Laparoscopic Cholecystectomy-Analgesia Research Papers - Academia.edu (original) (raw)

The changes in liver function tests (LFTs) after laparoscopic cholecystectomy (LC) have been described in the literature. The aims of this study are to value the increases of the LFTs and its clinical appearance after LC. Furthermore we... more

The changes in liver function tests (LFTs) after laparoscopic cholecystectomy (LC) have been described in the literature. The aims of this study are to value the increases of the LFTs and its clinical appearance after LC. Furthermore we studied the correlation of the changes of LFTs with the operative time and the role of elevated BMI. In the period October 2012 - May 2013, 81 patients undergone to elective LC were analyzed by examining bilirubin, AST, ALT, ALP, GGT at the admission, 1 and 3 days after surgery. Correlations of the length of intervention and BMI with changes of LFTs are evaluated. During surgery, the intrabdominal pressure has been 12 mmHg in all patients. The Student t test, PCC (Pearson's correlation coefficient) OR (odds ratio) were performed to determine statistical significance. The level of (serum) AST, ALT increased significantly during 24-48 hours after LC (p < 0,0001). The increase of (total and direct) bilirubin has not the statistical significance. ...

An investigation of end-tidal carbon dioxide tension changes was carried out in 19 healthy adult patients undergoing laparoscopic cholecystectomy. Following induction of anaesthesia, and throughout surgery, the end-tidal carbon dioxide... more

An investigation of end-tidal carbon dioxide tension changes was carried out in 19 healthy adult patients undergoing laparoscopic cholecystectomy. Following induction of anaesthesia, and throughout surgery, the end-tidal carbon dioxide tension was continuously monitored by capnography. The value following carbon dioxide insufflation increased with time to reach a maximum value after 40 min. Correlation of the individual maximum end-tidal carbon dioxide tension during laparoscopy with the corresponding baseline value prior to carbon dioxide insufflation showed a positive linear relationship (correlation coefficient 0.86). The correlation showed that an end-tidal carbon dioxide tension of 5.32 kPa (40 mmHg) can be achieved during laparoscopy when the baseline value is adjusted to around 4.0 kPa (30 mmHg).

No procedure has yet been identified as the standard for the detection and management of choledocholithiasis in patients undergoing laparoscopic cholecystectomy. A prospective study involved 1305 patients undergoing elective laparoscopic... more

No procedure has yet been identified as the standard for the detection and management of choledocholithiasis in patients undergoing laparoscopic cholecystectomy. A prospective study involved 1305 patients undergoing elective laparoscopic cholecystectomy. Intravenous cholangiography was performed on all patients except those with jaundice or cholangitis, acute pancreatitis, or allergy to contrast material. Patients underwent endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy when there was a strong suspicion of choledocholithiasis, positive or inconclusive findings on intravenous cholangiography or allergy to contrast material with signs of possible choledocholithiasis. Intraoperative cholangiography was performed when patients did not undergo ERC or intravenous cholangiography and whenever the surgeon was in doubt about biliary anatomy or biliary clearance. Two hundred thirty-one patients (17.7%) were referred for preoperative ERC; 14 of them were referred for open surgery because of failure of ERC or sphincterotomy. Only 54 patients underwent intraoperative cholangiography. Bile duct stones, detected in 186 cases (14.2%) (68 of which were asymptomatic), were removed before surgery in 162 cases (87.1%) and during surgery in 20 (10.7%). Self-limited pancreatitis occurred in 3.6% of the patients after sphincterotomy. Laparoscopic cholecystectomy was performed in 98.7% of the cases. The conversion rate was 8% if sphincterotomy had been performed previously, and 3% after standard laparoscopic cholecystectomy (p &lt; 0.001). The morbidity rate was 5% and the mortality rate 0.08%. During the follow-up period 4 patients had retained stones that were treated endoscopically. Preoperative ERC followed by laparoscopy is the best approach to treatment of patients with cholecystolithiasis and suspected choledocholithiasis.

Background:The widespread application of laparosopic cholecystectomy has led to a rise in the numbers of major bile duct injuries (BDI). Perioperative management of these injuries is complex and challenging. There are few published... more

Background:The widespread application of laparosopic cholecystectomy has led to a rise in the numbers of major bile duct injuries (BDI). Perioperative management of these injuries is complex and challenging. There are few published reports locally regarding the perioperative management of BDI. Purpose of this review was to analyze our experience in diagnosis, management and prevention of BDI. Methods:This study was conducted in department of surgery at B. P. Koirala Institute of Health Sciences. From January 2001 to September 2010, a observational study of all patients with a BDI following cholecystectomy was maintained. Patients’ charts were retrospectively reviewed to analyze incidence, type of injury, presentation, and perioperative management of BDI. Results:A total of 92 patients had BDI which occurred during cholecystectomy, were analysed retrospectively. There were 60/92 (65.5%) patients with BDI resulting from the wrong identification of the anatomy of the Calot’s triangle d...

Hepatobiliary Iminodiacetic Acid (HIDA) scan provides a technique to quantify gallbladder ejection fraction (EF) in patients suffering acalculous biliary colic (ACBC). We wished to evaluate the accuracy of EF in the prediction of... more

Hepatobiliary Iminodiacetic Acid (HIDA) scan provides a technique to quantify gallbladder ejection fraction (EF) in patients suffering acalculous biliary colic (ACBC). We wished to evaluate the accuracy of EF in the prediction of gallbladder pathology in patients undergoing cholecystectomy. Data were retrieved from a database of patients referred for HIDA scan for ACBC, including EF and the pathological outcome of those undergoing cholecystectomy, and compared to normal values obtained from a review of related studies. Significant associations were demonstrated by chi-square, Mann-Whitney test, and linear regression. The predictive accuracy of different cut-offs of EF was demonstrated by the ROC curve analysis. Of 83 patients referred for HIDA scan for ACBC, 41 underwent cholecystectomy. The median EF of this group (33%) was significantly lower than the composite normal median value from previous studies (56%). Thirty-two patients revealed evidence of gallbladder pathology. The EF d...

Laparoscopic cholecystectomy is slowly taking its place also in an emergency setting, regardless of its initial unfortunate course when iatrogenic lesions during surgery, complications and conversion rate make the laparoscopic approach in... more

Laparoscopic cholecystectomy is slowly taking its place also in an emergency setting, regardless of its initial unfortunate course when iatrogenic lesions during surgery, complications and conversion rate make the laparoscopic approach in acute cholecystitis a hazard. With the development of laparoscopic technique, the laparoscopic cholecystectomy for acute cholecystitis becomes a reality, but its role in emergency is not yet defined. From December 1998 to December 2005, 133 consecutive laparoscopic cholecystectomies for acute cholecystitis were performed in our institution by the same surgeon. The mean age of patients was 48 years old, 21 were over seventy. In the series patients in ASA III and IV were included. All procedures were performed with the same technique, developed in the examined period, which represents a standardized downwards laparoscopic cholecystectomy, easy to reproduce and safe to perform. We report our surgical technique and our results. We did not report mortal...

Background The peroral transluminal approach to the peritoneal cavity appears safe, feasible, and may further reduce the invasiveness of surgery. However, flexible endoscopes have multiple limitations inside the peritoneal cavity, which... more

Background The peroral transluminal approach to the peritoneal cavity appears safe, feasible, and may further reduce the invasiveness of surgery. However, flexible endoscopes have multiple limitations inside the peritoneal cavity, which can potentially be overcome by blending the use of both a laparoscope and a flexible upper endoscope—a hybrid approach. The goal of the present study was to evaluate a hybrid

In the care of acute pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because... more

In the care of acute pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Examinations necessary for diagnosing gallstone-induced acute pancreatitis include blood tests and ultrasonography. Early ERCP/ES should be performed in patients with gallstone-induced acute pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. The treatment for bile duct stones with the use of ERCP/ES alone is not recommended in cases of gallstone-induced pancreatitis with gallbladder stones. Cholecystectomy for gallstone-induced acute pancreatitis should be performed using a laparoscopic procedure as the first option as soon as the disease has subsided.

To report on a large experience with laparoscopic cholecystectomy-associated bile duct injuries (LC-BDIs) and examine factors influencing outcomes. A retrospective medical record review. Univariate statistical analysis was used to... more

To report on a large experience with laparoscopic cholecystectomy-associated bile duct injuries (LC-BDIs) and examine factors influencing outcomes. A retrospective medical record review. Univariate statistical analysis was used to identify risk factors for postoperative complications. Two university-affiliated hospitals. Sixty-nine patients who underwent surgical repair of LC-BDI between January 1, 1992, and December 31, 2007. Outcomes following repair of LC-BDI, relationship between timing of LC-BDI repair and outcomes, complications, and long-term results following LC-BDI repair. Thirteen immediate repairs (0-72 hours post-LC), 34 intermediate repairs (72 hours-6 weeks), and 22 late repairs (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;6 weeks) were performed. The LC-BDIs were Strasberg type A in 1 patient (1%), D in 2 patients (3%), E1 in 22 patients (32%), E2 in 16 patients (23%), E3 in 22 patients (32%), E4 in 4 patients (6%), and E5 in 2 patients (3%). Forty-one hepaticojejunostomies (59%), 24 choledochojejunostomies (35%), 3 right hepatic hepatectomies with biliary reconstruction (4%), and 1 primary common bile duct repair (1%) were performed. The overall morbidity rate was 30% (21 patients). The mortality rate was 1% (1 patient). Twelve patients (17%) developed short-term postoperative complications. There were no factors found to be associated with early postoperative morbidity. The most common long-term complication was biliary stricture, which occurred in 10 patients (14%). Patients whose BDIs were repaired in the intermediate period were more likely to develop biliary stricture than patients with repairs performed in the immediate or late periods (P = .03). Our results suggest that the timing of LC-BDI repair is an important determinant of long-term outcome. Repairs in the intermediate period were significantly associated with biliary stricture. Thus, repairs should be undertaken either in the immediate (0-72 hours) or delayed (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;6 weeks) periods after LC.