The purpose of this study is to determine if early laparoscopic cholecystectomy in patients with uncomplicated gallstone disease and symptoms of dyspepsia will produce complete symptomatic resolution 1 year postoperatively and to identify appropriate timing of laparoscopic cholecystectomy to decrease cholecystectomy failure rate. Specific research objectives were to determine: <p>1) if laparoscopic cholecystectomy in patients with gallstones and symptoms of dyspepsia will achieve complete symptomatic relief; <p>2) the change in the preoperative score to the postoperative score and satisfaction after laparoscopic cholecystectomy for the two groups: patients with gallstones and symptoms of dyspepsia and the patients with gallstones and no dyspepsia; <p>3) the relationship between the duration of preoperative episodes and the probability of complete resolution of symptoms with laparoscopic cholecystectomy in patients with gallstones and symptoms of dyspepsia; <p>4) the relationship between the frequency of preoperative episodes and the probability of complete resolution of symptoms with early laparoscopic cholecystectomy in patients with gallstones and symptoms of dyspepsia and <p>5) the differences in pathologic findings between patients with gallstones and no symptoms of dyspepsia versus patients with symptoms of dyspepsia.<p>The methods included a retrospective chart review for patient identification, a follow up survey and microscopic pathological examination of gallbladder specimens. Nine hundred and forty two patients entered the study. Three hundred and fifty nine surveys were returned producing a response rate of 43%. Two hundred and sixty four patients (77.0%) had symptoms of dyspepsia (Group I) and 79 patients (23.0%) had no symptoms of dyspepsia (Group II). <p>Laparoscopic cholecystectomy for patients with gallstones and symptoms of dyspepsia does not achieve complete symptomatic relief 1 year after surgery. The frequency and duration of preoperative episodes have no relation to the outcome of surgery. The majority of patients in both Groups (I, II) were found to have morphological evidence of acute cholecystitis and only a small number had chronic cholecystitis. Group I had a greater reduction in the Buckley score than Group II after LC but had similar rates of satisfaction from surgery.

The purpose of this study is to determine if early laparoscopic cholecystectomy in patients with uncomplicated gallstone disease and symptoms of dyspepsia will produce complete symptomatic resolution 1 year postoperatively and to identify appropriate timing of laparoscopic cholecystectomy to decrease cholecystectomy failure rate. Specific research objectives were to determine: <p>1) if laparoscopic cholecystectomy in patients with gallstones and symptoms of dyspepsia will achieve complete symptomatic relief; <p>2) the change in the preoperative score to the postoperative score and satisfaction after laparoscopic cholecystectomy for the two groups: patients with gallstones and symptoms of dyspepsia and the patients with gallstones and no dyspepsia; <p>3) the relationship between the duration of preoperative episodes and the probability of complete resolution of symptoms with laparoscopic cholecystectomy in patients with gallstones and symptoms of dyspepsia; <p>4) the relationship between the frequency of preoperative episodes and the probability of complete resolution of symptoms with early laparoscopic cholecystectomy in patients with gallstones and symptoms of dyspepsia and <p>5) the differences in pathologic findings between patients with gallstones and no symptoms of dyspepsia versus patients with symptoms of dyspepsia.<p>The methods included a retrospective chart review for patient identification, a follow up survey and microscopic pathological examination of gallbladder specimens. Nine hundred and forty two patients entered the study. Three hundred and fifty nine surveys were returned producing a response rate of 43%. Two hundred and sixty four patients (77.0%) had symptoms of dyspepsia (Group I) and 79 patients (23.0%) had no symptoms of dyspepsia (Group II). <p>Laparoscopic cholecystectomy for patients with gallstones and symptoms of dyspepsia does not achieve complete symptomatic relief 1 year after surgery. The frequency and duration of preoperative episodes have no relation to the outcome of surgery. The majority of patients in both Groups (I, II) were found to have morphological evidence of acute cholecystitis and only a small number had chronic cholecystitis. Group I had a greater reduction in the Buckley score than Group II after LC but had similar rates of satisfaction from surgery.

No description available.

Objectives: Study wanted to explore the factors that will affect the total medical expense in the patients who receive laparoscopic cholecystectomy (LC). We also to confer the influencing factor that will associate with the difference of reports the expense under the case payment system. Methods:Retrospective study . Collected from year 2003 to 2007, received LC in a general teaching hospital in Kaohsiung city. We also adopt the chart review and combined with the health insurance expense data to explore the important factors that were associated with total hospitalized expenses, declaration of expense differences, and profits. The methods of multiple linear and logistic regressions were needed. Results: 1539 subjects, 613 male and 926 female. The average age was 54.4 , and 1313 subjects were hospitalized from outpatient. All subject¡¦s average hospitalized days were 3.79 and medical expenses were 42528.1 dollars. The frequencies of the type of declaration about ¡¥not exceed¡¦, ¡¥exceed but actually¡¦, and ¡¥exceed but no actually¡¦ were 88.8%, 8.6%, and 2.6%, in sequence. The average declaration of expense differences was 14484.1 dollars. The significant factors that were associated with total hospitalized expenses were the age, surgical year, source of hospitalize, major symptom, combine disease, a complication after surgery, hospitalized days, type of declaration. In the other linear regression model, we found the age, surgery year, source of hospitalize, major symptom, high technology examination before surgery, combine disease, a complication after surgery, hospitalized days, and physician¡¦s surgery quantity per year had been statistically significant with the declaration of expense differences. For the odds of hospital¡¦s profits, the significant factors include the surgery year, source of hospitalize, major symptom, high technology examination before surgery, and hospitalized days. Conclusion: We found a few significant factors that were associated with dependent variable in three regression models in this study. The major factor is hospitalized days that were a stronger influence total hospitalized expenses, declaration of expense differences, and hospital¡¦s profits. The hospital¡¦s superintendent can carry on the management through the appropriate method to control the medical resource consumes.

Background: Opioid abuse has become a serious public health issue. While adequate pain management is an ethical responsibility for health care providers, responsible stewardship of controlled substances is of equal concern. Opioids are often prescribed for treatment of acute pain post-operatively. The purpose of this study is to examine opioid prescription practices and use of opioids after laparoscopic cholecystectomy. Methods: A convenience sample of 42 patients scheduled for laparoscopic cholecystectomy were enrolled in the study. Using a descriptive study design, patients were interviewed by phone 6-10 days post-operatively using a scripted questionnaire. The average number of excess prescribed opioid medication pills, patient perception of prescribed quantity, duration of opioid use, and average pain score with and without activity on the date of contact was determined. Participants were also asked about any instruction received regarding proper medication disposal. Results: A final sample of 34 patients met inclusion criteria and completed the phone questionnaire. Average number of excess pills ranged from 0-42 (M:14; SD 11.7). Nearly half of patients (47%) perceived the prescribed quantity as 'too many', 41% indicated the prescription quantity was 'just right' but many had left-over pills, and 11.8% believed the prescribed quantity to be 'too few'. The average number of days of opioid use following surgery was 4.2 days with 71% of patients using opioids for five or fewer days. The average pain score at the time of the interview was 2.0 without activity, and 4.1 with activity. Almost all (88%) patients did not recall any instruction or knowledge of appropriate medication disposal. A few participants volunteered plans to dispose of unused medications by various means, while others indicated they planned to keep excess pills. Conclusion: Pain management experts advise using around-the-clock regimens of over-thecounter analgesics (i.e. acetaminophen or non-steroidal anti-inflammatory medication (NSAID)) and using opioids sparingly as an adjunct therapy following uncomplicated laparoscopic cholecystectomy. The data in this study indicated currently prescribed opioid quantities after laparoscopic cholecystectomy are more than adequate and could be decreased without affecting adequate pain management. In addition, the data show a large majority of patients are not provided with personalized instruction on proper medication disposal procedures.

Massive bilateral adrenal hemorrhage occurring in the postoperative period is an unusual but potentially life-threatening complication of any abdominal operation. The diagnosis is often difficult due to the nonspecific nature of the clinical presentation, which is easily attributable to other more common postoperative conditions. We report a case of bilateral adrenal hemorrhage resulting in acute primary adrenal insufficiency following an otherwise-uncomplicated laparoscopic cholecystectomy, which has not previously been described. An awareness of the possibility of this uncommon condition complicating laparoscopic cholecystectomy may lead to a higher index of suspicion, which is important in timely diagnosis and prompt treatment.

Bakgrund: Att förebygga och behandla postoperativ smärta är anestesisjuksköterskans ansvar genom det perioperativa förloppet. Tidigare studier har visat att förekomsten av postoperativ smärta efter laparoskopisk kolecystektomi är hög. Syfte: Syftet med studien var att beskriva postoperativ smärtskattning hos patienter som genomgått laparoskopisk kolecystektomi på en sluten operationsavdelning och en dagkirurgisk operationsavdelning. Syftet var också att undersöka skillnader i förekomst av postoperativ smärta mellan män och kvinnor, yngre och äldre patienter samt mellan patienter som opererats på sluten- respektive dagkirurgisk operationsavdelning. Metod: Studien var en retrospektiv registerstudie med kvantitativ ansats. Registerdata innehållande data från 338 patienter inhämtades från kvalitetsregistret Svenskt Perioperativt Register från år 2016–2018. Materialet analyserades med beskrivande och jämförande statistik. Resultat: Resultatet visade att 70 % av patienterna skattade måttlig till svår postoperativ smärta (NRS 4-10). Det framkom även att kvinnor samt yngre patienter (&lt;50 år) på den dagkirurgiska operationsavdelningen skattade signifikant högre postoperativ smärta jämfört med män och äldre patienter. Slutsatser: Även om inga generella slutsatser kan dras tyder resultaten på att kvinnor samt patienter 50 år och yngre är särskilt utsatta för otillräcklig smärtbehandling i samband med laparoskopisk kolecystektomi. Eftersom alla människor har rätt till god smärtlindring behöver omvårdnaden således anpassas efter patientens individuella förutsättningar och behov. När anestesisjuksköterskan når en förtrolig relation till patienten finns goda förutsättningar för en tillfredställande postoperativ omvårdnad.

Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.

A infecção de sítio cirúrgico (ISC) é uma complicação que pode acometer o paciente, acarretando incremento da mortalidade e morbidade, bem como aumento dos custos em saúde. A videocirurgia surgiu como opção menos invasiva de acesso à cavidade abdominal, reduzindo as taxas de ISC, mas nem mesmo a modernização gerada pela cirurgia minimamente invasiva conseguiu extinguir esse tipo de infecção. O presente estudo teve como objetivo geral analisar a ocorrência e os fatores de risco de infecção de sítio cirúrgico, em pacientes submetidos à colecistectomia videolaparoscópica. Trata-se de estudo descritivo exploratório conduzido em hospital de pequeno porte, localizado no sudoeste de Minas Gerais. A amostra foi composta por 118 pacientes. Para a coleta de dados, elaborou-se instrumento, o qual foi submetido à validação de face e conteúdo por estudiosos da área de conhecimento de enfermagem perioperatória. A coleta dos dados foi realizada no período de março a novembro de 2016 e, em três momentos, a saber: perioperatório, retorno ambulatorial e busca ativa fonada. Os dados foram coletados pelo pesquisador e um auxiliar de pesquisa devidamente treinados. A ocorrência de ISC foi de 5,9% (n=7), sendo todos os casos diagnosticados como infecção incisional superficial. As variáveis investigadas relacionadas ao paciente foram sexo, faixa etária, Índice de Massa Corporal, presença de doença crônica e classificação ASA. As variáveis estudadas relacionadas ao procedimento anestésico-cirúrgico foram tempo total de internação, porte cirúrgico, tempo de anestesia e tempo de cirurgia. Os resultados não apresentaram diferença estatisticamente entre as variáveis de interesse e a presença de ISC. Todos os casos de ISC foram diagnosticados, após a alta hospitalar, desses, seis pacientes (86%) tiveram o diagnóstico no retorno ambulatorial, e um paciente (14%) foi diagnosticado durante a busca ativa fonada. A condução do estudo oferece subsídios para a compreensão da problemática, no âmbito nacional. Além disso, gerou evidências para a reflexão dos profissionais de saúde em relação à subnotificação desse tipo de infecção em cirurgia minimamente invasiva, reforçando a necessidade de implantação de programa de vigilância pós-alta, nos serviços de saúde / Surgical site infection (SSI) is a complication that can affect the patient, leading to an increase in mortality and morbidity, as well as an increase in health costs. Video surgery emerged as a less invasive option for access to the abdominal cavity, reducing SSI rates; however, not even the improvement generated by minimally invasive surgery was enough to eliminate this type of infection. This study aimed to analyze the occurrence and risk factors of surgical site infection in patients submitted to laparoscopic cholecystectomy. It is an exploratory-descriptive study conducted in a small hospital, located in the southwest of Minas Gerais. The sample consisted of 118 patients. An instrument was developed for data collection, which was submitted to face and content validation by experts in perioperative nursing. Data collection was performed from March to November 2016 and, in three stages: perioperative, outpatient return and active phone search. Data were collected by the researcher and a properly trained research assistant. The occurrence of SSI was 5.9% (n=7), being all cases diagnosed as superficial incisional infection. The studied variables related to the patient were gender, age, Body Mass Index, presence of chronic disease and ASA classification. The studied variables related to the anesthetic surgical procedure were total length of hospitalization, surgical procedure size, time of anesthesia and time of surgery. The results did not show statistically difference between the variables of interest and the presence of SSI. All cases of SSI were diagnosed after patient discharge, and among them, six patients (86%) were diagnosed during outpatient return, and one patient (14%) was diagnosed during the active phone search. This study offers subsidies for understanding the problem at national level. In addition, it generated evidence for the reflection of health professionals regarding the underreporting of this type of infection in minimally invasive surgery, reinforcing the need to implement a post-discharge surveillance program in health services

Introdução: A colelitíase é uma das afecções do sistema digestório mais frequente, acometendo 20% da população adulta. Atualmente, a colecistectomia videolaparoscópica (CVL) é o tratamento de escolha nas doenças benignas da vesícula biliar, inclusive, na colecistite aguda. Entretanto, independente dos benefícios indiscutíveis da cirurgia minimalmente invasiva, esse procedimento não exclui a possibilidade de complicações ou desconfortos ao paciente no pós-operatório. Objetivo: Identificar a relação entre as variáveis pré e intra-operatórias e as ocorrências de complicações e desconfortos pós-operatórios em pacientes submetidos à CVL. Casuística e método: Trata-se de um estudo retrospectivo, do tipo descritivo, exploratório, de nível I e com abordagem quantitativa. A amostra do estudo foi composta por 495 prontuários de pacientes submetidos à CVL, em caráter eletivo no Hospital Estadual de Diadema, no período entre janeiro de 2009 e agosto de 2012. Os dados foram obtidos com base no preenchimento de um instrumento semiestruturado, contendo: dados demográficos, variáveis clínicas do pré, intra e pós-operatórias. O estudo estatístico foi realizado no sistema SPSS 15.0, sendo adotado o nível de significância de 5%. Resultados: Na amostra estudada houve: predominância do feminino (89,5%), residentes em Diadema (46,5%), estado civil casado (43,4%), baixa escolaridade (58%) e média de idade 48 anos (18 a 89 anos). A comorbidade mais prevalente foi obesidade (41%), seguida por hipertensão arterial (40,6%) e Diabetes mellitus tipo II (12,5%). A maior parte da amostra foi classificada como ASA II (55,8%), todos receberam cefazolina como antibioticoprofilaxia e 64% fizeram uso de Midazolan, como medicação pré-anestésica. Aproximadamente, a metade da população (49,3%) usou fármacos inalatórios, propofol, opióides e bloqueador neuromuscular no intra-operatório. Em relação a outras drogas utilizadas nesse período, 57,6% fizeram uso analgésico isolado (dipirona), 52,3% receberam anti-inflamatório (tenoxican) e 62,2% foram submetidos à terapia anti-emética com metoclopramida ou dimenidrato. O tempo cirúrgico médio foi de 80,5 minutos e a permanência média hospitalar de 43,7 horas. A prevalência de complicações ou desconfortos foi de 54,5% na sala de recuperação pós-anestésica (SRPA) e de 51,7% na enfermaria médico-cirúrgica (EMC). Os eventos de maior ocorrência na SRPA foram hipertensão (46,5%), dor (8,5%) e náuseas e vômitos (5,5%), e na EMC, foram dor (32,5%), náuseas e vômitos (19,2%). A análise de regressão logística indicou a associação com o aparecimento de complicações e desconfortos na SRPA para as seguintes variáveis (OD Odds ratio, IC intervalo de confiança a 95%): idade (OR= 1,02 IC 1,01-1,04); ASA II (OR= 1,59 IC 1,03-2,45); e uso de cloridrato de tramadol no intra-operatório (OR= 0,57 IC 0,39-0,83). Na EMC, foram encontradas as seguintes associações: uso de dipirona no intra-operatório (OR= 0,41 IC 0,18-0,94); hipotireoidismo (OR= 0,33 IC 0,14-0,81); e tempo cirúrgico (OR= 1,57 IC 1,102,24). Conclusão: A idade, a classificação ASA e o tempo cirúrgico influenciaram no aparecimento de complicações ou desconfortos pós-operatórios. Em face dos dados obtidos, o enfermeiro deve estar apto a avaliar e identificar as condições precoces que possam indicar a ocorrência desses eventos e promover, em conjunto com a equipe multiprofissional, o conforto do paciente e seu sucesso terapêutico. / Introduction: Cholelithiasis is one of the digestive disorders more common, affecting 20 % of the adult population. Laparoscopic cholecystectomy (LC) is indicated for the treatment of all benign diseases of the gallbladder, including in acute cholecystitis. However, regardless of the benefits of the minimal invasive surgery it does not exclude the possibility of postoperative complications or discomfort to the patient. Objective To assess the relationship among pre and intraoperative factors and occurrences of complications and discomfort in patients undergoing laparoscopic cholecystectomy in a community hospital. Method and Casuistic: This was a retrospective and descriptive study. The data was composed of 495 medical records of patients undergoing laparoscopic cholecystectomy surgery for elective, in a community hospital Diadema Hospital, between January 2009 and August 2012. The authors analyzed demographic and clinical variables pre and intra and postoperative complications. Statistical analysis was performed at SPSS 15.0 software, (significance level of 5%). Results: A total of 495 cases, there was a female prevalence (89.5 %), living in Diadema city (46.5 %), married (43.4 %), low education (58 %) and median age 48 years. Obesity (IMC > 35) was more prevalent (41 %), followed by hypertension (40.6 %) and Diabetes mellitus type II (12.5 %). The American Society of Anesthesiology classification (ASA) was II in 55.8%, all patients received prophylactic antibiotics (cefazolin) and 64% used midazolam before the surgical procedure. The anesthesy wasperformed with inhalatory drugs, propofol, opioids and neuromuscular block (49.3 %). During the intra-operative time 57.6 % received 52.3% dipyrone and 62.2% anti-inflammatory (tenoxican), antiemetic therapy (metoclopramide or dimenhydrinate) the mean operative time was 80.5 minutes and the hospital stay of 43.7 hours. The prevalence of complications or discomfort was 54.5% in the recovery room just after anesthesia (PACU), and 51.7% in the medical-surgical ward (EMC). The most frequent events in the PACU were hypertension (46.5 %), pain (8.5%) and nausea and vomiting (5.5%), and EMC, were pain (32.5 %), nausea and vomiting (19.2%). The logistic regression analysis showed an association with the onset of complications and discomfort in the recovery room for the following variables (OD Odds ratio, CI confidence interval 95 % ) : age (OR = 1.02 CI 1.01-1.04); ASA II (OR = 1.59 CI 1.03 to 2.45), and tramadol hydrochloride used during surgery (OR = 0.57 CI 0.39 to 0.83). At EMC, we found the following associations: Dipyrone intraoperatively (OR = 0.41 CI 0.18 to 0.94), hypothyroidism (OR = 0.33 CI 0.14 to 0.81), and operative time (OR = 1.57 CI 1.10 to 2.24). Conclusion: Age, ASA classification and surgical time had influence in the development of complications or discomfort postoperatively. Considering the results of this study, the nurse must be able to assess and identify conditions that may indicate the early occurrence of these events and promote, together with a multidisciplinary team, patient comfort and its therapeutic success.