Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy

Sungler, P.; Heinerman, P. M.; Steiner, H.; Waclawiczek, H. W.; Holzinger, Josef; Mayer, Frank; Heuberger, A.; Boeckl, O

doi:10.1007/s004640000037

Cited by 82 publications

(33 citation statements)

References 31 publications

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“…Low quality: it very likely that future studies change our confidence in the estimate of effect, therefore our confidence is low. Table. 2001; Elder, 1996;Finan, 2006;Zacks, 2002;Collet, 1997;Ibrahim, 2006;Weber, 2003;Feldman, 1994;Perez Lara, 2006;Sungler, 2000;Daradkeh, 1999;Ji, 2005;Fernandes, 2000;Palanivelu, 2006;da Silveira, 2006;Gurusamy, 2006;Chandler, 2000;Kiviluoto, 1998;Glavic, 2001;Eldar, 1998;Lujan, 1995;Tan, 2006;Perez-Morales, 2005;Bagia, 2001;Schafer, 2003;Kwon, 2001;Woods, 1996).…”

Section: Discussionmentioning

confidence: 99%

“…One RCT on acute cholecystitis (AC) compared safety and cost-effectiveness of urgent versus elective LC (use of percutaneous decompression prior to LC). Elective surgery did not show any advantages in terms of operating time, complication rate, blood loss, and conversion rate or hospital stay as compared with urgent LC (Sungler, 2000). Another low quality RCT comparing safety and results of LC vs. open surgery in patients with gangrenous AC found a similar operating duration and hospital stay but time to return to work was longer in the open group (Kiviluoto, 1998), (Treatment studies 2b).…”

Section: (Treatment Studies 2b)mentioning

confidence: 96%

“…According to the authors, special care should be taken with the trocar position in women after their 32 nd week of pregnancy, a maximum pneumoperitoneum level of 10 mmHg should be used and the routine intraoperative cholangiography (RIOC) should be avoided (Sungler, 2000;Daradkeh, 1999), (Treatment studies 4).…”

Section: (Treatment Studies 2b)mentioning

confidence: 99%

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Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

et al. 2010

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SUMMARY:The aim of the present study was to evaluate the available evidence on the effectiveness of laparoscopic surgery for treating gallstones and common bile duct lithiasis (CBDL). A systematic overview was performed. Medline, EMBASE and The Cochrane Library were searched (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Systematic reviews (SR), clinical practice guidelines (CPG), randomised clinical trials (RCT) and observational studies were included. Internal validity and overall quality of the evidence were assessed. The available evidence was classified according to the Oxford Centre for Evidence Based Medicine proposal. 87 studies were included in this review (12 SR, 23 RCT, 3 CPG, 13 cohort studies, 3 cross-sectional studies, 2 case and control studies and 31 case series). Compared with open cholecystectomy, laparoscopic cholecystectomy (LC) is associated with shorter operating time, shorter hospital stay and better quality of life (high quality evidence). The use of antibiotic prophylaxis does not appear to reduce the infection rate in low-risk patients (high quality evidence). Although many techniques have been advocated to perform LC their effectiveness is as yet inconclusive (low-quality evidence). Two-stage surgery is the most appropriate strategy for high-risk patients with CBDL (high-quality evidence). Mortality is similar to open surgery, as the effectiveness is similar to that of endoscopic treatment (high-quality evidence). As a conclusion we can state that the evidence concerning the effectiveness of laparoscopic surgery for gallstones and CBDL is scarce and of low methodological quality and that better quality studies are warranted to assess these techniques more adequately.

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Section: Discussionmentioning

confidence: 99%

Section: (Treatment Studies 2b)mentioning

confidence: 96%

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Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

et al. 2010

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“…Fetal damage by radiation is related to the time of pregnancy and the radiation dose. Several studies have demonstrated that ERCP can be successfully and safely performed during pregnancy [2,6,[8][9][10] . The role of ERCP during pregnancy for complicated biliary tract diseases is well established.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography during pregnancy without radiation

Akçakaya¹,

Özkan²,

Okan³

et al. 2009

WJG

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AIM: To present our experience with pregnant patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) without using radiation, and to evaluate the acceptability of this alternative therapeutic pathway for ERCP during pregnancy. METHODS:Between 2000 and 2008, six pregnant women underwent seven ERCP procedures. ERCP was performed under mild sedoanalgesia induced with pethidine HCl and midazolam. The bile duct was cannulated with a guidewire through the papilla. A catheter was slid over the guidewire and bile aspiration and/or visualization of the bile oozing around the guidewire was used to confirm correct cannulation. Following sphincterotomy, the bile duct was cleared by balloon sweeping. When indicated, stents were placed. Confirmation of successful biliary cannulation and stone extraction was made by laboratory, radiological and clinical improvement. Neither fluoroscopy nor spot radiography was used during the procedure. RESULTS:The mean age of the patients was 28 years (range, 21-33 years). The mean gestational age for the fetus was 23 wk (range, 14-34 wk). Five patients underwent ERCP because of choledocholithiasis and/or choledocholithiasis-induced acute cholangitis. In one case, a stone was extracted after precut papillotomy with a needle-knife, since the stone was impacted. One patient had ERCP because of persistent biliary fistula after hepatic hydatid disease surgery. Following sphincterotomy, scoleces were removed from the common bile duct. Two weeks later, because of the absence of fistula closure, repeat ERCP was performed and a stent was placed. The fistula was closed after stent placement. Neither post-ERCP complications nor premature birth or abortion was seen. CONCLUSION:Non-radiation ERCP in experienced hands can be performed during pregnancy. Stent placement should be considered in cases for which complete common bile duct clearance is dubious because of a lack of visualization of the biliary tree.

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“…Gebelik sırasında kadınların gebelikten ilişkisiz cerrahi operasyona maruz kalma sıklığının yaklaşık olarak %1-3 oranında olduğu ileri sürülmektedir [2]. Gebelik sırasında en yaygın abdominal cerrahi endikasyonlar arasında akut apandisit ve intestinal obstrüksiyonlar yer almaktadır [3].…”

Section: Bulgularunclassified

Acute cholecystitis in pregnancy: Retrospective evaluation of 21 patients

Şeker¹

2014

Diclemedj

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Objective: We aimed to evaluate our diagnosis and treatment approach to pregnant patients with acute cholecystitis in our high birth rate region. Methods:Twenty-one patients who suffering from acute cholecystitis during their pregnancy were analyzed retrospectively between January 2010 August 2014 at Harran University Medical School, Department of General Surgery. Treatment methods, complications, demographic and laboratory data were recorded for each patient.Results: Twenty one patients with abdominal pain and diagnosed as acute cholecystitis were included in this study. The mean age and gestational weeks of patients were 28 ± 7.4 years, 23.4 ± 8.5 respectively. Upper abdominal pain and nausea-vomiting were the most frequent complaints of the patients to hospital admissions. For the surgical treatment one patient underwent open cholecystectomy due to bladder perforation during the second trimester of her pregnancy, laparoscopic cholecystectomy was performed in one patient due to recurrent cholecystitis and in two patients due to decline cholecystitis findings.All other patients were treated medically. Maternal or fetal complication after treatment was not observed. Conclusion:Although, during pregnancy acute cholecystitis episodes are seen rare successful results can be obtained with medical therapy. When medical therapy has failed, especially in the second trimester, laparoscopic surgery can be considered as reliable surgical intervention for mother and fetus. Bulgular: Çalışmamıza gebeliği sırasında üst karın ağrısı şikayeti ile başvuran ve akut kolesistit tanısı konan toplam 21 hasta dâhil edildi. Hastaların yaş ortalaması 28±7,4, ortalama gebelik haftası 23,4±8,5 olarak tespit edildi. En sık hastaneye başvuru şikâyetlerinin üst karın ağrısı ve bulantı-kusma olduğu görüldü. Tedavi olarak; bir hastada ikinci trimester sırasında gelişen kese perforasyonu nedeniyle açık kolesistektomi, bir hastada tekrarlayan kolesistite bağlı, iki hastada ise kolesistit bulgularının medikal tedavi rağmen gerilememesi nedeniyle laparoskopik kolesistektomi yapıldı. Diğer bütün hastalara ise medikal tedavi uygulandı. Uygulanan tedaviler sonrasında maternal ya da fetal herhangi bir komplikasyon tespit edilmedi.

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Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy

Abstract: The combination of ERCP and laparoscopic cholecystectomy offers a safe and effective option for the definitive treatment of complicated gallstone disease and intractable pain during pregnancy, and there is sufficient access for the combined treatment to be employed.

Cited by 82 publications

References 31 publications

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

Endoscopic retrograde cholangiopancreatography during pregnancy without radiation

Acute cholecystitis in pregnancy: Retrospective evaluation of 21 patients

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