29:
909:
788:
issues such as adherent bowel or colon, inability to properly identify anatomical planes from previously formed scar-tissue. If there is an inability to safely isolate the structures needed to isolate for cholecystectomy (the cystic duct and the cystic artery) for whatever reason (many times patients have part of the small bowel or colon stuck to the gallbladder, which make it dangerous to pull off without making an accidental hole in the small bowel), the surgical team may elect to do a subtotal cholecystectomy; either a fenestrated or reconstituting type. Essentially, only part of the gallbladder is removed and a drain is left in place for several days. Complications include continued output from drain, which may result in the need for ERCP stent placement to stop drainage.
937:
long thin tube with a camera on the end, is passed through the mouth and down the esophagus. The doctor advances the camera through the stomach and into the first part of the small intestine to reach the opening of the bile duct. The doctor can inject a special, radiopaque dye through the endoscope into the bile duct to see stones or other blockages on x-ray. ERCP does not require general anaesthesia and can be done outside of the operating room. While ERCP can be used to remove a specific stone that is causing a blockage to allow drainage, it cannot remove all stones in the gallbladder. Thus, it is not considered a definitive treatment and people with recurrent complications from stones will still likely need a cholecystectomy.
581:
duct stones discovered during laparoscopic cholecystectomy. This technique was first described in 1993 by
Deslandres et al. and has, in several studies, been shown to have a high rate of CBD stones clearance and a reduced number of complications, particularly post-ERCP pancreatitis, in comparison with conventional ERCP. This is probably due to the facilitated access to the common bile duct with a lesser degree of manipulation and trauma to the papilla Vateri. In a study by Swahn et al. the rendezvous method was shown to reduce the risk of PEP from 3.6 to 2.2% compared with conventional biliary cannulation. The success rate of passing the transcystic guidewire into the duodenum has been reported to be over 80%.
611:
603:
3477:
1240:
261:, is moderate to severe, and goes away on its own after a few hours when the stone dislodges. Biliary colic usually occurs after meals when the gallbladder contracts to push bile out into the digestive tract. After a first attack of biliary colic, more than 90% of people will have a repeat attack in the next 10 years. Repeated attacks of biliary colic are the most common reason for removing the gallbladder, and lead to about 300,000 cholecystectomies in the US each year.
871:(PGB), a condition where the gallbladder wall shows calcification on imaging tests, was previously considered a reason to remove the gallbladder because it was thought that people with this condition had a high risk of developing gallbladder cancer. However, recent studies have shown that there is no strong association between gallbladder cancer and porcelain gallbladder, and that PGB alone is not a strong enough indication for a prophylactic cholecystectomy.
1025:
strong resistance by the German surgical establishment and he had difficulty communicating it in
English. It was consequently ignored. Mühe's work was further disparaged in 1987, when he was charged with manslaughter for a postoperative patient death that was mistakenly attributed to his innovative technique. He was exonerated in 1990 after further investigation. His pioneering work was eventually recognized by the German Surgical Society Congress in 1992.
917:
590:
998:, or gallstone removal. Langenbuch's rationale for developing the new technique stemmed from 17th century studies in dogs that demonstrated the gallbladder to be nonessential and medical opinion among his colleagues that gallstones formed in the gallbladder. Although the technique was initially controversial, cholecystectomy became established as a lower mortality procedure than cholecystostomy by the 20th century.
421:. Complications from a bile leak can follow a person for years and can lead to death. Bile leak should always be considered in any patient who is not recovering as expected after cholecystectomy. Most bile injuries require repair by a surgeon with special training in biliary reconstruction. If biliary injuries are properly treated and repaired, more than 90% of patients can have a long-term successful recovery.
406:, or damage to the bile ducts. Laparoscopic cholecystectomy has a higher risk of bile duct injury than the open approach, with injury to bile ducts occurring in 0.3% to 0.5% of laparoscopic cases and 0.1% to 0.2% of open cases. In laparoscopic cholecystectomy, approximately 25–30% of biliary injuries are identified during the operation; the rest become apparent in the early post-operative period.
212:
717:) is an experimental technique where the laparoscope is inserted through natural orifices and internal incisions, rather than skin incisions, to access to the abdominal cavity. This offers the potential to eliminate visible scars. Since 2007, cholecystectomy by NOTES has been performed anecdotally via transgastric and transvaginal routes. As of 2009 the risk of
980:
336:. The common bile duct drains the liver and pancreas, and a blockage there can lead to inflammation and infection in both the pancreas and biliary system. While cholecystectomy is not usually the immediate treatment choice for either of these conditions, it is often recommended to prevent repeat episodes from additional gallstones getting stuck.
701:, instead of the 3-4 four small different incisions used in standard laparoscopy. There appears to be a cosmetic benefit over conventional four-hole laparoscopic cholecystectomy, and no advantage in postoperative pain and hospital stay compared with standard laparoscopic procedures. There is no scientific consensus regarding risk for
949:
complications from surgery under general anaesthesia, such as elderly people and those with co-existing illnesses. Draining pus and infected material through the tube reduces inflammation in and around the gallbladder. It can be a lifesaving procedure, without requiring that the person undergo emergency surgery.
2284:
Rábago LR, Vicente C, Soler F, Delgado M, Moral I, Guerra I, Castro JL, Quintanilla E, Romeo J, Llorente R, Vázquez
Echarri J, Martínez-Veiga JL, Gea F (August 2006). "Two-stage treatment with preoperative endoscopic retrograde cholangiopancreatography (ERCP) compared with single-stage treatment with
948:
is the drainage of the gallbladder via insertion of a small tube through the abdominal wall. This is usually done using guidance from imaging scans to find the right place to insert the tube. Cholecystostomy can be used for people who need immediate drainage of the gallbladder but have a high risk of
887:
Conservative management for biliary colic involves a "watch and wait" approach—treating symptoms as-needed with oral medications. Experts agree that this is the preferred treatment for people with gallstones but no symptoms. Conservative management may also be appropriate for people with mild biliary
855:
It is generally safe for pregnant women to undergo laparoscopic cholecystectomy during any trimester of pregnancy. Early elective surgery is recommended for women with symptomatic gallstones to decrease the risk of spontaneous abortion and pre-term delivery. Without cholecystectomy, more than half of
778:
After surgery, most patients are admitted to the hospital for routine monitoring. For uncomplicated laparoscopic cholecystectomies, people may be discharged on the day of surgery after adequate control of pain and nausea. Patients who were high-risk, those who required emergency surgery, and/or those
614:
The 1-week-old incisions of a post-operative laparoscopic cholecystectomy as indicated by red arrows. The 3 abdominal incisions are approximately 6mm, while the fourth incision near the umbilicus is 18mm, each closed with dissolvable sutures. Minor inflammation can be seen surrounding each site due
393:
All surgery carries risk of serious complications including damage to nearby structures, bleeding, infection, or even death. The operative death rate in cholecystectomy is about 0.1% in people under age 50 and about 0.5% in people over age 50. The greatest risk of death comes from co-existing illness
2407:
Tzovaras G, Baloyiannis I, Zachari E, Symeonidis D, Zacharoulis D, Kapsoritakis A, Paroutoglou G, Potamianos S (March 2012). "Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: interim analysis of a controlled
936:
procedure that can remove gallstones or prevent blockages by widening parts of the bile duct where gallstones frequently get stuck. ERCP is often used to retrieve stones stuck in the common bile duct in patients with gallstone pancreatitis or cholangitis. In this procedure, an endoscope, or small,
580:
In recent years the LERV technique, in which access to the common bile duct by ERCP is facilitated by an antegrade guidewire, which is intraoperatively introduced during fluoroscopy and is advanced through the cystic duct to the duodenum, has been established as an alternative to treat common bile
959:
For some people, drainage with cholecystostomy is enough and they do not need to have the gallbladder removed later. For others, percutaneous cholecystostomy allows them to improve enough in the short term that they can get surgery at a later time. There is no clear evidence one way or another to
1024:
in 1980. He subsequently designed an optical laparoscope with a working channel large enough to fit a distended gallbladder. Mühe presented his technique to the
Congress of the German Surgical Society in 1986, claiming reduced postoperative pain and shorter hospitalization. His work was met with
593:
Abdomen of a 45-year-old male approximately one month after a laparoscopic cholecystectomy. Surgical incision points are highlighted; the point at top right is barely visible. The gall bladder was removed via the incision at the navel. There is a fourth incision (not shown) on the person's right
787:
Intra-operative decisions, with patient safety at the forefront, sometimes call for, what is known in surgical education as, "bail-out" procedures. This is usually due to the surgical team making a clinical decision in the operating room to not proceed with the intended cholecystectomy, due to
276:
of the gallbladder caused by interruption in the normal flow of bile, is another reason for cholecystectomy. It is the most common complication of gallstones; 90–95% of acute cholecystitis is caused by gallstones blocking drainage of the gallbladder. If the blockage is incomplete and the stone
841:
concluded that cholecystecomy has no effect on the risk of colorectal cancer overall, but does have a harmful effect on the risk of right-sided colon cancer. A nationwide cohort study in Korea reported a significantly increased total cancer risk, including increased risk of several different
242:) done for some other reason. The traditional risk factors for gallstones are the four “F's: female, fat, forty, and fertile. Of the more than 20 million people in the US with gallstones, only about 30% will eventually require cholecystectomy to relieve symptoms (pain) or treat complications.
769:
After removal, the gallbladder should be sent for pathological examination to confirm the diagnosis and look for any incidental cancer. Incidental cancer of the gallbladder is found in approximately 1% of cholecystectomies. If cancer is present in the gallbladder, it is usually necessary to
372:
There are no specific contraindications for cholecystectomy, and in general it is considered a low-risk surgery. However, anyone who cannot tolerate surgery under general anesthesia should not undergo cholecystectomy. People can be split into high and low risk groups using a tool such as the
1032:. His technique was rapidly adopted and improved in France. It was subsequently introduced to the rest of the world over the next three years. Driven by popularity among patients, the laparoscopic technique became preferred over open surgery and noninvasive treatments for gallstones.
733:. Open cholecystectomy is often done if difficulties arise during a laparoscopic cholecystectomy, for example, the patient has unusual anatomy, the surgeon cannot see well enough through the camera, or the patient is found to have cancer. It can also be done if the patient has severe
899:
Conservative management for acute cholecystitis involves treating the infection without surgery. It is usually only considered in patients at very high risk for surgery or other interventions listed below. It consists of treatment with intravenous antibiotics and fluids.
565:
Experts agree that many biliary injuries in laparoscopic cases are caused by difficulties seeing and identifying the anatomy clearly. If the surgeon has problems identifying anatomical structures, they might need to convert from laparoscopic to open cholecystectomy.
576:
CBDS are found in 10–15% of patients during cholecystectomy when intraoperative cholangiography (IOC) is routinely performed. There are several strategies to manage choledocholithiasis but the optimal method as well as the timing of treatment is still under debate.
2478:
Tommasi C, Bencini L, Bernini M, Naspetti R, Cavallina G, Manetti R, Talamucci L, Farsi M (May 2013). "Routine use of simultaneous laparoendoscopic approach in patients with confirmed gallbladder and bile duct stones: fit for laparoscopy fit for "rendezvous"".
28:
2248:
Möller M, Gustafsson U, Rasmussen F, Persson G, Thorell A (October 2014). "Natural course vs interventions to clear common bile duct stones: data from the
Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks)".
537:
Leakage from the stump of the cystic duct is a complication that is more common with the laparoscopic approach than the open approach but is still rare, occurring in less than 1% of procedures; it is treated by drainage followed by insertion of a bile duct
1384:
Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G, Barlera S, Davoli M (May 2015). "Laparoscopic cholecystectomy: consensus conference-based guidelines".
2707:
Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, Miura F, Mayumi T, Yoshida M, Strasberg S, Pitt HA, de
Santibanes E, Belghiti J, Büchler MW, Gouma DJ, Fan ST, Hilvano SC, Lau JW, Kim SW, Belli G, Windsor JA, Liau KH, Sachakul V (January 2007).
1938:
429:
359:
between adults, a cholecystectomy is performed in the donor because the gallbladder interferes with removal of the right (lateral) lobe of the liver and to prevent the formation of gallstones in the recipient. The gallbladder is not removed in
300:
on physical exam – meaning that when a doctor asks the patient to take a deep breath and then pushes down on the upper right side of their abdomen, the patient stops their inhalation due to pain from the pressure on their inflamed gallbladder.
308:
cholecystitis. It usually develops in people who have abnormal bile drainage secondary to a serious illness, such as people with multi-organ failure, serious trauma, recent major surgery, or following a long stay in the intensive care unit.
924:, an x-ray of the bile ducts using contrast medium to make the bile ducts visible. 1 – Duodenum. 2 – Common bile duct. 3 – Cystic duct. 4 – Hepatic duct. The gallbladder is not seen as the cystic duct is occluded by a surgical instrument.
660:
cholecystectomy uses several (usually 4) small incisions in the abdomen to allow the insertion of operating ports, small cylindrical tubes approximately 5 to 10 mm in diameter, through which surgical instruments are placed into the
640:
is given to prevent deep vein thrombosis. Use of prophylactic antibiotics is controversial; however, a dose may be given prior to surgery to prevent infection in certain people at high risk. Gas may be removed from the stomach with an
1642:
Kimura Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Windsor JA, Mayumi T, Yoshida M, Miura F, Higuchi R, Gabata T, Hata J, Gomi H, Dervenis C, Lau WY, Belli G, Kim MH, Hilvano SC, Yamashita Y (January 2013).
669:, an instrument with a video camera and light source at the end, illuminates the abdominal cavity and sends a magnified image from inside the abdomen to a video screen, giving the surgeon a clear view of the organs and tissues. The
856:
such women will have recurrent symptoms during their pregnancy, and nearly one in four will develop a complication, such as acute cholecystitis, that requires urgent surgery. Acute cholecystitis is the second most common cause of
377:. In this system, people who are ASA categories III, IV, and V are considered high risk for cholecystectomy. Typically this includes very elderly people and people with co-existing illness, such as end-stage liver disease with
312:
People with repeat episodes of acute cholecystitis can develop chronic cholecystitis from changes in the normal anatomy of the gallbladder. This can also be an indication for cholecystectomy if the person has ongoing pain.
684:
As of 2008, 90% of cholecystectomies in the United States were done laparoscopically. Laparoscopic surgery is thought to have fewer complications, shorter hospital stay, and quicker recovery than open cholecystectomy.
2671:
Ingraham AM, Cohen ME, Ko CY, Hall BL (August 2010). "A current profile and assessment of north
American cholecystectomy: results from the American college of surgeons national surgical quality improvement program".
2860:
Chamberlain RS, Sakpal SV (September 2009). "A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy".
2011:
Siiki A, Rinta-Kiikka I, Sand J, Laukkarinen J (May 2015). "Biodegradable biliary stent in the endoscopic treatment of cystic duct leak after cholecystectomy: the first case report and review of literature".
2320:
Deslandres E, Gagner M, Pomp A, Rheault M, Leduc R, Clermont R, Gratton J, Bernard EJ (1993). "Intraoperative endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy".
1691:
Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, Yoshida M, Mayumi T, Wada K, Miura F, Yasuda H, Yamashita Y, Nagino M, Hirota M, Tanaka A, Tsuyuguchi T, Strasberg SM, Gadacz TR (2007).
2443:
Swahn F, Nilsson M, Arnelo U, Löhr M, Persson G, Enochsson L (April 2013). "Rendezvous cannulation technique reduces post-ERCP pancreatitis: a prospective nationwide study of 12,718 ERCP procedures".
2047:
Schafer M, Suter C, Klaiber C, et al. (Apr 1998). "Spilled gallstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies".
545:
Another complication singular to the laparoscopic procedure is the phenomenon of the "spilled gallstone" which complicates 0.08–0.3% of cases. Here a stone escapes the resected gallbladder into the
176:
and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed in hospitals in the United States. Cholecystectomy can be performed either
1840:
Abbasoğlu O, Tekant Y, Alper A, Aydın Ü, Balık A, Bostancı B, Coker A, Doğanay M, Gündoğdu H, Hamaloğlu E, Kapan M, Karademir S, Karayalçın K, Kılıçturgay S, Şare M, Tümer AR, Yağcı G (2016).
729:
In open cholecystectomy, a surgical incision of around 8 to 12 cm is made below the edge of the right rib cage and the gallbladder is removed through this large opening, typically using
952:
The procedure does come with significant risks and complications—in one retrospective study of patients who received percutaneous cholecystostomy for acute cholecystitis, 44% developed
234:
Gallstones are very common but 50–80% of people with gallstones are asymptomatic and do not need surgery; their stones are noticed incidentally on imaging tests of the abdomen (such as
1521:
3417:
409:
Damage to the bile ducts is very serious because it causes leakage of bile into the abdomen. Signs and symptoms of a bile leak include abdominal pain, tenderness, fever and signs of
347:(also called carcinoma of the gallbladder) is a rare indication for cholecystectomy. In cases where cancer is suspected, the open technique for cholecystectomy is usually performed.
1057:
Laparoscopic cholecystectomy can be a challenging procedure and surgeons must be trained with advanced laparoscopic skills to complete the operation with safety and effectiveness.
3640:
432:
and routine use deemed to decrease risk of injury and morbidity following unaddressed injury while only increasing cancer rates due to radiation exposure by a lesser fraction.
277:
passes quickly, the person experiences biliary colic. If the gallbladder is completely blocked and remains so for a prolonged period, the person develops acute cholecystitis.
803:. Symptoms are typically similar to the pain and discomfort of biliary colic with persistent pain in the upper right abdomen and commonly include gastrointestinal distress (
187:
The surgery is usually successful in relieving symptoms, but up to 10 percent of people may continue to experience similar symptoms after cholecystectomy, a condition called
908:
4541:
424:
Injury of the bile ducts can be prevented and treated by routinely using X-ray investigation of the bile ducts (intraoperative cholangiography (IOC)). This method was
714:
4312:
929:
257:, occurs when a gallstone temporarily blocks the bile duct that drains the gallbladder. Typically, pain from biliary colic is felt in the right upper part of the
4273:
3442:
Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di
Saverio S, Leandro G, Montori G, Ceresoli M, Corbella D, Sartelli M, Sugrue M, Ansaloni L (June 2015).
2141:"Need brooks no delay. Peritoneo-cutaneous fistula formation secondary to gallstone dropped at laparoscopic cholecystectomy 20 years previously: a case report"
4338:
2955:"Laparoscopic subtotal cholecystectomy: a classification, which encompasses the variants, technical modalities, and extent of resection of the gallbladder"
4577:
2548:
Sanabria A, Dominguez LC, Valdivieso E, Gomez G (December 2010). "Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy".
879:
There are several alternatives to cholecystectomy for people who do not want surgery, or in whom the benefits of surgery would not outweigh the risks.
830:. Most cases resolve within weeks or a few months, though in rare cases the condition can last for years. It can be controlled with medication such as
4343:
3633:
374:
3576:
4079:
3109:
Gurusamy KS, Rossi M, Davidson BR (August 2013). "Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis".
826:, the portion of the intestine where these salts are normally reabsorbed, becomes overwhelmed, does not absorb everything, and the person develops
4236:
1304:
796:
In 95% of people undergoing cholecystectomy as treatment for simple biliary colic, removing the gallbladder completely resolves their symptoms.
122:
3499:
3259:
3004:"The association between cholecystectomy and the risk of colorectal cancer: an updated systematic review and meta-analysis of cohort studies"
2647:
2532:
1626:
1586:
1497:
1349:
1174:
1529:
4582:
3791:
3626:
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lower flank, used for draining. All incisions have healed well and the most visible remaining effect of surgery is from the pre-operative
553:
if it is not identified and removed. Some reports exist of spilled stones lying unnoticed for up to 20 years before eventually causing an
1138:
3840:
971:
In a study of
Medicaid-covered and uninsured U.S. hospital stays in 2012, cholecystectomy was the most common operating room procedure.
912:
In ERCP, the endoscope enters through the mouth and passes through the stomach and start of the small intestine to reach the bile ducts.
889:
4278:
1964:"Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis"
356:
328:
are rarer and more serious complications from gallstone disease. Both can occur if gallstones leave the gallbladder, pass through the
3217:
721:, difficulty visualizing the abdominal cavity and other technical limitations limited further adoption of NOTES for cholecystectomy.
4536:
4531:
1930:
837:
A systematic review and meta analysis of eighteen studies on the association between cholecystectomy and the risk of development of
2760:
Lirici MM, Tierno SM, Ponzano C (October 2016). "Single-incision laparoscopic cholecystectomy: does it work? A systematic review".
602:
1776:
1255:"Right hepatectomy due to portal vein thrombosis in vasculobiliary injury following laparoscopic cholecystectomy: a case report"
4069:
3776:
3727:
280:
Pain in cholecystitis is similar to that of biliary colic, but lasts longer than six hours and occurs together with signs of
143:
3750:
1553:
Gallstone
Disease: Diagnosis and Management of Cholelithiasis, Cholecystitis and Choledocholithiasis. Clinical Guideline 188
610:
1962:
Pucher PH, Brunt LM, Davies N, Linsk A, Munshi A, Rodriguez HA, Fingerhut A, Fanelli RD, Asbun H, Aggarwal R (March 2018).
4158:
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181:
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3916:
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800:
718:
425:
188:
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1794:
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indicate that surgical removal after cholecystostomy is best for high-risk surgical patients with acute cholecystitis.
956:(one or more stones stuck in the common bile duct), 27% had tube dislodgment, and 23% developed postoperative abscess.
4333:
4168:
1842:"Prevention and acute management of biliary injuries during laparoscopic cholecystectomy: Expert consensus statement"
1305:"The National Institutes of Health (NIH) Consensus Development Program: Gallstones and Laparoscopic Cholecystectomy"
571:
Peroperative Endoscopic Retrograde Cholangio-Pancreaticography (ERCP)/ Laparo-endoscopic rendezvous (LERV) technique
4241:
4163:
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are the most common reasons for removal of the gallbladder. The gallbladder can also be removed in order to treat
4429:
4219:
4133:
4041:
3960:
3732:
3722:
1066:
1039:
cholecystectomy had replaced open cholecystectomy as the first-choice of treatment for people with uncomplicated
815:
681:
with clips and cut in order to remove the gallbladder. The gallbladder is then removed through one of the ports.
4523:
4378:
4036:
3717:
3659:
3055:"Increased Risk of Cancer after Cholecystectomy: A Nationwide Cohort Study in Korea including 123,295 Patients"
697:) or laparoendoscopic single site surgery (LESS) is a technique in which a single incision is made through the
304:
Five to ten percent of acute cholecystitis occurs in people without gallstones, and for this reason, is called
129:
440:
A review of safety data in laparoscopic cholecystectomy found the following complications to be most common:
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4013:
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3618:
1076:
694:
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1239:
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Swahn F, Regnér S, Enochsson L, Lundell L, Permert J, Nilsson M, Thorlacius H, Arnelo U (September 2013).
1758:
953:
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1693:"Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines"
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4263:
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3818:
868:
746:
637:
321:
4546:
3169:"High rate of common bile duct stones and postoperative abscess following percutaneous cholecystostomy"
1892:
Stewart L (April 2014). "Iatrogenic biliary injuries: identification, classification, and management".
1010:
814:. The cause is unclear, but is presumed to be due to disturbances in the biliary system that speed up
3444:"Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis"
2358:"Endoscopic retrograde cholangiopancreatography with rendezvous cannulation reduces pancreatic injury"
1312:
1013:. Mühe was inspired to develop a technique for laparoscopic cholecystectomy by the first laparoscopic
4074:
2285:
intraoperative ERCP for patients with symptomatic cholelithiasis with possible choledocholithiasis".
1051:
1036:
633:
629:
527:
418:
4449:
4373:
4268:
4173:
4148:
4064:
4059:
4003:
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1811:
754:
678:
378:
3374:"Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time"
1485:
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3786:
2935:
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2785:
2611:
2072:
1410:
779:
undergoing open cholecystectomy usually need to stay in the hospital several days after surgery.
531:
344:
235:
228:
224:
1740:
1139:"Characteristics of Operating Room Procedures in U.S. Hospitals, 2011 – Statistical Brief #170"
33:
A US Navy general surgeon and an operating room nurse performing a laparoscopic cholecystectomy
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1993:
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1355:
1345:
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1180:
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1120:
1071:
838:
465:
117:
105:
1645:"TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis"
770:
re-operate to remove parts of the liver and lymph nodes and test them for additional cancer.
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3756:
3544:
3536:
3523:
Mulita, Francesk; Benetatos, Nikolaos; Maroulis, Ioannis; Germanos, Stylianos (2021-01-18).
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2553:
2523:
Brunicardi FC, Andersen DK, Dunn DL, Hunter JG, Matthews JB, Pollock RE, Billiar TR (2014).
2488:
2452:
2417:
2379:
2369:
2330:
2294:
2258:
2201:
2160:
2152:
2111:
2103:
2056:
2021:
1983:
1975:
1901:
1861:
1853:
1712:
1704:
1656:
1449:
1441:
1394:
1276:
1266:
1218:
702:
662:
333:
297:
44:
916:
4551:
4328:
4324:
4307:
4089:
3985:
3975:
3950:
3938:
3925:
3877:
995:
994:
on July 15, 1882. Before this, surgical therapy for symptomatic gallstones was limited to
987:
945:
921:
742:
589:
414:
110:
1165:
Mulholland MW, Lillemoe KD, Doherty GM, Upchurch GR, Alam HB, Pawlik TM (December 2016).
3030:
3003:
4556:
4383:
4246:
4191:
3897:
3867:
3761:
3702:
3685:
3549:
3524:
3390:
3373:
3349:
3332:
3293:
3276:
3193:
3168:
3079:
3054:
2979:
2954:
2834:
2807:
2734:
2709:
2384:
2357:
2165:
2140:
2116:
2091:
1988:
1963:
1866:
1841:
1717:
1692:
1454:
1429:
1281:
1254:
1253:
Jadrijevic, S; Sef, D; Kocman, B; Mrzljak, A; Matasic, H; Skegro, D (7 December 2014).
831:
730:
646:
403:
192:
2685:
2334:
2190:"Iatrogenic biliary injuries during laparoscopic cholecystectomy. A continuing threat"
444:
Rates of complications other than bile duct injury after laparoscopic cholecystectomy
4571:
4467:
4196:
4126:
3862:
3697:
3599:
2922:
2905:
2584:"SAGES guidelines for the clinical application of laparoscopic biliary tract surgery"
2092:"Spilled gall stones during laparoscopic cholecystectomy: a review of the literature"
1044:
1006:
857:
734:
674:
269:
250:
3494:. Agresta, Ferdinando, Campanile, Fabio Cesare, Vettoretto, Nereo. Cham : Springer.
2939:
2615:
1414:
4444:
4258:
4153:
4138:
3993:
3118:
2890:
2789:
2557:
1029:
1018:
1014:
595:
382:
325:
293:
273:
3140:
2076:
2421:
1939:
Swedish Agency for Health Technology Assessment and Assessment of Social Services
1445:
135:
4434:
4290:
4253:
4121:
4116:
4101:
3965:
3852:
3835:
3813:
3803:
3707:
670:
666:
657:
329:
177:
169:
3460:
3443:
3333:"Twenty years of laparoscopic cholecystectomy: Philippe Mouret--March 17, 1987"
2206:
2189:
1741:"What to expect after your liver transplant | Nebraska Medicine Omaha, NE"
1223:
1206:
1108:
968:
About 600,000 people receive a cholecystectomy in the United States each year.
526:
The same study found the prevalence of bowel injury, sepsis, pancreatitis, and
211:
195:, wound infection, bleeding, vasculobiliary injury, retained gallstones, liver
4497:
4439:
4416:
4183:
4051:
3830:
3808:
2874:
2773:
2725:
2657:
2599:
2492:
2262:
1979:
1905:
1708:
1661:
1644:
1507:
1398:
1342:
Sabiston textbook of surgery: the biological basis of modern surgical practice
979:
220:
3509:
3184:
2970:
2808:"New minimally invasive approaches for cholecystectomy: Review of literature"
2374:
1596:
1359:
1184:
1028:
Philippe Mouret performed laparoscopic cholecystectomy on March 17, 1987, in
4294:
4097:
4008:
3998:
3955:
3885:
3689:
3540:
2824:
2107:
1271:
1040:
1021:
933:
819:
804:
758:
750:
361:
281:
254:
173:
3558:
3469:
3399:
3358:
3302:
3229:
3202:
3126:
3088:
3039:
2988:
2931:
2882:
2843:
2781:
2743:
2710:"Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines"
2693:
2607:
2565:
2500:
2464:
2429:
2393:
2306:
2270:
2215:
2174:
2125:
2033:
1997:
1913:
1875:
1726:
1670:
1560:
1463:
1406:
1290:
1232:
1124:
1009:
performed the first laparoscopic cholecystectomy on September 12, 1985, in
799:
Up to 10% of people who undergo cholecystectomy develop a condition called
2342:
2298:
2156:
2068:
2060:
2025:
1857:
990:
performed the first successful cholecystectomy at the Lazarus hospital in
4365:
4106:
3020:
2456:
827:
811:
616:
200:
3490:
Agresta, Ferdinando; Campanile, Fabio Cesare; Vettoretto, Nereo (2014).
888:
colic, as the pain from colic can be managed with pain medications like
413:
several days following surgery, or through laboratory studies as rising
3742:
1107:
Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK (May 2014).
983:
Carl Langenbuch performed the first successful cholecystectomy in 1882.
738:
554:
546:
258:
239:
196:
3070:
2014:
Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
155:
4459:
4023:
3216:
Lopez-Gonzalez L, Pickens GT, Washington R, Weiss AJ (October 2014).
991:
893:
515:
410:
289:
3053:
Choi YJ, Jin EH, Lim JH, Shin CM, Kim N, Han K, Lee DH (May 2022).
4228:
3224:(183). Rockville, MD: Agency for Healthcare Research and Quality.
3218:"Characteristics of Medicaid and Uninsured Hospitalizations, 2012"
978:
915:
907:
823:
698:
609:
601:
588:
539:
285:
210:
2230:
2582:
Overby DW, Apelgren KN, Richardson W, Fanelli R (October 2010).
364:
transplantations as the left lobe of the liver is used instead.
3622:
3331:
Polychronidis A, Laftsidis P, Bounovas A, Simopoulos C (2008).
2231:"Årsrapport för Svenskt Kvalitetsregister för gallstenskirurgi"
2090:
Satesh-Kumar T, Saklani A, Vinayagam R, Blackett R (Feb 2004).
2642:. Yeo, Charles J. (8th ed.). Philadelphia, PA: Elsevier.
296:. People with cholecystitis will also usually have a positive
3254:(5th ed.). Philadelphia: Elsevier Saunders. p. 6.
3252:
Blumgart's surgery of the liver, biliary tract, and pancreas
2806:
Gaillard M, Tranchart H, Lainas P, Dagher I (October 2015).
1555:. National Institute for Health and Care Excellence (NICE).
1340:
Townsend CM, Evers BM, Mattox KL, Beauchamp RD (June 2016).
3418:"The first Lap Chole in Europe: A 'Criminal' Is Vindicated"
705:
with SILS versus traditional laparoscopic cholecystectomy.
92:
86:
77:
59:
1167:
Greenfield's surgery: scientific principles & practice
53:
606:
Steps of a cholecystectomy, as seen through a laparoscope
65:
2188:
Malik AM, Laghari AA, Talpur AH, Khan A (October 2008).
3167:
Furtado R, Le Page P, Dunn G, Falk GL (February 2016).
1551:
Internal Clinical Guidelines Team (UK) (October 2014).
385:. Alternatives to surgery are briefly mentioned below.
172:. Cholecystectomy is a common treatment of symptomatic
2959:
The Annals of the Royal College of Surgeons of England
1344:(20th ed.). Philadelphia, PA: Elsevier Saunders.
3492:
Laparoscopic Cholecystectomy: an Evidence-based Guide
80:
68:
62:
50:
47:
2229:
Persson G, Enochsson L, Sandblom G (8 August 2017).
1572:
1570:
1050:
By 2014 laparoscopic cholecystectomy had become the
83:
74:
56:
4522:
4490:
4458:
4415:
4406:
4364:
4289:
4227:
4218:
4182:
4088:
4050:
4022:
3984:
3924:
3915:
3876:
3741:
3684:
3675:
3666:
3577:"Operation Brochures for Patients: Cholecystectomy"
1931:"Intraoperative cholangiography in cholecystectomy"
1109:"Surgical and nonsurgical management of gallstones"
142:
128:
116:
104:
89:
71:
38:
21:
3173:Annals of the Royal College of Surgeons of England
1621:(24th ed.). Philadelphia: Elsevier Saunders.
1479:
1477:
1475:
1473:
810:Some people following cholecystectomy may develop
2633:
2631:
2629:
2627:
2625:
1835:
1833:
1831:
1812:"Treatment of Gallstones and Gallbladder Disease"
842:specific types of cancer, after cholecystectomy.
713:Natural orifice transluminal endoscopic surgery (
3326:
3324:
3322:
3320:
3318:
3316:
3314:
3312:
3104:
3102:
3100:
3098:
1759:"Living Donor Liver Transplant | Baltimore"
3162:
3160:
1887:
1885:
1379:
1377:
1375:
1373:
1371:
1369:
2855:
2853:
1957:
1955:
1612:
1610:
1608:
1606:
1335:
1333:
1331:
1329:
1169:(6th ed.). Philadelphia: Wolters Kluwer.
930:endoscopic retrograde cholangiopancreatography
4274:Transjugular intrahepatic portosystemic shunt
3634:
3250:Jarnagin WR, Belghiti J, Blumgart LH (2012).
3002:Mu L, Li W, Ren W, Hu D, Song Y (June 2023).
2755:
2753:
2640:Shackelford's surgery of the alimentary tract
1649:Journal of Hepato-Biliary-Pancreatic Sciences
1160:
1158:
1054:for the treatment of symptomatic gallstones.
402:A serious complication of cholecystectomy is
8:
2714:Journal of Hepato-Biliary-Pancreatic Surgery
1697:Journal of Hepato-Biliary-Pancreatic Surgery
1686:
1684:
1682:
1680:
1200:
1198:
1196:
1194:
649:may be used to empty the patient's bladder.
3245:
3243:
3241:
3239:
3111:The Cochrane Database of Systematic Reviews
2801:
2799:
2674:Journal of the American College of Surgeons
2550:The Cochrane Database of Systematic Reviews
2518:
2516:
2514:
2512:
2510:
1816:Society for Surgery of the Alimentary Tract
191:. Complications of cholecystectomy include
4412:
4224:
3921:
3681:
3672:
3641:
3627:
3619:
1797:. Johns Hopkins Medical. 19 November 2019.
1490:CURRENT Diagnosis & Treatment: Surgery
27:
3548:
3459:
3389:
3348:
3292:
3192:
3078:
3029:
3019:
2978:
2921:
2833:
2823:
2812:World Journal of Gastrointestinal Surgery
2733:
2577:
2575:
2383:
2373:
2205:
2164:
2115:
1987:
1865:
1716:
1660:
1453:
1280:
1270:
1222:
1205:Jaunoo SS, Mohandas S, Almond LM (2010).
1102:
1100:
1098:
1096:
1094:
1092:
375:ASA physical status classification system
4080:Transanal hemorrhoidal dearterialization
3277:"The first laparoscopic cholecystectomy"
3141:"ERCP: MedlinePlus Medical Encyclopedia"
2910:The American Journal of Gastroenterology
2527:(10th ed.). McGraw-Hill Education.
1777:"Liver Donors FAQ: The Donation Surgery"
1492:(14th ed.). McGraw-Hill Education.
615:to skin irritation caused by removal of
442:
4237:Artificial extracorporeal liver support
1806:
1804:
1088:
483:Retained stone in the common bile duct
3411:
3409:
860:in pregnant women after appendectomy.
693:Single incision laparoscopic surgery (
317:Cholangitis and gallstone pancreatitis
18:
1925:
1923:
1894:The Surgical Clinics of North America
7:
3792:Vertical banded gastroplasty surgery
1207:"Postcholecystectomy syndrome (PCS)"
3841:Percutaneous endoscopic gastrostomy
3649:Tests and procedures involving the
2863:Journal of Gastrointestinal Surgery
677:are identified and dissected, then
394:like cardiac or pulmonary disease.
151:
16:Surgical removal of the gallbladder
4279:Distal splenorenal shunt procedure
561:Conversion to open cholecystectomy
383:whose blood does not clot properly
357:living donor liver transplantation
14:
4578:Accessory digestive gland surgery
2686:10.1016/j.jamcollsurg.2010.04.003
2139:Nugent L, Chandran P (Feb 2018).
1430:"Risk Factors for Cholelithiasis"
1428:Pak, M; Lindseth, G (July 2016).
219:Pain and complications caused by
3475:
3448:International Journal of Surgery
2923:10.1111/j.1572-0241.2001.03597.x
2525:Schwartz's principles of surgery
2194:International Journal of Surgery
2145:Journal of Surgical Case Reports
1387:Langenbeck's Archives of Surgery
1238:
1211:International Journal of Surgery
43:
4070:Lateral internal sphincterotomy
2906:"Incidental gallbladder cancer"
1528:. November 2013. Archived from
1259:Journal of Medical Case Reports
294:elevated white blood cell count
168:is the surgical removal of the
3777:Endoscopic sleeve gastroplasty
3728:Functional Lumen Imaging Probe
3119:10.1002/14651858.CD007088.pub2
2558:10.1002/14651858.CD005265.pub2
1581:. Philadelphia, PA: Elsevier.
203:(narrowing) of the bile duct.
1:
4159:Lower gastrointestinal series
3903:Upper gastrointestinal series
2335:10.1016/s0016-5107(93)70011-5
1579:Essential surgical procedures
737:, emphysematous gallbladder,
4425:Diagnostic peritoneal lavage
4144:Double-contrast barium enema
3971:Partial ileal bypass surgery
3848:Esophagogastric dissociation
3581:American College of Surgeons
2953:Lunevicius, R (April 2020).
2422:10.1097/SLA.0b013e3182456ec0
1446:10.1097/SGA.0000000000000235
801:postcholecystectomy syndrome
709:Natural orifice transluminal
653:Laparoscopic cholecystectomy
189:postcholecystectomy syndrome
4583:Surgical removal procedures
4242:Bioartificial liver devices
4169:Transrectal ultrasonography
1577:Velasco JM (October 2015).
4599:
4164:Small-bowel follow-through
4032:Abdominoperineal resection
3891:Esophagogastroduodenoscopy
3461:10.1016/j.ijsu.2015.04.083
2207:10.1016/j.ijsu.2008.07.005
1224:10.1016/j.ijsu.2009.10.008
4524:Clinical prediction rules
4430:Intraperitoneal injection
4134:Abdominal ultrasonography
4042:Total mesorectal excision
3961:Intestine transplantation
3751:Sengstaken–Blakemore tube
3733:High resolution manometry
3723:Esophageal motility study
3657:
2875:10.1007/s11605-009-0902-y
2774:10.1007/s00464-016-4757-5
2726:10.1007/s00534-006-1161-x
2600:10.1007/s00464-010-1268-7
2493:10.1007/s00268-013-1962-4
2263:10.1001/jamasurg.2014.249
1980:10.1007/s00464-017-5974-2
1906:10.1016/j.suc.2014.01.008
1709:10.1007/s00534-006-1152-y
1662:10.1007/s00534-012-0564-0
1399:10.1007/s00423-015-1300-4
1113:American Family Physician
1067:List of surgeries by type
774:Post-operative management
624:Pre-operative preparation
534:to be around 0.15% each.
152:
26:
4379:Pancreas transplantation
4037:Lower anterior resection
3718:Esophageal pH monitoring
3660:Digestive system surgery
3525:"Enlarged cystic artery"
3416:Stern V (10 June 2013).
3185:10.1308/rcsann.2016.0004
2971:10.1308/rcsann.2020.0007
2904:Kapoor VK (March 2001).
2638:Yeo, Charles J. (2018).
2375:10.3748/wjg.v19.i36.6026
1781:ucsfbenioffchildrens.org
1619:Goldman's Cecil Medicine
1434:Gastroenterology Nursing
783:Subtotal Cholecystectomy
507:Intra-abdominal abscess
4473:Inguinal hernia surgery
4389:Pancreaticoduodenectomy
3772:Adjustable gastric band
3713:Impedance–pH monitoring
3541:10.1136/bcr-2020-240056
2825:10.4240/wjgs.v7.i10.243
2108:10.1136/pmj.2003.006023
1488:. In Doherty GM (ed.).
1272:10.1186/1752-1947-8-412
1077:Waltman Walter syndrome
883:Conservative management
875:Alternatives to surgery
332:, and get stuck in the
4503:Exploratory laparotomy
4318:Hepatoportoenterostomy
3782:Gastric bypass surgery
3651:human digestive system
3222:HCUP Statistical Brief
1846:Ulusal Cerrahi Dergisi
1002:Laparoscopic technique
984:
925:
913:
638:Prophylactic treatment
636:are usually obtained.
620:
607:
599:
549:where it can become a
326:gallstone pancreatitis
216:
4478:Femoral hernia repair
4264:Liver transplantation
3858:Nissen fundoplication
3600:"Gallbladder removal"
2362:World J Gastroenterol
2299:10.1055/s-2006-944617
2061:10.1007/s004649900659
2026:10.1089/lap.2015.0068
1858:10.5152/UCD.2016.3683
982:
919:
911:
869:Porcelain gallbladder
864:Porcelain gallbladder
719:gastrointestinal leak
613:
605:
592:
351:Liver transplantation
214:
4075:Rubber band ligation
4014:Hartmann's operation
3422:General Surgery News
3372:Litynski GS (1998).
3021:10.21037/tcr-22-2049
2457:10.1038/ajg.2012.470
1143:www.hcup-us.ahrq.gov
725:Open cholecystectomy
634:liver function tests
630:complete blood count
528:deep vein thrombosis
419:alkaline phosphatase
253:, or pain caused by
184:surgical technique.
4450:Peritoneal dialysis
4269:Portal hypertension
4174:Virtual colonoscopy
4149:Endoanal ultrasound
4065:Anorectal manometry
4060:Anal sphincterotomy
4004:Colonic polypectomy
3799:Collis gastroplasty
3275:Reynolds W (2001).
2408:randomized trial".
2323:Gastrointest Endosc
2157:10.1093/jscr/rjy013
1745:www.nebraskamed.com
1484:Doherty GM (2015).
1045:acute cholecystitis
954:choledocholithiasis
892:(ex: ketorolac) or
792:Long-term prognosis
755:portal hypertension
741:of gallbladder and
551:focus for infection
445:
436:Other complications
379:portal hypertension
265:Acute cholecystitis
215:Gallbladder anatomy
3944:Jejunoileal bypass
3787:Sleeve gastrectomy
2762:Surgical Endoscopy
2588:Surgical Endoscopy
2445:Am J Gastroenterol
1968:Surgical Endoscopy
1617:Goldman L (2011).
1011:Böblingen, Germany
985:
926:
914:
628:Before surgery, a
621:
608:
600:
532:pulmonary embolism
443:
345:Gallbladder cancer
340:Gallbladder cancer
229:gallbladder cancer
225:biliary dyskinesia
217:
4565:
4564:
4510:Rapid urease test
4486:
4485:
4402:
4401:
4394:Puestow procedure
4356:Cholescintigraphy
4214:
4213:
4210:
4209:
4202:Stool guaiac test
4112:Capsule endoscopy
3934:Bariatric surgery
3911:
3910:
3826:Gastroenterostomy
3767:Bariatric surgery
3606:. 23 October 2017
3501:978-3-319-05407-0
3261:978-1-4557-4606-4
3071:10.5009/gnl210009
3008:Transl Cancer Res
2649:978-0-323-40232-3
2534:978-0-07-179674-3
1941:(SBU). 2018-08-17
1795:"Cholecystectomy"
1628:978-1-4377-2788-3
1588:978-0-323-37567-2
1499:978-0-07-179211-0
1351:978-0-323-29987-9
1309:consensus.nih.gov
1176:978-1-4698-9001-2
1072:List of -ectomies
839:colorectal cancer
524:
523:
466:Urinary retention
368:Contraindications
163:
162:
4590:
4547:Child–Pugh score
4514:Urea breath test
4413:
4374:Frey's procedure
4351:Cholecystography
4225:
3922:
3757:Nasogastric tube
3682:
3673:
3643:
3636:
3629:
3620:
3615:
3613:
3611:
3595:
3593:
3592:
3583:. Archived from
3563:
3562:
3552:
3529:BMJ Case Reports
3520:
3514:
3513:
3487:
3481:
3480:
3479:
3473:
3463:
3439:
3433:
3432:
3430:
3428:
3413:
3404:
3403:
3393:
3369:
3363:
3362:
3352:
3328:
3307:
3306:
3296:
3272:
3266:
3265:
3247:
3234:
3233:
3213:
3207:
3206:
3196:
3164:
3155:
3154:
3152:
3151:
3137:
3131:
3130:
3106:
3093:
3092:
3082:
3050:
3044:
3043:
3033:
3023:
2999:
2993:
2992:
2982:
2950:
2944:
2943:
2925:
2901:
2895:
2894:
2857:
2848:
2847:
2837:
2827:
2803:
2794:
2793:
2757:
2748:
2747:
2737:
2704:
2698:
2697:
2668:
2662:
2661:
2635:
2620:
2619:
2579:
2570:
2569:
2552:(12): CD005265.
2545:
2539:
2538:
2520:
2505:
2504:
2475:
2469:
2468:
2440:
2434:
2433:
2404:
2398:
2397:
2387:
2377:
2353:
2347:
2346:
2317:
2311:
2310:
2281:
2275:
2274:
2245:
2239:
2238:
2226:
2220:
2219:
2209:
2185:
2179:
2178:
2168:
2136:
2130:
2129:
2119:
2087:
2081:
2080:
2044:
2038:
2037:
2008:
2002:
2001:
1991:
1959:
1950:
1949:
1947:
1946:
1927:
1918:
1917:
1889:
1880:
1879:
1869:
1837:
1826:
1825:
1823:
1822:
1808:
1799:
1798:
1791:
1785:
1784:
1773:
1767:
1766:
1755:
1749:
1748:
1737:
1731:
1730:
1720:
1688:
1675:
1674:
1664:
1639:
1633:
1632:
1614:
1601:
1600:
1574:
1565:
1564:
1548:
1542:
1541:
1539:
1537:
1518:
1512:
1511:
1481:
1468:
1467:
1457:
1425:
1419:
1418:
1381:
1364:
1363:
1337:
1324:
1323:
1321:
1320:
1311:. Archived from
1301:
1295:
1294:
1284:
1274:
1250:
1244:
1243:
1242:
1236:
1226:
1202:
1189:
1188:
1162:
1153:
1152:
1150:
1149:
1135:
1129:
1128:
1104:
964:Frequency of use
928:ERCP, short for
759:blood dyscrasias
703:bile duct injury
663:abdominal cavity
457:Wound infection
446:
334:common bile duct
193:bile duct injury
178:laparoscopically
156:edit on Wikidata
138:
99:
98:
95:
94:
91:
88:
85:
82:
79:
76:
73:
70:
67:
64:
61:
58:
55:
52:
49:
31:
19:
4598:
4597:
4593:
4592:
4591:
4589:
4588:
4587:
4568:
4567:
4566:
4561:
4552:Ranson criteria
4518:
4482:
4454:
4398:
4360:
4329:Cholangiography
4325:Medical imaging
4308:Cholecystostomy
4303:Cholecystectomy
4285:
4206:
4178:
4090:Medical imaging
4084:
4046:
4018:
3980:
3976:Strictureplasty
3951:Bowel resection
3939:Duodenal switch
3907:
3878:Medical imaging
3872:
3737:
3668:Digestive tract
3662:
3653:
3647:
3609:
3607:
3598:
3590:
3588:
3575:
3572:
3570:Further reading
3567:
3566:
3522:
3521:
3517:
3502:
3489:
3488:
3484:
3474:
3441:
3440:
3436:
3426:
3424:
3415:
3414:
3407:
3371:
3370:
3366:
3330:
3329:
3310:
3274:
3273:
3269:
3262:
3249:
3248:
3237:
3215:
3214:
3210:
3166:
3165:
3158:
3149:
3147:
3145:medlineplus.gov
3139:
3138:
3134:
3113:(8): CD007088.
3108:
3107:
3096:
3052:
3051:
3047:
3001:
3000:
2996:
2952:
2951:
2947:
2903:
2902:
2898:
2859:
2858:
2851:
2805:
2804:
2797:
2768:(10): 4389–99.
2759:
2758:
2751:
2706:
2705:
2701:
2670:
2669:
2665:
2650:
2637:
2636:
2623:
2594:(10): 2368–86.
2581:
2580:
2573:
2547:
2546:
2542:
2535:
2522:
2521:
2508:
2487:(5): 999–1005.
2477:
2476:
2472:
2442:
2441:
2437:
2406:
2405:
2401:
2368:(36): 6026–34.
2355:
2354:
2350:
2319:
2318:
2314:
2283:
2282:
2278:
2257:(10): 1008–13.
2247:
2246:
2242:
2228:
2227:
2223:
2187:
2186:
2182:
2138:
2137:
2133:
2089:
2088:
2084:
2046:
2045:
2041:
2010:
2009:
2005:
1961:
1960:
1953:
1944:
1942:
1929:
1928:
1921:
1891:
1890:
1883:
1839:
1838:
1829:
1820:
1818:
1810:
1809:
1802:
1793:
1792:
1788:
1775:
1774:
1770:
1757:
1756:
1752:
1739:
1738:
1734:
1690:
1689:
1678:
1641:
1640:
1636:
1629:
1616:
1615:
1604:
1589:
1576:
1575:
1568:
1550:
1549:
1545:
1535:
1533:
1532:on 28 July 2016
1520:
1519:
1515:
1500:
1486:"Biliary Tract"
1483:
1482:
1471:
1427:
1426:
1422:
1383:
1382:
1367:
1352:
1339:
1338:
1327:
1318:
1316:
1303:
1302:
1298:
1252:
1251:
1247:
1237:
1204:
1203:
1192:
1177:
1164:
1163:
1156:
1147:
1145:
1137:
1136:
1132:
1119:(10): 795–802.
1106:
1105:
1090:
1085:
1063:
1017:, performed by
1004:
996:cholecystostomy
988:Carl Langenbuch
977:
966:
946:Cholecystostomy
943:
941:Cholecystostomy
906:
885:
877:
866:
853:
848:
794:
785:
776:
767:
743:gallstone ileus
727:
711:
691:
689:Single incision
655:
626:
587:
572:
563:
438:
428:by the Swedish
415:total bilirubin
400:
391:
370:
353:
342:
319:
267:
248:
209:
166:Cholecystectomy
159:
134:
111:General surgery
46:
42:
34:
22:Cholecystectomy
17:
12:
11:
5:
4596:
4594:
4586:
4585:
4580:
4570:
4569:
4563:
4562:
4560:
4559:
4557:Milan criteria
4554:
4549:
4544:
4539:
4534:
4528:
4526:
4520:
4519:
4517:
4516:
4507:
4506:
4505:
4494:
4492:
4488:
4487:
4484:
4483:
4481:
4480:
4475:
4470:
4464:
4462:
4456:
4455:
4453:
4452:
4447:
4442:
4437:
4432:
4427:
4421:
4419:
4410:
4408:Abdominopelvic
4404:
4403:
4400:
4399:
4397:
4396:
4391:
4386:
4384:Pancreatectomy
4381:
4376:
4370:
4368:
4362:
4361:
4359:
4358:
4353:
4348:
4347:
4346:
4341:
4336:
4321:
4320:
4315:
4310:
4305:
4299:
4297:
4287:
4286:
4284:
4283:
4282:
4281:
4276:
4266:
4261:
4256:
4251:
4250:
4249:
4247:Liver dialysis
4244:
4233:
4231:
4222:
4216:
4215:
4212:
4211:
4208:
4207:
4205:
4204:
4199:
4194:
4192:Fecal fat test
4188:
4186:
4180:
4179:
4177:
4176:
4171:
4166:
4161:
4156:
4151:
4146:
4141:
4136:
4130:
4129:
4124:
4119:
4114:
4109:
4104:
4094:
4092:
4086:
4085:
4083:
4082:
4077:
4072:
4067:
4062:
4056:
4054:
4048:
4047:
4045:
4044:
4039:
4034:
4028:
4026:
4020:
4019:
4017:
4016:
4011:
4006:
4001:
3996:
3990:
3988:
3982:
3981:
3979:
3978:
3973:
3968:
3963:
3958:
3953:
3948:
3947:
3946:
3941:
3930:
3928:
3919:
3917:Lower GI tract
3913:
3912:
3909:
3908:
3906:
3905:
3900:
3898:Barium swallow
3895:
3894:
3893:
3882:
3880:
3874:
3873:
3871:
3870:
3868:Schilling test
3865:
3860:
3855:
3850:
3845:
3844:
3843:
3833:
3828:
3823:
3822:
3821:
3816:
3811:
3801:
3796:
3795:
3794:
3789:
3784:
3779:
3774:
3764:
3762:Gastric lavage
3759:
3754:
3747:
3745:
3739:
3738:
3736:
3735:
3730:
3725:
3720:
3715:
3710:
3705:
3703:Heller myotomy
3700:
3694:
3692:
3679:
3677:Upper GI tract
3670:
3664:
3663:
3658:
3655:
3654:
3648:
3646:
3645:
3638:
3631:
3623:
3617:
3616:
3596:
3571:
3568:
3565:
3564:
3535:(1): e240056.
3515:
3500:
3482:
3434:
3405:
3364:
3308:
3267:
3260:
3235:
3208:
3156:
3132:
3094:
3065:(3): 465–473.
3045:
3014:(6): 1452–65.
2994:
2945:
2896:
2869:(9): 1733–40.
2849:
2795:
2749:
2699:
2663:
2648:
2621:
2571:
2540:
2533:
2506:
2470:
2435:
2399:
2348:
2312:
2276:
2240:
2221:
2180:
2131:
2096:Postgrad Med J
2082:
2039:
2003:
1974:(5): 2175–83.
1951:
1919:
1900:(2): 297–310.
1881:
1827:
1800:
1786:
1768:
1750:
1732:
1676:
1634:
1627:
1602:
1587:
1566:
1543:
1513:
1498:
1469:
1440:(4): 297–309.
1420:
1365:
1350:
1325:
1296:
1245:
1190:
1175:
1154:
1130:
1087:
1086:
1084:
1081:
1080:
1079:
1074:
1069:
1062:
1059:
1003:
1000:
976:
973:
965:
962:
942:
939:
905:
902:
884:
881:
876:
873:
865:
862:
852:
849:
847:
846:Considerations
844:
832:cholestyramine
824:terminal ileum
793:
790:
784:
781:
775:
772:
766:
763:
731:electrocautery
726:
723:
710:
707:
690:
687:
654:
651:
647:Foley catheter
625:
622:
586:
583:
570:
562:
559:
522:
521:
518:
512:
511:
508:
504:
503:
500:
496:
495:
492:
488:
487:
484:
480:
479:
476:
472:
471:
468:
462:
461:
458:
454:
453:
450:
437:
434:
404:biliary injury
399:
398:Biliary injury
396:
390:
387:
369:
366:
352:
349:
341:
338:
318:
315:
266:
263:
247:
244:
208:
205:
199:formation and
161:
160:
153:
150:
149:
146:
140:
139:
132:
126:
125:
120:
114:
113:
108:
102:
101:
40:
36:
35:
32:
24:
23:
15:
13:
10:
9:
6:
4:
3:
2:
4595:
4584:
4581:
4579:
4576:
4575:
4573:
4558:
4555:
4553:
4550:
4548:
4545:
4543:
4540:
4538:
4535:
4533:
4530:
4529:
4527:
4525:
4521:
4515:
4511:
4508:
4504:
4501:
4500:
4499:
4496:
4495:
4493:
4489:
4479:
4476:
4474:
4471:
4469:
4468:Hernia repair
4466:
4465:
4463:
4461:
4457:
4451:
4448:
4446:
4443:
4441:
4438:
4436:
4433:
4431:
4428:
4426:
4423:
4422:
4420:
4418:
4414:
4411:
4409:
4405:
4395:
4392:
4390:
4387:
4385:
4382:
4380:
4377:
4375:
4372:
4371:
4369:
4367:
4363:
4357:
4354:
4352:
4349:
4345:
4342:
4340:
4337:
4335:
4332:
4331:
4330:
4326:
4323:
4322:
4319:
4316:
4314:
4311:
4309:
4306:
4304:
4301:
4300:
4298:
4296:
4292:
4288:
4280:
4277:
4275:
4272:
4271:
4270:
4267:
4265:
4262:
4260:
4257:
4255:
4252:
4248:
4245:
4243:
4240:
4239:
4238:
4235:
4234:
4232:
4230:
4226:
4223:
4221:
4217:
4203:
4200:
4198:
4197:Fecal pH test
4195:
4193:
4190:
4189:
4187:
4185:
4181:
4175:
4172:
4170:
4167:
4165:
4162:
4160:
4157:
4155:
4152:
4150:
4147:
4145:
4142:
4140:
4137:
4135:
4132:
4131:
4128:
4127:Sigmoidoscopy
4125:
4123:
4120:
4118:
4115:
4113:
4110:
4108:
4105:
4103:
4099:
4096:
4095:
4093:
4091:
4087:
4081:
4078:
4076:
4073:
4071:
4068:
4066:
4063:
4061:
4058:
4057:
4055:
4053:
4049:
4043:
4040:
4038:
4035:
4033:
4030:
4029:
4027:
4025:
4021:
4015:
4012:
4010:
4007:
4005:
4002:
4000:
3997:
3995:
3992:
3991:
3989:
3987:
3983:
3977:
3974:
3972:
3969:
3967:
3964:
3962:
3959:
3957:
3954:
3952:
3949:
3945:
3942:
3940:
3937:
3936:
3935:
3932:
3931:
3929:
3927:
3923:
3920:
3918:
3914:
3904:
3901:
3899:
3896:
3892:
3889:
3888:
3887:
3884:
3883:
3881:
3879:
3875:
3869:
3866:
3864:
3863:Pyloromyotomy
3861:
3859:
3856:
3854:
3851:
3849:
3846:
3842:
3839:
3838:
3837:
3834:
3832:
3829:
3827:
3824:
3820:
3817:
3815:
3812:
3810:
3807:
3806:
3805:
3802:
3800:
3797:
3793:
3790:
3788:
3785:
3783:
3780:
3778:
3775:
3773:
3770:
3769:
3768:
3765:
3763:
3760:
3758:
3755:
3752:
3749:
3748:
3746:
3744:
3740:
3734:
3731:
3729:
3726:
3724:
3721:
3719:
3716:
3714:
3711:
3709:
3706:
3704:
3701:
3699:
3698:Esophagectomy
3696:
3695:
3693:
3691:
3687:
3683:
3680:
3678:
3674:
3671:
3669:
3665:
3661:
3656:
3652:
3644:
3639:
3637:
3632:
3630:
3625:
3624:
3621:
3605:
3601:
3597:
3587:on 2019-08-01
3586:
3582:
3578:
3574:
3573:
3569:
3560:
3556:
3551:
3546:
3542:
3538:
3534:
3530:
3526:
3519:
3516:
3511:
3507:
3503:
3497:
3493:
3486:
3483:
3478:
3471:
3467:
3462:
3457:
3453:
3449:
3445:
3438:
3435:
3423:
3419:
3412:
3410:
3406:
3401:
3397:
3392:
3387:
3383:
3379:
3375:
3368:
3365:
3360:
3356:
3351:
3346:
3343:(1): 109–11.
3342:
3338:
3334:
3327:
3325:
3323:
3321:
3319:
3317:
3315:
3313:
3309:
3304:
3300:
3295:
3290:
3286:
3282:
3278:
3271:
3268:
3263:
3257:
3253:
3246:
3244:
3242:
3240:
3236:
3231:
3227:
3223:
3219:
3212:
3209:
3204:
3200:
3195:
3190:
3186:
3182:
3178:
3174:
3170:
3163:
3161:
3157:
3146:
3142:
3136:
3133:
3128:
3124:
3120:
3116:
3112:
3105:
3103:
3101:
3099:
3095:
3090:
3086:
3081:
3076:
3072:
3068:
3064:
3060:
3056:
3049:
3046:
3041:
3037:
3032:
3027:
3022:
3017:
3013:
3009:
3005:
2998:
2995:
2990:
2986:
2981:
2976:
2972:
2968:
2964:
2960:
2956:
2949:
2946:
2941:
2937:
2933:
2929:
2924:
2919:
2915:
2911:
2907:
2900:
2897:
2892:
2888:
2884:
2880:
2876:
2872:
2868:
2864:
2856:
2854:
2850:
2845:
2841:
2836:
2831:
2826:
2821:
2818:(10): 243–8.
2817:
2813:
2809:
2802:
2800:
2796:
2791:
2787:
2783:
2779:
2775:
2771:
2767:
2763:
2756:
2754:
2750:
2745:
2741:
2736:
2731:
2727:
2723:
2719:
2715:
2711:
2703:
2700:
2695:
2691:
2687:
2683:
2680:(2): 176–86.
2679:
2675:
2667:
2664:
2659:
2655:
2651:
2645:
2641:
2634:
2632:
2630:
2628:
2626:
2622:
2617:
2613:
2609:
2605:
2601:
2597:
2593:
2589:
2585:
2578:
2576:
2572:
2567:
2563:
2559:
2555:
2551:
2544:
2541:
2536:
2530:
2526:
2519:
2517:
2515:
2513:
2511:
2507:
2502:
2498:
2494:
2490:
2486:
2482:
2474:
2471:
2466:
2462:
2458:
2454:
2450:
2446:
2439:
2436:
2431:
2427:
2423:
2419:
2415:
2411:
2403:
2400:
2395:
2391:
2386:
2381:
2376:
2371:
2367:
2363:
2359:
2352:
2349:
2344:
2340:
2336:
2332:
2328:
2324:
2316:
2313:
2308:
2304:
2300:
2296:
2293:(8): 779–86.
2292:
2288:
2280:
2277:
2272:
2268:
2264:
2260:
2256:
2252:
2244:
2241:
2236:
2232:
2225:
2222:
2217:
2213:
2208:
2203:
2199:
2195:
2191:
2184:
2181:
2176:
2172:
2167:
2162:
2158:
2154:
2151:(2): rjy013.
2150:
2146:
2142:
2135:
2132:
2127:
2123:
2118:
2113:
2109:
2105:
2102:(940): 77–9.
2101:
2097:
2093:
2086:
2083:
2078:
2074:
2070:
2066:
2062:
2058:
2054:
2050:
2043:
2040:
2035:
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2020:(5): 419–22.
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2015:
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1393:(4): 429–53.
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1315:on 2018-03-20
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922:cholangiogram
918:
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863:
861:
859:
858:acute abdomen
850:
845:
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835:
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821:
818:recycling of
817:
816:enterohepatic
813:
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771:
764:
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739:fistulization
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735:cholecystitis
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675:cystic artery
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643:OG or NG tube
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270:Cholecystitis
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251:Biliary colic
246:Biliary colic
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97:
41:
39:Pronunciation
37:
30:
25:
20:
4445:Paracentesis
4302:
4259:Liver biopsy
4154:Enteroclysis
4139:Defecography
3994:Appendectomy
3608:. Retrieved
3603:
3589:. Retrieved
3585:the original
3580:
3532:
3528:
3518:
3491:
3485:
3451:
3447:
3437:
3425:. Retrieved
3421:
3384:(4): 341–6.
3381:
3377:
3367:
3340:
3336:
3287:(1): 89–94.
3284:
3280:
3270:
3251:
3221:
3211:
3179:(2): 102–6.
3176:
3172:
3148:. Retrieved
3144:
3135:
3110:
3062:
3058:
3048:
3011:
3007:
2997:
2965:(4): 315–7.
2962:
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2702:
2677:
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2524:
2484:
2481:World J Surg
2480:
2473:
2451:(4): 552–9.
2448:
2444:
2438:
2416:(3): 435–9.
2413:
2409:
2402:
2365:
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2351:
2326:
2322:
2315:
2290:
2286:
2279:
2254:
2250:
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2224:
2200:(5): 392–5.
2197:
2193:
2183:
2148:
2144:
2134:
2099:
2095:
2085:
2055:(4): 291–3.
2052:
2048:
2042:
2017:
2013:
2006:
1971:
1967:
1943:. Retrieved
1934:
1897:
1893:
1852:(4): 300–5.
1849:
1845:
1819:. Retrieved
1815:
1789:
1780:
1771:
1763:www.umms.org
1762:
1753:
1744:
1735:
1703:(1): 15–26.
1700:
1696:
1652:
1648:
1637:
1618:
1578:
1563:. NBK258747.
1552:
1546:
1534:. Retrieved
1530:the original
1525:
1522:"Gallstones"
1516:
1489:
1437:
1433:
1423:
1390:
1386:
1341:
1317:. Retrieved
1313:the original
1308:
1299:
1262:
1258:
1248:
1214:
1210:
1166:
1146:. Retrieved
1142:
1133:
1116:
1112:
1056:
1049:
1037:laparoscopic
1034:
1030:Lyon, France
1027:
1019:gynecologist
1015:appendectomy
1005:
986:
970:
967:
958:
951:
944:
927:
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886:
878:
867:
854:
836:
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795:
786:
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728:
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692:
683:
658:Laparoscopic
656:
627:
596:hair removal
579:
575:
569:
568:
564:
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536:
525:
491:Respiratory
439:
423:
408:
401:
392:
371:
354:
343:
320:
311:
305:
303:
279:
274:inflammation
268:
249:
233:
218:
186:
180:, or via an
165:
164:
4435:Laparoscopy
4291:Gallbladder
4254:Hepatectomy
4184:Stool tests
4122:Proctoscopy
4117:Enteroscopy
4102:Colonoscopy
3986:Large bowel
3966:Jejunostomy
3926:Small bowel
3853:Hill repair
3836:Gastrostomy
3814:Billroth II
3804:Gastrectomy
3708:Sialography
3454:: 196–204.
2720:(1): 91–7.
2329:(1): 54–8.
2049:Surg Endosc
1655:(1): 8–23.
1217:(1): 15–7.
747:cholangitis
671:cystic duct
667:laparoscope
452:Prevalence
330:cystic duct
322:Cholangitis
298:Murphy sign
207:Medical use
170:gallbladder
4572:Categories
4498:Laparotomy
4440:Omentopexy
4417:Peritoneum
4052:Anal canal
3831:Gastropexy
3809:Billroth I
3591:2018-03-20
3150:2018-03-19
2658:1003489504
1945:2019-09-02
1935:www.sbu.se
1821:2018-03-27
1508:1328625901
1319:2018-03-20
1148:2018-01-24
1083:References
1041:gallstones
1007:Erich Mühe
934:endoscopic
920:This is a
820:bile salts
619:dressings.
306:acalculous
255:gallstones
236:ultrasound
221:gallstones
174:gallstones
4295:bile duct
4220:Accessory
4098:Endoscopy
4009:Colostomy
3999:Colectomy
3956:Ileostomy
3886:Endoscopy
3819:Roux-en-Y
3690:Esophagus
3610:4 January
3510:880422516
3427:4 October
3059:Gut Liver
2287:Endoscopy
2251:JAMA Surg
1597:949278311
1360:951748294
1185:933274207
1035:By 2013,
1022:Kurt Semm
851:Pregnancy
805:dyspepsia
751:cirrhosis
585:Procedure
557:to form.
475:Bleeding
362:pediatric
282:infection
106:Specialty
4366:Pancreas
4107:Anoscopy
3559:33462065
3470:25958296
3400:10036125
3359:18402752
3303:11304004
3230:25535644
3203:26741665
3127:23939652
3089:35502586
3040:37434692
3031:10331452
2989:32003580
2940:28999270
2932:11280526
2883:19412642
2844:26523212
2782:26895901
2744:17252302
2694:20670855
2616:10656813
2608:20706739
2566:21154360
2501:23430003
2465:23419386
2430:22261836
2410:Ann Surg
2394:24106403
2307:17001567
2271:25133326
2235:GallRiks
2216:18823829
2175:29479416
2126:14970293
2034:25853929
1998:29556977
1914:24679422
1876:28149133
1727:17252293
1671:23307004
1561:25473723
1464:27467059
1415:19853338
1407:25850631
1291:25481385
1233:19857610
1125:24866215
1061:See also
932:, is an
828:diarrhea
812:diarrhea
617:Tegaderm
499:Cardiac
426:assessed
292:, or an
284:such as
201:stenosis
118:ICD-9-CM
3743:Stomach
3550:7816909
3391:3015244
3350:3016026
3294:3015420
3194:5210469
3080:9099388
2980:7099162
2891:8037138
2835:4621474
2790:5966494
2735:2784499
2385:3785624
2343:8454146
2166:5811847
2117:1742934
2069:9543518
1989:5897463
1867:5245728
1718:2784509
1536:27 July
1455:8802735
1282:4295332
1265:: 412.
975:History
894:opioids
679:ligated
555:abscess
547:abdomen
259:abdomen
197:abscess
136:D002763
4460:Hernia
4024:Rectum
3557:
3547:
3508:
3498:
3468:
3398:
3388:
3357:
3347:
3301:
3291:
3258:
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2163:
2124:
2114:
2077:610548
2075:
2067:
2032:
1996:
1986:
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1405:
1358:
1348:
1289:
1279:
1231:
1183:
1173:
1123:
992:Berlin
890:NSAIDs
822:. The
765:Biopsy
757:, and
665:. The
520:0.21%
516:Hernia
510:0.34%
502:0.36%
494:0.48%
486:0.50%
478:0.79%
470:0.90%
460:1.25%
411:sepsis
290:chills
100:
4542:UKELD
4491:Other
4229:Liver
2936:S2CID
2887:S2CID
2786:S2CID
2612:S2CID
2073:S2CID
1526:NIDDK
1411:S2CID
715:NOTES
699:navel
540:stent
389:Risks
286:fever
272:, or
154:[
148:47562
123:575.0
4537:PELD
4532:MELD
4339:MRCP
4313:ERCP
3612:2020
3555:PMID
3506:OCLC
3496:ISBN
3466:PMID
3429:2017
3396:PMID
3378:JSLS
3355:PMID
3337:JSLS
3299:PMID
3281:JSLS
3256:ISBN
3226:PMID
3199:PMID
3123:PMID
3085:PMID
3036:PMID
2985:PMID
2928:PMID
2879:PMID
2840:PMID
2778:PMID
2740:PMID
2690:PMID
2654:OCLC
2644:ISBN
2604:PMID
2562:PMID
2529:ISBN
2497:PMID
2461:PMID
2426:PMID
2390:PMID
2339:PMID
2303:PMID
2267:PMID
2212:PMID
2171:PMID
2149:2018
2122:PMID
2065:PMID
2030:PMID
1994:PMID
1910:PMID
1872:PMID
1723:PMID
1667:PMID
1623:ISBN
1593:OCLC
1583:ISBN
1557:PMID
1538:2016
1504:OCLC
1494:ISBN
1460:PMID
1403:PMID
1356:OCLC
1346:ISBN
1287:PMID
1229:PMID
1181:OCLC
1171:ISBN
1121:PMID
1043:and
904:ERCP
695:SILS
673:and
645:. A
632:and
417:and
381:and
324:and
182:open
130:MeSH
4344:PTC
3686:SGs
3604:NHS
3545:PMC
3537:doi
3456:doi
3386:PMC
3345:PMC
3289:PMC
3189:PMC
3181:doi
3115:doi
3075:PMC
3067:doi
3026:PMC
3016:doi
2975:PMC
2967:doi
2963:102
2918:doi
2871:doi
2830:PMC
2820:doi
2770:doi
2730:PMC
2722:doi
2682:doi
2678:211
2596:doi
2554:doi
2489:doi
2453:doi
2449:108
2418:doi
2414:255
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2370:doi
2331:doi
2295:doi
2259:doi
2255:149
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2161:PMC
2153:doi
2112:PMC
2104:doi
2057:doi
2022:doi
1984:PMC
1976:doi
1902:doi
1862:PMC
1854:doi
1713:PMC
1705:doi
1657:doi
1450:PMC
1442:doi
1395:doi
1391:400
1277:PMC
1267:doi
1219:doi
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430:SBU
355:In
238:or
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