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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gallstones may fall into the peritoneal cavity during performance of cholecystectomy. They are more easily retrieved in an open operation. Some controversy exists as to what should be done with gallstones lost during laparoscopic cholecystectomy (LC) because complications of abandoned stones have been reported. This case report describes a patient who presented with an incarcerated hernia and an associated abscess cavity containing a large spilled gallstone, which on computed tomography scan suggested a possible abdominal wall tumor. Spilled stones may cause subsequent problems and should be removed whenever possible, but should not be an indication for conversion to open operation.
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PMID:Incarcerated paraumbilical incisional hernia and abscess--complications of a spilled gallstone. 754 94

After a decade of effort to develop a minimalist alternative to standard cholecystectomy as the treatment for gallstone disease, laparoscopic cholecystectomy (LC) has emerged as the treatment of choice. Gallstone dissolution and lithotripsy failed to meet the tests of applicability and reliability. In fact, lithotripsy was denied approval by the US Food and Drug Administration in 1989. LC achieves the benchmark of treatment--removal of the diseased gallbladder and its stones--with less pain, disability, and disfigurement than standard surgery. The procedure is applicable in more than 90% of cases, being limited primarily by the severity of inflammation and the surgeon's experience. During the past 3 years, the special instrumentation has improved and operative techniques have been standardized resulting in fewer complications. For these reasons, laparoscopic surgical techniques are now being applied to a widening array of procedures including hernia repairs, bowel resections, antireflux procedures, common bile duct stone removal, lymph node dissections, and peptide ulcer disease treatment.
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PMID:Gallstone disease: current therapy. 825 24

The management of biliary tract disease has changed completely as a result of minimally invasive treatment. For most patients with gallstones that cause symptoms a laparoscopic cholecystectomy will treat the condition with minimal morbidity and a short recovery period. If complications are encountered, conversion to a mini-cholecystectomy gives results that are nearly as good. Acute cholecystitis can be treated by percutaneous drainage followed either by percutaneous cholecystolithotomy or a laparoscopic cholecystectomy. Gallstones in the bile duct are best treated by endoscopic sphincterotomy with duct clearance. The day of the large cholecystectomy scar with its subsequent incisional hernia has gone.
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PMID:General surgery: biliary surgery. 831 78

From November 1990 to April 1994 we attempted laparoscopic cholecystectomy (LC) in 1,788 consecutive patients. The intraoperative findings related to gallbladder's pathology were as following: chronic cholecystitis in 792 patients (44.3%), simple cholecystolithiasis in 760 (42.5%), acute cholecystitis in 98 (5.5%), hydrops in 44 (2.5%), empyema in 38 (2.1%), gangrenous cholecystitis in 12 patients, acalculous cholecystitis in 20 patients, polyps in 11 patients, adenomyomatosis in 9 patients, and gallbladder's carcinoma in 4 patients. Although we had a considerable number of cases with severe inflammation and/or dense adhesions the conversion rate to open surgery was relatively low (2.5%). There was no procedure-related mortality and no common bile duct injury. Postoperative complications occurred in 58 patients (3.2%). Bile leak was present in 19 patients, retained bile duct stones in 8, severe bleeding in 6, mild pancreatitis in 4, pulmonary embolism in 1, cerebral bleeding in 1, wound infection in 6, abdominal wall hematoma in 4, and umbilical incisional hernia in 2; 7 patients presented other minor complications. The mean postoperative hospital stay of our patients was 1.8 days (range 1-12 days). Adequate measures to prevent intraoperative accidents, meticulous technique, and full maintenance of the equipment are among the most important factors in keeping a low conversion and complication rate in the patients undergoing LC.
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PMID:Laparoscopic cholecystectomy. Intraoperative findings and postoperative complications. 852 41

Gallstone ileus is an uncommon intestinal obstruction with unexpectedly high mortality. It is not easy to diagnose this uncommon disease preoperatively. The aim of our study is to establish some simple criteria supporting the suspicion of gallstone ileus in patients with small intestine obstruction. We retrospectively analysed hospital records of 8 patients with gallstone ileus and 1230 cases of mechanical intestinal obstruction, excluding incarcerated external hernias. Gallstones were the cause of occlusion in 0.9% (8/886) of patients with small bowel obstruction. All our 8 patients were women with an average age of 74 years. Gallstone ileus was diagnosed in 18% of elderly (+70 years) women with small intestine obstruction. This rate raised to 36% in this group of elderly women if previous abdominal operations that would produce adhesion were excluded. Previous ultrasonographic examinations had demonstrated gallstones in 5 (62%) patients. Only one patient (12.5%) was diagnosed preoperatively with plain X ray film demonstrating gas in the biliary tract. The obstruction was treated with enterolithotomy. Cholecystectomy was performed in two (25%) patients. The mortality was 25% in early postoperative period. Advanced age, female sex, and positive patient's history of known gallstone in the gallbladder have appeared as strong criteria. Gallstone ileus is a common cause of intestinal obstruction in elderly women with no previous abdominal operations and without incarcerated external hernia. Pneumobilia is more common radiological finding to establish the diagnosis of gallstone ileus in these patients.
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PMID:Gallstone ileus: demographic and clinical criteria supporting preoperative diagnosis. 1170 70

Gallstones ileus is an uncommon cause but important cause of small bowel obstruction. The gallstone enters the intestinal lumen via a fistula located in the duodenum (cholecystoduodenal), or rarely, in the colon (cholecystocolonic) or stomach (cholecystogastric). This may result in large bowel or gastric outlet obstruction (Bouveret's Syndrome). Gallstone ileus affects the elderly females pre-dominantly and is associated with a high morbidity and mortality rate if diagnosis and urgent surgical intervention are delayed. In this paper, we report on the case of an elderly lady who presented with classical symptoms and signs of small bowel obstruction. She was subsequently diagnosed with gallstone ileus due to a large gallstones lodged in the intestinal lumen. We perform a literature review on this rare disease and discuss the two main surgical approaches in managing this condition. Gallstone ileus should be considered in the differential diagnosis of small bowel obstruction especially in elderly women who have no history of abdominal surgery or abdominal hernia. Early intervention is important because of the high mortality rate due to the poor general condition that often exists in this subgroup of patients. There is no general consensus on gold standard surgical approach in these cases but a two-stage procedure (either enterotomy alone or enterotomy and subsequent cholecystectomy) has been shown to be associated with lower mortality rates.
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PMID:Pneumobilia: a case report and literature review on its surgical approaches. 2447 Aug 47

Gastric bypass patients are at risk of late procedure-related complications, e.g. internal hernia or cholecystolithiasis. These complications may be important to identify before other surgical procedures are performed. The treatment of cholecystitis based on cholecystolithiasis in a patient who had recently undergone abdominoplasty may be highly problematic and may lead to an exacerbated situation.
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PMID:[Problematic treatment of cholecystitis in a gastric bypass patient after abdominoplasty]. 2561 59