Combined Laparoscopic cholecystectomy and laparoscopic appendicectomy surgery together in same patient
Laparoscopic cholecystectomy has substituted not only open cholecystectomies as the preferred method of removing the gallbladder, but also inspired by the surgeon for the implementation of laparoscopic techniques to treat many other conditions. Laparoscope gives a superb view of the complete belly, opens up the possibility of combining two or more operations in a single operation.
The combination of procedures cause more surgery period, more anesthesia and the risk of increase bleeding. Minimal access surgery has the advantage of a shorter hospital stay, less postoperative pain and morbidity, early return to work and a better aesthetic result. Then evaluate the safety and effectiveness of a number of operations, combined with laparoscopic cholecystectomy.
Patients and methods
In a retrospective study from January 2005 to June 2014, analyzed data from 301 patients who underwent the procedures associated with laparoscopic cholecystectomy. Analyzed demographics, case notes, records, operational data and follow-up records of these patients.
The patients were all basic research for laparoscopic cholecystectomy including liver function tests and abdominal USG. Patients with suspected CBD stones are undertook Intraoperative cholangiogram and research CBD, if necessary. Patients with appendicitis or adhesions had no further study. Patients with gynecological diseases are also relevant, such as tests of serum CA125 of ovarian mass and the Papanicolaou check before the full hysterectomy. Patients undergoing surgery of the urinary and undergo TURP flowmetry and assessment of PSA. Patients undergoing surgery for obesity are pulmonary function tests and UGI endoscopy, lipid profile, thyroid function tests. Study on sleep is done in patients with sleep disorders or history of snoring.
The most common procedure is the Appendectomy was performed in these patients. Adhesiolysis was conducted in 25 cases. Hysterectomies are performed for abnormal uterine bleeding or more symptomatic fibroids. Adrenal form was Myelolipoma that adrenalectomy was performed.
The combination of different procedures with laparoscopic cholecystectomy
In all cases, cholecystectomy was performed for the first time, then a second procedure, except in the case of inguinal hernia repair. TEP is implemented in the first place. Any change in the placement of additional ports and connections are made to the accompanying diseases. In the process it takes to work in the lower abdominal have made additional ports. The 401 patients who had undergone a laparoscopic cholecystectomy in the same period were randomly selected and analyzed demographic characteristics of the patients, and monitoring and follow-up data files were compared.
No mortality in the series. The average operating time was 75 minutes. Postoperative pain was measured in accordance with claim injectable analgesics. Most patients request to be injected in 2 days. The average hospital stay was 3 days. Oral intake was started on average 18 hours later. The oral intake has resumed after exploring the CBD on the second POD. Oral fluid started the day in which patients undergoing hernia repair, appendicectomy, diagnostic laparoscopy, cystoscopy and TURP. Hysterectomy and adrenalectomy patients began oral intake on the first POD. After gastric procedures for obesity, water-soluble gastrograffin on the second day of the test is done to check the leakage and oral fluid began.
Average Operation Times
5 patients showed a hematoma at the site of the port, 3 patients developed fever after surgery, 6 patients had minor wound infections and 18 patients had urinary retention. Urinary retention was noted in patients who have undergone pubic processes. There were no cases of return in patients who undertook hernia repair. Bariatric patients had a satisfactory lose excessive weight and reported better quality of life. None of the patients requiring extended hospitalization.
Beyond two decades since the first laparoscopic cholecystectomy was performed by Muhe in 1985. Laparoscopy has come a long way since then, and today a number of procedures performed laparoscopically. Each procedure is performed laparoscopic postoperative pain reduced, early mobility and quick return to oral feeding, early departure and return to work faster. Advantages of a patient's exposure to one anesthesia, hospitalization once and the one sick leave. Combination of procedures proved equally safe and effective when it have to be done once. Warren et al in their study found that accidental appendectomy during cholecystectomy has resulted in an increased occurrence of wound infection compared with only cholecystectomy. Voitko and Lowry in his review of elective cholecystectomy and appendectomy during abdominal hysterectomies found no increased operating time, cold, or infectious complications. Our study did not show an increase in post-operative wound infections compared with patients of control. In fact, we have had cases of infection of the umbilical connector which is used in Appendix extraction. Cholecystectomy with CBD research becomes a process of choice for CBD stones in expert hands. Among gynecological surgery, patients who undertook oophorectomy patients, ovarian drilling and tubal ligation she had no additional morbidity compared with cholecystectomy only patients, or those who have had a hysterectomy had more post-operative pain. Many bariatric surgeons regularly perform cholecystectomy together with stomach surgery because of the high incidence and severity of postoperative biliary diseases. Cholecystectomy is not responsible morbidity of the procedure. The postoperative course of the patient followed the most morbid procedure. Despite the umbilical incision hernia caused some difficulties in positioning the port repair with mesh back and after surgery were without incident. We had no hernia recurrence during our follow-up (ranging from 3 months to 3 years). Wadhwa et al in the study had an average surgery of 62 minutes to laparoscopic cholecystectomy and ventral hernia repair. We request 70 minutes for the same. Time for laparoscopic cholecystectomy with hysterectomy is 80 minutes, and our duration is 100 minutes.
Postoperative oral fluid continues 3-4 hours after, a normal diet after the first POD. Oral fluid began 6 hours after surgery and normal supply in the first POD. The average length of hospitalization for endoscopic / laparoscopic procedures in the study was 2.9 days, while the average length of hospital stay in our study was 3.2 days. Our stay in the hospital is an average operating time and a half was slightly more than in his study, but his case combination was different from ours.
The most common procedure in their study is the laparoscopic cholecystectomy and ventral hernia repair, and our laparoscopic cholecystectomy in research CBD. Post-operative pain, return to oral and the average hospital stay was dependent on more morbid procedure. Wadhwa et al found that the recovery time in these patients was not different from those who have gone through single procedures. We found out no significant increase in the duration of hospitalization or post-operative complications in combined procedures. The combined actions follow the trend higher than the postoperative and post-operative pain. A comparative study of single and combined operations carried out in minimal access surgery.
In addition to the benefits of minimal access, the patient gets an additional benefit of a hospital stay and exposure to anesthesia once. Therefore, it is more convenient for the patient and cost-effective. In fact, the procedures associated with laparoscopic cholecystectomy 'kills two diseases with a scope’.
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