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: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall bladder disease. However, there still a substantial proportion of patients in whom Laparoscopic cholecystectomy cannot be...Background: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall bladder disease. However, there still a substantial proportion of patients in whom Laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. Method: In this study, 1600 laparoscopic cholecystectomy performed at Al karamah teaching hospital from January 2010 to January 2015, were prospectively analyzed. The patients studied included 1600, 1245 where females (78.4%) and 346 where males (21.6%) with a mean age of 41.2 years. From the data collected, only factors available to surgeon preoperatively were considered for analysis. These factors included: age, gender, history of acute Cholecystitis, jaundice, previous abdominal surgery, obesity and concomitant disease, ultrasound preoperatively & ERCP. Results: Of the 1600 patients in whom Laparoscopic cholecystectomy was attempted 56 patients (3.5%) required conversion to open surgery. The most common reason for conversion was difficult to define anatomy in patients with inflamed, contracted gall bladder (n = 42). Significant predictor factors for conversion were male gender, previous abdominal surgery, acute Cholecystitis, and obesity. Conclusion: An appreciation for these predictors for conversion will allow appropriate planning by the patient, the institution and the surgeon.展开更多
Purpose: To compare the short-term efficacy and side effects of betaxolol and timoloi in treatment of primary open angle glaucoma or ocular hypertension. Methods: Fourteen patients with newly diagnosed early primary o...Purpose: To compare the short-term efficacy and side effects of betaxolol and timoloi in treatment of primary open angle glaucoma or ocular hypertension. Methods: Fourteen patients with newly diagnosed early primary open angle glaucoma or ocular hypertension were included.Each patient received 0.5% timoloi and 0.5% betaxolol twice daily for four weeks in two phases. Between two courses of treatment there was four weeks wash out period. At the end of study the effect of these two drugs on intraocular pressure, mean arterial blood pressure,pulse rate,basic tear secretion and ocular symptoms were evaluated and statistically analyzed,using wilcoxon and chi-squar test.RESULTS:The study was performed on fourteen patients with baseline IOP of 26.7 ±1.5 mmHg.After four weeks treatmem,timoiol and betax-olol reduced IOP by 7.8±1.2mmHg or 29% and 6.1±1.3mmHg or 23%, respectively (P<0.001). The difference between two groups was significant(P<0.001). Mean arterial blood pressure was reduced with betaxolol and展开更多
AIM:To present and integrate findings of studies investigating the effects of laparoscopic cholecystectomy on various aspects of lung function.METHODS:We extensively reviewed literature of the past 24 years concerning...AIM:To present and integrate findings of studies investigating the effects of laparoscopic cholecystectomy on various aspects of lung function.METHODS:We extensively reviewed literature of the past 24 years concerning the effects of laparoscopic cholecystectomy in comparison to the open procedure on many aspects of lung function including spirometricvalues,arterial blood gases,respiratory muscle performance and aspects of breathing control,by critically analyzing physiopathologic interpretations and clinically important conclusions.A total of thirty-four articles were used to extract information for the meta-analysis concerning the impact of the laparoscopic procedure on lung function and respiratory physiopathology.The quality of the literature reviewed was evaluated by the number of their citations and the total impact factor of the corresponding journals.A fixed and random effect meta-analysis was used to estimate the pooled standardized mean difference of studied parameters for laparoscopic(LC)and open(OC)procedures.A crude comparison of the two methods using all available information was performed testing the postoperative values expressed as percentages of the preoperative ones using the Mann-Whitney two-sample test.RESULTS:Most of the relevant studies have investigated and compared changes in spirometric parameters.The median percentage and interquartile range(IQR)of preoperative values in forced vital capacity(FVC),forced expiratory volume in 1 s and forced expiratory flow(FEF)at 25%-75%of FVC(FEF25%-75%)expressed as percentage of their preoperative values 24 h after LC and OC were respectively as follows:[77.6(73.0,80.0)L vs 55.4(50.0,64.0)L,P<0.001;76.0(72.3,81.0)L vs 52.5(50.0,56.7)L,P<0.001;and 78.8(68.8,80.9)L/s vs 60.0(36.1,66.1)L/s,P=0.005].Concerning arterial blood gases,partial pressure of oxygen[Pa O2(k Pa)]at 24 or 48 h after surgical treatment showed reductions that were significantly greater in OC compared with LC[LC median 1.0,IQR(0.6,1.3);OC median 2.4,IQR(1.2,2.6),P=0.019].Fewer studies have investigated the effect of LC on respiratory muscle performance showing less impact of this surgical method on maximal respiratory pressures(P<0.01);and changes in the control of breathing after LC evidenced by increase in mean inspiratory impedance(P<0.001)and minimal reduction of duty cycle(P=0.01)compared with preoperative data.CONCLUSION:Laparoscopic cholecystectomy seems to be associated with less postoperative derangement of lung function compared to the open procedure.展开更多
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
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
BACKGROUND The management of gallbladder perforation(GBP)with fistulous communication(Neimeier type I)is controversial.AIM To recommend management options for GBP with fistulous communication.METHODS A systematic revi...BACKGROUND The management of gallbladder perforation(GBP)with fistulous communication(Neimeier type I)is controversial.AIM To recommend management options for GBP with fistulous communication.METHODS A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines.The search strategy was conducted in Scopus,Web of Science,MEDLINE,and EMBASE(May 2022).Data extraction was obtained for patient characteristics,type of intervention,days of hospitalization(DoH),complications,and site of fistulous communication.RESULTS A total of 54 patients(61%female)from case reports,series,and cohorts were included.The most frequent fistulous communication occurred in the abdominal wall.Patients from case reports/series had a similar proportion of complications between open cholecystectomy(OC)and laparoscopic cholecystectomy(LC)(28.6 vs 12.5;P=0.569).Mortality was higher in OC(14.3 vs 0.0;P=0.467)but this proportion was given by only one patient.DoH were higher in OC(mean 26.3 d vs 6.6 d).There was no clear association between higher rates of complications of a given intervention in cohorts,and no mortality was observed.CONCLUSION Surgeons must evaluate the advantages and disadvantages of the therapeutic options.OC and LC are adequate options for the surgical management of GBP,with no significant differences.展开更多
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: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall bladder disease. However, there still a substantial proportion of patients in whom Laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. Method: In this study, 1600 laparoscopic cholecystectomy performed at Al karamah teaching hospital from January 2010 to January 2015, were prospectively analyzed. The patients studied included 1600, 1245 where females (78.4%) and 346 where males (21.6%) with a mean age of 41.2 years. From the data collected, only factors available to surgeon preoperatively were considered for analysis. These factors included: age, gender, history of acute Cholecystitis, jaundice, previous abdominal surgery, obesity and concomitant disease, ultrasound preoperatively & ERCP. Results: Of the 1600 patients in whom Laparoscopic cholecystectomy was attempted 56 patients (3.5%) required conversion to open surgery. The most common reason for conversion was difficult to define anatomy in patients with inflamed, contracted gall bladder (n = 42). Significant predictor factors for conversion were male gender, previous abdominal surgery, acute Cholecystitis, and obesity. Conclusion: An appreciation for these predictors for conversion will allow appropriate planning by the patient, the institution and the surgeon.
文摘Purpose: To compare the short-term efficacy and side effects of betaxolol and timoloi in treatment of primary open angle glaucoma or ocular hypertension. Methods: Fourteen patients with newly diagnosed early primary open angle glaucoma or ocular hypertension were included.Each patient received 0.5% timoloi and 0.5% betaxolol twice daily for four weeks in two phases. Between two courses of treatment there was four weeks wash out period. At the end of study the effect of these two drugs on intraocular pressure, mean arterial blood pressure,pulse rate,basic tear secretion and ocular symptoms were evaluated and statistically analyzed,using wilcoxon and chi-squar test.RESULTS:The study was performed on fourteen patients with baseline IOP of 26.7 ±1.5 mmHg.After four weeks treatmem,timoiol and betax-olol reduced IOP by 7.8±1.2mmHg or 29% and 6.1±1.3mmHg or 23%, respectively (P<0.001). The difference between two groups was significant(P<0.001). Mean arterial blood pressure was reduced with betaxolol and
文摘AIM:To present and integrate findings of studies investigating the effects of laparoscopic cholecystectomy on various aspects of lung function.METHODS:We extensively reviewed literature of the past 24 years concerning the effects of laparoscopic cholecystectomy in comparison to the open procedure on many aspects of lung function including spirometricvalues,arterial blood gases,respiratory muscle performance and aspects of breathing control,by critically analyzing physiopathologic interpretations and clinically important conclusions.A total of thirty-four articles were used to extract information for the meta-analysis concerning the impact of the laparoscopic procedure on lung function and respiratory physiopathology.The quality of the literature reviewed was evaluated by the number of their citations and the total impact factor of the corresponding journals.A fixed and random effect meta-analysis was used to estimate the pooled standardized mean difference of studied parameters for laparoscopic(LC)and open(OC)procedures.A crude comparison of the two methods using all available information was performed testing the postoperative values expressed as percentages of the preoperative ones using the Mann-Whitney two-sample test.RESULTS:Most of the relevant studies have investigated and compared changes in spirometric parameters.The median percentage and interquartile range(IQR)of preoperative values in forced vital capacity(FVC),forced expiratory volume in 1 s and forced expiratory flow(FEF)at 25%-75%of FVC(FEF25%-75%)expressed as percentage of their preoperative values 24 h after LC and OC were respectively as follows:[77.6(73.0,80.0)L vs 55.4(50.0,64.0)L,P<0.001;76.0(72.3,81.0)L vs 52.5(50.0,56.7)L,P<0.001;and 78.8(68.8,80.9)L/s vs 60.0(36.1,66.1)L/s,P=0.005].Concerning arterial blood gases,partial pressure of oxygen[Pa O2(k Pa)]at 24 or 48 h after surgical treatment showed reductions that were significantly greater in OC compared with LC[LC median 1.0,IQR(0.6,1.3);OC median 2.4,IQR(1.2,2.6),P=0.019].Fewer studies have investigated the effect of LC on respiratory muscle performance showing less impact of this surgical method on maximal respiratory pressures(P<0.01);and changes in the control of breathing after LC evidenced by increase in mean inspiratory impedance(P<0.001)and minimal reduction of duty cycle(P=0.01)compared with preoperative data.CONCLUSION:Laparoscopic cholecystectomy seems to be associated with less postoperative derangement of lung function compared to the open procedure.
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.
文摘BACKGROUND The management of gallbladder perforation(GBP)with fistulous communication(Neimeier type I)is controversial.AIM To recommend management options for GBP with fistulous communication.METHODS A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines.The search strategy was conducted in Scopus,Web of Science,MEDLINE,and EMBASE(May 2022).Data extraction was obtained for patient characteristics,type of intervention,days of hospitalization(DoH),complications,and site of fistulous communication.RESULTS A total of 54 patients(61%female)from case reports,series,and cohorts were included.The most frequent fistulous communication occurred in the abdominal wall.Patients from case reports/series had a similar proportion of complications between open cholecystectomy(OC)and laparoscopic cholecystectomy(LC)(28.6 vs 12.5;P=0.569).Mortality was higher in OC(14.3 vs 0.0;P=0.467)but this proportion was given by only one patient.DoH were higher in OC(mean 26.3 d vs 6.6 d).There was no clear association between higher rates of complications of a given intervention in cohorts,and no mortality was observed.CONCLUSION Surgeons must evaluate the advantages and disadvantages of the therapeutic options.OC and LC are adequate options for the surgical management of GBP,with no significant differences.
