OBJECTIVETo evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on the quality of recovery during the early period after laparoscopic cholecystectomy and the dosage of anesthetic and analgesic.

METHODSOne hundred patients who received laparoscopic cholecystectomy with gradeⅠand Ⅱ of American Society of Anesthesiologists (ASA) criteria were randomly assigned into an observation group and a control group according to random number table, 50 cases in each group. The patients in the two groups were treated with conventional endotracheal intubation anesthesia, anesthesia induction and maintenance. The patients in the observation group were treated with TEAS (2 Hz/100 Hz, 8 to 12 mA) at bilateral Hegu (LI 4) and Neiguan (PC 6), as well as Zusanli (ST 36) and the non-acupoint 2 outboard from Zusanli (ST 36) from 30 min before anesthesia induction to the end of operation. The patients in the control group were applied by stimulation electrode in the corresponding points without electrical stimulation. The dosage of intraoperative remifentanil and the analgesic dosage of dezocine for postoperation were recorded. The recovery time, extubation time, the changes of heart rate (HR) and mean arterial pressure (MAP) during extubation were recorded. The quality of recovery was assessed by the quality of recovery-40 questionnaire (QoR-40) 1 day before surgery (T)，and 4 h (T), 8 h (T), 24 h (T), 48 h (T) after surgery. The patient's cognitive function was assessed by mini-mental state examination (MMSE) scale at the 5 time points. The incidences of postoperative nausea and vomiting were recorded at T through T.

RESULTSThe dosages of intraoperative remifentanil and dezocine in the observation group were less than those in the control group; the recovery time and extubation time were shorter than those in the control group; the HR of extubation was lower than that in the control group (all <0.05). There was no statistic difference about MAP between the two groups (>0.05). Compared with T, the total scores of QoR-40 decreased in the two groups at T, T, T (all <0.05), and the total scores in the observation group were higher than those in the control group (all <0.05). The emotional state, physical comfort, psychological support, self-care ability, pain scores at T in the observation group and at T, T, T in the control group were lower than those at T (all <0.05). The emotional state, physical comfort, psychological support, self-care ability, pain scores in the observation group were higher than those in the control group at T, T, T (all <0.05). Compared with T, the MMSE scores in the two groups decreased at T and T (all <0.05). At T, T, T, the MMSE scores in the observation group were higher than those in the control group (all <0.05). At T and T, the incidence rates of nausea and vomiting were 22.0% (11/50), 12.0% (6/50) respectively in the observation group, which were lower than 32.0% (16/50) and 24.0% (12/50) in the control group (both <0.05). At T and T, the incidence rates of nausea and vomiting were 6.0% (3/50), 2.0% (1/50) respectively in the observation group, which were not significantly different from 8.0% (4/50) and 4.0% (2/50) in the control group (both >0.05).

CONCLUSIONTEAS can improve the quality of recovery during the early period after laparoscopic cholecystectomy and reduce the dosage of anesthetic and analgesic.

Acupuncture Points ; Cholecystectomy, Laparoscopic ; adverse effects ; Humans ; Postoperative Nausea and Vomiting ; therapy ; Transcutaneous Electric Nerve Stimulation

Laparoscopic cholecystectomy has now rapidly replaced open cholecystectomy. Rarely a calculus may arise from a metallic surgical clip migrated into the common bile duct (CBD) after this surgical procedure was performed. We report a 50-year-old man with CBD stone formed around a surgical clip, who had undergone a laparoscopic cholecystectomy because of acute calculous cholecystitis 14 months before. Abdominal CT revealed a single stone in mildly dilated CBD. A high density core within the CBD stone, was suspected to be a surgical clip. The stone was removed using a retrieval balloon catheter and basket after endoscopic sphincterotomy.
Cholecystectomy, Laparoscopic/adverse effects/*instrumentation ; Choledocholithiasis/*etiology ; *Foreign-Body Migration ; Humans ; Male ; Middle Aged ; Surgical Instruments/*adverse effects

OBJECTIVETo evaluate the safety and effectiveness of transumbilical single port laparoscopic cholecystectomy (TSPLC).

METHODSA retrospective analysis was conducted for the 141 patients, who received TSPLC by DR. Jian in our hospital since April 2011 to October 2012, and the operative and postoperative effects of these patients were evaluated by comparing with that of the conventional laparoscopic cholecystectomy (CLC).

RESULTSIn the total of 141 TSPLC cases that included in the study, 3 cases converted to CLC. 2 cases converted to open cholecystectomy. Additionally, 1 case was diagnosed as an unexplained bowel perforation after operation, fat liquefaction occurred in 2 patients. When comparing with these cases to 306 CLC patients, there was no obvious statistical difference in the terms of patients age, gender, BMI and abdominal surgery history (P>0.05). Meanwhile, There were similar effects of the two groups of patients on the operation time (28.5∓19.3 min vs 33.4∓14.2 min, P=0.001), estimate blood loss (6.4∓18.9 ml vs 9.8∓20.6 ml, P=0.06), the time needed for closing abdomen (5.1∓3.8 min vs 5.8∓4.3 min, P=0.06) and postoperative complications (3/141 vs 5/306, P=1.00). However, the TSPLC group was superior to CLC group in the terms of the conversion rate (2/141 vs 25/306,P=0.001), and postoperative hospitalization (1.2∓1.4 d vs 2.6∓1.7 d,P<0.01), meanwhile, TSPLC was also superior to LC on the satisfactory degree of operative effect through the one week follow-up (8.5∓1.1 vs 7.9∓0.7, P<0.01).

CONCLUSIONSTSPLC is both safer and more effective than that of CLC, and thus it is worth adopting in selected hospitals.

Adult ; Cholecystectomy, Laparoscopic ; adverse effects ; instrumentation ; methods ; Female ; Gallbladder Diseases ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

The present case is one of gallstone obstructive ileus due to gallstones 3 yr after laparoscopic cholecystectomy. It is interesting because of the sex of the patient, the fact that ileus occurred 3 yr after cholecystectomy and that the localization of the obstruction was an old side-to-side ileoileal anastomosis due to a diverticulectomy following intussusception of Meckels' diverticulum at the age of 3.
Adult ; Anastomosis, Surgical/*adverse effects ; Child, Preschool ; Cholecystectomy, Laparoscopic/*adverse effects ; Gallstones/*complications ; Humans ; Ileum/pathology/*surgery ; Ileus/*etiology ; Intestinal Obstruction/*etiology ; Male ; Meckel Diverticulum/surgery

Surgical clips can migrate into the biliary tract and act as a nidus for stone formation. We report a case of common bile duct stone developed due to a surgical clip in a 48-year-old man. Endoscopic retrograde cholangiogram revealed a common bile duct stone a with metallic clip in it. He had laparoscopic cholecystectomy 10 years ago. The stone was removed endoscopically. The use of resorbable clips during laparoscopic cholecystectomy is recommended to avoid this type of complication.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic/adverse effects/*instrumentation ; Choledocholithiasis/*etiology/radiography/therapy ; *Foreign-Body Migration ; Humans ; Male ; Middle Aged ; Surgical Instruments/*adverse effects

OBJECTIVETo compare the effects of propofol target controlled infusion (TCI) and sevoflurane inhalational anesthesia on the hemodynamics and postoperative recovery in patients undergoing laparoscopic cholecystectomy.

METHODSSixty ASA IorII patients scheduled for laparoscopic cholecystectomy were randomized into propofol TCI group (group P) and sevoflurane inhalational anesthesia group (group S). In group P, TCI propofol was maintained after intubation until incision closure with the target concentration at 3 microg/ml. In group S, sevoflurane (end-tidal concentration of 2%) was maintained with oxygen flow rate of 2 L/min until incision closure. Fentanyl and vecuronium were intravenously infused according to the depth of anesthesia during the operation. MAP and HR were measured before anesthesia (T(1)), immediately after intubation (T(2)), at skin incision (T(3)), 10 min after pneumoperitoneum (T(4)) and immediately after completion of the operation (T(5)) respectively. Awake time, postoperative nausea and vomiting of the patients were observed after operation.

RESULTSThere was significant difference in MAP and HR at T(4) between the two groups (P<0.05), but not at T(1), T(2), T(3) and T(5) (P>0.05). No significant difference was also found in the awake time between the two groups (P>0.05). The incidence of PONV, however, was significantly lower in group P than in group S (P<0.05).

CONCLUSIONPropofol TCI and sevoflurane inhalational anesthesia are all effective in inducing good anesthetic effect, maintaining hemodynamic stability and ensuring rapid recovery, but propofol TCI causes lower incidence of PONV in operations such as laparoscopic cholecystectomy.

Adolescent ; Adult ; Anesthesia, Inhalation ; adverse effects ; methods ; Cholecystectomy, Laparoscopic ; Female ; Hemodynamics ; drug effects ; Humans ; Infusion Pumps ; Male ; Methyl Ethers ; administration & dosage ; adverse effects ; pharmacology ; Middle Aged ; Postoperative Complications ; etiology ; Propofol ; administration & dosage ; adverse effects ; pharmacology ; Young Adult

BACKGROUND/AIMS: Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Percutaneous cholecystostomy is an alternative treatment to resolve acute inflammation in patients with severe comorbidities. The purpose of this study is to determine the optimal timing of laparoscopic cholecystectomy after percutaneous cholecystostomy for the patients with acute cholecystitis. METHODS: This retrospective study was conducted in patients who underwent cholecystectomy after percutaneous cholecystostomy from January 2010 through November 2014. Seventy-four patients were included in this study. The patients were divided into two groups by the operation timing. Group I patients underwent cholecystectomy within 10 days after percutaneous cholecystostomy (n=30) and group II patients underwent cholecystectomy at more than 10 days after percutaneous cholecystostomy (n=44). RESULTS: There was no significant difference between groups in conversion rate to open surgery, operation time, perioperative complications rate, and days of hospital stay after operation. However, complications related to cholecystostomy such as catheter dislodgement occurred significantly more often in group II than group I (group I:group II=0%:18.2%; p=0.013). CONCLUSIONS: Timing of laparoscopic cholecystectomy after percutaneous cholecystostomy did not influence postoperative outcomes. However, late surgery caused more complications related to cholecystostomy than early surgery. Therefore, early laparoscopic cholecystectomy should be considered over late surgery after percutaneous cholecystostomy insertion.
Aged ; Aged, 80 and over ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystitis, Acute/*diagnosis/surgery ; Cholecystostomy ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies

OBJECTIVETo summarize the reasons for bile duct injury (BDI) after laparoscopic cholecystectomy (LC), and to determine the effect of multiple treatment after BDI.

METHODSA retrospective cohort study was performed. The medical records of 110 patients diagnosed with BDI after LC from October 1993 to November 2007, in ten large hospitals in Guangdong of China, were reviewed.

RESULTSAmong 110 patients with BDI, 58 cases (52.7%) were local patients, whereas 52 cases (47.3%) were transferred from outside hospitals. Reasons for BDI following LC were: (1) Lack of experience of the LC operator (48.2%); (2) LC performed during acute cholecystitis (20.0%); (3) The structure of Calot triangle was unclear (15.5%); (4) Variable anatomical position (11.8%); (5) Intra-operation bleeding (4.5%). The commonest sites of injury were the choledochus and common hepatic duct (76.4%). Following BDI, endoscopic stenting or operative repair was performed in 106 patients. The overall success rate was 95.3% (101/106), with a mortality rate was 0.9% (1/106). Cholangitis occurred in 3.8% (4/106) cases. Choledocho-enterostomy operation was performed in almost 60.0% (63/106) cases, and the success rate was 93.7% (59/63). Endoscopic stenting or operative repair was performed immediately following BDI in 23.6% (25/106) patients, the success rate was 100%; and within 30 days in 63.2% (67/106) patients. Eighty-eight out of 106 patients who underwent repair were successful following the first operative procedure.

CONCLUSIONSFactors such as an un-experienced operator and unclear anatomical position were causes of BDI following LC. Early operative repair should be regarded as the treatment of choice, in patients diagnosed with BDI. Early refer to an experienced hepatobiliary operator ensures a high success rate.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bile Ducts ; injuries ; surgery ; Cholecystectomy, Laparoscopic ; adverse effects ; Female ; Humans ; Iatrogenic Disease ; Intraoperative Complications ; diagnosis ; etiology ; surgery ; Male ; Middle Aged ; Retrospective Studies

INTRODUCTIONLaparoscopic cholecystectomy for acute cholecystitis is associated with higher rate of conversion to laparotomy. The value of several factors that might influence the rate of conversion is analysed.

MATERIALS AND METHODSIn a retrospective analysis of a prospective database, the medical records of patients who underwent laparoscopic cholecystectomy from May 1998 to June 2004 were reviewed. Patients who had acute cholecystitis and had undergone interval laparoscopic cholecystectomy were included in this study.

RESULTSOut of 1000 laparoscopic cholecystectomies, 201 were operated on for acute cholecystitis. One hundred and forty-five patients (72.3%) underwent successful laparoscopic cholecystectomy and 56 patients (27.7%) needed conversion to open cholecystectomy. Patient's age (P = 0.031), total white cell count (P = 0.014), total bilirubin (P = 0.002), alkaline phosphatase (P = 0.003) and presence of common bile duct stone (P = 0.001) were found to be independently associated with conversion.

CONCLUSIONLaparoscopic cholecystectomy can be performed safely for acute cholecystitis. Predictors of conversion will be helpful when planning the laparoscopic approach and for counselling patients preoperatively.

Adult ; Cholecystectomy, Laparoscopic ; adverse effects ; utilization ; Cholecystitis, Acute ; epidemiology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Retrospective Studies ; Risk Factors ; Singapore

OBJECTIVETo investigate the cause of hemorrhage from the gallbladder bed during laparoscopic cholecystectomy.

METHODSColor Doppler ultrasound was used to examine the cause of venous hemorrhage from the gallbladder bed during laparoscopic cholecystectomy in 1 patient postoperatively and to examine the anatomic relationship between the gallbladder bed and branches of the middle hepatic vein in 91 patients preoperatively.

RESULTSThere is a major branch of middle hepatic vein extended close to the gallbladder bed. The branch of the middle hepatic vein was completely adherent to the gallbladder bed in 14 of 91 patients (15.4%). The mean distance between the closest point of the middle hepatic vein and the gallbladder bed is 5.0 +/- 4.6 mm, the mean diameter of this point is 3.2 +/- 1.1 mm.

CONCLUSIONSPatients with large branches of the middle hepatic vein close to the gallbladder bed are at risk of hemorrhage during laparoscopic cholecystectomy and should be identified preoperatively with ultrasound.

Cholecystectomy, Laparoscopic ; adverse effects ; Female ; Hepatic Veins ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage ; etiology ; Risk Factors ; Ultrasonography, Doppler, Color