The evolution of postoperative ileus after laparoscopic cholecystectomy

Summary Our study is prompted by the arrival of laparoscopic cholecystectomy in connection with the evolution of postoperative ileus (PI) and by its avoidance of the intraabdominal handling implied in conventional cholecystectomy.With this aim a prospective, controlled, randomized, and blind clinical trial was designed using 100 patients divided into five groups (n=20): I, conventional cholecystectomy (CC); II, CC + injection of 20 ml bupivacaine 0.5% into the mesentery root; III, CC + 7.5 mg propanolol i.v. and 0.5 mg neostigmine s.c., postoperatively until the first defecation; IV, II + III; and V, laparoscopic cholecystectomy.The shortest period of PI was observed in group V. This period increases notably in group IV (53 h), group II (72 h), and group III (84 h) relative to the control group with (89 h). This reduction in PI time runs parallel with an improvement in the patient's general state of well-being.We concluded that after laparoscopic cholecystectomy PI is nonexistent. Furthermore, this study confirms the correlation between the avoidance of intraabdominal manipulation and the evolution of postoperative ileus.     

Case report: an unwanted leftover after laparoscopic cholecystectomy

Background: A 72-year-old female patient with a history of laparoscopic cholecystectomy presented at the gastroenterology consultation with intermittent complaints of abdominal pain since two months in the right hemi abdomen.

Methods: Imaging discovered a subhepatic abscess. Explorative surgery showed multiple gallstones as the cause of the abscess. A brief literature study was conducted and after a thorough selection based on title and abstract, we ended up with 14 articles. These were compared in the discussion with the literature concerning incidence, range of complications, risk factors and prevention and management.

Results: Spilled gallstones are an unusual complication of a frequently performed procedure.

Conclusions: This case report elaborates on the incidence, different complications, prevention and management of spilled gallstones by means of a brief literature study. In case spillage happens removal of as many gallstones as possible is indicated the spillage should also be communicated to the patient to ease the diagnosis of a possible complication.     

Large postoperative umbilical hernia following laparoscopic cholecystectomy

The authors report a case of large postoperative umbilical hernia following laparoscopic cholecystectomy, which occurred in the early postoperative period despite primary suture of the trocar insertion site. Forced dilation of the fascial layer is proposed as the etiological mechanism. This procedure should be avoided and an accurate and aseptic removal of the gallbladder should be performed in order to prevent risk of abdominal wall weakness and visceral herniation.     

腹腔镜与开腹胆囊切除术的住院费用对比

目的　比较腹腔镜与开腹胆囊切除术的住院费用。　方法　LC开展初期 ( 1991年 )和成熟期 ( 2 0 0 0年 )选取LC10 0例与同一时期开腹胆囊切除术 (OC) 10 0例住院费用进行对比分析。　结果　LC开展初期 ,LC组住院费用总费用( 2 575 86± 2 61 61)元明显高于OC组 ( 12 40 61± 3 82 67)元 (t=2 8 80 5,P <0 0 0 1) ,主要与手术及材料费用高 (t =199 83 3 ,P <0 0 0 1)有关。LC开展成熟期 ,LC组住院费用总支出 ( 583 3 0 0± 464 97)元明显低于OC组 ( 7489 2 6± 2 491 2 4)元 (t=6 53 5,P <0 0 0 1) ,虽然手术及材料支出仍高 (t=17 0 2 9,P <0 0 0 1) ,但药品、床位、检查等项均低于OC组 (t值分别为 8 83 9、12 0 0 5、6 2 0 3 ,P <0 0 0 1)。　结论　随着LC技术的成熟 ,费用降低已成为其一大特点     

Preincisional local anesthesia with bupivacaine and pain after laparoscopic cholecystectomy

Summary The aim of this study was to investigate whether local anesthesia of abdominal wall wounds prior to laparoscopic cholecystectomy leads to decreased pain beyond the immediate postoperative period and thus improves the comfort of the patient. In a randomized, double-blind study 50 patients scheduled for laparoscopic cholecystectomy were divided into two groups. In one group (n=25) the skin, subcutis, fascia, muscle, and preperitoneal space were infiltrated with 8 ml of bupivacaine 0.5% 5 min before each abdominal wall incision. The control group (n=25) received normal saline.The intensity of pain was assessed by a 100-point visual analogue scale (VAS) at rest and during movement and by the consumption of analgesics. Analgesic therapy was provided by on-demand analgesia with piritramid intravenously for 24 h and continued by ibuprofen orally on request.The mean intensity of pain at rest and during movement was lower but not statistically significant in patients who received bupivacaine compared to the control group up to the second postoperative day. The difference was between 4 and 9 VAS points and therefore of doubtful clinical relevance. Similar statistically nonsignificant results were found for the mean consumption of piritramid up to 16 h after the operation. Three patients (12%) in the bupivacaine group localized the most severe pain up to the second postoperative day to the right lower abdominal wall wound where the gallbladder had been extracted compared to 11 patients (44%) of the control group (P=0.012). These results indicate that bupivacaine was effective at the site where it was administered. However, preincisional local anesthesia of the abdominal wall wounds in laparoscopic cholecystectomy does not lead to a significant clinical benefit for the patient.     

Bile causing an acute scrotum immediately after laparoscopic cholecystectomy.

We report our experience with a patient that developed an acute right hemiscrotum immediately after undergoing an uncomplicated laparoscopic cholecystectomy for gallbladder dyskinesia. The etiology of the acute scrotal pain was due to bile which was spilled into the peritoneum after entry into the gallbladder during dissection. The bile obtained access to the right hemiscrotum via a communicating hydrocele. To the best of our knowledge this is the first report of bile causing an acute scrotum following laparoscopic surgery. A review of the current literature on the topic of the postoperative acute scrotum follows our case presentation.     

Is there a difference in laparoscopic cholecystectomy performed in a teaching hospital or a general hospital in The Netherlands?

Introduction: Laparoscopic cholecystectomy may have a complicated course with severe complications such as bile duct injury. Studies in other countries than the Netherlands report ambivalent results regarding the influence of a residency program on patient safety, efficacy and financial consequences. This study aims to determine whether there is a difference between laparoscopic cholecystectomy performed in a teaching hospital or a non-teaching general hospital in Dutch clinics.

Materials and methods: A prospective cohort study was performed to examine the safety of laparoscopic cholecystectomies in a teaching hospital with a residency program and a general hospital without surgical residents. All consecutive cholecystectomies in these two hospitals between September 2014 and March 2015 were included. Patient characteristics, operative procedure, level of experience, operation time, per- and postoperative complications, mortality, length of hospital stay, re-admittance and conversions to laparotomy were analyzed.

Results: A total of 294 consecutive cholecystectomies were performed in both hospitals. Cholecystectomies performed in the teaching hospital took an average of 25?min longer to complete compared with a non-residency setting. Both the number of conversions and the number of re-admissions were not significantly different between both clinics. The residency program showed smaller peroperative liver lesions along with more postoperative complications, with most complications in patients that required a conversion.

Discussion: Current practice where residents perform supervised cholecystectomies should not be discouraged. We believe that is safe and lead to an acceptable increase in operation time.     

Giant gallstone performed by emergency laparoscopic cholecystectomy

INTRODUCTIONGallstone disease is very common, but the gallstone bigger than 5 cm in diameter is very rare. It is very challenging to be removed by laparoscopic cholecystectomy (LC) and poses extra difficulty in emergency.PRESENTATION OF CASEA 70-year-old man complained of abdominal pain in the right upper quadrant with fever of 38 °C for two days. Abdominal ultrasound indicated acute cholecystitis and a single, extremely large gallstone (95 mm × 60 mm × 45 mm). Emergency laparoscopic cholecystectomy was performed successfully.DISCUSSIONGallstone over 5 cm in diameter is very rare. LC will be very difficult for these cases, especially for the emergency cases. Emergency laparoscopic cholecystectomy can be successfully performed with clear exposure of the anatomy of the Calot's triangle. To the best of our knowledge, such giant gallstone has been rarely reported.CONCLUSIONWe have proven that for the rare giant gallstone about 10 cm in size, LC is a feasible option if the anatomy of the Calot's triangle can be clearly exposed; otherwise, open cholecystectomy is a safe choice.     

The cost of laparoscopic versus open cholecystectomy in a community hospital

This retrospective study reviewed the hospital and professional costs, charges, and reimbursements for laparoscopic cholecystectomy (lap chole) and open cholecystectomy (open chole) and compared the two procedures. There was no significant difference in hospital costs between lap and open chole procedures; however, there were marked differences in the categories of costs for each procedure. The mean total (hospital and professional) charge was 8% greater for lap chole. The mean total (hospital and professional) reimbursement for patients with private insurance was 23% greater for lap chole, but no significant difference was seen for patients on Medicare or Medicaid. Lap chole patients returned to work 11 days sooner than open chole patients; this can result in a 69% decrease in short-term disability costs to employers. The clinical variables that significantly affect total charges and reimbursement are discussed.     

Timing of early laparoscopic cholecystectomy for acute cholecystitis

OBJECTIVE: Although many surgeons advocate early laparoscopic cholecystectomy (LC) in acute cholecystitis, debate still exists regarding its optimal timing. This study compares the outcome of LC performed within and after 72 hours of admission in patients with acute cholecystitis. METHODS: Between January 2001 and December 2006, LC was performed in 196 consecutive patients with acute cholecystitis. Laparoscopic cholecystectomy was performed within 72 hours of admission in 82 patients (group 1) and after 72 hours in 114 patients (group 2). Data were collected prospectively. RESULTS: Both groups were matched in terms of age, sex, body mass index, fever, white blood cell count, and ultrasound findings. The overall conversion rate was 5%. No significant difference existed in conversion rates between group 1 (2.4%) and group 2 (7%) (P=0.3). The operation time (105 versus 126 minutes, P=0.008), complications (0% versus 6%, P=0.02), and total hospital stay (5 versus 12 days, P<0.001) were significantly reduced in group 1. No deaths occurred in this study. CONCLUSION: Early LC can be performed safely in most patients with acute cholecystitis, but we recommend intervention within 72 hours of admission to minimize the complication rate and shorten the operation time and total hospital stay.     

Pain after laparoscopic cholecystectomy

It is postulated that laparoscopic cholecystectomy as patient-friendly surgery leads to more comfort and in particular to less pain. A prospective study on pain was performed on all patients undergoing the operation over the period of 1 year (n=382) out of a series of more than 1,000 patients who have undergone the operation in our clinic. Pain was measured by a 100-point visual analogue scale (VAS), by a five-point verbal rating scale, and by the consumption of analgesics. Pain was the most frequent symptom, both before and after the operation. The mean level of pain was 37 VAS points 5 h after the operation and declined to 16 points on the third day. In 106 patients (27.8%) the intensity of pain was higher than 50 VAS points. Analgesics were used by 282 patients (73.8%), opioids by 112 (29.3%). Pain was significantly higher in female than male patients (P<0.05), but consumption of analgesics was similar in both groups. The most severe pain was localized to the abdominal wall wounds by 157 (41.1%) and to the right upper abdomen by 138 patients (36.1%) on the first postoperative day. Patients who needed opioids and/or had a pain level of >50 VAS points (n=138) had higher preoperative pain levels (P=0.018) and preoperatively complained more frequently about nausea, vomiting, bloating, and a feeling of abdominal pressure (P=0.003–0.031). However, predictive values of these variables were too small to be of clinical benefit. The duration of operation, intraoperative events (loss of bile, blood, or gallstones), and additional laparoscopic procedures (adhesiolysis, lavage, extension of an incision, suture of fascia) did not influence the intensity of postoperative pain. We conclude that laparoscopic cholecystectomy did cause significant postoperative pain in one-third of our patients only up to the first postoperative day. As predictors for high intensity of pain were not identified, pain should be monitored and analgesics should be delivered liberally.     

吸烟对腹腔镜胆囊切除术后布托啡诺镇痛镇静的影响

目的观察吸烟对腹腔镜胆囊切除术患者术后布托啡诺镇痛镇静的影响。方法 200例行腹腔镜胆囊切除术男性患者,分为吸烟组(S组,n=100)和非吸烟组(NS组,n=100),术后均采用静脉布托啡诺镇痛。在术后1、2、6、12、18、24、48h分别采用数字评分法(NRS)和肌肉活动评分法(MAAS)评估镇痛和镇静程度。结果 S组术后1、2、6hNRS评分高于NS组,术后1、2hMAAS评分高于NS组(P<0.05)。结论吸烟患者行腹腔镜胆囊切除手术后,布托啡诺的镇痛和镇静效果弱于非吸烟患者。     

切口浸润麻醉复合帕瑞昔布静注用于腹腔镜胆囊切除术后镇痛

目的 探讨切口浸润麻醉复合帕瑞昔布对腹腔镜胆囊切除术(LC)后内脏痛的镇痛效果.方法 60例择期行LC患者随机均分为帕瑞昔布组(P组)、腹腔内局麻组(B组)和对照组(C组).P组于手术结束前约30 min静脉注射帕瑞昔布40 mg;B组于胆囊切除后在腹腔内喷洒0.25%布比卡因30 ml;C组于手术结束前约30 min静脉注射生理盐水.采用VAS评分记录患者术后1、4和24 h时内脏痛以及镇痛药的用量.结果 术后1、4 h时,P组的内脏痛VAS评分显著小于C组(P相似文献   

National survey on laparoscopic cholecystectomy in Spain

We present a joint study conducted by the Committee for Endoscopic Surgery in Spain. Sixty-nine surgeons reported 2,342 laparoscopic cholecystectomies (LCs) performed until November 1992. The conversion rate was 5.1%. The overall morbidity was 7.1%. The biliary morbidity was 0.45%: Seven severe bile duct injuries were recognized at laparoscopy (0.28%) and four lesions were postoperatively diagnosed (0.16%). Bile leak unrelated to bile duct lesion occurred in 14 patients (0.7%), leading to five reoperations. The mortality was 0.12% and was unrelated to the laparoscopic approach in two cases. The risk factors for biliary complications were obesity, previous history of jaundice, and previous hospital admissions.Surgeon experience was defined by 50 LCs performed, and the overall complication rate presented a statistically significant relation to surgeon experience (P<0.001).Study coordinatorsParticipating institutions: Hospital de Albacete (Albacete). Centro Médico de Asturias, Hospital Cabueñez, Hospital General de Asturias (Asturias). Centro Hospitalario Manresa, Clínica Corachan, Clínica Adria, Clínica la Cunila, Clínica Teknon, Hospital Clinic, Hospital de la Cruz Roja de Hospitalet, Hospital Sagrado Corazon, Hospital San Pau, Hospital Valle de Ebron, Instituto Dexeus (Barcelona). Hospital Naval San Carlos, Hospital San Rafael, Hospital Santa María del Puerto (Cadiz). Hospital Cruz Roja, (Ceuta). Clínica la Inmaculada (Granada). Hospital General de Galicia, Hospital Juan Canalejo (La Coruña). Hospital Nuestra Señora del Pino (Las Palmas). Hospital de Leon, Hospital Nuestra Señora de la Regla (Leon). Hospital Xeral Calde (Lugo). Hospital Clinico (Malaga). Clínica Ruber, Hospital de Getafe, Hospital de Mostoles, Hospital Severo Ochoa, Hospital Universitario San Carlos, Residencia Sanitaria La Paz (Madrid). Hospital General de Murcia, Hospital Los Arcos (Murcia). Clínica Nuestra Señora del Cristal (Orense). Policlínica Miramar (Palma de Mallorca). Policlínica Guipuzcoa (País Vasco). Hospital de Salamanca (Salamanca). Hospital Universitario de Canarias (Tenerife). Hospital General Universitario, Hospital Dr Peset (Valencia). Hospital de Galdacao (Vizcaya). Clínica Quiron Montpellier, Hospital Miguel Servet (Zaragoza)     

罗哌卡因局部麻醉减轻腹腔镜胆囊切除术后疼痛的临床观察

目的 观察腹腔镜胆囊切除术后应用罗哌卡因行局部麻醉对术后疼痛的缓解作用.方法 90例实施腹腔镜胆囊切除术患者,随机均分为三组:Ⅰ组用1%罗哌卡因10ml进行胆囊床喷洒;Ⅱ组用1%罗哌卡因5ml进行胆囊床喷洒,同时再用1%罗哌卡因5ml对三个切口进行局部注射,Ⅲ组为对照组.记录术后1、2、4、6、12、24 h的VAS.结果 术后1、2、4 h时,Ⅰ组和Ⅱ组的VAS显著低于Ⅲ组(P＜0.05),且Ⅱ组的VAS显著低于Ⅰ组(P＜0.05).术后6 h时,Ⅰ组和Ⅱ组的VAS显著低于Ⅲ组(P＜0.05),Ⅰ组和Ⅱ组差异无统计学意义.术后Ⅲ组需要哌替啶镇痛的患者数量显著多于Ⅰ组和Ⅱ组(P＜0.05).结论 罗哌卡因局部麻醉能显著减轻腹腔镜胆囊切除术后疼痛.     

老年患者全麻下腹腔镜胆囊切除术后转运途中的低氧血症

目的 探讨老年患者全麻下行腹腔镜胆囊切除术后转运途中低氧血症的发生。方法 术毕围拔管期连续监测SPO2，重点观察转运途中1、2、3、4、5min内有无低氧血症的发生。结果 100例中有15例SPO2降至≤92％，低氧血症发生率为15％(15／100)。结论 为防止老年患者术后从手术室到病房转运途中发生低氧血症，必须进行SNO2监测和持续吸氧治疗。     

Pre-emptive multimodal analgesic bundle with transversus abdominis plane block enhances early recovery after laparoscopic cholecystectomy

BackgroundAs postoperative pain after laparoscopic cholecystectomy may delay recovery and discharge, a multimodal and pre-emptive analgesic approach is necessary. This study demonstrated that a multimodal analgesic bundle improves postoperative recovery, using the Quality of Recovery-40K (QoR-40K) questionnaire during the first 24 h after laparoscopic cholecystectomy.MethodsIn this prospective non-randomized study with two parallel groups, 80 patients undergoing laparoscopic cholecystectomy were allocated into either the multimodal analgesia group or the conventional analgesia group. The multimodal analgesia group received a pre-emptive analgesic bundle (preoperative intravenous administration of paracetamol, ketorolac, and dexamethasone, and a posterior approach to the transversus abdominis plane block), while the conventional analgesia group did not. The primary outcome was the QoR-40K score during the first 24 h after surgery. Secondary outcomes were the peak visual analog scale pain score at rest and the incidence rates of rescue analgesic use and nausea/vomiting during the first 24 h after surgery.ResultsThe QoR-40K score was higher in the multimodal analgesia group than in the conventional analgesia group (196 [190–199] vs. 182 [172–187], p < 0.001). The peak visual analog scale pain score was significantly lower in the multimodal analgesia group than in the conventional analgesia group. Multimodal analgesia also reduced the incidence rates of rescue analgesic use and postoperative nausea/vomiting (22.5% [95% CI, 9.6–35.4%] vs. 55.0% [39.6–70.4%], p = 0.003), compared to conventional analgesia.ConclusionsMultimodal analgesia significantly improves the quality of early postoperative recovery after laparoscopic cholecystectomy, as shown by the QoR-40K score.     

Complications of laparoscopic cholecystectomy —An analysis of 2100 operations

European Surgery - Background Laparoscopic cholecystectomy (LC) is taking the place of an effective and tested procedure in surgery, therefore it must not be inferior to the standard modality in...     

Irrigation with bupivacaine at the surgical bed for postoperative pain relief after laparoscopic cholecystectomy

Purpose:

The aim of this study was to evaluate the effect of bupivacaine irrigated at the surgical bed on postoperative pain relief in laparoscopic cholecystectomy patients.

Methods:

This study included 60 patients undergoing elective laparoscopic cholecystectomy who were prospectively randomized into 2 groups. The placebo group (n=30) received 20cc saline without bupivacaine, installed into the gallbladder bed. The bupivacaine group (n=30) received 20cc of 0.5% bupivacaine in at the same surgical site. Pain was assessed at 0, 6, 12, and 24 hours by using a visual analog scale (VAS).

Results:

A significant difference (P=.018) was observed in pain levels between both groups at 6 hours postoperatively. The average analgesic requirement was lower in the bupivacaine group, but this did not reach statistical significance.

Conclusions:

In our study, the use of bupivacaine irrigated over the surgical bed was an effective method for reducing pain during the first postoperative hours after laparoscopic cholecystectomy.     

Optimal timing of elective laparoscopic cholecystectomy after acute cholangitis and subsequent clearance of choledocholithiasis

Background

Elective laparoscopic cholecystectomy is recommended after endoscopic clearance of choledocholithiasis for patients with acute cholangitis, according to Toyko guidelines. However, the optimal timing remains uncertain.

Methods

Perioperative outcomes were retrospectively reviewed and compared between patients with early (< 6 weeks) and late (> 6 weeks) surgeries, while risk factors for postoperative complications were assessed using multivariate analysis.

Results

One hundred twelve patients (mean age, 64 years; range, 30-85 years) were analyzed. Rate of conversion and intraoperative and postoperative complications (classified per Dindo et al) were 21.4% (24 of 112), 23.2% (26 of 112), and 34.8% (39 of 112), respectively. The late surgery group had significantly more intraoperative (28.8% vs 9.4%, P = .029) and postoperative (42.5% vs 15.6%, P = .007) complications compared with the early surgery group. Multivariate analysis showed both late surgery (95% confidence interval, 1.47-12.5; P = .008) and a history of endoscopic sphincterotomy (95% confidence interval, 1.06-8.26; P = .038) to be independent risk factors for postoperative complications.

Conclusions

Patients with endoscopic clearance of choledocholithiasis, especially after endoscopic sphincterotomy, should receive elective laparoscopic cholecystectomy within 6 weeks after a cholangitic attack.