BACKGROUND: Since the widespread adoption of laparoscopic cholecystectomy (LC) in the late 1980s, a rise in common bile duct (CBD) injury has been reported. We analyzed the factors contributing to a record of zero CBD...BACKGROUND: Since the widespread adoption of laparoscopic cholecystectomy (LC) in the late 1980s, a rise in common bile duct (CBD) injury has been reported. We analyzed the factors contributing to a record of zero CBD injuries in 10 000 consecutive LCs. METHODS: The retrospective investigation included 10 000 patients who underwent LC from July 1992 to June 2007. LC was performed by 4 teams of surgeons. The chief main surgeon of each team has had over 10 years of experience in hepatobiliary surgery. Calot's triangle was carefully dissected, and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified. A clip was applied to the cystic duct at the neck of the gallbladder and the duct was incised with scissors proximal to the clip. The cystic artery was dissected by the same method. Then, the gallbladder was dissected from its liver bed. A drain was routinely left at the gallbladder bed for 1-2 days postoperatively. RESULTS: No CBD injuries occurred in 10 000 consecutive LCs, and there were 16 duct leaks (0.16%). Among these there were 10 Luschka duct leaks (0.1%) and 6 cystic duct leaks (0.06%). Four hundred thirty cases were converted to open cholecystectomy (OC), giving a conversion rate of 4.3%. After a mean follow-up of 17.5 months (range 6-24 months), no postoperative death due to LC occurred, and good results were observed in 95% of the patients. CONCLUSIONS: In our 10 000 LCs with zero CBD injuries, the techniques used and practices at our department have been successful. Surgeon's expertise in biliary surgery, preoperative imaging, precise operative procedures, and conversion from LC to OC when needed are important measures to prevent CBD injuries.展开更多
Objective:To evaluate the therapeutic effect of laparoscopic cholecystectomy(LC)and open cholecystectomy(OC)on cholelithiasis.Methods:92 cases of cholelithiasis patients admitted to the hospital in the past 2 years we...Objective:To evaluate the therapeutic effect of laparoscopic cholecystectomy(LC)and open cholecystectomy(OC)on cholelithiasis.Methods:92 cases of cholelithiasis patients admitted to the hospital in the past 2 years were selected and grouped by random number table;the observation group was treated with LC;the reference group was treated with OC,and the inflammatory factor and other indexes were compared.Results:The total effective rate of the observation group was higher than that of the reference group,and the perioperative indexes were better than that of the reference group(P<0.05).Preoperatively,the C-reactive protein(CRP)and interleukin-1β(IL-1β)levels and immune function indexes of the two groups were compared,and no difference was seen(P>0.05).At 5 days postoperatively,the CRP and IL-1βlevels of the observation group were lower than those of the reference group,and the immune function indicators were higher than those of the reference group(P<0.05).The complication rate of the observation group was lower than that of the reference group(P<0.05).Conclusion:LC can increase the effective rate of cholelithiasis patients,improve their perioperative indexes,reduce the inflammatory response,protect patients’immune function,and ensure higher surgical safety.展开更多
AIM:To investigate the comparative effect of laparoscopic and open cholecystectomy in elderly patients.METHODS:Laparoscopic cholecystectomy has induced a revolution in the treatment of gallbladder disease.Nevertheless...AIM:To investigate the comparative effect of laparoscopic and open cholecystectomy in elderly patients.METHODS:Laparoscopic cholecystectomy has induced a revolution in the treatment of gallbladder disease.Nevertheless,surgeons have been reluctant to implement the concepts of minimally invasive surgery in older patients.A systematic review of Medline was embarked on,up to June 2013.Studies which provided outcome data on patients aged 65 years or older,subjected to laparoscopic or open cholecystectomy were considered.Mortality,morbidity,cardiac and pulmonary complications were the outcome measures of treatment effect.The methodological quality of selected studies was appraised using valid assessment tools.Τhe random-effects model was applied to synthesize outcome data.RESULTS:Out of a total of 337 records,thirteen articles(2 randomized and 11 observational studies)reporting on the outcome of 101559 patients(48195in the laparoscopic and 53364 in the open treatment group,respectively)were identified.Odds ratios(OR)were constantly in favor of laparoscopic surgery,in terms of mortality(1.0%vs 4.4%,OR=0.24,95%CI:0.17-0.35,P<0.00001),morbidity(11.5%vs 21.3%,OR=0.44,95%CI:0.33-0.59,P<0.00001),cardiac(0.6%vs 1.2%,OR=0.55,95%CI:0.38-0.80,P=0.002)and respiratory complications(2.8%vs 5.0%,OR=0.55,95%CI:0.51-0.60,P<0.00001).Critical analysis of solid study data,demonstrated a trend towards improved outcomes for the laparoscopic concept,when adjusted for age and co-morbid diseases.CONCLUSION:Further high-quality evidence is necessary to draw definite conclusions,although bestavailable evidence supports the selective use of laparoscopy in this patient population.展开更多
BACKGROUND Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Cholecystectomy remains the definitive treatment of choice to prevent recurrence.The rate of early cholecystectomies during inde...BACKGROUND Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Cholecystectomy remains the definitive treatment of choice to prevent recurrence.The rate of early cholecystectomies during index admission remains low due toperceived increased risk of complications.AIMTo compare outcomes including length of stay, duration of surgery, biliarycomplications, conversion to open cholecystectomy, intra-operative, and postoperativecomplications between patients who undergo cholecystectomy duringindex admission as compared to those who undergo cholecystectomy thereafter.METHODSStatistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (randomeffects model).RESULTSInitial search identified 163 reference articles, of which 45 were selected andreviewed. Eighteen studies (n = 2651) that met the inclusion criteria were includedin this analysis. Median age of patients in the late group was 43.8 years while thatin the early group was 43.6. Pooled analysis showed late laparoscopiccholecystectomy group was associated with an increased length of stay by 88.96 h(95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled riskdifference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group.Pooled analysis showed no risk difference in intraoperative complications [riskdifference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [riskdifference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy[risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and latecholecystectomy groups. Pooled analysis showed the duration of surgery to beprolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy groupas compared to the early group.CONCLUSIONIn patients with mild gallstone pancreatitis early cholecystectomy leads to shorterhospital stay, shorter duration of surgery, while decreasing the risk of biliarycomplications. Rate of intraoperative, post-operative complications and chances ofconversion to open cholecystectomy do not significantly differ whethercholecystectomy was performed early or late.展开更多
AIM:To evaluate the feasibility,safety,and effectiveness of consecutive laparoscopic cholecystectomy(LC)plus splenectomy(LS)in liver cirrhosis patients.METHODS:From 2003 to 2013,17(group 1)patients with liver cirrhosi...AIM:To evaluate the feasibility,safety,and effectiveness of consecutive laparoscopic cholecystectomy(LC)plus splenectomy(LS)in liver cirrhosis patients.METHODS:From 2003 to 2013,17(group 1)patients with liver cirrhosis complicated by hypersplenism and symptomatic gallstones were treated with combined LC and LS,while 58(group 2)patients with liver cirrhosis and hypersplenism received LS alone.An additional 14(group 3)patients who received traditional open procedures during the same period were included as controls.Data were retrospectively collected and reviewed in regard to demographic characteristics and preoperative,intraoperative and postoperative features.Differences between the three groups were assessed by statistical analysis.RESULTS:The three groups showed no significant differences in the demographic characteristics or preoperative status.However,the patients treated with LC and LS required significantly longer operative time,shorter postoperative stay as well as shorter time of return to the first oral intake,and suffered less intraoperative blood loss as well as fewer postoperative surgical infections than the patients treated with traditional open procedures(group 1 vs group 3,P<0.05 for all).The patients treated with LC and LS showed no significant differences in the intraoperative and postoperative variables from those treated with LS alone(group 1 vs group 2).All patients showed significant improvements in the haematological responses(preoperative period vs postoperative period,P<0.05 for all).None of the patients treated with LC and LS presented with any gallstone-associated symptoms following discharge,while the patients treated with the traditional open procedures expressed complaints of discomfort related to their surgical incisions.CONCLUSION:Consecutive LC and LS is an appropriate treatment option for liver cirrhosis patients with gallstones and hypersplenism,especially for those with Child-Pugh A and B.展开更多
文摘BACKGROUND: Since the widespread adoption of laparoscopic cholecystectomy (LC) in the late 1980s, a rise in common bile duct (CBD) injury has been reported. We analyzed the factors contributing to a record of zero CBD injuries in 10 000 consecutive LCs. METHODS: The retrospective investigation included 10 000 patients who underwent LC from July 1992 to June 2007. LC was performed by 4 teams of surgeons. The chief main surgeon of each team has had over 10 years of experience in hepatobiliary surgery. Calot's triangle was carefully dissected, and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified. A clip was applied to the cystic duct at the neck of the gallbladder and the duct was incised with scissors proximal to the clip. The cystic artery was dissected by the same method. Then, the gallbladder was dissected from its liver bed. A drain was routinely left at the gallbladder bed for 1-2 days postoperatively. RESULTS: No CBD injuries occurred in 10 000 consecutive LCs, and there were 16 duct leaks (0.16%). Among these there were 10 Luschka duct leaks (0.1%) and 6 cystic duct leaks (0.06%). Four hundred thirty cases were converted to open cholecystectomy (OC), giving a conversion rate of 4.3%. After a mean follow-up of 17.5 months (range 6-24 months), no postoperative death due to LC occurred, and good results were observed in 95% of the patients. CONCLUSIONS: In our 10 000 LCs with zero CBD injuries, the techniques used and practices at our department have been successful. Surgeon's expertise in biliary surgery, preoperative imaging, precise operative procedures, and conversion from LC to OC when needed are important measures to prevent CBD injuries.
文摘Objective:To evaluate the therapeutic effect of laparoscopic cholecystectomy(LC)and open cholecystectomy(OC)on cholelithiasis.Methods:92 cases of cholelithiasis patients admitted to the hospital in the past 2 years were selected and grouped by random number table;the observation group was treated with LC;the reference group was treated with OC,and the inflammatory factor and other indexes were compared.Results:The total effective rate of the observation group was higher than that of the reference group,and the perioperative indexes were better than that of the reference group(P<0.05).Preoperatively,the C-reactive protein(CRP)and interleukin-1β(IL-1β)levels and immune function indexes of the two groups were compared,and no difference was seen(P>0.05).At 5 days postoperatively,the CRP and IL-1βlevels of the observation group were lower than those of the reference group,and the immune function indicators were higher than those of the reference group(P<0.05).The complication rate of the observation group was lower than that of the reference group(P<0.05).Conclusion:LC can increase the effective rate of cholelithiasis patients,improve their perioperative indexes,reduce the inflammatory response,protect patients’immune function,and ensure higher surgical safety.
文摘AIM:To investigate the comparative effect of laparoscopic and open cholecystectomy in elderly patients.METHODS:Laparoscopic cholecystectomy has induced a revolution in the treatment of gallbladder disease.Nevertheless,surgeons have been reluctant to implement the concepts of minimally invasive surgery in older patients.A systematic review of Medline was embarked on,up to June 2013.Studies which provided outcome data on patients aged 65 years or older,subjected to laparoscopic or open cholecystectomy were considered.Mortality,morbidity,cardiac and pulmonary complications were the outcome measures of treatment effect.The methodological quality of selected studies was appraised using valid assessment tools.Τhe random-effects model was applied to synthesize outcome data.RESULTS:Out of a total of 337 records,thirteen articles(2 randomized and 11 observational studies)reporting on the outcome of 101559 patients(48195in the laparoscopic and 53364 in the open treatment group,respectively)were identified.Odds ratios(OR)were constantly in favor of laparoscopic surgery,in terms of mortality(1.0%vs 4.4%,OR=0.24,95%CI:0.17-0.35,P<0.00001),morbidity(11.5%vs 21.3%,OR=0.44,95%CI:0.33-0.59,P<0.00001),cardiac(0.6%vs 1.2%,OR=0.55,95%CI:0.38-0.80,P=0.002)and respiratory complications(2.8%vs 5.0%,OR=0.55,95%CI:0.51-0.60,P<0.00001).Critical analysis of solid study data,demonstrated a trend towards improved outcomes for the laparoscopic concept,when adjusted for age and co-morbid diseases.CONCLUSION:Further high-quality evidence is necessary to draw definite conclusions,although bestavailable evidence supports the selective use of laparoscopy in this patient population.
文摘BACKGROUND Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Cholecystectomy remains the definitive treatment of choice to prevent recurrence.The rate of early cholecystectomies during index admission remains low due toperceived increased risk of complications.AIMTo compare outcomes including length of stay, duration of surgery, biliarycomplications, conversion to open cholecystectomy, intra-operative, and postoperativecomplications between patients who undergo cholecystectomy duringindex admission as compared to those who undergo cholecystectomy thereafter.METHODSStatistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (randomeffects model).RESULTSInitial search identified 163 reference articles, of which 45 were selected andreviewed. Eighteen studies (n = 2651) that met the inclusion criteria were includedin this analysis. Median age of patients in the late group was 43.8 years while thatin the early group was 43.6. Pooled analysis showed late laparoscopiccholecystectomy group was associated with an increased length of stay by 88.96 h(95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled riskdifference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group.Pooled analysis showed no risk difference in intraoperative complications [riskdifference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [riskdifference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy[risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and latecholecystectomy groups. Pooled analysis showed the duration of surgery to beprolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy groupas compared to the early group.CONCLUSIONIn patients with mild gallstone pancreatitis early cholecystectomy leads to shorterhospital stay, shorter duration of surgery, while decreasing the risk of biliarycomplications. Rate of intraoperative, post-operative complications and chances ofconversion to open cholecystectomy do not significantly differ whethercholecystectomy was performed early or late.
基金Supported by Grant from the West China Hospital at Sichuan University
文摘AIM:To evaluate the feasibility,safety,and effectiveness of consecutive laparoscopic cholecystectomy(LC)plus splenectomy(LS)in liver cirrhosis patients.METHODS:From 2003 to 2013,17(group 1)patients with liver cirrhosis complicated by hypersplenism and symptomatic gallstones were treated with combined LC and LS,while 58(group 2)patients with liver cirrhosis and hypersplenism received LS alone.An additional 14(group 3)patients who received traditional open procedures during the same period were included as controls.Data were retrospectively collected and reviewed in regard to demographic characteristics and preoperative,intraoperative and postoperative features.Differences between the three groups were assessed by statistical analysis.RESULTS:The three groups showed no significant differences in the demographic characteristics or preoperative status.However,the patients treated with LC and LS required significantly longer operative time,shorter postoperative stay as well as shorter time of return to the first oral intake,and suffered less intraoperative blood loss as well as fewer postoperative surgical infections than the patients treated with traditional open procedures(group 1 vs group 3,P<0.05 for all).The patients treated with LC and LS showed no significant differences in the intraoperative and postoperative variables from those treated with LS alone(group 1 vs group 2).All patients showed significant improvements in the haematological responses(preoperative period vs postoperative period,P<0.05 for all).None of the patients treated with LC and LS presented with any gallstone-associated symptoms following discharge,while the patients treated with the traditional open procedures expressed complaints of discomfort related to their surgical incisions.CONCLUSION:Consecutive LC and LS is an appropriate treatment option for liver cirrhosis patients with gallstones and hypersplenism,especially for those with Child-Pugh A and B.