The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland · 2009
Laparoscopic subtotal cholecystectomy: initial experience with laparoscopic management of difficult cholecystitis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Singhal T, Balakrishnan S, Hussain A, Nicholls J, Grandy-Smith S, El-Hasani S
Аннотация
AIM: Laparoscopic cholecystectomy (LC) is now accepted as the 'gold standard' procedure for cholecystectomy. However, a significant proportion of patients with complicated cholecystitis are still converted to 'open' to complete the procedure. Laparoscopic subtotal cholecystectomy (LSC) is an option, which is still too infrequently used.
METHODS: A single surgeon in our NHS trust has performed 1150 LCs since September 1999. The procedure was converted to LSC in 52 cases (4.52%) due to complicated cholecystitis. The data were collected and prospectively analysed for any morbidity or complications in the peri-operative period.
RESULTS: At the initial presentation, 21 patients (40.38%) were diagnosed with recurrent biliary colic, 24 patients (46.15%) had acute cholecystitis, 6 patients (11.53%) had jaundice, and 1 patient (1.92%) had peritonitis due to gallbladder (GB) perforation. Twenty-six cases (50%) were performed as emergencies, i.e. within one week of symptoms, and 26 (50%) were planned for surgery within four weeks after symptoms started. The cystic duct or Hartmann's pouch stump was closed using endo-loop application in 34 (65.38%), intracorporeal suturing of stump of Hartmann's pouch in 13 (25%), and closure of cystic duct opening in the Hartmann's pouch by purse-string suturing in 5 cases (9.62%).
CONCLUSION: LSC is a safe option in treating gallstone disease when inflammation or fibrosis precludes conventional dissection of Calot's triangle. LSC can clearly help reduce morbidity associated with open laparotomy.
METHODS: A single surgeon in our NHS trust has performed 1150 LCs since September 1999. The procedure was converted to LSC in 52 cases (4.52%) due to complicated cholecystitis. The data were collected and prospectively analysed for any morbidity or complications in the peri-operative period.
RESULTS: At the initial presentation, 21 patients (40.38%) were diagnosed with recurrent biliary colic, 24 patients (46.15%) had acute cholecystitis, 6 patients (11.53%) had jaundice, and 1 patient (1.92%) had peritonitis due to gallbladder (GB) perforation. Twenty-six cases (50%) were performed as emergencies, i.e. within one week of symptoms, and 26 (50%) were planned for surgery within four weeks after symptoms started. The cystic duct or Hartmann's pouch stump was closed using endo-loop application in 34 (65.38%), intracorporeal suturing of stump of Hartmann's pouch in 13 (25%), and closure of cystic duct opening in the Hartmann's pouch by purse-string suturing in 5 cases (9.62%).
CONCLUSION: LSC is a safe option in treating gallstone disease when inflammation or fibrosis precludes conventional dissection of Calot's triangle. LSC can clearly help reduce morbidity associated with open laparotomy.