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Interval Laparoscopic Cholecystectomy in the Management of Acute Biliary Pancreatitis  [PDF]
M. D. Pinhas Schachter,M. D. Timor Peleg,M. D. Oded Cohen
HPB Surgery , 2000, DOI: 10.1155/2000/40290
Abstract: The timing of laparoscopic cholecystectomy following an attack of acute biliary pancreatitis is controversial. The traditional approach of interval cholecystectomy has been challenged recently. The present study was designed to evaluate the benefits of interval laparoscopic cholecystectomy for patients with mild acute pancreatitis (Ranson less than 3). Nineteen patients with mild pancreatitis underwent ultrasonographic evaluation to confirm the biliary etiology. ERCP was performed in all patients on the first available endoscopy list, and endoscopic sphincterotomy was performed in two patients with calculi or dilated common bile duct on ultrasonographic examination. Medical treatment was administered and laparoscopic cholecystectomy was scheduled after 8–12 weeks to allow the inflammatory process to settle. There were no recurrent attacks of pancreatitis during this period. The degree of difficulty of the laparoscopic procedure was assessed by the presence of adhesions to the gallbladder area, difficulty of dissection in the Calot's triangle, intraoperative bleeding and the need for a drain. Six patients (31.5%) had severe adhesions, difficult dissection of the cystic duct and artery, bleeding and prolonged operating time. In two of these patients (10.5%) the procedure was converted to open cholecystectomy. In conclusion, our results suggest that postponing laparoscopic cholecystectomy in acute pancreatitis patients is not advantageous surgically and does not justify the risk of further morbidity caused by the gallbladder disease.
Extra-biliary complications during laparoscopic cholecystectomy: How serious is the problem?  [cached]
Malik Arshad,Laghari Abdul,Mallah Qasim,Hashmi Fazila
Journal of Minimal Access Surgery , 2008,
Abstract: Objective: To deteremine the incidence, nature and management of extra-biliary complications of laparoscopic cholecystectomy. Materials and Methods: This study presents a retrospective analysis of extra-biliary complications occuring during 1046 laparoscopic cholecystectomies performed from August 2003 to December 2006. The study population included all the patients with symptomatic gallstone disease in whom laparoscopic cholecystectomy was performed. The extra-biliary complications were divided into two distinct categories: (i) Procedure related and (ii) Access related. Results: The incidence of access-related complications was 3.77% and that of procedure-related complications was 6.02%. Port-site bleeding was troublesome at times and demanded a re-do laparoscopy or conversion. Small bowel laceration occurred in two patients where access was achieved by closed technique. Five cases of duodenal and two of colonic perforations were the major complications encountered during dissection in the area of Calot′s triangle. In 21 (2%) patients the procedure was converted to open surgery due to different complications. Biliary complications occurred in 2.6% patients in the current series. Conclusion: Major extra-biliary complications are as frequent as the biliary complications and can be life-threatening. An early diagnosis is critical to their management.
Elimination of biliary stones through the urinary tract: a complication of the laparoscopic cholecystectomy
Castro, Maurício Gustavo Bravim de;Alves, Ant?nio Sérgio;Oliveira, Cláudio Almeida de;Vieira Júnior, álvaro;Vianna, José Luiz Campello de Mello;Costa, Renato Freitas Carvalho;
Revista do Hospital das Clínicas , 1999, DOI: 10.1590/S0041-87811999000600007
Abstract: the introduction and popularization of laparoscopic cholecystectomy has been accompanied with a considerable increase in perforation of gallbladder during this procedure (10%?32%), with the occurrence of intraperitoneal bile spillage and the consequent increase in the incidence of lost gallstones (0.2%?20%). recently the complications associated with these stones have been documented in the literature. we report a rare complication occurring in an 81-year-old woman who underwent laparoscopic cholecystectomy and developed cutaneous fistula to the umbilicus and elimination of biliary stones through the urinary tract. during the cholecystectomy, the gall bladder was perforated, and bile and gallstones were spilled into the peritoneal cavity. two months after the initial procedure there was exteriorization of fistula through the umbilicus, with intermittent elimination of biliary stones. after eleven months, acute urinary retention occurred due to biliary stones in the bladder, which were removed by cystoscopy. we conclude that efforts should be concentrated on avoiding the spillage of stones during the surgery, and that no rules exist for indicating a laparotomy simply to retrieve these lost gallstones.
Elimination of biliary stones through the urinary tract: a complication of the laparoscopic cholecystectomy  [cached]
Castro Maurício Gustavo Bravim de,Alves Ant?nio Sérgio,Oliveira Cláudio Almeida de,Vieira Júnior álvaro
Revista do Hospital das Clínicas , 1999,
Abstract: The introduction and popularization of laparoscopic cholecystectomy has been accompanied with a considerable increase in perforation of gallbladder during this procedure (10%--32%), with the occurrence of intraperitoneal bile spillage and the consequent increase in the incidence of lost gallstones (0.2%--20%). Recently the complications associated with these stones have been documented in the literature. We report a rare complication occurring in an 81-year-old woman who underwent laparoscopic cholecystectomy and developed cutaneous fistula to the umbilicus and elimination of biliary stones through the urinary tract. During the cholecystectomy, the gall bladder was perforated, and bile and gallstones were spilled into the peritoneal cavity. Two months after the initial procedure there was exteriorization of fistula through the umbilicus, with intermittent elimination of biliary stones. After eleven months, acute urinary retention occurred due to biliary stones in the bladder, which were removed by cystoscopy. We conclude that efforts should be concentrated on avoiding the spillage of stones during the surgery, and that no rules exist for indicating a laparotomy simply to retrieve these lost gallstones.
Remarks regarding the relationship between biliary lithiasis and/or cholecystectomy and colorectal cancer  [PDF]
Fabian O, ,,Oniu T,Bosu R,,?imon I
Jurnalul de Chirurgie , 2012,
Abstract: PURPOSE: The aim of this study is to investigate the relationship between gallstones/cholecystectomy and colorectal cancer. MATERIAL AND METHODS: We designed a retrospective study including all the patients with different cancers treated in our surgical unit from 1995 until 2010. We analyzed 1696 patients: 1072 with colorectal cancer, 404 with gastric cancer, 119 with pancreatic cancer, 11 with gallbladder cancer and 70 with renal cancer. RESULTS: Gallstones were significantly associated with colon cancer (8.8%) than with gastric (3%) or renal cancer (2.2%) – P=0.001, respectively P=0.04. Cholecystectomy was also significantly associated with colon cancer (10.8%) than with gastric (8.2%), pancreatic (1.7%) or renal cancer (5.6%) – P=0.06, P=0.01, respectively P=0.11. We found a statisticaly significant correlation between biliary lithiasis (gallstones and cholecystectomy) and right colon cancer: P=0.01 and respectively P=0.001. CONCLUSIONS: Biliary lithiasis is associated with colorectal cancer. The risk is higher for the right colon neoplasms than for left colon or rectal cancers.
Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial
Bouwense Stefan A,Besselink Marc G,van Brunschot Sandra,Bakker Olaf J
Trials , 2012, DOI: 10.1186/1745-6215-13-225
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 laparoscopic cholecystectomy (within 72 hours) reduces the combined endpoint of mortality and re-admissions for biliary events as compared with interval laparoscopic cholecystectomy (between 25 and 30 days) after recovery of a first episode of mild biliary pancreatitis. Trial registration Current Controlled Trials: ISRCTN72764151
A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy
Vincenzo Napolitano, Roberto Cirocchi, Alessandro Spizzirri, Lorenzo Cattorini, Francesco La Mura, Eriberto Farinella, Umberto Morelli, Carla Migliaccio, Pamela Del monaco, Stefano Trastulli, Micol Di Patrizi, Diego Milani, Francesco Sciannameo
World Journal of Emergency Surgery , 2009, DOI: 10.1186/1749-7922-4-37
Abstract: We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage.The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.Percutaneous transhepatic biliary drainage (PTHBD) is one of the most therapeutic options for the menagement of biliary obstructive disorders, but the use of interventional procedures is associated with an increased incidence of arteriovenous shunting, hepatic artery pseudoaneurysm and vascular stenoses that result in hemobilia[1].The diagnosis of hemobilia may be difficult because of a variety of clinical manifestations and sometimes can be fatal. Its management aims to stopping the bleeding and resolve obstruction. Actually the development of interventional radiology, such as transarterial embolization, has been recognized the first line of procedure to stop hemobilia with a success rate of about 80%-100%, by ensuring that the classic surgery interventions, such as ligation of bleeding vessels or excisions of aneurysms, should be considered fails and burdened by high mortality [2,3].A 60-year-old man came to our observation with intermittent pain localized to upper quadrants of the abdomen, fever (39°C) preceded by thrill, vomiting and signs of peritoneal interesting. Laboratory tests revealed leucocytosis (18300 WBC), and the increment of cholestasis markers, while US scan demonstred an acute cholecystitis with lithiasis, without biliary tree dilatation, and a small liquid flap next to gallbladder.Because of poor conditions, we decided to perform a surgical o
The outcome of early laparoscopic cholecystectomy in patients with acute biliary pancreatitis  [PDF]
Murat Kapan,ünal Beyaz?t,Metehan Gümü?,Ak?n ?nder
Journal of Clinical and Experimental Investigations , 2010,
Abstract: Objectives: It is still controversial to perform a laparoscopic cholecystectomy (LC) for the management of acute biliary pancreatitis (ABP) at the early hospitalization period, because of adhesions and dissection difficulties. The aim of this study was to evaluate the outcome of the patients with ABP who underwent LC prior to hospital discharge.Methods: A total of 43 patients with ABP, that underwent LC after clinical and laboratory improvement, were retrospectively evaluated. Patient’s age, gender, laboratory findings; ultrasonography (USG), magnetic resonance and other imaging results, surgical operation duration, complications, mortality and postoperative hospital stay days were recorded and statistically analyzed.Results: The median age of patients was 51.8 (20-83) years. A total of 29 (67.4%) patients were women and 14 (32.6%) were male. The cause was gallstone in all patients. In addition, hyperparathyroidism was found in one patient and hyperlipidemia was present in the other one. Gallbladder stones were determined in all patients. Common bile duct enlargement and stones were detected in 7 patients. Three patients underwent sphyncterectomy and stone extraction according to clinical status. Operations were performed at the mean hospitalization day of 11.4 (3-23). LC was performed to 39 (%90.6) of patients. However, 4 (9.4%) patients had intra-abdominal adhesions secondary to infection and were switched to open surgery. The mean operation time was 70 (25-160) minutes and the mean duration of postoperative hospital stay was 3 (1-6) days. In a patient who underwent LC and ERCP preoperatively complication occurred. A second drainage operation was performed and due to development of necrotizing pancreatitis, the patient was lost at the postoperative 7th day secondary to adult type respiratory distress syndrome.Conclusions: In patients with ABP whose clinical and laboratory findings were improved, late LC can be performed safely during their first hospitalization.
Cholecystectomy and sphincterotomy in patients with mild acute biliary pancreatitis in Sweden 1988 - 2003: a nationwide register study
Birger Sandzén, Markku M Haapam?ki, Erik Nilsson, Hans C Stenlund, Mikael ?man
BMC Gastroenterology , 2009, DOI: 10.1186/1471-230x-9-80
Abstract: 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).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 between the four groups.Cholecystectomy during index stay slightly prolongs this stay, but drastically reduces readmissions for biliary indications.The annual incidence of first attack of acute pancreatitis varies from below 10 to over 40 per 100000 inhabitants per year [1]. In population-based studies one-fourth to one-half of all cases with first attack acute pancreatitis is attributable to gallstone disease [1-3]. Whereas patient
Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit?
Martínez Vieira,A.; Docobo Durántez,F.; Mena Robles,J.; Durán Ferreras,I.; Vázquez Monchul,J.; López Bernal,F.; Romero Vargas,E.;
Revista Espa?ola de Enfermedades Digestivas , 2004, DOI: 10.4321/S1130-01082004000700003
Abstract: objective: analysis of clinical and surgical factors in a series of patients subjected to laparoscopic cholecystectomy in an outpatient unit and their relationship with time of discharge and patient acceptance. patients and method: eighty one consecutive patients underwent to elective laparoscopic cholecystectomy during year 2002 within s.a.s. (andalusian health service) from a surgical waiting list. retrospective and comparative study between two groups: group a includes patients discharged between 24 and 48 hours after intervention; group b includes patients discharged in less than 24 hours. we analyse the clinical and surgical characteristics and post-operative outcome of both groups of patients. results: group a was composed of 53 patients and group b of 28 patients. factors of clinical significance which determined discharge after 24 hours included: early post-surgical incidences or complications (p = 0.017), inability to tolerate oral diet (p = 0.002), and doubts and feelings insecurity of patients regarding discharge by traditional means 62.3% (p = 0.0003). conclusions: outpatient laparoscopic cholecystectomy is a safe and reliable procedure with a high acceptance rate and few complications. perhaps traditional culture has to be changed to obtain better results.
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