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At least 19 recordsLinked to original sources
PubMed1997

Long-term results after laparoscopic cholecystotomy in a child with symptomatic gallstone disease.

Cholecystotomy has been suggested for symptomatic gallstone disease in selected children. This suggestion is supported by a potential reduction in the frequency of the so-called postcholecystotomy syndrome. To our knowledge, laparoscopic cholecystotomy has not been reported yet. However, gallstone recurrence has been reported up to 4 years after conventional cholecystotomy and therefore we waited to publish our results for that period of time. A 12-year-old girl with idiopathic symptomatic gallstone disease and a normal kinetic of the gallbladder underwent laparoscopic cholecystotomy. The laparoscopic technique was similar to laparoscopic cholecystectomy but the gallbladder was left in place and multiple gallstones were removed. Intraoperative cholecystoscopy revealed three additional small stones. They were removed by subsequent lavage of the gallbladder. Choledocholithiasis was excluded by intraoperative cholangiography and the gallbladder was closed using an Endo GIA. There were no intraoperative or postoperative events. The patient is free of complaints without recurrent gallstones on ultrasound examination today, 4 years after the operation. Laparoscopic cholecystotomy represents a feasible alternative to laparoscopic cholecystectomy.

Child↗
PubMedDate not supplied

Drainage of the gallbladder in patients with acute acalculous cholecystitis by transpapillary endoscopic cholecystotomy.

The mortality associated with acute acalculous cholecystitis approaches 50%. Removal or decompression of the gallbladder in these patients may prevent gallbladder rupture and may be lifesaving. This is usually accomplished by cholecystectomy, cholecystotomy, or percutaneous gallbladder drainage. We describe a novel transpapillary endoscopic approach to gallbladder drainage in patients at high surgical risk. A total of seven high surgical risk patients were treated with transpapillary endoscopic cholecystotomy. Cannulation of the cystic duct was accomplished by using standard hourglass-tipped catheters in two patients. A new "selector" catheter was developed for selective cannulation of the cystic duct and used in the other five patients. Five of the seven patients showed evidence of clinical, radiographic, and laboratory improvement after treatment. We conclude that transpapillary endoscopic cholecystotomy may be an effective treatment alternative for high surgical risk patients with acalculous cholecystitis.

Acetylcysteine↗
PubMed2001

Outcome after laparoscopic cholecystotomy and cholecystectomy in children with symptomatic cholecystolithiasis: a preliminary report.

Laparoscopic cholecystectomy (LCE) has become the procedure of choice for symptomatic gallstones in children. However, there is concern about the disadvantages of cholecystectomy. Numerous postoperative symptoms and a possible correlation of the procedure with a higher incidence of right-sided colon carcinoma have been described. Therefore, it has been suggested to remove the gallstones via a cholecystotomy, leaving the gallbladder in place. This is the first report on the functional and symptomatic outcome of laparoscopic cholecystotomy (LCO) versus LCE in a consecutive series of children. A follow-up study of all children who underwent surgery for symptomatic gallstone disease from 1993 to 1999 was performed. Nine underwent LCO and 8 standard LCE. The procedure was chosen according to the preference of the surgeon. Patients and parents underwent a standardized follow-up interview. The intensitiy of six gastrointestinal symptoms was graded from 0 to 3. The patients and parents scored the symptomatic outcome using a 100-point visual analogue scale. There were no intraoperative complications. Bleeding of a port site required suturing in 1 patient after LCO, and fever with a further uneventful course occurred in another after LCE. The mean duration of hospital stay was 3.0 days after LCO and 2.4 days after LCE. In 1 patient a missed gallstone was identified 4 weeks after LCO. The patient underwent LCE with a further uneventful course. At follow-up (mean 20.7 months after LCO, 28.3 months after LCE, P = n.s.) there was a tendency toward a lower incidence of symptoms after LCO. Symptoms were reported by 3 of 8 patients after LCO and 5 of 8 after LCE. The mean score of the symptomatic outcome was not statistically different. All patients with LCO were free of stones on ultrasound examination with normal contraction of the gallbladder. LCO thus represents an alternative approach. We consider LCO for children with symptomatic cholecystolithiasis before the onset of puberty. However, data on the long-term outcome from larger series are mandatory before a general recommendation can be given.

Age of Onset↗
PubMed1997

Rapid formation of cholesterol crystals in gallbladder bile is associated with stone recurrence after laparoscopic cholecystotomy.

Laparoscopic cholecystotomy (LCT) with subsequent extraction of gallstones and primary closure of the gallbladder has been introduced as an alternative therapy for patients with cholecystolithiasis and preserved gallbladder function. However, stone recurrence has to be considered as a major drawback that might be related to lithogenic factors of gallbladder bile or the composition of gallbladder stones. Therefore, these were studied in relation to stone recurrence within an observation period of 1 to 5 years (median, 3.6 years) in 50 patients after LCT. The concentrations of total and individual bile acids, phospholipids, cholesterol, total lipids, mucin, protein, and the cholesterol saturation indices in gallbladder bile were not significantly different between 10 patients with and 40 patients without stone recurrence. However, the crystal observation time was significantly (P < .02) shorter (range, 1-2 days; median, 1.5) in the bile of patients with stone recurrence compared to those without (range, 1-21 days, median 3.5). Moreover, all 10 stone recurrences were observed in the 28 patients with a crystal observation time in the bile of less than or equal to 2 days (approximate annual risk: 12%-15%), and no recurrences were observed in the 22 patients with a crystal observation time greater than 2 days (P < .0001) or in patients with pigment stones. The rapid formation of cholesterol monohydrate crystals in bile seems to be the major risk factor for recurrent stones after LCT. These are most likely cholesterol stones and, therefore, are amenable to oral bile-acid prevention or treatment.

Bile↗
PubMed1991

Experimental laparoscopic cholecystotomy.

This instrument set for a single puncture technique of laparoscopic cholecystotomy was developed in 100 phantom tests with pig gallbladders and was later evaluated in 12 animal experiments. No complications were observed. After clinical development, treatment on an outpatient basis under local anaesthesia seems possible. For the patient this would mean avoiding general anaesthesia, shorter hospitalization, pain reduction and good cosmetic results, while reducing expenditure for the public health authorities at the same time. To avoid recurrent stones, diet and low-dose drug therapy should be considered. Because the procedure is minimally invasive, repetition of the laparoscopic procedure seems justified if stones recur.

Animals↗
PubMed1999

Laparoscopic cholecystotomy.

Laparoscopic cholecystotomy (LCT) with primary closure of the gallbladder is a treatment option for patients with symptomatic cholecystolithiasis in a well-functioning gallbladder. In contrast to other gallbladder-preserving minimally invasive or interventional methods, LCT is a one-session procedure avoiding the need for post-operative drainage of the gallbladder by a balloon catheter. LCT does not cause functional disturbances or severe bile duct injury, as is observed after laparoscopic cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed1992

Evaluation of laparoscopic cholecystotomy in the treatment of gallbladder stones.

Laparoscopic cholecystotomy (LCT) was attempted in 34 patients with biliary type symptoms; 33 patients suffered from gallbladder stones and one patient from gallbladder polyps. In one patient the gallbladder was not accessible with the laparoscope due to extensive adhesions. In the other patients endoscopic removal of stones and polyps was possible in all cases. In the first five patients the gallbladder was drained with a Foley type catheter at the end of the procedure; in the other patients the incision of the gallbladder was closed primarily with clips and fibrin glue. At the beginning of the series two cases of complications were observed: balloon catheter deflation due to material defect and postoperative bleeding into the gallbladder; after conventional cholecystectomy the two patients made an uneventful recovery. LCT is a one-session procedure suitable for removal of symptomatic stones in well functioning gallbladders with no restrictions concerning the composition, number or size of the stones.

Adult↗
PubMed1992

In vitro fragmentation of gallstones with lithotriptors for use in laparoscopic cholecystotomy.

In preliminary in vitro experiments, five different lithotriptors for use in laparoscopic cholecystotomy were tested to determine the fragmentation time and rate of a defined group of gallstones. The Alexandrit laser and the ultrasonic lithotriptor were too ineffective to warrant further investigation. In phantom tests with pig gallbladders, the pulsed dye laser and the electrohydraulic lithotriptor had a fragmentation rate of 100%, but the rate of clearing of the gallbladder was 0% as stone debris always remained in the gallbladder. The clearing rate of the RotoLith mechanical lithotriptor was 84.6%. The RotoLith lithotriptor was the most effective device because the stones were ground into such small particles that they could easily be rinsed out of the gallbladder. As the RotoLith procedure does not need to be monitored optically, the opening of the gallbladder need not exceed 3 mm compared to 10 mm for the other lithotriptors. This makes closure of the gallbladder safer and it would seem feasible to perform the procedure using the RothoLith lithotriptor under local anaesthesia.

Animals↗
PubMed2005

Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy.

Emergency cholecystectomy for acute cholecystitis is associated with high morbidity and mortality rates in patients with significant comorbidities and high-risk surgery. The aim of this study was to evaluate the effectiveness, possible advantages, and complications of percutaneous cholecystostomy (PC) followed by an early laparoscopic cholecystectomy (LC) in relation to conservative treatment followed by a delayed LC in high-surgical risk patients. Between 2002 and 2004, patients were randomly classified into 2 groups: the first group consisted of patients who had PC followed by an early LC (PCLC group, n = 31) and the second group consisted of patients who had conservative treatment followed by a delayed LC (DLC group, n = 30). The groups were statistically compared regarding their demographic, comorbidity, hospital stay, conversion, and complication rates. PC was technically successful in 31 patients with no attributable mortality or major complications. No difference had been found in regarding demographic, comorbidity, and complication rates. In PCLC group, all the patients experienced symptom relief within 24 hours, and early LC was attempted in 31 patients once their clinical condition was sufficiently stable, this was successfully accomplished in 29 (93.5%). In the DLC group, delayed LC was attempted in 30 patients, and this was successfully accomplished in 26 (86.6%). The hospital stay was shorter and cost was in the PCLC group was lower than in the DLC group. PC allows resolution of sepsis in patients at high surgical risk. Early LC could be safely performed once sepsis and acute infection resolved in these patients.

Acute Disease↗
PubMed2003

[Surgical treatment of cholelithiasis in children. Role of cholecystotomy].

Cholelithiasis is a rare pathology in children and with a different etiology, composition and clinic than adult. Cholecystectomy is the standardized treatment. The cholecystectomy is an alternative treatment in childhood. We studied 30 patients, aged between 8 months and 13 years, 15 of them with cholecystectomy and 15 with removal of pigment gallstones. The patients were followed up for 3 months-11 years. Recurrent stone formation was noted in one patient. 14 of the patients were non-symptomatic with normal ecography controls.

Adolescent↗