Elective laparoscopic cholecystectomy for "all-comers"

Wilson, Paul; Leese, T; Morgan, William P.; Kelly, J. F.; Brigg, J.K.

doi:10.1016/0140-6736(91)90674-e

Cited by 72 publications

(28 citation statements)

References 8 publications

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“…Except for bile duct injury, the complications of LC are considerably less than for OC (Tables 3 and 4); this is particularly true for pulmonary and cardiac complications, which are frequently expensive. Although the incidence of wound (188,191,(212)(213)(214) The foregoing implies that ESWL and BAT will be less competitive against LC than they are against OC. Although the exact figure of comparative costeffectiveness among these procedures is not yet known, this information will affect current recommendations.…”

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confidence: 96%

Cholecystolithiasis: Lithotherapy for the 1990S

Strasberg

Clavien

1992

Hepatology

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Cholelithiasis afTects from 10% to 15% of the adult population in industrialized Western countries, with higher prevalence in women, in women with high parity, in the obese, in patients with hypertriglyceridemia and in older patients (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In the United States, it has been estimated that 20 to 25 million people have gallstones, and more than 500,000 cholecystectomies are performed annually. Cholecystectomy is the most frequently performed surgical procedure, after cesarean section in this country (141, with an annual cost estimated at $4 to 5 billion. About a quarter of all women will experience cholelithiasis by age 60 in industrialized Western societies; the prevalence in men is about half that of womenThe fist effective treatment for cholelithiasis was cholecystostomy (15, 161, a procedure that was abandoned in the early decades of this century because of the high incidence of stone recurrence. Open cholecystectomy (OC) was introduced more than 100 yr ago (17) and remained the sole effective treatment of this disease for about 90 yr. During this period, the only decision that was required for a patient with cholelithiasis was whether treatment was indicated or not. In the last two decades several new treatments, such as oral bile acid therapy (BAT), extracorporeal shock wave lithotripsy (ESWL) and, more recently, laparoscopic cholecystectomy (LC) have become available. Therefore, it is now not only necessary for physicians to decide whether to treat gallstones but also to recommend the most suitable type of treatment. The purpose of this work is to present an evaluation of the newer therapies (mainly in comparison with OC) including the basis for selection of therapy in individual patients. CLINICAL STAGES OF CHOLELITHIASISCholelithiasis has three clinical stages: the asymptomatic and symptomatic stages and the stage of complications. Complicated forms of cholecystolithiasis include acute cholecystitis and its complications, choledocholithiasis and its complications, gallstone ileus and gallbladder cancer. These complications are much 31/1/40081 more serious than symptomatic cholelithiasis and usually require prompt and invasive treatment. Treatment of the complicated forms of cholelithiasis will not be considered in this work, but it should be noted that it is the avoidance of such complications that constitutes an important rationale for therapy in the symptomatic stage or even under special circumstances in the asymptomatic stage (18)(19)(20)(21)(22)(23)(24)(25).Of critical importance in making recommendations about treatment is knowledge of the natural history of cholelithiasis (i.e., the rate of conversion from the asymptomatic stage to the other stages). Such information is necessary to weigh the risk of expectant management against the hazards of treatment. Historical series on the natural history of gallstones have yielded controversial results, mainly because of the inclusion of many patients with biliary symptoms at the start of the study; this distorts the resu...

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confidence: 96%

Cholecystolithiasis: Lithotherapy for the 1990S

Strasberg

Clavien

1992

Hepatology

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“…18 With increasing experience and expertise in laparoscopic cholecystectomy, however, the concerns about performing the operation in inflamed tissue has become less relevant.…”

Section: Discussionmentioning

confidence: 99%

A clinical study on diagnostic, clinicopathological correlation of acute cholecystitis

2018

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Background: Acute cholecystitis (AC) one of the common surgical emergency. Thorough understanding of the profile of clinical presentation may help in clinical decision making in resource poor settings. Hence the present study is conducted with the objectives to study the clinico pathological profile of acute cholecystitis cases presenting to a tertiary care teaching hospital and to describe the management and complications.Methods: A prospective observational study was conducted in the department of emergency and general surgery of Dhanalakshmi Srinivas medical college and hospital. The study included 50 clinically confirmed cases of acute cholestasis presented between June 2017 to December 2017.Results: A total of 50 subjects were included in the final analysis. The highest proportion of subjects were in 46 to 50 years (28%) or 51 and above (26%) age groups. Females (56%) outnumbered males (44%). Right hypo chondral tenderness (100%) was the most common clinical presentation. The proportion of calculous and acalculous cholecystitis was 84% and 14% respectively, remaining 2% of cases were malignancies. The proportion of emergency and elective surgeries were 12% and 88% respectively. The most common organism cultured was E. coli in 24%, Staph, aureus in 14%, salmonella in 2% of the population. Post-operative wound infection was more commonly seen in culture positive cases.Conclusions: Health care practitioners at various levels need to have a good understanding of varied clinical presentation of acute cholecystitis and different management options, their advantages, and disadvantages to be able to treat the condition effectively.

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“…L aparoscopic cholecystectomy is now being considered the new "Gold Standard" for the treatment of symptomatic gallstone disease in the west since 80-90 per cent of their patients are being operated by this technique [1][2][3][4], and a number of reports have shown that even patients with acute cholecystitis, Mirizzi's syndrome, cholecystocolic fistulae and pregnancy can be safely operated upon by this technique [5][6][7][8]. A higher rate of complications and conversion to open operation are reported to occur early in the learning curve, mostly during a surgeon's first dozen laparoscopic cholecystectomies, and in hospitals which have done less than a 100 procedures [9][10].…”

Section: Introductionmentioning

confidence: 99%

Our First Hundred Laparoscopic Cholecystectomies

Sharma

Rangan

Choubey

1998

Medical Journal Armed Forces India

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Hundred patients with symptomatic gallstone disease underwent laparosopic cholecystectomy between June 1996 and August 1997. There were 78 females and 22 males, with a mean age of 46.2 (SO 17.8; range 21 to 85) years. The common presentations were right upper abdominal pain (n=66), acute cholecystitis (n=8) and history of jaundice (n=II). Sixteen patients underwent ERCP for suspected CBO stones. Endoscopic papillotomy and basketing cleared the CBO of all calculi in 12. Three patients required c'Jnversion to open cholecystectomy because of dense adhesions (n=2) and to control intraoperative haemorrhage (n=I). Mean operating time was 67.2 (SO 39.2; range 22 to 186) minutes. The mean requirement of analgesics was 2.8 (SO 1.3; range 2 to 5) doses and post-operative hospital stay was 1.6 (SO 1.4; range I to 7) days. All patients resumed normal activity within 14 days of operation and are well and satisfied with their operation at a median follow up of8.6 months. MJAFI 1998; 54: 185-187

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Elective laparoscopic cholecystectomy for "all-comers"

Cited by 72 publications

References 8 publications

Cholecystolithiasis: Lithotherapy for the 1990S

Cholecystolithiasis: Lithotherapy for the 1990S

A clinical study on diagnostic, clinicopathological correlation of acute cholecystitis

Our First Hundred Laparoscopic Cholecystectomies

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