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Lee MH, Jang Y, Kang E, Kim YC, Min S, Lee SH, Cho IR, Paik WH, Lee H. Silent gallbladder stone in kidney transplantation recipients: should it be treated? A retrospective cohort study. Int J Surg 2024; 110:3571-3579. [PMID: 38573083 PMCID: PMC11175749 DOI: 10.1097/js9.0000000000001394] [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: 07/25/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Treatment and follow-up strategies for silent gallbladder stones in patients before kidney transplantation (KT) remain unknown. Therefore, the authors aimed to elucidate the role of pre-KT cholecystectomy in preventing biliary and surgical complications. MATERIALS AND METHODS This study retrospectively analyzed 2295 KT recipients and 3443 patients waiting for KT at a single tertiary center from January 2005 to July 2022. The primary outcomes were the incidences of biliary and postcholecystectomy complications in KT recipients. Firth's logistic regression model was used to assess the risk factors for biliary complications. RESULTS Overall, 543 patients awaiting KT and 230 KT recipients were found to have biliary stones. Among the KT recipients, 16 (7%) underwent cholecystectomy before KT, while others chose to observe their biliary stones. Pre-KT cholecystectomy patients did not experience any biliary complications, and 20 (9.3%) patients who chose to observe their stones experienced complications. Those who underwent cholecystectomy before KT developed fewer postcholecystectomy complications (6.3%) compared with those who underwent cholecystectomy after KT (38.8%, P =0.042), including reduced occurrences of fatal postoperative complications based on the Clavien-Dindo classification. Multiple stones [odds ratio (OR), 3.09; 95% CI: 1.07-8.90; P =0.036), thickening of the gallbladder wall (OR, 5.39; 95% CI: 1.65-17.63; P =0.005), and gallstones >1 cm in size (OR 5.12, 95% CI: 1.92-13.69, P =0.001) were independent risk factors for biliary complications. Among patients awaiting KT, 23 (4.2%) underwent cholecystectomy during the follow-up, resulting in one postcholecystectomy complication. CONCLUSION Gallstone-related biliary complications following KT and subsequent cholecystectomy was associated with more serious complications and worse treatment outcomes. Therefore, when KT candidates had risk factor for biliary complications, pre-emptive cholecystectomy for asymptomatic cholecystolithiasis could be considered to reduce further surgical risk.
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Affiliation(s)
| | - Yunyoung Jang
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital
| | - Eunjeong Kang
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital
| | - Yong Chul Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital
| | - Sang Min
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | - Hajeong Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital
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Alves JR, Klock DM, Ronzani FG, Santos SLD, Amico EC. ASYMPTOMATIC CHOLELITHIASIS: EXPECTANT OR CHOLECYSTECTOMY. A SYSTEMATIC REVIEW. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1747. [PMID: 37466567 DOI: 10.1590/0102-672020230029e1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/16/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Asymptomatic cholelithiasis is a highly prevalent disease, and became more evident after the currently greater access to imaging tests. Therefore, it is increasingly necessary to analyse the risks and benefits of performing a prophylactic cholecystectomy. AIMS To seek the best evidence in order to indicate prophylactic cholecystectomy or conservative treatment (clinical follow-up) in patients with asymptomatic cholelithiasis. METHODS A systematic review was performed using the PubMed/Medline database, according to PRISMA protocol guidelines. The review was based on studies published between April 26, 2001 and January 07, 2022, related to individuals older than 18 years., The following terms/operators were used for search standardization: (asymptomatic OR silent) AND (gallstones OR cholelithiasis). RESULTS We selected 18 studies eligible for inference production after applying the inclusion and exclusion criteria. Also, the Tokyo Guideline (2018) was included for better clarification of some topics less or not addressed in these studies. CONCLUSIONS Most evidence point to the safety and feasibility of conservative treatment (clinical follow-up) of asymptomatic cholelithiasis. However, in post-cardiac transplant patients and those with biliary microlithiasis with low preoperative surgical risk, a prophylactic cholecystectomy is recommended. To establish these recommendations, more studies with better levels of evidence must be conducted.
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Affiliation(s)
- Jose Roberto Alves
- Universidade Federal de Santa Catarina, Department of Surgery - Florianópolis (SC), Brazil
| | | | | | - Sheyne Luiz Dos Santos
- Hospital Universitário Polydoro Ernani de São Thiago, General Surgery - Florianópolis (SC), Brazil
| | - Enio Campos Amico
- Universidade Federal do Rio Grande do Norte, Department of Integrated Medicine - Natal (RN), Brazil
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Giri S, Dash KA, Varghese J, Afzalpurkar S. The Role of Gastroenterologists in Preoperative Assessment and Management of Prospective Renal Transplantation Candidates. Euroasian J Hepatogastroenterol 2023; 13:18-25. [PMID: 37554975 PMCID: PMC10405807 DOI: 10.5005/jp-journals-10018-1390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/26/2023] [Indexed: 08/10/2023] Open
Abstract
Renal transplant is the most common organ transplant worldwide, accounting for 65% of the total number of transplants. End-stage renal disease (ESRD) often has multiple significant comorbidities. Among the gastrointestinal (GI) disorders, peptic ulcer disease (PUD), cholelithiasis, and colon and liver diseases increase the risk of posttransplant morbidity. Potential renal transplantation (RT) candidates need a multidisciplinary assessment of coexisting illnesses, which may affect the perioperative risk and survival after transplantation. Successful outcome of RT depends on careful selection of the recipients by a thorough medical evaluation and screening. This review summarizes the role of gastroenterologists and hepatologists in preoperative assessment and management of renal transplant recipients. How to cite this article Giri S, Dash KA, Varghese J, et al. The Role of Gastroenterologists in Preoperative Assessment and Management of Prospective Renal Transplantation Candidates. Euroasian J Hepato-Gastroenterol 2023;13(1):18-25.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kumar Avijeet Dash
- Department of Nephrology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Jijo Varghese
- Department of Gastroenterology, KM Cherian Institute of Medical Sciences, Kallissery, India
| | - Shivaraj Afzalpurkar
- Department of Gastroenterology, Nanjappa Multi-Speciality Hospitals, Davanagere, Karnataka, India
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Cholecystectomy-Associated Complications in Kidney Transplant Recipients Compared With the General Population. Transplant Proc 2021; 53:2291-2297. [PMID: 34412910 DOI: 10.1016/j.transproceed.2021.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
Cholelithiasis is one of the most prevalent diseases in the general population. Among kidney transplant (KT) recipients, atypical clinical presentation may delay the diagnosis and proper treatment. This single-center retrospective cohort study compared cholelithiasis clinical presentation and cholecystectomy-associated complications in 230 KT recipients and in 172 members of the general population. KT recipients had a higher proportion of men, comorbidities, biliary pancreatitis, choledocholithiasis, and acute cholecystitis clinical presentations than the general population. KT recipients presented higher American Society of Anesthesiologists scores and higher rates of emergency surgeries (15.7% vs 9.9%, P = .091), conversion (5.7% vs 1.2%, P = .019), drainage (7.8% vs 2.3%, P = .016), postoperative complications (10% vs 4.7%, P = .047), and longer hospital length of stay (1 vs 1 days, interquartile range, 2 vs 0 days; P < .001). There were 5 deaths, all of which occurred in KT recipients. History of diabetes mellitus, renal function, and surgical conversion were independent risk factors associated with postoperative complications. Male sex and level of renal function were independent risk factors associated with postoperative acute cholecystitis. KT was an independent risk factor associated with postoperative choledocholithiasis (adjusted odds ratio, 5.89; 95% confidence interval, 3.03-15.66) and pancreatitis (adjusted odds ratio, 6.89; 95% confidence interval, 2.99-11.61). In conclusion, KT recipients with cholelithiasis have an increased risk for clinical and surgical complications compared with the general population.
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KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Transplantation 2021; 104:S11-S103. [PMID: 32301874 DOI: 10.1097/tp.0000000000003136] [Citation(s) in RCA: 294] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The 2020 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation is intended to assist health care professionals worldwide who evaluate and manage potential candidates for deceased or living donor kidney transplantation. This guideline addresses general candidacy issues such as access to transplantation, patient demographic and health status factors, and immunological and psychosocial assessment. The roles of various risk factors and comorbid conditions governing an individual's suitability for transplantation such as adherence, tobacco use, diabetes, obesity, perioperative issues, causes of kidney failure, infections, malignancy, pulmonary disease, cardiac and peripheral arterial disease, neurologic disease, gastrointestinal and liver disease, hematologic disease, and bone and mineral disorder are also addressed. This guideline provides recommendations for evaluation of individual aspects of a candidate's profile such that each risk factor and comorbidity are considered separately. The goal is to assist the clinical team to assimilate all data relevant to an individual, consider this within their local health context, and make an overall judgment on candidacy for transplantation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Guideline recommendations are primarily based on systematic reviews of relevant studies and our assessment of the quality of that evidence, and the strengths of recommendations are provided. Limitations of the evidence are discussed with differences from previous guidelines noted and suggestions for future research are also provided.
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6
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Dobosz Ł, Kobiela J, Danielewicz R, Śledziński Z, Dębska-Ślizień A. Gallbladder Pathologies in Kidney Transplant Recipients: Single-Center Experience and a Review of the Literature. Ann Transplant 2018; 23:572-576. [PMID: 30104561 PMCID: PMC6248059 DOI: 10.12659/aot.909653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background In patients with end-stage renal disease, cholelithiasis is observed with an increased frequency. In transplant recipients, symptoms might be obscured, which may delay the diagnosis and lead to complications. The aim of our study was to evaluate the frequency of gallbladder pathologies in kidney transplant recipients (KTRs) in the Caucasian population, and to discuss the potential benefits of prophylactic cholecystectomy before kidney transplantation (KT). Material/Methods Data from 434 patients who underwent KT was analyzed. Demographic data along with gallbladder status were collected from the pre-transplantation charts. We compared our results to data from the general Polish population. Results In our analyzed group of KTRs, there were 284 men and 150 women. Complete data, including abdominal ultrasound description, were available in 412 cases. In this group, 36 patients (8.74%) underwent cholecystectomy before KT. Other gallbladder pathologies (gallstones and polyps) were found in 41 patients (9.95%) at pre-transplantation evaluation. The incidence of gallbladder pathologies in KTRs, being mostly cholelithiasis, was higher than in the general Polish population. Conclusions In specific age subgroups of KTRs, the frequency of gallbladder pathologies was higher than in the general population. Prophylactic cholecystectomy may potentially offer benefits in these subgroups of patients.
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Affiliation(s)
- Łukasz Dobosz
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Jarek Kobiela
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Roman Danielewicz
- Department of Surgical and Transplant Nursing, Medical University of Warsaw, Warsaw, Poland.,Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland
| | - Zbigniew Śledziński
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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7
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Varga M, Kudla M, Vargova L, Fronek J. Cholecystectomy for Acute Cholecystitis After Renal Transplantation. Transplant Proc 2017; 48:2072-5. [PMID: 27569946 DOI: 10.1016/j.transproceed.2016.02.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/15/2016] [Accepted: 02/24/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of our study was to evaluate the rate of surgical complications, patient outcomes, and impact on graft function in renal transplant recipients in whom cholecystectomy for acute cholecystitis was performed. METHODS We reviewed data on transplant patients from January 1, 2006, to December 31, 2013. The subgroup of patients who required subsequent cholecystectomy for acute cholecystitis was assessed, and their data were further analyzed. RESULTS Thirty-one patients who underwent cholecystectomy for acute cholecystitis after renal transplantation were included in the study. Clinical signs such as pain in the right upper quadrant, temperature >38°C, and elevation in bilirubin levels occurred in 20 (64.5%), 8 (25.8%), and 3 (9.7%) patients, respectively. Ultrasound signs of acute cholecystitis were present in 27 patients (87.1%). In terms of laboratory values, white blood cell counts >10 × 10(9)/L occurred in 17 patients (54.8%), and C-reactive protein levels >40 mg/L were reported in 21 patients (67.7%). The conversion rate to open surgery was 32.3% (10 patients). In 13 cases, acalculous cholecystitis was present (41.9%). The average serum creatinine level 1 year after cholecystectomy had no statistically significant differences. One patient required temporary dialysis during the postoperative period (with subsequent graft recovery), and 1 graft was lost. CONCLUSIONS Acute cholecystitis in kidney transplant recipients is a serious complication, with frequent difficulties related to evaluation and diagnosis. Because clinical signs could be very mild compared with severity of gallbladder affliction, there is little room if any for conservative treatment in these patients. We have not noticed adverse impact of acute cholecystitis on 1-year graft function.
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Affiliation(s)
- M Varga
- Universitätsklinik für Chirurgie, Landeskrankenhaus Salzburg-Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich; Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
| | - M Kudla
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - L Vargova
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - J Fronek
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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de'Angelis N, Esposito F, Memeo R, Lizzi V, Martìnez-Pérez A, Landi F, Genova P, Catena F, Brunetti F, Azoulay D. Emergency abdominal surgery after solid organ transplantation: a systematic review. World J Emerg Surg 2016; 11:43. [PMID: 27582783 PMCID: PMC5006611 DOI: 10.1186/s13017-016-0101-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 08/17/2016] [Indexed: 02/07/2023] Open
Abstract
AIMS Due to the increasing number of solid organs transplantations, emergency abdominal surgery in transplanted patients is becoming a relevant challenge for the general surgeon. The aim of this systematic review of the literature is to analyze morbidity and mortality of emergency abdominal surgery performed in transplanted patients for graft-unrelated surgical problems. METHODS The literature search was performed on online databases with the time limit 1990-2015. Studies describing all types of emergency abdominal surgery in solid organ transplanted patients were retrieved for evaluation. RESULTS Thirty-nine case series published between 1996 and 2015 met the inclusion criteria and were selected for the systematic review. Overall, they included 71671 transplanted patients, of which 1761 (2.5 %) underwent emergency abdominal surgery. The transplanted organs were the heart in 65.8 % of patients, the lung in 22.1 %, the kidney in 9.5 %, and the liver in 2.6 %. The mean patients' age at the time of the emergency abdominal surgery was 49.4 ± 7.4 years, and the median time from transplantation to emergency surgery was 2.4 years (range 0.1-20). Indications for emergency abdominal surgery were: gallbladder diseases (80.3 %), gastrointestinal perforations (9.2 %), complicated diverticulitis (6.2 %), small bowel obstructions (2 %), and appendicitis (2 %). The overall mortality was 5.5 % (range 0-17.5 %). The morbidity rate varied from 13.6 % for gallbladder diseases to 32.7 % for complicated diverticulitis. Most of the time, the immunosuppressive therapy was maintained unmodified postoperatively. CONCLUSIONS Emergency abdominal surgery in transplanted patients is not a rare event. Although associated with relevant mortality and morbidity, a prompt and appropriate surgery can lead to satisfactory results if performed taking into account the patient's immunosuppression therapy and hemodynamic stability.
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Affiliation(s)
- Nicola de'Angelis
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Francesco Esposito
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Riccardo Memeo
- Department of Hepato-biliary and Pancreatic Surgery, Nouvel Hôpital Civil, Strasbourg, France
| | - Vincenzo Lizzi
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Aleix Martìnez-Pérez
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Filippo Landi
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Pietro Genova
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Fausto Catena
- Department of Emergency Surgery, University Hospital "Ospedale Maggiore" of Parma, Parma, Italy
| | - Francesco Brunetti
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Daniel Azoulay
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Lee RD, Youn SH, Shin DH. Management of Asymptomatic Gallstones in Renal Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2014. [DOI: 10.4285/jkstn.2014.28.3.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ru Da Lee
- Hepato-Biliary-Pancreas Center and Division of Transplantation, Department of General Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Seok Hwa Youn
- Hepato-Biliary-Pancreas Center and Division of Transplantation, Department of General Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Dong Hoon Shin
- Hepato-Biliary-Pancreas Center and Division of Transplantation, Department of General Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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Asymptomatic Gallstones (AsGS) - To Treat or Not to? Indian J Surg 2011; 74:4-12. [PMID: 23372301 DOI: 10.1007/s12262-011-0376-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 11/10/2011] [Indexed: 12/15/2022] Open
Abstract
With ready availability of abdominal ultrasound, asymptomatic gallstones (AsGS) are being diagnosed with increasing frequency. Management decisions need to take into account the natural history of AsGS as well as the risks of cholecystectomy. Long-term follow up studies from the West have consistently shown that only a small minority of asymptomatic gallstones lead to development of symptoms or complications. Some sub-groups of patients (eg those with chronic hemolytic syndromes) have been shown to be at a higher risk of developing symptoms and complications and prophylactic cholecystectomy has been advised for them. Clear division of patients into low or high risk categories is still far from ideal and better identification of risk factors and risk stratification is needed. Overall, both open and laparoscopic cholecystectomy, are generally safe procedures. However, the incidence of bile duct injury (with all its serious consequences) continues to be higher with laparoscopic cholecystectomy and this should receive due consideration before offering prophylactic cholecystectomy to an asymptomatic patient who is not expected to receive any clinical benefit from it. Gallbladder cancer is rare in most of the developed world and prophylactic cholecystectomy has generally not been recommended to prevent development of GBC. Considering the wide geographical/ethnic variation in incidence of GBC across the world and the strong association of GBC with gallstones, it may not be prudent to extrapolate the results of studies of natural history of AsGS from one part of the world to another. Since northern India has one of the highest incidences of GBC in the world, it is imperative to have data on natural history of AsGS in patients from this area to allow formulation of precise guidelines for management of AsGs.
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Coelho JCU, Contieri FLC, de Freitas ACT, da Silva FC, Kozak VN, da Silva Junior AS. [Laparoscopic cholecystectomy in transplant patients]. Rev Col Bras Cir 2010; 37:23-6. [PMID: 20414572 DOI: 10.1590/s0100-69912010000100006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 02/28/2009] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study reviews our experience with laparoscopic cholecystectomy in the treatment of cholelithiasis in transplant patients. METHODS Demographic data, medications used, and operative and postoperative data of all transplant recipients who were subjected to laparoscopic cholecystectomy for cholelithiasis at our hospital were obtained. RESULTS A total of 15 transplant patients (13 renal transplantation and 2 bone marrow transplantation) underwent laparoscopic cholecystectomy. All patients were admitted to the hospital on the day of the operation. The immunosuppressive regimen was not modified during hospitalization. Clinical presentation of cholelithiasis was biliary colicky (n=12), acute cholecystitis (n=2), and jaundice (n=1). The operation was uneventful in all patients. Postoperative complications were nausea and vomiting in 2 patients, prolonged tracheal intubation in 1, wound infection in 1 and large superficial hematoma in 1 patient. CONCLUSION Laparoscopic cholecystectomy is associated to a low morbidity and mortality and good postoperative outcome in transplant patients with uncomplicated cholecystitis.
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Affiliation(s)
- Júlio Cezar Uili Coelho
- Serviço de Cirurgia do Aparelho Digestivo e Transplante Hepático, Hospital de Clínicas, da Universidade Federal do Paraná, Paraná, BR.
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12
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Abstract
The number of gallstone patients is increasing in ageing populations with a high prevalence of metabolic syndrome and obesity. Recently variants of hepatic ATP binding cassette transporters have been identified as genetic susceptibility factors for gallstone disease, pointing to novel means for risk assessment and prevention. Although laparoscopic cholecystectomy is the mainstay of therapy for symptomatic gallbladder stones, the clinical management of gallstone disease is changing rapidly, with an increase in day case surgery and the advent of transluminal endoscopic surgery. Here, we summarize the molecular and genetic mechanisms of gallstone formation as well as the current evidence-based algorithms for diagnosis and therapy of gallbladder and bile duct stones.
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Affiliation(s)
- Frank Lammert
- Department Internal Medicine II, Saarland University Hospital, Saarland University, Kirrberger Str., 66421 Hamburg/Saar, Germany.
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Schaberg FJ, Doyle MM, Chapman WC, Vollmer CM, Zalieckas JM, Birkett DH, Miner TJ, Mazzaglia PJ. Incidental Findings at Surgery—Part 1. Curr Probl Surg 2008; 45:325-74. [DOI: 10.1067/j.cpsurg.2008.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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van Petersen AS, van der Pijl HW, Ringers J, Lemkes HH, de Fijter HW, Masclee AAM. Gallstone formation after pancreas and/or kidney transplantation: an analysis of risk factors. Clin Transplant 2007; 21:651-8. [PMID: 17845641 DOI: 10.1111/j.1399-0012.2007.00704.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pancreas and kidney transplantation (SPK) is the treatment of choice for patients with type 1 diabetes mellitus and end-stage renal failure. Gallstones are common after SPK transplantation but little is known about the true incidence and etiology of gallstones in this group. We therefore evaluated the incidence of gallstones and the presence of transplant-related risk factors in patients after SPK and kidney transplantation alone (KTA). Data were evaluated of 56 consecutive patients who underwent SPK transplantation and compared the results with those of 91 consecutive nondiabetic patients who underwent KTA transplantation at the Leiden University Medical Center between 1987 and 1994. Of the 58 evaluable KTA patients, 20.7% developed gallstones during 7.7 yr of follow-up and in the SPK group 43.9% of the 41 evaluable patients developed gallstones during 7.1 yr of follow-up. Postoperative weight loss and cyclosporin A-related hepatotoxicity correlated with gallstone formation both in SPK and KTA patients. In addition, the duration of postoperative fasting and autonomic neuropathy correlated with gallstones in SPK patients. It is concluded that both in patients after SPK transplantation and in patients after KTA transplantation, the risk to develop gallstones is significantly increased. Physicians should be aware of the high incidence of gallstones in SPK recipients.
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Affiliation(s)
- Andre S van Petersen
- Department of Surgery, Leiden Univresity Medical Center, Leiden, The Netherlands
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15
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Sakorafas GH, Milingos D, Peros G. Asymptomatic cholelithiasis: is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci 2007; 52:1313-25. [PMID: 17390223 DOI: 10.1007/s10620-006-9107-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 01/12/2006] [Indexed: 12/14/2022]
Abstract
Asymptomatic cholelithiasis is increasingly diagnosed today, mainly as a result of the widespread use of abdominal ultrasonography for the evaluation of patients for unrelated or vague abdominal complaints. About 10-20% of people in most western countries have gallstones, and among them 50-70% are asymptomatic at the time of diagnosis. Asymptomatic gallstone disease has a benign natural course; the progression of asymptomatic to symptomatic disease is relatively low, ranging from 10-25%. The majority of patients rarely develop gallstone-related complications without first having at least one episode of biliary pain ("colic"). In the prelaparoscopy era, (open) cholecystectomy was generally performed for symptomatic disease. The minimally invasive laparoscopic cholecystectomy refueled the discussion about the optimal management of asymptomatic cholelithiasis. Despite some controversy, most authors agree that the vast majority of subjects should be managed by observation alone (expectant management). Selective cholecystectomy is indicated in defined subgroups of subjects, with an increased risk for the development of gallstone-related symptoms and complications. Concomitant cholecystectomy is a reasonable option for good-risk patients with asymptomatic cholelithiasis undergoing abdominal surgery for unrelated conditions. Routine cholecystectomy for all subjects with silent gallstones is a too aggressive management option, not indicated for most subjects with asymptomatic cholelithiasis. An in-depth knowledge of the natural history of gallstone disease is required to select the optimal management option for the individual subject with silent gallstones. Management options should be extensively discussed with the patient; he or she should be actively involved in the process of therapeutic decision making.
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Affiliation(s)
- George H Sakorafas
- 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, Arkadias 19-21, GR-115 26, Athens, Greece.
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Abstract
BACKGROUND Cholecystectomy is currently advised only for patients with symptomatic gallstones. However, about 4% of patients with asymptomatic gallstones develop symptoms including cholecystitis, obstructive jaundice, pancreatitis, and gallbladder cancer. OBJECTIVES To assess the benefits and harms of surgical removal of the gallbladder for patients with asymptomatic gallstones. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until 2006 for identifying the randomised trials using The Cochrane Hepato-Biliary Group search strategy. SELECTION CRITERIA Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing cholecystectomy and no cholecystectomy were considered for the review. DATA COLLECTION AND ANALYSIS We were unable to identify any randomised clinical trials comparing cholecystectomy versus no cholecystectomy. MAIN RESULTS We were unable to identify any randomised clinical trial comparing cholecystectomy versus no cholecystectomy. AUTHORS' CONCLUSIONS There are no randomised trials comparing cholecystectomy versus no cholecystectomy in patients with silent gallstones. Further evaluation of observational studies, which measure outcomes such as obstructive jaundice, gallstone-associated pancreatitis, and/or gall-bladder cancer for sufficient duration of follow-up is necessary before randomised trials are designed in order to evaluate whether cholecystectomy or no cholecystectomy is better for asymptomatic gallstones.
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Affiliation(s)
- K S Gurusamy
- Royal Free Hospital, Surgery, 291 Greenhaven Drive, Thamesmead, London, UK, SE28 8FY.
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Whiting J. Perioperative concerns for transplant recipients undergoing nontransplant surgery. Surg Clin North Am 2006; 86:1185-94, vi-vii. [PMID: 16962408 DOI: 10.1016/j.suc.2006.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
At some time in a general surgeon's career it is likely that they will be asked to care for a surgical problem in a transplant recipient. In many instances, the treating surgeon may opt for transferring the patient to a transplant center more familiar with organ transplant recipients, but at other times transfer may not be the optimal option for the patient. This article is intended to touch on some of the more common situations that a general surgeon in community practice might encounter in dealing with organ transplant recipients, and highlight perioperative and in a few cases, intraoperative, concerns.
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Affiliation(s)
- James Whiting
- Division of Organ Transplantation, Maine Medical Center, 887 Congress Street, Suite 400, Portland, ME 04102, USA.
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Abstract
Gastrointestinal complications are common after kidney, liver, pancreas, heart, and lung transplantation. Complications can include gastrointestinal conditions preceding the transplantation, viral, fungal, and bacterial gastrointestinal infections, and gastrointestinal side effects of medications including immunosuppressive agents. Establishing the etiology of gastrointestinal complaints is often difficult because any one or a combination of these factors might be contributory in the same patient.
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Affiliation(s)
- Amitabh Gautam
- Brown Medical School, Division of Organ Transplantation, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
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Pusl T, Hüttl TP, Beuers U. Cholezystolithiasis – ein Wandel im interdisziplinären Vorgehen? Visc Med 2006. [DOI: 10.1159/000097759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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