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Mini-lap cholecystectomy.

Abstract

With the introduction of laparoscopic cholecystectomy, the surgical community witnessed a revolution in basic ideology. Gone are the days when surgeons spoke of wounds healing "from side to side, and not top to bottom." The surgical community has become aware of the concept of minimally invasive surgery. Despite this recent advance, surgeons have long realized that the surgical wound does contribute to morbidity and mortality. The mini-lap cholecystectomy, described as early as 1982, is an indication that surgeons are making an attempt to reduce this morbidity. Mini-lap cholecystectomy is now being suggested as an alternative to laparoscopic cholecystectomy--a technique that boasts many of the same benefits without the problems inherent in laparoscopic surgery. The author has reviewed the literature for mini-lap cholecystectomy, laparoscopic cholecystectomy, and conventional cholecystectomy. Using this "historical" database, he then compares the three techniques to determine whether mini-lap cholecystectomy is a viable alternative.

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BibTeXRIS

D O Olsen. 1993. Mini-lap cholecystectomy.. https://doi.org/10.1016/s0002-9610(05)80937-7

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Systematic review and meta-analysis: does gall-bladder ejection fraction on cholecystokinin cholescintigraphy predict outcome after cholecystectomy in suspected functional biliary pain?

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.

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[Micro and mini-cholecystectomies in the 21st century].

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.

Cholecystectomy↗