M J Heili | PubMed Health

PubMed1999

Choledocholithiasis: endoscopic versus laparoscopic management.

Choledocholithiasis is present in 6 to 10 per cent of patients who have cholelithiasis. In the era of laparoscopic cholecystectomy, endoscopic retrograde cholangiopancreatography with endoscopic retrograde sphincterotomy (ERCP/ERS) and laparoscopic common bile duct exploration (LSCBDE) have been used to treat choledocholithiasis. The purpose of this study is to compare ERCP/ERS with LSCBDE. A retrospective review of 913 patients undergoing laparoscopic cholecystectomy identified 61 patients who had ERCP/ERS or LSCBDE to treat choledocholithiasis at a community medical center between 1990 and 1996. Outcome parameters were hospital length of stay (LOS), hospital cost, and complications. The results were: ERCP (n=26; LOS, 5.0+/-3.6 days; cost, $11,823+/-$7,000; complications, 23.1%); LSCBDE (n=35; LOS, 3.4+/-2.4 days; cost, $9,100+/-$2,884; complications, 2.9%); and P value (LOS, 0.028; cost, 0.066; complications, 0.034). LSCBDE results in a significantly shorter LOS and significantly fewer complications, and is less costly than ERCP/ERS. LSCBDE, when feasible, should be considered the gold standard for the management of choledocholithiasis.

Adult↗

PubMedDate not supplied

Laparoscopic-assisted colectomy: a comparison of dissection techniques.

BACKGROUND AND OBJECTIVES: Mobilization of the colon and dissection of the mesentery are difficult laparoscopic techniques. Traditional methods have been used for this dissection, but often with great difficulty. The ultrasonically activated shears, when introduced in 1993, had the possibility to make this dissection less technically difficult. This is a retrospective review of the use of these shears for these techniques during laparoscopic-assisted colectomy. MATERIALS AND METHODS: Eighty-five patients underwent a laparoscopic-assisted right hemicolectomy or sigmoid resection. Colon mobilization and mesenteric dissection were completed intracorporeally. Complications, operative time, estimated blood loss, and length of stay were compared for resections completed with and without the ultrasonically activated shears. RESULTS: Thirty-six patients had laparoscopic-assisted colectomy without the shears, and 49 patients had the procedure with the shears. There were no complications due to the ultrasonic energy. Use of the shears resulted in shorter operative times (170 min. vs. 187 min., p=0.1989), similar median blood loss (98 mL vs. 95 mL, p=0.7620), and shorter lengths of stay (4.3 days vs. 6.9 days, p=0.0018). CONCLUSIONS: The ultrasonically activated shears are safe and effective for colon mobilization and mesenteric division. The use of the shears may result in shorter operative times and shorter lengths of stay.

Adult↗