COMPARATIVE STUDY OF MORBIDITY OF LAPAROSCOPIC VERSUS OPEN CHOLECYSTECTOMY IN COMPLICATED GALLSTONE DISEASE (original) (raw)
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Surgical Endoscopy, 2013
Background The purpose of this study was to compare length of stay, as one of the efficacy indicators, and effectiveness, in terms of operative complications and mortality, between laparoscopic (LC) and open cholecystectomy, and to verify the 10-year temporal trends in the application of the LC technique in a large regional population. Methods This was a retrospective cohort study based on 73,853 hospital discharge records of cholecystectomies for gallstone disease (GD) in residents of the Veneto from 2001 to 2010, at both public and accredited private hospitals. The data are from a regional administrative database. The main epidemiological rates calculated, and expressed per 100,000 residents, were the cholecystectomy rate (CR) for gallstones by surgical technique (laparoscopic or open surgery), and the in-hospital mortality rate (MR), considered as the in-hospital MR regardless of the specific cause of death. Results The CR was 139.7 higher in females, with a male-to-female ratio of 1:1.5. LC was performed more frequently in females than in males and in younger than in older patients. From 2001 to 2010, there was a significant linear rising trend in the use of LC, in fact during the period considered, the use of laparoscopic surgery increased significant (v 2 trend: 316,917; p \ 0.05), reaching 93.6 % of surgical procedures for gallstones during the year 2010. Conclusions There are still some age-and gender-related disparities in its usage, although LC is an increasingly widely applied, as effective procedure.
Annals of Saudi medicine
Laparoscopic cholecystectomy (LC) is now a common method of treating symptomatic gallstones, and it is increasingly being requested by the informed general public. Our aim was to evaluate the role of LC for cholelithiasis and to establish its outcome and the effect of gender on the results. Between September 1994 and June 1999, all patients who underwent LC for cholelithiasis were retrospectively reviewed. They were classified as having acute or chronic cholecystitis (AC or CC). There were 791 patients with CC (633 females, 158 males) and 204 patients with AC (124 females, 80 males). Conversion to open cholecystectomy was needed in 0.76% and 11.8% of the patients with CC and AC, respectively (P<0.00). Four percent of the female patients with AC needed conversion as compared to 23.8% in the males (P<0.00). The low conversion rate in CC limited gender comparison. Median operation time in the patients with CC was 53+/-16 minutes as compared to 74.5+/-35.7 minutes in those with AC...
Gut, 1993
The pre and postoperative symptoms and outcome after surgery in patients with symptomatic gall stone disease were evaluated by a detailed self administered postal questionnaire. The survey was conducted in two groups: 80 patients treated by laparoscopic cholecystectomy and an age matched cohort of patients who had conventional open cholecystectomy. The overall response rate on which the data were calculated was 76%. Symptomatic benefit ratios accruing from the surgical removal ofthe gall bladder were calculated. The symptoms that were relieved by cholecystectomy were nausea (0.98), vomiting (0-91), colicky abdominal pain (0.81), and backpain (0.76). Flatulence, fat intolerance, and nagging abdominal pain were unaffected as shown by a benefit ratio of 0 5 or less. Relief of heartburn (39/49) outweighed the de novo development of this symptom after cholecystectomy (7/49), resulting in a benefit ratio of 0*65. Postcholecystectomy diarrhoea occurred in 21/118 patients (18%): 10 after open cholecystectomy and 11 after laparoscopic cholecystectomy. The type ofsurgical access did not influence the symptomatic outcome but had a significant bearing on the time to return to work or full activity after surgery (laparoscopic cholecystectomy two weeks, open cholecystectomy eight weeks, p=000001). In the elderly age group (>60 years), significantly more patients (29/30) regained full activity after laparoscopic cholecystectomy when compared with the open cholecystectomy group (16/22), p=OOOl. The patient appreciation of a satisfactory cosmetic result was 72% in the open group compared with 100% of patients who were treated by laparoscopic cholecystectomy (p=0 0017). Despite the persistence or de novo occurrence of symptoms, 111/117 patients (95%) considered that they had obtained overall symptomatic improvement by their surgical treatment and 110/118 (93%) were pleased with the end result regardless of the access used.
Changing trends in the management of gallstone disease
Surgical Endoscopy and Other Interventional Techniques, 2003
Background: Day case cholecystectomy is increasingly becoming a management option for elective cases while “same admission” cholecystectomy is now considered a favorable option in the treatment of acute cholecystitis. To assess the advent of these changes in our surgical practice, a retrospective analysis of our experience is presented. Methods: All patients undergoing cholecystectomy between January 2000 and January 2001 were analyzed according to admission status, operation type, conversion rate, complications, and nonsurgical intervention. Results: 156 patients underwent cholecystectomy and 152 charts were retrieved. Laparoscopic cholecystectomy was performed on 95% of patients with a conversion rate of 9%. Morbidity for the series was 12.5%, including one common bile duct injury (0.6%). Day case and acute cholecystectomy comprised 67% of our cholecystectomy practice. Conclusions: Our findings suggest that there is an increasing trend toward shortening the hospital stay of patients undergoing laparoscopic cholecystectomy. This does not appear to have had a deleterious effect on outcome.
Laparoscopic Cholecystectomy–An Audit at LUH/Jam
Rawal Medical Journal, 2011
To evaluate the results of laparoscopic cholecystectomy in symptomatic gall stones disease emphasizing on complications, morbidity and mortality. Patients and Methods This descriptive retrospective study was carried out in department of general surgery Liaquat University Hospital Jamshoro, Sind. Notes of all patients who underwent laparoscopic cholecystectomy in the department over an 18 month's period were reviewed. Demographics as well as details of cases of conversion to open operation and complications were noted on a designed performa. Data were analyzed using SPSS10. Results Out of 120 patients, 107 (85%) were females and 18 (15%) were males. The age ranged from 17 to 60 years (Mean 40 years). Six (9.9%) patients had bile leak, 3 (3.9%) developed port site wound infection, 3 (3.9%) developed collection in Morrison pouch and in 3 (3.9%) stones were recovered from epigastric port site wound. There were two cases of bile duct injury and one case of colonic injury. Conversion rate was10% and one patient died in post-operative period. Conclusion Though laparoscopic cholecystectomy is a safe and effective treatment for gall stone disease, our study showed relatively high complication rate. It may be because of learning curve, as it remains a procedure with the potentials for serious complications. Thus we need to have a structured training program involving stepwise progression of training. (Rawal Med J 2011;36:7-9).