Complications of laparoscopic cholecystectomy

Lee, Vivian S.; Chari, Ravi S.; Cucchiaro, Giovanni; Meyers, William C.

doi:10.1016/s0002-9610(05)80955-9

Cited by 138 publications

(65 citation statements)

References 17 publications

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“…However, the intraperitoneal application of bupivacaine 0.25% combined with morphine, at the end of surgery is effective in achieving reduction in pain (36,37,38).…”

Section: Discussionmentioning

confidence: 99%

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Ivanov

Veljkova

2011

JHSCI

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Introduction: Intraperitoneal administration of local anesthetic in combination with an opioid, for the relief of postoperative pain, has already been reported after laparoscopic cholecystectomy. This study aimed to assess the analgesic effect of the intraperitoneal administration of bupivacaine and morphine, in patients undergoing laparoscopic cholecystectomy. Methods: 90 patients (30 patients in each group) were included in a double blind, randomized manner. At the end of laparoscopic cholecystectomy, the patients were intraperitoneally treated with 30 ml of: physiological saline (Group 1) or 0.25% bupivacaine (Group 2) or 0.25% bupivacaine + 2 mg morphine (Group 3). Patient's postoperative pain was evaluated using a visual analogue scale and a verbal rating score. The postoperative analgesic requirement was assessed by the total dose of Ketorolak, administered by intravenous or intramuscular route. Pain, vital signs, supplemental analgesics consumption and side effects were recorded for all patients for 12h. Results: There were no difference between the three groups, regarding pain scores (et rest and coughing) during the study, except in the fi rst 6 h, when scores were lower for patients receiving intraperitoneal bipuvacaine + morphine (p<0.05). Conclusions:In the patients undergoing laparoscopic cholecystectomy, the intraperitoneal administration of bupivacaine + morphine, reduced the analgesic requirements during the fi rst 6 postoperative hours compared with the control groups. The combination of intraperitoneal bupivacaine 0.25% and morphine was more effective for treatment of pain after laparoscopic cholecystectomy.

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“…However, the intraperitoneal application of bupivacaine 0.25% combined with morphine, at the end of surgery is effective in achieving reduction in pain (36,37,38).…”

Section: Discussionmentioning

confidence: 99%

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Ivanov

Veljkova

2011

JHSCI

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“…The initial pneumoperitoneum formed in the LC was created classically with the VN, which was due to the apprehension to avoid damage to intra-abdominal formations during trocar insertion. However, the VN has been reported not to be a complete intervention without a complication [15][16]. An initial intra-abdominal injury was reported after a successful pneumoperitoneum with the VN [17].…”

Section: Discussionmentioning

confidence: 99%

The First Trocar Entry in the Laparoscopic Cholecystectomy, Which Technique?

Karaca¹,

Çapar²,

Ali³

2014

Ann Clin Anal Med

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ÖzetAmaç: Laparoskopik cerrahide sık kullanımı olan verees needle(VN) ve direct trokar(DT) insertion tekniklerini prospektif randomize bir klinik çalışma ile karşılaştırmayı planladık. Gereç ve Yöntem: Laparoskopik kolesistektomi uygulanan 400 hasta bu prospektif randomize klinik çalışmaya dahil edildi. İs-tatistiksel analiz için SPSS 17.0 (SPSS Inc., Chicago, IL). kullanıldı. İnsfluas-yon teknik komplikasyonları 2 grupta incelendi. Major komplikasyonlar olarak açık ameliyata geçilmesini gerektiren durumlar (mesenterik laserasyon, kanama, organ perforasyonu, solid organ yaralanması ve damar yaralanmaları), ve minör komplikasyonlar (subcutan amfizem, extraperitoneal insflulasyon) hastanede kalış süresini değiştirmeyen faktörler olarak belirlendi. Bulgular: Her iki grupta da mortalite gözlenmezken grupler arasında ortalama yaş, erkek-kadın oranı, BMI ve ameliyat süreleri açısından bir fark gözlenme-di. 33 adet minör komplikasyon gözlendi. Bu komplikasyonların 27 Tanesi VN grubunda gözlenirken, DT grupta 6 minör komplikasyon gözlendi. VN grupta 3 adet major komplikasyon görülürken, DT grubunda major komplikasyon 1 adet gözlendi. Tartışma: Pneumoperitoneum kapalı olarak gerçekleştirilecek ise DT sokulması ile VN sokulması arasında güvenlik açısından bir fark yoktur. Anahtar KelimelerLaparoskopi; Trokar Abstract Aim: We planned a comparison of veress needle (VN) and direct trocar (DT) insertion techniques, which have been commonly used in laparoscopic surgical procedures, via a prospective randomized clinical study. Material and Method: 400 patients who had undergone laparoscopic cholecystectomy were included to the present prospective randomized clinical study. SPSS 17.0 (SPSS Inc., Chicago, IL) was used for the statistical analysis. Insufflation-related technical complications were investigated in two groups. The cases requiring open surgery (mesenteric laceration, bleeding, organ perforation, solid organ injury and blood vessel injuries) were determined as major complications. Minor complications (subcutaneous emphysema, phison and extraperitoneal insufflation) were established as factors not changing the length of hospital stay. Results: Mortality was not observed in both groups. There was no difference between the groups with respect to mean age, male to female ratio, BMI and duration of surgery. 33 minor complications were detected. 27 of these complications were observed in the VN group, whereas the number of minor complications seen in the DT group was 6. Major complications seen in the VN and DT groups were respectively 3 and 1. Discussion: If pneumoperitoneum is established by close method, there is no safetyrelated significant difference between the insertion of DT and VN.

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“…20,21 It can be argued that morbidly obese patients are at higher risk for complications compared to the general population. Including costs for surgical complications in this analysis would have a bigger impact on the placebo arm, thus favoring ursodiol.…”

Section: Costsmentioning

confidence: 99%

Estimation of the cost savings resulting from the use of ursodiol for the prevention of gallstones in obese patients undergoing rapid weight reduction

1997

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BACKGROUND: Morbidly obese patients enrolled in a rapid weight reduction program are at a high risk of developing gallstones. Two multicenter, placebo-controlled, randomized, double-blind trials have demonstrated that the prophylactic use of ursodiol in males and femals 18 to 70 years of age is effective for the prevention of gallstone formation in this patient population. This study examines the cost consequences associated with the prophylactic use of ursodiol. METHODS: A medical decision analysis model for the prophylactic administration of ursodiol in morbidly obese patients undergoing rapid weight reduction by either gastric bypass surgery or very-low-calorie-diet, was developed through the use of data from two clinical trials and review of the related literature. The expert opinion of clinicians from the ®elds of internal medicine, gastroenterology and surgery were solicited. Financial data for the charges associated with cholecystectomies, physician fees and ursodiol were obtained from current ®nancial databases. RESULTS: The model demonstrates that the prophylactic administration of ursodiol, in morbidly obese patients undergoing rapid weight reduction, results in cost savings. Sensitivity analysis was performed to illustrate that the cost savings achieved by the prophylactic use of ursodiol were valid over a realistic range of charges and assumptions. CONCLUSION: The decision model may allow health care decision makers to apply their own data to the model to determine the cost savings obtainable through the prophylactic use of ursodiol in patients undergoing rapid weight reduction.

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Complications of laparoscopic cholecystectomy

Cited by 138 publications

References 17 publications

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

The First Trocar Entry in the Laparoscopic Cholecystectomy, Which Technique?

Estimation of the cost savings resulting from the use of ursodiol for the prevention of gallstones in obese patients undergoing rapid weight reduction

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