Laparoscopic cholecystectomy in acute cholecystitis

Pessaux, Patrick; Tuech, Jean‐Jacques; Rouge, Clotilde; Duplessis, R.; Cervi, Charles; Arnaud, Jean‐Pierre

doi:10.1007/s004640020088

Cited by 136 publications

(70 citation statements)

References 26 publications

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“…A similar fi nding is reported by other studies 15,24 . GA, pneumoperitoneum and upper abdominal surgery impact negatively on pulmonary function.…”

Section: Discussionsupporting

confidence: 81%

“…Interaction among effects of exogenous CO 2 , raised IAP and reverse Trendelenburg position during LC can thus precipitate myocardial ischemia and dysrhythmias [21][22][23] . LC still remains the therapy of choice even in the sick elderly in order to prevent serious complications of cholelithiasis, but at the cost of a higher rate of morbidities under GA 15,24,25 . Notably, none of our patients required treatment for hypertension and tachycardia.…”

Section: Discussionmentioning

confidence: 99%

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Spinal anaesthesia in elderly for laparoscopic cholecystectomy

Gautam

2018

J. Kathmandu Med. Coll.

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Background: Prevalence of aging patients appearing for laparoscopic cholecystectomy to treat cholelithiasis is ever on the rise. Associated co-morbidities make the elderly prone to peri-operative complications during laparoscopic cholecystectomy performed under general anaesthesia. Objectives: This study aims to assess the safety and applicability of spinal anaesthesia for the elderly undergoing laparoscopic cholecystectomy. Methodology: In this cross-sectional study, fi fty-four patients of age 65 years or more undergoing laparoscopic cholecystectomy were studied. Hyperbaric Bupivacaine 15 milligrams was used in spinal anaesthesia to obtain sensory block to fi fth thoracic dermatome. Local anaesthetics were instilled intra-peritoneally before surgical dissection. Surgery was performed through three ports with carbon dioxide pneumoperitoneum at eight mmHg intra-abdominal pressure. Data included demography, co-morbidities, need for analgesics or general anaesthesia, operative and post-operative complications and hospital stay. Univariate analysis for peri-operative events and bivariate analysis for outcome and explanatory variables were done. Results: The mean age was 71.4 years with co-morbidity in 40 patients. Conversion to open cholecystectomy occurred in three patients necessitating general anaesthesia. Surgery was completed laparoscopically under spinal anaesthesia in remaining 51 patients. Increment in intra-abdominal pressure was required in fi ve patients. Six patients needed analgesics for shoulder pain. Intra-operative hypotension and shivering occurred in 15 and four patients respectively. Post-operatively, urinary retention and nausea occurred in four and three patients respectively. Mean hospital stay was 3.2 days. Conclusion: There is no undue risk in spinal anaesthesia for conducting laparoscopic cholecystectomy in the elderly and it is effi cient for uncomplicated cholelithiasis with minimal modifi cations in surgical technique.

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“…A similar fi nding is reported by other studies 15,24 . GA, pneumoperitoneum and upper abdominal surgery impact negatively on pulmonary function.…”

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Spinal anaesthesia in elderly for laparoscopic cholecystectomy

Gautam

2018

J. Kathmandu Med. Coll.

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“…In our study there were no significant differences in the conversion rate between the two age groups. [15,16] In the present study, conversion rate appeared to be significantly higher for men (61%) than women (39%), a finding that has been reported previously. [7,8] The reason for the increased risk of conversion for men is not clear.…”

Section: Discussionsupporting

confidence: 76%

A Study of Laparoscopic Cholecystectomy in Patients Above and Below 50 Years of Age

Nr¹,

Sc²,

Sp³

2017

AIMDR

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Background: Cholecystectomy is the commonest operation of the biliary tract. Laparoscopic cholecystectomy (LC) is the standard treatment of symptomatic gallbladder disease. It has numerous advantages over open cholecystectomy (OC). However, current literature suggests that rate of conversion from LC to OC is 1%-15%.Methods: This retrospective study aims to evaluate the risk factors of conversion of LC to open between the elderly (> 50 years old) and the young (≤ 50 years old) and its relation with preoperative data and intraoperative findings. A total of 120 patients, 60 in each group, over a period of January 2016 to June 2017 were studied. Results: A total of 36 cases out of 120 were converted. Of these 36, 14 were in the young age group and 22 in the elderly. In each group, majority cases who were converted, were men (P value <0.05) and duration of symptoms of more than 1 year (P value<0.001). There was highly significant difference seen in the cases converted in the young age group and comorbidities (P value<0.001). Of all the converted cases, a highly significant difference was seen in both age groups with adhesions, intrahepatic and gangrenous gall bladder Conclusion: We believe this is the first study in a developing country like ours suggesting laparoscopic cholecystectomy is a safe procedure irrespective of the age of the patient. While in fact, it is the chronicity of the symptoms, the gender and the intraoperative findings which predict and mandate the conversion of LC to OC.

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“…7,8 . La cifra de 19% de conversión a cirugía laparotómica resulta mayor que la observada para la colecistectomía videolaparoscó-pica en la población general [9][10][11] , pero muy acorde a las publicaciones internacionales en pacientes mayores de 70 años, donde corresponde al doble o más aún que las correspondientes a pacientes no geriátricos 12,13 . Un problema a considerar especialmente en la colecistectomía videolaparoscópica, es la presencia del carcinoma oculto de la vesícula biliar.…”

Section: Discussionunclassified

“…Todo lo anterior, explica que la colecistectomía videolaparoscópica en el paciente adulto mayor sea frecuente hoy en día [8][9][10] . De particular interés es el hecho que en este grupo etario se incluye pacientes de mayor riesgo anestésico quirúrgico en función de la coexistencia habitual de patología médica de variada índole 11,12 ; además de condiciones anatómicas locales menos favorables debido a una más prolongada evolución de su patología biliar [13][14][15] .…”

Section: Introductionunclassified

Resultados de la colecistectomía videolaparoscópica en el adulto mayor

Rioseco

2007

Rev Chil Cir

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RESUMENSe presenta la experiencia en el tratamiento quirúrgico de la patología vesicular litiásica, mediante videolaparoscopia, en una serie prospectiva de 119 pacientes de 60 o más años de edad, de ambos sexos, operados entre Marzo de 2003 y Marzo de 2004, en el Departamento y Servicio de Cirugía del Hospital Barros Luco Trudeau analizando la patología médica asociada, presente en el 70%, los hallazgos relevantes del estudio ecotomográfico preoperatorio (99,1%), las cifras de conversión a cirugía laparotómica (19%), la morbilidad (8,4%) y la mortalidad (0%).PALABRAS CLAVE: Colecistectomía videolaparoscópica, paciente geriátrico, cirugía en adulto mayor. SUMMARYWe report our surgical experience in videolaparoscopic cholecystectomy in 119 patients with 60 or more years old, operated between March 2003 and March 2004, at the Barros Luco's Surgical Department and Service. We analized the medical pathology (70% of patients); the relevant finding at the preoperative ultrasonic study (99,2% of patients); the conversion rate (19%) and postoperatory results. Gran Avda 3100, Santiago, Chile e mail: smontalva@med.uchile.cl INTRODUCCIÓNResulta de interés el estudio de la colecistectomía videolaparoscopia en el paciente adulto mayor en nuestro medio quirúrgico, ya que se ha producido un incremento de la cirugía tanto laparotómica como laparoscópica en general, en pacientes de edad avanzada 1-3 . Por otro lado, la colecistolitiasis en Chile es una patología quirúrgica de muy alta incidencia, afectando también a la población de ambos sexos, en edades iguales o mayores de 60 años [4][5][6] . Todo lo anterior, explica que la colecistectomía videolaparoscópica en el paciente adulto mayor sea frecuente hoy en día [8][9][10] . De particular interés es el hecho que en este grupo etario se incluye pacientes de mayor riesgo anestésico

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Laparoscopic cholecystectomy in acute cholecystitis

Cited by 136 publications

References 26 publications

Spinal anaesthesia in elderly for laparoscopic cholecystectomy

Spinal anaesthesia in elderly for laparoscopic cholecystectomy

A Study of Laparoscopic Cholecystectomy in Patients Above and Below 50 Years of Age

Resultados de la colecistectomía videolaparoscópica en el adulto mayor

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