A Comparison of Open and Laparoscopic Cholecystectomy for Patients with Liver Cirrhosis / 한국간담췌외과학회지

BACKGROUNDS/AIMS: Cholelithiasis is a prevalent diseases worldwide and it is known that its incidence is twice as common in cirrhotic patients compared with noncirrhotic patients. Liver cirrhosis is a critical factor contributing to morbidity and mortality in biliary tract surgery, as patient with cirrhosis are at particular risk of developing bleeding, infection and intractable ascites. Recently laparoscopic cholecystectomy has become the procedure of choice for cholelithiasis in the general population. This retrospective study was conducted to assess the effective treatment by comparing the results of open cholecystectomy versus laparoscopic cholecytectomy in cirrhotic patients. METHODS: Between January 1991 and December 1998, 53 patients with liver cirrhosis underwent cholecystectomy for cholelithiasis in the department of surgery at asan medical center. The patients were classified into two groups: one consisting of 18 patients who underwent open cholecystectomy and another consisting of 35 patients who underwent laparoscopic cholecystectomy. All cases that converse to an open cholecystectomy from a laparoscopic cholecystectomy were excluded from this analysis. RESULTS: No statistical difference was observed in the duration of surgery(OC: 110.6+/-32.6 vs. LC: 82.1 +/-26.7 min, p>0.05). Laparoscopic cholecystectomy was followed by a significantly smaller intraoperative blood loss(OC: 730.5+/-384.6 vs. LC: 324+/-168 ml, p<0.05), a earlier resumption of a normal diet(OC: 4.3+/-1.3 vs. LC: 1.3+/-0.4 days, p<0.05), and a shorter hospital stay(OC: 13.8+/-6.1 vs. LC: 4.7 +/-2.1 days, p<0.05) in comparison to open cholecystectomy. Postoperative complications in laparoscopic cholecystectomy group was significantly less(OC: 9 vs. LC: 4, p<0.05). There was no operative mortality in both group. CONCLUSIONS: Laparoscopic cholecystectomy can be safely performed in compensated cirrhotic patients and may be the procedure of choice whenever cholecystectomy is indicated in a cirrhotic patient because it may be associated with more advantages.

Lumbar Disc Herniation at High Levels: MRI and Clinical Findings

PURPOSE: To assess the frequency, location, associated MR findings, and clinical symptoms of the high levellumbar disc herniation(HLDH). MATERIALS AND METHODS: A total of 1076 patients with lumbar disc herniation wereretrospectively reviewed. MR images of 41 of these with HLDH(T12-L1, L1-2, L2-3) were analysed in terms offrequency, location, and associated MR findings, and correlated with clinical symptoms of HLDH. RESULTS: Theprevalence of HLDH was 3.8%(41/1076). HLDH was located at T12-L1 level in four patients(10%), at L1-2 level in14(34%), at L2-3 level in 21(51%), and at both L1-2 and L2-3 levels in two. The age of patients ranged from 20 to72 years (mean, 44), and there were 26 men and 16 women. In 11(27%), whose mean age was 32 years, isolated discherniation was limited to these high lumbar segments. The remaining 30 patients had HLDH associated with variableinvolvement of the lower lumbar segments. Associated lesions were as follow : lower level disc herniation(14patients, 34%); apophyseal ring fracture(8 patients, 19%); Schmorl's node and spondylolisthesis (each 6patients, each 14%); spondylolysis(3 patients, 7%); and retrolisthesis(2 patients, 5%). In 20 patients(49%) withHLDH(n=41), there was a previous history. CONCLUSION: Patients with HLDH showed a relatively high incidence ofassociated coexisting abnormalities such as lower lumbar disc herniation, apophyseal ring fracture, Schmorl'snode, spondylolysis, and retrolisthesis. In about half of all patients with HLDH there was a previous history oftrauma. The mean age of patients with isolated HLDH was lower; clinical symptoms of the condition were relativelynonspecific and their incidence was low.