Jiang, Sheng-Jun; Shi, Hong; Swar, Gyanendra; Wang, Hai-Xia; Liu, Xiao-Jing; Wang, Yong-Guang
To investigate the feasibility and safety of Natural orifice trans-umbilical endoscopic cholecystectomy with a water-jet hybrid-knife in a non-survival porcine model. Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy was performed on three non-survival pigs, by transumbilical approach, using a water-jet hybrid-knife. Under general anesthesia, the following steps detailed the procedure: (1) incision of the umbilicus followed by the passage of a double-channel flexible endoscope through an overtube into the peritoneal cavity; (2) establishment of pneumoperitoneum; (3) abdominal exploration; (4) endoscopic cholecystectomy: dissection of the gallbladder performed using water jet equipment, ligation of the cystic artery and duct conducted using nylon loops; and (5) necropsy with macroscopic evaluation. Transumbilical endoscopic cholecystectomy was successfully completed in the first and third pig, with minor bleedings. The dissection times were 137 and 42 min, respectively. The total operation times were 167 and 69 min, respectively. And the lengths of resected specimen were 6.5 and 6.1 cm, respectively. Instillation of the fluid into the gallbladder bed produced edematous, distended tissue making separation safe and easy. Reliable ligation using double nylon loops insured the safety of cutting between the loops. There were no intraoperative complications or hemodynamic instability. Uncontrolled introperative bleeding occurred in the second case, leading to the operation failure. Pure NOTES trans-umbilical cholecystectomy with a water-jet hybrid-knife appears to be feasible and safe. Further investigation of this technique with long-term follow-up in animals is needed to confirm the preliminary observation.
Rafael Torres Peña
faced for its application in the clinical practice. Up to date have been described the techniques of Transumbilical endoscopic surgery with flexible endoscopy, with multi-channels, with some trocars in a only incision, as well as different retraction systems like that of the suture retraction (marionette techniques and the magnetic retraction. The aim of present research was to assess in a pig model the feasibility of a new Transumbilical endoscopic cholecystectomy technique. METHODS. A longitudinal and prospective study was conducted in 6 pigs weighing between 22 and 26 kg. The above mentioned technique was applied from a portal, with an only work channel and with a new vesicular retraction system (TORCAM. Animal were immediately sacrificed and the following variables were assessed: feasibility, exposition quality, adverse effects of retraction system, surgical time and postoperative macroscopic examination of surgical area. RESULTS. Retraction quality and gall bladder exposition were optimal in all cases, allowing the carrying out of surgical technique in the 100% of sample. There were neither complications nor adverse effects related to the vesicular retraction system. Average surgical time was of 46 minutes. CONCLUSIONS. The proposed transumbilical endoscopic cholecystectomy is a new technique demonstrating its feasibility in the animal model.
GERALDO JOSÉ DE SOUZA LIMA
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.
Millan, Carolina; Bignon, Horacion; Bellia, Gaston; Buela, Enrique; Rabinovich, Fernando; Albertal, Mariano; Martinez Ferro, Marcelo
The use of magnets in transumbilical cholecystectomy (TUC) improves triangulation and achieves an optimal critical view. Nonetheless, the tendency of the magnets to collide hinders the process. In order to simplify the surgical technique, we developed a hybrid model with a single magnet and a curved grasper. All TUCs performed with a hybrid strategy in our pediatric population between September 2009 and July 2012 were retrospectively reviewed. Of 260 surgical procedures in which at least one magnet was used, 87 were TUCs. Of those, 62 were hybrid: 33 in adults and 29 in pediatric patients. The technique combines a magnet and a curved grasper. Through a transumbilical incision, we placed a 12-mm trocar and another flexible 5-mm trocar. The laparoscope with the working channel used the 12-mm trocar. The magnetic grasper was introduced to the abdominal cavity using the working channel to provide cephalic retraction of the gallbladder fundus. Across the flexible trocar, the assistant manipulated the curved grasper to mobilize the infundibulum. The surgeon operated through the working channel of the laparoscope. In this pediatric population, the mean age was 14 years (range, 4-17 years), and mean weight was 50 kg (range, 18-90 kg); 65% were girls. Mean operative time was 62 minutes. All procedures achieved a critical view of safety with no instrumental collision. There were no intraoperative or postoperative complications. The hospital stay was 1.4±0.6 days, and the median follow-up was 201 days. A hybrid technique, combining magnets and a curved grasper, simplifies transumbilical surgery. It seems feasible and safe for TUC and potentially reproducible.
Noguera, José F; Cuadrado, Angel; Dolz, Carlos; Olea, José M; García, Juan C
Natural orifice transluminal endoscopic surgery (NOTES) is a technique still in experimental development whose safety and effectiveness call for assessment through clinical trials. In this paper we present a three-arm, noninferiority, prospective randomized clinical trial of 1 year duration comparing the vaginal and transumbilical approaches for transluminal endoscopic surgery with the conventional laparoscopic approach for elective cholecystectomy. Sixty female patients between the ages of 18 and 65 years who were eligible for elective cholecystectomy were randomized in a ratio of 1:1:1 to receive hybrid transvaginal NOTES (TV group), hybrid transumbilical NOTES (TU group) or conventional laparoscopy (CL group). The main study variable was parietal complications (wound infection, bleeding, and eventration). The analysis was by intention to treat, and losses were not replaced. Cholecystectomy was successfully performed on 94% of the patients. One patient in the TU group was reconverted to CL owing to difficulty in maneuvering the endoscope. After a minimum follow-up period of 1 year, no differences were noted in the rate of parietal complications. Postoperative pain, length of hospital stay, and time off from work were similar in the three groups. No patient developed dyspareunia. Surgical time was longer among cases in which a flexible endoscope was used (CL, 47.04 min; TV, 64.85 min; TU, 59.80 min). NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.
Ross, S B; Mangar, D; Karlnoski, R; Patel, R S; Camporesi, E M; Barry, L K; Luberice, K; Sprenker, C J; Rosemurgy, A S
Transumbilical Laparo-Endoscopic Single Site (LESS) surgery promises improved cosmesis, quick recovery, reduced postoperative pain and shorter length of hospital stay. Since only a simple umbilical incision is used, LESS surgery can be completed with segmental epidural anesthesia. This study describes the evolution of our technique of LESS cholecystectomy from a combination of spinal and epidural anesthesia to thoracic epidural alone and presents our experience with its safety, the observed morbidity, and the reported patient satisfaction. In August 2009, a prospective evaluation of LESS cholecystectomy with regional anesthesia was undertaken. We recruited patients with chronic cholecystitis or symptomatic cholelithasis. Blood loss, operative time, complications, and length of hospital stay were measured. Preoperatively and 14 days postoperatively, outcome and symptom resolution were scored. Fifteen consecutive patients underwent LESS cholecystectomy; first with combined spinal-epidural (CSE), and then with thoracic epidural anesthesia alone. Immediate postoperative pain and discomfort were well tolerated. VAS scores upon admission to PACU were 0.4 (1.7±2.2). At postoperative day 14, the patients scored high values for "Satisfaction", 10 (10±1.0) and "Cosmesis", 10 (9.3±1.5). LESS cholecystectomy with epidural anesthesia can be undertaken safely. Patient satisfaction and cosmesis are particularly prominent amongst our patients. Our experience supports further utilization of epidural anesthesia for selected patients undergoing LESS cholecystectomy.
Zhou, Xuewu; Peng, Lei; Sha, Yongliang; Song, Daiqiang
To describe transumbilical laparoscopic herniorrhaphy after unsuccessful attempted manual reduction of incarcerated inguinal hernias in infants and children. In our two hospitals, two-trocar transumbilical endoscopic surgery (TUES) is the standard technique used to repair incarcerated inguinal hernias in infants and children. Seventeen patients (aged 8months to 2.5years; median, 15months; 15 boys, 2 girls) with incarcerated inguinal hernias underwent urgent laparoscopy after unsuccessful attempted manual reduction. Two 3- or 5-mm trocars were inserted into the abdomen through two intraumbilical incisions, under laparoscopic guidance. The hernia was reduced by combined external manual pressure and internal pulling with bowel forceps. After inspection of the bowel, a round needle with a 2-0 nonabsorbable suture was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The hernial orifice was closed with an extraperitoneal purse-string suture around the internal inguinal ring, and tied with an intraperitoneal knot. A similar procedure was performed on the contralateral side if the processus vaginalis was patent. The TUES procedure was successful in all patients. No conversions to open surgery were required. The mean operating time was 30min (range, 25-40min). All patients were discharged on the second postoperative day. No complications such as postoperative bleeding, hydrocele, or scrotal edema were observed. The mean follow-up period was 15months. No cases of testicular atrophy, hypotrophy, or hernia recurrence were reported. Our preliminary experience with using TUES for the treatment of incarcerated inguinal hernias in infants and children had satisfactory outcomes. This technique appeared to be safe, effective, and reliable, and had excellent cosmetic results. Published by Elsevier Inc.
Cuadrado-Garcia, Angel; Noguera, Jose F; Olea-Martinez, Jose M; Morales, Rafael; Dolz, Carlos; Lozano, Luis; Vicens, Jose-Carlos; Pujol, Juan José
Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. Currently, it is not possible to perform these interventions without the help of abdominal wall entryways, so these procedures are hybrids fusing minilaparoscopy and transluminal endoscopic surgery. This report presents a prospective clinical series of 25 patients who underwent transvaginal hybrid cholecystectomy for cholelithiasis. The study comprised a clinical series of 25 consecutive nonrandomized women who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two trocars for cholelithiasis: one 5-mm umbilical trocar and one 3-mm trocar in the upper left quadrant. The study had no control group. The scheduled surgical intervention was performed for all 25 women. No intraoperative complications occurred. One patient had mild hematuria that resolved in less than 12 h, but no other complications occurred during an average follow-up period of 140 days. Of the 25 women, 20 were discharged in 24 h, and 5 were discharged less than 12 h after the procedure. Hybrid transvaginal cholecystectomy, combining NOTES and minilaparoscopy, is a good surgical model for minimally invasive surgery. It can be performed in surgical settings where laparoscopy is practiced regularly using the instruments normally used for endoscopy and laparoscopic surgery. Due to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.
Friis, C; Rothman, J P; Burcharth, J; Rosenberg, J
Endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy is often used as definitive treatment for common bile duct stones. The aim of this study was to investigate the optimal time interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. PubMed and Embase were searched for studies comparing different time delays between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Observational studies and randomized controlled trials were included. Primary outcome was conversion rate from laparoscopic to open cholecystectomy and secondary outcomes were complications, mortality, operating time, and length of stay. A total of 14 studies with a total of 1930 patients were included. The pooled estimate revealed an increase from a 4.2% conversion rate when laparoscopic cholecystectomy was performed within 24 h of endoscopic retrograde cholangiopancreatography to 7.6% for 24-72 h delay to 12.3% when performed within 2 weeks, to 12.3% for 2-6 weeks, and to a 14% conversion rate when operation was delayed more than 6 weeks. According to this systematic review, it is preferable to perform cholecystectomy within 24 h of endoscopic retrograde cholangiopancreatography to reduce conversion rate. Early laparoscopic cholecystectomy does not increase mortality, perioperative complications, or length of stay and on the contrary it reduces the risk of reoccurrence and progression of disease in the delay between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.
Riveron Quevedo, Kelly; Irsula Ballaga, Vladimir; Gonzalez Ulloa, Lianne; Deborah LLorca, Armando
The case report of a 30 year-old presumably healthy patient, who attended the Gastroenterology Department from 'Dr Juan Bruno Zayas Alfonso' Teaching General Hospital in Santiago de Cuba, and suffering from biliary cholic, ictero, choluria, nausea, vomit and loss of appetite is presented. The complementary examinations confirmed the choledocolitiasis and cholelitiasis diagnosis, reason why it was necessary to carry out a endoscopic retrograde cholangiopancreatography, endoscopic esphinterotomy and ambulatory laparoscopic cholecystectomy, in a single anesthetic injection. The postoperative clinical course was favorable and she was discharged without complications 24 hours before the intervention
Lau, James Y W; Leow, Chon-Kar; Fung, Terence M K; Suen, Bing-Yee; Yu, Ly-Mee; Lai, Paul B S; Lam, Yuk-Hoi; Ng, Enders K W; Lau, Wan Yee; Chung, Sydney S C; Sung, Joseph J Y
In patients with stones in their bile ducts and gallbladders, cholecystectomy is generally recommended after endoscopic sphincterotomy and clearance of bile duct stones. However, only approximately 10% of patients with gallbladders left in situ will return with further biliary complications. Expectant management is alternately advocated. In this study, we compared the treatment strategies of laparoscopic cholecystectomy and gallbladders left in situ. We randomized patients (>60 years of age) after endoscopic sphincterotomy and clearance of their bile duct stones to receive early laparoscopic cholecystectomy or expectant management. The primary outcome was further biliary complications. Other outcome measures included adverse events after cholecystectomy and late deaths from all causes. One hundred seventy-eight patients entered into the trial (89 in each group); 82 of 89 patients who were randomized to receive laparoscopic cholecystectomy underwent the procedure. Conversion to open surgery was needed in 16 of 82 patients (20%). Postoperative complications occurred in 8 patients (9%). Analysis was by intention to treat. With a median follow-up of approximately 5 years, 6 patients (7%) in the cholecystectomy group returned with further biliary events (cholangitis, n = 5; biliary pain, n = 1). Among those with gallbladders in situ, 21 (24%) returned with further biliary events (cholangitis, n = 13; acute cholecystitis, n = 5; biliary pain, n = 2; and jaundice, n = 1; log rank, P = .001). Late deaths were similar between groups (cholecystectomy, n = 19; gallbladder in situ, n = 11; P = .12). In the Chinese, cholecystectomy after endoscopic treatment of bile duct stones reduces recurrent biliary events and should be recommended.
Song, Myung Eun; Chung, Moon Jae; Lee, Dong Jun; Oh, Tak Geun; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Song, Si Young; Chung, Jae Bock
Cholecystectomy in patients with an intact gallbladder after endoscopic removal of stones from the common bile duct (CBD) remains controversial. We conducted a case-control study to determine the risk of recurrent CBD stones and the benefit of cholecystectomy for prevention of recurrence after endoscopic removal of stones from the CBD in Korean patients. A total of 317 patients who underwent endoscopic CBD stone extraction between 2006 and 2012 were included. Possible risk factors for the recurrence of CBD stones including previous cholecystectomy history, bile duct diameter, stone size, number of stones, stone composition, and the presence of a periampullary diverticulum were analyzed. The mean duration of follow-up after CBD stone extraction was 25.4±22.0 months. A CBD diameter of 15 mm or larger [odds ratio (OR), 1.930; 95% confidence interval (CI), 1.098 to 3.391; p=0.022] and the presence of a periampullary diverticulum (OR, 1.859; 95% CI, 1.014 to 3.408; p=0.045) were independent predictive factors for CBD stone recurrence. Seventeen patients (26.6%) in the recurrence group underwent elective cholecystectomy soon after endoscopic extraction of CBD stones, compared to 88 (34.8%) in the non-recurrence group; the difference was not statistically significant (p=0.212). A CBD diameter of 15 mm or larger and the presence of a periampullary diverticulum were found to be potential predictive factors for recurrence after endoscopic extraction of CBD stones. Elective cholecystectomy after clearance of CBD stones did not reduce the incidence of recurrent CBD stones in Korean patients.
Jakobsen, Henrik Loft; Vilmann, Peter; Rosenberg, Jacob
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...... 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...
de Vries, A.; Donkervoort, S. C.; van Geloven, A. A. W.; Pierik, E. G. J. M.
Background: Preceding endoscopic retrograde cholangiography (ERC) in patients with choledochocystolithiasis impedes laparoscopic cholecystectomy (LC) and increases risk of conversion. We studied the influence of time interval between ERC and LC on the course of LC. Methods: All patients treated for
Ahn, Woojin; Dargar, Saurabh; Halic, Tansel; Lee, Jason; Li, Baichun; Pan, Junjun; Sankaranarayanan, Ganesh; Roberts, Kurt; De, Suvranu
The first virtual-reality-based simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) is developed called the Virtual Translumenal Endoscopic Surgery Trainer (VTESTTM). VTESTTM aims to simulate hybrid NOTES cholecystectomy procedure using a rigid scope inserted through the vaginal port. The hardware interface is designed for accurate motion tracking of the scope and laparoscopic instruments to reproduce the unique hand-eye coordination. The haptic-enabled multimodal interactive simulation includes exposing the Calot's triangle and detaching the gall bladder while performing electrosurgery. The developed VTESTTM was demonstrated and validated at NOSCAR 2013.
Michael C Meadows
Full Text Available Michael C Meadows1,3, Ronald S Chamberlain1,2,31Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; 2Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA; 3Saint George’s University, School of Medicine, West Indies, GrenadaIntroduction: The evolution of techniques for the performance of a cholecystectomy over the last 25 years has been swift. The laparoscopic approach is now the gold standard for removal of the gall bladder and is the most frequently performed minimally invasive procedure globally. Currently in its infancy stage, natural orifice transluminal endoscopy surgery, or NOTES, is purported to be the next leap forward in minimally invasive approaches. The safety, feasibility, and effectiveness of this procedure, as well as the significance of potential benefits to patients beyond current surgical approaches are yet undetermined.Methods: A comprehensive literature search was conducted using PubMed, a search engine created by the National Library of Medicine. Keywords used in the search included “natural orifice transluminal endoscopic surgery”, “NOTES”, “cholecystectomy”, “transcolonic”, “transvaginal”, and “transgastric”. The accumulated literature was critically analyzed and reviewed.Results: One-hundred and eighty-six cases of NOTES cholecystectomies have been published to date. Of these, 174 have been performed through a transvaginal approach. The remainder of the procedures were performed transgastrically. There are no published reports of transcolonic cholecystectomies performed in humans. Four of 186 cases (2.15% were converted to traditional laparoscopy due to intraoperative complications. No significant complications or mortalities have been reported.Conclusion: NOTES cholecystectomy appears to be a feasible procedure. However, technical, safety, and ethical issues remain relatively unresolved. Besides improved cosmesis, whether additional
Full Text Available Laparoscopic cholecystectomy has become the standard procedure for the surgical management of symptomatic cholelithiasis. Laparoscopic cholecystectomy is generally considered a safe procedure although a few complications such as major bleeding, wound infection, bile leakage, biliary and bowel injury are well known. We are reporting a case of a thirty-seven year old male who presented with abdominal pain, three weeks after laparoscopic cholecystectomy. Abdominal ultrasound revealed a filling defect in common bile duct with deranged liver function tests. With an impression of choledocholithiasis, his endoscopic retrograde cholangiopancreatography (ERCP was done which revealed a surgical clip impacted in the ampulla. The surgical clip was retrieved successfully by ERCP. Intraductal clip migration is a rarely encountered complication after laparoscopic cholecystectomy. Appropriate management requires timely identification and retrieval during ERCP.
Schreuder, Anne Marthe; Booij, Klaske A. C.; de Reuver, Philip R.; van Delden, Otto M.; van Lienden, Krijn P.; Besselink, Marc G.; Busch, Olivier R.; Gouma, Dirk J.; Rauws, Erik A. J.; van Gulik, Thomas M.
Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous
Donkervoort, S. C.; van Ruler, O.; Dijksman, L. M.; van Geloven, A. A.; Pierik, E. G.
Laparoscopic cholecystectomy (LC) after an endoscopic retrograde cholangiography (ERC) has higher rates for complications and conversion caused by unpredictable adhesions. The risk factors for an adverse outcome of LC after an ERC were analyzed. Variables from patients treated by LC after ERC for
Boerma, Djemila; Rauws, Erik A. J.; Keulemans, Yolande C. A.; Janssen, Ignace M. C.; Bolwerk, Clemens J. M.; Timmer, Ron; Boerma, Egge J.; Obertop, Huug; Huibregtse, Kees; Gouma, Dirk J.
Background Patients who undergo endoscopic sphincterotomy for common bile-duct stones, who have residual gallbladder stones, are referred for laparoscopic cholecystectomy. However, only 10% of patients who do not have this operation are reported to develop recurrent biliary symptoms. We aimed to
Tanaka, Takayuki; Haraguchi, Masashi; Tokai, Hirotaka; Ito, Shinichiro; Kitajima, Masachika; Ohno, Tsuyoshi; Onizuka, Shinya; Inoue, Keiji; Motoyoshi, Yasuhide; Kuroki, Tamotsu; Kanemastu, Takashi; Eguchi, Susumu
A 50-year-old male was examined at another hospital for fever, general fatigue and slight abdominal pain. He was treated with antibiotics and observed. However, his symptoms did not lessen, and laboratory tests revealed liver dysfunction, jaundice and an increased inflammatory response. He was then admitted to our hospital and underwent an abdominal computed tomography scan and magnetic resonance cholangiopancreatography (MRCP), which revealed common bile duct (CBD) stones. He was diagnosed with mild acute cholangitis. As the same time, he was admitted to our hospital and an emergency endoscopic retrograde cholangiopancreatography was performed. Vater papilla opening in the third portion of the duodenum and presence of a peripapillary duodenal diverticulum made it difficult to perform cannulation of the CBD. In addition, MRCP revealed that the CBD was extremely narrow (diameter 5 mm). We therefore performed laparoscopic cholecystectomy and endoscopic sphincterotomy using the rendezvous technique for choledocholithiasis simultaneously rather than laparoscopic CBD exploration. After the operation, the patient was discharged with no complications. Although the rendezvous technique has not been very commonly used because several experts in the technique and a large operating room are required, this technique is a very attractive and effective approach for treating choledocholithiasis, for which endoscopic treatment is difficult.
Full Text Available A 50-year-old male was examined at another hospital for fever, general fatigue and slight abdominal pain. He was treated with antibiotics and observed. However, his symptoms did not lessen, and laboratory tests revealed liver dysfunction, jaundice and an increased inflammatory response. He was then admitted to our hospital and underwent an abdominal computed tomography scan and magnetic resonance cholangiopancreatography (MRCP, which revealed common bile duct (CBD stones. He was diagnosed with mild acute cholangitis. As the same time, he was admitted to our hospital and an emergency endoscopic retrograde cholangiopancreatography was performed. Vater papilla opening in the third portion of the duodenum and presence of a peripapillary duodenal diverticulum made it difficult to perform cannulation of the CBD. In addition, MRCP revealed that the CBD was extremely narrow (diameter 5 mm. We therefore performed laparoscopic cholecystectomy and endoscopic sphincterotomy using the rendezvous technique for choledocholithiasis simultaneously rather than laparoscopic CBD exploration. After the operation, the patient was discharged with no complications. Although the rendezvous technique has not been very commonly used because several experts in the technique and a large operating room are required, this technique is a very attractive and effective approach for treating choledocholithiasis, for which endoscopic treatment is difficult.
Teoh, Anthony Yuen Bun; Ng, Enders Kwok Wai; Chock, Alana; Swanstrom, Lee; Varadarajulu, Shyam; Chiu, Philip Wai Yan
Patient and physician perceptions of natural orifice transluminal endoscopic surgery (NOTES) have been reported for the Western population. However, whether Asian-Chinese patients share the same perspectives as compared to the Western population is unknown. This was a cross-sectional survey carried out in the surgical outpatient's clinic at the Prince of Wales Hospital between June and September 2011. Patients were provided with an information leaflet and asked to complete a questionnaire regarding their perceptions of and preferences for NOTES cholecystectomy. Female patients attending the clinic were given an additional questionnaire regarding attitudes towards transvaginal surgery. Two hundred patients were recruited to complete the questionnaire(s) and the male to female ratio was 1:1. One hundred and fourteen patients (57%) preferred to undergo NOTES cholecystectomy for cosmetic reasons (P=0.009). Oral and anal routes were both acceptable for NOTES accesses in males and females. Forty-one percent of the female patients would consider transvaginal NOTES. Of these patients, significantly more patients indicated that the reason for choosing transvaginal NOTES was to minimize the risk of hernia (P=0.016) and to reduce pain associated with the procedure (P=0.017). The risk of complications (84.5%) and the cost of the procedure (58%) were considered the most important aspects when choosing a surgical approach by Asian-Chinese patients. Asian-Chinese preferred NOTES mainly for cosmetic reasons. However, the transvaginal route was less acceptable to females. Significant differences in patient perception on NOTES were observed between Asian-Chinese and Western patients. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.
Vettoretto, Nereo; Arezzo, Alberto; Famiglietti, Federico; Cirocchi, Roberto; Moja, Lorenzo; Morino, Mario
The management of gallbladder stones (lithiasis) concomitant with bile duct stones is controversial. The more frequent approach is a two-stage procedure, with endoscopic sphincterotomy and stone removal from the bile duct followed by laparoscopic cholecystectomy. The laparoscopic-endoscopic rendezvous combines the two techniques in a single-stage operation. To compare the benefits and harms of endoscopic sphincterotomy and stone removal followed by laparoscopic cholecystectomy (the single-stage rendezvous technique) versus preoperative endoscopic sphincterotomy followed by laparoscopic cholecystectomy (two stages) in people with gallbladder and common bile duct stones. We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, Science Citation Index Expanded Web of Science, and two trials registers (February 2017). We included randomised clinical trials that enrolled people with concomitant gallbladder and common bile duct stones, regardless of clinical status or diagnostic work-up, and compared laparoscopic-endoscopic rendezvous versus preoperative endoscopic sphincterotomy procedures in people undergoing laparoscopic cholecystectomy. We excluded other endoscopic or surgical methods of intraoperative clearance of the bile duct, e.g. non-aided intraoperative endoscopic retrograde cholangiopancreatography or laparoscopic choledocholithotomy (surgical incision of the common bile duct for removal of bile duct stones). We used standard methodological procedures recommended by Cochrane. We included five randomised clinical trials with 517 participants (257 underwent a laparoscopic-endoscopic rendezvous technique versus 260 underwent a sequential approach), which fulfilled our inclusion criteria and provided data for analysis. Trial participants were scheduled for laparoscopic cholecystectomy because of suspected cholecysto-choledocholithiasis. Male/female ratio was 0.7; age of men and women ranged from 21 years to 87
Yasui, Takaharu; Takahata, Shunichi; Kono, Hiroshi; Nagayoshi, Yosuke; Mori, Yasuhisa; Tsutsumi, Kosuke; Sadakari, Yoshihiko; Ohtsuka, Takao; Nakamura, Masafumi; Tanaka, Masao
Although patients with cholecystocholedocholithiasis are generally referred to cholecystectomy after endoscopic sphincterotomy (ES) and common bile duct clearance, we often have a conflict whether cholecystectomy is necessary in very elderly patients with comorbid diseases. The aim of this study is to assess whether cholecystectomy in very elderly patients is justified after ES. Patients with cholecystocholedocholithiasis who underwent ES and stone extraction and were followed-up for more than 10 years were retrospectively reviewed. We divided these patients into two groups: the elderly group (equal to or more than 80 years old) and young group (less than 80 years old) and compared late biliary complications and mortality. The 10-year cumulative incidence of overall biliary complications was significantly lower in cholecystectomized patients than in patients with gallbladder in situ in the young group (7.5 vs. 21.7%, p = 0.0037), but not different in the elderly group (8.3 vs. 7.4%, p = 0.92). When each complication was evaluated separately, the rate of recurrent common bile duct stones (CBDS) was not different, but that of acute cholecystitis was significantly lower in the elderly group than in the young group (4.1 vs. 22.6%, p = 0.011). In very elderly patients the incidence of acute cholecystitis is low even when the gallbladder is preserved after endoscopic treatment of CBDS, with a similar risk of CBDS recurrence. Thus, it may not be necessary to recommend cholecystectomy after ES for CBDS in very elderly patients.
Liu, Hung-Ping; Chu, Yen; Wu, Yi-Cheng; Hsieh, Ming-Ju; Liu, Chieng-Ying; Chen, Tzu-Ping; Chao, Yin-Kai; Wu, Ching-Yang; Yeh, Chi-Ju; Ko, Po-Jen; Liu, Yun-Hen
Safe pulmonary vessel sealing device plays a crucial role in anatomic lung resection. In 2014, we reported high rates of massive bleeding complications during transumbilical lobectomy in a canine model due to difficulty in managing the pulmonary vessel with an endostapler. In this animal survival series, we aimed to evaluate the outcome of pulmonary vessel sealing with an electrocautery device to simplify the transumbilical thoracic surgery. Under general anesthesia, a 3-cm longitudinal incision was made over the umbilicus. Under video guidance, a bronchoscope was inserted through the incision for exploration. The diaphragmatic wound was created with an electrocautery knife and used as the entrance into the thoracic cavity. Using the transumbilical technique, anatomic lobectomy was performed with electrosurgical devices and endoscopic vascular staplers in 15 canines. Transumbilical endoscopic anatomic lobectomy was successfully completed in 12 of the 15 animals. Intraoperative bleeding developed in three animals during pulmonary hilum dissection, where one animal was killed due to hemodynamic instability and the other two animals required thoracotomy to complete the operation. There were five delayed bleeding and surgical mortality cases caused by inadequate vessel sealing by electrosurgical devices. Postmortem examination confirmed correct transumbilical lobectomy in the twelve animals that survived the operations. Transumbilical anatomic lobectomy is technically feasible in a canine model; however, the electrosurgical devices were not effective in sealing the pulmonary vessel in the current canine model.
Santos, Byron F; Auyang, Edward D; Hungness, Eric S; Desai, Kush R; Chan, Edward S; van Beek, Darren B; Wang, Edward C; Soper, Nathaniel J
Extraction of a gallbladder through an endoscopic overtube during natural orifice translumenal endoscopic surgery (NOTES) transgastric cholecystectomy avoids potential injury to the esophagus. This study examined the rate of successful gallbladder specimen extraction through an overtube and hypothesized that preoperative ultrasound findings could predict successful specimen passage. Gallbladder specimens from patients undergoing laparoscopic cholecystectomy were measured, and an attempt was made to pull the specimens through a commercially available overtube with an inner diameter of 16.7-mm. A radiologist blinded to the outcomes reviewed the available preoperative ultrasound measurements from these patients. Ultrasound dimensions including gallbladder length, width, and depth; wall thickness; common bile duct diameter; and size of the largest gallstone (LGS) were recorded. Multiple logistic regression analysis was performed to determine whether ultrasound findings and patient characteristics (age, body mass index [BMI], and sex) could predict the ability of a specimen to pass through the overtube. Of 57 patients, 44 (77%) who had preoperative ultrasounds available for electronic review were included in the final analysis. Gallstones were present in 35 (79%) of these 44 patients. Intraoperative gallbladder perforation occurred in 18 (41%) of the 44 patients, and 16 (36%) of the 44 gallbladders could be extracted through the overtube. Measurement of LGS was possible for 23 patients, and indeterminate gallstone size (IGS) was determined for 12 patients. The rate for passage of perforated versus intact gallbladders was similar (40% vs. 23%; p = 0.054). The LGS (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.02-1.33; p = 0.021) and IGS (OR, 22.97; 95% CI, 1.99-265.63; p = 0.025) predicted failed passage on multivariate logistic regression analysis. The passage rate was 80% for LGS smaller than 10 mm or no stones present, 18% for LGS 10 mm or larger, and 8% for
Noel, Rozh; Enochsson, Lars; Swahn, Fredrik; Löhr, Matthias; Nilsson, Magnus; Permert, Johan; Arnelo, Urban
Rendezvous intraoperative endoscopic retrograde cholangiography (RV-IOERC), also called guidewire-facilitated IOERC, is one of the single-stage options available for managing common bile duct stones (CBDS) during laparoscopic cholecystectomy. The objective of this study is to investigate procedure-related complications in IOERC patients and stone clearance. All patients who underwent IOERC between January 2000 and December 2009 were identified from the local registry of Karolinska University Hospital in Huddinge. Medical charts and ERC reports were studied, and descriptive statistics were obtained. Outcomes were procedure-related complications, especially post-ERCP pancreatitis (PEP), stone clearance, and mortality. 307 patients were identified. In 264 of the patients, the rendezvous cannulation technique was successful (86 %); in the remaining 43 patients, conventional cannulation technique was necessary. In total, PEP occurred in seven patients (2.28 %). One of the PEP patients was in the rendezvous cannulated group (0.37 %), whereas six patients developed PEP in the nonrendezvous group (13.95 %, p < 0.001). The primary stone clearance rate was 88.27 % (271/307). There was no mortality within 90 days in the series. IOERC with RV cannulation technique for management of CBDS during laparoscopic cholecystectomy has a low PEP rate and a high stone clearance rate, making it a safe and feasible method for removing CBDS. However, the technique requires logistics to perform IOERC in the operating theater. The present data suggest that IOERC with RV cannulation is superior to conventional cannulation with respect to risk of PEP.
Schreuder, Anne Marthe; Booij, Klaske A C; de Reuver, Philip R; van Delden, Otto M; van Lienden, Krijn P; Besselink, Marc G; Busch, Olivier R; Gouma, Dirk J; Rauws, Erik A J; van Gulik, Thomas M
Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous procedure. All consecutive patients with BDI referred to our tertiary referral center between 1995 and 2016 were analyzed. A rendezvous procedure was performed when endoscopic or radiologic intervention failed, and when deemed feasible by a dedicated multidisciplinary team including hepatopancreaticobiliary surgeons, gastrointestinal endoscopists, and interventional radiologists. Classification of BDI, technical success of the rendezvous procedure, procedure-related adverse events, and outcomes were assessed. Among a total of 812 patients, rendezvous was performed in 47 (6 %), 31 (66 %) of whom were diagnosed with complete transection of the bile duct (Amsterdam type D/Strasberg type E injury). The primary success rate of rendezvous was 94 % (44 /47 patients). Overall morbidity was 18 % (10 /55 procedures). No life-threatening adverse events or 90-day mortality occurred. After a median follow-up of 40 months (interquartile range 23 - 54 months), rendezvous was the final successful treatment in 26 /47 patients (55 %). In 14 /47 patients (30 %), rendezvous acted as a bridge to surgery, with hepaticojejunostomy being chosen either primarily or secondarily to treat refractory or relapsing stenosis. In experienced hands, rendezvous was a safe procedure, with a long-term success rate of 55 %. When endoscopic or transhepatic interventions fail to restore bile duct continuity in patients with BDI, rendezvous should be considered, either as definitive treatment or as a bridge to elective surgery. © Georg Thieme Verlag KG Stuttgart · New York.
Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial.
Bansal, Virinder Kumar; Misra, Mahesh C; Rajan, Karthik; Kilambi, Ragini; Kumar, Subodh; Krishna, Asuri; Kumar, Atin; Pandav, Chandrakant S; Subramaniam, Rajeshwari; Arora, M K; Garg, Pramod Kumar
The ideal method for managing concomitant gallbladder stones and common bile duct (CBD) stones is debatable. The currently preferred method is two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). This prospective randomized trial compared the success and cost effectiveness of single- and two-stage management of patients with concomitant gallbladder and CBD stones. Consecutive patients with concomitant gallbladder and CBD stones were randomized to either single-stage laparoscopic CBD exploration and cholecystectomy (group 1) or endoscopic retrograde cholangiopancreatography (ERCP) for endoscopic extraction of CBD stones followed by LC (group 2). Success was defined as complete clearance of CBD and cholecystectomy by the intended method. Cost effectiveness was measured using the incremental cost-effectiveness ratio. Intention-to-treat analysis was performed to compare outcomes. From February 2009 to October 2012, 168 patients were randomized: 84 to the single-stage procedure (group 1) and 84 to the two-stage procedure (group 2). Both groups were matched with regard to demographic and clinical parameters. The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (91.7 vs. 88.1 %). The overall success rate also was comparable: 88.1 % in group 1 and 79.8 % in group 2 (p = 0.20). Direct choledochotomy was performed in 83 of the 84 patients. The mean operative time was significantly longer in group 1 (135.7 ± 36.6 vs. 72.4 ± 27.6 min; p ≤ 0.001), but the overall hospital stay was significantly shorter (4.6 ± 2.4 vs. 5.3 ± 6.2 days; p = 0.03). Group 2 had a significantly greater number of procedures per patient (p gallbladder and CBD stones had similar success and complication rates, but the single-stage strategy was better in terms of shorter hospital stay, need for fewer procedures, and cost effectiveness.
Endoscopic retrograde cholangiopancreatography, endoscopic esphinterotomy and laparoscopic cholecystectomy in a patient with choledocolitiasis and cholelitiasis; Colangiopancreatografia retrograda endoscopica, esfinterotomia endoscopica y colecistectomia laparoscopica en un paciente con coledocolitiasis y colelitiasis
Riveron Quevedo, Kelly; Irsula Ballaga, Vladimir [Hospital General Docente ' Dr. Juan Bruno Zayas Alfonso' , Santiago de Cuba (Cuba); Gonzalez Ulloa, Lianne [Policlinico Docente ' Josue Pais Garcia' , Santiago de Cuba (Cuba); Deborah LLorca, Armando, E-mail: email@example.com [Hospital General Docente ' Emilio Barcenas Pier' , II Frente, Santiago de Cuba (Cuba)
The case report of a 30 year-old presumably healthy patient, who attended the Gastroenterology Department from 'Dr Juan Bruno Zayas Alfonso' Teaching General Hospital in Santiago de Cuba, and suffering from biliary cholic, ictero, choluria, nausea, vomit and loss of appetite is presented. The complementary examinations confirmed the choledocolitiasis and cholelitiasis diagnosis, reason why it was necessary to carry out a endoscopic retrograde cholangiopancreatography, endoscopic esphinterotomy and ambulatory laparoscopic cholecystectomy, in a single anesthetic injection. The postoperative clinical course was favorable and she was discharged without complications 24 hours before the intervention.
Jakobsen, Henrik Loft; Vilmann, Peter; Rosenberg, Jacob
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...
Zargar, Showkat A; Mushtaq, Mosin; Beg, Mashkoor A; Javaid, Gul; Khan, Bashir A; Hassan, Rayhana; Kasana, Reyaz A; Tabassum, Sameena
Endoscopic sphincterotomy (ES) is one of the most important advances in the treatment of common bile duct (CBD) stones. However, the use of ES to remove CBD stones in high-risk patients without cholecystectomy is still debatable. The aim of this study was to compare the efficacy of a wait-and-see policy versus cholecystectomy after ES for CBD stones in high-risk patients with co-existing cholelithiasis. A total of 162 patients after undergoing ES with the clearance of CBD stones were randomised after informed consent to cholecystectomy or conservative management of their gallbladder stones. The results indicated that cholecystectomy after ES for CBD stones significantly reduced the biliary complications in high-risk patients. Every patient who has both CBD stones and gallstones with significant co-morbid illnesses, after clearance of CBD stones by ES, should undergo early cholecystectomy. Copyright © 2014 Arab Journal of Gastroenterology. Published by Elsevier Ltd. All rights reserved.
Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones: Results of a retrospective, single center study between 1996-2002
Lakatos, Laszlo; Mester, Gabor; Reti, Gyorgy; Nagy, Attila; Lakatos, Peter Laszlo
AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients undergoing preoperative ERCP ( ≤ 90 d before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1st of January 1996 to the 31st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct ( ≥ 8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient’s history. Suspected prognostic factors and the combination of factors were compared to the result of ERCP. RESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%, for three 72.5%, for four or more 91.4%. CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients). Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g. skill of the endoscopist, other diagnostic tools). PMID:15526372
A modified technique reduced operative time of laparoendoscopic rendezvous endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for concomitant gallstone and common bile ductal stone.
Liu, Wei; Wang, Qunwei; Xiao, Jing; Zhao, Liying; Huang, Jiangsheng; Tan, Zhaohui; Li, Pengfei
Laparoendoscopic rendezvous (LERV) endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC+ERCP/LERV) are considered an optimal approach for concomitant gallstones and common bile duct stones. The rendezvous technique is essential for the success of procedure. We applied two different LERV techniques, traditional technique and modified technique, in 60 consecutive cases from January 2011 to November 2012. 32 cases who underwent modified technique (group 1) from February 2012 to November 2012 were retrospectively compared to 28 cases (group 2) who underwent traditional technique from January 2011 to January 2012. There was no significant difference between two groups with respect to preoperative demographic features. Although the difference was not statistically significant, the procedure was successfully performed in 31 cases (96.9%) in group 1 and 24 cases (86.2%) in group 2. The mean operative time and time of endoscopic part were 82.6 ± 19.6 min and 26.5 ± 5.99 min in group 1 which were significantly shorter than those in group 2 (118.0 ± 23.1 min and 58.7 ± 13.3 min, resp.). There was no postoperative pancreatitis and mortality in both groups. The mean hospital stay, blood loss, incidence of complications, and residual stone were of no difference in both groups. This study proved that this modified technique can effectively reduce the operative time and time of endoscopic part of LC+ERCP/LERV compared with traditional technique.
A Modified Technique Reduced Operative Time of Laparoendoscopic Rendezvous Endoscopic Retrograde Cholangiopancreatography Combined with Laparoscopic Cholecystectomy for Concomitant Gallstone and Common Bile Ductal Stone
Full Text Available Laparoendoscopic rendezvous (LERV endoscopic retrograde cholangiopancreatography (ERCP and laparoscopic cholecystectomy (LC+ERCP/LERV are considered an optimal approach for concomitant gallstones and common bile duct stones. The rendezvous technique is essential for the success of procedure. We applied two different LERV techniques, traditional technique and modified technique, in 60 consecutive cases from January 2011 to November 2012. 32 cases who underwent modified technique (group 1 from February 2012 to November 2012 were retrospectively compared to 28 cases (group 2 who underwent traditional technique from January 2011 to January 2012. There was no significant difference between two groups with respect to preoperative demographic features. Although the difference was not statistically significant, the procedure was successfully performed in 31 cases (96.9% in group 1 and 24 cases (86.2% in group 2. The mean operative time and time of endoscopic part were 82.6 ± 19.6 min and 26.5 ± 5.99 min in group 1 which were significantly shorter than those in group 2 (118.0 ± 23.1 min and 58.7 ± 13.3 min, resp.. There was no postoperative pancreatitis and mortality in both groups. The mean hospital stay, blood loss, incidence of complications, and residual stone were of no difference in both groups. This study proved that this modified technique can effectively reduce the operative time and time of endoscopic part of LC+ERCP/LERV compared with traditional technique.
cysts (n = 3), patent urachus (n = 3), postoperative complications of ... Keywords: abdominal masses, infants, laparotomy, transumbilical approach. Pediatric Surgery ... to the abdomen to facilitate the management of surgical pathologies other.
Sumiyoshi, Kinjiro; Sato, Norihiro; Akagawa, Shin; Hirano, Tatsuya; Koikawa, Kazuhiro; Horioka, Kohei; Ozono, Keigo; Fujiwara, Kenji; Tanaka, Masao; Sada, Masayuki
Single-incision laparoscopic cholecystectomy (SILC) is a promising alternative to standard multi-incision laparoscopic cholecystectomy (LC). However, generalization of SILC is still hampered by technical difficulties mainly associated with the lack of trocars used for retraction of the gallbladder. We therefore developed a modified method of SILC with the use of needle graspers (SILC-N) for optimal retraction and exposure. In addition to two trocars inserted through a single transumbilical incision, two needle ports were placed on the right subcostal and lateral abdominal wall, through which needle graspers were used for retraction of the gallbladder. Since December, 2009, 12 patients with symptomatic cholelithiasis were treated by SILC-N. SILC-N was successfully performed in all but one patient requiring a conversion to the 4-port LC with a mean operative time of 71.5 (48-107) minutes. None of the patients experienced intraoperative or postoperative complications. The transumbilical incision and pinholes for needle graspers were almost invisible on discharge. Our preliminary results suggest that SILC-N is a simple, safe and feasible technique of cholecystectomy offering similar postoperative recovery and better cosmetic outcome as compared to conventional LC.
Endoscopic management of bile leaks after laparoscopic cholecystectomy. ... endoscopic management at a median of 12 days (range 2 - 104 days) after surgery. Presenting features included intra-abdominal collections with pain in 58 cases ...
Randomised study on single stage laparo-endoscopic rendezvous (intra-operative ERCP) procedure versus two stage approach (Pre-operative ERCP followed by laparoscopic cholecystectomy) for the management of cholelithiasis with choledocholithiasis.
Sahoo, Manash Ranjan; Kumar, Anil T; Patnaik, Aashish
The 'Rendezvous' technique consists of laparoscopic cholecystectomy (LC) standards with intra-operative cholangiography followed by endoscopic sphincterotomy. The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. In this study, we intended to compare the two methods in a prospective randomised trial. From 2005 to 2012, we enrolled 83 patients with a diagnosis of cholecysto-choledocolithiasis. They were randomised into two groups. In 'group-A',41 patients were treated with two stages management, first by pre-operative endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct (CBD) clearance and second by LC. In 'group-B', 42 patients were treated with LC and intra-operative cholangiography; and when diagnosis of choledocholithiasis was confirmed, patients had undergone one stage management of by Laparo-endoscopic Rendezvous technique. In arm-A and arm-B groups, complete CBD clearance was achieved in 29 and 38 patients, respectively. Failure of the treatment in arm-A was 29% and in arm-B was 9.5%. In arm-A, selective CBD cannulation was achieved in 33 cases (80.5%) and in arm-B in 39 cases (93%). In arm-Agroup, post-ERCP hyperamylasia was presented in nine patients (22%) and severe pancreatitis in five patients (12%) versus none of the patients (0%) in arm-B group, respectively. Mean post-operative hospital stay in arm-A and arm-B groups are 10.9 and 6.8 days, respectively. One stage laparo-endoscopic rendezvous approach increases selective cannulation of CBD, reduces post-ERCP pancreatitis, reduces days of hospital stay, increases patient's compliance and prevents unnecessary intervention to CBD.
Randomised study on single stage laparo-endoscopic rendezvous (intra-operative ERCP procedure versus two stage approach (Pre-operative ERCP followed by laparoscopic cholecystectomy for the management of cholelithiasis with choledocholithiasis
Manash Ranjan Sahoo
Full Text Available Introduction : The ′Rendezvous′ technique consists of laparoscopic cholecystectomy (LC standards with intra-operative cholangiography followed by endoscopic sphincterotomy. The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. In this study, we intended to compare the two methods in a prospective randomised trial. Materials And Methods: From 2005 to 2012, we enrolled 83 patients with a diagnosis of cholecysto-choledocolithiasis. They were randomised into two groups. In ′group-A′,41 patients were treated with two stages management, first by pre-operative endoscopic retrograde cholangiopancreatography (ERCP and common bile duct (CBD clearance and second by LC. In ′group-B′, 42 patients were treated with LC and intra-operative cholangiography; and when diagnosis of choledocholithiasis was confirmed, patients had undergone one stage management of by Laparo-endoscopic Rendezvous technique. Results: In arm-A and arm-B groups, complete CBD clearance was achieved in 29 and 38 patients, respectively. Failure of the treatment in arm-A was 29% and in arm-B was 9.5%. In arm-A, selective CBD cannulation was achieved in 33 cases (80.5% and in arm-B in 39 cases (93%. In arm-Agroup, post-ERCP hyperamylasia was presented in nine patients (22% and severe pancreatitis in five patients (12% versus none of the patients (0% in arm-B group, respectively. Mean post-operative hospital stay in arm-A and arm-B groups are 10.9 and 6.8 days, respectively. Conclusion: One stage laparo-endoscopic rendezvous approach increases selective cannulation of CBD, reduces post-ERCP pancreatitis, reduces days of hospital stay, increases patient′s compliance and prevents unnecessary intervention to CBD.
Background: Laparoscopic appendectomy is a feasible and safe alternative to open appendectomy for uncomplicated appendicitis. In the past decade several laparoscopic procedures have been described using one or more ports. We report our experience in treating acute appendicitis with one-port transumbilical ...
Trans-umbilical Laparoscopic Appendectomy for Acute Appendicitis without Raising Skin-flaps: An Easy-to-use Modification Applied to the Series of 164 Patients from a Rural Institute of Central India. Priyadarshan Anand Jategaonkar, Sudeep Pradeep Yadav1. INTRODUCTION. Laparoscopic appendectomy (LA) is widely ...
Background: Supra-Transumbilical Laparotomy (STL) has been used in paediatric surgery for a broad spectrum of abdominal procedures. We report our experience with STL approach for small bowel atresia repair in newborns and review previous published series on the topic. Patients and Methods: Fourteen patients with ...
Full Text Available Duodenal duplication cysts are rare congenital lesions. Their presentation is often non-specific and physical examination and laboratory studies usually reveal no abnormal findings. The diagnosis of duodenal duplication cysts can thus be challenging and relies on ultrasonography, barium swallow, contrast enhanced computed tomography (CT, magnetic resonance imaging (MRI, and magnetic resonance cholangiopancreatography (MRCP. The management of duodenal duplication cyst is surgical. Laparotomy is usually necessary, and complete resection is the management goal. Subtotal excision with stripping of the mucosa due to close involvement of the pancreatobiliary tree, and endoscopic resection have Duodenal duplication cysts are rare congenital lesions usually diagnosed in infancy, although they may present in adulthood. Prenatal diagnosis is difficult, and postnatal diagnosis relies on ultrasonography, barium swallow, contrast-enhanced computerized tomography, magnetic resonance imaging (MRI, and magnetic resonance cholangiopancreatography. A female newborn was diagnosed with an abdominal cyst (size around 6 ×; 5 × 4 cm at gestational age (GA 24 weeks, by regular prenatal examination. After her birth at GA 37 weeks, we performed abdominal ultrasonography and MRI, but there was no definite diagnosis. The usual management of an abdominal cyst involves resection by laparotomy (requiring a large incision or laparoscopy (requiring several small incisions. We performed an exploratory trans-umbilical minimal laparotomy excision for surgery, and the pathology revealed duodenal duplication. In our case, there was no recurrence of the cyst after 18 months follow-up, and the operation scar was almost undetectable. Trans-umbilical minimal laparotomy excision may be considered as an alternative choice for the management of abdominal and duodenal duplication cysts.
Colangiopancreatografía retrógrada endoscópica, esfinterotomía endoscópica y colecistectomía laparoscópica en un paciente con coledocolitiasis y colelitiasis Endoscopic retrograde cholangiopancreatography, endoscopic esphinterotomy and laparoscopic cholecystectomy in a patient with choledocolitiasis and cholelitiasis
Kelly Riverón Quevedo
Full Text Available Se presenta el caso clínico de una paciente de 30 años de edad, presumiblemente saludable, quien acudió a la consulta de Gastroenterología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por presentar cólico biliar, íctero, coluria, náuseas, vómitos e inapetencia. Los exámenes complementarios efectuados confirmaron el diagnóstico de coledocolitiasis y colelitiasis, por lo cual fue preciso realizarle colangiopancreatografía retrógrada endoscópica, esfinterotomía endoscópica y colecistectomía laparoscópica en un tiempo anestésico. La evolución posoperatoria resultó favorable y fue dada de alta sin complicaciones antes de las 24 horas de haber sido intervenida.The case report of a 30 year-old presumably healthy patient, who attended the Gastroenterology Department from "Dr Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, and suffering from biliary cholic, ictero, choluria, nausea, vomit and inappetence is presented. The complementary examinations confirmed the choledocolitiasis and cholelitiasis diagnosis, reason why it was necessary to carry out a endoscopic retrograde cholangiopancreatography, endoscopic esphinterotomy and ambulatory laparoscopic cholecystectomy, in a single anesthetic injection. The posoperative clinical course was favorable and she was discharged without complications 24 hours before the intervention.
Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis.
Singh, Anand Narayan; Kilambi, Ragini
The ideal management of common bile duct (CBD) stones associated with gall stones is a matter of debate. We planned a meta-analysis of randomized trials comparing single-stage laparoscopic CBD exploration and cholecystectomy (LCBDE) with two-stage preoperative endoscopic stone extraction followed by cholecystectomy (ERCP + LC). We searched the Pubmed/Medline, Web of science, Science citation index, Google scholar and Cochrane Central Register of Controlled trials electronic databases till June 2017 for all English language randomized trials comparing the two approaches. Statistical analysis was performed using Review Manager (RevMan) [Computer program], Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014 and results were expressed as odds ratio for dichotomous variables and mean difference for continuous. p value ≤ 0.05 was considered significant. Trial sequential analysis (TSA) was performed using TSA version 0.9.5.5 (Copenhagen: The Copenhagen Trial Unit, Centre for Clinical Intervention Research, 2016). PROSPERO trial registration number is CRD42017074673. A total of 11 trials were included in the analysis, with a total of 1513 patients (751-LCBDE; 762-ERCP + LC). LCBDE was found to have significantly lower rates of technical failure [OR 0.59, 95% CI (0.38, 0.93), p = 0.02] and shorter hospital stay [MD - 1.63, 95% CI (- 3.23, - 0.03), p = 0.05]. There was no significant difference in mortality [OR 0.37, 95% CI (0.09, 1.51), p = 0.17], morbidity [OR 0.97, 95% CI (0.70, 1.33), p = 0.84], cost [MD - 379.13, 95% CI (- 784.80, 111.2), p = 0.13] or recurrent/retained stones [OR 1.01, 95% CI (0.38, 2.73), p = 0.98]. TSA showed that although the Z-curve crossed the boundaries of conventional significance, the estimated information size is yet to be achieved. Single-stage LCBDE is superior to ERCP + LC in terms of technical success and shorter hospital stay in good-risk patients with
Cholangiography and endoscopic sphincterotomy in the management of severe acute gallstone pancreatitis discovered at diag~osticlaparotomy. ... in these cases Included cholecystectomy and Ttube drainage (2 patients) cholecystostomy drainage (3 patients), and closure of the abdomen without drainage (2 patients).
Egawa, Noriyuki; Ueda, Junji; Hiraki, Masatsugu; Ide, Takao; Inoue, Satoshi; Sakamoto, Yuichiro; Noshiro, Hirokazu
Abstract Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy. PMID:27462188
Full Text Available Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy.
Vladimirov, B; Petkov, R; Viiachki, I; Damianov, D; Iarŭmov, N
Endoscopic sphincterotomy (ES) with extraction of calculi is a basic method of treating choledocholithiasis in post-cholecystectomy patients (8, 9). Endoscopic treatment contributes to a considerable reduction of the indications for reoperation. The existing views concerning ES done in patients with preserved gallbladder, especially in the era of laparoscopic surgery, are still conflicting (3, 6). There are several options: cholecystectomy with removal of calculi in the common bile duct by ES in a subsequent stage, or vice versa-primary ES with ensuring cholecystectomy. The undertaking of independent surgical or endoscopic treatment is likewise practicable (2, 6).
Nielsen, Liv Bjerre Juul; Harboe, Kirstine Moll; Bardram, Linda
The number of Danish inhabitants older than 65 years is increasing, and cholecystectomy is one of the most common surgical procedures performed for this age group. This study aimed to analyze the role of age as an independent predictor of outcome for elderly cholecystectomy patients....
Martin, D J; Vernon, D R; Toouli, J
10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery.......10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery....
Ainsworth, Alan Patrick; Axelsen, Anne Reiss; Rasmussen, Lars
It is recommended that children with typical clinical signs of biliary colic should be offered surgery if gallstones are present. The aim of this study was to describe a population of children having undergone cholecystectomy.......It is recommended that children with typical clinical signs of biliary colic should be offered surgery if gallstones are present. The aim of this study was to describe a population of children having undergone cholecystectomy....
Gaurav V Kulkarni
Full Text Available Traditional management of gallstone pancreatitis (GP has been to perform cholecystectomy during the same hospital admission after resolution. However, when GP develops in the immediate postoperative period from a major colorectal operation, cholecystectomy may be fraught with difficulty due to the inflammatory response that occurs. Thus, delaying cholecystectomy until the inflammatory response subsides may be worthwhile, and it maximizes the chances of completing the cholecystectomy laparoscopically. We have described our management of 2 patients with GP occurring after colorectal operations, which required proximal diverting ileostomy. In both cases, we deferred management of GP with either endoscopic retrograde cholangiopancreatography (ERCP or medical conservative measures during the acute attack and performed laparoscopic cholecystectomy during ostomy reversal surgery utilizing the existing ostomy takedown site for port placement. Both patients tolerated this management well.
Conclusions : Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.
Full Text Available Various strategies have been proposed for the management of retained calculi within the biliary tree following cholecystectomy. We present a unique case of a cystic duct remnant calculus causing Mirizzi syndrome, only the fourth such case of its kind. An open procedure was planned, however the calculus was eventually extracted endoscopically. The pathophysiology and management of Mirizzi syndrome and retained calculi within the cystic duct remnant are discussed along with the merits of a minimally invasive approach.
Chen, Tzu-Ping; Yen-Chu; Wu, Yi-Cheng; Yeh, Chi-Ju; Liu, Chien-Ying; Hsieh, Ming-Ju; Yuan, Hsu-Chia; Ko, Po-Jen; Liu, Yun-Hen
Transumbilical single-port surgery has been associated with less postoperative pain and offers better cosmetic outcomes than conventional 3-port laparoscopic surgery. This study compares the safety and efficacy of transumbilical thoracoscopy and conventional thoracoscopy for lung wedge resection. The animals (n = 16) were randomly assigned to the transumbilical thoracoscopic approach group (n = 8) or conventional thoracoscopic approach group (n = 8). Transumbilical lung resection was performed via an umbilical incision and a diaphragmatic incision. In the conventional thoracoscopic group, lung resection was completed through a thoracic incision. For both procedures, we compared the surgical outcomes, for example, operating time and operative complications; physiologic parameters, for example, respiratory rate and body temperature; inflammatory parameters, for example, white blood cell count; and pulmonary parameters, for example, arterial blood gas levels. The animals were euthanized 2 weeks after the surgery for gross and histologic evaluations. The lung wedge resection was successfully performed in all animals. There was no significant difference in the mean operating times or complications between the transumbilical and the conventional thoracoscopic approach groups. With regard to the physiologic impact of the surgeries, the transumbilical approach was associated with significant elevations in body temperature on postoperative day 1, when compared with the standard thoracoscopic approach. This study suggests that both approaches for performing lung wedge resection were comparable in efficacy and postoperative complications. © The Author(s) 2014.
Williams, J K; Rosemurgy, A S; Albrink, M H; Parsons, M T; Stock, S
Laparoscopic cholecystectomy was performed on a pregnant woman at 18 weeks of gestation without complications. Considering the risk/benefit ratio, laparoscopic cholecystectomy in pregnant women is preferable to conventional cholecystectomy.
Hodgett, Steven E; Hernandez, Jonathan M; Morton, Connor A; Ross, Sharona B; Albrink, Michael; Rosemurgy, Alexander S
The journey from conventional "open" operations to truly "minimally invasive" operations naturally includes progression from operations involving multiple trocars and multiple incisions to operations involving access through the umbilicus alone. Laparoscopic operations through the umbilicus alone, laparoendoscopic single site surgery (LESS), offer improved cosmesis and hopes for less pain and improved recovery. This study was undertaken to evaluate our initial experience with LESS cholecystectomy and to compare our initial experience to concurrent outcomes with more conventional multiport, multi-incision laparoscopic cholecystectomy. All patients referred for cholecystectomy over a 6-month period were offered LESS. Outcomes, including blood loss, operative time, complications, and length of stay were recorded. Outcomes with our first LESS cholecystectomies were compared to an uncontrolled group of concurrent patients undergoing multiport, multi-incision laparoscopic cholecystectomy at the same hospital by the same surgeon. Twenty-nine patients of median age 50 years undergoing LESS cholecystectomy from November 2007 until May 2008 were compared to 29* patients, median age 48 years, undergoing standard multiport, multiple-incision laparoscopic cholecystectomy over the same time period. Median operative time for patients undergoing LESS cholecystectomy was 72 min and was not different from that of patients undergoing multiport, multi-incision laparoscopic cholecystectomy (p = 0.81). Median length of hospital stay was 1.0 day for patients undergoing LESS cholecystectomy and was not different from patients undergoing standard laparoscopic cholecystectomy (p = 0.46). Operative estimated blood loss was less than 100 cc for all patients. No patients undergoing attempted LESS cholecystectomy had conversions to "open" operations; two patients had an additional trocar(s) placed distant from the umbilicus to aid in exposure. Three patients undergoing LESS cholecystectomy had
Natalie E. Cookson
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.
Booij, Klaske A. C.; de Reuver, Philip R.; Yap, Kenneth; van Dieren, Susan; van Delden, Otto M.; Rauws, Erik A.; Gouma, Dirk J.
Cystic duct and Luschka duct leakage after laparoscopic cholecystectomy are often classified as minor injuries because the outcome of endoscopic stenting and percutaneous drainage is generally reported to be good. However, the potential associated early mortality and risk factors for mortality are
Bouwense Stefan A
Full Text Available Abstract Background After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. During this waiting period, the patient is at risk of recurrent biliary events. In current clinical practice, surgeons usually postpone cholecystectomy for 6 weeks due to a perceived risk of a more difficult dissection in the early days following pancreatitis and for logistical reasons. We hypothesize that early laparoscopic cholecystectomy minimizes the risk of recurrent biliary pancreatitis or other complications of gallstone disease in patients with mild biliary pancreatitis without increasing the difficulty of dissection and the surgical complication rate compared with interval laparoscopic cholecystectomy. Methods/Design PONCHO is a randomized controlled, parallel-group, assessor-blinded, superiority multicenter trial. Patients are randomly allocated to undergo early laparoscopic cholecystectomy, within 72 hours after randomization, or interval laparoscopic cholecystectomy, 25 to 30 days after randomization. During a 30-month period, 266 patients will be enrolled from 18 hospitals of the Dutch Pancreatitis Study Group. The primary endpoint is a composite endpoint of mortality and acute re-admissions for biliary events (that is, recurrent biliary pancreatitis, acute cholecystitis, symptomatic/obstructive choledocholithiasis requiring endoscopic retrograde cholangiopancreaticography including cholangitis (with/without endoscopic sphincterotomy, and uncomplicated biliary colics occurring within 6 months following randomization. Secondary endpoints include the individual endpoints of the composite endpoint, surgical and other complications, technical difficulty of cholecystectomy and costs. Discussion The PONCHO trial is designed to show that early
Islim, F.; Ors, S.; Salik, A.; Guven, K.; Yanar, F.; Alis, H.
Full text: Introduction: The risk of bile duct injury after laparoscopic cholecystectomy is higher than open cholecystectomy. Objective: To discuss the importance of minimally invasive treatment options in the management of bile duct injuries after laparoscopic cholecystectomy and to present our approach in the management. Materials and methods: Management of 25 patients with symptomatic bile duct injury after laparoscopic cholecystectomy was retrospectively evaluated. Percutaneous collection drainage, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and percutaneous biliary drainage were performed for the management of the patients. Results: Mean age of the patients (15 women, 10 men) was 55. Either ultrasonography or computed tomography guided percutaneous drainage was performed in 13 patients. 9 of them completely recovered only with percutaneous drainage. In 4 of them ERCP was performed because of high drainage volume. In 9 of the patients with jaundice and high bilirubin levels ERCP was performed as the first option. And 3 patients were reoperated because of acute abdomen signs. ERCP, MRCP and PTC revealed type A in 7, type E2 in 3, type E3 in 3 and type E4 in 1 of the patients according to Strasberg classification. Conclusion: Presenting symptoms of the patients with symptomatic bile duct injury are useful in the determination of the treatment option.
Thesbjerg, Simon E; Harboe, Kirstine Moll; Bardram, Linda
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...
Alam, Mohammed K.
The objective of this report was to study the sensitivity of indicators used for predicting bile duct stones and their endoscopic removal before laparoscopic cholecystectomy. A retrospective study was conducted on 104 patients who successfully underwent endoscopic retrograde cholangiopancreatogram (ERCP) before laparoscopic cholecysectomy at Riyadh Medical Complex between 1992 and 1994 (1412H-1414H). Six indicators --- jaundice, biliary pancreatitis, stones in bile duct on sonography, dilated bile duct (>7mm) on ultrasonography, dilated bile duct with deranged liver function test and deranged liver function test without jaundice ---were used for suspecting choledocholithiasis and endoscopic removal before laparoscopic cholecystectomy. Ultrasound correctly predicted bile duct stone in 75%, followed by dilated bile duct with deranged liver function test (46%). Clinical jaundice and biliary pancreatitis were equally sensitive indicators (42% each). Sensitivity of only dilated bile duct on ultrasonography in predicting duct stone was 36%. Deranged liver function without jaundice was the least sensitive (22%) of the predictors. Overall, these indicators correctly diagnosed bile duct stones in 34% of patients. Until laparoscopic exploration of bile duct or a noninvasive technique, such as magnetic resonance cholangiopancreatogram (MRCP), is widely available, these predictors will help in selecting patients with bile duct stones for preoperative removal. Other workers have suggested combining these indicators to improve the predictive value. (author)
Full Text Available The present study is undertaken to establish the usefulness of laparoscopic cholecystectomy and to know its merits and demerits as compared to open cholecystectomy in children. In all, 28 patients who underwent cholecystectomy (8 open and 20 laparoscopic cholecystectomy in B.Y.L. Nair hospital between July 1999 and March 2004 were analyzed. Calculous cholecystitis was found to be the most common indication for surgery. Operative time for laparoscopic cholecystectomy was more than that in open cholecystectomy in the early phase of laparoscopy, which got reduced as we gained experience. The requirement of parenteral antibiotics and analgesics and the duration of stay were significantly shorter with laparoscopy. The advantages for a child in laparoscopic cholecystectomy as compared to open cholecystectomy are minimal pain, avoidance of an upper abdominal incision, cosmesis and shorter duration of hospitalization with quick return to home and school. Thus, laparoscopic cholecystectomy is safe and efficacious in children.
Coelho, Júlio Cezar Uili; Contieri, Fabiana L C; de Freitas, Alexandre Coutinho Teixeira; da Silva, Fernanda Cristina; Kozak, Vanessa Nascimento; da Silva Junior, Alzemir Santos
This study reviews our experience with laparoscopic cholecystectomy in the treatment of cholelithiasis in transplant patients. Demographic data, medications used, and operative and postoperative data of all transplant recipients who were subjected to laparoscopic cholecystectomy for cholelithiasis at our hospital were obtained. A total of 15 transplant patients (13 renal transplantation and 2 bone marrow transplantation) underwent laparoscopic cholecystectomy. All patients were admitted to the hospital on the day of the operation. The immunosuppressive regimen was not modified during hospitalization. Clinical presentation of cholelithiasis was biliary colicky (n=12), acute cholecystitis (n=2), and jaundice (n=1). The operation was uneventful in all patients. Postoperative complications were nausea and vomiting in 2 patients, prolonged tracheal intubation in 1, wound infection in 1 and large superficial hematoma in 1 patient. Laparoscopic cholecystectomy is associated to a low morbidity and mortality and good postoperative outcome in transplant patients with uncomplicated cholecystitis.
Rosenberg-Adamsen, S; Skarbye, M; Wildschiødtz, G
.01). SWS was absent in four of the patients after operation, whereas in six patients it was within the normal range (5-20% of the night). The proportion of rapid eye movement (REM) sleep was not significantly changed after operation. There were no changes in arterial oxygen saturation on the postoperative...... compared with the preoperative night. Comparison of our results with previous studies on SWS and REM sleep disturbances after open laparotomy, suggests that the magnitude of surgery or administration of opioids, or both, may be important factors in the development of postoperative sleep disturbances.......The sleep pattern and oxygenation of 10 patients undergoing laparoscopic cholecystectomy were studied on the night before operation and the first night after operation. Operations were performed during general anaesthesia and postoperative analgesia was achieved without the administration...
Ross, Sharona; Rosemurgy, Alexander; Albrink, Michael; Choung, Edward; Dapri, Giovanni; Gallagher, Scott; Hernandez, Jonathan; Horgan, Santiago; Kelley, William; Kia, Michael; Marks, Jeffrey; Martinez, Jose; Mintz, Yoav; Oleynikov, Dmitry; Pryor, Aurora; Rattner, David; Rivas, Homero; Roberts, Kurt; Rubach, Eugene; Schwaitzberg, Steven; Swanstrom, Lee; Sweeney, John; Wilson, Erik; Zemon, Harry; Zundel, Natan
Many surgeons attempting Laparo-Endoscopic Single Site (LESS) cholecystectomy have found the operation difficult, which is inconsistent with our experience. This article is an attempt to promote a standardized approach that we feel surgeons with laparoscopic skills can perform safely and efficiently. This is a four-trocar approach consistent with the four incisions utilized in conventional laparoscopic cholecystectomy. After administration of general anesthesia, marcaine is injected at the umbilicus and a 12-mm vertical incision is made through the already existing anatomical scar of the umbilicus. A single four-trocar port is inserted. A 5-mm deflectable-tip laparoscope is placed through the trocar at the 8 o'clock position, a bariatric length rigid grasper is inserted through the trocar at the 4 o'clock position (to grasp the fundus), and a rigid bent grasper is placed through the 10-mm port (to grasp the infundibulum). This arrangement of the instruments promotes minimal internal and external instrument clashing with simultaneous optimization of the operative view. This orientation allows retraction of the gallbladder in a cephalad and lateral direction, development of a window between the gallbladder and the liver which promotes the "critical view" of the cystic duct and artery, and provides triangulation with excellent visualization of the operative field. The operation is concluded with diaphragmatic irrigation of marcaine solution to minimize postoperative pain. Standardization of LESS cholecystectomy will speed adoption, reduce intraoperative complications, and improve the efficiency and safety of the approach.
Abu-Eshy, Saeed A.; Al-Rofaidi, Abdallah A.; Al-Faki, Ahmed S.; Ghalib, Hashim W.; Moosa, Riyadh A.; Sadik, Ali A.; Salati, Mohammad I.
Laparoscopic cholecystectomy, a minimal access surgery, is fast replacing open cholecystectomy and is being associated with less trauma. The objective of this study was to compare the proinflammatory cytokine levels in both laparoscopic cholecystectomy and open cholecystectomy. This study was carried out at Aseer Central Hospital, Aseer region, Abha Private Hospital and the College of Medicine and Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia, during the time period October 1998 through to November 2000. Sixty-one patients were included in the study, 27 of them had laparoscopic cholecystectomy and 34 had open cholecystectomy. Cytokines [Interleukin-6 Interleukin-1b, Tumor necrosis factor -a and Interleukin- 8] were measured in blood samples collected from the patients before, at and 24 hours post surgery, using commercially available kits. Interleukin-6 levels were significantly increased at 24 hours post surgery in the open cholecystectomy group of patients compared to the laparoscopic cholecystectomy group (P<0.04). No differences were found in the other cytokines levels (Interleukin-1b, tumor necrosis factor -a and Interleukin-8) between the open cholecystectomy and laparoscopic cholecystectomy groups. Laparoscopic cholecystectomy, a minimal access surgery, is associated with lower levels of the proinflammatory interleukin-6 cytokine compared to open cholecystectomy. (author)
Shah, S.F.; Waqar, S.; Chaudry, M.A.; Hameed, S.
To compare three ports laparoscopic cholecystectomy and four ports laparoscopic cholecystectomy in terms of complications, time taken to complete the procedure, hospital stay and cost effectiveness in local perspective. Methodology: This randomized control trial included 60 patients who underwent elective laparoscopic cholecystectomy at Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2013 to June 2013. These patients were randomized on computer generated table of random numbers into group A and Group B. In Group A patients four ports were passed to perform laparoscopic cholecystectomy and in Group B patients three ports were passed to perform the procedure. Results: The mean age in both groups was 44 years (range 18-72). Three ports laparoscopic cholecystectomy (43 min) took less time to complete than four ports laparoscopic cholecystectomy (51 min). Patients in three ports laparoscopic cholecystectomy experienced less pain as compared to four ports group. The total additional analgesia requirement in 24 hours calculated in milligrams was less in three port laparoscopic cholecystectomy group as compared four port laparoscopic cholecystectomy group. The mean hospital stay in three port laparoscopic cholecystectomy group is 25 hours while the mean hospital stay in the four port laparoscopic cholecystectomy group is 28 hours. Conclusion: Three ports laparoscopic cholecystectomy is safe and effective procedure and it did not compromise the patient safety. (author)
Jun, Zhang; Juntao, Ge; Shuli, Liu; Li, Long
Purpose: The purpose of this study is to determine whether singleport laparoscopic repair (SLR) for incarcerated inguinal hernia in children is superior toconventional repair (CR) approaches. Method: Between March 2013 and September 2013, 126 infants and children treatedwere retrospectively reviewed. All the patients were divided into three groups. Group A (48 patients) underwent trans-umbilical SLR, group B (36 patients) was subjected to trans-umbilical conventional two-port laparoscopic rep...
Goossens, Richard H. M.; van Eijk, Daan J.; Lange, Johan F.
Background Iatrogenic bile duct injury remains a current complication of laparoscopic cholecystectomy. One uniform and standardized protocol, based on the “critical view of safety” concept of Strasberg, should reduce the incidence of this complication. Furthermore, owing to the rapid development of minimally invasive surgery, technicians are becoming more frequently involved. To improve communication between the operating team and technicians, standardized actions should also be defined. The aim of this study was to compare existing protocols for laparoscopic cholecystectomy from various Dutch hospitals. Methods Fifteen Dutch hospitals were contacted for evaluation of their protocols for laparoscopic cholecystectomy. All evaluated protocols were divided into six steps and were compared accordingly. Results In total, 13 hospitals responded—5 academic hospitals, 5 teaching hospitals, 3 community hospitals—of which 10 protocols were usable for comparison. Concerning the trocar positions, only minor differences were found. The concept of “critical view of safety” was represented in just one protocol. Furthermore, the order of clipping and cutting the cystic artery and duct differed. Descriptions of instruments and apparatus were also inconsistent. Conclusions Present protocols differ too much to define a universal procedure among surgeons in The Netherlands. The authors propose one (inter)national standardized protocol, including standardized actions. This uniform standardized protocol has to be officially released and recommended by national scientific associations (e.g., the Dutch Society of Surgery) or international societies (e.g., European Association for Endoscopic Surgery and Society of American Gastrointestinal and Endoscopic Surgeons). The aim is to improve patient safety and professional communication, which are necessary for new developments. PMID:18224485
Full Text Available Introduction: Laparoscopic cholecystectomy has clearly become the choice over open cholecystectomy in the treatment of hepatobiliary disease since its introduction by Mouret in 1987. This study evaluates a series of patients with chronic calculus cholecystitis who were treated with laparoscopic and open cholecystectomy and assesses the outcomes of both techniques. Objective: To evaluate the efficacy of laparoscopic vs open cholecystectomy in chronic calculus cholecystitis and establish the out-comes of this treatment modality at Lumbini Medical College and Teaching Hospital. Methods: This was a retrospective analysis over a one-year period (January 1, 2012 to December 31, 2012, per-formed by single surgeon at Lumbini Medical College and Teaching Hospital located midwest of Nepal. 166 patients underwent surgical treatment for chronic calculus cholecystitis. Patients included were only chronic calculus cholecystitis proven histopathologocally and the rest were excluded. Data was collected which included patients demographics, medical history, presentation, complications, conversion rates from laparoscopic. cholecystectomy to open cholecystectomy, operative and postoperative time. Results: Patients treated with laparoscopic cholecystectomy for chronic calculus cholecystitis had shorter operating times and length of stay compared to patients treated with open cholecystectomy for chronic calculus cholecystitis. Conversion rates were 3.54% in chronic calculus cholecystitis during the study period. Complications were also lower in patients who underwent laparoscopic cholecystectomy versus open cholecystectomy for cholelithiasis. Conclusions: Laparoscopic cholecystectomy appears to be a reliable, safe, and cost-effective treatment modality for chronic calculus cholecystitis.
Santarelli, Luca; Gabrielli, Maurizio; Candelli, Marcello; Cremonini, Filippo; Nista, Enrico C; Cammarota, Giovanni; Gasbarrini, Giovanni; Gasbarrini, Antonio
At present there are no well-established pharmacological approaches in the management of post-cholecystectomy alkaline reactive gastritis. The aim of this study was to assess the effect of sucralfate versus rabeprazole or no treatment on dyspeptic symptoms and endoscopic/histological signs in a population of patients with a history of cholecystectomy and evidence of alkaline reactive gastritis. Sixty dyspeptic patients fulfilling the following criteria of inclusion took part in this study: (1) a history of cholecystectomy; (2) no use of anti-inflammatory steroidal and non-steroidal drugs, or abuse of alcohol; (3) evidence of abundant gastric bile reflux at endoscopy; (4) endoscopic signs of chronic gastritis; (5) histological signs of chronic gastritis; and (6) absence of Helicobacter pylori infection. Dyspeptic symptoms were evaluated by means of a self-administered validated questionnaire. Patients included in the study were randomly assigned to one of three treatment groups for 3 months: sucralfate, rabeprazole, observation. Patients were re-evaluated at the end of the treatment. Sucralfate and rabeprazole therapies were both able to significantly reduce epigastric pain, heartburn, bloating and halitosis. Endoscopic/histological signs were lower in both treatment groups compared to the observation group. Both sucralfate and rabeprazole therapies are effective treatment options in the patients with alkaline gastritis when compared with observation.
Kim, Yong-Wook; Park, Byung-Joon; Ro, Duck-Yeong; Kim, Tae-Eung
To evaluate the feasibility of single-port laparoscopic myomectomy with transumbilical morcellation and suturing. Continuing prospective study (Canadian Task Force classification II-3). University hospital. Fifteen patients who underwent single-port laparoscopic myomectomy between September 2008 and October 2009 to remove single or multiple uterine myomas, at least 1 in each patient measuring greater than 4 cm in diameter. All single-port laparoscopic myomectomy procedures were performed by a single surgeon (Dr. Y.W. Kim). Myomas were extracted transumbilically by cutting the myomas into smaller pieces with a knife or a conventional electromechanical morcellator. After making a single 1.5- to 2.0-cm umbilical incision, the single-port system, created with a wound retractor and a surgical glove, was inserted. All operations were performed using conventional rigid straight laparoscopic instruments. Laparoscopic suturing was performed in intramural myomas and some subserosal myomas. Patient mean (SD; range) age was 38.3 (5.6; 29-49) years. The number of myomas per patient was 1.6 (1.4; 1-6). The diameter of the largest myomas was 6.1 (1.5; 4.2-9.6) cm. In 4 patients, only a knife was required for transumbilical extraction of myomas, and in 11 patients, transumbilical morcellation with an electromechanical morcellator with or without a knife was used. Transumbilical drainage tubes were inserted into the pelvic cavity in 11 of 15 patients. Operative time was 96.7 (33.8; 35-150) minutes. The decrease in postoperative hemoglobin concentration was 1.8 (1.2; 0.4-3.6) g/dL. During the operations, no patients required blood transfusion. No patients developed postoperative fever. Neither bowel injury nor urinary tract injury occurred in any patient. The postoperative hospital stay was 3.1 (0.8; 2-4) days. Single-port transumbilical morcellation using a conventional electromechanical morcellator with or without a knife is feasible. Single-port laparoscopic myomectomy is an
Sangrasi, Ahmed Khan; Syed, Bm; Memon, Amir Iqbal; Laghari, Abdul Aziz; Talpur, K Altaf Hussain; Qureshi, Jawaid Naeem
Acute gallstone pancreatitis is quite common throughout the globe. Conventionally definitive cholecystectomy has been delayed in index hospital admission. Since the last decade timing of cholecystectomy is gradually shifting towards the earlier phase of disease and currently gallstone pancreatitis is being evaluated as a further indication for laparoscopic cholecystectomy. There is also great concern regarding compliance of patients for definitive surgery due to poverty, ignorance and illiteracy in developing countries. The aim of this study was to assess the feasibility and safety of laparoscopic cholecystectomy as a definitive treatment in patients with mild and resolving gall stone pancreatitis. This was a prospective study from July 2009 to June 2012. Patients were diagnosed by clinical examination, biochemical tests, ultrasonography and contrast enhanced CT. Patients with mild form of the disease (Ranson Score ≤3) and who showed clinical improvement were offered laparoscopic cholecystectomy in index hospital admission. Those who were unfit for surgery were referred for endoscopic sphincterotomy. Common bile duct stones were excluded preoperatively. A total of 38 patients were admitted with acute gallstone pancreatitis in the study period. The mean age of patients was 46.3 years with male to female ratio of 11/27. 22 (57.8%) patients were selected for laparoscopic cholecystectomy and procedure was completed successfully. Ten (26.3%) patients were referred for ERCP and endoscopic sphincterotomy and 11 (28.9%) were managed by conservative treatment and went without any definitive treatment. Mean duration of time from onset of symptoms and laparoscopic cholecystectomy was 7 days (range 4-10). Mean duration of operative time was 45 minutes and hospital stay was 7 days. There was no operative mortality. No major intra-operative or post-operative complication was recorded. two patients (9%) had minor complications. Laparoscopic cholecystectomy can be safely
Montano, D.; Polnitsky, J.; Pisano, A.
The authors present 107 cholecystectomies performed in CRAMI during 1999 for gallstone disease.52 were laparoscopic cholecystectomies and 55 open cholecystectomies, 24 in the urgency.The length of stay was 1.04 days for the laparoscopic cholecystectomies and 3.06 and 4.04 for open cholecystectomies in coordinated and urgency procedures.Less than 1/5 of analgesic and antibiotic were needed in laparoscopic cholecystectomies
Luis Augusto Zárate Suárez
Full Text Available Antecedentes: El tratamiento de la apendicitis aguda implica su extirpación; es frecuente la solicitud de cicatrices postquirúrgicas del mejor tamaño posible. Una de las estrategias disponibles es el abordaje transumbilical. Objetivos: Descubrir las características clínicas y los desenlaces operatorios de los pacientes pediátricos en quienes se realiza apendicectomía vía transumbilical. Metodología: Estudio prospectivo de 424 pacientes sucesivos en cuanto a los desenlaces operatorios a corto plazo. Resultados: El tiempo promedio de intervención quirúrgica fue de 22 minutos; 95,8% de los pacientes presentó evolución satisfactoria del postquirúrgico; 1,4% de los pacientes se reintervino para drenar un absceso intracavitario residual y 0,2% presentó infencción de sitio operatorio sin mas complicaciones. Conclusión: El abordaje transumbilical de la apendicitis es una alternativa minimamente invasiva para todos los estados de apendicitis aguda e implica disminución del tiempo de realización, menor estancia del postquirúrgico, menor incidencia de complicaciones y mayor conformidad con los resultados estéticos.
Donatsky, Anders M; Jørgensen, Lars N; Meisner, Søren
INTRODUCTION: Despite several benefits, patients are concerned that transvaginal cholecystectomy has a negative impact on sexual health. The objective of this systematic review was to assess the impact of transvaginal cholecystectomy on postoperative dyspareunia and sexual function. METHOD......: A literature search was performed in the PubMed and EMBASE databases. Papers reporting on postoperative dyspareunia, vaginal pain or discomfort, and sexual function were included. RESULTS: Seventeen papers reported on dyspareunia and vaginal pain or discomfort. Two papers reported a rate of de novo dyspareunia...... of 3.8% and 12.5%, respectively. One study reported a nonsignificant reduction in painful sexual intercourse and the remaining 14 reported no incidents of dyspareunia. Eight papers reported on sexual function. One paper using a nonvalidated questionnaire found impaired sexual function. The papers...
Geenen, J E; Hogan, W J; Shaffer, R D; Stewart, E T; Dodds, W J; Arndorfer, R C
Endoscopic papillotomy was performed in 13 patients after cholecystectomy for retained or recurrent common bile duct calculi (11 patients) and a clinical picture suggesting papillary stenosis (two patients). Following endoscopic papillotomy, ten of the 11 patients spontaneously passed common bile duct (CBD) stones verified on repeated endoscopic retrograde cholangiopancreatography (ERCP) study. One patient failed to pass a large CBD calculus; one patient experienced cholangitis three months after in inadequate papillotomy and required operative intervention. Endoscopic papillotomy substantially decreased the pressure gradient existing between the CBD and the duodenum in all five patients studied with ERCP manometry. Endoscopic papillotomy is a relatively safe and effective procedure for postcholecystectomy patients with retained or recurrent CBD stones. The majority of CBD stones will pass spontaneously if the papillotomy is adequate.
Objective: To determine the incidence of intraoperative anesthesia-related complications of laparoscopic cholecystectomy. Results: One hundred patients with male to female ratio of 1:8.09 in the age range of 20-80 years (mean 39 years) underwent general anesthesia for laparoscopic cholecystectomy. The duration of operation in 94 laparoscopic cholecystectomy was from 20 to 80 minutes (mean 60.63 minutes). The incidence of intraoperative hypotension was 9%. Four percent of the patients developed arrhythmias. Increase in end-tidal-carbon dioxide (ETCO/sub 2/) was observed in 3% of cases. Conversion rate to open cholecystectomy was 6%. Damage to intraabdominal vessels with trocar insertion occurred in 1% of cases. Conclusion: Although laparoscopic cholecystectomy has major surgical and anesthetic advantages, there are anesthesia related complications requiring specific anesthetic interventions to improve patients outcome without compromising their safety. (author)
Garner, J P; Sood, S K; Robinson, J; Barber, W; Ravi, K
Biliary symptoms whilst awaiting elective cholecystectomy are common, resulting in hospital admission, further investigation and increased hospital costs. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications. The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place. In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There were 112 patients who initially presented acutely and were managed conservatively. Twenty-four patients were re-admitted 37 times, which utilised 231 hospital bed-days and repeat investigations costing over 40,000 pounds. There would have been a marginal increase in tariff income if a policy of acute laparoscopic cholecystectomy had been in place. Adoption of a policy of acute laparoscopic cholecystectomy on the index admission would result in substantial cost savings to the trust, reduce elective cholecystectomy waiting times and increase tariff income.
The number of medical accidents in endoscopic surgery has recently increased. Surgical complications caused by inadequate preparation or immature technique or those resulting in serious adverse outcomes may be referred to as medical accidents. The Nationwide Survey of Endoscopic Surgery showed that bile duct injury and uncontrollable bleeding were seen in 0.68% and in 0.58%, respectively, of cholecystectomy patients; interoperative and postoperative complications in 0.84% and in 3.8%, respectively, of gastric cancer surgery patients; and operative complications in 6.74% of bowel surgery patients. Some required open repair, and 49 patients died. The characteristic causes of complications in endoscopic surgery are a misunderstanding of anatomy, handling of organs outside the visual field, burn by electrocautery, and injuries caused by forceps. Bleeding that requires a laparotomy for hemostasis is also a complication. Furthermore, since the surgery is usually videorecorded, immature techniques resulting in complications are easily discovered. To decrease the frequency of accidents, education through textbooks and seminars, training using training boxes, simulators, or animals, proper selection of the surgeon depending on the difficulty of the procedure, a low threshold for conversion to laparotomy, and use of the best optical equipment and surgical instruments are important. To avoid malpractice lawsuits, informed consent obtained before surgery and proper communication after accidents are necessary.
Stavrou, George; Fotiadis, Kyriakos; Panagiotou, Dimitrios; Faitatzidou, Afroditi; Kotzampassi, Katerina
Due to the current economic crisis in Greece, major cutbacks on healthcare costs have been imposed, resulting in a shortage of surgical supplies, including laparoscopic materials. In an attempt to reduce costs, we developed a homemade specimen retrieval bag for laparoscopic cholecystectomy. We used the polyethylene bag containing the catheter of a Redon drainage set. The bag was cut in half and pleated longitudinally; then, the gallbladder was placed in the bag and removed through the umbilicus with a grasping forceps. From September 2011 to June 2012, we used our homemade bag on 85 patients undergoing laparoscopic cholecystectomy. No rupture, accidental opening, or bile leak was observed. The learning curve was found to be five cases. Our homemade specimen retrieval bag seems to be a safe, effective, and easy tool for tissue extraction. Further studies need to be conducted to evaluate its full potential. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
Morita, Kiyomi; Ishizawa, Takeaki; Tani, Keigo; Harada, Nobuhiro; Shimizu, Atsushi; Yamamoto, Satoshi; Takemura, Nobuyuki; Kaneko, Junichi; Aoki, Taku; Sakamoto, Yoshihiro; Sugawara, Yasuhiko; Hasegawa, Kiyoshi; Kokudo, Norihiro
Fluorescence imaging using indocyanine green (ICG) has recently been applied to laparoscopic surgery to identify cancerous tissues, lymph nodes, and vascular anatomy. Here we report the application of ICG-fluorescence imaging to visualize the boundary between the liver and subserosal tissues of the gallbladder during laparoscopic full-thickness cholecystectomy. A patient with a potentially malignant gallbladder lesion was administered 2.5-mg intravenous ICG just before laparoscopic full-thickness cholecystectomy. Intraoperative fluorescence imaging enabled the real-time delineation of both extrahepatic bile duct anatomy and hepatic parenchyma throughout the procedure, which resulted in complete removal of subserosal tissues between liver and gallbladder. Safe and feasible ICG-fluorescence imaging can be widely applied to laparoscopic hepatobiliary surgery by utilizing a biliary excretion property of ICG. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
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.
An approach to suspected gallstone pancreatitis'based on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) was adopted in 1976 and was followed in 29 patients. ERCp became the routine method of early biliary tract assessment when gallstone pancreatitis was suspected on ...
Hadi, A.; Aman, Z.; Khan, S.A.
Objective: To evaluate the management of bile duct injuries following open and laparoscopic cholecystectomy in a tertiary care hospital. Methods: The descriptive case series was conducted from July 2002 to June 2008 at Hayatabad Medical Complex Peshawar, Pakistan. A total of 32 patients who sustained extra hepatic bile duct injuries during open and laparoscopic cholecystectomy were included. Patients having hepatobiliary malignancy or those managed through endoscopic retrograde cholangiopancreatography and stenting were excluded. Patients were thoroughly investigated including to reach a final diagnosis, and were followed up for 02 years. Results: The mean age of patients was 45.4+9-2.7 years with a female preponderance (M:F=1:9.7). The time of presentation was up to 03 months after initial surgery. Seven (21.87%) patients sustained bile duct injury during laparoscopic cholecystectomy, while 25 (78.13%) sustained injury during open procedure. Abdominal ultrasound scan was performed in 29 (90.63%) cases, endoscopic retrograde cholangiopancreatography in 14 (43.75%) and magnetic resonance cholangiopancreatography in 26 (81.25%) cases. Eleven (34.37%) patients had common bile duct leak, 9 (28.13%) had common hepatic duct injury, 9 (28.13%) had CBD strictures and 3 (09.37%) had injury to the biliary tree at porta hepatis level. Operative procedures performed included Roux-en-Y hepaticojejunostomy in 19 (59.38%) cases, choledochoduodenostomy in 7 (21.88%) cases, Roux-en-Y portoentrostomy and primary repair in 3 (09.37%) cases each. Postoperative morbidity included recurrent cholangitis 9 (28.12%), wound infection 4 (12.50%) and bile leakage 2 (06.25%). Hospital stay ranged 08-16 days. Hospital mortality rate was 03.13%, (n=1). Conclusion: The most frequent site of bile duct injury during open and laparoscopic cholecystectomy was the common bile duct, and Roux-en-Y hepaticojejunostomy was the procedure of choice by experienced surgeons for the management of such injuries
Khan, S.; Oonwala, Z.G.
To evaluate the outcome of Laparoscopic Cholecystectomy in Gall stone disease, critically analyzing the complication rate, morbidity and mortality rate. All patients (>12 years) with cholelithiasis were included in this study. Patients with common bile duct dilatation (>8mm) or stones, or gall bladder mass or jaundice, and those declared unfit for anaesthesia were excluded. The detailed data of all the cases was compiled and analyzed. Out of the total of 1345 patients operated during the study period, 1234 (91.75%) were females and 111 (8.25%) males; their ages ranged from 12 to 89 years, majority were in the age bracket of 30-50 years. Our conversion rate was 6.4%. Nine (0.67%) patients developed bleeding from the port site, 30 (2.23%) port site infection, 43 (3.20%) umbilical port hernia, two bile ducty injury and one colonic injury. There was no mortality in this series. Laparoscopic Cholecystectomy is a safe and effective treatment for Cholelithiasis. (author)
Rashid, T.; Farooq, U.; Naheed, A.; Iqbal, M.; Barkat, N.
Background: Laparoscopic cholecystectomy is getting popularity in developing countries especially in Pakistan. Conversion from laparoscopic to open cholecystectomy is also common. This study intends to evaluate the causes of conversion from laparoscopic cholecystectomy to open cholecystectomy and to establish the efficacy and safety of the procedure. Methods: This descriptive case series was conducted in the department of General Surgery at Social Security Teaching Hospital Islamabad from November 2012 to October 2015. Patients of more than 20 years of age presenting in OPD with symptomatic gallstones were included in the study. Patients with dilated CBD (>8 mm in diameter), jaundice, acute cholecystitis, mass at porta hepatis and positive hepatitis B or C virology were excluded. Results: A total of 300 patients were included in the study; 262 (87.33 percentage) were females and 38 (12.67 percentage) were males. Twenty-one (7 percentage) patients were converted to open cholecystectomy. Most common cause of conversion was dense adhesions followed by obscure anatomy at Calots triangle. Other common causes were bleeding, bile leakage, visceral injuries and instrument failure. In the first 100 cases, 10 percentage patients were converted to open cholecystectomy followed by 6 percentage in the next 100 cases. Only 5 percentage patients were converted to open cholecystectomy in the last 100 cases. Conclusion: Most common cause of conversion from laparoscopic cholecystectomy to open cholecystectomy was dense adhesions followed by obscure anatomy at Calots triangle. (author)
Palanivelu, Chinnasamy; Rajan, Pidigu Seshiyer; Jani, Kalpesh; Shetty, Alangar Roshan; Sendhilkumar, Karuppasamy; Senthilnathan, Palanisamy; Parthasarthi, Ramakrishnan
Open cholecystectomy is associated with considerable morbidity and mortality in cirrhotic patients. Laparoscopic cholecystectomy may offer a better option because of the magnification available and the availability of newer instruments like the ultrasonic shears. We present our experience of 265 laparoscopic cholecystectomies and attempt to identify the difficulties encountered in this group of patients. Between 1991 and 2005, 265 cirrhotic patients of Child-Pugh Classification A and B, with symptomatic gallstones, were subjected to laparoscopic cholecystectomy. We describe here our tailored approach and our techniques of subtotal cholecystectomy. Features of acute cholecystitis were present in 35.1% of the patients, and 64.9% presented with chronic cholecystitis. In 81.5% of the patients, the diagnosis of cirrhosis was established preoperatively. In 8.3% of the patients, a fundus first method was adopted when the hilum could not be approached despite additional ports. Modified subtotal cholecystectomy was performed in a total of 206 patients. Mean operative time in the subtotal cholecystectomy group was 72 minutes; in the standard group, it was 41 minutes. There was no mortality. In 15% of patients, postoperative deterioration in liver function occurred. Worsening of ascites, port site infection, port site bleeding, intraoperative hemorrhage, bilious drainage, and stone formation in the remnant were the other complications encountered. Laparoscopic cholecystectomy is a safe and effective treatment for calculous cholecystitis in cirrhotic patients. Appropriate modification of subtotal cholecystectomy should be practiced, depending on the risk factors present, to avoid complications.
Burns, Brigid R; Hofmeister, Erik H; Brainard, Benjamin M
To determine if dogs that undergo laparotomy for cholecystectomy suffer from a greater number or magnitude of perianesthetic complications, including hypotension, hypothermia, longer recovery time, and lower survival rate, than dogs that undergo laparotomy for hepatic surgery without cholecystectomy. Retrospective cohort study. One hundred and three dogs, anesthetised between January 2007 and October 2011. The variables collected from the medical record included age, weight, gender, surgical procedure, pre-operative bloodwork, American Society of Anesthesiologists (ASA) status, emergency status, total bilirubin concentration, anesthetic agents administered, body temperature nadir, final body temperature, hypotension, duration of hypotension, blood pressure nadir, intraoperative drugs, anesthesia duration, surgery duration, time to extubation, final diagnosis, days spent in the intensive care unit (ICU), total bill, survival to discharge, and survival to follow-up. No significant difference in body temperature nadir, final temperature, presence of hypotension, duration of hypotension, blood pressure nadir, the use of inotropes, or final outcome was found between dogs undergoing cholecystectomy and dogs undergoing exploratory laparotomy for other hepatic disease. Dogs that had cholecystectomy had longer anesthesia durations and longer surgery durations than dogs that did not have cholecystectomy. No significant differences existed for temperature nadir (34.8 versus 35.3°C; non-cholecystectomy versus cholecystectomy), final temperature (35.6 versus 35.9°C), time to extubation (30 versus 49 minutes), duration of hypotension (27 versus 21 minutes), or MAP nadir (56 versus 55 mmHg). Hypotension occurred in 66% and 74% and inotropes were used in 64% and 53%, for non-cholecystectomy and cholecystectomy patients, respectively. Dogs that underwent cholecystectomies did not suffer a greater number of anesthesia complications than did dogs undergoing hepatic surgery without
Full Text Available Aim: Laparoscopic cholecystectomy has become the gold standard for the treatment of gallstones. Background: The objective of our study was to identify the preoperative predictors of conversion of laparoscopic cholecystectomy into open cholecystectomy. Materials and Methods: We carried out a cross-sectional study in the Surgical Unit 1, Holy Family Hospital, Rawalpindi, from September 2016 to February 2017. All patients undergoing laparoscopic cholecystectomy were included in the study. Patients undergoing open cholecystectomy due to the presence of contraindication to laparoscopic cholecystectomy or patients in which laparoscopic cholecystectomy was a part of some other laparoscopic intervention were not included in the study. SPSS version 21 was used to analyze the data. Results: The overall mean age of the patients was 43.67 ± 13.54 years. The male patients were significantly older as compared to the female patients. The conversion rate was higher in patients who had an elevated total leukocyte count and alanine aminotransferase before the operation (P < 0.05. The rate of conversion was significantly higher in male patients aged ≥50 years (P < 0.05. Difficulty in the dissection of the triangle of Calot, difficulty in dissecting the gallbladder fossa, bleeding in gallbladder fossa, presence of duodenal fistula, and autolyzed gangrenous gallbladder were the reasons for the conversion to open cholecystectomy. Conclusion: The rate of conversion of laparoscopic cholecystectomy to open cholecystectomy was found to be 5%. Male patients aged ≥50 years, acalculous acute cholecystitis, acute cholecystitis, elevated preoperative total leukocyte count, and alanine aminotransferase levels were found to be significant predictors of conversion to open cholecystectomy.
Horstmann, R; Kern, M; Joosten, U; Hohlbach, G
An ultrasound dissector especially developed for laparoscopic surgery was used during laparoscopic cholecystectomy on 34 patients. The ultrasound power, the volume of suction and irrigation could be determined individually at the generator and activated during the operation with a foot pedal. With the dissector it was possible to fragmentate, emulgate and aspirate simultaneously fat tissue as well as infected edematous structures. The cystic artery and cystic duct, small vessels, lymphatic and connective tissue were not damaged. Therefore this system seems to be excellent for the preparation of Calot's trigonum and blunt dissection of the gallbladder out of its bed, particularly in fatty, acute or chronic infected tissue. No complications were observed within the peri- and postoperative period.
Pan, Jun J; Ahn, Woojin; Dargar, Saurabh; Halic, Tansel; Li, Bai C; Sankaranarayanan, Ganesh; Roberts, Kurt; Schwaitzberg, Steven; De, Suvranu
Natural Orifice Transluminal Endoscopic Surgery (NOTES) provides an emerging surgical technique which usually needs a long learning curve for surgeons. Virtual reality (VR) medical simulators with vision and haptic feedback can usually offer an efficient and cost-effective alternative without risk to the traditional training approaches. Under this motivation, we developed the first virtual reality simulator for transvaginal cholecystectomy in NOTES (VTEST™). This VR-based surgical simulator aims to simulate the hybrid NOTES of cholecystectomy. We use a 6DOF haptic device and a tracking sensor to construct the core hardware component of simulator. For software, an innovative approach based on the inner-spheres is presented to deform the organs in real time. To handle the frequent collision between soft tissue and surgical instruments, an adaptive collision detection method based on GPU is designed and implemented. To give a realistic visual performance of gallbladder fat tissue removal by cautery hook, a multi-layer hexahedral model is presented to simulate the electric dissection of fat tissue. From the experimental results, trainees can operate in real time with high degree of stability and fidelity. A preliminary study was also performed to evaluate the realism and the usefulness of this hybrid NOTES simulator. This prototyped simulation system has been verified by surgeons through a pilot study. Some items of its visual performance and the utility were rated fairly high by the participants during testing. It exhibits the potential to improve the surgical skills of trainee and effectively shorten their learning curve. Copyright © 2016 Elsevier Inc. All rights reserved.
Oh, Hyung Jin; Lee, Jae Mun; Jung, Seung Eun; Kim, Eung Kook; Kim, Jae Kwang; Han, Sung Tae
The purpose of this study was to prospectively compare the clinical applicability of magnetic resonance cholangiography (MRC) with that of endoscopic retrograde cholangiography (ERC) in the evaluation of combined choledocholithiasis in patients with gall stones who were candidates for laparoscopic cholecystectomy. Twenty-seven patients with gall stones underwent fast spin-echo MR cholangiography using the half-Fourier acquisition single-shot turbo spin echo (HASTE) method, and half-Fourier rapid acquisition using the relaxation enhancement (RARE) method. Within five hours the same patients underwent ERC. The results of MRC was reviewed by two radiologists blinded to the results of ERC. The number and size of CBD stones and gall stones, and the degree of CBD dilatation, as seen on HASTE and RARE images, were compared with the results of ERC. MRC depicted common bile duct stones in 10 of 11 patients shown by ERC to have stones, while in the 16 patients in whom ERC did not reveal stones, MRC demonstrated the same finding. The number of CBD stones was exactly demonstrated by HASTE imaging in eight of eleven patients (73%) and by RARE imaging in ten of eleven patients (91%) in whom ERC revealed choledocholithiasis. The size of common bile duct stones visualized by ERC correlated in nine of eleven patients (82%) on HASTE images and in seven of eleven (64%) on RARE images. MRC showed CBD dilatation in all patients in whom dilatation was demonstrated by ERC. For the evaluation of choledocholithiasis before laparoscopic cholecystectomy in patients with gall stones, MRC and ERC are equally accurate. A comparison of HASTE imaging with RARE imaging, as used in the diagnosis of choledocholithiasis, revealed no significant differences. (author)
Borzellino, Giuseppe; Rodella, Luca; Saladino, Edoardo; Catalano, Filippo; Politi, Leonardo; Minicozzi, Annamaria; Cordiano, Claudio
To determine the feasibility and efficacy of the laparoscopic intraoperative rendezvous technique for common bile duct stones (CBDS). Case series. Verona University Hospital, Verona, Italy. A total of 110 patients were enrolled in the study; 47 had biliary colic; 39, acute cholecystitis; 19, acute biliary pancreatitis; and 5, acute biliary pancreatitis with associated acute cholecystitis. In all patients, CBDS diagnosis was reached by intraoperative cholangiography. Intraoperative endoscopy with rendezvous performed during laparascopic cholecystectomy for confirmed CBDS; for such a procedure, a transcystic guide wire was positioned into the duodenum. Intraoperative endoscopy with rendezvous was performed for retrieved CBDS during a laparoscopic cholecystectomy. Laparoscopic rendezvous feasibility, morbidity, postprocedure pancreatitis, and mortality. The laparoscopic rendezvous proved to be feasible in 95.5% (105 of 110 patients). The rendezvous failed in 3 cases of successfully performed laparoscopic cholecystectomy, and a conversion of the laparoscopy was needed in 2 cases of successful rendezvous. Two major complications and 2 cases of bleeding were registered after sphincterotomy was successfully performed with rendezvous, and severe acute pancreatitis complicated a traditional sphincterotomy performed after a failed rendezvous. Rendezvous is a feasible option for treatment of CBDS; it allows one to perform only 1 stage of treatment, even in acute cases such as cholecystitis and pancreatitis. Positioning of the guide wire may allow reduced complications secondary to papilla cannulation but not those of the endoscopic sphincterotomy.
Full Text Available Aim: Notwithstanding cholecystectomy’s being the standard cure for symptomatic gallbladder stones, it might as well trigger changes that result in the increase of duodenogastric reflux and the emergence of relevant clinic and laboratorial data. The aim of this thesis is to explore the effect of cholecystectomy on the duodenogastric reflux, histopathologic changes in the antral mucosa and Helicobacter pylori colonization. Material and Method: This prospective research is based upon data collected from 45 patients (28 of them being female and 17 of them being male patients with an average age of 50.9, who would undergo cholecystectomic surgery. Upper gastrointestinal endoscopy has been performed on patients before the operation and at least two months after the operation in order to examine the existence of bile in the stomach. The tissues removed from the antrum during these endoscopic biopsies have been examined to spot the histopathologic changes and the existence of Helicobacter pylori in the mucosa (chronic gastritis, activation findings, and intestinal metaplasia. Results: Duodenogastric reflux, chronic gastritis, and intestinal metaplasia have been observed to increase significantly after cholecystectomy (p<0.001 for duodenogastric reflux and chronic gastritis, p<0.05 for intestinal metaplasia. On the other hand, no significant data have been attained in terms of activation findings and the existence of H.pylori before and after the operation. Discussion: Although cholecystectomy cause duodenogastric reflux and histopathologic changes in the antrum, it does not affect H.pylori colonization.
Mar 5, 2018 ... Trend Over Time for Cholecystectomy following the Introduction of. Laparoscopy in a Nigerian Tertiary ... How to cite this article: Adisa AO, Lawal OO, Adejuyigbe O. Trend over time for cholecystectomy following .... The challenges with record keeping in the era of open cholecystectomy in our center made it ...
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used to manage post-cholecystectomy bile leaks. However, the best endoscopic intervention remains controversial. We investigated the success of a 7 French double pigtail stent following sphincterotomy in the management of such bile leaks. METHODS: Between July 1998 and June 2008, 48 patients were referred for ERCP for presumed post-cholecystectomy bile leaks. Leaks were confirmed at ERCP and managed by a combination of sphincterotomy and stent insertion unless contraindicated. RESULTS: Bile duct cannulation was successful in 44 (91.7%) patients. A leak of the cystic duct was demonstrated in 19 (43.2%) patients, the duct of Luschka in 11 (25.0%), and the common hepatic duct in 5 (11.4%). Complete transection of the common bile duct occurred in 4 patients. The remaining patients had no cholangiographic evidence of a leak. Sphincterotomy was performed in 34 patients. A 7 French double pigtail plastic stent was placed in all 35 patients with cholangiographic evidence of a bile leak. No bile leaks were demonstrated at a follow-up of 8-16 weeks and all stents were removed successfully. CONCLUSION: The combination of sphincterotomy and insertion of a 7 French double pigtail stent results in excellent outcomes in the management of post-cholecystectomy bile leaks.
Yang, Li; Tang, Shao-Tao; Li, Shuai; Aubdoollah, T H; Cao, Guo-Qing; Lei, Hai-Yan; Wang, Xin-Xing
Trans-umbilical colostomy (TUC) has been previously created in patients with Hirschsprung's disease and intermediate anorectal malformation (ARM), but not in patients with high-ARM. The purposes of this study were to assess the feasibility, safety, complications and cosmetic results of TUC in a divided fashion, and subsequently stoma closure and laparoscopic assisted anorectoplasty (LAARP) were simultaneously completed by using the colostomy site for a laparoscopic port in high-ARM patients. Twenty male patients with high-ARMs were chosen for this two-stage procedure. The first-stage consisted of creating the TUC in double-barreled fashion colostomy with a high chimney at the umbilicus, and the loop was divided at the same time, in such a way that the two diverting ends were located at the umbilical incision with the distal end half closed and slightly higher than proximal end. In the second-stage, 3 to 7 months later, the stoma was closed through a peristomal skin incision followed by end-to-end anastomosis and simultaneously LAARP was performed by placing a laparoscopic port at the umbilicus, which was previously the colonostomy site. Umbilical wound closure was performed in a semi-opened fashion to create a deep umbilicus. TUC and LAARP were successfully performed in 20 patients. Four cases with bladder neck fistulas and 16 cases with prostatic urethra fistulas were found. Postoperative complications were rectal mucosal prolapsed in three cases, anal stricture in two cases and wound dehiscence in one case. Neither umbilical ring narrowing, parastomal hernia nor obstructive symptoms was observed. Neither umbilical nor perineal wound infection was observed. Stoma care was easily carried-out by attaching stoma bag. Healing of umbilical wounds after the second-stage was excellent. Early functional stooling outcome were satisfactory. The umbilicus may be an alternative stoma site for double-barreled colostomy in high-ARM patients. The two-stage laparoscopic
Full Text Available Background. The aim of this population-based study was to describe characteristics of patients with liver cirrhosis undergoing cholecystectomy and evaluate the risk for perioperative and postoperative complications during the 30-day postoperative period. Method. All laparoscopic and open cholecystectomy procedures registered between 2006 and 2011 in the Swedish Registry for Gallstone Surgery and ERCP (GallRiks were included. Patients with liver cirrhosis were identified by linking data to the Swedish National Patient Registry (NPR. Results. Of 62,488 patients undergoing cholecystectomy, 77 (0.12% had cirrhosis, of which 29 patients (37.7% had decompensated cirrhosis. Patients with cirrhosis were older and had more often gallstone complications at the time for surgery. Postoperative complications were registered in 13 (16.9% patients with liver cirrhosis and in 5,738 (9.2% patients in the noncirrhotic group (P1 day (OR = 2.3, CI 1.11–4.84, P<0.05 than noncirrhotic patients. Conclusion. Patients with cirrhosis undergoing cholecystectomy have a higher incidence of postoperative complications than patients without cirrhosis. However, cholecystectomy is safe and if presented with adequate indication, surgery should not be delayed due to fears of surgical complications.
Full Text Available Introduction: Acute pancreatitis is often a relapsing condition, particularly when its triggering factor persists. Our goal is to determine the recurrence rate of acute biliary pancreatitis after an initial episode, and the time to relapse, as well as to identify the risk factors for recurrence. Material and method: We included all patients admitted for a first acute gallstone pancreatitis event during four years. Primary endpoints included readmission for recurrence and time to relapse. Results: We included 296 patients admitted on a total of 386 occasions. The incidence of acute biliary pancreatitis in our setting is 17.5/100,000 population/year. In all, 19.6% of pancreatitis were severe (22.6% of severe acute pancreatitis for first episodes versus 3.6% for recurring pancreatitis, with an overall mortality of 4.4%. Overall recurrence rate was 15.5%, with a median time to relapse of 82 days. In total, 14.2% of patients relapsed after an acute pancreatitis event without cholecystectomy or endoscopic retrograde cholangio-pancreatography. Severe acute pancreatitis recur in 7.2% of patients, whereas mild cases do so in 16.3%, this being the only risk factor for recurrence thus far identified. Conclusions: Patients admitted for pancreatitis should undergo cholecystectomy as soon as possible or be guaranteed priority on the waiting list. Otherwise, endoscopic retrograde cholangio-pancreatography with sphincterotomy may be an alternative to surgery for selected patients.
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.
Perini, Rafael F.; Uflacker, Renan; Cunningham, John T.; Selby, J. Bayne; Adams, David
Purpose. Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-up after treatment by a multidisciplinary approach. Methods. Twelve consecutive patients (9 women, mean age 48 years) were identified as having IRSHDI. Patients' demographics, clinical presentation, management and outcome were collected for analysis. The mean follow-up was 44 months (range 2-90 months). Results. Three patients had the LC immediately converted to open surgery without repair of the biliary injury before referral. Treatments before referral included endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage and surgery, isolated or in combination. The median interval from LC to referral was 32 days. Eleven patients presented with biliary leak and biloma, one with obstruction of an isolated right hepatic segment. Post-referral management of the biliary lesion used a combination of ERCP stenting, percutaneous drainage and stent placement and surgery. In 6 of 12 patients ERCP was the first procedure, and in only one case was IRSHDI identified. In 6 patients, percutaneous transhepatic cholangiography (PTC) was performed first and an isolated right hepatic segment was demonstrated in all. The final treatment modality was endoscopic management and/or percutaneous drainage and stenting in 6 patients, and surgery in 6. The mean follow-up was 44 months. No mortality or significant morbidity was observed. Conclusion. Successful management of IRSHDI after LC requires adequate identification of the lesion, and multidisciplinary treatment is necessary. Half of the patients can be treated successfully by nonsurgical procedures
Terhaar, O.A.; Abbas, S.; Thornton, F.J.; Duke, D.; O'Kelly, P.; Abdullah, K.; Varghese, J.C.; Lee, M.J.
AIM: To assess the role of ultrasound (US), magnetic resonance cholangiopancreatography (MRCP) and liver function tests (LFTs) in the evaluation of selected patients presenting with late post-cholecystectomy syndrome (PCS) who were referred for endoscopic retrograde cholangiopancreatography (ERCP) MATERIALS AND METHODS: In a retrospective study a final group of 42 patients with PCS referred for diagnostic ERCP underwent MRCP and abdominal US. ERCP and MRCP images were assessed for bile duct diameters and the presence of strictures and stones. A common bile duct (CBD) diameter of <10 mm was considered normal, whereas ≥10 mm was considered abnormal on US. Findings were correlated to LFTs with contingency table results performed for single techniques and combination of methods. RESULTS: In total 14 stones and one stricture were seen. US had a high negative predictive value (86.4%). MRCP had a sensitivity of 100% and specificity of 88.0%. ERCP is the most accurate test but failed in 11 patients, five of whom had a stone. The accuracy of US and LFTs increases to 93.8% if test results agree in either negative or positive outcome. CONCLUSION: US and LFTs are first-line tests in PCS. If the CBD on US is ≥10 mm, but no cause is identified, MRCP should be performed. If US and LFTs are normal then MRCP is not necessary. The availability of LFTs raises the diagnostic value of imaging
Kroh, Matthew; Chalikonda, Sricharan; Chand, Bipan; Walsh, R Matthew
Recent enthusiasm in the surgical community for less invasive surgical approaches has resulted in widespread application of single-incision techniques. This has been most commonly applied in laparoscopic cholecystectomy in general surgery. Cosmesis appears to be improved, but other advantages remain to be seen. Feasibility has been demonstrated, but there is little description in the current literature regarding complications. We report the case of a patient who previously underwent single-incision laparoscopic cholecystectomy for symptomatic gallstone disease. After a brief symptom-free interval, she developed acute pancreatitis. At evaluation, imaging results of ultrasonography and magnetic resonance cholangiopancreatography demonstrated a retained gallbladder with cholelithiasis. The patient was subsequently referred to our hospital, where she underwent further evaluation and surgical intervention. Our patient underwent 4-port laparoscopic remnant cholecystectomy with transcystic common bile duct exploration. Operative exploration demonstrated a large remnant gallbladder and a partially obstructed cystic duct with many stones. Transcystic exploration with balloon extraction resulted in duct clearance. The procedure took 75 minutes, with minimal blood loss. The patient's postoperative course was uneventful. Final pathology results demonstrated a remnant gallbladder with cholelithiasis and cholecystitis. This report is the first in the literature to describe successful laparoscopic remnant cholecystectomy and transcystic common bile duct exploration after previous single-port cholecystectomy. Although inadvertent partial cholecystectomy is not unique to this technique, single-port laparoscopic procedures may result in different and significant complications.
McGrath, D S
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.
Thapa, P B; Maharjan, D K; Tamang, T Y; Shrestha, S K
Safe dissection of Calot's Triangle is important during the performance of laparascopic cholucystectomy. The purpose of the study is to determine the frequency of demonstrable Rouviere's sulcus in patients with symptomatic gall stones and its role in safe dissection in Calot's triangle. This is a prospective descriptive study design done in Department of surgery, Kathmandu Medical College Teaching Hospital from Jan 2013 to Jan 2015. Patients who were posted for laparoscopic cholecystectomy were included. During laparoscopy, Rouviere's sulcus was noted in the operative note and classified according to following: Type I: Open type was defined as a cleft in which the right hepatic pedicle was visualized and the sulcus was opened throughout its length. Type II: if the sulcus was open only at its lateral end. Type III If the sulcus was open only at its medial end. Type IV: Fused type was defined as one in which the pedicle was not visualized. A total of 200 patients underwent laparoscopic cholecystectomy during period of 2 years. Out of which Rouviere's sulcus was visualized in 150 patients (75 %).Type I (open type) was commoner in 54%, type II in 12%, Type III in 9% and type IV (fused type) in 25%. Rouviere's Sulcus is an important extra biliary land mark for safe dissection of Calot's triangle during laparoscopic cholecystectomy. Rouviere's Sulcus, Laparoscopic cholecystectomy, Bile duct injury.
Smith, J Patrick; Samra, Navdeep S; Ballard, David H; Moss, Jonathan B; Griffen, Forrest D
Surgical site infections with elective laparoscopic cholecystectomy are less frequent and less severe, leading some to suggest that prophylactic antibiotics (PA) are no longer indicated. We compared the incidence of surgical site infections before and after an institutional practice change of withholding PA for elective laparoscopic cholecystectomy. Between May 7, 2013, and March 11, 2015, no PA were given to patients selected for elective cholecystectomy by two surgeons at a single center. The only patients excluded were those who received antibiotics before surgery for any reason. All others, including those at high risk for infection, were included. The incidence and severity of infections were compared with historical controls treated with prophylaxis by the same two surgeons from November 6, 2011, to January 13, 2013. There were 268 patients in the study group and 119 patients in the control group. Infection occurred in 3.0 per cent in the study group compared with 0.9 per cent in the controls (P = 0.29). All infections were mild except one. Based on these data, the routine use of PA for elective laparoscopic cholecystectomy is not supported.
Willingham, Field F; Brugge, William R
To review the current state of natural orifice surgery and examine the concerns, challenges, and opportunities presented by translumenal research. Translumenal endoscopic procedures have been the focus of extensive research. Researchers have reported natural orifice translumenal endoscopic surgery in a swine model in several areas involving the abdominal cavity. Diagnostic procedures have included endoscopic peritoneoscopy, liver biopsy, lymphadenectomy, and abdominal exploration. Several gynecologic procedures including tubal ligation, oophorectomy, and partial hysterectomy have been demonstrated using current commercial endoscopes. Gastrointestinal surgical procedures, including gastrojejunostomy, cholecystectomy, splenectomy, and distal pancreatectomy have been performed successfully via transgastric and/or transcolonic approaches. There have been no studies of natural orifice translumenal endoscopic surgery procedures published in humans. While fundamental questions about the emerging technology have not been scrutinized, limitations of the large animal model will pose a challenge to the development of large randomized trials. While natural orifice translumenal endoscopic surgery may represent a paradigm shift and may offer significant benefits to patients, rigorous testing of the techniques is lacking and current data have been drawn from case series.
Hernandez, Jonathan M; Morton, Connor A; Ross, Sharona; Albrink, Michael; Rosemurgy, Alexander S
Laparoendoscopic single site (LESS) surgery promises improved cosmesis and possibly less pain. However, given the small series reported to date, true estimates of the advantages and possible disadvantages of LESS surgery remain unknown. This study was undertaken to evaluate the first 100 patients undergoing LESS cholecystectomy at our institution. Patients referred for cholecystectomy since November 2007 were considered for LESS cholecystectomy. Outcomes, including blood loss, operative time, complications, and length of stay, were recorded. Outcomes are compared with an uncontrolled concurrent group of patients undergoing multi-incision laparoscopic (i.e., conventional) cholecystectomy. One hundred patients with a median age of 44 years underwent LESS cholecystectomy; 30 patients with a median age of 46 years underwent conventional cholecystectomy over the same time period. Median operative time (70 vs 66 minutes, P = 0.67, Mann-Whitney) and hospital length of stay (1 vs 1 day, P = 0.81, Mann-Whitney) were not different for patients undergoing LESS or multi-incision cholecystectomies, respectively. Five patients undergoing LESS cholecystectomy had postoperative complications: cystic duct stump leak (one), pain control issues (three), and urinary retention (one). LESS cholecystectomy is a safe and effective alternative to conventional cholecystectomy. It can be undertaken without added operative time and provides patients with minimal, if any, scarring.
Full Text Available Objectives: The most common indication for abdominal surgery in elderly (65 & older is gallstone disease.The elderly are more prone to complication of such surgery due to their other co-morbidity and thus they may benefit mostly from a safer method of surgical procedure. The purpose of this study was to evaluate the safety and outcome of laparoscopic cholecystectomy in elderly compare to the conventional method. Methods & Materials: Via prospective study from June 2005 to March 2008 included all patient older than 60 years of age who underwent cholecystectomy by open (Group A and laparoscopic (Group B method in Milad Hospital.The demographic data (sex age, American Society of Anesthesiologists’ (ASA score, postoperative mortality morbidity, length of stay and operative time were recorded for each patient and were compared between two methods. Data of patient’s analysis by SPSS with chi-square and t test. Results: The study included 311 elderlies (34% men and 66% women. Hundred fifty-seven patients underwent open cholecystectomy; 154 patients underwent laparoscopic cholecystectomy. The mean age was 7141 years. The outcome in group B (laparoscopic included: morality 0%, morbidity 2%, postoperative hospital stay 1 days, mean operation time was 40 minutes. In group A(open: mortality and morbidity rate were 21% and 12% respectively with postoperative hospital stay 331 days and similar operation time as group A. Conclusion: Laparoscopic cholecystectomy is the gold standard treatment and safe procedure in elderly patient and aging is not considered to be a contraindication laparoscopic surgery in such patients.
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.
Masud, M.; Adil, M.; Ashraf, F.; Aqil, A.
To evaluate laparoscopic cholecystectomy by a clinical practice audit at Military Hospital, Rawalpindi. Study Design: Prospective study. Place and Duration of Study: Surgical department Military Hospital from Jul 2011-Dec 2013. Material and Methods: A total of 1020 patients who underwent laparoscopic cholecystectomy for acute or chronic cholecystitis and gallstone pancreatitis were included in our study while those who had previously undergone abdominal surgeries, those with high risk for general anesthesia, immunocompromised patients, with age greater than 70 years and having comorbidities like cardiac insufficiency, severe asthma, chronic liver disease with ascites and compromised renal functions were excluded from the study. Patients demographic data, operative time, intra-operative findings, intra-operative difficulties, post-operative complications, conversion rate to open cholecystectomy and post-operative recovery time were recorded. Data was analyzed by using SPSS version 21. Results: Out of 1020 patients 907 were females while 113 were males with male to female ratio of 1:8.02. Age range was 20-70 with mean age of 50 ± 10.456 years. 44.7% patients presented with the clinical features of acute cholecystitis, 540 (52.94%) with chronic cholecystitis and 23 (2.28%) with acute pancreatitis. Mean operative time was 20 minutes in asymptomatic patients, while 40 minutes in acute cholecystitis and 35 minutes in chronic gallstone disease. Gall bladder perforation, bleeding from cystic artery and bile spillage were mostly encountered per-operative difficulties. Only 37 (3.6%) patients were converted to open cholecystectomy. Post-operative complications occur in only 122 (12%) patients. 938 (92%) patients were discharged within 48 hours. of surgery. Conclusion: Laparoscopic cholecystectomy in our setup has comparable results to the data available from other surgical facilities around the world and it has become a gold standard technique for the treatment of non
T S Chandrasekar
Full Text Available Bile duct injuries and subsequent leaks can occur following laparoscopic and open cholecystectomies and also during other hepatobiliary surgeries. Various patient related and technical factors are implicated in the causation of biliary injuries. Over a period of twenty five years managing such patients of biliary injuries our team has found a practical approach to assess the cause of biliary injuries based on the symptoms, clinical examination and imaging. Bismuth classification is helpful in most of the cases. Immediate referral to a centre experienced in the management of bile duct injury and timely intervention is associated with improved outcomes. Resuscitation, correcting dyselectrolytemia, aspiration of undrained biloma and antibiotics take the priority in the management. The goal is to restore the bile conduit, and to prevent short and longterm complications such as biliary fistula, intra-abdominal abscess, biliary stricture, recurrent cholangitis and secondary biliary cirrhosis. Endoscopic therapy by reducing the transpapillary pressure gradient helps in reducing the leak. Endoscopic therapy with biliary sphincterotomy alone or with additional placement of a biliary stent/ nasobiliary drainage is advocated. In our tertiary care referral unit, we found endoscopic interventions are useful in situations where there is leak with associated CBD calculus or a foreign body, peripheral bile duct injury, cystic duct stump leak and partial bile duct injury with leak/ narrowing of the lumen. Endotherapy is not useful in case of complete transection (total cut off and complete stricture involving common hepatic or common bile ducts. In conclusion, endoscopic treatment can be considered a highly effective therapy and should be the first-line therapy in such patients. Though less successful, an endoscopic attempt is warranted in patients suffering from central bile duct leakages failing which surgical management is recommended.
Pugliese, Raffaele; Forgione, Antonello; Sansonna, Fabio; Ferrari, Giovanni Carlo; Di Lernia, Stefano; Magistro, Carmelo
Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique that aims at reducing or abolishing skin incisions and potentially also postoperative pain. The purpose of this study was to analyse operative and long-term results of a series of hybrid transvaginal cholecystectomy. Between July 2007 and May 2009, transvaginal NOTES cholecystectomy for symptomatic cholelithiasis was performed by a hybrid technique in 18 women (mean age 54 years), including four women with a body mass index >30 kg/m(2). Dissection was conducted in the first four cases by a round-tip unipolar electrode (UE) introduced through the operative channel of the endoscope coming from the vagina and in the last 14 cases by a ultrasonic scalpel (US) introduced through a 5-mm abdominal port. The short-term outcomes and the long-term results of the two methods were compared. The transvaginal approach entailed no intraoperative complication and no conversion. The overall mean duration of procedures was 75 min (range 40-190). In the first four cases (UE), the operating time was 148 min (range 140-190), whilst in the last 14 (US), it was considerably shorter, 53 min (range 40-60, p < 0.01). We experienced one biliary leak in the UE group, whilst morbidity with US was nil (p < 0.005). The biliary leak healed in 7 days with nasobiliary drainage. No other complications were encountered in either group. The mean follow-up was 12 months (range 1-22), and none of the patients has complained of dyspareunia or other colpotomy-related complications so far. Until specifically designed endoscopic tools are available for NOTES, the hybrid technique with US dissection conducted through a 5-mm port should be preferred in transvaginal cholecystectomy in order to shorten the duration of surgery and make this approach effective, safe and reproducible. After a mean follow-up of 1 year, none of our patients has complained of any problem related to transvaginal approach.
Köksoy, F N; Bulut, T; Köse, H; Soybir, G; Yalçin, O; Aker, Y
In this prospective, clinical study, four groups, each consisting of 12 patients were established to determine how gastric emptying is influenced in cholelithiasis with accompanied flatulent dyspepsia and the relationship of symptoms and gastric emptying after cholecystectomy: group 1--healthy people; group 2--patients with dyspeptic cholelithiasis; group 3--patients with no dyspepsia after cholecystectomy; group 4--patients with dyspepsia after cholecystectomy. Groups are compared according to solid phase gastric emptying scintigraphies performed with Tc 99m sulphur colloid bound with scrambled eggs. Gastric emptying delayed in groups 2 (P 0.005). These results demonstrate that dyspepsia, in cholelithiasis and persisting after cholecystectomy, has a close relation with delay in gastric emptying.
Full Text Available We present the case of a ten-year-old female patient referred to Gastroenterolgy consultation for abdominal pain and cramping, usually worse after eating, recurring diarrhoea, hypochromic and microcytic anaemia with low serum iron and ferritin levels. Moderate to severe Crohn’s disease of the terminal ileum e right colon (L3 was diagnosed, based on endoscopic image and biopsy. The patient was treated with prednisone and azathioprine, but after one year of treatment she was steroids dependent and treatment was switched to infliximab. One year after beginning this treatment, the patient achieved remission (clinical and laboratorial parameters. A control colonoscopy showed mucosal healing with scars and deformation with stenosis of ileocecal valve (Figures 1-2. Surgical intervention will be probably necessary in near future.
Full Text Available Endoscopic ampullectomy offers a minimally invasive method of effectively treating non-invasive neoplasms of the ampulla of Vater and surrounding peri-ampullary region with high success and relative safety. These lesions would otherwise require surgical intervention, including pancreatico-duodenectomy. However, major complications may occur and a careful assessment of the patients comorbidities and their ability to tolerate adverse events needs to be factored into the treatment decision. Careful staging, often multi-modality is required, particularly for extensive lesions. Complete en-bloc excision of the entire neoplasm should be the goal with conventional papillary adenomas. Large lesions with extra-papillary extension currently require extended piecemeal excision, however with meticulous technique, recurrence is uncommon in longterm follow up.
Full Text Available Natural Orifice Transluminal Endoscopic Surgery (NOTES is an innovative approach in which a flexible endoscope enters the abdominal cavity via the transesophageal, transgastric, transcolonic, transvaginal or transvescical route, combining the technique of minimally invasive surgery with flexible endoscopy. Several groups have described different modifications by using flexible endoscopes with different levels of laparoscopic assistance. Transvaginal cholecystectomy (TVC consists in accessing the abdominal cavity through a posterior colpotomy and using the vaginal incision as a visual or operative port. An increasing interest has arisen around the TVC; nevertheless, the most common and highlighted concern is about the lack of specific instruments dedicated to the vaginal access route. TVC should be distinguished between “pure”, in which the entire operation is performed through the transvaginal route, and “hybrid”, in which the colpotomy represents only a support to introduce instruments and the operation is performed mainly by the classic transabdominal-introduced instruments. Although this new technique seems very appealing for patients, on the other hand it is very challenging for the surgeon because of the difficulties related to the mode of access, the limited technology currently available and the risk of complications related to the organ utilized for access. In this brief review all the most recent advancements in the field of TVC's techniques and instrumentations are listed and discussed.
To describe and evaluate a new cholecystectomy technique combining classical dissection with currently available mini-instrumentation (3 and 5 mm) and gallbladder removal through a short gastrotomy. After a feasibility study, we set up a protocol for this procedure using instrumentation currently available on the market. We performed 106 procedures, including 99 in a prospective study between January 2008 and July 2010. Cholecystectomy was performed with the described technique in 99 of 106 eligible patients (22 males and 77 females, mean age 45.8 years (range 18-77); median BMI 26.4 kg/m2 (range 22-36)). Forty-eight patients had at least one gallstone larger than 10 mm. There were no postoperative gastric complications and recovery was always rapid. This procedure is technically feasible, safe and reproducible. The results are good, with minimal abdominal wall trauma. Normal physical activity can be resumed rapidly with no risk of incisional hernia.
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
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
Full Text Available Laparoscopic cholecystectomy (LC has become the "gold standard" of treatment for benign gallbladder disease. This paper summarizes various surgical safety measures used in recent years, and suggests an emphasis on perioperative imaging examination, preoperative prevention of risk factors, training of surgical skills, and introduction of fast-track surgery concept, so as to avoid the incidence of complications and improve the safety of LC.
O. A. Dolina
Full Text Available The paper presents the results of a comparative study of different methods for preventing respiratory distress after laparoscopic cholecystectomy. It shows the advantages of use of noninvasive assisted ventilation that ensures excessive positive pressure in the respiratory contour, its impact on external respiratory function, arterial blood gases, oxygen transport and uptake. A scheme for the prevention of respiratory diseases applying noninvasive assisted ventilation is given.
Sindhu, M. A.; Haq, I.; Rehman, S.
Objectives: To evaluate the results of 160 consecutive laparoscopic cholecystectomy using sectorisation based port site selection to improve ergonomics for surgeons. Design: Descriptive study. Place and Duration of study: PNS Shifa Karachi, Pakistan from Feb 2011 to Feb 2012. Patients and Methods: In this prospective study, 160 consecutive patients had undergone laparoscopic cholecystectomy in a tertiary care hospital using sectorisation for trocar placement. All patients with symptomatic gallstones, acute calculous cholecystitis and empyema gallbladder were included. Patients with choledocholithiasis were excluded from the study. The collected data included age, sex, diagnosis, history of previous surgery, conversion to open surgery and its reasons, operative time, post-operative hospital stay, complications and laparoscopy related complications to the surgeon such as shoulder pain, wrist stress and pain, finger joint pain and stress exhaustion. Result: One hundred and sixty patients underwent laparoscopic cholecystectomy with mean age 45 +- 12.9 years. Female to male ratio was 7.8:1. A total of 110 patients had chronic cholecystitis / biliary colic, 34 patients were with acute cholecystitis and 16 patients had diagnosis of empyema gallbladder. The mean operative time was 35.3+-14.6 min. Conversion rate to open surgery was 1.2%. Complications included bleeding from cystic artery (n=1) and injury to common hepatic duct (CHD) (n=1). One patient developed port site hernia post operatively. There was no incidence of laparoscopy related complications in surgeon such as pain shoulder, strains on the wrist joint, stress exhaustion and hand-finger joint pain. Conclusion: Sectorisation technique can be used in laparoscopic cholecystectomy in order to avoid the physical constraints of laparoscopic shoulder, hand finger joint pain, tenosynovitis, stress exhaustion, and hand muscle injury without increasing any morbidity to the patients. (author)
Conrad, Claudius; Wakabayashi, Go; Asbun, Horacio J; Dallemagne, Bernard; Demartines, Nicolas; Diana, Michele; Fuks, David; Giménez, Mariano Eduardo; Goumard, Claire; Kaneko, Hironori; Memeo, Riccardo; Resende, Alexandre; Scatton, Olivier; Schneck, Anne-Sophie; Soubrane, Olivier; Tanabe, Minoru; van den Bos, Jacqueline; Weiss, Helmut; Yamamoto, Masakazu; Marescaux, Jacques; Pessaux, Patrick
An expert recommendation conference was conducted to identify factors associated with adverse events during laparoscopic cholecystectomy (LC) with the goal of deriving expert recommendations for the reduction of biliary and vascular injury. Nineteen hepato-pancreato-biliary (HPB) surgeons from high-volume surgery centers in six countries comprised the Research Institute Against Cancer of the Digestive System (IRCAD) Recommendations Group. Systematic search of PubMed, Cochrane, and Embase was conducted. Using nominal group technique, structured group meetings were held to identify key items for safer LC. Consensus was achieved when 80% of respondents ranked an item as 1 or 2 (Likert scale 1-4). Seventy-one IRCAD HPB course participants assessed the expert recommendations which were compared to responses of 37 general surgery course participants. The IRCAD recommendations were structured in seven statements. The key topics included exposure of the operative field, appropriate use of energy device and establishment of the critical view of safety (CVS), systematic preoperative imaging, cholangiogram and alternative techniques, role of partial and dome-down (fundus-first) cholecystectomy. Highest consensus was achieved on the importance of the CVS as well as dome-down technique and partial cholecystectomy as alternative techniques. The put forward IRCAD recommendations may help to promote safe surgical practice of LC and initiate specific training to avoid adverse events. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Siewert, J R; Ungeheuer, A; Feussner, H
Laparoscopic cholecystectomy is both resulting in a slightly higher incidence of biliary lesions and a change of prevalence of the type of lesions. Damage to the biliary system occurs in 4 different types: The most severe case is the lesion with a structural defect of the hepatic or common bile duct with (IVa) or without (IVb) vascular injury. Tangential lesions without structural loss of the duct should be denominated as type III (IIIa with additional lesion to the vessels, type IIIb without). Type II comprehends late strictures without obvious intraoperative trauma to the duct. Type I includes immediate biliary fistulae of usually good prognosis. The increasing prevalence of structural defects of the bile ducts appears to be a peculiarity of laparoscopic cholecystectomy necessitating highly demanding operative repair. In the majority of cases, hepatico-jejunostomy or even intraparenchymatous anastomoses are required. Adaptation of well proven principles of open surgery is the best prevention of biliary lesions in laparoscopic cholecystectomy as well as the readiness to convert early to the open procedure.
Full Text Available Background: Supra-Transumbilical Laparotomy (STL has been used in paediatric surgery for a broad spectrum of abdominal procedures. We report our experience with STL approach for small bowel atresia repair in newborns and review previous published series on the topic. Patients and Methods: Fourteen patients with small bowel atresia were treated via STL approach at our Institution over a 5-year period and their charts were retrospectively reviewed. Results: STL procedure was performed at mean age of 3.1 day. No malrotation disorders were detected with pre-operative contrast enema. Eight patients (54.1% presented jejunal atresia, five (35.7% ileal atresia, and one (7.1% multiple ileal and jejunal atresias. Standard repair with primary end-to-back anastomosis was performed in all but one patient. In the newborn with multiple atresia, STL incision was converted in supra-umbilical transverse incision due to difficulty of exposition. After surgery, one patient developed anastomotic stricture, and another developed occlusion due to adhesions: Both infants required second laparotomy. No infections of the umbilical site were recorded, and cosmetic results were excellent in all patients. Conclusions: Increasing evidence suggests that STL approach for small bowel atresia is feasible, safe and provides adequate exposure for small bowel atresia surgery. When malrotation and colonic/multiple atresia are pre-operatively ruled out, STL procedure can be choosen as first approach.
Kwon, A-Hon; Uetsuji, Shoji; Boku, Tsunehide; Yamada, Osamu; Inoue, Tomohisa; Kamiyama, Yasuo
We investigated 58 cases of cholecystolithiasis including 8 cases of choledocholithiasis treated with laparoscopic cholecystectomy. All patients received spiral CT scanning with drip infusion cholangiography (DIC-SCT), and 16 patients received endoscopic retrograde cholangiography (ERC), and the detection rates of the gallbladder, the bile duct and the cystic duct were compared. The gallbladder could be seen in 86.2% of cases with DIC-SCT and in 63.8% of cases with conventional DIC. The junction between the cystic duct and the common bile duct could be seen in 18 of 58 cases with DIC and in 49 of 58 cases with DIC-SCT. The DIC-SCT showed significantly superior anatomical datails compared with images with conventional DIC. A comparison of DIC, ERC and DIC-SCT revealed that the junction between the cystic duct and the common bile duct could be identified in 14 of 16 cases undergoing ERC, in 13 of 16 cases receiving DIC-SCT and in 4 of 16 cases receiving DIC. Significant differences were noted among DIC-SCT, ERC and conventional DIC. We concluded that DIC-SCT is easy, non-invasive and useful for the preoperative assessment of laparoscopic cholecystectomy and also helpful for avoiding damage to the bile duct. (author)
Moshonov, Joshua; Michaeli, Eli; Nahlieli, Oded
To describe an innovative endoscopic technique for root canal treatment. Root canal treatment was performed on 12 patients (15 teeth), using a newly developed endoscope (Sialotechnology), which combines an endoscope, irrigation, and a surgical microinstrument channel. Endoscopic root canal treatment of all 15 teeth was successful with complete resolution of all symptoms (6-month follow-up). The novel endoscope used in this study accurately identified all microstructures and simplified root canal treatment. The endoscope may be considered for use not only for preoperative observation and diagnosis but also for active endodontic treatment.
Full Text Available We describe a 66-year-old Caucasian man with type 1 Mirizzi syndrome diagnosed on endoscopic ultrasound. He presented with acute onset of jaundice, malaise, dark urine over 3-4 days, and was found to have obstructive jaundice on lab testing. CT scan of the abdomen showed intrahepatic biliary ductal dilation, a 1.5 cm common bile duct (CBD above the pancreas, and possible stones in the CBD, but no masses. Endoscopic retrograde cholangiopancreatography (ERCP by a community gastroenterologist failed to cannulate the CBD. At the University Center, type 1 Mirizzi syndrome was noted on endoscopic ultrasound with narrowing of the CBD with extrinsic compression from cystic duct stone. During repeat ERCP, the CBD could be cannulated over the pancreatic duct wire. A mid CBD narrowing, distal CBD stones, proximal CBD and extrahepatic duct dilation were noted, and biliary sphincterotomy was performed. A small stone in the distal CBD was removed with an extraction balloon. The cystic duct stone was moved with the biliary balloon into the CBD, mechanical basket lithotripsy was performed and stone fragments were delivered out with an extraction balloon. The patient was seen 7 weeks later in the clinic. Skin and scleral icterus had cleared up and he is scheduled for an elective cholecystectomy. Mirizzi syndrome refers to biliary obstruction resulting from impacted stone in the cystic duct or neck of the gallbladder and commonly presents with obstructive jaundice. Type 1 does not have cholecystocholedochal fistulas, but they present in types 2, 3 and 4. Surgery is the mainstay of therapy. Endoscopic treatment is effective and can also be used as a temporizing measure or definitive treatment in poor surgical risk candidates.
Kayaalp, Cuneyt; Tardu, Ali; Yagci, Mehmet Ali; Sumer, Fatih
The length of incisions on the abdominal wall directly correlates with wound-related morbidities and patient comfort. Both mini-laparoscopy (only ≤5-mm trocars) and natural orifice specimen extraction avoid larger abdominal incisions. This study described a new natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) cholecystectomy technique by combination of these two advanced laparoscopic techniques for cholelithiasis in patients who had prior laparoscopic Roux-en-Y gastric bypass (LRYGB) for obesity. Three patients (two males, one female; 39, 62, and 34 years old, respectively) were admitted with symptomatic cholelithiasis (multiple millimeter-sized gallstones), and all had previously had LRYGB. They were treated by mini-laparoscopic cholecystectomy using three 5-mm trocars. The gallbladder was removed through the dilated efferent limb of the jejunum, 5 cm distal from the gastrojejunostomy. Transjejunal extraction was performed under endoscopic guidance. The gallbladder in the jejenum was passed through the anastomosis and extracted with an endoscopic snare by the transoral way. The enterotomy was closed intracorporeally. There was no conversion or additional trocar requirement. All the procedures were completed successfully without problems. Respective operating times were 95, 75, and 120 minutes. Only 1 patient required postoperative analgesic; the others did not. The patients started to get a liquid diet on the night of surgery and were discharged on Days 1, 1, and 2, respectively, with normal diet recommendations. There were no morbidities. Mini-laparoscopic cholecystectomy is technically feasible in patients with previous LRYGB. Prior LRYGB was not an obstacle for transoral specimen extraction. The dilated efferent jejunal limb is a good alternative route for natural orifice specimen extraction. This
... 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. Keywords: Day case, laparoscopic cholecystectomy, ...
Harboe, Kirstine M; Bardram, Linda
To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones.......To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones....
Rothman, Josephine Philip; Burcharth, Jakob; Pommergaard, Hans-Christian
to weekdays. METHODS: The population originated from the Danish Cholecystectomy Database. It consists of adult patients, who had a cholecystectomy performed by standard four-port laparoscopic or open surgery. Adjusted analyses were used to study if day of the week had an influence on conversion, readmission...
Cheung, Cherry X
Chylous ascites a rare complication post cholecystectomy. There are to our knowledge only 3 reported cases in the literature. We describe a case of chylous ascites post open cholecystectomy in a patient with recent severe pancreatitis. We propose a potential relationship between acute biliary pancreatitis and the development of chylous ascites.
Langballe, Karen Oline; Bardram, Linda
into the secure Web site by the surgeon immediately after the operation. In the present analysis, we have included children ≤ 15 years from the five year period January 1, 2006, to December 31, 2010. RESULTS: In the study period 35,444 patients were operated with a cholecystectomy. Of these, 196 (0.5%) were ≤ 15......BACKGROUND: An increase in the frequency of cholecystectomy in children has been described during the last decades. Part of the reason is that more cholecystectomies in children are performed for dyskinesia of the gallbladder and not only for gallstone disease. We conducted the first nationwide...... study to describe outcome of cholecystectomies performed in children in Denmark by using data from the national Danish Cholecystectomy Database (DCD). METHODS: In the DCD, two data sources were combined: administrative data from the National Patient Registry (NPR) and clinical data entered...
Mumtaz KH Al-Naser
Full Text Available Background: Port site infection (PSI is an infrequent surgical site infection that complicates laparoscopic surgery but has a considerable influence in the overall outcome of laparoscopic cholecystectomy. The aim of this study was to evaluate factors that influence PSI after laparoscopic cholecystectomies and to analyze which of these factors can be modified to avoid PSI in a trail to achieve maximum laparoscopic advantages. Methods: A prospective descriptive qualitative study conducted on patients who underwent laparoscopic cholecystectomies. Swabs were taken for culture & sensitivity in all patients who developed PSI. Exploration under general anaesthesia, for patients, had deep surgical site infections and wound debridement was done, excisional biopsies had been taken for histopathological studies, and tissue samples for polymerase chain reaction for detection of mycobacterium tuberculosis was done. All patients were followed up for six months postoperatively. Factors as gender, site of infected port, type of microorganism, acute versus chronic cholecystitis, type of infection (superficial or deep infection and intraoperative spillage of stones, bile or pus were analyzed in our sample. Results: Port site infection rate was recorded in 40/889 procedures (4.5%, higher rates were observed in male patients 8/89 (8.9%, in acute cholecystitis 13/125 (10.4%, when spillage of bile, stones or pus occurred 24/80 (30%, and at epigastric port 32/40 (80%. Most of the PSI were superficial infections 77.5% with non-specific microorganism 34/40 (85%. Conclusion: There is a significant association of port site infection with spillage of bile, stones, or pus, with the port of gallbladder extraction and with acute cholecystitis. Especial consideration should be taken in chronic deep surgical site infection as mycobacterium tuberculosis could be the cause. Most of the PSIs are superficial and more common in males.
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
Herrera-Ramírez, María de Los Angeles; López-Acevedo, Hugo; Gómez-Peña, Gustavo Adolfo; Mata-Quintero, Carlos Javier
Concomitant cholelithiasis and choledocholithiasis is a disease where incidence increases with age and can have serious complications such as pancreatitis, cholangitis and liver abscesses, but its management is controversial, because there are minimally invasive laparoscopic and endoscopic surgical procedures. To compare the efficiency in the management of cholelithiasis and choledocholithiasis with laparoscopic cholecystectomy with common bile duct exploration vs cholangiopancreatography endoscopic retrograde+laparoscopic cholecystectomy. Retrospective analysis of a five year observational, cross sectional multicenter study of patients with cholelithiasis and concomitant high risk of choledocholithiasis who were divided into two groups and the efficiency of both procedures was compared. Group 1 underwent laparoscopic cholecystectomy with common bile duct exploration and group 2 underwent cholangiopancreatography endoscopic retrograde+laparoscopic cholecystectomy. 40 patients, 20 were included in each group, we found p=0.10 in terms of operating time; when we compared hospital days we found p=0.63; the success of stone extraction by study group we obtained was p=0.15; the complications presented by group was p=0.1 and the number of hospitalizations by group was p ≤ 0.05 demonstrating statistical significance. Both approaches have the same efficiency in the management of cholelithiasis and choledocholithiasis in terms of operating time, success in extracting stone, days of hospitalization, postoperative complications and conversion to open surgery. However the laparoscopic approach is favourable because it reduces the number of surgical anaesthetic events and the number of hospital admissions. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.
Pickuth, D; Leutloff, U
Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments; however, it is controversial. We have developed a new diagnostic strategy for the detection of bile duct stones. The concept is based on an ultrasound examination and on screening for the presence of six risk indicators of choledocholithiasis. A total of 120 patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of these six risk indicators: history of jaundice, history of pancreatitis, hyperbilirubinemia, hyperamylasemia, dilated bile duct, and unclear ultrasound findings. The sensitivity of ultrasound and intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. Twenty percent of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (P concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that routine use of intraoperative cholangiography is not necessary.
Song, Chul Gyu; Lee, Young Mook; Lee, Sang Min; Kim, Won Ky; Lee, Jae Ho; Lee, Myoung Ho
Endoscopy has become a crucial diagnostic and therapeutic procedure in clinical areas. Over the past four years, we have developed a computerized system to record and store clinical data pertaining to endoscopic surgery of laparascopic cholecystectomy, pelviscopic endometriosis, and surgical arthroscopy. In this study, we developed a computer system, which is composed of a frame grabber, a sound board, a VCR control board, a LAN card and EDMS. Also, computer system controls peripheral instruments such as a color video printer, a video cassette recorder, and endoscopic input/output signals. Digital endoscopic data management system is based on open architecture and a set of widely available industry standards; namely Microsoft Windows as an operating system, TCP/IP as a network protocol and a time sequential database that handles both images and speech. For the purpose of data storage, we used MOD and CD- R. Digital endoscopic system was designed to be able to store, recreate, change, and compress signals and medical images. Computerized endoscopy enables us to generate and manipulate the original visual document, making it accessible to a virtually unlimited number of physicians.
Planells Roig, Manuel; Arnal Bertomeu, Consuelo; Garcia Espinosa, Rafael; Cervera Delgado, Maria; Carrau Giner, Miguel
Difference analysis of ambulatorization rate, pain, analgesic requirements and daily activities recovery in patients undergoing laparoscopic cholecystectomy with standard multiport access (CLMP) versus a minilaparoscopic, 3mm size, technique. Prospective randomized trial of 40 consecutive patients undergoing laparoscopic cholecystectomy. Comparison criteria included predictive ultrasound factors of difficult cholecystectomy, previous history of complicated biliary disease and demographics. Results are analyzed in terms of ambulatorization rate, pain, analgesic requirements, postoperative recovery, technical difficulty, hemorrhage intensity, overnight stay, readmission rate and total or partial conversion. Both procedures were similar in surgery time, technical score and hemorrhage score. MLC was associated with similar ambulatorization rate, 85%, and over-night stay 15%, with only 15% partial conversion rate. MLC showed less postoperative pain (P=.026), less analgesic consumption (P=.006) and similar DAR (P=.879). MLC is similar to CLMP in terms of ambulatorization with less postoperative pain and analgesic requirements without differences in postoperative recovery. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
Sayar, Suleyman; Olmez, Sehmus; Avcioglu, Ufuk; Tenlik, Ilyas; Saritas, Bunyamin; Ozdil, Kamil; Altiparmak, Emin; Ozaslan, Ersan
Bile leakage, while rare, can be a complication seen after cholecystectomy. It may also occur after hepatic or biliary surgical procedures. Etiology may be underlying pathology or surgical complication. Endoscopic retrograde cholangiopancreatography (ERCP) can play major role in diagnosis and treatment of bile leakage. Present study was a retrospective analysis of outcomes of ERCP procedure in patients with bile leakage. Patients who underwent ERCP for bile leakage after surgery between 2008 and 2012 were included in the study. Etiology, clinical and radiological characteristics, and endoscopic treatment outcomes were recorded and analyzed. Total of 31 patients (10 male, 21 female) were included in the study. ERCP was performed for bile leakage after cholecystectomy in 20 patients, after hydatid cyst operation in 10 patients, and after hepatic resection in 1 patient. Clinical signs and symptoms of bile leakage included abdominal pain, bile drainage from percutaneous drain, peritonitis, jaundice, and bilioma. Twelve (60%) patients were treated with endoscopic sphincterotomy (ES) and nasobiliary drainage (NBD) catheter, 7 patients (35%) were treated with ES and biliary stent (BS), and 1 patient (5%) was treated with ES alone. Treatment efficiency was 100% in bile leakage cases after cholecystectomy. Ten (32%) cases of hydatid cyst surgery had subsequent cystobiliary fistula. Of these patients, 7 were treated with ES and NBD, 2 were treated with ES and BS, and 1 patient (8%) with ES alone. Treatment was successful in 90% of these cases. ERCP is an effective method to diagnose and treat bile leakage. Endoscopic treatment of postoperative bile leakage should be individualized based on etiological and other factors, such as accompanying fistula.
Köksoy, F N; Bulut, T; Köse, H; Soybir, G; Yalçin, O; Aker, Y
In this clinical study, four groups, each consisting of 12 patients are established to determine how gastric emptying is influenced in cholelithiasis with accompanied flatulent dyspepsia and the relationship of symptoms and gastric emptying after cholecystectomy. 1. group: healthy people, 2. group: patients with dyspeptic cholelithiasis, 3. group: patients who have no dyspepsia after cholecystectomy, 4. group: patients whose dyspepsia is continued after cholecystectomy. Groups are compared according to solid phase gastric emptying scintigraphies performed with Tc 99m sulfur colloid bound with scrambled eggs. Gastric emptying delayed in second (p 0.005). These results demonstrate that dyspepsia, in cholelithiasis and persisting after cholecystectomy have a close relation with delay in gastric emptying.
McCormack, T. T.; Abel, P. D.; Collins, C. D.
A prospective trial to assess the effect of suction in an abdominal drain following cholecystectomy was carried out. Three types of closed drainage system were compared: a simple tube drain, a low negative pressure drain, and a high negative pressure drain: 120 consecutive patients undergoing cholecystectomy were randomly allocated to one of the three drainage groups. There was no significant difference in postoperative pyrexia, wound infection, chest infection, or hospital stay. This study f...
Pimentel-Nunes, Pedro; Dinis-Ribeiro, Mário; Ponchon, Thierry
evidence). 2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may...... RECOMMENDATIONS: 1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when...
Pandya, Seema R; Paranjape, Saloni
An increasing number of cardiac transplants are being carried out around the world. With increasing longevity, these patients present a unique challenge to non-transplant anesthesiologists for a variety of transplant related or incidental surgeries. The general considerations related to a cardiac transplant recipient are the physiological and pharmacological problems of allograft denervation, the side-effects of immunosuppression, the risk of infection and the potential for rejection. A thorough understanding of the physiology of a denervated heart, need for direct vasoactive agents and post-transplant morbidities is essential in anesthetic management of such a patient. Here, we describe a case of a heart transplant recipient who presented for a cholecystectomy at our center.
Carraro, Amedeo; Mazloum, Dania El; Bihl, Florian
Gallbladder diseases are very common in developed countries. Complicated gallstone disease represents the most frequent of biliary disorders for which surgery is regularly advocated. As regards, cholecystectomy represents a common abdominal surgical intervention; it can be performed as either an elective intervention or emergency surgery, in the case of gangrene, perforation, peritonitis or sepsis. Nowadays, the laparoscopic approach is preferred over open laparotomy. Globally, numerous cholecystectomies are performed daily; however, little evidence exists regarding assessment of post-surgical quality of life (QOL) following these interventions. To assess post-cholecystectomy QOL, in fact, documentation of high quality care has been subject to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years. However, there has been little research published regarding QOL outcomes following cholecystectomy; in addition, much of the current literature lacks systematic data on patient-centered outcomes. Then, although several tools have been used to measure QOL after cholecystectomy, difficulty remains in selecting meaningful parameters in order to obtain reproducible data to reflect postoperative QOL. The aim of this study was to review the impact of surgery for gallbladder diseases on QOL. This review includes Medline searches of current literature on QOL following cholecystectomy. Most studies demonstrated that symptomatic patients profited more from surgery than patients receiving an elective intervention. Thus, the gain in QOL depends on the general conditions before surgery, and patients without symptoms profit less or may even have a reduction in QOL.
Schwartz, Diane A; Shah, Adil A; Zogg, Cheryl K; Nicholas, Lauren H; Velopulos, Catherine G; Efron, David T; Schneider, Eric B; Haider, Adil H
Health care providers are increasingly focused on cost containment. One potential target for cost containment is in-hospital management of acute cholecystitis. Ensuring cholecystectomy within 24 hours for cholecystitis could mitigate costs associated with longer hospitalizations. We sought to determine the cost consequences of delaying operative management. The Nationwide Inpatient Sample (2003-2011) was queried for adult patients (≥16 years) who underwent laparoscopic cholecystectomy for a primary diagnosis of acute cholecystitis. Patients who underwent open procedures or endoscopic retrograde cholangiopancreatography were excluded. Generalized linear models (GLMs) were used to analyze costs for each day's delay in surgery. Multivariable analyses adjusted for patient demographics, hospital descriptors, Charlson comorbidity index, mortality, and length of stay. We analyzed 191,032 records. Approximately 65% of the patients underwent surgery within 24 hours of admission. The average cost of care for surgery on the admission day was $11,087. Costs disproportionately increased by 22% on the second hospital day ($13,526), by 37% on the third day ($15,243), by 52% on the fourth day ($16,822), by 64% on the fifth day ($18,196), by 81% on the sixth day ($20,125), and by 100% on the seventh day ($22,250) when compared with the cost of care for procedures performed within 24 hours of admission. Subset analysis of patients discharged 24 hours or earlier from the time of surgery demonstrated similar trends. After controlling for patient- and hospital-related factors, we noted significant costs associated with each day's delay in operative management. Cost containment practices for acute cholecystitis justify consideration of same-day or next-day surgery where the diagnosis is straightforward. Economic and value-based analysis, level III.
Ferreira, Rosa; Loureiro, Rui; Nunes, Nuno; Santos, António Alberto; Maio, Rui; Cravo, Marília; Duarte, Maria Antónia
Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cholangitis and to chronic pancreatitis. Endoscopic treatment of benign biliary strictures is widely used as first line therapy, since it is effective, safe, noninvasive and repeatable. Endoscopic techniques currently used are dilation, multiple plastic stents insertion and fully covered self-expandable metal stents. The main indication for dilation alone is primary sclerosing cholangitis related strictures. In the vast majority of the remaining cases, temporary placement of multiple plastic stents with/without dilation is considered the treatment of choice. Although this approach is effective, it requires multiple endoscopic sessions due to the short duration of stent patency. Fully covered self-expandable metal stents appear as a good alternative to plastic stents, since they have an increased radial diameter, longer stent patency, easier insertion technique and similar efficacy. Recent advances in endoscopic technique and various devices have allowed successful treatment in most cases. The development of novel endoscopic techniques and devices is still ongoing. PMID:26962404
Costa, D.W. da; Bouwense, S.A.; Schepers, N.J.; Besselink, M.G.; Santvoort, H.C. van; Brunschot, S. van; Bakker, O.J.; Bollen, T.L.; Dejong, C.H.; Goor, H. van; Boermeester, M.A.; Bruno, M.J.; Eijck, C.H. van; Timmer, R.; Weusten, B.L.; Consten, E.C.; Brink, M.A.; Spanier, B.W.; Bilgen, E.J.; Nieuwenhuijs, V.B.; Hofker, H.S.; Rosman, C.; Voorburg, A.M.; Bosscha, K.; Duijvendijk, P. van; Gerritsen, J.J.; Heisterkamp, J.; Hingh, I.H. de; Witteman, B.J.; Kruyt, P.M.; Scheepers, J.J.; Molenaar, I.Q.; Schaapherder, A.F.; Manusama, E.R.; Waaij, L.A. van der; Unen, J. van; Dijkgraaf, M.G.; Ramshorst, B. van; Gooszen, H.G.; Boerma, D.
BACKGROUND: In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission
da Costa, David W.; Bouwense, Stefan A.; Schepers, Nicolien J.; Besselink, Marc G.; van Santvoort, Hjalmar C.; van Brunschot, Sandra; Bakker, Olaf J.; Bollen, Thomas L.; Dejong, Cornelis H.; van Goor, Harry; Boermeester, Marja A.; Bruno, Marco J.; van Eijck, Casper H.; Timmer, Robin; Weusten, Bas L.; Consten, Esther C.; Brink, Menno A.; Spanier, B. W. Marcel; Bilgen, Ernst Jan Spillenaar; Nieuwenhuijs, Vincent B.; Hofker, H. Sijbrand; Rosman, Camiel; Voorburg, Annet M.; Bosscha, Koop; van Duijvendijk, Peter; Gerritsen, Jos J.; Heisterkamp, Joos; de Hingh, Ignace H.; Witteman, Ben J.; Kruyt, Philip M.; Scheepers, Joris J.; Molenaar, I. Quintus; Schaapherder, Alexander F.; Manusama, Eric R.; van der Waaij, Laurens A.; van Unen, Jacco; Dijkgraaf, Marcel G.; van Ramshorst, Bert; Gooszen, Hein G.; Boerma, Djamila
Background In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission
Da Costa, David W.; Bouwense, Stefan A.; Schepers, Nicolien J.; Besselink, Marc G.; van Santvoort, Hjalmar C.; Van Brunschot, Sandra; Bakker, Olaf J.; Bollen, Thomas L.; Dejong, Cornelis H.; Van Goor, Harry; Boermeester, Marja A.; Bruno, Marco J.; Van Eijck, Casper H.; Timmer, Robin; Weusten, Bas L.; Consten, Esther C.; Brink, Menno A.; Spanier, B. W Marcel; Bilgen, Ernst Jan Spillenaar; Nieuwenhuijs, Vincent B.; Hofker, H. Sijbrand; Rosman, Camiel; Voorburg, Annet M.; Bosscha, Koop; Van Duijvendijk, Peter; Gerritsen, Jos J.; Heisterkamp, Joos; De Hingh, Ignace H.; Witteman, Ben J.; Kruyt, Philip M.; Scheepers, Joris J.; Molenaar, I. Quintus; Schaapherder, Alexander F.; Manusama, Eric R.; Van Der Waaij, Laurens A.; Van Unen, Jacco; Dijkgraaf, Marcel G.; Van Ramshorst, Bert; Gooszen, Hein G.; Boerma, Djamila
Background In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission
Sampath, Kartik; Dinani, Amreen M; Rothstein, Richard I
The obesity epidemic, recognized by the World Health Organization in 1997, refers to the rising incidence of obesity worldwide. Lifestyle modification and pharmacotherapy are often ineffective long-term solutions; bariatric surgery remains the gold standard for long-term obesity weight loss. Despite the reported benefits, it has been estimated that only 1% of obese patients will undergo surgery. Endoscopic treatment for obesity represents a potential cost-effective, accessible, minimally invasive procedure that can function as a bridge or alternative intervention to bariatric surgery. We review the current endoscopic bariatric devices including space occupying devices, endoscopic gastroplasty, aspiration technology, post-bariatric surgery endoscopic revision, and obesity-related NOTES procedures. Given the diverse devices already FDA approved and in development, we discuss the future directions of endoscopic therapies for obesity.
Full Text Available Purpose: The purpose of this study is to determine whether singleport laparoscopic repair (SLR for incarcerated inguinal hernia in children is superior toconventional repair (CR approaches. Method: Between March 2013 and September 2013, 126 infants and children treatedwere retrospectively reviewed. All the patients were divided into three groups. Group A (48 patients underwent trans-umbilical SLR, group B (36 patients was subjected to trans-umbilical conventional two-port laparoscopic repair (TLR while the conventional open surgery repair (COR was performed in group C (42 patients. Data regarding the operating time, bleeding volume, post-operative hydrocele formation, testicular atrophy, cosmetic results, recurrence rate, and duration of hospital stay of the patients were collected. Result: All the cases were completed successfully without conversion. The mean operative time for group A was 15 ± 3.9 min and 24 ± 7.2 min for unilateral hernia and bilateral hernia respectively, whereas for group B, it was 13 ± 6.7 min and 23 ± 9.2 min. The mean duration of surgery in group C was 35 ± 5.2 min for unilateral hernia. The recurrence rate was 0% in all the three groups. There were statistically significant differences in theoperating time, bleeding volume, post-operative hydrocele formation, cosmetic results and duration hospital stay between the three groups (P < 0.001. No statistically significant differences between SLR and TLR were observed except the more cosmetic result in SLR. Conclusion: SLR is safe and effective, minimally invasive, and is a new technology worth promoting.
Jun, Zhang; Juntao, Ge; Shuli, Liu; Li, Long
The purpose of this study is to determine whether singleport laparoscopic repair (SLR) for incarcerated inguinal hernia in children is superior toconventional repair (CR) approaches. Between March 2013 and September 2013, 126 infants and children treatedwere retrospectively reviewed. All the patients were divided into three groups. Group A (48 patients) underwent trans-umbilical SLR, group B (36 patients) was subjected to trans-umbilical conventional two-port laparoscopic repair (TLR) while the conventional open surgery repair (COR) was performed in group C (42 patients). Data regarding the operating time, bleeding volume, post-operative hydrocele formation, testicular atrophy, cosmetic results, recurrence rate, and duration of hospital stay of the patients were collected. All the cases were completed successfully without conversion. The mean operative time for group A was 15 ± 3.9 min and 24 ± 7.2 min for unilateral hernia and bilateral hernia respectively, whereas for group B, it was 13 ± 6.7 min and 23 ± 9.2 min. The mean duration of surgery in group C was 35 ± 5.2 min for unilateral hernia. The recurrence rate was 0% in all the three groups. There were statistically significant differences in theoperating time, bleeding volume, post-operative hydrocele formation, cosmetic results and duration hospital stay between the three groups (P < 0.001). No statistically significant differences between SLR and TLR were observed except the more cosmetic result in SLR. SLR is safe and effective, minimally invasive, and is a new technology worth promoting.
Full Text Available We remind you of some technical artifices required in order to resolve difficult cases, such as: antegrade laparoscopic cholecystectomy (LC, subtotal laparoscopic cholecystectomy (SLC and the “stairs” clipping of the cystic duct. Also we acknowledge the closing of the cystic duct. We analyzed the medical records of 15251 laparoscopic cholecystectomies performed during 1994-2015, with emphasis on: surgical technique, conversion rate, hemorrhage, postoperative bile leaking, iatrogenic MBD injuries and mortality. We divided the cases in 5 study groups, group 1 (1994- 2004 N= 5138, group 2 (2005-2015 N= 10113, group 3 (fundus first cholecystectomies, N=2348, group 4 (retrograde cholecystectomies, N=12889 and group 5 (subtotal laparoscopic cholecystectomy-SLC, N=14 which we compared regarding the main parameters. We prefer to perform a “step by step” clipping each time the length of the clip does not cover all the circumference of the cystic duct. This artifices, is a simple laparoscopic gesture easy to perform and has the advantage of avoiding a large excessive and risky laparoscopic dissection in the vicinity of the main biliary duct. More seldom we appeal to the suture of the cystic stump using the intracorporeal knots or a simple stump ligation with an extracorporeal preformed not. We did not encounter any late or early complications following the implementation of this technical laparoscopic artifice. Laborious laparoscopic cholecystectomies performed by a well-trained surgical team ensure the premises of a good performance even while adopting laparoscopic ingenious and difficile gestures that also respect the intraoperatory rules and principals.
Cecin, Alexandre de Oliveira; Goldman, Suzan Menasce; Caetano, Simone; Rosas, George de Queiroz; Coelho, Rafael Darahem de Souza; Lobo, Edson Jose; Abdalla, Nitamar; Szejnfeld, Jacob
Objective: to determine the usefulness of magnetic resonance cholangiopancreatography (MRCP) in the diagnoses of bile duct injuries following cholecystectomy. Material and method: MRCP was retrospectively evaluated in 40 patients with suspected bile duct injury after laparoscopic or conventional cholecystectomy. Eight of these patients had been submitted to biliary reconstruction. All patients were symptomatic (jaundice, fever and chills, weight loss and abdominal pain). The scans were independently reviewed by two radiologists. The results were confirmed by surgery, percutaneous drainage, endoscopic retrograde cholangiopancreatography and clinical follow-up. The level and severity of bile duct injury were rated according to the Bismuth classification. Results: in a total of 40 symptomatic patients, 10 (25%) had normal findings on MRCP; Postoperative complications were seen in 29 (72.5%) patients, seven of them with more than one finding. Pancreatic head neoplasia was diagnoses in one patient. The most frequent finding was sclerosing (41.4%) followed by biliary duct stenosis (34.5%), residual or recurrent biliary stones (31.0%) and fluid collections (17.2%). The images obtained by MRCP were considered of good quality. Conclusion: MRCP is an effective method for the evaluation of patients with suspected postcholecystectomy biliary tract complications. (author)
Khan, Iftikhar A.; El-Tinay, Omer E.
To determine if preoperative clinical, laboratory and radiology data can predict conversion of laparascopic cholecystectomy for acute cholecystitis to open procedure. Retrospective analysis of 44 laparascopic cholecystectomies were performed for acute cholecystitisbetween August 2000 and July 2002 at King Khalid University Hospital, Riyadh, kingdom of Saudi Arabia. Data related to age and sex of patients, maximum body temprature,white blood cell count, gallbladder wall thickness or ultrasonography and timing of surgery from onset of symptoms were collected.The procedure was converted from laparascopic to open cholecystectomy in 10 patients (23%). Conversion rate was significantly high (33% versus zero; p=0.01) if the gallbladder wall was thickened. Conversion rate was significantly low ( Zero versus 32%: p=0.01) if the procedure was performed within 48 hours from the onset of the symptoms. The data relawted to age, sex, white blood cell count and body temprature did not reliably predict conversion of laparascopic cholecystectomy (LD) for acute cholecystitis to open procedure. There was no mortality or major morbidity. Laparascopic cholecystectomy is a safe modality of treatment for acute cholecystitis. Factors associated with increased conversion rate are thickened gallbladder wall on ultrasonographyand delay in surgery for more than 48 hours from the onset of symptoms. (author)
Rizzotti, L; Vassiliou, M; Amygdalou, A; Psarakis, Ch; Rasmussen, T R; Laopodis, V; Behrakis, P
The influence of laparoscopic cholecystectomy (LC) on the mechanical properties of the respiratory system (RS) was examined using multiple regression analysis (MRA). Measurements of airway pressure (PaO) and flow (V') were obtained from 32 patients at four distinct stages of the LC procedure: 1) Immediately before the application of pneumoperitoneum (PP) at supine position, 2) 5 min after the induction of PP at Trendelenburg position, 3) 5 min after the patients position at reverse Trendelenburg, and 4) 5 min after the end ofthe surgical procedure with the patient again in supine position. Evaluated parameters were the RS elastance (Ers), resistance (Rrs), impedance (Zrs), the angle theta indicating the balance between the elastic and resistive components of the impedance, as well as the end-expiratory elastic recoil pressure (EEP). Ers and Zrs increased considerably during PP and remained elevated immediately after abolishing PP Rrs, on the contrary, returned to pre-operative levels right after the operation. Change of body position from Trendelenburg (T) to reverseTrendelenburg (rT) mainly induced a significant change in theta, thus indicating an increased dominance of the elastic component of Zrs on changing fromT to rT. There was no evidence of increased End-Expiratory Pressure during PP
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.
Full Text Available Laparoscopic cholecystectomy is the gold standard method for treating gallstone related disease. Despite its widespread and well established application, clear consensus is not arrived at regarding the comparative risks and benefits of acute versus interval cholecystectomy. The complications of this technique are well known, with respect to both the operative intervention and the technique used. This case describes a case of cholecystitis in a 76-year-old man, who underwent acute laparoscopic cholecystectomy for cholecystitis refractory to antibiotic therapy. Postoperative complications included subhepatic collections bilaterally, eventually leading to the formation of an enterocutaneous fistula to the left chest wall - a previously undocumented phenomenon. The protracted course of the disease is discussed, with reference to investigations performed and the eventual successful outcome.
Swahn, Fredrik; Regnér, Sara; Enochsson, Lars; Lundell, Lars; Permert, Johan; Nilsson, Magnus; Thorlacius, Henrik; Arnelo, Urban
To examine whether rendezvous endoscopic retrograde cholangiopancreatography (ERCP) is associated with less pancreatic damage, measured as leakage of proenzymes, than conventional ERCP. Patients (n = 122) with symptomatic gallstone disease, intact papilla and no ongoing inflammation, were prospectively enrolled in this case-control designed study. Eighty-one patients were subjected to laparoscopic cholecystectomy and if intraoperative cholangiography suggested common bile duct stones (CBDS), rendezvous ERCP was performed intraoperatively (n = 40). Patients with a negative cholangiogram constituted the control group (n = 41). Another 41 patients with CBDS, not subjected to surgery, underwent conventional ERCP. Pancreatic proenzymes, procarboxypeptidase B and trypsinogen-2 levels in plasma, were analysed at 0, 4, 8 and 24 h. The proenzymes were determined in-house with a double-antibody enzyme linked immunosorbent assay. Pancreatic amylase was measured by an enzymatic colourimetric modular analyser with the manufacturer's reagents. All samples were blinded at analysis. Post ERCP pancreatitis (PEP) occurred in 3/41 (7%) of the patients cannulated with conventional ERCP and none in the rendezvous group. Increased serum levels indicating pancreatic leakage were significantly higher in the conventional ERCP group compared with the rendezvous ERCP group regarding pancreatic amylase levels in the 4- and 8-h samples (P = 0.0015; P = 0.03), procarboxypeptidase B in the 4- and 8-h samples (P rendezvous cannulation technique compared with patients that underwent cholecystectomy alone (control group). Post procedural concentrations of pancreatic amylase and procarboxypeptidase B were significantly correlated with pancreatic duct cannulation and opacification. Rendezvous ERCP reduces pancreatic enzyme leakage compared with conventional ERCP cannulation technique. Thus, laparo-endoscopic technique can be recommended with the ambition to minimise the risk for post ERCP
Full Text Available A 79-year-old man, with history of recent laparoscopic cholecystectomy, came to our attention for persistent hiccup, dysphonia, and dysphagia. Noninvasive imaging studies showed a nodular lesion in the right hepatic lobe with transdiaphragmatic infiltration and increased tracer uptake on positron emission tomography. Suspecting a malignant lesion and given the difficulty of performing a percutaneous transthoracic biopsy, the patient underwent surgery. Histological analysis of surgical specimen showed biliary gallstones surrounded by exudative inflammation, resulting from gallbladder rupture and gallstones spillage as a complication of the previous surgical intervention. This case highlights the importance of considering such rare complication after laparoscopic cholecystectomy.
Korzeniowski, Przemyslaw; Barrow, Alastair; Sodergren, Mikael H; Hald, Niels; Bello, Fernando
Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians. We developed NOViSE-the first force-feedback-enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom-built, and the behaviour of the virtual flexible endoscope is based on an established theoretical framework-the Cosserat theory of elastic rods. We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES. VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype, and the initial results indicate that it provides promising foundations for further development.
Full Text Available Background: A majority of gallbladder specimens show changes associated with chronic cholecystitis; however few harbour a highly lethal carcinoma. This study was conducted to review the significant histopathological findings encountered in gallbladder specimens received in our laboratory.Materials and Methods: Four hundred cholecystectomy specimens were studied over a period of five years (May, 2002 to April, 2007 received at department of pathology, Kasturba Medical College, Mangalore, India. Results: Gallstones and associated diseases were more common in women in the 4th to 5th decade as compared to men with M: F ratio of 1:1.33. Maximum number of patients (28.25% being 41 to 50 years old. Histopathologically, the most common diagnosis was chronic cholecystitis (66.75%, followed by chronic active cholecystitis (20.25%, acute cholecystitis (6%, gangrenous cholecystitis (2.25%,xanthogranulomatous cholecystitis (0.50%, empyema (1%, mucocele (0.25%, choledochal cyst (0.25%, adenocarcinoma gallbladder (1.25% and normal gallbladders (1%.Conclusion: All lesions were found more frequently in women except chronic active cholecystitis. Gallstones were present in (80.25% cases, and significantly associated with various lesions (P value 0.009. Pigment stones were most common, followed by cholesterol stones and mixed stones. Adequate sectioning is mandatory in all cases to assess epithelial changes arising from cholelithiasis and chronic cholecystitis as it has been known to progress to malignancy in some cases.
Rafiq, Muhammad Salman; Khan, Mah Muneer
To compare patient-satisfaction, scar-pain and cosmesis between laparoscopic and open-cholecystectomy. Cross-sectional survey. Khyber Teaching Hospital, Peshawar, from August 2012 to May 2014. A total of 400 patients, who had undergone open or laparoscopic cholecystectomy in all units of the Surgical Department, were included. Data was collected on questionnaires given and read to the patients along with counselling and information regarding scar-pain using visual analog score, and satisfaction and cosmesis on a 0 - 10 scale, by a medical professional in the patients' native language. This was done postoperatively on patients' follow-up visits at 1 and 4 weeks. Mean scar pain score at 1 and 4 weeks postoperatively was higher for open-cholecystectomy; 4.96 ±1 and 0.96 ±1, compared to 2.24 ±0.6 and 0, respectively for laparoscopic-cholecystectomy (p < 0.001 and < 0.001). Cosmesis was higher for laparoscopic-group; 8.6 ±1.2 vs. 6.2 ±1.46 for open-cholecystectomy (p < 0.001). Patient-satisfaction was higher for laparoscopic-cholecystectomy; 9.28 ±1.5 vs. 8.32 ±2.3 for open-cholecystectomy (p < 0.001). Mean-cosmesis score was higher for laparoscopic-cholecystectomy for those younger than 40, females and unmarried. Mean patient-satisfaction score was higher for those older than 40 years who had undergone open-cholecystectomy, women who had undergone laparoscopic-cholecystectomy and for unmarried patients who had laparoscopic-cholecystectomy. Overall patient-satisfaction and cosmesis scoring was higher for laparoscopic-cholecystectomy especially among females, unmarried and younger than 40 years. Patients of 40 years and older had greater satisfaction scoring for open-cholecystectomy. Therefore, laparoscopic-cholecystectomy should be favoured in females and unmarried patients and those younger than 40 years.
van Vilsteren, Frederike G. I.; Pouw, Roos E.; Herrero, Lorenza Alvarez; Bisschops, Raf; Houben, Martin; Peters, Frans T. M.; Schenk, B. E.; Weusten, Bas L. A. M.; Schoon, Erik J.; Bergman, Jacques J. G. H. M.
Background: Endoscopic resection is the cornerstone of endoscopic management of esophageal early neoplasia. However, endoscopic resection is a complex technique requiring knowledge and expertise. Our aims were to identify the most important learning points in performing endoscopic resection in a
Machida, Hiromichi; Nakaya, Yuzou; Kojima, Kojirou
We studied the usefulness of three dimensional helical CT (3D-CT) combined with drip infusion cholangiography for determining the application of laparoscopic cholecystectomy (LC) and evaluating the cholecyst severity. The subjects were 56 patients who underwent LC with preoperative 3D-CT. Particularly, in 42 patients undergoing endoscopic retrograde cholangiography (ERC) and 3D-CT simultaneously, the results with both methods were compared. The detection rates of the original site, forward and backward direction, and left and right direction in the confluence form of the cystic duct by means of 3D-CT versus ERC were 100% vs. 92.9% 92.9% vs. 71.4%, and 92.9% vs. 88.1%, respectively. Abnormal biliary distribution was visualized in 5 cases and all of them were depicted by 3D-CT. The 3D-CT was superior to ERC in terms of X-ray dose and cost. These results indicate the usefulness of 3D-CT as a LC preoperative examination. (author)
Boraschi, P.; Gigoni, R.; Falaschi, F.; Braccini, G.; Lamacchia, M.; Rossi, M.
Purpose: To assess the diagnostic value of MR cholangiography (MRC) for detecting common bile duct (CBD) stones in candidates for laparoscopic cholecystectomy (LC). Material and Methods: A series of 95 selected patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and/or CBD size 6.5 mm at US) were referred to our institution for MRC, before LC. MRC was performed on a 0.5 T magnet through a non-breath-hold, respiratory-triggered, fat-suppressed, thin-slab, heavily T2-weighted fast spin-echo sequence and through a breath-hold, thick-slab, single-shot T2-weighted sequence in the coronal plane. Axial T1- and T2-weighted sequences were first obtained. Two observers in conference reviewed source images and maximum intensity projections to determine the presence or absence of choledocholithiasis. MR findings were compared with endoscopic retrograde cholangiography and intraoperative cholangiography (IOC); IOC was always performed during LC. Results: CBD calculi (single or multiple) were identified in 41 out of 95 patients (43%). Two false-positive and 4 false-negative cases were found on MRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRC for choledocholithiasis were 90%, 96%, 94%, 95%, and 93%, respectively. Conclusion: MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC Bile ducts gallbladder calculi stenosis or obstruction MR imaging
Pierie, J P; van Vroonhoven, T J
In two women aged 76 and 29 years, who presented with cholangitis and small ductus choledochus calculi and with painless icterus respectively, endoscopic retrograde cholangiopancreatography (ERCP) was carried out with papillotomy. Both developed a duodenal perforation which, however, could not be localized. The first patient eventually died, the second recovered after prolonged hospitalization. A third patient, a 53-year-old man, developed abdominal pain and fever four days after laparoscopic cholecystectomy. ERCP was planned, but in the meantime the patient showed signs of recovery. The ERCP was carried out nevertheless. It failed and the patient suffered a prolonged recovery with necrotizing pancreatitis and multiple operations necessitating a temporary colostoma. In all three patients the endoscopic procedure was performed routinely without strict individualized indication. ERCP and papillotomy may be relatively safe procedures, but it should always be considered whether they will really serve the patient.
Nicholson, Tony; Travis, Simon; Ettles, Duncan; Dyet, John; Sedman, Peter; Wedgewood, Kevin; Royston, Christopher
Purpose: The effectiveness of angiography and embolization in diagnosis and treatment were assessed in a cohort of patients presenting with upper gastrointestinal hemorrhage secondary to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Methods: Over a 6-year period 1513 laparoscopic cholecystectomies were carried out in our region. Nine of these patients (0.6%) developed significant upper gastrointestinal bleeding, 5-43 days after surgery. All underwent emergency celiac and selective right hepatic artery angiography. All were treated by coil embolization of the right hepatic artery proximal and distal to the bleeding point. Results: Pseudoaneurysms of the hepatic artery adjacent to cholecystectomy clips were demonstrated in all nine patients at selective right hepatic angiography. In three patients celiac axis angiography alone failed to demonstrate the pseudoaneurysm. Embolization controlled hemorrhage in all patients with no further bleeding and no further intervention. One patient developed a candidal liver abscess in the post-procedure period. All patients are alive and well at follow-up. Conclusion: Selective right hepatic angiography is vital in the diagnosis of upper gastrointestinal hemorrhage following laparoscopic cholecystectomy. Embolization offers the advantage of minimally invasive treatment in unstable patients, does not disrupt recent biliary reconstruction, allows distal as well as proximal control of the hepatic artery, and is an effective treatment for this potentially life-threatening complication
Donkervoort, S. C.; Kortram, K.; Dijksman, L. M.; Boermeester, M. A.; van Ramshorst, B.; Boerma, D.
Complication rates after a laparoscopic cholecystectomy are still up to 10 %. Knowledge of individual patient risk profiles could help to reduce morbidity. The aim of this study is to create risk profiles for specific complications to anticipate on individual outcome. Individual patient outcome for
Holte, Kathrine; Bardram, Linda; Wettergren, André
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...
Conclusion: According to above statistically significant relation, we recommend that in patients who are candidate for cholecystectomy, if elevated preoperative serum alkaline phosphatase or elevated preoperative serum bilirubin or abnormal ultrasound findings were observed, more diagnostic evaluation should be done for them including MRC and ERC.
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.
Prabin Bikram Thapa
Full Text Available Introduction: Safe dissection of Calot’s Triangle is important during the performance of laparascopic cholucystectomy. The purpose of the study is to determine the frequency of demonstrable Rouviere’s sulcus in patients with symptomatic gall stones and its role in safe dissection in Calot’s triangle. Methods: This is a prospective descriptive study design done in Department of surgery, Kathmandu Medical College Teaching Hospital from Jan 2013 to Jan 2015. Patients who were posted for laparoscopic cholecystectomy were included. During laparoscopy, Rouviere’s sulcus was noted in the operative note and classified according to following: Type I: Open type was defined as a cleft in which the right hepatic pedicle was visualized and the sulcus was opened throughout its length. Type II: if the sulcus was open only at its lateral end. Type III If the sulcus was open only at its medial end. Type IV: Fused type was defined as one in which the pedicle was not visualized. Results: A total of 200 patients underwent laparoscopic cholecystectomy during period of 2 years. Out of which Rouviere’s sulcus was visualized in 150 patients (75 %.Type I (open type was commoner in 54%, type II in 12%, Type III in 9% and type IV (fused type in 25%. Conclusions: Rouviere’s Sulcus is an important extra biliary land mark for safe dissection of Calot’s triangle during laparoscopic cholecystectomy. Keywords: Rouviere’s Sulcus, laparoscopic cholecystectomy, bile duct injury.
risk of gallstone formation in transplant patients because of reasons such as immunosuppressive drugs, obesity, hyperlipidemia, and diabetes mellitus. Laparoscopic cholecystectomy, when performed in this group of patients, has been reported to have similar morbidity and mortality as in non-transplant patients. Here ...
Henriksen, Nadia A; Al-Tayar, Haytham; Rosenberg, Jacob
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...
Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus
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, 1week postoperatively...
Bartosiak, Katarzyna; Liszka, Maciej; Drazba, Tomasz; Paśnik, Krzysztof; Janik, Michal R
Gallbladder specimens are routinely sent for histopathological examination after cholecystectomy in order to rule out the presence of unexpected pathological findings. To establish the overall incidence of unexpected pathological findings in patients who underwent laparoscopic cholecystectomy for symptomatic gallbladder disease and determine whether the macroscopic appearance of the gallbladder in ultrasound examination could be a valid method for identifying patients with gallbladder malignancy. A retrospective study was conducted between 2013 and 2015. All histological reports (n = 1131) after cholecystectomy were searched for unexpected pathological findings. In cases where unexpected pathological findings were identified the additional analysis of preoperative abdominal ultrasound examination (USG) was done to determine the usefulness of USG in diagnosis of gallbladder malignancy. Of the 1131 patients included in the study, 356 (31.47%) were male and 774 (68.43%) were female. Unexpected pathological findings were present in 21 cases. The overall incidence of unexpected pathological findings was 1.86%. Only in 5 patients were suspicious appearances of gallbladder observed in preoperative ultrasound examination. In 16 patients there was no suspicion of malignancy. The positive predictive value of USG was 0.238. The incidence of unexpected pathological findings after laparoscopic cholecystectomy was 1.86%. Ultrasonography has low positive predictive value for identifying patients with malignant findings in a gallbladder specimen.
Borly, L; Anderson, I B; Bardram, L
patients completed all questionnaires. Twenty-one patients continued to have abdominal pain after the operation. Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score, 'irritating' abdominal pain, and an introverted personality...
L.S.G.L. Wauben; R.H.M. Goossens (Richard); D.J. van Eijk (Daan); J.F. Lange (Johan)
textabstractBackground: Iatrogenic bile duct injury remains a current complication of laparoscopic cholecystectomy. One uniform and standardized protocol, based on the "critical view of safety" concept of Strasberg, should reduce the incidence of this complication. Furthermore, owing to the rapid
Lehmann, Kai S; Ritz, Jörg P; Wibmer, Andreas; Gellert, Klaus; Zornig, Carsten; Burghardt, Jens; Büsing, Martin; Runkel, Norbert; Kohlhaw, Kay; Albrecht, Roland; Kirchner, Tom G; Arlt, Georg; Mall, Julian W; Butters, Michael; Bulian, Dirk R; Bretschneider, Jörgen; Holmer, Christoph; Buhr, Heinz J
To analyze patient outcome in the first 14 months of the German natural orifice translumenal endoscopic surgery (NOTES) registry (GNR). NOTES is a new surgical concept, which permits scarless intra-abdominal operations through natural orifices, such as the mouth, vagina, rectum, or urethra. The GNR was established as a nationwide outcome database to allow the monitoring and safe introduction of this technique in Germany. The GNR was designed as a voluntary database with online access. All surgeons in Germany who performed NOTES procedures were requested to participate in the registry. The GNR recorded demographical and therapy data as well as data on the postoperative course. A total of 572 target organs were operated in 551 patients. Cholecystectomies accounted for 85.3% of all NOTES procedures. All procedures were performed in female patients using transvaginal hybrid technique. Complications occurred in 3.1% of all patients, conversions to laparoscopy or open surgery in 4.9%. In cholecystectomies, institutional case volume, obesity, and age had substantial effect on conversion rate, operation length, and length of hospital stay, but no effect on complications. Despite the fact that NOTES has just recently been introduced, the technique has already gained considerable clinical application. Transvaginal hybrid NOTES cholecystectomy is a practicable and safe alternative to laparoscopic resection even in obese or older patients.
Wood, Stephanie G; Panait, Lucian; Duffy, Andrew J; Bell, Robert L; Roberts, Kurt E
To review the complications encountered in our facility and in previously published studies of transvaginal (TV) natural orifice transluminal endoscopic surgery (NOTES) to date. TV NOTES is currently observed with critical eyes from the surgical community, despite encouraging data to suggest improved short-term recovery and pain. All TV NOTES procedures performed in female patients between 18 and 65 years of age were included. The median follow-up was 90 days. The TV appendectomies and ventral hernia repairs were pure NOTES, through a SILS port in the vagina, whereas TV cholecystectomies were hybrid procedures with the addition of a 5-mm port in the umbilicus. A total of 102 TV NOTES procedures, including 72 TV cholecystectomies, 24 TV appendectomies, and 6 TV ventral hernia repairs, were performed. The average age was 37 years old and body mass index was 29 kg/m. Three major and 7 minor complications occurred. The first major complication was a rectal injury during a TV access port insertion. The second major complication was an omental vessel bleed after a TV cholecystectomy. The third complication was an intra-abdominal abscess after a TV appendectomy. Seven minor complications were urinary retention (4), transient brachial plexus injury, dislodgement of an intrauterine device, and vaginal granulation tissue. As techniques in TV surgery are adopted, inevitably, complications may occur due to the inherent learning curve. Laparoscopic instruments, although adaptable to TV approaches, have yet to be optimized. A high index of suspicion is necessary to identify complications and optimize outcomes for patients.
Lindert, E.J. van; Grotenhuis, J.A.
OBJECTIVE: To describe a new endoscope shaft developed for suction-aspiration during endoscopic transsphenoidal pituitary surgery. METHODS: A custom-made shaft for a Wolf endoscope (Richard Wolf GmbH, Knittlingen, Germany) was developed with a height of 10 mm and a width of 5 mm, allowing an
Full Text Available Abstract Background Epidemiological data on characteristics of patients undergoing open or laparoscopic cholecystectomy are limited. In this register study we examined characteristics and mortality of patients who underwent cholecystectomy during hospital stay in Sweden 2000 – 2003. Methods Hospital discharge and death certificate data were linked for all patients undergoing cholecystectomy in Sweden from January 1st 2000 through December 31st 2003. Mortality risk was calculated as standardised mortality ratio (SMR i.e. observed over expected deaths considering age and gender of the background population. Results During the four years of the study 43072 patients underwent cholecystectomy for benign biliary disease, 31144 (72% using a laparoscopic technique and 11928 patients (28% an open procedure (including conversion from laparoscopy. Patients with open cholecystectomy were older than patients with laparoscopic cholecystectomy (59 vs 49 years, p Conclusion Laparoscopic cholecystectomy is performed on patients having a lower mortality risk than the general Swedish population. Patients with open cholecystectomy are more sick than patients with laparoscopic cholecystectomy, and they have a mortality risk within 90 days of admission for cholecystectomy, which is four times that of the general population. Further efforts to reduce surgical trauma in open biliary surgery are motivated.
Badru, Faidah; Saxena, Saurabh; Breeden, Robert; Bourdillon, Maximillan; Fitzpatrick, Colleen; Chatoorgoon, Kaveer; Greenspon, Jose; Villalona, Gustavo
Little data exist regarding the recurrence of pancreatitis in pediatric patients with gallstone pancreatitis awaiting cholecystectomy. This study evaluates the recurrence rate of pancreatitis after acute gallstone pancreatitis based on the timing of cholecystectomy in pediatric patients. A retrospective chart review of all patients admitted with gallstone pancreatitis from 2007 to 2015 was performed. Children were divided into the following five groups. Group 1 had surgery during the index admission. Group 2 had surgery within 2 wk of discharge. Group 3 had surgery between 2 and 6 wk postdischarge. Group 4 had surgery 6 wk after discharge, and group 5 patients had no surgery. The recurrence rates of pancreatitis were calculated for all groups. Forty-eight patients with gallstone pancreatitis were identified in this study. The 19 patients in group 1 had no recurrence of their pancreatitis. Of the remaining 29 patients, nine (31%) had recurrence of pancreatitis or required readmission for abdominal pain prior to their cholecystectomy. In group 2, two of the eight patients (25%) had recurrent pancreatitis. In group 3, three of eight patients (37.5%) developed recurrent pancreatitis. In group 4, three of five patients (60%), and in group 5, one of eight. No children in group 5 had demonstrable gallstones at presentation, only sludge in their gallbladder. Cholecystectomy during the index admission is associated with no recurrence or readmission for pancreatitis. Therefore, we recommend that cholecystectomy be performed after resolution of an episode of gallstone pancreatitis during index admission. Copyright © 2017 Elsevier Inc. All rights reserved.
Efendiyeva, M T; Abdurakhmanova, A Z
Investigation of efficiency of liquid synbiotics and structure-resonance electric magnetic therapy (SRMT) among patients after cholecystectomy. 90 patients after cholecystectomy have been investigated (CE). Along with general clinical meth-ods of investigation, patients passed US investigation of abdomen, biochemical blood tests, bacteriological test of faeces, investigation of short-chain fatty acids (SCFA) by gas-liquid osteal chromatographic analysis. State of vegetative nervous system passed analysis according to variability of heart rhythm (VHR) by spectral analysis method using "Cardiac technic 4000 AD" cardiac monitor in frame of 24-hr ECG monitoring. Estimation of life quality (LQ) of patients after cholecystectomy has been conducted by "SF-36 Health status survey". Patients have been divided into 3 groups, comparable according to the main clinical and functional indicators. Patients of first group (30 people) passed correction of dysbiosis by liquid synbiotics. Patients of a second group (30 persons) passed complex treatment of SRMT and liquid synbiotics. Control group was composed by 30 patients after cholecystectomy who had been receiving diet therapy. In term of investigation 90% of patients have shown decrease of number and methabolic activity of microflora, change of activity of anaerobic microorganisms. Analysis of variability of heart rhythm have displayed relative prevalence of sympathetic modulation of a rhythm on the background of elevated ergotropic component of the total capacity of a spectrum; estimation of life quality (LQ) has shown that limitation of physical activity is a most considerable contribution to decrease of LQ among patients after cholecystectomy. After a course of liquid synbiotics and SMRT recovery and improvement of intestines and improvement of all indicator of life quality is observed.
Karam, K.; Khan, B.I.
Pain after laparoscopic cholecystectomy is mild to moderate in intensity. Several modalities are employed for achieving safe and effective postoperative analgesia, the benefits of which adds to the early recovery of the patients. As a part of multimodal analgesia, various approaches of Transversus abdominis plane (TAP) block has been used for management of parietal and incisional components of pain after laparoscopic cholecystectomy. This study was designed to compare the analgesic efficacy of two different approaches of ultrasound guided TAP block, i.e., Subcostal-TAP block technique with ultrasound guided Posterior-TAP block for post-operative pain management in patients undergoing laparoscopic cholecystectomy under general anaesthesia. Methods: In this double blinded randomized controlled study, consecutive nonprobability sampling was done and a total of 126 patients admitted for elective laparoscopic cholecystectomy fulfilling the inclusion criteria were selected. After induction of general anaesthesia, patients were randomized through draw method and received either ultrasound guided posterior TAP block with 0.375% bupivacaine (20ml volume) on each side of the abdomen or subcostal TAP block bilaterally with the same. Up to 24 hours postoperatively, static and dynamic numeric rating pain scores were assessed. Results: We found statistically significant difference in mean static pain scores over 24 hours postoperatively in subcostal TAP group, suggesting improved analgesia. However, mean dynamic postoperative pain scores were comparable between the two groups. Whereas, patients in both groups were satisfied with pain management. Conclusions: Ultrasound guided subcostal TAP block provides better postoperative analgesia as compared to the Posterior TAP block in laparoscopic cholecystectomy. Otherwise both of the approaches improve patient outcomes towards early recovery and discharge from hospital. (author)
Kühner, W; Frimberger, E; Ottenjann, R
Endoscopic extraction of gallbladder stones were performed, as far as we know for the first time, in three patients with combined choledochocystolithiasis. Following endoscopic papillotomy (EPT) and subsequent mechanical lithotripsy of multiple choledochal concrements measuring up to 3 cm the gallbladder stones were successfully extracted with a Dormia basket through the cystic duct. The patients have remained free of complications after the endoscopic intervention.
Meier, Benjamin; Caca, Karel; Fischer, Andreas; Schmidt, Arthur
Colorectal adenomas are well known precursors of invasive adenocarcinoma. Colonoscopy is the gold standard for adenoma detection. Colonoscopy is far more than a diagnostic tool, as it allows effective treatment of colorectal adenomas. Endoscopic resection of colorectal adenomas has been shown to reduce the incidence and mortality of colorectal cancer. Difficult resection techniques are available, such as endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic full-thickness resection. This review aims to provide an overview of the different endoscopic resection techniques and their indications, and summarizes the current recommendations in the recently published guideline of the European Society of Gastrointestinal Endoscopy.
Initial 100 consecutive laparoscopic cholecystectomies performed by one surgeon were studied prospectively. The standard technique was modified in that the gallbladder removal was accomplished through the upper epigastric incision; there was no need to change the location of the camera. The conversion rate to open cholecystectomy was 2%. There were no major complications and no mortality. Minor complications occurred in 9% of the patients. Laparoscopic cholecystectomy can be performed safely ...
Tsujino, Takeshi; Kawabe, Takao; Isayama, Hiroyuki; Yashima, Yoko; Yagioka, Hiroshi; Kogure, Hirofumi; Sasaki, Takashi; Arizumi, Toshihiko; Togawa, Osamu; Ito, Yukiko; Matsubara, Saburo; Nakai, Yousuke; Sasashira, Naoki; Hirano, Kenji; Tada, Minoru; Omata, Masao
Patients with untreated gallbladder stones in situ are at high risk for late biliary complications after endoscopic papillary balloon dilation (EPBD) and bile duct stone extraction. Few data exist on the short-term and long-term results in these patients after the recurrence of bile duct stones and acute cholecystitis. The aim of this study was to evaluate the outcome of late biliary complications in patients with gallbladder stones in situ after EPBD. Fifty-six patients who developed late biliary complications, including bile duct stone recurrence (n=43) and acute cholecystitis (n=13), were managed at our institutions. We investigated the short-term and long-term outcomes after the management of late biliary complications. Complete removal of recurrent bile duct stones was achieved in 38 of 43 patients (88%) by repeated EPBD alone. Pancreatitis after repeated EPBD occurred in two patients (5%). After successful bile duct stone extraction by EPBD, none of the 16 patients who underwent cholecystectomy developed late biliary complications (mean follow-up period of 5.2 years), whereas re-recurrent bile duct stones occurred in three of the 21 patients (14%) with gallbladder stones left in situ (mean follow-up period of 4.4 years)(P=0.1148). Re-recurrent bile duct stones were successfully treated endoscopically. One of the eight patients who did not undergo cholecystectomy for acute cholecystitis had a recurrence of cholecystitis, which was managed conservatively. The long-term outcomes of late biliary complications are favorable when patients with concomitant gallbladder stones undergo cholecystectomy. Re-recurrent bile duct stones are considerable when gallbladder stones are left in situ, but should be treated endoscopically.
Pierre H Deprez
Full Text Available Benign biliary strictures for which endoscopic treatment is proposed are mostly related to liver transplantation or chronic pancreatitis (one third of cases each and, less frequently, to other causes (e. g., cholecystectomy, sphincterotomy. The question of futility of exercise may therefore be of importance before embarking in these techniques. Endoscopic treatment of iatrogenic (post-operative benign strictures may be considered as the gold standard since 90% of success is achieved with multiple stent placement. In strictures due to chronic pancreatitis, success rates are lower and surgery may be an appropriate alternative, although it may not be futile to propose an endoscopic try, especially when strictures are related to acute pancreatitis, pseudocyst obstruction or any reversible pancreatic cause of obstruction. In sclerosing cholangitis, endoscopic management is also focused on detection of malignancy. It should therefore not be considered as a futile exercise, but indications and aims of endotherapy should be discussed in a multidisciplinary team involving gastroenterologists, radiologists, and surgical specialists.
Lee, Ji Hyun; Huh, Jin; Kim, Duk Kyung; Gil, Jea Ryoung; Min, Sung Won; Han, Sun Sook
Laparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC. Twelve American Society of Anesthesiologists class I or II patients received an epidural block for LC. The level of epidural block and the satisfaction score of patients and the surgeon were checked to evaluate the efficacy of epidural block for LC. LC was performed successfully under epidural block, with the exception of 1 patient who required a conversion to general anesthesia owing to severe referred pain. There were no special postoperative complications, with the exception of one case of urinary retention. Epidural anesthesia might be applicable for LC. However, the incidence of intraoperative referred shoulder pain is high, and so careful patient recruitment and management of shoulder pain should be considered.
Hance, Julian; Aggarwal, Rajesh; Moorthy, Krishna; Munz, Yaron; Undre, Shabnam; Darzi, Ara
Standardized short courses in laparoscopic cholecystectomy aim to teach laparoscopic skills to surgical trainees, although end-of-course assessments of performance remain subjective. The current study aims to objectively assess psychomotor skills acquisition of trainees attending laparoscopic cholecystectomy courses. Thirty-seven junior surgical trainees had their laparoscopic skills assessed before and after attending 1 of 3 separate 2-day courses (A, B, and C), all with identical format. Assessments were comprised of a standardized simulated laparoscopic task, with performance measured using a valid electromagnetic hand-motion tracking device. Overall, trainees made significant improvements in path length (P=.006), number of movements (Ppsychomotor skills on courses. In addition to providing participants with an insight into their skills, these data can be used to demonstrate course efficacy.
Ege, B.; Gulen, M.
The need to integrate aspects of functional, psychosocial and cosmetic impairment into medical care is increasingly accepted among the physicians and the patients. For these reasons, single-port robotic surgery emerges as the most advanced approach using the technology. In this study, authors used a new robotic dissector with monopolar electrocautery feature in order to determine the device's safety and efficacy. Between January 2015 and February 2016, 10 out of 11 consecutive cholecystectomies were included in the study. There was no significant differences in port placement and docking time between two groups (p=0.382, p=0.789). The time spent by surgeon was significantly shorter in group 2 (p=0.005). Using robotic dissector with monopolar cautery significantly shortened the console time. This new instrument (Maryland monopolar dissector) provides more feasible and faster dissection of the Calot's triangle, supporting further the advantages of robotic single-site cholecystectomy. (author)
Full Text Available Gastric outlet obstruction caused by a large gallstone in the duodenum or pylorus (Bouveret's syndrome is a rare complication of gallstone disease. The presenting symptoms are often nonspecific and include nausea, vomiting, epigastric pain and a history of gallbladder disease. Although the diagnosis is established only at surgery in many cases, preoperative recognition by imaging techniques and endoscopy is desirable. Surgical treatment aims at removal of the ectopic gallstone, closure of the fistula and cholecystectomy. A case of Bouveret's syndrome is presented where endoscopic extraction of the duodenal gallstone was accomplished providing definitive treatment for this patient.
Veres needle in the umbilical fundus, followed by the insertion of a 5-mm trocar. A second 3-mm trocar was placed in the right upper quadrant. A colpotomy was performed, and a 12-mm trocar placed inside the vagina allowed the insertion of a videogastroscope as far as the hilum of the liver. Results: cholecystectomy was performed by using a combination of working tools inserted through the entry port for the minilaparoscopy and the videogastroscope. The gallbladder was removed transvaginally through the videogastroscope. There were no postoperative complications, and the patient was discharged within 24 hours. Conclusions: transvaginal cholecystectomy is possible and safe when performed by a multidisciplinary team working together. Natural orifice transluminal endoscopic surgery (NOTES is an emerging modality that seeks to be less invasive, better tolerated, and more respectful of esthetics than laparoscopic surgery. It will probably open the way for very important medical and technological innovations over the coming years.
Harboe, Kirstine Moll; Anthonsen, Kristian; Bardram, Linda
and postoperative complications RESEARCH DESIGN AND SUBJECTS: Data from 1360 medical records of patients undergoing cholecystectomy were compared to the relevant administrative data from the National Patient Registry. The medical records served as the "gold standard". The association between the individual...... indicators and the occurrence of a postoperative complication was assessed. MEASURES: Validation of administrative data against the gold standard was done by the calculation of per cent agreement (including kappa-values) sensitivity/specificity and predictive values. The association between indicators...
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.
Full Text Available Introduction: Postoperative pain as an important medical concern is usually treated by opioids which also are of various inevitable side effects. The aim of this study was to assess the efficacy of multimodal preincisional premedication on preventing post-cholecystectomy acute pain. Methods: In a randomized clinical trial, sixty patients undergoing open cholecystectomy were randomized into two groups. Before anesthesia induction, Diclofenac suppository (100 mg and oral Clonidine (0.2 mg were administered in the first group. Immediately before operation, patients received Ketamine (1 mg/kg IV while the control group received placebo. The site of incision was infiltrated by the surgeon with 20 mL Bupivacaine 0.25% in both groups. Anesthesia induction and maintenance were similar in both groups. The severity of pain was recorded 2, 4, 6, 12, 24 and 48 hours after operation according to Visual Analogue Scale. Results: The severity of pain at two defined stages (6 and 12 hours later was significantly less in the intervention group than the control group (P<0.005. The average pain severity score was less than the control group (P<0.005. Conclusion: In our study, the administration of Clonidine, Diclofenac and Ketamine and bupivacaine infiltration to the site of incision, altogether was associated with a significant decrease in pain score and opioid requirement after cholecystectomy in comparison to bupivacaine infiltration to the site of incision.
Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments, however, this is discussed controversially. We have developed a new diagnostic strategy to detect bile duct stones. The concept is based on an ultrasound examination and on a screening for the presence of six risk indicators of choledocholithiasis. 120 consecutive patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of six risk indicators of choledocholithiasis: history of jaundice; history of pancreatitis; hyperbilirubinemia; hyperamylasemia; dilated bile duct; unclear ultrasound findings. The sensitivity of ultrasound and of intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. 20% of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (p concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that the routine use of intraoperative cholangiography in patients undergoing laparoscopic cholecystectomy is not necessary.
Salleh, A A M; Affirul, C A; Hairol, O; Zamri, Z; Azlanudin, A; Hilmi, M A; Razman, J
This present study sought to review the feasibility and patients' satisfaction of laparoscopic cholecystectomy to be perform as daycare procedure. Sixty-two patients with symptomatic gallstones were recruited within a year. They were randomized into overnight stay and daycare groups. The outcomes and post-operative complications were analyzed. Fifty-eight patients were eligible for analysis and four patients were excluded because of conversion to open cholecystectomy. All patients in daycare group reported no fever but two patients in the overnight stay group complaint of post-operative fever (p=0.150). The mean pain score using Visual Analogue Score (VAS) in daycare group was 2.93 but in the overnight stay was recorded as 3.59 (p=0.98). Five patients had post-operative nausea and vomiting (PONV) in daycare group compared to 2 patients in the overnight stay group (p=0.227). Patient's satisfaction were higher in the daycare group (p=0.160). All patients in daycare group were back at work within a week but in overnight stay, 11 patients had to stay off work for more than one week (p=0.01). Daycare laparoscopic cholecystectomy is safe and feasible. The satisfaction of daycare surgery is higher than overnight stay group. Patients' selection is an important aspect of its success.
Ikonen, T S; Antikainen, T; Silvennoinen, M; Isojärvi, J; Mäkinen, E; Scheinin, T M
Simulators are widely used in occupations where practice in authentic environments would involve high human or economic risks. Surgical procedures can be simulated by increasingly complex and expensive techniques. This review gives an update on computer-based virtual reality (VR) simulators in training for laparoscopic cholecystectomies. From leading databases (Medline, Cochrane, Embase), randomised or controlled trials and the latest systematic reviews were systematically searched and reviewed. Twelve randomised trials involving simulators were identified and analysed, as well as four controlled studies. Furthermore, seven studies comparing black boxes and simulators were included. The results indicated any kind of simulator training (black box, VR) to be beneficial at novice level. After VR training, novice surgeons seemed to be able to perform their first live cholecystectomies with fewer errors, and in one trial the positive effect remained during the first ten cholecystectomies. No clinical follow-up data were found. Optimal learning requires skills training to be conducted as part of a systematic training program. No data on the cost-benefit of simulators were found, the price of a VR simulator begins at EUR 60 000. Theoretical background to learning and limited research data support the use of simulators in the early phases of surgical training. The cost of buying and using simulators is justified if the risk of injuries and complications to patients can be reduced. Developing surgical skills requires repeated training. In order to achieve optimal learning a validated training program is needed.
Angelou, Anastasios; Skarmoutsos, Athanasios; Margonis, Georgios A; Moris, Demetrios; Tsigris, Christos; Pikoulis, Emmanouil
Minimally invasive techniques are used more and more frequently. Since conventional laparoscopic approach has been the gold standard, surgeons in their effort to further reduce the invasiveness of conventional laparoscopic cholecystectomy have adopted Single Incision approach. The widespread adoption of robotics has led to the inevitable hybridization of robotic technology with laparoendoscopic single-site surgery (LESS). As a result, employment of the da Vinci surgical system may allow greater surgical maneuverability, improving ergonomics. A review of the English literature was conducted to evaluate all robotic single port cholecystectomy performed till today. Demographic data, operative parameters, postoperative outcomes and materials used for the operation were collected and assessed. A total of 12 studies, including 501 patients were analyzed. Demographics and clinical characteristics of the patients was heterogeneous, but in most studies a mean BMI port cholecystectomy is a safe and feasible alternative to conventional multiport laparoscopic or manual robotic approach. However, current data do not suggest a superiority of robotic SILC over other established methods.
Han, In Woong; Jang, Jin-Young; Kang, Mee Joo; Lee, Kyoung Bun; Lee, Seung Eun; Kim, Sun-Whe
Percutaneous transhepatic gallbladder drainage (PTGBD) is a procedure to resolve acute cholecystitis (AC). It may decrease the technical difficulty of laparoscopic cholecystectomy (LC) and thus may facilitate successful surgery when a patients' condition improves. However, the timing of LC after PTGBD remains controversial. From 2004 to 2010, cholecystectomy after PTGBD was performed in 67 patients with AC. Group I members underwent LC within 72 h of PTGBD (n = 21), whereas group II members underwent LC at more than 72 h after PTGBD (n = 46). The open conversion rate was similar in the two groups. The perioperative complication rate was higher in group I than in group II, but with marginal significance (19.0 vs. 4.3%; p = 0.07). Mean operative time was longer in group I than in group II (79.3 ± 25.3 vs. 53.7 ± 45.3 min; p = 0.02). However, overall hospital stay was shorter in group I than in group II, but with marginal significance (10.8 ± 4.5 vs. 14.7 ± 9.3 days; p = 0.08). Pros and cons were well balanced between the two groups. Decisions on the timing of cholecystectomy after PTGBD should be made based on considerations of patient condition, hospital facilities, and surgical experience.
Full Text Available ObjectiveTo investigate whether operative time of laparoscopic cholecystectomy impacts the carbonyl hemoglobin (COHb concentration in peripheral blood. MethodsForty patients with gallstones and indications for laparoscopic cholecystectomy were enrolled in the study. Peripheral venous blood samples were collected at the beginning and end of the operative procedure. COHb concentration was measured by UV spectroscopy. The significance of changes in COHb concentration in relation to time of the operative procedure (rounded to the nearest minute was assessed by statistical correlation coefficient test. ResultsThe laparoscopic procedure was completed in 38 cases, and two patients required conversion to laparotomy. The content of COHb in peripheral venous blood had significantly increased during the laparoscopic operation (operation beginning: 11.07%±1.18% vs. operation end: 1.44%±0.26%, P＜0.05. The change was positively correlated with operation time (r=0.85. ConclusionCarbon monoxide produced during the laparoscopic cholecystectomy procedure can lead to an increase in peripheral venous blood COHb. The longer the operation lasts, the greater the increase in COHb.
Go, P. M.; Stolk, M. F.; Obertop, H.; Dirksen, C.; van der Elst, D. H.; Ament, A.; van Erpecum, K. J.; van Berge Henegouwen, G. P.; Gouma, D. J.
In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis were compared in a cost-effectiveness study: extracorporeal shock-wave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopic cholecystectomy
Haberkern, CM; Neumayr, LD; Orringer, EP; Earles, AN; Robertson, SM; Abboud, MR; Koshy, M; Idowu, O; Vichinsky, EP; Black, D.
Cholecystectomy is the most common surgical procedure performed in sickle cell anemia (SCA) patients. We investigated the effects of transfusion and surgical method on perioperative outcome. A total of 364 patients underwent cholecystectomy: group 1 (randomized to aggressive transfusion) 110
Full Text Available Marina Yiasemidou, Daniel Glassman, Peter Vasas, Sarit Badiani, Bijendra Patel Barts and the London School of Medicine and Dentistry, Department of Upper GI Surgery, Barts and The Royal London Hospital, London, UK Background: Virtual reality simulators have been gradually introduced into surgical training. One of the enhanced features of the latest virtual simulators is haptic feedback. The usefulness of haptic feedback technology has been a matter of controversy in recent years. Previous studies have assessed the importance of haptic feedback in executing parts of a procedure or basic tasks, such as tissue grasping. The aim of this study was to assess the role of haptic feedback within a structured educational environment, based on the performance of junior surgical trainees after undergoing substantial simulation training. Methods: Novices, whose performance was assessed after several repetitions of a task, were recruited for this study. The performance of senior house officers at the last stage of a validated laparoscopic cholecystectomy curriculum was assessed. Nine senior house officers completed a validated laparoscopic cholecystectomy curriculum on a haptic simulator and nine on a nonhaptic simulator. Performance in terms of mean total time, mean total number of movements, and mean total path length at the last level of the validated curriculum (full procedure of laparoscopic cholecystectomy was compared between the two groups. Results: Haptic feedback significantly reduced the time required to complete the full procedure of laparoscopic cholecystectomy (mean total time for nonhaptic machine 608.83 seconds, mean total time for haptic machine 553.27 seconds; P = 0.019 while maintaining safety standards similar to those of the nonhaptic machine (mean total number of movements: nonhaptic machine 583.74, haptic machine 603.93, P = 0.145, mean total path length: for nonhaptic machine 1207.37 cm, for haptic machine 1262.36 cm, P = 0
Afzal, M.; Butt, M.Q.
To analyze the complications of first 400 laparoscopic cholecystectomies (LC) for patients with symptomatic gall stone disease at a tertiary care hospital. Study Design: Quasi-experimental study. Place and Duration of Study: PNS Shifa Karachi and CMH Lahore, Pakistan from Nov 2009 to Jan 2013. Patients and Methods: A prospective analysis of complications occurring in first 400 consecutive laparoscopic cholecystectomies by a single consultant/unit at a tertiary care hospital was made. Out of total 421 patients presenting with symptomatic gall stone disease in a single unit, 21 cases that underwent open cholecystectomy were excluded from the study. Laparoscopic cholecystectomies were performed using three port and four port technique and data including age, sex, diagnosis, number of trocar placements, conversion to open surgery and its reasons, operative time, post-operative hospital stay and complications was collected on personal computer and analyzed using Statistical package for social sciences (SPSS) version 13. Results: Total 400 patients were included in study with median age of 44 years. Female to male ratio was 5.3: 1. Depending upon the preoperative diagnosis and laparoscopic findings, patients had diagnosis of Chronic cholecystitis / biliary colic 68.25%, acute cholecystitis 23.75%, empyema gall bladder 7.25%, gallstone pancreatitis 0.5% and mucocele gallbladder 0.25%. Median operating time was 30min. Median hospital stay was 1 days (range 1 -20 days). Conversion rate was 1.25%. Postoperative complications included bleeding 0.5%, biliaryperitonitis due to cystic duct leak 0.25%, biloma 0.25%, sub hepaticabscess 0.25%, subcutaneous fat necrosis right flank at drain site 0.25%, umbilical trocarsite infection 2%, keloid at umbilical port site 0.25% and incisional hernia at umbilicus 0.25%. There was one hospital death due to myocardial infarction on 2nd post-operative day. Conclusion: Laparoscopic Cholecystectomy is associated with some serious complications
Full Text Available The axillary technique is the most popular approach to breast augmentation among Korean women. Transaxillary breast augmentation is now conducted with sharp electrocautery dissection under direct endoscopic vision throughout the entire process. The aims of this method are clear: both a bloodless pocket and a sharp non-traumatic dissection. Round textured or anatomical cohesive gel implants have been used to make predictable well-defined inframammary creases because textured surface implants demonstrated a better stability attributable to tissue adherence compared with smooth surface implants. The axillary endoscopic technique has greatly evolved, and now the surgical results are comparable to those with the inframammary approach. The author feels that this technique is an excellent choice for young patients with an indistinct or absent inframammary fold, who do not want a scar in the aesthetic unit of their chest.
Smart, Christopher J; Cunningham, Chris; Bach, Simon P
Transanal endoscopic microsurgery (TEMS) is a well established method of accurate resection of specimens from the rectum under binocular vision. This review examines its role in the treatment of benign conditions of the rectum and the evidence to support its use and compliment existing endoscopic treatments. The evolution of TEMS in early rectal cancer and the concepts and outcomes of how it has been utilised to treat patients so far are presented. The bespoke nature of early rectal cancer treatment is changing the standard algorithms of rectal cancer care. The future of TEMS in the organ preserving treatment of early rectal cancer is discussed and how as clinicians we are able to select the correct patients for neoadjuvant or radical treatments accurately. The role of radiotherapy and outcomes from combination treatment using TEMS are presented with suggestions for areas of future research. Copyright © 2014. Published by Elsevier Ltd.
A couple of minimally-invasive, endoscopic antireflux procedures have been developed during the last years. Beside endoscopic suturing these included injection/implantation technique of biopolymers and application of radiofrequency. Radiofrequency (Stretta) has proved only a very modest effect, while implantation techniques have been abandoned due to lack of long-term efficacy (Gatekeeper) or serious side effects (Enteryx). While first generation endoluminal suturing techniques (EndoCinch, ESD) demonstrated a proof of principle their lack of durability, due to suture loss, led to the development of a potentially durable transmural plication technique (Plicator). In a prospective-randomized, sham-controlled trial the Plicator procedure proved superiority concerning reflux symptoms, medication use and esophageal acid exposure (24-h-pH-metry). While long-term data have to be awaited to draw final conclusions, technical improvements will drive innovation in this field.
Harewood, Gavin C
The extremely poor outcome in patients with cholangiocarcinoma, in large part, reflects the late presentation of these tumors and the challenging nature of establishing a tissue diagnosis. Establishing a diagnosis of cholangiocarcinoma requires obtaining evidence of malignancy from sampling of the epithelium of the biliary tract, which has proven to be challenging. Although endoscopic ultrasound-guided fine needle aspiration performs slightly better than endoscopic retrograde cholangiopancreatography in diagnosing cholangiocarcinoma, both endoscopic approaches demonstrate disappointing performance characteristics.
Gessner, C E; Jowell, P S; Baillie, J
The development of past, present, and future endoscopic training methods is described. A historical perspective of endoscopy training guidelines and devices is used to demonstrate support for the use of novel endoscopic training techniques. Computer simulation of endoscopy, interactive learning, and virtual reality applications in endoscopy and surgery are reviewed. The goals of endoscopic simulation and challenges facing investigators in this field are discussed, with an emphasis on current and future research.
Zubair, M; Habib, L; Mirza, M R
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...
Full Text Available The results of a comprehensive examination of 136 patients after cholecystectomy are provided. High efficiency and informativeness of the 13C-mixed triglyceride breath test for determining exocrine pancreatic insufficiency at its early stages was noted in patients after cholecystectomy.
Yousef, Gamal T.; Lasheen, Ahmed E.
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 an...
Jani, Kalpesh; Rajan, P S; Sendhilkumar, K; Palanivelu, C
This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease.
Jani, Kalpesh; Rajan, P S; Sendhilkumar, K; Palanivelu, C
This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease
Rosemurgy, Alexander; Ryan, Carrie; Klein, Richard; Sukharamwala, Prashant; Wood, Thomas; Ross, Sharona
Robotic application to cholecystectomy has dramatically increased, though its impact on cost of care and reimbursement has not been elucidated. We undertook this study to evaluate and compare cost of care and reimbursement with robotic versus laparoscopic cholecystectomy. The charges and reimbursement of all robotic and laparoscopic cholecystectomies at one hospital undertaken from June 2012 to June 2013 were determined. Operative duration is defined as time into and time out of the operating room. Data are presented as median data. Comparisons were undertaken using the Mann-Whitney U-test with significance accepted at p ≤ 0.05. Robotic cholecystectomy took longer (47 min longer) and had greater charges ($8,182.57 greater) than laparoscopic cholecystectomy (p depreciation, interest, and taxes (EBDIT), and Net Income were not impacted by approach. Relative to laparoscopic cholecystectomy, robotic cholecystectomy takes longer and has greater charges. Revenue, EBDIT, and Net Income are similar after either approach; this indicates that costs with either approach are similar. Notably, this is possible because much of hospital-based costs are determined by cost allocation and not cost accounting. Thus, the cost of longer operations and costs inherent to the robotic approach for cholecystectomy do not translate to a perceived financial burden.
MARISA DE CARVALHO BORGES
Full Text Available ABSTRACT Objective: to evaluate the pulmonary function of women submitted to conventional and single-port laparoscopic cholecystectomy. Methods: forty women with symptomatic cholelithiasis, aged 18 to 70 years, participated in the study. We divided the patients into two groups: 21 patients underwent conventional laparoscopic cholecystectomy, and 19, single-port laparoscopic cholecystectomy. We assessed pulmonary function through forced vital capacity (FVC, forced expiratory volume in the first second (FEV1, and the FEV1/FVC ratio, measured before and 24 hours after the procedure. Results: in both groups, FVC and FEV1 were lower in the postoperative period than those obtained in the preoperative period, with a greater reduction in the group undergoing conventional laparoscopic cholecystectomy. Regarding the FEV1/FVC (% values, there was no statistically significant difference in any of the groups or times analyzed. Conclusion: there was a greater decline in FVC and FEV1 in the postoperative group of patients submitted to conventional laparoscopic cholecystectomy.
Christoffersen, Mette W; Brandt, Erik; Oehlenschläger, Jacob
and matched 1:2 with patients subjected to CLC using pre-defined criteria. Follow-up data were obtained from the Danish National Patient Registry, mailed patient questionnaires, and clinical examination. A port-site hernia was defined as a repair for a port-site hernia or clinical hernia located at one......BACKGROUND: Conventional laparoscopic cholecystectomy (CLC) is regarded as the gold standard for cholecystectomy. However, single-incision laparoscopic cholecystectomy (SLC) has been suggested to replace CLC. This study aimed at comparing long-term incidences of port-site hernia and chronic pain...... after SLC versus CLC. METHODS: We conducted a matched cohort study based on prospective data (Jan 1, 2009-June 1, 2011) from the Danish Cholecystectomy Database with perioperative information and clinical follow-up. Consecutive patients undergoing elective SLC during the study period were included...
Tytgat, G. N.
The contamination of endoscopes and biopsy forceps with Helicobacter pylori occurs readily after endoscopic examination of H. pylori-positive patients. Unequivocal proof of iatrogenic transmission of the organism has been provided. Estimates for transmission frequency approximate to 4 per 1000
The objective was to prove the advantage of endoscopic laser-urethroplasty over internal urethrotomy in acquired urethral strictures. Patients and Method: From January, 1996 to June, 2005, 35 patients with a mean age of 66 years were submitted to endoscopic laser-urethroplasty for strictures of either the bulbar (30) or membranous (5) urethra. The operations were carried out under general anesthesia. First of all, the strictures were incised at the 4, 8 and 12 o'clock position by means of a Sachse-urethrotom. Then the scar flap between the 4 and 8 o'clock position was vaporized using a Nd:YAG laser, wavelength 1060 nm and a 600 pm bare fiber, the latter always being in contact with the tissue. The laser worked at 40W power in continuous mode. The total energy averaged 2574 J. An indwelling catheter was kept in place overnight and the patients were discharged the following day. Urinalysis, uroflowmetry and clinical examination were performed at two months after surgery and from then on every six months. Results: No serious complications were encountered. Considering a mean follow-up of 18 months, the average peak flow improved from 7.3 ml/s preoperatively to 18.7 mVs postoperatively. The treatment faded in 5 patients ( 14.3% ) who finally underwent open urethroplasty. Conclusions: Endoscopic laser-urethroplasty yields better short-term results than internal visual urethrotomy. Long-term follow-up has yet to confirm its superiority in the treatment of acquired urethral strictures.
Lacher, Martin; Yannam, Govardhana R; Muensterer, Oliver J; Aprahamian, Charles J; Haricharan, Ramanath N; Perger, Lena; Bartle, Donna; Talathi, Sonia S; Beierle, Elizabeth A; Anderson, Scott A; Chen, Mike K; Harmon, Carroll M
The treatment of children with biliary dyskinesia (BD) is controversial. As we recently observed an increasing frequency of referrals for BD in our institution the aim of the study was to re-evaluate the long-term outcome in children with BD. Children with laparoscopic cholecystectomy (LC) for suspected BD between 8/2006 and 5/2011 were included. A pathologic ejection fraction (EF) was defined as <35%. The long-term effect of cholecystectomy was assessed via a Likert scale symptom questionnaire. 82 children (median age 13.5 years, mean BMI 25.8) were included. CCK-HIDA scan was pathologic in 74 children (90.2%). Mean EF was 16.4%. Histology revealed chronic cholecystitis in 48 (58.5%) children and was normal in 30 children (36.5%). The frequency of LC for suspected BD increased by a factor of 4.3 in the last 10 years. Long term follow-up showed that only 23/52 children (44.2%) were symptom-free after LC. Patients with chronic inflammation were more likely to have persistent symptoms (p=0.017). An EF<15% was associated with a resolution of symptoms (p=0.031). The frequency of LC for suspected BD in our institution has increased significantly during recent years. The long-term efficacy in our cohort was only 44.2%. We believe that laparoscopic cholecystectomy is likely helpful in patients with an EF<15%. However, in children with an EF of 15%-35%, based upon our data, we would highly recommend an appropriately thorough pre-op testing to exclude other gastrointestinal disorders prior to consideration of operative management. Copyright © 2013 Elsevier Inc. All rights reserved.
Aldred, Martha Aurelia; Paes, Walter Siqueira; Fausto, Agnes M.F.; Nucci, Jose Roberto; Yoshimura, Elisabeth Mateus; Okuno, Emico; Maruta, Luis Massuo
Equivalent and effective doses in occupational exposures are evaluated considering that some specific endoscopic examinations, radiographic and fluoroscopic images of patients are taken with the medical staff near to the radiation field. Examinations are simulated using an anthropomorphic phantom as a member of the medical staff. Thermoluminescent dosemeters are attached in several positions of the phantom in order to determine some organ doses. From the comparison between the doses experimentally determined and the International and the Brazilian recommended occupational dose limits, the maximum number of examination that any member of the staff can perform was calculated
Full Text Available Craniopharyngiomas are slow growing tumours arising from remnants of the craniopharyngeal duct and occupy the sellar region. The patients may remain asymptomatic for long duration or present with headache or visual disturbances. Surgery is the mainstay of the treatment. Traditionally these tumours have been removed by neurosurgeons through the cranial approach but the advent of nasal endoscopes has opened new avenues for ENT surgeons to treat such patients. We hereby present a case of craniopharyngioma who was successfully treated by Trans-nasal Hypophysectomy.
Schmidt, Arthur; Bauder, Markus; Riecken, Bettina; Caca, Karel
Management of subepithelial tumors (SETs) remains challenging. Endoscopic ultrasound (EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods.
Nickel, Felix; Brzoska, Julia Anja; Gondan, Matthias
Objective: This study compared virtual reality (VR) training with low cost blended learning (BL) in a structured training program. Background: Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks. Methods: Laparoscopy-naïve medical students...... were randomized in two groups stratified for gender. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, USA). Each group trained 3×4 hours...
Sammartino, P; De Cesare, A; Barillari, P; Bononi, M; Chirletti, P; Bovino, A; Atella, F; Cioè, I
From March 1992 to September 1994, 281 patients were submitted to laparoscopic cholecystectomy for cholelithiasis. 27 patients were admitted with diagnosis of acute cholecystitis and in 17 patients common duct stones were discovered and managed by ERCP before laparoscopic procedure. Surgical procedure was the standard one described by Cox. The mean duration of the operation was 60 minutes and was significantly related to the surgeon's experience; the incedence of conversion to open procedure was 5.7%. There was no postoperative mortality; the total morbility rate was 2.8%, with 3 major complications, and 5 minor complications.
Uriza, Luis F; Rodriguez Jose L; Caballero, Ligia M.
We report a case of a woman who consulted for right upper quadrant abdominal pain with history of cholecystectomy six weeks ago. The ultrasound showed sub phrenic and peri hepatic nodular images, interpreted as biliary stones, confirmed with CT. Some of these nodules showed peripheral enhancement and suggested the presence of abscesses. The patient underwent surgery confirming the imaging findings. The case is very important for the role of imaging studies in the diagnostic approach of a surgical complication which has various clinical presentations that range from the absence of symptoms to a septic life-threatening disease.
Bala S Bhaskar
Full Text Available Bartter′s syndrome is a rare inherited anamoly with defect in the thick segment of the ascending limb of the loop of Henle, with reduced reabsorption of potassium. Growth is affected with worsening renal function, hypokalaemia, hypochloraemic metabolic alkalosis, hypocalcemia, hypomagnesemia, increased levels of aldosterone, renin and angiotensin without hypertension and lack of responses to vasopressors. Treatment consists of potassium supplementation along with other medications. We present the case report, probably the first, of a child suffering from Bartter′s syndrome with gall stones posted for laparoscopic cholecystectomy. The pre-operative correction of hypokalemia and successful anaesthetic and fluid and electrolyte management of the patient are discussed.
Valadez-Caballero, David; González-Santamaría, Roberto; Soto-Mendoza, Héctor; Alberto Blanco-Figueroa, Jorge; Flores-Pantoja, Juan Manuel
Complications associated with choledocholithiasis are uncommon during pregnancy. However, when it occurs, the morbidity and mortality related for the product and the mother increases, so a proper treatment is imperative in these patients. A 25-year-old pregnant woman on her second trimester. The current condition was started four days prior to the hospital admission with abdominal pain in the right upper quadrant with nausea and vomit.Twenty-four hours later jaundice and dark urine is observed. Physical examination shows scleral jaundice, right upper quadrant abdominal pain without peritoneal irritation. Uterus at umbilicus level without uterine activity. Uterus at umbilicus level without uterine activity. Laboratory tests showed elevated bilirubin and transaminases without leukocytosis; ultrasound reported live intrauterine unique product, with a heart rate of 128 beats per minute, gallbladder with multiple images inside that cast acoustic shadowing, and a 10 mm common bile duct dilated bile duct with dilatation of intrahepatic bile ducts. It was perform laparoscopic cholecystectomy with intraoperative cholangiography and placement of a transcystic jaguar guide for selective cannulation of the common bile duct. Intraoperative endoscopic retrograde cholangiopancreatography was performed with endoscopic stone extraction. The outcome was satisfactory with a hospital discharge at 48 hours. Current evidence has shown that the combined use of laparoscopy and therapeutic endoscopic cholangiography in one step is effective for the treatment of choledocholithiasis, decreasing the risk of complications associated with cannulation of the bile duct.
Pellegrini, Pablo; Campana, Juan Pablo; Dietrich, Agustín; Goransky, Jeremías; Glinka, Juan; Giunta, Diego; Barcan, Laura; Alvarez, Fernando; Mazza, Oscar; Sánchez Claria, Rodrigo; Palavecino, Martin; Arbues, Guillermo; Ardiles, Victoria; de Santibañes, Eduardo; Pekolj, Juan; de Santibañes, Martin
Acute calculous cholecystitis represents one of the most common complications of cholelithiasis. While laparoscopic cholecystectomy is the standard treatment in mild and moderate forms, the need for antibiotic therapy after surgery remains undefined. The aim of the randomised controlled Cholecystectomy Antibiotic Randomised Trial (CHART) is therefore to assess if there are benefits in the use of postoperative antibiotics in patients with mild or moderate acute cholecystitis in whom a laparoscopic cholecystectomy is performed. A single-centre, double-blind, randomised trial. After screening for eligibility and informed consent, 300 patients admitted for acute calculus cholecystitis will be randomised into two groups of treatment, either receiving amoxicillin/clavulanic acid or placebo for 5 consecutive days. Postoperative evaluation will take place during the first 30 days. Postoperative infectious complications are the primary end point. Secondary end points are length of hospital stay, readmissions, need of reintervention (percutaneous or surgical reinterventions) and overall mortality. The results of this trial will provide strong evidence to either support or abandon the use of antibiotics after surgery, impacting directly in the incidence of adverse events associated with the use of antibiotics, the emergence of bacterial resistance and treatment costs. This study and informed consent sheets have been approved by the Research Projects Evaluating Committee (CEPI) of Hospital Italiano de Buenos Aires (protocol N° 2111). The results of the trial will be reported in a peer-reviewed publication. NCT02057679. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Müller, Michaela; Eckardt, Alexander J; Wehrmann, Till
Achalasia is a primary esophageal motor disorder. The etiology is still unknown and therefore all treatment options are strictly palliative with the intention to weaken the lower esophageal sphincter (LES). Current established endoscopic therapeutic options include pneumatic dilation (PD) or botulinum toxin injection. Both treatment approaches have an excellent symptomatic short term effect, and lead to a reduction of LES pressure. However, the long term success of botulinum toxin (BT) injection is poor with symptom recurrence in more than 50% of the patients after 12 mo and in nearly 100% of the patients after 24 mo, which commonly requires repeat injections. In contrast, after a single PD 40%-60% of the patients remain asymptomatic for ≥ 10 years. Repeated on demand PD might become necessary and long term remission can be achieved with this approach in up to 90% of these patients. The main positive predictors for a symptomatic response to PD are an age > 40 years, a LES-pressure reduction to 40 years, was nearly equivalent to surgery. A new promising technique might be peroral endoscopic myotomy, although long term results are needed and practicability as well as safety issues must be considered. Treatment with a temporary self expanding stent has been reported with favorable outcomes, but the data are all from one study group and must be confirmed by others before definite recommendations can be made. In addition to its use as a therapeutic tool, endoscopy also plays an important role in the diagnosis and surveillance of patients with achalasia. PMID:23951393
Peroral endoscopic myotomy （POEM） incorporatesconcepts of natural orifice translumenal endoscopicsurgery and achieves endoscopic myotomy by utilizinga submucosal tunnel as an operating space.Although intended for the palliation of symptoms ofachalasia, there is mounting data to suggest it is alsoefficacious in the management of spastic esophagealdisorders. The technique requires an understanding ofthe pathophysiology of esophageal motility disorders aswell as knowledge of surgical anatomy of the foregut.POEM achieves short term response in 82% to 100% ofpatients with minimal risk of adverse events. In addition,it appears to be effective and safe even at the extremesof age and regardless of prior therapy undertaken.Although infrequent, the ability of the endoscopist tomanage an intraprocedural adverse event is critical asfailure to do so could result in significant morbidity. Themajor late adverse event is gastroesophageal refluxwhich appears to occur in 20% to 46% of patients.Research is being conducted to clarify the optimaltechnique for POEM and a personalized approach bymeasuring intraprocedural esophagogastric junctiondistensibility appears promising. In addition toesophageal disorders,POEM is being studied in themanagement of gastroparesis （gastric pyloromyotomy）with initial reports demonstrating technical feasibility.Although POEM represents a paradigm shift themanagement of esophageal motility disorders, theresults of prospective randomized controlled trials withlong-term follow up are eagerly awaited.
Decristoforo, P; Kaltseis, J; Fritz, A; Edlinger, M; Posch, W; Wilflingseder, D; Lass-Flörl, C; Orth-Höller, D
Several outbreaks of severe infections due to contamination of gastrointestinal (GI) endoscopes, mainly duodenoscopes, have been described. The rate of microbial endoscope contamination varies dramatically in literature. The aim of this multicentre prospective study was to evaluate the hygiene quality of endoscopes and automated endoscope reprocessors (AERs) in Tyrol/Austria. In 2015 and 2016, a total of 463 GI endoscopes and 105 AERs from 29 endoscopy centres were analysed by a routine (R) and a combined routine and advanced (CRA) sampling procedure and investigated for microbial contamination by culture-based and molecular-based analyses. The contamination rate of GI endoscopes was 1.3%-4.6% according to the national guideline, suggesting that 1.3-4.6 patients out of 100 could have had contacts with hygiene-relevant microorganisms through an endoscopic intervention. Comparison of R and CRA sampling showed 1.8% of R versus 4.6% of CRA failing the acceptance criteria in phase I and 1.3% of R versus 3.0% of CRA samples failing in phase II. The most commonly identified indicator organism was Pseudomonas spp., mainly Pseudomonas oleovorans. None of the tested viruses were detected in 40 samples. While AERs in phase I failed (n = 9, 17.6%) mainly due to technical faults, phase II revealed lapses (n = 6, 11.5%) only on account of microbial contamination of the last rinsing water, mainly with Pseudomonas spp. In the present study the contamination rate of endoscopes was low compared with results from other European countries, possibly due to the high quality of endoscope reprocessing, drying and storage. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Hernandez, Jonathan; Ross, Sharona; Morton, Connor; McFarlin, Kellie; Dahal, Sujat; Golkar, Farhaad; Albrink, Michael; Rosemurgy, Alexander
The applications of laparoendoscopic single-site (LESS) surgery, including cholecystectomy, are occurring quickly, although little is generally known about issues associated with the learning curve of this new technique including operative time, conversion rates, and safety. We prospectively followed all patients undergoing LESS cholecystectomy, and compared operations undertaken at our institutions in cohorts of 25 patients with respect to operative times, conversion rates, and complications. One-hundred fifty patients of mean age 46 years underwent LESS cholecystectomy. No significant differences in operative times were demonstrable between any of the 25-patient cohorts operated on at our institution. A significant reduction in operative times (p < 0.001) after completion of 75 LESS procedures was, however, identified with the experience of a single surgeon. No significant reduction in the number of procedures requiring an additional trocar(s) or conversion to open operations was observed after completion of 25 LESS cholecystectomies. Complication rates were low, and not significantly different between any 25-patient cohorts. For surgeons proficient with multi-incision laparoscopic cholecystectomy, the learning curve for LESS cholecystectomy begins near proficiency. Operative complications and conversions were infrequent and unchanged across successive 25-patient cohorts, and were similar to those reported for multi-incision laparoscopic cholecystectomy after the learning curve. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Pérez-Ayuso, Rosa María; Hernández, Verónica; González, Berta; Carvacho, Claudia; Navarrete, Carlos; Alvarez, Manuel; González, Robinson; Marshall, Guillermo; Miquel, Juan Francisco; Nervi, Flavio
Cholelithiasis is the second cause of hospital admissions in Chile. To study the prevalence of symptomatic gallstone disease and opportunity of cholecystectomy in La Florida, Santiago and among Mapuche Indians in Huapi Island. In the period 2000-2001, we contacted to 71% (1127 subjects) and to 61% (145 subjects) patients of La Florida and Huapi Island, respectively, that had previously participated in an epidemiological study on cholelithiasis in 1993. We defined symptomatic gallstone patients as those with a history of biliary colic. Each patient was subjected to gallbladder ultrasound. In 1993, 30-35% of gallstone patients were symptomatic (approximately 70% women). During the lapse 1993-2001, only 50% of subjects from La Florida and 25% of patients from Huapi Island were cholecystectomized (p Mapuche Indians from Huapi, cholecystectomy was indicated in 2001. After five months of the indication, only one of these subjects had been operated. Laparoscopic cholecystectomy represented 40% of all cholecystectomies performed in the National Health Service Hospitals. This study demonstrates an unacceptable high prevalence of symptomatic gallstone patients remaining non-operated in both the urban and rural communities. This reciprocally correlates with the high frequency of emergency cholecystectomies and the high incidence of gallbladder cancer among Chileans. This study contrasts negatively with the situation of Scotland, where 73.5% of cholecystectomies were laparoscopic in 1998-1999. To reach Scotland standards, the Chilean Public Health System should increase the number of cholecystectomies from 27,000 in 2001 to 57,510
Feng, Yuanyuan; Wong, Christopher; Park, Adrian; Mentis, Helena
Although simulation-based training allows residents to become proficient in surgical skills outside the OR, residents still depend on senior surgeons' guidance in transferring skills accumulated from simulators into the operating room. This study aimed to identify and classify explicit instructions made by attending surgeons to their residents during laparoscopic surgery. Through these instructions, we examined the role gaze guidance plays in OR-based training. A total of ten laparoscopic cholecystectomy cases being performed by PGY4 residents were analyzed. The explicit directional instructions given by the mentoring attending surgeons to their residents were identified and classified into four categories based on their locations in the coordinate system. These categories were further combined into two classes, based on the target of instructions. The frequencies of instructions in the two classes were compared, and effect size was calculated. There were 1984 instructions identified in the ten cases. The instructions were categorized into instrument guidance (38.51%) and gaze guidance (61.49%). The instrument guidance focused on moving the instruments to perform surgical tasks, including directions to targets, instrument manipulation, and instrument interaction. The gaze guidance focused on achieving common ground during the operation, including target identification and target fixation. The frequency of gaze guidance is significantly higher than instrument guidance in a laparoscopic cholecystectomy (p guidance has become the main focus of OR-based training. The results show a tight connection between adopting expert gaze and performing surgical tasks and suggest that gaze training should be integrated into the simulation training.
Ye, Jian; Yang, Chaoyu; Gan, Qi; Ma, Rong; Zhang, Zeshu; Chang, Shufang; Shao, Pengfei; Zhang, Shiwu; Liu, Chenhai; Xu, Ronald
In this paper we proposed a portable fluorescence microscopic imaging system to prevent iatrogenic biliary injuries from occurring during cholecystectomy due to misidentification of the cystic structures. The system consisted of a light source module, a CMOS camera, a Raspberry Pi computer and a 5 inch HDMI LCD. Specifically, the light source module was composed of 690 nm and 850 nm LEDs, allowing the CMOS camera to simultaneously acquire both fluorescence and background images. The system was controlled by Raspberry Pi using Python programming with the OpenCV library under Linux. We chose Indocyanine green(ICG) as a fluorescent contrast agent and then tested fluorescence intensities of the ICG aqueous solution at different concentration levels by our fluorescence microscopic system compared with the commercial Xenogen IVIS system. The spatial resolution of the proposed fluorescence microscopic imaging system was measured by a 1951 USAF resolution target and the dynamic response was evaluated quantitatively with an automatic displacement platform. Finally, we verified the technical feasibility of the proposed system in mouse models of bile duct, performing both correct and incorrect gallbladder resection. Our experiments showed that the proposed system can provide clear visualization of the confluence between the cystic duct and common bile duct or common hepatic duct, suggesting that this is a potential method for guiding cholecystectomy. The proposed portable system only cost a total of $300, potentially promoting its use in resource-limited settings.
Alekberzade, A V; Lipnitsky, E M; Krylov, N N; Sundukov, I V; Badalov, D A
To analyze the outcomes of single-port laparoscopic cholecystectomy. Early and long-term postoperative period has been analyzed in 240 patients who underwent laparoscopic cholecystectomy (LCE) including 120 cases of single-port technique and 120 cases of four-port technique. Both groups were compared in surgical time, pain syndrome severity (visual analog scale), need for analgesics, postoperative complications, hospital-stay, daily activity recovery and return to physical work, patients' satisfaction of surgical results and their aesthetic effect. It was revealed that single-port LCE is associated with lower severity of postoperative pain, quick recovery of daily activity and return to physical work, high satisfaction of surgical results and their aesthetic effect compared with four-port LCE. Disadvantages of single-port LCE include longer duration of surgery, high incidence of postoperative umbilical hernia. However hernia was predominantly observed during the period of surgical technique development. Further studies to standardize, evaluate the safety and benefits of single-port LCE are necessary.
Sumanta Kumar Ghosh
Full Text Available Double gallbladder is a rare embryological anomaly of clinical significance. Despite availability of modern imaging, only 50% of recently reported cases had preoperative diagnosis, which is desirable in every case to avoid serious operative complications. Double pathology in double gallbladder is extremely rare with only 3 reporting′s available till date to the best of author′s knowledge. With a preoperative diagnosis of double gallbladder, laparoscopic cholecystectomy can be safely and successfully performed with meticulous dissection, aided by operative cholangiogram. However in all such attempts a lower threshold should be kept for conversion to open surgery. Awareness about this anomaly amongst radiologists and surgeons is of crucial importance. Double gallbladder does not present with any specific symptom, neither it increases disease possibility in either lobe. Prophylactic cholecystectomy has no role in asymptomatic cases diagnosed accidentally. Author reports a case of a symptomatic young male with double gallbladder who presented with short history of dyspepsia, abdominal pain and fever. Definite preoperative diagnosis was reached with ultrasound scan and magnetic resonance cholangio pancreatography and subsequently dealt with laparoscopically. Calculous cholecystitis affected one lobe and acalculous empyema the other. While the 1st lobe drained though a cystic duct into common bile duct (CBD, the 2nd was without any communication with either CBD or its counterpart, thus remained as a blind vesicle.
Ghosh, Sumanta Kumar
Double gallbladder is a rare embryological anomaly of clinical significance. Despite availability of modern imaging, only 50% of recently reported cases had preoperative diagnosis, which is desirable in every case to avoid serious operative complications. Double pathology in double gallbladder is extremely rare with only 3 reporting's available till date to the best of author's knowledge. With a preoperative diagnosis of double gallbladder, laparoscopic cholecystectomy can be safely and successfully performed with meticulous dissection, aided by operative cholangiogram. However in all such attempts a lower threshold should be kept for conversion to open surgery. Awareness about this anomaly amongst radiologists and surgeons is of crucial importance. Double gallbladder does not present with any specific symptom, neither it increases disease possibility in either lobe. Prophylactic cholecystectomy has no role in asymptomatic cases diagnosed accidentally. Author reports a case of a symptomatic young male with double gallbladder who presented with short history of dyspepsia, abdominal pain and fever. Definite preoperative diagnosis was reached with ultrasound scan and magnetic resonance cholangio pancreatography and subsequently dealt with laparoscopically. Calculous cholecystitis affected one lobe and acalculous empyema the other. While the 1st lobe drained though a cystic duct into common bile duct (CBD), the 2nd was without any communication with either CBD or its counterpart, thus remained as a blind vesicle.
Jurczak, F; Pousset, J-P; Raffaitin, P
To evaluate a newly developed cholecystectomy technique which combines classical dissection with currently available mini-instrumentation (3 and 5 mm) and removal of the gallbladder through a short gastrotomy. After a feasibility study, we set up a protocol for this procedure using instrumentation currently available on the market. The resected gallbladder was removed through a short gastrotomy on the anterior gastric wall, thereby minimizing abdominal wall trauma and permitting the patient to resume physical activity more quickly with no risk of trocar herniation. Cholecystectomy was performed by the described technique in 18 of 23 eligible patients between April 2008 and August 2008. There were seven males and 11 females with a mean age of 48 (range: 28-77); median BMI was 30 kg/m2 (range: 22-36). Eleven patients had a gallstone larger than 12 mm. There were no postoperative complications and recovery was rapid for all patients in our study. This procedure is technically feasible, safe and reproducible; results are good with minimal trauma to the abdominal wall. Normal physical activity can be rapidly resumed with no risk of incisional hernia.
Park, Woo Young; Lee, Kwang Ho; Lee, Young Bok; Kim, Myeong Hoon; Lim, Hyun Kyo; Choi, Jong Bum
Laparoscopic upper abdominal surgery can cause spontaneous respiration due to diaphragmatic stimulation and intra-abdominal CO 2 inflation. Therefore, sufficient muscle relaxation is necessary for a safe surgical environment. We investigated if the combination of rocuronium and cisatracurium can counteract the delayed onset of cisatracurium's action and delayed recovery of muscle relaxation and whether the dosage of rocuronium, which is metabolized hepatically, can be reduced. A total of 75 patients scheduled for laparoscopic cholecystectomy with an American Society of Anesthesiology physical status I-II, in the age range of 20-60 years, and with a 20-30 kg/m 2 body mass index were included in the study. The patients were divided into the following groups: combination group (Group RC, rocuronium 0.3 mg/kg and cisatracurium 0.05 mg/kg), rocuronium group (Group R, rocuronium 0.6 mg/kg), and cisatracurium group (Group C, cisatracurium 0.1 mg/kg), and the onset, 25% duration, recovery index, and addition/time ratio were measured. Patients in Group RC exhibited a significantly different addition/time ratio compared with patients in the other two groups (p = 0.003). During laparoscopic cholecystectomy, the 95% effective dose of rocuronium in combination with cisatracurium is expected to provide a sufficient muscle relaxant effect.
Slack, Daniel R; Grisby, Shaunda; Dike, Uzoamaka Kimberly; Kohli, Harjeet
Many risk factors have been identified in minimally invasive cholecystectomies that lead to higher complications and conversion rates. No study that we encountered looked at nonvisualization of the gallbladder (GB) during surgery as a risk factor. We hypothesized that nonvisualization was associated with an increased risk of complications and could be an early intraoperative identifier of a higher risk procedure. Recognizing this could allow surgeons to be aware of potential risks and to be more likely to convert to open for the safety of the patient. We looked at minimally invasive cholecystectomies performed at our institution from January 2015 through April 2016 and had the performing resident fill out a survey after the surgery. Outcomes were conversion rates, intraoperative complications, and blood loss and were analyzed via Pearson χ 2 test or Mann-Whitney U test. The primary outcome showed a conversion rate of 37% in nonvisualized GBs versus 0% in visualized ( P = .001). Secondary outcomes showed significant differences in GB perforations (74% vs 13%, P = .001), omental vessel bleeding (16% vs. 0%, P = .005), and EBL (46 mL vs 29 mL, P = .001). Intraoperative nonvisualization of the GB after adequate positioning caused significantly increased risk of intraoperative complications and conversion. This knowledge could be useful during intraoperative assessment, to decide whether a case should be continued as a minimally invasive procedure or converted early to help reduce risk to the patient. Further randomized controlled studies should be performed to further demonstrate the value of this assessment.
Bisgaard, Thue; Schulze, S.; Hjortso, N.C.
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...
Ivan J Pokorny
Full Text Available Initial 100 consecutive laparoscopic cholecystectomies performed by one surgeon were studied prospectively. The standard technique was modified in that the gallbladder removal was accomplished through the upper epigastric incision; there was no need to change the location of the camera. The conversion rate to open cholecystectomy was 2%. There were no major complications and no mortality. Minor complications occurred in 9% of the patients. Laparoscopic cholecystectomy can be performed safely in a community hospital setting. Simplified technique of gallbladder extraction is recommended.
Efficiency and Safety of One-Step Procedure Combined Laparoscopic Cholecystectomy and Eretrograde Cholangiopancreatography for Treatment of Cholecysto-Choledocholithiasis: A Randomized Controlled Trial.
Liu, Zhiyi; Zhang, Luyao; Liu, Yanling; Gu, Yang; Sun, Tieliang
We aimed to evaluate the efficiency and safety of one-step procedure combined endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) for treatment of patients with cholecysto-choledocholithiasis. A prospective randomized study was performed on 63 consecutive cholecysto-choledocholithiasis patients during 2008 and 2011. The efficiency and safety of one-step procedure was assessed by comparing the two-step LC with ERCP + endoscopic sphincterotomy (EST). Outcomes including intraoperative features, postoperative features (length of stay and postoperative complications) were evaluated. One- or two-step procedure of LC with ERCP + EST was successfully performed in all patients, and common bile duct stones were completely removed. Statistical analyses showed that length of stay and pulmonary infection rate were significantly lower in the test group compared with that in the control group (P 0.05). The one-step procedure of LC with ERCP + EST is superior to the two-step procedure for treatment of patients with cholecysto-choledocholithiasis regarding to the reduced hospital stay and inhibited occurrence of pulmonary infections. Compared with two-step procedure, one-step procedure of LC with ERCP + EST may be a superior option for cholecysto-choledocholithiasis patients treatment regarding to hospital stay and pulmonary infections.
Harith M. Alkhateeb
Conclusions: (1 Following endoscopic retrograde cholangiopancreatography, a patient’s complaints should not be ignored. (2 A massive biloma can occur due to such procedures. (3 Conservative treatment with minimal invasive technique can prove to be effective.
Full Text Available Oriental cholangiohepatitis (OCH is a disease characterized by intrabiliary pigment stone formation, resulting in recurrent bouts of cholangitis. OCH is found mostly in Southeast Asia but it is occasionally recognized in Western societies. OCH etiology is largely unknown. We report our experience with a patient who presented with acute cholecystitis. Following laparoscopic cholecystectomy, she developed acute cholangitis due to multiple biliary tree stones. She underwent ERCP to clear the stones from common bile duct. For the intrahepatic stones, she underwent novel hybrid percutaneous endoscopic technique. The procedure resulted in complete clearance of biliary tree stones and resolution of her symptoms. The aim of this case is to increase awareness of this disease when patients from endemic areas present with biliary stones.
Natural orifice translumenal endoscopic surgery (NOTES) has captured the interest of interventional endoscopists and may represent the next stage of evolution of minimally invasive surgery. It provides the potential for performance of incisionless operations. It is gaining momentum both in the animal laboratory and in human case reports. Developments in the field of NOTES have led to the formation of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) in 2006. In this special issue, the current trends in NOTES in the field of hepatobiliary and pancreatic surgery are featured, including NOTES cholecystectomy, hepatectomy splenectomy, pancreatic necrosectomy, and the future of NOTES. In this issue, we discuss the potential benefits of these procedures in hepatobiliary and pancreatic surgery. We have just started the evaluation process for this new technology. The concept of NOTES is becoming established and is enormously advantageous for the patient. Both the surgeon and gastroenterologist should contribute to developing NOTES in making use of their specialties.
Horii, S.C.; Garra, B.S.; Zeman, R.K.; Krasner, B.H.; Lo, S.C.B.; Davros, W.J.; Silverman, P.M.; Cattau, E.L.; Fleischer, D.E.; Benjamin, S.B.S.B.
As part of the clinical evaluation of image management and communications system (IMACS), the authors undertook a prospective study to compare conventional film versus digitized film viewed on a workstation. Twenty-five each of normal and abnormal endoscopic retrograde cholangiopancreatographic (ERCP) studies were digitized with a 1,684 x 2,048-pixel matrix and evaluated in a single-blind fashion on the workstation. The resulting interpretations were then compared with those resulting from interpretation of film (spot film and 100-mm photospot) images. They report that no significant differences were found in ability to see anatomic detail or pathology. A second study involved performing 10 ERCP studies in a lithotripsy suite equipped with biplane digital fluoroscopy. The digital video displays were comparable in quality to that of film. Progress is being made in using the IMACS for archiving and retrieval of all current ERCP images
Gay, F; el Nawar, A; Van Gossum, A
From March 87 to March 92, fifty eight patients were referred to our department for percutaneous endoscopic gastrostomy (PEG). The modality of the feeding tube insertion is described. The most common indications for placement were neurologic disorders in 62% of the cases (n = 36) and malignant diseases in 32% (n = 19). The success rate of the technique was 98.3% (n = 57). No procedure-related mortality was observed. A low rate of major complication (1.7%) and minor complication (10.5%) was noted. Feeding tubes were removed in 21% of patients (n = 12); none of them with malignant disease. Survival curve analysis demonstrated that 50% of patients died within 3 months of PEG placement. Such results raise questions about the selection of patients undergoing PEG. Our experience of patients undergoing PEG. Our experience suggests that PEG is easy and safe, even in debilitated patients, having an acceptable life expectancy.
Yad Ram Yadav
Full Text Available Endoscopic third ventriculostomy (ETV is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intra-operative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post-operative, but fatal complications can develop late which indicate an importance of
Single-Incision Transumbilical Surgery (SITUS) versus Single-Port Laparoscopic Surgery and conventional laparoscopic surgery: a prospective randomized comparative study of performance with novices in a dry laboratory.
Schoenthaler, Martin; Avcil, Tuba; Sevcenco, Sabina; Nagele, Udo; Hermann, Thomas E W; Kuehhas, Franklin E; Shariat, Shahrokh F; Frankenschmidt, Alexander; Wetterauer, Ulrich; Miernik, Arkadiusz
To evaluate the Single-Incision Transumbilical Surgery (SITUS) technique as compared to an established laparoendoscopic single-site surgery (LESS) technique (Single-Port Laparoscopic Surgery, SPLS) and conventional laparoscopy (CLS) in a surgical simulator model. Sixty-three medical students without previous laparoscopic experience were randomly assigned to one of the three groups (SITUS, SPLS and CLS). Subjects were asked to perform five standardized tasks of increasing difficulty adopted from the Fundamentals of Laparoscopic Surgery curriculum. Statistical evaluation included task completion times and accuracy. Overall performances of all tasks (except precision cutting) were significantly faster and of higher accuracy in the CLS and SITUS groups than in the SPLS group (p = 0.004 to p port-assisted LESS technique such as SPLS. The demonstrated advantages of SITUS may be attributed to a preservation of the basic principles of conventional laparoscopy, such as the use of straight instruments and an adequate degree of triangulation.
Reddy, Nischita K; Ioncica, Ana Maria; Saftoiu, Adrian
Contrast agents are increasingly being used to characterize the vasculature in an organ of interest, to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures. We review the mechanisms of action of first, second and third generation contrast...... agents and their use in various endoscopic procedures in the gastrointestinal tract. Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy, assessment of depth of invasion of esophageal, gastric and gall bladder...
L.S.G.L. Wauben; R.H.M. Goossens (Richard); J.F. Lange (Johan)
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
van Bruwaene, Siska; Schijven, Marlies P.; Napolitano, Daniel; de Win, Gunter; Miserez, Marc
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
Mohammad Ali Pakaneh
Full Text Available Abstract Backgrounds: There are controversies among surgeons about prophylaxis of deep vein thrombosis (DVT in laparoscopic cholecystectomy. The aim of this study was the assessment of patients’ condition after laparoscopic cholecystectomy without any prophylactic measure. Methods: 100 cases of laparoscopic cholecystectomy without DVT prophylaxis were followed by duplex scanning in the first postoperative day and by physical examination and patient history at the first to second postoperative week however no clinical sign was found for DVT. Results: Only one case of partially thrombosis (1% was found by duplex scanning which was managed conservatively. Conclusion: Laparoscopic cholecystectomy may consider as a low-risk procedure and routine prophylaxis may not be justified in the absence of other risk factor.
Andersen, T F; Brønnum-Hansen, H; Jørgensen, T
It has been a prevailing assumption that cholecystectomy patients by and large follow a pattern of survival similar to that of the normal population. This paper presents a population-based study of the long-term survival after cholecystectomy in order to reassess this assumption. Based on data...... to both hysterectomy patients and a sample of the female population. Adjusting for age and other covariates, patients with psychiatric hospital admissions prior to surgery experienced a threefold risk of dying within 6 years after surgery. Patients with prior somatic admissions and patient with acute...... admissions had a relative risk (RR) of about 1.5. Cholecystectomy patients had a significantly increased mortality when compared to hysterectomy patients, RR = 1.3 (1.1-1.6), and to the population sample. Heart diseases and cancer occurred significantly more often as causes of death among cholecystectomy...
Full Text Available Available evidence of the relationship between cholelithiasis, cholecystectomy, and risk of liver cancer and hence we conducted a meta-analysis to investigate the relationships. PubMed, EMBASE, and ISI Web of Knowledge were searched to identify all published cohort studies and case-control studies that evaluated the relationships of cholelithiasis, cholecystectomy and risk of liver cancer and single-cohort studies which evaluated the incidence of liver cancer among patients who understood cholecystectomy (up to February 2013. Comprehensive meta-analysis software was used for meta-analysis. A total of 11 observational studies (six cohort studies and five case-control studies were included in this meta-analysis. The result from meta-analysis showed that cholecystectomy (risk ratio [RR]: 1.59, 95% confidence interval [CI]: 1.01-2.51, I2 = 72% and cholecystolithiasis (RR: 5.40, 95% CI: 3.69-7.89, I2 = 93% was associated with more liver cancer, especially for intrahepatic cholangiocarcinoma (ICC (cholecystectomy: RR: 3.51, 95% CI: 1.84-6.71, I2 = 26%; cholecystolithiasis: RR: 11.06, 95% CI: 6.99-17.52, I2 = 0%. The pooled standardized incidence rates (SIR of liver cancer in patients who understood cholecystectomy showed cholecystectomy might increase the incidence of liver cancer (SIR: 1.57, 95% CI: 1.13-2.20, I2 = 15%. Based on the results of the meta-analysis, cholecystectomy and cholecystolithiasis seemed to be involved in the development of liver cancer, especially for ICC. However, most available studies were case-control studies and short-term cohort studies, so the future studies should more long-term cohort studies should be well-conducted to evaluate the long-term relationship.
Campbell, Beth M; Lambrianides, Andreas L; Dulhunty, Joel M
The laparoscopic approach to cholecystectomy has overtaken open procedures in terms of frequency, despite open procedures playing an important role in certain clinical situations. This study explored exposure and confidence of Australasian surgical trainees and new fellows in performing an open versus laparoscopic cholecystectomy. An online survey was disseminated via the Royal Australasian College of Surgeons to senior general surgery trainees (years 3-5 of surgical training) and new fellows (fellowship within the previous 5 years). The survey included questions regarding level of experience and confidence in performing an open cholecystectomy and converting from a laparoscopic to an open approach. A total of 135 participants responded; 58 (43%) were surgical trainees, 58 (43%) were fellows and 19 (14%) did not specify their level of training. Respondents who were involved in more than 20 open cholecystectomy procedures as an assistant or independent operator compared with those less exposed were more likely to feel confident to independently perform an elective open cholecystectomy (87.8% vs. 57.3%, P = 0.001), independently convert from a laparoscopic to open cholecystectomy (87.8% vs. 58.7%, P = 0.001) and independently perform an open cholecystectomy as a surgical consultant based on their level of exposure as a trainee (73.2% vs. 45.3%, P = 0.004). This study suggests the need to ensure surgical trainees are exposed to sufficient open cholecystectomies to enable confidence and skill with performing these procedures when indicated. Greater recognition of the need for exposure during training, including meaningful simulation, may assist. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.
Full Text Available This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease
Ali, A.; Saeed, S.; Khawaja, R.; Samnani, S.S
Laparoscopic cholecystectomy is considered to be gold standard treatment for symptomatic gall stones. Despite several benefits there are still disadvantages of laparoscopic cholecystectomy in difficult cases where anatomy is disturbed even in experienced hand. Aim of this study is to identify advantages of early conversion to open cholecystectomy in difficult cases and how it should not be associated with surgeon's failure. Methods: Observational study was conducted at tertiary care hospital of Karachi, Pakistan from January 2012 till June 2015. All patients who presented to general surgery department with symptomatic gall stones and planned for laparoscopic cholecystectomy was included in the study. Demographic data was collected. Preoperative workup includes baselines investigations with liver profile test and imaging study (ultrasound scan). All patient underwent laparoscopic cholecystectomy at first. Operative difficulties, incidence of conversion, reason for conversion and complication intra-operative or postoperative were recorded. Data was analyzed using SPSS 20. Results: Out of 1026 patients, 78.26 percent (803) were female. Mean age of patients were 41.30+-8.43 years (range 26-68 years). Common presenting symptoms were pain at upper abdomen and dyspepsia. Most of the patients had multiple gall stones (93.85 percent). Nine hundred and ninety-two patients (96.68 percent) of patients underwent successful laparoscopic cholecystectomy. This includes patients in whom dissections were difficult because of disturbed anatomy of calots triangle. Only 3.13 percent of patients were converted to open cholecystectomy. There was a significant difference (<0.05) in complications observed between completed and converted cholecystectomies. Conclusion: Conversion from laparoscopic to open procedure should be done in cases of technically difficult situations to avoid significant mortality and morbidity. Surgeons experience had a pivotal role in determining its need and
(CBD) stones or missed CBD stones underwent pre-operative or postoperative endoscopic retrograde cholangiopancreatography. Data sheets for patients, containing demographic, pre-operative, operative and postoperative findings, were prospectively generated. Pre-operative notes contained information on the presence ...
Gurusamy, Kurinchi Selvan; Vaughan, Jessica; Davidson, Brian R
Generally, before being operated on, patients will be given informal information by the healthcare providers involved in the care of the patients (doctors, nurses, ward clerks, or healthcare assistants). This information can also be provided formally in different formats including written information, formal lectures, or audio-visual recorded information. To compare the benefits and harms of formal preoperative patient education for patients undergoing laparoscopic cholecystectomy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2013), MEDLINE, EMBASE, and Science Citation Index Expanded to March 2013. We included only randomised clinical trials irrespective of language and publication status. Two review authors independently extracted the data. We planned to calculate the risk ratio with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) or standardised mean difference (SMD) with 95% CI for continuous outcomes based on intention-to-treat analyses when data were available. A total of 431 participants undergoing elective laparoscopic cholecystectomy were randomised to formal patient education (215 participants) versus standard care (216 participants) in four trials. The patient education included verbal education, multimedia DVD programme, computer-based multimedia programme, and Power Point presentation in the four trials. All the trials were of high risk of bias. One trial including 212 patients reported mortality. There was no mortality in either group in this trial. None of the trials reported surgery-related morbidity, quality of life, proportion of patients discharged as day-procedure laparoscopic cholecystectomy, the length of hospital stay, return to work, or the number of unplanned visits to the doctor. There were insufficient details to calculate the mean difference and 95% CI for the difference in pain scores at 9 to 24 hours (1 trial; 93 patients); and we did not identify clear evidence of
BACKGROUND: Small cell carcinoma of the cervix is a rare cancer, comprising less than 3% of all cervical neoplasms. It uniformly has a poor prognosis, and has a high mortality even with early stage disease. It can metastasise rapidly and metastatic sites include lung, liver, brain, bone, pancreas and lymph nodes. CASE: Here, we report the case of a 60-year-old woman with no symptoms of cervical pathology who developed post-renal failure following a laparoscopic cholecystectomy. The cause was bilateral ureteric obstruction from metastatic small cell cervical cancer and metastases were subsequently found on her gallbladder specimen. CONCLUSION: This is an unusual presentation of small cell cervical cancer and demonstrates the aggressive nature of this disease.
Marmorale, C; Scibé, R; Siquini, W; Massa, M; Brunelli, A; Landi, E
Laparoscopic cholecystectomy (VALC) represents the treatment of choice for the symptomatic gallstones. However the occurrence of an adenocarcinoma of the gallbladder results a controindication for this surgical technique. We present a case of a 52 years old woman who underwent a VALC; histology revealed a gallbladder adenocarcinoma. For this reason the patient underwent a second operation that is right hepatic trisegmentectomy. Six months later the patient presented with a parietal recurrence at the extraction site of the gallbladder. We discuss the possible mechanism responsible for carcinomatous dissemination during laparoscopic surgery and we raccommend the use of some procedures in order to limit the risk and eventually to treat a neoplastic parietal seeding. These complications suggest the problem about the utility and the future played by video assisted laparoscopic surgery in the diagnosis and treatment of intraabdominal malignancies.
Lehrskov, Lars Lang; Larsen, Søren S; Kristensen, Billy B
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...
Wakizaka, Yoshitaka; Sano, Syuichi; Nakanishi, Yoshimi; Koike, Yoshinobu; Ozaki, Susumu; Iwanaga, Rikizo; Uchino, Junichi.
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)
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.
Gumbs, Andrew A; Hoffman, John P
The role of minimally invasive surgery in the surgical management of gallbladder cancer is a matter of controversy. Because of the authors' growing experience with laparoscopic liver and pancreatic surgery, they have begun offering patients laparoscopic completion partial hepatectomies of the gallbladder bed with laparoscopic hepatoduodenal lymphadenectomy. The video shows the steps needed to perform laparoscopic resection of the residual gallbladder bed, the hepatoduodenal lymph node nodes, and the residual cystic duct stump in a setting with a positive cystic stump margin. The skin and fascia around the previous extraction site are resected, and this site is used for specimen retrieval during the second operation. To date, three patients have undergone laparoscopic radical cholecystectomy with hepatoduodenal lymph node dissection for gallbladder cancer. The average number of lymph nodes retrieved was 3 (range, 1-6), and the average estimated blood loss was 117 ml (range, 50-200 ml). The average operative time was 227 min (range, 120-360 min), and the average hospital length of stay was 4 days (range, 3-5 days). No morbidity or mortality was observed during 90 days of follow-up for each patient. Although controversy exists as to the best surgical approach for gallbladder cancer diagnosed after routine laparoscopic cholecystectomy, the minimally invasive approach seems feasible and safe, even after previous hepatobiliary surgery. If the previous extraction site cannot be ascertained, all port sites can be excised locally. Larger studies are needed to determine whether the minimally invasive approach to postoperatively diagnosed early-stage gallbladder cancer has any drawbacks.
Sujka, Joseph A; Safcsak, Karen; Bhullar, Indermeet S; Havron, William S
To determine if pager interruptions affect operative time, safety, or complications and management of pager issues during a simulated laparoscopic cholecystectomy. Twelve surgery resident volunteers were tested on a Simbionix Lap Mentor II simulator. Each resident performed 6 randomized simulated laparoscopic cholecystectomies; 3 with pager interruptions (INT) and 3 without pager interruptions (NO-INT). The pager interruptions were sent in the form of standardized patient vignettes and timed to distract the resident during dissection of the critical view of safety and clipping of the cystic duct. The residents were graded on a pass/fail scale for eliciting appropriate patient history and management of the pager issue. Data was extracted from the simulator for the following endpoints: operative time, safety metrics, and incidence of operative complications. The Mann-Whitney U test and contingency table analysis were used to compare the 2 groups (INT vs. NO-INT). Level I trauma center; Simulation laboratory. Twelve general surgery residents. There was no significant difference between the 2 groups in any of the operative endpoints as measured by the simulator. However, in the INT group, only 25% of the time did the surgery residents both adequately address the issue and provide effective patient management in response to the pager interruption. Pager interruptions did not affect operative time, safety, or complications during the simulated procedure. However, there were significant failures in the appropriate evaluations and management of pager issues. Consideration for diversion of patient care issues to fellow residents not operating to improve quality and safety of patient care outside the operating room requires further study. Copyright © 2018. Published by Elsevier Inc.
Meier, B; Schmidt, A; Caca, K
Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (>2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.
Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography. M Brand, D Bisoz. Abstract. Background. Antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP) is controversial. We set out to assess the current antibiotic prescribing practice among ...
Reilink, Rob; Kappers, Astrid M.L.; Stramigioli, Stefano; Misra, Sarthak
Background Advanced flexible endoscopes and instruments with multiple degrees of freedom enable physicians to perform challenging procedures such as the removal of large sections of mucosal tissue. However, these advanced endoscopes are difficult to control and require several physicians to
Gurusamy, Kurinchi Selvan; Vaughan, Jessica; Rossi, Michele; Davidson, Brian R
Traditionally, laparoscopic cholecystectomy is performed using two 10-mm ports and two 5-mm ports. Recently, a reduction in the number of ports has been suggested as a modification of the standard technique with a view to decreasing pain and improving cosmesis. The safety and effectiveness of using fewer-than-four ports has not yet been established. To assess the benefits (such as improvement in cosmesis and earlier return to activity) and harms (such as increased complications) of using fewer-than-four ports (fewer-than-four-ports laparoscopic cholecystectomy) versus four ports in people undergoing laparoscopic cholecystectomy for any reason (symptomatic gallstones, acalculous cholecystitis, gallbladder polyp, or any other condition). We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 8, 2013), MEDLINE, EMBASE, Science Citation Index Expanded, and the World Health Organization International Clinical Trials Registry Platform portal to September 2013. We included all randomised clinical trials comparing fewer-than-four ports versus four ports, that is, with standard laparoscopic cholecystectomy that is performed with two ports of at least 10-mm incision and two ports of at least 5-mm incision. Two review authors independently identified the trials and extracted the data. We analysed the data using both the fixed-effect and the random-effects models. For each outcome, we calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis, whenever possible. We found nine trials with 855 participants that randomised participants to fewer-than-four-ports laparoscopic cholecystectomy (n = 427) versus four-port laparoscopic cholecystectomy (n = 428). Most trials included low anaesthetic risk participants undergoing elective laparoscopic cholecystectomy. Seven of the nine trials used a single port laparoscopic cholecystectomy and the remaining two trials used three-port laparoscopic
Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M.
Background The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Methods Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. Results There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Conclusion Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it
Lu, Ping; Yang, Nan-Ping; Chang, Nien-Tzu; Lai, K Robert; Lin, Kai-Biao; Chan, Chien-Lung
Although numerous epidemiological studies on cholecystectomy have been conducted worldwide, only a few have considered the effect of socioeconomic inequalities on cholecystectomy outcomes. Specifically, few studies have focused on the low-income population (LIP). A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2003-2012. The International Classification of ICD-9-CM procedure codes 51.2 and 51.21-51.24 were identified as the inclusion criteria for cholecystectomy. Temporal trends were analyzed using a joinpoint regression, and the hierarchical linear modeling (HLM) method was used as an analytical strategy to evaluate the group-level and individual-level factors. Interactions between age, gender and SES were also tested in HLM model. Analyses were conducted on 225,558 patients. The incidence rates were 167.81 (95% CI: 159.78-175.83) per 100,000 individuals per year for the LIP and 123.24 (95% CI: 116.37-130.12) per 100,000 individuals per year for the general population (GP). After cholecystectomy, LIP patients showed higher rates of 30-day mortality, in-hospital complications, and readmission for complications, but a lower rate of routine discharge than GP patients. The hospital costs and length of stay for LIP patients were higher than those for GP patients. The multilevel analysis using HLM revealed that adverse socioeconomic status significantly negatively affects the outcomes of patients undergoing cholecystectomy. Additionally, male sex, advanced age, and high Charlson Comorbidity Index (CCI) scores were associated with higher rates of in-hospital complications and 30-day mortality. We also observed that the 30-day mortality rates for patients who underwent cholecystectomy in regional hospitals and district hospitals were significantly higher than those of patients receiving care in a medical center. Patients with a disadvantaged finance status appeared to be more vulnerable to cholecystectomy surgery
Dian, A.; Azam, U.F.; Malik, N.A.; Khan, J.S.; Khan, M.
Introduction: Open cholecystectomy (OC) has gradually been superseded by laparoscopic cholecystectomy (LC) for the treatment of cholelithiasis. Laparoscopic cholecystectomy is associated with fewer complications than open cholecystectomy when performed in experienced hands. The study was conducted to compare the two techniques for management of symptomatic gall stones. Objective: Our objective was to compare the management outcomes of laparoscopic cholecystectomy with those of open holecystectomy in the treatment of symptomatic cholelithiasis. Study Design: Quasi experimental study. Settings: It was carried out at Surgical Unit - I of Holy Family Hospital, Rawalpindi. Subjects and Methods: Eighty consecutive patients with symptomatic cholelithiasis confirmed on ultrasonography from September 2007 to March 2008 were included in the study. They were randomly allocated to LC or OC and were eventually operated. Results: Mean operating time of LC was 64 minutes (30-90) (SD=13.4) where as in OC it was 37.12 minutes (25-70) (SD-9.6). Return of bowel sounds postoperatively was within 12 hours (9-18) (SD=3.25) in LC while it was 16 hours (9-30) in OC group (SD=4.75). Postoperative hospital stay was 1.5 days mean (1-4 days) (SD=0.71). In LC while it was 2.9 days (2-5) in OC group (SD=0.84). The duration of injectable analgesia requirement was 1.3 days (1-3) (SD=0.51) and 1.8 days (1-3) (SD=0.7) in LC and OC patients respectively. The gall bladder perforation was 22.5% in OC and 15% in LC. The common bile duct injury occurred in 2% of patients with LC while none with OC. The conversion rate was 5%. Conclusion: Laparoscopic cholecystectomy is safe treatment of cholelithiasis with short duration of postoperative hospital stay, lesser post operative pain, early return of normal bowel activity as compared to the open cholecystectomy. (author)
Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M
The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it cannot be justified for routine use. Our
Full Text Available Pancreatic cancer is devastating due to its poor prognosis. Patients require a multidisciplinary approach to guide available options, mostly palliative because of advanced disease at presentation. Palliation including relief of biliary obstruction, gastric outlet obstruction, and cancer-related pain has become the focus in patients whose cancer is determined to be unresectable. Endoscopic stenting for biliary obstruction is an option for drainage to avoid the complications including jaundice, pruritus, infection, liver dysfunction and eventually failure. Enteral stents can relieve gastric obstruction and allow patients to resume oral intake. Pain is difficult to treat in cancer patients and endoscopic procedures such as pancreatic stenting and celiac plexus neurolysis can provide relief. The objective of endoscopic palliation is to primarily address symptoms as well improve quality of life.
Maliniemi, H.; Muukka, E.
For over ten years, Imatran Voima Oy (IVO) has developed, complementary inspection methods for steam turbine condition monitoring, which can be applied both during operation and shutdown. One important method used periodically during outages is endoscopic inspection. The inspection is based on the method where the internal parts of the turbine is inspected through access borings with endoscope and where the magnified figures of the internal parts is seen on video screen. To improve inspection assurance, an image-processing based pattern recognition method for cracks has been developed for the endoscopic inspection of turbine blades. It is based on the deduction conditions derived from the crack shape. The computer gives an alarm of a crack detection and prints a simulated image of the crack, which is then checked manually
Patel, Bhupendra C K
Innumerable approaches to the ptotic brow and forehead have been described in the past. Over the last twenty-five years, we have used all these techniques in cosmetic and reconstructive patients. We have used the endoscopic brow lift technique since 1995. While no one technique is applicable to all patients, the endoscopic brow lift, with appropriate modifications for individual patients, can be used effectively for most patients with brow ptosis. We present the nuances of this technique and show several different fixation methods we have found useful.
Tapash Kumar Maitra
Full Text Available Background and objectives:Laparoscopic cholecystectomy (LC has virtually replaced conventional open cholecystectomy (OC as the standard procedure of treatment for cholelithiasis and cholecystitis. However, OC sometimes becomes a necessity considering the feasibility and safety of the surgical procedure. But the factors that demand conversion from LC to OC differ widely. The present study aimed to determine the prevalence of conversion from LC to OC and to assess the causes of conversion and risk factors related to conversion. Methods: The study was conducted in a referral hospital – ‘Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM’ from September 2014 to September 2016. Cases of cholelithiasis with or without cholecystitis, and other gall bladder pathology were included in the study. A team of experienced surgeon performed LC of all selected cases. The causes of conversion to OC were systematically recorded by the surgical team and the risk factors (age, sex, obesity, history of previous abdominal surgery, gallbladder thickness related to conversion from LC to OC was investigated. Results: A total of 261 (M / F = 87 /174 patients were considered eligible for the study. The mean age of all patients was 43 (±1.75 years. For the male and female groups the mean ages were 44±1.9 and 42±1.6 years respectively. Of the total 261 cases, 210 (80.5% patients had cholelithiasis with chronic cholecystitis, 47 (18.0% had gallbladder stone plus acute cholecystitis and 4 (1.5% had gallbladder polyp. Open conversion was required in case of 19 patients. Thus, overall conversion rate was 7.3%. The common causes of conversion were a difficulty in defining Calot’s triangle (42.1%, b injury to cystic artery (21.1% and c injury to bile duct (15.8%. Both male and female had equal risk for conversion. The investigated risk factors like history of previous abdominal surgery, preoperative ERCP, acute
Sulz, Michael C; Zerz, Andreas; Sagmeister, Markus; Roll, Thomas; Meyenberger, Christa
Few data are available regarding patients' perceptions of new cholecystectomy (CC) techniques, in the context of the patients' risk behaviours. We investigated patients' preferences for transgastric pure natural orifice translumenal endoscopic surgery (NOTES; transgastric NCC) and rigid-hybrid transvaginal NOTES CC (tvNCC) compared with the standard laparoscopic CC (SL-CC), and patients' risk behaviours. A total of 140 inpatients scheduled for elective laparoscopic CC were enrolled in this prospective single-centre study, from January 2009 to January 2010. Patients judged the potential advantages and disadvantages of transgastric NCC and tvNCC compared with SL-CC. The individual's risk behaviour was analysed by means of the validated 40-item Domain-Specific Risk Attitude Scale (DOSPERT). Of the 140 recruited patients, 57 (65% females; mean age 51.5 years) were analysed. Twenty-five percent of males opted for transgastric NCC and 75% opted for SL-CC. Among females, 10.8%, 37.8% and 51.4% opted for transgastric NCC, tvNCC and SL-CC, respectively. Faster convalescence was graded as the primary potential advantage of transgastric NCC, whereas the potential risk of long-term stomach injuries was considered a primary disadvantage. Females graded the reduction of hospital-acquired morbidity as the primary advantage of tvNCC. The risk assessment showed significantly more risk-taking behaviour in the recreational domain of life among patients who opted for innovative surgical techniques than among those opting for conventional surgery. Transgastric NCC is rarely accepted by females but accepted by a quarter of males. Females consider rigid-hybrid tvNCC and SL-CC similarly attractive. Despite promising new techniques, three-quarters of male and one half of female patients still prefer the standard laparoscopic CC.
M. J. Varas Lorenzo
Full Text Available Se presenta una revisión actual, puesta al día, y punto de vista de los autores sobre un tema sumamente novedoso y atractivo, como es la Cirugía Endoscópica Transluminal por Orificios Naturales (NOTES: Natural Orifice Translumenal Endoscopic Surgery. La mayoría de los trabajos revisados se han realizado en animales de experimentación, pero la publicación de la colecistectomía por vía transvaginal, y la aparición de editoriales y artículos de revisión sobre el tema, nos llevan a realizar una serie de preguntas no resueltas actualmente sobre este tipo de cirugía, que representa un avance potencial para conseguir "una cirugía endoscópica sin cicatrices, sin infecciones, con mínimos requerimientos de anestesia y una inmediata recuperación".A current review and update of an exceedingly novel and appealing topic, namely natural orifice transluminal endoscopic surgery (NOTES, is discussed, as well as the authors' viewpoint thereon. Most reviewed studies were performed in laboratory animals, but reports on transvaginal cholecystectomy and the emergence of editorials and review articles on this topic pose a number of as yet unanswered questions on this type of surgery, which represents a potential advance towards "endoscopic surgery with no scars, no infection, minimal anesthesia requirements, and immediate recovery".
Haricharan, Ramanath N; Proklova, Lyudmila V; Aprahamian, Charles J; Morgan, Traci L; Harmon, Carroll M; Barnhart, Douglas C; Saeed, Shehzad A
The purpose of this study was to determine the effectiveness of laparoscopic cholecystectomy in children with biliary dyskinesia. Reports of children with an abnormal cholecystokinin (CCK)-stimulated HIDA scan between January 2001 and July 2006 who underwent laparoscopic cholecystectomy were reviewed. Postoperatively, a 23-item Likert scale, symptom questionnaire was administered to parents. Sixty-four children with chronic abdominal pain and no gallstones on ultrasound had an abnormal CCK-HIDA scan. Twenty-three children (median age, 14 years; 16 girls), with mean (SD) ejection fraction of 17% (8), underwent laparoscopic cholecystectomy and were further analyzed. Preoperatively, these children had right upper quadrant/epigastric pain (78%), nausea (52%), vomiting (43%), and generalized abdominal pain (22%) lasting for a median of 3 months (range, 1 month to 2.5 years). Median postoperative follow-up was 2.7 years. Sixteen (70%) parents completed the questionnaire. Of those who responded, 63% indicated that their children had no abdominal pain, 87% had no vomiting, and 69% had no nausea in the month preceding the questionnaire. Overall, 67% of parents indicated that their children's symptoms were completely relieved after cholecystectomy, whereas 7% indicated that the symptoms were not relieved. Laparoscopic cholecystectomy is effective in providing both short-term and long-term improvement of symptoms in children with biliary dyskinesia.
Tandon, A.; Shahzad, K.; Nunes, Q.; Shrotri, M.; Lunevicius, R.
Background: Although the practice of preoperative testing of ABO group and Rh (D) type for elective cholecystectomy has deep historical roots, it is not evidence-based. We aimed to assess the preoperative blood group and save testing practice for a cohort of patients subjected to elective laparoscopic cholecystectomy for symptomatic cholecystolithiasis between January 2010 and October 2014. Methods: National Health Service (NHS) hospital based, surgical procedure-specific, retrospective study was conducted. A final group consisted of 2,079 adult patients. We estimated the incidence of perioperative blood transfusion attributable to laparoscopic cholecystectomy. The results of eight other studies are presented. Results: A preoperative blood group and save test was performed in 907 patients (43.6%), whereas cross-matching was documented in 28 patients (3.1%). None required an intraoperative blood transfusion. Twelve patients (0.58%) underwent blood transfusion postoperatively following laparoscopic cholecystectomy, of which ten were transfused due to severe intra-abdominal bleeding (0.48%). There were no deaths. Conclusions: The likelihood of blood transfusion attributable to elective laparoscopic cholecystectomy is 1:200. A routine preoperative blood group and save testing is unnecessary. It neither alters the management of severe hypovolemia, secondary to perioperative bleeding, nor does it lead to better outcomes. (author)
Escarce, J J; Bloom, B S; Hillman, A L; Shea, J A; Schwartz, J S
Introduced in 1989, laparoscopic cholecystectomy has rapidly become the treatment of choice for symptomatic gallstones. This study describes the diffusion of laparoscopic cholecystectomy among general surgeons; assesses the importance of various reasons for surgeons adopting the procedure; and examine the influence of surgeon, practice, and health care market characteristics on the timing of adoption. The data were obtained from a survey of a national sample of surgeons. Most surgeons (81%) adopted laparoscopic cholecystectomy by early 1992. More than three fourths of adopters identified the desire to keep up with the state-of-the-art and improved patient outcomes as very or extremely important reasons for adoption. Results of proportional hazards regression analysis indicate that individual surgeons' adoption behavior generally was consistent with expected utility maximization in an uncertain new technological environment. Of particular interest, fee-for-service payment and more competitive practice settings and markets were associated with earlier adoption. These findings suggest that the "technological imperative" and surgeons' perception of the relative clinical and financial advantages of laparoscopic cholecystectomy were important reasons for the rapid diffusion of laparoscopic cholecystectomy. Policies that accelerate current trends toward payment of physicians based on salary or capitation and promote the growth of multispecialty group practice could slow the diffusion of new physician-based product innovations in health care.
Full Text Available Background As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain compared how their Diagnosis-Related Groups (DRG systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. Results European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England. The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. Conclusion Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries’ DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement.
Paat-Ahi, Gerli; Aaviksoo, Ain; Swiderek, Maria
As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England). The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries' DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement.
Biétry, Fabienne A; Reich, Oliver; Schwenkglenks, Matthias; Meier, Christoph R
Using claims data from the Helsana Group, a large Swiss health insurance provider, we examined the association between statin use and the risk of cholecystectomy in a case-control analysis. We identified 2,200 cholecystectomy cases between 2013 and 2014 and matched 4 controls to each case on age, sex, index date and canton. We categorized statin users into current or past users (last prescription ≤ 180 or > 180 days before the index date, respectively) and classified medication use by duration based on number of prescriptions before the index date. We applied conditional logistic regression analyses to calculate odds ratios (ORs) with 95% confidence intervals (CIs) and adjusted the analyses for history of cardiovascular diseases and for use of estrogens, fibrates and other lipid-lowering agents. The adjusted OR (aOR) for cholecystectomy was 0.85 (95% CI: 0.74, 0.99) for current statin users compared to non-users. Long-term current statin use (5-19 prescriptions) was associated with a reduced OR (aOR 0.77, 95% CI: 0.65, 0.92). However, neither short-term current use nor past statin use affected the risk of cholecystectomy. The study supports the previously raised hypothesis that long-term statin use reduces the risk of cholecystectomy.
Liu, Gui-Bao; Mao, Yuan-Yuan; Yang, Chang-Ping; Cao, Jin-Lin
The best method to ligate the arteries during laparoscopic cholecystectomy or appendectomy remains controversy. The aim of this study is to introduce a new approach during laparoscopic combined cholecystectomy and appendectomy using a monopolar electrocautery to seal the cystic and appendix arteries. We retrospectively reviewed data from 57 patients who underwent laparoscopic combined cholecystectomy and appendectomy between December 2006 and June 2016. Each laparoscopic combined cholecystectomy and appendectomy was performed by coagulating and sealing the cystic and appendix arteries. Absorbable clip or coils were then used to ligate the proximal of cystic duct and the stump of appendix. The other side of the cystic duct and appendix which subsequently were to be removed from abdomen were used titanium clips or silk ligature. Of the 57 patients, 3 patients (5.3%) were converted to open surgery due to severe abdominal adhesions or gallbladder perforation. The mean operative time was 56 minutes (range, 40-80 minutes). Mean blood loss was 12 mL (range, 5-120 mL), and the mean postoperative hospital stay was 3.0 days (range, 2-5 days). No postoperative bleeding, biliary leakage, infection, or mortality occurred. Monopolar electrocautery to seal the cystic and appendix arteries is a safe, effective, and economical surgical procedure during laparoscopic combined cholecystectomy and appendectomy. Further randomized controlled clinical trials are required to validate our findings.
Liu, Yu-Yin; Yeh, Chun-Nan; Lee, Hsiang-Lin; Wang, Shang-Yu; Tsai, Chun-Yi; Lin, Chih-Chung; Chao, Tzu-Chieh; Yeh, Ta-Sen; Jan, Yi-Yin
AIM: To investigate the effect of pain relief after infusion of ropivacaine at port sites at the end of surgery. METHODS: From October 2006 to September 2007, 72 patients undergoing laparoscopic cholecystectomy (LC) were randomized into two groups of 36 patients. One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline. A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room, 6 and 24 h after surgery, and before discharge. The amount of analgesics use was also recorded. The demographics, laboratory data, hospital stay, and perioperative complications were compared between the two groups. RESULTS: There was no difference between the two groups preoperatively in terms of demographic and laboratory data. After surgery, similar operation time, blood loss, and no postoperative morbidity and mortality were observed in the two groups. However, a significantly lower pain score was observed in the patients undergoing LC with local anesthesia infusion at 1 h after LC and at discharge. Regarding analgesic use, the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion. This group also had a shorter hospital stay. CONCLUSION: Local anesthesia with ropivacaine at the port site in LC patients significantly decreased postoperative pain immediately. This explains the lower meperidine use and earlier discharge for these patients. PMID:19452582
Pandian, T K; Ubl, Daniel S; Habermann, Elizabeth B; Moir, Christopher R; Ishitani, Michael B
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.
Daradkeh, S S; Suwan, Z; Abu-Khalaf, M
A prospective study was carried out to investigate the value of preoperative ultrasound findings for predicting difficulties encountered during laparoscopic cholecystectomy (LC). Altogether 160 consecutive patients with symptomatic gallbladder (GB) disease (130 females, 30 males) referred to the Jordan University Hospital were recruited for the purpose of this study. All patients underwent detailed ultrasound examination 24 hours prior to LC. The overall difficulty score (ODS), as a dependent variable, was based on the following operative parameters: duration of surgery, bleeding, dissection of Calot's triangle, dissection of gallbladder wall, adhesions, spillage of bile, spillage of stone, and difficulty of gallbladder extraction. Multiple regression analysis was used to assess the significance of the following preoperative ultrasound variables (independent) for predicting the variation in the ODS: size of the GB, number of GB stones, size of stones, location of GB stones, thickness of GB wall, common bile duct (CBD) diameter, and liver size. Only thickness of GB wall and CBD diameter were found to be significant predictors of the variation in the ODS (adjusted R2 = 0.25). We conclude that the preoperative ultrasound examination is of value for predicting difficulties encountered during LC, but it is not the sole predictor.
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.
Full Text Available Liver cirrhosis is a major health problem worldwide with a prevalence that varies greatly from one geographical area to another. Besides the risk factors common to the general population to develop gallstone disease such as advanced age, female sex or positive family history of gallstones, in patients with liver cirrhosis there are additional risk factors that contribute to the occurrence of gallstones. They are more frequent in patients with a longer duration of the disease and in Child B and C stages. Gallstones disease occurs three times more frequently in patients with liver cirrhosis than in noncirrhotic patients. Surgery is required if symptoms or complications related to the presence of gallstones occur and a thorough preoperative evaluation and optimization of patient’s condition is necessary prior to surgery. The procedure of choice in these situations is laparoscopic cholecystectomy. The technique has some particularities resulting from local anatomical changes and conversion to open technique remains low and morbidity and mortality rates are within acceptable limits.
Full Text Available BACKGROUND: Dexmedetomidine a newer generation highly selective alpha - 2 adrenergic agonist are well known to inhibit catecholamine release. The present study compares the effects of intravenously administered dexmedetomidine to attenuate hemodynamic response to pneumoperitoneum to laparoscopic cholecystectomy under general anaesthesia. METHODOLOGY: 60 patients ASA Physical status I and II, aged between 18 and 50 years of either sex, scheduled for elective laparoscopic cholecy stectomy were randomized in to 2 groups ( group D and S inn a double blind fashion to receive either Dexmedetomidine ( 1microgram/kg in 100ml of 0.9% normal saline or only 0.9%plain normal saline respectively. It is given 30 min prior to induction. Patient vitals like HR, SBP, DBP, MAP were monitored during the study at various time intervals. RESULTS: Following intubation and pneumoperitoneum there significant rise in HR, MAP, SBP, DBP in group S but no significant rise in Group D. CONCLUSION: Dexmedetomid ine given in a dose of 1microgram/kg as a premedication is e ffective in attenuating the hemodynamic responses in laparoscopic surgery
Tayeb, M.; Khan, Muhammad R.; Riaz, N.
Although laparoscopic cholecystectomy (LC) has become the procedure ofchoice for cholelithiasis in the general population, many consider cirrhosisas a relative or absolute contraindication for laparoscopic surgery. The aimof this study was to confirm the safety of LC in cirrhotic patients in ourset-up. This is a retrospective case series including all patients withcirrhosis who underwent LC for gallstones from January 2000 to December2006at our institution. Data were analyzed for Child class, indication forsurgery, hospital stay and procedure-related morbidity and mortality. Resultsare given as +- standard deviation. Thirty patients, including 21 females(median age: 42 years) underwent LC during the study period. There was nooperative mortality. Twenty-four patients belonged to Child class A and 6belonged to Child class B. Mean operative time was 80+-26 min. There was noincident of bile duct injury, but two patients (6.7%) required conversion toopen procedure. Mean hospital stay was 3+-2.7 days. Postoperative morbiditywas observed in 7 patients, including postoperative deterioration of liverfunction in 2, worsening of ascites in 2 and pneumonia and port-siteinfection in 1. Two patients had significant in hemoglobin requiring bloodtransfusion. Cirrhosis is not a contraindication for LC and it can beperformed safely in compensated cirrhotic patients with acceptable morbidityand mortality. (author)
Xu, Xiequn; Hong, Tao; Li, Binglu; Liu, Wei
It is a growing trend that patients seek health information on the internet to self-educate and self-diagnose, which impacts their health decisions. The aim of the study was to investigate how Chinese patients undergoing elective laparoscopic cholecystectomy (LC) sought information about their disease and treatment, how they preferred the information to be presented, and how it influenced them. A descriptive, cross-sectional-designed questionnaire was employed to obtain information from 248 Chinese patients undergoing elective LC in Peking Union Medical College Hospital. A total of 223 patients (89.9 %) sought health information from the internet. Patients searching the internet for information about LC were younger than those who did not. It varied with employment status, educational level, and household average income. Among patients searching the internet for LC information, 35.4 % felt more worried and 37.2 % felt more assured; 15.2 % went to visit other doctors and 8.5 % considered changing their treatment because of internet use. A significant proportion of patients used the internet to obtain information about their disease. Age, employment status, educational level, and household average monthly income had an effect on internet usage for LC information. The use of the internet could cause mixed emotional outcomes among patients. Physicians should guide Chinese patients to professional websites of high quality and take time to discuss the information with patients during their visits and consultations.
Bredenoord, A. J.; Rösch, T.; Fockens, P.
Treatment of achalasia is complicated by symptom recurrence and a significant risk for severe complications. Endoscopic myotomy was developed in the search for a highly efficacious treatment with lower risks. Since its introduction in 2010, several centers have adopted the technique and published
We highlight a potentially lethal complication of acute severe pancreatitis that may not be suspected in severely ill patients. A 41-year-old woman developed acute severe pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis. When her condition deteriorated ...
Siada, Sammy S; Schaetzel, Shaina S; Chen, Allen K; Hoang, Huy D; Wilder, Fatima G; Dirks, Rachel C; Kaups, Krista L; Davis, James W
Recent studies have suggested higher complication and conversion to open rates for nighttime laparoscopic cholecystectomy (LC) and recommend against the practice. We hypothesize that patients undergoing night LC for acute cholecystitis have decreased hospital length of stay and cost with no difference in complication and conversion rates. A retrospective review of patients with acute cholecystitis who underwent LC from October 2011 through June 2015 was performed. Complication rates, length of stay, and cost of hospitalization were compared between patients undergoing day cholecystectomy and night cholecystectomy. Complication rates and costs did not differ between the day and night groups. Length of stay was shorter in the night group (2.4 vs 2.8 days, p = 0.002). Performing LC for acute cholecystitis during night-time hours does not increase risk of complications and decreases length of stay. Copyright © 2017 Elsevier Inc. All rights reserved.
Bisgaard, T; Klarskov, B; Trap, R
cholecystectomy using two 10-mm and two 5-mm trocars (LC). Incisional pain at each port incision and overall pain were recorded for 1 week after the operation. Fatigue, nausea and vomiting, pulmonary function, and cosmetic results were also measured. RESULTS: Data from 52 patients were analyzed; eight patients......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.......01). In both groups, pain scores at the supraumbilical 10-mm port were significantly higher compared with other port sites (p
Kimura, T; Goto, H; Takeuchi, Y; Yoshida, M; Kobayashi, T; Sakuramachi, S; Harada, Y
Gallbladder perforation often occurs during laparoscopic cholecystectomy. The frequency and causes of gallbladder perforation as well as the relevant clinical background factors were investigated in 110 patients undergoing laparoscopic cholecystectomy. We also evaluated intraperitoneal contamination by bacteria and gallstones at the time of gallbladder perforation and investigated whether perforation caused early or late postoperative complications. Intraoperative gallbladder perforation occurred in 29 of the 110 patients (26.3%). It was caused by injury with an electric knife during dissection of the gallbladder bed, injury during gallbladder retraction with grasping forceps, injury during gallbladder extraction from the abdomen, and slippage of cystic duct clips (potentially causing bile and stone spillage). Perforation was more frequent in patients with positive bile cultures and in those with pigment stones (p gallbladder perforation is sometimes unavoidable during laparoscopic cholecystectomy, the risk of severe complications appears to be minimized by early closure of perforation, retrieval of as many of the spilled stones as possible, and intraperitoneal lavage.
Ciulla, A; Romeo, G; Genova, G; Tomasello, G; Agnello, G; Cstronovo, Gaetano
A potentially serious complication of laparoscopic cholecystectomy is the inadvertent dissemination of unsuspected gallbladder carcinoma. There are increasing reports of seeding of tumor at the trocar sites following laparoscopic cholecystectomy in patients with unexpected or inapparent gallbladder carcinoma. Although the mechanism of the abdominal wall recurrence is still unclear, laparoscopic handling of the tumor, perforation of the gallbladder, and extraction of the specimen without an endobag may be risk factors for the spreading of malignant cells. The Authors report the case of late development of umbilical metastasis after laparoscopic cholecystectomy; the presence of an incisional hernia and the finding of a stone in subcutaneous tissue demonstrate the diffusion of tumor cells into subcutaneous tissue during the extraction of gallbladder. The patient underwent an excision of the metastases. She is disease free two years after surgical treatment.
Mosquera P, Manuel S; Kadamani, A Akram; Gomez D, Oscar M and others
Since 1987 when this procedure began in France and them, became popular all over the world, it isn't any doubt that is the best choice for Cholecystectomy in patients with cholelytiasis. We began our experience in 1996 they have been operated 562 patients by this technique over 1839 cholecystectomy until April 2004, which corresponds to a 31%. We have suffered all the changes in the interpretation and application of law 100, which excludes the procedure from the State Obligatory Health insurance and many Promoting health Enterprises prohibit it's practice, essentially because they ignore the good results it has which are similar to open cholecystectomy. We registered our patients and procedures since the beginning of this experience for evaluation, also to compare it with the medical literacy about it and to verify by ourselves the benefits of minimal invasive surgery
Tosun, Alptekin, E-mail: firstname.lastname@example.org [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)
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.
Kim, Myung Hi; Yeo, Seong Jae; Jung, Min Kyu; Cho, Chang Min
Endoscopic sphincterotomy (EST) with stone extraction is the standard management for choledocholithiasis. However, the necessity for subsequent management of gallstone to prevent the biliary complications remained controversial and few data were evaluated for the impact of status of gallbladder on recurrent biliary complications. We retrospectively investigated the relationship between the status of gallbladder and the occurrence of biliary complications after endoscopic removal of choledocholithiasis. Between January 1998 and December 2008, we enrolled 453 patients with intact gallbladder who underwent EST for choledocholithiasis and allocated into two groups: calculous gallbladder (n = 256) and acalculous gallbladder (n = 197). By reviewing patients' medical records, we compared the occurrence of biliary complications according to the presence or absence of gallstone in GB in situ. In total, biliary complications occurred in 83 patients (18.3 %) during the follow-up period. Calculous GB group had higher rate of overall complications (22.7 vs. 12.7 %; p = 0.007) and GB-associated complications (11.3 vs. 2.5 %; p = 0.001) than acalculous GB group. On the multivariate analysis, only the presence of gallstone was shown to be significant risk factor for overall biliary complication (OR 2.029; 95 % CI 1.209-3.405; p = 0.007) and GB-associated complications (OR 5.077; 95 % CI 1.917-13.446; p = 0.001). Mean event-free period was shorter in calculous GB group than acalculous GB group for overall complications (1774 vs. 2159 days; p = 0.012) and GB-associated complication (2153 vs. 2591 days; p = 0.001). Prophylactic cholecystectomy may not be necessary to prevent biliary complication in patients with acalculous gallbladder after endoscopic removal of pigment stones from bile duct.
Full Text Available Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.
Full Text Available This study aimed to elucidate the effects of cholecystectomy on the risk of colorectal cancer (CRC by conducting a meta-analysis of 10 cohort studies.The eligible cohort studies were selected by searching the PubMed and EMBASE databases from their origination to June 30, 2016, as well as by consulting the reference lists of the selected articles. Two authors individually collected the data from the 10 papers. When the data showed marked heterogeneity, we used a random-effects model to estimate the overall pooled risk; otherwise, a fixed effects model was employed.The final analysis included ten cohort studies. According to the Newcastle-Ottawa Scale (NOS, nine papers were considered high quality. After the data of these 9 studies were combined, an increased risk of CRC was found among the individuals who had undergone cholecystectomy (risk ratio (RR 1.22; 95% confidence interval (CI 1.08-1.38. In addition, we also found a promising increased risk for colon cancer (CC (RR 1.30, 95% CI 1.07-1.58, but no relationship between cholecystectomy and rectum cancer (RC (RR 1.09; 95% CI 0.89-1.34 was observed. Additionally, in the sub-group analysis of the tumor location in the colon, a positive risk for ascending colon cancer (ACC was found (RR 1.18, 95% CI 1.11-1.26. After combining the ACC, transverse colon cancer (TCC, sigmoid colon cancer (SCC and descending colon cancer (DCC patients, we found a positive relationship with cholecystectomy (RR 1.18, 95% CI 1.11-1.26. Furthermore, after combining the ACC and DCC patients, we also found a positive relationship with cholecystectomy (RR 1.28; 95% CI 1.11-1.26 in the sub-group analysis. In an additional sub-group analysis of patients from Western countries, there was a positive relationship between cholecystectomy and the risk of CRC (RR 1.20; 95% CI 1.05-1.36. Furthermore, a positive relationship between female gender and CRC was also found (RR 1.17; 95% CI 1.03-1.34. However, there was no relationship
Widjaja, Sandra P; Fischer, Henning; Brunner, Alexander R; Honigmann, Philipp; Metzger, Jürg
Currently, most patients undergoing laparoscopic cholecystectomy (LC) in Switzerland are inpatients for 2-3 days. Due to a lack of available hospital beds, we asked whether day-case surgery would be an option for patients in central Switzerland. The questions of acceptability of outpatient LC and factors contributing to the acceptability thus arose. Hundred patients suffering from symptomatic cholecystolithiasis, capable of communicating in German, and between 18 and 65 years old, were included. Patients received a pre-operative questionnaire on medical history and social situation when informed consent on surgery and participation in the study was obtained. Exclusion criteria were patients suffering from acute cholecystitis or any type of cancer; having a BMI >40 kg/m 2 ; needing conversion to open cholecystectomy or an intraoperative drainage; and non-German speakers. Surgery was performed laparoscopically. Both surgeon and patient filled in a postoperative questionnaire. The surgeon's questionnaire listed medical and technical information, and the patients' questionnaire listed medical information, satisfaction with the treatment and willingness to be released on the same day. These data from both questionnaires were grouped into social and medical factors and analysed on their influence upon willingness to accept an ambulatory procedure. No outpatient follow-up apart from checking for readmission to our hospital within 1 month after discharge was performed. Of the 100 participants, one-third was male. More than two-thirds were Swiss citizens. Only one participant was ineligible for rapid release evaluation due to need of a drainage. Among the social factors contributing to the acceptability of ambulatory care, we found nationality to be relevant; Swiss citizens preferred an inpatient procedure, whereas non-Swiss citizens were significantly more willing to return home on the same day. Household size, sex and age did not correlate with a preference for
Barakat, Monique T; Girotra, Mohit; Huang, Robert J; Banerjee, Subhas
Outbreaks of transmission of infection related to endoscopy despite reported adherence to reprocessing guidelines warrant scrutiny of all potential contributing factors. Recent reports from ambulatory surgery centers indicated widespread significant occult damage within endoscope working channels, raising concerns regarding the potential detrimental impact of this damage on the adequacy of endoscope reprocessing. We inspected working channels of all 68 endoscopes at our academic institution using a novel flexible inspection endoscope. Inspections were recorded and videos reviewed by 3 investigators to evaluate and rate channel damage and/or debris. Working channel rinsates were obtained from all endoscopes, and adenosine triphosphate (ATP) bioluminescence was measured. Overall endoscope working channel damage was rated as minimal and/or mild and was consistent with expected wear and tear (median 1.59 on our 5-point scale). Our predominant findings included superficial scratches (98.5%) and scratches with adherent peel (76.5%). No channel perforations, stains, or burns were detected. The extent of damage was not predicted by endoscope age. Minor punctate debris was common, and a few small drops of fluid were noted in 42.6% of endoscopes after reprocessing and drying. The presence of residual fluid predicted higher ATP bioluminescence values. The presence of visualized working channel damage or debris was not associated with elevated ATP bioluminescence values. The flexible inspection endoscope enables high-resolution imaging of endoscope working channels and offers endoscopy units an additional modality for endoscope surveillance, potentially complementing bacterial cultures and ATP values. Our study, conducted in a busy academic endoscopy unit, indicated predominately mild damage to endoscope working channels, which did not correlate with elevated ATP values. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights
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.
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 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
Ali, M.A.; Niazi, W.A.K.
The aim of the study was to make a comparison between skin incisions made with electrocautery versus scalpel in terms of their safety, efficacy and post-operative complications. Design: A randomized controlled study. Setting: The study was conducted in Combined Military Hospital (CMH) Kharian, Pakistan airforce (PAF) Hospital Sargodha. Duration of Study: May 2008 to August 2011. Patients and Methods: Ninety seven patients who underwent open cholecystectomy were randomly divided into two groups on the basis of the use of electrocautery versus steel scalpel for making skin incision and sub-cutaneous tissue dissection. Parameters recorded were, time taken from skin incision to full incising of the peritoneum, length of the wound, amount of blood loss during this step of surgery in each group. Post-operative pain scoring using visual analogue scale was done. Wound complications such as infection, haematoma/seroma and dehiscence were noted too. One month of follow up was recorded in each group. Subsequently a comparison of these findings was done. Results: Incision time (sec/cm/sub 2/) was longer in scalpel group than in diathermy group (p = 0.001), whereas, incision blood loss (ml/cm/sub 2/) was significantly less in diathermy group than in scalpel group (p = 0.03). There was no difference in post-operative pain perception as delineated by visual pain analogue scoring system between the two groups (p = 0.57). Post-operative wound complications and the final healing of wound at 01 month of follow-up were almost similar in both groups. Conclusion: Electrocautery may be used safely without any untoward complication in making skin incision and sub-cutaneous tissue dissection with an advantage of reduced incision time and and less blood loss. (author)
Reddy, Nischita K; Ioncică, Ana Maria; Săftoiu, Adrian
Contrast agents are increasingly being used to characterize the vasculature in an organ of interest, to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures. We review the mechanisms of action of first, second and third generation contrast...... agents and their use in various endoscopic procedures in the gastrointestinal tract. Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy, assessment of depth of invasion of esophageal, gastric and gall bladder...... cancers and visualization of the portal venous system and esophageal varices. In addition, contrast agents can be used to differentiate pancreatic lesions. The use of color Doppler further increases the ability to diagnose and differentiate various pancreatic malignancies. The sensitivity of power Doppler...
Full Text Available Endoscopic retrograde cholangiopancreatography (ERCP is a well-established advanced endoscopic technique for the diagnosis and treatment of pancreatobiliary diseases. New advances have been made in the treatment concept and techniques of ERCP in recent years. This article elaborates on the recent advances in ERCP, including the application of pancreatic duct stent, non-steroidal anti-inflammatory drugs, and aggressive hydration to prevent postoperative pancreatitis, covered metal stent for the treatment of benign bile duct stenosis, intraluminal radiofrequency ablation for malignant bile duct stenosis, extracorporeal shockwave lithotripsy and covered metal stent for the treatment of chronic pancreatitis, peroral choledochoscopy for qualitative diagnosis of bile duct stenosis and huge refractory stones, definition of difficult intubation, timing of pre-cut technique, and ERCP after gastrointestinal reconstruction.
Rana, Surinder S; Gonen, Can; Vilmann, Peter
Pancreas divisum is the most common congenital anatomic variation of the pancreatic ductal anatomy and in most of the individuals it is asymptomatic. However, in minority of individuals it is presumed to cause recurrent acute pancreatitis and chronic pancreatitis. Endoscopic retrograde cholangiop......Pancreas divisum is the most common congenital anatomic variation of the pancreatic ductal anatomy and in most of the individuals it is asymptomatic. However, in minority of individuals it is presumed to cause recurrent acute pancreatitis and chronic pancreatitis. Endoscopic retrograde...... of the parenchyma also. Therefore EUS, both radial and linear, has potential for being a minimally invasive diagnostic modality for pancreas divisum. A number of EUS criteria have been suggested for the diagnosis of pancreas divisum. These criteria have varying sensitivity and specificity and hence there is a need...
Zacharia, Brad E; Amine, Muhamad; Anand, Vijay; Schwartz, Theodore H
Craniopharyngioma is a rare clinical entity that poses a significant management challenge given their location and propensity to recur. As part of a minimally disruptive treatment paradigm, the expanded endonasal approach has the potential to improve rates of resection, improve postoperative visual recovery, and minimize surgical morbidity. This article updates the otolaryngologic community on the basic principles and techniques regarding the incorporation of the endoscopic, endonasal approach in the management paradigm of craniopharyngioma. Copyright © 2016 Elsevier Inc. All rights reserved.
Irion, K M; Novak, P
With the advent of minimally invasive surgery (MIS) a decade ago, the requirements for operating rooms (OR) and their equipment have been increased. Compared with conventional open surgery, the new endoscopic techniques require additional tools. Television systems, for video-assisted image acquisition and visualisation, including cameras, monitors and light systems, as well as insufflators, pumps, high-frequency units, lasers and motorised therapy units, are nowadays usually made available on carts during endoscopic surgery. In conjunction with a set of endoscopic instruments, these high-tech units allow new operating techniques to be performed. The benefit for patients has become clear in recent years; however, the technical complexity of OR has also increased considerably. To minimise this problem for the OR personnel, the MIS concept 'OR1' (Operating Room 1) was developed and implemented. OR1 is a fully functional and integrated multi-speciality surgical suite for MIS. The centrepieces of the OR1 are the Storz Communication Bus (SCB) and the advanced image and data archiving system (Aida) from Karl Storz, Tuttlingen, Germany. Both components allow monitoring, access and networking of the MIS equipment and other OR facilities, as well as the acquisition, storage and display of image, patient and equipment data during the endoscopic procedure. A central user interface allows efficient, simplified operation and online clinical images. Due to the system integration, the handling of complex equipment is considerably simplified, logistical procedures in the OR are improved, procedure times are shorter and, particularly noteworthy, operative risk can be reduced through simplified device operation.
Paul, J.; Kanotra, Sohit Paul; Kanotra, Sonika
The traditional method of management of posterior epistaxis has been with anteroposterior nasal packing. Apart from the high failure rate of 26–50% reported in various series, nasal packing is associated with marked discomfort and several complications. In order to avoid nasal packing, we started doing endoscopic cauterization in cases of posterior epistaxis. A total of 23 patients with posterior epistaxis were subjected to nasal endoscopy with the intent to stop bleeding by cauterization of ...
Esposito, Dario; Maione, Francesco; D'Alessandro, Alessandra; Sarnelli, Giovanni; De Palma, Giovanni D
Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type II achalasia are better after treatment compared to younger patients, males and type III achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies.
Esposito, Dario; Maione, Francesco; D’Alessandro, Alessandra; Sarnelli, Giovanni; De Palma, Giovanni D
Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type II achalasia are better after treatment compared to younger patients, males and type III achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies. PMID:26839644
Paul, J; Kanotra, Sohit Paul; Kanotra, Sonika
The traditional method of management of posterior epistaxis has been with anteroposterior nasal packing. Apart from the high failure rate of 26-50% reported in various series, nasal packing is associated with marked discomfort and several complications. In order to avoid nasal packing, we started doing endoscopic cauterization in cases of posterior epistaxis. A total of 23 patients with posterior epistaxis were subjected to nasal endoscopy with the intent to stop bleeding by cauterization of the bleeding vessel. Of these, in four cases unsuspected diagnosis was made. Of the remaining 19, in three patients, the bleeding point could not be localized accurately and these patients were managed by anteroposterior packing. The rest of the 16 patients were managed by endoscopic cauterization. In four patients, there was recurrence of bleeding within 24 h. In one of these, cauterization controlled the bleeding while in the rest nasal packing had to be resorted to. Thus, of the 23 patients of posterior epistaxis subjected to nasal endoscopy, we could avoid nasal packing in 17 (74%). To conclude, endoscopic nasal cauterization is recommended as the first line to treatment in all cases of posterior epistaxis. This will not only prevent the uncomfortable and potentially dangerous nasal packing but also help in finding the underlying pathology.
Full Text Available Background. Although uncommon, giant submucosal colon lipomas merit attention as they are often presented with dramatic clinical features such as bleeding, acute bowel obstruction, perforation and sometimes may be mistaken for malignancy. There is a great debate in the literature as to how to treat them. Case report. A patient, 67-year old, was admitted to the Clinic due to a constipation over the last several months, increasing abdominal pain mainly localized in the left lower quadrant accompanied by nausea, vomiting and abdominal distension. Physical examination was unremarkable and the results of the detailed laboratory tests and carcinoembryonic antigen remained within normal limits. Colonoscopy revealed a large 10 cm long, and 4 to 5 cm in diameter, mobile lesion in his sigmoid colon. Conventional endoscopic ultrasound revealed 5 cm hyperechoic lesion of the colonic wall. Twenty MHz mini-probe examination showed that lesion was limited to the submucosa. Since polyp appeared too large for a single transaction, it was removed piecemeal. Once the largest portion of the polyp has been resected, it was relatively easy to place the opened snare loop around portions of the residual polyp. Endoscopic resection was carried out safely without complications. Histological examination revealed the common typical histological features of lipoma elsewhere. The patient remained stable and eventually discharged home. Four weeks later he suffered no recurrent symptoms. Conclusion. Colonic lipomas can be endoscopically removed safely eliminating unnecessary surgery.
Knudsen, Marie Høxbro; Vilmann, Peter; Hassan, Hazem; Karstensen, John Gésdal
Endoscopic retrograde cholangiography (ERCP) is currently standard treatment for biliary drainage. Endoscopic ultrasound guided rendezvous (EUS-RV) is a novel method to overcome an unsuccessful biliary drainage procedure. Under endoscopic ultrasound guidance a guidewire is passed via a needle from the stomach or duodenum to the common bile duct and from there on to the duodenum enabling ERCP. With a relatively high rate of success EUS-RV should be considered as an alternative to biliary drainage and surgical intervention.
Mohanty, Sanjeev; Gopinath, M.
Endoscopy has changed the perspective of rhinologist towards the nose. It has revolutionised the surgical management of sinonasal disorders. Sinus surgeries were the first to get the benefit of endoscope. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach. Endoscopic medial maxillectomy has been advocated by a number of authors in the management ...
Rafael Antonio Luengas Tello
Full Text Available Gastrointestinal endoscopic surgery has been making great progress since the seventies in the management paradigms of conditions such as gastrointestinal bleeding, polyp resection and diagnostic and therapeutic management of the biliary tract. The current challenge is the development of techniques that allow endoscopic treatment of emerging diseases such as cancer, morbid obesity, gastro-esophageal reflux and achalasia. This article reports on new techniques and expectations for the future in the endoscopic management of these diseases.
Mohanty, Sanjeev; Gopinath, M
Endoscopy has changed the perspective of rhinologist towards the nose. It has revolutionised the surgical management of sinonasal disorders. Sinus surgeries were the first to get the benefit of endoscope. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach. Endoscopic medial maxillectomy has been advocated by a number of authors in the management of benign sino-nasal tumours. We present our experience of endoscopic medial maxillectomy in the management of sinonasal pathologies.
Full Text Available Endoscopic treatment has generally been accepted in the management of bleeding esophageal varices. Both the control of acute variceal bleeding and elective variceal eradication to prevent recurrent bleeding can be achieved via endoscopic methods. In contrast to acute and elective treatment, the role of endoscopic therapy in asymptomatic patients who have never had variceal bleeding remains controversial because of the rather disappointing results obtained from prophylactic sclerotherapy. Most published randomized controlled trials showed that prophylactic sclerotherapy had no effect on survival. In some studies, neither survival rate nor bleeding risk was improved. In this article, the author champions the view that asymptomatic esophageal varices should be endoscopically treated.
Schmidt, Arthur; Meier, Benjamin; Caca, Karel
Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.
Full Text Available Introduction. Early laparoscopic cholecystectomy is usually associated with reduced hospital stay, sick leave, and health care expenditures. Early diagnosis and treatment of acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies. Objectives. To compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction. Patients and Methods. Patients with acute cholecystitis were divided into two groups, early (A and delayed (B cholecystectomy. Diagnosis of acute cholecystitis was confirmed by clinical examination, laboratory data, and ultrasound study. The primary end point was operative and postoperative outcome and the secondary was patient’s satisfaction. Results. The number of readmissions in delayed treatment group B was three times in 10% of patients, twice in 23.3%, and once in 66.7% while the number of readmissions was once only in patients in group A and the mean total hospital stays were higher in group B than in group A. The overall patient’s satisfaction was 92.66±6.8 in group A compared with 75.34±12.85 in group B. Conclusion. Early laparoscopic cholecystectomy resulted in significant reduction in length of hospital stay and accepted rate of operative complications and conversion rates when compared with delayed techniques.
Ndoye, M Diop; Bah, M Diao; Pape, I Ndiaye; Diouf, E; Kane, O; Bèye, M; Fall, B; Ka-Sall, B
Sickle cell disease is a public health problem in Africa. The aim of this prospective study was to evaluate per and post-operative complications of laparoscopic cholecystectomy in sickle cell children in Senegal. from January 1999 to December 2006, an anesthetic protocol was applied to 39 sickle cell children undergoing a cholecystectomy. Among them, 20 experienced laparoscopic cholecystectomy. All these 20 patients had previously suffered from sickle cell visceral complications and were classified as ASA II (11 cases) and as ASA III (9 cases). Blood transfusion program aimed at sustaining haemoglobin level between 10 and 12 g/dl was implemented. The preoperative monitoring and anesthesia management were the same for these patients. During perioperative period, the prevention of pain, hypovolemia, hypothermia and acidosis was achieved. The mean insufflation duration of laparoscopy was 23 min (17-60 min), the mean surgery duration was 55 min (40-110 min), and the mean anesthesia duration was 78 min (88-135 min). Postoperative complications occurred in 9 patients: acute chest syndrome (n=2), postoperative hemolysis (n=5), vaso-occlusive crisis (n=2). Laparoscopic cholecystectomy can be carried out in sickle cell children affected with gallstones, provided that general anaesthetic rules were respected. An appropriate pre-, per- and postoperative anaesthesia is mandatory to reduce postoperative complications in children with sickle cell disease. Searching for early diagnosis of gallstones before occurrence of visceral complications should allow further optimal laparoscopic surgery.
Araki, Kenichiro; Shirabe, Ken; Watanabe, Akira; Kubo, Norio; Sasaki, Shigeru; Suzuki, Hideki; Asao, Takayuki; Kuwano, Hiroyuki
Although single-incision laparoscopic cholecystectomy is now widely performed in patients with cholecystitis, some cases require an additional port to complete the procedure. In this study, we focused on risk factor of additional port in this surgery. We performed single-incision cholecystectomy in 75 patients with acute cholecystitis or after cholecystitis between 2010 and 2014 at Gunma University Hospital. Surgical indications followed the TG13 guidelines. Our standard procedure for single-incision cholecystectomy routinely uses two needlescopic devices. We used logistic regression analysis to identify the risk factors associated with use of an additional full-size port (5 or 10 mm). Surgical outcome was acceptable without biliary injury. Nine patients (12.0%) required an additional port, and one patient (1.3%) required conversion to open cholecystectomy because of severe adhesions around the cystic duct and common bile duct. In multivariate analysis, high C-reactive protein (CRP) values (>7.0 mg/dl) during cholecystitis attacks were significantly correlated with the need for an additional port (P = 0.009), with a sensitivity of 55.6%, specificity of 98.5%, and accuracy of 93.3%. This study indicated that the severe inflammation indicated by high CRP values during cholecystitis attacks predicts the need for an additional port. J. Med. Invest. 64: 245-249, August, 2017.
Christopher Nonso Ekwunife
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.
Kassem, Mohamed I; Hassouna, Ehab M
Cirrhotic patients have been known to be more affected with gallstones than their non-cirrhotic counterparts; since laparoscopy was introduced, it has been generally approved as the standard approach for cholecystectomies with the exception of end-stage cirrhosis. The purpose of this study was to evaluate the safety and efficacy of clipless laparoscopic cholecystectomy using the harmonic scalpel in complicated cholelithiasis in cirrhotic patients. This prospective study was conducted on 62 cirrhotic patients presenting to the Gastrointestinal Surgery Unit in Alexandria Main University Hospital with complicated gallstones between March 2013 and March 2016. Both intraoperative time and blood loss were calculated in addition to rates of conversion to open cholecystectomy, morbidity and mortality. Most of our cases were females with a ratio of 1.7:1, with a mean age of 45.21 years, ranging from 25 to 65 years. The most common cause of cirrhotic liver was hepatitis C in 45.1% of patients. Among the 62 patients included in the study, 56 patients (90.3%) were presenting with acute cholecystitis and six patients were operated at the onset of acute biliary pancreatitis. The mean operative time was 72.9 min with mean blood loss 45.45 mL. The study concluded safety of total clipless laparoscopic cholecystectomy using a harmonic scalpel in Child A and B type cirrhotic patients, who presented with complicated gallstones. © 2017 Royal Australasian College of Surgeons.
Pasmans, H. L.; Go, P. M.; Gouma, D. J.; Heidendal, G. A.; van Engelshoven, J. M.; van Kroonenburgh, M. J.
To assess the role of Tc-99m IDA cholescintigraphy in diagnosing bile leakage and bile obstruction after laparoscopic cholecystectomy, 51 studies were performed in 51 patients on the first postoperative day. Two different radioactive bile acid analogs were used, Tc-99m HIDA and Tc-99m trimethylbromo
Rangarajan, M.; Palanivelu, C.; Madankumar, M.V.
This report describes a pregnant patient on whom emergency laparoscopic cholecystectomy was performed for empyema gallbladder. The patient was in her second trimester of pregnancy. The distended gallbladder was decompressed before dissection was commenced. There was no mortality, morbidity or conversion. There were no complications for either mother or child related to general anesthesia. (author)
Janssen, I.M.; Swank, D.J.; Boonstra, O.; Knipscheer, B.C.; Klinkenbijl, J.H.G.; Goor, H. van
BACKGROUND: Laparoscopic cholecystectomy is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity. The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and
Janssen, I. M. C.; Swank, D. J.; Boonstra, O.; Knipscheer, B. C.; Klinkenbijl, J. H. G.; van Goor, H.
Laparoscopic cholecystectomy is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity. The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and
Full Text Available Background : Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Routine drainage after laparoscopic cholecystectomy is an issue of considerable debate. Therefore, a controlled randomised trial was designed to assess the value of drains in elective laparoscopic cholecystectomy. Materials and Methods: During a two-year period (From April 2008 to January 2010, 80 patients were simply randomised to have a drain placed (group A, an 8-mm pentose tube drain was retained below the liver bed, whereas 80 patients were randomised not to have a drain (group B placed in the subhepatic space. End points of this trial were to detect any differences in morbidity, postoperative pain, wound infection and hospital stay between the two groups. Results : There was no mortality in either group and no statistically significant difference in postoperative pain, nausea and vomiting, wound infection or abdominal collection between the two groups. However, hospital stay was longer in the drain group than in group without drain and it is appearing that the use of drain delays hospital discharge. Conclusion : The routine use of a drain in non-complicated laparoscopic cholecystectomy has nothing to offer; in contrast, it is associated with longer hospital stay.
O. V. Lebedeva
Full Text Available Rationale: At present, the metabolic syndrome and pathophysiology of non-alcoholic fatty liver disease, as well as identification of factors that may influence the rate of development of dystrophy and fibrosis in the liver are in the focus of investigators' attention. This study represents an attempt to detail metabolic derangements and liver tissue abnormalities after cholecystectomy in patients with metabolic syndrome at baseline.Aim: To study the influence of cholecystectomy performed at younger age on the course of metabolic syndrome in women.Materials and methods: This was a retrospective analytical study in a sample of 57 female patients with metabolic syndrome (International Diabetes Federation criteria 2005 aged from 18 to 44 years (young age according to the World Health Organization definition. From those, 30 patients with cholelithiasis were included into the control group and 27 patients who had undergone cholecystectomy in this age range were included into the comparison group. We analyzed their past history, results of clinical examination, laboratory tests, abdominal ultrasound examination, esophagogastroduodenoscopy, hydrogen respiration test with lactulose, as well as the results of needle liver biopsy.Results: Non-alcoholic steatohepatitis after cholecystectomy was associated with the excessive bacterial growth in the small intestine (р = 0.026, ultrasound signs of cholangitis (р = 0.041, and diarrhea syndrome (р = 0.027. Liver fibrosis was significantly more frequent in association with chronic diarrhea (р = 0.034 and past clinical signs of post-cholecystectomy syndrome (р = 0.044. There was a strong direct correlation between the grade of fibrosis and the time since cholecystectomy (r = 0.77; р = 0.047.Conclusion: Cholecystectomy performed at young age predicts progression of metabolic
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.
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.
Madani, Amin; Watanabe, Yusuke; Feldman, Liane S; Vassiliou, Melina C; Barkun, Jeffrey S; Fried, Gerald M; Aggarwal, Rajesh
Bile duct injuries from laparoscopic cholecystectomy remain a significant source of morbidity and are often the result of intraoperative errors in perception, judgment, and decision-making. This qualitative study aimed to define and characterize higher-order cognitive competencies required to safely perform a laparoscopic cholecystectomy. Hierarchical and cognitive task analyses for establishing a critical view of safety during laparoscopic cholecystectomy were performed using qualitative methods to map the thoughts and practices that characterize expert performance. Experts with more than 5 years of experience, and who have performed at least 100 laparoscopic cholecystectomies, participated in semi-structured interviews and field observations. Verbal data were transcribed verbatim, supplemented with content from published literature, coded, thematically analyzed using grounded-theory by 2 independent reviewers, and synthesized into a list of items. A conceptual framework was created based on 10 interviews with experts, 9 procedures, and 18 literary sources. Experts included 6 minimally invasive surgeons, 2 hepato-pancreatico-biliary surgeons, and 2 acute care general surgeons (median years in practice, 11 [range 8 to 14]). One hundred eight cognitive elements (35 [32%] related to situation awareness, 47 [44%] involving decision-making, and 26 [24%] action-oriented subtasks) and 75 potential errors were identified and categorized into 6 general themes and 14 procedural tasks. Of the 75 potential errors, root causes were mapped to errors in situation awareness (24 [32%]), decision-making (49 [65%]), or either one (61 [81%]). This study defines the competencies that are essential to establishing a critical view of safety and avoiding bile duct injuries during laparoscopic cholecystectomy. This framework may serve as the basis for instructional design, assessment tools, and quality-control metrics to prevent injuries and promote a culture of patient safety. Copyright
Kamila Rafaela Alves
Full Text Available ABSTRACT: CONTEXT AND OBJECTIVE: There are few data in the literature on the frequency of cholecystectomy in Brazil. The frequency of cholecystectomy and associated risk factors were evaluated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil. DESIGN AND SETTING: Cross-sectional study using baseline data on 5061 participants in São Paulo. METHODS: The frequency of cholecystectomy and associated risk factors were evaluated over the first two years of follow-up of the study and over the course of life. A multivariate regression analysis was presented: odds ratio (OR and 95% confidence interval (95% CI. RESULTS: A total of 4716 individuals (93.2% with information about cholecystectomy were included. After two years of follow-up, 56 had undergone surgery (1.2%: 1.7% of the women; 0.6% of the men. A total of 188 participants underwent cholecystectomy during their lifetime. The risk factors associated with surgery after the two-year follow-up period were female sex (OR, 2.85; 95% CI, 1.53-5.32, indigenous ethnicity (OR, 2.1; 95% CI, 2.28-15.85 and body mass index (BMI (OR, 1.10; 95% CI, 1.01-1.19 per 1 kg/m2 increase. The risk factors associated over the lifetime were age (OR, 1.03; 95% CI, 1.02-1.05 per one year increase, diabetes (OR, 1.92; 95% CI, 1.34-2.76 and previous bariatric surgery (OR, 5.37; 95% CI, 1.53-18.82. No association was found with parity or fertile age. CONCLUSION: Female sex and high BMI remained as associated risk factors while parity and fertile age lost significance. New factors such as bariatric surgery and indigenous ethnicity have gained importance in this country.
Hun, T.S.; Burud, I.A.S.; Lin, L.S.; Roy, P.; Selwyn, D.; Tata, M.D.
Objectives: To identify pre-operative factors that predisposes to conversion of laparoscopic cholecystectomy. Methodology: Patients with symptomatic cholelithiasis from a tertiary hospital were selected for this cross-sectional study. The patient data was obtained from the hospital online database. Patients aged ?18 years with clinical diagnosis of symptomatic cholelithiasis who underwent laparoscopic cholecystectomy from January 2013 to December 2014 were included in the study. Those who underwent planned open cholecystectomy, patients with gallbladder polyps, acalculous cholecystitis and history of previous laparotomy were excluded from the study. Data were analyzed using chi-square test, Fisher's exact test and logistic regression. Results: Two hundred patients fulfilled the inclusion criteria. Conversion to open cholecystectomy was seen in 28 patients (14%). Patients with acute cholecystitis were 3.4 times more likely and males were 2.5 times more likely to undergo conversion. The likelihood of conversion increased by 0.9 times for each year of increase in age. Patients with diabetes mellitus were 3.8 times more likely to undergo conversion. Hypertension was also a significant factor contributing to a conversion. After a logistic regression analysis, only three factors remained statistically independently significant: diabetes mellitus (95% CI: 0.1 to 0.6), acute cholecystitis (95% CI: 0.1 to 0.7) and male gender (95%CI: 0.7 to 0.9). Conclusions: Decision to convert laparoscopic cholecystectomy to open should be taken earlier in a male patient with diabetes mellitus, acute cholecystitis and advancing age. (author)
Eichhorn, Klaus Wolfgang; Westphal, Ralf; Rilk, Markus; Last, Carsten; Bootz, Friedrich; Wahl, Friedrich; Jakob, Mark; Send, Thorsten
Having one hand occupied with the endoscope is the major disadvantage for the surgeon when it comes to functional endoscopic sinus surgery (FESS). Only the other hand is free to use the surgical instruments. Tiredness or frequent instrument changes can thus lead to shaky endoscopic images. We collected the pose data (position and orientation) of the rigid 0° endoscope and all the instruments used in 16 FESS procedures with manual endoscope guidance as well as robot-assisted endoscope guidance. In combination with the DICOM CT data, we tracked the endoscope poses and workspaces using self-developed tracking markers. All surgeries were performed once with the robot and once with the surgeon holding the endoscope. Looking at the durations required, we observed a decrease in the operating time because one surgeon doing all the procedures and so a learning curve occurred what we expected. The visual inspection of the specimens showed no damages to any of the structures outside the paranasal sinuses. Robot-assisted endoscope guidance in sinus surgery is possible. Further CT data, however, are desirable for the surgical analysis of a tracker-based navigation within the anatomic borders. Our marker-based tracking of the endoscope as well as the instruments makes an automated endoscope guidance feasible. On the subjective side, we see that RASS brings a relief for the surgeon.
Conclusions: Endoscopic endonasal transpterygoid approach is considered one of the most useful surgical solutions to manage selected tumors that involve the infratemporal fossa. A good understanding of the endoscopic anatomy of infratemporal fossa allows safe and complete resection of lesions arising or extending to infratemporal fossa.
Full Text Available Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.
The integral search for improved living conditions for those patients with gastric cancer who have not received curative surgical treatment continues to challenge the knowledge, dexterity and ethical foundations of medical teams. The justification for palliative treatment must be based on a thorough consideration of the available options and the particular situation in each case. This article reviews endoscopic therapy with auto expandable prosthetics for palliative treatment of gastric cancer, as well as the scientific evidence that supports its use and the factors that determine its indication.
Muguruma, Naoki; DaCosta, Ralph S.; Wilson, Brian C.; Marcon, Norman E.
Gastrointestinal endoscopy has made great progress during last decade. Diagnostic accuracy can be enhanced by better training, improved dye-contrast techniques method, and the development of new image processing technologies. However, diagnosis using conventional endoscopy with white-light optical imaging is essentially limited by being based on morphological changes and/or visual attribution: hue, saturation and intensity, interpretation of which depends on the endoscopist's eye and brain. In microlesions in the gastrointestinal tract, we still rely ultimately on the histopathological diagnosis from biopsy specimens. Autofluorescence imaging system has been applied for lesions which have been difficult to morphologically recognize or are indistinct with conventional endoscope, and this approach has potential application for the diagnosis of dysplastic lesions and early cancers in the gastrointestinal tract, supplementing the information from white light endoscopy. This system has an advantage that it needs no administration of a photosensitive agent, making it suitable as a screening method for the early detection of neoplastic tissues. Narrow band imaging (NBI) is a novel endoscopic technique which can distinguish neoplastic and non-neoplastic lesions without chromoendoscopy. Magnifying endoscopy in combination with NBI has an obvious advantage, namely analysis of the epithelial pit pattern and the vascular network. This new technique allows a detailed visualization in early neoplastic lesions of esophagus, stomach and colon. However, problems remain; how to combine these technologies in an optimum diagnostic strategy, how to apply them into the algorithm for therapeutic decision-making, and how to standardize several classifications surrounding them. 'Molecular imaging' is a concept representing the most novel imaging methods in medicine, although the definition of the word is still controversial. In the field of gastrointestinal endoscopy, the future of
Singh, Rajiv Ranjan; Singh, Virendra
Hilar biliary strictures are caused by various benign and malignant conditions. It is difficult to differentiate benign and malignant strictures. Postcholecystectomy benign biliary strictures are frequently encountered. Endoscopic management of these strictures is challenging. An endoscopic method has been advocated that involves placement of increasing number of stents at regular intervals to resolve the stricture. Malignant hilar strictures are mostly unresectable at the time of diagnosis and only palliation is possible.Endoscopic palliation is preferred over surgery or radiological intervention. Magnetic resonance cholangiopancreaticography is quite important in the management of these strictures. Metal stents are superior to plastic stents. The opinion is divided over the issue of unilateral or bilateral stenting.Minimal contrast or no contrast technique has been advocated during endoscopic retrograde cholangiopancreatography of these patients. The role of intraluminal brachytherapy, intraductal ablation devices, photodynamic therapy, and endoscopic ultrasound still remains to be defined. PMID:26191345
Endoscopic imaging systems that perform as the "eye" of the operator during endoscopic surgical procedures have developed rapidly due to various technological developments. In addition, since the most recent turn of the century robotic surgery has increased its scope through the utilization of systems such as Intuitive Surgical's da Vinci System. To optimize the imaging required for precise robotic surgery, a unique endoscope has been developed, consisting of both a two dimensional (2D) image optical system for wider observation of the entire surgical field, and a three dimensional (3D) image optical system for observation of the more precise details at the operative site. Additionally, a "near infrared radiation" endoscopic system is under development to detect the sentinel lymph node more readily. Such progress in the area of endoscopic imaging is expected to enhance the surgical procedure from both the patient's and the surgeon's point of view.
Pinchuk, Alexey V; Dmitriev, Ilya V; Shmarina, Nonna V; Teterin, Yury S; Balkarov, Aslan G; Storozhev, Roman V; Anisimov, Yuri A; Gasanov, Ali M
An evaluation of the efficacy of endoscopic methods for the diagnosis and correction of surgical and immunological complications after retroperitoneal pancreas transplantation. From October 2011 to March 2015, 27 patients underwent simultaneous retroperitoneal pancreas-kidney transplantation (SPKT). Diagnostic oesophagogastroduodenoscopy (EGD) with protocol biopsy of the donor and recipient duodenal mucosa and endoscopic retrograde pancreatography (ERP) were performed to detect possible complications. Endoscopic stenting of the main pancreatic duct with plastic stents and three-stage endoscopic hemostasis were conducted to correct the identified complications. Endoscopic methods showed high efficiency in the timely diagnosis and adequate correction of complications after retroperitoneal pancreas transplantation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Full Text Available ObjectiveTo investigate whether blood lipid control can delay the progression of asymptomatic gallstones and reduce the risk of cholecystectomy in patients with gallstones and hyperlipidemia, as well as the influence of hyperlipidemia on postoperative pain after cholecystectomy. MethodsA total of 153 patients with asymptomatic gallstones and hyperlipidemia who underwent physical examination from February 2013 to February 2015 were enrolled and randomly divided into experimental group with 72 patients and control group with 81 patients. The patients in the experimental group were given blood lipid control via diet, exercise, and drugs, and according to fasting triglyceride (TG and total cholesterol (TC after 3 months, these patients were further divided into normal blood lipid group with 47 patients and abnormal blood lipid group with 25 patients. All the patients were followed up for 2 years with an interval of 3 months. The surgical indications for laparoscopic cholecystectomy were persistent pain in the gallbladder or more than 3 times of gallbladder discomfort within the past one month. A subgroup analysis was performed based on the number and size of gallstones to evaluate the risk of cholecystectomy. A numerical pain scale was used to assess the improvement in pain during hospitalization and at 3 and 6 months after surgery. The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between three groups, and the Bonferroni test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups. ResultsThe normal blood lipid group had a significantly lower rate of cholecystectomy than the abnormal blood lipid group and the control group (23.4% vs 68.8%/70.4%, χ2=2772, P＜0.01. The patients in the normal blood lipid group had moderate pain during hospitalization, while those in the abnormal blood lipid
Full Text Available United European Gastroenterology provide wide studies and researches on the economic impact of the digestive diseases across the countries that are members of the European Union, very useful in planning health services, in making the case for investment in research where there are clear gaps in knowledge, and in reflecting the economic differences across the EU member states in the funding available to support health services. These studies reflect that there are important disparities in the accessibility to high-quality healthcare even among the industrialized countries. Out of all the digestive diseases, the gallstone disease is one of the most common and expensive of the health problems, in industrialized countries, like those of the European Union are. In general, symptomatic or complicated gallstone disease is treated by cholecystectomy, with surgical removal of the gallbladder. The advent of laparoscopic cholecystectomy has revolutionized the management of the gallstone disease, causing an increase in the rate of cholecystectomies. This study represents an analysis of the hospitalization costs involved by two surgical treatment options: laparoscopic cholecystectomy and open cholecystectomy. The investigation of the costs was done according to the type of intervention chosen and comprised the direct costs of hospitalization, including diagnostic tests and general expenses of medical assistance, pharmaceutical and medical supplies. The results are based on the analysis of the costs of cholecystectomies in the surgical department of the Emergency County Hospital Oradea for the year 2014 (781 cases. The average cost per hospitalized patient was 1.970 RON, lower in patients with laparoscopic cholecystectomy (1.579 RON. The average cost per patient with open cholecystectomy was 55% higher than for laparoscopic surgery (2.442 RON. Even if the laparoscopic operation cost is higher because of the equipment it uses, the reduction of the number of
Tsiopoulos, Fotios; Kapsoritakis, Andreas; Psychos, Athanassios; Manolakis, Anastasios; Oikonomou, Konstantinos; Tzovaras, George; Baloyiannis, Ioannis; Tsikrika, Alexandra; Potamianos, Spyros
Endoscopic retrograde cholangiopancreatography (ERCP), followed by laparoscopic cholecystectomy (LC), remains the standard way of management for patients with cholecystocholedocholithiasis. Laparoendoscopic rendezvous (LERV), a combined procedure for removing the gallbladder laparoscopically and clearing the common bile duct (CBD) endoscopically at the same time, could be an attractive alternative. The aim of this study was to compare LERV with classic ERCP in patients with cholecystocholedocholithiasis. 886 patients with cholecystocholedocholithiasis were treated either with the LERV technique (90 patients), or with the 2-stage approach, which includes preoperative ERCP followed by LC (796 patients). The primary endpoint was any difference in the success of CBD cannulation and clearance; secondary endpoints were the detection of differences in morbidity (especially post-ERCP pancreatitis [PEP]), and the feasibility of the two approaches. Successful cannulation of the CBD was more frequent with conventional ERCP compared with the LERV technique (89.8% vs. 75.5%, P=0.0001). LERV appears to be as effective as conventional ERCP for complete CBD clearance (85.5% vs. 82.8%, P<0.1). None of the patients in the LERV group had an episode of clinical PEP, whereas in the conventional ERCP group there were 23 episodes of PEP and one death. The median amylase level was higher in patients undergoing conventional ERCP group compared to patients in LERV group. Classic ERCP has a higher rate of successful CBD cannulation and a similar rate of CBD clearance compared to LERV.
Muench, J; Albrink, M; Serafini, F; Rosemurgy, A; Carey, L; Murr, M M
Recent reports indicate that laparoscopic cholecystectomy in pregnancy is safe. The aim of this study was to evaluate whether delays in definitive treatment of symptomatic cholelithiasis increase morbidity. We reviewed the records of 16 women who underwent laparoscopic cholecystectomy during pregnancy between 1992 and 1999. Mean age was 24 +/- 5 years (mean +/- standard error). Symptom onset was during the first trimester in nine patients, second trimester in six patients, and third trimester in one patient. Patients had abdominal pain (93%), nausea (93%), emesis (80%), and fever (66%) for a median of 45 days (range 1-195 days) before cholecystectomy. Nine of 11 women who underwent cholecystectomy more than 5 weeks after onset of symptoms experienced recurrent attacks necessitating 15 hospital admissions and four emergency room visits. Moreover four women who developed symptoms in the first and second trimesters but whose operations were delayed to the third trimester had 11 hospital admissions and four emergency room visits; three of those four (75%) women developed premature contractions necessitating tocolytics. Cholecystectomy was completed laparoscopically in 14 women. There was no hospital infant or maternal mortality or morbidity. We recommend prompt laparoscopic cholecystectomy in pregnant women with symptomatic biliary disease because it is safe and it reduces hospital admissions and frequency of premature labor.
Gerard, Justin; Luu, Minh B; Poirier, Jennifer; Deziel, Daniel J
The revised Tokyo Guidelines include criteria for determining the severity of acute cholecystitis with treatment algorithms based on severity. The aim of this study was to investigate the relationship of the revised Tokyo Guidelines severity grade to clinical outcomes of cholecystectomy for acute cholecystitis. We identified 66 patients with acute cholecystitis from a prior study of difficult cholecystectomy cases. We examined the relationship between severity grade and multiple variables related to perioperative and postoperative outcomes. A more severe revised Tokyo Guidelines grade was associated with a higher number of complications (p = 0.03) and a higher severity of complications (p = 0.01). Severity grade did not predict operative time, estimated blood loss, intensive care unit admission or length of stay. Compared to planned open cholecystectomy, intended laparoscopic cholecystectomy was associated with significantly fewer total and Clavien-Dindo grade 3 complications, fewer intensive care unit admissions, and shorter length of stay (p values range from 0.03 to < 0.0001). In technically difficult operations for acute cholecystitis, the revised Tokyo guidelines severity grade correlates with the number and severity of complications. However, intended performance of laparoscopic cholecystectomy rather than open cholecystectomy in difficult operations predicts broader beneficial outcomes than severity grade.
Woodward, Timothy A.
Endoscopic ultrasound (EUS) is a technology that had been used primarily as a passive imaging modality. Recent advances have enabled us to move beyond the use of EUS solely as a staging tool to an interventional device. Current studies suggest that interventional applications of EUS will allow for minimally invasive assessment and therapies in a cost-effective manner. Endoscopic ultrasound with fine needle aspiration (EUS-FNA) has been demonstrated to be a technically feasible, relatively safe method of obtaining cytologic specimens. The clinical utility of EUS- FNA appears to be greatest in the diagnosis and staging of pancreatic cancer and in the nodal staging of gastrointestinal and pulmonary malignancies. In addition, EUS-FNA has demonstrated utility in the sampling pleural and ascitic fluid not generally appreciated or assessable to standard interventions. Interventional applications of EUS include EUS-guided pseudocyst drainage, EUS-guided injection of botulinum toxin in the treatment of achalasia, and EUS- guided celiac plexus neurolysis in the treatment of pancreatic cancer pain. Finally, EUS-guided fine-needle installation is being evaluated, in conjunction with recent bimolecular treatment modalities, as a delivery system in the treatment of certain gastrointestinal tumors.
Liew, Kong Yew; Narayanan, Prepageran; Waran, Vicknes
Objectives To demonstrate, step-by-step, the technique and efficacy of endoscopic transsphenoidal approach in resection of a suprasellar craniopharyngioma. Design The video shows a step-by-step approach to the resection, covering the exposure, access, resection, and confirmation of resection and reconstruction. Setting The surgery was performed in the University of Malaya Medical Centre, a tertiary referral center in the capital of Malaysia. Participants Surgery was performed jointly by Professor Prepageran from the department of otorhinolaryngology and Professor Vicknes Waran from the division of neurosurgery. Both surgeons are from the University of Malaya. Video compilation, editing, and voice narration was done by Dr. Kong Yew Liew. Main Outcome Measures Completeness of resection and avoidance of intra- and postoperative complications. Results Based on intraoperative views and MRI findings, the tumor was completely resected with the patient suffering only transient diabetes insipidus. Conclusion Central suprasellar tumors can be removed completely via an endoscopic transsphenoidal approach with minimal morbidity to the patient. The link to the video can be found at: https://youtu.be/ZNIHfk12cYg .
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Endoscopic electrocautery and accessories. 884... Surgical Devices § 884.4100 Endoscopic electrocautery and accessories. (a) Identification. An endoscopic electrocautery is a device used to perform female sterilization under endoscopic observation. It is designed to...
Friedel, David; Modayil, Rani; Iqbal, Shahzad; Grendell, James H.
Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy. PMID:23503707
Farooqi, J.I.; Farooqi, R.J.
Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)
Ye, Jian; Liu, Guanghui; Liu, Peng; Zhang, Shiwu; Shao, Pengfei; Smith, Zachary J.; Liu, Chenhai; Xu, Ronald X.
We propose a portable fluorescence microscopic imaging system (PFMS) for intraoperative display of biliary structure and prevention of iatrogenic injuries during cholecystectomy. The system consists of a light source module, a camera module, and a Raspberry Pi computer with an LCD. Indocyanine green (ICG) is used as a fluorescent contrast agent for experimental validation of the system. Fluorescence intensities of the ICG aqueous solution at different concentration levels are acquired by our PFMS and compared with those of a commercial Xenogen IVIS system. We study the fluorescence detection depth by superposing different thicknesses of chicken breast on an ICG-loaded agar phantom. We verify the technical feasibility for identifying potential iatrogenic injury in cholecystectomy using a rat model in vivo. The proposed PFMS system is portable, inexpensive, and suitable for deployment in resource-limited settings.
Gurusamy, Kurinchi Selvan; Samraj, Kumarakrishnan; Fusai, Giuseppe; Davidson, Brian R
The role of a robotic assistant in laparoscopic cholecystectomy is controversial. While some trials have shown distinct advantages of a robotic assistant over a human assistant others have not, and it is unclear which robotic assistant is best. The aims of this review are to assess the benefits and harms of a robot assistant versus human assistant or versus another robot assistant in laparoscopic cholecystectomy, and to assess whether the robot can substitute the human assistant. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded (until February 2012) for identifying the randomised clinical trials. Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing robot assistants versus human assistants in laparoscopic cholecystectomy were considered for the review. Randomised clinical trials comparing different types of robot assistants were also considered for the review. Two authors independently identified the trials for inclusion and independently extracted the data. We calculated the risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) using the fixed-effect and the random-effects models based on intention-to-treat analysis, when possible, using Review Manager 5. We included six trials with 560 patients. One trial involving 129 patients did not state the number of patients randomised to the two groups. In the remaining five trials 431 patients were randomised, 212 to the robot assistant group and 219 to the human assistant group. All the trials were at high risk of bias. Mortality and morbidity were reported in only one trial with 40 patients. There was no mortality or morbidity in either group. Mortality and morbidity were not reported in the remaining trials. Quality of life or the proportion of patients who were discharged as day-patient laparoscopic cholecystectomy patients were not reported in any
Sanawan, Ejaz; Qureshi, Ahmad Uzair; Qureshi, Sidra Shoaib; Cheema, Khalid M; Cheema, Muhammad Arshad
To determine the efficacy of ultrasound shear in laparoscopic cholecystectomy in terms of total operative time, postoperative bile leaks, gall bladder perforation rate, and postoperative bleeding from cystic artery and collateral injury to bowel and duodenum. Comparative study. Mayo Hospital, Lahore, from June 2013 to May 2014. 150 cases (75 in each group) were randomized into two groups, i.e. harmonic scalpel clipless group (HSG) versus conventional laparoscopic cholecystectomy (CLC) with electrocautery group. The above stated variables were documented. The data for age, blood loss, and drain output were positively skewed as calculated using the Shapiro-Wilk test. The histograms, Q-Q plots and box plots were analyzed for all the dependent variables. Skewed qualitative continuous data was analyzed using the Mann-Whitney U-Test. Operative time was significantly lower in HSG as compared to CLC. Median operative times were 30 minutes (IQR 10) versus 35 minutes (IQR 10) (pelectrocautery.
Bisgaard, T; Kristiansen, V B; Hjortsø, N C
BACKGROUND: Preoperative oral carbohydrate can attenuate postoperative insulin resistance and catabolism, and may have the potential to improve postoperative recovery. There are no data from randomized studies on postoperative clinical outcome after specific surgical procedures. This study...... evaluated the clinical effects of a preoperative carbohydrate beverage in patients undergoing laparoscopic cholecystectomy. METHODS: Ninety-four patients undergoing laparoscopic cholecystectomy were included in a randomized clinical trial. Patients were randomized to receive 800 ml of an iso-osmolar 12.......5 per cent carbohydrate-rich beverage the evening before operation (100 g carbohydrate) and another 400 ml (50 g carbohydrate) 2 h before initiation of anaesthesia, or the same volume of a placebo beverage. The primary endpoint was general well-being the day after operation. Patients were evaluated from...
Liu, J B; Zhuang, T G
A practical PACS-based Endoscope Image Acquisition Workstation is here introduced. By a Multimedia Video Card, the endoscope video is digitized and captured dynamically or statically into computer. This workstation realizes a variety of functions such as the endoscope video's acquisition and display, as well as the editing, processing, managing, storage, printing, communication of related information. Together with other medical image workstation, it can make up the image sources of PACS for hospitals. In addition, it can also act as an independent endoscopy diagnostic system.
Kejriwal, Aditya Kumar; Begum, Shaheen; Krishan, Gopal; Agrawal, Richa
Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial. We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient. We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml?1 mixed with 0.5 ml of fentanyl 50 ?g ml?1. Other drugs we...
Van Bruwaene, Siska; Schijven, Marlies P; Napolitano, Daniel; De Win, Gunter; Miserez, Marc
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 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.
YİĞİTLER, Cengizhan; DUMAN, Kazım; ÖZCAN, Ali
We aim to report a case of abdominal wall mass formation secondary to gallbladder perforation and stone spillage occurring during laparoscopic cholecystectomy (LC). A 73-year-old women presented with purulent discharge from one of her previous port sites one year after she underwent LC. The latter revealed a round opaque mass in an abscess like cavity, and subsequently an ultrasonography showed a round echogenity with acoustic shadow posteriorly. Axial CT images verified the presence of a wel...
Staehr-Rye, Anne K; Rasmussen, Lars S.; Rosenberg, Jacob
: In this assessor-blinded study, 48 patients undergoing elective laparoscopic cholecystectomy were administered rocuronium for neuromuscular blockade and randomized to either deep neuromuscular blockade (rocuronium bolus plus infusion maintaining a posttetanic count 0-1) or moderate neuromuscular blockade...... (rocuronium repeat bolus only for inadequate surgical conditions with spontaneous recovery of neuromuscular function). Patients received anesthesia with propofol, remifentanil, and rocuronium. The primary outcome was the proportion of procedures with optimal surgical space conditions (assessed by the surgeon...
Borello Alessandro; Ferrarese Alessia; Passera Roberto; Surace Alessandra; Marola Silvia; Buccelli Claudio; Niola Massimo; Di Lorenzo Pierpaolo; Amato Maurizio; Di Domenico Lorenza; Solej Mario; Martino Valter
Abstract Background Surgical informed consent forms can be complicated for patients to read and understand. We created a consent form with key information presented in bulleted texts and diagrams combined in a graphical format to facilitate the understanding of information during the verbal consent discussion. Methods This prospective, randomized study involved 70 adult patients awaiting cholecystectomy for gallstones. Consent was obtained after standard verbal explanation using either a grap...
Gerli Paat-Ahi; Ain Aaviksoo; Maria Świderek
Background As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a procedure of cholecystectom...
Kienzle, H F
The Expert Commission for medical malpractice which is part of the Medical Chamber of Nordrhein received about 60 applications in connection with laparoscopic cholecystectomy; as of August 1998 5 complaints were let off and 11 of them are still being considered. So far 44 complaints have been considered and in 25 of them medical malpractice has been established. The medical malpractice detected laparoscopic cholecystectomy cases were mainly bile duct injuries of which 13 required a biliodigestive anastomosis for reconstruction, four cases required and end-to-end anastomosis and in one case a T-tube drainage was needed. The youngest one of these patients was 21 years old, the oldest one was 61 years old. Four times the bile duct injury was not considered as malpractice, because it could be intraoperatively made out and immediately treated. Trocar injuries were twice a cause for malpractice and once it was not. Each of the following cases was also recognized as a malpractice. One lost gallstone one dislocated Roedersnare, one electric injury, one delayed reintervention and one insufficient information. The following cases were decided as non-malpractice: in two cases a slipped clip, in five cases subhepatical hematoma/abscess, in three cases a secondary bleeding, once a lesion of the splenic capsule and finally a running sore with subsequent incisional hernia. Three courses of treatment with consequence of death also contained mistakes: one electric injury of the bowel, one bile duct lesion and one information rebuke. The bile duct injury is the most considerable risk for laparoscopic cholecystectomy and implies also a high risk for the future health. The experienced surgeon distinguishes himself by the fact that he is right about the situation and converts sooner that later to conventional cholecystectomy if there's any doubt. In open surgery the principle is applied that structures may be only divided when they are clearly identified. The same goes even on a wider
Hajong, Ranendra; Hajong, Debobratta; Natung, Tanie; Anand, Madhur; Sharma, Girish
Cholelithiasis is one of the most common disorders of the digestive tract encountered by general surgeons worldwide. Conventional or open cholecystectomy was the mainstay of treatment for a long time for this disease. In the 1980s laparoscopic surgery revolutionized the management of biliary tract diseases. It brought about a revolutionary change in the basic concepts of surgical principles and minimal access surgery gradually started to be acknowledged as a safe means of carrying out surgeries. To investigate the technical feasibility, safety and benefit of Single Incision Laparoscopic Cholecystectomy (SILC) versus Conventional Four Port Laparoscopic Cholecystectomy (C4PLC). This prospective randomized control trial was conducted to compare the advantages if any between the SILC and C4PLC. Thirty two patients underwent SILC procedure and C4PLC, each. The age of the patients ranged from 16-60years. Other demographic data and indications for cholecystectomy were comparable in both the groups. Simple comparative statistical analysis was carried out in the present study. Results on continuous variables are shown in Mean ± SD; whereas results on categorical variables are shown in percentage (%) by keeping the level of significance at 5%. Intergroup analysis of the various study parameters was done by using Fisher exact test. SPSS version 22 was used for statistical analysis. The mean operating time was higher in the SILC group (69 ± 4.00 mins vs. 38.53 ± 4.00 mins) which was of statistical significance (p=post-operative pain, with lesser analgesic requirements (p=operating time was longer otherwise it has almost similar clinical outcomes to those of C4PLC.
Zaorska-Rajca, J.; Piecinska, T.; Samojlow, R.; Dudzik, M.; Wnuk, W.
Cholescintigraphy was made in 42 patients with postcholecystectomy syndrome and 8 asymptomatic volunteers. In 7 cases organic disorders were diagnosed. Among the remaining 35, in 11 patients sphincter Oddi dysfunction and in 12 duodenogastric reflux were diagnosis. The others had normal results of cholescintigraphy. This study shows that cholescintigraphy is useful in diagnosis of functional disorders of bile in patients after cholecystectomy. (author). 21 refs, 4 figs, 2 tabs
Ayabe, Reed I; Parrish, Aaron B; Dauphine, Christine E; Hari, Danielle M; Ozao-Choy, Junko J
It has become increasingly important to expose surgical residents to robotic surgery as its applications continue to expand. Single-site robotic cholecystectomy (SSRC) is an excellent introductory case to robotics. Resident involvement in SSRC is known to be feasible. Here, we sought to determine whether it is safe to introduce SSRC to junior residents. A total of 98 SSRC cases were performed by general surgery residents between August 2015 and August 2016. Cases were divided into groups based on resident level: second- and third-years (juniors) versus fourth- and fifth-years (seniors). Patient age, gender, race, body mass index, and comorbidities were recorded. The number of prior laparoscopic cholecystectomies completed by participating residents was noted. Outcomes including operative time, console time, rate of conversion to open cholecystectomy, and complication rate were compared between groups. Juniors performed 54 SSRC cases, whereas seniors performed 44. There were no significant differences in patient age, gender, race, body mass index, or comorbidities between the two groups. Juniors had less experience with laparoscopic cholecystectomy. There was no significant difference in mean operative time (92.7 min versus 98.0 min, P = 0.254), console time (48.7 min versus 50.8 min, P = 0.639), or complication rate (3.7% versus 2.3%, P = 0.68) between juniors and seniors. SSRC is an excellent way to introduce general surgery residents to robotics. This study shows that with attending supervision, SSRC is feasible and safe for both junior and senior residents with very low complication rates and no adverse effect on operative time. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available Post-endoscopic sphincterotomy bleeding is a common complication of biliary sphincterotomy, and the incidence varies from 1% to 48%. It can be challenging to localize the bleeder or to administer various interventions through a side-viewing endoscope. This study aimed to evaluate the risk factors of post-endoscopic sphincterotomy bleeding and the outcome of endoscopic intervention therapies. We retrospectively reviewed the records of 513 patients who underwent biliary sphincterotomy in Mackay Memorial Hospital between 2011 and 2016. The blood biochemistry, comorbidities, indication for sphincterotomy, severity of bleeding, endoscopic features of bleeder, and type of endoscopic therapy were analyzed. Post-endoscopic sphincterotomy bleeding occurred in 65 (12.6% patients. Forty-five patients had immediate bleeding and 20 patients had delayed bleeding. The multivariate analysis of risk factors associated with post-endoscopic sphincterotomy bleeding were liver cirrhosis (P = 0.029, end-stage renal disease (P = 0.038, previous antiplatelet drug use (P<0.001, and duodenal ulcer (P = 0.023. The complications of pancreatitis and cholangitis were higher in the bleeding group, with statistical significance. Delayed bleeding occurred within 1 to 7 days (mean, 2.5 days, and 60% (12/20 of the patients received endoscopic evaluation. In the delayed bleeding group, the successful hemostasis rate was 71.4% (5/7, and 65% (13/20 of the patients had ceased bleeding without endoscopic hemostasis therapy. Comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray (P = 0.042 and pancreatitis was higher in patients who received epinephrine injection and electrocoagulation (P = 0.041 and P = 0.039 respectively. Clinically, post-endoscopic sphincterotomy bleeding and further endoscopic hemostasis therapy increase the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each
Full Text Available Background. Situs inversus viscerum totalis (reciprocally reversed position of internal organs is a rare case with genetic predisposition, inherited autosomnously recessive. The presented case involves an older patient with complete transposition of internal organs having acute calculous cholecystitis, which was successfully performed the laparoscopic cholecystectomy. Whilst the production of biliary stones in a case of transposed internal organs is very rare, it may well represent a diagnostic problem. It is not, however, the contraindication for laparoscopic surgery.Patients and methods. The case presents a 64-year-old patient, whose persistent biliary colic trouble eventually resulted in acute cholecystitis. Following routine diagnostics, a laparoscopic cholecystectomy was performed and the patient was released in domestic care after three day hospitalization.Conclusions. The laparoscopic cholecystectomy may also be safely performed in a patient with reciprocal transposition of all internal organs, but it is imperative to consider the fact that the extra-hepatic anatomy of gall bladder and vascular system is the mirror image of normal, right-hand positioned liver.
M. G. Clarke
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.
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
Butt, U. I.; Khan, A.; Nawaz, A.; Mansoor, R.; Malik, A. A.; Sher, F.; Ayyaz, M.
Objective: To compare the frequency of surgical site infections in patients with type II diabetes undergoing laparoscopic cholecystectomy as compared with non-diabetic patients. Study Design: Cohort study. Place and Duration of Study: Surgical Unit 2, Services Hospital, Lahore, from May to October 2012. Methodology: Patients were divided into two groups of 60 each, undergoing laparoscopic cholecystectomy. Group A comprised non-diabetic patients and group B comprised type II diabetic patients. Patients were followed postoperatively upto one month for the development of SSIs. Proportion of patients with surgical site infections or otherwise was compared between the groups using chi-square test with significance of p < 0.05. Results: In group A, 35 patients were above the age of 40 years. In group B, 38 patients were above the age of 40 years. Four patients in group A developed a surgical site infection. Seven patients in group B developed SSIs (p = 0.07). Conclusion: Presence of diabetes mellitus did not significantly affect the onset of surgical site infection in patients undergoing laparoscopic cholecystectomy. (author)
Full Text Available BACKGROUND AND OBJECTIVE: One of the complications of laparoscopic cholecystectomy is trocar incision hernia (TSIH: Trocar Site Incisional Hernia, which occurs almost exclusively in the navel area and could cause significant problems. The aim of this study was to evaluate the prevalence of hiatal hernia in laparoscopic cholecystectomy and identify the associated risk factors. METHODS: This cross sectional study was done on patients who underwent laparoscopic cholecystectomy during one year in different hospitals of Babol. Information including age, gender, BMI, diagnosis prior to surgery, duration of hospitalization, duration of surgery, the thickness of the lining of the gallbladder, surgical site infection and umbilical hernia during 12 months follow-up for patients were confirmed and examined. FINDINGS: Among 270 studied patients, there were 236 women (87.4% and 34 men (12.59 %. Eleven patients (4.07% during the 12-month follow-up; they had a hiatal hernia surgical site infection in the navel area (223.82-4.33: CI-95%, OR: 31.14 and BMI (60.18-1.72 CI-95%; OR: 10.21 were associated with increased incidence of inguinal hernias. There was no relationship between other variables and umbilical hernia. CONCLUSION: According to the results of this study obesity and surgical site infections have been linked with an increased incidence of inguinal hernias.
Bordelon, B M; Hobday, K A; Hunter, J G
An unsolved problem of laparoscopic cholecystectomy is the optimal method of removing the gallbladder with thick walls and a large stone burden. Proposed solutions include fascial dilatation, stone crushing, and ultrasonic, high-speed rotary, or laser lithotripsy. Our observation was that extension of the fascial incision to remove the impacted gallbladder was time efficient and did not increase postoperative pain. We reviewed the narcotic requirements of 107 consecutive patients undergoing laparoscopic cholecystectomy. Fifty-two patients required extension of the umbilical incision, and 55 patients did not have their fascial incision enlarged. Parenteral meperidine use was 39.5 +/- 63.6 mg in the patients requiring fascial incision extension and 66.3 +/- 79.2 mg in those not requiring fascial incision extension (mean +/- standard deviation). Oral narcotic requirements were 1.1 +/- 1.5 doses vs 1.3 +/- 1.7 doses in patients with and without incision extension, respectively. The wide range of narcotic use in both groups makes these apparent differences not statistically significant. We conclude that protracted attempts at stone crushing or expensive stone fragmentation devices are unnecessary for the extraction of a difficult gallbladder during laparoscopic cholecystectomy.
Pavlidis, T E; Papaziogas, B T; Koutelidakis, I M; Papaziogas, T B
During laparoscopic cholecystectomy, perforation of the gallbladder can occurs in extraction of the gallbladder. The fate of such lost gallstones, which can lead to the formation of an abscess, an abdominal wall mass, or a persistent sinus, has not been studied adequately. Herein we report the case of a persistent sinus of the abdominal wall after an emergent laparoscopic cholecystectomy in an 82-year-old woman with gangrenous cholecystitis and perforation of the friable wall in association with an empyema of the gallbladder. The culture of the obtained pus was positive for Escherichia coli. After a small leak of dirty fluid from the wound of the epigastric port site of 4 months' duration, surgical exploration under local anesthesia revealed that the sinus was caused by spilled gallstones impacting into the abdominal wall between the posterior sheath and left rectus abdominalis muscle. The removal of the stones resulted in complete healing. Long-term complications after laparoscopic cholecystectomy involving the abdominal wall are rare but important possible consequences that could be avoided.
Figueroa-Balderas, Lorena; Franco-López, Francisco; Flores-Álvarez, Efrén; López-Rodríguez, Jorge Luis; Vázquez-García, José Antonio; Barba-Valadez, Claudia Teresa
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.
Full Text Available BACKGROUND This study aimed at assessing the outcome of laparoscopic cholecystectomy (LC by determining the frequency of complications, especially of bile duct injuries. MATERIALS AND METHODS The case files of all patients undergoing laparoscopic cholecystectomy between January 2008 and December 2016 at Government General Hospital, Kakinada were retrospectively analysed. We evaluated the data according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose resections had to be converted from laparoscopic to open. RESULTS During the eight years (January 2008 and December 2016, 336 patients underwent LC for chronic cholecystitis (CC, of whom 22 (6.5% developed complications. Among those who developed complications, two patients had major bile duct injuries (0.4%; 43 other patients (12.8% had planned laparoscopic operations converted to open cholecystectomy intra-operatively. None of the patients in this study died as a result of LC. CONCLUSION Bile duct injury is a major complication of LC. Anatomical anomalies, local pathology, and poor surgical techniques are the main factors responsible. The two patients who had severe common bile duct injury in this study had major anatomical anomalies that were only recognized during surgery.
Hamid Reza Hemati
Full Text Available Introduction: Wound infection is one of the most common complications of surgical procedures.At present, different procedures are used to reduce wound infection including prophylactic antibiotics.Since laparoscopy controls the most sources of wound infection such as mechanical factors, the role ofprophylactic antibiotic therapy may be in doubt. In this study, we evaluated the antibiotic effects inprevention of wound infection in laparoscopic cholecystectomy.Methods and Materials: In this double-blind clinical trial study, patients who were candidate forlaparoscopic cholecystectomy were divided randomly into two groups: antibiotic receivers (38patients and placebo (Normal Saline receivers (32 patients group. The patients were visited in 24hours, 4-7, 10-15 and 30 days after surgery for wound infection and then 2 groups compared.Results: The study showed that there were no significant differences between two groups withrespect to age, body mass index and smoking. In addition, no wound infection was observed in first 24hours, 4-7, 10-15 and 30 days after operation in both groups.Conclusion: The findings showed that prophylactic antibiotic therapy in laparoscopiccholecystectomy has no effect on the incidence of wound infection. Therefore, it is suggested thatprophylactic antibiotic therapy does not use in laparoscopic cholecystectomy because of producingantibiotic resistance, unnecessary complications and also reducing economical costs.
Shrestha, B B; Karmacharya, M; Gharti, B B; Timilsina, B; Ghimire, P
Laparoscopic cholecystectomy (LC) is elective surgical procedure for uncomplicated gallstone disease and gallbladder polyp. The objective of this study was to assess the efficacy of Dexamethasone and Pheniramine hydrogen maleate on reducing stress response and pain after surgery in patients undergoing laparoscopic cholecystectomy. After obtaining approval from the institutional ethics committee and written informed consent, 120 patients undergoing elective laparoscopic cholecystectomy were enrolled in the study from Sep 2103 to Aug 2014 at Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal. Patients were randomized to receive either 8mg/2ml of Dexamethasone + 45.5/2ml Pheniramine hydrogen maleate (treatment group, n= 60) or 5 ml of normal saline (control group, n=60) 90 minutes before skin incision. There was a reduction of total bilirubin, C-reactive protein (CRP) value and Visual Analogue Score (VAS) in treatment group as compared to control group (p Pheniramine hydrogen maleate prior to surgical skin incision helps to reduce both postoperative pain and acute physiological stress.
Wanjura, Viktor; Sandblom, Gabriel
Previous studies have indicated a correlation between indication for cholecystectomy and long-term gastrointestinal quality-of-life (QoL). The aim of the present study was to compare QoL in a post-cholecystectomy cohort with the background population and with historical controls. A post-cholecystectomy study group (on average 4 years after cholecystectomy) was compared with a control group from the background population using the Gastrointestinal Quality-of-Life Index (GIQLI). EQ-5D scores were compared with expected scores derived from recent historical data. The post-cholecystectomy study group (N = 451) had better QoL measured by the EQ-5D compared with historical controls (p < 0.001), similar total GIQLI scores as the control group (N = 390), but scored worse on the GIQLI gastrointestinal symptoms subscale score (p < 0.001). The results include an item-by-item breakdown of the GIQLI questionnaire where the scores for diarrhea, bowel urgency, bloating, regurgitation, abdominal pain, flatus, fullness, nausea, uncontrolled stools, belching, heartburn, restricted eating, and bowel frequency were found to be significantly lower (i.e. worse) in the post-cholecystectomy cohort than in the control group. The opposite was true for relationships, endurance, sexual life, physical strength, feeling fit, not being frustrated by illness, and being able to carry out leisure activities, i.e. items related to general performance and well-being. In this study, QoL after cholecystectomy was good, but there was an increased prevalence of gastrointestinal symptoms compared to the background population.
Albrecht, R; Haase, D; Zippel, R; Koch, H; Settmacher, U
By means of a matched-pair analysis comparing data obtained from laparoscopic cholecystectomy (LC) and robot-assisted laparoscopic cholecystectomy (RAC), the value of both methods as well as the advantages and disadvantages of both approaches were elucidated. The consideration was carried out by evaluation of postoperative surgical results, a cost analysis and a subjective survey of the patients using a questionnaire. Thus, from the 35 consecutive RAC, 35 (parallel) retrospectively matched pairs were established. Postoperative surgical results did not show any significant differences between LC and RAC. In the individual assessment by each patient, there were also no significant differences; however, there was a tendency towards the assessment of the RAC to be slightly worse. A striking difference was found with respect to the cost analysis at the time of surgery. The RAC operation alone is significantly more expensive compared to LC with respect to maintenance and acquisition costs. In addition, RAC can at present not be completely reimbursed under the current German diagnosis-related system. The postulated advantages of RAC comprise mainly the precise preparation within narrow confinements and the favorable ergonomic handling for the surgeon. The basic prerequisites are control of the costs and a reasonable reflection in the current reimbursement system.
De Sagher, L I; Van den Heule, B; Van Houtte, P; Engelholm, L; Balikdjan, D; Bleiberg, H
Irradiation of the epigastric area for gastric cancer may induce actinic lesions of the stomach characterized on endoscopic examination by ulcerations, haemorrhagic gastritis, fragility of the mucosa, thickening and congestion of the gastric folds.
Patients' medical records, operative notes, and neural tube database records were used to complete a structured questionnaire. The difference in ... likely after 6 months. Keywords: obstructive hydrocephalus; endoscopic third ventriculostomy; ventriculoperitoneal shunt; children; paediatric surgery; neurosurgery; Ethiopia ...
Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis. Rinki Saha, Anuradha Sinha, Jyoti Prakash Phukan. Abstract. Background: Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed ...
Paspatis, Gregorios A; Dumonceau, Jean-Marc; Barthet, Marc
This Position Paper is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of iatrogenic perforation occurring during diagnostic or therapeutic digestive endoscopic procedures. Main recommendations 1 ESGE recommends that ea...
A. M. Gasanov
Full Text Available In the article, we report the incidence and etiology of pulmonary hemorrhage, and modern classifications according to the literature data. Methods of endoscopic diagnosis and treatment of pulmonary hemorrhage are analyzed.
Usefulness of magnetic resonance cholangiography in the diagnosis of biliary tract lesions in patients with suspected complication following cholecystectomy; Valor da colangiopancreatografia por ressonancia magnetica no diagnostico de lesoes das vias biliares em pacientes com suspeita de complicacao pos-colecistectomia
Cecin, Alexandre de Oliveira [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil); Goldman, Suzan Menasce; Caetano, Simone; Rosas, George de Queiroz; Coelho, Rafael Darahem de Souza [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem; Lobo, Edson Jose [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Gastroenterologia Cirurgica; Abdalla, Nitamar; Szejnfeld, Jacob [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem
Objective: to determine the usefulness of magnetic resonance cholangiopancreatography (MRCP) in the diagnoses of bile duct injuries following cholecystectomy. Material and method: MRCP was retrospectively evaluated in 40 patients with suspected bile duct injury after laparoscopic or conventional cholecystectomy. Eight of these patients had been submitted to biliary reconstruction. All patients were symptomatic (jaundice, fever and chills, weight loss and abdominal pain). The scans were independently reviewed by two radiologists. The results were confirmed by surgery, percutaneous drainage, endoscopic retrograde cholangiopancreatography and clinical follow-up. The level and severity of bile duct injury were rated according to the Bismuth classification. Results: in a total of 40 symptomatic patients, 10 (25%) had normal findings on MRCP; Postoperative complications were seen in 29 (72.5%) patients, seven of them with more than one finding. Pancreatic head neoplasia was diagnoses in one patient. The most frequent finding was sclerosing (41.4%) followed by biliary duct stenosis (34.5%), residual or recurrent biliary stones (31.0%) and fluid collections (17.2%). The images obtained by MRCP were considered of good quality. Conclusion: MRCP is an effective method for the evaluation of patients with suspected postcholecystectomy biliary tract complications. (author)
Cho, Young Kwan; Kim, Seong Hwan
Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic ...
Full Text Available The endoscopic retrograde cholangiopancreatography (ERCP is known for its varied diagnostic and therapeutic utility for a variety of disorders. However it has greater likelihood of procedure related complications among the endoscopic procedures of gastrointestinal tract. The extraluminal hemorrhagic complications following ERCP are potentially life threatening though relatively rare. We present a 50 year patient with choledocholithiasis and cholelithiasis developing rare complication of subcapsular hepatic hematoma, following ERCP due to guide wire injury.
Greenberg, H.M.; Goldberg, H.I.; Shapiro, H.A.
The radiographic features of endoscopic sphincterotomies performed in 44 patients were evaluated. Radiographic landmarks aided in proper sphincterotome placement and also disclosed conditions and anatomic variations that made catheter placement difficult. Fluoroscopic and radiographic monitoring not only assisted the performance of endoscopic sphincterotomy, but also confirmed successful results and revealed reasons for failure. Radiographic changes in the biliary tract after sphincterotomy, as well as potential complications of sphincterotomy, are discussed and illustrated
Yousef, Gamal T; Lasheen, Ahmed E
Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. 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. 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. 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. The present study not only confirmed that both segmental TSA and conventional
Hakeem, Abdul R; Birks, Theodore; Azeem, Qasim; Di Franco, Filippo; Gergely, Szabolcs; Harris, Adrian M
There is conflicting evidence for the use of warmed, humidified carbon dioxide (CO2) for creating pneumoperitoneum during laparoscopic cholecystectomy. Few studies have reported less post-operative pain and analgesic requirement when warmed CO2 was used. This systematic review and meta-analysis aims to analyse the literature on the use of warmed CO2 in comparison to standard temperature CO2 during laparoscopic cholecystectomy. Systematic review and meta-analysis carried out in line with the PRISMA guidelines. Primary outcomes of interest were post-operative pain at 6 h, day 1 and day 2 following laparoscopic cholecystectomy. Secondary outcomes were analgesic usage and drop in intra-operative core body temperature. Standard Mean Difference (SMD) was calculated for continuous variables. Six randomised controlled trials (RCTs) met the inclusion criteria (n = 369). There was no significant difference in post-operative pain at 6 h [3 RCTs; SMD = -0.66 (-1.33, 0.02) (Z = 1.89) (P = 0.06)], day 1 [4 RCTs; SMD = -0.51 (-1.47, 0.44) (Z = 1.05) (P = 0.29)] and day 2 [2 RCTs; SMD = -0.96 (-2.30, 0.37) (Z = 1.42) (P = 0.16)] between the warmed CO2 and standard CO2 group. There was no difference in analgesic usage between the two groups, but pooled analysis was not possible. Two RCTs reported significant drop in intra-operative core body temperature, but there were no adverse events related to this. This review showed no difference in post-operative pain and analgesic requirements between the warmed and standard CO2 insufflation during laparoscopic cholecystectomy. Currently there is not enough high quality evidence to suggest routine usage of warmed CO2 for creating pneumoperitoneum during laparoscopic cholecystectomy. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
Cho, Young Kwan; Kim, Seong Hwan
Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.
Cho, Young Kwan; Kim, Seong Hwan
Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders. PMID:29397656
Young Kwan Cho
Full Text Available Peroral endoscopic myotomy (POEM has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.
Stenlund Hans C
Full Text Available Abstract Background Gallstones represent the most common cause of acute pancreatitis in Sweden. Epidemiological data concerning timing of cholecystectomy and sphincterotomy in patients with first attack of mild acute biliary pancreatitis (MABP are scarce. Our aim was to analyse readmissions for biliary disease, cholecystectomy within one year, and mortality within 90 days of index admission for MABP. Methods Hospital discharge and death certificate data were linked for patients with first attack acute pancreatitis in Sweden 1988-2003. Mortality was calculated as case fatality rate (CFR and standardized mortality ratio (SMR. MABP was defined as acute pancreatitis of biliary aetiology without mortality during an index stay of 10 days or shorter. Patients were analysed according to four different treatment policies: Cholecystectomy during index stay (group 1, no cholecystectomy during index stay but within 30 days of index admission (group 2, sphincterotomy but not cholecystectomy within 30 days of index admission (group 3, and neither cholecystectomy nor sphincterotomy within 30 days of index admission (group 4. Results Of 11636 patients with acute biliary pancreatitis, 8631 patients (74% met the criteria for MABP. After exclusion of those with cholecystectomy or sphincterotomy during the year before index admission (N = 212, 8419 patients with MABP remained for analysis. Patients in group 1 and 2 were significantly younger than patients in group 3 and 4. Length of index stay differed significantly between the groups, from 4 (3-6 days, (representing median, 25 and 75 percentiles in group 2 to 7 (5-8 days in groups 1. In group 1, 4.9% of patients were readmitted at least once for biliary disease within one year after index admission, compared to 100% in group 2, 62.5% in group 3, and 76.3% in group 4. One year after index admission, 30.8% of patients in group 3 and 47.7% of patients in group 4 had undergone cholecystectomy. SMR did not differ
F.J.C. van den Broek (Frank); E.J.R. de Graaf (Eelco); M.G.W. Dijkgraaf (Marcel); J.B. Reitsma (Johannes); J. Haringsma (Jelle); R. Timmer (Robin); B.L. Weusten (Bas); M.F. Gerhards (Michael); E.C. Consten (Esther); M.P. Schwartz (Matthijs); M.J. Boom (Maarten); E.J. Derksen (Erik); A.B. Bijnen (Bart); P.H.P. Davids (Paul); C. Hoff (Christiaan); H.M. van Dullemen (Hendrik); G.D.N. Heine (Dimitri); K. van der Linde (Klaas); J.M. Jansen (Jeroen); R.C.H. Mallant-Hent (Rosalie); R. Breumelhof (Ronald); H. Geldof (Han); J.C. Hardwick (James); P. Doornebosch (Pascal); A.C.T.M. Depla (Annekatrien); M.F. Ernst (Miranda); I.P. van Munster (Ivo); I.H.J.T. de Hingh (Ignace); E.J. Schoon (Erik); W.A. Bemelman (Willem); P. Fockens (Paul); E. Dekker (Evelien)
textabstractBackground: Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might be a more cost-effective approach as this strategy does
van den Broek, Frank J. C.; de Graaf, Eelco J. R.; Dijkgraaf, Marcel G. W.; Haringsma, Jelle; Timmer, Robin; Weusten, Bas L. A. M.; Gerhards, Michael F.; Consten, Esther C. J.; Schwartz, Matthijs P.; Boom, Maarten J.; Derksen, Erik J.; Bijnen, A. Bart; Davids, Paul H. P.; Hoff, Christiaan; van Dullemen, Hendrik M.; Heine, G. Dimitri N.; van der Linde, Klaas; Jansen, Jeroen M.; Mallant-Hent, Rosalie C. H.; Breumelhof, Ronald; Geldof, Han; Hardwick, James C. H.; Doornebosch, Pascal G.; Depla, Annekatrien C. T. M.; Ernst, Miranda F.; van Munster, Ivo P.; de Hingh, Ignace H. J. T.; Schoon, Erik J.; Bemelman, Willem A.; Fockens, Paul; Dekker, Evelien; Reitsma, J.
Background: Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might be a more cost-effective approach as this strategy does not require
Chan, Jason Y K; Leung, Iris; Navarro-Alarcon, David; Lin, Weiyang; Li, Peng; Lee, Dennis L Y; Liu, Yun-hui; Tong, Michael C F
To evaluate the feasibility of a unique prototype foot-controlled robotic-enabled endoscope holder (FREE) in functional endoscopic sinus surgery. Cadaveric study. Using human cadavers, we investigated the feasibility, advantages, and disadvantages of the robotic endoscope holder in performing endoscopic sinus surgery with two hands in five cadaver heads, mimicking a single nostril three-handed technique. The FREE robot is relatively easy to use. Setup was quick, taking less than 3 minutes from docking the robot at the head of the bed to visualizing the middle meatus. The unit is also relatively small, takes up little space, and currently has four degrees of freedom. The learning curve for using the foot control was short. The use of both hands was not hindered by the presence of the endoscope in the nasal cavity. The tremor filtration also aided in the smooth movement of the endoscope, with minimal collisions. The FREE endoscope holder in an ex-vivo cadaver test corroborated the feasibility of the robotic prototype, which allows for a two-handed approach to surgery equal to a single nostril three-handed technique without the holder that may reduce operating time. Further studies will be needed to evaluate its safety profile and use in other areas of endoscopic surgery. NA. Laryngoscope, 126:566-569, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
van der Stap, Nanda; van der Heijden, Ferdinand; Broeders, Ivo A M J
The design of flexible endoscopes has not changed significantly in the past 50 years. A trend is observed towards a wider application of flexible endoscopes with an increasing role in complex intraluminal therapeutic procedures. The nonintuitive and nonergonomical steering mechanism now forms a barrier in the extension of flexible endoscope applications. Automating the navigation of endoscopes could be a solution for this problem. This paper summarizes the current state of the art in image-based navigation algorithms. The objectives are to find the most promising navigation system(s) to date and to indicate fields for further research. A systematic literature search was performed using three general search terms in two medical-technological literature databases. Papers were included according to the inclusion criteria. A total of 135 papers were analyzed. Ultimately, 26 were included. Navigation often is based on visual information, which means steering the endoscope using the images that the endoscope produces. Two main techniques are described: lumen centralization and visual odometry. Although the research results are promising, no successful, commercially available automated flexible endoscopy system exists to date. Automated systems that employ conventional flexible endoscopes show the most promising prospects in terms of cost and applicability. To produce such a system, the research focus should lie on finding low-cost mechatronics and technologically robust steering algorithms. Additional functionality and increased efficiency can be obtained through software development. The first priority is to find real-time, robust steering algorithms. These algorithms need to handle bubbles, motion blur, and other image artifacts without disrupting the steering process.
Chang Min Cho
Full Text Available Endoscopic ultrasound (EUS has been recently established as an indispensable modality for the diagnosis and management of pancreatobiliary and gastrointestinal (GI disorders. EUS proficiency requires both cognitive and technical abilities, including an understanding of the appropriate indications, the performance of appropriate evaluations before and after the procedure, and the management of procedure-related complications. An increasing demand for skills to handle a growing range of interventional EUS procedures and a continual shortage of EUS training programs are two major obstacles for EUS training. Acquiring the skills necessary to comprehend and conduct EUS often requires training beyond the scope of a standard GI fellowship program. In addition to traditional formal EUS training and preceptorships, regular short-term intensive EUS training programs that provide training at various levels may help EUS practitioners improve and maintain EUS-related knowledges and skills. Theoretical knowledge can be acquired from lectures, textbooks, atlases, slides, videotapes, digital video discs, interactive compact discs, and websites. Informal EUS training is generally based on 1- or 2-day intensive seminars, including didactic lectures, skills demonstrated by expert practitioners through live video-streaming of procedures, and hands-on learning using animal or phantom models.
Huang, Yu-Chih; Yeh, Wen-Lin
Operative treatment of prepatellar bursitis is indicated in intractable bursitis. The most common complication of surgical treatment for prepatellar bursitis is skin problems. For traumatic prepatellar bursitis, we propose a protocol of outpatient endoscopic surgery under local anaesthesia. From September 1996 to February 2001, 60 cases of failed nonoperative treatment for prepatellar bursitis were included. The average age was 33.5 ± 11.1 years (range 21-55). The average operation duration was 18 minutes. Two to three mini-arthroscopic portals were used in our series. No sutures or a simple suture was needed for the portals after operation. After follow-up for an average of 36.3 months, all patients are were symptom-free and had regained knee function. None of the population had local tenderness or hypo-aesthesia around their wound. Their radiographic and sonographic examinations showed no recurrence of bursitis. Outpatient arthroscopic bursectomy under local anaesthesia is an effective procedure for the treatment of post-traumatic prepatellar bursitis after failed conservative treatments. Both the cosmetic results and functional results were satisfactory.
Full Text Available Introduction: Juvenile nasopharyngeal angiofibroma (NAJ is a tumor with vascular component, slow growing, benign but very aggressive because of its local invasiveness. The NAJ is rare, accounting for 0.05% of all head and neck cancers. The classic triad of epistaxis, unilateral nasal obstruction and a mass in the nasopharynx suggests the diagnosis of NAJ and is then supplemented by imaging. Over the past 10 years the treatment of this disease has been discussed with the aim of designing a management protocol. Currently, surgery appears to be the best treatment of the NAJ. Other methods such as hormone therapy, radiotherapy and chemotherapy treatment modalities are now used occasionally as complementary treatments. Objective: To present the cases of this disease in the Hospital Infantil between October 2007 and August 2008. Methods: A retrospective case study of five cases of NAJ underwent surgery solely with endoscopic technique of two surgeons. Classifieds between IIA and IIIA. All patients underwent angiography with embolization of the tumor 3-4 days before surgery. Follow-up after surgery to detect recurrence. Results: There were two relapses in the following two years after surgery. Conclusion: Given the short period of patient follow-up, there were only two relapses in one year. So there is need for further action to claim that this technique has a low recurrence rate, since the recurrence is probably related to incomplete resection the initial tumor.
Wells, Katie M; Lee, Yu-Jin; Erdene, Sandag; Erdene, Sarnai; Sanchin, Urjin; Sergelen, Orgoi; Zhang, Chong; Rodriguez, Brandon P; deVries, Catherine R; Price, Raymond R
The benefits of laparoscopic cholecystectomy, including rapid recovery and fewer infections, have been largely unavailable to the majority of people in developing countries. Compared to other countries, Mongolia has an extremely high incidence of gallbladder disease. In 2005, only 2% of cholecystectomies were performed laparoscopically. This is a retrospective review of the transition from open to laparoscopic cholecystectomy throughout Mongolia. A cross-sectional, retrospective review was conducted of demographic patient data, diagnosis type, and operation performed (laparoscopic versus open cholecystectomy) from 2005-2013. Trends were analyzed from 6 of the 21 provinces (aimags) throughout Mongolia, and data were culled from 7 regional diagnostic referral and treatment centers and 2 tertiary academic medical centers. The data were analyzed by individual training center and by year before being compared between rural and urban centers. We analyzed and compared 14,522 cholecystectomies (n = 4,086 [28%] men, n = 10,436 [72%] women). Men and women were similar in age (men 52.2, standard deviation 14.8; women 49.4, standard deviation 15.7) and in the percentage undergoing laparoscopic cholecystectomy (men 39%, women 42%). By 2013, 58% of gallbladders were removed laparoscopically countrywide compared with only 2% in 2005. In 2011, laparoscopic cholecystectomy surpassed open cholecystectomy as the primary method for gallbladder removal countrywide. More than 315 Mongolian health care practitioners received laparoscopic training in 19 of the country's 21 aimags (states). By 2013, 58% of cholecystectomies countrywide were performed laparoscopically, a dramatic increase over 9 years. The expansion of laparoscopic cholecystectomy has transformed the care of biliary tract disease in Mongolia despite the country's limited resources. Copyright © 2016 Elsevier Inc. All rights reserved.
Harboe, Kirstine Moll; Bardram, Linda
included 20,307 patients (82% of all cholecystectomies). The conversion rate was 7.6%. Male sex, acute cholecystitis, and previous upper abdominal surgery were risk factors for conversion, with respective odds ratios of 1.50, 4.61, and 3.54. The mean LOS was 1.5 days, and 37.3% of the patients had same.......27%. Age older than 60 years, American Society of Anesthesiology (ASA) score exceeding 1, and open procedure were significant risk factors for all the outcomes. Body mass index (BMI) was not a risk factor for any of the outcomes. Conclusion The quality of cholecystectomy is high in Denmark, with a low......Background Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstones. The quality of the procedure frequently is included in quality improvement programs, but outcome values have not been described to define the standard of care for a general population. This study included...
Bartnicka, Joanna; Zietkiewicz, Agnieszka A; Kowalski, Grzegorz J
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.
Costantini, Raffaele; Affaitati, Giannapia; Massimini, Francesca; Tana, Claudio; Innocenti, Paolo; Giamberardino, Maria Adele
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
Ausania, F; White, SA; French, JJ; Jaques, BC; Charnley, RM; Manas, DM
Introduction Advanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection. Methods The records of 60 consecutive referrals for incidental gallbladder cancer in a single tertiary centre from 2003 to 2011 were reviewed retrospectively. Decision on re-resection of incidental gallbladder cancer was based on delayed interval restaging at three months following cholecystectomy. Demographics, index cholecystectomy data, primary pathology, CA19–9 tumour marker levels at referral and time from cholecystectomy to referral as well as from referral to restaging were analysed. Results Thirty-seven patients with pT2 and twelve patients with pT3 incidental gallbladder cancer were candidates for radical re-resection. Following interval restaging, 24 patients (49%) underwent radical resection and 25 (51%) were deemed inoperable. The inoperable group had significantly more patients with positive resection margins at cholecystectomy (p=0.002), significantly higher median CA19–9 levels at referral (p=0.018) and were referred significantly earlier (p=0.004) than the patients who had resectable tumours. On multivariate analysis, urgent referral (p=0.036) and incomplete cholecystectomy (p=0.048) were associated significantly with inoperable disease following restaging. Conclusions In patients with incidental, potentially resectable, pT2/T3 gallbladder cancer, inappropriate index cholecystectomy may have a significant impact on tumour dissemination. Early referral of breached tumours is not associated with resectability. PMID:25723690
Abdel-Aziz, Mosaad; El-Bosraty, Hussam; Qotb, Mohamed; El-Hamamsy, Mostafa; El-Sonbaty, Mohamed; Abdel-Badie, Hazem; Zynabdeen, Mustapha
Nasal encephalocele may presents as a nasal mass, its treatment is surgical and it should be done early in life. When removal is indicated, there are multiple surgical approaches; including lateral rhinotomy, a transnasal approach and a coronal flap approach. However, the treatment of a basal intranasal encephalocele using transnasal endoscopic approach could obviates the possible morbidity associated with other approaches. The aim of this study was to evaluate the efficacy of endoscopic removal of intranasal encephalocele, also to document the role of anesthetist in the operative and postoperative periods. Nine cases with nasal encephalocele were included in this study; CT and/or MRI were used in their examination. The lesions were removed via transnasal endoscopic approach. Preoperative evaluation, intervention and postoperative follow-up were presented with discussion of anesthesia used for those children. The lesions of all patients were removed successfully with no recurrence through the follow-up period of at least 21 months. No cases showed morbidity or mortality intra- or post-operatively. Endoscopic excision of intranasal encephalocele is an effective method with high success rate. Anesthetist plays an important role in the operative and postoperative period, even during the endoscopic follow up; sedation of the children is usually needed. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
Watson, David I; Immanuel, Arul
Gastroesophageal reflux is extremely common in Western countries. For selected patients, there is an established role for the surgical treatment of reflux, and possibly an emerging role for endoscopic antireflux procedures. Randomized trials have compared medical versus surgical management, laparoscopic versus open surgery and partial versus total fundoplications. However, the evidence base for endoscopic procedures is limited to some small sham-controlled studies, and cohort studies with short-term follow-up. Laparoscopic fundoplication has been shown to be an effective antireflux operation. It facilitates quicker convalescence and is associated with fewer complications, but has a similar longer term outcome compared with open antireflux surgery. In most randomized trials, antireflux surgery achieves at least as good control of reflux as medical therapy, and these studies support a wider application of surgery for the treatment of moderate-to-severe reflux. Laparoscopic partial fundoplication is an effective surgical procedure with fewer side effects, and it may achieve high rates of patient satisfaction at late follow-up. Many of the early endoscopic antireflux procedures have failed to achieve effective reflux control, and they have been withdrawn from the market. Newer procedures have the potential to fashion a surgical fundoplication. However, at present there is insufficient evidence to establish the safety and efficacy of endoscopic procedures for the treatment of gastroesophageal reflux, and no endoscopic procedure has achieved equivalent reflux control to that achieved by surgical fundoplication.
Kim, Yong Sik; Kim, Chul Young; Chun, Hoon Jai
Recently, the field of gastrointestinal endoscopy is developing rapidly. Once limited to the gastroinstestinal lumen, the endoscopic technology is now breaking the barriers and extending its boundary to peritoneal and pleural space. In 2004, Dr. Kalloo, a gastroenterologist, observed intraperitoneal organs of a pig using a conventional endoscope through the stomach wall. Since then, new endoscopic technique of intraperitoneal intervention with transluminal approach named the Natural Orifice Transluminal Endoscopic Surgery or NOTES has been introduced. NOTES reaches the target organ by inserting the endoscope through a natural orifice (e.g. mouth, anus, vagina, urethra) and entering the peritoneal lumen by means of making an incision on the luminal wall. After a series of successful experiences in animal studies, NOTES are now being tried on human subjects. There are still many obstacles to overcome, but bright future for this new technology is expected because of its proposed advantages of less pain, lower complication rate, short recovery time, and scarless access. In this review, we plan to learn about NOTES.
Gellner, Verena; Tomazic, Peter V
The endoscopic transnasal trans-sphenoidal transtubercular approach has become a standard alternative approach to neurosurgical transcranial routes for lesions of the anterior skull base in particular pathologies of the anterior tubercle, sphenoid plane, and midline lesions up to the interpeduncular cistern. For both the endoscopic and the transcranial approach indications must strictly be evaluated and tailored to the patients' morphology and condition. The purpose of this review was to evaluate the evidence in literature of the limitations of the endoscopic transtubercular approach. A PubMed/Medline search was conducted in January 2018 entering following keywords. Upon initial screening 7 papers were included in this review. There are several other papers describing the endoscopic transtubercular approach (ETTA). We tried to list the limitation factors according to the actual existing literature as cited. The main limiting factors are laterally extending lesions in relation to the optic canal and vascular encasement and/or unfavorable tumor tissue consistency. The ETTA is considered as a high level transnasal endoscopic extended skull base approach and requires excellent training, skills and experience.
Bloomfield, Ian; Van Dalen, Roelof; Lolohea, Simione; Wu, Linus
Transanal endoscopic microsurgery (TEMS) is a proven alternative therapy to either radical surgery or endoscopic mucosal resection for rectal neoplasms. It has proven benefits with lower morbidity and mortality compared with total mesorectal excision, and a lower local recurrence rate when compared to endoscopic mucosal techniques. A retrospective data collection of TEMS procedures performed through Waikato District Health Board, New Zealand, from 2010 to 2015 was conducted. Supportive follow-up data were sourced from patient records and from local centres around New Zealand. A total of 137 procedures were performed over the study period, with five being repeat procedures. Procedures were mostly performed for benign lesions (66.4%) with an overall complication rate of 15.3%, only five of which were Clavien-Dindo grade III (3.6%). Our local recurrence rate after resection of benign lesions was 5.1%. Our data set demonstrates the TEMS procedure to be safe compared to radical resection (total mesorectal excision) for sessile rectal lesions. Close endoscopic follow-up is recommended, especially for close or incomplete margins. Good therapeutic results can be obtained for appropriately selected early malignant lesions. TEMS provides better oncological results than endoscopic mucosal resection or transanal excision. © 2017 Royal Australasian College of Surgeons.
... Endoscopic electrosurgical unit and accessories. (a) Identification. An endoscopic electrosurgical unit and... device includes the electrosurgical generator, patient plate, electric biopsy forceps, electrode, flexible snare, electrosurgical alarm system, electrosurgical power supply unit, electrical clamp, self...
Conclusion: Endoscopic harvest of the radial artery is technically demanding, but excellent results can be achieved. The endoscopic approach can provide suitable conduits in a less invasive way than the open harvest technique.
The endoscopic preperitoneal technique (TEP) is an appealing inguinal hernia repair technique, theoretically superior to other approaches. In practice some problems remain unsolved. Real incidences of chronic postoperative inguinal pain (CPIP) and other important sequelae of endoscopic hernia repair
McCloy, R.; Randall, D.; Schug, S.A.
BACKGROUND: In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision ... using MEDLINE and EmBASE. Only randomized controlled trials in English, investigating minilaparoscopic versus conventional LC (total size of trocar incision > or = 25 mm) and reporting pain scores were included. Quantitative analyses (meta-analyses) were performed on postoperative pain scores and other.......00001]. CONCLUSIONS: The data included in this review suggest that reducing the size of trocar incision results in some limited improvements in surgical outcomes after LC. However, it carries a higher risk of conversion to conventional LC or open cholecystectomy Udgivelsesdato: 2008/12...
Full Text Available Aim: To assess the causes, frequency and time of conversion from laparoscopic to classic cholecystectomy in our ownmaterial.Material and methods: 547 patients were qualified for laparoscopic cholecystectomy in the Surgery Department ofthe Mogilno District Hospital in Strzelno during the period of 1999-2005; 515 minimally invasive operations were performedand 32 patients required conversion.Results: The 547 patients were qualified for the laparoscopic operation; of these 148 were operated on as emergencycases and 399 as elective cases. There were 20 conversions among emergency patients and 12 conversions amongelective patients. On average the decision to convert was made in the 35th min of the operation. The shortest time toconversion was 15 min and the longest was 90 min. Five conversions were performed in the 25th and 35th minand 4 in the 20th, 30th, and 40th mine. Most frequently conversions occurred between the 20th and 40th min of theprocedure. Intentional conversions were performed in 27 patients. Adhesions and clumps around the gallbladder werethe cause of conversion in 10 patients and that was the most frequent reason for the operative modality change. Thenext cause of conversion was changes observed in the course of acute cholecystitis in the form of gallbladder empyemaor cholecystocele (9 patients. Small, fibrotic gallbladder, immersed in the liver, was the reason for conversion ina further 4 patients. In 4 cases the conversion was caused by difficulties in the identification of anatomical structures.Four cases of forced conversions and 1 anticipated conversion were found in the analysed material.Conclusions: A change of operative modality during laparoscopic cholecystectomy was made on average in 5.85% ofoperations. The average time before the conversion was 35 min. Emergency patients required a change of operativemodality 4 times more often. The most frequent were intentional conversions (84%, caused by pericystic adhesionsand by
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.
Oksar, Menekse; Koyuncu, Onur; Turhanoglu, Selim; Temiz, Muhyittin; Oran, Mustafa Cemil
To evaluate and compare intercostal-iliac transversus abdominis plane (TAP) and oblique subcostal TAP (OSTAP) blocks for multimodal analgesia in patients receiving laparoscopic cholecystectomy. A prospective, randomized, double-blinded clinical study. Operating room, postoperative recovery area, and ward. In total, 60 laparoscopic cholecystectomy patients (43 women, 17 men, American Society of Anesthesiologists grades I-II) were enrolled from the general surgery department of our tertiary care center. The patients were assigned to 1 of the 3 groups. Group 1 received TAP blocks (n=20), group 2 received OSTAP blocks (n=20), and group 3 patients were used as controls and received patient-controlled analgesia (PCA) only (n=20). After the induction of anesthesia, blocks were performed bilaterally in study groups 1 and 2, using 20mL of lidocaine (5mg/mL). PCA with intravenous tramadol was routinely provided for all patients during the first 24hours. The intraoperative use of remifentanil, postoperative visual analog scale (VAS) scores, demand for PCA, and total analgesic consumption were recorded. The patients in the control group had greater analgesic demands and analgesic consumption than did those in groups 1 and 2. However, patients in the OSTAP group had lower VAS scores than did those in groups 1 and 3. The demand for analgesia was greater in the control group than in groups 1 and 2. Moreover, lower VAS scores were recorded in the OSTAP group than in groups 1 and 3 and were positively correlated with total PCA consumption among all patients. However, postoperative VAS scores were negatively correlated with the total intraoperative consumption of remifentanil at 24hours. TAP and OSTAP blocks improved postoperative analgesia in patients receiving laparoscopic cholecystectomy, which resulted in lower VAS scores and reduction in total analgesic consumption. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available Abstract Background and goal of study: After laparoscopic cholecystectomy, patients have moderate pain in the early postoperative period. Some studies shown beneficial effects of subcostal transversus abdominis plane block on reducing this pain. Our goal was to investigate influence of subcostal transversus abdominis plane block on postoperative pain scores and opioid consumption. Materials and methods: We have randomized 76 patients undergoing laparoscopic cholecystectomy to receive either subcostal transversus abdominis plane block (n = 38 or standard postoperative analgesia (n = 38. First group received bilateral ultrasound guided subcostal transversus abdominis plane block with 20 mL of 0.33% bupivacaine per side before operation and tramadol 1 mg.kg−1 IV for pain breakthrough (≥6. Second group received after operation tramadol 1 mg.kg−1/6 h as standard hospital analgesia protocol. Both groups received acetaminophen 1 g/8 h IV and metamizole 2.5 g/12 h. Pain at rest was recorded for each patient using NR scale (0–10 in period of 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 16 h after the surgery. Results and discussion: We obtained no difference between groups according age, weight, intraoperative fentanyl consumption and duration of surgery. Subcostal transversus abdominis plane block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the subcostal transversus abdominis plane (24.29 ± 47.54 g than in the standard analgesia group (270.2 ± 81.9 g (p = 0.000. Conclusion: Our results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cholecystectomy.
Vrsajkov, Vladimir; Mančić, Nedjica; Mihajlović, Dunja; Milićević, Suzana Tonković; Uvelin, Arsen; Vrsajkov, Jelena Pantić
After laparoscopic cholecystectomy, patients have moderate pain in the early postoperative period. Some studies shown beneficial effects of subcostal transversus abdominis plane block on reducing this pain. Our goal was to investigate influence of subcostal transversus abdominis plane block on postoperative pain scores and opioid consumption. We have randomized 76 patients undergoing laparoscopic cholecystectomy to receive either subcostal transversus abdominis plane block (n=38) or standard postoperative analgesia (n=38). First group received bilateral ultrasound guided subcostal transversus abdominis plane block with 20mL of 0.33% bupivacaine per side before operation and tramadol 1mg.kg -1 IV for pain breakthrough (≥6). Second group received after operation tramadol 1mg.kg -1 /6h as standard hospital analgesia protocol. Both groups received acetaminophen 1g/8h IV and metamizole 2.5g/12h. Pain at rest was recorded for each patient using NR scale (0-10) in period of 10min, 30min, 2h, 4h, 8h, 12h and 16h after the surgery. We obtained no difference between groups according age, weight, intraoperative fentanyl consumption and duration of surgery. Subcostal transversus abdominis plane block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the subcostal transversus abdominis plane (24.29±47.54g) than in the standard analgesia group (270.2±81.9g) (p=0.000). Our results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cholecystectomy. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
Riñón, C; de Mingo, L; Cortés, M J; Ollero, J C; Alvarez, M; Espinosa, R; Rollán, V
Biliary lithiasis is not much frequent in paediatric patients. The manegement of cholelithiasis in patients undergoing laparoscopic cholecystectomy is still controversial. We propose the preoperatory echographic study of the biliary tree 24-48 h before surgery, as the first choice, instead of the intraoperatory cholangiography. We made a retrospective study of 42 patients undergoing laparoscopic cholecystectomy due to symptomatic biliary lithiasis during the last 15 years, with ages between 18 months and 17-years-old (mean age 9,6-years-old) and weight between 11 and 70 kg (mean weight 42 kg) at the moment of surgery. Six of them had haematological illnesses, 17 came to the hospital because of acute abdominal pain, 10 had been studied because of recurrent abdominal pain and 9 had casual diagnoses. Abdominal sonography was performed in all patients 24-48 hours before surgery. Four children were diagnosed of biliary duct lithiasis: two choledocolithiasis and two stones in the cystic duct. One of the cystic stones was extracted in the operating room and the rest resolved spontaneously. One patient presented dilatation of choledocal duct after surgery, without any stones' evidence. Also this patient resolved spontaneously. We had no complications. Biliary lithiasis is not frequent in children, even if it seems to be increasing. A few of these patients will suffer of choledocolithiasis. The intraoperatory exploration of the biliary tree during laparoscopic surgery is technically difficult due the small size of paediatric patients. Cholangiography is not always successful and can produce some important complications as pancreatitis. Preoperative sonography 24-48 hours before surgery is a safe and efficient method for the diagnosis and follow-up of paediatric patients with biliary lithiasis undergoing laparoscopic cholecystectomy. It is safe enough to be performed without intraoperatory cholangiography.
Full Text Available Background and Objective: Today, the control or reduction of pain and anxiety is considered to be of great importance. Thus, the use of complementary medicine therapies has gained much attention. The present study was performed with the aim to investigate the effect of music on anxiety and pain in patients undergoing cholecystectomy. Materials and Method: This single-blind randomized clinical trial was performed on 60 patients undergoing cholecystectomy in Sina Hospital of Tabriz, Iran, in 2013. Subjects were selected through simple random sampling method and divided into intervention (n = 30 and control groups (n = 30 using a random number table. For the intervention group, 8 and 16 hours after surgery, the music was played for 15-30 minutes. For the control group, routine care was performed. Data collection tools included demographic information form and a visual analogue scales (VAS for anxiety and pain. Data analysis was performed using SPSS software version 13, and chi-square, Students’ independent t-test, and repeated measures ANOVA. Results: Comparison of changes in anxiety and pain in the two groups showed a significant decrease in anxiety 8 hours (6/27 ± 3.23 and 16 hours (5.33 ± 3.03 after surgery (P = 0.001. Moreover, the reduction in pain 8 hours (7.51 ± 1.83 and 16 hours (6.61 ± 1.86 after surgery was greater in the intervention group than the control group (P = 0.001. Conclusion: The results illustrated the positive impact of music on anxiety and pain reduction 8 and 16 hours after cholecystectomy. Therefore, this method can be used as an inexpensive and non-invasive nursing care technique.
Altuntas, Yunus Emre; Oncel, Mustafa; Haksal, Mustafa; Kement, Metin; Gundogdu, Ersin; Aksakal, Nihat; Gezen, Fazli Cem
OBJECTIVE: This study aimed to reveal the risk factors and outcomes of gallbladder perforation (GP) during laparoscopic cholecystectomy. METHODS: Videotapes of all patients who underwent an elective cholecystectomy at our department were retrospectively analyzed, and the patients were divided into two groups based on the presence of GP. The possible risk factors and early outcomes were analyzed. RESULTS: In total, 664 patients [524 (78.9%) females, 49.7±13.4 years of age] were observed, and GP occurred in 240 (36.1%) patients, mostly while dissecting the gallbladder from its bed (n=197, 82.1%). GP was not recorded in the operation notes in 177 (73.8%) cases. Among the studied parameters, there was no significant risk factor for GP, except preoperatively elevated alanine transaminase level (p=0.005), but the sensitivity and specificity of this measure in predicting GP were 14.2% and 7.4%, respectively. The two groups had similar outcomes, but the operation time (35.4±17.5 vs 41.4±18.7 min, p=0.000) and incidence of drain use (25% vs 45.8%, p=0.000) increased in the GP group. CONCLUSION: The present study reveals that GP occurs in 36.1% of patients who undergo laparoscopic elective cholecystectomy, but it may not be recorded in most cases. We did not find any reliable risk factor that increases the possibility of GP. GP causes an increase in the operation time and incidence of drain use; however, the other outcomes were found to be similar in patients with GP and those without. PMID:29607432
Pedersen, Benjamin; Ellebæk, Mark B.; Dorfelt, Allan
pain. The objective of the present study was to investigate whether the indication “socially debilitating pain” was reported in the patien’s file when he or she was referred to surgery. METHODS: Hospital files for all patients referred to surgical evaluation for uncomplicated gallbladder stones from......, the indication of socially debilitating pain was described in the patient files. CONCLUSIONS: Our results may represent overtreatment and/or incorrect selection of patients suitable for surgery. More and larger prospective cohort studies are warranted to elucidate the indications for cholecystectomy...
Gögenur, Ismail; Kücükakin, Bülent; Bisgaard, Thue
= 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 ) compared...... with placebo (28 min ) 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....
Kang, Chang Moo; Chi, Hoon Sang; Hyeung, Woo Jin; Kim, Kyung Sik; Choi, Jin Sub; Kim, Byong Ro
With the advancement of laparoscopic instruments and computer sciences, complex surgical procedures are expected to be safely performed by robot assisted telemanipulative laparoscopic surgery. The da Vinci system (Intuitive Surgical, Mountain View, CA, USA) became available at the many surgical fields. The wrist like movements of the instrument's tip, as well as 3-dimensional vision, could be expected to facilitate more complex laparoscopic procedure. Here, we present the first Korean experience of da Vinci robotic assisted laparoscopic cholecystectomy and discuss the introduction and perspectives of this robotic system. PMID:17594166
Holme, Jørgen Bendix; Mortensen, Frank Viborg
To test the use of a simple and cheap powder-free glove bag to extract the gallbladder during laparoscopic cholecystectomy (LC). The medical records of 142 consecutive patients who had their gallbladder removed using a powder-free glove bag were reviewed. No complications in the form of bile or stone spillage during extraction were observed. The absence of complications and the low cost make routine use of the glove bag a wise option for extracting the gallbladder during LC. The use of the glove bag seems to reduce the risk of contamination with bacteria, bile, and gallstones and may reduce contamination by malignant cells in case of unexpected gallbladder carcinoma.
Marco Aurélio Lameirão Pinto
Full Text Available The authors describe a surgical technique which allows, without increasing costs, to perform laparoscopic cholecystectomy with a single incision, without using specific materials and with better surgical ergonomics. The technique consists of a longitudinal umbilical incision, navel detachment, use of a permanent 10mm trocar and two clamps directly and bilaterally through the aponeurosis without the use of 5mm trocars, transcutaneous gallbladder repair with straight needle cotton suture, ligation with unabsorbable suture and umbilical incision for the specimen extraction. The presented technique enables the procedure with conventional and permanent materials, improving surgical ergonomics, with safety and aesthetic advantages.
Bredesen, J; Jørgensen, T; Andersen, T F
to women who had a simple hysterectomy. The mortality was significantly higher than in the general female population (p less than 0.05). Increased age, acute admission, admissions to hospital within 3 months prior to the index admission, the number of discharge diagnoses, and the geographical region were...... significantly associated with increased mortality. Exploration of the common bile duct was associated with higher mortality in the bivariate analysis, but the association disappeared when the number of discharge diagnoses was taken into account. Type of hospital and the population based cholecystectomy rate...
Jye Hae Park
Full Text Available Purpose: Percutaneous endoscopic gastrostomy (PEG can improve nutritional status and reduce the amount of time needed to feed neurologically impaired children. We evaluated the characteristics, complications, and outcomes of neurologically impaired children treated with PEG. Methods: We retrospectively reviewed the records of 32 neurologically impaired children who underwent PEG between March 2002 and August 2008 at our medical center. Forty-two PEG procedures comprising 32 PEG insertions and 10 PEG exchanges, were performed. The mean follow-up time was 12.2 (6.6 months. Results: Mean patient age was 9.4 (4.5 years. The main indications for PEG insertion were swallowing difficulty with GI bleeding due to nasogastric tube placement and/or the presence of gastroesophageal reflux disease (GERD. The overall rate of complications was 47%, with early complications evident in 25% of patients and late complications in 22%. The late complications included one gastro-colic fistula, two cases of aggravated GERD, and four instances of wound infection. Among the 15 patients with histological evidence of GERD before PEG, 13 (87% had less severe GERD, experienced no new aspiration events, and showed increased body weight after PEG treatment. Conclusion: PEG is a safe, effective, and relatively simple technique affording long-term enteral nutritional support in neurologically impaired children. Following PEG treatment, the body weight of most patients increased and the levels of vomiting, GI bleeding, and aspiration fell. We suggest that PEG with post-procedural observation be considered for enteral nutritional support of neurologically impaired children.
Ainsworth, A P; Rafaelsen, S R; Wamberg, P A
BACKGROUND: It is not known whether initial endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) is more cost effective than endoscopic retrograde cholangiopancreatography (ERCP). METHODS: A cost-effectiveness analysis of EUS, MRCP and ERCP was performed on 163...
Goyal, Jatinder; Ramesh, Jayapal
Peripancreatic fluid collections are a well-known complication of pancreatitis and can vary from fluid-filled collections to entirely necrotic collections. Although most of the fluid-filled pseudocysts tend to resolve spontaneously with conservative management, intervention is necessary in symptomatic patients. Open surgery has been the traditional treatment modality of choice though endoscopic, laparoscopic and transcutaneous techniques offer alternative drainage approaches. During the last decade, improvement in endoscopic ultrasound technology has enabled real-time access and drainage of fluid collections that were previously not amenable to blind transmural drainage. This has initiated a trend towards use of this modality for treatment of pseudocysts. In this review, we have summarised the existing evidence for endoscopic drainage of peripancreatic fluid collections from published studies.
Soendenaa, K.; Horn, A.; Viste, A.
Endoscopic retrograde cholangiopancreatography (ERCP) was carried out for the first time in 1968. Five years later endoscopic sphincterotomy was performed. Since then both modalities have become established as necessary adjuncts in the diagnosis and treatment of patients with pathology in the bile duct or pancreas. The main indication is common bile duct stone, and as a consequence of this treatment fewer patients are now treated surgically. Patients with malignant bile duct obstruction can be given reasonable palliation of both jaundice and pruritus and therefore improved quality of life. Some reports indicate that endoscopic drainage may be useful for pancreatic stenosis. Complications are few, but vigilance and prompt treatment is necessary to keep morbidity at a minimum. Follow-up after several years shows that sphincterotomy is successful also in the long term. The authors discuss the present diagnostic and therapeutic situation. 31 refs., 2 tabs
Sakai, Y; Kobayashi, S; Watanabe, E; Sekiya, S; Ohmori, K
In the reconstruction of asymmetrical deformities of the facial skeleton, both an endoscope and a neuronavigator have been used. The endoscope allows the surgeon a wide view of the object on a television monitor, reduces the scarring, minimizes the undermined field, and reduces the need to work blind. The neuronavigator is a frameless computed tomographic stereotactic device that has been mainly used in neurosurgery. The device is easy to use and can offer the surgeon three-dimensional coordinates of the status during the operation. We have used this new technique in three clinical cases, two involving augmentation of the zygomatic bone on one side and one involving reduction of the frontal bone on one side. The surgical techniques we used and the versatility of both the endoscope and the neuronavigator are discussed herein based on our own experience.
Meier, Benjamin; Caca, Karel
Most patients with cholangiocarcinoma (CCA) have unresectable disease. Endoscopic bile duct drainage is one of the major objectives of palliation of obstructive jaundice. Stent implantation using endoscopic retrograde cholangiography is considered to be the standard technique. Unilateral versus bilateral stenting is associated with different advantages and disadvantages; however, a standard approach is still not defined. As there are various kinds of stents, there is an ongoing discussion on which stent to use in which situation. Palliation of obstructive jaundice can be augmented through the use of photodynamic therapy (PDT). Studies have shown a prolonged survival for the combinations of PDT and different stent applications as well as combinations of PDT and additional systemic chemotherapy. More well-designed studies are needed to better evaluate and standardize endoscopic treatment of unresectable CCA.
Endoscopic sphincterotomy is an integral component of endoscopic retrograde cholangiopancreatography. Post-sphincterotomy hemorrhage is a recognized complication. First line treatment involves a variety of endoscopic techniques performed at the time of sphincterotomy. If these are not successful, transcatheter arterial embolization or open surgical vessel ligation are therapeutic considerations.
D. V. Samsonov
Full Text Available Total mesorectal excision is the “golden standard” of surgical treatment for rectal cancer. Development of endoscopic technologies allowed to implement the benefits of minimally invasive surgery in early rectal cancer treatment, decrease morbidity and mortality, improve functional outcome and quality of life. Oncological safety of this method is still a subject for discussion due to lack of lymph node harvest. Endoscopic operations for early rectal cancer are being actively implemented in daily practice, but lack of experience does not allow to include this method in national clinical prac-tice guidelines.
Lu, Yidan; Chen, Yen-I; Barkun, Alan
This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.
Full Text Available Gallbladder carriage of invasive Salmonella is considered fundamental in sustaining typhoid fever transmission. Bile and tissue was obtained from 1,377 individuals undergoing cholecystectomy in Kathmandu to investigate the prevalence, characteristics and relevance of invasive Salmonella in the gallbladder in an endemic area. Twenty percent of bile samples contained a Gram-negative organism, with Salmonella Typhi and Salmonella Paratyphi A isolated from 24 and 22 individuals, respectively. Gallbladders that contained Salmonella were more likely to show evidence of acute inflammation with extensive neutrophil infiltrate than those without Salmonella, corresponding with higher neutrophil and lower lymphocyte counts in the blood of Salmonella positive individuals. Antimicrobial resistance in the invasive Salmonella isolates was limited, indicating that gallbladder colonization is unlikely to be driven by antimicrobial resistance. The overall role of invasive Salmonella carriage in the gallbladder is not understood; here we show that 3.5% of individuals undergoing cholecystectomy in this setting have a high concentration of antimicrobial sensitive, invasive Salmonella in their bile. We predict that such individuals will become increasingly important if current transmission mechanisms are disturbed; prospectively identifying these individuals is, therefore, paramount for rapid local and regional elimination.
Full Text Available 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.
Chee Wei Tay
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.
El-Awadi, Saleh; El-Nakeeb, Ayman; Youssef, Tamer; Fikry, Amir; Abd El-Hamed, Tito M; Ghazy, Hosam; Foda, Elyamany; Farid, Mohamed
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.
Sun Wei; Zhu Gaohong; Wei Jiangliang; Hu Jianwei
Objective: To investigate the effects of laparoscopic cholecystectomy on the plasma levels of endothelin and calcitonin gene-related peptide (CGRP)in elderly patients. Methods: Sixty patients undergoing elective laoaroscopic cholecystectomy were divided into 65 years old group according to their ages (30 cases in each group). The plasma levels of endothelin and CGRP were measured before surgery, after intubation, at the time of gallbladder removal, immediately after surgery and 24 hours after surgery by radioimmunoassay. Results: There was no significant difference in endothelin levels between the two groups before the surgery (t=0.971, P>0.05). The endothelin levels in both groups gradually increased after the intubation, but more significantly in the > 65 years old group (t=4.258, P 65 years old group (t=5.134, P 65 years old group continued to increase, but it decreased in the 0.05). The CGRP levels had not significantly changed during the perioperative period in the 65 years old group, CGRP levels decreased after anaesthesia, but increased during the surgery, and then reached the highest level at the time of the surgery completed. CGRP levels were significant difference between the two groups after intubation and immediately after surgery (t=4.084 and t=4.085, P<0.05). Conclusion: The levels of endothelin and CGRP had significantly changed elderly patients than those in young patients, especially for endothelin. (authors)
Full Text Available Background and objectives:Dexmedetomidine is an α2 agonist with sympatholytic, anxiolytic, sedative and analgesic effect used as adjunct during surgeries for its haemodynamic stabilizing effect and analgesic effect. Primary aims of the study were to evaluate the haemodynamic effect of intravenous dexmedetomidine and the duration and quality of analgesia in laparoscopic cholecystectomy. Secondary aims were sedation levels and occurrence of side effects.Materials and methods:Eighty four patients, American society of Anaesthesiologists physical status I and II, aged 18-60 years of either gender undergoing laparoscopic cholecystectomy in general anaesthesia were randomly allocated into two equal groups. Group C patient received Normal Saline and Group S patient received dexmedetomidine loading dose infusion of 1µg/kg over 10 minutes before induction and maintained with 0.4µg/kg/hr till the removal of gall bladder. Induction with propofol and fentanyl was done. Standard monitoring including Heart Rate, Mean arterial pressure, oxygen saturation were monitored perioperatively. Postoperative analgesia requirement and sedation score were assessed.Results: In Group S, the haemodynamic responses were significantly attenuated. During postoperative period, 24 hours analgesic requirement of diclofenac sodium was 141.43mg in group S as compared to 217.50mg in group C(p<0.001. Side effects were treatable. Sedation was better in Group S.Conclusion:Dexmedetomidine effectively attenuates haemodynamic stress response during laparoscopic surgery with reduction in postoperative analgesic requirements.
Judge, Joshua M; Stukenborg, George J; Johnston, William F; Guilford, William H; Slingluff, Craig L; Hallowell, Peter T
A source of frustration during laparoscopic cholecystectomy involves extraction of the gallbladder through port sites smaller than the gallbladder itself. We describe the development and testing of a novel device for the safe, minimal enlargement of laparoscopic port sites to extract large, stone-filled gallbladders from the abdomen. The study device consists of a handle with a retraction tongue to shield the specimen and a guide for a scalpel to incise the fascia within the incision. Patients enrolled underwent laparoscopic cholecystectomy. Gallbladder extraction was attempted. If standard measures failed, the device was implemented. Extraction time and device utility scores were recorded for each patient. Patients returned 3-4 weeks postoperatively for assessment of pain level, cosmetic effect, and presence of infectious complications. Twenty (51 %) of 39 patients required the device. Average extraction time for the first eight patients was 120 s. After interim analysis, an improved device was used in 12 patients and average extraction time was 24 s. There were no adverse events. Postoperative pain ratings and incision cosmesis were comparable between patients with and without use of the device. The study device enables safe and rapid extraction of impacted gallbladders through the abdominal wall.
Gerlinzani, S; Tos, M; Gornati, R; Molteni, B; Poliziani, D; Taschieri, A M
Laparoscopic cholecystectomy entails an increased risk of gallbladder rupture and consequent loss of stones in the abdominal cavity. Herein we report the case of a 51-year-old male patient, who underwent laparoscopic cholecystectomy 2 years before presentation to our hospital. He had experienced tension sensation and epigastric pain since 4 months postoperatively. A well-defined epigastric mass, which was hard and painful on palpation, was detected and later confirmed by ultrasonography and CT scan. Explorative laparotomy revealed a mass in the area of the gastrocolic ligament,resulting from biliary gallstones in conjunction with a perimetral inflammatory reaction. A review of the literature showed that the incidence of gallbladder lesions during laparoscopy is 13-40%. In order to prevent this complication, meticulous isolation of the gallbladder, proper dissection of the cystic duct and artery, and careful extraction through the umbilical access are required. Ligation after the rupture or use of an endo-bag may be helpful. The loss of gallstones and their retention in the abdominal cavity should be noted in the description of the surgical procedure.
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.
Aziza M Hussain
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.
Arya, S V; Das, Anupam; Singh, Sunil; Kalwaniya, Dheer Singh; Sharma, Ashok; Thukral, B B
Laparoscopic cholecystectomy is considered to be the gold standard surgical procedure for cholelithiasis and is one of the commonest surgical procedures in the world today. However, in rare cases of previously undiagnosed situs inversus totalis (with dextrocardia), the presentation of the cholecystitis, its diagnosis and the operative procedure can pose problems. We present here one such case and discuss how the diagnosis was made and difficulties encountered during surgery and how they were coped with. A 35 year old female presented with left hypochondrium pain and dyspepsia, for 2 years. A diagnosis of cholelithiasis with situs inversus was confirmed after thorough clinical examination, abdominal and chest X-rays and ultrasonography of the abdomen. Laparoscopic cholecystectomy, which is the standard treatment, was performed with numerous modifications in the positioning of the monitor, insufflator, ports and the position of the members of the surgical team and the laparoscopic instruments. The patient had an uneventful recovery. Situs inversus totalis is itself a rare condition and when associated with cholelithiasis poses a challenge in the management of the condition. We must appreciate the necessity of setting up the operating theatre, the positioning of the ports, the surgical team and the instruments. Therefore, it becomes important for the right handed surgeons to modify their techniques and establish a proper hand eye coordination to adapt to the mirror image anatomy of the Calot's triangle in a patient of situs inversus totalis. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Khoo, Joon Joon; Nurul, Akmar Misron
An audit of 1122 cholecystectomies for a 6-year period from 2000 to 2005 was done to review cases of primary carcinoma of gallbladder. There were nine cases of primary carcinoma of gallbladder. Six were females and 3 males. Their ages ranged from 27 to 81 years. Pre-operatively, only 2 (11.1%) were clinically suspected of carcinoma while 3 were diagnosed as cholecystitis, two as cholelithiasis and one case each of ovarian cyst and intestinal obstruction. Intra-operatively, an additional four cases were suspected as gallbladder carcinoma with the remaining three cases diagnosed as only having gallstones. Altogether only 5 (55.6%) cases were associated with gallstones. Six (66.67%) cases of gallbladder carcinoma had abnormal macroscopical lesions noted; either papillary lesions or polypoid masses. The remaining 3 cases had thickening of the wall, consistent with chronic cholecystitis. Seven cases were found histologically to be adenocarcinoma. Of these, two were papillary carcinoma and one signet ring cell type adenocarcinoma. One case of squamous cell carcinoma and one case of adenosquamous carcinoma were noted. This study highlights the importance of careful macroscopical and microscopical evaluation of a routine pathological examination of gallbladder removed for cholecystitis or cholelithiasis. It provides the incidence of gallbladder carcinoma in patients who underwent cholecystectomies in a government hospital in Johor, Malaysia.
Ju Hyun Oak
Full Text Available Purpose. The recurrence of CBD stone is still observed in a considerable number of patients. The study was to evaluate the risk factors for recurrence of symptomatic CBD stone in patients who underwent cholecystectomy after the removal of CBD stone. Methods. The medical records of patients who underwent removal of CBD stone with subsequent cholecystectomy were reviewed. The risk factors for the recurrence of symptomatic CBD stone were compared between the recurrence and the nonrecurrence group. Results. The mean follow-up period was 40.6 months. The recurrence of symptomatic CBD stones was defined as the detection of bile duct stones no sooner than 6 months after complete clearance of CBD stones, based on symptoms or signs of biliary complication. 144 patients (68 males, 47.2% were finally enrolled and their mean age was 59.8 (range: 26~86 years. The recurrence of CBD stone occurred in 15 patients (10.4%. The mean period until first recurrence was 25.9 months. The presence of type 1 or 2 periampullary diverticulum and multiple CBD stones were the independent risk factors. Conclusion. For the patients with type 1 or 2 periampullary diverticulum or multiple CBD stones, careful followup is needed for the risk in recurrence of symptomatic CBD stone.
Gouda M El-labban
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.
Hu, Alan Shiun Yew; Donohue, Peter O'; Gunnarsson, Ronny K; de Costa, Alan
Valid and user-friendly prediction models for conversion to open cholecystectomy allow for proper planning prior to surgery. The Cairns Prediction Model (CPM) has been in use clinically in the original study site for the past three years, but has not been tested at other sites. A retrospective, single-centred study collected ultrasonic measurements and clinical variables alongside with conversion status from consecutive patients who underwent laparoscopic cholecystectomy from 2013 to 2016 in The Townsville Hospital, North Queensland, Australia. An area under the curve (AUC) was calculated to externally validate of the CPM. Conversion was necessary in 43 (4.2%) out of 1035 patients. External validation showed an area under the curve of 0.87 (95% CI 0.82-0.93, p = 1.1 × 10 -14 ). In comparison with most previously published models, which have an AUC of approximately 0.80 or less, the CPM has the highest AUC of all published prediction models both for internal and external validation. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.
Ragozzino, Alfonso; Puglia, Marta; Romano, Federica; Imbriaco, Massimo
Spillage of gallstones in the abdominal cavity may rarely occur during the course of laparoscopic cholecystectomy. Dropped gallstones in the peritoneal and extra-peritoneal cavity are usually asymptomatic. However, they may lead to abscess formation with an estimated incidence of about 0.3%. Common locations of the abscess are in the abdominal wall followed by the intra-abdominal cavity, usually in the sub-hepatic or retro-peritoneum inferior to the sub-hepatic space. We hereby describe an unusual case of infected spilled gallstones in the right sub-phrenic space, prospectively detected on abdominal MRI performed two years after laparoscopic cholecystectomy, in a patient with only a mild right-sided abdominal complaint. This case highlights the role of MRI in suggesting the right diagnosis in cases with vague or even absent symptomatology. In our case the patient’s history together with high quality abdomen MRI allowed the correct diagnosis. Radiologists should be aware of this rare and late onset complication, even after many years from surgery as an incidental finding in almost asymptomatic patients
Friedel, David; Modayil, Rani; Stavropoulos, Stavros N
Per-oral endoscopic myotomy (POEM) represents a natural orifice endoscopic surgery (NOTES) approach to laparoscopy Heller myotomy (LHM). POEM is arguably the most successful clinical application of NOTES. The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM. Initial efficacy, safety and acid reflux data suggest at least equivalence of POEM to LHM, the previous gold standard for achalasia therapy. Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM. The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis. PMID:25548473
Full Text Available Purpose. Percutaneous cholecystostomy (PC has increasingly been used as bridge to surgery as well as sole treatment for patients with acute cholecystitis (AC. The aim of the study was to assess the outcome after PC compared to acute cholecystectomy in patients with AC. Methods. A review of medical records was performed on all patients residing in Stockholm County treated for AC in the years 2003 and 2008. Results. In 2003 and 2008 altogether 799 and 833 patients were admitted for AC. The number of patients treated with PC was 21/799 (2.6% in 2003 and 50/833 (6.0% in 2008. The complication rate (Clavien-Dindo ≥ 2 was 4/71 (5.6% after PC and 135/736 (18.3% after acute cholecystectomy. Mean (standard deviation hospital stay was 11.4 (10.5 days for patients treated with PC and 5.1 (4.3 days for patients undergoing acute cholecystectomy. After adjusting for age, gender, Charlson comorbidity index, and degree of cholecystitis, the hospital stay was significantly longer for patients treated with PC than for those undergoing acute cholecystectomy (P<0.001 but the risk for intervention-related complications was found to be significantly lower (P=0.001 in the PC group. Conclusion. PC can be performed with few serious complications, albeit with a longer hospital stay.
Ekmekçi, Perihan; Kazak Bengisun, Züleyha; Kazbek, Baturay Kansu; Öziş, Salih Erpulat; Taştan, Huri; Süer, Arif Hikmet
Pain treatment in laparoscopic cholecystectomy, which is performed in increasing numbers as an ambulatory procedure, is an important issue.Although laparoscopic cholecystectomy is regarded as an ambulatory procedure, patients are often hospitalized due to pain and this increases opioid consumption and side effects caused by opioids. This study aims at evaluating the efficacy of adding dexketoprofen trometamol to tramadol with patient controlled analgesia (PCA) in postlaparoscopic cholecystectomy pain treatment. 40 patients in ASA I-II risk groups aged between 18-65 years were enrolled in the study and were randomized using closed envelope method. In Group TD 600 mg tramadol and 100 mg dexketoprofen trometamol, in Group T 600 mg tramadol was added to 100 ml 0.9% normal saline for PCA. 8 mg lornoxicam iv was given if VAS >40 in the postoperative period. There was no statistically significant difference in terms of adverse effects (hypotension, bradycardia, sedation) but in Group T 4 patients complained of nausea and 3 complained of vomiting. Opioid consumption was lower and patient satisfaction was higher in group TD. This study has shown that adding dexketoprofen trometamol to tramadol in patient controlled analgesia following laparoscopic cholecystectomy lowers VAS scores, increases patient satisfaction and decreases opioid consumption.
Ankersmit, M.; Dam, D.A. van; Rijswijk, A.S. van; Tuynman, J.B.; Meijerink, W.J.H.J.
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
Jensen, K; Kehlet, H; Lund, Claus
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...
van Vliet, Jaap L. P.; van Gulik, Thomas M.; Verbeek, Paul C. M.
Gallbladder specimens are routinely sent for histopathological examination after cholecystectomy in order to rule out the presence of gallbladder carcinoma (GBC). However, there is no evidence for the benefit of this costly practice. Our aim was to determine whether a selective strategy based on
Harling, R; Moorjani, N; Perry, C; MacGowan, A P; Thompson, M H
Septic complications are rare following laparoscopic cholecystectomy if prophylactic antibiotics are given, as demonstrated in previous studies. Antibiotic treatment may be unnecessary and, therefore, undesirable, so we compared two forms of prophylaxis: a cephalosporin antibiotic and bag extraction of the dissected gallbladder. A total of 76 patients undergoing laparoscopic cholecystectomy were randomised to either receive an antibiotic or to have their gallbladder removed from the abdomen in a plastic bag. Complicated cases were excluded. There was a total of 6 wound infections (7.9%), 3 in each of the study groups. All these were associated with skin commensals. There were no other septic complications. Bacteriological studies grouped the organisms isolated from the bile and the wound as potential pathogens and likely commensals. A total of 10 potential pathogens were isolated, 9 of which were found in the group receiving antibiotics. We conclude that septic sequelae of uncomplicated laparoscopic cholecystectomy are uncommon, but clearly not entirely prevented by antibiotic or mechanical prophylaxis. Prophylactic antibiotics may not be required in uncomplicated laparoscopic cholecystectomy. Further study is warranted.
Full Text Available Introduction. Ectopic pelvic liver is an exceedingly rare condition usually resulting after repair of congenital abdominal wall defects. Intrahepatic gallbladder is another rare condition predisposing patients to cholelithiasis and its sequelae. We describe a cholecystectomy in a patient with an intrahepatic gallbladder in a pelvic ectopic liver. Presentation of Case. A 33-year-old woman with a history of omphalocele repair as an infant presented with signs and symptoms of symptomatic cholelithiasis and chronic cholecystitis, however, in an unusual location. After extensive workup and symptomatic treatment, cholecystectomy was recommended and performed via laparotomy and hepatotomy using microwave technology for parenchymal hepatic transection. Discussion. Given the rare combination of an intrahepatic gallbladder and an ectopic pelvic liver, advanced surgical techniques must be employed for cholecystectomies, in addition to involvement of hepatobiliary experienced surgeons due to the distortion of the biliary and hepatic vascular anatomy. Conclusion. Cholecystectomy by experienced hepatobiliary surgeons is a safe and effective treatment for cholecystitis in patients with intrahepatic gallbladders in ectopic pelvic livers.
Wakabayashi, Go; Iwashita, Yukio; Hibi, Taizo; Takada, Tadahiro; Strasberg, Steven M.; Asbun, Horacio J.; Endo, Itaru; Umezawa, Akiko; Asai, Koji; Suzuki, Kenji; Mori, Yasuhisa; Okamoto, Kohji; Pitt, Henry A.; Han, Ho-Seong; Hwang, Tsann-Long; Yoon, Yoo-Seok; Yoon, Dong-Sup; Choi, In-Seok; Huang, Wayne Shih-Wei; Giménez, Mariano Eduardo; Garden, O. James; Gouma, Dirk J.; Belli, Giulio; Dervenis, Christos; Jagannath, Palepu; Chan, Angus C. W.; Lau, Wan Yee; Liu, Keng-Hao; Su, Cheng-Hsi; Misawa, Takeyuki; Nakamura, Masafumi; Horiguchi, Akihiko; Tagaya, Nobumi; Fujioka, Shuichi; Higuchi, Ryota; Shikata, Satoru; Noguchi, Yoshinori; Ukai, Tomohiko; Yokoe, Masamichi; Cherqui, Daniel; Honda, Goro; Sugioka, Atsushi; de Santibañes, Eduardo; Supe, Avinash Nivritti; Tokumura, Hiromi; Kimura, Taizo; Yoshida, Masahiro; Mayumi, Toshihiko; Kitano, Seigo; Inomata, Masafumi; Hirata, Koichi; Sumiyama, Yoshinobu; Inui, Kazuo; Yamamoto, Masakazu
In some cases, laparoscopic cholecystectomy (LC) may be difficult to perform in patients with acute cholecystitis (AC) with severe inflammation and fibrosis. The Tokyo Guidelines 2018 (TG18) expand the indications for LC under difficult conditions for each level of severity of AC. As a result of
P.W. Plaisier; M.Y. Berger (Marjolein); R.L. van der Hul (René); H.G. Nijs (Huub); R. den Toom (Rene); O.T. Terpstra (Onno); H.A. Bruining (Hajo); S.M. Strasberg (S.)
textabstractShortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new treatment modality for gallstone disease, a randomized controlled study was performed to assess the cost-effectiveness of ESWL compared to open cholecystectomy, the gold standard. During the
Hwang, Na-Hyun; Lee, Yoon-Hwan; You, Hi-Jin; Yoon, Eul-Sik; Kim, Deok-Woo
In recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver.
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
Zhou, Pinghong; Yao, Liqing; Qin, Xinyu; Xu, Meidong; Zhong, Yunshi; Chen, Weifeng
The objective of this study was to determine the efficacy and safety of endoscopic submucosal dissection for locally recurrent colorectal cancer after previous endoscopic mucosal resection. A total of 16 patients with locally recurrent colorectal lesions were enrolled. A needle knife, an insulated-tip knife and a hook knife were used to resect the lesion along the submucosa. The rate of the curative resection, procedure time, and incidence of complications were evaluated. Of 16 lesions, 15 were completely resected with endoscopic submucosal dissection, yielding an en bloc resection rate of 93.8 percent. Histologic examination confirmed that lateral and basal margins were cancer-free in 14 patients (87.5 percent). The average procedure time was 87.2 +/- 60.7 minutes. None of the patients had immediate or delayed bleeding during or after endoscopic submucosal dissection. Perforation in one patient (6.3 percent) was the only complication and was managed conservatively. The mean follow-up period was 15.5 +/- 6.8 months; none of the patients experienced lesion residue or recurrence. Endoscopic submucosal dissection appears to be effective for locally recurrent colorectal cancer after previous endoscopic mucosal resection, making it possible to resect whole lesions and provide precise histologic information.
Vignesh, Shivakumar; Hoffe, Sarah E; Meredith, Kenneth L; Shridhar, Ravi; Almhanna, Khaldoun; Gupta, Akshay K
Barrett's esophagus (BE) is the most important identifiable risk factor for the progression to esophageal adenocarcinoma. This article reviews the current endoscopic therapies for BE with high-grade dysplasia and intramucosal cancer and briefly discusses the endoscopic palliation of advanced esophageal cancer. The diagnosis of low-grade or high-grade dysplasia (HGD) is based on several cytologic criteria that suggest neoplastic transformation of the columnar epithelium. HGD and carcinoma in situ are regarded as equivalent. The presence of dysplasia, particularly HGD, is also a risk factor for synchronous and metachronous adenocarcinoma. Dysplasia is a marker of adenocarcinoma and also has been shown to be the preinvasive lesion. Esophagectomy has been the conventional treatment for T1 esophageal cancer and, although debated, is an appropriate option in some patients with HGD due to the presence of occult cancer in over one-third of patients. Endoscopic ablative modalities (eg, photodynamic therapy and cryoablation) and endoscopic resection techniques (eg, endoscopic mucosal resection) have demonstrated promising results. The significant morbidity and mortality of esophagectomy makes endoscopic treatment an attractive potential option.
Fusco, Stefano; Kratt, Thomas; Gani, Cihan; Stueker, Dietmar; Zips, Daniel; Malek, Nisar P; Goetz, Martin
Complete esophageal obstruction after (chemo)radiation for head and neck cancers is rare. However, inability to swallow one's own saliva strongly inflicts upon quality of life. Techniques for endoscopic recanalization in complete obstruction are not well established. We assessed the efficacy and safety of rendezvous recanalization. We performed a retrospective review of all patients who underwent endoscopic recanalization of complete proximal esophageal obstruction after radiotherapy between January 2009 and June 2016. Technical success was defined as an ability to pass an endoscope across the recanalized lumen, clinical success by changes in the dysphagia score. Adverse events were recorded prospectively. 19 patients with complete obstruction (dysphagia IV°), all of whom had failed at least one trial of conventional dilatation, underwent recanalization by endoscopic rendezvous, a combined approach through a gastrostomy and perorally under fluoroscopic control. Conscious sedation was used in all patients. In 18/19 patients (94.7%), recanalization was technically successful. In 14/18 patients (77.8%), the post-intervention dysphagia score changed to ≤ II. Three patients had their PEG removed. Factors negatively associated with success were obstruction length of 50 mm; and tumor recurrence for long-term success. No severe complications were recorded. Rendezvous recanalization for complete esophageal obstruction is a reliable and safe method to re-establish luminal patency. Differences between technical and clinical success rates highlight the importance of additional functional factors associated with dysphagia. Given the lack of therapeutic alternatives, rendezvous recanalization is a valid option to improve dysphagia.
Kim, Jung Hee; Hur, Kyu Yeon; Lee, Jung Hyun; Lee, Ji Hyun; Se, Young-Bem; Kim, Hey In; Lee, Seung Hoon; Nam, Do-Hyun; Kim, Seong Yeon; Kim, Kwang-Won; Kong, Doo-Sik; Kim, Yong Hwy
Endoscopic transsphenoidal surgery has recently been introduced in pituitary surgery. We investigated outcomes and complications of endoscopic surgery in 2 referral centers in Korea. We enrolled 134 patients with acromegaly (microadenomas, n = 15; macroadenomas, n = 119) who underwent endoscopic transsphenoidal surgery at Seoul National University Hospital (n = 74) and Samsung Medical Center (n = 60) between January 2009 and March 2016. Remission was defined as having a normal insulin-like growth factor-1 and a suppressed growth hormone (GH) surgery, normal pituitary function was maintained in 34 patients (25.4%). Sixty-four patients (47.7%) presented complete (n = 59, 44.0%) or incomplete (n = 5, 3.7%) recovery of pituitary function. Hypopituitarism persisted in 20 patients (14.9%) and worsened in 16 patients (11.9%). Postoperatively, transient diabetes insipidus was reported in 52 patients (38.8%) but only persisted in 2 patients (1.5%). Other postoperative complications were epistaxis (n = 2), cerebral fluid leakage (n = 4), infection (n = 1), and intracerebral hemorrhage (n = 1). Endoscopic transsphenoidal surgery for acromegaly presented high remission rates and a low incidence of endocrine deficits and complications. Regardless of surgical techniques, invasive pituitary tumors were associated with poor outcome. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available Traumatic acute subdural hematoma (ASDH is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4. Computed tomography (CT demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately. Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.
Upper gastrointestinal endoscopic findings and prevalence of Helicobacter pylori infection among adult patients with dyspepsia in northern Tanzania. ... Endoscopy (EGD) for initial work up. Study on antimicrobial susceptibility pattern of H. pylori is recommended to guide choices for evidence based treatment option.