[306][307][308][309][310][311][312] Audit weeks. This would take the form of a cholecystectomy (and bile duct clearance if necessary) in fit patients and an endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy in the unfit. Indeed the risk of recurrence of acute biliary pancreatitis in the presence of cholelithiasis could be as high as 60% within 6 months. 3Endoscopic sphincterotomy significantly reduces the risk of recurrent acute biliary pancreatitis in unfit patients to 2-5% at 2 years. [4][5][6] In the management of acute cholecystitis, the conventionally adopted approach of conservative treatment and interval cholecystectomy has its distinct disadvantages. Whilst the majority of patients respond to such treatment approach, up to one-fifth of patients fail to do so and require an urgent cholecystectomy. [7][8][9] Moreover, up to one-quarter of patients who have recovered from acute cholecystitis relapse while awaiting an interval cholecystectomy. 7 In a randomised controlled trial of early versus delayed open cholecystectomy for acute cholecystitis some 25 years ago, Lahtinen and colleagues 7 found early surgery to be safe and associated with significantly shorter operating time, and had avoided the complications of failed medical treatment. A number of recent randomised clinical trials have addressed the timing and surgical approach to cholecystectomy in patients with acute cholecystitis, 9-13 and demonstrated that laparoscopic cholecystectomy performed during the index admission with acute cholecystitis was associated with a shorter hospital stay, 9,11-13 quicker recovery, 9 and a reduction in the overall treatment cost when compared with open cholecystectomy during the index admission with acute cholecystitis 12 or interval laparoscopic cholecystectomy. 9,11,13 Moreover, early laparoscopic cholecystectomy was safe, and earlier reports of increased risk of bile duct injuries 14 were not substantiated by more recent experiences. 9,11,13,15 The aims of this study, therefore, were to survey the currently adopted practice of the UK surgeons in the surgical management of acute biliary pancreatitis and acute cholecystitis, to evaluate the impact of various subspecialty interests on the practice adopted, and to suggest pathways towards a better implementation of the guidelines and other evidence-based management approaches. Materials and MethodsThe names and addresses of the practising members of the Association of the Surgeons of Great Britain and Ireland were obtained from the Association's office, and a postal questionnaire was sent to its 1086 current members. The survey included a general questionnaire, as well as a questionnaire that addressed the current practice adopted by each surgeon in relation to the timing and approach to the surgical management of acute biliary pancreatitis and acute cholecystitis (see Appendix). The reply to the questionnaire was anonymous. Statistical analysisThe replies were compiled on a computer database for analysis. Data were analysed using SPS...
Laparoscopic cholecystectomy during the index admission with acute cholecystitis can be performed safely and successfully. Earlier surgery has a beneficial impact for patients and the National Health Service.
The transgastric pseudocyst-gastrostomy is the standard approach for internal drainage of persistent and large retrogastric pancreatic pseudocysts that complicate acute necrotizing pancreatitis. We report on the application of a laparoscopic endogastric approach for drainage of pancreatic pseudocysts and discuss the merits of this technique as well as of the other previously described minimally invasive approaches for the management of pancreatic pseudocysts. Between January 2001 and August 2001, three female patients presented with large symptomatic pseudocysts 3-10 months after an episode of acute necrotizing pancreatitis. Internal drainage was effected by a laparoscopic endogastric pseudocyst gastrostomy, and the necrotic pancreas was debrided. There were no conversions and no postoperative complications. The median postoperative hospital stay was 4 days (range, 3-5). All patients remain asymptomatic, and resolution of the pseudocyst was radiologically evident at a median follow-up of 6 months (range, 4-11). The laparoscopic endogastric pseudocyst gastrostomy appears to be a safe and effective minimally invasive approach for internal drainage of large retrogastric pancreatic pseudocysts and facilitates debridement of the necrotic pancreas.
S urgeons' operative work-load has by tradition been assessed by weighting individual operations for complexity on the basis of the BUPA schedule of procedures.1 Each operation can be given an intermediate equivalent value (IEV), or hernia equivalent, in order to convert the case-load to a work-load.It has been suggested that a consultant surgeon in a district general hospital might perform 3-4 intermediate equivalents per operating list, which would amount to a total operative work-load of 900 intermediate equivalents per year.2 However, our own prospective audit over a period of 3 years has raised questions regarding the accuracy and correlation between the weighting given and certain common complex major operations by the BUPA schedule, 3 and the actual time taken to perform the surgery. The aim of this study, therefore, was to determine whether a relationship exists between the intermediate equivalent weighting of a surgical operation, anaesthetic preparation time, operative time, and the complexity of commonly performed general surgical operations. A clear and consistent relationship between the intermediate equivalent rating of an operation, and the actual theatre time required to complete the procedure, would allow transparent planning of operating lists with regard to available operating theatre time, and facilitate accurate audits of a work-load. MethodsThe operative work-load of 9 consultant surgeons working in a district general hospital serving a population of 480,000 was studied retrospectively. General surgical services are provided by 8 general surgeons, two vascular,
The semi-open blunt technique of primary cannulation of the peritoneal cavity achieves rapid, safe, and successful access to the abdomen for laparoscopy. It is associated with minimal periportal gas leakage and port dislodgement and is an alternative method for primary cannulation.
A 58-year-old man presented acutely with features of post-surgical adhesive small bowel obstruction. Following an unsuccessful trial of conservative management, computed tomography (CT) of the abdomen was performed. This revealed a mass in the ileocaecal region, for which he underwent a subsequent right hemicolectomy. Histology revealed diffuse B-cell Non-Hodgkin’s lymphoma of the terminal ileum. Confounding obstructive lesion of the intestine in patients with a history of previous laparotomy is extremely uncommon. Early high resolution imaging may predict diagnosis and consolidate clinical management plans.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.