Use Of Laparoscopic Cholecystectomy Research Articles

Laparoscopic cholecystectomy in calculous cholecystitis: are antibiotics necessary?

Laparoscopic cholecystectomy in patients with cholecystitis is considered the best, appropriate and safe method of treatment for gallstone disease. However, the role of antibiotic administration before or after cholecystectomy to reduce infectious complications, particularly surgical site infections, or mortality is less clear. Many patients receive empiric antibiotics, but the feasibility of their use has not been proven. Some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any benefit to this practice in the absence of risk factors. This review examines the results of antibiotic use in laparoscopic cholecystectomy for chronic and acute calculous cholecystitis. Most studies argue against the need to use prophylactic antibiotics during elective surgery in low-risk patients. In cases of mild and moderate acute cholecystitis, the use of antibiotics to prevent postoperative infectious complications has no evidence of effectiveness, although these recommendations are also ambiguous. It is not recommended to use postoperative antibiotics after elective laparoscopic cholecystectomy, as well as for mild or moderate acute cholecystitis. However, additional studies with well-defined patient populations and comparable outcomes are needed to better assess the most appropriate timing and duration of antibiotic use in patients undergoing laparoscopic cholecystectomy. We used MedLine database on the PubMed platform and the Cochrane library to search for literature sources.

The impact of cholecystectomy on the symptom relief and quality of life of patients with gallbladder dysmotility.

The aim of this study was to demonstrate the impact of laparoscopic cholecystectomy on the physical and mental health of patients with gallbladder dysmotility. Retrospective data was collected from 314 patients who had undergone a hepatobiliary iminodiacetic acid (HIDA) scan between June 2012 and June 2022 in a District General Hospital in South East England. Sixty-three patients who were diagnosed with gallbladder dysmotility were then contacted and asked to participate in a telephone interview regarding their symptoms. We measured their health-related quality of life using the HRQoL SF-12 v2 (Health Related Quality of Life Short Form-12 version 2) questionnaire. Differences in the resolution of symptoms between those that had undergone a cholecystectomy and those who did not, were assessed using a chi square test. The two groups were then compared using the student t-test to assess statistically significant differences. 94% (n=31/33) of the participants in the non-cholecystectomy group demonstrated persistent biliary pain symptoms as opposed to the 6% (n=2/30) in the cholecystectomy group. A statistically significant improvement in five out of the eight domains of the HRQoL SF-12 questionnaire was demonstrated. These domains include PCS (physical component summary), MCS (mental component summary), mental health, general health and bodily pain. The results of our retrospective analysis demonstrate an improvement in both the physical and mental health-related quality of life symptoms in patients who underwent laparoscopic cholecystectomy. These findings support the use of laparoscopic cholecystectomy as an effective method for managing gallbladder dysmotility.

A Systematic Review and Meta-Analysis of the Outcomes of Laparoscopic Cholecystectomy Compared to the Open Procedure in Patients with Gallbladder Disease.

Background Conflicting evidence regarding the laparoscopic versus open cholecystectomy outcomes in scientific literature impacts the medical decision-making for patients with gallbladder disease. This study aimed to compare a range of primary and secondary outcomes between patients receiving laparoscopic cholecystectomy and those with open intervention. Methods Articles published from 1993 to 2023 were explored by utilizing advanced filters of PubMed Central/Medline, Web of Science, CINAHL, JSTOR, Cochrane Library, Scopus, and EBSCO. The gallbladder disease was determined by the presence of one or more of the following conditions: 1) Gangrenous cholecystitis, 2) acute cholecystitis, 3) chronic gallbladder diseases, and 4) cholelithiasis. The primary end-point was mortality, while the secondary outcome included (1) bile leakage, 2) common bile duct injury, 3) gangrene, 4) hospital stay (days), 5) major complications, 6) median hospital stay (days), (7) pneumonia, 8) sick leaves (days), and 9) wound infection. Results Statistically significant reductions were observed in mortality (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.30, 0.45, p < 0.00001), mean hospital stay duration (mean difference: -2.68, 95% CI: -3.66, -1.70, p < 0.00001), major complications (OR: 0.35, 95% CI: 0.19, 0.64, p = 0.0005), post/intraoperative wound infection (OR: 0.29, 95% CI: 0.16, 0.51, p < 0.0001), and sick leaves (OR: 0.34, 95% CI: 0.14, 0.80, p = 0.01) in patients who underwent laparoscopic cholecystectomy compared with those with the open intervention. No statistically significant differences were recorded between the study groups for bile leakage, common bile duct injury, gangrene, median hospital stay days, and pneumonia ( p > 0.05). Conclusions The pooled outcomes favored the use of laparoscopic cholecystectomy over the open procedure in patients with gallbladder disease. The consolidated findings indicate the higher impact of laparoscopic cholecystectomy in improving patient outcomes, including safety episodes, compared with open cholecystectomy.

SP2.1 The Impact of Cholecystectomy on The Symptom Relief and Quality of Life of Patients with Gallbladder Dysmotility

Abstract Aims The aim of this study was to demonstrate the impact of laparoscopic cholecystectomy on the physical and mental health of patients with gallbladder dysmotility. Methods Retrospective data was collected from patients who had undergone a Hepatobiliary Iminoacetic Acid (HIDA) scan between June 2012 and June 2022 in a District General Hospital in South East England. Patients diagnosed with gallbladder dysmotility were then contacted and asked to participate in a telephone interview regarding their symptoms. Their health-related quality of life was measured using the HRQoL SF-12 v2 questionnaire. Differences in the resolution of symptoms between those that had undergone a cholecystectomy and those who did not, were assessed using a chi square test. The two groups were then compared using the student t-test to assess statistically significant differences. Results 94% (n=31/33) of participants in the non-cholecystectomy group demonstrated persistent biliary pain symptoms as opposed to the 6% (n=2/33) in the cholecystectomy group. A statistically significant improvement in five out of the eight domains of the HRQoL SF-12 questionnaire was demonstrated. These domains include PCS (physical component summary), MCS (mental component summary), mental health, general health and bodily pain. Conclusion The results of our retrospective analysis demonstrate an improvement in both the physical and health-related quality of life symptoms in patients who underwent laparoscopic cholecystectomy. These findings support the use of laparoscopic cholecystectomy as an effective method for managing gallbladder dysmotility.

Bile Duct Injury and Repair: Case Series from 1989 to 2020

BACKGROUND: The benign lesion of the bile duct is a complication of difficult diagnosis and treatment; which has increased due to the use of laparoscopic cholecystectomy (LC) in the management of cholecystolithiasis. Rates of 0.2 to 0.4% of bile duct injuries have been reported, becoming a significant cause of mortality at the time of repair. METHODS: This is an observational, descriptive study, a retrospective case series, based on primary sources of information. The universe of the study are the patients who underwent surgery for bile duct injury from 1989 to 2020, in a private clinic in the city of Cuenca-Ecuador. RESULTS: In more than 30 years, 24 bile duct injury repairs were performed, which occurred: 6 during conventional surgery and 18 during laparoscopic surgery. 54.2% of the lesions occurred less than two centimeters from the confluence of the hepatic ducts. 58.4% of lesions were repaired with Roux-en-Y anastomosis. Antibiotic therapy and drainage were administered to 100% of the patients; 45.83% of the drains placed were tubular drains. 70.8% of the patients didn´t have complications after the repair procedure; the complications that occurred are: bilioma, fistulas, stenosis, cholangitis. CONCLUSION: In most patients who had bile duct injury, the injury occurred during laparoscopic surgery. The injury was most often located less than two centimeters from the confluence of the hepatic ducts. The most frequently performed repair procedure was the Roux-en-Y anastomosis. The most frequent complication after repair was cholangitis.

Comparison of Frequency of Complications of i-Gel and Laryngeal Mask Airway Supreme™ in Laparoscopic Cholecystectomy

Aim: To compare the frequency of complications of i-gel versus laryngeal mask airway supreme™ (LMA Supreme) in laparoscopic cholecystectomy. Study Design: Randomized Controlled Trial Place and Duration of Study: Department of Anesthesia, Jinnah Postgraduate Medical Institute Karachi from 16th September 2019 to 15th March 2020. Methodology: One hundred and fifty four patients having gallstones ≤5 in numbers (size &lt;2cm) on ultrasound for &gt;6 months requiring cholecystectomy and planned for elective list under general anesthesia of age ranges from 25-55 years of both gender were included. Patients with known or predicted difficult airway, oropharyngeal pathology, cervical spine fracture, GERD and hiatus hernia were excluded. In group A, airway was secured with i-gel while in group B, airway was secured with laryngeal mask airway supreme™. In all patients, anesthesia was given by one consultant anesthetist (at least 3 years 0f post-fellowship experience). All patients were followed by the researcher in the first 24 hours for presence or absence of dysphagia and sore throat. Results: The mean age was 34.78±6.30 years in group A and 34.38±6.37 years in group B. Majority of the patients 119 (77.27%) were between 25 to 40 years of age. There were 54 (35.06%) males and 100 (64.94%) were females with male to female ratio of ratio of 1:2.9. The complications of i-gel vs laryngeal mask airway supreme™ were found to be as follows; dysphagia on 0.0% vs 6.49% (p-value = 0.023) and sore throat in 3.90% vs 20.78% (p=0.001). Conclusion: The frequency of dysphagia and sore throat is less after i-gel use in laparoscopic cholecystectomy as compared to laryngeal mask airway supreme™. Keywords: General anesthesia, I-gel, Dysphagia

Erector Spinae Plane Block for Different Abdominal Surgeries: Case Series

The ultrasound guided erector spinae plane (ESP) block is a recent block described for various surgeries for postoperative analgesia. ESP block has effect on both visceral and somatic pain; therefore, its use in laparoscopic cholecystectomy and other abdominal surgeries can be advantageous. The technique is considered a quality standard because it provides good control of the anticipated pain. The local anesthetic is injected between the erector spinae muscle and the transverse process and it spreads cranially and caudally into the paravertebral space, affecting the ventral and dorsal branches of the thoracic spinal nerves and the rami communicants that contain sympathetic nerve fibers. This relatively simple and safe block dramatically reduced the amount of IV pain medication we usually administer for the specific procedure. The overall result was increased satisfaction of the patient and avoidance of opioid use. We described five case series of ESP blocks successfully performed for postoperative analgesia in various abdominal surgeries.

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A Scoring Method

Abstract Background: Laparoscopic cholecystectomy is the most frequent operation nowadays for gallbladder stones. It is associated with faster recovery and shorter hospital stay. On the wide use of laparoscopic cholecystectomy, various com-plications appeared. This made researches work on studies to predict the difficulty of laparoscopic cholecystectomy through different scoring system. This study validates the usage of a scoring system for preoperative prediction of intraoperative difficulties of lapar-oscopic cholecystectomy that may help the patient as well as surgeon in being better prepared for intraoperative challenges. Gallbladder-related disease is one of the common surgical elective and emergency indications. Laparoscopic cholecys-tectomy (LC) is the gold standard nowadays for gallbladder removal. The frequency of complications associated with laparo-scopic cholecystectomy varies from 0.5-6%. Complications of cholecystectomy include iatrogenic perforation of gallblad-der with spilt gallstones that is considered the most common, bile duct injury, bile leaks, bleeding and bowel injury. Con-version rate was about 5% of all laparoscopic cholecystecto-mies. Many risk factors have been found to be associated with difficult laparoscopic cholecytectomy. These result in part from patient selection, surgical inexperience, and the technical constraints that are inherent to the minimally invasive approach. Scoring proposed by Randhawa and Pujahari in 2008 is the most used currently. They found its statistically and clinically good test for predicting outcome in LC. This score had positive predictive value of 88.8% and 92.2% for easy and difficult. One of the unique features in this score is the inclusion of palpable Gallbladder that was not reported earlier. But there was no correlation of score and conversion in this study as all cases of conversion were due to anomalous ducts that could have been predicted by MRCP. It included various clinical and ultrasonographic parameters. Aim of Study: To validate a risk score based on the patient's history, physical examination and abdominal ultrasonography parameters for preoperative prediction of difficult laparoscopic cholecystectomy. Patients and Methods: Our study included 30 patients underwent laparoscopic cholecystectomy in Ain Shams Hos-pital and Alamria Hospital. Results: In our study, males were more predominant than females (73.3% vs 26.7%) with mean age of (40.23±13.64) years. Our patients had mean BMI of (28.43±4.03) kg/m2 with most of them were obese (63.3%). Intra operative diffi-culty showed significant relation with sex and BMI. 13.3% of patients had leukocytosis and all our patients had normal alkaline phosphatase. 56.7% of the study patients were presented with previous acute attacks, 20% presented with fever, 6.7% had palpable GB and 33.3% had abdominal scar. Intra operative difficulty showed significant relation with previous acute attack, abdominal scar and GB wall thickness. We found that preoperative scoring had a sensitivity of 89.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 84.6%, diagnostic accuracy of 93.3%, and Kappa agreement of 0.862 compared to the intraoperative scoring system. Conclusion: We strongly recommend using the preoper-ative scoring system for predicting the degree of difficulty for laparoscopic cholecystectomy.

TO COMPARE THE TYPE OF WOUND INFECTION OF SINGLE DOSE VERSUS CONVENTIONAL (MULTIPLE DOSES) ANTIBIOTIC USE IN LAPAROSCOPIC CHOLECYSTECTOMY IN TERMS OF TYPE OF SSI (SUPERFICIAL INCISIONAL SSI OR DEEP INCISIONAL SSI)

Background: To compare the type of wound infection of single dose versus conventional (multiple doses) antibiotic use in laparoscopic cholecystectomy in terms of SSI&#x0D; Methods: This study was carried out in the department of General Surgery Indira Gandhi Medical College Shimla (H.P.) on patients admitted with radiologically proven cholelithiasis.&#x0D; Results: In SD group out of 03 patients who developed wound sepsis all were having Superficial incisional SSI and in C group also all patients (02) who developed wound sepsis had superficial incisional SSI.&#x0D; Conclusion: The type of infection wise difference in both groups was found insignificants.&#x0D; Keywords: Superfical, Deep, Gallstone, Wound sepsis

TO COMPARE THE EFFICACY OF SINGLE DOSE VERSUS CONVENTIONAL (MULTIPLE DOSES) ANTIBIOTIC USE IN LAPAROSCOPIC CHOLECYSTECTOMY IN TERMS OF SSI

Background: To compare the efficacy of single dose versus conventional (multiple doses) antibiotic use in laparoscopic cholecystectomy in terms of SSI&#x0D; Methods: This study was carried out in the department of General Surgery Indira Gandhi Medical College Shimla (H.P.) on patients admitted with radiologically proven cholelithiasis.&#x0D; Results: In SD group of patients out of 50 patients, 03 patients (6%) developed wound sepsis and in C group 02 patients (4%) developed wound sepsis. P value was 0.65 which is statistically insignificant.&#x0D; Conclusion: The wound sepsis wise difference in both groups was found insignificants.&#x0D; Keywords: Single dose, Conventional, Gallstone, Wound sepsis

Trends in primary gallbladder cancer incidence and incidence-based mortality in the United States, 1973 to 2015.

e16133 Background: Primary gallbladder carcinoma (GBC) is the most common biliary tract cancer with poor survival despite aggressive treatment. The purpose of our study was to investigate the trends of GBC incidence and incidence-based mortality (IBM), as well as to identify the factors responsible for any observed changes. Methods: GBC cases diagnosed between 1973 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results database (SEER) database. Incidence and IBM rates age-adjusted to the 2000 US standard population were calculated and were stratified according to population and tumor-associated characteristics. Joinpoint Regression Analysis program was used to calculate the annual percent changes (APCs) for trend analysis. Results: Among the 10,792 patients with GBC, there was a predominance of white (81%) and female (71%) patients. The overall incidence rate was 1.086 (95% CI: 1.065 to 1.106) and the overall IBM rate was 0.995 (95% CI: 0.976 to 1.015). GBC incidence decreased by 1.645% (95% CI: 1.448 to 1.842, p &lt; 0.001) per year, but the decreasing trend was only statistically significant from 1973 to 2002, after which the incidence rates stabilized. Conversely, IBM decreased by 1.689% (95% CI: 1.217 to 2.159, p &lt; 0.001) per year from 1980 to 2015; the degree of decline in IBM rates during 1997-2015 (-1.194, 95% CI: -1.680 to -0.705, p &lt; 0.001) was lower compared to that during 1980-1997 (-3.132, 95% CI: -3.682 to -2.578, p &lt; 0.001). Mortality rates of GBC decreased in all age groups and in all races except for African American. There was a significant decrease in IBM in all SEER stages of GBC, except for distant stage GBC. Conclusions: GBC incidence and IBM rates have been decreasing over the last 40 years. However, the decrease in incidence and IBM appeared to have plateaued in the last two decades. The roles of increasing widespread use of laparoscopic cholecystectomy and use of newer treatment modalities, such as adjuvant chemotherapy and radiation, need to be investigated further.[Table: see text]

Pharmacological evaluation of prophylactic anti-microbial use in laparoscopic cholecystectomy; an open labelled study evaluating theconcentrations of single dose intravenous ceftriaxone at serum and tissue level.

The goal of administering preoperative systemic prophylactic antibiotics is to have the concentration in the tissues at its optimum level at the start and throughout the surgery. The rationale for the use of antibiotics is not well accepted; possible side effects and development of microbial resistance patterns are potential risks along with the financial burden. Therefore, the present study was conducted with the aim to clinically evaluate the serum and tissue concentration of single-dose prophylactic ceftriaxone during an ongoing laparoscopic cholecystectomy (LC) and to find out risk factors for post operative surgical site infections (SSI). It was an open labelled prospective study in 50 consecutive patients who underwent elective laparoscopic cholecystectomy under prophylactic cover of ceftriaxone. Serum and tissue concentration were estimated by HighPerformanceLiquidChromatography during the ongoing surgery. Subjects were observed for any post-operative complications including SSI. Serum and tissue concentrations of ceftriaxone were significant at test value of 4milligrams/Litre. Body mass index was significantly correlated with the tissue concentration of ceftriaxone at the time of incision. The rate of SSI was 2%. It significantly correlated with age more than 60years, diabetes and infected bile. A single prophylactic intra-venous dose of 1g ceftriaxone immediately prior to skin incision in LC is good enough for prevention of SSI in Indian patients.

Surgical Treatments of Hepatobiliary Cancers.

Hepatobiliary cancers which include hepatocellular carcinoma (HCC) and biliary tract cancers (i.e., cholangiocarcinoma and gallbladder carcinoma) are associated with significant morbidity and mortality based on the stage of the disease at presentation. With improved screening for hepatobiliary malignancies in patients with risk factors and with widespread use of laparoscopic cholecystectomy, hepatobiliary malignancies, including incidental diagnosis of gallbladder carcinoma, are on the rise. Definitive treatment of hepatobiliary malignancies include surgical resection, ablation, and liver transplantation. However, management of these cancers is challenging due to the complex hepatobiliary anatomy and the need for meticulous perioperative management especially in patients with advanced liver disease. The management and prognosis of hepatobiliary malignancies vary widely based on the stage of presentation, with surgical options providing the possibility of definitive cure in patients presenting with early-stage disease. Surgical resection for HCC results in good outcomes if performed in ideal candidates. For patients with early HCC who are not candidates for surgical resection, ablation and liver transplantation should be considered. Similarly, surgical resection is also the definitive treatment for biliary tract cancers, and liver transplantation can be curative in selected patients with perihilar cholangiocarcinoma after neoadjuvant chemoradiotherapy. The role of routine adjuvant chemotherapy and radiotherapy is not clearly established, but adjuvant therapies can offer better outcomes in patients with advanced disease at presentation. Outcomes of surgical management of hepatobiliary cancers seem to be improving. Given the complex decision-making process involved, multidisciplinary evaluation is essential to provide and coordinate the best treatments for these patients.

NATURE OF POST-SURGERY COMPLICATIONS AFTER CHOLECYSTECTOMY OF DESTRUCTIVE CHOLECYSTITIS IN PATIENTS OF AN OLDER AGE GROUP WITH A ISCHEMIC HEART DISEASE

Аbstract. The significance of the problem of acute cholecystitis in the elderly and senile is due to a high increase in the incidence, the presence of marked concomitant diseases.&#x0D; There is no literature data on a comparative analysis of early post-surgery complications of acute destructive cholecystitis in elderly and senile patients with concomitant coronary heart disease after traditional cholecystectomy and laparoscopic cholecystectomy.&#x0D; The Aim of the study is a comparative analysis of the nature of early post-surgery complications after traditional cholecystectomy and laparoscopic cholecystectomy of acute destructive cholecystitis in the elderly and senile with concomitant coronary heart disease.&#x0D; Materials and methods of research. A comparative analysis of early post-surgery complications was performed in 392 patients aged 60 and over with concomitant coronary heart disease who underwent surgical treatment for acute destructive cholecystitis. Depending on the method of surgical treatment, patients were divided into two groups: the І group (n = 178) — surgical treatment was carried out in the amount of traditional cholecystectomy, sanitation of the abdominal cavity with saline and decasan solution; the ІІ group (n = 214) — surgical treatment included laparoscopic cholecystectomy, sanitation of the abdominal cavity with saline and «decasan» solution, extraction of the gallbladder in a rubber sterile container through a subxiphoid wound, which, after removal of the gallbladder, was sanitized with «decasan» solution.&#x0D; Research results. Complications from the cardiovascular system in the 1st group were noted in 2.8 % of patients, pneumonia — 1.1 %, from the abdominal cavity — 8.5 %, wounds — 25.8 %, postoperative intestinal paresis — 19, 1 %, mortality — 1.1 %. In the 2nd group, complications from the cardiovascular system — 0.5 %, from the abdominal cavity — 4.7 %, wounds — 4.2 %, postoperative intestinal paresis — 8.4 %, mortality — 0.5 %. Complications related to bile leakage, the development of biloma or biliary peritonitis in the groups did not differ.&#x0D; Conclusions. The use of laparoscopic cholecystectomy in acute destructive cholecystitis in elderly people with concomitant coronary heart disease has reduced the number of postoperative complications from the cardiovascular system compared with traditional cholecystectomy from 2.8 % to 0.5 %, from the abdominal cavity — from 8.5 to 4.7 %, from the side of the wound — from 25.8 to 4.2 %, reduce mortality from 1.1 to 0.5 %.

Efficacy of laparoscopy for acute Cholecystitis: A comparative study

Background: Laparoscopic cholecystectomy (LC) represents a significant change in the management of gallbladder disease and it is the most commonly performed operation of the digestive tract. It is considered as the gold standard treatment for Cholelithiasis. For acute Cholecystitis, however, the use of laparoscopic cholecystectomy has been controversial up until recently, because of the high open conversion rate and the high incidence of postoperative complications.Aim of the study: To study efficacy of laparoscopy for acute Cholecystitis.Materials and methods: For the study, we retrospectively reviewed the medical records of patients aged 30-65 years with acute Cholecystitis who underwent Laparoscopic cholecystectomy (LC) and were compared patients who underwent open cholecystectomy (OC). A total of 120 patients (70 for LC and 50 for OC) were reviewed.Results: Our study group comprised of 120 total patients. 70 had undergone LC and 50 had undergone OC. On comparing the demographics of the patients, the results were found to be statistically non-significant for all the parameters. We observed that mean operative time for LC was 49.69 min and for OC was 62.36 min.Conclusion: Within the limitations of the present study, it can be concluded that laparoscopic cholecystectomy has equal efficacy for acute Cholecystitis patients as compared to open cholecystectomy.

A study of factors determining difficult surgery among patients undergoing laparoscopic cholecystectomy

Background: With widespread use of laparoscopic cholecystectomy and its applicability in many difficult situation, the chances of complication and difficulty during surgery have increased. This study was done to determine the factors which could preoperatively predict difficulty undergoing laparoscopic cholecystectomy.Methods: The data were obtained from the patients admitted to in wards of General Surgery, JN Medical Collage, Aligarh Muslim University, and Aligarh, India undergoing laparoscopic cholecystectomy. The difficult laparoscopic cholecystectomy was defined as procedures exceeded 70 minutes in duration or those which were converted to open procedure. Dependent variable included demographic factors, clinical and sonographic findings. P value was kept at 0.05.Results: During the study duration, 200 patients were included in the study undergoing for the laparoscopic cholecystectomy and out of this 85 had difficult outcome procedure. High BMI, hypertension, previous upper abdomen surgery, deranges AST and serum creatinine along sonographic findings of gall balder wall thickening and pericholecytsic edema were found to be significantly associated with difficult LC.Conclusions: This study demonstrates that presence of various factors can predict the difficult outcome of laparoscopic cholecystectomy. This can help in minimizing the complication and council the patients regarding difficult procedure and need for conversion to open cholecystectomy, especially relevant for funds-limited settings like India.

Global trends in mortality from intrahepatic and extrahepatic cholangiocarcinoma

Intrahepatic (ICC) and extrahepatic cholangiocarcinoma (ECC) have rarely been studied individually, probably due to difficulties in their diagnosis and certification. Mortality trends from these 2 neoplasms have been inconsistent over the last decades. The aim of this study was to analyze worldwide trends in mortality from ICC and ECC in selected countries. We extracted death certification data for ICC and ECC, and population estimates from the World Health Organization and Pan American Health Organization databases for 32 selected countries from Europe, the Americas, and Australasia from 1995 to 2016. We computed age-standardized (world population) mortality rates from ICC and ECC, and performed joinpoint regression analysis. Mortality rates from ICC increased in all countries considered, with a levelling off over recent years in Germany (women), Italy (men), Argentina (men), the USA (men), Hong Kong (men), and Japan (both sexes). The highest rates in 2010-2014 (1.5-2.5/100,000 in men and 1.2-1.7/100,000 in women) were registered in Hong Kong, France, Austria, Spain, the UK, and Australia. The lowest rates (0.2-0.6/100,000 in both sexes) were registered in Latin American and eastern European countries. Mortality from ECC decreased in most of the countries considered, with rates below 1/100,000 in both sexes between 2010 and 2014, with the only exception being Japan (2.8/100,000 in men and 1.4/100,000 in women). Increasing mortality from ICC was observed globally, due to trends in risk factors and possibly, in part, due to better disease classification. Mortality from ECC levelled off or decreased, most likely following the increased use of laparoscopic cholecystectomy. Biliary tract cancers include intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC), however there are some differences in their risk factors. Consequently, the distinction between ICC and ECC is important. Over the last few decades, mortality from ICC has tended to rise in several areas of the world, following the increased prevalence of its major risk factors. In contrast, mortality from ECC tended to decrease in most countries, following the increased use of laparoscopic cholecystectomy.

Surgical Innovation and the Multiple Meanings of Randomized Controlled Trials: The First RCT on Minimally Invasive Cholecystectomy (1980-2000).

This article uses the case of the first randomized controlled trial (RCT) evaluating laparoscopic cholecystectomy to investigate the introduction of minimally invasive surgery in the 1990s and explore the meaning of RCTs within the context of the introduction of a new surgical technology. It thus brings together the history of the use of laparoscopic cholecystectomy to remove the gallbladder, and the history of the RCT, shedding light on particular aspects of both. We first situate the RCT in the context of the history of the various treatment options for gallstones, or cholelithiasis, then characterize the specific situation of the rapid, patient-driven spread of laparoscopic cholecystectomy, and in a next step describe how the local context of laparoscopic cholecystectomy as a new technology made it possible and desirable to conduct an RCT, despite numerous obstacles. This article then shows that in order to capture and understand the rationale of an RCT it is worth it to explore the various levels and dimensions of its context, demonstrating how even the RCT as an ostensibly universal tool draws its meaning from its contexts and that this meaning goes beyond the simple determination of efficiency and safety, including, maybe most importantly, the control and management of new technologies.

The Benefits of Percutaneous Transhepatic Gallbladder Drainage prior to Laparoscopic Cholecystectomy for Acute Cholecystitis

Purpose: Several studies have reported that laparoscopic cholecystectomy with percutaneous transhepatic gallbladder drainage (PTGBD) is associated with a reduced duration of surgery and a lower rate of conversion to open laparotomy compared with laparoscopic cholecystectomy without PTGBD and delayed laparoscopic cholecystectomy after conservative therapy. However, these results are contradictory. This retrospective study investigated the safety and usefulness of laparoscopic cholecystectomy combined with pre-operative PTGBD in patients with acute cholecystitis. Methods: The clinicopathologic data and surgical outcomes of 101 patients who underwent laparoscopic cholecystectomy between January 2010 and September 2015 were reviewed retrospectively. Results: Patients in the PTGBD group vs. the non-PTGBD group were significantly older (mean age: 65.47±12.2 vs. 56.32±13.7; p=0.001). Underlying diseases were also significantly more common in the PTGBD group (75.4% vs. 45.5%; p=0.002). There were no significant differences between the two groups in terms of operative time, blood loss, rate of open conversion, postoperative oral intake, and postoperative hospital stay. Total hospital day was significantly longer in the PTGBD group (11.14±7.22 vs. 6.23±5.17; p=0.049). There was no significant difference in the postoperative complications between the two groups, and all patients in this study lived. Conclusion: This study suggested that satisfactory results can be achieved with selective preoperative PTGBD in older and sicker patients with acute cholecystitis.

Bleeding complications in cholecystectomy: a register study of over 22,000 cholecystectomies in Finland.

BackgroundMajor bleeding is rare but among the most serious complications of laparoscopic surgery. Still very little is known on bleeding complications and related blood component use in laparoscopic cholecystectomy (LC). The aim of this study is to compare bleeding complications, transfusion rates and related costs between LC and open cholecystectomy (OC).MethodsData concerning LCs and OCs and related blood component use between 2002 and 2007 were collected from existing computerized medical records (Finnish Red Cross Register) of ten Finnish hospital districts.ResultsRegister data included 17175 LCs and 4942 OCs. In the LC group, 1.3 % of the patients received red blood cell (RBC) transfusion compared to 13 % of the patients in the OC group (p < 0.001). Similarly, the proportions of patients with platelet (0.1 % vs. 1.2 %, p < 0.001) and fresh frozen plasma (FFP) products (0.5 % vs. 5.8 %) transfusions were respectively higher in the OC group than in the LC group. The mean transfused dose of RBCs, PTLs and FFP product Octaplas® or the mean cost of the transfused blood components did not differ significantly between the LC and OC groups.ConclusionsLaparoscopic cholecystectomy was associated with lower transfusion rates of blood components compared to open surgery. The severity of bleeding complications may not differ substantially between LC and OC.