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At least 19 recordsLinked to original sources
PubMedDate not supplied

Laparoscopic cholecystectomy combined with endoscopic sphincterotomy and stone extraction or laparoscopic choledochoscopy and electrohydraulic lithotripsy for management of cholelithiasis with choledocholithiasis.

Six hundred twenty-two laparoscopic cholecystectomies were performed at St. Vincent Hospital over a 14-month period. We reviewed the records of 366 of these patients who were referred to the authors. Thirty-six patients had suspected choledocholithiasis. The primary author (M.E.A.) performed 38 endoscopic retrograde cholangiopancreatography (ERCPs) on these patients for diagnosis and management. Seventeen of the 36 patients had common bile duct stones; 19 patients had negative studies. Of the 17 patients with choledocholithiasis, 15 had successful cannulation of the common bile duct, and, of these, 10 underwent laparoscopic cholecystectomy plus endoscopic sphincterotomy and extraction of the common duct stone(s). In one high-risk elderly patient, we extracted the stone from the common duct and left the gallbladder in situ. Two patients failed endoscopic cannulation and underwent open cholecystectomy with common bile duct exploration. Four additional patients, cannulated successfully, had unsuccessful endoscopic stone removal because the stones were too large or were impacted. Two of these patients underwent open cholecystectomy and common duct exploration. The two other patients underwent laparoscopic cholecystectomy and choledochoscopy through the cystic duct with the flexible choledochoscope. An electrohydraulic lithotripsy probe was then inserted through the choledochoscope to fragment the stones, and stone fragments were allowed to pass through the previously created sphincterotomy. We believe our data, supported by data in the literature, show that these alternative methods for treating choledocholithiasis are safe and effective and should be considered primary modalities for treating this condition now that laparoscopic cholecystectomy is the treatment of choice for cholelithiasis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1992

Early experiences of laparoscopic cholecystectomy in five Irish hospitals. Irish Laparoscopic Group.

There are many concerns about the widespread introduction of laparoscopic cholecystectomy. The initial experience of five hospitals in introducing laparoscopic cholecystectomy was reviewed. Three hundred and eight patients were operated upon, and the operations were completed laparoscopically in 279 (91 percent). One patient sustained a diathermy injury to the right hepatic duct. There was no mortality and the overall morbidity was 10 percent. Mean postoperative stay was 3.6 days. The participating surgeons considered training workshops to be desirable and felt that trainees should be supervised for at least ten cases. Laparoscopic cholecystectomy can be safely introduced and performed, and it should be considered in all patients undergoing cholecystectomy.

Adolescent↗
PubMed1992

[Laparoscopic cholecystectomy--what is the value of laparoscopic technique in "difficult" cases?].

This prospective study with an external control group of patients investigates the technical aspects of laparoscopic cholecystectomy in patients with difficult intraabdominal situations as well as the postoperative quality of life of these persons. Difficult concomitant circumstances were defined when those patients had multiple adhesions after previous abdominal surgery in the middle and upper quadrants, acute cholecystitis, and severe obesity. 100 patients after classic cholecystectomy represented the external control group. 170 patients were followed after laparoscopic cholecystectomy. Endpoints of investigation were duration of operation, complications, postoperative hospitalization, and postoperative quality of life. Major complications occurred in 1.2%. Although in patients after laparoscopy minor complications were registered at a higher incidence than in classic cholecystectomy, the patients' postoperative quality of life improved significantly faster after laparoscopy in all patients groups. These results show that even patients with severe adhesions, with acute cholecystitis and with prolonged duration of operation still profit from the laparoscopic technique in comparison to laparotomy.

Adolescent↗
PubMedDate not supplied

Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results.

From 1960 10 1984, 2,501 women underwent diagnostic laparoscopy (index laparoscopy) because of a clinical suspicion of acute pelvic inflammatory disease (PID). Of these women, 1,844 had abnormal laparoscopic findings (patients) and 657 had normal findings (control subjects). The reproductive events after index laparoscopy of 1,732 patients and 601 control subjects were followed. The patients and control subjects were followed for a total of 13,400 and 3,958 woman-years, respectively. During the follow-up period, 1,309 (75.6%) of the patients and 451 (75.0%) of the control subjects attempted to conceive. Of these women, 209 (16.0%) of the patients and 12 (2.7%) of the control subjects failed to conceive. A total of 141 (10.8%) of the patients and 0 (0%) of the control subjects had confirmed tubal factor infertility, 21 (1.6%) of the patients and 3 (0.7%) control subjects had other causes of infertility, and 47 (3.6%) patients and 9 (2.0%) control subjects did not have a complete infertility evaluation. Additional information on tubal morphology (hysterosalpingography, laparoscopy, or laparotomy) in women from couples for whom evaluation was incomplete indicated that 165 (12.2%) patients and 4 (0.9%) of the control subjects had abnormal tubal function or morphology after index laparoscopy. Tubal factor infertility after PID was associated with number and severity of PID episodes. The ectopic pregnancy rate for first pregnancy after index laparoscopy was 9.1% among the patients and 1.4% among control subjects.

Adult↗
PubMed1979

[Laparoscopic picture and a working laparoscopic classification of chronic perihepatitis].

The author established chronic perihepatitis, via laparoscopy, in 61.6 percent of the investigated 350 patients in the course of 12 years. Describing the most characteristic mascoscopic varieties of chronic perihepatitis, the author groups them in seven separate form: I. Perihepatitis diffusa, corresponding to Zuckergussleber of Curschmann. II. Perihepatitis adhesiva and III. Perihepatitis circumscripta. The latter, on its part is subdivided to 5 separate forms of chronic perihepatitis: 1. Perihepatitis arachnoidealis, 2. Perihepatitis marginalis, 3. Perihepatitis areata et striata, 4. Perihepatitis miliaris disseminata, 5. Perihepatitis paravesicalis. That working laparoscopic classification contributes to the precise diagnostics and to the clinical interpretation of the separate forms of chronic perihepatitis. With the aid of lapraoscope the author performed a partial decapsulation of diffuse perihepatitis in 12 patients, without complications observed. Diffuse perihepatitis is, for the first time, described in patients with chronic hepatitis, in a patient with multiple liver abscesses and in one female-patient with peritoneal carcinosis and hemorrhagic ascites.

Biopsy, Needle↗
PubMed1992

Comparison of laparoscopic cholecystectomy versus elective open cholecystectomy.

Laparoscopic cholecystectomy has essentially replaced open cholecystectomy as the procedure of choice for gallbladder disease. This rapid shift to laparoscopic cholecystectomy, however, has resulted more from marketing forces than from prospective clinical trials. To evaluate the safety and efficacy of laparoscopic cholecystectomy, the first 486 laparoscopic cholecystectomies at two institutions were studied. These results were then compared to the results of the last 6 months of elective open cholecystectomy cases prior to the introduction of laparoscopic surgery. The age, sex, height, and weight were similar in both groups. The mean operative time was 78.8 +/- 1.8 min for laparoscopic cholecystectomy and 62.7 +/- 2.6 min for open cholecystectomy (p < 0.01). The mean time for tolerating a regular diet was 1.23 +/- 0.04 days in the laparoscopic group versus 2.44 +/- 0.07 days in the open group (p < 0.01). Laparoscopic cholecystectomy patients required only oral pain medications by a mean of 1.22 +/- 0.03 days postoperatively compared to 2.55 +/- 0.07 days postoperatively for those undergoing open cholecystectomy (p < 0.01). The mean length of hospitalization was 1.58 +/- 0.07 days for laparoscopic patients and 3.55 +/- 0.11 days for open patients (p < 0.01). Thirty-one patients undergoing laparoscopic cholecystectomy were converted to open cholecystectomy (6.4%). The most common reasons for conversion to open cholecystectomy were acute inflammation, adhesions, and bleeding. For the laparoscopic patients, the morbidity rate was 8.4% and the mortality rate 0.2% (1 death). In the open cholecystectomy group the morbidity rate was 8.0% and there were no deaths. The most troublesome complication in laparoscopic cholecystectomies continues to be bile leaks and bile duct injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1992

Training, credentialing, and evaluation in laparoscopic surgery.

Laparoscopic cholecystectomy has become the procedure of choice for the treatment of gallbladder disease. Many general surgeons have incorporated laparoscopic cholecystectomy into their clinical practices, usually after completing a postgraduate didactic and laboratory animal training course. This additional formal training is both appropriate and necessary because laparoscopic surgery involves techniques different from those of traditional celiotomy, and most surgeons who completed their residencies prior to 1992 have had no laparoscopic training. Because additional formal training for practicing surgeons is necessary at this time, it is appropriate for hospitals to mandate separate granting of operative privileges for laparoscopic surgical procedures. In the near future, when graduates of general surgery residency programs have had training in laparoscopic surgery, separate privileges will no longer be necessary, and laparoscopic procedures should be included in the standard privilege category of biliary tract surgery. Once privileges in laparoscopic surgery are granted, laparoscopic operations, like all surgical procedures, should be monitored by peer review to ensure that they continue to be performed safely and appropriately. Only those laparoscopic procedures that are similar to open operations and have been shown by pilot studies to be safe (e.g., cholecystectomy) should be included currently in a surgeon's laparoscopic privileges. Laparoscopic procedures that are very different from proven open procedures and are investigational (e.g., inguinal herniorrhaphy) should be permitted by the hospital only as part of an experimental protocol monitored by an institutional review board. Only after their safety and efficacy have been established should they become part of standard privilege categories.

Credentialing↗
PubMed1992

Laparoscopic herniorrhaphy.

Laparoscopic inguinal hernia repair could represent an attractive alternative to conventional inguinal herniorrhaphy if it can be shown to result in less perioperative morbidity (primarily postoperative pain) or a decreased long-term recurrence rate. The data addressing either of these concerns will be forthcoming in ensuing years. The variations in the laparoscopic approach to the preperitoneal space and the differences in dissection and fixation techniques outlined in this article reflect the fact that the procedure is still evolving, and there is not yet a consensus on the best laparoscopic herniorrhaphy. It is likely that there will not be one laparoscopic technique applicable to all inguinal hernias. Rather, the patient's body habitus and the type of hernia encountered at laparoscopy will persuade the surgeon to use one of several techniques. Once a consensus is reached among surgeons as to the optimal laparoscopic hernia repair(s), it will be possible to begin gathering data concerning perioperative morbidity and recurrence rates. Only then can the question be answered whether laparoscopic inguinal herniorrhaphy has any advantages over the conventional extraperitoneal operation. A multicenter prospective nonrandomized trial has been initiated by our group in an attempt to determine whether laparoscopic inguinal herniorrhaphy has efficacy. The exact technique employed by the individual centers has not been strictly regulated, but general guidelines have been given. It is hoped that this project will provide information on whether laparoscopic inguinal herniorrhaphy is a useful alternative to conventional repair. Most of the laparoscopic inguinal herniorrhaphy techniques described in this article expose the patients to the inherent risks of initial laparoscopic penetration of the abdomen and the long-term possibility of adhesions to the sites where the peritoneum has been breached. Because these risks are not present in a conventional repair, the laparoscopic technique must have other advantages if it truly is to obtain a place in the armamentarium of general surgeons.

Anesthesia↗
PubMed1992

Laparoscopic gastrointestinal and gallbladder surgery: will the promise be fulfilled?

The results of the first 181 consecutive patients who underwent laparoscopic cholecystectomy and 12 patients who underwent laparoscopic colon resection in our hospital are described. Our results show that laparoscopic cholecystectomy has proved to be the standard surgical procedure for treating gallbladder disease. The place of laparoscopic surgery in the treatment of other abdominal diseases is less clear. Our results in laparoscopic colon surgery indicate that a laparoscopic approach in segmental colon resection is feasible. The operation time is long, however, expressing the long learning curve for the operating team, as well as the technical difficulties encountered with this minimal invasive method. On the other hand, it has been proved that large abdominal operations can be performed via the laparoscope. By improving the laparoscopic instruments and increasing the laparoscopic surgeon's experience, further application of this method in gastrointestinal surgery may be expected. Surgeons should, however, be aware of the long learning curve involved in advanced laparoscopic surgery.

Adolescent↗
PubMed1992

Laparoscopic versus open appendicectomy: a prospective evaluation.

A prospective evaluation of laparoscopic surgery for acute appendicitis over a 6-month period is reported. Sixty-five patients with signs and symptoms of appendicitis necessitating surgery were assigned to open (n = 36) or laparoscopic (n = 29) appendicectomy. Thirty-seven patients were female (22 open) and 28 were male (14 open). The median age was 24 (range 14-64) years for open appendicectomy and 18 (range 14-60) years for the laparoscopic procedure. The mean postoperative stay for open operation was 4.8 (range 1-21) days and for the laparoscopic route 2.2 (range 1-11) days (P < 0.05). Inflammation was confirmed histologically in 72 per cent of the open cases and in 74 per cent of the laparoscopic cases (P not significant). The wound infection rate was 11 per cent (n = 4) for open and 4 per cent (n = 1) for laparoscopic appendicectomy (P < 0.05). The median anaesthesia time was 52 (range 15-90) min for open appendicectomy and 48 (range 20-120) min for laparoscopic surgery (P not significant). After open appendicectomy patients had a median of 5 (range 2-12) intramuscular injections of analgesia compared with a median of 1 (range 0-5) in the laparoscopic group (P < 0.05). Two laparoscopic operations were converted to an open procedure. The results suggest that emergency laparoscopic appendicectomy should be explored further as an alternative to open surgery for acute appendicitis.

Acute Disease↗
PubMed1992

Cost effectiveness of laparoscopic cholecystectomy.

An investigation was undertaken to determine whether hospital charges for laparoscopic cholecystectomy are higher than those for traditional open cholecystectomy. Thirty consecutive cases of successfully completed laparoscopic procedures in a single surgeon's experience were compared to 30 open cases performed within the previous calendar year. Patients undergoing open cholecystectomy were excluded if coexisting medical problems or complications prolonged hospitalization beyond 7 days. Mean patient age was comparable (open cholecystectomy = 47.3 +/- 2.9, laparoscopic cholecystectomy = 46.5 +/- 2.7 years), as was the incidence of other significant medical problems. Average duration of hospitalization was significantly longer for open cholecystectomy (3.6 = 0.2 days) than for laparoscopic cholecystectomy (1.0 +/- days, p less than .001). Average hospital charges for open cholecystectomy were $5606 +/- 496 and for laparoscopic cholecystectomy $4726 +/- 98. Hospital charges from operating room and recovery room charges alone were $2684 +/- 131 for laparoscopic cholecystectomy and $2196 +/- 113 for open cholecystectomy. These operating room charges represent a significantly higher percentage of total hospital charges for laparoscopic cholecystectomy than open cholecystectomy patients (laparoscopic cholecystectomy = 56.3 +/- 1.9%, open cholecystectomy = 41.2 +/- 1.5%, p less than .05). Average time for return to work or normal activity was significantly shorter for laparoscopic cholecystectomy 8.6 +/- 9 days) than for open cholecystectomy (32.4 +/- 3.6 days, p less than .001). The authors conclude that laparoscopic cholecystectomy is a cost effective procedure for the treatment of symptomatic cholelithiasis, and that increased operative costs more than offset the significantly decreased length of hospitalization.

Adult↗
PubMedDate not supplied

Gallstones and laparoscopic cholecystectomy.

The National Institutes of Health Consensus Development Conference on Gallstones and Laparoscopic Cholecystectomy brought together surgeons, endoscopists, hepatologists, gastroenterologists, internists, radiologists, and epidemiologists as well as other health care professionals and the public to address (1) the indications for treatment of patients with gallstones; (2) the role of laparoscopic cholecystectomy in treating patients with gallstones; (3) the role of alternative medical and surgical treatments for gallstones; (4) the comparative results of laparoscopic cholecystectomy with open cholecystectomy and other available treatments; (5) techniques for detecting and treating bile duct stones with or without laparoscopic cholecystectomy; and (6) future directions for research in prevention and management of gallstone disease and in laparoscopic cholecystectomy. Following 2 days of presentations by experts and extensive discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) most patients who experience symptoms of gallstones should be treated; (2) in comparison with open cholecystectomy, laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gallstones and has become the treatment of choice for many patients; (3) patients who are not good candidates for laparoscopic cholecystectomy include those with generalized peritonitis, septic shock from cholangitis, severe acute pancreatitis, endstage cirrhosis, and gallbladder cancer; (4) laparoscopic cholecystectomy decreases pain and disability without increasing mortality and morbidity and can be performed at an equal or lower cost than open cholecystectomy; and (5) every effort should be made to ensure that surgeons performing laparoscopic cholecystectomy are properly trained and credentialed. The full text of the consensus panel's statement follows.

Bile Acids and Salts↗
PubMed1992

Laparoscopic bowel resection: advantages and limitations.

Laparoscopic surgery has been successfully employed for many years by gynecologic surgeons. Over the last several years, a tremendous increase in the enthusiasm towards laparoscopic surgery has reached the general and colorectal surgical communities. This enthusiasm was initially directed towards laparoscopic cholecystectomy but subsequently has expanded to laparoscopic appendectomy and laparoscopic bowel resection. Currently, laparoscopic bowel surgery is undergoing critical appraisal. Through meaningful prospective data retrieval, answers are being obtained to questions dealing with the efficacy and utility of this technique for colorectal diseases. Specifically, although laparoscopic colorectal surgery is feasible, one cannot definitively attest to its superiority over or even equivalence to standard open laparotomy at the present time. However, in small select series, including our own, our preliminary experience indicates that laparoscopic surgery may well, in the near future, be an acceptable substitute for standard laparotomy. This article will discuss the techniques of, instrumentation for, and preliminary results with a program of laparoscopic bowel resection.

Adolescent↗