Cholecystectomy: Surgical removal of the GALLBLADDER.Cholecystectomy, Laparoscopic: Excision of the gallbladder through an abdominal incision using a laparoscope.Cholelithiasis: Presence or formation of GALLSTONES in the BILIARY TRACT, usually in the gallbladder (CHOLECYSTOLITHIASIS) or the common bile duct (CHOLEDOCHOLITHIASIS).Gallbladder Diseases: Diseases of the GALLBLADDER. They generally involve the impairment of BILE flow, GALLSTONES in the BILIARY TRACT, infections, neoplasms, or other diseases.Cholecystitis: Inflammation of the GALLBLADDER; generally caused by impairment of BILE flow, GALLSTONES in the BILIARY TRACT, infections, or other diseases.Gallstones: Solid crystalline precipitates in the BILIARY TRACT, usually formed in the GALLBLADDER, resulting in the condition of CHOLELITHIASIS. Gallstones, derived from the BILE, consist mainly of calcium, cholesterol, or bilirubin.Cholecystitis, Acute: Acute inflammation of the GALLBLADDER wall. It is characterized by the presence of ABDOMINAL PAIN; FEVER; and LEUKOCYTOSIS. Gallstone obstruction of the CYSTIC DUCT is present in approximately 90% of the cases.Cholecystolithiasis: Presence or formation of GALLSTONES in the GALLBLADDER.Gallbladder: A storage reservoir for BILE secretion. Gallbladder allows the delivery of bile acids at a high concentration and in a controlled manner, via the CYSTIC DUCT to the DUODENUM, for degradation of dietary lipid.Cholangiography: An imaging test of the BILIARY TRACT in which a contrast dye (RADIOPAQUE MEDIA) is injected into the BILE DUCT and x-ray pictures are taken.Bile Ducts: The channels that collect and transport the bile secretion from the BILE CANALICULI, the smallest branch of the BILIARY TRACT in the LIVER, through the bile ductules, the bile ducts out the liver, and to the GALLBLADDER for storage.Cystic Duct: The duct that is connected to the GALLBLADDER and allows the emptying of bile into the COMMON BILE DUCT.Intraoperative Complications: Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure.Common Bile Duct: The largest bile duct. It is formed by the junction of the CYSTIC DUCT and the COMMON HEPATIC DUCT.Gallbladder Neoplasms: Tumors or cancer of the gallbladder.Cholangiopancreatography, Endoscopic Retrograde: Fiberoptic endoscopy designed for duodenal observation and cannulation of VATER'S AMPULLA, in order to visualize the pancreatic and biliary duct system by retrograde injection of contrast media. Endoscopic (Vater) papillotomy (SPHINCTEROTOMY, ENDOSCOPIC) may be performed during this procedure.Umbilicus: The pit in the center of the ABDOMINAL WALL marking the point where the UMBILICAL CORD entered in the FETUS.Laparoscopes: ENDOSCOPES for examining the abdominal and pelvic organs in the peritoneal cavity.Cholecystography: Radiography of the gallbladder after ingestion of a contrast medium.Choledocholithiasis: Presence or formation of GALLSTONES in the COMMON BILE DUCT.Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.Sphincterotomy, Endoscopic: Incision of Oddi's sphincter or Vater's ampulla performed by inserting a sphincterotome through an endoscope (DUODENOSCOPE) often following retrograde cholangiography (CHOLANGIOPANCREATOGRAPHY, ENDOSCOPIC RETROGRADE). Endoscopic treatment by sphincterotomy is the preferred method of treatment for patients with retained or recurrent bile duct stones post-cholecystectomy, and for poor-surgical-risk patients that have the gallbladder still present.Bile Duct Diseases: Diseases in any part of the ductal system of the BILIARY TRACT from the smallest BILE CANALICULI to the largest COMMON BILE DUCT.Biliary Dyskinesia: A motility disorder characterized by biliary COLIC, absence of GALLSTONES, and an abnormal GALLBLADDER ejection fraction. It is caused by gallbladder dyskinesia and/or SPHINCTER OF ODDI DYSFUNCTION.Pneumoperitoneum, Artificial: Deliberate introduction of air into the peritoneal cavity.Biliary Tract Diseases: Diseases in any part of the BILIARY TRACT including the BILE DUCTS and the GALLBLADDER.Cholecystostomy: Establishment of an opening into the gallbladder either for drainage or surgical communication with another part of the digestive tract, usually the duodenum or jejunum.Length of Stay: The period of confinement of a patient to a hospital or other health facility.Hepatic Duct, Common: Predominantly extrahepatic bile duct which is formed by the junction of the right and left hepatic ducts, which are predominantly intrahepatic, and, in turn, joins the cystic duct to form the common bile duct.Ambulatory Surgical Procedures: Surgery performed on an outpatient basis. It may be hospital-based or performed in an office or surgicenter.Common Bile Duct Diseases: Diseases of the COMMON BILE DUCT including the AMPULLA OF VATER and the SPHINCTER OF ODDI.Cholangiopancreatography, Magnetic Resonance: Non-invasive diagnostic technique for visualizing the PANCREATIC DUCTS and BILE DUCTS without the use of injected CONTRAST MEDIA or x-ray. MRI scans provide excellent sensitivity for duct dilatation, biliary stricture, and intraductal abnormalities.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Conversion to Open Surgery: Changing an operative procedure from an endoscopic surgical procedure to an open approach during the INTRAOPERATIVE PERIOD.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Pain, Postoperative: Pain during the period after surgery.Hemobilia: Hemorrhage in or through the BILIARY TRACT due to trauma, inflammation, CHOLELITHIASIS, vascular disease, or neoplasms.Intraoperative Care: Patient care procedures performed during the operation that are ancillary to the actual surgery. It includes monitoring, fluid therapy, medication, transfusion, anesthesia, radiography, and laboratory tests.Sphincter of Oddi: The sphincter of the hepatopancreatic ampulla within the duodenal papilla. The COMMON BILE DUCT and main pancreatic duct pass through this sphincter.Pancreatitis: INFLAMMATION of the PANCREAS. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of CHRONIC PANCREATITIS (International Symposium on Acute Pancreatitis, Atlanta, 1992). The two most common forms of acute pancreatitis are ALCOHOLIC PANCREATITIS and gallstone pancreatitis.Biliary Fistula: Abnormal passage in any organ of the biliary tract or between biliary organs and other organs.Iatrogenic Disease: Any adverse condition in a patient occurring as the result of treatment by a physician, surgeon, or other health professional, especially infections acquired by a patient during the course of treatment.Laparoscopy: A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy.Intraoperative Period: The period during a surgical operation.Laparotomy: Incision into the side of the abdomen between the ribs and pelvis.Natural Orifice Endoscopic Surgery: Surgical procedures performed through a natural opening in the body such as the mouth, nose, urethra, or anus, and along the natural body cavities with which they are continuous.Postcholecystectomy Syndrome: Abdominal symptoms after removal of the GALLBLADDER. The common postoperative symptoms are often the same as those present before the operation, such as COLIC, bloating, NAUSEA, and VOMITING. There is pain on palpation of the right upper quadrant and sometimes JAUNDICE. The term is often used, inaccurately, to describe such postoperative symptoms not due to gallbladder removal.Situs Inversus: A congenital abnormality in which organs in the THORAX and the ABDOMEN are opposite to their normal positions (situs solitus) due to lateral transposition. Normally the STOMACH and SPLEEN are on the left, LIVER on the right, the three-lobed right lung is on the right, and the two-lobed left lung on the left. Situs inversus has a familial pattern and has been associated with a number of genes related to microtubule-associated proteins.Surgical Procedures, Elective: Surgery which could be postponed or not done at all without danger to the patient. Elective surgery includes procedures to correct non-life-threatening medical problems as well as to alleviate conditions causing psychological stress or other potential risk to patients, e.g., cosmetic or contraceptive surgery.Colic: A clinical syndrome with intermittent abdominal pain characterized by sudden onset and cessation that is commonly seen in infants. It is usually associated with obstruction of the INTESTINES; of the CYSTIC DUCT; or of the URINARY TRACT.Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Bile: An emulsifying agent produced in the LIVER and secreted into the DUODENUM. Its composition includes BILE ACIDS AND SALTS; CHOLESTEROL; and ELECTROLYTES. It aids DIGESTION of fats in the duodenum.Drainage: The removal of fluids or discharges from the body, such as from a wound, sore, or cavity.Incidental Findings: Unanticipated information discovered in the course of testing or medical care. Used in discussions of information that may have social or psychological consequences, such as when it is learned that a child's biological father is someone other than the putative father, or that a person tested for one disease or disorder has, or is at risk for, something else.Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks.Cholangitis: Inflammation of the biliary ductal system (BILE DUCTS); intrahepatic, extrahepatic, or both.Appendectomy: Surgical removal of the vermiform appendix. (Dorland, 28th ed)Gallbladder Emptying: A process whereby bile is delivered from the gallbladder into the duodenum. The emptying is caused by both contraction of the gallbladder and relaxation of the sphincter mechanism at the choledochal terminus.Technetium Tc 99m Lidofenin: A nontoxic radiopharmaceutical that is used in RADIONUCLIDE IMAGING for the clinical evaluation of hepatobiliary disorders in humans.Postoperative Nausea and Vomiting: Emesis and queasiness occurring after anesthesia.Preoperative Care: Care given during the period prior to undergoing surgery when psychological and physical preparations are made according to the special needs of the individual patient. This period spans the time between admission to the hospital to the time the surgery begins. (From Dictionary of Health Services Management, 2d ed)Operative Time: The duration of a surgical procedure in hours and minutes.Subphrenic Abscess: Accumulation of purulent EXUDATES beneath the DIAPHRAGM, also known as upper abdominal abscess. It is usually associated with PERITONITIS or postoperative infections.Biliary Tract Surgical Procedures: Any surgical procedure performed on the biliary tract.Bile Ducts, Extrahepatic: Passages external to the liver for the conveyance of bile. These include the COMMON BILE DUCT and the common hepatic duct (HEPATIC DUCT, COMMON).Acalculous Cholecystitis: Inflammation of the GALLBLADDER wall in the absence of GALLSTONES.Reoperation: A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery.Time Factors: Elements of limited time intervals, contributing to particular results or situations.Acute Disease: Disease having a short and relatively severe course.Abdominal Abscess: An abscess located in the abdominal cavity, i.e., the cavity between the diaphragm above and the pelvis below. (From Dorland, 27th ed)Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.Duodenogastric Reflux: Retrograde flow of duodenal contents (BILE ACIDS; PANCREATIC JUICE) into the STOMACH.Jejunostomy: Surgical formation of an opening through the ABDOMINAL WALL into the JEJUNUM, usually for enteral hyperalimentation.Postoperative Period: The period following a surgical operation.General Surgery: A specialty in which manual or operative procedures are used in the treatment of disease, injuries, or deformities.Technetium Tc 99m Disofenin: A radiopharmaceutical used extensively in cholescintigraphy for the evaluation of hepatobiliary diseases. (From Int Jrnl Rad Appl Inst 1992;43(9):1061-4)Sphincter of Oddi Dysfunction: Organic or functional motility disorder involving the SPHINCTER OF ODDI and associated with biliary COLIC. Pathological changes are most often seen in the COMMON BILE DUCT sphincter, and less commonly the PANCREATIC DUCT sphincter.Electrocoagulation: Procedures using an electrically heated wire or scalpel to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. It is different from ELECTROSURGERY which is used more for cutting tissue than destroying and in which the patient is part of the electric circuit.Feasibility Studies: Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project.Postoperative Care: The period of care beginning when the patient is removed from surgery and aimed at meeting the patient's psychological and physical needs directly after surgery. (From Dictionary of Health Services Management, 2d ed)Anastomosis, Roux-en-Y: A Y-shaped surgical anastomosis of any part of the digestive system which includes the small intestine as the eventual drainage site.Biliary Tract: The BILE DUCTS and the GALLBLADDER.Cholestasis, Extrahepatic: Impairment of bile flow in the large BILE DUCTS by mechanical obstruction or stricture due to benign or malignant processes.Dissection: The separation and isolation of tissues for surgical purposes, or for the analysis or study of their structures.Video-Assisted Surgery: Endoscopic surgical procedures performed with visualization via video transmission. When real-time video is combined interactively with prior CT scans or MRI images, this is called image-guided surgery (see SURGERY, COMPUTER-ASSISTED).Antiemetics: Drugs used to prevent NAUSEA or VOMITING.Time-to-Treatment: The interval of time between onset of symptoms and receiving therapy.Emergencies: Situations or conditions requiring immediate intervention to avoid serious adverse results.Hepatic Artery: A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum.Surgical Procedures, Operative: Operations carried out for the correction of deformities and defects, repair of injuries, and diagnosis and cure of certain diseases. (Taber, 18th ed.)Surgical Wound Infection: Infection occurring at the site of a surgical incision.Patient Readmission: Subsequent admissions of a patient to a hospital or other health care institution for treatment.Surgical Procedures, Minimally Invasive: Procedures that avoid use of open, invasive surgery in favor of closed or local surgery. These generally involve use of laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device.Polyps: Discrete abnormal tissue masses that protrude into the lumen of the DIGESTIVE TRACT or the RESPIRATORY TRACT. Polyps can be spheroidal, hemispheroidal, or irregular mound-shaped structures attached to the MUCOUS MEMBRANE of the lumen wall either by a stalk, pedunculus, or by a broad base.Anesthesia, General: Procedure in which patients are induced into an unconscious state through use of various medications so that they do not feel pain during surgery.Intestinal Fistula: An abnormal anatomical passage between the INTESTINE, and another segment of the intestine or other organs. External intestinal fistula is connected to the SKIN (enterocutaneous fistula). Internal intestinal fistula can be connected to a number of organs, such as STOMACH (gastrocolic fistula), the BILIARY TRACT (cholecystoduodenal fistula), or the URINARY BLADDER of the URINARY TRACT (colovesical fistula). Risk factors include inflammatory processes, cancer, radiation treatment, and surgical misadventures (MEDICAL ERRORS).Foreign-Body Migration: Migration of a foreign body from its original location to some other location in the body.Trimebutine: Proposed spasmolytic with possible local anesthetic action used in gastrointestinal disorders.Duodenal Diseases: Pathological conditions in the DUODENUM region of the small intestine (INTESTINE, SMALL).Abdomen: That portion of the body that lies between the THORAX and the PELVIS.Chi-Square Distribution: A distribution in which a variable is distributed like the sum of the squares of any given independent random variable, each of which has a normal distribution with mean of zero and variance of one. The chi-square test is a statistical test based on comparison of a test statistic to a chi-square distribution. The oldest of these tests are used to detect whether two or more population distributions differ from one another.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Ileus: A condition caused by the lack of intestinal PERISTALSIS or INTESTINAL MOTILITY without any mechanical obstruction. This interference of the flow of INTESTINAL CONTENTS often leads to INTESTINAL OBSTRUCTION. Ileus may be classified into postoperative, inflammatory, metabolic, neurogenic, and drug-induced.Blood Loss, Surgical: Loss of blood during a surgical procedure.Bile Reflux: Retrograde bile flow. Reflux of bile can be from the duodenum to the stomach (DUODENOGASTRIC REFLUX); to the esophagus (GASTROESOPHAGEAL REFLUX); or to the PANCREAS.Hernia, Abdominal: A protrusion of abdominal structures through the retaining ABDOMINAL WALL. It involves two parts: an opening in the abdominal wall, and a hernia sac consisting of PERITONEUM and abdominal contents. Abdominal hernias include groin hernia (HERNIA, FEMORAL; HERNIA, INGUINAL) and VENTRAL HERNIA.Equipment Design: Methods of creating machines and devices.Abdominal Wall: The outer margins of the ABDOMEN, extending from the osteocartilaginous thoracic cage to the PELVIS. Though its major part is muscular, the abdominal wall consists of at least seven layers: the SKIN, subcutaneous fat, deep FASCIA; ABDOMINAL MUSCLES, transversalis fascia, extraperitoneal fat, and the parietal PERITONEUM.

Perforation of the gallbladder: analysis of 19 cases. (1/893)

Perforation of the gallbladder occurred in 19 (3.8%) of 496 patients with acute cholecystitis treated at one hospital in an 8-year period. The average age of the 19 patients was 69 years and the female:male ratio was 3:2. Most had a history suggestive of gallbladder disease and most had coexisting cardiac, pulmonary, renal, nutritional or metabolic disease. The duration of the present illness was short, perforation occurring within 72 hours of the onset of symptoms in half the patients; the diagnosis was not suspected preoperatively in any. In the elderly patient with acute cholecystitis who has a long history of gallbladder disease, cholecystectomy should be performed early, before gangrene and perforation of the gallbladder can occur.  (+info)

Gallstones, cholecystectomy and risk of cancers of the liver, biliary tract and pancreas. (2/893)

To examine the association between gallstones and cholecystectomy, we conducted a nationwide population-based cohort study in Denmark. Patients with a discharge diagnosis of gallstones from 1977 to 1989 were identified from the Danish National Registry of Patients and followed up for cancer occurrence until death or the end of 1993 by record linkage to the Danish Cancer Registry. Included in the cohort were 60 176 patients, with 471 450 person-years of follow-up. Cancer risks were estimated by standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) stratified by years of follow-up and by cholecystectomy status. Among patients without cholecystectomy, the risks at 5 or more years of follow-up were significantly elevated for cancers of liver (SIR = 2.0, CI = 1.2-3.1) and gallbladder (SIR = 2.7, CI = 1.5-4.4) and near unity for cancers of extrahepatic bile duct (SIR = 1.1), ampulla of Vater (SIR = 1.0) and pancreas (SIR = 1.1). The excess risk of liver cancer was seen only among patients with a history of hepatic disease. Among cholecystectomy patients, the risks at 5 or more years of follow-up declined for cancers of liver (SIR = 1.1) and extrahepatic bile duct (SIR = 0.7), but were elevated for cancers of ampulla of Vater (SIR = 2.0, CI = 1.0-3.7) and pancreas (SIR = 1.3, CI = 1.1-1.6). These findings confirm that gallstone disease increases the risk of gallbladder cancer, whereas cholecystectomy appears to increase the risk of cancers of ampulla of Vater and pancreas. Further research is needed to clarify the carcinogenic risks associated with gallstones and cholecystectomy and to define the mechanisms involved.  (+info)

How can videolaparoscopy be used in a peritoneal dialysis programme? (3/893)

BACKGROUND: Recently videolaparoscopy is considered to have a vaster use in surgery due to the undeniable benefits such as low operatory traumatism, quick recovery of canalization, a short stay in the hospital and minor scarring. METHODS: Forty patients were treated with peritoneal dialysis (PD); 15 videolaparoscopic procedures were performed on 13 patients before starting PD and two during the course of PD. The videolaparoscopy procedure was started by inducing pneumoperitoneum after initiation of general anaesthesia through endotracheal intubation. RESULTS: Peritoneal catheter placement was carried out in 11 ESRD patients showing abdominal scars due to previous laparotomies; their abdominal condition precluded safe PC placement using conventional non-laparoscopic procedures with local anaesthesia. Release of adhesions was performed only in two patients. Videolaparoscopy was also used in three patients for elective cholecystectomy; 2/3 underwent concomitant PC insertion. One patient was submitted to cholecystectomy during the course of CAPD; following the procedure we left the peritoneum dry overnight and then we started temporary IPD, using small volumes, avoiding haemodialysis (HD). Regular CAPD was resumed 6 days later. Finally, videolaparoscopy was also used for diagnostic purpose i.e. in one 59-year-old man patient who had a peritoneal catheter obstruction. Repeated rescue attempts using urokinase solution to irrigate the peritoneal catheter had been used in vain attempts prior to the procedure. CONCLUSIONS: Videolaparoscopy proves to be a useful tool in a PD programme. Firstly, it may be used as a technique for catheter implantation, not as a routine procedure but in patients with extensive abdominal scars due to previous laparotomy, i.e. at risk for accidental viscera perforation due to the possibility of adhesions between intestinal loops and parietal peritoneum. Secondly, videolaparoscopy used for abdominal surgery allows the resumption of PD immediately after surgical procedure and thus avoiding HD. Videolaparoscopy is fundamental for diagnosis and rescue of catheter dysfunction and has an integral role in the successful management of these patients in extending catheter function and permitting safe replacement of peritoneal catheter if it becomes necessary. Along with the undeniable advantages, remains the disadvantages that it must be carried out by an expert surgeon in an operating theatre while the patient is under general anaesthesia.  (+info)

Evidence for validity of a health status measure in assessing short term outcomes of cholecystectomy. (4/893)

OBJECTIVE: To assess the validity of the Nottingham health profile (NHP) as an indicator of short term outcome of cholecystectomy. DESIGN: Prospective assessment of outcome. SETTING: One teaching hospital. Patients--161 consecutive patients admitted for cholecystectomy between January 1989 and September 1990. MAIN MEASURES: Patients' reported symptoms and self assessed NHP scores before cholecystectomy and at follow up at three and 12 months (76 patients); assessment before admission (19). RESULTS: Complete data were obtained preoperatively and at three months' follow up from 154 patients; seven did not respond to the follow up questionnaire. 76/84(90%) patients in the study 12 months or more answered the 12 month follow up questionnaire; eight did not respond. Significant changes in score before and at three months after the operation were observed for four of the six dimensions: energy (35.34 v 19.53, p < 0.0001), pain (27.38 v 9.8, p < 0.0001), sleep (26.99 v 17.51, p = 0.0002), and emotional reactions (16.12 v 7.56, p = 0.001). The mean scores for 76 patients followed up at three and 12 months showed little subsequent change. Scores in readmitted patients were all significantly higher, suggesting poor health. Patients with five reported symptoms had significantly worse scores for all dimensions. Scores were similar before cholecystectomy whether the questionnaire was completed before or after admission. CONCLUSION: The NHP is an appropriate tool for monitoring changes in health after cholecystectomy.  (+info)

Comparison of short term outcomes of open and laparoscopic cholecystectomy. (5/893)

OBJECTIVE: To compare the three month outcome of open and laparoscopic cholecystectomy. DESIGN: Prospective assessment of outcome for a series of patients encompassing the introduction of the laparoscopic technique. SETTING: One teaching hospital. PATIENTS: 269 patients admitted for open cholecystectomy between January 1989 and March 1992 and 122 admitted for laparoscopic cholecystectomy between January 1991 and March 1992. MAIN MEASURES: Patients' reported symptoms and self assessed scores with the Nottingham health profile before operation and at three month follow up. Incidence of complications and adverse events after discharge. RESULTS: Similar improvements in symptom rates and health scores were seen regardless of surgical technique. A lower rate of postoperative complications was seen in the patients given laparoscopic surgery (6/95(6%) v 45/235(19%)), and their mean length of stay was lower (4.5 v 9.8 days). Similar results were obtained when the analysis was restricted to a subset of fairly uncomplicated cases (patients aged 60 or less without other illnesses on admission who were not undergoing emergency or urgent surgery), which constituted a larger proportion of the group given laparoscopy (35/95(37%) v 40/235(17%)). Between these two groups no significant difference was seen in the frequency of relevant readmissions to hospital or visits to general practitioners or accident and emergency departments. CONCLUSION: Ideally, a new surgical technique would be evaluated in a randomised trial. In the absence of such a trial, this observational study provides some evidence that the switch from open to laparoscopic cholecystectomy has brought benefits, particularly in terms of reduced length of stay in hospital. A range of clinical and patient derived indicators suggests that these gains have not been associated with a reduction in the quality of the outcome at three months.  (+info)

Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. (6/893)

BACKGROUND: Previous studies suggest that laparoscopic cholecystectomy (LC) is associated with an increased risk of intraoperative injury involving the bile ducts, bowel, and vascular structures compared with open cholecystectomy (OC). Population-based studies are required to estimate the magnitude of the increased risk, to determine whether this is changing over time, and to identify ways by which this might be reduced. METHODS: Suspected cases of intraoperative injury associated with cholecystectomy in Western Australia in the period 1988 to 1994 were identified from routinely collected hospital statistical records and lists of persons undergoing postoperative endoscopic retrograde cholangiopancreatography. The case records of suspect cases were reviewed to confirm the nature and site of injury. Ordinal logistic regression was used to estimate the risk of injury associated with LC compared with OC after adjusting for confounding factors. RESULTS: After the introduction of LC in 1991, the proportion of all cholecystectomy cases with intraoperative injury increased from 0.67% in 1988-90 to 1.33% in 1993-94. Similar relative increases were observed in bile duct injuries, major bile leaks, and other injuries to bowel or vascular structures. Increases in intraoperative injury were observed in both LC and OC. After adjustment for age, gender, hospital type, severity of disease, intraoperative cholangiography, and calendar period, the odds ratio for intraoperative injury in LC compared with OC was 1.79. Operative cholangiography significantly reduced the risk of injury. CONCLUSION: Operative cholangiography has a protective effect for complications of cholecystectomy. Compared with OC, LC carries a nearly twofold higher risk of major bile, vascular, and bowel complications. Further study is required to determine the extent to which potentially preventable factors contribute to this risk.  (+info)

Gastrointestinal surgical workload in the DGH and the upper gastrointestinal surgeon. (7/893)

Workload implications of upper gastrointestinal (UGI) subspecialisation within the district general hospital (DGH) have been assessed by prospective data collection over a 12-month period in a DGH with six general surgeons serving a population of 320,000. The single UGI surgeon (UGIS) performed all ten oesophageal resections, ten of 11 gastric resections for malignancy and all eight pancreatic operations. He also performed 91 of the 182 cholecystectomies, 164 of the 250 endoscopic retrograde cholangiopancreatograms (ERCP) and all endoscopic procedures for the palliation of unresected oesophageal tumours. The UGIS was responsible for the management of all patients with severe pancreatitis, yet he also performed 51 colorectal resections over the 12-month period. Successful management of severely ill patients with upper GI disease requires consultant supervision on a day-to-day basis. If such UGI disease is to be managed in the DGH, two surgeons with UGI experience will be required if high quality care and reasonable working conditions are to be achieved. Such UGIS will continue to perform some colorectal surgery.  (+info)

Ultrasonographic evaluation of the common bile duct in biliary acute pancreatitis patients: comparison with endoscopic retrograde cholangiopancreatography. (8/893)

We compared the morphologic findings of the common bile duct by ultrasonography and endoscopic retrograde cholangiopancreatography in patients with biliary acute pancreatitis. Forty-five patients were studied. The diagnosis of acute pancreatitis was based on the presence of characteristic abdominal pain associated with an elevation of serum amylase and lipase concentrations. All patients underwent ultrasonography and subsequently urgent endoscopic retrograde cholangiopancreatography and eventually endoscopic sphincterotomy. Ultrasonography showed gallstones in 33 patients and sludge of the gallbladder in seven patients. In the common bile duct, lithiasis was found in two patients and sludge in 25. Endoscopic retrograde cholangiopancreatography showed choledocolithiasis in eight patients and sludge of the common bile duct in 32. In 27 cases (60%) concordance occurred between ultrasonographic and endoscopic retrograde cholangiopancreatographic detection of lithiasis or sludge of the common bile duct. The average diameter of the common bile duct determined by sonography was significantly smaller (P < 0.001) than that obtained by endoscopic retrograde cholangiopancreatography. The evaluation of this parameter indicated that a good correlation existed between the values obtained with the two techniques (r(s) = 0.765, P < 0.001). Both ultrasonography and endoscopic retrograde cholangiopancreatography can provide reliable measurements of the common bile duct diameter. Ultrasonography is the technique of choice in the initial investigation of patients with biliary acute pancreatitis.  (+info)

  • This prospective cohort study, carried out in one institution using the single-site da Vinci surgical platform to complete the procedures, included all patients requiring cholecystectomy that consented to participate in the trial. (2minutemedicine.com)
  • This study suggests that early cholecystectomy after admission seems warranted and that patients admitted on a Friday should not wait until Monday to undergo the operation," lead author Dr. Michael Scott and colleagues from Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, write in an abstract presented October 30 at the American College of Surgeons (ACS) Clinical Congress in San Francisco. (medscape.com)
  • After adjusting for confounding factors such as age, BMI and diabetes, patients who had cholecystectomy more than 72 hours after admission had significantly longer hospital stay (about five days versus two days with surgery within 24-72 hours and one day with surgery in under 24 hours). (medscape.com)
  • 1. 87 of 95 patients completed single-site robotic cholecystectomy without conversion to traditional approaches. (2minutemedicine.com)
  • 2. Following single-site robotic cholecystectomy, 11.6% of patients required hospital admission and 6.3% required readmission. (2minutemedicine.com)
  • Of the 95 patients who participated in the trial, 87 completed their cholecystectomies through the single incision, 6 were converted to laparoscopic, 1 converted to open, and 1 case was aborted out of concern that the patient had cancer. (2minutemedicine.com)
  • In a single-site robotic-assisted cholecystectomy, the surgeon makes a 2 - 2.5 cm incision at the belly button and a special port with multiple holes is placed. (memorialcare.org)
  • You also run the risk of a problem doctors call "post-cholecystectomy syndrome" (PCS). (webmd.com)
  • Palanivelu C, Rajan PS, Jani K, Shetty AR, Sendhilkumar K, Senthilnathan P, Parthasarthi R. Laparoscopic cholecystectomy in cirrhotic patients: the role of subtotal cholecystectomy and its variants. (springer.com)
  • Subtotal cholecystectomy has been carried out in 34 patients from 1972 to 1992. (hindawi.com)
  • Subtotal cholecystectomy is a safe, feasible and definitive operation in patients for whom the standard operation could be dangerous. (hindawi.com)
  • If you're overweight and have just had your gallbladder removed in an operation known as a cholecystectomy, you may be wondering if the operation will make your weight-loss goals tougher to achieve. (livestrong.com)
  • A cholecystectomy is generally done while you are given medicines to put you into a deep sleep (under general anesthesia). (vidanthealth.com)
  • A cholecystectomy is generally performed while you are asleep under general anesthesia. (nyhq.org)
  • These contraindications are likely to evolve as cholecystectomy via NOTES advances and gains momentum and surgeon expertise increases. (medscape.com)
  • When performing a minimally invasive cholecystectomy with the assistance of the da Vinci System, a surgeon is seated at an ergonomically designed console. (moffitt.org)
  • Mr. King's (not real name) surgeon went to a weekend course and learned how to do a laparoscopic cholecystectomy on a pig. (medleague.com)
  • HealthDay News) - For premenopausal women and those using hormone replacement therapy (HRT) , there is an inverse association between coffee consumption and risk of cholecystectomy, according to a study published in the June issue of Clinical Gastroenterology and Hepatology . (empr.com)
  • We observed an inverse association between coffee consumption and risk of cholecystectomy in women who were premenopausal or used HRT but not in other women or in men," the authors write. (empr.com)
  • Your healthcare provider may have other reasons to recommend a cholecystectomy. (vidanthealth.com)
  • There may be other reasons for your doctor to recommend a cholecystectomy. (nyhq.org)
  • Compared with the background population, the incidence of cholecystectomy was substantially elevated already before RYGB and increased further 6-36 months after RYGB. (diva-portal.org)
  • The incidence of cholecystectomy was higher in irritable bowel syndrome and abdominal pain and normal bowel groups than in controls and altered bowel and no abdominal pain group. (helpforibs.com)
  • A consensus development approach was used to assess the extent to which doctors in the UK agreed about the appropriate indications for cholecystectomy. (bmj.com)
  • The relationship between cholecystectomy and the occurrence of subsequent colon cancer has been controversial. (nih.gov)
  • Objective To investigate the relationship between cholecystectomy and the subsequent occurrence of primary choledocholithiasis and to review the surgical treatment of primary choledocholithiasis. (ebscohost.com)
  • No other post cholecystectomy sequelae were noticed in the remaining 32 patients. (hindawi.com)
  • The most common cause of post-cholecystectomy syndrome are the extra-biliary disorders such as peptic ulcer disease, gastroesophageal reflux disease and irritable bowel syndrome. (scielo.br)
  • Materials and Methods: Levels of PAI-1, MMP-3, MMP-8, TIMP-1 and TIMP-2 in 35 patients with post-cholecystectomy BDI by complete biliary obstruction were measured and compared to a healthy control group. (scirp.org)
  • The over-expression of fibrinolytic proteins such as MMP-8 could limit liver fibrosis, preventing hepatic dysfunction in post-cholecystectomy BDI. (scirp.org)
  • In this study, robotic cholecystectomy was associated with lesser lengths of stay and readmission rates than laparoscopic cholecystectomy. (ormanager.com)
  • Hospitals and surgeons need to consider the improved outcomes but also the monetary and time investments required for robotic cholecystectomy, the authors note. (ormanager.com)