PubMed · 6520106
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H S Wasir, J C Mohan. 1984. Pulmonary embolism.. https://pubmed.ncbi.nlm.nih.gov/6520106/
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BACKGROUND: Patients with suspected functional biliary pain often undergo cholecystectomy if a decreased gall-bladder ejection fraction (GBEF <35%) is demonstrated by cholecystokinin cholescintigraphy. However, the validity of GBEF in predicting which patients will have symptomatic relief following cholecystectomy is unclear. AIM: To determine whether patients with suspected functional biliary pain with decreased GBEF have a better symptomatic outcome after cholecystectomy than those with normal GBEF. METHODS: Systematic review and meta-analysis of the published literature through MEDLINE and EMBASE databases. RESULTS: We included nine studies with a total of 974 patients with suspected functional biliary pain; 362 patients underwent cholecystectomy. Most studies assessed outcome by direct patient interview. Mean ages across the studies ranged from 35 to 47 years; 78% of all patients were female. Mean duration of follow-up after surgery ranged from 1 to 2.5 years. After cholecystectomy, 94% of the patients with reduced GBEF had a positive outcome compared to 85% among those with normal GBEF. The pooled Mantel-Haenszel odds ratio for positive outcome was 1.37 (95% confidence interval 0.56-3.34), P=0.56. CONCLUSION: These data do not support the use of GBEF to select patients with suspected functional biliary pain for cholecystectomy. Prospective randomized trials are required if this practice is to be evidence-based.
INTRODUCTION: Today the removal of the gallbladder is the safest, the most effective and widely recommended treatment for gallstone disease. Three essential methods are used for the removal of the gallbladder: standard open cholecystectomy, laparoscopic cholecystectomy and minicholecystectomy. Traditionally, the surgical community has resisted accepting minicholecystectomy. AIM: It is the Author's objective to illustrate the advantages and disadvantages of laparoscopic and microlaparotomy cholecystectomy. METHODS: The 2400 unselected patients who were operated with micro- and minicholecystectomy by them and a review of the relevant data of laparoscopic and standard minicholecystectomies permit some inferences to be made about the validity of microlaparotomy cholecystectomy. CONCLUSIONS: Main outcome measures regarding to mortality (0.12%), common bile duct injuries (0.08%), conversion an incision longer than 8 cm (0.29%) and syncronical choledocholithotomy (5.5%) as well as complete cholecystectomy (98.1%) indicate that micro- and minilaparotomy cholecystectomy with suitable technique and equipment are safe, less expensive choice either than the laparoscopic or the standard open cholecystectomy.