Combined Cholecystectomy Research Articles

Assessment of early results of surgical treatment of acute biliary pancreatitis at Viet Duc University Hospital

treatment requires radical treatment. ERCP, percutaneous lithotripsy, and surgery are effective treatments. The purpose of this paper is to evaluate the early results of surgical treatment of acute biliary pancreatitis. Patients and methods: A retrospective review of all patients diagnosed with acute pancreatitis due to gallstones was surgically treated at the Department of Hepatobiliary Surgery of Viet Duc University Hospital from January 2019 to December 2021. Results: The study group has 49 patients (26 female, 23 male). The mean age at surgery was 56.8 (28-87 years). CT scan identified 100% of pancreatic lesions and gallstones before surgery, of which common bile duct stones accounted for 20.4%, the rest were common bile duct stones combined with gallstones and stones in the liver. One patient was diagnosed with septic shock caused by cholangitis had to be resuscitated before surgery. The surgical intervention on biliary tract was cholecystectomy, stone removal, endoscopic lithotripsy, T tube drainage, combined cholecystectomy and left lobectomy. Open surgery was performed on 35 patients, accounting for 71.4%, and laparoscopic surgery accounted for 28.6%. The intervention on the pancreas was on 8 patients, mainly removing the necrotic pancreatic tissue, draining the lesser sac. Most patients had surgery in the first 2 days, as early as 22 hours, as late as 8 days. There were two patients complicated the surgical site infection, two patients with biliary leak, one patient with acute pancreatitis, all were treated medically. The mean hospital stay was 5.1 days. Laparoscopic surgery gave good results, accounting for 92.9%, there were no severe cases of recurrence or death. 49 patients were followed up 30 days after surgery with a good result (85.7%), no mortality was observed. Conclusion: Surgical treatment for acute biliary pancreatitis is safe which assesses pancreatic damage, gives good postoperative results. Keywords: Acute pancreatitis, gallstones, surgery

Pediatric combined laparoscopic splenectomy and cholecystectomy performed through four ports

Pediatric combined laparoscopic splenectomy and cholecystectomy performed through four ports

Surgical considerations of combined laparoscopic cholecystectomy and cesarean delivery

A 32-year-old female, with history of two previous cesarean sections. She was scheduled for an elective cesarean section. The night before surgery, she hada spike of fever and abdominal pain in the epigastrium and felt nauseated. She was brought to the emergency room, and her ultrasound examination revealed edema n the peri- gallbladder area and cholecystitis. A general surgical consult was made, and the opinion was that she needs to be operated urgently. Laparoscopic cholecystectomy was done with initial port placement at Palmer's point with a 5-cm Covidien optical port. Procedure completed with no complication. The obstetric team then made a Pfannenstiel incision to deliver the baby. The delivery was completed in 10 min after the closure of the laparoscopic ports. The patient was in hospital for the next 3 days, and her puerperium was unremarkable. There were no further complications during her stay. The baby was discharged from NICU on the1stpostoperativeday.

Sealing of the cystic and appendix arteries with monopolar electrocautery during laparoscopic combined cholecystectomy and appendectomy.

The best method to ligate the arteries during laparoscopic cholecystectomy or appendectomy remains controversy. The aim of this study is to introduce a new approach during laparoscopic combined cholecystectomy and appendectomy using a monopolar electrocautery to seal the cystic and appendix arteries. We retrospectively reviewed data from 57 patients who underwent laparoscopic combined cholecystectomy and appendectomy between December 2006 and June 2016. Each laparoscopic combined cholecystectomy and appendectomy was performed by coagulating and sealing the cystic and appendix arteries. Absorbable clip or coils were then used to ligate the proximal of cystic duct and the stump of appendix. The other side of the cystic duct and appendix which subsequently were to be removed from abdomen were used titanium clips or silk ligature. Of the 57 patients, 3 patients (5.3%) were converted to open surgery due to severe abdominal adhesions or gallbladder perforation. The mean operative time was 56 minutes (range, 40–80 minutes). Mean blood loss was 12 mL (range, 5–120 mL), and the mean postoperative hospital stay was 3.0 days (range, 2–5 days). No postoperative bleeding, biliary leakage, infection, or mortality occurred. Monopolar electrocautery to seal the cystic and appendix arteries is a safe, effective, and economical surgical procedure during laparoscopic combined cholecystectomy and appendectomy. Further randomized controlled clinical trials are required to validate our findings.

Analysis of clinicopathological features and risk factors for postoperative complications in the elderly gastric cancer patients

To investigate the clinicopathological features and postoperative short-term complications in the elderly gastric cancer patients. Clinical data of 270 elderly patients with gastric cancer who underwent gastrectomy in Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine between July 2012 and June 2014 were analyzed retrospectively. Among 270 patients, 220 were 70 to 79 years old( old group) and 50 were ≥80 years old(oldest group). The clinicopathological features were compared between the two groups. Perioperative factors were analyzed to determine if they are associated with postoperative complications. Multivariate logistic regression model was performed. Before operation, most elderly patients (n=161, 59.6%) had 2 or more than 2 comorbidities, including hypertension (n=154, 57.0%), anaemia (n=126, 46.7%), diabetes (n=53, 19.6%), arhythmia (n=52, 19.3%), cardiovascular disease(n=33, 12.2%), and chronic pulmonary disease(n=28, 10.4%). Elderly gastric cancers were more likely to locate at the lower third of the stomach (n=116, 43.0%). The pathological type was mainly the poorly differentiated carcinoma (n=152, 56.3%), and stage III was more common in TNM staging(n=138, 51.1%). As compared to the old group, the oldest group had more preoperative comorbid diseases(P=0.048), more previous surgery(P=0.029), more preoperative transfusion (P=0.019), more combined cholecystectomy (P=0.007) and feeding jejunostomy (P=0.037), but less tumor invasion of nerves(P=0.045). No significant differences in other clinicopathological parameters were found between the two groups (all P>0.05). A total of 121 (44.8%) patients presented postoperative complications, including severe complication in 30 cases(11.1%) and death in 4 cases(1.5%). Forty-seven patients(17.4%) presented operation-associated complications, including infection in 28 cases(10.4%) and leakage in 21 cases(7.8%). One hundred and seven(39.6%) patients presented non-operation-associated complications, including pneumonia in 48 cases(17.8%), hypertension in 23 cases(8.5%), and arhythmia in 17 cases(6.3%). Postoperative morbidities of Clavien-Dindo class II complication and non-operation-associated complication were higher in the oldest group compared with old group(P<0.05), while other postoperative complications were compared between the two groups, only urinary tract infection was significantly different(P<0.05). Univariate analysis showed that postoperative complications were significantly associated with age(χ(2)=7.308, P=0.007), number of comorbid diseases (χ(2)=10.872, P=0.001), cardiovascular disease (χ(2)=9.412, P=0.002), hypertension (χ(2)=4.934, P=0.026) and preoperative transfusion (χ(2)=3.911, P=0.048). Multivariate analysis showed that only the number of comorbid diseases was an independent risk factor for postoperative complications(OR=2.810, 95% CI: 1.710 to 4.616, P=0.000). Non-operation-associated postoperative complications are more likely to occur in the elderly patients due to more comorbid diseases. Perioperative intensive care should be carried out for the elderly gastric cancer patients with comorbid diseases in order to improve surgical safety and efficacy.

Calculating Additional Risk of Concomitant Laparoscopic Surgery in Living Kidney Donors: Cholecystectomy in Combination with Living Donor Nephrectomy

Background: During the evaluation of a donor candidate for living kidney donation, occasionally a concomitant benign abdominal disease is diagnosed. Combining organ donation and surgical treatment of that disease could be beneficial to the donor. This paper quantified the additional risk to the donor if the two operations were combined. Study design: The clinical database of 155 academic medical centers and affiliated hospitals of University HealthSystem Consortium was used to predict the minimum expected surgical risk of a combined laparoscopic cholecystectomy and laparoscopic donor nephrectomy. Results: Our model predicted that a minimum of 8.64% of patients undergoing laparoscopic cholecystectomy at the same time as a donor nephrectomy would experience at least one complication. This represents an increase of 2.3% (relative risk=1.24) from the 6.34% risk for patients undergoing only the cholecystectomy. Conclusion: The estimation of increased risk is a necessary step to obtain informed consent from a donor offered or who wants to undergo multiple procedures simultaneously.

Single-incision laparoscopic combined cholecystectomy and appendectomy.

Background and Objectives:Single-incision laparoscopic surgery is becoming more widely used, but few combined procedures have been reported. Herein we share our experience with single-incision laparoscopic combined cholecystectomy and appendectomy.Methods:We reviewed data from 26 patients who underwent single-incision laparoscopic combined cholecystectomy and appendectomy between May 1, 2009 and June 1, 2013 at Shengjing Hospital. All the procedures were performed with conventional laparoscopic instruments placed through a single operating portal of entry created within the umbilicus.Results:All the operations were successfully completed without conversion to conventional laparoscopic or open surgery. No intraoperative complications occurred. Patients were satisfied with the therapeutic and cosmetic outcomes.Conclusions:Single-incision laparoscopic combined cholecystectomy and appendectomy appear to be a technically feasible alternative to the standard laparoscopic procedure in simultaneous management of coexisting benign gallbladder and appendix pathologies. Larger studies are required to confirm these findings.

Combined cholecystectomy in gastric cancer surgery

BackgroundMany studies have described the risk factors of gallstone formation in gastric cancer patients after gastrectomy, but few studies focus on the management of asymptomatic gallstones. Our goal is to examine the rationale of simultaneous cholecystectomy during gastric cancer surgery, and influence of surgical mortality, morbidity and overall survival after combined cholecystectomy and gastrectomy. MethodsWe retrospectively reviewed 445 gastric cancer patients and the gallbladders evaluated by abdominal ultrasound or computed tomography preoperatively and postoperatively. Clinicopathologic factors, including surgical morbidity, mortality and overall survival of combined surgery, were compared between patients receiving gastrectomy with simultaneous cholecystectomy and patients receiving gastrectomy only. We also evaluated the risk factors of gallstone formation after gastrectomy and the probability of subsequent cholecystectomy after gastrectomy in gastric cancer patients with or without asymptomatic gallstones. ResultsOf 445 gastric cancer patients, 52 (11.7%) patients had asymptomatic gallstones upon diagnosis of gastric cancer. Among patients with healthy gallbladders, 15.2% developed gallstones after gastrectomy. Men and older patients (age over 60) had significantly higher risk of gallstone formation. Rate of subsequent cholecystectomy in patients with and without preoperative asymptomatic gallstones was 30.8% and 4.5%, respectively (p = 0.005). The rates of mortality and morbidity were not significantly different between combined surgery (3.4%, 24.2%) and gastrectomy only (3.1%, 22%). There was also no significant difference in 5-year survival between combined surgery (61%) and gastrectomy only (63%) groups. ConclusionCombined cholecystectomy for asymptomatic gallstone in gastric cancer surgery may be considered. It was not associated with increased surgical morbidity or mortality, and had no significant effect on overall survival.

Combined Laparoendoscopic Single-Site Surgery: Initial Experience of a Single Center

This study reports the initial experience with combined laparoendoscopic single-site surgery (LESS) referring to cholecystectomy, appendectomy, oophorocystectomy and liver cyst and renal cyst fenestration and explore the feasibility and safety of combined LESS. From October 2008 to May 2011 selective 24 patients underwent combined LESS in our center. The single incision in umbilicus was about 2cm. All the operations were performed by the same surgical team and used conventional rigid instruments. In 24 patients, combined laparoendoscopic single-site cholecystectomy and appendectomy were performed in 17 cases, combined cholecystectomy and liver cyst fenestration in 5 cases and combined cholecystectomy and oophorocystectomy in 2 cases. Twenty one patients were successfully operated and the other 3 were converted to conventional laparoscopic surgery because of separating Calot's triangle difficulty. The mean operating time was 87.3 minutes. One urinary retention (4.2%) and one fat liquefaction in abdominal incision (4.2%) occurred and were cured conservatively. There was no mortality in the study. Combined laparoendoscopic single-site surgery is safe, feasible, minimally invasive and cosmetic technique but is more difficult than conventional laparoscopic surgery. It is a reasonable alternative to be performed in selective patients by experienced laparoscopic surgeons.

Synchronous presentation of acute acalculous cholecystitis and appendicitis: a case report

IntroductionAcute acalculous cholecystitis is traditionally associated with elderly or critically ill patients.Case presentationWe present the case of an otherwise healthy 23-year-old Caucasian man who presented with acute right-sided abdominal pain. An ultrasound examination revealed evidence of acute acalculous cholecystitis. A laparoscopy was undertaken and the dual pathologies of acute acalculous cholecystitis and acute appendicitis were discovered and a laparoscopic cholecystectomy and appendectomy were performed.ConclusionAcute acalculous cholecystitis is a rare clinical entity in young, healthy patients and this report describes the unusual association of acute acalculous cholecystitis and appendicitis. A single stage combined laparoscopic appendectomy and cholecystectomy is an effective treatment modality.

Totally laparoscopic sigmoid colectomy with transanal specimen extraction

Conventional techniques for laparoscopic-assisted colectomy (LAC) require abdominal minilaparotomy for extraction of the specimen. Abdominal wound complications often increase the invasiveness of LAC. To decrease the incidence of wound complications, natural orifice specimen extraction (NOSE) has been reported. However, only a few devices that allow smooth extraction and reduced intracorporeal contamination have been reported previously. We performed totally laparoscopic sigmoid colectomy using transanal specimen extraction (TASE) and the Alexis(®) wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA). We document this simple and safe technique and its short-term results. We prospectively collected data on 18 patients who underwent totally laparoscopic sigmoid colectomy with TASE from April 2009 to July 2010. Lymph node dissection and transection of proximal and distal colon were performed in conventional manner. The transected rectal stump was opened transversely, and a long Babcock grasper was inserted transanally through the opened rectal stump. One of a pair of Alexis rings was held and pulled out of the anus. The other ring was placed in the opened rectal stump. The specimen was then extracted transanally through the Alexis. After the Alexis had been removed, the rectal opening was reclosed with a linear stapler. End-to-end colorectal anastomosis was then performed using the double-stapling technique. Transanal extraction was achieved in 17 cases. We switched to conventional LAC in a case involving a bulky specimen. In 16 cases not including the combined cholecystectomy case, mean operation time was 241min. One case was complicated by anastomotic leakage and wound infection, while another had enterocolitis. Median hospital stay was 6days. All patients remained disease free. Mean Wexner score at 12months after operation was 2.3. Totally laparoscopic sigmoid colectomy using TASE and the Alexis appears to be feasible, safe, and oncologically acceptable for selected cases.

Initial experience in children using conventional laparoscopic instruments in single-incision laparoscopic surgery

Background Single-incision laparoscopic surgery (SILS) has been successfully performed in children using 5-mm reticulating instruments. There are, however, few reports investigating the use of conventional instruments in SILS in the pediatric population. Methods We conducted a retrospective review of all consecutive children who underwent SILS from October 2009 to January 2010, with the procedure being solely performed by conventional 3- and 5-mm instruments through a standard access technique. Results A total of 19 SILS procedures were successfully performed in children aged 3 to 15 years. They included appendectomy (n = 10), nephrectomy (n = 1), combined cholecystectomy and splenectomy (n = 2), cholecystectomy (n = 1), high ligation for varicocele (n = 2), excision of Meckel diverticulum (n = 1), and staged orchidopexy and exploration for impalpable testis (n = 2). There was one conversion to conventional laparoscopic surgery, and that occurred in our first case of splenectomy. All the patients had smooth recovery from surgery without complications. Conclusions Using conventional instruments in SILS is technically feasible in children from simple to complex procedures and may have the potential to popularize this approach by eliminating the mandatory demand for specially designed instruments.

Technical Report on the Initial Cases of Single-Incision Laparoscopic Combined Cholecystectomy and Splenectomy in Children, Using Conventional Instruments

The authors report a technique to perform single-incision laparoscopic combined cholecystectomy and splenectomy in 3 children using conventional instruments. Three ports, including 5-mm and 3-mm ports, were placed through an infraumbilical incision for the procedure. Splenectomy was completed in most parts by crossing the 2 straight instruments. The 3 patients, aged 11 to 13 years, with body weight 29 kg to 32 kg, underwent the procedure. In the first patient, 2 additional extraumbilical 5-mm ports were required to complete the splenectomy. After modification of the technique, combined cholecystectomy and splenectomy by SILS were successfully performed in the other 2 patients without complications, and postoperative courses were uneventful. Combined cholecystectomy and splenectomy in children by SILS is technically feasible using conventional instruments. Further studies are required to investigate its safety, benefits over conventional laparoscopic surgery, and refinements in the technique.

Outcomes after Combined Laparoscopic Gastrectomy and Laparoscopic Cholecystectomy in Gastric Cancer Patients

Background/Aims: The purpose of this study was to determine the effect of performing laparoscopic cholecystectomy on patients undergoing laparoscopic-assisted gastrectomy for gastric cancer. Methods: This single center study involved a retrospective review of a database of 400 patients who underwent consecutive laparoscopic-assisted gastrectomy for early gastric cancer from June 2003 to July 2007. Outcomes in 26 patients who underwent both laparoscopic-assisted gastrectomy and laparoscopic cholecystectomy were compared with outcomes from 364 patients who underwent laparoscopic-assisted gastrectomy without laparoscopic cholecystectomy. Results: There were no postoperative 30-day mortalities in the combined cholecystectomy group. The mean surgery duration, time to first flatus and postoperative hospital stay for the laparoscopic gastric resection without combined operation were 181.7 min, 2.7 days and 9.7 days, respectively, and 196.7 min, 2.6 days and 8.8 days, respectively, for the combined cholecystectomy group. None of the postoperative complications was related to combined cholecystectomy. Conclusion: Performing a combined cholecystectomy prolonged the mean surgery duration by approximately 15 min, but had no effect on surgical outcomes. It appears that performing a cholecystectomy at the same time as laparoscopic gastric resection is safe and feasible in patients with both early gastric cancer and gallbladder disease.

Laparoscopic Splenectomy Using LigaSure in Benign Hematologic Diseases

Today laparoscopic splenectomy (LS) is considered the gold standard for the treatment of hematologic disorders of the spleen with the aid of advancements in laparoscopy technique and modern electrosurgical devices. LigaSure vessel sealing system permanently fuses vessels up to 7 mm in diameter by applying a precise amount of pressure and bipolar energy to the tissue. We performed 14 LSs (7 has autoimmune hemolytic anemia, 6 has idiopathic thrombocytopenic purpura, and 1 has hereditary spherocytosis) using LigaSure. The mean spleen weight was 247 g (range, 147 to 620) and the largest diameter of the spleen was 12.1 cm (range, 10 to 23). The average operative time was 84.7 minutes (range, 30 to 190) including combined laparoscopic cholecystectomy in 2 patients and transabdominal preperitoneal inguinal hernia repair in 1 patient. Conversion to open procedure was unnecessary in our series. Minor morbidity occurred in 2 patients; no perioperative hemorrhage or mortality was observed. The average postoperative hospital stay was 3.1 days (range, 2 to 8). LS is a safe and feasible procedure for patients with previous abdominal surgery; gallstones in association with hemolytic anemia can also be treated during LS. LigaSure vessel sealing system during LS is safe and cost-effective method and reduces operating time.

Preference for proximal gastric vagotomy combined with cholecystectomy.

The incidence and severity of postvagotomy diarrhoea has been studied in 32 patients who had undergone both vagotomy and cholecystectomy. Sixteen of these patients had had a proximal gastric vagotomy and 16 a truncal vagotomy and pyloroplasty. Diarrhoea was present in 68 per cent of patients in whom the vagotomy was truncal and in 31 per cent of those in whom it was proximal gastric. Matched groups of patients with truncal vagotomy with pyloroplasty and proximal gastric vagotomy without cholecystectomy were also compared. The possible mechanisms of this diarrhoea following combined vagotomy and cholecystectomy have been discussed.

Prevention or Surgical Treatment of Gallstones in Patients Undergoing Gastric Bypass Surgery for Obesity.

It is well known that obesity is a risk for gallstone formation and biliary sludge. Additionally, it has been clearly shown that rapid weight loss following bariatric surgery is a risk factor for cholesterol cholelithiasis. Multiple serious complications from gallstones such as cholecystitis, cholangitis, gallstone pancreatitis, and cholecystenteric fistulae may occur. Thus, it is necessary to employ medical or surgical methods to prevent or treat gallstones in this group. Therapy should be individualized. Although there is a high incidence of gallstones in this group, only a minority of individuals will develop symptomatic disease. When used in patients who are compliant, ursodeoxycholic acid therapy can be effective to prevent gallstone formation during rapid weight loss. The cost effectiveness of routine ursodeoxycholic acid therapy compared with the potential costs of complicated gallstone disease needs to be further investigated. Combined cholecystectomy with Roux-en-Y gastric bypass surgery is a safe and appropriate therapeutic option in those with preoperatively known gallstones, biliary sludge, and prior episodes of cholecystitis. However, routine cholecystectomy at the time of gastric bypass surgery is not warranted for all patients because of the increased time of operation and postoperative hospitalization, as well as all the potential complications after cholecystectomy. The approach of routine cholecystectomy in this setting subjects many patients to an unnecessary procedure because the majority will not develop symptoms or complications of gallstones. Furthermore, cholecystectomy is technically easier to perform after weight loss occurs.

A Novel Approach in the Treatment of Abdominal Aortic Aneurysms with Coexisting Cholelithiasis

The treatment of abdominal aortic aneurysms (AAAs) with concomitant biliary tract disease remains controversial. Treatment of both conditions in a single stage has been reported by use of a transabdominal approach, closing the retroperitoneum and then removing the gallbladder. The authors report a case of combined AAA repair and cholecystectomy using retroperitoneal exposure to operate on the aorta and then laparoscopic removal of the diseased gallbladder. This approach was associated with rapid recovery and decreased concern with infection inherent with simultaneous transperitoneal exposure of both lesions.

Technical report: Combined laparoscopic cholecystectomy and umbilical hernia repair

SummarySymptomatic gallstones are commonly associated with other surgically correctable conditions. We present 14 patients suffering from a non-incarcerated umbilical hernia and cholelithiasis. All underwent a combined laparoscopic cholecystectomy and umbilical hernia repair through the incision made to insert the umbilical trocar.

Combined cholecystectomy and radical genitourinary cancer surgery

We have routinely performed simultaneous cholecystectomy in patients with cholelithiasis undergoing selected radical genitourinary cancer surgery. A total of 31 patients have undergone cholecystectomy at the time of radical nephrectomy (25), radical cystectomy (5), and radical prostatectomy (1). Operative time was increased twenty-five to forty-five minutes. There was no significant increase in blood loss, postoperative total bilirubin, or number of complications. No complications were directly attributable to the cholecystectomy except for 1 patient who had prolonged drainage from a closed suction drain in the gallbladder fossa. We conclude that concomitant cholecystectomy at the time of radical genitourinary cancer surgery does not significantly increase morbidity and recommend that it be performed in the presence of cholelithiasis.