Biomedical subjects

G N Costantino

Publications and source records attributed to G N Costantino.

6 recordsLinked to original sources

PubMed1995

Increased ERCP rate following the introduction of laparoscopic cholecystectomy.

Over the past 5 years there has been a remarkable change in the manner in which symptomatic gallstones are surgically managed. In this study we reviewed the experience of a large HMO to determine the relationship between the rate of increase of ERCP and that of cholecystectomy. All individuals enrolled in US Healthcare's HMO-PA, in the region of southeastern Pennsylvania from 1988 through 1993, were included in the analysis. Using the HMO claims database, patients who underwent an open or laparoscopic cholecystectomy during the study period were identified. We then identified those patients who had a pre- or post- operative ERCP. Over the study period, there has been a substantial increase in cholecystectomies per 1000 members-from 1.37 in 1988 to 2.16 (p < 0.0001) in 1993. In our study population there were 1261 ERCPs performed in 979 patients with an average of 1.3 ERCPs per patient during the study period. The ERCP rate per 1000 members has increased from 0.16 to 0.56 (p < 0.0001) from 1988 to 1993, at the same time that the cholecystectomy rate was substantially increasing. The correlation for the ERCP and cholecystectomy rates from 1988 to 1993 was 0.994 (p < 0.0001). Since the introduction of laparoscopic cholecystectomy in 1989-1990, many more ERCPs are now being performed. It is necessary to determine the implications related to the rapid diffusion of laparoscopic cholecystectomy, including the effect that this technology has had on other older and stable technologies such as ERCP. Our results describe the dramatic effect that laparoscopic cholecystectomy has had on the utilization of ERCPs.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1994

Laparoscopic cholecystectomy in pregnancy.

Acute calculus cholecystitis during pregnancy can be a difficult management problem. Two pregnant patients with cholecystitis refractory to conservative management underwent laparoscopic cholecystectomy at a community hospital. One patient was treated under epidural anesthesia. Pregnancy should not be an absolute contraindication to laparoscopic cholecystectomy, and epidural anesthesia should be considered.

Adult↗

PubMed1994

Laparoscopic reversal of Hartmann procedure.

Laparoscopic surgery has expanded rapidly since the introduction of laparoscopic cholecystectomy. We have performed three laparoscopic Hartmann reversals in the last year and have compared these cases to eight open reversals. Laparoscopic technique has the advantage with regard to early oral intake, shortened length of stay, decreased blood loss, and decreased postoperative pain. Laparoscopic Hartmann reversal has comparable operative time with the open technique. We believe that laparoscopic Hartmann reversal should be considered by experienced laparoscopic surgeons.

Adult↗

PubMed1993

Laparoscopic adrenalectomy.

Presented is a case of a laparoscopic adrenalectomy and a small series of adrenalectomies performed by more traditional approaches both anterior and posterior. The laparoscopic adrenalectomy compares favorably with operating time and estimated blood loss and resulted in a shorter hospital stay and decreased total disability.

Adrenalectomy↗

PubMed1980

Fundoplication for major reflux in patients with gallstones.

Patients referred with gallstones were screened for symptoms of reflux. Positive clinical history led to investigation with an upper gastrointestinal series as well as esophageal pH and manometric studies to identify and quantify reflux. Selected patients with symptomatic reflux in whom major or surgical reflux was discovered underwent the combined procedures of cholecystectomy and fundoplication. In all, 250 patients with gallstones were screened. Sixty patients with symptoms of reflux were considered for further study; of that group, 48 patients had major reflux, 38 of whom underwent the combined operative procedures. Fundoplication alone or in combination with cholecystectomy was carried out on 126 occasions upon 121 patients without a death. The combination of fundoplication and cholecystectomy did not prolong the hospital stay significantly, did not materially increase the incidence of postoperative complications and did not compromise the control of reflux symptoms. The postfundoplication syndrome did not occur following the combined procedures and was observed in only one patient in the entire series. Results of our study justify the liberization of indications for fundoplication in selected patients with gallstones who fulfill the criteria of major reflux, as already outlined.

Cholecystectomy↗

PubMedDate not supplied

Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy.

OBJECTIVE: To examine if overall cost savings may fail to result from laparoscopic ("closed") cholecystectomy if it also results in an increased total rate of cholecystectomies or generates additional costs unassociated with the open procedure. OUTCOME MEASURES: Inpatient and outpatient expenditures, incidence rates, and length of inpatient stay data for 6909 health maintenance organization enrollees with gallbladder complaints were analyzed from 1988 through 1992 using claims data from a large, private practice-based health maintenance organization. RESULTS: The incidence of cholecystectomy and total health maintenance organization expenditures on gallbladder disease have increased since the introduction of laparoscopic closed cholecystectomy. The rate of cholecystectomy procedures per 1000 enrollees increased from 1.35 in 1988 to 2.15 in 1992 (P < .001). Total annual medical expenditures on gallbladder disease per 1000 enrollees (in 1992 dollars) rose 11.4% during the study period (P < .001), despite a concurrent 25.1% decline in the unit cost (physician and hospital cost) for cholecystectomy procedures (P < .001). During the same study period, no significant change was noted in the rate of appendectomy per 1000 enrollees (0.76 in 1988 to 0.73 in 1992), which is a measure of nonelective surgical care, or in the inguinal hernia repair rate (2.01 in 1988 to 2.19 in 1992), which has a physician and patient discretionary component similar to that of cholecystectomy. CONCLUSIONS: The introduction of laparoscopic gallbladder surgery resulted in rising rates of cholecystectomy for a population of patients in a private, independent practice-based health maintenance organization. Such a rise was not seen for hernia repair surgery or appendectomy. It seems that the use of laparoscopic cholecystectomy, a new technology touted as reducing health care costs, may result in an increased consumption of health care resources due to changes in the indications for gallbladder surgery.

Cholecystectomy↗