Can cholangiography be safely abandoned in laparoscopic cholecystectomy? Laparoscopic operative cholangiography: a simple, successful, cost-effective method.
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From April 1994 to June 1995 322 laparoscopic cholecystectomies were performed in S. Camillo hospital Treviso, 294 in election and 28 in urgency. The technique and results of this experience are reported. No mortality was observed and morbility was 1.8%. Utility of gallstones in main biliary duct screening is discussed to select patients to subject to preoperative ERCP and the role of intraoperative cholangiography. Laparoscopic cholecystectomy is considered the choice option in cholelitiasis. In case of evidence of choledocholithiasis with anamnesis or preoperative tests, the tactics of choice in authors opinion is the sequential one, providing preoperative ERCP and laparoscopic cholecystectomy.
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Gallstone spillage is a common intraoperative event during laparoscopic cholecystectomy (LC). Patients present months to years with nonspecific symptoms after the original procedure. The complications of retained peritoneal gallstones are infrequent. Having a high index of suspicion is the key to early diagnosis. Every effort should be made to remove spilled gallstones at the index operation to prevent future complications, however, conversion from laparoscopy to laparotomy for retrieval of spilt gallstone is not recommended. Here we present a case of retained gallstone presenting as a large intra-abdominal mass four years after laparoscopic cholecystectomy in a middle age bariatric patient.
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Although the indications for laparoscopic cholecystectomy are generally the same as those for open cholecystectomy, there has been a suspicion that indications for cholecystectomy have broadened and the spectrum of patients undergoing this procedure has changed. This study was designed to determine whether surgeons and patients have lowered the threshold for proceeding to cholecystectomy with use of laparoscopic cholecystectomy. Discharge data were collected for all patients who underwent an elective operation in general surgery clinics in Ankara Numune Teaching and Research Hospital between 1990 to 2001. The rate of total cholecystectomy to all elective operations and rate of laparoscopic technique to all cholecystectomies were analyzed. Total number of operations and rate of cholecystectomy were relatively stable over 6 years prior to laparoscopy. With the introduction of laparoscopic cholecystectomy, although total number of elective operations seems stable, the proportion of cholecystectomy to all operations showed an increase. Our study could not explain the increase of total number of cholecystectomies since the widespread introduction of laparoscopy. First, it may be due to changing selection criteria for surgical treatment of gallstones. Second, surgery may have been done for asymptomatic gallstones. And third, patients with moderate symptoms who refused the (open) operation in the past may now be more willing to undergo a laparoscopic cholecystectomy.
Open cholecystectomy
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Concomitant
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Gallbladder disease
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This paper gives a short historical overview of the evolution of biliary surgery from John Stough Bobbs (1867) until the present day. The development of different diagnostic methods (from cholangiography to sonography) are described also, as well as the different therapeutic methods including laparoscopic cholecystectomy. Hans Kehr (1862-1916) was a distinguished pioneer in the development of biliary surgery.
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Background: To survey the current practice of general surgeons in Queensland in their management of patients with gallstones. Methods: A postal survey of 123 surgeons practising in Queensland. Results: There were 114 responses to the questionnaire (92.7%) and seven were excluded from the analysis. Laparoscopic cholecystectomy (LC) was preferred by 97.2% and operative cholangiography was almost always attempted by 82.3%. One‐third of surgeons used drains routinely. In cases of acute cholecystitis, 56 surgeons (52.3%) favoured laparoscopic cholecystectomy on the same admission. Operative cholangiography (OC) was almost always attempted by 64.8% of surgeons during acute laparoscopic cholecystectomy. Only 3.8% of surgeons frequently offered day case surgery and 51% never offered it. Conclusions: Laparoscopic cholecystectomy is the treatment of choice of nearly all Queensland surgeons in the elective and acute situations. Routine operative cholangiography is favoured by the majority of surgeons. Day case surgery is presently offered by a minority of surgeons.
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