ABSTRACT
BACKGROUND: Laparoscopic cholecystectomy has become the standard treatment of benign gallbladder disease. It requires the skill of a trained surgeon, and its safe performance. The advantages of laparoscopy are less postoperative pain, absence of cosmetic damage, shorter recovery times, and decreased length of hospital stays compared with conventional open surgery. METHODS: We reviewed 500 consecutive laparoscopic cholecystectomies retrospectively at the department of general surgery of Maryknoll Hospital from February 1992 to May 1999. RESULTS: There were 175 males and 325 females(M:F=1:1.86) with ages ranged from 21 to 78 years (mean: 50.0 year). Preoperatively, 72 patients underwent endoscopic retrograde cholagiography and 7 patients underwent endoscopic sphincterotomy due to common bile duct stone. Mean operation time was 73.7 minutes. Operative cholangiogram was attempted in 8 patients. Conversion to open cholecystectomy during operation was done in 8 cases(1.6%) and leading causes were severe adhesion, uncontrolled bleeding, suspected malignancy, bile duct injury. Operative Complications occured in 18 patients(3.6%): bile duct injury 1, postoperative bleeding 1, bile leakage 4,subcutaneous emphysema 1, abdominal wall hematoma 3, wound infection 8. There was no operative mortality. The length of hospital stay ranged from 2 to 15 day with average of 4.7 day. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective operation in patients with benign gallbladder diseases.
Subject(s)
Humans , Male , Abdominal Wall , Bile , Bile Ducts , Cholecystectomy , Cholecystectomy, Laparoscopic , Common Bile Duct , Emphysema , Gallbladder Diseases , Hematoma , Hemorrhage , Laparoscopy , Length of Stay , Mortality , Pain, Postoperative , Retrospective Studies , Sphincterotomy, Endoscopic , Wound InfectionABSTRACT
Hepatolithiasis is said to exist when stones are present in the right or the left hepatic ducts or their tributaries. Although it is a pathophysiologically benign disease, it causes frequently serious problems-recurrent cholangitis, liver abscess, obstructive jaundice, liver cirrhosis, and sepsis - and has challenged surgeons. Until recently, its fundamental pathogenetic mechanisms have not been elucidated, but bile duct stenosis, bile stasis, and secondary infection are considered as important pathogenetic factors. Therefore, the ultimate goal of the treatment is directed to the correction of these factors. We were retrospectively reviewed 119 cases of patients with hepatolithiasis treated by various surgical methods from Jul. 1989 to Dec. 1996 at the Department of Surgery of Maryknoll Hospital, Pusan. There were 72 women and 47 men, and the mean age was 45.5 years. Thirty-nine patients (32.8%) had previous histories of operations related to biliary stone diseases - cholecystectomy (n=13), T-tube choledocholithotomy (n=21), choledochoduodenostomy (n=9), Roux-en-Y choledochojejunostomy (n=6), and transduodenal sphincteroplasty (n=1). Operative procedures were 24 (20.2%) lithotomy, 60 (50.4%) drainages, and 35 (29.4%) hepatectomies and determined by the location of the stones, the general condition of the patient, and the anatomical change (stenosis or cystic dilatation) in intrahepatic duct. Postoperative complications occurred in 33 (27.7%) patients : wound infection (n=23), atelectasis (n=5), intra-abdominal bile collection (n=3), choledochocutaneous fistula (n=2), hemobilia (n=1), and adhesive ileus (n=1). Residual stones were detected in 39 (32.7%) patients by T-tube cholangiography, ultrasonography, computed tomography. The instances of residual stones was the lowest (17.1%) for hepatectomy compared to 45.8% for a lithotomy and 39.3% for a drainage. The follow-up study showed symptom improvement in 91.5% of the patients with a hepatectomy compared to 58.3% for a lithotomy and 71.7% for a drainage which was statistically significant(P<0.05). Since incomplete stone removal in hepatolithiasis and presence of stenosis in intrahepatic duct frequently require a repeat operation or other invasive management, the authors conclude that a hepatectomy, as an initial treatment for hepatolithiasis, is a safe, satisfactory treatment where possible.
Subject(s)
Female , Humans , Male , Adhesives , Bile , Bile Ducts , Cholangiography , Cholangitis , Cholecystectomy , Choledochostomy , Coinfection , Constriction, Pathologic , Drainage , Fistula , Follow-Up Studies , Hemobilia , Hepatectomy , Hepatic Duct, Common , Ileus , Jaundice, Obstructive , Liver Abscess , Liver Cirrhosis , Postoperative Complications , Pulmonary Atelectasis , Retrospective Studies , Sepsis , Sphincterotomy, Transduodenal , Surgical Procedures, Operative , Ultrasonography , Wound InfectionABSTRACT
No abstract available.