scholarly journals Reducing waiting lists for laparoscopic cholecystectomy: An intensive approach to aid COVID-19 recovery

2021 ◽  
Author(s):  
Rachael Elizabeth Clifford ◽  
Kunal Rajput ◽  
Chyu Yan Naing ◽  
Karen MacDonald ◽  
Thomas Pantak ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Waiting Lists ◽  
Intensive Approach

scholarly journals P-BN44 The impact of the COVID-19 pandemic on waiting lists for laparoscopic cholecystectomy and its effect on patient care and outcomes

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Geraint Herbert ◽  
Charlotte Thomas
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Patient Care ◽  
Positive Impact ◽  
Elective Surgery ◽  
Emergency Operation ◽  
Waiting Lists ◽  
Waiting List ◽  
Subtotal Cholecystectomy ◽  
Significant Difference ◽  
The Impact

Abstract Background It has been widely reported that the COVID-19 pandemic has had a detrimental impact on waiting lists for elective surgery in the NHS. Delays in laparoscopic cholecystectomy (LC) are likely to prolong suffering for symptomatic patients and risk increasing complications for patients which may then require emergency care and intervention. In this study we aim to quantify the impact of the COVID-19 pandemic on elective waiting lists and to assess what implications this might have on patient care and outcomes.  Methods Electronic health records were retrospectively interrogated for patients undergoing LC in both March 2019 (prior to the COVID-19 pandemic) and March 2021. The following data was captured: age, gender, elective vs emergency operation, laparoscopic vs open, total vs subtotal cholecystectomy, use of drains, length of stay/daycase rates, the number of emergency presentations prior to operation and the number of days between being listed for surgery and their operation. The results were analysed using SPSS Statistics (IBM, New York).  Results 111 patients were included in the study (25 male and 86 female). Of these, 60 had their LC in 2019, and 51 in 2021. The age and gender distribution of the patients in both time periods were similar. The median number of days on the waiting list was significantly higher (P < 0.001) for patients in 2021 at 379.5 days, compared with 153 days in 2019. There was a significant increase in the number of emergency presentations prior to LC in 2021 (P = 0.025) with an average of 0.7 presentations per patient compared with 0.45 in 2019. Additionally, there was a significant increase in the number of emergency LC performed in 2021 (P = 0.002), with 15 performed compared with 4 in 2019, representing 29.4% and 6.7% of all LC respectively. There was no significant change in rates of conversion to open, drains or subtotal cholecystectomy. There was no significant difference in daycase rates for elective patients in either period (55% vs 58%). Conclusions Whilst there has been no change in the operative outcomes for patients undergoing LC, there has been a stark increase in the length of time patients are on a waiting list prior to undergoing elective LC. This has resulted in a significant increase in the number of emergency presentations and the number of emergency LC performed. This study demonstrates the wider impact of increasing waiting list times beyond the prolonged suffering of symptomatic patients. A significant reduction in waiting list times would be beneficial to both patients and healthcare providers, with the aim of reducing the number of emergency presentations. A reduction in these would have a positive impact on acute services and on the associated cost implications.  

Laparoscopic Cholecystectomy

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 250-254
Author(s):  
Vogelbach ◽  
Bogdan ◽  
Rosenthal ◽  
Pfefferkorn ◽  
Triponez
Keyword(s):  
Virtual Reality ◽  
Laparoscopic Cholecystectomy ◽  
Neue Technik

Fragestellung: Die dieser Untersuchung zugrunde liegende Frage war, ob das angewandte Ausbildungskonzept geeignet war, um am Beispiel der Einführung der laparoskopischen Cholezystektomie eine neue Operationsmethode in einer universitären Ausbildungsklinik mit einer grossen Anzahl Chirurgen zu etablieren. Patienten und Methodik: Seit Einführung der ersten laparoskopischen Cholezystektomie wurden alle Cholezystektomien während zwei Jahren (Mai 1990 bis Mai 1992) prospektiv erfasst. Ein Ausbildungskonzept wurde gewählt, bei dem jeweils ein Operateur durch einen Tutor geschult wurde und so 15 konsekutive Eingriffe durchführte, um dann die Technik einem weiteren auszubildenden Chirurgen zu instruieren. Resultate: In zwei Jahren wurden 355 Patienten cholezystektomiert. 60% der Operationen wurden laparoskopisch durchgeführt oder begonnen. 40% der Operationen wurden offen durchgeführt. In den ersten zwei Jahren konnten 13 Operateure (durchschnittlich 16 Operationen / Operateur , range 1 - 60) in die neue Technik eingeführt werden. Es traten keine schweren Komplikationen, insbesondere keine Gallenwegsverletzungen in dieser Einführungsphase auf. Diskussion: In der Literatur wird dieses Vorgehen bei der Einführungsphase seit 1992 wiederholt vorgestellt, diskutiert und empfohlen. Zwischenzeitlich gibt es Richtlinien von Fachgesellschaften und nationalen Institutionen, welche die Ausbildung zur Ausführung neuer chirurgischer Techniken reglementieren. In den letzten Jahren verlagern sich die ersten Ausbildungsschritte in Richtung Trainingskurse an skill-stations und virtual reality Trainer. Schlussfolgerung: Das beschriebene Ausbildungskonzept bewährte sich in der Einführungsphase der laparoskopischen Cholezystektomie zu Beginn der 90er-Jahre.

Association between Socioeconomic Factors and Postoperative Complications of Cholecystectomy

2021 ◽  
pp. 1-13
Author(s):  
Herman Romero Ramírez ◽  
Norma Muñoz Albán ◽  
Consuelo Albán Meneses ◽  
Alicia Escobar Torres
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Socioeconomic Factors ◽  
Control Variable ◽  
Laparoscopic Technique ◽  
Safe Operation ◽  
Conventional Surgery ◽  
Socioeconomic Characteristics ◽  
Dependent Variables ◽  
Education Levels

The article´s goal isto determine if socioeconomic factors influence the postoperative complications of cholecystectomy. For this, the observational study was defined, analytical and quantitative study was conducted in 100 patients who underwent cholecystectomy. A logistic regression model was applied in which risk factors, socioeconomic characteristics, along with a control variable, were incorporated as variables. Three models were run with alternative dependent variables that are delimited by the type of postoperative complication recorded. The results found showed that women show a higher risk of presenting complications after cholecystectomy, the same occurs in older patients. Likewise, the risk is much lower in people with higher education levels and in patients who underwent laparoscopic cholecystectomy, they only have a 5% risk of presenting complications. Postoperative complications after cholecystectomy are minimized by using the laparoscopic technique and socioeconomic factors would influence the risk of suffering postoperative complications after said surgery, which makes laparoscopic cholecystectomy a safe operation with many other benefits and advantages over traditional or conventional surgery.

Laparoscopic Cholecystectomy in Acute Gall Bladder Disease

1970 ◽  
Vol 24 (1) ◽  
pp. 10-13
Author(s):  
TK Maitra ◽  
NA Alam ◽  
E Haque ◽  
MH Khan ◽  
HK Chowdhury
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Early Phase ◽  
Gall Bladder Disease ◽  
Laparoscopic Procedure ◽  
Bladder Disease ◽  
Complication Of Surgery

Laparoscopic cholecystectomy is one of the procedures through which gall bladder can be removed. Acute cholecystitis was considered a contraindication for laparoscopic procedure but with time and experience this shortcoming is now overcome. Here is a study of 32 patients who were selected for laparoscopic cholecystectomy. Among them, 29 patients were operated by laparoscopic method and rest three patients were converted. This study showed the appropriate time for surgery, technical difficulties and the complication of surgery. It may be concluded that laparoscopic cholecystectomy is feasible and beneficial to the patient with acute cholecystitis in its early phase, if necessary support and expertise is available. (J Bangladesh Coll Phys Surg 2006; 24: 10-13)

Duodenal Ulcer Induced by Hem-o-Lok clip after Reduced Port Laparoscopic Cholecystectomy

2016 ◽  
Vol 25 (1) ◽  
pp. 95-98 ◽  
Author(s):  
Koichi Soga ◽  
Kyoichi Kassai ◽  
Kenji Itani
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Cystic Duct ◽  
Duodenal Bulb ◽  
Mucosal Injury ◽  
Normal Mucosa ◽  
Surrounding Tissue ◽  
Inferior Wall ◽  
Endoscopic Clip

The patient was a 66-year-old woman who had undergone laparoscopic cholecystectomy (Lap-C) secondary to chronic cholecystitis status post endoscopic choledocholithotomy 13 months previously. During surgery, Hem-o-Lok clips were used to control the cystic duct and the cystic artery. Due to the presence of extensive adhesions of the cystic duct and surrounding tissue, the surgeons had difficulty in debriding the area. Thirteen months after Lap-C, the patient underwent a screening esophagogastroduodenoscopy (EGD), which demonstrated clip appearance at the inferior wall of the first part of the duodenum. In the EGD, duodenal erosions and edema were observed around the clip. We appreciated that endoscopic clip removal would be difficult because of the presence of severe adhesions and inflammation of the duodenal bulb. On clinical examination of the patient, no major abnormalities or physical findings were noted. Therefore, we decided not to attempt to remove the clip. The patient was treated with an oral proton pump inhibitor to prevent extensive duodenal mucosal injury. Two months later, we repeated the EGD, which revealed that the clip was no longer present, and the duodenum was covered with normal mucosa surrounding the scar. Abbreviations: EGD: esophagogastroduodenoscopy; Lap-C: laparoscopic cholecystectomy; PPI: proton pump inhibitor.

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