Laparoscopie Cholecystectomy Treatment of Choice for Symptomatic Cholelithiasis

Abstract

Our initial experience with laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis has involved 152 patients. Patient age ranged from 17 to 83 years; most were female (78%). Their average weight was 170 pounds (range, 75 to 365 lbs.). Twenty-two per cent had a single gallstone, while 9% had two to three stones and 64% had more than three stones. Exclusion criteria initially included upper abdominal scarring, severe acute cholecystitis, choledocholithiasis, and inability to tolerate general anesthesia. The first two of these are now only relative contraindications with increased experience. Thirteen of the one hundred fifty-two procedures (8.5%) required conversion to an open operation. Average time of operation was 138 minutes. Intraoperative cholangiography was attempted in 78% of cases and was completed successfully in 66% of those attempted. There have been no deaths. The complication rate has been low: 4% major, 0% life-threatening, and 7.2% minor complications. Postoperative analgesic requirements are remarkably low: 36% of patients required no narcotics after leaving the recovery room. Eighty-seven per cent of patients successfully undergoing LC were discharged by the first postoperative day. Most patients resumed normal activities within 1 week after discharge. Laparoscopic cholecystectomy offers the majority of patients with symptomatic cholelithiasis an improved treatment option, resulting in significantly less postoperative pain, hospitalization, and recuperation time.

Laparoscopic Cholecystectomy: A Retrospective Four-Year Study

“…In this study the mean length of hospitalization was 1.6 days, which was comparable with the similar studies (1 -4 days) (6,7,(11)(12)(13)(17)(18)(19). Some factors can influence the operative time, such as acute phase of cholecystitis, higher BMI level, previous upper abdominal surgery, male gender, and surgical expertise.…”

“…In this study, the mean operative time was 70 minutes, which was fair compared with other studies. Similar studies have reported different mean operative time ranging from 61 minutes to 149 minutes (7,12,18,20).…”

Effects of Open vs. Laparoscopic Cholecystectomy on Oxidative Stress

“…From the beginning, laparoscopic cholecystectomy (LC) has been the pacemaker of this development. Elective LC, using the pneumoperitoneum or wall-lifting techniques, has become the gold standard for symptomatic cholelithiasis and the first choice for treatment of this disease in nearly all surgical clinics (Schirmer et al 1991;Kitano et al 1993;Niomiya et al 1998;Ogawa et al 2001). Therefore, laparoscopic cholecystectomy is the most common minimally invasive procedure.…”

The Benefits of Percutaneous Transhepatic Gallbladder Drainage prior to Laparoscopic Cholecystectomy for Acute Cholecystitis

“…12,13 However, with the development of greater technical skills and superior laparoscopic instruments, the number of surgical teams that apply laparoscopic cholecystectomy first in acute cholecystitis patients is increasing. While laparoscopic cholecystectomy has gained a leading role in the treatment of acute cholecystitis despite its reportedly high rates of conversion to open surgery, the optimal timing for laparoscopic cholecystectomy in patients with acute cholecystitis has been a matter of controversy during the few past decades.…”

“…Thus, elderly patients who had more general risk factors and were at an increased surgical risk, as well as those with acute cholecystitis of a greater severity, were selected for PTGBD. Spira et al 13 categorized severe cholecystitis-induced symptoms and advanced age as indications for PTGBD prior to laparoscopic cholecystectomy. Interestingly, the average body temperature ( o C) was 37.39±0.9 in the PTGBD group and 36.90±0.4 in the non-PTGBD group (p=0.001).…”