Objective To explore the diameter change of the extrahepatic bile duct before and after laparoscopic cholecystectomy (LC). Methods From Jan. 2006 to Dec. 2007， 113 patients including chronic gallstone cholecystitis （n=55）, inactive cholecystolithiasis （n=46） and gallbladder polyps （n=12） were collected and treated by LC. The diameters of their extrahepatic bile ducts were measured by B ultrasonography before operation， 3 months and 6 months after operation. These data were collected and analyzed retrospectively. Results The diameters of the extrahepatic bile ducts of all patients before LC， 3 months and 6 months after LC were (5±2) mm, (8±2) mm and (6±2) mm respectively. And in chronic gallstone cholecystitis patients they were (5±2) mm, (9±2) mm and (6±2) mm respectively， in inactive gallstone cholelithiasis patients they were (5±2) mm, (8±2) mm and (6±2) mm respectively， and in gallbladder polyps ones they were (5±2) mm, (7±2) mm and (5±2) mm respectively. Conclusion The change of the extrahepatic bile duct diameter after LC is a dynamic process. It is enlarged on the third month after operation than before operation. In the sixth month after operation marked retraction occurs, and compared with before operation, it shows no obvious statistic significance.
Objective To explore the operative managements of ectopic gallbladder during laparoscopic cholecystectomy (LC).Methods Twenty one cases of ectopic gallbladder undergone LC in this hospital were analyzed regarding the perioperative management, principle, and technique of operation.Results There were 2 cases of situs transversus, 1 case with gallbladder under right posterior lobe of liver, 2 under left lateral lobe of liver and 16 in the liver. All 21 cases of ectopic gallbladder had undergone LC successfully, and no complications were found during and after operation. Conclusion Anatomic ectopia of gallbladder tosses a challenging problem to laparoscopic surgeon. It is safe for surgeons to recognise actual anatomical anomaly and to manage them appropriately.
ObjectiveTo evaluate the value of incision closure device in laparoscopic cholecystolithotomy.
MethodsThe clinical data of 130 patients underwent laparoscopic cholecystectomy from Oct. 2014 to Feb. 2015 were retrospectively analyzed. According to the methods of gallbladder suture, 130 cases were divided into two groups, 72 cases underwent traditional manual suture (MS group), and 58 cases underwent incision closure device (ICD group). The operative time, postoperative gastrointestinal function recovery time, bleeding volume, postoperative hospitalization time, hospitalization expenses, complications, and postoperative 6-12 months follow-up of patients in 2 groups were observed.Results One hundred and thirty cases were performed laparoscopic cholecystolithotomy successfully. The operative time and postoperative gastrointestinal function recovery time of ICD group were significantly shorter than those of MS group, the difference was statistically significant (P < 0.05). The hospitalization expenses of the patients in ICD group were significantly higher than those in the MD group (P < 0.05). There were no significant difference between the two groups in the bleeding volume and postoperative hospital stay (P > 0.05). The patients were followed up for 6-12 months, with an average of 8 months, and no complications occurred and stone recurrence.
ConclusionIncision closure device can shorten the time of laparoscopic cholecystolithotomy and postoperative recovery of gastrointestinal function, but the cost is higher. Next development, still need decrease the expend and strengthen clinical promotion.
Objective To evaluate the value of the application of laparoscopic hepatectomy in hepatolithiasis. Methods The clinical data of 35 patients with hepatolithiasis performed with laparoscopic hepatectomy were analyed retrospectively. Operations included laparoscopic left lateral sectionectomy， left hemihepatectomy， cholecystectomy， choledocholithotomy， choledochoscopy， and T-tube drainage. Results All operations of 35 patients were performed complete laparoscopically. The mean operative time was 205 minutes （150-370minutes）. The mean blood loss was 330mL（50-1 000mL）. Patients felt less pain without administration of painkillers after operation. Ambulation resumed on thefirst day and liquid diet resumed on the second day after operation. The average hospital stay was 12.7 days （4-15d）. There was no death. The excellent and good rate of operation was 71.4% and 25.7%， respectively. Conclusion Laparoscopic hepatetomy is an effect and minimally invasive alternative method for hepatolithiasis in slective patients.
The aim of this study was to evaluate ultrasonic findings as predictor of potential operative difficulties and complications during laparoscopic cholecystectomy (LC). From Auguest 1995 to December 1996 a total of 328 patients with symptomatic cholelithiasis (92 males, 236 females, mean age 45±17 years) were examined by ultrasonography (US) 1 to 3 days before LC. The US examination assessed six paramenters: (GB) volume of gallbladder thichness of GB wal position of neck of GB, stone mobility, maximal size of stone, and GB adhesions. On the basis of these US findings, a predictive judgment of technical difficulties was expressed as easy, difficult, and very difficult. Two hundred and twenty five patients presented with uncomplicated symptomatic cholelithiasis, and 103 had acute cholecystitis. The operation was predicted to be easy in 38% of cases, difficult in 48% and very difficult in 14% with a good correlation with the surgeon’s intraoperative judgment (Ｐ＜0.01). A significant association was found between stone mobility (Ｐ＜0.01), presence of adhesions (Ｐ＜0.01) and the difficulty of the procedure. Our results suggest that preoperative US is a useful screening test for patients undergoing LC, and it can help predict technical difficulties during LC.
Objective To review the complex situation，surgical experience，and surgical technique of laparoscopic cholecystectomy （LC）．Methods The clinical data of 86 patients who underwent LC in our hospital and the consulting hospitals from February 2005 to April 2011 were retrospectively analyzed．According to the complicated conditions，the different surgical techniques were applied during LC such as lamellar dissection，aspirater stripping method，laparoscopic suture，and intraoperative cholangiography．Results The operation time was （68±23）min （25－210 min），blood loss was （55±13）ml （15－200 ml）．LC was successfully performed in 84 of 86 cases．Only two patients received transferring laparotomy because of scar tissue in Calot triangle that was hard to dissect．No severe complications occurred，such as biliary leakage，bleeding after operation，stricture of bile duct，retained calculus，and so on．All the patients were cured before discharge．Conclusion Lamellar dissection，aspirater stripping method，and laparoscopic suture combined with the view of laparotomy can be used to deal with complicated LC successfully．
Objective To discuss the safety，feasibility，and advantages of two-port laparoscopic cholecystectomy （LC）．Methods The clinical data of 114 patients underwent LC from June 2008 to October 2010 were retrospectively analyzed，of which 46 underwent two-port LC （two-port LC group，n=46） and 68 underwent three-port LC （three-port LC group，n=68）. The operation time，intraoperative blood loss，postoperative feeding time，postoperative pain，postoperative hospital stay，and hospitalization expenses were compared between two groups. Results All the operations were successful，no postoperative complications occurred in both groups．The operation time in the two-port LC group was longer than that in the three-port LC group （P＜0.05）. The intraoperative blood loss，postoperative feeding time，postoperative pain，and postoperative hospital stay had no significant differences in two groups （P＞0.05）. The hospitalization expenses in the two-port group was less than that in the three-port group（P＜0.05）. Conclusions Two-port LC is a safe and feasible operation in the simple gallstone patients. It is cautious in those patients with acute cholecystitis because of the restricted vision and operation．
ObjectiveTo compare the efficacy between laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in treatment of carcinoma of head of pancreas.
MethodsClinical data of 60 patients with locally advanced carcinoma of head of pancreas who underwent pancreaticoduodenectomy in our hospital from October 2004 to October 2009 were collected, of which 26 patients were in LPD group and 34 patients were in OPD group.
ResultsOperative time and hospitalization expense of patients in LPD group were both longer or more than those of OPD group (P<0.05), but blood loss, time of starting activity, time of aeration, time of pulling out the drainage tube, time of pulling out the stomach tube, time of absolute resting on bed, and hospitalization time in LPD group were all shorter or lower than those of OPD group (P<0.05). There were 25 patients suffered with postoperative complications, including 10 patients in LPD group and 15 patients in OPD group, and there was no significant difference between the 2 groups in total incidence of postoperative complication (P>0.05). But in the specific postoperative complication, the incidences of pancreatic fistula and biliary fistula of LPD group were higher than those of OPD group (P<0.05), but incidences of incision infection, pulmonary infection, and systemic infection were all lower than those of OPD group (P<0.05). All patients were followed up for 1-60 months with the median time of 21.5 months. During the follow-up period, in LPD group, 24 patients suffered with recurrence, 20 patients suffered with tumor metastasis, and 24 patients died; in LPD group, 31 patients suffered with recurrence, 25 patients suffered with tumor metastasis, and 31 patients died. There were no significant difference between the 2 groups in the recurrence rate, metastasis rate, mortality, and survival situation (P>0.05).
ConclusionsFor carcinoma of head of pancreas, postoperative recovery and infection complications of LPD are significantly superior than those of OPD. But compared with the OPD, it has no obvious advantage in reducing the pancreatic fistula, biliary fistula, delayed gastric emptying, and other complications, and it also has no obvious advantage in improving the long-term survival situation too.
ObjectiveTo systematically review the efficacy and safety of laparoscopic pyeloplasty (LP) versus open pyeloplasty (OP) for patients with ureterpelvic junction obstruction (UPJO).
MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 11, 2015), Sciverse, VIP, WanFang Data and CNKI from inception to Dec., 2015, to collect randomized controlled trials (RCTs) and non-randomized clinical controlled trials (CCTs) about LP versus OP for UPJO patients. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.
ResultsA total of 38 studies including 8 RCTs and 30 CCTs were included. The results of meta-analysis based on RCTs showed that, there were no significant differences in successful operation rate (OR=0.50, 95%CI 0.20 to 1.24, P=0.13) and the incidence of postoperative complications (OR=1.19, 95%CI 0.61 to 2.31, P=0.62) between the OP group and the LP group; The operation time of the OP group was shorter than that of the LP group (MD=62.07, 95%CI 3.94 to 120.19, P=0.04), but this difference was not found in subgroup analysis of retroperitoneal approach (MD=49.99, 95%CI -23.69 to 123.67, P=0.18); The hospital stay of the LP group was shorter than that of the OP group (MD=-3.96, 95%CI -4.92 to -2.99, P<0.0001). The results of meta-analysis based on CCTs showed that, there was no significant difference in successful operation rate between two groups (OR=1.34, 95%CI 0.84 to 2.16, P=0.22), and similar results were found in subgroup analysis of transperitoneal or retroperitoneal approaches; The incidence of postoperative complications of the LP group was shorter than that of the OP group (OR=0.51, 95%CI 0.37 to 0.69, P<0.0001); The hospital stay of the LP group was shorter than that of the OP group (MD=-3.87, 95%CI -4.90 to -2.83, P<0.00001) and similar result was found in subgroup analysis of transperitoneal approach (MD=-4.08, 95%CI -5.21 to -2.95, P<0.0001); There was no significant difference between two groups in operation time (MD=24.15, 95%CI -7.56 to 55.87, P=0.14).
ConclusionCurrent evidence shows that, the successful operation rate between LP and OP operations is similar, but the LP operation has less incidence of postoperative complication and shorter hospital stay. Due to limited quality of the included studies, the above conclusion needs more high quality studies to verify.
Day surgery has been developed in China for over 30 years. However, the admission decisions for day surgery patients are still mainly based on expert experience, brainstorming, and institutional recommendation, and lack scientific admission criteria and universality. West China Hospital of Sichuan University has implemented methods such as semi-supervised learning based on heterogeneous data, to construct a more objective and accurate patient admission model based on large amounts of diagnosis and treatment data. This initiative aims to assist the country and hospital in reducing medical costs and alleviating the acute problem of the current contradiction between supply and demand of medical resources. It also seeks to optimize the utilization and allocation of bed resources, reduce the cost of patient management, enhance the theoretical research on patient admission methods in day surgery in China, and provide reference and inspiration for other hospitals in the day surgery industry in China.
