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ABSTRACT: The introduction of laparoscopic cholecystectomy (LC) changed the treatment strategies for patients undergoing biliary surgery. There is a lack of data about acute postoperative pancreatitis (APP) as a complication of LC.
To determine the incidence, morbidity, and mortality of APP after LC and to analyze the possible intraoperative and pathogenic factors associated with APP.
A prospective cohort study of 10174 patients who underwent LC. The data for 32 patients with APP after the completion of LC and 8 patients with APP after an attempted LC that was converted to an open cholecystectomy were analyzed.
A multi-institutional study of the Swiss Association of Laparoscopic and Thoracoscopic Surgery. Eighty-one surgical services or surgeons in private practice participated.
The incidence of APP after a completed LC was 0.34%. In comparison, the incidence of APP after conversion to an open procedure (0.96%) was significantly (P = .02) increased. A biliary origin of APP could be established in 4 (12.5%) of the 32 patients. No evidence for a causative role of intraoperative cholangiography or trauma to the pancreas was found. Factors shown to be associated with APP were the surgeon's experience level and a high morbidity of 31.3%. The mortality was 3%.
The incidence of APP after LC is low; the risk increases after conversion to an open procedure. In the rare event of an APP after LC, a biliary cause should be suspected. The mortality of patients with APP did decrease substantially compared with those undergoing open biliary surgery.
Archives of Surgery 10/1997; 132(9):1026-30; discussion 1031. · 4.24 Impact Factor
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ABSTRACT: Infarctions of the greater omentum and of the epiploic appendages are rare etiologies of acute abdominal pain. The aims of the study were to determine the incidence of abdominal fat tissue necroses and to discuss the clinical features and the role of laparoscopy in the treatment of these conditions.
A retrospective study in 563 consecutive patients with acute abdominal pain was performed. In all patients diagnostic laparoscopy was indicated.
The incidence of abdominal fat tissue necroses in 563 patients with acute abdominal pain was 1.1%. Six patients had either infarctions of the omentum or of the epiploic appendages. Pain was the predominant clinical symptom and the preoperative diagnosis depended upon the location of the omental or epiploic necroses. Diagnosis and treatment were performed laparoscopically without morbidity.
The incidence of abdominal fat tissue necroses in our patients was increased compared to the prelaparoscopic period. Omental and epiploic necroses are significant in the differential diagnosis of appendicitis, acute cholecystitis, and diverticulitis.
Surgical Endoscopy 08/1997; 11(7):737-40. · 4.01 Impact Factor
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ABSTRACT: Background: Infarctions of the greater omentum and of the epiploic appendages are rare etiologies of acute abdominal pain. The aims of
the study were to determine the incidence of abdominal fat tissue necroses and to discuss the clinical features and the role
of laparoscopy in the treatment of these conditions.
Methods: A retrospective study in 563 consecutive patients with acute abdominal pain was performed. In all patients diagnostic laparoscopy
was indicated.
Results: The incidence of abdominal fat tissue necroses in 563 patients with acute abdominal pain was 1.1%. Six patients had either
infarctions of the omentum or of the epiploic appendages. Pain was the predominant clinical symptom and the preoperative diagnosis
depended upon the location of the omental or epiploic necroses. Diagnosis and treatment were performed laparoscopically without
morbidity.
Conclusion: The incidence of abdominal fat tissue necroses in our patients was increased compared to the prelaparoscopic period. Omental
and epiploic necroses are significant in the differential diagnosis of appendicitis, acute cholecystitis, and diverticulitis.
Surgical Endoscopy 01/1997; 11(7):737-740. · 4.01 Impact Factor
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ABSTRACT: The value of laparoscopic appendectomy remains controversial. Therefore, we investigated the accuracy of diagnostic laparoscopy in detecting acute appendicitis and tested the applicability and safety of stapling appendectomy as a routine procedure.
Data from 267 consecutive patients with suspicion of acute appendicitis were recorded prospectively.
Histopathological examination revealed nonperforated and perforated appendicitis in 63.3% and 13.1%, respectively, and no inflammation in 10.8%. Other pathological findings were observed in 12.7%. Diagnostic laparoscopy detected appendicitis with a sensitivity and specificity of 95.6% and 96.6%, respectively; the positive and negative predictive value were 99.5% and 74.3%, respectively. Morbidity was 10.2% in total and 40% for perforated appendicitis. Planned laparoscopic reexploration reduced morbidity by 23.4% in patients with perforated appendicitis and substantial peritonitis. Mortality was 0.4%.
Laparoscopy improves diagnostic accuracy for acute appendicitis and laparoscopic stapling appendectomy is a safe and efficient procedure for all forms of appendicitis.
Surgical Endoscopy 10/1996; 10(9):895-9. · 4.01 Impact Factor
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ABSTRACT: Background: The value of laparoscopic appendectomy remains controversial. Therefore, we investigated the accuracy of diagnostic laparoscopy in detecting acute appendicitis and tested the applicability and safety of stapling appendectomy as a routine procedure.
Methods: Data from 267 consecutive patients with suspicion of acute appendicitis were recorded prospectively.
Results: Histopathological examination revealed nonperforated and perforated appendicitis in 63.3% and 13.1%, respectively, and no inflammation in 10.8%. Other pathological findings were observed in 12.7%. Diagnostic laparoscopy detected appendicitis with a sensitivity and specificity of 95.6% and 96.6%, respectively; the positive and negative predictive value were 99.5% and 74.3%, respectively. Morbidity was 10.2% in total and 40% for perforated appendicitis. Planned laparoscopic reexploration reduced morbidity by 23.4% in patients with perforated appendicitis and substantial peritonitis. Mortality was 0.4%.
Conclusions: Laparoscopy improves diagnostic accuracy for acute appendicitis and laparoscopic stapling appendectomy is a safe and efficient procedure for all forms of appendicitis.
Surgical Endoscopy 08/1996; 10(9):895-899. · 4.01 Impact Factor
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ABSTRACT: Primary neuroendocrine tumors of the cystic duct are extremely rare. Only 4 cases have been described to date. We report 2 patients in whom a primary neuroendocrine tumor of the cystic duct was incidentally detected during histological examination following cholecystectomy. With regard to the primary neuroendocrine tumor both patients were asymptomatic at the time of diagnosis. However, histologic examination did not confirm that the neuroendocrine tumors had been completely removed. Both patients underwent a second procedure. They are well after 47 and 49 months, respectively.
Digestion 60(5):493-6. · 2.05 Impact Factor
