Abstract | BACKGROUND: Laparoscopic ultrasound (LUS) is a method of intraoperative bile duct imaging that can be used prior to any potentially hazardous dissection. The purpose of this study was to determine whether LUS could permit safe laparoscopic completion of difficult cholecystectomy (LC) cases and to assess whether its use had any impact on clinical outcome. METHODS: We identified prospectively 44 patients with severe cholecystitis in whom LUS was considered critical for intraoperative identification of the bile ducts. LC patients were compared, on an intention to treat basis, with 41 contemporaneous patients with severe cholecystitis who had planned open cholecystectomy (OC). RESULTS: LUS identified the extrahepatic bile ducts in all cases. Of the cases, 40 (91%) were completed laparoscopically. OC patients had a higher rate of acute cholecystitis and preoperative percutaneous cholecystostomy tubes and a higher mean ASA classification. Intraoperatively, LC patients had significantly less estimated blood loss and fewer drains were placed. Postoperatively, LC patients had significantly fewer total complications, Clavien-Dindo grade 3 complications, biliary complications, biliary reinterventions, intra-abdominal abscesses, and bleeding complications. LC patients had significantly fewer ICU admissions and shorter LOS. CONCLUSION:
|
Authors | Elizabeth C Gwinn, Shaun Daly, Daniel J Deziel |
Journal | Surgery
(Surgery)
Vol. 154
Issue 4
Pg. 909-15; discussion 915-7
(Oct 2013)
ISSN: 1532-7361 [Electronic] United States |
PMID | 24074430
(Publication Type: Journal Article)
|
Copyright | Copyright © 2013 Mosby, Inc. All rights reserved. |
Topics |
- Adult
- Aged
- Aged, 80 and over
- Bile Ducts
(diagnostic imaging)
- Cholecystectomy, Laparoscopic
(adverse effects, methods)
- Cholecystitis
(surgery)
- Female
- Humans
- Length of Stay
- Male
- Middle Aged
- Prospective Studies
- Ultrasonography
|