Obesity Increases Operative Time in Children Undergoing Laparoscopic Cholecystectomy
Journal of Laparoendoscopic&Advanced Surgical Techniques , Vol. 0, No. 0.
Laparoscopic cholecystectomy in the morbidly obese may be associated with increased operative difficulty and morbidity compared with non-obese patients. Obesity itself is a factor for the development of gallstone disease, and periods of weight loss further increase the risk of gallstone formation. In the obese patient, the hypersecretion of cholesterol is considered to be the culprit that increases the risk of gallstone disease. Jonas et al. described a five-fold increased risk of symptomatic gallstone disease after obesity surgery compared with the general population .
Obesity and rapid weight loss following bariatric surgery are risk factors for developing gallstones and gallstone-related complications. Optimal perioperative management of bariatric surgical patients with asymptomatic gallstones remains controversial. We performed a systematic review to determine the safety of prophylactic cholecystectomy (PCC) concurrent with laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG).
Cholelithiasis is a very common comorbidity in morbidly obese. Cholecystectomy at the time of Laparoscopic sleeve gastrectomy (LSG) is a proper solution that usually done by five port technique. Using four ports technique is safer, less painful and no ugly scar resulted from the Epigastric port. We here showing our results in Helwan University Hospitals from 2016 to 2019.
Conclusions: Common bile duct clearance by Endoscopic Retrograde Cholangio-Pancreatography requires multiple procedures and complications are frequent leading to prolonged treatment and hospitalization suggesting a limited efficacy. PMID: 31526285 [PubMed - as supplied by publisher]
Despite many advances in health care, managing pain in the post-anesthetic period continues to be a challenge. With more procedures being performed on an outpatient basis, shorter lengths of stay and drive to improve patient satisfaction, providers are looking for ways to enhance the surgical care experience and reduce opioid use. In addition, the increase burden of obesity in society has contributed to a rise in co-morbidities such as diabetes, cardiovascular, and gallbladder disease making laparoscopic cholecystectomies the second most frequently performed general surgery procedure in the United States.
ConclusionsLC with NIR-ICG fluorescent cholangiography is safe and effective for early recognition of anatomical landmarks, reducing operative time as compared to LC with IOC, even when residents were the main operator. NIR-ICG fluorescent cholangiography was effective in patients with acute cholecystitis and in the obese. Data collection into large registries on the results of NIR-ICG fluorescent cholangiography during LC should be encouraged to establish whether this technique might set a new safety standard for LC.
ConclusionOur preliminary experience showed that ICG fluorescence is a safe, useful, and versatile technique to adopt in pediatric MIS to achieve a better identification of anatomy and an easier surgical dissection or resection in challenging cases. Currently, the main indications are varicocelectomy, difficult cholecystectomy, tumor excision, nephrectomy, and partial nephrectomy. The main limitation is the needing of a special equipment to use ICG technology.
Journal of Laparoendoscopic&Advanced Surgical Techniques, Ahead of Print.
We describe the case of a 12-year-old morbidly obese boy, without previous medical issues, scheduled for elective laparoscopic cholecystectomy. Immediately after pneumoperitoneum was established, mechanical ventilation could not be performed. Intraoperative exploration with flexible bronchoscopy showed that the tip of the endotracheal tube was nearly occluded by the posterior tracheal wall bulging anteriorly. Anesthesiologists should be aware of undiagnosed tracheomalacia as a cause of sudden airway collapse, even after the airway is secured with an endotracheal tube.
Authors: Choromanska B, Mysliwiec P, Hady HR, Dadan J, Mysliwiec H, Bonda T, Chabowski A, Miklosz A Abstract Obesity is characterised by imbalance in lipid metabolism manifested by high concentrations of circulating triacylglycerols and total cholesterol as well as low high-density lipoprotein (HDL) levels. Abnormalities related to these lipids lead to metabolic complications such as type 2 diabetes, arterial hypertension and cardiovascular disease. Despite extensive research, it is still unclear why a subset of obese subjects develop metabolic syndrome, while others do not. The aim of our work was to assess total ...