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1.
Zhonghua Yi Xue Za Zhi ; 99(32): 2507-2510, 2019 Aug 27.
Artigo em Chinês | MEDLINE | ID: mdl-31484277

RESUMO

Objective: To explore the application of indocyanine green fluorescence navigation in open cholecystectomy. Methods: Forty-eight patients with extrahepatic cholangiography who underwent open cholecystectomy in our hospital from March 2016 to February 2018 were enrolled. They were divided into the control group (24 cases) and the experimental group (24 cases) by using the random number table method. The control group was treated with conventional X-ray cholangiopancreatography, and the experimental group was treated with indocyanine green near-infrared fluorescence imaging for extrahepatic cholangiography. The cholangiography success rate, cholangiography time, cholangiography economic costs, imaging accuracy and security were compared between two groups. The operation time, intraoperative blood loss, blood transfusion amount, length of hospital stays, and hospital expenses were also compared between two groups. Results: The success rate of cholangiography (98.62% vs 97.22%) and the incidence of adverse reactions (25.00 vs 29.17) were not significantly different between the two groups (P>0.05). The cholangiography time (25.69±3.47 min vs 31.42±4.66 min), operation time (90.18±10.27 min vs 81.44±9.35 min), intraoperative blood loss (82.35±8.24 ml vs 78.14±7.82 ml), blood transfusion volume (35.19±4.77 ml vs 29.58±4.03 ml), hospitalization time (7.59±1.52 d vs 6.24±1.25 d), and hospitalization cost (12.7±3.1 thousands vs 10.4±2.5 thousands) of the experimental group were significant lower than those of the control group. The accuracy rate (92.22% vs 87.50%), sensitivity (85.71% vs 50.00%) and specificity (88.24% vs 68.75%) of cholangiography in the experimental group were significantly higher than those in the control group, with statistically significant differences (P<0.05). Conclusion: Indocyanine green fluorescent navigation is more timely and accurate than traditional X-ray cholangiography during temporary angiography in open cholecystectomy, which can effectively shorten the operation time, intraoperative blood loss, blood transfusion, hospitalization time and hospitalization expenses. It does not increase the incidence of adverse reactions, has high safety, and is worthy of clinical promotion.


Assuntos
Colecistectomia Laparoscópica , Laparotomia , Colangiografia , Humanos , Verde de Indocianina
2.
Am Surg ; 85(7): 761-763, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405424

RESUMO

The operative experience of present-day surgical residency training has evolved as a result of the contributions of laparoscopic surgery. Some traditional open procedures are now more descriptive and less of a familiarity to many general surgery residents (GSRs). The aim of this study was to investigate how open operative experience compares with laparoscopy for GSRs. A retrospective, multicenter, consecutive cohort study of all patients undergoing surgical intervention involving the appendix and gallbladder identified from the ACS-NSQIP database over a 2.5-year period. All GSR postgraduate year-level operative experience was recorded. Of 777 procedures, 13 laparoscopic appendectomy conversions to open (4.3%) by Rocky-Davis (15%) or lower midline (84.6%) incisions were performed versus 285 that remained laparoscopic (95.6%). Fifty (10.4%) open cholecystectomies (38 open + 10 conversions + 2 common bile duct (CBD) exploration), 27 (5.6%) laparoscopic cholecystectomies with cholangiogram, and 402 (83.9%) laparoscopic cholecystectomies were performed. Twenty-nine different GSRs participated in procedures. Eighty-five (10.9%) operations were performed with multi-postgraduate year levels. Surgical residents have an unequal operative experience for case-specific open procedures. A competency-based system to demonstrate a resident's hands-on surgical skills is fundamental to residency training and should be considered for specific types of low-volume open surgical cases.


Assuntos
Apendicectomia/métodos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colecistectomia/métodos , Laparoscopia/educação , Colecistectomia Laparoscópica/educação , Competência Clínica , Humanos , Internato e Residência/estatística & dados numéricos , Estudos Retrospectivos
4.
Arq Bras Cir Dig ; 32(2): e1438, 2019 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31460598

RESUMO

BACKGROUND: Laparoscopic cholecystectomy is the preferable treatment for chronic or acute cholecystitis. Some factors may increase the rate of laparoscopic conversion to open cholecystectomy and perioperative complications. The role of gender as a risk factor for laparoscopic cholecystectomy is controversial. AIM: To evaluate the role of the gender on the operative findings and outcome of laparoscopic cholecystectomy. METHOD: All patients who underwent laparoscopic cholecystectomy for chronic or acute cholecystitis were included. Demographic, clinical, laboratory, imaging exams, intraoperative and postoperative data were obtained and analyzed. The data was obtained retrospectively from electronic medical records and study protocols. RESULTS: Of a total 1,645 patients who were subjected to laparoscopic cholecystectomy, 540 (32.8%) were men and 1,105 (67.2%) were women. Mean age was similar in both genders (p=0.817). Operative time has longer in the male (72.48±28.50) than in the female group (65.46±24.83, p<0.001). The rate of acute cholecystitis was higher in the male (14.3%) than in the female group (5.1%, p<0.001). There was no difference between the genders in regard to the rate of conversion (p=1.0), intraoperative complication (p=1.0), postoperative complication (p=0.571), and operative mortality (p=1.0). CONCLUSION: Male gender is not an independent risk factor for laparoscopic conversion and perioperative complications.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Colecistite/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
6.
Am Surg ; 85(6): 671-675, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267910

RESUMO

This study aims to provide some experience in diagnosis and treatment of unexpected gallbladder cancer (UGBC) and find the major risk factors. Retrospective data were collected and analyzed on 22 patients who were diagnosed with UGBC during or after laparoscopic cholecystectomy from January 2013 to January 2018 at our hospital. Average age of the patients was (60.2 ± 12.8) years (range, 42-83 years). Among them, there were 6 men and 16 women. Gallbladder stones, atrophic gallbladder, uneven thickened wall of the gallbladder, and choledocholithiasis were found to be the major risk factors. Eight patients (36.4%) were diagnosed intraoperatively. Seven cases (31.8%) were at the T1 stage; of these, three were treated with laparoscopic cholecystectomy; two were converted to cholecystectomy; and two underwent cholecystectomy, lymph node dissection, and liver resection. Eight (36.4%) T2 patients, five (22.7%) T3 patients, and one T4 patient had radical cholecystectomy. Partial cholecystectomy and cholecystotomy were carried out in another T4 patient. T1 patients did not receive chemotherapy or radiotherapy. Eleven had chemotherapy and four received chemoradiotherapy. The follow-up period ranged from six months to five years. The one-year survival rate for T1 to T4 patients was 100 per cent, 75 per cent, 40 per cent, and 0 per cent, respectively. A high index of clinical suspicion of UGBC is needed if one patient suffered from both gallbladder stones and choledocholithiasis with atrophic gallbladder or uneven thickened wall of the gallbladder preoperatively. To avoid more UGBC and reoperation, imaging examinations combined with tumor marker tests and intraoperative histopathologic examination are highly recommended.


Assuntos
Causas de Morte , Colecistectomia Laparoscópica/métodos , Colelitíase/cirurgia , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Achados Incidentais , Adulto , Fatores Etários , Idoso , Colecistectomia Laparoscópica/efeitos adversos , Colelitíase/diagnóstico por imagem , Bases de Dados Factuais , Feminino , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/mortalidade , Humanos , Incidência , Complicações Intraoperatórias/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Prognóstico , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida
7.
JSLS ; 23(2)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31148915

RESUMO

Background and Objectives: Single-port cholecystectomy has emerged as an alternative technique to reduce the number of ports and improve cosmesis. Few previous studies have assessed obesity-related surgical outcomes following single-port cholecystectomy. In this study, technical feasibility and surgical outcomes of single-port laparoscopic cholecystectomy (SPLC) and robotic single-site cholecystectomy (RSSC) in obese patients were investigated. Methods: We conducted a two-center collaborative study and retrospectively reviewed initial experiences of RSSC and SPLC in patients whose body mass index was over 25 kg/m2. Medical records of patients were reviewed. Clinical characteristics and short-term oncologic outcomes were considered and compared between SPLC and RSSC groups. Results: RSSC and SPLC were performed in 39 and 78 patients, respectively. In comparative analysis, the total operative time was longer in the RSSC group (109.92 minutes vs. 60.99 minutes; P < .001).However, requiring additional port for completion of surgical procedure was less frequent in the RSSC group (0% vs. 12.8%; P = .029). Immediate postoperative pain score was not significantly different between the two groups (4.95 vs. 5.00; P = .882). However, pain score was significantly lower in the RSSC group at the time of discharge (1.79 vs. 2.38; P = .010). Conversion to conventional multiport cholecystectomy, intraoperative bile spillage, or complication rate was not significantly different between the two groups (P > .05). Conclusions: SPLC and RSSC could be safely performed in selected patients with high body mass index, showing no significant clinical differences.


Assuntos
Índice de Massa Corporal , Colecistectomia Laparoscópica/métodos , Cálculos Biliares/cirurgia , Obesidade/complicações , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Feminino , Cálculos Biliares/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Alta do Paciente , Estudos Retrospectivos
8.
Wiad Lek ; 72(5 cz 1): 790-794, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31175774

RESUMO

OBJECTIVE: Introduction: The laparoscopic cholecystectomy (LCE) has become "gold standard" in treatment of the gallstone disease (GSD). However, introduction of LCE is accompanied by increase in the frequency of the bile duct injuries by 2-5 times, and transfer to the conversion offsets main advantages of the laparoscopic access. The aim:Тo improve the results of treatment of the patients with complicated course of the calculous cholecystitis by developing new methods of the laparoscopic cholecystectomy. PATIENTS AND METHODS: Materials and methods: The results of surgical treatment of 420 patients with complicated course of the calculous cholecystitis were analyzed. The patients were divided intwo groups: group I (n = 210) where the standard four-trocar LCE was used and the group II (n = 210) where the developed methods of LCE were used. The average age made up 62 ± 6.0 years. Duration of disease made up from 1 month to 35 years. RESULTS: Results: The patients in group I LCE with complicated course of the acute cholecystitis was performed in 108 (25.7%) cases, chronic - in 102 (24.3%) cases. The patients in group II surgical intervention with complicated course of the acute cholecystitis was performed in 112 (26.7%) cases, chronic - in 98 (23.3%) cases. The patients of group I intraoperative injuries were observed in 12 (5.7%) cases and patients of group II - in 4 (1.9%) cases. The conversion was applied in 13 (6.2%) and in 4 (1.9%) cases, respectively. 2 (0.9%) patients died. CONCLUSION: Conclusions: Introduction of the developed methods of LCE with complicated course of the calculous cholecystitis allows to reduce the frequency of intraoperative injuries by 3,8% and conversion rate - by 4,3% (p <0,001).


Assuntos
Colecistectomia Laparoscópica , Colecistite , Idoso , Humanos , Pessoa de Meia-Idade
9.
Pan Afr Med J ; 32: 91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223382

RESUMO

After Malaria, schistosomiasis remains the most important tropical disease in large parts of the world. It affects mainly the colon and the urinary tract. The hepatic involvement is significantly frequent, particularly by the mansoni species. Still one of the extremely rare locations is the gallbladder. Our case is about a 51 year old woman from Tunisia, which is no longer considered an endemic country, with no particular medical history, underwent surgery for symptomatic cholelithiasis. She had a laparoscopic cholecystectomy. Post operative period was uneventful. Histology of the gallbladder showed fibrosis in the mucosa and schistosomal ova in the wall. As a conclusion we can see that due to the lack of specific clinical and radiological signs, the diagnosis of gallbladder schistosomiasis is established only after the histological examination.


Assuntos
Colecistectomia Laparoscópica/métodos , Doenças da Vesícula Biliar/diagnóstico , Esquistossomose/diagnóstico , Colelitíase/diagnóstico , Colelitíase/cirurgia , Feminino , Doenças da Vesícula Biliar/parasitologia , Doenças da Vesícula Biliar/cirurgia , Humanos , Pessoa de Meia-Idade , Esquistossomose/cirurgia , Tunísia
10.
Ann R Coll Surg Engl ; 101(6): 428-431, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155897

RESUMO

INTRODUCTION: Intraoperative cholangiography is sporadically used in patients undergoing laparoscopic cholecystectomy to delineate common bile duct anatomy and exclude retained stones. In patients with acute gallstone pancreatitis, intraoperative cholangiography may reduce the need for preoperative magnetic resonance cholangiopancreatography. MATERIALS AND METHODS: A retrospective review of a prospectively collected patient database was undertaken over a 15-year period. The primary objective was to evaluate intraoperative assessment of the common bile duct with intraoperative cholangiography in patients with acute gallstone pancreatitis. RESULTS: A total of 2215 patients underwent laparoscopic cholecystectomy between October 1998 and December 2013; 113 patients (of whom 77 were women) with a mean age of 54 years (range 16-88 years) were diagnosed with acute gallstone pancreatitis. Of these, 102 patients (90%) underwent laparoscopic cholecystectomy with intraoperative cholangiography, which was normal in 89 cases. Thirteen patients had choledocholithiasis on intraoperative cholangiography, 11 of whom were managed with concomitant trans-cystic duct exploration and clearance. Two patients required postoperative endoscopic retrograde cholangiopancreatography. CONCLUSIONS: In patients diagnosed with acute gallstone pancreatitis, it is reasonable to proceed directly to surgery using intraoperative cholangiography on the same admission as the definitive assessment of the common bile duct. This negates the need for magnetic resonance cholangiopancreatography and can translate into cost savings and reduced length of stay.


Assuntos
Colangiografia , Colangiopancreatografia por Ressonância Magnética , Colecistectomia Laparoscópica/métodos , Cálculos Biliares/cirurgia , Pancreatite/cirurgia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ducto Colédoco/diagnóstico por imagem , Feminino , Cálculos Biliares/diagnóstico por imagem , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico por imagem , Estudos Retrospectivos , Adulto Jovem
11.
Medicine (Baltimore) ; 98(25): e16022, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232934

RESUMO

BACKGROUND: Laryngeal mask airway (LMA) insertion provokes fewer stress responses than endotracheal intubation. This study aimed to evaluate the LMA Protector for assessing improvements in intraoperative hemodynamic stability and to reduce postoperative discomfort compared with endotracheal intubation in laparoscopic cholecystectomy. METHODS: Fifty-six patients who underwent laparoscopic cholecystectomy while under sevoflurane-based general anesthesia were randomly allocated to airway management using LMA (LMA group) or endotracheal tube (ETT group). Heart rate, blood pressure, and peak airway pressure were recorded before and after carboperitoneum. Postoperative pain and analgesic requirements were assessed, in addition to nausea, hoarseness, dysphonia, and sore throat during the first 1 hour postoperatively and until postoperative day 1. RESULTS: All patients underwent successful LMA or ETT placement within 2 attempts. There was no difference in highest mean (SD) peak airway pressure during carboperitoneum between the LMA and ETT groups (17.7 [2.8] mm Hg vs 19.1 [3.8] mm Hg, P = .159, respectively). The incidence of high systolic blood pressure and bradycardia was higher in the LMA group. The highest pain scores 1 hour postoperatively and on postoperative day 1 were lower in the LMA group than in the ETT group (3.9 [2.0] vs 5.4 [2.3], P = .017 and 5.6 [1.9] vs 6.7 [1.7], P = .042, respectively); requirements for analgesics were similar in the 2 groups. The incidence of nausea was lower in the LMA group than in the ETT group until postoperative day 1 (4/28 [14%] vs 12/28 [43%], P = .031, respectively). CONCLUSION: The LMA Protector was an effective ventilator device associated with fewer intraoperative hemodynamic stress responses and improved the quality of early recovery after laparoscopic cholecystectomy.


Assuntos
Colecistectomia Laparoscópica , Intubação Intratraqueal/efeitos adversos , Máscaras Laríngeas/efeitos adversos , Dor Pós-Operatória/etiologia , Faringite/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento , Adulto Jovem
12.
Ann Vasc Surg ; 59: 307.e17-307.e20, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075475

RESUMO

Vascular complications secondary to acute pancreatitis carry a high morbidity and mortality, often because of their hemorrhagic or thrombotic effects. When thrombosis presents, it is typically localized to the splanchnic venous system. In this report, we present a case of acute superior mesenteric artery thrombosis secondary to necrotizing pancreatitis after a laparoscopic cholecystectomy. The patient was successfully treated with catheter-directed thrombolysis and mechanical thrombectomy.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Colecistite Aguda/cirurgia , Artéria Mesentérica Superior , Oclusão Vascular Mesentérica/etiologia , Pancreatite Necrosante Aguda/etiologia , Trombose/etiologia , Colecistite Aguda/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/terapia , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/diagnóstico por imagem , Trombectomia/métodos , Terapia Trombolítica/métodos , Trombose/diagnóstico por imagem , Trombose/terapia , Resultado do Tratamento
13.
JSLS ; 23(2)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31097907

RESUMO

Background and Objectives: In several developed countries, most laparoscopic cholecystectomies (LCs) are performed as an ambulatory operation (ALC) with a high rate of success. In Latin America, the experience with this procedure is still limited. Our objective is to evaluate the feasibility to implement ALC in a Brazilian teaching hospital. Methods: Data obtained from electronic medical records and study protocols of all patients who underwent an LC between January 2011 and March 2018 were evaluated. All patients with chronic or acute cholecystitis were initially considered for an ALC. Results: Of a total of 1645 patients who underwent LC, 1577 (95.9%) were discharged on the same day of the operation. The main reasons for hospital admission after ALC were patient refusal to be discharged (n = 23; 1.4%), nausea and vomiting (n = 15; 0.9%), and complicated acute cholecystitis. No patient was excluded from consideration for ALC based only on age, history of previous upper abdominal operation, and presence of comorbidity. Patient age ranged from 12 to 100 years, with a mean of 50.23 ± 15.35 years. Intraoperative and postoperative complication rates were 0.4% and 5.5%, respectively. Most perioperative complications were because of technical surgical difficulties and complications common to most abdominal operations (surgical site, pulmonary, urinary, and venous complications). Thirteen (0.8%) patients were readmitted to the hospital because of abdominal pain and fever (n = 4), pneumonia (n = 3), deep venous thrombosis (n = 3), or urinary retention (n = 3). Conclusions: ALC may be performed in Brazil with low rates of morbidity, mortality, and hospital readmission. Its implementation should be stimulated in Latin America.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Colecistectomia Laparoscópica/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Colecistectomia Laparoscópica/efeitos adversos , Estudos de Viabilidade , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Adulto Jovem
14.
J Laparoendosc Adv Surg Tech A ; 29(6): 741-746, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31074684

RESUMO

Background: Primary laparoscopic approach for the treatment of cancers of the biliary tract is not popular in the surgical community. The aim of this study is to report the short-term data of patients who underwent total laparoscopic radical cholecystectomy for gallbladder cancer (GBC) at a single center of specialized hepatobiliary surgery. Methods: From November 2016 to January 2019, we routinely performed a laparoscopic approach for two groups of patients: (1) patients with primary GBC (diagnosed preoperatively) and (2) patients with incidental GBC (IGBC) discovered after cholecystectomy. Results: Our retrospective study included 18 patients (7 primary GBCs, 11 IGBCs). Conversion rate from laparoscopy to laparotomy was 28.6% and 9.1%, respectively, for the two groups, but this difference was not statistically significant (P = .28). Only 3 patients had liver recurrence (27.3%) and 1 had liver invasion (14.3%). A more advanced T category and TNM stage were presented in the preoperative suspicion cases (T3-T4 18.2% versus 57.1%, P = .06, stage IVA-B 9.1% versus 71.4%, P = .017). Regional lymphadenectomy was performed in 15 patients, in 73.3% the total number of lymph nodes (total LNs) retrieved was more than 7 (7-12 LNs in 66.7% of patients and >12 LNs in 6.6% of patients). The mean postoperative long stay was 8 days excluding for cases who developed complication. Conclusions: Laparoscopy can be considered a safe treatment for IGBC or primary GBC. The T3 stage with only liver involvement was not a contraindication. The real reasons that lead to convert the laparoscopic procedure were due to oncological concerns, unrelated to the liver infiltration.


Assuntos
Colecistectomia Laparoscópica/métodos , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/cirurgia , Recidiva Local de Neoplasia/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Achados Incidentais , Excisão de Linfonodo , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pós-Operatório , Estudos Retrospectivos
15.
BMC Res Notes ; 12(1): 245, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036075

RESUMO

OBJECTIVE: At present, cholecystectomy is carried out for thalassaemia patients with gall stone disease only if they develop symptoms of cholecystitis, except in the rare instance where an un-inflammed gall bladder is removed simultaneously with splenectomy. We carried out this retrospective analysis of case records to examine if patients with thalassaemia have a higher rate of peri operative complications compared to non-thalassaemics with gall stone disease, warranting a change of policy to justify elective cholecystectomy. RESULTS: Case records of 540 patients with thalassaemia were retrospectively analysed of which 98 were found to have gallstones. Records of 62 patients without thalassaemia with gall stone disease too were used for comparison. 19 of patients with thalassaemia and 52 of non-thalassaemic who had gallstones had undergone cholecystectomy. In all but 5 patients with thalassaemia cholecystectomy was done following attacks of acute cholecystitis as was the case in the non-thalassaemic controls. A significantly higher proportion of early and late complications had occurred in thalassaemia patients compared to non-thalassaemic patients post operatively. Six deaths related to sepsis following acute cholecystitis in the peri operative period were reported among 19 thalassaemia patients whereas no deaths were reported among 55 non-thalassaemic patients who underwent cholecystectomy for gallstones.


Assuntos
Colecistectomia Laparoscópica/estatística & dados numéricos , Colecistite Aguda/cirurgia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Esplenectomia/estatística & dados numéricos , Talassemia beta/cirurgia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Pré-Escolar , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/mortalidade , Colecistite Aguda/complicações , Colecistite Aguda/mortalidade , Colecistite Aguda/patologia , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/mortalidade , Feminino , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Cálculos Biliares/patologia , Cálculos Biliares/cirurgia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Baço/patologia , Baço/cirurgia , Esplenectomia/mortalidade , Análise de Sobrevida , Fatores de Tempo , Talassemia beta/complicações , Talassemia beta/mortalidade , Talassemia beta/patologia
16.
Surg Technol Int ; 34: 129-133, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31037715

RESUMO

INTRODUCTION: Needlescopic cholecystectomy (NC) was introduced in the late 1990s. It uses a reduced trocar caliber in an otherwise standard four-port laparoscopic cholecystectomy (LC) and seeks to achieve "scarless" surgery without compromising patient safety. MATERIALS AND METHODS: Between May 2016 and November 2017, 29 patients underwent elective NC at the Department of General Surgery of Sant'Andrea Hospital (La Spezia, Italy). Inclusion criteria were female sex, age between 18 and 45 years, good performance status (ASA 1-2) and BMI lower than 25. Twenty-one patients underwent a standard 4-port technique: 12mm port in the supraumbilical area, 5mm port in the subxiphoid position, 3mm port in the mid-epigastric area and another 3 mm port in the right mid-clavicular position. In 8 patients, 3mm ports were replaced by 2mm angiocath. A Critical View of Safety (CVS) was achieved in all procedures. Intra-operative cholangiography (IOC) via the cystic duct before any transection of the structures was routinely performed in selected cases, such as those with an unclear biliary anatomy or risk factors for main-duct stones. In our institution, laparoscopic transcystic common bile duct (CBD) exploration is routinely performed in CBD lithiasis. RESULTS: The mean operative time was 66.79 min (range 25-120 min). IOC was performed in 12 patients (41.4%) with suspected choledocolythiasis. There was no conversion to conventional laparoscopic cholecystectomy or open cholecystectomy. The mean hospital stay was 1.48 days (1-7 days). A Clavien-Dindo IIIB complication occurred in one patient on the third postoperative day. The mean VAS pain score was 3 (0-7). Closure of the skin with primary intention was achieved in all patients. Mean return to work was 6.76 days (3-15 days) and the mean return to previous physical activity was 12.17 days (4-30 days). All of the patients completed the Scar Satisfaction Questionnaire: 26 (89.7% ) and 3 patients (10.3%) were very satisfied and satisfied, respectively. CONCLUSION: Any effort to reduce invasiveness and improve cosmesis must not jeopardize safety. Our case series demonstrates that needlescopy can be safely associated with intraoperative cholangiography to recognize CBD stones. This technique offers the advantage of minor postoperative pain, better cosmesis results, early return to routine life activities and great satisfaction for the patient. Needlescopy is a valuable and safe alternative that is suitable for elective cholecystectomy in properly selected patients, such as young female patients.


Assuntos
Colecistectomia Laparoscópica/instrumentação , Colecistectomia Laparoscópica/métodos , Adolescente , Adulto , Colangiografia/métodos , Coledocolitíase/cirurgia , Técnicas Cosméticas/instrumentação , Feminino , Humanos , Cuidados Intraoperatórios , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto Jovem
17.
Am Surg ; 85(5): 471-473, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31126358

RESUMO

Gallbladder torsion (GT) causes ischemia of the gallbladder, which potentially leads to a fatal condition. Consequently, GT requires urgent treatment. An urgent laparoscopic cholecystectomy (LC) might be the optimal approach, in view of the anatomical abnormality, "floating gallbladder," which is associated with GT. However, the feasibility of LC for GT has not been well investigated. Thus, in this study, we investigated the feasibility of LC for GT in a case series. A total of 393 patients underwent urgent LC for acute gallbladder diseases at our institution during the study period. Among these patients, six had GT (1.5%) and were enrolled in this study. We retrospectively analyzed the surgical results of LC. Of the six cases, four (66.7%) were correctly diagnosed with GT preoperatively. There were two cases of Type I and four cases of Type II, based on the Gross classification for GT. The median operation time and intraoperative bleeding volume were 64 minutes and 18 mL, respectively. No cases required conversion to open surgery. All six cases experienced an uneventful postoperative course. The median postoperative hospital stay was six days. The surgical results of LC were favorable for six cases of GT. These results showed that LC was feasible for GT.


Assuntos
Colecistectomia Laparoscópica , Doenças da Vesícula Biliar/cirurgia , Anormalidade Torcional/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos de Viabilidade , Feminino , Doenças da Vesícula Biliar/diagnóstico por imagem , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Anormalidade Torcional/diagnóstico por imagem
18.
BMJ Case Rep ; 12(4)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975777

RESUMO

A 42-year-old woman sustained complete transection of common hepatic duct during routine laparoscopic cholecystectomy. The surgery was being performed at a rural setting, and the injury was identified intraoperatively. The surgeon sought the opinion of an expert biliary surgeon via telephone and discussed the possibility of an immediate end-to-end bile duct repair. Since he lacked the experience of doing biliary-enteric anastomosis, he was advised to place a subhepatic drain and transfer the patient to the hepatobiliary centre for definitive surgery. At the referral centre, the patient was evaluated and planned an immediate biliary repair. On exploration, she was found to have a major type, Strasberg E5 injury. The transected ducts were small in calibre and required double Roux-en-Y hepaticojejunostomy over transanastomotic stents. The postoperative recovery was uneventful. Transanastomotic stents were removed after 6 months, and the patient remained perfectly well at a follow-up of 1 year.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Ducto Hepático Comum/lesões , Encaminhamento e Consulta , Adulto , Anastomose Cirúrgica , Diagnóstico Diferencial , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia
19.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(2): 345-348, 2019 Apr 18.
Artigo em Chinês | MEDLINE | ID: mdl-30996380

RESUMO

OBJECTIVE: To explore the feasibility and to compare the merits and demerits of laparoscopic and endoscopic approach in removing common bile duct stones in patients with gastrojejunostomy after gastrectomy. METHODS: Between January 2012 and December 2016, 25 patients with common bile duct stones after gastrojejunostomy received laparoscopic or endoscopic treatment in our centers. They were divided into laparoscopic group and endoscopic group based on treatment approaches for common bile duct stones, including 15 patients in laparoscopic group and 10 in endoscopic group. The clinical characteristics and outcomes between the two groups were retrospectively analyzed. RESULTS: Among the 25 patients with gastrojejunostomy, the method of reconstruction was Billroth II in 21 patients and Roux-en-Y in 4 patients. Six patients received laparoscopic or endoscopic treatment during the acute cholangitis state. Among the laparoscopic group, 5 patients with stones more than 1 cm, 7 patients with multiple stones, while in the endoscopic group, 3 patients with stones more than 1 cm and 4 patients with multiple stones. Fourteen patients in the laparoscopic group with coexisting gallbladder stones, and 6 of their common bile duct stones were successfully removed by transcystic approach without T tube drainage. Stone removals were successful in 4 patients of the endoscopic group by a single performance, including 3 patients with single small stone and one patient with multiple small stones. Two patients in the laparoscopic group were converted to open surgery for severe adhesion and one patient in the endoscopic group turned to laparoscopic operation for failing of finding papilla in the Roux-en-Y anastomotic status. The median hospital stays were 12 d and 10 d, respectively in the laparoscopic and endoscopic group. There were 3 patients with postoperative complications, including one patient with paralytic ileus in the laparoscopic group and 2 patients with biliary pancreatitis or bacteremia in the endoscopic group, and all of them recovered uneventfully with conservative treatment. CONCLUSION: Both laparoscopic and endoscopic approaches are feasible for removing stones in the common bile duct in patients with gastrojejunostomy after gastrectomy, and they complement each other. In addition, both techniques are difficult to conduct, and a technical competence should be considered in selection of each method.


Assuntos
Colecistectomia Laparoscópica , Derivação Gástrica , Laparoscopia , Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco , Humanos , Estudos Retrospectivos
20.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-30939279

RESUMO

INTRODUCTION: Mucinous cystic neoplasms of the gallbladder are extremely rare, benign, unilocular or multilocular cystic tumors that contain septations. Mucinous cystadenoma, a subtype of mucinous cystic neoplasm, is defined as epithelial cystic proliferations composed of cells that contain intracytoplasmic mucin. CASE PRESENTATION: A 70-year-old African American woman was admitted to the hospital because of progressive lower back pain and inability to walk. She was scheduled for a kyphoplasty. However, the day before surgery, she reported severe abdominal pain radiating to her right shoulder. On further workup, results of abdominal ultrasonography revealed a cystic mass in the lumen of the gallbladder. The kyphoplasty was postponed and a laparoscopic cholecystectomy was performed. Pathologic evaluation of the gallbladder revealed a multiloculated mucinous cystic neoplasm. DISCUSSION: Mucinous cystadenoma of the gallbladder account for 0.02% of the total number of cases in the hepatobiliary system. They are more frequently seen in middle-age women with a mean age at presentation of 45 years. Symptoms vary depending on the location of the tumor, but it typically presents as acute or chronic right upper quadrant pain, epigastric pain, and nausea and vomiting. The multilocular form is more common than unilocular. The cystic lesions can be filled with serous, hemorrhagic, mucinous, or mixed fluids. Clinicians should be suspicious of mucinous cystadenoma of the gallbladder when common gallbladder disease is excluded because malignant features can be present in the lesion.


Assuntos
Cistadenoma Mucinoso/diagnóstico por imagem , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Idoso , Colecistectomia Laparoscópica/métodos , Cistadenoma Mucinoso/cirurgia , Diagnóstico Diferencial , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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