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      CURRENT TRENDS IN LAPAROSCOPIC CHOLECYSTECTOMY

      review-article
      Author(s): , FRCSI
      Publication date (Print):
      Journal: Journal of Family & Community Medicine
      Publisher: Medknow Publications & Media Pvt Ltd
      Keywords: Laparoscopy, cholecystectomy

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          Abstract

          Gallstone disease is still a major health problem worldwide. Open cholecystectomy was the standard treatment for symptomatic gallstones for more than 100 years. The introduction of laparoscopic cholecystectomy in the late 1980s has led to dramatic changes in the management of gallstone disease. The aim of this review is to equip the general practitioner with the answers to questions a patient may ask about the current management of gallstones.

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          A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern Surgeons Club.

          WC Meyers, M. Farouk, GD Branum (1991)
          The Southern Surgeons Club conducted a prospective study of 1518 patients who underwent laparoscopic cholecystectomy for treatment of gallbladder disease in order to evaluate the safety of this procedure. Seven hundred fifty-eight operations (49.9 percent) were performed at academic hospitals, and 760 (50.1 percent) at private hospitals. In 72 patients (4.7 percent) the operation was converted to conventional open cholecystectomy; the most common reason for the change was the inability to identify the anatomy of the gallbladder as a result of inflammation in the region of this organ. A total of 82 complications occurred in 78 (5.1 percent) of the patients; this is comparable with the rates of 6 to 21 percent that have been reported for conventional cholecystectomy. Overall, the most common complication was superficial infection of the site of insertion of the umbilical trocar. A total of seven injuries to the common bile duct or the hepatic duct occurred during the operation, for a rate of 0.5 percent. Four of the seven injuries were simple lacerations, which were repaired after conversion to conventional cholecystectomy. The incidence of bile-duct injury in the first 13 patients operated on by each surgical group was 2.2 percent, as compared with 0.1 percent for subsequent patients. No complications were attributed directly to either cautery or laser-surgical technique, and similar numbers of complications occurred in academic and private hospitals. The mean hospital stay for the entire group was 1.2 days (range, 6 hours to 30 days). The results of laparoscopic cholecystectomy compare favorably with those of conventional cholecystectomy with respect to mortality, complications, and length of hospital stay. A slightly higher incidence of biliary injury with the laparoscopic procedure is probably offset by the low incidence of other complications.
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            Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases.

            M Airan, A Doolas, K. Millikan … (1992)
            Complications of laparoscopic cholecystectomy were evaluated by a survey of surgical department chairpersons at 4,292 US hospitals. The 77,604 cases were reported by 1,750 respondents. Laparotomy was required for treatment of a complication in 1.2% of patients. The mean rate of bile duct injury (exclusive of cystic duct) was 0.6% and was significantly lower at institutions that had performed more than 100 cases. Bile duct injuries were recognized postoperatively in half of the cases and most frequently required anastomotic repair. Intraoperative cholangiography was practiced selectively by 52% of the respondents and routinely by 31%. Bowel and vascular injuries, which occurred in 0.14% and 0.25% of cases, respectively, were the most lethal complications. Postoperative bile leak was recognized in 0.3% of patients, most commonly originating from the cystic duct. Eighteen of 33 postoperative deaths resulted from operative injury. These data demonstrate that laparoscopic cholecystectomy is associated with low rates of morbidity and mortality but a significant rate of bile duct injury.
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              The European experience with laparoscopic cholecystectomy.

              M Trede, Stanislas Dubois, J Mouiel … (1991)
              A retrospective survey of 7 European centers involving 20 surgeons who undertook 1,236 laparoscopic cholecystectomies was performed. The procedure was completed in 1,191 patients. Conversion to open cholecystectomy was necessary in 45 patients (3.6%) either because of technical difficulty (n = 33), the onset of complications (n = 11), or instrument failure (n = 1). There were no deaths reported, and the total postoperative complication rate was 20 of 1,203 (1.6%), with 9 being serious complications requiring laparotomy. The total incidence of bile duct damage was 4 of 1,203. The median hospital stay was 3 days (range: 1 to 27 days) and the median time to return to full activity after discharge was 11 days (range: 7 to 42 days).
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Family Community Med
                Journal ID (iso-abbrev): J Family Community Med
                Journal ID (publisher-id): JFCM
                Title: Journal of Family & Community Medicine
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1319-1683
                ISSN (Electronic): 2229-340X
                Publication date (Print): Jul-Dec 1997
                Volume: 4
                Issue: 2
                Pages: 33-40
                Affiliations
                [1] Department of Surgery, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
                Author notes
                Correspondence to: Dr. Abdulmohsen A. Al-Mulhim, P.O. Box 1917, Al-Khobar 31952, Saudi Arabia
                Article
                Publisher ID: JFCM-4-33
                PMC ID: 3437091
                PubMed ID: 23008571
                SO-VID: 0c0835a8-33e6-4445-997a-dae5f39f03d0
                Copyright © Copyright: © Journal of Family and Community Medicine
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Health & Social care
                Keywords: laparoscopy,cholecystectomy
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: laparoscopy, cholecystectomy

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