ABSTRACT
In a retrospective study, the first 301 patients who had laparoscopic cholecystectomy (LC) in a university-affiliated community hospital were compared with a historical matched control group of patients who had open cholecystectomy. The patients who had LC had a shorter hospital stay, required less postoperative pain medication, resumed normal activities and returned to work sooner, and had a lower minor and total complication rate. The mean operating time was 45 minutes longer for LC. Major complications, common bile duct injuries, and mortality were similar in both patient groups. The learning curve, use of laser, and use of cholangiography were all analyzed. Our results with LC compared favorably with results reported in the medical literature.
Subject(s)
Cholecystectomy, Laparoscopic/adverse effects , Cholecystectomy/adverse effects , Hospitals, Community/statistics & numerical data , Postoperative Complications/epidemiology , Cholecystectomy/economics , Cholecystectomy/mortality , Cholecystectomy, Laparoscopic/economics , Cholecystectomy, Laparoscopic/mortality , Cholecystitis/surgery , Female , Follow-Up Studies , Hospital Costs , Humans , Length of Stay , Male , Middle Aged , Ohio , Pain, Postoperative/epidemiology , Patient Selection , Retrospective StudiesABSTRACT
The objective of this study was to identify those patients in whom mesenteric venous thrombosis (MVT) is likely to develop and to review the pathophysiology, clinical presentation, diagnostic modalities, and patient outcome. We present a review of the literature from 1911 to 1984 with respect to 372 patients with MVT, including five of our own patients. Data on 99 of these patients were obtained from autopsy reports and were not included in the study. This disease is common in the sixth and seventh decades of life, with 81% of these older patients having associated illnesses. MVT involves segments of the small bowel, but rarely of the colon, with hemorrhagic infarcts rather than gangrene. This disease does not conform to a pattern, although a prodromal period of days or weeks of abdominal pain (which is usually out of proportion to physical findings), marked leukocytosis, and dehydration are all highly suggestive of MVT. Serosanguineous fluid obtained by means of peritoneal tap is a useful diagnostic tool. A high index of suspicion, early diagnosis, and prompt surgical intervention with the addition of anticoagulants seems to improve survival and reduce recurrence.
