Laparoscopic Cholecystectomy Versus Mini-Laparotomy Cholecystectomy

Ros, Axel; Gustafsson, Lennart; Krook, Hans; Nordgren, Carl-Eric; Thorell, Anders; Wallin, Göran; Nilsson, Erik

doi:10.1097/00000658-200112000-00005

Cited by 151 publications

(100 citation statements)

References 23 publications

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“…In both trials, conversion to open cholecystectomy was necessary for more than 20% of the patients [9,10]. In contrast, among patients with uncomplicated gallstone disease (i.e., without CBD stones or need for ES), the conversion rate for LC is known to be 3% to 5% [2,18,20,21,[23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

et al. 2008

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Background According to the literature, the conversion rate for laparoscopic cholecystectomy (LC) after endoscopic sphincterotomy (ES) for cholecystodocholithiasis reaches 20%, at least when LC is performed 6 to 8 weeks afterward. It is hypothesized that early planned LC after ES prevents recurrent biliary complications and reduces operative morbidity and hospital stay. Methods All consecutive patients who underwent LC after ES between 2001 and 2004 were retrospectively evaluated. Recurrent biliary complications during the waiting time for LC, conversion rate, postoperative complications, and hospital stay were documented. Results This study analyzed 167 consecutive patients (59 men) with a median age of 54 years. The median interval between ES and LC was 7 weeks (range, 1-49 weeks). During the waiting time for LC, 33 patients (20%) had recurrent biliary complications including cholecystitis (n = 18, 11%), recurrent choledocholithiasis (n = 9, 5%), cholangitis (n = 4, 2%), and biliary pancreatitis (n = 2, 1%). Of these 33 patients, 15 underwent a second endoscopic retrograde cholangiography (ERC). The median time between ES and the development of recurrent complications was 22 days (range, 3-225 days). Most of the biliary complications (76%) occurred more than 1 week after ES. Conversion to open cholecystectomy occurred for 7 of 33 patients with recurrent complications during the waiting period, compared with 13 of 134 patients with an uncomplicated waiting period (p = 0.14). This concurred with doubled postoperative morbidity (24% vs 11%; p = 0.09) and a longer hospital stay (median, 4 vs 2 days; p \ 0.001). Conclusion In this retrospective analysis, 20% of all patients had recurrent biliary complications during the waiting period for cholecystectomy after ES. These recurrent complications were associated with a significantly longer hospital stay. Cholecystectomy within 1 week after ES may prevent recurrent biliary complications in the majority of cases and reduce the postoperative hospital stay.Keywords Biliary complications Á Cholecystectomy Á Common bile duct Á Conversion rate Á Endoscopic sphincterotomyOf the patients presenting with cholecystolithiasis, 4% to 15% have concomitant common bile duct (CBD) stones [1][2][3]. The current standard of treatment for symptomatic

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Section: Discussionmentioning

confidence: 99%

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

et al. 2008

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“…However, we feel that this has little bearing on the 'mini' approach, which results in far less morbidity than the conventional operation. In all probability, a more valid comparison is available in several reports comparing mini approaches for cholecystectomy and laparoscopic cholecystectomy [16]. In a large randomized single-blinded control Swedish study of >700 patients, there was no difference between the mini and laparoscopic cholecystectomy, apart from the laparoscopic approach being more expensive [17].…”

Section: Discussionmentioning

confidence: 99%

“…MAU was used in 112 patients (mean age 38 years, range 26-57) between 1991 and 2001; the mean (range) stone size was 12 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)) mm, with 30 stones in the upper, 69 in the mid-and 13 in the lower ureter. In 15 patients the stones were impacted and there were signs of infection in the proximal ureter.…”

Section: Methodsmentioning

confidence: 99%

Open mini‐access ureterolithotomy: the treatment of choice for the refractory ureteric stone?

2003

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RESULTSMAU was successful in 111 patients; the one failure was caused by proximal stone migration early in the series. The mean (range) operative duration was 28 (10-44) min and the hospital stay 42 (24-72) h; 33 patients were in hospital for 24 h, 72 for 48 h and seven for 72 h. The blood loss was minimal, at 50 (30-150) mL. The drain was removed after 5 (5-7) days. Patients reported using opioid or nonsteroidal anti-inflammatory analgesia for a mean of 4 (1-7) days after surgery. The mean time to resumption of work was 16 (8-35) days. CONCLUSIONSMAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first-line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first-line treatment. KEYWORDS mini-access, ureterolithotomy, technique, complications, indications, surgeon OBJECTIVETo report the experience in one centre of the efficacy and safety of open mini-access ureterolithotomy (MAU) and to discuss relevant current indications. PATIENTS AND METHODSMAU was undertaken in 112 patients (mean age 38 years, range 26-57) between 1991 and 2001; the details and outcomes are reviewed. The mean (range) stone size was 12 (8-22) mm, with 30 stones in the upper, 69 in the mid-and 13 in the lower ureter. In 15 cases the stones were impacted and there were signs of infection in the proximal ureter.

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“…Four SRs (ANDEM, 1994;Downs, 1996;Korolija, 2004;Keus, 2006a;Keus, 2006b), two RCTs (Mimica, 2000;Ros, 2001), three cohort studies (Devereaux, 2005;Elder, 1996;Finan, 2006), one CPG (Zacks, 2002), one cross-sectional study (Collet, 1997) and one case series (Ibrahim, 2006) were included. One SR concluded that laparoscopic techniques take longer than conventional techniques.…”

Section: Effectiveness Of Laparoscopic Cholecystectomymentioning

confidence: 99%

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

et al. 2010

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SUMMARY:The aim of the present study was to evaluate the available evidence on the effectiveness of laparoscopic surgery for treating gallstones and common bile duct lithiasis (CBDL). A systematic overview was performed. Medline, EMBASE and The Cochrane Library were searched (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Systematic reviews (SR), clinical practice guidelines (CPG), randomised clinical trials (RCT) and observational studies were included. Internal validity and overall quality of the evidence were assessed. The available evidence was classified according to the Oxford Centre for Evidence Based Medicine proposal. 87 studies were included in this review (12 SR, 23 RCT, 3 CPG, 13 cohort studies, 3 cross-sectional studies, 2 case and control studies and 31 case series). Compared with open cholecystectomy, laparoscopic cholecystectomy (LC) is associated with shorter operating time, shorter hospital stay and better quality of life (high quality evidence). The use of antibiotic prophylaxis does not appear to reduce the infection rate in low-risk patients (high quality evidence). Although many techniques have been advocated to perform LC their effectiveness is as yet inconclusive (low-quality evidence). Two-stage surgery is the most appropriate strategy for high-risk patients with CBDL (high-quality evidence). Mortality is similar to open surgery, as the effectiveness is similar to that of endoscopic treatment (high-quality evidence). As a conclusion we can state that the evidence concerning the effectiveness of laparoscopic surgery for gallstones and CBDL is scarce and of low methodological quality and that better quality studies are warranted to assess these techniques more adequately.

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Laparoscopic Cholecystectomy Versus Mini-Laparotomy Cholecystectomy

Abstract: Operating time was longer and convalescence was smoother for LC compared with MC. Further analyses of LC versus MC are necessary regarding surgical training, surgical outcome, and health economy.

Cited by 151 publications

References 23 publications

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

Open mini‐access ureterolithotomy: the treatment of choice for the refractory ureteric stone?

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

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