2007, Number 2
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Cir Gen 2007; 29 (2)
Laparoscopic cholecystectomy at a public hospital
González RV, López LJ, Higuera HFR, López LA, Rico HMA, Rodríguez MJ
Language: Spanish
References: 20
Page: 131-135
PDF size: 79.88 Kb.
ABSTRACT
Objective: To present the experience attained at the General Hospital of Mexico regarding the learning curve for laparoscopic cholecystectomy.
Setting: Third level health care center.
Design: Retrospective, transversal, comparative study.
Statistical analysis: Percentages as summary measure for qualitative variables and chi square test.
Material and methods: We reviewed the clinical records of patients subjected to laparoscopic cholecystectomy in two periods of seven years each. Analyzed variables were: age, gender, use of the procedure, conversion frequency, complications, and surgical time.
Results: From a total of 14,950 cholecystectomies, 5,011 were laparoscopically approached at a 1:1.9 relation; predominating women over men at a 4.3:1 relation, average age was of 68 years. The frequency in the use of the procedure increased between the two analyzed periods from 34 to 42% (p ‹ 0.001). Conversion decreased from 4.4% to 2.6% (p ‹ 0.001). Seven cases of injury to the extra-hepatic biliary tract were recorded in the first period and four in the second (p › 0.05), with a total frequency of 0.20%. Surgical time decreased in average from 4 hours to 35 minutes.
Conclusions: 1. The conversion percentage and surgical time tends to decrease with time. 2. Causes for conversion are similar to those reported worldwide. 3. Frequency of biliary tract injury lies within internationally reported ranges.
REFERENCES
González RV, Marenco CCA, Chávez GA, González DS, Montalvo JE. Colecistectomía laparoscópica: resultados de la experiencia del Hospital General de México a nueve años de implementada. Rev Mex Cir Endoscop 2002; 3(2): 71-73.
Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg 2001; 234: 549-59.
Yusoff IF, Barkun JS, Barkun AN. Diagnosis and management of cholecystitis and cholangitis. Gastroenterol Clin North 2003; 32: 1145-1168.
Bellows C, Berger DH, Grass RA. Management of gallstones. Am Fam Physician 2005; 72: 637-42.
Sylla P, Kirman I, Whelan RL. Immunological advantages of advanced laparoscopy. Surg Clin Nort Am 2005; 85: 1-18.
Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology 2006; 104: 835-46.
Jainero JMJ, Prado OE, Vicent GT, de la Rosa PR, Lozano EA. Colecistectomía laparoscópica ambulatoria. Una buena alternativa. Cir Gen 2004; 26: 306-310.
Richardson WS, Fuhrman GS, Burch E, Bolton JS, Bowen JC. Outpatient laparoscopic cholecystectomy. Outcomes of 847 planned procedures. Surg Endosc 2001; 15: 193-5.
Giurgiu DI, Roslyn JJ. Treatment of gallstones in the 1990s. Prim Care 1996; 23: 497-513.
Shea JA, Berlin JA, Backwich DR, Staroscik RN, Malet PF, McGukin M, et al. Indications for and outcomes of cholecystectomy: a comparison of the pre and postlaparoscopic eras. Ann Surg 1998; 227: 343-350.
Francoeur JR, Wiseman K, Buczkowski AK, Chung SW, Scudamore CH. Surgeons’ anonymous response after bile duct injury during cholecystectomy. Am J Surg 2003; 185: 468-475.
Beckingham IJ, Krige JE. ABC of diseases of liver, pancreas, and biliary system: Liver and pancreatic trauma. BMJ 2001; 322: 783-5.
Stepp K, Falcone T. Laparoscopy in the second trimester of pregnancy. Obstet Gynecol Clin North Am 2004; 31: 485-496.
Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Stroscick RN. Mortality and complications associated with laparoscopic cholecistectomy. A meta-analysis. Ann Surg 1996; 224: 609-20.
Liu CL, Fan ST, Lai EC, Lo CM, Chu KM. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg 1996; 131: 98-101.
Zisman A, Gold-Deutch R, Zisman E, Negri M, Halpern Z, Lin G, et al. Is male gender a risk factor for conversion of laparoscopic into open cholecystectomy? Surg Endosc 1996; 10: 892-4.
Johanning JM, Gruenberg JC. “AEIOU: the ABCs” of conversion from laparoscopic to open cholecystectomy. JSLS 1997; 1: 181-3.
Gadacz TR. Update on laparoscopic cholecystectomy, including a clinical pathway. Sur Clin North Am 2000; 80: 1127-49.
Buschemeyer WC, Cunningham DK, Edwards MJ. Surgical training and implementation of emerging surgical technologies. Am J Surg 2005; 190: 166-172.
Strasberg SM. Biliary Injury in laparoscopic surgery: part 2. Changing the Culture of Cholecystectomy. J Am Coll Surg 2005; 201: 604-611.
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