Laparoscopic Cholecystectomy: An Initial Community Experience

McGee, J. Michael; Randel, Mark; Morgan, Rocky M.; Nolen, Michael; Weaver, Gerald E.; Malnar, Karen F.; Yamanashi, William S.; Lytle, Glenn H.

doi:10.1089/lps.1992.2.293

Cited by 8 publications

(3 citation statements)

References 21 publications

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“…Of 13 deaths attributable to cholecystectomy (2 LC, 3 CC, and 8 OC) ( Table 6), 50% of the OC deaths were pulmonary related and 25% were renal related of the 2 deaths of LC patients, 1 was due to pneumonia, and the other was due to renal failure. One death was due to a myocardial infection and 1 to the missed diagnosis of a perfo- (6) Resp failure (6) Septic shock (10) Resp arrest (10) ARDS (13) Hepatorenal syndrome (23) Trauma (8) Renal cancer (12) Pancreas cancer (14) Alcoholic cirrhosis (15) Cholang cancer (18) Chronic renal failure (21) aThe left column lists the 30-day mortality detailing the related and nonrelated deaths. The right column shows all the deaths in this series that have occurred until the present.…”

Section: Resultsmentioning

confidence: 99%

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Longitudinal Cholecystectomy Study: Patterns of Care in a Total Community Experience

McGee

Malnar²,

Bellefeuille³

et al. 1997

Journal of Laparoendoscopic & Advanced Surgical Techniques

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The purpose of this study was to determine outcomes and safety of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) in a community setting at multiple open staff hospitals with multiple surgeons. This second-year study retrospectively examined all cholecystectomy records in one city at each of five hospitals over a 1-year period beginning in April 1991 through March 1992. All charts were examined for type of surgery, rate of conversion to open procedure, sex, weight, previous abdominal surgery, surgeon, hospital, preoperative workup, operative time, antibiotic prophylaxis, cholangiograms, concurrent procedures, drains, hospital stay, common duct stones and their follow-up, pathology, reoperations, complications, and mortality. One thousand eight hundred one gallbladders were removed. One thousand three hundred four (72.4%) were successfully removed at LC. One hundred eighty-three (10.2%) others were attempted laparoscopically and converted to open cholecystectomy (CC), which represented 12.3% of the attempted LCs. Three hundred fourteen (17.4%) were removed via a standard OC. The mean operative times were 72.3 minutes for LC, 100.1 minutes for CC, and 86.2 minutes for OC. Cholangiography was attempted in 916 (70.3%) LCs, 144 (78.7%) CCs, and 250 (79.6%) OCs, with similar operative times, except in LC, when done via the GB, operative time was 65.2 versus 73.4 minutes when done via the cystic duct. Diagnosis of acute cholecystitis occurred in 306 (23.5%) LCs, 119 (65.0%) CCs, and 145 (46.2%) OCs. Complications requiring reoperation occurred in 30 (2.3%) LCs, 5 (2.7%) CCs, and 5 (1.6%) OCs. Common bile duct (CBD) injuries occurred in 5 (34%) LCs, with 4 converted to CC and 1 repaired 5 days later. Trocar site hernias occurred in 11 (0.8%) LCs. Thirty-nine surgeons participated in the study with mean numbers of 33.4 LC cases, 5.5 CC cases, and 7.2 OC cases, with ranges of 1 to 165 LC cases, 1 to 17 CC cases, and 1 to 24 OC cases. Death occurred in 12 (0.9%) LC cases, 4 (2.2%) CC cases, and 25 (8.0%) OC cases. The mean hospital stay was 39.6 hours for LC, 156.5 hours for CC, and 198.3 hours for OC.

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Section: Resultsmentioning

confidence: 99%

“…It is compared to that of the previous year reported. 6 The operative time on the right has reached a steady state as LC has become the procedure of choice. for OC, we surmise, were selected, in part, because of their worse overall status, as noted by a mortality rate of 4.5%.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Cholecystectomy Study: Patterns of Care in a Total Community Experience

McGee

Malnar²,

Bellefeuille³

et al. 1997

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…The mean time per procedure was 113 minutes (range, 49–265 minutes). This was longer than the mean procedure time described in other studies [2, 12, 13, 14, 15]. Two main reasons were identified for this: A POC was attempted in all cases.…”

Section: Discussionmentioning

confidence: 75%

Itemized Bill: Novel Method to Audit the Process of Laparoscopic Cholecystectomy

Pal

Ahmed

2003

World j. surg.

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One of the recurring obstacles to the successful completion of a medical audit cycle is the unavailability of accurate and complete information. This is particularly evident in the review of clinical processes, where the hand-written medical record is the source of information. We have attempted to bypass this information deficit by using information recorded primarily for financial transactions, using the itemized bill. The study was conducted in two parts. Initially information recorded as an itemized bill for the in-hospital process of laparoscopic cholecystectomies over a one-year period was analyzed. Areas for change in practice were identified, and recommendations were developed. These recommendations were presented to a multidisciplinary group consisting of consultants, residents, and nursing staff involved in caring for these patients. A clinical pathway was developed and implemented from these recommendations. One year after introduction, a review of the clinical pathway was undertaken using the same methodology. The in-hospital process consisted of 23 charge categories according to the itemized bill. Of these, 8 accounted for 95% of the total charge. The surgeon's fee and the anesthesiologist's fee accounted for 34% of the total; medical/surgical supplies, 20%; operating theater time, 17%; pharmacy, 7%; radiology, 5%; laboratory, 7%; and ward, 4%. Areas were identified in the latter 6 categories for change. Review of practice 1 year after implementation of the changes showed that a large number of recommendations were in place. We describe a new method for auditing the processes of medical care, using the itemized bill to adapt and use information primarily recorded for financial purposes.

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Bile duct injury and bile leakage in laparoscopic cholecystectomy

McMahon

Fullarton

Baxter

et al. 1995

Journal of British Surgery

228

134

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The introduction of laparoscopic cholecystectomy has been associated with an increased incidence of bile duct injury. This review presents the incidence of bile duct injury in reported series and examines the role of the learning curve and other contributing factors. There is good evidence to suggest that, with adequate training and experience, the incidence of biliary injury can be reduced to a level comparable to that of open cholecystectomy. Continued audit is required to ensure that the low complication rates achieved in selected centres with wide experience are reproduced by the surgical community in general.

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Laparoscopic Cholecystectomy: An Initial Community Experience

Cited by 8 publications

References 21 publications

Longitudinal Cholecystectomy Study: Patterns of Care in a Total Community Experience

Longitudinal Cholecystectomy Study: Patterns of Care in a Total Community Experience

Itemized Bill: Novel Method to Audit the Process of Laparoscopic Cholecystectomy

Bile duct injury and bile leakage in laparoscopic cholecystectomy

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