scholarly journals Leukocytosis can predict the increased risk of conversion in elective laparoscopic cholecystectomy

2017 ◽  
Author(s):  
Uğur Ekici
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Increased Risk ◽  
Elective Laparoscopic Cholecystectomy

scholarly journals Laparoscopic Cholecystectomy in Cirrhotic Patient

HPB Surgery ◽  
1996 ◽  
Vol 10 (2) ◽  
pp. 79-82 ◽  
Author(s):  
Jean Gugenheim ◽  
Marco Casaccia ◽  
Davide Mazza ◽  
James Toouli ◽  
Vanna Laura ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Laparoscopic Cholecystectomy ◽  
Portal Hypertension ◽  
Blood Transfusion ◽  
Absolute Contraindication ◽  
Median Hospital Stay ◽  
Increased Risk ◽  
Cirrhotic Patients ◽  
Elective Laparoscopic Cholecystectomy ◽  
Median Hospital

Cholecystectomy is associated with increased risk in patients with liver cirrhosis. Moreover, cirrhosis and portal hypertension have been considered relative or absolute contraindication to laparoscopic cholecystectomy. As experience with laparoscopic cholecystectomy increased, we decided to treat cirrhotic patients via this approach. Between January 1994 and April 1995, nine patients with a Child-Pugh's stage A cirrhosis underwent elective laparoscopic cholecystectomy with intraoperative cholangiography. There was no significant per- or post-operative bleeding and no blood transfusion was necessary. There was no mortality and very low morbidity. Median hospital stay was 3 days. This series suggests that wellcompensated cirrhosis can not be considered a contraindication to laparoscopic cholecystectomy.

scholarly journals Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy

2022 ◽  
Author(s):  
James Lucocq ◽  
John Scollay ◽  
Pradeep Patil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Adverse Outcomes ◽  
Clinical Indication ◽  
Biliary Colic ◽  
Surgical Decision ◽  
Operative Outcomes ◽  
Increased Risk ◽  
Difficult Cholecystectomy ◽  
Elective Laparoscopic Cholecystectomy ◽  
Surgical Decision Making

Abstract Introduction Patients undergoing elective laparoscopic cholecystectomy (ELLC) represent a heterogeneous group making it challenging to stratify risk. The aim of this paper is to identify pre-operative factors associated with adverse peri- and post-operative outcomes in patients undergoing ELLC. This knowledge will help stratify risk, guide surgical decision making and better inform the consent process. Methods All patients who underwent ELLC between January 2015 and December 2019 were included in the study. Pre-operative data and both peri- and post-operative outcomes were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were divided into groups based on clinical indication (i.e. biliary colic versus cholecystitis) and adverse outcomes were compared. Multivariate regression models were generated for each adverse outcome using pre-operative independent variables. Results Two-thousand one hundred and sixty-six ELLC were identified. Rates of peri- and post-operative adverse outcomes were significantly higher in the cholecystitis versus biliary colic group and increased with number of admissions of cholecystitis (p < 0.05). Rates of subtotal (29.5%), intra-operative complication (9.8%), post-operative complications (19.6%), prolonged post-operative stay (45.9%) and re-admission (16.4%) were significant in the group of patients with ≥ 2 admissions with cholecystitis. Conclusion Our data demonstrate that patients with repeated biliary admission (particularly cholecystitis) ultimately face an increased risk of a difficult ELLC with associated complications, prolonged post-operative stay and readmissions. These data provide robust evidence that individualised risk assessment and consent are necessary before ELLC. Strategies to minimise recurrent biliary admissions prior to LC should be implemented.

scholarly journals SP6.1.5 Morbidity following emergency and elective laparoscopic cholecystectomy for cholecystitis: a retrospective comparative cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
James Lucocq ◽  
Ganesh Radhakishnan ◽  
John Scollay ◽  
Pradeep Patil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Elective Surgery ◽  
Multivariate Regression Analysis ◽  
Operative Outcomes ◽  
Increased Risk ◽  
Biliary Pathology ◽  
Elective Laparoscopic Cholecystectomy ◽  
The Difference ◽  
Current Guidance ◽  
Emergency Cholecystectomy

Abstract Aims A comprehensive comparison of post-operative outcomes between emergency and elective laparoscopic cholecystectomy (LC) for cholecystitis has not been conducted and the relative morbidity associated with emergency LC remains uncertain. Our aim was to evaluate the difference in early post-operative outcomes between emergency and elective LC for patients with cholecystitis. Method LC performed for cholecystitis across three surgical units between January 2015 and January 2020 were analysed retrospectively from multiple regional databases using deterministic records-linkage methodology. Rates of complications, further imaging, re-intervention, prolonged post-operative stay and re-admissions over a 100-day follow-up period were compared between emergency and elective groups using univariate and multivariate analysis. Results LC were performed for cholecysitits in 962 cases (median age, 52 years; M:F, 1:2.7; emergency:elective; 1:3.9). Emergency cholecystectomy had higher rates of complication (15.8% versus 8.8%;p&lt;0.0001), prolonged post-operative stay (40.3% vs. 12.7%;p&lt;0.0001), post-operative imaging and intervention (19.1% vs. 9.4%;p&lt;0.0001) and readmission (11.1% vs. 7.0%;p=0.017). In the multivariate regression analysis, emergency LC was associated with prolonged admission (OR,5.7;p&lt;0.0001), complication (OR,2.97;p&lt;0.0001), post-operative imaging and intervention (OR,2.4;p=0.002) and readmission (OR,1.9; p = 0.06). Conclusions Despite current guidance, an emergency cholecystectomy remains a morbid procedure and we demonstrate increased risks of emergency LC versus elective LC. The increased risk of an emergency LC needs to be weighed up against the risk of further attacks from biliary pathology until elective surgery. Our data indicates that we need to readjust our selection criteria for the ‘emergency cholecystectomy patient’ and identify patients who will specifically benefit from earlier surgery.

scholarly journals P17 An audit of Trakcare discharge times for Laparoscopic Cholecystectomy

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jacob Rapier ◽  
Steven Hornby ◽  
Jacob Rapier
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Initial Data ◽  
Best Practice ◽  
Average Length ◽  
Accurate Data ◽  
Day Case ◽  
Average Length Of Stay ◽  
Number Of Patients ◽  
Elective Laparoscopic Cholecystectomy

Abstract Introduction Nationally 61,220 Laparoscopic Cholecystectomies are carried out annually. Those carried out as day-cases reduce providers’ costs and increase income through the best practice tariff. The system in our trust to record discharges is ‘Trakcare’. The aim of this audit was to accurately measure the discharge times of patients undergoing elective Laparoscopic Cholecystectomies, to try and reduce the number of patients recorded as having an overnight stay by accurate data collection. Methods Initial data was collected for all elective Laparoscopic Cholecystectomy discharge times on Trakcare, over a 1 month period. This data was then re-audited prospectively both from Trakcare and discharges reported by nurses/patients. A comparison was then made of Trakcare against reported discharge times. Results Initially 54 operations were recorded, with 30 completed as day cases (55.6%). The re-audited data (on Trakcare) recorded 47 operations, with 15 completed as day cases (37.91%). Of these discharges we were able to capture 26 (55.32%) manually, and 11 were completed as day cases (42.31%). Measuring these 26 with the same operations on Trakcare we were unable to show a difference in the number of cases completed as a day case (11 vs 11), with only a 33 minute decrease in the average length of stay. Conclusion Trakcare is a reliable tool for measuring the date of discharge for patients. The recommendations in are: scheduling surgery for a time pre-13:00 shows a higher proportion of patients discharged the same day, and continue to use Trakcare to record discharge times.

scholarly journals Are complications of endoscopic sphincterotomy age related?

Gut ◽  
1997 ◽  
Vol 41 (4) ◽  
pp. 545-548 ◽  
Author(s):  
G T Deans ◽  
P Sedman ◽  
D F Martin ◽  
C M S Royston ◽  
C K Leow ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Endoscopic Sphincterotomy ◽  
Short Term ◽  
Endoscopic Retrograde ◽  
Younger Patients ◽  
Age Related ◽  
Increased Risk ◽  
Ascending Cholangitis ◽  
Retroperitoneal Perforation ◽  
The Common

Background—Endoscopic retrograde cholangiopancreatography sphincterotomy is increasingly performed in younger patients undergoing laparoscopic cholecystectomy. However, the safety of endo- scopic sphincterotomy in this age group, relative to that in older patients, is unknown.Aim—To determine whether the development of short term complications following endoscopic sphincterotomy is age related.Patients and methods—A prospective multicentre audit of 958 patients (mean age 73, range 14–97, years) undergoing a total of 1000 endoscopic sphincterotomies.Results—Two deaths occurred, both from postsphincterotomy acute pancreatitis. Postprocedural complications developed in 24 patients: pancreatitis in 10, ascending cholangitis in seven, bleeding in four, and retroperitoneal perforation in three. There were six complications (five cases of pancreatitis and one bleed; 2.2%) and no deaths in the 281 (29.3%) patients aged under 65 years. In comparison, 18 (2.6%) of the 677 patients aged over 65 years developed a complication (cholangitis in seven, pancreatitis in five, bleeding in three, and perforation in three). Patients under 35, 45, 55, and 65 years were not at significantly increased risk of complication than those over these ages (relative risk for those under compared with those over 65 years 0.83, 95% confidence intervals 0.41–1.67, p=0.74).Conclusion—Short term complications following endoscopic sphincterotomy are not related to age. Younger patients undergoing laparoscopic cholecystectomy need not be denied endoscopic sphincterotomy for fear that the risks are greater than if they undergo surgical exploration of the common bile duct.

Moy.02Using aboutmyop.org as an alternative method for post-operative follow-up after elective laparoscopic cholecystectomy – a feasibility study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Prita Daliya ◽  
Jody Carvell ◽  
Judith Rozentals ◽  
Maria Ubhi ◽  
Dileep Lobo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Feasibility Study ◽  
Controlled Trial ◽  
Digital Data ◽  
National Guidelines ◽  
Patient Acceptability ◽  
Safe Alternative ◽  
Operative Care ◽  
Elective Laparoscopic Cholecystectomy

Abstract Introduction The majority of institutions no longer offer routine post-operative follow-up after elective laparoscopic cholecystectomy. National guidelines however recommend the use of post-operative hotlines or planned telephone follow-up for day-case procedures. At a time when NHS resources are limited, a digital solution may provide a safe alternative to telephone or physical follow-up. Our aim was to identify if digital follow-up with aboutmyop.org; a digital data-sharing platform, was equivalent to telephone follow-up. Method Study participants were invited to use aboutmyop.org before and after surgery. Patients were given free choice on whether they opted to use post-operative digital follow-up or routine post-operative care (no follow-up or telephone follow-up). In addition to follow-up compliance, the outcomes measured included 30-day post-operative complications, readmission, and re-operation. Results Of 597 laparoscopic cholecystectomy patients who were offered follow-up, 16.4% opted for digital follow-up, and 33.3% phone follow-up. Over 5 times as many patients who opted for telephone follow-up missed their appointment when compared to those who chose digital follow-up (5.6% vs. 30.9%, p &lt; 0.001). Digital follow-up had a high sensitivity (68.2%-100%) and specificity (100%) for identifying complications at 30-days post-operatively and was completed significantly earlier than phone follow-up (median 6 days vs. 13.5 days, p = 0.001) with high patient acceptability. Conclusion This feasibility study demonstrates that digital follow-up utilising the aboutmyop.org platform is an acceptable alternative modality to telephone follow-up in elective laparoscopic cholecystectomy patients. Future work should aim to compare matched cohorts of patients undergoing digital follow-up, telephone follow-up, and no follow-up as a randomised controlled trial.

scholarly journals The Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Abdominal Surgery

HPB Surgery ◽  
1998 ◽  
Vol 10 (6) ◽  
pp. 353-356 ◽  
Author(s):  
J. Diez ◽  
R. Delbene ◽  
A. Ferreres
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Marlex Mesh ◽  
Previous Surgery ◽  
Open Laparoscopy ◽  
Previous Abdominal Surgery ◽  
Abdominal Organs ◽  
Abdominal Operations ◽  
Elective Laparoscopic Cholecystectomy ◽  
Verres Needle

A retrospective study was carried in 1500 patients submitted to elective laparoscopic cholecystectomy to ascertain its feasibility in patients with previous abdominal surgery. In 411 patients (27.4%) previous infraumbilical intraperitoneal surgery had been performed, and 106 of them (7.06%) had 2 or more operations. Twenty five patients (1.66%) had previous supraumbilical intraperitoneal operations (colonic resection, hydatid liver cysts, gastrectomies, etc.) One of them had been operated 3 times. In this group of 25 patients the first trocar and pneumoperitoneum were performed by open laparoscopy. In 2 patients a Marlex mesh was present from previous surgery for supraumbilical hernias. Previous infraumbilical intraperitoneal surgery did not interfere with laparoscopic cholecystectomy, even in patients with several operations. There was no morbidity from Verres needle or trocars. In the 25 patients with supraumbilical intraperitoneal operations, laparoscopic cholecystectomy was completed in 22. In 3, adhesions prevented the visualization of the gallbladder and these patients were converted to an open procedure. In the 2 patients Marlex mesh prevented laparoscopic cholecystectomy because of adhesions to abdominal organs. We conclude that in most instances previous abdominal operations are no contraindication to laparoscopic cholecystectomy.

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