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Query: UMLS:C0149520 (acute cholecystitis)
 2,784 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

After performing selectively 25 laparoscopic cholecystectomies (LC) to determine the place of LC in the management of complicated gallstones, all patients presenting with gallstones were evaluated by the authors for LC. Eighty-six consecutive patients were evaluated and 84 were studied. Follow-up in every case exceeded 6 months. In three of 10 patients with acute cholecystitis, LC was not possible; each had a history longer than 48 h and all had gangrene of the gallbladder. In four patients with empyema, LC was successful, but operative cholangiography failed. Operative cholangiography was successful in 76 of the remaining 77. Of eight patients suspected of having stones in the CBD, cholangiography excluded stones in six and confirmed them in two. Cholangiography identified three other patients with totally unsuspected CBD stones. Of the five patients with CBD stones, four had them flushed to the duodenum at LC following transcystic balloon dilatation of the papilla and one had a post-op. ERCP. Of four patients with acute pancreatitis, three had LC in the same admission. LC was possible in all three patients with morbid obesity. We conclude that with experience, LC is possible for complicated gallstones. In acute cholecystitis, the probability of success is higher with earlier operative intervention. Operative cholangiography is essential. It not only identifies unsuspected CBD stones but also allows LC without ERCP in those with suspected CBD stones and with modification it allows treatment of those stones.
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PMID:Laparoscopic cholecystectomy for complicated gallstone disease. 138 34

Acute cholecystitis, morbid obesity, and previous upper abdominal surgery have been reported as relative contraindications to laparoscopic cholecystectomy. An analysis of 706 laparoscopic cholecystectomies performed at our institution was undertaken to determine if these relative contraindications led to increased morbidity, an increased rate of conversion to the open technique, or longer operating time. One hundred ninety-seven patients demonstrated one or more relative contraindications to laparoscopic cholecystectomy. Morbidity was not increased in patients with these risk factors, but conversion to open cholecystectomy was required in a greater percentage of patients with acute cholecystitis. We favor an attempt at laparoscopic cholecystectomy in patients with these risk factors; however, they should be counseled as to the increased risk of conversion to open cholecystectomy in the presence of acute cholecystitis.
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PMID:What are the contraindications for laparoscopic cholecystectomy? 144 75

From April to August 1990, 60 patients underwent laparoscopic cholecystectomy. Patients with biliary colic were included, but those who had florid acute cholecystitis, morbid obesity or scars in the upper portion of the abdomen were excluded. Three patients had acute cholecystitis, 56 had chronic cholecystitis and 1 had hydrops of the gallbladder. Nineteen patients had had previous lower abdominal surgery. Five patients did not require analgesia, but the remainder needed parenteral analgesia on an average of 1.7 occasions and enteral analgesia on an average of 1.8 occasions. There were no intraoperative complications, and no patient had the procedure completed by standard surgery. Postoperative hospital stay averaged 2.5 days. The mean follow-up was 39 days. Few postoperative complications were noted: two patients suffered from ileus; two patients had biliary colic postoperatively (one required endoscopic sphincterotomy with stone extraction, and in the other no common-duct stones were seen on retrograde cholangiography); one patient had an intra-abdominal abscess, which was drained percutaneously; and one patient complained of upper abdominal pain that was incisional in origin. Laparoscopic cholecystectomy should be considered the procedure of choice for elective treatment of uncomplicated symptomatic gallstone disease.
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PMID:Laparoscopic cholecystectomy: a report of 60 cases. 182 56

Salient features of an operative technique designed to reduce to a minimum the iatrogenic trauma of cholecystectomy include a limited incision, muscle retraction (instead of division), specific packing and retraction, and distant manipulations by long instruments. Eighty two unselected consecutive patients with primary gallbladder disease underwent operation by this technique. Two permanently bed-confined patients were excluded from study. Acute cholecystitis was documented by histopathology review in 23 cases and chronic cholecystitis in 57 cases. Case material included usual pre-existing concomitant medical problems; five patients meeting formal criteria for the diagnosis of morbid obesity; 15 patients exceeding 199 pounds and one weighing 315 pounds; ambulatory (outpatient) cholecystectomy; 17 patients over 70 and four patients over 80 years of age; five gangrenous and one perforated gallbladders, and perigallbladder abscesses without gangrene in one case; and conspicuous absence of respiratory complications. Median and average incision length was 5.5 cm. There were no major and five minor complications. Recent experience demonstrated safe performance of elective cholecystectomy for chronic disease, regardless of degree of patient obesity, with median incision length 5 cm, median operative time 65 minutes and median post-operative hospital stay 2 days.
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PMID:Minimal trauma cholecystectomy (a "no-touch" procedure in a "well"). 336 59

Since the first laparoscopic cholecystectomy in 1987 by Mouret, the scope of biliary surgery available to a laparoscopic surgeon has increased. In the early days of the procedure there were several accepted contraindications. Some of these were acute cholecystitis, morbid obesity, adherent gallbladder, jaundiced patients, ductal calculi, and biliary tract anomalies. In a series of 300 laparoscopic cholecystectomies we encountered five cholecystoduodenal fistulae. It was possible to deal with four fistulae laparoscopically. Two patients underwent a laparotomy, one for a failed laparoscopic repair of cholecystoduodenal fistula and the other for several common bile duct (CBD) stones, which could not be removed laparoscopically via the cystic duct. We maintain that with increasing expertise and improved instrumentation, most cases of cholecystoduodenal fistula could be dealt with laparoscopically.
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PMID:Laparoscopic repair of cholecystoduodenal fistulae. 786 12

Most experienced laparoscopic units suggest a rate of conversion to open cholecystectomy of about 5%. Some failures are predictable preoperatively. We have reviewed the prospective data collected on our first 285 laparoscopic cholecystectomies to provide a basis for advising patients about the likelihood of conversion (failure) if laparoscopic cholecystectomy is attempted. Risk factor analysis was performed to assess the effect on the conversion rate of clinical presentation, preoperative ultrasound features, previous abdominal surgery, and morbid obesity. The overall conversion rate was 4.9%. We identified three preoperative clinical parameters associated with a high risk of failure at laparoscopic cholecystectomy: a contracted gallbladder on ultrasound, gallstone pancreatitis, and a previous history of upper abdominal surgery. Factors that did not predict failure were: an ultrasound report of a thick gallbladder wall, morbid obesity, or acute cholecystitis. It is concluded that laparoscopic cholecystectomy is technically feasible in most patients, but those having the above-mentioned risk factors should be warned of a higher than usual chance of conversion to open cholecystectomy.
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PMID:Laparoscopic cholecystectomy. A prospective analysis of the potential causes of failure. 825 73

Laparoscopic cholecystectomy (LC) has been performed increasingly in an outpatient setting. Conversion from LC to open cholecystectomy (OC) is sometimes required. To predict conversion to OC, a single institutional study of 1,676 consecutive patients in whom LC was attempted was performed. Factors evaluated were age, sex, history of acute cholecystitis, pancreatitis, or jaundice, previous abdominal surgery, abnormalities of liver function tests, thickened gallbladder wall identified by preoperative ultrasound, obesity or morbid obesity, and cumulative institutional experience in LC. Conversion to OC was required in 90 of 1,676 (5.4%) patients. Significant preoperative predictors of conversion were acute cholecystitis, increasing age, male sex, obesity, and thickened gallbladder wall found by ultrasound. Nonobese women younger than age 65 years with symptoms of biliary colic and normal gallbladder wall thickness found by preoperative ultrasound required conversion only 1.9% of the time. These predictors may be useful in planning a program of ambulatory or short stay surgical units for patients undergoing LC and for comparing data between series.
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PMID:Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. 831 Nov 38

Laparoscopic cholecystectomy has proven to be a safe and effective treatment for symptomatic gallstone disease. Several subsets of patients, however, may not be candidates for the laparoscopic approach, including patients with morbid obesity, acute cholecystitis, and previous abdominal surgery. Because of peritoneal thickening and abdominal adhesions secondary to peritoneal dialysis, the applicability of laparoscopic cholecystectomy in patients maintained on chronic peritoneal dialysis is also unclear. We performed laparoscopic cholecystectomy on three peritoneal dialysis patients without intraoperative complications. We have noted several unique advantages to laparoscopic surgery in this patient population and advocate this approach in peritoneal dialysis patients requiring cholecystectomy.
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PMID:Cholecystectomy in the peritoneal dialysis patient. Unique advantages to the laparoscopic approach. 852 46

BACKGROUND: This study concerns 33 patients treated for morbid obesity with the procedure proposed by Scopinaro. Results are reviewed retrospectively in terms of complication rates. METHODS: The group consisted of ten men and 23 women with a mean age of 34 years (range 20-51 years), and a mean BMI of 49.5 kg/m(2) (range 37-77). Adequate attempts at medical management had failed repeatedly. The operative procedure involved a 2/3 partial gastrectomy and biliopancreatic diversion by Roux-en-Y reconstruction 50 cm before the ileocecal valve. In one patient, a cholecystectomy was added. RESULTS: The mean weight loss after 6 months was 18.9% of the initial weight, with mean BMI 41 kg/m(2) (range 29-60). Early complications included four wound infections (15%), while two patients complained of an early dumping syndrome (6%), treated by dietary measures. There were no respiratory infections and no pulmonary embolism, likely as a result of the thoracic epidural anesthesia and high doses of prophylactic heparin used. There was no mortality. As to late complications, nine patients complained of diarrhea due to bacterial overgrowth (27%) and were treated with antibiotic therapy. There were five incisional hernias (15%). Five patients had a peptic ulcer (15%) and required medical treatment. Two patients had acute cholecystitis (6%). One patient had an afferent loop obstruction (3%), requiring reoperation. CONCLUSIONS: Overall, this series of intestinal diversion procedures by the method of Scopinaro had a larger complication rate than generally accepted.
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PMID:Complications of Biliopancreatic Diversion Surgery as Proposed by Scopinaro in the Treatment of Morbid Obesity. 1072 87

Laparoscopic cholecystectomy is now considered the "gold standard" operation for patients with gallstone disease. A number of patients require conversion to an open cholecystectomy for the safe completion of the procedure. This study investigates how the etiology and incidence of conversion from laparoscopic to open cholecystectomy has changed over time. All 5884 patients undergoing laparoscopic cholecystectomy between March 1991 and June 2001 were prospectively collected in a database. A total of 310 patients (5.2%) had had their cholecystectomies converted to an open procedure. The mortality rate for these patients was 0.7%. Causes for conversion were inability to correctly identify anatomy (50%), "other" indications (16%), bleeding (14%), suspected choledocholithiasis (11%), and suspected bile duct injury (8%). After an initial learning curve in thin patients with symptomatic cholelithiasis, inclusion of patients with acute cholecystitis, morbid obesity, or a prior celiotomy resulted in a peak conversion rate of 11% by 1994. From 1994 to the first half of 2001, the conversion rate has declined significantly for all patients (10% to 1%), as well as for patients with acute cholecystitis (26% to 1%). Although unclear anatomy secondary to inflammation remains the most common reason for conversion, the impact of acute cholecystitis on the operative outcome has decreased with time.
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PMID:Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. 1250 17


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