S Yellapu | PubMed Health

PubMed2000

Acute laparoscopic cholecystectomy. A case controlled study.

BACKGROUND: Acute laparoscopic cholecystectomy (ALC) has been performed successfully at a number of institutions. Interval laparoscopic cholecystectomy (ILC) is preferred by many surgeons because of its convenience and a perceived increased risk with acute surgery. METHODS: A case control study was undertaken. The case group was a consecutive series of patients who underwent ALC between October 1996 and October 1997. The control group underwent ILC between March 1996 and March 1997 after at least one previous acute admission for gallstone disease. RESULTS: There were 81 patients in the case group and 100 in the control group. The groups were similar in terms of age, sex, and clinical diagnosis. Operative times (70 min vs 78 min, p = 0.60), major complications (4.9% vs 2%, p = 0.41), minor complications (4.9% vs 7%, p = 0.76), and conversion rates (7. 4% vs 7%) were similar in both groups. There were no bile duct injuries in either group. The median total hospital stay was 5 days in the case group and 8 days in the control group (p < 0.0001). CONCLUSIONS: Acute laparoscopic cholecystectomy can be performed safely at the first hospital admission, thus reducing hospital stay and minimizing inconvenience to patients.

Adult↗

PubMed2000

Laparoscopic anti-reflux surgery in New Zealand: a trend towards partial fundoplication.

BACKGROUND: The advent of laparoscopic anti-reflux surgery has generated considerable debate regarding the best technique. The present study was undertaken to determine the trends and current technique in laparoscopic anti-reflux surgery in New Zealand. METHODS: A confidential nationwide postal survey was sent to all general surgeons in New Zealand; it was repeated after a month, and followed up with a telephone prompt, if necessary. RESULTS: Of the 146 questionnaires sent out, 126 were returned (response rate: 86%), and 104 were excluded (no anti-reflux surgery performed (n = 96); surgeon retired (n = 5); paediatric surgeon (n = 3)). The number of operations performed by the 22 (16%) adult general surgeons who had performed laparoscopic anti-reflux surgery increased 4.6 times from 1991 to 1997 (474 open and 1218 laparoscopic operations). The median number of cases per surgeon was 30 (range: 5-300). In 1997 there were 208 (60%) total fundoplications (TF) and 135 (40%) partial fundoplications (PF) performed. Variations in the technique of TF included the Nissen-DeMeester (10 surgeons), the Nissen-Rosetti (nine surgeons), division of short gastric vessels (10 surgeons), and routine cruroplasty (14 surgeons). A PF had never been performed by six surgeons, was preferred by six surgeons, and four other surgeons were performing it more often. Variations in the technique of PF included posterior (12 surgeons) and anterior (four surgeons) forms. CONCLUSION: There is significant variation in the technique of laparoscopic anti-reflux surgery in New Zealand. A TF is preferred by 16 surgeons, but there appears to be a trend towards PF among the more experienced surgeons.

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