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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: October 18, 2006

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: October 18, 2006

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: October 18, 2006

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: April 18, 2007

Surgical removal of the gallbladder is done routinely. Stones in the common bile duct usually come from the gallbladder and can be harmful. The usual treatment for gallstones that are in the common bile duct is endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy. ERCP is an endoscopic procedure to remove stones from the common bile duct. More stones may enter the common bile duct from the gallbladder but it is not clear if the gallbladder should be removed preventively (prophylactic cholecystectomy) or if a wait‐and‐see policy (cholecystectomy deferral) would be better. We included 5 randomised trials with 662 participants out of 93 publications identified through the literature searches. The number of deaths was 47 in the wait‐and‐see group (334 patients) compared with 26 in the prophylactic cholecystectomy group (328 patients). This review of randomised clinical trials suggests that early removal of the gallbladder decreases the risk of death or of complications from gallstones. The number of patients (662) reviewed in this report prevents some of the subgroup analyses from being conclusive. Further clinical trials, particularly of high‐risk patients, would solve this problem.

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

Version: October 17, 2007

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: January 21, 2009

Laparoscopic cholecystectomy (key hole removal of gallbladder) is currently the preferred method of treatment of gallstones. During laparoscopic cholecystectomy, it is necessary to occlude the cystic duct (duct connecting the gallbladder and the bile duct) permanently. A total of three trials including 255 patients qualified for this review of randomised clinical trials. Two trials randomised 150 patients in total to absorbable clips (n = 75) and non‐absorbable clips (n = 75). A third trial randomised a total of 105 patients to absorbable ligatures (n = 53) and non‐absorbable clips (n = 52). All three trials were of high risk of bias. There was no difference in the morbidity between the groups. The operating time was 12 minutes longer in the absorbable ligature group than in the group randomised to non‐absorbable clips.The duration and method of follow‐up were not adequate to determine the incidence of long‐term complications. We are unable to determine the benefits and harms of different methods of cystic duct occlusion because of the small sample size, short period of follow‐up, and lack of reporting of important outcomes in the included trials. New trials with long periods of follow‐up and assessing the important outcomes are necessary. Such trials should be designed well to decrease the risk of random errors and systematic errors.

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

Version: October 6, 2010

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: January 20, 2010

Approximately 50 to 250 out of every 1000 adults in the western world have gallstones. Of every 100 people with gallstones, two to four people develop symptoms such as pain in the upper abdomen. This condition is treated by surgical removal of the gallbladder through 'keyhole surgery', a procedure that is known as laparoscopic cholecystectomy. It is possible to perform the operation and allow the patient to go home on the same day ('day surgery'). During surgery, the patient is given a range of medicines to provide lack of awareness of the procedure undertaken, reduce pain, and relax muscles (allowing the surgeon adequate access and vision). Together, this is called an anaesthetic regimen. Many different anaesthetic regimens have been suggested for use in day‐procedure laparoscopic cholecystectomy. We sought to find the best anaesthetic regimen by performing a thorough search of the literature for randomized controlled trials, reported until November 2013.

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

Version: January 24, 2014

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. 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) is considered to be an effective way of decreasing the pain after laparoscopic cholecystectomy. However, the best method of administration of local anaesthetics is not known. The controversies include which drug to use, when to administer it, whether it should be administered in the form of liquid or in the form of misty spray, and to which part of the tummy it should be administered. We sought to answer these questions by reviewing the medical literature and obtaining information from randomised clinical trials for assessment of benefit. When conducted well, such studies provide the most accurate information on the best treatment. We included comparative non‐randomised studies for the assessment of treatment‐related harms. 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: March 25, 2014

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: September 12, 2012

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: March 28, 2014

This review compares same‐day discharge (day‐surgery) with overnight stay after keyhole removal of the gallbladder (laparoscopic cholecystectomy) for various conditions affecting the gallbladder but mainly for gallstones causing pain.

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

Version: July 31, 2013

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: March 18, 2014

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: September 3, 2013

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 in the abdomen (belly) 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 one 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 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). Generally, before being operated on, patients will be given informal information by the healthcare providers involved in the care of the patients (doctors, nurses, ward clerks, or healthcare assistants). This information is likely to include some information on the type of anaesthesia, expected duration of surgery, expected outcome of surgery including the complications, duration of hospital stay, wound dressing care (if applicable), return to normal activity, and return to work. This information can also be provided formally in different formats including written information, formal lectures, video, or computer presentations. The review authors set out to determine whether it is preferable to provide formal information to the patients before the operation.

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

Version: February 28, 2014

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: March 13, 2014

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: March 12, 2014

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: June 30, 2013

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: February 20, 2014

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