Randomised controlled trial of laparoscopic versus mini cholecystectomy

Barkun, Jeffrey; Sampalls, J.S.; Fried, Gerald M.; Wexler, Marvin J.; Meakins, Jonathan L.; Taylor, Beverley Joan; Barkun, Alan N.; Goresky, Carl A.; Sampalis, John S.

doi:10.1016/0140-6736(92)93148-g

Cited by 395 publications

(189 citation statements)

References 21 publications

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“…This is inconsistent with other series in which up to 50% of patients received additional on-demand analgesia [12][13][14]24 . Cheah et al 13 showed a mean of seven and 12 doses of meperidine for patients operated on by needlescopic and laparoscopic cholecystectomy, respectively, concluding that the needlescopic group required fewer intramuscular meperidine injections (p=0.05).…”

Section: 75contrasting

confidence: 54%

Needlescopic versus laparoscopic cholecystectomy: a prospective study of 60 patients

Cabral¹,

Silva

Melo³

et al. 2008

Acta Cir. Bras.

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Purpose:To test the hypothesis that needlescopic cholecystectomies (NC) offer superior outcomes in comparison to common laparoscopic cholecystectomies (LC). Methods: Sixty consecutive patients with gallbladder disease undergoing either LC or NC were evaluated with respect to differences in operative time, frequency of per-operative incidents, post-operative pain, late postoperative symptoms, length of scars and level of postoperative satisfaction. Results: Mean operative time was similar in both groups. Most of the patients, irrespective of the technique, informed mild postoperative pain. NC patients had lower levels of pain on the 7 th postoperative day (PO7) (p<0.01) and decreased need for additional analgesia. Less frequency of epigastric wound pain was observed in NC patients until PO4 (p<0.01). Aesthetic result was far superior after NC (total length of scars less than half after LC). No differences regarding postoperative satisfaction with the operation were observed between the studied groups. Conclusions: Both techniques were safe and effective, presenting similar operative times and low levels of postoperative pain. Downsizing the ports to 2-3 mm was associated with significantly less frequency of postoperative pain only in the epigastric wound until PO4. Aesthetic outcome of NC was significantly superior to LC, although this advantage did not influence patient level of satisfaction Key words: Cholecystectomy, Laparoscopic. Pain Postoperative. RESUMOObjetivo: Testar a hipótese de que colecistectomias agulhascópicas oferecem resultados superiores aos da colecistectomia laparoscópica usual (CL). Métodos: Sessenta pacientes consecutivos com colecistopatia submetidos à CA ou CV foram avaliados quanto ao tempo operatório, freqüência de acidentes peroperatórios, dor pós-operatória, sintomas pós-operatórios tardios, comprimento das cicatrizes e grau de satisfação. Resultados: O tempo operatório médio foi semelhante em ambos os grupos. A maioria dos pacientes, independentemente da técnica, relataram dor pós-operatória leve. Aqueles operados por CA tiveram menores níveis de dor no 7º dia de pós-operatório (PO7) (p<0.01) e menor necessidade de analgesia adicional. Menor freqüência de dor epigástrica foi observada no grupo CA até o PO4 (p<0.01). O resultado estético foi amplamente superior após CA (comprimento total das cicatrizes menor que a metade após CL). Não houve diferença quanto ao grau de satisfação entre os grupos. Conclusões: As duas técnicas foram seguras e eficazes, apresentando tempos operatórios semelhantes e baixos níveis de dor pós-operatória. A redução dos portais para 2-3 mm associou-se a menor freqüência de dor pós-operatória apenas na incisão epigástrica até o PO4. O resultado estético da agulhascopia foi significantemente superior ao da laparoscopia, apesar desta vantagem não ter influenciado o grau de satisfação dos doentes. Descritores: Colecistectomia Laparoscópica. Dor Pós-Operatória.

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Section: 75contrasting

confidence: 54%

Needlescopic versus laparoscopic cholecystectomy: a prospective study of 60 patients

Cabral¹,

Silva

Melo³

et al. 2008

Acta Cir. Bras.

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“…In both trials, conversion to open cholecystectomy was necessary for more than 20% of the patients [9,10]. In contrast, among patients with uncomplicated gallstone disease (i.e., without CBD stones or need for ES), the conversion rate for LC is known to be 3% to 5% [2,18,20,21,[23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

et al. 2008

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Background According to the literature, the conversion rate for laparoscopic cholecystectomy (LC) after endoscopic sphincterotomy (ES) for cholecystodocholithiasis reaches 20%, at least when LC is performed 6 to 8 weeks afterward. It is hypothesized that early planned LC after ES prevents recurrent biliary complications and reduces operative morbidity and hospital stay. Methods All consecutive patients who underwent LC after ES between 2001 and 2004 were retrospectively evaluated. Recurrent biliary complications during the waiting time for LC, conversion rate, postoperative complications, and hospital stay were documented. Results This study analyzed 167 consecutive patients (59 men) with a median age of 54 years. The median interval between ES and LC was 7 weeks (range, 1-49 weeks). During the waiting time for LC, 33 patients (20%) had recurrent biliary complications including cholecystitis (n = 18, 11%), recurrent choledocholithiasis (n = 9, 5%), cholangitis (n = 4, 2%), and biliary pancreatitis (n = 2, 1%). Of these 33 patients, 15 underwent a second endoscopic retrograde cholangiography (ERC). The median time between ES and the development of recurrent complications was 22 days (range, 3-225 days). Most of the biliary complications (76%) occurred more than 1 week after ES. Conversion to open cholecystectomy occurred for 7 of 33 patients with recurrent complications during the waiting period, compared with 13 of 134 patients with an uncomplicated waiting period (p = 0.14). This concurred with doubled postoperative morbidity (24% vs 11%; p = 0.09) and a longer hospital stay (median, 4 vs 2 days; p \ 0.001). Conclusion In this retrospective analysis, 20% of all patients had recurrent biliary complications during the waiting period for cholecystectomy after ES. These recurrent complications were associated with a significantly longer hospital stay. Cholecystectomy within 1 week after ES may prevent recurrent biliary complications in the majority of cases and reduce the postoperative hospital stay.Keywords Biliary complications Á Cholecystectomy Á Common bile duct Á Conversion rate Á Endoscopic sphincterotomyOf the patients presenting with cholecystolithiasis, 4% to 15% have concomitant common bile duct (CBD) stones [1][2][3]. The current standard of treatment for symptomatic

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“…However, further publications have reported that this incidence remains higher even when ''learning curve'' is accounted for [4,13,14], even in light of technological advances that have improved visualization and instrumentation [14][15][16][17][18]. Despite this evidence, LC remains the treatment of choice for symptomatic gallstones, a fact most likely attributable to the benefits of less postoperative pain, shorter hospital stay, better cosmetic result, and increased patient satisfaction [12,[19][20][21][22]. In fact, the number of cholecystectomies in the United Kingdom has nearly doubled during the past decade ( Fig.…”

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confidence: 99%

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

et al. 2012

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Laparoscopic cholecystectomy is now one of the most frequently performed abdominal surgical procedures in the world. The most common major complication is bile duct injury, which can have catastrophic repercussions for patients and it has been suggested that intraoperative cholangiography may reduce the rate of bile duct injury. Whether this procedure should be performed routinely is still an active subject of debate. We discuss the available evidence and likely implications for the future.

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Randomised controlled trial of laparoscopic versus mini cholecystectomy

Cited by 395 publications

References 21 publications

Needlescopic versus laparoscopic cholecystectomy: a prospective study of 60 patients

Needlescopic versus laparoscopic cholecystectomy: a prospective study of 60 patients

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

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