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Khoury J, Li B, Zhu J, Lin T, Hasan E, Lamba A, Gustainyte V, Kocharyan H, Yeisley C, Salloum E, Ahmed A, Greben C, Al-Roubaie M. Diagnosis and management of radiation cholecystitis as a complication of Y90 radioembolization for hepatocellular carcinoma. Radiol Case Rep 2024; 19:3363-3366. [PMID: 38832339 PMCID: PMC11145197 DOI: 10.1016/j.radcr.2024.04.097] [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: 04/17/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
Radiation induced cholecystitis is a known but rare complication of Yttrium90 (Y90) radioembolization of hepatic tumors due to nontarget embolization. Many documented cases of radiation induced cholecystitis have been treated with cholecystectomy, which is significant given the typical patient population undergoing radioembolization tends to be of higher surgical risk. Here, we present a case of a 68 year old male who developed radiation induced cholecystitis status post hepatic radioembolization that resolved with conservative management alone. This case highlights that radiation induced cholecystitis may be successfully and safely treated conservatively.
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Affiliation(s)
- Joe Khoury
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA
| | - Brenden Li
- University of South Florida Morsani, College of Medicine, 560 Channelside Dr, Tampa, FL 33602, USA
| | - Joyce Zhu
- University of South Florida Morsani, College of Medicine, 560 Channelside Dr, Tampa, FL 33602, USA
| | - Trevor Lin
- University of South Florida Morsani, College of Medicine, 560 Channelside Dr, Tampa, FL 33602, USA
| | - Eusha Hasan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA
| | - Ashley Lamba
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA
| | - Vaiva Gustainyte
- Moffitt Cancer Center, University of South Florida Morsani College of Medicine, 12902 USF Magnolia Drive, Tampa, FL,33612, USA
| | - Hakob Kocharyan
- Moffitt Cancer Center, University of South Florida Morsani College of Medicine, 12902 USF Magnolia Drive, Tampa, FL,33612, USA
| | | | - Elias Salloum
- Moffitt Cancer Center, University of South Florida Morsani College of Medicine, 12902 USF Magnolia Drive, Tampa, FL,33612, USA
| | - Altan Ahmed
- Moffitt Cancer Center, University of South Florida Morsani College of Medicine, 12902 USF Magnolia Drive, Tampa, FL,33612, USA
| | - Craig Greben
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA
| | - Mustafa Al-Roubaie
- Moffitt Cancer Center, University of South Florida Morsani College of Medicine, 12902 USF Magnolia Drive, Tampa, FL,33612, USA
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Mencarini L, Vestito A, Zagari RM, Montagnani M. The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach. J Clin Med 2024; 13:2695. [PMID: 38731224 PMCID: PMC11084823 DOI: 10.3390/jcm13092695] [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: 04/04/2024] [Revised: 04/17/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Acute cholecystitis (AC), generally associated with the presence of gallstones, is a relatively frequent disease that can lead to serious complications. For these reasons, AC warrants prompt clinical diagnosis and management. There is general agreement in terms of considering early laparoscopic cholecystectomy (ELC) to be the best treatment for AC. The optimal timeframe to perform ELC is within 72 h from diagnosis, with a possible extension of up to 7-10 days from symptom onset. In the first hours or days after hospital admission, before an ELC procedure, the patient's medical management comprises fasting, intravenous fluid infusion, antimicrobial therapy, and possible administration of analgesics. Additionally, concomitant conditions such as choledocholithiasis, cholangitis, biliary pancreatitis, or systemic complications must be recognized and adequately treated. The importance of ELC is related to the frequent recurrence of symptoms and complications of gallstone disease in the interval period between the onset of AC and surgical intervention. In patients who are not eligible for ELC, it is suggested to delay surgery at least 6 weeks after the clinical presentation. Critically ill patients, who are unfit for surgery, may require rescue treatments, such as percutaneous or endoscopic gallbladder drainage (GBD). A particular treatment approach should be applied to special populations such as pregnant women, cirrhotic, and elderly patients. In this review, we provide a practical diagnostic and therapeutic approach to AC, even in specific clinical situations, based on evidence from the literature.
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Affiliation(s)
- Lara Mencarini
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; (L.M.); (R.M.Z.)
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Amanda Vestito
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; (L.M.); (R.M.Z.)
- Esophagus and Stomach Organic Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marco Montagnani
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; (L.M.); (R.M.Z.)
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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Aranda-Nárvaez JM, Fernández-Galeano P, Romacho-López L, Cabrera-Serna I, Titos-García A, Mirón-Fernández I, Santoyo-Santoyo J. Improving early cholecystectomy rate in acute cholecystitis with an evidence-based local multidisciplinary protocol and a surgical audit: single-center experience through an Acute Care Surgery Division. Langenbecks Arch Surg 2024; 409:131. [PMID: 38634929 DOI: 10.1007/s00423-024-03305-z] [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: 02/11/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To analyze if, after implementation of an evidence-based local multidisciplinary protocol for acute cholecystitis (AC), an intermediate surgical audit could improve early cholecystectomy (EC) rate and other therapeutic indicators. METHODS Longitudinal cohort study at a tertiary center. The local protocol, promoted, created, and periodically revised by the Acute Care Surgery Unit (ACSu) was updated and approved on March 2019. A specific registry was prospectively fulfilled with demographics, comorbidity, type of presentation, diagnostic items, therapeutic decision, and clinical course, considering both non-operative management (NOM) or cholecystectomy, early and delayed (EC and DC). Phase 1: April 2019-April 2021. A critical analysis and a surgical audit with the participation of all the involved Departments were then performed, especially focusing on improving global EC rate, considered primary outcome. Phase 2: May 2021-May 2023. Software SPSS 23.0 was used to compare data between phases. RESULTS Initial EC rate was significantly higher on Phase 2 (39.3%vs52.5%, p < 0.004), as a significantly inferior rate of patients were initially bailed out from EC to NOM because of comorbidity (14.4%vs8%, p < 0.02) and grade II with severe inflammatory signs (7%vs3%, p < 0.04). A higher percentage of patients was recovered for EC after an initial decision of NOM on Phase 2, but without reaching statistical significance (21.8%vs29.2%, n.s.). Global EC rate significantly increased between phases (52.5%vs66.3%, p < 0.002) without increasing morbidity and mortality. A significant minor percentage of elective cholecystectomies after AC episodes had to be performed on Phase 2 (14%vs6.7%, p < 0.009). Complex EC and those indicated after readmission or NOM failure were usually performed by the ACSu staff. CONCLUSION To adequately follow up the implementation of a local protocol for AC healthcare, registering and periodically analyzing data allow to perform intermediate surgical audits, useful to improve therapeutic indicators, especially EC rate. AC constitutes an ideal model to work with an ACSu.
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Affiliation(s)
- J M Aranda-Nárvaez
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain.
- Faculty of Medicine, Malaga University, Malaga, Spain.
| | - P Fernández-Galeano
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
| | - L Romacho-López
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
| | - I Cabrera-Serna
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
| | - A Titos-García
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
| | - I Mirón-Fernández
- Trauma and Emergency Surgery Division, General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
| | - J Santoyo-Santoyo
- General, Digestive and Transplantation Surgery Department, University Regional Hospital, Malaga, Spain
- Faculty of Medicine, Malaga University, Malaga, Spain
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Tao L, Wang H, Guo Q. Single-operator cholangioscopy system for management of acute cholecystitis secondary to choledocholithiasis. Endosc Int Open 2023; 11:E1138-E1142. [PMID: 38221948 PMCID: PMC10785000 DOI: 10.1055/a-2201-6871] [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: 08/28/2023] [Accepted: 10/27/2023] [Indexed: 01/16/2024] Open
Abstract
This study aimed to investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) + EyeMax (single-operator cholangioscopy system; SOC) (i.e., ERCP+SOC) for the treatment of choledocholithasis-associated acute cholecystitis. Twenty-five patients were evaluated between January 2022 and June 2023. The success rate (technical + clinical), procedure time, postoperative recovery, postoperative length of hospital stay, and complications rates were recorded. The procedure and clinical success rates were 92% (23/25) and 96% (24/25), respectively. The mean procedure time was 36.6±10 minutes (standard deviation [SD]). The average postoperative hospitalization was 2±0.8 days. No adverse events such as bleeding, perforation, or bile leakage occurred. Cholecystitis did not recur during the 2 to 18 months of follow-up. ERCP+SOC may be a feasible, safe, and effective alternative treatment for acute cholecystitis secondary to choledocholithiasis. ERCP+SOC was able to simultaneously resolve both biliary tract and gallbladder problems via natural orifice endoscopy. Its advantages included no skin wound, reduced postoperative pain, quick recovery, limited to no exposure to x-rays, and a short hospital stay.
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Affiliation(s)
- Liying Tao
- Department of Gastroenterology, Jilin People's Hospital, Jilin, China
- Digestive Endoscopy Center, Jilin People’s Hospital, Jilin, China
| | - Hongguang Wang
- Department of Gastroenterology, Jilin People's Hospital, Jilin, China
- Digestive Endoscopy Center, Jilin People’s Hospital, Jilin, China
| | - Qingmei Guo
- Department of Gastroenterology, Jilin People's Hospital, Jilin, China
- Digestive Endoscopy Center, Jilin People’s Hospital, Jilin, China
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Kivivuori A, Salminen P, Ukkonen M, Ilves I, Vihervaara H, Zalevskaja K, Pajari J, Paajanen H, Rantanen T. Laparoscopic cholecystectomy versus antibiotic therapy for acute cholecystitis in patients over 75 years: Randomized clinical trial and retrospective cohort study. Scand J Surg 2023; 112:219-226. [PMID: 37572012 DOI: 10.1177/14574969231178650] [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: 08/14/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of acute cholecystitis among elderly patients is increasing. The aim of this study was to compare laparoscopic cholecystectomy (LC) to antibiotics in elderly patients with acute cholecystitis. METHODS A randomized multicenter clinical trial including patients over 75 years with acute calculous cholecystitis was conducted in four hospitals in Finland between January 2017 and December 2019. Patients were randomized to undergo LC or antibiotic therapy. Due to patient enrollment challenges, the trial was prematurely terminated in December 2019. To assess all eligible patients, we performed a retrospective cohort study including all patients over 75 years with acute cholecystitis during the study period. The primary outcome was morbidity. Predefined secondary outcomes included mortality, readmission rate, and length of hospital stay. RESULTS Among 42 randomized patients (LC n = 24, antibiotics n = 18, mean age 82 years, 43% women), the complication rate was 17% (n = 4/24) after cholecystectomy and 33% (n = 6/18, 5/6 patients underwent cholecystectomy due to antibiotic treatment failure) after antibiotics (p = 0.209). In the retrospective cohort (n = 630, mean age 83 years, 49% women), 37% (236/630) of the patients were treated with cholecystectomy and 63% (394/630) with antibiotics. Readmissions were less common after surgical treatment compared with antibiotics in both randomized and retrospective cohort patients (8% vs 44%, p < 0.001% and 11 vs 32%, p < 0.001, respectively). There was no 30-day mortality within the randomized trial. In the retrospective patient cohort, overall mortality was 6% (35/630). CONCLUSIONS LC may be superior to antibiotic therapy for acute cholecystitis in the selected group of elderly patients with acute cholecystitis.
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Affiliation(s)
- Antti Kivivuori
- Kuopio University Hospital Puijonlaaksontie 270210 Kuopio Finland
| | - Paulina Salminen
- Turku University Hospital, Turku, Finland
- University of Turku, Turku, Finland
| | | | - Imre Ilves
- Mikkeli Central Hospital, Mikkeli, Finland
| | - Hanna Vihervaara
- Turku University Hospital, Turku, Finland
- University of Turku, Turku, Finland
| | | | | | - Hannu Paajanen
- Mikkeli Central Hospital, Mikkeli, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Tuomo Rantanen
- Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
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Li ZZ, Guan LJ, Ouyang R, Chen ZX, Ouyang GQ, Jiang HX. Global, regional, and national burden of gallbladder and biliary diseases from 1990 to 2019. World J Gastrointest Surg 2023; 15:2564-2578. [PMID: 38111771 PMCID: PMC10725539 DOI: 10.4240/wjgs.v15.i11.2564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Gallbladder and biliary diseases (GABDs) are a major public health issue. AIM To analysis the cause-specific incidence, prevalence, and years lived with disability (YLDs) and its temporal trends of GABDs at the global, regional, and national level. Data on GABD were available from the Global Burden of Disease study 2019. METHODS The estimated annual percentage change (EAPC) was used to quantify temporal trend in GABD age-standardized incidence rates (ASIRs), age-standardized prevalence rate (ASPR), and age-standardized YLD rate (ASYR) by region, sex. We analyzed the relationship between the GABD burden and country development level using the human development index (HDI). RESULTS In 2019, the incident cases of GABD were 52003772, with an ASIR of 63432/100000 population. Globally, the number of incident cases and ASIR of GABD increased 97% and 58.9% between 1990 and 2019. Although, the ASPR and ASYR decreased from 1990 to 2019, the number of prevalent and YLDs cases increased. The highest ASIR was observed in Italy, and the highest ASPR and ASYR was observed in United Kingdom. The highest burden of GABD was found in low-SDI region, and the burden in female was significantly higher than males. A generally negative correlation (ρ = -0.24, P < 0.05) of GABD with the EAPC and human development index (HDI) (in 2021) were observed for ASIR. What's more, no correlation in ASPR (ρ = -0.06, P = 0.39) and ASYR (ρ = -0.07, P = 0.36) of GABD with the EAPC and HDI (in 2021) were observed, respectively. CONCLUSION GABD remain a major global public health challenge; however, the burden of GABD varies geographically. Globally, the number of incident cases and ASIR of GABD increased between 1990 and 2019. The results of our study provide insight into the global disease burden of GABD and may assist policymakers in formulating effective policies to mitigate modifiable risk factors.
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Affiliation(s)
- Zhong-Zhuan Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Department of Gastroenterology, Liuzhou Workers’ Hospital (The Fourth Affiliated Hospital of Guangxi Medical University), Liuzhou 545007, Guangxi Zhuang Autonomous Region, China
| | - Lin-Jing Guan
- Department of Abdomen Ultrasound, Nanning Sixth People’s Hospital, Nanning 530002, Guangxi Zhuang Autonomous Region, China
| | - Rong Ouyang
- Department of Gastroenterology, Liuzhou Workers’ Hospital (The Fourth Affiliated Hospital of Guangxi Medical University), Liuzhou 545007, Guangxi Zhuang Autonomous Region, China
| | - Zhi-Xin Chen
- Department of Gastroenterology, Liuzhou Workers’ Hospital (The Fourth Affiliated Hospital of Guangxi Medical University), Liuzhou 545007, Guangxi Zhuang Autonomous Region, China
| | - Guo-Qing Ouyang
- Department of General Surgery, Liuzhou People’s Hospital Affiliated to Guangxi Medical University, Liuzhou 545006, Guangxi Zhuang Autonomous Region, China
| | - Hai-Xing Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Hazan D, Leibovitz E, Jazmawi M, Shimonov M. Does percutaneous cholecystostomy affect prognosis of patients with acute cholecystitis that are unresponsive to conservative treatment? Saudi J Gastroenterol 2023; 29:376-380. [PMID: 37417190 PMCID: PMC10754375 DOI: 10.4103/sjg.sjg_87_23] [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: 03/01/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 07/08/2023] Open
Abstract
Background Percutaneous cholecystostomy (PC) can be used as bridging or definitive therapy in some cases of acute cholecystitis. We aimed to compare hospital stay and survival of patients that underwent PC insertion because of acute calculus cholecystitis (ACC) compared to those who did not. Methods This is a retrospective study in which patients with gangrenous cholecystitis and perforation were excluded. Regression models were used to evaluate the influence of PC on mortality and hospital stay. Results Six hundred and eighty-three patients were admitted because of ACC, and 50 patients were referred to PC. Indication for PC insertion were high disease severity index (DSI, 8 pts) and failure of conservative treatment with total disease duration >7 days (42 pts). Those who underwent PC were older (76.0 ± 12.4 vs. 60.8 ± 19.2, P < 0.001); PC was associated with longer hospital stay (12.8 vs. 6.5 days) and higher one-year mortality (20% vs. 4.9%, P < 0.001). Among patients with non-severe disease severity index (DSI), PC was associated with longer length of hospital stay and higher one-year mortality compared to patients treated conservatively (9.9 ± 0.6 vs. 6.0 ± 0.2 days, and 16.7% vs. 4.0%, respectively, P < 0.001 for both). For patients with severe DSI, PC was associated with similar length of hospital stay and one-year mortality compared to similar patients treated conservatively (16.1 ± 8.1 vs. 18.4 ± 4.0 days, and 37.5% vs. 22.6%, respectively, P = 0.802 and P = 0.389, respectively). Conclusions In patients with mild-moderate DSI unresponsive to conservative treatment, PC may be associated with deteriorated prognosis compared to conservative treatment. The decision to insert PC in patients unresponsive to conservative therapy even with disease duration >7 days must be re-evaluated.
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Affiliation(s)
- Danny Hazan
- Surgery A, Edith Wolfson Medical Center, Holon, Israel
| | - Eyal Leibovitz
- Internal Medicine “A”, Yoseftal, Hospital, Eilat, Israel
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Bliton JN. Inefficiency in Delivery of General Surgery to Black Patients: A National Inpatient Sample Study. Surg J (N Y) 2023; 9:e123-e134. [PMID: 38197094 PMCID: PMC10730284 DOI: 10.1055/s-0043-1777811] [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: 06/28/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
Background Racial disparities in outcomes among patients in the United States are widely recognized, but disparities in treatment are less commonly understood. This study is intended to identify treatment disparities in delivery of surgery and time to surgery for diagnoses managed by general surgeons-appendicitis, cholecystitis, gallstone pancreatitis, abdominal wall hernias, intestinal obstructions, and viscus perforations. Methods The National Inpatient Sample (NIS) was used to estimate and analyze disparities in delivery of surgery, type of surgery received, and timing of surgery. Age-adjusted means were compared by race/ethnicity and trends in treatment disparities were evaluated from 1993 to 2017. Linear modeling was used to measure trends in treatment and outcome disparities over time. Mediation analysis was performed to estimate contributions of all available factors to treatment differences. Relationships between treatment disparities and disparities in mortality and length of stay were similarly evaluated. Results Black patients were less likely to receive surgery for appendicitis, cholecystitis, pancreatitis, and hernias, and more likely to receive surgery for obstructions and perforations. Black patients experienced longer wait times prior to surgery, by 0.15 to 1.9 days, depending on the diagnosis. Mediation analysis demonstrated that these disparities are not attributable to the patient factors available in the NIS, and provided some insight into potential contributors to the observed disparities, such as hospital factors and socioeconomic factors. Conclusion Treatment disparities are present even with common indications for surgery, such as appendicitis, cholecystitis, and gallstone pancreatitis. Black patients are less likely to receive surgery with these diagnoses and must wait longer for surgery if it is performed. Surgeons should plan institution-level interventions to measure, explain, and potentially correct treatment disparities.
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Affiliation(s)
- John N. Bliton
- Department of Surgery, Jamaica Hospital Medical Center, Queens, New York
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9
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Aly DM, Fteah AM, Al Assaly NM, Elashry MA, Youssef YF, Hedaya MS. Correlation of serum biochemical characteristics and ABCG8 genetic variant (rs 11887534) with gall stone compositions and risk of gallstone disease in Egyptian patients. Asian J Surg 2023; 46:3560-3567. [PMID: 37344314 DOI: 10.1016/j.asjsur.2023.05.156] [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: 12/06/2022] [Revised: 02/27/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The overexpression of the cholesterol transporter: ATP-binding cassette transporter (ABCG8) due to the effect of ABCG8 genetic variant (rs11887534) leads to the precipitation of cholesterol crystals and gallstone disease (GSD). OBJECTIVE To evaluate the chemical composition of gallstones and the role of ABCG8 (rs11887534) in the susceptibility to GSD. METHODS We enrolled 77 patients with GSD treated with standard laparoscopic or open cholecystectomy and 75 age and sex-matched healthy controls. Chemical analysis of the extracted gallstones was performed. Analysis of the rs11887534 was performed by real-time PCR TaqMan technique for both cases and controls. RESULTS Pure cholesterol stones were the main type of stones in GSD patients. The CC genotype carriers of rs11887534 were more prone to gallstone formation than other genotypes. The CC genotype carriers were 100 folds at increased risk to develop pure cholesterol stones. CONCLUSION The most prevalent type of gallbladder stones is pure cholesterol stone. ABCG8 (rs11887534) could be associated with increased risk for cholesterol gallstones formation, this risk was more pronounced in female patients.
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Affiliation(s)
- Doaa Mamdouh Aly
- Clinical Chemistry Department, Theodor Bilharz Research Institute, Egypt.
| | | | - Nihal M Al Assaly
- Clinical Chemistry Department, Theodor Bilharz Research Institute, Egypt
| | - Mohamed A Elashry
- General Surgery Department, Theodor Bilharz Research Institute, Egypt
| | - Youssef F Youssef
- General Surgery Department, Theodor Bilharz Research Institute, Egypt
| | - Mohammed S Hedaya
- General Surgery Department, Theodor Bilharz Research Institute, Egypt
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10
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Bekheit M, Rajan S, Wohlgemut JM, Watson AJM, Ramsay G. Comprehensive assessment of the management of acute cholecystitis in Scotland: population-wide cohort study. BJS Open 2023; 7:zrad073. [PMID: 37578027 PMCID: PMC10424165 DOI: 10.1093/bjsopen/zrad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/08/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Acute cholecystitis is one of the most common diagnoses presenting to emergency general surgery and is managed either operatively or conservatively. However, operative rates vary widely across the world. This real-world population analysis aimed to describe the current clinical management and outcomes of patients with acute cholecystitis across Scotland, UK. METHODS This was a national cohort study using data obtained from Information Services Division, Scotland. All adult patients with the admission diagnostic code for acute cholecystitis were included. Data were used to identify all patients admitted to Scottish hospitals between 1997 and 2019 and outcomes tracked for inpatients or after discharge through the unique patient identifier. This was linked to death data, including date of death. RESULTS A total of 47 558 patients were diagnosed with 58 824 episodes of acute cholecystitis (with 27.2 per cent of patients experiencing more than one episode) in 46 Scottish hospitals. Median age was 58 years (interquartile range (i.q.r.) 43-71), 64.4 per cent were female, and most (76.1 per cent) had no comorbidities. A total of 28 741 (60.4 per cent) patients had an operative intervention during the index admission. Patients who had an operation during their index admission had a lower risk of 90-day mortality compared with non-operative management (OR 0.62, 95% c.i. 0.55-0.70). CONCLUSION In this study, 60 per cent of patients had an index cholecystectomy. Patients who underwent surgery had a better survival rate compared with those managed conservatively, further advocating for an operative approach in this cohort.
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Affiliation(s)
- Mohamed Bekheit
- Department of General Surgery, NHS Grampian, Aberdeen, UK
- HPB Surgery Unit, Integrated Centres of Excellence, Elite Healthcare, Alexandria, Egypt
| | - Sendhil Rajan
- Department of General Surgery, NHS Grampian, Aberdeen, UK
| | - Jared M Wohlgemut
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | | | - George Ramsay
- Department of General Surgery, NHS Grampian, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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11
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Haridoss M, Kumar S, Natarajan M, Sasidharan A, Rajsekar K, Oswal NK, Bagepally BS. Cost-effectiveness of cholecystectomy compared to conservative management in people presenting with uncomplicated symptomatic gallstones or cholecystitis in India. Expert Rev Pharmacoecon Outcomes Res 2023; 23:215-224. [PMID: 36527392 DOI: 10.1080/14737167.2023.2160706] [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: 12/23/2022]
Abstract
OBJECTIVES Gallstone diseases impose a significant economic burden on the health care system; thus, determining cost-effective management for gallstones is essential. We aim to estimate the cost-effectiveness of cholecystectomy compared with conservative management in individuals with uncomplicated symptomatic gallstones or cholecystitis in India. METHODS A decision-analytic Markov model was used to compare the costs and QALY of early laparoscopic cholecystectomy (ELC), delayed laparoscopic cholecystectomy (DLC), and conservative management (CM) in patients with symptomatic uncomplicated gallstone/cholecystitis from an Indian health system perspective. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were performed to test parameter uncertainties. RESULTS ELC and DLC, compared to CM, incurred an incremental cost of -₹10,948 ($146) and ₹1,054 ($14) for the 0.032 QALYs gained. The ICER was -₹3,42,758 ($4577) for ELC vs. CM, and ₹33,183 ($443) for DLC vs. CM, suggesting ELC and DLC are cost-effective. ELC saved ₹12,001 ($160) for 0.0002 QALYs gained compared to DLC, resulting in an ICER of -₹6,43,89,441 ($8,59,733). The results were robust to changes in the input parameters in sensitivity analyses. CONCLUSION ELC is dominant compared to both DLC and CM, and DLC is more cost-effective than CM. Thus, ELC may be preferable to other gallstone disease managements.
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Affiliation(s)
- Madhumitha Haridoss
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India
| | - 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
| | - Kavitha Rajsekar
- Department of Health Research, MoHFW, Health Technology Assessment in India (HTAIn) Secretariat, GOI, GOINew Delhi, India New Delhi
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12
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Popowicz A, Enochsson L, Sandblom G. Timing of Elective Cholecystectomy After Acute Cholecystitis: A Population-based Register Study. World J Surg 2023; 47:152-161. [PMID: 36280615 PMCID: PMC9726773 DOI: 10.1007/s00268-022-06772-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute cholecystectomy is standard treatment for acute cholecystitis. However, many patients are still treated conservatively and undergo delayed elective surgery. The aim of this study was to determine the ideal time to perform an elective cholecystectomy after acute cholecystitis. METHODS All patients treated for acute cholecystitis in Sweden between 2006 and 2013 were identified through the Swedish Patient Register. This cohort was cross-linked with the Swedish Register for Gallstone Surgery, GallRiks, where information on surgical outcome was retrieved. The impact of the time interval after discharge from hospital to elective surgery was analysed by multivariate logistic regression adjusting for gender and age. RESULTS After exclusion of patients not subjected to surgery, not registered in GallRiks and patients treated with acute cholecystectomy, 8532 remained. This cohort was divided into six-time categories. Using the first time interval < 11 days from discharge to elective surgery as the reference category the chance of completing surgery with a minimally invasive technique was increased for all categories (p < 0.05). The risk for perioperative complication and cystic duct leakage was reduced if surgery was undertaken > 30 days after discharge (both p < 0.05). The risk for bile duct injury was significantly increased if the procedure was undertaken > 365 days after discharge (p = 0.030). The chance of completing the procedure within 100 min was not affected by time. CONCLUSION For patients undergoing elective cholecystectomy after acute cholecystitis, the safety of the procedure increases if surgery is performed more than 30 days after discharge from the primary admission.
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Affiliation(s)
- Agnieszka Popowicz
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Trauma and Emergency Surgery, Karolinska Institute, Karolinska University Hospital, SE-141 52, Solna, Stockholm, Sweden.
| | - Lars Enochsson
- grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Gabriel Sandblom
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Department of Surgery, Södersjukhuset, Karolinska Institute, Stockholm, Solna, Stockholm Sweden
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13
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Chang YR, Wu CH, Chen HW, Hung YL, Hu CH, Huang RY, Wu MJ, Kou HW, Chen MY, Tsai CY, Wang SY, Liu KH, Hsu JT, Yeh CN, Liu NJ, Jan YY. Optimal Timing of Cholecystectomy for Patients with Concurrent Acute Cholecystitis and Acute Cholangitis after Successful Biliary Drainage by Interventional Endoscopic Retrograde Cholangiopancreatography. J Clin Med 2022; 11:jcm11216603. [PMID: 36362831 PMCID: PMC9654930 DOI: 10.3390/jcm11216603] [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: 09/14/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Concurrent acute cholecystitis and acute cholangitis is a unique clinical situation. We tried to investigate the optimal timing of cholecystectomy after adequate biliary drainage under this condition. Methods: From January 2012 to November 2017, we retrospectively screened all in-hospitalized patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and then identified patients with concurrent acute cholecystitis and acute cholangitis from the cohort. The selected patients were stratified into two groups: one-stage intervention (OSI) group (intended laparoscopic cholecystectomy at the same hospitalization) vs. two-stage intervention (TSI) group (interval intended laparoscopic cholecystectomy). Interrogated outcomes included recurrent biliary events, length of hospitalization, and surgical outcomes. Results: There were 147 patients ultimately enrolled for analysis (OSI vs. TSI, 96 vs. 51). Regarding surgical outcomes, there was no significant difference between the OSI group and TSI group, including intraoperative blood transfusion (1.0% vs. 2.0%, p = 1.000), conversion to open procedure (3.1% vs. 7.8%, p = 0.236), postoperative complication (6.3% vs. 11.8%, p = 0.342), operation time (118.0 min vs. 125.8 min, p = 0.869), and postoperative days until discharge (3.37 days vs. 4.02 days, p = 0.643). In the RBE analysis, the OSI group presented a significantly lower incidence of overall RBE (5.2% vs. 41.2%, p < 0.001) than the TSI group. Conclusions: Patients with an initial diagnosis of concurrent acute cholecystitis and cholangitis undergoing cholecystectomy after ERCP drainage during the same hospitalization period may receive some benefit in terms of clinical outcomes.
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Affiliation(s)
- Yau-Ren Chang
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chi-Huan Wu
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Yu-Liang Hung
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chia-Hsiang Hu
- Department of General Surgery, Jen Ai Chang Gung Health, Dali Branch, Taichung 412224, Taiwan
| | - Ruo-Yi Huang
- Department of General Surgery, Jen Ai Chang Gung Health, Dali Branch, Taichung 412224, Taiwan
| | - Min-Jung Wu
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hao-Wei Kou
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ming-Yang Chen
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: or ; Fax: +886-3-3285818
| | - Keng-Hao Liu
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Nai-Jen Liu
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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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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Osterman E, Helenius L, Larsson C, Jakobsson S, Majumder T, Blomberg A, Wickenberg J, Linder F. Surgery for acute cholecystitis in severely comorbid patients: a population-based study on acute cholecystitis. BMC Gastroenterol 2022; 22:371. [PMID: 35927715 PMCID: PMC9354429 DOI: 10.1186/s12876-022-02453-0] [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: 05/25/2022] [Accepted: 07/28/2022] [Indexed: 12/07/2022] Open
Abstract
Background International guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis.
Method 1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery. Results 725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months. Conclusion Patients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery. Trial registration: Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02453-0.
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Affiliation(s)
- Erik Osterman
- Department of Surgery, Gävle Hospital, 80187, Gävle, Gävleborg Region, Sweden. .,Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden. .,Centre for Research and Development, Gävle, Gävleborg Region, Sweden.
| | - Louise Helenius
- Department of Surgery, Gävle Hospital, 80187, Gävle, Gävleborg Region, Sweden
| | - Christina Larsson
- Department of Surgery, Gävle Hospital, 80187, Gävle, Gävleborg Region, Sweden
| | - Sofia Jakobsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tamali Majumder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Blomberg
- Department of Surgery, Gävle Hospital, 80187, Gävle, Gävleborg Region, Sweden
| | - Jennie Wickenberg
- Department of Surgery, Gävle Hospital, 80187, Gävle, Gävleborg Region, Sweden
| | - Fredrik Linder
- Department of Surgery, Uppsala University Hospital, Uppsala, Uppsala Region, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Analysis of the Effect of Laparoscopic Cholecystectomy for Acute Cholecystitis after Percutaneous Transhepatic Gallbladder Puncture and Drainage. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2071326. [PMID: 35911166 PMCID: PMC9328954 DOI: 10.1155/2022/2071326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/07/2022]
Abstract
Objective To assess the effect of laparoscopic cholecystectomy for acute cholecystitis after percutaneous transhepatic gallbladder drainage (PTGBD). Methods A total of 70 patients with acute cholecystitis diagnosed and treated in our hospital between April 2020 and November 2021 were recruited and assigned to receive either conventional treatment (conventional group) or PTGBD plus laparoscopic cholecystectomy (experimental group) according to the order of admission (with January 2021 as the cut-off time point), with 35 cases in each group. Outcome measures included treatment outcomes, surgical indices, and postoperative recovery. Results Patients in the experimental group showed significantly less intraoperative hemorrhage volume and shorter operative time, time-lapse before passing gas, and hospital stay (83.15 ± 31.17, 32.54 ± 12.61, 23.02 ± 4.61, 7.98 ± 3.24) versus those in the conventional group (120.56 ± 30.55, 61.01 ± 15.54, 28.15 ± 5.91, 11.95 ± 4.15) (P < 0.05). The incidence of conversion to open surgery and postoperative drainage in the experimental group was significantly lower (2.86%, 5.71%) than that of the conventional group (25.71%, 45.71%) (P < 0.05). The differences in the postoperative body temperature of the two groups did not come up to statistical standard (P > 0.05). The experimental group had faster body temperature recovery and leukocyte recovery and better leukocyte levels (1.25 ± 0.56, 2.36 ± 0.48, 7.92 ± 1.36) than the conventional group (3.11 ± 1.05, 5.41 ± 0.63, 10.52 ± 2.78) (P < 0.05). There was 1 (2.86%) case of pneumothorax and 1 (2.86%) case of intestinal bleeding in the experimental group, and there were 2 (5.71%) cases of biliary leakage, 3 (8.57%) cases of pneumothorax, 4 (11.43%) cases of intestinal bleeding, 5.71% cases of incisional infection, 1 (2.86%) case of respiratory failure, and 1 (2.86%) case of liver damage in the conventional group. The experimental group showed a significantly lower incidence of complications (5.71%) versus the conventional group (37.14%) (P < 0.05). Conclusion PTGBD plus laparoscopic cholecystectomy for acute cholecystitis effectively improves surgical safety, promotes patients' postoperative recovery, and reduces the incidence of conversion to open surgery and postoperative complications with a high safety profile. Further trials are, however, required prior to clinical promotion.
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Strohaeker J, Sabrow J, Yurttas C, Königsrainer A, Ladurner R, Hoenes F. Management of Symptomatic Gallstone Disease during COVID-19 Lockdown in a High-Resource Setting: Is There a Need for Treatment Alterations? Visc Med 2022; 38:265-271. [PMID: 36160825 PMCID: PMC9421663 DOI: 10.1159/000519789] [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: 06/29/2021] [Accepted: 09/17/2021] [Indexed: 08/03/2023] Open
Abstract
Introduction Cholecystectomy (CCE) is the treatment of choice of symptomatic gallstones. Due to the SARS-CoV-2 pandemic, operating room (OR) capacities have been reduced. The goal of this study was to evaluate the duration of symptoms of patients presenting with gallstone disease during a lockdown, the surgical management, and the severity grade of their disease. Materials and Methods A cohort study of 353 CCEs performed at a university hospital over two 10-week periods during 2 pandemic lockdowns in Germany compared to corresponding periods in 2018 and 2019. Results During the lockdowns, 101 CCEs were performed compared to 252 in the prior years. The number of elective CCEs was reduced to save OR capacities (p < 0.001), and the most common indication for CCE was acute cholecystitis. The median time to CCE after symptom onset was 3 days in both groups for acute cholecystitis. The severity of cholecystitis was comparable (p = 0.760). The time to CCE after choledocholithiasis was shorter during the lockdowns (median of 4 days vs. 9 days; p = 0.006). Conclusions The incidence and severity of acute cholecystitis during the lockdowns were comparable to the prior years. Acute care surgery was provided at the expense of elective procedures, and there was no need for treatment alterations.
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Incidence and Risk Factors for Hospital-acquired Cholecystitis. J Hosp Infect 2022; 128:13-18. [PMID: 35830937 DOI: 10.1016/j.jhin.2022.07.003] [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: 06/03/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute cholecystitis can occur both inside and outside hospital settings. However, little is known about the clinical characteristics of hospital-acquired cholecystitis (HAC). AIM The objective of our study is to investigate the clinical characteristics of HAC in a tertiary academic hospital. METHODS This retrospective cohort study included hospitalized patients who were found to have gallstones without cholecystitis or cholangitis on admission between January 2018 and December 2021. We used multivariate logistic regression analysis to make comparisons between patients with and without HAC. FINDINGS A total of 890 patients met the inclusion criteria and were evaluated in this study. Forty-one patients (4.6%) developed HAC during the study period. Multivariate logistic regression analysis showed that a history of cholecystitis or cholangitis, fasting at least one day, and gallstones in the gallbladder neck were independently associated with increased risk of HAC. HAC occurred most frequently after about several weeks of admission, and only four patients (9.8%) had bacteremia. CONCLUSIONS HAC was relatively common among hospitalized patients. Physicians should be aware of the possibility of HAC in symptomatic hospitalized patients with certain risk factors.
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Correlation of Inpatients Suffering from Acute Acalculous Cholecystitis during ICU Treatment with Acute Physiology and Chronic Health Evaluation II Score, Duration of Ventilator Use, and Time on Total Parenteral Nutrition. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3407997. [PMID: 35813420 PMCID: PMC9262504 DOI: 10.1155/2022/3407997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the correlation of inpatients suffering from acute acalculous cholecystitis (AAC) during ICU treatment with Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, duration of ventilator use, and time on total parenteral nutrition (TPN). Methods From March 2016 to March 2022, the clinical data of 47 patients with AAC who received ICU treatment in our hospital were retrospectively reviewed, and these patients were included in the AAC group. Another 36 patients treated in the ICU in the same period with age and gender matching with those in the AAC group were selected as the non-AAC group. Patients' various clinical data were recorded to analyze the correlation of AAC with APACHE-II score, duration of ventilator use, and time on TPN. Results The shock time, duration of ventilator usage, and duration of sedative medicine use were all substantially longer in the AAC group than in the non-AAC group, according to the univariate analysis (P < 0.05); the amount of norepinephrine used, white blood cell count, C-reactive protein (CRP) amount, and APACHE-II score were significantly higher in the AAC group than in the non-AAC group (P < 0.05); between the two groups, the time on TPN and fasting time were different, but with no statistical significance (P > 0.05); after performing Spearman's correlation with the significantly between-group different indicators, the result showed that the amount of norepinephrine used, duration of ventilator use, white blood cell count, and CRP amount were significantly correlated with the occurrence of AAC, and the correlation was positive (P all <0.001). Conclusion The APACHE-II score and time on TPN are not significantly correlated with the occurrence of AAC; and the amount of norepinephrine used, duration of ventilator use, white blood cell count, and serum CRP are positively correlated with the occurrence of AAC. Measuring the variations in the levels of various markers can signal the onset of AAC or reflect the state and prognosis, suggesting a possible application in clinic-based targeted prevention and treatment of AAC.
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The Effect of MDT Collaborative Nursing Combined with Hierarchical Nursing Management Model on the Quality of Life and Comfort of Patients with Gallbladder Stones Combined with Acute Cholecystitis after Surgery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8696084. [PMID: 35734780 PMCID: PMC9208964 DOI: 10.1155/2022/8696084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 12/07/2022]
Abstract
Objective To explore the effect of MDT (multidisciplinary team) collaborative nursing combined with hierarchical nursing management mode on the quality of life and comfort of patients with gallbladder stones combined with acute cholecystitis after surgery. Methods A total of 120 patients with gallbladder stones and acute cholecystitis who were treated in our hospital from March 2019 to March 2021 were selected as prospective research objects. According to the order of care, they were divided into control group and observation group with 60 cases each. Among them, the control group implements a hierarchical nursing management model, and the observation group implements MDT collaborative nursing based on this and compares the impact of the two groups on patient's quality of life scores, daily self-care ability, nursing satisfaction, and comfort after nursing. Results Before nursing, the comparison of the quality of life score, nursing comfort, and nursing ability of the two groups of patients was not statistically significant (P > 0.05). After nursing, the mental vitality score, social interaction score, emotional restriction score, and mental status of the observation group were significantly higher than those of the control group. Statistics showed that the difference was statistically significant (P < 0.05). After nursing, the scores of social comfort, physical comfort, and psychological comfort of the observation group were significantly higher than those of the control group, and statistics showed that the difference was statistically significant (P < 0.05). The health knowledge level, self-care skills, self-care responsibility, and self-concept of the observation group after nursing were higher than those of the control group, while the score of depression and mood disorder was significantly lower than that of the control group. Statistics showed that this difference was statistically significant (P < 0.05). After nursing, patients in the observation group had higher operating technique scores, service attitude scores, health education scores, psychological intervention scores, and nursing quality scores than those of the control group. Statistics showed that the difference was statistically significant (P < 0.05). Conclusion MDT collaborative nursing combined with hierarchical nursing management mode can effectively improve the self-care ability of patients with gallbladder stones complicated with acute cholecystitis, effectively improve the quality of life of patients, and improve the satisfaction and comfort of patients with nursing care. The postnursing care of patients after inflammation has a certain reference value.
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Early laparoscopic cholecystectomy in oldest-old patients: a propensity score matched analysis of a nationwide registry. Updates Surg 2022; 74:979-989. [DOI: 10.1007/s13304-022-01254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/10/2022] [Indexed: 12/07/2022]
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22
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Vural S, Aydin I, Kesicioglu T. Association of Serum C-Reactive Protein Level and Treatment Duration in Acute Cholecystitis Patients Treated Conservatively. Cureus 2022; 14:e22146. [PMID: 35308770 PMCID: PMC8919242 DOI: 10.7759/cureus.22146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Acute cholecystitis (AC) is one of the most common gastrointestinal diseases that require hospitalization and surgical treatment. The treatment of the disease depends upon the severity of the disease and the patients’ medical status. Objective: In this study, we aimed to investigate if there is an association between the serum C-reactive protein (CRP) value and treatment response and the duration and length of hospital stay in AC patients who are treated conservatively. Methodology: The medical records of all patients with the diagnosis of AC who were treated with conservative management were included in the study. The demographic and laboratory data including CRP level at first admission to hospital, length of hospital stay, and complications during the conservative treatment were obtained from the patients’ records. Patients were divided into two groups according to the treatment response and length of hospital stay. Group 1 patients were defined as patients who responded to the medical treatment in less than three days, and Group 2 patients were defined as patients who did not respond to the medical treatment in three days and stayed at the hospital for more than three days. Results: We identified 101 patients with AC treated medically. Mean age (51.3 ± 16.3, 59.5 ± 15.7; p = 0.013), total leukocyte count (11.8 ± 4.4, 8.2 ± 2.8; p = 0.0005), and CRP value (19.3 ± 13.9, 9.6 ± 5.2; p = 0.0003) were higher in Group 2 compared to Group 1. Correlation analyses demonstrated a significant positive association between the length of hospital stay, total leukocyte count (r = 0.35; p = 0.0002), and CRP value (r = 0.59; p = 0.0004). Conclusion: We found that CRP level is associated with treatment duration and hospital stay in AC patients. However, large-scale, prospective further studies are needed to confirm our results and to determine whether CRP levels can be used to discriminate which patient would benefit from medical treatment.
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Surgeons have hesitated early cholecystectomy because of cardiovascular comorbidities during adoption of guidelines. Sci Rep 2022; 12:502. [PMID: 35017567 PMCID: PMC8752855 DOI: 10.1038/s41598-021-04479-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/23/2021] [Indexed: 12/07/2022] Open
Abstract
The introduction of the guidelines has resulted in an increase of laparoscopic surgeries performed, but the rate of early surgery was still low. Here, the initial effect of the introduction of the guideline was confirmed in single center, and factors disturbing early cholecystectomy were analyzed. This study included 141 patients who were treated for acute cholecystitis from January 2010 to October 2014 at Kanazawa Medical Center. Each patient was assigned into a group according to when they received treatment. Patients in Group A were treated before the Tokyo Guidelines were introduced (n = 48 cases), those in Group B were treated after the introduction of the guidelines (93 cases). After the introduction of the guidelines, early laparoscopic cholecystectomy was significantly increased (P < 0.001), however, the rate of early operations was still 38.7% only. There are many cases with cardiovascular disease in delayed group, the prevalence had reached 50% as compared with early group of 24% (P < 0.01). Approximately 25% of patients continued antiplatelet or anticoagulant therapy. In the early days of guidelines introduction, the factor which most disturbed early surgery was the coexistence of cardiovascular disease. These contents could be described in the next revision of the guidelines.
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Lucocq J, Hamilton D, Scollay J, Patil P. Subtotal Cholecystectomy Results in High Peri-operative Morbidity and Its Risk-Profile Should be Emphasised During Consent. World J Surg 2022; 46:2955-2962. [PMID: 36209338 PMCID: PMC9636087 DOI: 10.1007/s00268-022-06737-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Subtotal cholecystectomy aims to reduce the likelihood of bile duct injury but risks a multitude of less severe, yet significant complications. The primary aim of the present study was to report peri-operative outcomes of subtotal laparoscopic cholecystectomy (SLC) relative to total laparoscopic cholecystectomy (TLC) to inform the consent process. METHOD All laparoscopic cholecystectomies between 2015 and 2020 in one health board were included. The peri-operative outcomes of SLC (n = 87) and TLC (n = 2650) were reported. Pre-operative variables were compared between the two groups to identify risk factors for SLC. The outcomes between the SLC and TLC were compared using univariate, multivariate and propensity analysis. RESULTS Risk factors for SLC included higher age, male gender, cholecystitis, increased biliary admissions, ERCP, cholecystostomy and emergency cholecystectomy. Following SLC, rates of post-operative complication (45.9%), imaging (37.9%) intervention (28.7%) and readmission (29.9%) were significant. The risk profile was vastly heightened compared to that of TLC: intra-operative complications (RR 9.0; p < 0.001), post-operative complications [bile leak (RR 58.9; p < 0.001), collection (RR 12.2; p < 0.001), retained stones (RR 7.2; p < 0.001) and pneumonia (RR 5.4; p < 0.001)], post-operative imaging (RR 4.4; p < 0.001), post-operative intervention (RR 12.3; p < 0.001), prolonged PLOS (RR 11.3; p < 0.001) and readmission (RR 4.5; p < 0.001). The findings were consistent using multivariate logistic regression and propensity analysis. CONCLUSION The relative morbidity associated with SLC is significant and high-risk patients should be counselled for the peri-operative morbidity of subtotal cholecystectomy.
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Affiliation(s)
- James Lucocq
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, Scotland
| | - David Hamilton
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, Scotland
| | - John Scollay
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, Scotland
| | - Pradeep Patil
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, Scotland
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Kayaoglu SA, Tilki M. When to remove the drainage catheter in patients with percutaneous cholecystostomy? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 68:77-81. [PMID: 34909967 DOI: 10.1590/1806-9282.20210787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/13/2021] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The treatment for patients with acute calculous cholecystitis who have high surgical risk with percutaneous cholecystostomy instead of surgery is an appropriate alternative choice. The aim of this study was to examine the promising percutaneous cholecystostomy intervention to share our experiences about the duration of catheter that has yet to be determined. METHODS A total of 163 patients diagnosed with acute calculous cholecystitis and treated with percutaneous cholecystostomy between January 2011 and July 2020 were reviewed retrospectively. The Tokyo Guidelines 2018 were used to diagnose and grade patients with acute cholecystitis. RESULTS The mean age was 71.81±12.81 years. According to the Tokyo grading, 143 patients had grade 2 and 20 patients had grade 3 disease. The mean duration of catheter was 39.12±37 (1-270) days. Minimal bile leakage into the peritoneum was noted in 3 (1.8%) patients during the procedure. The rate of complications during follow-up of the patients who underwent percutaneous cholecystostomy was 6.9% (n=11), and the most common complication was catheter dislocation. Cholecystectomy was performed in 33.1% (n=54) of the patients at follow-up. Post-cholecystectomy complication rate was 12.9%. At the follow-up, the rate of recurrent acute cholecystitis episodes was 5.5%, while the mortality rate was 1.8%. The length of follow-up was five years. CONCLUSIONS The rate of recurrence was significantly higher among the patients with catheter for <21 days. We recommend that the duration of catheter should be minimum 21 days in patients undergoing percutaneous cholecystostomy.
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Affiliation(s)
- Sevcan Alkan Kayaoglu
- Haydarpasa Numune Training and Research Hospital, Department of General Surgery - Istanbul, Turkey
| | - Metin Tilki
- Haydarpasa Numune Training and Research Hospital, Department of General Surgery - Istanbul, Turkey
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Vila JJ, Fernández-Urién I, Carrascosa J, Jusué V, Uribarri L. Management of acute calculous cholecystitis in high risk surgical patients. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:574-578. [PMID: 34890720 DOI: 10.1016/j.gastrohep.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/28/2021] [Indexed: 12/07/2022]
Affiliation(s)
- Juan José Vila
- Unidad de Endoscopia, Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, España.
| | - Iñaki Fernández-Urién
- Unidad de Endoscopia, Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, España
| | - Juan Carrascosa
- Unidad de Endoscopia, Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, España
| | - Vanesa Jusué
- Unidad de Endoscopia, Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, España
| | - Laura Uribarri
- Unidad de Endoscopia, Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, España
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Rosa F, Covino M, Cozza V, Fransvea P, Quero G, Fiorillo C, Simeoni B, Sganga G, Gasbarrini A, Franceschi F, Alfieri S. Management of acute cholecystitis in elderly patients: A propensity score-matched analysis of surgical vs. medical treatment. Dig Liver Dis 2021; 53:1620-1626. [PMID: 33500239 DOI: 10.1016/j.dld.2021.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/09/2020] [Accepted: 01/13/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute cholecystitis (AC) is a life-threatening emergency in elderly patients. AIMS To compare the commonly used management strategies for elderly patients with AC as well as resulting morbidity, mortality and length of hospital stay (LOS). METHODS All patients ≥ 65 years admitted to our emergency department for AC between January 1st, 2014 and December 31st, 2018 were included in the study. We compared patients that received medical treatment to patients who received operative procedures. In order to correct for baseline covariates and factors associated to clinical management, we used a 1:1 propensity score matching (PSM) analysis. The primary outcome was the overall in-hospital mortality. Secondary outcomes included occurrence of major complications and LOS. RESULTS A total of 1075 patients were enrolled: 483 patients received a medical treatment and 592 patients underwent interventional procedures. After PSM, 770 patients (385 for each treatment group) were included in the analysis. The analysis revealed that both mortality and cumulative major complications were similar in medical and interventional group. We found that among comorbidities, Charlson comorbidity index and congestive heart failure were significantly higher in the medical treatment group (5 [4-6] vs. 4 [3-6] and 11.7% vs. 4.7%, respectively; p<0.001). LOS was slightly lower in the medical treatment group (7.0 days [4.9-11.1] vs. 7.9 [4.9-13.5]; p = 0.046). CONCLUSION Medical management outcomes for AC in elderly patients were similar to operative treatments in terms of mortality and cumulative major complications. A conservative approach should always be considered.
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Affiliation(s)
- Fausto Rosa
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Marcello Covino
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Cozza
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Pietro Fransvea
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Quero
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benedetta Simeoni
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gabriele Sganga
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Alfieri
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
Laparoscopic cholecystectomy is a common operation; approximately 20 million Americans have gallstones, the most common indication. Surgeons who operate on the biliary tree must be familiar with the presentations and treatment options for acute and chronic biliary pathology. We focus on the difficult "bad" gallbladder. We explore the available evidence as to what to do when a gallbladder is too inflamed, too technically challenging, or a patient is too sick to undergo standard laparoscopic cholecystectomy. We discuss whether or not open cholecystectomy is a relevant tool and what can be done to manage common bile duct stones found unexpectedly intraoperatively.
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Affiliation(s)
- Miloš Buhavac
- Texas Tech University Health Sciences Center, Department of Surgery, 3601 4th Street, Lubbock, TX 79430, USA.
| | - Ali Elsaadi
- Texas Tech University Health Sciences Center, Department of Surgery, 3601 4th Street, Lubbock, TX 79430, USA
| | - Sharmila Dissanaike
- Texas Tech University Health Sciences Center, Department of Surgery, 3601 4th Street, Lubbock, TX 79430, USA
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Lee D, Appel S, Nunes L. CT findings and outcomes of acute cholecystitis: is additional ultrasound necessary? Abdom Radiol (NY) 2021; 46:5434-5442. [PMID: 34235552 DOI: 10.1007/s00261-021-03160-2] [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: 03/06/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND While ultrasound is often the preferred imaging modality for suspected acute cholecystitis (AC), CT is often the first line study when patients are being evaluated for abdominal pain. The diagnostic value of CT in the setting of AC is controversial, given the prevalent use of additional imaging. PURPOSE To evaluate the positive predictive value (PPV) of CT for diagnosing acute cholecystitis (AC) when used as a first line imaging study for evaluating abdominal pain and assess if additional imaging with ultrasound studies provides additional clinically useful information. MATERIALS AND METHODS Abnormal gallbladder findings in CT imaging studies were queried in a retrospective study over a 25-month period within a large urban health system. Sonographic (US) studies performed within 72 h of the initial CT were also included. Outcomes were determined by surgical pathology, fluid analysis, and clinical outcomes. Cases were stratified by the interpreting radiologist's subjective confidence level of diagnosing AC, and the PPVs were compared between cases using CT without US and cases with both CT and US. RESULTS Of the 468 CT studies meeting criteria, 192 were read as concerning for AC. PPV of CT was 44.7% without US and 50.5% when US was positive, which amounted to an insignificant gain (p = 0.41). When subdividing by confidence level, high-confidence positive CTs demonstrated no significant difference without ultrasound (80%) compared to with ultrasound (75%). Less confident reads in CT demonstrated potential gain from ultrasound; in the case of a "probable" CT impression, PPV increased from 45% without US to 90% with a high-confidence ultrasound impression. CONCLUSION Based on current practice within a large health system, CT examinations with high suspicion for AC demonstrated little gain from follow-up ultrasound. However, ultrasound may be of benefit when CT interpretations are less confident but still suspicious for AC.
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Bagepally BS, Haridoss M, Sasidharan A, Jagadeesh KV, Oswal NK. Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000675. [PMID: 34261757 PMCID: PMC8280848 DOI: 10.1136/bmjgast-2021-000675] [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: 04/05/2021] [Accepted: 07/04/2021] [Indexed: 01/07/2023] Open
Abstract
Background The effectiveness of early cholecystectomy for gallstone diseases treatment is uncertain compared with conservative management/delayed cholecystectomy. Aims To synthesise treatment outcomes of early cholecystectomy versus conservative management/delayed cholecystectomy in terms of its safety and effectiveness. Design We systematically searched randomised control trials investigating the effectiveness of early cholecystectomy compared with conservative management/delayed cholecystectomy. We pooled the risk ratios with a 95% CI, also estimated adjusted number needed to treat to harm. Results Of the 40 included studies for systematic review, 39 studies with 4483 patients are included in meta-analysis. Among the risk ratios of gallstone complications, pain (0.38, 0.20 to 0.74), cholangitis (0.52, 0.28 to 0.97) and total biliary complications (0.33, 0.20 to 0.55) are significantly lower with early cholecystectomy. Adjusted number needed to treat to harm of early cholecystectomy compared with conservative management/delayed cholecystectomy are, for pain 12.5 (8.3 to 33.3), biliary pancreatitis >1000 (50–100), common bile duct stones 100 (33.3 to 100), cholangitis (100 (25–100), total biliary complications 5.9 (4.3 to 9.1) and mortality >1000 (100 to100 000). Conclusions Early cholecystectomy may result in fewer biliary complications and a reduction in reported abdominal pain than conservative management. PROSPERO registration number 2020 CRD42020192612.
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Affiliation(s)
- Bhavani Shankara Bagepally
- ICMR-NIE Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Madhumitha Haridoss
- ICMR-NIE Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Akhil Sasidharan
- ICMR-NIE Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Kayala Venkata Jagadeesh
- Health Technology Assessment in India (HTAIn) Secretariat, Department of Health Research, MoHFW, GOI, New Delhi, India
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Ielpo B, Prieto M, Ortega I, Balibrea JM, Rubio-Pérez I, Juvany M, Gómez-Bravo MÁ, Ramia JM. [National survey on the treatment of cholelitiasis in Spain during the initial period of the COVID-19 pandemic]. Cir Esp 2021; 99:346-353. [PMID: 38620242 PMCID: PMC7368890 DOI: 10.1016/j.ciresp.2020.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 02/06/2023]
Abstract
Introduction The extraordinary impact of COVID-19 pandemic on Spanish hospitals has led to a redistribution of resources for the treatment of these patients, with a decreased capacity of care for other common diseases. The aim of the present study is to analyse how this situation has affected the treatment of cholecystitis and cholelythiasis. Methods It is a descriptive national study after online voluntary distribution of a specific questionnaire with Google Drive™ to members of the Spanish Association of Surgeons (AEC). Results We received 153 answers (one per hospital). Elective cholecystectomies have been cancelled in 96.7% of centres. Conservative treatment for acute cholecystitis has been selected in 90% (previously 18%), and if operated, 95% have been performed laparoscopically. Globally, only 49% perform preoperative diagnostic tests for SARS-CoV-2, and 58.5% recognize there have been cases confirmed postoperatively after other surgeries, with worse surgical outcomes in 54%. Conclusions This survey shows that most of the Spanish centers are following the surgical societies suggestions during the pandemic. However, some data requires to be taken into account for the next phase of the pandemic.
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Affiliation(s)
- Benedetto Ielpo
- Unidad de Cirugia Hepatobiliopancreática, Hospital Universitario del Mar, Barcelona, España
| | - Mikel Prieto
- Unidad Hepatobiliar, Transplante Hepático y Retroperitoneo, Hospital Universitario Cruces, Bilbao, España
| | - Irene Ortega
- Sección de Cirugía Hepatobiliopancreática, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid. Universidad Europea de Madrid, Madrid, España
| | - José María Balibrea
- Servicio de Cirugía Gastrointestinal (ICMDiM), Hospital Clínic de Barcelona, Universitat de Barcelona. Sección de Infección Quirúrgica, AEC, Barcelona, España
| | - Inés Rubio-Pérez
- Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España
| | - Montse Juvany
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, España
| | | | - José Manuel Ramia
- Servicio de Cirugía, Hospital Universitario de Guadalajara, Guadalajara, España
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Ielpo B, Prieto M, Ortega I, Balibrea JM, Rubio-Pérez I, Juvany M, Gómez-Bravo MÁ, Ramia JM. National survey on the treatment of cholelitiasis in Spain during the initial period of the COVID-19 pandemic. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2021. [PMID: 32892980 PMCID: PMC8088215 DOI: 10.1016/j.cireng.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Introduction The extraordinary impact of COVID-19 pandemic on Spanish hospitals has led to a redistribution of resources for the treatment of these patients, with a decreased capacity of care for other common diseases. The aim of the present study is to analyse how this situation has affected the treatment of cholecystitis and cholelythiasis. Methods It is a descriptive national study after online voluntary distribution of a specific questionnaire with Google Drive™ to members of the Spanish Association of Surgeons (AEC). Results We received 153 answers (one per hospital). Elective cholecystectomies have been cancelled in 96.7% of centres. Conservative treatment for acute cholecystitis has been selected in 90% (previously 18%), and if operated, 95% have been performed laparoscopically. Globally, only 49% perform preoperative diagnostic tests for SARS-CoV-2, and 58.5% recognize there have been cases confirmed postoperatively after other surgeries, with worse surgical outcomes in 54%. Conclusions This survey shows that most of the Spanish centers are following the surgical societies suggestions during the pandemic. However, some data requires to be taken into account for the next phase of the pandemic.
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Multicentre cohort study of acute cholecystitis management during the COVID-19 pandemic. Eur J Trauma Emerg Surg 2021; 47:683-692. [PMID: 33742223 PMCID: PMC7978438 DOI: 10.1007/s00068-021-01631-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/26/2021] [Indexed: 01/19/2023]
Abstract
Purpose To analyse acute cholecystitis (AC) management during the first pandemic outbreak after the recommendations given by the surgical societies estimating: morbidity, length of hospital stay, mortality and hospital-acquired SARS-CoV-2 infection rate. Methods Multicentre-combined (retrospective–prospective) cohort study with AC patients in the Community of Madrid between 1st March and 30th May 2020. 257 AC patients were involved in 16 public hospital. Multivariant binomial logistic regression (MBLR) was applied to mortality. Results Of COVID-19 patients, 30 were diagnosed at admission and 12 patients were diagnosed during de admission or 30 days after discharge. In non-COVID-19 patients, antibiotic therapy was received in 61.3% of grade I AC and 40.6% of grade II AC. 52.4% of grade III AC were treated with percutaneous drainage (PD). Median hospital stay was 5 [3–8] days, which was higher in the non-surgical treatment group with 7.51 days (p < 0.001) and a 3.25% of mortality rate (p < 0.21). 93.3% of patients with SARS-CoV-2 infection at admission were treated with non-surgical treatment (p = 0.03), median hospital stay was 11.0 [7.5–27.5] days (p < 0.001) with a 7.5% of mortality rate (p > 0.05). In patients with hospital-acquired SARS-CoV-2 infection, 91.7% of grade I–II AC were treated with non-surgical treatment (p = 0.037), with a median hospital stay of 16 [4–21] days and a 18.2% mortality rate (p > 0.05). Hospital-acquired infection risk when hospital stay is > 7 days is OR 4.7, CI 95% (1.3–16.6), p = 0.009. COVID-19 mortality rate was 11.9%, AC severity adjusted OR 5.64 (CI 95% 1.417–22.64). In MBLR analysis, age (OR 1.15, CI 95% 1.02–1.31), SARS-CoV-2 infection (OR 14.49, CI 95% 1.33–157.81), conservative treatment failure (OR 8.2, CI 95% 1.34–50.49) and AC severity were associated with an increased odd of mortality. Conclusion In our population, during COVID-19 pandemic, there was an increase of non-surgical treatment which was accompanied by an increase of conservative treatment failure, morbidity and hospital stay length which may have led to an increased risk hospital-acquired SARS-CoV-2 infection. Age, SARS-CoV-2 infection, AC severity and conservative treatment failure were mortality risk factors.
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Current Management of Acute Calculous Cholecystitis. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-020-00282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Lyu Y, Li T, Wang B, Cheng Y, Chen L, Zhao S. Endoscopic Ultrasound-Guided Gallbladder Drainage Versus Percutaneous Transhepatic Gallbladder Drainage for Acute Cholecystitis with High Surgical Risk: An Up-to-Date Meta-Analysis and Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 31:1232-1240. [PMID: 33400595 DOI: 10.1089/lap.2020.0786] [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: 12/11/2022] Open
Abstract
Background: To compare the safety and effectiveness of endoscopic ultrasound-guided gallbladder drainage (EUSGBD) with percutaneous transhepatic gallbladder drainage (PTGBD) for acute cholecystitis with high surgical risk. Methods: An electronic search was performed of the major databases, namely PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until July 1, 2020. Studies comparing EUSGBD with PTGBD were included. Results: We identified 8 studies involving 801 patients, and patients were divided into two groups (EUSGBD group = 338 and PTGBD = 463). EUSGBD was associated with less reintervention (odds ratio [OR] = 0.15; 95% confidence interval [CI]: 0.07-0.32; P < .00001) and readmission (OR = 0.24; 95% CI: 0.08-0.67; P = 7). With lumen-apposing metal stents (LAMS), EUSGBD was associated with fewer adverse events (OR = 0.35; 95% CI: 0.13-0.93; P = .03), recurrent cholecystitis (OR = 0.27; 95% CI: 0.10-0.71; P = .008) and readmission (OR = 0.10; 95% CI: 0.03-0.32; P = .0001). There were no significant differences between the groups regarding clinical success (OR = 1.47; 95% CI: 0.75-2.90; P = .26). Technical success with PTGBD was higher than that with EUSGBD (OR = 0.32; 95% CI: 0.13-0.83; P = .02). Conclusions: EUSGBD was comparable with PTGBD regarding clinical success, with less reintervention and readmission, for acute cholecystitis with high surgical risk. The cholecystitis recurrence rate was lower with EUSGBD with LAMS.
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Affiliation(s)
- Yunxiao Lyu
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Ting Li
- Department of Personnel Office, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Bin Wang
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Yunxiao Cheng
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Liang Chen
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Sicong Zhao
- Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, P.R. China
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Emergency surgery and trauma care during COVID-19 pandemic. Recommendations of the Spanish Association of Surgeons. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2020. [PMCID: PMC7513833 DOI: 10.1016/j.cireng.2020.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Feldman I, Feldman L, Shapiro DS, Munter G, Yinnon AM, Friedman R. Characteristics and outcome of elderly patients admitted for acute Cholecystitis to medical or surgical wards. Isr J Health Policy Res 2020; 9:23. [PMID: 32741359 PMCID: PMC7397574 DOI: 10.1186/s13584-020-00383-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/27/2020] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Elderly patients admitted because of acute cholecystitis are usually not operated during their initial admission and receive conservative treatment. To help formulate a new admission policy regarding elderly patients with acute cholecystitis we compared the demographic and clinical characteristics and outcome of patients > 65 with acute cholecystitis admitted to medical or surgical wards. METHODS This retrospective study included all patients > 65 years admitted for acute cholecystitis between January, 2009 and September, 2016. Data were retrieved from the electronic health records. RESULTS A total of 187 patients were detected, 54 (29%) in medical departments and 133 (71%) in surgical wards. The mean age (±SD) was 80 ± 7.5 and was higher among those in medical than surgical wards (84 ± 7 versus 79 ± 7, p < 0.05). Patients hospitalized in medical departments had more comorbidity, disability and mental impairment. However, there was no difference in mortality between the two groups, 1 (2%) and 6 (4%) respectively. Independent predictors for hospitalization in medical departments were chronic obstructive pulmonary disease (OR = 9.8, 95% C. I 1.6-59) and the Norton Scale score (NSS)(OR = 0.7, 95% C. I 0.7-0.8). Impaired mental condition was the only predictor for hospitalization > 1 week. The strongest predictor for having cholecystostomy was admission to the surgical department (OR = 14.7, 95% C. I 3.9-56.7). Linear regression showed a negative correlation between NSS and length of hospitalization (LOH; Beta = - 0.5). CONCLUSION Elderly patients with acute cholecystitis who require conservative management, especially those with severe functional and mental impairment can be safely hospitalized in medical departments. Outcome was not inferior in terms of mortality and LOH. These results have practical policy implications for the placement of elderly patients with acute cholecystitis in medical rather than surgical departments.
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Affiliation(s)
- Itamar Feldman
- Department of Geriatrics, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Lena Feldman
- Department of Geriatrics, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Dvorah S Shapiro
- Department of Geriatrics, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Gabriel Munter
- Division of Internal Medicine, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, P.O. Box 3235, 91031, Jerusalem, Israel
| | - Amos M Yinnon
- Division of Internal Medicine, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, P.O. Box 3235, 91031, Jerusalem, Israel.
| | - Reuven Friedman
- Department of Geriatrics, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Fan N, Meng K, Zhang Y, Hu Y, Li D, Gao Q, Wang J, Li Y, Wu S, Cui Y. The effect of ursodeoxycholic acid on the relative expression of the lipid metabolism genes in mouse cholesterol gallstone models. Lipids Health Dis 2020; 19:158. [PMID: 32615989 PMCID: PMC7333299 DOI: 10.1186/s12944-020-01334-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many studies indicate that gallstone formation has genetic components. The abnormal expression of lipid-related genes could be the basis for particular forms of cholesterol gallstone disease. The aim of this study was to obtain insight into lipid metabolism disorder during cholesterol gallstone formation and to evaluate the effect of ursodeoxycholic acid (UDCA) on the improvement of bile lithogenicity and its potential influence on the transcription of lipid-related genes. METHODS Gallstone-susceptible mouse models were induced by feeding with a lithogenic diet (LD) for 8 weeks. Bile and liver tissues were obtained from these mouse models after 0, 4 and 8 weeks. Bile lipids were measured enzymatically, and the cholesterol saturation index (CSI) was calculated to evaluate the bile lithogenicity by using Carey's critical tables. Real-time polymerase chain reaction (RT-PCR) was used to detect the mRNA expression levels of farnesoid X receptor (FXR), liver X receptor (LXR), adenosine triphosphate-binding cassette subfamily G member 5/8 (ABCG5/8), cholesterol 7-α hydroxylase (CYP7A1), oxysterol 7-α hydroxylase (CYP7B1), sterol 27-α hydroxylase (CYP27A1), peroxisome proliferator-activated receptor alpha (PPAR-α) and adenosine triphosphate-binding cassette subfamily B member 11 (ABCB11). RESULTS The rate of gallstone formation was 100% in the 4-week group but only 30% in the UDCA-treated group. The UDCA-treated group had a significantly lower CSI compared with other groups. Of special note, the data on the effects of UDCA showed higher expression levels of ABCG8, ABCB11 and CYP27A1, as well as lower expression levels of LXR and PPAR-α, compared to the model control group. CONCLUSIONS UDCA exhibits tremendously potent activity in restraining lipid accumulation, thus reversing the lithogenic effect and protecting hepatocytes from serious pathological damage. The abnormal expression of ABCG8, CYP7A1, CYP27A1, LXR and PPAR-α might lead to high lithogenicity of bile. These results are helpful in exploring new lipid metabolism pathways and potential targets for the treatment of cholesterol stones and for providing some basis for the study of the pathogenesis and genetic characteristics of cholelithiasis. Research on the mechanism of UDCA in improving lipid metabolism and bile lithogenicity may be helpful for clinical treatment and for reducing the incidence of gallstones.
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Affiliation(s)
- Ning Fan
- Beichen Chinese Medicine Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, 436 Jingjin Road, Beichen District, Tianjin, 300400, China
| | - Ke Meng
- Department of Obstetrics and Gynecology, General Hospital of Tianjin Medical University, 154 AnShan Road, HePing District, Tianjin, 300052, China
| | - Yuqing Zhang
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, 122 Sanwei Road Nankai District, Tianjin, 300100, China
| | - Yong Hu
- Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Donghua Li
- Institute of Acute Abdomen in Integrative Medicine, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, 122 Sanwei Road Nankai District, Tianjin, 300100, China
| | - Qiaoying Gao
- Institute of Acute Abdomen in Integrative Medicine, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, 122 Sanwei Road Nankai District, Tianjin, 300100, China
| | - Jianhua Wang
- Beichen Chinese Medicine Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, 436 Jingjin Road, Beichen District, Tianjin, 300400, China
| | - Yanning Li
- Beichen Chinese Medicine Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, 436 Jingjin Road, Beichen District, Tianjin, 300400, China
| | - Shangwei Wu
- Institute of Acute Abdomen in Integrative Medicine, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, 122 Sanwei Road Nankai District, Tianjin, 300100, China
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, 122 Sanwei Road Nankai District, Tianjin, 300100, China.
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Safety of Percutaneous Cholecystostomy Early Removal: A Retrospective Cohort Study. Surg Laparosc Endosc Percutan Tech 2020; 30:410-415. [PMID: 32398449 DOI: 10.1097/sle.0000000000000799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION There are no strong recommendations regarding the management of percutaneous cholecystostomy (PC). The aim of this study was to assess the safety of early PC removal in terms of complications and recurrent disease. MATERIALS AND METHODS Retrospective observational study of consecutive patients who underwent PC for acute cholecystitis from January 2012 to December 2017. We first evaluated PC-related complications and recurrent disease in patients whose drainage was removed as inpatients (IPR) or as outpatients (OPR). Patients were then divided into 2 groups according to the timing of PC removal: G1 with the PC removed within the first 7 days after its collocation and G2 with the PC removed after 7 days. RESULTS We included 151 patients. Patients in the OPR group had their catheters removed after 52 days (26 to 67 d) while the IPR group after 8 days (6 to 11 d); P<0.001. No difference was seen regarding complications, recurrent disease rate, or readmissions.G1 was comprised of 56 patients (37.1%), whereas G2 had 95 (62.9%). When G1 was compared with G2, no differences were seen in terms of complications. However, G1 presented a shorter duration of antibiotic treatment with 11 days (8 to 14 d) versus 15 days (12 to 23 d) in G2; P<0.001, but had a higher rate of recurrent disease 32.1% versus 14.7% in G2; P=0.014 and a higher rate of readmission 30.3% versus 13.6% in G2; P=0.019. CONCLUSIONS Removal of the PC during the index admission was not associated with a higher risk of complications. However, the PC removal before 7 days could be related to an increase in recurrent disease and readmissions.
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Aranda-Narváez JM, Tallón-Aguilar L, Pareja-Ciuró F, Martín-Martín G, González-Sánchez AJ, Rey-Simó I, Tamayo-Medel G, Yánez-Benítez C, Costa-Navarro D, Montón-Condón S, Navarro-Soto S, Turégano-Fuentes F, Pérez-Díaz MD, Ceballos-Esparragón J, Jover-Navalón JM, Balibrea JM, Morales-Conde S. [Emergency Surgery and Trauma Care During COVID-19 Pandemic. Recommendations of the Spanish Association of Surgeons]. Cir Esp 2020; 98:433-441. [PMID: 32439139 PMCID: PMC7188641 DOI: 10.1016/j.ciresp.2020.04.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 01/08/2023]
Abstract
La infección por el nuevo coronavirus SARS-CoV-2 (enfermedad por coronavirus 2019 [COVID-19]) ha determinado la necesidad de la reorganización de muchos centros hospitalarios en el mundo. España, como uno de los epicentros de la enfermedad, ha debido asumir cambios en la práctica totalidad de su territorio. Sin embargo, y desde el inicio de la pandemia, en todos los centros que atienden urgencias quirúrgicas ha sido necesario el mantenimiento de su cobertura, aunque igualmente ha sido inevitable introducir directrices especiales de ajuste al nuevo escenario que permitan el mantenimiento de la excelencia en la calidad asistencial. Este documento desarrolla una serie de indicaciones generales para la cirugía de urgencias y la atención al politraumatizado desarrolladas desde la literatura disponible y consensuadas por un subgrupo de profesionales desde el grupo general Cirugía-AEC-COVID-19. Estas medidas van encaminadas a contemplar un riguroso control de la exposición en pacientes y profesionales, a tener en cuenta las implicaciones de la pandemia sobre diferentes escenarios perioperatorios relacionados con la urgencia y a una adaptación ajustada a la situación del centro en relación con la atención a pacientes infectados.
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Affiliation(s)
| | - Luis Tallón-Aguilar
- Servicio de Cirugía, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Felipe Pareja-Ciuró
- Servicio de Cirugía, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | | | - Ignacio Rey-Simó
- Servicio de Cirugía, Complejo Hospitalario Universitario, A Coruña, España
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Pisano M, Ceresoli M, Cimbanassi S, Gurusamy K, Coccolini F, Borzellino G, Costa G, Allievi N, Amato B, Boerma D, Calcagno P, Campanati L, Campanile FC, Casati A, Chiara O, Crucitti A, di Saverio S, Filauro M, Gabrielli F, Guttadauro A, Kluger Y, Magnone S, Merli C, Poiasina E, Puzziello A, Sartelli M, Catena F, Ansaloni L. 2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population. World J Emerg Surg 2019; 14:10. [PMID: 30867674 PMCID: PMC6399945 DOI: 10.1186/s13017-019-0224-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/28/2019] [Indexed: 12/18/2022] Open
Abstract
Background Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide. Aim The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population. Material and methods The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences. Results The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain. Discussion and conclusions The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.
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Affiliation(s)
- Michele Pisano
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Marco Ceresoli
- 2General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | | | - Kurinchi Gurusamy
- 4Division of Surgery and Interventional Science, University College London, London, UK
| | - Federico Coccolini
- 5General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Gianluca Costa
- 7Surgical and Medical Department of Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Niccolò Allievi
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Bruno Amato
- 8Department of Clinical Medicine and Surgery, University of Naples Federico II, Medical School, Naples, Italy
| | - Djamila Boerma
- 9Department of Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Pietro Calcagno
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Luca Campanati
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | | | | | - Osvaldo Chiara
- 3Milano Trauma Network, ASST Niguarda Hospital, Milan, Italy
| | - Antonio Crucitti
- 12General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Sacro Cuore Catholic University, Rome, Italy
| | - Salomone di Saverio
- 13Cambridge Colorectal Unit, Box 201,Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Marco Filauro
- 14E.O.Ospedale Galliera di Genova, SC Chirurgia generale ed epatobiliopancreatica, Genova, Italy
| | - Francesco Gabrielli
- 2General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Angelo Guttadauro
- 2General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Yoram Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Stefano Magnone
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Cecilia Merli
- 16Unit of Emergency Medicine Bufalini Hospital, Cesena, Italy
| | - Elia Poiasina
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Alessandro Puzziello
- 17General and Day Surgery Unit, San Giovanni di Dio Hospital, University of Salerno, Fisciano, Italy
| | | | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Luca Ansaloni
- 6Department of Surgery, University Hospital of Verona, Verona, Italy
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Mora-Guzmán I, Di Martino M, Bonito AC, Jodra VV, Hernández SG, Martin-Perez E. Conservative Management of Gallstone Disease in the Elderly Population: Outcomes and Recurrence. Scand J Surg 2019; 109:205-210. [PMID: 30791835 DOI: 10.1177/1457496919832147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The prevalence of gallstone disease increases with age, being early cholecystectomy the most accepted treatment in the vast majority of patients in order to prevent complications and recurrence. The aim of this study is to determine the recurrence rate and its possible predictors after initial non-operative management. MATERIALS AND METHODS We reviewed a consecutive series of patients, older than 65 years, admitted for a gallstone-related disease and treated with a non-operative management between January 2010 and December 2013. We analyzed comorbidities, clinical data, diagnosis, management, recurrence, and its treatment. Median follow-up after the discharge was 2 years. Recurrence was analyzed by a Kaplan-Meier survival curve. Possible recurrence's predictors were analyzed. RESULTS The study included 226 patients. Mean age was 80.4 ± 7.2 years, 127 (56%) were female. The main causes of index hospitalization were acute cholecystitis (58%) and biliary pancreatitis (18.1%). After 2 years of follow-up, the recurrence rate was 39.8%; mean time to recurrence was 255.2 ± 42.1 days, 81% of patients recurred within 1 year. Bile duct disease implied a higher recurrence rate than the gallbladder disease group (52% vs 33%, p < 0.001). Subjects with two or more diagnoses during index admission presented higher recurrence rate (32% vs 49%, p < 0.001). CONCLUSION More than a third of elderly patients could present a recurrence within 2 years after initial non-operative management. Early cholecystectomy should be considered at index admission in order to prevent recurrence.
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Affiliation(s)
- I Mora-Guzmán
- Department of General and Digestive Surgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - M Di Martino
- Department of General and Digestive Surgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - A C Bonito
- Department of General and Digestive Surgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - V V Jodra
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - S G Hernández
- Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Martin-Perez
- Department of General and Digestive Surgery, Hospital Universitario de la Princesa, Madrid, Spain
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Anand A, Pilala P, Balachandra S, Sawant P, Prasad R, Rao BC. Managing a case of acute calculous cholecystitis at home: Highlighting the role of family physicians in providing home-based care. J Family Med Prim Care 2019; 8:2548-2550. [PMID: 31463295 PMCID: PMC6691430 DOI: 10.4103/jfmpc.jfmpc_259_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Laparoscopic cholecystectomy is the generally recommended management of acute calculous cholecystitis. It is important for family physicians to be taken into consideration that for some patients the surgical risk–benefit profile favors conservative management. Here, we highlight the possibility of safe, home-based, conservative management of acute calculous cholecystitis in a patient-centered and evidence-based manner by a team of family physicians with backup support of their specialist referral network. We use this case to highlight the value of family physicians providing home-based care.
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