Comparative evaluation of the inflammatory mediators in patients undergoing laparoscopic versus conventional cholecystectomy.

BACKGROUND: Injury induces systemic inflammatory response. The degree of response is proportionate to the trauma. METHODS: Patients with ultrasound-proven gall stones posted for operation were randomized into two groups. Laparoscopic cholecystectomy was performed in one group while the other group underwent conventional cholecystectomy. Peripheral venous blood samples for inflammatory mediators, namely tumour necrosis factor, C-reactive protein, oxygen release from monocytes and polymorphonuclear leucocytes were drawn 1 day before surgery and repeated on the first and third days after surgery. Partial pressure of arterial oxygen was also measured in both groups. Only patients who met selection criteria and had uncomplicated postoperative courses were included in the study.There was a total of 40 patients for the final analysis, 20 in each group. RESULTS: There was no significant difference (P > 0.1) in age, sex or body mass index in both groups of patients. The level of all of the inflammatory mediators was elevated on the first postoperative day; however, the elevation was significantly less following laparoscopic cholecystectomy compared to conventional cholecystectomy (P < 0.01). Although the values came down on the third postoperative day, they remained above the respective controls. Postoperative hypoxaemia was significantly more in patients of conventional than laparoscopic cholecystectomy (P < 0.001). CONCLUSIONS: Trauma-induced inflammatory response is significantly less following laparoscopic cholecystectomy compared to conventional cholecystectomy. It appears to be related to degree of trauma.     

Systemic response in patients undergoing laparoscopic cholecystectomy using gasless or carbon dioxide pneumoperitoneum: a randomized study

In general, laparoscopic cholecystectomy produces a surgical stress response very similar to which occurs after open cholecystectomy. The question is whether the pneumoperitoneum constitutes a significant pathophysiologic trauma, which might be followed by profound changes in the stress response. We conducted a prospective, randomized trial involving 50 consecutive patients scheduled for laparoscopic cholecystectomy, who had a body mass index equal to or less than 30 kg/m² with no acute cholecystitis, pancreatitis, or liver or renal disease. These patients were randomized to undergo either the gasless (GLC, n= 24) or the carbon dioxide pneumoperitoneum (CLC, n = 26) procedure. Perioperative assessment of cortisol, insulin, glucose, and C-reactive protein levels was the main determinant of outcome. During the operative procedure, significantly higher levels of serum cortisol and insulin were found in the CLC group than in the GLC group (P < 0.05). No difference in glucose levels was observed between the two groups. The inflammatory response was moderate in both groups. However, on postoperative day 1 the median C-reactive protein level was significantly higher in the GLC group than that in the CLC group (P < 0.05). Carbon dioxide and the positive intra-abdominal pressure during conventional laparoscopy may contribute to the activation of the surgical stress response. Supported by grants from Nordjyllands Amts Forskningsrad, Aalborgs Stifts Julelotteri and Det Obelske Familiefond.     

Timing of laparoscopic cholecystectomy for subacute calculous cholecystitis: early or interval--a prospective study

Background/Purpose The aim of this prospective study was to evaluate the safety and feasibility of early laparoscopic cholecystectomy for subacute cholecystitis and to compare it with interval laparoscopic cholecystectomy. Methods The study was performed in 74 patients who had been diagnosed with subacute cholecystitis between January 2000 and June 2005. The patients were divided into two groups. The early laparoscopic cholecystectomy group was composed of 31 patients who underwent laparoscopic cholecystectomy 24 h after admission to the hospital. The interval laparoscopic cholecystectomy group was composed of 43 patients who underwent laparoscopic cholecystectomy 8–12 weeks after medical treatment. Results There was no significant difference between the conversion rate, intraoperative bleeding, need for intraoperative cholangiography, minor bile duct injury, and postoperative complications in the two groups. Eleven patients in the interval group underwent urgent laparoscopic cholecystectomy or additional procedures because of recurrent cholecystitis, choledocholithiasis, or biliary pancreatitis. The early group had a significantly shorter total hospital stay (P = 0.031), lower cost of treatment (P = 0.042), and less difficulty with Calot's triangle dissection (P = 0.008). Conclusions Early laparoscopic cholecystectomy can be done without hesitation in patients with subacute cholecystitis, in the light of obstacles observed in the interval group, such as dissection difficulty, lack of success in “cooling down”, and additional problems such as choledocholithiasis and biliary pancreatitis.     

腹腔镜与开腹胆囊切除治疗急性结石性胆囊炎的临床分析

目的探讨腹腔镜与开腹胆囊切除治疗急性结石性胆囊炎的临床疗效及对机体炎症反应的影响。 方法回顾性分析2015年1月至2017年6月收治的117例急性结石性胆囊炎的临床资料,根据手术方式分为腹腔镜组(61例)和开腹组(56例),采用SPSS17.0软件对所有临床数据进行统计学分析,两组患者术前术后各项指标、疼痛视觉模拟评分(VSA)及炎症相关指标等计量资料以( ±s)表示,采用独立t检验;全身炎症反应综合征(SIRS)发生率及并发症发生率等组间比较采用χ²检验,均以P<0.05为差异有统计学意义。 结果腹腔镜组患者手术时间、切口长度、术中出血量、肛门首次排气时间、VSA评分、下床活动时间、恢复饮食时间以及平均住院时间均明显优于开腹组(均P<0.05);两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。腹腔镜组患者术后1 d、3 d、5 d的血清中C－反应蛋白(CRP)、白介素－6(IL－6)水平和7 d内全身炎症反应综合征(SIRS)发生率均明显低于开腹组(P<0.05)。 结论腹腔镜胆囊切除治疗急性结石性胆囊炎是安全可行的,具有手术时间短、术中出血少、术后恢复快及炎症反应轻的优势,值得在临床中进一步推广应用。     

腹腔镜胆囊大部切除术治疗复杂胆囊结石的临床分析

目的:探讨腹腔镜胆囊大部切除术治疗复杂胆囊结石的应用价值。方法:回顾分析近10年259例复杂胆囊结石患者的临床资料。将患者随机分为两组,实验组146例,行腹腔镜胆囊大部切除术;对照组113例,行开腹胆囊大部切除术。对比分析两组手术时间、术中出血量、术后下床活动时间、开始进食时间、住院时间、术后胆漏等并发症。结果:实验组患者手术时间显著长于对照组,两组相比差异有统计学意义(P<0.05);实验组术中出血量、术后下床活动时间、开始进食时间、住院时间、术后胆漏等并发症发生率均优于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜胆囊大部切除术治疗复杂胆囊结石具有患者创伤小、术后康复快、并发症发生率低等优点,手术的成功取决于术者的技术水平,只有成熟精湛的技术与丰富的手术经验相结合才能体现其价值。     

Two-port versus four-port laparoscopic cholecystectomy

Background: Two-port laparoscopic cholecystectomy has been reported to be safe and feasible. However, whether it offers any additional advantages remains controversial. This study reports a randomized trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Methods: One hundred and twenty consecutive patients who underwent elective laparoscopic cholecystectomy were randomized to receive either the two-port or the four-port technique. All patients were blinded to the type of operation they underwent. Four surgical tapes were applied to standard four-port sites in both groups at the end of the operation. All dressings were kept intact until the first follow-up 1 week after surgery. Postoperative pain at the four sites was assessed on the first day after surgery using a 10-cm unscaled visual analog scale (VAS). Other outcome measures included analgesia requirements, length and difficulty of the operation, postoperative stay, and patient satisfaction score on surgery and scars. Results: Demographic data were comparable for both groups. Patients in the two-port group had shorter mean operative time (54.6 ± 24.7 min vs 66.9 ± 33.1 min for the four-post group; p = 0.03) and less pain at individual subcostal port sites [mean score using 10-cm unscaled VAS: 1.5 vs 2.8 (p = 0.01) at the midsubcostal port site and 1.3 vs 2.3 (p = 0.02) at the lateral subcostal port site]. Overall pain score, analgesia requirements, hospital stay, and patient satisfaction score on surgery and scars were similar between the two groups. Conclusion: Two-port laparoscopic cholecystectomy resulted in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port laparoscopic cholecystectomy. Thus, it can be recommended as a routine procedure in elective laparoscopic cholecystectomy. Paper presented at the Fifth World Congress of the International Hepato-pancreato-biliary Association, Tokyo, Japan, April 2002     

改良式单孔腹腔镜与传统腹腔镜胆囊切除术临床对比研究

目的通过对改良式经脐入路单孔腹腔镜胆囊切除术(transumbilical single-port laparoscopic cholecystectomy,TSPLC)与传统腹腔镜胆囊切除术(LC)的临床效果对比,研究改良式经脐单孔腹腔镜胆囊切除术在临床应用的安全性、优越性及技术要点。方法回顾性分析我院2014年9月至2016年5月行LC的98例患者(经脐单孔LC组为50例,传统三孔LC组为48例)的临床资料,分别观察并对比两组手术时间、术中出血量、术后疼痛评分、术后止痛药物的使用率、住院时间、切口并发症及切口满意度。结果两组患者均成功完成手术;经脐单孔组手术时间(65.7±13.6)min,传统三孔组(40.2±9.8)min,两者差异有统计学意义(P0.01);经脐单孔组术后6 h疼痛评分(3.83±1.73)及术后止痛药物使用率(8%)均明显低于传统三孔组[术后6 h疼痛评分(4.02±7.5),P=0.025;止痛药物应用率(31.25%),P0.01]。术后患者对切口的满意度,经脐单孔组(95.3±10.78)明显高于传统三孔组(78.57±12.65)(P0.01)。两组术中出血量、术后24 h疼痛评分及术后住院时间比较均无统计学差异(P0.05)。术后随访2~3个月,无胆漏、出血、腹腔积液、切口感染等并发症发生。结论使用改良式经脐入路单孔腹腔镜胆囊切除术安全可行,与传统LC相比具有更加美观、微创,术后恢复快,术后疼痛轻等诸多优势,且不增加手术风险;但该手术操作难度较大,学习曲线相对较长,有一定腹腔镜手术经验的外科医师才能完成。     

Lung function after open versus laparoscopic cholecystectomy

Postoperative lung function and gas exchange were studied in 36 patients after cholecystectomy. Twenty-four of the patients underwent laparoscopic cholecystectomy while the remaining twelve were operated with open technique. Before surgery all patients had normal ventilatory volumes (forced vital capacity, FVC and forced expired volume in 1 s, FEV₁) and normal gas exchange. Two hours postoperativley FVC was reduced to 64±16% (P<0.05) of the preoperative level in the laparoscopic group and to 45±23% (P<0.05) after open cholecystecomy. On the first postoperative day FVC was virtually normal in the laparoscopic patients (77±17% of preoperative level, NS), whereas the open surgery patients still had a decreased FVC (56±13% of preoperative, P<0.05). FEV₁ in the postoperative period followed the same course as FVC. Gas exchange was significantly impaired in the early postoperative period in all patients but no difference between the two groups was found. Two hours postoperatively Pao₂ was reduced to 85% (P<0.05) of preoperative value and Paco₂ had increased by 0.5 kPa (p<0.05). The alveolo-arterial oxygen tension difference (PA-ao₂) had increased by approximately 45% to a mean of 3.7 kPa (P<0.05). On the first postoperative day gas exchange was still significantly impaired in the open surgery patients. Atelectasis detected by computed X-ray tomography of the lungs were found in both groups. However, the amount of atelectasis tended to be smaller in the laparoscopic group than in the open surgery patients. In summary, cholecystectomy irrespective of whether it was performed by open or laparoscopic technique was followed by deterioration in ventilatory function and gas exchange. However, the magnitude of this impairment was less pronounced in laparoscopic cholecystectomy patients than in the open surgery patients which may suggest that this minimal invasive procedure is favourable with respect to postoperative lung function.     

改良戳孔孔径对腹腔镜胆囊切除术后机体疼痛及应激反应影响的临床对照研究

目的 在术后机体疼痛及应激反应等方面探讨改良戳孔孔径腹腔镜胆囊切除术是否优于传统腹腔镜胆囊切除术.方法 前瞻性收集2019年1月至6月高淳人民医院因胆囊息肉或胆囊结石合并慢性胆囊炎需行胆囊切除术的患者150例,随机分为研究组75例(改良戳孔孔径腹腔镜胆囊切除术)和对照组75例(传统腹腔镜胆囊切除术),统计两组患者的年龄...     

快速康复外科在腹腔镜胆囊切除术围手术期护理中的应用

目的：探讨快速康复外科（ fast track surgery ,FTS）在腹腔镜胆囊切除术（ laparoscopic cholecystectomy ,LC）围手术期护理中的应用效果。方法2012年1～12月将200例LC按住院号的单双号分为2组,每组100例,比较2组患者康复和并发症发生情况。结果 FTS组术后首次肛门排气时间（12．0±4．4）h ,明显短于对照组（24．9±5．4）h（t＝-18．519,P＝0．000）;术后出院时间（3．2±1．3）d明显短于对照组（4．2±2．1） d（t＝-4．049,P＝0．000）;术后5 d体重下降值（3．2±0．3） kg明显低于对照组（5．2±0．6）kg（t＝-29．814,P＝0．000）。结论 FTS应用于LC能加速患者术后康复。     

Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial

Background

In recent years, new devices providing multiple channels have made the performance of laparoscopic cholecystectomy through a single access site not only feasible but much easier. The potential benefits of laparoendoscopic single-site (LESS) cholecystectomy may include scarless surgery, reduced postoperative pain, reduced postoperative length of stay, and improved postoperative quality of life. There are no comparative data between LESS cholecystectomy and standard laparoscopic cholecystectomy (LC) available at present with which to quantify these benefits.

Methods

This study was a prospective, randomized, dual-institutional pilot trial comparing LESS cholecystectomy with standard LC. The primary end point was postoperative quality of life, measured as length of hospital stay, postoperative pain, cosmetic results, and SF-36 questionnaire scores. Secondary end points included operative time, conversion to standard LC, difficulty of exposure, difficulty of dissection, and complication rate.

Results

No significant differences in postoperative lengths of stay were found in the two groups. Postoperative pain evaluation using a visual analogue scale showed significantly better outcomes in the standard LC arm on the same day of surgery (P = .041). No differences in postoperative pain were found at the next visual analogue scale evaluation or in the postoperative administration of pain-relieving medications. Cosmetic satisfaction was significantly higher in the LESS group at 1-month follow-up (mean, 94.5 ± 9.4% vs 86 ± 22.3%; median, 100% vs 90%; P = .025). Among the 8 scales of the SF-36 assessing patients' physical and mental health, scores on the Role Emotional scale were significantly better in the LESS group (mean, 80.05 ± 29.42 vs 68.33 ± 25.31; median, 100 vs 66.67; P < .0001).

Conclusions

In this pilot trial, LESS cholecystectomy resulted in similar lengths of stay and improved cosmetic results and SF-36 Role Emotional scores but performed less well on pain immediately after surgery. A larger multicenter trial is needed to confirm and further investigate these results.     

Surgical Outcomes of Laparoscopic Cholecystectomy for Severe Acute Cholecystitis

The aim of this study was to evaluate the surgical outcomes of laparoscopic cholecystectomy (LC) in patients who were diagnosed with severe acute cholecystitis (SAC) and to clarify the useful treatment modalities of SAC. Of 112 patients who presented SAC, we selected 99 patients and divided them into 3 groups: 37 patients who underwent preoperative percutaneous transhepatic gallbladder drainage (PTGBD; group 1), 62 patients with SAC but not indicated for PTGBD (group 2), and 59 patients with acute and chronic cholecystitis (group 3). The conversion rate was 2.7% (1/37) in group 1, 6.5% (4/62) in group 2, and 1.7% (1/59) in group 3. In groups 1 and 2, the postoperative stay and operative time were longer than those in group 3 with significant difference, respectively (P < 0.05). In group 2, there was correlation not only between postoperative stay and age but also between postoperative stay and ASA class (P < 0.05). In group 2, there was no correlation between time to operation and operative time and also between time to operation and postoperative stay, however, there was surprisingly significant correlation between time to operation and conversion rate in SAC (P = 0.018). In conclusion, PTGBD should selectively be performed in patients with severe comorbidities rather than improving surgical outcomes of LC for severe acute cholecystitis. If patients are not indicated for PTGBD, an early laparoscopic cholecystectomy is recommended because it can decrease conversion rate, although it cannot decrease operative time and postoperative stay.     

The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial

The aim of this study was to determine whether the use of prophylactic antibiotics had any effects on the development of postoperative surgical wound infections between laparoscopic cholecystectomy patients. Patients who received a single dose of prophylactic antibiotics prior to surgery were included in the prophylaxis group, and those who did not receive preoperative and postoperative intravenous and/or oral antibiotics were included in the no prophylaxis group. A total of 206 patients who underwent laparoscopic cholecystectomy were examined; the infection rate in patients who received prophylaxis was 4.5%, while it was 4.2% in the non‐prophylactic group. There was no statistically significant difference between the groups in terms of infection development rates (P > .05). We suggest that antibiotics should not be given for prophylaxis before low‐risk laparoscopic cholecystectomy as there is no statistically significant difference in the rate of postoperative wound infection among patients who were either given or not given prophylaxis.     

Evaluation of fundus-first laparoscopic cholecystectomy.

OBJECTIVES: Laparoscopic cholecystectomy is the gold standard for gallbladder surgery. Cholecystectomy from the fundus to the cystic duct may be advantageous when cystic duct exposure becomes difficult due to adhesions on Calot's triangle. The aim of this study was to compare conventional laparoscopic cholecystectomy with the fundus-first procedure and to evaluate whether the fundus-first technique can prevent conversion in difficult cases. METHODS: The study included 145 patients treated over 18 months. The inclusion criterion was the presence of ultrasound proven gallstones. Patients were excluded from the study if there was evidence of common bile duct stones, a bilioenteric fistula, or carcinoma of the gallbladder. RESULTS: The fundus-first approach was started in 45 patients; all procedures were completed laparoscopically. Conventional laparoscopic cholecystectomy was begun in 100 patients. Twenty-seven of the 100 patients were converted to fundus dissection (adhesions within Calot's triangle). Four of the 27 were further converted to open surgery. One patient had a drop in blood pressure on creation of pneumoperitoneum. Time taken for severely inflammatory and noninflammatory cases was significantly greater (P<0.05) in the fundus-first group. The average hospital stay was 48 hours in both groups. No major complications were observed. CONCLUSION: The rate of conversion in the conventional laparoscopic cholecystectomy group decreased from 18.75% (27/144) to 2.08% (3/144). The fundus-first technique has the potential to decrease conversion in difficult cases.     

Adhesion formation with open versus laparoscopic cholecystectomy: an immunologic and histologic study

Background This randomized study aimed to compare the reaction of the immune system to the process of postoperative adhesion formation after open and laparoscopic cholecystectomy. Methods In this study, 20 mongrel dogs were used: 10 each in the laparoscopic and open cholecystectomy groups. Blood and peritoneal lavage samples were taken up to postoperative day 14, followed by second-look laparoscopy and reoperation to detect the rate of adhesion formation. Also, specimens were obtained from the liver bed for histology. Results In the open cholecystectomy group, the white blood cell count was higher in blood samples and lower in lavage specimens. Adhesion formation was extensive, and the histologic immune reaction was more intensive in the open cholecystectomy group. Conclusion This randomized study proved that laparoscopic cholecystectomy was associated with less immune suppression, less inflammatory reaction, and therefore less adhesion formation than open cholecystectomy.     

Urgent versus interval laparoscopic cholecystectomy for acute cholecystitis: a comparative study

Background/Purpose: The surgical management of patients presenting with acute cholecystitis remains controversial. The aim of this study was to evaluate the safety and feasibility of urgent laparoscopic cholecystectomy (LC) during the “index” (acute) admission with acute cholecystitis, and to compare that with a policy of interval LC. Methods: Between October 2000 and October 2001, 50 patients who had suffered with acute cholecystitis underwent LC. Thirty-three patients underwent surgery during the index admission (group I), of whom 11 patients had surgery within 96 h of admission. Seventeen patients were referred by colleagues to outpatients for, and underwent, an interval LC (group II). Results: All operations were completed laparoscopically. There was no difference between the groups in the operating time (median [interquartile range]: 78 [61–124] versus 93 [53–128] min) or postoperative hospital stay (median, 1 day). The delay in performing an urgent LC beyond 96 h did not affect the operating time or postoperative stay but significantly increased the total hospital stay (median [interquartile range]: 5 (5–8) versus 13 [8–17] days; P = 0.001). Conclusions: Laparoscopic cholecystectomy during the index admission with acute cholecystitis can be performed safely and successfully. Earlier surgery has a beneficial impact for patients and the National Health Service. Received: March 1, 2002 / Accepted: May 12, 2002 Offprint requests to: B.J. Ammori Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK     

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.     

The effect of short-term continuous epidural morphine on postoperative pain after laparoscopic cholecystectomy

This study was undertaken to determine whether short-term continuous epidural analgesia using morphine would relieve pain after laparoscopic cholecystectomy. The authors retrospectively reviewed the clinical data of 182 cases who had undergone a laparoscopic cholecystectomy. These cases were divided into four groups according to their anesthetic modes as follows: a control group with general anesthesia only (n=37); group I, general anesthesia combined with one shot of epidural morphine (n=78); and group II, general anesthesia combined with continuous epidural analgesia using morphine (IIa for 12 h (n=33); IIb for 8 h (n=34)). The pain score on a four-category verbal scale and the frequency of analgesic use were investigated. There were no differences in the background characteristics of the patients among the groups, except for the duration of surgery (Ivs IIa;P=0.006). The pain scores were significantly different between the control group and the other groups. The frequency of analgesic use in the control group was also significantly higher than in the other groups. A tendency toward a higher frequency of analgesic use in group I, compared with that in groups IIa and IIb, was observed. These findings thus suggest that short-term continuous epidural analgesia using morphine can effectively relieve postoperative pain after a laparoscopic cholecystectomy.     

Early laparoscopic cholecystectomy for acute cholecystitis

Background: The timing of laparoscopic cholecystectomy for acute cholecystitis remains controversial. Methods: One hundred ninety-four patients with acute cholecystitis were reviewed. The conversion rates for the various number of days of symptoms before surgery were analyzed. The conversion rate dramatically increased from 3.6% for those patients with 4 days of symptoms to 26% for those patients with 5 days of symptoms. The mean number of days of symptoms prior to surgery in those patients who underwent successful laparoscopic cholecystectomy was 4.1 as compared to 8.0 in those patients who required open cholecystectomy (p < 0.0001). Based on this data the patients were divided into two groups. Group 1 consisted of 109 patients who underwent laparoscopic cholecystectomy within 4 days of onset of symptoms and group 2 consisted of 85 patients who underwent laparoscopic cholecystectomy after more than 4 days following onset of symptoms. Results: The conversion rate from laparoscopic to open cholecystectomy was 15%. The conversion rate for group 1 was 1.8% as compared to 31.7% for group 2 (p < 0.0001). Indications for conversion were inability to identify the anatomy secondary to inflammatory adhesions (68%), cholecystoduodenal fistula (18%), and bleeding (14%). The major complication rate for group 1 was 2.7% as compared to 13% for group 2 (p= 0.007). The mortality rate for all patients with attempted laparoscopic cholecystectomy for acute cholecystitis was 1.5%. The average procedure time for group 1 was 100 ± 37 min vs 120 ± 55 min in group 2. The average number of postoperative hospital days in group 1 was 5.5 ± 2.7 days as compared to 10.8 ± 2.7 days in group 2. Conclusions: We advocate early laparoscopic cholecystectomy within 4 days of onset of symptoms to decrease major complications and conversion rates. This decreased conversion rate results in decreased length of procedure and hospital stay. Received: 28 March 1996/Accepted: 12 September 1996     

General stress response to conventional and laparoscopic cholecystectomy.

OBJECTIVE: In many retrospective and prospective observational studies, laparoscopic cholecystectomy (LC) compares favorably with conventional cholecystectomy (CC), with respect to length of hospital stay, postoperative pain, and pulmonary function, indicating a diminished operative trauma. Comparison of laboratory findings (stress hormones, blood glucose, interleukins) are a possibility to objectify stress and tissue trauma of laparoscopic and conventional cholecystectomy. SUMMARY BACKGROUND DATA: Major body injury, surgical or accidental, evokes reproducible hormonal and immunologic responses. The magnitude of many of these changes essentially is proportional to the extent of the injury. METHODS: In a prospective study, biochemical stress parameters were measured in the blood of patients undergoing elective cholecystectomy because of symptomatic cholecystolithiasis. Patients with acute cholecystitis, pancreatitis, choledocholithiasis, or malignant disease were excluded. Values from 40 patients after LC and from 18 patients after CC were compared. Both groups had similar patient characteristics, baseline values, and perioperative care, except for deeper anesthesia during CC. RESULTS: On postoperative day 1, epinephrine (p = 0,05), norepinephrine (p = 0.02), and glucose (p = 0.02) responses were higher after CC. Two days postoperatively, norepinephrine remained higher after CC (p < 0.01). Interleukin-1 beta responses were higher during (p < 0.01) and 6 hours after CC (p = 0.03). Interleukin-6 responses were higher 6 hours (p = 0.03), 1 day (p = 0.02), and 2 days (p < 0.01) after CC. CONCLUSIONS: The results show significant lower values of intraoperatively and postoperatively measured epinephrine, norepinephrine, interleukin-1 beta, and interleukin-6 in patients with laparoscopic cholecystectomy, indicating a minor stress response and tissue trauma in this group of patients. The results correspond to the favorable results of most other trials evaluating clinical aspects of laparoscopic cholecystectomy.