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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 23 year experience with papillotomy, sphincterotomy and sphincteroplasty for stenosis of the sphincter of Oddi shows sphincteroplasty to be the best procedure, with 79% of the patients obtaining a good result. The procedure was done for a demonstrable organic change in the sphincter, often associated with acute cholecystitis in older patients, the postcholecystectomy syndrome in those in whom a long cystic stump had been left at the first operation or in patients with chronic recurring pancreatitis. The study included 138 private patients observed from two months to 22 years. There were four postoperative deaths, an operative mortality of 2.9%, as two patients had been operated upon twice. The poor results were associated with recurring attacks of pancreatitis not cured by the procedure or developing subsequent to it, probably being attributable to persistent obstruction of the terminal part of the pancreatic duct. The results suggest that sphincteroplasty, if performed on suitably selected patients, is a safe procedure which should give good results in more than 75% of the patients.
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PMID:Twenty-three years of experience with sphincterotomy and sphincteroplasty for stenosis of the sphincter of Oddi. 87 33

From their experimental findings in 120 rabbits, the authors conclude that, at first, cholecystitis is usually an aseptic lesion and infection occurs only secondarily. In a large number of cases the initial physiopathological mechanism is that of inflammation which may be due to mechanical causes such as obstruction of the gall bladder siphon and vasomotor phenomena under autonomic control. The histological lesions and course are comparable to those observed in clinical medicine. The interest of this experimental study is to compare the pathology of acute cholecystitis with pancreatitis and Reilly's syndrome and Gregoire and Couvelaire's theory of visceral apoplexy.
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PMID:[Experimental study of anatomo-pathological and physiopathological manifestations of acute cholecystitis]. 96 37

450 successive celioscopic cholecystectomies (May, 1990-April, 1992) are reported for 312 cases of uncomplicated gallstone (69%) operated electively and 138 cases operated in emergency, including 120 cases of acute cholecystitis, 17 cases of biliary pancreatitis and 1 case of angiocholitis. Immediate conversion into laparotomy was required in 10 cases (2.2%) either for technical reasons (1.1%) or because of lithiasis of the common bile duct (1.1%). The stay in hospital lasted an average of 2.2% days for elective admission and 3.3 days for emergent admission. The average operating time was 65 minutes (75 minutes until May, 1991, and 55 minutes between May, 1991 and April, 1992). Preoperative retrograde cholangiography was performed in 67 cases and intraoperative cholangiography in 16 cases. Second surgery was required for suture in one case because of cholerrhagia in a secondary duct of the gallbladder bed. This cholerrhagia would not have been amenable to simple aspiration. One patient (0.2%) died of myocardial infarction at D + 10. Complications include 4 cases of pulmonary embolism, 3 cases of cystic biliary fistula without second surgery and 4 cases of umbilical hernia. A more peculiar case is that of a patient admitted 5 months after surgery for gangrenous acute cholecystitis. This patient was admitted for fever and epigrastric pain. He had a very low-flow duodenocutaneous fistula of uncertain origin. This patient was not operated again. This may not be a complication connected to celioscopic surgery. Celioscopic cholecystectomy is superseding conventional cholecystectomy. Surgeons' efforts should strive at eliminating operative errors, reducing postoperative morbidity, improving techniques and instruments, teaching celioscopic surgery and extending its indications to other intraabdominal operations.
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PMID:[Laparoscopic cholecystectomy. Apropos of 450 cases]. 134 88

A careful analysis of the series of patients with asymptomatic gallstones suggests that prophylactic cholecystectomy is not necessary. The purpose of this work was to try to detect subgroups of asymptomatic patients with factors predictive of symptoms or of severe complications such as acute cholecystitis, pancreatitis, or gallbladder carcinoma. Among local factors, neither the size, number or nature of gallstones, nor alterations of the walls or contractility of the gallbladder were predictive of symptoms or complications. Among general factors, neither the age or sex of patients nor associated diseases such as diabetes mellitus or recent organ transplantation were predictive of symptoms or complications. Only the few patients with a porcelain gallbladder were at high risk for gallbladder carcinoma requiring prophylactic cholecystectomy. In all other patients treatment of asymptomatic gallbladder stones is unnecessary as well as any surveillance.
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PMID:[Management of asymptomatic lithiasis]. 141 Nov 68

A series of 200 consecutive patients were considered for laparoscopic laser cholecystectomy. Laparoscopic laser cholecystectomy was attempted in 195 cases and was performed in 192 cases. Laparoscopy was performed in five patients, but laparoscopic cholecystectomy was not attempted owing to dense adhesions (3), cholangiocarcinoma (1) and an absent gallbladder (1). The indications for operation were symptomatic gallstones which included biliary colic (142), acute cholecystitis (49) and gallstone pancreatitis (9). The median duration of operation was 75 min. Operative cholangiography was attempted in 151 (77%) of cases, and was successful in 85% of attempts. Laparoscopic common bile duct visualisation was performed three times with successful stone extraction twice. The other common bile duct was normal. The median duration of postoperative hospital stay was 2 days, for return to normal activity 6 days, and for return to work 10 days. Mean analgesic and antiemetic requirements were approximately one-third of those for open cholecystectomy. Of the patients, 94% reported good or excellent overall satisfaction and 96% reported excellent cosmetic results. Seven complications occurred (4%). Three patients had immediate conversion to laparotomy owing to haemorrhage (2) and gallbladder rupture (1). Four patients required laparotomy for postoperative complications (common bile duct damage, slipped clips from cystic duct, perforated duodenum and leaking accessory hepatic duct). No complications occurred in the last 140 cases. These data suggest that laparoscopic laser cholecystectomy reduces the discomfort of laparotomy and allows a shorter postoperative recovery. The operation has a learning curve, but will ultimately be applicable to the majority of patients with symptomatic gallstones.
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PMID:Laparoscopic laser cholecystectomy: our first 200 patients. 141 73

Recently, general surgeons have become actively involved in laparoscopic operations. The best method for teaching these techniques to surgical residents is unclear. Since June 1990, at St. Luke's-Roosevelt Hospital Center in New York City, we have instituted a formal course of instruction for surgical residents. This includes a reference syllabus, didactic instruction, use of an inanimate training device and a hands-on practice in swine. Clinically, the residents progress from observer to camera operator and, finally, operator. During the first year of this program, the authors performed 90 laparoscopic cholecystectomies, of which 71 were elective and 19 were for acute cholecystitis. There were seven morbidly obese patients, while 25 had undergone prior abdominal operations. The first 25 operations performed by the authors averaged 93.2 minutes, while the last 40 operations performed primarily by the surgical residents with assistance of the authors averaged 70 minutes. There were nine complications, including postoperative pancreatitis in two patients, Clostridium difficile enterocolitis in two and one each of prolonged paralytic ileus, postoperative transfusion and umbilical incision dehiscence. Two patients had postoperative common duct stones. There were no wound infections, bile duct injuries or deaths. Complications were evenly distributed throughout the series and did not correlate with whether the surgeon was a resident or an attending surgeon. The results of this plan have been quite successful and thus far, 12 residents have completed this program.
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PMID:Surgical laparoscopic experience during the first year on a teaching service. 144 32

Controversy exists over whether pregnancy is a risk factor for gallstone formation; however, changes in hepatobiliary function do occur during pregnancy to create a lithogenic environment; these changes include gallbladder stasis and secretion of bile with increased amounts of cholesterol and decreased amounts of chenodeoxycholic acid. In women with existing gallstones, pregnancy may bring out symptoms, including pain and even acute cholecystitis. This may be more common during the postpartum period than during pregnancy itself; however, the overall occurrence of symptomatic biliary disease in association with pregnancy is low. The effects of pregnancy, if any, on pancreatic exocrine function are undefined. Acute pancreatitis can occur during pregnancy but does not appear to do so with either increased or, alternatively, decreased frequency. The concept of pancreatitis caused by pregnancy per se is not valid, although in susceptible women with lipid disorders, hypertriglyceridemia can occur and serve as an etiologic factor. Gallstones are a common cause of pancreatitis, but in contrast to nonpregnant women, alcohol is unusual as a cause. Although the presentation of both acute cholecystitis and acute pancreatitis may be similar to that in the nonpregnant state, the differential diagnosis of both these disorders is expanded because of unique pregnancy-related conditions and the shift of abdominal viscera by the enlarging uterus. The diagnosis is clinical and supported with conventional laboratory studies and ultrasound; management is supportive and in most patients successful. Cholecystectomy is seldom necessary during pregnancy, either for acute cholecystitis or gallstone pancreatitis, but can be safely performed if necessary after the first trimester. Endoscopic papillotomy and stone removal for choledocholithiasis are possible during pregnancy and may be the treatment of choice for this unusual condition. Specific enteral or parenteral nutrition may be necessary in women with pancreatitis associated with hypertriglyceridemia.
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PMID:Gallstone disease and pancreatitis in pregnancy. 147 36

The most certain symptomatic manifestation of gallstones is episodic upper abdominal pain. Characteristically, this pain is severe and located in the epigastrium and/or the right upper quadrant. The onset is relatively abrupt and often awakens the patient from sleep. The pain is steady in intensity, may radiate to the upper back, be associated with nausea and lasts for hours to up to a day. Dyspeptic symptoms of indigestion, belching, bloating, abdominal discomfort, heartburn and specific food intolerance are common in persons with gallstones, but are probably unrelated to the stones themselves and frequently persist after surgery. Many, if not most, persons with gallstones have no history of pain attacks. Persons discovered to have gallstones in the absence of typical symptoms appear to have an annual incidence of biliary pain of 2-5% during the initial years of follow-up, with perhaps a declining rate thereafter. Gallstone-related complications occur at a rate of less than 1% annually. Those whose stones are symptomatic at discovery have a more severe course, with approximately 6-10% suffering recurrent symptoms each year and 2% biliary complications. The far higher rates of symptom development reported in a few studies raise the possibility that these incidence estimates may be too low. The best predictors of future biliary pain are a history of pain at the time of diagnosis, female gender and possibly obesity. The risk of acute cholecystitis appears to be greater in those with large solitary stones, that of biliary pancreatitis in those with multiple small stones, and that of gallbladder cancer in those with large stones of any number. Drugs that inhibit the synthesis of prostaglandins may now be the treatment of choice in patients with gallstones who are suffering acute pain attacks. Persistent dyspeptic symptoms occur frequently following cholecystectomy. A prolonged history of such symptoms prior to surgery and evidence of significant psychological distress appear to be the best predictors of unsatisfactory outcome.
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PMID:Symptoms of gallstone disease. 148 6

Though laparoscopic cholecystectomy has become widespread, questions remain as to its success rate, its role in acute cholecystitis, the role of cholangiography, and whether laser use is necessary. To attempt to answer these questions, the first 100 patients undergoing laparoscopic cholecystectomy at Emory University using electrosurgical diathermy were reviewed. Patients underwent cholecystectomy for biliary colic (87), gallstone pancreatitis (1), and acute cholecystitis (12). The average length of hospital stay was 29 hours (range: 12 hours to 5 days). Laparoscopic cholecystectomy was not possible in 7 patients because of gangrenous cholecystitis (2), adhesions from previous surgery (2), equipment failure (2), and choledochoduodenal fistula found at surgery (1). Two patients developed bile leaks from accessory bile ducts that healed spontaneously. There were no other complications. The average time required to complete the laparoscopic cholecystectomy was 115 minutes (range: 45 to 238 minutes) and was not significantly different in those patients undergoing intraoperative cholangiography (117 minutes) versus those without (109 minutes). Common duct stones were uncommon in this series. Thirty-three patients underwent intraoperative cholangiogram. One patient was found to have a common duct stone, which was pushed into the duodenum using a Fogarty catheter (American Edwards Laboratories; Anasco, Puerto Rico) inserted through the cystic duct at the time of laparoscopic cholecystectomy. Twelve patients with acute cholecystitis underwent an attempt at laparoscopic cholecystectomy that was successful in nine. These procedures were difficult and lengthy (mean of 143 minutes). Causes for failure were gangrenous cholecystitis (2) and equipment failure (1). In conclusion, laparoscopic cholecystectomy can be performed with a high success rate (93%) and low morbidity (2%). No complications seemed attributable to electrosurgical dissection.
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PMID:Electrosurgical laparoscopic cholecystectomy. 153 95

Cholelithiasis is a common clinical situation. In most individuals it takes an inconspicuous clinical course. In symptomatic patients the complications have to be considered: acute cholecystitis, cholangitis, choledocholithiasis, pancreatitis, ileus by large stones and--in a subgroup of patients--carcinoma of the biliary system. Therapy is warranted in symptomatic patients in order to prevent complications. The decision for use of surgical versus non surgical interventions is decided on a individual basis. In general laparoscopic cholecystectomy is the procedure of choice nowadays. A prophylactic cholecystectomy is as a rule not indicated in asymptomatic patients.
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PMID:[Gallstones: natural course and complications]. 163 53


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