Laparoscopic cholecystectomy

Article Abstract:

Until recently, surgery to remove the gall bladder (cholecystectomy) has always been performed by making a sizable incision in the abdominal wall. However, the frequency of laparoscopic cholecystectomies, in which four or five small incisions are made, has been increasing. In this procedure, a laparoscope (an imaging tube) is placed in one incision, and images are transmitted to a high-resolution television camera, permitting surgeons to visualize the operating area. The other slits are used to insert surgical instruments and to instill carbon dioxide into the region to improve imaging. Blood vessels and ducts to the gall bladder are identified and tied off, and the gall bladder is dissected and removed through one of the incisions. The total time required for laparoscopic cholecystectomy is about one and one half hours, approximately 30 minutes longer than standard surgery. In one small study, patients treated with the laparoscopic procedure were hospitalized an average of one day less and returned to work an average of 27 days sooner than those who underwent the standard open procedure. The surgery is not suitable for patients with adhesions from previous surgery, as this would make carbon dioxide instillation and laparoscope manipulation difficult. In addition, those who are abnormally obese or tall may not be eligible for the procedure as the surgical instruments may be not be long enough. In the small comparative study, no complications were found with either laparoscopic or open surgery. However, complications associated with laparoscopic surgery have been reported, and range from nausea and upper back pain to damage to abdominal organs and death due to pulmonary embolism (lodging of particles in lung blood vessels), blood vessel damage, or infection. Extensive studies comparing the two procedures have not been performed, but some physicians suspect that serious complications may be more frequent following laparoscopic cholecystectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Laparoscopic cholecystectomy during pregnancy

Article Abstract:

Cholecystitis (inflammation of the gallbladder) and cholecystolithiasis (gallbladder stones) are common during pregnancy. These conditions can cause intense pain, and in some cases the symptoms can be treated by means of intravenous feeding and pain medication. However, if the symptoms persist and jaundice (yellow skin) develops, the gallbladder should be removed (cholecystectomy). It is estimated that between three and eight out of every 10,000 pregnant women require gallbladder surgery. If a cholecystectomy becomes necessary it should be performed during the second trimester of pregnancy. In most cases, the operation is simple and usually does not harm the fetus. The fetal death rate following cholecystectomy is less than 5 percent. Traditionally, the operation has been performed by making a large cut or incision into the abdomen (laparotomy). However, this procedure requires a longer recovery period and increases the risk of infection following surgery. More recently, laparoscopy involving an optical device fitted with a surgical device has been used for performing gallbladder surgery in pregnant women. This procedure does not require a large incision and it reduces the pain and recovery time following surgery. The case is reported of a 41-year-old woman who underwent gallbladder surgery during pregnancy. Prior to becoming pregnant, the patient was diagnosed as having gallstones and was scheduled for a laparoscopic cholecystectomy. After the woman became pregnant, attempts were made to treat her gallbladder condition without surgery. However, these treatments failed and surgery was performed. The surgery was uneventful. The patient made a full recovery and the fetus was not harmed. It is concluded that laparoscopy should be considered as an alternative to laparotomy for performing gallbladder surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnant women, Abdomen, Laparotomy

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Acute cholecystitis in the elderly

Article Abstract:

Management of acute cholecystitis (inflammation of the gallbladder) in the elderly has been considered problematic. There is contradictory evidence regarding when and if surgery should be performed on the elderly patient. A review of treatment of cholecystitis in patients over the age of 70 is reported. There were 125 patients treated in the early 1960s; this group was treated conservatively, with surgery being delayed for six to eight weeks after the acute gallbladder attack. A second group of 144 patients was treated in the 1970s. This group was operated on soon after the diagnosis of cholecystitis was made. In the first group, eight patients required emergency surgery; three of these died. There were 56 patients who either refused surgery or were felt to be unfit for surgery. A delayed operation was performed on 50 patients, with ll deaths. The total mortality for this early group of conservatively treated patients was 25 of 125 patients. In the second group of patients, 105 of 144 patients underwent surgery, with 6 deaths following surgery, and 39 patients were treated conservatively, with three deaths. Total deaths in this group numbered 9 out of 144 patients. The cure rate (defined as being free of disease) for the early group was 44 of 125 patients, compared with 120 of 144 patients in the second group. The difference in mortality between the two groups is attributed to the development of fistulas and abscesses in the conservatively treated group; these develop only when the inflammation of the gallbladder is severe, as occurs when surgery is delayed. The authors strongly recommend early cholecystectomy in elderly patients with acute cholecystitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Cholecystitis

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