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Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis  [PDF]
Aly Saber,Emad N. Hokkam
Minimally Invasive Surgery , 2014, DOI: 10.1155/2014/162643
Abstract: 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 in group A compared with 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. 1. Introduction Early cholecystectomy is the optimal treatment for acute cholecystitis using established optimal surgical treatment for each grade of severity. Several studies have shown that early laparoscopic cholecystectomy conducted within 72–96 hours after the onset of symptoms is usually associated with advantages such as reduced hospital stay, sick leave, and health care expenditures and no disadvantages with regard to mortality and morbidity [1]. Early diagnosis and treatment of patients with acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies [2]. The typical ultrasound image of acute cholecystitis demonstrates gallbladder swelling, wall thickening with sonolucent layers, massive debris, and the stone impaction in the cystic duct [3]. 2. Objectives The aim of this study was to compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction. 3. Patients and Methods A total of 120 patients with acute cholecystitis were enrolled to this prospective randomized study from April 2009 to November 2014 at Port-Fouad General Hospital and Suez
Four port-sites metastasis of gallbladder cancer after laparoscopic cholecystectomy: a case report
Ghafouri A,Nasiri Sh,Karam nejad M,Farshidfar F
Tehran University Medical Journal , 2008,
Abstract: "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Port-site metastasis following laparoscopic cholecystectomy with unsuspected gallbladder carcinoma is a serious problem. Gallbladder carcinoma is found in 1% of all biliary tract operations, in most being diagnosed only after histological examination of the gallbladder. The spread of cancer following laparoscopy appears aggressive and widespread, as noticed from re-operation for radical treatment. The pathologic findings of gallbladder were consisting of tumoral and necrotic tissue, indicating of well differentiated adenocarcinoma. Mucosa and submucosa were involved, but no evidence of invasion to muscular layer and gall bladder serosa was found (T1). In this article we present the first of an unusual case of four port site adenocarcinoma metastasis from gallbladder cancer."n"n Case report: A 63 year old woman underwent laparoscopic cholecystectomy for acute cholecystitis. Thirty months later, she was admitted to the hospital with a complaint of masses at the four trocar sites. A biopsy from the port sites was undertaken and led to the diagnosis of adenocarcinoma metastasis. There is no published report of all four port site metastasis of gallbladder cancer after laparoscopic cholecystectomy."n"nKeywords: Gallbladder, laparoscopic cholecystectomy, carcinoma.
Single-Incision Laparoscopic Cholecystectomy: Is It a Plausible Alternative to the Traditional Four-Port Laparoscopic Approach?  [PDF]
Juan Pablo Arroyo,Luis A. Martín-del-Campo,Gonzalo Torres-Villalobos
Minimally Invasive Surgery , 2012, DOI: 10.1155/2012/347607
Abstract: The current standard-of-care for treatment of cholecystectomy is the four port laparoscopic approach. The development of single incision/laparoendoscopic single site surgery (SILC/LESS) has now led to the development of new techniques for removal of the gallbladder. The use of SILC/LESS is now currently being evaluated as the next step in treatment of cholecystectomy. This review is an attempt to consolidate the current knowledge and analyze the feasibility of world-wide implementation of SILC/LESS. 1. Introduction The ultimate goal of surgery has always been providing the best and most effective procedure with the least amount of postoperative complications, and pain and the best possible aesthetic results. Surgery of the biliary tract is by no means the exception. The first reported elective cholecystectomy was carried out by Langenbuch in 1882 [1] and open cholecystectomy became the standard-of-care well into the 1980s with mortality rates at less than 1%, and bile duct injuries affecting 0.1-0.2% of patients [2, 3]. This approach however required a large abdominal incision associated with significant postoperative pain and a longer convalescence. A revolution in the surgical treatment of biliary disease came in the 1980s with the introduction of laparoscopic surgery. The first laparoscopic cholecystectomy was performed by Mühe [4] however his approach did not become popular until both French and American groups popularized the four-port technique in the early 1990s. The idea of minimally invasive surgery for the removal of the gallbladder had now become a plausible technique that was rapidly accepted as the standard-of-care. Patients quickly learned of the new procedure and began to request it on the basis of a shorter hospital stay, less pain, and smaller scars [5]. The possibility of performing laparoscopic cholangiography, common bile duct exploration, and choledochotomy expanded the role of laparoscopic surgery in the treatment of biliary disease [6] and further advanced the idea of minimally invasive surgery as the gold-standard for surgery of the biliary tract. Recently the development of natural orifice transluminal endoscopic surgery (NOTES) opened the field of incision-less surgery. The main goal of NOTES is to eliminate the need for skin incisions along with other theoretical advantages which include: decreased postoperative pain, performing procedures in the out-patient setting, reduced incidence of hernias, reduced hospital stay, and increased overall patient satisfaction [5, 7]. The idea of accessing internal organs through the wall of
Laparoscopic cholecystectomy for acute cholecystitis  [cached]
Al Qasabi Qassim
Saudi Journal of Gastroenterology , 1998,
Abstract: One hundred and eight patients with histopathologically confirmed acute cholecystitis underwent laparoscopic or attempted laparoscopic cholecystectomy in the Security Forces Hospital, from October 1991 to April 1996 were retrospectively reviewed. All the patients had routine laboratory works including abdominal ultrasonography. Females represented 75% and 57% had previous admission. Diabetes mellitus was found in 43.5%. Laparoscopic cholecystectomy was successfully completed in 71.2%. The main reasons for conversion in 31 patients were adhesions and unclear anatomy in 87%. The mean operative time was 96 minutes. Laparoscopic cholecystectomy for acute cholecystitis can be a safe and effective alternative to open cholecystectomy provided a safe dissection of the ductal and vascular anatomy with liberal attitude towards conversion is adopted. Patients presenting with leukocytosis> 15,000/mm3, mass or diabetes are the most likely to be converted to open surgery.
Laparoscopic cholecystectomy of acute cholecystitis  [PDF]
Stani?i? Veselin,Baki? Milorad,Magdelini? Milorad,Kola?inac Hamdija
Medicinski Pregled , 2010, DOI: 10.2298/mpns1006404s
Abstract: Introduction. Laparoscopic cholecystectomy is a method of choice for surgical treatment of diseases of gallbladder. Although most surgeons today use laparoscopic cholecystectomy in treatment of severe acute cholecystitis, most surgeons still consider acute cholecystitis a relevant contraindication for laparoscopic cholecystectomy because of ”confused” anatomy and ”severe” pathology. Aim of the study was to analyze laparoscopic cholecystectomy outcomes in treatment of acute cholecystitis. Material and methods. A prospective analysis included 78 patients operated for acute calculose cholecystitis from Jan 2007 to Dec 2008. We analyzed clinical characteristics of the course of disease, associated diseases, duration of operation, operative and postoperative complications, reasons for conversion into open cholecystectomy. Results. The study indicated a low percentage of operative and postoperative complications, short stay in hospital, quick recovery and saving in treatment. The length of preoperative and postoperative hospitalization was 1.4±0.5 days and 2.5±1.6 days, respectively. 25 (32%) patients were operated within 72 hours from the onset of symptoms, some operative difficulties were present in 56 (71%) patients, light identification of artery and ductus cysticus in 30 (38.5%) patients, intraoperative lesion of ductus choledohus in 1 (1.3%); in 6 (7.7%) patients conversion into open cholecystectomy was done, the average duration of laparascopic cholecystectomy was 58.1±26.2 min. There were no lethal outcomes. Conclusion. Laparoscopic cholecystectomy is an efficient and reliable operative procedure in treatment of acute cholecystitis. It is much easier to select patients for laparoscopic cholecystectomy when preoperative risk factors predicting difficulties during the operation are known. An early conversion into open cholecystectomy is a rational choice of any surgeon when anatomy is not clear and in cases of advanced inflammatory process in order to decrease operative and postoperative morbidity.
Early versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective Randomized Trial  [PDF]
Sushant Verma,P. N. Agarwal,Rajandeep Singh Bali,Rajdeep Singh,Nikhil Talwar
ISRN Minimally Invasive Surgery , 2013, DOI: 10.1155/2013/486107
Abstract: Introduction. Very few studies demonstrate the feasibility of laparoscopic cholecystectomy for acute cholecystitis. However, most surgeons prefer to delay surgery in the acute phase. The aim of this prospective randomized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis. Materials and Methods. Between August 2010 and March 2012, 30 patients with a diagnosis of acute cholecystitis underwent early laparoscopic cholecystectomy within 72?h of admission. This study group was compared with a control group of 30 patients of acute cholecystitis, who underwent delayed laparoscopic cholecystectomy after an initial period of conservative treatment. Results. There was no significant difference in the conversion rates (3 early versus 2 delayed), postoperative analgesia requirements, postoperative pain scores, or duration of postoperative stay (1.67 days early versus 1.47 days delayed). However, duration of surgery was significantly more in the early group (65.78 minutes early versus 56.83 minutes delayed). Surgery was abandoned in 2 patients from the early group because of difficult anatomy. No complications and mortality were seen in either group. Conclusions. Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible, offering the additional benefit of a shorter hospital stay. It should be offered to patients with acute cholecystitis, provided the surgery is performed within 72?h from the onset of symptoms. 1. Introduction Laparoscopic cholecystectomy is the most common laparoscopic surgery performed in the world [1]. The traditional treatment (initial) of acute calculus cholecystitis includes bowel rest, intravenous hydration, correction of electrolyte abnormalities, analgesia, and intravenous antibiotics. Following this treatment, patients with uncomplicated disease are managed on outpatient basis and are called for laparoscopic cholecystectomy after a period of 6–8 weeks. Laparoscopic cholecystectomy is avoided for acute cholecystitis due to concerns about the potential hazards of complications, especially common bile duct injury and a high conversion rate to open cholecystectomy [2]. Initial studies, however have shown that early laparoscopic cholecystectomy can be done during acute cholecystitis [3–5]. Since most surgeons prefer to delay surgery during the acute phase, we undertook a prospective randomized study to compare early and delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis. 2. Materials and Methods The study was conducted at the Department of
Laparoscopic cholecystectomy in acute gangrenous cholecystitis  [cached]
Аbdukhakim Khadjibaev,Shukhrat Аtajanov,Farkhod Khadjibaev,Khikmat Anvarov
Medical and Health Science Journal , 2011,
Abstract: The clinic, laboratorial, intraoperative, and morphologic findings of 482 patients with acute gangrenous cholecystitis have been studied. There were 162 men (33.6%) and 320 (67.4%) women at the age of 15-91 years, with average 55.3±6.5 years old. 218 patients were operated by laparoscopic method, traditional access was provided in 264 patients. Conversion was performed in 17 from 218 cases (7.8%). Postoperative complications made 8.3% and 13.6% in both groups respectively. Intraoperative complication during laparoscopic cholecystectomy (common bile duct injury) occurred in 1 (0.46%) patient operated at the fifth day since the commencement of disease. Conversions and complications reduction was provided by the offered technical improvements of laparoscopic cholecystectomy such as a change of the points of trocars injection, using the modified instruments for the tissues dissection, gallbladder mobilization and hemostasis.
Factors associated with time to laparoscopic cholecystectomy for acute cholecystitis  [cached]
Chris N Daniak, David Peretz, Jonathan M Fine, Yun Wang, Alan K Meinke, William B Hale
World Journal of Gastroenterology , 2008,
Abstract: AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis.METHODS: A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted. Data collected included demographic data, co-morbidities, symptoms and physical findings at presentation, laboratory and radiological investigations, length of stay, complications, and admission service (medical or surgical). Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis. Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures, presenting signs, and admitting service with time to surgery.RESULTS: Seventy cases met inclusion and exclusion criteria, among which 12 were admitted to the medical service and 58 to the surgical service. Mean ± SD time to surgery was 39.3 ± 43 h, with 87% of operations performed within 72 h of hospital arrival. In the adjusted models, longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP, P = 0.01) as well with admission to medical service without adjustment for ERCP (P < 0.05). Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery. Patients admitted to the surgical versus medical service underwent surgery earlier (30.4 ± 34.9 vs 82.7 ± 55.1 h, P < 0.01), had less post-operative complications (12% vs 58%, P < 0.01), and shorter length of stay (4.3 ± 3.4 vs 8.1 ± 5.2 d, P < 0.01).CONCLUSION: Admission to the medical service and performance of numerous diagnostic procedures, ERCP, or MRCP combined with CT scan were associated with longer time to surgery. Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.
Laparoscopic cholecystectomy is feasible and safe in acute cholecystitis  [cached]
Al-Mulhim Abdulmohsen
Saudi Journal of Gastroenterology , 1999,
Abstract: Objective: To assess the feasibility and safety of laparoscopic cholecystectomy in acute cholecystitis. Subjects and Methods: Between June 1993 and December 1996, 424 consecutive patients underwent laparoscopic cholecystectomy; 45 (10.6%) had acute cholecystitis confirmed by ultrasound. Results: All 45 patients were opened within 72 hours of admission. Conversion to open cholecystectomy was necessary in three patients (6.7%). The mean operating time was 126 minutes (range: 40-300 minutes). There was no mortality or common bile duct injury in this series. The postoperative stay averaged 3.9 days (range: I to 11 days). There was no delayed morbidity after a mean follow-up of 2 years. Conclusion: Laparoscopic cholecystectomy is feasible and safe in patients with acute cholecystitis, provided it is performed by experienced surgeons. Although the procedure is somewhat lengthy, it is associated with low conversion rate, no serious morbidity and zero mortality.
Laparoscopic cholecystectomy in acute cholecystitis: An analysis of the risk factors
S Botaitis, M Pitiakoudis, S Perente, G Tripsianis, A Polychronidis, C Simopoulos
South African Journal of Surgery , 2012,
Abstract: Background and aim: Laparoscopic cholecystectomy (LC) is increasingly being used as the initial surgical approach in patients with acute cholecystitis (AC). We describe our experience with LC in the treatment of AC. Materials and methods: In this study 2 412 patients underwent LC, in 315 cases for AC. The diagnosis was based on clinical, laboratory and intra- operative findings. Rates of conversion, complications, length of hospital stay, operating times, and factors associated with conversion or morbidity were analysed. Results: Conversion to open cholecystectomy was necessary in 60 patients (19.04%) with AC. Factors associated with conversion were age >65 years, male gender, presence of empyema, previous abdominal surgery, and fever (temperature >37.5oC). There were no deaths, and the complication rate was 6.4%. The only risk factor for morbidity was a bilirubin level of >20.52 μmol/l. The operating time and hospital stay were significantly longer in AC than in elective cases. Conclusions: LC for AC is technically demanding but safe and effective. With patience, experience, careful dissection and identification of vital structures, the laparoscopic approach is safe in the majority of cases.
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