Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer?

Background: Laparoscopy is thought to worsen the prognosis of gallbladder cancer (GBC) discovered unexpectedly at laparoscopic cholecystectomy (LC). However, laproscopy has never been shown to have an influence on patient survival in clinical series. Methods: We Performed a two-center retrospective analysis of 28 patients with GBC (11 previously known, 17 unexpectedly discovered by LC) to determine whether laparoscopy and complications related to LC had any influence on the prognosis of GBC. Resectability for cure after LC, survival, and recurrence related to both the procedure itself and complications associated with LC were analyzed. Results: Of the 17 patients with unexpected GBC, 16 were considered resectable for cure at the time of LC. Advanced disease was detected in eight patients by re staging (n = 5) or exploration (n = 3). Seven patients (43.8%) underwent reoperation for cure. Mean survival of patients with unexpected GBC was 26.5 months. Mean survival was shorter when complications (bile spillage, injury of common bile duct, or tumor violation) occurred during LC (10.2 vs 33 months, p = 0.016). If bile spillage was the only complication at LC, there was also a trend to shorter survival (12 vs 33 months, p = 0.061). Conclusion: Complications during LC significantly worsen the prognosis of GBC. Therefore, bile spillage and excessive manipulation of the gallbladder should be avoided.     

Is laparoscopic cholecystectomy cheaper?

As laparoscopic cholecystectomy is being used more and more frequently, a cost analysis was aimed to be performed to evaluate cost effectiveness in Turkey. Records of 376 patients who underwent cholecystectomy by various methods were analyzed retrospectively. Mean duration of postoperative hospital stay was 5.1 +/- 2.6 days for the open cholecystectomy group (OC group), composed of 177 patients; 5.6 +/- 2.1 days for the converted open cholecystectomy group (CC group) composed of 15 patients; and 2.5 +/- 1.8 days for the laparoscopic cholecystectomy group (LC group), which included 184 patients. The mean cost per patient was 778 dollars +/- 75, 1964 dollars +/- 82, and 2357 dollars +/- 80 for the OC, LC, and CC groups, respectively. It was concluded that laparoscopic cholecystectomy will gain economic feasibility over conventional cholecystectomy in our country only when costs of laparoscopic equipment lower and personnel wages increase sufficiently.     

Why laparoscopic cholecystectomy today?

Traditional open cholecystectomy became the gold standard of surgical treatment for symptomatic gallstone disease during the last century. In spite of its good results, clinicians have been trying to establish effective nonsurgical methods of eliminating gallstones. Although oral, percutaneous, or retrograde litholysis can be used effectively for cholesterol stones, these represent only 10% of all gallstones. Moreover, intracorporeal lithotripsy is an invasive method, and while extracorporeal shock wave lithotripsy is a promising procedure, even after careful selection, only 70%–80% of the patients become stone-free within 1 year. In fact, none of the methods which leave the gallbladder intact are free of complications, and they are followed by 50% stone recurrence within 5 years. Since 1987, laparoscopic cholecystectomy has become the procedure of choice as it is safe and only minimally invasive. We believe that the laparoscopic technique is a promising way to the surgery of the future.     

Does gender affect laparoscopic cholecystectomy?

The relationship between sex and outcome after laparoscopic surgery for symptomatic cholelithiasis remains unclear. The purpose of this study was to determine the influence of sex on the clinical presentation of patients with symptomatic gallstone disease and the clinical outcomes of laparoscopic cholecystectomy. The rates of conversion to open cholecystectomy, complication rates, operative times, and lengths of hospital stay were compared between the sexes. Compared with female patients, males were significantly older and more likely to have coexisting cardiovascular disease, previous upper abdominal surgery, previous hospitalization for acute cholecystitis and pancreatitis, acute cholecystitis, and suppurative cholecystitis (such as empyema), conversions, and complications. The mortality rate was nil. Analyses revealed an independent effect of sex on the prevalence of complications, even when including all of the major confounding factors in the model. In contrast, the effect of sex on conversion to open cholecystectomy was not significant when controlling for patient age. Operative time and postoperative hospital stay were significantly longer in males than in females. The tendency of male patients to have cholecystitis of greater severity should remind surgeons of the need to inform patients about the higher conversion rate among male patients, to reduce the disappointment of a large laparotomy wound or prolonged recovery period. On the other hand, there may be an increased need for surgeons to strongly advice male patients with symptomatic cholelithiasis to undergo early intervention.     

Assessment of cosmetic outcome after laparoscopic cholecystectomy among women 4?years after laparoscopic cholecystectomy: is there a problem?

Background  

Advocates of single-port laparoscopic cholecystectomy (SPLC) claim that improved cosmetic outcome is one of its main benefits over conventional laparoscopic cholecystectomy (CLC). However, the published data quantifying the cosmetic outcome after CLC is sparse. This study aimed to determine the cosmetic outcome after CLC using a validated scar assessment tool.     

Who did the first laparoscopic cholecystectomy?

Laparoscopic cholecystectomy (LC) has served as the igniting spark in the laparoscopic surgery explosion; however, it is unclear who created the spark. The question remains: Who did the first LC?     

Mini-laparotomy cholecystectomy versus laparoscopic cholecystectomy: which way to go?

PURPOSE: The aim of this paper is to report the results of a prospective clinical trial investigating traditional laparoscopic cholecystectomy versus "mini-lap" cholecystectomy in a tertiary care University Hospital. MATERIALS AND METHODS: This is a prospective, randomized, single-center observational study. Forty-four patients were allocated in each group; patients in group L underwent laparoscopic cholecystectomy, whereas patients in group M had open "mini-laparotomy" cholecystectomy with a small incision through the rectus abdominis muscle. RESULTS: The operation lasted significantly longer in group L compared with group M, whereas patients of group L had a shorter hospital stay. There was no difference between groups regarding postoperative day on which patients commenced eating. There was no significant difference between groups regarding doses of analgesics used during surgery or in the recovery room. However, patients in group M used significantly more opioids in the postoperative period. Time to resume normal activity was significantly shorter in group L. A very good aesthetic result was obtained in 97.7% of patients in group L and 77.3% of patients in group M. CONCLUSIONS: Cholecystectomy through a mini-laparotomy incision is a lower-cost, versatile, and safe alternative to laparoscopic cholecystectomy.     

Timing of laparoscopic cholecystectomy in acute cholecystitis: Any controversy?

Objective: The timing of laparoscopic cholecystectomy for acute cholecystitis remains controversial. This article reviews the latest evidence for the timing of laparoscopic cholecystectomy in the management of acute cholecystitis. Methodology: Trials comparing early laparoscopic cholecystectomy (ELC; carried out within 1 week of onset of symptoms) versus delayed laparoscopic cholecystectomy (DLC; carried out at least 6 weeks after symptoms settled) for acute cholecystitis were identified from Ovid Medline, Cochrane Library and PubMed database. Only meta‐analyses and randomized clinical trials were reviewed. Results: A total of seven prospective randomized trials including 670 patients and four meta‐analyses were reviewed. ELC was superior to DLC in terms of a shorter hospital stay without any significant difference in perioperative mortality and morbidity. Conclusions: Current evidence supports ELC as the preferred treatment strategy for acute cholecystitis. It allows a shorter hospital stay, but shares similar operative morbidity, mortality and conversion rate as DLC.     

Day-case laparoscopic cholecystectomy: treatment of choice for selected patients?

Background The authors report their 7-year experience with day-case laparoscopic cholecystectomy (LC) to determine its applicability, safety, and cost effectiveness. Methods Of 920 consecutive patients who underwent elective LC over a 7-year period, 567 (62%) were scheduled for day-case surgery. The median age of the patients was 48 years (range, 16–74 years), and the male/female ratio was 148/419. The selection criteria required an American Society of Anesthesiologists (ASA) grade of 1 or 2, absence of morbid obesity, low risk of common bile duct stones, adult company at home, and residence within 100 km of the hospital. The LC procedure was performed using a standard four-cannula technique. Propofol-opiate-rocuron-sevofluran anesthesia, prophylactic antiemetics, and preemptive analgesia were administered in all cases. Results The mean length of the operation was 56 ± 18 min. There was no hospital mortality, and 7 (1.2%) of 567 patients required conversion to open cholecystectomy. Approximately 356 (63%) of the 567 patients were discharged home on the same day as the operation, whereas 211 patients (37%) were admitted overnight after the operation because of social reasons (13.7%), surgeon preference (15.2%), nausea and/or pain (15.2%), operation late in the afternoon (14.2%), or patient preference (41.7%). There were no serious complications. A total of 22 patients visited the emergency unit, and 7 patients required readmission, giving a readmission rate of 2%. The overall postoperative morbidity rate was 6% (n = 22), with morbidities including retained stones (n = 2), bile leakage (n = 1), and pneumonia (n = 1). The mean procedural cost to the hospital was 1,836 euros for day-case LC, as compared with 2,712 euros for an inpatient operation. Conclusions For selected patients, day-case LC is feasible and safe, providing a substantial reduction in hospital costs.     

Does laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer?

BACKGROUND: Several reports claim that there is a risk that laparoscopic cholecystectomy (LC) might worsen the prognosis of unsuspected gallbladder cancer. HYPOTHESIS: Several factors rather than LC could influence prognosis. METHODS: A retrospective clinicopathologic study was performed on 20 patients, 9 patients (3 men and 6 women, aged from 36 to 75 years [mean age, 62.3 years]) undergoing LC and 11 patients (2 men and 9 women, aged from 53 to 91 years [mean age, 65.3 years]) undergoing open cholecystectomy (OC), with postoperatively diagnosed gallbladder cancer. The correlation was evaluated between cumulative survival rates and the following 7 prognostic factors: age, sex, histopathological grade, pathologic stage, occurrence of bile spillage, type of cholecystectomy (LC or OC), and additional surgical treatments. RESULTS: Seven patients (87%) after LC and 9 patients (82%) after OC had cancer recurrence: the difference is of no statistical significance (P =.9). There were no recurrences of cancer in the abdominal wall after either LC or OC. Survival rate was statistically correlated to tumor stage (P =.007) and to the occurrence of bile spillage (P =.002). Survival rate did not change according to whether the operation was carried out using LC or OC (P =.60). CONCLUSION: These results would seem to lend support to the opinion that LC does not worsen the prognosis for unsuspected gallbladder cancer.     

Is laparoscopic cholecystectomy a mature operative technique?

Background: More than 10 years after its introduction, laparoscopic cholecystectomy has become the method of choice for the treatment of cholecystolithiasis. However intraoperative difficulties with dramatic postoperative consequences have been reported. The aim of this study was to identify what role the two-dimensional view, the surgeon's experience, the instruments, technical tools and their (time) influence exercised on the operation course in daily laparoscopic operations. Methods: The operative times for 30 laparoscopic cholecystectomies were investigated by ergonomic sequence analysis and analyzed statistically with the use of the Wilcoxon test. Results: Comparing experienced and less experienced surgeons, a significant difference in the duration of the operation was observed (56 ± 24 min compared to 75 ± 13 min p = 0,025), especially in the laparoscopic intra-abdominal phase of the operation. The prolonged duration of the operation (15–20%) was mainly due to problems with the technical tools (40%) and the use of instruments (23.5%). Visualization had a minor influence (14.4%) on the duration of the operation, and the negative effect of the two-dimensional view (0.5%) was negligible. The last two factors did not cause any complications. Conclusions: The recognized difficulties still cause a loss of time and in some cases complications, which can only partly be compensated by the surgeon's experience. This leads to reluctance in the application of laparoscopic cholecystectomy in more complicated stages of the disease. Two-dimensional view satisfies the surgeon's demands for a safe procedure.