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Fehring L, Brinkmann H, Hohenstein S, Bollmann A, Dirks P, Pölitz J, Prinz C. Timely cholecystectomy: important factors to improve guideline adherence and patient treatment. BMJ Open Gastroenterol 2024; 11:e001439. [PMID: 39053927 DOI: 10.1136/bmjgast-2024-001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE Cholecystectomy is one of the most frequently performed surgeries in Germany and is performed as a treatment of acute cholecystitis (guideline S3 IIIB.8) and after endoscopic retrograde cholangiopancreatography for choledocholithiasis with simultaneous cholecystolithiasis (guideline S3 IIIC.6). This article examines the effects of a guideline update from 2017, which recommends prompt cholecystectomy within 24 hours of admission due to cholecystitis or within 72 hours after bile duct repair. In addition, it aims to identify reasons (eg, financial disincentives) and potential for improvement for non-adherence to the guidelines. DESIGN Methodologically, a retrospective analysis based on routine billing data from 84 Helios Group hospitals from 2016 and 2022, with a total of 45 393 included cases, was applied. The guideline adherence rate is used as the main outcome measure. RESULTS Results show the guideline updates led to a statistically significant increase in the proportion of cholecystectomy performed in a timely manner (guideline S3 IIIB.8: increase from 43% to 49%, p<0.001; guideline S3 IIIC.6: increase from 7% to 20%, p<0.001). Medical, structural and financial reasons for non-adherence could be identified. CONCLUSION As possible reasons for non-adherence, medical factors such as advanced age, multimorbidity and frailty could be identified. Analyses of structural factors revealed that hospitals in very rural regions are less likely to perform timely cholecystectomies, presumably due to infrastructural and personnel-capacity bottlenecks. A similar picture emerges for maximum-care hospitals, which might be explained by more severe and complex cases on average. Further evaluation indicates that an increase in and better hospital-internal participation of gastroenterologists in remuneration could lead to even greater adherence to the S3 IIIC.6 guideline.
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Affiliation(s)
- Leonard Fehring
- Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- Gastroenterology, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Nordrhein-Westfalen, Germany
| | - Hendrik Brinkmann
- Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | | | | | | | - Jörg Pölitz
- Helios Health Institute GmbH, Leipzig, Germany
| | - Christian Prinz
- Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- Gastroenterology, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Nordrhein-Westfalen, Germany
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Proctor DW, Goodall R, Borsky K, Salciccioli JD, Marshall DC, Shanmugarajah K, Shalhoub J. Temporal Analysis of the Incidence, Mortality and Disability-Adjusted Life Years of Benign Gallbladder and Biliary Diseases in High-Income Nations, 1990-2019. ANNALS OF SURGERY OPEN 2024; 5:e453. [PMID: 38911626 PMCID: PMC11191896 DOI: 10.1097/as9.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Objective The aim of this observational study was to analyze trends in the incidence, mortality, and disability-adjusted life years (DALYs) of benign gallbladder and biliary diseases across high-income countries between 1990 and 2019. Background Benign gallbladder and biliary diseases place a substantial burden on healthcare systems in high-income countries. Accurate characterization of the disease burden may help optimize healthcare policy and resource distribution. Materials and methods Age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and DALYs data for gallbladder and biliary diseases in males and females were extracted from the 2019 Global Burden of Disease (GBD) study. A mortality-incidence index (MII) was also calculated. Joinpoint regression analysis was performed. Results The median ASIRs across the European Union 15+ countries in 2019 were 758/100,000 for females and 282/100,000 for males. Between 1990 and 2019 the median percentage change in ASIR was +2.49% for females and +1.07% for males. The median ASMRs in 2019 were 1.22/100,000 for females and 1.49/100,000 for males with a median percentage change over the observation period of -21.93% and -23.01%, respectively. In 2019, the median DALYs was 65/100,000 for females and 37/100,000 among males, with comparable percentage decreases over the observation period of -21.27% and -19.23%, respectively. Conclusions International variation in lifestyle factors, diagnostic and management strategies likely account for national and sex disparities. This study highlights the importance of ongoing clinical efforts to optimize treatment pathways for gallbladder and biliary diseases, particularly in the provision of emergency surgical services and efforts to address population risk factors.
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Affiliation(s)
- Dominic W. Proctor
- From the Department of Undergraduate Medical Education, Royal Free London NHS Foundation Trust, London, UK
| | - Richard Goodall
- Department of Surgery and Cancer, Imperial College London, UK
| | - Kim Borsky
- Department of Plastic Surgery, Salisbury Hospital, Salisbury, UK
| | - Justin D. Salciccioli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | | | | | - Joseph Shalhoub
- Department of Surgery and Cancer, Imperial College London, UK
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
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Emre B, Mehlika BK, Metehan A, Taylan UE, Sezgin Y. The effect of previous endoscopic retrograde cholangiopancreatography on subsequent laparoscopic cholecystectomy: The retrospective analysis of 1500 patients. J Minim Access Surg 2024:01413045-990000000-00027. [PMID: 38214285 DOI: 10.4103/jmas.jmas_217_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/03/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the gold standard for patients with acute cholecystitis at early period. However, 15%-20% of patients with acute cholecystitis develop obstructive jaundice, cholangitis and bile duct stones ultimately requiring endoscopic retrograde cholangiopancreatography (ERCP). In such cases, a two-session approach is usually recommended, first ERCP followed by LC thereafter. However, the effect of prior ERCP on the difficulty of subsequent LC is unknown. Hence, the aim of the present study is to determine the effects of previous ERCP on the results of LC. PATIENTS AND METHODS In this study, the files of 1500 patients who underwent LC were reviewed retrospectively. The patients were divided into three groups (500 patients for each group). The patients undergoing LC for asymptomatic cholelithiasis were assigned to the L-e group. The patients who underwent LC for acute cholecystitis were assigned to the L-c group. The patients with acute cholecystitis who underwent ERCP first and then LC were assigned to the L-ercp group. The rates of conversion to open cholecystectomy, operation times, complication rates and hospital stays of the three groups were compared. RESULTS The results of LC performed after ERCP are similar to the results of LC for cholecystitis without ERCP in terms of operation time, hospital stay, conversion and complications. CONCLUSIONS Previous ERCP does not affect the safety and effectiveness of early LC in patients with acute cholecystitis.
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Affiliation(s)
- Balli Emre
- Department of General Surgery, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Bilgi Kirmaci Mehlika
- Department of General Surgery, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Aydin Metehan
- Department of General Surgery, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ugurlu Esat Taylan
- Department of General Surgery, Mehmet Akıf Inan Educatıon and Research Hospıtal, Şanlıurfa, Turkey
| | - Yilmaz Sezgin
- Department of General Surgery, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Wu H, Liao B, Cao T, Ji T, Huang J, Luo Y, Ma K. Comparison of the safety profile, conversion rate and hospitalization duration between early and delayed laparoscopic cholecystectomy for acute cholecystitis: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1185482. [PMID: 38148916 PMCID: PMC10750350 DOI: 10.3389/fmed.2023.1185482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/13/2023] [Indexed: 12/28/2023] Open
Abstract
Background Although the past decade has witnessed unprecedented medical progress, no consensus has been reached on the optimal approach for patients with acute cholecystitis. Herein, we conducted a systematic review and meta-analysis to assess the differences in patient outcomes between Early Laparoscopic Cholecystectomy (ELC) and Delayed Laparoscopic Cholecystectomy (DLC) in the treatment of acute cholecystitis. Our protocol was registered in the PROSPERO database (registration number: CRD42023389238). Objectives We sought to investigate the differences in efficacy, safety, and potential benefits between ELC and DLC in acute cholecystitis patients by conducting a systematic review and meta-analysis. Methods The online databases PubMed, Springer, and the Cochrane Library were searched for randomized controlled trials (RCTs) and retrospective studies published between Jan 1, 1999 and Jan 1, 2022. Results 21 RCTs and 13 retrospective studies with a total of 7,601 cases were included in this research. After a fixed-effects model was applied, the pooled analysis showed that DLC was associated with a significantly high conversion rate (OR: 0.6247; 95%CI: 0.5115-0.7630; z = -4.61, p < 0.0001) and incidence of postoperative complications (OR: 0.7548; 95%CI: 0.6197-0.9192; z = -2.80, p = 0.0051). However, after applying a random-effects model, ELC was associated with significantly shorter total hospitalization duration than DLC (MD: -4.0657; 95%CI: -5.0747 to -3.0566; z = -7.90, p < 0.0001). Conclusion ELC represents a safe and feasible approach for acute cholecystitis patients since it shortens hospitalization duration and decreases the incidence of postoperative complications of laparoscopic cholecystectomy. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=389238, identifier (CRD42023389238).
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Affiliation(s)
- Hongsheng Wu
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, China
| | | | | | | | | | | | - Keqiang Ma
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, China
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Kilinc Tuncer G, Tuncer K, Sert I, Emiroglu M. Effect of Early Versus Delayed Laparoscopic Cholecystectomy on Postoperative Morbidity and Difficult Cholecystectomy in Patients With Grade II Cholecystitis According to Tokyo 2018 Guidelines: A Prospective Study. Am Surg 2023; 89:5775-5781. [PMID: 37158308 DOI: 10.1177/00031348231175113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND The timing of the cholecystectomy in patients with acute cholecystitis is still controversial. In our study, we aimed to investigate the effect of early and delayed cholecystectomy on difficult cholecystectomy, morbidity and mortality in patients diagnosed with Grade II acute cholecystitis according to Tokyo 2018 guidelines. METHODS Patients who presented to the emergency department and diagnosed with Grade II acute cholecystitis between December 2019 and June 2021 were included in this study. Cholecystectomy was performed within 7 days and 6 weeks after symptom onset. The effect of early and delayed cholecystectomy was observed. RESULTS A total of 92 patients were included in the study. The timing of cholecystectomy was not a risk factor for mortality, morbidity and difficult cholecystectomy. The conversion rate was higher in delayed group (P = .007). The bleeding was significantly higher in early group (P = .033). Total hospital stay was higher in delayed group (P < .001). CRP was a predictive parameter for increased Parkland score in early group (P < .001). CONCLUSIONS Delayed cholecystectomy does not facilitate cholecystectomy in patients with Grade II acute cholecystitis. Early cholecystectomy can be performed safely and high CRP levels can be used to determine difficult cholecystectomy in early period.
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Affiliation(s)
- Gizem Kilinc Tuncer
- Department of General Surgery, University of Health Sciences Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Korhan Tuncer
- Department of General Surgery, Cigli Training and Research Hospital, Izmir, Turkey
| | - Ismail Sert
- Department of General Surgery, Izmir Egepol Hospital, Izmir, Turkey
| | - Mustafa Emiroglu
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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Woong Choi JD, John Fong M, Shanmugalingam A, Aslam A, Aqeel Abbas Kazmi S, Kulkarni R, James Curran R. Safe postoperative outcomes following early cholecystectomy for acute calculus cholecystitis regardless of symptom onset. Turk J Surg 2023; 39:321-327. [PMID: 38694534 PMCID: PMC11057926 DOI: 10.47717/turkjsurg.2023.6165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/06/2023] [Indexed: 05/04/2024]
Abstract
Objectives There is growing evidence for reduced post-operative complications, and lower hospital costs associated with early cholecystectomy for acute calculus cholecystitis (AC) compared to delayed surgery. Limited high-quality evidence exists for how early, if at all, should surgeons be operating emergently for AC based on symptom onset. Material and Methods Seven hundred seventy-four patients who had cholecystectomy performed by a single surgeon between January 2015-October 2022 were retrospectively reviewed. Five hundred fourty-one patients were analysed. Patients were divided into three groups based on symptom onset: Group 1: 0-72 hours (n= 305), Group 2: 72 hrs-1 week (n= 154) and Group 3: >1 week (n= 82). Results Median operative time was most prolonged in Group 2 (96.5 minutes), and had the greatest proportion of reconstituting 95% cholecystectomies (n= 22/154, 14.29%) compared to Group 1 (p> 0.05). The conversion to open was between 0.65-1.64% in all groups. The greatest proportion of bile leak occurred in Group 1 (n= 7/305, 2.3%) followed by Group 3 (n= 1/82, 1.22%) (p> 0.05). All were successfully managed with ERCP and biliary stent. Median hospital stay was significantly prolonged in Group 2 (2.3 days) compared to Group 1 (2 days) (p= 0.03). The proportion of 95% cholecystectomies in Group 2 and 3 were not significant compared to Group 1. Conclusion Early cholecystectomy for calculus cholecystitis, irrespective of the timing of symptoms appears to have safe postoperative outcomes. Surgeons do not necessarily need to limit early cholecystectomy for within 72 hours of symptom onset.
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Affiliation(s)
- Joseph Do Woong Choi
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
- Discipline of Surgery, University of Sydney Faculty of Medicine and Health, New South Wales, Australia
| | - Matthew John Fong
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Aswin Shanmugalingam
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Anoosha Aslam
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Syed Aqeel Abbas Kazmi
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Rukmini Kulkarni
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Richard James Curran
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
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Li F, Ren Y, Fan J, Zhou J. The predictive value of the preoperative albumin-to-fibrinogen ratio for postoperative hospital length of stay in liver cancer patients. Cancer Med 2023; 12:20321-20331. [PMID: 37815011 PMCID: PMC10652297 DOI: 10.1002/cam4.6606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a significant global health burden, with postoperative hospital length of stay (LOS) impacting patient outcomes and healthcare costs. Existing nutritional, inflammatory, and coagulation indices can predict LOS, with particular interest in albumin, fibrinogen, and D-dimer. This study investigates the predictive value of preoperative albumin-to-fibrinogen ratio (AFR) and albumin-to-D-dimer ratio (ADR) for postoperative LOS in HCC patients. METHODS This retrospective study involved 462 adult HCC patients who underwent partial hepatic lesion excision between February 2016 and August 2022. We analyzed demographic and clinical data, including preoperative blood samples, surgical approach, and LOS. The primary outcome measure was LOS, calculated from the date of surgery to the date of hospital discharge. Preoperative AFR and ADR were calculated. The ROC curves determined optimal cutoff points. The Cox proportional hazards model, Kaplan-Meier method, and the log-rank test were used for statistical analysis. RESULTS The study established an optimal AFR cutoff value of 15.474, with a higher AUC value than ADR, indicating superior predictive potential for postoperative LOS. Participants with high-AFR (AFR > 15.474) had a shorter median LOS (13 vs. 15 days, p < 0.001) compared to those with low-AFR (AFR ≤15.474). Multivariate analysis revealed high-AFR (HR: 1.99; p < 0.001) as a positive influence on LOS reduction, whereas Child-Pugh rated as B (HR: 0.49; p < 0.001), laparotomy (HR: 0.37; p < 0.001) and total bilirubin >20.5 μmol/L (HR: 0.58; p < 0.001) negatively impacted LOS reduction. Subgroup analysis confirmed AFR's predictive ability for patients experiencing reduced or prolonged LOS due to Child-Pugh score, surgical methods, and total bilirubin concentrations. Even within normal albumin and fibrinogen levels, patients with high-AFR exhibited a shorter LOS (all p < 0.001). CONCLUSIONS Our findings underscore the value of the AFR as a reliable predictor of LOS in HCC patients. An AFR greater than 15.474 consistently correlated with a shorter LOS, suggesting its potential clinical utility in guiding perioperative management and resource allocation in HCC patients.
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Affiliation(s)
- Fang Li
- Department of Hepatobiliary SurgeryLiaoning Cancer Hospital & Institute, Cancer Hospital of China Medical UniversityShenyangLiaoningChina
| | - Yuetong Ren
- Department of Hepatobiliary SurgeryLiaoning Cancer Hospital & Institute, Cancer Hospital of China Medical UniversityShenyangLiaoningChina
| | - Jiacheng Fan
- Department of Medical Laboratory Technology, Medical SchoolShandong Xiandai UniversityJinanShandongChina
| | - Jin Zhou
- Medical Oncology Department of Gastrointestinal CancerLiaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of TechnologyLiaoningShenyangChina
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Arkoudis NA, Moschovaki-Zeiger O, Reppas L, Grigoriadis S, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. Percutaneous cholecystostomy: techniques and applications. Abdom Radiol (NY) 2023; 48:3229-3242. [PMID: 37338588 DOI: 10.1007/s00261-023-03982-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
Acute cholecystitis (AC) is a critical condition requiring immediate medical attention and treatment and is one of the most frequently encountered acute abdomen emergencies in surgical practice, requiring hospitalization. Laparoscopic cholecystectomy is considered the favored treatment for patients with AC who are fit for surgery. However, in high-risk patients considered poor surgical candidates, percutaneous cholecystostomy (PC) has been suggested and employed as a safe and reliable alternative option. PC is a minimally invasive, nonsurgical, image-guided intervention that drains and decompresses the gallbladder, thereby preventing its perforation and sepsis. It can act as a bridge to surgery, but it may also serve as a definitive treatment for some patients. The goal of this review is to familiarize physicians with PC and, more importantly, its applications and techniques, pre- and post-procedural considerations, and adverse events.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
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Barka M, Jarrar MS, Ben Abdessalem Z, Hamila F, Youssef S. Early laparoscopic cholecystectomy for acute cholecystitis: Does age matter? Geriatr Gerontol Int 2023; 23:671-675. [PMID: 37463676 DOI: 10.1111/ggi.14643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/18/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
AIM Advances in laparoscopic surgery and perioperative care have improved the prognosis of operated patients, especially the oldest among them. This study aimed to assess the outcomes of early laparoscopic cholecystectomy for acute calculous cholecystitis in older adult patients. METHODS A retrospective analysis was carried out of 567 patients who underwent early laparoscopic cholecystectomy for acute calculous cholecystitis between January 2003 and July 2021. The outcomes of older adult patients (≥ 75 years) were compared with those of younger patients. RESULTS The older adult group had significantly more patients with an American Society of Anesthesiologists score ≥3 (37.5% vs 8.3%; P < 0.001) and more severe acute calculous cholecystitis (grade II; 82.8% vs 67%; P = 0.01). There were no significant differences regarding operative time (90 vs 80 min; P = 0.064), conversion rate (20.3% vs 13.5%; P = 0.144), and both intra- and postoperative morbidity, principally bile duct injuries (1.6% vs 0%; P = 0.113) and bile leakage (0% vs 1.2%; P = 1). CONCLUSION Early laparoscopic cholecystectomy could be proposed safely for older adult patients with mild and moderate acute cholecystitis. Geriatr Gerontol Int 2023; 23: 671-675.
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Affiliation(s)
- Malek Barka
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Mohamed Salah Jarrar
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Zied Ben Abdessalem
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Fehmi Hamila
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Sabri Youssef
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
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Wani H, Meher S, Srinivasulu U, Mohanty LN, Modi M, Ibrarullah M. Laparoscopic cholecystectomy for acute cholecystitis: Any time is a good time. Ann Hepatobiliary Pancreat Surg 2023; 27:271-276. [PMID: 37088998 PMCID: PMC10472128 DOI: 10.14701/ahbps.22-127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 04/25/2023] Open
Abstract
Backgrounds/Aims Laparoscopic cholecystectomy within one week of acute cholecystitis is considered safe and advantageous. Surgery beyond first week is reserved for non-resolving attack or complications. To compare clinical outcomes of patients undergoing laparoscopic cholecystectomy in the first week and between two to six weeks of an attack of acute cholecystitis. Methods In an analysis of a prospectively maintained database, all patients who underwent laparoscopic cholecystectomy for acute cholecystitis were divided into two groups: group A, operated within one week; and group B, operated between two to six weeks of an attack. Main variables studied were mean operative time, conversion to open cholecystectomy, morbidity profile, and duration of hospital stay. Results A total of 116 patients (74 in group A and 42 in group B) were included. Mean interval between onset of symptoms & surgery was five days (range, 1-7 days) in group A and 12 days (range, 8-20 days) in group B. Operative time and incidence of subtotal cholecystectomy were higher in group B (statistically not significant). Mean postoperative stay was 2 days in group A and 3 days in group B. Laparoscopy was converted to open cholecystectomy in two patients in each group. There was no incidence of biliary injury. One patient in group B died during the postoperative period due to continued sepsis and multiorgan failure. Conclusions In tertiary care setting, with adequate surgical expertise, laparoscopic cholecystectomy can be safely performed in patients with acute cholecystitis irrespective of the time of presentation.
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Affiliation(s)
- Hamza Wani
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sadananda Meher
- Department of Surgical Gastroenterology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | | | | | - Madhusudan Modi
- Department of Surgical Gastroenterology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Mohammad Ibrarullah
- Department of Surgical Gastroenterology, Apollo Hospitals, Bhubaneswar, Odisha, India
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Porras Fimbres DC, Nussbaum DP, Mosca PJ. Racial disparities in time to laparoscopic cholecystectomy for acute cholecystitis. Am J Surg 2023; 226:261-270. [PMID: 37149406 DOI: 10.1016/j.amjsurg.2023.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/25/2023] [Accepted: 05/02/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Disparities in healthcare exist, yet few data are available on racial differences in time from admission to surgery. This study aimed to compare time from admission to laparoscopic cholecystectomy for acute cholecystitis between non-Hispanic Black and non-Hispanic White patients. METHODS Patients who underwent laparoscopic cholecystectomy for acute cholecystitis from 2010 to 2020 were identified using NSQIP. Time to surgery and additional preoperative, operative, and postoperative variables were analyzed. RESULTS In the univariate analysis, 19.4% of Black patients experienced a time to surgery >1 day compared with 13.4% of White patients (p < 0.0001). In the multivariable analysis, controlling for potential confounding factors, Black patients were found to be more likely than White patients to experience a time to surgery >1 day (OR 1.23, 95% CI 1.17-1.30, p < 0.0001). CONCLUSIONS Further investigation is indicated to better define the nature and significance of gender, race, and other biases in surgical care. Surgeons should be aware that biases may adversely impact patient care and should strive to identify and proactively address them to promote health equity in surgery.
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Affiliation(s)
| | - Daniel P Nussbaum
- Duke University School of Medicine, Duke University Health System, Durham, NC, USA; Department of Surgery, Duke University School of Medicine, Duke University Health System, Durham, NC, USA; Duke Network Services, Duke University Health System, Durham, NC, USA
| | - Paul J Mosca
- Duke University School of Medicine, Duke University Health System, Durham, NC, USA; Department of Surgery, Duke University School of Medicine, Duke University Health System, Durham, NC, USA; Duke Network Services, Duke University Health System, Durham, NC, USA.
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12
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Arkoudis NA, Moschovaki-Zeiger O, Grigoriadis S, Palialexis K, Reppas L, Filippiadis D, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. US-guided trocar versus Seldinger technique for percutaneous cholecystostomy (TROSELC II trial). Abdom Radiol (NY) 2023; 48:2425-2433. [PMID: 37081229 DOI: 10.1007/s00261-023-03916-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES The purpose of this study is to investigate the safety and effectiveness of the US-guided bedside trocar vs. the Seldinger technique for percutaneous cholecystostomy (PC) procedures. METHODS This is a prospective single-center, randomized, controlled trial (RCT) comparing the trocar (group T; 50 patients [27 men]; mean [± SD] age, 74.16 ± 15.59 years) with the Seldinger technique for PC (group S; 50 patients [23 men]; mean [± SD] age, 80.78 ± 14.09 years) in consecutive patients undergoing the procedure in a bedside setting with the sole employment of US as a guidance modality. Primary outcomes consisted of technical success and complications associated with the procedure. Secondary outcome measures involved procedure duration, intra-/post-procedure pain evaluation, and clinical success. RESULTS PC was technically successful for all 100 patients. Clinical success rates were similar between group T and S (94% vs. 92%, respectively; p = 0.34). Equal total procedure-related complications were noted in both groups (4% vs. 4%; p = 0.5). A minor bleeding event (bile mixed with blood) occurred in one patient (2%) in group T and one patient (2%) in group S; accidental catheter dislodgement in one patient (2%) from group T, and a small biloma in one patient (2%) from group S. No procedure-related deaths or major bleeding events were noted. PC was significantly faster in group T (1.41 ± 1.13 vs. 4.41 ± 2.68 min; p < 0.001). Mean pain score during PC was significantly lower in group T compared with group S at 12 h of follow-up (1.43 ± 1.45 vs. 3.36 ± 2.05; p < 0.01). CONCLUSION US-guided bedside trocar technique for PC was equally effective and safe as the Seldinger technique, but it was faster and simpler to perform and led to reduced pain following the procedure.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
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13
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Vargheese S, Nelson T, Akhtarkhavari A, Patra SR, Algud SM. Laparoscopic Cholecystectomy in Acute Calculous Cholecystitis: A Secondary Center Experience. Cureus 2023; 15:e41114. [PMID: 37519502 PMCID: PMC10382714 DOI: 10.7759/cureus.41114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Background Laparoscopic cholecystectomy (LC) has increasingly been accepted as the procedure of choice for the treatment of acute cholecystitis (AC). However, the timing of this procedure in the management of AC remains controversial. Hence this study was conducted to assess the feasibility of early laparoscopic cholecystectomy in acute cholecystitis. Materials and methods Patients who presented with symptoms of acute cholecystitis such as pain and tenderness in the right upper quadrant, systemic signs of inflammation, and positive ultrasound findings according to Tokyo guidelines were included for evaluation. Group 1 includes patients presented within 24 hours of the onset of symptoms whereas those presented between 25 and 72 hours of the onset of symptoms belonged to Group 2. All patients were taken up for early LC after assessment. Intraoperative and postoperative complications were analysed. Results Out of 120 patients, 37 belonged to Group 1 (30.83%) and 83 belonged to Group 2 (69.17%). There was a significant difference between the study groups in terms of certain demographic, laboratory findings and duration of surgery. None of the patients in Group 1 developed postoperative complications, whereas one patient in Group 2 had a bile leak on postoperative Day 2. Group 2 had a higher conversion rate to open procedure (p = 0.059). The mean duration of hospital stay for patients in Groups 1 and 2 were 3 and 3.3 days, respectively. Conclusion Laparoscopic cholecystectomy is safe and feasible with minimal conversion rates in patients presenting with early symptoms of AC. With the availability of good visualisation, optics, instruments and energy sources, good outcomes can be achieved.
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Affiliation(s)
- Saji Vargheese
- General Surgery, Andaman & Nicobar Islands Institute of Medical Sciences, Govind Ballabh Pant Hospital, Port Blair, IND
| | - Thirugnanam Nelson
- Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, IND
- General Surgery, Andaman & Nicobar Islands Institute of Medical Sciences, Govind Ballabh Pant Hospital, Port Blair, IND
| | - Anis Akhtarkhavari
- General Surgery, Andaman & Nicobar Islands Institute of Medical Sciences, Govind Ballabh Pant Hospital, Port Blair, IND
| | - Satya R Patra
- General Surgery, Andaman & Nicobar Islands Institute of Medical Sciences, Govind Ballabh Pant Hospital, Port Blair, IND
| | - Shivakumar M Algud
- General Surgery, Andaman & Nicobar Islands Institute of Medical Sciences, Govind Ballabh Pant Hospital, Port Blair, IND
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Hamid M, Khalid A, Parmar J. Does percutaneous cholecystostomy timing in high anaesthetic-risk patients impact on outcome? Updates Surg 2023; 75:133-140. [PMID: 36333564 DOI: 10.1007/s13304-022-01405-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
The optimal timing for percutaneous cholecystostomy (PCT) in patients with acute biliary sepsis, who are high-risk for cholecystectomy, requires further investigation. We aimed to study local factors influencing the timing to PCT placement, and investigate patient outcomes in early (≤ 48 h) vs. delayed PCT over a six-year period. A retrospective observational study investigating patients who required a PCT at a single hospital in the UK between January 2014 and December 2019. Placement of a PCT was at the discretion of the on-call surgical consultant according to their own personal experience and not based on a standard local protocol. Clinical outcomes, hospital statistics and details of any subsequent bridging surgery were analysed using multivariate logistic regression models adjusting for age, sex, Charlson Comorbidity Index (CCI) and American Society of Anaesthesiologists (ASA) grade. There were 72 patients with 35/72 (48.6%) classed as TG18 AC grade 3; 26/72 (36.1%) had an early PCT placed and 46/72 (63.9%) delayed. Median age was 76 (65-83) years, 52.8% were female, and 51.4% were classed ASA ≥ 3 with 94.0% scoring CCI > 2. Trial on antibiotic therapy was the primary reason for delayed PCT. In adjusted models, early PCT was associated with a shorter length in hospital stay (OR 3.02, p = 0.044), successful definitive treatment (OR 6.26, p = 0.009); and reduced likelihood for catheter dislodgment (OR 0.12, p = 0.004) with fewer patients bridging to later emergency open surgery (OR 0.19, p = 0.024). Clinical outcomes may be superior in urgent or early PCT for high anaesthetic-risk patients following acute biliary sepsis.
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Affiliation(s)
- Mohammed Hamid
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK. .,Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK.
| | - Ayesha Khalid
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.,Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Jitesh Parmar
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.,Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
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15
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Handler C, Kaplan U, Hershko D, Abu-Hatoum O, Kopelman D. High rates of recurrence of gallstone associated episodes following acute cholecystitis during long term follow-up: a retrospective comparative study of patients who did not receive surgery. Eur J Trauma Emerg Surg 2022; 49:1157-1161. [PMID: 36197463 DOI: 10.1007/s00068-022-02106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients who are admitted with acute cholecystitis (AC) and do not undergo urgent cholecystectomy, are usually referred for interval cholecystectomy. Many do not have surgery for various reasons, and some of those do not suffer from any recurrent symptoms. The primary objective of this study was to assess the rate and nature of recurrent gallstone-related events in this population over a long period, and its association with demographic and clinical parameters. A secondary objective was to assess the reasons for not undergoing surgery. METHODS This is a retrospective cohort study, where the study group were adult patients admitted with AC. Patients that have suffered recurrent episodes were compared with those who did not. A control group of patients that had undergone cholecystectomy following an admission with AC was used for comparison. Demographic and clinical parameters were recorded for all patients, and the association with a recurrent episode was analyzed using univariate analysis. RESULTS The study population was 197 patients. The group of patients who did not undergo surgery were significantly older (68.7 vs 54.2) and sicker (ASA > 3 50% vs 19%). The rate of recurrent episodes in the study group was 38.5%, and it was not found to be associated with the studied parameters. There was a trend towards higher gallstone disease specific mortality in the study group (5.5% vs 1.45% p = 0.062). CONCLUSIONS This is a study of long-term follow-up of patients following an episode of AC we showed that the rate of recurrent episodes is quite high and involves severe inflammatory diseases, such as obstructive jaundice and pancreatitis.
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Affiliation(s)
- Chovav Handler
- Department of General Surgery, Ziv Medical Center, Rambam st, 13100, Tzfat, Israel. .,Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold st, Tzfat, Israel.
| | - Uri Kaplan
- Department of General Surgery B, HaEmek Medical Center, 21 Yitshak Rabin Boulevard, 1834111, Afula, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Dan Hershko
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Department of General Surgery A, HaEmek Medical Center, 21 Yitshak Rabin Boulevard, 1834111, Afula, Israel
| | - Ossama Abu-Hatoum
- Department of General Surgery B, HaEmek Medical Center, 21 Yitshak Rabin Boulevard, 1834111, Afula, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Doron Kopelman
- Department of General Surgery B, HaEmek Medical Center, 21 Yitshak Rabin Boulevard, 1834111, Afula, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Koishibayeva L, Turgunov Y, Sandblom G, Koishibayev Z, Teleuov M. Quality-of-life After Cholecystectomy in Kazakhstan and Sweden: Comparative Study Based on the Gastrointestinal Quality-of-life Index Questionnaire. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: As severe morbidity rarely is the focus in gallstone surgery, health-related quality of life has evolved as the main outcome measure of the management of patients with gallstone disease (GSD). The lack of universally accepted guidelines on treatment of GSD has also resulted in regional differences in the preoperative evaluation and management of patients with GSD.
AIM: The aim of this study was to compare quality-of-life (QoL) following gallstone surgery in cohorts from Kazakhstan and Sweden.
METHODS: A comparative study on QoL after cholecystectomy (CE) in two cohorts from Sweden and Kazakhstan using the gastrointestinal QoL index (GIQLI) questionnaire. QoL measures of 259 patients in Kazakhstan and 448 patients in Sweden were compared taking into account surgical approach, mode of admission, and indication for surgery. Patients in both cohorts were requested to fill in the GIQLI questionnaire after surgery. Similar routines were applied to ensure high coverage in both countries.
RESULTS: The mean overall GIQLI score was higher for patients undergoing CE in Sweden than those in Kazakhstan (p < 0.01). The same was seen when stratifying for open or laparoscopic surgery (both p < 0.05), absence of presence of acute cholecystitis (both p < 0.05), and emergency admission (p < 0.05), but not in case of planned admission (p = 0.54).
CONCLUSIONS: There were large differences in QoL, especially in the group having undergone surgery for pain attacks or chronic cholecystitis. These differences in may be explained by differences in attitudes to health status and treatment expectations. Standardized routines for evaluating the outcome after surgery are needed.
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The Need for Standardizing Diagnosis, Treatment and Clinical Care of Cholecystitis and Biliary Colic in Gallbladder Disease. Medicina (B Aires) 2022; 58:medicina58030388. [PMID: 35334564 PMCID: PMC8949253 DOI: 10.3390/medicina58030388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 02/06/2023] Open
Abstract
Gallstones affect 20% of the Western population and will grow in clinical significance as obesity and metabolic diseases become more prevalent. Gallbladder removal (cholecystectomy) is a common treatment for diseases caused by gallstones, with 1.2 million surgeries in the US each year, each costing USD 10,000. Gallbladder disease has a significant impact on the logistics and economics of healthcare. We discuss the two most common presentations of gallbladder disease (biliary colic and cholecystitis) and their pathophysiology, risk factors, signs and symptoms. We discuss the factors that affect clinical care, including diagnosis, treatment outcomes, surgical risk factors, quality of life and cost-efficacy. We highlight the importance of standardised guidelines and objective scoring systems in improving quality, consistency and compatibility across healthcare providers and in improving patient outcomes, collaborative opportunities and the cost-effectiveness of treatment. Guidelines and scoring only exist in select areas of the care pathway. Opportunities exist elsewhere in the care pathway.
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Single Incision Cholecystectomies for Acute Cholecystitis: A Single Surgeon Series from the Caribbean. Minim Invasive Surg 2022; 2022:6781544. [PMID: 35223097 PMCID: PMC8865982 DOI: 10.1155/2022/6781544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Single incision laparoscopic surgery (SILS) is accepted as a safe alternative to conventional multiport laparoscopic (MPL) cholecystectomy for benign gallbladder disease. Since many surgeons carefully select patients without inflammation, there are limited data on SILS for acute cholecystitis. We report a single surgeon experience with SILS cholecystectomy for patients with acute cholecystitis. Materials and Methods. After securing ethical approval, we performed an audit of all SILS cholecystectomies for acute cholecystitis by a single surgeon from January 1, 2009, to December 31, 2019. The following data were extracted: patient demographics, intraoperative details, surgical techniques, specialized equipment utilized, conversions (additional port placement), morbidity, and mortality. Data were analyzed using SPSS 12.0. Results. SILS cholecystectomy was performed in 25 females at a mean age of 35 ± 4.1 (SD) years and a mean BMI of 31.9 ± 3.8 (SD) using a direct fascial puncture technique without access platforms. The operations were completed in 83 ± 29.4 minutes (mean ± SD) with an estimated blood loss of 76.9 ± 105 (mean + SD). Three (12%) patients required additional 5 mm port placement (conversions), but no open operations were performed. The patients were hospitalized for 1.96 ± 0.9 days (mean ± SD). There were 2 complications: postoperative superficial SSI (grade I) and a diaphragmatic laceration (grade III). No bile duct injuries were reported. There were 9 patients with complicated acute cholecystitis, and this sub-group had longer mean operating times (109.2 ± 27.3 minutes) and mean postoperative hospital stay (1.3 ± 0.87 days). Conclusion. The SILS technique is a feasible and safe approach to perform cholecystectomy for acute cholecystitis. We advocate a low threshold to place additional ports to assist with difficult dissections for patient safety.
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Bustos-Guerrero AM, Guerrero-Macías SI, Manrique-Hernández EF, Gomez-Rincón GA. Severidad de la colecistitis aguda en tiempos de COVID-19: ¿mito o realidad? REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Introducción. La colecistitis aguda es una de las causas más frecuentes de ingresos hospitalarios y la colecistectomía laparoscópica es el estándar de oro para su manejo. Dentro de los efectos de la pandemia por COVID-19 se ha percibido un aumento en la severidad de presentación en estos pacientes. Este estudio tuvo como objetivo comparar la presentación clínica y quirúrgica de la colecistitis aguda antes y durante la pandemia por COVID-19.
Métodos. Estudio retrospectivo de una cohorte con pacientes llevados a colecistectomía laparoscópica por colecistitis aguda entre 2019 y 2020. Se realizó un análisis bivariado y de Kaplan Meier con el tiempo transcurrido entre inicio de síntomas y el ingreso al hospital, y entre el ingreso del hospital y la realización de la cirugía.
Resultados. Fueron llevados a colecistectomía laparoscópica por colecistitis aguda un total de 302 pacientes. El tiempo de evolución de los síntomas hasta el ingreso fue de 83,3 horas (IC95%: 70,95 – 96,70) antes de la pandemia y 104,75 horas (IC95%: 87,26 – 122,24) durante la pandemia. El tiempo entre el ingreso al hospital y el procedimiento quirúrgico fue significativamente menor en el período de pandemia (70,93 vs. 42,29; p<0,001). El porcentaje con mayor severidad (Parkland 5) fue igual antes y durante la pandemia (29 %).
Conclusión. Se reporta una severidad clínica y quirúrgica similar antes y durante la pandemia por COVID-19, probablemente secundario a los resultados de un tiempo de entrada al quirófano significativamente menor durante la pandemia, debido a una mayor disponibilidad de quirófanos para las patologías quirúrgicas urgentes.
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Bagepally BS, Sajith Kumar S, Natarajan M, Sasidharan A. Incremental net benefit of cholecystectomy compared with alternative treatments in people with gallstones or cholecystitis: a systematic review and meta-analysis of cost–utility studies. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000779. [PMID: 35064024 PMCID: PMC8785172 DOI: 10.1136/bmjgast-2021-000779] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/17/2021] [Indexed: 11/04/2022] Open
Abstract
IntroductionCholecystectomy is a standard treatment in the management of symptomatic gallstone disease. Current literature has contradicting views on the cost-effectiveness of different cholecystectomy treatments. We have conducted a systematic reappraisal of literature concerning the cost-effectiveness of cholecystectomy in management of gallstone disease.MethodsWe systematically searched for economic evaluation studies from PubMed, Embase and Scopus for eligible studies from inception up to July 2020. We pooled the incremental net benefit (INB) with a 95% CI using a random-effects model. We assessed the heterogeneity using the Cochrane-Q test, I2 statistic. We have used the modified economic evaluation bias (ECOBIAS) checklist for quality assessment of the selected studies. We assessed the possibility of publication bias using a funnel plot and Egger’s test.ResultsWe have selected 28 studies for systematic review from a search that retrieved 8710 studies. Among them, seven studies were eligible for meta-analysis, all from high-income countries (HIC). Studies mainly reported comparisons between surgical treatments, but non-surgical gallstone disease management studies were limited. The early laparoscopic cholecystectomy (ELC) was significantly more cost-effective compared with the delayed laparoscopic cholecystectomy (DLC) with an INB of US$1221 (US$187 to US$2255) but with high heterogeneity (I2=73.32%). The subgroup and sensitivity analysis also supported that ELC is the most cost-effective option for managing gallstone disease or cholecystitis.ConclusionELC is more cost-effective than DLC in the treatment of gallstone disease or cholecystitis in HICs. There was insufficient literature on comparison with other treatment options, such as conservative management and limited evidence from other economies.PROSPERO registration numberCRD42020194052.
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Affiliation(s)
| | - S Sajith Kumar
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India
| | - Meenakumari Natarajan
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India
| | - Akhil Sasidharan
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India
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Elective Laparoscopic Cholecystectomy Is Better than Conservative Treatment in Elderly Patients with Acute Cholecystitis After Percutaneous Transhepatic Gallbladder Drainage. J Gastrointest Surg 2021; 25:3170-3177. [PMID: 34173163 DOI: 10.1007/s11605-021-05067-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is unclear whether cholecystectomy is beneficial after percutaneous transhepatic gallbladder drainage (PTGBD) in elderly patients with acute cholecystitis (AC). METHODS This single-center, retrospective study included 202 patients aged >80 years with AC without common bile duct (CBD) stones who underwent PTGBD between January 2010 and December 2019. RESULTS One hundred and forty-two patients underwent elective laparoscopic cholecystectomy (ELC), and 60 underwent conservative treatment, specifically PTGBD removal (PTGBD-R) in 36 patients and PTGBD maintained (PTGBD-M) in 24 patients. The postoperative major complication (POMC) rate in the ELC group was 8.5%. The cumulative incidence for recurrence of biliary events (BE) in the PTGBD-R group was 22.2%. The cumulative incidence for PTGBD-related complication in the PTGBD-M group was 70.8%. Mortality after initial treatment was not significantly different between the three groups (2.8% vs. 2.8% vs. 8.3%, p=0.381). In multivariate analysis, a Charlson age comorbidity index ≥6 and body mass index ≤19 were significant risk factors for POMC after ELC, and a closed cystic duct was a significant risk factor for recurrent BE after PTGBD-R. CONCLUSION ELC is recommended in AC after PTGBD for selected patients aged >80 years without CBD stones due to the high recurrence rate of BE after PTGBD-R and the difficulty associated with PTGBD-M.
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Laparoscopy in Emergency: Why Not? Advantages of Laparoscopy in Major Emergency: A Review. Life (Basel) 2021; 11:life11090917. [PMID: 34575066 PMCID: PMC8470929 DOI: 10.3390/life11090917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 01/09/2023] Open
Abstract
A laparoscopic approach is suggested with the highest grade of recommendation for acute cholecystitis, perforated gastroduodenal ulcers, acute appendicitis, gynaecological disorders, and non-specific abdominal pain (NSAP). To date, the main qualities of laparoscopy for these acute surgical scenarios are clearly stated: quicker surgery, faster recovery and shorter hospital stay. For the remaining surgical emergencies, as well as for abdominal trauma, the role of laparoscopy is still a matter of debate. Patients might benefit from a laparoscopic approach only if performed by experienced teams and surgeons which guarantee a high standard of care. More precisely, laparoscopy can limit damage to the tissue and could be effective for the reduction of the overall amount of cell debris, which is a result of the intensity with which the immune system reacts to the injury and the following symptomatology. In fact, these fragments act as damage-associated molecular patterns (DAMPs). DAMPs, as well as pathogen associated molecular patterns (PAMPs), are recognised by both surface and intracellular receptors of the immune cells and activate the cascade which, in critically ill surgical patients, is responsible for a deranged response. This may result in the development of progressive and multiple organ dysfunctions, manifesting with acute respiratory distress syndrome (ARDS), coagulopathy, liver dysfunction and renal failure. In conclusion, none of the emergency surgical scenarios preclude laparoscopy, provided that the surgical tactic could ensure sufficient cleaning of the abdomen in addition to resolving the initial tissue damage caused by the “trauma”.
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Cecire J, Sutherland A, Das KK. Gallbladder Torsion Masking as Acalculus Cholecystitis: A Review of Two Cases Including Unsuccessful Management With Percutaneous Cholecystostomy. J Med Cases 2021; 12:223-225. [PMID: 34434462 PMCID: PMC8383507 DOI: 10.14740/jmc3683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Gallbladder torsion is a rare cause of abdominal pain; however, it is important to diagnose pre-operatively. We report two cases of gallbladder torsion, both of which were not recognized until the time of surgery. Both patients were elderly thin females, presenting with right upper quadrant pain, and on examination had a positive Murphy’s sign, and pre-operative imaging was suggestive of acalculus cholecystitis. One patient was initially managed by percutaneous insertion of a cholecystostomy tube, with progression to a laparoscopic cholecystectomy after a failure of resolution of symptoms. The second patient was taken to theater shortly after presentation, with the gallbladder torsion recognized intra-operatively. In both cases, the gallbladder was distorted and a routine laparoscopic cholecystectomy was performed with good recovery following. These two cases highlight the need for gallbladder torsion to be considered as a diagnostic possibility in those presenting with right upper quadrant pain, particularly those groups at most risk, including elderly thin females. Whilst other causes of cholecystitis can be managed non-operatively, at least in the acute phase, gallbladder torsion requires urgent operative intervention.
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Affiliation(s)
- Jack Cecire
- Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, NSW, Australia
| | - Andrew Sutherland
- Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, NSW, Australia
| | - Kamala Kanta Das
- Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, NSW, Australia
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Mytton J, Daliya P, Singh P, Parsons SL, Lobo DN, Lilford R, Vohra RS. Outcomes Following an Index Emergency Admission With Cholecystitis: A National Cohort Study. Ann Surg 2021; 274:367-374. [PMID: 31567508 DOI: 10.1097/sla.0000000000003599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the differences between patients who undergo cholecystectomy following index admission for cholecystitis, and those who are managed nonoperatively. SUMMARY BACKGROUND DATA Index emergency cholecystectomy following acute cholecystitis is widely recommended by national guidelines, but its effect on clinical outcomes remains uncertain. METHODS Data collected routinely from the Hospital Episode Statistics database (all admissions to National Health Service organizations in England and Wales) were extracted between April 1, 2002 and March 31, 2015. Analyses were limited to patients aged over 18 years with a primary diagnosis of cholecystitis. Exclusions included records with missing or invalid datasets, patients who had previously undergone a cholecystectomy, patients who had died without a cholecystectomy, and those undergoing cholecystectomy for malignancy, pancreatitis, or choledocholithiasis. Patients were grouped as either "no cholecystectomy" where they had never undergone a cholecystectomy following discharge, or "cholecystectomy." The latter group was then subdivided as "emergency cholecystectomy" when cholecystectomy was performed during their index emergency admission, or "interval cholecystectomy" when a cholecystectomy was performed within 12 months following a subsequent (emergency or elective) admission. Propensity Score Matching was used to match emergency and interval cholecystectomy groups. Main outcome measures included 1) One-year total length of hospital stay due to biliary causes following an index emergency admission with cholecystitis. 2) One-year mortality; defined as death occurring within 1 year following the index emergency admission with acute cholecystitis. RESULTS Of the 99,139 patients admitted as an emergency with acute cholecystitis, 51.1% (47,626) did not undergo a cholecystectomy within 1 year of index admission. These patients were older, with more comorbidities (Charlson Comorbidity Score ≥ 5 in 23.5% vs. 8.1%, P < 0.001) when compared to patients who did have a cholecystectomy. While all-cause 1-year mortality was higher in the nonoperated versus the operated group (12.2% vs. 2.0%, P < 0.001), gallbladder-related deaths were significantly lower than all other causes of death in the non-operated group (3.3% vs. 8.9%, P < 0.001). Following matching, 1-year total hospital admission time was significantly higher following emergency compared with interval cholecystectomy (17.7 d vs. 13 d, P < 0.001). CONCLUSIONS Over 50% of patients in England did not undergo cholecystectomy following index admission for acute cholecystitis. Mortality was higher in the nonoperated group, which was mostly due to non-gallbladder pathologies but total hospital admission time for biliary causes was lower over 12 months. Increasing the numbers of emergency cholecystectomy may risk over-treating patients with acute cholecystitis and increasing their time spent admitted to hospital.
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Affiliation(s)
- Jemma Mytton
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Prita Daliya
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK
| | - Pritam Singh
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Simon L Parsons
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK
- MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | | | - Ravinder S Vohra
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK
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Cawich SO, Mahabir AH, Griffith S, FaSiOen P, Naraynsingh V. Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice. Trop Doct 2021; 51:539-541. [PMID: 34162285 DOI: 10.1177/00494755211010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.
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Affiliation(s)
- Shamir O Cawich
- Professor of Liver and Pancreas Surgery, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad & Tobago, West Indies
| | - Avidesh H Mahabir
- Surgery House Officer, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad & Tobago, West Indies
| | - Sahle Griffith
- Consultant General Surgeon, Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados, West Indies
| | - Patrick FaSiOen
- Consultant General Surgeon, Department of Surgery, Sint Elizabeth Hospital, Curacao, Dutch Caribbean
| | - Vijay Naraynsingh
- Professor of Surgery, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad & Tobago, West Indies
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Kimura K, Adachi E, Omori S, Toyohara A, Higashi T, Ohgaki K, Ito S, Maehara SI, Nakamura T, Ikeda Y, Maehara Y. The influence of the interval between percutaneous transhepatic gallbladder drainage and cholecystectomy on perioperative outcomes: a retrospective study. BMC Gastroenterol 2021; 21:226. [PMID: 34011273 PMCID: PMC8132394 DOI: 10.1186/s12876-021-01810-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/06/2021] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Percutaneous transhepatic gallbladder drainage (PTGBD) is recommended for acute cholecystitis patients at high risk for surgical treatment. However, there is no evidence about the best timing of surgery after PTGBD. Here, we retrospectively investigated the influence of the interval between PTGBD and surgery on perioperative outcomes and examined the optimal timing of surgery after PTGBD. METHODS We performed a retrospective analysis of 22 patients who underwent cholecystectomy after PTGBD from January 2008 to August 2019. We examined perioperative factors between patients with an interval of ≤ 7 days between PTGBD and cholecystectomy (≤ 7-day group; n = 12) and those with an interval of ≥ 8 days (≥ 8-day group; n = 10). Moreover, we also examined perioperative factors between patients with an interval of ≤ 14 days from PTGBD to cholecystectomy (≤ 14-day group; n = 10) and those with an interval of ≥ 15 days (≥ 15-day group; n = 12). RESULTS Of the 22 patients, 9 had Grade I cholecystitis, 12 had Grade II cholecystitis, and 2 had Grade III cholecystitis. Nine patients had high-grade cholecystitis before PTGBD and 13 had a poor general condition. We examined perioperative factors between patients with an interval of ≤ 7 days between PTGBD and cholecystectomy (≤ 7-day group; n = 12) and those with an interval of ≥ 8 days (≥ 8-day group; n = 10). The C-reactive protein (CRP) level before surgery was significantly higher (12.70 ± 1.95 mg/dL vs. 1.13 ± 2.13 mg/dL, p = 0.0007) and the total hospitalization was shorter (17.6 ± 8.0 days vs. 54.1 ± 8.8 days, p = 0.0060) in the ≤ 7-day group than in the ≥ 8-day group. We also examined perioperative factors between patients with an interval of ≤ 14 days from PTGBD to cholecystectomy (≤ 14-day group; n = 14) and those with an interval of ≥ 15 days (≥ 15-day group; n = 8). The CRP level before surgery was significantly higher (11.13 ± 2.00 mg/dL vs. 0.99 ± 2.64 mg/dL, p = 0.0062) and the total hospitalization was shorter (19.5 ± 7.2 days vs. 59.9 ± 9.5 days, p = 0.0029) in the ≤ 14-day group than in the ≥ 15-day group. However, there were no significant differences between the ≤ 14-day group and the ≥ 15-day group in the levels of hepatic enzymes before surgery, adhesion grade, amount of bleeding during surgery, operative duration, frequency of surgical complications, or length of hospitalization after surgery. CONCLUSIONS The interval between PTGBD and surgery has little influence on perioperative outcomes.
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Affiliation(s)
- Koichi Kimura
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan.
| | - Eisuke Adachi
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan
| | - Sachie Omori
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan
| | - Ayako Toyohara
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan
| | - Takahiro Higashi
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan
| | - Kippei Ohgaki
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan
| | - Shuhei Ito
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan
| | - Shin-Ichiro Maehara
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan
| | - Toshihiko Nakamura
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan
| | - Yoichi Ikeda
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan
| | - Yoshihiko Maehara
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, 3-23-1, Shiobaru, Minamiku, Fukuoka City, 815-8588, Japan
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Imtiaz M, Prakash S, Iqbal S, Fernandes R, Shah A, Shrestha AK, Basu S. 'Hot gall bladder service' by emergency general surgeons: Is this safe and feasible? J Minim Access Surg 2021; 18:45-50. [PMID: 33885031 PMCID: PMC8830581 DOI: 10.4103/jmas.jmas_271_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Despite NICE/AUGIS recommendations, the practice of early laparoscopic cholecystectomy (ELC) has been particularly poor in the UK offered only by 11%–20% surgeons as compared to 33%–67% internationally, possibly due to financial constraints, logistical difficulties and shortage of expertise, thus, reflecting the varied provision of emergency general surgical care. To assess whether emergency general surgeons (EGS) could provide a 'Hot Gall Bladder Service' (HGS) with an acceptable outcome. Patients and Methods: This was a prospective HGS observational study that was protocol driven with strict inclusion/exclusion criteria and secure online data collection in a district general hospital between July 2018 and June 2019. A weekly dedicated theatre slot was allocated for this list. Results: Of the 143 referred for HGS, 86 (60%) underwent ELC which included 60 (70%) women. Age, ASA and body mass index was 54* (18–85) years, II* (I-III) and 27* (20–54), respectively. 86 included 46 (53%), 19 (22%), 19 (22%) and 2 (3%) patients presenting with acute calculus cholecystitis, gallstone pancreatitis, biliary colic, and acalculus cholecystitis, respectively. 85 (99%) underwent LC with a single conversion. Grade of surgical difficulty, duration of surgery and post-operative stay was 2* (1–4) 68* (30–240) min and 0* (0–13) day, respectively. Eight (9%) required senior surgical input with no intra-operative complications and 2 (2%) 30-day readmissions. One was post-operative subhepatic collection that recovered uneventfully and the second was pancreatitis, imaging was clear requiring no further intervention. Conclusion: In the current climate of NHS financial crunch, COVID pandemic and significant pressure on inpatient beds: Safe and cost-effective HGS can be provided by the EGS with input from upper GI/HPB surgeons (when required) with acceptable morbidity and a satisfactory outcome.
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Affiliation(s)
- Mohammad Imtiaz
- Department of General Surgery, William Harvey Hospital, Ashford, Kent, UK
| | - Samip Prakash
- Department of General Surgery, William Harvey Hospital, Ashford, Kent, UK
| | - Sara Iqbal
- Department of General Surgery, William Harvey Hospital, Ashford, Kent, UK
| | - Roland Fernandes
- Department of General Surgery, William Harvey Hospital, Ashford, Kent, UK
| | - Ankur Shah
- Department of General Surgery, William Harvey Hospital, Ashford, Kent, UK
| | - Ashish K Shrestha
- Department of General Surgery, William Harvey Hospital, Ashford, Kent, UK
| | - Sanjoy Basu
- Department of General Surgery, William Harvey Hospital, Ashford, Kent, UK
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Rabie M, Boshnaq M, Eldesouky S, Elabbassy I. Surgical and financial impact of delayed cholecystectomy in mild and moderate acute cholecystitis. Eur Surg 2021. [DOI: 10.1007/s10353-021-00701-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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McCarty TR, Chouairi F, Hathorn KE, Sharma P, Muniraj T, Thompson CC. Healthcare Disparities in the Management of Acute Cholecystitis: Impact of Race, Gender, and Socioeconomic Factors on Cholecystectomy vs Percutaneous Cholecystostomy. J Gastrointest Surg 2021; 25:880-886. [PMID: 33629232 DOI: 10.1007/s11605-021-04959-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND While percutaneous cholecystostomy (PC) is a recommended treatment strategy in lieu of cholecystectomy (CCY) for acute cholecystitis among patients who may not be considered good surgical candidates, reports on disparities in treatment utilization remain limited. The aim of this study was to investigate the role of demographic, clinical, and socioeconomic factors in treatment of acute cholecystitis. METHODS Patients with a diagnosis of acute cholecystitis who underwent CCY versus PC were reviewed from the U.S. Nationwide Inpatient Sample (NIS) database between 2008-2014. Measured variables including age, race/ethnicity, Charlson comorbidity index (CCI), hospital type/region, insurance payer, household income, length of stay (LOS), hospital cost, and mortality were compared using chi-square and ANOVA. Multivariable logistic regression was performed to identify specific predictors of cholecystitis treatment. RESULTS A total of 1,492,877 patients (CCY:n=1,435,255 versus PC:n=57,622) were analyzed. The majority of patients that received PC were at urban teaching hospitals (65.2%). LOS was significantly longer with higher associated costs for PC [(11.1±11.0 versus 4.5±5.3 days; P<0.001) and ($99577±138850 versus $48399±58330; P<0.001)]. Mortality was also increased for patients that received PC compared to CCY (8.8% versus 0.6%; P<0.001). Multivariable regression demonstrated multiple socioeconomic and healthcare-related factors influencing the utilization of PC including male gender, Black or Asian race/ethnicity, Medicare payer status, urban hospital location, and household income (all P<0.001). CONCLUSION Although patients receiving PC had higher CCI scores, multiple socioeconomic and healthcare related factors appeared to also influence this treatment decision. Additional studies to investigate these disparities are indicated to improve outcomes for all individuals with this condition.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Prabin Sharma
- Section of Gastroenterology, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Thiruvengadam Muniraj
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Schuster KM, O'Connor R, Cripps M, Kuhlenschmidt K, Taveras L, Kaafarani HM, El Hechi M, Puri R, Mull J, Schroeppel TJ, Rodriquez J, Cullinane DC, Cullinane LM, Enniss TM, Sensenig R, Zilberman B, Crandall M. Multicenter validation of the American Association for the Surgery of Trauma grading scale for acute cholecystitis. J Trauma Acute Care Surg 2021; 90:87-96. [PMID: 33332782 DOI: 10.1097/ta.0000000000002901] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The American Association for the Surgery of Trauma (AAST) patient assessment committee has created grading systems for emergency general surgery diseases to assist with clinical decision making and risk adjustment during research. Single-institution studies have validated the cholecystitis grading system as associated with patient outcomes. Our aim was to validate the grading system in a multi-institutional fashion and compare it with the Parkland grade and Tokyo Guidelines for acute cholecystitis. METHODS Patients presenting with acute cholecystitis to 1 of 8 institutions were enrolled. Discrete data to assign the AAST grade were collected. The Parkland grade was collected prospectively from the operative surgeon from four institutions. Parkland grade, Tokyo Guidelines, AAST grade, and the AAST preoperative grade (clinical and imaging subscales) were compared using linear and logistic regression to the need for surgical "bailout" (subtotal or fenestrated cholecystectomy, or cholecystostomy), conversion to open, surgical complications (bile leak, surgical site infection, bile duct injury), all complications, and operative time. RESULTS Of 861 patients, 781 underwent cholecystectomy. Mean (SD) age was 51.1 (18.6), and 62.7% were female. There were six deaths. Median AAST grade was 2 (interquartile range [IQR], 1-2), and median Parkland grade was 3 (interquartile range [IQR], 2-4). Median AAST clinical and imaging grades were 2 (IQR, 2-2) and 1 (IQR, 0-1), respectively. Higher grades were associated with longer operative times, and worse outcomes although few were significant. The Parkland grade outperformed the AAST grade based on area under the receiver operating characteristic curve. CONCLUSION The AAST cholecystitis grading schema has modest discriminatory power similar to the Tokyo Guidelines, but generally lower than the Parkland grade, and should be modified before widespread use. LEVEL OF EVIDENCE Diagnostic study, level IV.
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Affiliation(s)
- Kevin M Schuster
- From the Department of Surgery (K.M.S., R.O.), Yale School of Medicine, New Haven, CT; Department of Surgery (M. Cripps, K.K., L.T.), University of Texas Southwestern School of Medicine, Dallas, TX; Department of Surgery (H.M.K., M.E.), Massachusetts General Hospital, Boston, MA; Department of Surgery (R.P., M. Crandall, J.M.), College of Medicine - Jacksonville, University of Florida, Jacksonville, FL; Department of Surgery (T.J.S., J.R.), UC Health, Colorado Springs, CO; Department of Surgery (D.C.C., L.M.C.), Marshfield Clinic, Marshfield, WI; Department of Surgery (T.M.E.), School of Medicine, University of Utah, Salt Lake City, UT; and Department of Surgery (R.S., B.Z.), Cooper Medical School of Rowan University, Camden, NJ
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Markopoulos G, Mulita F, Kehagias D, Tsochatzis S, Lampropoulos C, Kehagias I. Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis. PRZEGLAD GASTROENTEROLOGICZNY 2021; 16:188-195. [PMID: 34584579 PMCID: PMC8456769 DOI: 10.5114/pg.2020.100658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Percutaneous cholecystostomy (PC) represents a management option to control sepsis in patients with acute cholecystitis, who are unable to tolerate surgery. AIM This review aimed to evaluate the outcomes of elderly patients treated with PC and compare it with emergent cholecystectomy. MATERIAL AND METHODS An electronic search of the Embase, Medline Web of Science, and Cochrane databases was performed. Percutaneous cholecystostomy was used as the reference group, and weighted mean differences (WMD) were calculated for the effect of PC on continuous variables, and pooled odds ratios (POR) were calculated for discrete variables. RESULTS There were 20 trials included in this review. Utilisation of PC was associated with significantly increased mortality (POR = 4.85; 95% CI: 1.02-7.30; p = 0.0001) and increased re-admission rates (POR = 2.95; 95% CI: 2.21-3.87; p < 0.0001). CONCLUSIONS This pooled analysis established that patients treated with PC appear to have increased mortality and readmission rates relative to those managed with cholecystectomy.
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Affiliation(s)
- George Markopoulos
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Dimitris Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | | | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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Tur-Martínez J, Escartin Arias A, Muriel P, González M, Cuello E, Pinillos A, Salvador H, Olsina JJ. Days of symptoms and days of hospital admission before surgery do not influence the results of cholecystectomy in moderate acute calculous cholecystitis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 114:213-218. [PMID: 33267590 DOI: 10.17235/reed.2020.7405/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND AND AIMS Early cholecystectomy is the gold standard treatment for acute calculous cholecystitis (AC), although for grade II, many surgeons still prefer delayed cholecystectomy, to avoid surgical complications. The aim of this study is to analyze postoperative morbidity and mortality for Tokyo Guidelines grade II AC treated with cholecystectomy, taking in to account the days of symptoms and the days since hospital admission. MATERIALS AND METHODS Unicentre, retrospective study based on a prospective database. Patients with grade II AC treated with cholecystectomy were selected. Patients were analyzed according to Days of Symptoms (DS) and Days of Hospital Admission (DHA) until cholecystectomy. Patients were subdivided in: < 3 days, 3-5 days, >5 days. Univariant and multivariant analysis for morbidity and mortality. Categorical variables were compared using chi square or Fischer's exact test. Continuous variables were compared using the Mann Whitney U test. Level of statistical significance was set at p < 0.05. RESULTS 998 patients with AC diagnoses were included; 567 with grade II AC; 368 treated with cholecystectomy. Nearly 90% were treated laparoscopically; 48.1% were operated the same day of emergency admission. For DS and DHA there were no statistical differences for severe postoperative complications, although a greater number of complications were detected in >5 DS (p: 0.32) and >5 DHA (p: 0.00). Statistically differences were found in DS for mortality (p:0.04). Postoperative length of stay was longer for >5 DHA cholecystectomies, (p > 0.05). No differences for hospital readmission. CONCLUSION Regardless of DS or DHA until cholecystectomy, do not exist statistically significant differences related to severe postoperative complications, length of stay or mortality.
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Affiliation(s)
- Jaume Tur-Martínez
- Cirugía General y del Aparato Digestivo, Hospital Universitario Arnau de Vilanova de Lleida, Espanya
| | - Alfredo Escartin Arias
- Cirugía General y del Aparato Digestivo, Hospital Universitario Arnau de Vilanova de Lleida, España
| | - Pablo Muriel
- Cirugía General y del Aparato Digestivo, Hospital Universitario Arnau de Vilanova de Lleida
| | - Marta González
- Cirugía General y del Aparato Digestivo, Hospital Universitario Arnau de Vilanova de Lleida
| | - Elena Cuello
- Hospital Universitario Arnau de Vilanova de Lleida
| | - Ana Pinillos
- Hospital Universitario Arnau de Vilanova de Lleida
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Bourgouin S, Monchal T, Julien C, d'Argouges F, Balandraud P. Early versus delayed cholecystectomy for cholecystitis at high risk of operative difficulties: A propensity score-matching analysis. Am J Surg 2020; 221:1061-1068. [PMID: 33066954 DOI: 10.1016/j.amjsurg.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/07/2022]
Abstract
BACKGROUND Numerous studies have demonstrated the superiority of early (EC) over delayed (DC) cholecystectomy for acute cholecystitis (AC). However, none have assessed the effect of operative difficulty when reporting on treatment outcomes. METHODS Outcomes of patients who underwent EC or DC between 2010 and 2019 were compared taking into account the operative difficulty evaluated by the Difficult Laparoscopic Cholecystectomy score (DiLC). For each patient, the DiLC score was retrospectively calculated and corresponded to the foreseeable operative difficulty measured on admission for AC. A propensity score was used to account for confounders. Primary endpoints were the length of stay (LOS) and the occurrence of a serious operative/post-operative event (SOE). RESULTS DC in patients with DiLC≥10 reduced the risk of SOE without increasing the LOS. Conversely, DC in patients with DiLC<10 increased the LOS without improving outcomes. Multivariate analysis found EC in patients with DiLC≥10 as the main independent predictor of SOE. CONCLUSIONS Provided prospective validation, DC for AC in patients with DiLC≥10 seems safer than EC and is not hospital-stay consuming.
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Affiliation(s)
- Stéphane Bourgouin
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France.
| | - Tristan Monchal
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France
| | - Clément Julien
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France
| | - Florent d'Argouges
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France
| | - Paul Balandraud
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
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Thapar P, Salvi P, Killedar M, Roji P, Rokade M. Utility of Tokyo guidelines and intraoperative safety steps in improving the outcome of laparoscopic cholecystectomy in complex acute calculus cholecystitis: a prospective study. Surg Endosc 2020; 35:4231-4240. [PMID: 32875415 DOI: 10.1007/s00464-020-07905-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/17/2020] [Indexed: 12/07/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) in complicated acute calculus cholecystitis (ACC) poses multiple challenges. This prospective, observational study assessed the utility and safety of a set protocol and intraoperative steps in LC for complex ACC. METHODS All cases of ACC from 2008 to 2018 were graded as per Tokyo guidelines; moderate and severe ACC were termed as 'complex ACC (CACC).' Patients were subjected to upfront LC or percutaneous drainage (PCD) followed by LC. Seven intraoperative safety steps were used to achieve critical view of safety (CVS). Use of safety steps, duration of surgery, and length of hospital stay were compared between moderate and severe ACC; complications were classified using Clavien-Dindo classification. RESULTS We analyzed 145 patients with moderate (74.5%) and severe (25.5%) ACC. There were significantly more male (p = 0.0059) and older (p = 0.0006) patients with severe ACC. Upfront LC was performed in 81.4%; PCD required in 6.9%. Timing of LC from symptom onset was < 1 week (53.1%), 2-5 weeks (28.3%), and ≥ 6 weeks (18.6%). CVS was achieved in 97.2%, subtotal cholecystectomy performed in 2.8%, conversion rate was 1.4%, major postoperative complications (Clavien-Dindo Grade IIIa and IIIb) were seen in 4.1%, no bile duct injury, and mortality was 0.7%. The outcomes were similar irrespective of timing of intervention. CONCLUSION The study concludes that preoperative assessment by Tokyo guidelines, algorithmic plan of treatment and use of intraoperative safety steps results in favorable outcome of LC in ACC.
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Affiliation(s)
- Pinky Thapar
- Department of Minimal Invasive Surgery, Jupiter Hospital, Off Eastern Express Highway, Thane, Maharashtra, 400 601, India.
| | - Prashant Salvi
- Department of Minimal Invasive Surgery, Jupiter Hospital, Off Eastern Express Highway, Thane, Maharashtra, 400 601, India
| | - Madhura Killedar
- Department of Minimal Invasive Surgery, Jupiter Hospital, Off Eastern Express Highway, Thane, Maharashtra, 400 601, India
| | - Philip Roji
- Department of Minimal Invasive Surgery, Jupiter Hospital, Off Eastern Express Highway, Thane, Maharashtra, 400 601, India
| | - Muktachand Rokade
- Department of Radiology, Jupiter Hospital, Off Eastern Express Highway, Thane, Maharashtra, 400 601, India
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Nassar AHM, Ng HJ, Ahmed Z, Wysocki AP, Wood C, Abdellatif A. Optimising the outcomes of index admission laparoscopic cholecystectomy and bile duct exploration for biliary emergencies: a service model. Surg Endosc 2020; 35:4192-4199. [PMID: 32860135 PMCID: PMC8263394 DOI: 10.1007/s00464-020-07900-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/17/2020] [Indexed: 01/12/2023]
Abstract
Aims The rate of acute laparoscopic cholecystectomy remains low due to operational constraints. The purpose of this study is to evaluate a service model of index admission cholecystectomy with referral protocols, refined logistics and targeted job planning. Methods A prospectively maintained dataset was evaluated to determine the processes of care and outcomes of patients undergoing emergency biliary surgery. The lead author has maintained a 28 years prospective database capturing standard demographic data, intraoperative details including the difficulty of cholecystectomy as well as postoperative outcome parameters and follow up data. Results Over five thousand (5555) consecutive laparoscopic cholecystectomies were performed. Only patients undergoing emergency procedures (2399,43.2% of entire group) were analysed for this study. The median age was 52 years with 70% being female. The majority were admitted with biliary pain (34%), obstructive jaundice (26%) and acute cholecystitis (16%). 63% were referred by other surgeons. 80% underwent surgery within 5 days (40% within 24 h). Cholecystectomies were performed on scheduled lists (44%) or dedicated emergency lists (29%). Two thirds had suspected bile duct stones and 38.1% underwent bile duct exploration. The median operating time was 75 min, median hospital stay 7 days, conversion rate 0.8%, morbidity 8.9% and mortality rate 0.2%. Conclusion Index admission cholecystectomy for biliary emergencies can have low rates of morbidity and mortality. Timely referral and flexible theatre lists facilitate the service, optimising clinical results, number of biliary episodes, hospital stay and presentation to resolution intervals. Cost benefits and reduced interval readmissions need to be weighed against the length of hospital stay per episode.
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Affiliation(s)
- Ahmad H M Nassar
- Laparoscopic Biliary Service, University Hospital Monklands, Airdrie, Scotland, UK.
| | - Hwei J Ng
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | - Colin Wood
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Ayman Abdellatif
- Laparoscopic Biliary Service, University Hospital Monklands, Airdrie, Scotland, UK
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Argiriov Y, Dani M, Tsironis C, Koizia LJ. Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management. Front Surg 2020; 7:42. [PMID: 32793627 PMCID: PMC7385246 DOI: 10.3389/fsurg.2020.00042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Gallstone disease accounts for the vast majority of acute surgical admissions in the UK, with a major treatment being cholecystectomy. Practice varies significantly as to whether surgery is performed during the acute symptomatic phase, or after a period of recovery. Differences in practice relate to operative factors, patient factors, surgeon factors and hospital and trust wide policies. In this review we summarize recent evidence on management of gallstone disease, particularly with respect to whether cholecystectomy should occur during index presentation or following recovery. We highlight morbidity and mortality studies, cost, and patient reported outcomes. We speculate on barriers to change in service delivery. Finally, we propose potential solutions to optimize care.
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Affiliation(s)
- Yanna Argiriov
- Cutrale Perioperative and Ageing Research Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Melanie Dani
- Cutrale Perioperative and Ageing Research Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Christos Tsironis
- Department of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Louis J Koizia
- Cutrale Perioperative and Ageing Research Group, Department of Bioengineering, Imperial College London, London, United Kingdom
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Predictive factors for developing acute cholangitis and/or cholecystitis in patients undergoing delayed cholecystectomy: A retrospective study. Asian J Surg 2020; 44:280-285. [PMID: 32709456 DOI: 10.1016/j.asjsur.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/27/2020] [Accepted: 07/05/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND /Objective: We evaluated the risk of acute cholangitis and/or cholecystitis while waiting for cholecystectomy for gallstones. METHODS We retrospectively enrolled 168 patients who underwent cholecystectomy for gallstones after conservative therapy. We compared clinical data of 20 patients who developed acute cholangitis and/or cholecystitis while waiting for cholecystectomy (group A) with 148 patients who did not develop (group B). We investigated surgical outcomes and risk factors for developing acute cholangitis and/or cholecystitis. RESULTS Preoperatively, significant numbers of patients with previous history of acute grade II or III cholecystitis (55.0% vs 10.8%; p < 0.001) and biliary drainage (20.0% vs 2.0%; p = 0.004) were observed between groups A and B. White blood cell counts (13500/μL vs 8155/μL; p < 0.001) and C-reactive protein levels (12.6 vs 5.1 mg/dL; p < 0.001) were significantly higher in group A than in group B; albumin levels (3.2 vs 4.0 g/dL; p < 0.001) were significantly lower in group A. Gallbladder wall thickening (≥5 mm) (45.0% vs 18.9%; p = 0.018), incarcerated gallbladder neck stones (55.0% vs 22.3%; p = 0.005), and peri-gallbladder abscess (20.0% vs 1.4%; p = 0.002) were significantly more frequent in group A than in group B. A higher conversion rate to open surgery (20.0% vs 2.0%; p = 0.004), longer operation time (137 vs 102 min; p < 0.001), and higher incidence of intraoperative complications (10.0% vs 0%; p = 0.014) were observed in group A, compared with group B. CONCLUSION A history of severe cholecystitis may be a risk factor for acute cholangitis and/or cholecystitis in patients waiting for surgery; it may also contribute to increased surgical difficulty.
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Ninomiya S, Amano S, Ogawa T, Ueda Y, Shiraishi N, Inomata M, Shimoda K. The impact of dementia on surgical outcomes of laparoscopic cholecystectomy for symptomatic cholelithiasis and acute cholecystitis: A retrospective study. Asian J Endosc Surg 2020; 13:351-358. [PMID: 31389183 DOI: 10.1111/ases.12743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/03/2019] [Accepted: 07/17/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of this study was to clarify the impact of dementia on surgical outcomes of laparoscopic cholecystectomy for symptomatic cholelithiasis and acute cholecystitis. METHODS We reviewed medical data of 96 patients who underwent laparoscopic cholecystectomy for symptomatic cholecystitis and acute cholecystitis. The patients were divided into the dementia group (n = 18) and non-dementia group (n = 78). Clinical features of the patients and surgical outcomes were compared between the two groups. RESULTS Mean age and rates of The American Society of Anesthesiologists Physical Status classification score > 2 in the dementia group were significantly higher than those of the non-dementia group (P < .001, P = .008, respectively). Incidences of acute cholecystitis and the rate of percutaneous transhepatic gallbladder drainage in the dementia group were significantly higher than those of the non-dementia group (P = .009, P = .01, respectively). The rates of conversion to laparotomy and non-surgical complications in the dementia group were higher than those in the non-dementia group (P = .02, P = .03, respectively). Postoperative hospital stay in the dementia group was significantly longer than that in the non-dementia group (15.2 ± 9.3 vs 8.2 ± 3.2 days, P = .009). Subgroup analysis of patients with acute cholecystitis showed postoperative hospital stay in the dementia group to be significantly longer than that in the non-dementia group (18.7 ± 10.7 vs 10.3 ± 4.2 days, P = .03). CONCLUSION Patients with dementia who underwent laparoscopic cholecystectomy have a high incidence of acute cholecystitis and a high rate of percutaneous transhepatic gallbladder drainage, which may result in increased rates of conversion to laparotomy and prolong the postoperative hospital stay.
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Affiliation(s)
- Shigeo Ninomiya
- Department of Surgery, Cosmos Hospital, Usuki, Japan.,Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | - Shota Amano
- Department of Surgery, Cosmos Hospital, Usuki, Japan
| | - Tadashi Ogawa
- Department of Surgery, Cosmos Hospital, Usuki, Japan
| | - Yoshitake Ueda
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Norio Shiraishi
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
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Enhanced Recovery After Emergency Surgery: Utopia or Reality? Cir Esp 2020; 99:258-266. [PMID: 32532473 DOI: 10.1016/j.ciresp.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/19/2020] [Accepted: 04/26/2020] [Indexed: 11/20/2022]
Abstract
Enhanced Recovery After Surgery (ERAS) constitutes the application of a series of perioperative measures based on the evidence, in order to achieve a better recovery of the patient and a decrease of the complications and the mortality. These ERAS programs initially proved their advantages in the field of colorectal surgery being progressively adopted by other surgical areas within the general surgery and other surgical specialties. The main excluding factor for the application of such programs has been the urgent clinical presentation, which has caused that despite the large volume of existing literature on ERAS in elective surgery, there are few studies that have investigated the effectiveness of these programs in surgical patients in emergencies. The aim of this article is to show ERAS measures currently available according to the existing evidence for emergency surgery.
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Cheng X, Cheng P, Xu P, Hu P, Zhao G, Tao K, Wang G, Shuai X, Zhang J. Safety and feasibility of prolonged versus early laparoscopic cholecystectomy for acute cholecystitis: a single-center retrospective study. Surg Endosc 2020; 35:2297-2305. [PMID: 32444970 PMCID: PMC8057981 DOI: 10.1007/s00464-020-07643-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 05/13/2020] [Indexed: 01/08/2023]
Abstract
Background Laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis (AC), and it should be performed within 72 h of symptoms onset if possible. In many undesired situations, LC was performed beyond the golden 72 h. However, the safety and feasibility of prolonged LC (i.e., performed more than 72 h after symptoms onset) are largely unknown, and therefore were investigated in this study. Methods We retrospectively enrolled the adult patients who were diagnosed as AC and were treated with LC at the same admission between January 2015 and October 2018 in an emergency department of a tertiary academic medical center in China. The primary outcome was the rate and severity of adverse events, while the secondary outcomes were length of hospital stay and costs. Results Among the 104 qualified patients, 70 (67.3%) underwent prolonged LC and 34 (32.7%) underwent early LC (< 72 h of symptom onset). There were no differences between the two groups in mortality rate (none for both), conversion rates (prolonged LC 5.4%, and early LC 8.8%, P = 0.68), intraoperative and postoperative complications (prolonged LC 5.7% and early LC 2.9%, P ≥ 0.99), operation time (prolonged LC 193.5 min and early LC 198.0 min, P = 0.81), and operation costs (prolonged LC 8,700 Yuan, and early LC 8,500 Yuan, P = 0.86). However, the prolonged LC was associated with longer postoperative hospitalization (7.0 days versus 6.0 days, P = 0.03), longer total hospital stay (11.0 days versus 8.0 days, P < 0.01), and subsequently higher total costs (40,400 Yuan versus 31,100 Yuan, P < 0.01). Conclusions Prolonged LC is safe and feasible for patients with AC for having similar rates and severity of adverse events as early LC, but it is also associated with longer hospital stay and subsequently higher total cost.
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Affiliation(s)
- Xing Cheng
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Ping Cheng
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Peng Xu
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Ping Hu
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Gang Zhao
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Guobin Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Xiaoming Shuai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430022, Hubei, People's Republic of China
| | - Jinxiang Zhang
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430022, Hubei, People's Republic of China.
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The Changing Face of Emergency General Surgery: A 20-year Analysis of Secular Trends in Demographics, Diagnoses, Operations, and Outcomes. Ann Surg 2020; 271:581-589. [PMID: 30260804 DOI: 10.1097/sla.0000000000003066] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate secular trends in the epidemiology of emergency general surgery (EGS), by analyzing changes in demographics, diagnoses, operations, and outcomes between 1997 and 2016. SUMMARY BACKGROUND DATA The provision and delivery of EGS services is a globally and regionally important issue. The impact of changing demographics and surgical disease incidence on EGS services is not well understood. METHODS Data from all EGS hospital episodes of adults (aged >15) in Scotland between 1997 and 2016 were prospectively collected, including ICD-10 diagnostic codes and OPCS-4 procedure codes. The number and age- and sex-standardized rates per 100,000 population, per year, of the most common diagnoses and operations were calculated. We analyzed demographic changes over time using linear regression, and changes in characteristics, diagnoses, operations, and outcomes using Poisson analysis. RESULTS Data included 1,484,116 EGS hospital episodes. The number and age- and sex-standardized rate, per 100,000 population, of EGS admissions have increased over time, whereas that of EGS operations have decreased over time. Male admissions were unchanged, but with fewer operations over time, whereas female admissions increased significantly over time with no change in the operation rate. Poisson analysis demonstrated secular trends in demographics, admissions, operations, and outcomes in depth. CONCLUSIONS This 20-year epidemiological study of all EGS hospital episodes in Scotland has enhanced our understanding of secular trends of EGS, including demographics, diagnoses, operations, and outcomes. These data will help inform stakeholders in EGS service planning and delivery, as well as in surgical training, what has occurred in recent history.
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Yahya Gumusoglu A, Ferahman S, Gunes ME, Surek A, Yilmaz S, Aydin H, Gezmis AC, Aliyeva Z, Donmez T. High-Volume, Low-Concentration Intraperitoneal Bupivacaine Study in Emergency Laparoscopic Cholecystectomy: A Double-Blinded, Prospective Randomized Clinical Trial. Surg Innov 2020; 27:445-454. [PMID: 32242764 DOI: 10.1177/1553350620914198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Laparoscopic cholecystectomy (LC) often results in postoperative pain, especially in the abdomen. Intraperitoneal local anesthesia (IPLA) reduces pain after LC. Acute cholecystitis-associated inflammation, increased gallbladder wall thickness, dissection difficulties, and a longer operative time are several reasons for assuming a benefit in pain scores in urgent LC with IPLA application. The aim was to determine the postoperative analgesic efficacy of high-volume, low-dose intraperitoneal bupivacaine in urgent LC. Materials and Methods. Fifty-seven patients who were American Society of Anesthesiologists physical status I or II were randomly assigned to receive either normal saline (control group) or intraperitoneal bupivacaine (test group) at the beginning or end of urgent LC. The primary outcome was the postoperative pain score of the Visual Analogue Scale (VAS). The secondary outcomes included Visual Rating Prince Henry Scale (VRS), patient satisfaction, and analgesic consumption. Results. Postoperative VAS scores at the first and fourth hours were significantly lower in the test group than in the control group (P < .001). Postoperative VRS scores at the first, fourth, and eighth hours were significantly lower in the test group than in the control group (P < .001, P = .002, P = .004, respectively). Analgesic use was significantly higher in the control group at the first postoperative hour (P < .001). Shoulder pain was significantly lower, and patient satisfaction was significantly higher in the test group relative to the control group (both P < .001). Conclusion. High-volume, low-concentration intraperitoneal bupivacaine resulted in better postoperative pain control and reduced incidence of shoulder pain and analgesic consumption in urgent LC.
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Affiliation(s)
| | - Sina Ferahman
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Emin Gunes
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Surek
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Serhan Yilmaz
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Husnu Aydin
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Abdul Celil Gezmis
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Zumrud Aliyeva
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Turgut Donmez
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Goh SNS, Chia CLK, Ong JW, Quek JJX, Lim WW, Tan KY, Goo JTT. Improved outcomes for index cholecystectomy for acute cholecystitis following a dedicated emergency surgery and trauma service (ESAT). Eur J Trauma Emerg Surg 2020; 47:1535-1541. [PMID: 32020247 DOI: 10.1007/s00068-020-01308-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/20/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Si Ning Serene Goh
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
| | - Clement Luck Khng Chia
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Jing Wen Ong
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - John Jian Xian Quek
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Woan Wui Lim
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Jerry Tiong Thye Goo
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
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Reppas L, Arkoudis NA, Spiliopoulos S, Theofanis M, Kitrou PM, Katsanos K, Palialexis K, Filippiadis D, Kelekis A, Karnabatidis D, Kelekis N, Brountzos E. Two-Center Prospective Comparison of the Trocar and Seldinger Techniques for Percutaneous Cholecystostomy. AJR Am J Roentgenol 2020; 214:206-212. [PMID: 31573856 DOI: 10.2214/ajr.19.21685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE. The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). SUBJECTS AND METHODS. This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the trocar group; 53 patients [28 men and 25 women]; mean [± SD] age, 74.31 ± 16.19 years) with the US- and fluoroscopy-guided Seldinger technique for PC (the Seldinger group; 52 patients [26 men and 26 women], mean age, 79.92 ± 13.38 years) in consecutive patients undergoing PC at two large tertiary university hospitals. The primary endpoints were technical success and procedure-related complication rates. Secondary endpoints included procedural duration, pain assessment, and clinical success after up to 3 months of follow-up. RESULTS. PC was successfully performed for all 105 patients. The clinical success rate was similar between the two study groups (86.8% in the trocar group vs 76.9% in the Seldinger group; p = 0.09). Mean procedural time was significantly lower in the trocar group than in the Seldinger group (1.77 ± 1.62 vs 4.88 ± 2.68 min; p < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; p = 0.02). Among patients in the Seldinger group, bile leak occurred in 7.7%, abscess formation in 1.9%, and gallbladder rupture in 1.9%. No procedure-related death was noted. Minor bleeding occurred in one patient (1.9%) in the trocar group, but the bleeding resolved on its own. The mean pain score during the procedure was significantly lower in the Seldinger group than in the trocar group (3.2 ± 1.77 vs 4.76 ± 2.17; p = 0.01). At 12 hours after the procedure, the mean pain score was significantly lower for patients in the trocar group (0.78 ± 1.0 vs 3.12 ± 1.36; p = 0.0001). CONCLUSION. Use of the bedside US-guided trocar technique for PC was equally effective as the Seldinger technique but was associated with fewer procedure-related complications, required less procedural time, and resulted in decreased postprocedural pain, compared with fluoroscopically guided PC using the Seldinger technique.
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Affiliation(s)
- Lazaros Reppas
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Theofanis
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Panagiotis M Kitrou
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexis Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Karnabatidis
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Rice CP, Vaishnavi KB, Chao C, Jupiter D, Schaeffer AB, Jenson WR, Griffin LW, Mileski WJ. Operative complications and economic outcomes of cholecystectomy for acute cholecystitis. World J Gastroenterol 2019; 25:6916-6927. [PMID: 31908395 PMCID: PMC6938729 DOI: 10.3748/wjg.v25.i48.6916] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent management of acute cholecystitis favors same admission (SA) or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings. We adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this practice. We hypothesized that the existence of complications, particularly among patients with a higher degree of disease severity, during SA cholecystectomy could negate the cost savings.
AIM To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.
METHODS Under an IRB-approved protocol, complications and charges for were obtained for SA, later after conservative management (Delayed), or elective cholecystectomies over an 8.5-year period. Patients were identified using the acute care surgery registry and billing database. Data was retrieved via EMR, operative logs, and Revenue Cycle Operations. The severity of acute cholecystitis was graded according to the Tokyo Guidelines. TG18 categorizes acute cholecystitis by Grades 1, 2, and 3 representing mild, moderate, and severe, respectively. Comparisons were analyzed with χ2, Fisher’s exact test, ANOVA, t-tests, and logistic regression; significance was set at P < 0.05.
RESULTS Four hundred eighty-six (87.7%) underwent a SA while 68 patients (12.3%) received Delayed cholecystectomy. Complication rates were increased after SA compared to Delayed cholecystectomy (18.5% vs 4.4%, P = 0.004). The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy (7.4%, P = 0.35). Mortality rates were 0.6% vs 0% for SA vs Delayed. Patients with moderate disease (Tokyo 2) suffered more complications among SA while none who were delayed experienced a complication (16.1% vs 0.0%, P < 0.001). Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach ($44500 ± $59000 vs $35300 ± $16700, P = 0.019). The relative risk of developing a complication was 4.2x [95% confidence interval (CI): 1.4-12.9] in the SA vs Delayed groups. Among eight patients (95%CI: 5.0-12.3) with acute cholecystitis undergoing SA cholecystectomy, one patient will suffer a complication.
CONCLUSION Patients with Tokyo Grade 2 acute cholecystitis had more complications and increased hospital charges when undergoing SA cholecystectomy. This data supports a selective approach to SA cholecystectomy for acute cholecystitis.
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Affiliation(s)
- Christopher P Rice
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | | | - Celia Chao
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Daniel Jupiter
- Department of Preventive Medicine and Community Health, Department of Biostatistics, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - August B Schaeffer
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Whitney R Jenson
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Lance W Griffin
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - William J Mileski
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
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Jia Z, Peng J, Wan X, He P, Luo D. Endoscopic minimally invasive cholecystolithotomy in a patient with duplicate gallbladder: a case report. J Int Med Res 2019; 48:300060519886973. [PMID: 31878802 PMCID: PMC7607051 DOI: 10.1177/0300060519886973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Gallstone disease is common in China and is generally treated with laparoscopic cholecystectomy. For some patients with normal contraction function and a small number of stones, endoscopic minimally invasive cholecystolithotomy is an additional possible treatment method that avoids complications related to laparoscopic cholecystectomy. Here, we describe a 45-year-old woman who underwent endoscopic minimally invasive cholecystolithotomy and was found to have duplicate gallbladder, which was not diagnosed preoperatively. We discuss the usefulness of the endoscopic minimally invasive cholecystolithotomy procedure and the management of duplicate gallbladder in patients undergoing endoscopic minimally invasive cholecystolithotomy.
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Affiliation(s)
- Zeming Jia
- Hepatobiliary and Enteric Surgery Research Center of Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Jian Peng
- Hepatobiliary and Enteric Surgery Research Center of Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Xiaoping Wan
- Hepatobiliary and Enteric Surgery Research Center of Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Panxiang He
- Hepatobiliary and Enteric Surgery Research Center of Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Dongren Luo
- Hepatobiliary and Enteric Surgery Research Center of Xiangya Hospital, Central South University, Changsha, P.R. China
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Nguyen CL, van Dijk A, Smith G, Leibman S, Mittal A, Albania M, de Reuver P, Hugh TJ. Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters. ANZ J Surg 2019; 90:295-299. [PMID: 31845500 DOI: 10.1111/ans.15603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/21/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is often performed during the index admission after emergency presentation for acute biliary pain. Many patients have acute cholecystitis (AC) that may increase operative difficulty and complications. Our primary aim was to assess the validity of Tokyo Guidelines (TG18) for diagnosing AC by comparison with the admitting team diagnosis, operative findings and histopathology. The secondary aim was to assess outcomes after same-admission or delayed LC. METHODS Retrospective analysis of patients who underwent LC after presenting to a tertiary hospital emergency department over a 12-month period was conducted. RESULTS A total of 139 patients underwent LC with no mortality or bile duct injury. A diagnosis of AC made by the admitting surgical team had sensitivity of 84% and specificity of 57%. The TG18 diagnosis had sensitivity of 84% and specificity of 53%. A diagnosis of AC by the admitting surgical team correlated well with TG18 criteria diagnosis. There was poor correlation between clinical and histopathological diagnoses. Nine percent of patients had complications and 4% required conversion to open procedure. Patients with a clinical diagnosis of AC had longer post-operative length of stay and more complications compared with those who had non-AC diagnosis. There was no difference in outcomes between same-admission LC or delayed LC. CONCLUSION TG18 diagnosis of AC does not improve accuracy of diagnosis or predictability of a poor outcome over the admitting surgical team diagnosis. Same-admission LC for patients with AC is associated with similar outcomes compared to those who undergo delayed LC.
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Affiliation(s)
- Chu Luan Nguyen
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Aafke van Dijk
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Garett Smith
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven Leibman
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Maria Albania
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Philip de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Thomas J Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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48
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Alore EA, Ward JL, Todd SR, Wilson CT, Gordy SD, Hoffman MK, Suliburk JW. Ideal timing of early cholecystectomy for acute cholecystitis: An ACS-NSQIP review. Am J Surg 2019; 218:1084-1089. [DOI: 10.1016/j.amjsurg.2019.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/09/2019] [Accepted: 08/10/2019] [Indexed: 01/25/2023]
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49
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Wan RR, Wang YL, Wu XC, Qian H, Tan ZH, Xiao RY, Xie P. Hidden blood loss and the influencing factors after laparoscopic cholecystectomy. ANZ J Surg 2019; 90:103-108. [PMID: 31625246 DOI: 10.1111/ans.15502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/05/2019] [Accepted: 09/22/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND A small amount of bleeding usually occurs during laparoscopic cholecystectomy (LC), but the occurrence of perioperative hidden blood loss (HBL) is ignored. So our objective is to investigate the amount of HBL and find out the influential factors in LC. METHODS From January 2017 to May 2019, 139 patients scheduled for LC were enrolled in the study. The data of patients' sex, age, height, weight, body mass index (BMI), form of gallbladder bed, gallbladder status, hypertension, diabetes, liver cirrhosis, drainage volume and operation time were recorded. The patients' height, weight and preoperative and postoperative haematocrit and haemoglobin were recorded and applied to the Gross formula to determine the amount of blood loss. The data of sex, age, BMI, hypertension, diabetes, gallbladder status, liver cirrhosis and operation time were analysed by multivariate linear regression analysis. One-way analysis of variance was performed to find out the relative correlation between HBL and the type of gallbladder bed. RESULTS The HBL was 259.3 ± 188.5 mL. On the basis of multivariate linear regression analysis and analysis of variance, the gallbladder bed, hypertension and the operation time are influential factors of HBL in patients with LC. However, sex, age, BMI, gallbladder status, liver cirrhosis and diabetes are not significantly correlated with HBL. CONCLUSIONS HBL should not be overlooked during the perioperative period of LC, especially in patients with hypertension, gallbladder bed >50% gallbladder surface or operation time >60 min.
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Affiliation(s)
- Ren-Rui Wan
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, China
| | - Yong-Li Wang
- Department of Orthopaedic Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, China
| | - Xiao-Chang Wu
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, China
| | - Hai Qian
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, China
| | - Zhen-Hua Tan
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, China
| | - Ren-Yi Xiao
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, China
| | - Pin Xie
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, China
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50
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Brunée L, Hauters P, Closset J, Fromont G, Puia-Negelescu S. Assessment of the optimal timing for early laparoscopic cholecystectomy in acute cholecystitis: a prospective study of the Club Coelio. Acta Chir Belg 2019; 119:309-315. [PMID: 30354853 DOI: 10.1080/00015458.2018.1529344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: The optimal timing for cholecystectomy in patients with acute cholecystitis remains controversial. The aim of this study is to assess prospectively the impact of the duration of symptoms on outcomes in early laparoscopic cholecystectomy (ELC) for acute cholecystitis. Methods: The series consisted of 276 consecutive patients who underwent ELC for acute cholecystitis in 2016. The patients were divided into three groups according to the timing of surgery: within the first 3 days (group 1), between 4 and 7 days (group 2) and beyond 7 days (group 3) from the onset of symptoms. Results: The percentage of surgical procedure rated as difficult was respectively: 12% in G1, 18% in G2 and 38% in G3 (p < .001). Accordingly, we observed an increased mean operative time within groups but no significant difference in the conversion rate. We noted a different overall postoperative complication rate within groups, respectively: 9% in G1, 14% in G2 and 24% in G3 (p < .04). The median hospital stay was also different within groups, respectively: 3 in G1, 4 in G2 and 6 days in G3 (p < .001). On univariate analysis, age ≥60, male gender, ASA 3, WBC ≥13.000/µL, CRP ≥100 mg/l and delay between onset of symptoms and surgery were factors statistically associated with increased morbidity rate. On multivariate analysis, the delay was the only independent predictive factor of postoperative morbidity (OR: 1,08, 95% CI: 1.01-1.61, p < .031). Conclusion: Our study confirms that it is ideal to perform ELC within 3 days of symptoms onset and reasonable between 4 to 7 days. We do not recommend performing ELC beyond 7 days because of more difficult procedure and significantly increased risk of post-operative complications.
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Affiliation(s)
| | | | - J. Closset
- Erasme University Hospital, Bruxelles – B, Belgium
| | - G. Fromont
- Hôpital de Bois-Bernard, Bois-Bernard – F, Belgium
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