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Colecistectomía de urgencia por laparoscopia por colecistitis aguda en adultos mayores Emergency laparoscopic cholecystectomy in the elderly
Luis Carlos Domínguez,Wilmar Eduardo Herrera,Aura María Rivera,Charles E Bermúdez
Revista Colombiana de Cirugía , 2011,
Abstract: Introducción y objetivos. La colecistectomía de urgencia por laparoscopia en el adulto mayor con colecistitis aguda, ha aumentado en el mundo. En Colombia no existe información al respecto. En este estudio se evalúan los resultados del procedimiento, efectuando un análisis discriminado por subgrupos de edad. Métodos. Análisis descriptivo de los factores demográficos, clínicos, bioquímicos y de imágenes diagnósticas, en una población de adultos mayores sometidos a colecistectomía por laparoscopia de urgencia en comparación con la población general. Se evaluó la tasa de morbilidad, de mortalidad, conversión y estancia hospitalaria para cada grupo y en dos poblaciones de adultos mayores (mayores de 65 a 74 a os y mayores de 75 a os). Un valor p menor de 0,05 se consideró estadísticamente significativo. Resultados. Se incluyeron 703 pacientes (18,3% adultos mayores). La hipertensión, la diabetes, la colangitis, la coledocolitiasis y la clasificación ASA III-IV fueron factores significativamente estadísticos en los adultos mayores. Las tasas de reintervención, de conversión y de hemorragia fueron estadísticamente significativas en los adultos mayores. La diabetes y la tasa de conversión fueron superiores en los adultos mayores de 75 a os, comparados con los de 65 a 74 a os. Las tasas de lesión de la vía biliar, infección y mortalidad, no mostraron diferencia en ninguno de los grupos. La estancia hospitalaria fue de 4,5 días en promedio en los adultos mayores, contra 1,8 días en promedio en la población general (p<0,001). Conclusiones. La colecistectomía de urgencia por laparoscopia continúa siendo un procedimiento relevante en adultos mayores con colecistitis aguda. Se debe tener precaución pues las tasas de hemorragia, reintervención y conversión, son ligeramente superiores en este grupo. Introduction: Laparoscopic cholecystectomy for acute cholecystitis in the elderly is increasing worldwide. Most trials report different results; however, their performance in Colombia is unknown. This study evaluates their results conducting a discriminative analysis in different aging populations. Methods: Prospective analysis of patients >65 years old with acute cholecystitis submitted to urgent laparoscopic cholecystectomy in a fourth level, teaching and referral center in Bogotá, Colombia. We performed a univariate analysis of demographic, clinical, biochemical and imaging characteristics to identify significant variables in the elderly, in comparison with general population. Then we compared two different elderly populations (65-74years and >75years). We identified mor
The Professional Medical Journal , 2003,
Abstract: Background: Postoperative shoulder tip pain occurs frequently following laparoscopic cholecystectomy. The aim of thisrandomized clinical trial was to evaluate the efficacy of a low pressure carbon dioxide pneumoperitoneum during laparoscopicsurgery in reducing the incidence of postoperative shoulder tip pain. Material & Methods: Ninety consecutive patients undergoinglaparoscopic cholecystectomy were randomized prospectively into low pressure (group A) and normal pressure (group B)laparoscopic cholecystectomy groups. Patients in group A (n=46) underwent laparoscopic cholecystectomy with 10 mm Hg carbondioxide pneumoperitoneum during most of the operation and those in group B (n=44) had laparoscopic cholecystectomy with 14mmHg pneumoperitoneum. Shoulder tip pain was recorded on a visual analogue pain scale 1,3,6,12, 24 and 48 hours afteroperation. Results: The low pressure pneumoperitoneum did not increase the duration of surgery. There were no significantintraoperative or postoperative complications in either group. Fourteen patients (32%) in group B and five (11%) in group Acomplained of shoulder pain. Mean shoulder tip pain scores at 12 and 24 hours and postoperative analgesia requirements werealso significantly lower in the low pressure laparoscopic cholecystectomy group. Conclusion: A carbon dioxidepneumoperitoneum pressure lower than that usually utilized to perform laparoscopic surgery reduces both the frequency andintensity of shoulder tip pain following laparoscopic cholecystectomy.
The Professional Medical Journal , 2009,
Abstract: Objective: To determine the frequency of bleeding, surgical site infection and common bile duct injury after laparoscopic Cholecystectomy in patients with co-morbidity. Study design: Descriptive study. (Case series). Setting: Department of Allied & D.H.Q hospital Faisalabad. Period: July 2006 to December 2007. Patients and Methods: It comprised of 30 consecutive patients of cholelithiasis with co-morbidity presenting in surgical department. Patients having uncontrolled hypertension, chronic obstructive airway disease and malignancy were excluded. Detailed history and physical examination was carried out as per protocol. It was followed up by relevant investigations. All the cases underwent laparoscopic cholecstectomy. Results: The age of the patients ranged from 23-68 y, with mean age of 40-56 y. Among these 14 cases were having D.M (46.66 %), 06 patients were cirrhotic (20%), 06 patients had acute cholecystitis (20%), 02 patients were having H.T.N (6.6%), and 02 patients were >70 years (6.6%). All the patients were females. Out of diabetic patients undergoing laparoscopic cholecystectomy, SSI was noted in 02 ( 6.66%) patients. While mild postoperative bleeding was noted in 01 (16.6%) of cirrhotic patients after laparoscopic cholecystectomy. No untoward event was noted in patients with H.T.N ac. Cholecystitis & advanced age. Conclusion: In high risk patients undergoing laparoscopic cholecystectomy, very few complications were noted. Postoperatively. Morbidity following above procedure was quite low as compared to conventional one. Laparoscopic cholecystectomy should be the preferred option in high risk patients for better outcome.
The Professional Medical Journal , 2011,
Abstract: Laparoscopic cholecystectomy is the gold standard treatment for patients presenting with acute gall stone disease necessitatinghospital admission. Objective: To assess the impact of timing of laparoscopic cholecystectomy on conversion rate, hospital stay and morbidity.Period: Jan 2008-2010. Setting: Department of Surgery, Independent University Hospital, Faisalabad. Study Design: Experimental study.Material & Methods: The subjects were included by consecutive sampling technique. 81 cases were divided into 3 groups. Group A (Surgerywithin 72 hrs of onset symptoms). Group B (surgery between 72hrs to 96 hours of onset of symptoms). Group C (surgery after 96 hours of onsetof symptoms). Results: The mean age was 41-95 years. Female to male ratio was 4.5:1. The overall complication rate was 12.69%. Meanhospital stay was 2.85 days. The open conversion rate was 8.64%. In group A the complication rate was 6%, group B 11.5% and group C 12.8&.The mean hospital stay and conversion rate had no significant difference. Conclusions: The timing of laparoscopic cholecystectomy has nosignificant impact on the conversion rate and length of hospital stay in cases with acute cholecystitis. However the complication rate was higherwhen surgery performed after 72 hours of onset of symptoms.
The Professional Medical Journal , 2009,
Abstract: Objective: To determine if intraoperative instillation of bupivacaine into gall bladder fossa would decrease early postoperative pain after laparoscopic cholecystectomy, Design: Double-blind, randomized, controlled trial. Setting: Surgical Unit-I, Holy Family Hospital, Rawalpindi and Surgical Unit-1, Benazir Bhutto Hospital, Duration: Two year study. Patients: Fifty patients underwent laparoscopic cholecystectomy group-A. They were compared with a control group of fifty patients who had laparoscopic cholecystectomy but did not receive bupivacaine Group-B. Intervention: Instillation of 10 ml of 0.5% bupivacaine into gall bladder fossa intra operatively after removal of gall bladder. Main Outcome Measures: Visual analogue scale (VAS) pain scores assessed 3 times post operatively, at 1, 6 & 24 hours, using similar peroperative and postoperative analgesics in both groups. Main Outcome Measure: Mean VAS pain scores (range 0 [no pain] to 10 [severe pain]) at 1 hour and at 6 hours after surgery were 6.5 and 4.2 respectively, in the bupivacaine group (Group-A) compared with 6.2 and 4.5 respectively, in the control group(Group-B) (p =.085 and 0.078,sd=.919 and.495). VAS scores at 24 hours postoperatively did not differ between the two groups (2.4 VS 2.5)(p=.282,sd=.636). Conclusion: Instillation of bupivacaine into gall bladder fossa has no effect on post operative pain control in elective laparoscopic cholecystectomy
The Professional Medical Journal , 2010,
Abstract: Objective: To determine the frequency of common bile duct (CBD) injury in laparoscopic cholecystectomy in our settings, in mylast 500 cases, after going through the learning curve associated CBD injuries. Design: Descriptive study. Place and Duration of Study:Surgical Unit-I, Rawalpindi General Hospital and the author’s Surgical Clinics from January 2003 to December 2008. Patients and Methods:Five hundred patients undergoing laparoscopic cholecystectomy by the same surgeon were included. The important variables includeddemographic data, intra operative time and findings, frequency of CBD injury and post operative hospital stay. Results: There were 419(83.8%)females and 81(16.2%) males with mean age 45.04±11.03 years. 294(58.8% )patients had chronic cholecystitis with Cholelithiasis and were admitted through Out Patient Department whereas 206(41.2%) were admitted through Accident and Emergency Department with acutecholecystitis. Abdominal ultrasound showed multiple calculi in 351(70.2%) patients and 149(29.8%) patients had single calculus preoperatively. Empyema was found in 97(19.4%) cases whereas adhesions were present in 182( 36.4%) patients. In our study frequency of CBD injury was 1%. Mean operating time was 35 minutes. 96.8 % of the patients were discharged within 48 hrs of operation. Conclusion: Laparoscopic Cholecystectomy in our set up proved to be a safe procedure, having frequency of CBD injury of only 1% and a short hospital stay 493(96.8% )being discharged in less than 2 days.
Role of laparoscopic cholecystectomy in children  [cached]
Oak Sanjay,Parelkar S,Akhtar T,Pathak R
Journal of Indian Association of Pediatric Surgeons , 2005,
Abstract: 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.
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.
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.
Biloma after laparoscopic cholecystectomy  [cached]
T.E. Pavlidis, K.S. Atmatzidis, B.T. Papaziogas, I.N. Galanis, I.M. Koutelidakis, T.B. Papaziogas
Annals of Gastroenterology , 2007,
Abstract: SUMMARY Purpose: Laparoscopic cholecystectomy has become the standard method in the management of cholelithiasis. Subhepatic bile collection or biloma is a relatively uncommon complication, which is highlighted in this paper. Methods-Results: Over the past two-year period the same surgeon performed 180 laparoscopic cholecystectomies without any intra-operative event. All patients but three had an uneventful postoperative course (morbidity 1.6%). In 3 cases (women, 72-74-88 years-old) the US-scanning revealed a sub-hepatic biloma manifested by persistent right upper quadrant or epigastric pain, abdominal distention, fever and leukocytosis. In one case there was co-existent gastric outlet obstruction two weeks after the operation and mild obstructive jaundice in another one. All were managed successfully by drainage under ultrasound guidance and antibiotics, prolonging the hospitalization. Conclusions: Small bile leakage and biloma formation is a rather unusual complication after laparoscopic cholecystectomy that should be kept in mind. Key words: Laparoscopy, Cholelithiasis, Laparoscopic cholecystectomy, Complications, Biloma, Bile leakage
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