scholarly journals IMPROVING THE RESULTS OF THE LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH COMPLICATED COURSE OF THE CALCULOUS CHOLECYSTITIS

2019 ◽  
Vol 72 (5) ◽  
pp. 790-794
Author(s):  
Oleg Y. Kanikovskyi ◽  
Yaroslav V. Karyi ◽  
Yura V. Babiichuk ◽  
Yevhen V. Shaprynskyi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gallstone Disease ◽  
Results Of Treatment ◽  
Bile Duct Injuries ◽  
Group I ◽  
Complicated Course ◽  
Duration Of Disease ◽  
Group Ii ◽  
Calculous Cholecystitis

Introduction: The laparoscopic cholecystectomy (LCE) has become “gold standard” in treatment of the gallstone disease (GSD). However, introduction of LCE is accompanied by increase in the frequency of the bile duct injuries by 2-5 times, and transfer to the conversion offsets main advantages of the laparoscopic access. The aim: Тo improve the results of treatment of the patients with complicated course of the calculous cholecystitis by developing new methods of the laparoscopic cholecystectomy. Materials and methods: The results of surgical treatment of 420 patients with complicated course of the calculous cholecystitis were analyzed. The patients were divided intwo groups: group I (n = 210) where the standard four-trocar LCE was used and the group II (n = 210) where the developed methods of LCE were used. The average age made up 62 ± 6.0 years. Duration of disease made up from 1 month to 35 years. Results: The patients in group I LCE with complicated course of the acute cholecystitis was performed in 108 (25.7%) cases, chronic – in 102 (24.3%) cases. The patients in group II surgical intervention with complicated course of the acute cholecystitis was performed in 112 (26.7%) cases, chronic – in 98 (23.3%) cases. The patients of group I intraoperative injuries were observed in 12 (5.7%) cases and patients of group II – in 4 (1.9%) cases. The conversion was applied in 13 (6.2%) and in 4 (1.9%) cases, respectively. 2 (0.9%) patients died. Conclusions: Introduction of the developed methods of LCE with complicated course of the calculous cholecystitis allows to reduce the frequency of intraoperative injuries by 3,8% and conversion rate – by 4,3% (p <0,001).

scholarly journals THE IMPORTANCE OF NON-INVASIVE REGIONAL BRAIN OXIMETRY IN PREVENTING POSTOPERATIVE COGNITIVE DYSFUNCTION DURING LAPAROSCOPIC CHOLECYSTECTOMY IN ELDERLY AND SENILE PATIENTS

2020 ◽  
Vol 4 ◽  
pp. 11-17
Author(s):  
Olena Bielykh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cognitive Dysfunction ◽  
Cognitive Functions ◽  
Gallstone Disease ◽  
Postoperative Cognitive Dysfunction ◽  
Test Group ◽  
Non Invasive ◽  
Regional Brain ◽  
Group I ◽  
Group Ii

The adverse effect of general anesthesia in elderly patients during surgery requires monitoring of functions and processes to identify their dangerous abnormalities to prevent complications. The aim of the study. To establish the effectiveness of non-invasive regional brain oximetry with rSO2 determination during anesthetic support in laparoscopic cholecystectomy (LCE) to prevent postoperative cognitive dysfunction in elderly and senile patients. Material and methods. 84 elderly and senile patients with diagnosed gallstone disease, acute cholecystitis, who underwent LCE with sevofluran inhalational anesthesia and total intravenous anesthesia with propofol were examined. rSO2 was monitored. Cognitive functions were assessed using neuropsychological scales and the MMSE mental state examination scale. Results. rSO2 was found to be significantly decreased during the carbon dioxide insufflation as compared to before premedication: in LH (left hemisphere) – by 7.0 %, in RH (right hemisphere) – by 6.9 % (Group I); in LH – by 7.4 %, in RH – by 7.5 % (Group II). rSO2 was significantly increased during the surgery, particularly in the middle of the operation, as compared to before premedication: in LH – by 14.66 %, in RH – by 13.94 % (Group I); in LH – by 11.60 %, in RH – by 11.53 % (Group II). The day following the surgery, cognitive functions significantly decreased by 8.7 % on the Luria's test, by 6.0 % on the MMSE test (Group I); in Group II – by 10.1 % and 6.3 %, respectively, as compared to before premedication. On Day 5 after the surgery, cognitive functions decreased by 2.7 % on the Luria's test, by 0.35 % on the MMSE test (Group I); in Group II – by 2.7 % and 0.35 %, respectively, as compared to before premedication. Conclusions. A decrease in rSO2 can occur during LCE in the Trendelenburg position, despite the fact that other intraoperative indicators remain stable, which allows it to remain unrecognized. rSO2 monitoring in the perioperative period contributes to alertness and timely measures to prevent postoperative cognitive dysfunction.

scholarly journals Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yunxiao Lyu ◽  
Ting Li ◽  
Bin Wang ◽  
Yunxiao Cheng
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Medical Costs ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Group Ii

AbstractThere is no consensus on the optimal timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute cholecystitis (AC). We retrospectively evaluated patients who underwent LC after PTGBD between 1 February 2016 and 1 February 2020. We divided patients into three groups according to the interval time between PTGBD and LC as follows: Group I (within 1 week), (Group II, 1 week to 1 month), and Group III (> 1 month) and analyzed patients’ perioperative outcomes. We enrolled 100 patients in this study (Group I, n = 22; Group II, n = 30; Group III, n = 48). We found no significant difference between the groups regarding patients’ baseline characteristics and no significant difference regarding operation time and estimated blood loss (p = 0.69, p = 0.26, respectively). The incidence of conversion to open cholecystectomy was similar in the three groups (p = 0.37), and we found no significant difference regarding postoperative complications (p = 0.987). Group I had shorter total hospital stays and medical costs (p = 0.005, p < 0.001, respectively) vs Group II and Group III. Early LC within 1 week after PTGBD is safe and effective, with comparable intraoperative outcomes, postoperative complications, and conversion rates to open cholecystectomy. Furthermore, early LC could decrease postoperative length of hospital stay and medical costs.

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.

scholarly journals Surgical treatment of patients with sagittal imbalance of degenerative etiology: a comparison of two methods

2020 ◽  
Vol 27 (3) ◽  
pp. 16-26
Author(s):  
Evgenii S. Baykov ◽  
Alexey V. Peleganchuk ◽  
Abdugafur J. Sanginov ◽  
Olga N. Leonova ◽  
Aleksandr V. Krutko
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Perioperative Complications ◽  
Sagittal Imbalance ◽  
Radiological Parameters ◽  
Results Of Treatment ◽  
Group I ◽  
Surgical Methods ◽  
Group Ii ◽  
Clinical And Radiological Results

Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine. Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later. Results. Postoperative hospitalization in group I 32.5 7.4 days, 27.1 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 55.6 minutes, in group II 526.0 116.2 minutes (p = 0.001124); blood loss 1862.5 454.3 ml versus 1096.0 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II in 13 (43.3%) patients (p = 0.001). Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.

scholarly journals Regarding operative treatment of thoracoabdominal injuries

2019 ◽  
Vol 36 (1) ◽  
pp. 14-20
Author(s):  
Dmitriy G. Amarantov ◽  
Mikhail F. Zarivchatsky ◽  
Andrey A. Kholodar ◽  
Andrey S. Nagaev ◽  
Oleg S. Gudkov
Keyword(s):  
Operative Treatment ◽  
Clinical Situation ◽  
Rational Approach ◽  
Quality Of Treatment ◽  
Results Of Treatment ◽  
Group I ◽  
Thoracoabdominal Injuries ◽  
Group Ii

Aim. To improve the results of treatment in patients with thoracoabdominal injuries (TAI) by means of creating the method of determining indications for the use of classical or endoscopic surgeries in respect of this pathology. Materials and methods. Seventy-six sufferers from TAI were divided into 2 groups. Results. The method of successive determination of indications for the use of classical or endoscopic surgeries in patients with TAI was created on the basis of treatment of 41 (53.95 %) patients of group II. This method was used to treat 35 (46.05 %) patients of group I. Conclusions. Rational approach to the choice between the use of advantages of classical and endoscopic surgeries depending on characteristics of clinical situation permitted to elevate the quality of treatment in patients with TAI.

Timing of Laparoscopic Cholecystectomy for Acute Cholecystitis: Evidence to Support a Proposal for an Early Interval Surgery

2007 ◽  
Vol 73 (11) ◽  
pp. 1188-1192 ◽  
Author(s):  
Jee K. Low ◽  
Paul Barrow ◽  
Anas Owera ◽  
Basil J. Ammori
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Operating Time ◽  
Cost Effective ◽  
Delayed Surgery ◽  
Urgent Surgery ◽  
Bile Duct Injuries ◽  
Total Hospital Stay ◽  
Interval Surgery

We evaluated the safety and feasibility of delayed urgent laparoscopic cholecystectomy (LC) performed beyond 72 hours to overcome the logistical difficulties in performing early urgent LC within 72 hours of admission with acute cholecystitis (AC), and to avoid earlier readmission with recurrent AC in patients awaiting delayed interval. Patients admitted with AC were scheduled for urgent LC. Patients who underwent early urgent LC were compared with those who had delayed urgent surgery. Fifty consecutive patients underwent urgent LC for AC within 2 weeks of admission. There were no conversions and no bile duct injuries. Delayed surgery (n = 36) neither prolonged operating time (90 vs 85 minutes), nor increased operative morbidity (9.7% vs 7.7%) or mortality (2.4% vs 7.7%) compared with early surgery (n = 14). Although delayed surgery was associated with shorter postoperative hospital stay (1 vs 2 days, P = 0.029), it prolonged total hospital stay (9 vs 5 days, P < 0.0001). Delay of LC beyond 72 hours neither increases operative difficulty nor prolongs recovery. It might be more cost effective to schedule patients who could not undergo early urgent LC but are responding to conservative treatment for an early interval LC within 2 weeks of presentation with AC.

scholarly journals The Effect of Leucocytosis, Gender Difference, and Ultrasound in the Diagnosis of Acute Cholecystitis in the Elderly Population

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Arda Demirkan ◽  
Ayça Koca Tanrıverdi ◽  
Arda Çetinkaya ◽  
Onur Polat ◽  
Müge Günalp
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Acute Cholecystitis ◽  
Blood Cells ◽  
White Blood Cells ◽  
Young Patients ◽  
The Elderly ◽  
Quadrant Pain ◽  
Group I ◽  
Group Ii

Introduction. Acute cholecystitis is one of the most common reasons of acute abdominal pain for older patients to present to the emergency department (ED). Presentation may differ from that of the younger patient and is often complicated by coexistent disease due to elderliness. In this study, we aimed to evaluate the clinical presentation of acute cholecystitis, with special focus on comparision between elderly and young patients. Materials and Methods. This study included 318 patients who were admitted to the emergency department with right upper quadrant pain during a period of determined 8 months. After retrospective data collection, patients were groupped in accordance with their age, <65 and ≥65 years. Those who had ultrasonographic signs such as wall thickening and fluid collection were diagnosed as acute cholecystitis. Results. The young group (Group I) consisted of 225 patients, 132 females and 93 males. In Group I, 39 patients were diagnosed as acute cholecystitis of whom 27 were females and 15 were males. The elderly group (Group II) consisted of 93 patients 48 females and 45 males. In Group II, 36 patients were diagnosed as acute cholecystitis of whom 15 were females and 21 were males. Regarding the diagnosis of acute cholecystitis, the female to male ratio is 2.25 in Group I and 0.71 in Group II (p=0.016). The average white blood cells counts of patients with acute cholecystitis in Group I and in Group II were 9907x109/L(±4.437) and 17083x109/L(±7485), respectively (p<0,001). Conclusions. Acute cholecystitis is a common diagnosis in elderly patients with right upper quadrant pain. It is more frequent in female in the early ages, but the gender difference tends to change with age. Elderly patients demonstrate a higher level of white blood cells when compared to young patients in acute cholecystitis. Clinicians must maintain a degree of awareness in the evaluation of geriatric patients with right upper quadrant abdominal pain.

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 The role of external osteosynthesis in treatment of unstable pelvic osseous injuries

2019 ◽  
Vol 86 (5) ◽  
pp. 48-53
Author(s):  
N. L. Аnkin ◽  
L. N. Аnkin ◽  
T. M. Petryk ◽  
V. А. Ladyka
Keyword(s):  
External Fixation ◽  
Pelvic Ring ◽  
Fixation Method ◽  
Group Iii ◽  
Results Of Treatment ◽  
Pelvic Injuries ◽  
Group I ◽  
Joint Revision ◽  
Effect Of Treatment ◽  
Group Ii

Objective. To specify the role and indications for application of аpparatus of external fixation (АEF) in treatment of unstable pelvic osseous injuries (UPOI); to study up the advantages and faults of the external fixation method; to share the experience of treatment, using this procedure. Маterials and methods. There were 229 patients, suffering pelvic injuries, examined on the base of orthopedic-traumatological centre of Kyiv’s Regional Clinical Hospital in 2005 - 2017 yrs and distributed into three Groups. In Group I 143 (62.4%) injured persons were included, in whom external osteosynthesis played the function of temporary measures of fixation, in Group II - 27 (11.8%) patients, in whom while hospitalization a fracture was fixed, using AEF, аnd after stabilization of the state the posterior pelvis osteosynthesis and reposition was conducted, in Group III - 59 (25.8%) patients, who, using several indications, were definitely treated, applying the external fixation method only. Results. Excellent effect of treatment in Group I was registered in 23 (19.0%), a good one - in 58 (47.9%), satisfactory - in 32 (26.4%), poor - in 8 (6.6%) of 121 patients; in Group II - accordingly, - in 5 (20.8%), 11 (45.8%), 7 (29.2%) and 1 (4.2%) of 24 patients; in Group III - accordingly, in 4 (8.3%), 12 (25%), 23 (47.9%) and 9 (18.6%) of 48 patients. Conclusion. Best results of treatment of patients with unstable pelvic osseous injuries were obtained while applying the tactics of change from external fixation into internal one. On the first stage the pelvic ring fixation, using AEF, was performed, аnd after stabilization of a patient general status - internal osteosynthesis. Application of the internal osteosynthesis method permits to control and stabilize the reposition achieved, to conduct the sacro-ileal joint revision.

scholarly journals INFLUENCE OF PHYSICAL REHABILITATION ON QUALITY OF LIFE AFTER RENAL TRANSPLANTATION

2015 ◽  
Vol 69 (3-4) ◽  
pp. 65-70 ◽  
Author(s):  
T. Y. Zhirnova ◽  
E. E. Аchkasov ◽  
O. M. Tsirulnikova ◽  
E. M. Shilov ◽  
O. B. Dobrovolskiy
Keyword(s):  
Quality Of Life ◽  
Kidney Transplantation ◽  
Organ Transplant ◽  
Rehabilitation Program ◽  
Physical Rehabilitation ◽  
Group Iii ◽  
Results Of Treatment ◽  
Group I ◽  
Group Ii

Background: Aim of this study was to evaluate the role of physical rehabilitation to improve the quality of life (QOL) of people after kidney transplantation. Patients and methods: Analyzes the results of treatment of 57 recipients (mean age 35±9,65 years) donor kidney at different times of the postoperative period. Depending on the physical rehabilitation program allocated 3 groups of patients: group II — physical rehabilitation was carried out only in the first week after surgery to prevent early postoperative complications, in group I — during the year; in group III combined 30 relatively healthy people do not need an organ transplant and with a mean age 33,7±8,7 years, leading a normal life, not engaged in regular recreational physical culture. Quality of life was assessed using a questionnaire SF36 at 1, 3, 6 and a 12 months after surgery. Results: One year after surgery in both groups compared with preoperative indicators marked improvement according to all scales of the questionnaire. However, in group I indicators of quality of life were higher than in group II from 11,4 to 19,7%, and even some items questionnaire SF-36 is higher than in group III which is associated with the physical rehabilitation. Conclusion: It has been shown that exercises is an important component of treatment and rehabilitation after kidney transplantation and help improve both the psychological and the physical component of quality of life.

Sign in / Sign up

Export Citation Format

Share Document