Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 1.595
Filter
1.
Journal of Clinical Hepatology ; (12): 160-163, 2022.
Article in Chinese | WPRIM | ID: wpr-913132

ABSTRACT

Objective To investigate the application of intraoperative indocyanine green (ICG) cholangiography in the accurate identification of the common bile duct since common bile duct injury is a common complication of laparoscopic cholecystectomy (LC), and to reduce the incidence rate of common bile duct injury during LC. Methods A total of 68 patients who underwent LC in Zhuhai People's Hospital from April 2021 to Jane 2021 were enrolled, among whom 56 patients underwent conventional LC and 12 patients underwent LC under the guidance of ICG cholangiography. The common bile duct, cystic duct, and gallbladder were examined by white light laparoscopy for the conventional LC group and near-infrared laparoscopy for the ICG cholangiography group. The propensity score matching method was used to balance the preoperative data between the two groups. The t -test and the chi-square test were used for comparison of intraoperative blood loss, time of operation, length of postoperative hospital stay, and incidence rate of common bile duct injury between the two groups. Results Compared with the conventional LC group, the ICG cholangiography group had significantly lower intraoperative blood loss 3.1±0.9 mL vs 10.8±2.3 mL, t =-22.709, P < 0.05), significantly shorter time of operation (20.2±1.6 min vs 48.3±5.1 min, t =-19.856, P < 0.05) and length of postoperative hospital stay (1.2±0.3 days vs 2.3±0.8 days, t =-19.507, P < 0.05), and a significantly lower incidence rate of complications (0 vs 8.3%, χ 2 =1.287, P < 0.05). Conclusion ICG cholangiography is an effective method to differentiate between the common bile duct and the cystic duct during LC and can prevent common bile duct injury. This method has great advantages in the treatment of patients with gallstones due to its high degree of identification of the biliary tract, long onset time, repeated application, convenient operation, and ability to be combined with intraoperative navigation device.

2.
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 161-166, Dec. 2021.
Article in Spanish | LILACS | ID: biblio-1352984

ABSTRACT

Mujer de 54 años sometida a colecistectomía laparoscópica programada por colecistolitiasis sintomática, el procedimiento fue convertido a abordaje abierto por presencia de bilirragia perioperatoria no localizada, tratada con sutura primaria del lecho vesicular bajo sospecha de un conducto aberrante de Luschka. Al vigésimo día postoperatorio se diagnostica una fístula biliar tras la aparición de bilirragia a través de la herida quirúrgica. Una colangiografía transhepática percutánea mostró una pérdida completa de continuidad con fuga a ese nivel, confirmando la lesión del conducto hepático derecho, con un extremo cortado retraído del conducto hepático. Debido a la compleja lesión de la vía biliar proximal, a los 3 meses de la primera cirugía se realiza una hepatectomía derecha. Aunque la hepatectomía no es un procedimiento estándar para pacientes con lesiones quirúrgicas de la via biliar, debe considerarse como parte del arsenal quirúrgico para la reparación de un grupo seleccionado de pacientes en lesiones postcolecistectomía


A 54-year-old female underwent a planned laparoscopic cholecystectomy due to a symptomatic cholecystolithiasis, the procedure was converted to an open approach due to the presence of a not located perioperative bilirhagia, treated with a primary suture of the gallbladder bed under the suspicion of an aberrant duct of Luschka. On the 20th postoperative day, the patient is diagnosed with a biliary fistula after the appearance of bilirhagia through the surgical wound. A percutaneous transhepatic cholangiography showed a complete loss of continuity with leakage at that level, confirming the right hepatic duct injury, with a retracted cut end from the hepatic duct. Due to the complex proximal bile duct injury, 3 months after the first surgery, a right hepatectomy is performed. Although an hepatectomy is not a standard procedure for patients with IBDI, it should be considered as a part of the surgical armamentarium for the repair of a selected group of patients in postcholecystectomy injuries


Subject(s)
Cholecystectomy , Hepatectomy , Bile Ducts
3.
Rev. medica electron ; 43(3): 732-749, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289815

ABSTRACT

RESUMEN Introducción: en enero de 2000, comenzó la cirugía videolaparoscópica en el Hospital Militar Docente Dr. Mario Muñoz Monroy, de la ciudad de Matanzas. El equipo quirúrgico, en esa época, lo constituían cirujanos con varios años de experiencia y con una sólida formación en cirugía convencional. También poseían habilidades demostradas en la realización de colecistectomía a cielo abierto. A partir de 2011, una nueva generación de cirujanos desarrolló la cirugía mínimamente invasiva, con poca experiencia en cirugía a cielo abierto. Por lo tanto, se presentó la contradicción de que cada vez menos cirujanos tenían la experiencia técnica que requieren los casos más difíciles. Objetivo: determinar la seguridad en la realización de la colecistectomía laparoscópica. Materiales y métodos: Investigación observacional, descriptiva y retrospectiva de los pacientes intervenidos de afecciones biliares benignas, por la técnica de colecistectomía laparoscópica, entre enero de 2014 y diciembre de 2017. Resultados: fueron colecistectomizados 2 016 pacientes. De ellos, 1 759 (87 %) correspondieron al sexo femenino, y 257 (13 %) al masculino. Comorbilidades presentes en el 46,3 %. Cirugías: electivas, 1 801; urgentes, 215. Eventos adversos, 38 (1,88 %). Conversiones, 28 (1,3 %). Mortalidad operatoria, 5 (0,24 %). Conclusiones: resultan seguras las colecistectomías laparoscópicas por el bajo índice de eventos adversos, conversiones y mortalidad operatoria (AU).


ABSTRACT Introduction: video laparoscopic surgery began in January 2000, at the Dr. Mario Muñoz Monroy Military Hospital. The surgical team, at that time, were surgeons with years of experience and a solid training in conventional surgery. They also had demonstrated skills in performing open cholecystectomy. Starting in 2011, a new generation of surgeons developed minimally invasive surgery, with little experience in open surgery. Therefore, it arose the paradox that fewer and fewer surgeons had the technical experience required in the most difficult cases. Objective: to determine the safety in performing laparoscopic cholecystectomy. Materials and methods: retrospective, descriptive and observational research of the patients who underwent surgeries of benign biliary conditions, by the technique of laparoscopic cholecystectomy in the period January 2014- December 2017. Results: 1759 patients were cholecystectomized. 87.25% were female ones and 257 (13%) were male: Comorbidities were present in 46.3%. 1 801 were elective surgeries; emergency surgeries were 215. There were 38 (1.88%) adverse events and 28 (1.3%) conversions. The operatory mortality was 5 (0.24%). Conclusions: laparoscopic cholecystectomy are safe because of the low index of adverse events, conversion and operatory mortality (AU).


Subject(s)
Humans , Male , Female , Cholecystectomy, Laparoscopic/methods , Hospitals, State/methods , General Surgery/methods , Bile Ducts/injuries , Cholecystectomy, Laparoscopic/standards , Toxicity/methods
4.
Prensa méd. argent ; 107(3): 167-171, 20210000. tab, fig
Article in English | LILACS, BINACIS | ID: biblio-1361256

ABSTRACT

Introducción: La colecistectomía laparoscópica se ha convertido rápidamente en el procedimiento de elección de rutina para la enfermedad de la vesícula biliar, y actualmente es el procedimiento abdominal mayor que se realiza con mayor frecuencia en los países occidentales; la mayoría de los autores sugieren que es seguro observar a pacientes con cálculos biliares asintomáticos, y que la colecistectomía solo se realiza por aquellos pacientes que desarrollan síntomas. El quince por ciento de los pacientes persiste teniendo síntomas posteriores a la colecistectomía. Este estudio tuvo como objetivo evaluar el uso de la esofagogastroduodenoscopía previa a la colecistectomía laparoscópica y su impacto en el manejo. Método: Este fue un estudio clínico prospectivo que involucró a pacientes con cálculos biliares ingresados en el Hospital Docente de Al-Basra, Departamento de Cirugía General desde enero de 2016 hasta diciembre de 2019. Todos los pacientes fueron seguidos desde el momento del ingreso hasta seis meses después. Estos pacientes se dividieron en siete grupos según la edad. A todos los pacientes se les realizó una ecografía abdominal para diagnosticar la presencia de colelitiasis y descartar otros problemas abdominales. Todos los pacientes programados para colecistectomía laparoscópica se sometieron a una endoscopia del tracto gastrointestinal superior antes de la operación. Resultados: Se incluyeron un total de 1200 pacientes con rango de edad de 21 a 82 años (mujeres, 83,33%, hombres, 16,66%) con colelitiasis. La proporción de mujeres a hombres fue de 5:1. Se observaron hallazgos endoscópicos positivos en 380 (31,6%) pacientes. En estos pacientes se modificó el plan de manejo con hallazgos positivos por endoscopia y se pospuso su cirugía hasta recibir el tratamiento adecuado. Conclusión: El uso rutinario de esofagogastroduodenoscopia previa a la colecistectomía disminuiría la colecistectomía innecesaria en pacientes con colelitiasis y hallazgos endoscópicos positivos, lo que disminuye la persistencia de síntomas post colecistectomía.


Introduction: Laparoscopic cholecystectomy has rapidly become the procedure of choice for routine gallbladder disease, and it is currently the most performed major abdominal procedure in Western countries, most authors suggest that it's safe to observe patients with asymptomatic gallstones, with cholecystectomy only being performed for those patients who develop symptoms. Fifteen percent of patients persist to have post cholecystectomy symptoms. This study aimed to evaluate the use of oesophagogastroduodenoscopy prior to laparoscopic cholecystectomy, and its impact on the management. Method: This was a prospective clinical study involving patients with gallstone admitted to the Al-Basra Teaching Hospital, Department of General Surgery from January 2016 to December 2019. All patients were followed up from the time of admission until six months later. These patients were divided into seven groups according to age. All patients were having an abdominal ultrasound examination in order to diagnose the presence of cholelithiasis and to exclude other abdominal problems. All patients scheduled for laparoscopic cholecystectomy underwent upper GIT endoscopy preoperatively. Results: A total of 1200 patient age range from 21 to 82 years were included (women, 83.33%, men, 16.66%) had cholelithiasis. Female to male ratio was 5:1. Positive endoscopic findings were observed in 380(31.6 %) patients. The management plan was changed in these patients with positive findings by endoscopy and their surgery was postponed until they received proper treatment. Conclusion: The routine use of oesophagogastroduodenoscopy prior to cholecystectomy would decrease the unneeded cholecystectomy in patients with cholelithiasis and positive endoscopic findings, which decrease post cholecystectomy persistence of symptoms.


Subject(s)
Humans , Adult , Middle Aged , Aged , Prospective Studies , Endoscopy, Digestive System/statistics & numerical data , Cholecystectomy, Laparoscopic , Aftercare , Unnecessary Procedures , Gallbladder Diseases/therapy
5.
Rev. colomb. cir ; 36(3): 462-470, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1254292

ABSTRACT

Introducción. La colecistectomía es uno de los procedimientos quirúrgicos más realizados a nivel mundial, por lo que su aprendizaje es cada vez más necesario para los médicos residentes en entrenamiento, pero sin comprometer la seguridad de los pacientes. El objetivo de este estudio fue determinar el impacto de la participación de los médicos residentes en los principales desenlaces clínicos de la colecistectomía. Métodos. Se realizó un estudio prospectivo de cohortes, donde se incluyeron los pacientes llevados a colecistectomía laparoscópica, desde junio de 2019 hasta julio de 2020. Se llevó a cabo el análisis estadístico para describir medidas de frecuencia, tendencia central, dispersión y análisis bivariados para los desenlaces de interés. Resultados. Se incluyeron 482 pacientes a quienes se les practicó colecistectomía, 475 de ellas por vía laparoscópica. El 62,5 % fueron mujeres y el 76,2 % se realizaron de carácter urgente. En el 96 % de los procedimientos se contó con la participación de un residente. En el análisis bivariado no se encontró una diferencia estadísticamente significativa entre la participación del residente y un impacto negativo en los desenlaces clínicos de las variables relevantes. Discusión. No hay evidencia de que la participación de médicos residentes en la colecistectomía laparoscópica se asocie con desenlaces adversos en los pacientes, lo que sugiere estar en relación con una introducción temprana y responsable a este procedimiento por parte de los docentes, permitiendo que la colecistectomía sea un procedimiento seguro


Introduction. Cholecystectomy is one of the most performed surgical procedures worldwide, so its learning is increasingly necessary for resident physicians in training, but without compromising the safety of patients. The objective of this study was to determine the impact of the participation of resident physicians on the main clinical outcomes of cholecystectomy. Methods. A prospective cohort study was performed, which included patients undergoing laparoscopic cholecys-tectomy from June 2019 to July 2020. Statistical analysis was carried out to describe measures of frequency, central tendency, dispersion, and bivariate analysis for outcomes of interest. Results. 482 patients who underwent cholecystectomy were included, 475 of them laparoscopically; 62.5% were women and 76.2% were performed urgently, and 96% of the procedures involved the participation of a resident. In the bivariate analysis, no statistically significant difference was found between resident participation and a negative impact on the clinical outcomes of the relevant variables. Discussion. There is no evidence that the participation of resident physicians in laparoscopic cholecystectomy is associated with adverse outcomes in patients, which suggests being related to an early and responsible introduction to this procedure by teachers, allowing cholecystectomy to be a safe procedure


Subject(s)
Humans , General Surgery , Cholecystectomy, Laparoscopic , Education, Medical , Cholelithiasis , Health Postgraduate Programs , Intraoperative Complications
6.
Rev. argent. cir ; 113(1): 125-130, abr. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1288183

ABSTRACT

RESUMEN La vesícula izquierda (VI) es una rara anomalía de la vía biliar que, cuando enferma, no suele dar sín tomas diferentes de aquella normoposicionada, haciendo infrecuente su diagnóstico preoperatorio. Presentamos el caso de una colecistitis aguda en un paciente con VI, resuelto en forma segura por vía laparoscópica. Un paciente ingresa por un cuadro típico de colecistitis aguda. Como hallazgo in traoperatorio se constata una vesícula biliar inflamada, ubicada en posición siniestra. Se modificó la ubicación de los puertos de trabajo y se realizó colangiografía transvesicular por punción, antes de iniciar la disección del hilio vesicular. Luego de identificar el conducto cístico, se realizó colangiografía transcística que confirmó la anatomía de la vía biliar completa y expedita. Se completó la colecistec tomía laparoscópica en forma segura. El hallazgo de una VI obliga al cirujano a cambiar la técnica de una colecistectomía laparoscópica. Esta anomalía incrementa el riesgo de lesiones de la vía biliar. La disección cuidadosa del hilio vesicular logrando una visión crítica de seguridad y el uso de colangiogra fía intraoperatoria son de extrema importancia para una colecistectomía segura.


ABSTRACT Left-sided gallbladder (LSGB) is a rare bile duct abnormality, usually found during a cholecystectomy. Symptoms usually do not differ from those of a normally positioned gallbladder, making the preoperative diagnosis extremely uncommon. We report the case of an acute cholecystitis in a patient whit LSGB, safely managed with laparoscopic surgery. A 24-year-old male patient was admitted to our institution with clinical and radiological signs of acute cholecystitis. The intraoperative finding of an acute cholecystitis in a LSGB made us modify ports positioning and a cholangiograhy was done by direct puncture of the gallbladder before hilum dissection. After the cystic duct was identified, a transcystic cholangiography was performed which confirmed a complete and clear bile duct anatomy and laparoscopic cholecystectomy was safely completed. The intraoperative finding of a LSGB makes the surgeon change some aspects of the usual technique to perform a safe cholecystectomy as LSGB significantly increases the risk of common bile duct injuries. Meticulous dissection of the gallbladder hilum to achieve a critical view of safety and the systematic use of intraoperative cholangiography are extremely important to perform a safe laparoscopic cholecystectomy.


Subject(s)
Humans , Male , Adult , Cholecystitis, Acute/diagnostic imaging , Gallbladder , Cholangiography , Monitoring, Intraoperative , Cholecystectomy, Laparoscopic , Laparoscopy
7.
Acta méd. peru ; 38(2): 127-133, abr.-jun 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1339023

ABSTRACT

RESUMEN Los trastornos pancreáticos, las pancreatitis agudas de etiología biliar son infrecuentes en pediatría y más aún los pseudoquistes pancreáticos, los cuales son colecciones líquidas rodeadas por una cápsula fibrosa sin epitelio, generalmente secundario a una pancreatitis aguda. Presentamos el caso de una paciente femenina de 14 años, con antecedente de pancreatitis aguda de origen biliar hace 10 meses, que presenta dolor abdominal y una masa palpable en epigastrio. Se realizaron estudios imagenológicos, confirmando el diagnóstico de pseudoquiste pancreático y colelitiasis. Se optó por las bondades técnicas y estéticas de la laparoscopía, para esta población. Por lo cual, se realizó una cistogastroanastomosis y colecistectomía laparoscópica, con una evolución favorable. Nosotros reafirmamos que esta técnica, es un método seguro y efectivo, para el manejo de esta patología en pacientes pediátricos, y debería considerarse como primera opción, al no contar con procedimientos endoscópicos. Siendo este, el primer reporte en nuestro medio.


ABSTRACT The pancreatic disorders, as acute pancreatitis, of biliary etiology are rare in pediatrics, even more the pancreatic pseudocysts. They are liquid collections surrounded of a fibrous capsule without epithelium, secondary to acute pancreatitis. We present the case of a 14-year-old female patient with a history of acute pancreatitis because of biliary etiology, 10 months prior. She complained of intermittent abdominal pain and a palpable mass in the epigastrium. The Imaging studies showed a pancreatic pseudocyst and cholelithiasis. The laparoscopy was chosen because the technical and esthetic benefits for this population. Therefore, a laparoscopic cystogastro-ostomy-anastomosis and cholecystectomy were performed, with good progress. We affirm this technique is a safe and effective method for the management of this pathology in pediatric patients, and it should be considered as the first option in case endoscopic procedures are not available. This is the first report in our settings.

8.
Rev. méd. Urug ; 37(1): e202, mar. 2021. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1180959

ABSTRACT

Resumen: Introducción: la colecistectomía laparoscópica (CL) es la cirugía más frecuente del tracto digestivo. A pesar de considerarse un procedimiento seguro, la morbilidad se reporta hasta en un 10%, no existiendo registro a nivel nacional. Objetivo: describir la incidencia de complicaciones y morbimortalidad de la CL electiva en una población no seleccionada de un servicio universitario. Método: se realizó un estudio retrospectivo observacional de los pacientes intervenidos en forma electiva de CL, entre el 1/1/2010 y el 31/12/2019 en la Clínica Quirúrgica B del Hospital de Clínicas y en la Unidad Docente Asistencial de Cirugía del Hospital Español. Las variables incluidas fueron demográficas, diagnóstico operatorio, conversión, morbimortalidad, reintervenciones y readmisiones. Resultados: se reclutó un total de 1.499 CL electivas, edad promedio 49 años (15-87), 79% sexo femenino, incidencia de litiasis de vía biliar principal (LVBP) en 210 (17%) casos; 25 conversiones (1,7%). Hubo un total de 64 complicaciones (4,3%) con una incidencia significativamente mayor en pacientes con LVBP (2,8% vs 7,6%, p 0,01). Hubo dos lesiones del hepato-colédoco (0,13%) (tipo Hannover D y C), ambas detectadas y reparadas en la misma cirugía y tres lesiones viscerales (0,20%). Hubo 16 readmisiones (1,07%) y 9 reintervenciones (0,6%). Dos pacientes fallecieron (0,13%) en el posoperatorio (insuficiencia hepatocítica crónica descompensada y pancreatitis grave pos-CPRE posoperatoria). Conclusiones: la CL en la población no seleccionada del servicio universitario analizado en este trabajo demuestra ser un procedimiento seguro, con tasas de complicaciones, reintervenciones y readmisiones que en este estudio se comparan favorablemente con las reportadas en la literatura. La presencia de litiasis en la vía biliar principal se asoció a una incidencia significativamente mayor de complicaciones posoperatorias y de mayor severidad.


Summary: Introduction: laparoscopic cholecystectomy (LC) is the most frequent surgery of the digestive tract. Despite it being considered a safe procedure, morbidity is reported to be up to 10%, there being no record at the national level. Objective: to describe the incidence of complications and morbimortality of elective LC in a non-selected population group in a university hospital. Method: retrospective observational study of patients who underwent elective LC between January 1, 2010 and December 31, 2019 in the Surgical Clinic B at the Clinicas Hospital and the surgery assistance Teaching Unit at Español Hospital. The following variables were included: demographics, surgical diagnosis, conversion, morbimortality, reoperations and readmissions. Results: 1.499 CL were found, average age was 49 years old (15-87), 79% were women, main bile duct lithiasis in 210 cases (17%), 25 conversions (1.7%). There were 64 complications (4.3%), the incidence being significantly higher in patients with main bile duct lithiasis (2.8% vs 7.6%, p 0,01). Two bile duct-hepatic lesions (Hannover type D and C), both detected and repaired in the same surgery, and three visceral lesions (0.20 %). There were 16 readmissions (1.07%) and 9 reoperations (0.6%). Two patients died (0.13%) in the postoperative: decompensated chronic liver failure and post Endoscopic retrograde cholangiopancreatography (ERCP) severe pancreatitis. Conclusions: CL in a non-selected population at the university service analysed in the study proved to be a safe procedure, and complications, reoperation and readmission rates found in the study are positively compared to those reported in literature. The presence of lithiasis in the bile duct was associated with postoperative complications and a greater severity.


Resumo: Introdução: a colecistectomia laparoscópica (CL) é a cirurgia mais comum do trato digestivo. Apesar de ser considerado um procedimento seguro, a morbidade descrita é de 10%, e não há um registro nacional. Objetivo: descrever a incidência de complicações e morbimortalidade das CL eletivas, em uma população não selecionada em serviço universitário. Método: estudo observacional retrospectivo de pacientes submetidos à CL eletiva, realizado no período 1 de janeiro de 2010 - 31 de dezembro de 2019 na Clínica Cirúrgica B do Hospital de Clínicas e Unidade Docente Assistencial de Cirurgia do Hospital Espanhol. Foram incluidas variáveis demográficas, diagnóstico operatório, conversão, morbimortalidade, reoperações e reinternações. Resultados: foram incluidas 1.499 LCs eletivas, a idade média dos pacientes foi 49 anos (15-87), sendo 79% mulheres com incidência de cálculos biliares principais (LVBP) em 210 (17%) casos; 25 conversões (1,7%). Houve um total de 64 complicações (4,3%) com uma incidência significativamente maior em pacientes com LVBP (2,8% vs 7,6%, p 0,01). Ocorreram duas lesões hepato-colédoco (0,13%) (Hannover tipos D e C), ambas detectadas e reparadas na mesma cirurgia, e três lesões viscerais (0,20%). Ocorreram 16 readmissões (1,07%) e 9 reoperações (0,6%). Dois pacientes morreram (0,13%) no pós-operatório (insuficiência hepatocítica crônica descompensada e pancreatite pós-operatória grave por CPRE). Conclusões: a LC na população não selecionada do serviço universitário analisado neste estudo, mostrou-se como um procedimento seguro, com índices de complicações, reoperações e reinternações que neste estudo se comparam favoravelmente com os relatados na literatura. A presença de litíase no ducto biliar principal foi associada a uma incidência significativamente maior de complicações pós-operatórias e de maior gravidade.


Subject(s)
Postoperative Complications , Indicators of Morbidity and Mortality , Cholecystectomy, Laparoscopic
9.
Rev. colomb. cir ; 36(2): 324-333, 20210000. fig
Article in Spanish | LILACS | ID: biblio-1223998

ABSTRACT

La colecistectomía laparoscópica es uno de los procedimientos más realizados a nivel mundial. La técnica laparoscópica se considera el estándar de oro para la resolución de la patología de la vesícula biliar secundaria a litiasis, y aunque es un procedimiento seguro, no se encuentra exenta de complicaciones. La complicación más grave es la lesión de la vía biliar, que, aunque es poco frecuente, con una incidencia de 0,2 a 0,4%, conduce a una disminución en la calidad de vida y contribuye a un aumento en la morbi-mortalidad. El objetivo de este artículo es reportar nuestra técnica quirúrgica, enfatizando los principios del programa de cultura para una colecistectomía segura, propuesta y descrita por the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), para minimizar los riesgos y obtener un resultado quirúrgico satisfactorio


Laparoscopic cholecystectomy is one of the most performed procedures worldwide. The laparoscopic technique is considered the gold standard for the resolution of gallbladder pathology secondary to lithiasis, and although it is a safe procedure, it is not without complications. The most serious complication is the injury to the bile duct, which, although rare, with an incidence of 0.2% to 0.4%, leads to a decrease in quality of life and contributes to an increase in morbidity and mortality. The objective of this article is to report our surgical technique, emphaszing the principles of the program for a safe cholecystectomy, proposed and described by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), to minimize the risks and obtain a satisfactory surgical result


Subject(s)
Humans , Cholecystectomy, Laparoscopic , Minimally Invasive Surgical Procedures , Common Bile Duct , Patient Safety , Intraoperative Complications
10.
Rev. cuba. cir ; 60(1): e1037, ene.-mar. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289373

ABSTRACT

Introducción: El abordaje de la vía aérea del paciente bajo cirugía laparoscópica representa múltiples retos para el anestesiólogo. Objetivo: Evaluar la efectividad y seguridad de tres dispositivos supraglóticos con acceso gástrico en el abordaje de la vía aérea de pacientes bajo colecistectomía laparoscópica. Métodos: Se realizó un estudio cuasiexperimental, prospectivo, longitudinal en el Hospital Universitario "General Calixto García", entre el 2017 y 2019. Se constituyeron tres grupos de 40 pacientes, según dispositivo: máscara laríngea proseal, máscara laríngea supreme y máscara I-gel. Se estudió: tiempo de inserción, número de intentos para colocación, facilidad de inserción de la sonda nasogástrica, presión y suficiencia de sellado orofaríngeo, presión pico con neumoperitoneo y complicaciones. Las variables cualitativas se analizaron con frecuencias absolutas y relativas, y las cuantitativas con medias y desviación estándar. Para la asociación entre variables cualitativas, se utilizó la prueba de chi-cuadrado, y el análisis de varianza para la asociación entre cuantitativas y cualitativas. Se consideró significativo valor de p < 0,05. Resultados: La máscara laríngea supreme se insertó con éxito al primer intento en la mayoría de los pacientes (p = 0,004). La I-gel registró el menor tiempo de inserción (10,05 ± 1,75 seg) y la Supreme mayor facilidad para la sonda nasogástrica (p < 0,001). La mayor presión de sellado fue con la máscara laríngea proseal (30,87 ± 2,60 cmH2O). Las complicaciones fueron pocas y similares con cada uno. Conclusiones: La utilización de dispositivos supraglóticos con acceso gástrico demostró seguridad y efectividad en pacientes intervenidos por colecistectomía laparoscópica(AU)


Introduction: Airway management in the patient undergoing laparoscopic surgery presents multiple challenges for the anesthesiologist. Objective: To assess the effectiveness and safety of three supraglottic devices with gastric access in the airway management in patients undergoing laparoscopic cholecystectomy. Methods: A quasiexperimental, prospective and longitudinal study was carried out, between 2017 and 2019, at General Calixto García University Hospital. Three groups of forty patients were made up, according to the usage of each device: ProSeal laryngeal mask, Supreme laryngeal mask, and I-gel mask. The following variables were studied: insertion time, number of placement attempts, ease of insertion of nasogastric tube, pressure and sufficiency of oropharyngeal sealing, peak pressure with pneumoperitoneum, and complications. Qualitative variables were analyzed with absolute and relative frequencies; and quantitative variables, with means and standard deviation. For the association between qualitative variables, the chi-square test was used, while variance analysis was used for the association between quantitative and qualitative variables. A value of P< 0.05 was considered significant. Results: The Supreme laryngeal mask was successfully inserted on the first attempt in most patients (P=0.004). The I-gel mask had the shortest insertion time (10.05±1.75 seconds), while the Supreme was the easiest for the nasogastric tube (P< 0.001). The highest sealing pressure was obtained with the ProSeal laryngeal mask (30.87±2.60 cmH2O). The complications were few and similar with each device. Conclusions: The use of supraglottic devices with gastric access showed safety and effectiveness in patients who underwent laparoscopic cholecystectomy(AU)


Subject(s)
Humans , Male , Female , Adult , Laryngeal Masks/adverse effects , Cholecystectomy, Laparoscopic/methods , Airway Management/methods , Prospective Studies , Longitudinal Studies
11.
Int. j. med. surg. sci. (Print) ; 8(1): 1-13, mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1151621

ABSTRACT

El objetivo de este artículo es determinar si los factores socioeconómicos inciden en las complicaciones posoperatorias de la colecistectomía. Para ello, se definió realizar un estudio de tipo observacional, analítico y enfoque cuantitativo, en 100 pacientes en los que se les realizó colecistectomía. Se aplicó un modelo de regresión logística en el que se incorporaron como variables, factores de riesgo, características socioeconómicas, junto con una variable de control. Se aplicaron tres modelos con variables dependientes alternativas que están delimitadas por el tipo de complicación posoperatoria registrado. Los resultados encontrados mostraron que las mujeres manifiestan un mayor riesgo de presentar complicaciones posteriores a la colecistectomía, igual ocurre en los pacientes de mayor edad. Asimismo el riesgo es mucho menor en las personas con niveles de educación superior y en los pacientes en los que se realizó colecistectomía laparoscópica, alcanzando solo un 5% de riesgo de presentar complicaciones. Las complicaciones posoperatorias luego de la colecistectomía se minimizan al emplear la técnica laparoscópica y los factores socioeconómicos incidirían en el riesgo de padecer complicaciones posoperatorias luego de dicha cirugía, lo que la convierte a la colecistectomía laparoscópica en una operación segura y con muchos otros beneficios y ventajas sobre la cirugía tradicional o convencional.


The article ́s goal isto determine if socioeconomic factors influence the postoperative complications of cholecystectomy. For this, the observational study was defined, analytical and quantitative study was conducted in 100 patients who underwent cholecystectomy. A logistic regression model was applied in which risk factors, socioeconomic characteristics, along with a control variable, were incorporated as variables. Three models were run with alternative dependent variables that are delimited by the type of postoperative complication recorded. The results found showed that women show a higher risk of presenting complications after cholecystectomy, the same occurs in older patients. Likewise, the risk is much lower in people with higher education levels and in patients who underwent laparoscopic cholecystectomy, they only have a 5% risk of presenting complications. Postoperative complications after cholecystectomy are minimized by using the laparoscopic technique and socioeconomic factors would influence the risk of suffering postoperative complications after said surgery, which makes laparoscopic cholecystectomy a safe operation with many other benefits and advantages over traditional or conventional surgery.


Subject(s)
Humans , Male , Female , Postoperative Complications , Socioeconomic Factors , Cholecystectomy/adverse effects , Cholecystectomy/methods , Biliary Tract Diseases/epidemiology , Cholecystitis/epidemiology , Epidemiology, Descriptive , Surveys and Questionnaires , Risk Factors , Ecuador , Observational Study
12.
Arq. gastroenterol ; 58(1): 71-76, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1248986

ABSTRACT

ABSTRACT BACKGROUND: Hepatobiliary surgery and hepatic trauma are frequent causes of bile leaks and this feared complication can be safely managed by endoscopic retrograde cholangiopancreatography (ERCP). The approach consists of sphincterotomy alone, biliary stenting or a combination of the two but the optimal form remains unclear. OBJECTIVE: The aim of this study is to compare sphincterotomy alone versus sphincterotomy plus biliary stent placement in the treatment of post-surgical and traumatic bile leaks. METHODS: We retrospectively analyzed 31 patients with the final ERCP diagnosis of "bile leak". Data collected included patient demographics, etiology of the leak and the procedure details. The treatment techniques were divided into two groups: sphincterotomy alone vs. sphincterotomy plus biliary stenting. We evaluated the volume of the abdominal surgical drain before and after each procedure and the number of days needed until cessation of drainage post ERCP. RESULTS: A total of 31 patients (18 men and 3 women; mean age, 51 years) with bile leaks were evaluated. Laparoscopic cholecystectomy was the etiology of the leak in 14 (45%) cases, followed by conventional cholecystectomy in 9 (29%) patients, hepatic trauma in 5 (16%) patients, and hepatectomy secondary to neoplasia in 3 (9.7%) patients. The most frequent location of the leaks was the cystic duct stump with 12 (38.6%) cases, followed by hepatic common duct in 10 (32%) cases, common bile duct in 7 (22%) cases and the liver bed in 2 (6.5%) cases. 71% of the patients were treated with sphincterotomy plus biliary stenting, and 29% with sphincterotomy alone. There was significant difference between the volume drained before and after both procedures (P<0.05). However, when comparing sphincterotomy alone and sphincterotomy plus biliary stenting, regarding the volume drained and the days needed to cessation of drainage, there was no statistical difference in both cases (P>0.005). CONCLUSION: ERCP remains the first line treatment for bile leaks with no difference between sphincterotomy alone vs sphincterotomy plus stent placement.


RESUMO CONTEXTO: Cirurgia hepatobiliar e trauma hepático são causas frequentes de fístulas biliares, e esta temida complicação pode ser manejada de forma segura através da colangiopancreatografia retrógrada endoscópica (CPRE). O procedimento consiste em esfincterotomia isolada, passagem de prótese biliar ou combinação das duas técnicas, porém a forma ideal permanece incerta. OBJETIVO: O objetivo desse estudo é comparar a realização de esfincterotomia isolada versus locação de prótese biliar no tratamento de fístulas pós-cirúrgicas e traumáticas. MÉTODOS: Foram analisados de forma retrospectiva 31 CPREs com diagnóstico final de "fístula biliar". A informação colhida incluía dados demográficos dos pacientes, etiologia das fístulas e detalhes dos procedimentos. As técnicas de tratamentos foram divididas em dois grupos: esfincterotomia isolada vs esfincterotomia associada a locação de prótese biliar. Foram analisados os volumes dos drenos abdominais cirúrgicos antes e depois de cada procedimento e o número de dias necessários para que ocorresse cessação da drenagem pelo dreno abdominal cirúrgico após a CPRE. RESULTADOS: Um total de 31 pacientes (18 homens e 3 mulheres; idade média de 51 anos) com fístulas biliares foram avaliados. Colecistectomia laparoscópica foi a etiologia da fístula em 14 (45%) casos, seguida de colecistectomia convenvional em 9 (29%) pacientes, trauma hepático em 5 (16%) pacientes, e hepatectomia secundária a neoplasia em 3 (9,7%) pacientes. As localizações mais frequentes das fístulas foram: coto do ducto císticos com 12 (38,6%) casos, seguido de ducto hepático comum em 10 (32%) casos, ducto colédoco em 7 (22%) cases e leito hepático em 2 (6,5%) casos. 71% dos pacientes foram tratados com esfincterotomia associada a passagem de prótese biliar e 29% com esfincterotomia isolada. Houve diferença estatística em relação ao volume drenado antes e depois de ambos os procedimentos (P<0,05). Entretanto, quando comparada esfincterotomia isolada e esfincterotomia associada a passagem de prótese biliar, em relação ao volume drenado e ao número de dias necessários para cessação da drenagem, não houve diferença estatística em ambos os casos (P>0,005). CONCLUSÃO: A CPRE permanece como tratamento de primeira linha no tratamento de fístulas biliares, sem diferença entra a esfincterotomia isolada versus esfincterotomia associada a passagem de prótese biliar.


Subject(s)
Humans , Male , Female , Cholecystectomy, Laparoscopic , Sphincterotomy , Postoperative Complications/surgery , Bile , Stents , Sphincterotomy, Endoscopic/adverse effects , Hospitals , Middle Aged
13.
Rev. colomb. cir ; 36(1): 83-90, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1150522

ABSTRACT

Introducción. La patología biliar es una causa frecuente de intervención quirúrgica, pero en Colombia no se cuenta con datos oficiales de mortalidad ni volumen quirúrgico asociados a este procedimiento. El objetivo de este estudio fue determinar el volumen de colecistectomías y describir la tasa general de mortalidad perioperatoria en seis regiones geográficas del país, en el periodo de 2012 a 2016.Métodos. Estudio de cohortes retrospectivo que incluyó pacientes mayores de 18 años, afiliados al régimen contributivo de salud, llevados a colecistectomía. Se utilizó la base de datos de suficiencia de la Unidad de Pago por Capitación (UPC), la base de estadísticas vitales del Departamento Administrativo Nacional de Estadística (DANE) y la del Sistema Integrado de Información de la Protección Social (SISPRO).Resultados. Durante el periodo de estudio, se realizaron 192.080 colecistectomías, lo que corresponde a 206 colecistectomías por 100.000 habitantes. Se encontró mayor volumen quirúrgico en personas entre los 65 y 80 años, en el sexo femenino y en la ciudad de Bogotá. La mortalidad perioperatoria encontrada correspondió al 0,6 %, siendo mayor en los pacientes de sexo masculino, de edad avanzada, en aquellos en quienes se practicó laparotomía y en los pacientes operados en la ciudad de Bogotá. Discusión. De acuerdo con los hallazgos, esta investigación puede servir de base para estudios posteriores, que muestren claramente las cifras oficiales de volumen quirúrgico y de mortalidad por colecistectomía en Colombia


Introduction. Biliary pathology is a frequent cause of surgical intervention, but in Colombia there are no official data on mortality or surgical volume associated with this procedure. The objective of this study is to determine the volume of cholecystectomies and to describe the general perioperative mortality rate in six geographic regions during the period from 2012 to 2016.Methods. Retrospective cohort study that included patients older than 18 years and affiliated to the contributory health regimen who underwent cholecystectomy. The sufficiency database of the Capitation Payment Unit (UPC), the vital statistics database of the National Administrative Department of Statistics (DANE) and that of the Integrated Social Protection Information System (SISPRO) were used.Results. During the study period, 192,080 cholecystectomies were performed, corresponding to 206 cholecystectomies per 100,000 inhabitants. Higher surgical volume was found in people between 65 and 80 years old, in females and geographically in the city of Bogotá. The perioperative mortality found corresponded to 0.58%, being higher in elderly male patients, in those who underwent laparotomy and in patients operated on in the city of Bogotá.Discussions. According to the findings, these results can serve as the basis for subsequent studies that clearly show the official figures for surgical volume and mortality from cholecystectomy in Colombia


Subject(s)
Humans , Cholecystectomy , Mortality , Perioperative Period
14.
Journal of Clinical Hepatology ; (12): 872-876, 2021.
Article in Chinese | WPRIM | ID: wpr-875898

ABSTRACT

ObjectiveTo investigate the clinical effect of laparoscopy, choledochoscopy, and duodenoscopy combined with T-tube-free drainage in the treatment of gallstones with common bile duct stones. MethodsA retrospective analysis was performed for the clinical data of 564 patients with gallstones and common bile duct stones who were admitted to Department of General Surgery, Pudong New Area People’s Hospital, Shanghai University of Medicine & Health Sciences, from December 2017 to December 2019. According to the surgical procedure, the patients were divided into laparoscopic transcystic common bile duct exploration (LTCBDE) group with 191 patients, three endoscopies+laparoscopic common bile duct exploration and primary suture (LBEPS) group with 138 patients, and endoscopic retrograde cholangiopancreatography (ERCP)+endoscopic sphincterotomy (EST)/endoscopic papillary balloon dilation (EPBD)+laparoscopic cholecystectomy (LC) group with 235 patients. The three groups were analyzed in terms of the general data including sex, age, bile duct diameter, and stone size/number, and surgical condition and complications were compared between groups. A one-way analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. ResultsThere were significant differences between the LBEPS group, the ERCP+EST/EPBD+LC group and the LTCBDE group in hospital costs, drainage volume, time to first flatus, length of hospital stay and time to extraction of drainage tube (F=416.40, 7.80, 33.99, 143.70, and 13.08, P<0.001, P=0.020, P<0.001, P<0.001, and P<0.001). Compared with the LBEPS group and ERCP+EST/EPBD+LC groups, the LTCBDE group had significantly lower hospital costs and a significantly longer time to first flatus, and significantly shorter length of hospital stay and time to extraction of drainage tube(all P<0.05). No serious complication was observed after surgery, and there was no significant difference in the incidence rate of complications between the three groups (P>0.05). All patients were discharged successfully after surgery. ConclusionThe three minimally invasive surgical procedures combined with T-tube-free drainage achieve the goal of little trauma and pain, fast postoperative recovery, and few serious complications, among which LTCBDE has the lowest treatment costs and the best postoperative recovery.

15.
Article in Chinese | WPRIM | ID: wpr-887872

ABSTRACT

Objective To investigate the incidence of surgical site infection(SSI)following conversion from laparoscopic to open cholecystectomy and to analyze the related risk factors. Methods The clinical data of 179 patients who had experienced conversion from laparoscopic to open cholecystectomy in Peking Union Medical College Hospital from January 2014 to August 2019 were analyzed retrospectively.Univariate and multivariate logistic regression analyses were performed to evaluate the associations between clinical variables and SSI. Results The incidence of SSI was 19.0%(34/179)after conversion from laparoscopic to open cholecystectomy.The multivariable analysis demonstrated that preoperative endoscopic retrograde cholangiopancreatography(ERCP)(


Subject(s)
Cholecystectomy , Humans , Laparoscopy , Retrospective Studies , Risk Factors , Surgical Wound Infection/etiology
16.
Chinese Journal of Anesthesiology ; (12): 1184-1188, 2021.
Article in Chinese | WPRIM | ID: wpr-911338

ABSTRACT

Objective:To evaluate the gastric emptying of orally administered enzyme-hydrolyzed rice flour solution before surgery in the patients undergoing laparoscopic cholecystectomy and effect on insulin resistance.Methods:One hundred patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, with body mass index of 19-30 kg/m 2, scheduled for elective laparoscopic cholecystectomy under general anesthesia, were divided into 2 groups ( n=50 each) using a random number table method: water group (group C) and enzyme-hydrolyzed rice flour group (group M). Routine fasting and water deprivation were executed at 1 day before operation in two groups, and 300 ml water in group C or 300 ml enzyme-hydrolyzed rice flour solution in group M were taken orally at 2-3 h before induction on the day of surgery.Bedside antrum ultrasonography was used to calculate the gastric volume (GV) before oral administration (V 0), immediately after oral administration (V 1), and before induction (V 2), and then the ΔGV (GV 1-GV 0) was calculated.Fasting plasma glucose and insulin CONCENTRATIONS were measured on admission to hospital (T 1) and on an empty stomach on 1st morning after surgery (T 2), and then the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated according to HOMA steady-state model formula.Visual analog scale (VAS) scores for subjective comfort (thirst, hunger, fatigue and anxiety) and grip strength were assessed before anesthesia (T 3) and before leaving PACU (T 4). Reflux and aspiration during induction, nausea and vomiting within 24 h after surgery, and anal exhaust time after surgery were recorded. Results:There was no significant difference in GV at V 0, V 1 and V 2 between the two groups ( P>0.05). Compared with the baseline at V 0, no significant was found in the GV at V 2 in both groups ( P>0.05). The fasting plasma glucose and insulin concentrations and HOMA-IR were significantly increased at T 2 than at T 1 in both groups ( P<0.05 or 0.01). Compared with group C, the fasting plasma glucose and insulin concentrations and HOMA-IR were significantly decreased at T 2, VAS scores for hunger, fatigue and anxiety were decreased at T 3, 4, grip strength was increased at T 3, 4, the postoperative anal exhaust time was shortened, and the incidence of nausea was reduced in group M ( P<0.05). No reflux and aspiration happened during induction in either group. Conclusion:The gastric emptying of 300 ml enzyme-hydrolyzed rice flour solution orally administered at 2 h before surgery is normal in the patients undergoing laparoscopic cholecystectomy, which does not increase the risk of reflux and aspiration during anesthesia induction, reduces postoperative insulin resistance, and increases patient′s subjective comfort, and enhances the postoperative recovery of intestinal function.

17.
Article in Chinese | WPRIM | ID: wpr-910632

ABSTRACT

Objective:To study the correlation between L-form bacterial infection and surgical site infection (SSI) after laparoscopic cholecystectomy (LC) in patients with chronic calculous cholecystitis, and to find out the interventional measures which can be used in clinical prevention of SSI.Methods:Using a prospective nested case-control study, patients with chronic calculous cholecystitis who underwent LC at the Third Affiliated Hospital of Guizhou Medical University from September 2016 to June 2020 were prospectively studied. The postoperative follow-up observation time was within 1 month from the date of surgery. The patients’ general information, perioperative conditions, presence of L-form bacteria in gallbladder contents, postoperative SSI and other indicators, as well as the data entered by the surgeons before the operations were collected in detail. According to whether SSI occurred or not after operation, these patients were paired and grouped in a ratio of 1∶4 between the SSI group versus the control group. Multivariate logistic regression analysis was used to determine the risk factors for SSI after LC.Results:Of 695 patients included in the study, there were 248 males and 447 females, aged (46.0±15.0) years old. The infection rates of L-form bacteria in the case group and the control group were 45.32% and 30.94%, respectively. The infection rate of L-form bacteria in the case group was significantly higher than that in the control group ( P<0.05). The L-form bacterial infection rate ( OR=2.082, 95% CI: 1.335-3.197, P=0.001) suggested that L-form bacterial infection significantly increased the risk of SSI. In addition, rupture of gallbladder during surgery, ( OR=2.249, 95% CI: 1.352-3.740, P=0.002), adhesion of gallbladder to surrounding tissues ( OR=1.903, 95% CI: 1.133-3.194, P=0.015), and excessive bleeding during operation ( OR=2.247, 95% CI: 1.418-3.561, P=0.001) also increased the risk of SSI, while increased experience of operating surgeons on number of surgical cases ( OR=0.549, 95% CI: 0.340-0.888, P=0.014) decreased the risk of SSI. Conclusion:L-form bacterial infection was one of the risk factors of SSI. L-form bacterial culture and tests for drug sensitivity were important in selecting antibiotics. Improved surgical skills, careful dissection of gallbladder from surrounding adhesions, reduction on intraoperative blood loss and avoiding gallbladder rupture contributed to a decrease in SSI.

18.
Article in Chinese | WPRIM | ID: wpr-910631

ABSTRACT

Objective:To study the optimal surgical timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) for acute cholecystitis.Methods:A retrospective analysis of the clinical data of patients with acute cholecystitis who were treated at Zhengzhou Central Hospital Affiliated to Zhengzhou University from April 2016 to October 2020 with initial PTGBD followed by LC. These patients were divided into three groups according to the time intervals between LC with PTGBD. Patients who underwent LC 3~4 weeks after PTGBD were in the short interval group ( n=67); patients who underwent LC 5~8 weeks after PTGBD were in the intermediate interval group ( n=78); and patients who underwent LC>8 weeks after PTGBD were in the long interval group ( n=73). The baseline and perioperative data of the three groups were compared. Results:In 218 patients, 97 were males and 121 were females, aged (72.1±8.4) years. Before LC, the gallbladder wall in the short interval group (4.77±0.62) mm was significantly thicker than that in the intermediate interval group (3.85±0.34) mm and the long interval group (3.81±0.25) mm (all P<0.05). Intraoperative blood loss in the intermediate interval group was significantly less than that in the short interval group ( P<0.05). The operation time, conversion to laparotomy, placement of drainage tube, postoperative hospital stay and total hospitalization expenses in the intermediate interval group were significantly better than those in the other two groups (all P<0.05). The incidence of complications in the intermediate interval group was significantly lower than that in the short interval group [2.56% (2/78) vs. 14.93% (10/67)], and the long interval group [2.56% (2/78) vs. 12.33% (9/73), all P<0.05]. Conclusion:The best timing for sequential LC after PTGBD in acute cholecystitis was shown in this study to be 5 to 8 weeks after PTGBD.

19.
Article in Chinese | WPRIM | ID: wpr-910615

ABSTRACT

Objective:To evaluate the day-surgery unit-based training of laparoscopic cholecystectomy (LC).Methods:Perioperative data of 438 patients (187 males and 251 females) with a median age of 54 (aged 17 to 91) years undergoing LC during January 2019 to April 2021 in the day-surgery unit of Chinese PLA General Hospital were retrospectively collected and subdivided according to the training methods of surgeons [Group A( n=260): conventional training vs. Group B ( n=178): protocoled stepwise training]. The protocoled stepwise training consists of the rotation in open biliary surgery unit, the stimulator-based laparoscopic training, and the stepwise procedural tutoring. The conventional training features the traditional surgical practice following senior surgeons. The technical data involving operation time, blood loss, the percentages of intraoperative decision-making by senior surgeons and the handing-over of procedure to senior surgeons, etc. were statistically analyzed. Results:The operation time was shortened in Group B [(55±30) min vs. (61±33) min], with significantly decreased percentages of intraoperative decision-making by senior surgeons [7.9% (14/178)vs. 16.9%(44/260), P<0.05] and the handing-over of procedure to senior surgeons [3.4%(6/178) vs. 11.2%(29/260), P<0.05]. Conclusion:Based on the protocoled stepwise training and the consecutive, high-volumed and standardized procedures, the laparoscopic technical proficiency and competency of the trainee surgeons have been improved.

20.
Article in Chinese | WPRIM | ID: wpr-909199

ABSTRACT

Objective:To investigate the efficacy of early versus delayed laparoscopic cholecystectomy (LC) in the treatment of acute calculous cholecystitis complicated by abnormal liver function. Methods:A total of 106 patients with acute calculous cholecystitis complicated by abnormal liver function who received LC in Nanjing Drum Tower Hospital, Nanjing University Medical School, China between February 2018 and February 2020 were included in this study. They were assigned to receive laparoscopic cholecystectomy either within 72 hours after disease onset (early group, n = 51) or 72 hours after disease onset (delayed group, n = 51). Perioperative indexes, complications, immune function and liver function were compared between the two groups. Results:Intraoperative blood loss in the early group was less than that in the delayed group [(63.11 ± 8.18) mL vs. (92.39 ± 7.23) mL, t = 19.558, P < 0.001]. Operative time, time to anal exhaust and length of hospital stay in the early group were (49.53 ± 6.33) minutes, (23.24 ± 4.65) hours and (6.38 ± 1.23) days in the early group were significantly shorter than those in the delayed group [(63.24 ± 5.42) minutes, (32.88 ± 5.78) hours, (8.34 ± 1.54) days, t = 12.004, 9.415, 7.204, all P < 0.001]. There was no significant difference in the rate of conversion to open cholecystectomy during LC between the two groups ( χ2 = 0.877, P > 0.05). There was no significant difference in the incidence of complications between early and delayed groups [11.76% (6/51) vs. 7.27% (4/55), χ2 = 0.625, P > 0.05]. On day 3 after surgery, the proportion of CD 3+ cells and the ratio of CD 4+/CD 8+ cells in the early group were (37.81 ± 4.29) % and (1.32 ± 0.29), respectively, which were significantly higher than those in the delayed group [(32.56 ± 5.26) %, 1.21 ± 0.23, t = 5.605, 6.379, both P < 0.001]. Total bilirubin, alanine aminotransferase and alkaline phosphatase levels in the early group were (21.05 ± 5.16) μmol/L, (71.58 ± 9.36) U/L and (175.73 ± 19.64) U/L, respectively, which were significantly lower than those in the delayed group [(27.81 ± 5.14) μmol/L, (82.54 ± 12.35) U/L, (214.62 ± 20.58) U/L, t = 6.921, 7.893, 9.865, all P < 0.001]. On day 5 after surgery, total bilirubin, alanine aminotransferase and alkaline phosphatase levels in the early group were (14.63 ± 4.58) μmol/L, (42.13 ± 8.24) U/L, (137.72 ± 17.62) U/L, respectively, which were significantly lower than those in the delayed group [(18.67 ± 6.45) μmol/L, (59.64 ± 11.29) U/L, (162.76 ± 18.39) U/L, t = 3.692, 8.265, 7.462, all P < 0.001]. Conclusion:Early LC for treatment of acute calculous cholecystitis complicated by abnormal liver function can effectively promote the recovery of liver function, mitigate immune injury, improve perioperative indicators, and dose not increase the incidence of complications.

SELECTION OF CITATIONS
SEARCH DETAIL