Progress with cholecystectomy: Improving results in England and Wales

Abstract

During 1994 the audit sampled approximately 10 per cent of all cholecystectomies performed in England and Wales. The results suggest progress in surgical techniques compared with findings in 1990-1991.

Changes in T cell subsets, interleukin-6 and C-reactive protein after laparoscopic and open colorectal resection for malignancy

“…The speed and enthusiasm with which laparoscopic procedures have been introduced in general surgery is unprecedented [25]. The clinically apparent benefits of the minimally invasive approach have prompted many researchers to seek basic science support for them [3,20,22,28,33].…”

Prevalence of Bile Duct Injury Following Cholecystectomy

“…On the other hand, because laparotomy was the only surgical approach until the end of eighties, consecutive series of open cholecystectomies are representing the true reality of BDI, with no selection's bias. In more recent studies of open cholecystectomies during the laparoscopic era, these results remained unchanged in term of biliary complications (Table 5) (11,12,40,41), despite the fact that more difficult cases are now selected for an open or a converted approach, representing thus a hyperselection of risky patients.…”

“…The conversion to an open approach has been considered to be a way to avoid BDI in difficult cases. However, the reported conversion rate is variable (from 0% to 15%) and could not be related with the incidence of BDI, because most of them occured before the conversion required for an adequate repair (Table 8) (9,(11)(12)(13)67,(83)(84)(85)(86)(87)(88).…”

“…However, the laparoscopic approach for cholecystectomy is now considered as the gold standard, due to its minimal invasive aspect and to its excellent results in term of morbidity and mortality. These features were demonstrated in many series of LC (Table 2) (6,(9)(10)(11)(12)(13) and in comparative series of open and laparoscopic cholecystectomies during the same period (Table 3) (11,12,14,15). The purpose of this paper is thus to critically evaluate the prevalence of BDI since the event of the laparoscopic era.…”

Alterations in the immune system and tumor growth in laparoscopy

“…Enthusiasm for this procedure stems from the widespread success of laparoscopic cholecystectomy, which has rapidly become the procedure of choice for the symptomatic gallbladder [27,74]. Laparoscopic techniques were quickly applied thereafter to a range of other general surgical procedures so that appendicectomy [54,58], herniorrhaphy [89], adrenalectomy [25], splenectomy [17], and Nissen fundoplication [22] have been performed laparoscopically on large numbers of patients worldwide.…”