PubMed · 8606607
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N H Antia. 1996-04-13. Laparoscopic cholecystectomy.. https://doi.org/10.1016/s0140-6736(96)90138-5
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The objective demonstration of improved postoperative recovery suggests that surgical injury induced by the laparoscopic approach is less intense than that after open surgery. Forty-two patients diagnosed as having noncomplicated gallstones were studied prospectively. They were operated on by laparoscopy (LC, n = 21) or open surgery (OC, n = 21). Both surgical procedures induced significant changes of investigated parameters (acute-phase response, free radical mediated reactions, neutrophil functions). Comparison of the results of the two cholecystectomy techniques showed that laparoscopic cholecystectomy induced a significantly less intense acute-phase response, a more attenuated oxidative stress characterising by free radical mediated reactions and that is less disruptive to neutrophil function. The results and the data from the literature suggest that surgical injury causing by the laparoscopic cholecystectomy is less intense than that after open cholecystectomy, which can explain partially the better clinical outcome following laparoscopic versus open procedure.
Severe hypophosphatemia has rarely been reported as a cause of acute paralysis. We present the clinical and electrophysiological findings on a patient who developed quadriparesis following several surgeries for complicated cholecystectomy. The paralysis was most likely the result of severe hypophosphatemia causing a neuropathy which improved readily after proper phosphate replacement. The possible pathogenic mechanisms of hypophosphatemic neuropathy are discussed.
Minilaparotomy cholecystectomy presents exposition difficulties, and laparoscopy requires expensive equipment and additional training. Laparotomy is more painful, causes trauma to the abdominal wall, and requires a longer convalescence; it is also less aesthetic. We present a new technique for minilaparotomy cholecystectomy, transcylindrical cholecystectomy (TC), based on the introduction of a 3.8- or 5.0-cm diameter cylinder (10.0 cm long). The cylinder serves the purpose of separating and isolating the hepatocystic triangle from the surrounding structures, thereby providing a stable surgical field and adequate vision of the hepatocystic triangle so the technique can be performed safely. Patients who have been diagnosed with symptomatic cholelithiasis, who are convalescent from biliary pancreatitis, or who have acute cholecystitis have been treated consecutively by TC. We have carried out the procedure on 116 occasions, 94 using the 3.8-cm cylinder and 28 with the 5.0-cm cylinder; both cylinders were used in 6 cases. The indications for using the 5.0-cm cylinder were mainly cholecystitis, pancreatitis, choledocholithiasis, and difficulty with the 3.8-cm cylinder. The result is a 4.5- or 7.0-cm incision. We had difficulty recognizing the anatomy in 11 dissections so we had to enlarge the incision. We have not had accidents related to placement of the cylinder, hemorrhage, or bile duct injuries. The median operating time was 43 minutes, and the mean postoperative stay was 1.8 days. Postoperative FVC and FEV, reductions were 21.7% and 27.4%, respectively. The technique has proved fast, safe, and practicable using conventional material. The cost of TC is $701 (US).