Objective To systematically review the effectiveness and safety of single-incision laparoscopic cholecystectomy (SILC) versus conventional multiport laparoscopic cholecystectomy (CMLC). Methods We electronically searched PubMed, EMbase, The Cochrane Library (Issue 1, 2013), CBM, CNKI, VIP and WanFang Data for randomized controlled trials (RCTs) on SILC versus CMLC from inception to January 1st, 2013. According to the Cochrane methods, the reviewers screened literature, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.2 software. Results Finally, 17 RCTs involving 1 233 patients were included. The results of meta-analysis showed that, compared with CMLC, SILC was lower in 24 h postoperative pain score (visual analogue scale, VAS) (SMD= –0.40, 95%CI –0.76 to –0.04, P=0.03), higher in cosmetic results score (SMD=1.56, 95%CI 0.70 to 2.43, P=0.000 4), and longer in operative time (MD=13.11, 95%CI 7.06 to 19.16, Plt;0.000 1). However, no significant difference was found in 6 h postoperative pain scores (VAS), postoperative complications, port-site hernia and hospital stay between the two groups. Conclusion SILC is a safe and effective technique for the treatment of uncomplicated benign gallbladder diseases, and it has certain advantages compared with CMLC, which is recommended in clinical application.
ObjectiveTo investigate the value of magnetic resonance (MR) imaging in the assessment of bile duct complications after cholecystectomy. MethodsFifty patients of having bile duct complications after cholecystectomy underwent MR imaging and had some positive manifestations. The indication for cholecystectomy was symptometic cholelithiasis in all cases. MR imaging was performed with a 1.5T clinical imager including all of the sequences of: ①T1 weighted imaging (T1WI) was performed in transverse and coronal plane before and after gadolinium-enhanced. ②T2 weighted imaging (T2WI) was performed in transverse plane. ③A true fast imaging with steadystate precession sequence (True fisp) was performed in coronal plane. ④MR cholangiopancreatography was also obtained. ResultsThe bile duct complications after cholecystectomy including: 22 cases of cholelithiasis, 15 cases of chronic cholangitis with or without bile duct abscess. Bile duct strictures or abruption at the confluence of hepatic and common bile duct in 6 and 3 cases respectively. Tumors of bile duct or pancreas in 9 cases. The other complications after cholecystectomy including bile leak with choleperitonitis and/or biloma and acute pancreatitis.ConclusionMR imaging was a valuable method for the assessment of bile duct complications after cholecystectomy. MR imaging could assess the etiology of bile duct complications. If there were bile duct obstruction, MR imaging could assess the location and the severe of obstruction. For bile duct or pancreatic tumors, MR imaging could assess the areas of tumor infiltration and resection and was helpful to select treatment methods. Before lapatoscopic cholecystectomy, the overall and careful imaging assessment for bile duct and gallbladder and its adjacent hepatic tissue and pancreas so to avoid missing the relative tumors.
【 Abstract 】 Objective To investigate the cause, management and prevention of biliary fistula with un-typical after laparoscopic cholecystectomy (LC). Methods Twenty-one cases of biliary fistula with un-typical after LC were reviewed retrospectively. Results All patients displayed with un-typical expression and had no obvious signs of peritonitis. Lump of right upper quadrant (6 cases) ， vague pain of epigastric zone (11 cases) ， abdominal distention (3 cases) and bowel obstruction (1 case) after operation were main manifestations. Abdominal paracentesis (14 cases) ， bile exuded from incisional opening of trocar (6 cases) and exploratory laparotomy (1 caes) were the methods of final diagnosis. The cause of biliary fistula included cystic stump fistula (2 cases) ， aberrant bile-duct fistula (9 cases) ， and accessory hepatic duct fistula (4 cases). Laparoscopic approach and puncturation and drainage under ultrasound were the main therapeutic methods. All patiens were discharged successfully with no death case. Nineteen cases were followed up for 3 months to 2 years, and all patients recovered very well. Conclusion The biliary fistula with un-typical after LC is scarce ， and it can lead to missed diagnosis and treatment. Strengthening recognition of biliary fistula after LC ， and paying attention to chief complaint and abdominal sign can help discover biliary fistula early. Laparoscopic approach and puncturation under ultrasound are the recommended therapeutic methods.
Objective To investigate the possibility of laparoscopic cholecystectomy （LC） on porcelain gallbladder. Methods Twenty-four cases of porcelain gallbladder， who were operated in China Medical University， including 13 LC cases， from 2006 to 2008 were retrospectively reviewed. Results Of 24 porcelain gallbladder cases (0.48%) in 4964 cholecystectomy patients， calcification of gallbladder in 87.50%(21/24) patients was diagnosed by ultrasonography. Of 13 patients who were cured by LC, one suffered from postoperative leak bile, no metastasis were found by following up 12 or 14 months in two gallbladder carcinoma cases. Conclusion There’s specificity of ultrasonographic image in porcelain gallbladder, in which LC is safe to be performed and routine frozen pathology during operation is necessary.
ObjectiveTo explore the reliability and safety of diagnosis and treatment for cholecystocolonic fistula during laparoscopic cholecystectomy. MethodsData of patients with cholecystocolonic fistula in department of general surgery, Gansu provincial hospital from Jan 2002 to Dec 2015 were analyzed retrospectively. There were 112 cases diagnosed by routine intraoperative cholangiography from 11 472 laparoscopic cholecystectomy patients, including 33 males and 79 females, age from 58 to 84 years〔(67.4±12.6) years〕. ResultsOne hundred and twelve cases of cholecystocolonic fistula were diagnosed by routine intraoperative cholangiography in laparoscopic cholecystectomy. There were 105 cases of cholecystocolonic fistula performed laparoscopic cholecystectomy and colon repair, and 7 cases performed colostomy, no surgical complications occurred. Seventy cases were followed-up for 6-27 months〔(16.4±5.3)months〕after operation, no long-term complications occurred. ConclusionsThere is a lack of specific symptoms and special diagnosis for cholecystocolonic fistula before operation. Intraoperative cholangiography is a only objective method for diagnosis, and treatment of cholecystocolonic fistula by laparoscopic cholecystectomy and colon repair or colostomy is safe and reliable based on experienced laparoscopic skill.
ObjectiveTo investigate and compare the advantages and disadvantages of laparoscopic cholecystolithotomy and laparoscopic cholecystectomy for patients with gallbladder stone. MethodsThe eligible patients with gallbladder stones hospitalized in our department between January 2007 and December 2011 were included, and all of them received either laparoscopic cholecystolithotomy (observation group) or laparoscopic cholecystectomy (control group) minimally-invasive surgery. The operation time, bleeding volume, enterokinesia recovery time, hospital stay, post-operative complication and follow-up results were compared between the two groups. ResultsA total of 148 patients were included, with 68 patients in the observation group and 80 patients in the control group. In this cohort, the success rate of surgery for the observation group and the control group was 100.0% (68/68) and 98.8% (79/80), respectively; and the success rate of complete stone removal was 100% for both two groups. B-ultrasound examination after 2 weeks of treatment showed that gallbladder wall was normal and gallbladder contraction rate was more than 30% for all patients with laparoscopic cholecystolithotomy. The operation time was (49.6±5.2) minutes for the observation group and (50.5±6.2) minutes for the control group, and bleeding volume was (9.5±1.4) mL for the observation group and (50.2±8.1) mL for the control group; the difference in bleeding volume was significant between the two groups (P<0.05). The difference in enterokinesia recovery time[(33.9±2.2) and (34.4±2.6) minutes] or hospital stay[(3.4±1.0) and (3.6±1.2) days] between the observation group and the control group was not significant (both P >0.05). The post-operative complications of bleeding, bile leakage and wound infection were not observed in both two groups, and all patients were followed up for 6 to 12 months with no stone recurrence; and only 2.7% of patients (1/37) had stone recurrence after 3-year follow-up. ConclusionBoth laparoscopic cholecystolithotomy and laparoscopic cholecystectomy procedures are safe and efficient. However, laparoscopic cholecystolithotomy not only reserves gallbladder but also has superiority of less bleeding volume.
ObjectiveTo investigate the feasibility and advantages of general laparoscopic cholecystectomy and gynecologic uterus and attachment surgery at the same time. MethodsSixty patients with gallbladder stones combined with ovarian cysts, benign gynecological disease or fallopian tube adhesions aged between 35 and 55 were chosen from the department of General Surgery and Gynecology and Obstetrics to be the study subjects between January 2009 and December 2013. The inclusion criteria included: gallbladder stones; gallbladder wall thickness <0.5 cm; non-acute inflammation; symptomatic gynecological diseases; and tumor size between 5.0 and 10.0 cm. Based on similar age, body mass, and histological type, the patients were divided into laparoscopic surgery (GLS) group and staging surgery group (control group) according to the will of the patients. The anesthesia time, surgery time, the number of abdominal perforations, length of hospital stay, and total costs were detected for comparison between the two groups. ResultsThe first-time operation was successful in all the patients in the CLS group, with two cases of abnormal liver function, which were cured within 5-6 days. In the control group, 2 cases of reoperation were transferred to laparotomy due to umbilical and peritoneal adhesions, and both of them were cured and discharged from hospital without incision infection or iatrogenic tissue and organ damage. CLS group had significant advantages in anesthesia time, surgery time, the number of abdominal perforations, length of hospital stay, and total costs over the control group (P<0.05). ConclusionThe combined gynecologic laparoscopic surgery is feasible, safe, mini-invasive, and economical.
ObjectiveTo study the relationship between cholecystectomy and Helicobacter pylori （Hp） infection. MethodsOne hundred and eleven patients with cholecystolithiasis were chosen as the investigation group, while 577 patients with upper digestive tract symptoms without cholecystolithiasis as the control group. All the patients took the 13C breath test to determine whether they were infected by Hp. All the patients with Hp infection continued eradical therapy for Hp infection for one course after cholecystectomy and were followed up on outpatient basis. ResultsThe infection rate in the investigation group was 45.9%, while 27.4% in the control group. During the 3 to 6 months of followup for the patients undergoing eradical therapy for Hp infection, we found no patient complaining of epigastric pain, malaise, belching and nausea. ConclusionThe infection rate of Hp in patients with cholecystolithiasis is high, Hp may be one of the factors causing “postcholecystectomy syndrome”. Eradical therapy for Hp after cholecystectomy will help improve the effects of operation.
Objective To study the suitable operation method of elderly patients with acute cholecystitis. Methods The clinical data of 149 elderly patients with acute cholecystitis were retrospectively analyzed. All patients were divided into two groups according to the operation: open cholecystectomy group (OC group, n=76) and laparoscopic cholecystectomy group (LC group, n=73). Some clinical data were compared in this paper such as operation time, blood loss, length of hospital stay, time of resumption of food, time of intestinal function recovery and complications. Results No marked difference was found between OC group and LC group about basic data except WBC count and examination of gallbladder by B ultrasound（P＞0.05）. But there were significant difference in operation time, blood loss, time of resumption of food, time of intestinal function recovery, length of hospital stay and complications between OC group and LC group （P＜0.01）. Conclusion Individualized treatment should be emphasized on elderly patients with acute cholecystitis. Selection of OC or LC to these patients should be based on the clinical condition and taken the safety as the first principle.
Objective To investigate the effect of cholecystectomy on the induction of large intestine cancer and its mechanism. Methods After cholecystectomy, the large intestine neoplasm in mice was induced with dimethylhydrazine(DMH).The histogenesis and growth pattern of large intestine cancer were observed.The Sphase fraction (SPF) of epithelium cells in large intestine mucosa was determined using flow cytometry. Before and after operation, the feces of mice were collected to determine the cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA) and lithocholic acid (LCA) concentration by highperformance liquid chromatography. Results The average number of large intestine neoplasms per mouse,percentage of large intestine adenomas in examined mice and SPF of experimental group were significantly higher than those of control group (P＜0.05). The fecal LCA concentration in postcholecystectomy was significantly higher than that in precholecystectomy and in sham operation group (P=0.00). Conclusion The large intestine neoplasm of mice induced by DMH is increased and the proliferation of epithelium cell in large intestine mucosa is increased after cholecystectomy. This suggests that cholecystectomy has promoting effect on induction of large intestine neoplasm in mice. The gut may deal with the increased secondary bile acid(LCA) concentration postcholecystectomy.