scholarly journals Acute Laparoscopic Cholecystectomy: Delays in Acute Surgery and Cost Analysis of Aproposed New Service

2011 ◽  
Vol 93 (7) ◽  
pp. 261-265
Author(s):  
AJ Cockbain ◽  
AL Young ◽  
E McGinnes ◽  
GJ Toogood
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Cochrane Review ◽  
Length Of Hospital Stay ◽  
Biliary Colic ◽  
Complication Rates ◽  
Acute Surgery ◽  
Symptomatic Gallstone Disease

Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for patients presenting with acute cholecystitis as supported by a recent meta-analysis and Cochrane review. Although the benefit of ALC is less clear in patients with biliary colic, few would disagree that earlier cholecystectomy is preferable for most patients with symptomatic gallstone disease. ALC has similar complication rates to elective laparoscopic cholecystectomy (ELC) and a reduced total length of hospital stay. Recurrent symptoms from untreated gallstone disease are common, with the risk of developing more severe complications such as acute cholecystitis, acute pancreatitis or cholangitis while waiting for an operation. It has been reported that patients awaiting ELC after an acute admission have significantly more general practitioner (GP) attendances than those who receive ALC, that they have an average of one emergency department attendance for symptom recurrence and that one in six requires hospital admission due to the severity of recurrent symptoms.

scholarly journals Index Admission Laparoscopic Cholecystectomy, Our Experience after the Inception of Acute Care Surgery Programme

2020 ◽  
Author(s):  
Muhammad Aakif ◽  
Zeeshan Razzaq ◽  
James Byrne ◽  
Hamid Mustafa ◽  
Mudassar Majeed ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Length Of Hospital Stay ◽  
Index Admission ◽  
Acute Care Surgery ◽  
Biliary Colic ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Symptomatic Disease ◽  
Care Surgery

Abstract Background: Gallstones are very common and frequently present as acute cholecystitis in up to 20 % of patients with symptomatic disease, with wide variation in severity. Laparoscopic Cholecystectomy (LC) has become the gold standard for treatment of symptomatic disease. Although multiple studies have confirmed its safety, LC at index admission is still not widely practiced in Ireland. We present our experience of a cohort of patients who underwent index admission laparoscopic cholecystectomy at Cork University Hospital since the start of the acute care surgery program in May 2017.Aim: To determine the feasibility and safety of laparoscopic cholecystectomy at index admission.Methods: All adult patients who presented to an acute surgical assessment unit (ASAU) with symptomatic gall stone disease and underwent early laparoscopic cholecystectomy at index admission were included. The duration of this prospective cohort study was 27 months (May 2017 to July 2019). Patient demographics, indication for surgery, post-operative complications and conversion rates were recorded. In addition, timing of imaging, imaging findings and length of hospital stay were also noted.Results: A total of 233 patients underwent laparoscopic Cholecystectomy at index admission for various indications. Median age was 50 years with range between 16 - 88. Male to female ratio was 1: 1.78. 142 (61%) patients had acute cholecystitis, while the other indications were CBD obstruction (15.5%), biliary colic (11%) and acute biliary pancreatitis (10.5%). 93 (40%) patients had pre-op MRCP while 41 (17.6%) underwent pre-op ERCP. All except 3 patients undergoing ERCP had pre-procedure MRCP. 2 patients had intra-operative cholangiograms. Overall morbidity was 4.7%. In terms of complications, 3 (1.3%) patients had bile leak and only 1 (0.85%) had re-operation. There was 1 common bile duct injury and only 1 conversion to open surgery. There was no mortality in this case series. The average length of hospital stay was 5.6 days. (Range 2 to 14 days).Conclusions: Index admission laparoscopic cholecystectomy for acute cholecystitis, choledocholithiasis, biliary colic and acute biliary pancreatitis, has been a safe and feasible treatment option in our hospital. A safe practice can be ensured by adherence to this care pathway and a multidisciplinary, consultant-led service. Index cholecystectomy service can be provided safely to reduce disease-related morbidity and multiple re-admissions in patients awaiting interval surgery.

scholarly journals Course and outcomes of complicated gallstone disease in pregnancy: a single centre experience

2019 ◽  
Vol 7 (7) ◽  
pp. 2686
Author(s):  
Nihida Akhter ◽  
Irfan Nazir Mir ◽  
Sheikh Viqar Manzoor
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Average Length ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Length Of Hospital Stay ◽  
Delay In Diagnosis ◽  
Medical College ◽  
Skilled Personnel ◽  
Symptomatic Gallstone Disease ◽  
In Pregnancy

Background: The incidence of acute abdomen during pregnancy is approximately 1 in 500 pregnancies. The incidence of symptomatic gallstone disease in pregnancy is reported in approximately 0.2-0.5 per 1,000 pregnancies. Symptoms are similar to those in the nonpregnant state. A delay in diagnosis may increase the risk of perforation. Treatment in most cases is conservative. However, recent trends, newer instrumentation and skilled personnel encourage arranging laparoscopic cholecystectomy at the time of diagnosis.Methods: This study was a retrospective study, included 117 pregnant patients with acute gallstone disease, who were treated and followed-up at Government Medical College, Srinagar, Department of General Surgery and Department of Gynae And Obstetrics, between January 2015 and April 2017.Results: The mean age of patients in our study was 28.6 years. Majority of patients 56 (47.86%) were in is trimester of pregnancy. Parity of the patients varied from 1 to 6, with a mean parity of 2.67. The presentation of majority of patients was colicky pain right upper abdomen,108 (92.30%). All patients had gallstones on USG scan.101(86.32%) patients had acute cholecystitis, while 8 (6.83%) patients had predominant features of acute pancreatitis,8(6.83%) patients had accompanying choledocholithiasis The average wall thickness of gallbladder in our patients was 4.62 mm. Majority 106 (90.59%) patients were managed conservatively. 8 (6.83%) patients underwent cholecystectomy in same admission, after failure of conservative management, 7 patients underwent laparoscopic cholecystectomy and one underwent open cholecystectomy. 3 patients (2.56%), who had features of cholangitis were managed by ERCP. The average length of hospital stay in our patient group was 8.61 days. There was one maternal death reported in our study, there were a total of 8 (6.83%) preterm deliveries.Conclusions: Symptomatic gallstone disease in pregnancy is a common surgical problem. Diagnosis during pregnancy can be difficult, majority of cases can be managed conservatively, intervention whenever indicated must be undertaken.

The quality of life in patients after laparoscopic cholecystectomy due to gallstone disease - evaluation of long-term postoperative results

2021 ◽  
Vol 93 (SUPLEMENT) ◽  
pp. 1-5
Author(s):  
Tomasz Gach ◽  
Paweł Bogacki ◽  
Beata Markowska ◽  
Joanna Bonior ◽  
Małgorzata Paplaczyk ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
Biliary Colic ◽  
Study Group ◽  
Post Surgery ◽  
Asymptomatic Patients ◽  
Symptomatic Gallstone Disease ◽  
The Impact

Introduction: Currently, the standard treatment of gallstone disease is laparoscopic cholecystectomy. Considering its availability, reduction of postoperative pain and shortened stay in the hospital, a constant upward trend in the number of such procedures is observed. However, about one third of patients undergoing such treatment report pain and dyspeptic disorders following the surgery. The assessment of the quality of life of patients undergoing laparoscopic cholecystectomy, based on standardized questionnaires, should be one of the elements allowing for the assessment of the impact of the applied treatment on patients' lives. Aim: The aim of this retrospective study is to evaluate the impact of laparoscopic cholecystectomy on the quality of life of patients operated in one center. Material and methods: The study has been carried out retrospectively with the use of a GIQLI questionnaire completed online by the patients 6 months after undergoing laparoscopic cholecystectomy. The study included patients over 18 years of age who have not experienced any complications within the perioperative period and did not require open surgery. The study group has been divided into two subgroups depending on the presence of symptoms of acute gallstone disease in the pre-operative period. Results: The study group consisted of 205 patients (53 men, 152 women, aged 19 to 87, with an average of 54.3). The subgroup with an asymptomatic gallstone disease (dyspeptic disorders, without biliary colic) consisted of 47 patients (18 men, 29 women, aged 19-87). Symptomatic gallstone disease occurred in 158 people (35 men, 123 women aged 22 to 81). There have been certain statistically significant differences in the post-operative health condition between the group of patients with symptoms of gallstone disease and the asymptomatic patients. 94.3% of symptomatic patients concluded that their condition has improved and 5.7% that it remained unchanged. Among asymptomatic patients, only 53.2% of patients stated that they felt better post-surgery, 44.7% reported no changes (p <0.001). There have been no significant differences in the overall QIQLI scores between these subgroups, although symptomatic patients assessed their social functioning better (8.9 ± 1.5 vs 8.11 ± 2.08, p = 0.004). There have been certain differences between men and women in the assessment of the quality of life in the context of the presence of key symptoms (M: 28.87 ± 4.23, F: 26.77 ± 5.0, p = 0.007) Conclusions: The patients with a symptomatic gallstone disease report they feel better after laparoscopic cholecystectomy as compared to the group of asymptomatic patients. The overall QOL score measured by the GIQLI form does not depend on the presence of symptoms in the preoperative period. Men benefited more from surgery as regards key symptoms.

Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

2021 ◽  
pp. 004947552110100
Author(s):  
Shamir O Cawich ◽  
Avidesh H Mahabir ◽  
Sahle Griffith ◽  
Patrick FaSiOen ◽  
Vijay Naraynsingh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gold Standard ◽  
Standard Treatment ◽  
Gallstone Disease ◽  
Acute Attack ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Surgery ◽  
Delayed Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results

2007 ◽  
Vol 22 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Giuseppe Borzellino ◽  
Stefan Sauerland ◽  
Anna Maria Minicozzi ◽  
Giuseppe Verlato ◽  
Carlo Di Pietrantonj ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Analysis Of Results

scholarly journals A prospective observational study to study and correlate the clinical and microbiological profile of bile cultures in patients with symptomatic cholelithiasis

2020 ◽  
Vol 7 (5) ◽  
pp. 1566
Author(s):  
Ramakrishnan Shankaran ◽  
Chaminda Amarasekara
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Gallstone Disease ◽  
Significant Proportion ◽  
Antibiotic Sensitivity ◽  
Klebsiella Species ◽  
Duration Of Symptoms ◽  
Symptomatic Cholelithiasis ◽  
Bile Culture ◽  
Symptomatic Gallstone Disease

Background: Biliary infection has been reported in a significant proportion of patients developing gallstones. Many studies have found biliary microflora in 20% to 46% patients with a post-operative infection rate of 7% to 20% in those who undergo cholecystectomy for symptomatic gallstone disease. Various antibiotics are also used empirically as prophylaxis against post-operative infection. The study was conducted in order to determine the bacteriology and to test its sensitivity to commonly used antibiotics of aspirated bile samples taken during laparoscopic cholecystectomy, and to correlate it with the clinical profile recorded in patients with symptomatic cholelithiasis.Methods: A total of 266 patients who underwent laparoscopic cholecystectomy were included in the study over a two year period. Intra operatively, bile was aspirated from gall bladder and sent for culture and antibiotic sensitivity testing.Results: 14.66% (39 out of 266) patients had positive growth with Escherichia coli most commonly isolated in 9.77% (26/266) patients, followed by the Klebsiella species in 4.89% (13 out of 266) patients. All the cultures were sensitive to amikacin and meropenem, 97.44% to imipenem, and only 43.39% were sensitive to ampicillin. A statistically significant correlation was observed between a positive bile culture with the duration of symptoms (p=0.01874) and gall bladder thickness (p<0.0001). No correlation was seen between bile culture and history of acute cholecystitis, number or size of calculi.Conclusions: The results of this study can help develop local guidelines and recommendations based on Indian data to ensure the rational use of prophylactic antibiotics in patients with symptomatic cholelithiasis.

scholarly journals Non-intubated thoracoscopic lobectomies for lung cancer: an exploratory systematic review and meta-analysis

2020 ◽  
Vol 31 (4) ◽  
pp. 499-506 ◽  
Author(s):  
Elena Prisciandaro ◽  
Luca Bertolaccini ◽  
Giulia Sedda ◽  
Lorenzo Spaggiari
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Complication Rates ◽  
Thoracoscopic Lobectomy ◽  
Retrospective Cohort Studies ◽  
The Individual

Abstract Our goal was to assess the safety, feasibility and oncological outcomes of non-intubated thoracoscopic lobectomies for non-small-cell lung cancer (NSCLC). A comprehensive search was performed in EMBASE (via Ovid), MEDLINE (via PubMed) and Cochrane CENTRAL from January 2004 to March 2020. Studies comparing non-intubated anaesthesia with intubated anaesthesia for thoracoscopic lobectomy for NSCLC were included. An exploratory systematic review and a meta-analysis were performed by combining the reported outcomes of the individual studies using a random effects model. For dichotomous outcomes, risk ratios were calculated and for continuous outcomes, the mean difference was used. Three retrospective cohort studies were included, with a total of 204 patients. The comparison between non-intubated and intubated patients undergoing thoracoscopic lobectomy showed no statistically significant differences in postoperative complication rates [risk ratio 0.65, 95% confidence interval (CI) 0.36–1.16; P = 0.30; I2 = 17%], operating times (mean difference −12.40, 95% CI −28.57 to 3.77; P = 0.15; I2 = 48%), length of hospital stay (mean difference −1.13, 95% CI −2.32 to 0.05; P = 0.90; I2 = 0%) and number of dissected lymph nodes (risk ratio 0.92, 95% CI 0.78–1.25; P = 0.46; I2 = 0%). Despite the limitation of only 3 papers included, awake and intubated thoracoscopic lobectomies for resectable NSCLC seem to have comparable perioperative and postoperative outcomes. Nevertheless, the oncological implications of the non-intubated approach should be considered. The long-term benefits for patients with lung cancer need to be carefully assessed.

scholarly journals Drainage versus No Drainage after Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis

2019 ◽  
Vol 85 (1) ◽  
pp. 86-91
Author(s):  
Ming Xu ◽  
You-Liang Tao
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Randomized Clinical Trials ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Wound Infection Rate ◽  
Cochrane Library ◽  
Prophylactic Drainage ◽  
Significant Difference ◽  
The Cochrane Library

To conduct a randomized controlled trial (RCT), meta-analysis to assess the effectiveness of drains in reducing complications after laparoscopic cholecystectomy (LC) for acute cholecystitis needs to be carried out. An electronic search of PubMed, Embase, Science Citation Index, and the Cochrane Library from January 1990 to January 2018 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in LC for acute cholecystitis. The outcomes were calculated as odds ratios (ORs) with 95 per cent confidence intervals (CIs) using RevMan 5.2. Four RCTs, which included 796 patients, were identified for analysis in our study. There was no statistically significant difference in the rate of morbidities (OR = 1.23, 95% CI 0.55–2.76, P = 0.61). Abdominal pain was more severe in the drain group 24 hours after surgery (mean difference = 0.80, 95% CI 0.47–1.14; P < 0.00001). No significant difference was present with respect to wound infection rate and hospital stay. The use of abdominal drainage does not appear to be of any benefit in patients having undergone early LC for acute cholecystitis.

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