Bile spillage should be avoided in elective cholecystectomy

SummaryTen patients for elective cholecystectomy were studied pre-, per- and postoperatively. All had neurolept anesthesia. Plasma concentrations of β-TG, TXB2 and 5-HT and intraplatelet 5-HT were measured. Aggregation to ADP was recorded.Serum cortisol concentration was used as index of the stress response, showing peroperative increase and postoperative decrease. Closely related to this we observed a significant increase in P-β-TG and P-TXB2 with postoperative normalization in 6 patients without complications. P-5-HT had a peak peropera-tively and remained elevated postoperatively. A negative correlation between P--5-HT and decreasing intraplatelet 5-HT postoperatively was observed.High postoperative levels of P--5-HT seem to be related to low arterial Po2 and pulmonary dysfunction. In 3 patients with complications a second increase in P-β-TG, P-TXB2 and partly in P--5-HT was found. Platelets were temporarily refractory to ADP immediately following surgery and showed increased aggregabil-ity postoperatively. We conclude that platelets are activated in surgical stress.

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Left-sided sinistroposition of the gall bladder: incidental presentation during elective cholecystectomy

BMJ Case Reports ◽

10.1136/bcr-2017-222837 ◽

2017 ◽

pp. bcr-2017-222837

Author(s):

Nilesh H Doctor ◽

Vijay Waman Dhakre

Keyword(s):

Gall Bladder ◽

Elective Cholecystectomy

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Biliary Disease: Calculous and Acalculous Cholecystitis

10.2310/gastro.8325 ◽

2020 ◽

Author(s):

Kimberly A Davis ◽

Lucy Ruangvoravat

Keyword(s):

United States ◽

Critically Ill Patients ◽

Acalculous Cholecystitis ◽

The United States ◽

Biliary Disease ◽

Significant Morbidity ◽

Emphysematous Cholecystitis ◽

Secondary Insult ◽

Hemodynamic Compromise ◽

Elective Cholecystectomy

Cholelithiasis is extremely common in the United States, affecting approximately 10 to 15% of the population. The vast majority of patients remain asymptomatic. Elective cholecystectomy for symptomatic cholelithiasis is a well-established procedure with excellent outcomes. The diagnosis in critically ill patients may not be straightforward. Inflammation and infection of the gallbladder can lead to significant morbidity and mortality. Whether the gallbladder is the primary etiology of hemodynamic compromise (as in emphysematous or gangrenous cholecystitis) or is the victim of secondary insult (as in ischemia-related acalculous cholecystitis), the intensivist must consider cholecystitis in the differential of clinical deterioration. This review contains 6 figures, 5 tables, and 59 references. Key words: acalculous, biliary disease, cholangitis, cholecystitis, emphysematous cholecystitis

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Routine Bile Cultures During Elective Cholecystectomy

Southern Medical Journal ◽

10.1097/00007611-198811000-00006 ◽

1988 ◽

Vol 81 (11) ◽

pp. 1358-1360 ◽

Cited By ~ 4

Author(s):

DAVID L ◽

MAJ E. DAVID

Keyword(s):

Elective Cholecystectomy

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Mo1575 Cost-Effectiveness of Elective Cholecystectomy vs. Observation in Older Patients Presenting With Mild Biliary Disease

Gastroenterology ◽

10.1016/s0016-5085(14)63853-1 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-1056

Author(s):

Abhishek Parmar ◽

Mark Coutin ◽

Gabriela Vargas ◽

Nina Tamirisa ◽

Kristin Sheffield ◽

...

Keyword(s):

Cost Effectiveness ◽

Older Patients ◽

Biliary Disease ◽

Elective Cholecystectomy

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Use of Blood Products During Elective Cholecystectomy

Southern Medical Journal ◽

10.1097/00007611-198107000-00005 ◽

1981 ◽

Vol 74 (7) ◽

pp. 785-788 ◽

Cited By ~ 1

Author(s):

WILLIAM E. PARKS ◽

MARTIN H. MAX

Keyword(s):

Blood Products ◽

Elective Cholecystectomy

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Outcome analysis of low pressure versus high pressure pneumoperitoneum laparoscopic cholecystectomy: a randomized clinical study

International Surgery Journal ◽

10.18203/2349-2902.isj20174898 ◽

2017 ◽

Vol 4 (11) ◽

pp. 3740

Author(s):

Salil Mahajan ◽

Manu Shankar ◽

Vinod K. Garg ◽

Vijender Gupta ◽

Jaya Sorout

Keyword(s):

High Pressure ◽

Laparoscopic Cholecystectomy ◽

Shoulder Pain ◽

Postoperative Period ◽

Low Pressure ◽

Randomized Clinical Study ◽

Early Return ◽

Significant Difference ◽

Duration Of Surgery ◽

Bile Spillage

Background: Laparoscopic cholecystectomy is established as gold standard for management of cholelithiasis. Intraoperative pneumoperitoneum affects the postoperative outcomes. The current stress is on increasing patient safety. Hence, this prospective study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10 mm Hg) versus high pressure pneumoperitoneum (HPP > 14 mm Hg) on postoperative pain and ileus.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14 mm Hg) group (n=60). Total duration of surgery, intra-operative gas consumption, occurrence of bile spillage during operation, shoulder pain and abdominal pain in postoperative period, additional requirement of analgesia in postoperative period and postoperative ileus were assessed.Results: There was no significant difference in terms of operative duration, consumption of CO2 gas, intraoperative bile spillage, total hospital stay and tolerance to early feeding. The incidence of shoulder pain was higher in patients who underwent HPP laparoscopic cholecystectomy (p<0.05). There was early recovery and early return of bowel activity in LPP which was statistically significant.Conclusions: Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative shoulder tip pain and near-equal operative time with early return of bowel activity compared with high-pressure pneumoperitoneum.

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