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Abdominal wall lift for people undergoing gallbladder removal by a key‐hole operation

Key‐hole removal of the gallbladder (laparoscopic cholecystectomy) is currently the preferred treatment for people with symptoms related to gallstones in the gallbladder. This is generally performed by distending the tummy (abdomen) using carbon dioxide gas (pneumoperitoneum) so that there is adequate space for instruments and to visualise the structures within the abdomen. This enables the surgeons to identify and divide the appropriate structures. However, distending the abdominal wall can result in various physiological changes that affect the functioning of the heart or lungs. These changes are more pronounced at higher pressures of the gas used to distend the abdomen. They are generally tolerated well in people with a low risk of anaesthetic problems. However, those with pre‐existing illnesses may not tolerate this distension of the abdomen well. So, an alternate method of enabling the surgeons to visualise the structures in the abdomen and to use instruments by lifting up the abdominal wall using special devices (abdominal wall lift) has been suggested for people undergoing laparoscopic cholecystectomy. We reviewed all the relevant information from randomised trials (a type of study which provides the best information on whether one treatment is better than the other, if conducted properly) in the literature to find out if abdominal wall lift is better than distending the abdomen using carbon dioxide gas. We adopted methods to identify all the possible studies and used methods that decrease the errors in data collection.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Need for further randomised clinical trials to assess the role of cholecystectomy in patients with suspected gallbladder dyskinesia

Gallbladder dyskinesia is a motility disorder of the gallbladder (the gallbladder does not contract properly). The disorder is associated with intermittent right upper abdominal pain typically lasting for at least half an hour. The optimal treatment for patients with suspected biliary dyskinesia is controversial. This review evaluates the two alternatives for the diagnosed patient group, that is, cholecystectomy (removal of the gallbladder) versus no intervention. The removal of the gallbladder can be performed by key hole surgery (laparoscopic cholecystectomy) or open surgery (open cholecystectomy). Cholescintigraphy after radiolabeled cholecystokinin (hormone that promotes gallbladder contraction) infusion can measure gallbladder contraction and has been used for the diagnosis of gallbladder dyskinesia. The duration of the cholecystokinin infusion and the cut‐off values of ejection fraction (of radioisotope cleared from the gallbladder on contraction) used for the diagnosis of gallbladder dyskinesia are variable, although the most popular cut‐off is 35%. Thus, currently, a gallbladder ejection fraction below 35% is considered to be gallbladder dyskinesia. However, there are some doctors who believe that irrespective of ejection fraction, pain related to the gallbladder in the absence of other causes of such pain can be considered gallbladder dyskinesia. One randomised clinical trial including 21 patients found significant cure in pain symptoms after removal of gallbladder (by open surgery) post cholecystectomy (10/11) in patients with a low ejection fraction prior to cholecystectomy compared to those who did not undergo cholecystectomy and had a low ejection fraction (1/10). Further randomised clinical trials of low bias‐risk (low risk of systematic error) are necessary to assess the role of cholecystectomy in suspected gallbladder dyskinesia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Small‐incision cholecystectomy and open cholecystectomy seem equivalent considering complications, but small‐incision cholecystectomy is associated with a shorter hospital stay

The classical open cholecystectomy and the minimally invasive small‐incision cholecystectomy are two alternative operations for removal of the gallbladder. There seem to be no significant differences in mortality and complications between these two techniques. Hospital stay is shorter using the small‐incision operation. This review shows that the small‐incision and open cholecystectomy should be considered equal, apart from a shorter hospital stay using the small‐incision technique.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Laparoscopic and open cholecystectomy seem equivalent considering complications and operative time, but laparoscopic cholecystectomy is associated with quicker recovery

The classical open cholecystectomy and the minimally invasive laparoscopic cholecystectomy are two alternative operations for removal of the gallbladder. There are no significant differences in mortality and complications between the laparoscopic and the open techniques. The laparoscopic operation has advantages over the open operation regarding duration of hospital stay and convalescence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Drains increase the harms to patients undergoing open cholecystectomy

Cholecystectomy is the removal of the gallbladder. It is performed mainly in patients having symptomatic gallstones. Drain usage after open cholecystectomy is controversial. The present review includes 28 trials assessing 20 comparisons of 'no drain' versus 'drain' and 12 comparisons of different drain types. The review reports that drains increase the harms to the patient. Drains do not provide any additional benefit for patients undergoing open cholecystectomy and should be avoided in open cholecystectomy. The review found no significant differences between different drain types.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Open, small‐incision, and laparoscopic cholecystectomy seem comparable with regard to mortality and complications

Gallstones are one of the major causes of morbidity in western society. Prevalence of persons with asymptomatic and symptomatic gallstones varies between 5% and 22%. There is consensus that only patients with symptomatic gallstones need treatment. Three different operation techniques for removal of the gallbladder exist: the classical open operation technique and two minimally invasive procedures, the laparoscopic and the small‐incision technique. This overview evaluates the three surgical procedures and comprises fifty‐six trials with 5246 patients randomised.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Laparoscopic and small‐incision cholecystectomy seem equivalent in complications and recovery, but small‐incision cholecystectomy is quicker to perform

The laparoscopic and the small‐incision cholecystectomy are two alternative minimally invasive techniques for removal of the gallbladder. There are no significant differences in mortality and complications between the two minimal invasive procedures. The laparoscopic and the small‐incision operation should be considered equal apart from a quicker operative time using the small‐incision technique. The complications in both techniques are common.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Robot assistant versus human or another robot assistant in patients undergoing laparoscopic cholecystectomy

Patients with symptomatic gallstones generally undergo laparoscopic cholecystectomy (key‐hole removal of the gallbladder). During this procedure there is only tunnel vision for the surgeon provided by a camera inserted through one of the key‐holes. The surgeon operates using instruments while a nurse or another doctor shows the surgeon the operating field using the camera. Thus, the human assistant acts as the 'surgeons' eyes' during the laparoscopic procedure. Recently, robots have been used to assist the surgeons in performing laparoscopic cholecystectomy. Various types of robots exist. Some just hold the camera and can be controlled by surgeons' voice commands or the surgeons' head movements. Adanced robotic systems can hold the camera and all the instruments, all of which are controlled by the surgeon using a console (like in a gaming device). The role of a robotic assistant in laparoscopic cholecystectomy is not known. We sought this information by undertaking a detailed literature search in a systematic way to obtain all the information available from randomised clinical trials. Such clinical trials, if designed well, provide the best estimate of the true effects of interventions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Routine abdominal drainage versus no drainage for patients undergoing uncomplicated laparoscopic cholecystectomy

The liver produces bile which has many functions, including elimination of waste processed by the liver and digestion of fat. The bile is temporarily stored in the gallbladder (an organ situated underneath the liver) before it reaches the small bowel. Concretions in the gallbladder are called gallstones. Gallstones are present in about 5% to 25% of the adult western population. Between 2% and 4% become symptomatic in a year. The symptoms include pain related to the gallbladder (biliary colic), inflammation of the gallbladder (cholecystitis), obstruction to the flow of bile from the liver and gallbladder into the small bowel resulting in jaundice (yellowish discolourisation of the body usually most prominently noticed in the white of the eye, which turns yellow), bile infection (cholangitis), and inflammation of the pancreas, an organ which secretes digestive juices and harbours the insulin secreting cells which maintain blood sugar level (pancreatitis). Removal of the gallbladder (cholecystectomy) is currently considered the best treatment option for patients with symptomatic gallstones. This is generally performed by key‐hole surgery (laparoscopic cholecystectomy). Drain is a tube that is left inside the tummy to allow drainage of fluids to outside the tummy. Some surgeons have routinely drained after laparoscopic cholecystectomy because of the fear of collection of bile or blood requiring re‐operation. As the name indicates, the drain may drain out these collections to the exterior, thereby avoiding open surgery. However, routine use of drains may necessitate the patient to stay overnight or require drain removal after discharge both of which increase resource utilisation in this era of day surgery (where patients are admitted and discharged on the same day of surgery). The review authors set out to determine whether it is preferable to use routine drainage after laparoscopic cholecystectomy. A systematic search of medical literature was performed in order to identify studies which provided information on the above question. The authors obtained information from randomised trials only since such types of trials provide the best information if conducted well. Two authors independently identified the trials and collected the information.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Low pressure pneumoperitoneum versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy

The liver produces bile, which has many functions, including elimination of waste processed by the liver and digestion of fat. Bile is temporarily stored in the gallbladder (an organ situated underneath the liver) before it reaches the small bowel. Concretions in the gallbladder are called gallstones. Gallstones are present in about 5% to 25% of the adult Western population. Between 2% and 4% become symptomatic within a year. Symptoms include pain related to the gallbladder (biliary colic), inflammation of the gallbladder (cholecystitis), obstruction to the flow of bile from the liver and gallbladder into the small bowel resulting in jaundice (yellowish discolouration of the body usually most prominently noticed in the white of the eye, which turns yellow), bile infection (cholangitis), and inflammation of the pancreas, an organ that secretes digestive juices and harbours the insulin‐secreting cells that maintain blood sugar level (pancreatitis). Removal of the gallbladder (cholecystectomy) is currently considered the best treatment option for patients with symptomatic gallstones. This is generally performed by key‐hole surgery (laparoscopic cholecystectomy). Laparoscopic cholecystectomy is generally performed by inflating the tummy with carbon dioxide gas to permit the organs and structures within the tummy to be viewed so that the surgery can be performed. The gas pressure used to inflate the tummy is usually 12 mm Hg to 16 mm Hg (standard pressure). However, this causes alterations in the blood circulation and may be detrimental. To overcome this, lower pressure has been suggested as an alternative to standard pressure. However, using lower pressure may limit the surgeon's view of the organs and structures within the tummy, possibly resulting in inadvertent damage to the organs or structures. The review authors set out to determine whether it is preferable to perform laparoscopic cholecystectomy using low pressure or standard pressure. A systematic search of medical literature was performed to identify studies that provided information on the above question. The review authors obtained information from randomised trials only because such types of trials provide the best information if conducted well. Two review authors independently identified the trials and collected the information.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic

The liver produces bile which has many functions including assisting in the elimination of waste processed by the liver and digestion of fat. The bile is temporarily stored in the gallbladder (an organ situated underneath the liver) before it reaches the small bowel. Concretions in the gallbladder are called gallstones. Gallstones are present in about 5% to 25% of the adult western population. Between 2% and 4% become symptomatic in a year. The symptoms include pain related to the gallbladder (uncomplicated biliary colic), inflammation of the gallbladder (cholecystitis), obstruction to the flow of bile from the liver and gallbladder into the small bowel resulting in jaundice (yellowish discolourisation of the body usually most prominent in the white of the eye, which turns yellow), bile infection (cholangitis), and inflammation of the pancreas, an organ which secretes digestive juices and harbours the insulin secreting cells which maintain blood sugar levels (pancreatitis). Removal of the gallbladder (cholecystectomy) is currently considered the best treatment option for people with symptomatic gallstones. This is generally performed by keyhole surgery (laparoscopic cholecystectomy). Gallbladder pain is one of the indications for laparoscopic cholecystectomy and can occur suddenly, with symptoms of intense pain in the right upper tummy which may or may not be associated with other symptoms such as heartburn. This is called biliary colic. Because of the limited resources available in a state‐funded health system, the people with biliary colic are added to a waiting list and operated on electively. However, delaying the surgery exposes the people to the risk of complications related to gallstones. The review authors set out to determine whether it is preferable to perform early laparoscopic cholecystectomy (within two weeks of people presenting to doctors with symptoms) or delayed laparoscopic cholecystectomy (more than two weeks after people present to doctors with symptoms). A systematic search of the medical literature was performed in order to identify studies which provided information on the above question. The authors obtained information from randomised trials only since such types of trials provide the best information if conducted well. Two authors independently identified the trials and collected the information.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis

The liver produces bile which has many functions including elimination of waste processed by the liver and digestion of fat. The bile is temporarily stored in the gallbladder (an organ situated underneath the liver) before it reaches the small bowel. Concretions in the gallbladder are called gallstones. Gallstones are present in about 10% to 15% of the adult western population. Between 1% and 4% become symptomatic in a year. The symptoms include pain related to the gallbladder (biliary colic), inflammation of the gallbladder (cholecystitis), obstruction to the flow of bile from the liver and gallbladder into the small bowel resulting in jaundice (yellowish discolourisation of the body usually most prominently noticed in the white of the eye, which turns yellow), bile infection (cholangitis), and inflammation of the pancreas, an organ which secretes digestive juices and harbours the insulin secreting cells which maintain blood sugar level (pancreatitis). Removal of the gallbladder (cholecystectomy) is currently considered the best treatment option for people with symptomatic gallstones. This is generally performed by key‐hole surgery (laparoscopic cholecystectomy). Cholecystitis (inflammation) of the gallbladder is one of the indications for laparoscopic cholecystectomy. Cholecystitis can occur suddenly, with symptoms such as fever along with intense pain in the right upper tummy. This is called acute cholecystitis. In comparison, chronic cholecystitis is a smouldering inflammation of the gallbladder which presents with less intense pain in the right upper tummy. For many years, surgeons have preferred to perform laparoscopic cholecystectomy once the inflammation settles down completely (which usually takes about six weeks) because of the fear of higher complication rates including injury to the bile duct (a tube through which the bile flows from the gallbladder to the small bowel). Injury to the bile duct is a life‐threatening condition which requires urgent corrective operation in most instances. In spite of the corrective surgery, people have poor quality of life several years after the operation due to repeated instances of bile infection caused by obstruction to the flow of bile into the small bowel. Another reason for the surgeons' preference for delaying the operation is to avoid an open operation, as there has been a perception that early operation increases the risk of an open operation. However, delaying the surgery exposes the people to the risk of complications related to gallstones. The review authors set out to determine whether it is preferable to perform early laparoscopic cholecystectomy (within seven days of people presenting to doctors with symptoms) or delayed laparoscopic cholecystectomy (more than six weeks after the initial admission). A systematic search of medical literature was performed in order to identify studies which provided information on the above question. The authors obtained information from randomised trials only since such types of trials provide the best information if conducted well. Two authors independently identified the trials and collected the information.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Three dimensional imaging (3D) compared with two dimensional (2D) imaging for key hole removal of gallbladder

The benefits and harms of three dimensional imaging (3D) versus traditional two dimensional (2D) imaging for key hole removal of the gallbladder (laparoscopic cholecystectomy) is not known. We set out to assess the benefits and harms of use of three dimensional systems versus two dimensional systems during laparoscopic cholecystectomy. We searched various medical databases and trials registers until October 2010 for identifying randomised clinical trials irrespective of language, blinding, or publication status.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Mini keyhole operation versus standard keyhole operation for removal of the gallbladder

About 10% to 15% of the adult western population have gallstones. Between 1% and 4% become symptomatic each year. Removal of the gallbladder (cholecystectomy) is the mainstay treatment for symptomatic gallstones. More than half a million cholecystectomies are performed per year in the United States alone. Laparoscopic cholecystectomy (removal of gallbladder through a key‐hole, also known as port) is now the preferred method of cholecystectomy. In standard port laparoscopic cholecystectomy, four ports (two of 10 mm diameter and two of 5 mm diameter) are usually used. Recently, use of smaller ports has been reported (miniport laparoscopic cholecystectomy). However, the safety of miniport laparoscopic cholecystectomy and whether it offers any advantages over standard port laparoscopic cholecystectomy is not known. We sought to answer this question by reviewing the medical literature and obtaining information from randomised clinical trials. When conducted well, such studies provide the most accurate information. Two authors searched the literature and obtained information from the studies thereby minimising errors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Wound infiltration with local anaesthetic agents for laparoscopic cholecystectomy (local anaesthetic administration into the surgical wound in people undergoing laparoscopic cholecystectomy)

About 10% to 15% of the adult western population have gallstones. Between 1% and 4% become symptomatic each year. Removal of the gallbladder (cholecystectomy) is the mainstay treatment for symptomatic gallstones. More than half a million cholecystectomies are performed per year in the United States alone. Laparoscopic cholecystectomy (removal of the gallbladder through a keyhole, also known as a port) is now the preferred method of cholecystectomy. While laparoscopic cholecystectomy is generally considered to be less painful than open surgery, pain is one the major reasons for delayed hospital discharge after laparoscopic cholecystectomy. Administration of local anaesthetics (drugs that numb part of the body, similar to the ones used by the dentist to prevent people from feeling pain) into the surgical wound (local anaesthetic wound infiltration) may be an effective way of decreasing pain after laparoscopic cholecystectomy. However, the benefits and harms of local anaesthetic wound infiltration is not known. We sought to answer these questions by reviewing the medical literature and obtaining information from randomised clinical trials on the benefits related to the treatment. When conducted well, such studies provide the most accurate information on the best treatment. We also considered comparative non‐randomised studies for treatment‐related harms. Two authors searched the literature until February 2013 and obtained information from the studies thereby minimising errors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Regular painkillers in people undergoing laparoscopic cholecystectomy

About 10% to 15% of the adult western population have gallstones. Between 1% and 4% become symptomatic each year. Removal of the gallbladder (cholecystectomy) is the mainstay treatment for symptomatic gallstones. More than half a million cholecystectomies are performed per year in the US alone. Laparoscopic cholecystectomy (removal of gallbladder through a keyhole, also known as port) is now the preferred method of cholecystectomy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Intra‐abdominal local anaesthetic administration in people undergoing laparoscopic cholecystectomy

About 10% to 15% of the adult western population have gallstones. Between 1% and 4% become symptomatic each year. Removal of the gallbladder (cholecystectomy) is the mainstay treatment for symptomatic gallstones. More than half a million cholecystectomies are performed per year in the US alone. Laparoscopic cholecystectomy (removal of gallbladder through a keyhole incision, also known as a port) is now the preferred method of cholecystectomy. While laparoscopic cholecystectomy is generally considered less painful than open surgery, pain is one the major reasons for delayed hospital discharge after laparoscopic cholecystectomy. Administration of local anaesthetics (drugs that numb part of the body, similar to the ones used by the dentist to prevent the people from feeling pain) into the tummy (abdomen) may be an effective way of decreasing the pain after laparoscopic cholecystectomy. However, the benefits and harms of intra‐abdominal administration of local anaesthetics is unknown. We sought to answer these questions by reviewing the medical literature and obtaining information from randomised clinical trials with regards to benefits and other comparative study designs for treatment‐related harms. When conducted correctly, randomised clinical studies provide the most accurate information on the best treatment. Two review authors searched the literature and obtained information from the studies thereby minimising errors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Fewer‐than‐four ports versus four ports for laparoscopic cholecystectomy

About 10% to 15% of the adult Western population have gallstones. Between 1% and 4% become symptomatic each year. Removal of the gallbladder (cholecystectomy) is the main stay treatment for symptomatic gallstones. More than half a million cholecystectomies are performed per year in the United States alone. Laparoscopic cholecystectomy (removal of gallbladder through a key‐hole‐sized incision, also known as port) is now the preferred method of cholecystectomy. In conventional or standard laparoscopic cholecystectomy (key hole removal of gallbladder), four ports (two of 10‐mm diameter and two of 5‐mm diameter) are usually used. The use of fewer ports has been reported (fewer‐than‐four‐ports laparoscopic cholecystectomy). However, the safety of fewer‐than‐four‐ports laparoscopic cholecystectomy and whether it offers any advantages over four‐port laparoscopic cholecystectomy is not known. We sought to answer this question by reviewing the medical literature and obtaining information from randomised clinical trials commonly called randomised controlled trials. When conducted well, such studies provide the most accurate information. Two review authors searched the literature to September 2013 and obtained information from the trials, thereby minimising errors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Early or delayed removal of gallbladder by key‐hole surgery after a sudden episode of gallstone‐related pancreatitis

There is considerable controversy regarding how long one should wait after a sudden attack of acute gallstone pancreatitis before removing the gallbladder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

External drainage of gallbladder for high‐risk surgical patients with acute calculous cholecystitis

Removal of the gallbladder (cholecystectomy) is generally recommended for people with symptoms related to gallstones. People at high risk of surgical complications ‐ that is, elderly people and people with co‐existing illness ‐ can become very unwell as a result of inflammation of the gallbladder. During anaesthesia and surgery, the body's ability to tolerate stress is lowered, particularly in elderly people and people with co‐existing illness. Thus, surgery can be detrimental to these people who are already unwell. The optimal clinical management of these people is not known. External drainage of gallbladder contents with a tube using guidance from scans (percutaneous cholecystostomy) has been proposed as the one of the ways that these patients can be treated. By draining the contents of gallbladder, any infected material can be removed from the body and this might improve the health. Some consider percutaneous cholecystostomy as the only treatment required and perform cholecystectomy only in those who develop further complications while others recommend routine cholecystectomy following percutaneous cholecystostomy. We sought to review all the information available in the literature on this topic and obtained information from randomised clinical trials (studies designed to lower the risk of arriving at wrong conclusions due to researcher's favouritism or differences in the type of people undergoing the different treatments) to determine the optimal method of managing these people. Two review authors collected data independently as a way of quality control.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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