ABSTRACT
INTRODUCTION: Traditional teaching dictates that it may not be prudent to take the jaundiced patient to theatre for emergency laparoscopic cholecystectomy as they may experience worse outcomes following surgery. METHODS: A prospective cohort of 104 patients undergoing emergency laparoscopic cholecystectomy was stratified into two groups using a serum total bilirubin of above 50 µmol/L (2.9 mg/dL) to define the jaundiced group. Primary outcomes were morbidity and mortality rate. The Clavien-Dindo classification and the novel Comprehensive Complication Index (CCI) were applied to the grading of surgical complications. Multivariate analysis to identify possible predictors of morbidity and length of stay was also performed. RESULTS: Overall morbidity rate in the jaundiced group was 28 versus 36% (control), p = 0.405. Mean CCI in the jaundiced group was 5.28 versus 8.00 in the control group, p = 0.229. Mean length of stay was shorter in the jaundiced group, 4.65 versus 6.51 days, p = 0.036. There were no peri-operative mortalities or conversions to open surgery. Only male gender and the presence of retained stones were found to be associated with morbidity. Serum total bilirubin was not associated with increased morbidity. CONCLUSION: Amongst patients undergoing laparoscopic cholecystectomy who are found to have choledocholithiasis on IOC, the presence of jaundice does not appear to contribute towards increased morbidity.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Choledocholithiasis/surgery , Jaundice/complications , Adolescent , Adult , Aged , Aged, 80 and over , Choledocholithiasis/complications , Conversion to Open Surgery , Female , Humans , Length of Stay , Liver Function Tests , Male , Middle Aged , Prospective Studies , Treatment Outcome , Young AdultSubject(s)
Disease Management , Pancreatitis/complications , Practice Patterns, Physicians'/trends , Acute Disease , Australia , Drainage/statistics & numerical data , Drainage/trends , Humans , Laparoscopy/statistics & numerical data , Laparoscopy/trends , Pancreatic Pseudocyst/etiology , Pancreatic Pseudocyst/therapy , Pancreatitis/therapy , Pancreatitis, Acute Necrotizing/therapy , Practice Patterns, Physicians'/statistics & numerical dataABSTRACT
A case of small bowel obstruction secondary to a left paraduodenal hernia is illustrated together with its radiological features and intra-operative appearance. Paraduodenal hernias are rare congenital causes of small bowel obstruction, and various approaches to surgical treatment are available including conventional open and minimally invasive laparoscopic techniques. This case presents one possible option for surgical management and briefly reviews the literature for the various surgical techniques and strategies available to the surgeon when faced with a left paraduodenal hernia.
