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.
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 preliminarily explore application and effectiveness of stimulation learning based on a live demonstration system in hepatobiliary surgical training, using laparoscopic cholecystectomy (LC) as an example. MethodsFrom March 2023 to February 2024, 60 surgical residents undergoing a 4-month standardized residency training at the Liver Transplant Center of West China Hospital, Sichuan University, were randomly assigned into an observation group (n=30) and a control group (n=30) using a random number table. The observation group received stimulation learning based on the live demonstration system, while the control group received traditional teaching methods. At the end of the training, both groups underwent an operative assessment on LC and completed a resident satisfaction questionnaire. Operative assessment used critical view of safety (CVS) scoring to evaluate surgical safety. Resident satisfaction was assessed using a self-designed questionnaire covering five domains: stimulating the learning atmosphere, increasing learning engagement, improving surgical proficiency, enhancing the understanding of surgical complications, and recognition of the teaching model. The final results were categorized as positive or negative evaluations. ResultsThe observation group had significantly higher CVS score than the control group (4.2±1.3 vs. 2.8±1.7, t=3.57, P=0.001). All 60 questionnaires were collected, and the observation group reported significantly higher positive evaluations in improving surgical proficiency, enhancing the understanding of surgical complications, and recognition of the teaching model compared to the control group (P<0.05). There were no statistically significant differences between the two groups regarding positive evaluations for stimulating the learning atmosphere and increasing learning engagement (P>0.05). ConclusionThe results of this study suggest that the stimulation learning model based on a live demonstration system demonstrates good effectiveness in hepatobiliary surgical training and can improve the quality of surgical teaching during standardized residency training for surgical residents.
Objective To comment the diagnosis and treatment the bile leakage from the injuried abnormal minute biliary in our laparosicopic cholecystectomy (LC) practice. Methods Fourteen cases of minute biliary duct injury in 2 050 cases of LC were studied retrospectively. Among them, 6 cases had been found the points of leakage during operation, and the points were treated by titanium nips. In 4 cases even though the bile leakage could be seen, but the points of leakage could not found, and were treated by drainage. Four cases with peritonitis, 1 needed to be explored, and treated with suture ligature, 1 was explored by laparoscopy again, another two cases were treated with multiple hole catheters to drainage of the abdominal cavities through stab wounds. Results All 14 cases recovered. Conclusion Small bile leakage in LC is almost inevitable. It is the best that the bile leakage can be discovered during operation and to be treated. If it is discovered after operation, an open or laparoscopic exploratory laparotomy and adequate drainage would be needed. In the case of small amount of leakage, catheter drainage through stab wound is feasible.
Objective To summarize the treatment experience for concomitant diseases of other abdominal organs in laparoscopic cholecystectomy （LC）. Methods The clinical data of 176 patients with LC and concomitant diseases of other abdominal organs were analyzed retrospectively， including preoperatively diagnosed cases （such as 53 with liver cyst， 15 with choledocholithiasis， 7 with chronic appendicitis， 5 with inguinal hernia， 4 with renal cyst， and 6 with ovarian cyst） and intraoperatively diagnosed cases （such as 72 with abdominal cavity adhesion， 4 with internal fistula between gallbladder and digestive tract， 3 with Mirizzi syndrome， and 7 with unsuspected gallbladder carcinoma）. Results All the operation were successfully completed in 176 patients without severe complications， including 53 cases treated with LC plus fenestration of hepatic cyst， 15 with choledocholithotomy， 7 with appendectomy， 5 with tension free hernia repair， 4 with renal cyst fenestration， 6 with oophorocystectomy， 72 with adhesiolysis， 3 with fistula resection plus intestine neoplasty， 2 with intraoperative cholangiography plus choledocholithotomy， 5 with LC plus gallbladder bed complete burning， and 4 cases treated with conversion to open surgery （1 with intestinal fistula repair， 1 with choledocholithotomy， and 2 with radical resection for gallbladder carcinoma）. Conclusions It is safe and effective to treat gallbladder diseases complicated with other concomitant diseases simultaneously with laparoscopic operation， if the principles of surgical operation are followed and the indications and applicable conditions are strictly followed. And conversion to open surgery is necessary.
ObjectiveTo investigate the application and effect of doctor-nurse collaboration model for patients undergoing day surgery of laparoscopic cholecystectomy. MethodsFrom April 2010 to October 2013, we established the day-case laparoscopic cholecystectomy rapid rehabilitation team by day-surgery ward nurses, anesthesiologists, and surgeons. Collaboration was practiced through preoperative health education for the 1 902 patients, perioperative nursing cooperation, postoperative early activity and feeding of the patients, and follow-up. ResultsAfter the operation, there were 8 cases of incision bleeding, 1 case of bile leakage, 8 cases of shoulder and back pain, and 12 cases of nausea and vomiting. All the patients' postoperitive complications were controlled after treatment. ConclusionThe doctor-nurse collaboration model can significantly ensure the medical quality and safety of day surgery and improve the patients' medical experience. All the Patients, hospital and society will benefit from the model.
Objective To explore whether bundled care for anesthesia management can reduce the risk of postoperative nausea and vomiting (PONV). Methods The data of laparoscopic cholecystectomy patients admitted to the Day Surgery Center of West China Hospital, Sichuan University between July and November 2021 were retrospectively collected. Patients were divided into a bundled care group and a control group based on whether anesthesia management was implemented according to the bundled care. The demographic characteristics, intraoperative anesthesia management methods, postoperative conditions, and incidence of PONV between the two groups of patients were analyzed and compared. Results A total of 314 patients were included. Among them, there were 124 cases in the bundled care group and 190 cases in the control group; PONV occurred in 52 cases, the incidence of PONV was 16.6% (52/314). Except for surgical time and postoperative incision infiltration (P>0.05), there were statistically significant differences in age, gender, body mass index, anesthesia time, airway establishment, and postoperative analgesic use between the two groups of patients (P<0.05). There was no statistically significant difference in the occurrence of PONV between the bundled care group and the control group (17 vs. 35 cases; χ2=1.205, P>0.05). The results of logistic regression analysis showed that PONV was correlated with gender [odds ratio=0.107, 95% confidence interval (0.030, 0.375), P<0.001], and using bundled care [odds ratio=0.388, 95% confidence interval (0.169, 0.894), P=0.026]. Conclusions Women are at high risk of PONV among patients undergoing day laparoscopic cholecystectomy. The risk of PONV is lower when using bundled care.
ObjectiveTo compare the effect of laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of cholecystolithiasis combined with choledocholithiasis in elderly patients and non-elderly patients. MethodsThe clinical data of 185 cases of cholecystolithiasis combined with choledocholithiasis who treated in our hospital from September 2010 to November 2015 were analyzed retrospectively. Then the 185 cases of holecystolithiasis combined with choledocholithiasis were divided into elderly patients group (n=74) and the non-elderly patients group (n=111). The operative time, intraoperative blood loss, postoperative exhaust time, postoperative activity time, abdominal drainage time, postoperative hospital stay, total hospital stay, hospitalization cost, incidence of complications, unplanned analgesia, stone-free rate, rate of conversion to laparotomy, recurrence of stone, and mortality were compared between the two groups. Results① Intraoperative and postoperative indexes. No significant difference was noted in operative time and intraoperative blood loss (P > 0.050), but the postoperative exhaust time, postoperative activity time, abdominal drainage time, postoperative hospital stay, total hospital stay, hospitalization cost, and ratio of indwelling T tube of elderly patients group were all higher or longer than corresponding index of non-elderly patients group (P < 0.050). ② Postoperative complications and unplanned analgesia. There was no striking discrepancy in incidence of complications (including biliary leakage, peritonitis, haemorrhage, vomit, ectoralgia, and fever), and Clavien-Dindo grade (P > 0.050), except unplanned analgesia (P=0.007), the rate of unplanned analgesia in elderly patients group was higher than that of non-elderly patients group. ③Surgical effect. There was no significant difference in the stone-free rate, rate of conversion to laparotomy, and rate of recurrence of stone between the 2 groups (P > 0.050). ConclusionLC+LCBDE is also safe and effective in treatment of cholecystolithiasis combined with choledocholithiasis in elderly patients, it's worthy to be expanded and be used broadly.
ObjectiveTo investigate the feasibility, safety, cost, and patient satisfaction of ambulatory laparo-scopic cholecystectomy(ALC). MethodsThe clinical data of patients who divided into ALC group(678 cases) and in-patient laparoscopic cholecystectomy(IPLC) group(1 534 cases) in our hospital from April 2011 to December 2012 were retrospectively analyzed. The operative time, conversion rate, complication rate, hospitalization time, cost of hospi-talization, rehospitalization rate, and patient satisfaction were analyzed and evaluated. ResultsThere were no significant differences of the operative time, postoperative complication rate, and rehospitalization rate between the 2 groups(P > 0.05). The conversion rate(0.44%), and hospitalization time[(1.2±0.5)d] of the ALC group were significantly lower or shorter than those of IPLC group[3.19%, (4.8±1.3) d], P < 0.05. The direct, indirect health care costs, and the total costs of the ALC group were (6 555.6±738.7), (230.0±48.0), and (8 856.0±636.0) yuan, respec-tively; and lower than those of the IPLC group[(7 863.71, 014.6), (973.0±136.5), and(8 856.0±636.0)yuan], P < 0.05. ConclusionALC is safe and feasible, and could shorten the hospitalization time, lower the medical cost, speed up the bed turnover, and increase the efficiency in the use of health resource.
ObjectiveTo explore the optimal surgical timing of sequential laparoscopic cholecystectomy (LC) following percutaneous cholecystostomy (PC) in the patients with acute cholecystitis, so as to provide a clinical reference. MethodsThe patients who underwent PC and then sequential LC in the Fifth Affiliated Hospital of Xinjiang Medical University from March 2021 to July 2023 were selected based on the inclusion and exclusion criteria, who were categorized into 3 groups: the short interval group (3–4 weeks), the intermediate interval group (5–8 weeks), and the long interval group (>8 weeks) based on the time interval between the PC and LC. The gallbladder wall thickness before LC, operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs were compared among the 3 groups. ResultsA total of 99 patients were enrolled, including 25 in the short interval group, 41 in the intermediate interval group, and 33 in the long interval group. The data of patients among the 3 groups including demographic characteristics, blood routine, C-reactive protein, interleukin-6, fibrinogen, international standardized ratio, liver function indicators, and comorbidities had no statistical differences (P>0.05). The gallbladder wall thickness before LC and the operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs during and after LC had statistical differences among the 3 groups (P<0.05). These indicators of the intermediate interval group were better than those of the other two groups by the multiple comparisons (P<0.05), but which had no statistical differences except total hospitalization costs (P=0.019) between the short interval group and the long interval group (P>0.05). ConclusionAccording to the results of this study, the optimal surgical timing of sequential LC following PC is 5–8 weeks, however, which needs to be further validated by large sample size and multicenter data.