Laparoscopic cholecystectomy: the evolution of general surgery

Article Abstract:

Cholecystectomy is the surgical removal of the gall bladder. The most common reason for removing the gall bladder is the presence of gallstones, which can be painful and, in some cases, cause serious abdominal infection. Until very recently, gall bladder surgery required an open incision, had a fairly high complication rate, and required a five-day stay in the hospital on average. Laparoscopy is a procedure in which tiny incisions are made into the abdomen, and thin surgical instruments, including a device for visualizing the organs, are inserted and manipulated. Laparoscopy has been used for a number of years for gynecological procedures, and in 1987, a French gynecologist used his laparoscopic instruments to observe and remove a diseased gall bladder. Within months, laparoscopic cholecystectomy was accepted as a desirable alternative to traditional gall bladder surgery. Approximately half of the general surgeons in this country are now trained in the procedure. If unforeseen complications develop while a laparoscopic cholecystectomy is being performed, the traditional open incision can be made, and the operation can be completed in the conventional manner. The laparoscopic procedure is quick, generally being performed in one to two hours. Patients can, in some cases, be discharged the day of surgery. The complication rate is far lower than that of the traditional procedure, and the recovery period is much shorter. An individual surgeon's complication rate decreases impressively after he or she has done approximately 20 to 30 procedures. The laparoscopic cholecystectomy is an example of the evolution of general surgery in recent years. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Usage, Gallbladder, Laparoscopes

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Combined endoscopic sphincterotomy and laparoscopic cholecystectomy in patients with choledocholithiasis and cholecystolithiasis

Article Abstract:

The gall bladder is an abdominal organ in which bile (a secretion of the liver) is stored until needed for the digestion of fats, at which time the bile passes through the bile duct into the intestine. Gall bladder removal, or cholecystectomy, is a surgical procedure commonly performed for the treatment of obstructive diseases of the gall bladder (cholecystolithiasis) and bile duct (choledocholithiasis), such as blockage with gallstones. Most often, cholecystectomy is performed by open-abdominal surgery with exploration of the bile duct to remove any additional stones. This procedure requires a hospital stay of from 5 to 15 days, and implantation of an inconvenient and painful latex tube for 10 to 21 days. A recently developed (much less invasive) pair of procedures, endoscopic sphincterotomy and laparoscopic cholecystectomy, is rapidly replacing the more traumatic exploratory procedure for the identification and removal of gall stones. In this procedure, a fiberoptic viewing device is used to determine the site and extent of biliary system blockage, and a small abdominal incision is made to remove the gall bladder. A series of 326 patients scheduled for gall bladder removal were subjected to either the conventional surgical treatment or endoscopic sphincterotomy and laparoscopic cholecystectomy. The average number of days spent in the hospital was greatly reduced in the latter group compared with the former (5 days versus 15 days), and the number of days between surgery and return to work was similarly reduced (9.3 days versus 41.7 days). (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Gallstones, Common bile duct calculi

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Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage: a randomized, clinical trial

Article Abstract:

A technique that redirects blood flow in bleeding liver vessels called transjugular intrahepatic portosystemic shunt (TIPS) may be equally effective in controlling bleeding as an injection therapy called sclerotherapy but may result in shorter survival. Survival rates, number of bleeding episodes, and other complicating factors were analyzed among 39 patients treated with sclerotherapy and 41 patients treated with TIPS. Eight patients treated with sclerotherapy and nine patients treated with TIPS experienced a re-bleeding episode within 1000 days of treatment. Death rates were higher among those treated with TIPS.

Hemorrhage, Sclerotherapy, Peritoneovenous shunts, Peritoneovenous shunt

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