a comparison between MLC and SLC and assesses whether MLC has any added benefits. Materials and Methods: Patients with symptomatic gall bladder disease undergoing MLC or SLC during the 2.5-month period were included in the study. Thirty-two patients underwent MLC while SLC was performed on 40 patients by the same surgeon. Data was collected prospectively and analysed retrospectively using a predesigned questionnaire. Results: In our study, both the groups had similar age, body mass index (BMI and gender distribution. No cases of MLC required insertion of additional ports. The mean operative time for MLC was 38.2 min (33-61 min, which is longer than SLC; but it was not statistically significant. There was no significant difference in mean operative blood loss, postoperative pain, analgesia requirement and mobilization. Patients who underwent MLC were able to return to normal activity earlier than patients undergoing SLC (P < 0.01. Conclusion: Our experience suggests that MLC can safely be used as an alternative to SLC. Compared to SLC, it has the added benefit of an early return to work along with excellent cosmetic results. Further large scale trials are required to prove any additional benefit of MLC.

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Lun Yu; Jun Zhang; Yong Jiao; Peng Yong

    2016-01-01

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

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

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    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.

  5. A Prospective Randomized Control Trial to Study the Role of Intraperitoneal Irrigation with Normal Saline in Reduction of Postoperative Pain In Patients Undergoing Laparoscopic Cholecystectomy

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    Pankaj Shivhare

    2014-08-01

    Results: Abdominal pain was worst during the first 24 hours after laparoscopic cholecystectomy. At 6, 12 and 24 hrs, group A exhibited significantly less abdominal pain than group B. Group A also experienced less shoulder tip pain during the first postoperative day as compared to the control group. Conclusion: Intraperitoneal irrigation with normal saline is effective in reducing postoperative abdominal and shoulder tip pain following laparoscopic cholecystectomy. [Arch Clin Exp Surg 2014; 3(4.000: 213-219

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

    Science.gov (United States)

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

    2016-01-01

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

  7. Lower gastrointestinal bleeding due to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy

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    Ajay D Mate

    2013-01-01

    Full Text Available Pseudoaneurysm of hepatic artery is a rare but known complication of laparoscopic cholecystectomy (LC. Such pseudoaneurysms may bleed in biliary tree, upper gastrointestinal (GI tract or peritoneal cavity leading to life-threatening internal haemorrhage. It is very rare for them to present as lower GI bleeding. We report an unusual case of Right hepatic artery pseudoaneurysm developed following LC, which ruptured into hepatic flexure of colon resulting in catastrophic lower GI bleeding. This was associated with partial celiac artery occlusion due to thrombosis. Due to failure of therapeutic embolisation, the patient was subjected to exploratory laparotomy to control haemorrhage. Postoperatively, patient recovered well and was discharged on postoperative day 10. A strong index of suspicion is necessary for early diagnosis of such condition and to limit resultant morbidity. Angioembolisation is the first-line treatment and surgery is indicated in selected cases.

  8. [The resorption of carbon dioxide from the pneumoperitoneum in laparoscopic cholecystectomy].

    Science.gov (United States)

    Blobner, M; Felber, A R; Gögler, S; Feussner, H; Weigl, E M; Jelen, G; Jelen-Esselborn, S

    1993-05-01

    Laparoscopic cholecystectomy is claimed to be a minimally invasive procedure, but uptake of carbon dioxide (CO2) from the pneumoperitoneum (CO2-PP) can cause clinically relevant hypercapnia. In this prospective study, CO2 resorption during laparoscopic cholecystectomy was investigated. METHODS. In 30 patients (ASA I and II) total intravenous anesthesia was performed with propofol and fentanyl. Controlled ventilation was started with a tidal volume of 10 ml/kg min, a respiratory rate of 10/min, and FiO2 = 0.4 using an Engström Erica ventilator. When end-tidal CO2 (PeCO2) rose to 42 mmHg the respiratory rate was increased. In addition to standard monitoring, intra-abdominal pressure (IAP) was measured. Minute volume (VI), CO2 elimination (VCO2), oxygen uptake (VO2), and the respiratory quotient (RQ) were registered by indirect calorimetry from the Erica Metabolic Monitor. The CO2 resorption (delta VCO2) was calculated from the equation: delta VCO2(Mi) = VCO2(Mi) RQ(M1)VO2(Mi). (i = 1; 2; ...;5) All values are medians (interquartile range) or ranges. All parameters were compared at five measuring points that are characteristic for laparoscopic cholecystectomy: M1 baseline, 30 min after induction of anaesthesia, M2 10 min after starting CO2 insufflation, M3 while mobilising the gallbladder from the liver bed, M4 while extracting the gallbladder from the abdominal cavity, and M5 10 min after desufflating the CO2-PP (spontaneous breathing). RESULTS. A typical pattern of VCO2 was observed (Fig. 1). Baseline VCO2 was 165 (145-180) ml/min, PeCO2 was 33 (31-35) mmHg, and VI was 6.0 (6.0-7.0) l/min. After insufflation of CO2 to an IAP of between 14 and 20 mmHg, an increase in VCO2 to 201 (179-222) ml/min was registered (P extraction of the gallbladder from the abdominal cavity, the CO2-PP deflated and IAP dropped to 1-5 mmHg. In this phase, maximal VCO2 and delta VCO2 were measured at 232 (206-245) ml/min and 43 (30-57) ml/min (P rose to 40 (37-42) mmHg (P CO2-PP must be

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

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2007-10-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

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

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    Pal Kamalesh

    2010-01-01

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

  13. 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

  14. Outpatient laparoscopic cholecystectomy and pain control: a series of 100 cases.

    Science.gov (United States)

    Jiménez Fuertes, Montiel; Costa Navarro, David

    2015-03-01

    We present our experience of 100 consecutive cases that underwent ambulatory cholecystectomy using a standard protocol of anesthesia and surgery. Prospective study of 100 consecutive patients assessed in the surgery outpatient clinic in Torrevieja Hospital (September 2008-september 2009). Both anesthetic and surgical techniques were protocolized, standardized. The protocol included the use of intraperitoneal and parietal anesthesia. One hundred patients were included. Average age was 53 years and average surgical time was 29±12 min. Day-case surgery rate was 96%. Postoperative pain (VAS scale) was less than 4 in all cases. Six patients complained of nausea that eased with the administration of ev metoclopramide. Average length of stay in the day-case surgery unit was 7.4h (maximum 9.6, minimum 7). Morbidity and mortality rates were 0%. No re-admission was registered and conversion rate was 0%. Postoperative follow-up was 100%. A total of 97% of the cases were fully satisfied with the procedure. Ambulatory laparoscopic cholecystectomy is a feasible and safe technique. Postoperative pain has classically been the reason to not perform day-case surgery, but we achieved an excellent control by the combined use of local anesthetics and warm intraperitoneal saline solution. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. 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.

  16. Laparoscopic cholecystectomy under neuraxial anesthesia compared with general anesthesia: Systematic review and meta-analyses.

    Science.gov (United States)

    Longo, Marcelo A; Cavalheiro, Bárbara T; de Oliveira Filho, Getúlio R

    2017-09-01

    Pneumoperitoneum during laparoscopic cholecystectomy (LC) can cause hypercapnia, hypoxemia, hemodynamic changes and shoulder pain. General anesthesia (GA) enables the control of intraoperative pain and ventilation. The need for GA has been questioned by studies suggesting that neuraxial anesthesia (NA) is adequate for LC. To quantify the prevalence of intraoperative pain and to verify whether evidence on the maintenance of ventilation, circulation and surgical anesthesia during NA compared with GA is consistent. Systematic review with meta-analyses. Anesthesia for laparoscopic cholecystectomy. We searched Medline, Cochrane and EBSCO databases up to 2016 for randomized controlled trials that compared LC in the two groups under study, neuraxial (subarachnoid or epidural) and general anesthesia. The primary outcome was the prevalence of intraoperative pain referred to the shoulder in the NA group. Hemodynamic and respiratory outcomes and adverse effects in both groups were also collected. Eleven comparative studies were considered eligible. The pooled prevalence of shoulder pain was 25%. Intraoperative hypotension and bradycardia occurred more frequently in patients who received NA, with a risk ratio of 4.61 (95% confidence interval [CI] 1.70-12.48, p=0.003) and 6.67 (95% CI 2.02-21.96, p=0.002), respectively. Postoperative nausea and vomiting was more prevalent in patients who submitted to GA. The prevalence of postoperative urinary retention did not differ between the techniques. Postoperative headache was more prevalent in patients who received NA, while the postoperative pain intensity was lower in this group. Performing meta-analyses on hypertension, hypercapnia and hypoxemia was not possible. NA as sole anesthetic technique, although feasible for LC, was associated with intraoperative pain referred to the shoulder, required anesthetic conversion in 3.4% of the cases and did not demonstrate evidence of respiratory benefits for patients with normal pulmonary

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

    Science.gov (United States)

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

    2017-01-01

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

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

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    Süreyya Özkan

    2015-03-01

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

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    Aftab Ahmad

    2015-07-01

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

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

    Science.gov (United States)

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

    1999-06-01

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

  2. 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.

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

    Institute of Scientific and Technical Information of China (English)

    Zhengnian Ding; Qinhai Zhou; Bo Gui

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    V. N Klymenko

    2015-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Aditya Kumar

    2016-02-01

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

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

    OpenAIRE

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

    2016-01-01

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

  7. Open-access technique and "critical view of safety" as the safest way to perform laparoscopic cholecystectomy.

    Science.gov (United States)

    Tsalis, Konstantinos; Antoniou, Nikolaos; Koukouritaki, Zambia; Patridas, Dimitrios; Christoforidis, Emmanuel; Lazaridis, Charalampos

    2015-04-01

    The 2 main challenges of laparoscopic cholecystectomy are primary peritoneal access and safe identification, ligation, and division of the cystic duct and cystic artery. This is a 13-year period retrospective study from January 2000 to December 2012. All the operations were performed by 1 surgeon and all the data were collected from the hospitals archive. A total of 929 laparoscopic cholecystectomies were performed for symptomatic cholelithiasis. The first author was involved in all the operations either by performing or assisting in them. The open access (OA) technique was used in all cases for the creation of pneumoperitoneum. After establishing the pneumoperitoneum, the "critical view of safety" (CVS) technique was used to ligate and divide the cystic duct and cystic artery. When the OA was not possible or CVS was not feasible, the operation was converted to open. Successful establishment of pneumoperitoneum with OA was possible in 911 of 929 (98.06%) patients and CVS was achieved in 873 patients (95.82%). In 18 patients the operation was converted to open because of dense adhesions not permitting the establishment of the pneumoperitoneum. No intraoperative or postoperative complications occurred in these patients. No bile duct injury occurred in this series. Postoperative complications were recorded in 19 patients (2.04%). Five patients had bleeding from port sites, 12 patients had wound infection at the umbilical incision, and 2 patients developed subhepatic collections, which were drained percutaneously under computed tomographic guidance. In this series of laparoscopic cholecystectomies, we used the "open access" technique to create pneumoperitoneum and we obtained the "critical view of safety" for the identification of the cystic duct. Our results show that this approach is the safest way to perform and teach laparoscopic cholecystectomy.

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

    Institute of Scientific and Technical Information of China (English)

    梁平; 黄小兵; 左国华; 李靖; 丁生才; 王细文

    2010-01-01

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

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

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    Shreya

    2015-10-01

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

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

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    Chavi

    2013-03-01

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

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

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    Singh, Shivinder; Arora, Kapil

    2011-01-01

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

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

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    Shivinder Singh

    2011-01-01

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

  13. 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.

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

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    Raghuram

    2014-04-01

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

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

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    Teerawattananon Yot

    2005-10-01

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

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

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    Vonlanthen René

    2011-09-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

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

  18. TOTAL COST OF HOSPITALIZATION OF PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY RELATED TO NUTRITIONAL STATUS.

    Science.gov (United States)

    Menezes, Francisco Julimar Correia de; Menezes, Lara Gadelha Luna de; Silva, Guilherme Pinheiro Ferreira da; Melo-Filho, Antônio Aldo; Melo, Daniel Hardy; Silva, Carlos Antonio Bruno da

    2016-01-01

    In the Western world, the population developed an overweight profile. The morbidly obese generate higher cost to the health system. However, there is a gap in this approach with regard to individuals above the eutrofic pattern, who are not considered as morbidly obese. To correlate nutritional status according to BMI with the costs of laparoscopic cholecystectomy in a public hospital. Data were collected from medical records about: nutritional risk assessment, nutricional state and hospital cost in patients undergoing elective laparoscopic cholecystectomy. Were enrolled 814 procedures. Average age was 39.15 (±12.16) years; 47 subjects (78.3%) were women. The cost was on average R$ 6,167.32 (±1830.85) to 4.06 (±2.76) days of hospitalization; 41 (68.4%) presented some degree of overweight; mean BMI was 28.07 (±5.41) kg/m²; six (10%) individuals presented nutritional risk ≥3. There was a weak correlation (r=0.2) and not significant (p sobrepeso; o IMC médio foi 28,07 (±5,41) kg/m²; seis (10%) indivíduos apresentavam risco nutricional ≥3. Houve correlação fraca (r=0,2) e não significativa (pSobrepeso não demonstrou correlação entre custo e tempo de internação. Entretanto, os indivíduos com sobrepeso apresentaram custo maior de internação em relação aos que não tiveram intercorrência, mas sem correlação com o estado nutricional. Em relação aos com IMC normal, houve correlação forte e estatisticamente significante com o custo para tempo de internação, reforçando que há provável distribuição normal envolvendo estado nutricional adequado e sucesso do procedimento cirúrgico com consequente impacto no custo de internação.

  19. Residual gallbladder stones after cholecystectomy: A literature review

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    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

  20. 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

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

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    Kamer E

    2007-01-01

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

  2. 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.

  3. Does thermodynamic stability of peritoneal collagen change during laparoscopic cholecystectomies? A differential scanning calorimetry (DSC) study.

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    Torres, Kamil; Trębacz, Hanna; Bącik-Donica, Magdalena; Atras, Agnieszka; Torres, Anna; Plewa, Zbigniew

    2014-09-01

    Carbon dioxide pneumoperitoneum used during laparoscopic surgeries alters the integrity of the peritoneum and results in denudation of the basal lamina that might cause altered immune response, inhibited fibrinolysis, hypoxia, and acidosis. The changes in the structure of pneumoperitoneum were described as bulging of mesothelial cells, irregular cell junction's cell membrane degradation, and mesodermal edema. As denaturation of peritoneal proteins reflects overall condition of its structure and interactions with the surrounding molecules, the physical status of collagen was assessed on the basis of parameters of thermal denaturation measured by DSC method. Twenty-four female patients operated on due to cholelithiasis were enrolled in this study. Laparoscopic cholecystectomy was performed using standard four-trocar technique, and standard values of insufflated carbon dioxide pneumoperitoneum were used. After trocar placement, the first collection of peritoneal sample (sample A) was performed. The second peritoneal sample (sample B) was collected after the removal of gall bladder. Differential scanning calorimetry (Q200 calorimeter, TA Instruments) was performed on samples defrosted at room temperature. In all samples of peritoneum, a nonreversible endothermal process recognized as denaturation was observed. Sample B obtained at the end of surgery did not differ from sample A obtained at the beginning in terms of all parameters under study. Temperature of denaturation in A and B was correlated only marginally, but enthalpy and specific heat were significantly correlated. The analysis of data from DSC measurements did not reveal differences in physical stability of collagen in peritoneal samples obtained at the beginning and at the end of surgery. Significant negative correlations between duration of CO2 pneumoperitoneum and enthalpy of denaturation in sample B were found. Differences in enthalpy of denaturation may reflect a quantitative relation between amount of

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

    Directory of Open Access Journals (Sweden)

    Padmaja

    2015-05-01

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

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

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  7. Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy. A matched case-control study.

    Science.gov (United States)

    Sarli, L; Costi, R; Gobbi, S; Iusco, D; Sgobba, G; Roncoroni, L

    2003-09-01

    The purpose of this prospective study was to evaluate if a recently proposed score system based on six preoperative parameters [history of colic pain and/or jaundice, dyspepsia, cholecystitis, ultrasound (US), evidence of common bile duct stones (CBDS), number and size of gallbladder stones at US, level of serum glutamic oxalacetic transaminase and/or alkaline phosphatase is effective in the selection of patients undergoing laparoscopic cholecystectomy (LC) with asymptomatic CBDS and could allow a significant reduction of the total number of preoperative examinations. In the case group, 408 patients were categorized into low-, medium-, and high-risk classes and underwent, respectively, no further preoperative assessment of the bile duct, intravenous cholangiography (IVC), and endoscopic retrograde cholangiography (ERC). Intraoperative cholangiography (IOC) was performed whenever the surgeon was in doubt as to biliary anatomy or bile duct clearance. These patients were compared with 408 retrospectively matched patients (control group) undergoing routine preoperative IVC and/or ERC. In the case group, significantly lower numbers of IVC (120 vs 392) and IOC (3 vs 16) were performed ( p < 0.005), whereas no difference in the total number of ERCs was noted. One patient in the control group had retained CBDS detected during follow-up evaluation, whereas none occurred in the case group. The proposed scoring system allows selective use of IVC, ERC, and/or IOC in patients undergoing elective LC.

  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 in patient with situs inversus totals: Diagnostic and treatment pitfalls

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    Roberto Marcellus de Barros Sena

    2016-06-01

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

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

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    Krishn Kant Rawal

    2017-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  13. Intrathecal dextmedetomidine to reduce shoulder tip pain in laparoscopic cholecystectomies under spinal anesthesia

    Science.gov (United States)

    Bhatia, Tarundeep; Bhatia, Jaideep; Attri, Joginder Pal; Singh, Sukhpreet; Khetarpal, Ranjana

    2015-01-01

    Background: General anesthesia as a technique for laparoscopic cholecystectomies has disadvantage in terms of the stress response, lack of postoperative analgesia and emesis. Regional anesthesia offers advantages over general anesthesia in terms of cost, postoperative analgesia, intact respiratory control mechanism and early ambulation. Shoulder tip pain remains the main concerns that can be alleviated by adding various adjuvants to local anesthetics. Aims and Objectives: To study the effect of adding intrathecal dexmedetomidine to bupivacaine to decrease shoulder tip pain, onset and duration of sensory and motor block, hemodynamic changes and side effects if any. Materials and Methods: Totally, 60 patients were divided into two groups of 30 each. Group A received 3 ml of bupivacaine heavy and group B received 5 µg of dexmedetomidine along with 3 ml of bupivacaine diluted to total volume of 3.5 ml in each group. Statistical Analysis: It was done using Chi-square and Student's t-test. Results and Conclusions: Intrathecal dexmedetomidine provides stable hemodynamics, excellent sedation and analgesia and abolishes shoulder tip pain. PMID:26712967

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

    LENUS (Irish Health Repository)

    Iohom, G

    2012-02-03

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

  15. Prediction of conversion of laparoscopic cholecystectomy to open surgery with artificial neural networks

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    Shalchi Rosita

    2009-08-01

    Full Text Available Abstract Background The intent of this study was to predict conversion of laparoscopic cholecystectomy (LC to open surgery employing artificial neural networks (ANN. Methods The retrospective data of 793 patients who underwent LC in a teaching university hospital from 1997 to 2004 was collected. We employed linear discrimination analysis and ANN models to examine the predictability of the conversion. The models were validated using prospective data of 100 patients who underwent LC at the same hospital. Results The overall conversion rate was 9%. Conversion correlated with experience of surgeons, emergency LC, previous abdominal surgery, fever, leukocytosis, elevated bilirubin and alkaline phosphatase levels, and ultrasonographic detection of common bile duct stones. In the validation group, discriminant analysis formula diagnosed the conversion in 5 cases out of 9 (sensitivity: 56%; specificity: 82%; the ANN model diagnosed 6 cases (sensitivity: 67%; specificity: 99%. Conclusion The conversion of LC to open surgery is effectively predictable based on the preoperative health characteristics of patients using ANN.

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

    LENUS (Irish Health Repository)

    Ahmad, Nasir Zaheer

    2012-01-31

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

  17. Efficacy evaluation of subtotal and total gastrectomies in robotic surgery for gastric cancer compared with that in open and laparoscopic resections: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Liang Zong

    Full Text Available Robotic gastrectomy (RG, as an innovation of minimally invasive surgical method, is developing rapidly for gastric cancer. But there is still no consensus on its comparative merit in either subtotal or total gastrectomy compared with laparoscopic and open resections.Literature searches of PubMed, Embase and Cochrane Library were performed. We combined the data of four studies for RG versus open gastrectomy (OG, and 11 studies for robotic RG versus laparoscopic gastrectomy (LG. Moreover, subgroup analyses of subtotal and total gastrectomies were performed in both RG vs. OG and RG vs. LG.Totally 12 studies involving 8493 patients met the criteria. RG, similar with LG, significantly reduced the intraoperative blood loss than OG. But the duration of surgery is longer in RG than in both OG and LG. The number of lymph nodes retrieved in RG was close to that in OG and LG (WMD = -0.78 and 95% CI, -2.15-0.59; WMD = 0.63 and 95% CI, -2.24-3.51. And RG did not increase morbidity and mortality in comparison with OG and LG (OR = 0.92 and 95% CI, 0.69-1.23; OR = 0.72 and 95% CI, 0.25-2.06 and (OR = 1.06 and 95% CI, 0.84-1.34; OR = 1.55 and 95% CI, 0.49-4.94. Moreover, subgroup analysis of subtotal and total gastrectomies in both RG vs. OG and RG vs. LG revealed that the scope of surgical dissection was not a positive factor to influence the comparative results of RG vs. OG or LG in surgery time, blood loss, hospital stay, lymph node harvest, morbidity, and mortality.This meta-analysis highlights that robotic gastrectomy may be a technically feasible alternative for gastric cancer because of its affirmative role in both subtotal and total gastrectomies compared with laparoscopic and open resections.

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

    Directory of Open Access Journals (Sweden)

    A. Yaghoobi Notash

    2004-06-01

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

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

    Institute of Scientific and Technical Information of China (English)

    耿良元; 白剑峰; 孙跃明; 陆文熊; 傅赞; 石毅

    2012-01-01

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

  20. The possibilities of single-port laparoscopic access in cholecystectomy after operations on the abdominal cavity organs

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    V. M. Klimenko

    2017-06-01

    Full Text Available Aim. To assess the possibility and effectiveness of single-port access in cholecystectomy using for chronic calculous cholecystitis in patients who were previously operated on the abdominal organs. Materials and Methods. For the period from September 2015 to March 2017, 27 patients were been operated by laparoscopic cholecystectomy using single-port access for chronic calculous cholecystitis. All patients were divided into 2 groups. The first group included 12 (44.4% patients with previous surgery on the abdominal organs, who were performed laparotomy. The second group (2 included 15 (55.5% patients who didn’t have surgical interventions on the abdominal organs. Results and Discussion. The average duration of surgical intervention in patients of the 1st group (n = 12 was 87.66 ± 4.03 minutes. In all cases chronic calculous cholecystitis was observed. There was no transition to open cholecystectomy. The average bed-day was 2.41 ± 0.20. Drainage of the abdominal cavity was carried out only for 7 patients (58.3%. In 7 (58.3% patients opioid analgesics were prescribed once to reduce postoperative pain. Activation of patients occurred on the first day after the operation. After 2 days the ultrasound of the abdominal cavity was performed. In 2 (16.6% patients there was a slight accumulation of fluid in the region of the removed gallbladder that did not require puncture. Patients in the second group in all cases were performed a single-port cholecystectomy without additional trocars. The average duration of the operation was 38.93 ± 1.85 minutes. In all cases chronic calculous cholecystitis was observed. Conversions to the open methodology have not been noted. The average bed-day was 2.06 ± 0.07.Drainage of the abdominal cavity has not been performed. In 2 (13.3% cases opioid analgesics were prescribed once for postoperative pain relieving. Activation of patients occurred on the next day after the operation. After 2 days on the day of releasing

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

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    Kumkum Gupta

    2011-01-01

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

  2. Pethidine efficacy in achieving the ultrasound-guided oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy: A prospective study

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    Caius Mihai Breazu

    2017-02-01

    Full Text Available Pethidine is a synthetic opioid with local anesthetic properties. Our goal was to evaluate the analgesic efficacy of pethidine for achieving the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP block in laparoscopic cholecystectomy. This prospective, double-blind study included 79 patients of physical status I and II according to American Society of Anesthesiologists, scheduled for elective laparoscopic cholecystectomy. The patients were randomly allocated into three groups, depending on the drug used to achieve preoperative bilateral OSTAP block: 1 OSTAP-Placebo (treated with normal saline; 2 OSTAP-Bupivacaine (treated with 0.25% bupivacaine; and 3 OSTAP-Pethidine (treated with 1% pethidine. The efficacy of pethidine in achieving the OSTAP block was analyzed using visual analog scale (VAS, intraoperative opioid dose, opioid consumption in post anesthesia care unit, and opioid consumption in the first 24 postoperative hours. The pain scores assessed by VAS at 0, 2, 4, 6, 12, and 24 hours were significantly lower in OSTAP-Pethidine than in OSTAP-Placebo group (p < 0.001. The mean intraoperative opioid consumption was significantly lower in OSTAP-Pethidine compared to OSTAP-Placebo group (150 versus 400 mg, p < 0.001, as well as the mean opioid consumption in the first 24 hours (20.4 versus 78 mg, p < 0.001. Comparing VAS assessment between OSTAP-Bupivacaine and OSTAP-Pethidine groups, statistically significant differences were observed only for the immediate postoperative pain assessment (0 hours, where lower values were observed in OSTAP-Pethidine group (p = 0.004. There were no statistically significant differences in the incidence of postoperative nausea and vomiting (p = 0.131 between the groups. The use of 1% pethidine can be an alternative to 0.25% bupivacaine in achieving OSTAP block for laparoscopic cholecystectomy.

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

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    Handan Güleç

    2012-01-01

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

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

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    H. Barıs Eryılmaz

    2012-01-01

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

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

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    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

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

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    Mridu Paban Nath

    2015-04-01

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

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

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    Nik Kholgh A

    2000-09-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2004-01-01

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

  10. A RETROSPECTIVE CLINICAL STUDY OF LAPAROSCOPIC AND OPEN SURGERY FOR CHOLECYSTECTOMY PROCEDURE

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    Konduru Siva Prasada Raju

    2017-03-01

    Full Text Available BACKGROUND The gall stone is one of the commonest ailments for which the hospital doors are knocked in India. Recent statistics suggest that about 15 to 30 percent of women in the fourth and fifth decade of life commonly suffer from this. The gall bladder should not be removed just considering the fact that the stones are there but the stones are formed in it and one major problem is its recurrence. Recent non – operative procedures like shock wave therapy and drugs are non - promising. Minimal access surgery is now the trend in any kind of surgery and cholecystectomy is no exception. Initially there was a huge benefit seen but now more and more complications are reported. In this study an effort has been put to understand the complications involved in both the Laparoscopic and Open type of surgery. This study is intended to help the practicing surgeon to anticipate the commonly involved complications in both the type of surgeries and also to help them understand the pros and cons of each type especially in resource challenged settings. MATERIALS AND METHODS This study was done in the Department of General Surgery in RIMS Medical College at Ongole. This study was done from January 2014 to December 2016. A sample size of 131 patients was selected and the retrospective analysis was done. RESULTS The mean age of the population in the sample size was 44.18 years and the range of the patients included from 10 years to 81 years. There were thirty seven males and ninety four females in the total study population. Female preponderance was seen which was statistically significant. Open surgery is the method of choice in an emergencyod of choice in case of emergency.All twenty three patients who underwent open surgery had significant post operative pain complained of post - operative pain requiring analgesic intervention. Only two patients complained of post – operative pain in case of laparoscopic procedure and none of them needed analgesics. Other

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

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    Rajeev Sinha

    2014-01-01

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

  12. 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

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

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    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

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

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    Hon-Yi Shi

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

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

    Science.gov (United States)

    Şen, Meral; Özol, Duygu; Bozer, Mikdat

    2009-12-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2003-01-01

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

  17. The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy.

    Science.gov (United States)

    Mishra, A; Catchpole, K; Dale, T; McCulloch, P

    2008-01-01

    Evidence from other professions suggests that training in teamwork and general cognitive abilities, collectively described as non-technical skills, may reduce accidents and errors. The relationship between non-technical teamwork skills and technical errors was studied using a behavioural marker system validated in aviation and adapted for use in surgery. 26 elective laparoscopic cholecystectomies were observed. Simultaneous assessments were made of surgical technical errors, by observation clinical human reliability assessment (OCHRA) task analysis, and non-technical performance, using the surgical NOTECHS behavioural marker system. NOTECHS assesses four categories: (1) leadership and management, (2) teamwork cooperation, (3) problem-solving and decision-making, (4) situation awareness. Each subteam (nurses, surgeons and anaesthetists) was scored separately on each of the four dimensions. Two observers - one surgical trainee and one human factors expert - were used to assess intra-rater reliability. The mean NOTECHS team score was 35.5 (95% C.I. +/- 1.88). The mean subteam scores for surgeons, anaesthetists and nurses were 13.3 (95% C.I. +/- 0.64), 11.4 (95% C.I. +/- 1.05), and 10.8 (95% C.I. +/- 0.87), respectively, with a significant difference between surgeons and anaesthetists (U = 197, p = 0.009), and surgeons and nurses (U = 0.134, p skills are an important component of surgical skill, particularly in relation to the development and maintenance of a surgeon's situational awareness. Experience from other industries suggests that it may be possible to improve the ability of surgeons to manage their own situation awareness, through training, intraoperative briefings and intraoperative workload management. In the future, it may be possible to use non-technical performance as a surrogate measure for technical performance, either for early identification of surgical difficulties, or as a method of evaluation by which non-surgically trained observers.

  18. Comparative study of intravenously administered clonidine and magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy

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    Nand Kishore Kalra

    2011-01-01

    Full Text Available Background: Both magnesium and clonidine are known to inhibit catecholamine and vasopressin release and attenuate hemodynamic response to pneumoperitoneum. This randomized, double blinded, placebo controlled study has been designed to assess which agent attenuates hemodynamic stress response to pneumoperitoneum better. Materials and Methods: 120 patients undergoing elective laparoscopic cholecystectomy were randomized into 4 groups of 30 each. Group K patients received 50 ml normal saline over a period of 15 min after induction and before pneumoperitoneum, group M patients received 50 mg/kg of magnesium sulfate in normal saline (total volume 50 ml over same time duration. Similarly group C1 patients received 1 μg/kg clonidine and group C2 1.5 μg/kg clonidine respectively in normal saline (total volume 50 ml. Blood pressure and heart rate were recorded before induction (baseline value, at the end of infusions and every 5 min after pneumoperitoneum. Statistical Analysis: Paired t test was used for intra-group comparison and ANOVA for inter-group comparison. Results: Systolic blood pressure was significantly higher in control group as compared to all other groups during pneumoperitoneum. On comparing patients in group M and group C1, no significant difference in systolic BP was found at any time interval. Patients in group C2 showed best control of systolic BP. As compared to group M and group C1, BP was significantly lower at 10, 30 and 40 min post pneumoperitoneum. No significant episodes of hypotension were found in any of the groups. Extubation time and time to response to verbal command like eye opening was significantly longer in group M as compared to other groups. Conclusion: Administration of magnesium sulfate or clonidine attenuates hemodynamic response to pneumoperitoneum. Although magnesium sulfate 50 mg/kg produces hemodynamic stability comparable to clonidine 1 μg/kg, clonidine in doses of 1.5μg/kg blunts the hemodynamic response

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  1. Identification and treatment of variation of extrahepatic bile duct in laparoscopic cholecystectomy

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    PENG Lei

    2015-10-01

    Full Text Available ObjectiveTo investigate the identification and treatment of variation of extrahepatic bile duct in laparoscopic cholecystectomy (LC, and to reduce the occurrence of bile duct injury. MethodsThis study included 60 patients who received LC in the People′s Hospital of Caidian District in Wuhan and had structural variation of extrahepatic bile duct found during the operation from January 2012 to January 2014. The clinical data were retrospectively analyzed, and the intraoperative and postoperative conditions were summarized. ResultsDuring operation, cystic duct variation was found in 32 cases, abnormal position of the point where the cystic duct joins the extrahepatic bile duct in 20 cases, the cystic duct and the common hepatic duct having the common wall before joining the common bile duct in 2 cases, aberrant bile duct in the gallbladder bed in 2 cases, and accessory hepatic duct in 4 cases. Fifty-one patients (85% successfully underwent LC; 9 patients (15% were converted to open surgery. All patients finished surgery successfully. There were 2 cases of postoperative complications; one patient developed residual stones in the bile duct, and bile leakage occurred in the other patient at one week after LC, who recovered after reoperation. All patients were cured and discharged, without severe complications such as intraperitoneal hemorrhage, infection, and intestinal injury. ConclusionIdentifying the structural variation of extrahepatic bile duct, dissecting the Calot′s triangle meticulously, and determining the type of variation of extrahepatic bile duct play important roles in LC and significantly reduce the incidence of bile duct injury.

  2. 使用普通腹腔镜器械行经脐腹腔镜胆囊切除术%Transumbilical Laparoscopic Cholecystectomy with Routine Laparoscopic Instruments

    Institute of Scientific and Technical Information of China (English)

    丁轶人; 江涌; 颜海; 赵伟; 葛玮; 谭梦志

    2015-01-01

    本文报道2010年2月~2014年4月122例单纯胆囊良性疾病使用普通腹腔镜器械行经脐腹腔镜胆囊切除术。脐周呈倒三角形置入3个trocar,使用30°腹腔镜和普通腹腔镜抓钳、电钩、钛夹完成胆囊切除术,不留置引流。手术均获成功,手术时间35~80 min,(45.0±9.3) min,术后脐部切口隐蔽、美观。全组术后随诊1~12个月,(6.3±1.2)月,无胆漏、胆道狭窄及残石、脐疝等并发症。%[Summary] Clinical data of 122 patients who underwent transumbilical laparoscopic cholecystectomy with routine laparoscopic instruments from Febrary 2010 to April 2014 were analyzed retrospectively.Three trocars were introduced periumbilically at the sites of apexes of an inverted triangle.By using a 30°laparoscope and laparoscopic forceps, electric hook, and titanium clips, the cholecystectomy was completed without indwelling drainage.All the operations were successfully performed.The mean operative time was (45.0 ±9.3) min (range, 35-80 min).Umbilical scar wasn’t obvious.The cases were followed up for 1-12 months (6.3 ± 1.2 months) , during which no biliary leakage, residual stones, biliary stenosis, or umbilical hernia occurred.

  3. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

    Directory of Open Access Journals (Sweden)

    Mehta N

    2015-12-01

    Full Text Available Nandita Mehta, Sunana Gupta, Atul Sharma, Mohd Reidwan Dar Department of Anesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India Abstract: Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency. Keywords: geriatric anesthesia, bupivacaine, segmental anesthesia, laparoscopic surgery

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

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Yan-Dong Jiang; Su-Min Zhao

    2016-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Thawatchai Akaraviputh; Charay Leelouhapong; Varut Lohsiriwat; Somkiat Aroonpruksakul

    2009-01-01

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

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

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    Veena Patodi

    2016-12-01

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

  8. Pulmonary function and stress response after laparoscopic cholecystectomy: comparison with subcostal incision and influence of thoracic epidural analgesia.

    Science.gov (United States)

    Rademaker, B M; Ringers, J; Odoom, J A; de Wit, L T; Kalkman, C J; Oosting, J

    1992-09-01

    Laparoscopic cholecystectomy (LPC) is increasingly used to treat symptomatic cholelithiasis. We compared the effects of cholecystectomy by subcostal incision to those of LPC on lung function and endocrine metabolic response. The effects of thoracic epidural analgesia for LPC were studied as well. Thirty patients undergoing elective cholecystectomy under general anesthesia were allocated to three study groups: group I, cholecystectomy by subcostal incision; group II, LPC; group III, LPC and epidural analgesia with 0.5% bupivacaine with epinephrine, followed by continuous epidural infusion of 6 mL of 0.5% bupivacaine. Forced vital capacity (FVC), peak expiratory flow, and forced expiratory volume in 1 s were measured with the patients in a half-sitting position. In all groups, sustained decreases in FVC, forced expiratory volume in 1 s, and peak expiratory flow were observed up to 24 h after surgery. Reduction of FVC was significantly more in group I compared with groups II and III (P less than 0.05). The FVC in group I decreased from 3.8 +/- 0.42 (SD) to 1.1 +/- 0.27 L (P less than 0.01), in group II from 3.6 +/- 1.46 to 2.1 +/- 0.94 L (P less than 0.05), and in group III from 3.8 +/- 0.92 to 2.8 +/- 0.90 L (P less than 0.05). In all groups, plasma glucose and cortisol increased after surgery compared with baseline levels (P less than 0.05). At 240 min after surgery, a small but significant decrease of cortisol was measured in group III (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

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

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    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

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

    Institute of Scientific and Technical Information of China (English)

    钱毅; 顾元龙; 李建平

    2011-01-01

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

  11. 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

  12. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency.

    Science.gov (United States)

    Mehta, Nandita; Gupta, Sunana; Sharma, Atul; Dar, Mohd Reidwan

    2015-01-01

    Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency.

  13. Validity and Reliability of Global Operative Assessment of Laparoscopic Skills (GOALS) in Novice Trainees Performing a Laparoscopic Cholecystectomy

    NARCIS (Netherlands)

    Kramp, Kelvin H.; van Det, Marc J.; Hoff, Christiaan; Lamme, Bas; Veeger, Nic J. G. M.; Pierie, Jean-Pierre E. N.

    2015-01-01

    PURPOSE: Global Operative Assessment of Laparoscopic Skills (GOALS) assessment has been designed to evaluate skills in laparoscopic surgery. A longitudinal blinded study of randomized video fragments was conducted to estimate the validity and reliability of GOALS in novice trainees. METHODS: In tota

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

    Institute of Scientific and Technical Information of China (English)

    张海江; 闫军; 王赢凯; 杨波; 王建忠

    2012-01-01

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

  15. Short-term outcomes and nutritional status after laparoscopic subtotal gastrectomy with a very small remnant stomach for cStage I proximal gastric carcinoma.

    Science.gov (United States)

    Furukawa, Haruna; Kurokawa, Yukinori; Takiguchi, Shuji; Tanaka, Koji; Miyazaki, Yasuhiro; Makino, Tomoki; Takahashi, Tsuyoshi; Yamasaki, Makoto; Nakajima, Kiyokazu; Mori, Masaki; Doki, Yuichiro

    2017-08-20

    Total or proximal gastrectomy is usually performed for early proximal gastric carcinoma, but the optimal type of gastrectomy is still unknown. We evaluated short-term outcomes and nutritional status after laparoscopic subtotal gastrectomy (LsTG) in comparison with laparoscopic total gastrectomy (LTG) and laparoscopic proximal gastrectomy (LPG). We analyzed 113 patients who underwent LsTG (n = 38), LTG (n = 48), or LPG (n = 27) for cStage I gastric cancer located in the upper third of the stomach. Postoperative morbidities, nutritional status including body weight, serum albumin, hemoglobin, the prognostic nutritional index (PNI), and endoscopic findings at 1 year after surgery were compared between LsTG and both LTG and LPG. Operation time and intraoperative blood loss were similar among the three groups. The incidence of postoperative morbidities was lower in LsTG than in LTG. The degree of body weight loss was significantly smaller in LsTG than in LTG at 6 and 12 months. At 12 months, LsTG resulted in better serum albumin and PNI than LPG, and better hemoglobin than LTG. Endoscopic examination demonstrated that one LsTG patient and two LPG patients had reflux esophagitis. Remnant gastritis was observed more frequently in LPG than in LsTG. No LsTG patient had bile reflux, although it was observed in four LPG patients. LsTG with a very small remnant stomach had favorable short-term outcomes and nutritional status compared with LTG and LPG, so it may be a better treatment option for cStage I proximal gastric carcinoma.

  16. Ambulatory laparoscopic cholecystectomy: An audit of day case vs overnight surgery at a community hospital in Japan.

    Science.gov (United States)

    Sato, Atsushi; Terashita, Yukio; Mori, Yoichiro; Okubo, Tomotaka

    2012-12-27

    To evaluate the applicability and safety of ambulatory laparoscopic cholecystectomy (LC) and to compare day case and overnight stay LC. Data were collected retrospectively and consecutively for day case and overnight stay LC patients from July 1, 2009 to April 30, 2011. Outcomes were analyzed for patient demographics, operation time, blood loss during operation and frequency and reasons for unexpected or prolonged hospitalization in each group. There was no hospital mortality and no patient was readmitted with serious morbidity after discharge. 50 patients received a day case LC and 19 had an overnight stay LC. There was a significant difference in age between both groups (P overnight stay LC groups, when the patient's request was excluded. Day case LC can be performed with a low rate of complications. In overnight stay patients, there are many who could be performed safely as a day case. Moreover, we need to take special care to treat elderly patients.

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

  18. Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial.

    Science.gov (United States)

    Geng, Ying-Jie; Wu, Qing-Hua; Zhang, Rui-Qin

    2017-05-01

    To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. Prospective, randomized, double-blind clinical trial. University-affiliated teaching hospital. One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Cognitive function was assessed using neuropsychological tests at baseline (1day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1-40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1h (T2) and 24h (T3) postoperatively. The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, Ppropofol vs. sevoflurane: D1, P=0.012; D3, P=0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 (P=0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1-40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. Propofol anesthesia may be an option for elderly surgical patients. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Anil Agarwal

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jyoti Bhalla

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

    We compared the effects of lidocaine and esmolol infusions on intraoperative hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery in laparoscopic cholecystectomy surgery. The first group (n=30) received IV lidocaine infusions at a rate of 1.5mg/kg/min and the second group (n=30) received IV esmolol infusions at a rate of 1mg/kg/min. Hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery characteristics were evaluated. In the lidocaine group, systolic arterial blood pressures values were lower after the induction of anesthesia and at 20min following surgical incision (p<0.05). Awakening time was shorter in the esmolol group (p<0.001); Ramsay Sedation Scale scores at 10min after extubation were lower in the esmolol group (p<0.05). The modified Aldrete scores at all measurement time points during the recovery period were relatively lower in the lidocaine group (p<0.05). The time to attain a modified Aldrete score of ≥9 points was prolonged in the lidocaine group (p<0.01). Postoperative resting and dynamic VAS scores were higher in the lidocaine group at 10 and 20min after extubation (p<0.05, p<0.01, respectively). Analgesic supplements were less frequently required in the lidocaine group (p<0.01). In laparoscopic cholecystectomies, lidocaine infusion had superiorities over esmolol infusions regarding the suppression of responses to tracheal extubation and postoperative need for additional analgesic agents in the long run, while esmolol was more advantageous with respect to rapid recovery from anesthesia, attenuation of early postoperative pain, and modified Aldrete recovery (MAR) scores and time to reach MAR score of 9 points. Copyright © 2014. Publicado por Elsevier Editora Ltda.

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

    Directory of Open Access Journals (Sweden)

    Serpil Dagdelen Dogan

    2016-04-01

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

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

    Science.gov (United States)

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

    2016-01-01

    We compared the effects of lidocaine and esmolol infusions on intraoperative hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery in laparoscopic cholecystectomy surgery. The first group (n=30) received IV lidocaine infusions at a rate of 1.5mg/kg/min and the second group (n=30) received IV esmolol infusions at a rate of 1mg/kg/min. Hemodynamic changes, intraoperative and postoperative analgesic requirements, and recovery characteristics were evaluated. In the lidocaine group, systolic arterial blood pressures values were lower after the induction of anesthesia and at 20min following surgical incision (p<0.05). Awakening time was shorter in the esmolol group (p<0.001); Ramsay Sedation Scale scores at 10min after extubation were lower in the esmolol group (p<0.05). The modified Aldrete scores at all measurement time points during the recovery period were relatively lower in the lidocaine group (p<0.05). The time to attain a modified Aldrete score of ≥9 points was prolonged in the lidocaine group (p<0.01). Postoperative resting and dynamic VAS scores were higher in the lidocaine group at 10 and 20min after extubation (p<0.05, p<0.01, respectively). Analgesic supplements were less frequently required in the lidocaine group (p<0.01). In laparoscopic cholecystectomies, lidocaine infusion had superiorities over esmolol infusions regarding the suppression of responses to tracheal extubation and postoperative need for additional analgesic agents in the long run, while esmolol was more advantageous with respect to rapid recovery from anesthesia, attenuation of early postoperative pain, and modified Aldrete recovery (MAR) scores and time to reach MAR score of 9 points. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  4. Laparoscopic management of Mirrizzi syndrome during laparoscopic cholecystectomy%腹腔镜胆囊切除术时Mirrizzi综合征的处理

    Institute of Scientific and Technical Information of China (English)

    董云生; 佟强; 赵刚

    2013-01-01

    Objective: To explore the oprate treatment of Mirrizzi syndrome in laparoscopic cholecystectomy (LC). Methods: LC in patients with diagnosis of Mirrizzi syndrome was performed in 12 cases,4 cases are prospected to have Mirrizzi syndrome preoperatively and the rest were found in LC. Patients who scored Sherry type Ⅰ underwent laparoscopic cholecystectomy while type Ⅱ with gallbladder excision plus repair of bile duct or R-Y entrerobiliary anastomosis. By means of curettage and aspiration technique in separation of Calot triangle is recommended. Results: 8 cases of Sherry Ⅰ underwent cholecystectomy. In Type Ⅱ ,2 of 4 cases received bile duct repair procedure and other 2 with enterobiliary anastomosis. All cases recovered well and had no severe complications after the operations. Conclusion; Mirrizzi syndrome is often encountered during LC. Operative methods are associated with different classification. Application of curettage and aspiration technique in separating Calot triangle can enhance the identifying of the disease and educe bile duct injury.%目的:探讨腹腔镜胆囊切除术时Mirrizzi综合征的处理.方法:腹腔镜胆囊切除术诊断Mirrizzi综合征患者12例,术前明确诊断者4例,其余均在术中发现.Sherry Ⅰ型患者采用腹腔镜胆囊切除术,Ⅱ型患者采用胆囊切除胆管修补成型术和胆肠吻合术,术中全部采用刮吸解剖技术分离处理胆囊三角.结果:Sherry分型Ⅰ型8例采用胆囊切除术;Ⅱ型4例中2例采用胆囊切除胆管修补成型术,2例采用胆囊切除胆肠吻合术.全部病例手术顺利,术后恢复良好,无严重并发症.结论:Mirrizzi综合征多在腹腔镜胆囊切除术中发现,术中应根据不同类型选择不同的术式.应用刮吸解剖技术分离处理胆囊三角可提高本病的发现率并减轻胆管损伤.

  5. 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

  6. Effect of perioperative intravenous lidocaine infusion on postoperative recovery following laparoscopic Cholecystectomy-A randomized controlled trial.

    Science.gov (United States)

    Song, Xiaoli; Sun, Yanxia; Zhang, Xiaomei; Li, Tianzuo; Yang, Binbin

    2017-09-01

    Intravenous lidocaine infusion has been shown to facilitate postoperative recovery after major abdominal surgery. The current randomized controlled study was performed to assess the effect of perioperative intravenous lidocaine infusion on pain intensity, bowel function and cytokine response after larparoscopic cholecystectomy. Eighty patients undergoing laparoscopic cholecystectomy were randomly allocated to receive intravenous lidocaine (bolus injection of 1.5 mg/kg lidocaine at induction of anesthesia, then a continuous infusion of 2 mg/kg/h until the end of surgery) or an equal volume of saline. Patients, anesthesiologists, and study personnel were blinded, and anesthesia and multimodal perioperative analgesia were standardized. Blood cytokines were measured at scheduled times within 48 h. Pain scores, opioid consumption, time to first flatus and time to first bowel movement were also measured after surgery. Seventy-one of the 80 patients who were recruited completed the study protocol. Patient demographics were similar in the two groups. Lidocaine significantly reduced pain intensity [visual analogue scale (VAS), 0-10 cm] at 2 h (lidocaine 3.01 ± 0.65 cm vs. placebo 4.27 ± 0.58 cm, p = 0.01) and 6 h (lidocaine 3.38 ± 0.42 cm vs. placebo 4.22 ± 0.67 cm, p = 0.01) and total fentanyl consumption 24 h after surgery (lidocaine 98.27 ± 16.33 μg vs. placebo 187.49 ± 19.76 μg, p = 0.005). Time to first flatus passage (lidocaine 20 ± 11 h vs. placebo 29 ± 10 h, p = 0.01) and time to first bowel movement (lidocaine 41 ± 16 h vs. placebo 57 ± 14 h, p = 0.01) were also significantly shorter in patients who received lidocaine. Intravenous lidocaine infusion experienced less cytokine release than the control group. This study indicates that perioperative systemic lidocaine improves postoperative recovery and attenuates the initiation of excessive inflammatory response following laparoscopic cholecystectomy

  7. [Laparoscopic cholecystectomy and lithiasis of the common bile duct: prospective study on the importance of preoperative endoscopic ultrasonography and endoscopic retrograde cholangiography].

    Science.gov (United States)

    Meduri, B; Aubert, A; Chiche, R; Fritsch, J

    1998-10-01

    Laparoscopic cholecystectomy is the standard treatment of symptomatic gallstones. At present, no consensus has been reached on the diagnostic and therapeutic methods of concomitant common bile duct stones. Systematic preoperative endoscopic ultrasonography followed, if necessary, by endoscopic retrograde cholangiography and sphincterotomy during the same anesthetic procedure could be a diagnostic and therapeutic alternative for common bile duct stones making possible a laparoscopic cholecystectomy without intraoperative investigation of the common bile duct. One hundred and twenty-five patients underwent a prospective endoscopic ultrasonographic evaluation prior to laparoscopic cholecystectomy for symptomatic gallstones. Fourty-four patients (35%) had at least one predictive factor for common bile duct stones. Endoscopic ultrasonography and cholecystectomy were performed on the same day. Endoscopic ultrasonography was followed by endoscopic retrograde cholangiography and sphincterotomy by the same endoscopist in case of common bile duct stones on endoscopic ultrasonography. Patients were routinely followed up between 3 and 6 months and one year after cholecystectomy. Endoscopic ultrasonography suggested common bile duct stones in 21 patients (17%). Endoscopic ultrasonography identified a stone in 17 of 44 patients (38.6%) with predictor of common bile duct stones and only in 4 of 81 patients (4.9%) without predictor of common bile duct stone. Among these 21 patients, one patient was not investigated with endoscopic retrograde cholangiography because of the high risk of sphincterotomy, 19 patients had a stone removed after sphincterotomy, one patient had no visible stone neither on endoscopic retrograde cholangiography, nor on exploration of the common bile duct after sphincterotomy. Endoscopic ultrasonography was normal in 104 patients (83%). However, two patients in this group were investigated with endoscopic retrograde cholangiography because endoscopic

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

    DEFF Research Database (Denmark)

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

    1999-01-01

    undergoing elective laparoscopic cholecystectomy. In addition, all patients received multi-modal prophylactic analgesic treatment. Fifty-eight patients were randomized to receive a total of 286 mg (66 mL) ropivacaine or 66 mL saline via periportal and intraperitoneal infiltration. During the first 3...... receiving prophylactic multi-modal analgesic treatment. IMPLICATIONS: A combination of incisional and intraabdominal local anesthetic treatment reduced incisional pain but had no effect on deep intraabdominal pain or shoulder pain in patients receiving multimodal prophylactic analgesia after laparoscopic...

  9. Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?

    Institute of Scientific and Technical Information of China (English)

    Hongyi Cui

    2011-01-01

    Single incision laparoscopic surgery (SILS) is a novel minimally invasive surgical technique that is gaining popularity around the world.One of the most commonly performed procedures is single incision laparoscopic cholecystectomy (SILC).Most reported techniques utilize special purpose-made access port and articulating instruments,rendering the procedure costly and difficult to learn.This article provides a stepwise description of SILC technique using all straight instruments without the need for a special port.It aims to shorten the learning curve for surgeons wishing to adopt a safe and cost-effective SILC technique to their practice.

  10. 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...

  11. Effect of pre-emptive pregabalin on pain management in patients undergoing laparoscopic cholecystectomy: A systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Yi; Wang, Yu; Zhang, Xi

    2017-08-01

    Pre-emptive pregabalin might be beneficial to the patients undergoing laparoscopic cholecystectomy. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the effect of pregabalin on pain management of patients undergoing laparoscopic cholecystectomy. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of pregabalin versus placebo on laparoscopic cholecystectomy were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was pain scores Meta-analysis was performed using random-effect model. Six RCTs involving 434 patients were included in the meta-analysis. Overall, compared with control intervention, pregabalin intervention was found to significantly reduce the pain scores (Std. mean difference = -0.57; 95% CI = -0.85 to -0.29; P < 0.0001) and postoperative fentanyl consumption (Std. mean difference = -1.74; 95% CI = -2.31 to -1.16; P < 0.00001), improve Ramsay Sedation score (Std. mean difference = 1.03; 95% CI = 0.46 to 1.60; P = 0.0004), but demonstrated no influence on nausea and vomiting (RR = 0.82; 95% CI = 0.57 to 1.19; P = 0.30), as well as headache (RR = 0.95; 95% CI = 0.55 to 1.64; P = 0.86). Compared to control intervention, pregabalin intervention was found to significantly reduce the pain scores and postoperative fentanyl consumption, and improve Ramsay Sedation score in patients undergoing laparoscopic cholecystectomy, but had no influence on nausea and vomiting, as well as headache. Copyright © 2017. Published by Elsevier Ltd.

  12. “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.

  13. [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.

  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. Changes in hemodynamics and autonomic nervous activity in patients undergoing laparoscopic cholecystectomy: differences between the pneumoperitoneum and abdominal wall-lifting method.

    Science.gov (United States)

    Uemura, N; Nomura, M; Inoue, S; Endo, J; Kishi, S; Saito, K; Ito, S; Nakaya, Y

    2002-08-01

    Intraoperative changes in circulatory hemodynamics and autonomic nervous activity were evaluated in 33 patients with cholelithiasis who underwent laparoscopic cholecystectomy. Of these patients, 18 were treated using a pneumoperitoneum (group G) and 15 using the abdominal wall-lifting method (group WL). Their ECG, blood pressure, arterial oxygen saturation, and expiratory carbon dioxide partial pressure were monitored. Autonomic nervous function was evaluated by spectral analysis of the heart rate. Mean blood pressure increased significantly in group G during surgery, but did not vary in group WL during any stage of surgery. The high-frequency (HF) power, an index of parasympathetic activity, decreased significantly in group G after pneumoperitoneum. However, the HF power did not decrease significantly in group WL. The LF/HF ratio, an index of sympathetic activity, increased significantly in group G after pneumoperitoneum, but did not vary in group WL. In addition, the incidence of ventricular or supraventricular arrhythmias and the severity of the arrhythmias as determined by Lown's classification were higher in group G than in group WL. These findings suggest that intraoperative changes in autonomic nervous activity, due to increased intra-abdominal pressure, were smaller in patients undergoing laparoscopic cholecystectomy using the abdominal wall-lifting method than in those undergoing laparoscopic cholecystectomy using pneumoperitoneum. The results also demonstrated that hemodynamic changes were smaller in patients undergoing the abdominal wall-lifting method than in those undergoing pneumoperitoneum. It was concluded that hemodynamics should be carefully monitored during pneumoperitoneum, and that the abdominal wall-lifting approach in laparoscopic cholecystectomy is a method worthy of consideration for elderly patients or those with cardiopulmonary complications.

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

    Institute of Scientific and Technical Information of China (English)

    马良; 李捷; 王家兴; 何永; 林龙英

    2011-01-01

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

  18. The Feasibility and Safety of Laparoscopic Cholecystectomy Approach without the Intraopertative Cholangiography Use: A Retrospective Study on 750 Consecutive Patients.

    Science.gov (United States)

    Atahan, Kemal; Gur, Serhat; Durak, Evren; Cokmez, Atilla; Tarcan, Ercument

    2012-08-01

    We have retrospectively reviewed the results of all common bile duct (CBD)-stone preoperative asymptomatic patients operated on our unit to point out the feasibility and safety of the laparoscopic cholecystectomy approach without the IOC use. From January 2004 and June 2008 we analyzed all the data from hospital records and follow up results of all the patients who underwent LC. The indications for performing preoperative endoscopic retrograde cholangiopancreatography (ERCP) or selective IOC were abnormal liver function tests, history of jaundice, cholangitis or pancreatitis, and ultrasonographic evidence of CBD stone or dilation (≥ 10 mm). These patients were excluded from study. The follow up of the all patients were done by liver function tests and abdominal ultrasonography when needed at the time of the visit. Between January 2006 and June 2010, 750 patients were operated in our clinic. In 34 patients, operations were converted to open cholecystectomy (OC). Of these 750 patients, 98 of them had one or more exclusion criteria and were excluded from the further analyzes. We did not perform any IOC during LC. Regular follow up of at least two years was obtained in 618 (618/657, 94.0%) patients. No operative mortality was encountered among the patients. Postoperative morbidity was detected in 15 of the patients (2.5%). In one patient, CBD injury was detected (0.017%). The mean follow up was 35 (24 - 74) months. Retained stone was detected in three patients (3/577, 0.5%) during the follow up. This approach allows to omit routine IOC and to perform LC safely in selected patients group given the low percentage of both CBD injuries and symptomatic retained stones observed in the late follow up period in our 618 operated patients, we consider our approach a feasible and safe approach to manage patients with gallbladder stones re-confirming the results of other studies.

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

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    Goldaracena Nicolas

    2009-09-01

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

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

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    Aftab Ahmad

    2015-05-01

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

  1. Single-incision laparoscopic cholecystectomy:Single institution experience and literature review

    Institute of Scientific and Technical Information of China (English)

    Yasumitsu; Hirano; Toru; Watanabe; Tsuneyuki; Uchida; Shuhei; Yoshida; Kanae; Tawaraya; Hideaki; Kato; Osamu; Hosokawa

    2010-01-01

    Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm ...

  2. Laparoscopic cholecystectomy in situs inversus totalis with "inferior" cystic artery:A case report

    Institute of Scientific and Technical Information of China (English)

    Sumihiro Kamitani; Yosihiro Tsutamoto; Kazuyoshi Hanasawa; Tohru Tani

    2005-01-01

    A 76-year-old man with known situs inversus totalis presented with left-sided discomfort. Abdominal ultrasonography and CT scan confirmed the diagnosis of a gallstone, as well as,situs inversus; the liver and gallbladder on the left side and the spleen on the right. The biliary system was thought to be left-right reversal, mirror image in the view of drip infusion cholangiogram and MRI. Laparoscopic cholecy stectomywas safely performed, despite of unexpected aberrant cystic artery running inferior to cystic duct of situs inversus.Laparoscopic surgeon should be careful for view of reversed relationships and also existence of other anomalies.

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

    Institute of Scientific and Technical Information of China (English)

    李潇娴; 朱江帆; 忻颖; 马颖璋

    2012-01-01

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

  4. 'It is Time to Prepare the Next patient' Real-Time Prediction of Procedure Duration in Laparoscopic Cholecystectomies.

    Science.gov (United States)

    Guédon, Annetje C P; Paalvast, M; Meeuwsen, F C; Tax, D M J; van Dijke, A P; Wauben, L S G L; van der Elst, M; Dankelman, J; van den Dobbelsteen, J J

    2016-12-01

    Operating Room (OR) scheduling is crucial to allow efficient use of ORs. Currently, the predicted durations of surgical procedures are unreliable and the OR schedulers have to follow the progress of the procedures in order to update the daily planning accordingly. The OR schedulers often acquire the needed information through verbal communication with the OR staff, which causes undesired interruptions of the surgical process. The aim of this study was to develop a system that predicts in real-time the remaining procedure duration and to test this prediction system for reliability and usability in an OR. The prediction system was based on the activation pattern of one single piece of equipment, the electrosurgical device. The prediction system was tested during 21 laparoscopic cholecystectomies, in which the activation of the electrosurgical device was recorded and processed in real-time using pattern recognition methods. The remaining surgical procedure duration was estimated and the optimal timing to prepare the next patient for surgery was communicated to the OR staff. The mean absolute error was smaller for the prediction system (14 min) than for the OR staff (19 min). The OR staff doubted whether the prediction system could take all relevant factors into account but were positive about its potential to shorten waiting times for patients. The prediction system is a promising tool to automatically and objectively predict the remaining procedure duration, and thereby achieve optimal OR scheduling and streamline the patient flow from the nursing department to the OR.

  5. 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.

  6. Validation of the mobile serious game application Touch Surgery™ for cognitive training and assessment of laparoscopic cholecystectomy.

    Science.gov (United States)

    Kowalewski, Karl-Friedrich; Hendrie, Jonathan D; Schmidt, Mona W; Proctor, Tanja; Paul, Sai; Garrow, Carly R; Kenngott, Hannes G; Müller-Stich, Beat P; Nickel, Felix

    2017-03-09

    Touch Surgery(™) (TS) is a serious gaming application for cognitive task simulation and rehearsal of key steps in surgical procedures. The aim was to establish face, content, and construct validity of TS for laparoscopic cholecystectomy (LC). Furthermore, learning curves with TS and a virtual reality (VR) trainer were compared in a randomized trial. The performance of medical students and general surgeons was compared for all three modules of LC in TS to establish construct validity. Questionnaires assessed face and content validity. For analysis of learning curves, students were randomized to train on VR or TS first, and then switched to the other training modality. Performance data were recorded. 54 Surgeons and 51 medical students completed the validation study. Surgeons outperformed students with TS: patient preparation (students = 45.0 ± 19.1%; surgeons = 57.3 ± 15.2%; p serious gaming application for learning cognitive aspects of LC with established construct, face, and content validity. There appeared to be a synergy between TS and the VR trainer. Therefore, the two training modalities should accompany one another in a multimodal training approach to laparoscopy.

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

    Institute of Scientific and Technical Information of China (English)

    Hussain Issa; Ahmed H Al-Salem

    2011-01-01

    AIM: To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis in patients with sickle cell anemia (SCA) in the era of laparoscopic cholecystectomy (LC).METHODS: Two hundred and twenty four patients (144 male, 80 female; mean age, 22.4 years; range, 5-70 years) with SCA underwent ERCP as part of their evaluation for cholestatic jaundice (CJ).The indications for ERCP were: CJ only in 97, CJ and dilated bile ducts on ultrasound in 103, and CJ and common bile duct (CBD) stones on ultrasound in 42.RESULTS: In total, CBD stones were found in 88 (39.3%) patients and there was evidence of recent stone passage in 16.Fifteen were post-LC patients.These had endoscopic sphincterotomy and stone extraction.The remaining 73 had endoscopic sphincterotomy and stone extraction followed by LC without an intraoperative cholangiogram.CONCLUSION: In patients with SCA and cholelithiasis, ERCP is valuable whether preoperative or postoperative, and in none was there a need to perform intraoperative cholangiography.Sequential endoscopic sphincterotomy and stone extraction followed by LC is beneficial in these patients.Endoscopic sphincterotomy may also prove to be useful in these patients as it may prevent the future development of biliary sludge and bile duct stones.

  8. Comparison of the Prophylactic Antiemetic Efficacy of Aprepitant Plus Palonosetron Versus Aprepitant Plus Ramosetron in Patients at High Risk for Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy: A Prospective Randomized-controlled Trial.

    Science.gov (United States)

    Choi, Eun Kyung; Kim, Dong Gyeong; Jeon, Younghoon

    2016-10-01

    We compared the antiemetic efficacy of aprepitant plus palonosetron versus aprepitant plus ramosetron in patients after laparoscopic cholecystectomy. A total of 88, nonsmoking, female patients undergoing laparoscopic cholecystectomy were randomly allocated to 2 groups of 44 each who received palonosetron 0.075 mg (aprepitant plus palonosetron group) and ramosetron 0.3 mg (aprepitant plus ramosetron group) after induction of anesthesia. All patients received aprepitant 80 mg 2 hours before surgery. The incidence of postoperative nausea and vomiting (PONV), use of rescue antiemetic, pain severity, and any side effects were assessed for 24 hours after surgery. The incidence of PONV and use of rescue antiemetic were less in aprepitant plus palonosetron group than in aprepitant plus ramosetron group for 24 hours after surgery (Pplus palonosetron significantly prevents PONV, compared with aprepitant plus ramosetron in patients at high risk for PONV after laparoscopic cholecystectomy.

  9. 3D 腹腔镜胆囊切除术36例报告%Application of 3D Laparoscopic Cholecystectomy:a Report of 36 Cases

    Institute of Scientific and Technical Information of China (English)

    徐安书; 傅朝春; 孙勇; 杨晓宾; 张世博; 许永平; 李洁

    2015-01-01

    Objective To investigate the clinical value of 3D laparoscopic cholecystectomy. Methods From June to October 2014, 36 cases of gallbladder disease, including 31 cases of gallbladder stones and 5 cases of gallbladder polyps, were treated by 3D laparoscopic cholecystectomy.The operation was performed by using the three ports technique, which was similar to conventional laparoscopic cholecystectomy. Results The operative time was 12-91 min ( average, 27.5 ±16.6 min) , and the blood loss was 5-120 ml (average, 45.0 ±26.9 ml).Two patients were given abdominal drainage, and the remaining patients required no drainage. No bile leakage, bleeding and other complications occurred.Postoperative follow-ups for 1-5 months ( average, 2 months) in 36 cases showed no discomfort. Conclusion 3D laparoscopic cholecystectomy is feasible and safe.As compared with 2D surgery, it is easier to operate and has more intuitive surgical vision.%目的:探讨3D腹腔镜胆囊切除术的临床应用价值。方法2014年6~10月我院对31例胆囊结石和5例胆囊息肉样病变施行3D腹腔镜胆囊切除术( laparoscopic cholecystectomy,LC),采用上腹部三孔法切除胆囊,建立腹腔镜操作通道,并维持气腹完成胆囊切除(手术方法同一般胆囊切除术)。结果手术时间12~91 min,(27.5±16.6) min;术中出血5~120 ml,(45.0±26.9) ml。2例由于炎症重放置引流管,其余未放引流管,无胆漏、出血等并发症。36例术后随访1~5个月,平均2个月,患者无不适。结论3D腹腔镜胆囊切除术是安全可行的,较2D腹腔镜易操作,更直观。

  10. Laparoscopic Techniques: What is the Role in Inflammatory Bowel Disease?

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    Tracy L Hull

    1995-01-01

    Full Text Available Laparoscopic cholecystectomy has quickly become the preferred technique for removing the gallbladder. Real advantages in the area of laparoscopic gallbladder removal have spurred interest towards other areas of laparoscopic surgery. There has been interest in laparoscopic bowel surgery but this approach has not gained popularity as quickly as gallbladder surgery. Reasons surround the fact that the bowel is a continuous organ (versus an end organ like the gallbladder laden with bacteria and it has a rich blood supply. These differences make laparoscopic bowel surgery more difficult and challenging. If inflammatory bowel disease (IBD is considered, the indications to approach surgery laparoscopically fall into two categories: current and future indications. The current indications are diagnostic laparoscopy, fecal diversion, limited bowel resections with extracorporeal anastomosis and stoma closures. Future indications include laparoscopic subtotal colectomy and laparoscopic assisted pelvic pouch procedures. As experience is gained and laparoscopic instruments are modified and refined for bowel surgery, intracorporeal anastomosis and more extensive bowel resections will be feasible. Currently laparoscopic bowel surgery can be done in select circumstances for problems associated with IBD. It has yet to be proven if doing the surgery laparoscopically provides advantages for bowel surgery as has been demonstrated with gallbladder surgery. Prospective studies are underway to answer these questions.

  11. Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during laparoscopic cholecystectomy.

    Science.gov (United States)

    Sen, Oznur; Umutoglu, Tarik; Aydın, Nurdan; Toptas, Mehmet; Tutuncu, Ayse Cigdem; Bakan, Mefkur

    2016-01-01

    Pressure-controlled ventilation (PCV) is less frequently employed in general anesthesia. With its high and decelerating inspiratory flow, PCV has faster tidal volume delivery and different gas distribution. The same tidal volume setting, delivered by PCV versus volume-controlled ventilation (VCV), will result in a lower peak airway pressure and reduced risk of barotrauma. We hypothesized that PCV instead of VCV during laparoscopic surgery could achieve lower airway pressures and reduce the systemic stress response. Forty ASA I-II patients were randomly selected to receive either the PCV (Group PC, n = 20) or VCV (Group VC, n = 20) during laparoscopic cholecystectomy. Blood sampling was made for baseline arterial blood gases (ABG), cortisol, insulin, and glucose levels. General anesthesia with sevoflurane and fentanyl was employed to all patients. After anesthesia induction and endotracheal intubation, patients in Group PC were given pressure support to form 8 mL/kg tidal volume and patients in Group VC was maintained at 8 mL/kg tidal volume calculated using predicted body weight. All patients were maintained with 5 cmH2O positive-end expiratory pressure (PEEP). Respiratory parameters were recorded before and 30 min after pneumoperitonium. Assessment of ABG and sampling for cortisol, insulin and glucose levels were repeated 30 min after pneumoperitonium and 60 min after extubation. The P-peak levels observed before (18.9 ± 3.8 versus 15 ± 2.2 cmH2O) and during (23.3 ± 3.8 versus 20.1 ± 2.9 cmH2O) pneumoperitoneum in Group VC were significantly higher. Postoperative partial arterial oxygen pressure (PaO2) values are higher (98 ± 12 versus 86 ± 11 mmHg) in Group PC. Arterial carbon dioxide pressure (PaCO2) values (41.8 ± 5.4 versus 36.7 ± 3.5 mmHg) during pneumoperitonium and post-operative mean cortisol and insulin levels were higher in Group VC. When compared to VCV mode, PCV mode may improve compliance during pneumoperitoneum

  12. Comparison between general anesthesia and spinal anesthesia in attenuation of stress response in laparoscopic cholecystectomy: A randomized prospective trial

    Directory of Open Access Journals (Sweden)

    Writuparna Das

    2015-01-01

    Full Text Available Background: Laparoscopy though minimally invasive produces significant hemodynamic surge and neuroendocrine stress response. Though general anesthesia (GA is the conventional technique, now-a-days, regional anesthesia has been accepted for laparoscopic diagnostic procedures, and its use is also being extended to laparoscopic surgeries. Objective: The aim was to compare the hemodynamic surge and neuroendocrine stress response during laparoscopic cholecystectomy (LC under GA and spinal anesthesia (SA in American Society of Anesthesiologists (ASA PS 1 patients. Materials and Methods: Thirty ASA physical status I patients, aged 18-65 years were randomly allocated into two equal groups of 15 each. Group A received GA with controlled ventilation. Patients were preoxygenated for 5 min with 100/5 oxygen, premedicated with midazolam 0.03 mg/kg intravenous (i.v, fentanyl 2 mcg/kg i.v; induction was done with thiopentone 3-5 mg/kg i.v; intubation was achieved after muscle relaxation with 0.5 mg/kg atracurium besylate i.v. Anesthesia was maintained with 1-2% sevoflurane and N2O:O2 (60:40 and intermittent i.v injection of atracurium besylate. Group B SA with 0.5% hyperbaric bupivacaine and 25 μg fentanyl along with local anesthetic instillation in the subdiaphragmatic space. Mean arterial pressure, heart rate (HR, oxygen saturation, end tidal carbon-dioxide were recorded. Venous blood was collected for cortisol assay before induction and 30 min after pneumoperitoneum. All data were collected in Microsoft excel sheet and statistically analyzed using SPSS software version 16 (SPSS Inc., Chicago, IL, USA. All numerical data were analyzed using Student′s t-test and paired t-test. Any value <0.05 was taken as significant. Results: Mean arterial pressure and mean HR and postpneumoperitoneum cortisol level were lower in group B than group A though the difference was not statistically significant in hemodynamic parameters but significant in case of cortisol

  13. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study

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    Mefkur Bakan

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: Intraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. METHODS: 80 Anesthesiologists I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF. All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6 h after surgery. The primary outcome variable was postoperative fentanyl consumption. RESULTS: Fentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75 ± 59 µg and 120 ± 94 µg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. CONCLUSION: Opioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting.

  14. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study.

    Science.gov (United States)

    Bakan, Mefkur; Umutoglu, Tarik; Topuz, Ufuk; Uysal, Harun; Bayram, Mehmet; Kadioglu, Huseyin; Salihoglu, Ziya

    2015-01-01

    Intraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. 80 Anesthesiologists I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6h after surgery. The primary outcome variable was postoperative fentanyl consumption. Fentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75 ± 59 μg and 120 ± 94 μg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. Opioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  15. [Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study].

    Science.gov (United States)

    Bakan, Mefkur; Umutoglu, Tarik; Topuz, Ufuk; Uysal, Harun; Bayram, Mehmet; Kadioglu, Huseyin; Salihoglu, Ziya

    2015-01-01

    Intraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. 80 Anesthesiologists I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6h after surgery. The primary outcome variable was postoperative fentanyl consumption. Fentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75±59μg and 120±94μg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. Opioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  16. The comparison of analgesic effects of various administration methods of diclofenac sodium, transdermal, oral and intramuscular, in early postoperative period in laparoscopic cholecystectomy operations.

    Science.gov (United States)

    Gulcin Ural, Sedef; Yener, Ozlem; Sahin, Hasan; Simsek, Tuncer; Aydinli, Bahar; Ozgok, Aysegul

    2014-01-01

    The aim of this study was to compare the efficacy of oral, intra muscular and transdermal diclofenac sodium for pain treatment in patients undergoing laparoscopic cholecystectomy, and their effect on postoperative opioid consumption. Following informed consent, 90 ASA I-II patients scheduled for laparoscopic cholecystectomy were randomized into three groups. Group PO got oral diclofenac sodium 1 hour before the operation, Group IM 75 mg diclofenac sodium intra muscular and Group TD diclofenac sodium patch 6 hours before the operation. Patients were not premedicated. Routine anaesthesia induction was used. After the operation in post anaesthesia care unit tramadol HCl infusion was delivered by intravenous patient controlled analgesia (iv PCA). Ramsey Sedation Score (RSS), Modified Aldrete's Score System(MASS) and Visual Analog Scale Pain Score (VAS) was used for postoperative evaluation. Postoperative opioid consumption was recorded. Demographic characteristics, intraoperative and postoperative hemodynamics of the patients were similar between groups. Postoperative VAS were lower at all time points in Group IM and Group TD than in Group PO. Lowest Postoperative RSS were in Group IM and the highest were in Group PO, and the difference between groups was significant. There was no significant difference in Postoperative MASS between groups. Postoperative tramadol consumption was statistically different between groups. Tramadol consumption in Group IM and Group TD was lower than Group PO. Postoperative nausea and vomiting was not observed. Local complications related to transdermal and intra muscular applications was not reported. In patients undergoing ambulatory laparoscopic cholecystectomy, a noninvasive application transdermal diclofenac sodium is as effective as intramuscular diclofenac sodium and can be preferred in postoperative pain treatment.

  17. Objective ergonomic risk assessment of wrist and spine with motion analysis technique during simulated laparoscopic cholecystectomy in experienced and novice surgeons

    Science.gov (United States)

    Dabholkar, Twinkle Yogesh; Yardi, Sujata Sudhir; Oak, Sanjay Narahari; Ramchandani, Sneha

    2017-01-01

    INTRODUCTION: There is a rise in prevalence of work-related musculoskeletal disorders in surgeons performing laparoscopic surgeries due to lack of ergonomic considerations to the minimal access surgical environment. The objective of this study was to assess the physical ergonomics in experienced and novice surgeons during a simulated laparoscopic cholecystectomy. METHODOLOGY: Thirty-two surgeons participated in this study and were distributed in two groups (experienced and novices) based on the inclusion criteria. Both groups were screened for the spinal and wrist movements on the orientation sensor-based, motion analysis device while performing a simulated laparoscopic cholecystectomy. Simultaneous video recording was used to estimate the other joint positions. The RULA (Rapid Upper Limb Assessment) ergonomic risk scores were estimated with the acquired data. RESULTS: We found that surgeons in both novice and experienced groups scored a high on the RULA. Limited awareness of the influence of monitor position on the postural risk caused surgeons to adopt non-neutral range cervical postures. The thoracolumbar spine is subjected to static postural demand. Awkward wrist postures were adopted during the surgery by both groups. There was no statistically significant difference in the RULA scores between the novice and experienced, but some differences in maximum joint excursions between them as detected on the motion analysis system. CONCLUSION: Both experienced and novice surgeons adopted poor spinal and wrist ergonomics during simulated cholecystectomy. We concluded that the physical ergonomic risk is medium as estimated by the RULA scoring method, during this minimally invasive surgical procedure, demanding implementation of change in the ergonomic practices. PMID:28281476

  18. Study on Clinical Nursing of Laparoscopic Cholecystectomy%腹腔镜胆囊切除术临床护理路径研究

    Institute of Scientific and Technical Information of China (English)

    刘影

    2015-01-01

    目的:研究临床护理路径在腹腔镜胆囊切除术中的作用。方法收集腹腔镜胆囊切除术的患者,分为临床路径组和对照组。临床路径组予临床路径规范护理,对照组常规护理,数据统计学分析比较住院天数、术后恢复状况、患者满意度的差异。结果与对照组比较,临床路径组患者住院天数缩短、术后恢复更快、患者满意度提高,有统计学意义。结论对于腹腔镜胆囊切除术的患者按照临床路径规范护理非常必要。%Objective Study on clinical nursing of laparoscopic cholecystectomy. Methods We selected feasible laparoscopic cholecystectomy patients to study who were divided into two groups,clinical nursing pathway group and paral el control group. According to clinical nursing pathway schedule,the clinical pathway group implemented the treatment table process. The paral el control group completed the treatment according to traditional customs. The data was statistical analyzed to compare the differences between two groups of patients hospitalized in length of hospital stay,health care quality and patient satisfaction. Results Compared with the control group,patients in the clinical pathway group hospitalization daysshorter,faster recovery after surgery,patient satisfaction increased,and results had a statistical significance. Conclusion Laparoscopic cholecystectomy for patients,accordingto clinical nursing path specification,is necessary.

  19. Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Bisgaard, T; Kristiansen, V B; Hjortsø, N C

    2004-01-01

    5 days before to 5 days after operation. Daily scores of general well-being, fatigue, appetite and pain, computerized measurements of physical activity and sleep (actigraphy), and subjective sleep quality were recorded. Nausea and vomiting were assessed twice within the first 24 h after surgery....... RESULTS: Data from 86 patients were available for statistical analysis, 43 in each treatment group. No significant intergroup differences in general well-being or any other outcome variable were found. CONCLUSION: A preoperative carbohydrate beverage did not improve clinical outcome after laparoscopic...

  20. Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review.

    Science.gov (United States)

    Vlek, S L; van Dam, D A; Rubinstein, S M; de Lange-de Klerk, E S M; Schoonmade, L J; Tuynman, J B; Meijerink, W J H J; Ankersmit, M

    2017-07-01

    Near-infrared imaging with indocyanine green (ICG) has been extensively investigated during laparoscopic cholecystectomy (LC). However, methods vary between studies, especially regarding patient selection, dosage and timing. The aim of this systematic review was to evaluate the potential of the near-infrared imaging technique with ICG to identify biliary structures during LC. A comprehensive systematic literature search was performed. Prospective trials examining the use of ICG during LC were included. Primary outcome was biliary tract visualization. Risk of bias was assessed using ROBINS-I. Secondly, a meta-analysis was performed comparing ICG to intraoperative cholangiography (IOC) for identification of biliary structures. GRADE was used to assess the quality of the evidence. Nineteen studies were included. Based upon the pooled data from 13 studies, cystic duct (Lusch et al. in J Endourol 28:261-266, 2014) visualization was 86.5% (95% CI 71.2-96.6%) prior to dissection of Calot's triangle with a 2.5-mg dosage of ICG and 96.5% (95% CI 93.9-98.4%) after dissection. The results were not appreciably different when the dosage was based upon bodyweight. There is moderate quality evidence that the CD is more frequently visualized using ICG than IOC (RR 1.16; 95% CI 1.00-1.35); however, this difference was not statistically significant. This systematic review provides equal results for biliary tract visualization with near-infrared imaging with ICG during LC compared to IOC. Near-infrared imaging with ICG has the potential to replace IOC for biliary mapping. However, methods of near-infrared imaging with ICG vary. Future research is necessary for optimization and standardization of the near-infrared ICG technique.

  1. Asymptomatic bile duct stones: selection criteria for intravenous cholangiography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy.

    Science.gov (United States)

    Sarli, L; Costi, R; Gobbi, S; Sansebastiano, G; Roncoroni, L

    2000-11-01

    Routine use of endoscopic retrograde cholangiography (ERC) and/or intravenous cholangiography (IVC) or magnetic resonance cholangiopancreatography (MRCP) before laparoscopic cholecystectomy (LC) is not cost-effective. The objective of this study was to determine precise and easily applicable criteria to select patients who should undergo IVC, MRCP and/or ERC before LC. Prospectively collected data from 74 consecutive patients who were diagnosed with asymptomatic common bile duct stones (CBDS) before undergoing LC, were compared with data from 74 matched controls without CBDS. Using the chi2 test, those variables were identified which were significantly related to the presence of CBDS. These were inserted into a logistic multiple regression model and, by means of conditional regression analysis, each variable was assigned a score from -2 to +4 proportional to the odds ratio. By adding up the scores obtained, a classification was made as to high, medium and low CBDS risk. As a result, 51 patients were found to be low-risk cases, 53 medium-risk and 44 high-risk. Assuming no further assessment of the bile duct needed to be carried out in low-risk patients, an IVC or MRCP in those at medium risk and an ERC in those at high risk, a calculation was made of the positive predictive value and the sensitivity of the system proposed. The positive predictive value and the sensitivity of the procedure were calculated as being greater than 90%. This predictive system for the risk of CBDS allows the selective use of ERC, IVC and MRCP to ensure a high yield and improve cost-effectiveness. A controlled prospective study will verify these results.

  2. Timing and nature of presentation of unsuspected retained common bile duct stones after laparoscopic cholecystectomy: a retrospective study.

    Science.gov (United States)

    Cox, Michael R; Budge, Joel P O; Eslick, Guy D

    2015-07-01

    Common bile duct (CBD) stones may be over looked at the time of laparoscopic cholecystectomy (LC), particularly when intra-operative cholangiography (IOC) is not performed. Currently, there is no data available about the time course and pattern of presentation for stones retained in the CBD at the time of LC. The aim of this study was to establish the time course and pattern of presentation of unsuspected retained CBD stones post LC. Patients presenting with symptomatic CBD stones from 1994 until 2010, having previously undergone LC were studied in this retrospective, case note review. CBD stones were confirmed at ERCP. Data collected included LC date, mode of presentation, imaging results including CBD diameter, stone appearance, length of stay and post ERCP complications. Patients having an ERCP for stones found on IOC at LC were excluded. Sixty-one patients met the inclusion criteria. The most common mode of presentation was abdominal pain (n = 38, 62%) with (17) or without (21) deranged liver function tests. Nineteen (31%) patients presented with clinical complications of the CBD stones: cholangitis (10), acute biliary pancreatitis (6) or obstructive jaundice (3). The CBD was usually mild-to-moderately dilated (8-15 mm) on ultrasound. The median time span from LC to presentation with CBD stones was 4 years (range: 6 days-18 years). Five (8.2%) patients had a complication from their ERCP; mild pancreatitis (3), bleed (1) and cholangitis (1). Nineteen (31.1%) patients required more than one ERCP to complete stone/stent removal. The median time for patients to present with symptomatic CBD stones after LC is 4 years. Patients with retrained stones may remain asymptomatic for many years. A third of the patients presented with potentially serious complications of the retained CBD stone. Future studies for CBD stones after LC need to follow patients for at least 10 years.

  3. [The variation of hepatic duct confluence and asymptomatic common bile duct stone with routine intraoperative cholangiogram during laparoscopic cholecystectomy].

    Science.gov (United States)

    Kim, Se Young; Kim, Ki Ho; Kim, Il Dong; Suh, Byung Sun; Shin, Dong Woo; Kim, Sang Wook; Park, Jin Soo; Lim, Hye In

    2011-12-01

    Intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC) has been used to evaluate bile duct stone. But, the routine use of IOC remains controversial. With routine IOC during LC, we reviewed the variation of hepatic duct confluence and try to suggest the diagnostic criteria of asymptomatic common bile duct (CBD) stone. We reviewed the medical record of 970 consecutive patients who underwent LC with IOC from January 1999 to December 2009, retrospectively. Nine hundered seventy patients were enrolled. IOC were successful in 957 (98.7%) and unsuccessful in 13 (1.3%). Eighty two of 957 patients (8.2%) were excluded because of no or poor radiologic image. According to Couinaud's classification, 492 patients (56.2%) had type A hepatic duct confluence, 227 patients (26.1%) type B, 15 patients (17%) type C1, 43 patients (4.9%) type C2, 72 patients (8.2%) type D1, 21 patients (2.4%) type D2, 1 patient (0.1%) type E1, 1 patient (0.1%) type E2, 2 patients (0.2%) type F, and 1 patient (0.1%) no classified type. The CBD stone was found in 116 of 970 (12.2%) patients. In 281 patients, preoperative serologic and radiologic tests did not show abnormality. When preoperative findings were not remarkable, there was no difference of clinical features between patients with or without CBD stones. Although IOC during LC has some demerits, it is a safe and accurate method for the detection of CBD stone and the anatomic variation of intrahepatic duct.

  4. STUDY OF THE ROLE OF ORAL CLONIDINE PREMEDICATION ON HAEMODYNAMIC CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANAESTHESIA WITH ENDOTRACHEAL INTUBATION

    Directory of Open Access Journals (Sweden)

    Subhrajyoti Chattopadhyay

    2016-07-01

    Full Text Available BACKGROUND Laparoscopic cholecystectomy (LC is known to produce Exaggerated Haemodynamic Responses (HDR owing to pneumoperitoneum. Different pharmacological agents like opioids, benzodiazepines, lignocaine, beta blockers, nitroglycerine, etc. are being used to alleviate HDR. Clonidine at doses varying from 2 to 6 mcg per kg body weight or a fixed dose of 150 or 200 mcg have been tested either through intravenous or oral routes with varying results thus creating confusion. Hence, we have designed to observe the effect of oral premedication with 200 mcg clonidine in attenuating HDR in patients undergoing LC under GA. METHODS Sixty adults aged between 18 and 60 years of either sex of American Society of Anaesthesiologists (ASA physical status I or II, undergoing LC under GA were randomly allocated to receive orally either tablet clonidine 200 mcg (Group 1, n=30 or multivitamin tablets (Group 2, n=30 about 60-90 minutes before induction of GA. Heart rate, mean arterial pressure (MAP, SpO2, and EtCO2 were recorded at different perioperative time points. The level of sedation was also noted using Ramsay Sedation Scale. Postoperatively, the incidence of shivering was recorded. RESULTS The surge in heart rate and MAP after intubation, 15 and 30 min after pneumoperitoneum, after release of CO2, and after extubation were found lower in the study group (p=0.0001. Patients receiving oral clonidine premedication showed a deeper level of sedation before induction (p=0.001 and in the postoperative period (p <0.001, better control of postoperative shivering (p=0.038, nausea (p=0.038 and vomiting (p=0.036. CONCLUSION Oral premedication with 200 mcg clonidine is effective in achieving better perioperative haemodynamic stability, deeper level of sedation, and reduced incidences of postoperative shivering, nausea, and vomiting compared with placebo. With such dose, clonidine does not produce any harmful changes in observed parameters like SpO2, EtCO2, or ECG.

  5. Nursing care of patients undergoing laparoscopic cholecystectomy%腹腔镜胆囊切除术的护理

    Institute of Scientific and Technical Information of China (English)

    周燕娥; 张宏; 曾茹英

    2010-01-01

    目的 探讨腹腔镜胆囊切除术(LC)的护理.方法 对165例腹腔镜胆囊切除术患者术前心理状况、术后并发症的观察等护理措施做回顾性分析.结果 本组患者通过系统的精心的护理措施干预,消除了患者的焦虑和抑郁的心理障碍,使其能较好的配合手术,痊愈出院.结论 依据患者的不同状况和进行腹腔镜专业知识进行系统的护理措施干预,能显著减轻患者的心理负担,为术后的护理工作提供有力的保障.%Objective To explore nursing care of patients undergoing laparoscopic cholecystectomy ( LC ). Methods The nursing intervention including observation of psychological state and postoperative complications were retrospectively analyzed in 165 patients undergoing LC. Results The general nursing intervention could relieve anxiety and depression in those patients. The procedure was successfully perfomed in all the patients and they were discharged with full recovery. Conclusions Nursing intervention based on the patients with different physical conditions and the expertise of laparoscopy can markedly lower psychologic burden in patients and provid great guarantee for postoperative nursing care.

  6. One-year experience with single incision laparoscopic cholecystectomy in a single center: without the use of inverse triangulation.

    Science.gov (United States)

    Ryu, Yun Beom; Lee, Jung Woo; Park, Yo Han; Lim, Man Sup; Cho, Ji Woong; Jeon, Jang Yong

    2016-02-01

    Single incision laparoscopic cholecystectomy (SILC) is generally performed with the use of inverse triangulation. In this study, we performed 3-channel or 4-channel SILC without the use of inverse triangulation. We evaluated the adequacy and feasibility of SILC using our surgical method. We retrospectively reviewed our series of 309 SILCs performed between March 2014 and February 2015. Among 309 SILCs, male were 148 and female were 161 patients, mean age was 48.7 ± 15.3 years old and mean body mass index was 24.8 ± 3.8 kg/m(2). Forty patients had previously undergone abdominal surgery including 6 cases of upper abdominal surgery. SILC after percutaneous transhepatic gallbladder (GB) drainage was completed in 8.7% of cases. There were 10 cases of emergency SILC. SILC was performed for noncomplicated GB including symptomatic GB stone and polyp in 66.7% of cases, acute cholecystitis in 33.3%. Overall, 96.8% of procedures were successfully completed without additional port. The reason for addition of an extra port or open conversion included technical difficulties due to severe adhesion and bleeding. The mean operating time was 60.7 ± 22.3 minutes. The overall complication rate was 4.8%: 9 patients of wound seroma, 1 case of bile leakage from GB bed, 4 cases of intra-abdominal abscess or fluid collection, and 1 case of incisional hernia were developed. There was no case of common bile duct injury. Our surgical method of SILC without the use of inverse triangulation is safe, feasible and effective technique.

  7. Preoperative routine magnetic resonance cholangiopancreatography before laparoscopic cholecystectomy: a prospective study.

    Science.gov (United States)

    Jendresen, M B; Thorbøll, J E; Adamsen, S; Nielsen, H; Grønvall, S; Hart-Hansen, O

    2002-01-01

    To assess the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in detecting common bile duct stones in the preoperative investigation of patients electively referred for gallstone disease, to find out the incidence of asymptomatic common duct stones, and to correlate clinical symptoms and history and liver function tests (LFT) with the actual occurrence of common duct stones. Prospective study. General hospital, Denmark. 180 consecutive non-jaundiced patients referred with symptomatic gallstones for elective cholecystectomy. LFT, abdominal ultrasonography, MRCP, endoscopic retrograde cholangiopancreatography (ERCP), questionnaire. Positive and negative predictive values and accuracy of MRCP, number of patients with asymptomatic stones, and correlation of symptoms with the presence of stones. 26/180 patients had common duct stones (14%). Only one (asymptomatic stone. For detection of such stones, MRCP's positive predictive value was 0.95 (95% confidence interval (CI): 0.86 to 1.00), negative predictive value 0.96 (0.93 to 0.99), and accuracy 0.85 (0.93 to 0.99). MRCP missed 5 stones 1-4 mm in size in 5 patients; 17/64 patients with raised LFTs had stones (27%). The probability of stones was highest when the patients had both raised LFTs and a dilated common (>7 mm) bile duct (82%). There were no readmissions with ductal stones in the 6-month postoperative period. The predicive values of MRCP were fairly good, but MRCP misses some small stones Asymptomatic stones in the common duct are not common in this population and should not be screened for. The probability of stones increases with the number of predictive factors. Patients should be questioned carefully about signs of biliary obstruction, and only be offered preoperative MRCP should they have a suspicious history, raised LFTs, or a dilated common duct.

  8. A comparison of the effects of droperidol and the combination of droperidol and ondansetron on postoperative nausea and vomiting for patients undergoing laparoscopic cholecystectomy.

    LENUS (Irish Health Repository)

    Awad, Imad T

    2012-02-03

    STUDY OBJECTIVES: To compare the prophylactic antiemetic efficacy of the combination of ondansetron and droperidol with that of droperidol alone in patients undergoing elective laparoscopic cholecystectomy. DESIGN: Randomized, double-blind controlled trial. University affiliated teaching hospital after induction of standardized general anesthesia. PATIENTS: 64 ASA physical status I or II patients aged 18 to 80 years, undergoing elective laparoscopic cholecystectomy. INTERVENTION: Following induction of general anesthesia, patients received either droperidol 1.25 mg intravenously (IV; n = 30; Group D) or the combination of droperidol 1.25 mg IV and ondansetron 4 mg IV (n = 34; Group D+O). MEASUREMENTS: Number and severity of nausea episodes, number of emetic episodes, total analgesic consumption, and rescue antiemetic administration were assessed at 1, 3, and 24 hours after admission to the recovery room. Data were analyzed using Fisher\\'s Exact test and unpaired Student\\'s t-test; a p-value <0.05 was considered significant. RESULTS: The proportions of patients who experienced nausea (70% and 53% for D and D+O groups, respectively) and vomiting (30% and 19% for D and D+O groups, respectively) were similar in the two groups. The frequency of moderate and severe nausea (requiring administration of antiemetic) was less in group D + O (7%) compared with group D (19%; p < 0.05). CONCLUSIONS: Patients who received the combination of droperidol and ondansetron experienced less severe nausea compared with patients who received droperidol alone.

  9. Comparative evaluation of the effects of propofol and sevoflurane on cognitive function and memory in patients undergoing laparoscopic cholecystectomy: A randomised prospective study

    Directory of Open Access Journals (Sweden)

    Upasana Goswami

    2015-01-01

    Full Text Available Background and Aims: General anaesthesia (GA may cause post-operative impairment of cognition and memory. This is of importance where time to discharge after anaesthesia is short as after laparoscopic cholecystectomy. This study was conducted to compare the effects of propofol and sevoflurane on cognitive function in the post-operative period. Methods: After approval of the Ethical Committee, 80 female patients posted for laparoscopic cholecystectomy to be performed under GA were randomly divided into two groups. Propofol was used in Group P and sevoflurane in Group S. Data analysis was done with California verbal learning test (CVLT, digit span test (DST, Rivermead behavioural memory test (RBMT, mini mental state examination (MMSE score, and semantic memory tests. Aldrete recovery scoring system and visual analogue scale for pain were assessed post-operatively. The level of statistical significance was set at P < 0.05. Results: There was no significant difference in demographic and haemodynamic data. Cognition and explicit memory were affected more in the propofol group in the immediate post-operative period. With majority of tests, such as semantic memory test, MMSE score, DST and RBMT, the difference was insignificant at 2 and 4 h post-operatively. But CVLT values were found to be statistically significant between groups even at 4 h. Conclusion: Propofol was associated with significant impact on cognitive functions in comparison to sevoflurane in the immediate post-operative period. Sevoflurane anaesthesia might be a better option in day care surgeries.

  10. Comparative evaluation of the effects of propofol and sevoflurane on cognitive function and memory in patients undergoing laparoscopic cholecystectomy: A randomised prospective study

    Science.gov (United States)

    Goswami, Upasana; Babbar, Savita; Tiwari, Saurabh

    2015-01-01

    Background and Aims: General anaesthesia (GA) may cause post-operative impairment of cognition and memory. This is of importance where time to discharge after anaesthesia is short as after laparoscopic cholecystectomy. This study was conducted to compare the effects of propofol and sevoflurane on cognitive function in the post-operative period. Methods: After approval of the Ethical Committee, 80 female patients posted for laparoscopic cholecystectomy to be performed under GA were randomly divided into two groups. Propofol was used in Group P and sevoflurane in Group S. Data analysis was done with California verbal learning test (CVLT), digit span test (DST), Rivermead behavioural memory test (RBMT), mini mental state examination (MMSE) score, and semantic memory tests. Aldrete recovery scoring system and visual analogue scale for pain were assessed post-operatively. The level of statistical significance was set at P < 0.05. Results: There was no significant difference in demographic and haemodynamic data. Cognition and explicit memory were affected more in the propofol group in the immediate post-operative period. With majority of tests, such as semantic memory test, MMSE score, DST and RBMT, the difference was insignificant at 2 and 4 h post-operatively. But CVLT values were found to be statistically significant between groups even at 4 h. Conclusion: Propofol was associated with significant impact on cognitive functions in comparison to sevoflurane in the immediate post-operative period. Sevoflurane anaesthesia might be a better option in day care surgeries. PMID:25838586

  11. 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.

  12. 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

  13. 超声刀在腹腔镜胆囊切除术中的应用%Application of ultrasonic harmonic scalpel in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    孙雪峰; 王军

    2009-01-01

    Objective To summarized the experiences and superiority of ultrasonic harmonic scalpel in laparoscopic cholecystectomy(LC).Methods The method was same as conventional LC. Ductus cysticus was cut off after it was closed. And then arteria cysticus and bed cysticus were separated, stripped,coagulated and cut off by ultrasonic harmonic scalpel.Results Two hundred and ninety eight patients have been cured, 2 patients were converted to open surgery.Conclusion The application of ultrasonic harmonic scalpel in laparoscopic cholecystectomy has the followingadvantages such as good-to-excellent effects on stopping bleeding, accurate cut, safe to the patients, short operation time.%目的 总结超声刀在腹腔镜胆囊切除术(LC)中的应用方法、技巧及注意事项.方法 基本同常规LC方法,夹闭胆囊管后将其切断,胆囊动脉及胆囊床组织用超声刀分离、剥离、凝固、切割止血.结果 本组298例均痊愈出院,其中中转开腹2例.结论 在LC手术中超声刀的应用具有以下优越性:①止血效果好;②切割精确;③安全性高;④手术时间短.

  14. 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.

  15. Colecistectomia videolaparoscópica por trocarte único (SITRACC®: uma nova opção Laparoscopic cholecystectomy by single trocar access(SITRACC®: a new option

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Dantas de Campos Martins

    2009-04-01

    Full Text Available OBJETIVO: Apresentar uma nova abordagem cirúrgica para realização de colecistectomia videolaparoscópica. MÉTODO: Em outubro de 2008 realizamos a primeira colecistectomia videocirúrgica por acesso transumbilical único, em humano, com a utilização do equipamento denominado SITRACC® - Single Trocar Access. A operação foi realizada em paciente do sexo feminino e constituiu dos passos clássicos da colecistectomia videolaparoscópica, com a utilização de instrumental flexível especial. RESULTADOS: O tempo operatório foi de 64 minutos, não sendo necessária a introdução de trocárteres adicionais. A evolução pós-operatória ocorreu de maneira satisfatória, sem nenhuma intercorrência. CONCLUSÃO: A colecistectomia por acesso umbilical único, com uso do SITRACC, mostro-se plenamente viável em humanos. Com o avançar tecnológico do instrumental, novas cirurgias poderão ser realizadas por esse método.BACKGROUND: To present a new device for the execution of Laparoscopic Cholecystectomy. METHODS: In October 2008 was performed the first human Single Trocar Acess - Sitracc Cholecystectomy, in a female patient. The operation consisted in the classical steps of a laparoscopic cholecystectomy, using special flexible instruments and a 5 mm optical device. RESULTS: The operative time was 64 minutes. There were no important complications at the post-operative phase. CONCLUSION: The cholecistectomy by the Single Trocar Access method is feasible in humans. With the improvement of the instruments and the multichannel trocar, new surgeries could be perform by this method, adding a new weapon in a continuous fight to benefit our patients.

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

    Institute of Scientific and Technical Information of China (English)

    姚时伟

    2013-01-01

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

  17. Transumbilical Single-Port Laparoscopic Cholecystectomy Using Conventional Laparoscopic Instrumentation%常规腹腔镜器械下经脐单孔腹腔镜胆囊切除术

    Institute of Scientific and Technical Information of China (English)

    杜贻豹; 韩晓东; 狄建忠; 张弘玮; 周玉龙; 张频

    2012-01-01

    Objective: A prospective case series of transumbilical single-port laparoscopic cholecystectomy (TUSPLC) using conventional laparoscopic instrument is described. Methods: Eighteen selected patients with gallbladder pathologies underwent TUSPLC between March 2009 and July 2009. Three trocars via a single small umbilical incision and conventional laparoscopic instrument were used to perform the cholecystectomy. Results: This series of 18 patients (5 men and 13 women) had no conversion to standard multiport laparoscopy or open surgery. The patients had an average age of 39 years (range, 25-53 years). The average operating time was 69 min (range, 45-115 min). No significant blood loss or complications occurred. The mean postoperative hospital stay was 1.7 (range, 1.0-3.0) days. All of the patients were pleased with their results. At the 2-week follow-up, the umbilical incisions were nearly invisible, even to the patients. Conclusions: TUSPLC using conventional laparoscopic instrument is feasible. It can be performed without specialized instrumentation and at no extra cost. Additional studies randomizing standard laparoscopic cholecystectomy and TUSPLC are necessary for defining the exact role of this procedure.%目的:前瞻性分析常规腹腔镜器械下的经脐单孔腹腔镜胆囊切除术.方法:2009年3月至2009年7月,入选18例胆囊疾病患者行经脐单孔腹腔镜胆囊切除术.该手术使用常规腹腔镜器械及经脐部同一小切口的三个穿刺套管.结果:18例患者(男性5人,女性13人)均没有中转为常规多孔腹腔镜或开放手术.患者平均年龄39岁(25-53岁),平均手术时间69 min(45-115 min).无明显失血或并发症发生.患者平均术后住院天数为1.7天(1-3天).术后患者满意度为100%.术后2周,患者脐部切口几乎不可见.结论:常规腹腔镜器械下经脐单孔腹腔镜胆囊切除术是可行的.它能够在没有专门器械及额外费用的情况下实施.

  18. Nursing for patients with laparoscopic approach to postoperative abdominal bleeding after laparoscopic cholecystectomy%腹腔镜胆囊切除术后腹腔出血再次腹腔镜探查患者的护理

    Institute of Scientific and Technical Information of China (English)

    何月红; 王建华; 刘维

    2013-01-01

    Objective To explore the perioperative nursing for the patients with laparoscopic approach to abdominal bleeding after laparoscopic cholecystectomy.Methods Clinical materials of 7 patients with laparoscopic approach to abdominal bleeding after laparoscopic cholecystectomy were analyzed retrospectively.Results Among the 7 patients,2 patients had Trocar bleeding,2 patients had vascular bleeding of omental adhesion stripped surface,one patient had posterior bleeding of cystic artery and 2 patients had staxis in gallbladder bed.All the patients underwent operations successfully,and the duration of operation time was 40 to 90 minutes.No complications such as rehaemorrhagia,bile leakage and infection were observed after operation.Conclusion After laparoscopic cholecystectomy,the related work such as rigorous observation on abdominal bleeding,placement of drainage tube in postoperative period,nursing for patients with rehabilitation of gastrointestinal function and mental nursing should be well arranged and implemented.%目的 探讨腹腔镜手术后腹腔出血的观察及再行腹腔镜探查术的围术期护理.方法 回顾性分析7例腹腔镜胆囊切除术后腹腔出血再次腹腔镜探查术患者的临床资料.结果 7例患者中,2例为Trocar戳孔出血,2例大网膜粘连剥离面血管出血,1例胆囊动脉后支出血,2例胆囊床渗血.7例患者再次手术均顺利,手术时间为40~80 min,无术后再出血、胆漏、感染等并发症.结论 腹腔镜胆囊切除术后应严密观察,腹腔出血再次手术后必须做好引流管、胃肠功能恢复护理及心理护理.

  19. Experience on Laparoscopic Cholecystectomy for Complicated Cholecystolithiasis: with A Report of 75 Cases%复杂性胆囊结石腹腔镜治疗体会

    Institute of Scientific and Technical Information of China (English)

    王崇高; 蔡永东; 胡昇庠; 赵新潮; 江秋生; 郑后珍; 刘福生

    2012-01-01

    目的 总结复杂性胆囊结石的腹腔镜手术治疗体会,探讨其安全性和可行性. 方法 对2009年5月~2012年5月行腹腔镜胆囊切除术的75例复杂性胆囊结石患者的临床资料进行回顾性分析.其中,急性胆囊炎48例,坏疽性胆囊炎12例,萎缩性胆囊炎5例,合并肝硬化5例,胆囊十二指肠瘘1例,Mirizzi综合征1例,合并腹部手术史3例. 结果 本组手术时间52~180 min,平均(67.5±35.5) min;术中出血量50~ 140 ml,平均(75.3±55.5)ml;术后住院时间5~30 d,平均(6.5±2.0)d.完成腹腔镜手术73例,其中腹腔镜下顺行胆囊切除术67例,顺逆结合胆囊切除4例,胆囊大部分切除2例.中转开腹2例,1例为胆总管损伤,行开腹胆囊切除加胆总管T管引流,另1例为右肝管和胆囊管并行过长解剖不清同时合并术中出血;术后并发急性脑梗塞1例.无术后大出血、胆瘘、腹腔脓肿、肠梗阻等并发症发生. 结论 充分的术前准备,术中仔细操作,及时中转开腹,以及认真细致地术后处理,腹腔镜治疗复杂性胆囊结石是安全可行的.%Objective To summarize the experience of laparoscopic cholecystectomy for complicated gallstone and to discuss its safety and feasibility. Methods The clinical data of 75 cases of complicated gallstone admitted from May 2009 to May 2012 were retrospectively analyzed. All patients were performed laparoscopic cholecystectomy. Results The average operation time was 67. 5 ± 35. 5 minutes ( ranged from 52 to 180 minutes) , the average blood loss was 75. 3 ±55. 5 ml( ranged from 50 to 140ml) , and the average postoperative hospitalization was 6.5 ±2.0 days (ranged from 5 to 30 days). A total of 73 cases accomplished the laparoscopic cholecystectomy, including anterograde gallbladder resection in 67 cases, anterograde and retrograde gallbladder resection in 4 cases and greater partial cholecystectomy in 2 cases. Another 2 cases were conversed to open surgery because of biliary duct

  20. 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

  1. 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.

  2. Resultados de la colecistectomía videolaparoscópica en ancianos Results of videoassisted laparoscopic cholecystectomy in the elderly

    Directory of Open Access Journals (Sweden)

    Iris Soberón Varela

    2007-06-01

    Full Text Available Desde su advenimiento y a raíz de sus innegables resultados, la cirugía videolaparoscópica se ha convertido en el método más empleado para el tratamiento de las patologías de la vesícula biliar. Con el propósito de analizar el comportamiento de los pacientes de la tercera edad con diagnóstico de colecistopatía, intervenidos quirúrgicamente por videolaparoscopia en nuestro centro, realizamos un estudio descriptivo y prospectivo de los pacientes de 60 años o más que fueron operados entre febrero del 2005 y junio del 2006.La litiasis vesicular fue el hallazgo operatorio más frecuente (134 pacientes; 84,8 %. Se realizó la conversión de la técnica a cirugía convencional en 2 pacientes (1,26 %. Se presentaron tres complicaciones mayores (1,89 % y el resto de los pacientes no presentó complicación alguna (155 pacientes; 98,1 %. En nuestra serie no hubo sepsis de las heridas quirúrgicas ni pacientes fallecidos. La colecistectomía videolaparoscópica mostró ser mejor tolerada y tener menos complicaciones que la técnica abierta. Su uso es recomendable en los ancianos, en quienes las tasas de morbilidad y mortalidad, así como de estancia hospitalaria, son mayores cuando se emplea la colecistectomía abiertaFrom its inception and as a result of its undeniable outcomes, videoassisted laparoscopic surgery has turned into the most used method in treating gallbladder pathologies. With the objective of analyzing the behaviour of aged patients diagnosed with cholecystopathy and operated on by videoassisted laparoscopy in our country, we conducted a prospective descriptive study of 60 years-old and over patients, who had been surgically treated from February 2005 to June 2006. Gallbladder lithiasis was the most frequent surgical finding (134 patients; 84,8%. Conversion of laparoscopic cholecystectomy to open surgery was made in 2 patients (1,26%. There were three major complications (1.89% but the rest of patients did not show any

  3. The effect of dexketoprofen pre-emptively administered on the consumption of tramadol and the incidence of nausea and vomiting after laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Costea D.

    2014-05-01

    Full Text Available The aim of our study has been to assess the comparative use of the two NSAIDs, dexketoprofen and ketoprofen, for postoperative analgesia after laparoscopic cholecystectomy mainly following: the quality of the analgesia, the incidence of potential adverse effects (for example, postoperative nausea and vomiting and the rescue analgesics consumption (tramadol. This prospective, randomized, double-blind study included 90 patients undergoing laparoscopic cholecystectomy under general anaesthesia. Patients were randomly assigned into 2 groups: group D (n = 45 - patients that have received dexketoprofen 50 mg in dilution with10 ml saline solution iv., 30 minutes before the induction and group K (n = 45 - patients that have received ketoprofen 100 mg in dilution with 10 ml saline solution iv., 30 minutes before the induction (preemptive analgesia. Surgical interventions were conducted under general anaesthesia, with identical protocol for the two groups of study. Post-surgery analgesic regime consisting in 4 g of paracetamol administered for example in the first 24 hours, was started immediately after surgery. Boluses of tramadol of 100 mg (until 400 mg /daily have been used as rescue analgesia. The main objectives of our study have been: post-surgery analgesia (VAS at mobilization, 0-100 mm at 0, 2, 6, 12 and 24 hours after the surgery,the consumption of tramadol, incidence of PONV and the length of hospitalization period (LOS. Secondary objectives of the study have been: the incidence of gastrointestinal symptoms and the incidence of postsurgery blood losses. In the two study groups there have not been any differences concerning demographic data, post-surgery gastro-intestinal symptoms, postsurgery loss of blood and the hospitalization period. VAS was significantly lower in group D vs. K, at 0 and 6 hours after the surgery (p <0,05. The incidence of PONV was lower in the group of patients who received preemptive analgesia with dexketoprofen (p <0

  4. Nursing Analysis on Patients With Bile Leakage After Laparoscopic Cholecystectomy%腹腔镜胆囊切除术后胆漏护理分析

    Institute of Scientific and Technical Information of China (English)

    方丽梅

    2015-01-01

    Objective Nursing method and its effect on patients with bile leakage after laparoscopic cholecystectomy are to be studied.Methods Chose 68 patients with bile leakage who were diagnosed and operated with laparoscopic cholecystectomy in hospital from December 2013 to August 2015 and separated them into one group that were given conventional nursing(35 cases) and another group that were given comprehensive nursing(35 cases)at random.Then observed and compared nursing effects between two groups.Results Patients'satisfaction rate in group that were given comprehensive nursing was much higher than group that were given conventional nursing,besides,patients'drainage-tube removal time and their hospitalization days in group that were given comprehensive nursing were much shorter than group that were given conventional nursing. There was differential between two groups and such a differential had statistic value(P<0.05). Conclusion Comprehensive care is of great efficacy for patients with bile leakage after laparoscopic cholecystectomy,and it is significant to improve patients'recovery and increase their satisfaction with treatment.%目的 分析腹腔镜胆囊切除术后胆漏的护理措施以及护理效果.方法 选取于2013年12月~2015年8月经临床确诊并且在我院接受治疗的腹腔镜胆囊切除术后胆漏患者68例,并随机分为常规护理组(33例)和综合干预组(35例),对以上两种护理措施进行对照研究.结果 综合干预组患者的护理满意度评分高于常规护理组,引流管拔除时间以及住院时间均短于常规护理组,组间差异有统计学意义(P<0.05).结论 腹腔镜胆囊切除术后胆漏患者应用综合护理的效果确切,能够促进患者痊愈以及提高护理满意度.

  5. 腹腔镜胆囊切除术243例护理分析%Nursing Analysis of 243 Laparoscopic Cholecystectomy Cases

    Institute of Scientific and Technical Information of China (English)

    王岩

    2015-01-01

    目的:探讨围手术期护理干预对腹腔镜胆囊切除术患者的临床意义。方法选择本院收治的需进行腹腔镜胆囊切除术的患者243例,随机分为对照组与观察组,对照组采用常规护理模式,观察组采用整体护理干预进行护理,对比观察两组患者的护理满意度,及手术时间、术中出血量和住院时间情况。结果观察组护理满意度显著高于对照组,差异有统计学意义(P<0.05);与对照组相比,观察组的手术时间、术中出血量、患者住院时间均具有明显优势,差异具有显著性(P<0.05)。结论完整的围术期护理干预模式可以降低腹腔镜胆囊切除术手术时间,提高患者康复速度,且减少并发症,患者满意度普遍较高。%Objective To study the clinical significance of nursing operation in peri-operation in patients with laparoscopic cholecystectomy.Methods Choose 243 patients who were treated with laparoscopic cholecystectomy in our hospital, randomly divided into control group and observation group, control group adopted the conventional care, observation group were treated with the whole nursing operation in peri-operation, observed patients satisfaction with nursing, the operation time, peri-operative bleeding and length of hospital stay.Results Compared with control group, the observation group had significantly advantage in clinical nursing satisfaction, the operation time, peri-operative bleeding and length of hospital stay. The difference was statistically significant(P<0.05).Conclusion Complete perioperative nursing intervention mode can reduce the operation time of laparoscopic cholecystectomy, improve patient recovery rate, reduce the complications, and improve patient satisfaction.

  6. 腹腔镜胆囊切除中转开腹的危险因素分析%Risk factors for conversion of laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    李晶

    2013-01-01

    Objective To analyze the risk factors of laparoscopic cholecystectomy converted to open management. Methods Collecting the patients undergoing cholecystectomy in our center,according to conversion to open management or not, we divided the patients in laparoscopic cholecystectomy( LC )group and laparoscopic to open cholecystectomy( LOC ) group. The single factor analysis would be performed with age, gender, diabetes, cardiovascular disease, arteriosclerosis, previous upper abdominal surgery, body mass index( BMI), gallbladder wall thickness, count of white blood cells, drinking, gallbladder enlargement and impacted stones and serum total bilirubin, then we enrolled those with statistical difference in the binary logistic regression model, and evaluated which was the independent risk factor. Results A total of 260 patients were enrolled. There were statistical differences in age, gender, diabetes, arteriosclerosis, previous upper abdominal surgery, BMI, gallbladder wall thickness, count of white blood cells and serum total bilirubin. After the logistic regression, we found that gender, BMI,gallbladder wall thickness and count of white blood cells could be treated as the independent risk factor. The operation time of LOC was higher than LC[ ( 83.48 ±7.25 )min vs( 42.77 ± 10.37 )min,t = 19. 54,P <0.01 ]. Conclusion LC is a safe and effective management for gallbladder disease but it is technically demanding. Patients with elder age,gender as man,obesity, gallbladder wall thickening and high WBC count prefer to have open cholecystectomy directly.%目的 分析影响腹腔镜胆囊切除中转开腹的相关因素,以进一步指导临床.方法 选取该院近5年行胆囊切除的患者,对其相关指标进行单因素及Logistic回归分析,从而找出相关危险因素或独立危险因素.结果 共260例患者纳入本次研究,经单因素分析显示中转组和非中转组年龄、性别、糖尿病、动脉硬化、上腹部手术史、BMI、胆囊壁厚

  7. Transumbilical single incision laparoscopic cholecystectomy in 51 cases%经脐单孔腹腔镜胆囊切除术51例分析

    Institute of Scientific and Technical Information of China (English)

    李健; 陈红兵; 李解生; 李学远

    2013-01-01

    目的 探讨经脐单孔腹腔镜胆囊切除术的可行性及安全性.方法 回顾分析51例胆囊结石及胆囊息肉病变患者经脐单孔腹腔镜胆囊切除术的临床资料,并与同期38例传统腹腔镜胆囊切除术患者的手术疗效进行比较.结果 观察组与对照组术后住院天数分别为(3.0±1.2)d、(5.7±1.6)d,VAS评分(1.2±1.0)、(2.5±1.2)分,腹壁创口满意度96.08%、22.68%,差异均有统计学意义(P<0.05或0.01),手术时间、术中出血量、并发症情况差异均无统计学意义(均P >0.05).结论 经脐单孔腹腔镜胆囊切除术治疗胆囊良性疾病安全有效,且更具微创性,美容效果更佳,有待于推广.%Objective To explore the feasibility and safety of laparoscopic cholecystectomy through a transumbilical single incision.Methods The clinical data of 51 patients with gallbladdder calculi or polyps who underwent transumbilical single incision laparoscopic cholecystectomy were retrospectively analyzed,and compared with the clinical efficiency of 38 patients with gallbladdder calculi or polyps who underwent conventional laparoscope cholecystectomy.Results In the observation group and control group,it showed significant differences (P<0.05 or 0.01) in the length of hospital stay of (3.0 ± 1.2) d vs (5.7 ± 1.6) d,and the VAS score of (1.2 ± 1.0) vs (2.5 ± 1.2),the abdominal wound satisfaction of 96.08% vs 22.68%,there was no difference in the operation time,the peri-operative bleeding and the complications situation (all P<0.05).Conclusion Transumbilical single incision laparoscopic cholecystectomy is a minimally invasive,safe and effective procedure for benign diseases of the gallbladdder with excellent cosmetic results,and deserves to generalize in clinic.

  8. 微型腹腔镜胆囊切除术临床疗效观察%Effect of mini laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    吴国庆; 王国范; 周晓娜

    2015-01-01

    Objective To compare the clinical curative effect between mini laparoscopic cholecystectomy (MLC) and conventional laparoscopic cholecystectomy (LC).Methods Using random number table method to divide the patients into conventional laparoscopic cholecystectomy group (30 cases) and mini laparoscopic cholecystectomy group (27 cases).Compared the operation time,bleeding volume,VAS score,postoperative hospital stay,complications.Results No conversion to laparotomy and serious complications,but each group has 6 cases from the three holes increase to four holes,and 4 cases of MLC group were converted to traditional LC.MLC group and LC group,average operation time (57.5 ± 17) min and (50 ± 15) min (P > 0.05);the average postoperative hospital stay was (2.5 ± 1.4) d and (3.1 ± 1.5) d (P > 0.05);postoperative pain degree of MLC group of 6 h and 12 hrespectively (4.8±2.6) and (3.5±1.1),LC group were (5.5 ±2.7) and (5.0±2.1) points (P< 0.05).Conclusion Postoperative pain of MLC is lighter than LC,in appropriate cases,is a safe and effective treatment method.%目的 通过随机对照方法比较微型腹腔镜胆囊切除术(MLC)与传统腹腔镜胆囊切除术(LC)的临床疗效.方法 将拟行LC的57例患者用随机数字表法分为传统腹腔镜胆囊切除术组(30例)和微型腹腔镜胆囊切除术组(27例).对比其手术时间、出血量、VAS评分、术后住院天数、并发症.结果 两组患者均无中转开腹及严重并发症出现,但各有6例从三孔L增加至四孔L,且MLC组中有4例转为传统LC.MLC组和LC组手术时间平均(57.5 ±17) min和(50±15) min(P>0.05);术后平均住院时间为(2.5±1.4)d和(3.1 ±1.5) d(P>0.05);术后疼痛程度MLC组6h和12 h分别为(4.8±2.6)分和(3.5±1.1)分,LC组分别为(5.5±2.7)分和(5.0±2.1)分(P<0.05).结论 MLC术后疼痛较LC更轻,对适合的病例,是一种安全有效的治疗方式.

  9. 完全经脐单孔腹腔镜胆囊切除术的手术方法及技术改进%Operative method and technique improvement of transumbilical single-port laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    杨富财; 王霞; 朵萍; 魏永俭; 任恒宽; 李建忠; 张志; 徐兴彦

    2011-01-01

    目的:探讨完全经脐单孔腹腔镜胆囊切除术(1aparoscopic cholecystectomy,LC)的手术方法及技术改进.方法:回顾分析在钟世镇院士提出的胆囊替代定位点理论指导下,开展完全经脐LC94例的手术方法及技术改进,并复习总结国內相关文献.结果:94例患者中1例因可疑胆囊癌中转开腹,3例因腹腔粘连、肥胖等因素,未明确找到Rouviere沟无法确定胆囊替代定位点而增加戮孔行常规LC.90例顺利完成手术.术后患者均获随访,无胆漏、梗阻性黄疸等并发症发生.患者术后恢复良好,治疗及美容效果满意.结论:经脐单孔LC在技术上是安全可行的,但与传统LC相比,操作难度增加.术者遵循正确的操作原则,操作困难及时增加戳孔或中转开腹,此术式可广泛开展.%Objective: To investigate the operative method and technique improvement of transumbilical single-port laparoscopic cholecystcctomy. Methods: The clinical data of 94 patients who underwent transumbilical single-port laparoscopic cholecystectomy were retrospectively analyzed. Results: One patient was converted to open surgery because of suspicious gallbladder cancer,3 underwent classic laparoscopic cholecystectomy because of undetected Rouviere groove. 90 patients successfully underwent transumbilical single-port laparoscopic cholecystectomy according to the principle of gallbladder substitution anchor point,these patients were all followed up,no complications occurred,such as bile leakage or obstructive jaundice. All patients recovered well and were satisfied with therapeutic and cosmetic result. Conclusions: Transu mhilical single-port laparoscopic cholecystectomy is safe and feasible,but difficult when compared with traditional laparoscopic cholecystectomy. Surgeons should follow correct operative principle, increase port or convert to laparotomy when the procedure is hard to continue. The operation can be widely applied in clinic.

  10. 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.

  11. 三维技术在腹腔镜胆囊切除术的应用探讨%Application of three -dimensional technique in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    陈光彬; 刘丹峰; 刘昌阔; 章新桥; 孙荣能; 孙礼侠

    2014-01-01

    Objective To explore the feasibility of three-dimensional (3D) laparoscopic system in laparoscopic cholecystectomy. Methods Three patients with benign gallbladder disease with a history of abdominal pain were selected to undergo the surgery. All the operations were performed with Viking 3D HD laparoscopic system. Results The 3 operations were completed successfully with no conversion to laparotomy. The operation time and intraoperative bleeding volume were quite equal to the conventional laparoscopy. All of them recovered successfully and were discharged 3 days postoperatively. Conclusion Three-dimensional technique can well reveal the tissue anatomy in the operative field,allows more precise operation with reduced complications and is suitable for more complex laparoscopic surgery.%目的:探讨三维(3D)技术应用于腹腔镜胆囊切除术的可行性及临床经验。方法临床筛选3例胆囊良性疾病患者,既往有右上腹疼痛病史,术中应用 Viking 3D 高清腹腔镜系统完成腹腔镜胆囊切除术。结果3例患者均顺利完成手术,无中转开腹,手术时间、术中出血量与传统腹腔镜相当;患者术后均恢复顺利,术后72 h 出院。结论3D 腹腔镜下纵深感明显、解剖层次感强、操作空间位置感明确,因此手术操作更加精准,有助于减少手术并发症、完成更为复杂的腹腔镜手术。

  12. 单孔腹腔镜与非单孔腹腔镜胆囊切除术安全性及有效性的荟萃分析%Meta-analysis of the Transumbilical Single-incision Laparoscopic Cholecystectomy and the Conventional Laparoscopic Cholecystectomy in Efficacy and Safety

    Institute of Scientific and Technical Information of China (English)

    顾钧; 刘颖斌; 穆嘉盛; 毕建威; 李茂岚; 吴文广; 董平; 陆建华; 丁琦晨; 张林; 杨佳华; 吴向嵩

    2012-01-01

    Objective To evaluate the safety,feasibility and advantages of transumbilical single-incision laparoscopic cholecystectomy. Methods PubMed and Wanfang database were reviewed using meta-analysis. Randomized controlled trials (RCT) describing the length of operation time,pain levels, postoperative complications and postoperative beauty score between the transumbilical single-incision laparoscopic cholecystectomy and the conventional laparoscopic cholecystectomy were collected. Cochrane review methodology was used for assessing the trial quality and efficacy. Results Only 4 clinical studies were selected and 236 eligible patients were included in the systematic review. Meta-analysis showed that there were no differences between two groups in the risk of postoperative complications (OR 1.47; 95% CI 0.73 ~ 2.97; P = 0.28). But it showed significant difference in postoperative beauty score( SMD 0.70; 95% CI 0.40 ~ 0.99; P <0.00001). Conclusions Transumbilical single-incision laparoscopic cholecystectomy is safe with better cosmetic effect comparing to the conventional laparoscopic cholecystectomy. However, it still need a large number of randomized and controlled study for e-valuation of the other advantages and disadvantages of these two operation methods.%目的 系统评价单孔腹腔镜与非单孔腹腔镜胆囊切除术安全性及有效性. 方法 计算机检索Pubmed和万方数据库中有关单孔腹腔镜与非单孔腹腔镜胆囊切除术的随机对照实验(RCT)文献,依据Cochrane评价手册评价偏倚风险,并提交手术时间、术后疼痛评分、术后并发症发生率及术后美容评分等的相关数据进行荟萃分析. 结果 纳入4篇RCT文献,共236例患者.荟萃分析结果显示相比非单孔腹腔镜胆囊切除术,单孔腹腔镜技术不会显著性影响手术并发症的发生(OR 1.47; 95%CI 0.73~2.97;P=0.28),且具有更高的术后美容评分(SMD 0.70; 95% CI 0.40 ~0.99;P<0.00 001).结论 单孔腹腔镜

  13. Evaluation of anatomical and functional changes esophageal stump of patients with advanced megaesophagus submitted to subtotal laparoscopic esophagectomy Avaliação das alterações anatômicas e funcionais do coto esofágico de pacientes portadores de megaesôfago avançado submetidos à esofagectomia subtotal laparoscópica

    Directory of Open Access Journals (Sweden)

    Júverson Alves Terra Júnior

    2012-09-01

    Full Text Available PURPOSE: Evaluate anatomical and functional changes of the esophageal stump and gastric fundus of patients with advanced megaesophagus, submitted to laparoscopic subtotal esophagectomy. METHODS: Twenty patients with advanced megaesophagus, previously submitted to a videolaparoscopic subtotal esophagectomy , were evaluated. Were conducted: radiological evaluation of the stump esophagus with transposed stomach, electromanometric, endoscopic examination and histopathology of the esophageal stump and gastric fundus, without making gastric tube or pyloroplasty. RESULTS: It was observed that the average height and pressure of the anastomosis, in the electromanometric evaluation, were 23.45cm (±1.84cm and 7.55mmHg (±5.65mmHg. In patients with megaesophagus III, the pressure of the anastomosis was 10.91mmHg (±6.33mmHg, and pressure from the UES, 31.89mmHg (±14.64mm Hg, were significantly higher than those in grade IV. The pathological evaluation detected mild esophagitis in 35% of patients, moderate in 20% and acanthosis glicogenica in 45%. The examination of the gastric fundus showed that 50% of patients were infected with Helicobacter pylori. Chronic gastritis occurred in 95% of the patients. CONCLUSIONS: The laparoscopic esophagectomy shown to be effective in the treatment of advanced achalasia. The cervical level anastomosis protects the esophageal stump from the aggression resulted from gastric reflux after the esophagectomy.OBJETIVO: Avaliar as alterações anatômicas e funcionais do coto esofágico e fundo gástrico de pacientes com megaesôfago avançado, submetidos à esofagectomia subtotal laparoscópica. MÉTODOS: Vinte pacientes com megaesôfago avançado, previamente submetidos à esofagectomia subtotal videolaparoscópica, foram avaliados. Foram realizados: avaliação radiológica do coto esofágico com o estômago transposto, eletromanometria endoscopia e exame histopatológico do coto esofágico e fundo gástrico,sem fazer tubo g

  14. 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.

  15. Preoperative evaluation of the cystic duct for laparoscopic cholecystectomy: comparison of navigator-gated prospective acquisition correction- and conventional respiratory-triggered techniques at free-breathing 3D MR cholangiopancreatography

    Energy Technology Data Exchange (ETDEWEB)

    Itatani, Ryo [Kumamoto Chuo Hospital, Department of Radiology, Kumamoto (Japan); Kumamoto University, Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto (Japan); Namimoto, Tomohiro; Sakamoto, Fumi; Yamashita, Yasuyuki [Kumamoto University, Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto (Japan); Kajihara, Hiroo; Yoshimura, Akira; Katahira, Kazuhiro [Kumamoto Chuo Hospital, Department of Radiology, Kumamoto (Japan); Nasu, Jiro [Kumamoto Chuo Hospital, Department of Digestive Surgery, Kumamoto (Japan); Matsushita, Ikuo [Kumamoto Chuo Hospital, Department of Gastroenterological Medicine, Kumamoto (Japan); Kidoh, Masafumi [Amakusa Medical Center, Department of Diagnostic Radiology, Amakusa, Kumamoto (Japan)

    2013-07-15

    To evaluate the quality of magnetic resonance cholangiopancreatography (MRCP) images obtained with a three-dimensional navigator-gated (NG) technique and compare findings with conventional respiratory-triggered (RT) images in pre-laparoscopic cholecystectomy patients. Turbo-spin-echo (TSE) RT-MRCP (average 242 s) and balanced turbo-field-echo (bTFE) NG-MRCP (average 263 s) were acquired at 1.5-T MRI for 49 pre-laparoscopic cholecystectomy patients. Two radiologists independently assessed image quality, visibility of anatomical structures, common bile duct (CBD) stones, and signal-to-noise ratios (SNRs). Interobserver agreement was also evaluated. The anatomical details of the cystic duct were clearly demonstrated in 33 (67.3 %, reader A) and 35 (71.4 %, reader B) patients on RT-MRCP, and in 45 (91.8 %) and 44 (89.7 %) patients on NG-MRCP. On NG-MRCP, visualisation of the cystic duct (3.22/3.12), its origin (3.57/3.55), and the gallbladder(3.61/3.59) was statistically better than on RT-MRCP (2.90/2.78, 3.29/3.12, 2.98/2.88, respectively). The overall image quality was statistically better on NG-MRCP than RT-MRCP. Each technique identified the presence of CBD stones in all affected patients. The SNR was significantly higher on NG-MRCP (CHD 22.40, gallbladder 17.13) than RT-MRCP (CHD 17.05, gallbladder 9.30). Interobserver agreement was fair to perfect. Navigator-gated MRCP is more useful than respiratory-triggered MRCP for evaluating the gallbladder and cystic duct in patients scheduled for laparoscopic cholecystectomy. circle Magnetic resonance cholangiopancreatography (MRCP) provides important cystic duct information before laparoscopic cholecystectomy. (orig.)

  16. 经脐单孔腹腔镜胆囊切除术15例临床分析%Transumbilical single-port laparoscopic cholecystectomy: an analysis of 15 cases

    Institute of Scientific and Technical Information of China (English)

    孙琳; 史炼钢; 于镜泊; 肖在鹏

    2011-01-01

    目的 总结经脐单孔腹腔镜胆囊切除术的手术经验.方法 回顾性分析2010年5-10月实施的经脐单孔腹腔镜胆囊切除术15例患者的临床资料.结果 15例患者手术时间30~85(45±16)min,术后住院时间(2.5±1.1)d,术后无一例发生出血、胆瘘等并发症.术后腹部瘢痕隐蔽,美容效果佳.结论 经脐单孔腹腔镜胆囊切除术安全可行,术后恢复快,美容效果好,但较传统腹腔镜胆囊切除术难度增加,早期开展经脐单孔腹腔镜胆囊切除术适应证选择很关键.%Objective To summarize the operative experience of transumbilical single-port laparoscopic cholecystectomy. Method The clinical data of 15 patients underwent transumbilical singleport laparoscopic cholecystectomy between May to October in 2010 was reviewed. Results The operative time was 30-85(45±16) min,hospitalization time was (2.5 ± 1.1 ) d. No surgical complications such as bile leak or uncontrolled hemorrhage occurred postoperatively. All the incision were healed well and the surgical scar was virtually concealed whit