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Gazzetta J, Orjionwe R, Fesmire A, Craft S, Esry L, Gazzetta E, Benedict LA, Nix S. Barriers to elective cholecystectomy following emergency department discharge for symptomatic cholelithiasis. Am J Surg 2024; 238:115837. [PMID: 39067082 DOI: 10.1016/j.amjsurg.2024.115837] [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: 04/03/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Patients with symptomatic cholelithiasis are often discharged from the Emergency Department (ED) and asked to follow-up for elective cholecystectomy. We aimed to identify the social determinants of health (SDOH) that serve as barriers to elective cholecystectomy and to assess the associated impact on patient outcomes. METHODS We conducted a multi-institutional, retrospective cohort study of patients discharged from the ED with symptomatic cholelithiasis. Univariable logistic regression was used to assess for variables associated with re-presenting to the ED rather than for elective cholecystectomy. P values < 0.05 identified significance. RESULTS Univariate analysis identified lack of a primary care physician, Black race, self-pay, language other than English as the primary language, and unemployed status to be independently associated with re-presentation to the ED for biliary disease. CONCLUSIONS Socially disadvantaged populations would benefit from surgery at the time of presentation to the ED versus being sent home for elective follow-up.
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Affiliation(s)
- Joshua Gazzetta
- Saint Luke's Hospital of Kansas City, University of Missouri Kansas City School of Medicine, 4320 Wornall Road, Suite 530, Kansas City, MO, 64113, United States.
| | - Rita Orjionwe
- Saint Luke's Hospital of Kansas City, University of Missouri Kansas City School of Medicine, 4320 Wornall Road, Suite 530, Kansas City, MO, 64113, United States.
| | - Alyssa Fesmire
- Saint Luke's Hospital of Kansas City, University of Missouri Kansas City School of Medicine, 4320 Wornall Road, Suite 530, Kansas City, MO, 64113, United States.
| | - Shaniece Craft
- Saint Luke's Hospital of Kansas City, University of Missouri Kansas City School of Medicine, 4320 Wornall Road, Suite 530, Kansas City, MO, 64113, United States.
| | - Laura Esry
- Saint Luke's Hospital of Kansas City, University of Missouri Kansas City School of Medicine, 4320 Wornall Road, Suite 530, Kansas City, MO, 64113, United States.
| | - Erika Gazzetta
- Saint Luke's Hospital of Kansas City, University of Missouri Kansas City School of Medicine, 4320 Wornall Road, Suite 530, Kansas City, MO, 64113, United States.
| | - Leo Andrew Benedict
- Saint Luke's Hospital of Kansas City, University of Missouri Kansas City School of Medicine, 4320 Wornall Road, Suite 530, Kansas City, MO, 64113, United States.
| | - Sean Nix
- Saint Luke's Hospital of Kansas City, University of Missouri Kansas City School of Medicine, 4320 Wornall Road, Suite 530, Kansas City, MO, 64113, United States.
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Mahmoudzadeh F, Akhgar A, Mirfazaelian H. External validation of the bedside score for the diagnosis of acute cholecystitis. Heliyon 2024; 10:e25183. [PMID: 38322927 PMCID: PMC10844041 DOI: 10.1016/j.heliyon.2024.e25183] [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: 02/20/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
Objective: Acute cholecystitis usually presents with right upper quadrant (RUQ) abdominal pain. However, there are other conditions with similar findings which make the diagnosis difficult. The objective of this study is to prospectively validate the performance of the bedside score for the diagnosis of cholecystitis in patients presenting to the emergency department (ED) with possible acute cholecystitis. Study design We performed a prospective observational study of a convenience sample of patients with RUQ pain admitted to the ED of three academic hospitals. Symptoms (post prandial symptoms), physical signs (RUQ tenderness, murphy's sign) and ultrasound findings (Murphy's sign, gallstone, and gallbladder thickening) were scoring system items. The final diagnosis of cholecystitis was confirmed with a surgical pathology and/or discharge diagnosis of the patient in a 30-day follow-up. The treating physicians' clinical gestalt of acute cholecystitis was also assessed by 5-point Likert scale. Results One hundred thirty patients were followed up and were included in the analysis. 42 patients (32 %) had cholecystitis. The bedside clinical score of less than 4 had a sensitivity of 100 % (CI95 %: 91.60 %-100 %), negative predictive value (NPV) of 100 % (CI 95 %: 41.35 %-63 %), and negative likelihood ratio (-LR) of 0. Score of 6 and above had a specificity of 90.91 % (CI 95 %: 82.87 %-95.99 %), positive predictive value (PPV) of 83.67 % (CI 95 %: 72.55 %-90.86 %), and positive likelihood ratio (+LR) of 10.74 (CI95 %: 5.54-20.83). Physicians' clinical gestalt at the scale of 4 and 5 showed a specificity of 95.45 % (CI 95 %: 88.77 %-98.75 %), PPV of 90.91 % (CI 95 %: 79.29 %-96.31 %), and +LR of 20.95 (CI95 %: 8.02-54.71). At the same time at the scale of 1 and 2, the sensitivity was 95.24 % (CI 95 %: 83.84 %-99.42 %), NPV was 97.22 % (CI 95 %: 90.01 %-99.27 %), and the -LR was 0.06 (CI 95 %: 0.02-0.423). The area under the curve of bedside clinical score was not significantly higher than clinical gestalt (97.58 (CI 95 %: 95.31-99.85) vs. 95.37 (CI 95: 99.24-100))(p-value = 0.35). Conclusion This study showed while the bedside score would be helpful to rule out and rule in acute cholecystitis, physicians' gestalt had similar diagnostic performance.
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Affiliation(s)
- Fatemeh Mahmoudzadeh
- Emergency Medicine Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atousa Akhgar
- Emergency Medicine Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Mirfazaelian
- Emergency Medicine Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Binda C, Anderloni A, Forti E, Fusaroli P, Macchiarelli R, Manno M, Fugazza A, Redaelli A, Aragona G, Lovera M, Togliani T, Armellini E, Amato A, Brancaccio ML, Badas R, Leone N, de Nucci G, Mangiavillano B, Sbrancia M, Pollino V, Lisotti A, Maida M, Sinagra E, Ventimiglia M, Repici A, Fabbri C, Tarantino I. EUS-Guided Gallbladder Drainage Using a Lumen-Apposing Metal Stent for Acute Cholecystitis: Results of a Nationwide Study with Long-Term Follow-Up. Diagnostics (Basel) 2024; 14:413. [PMID: 38396453 PMCID: PMC10887962 DOI: 10.3390/diagnostics14040413] [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: 12/04/2023] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Although endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) has become one of the treatments of choice for acute cholecystitis (AC) in fragile patients, scant data are available on real-life settings and long-term outcomes. METHODS We performed a multicenter retrospective study including EUS-guided GBD using LAMS for AC in 19 Italian centers from June 2014 to July 2020. The primary outcomes were technical and clinical success, and the secondary outcomes were the rate of adverse events (AE) and long-term follow-up. RESULTS In total, 116 patients (48.3% female) were included, with a mean age of 82.7 ± 11 years. LAMS were placed, transgastric in 44.8% of cases, transduodenal in 53.3% and transjejunal in 1.7%, in patients with altered anatomy. Technical success was achieved in 94% and clinical success in 87.1% of cases. The mean follow-up was 309 days. AEs occurred in 12/116 pts (10.3%); 8/12 were intraprocedural, while 1 was classified as early (<15 days) and 3 as delayed (>15 days). According to the ASGE lexicon, two (16.7%) were mild, three (25%) were moderate, and seven (58.3%) were severe. No fatal AEs occurred. In subgroup analysis of 40 patients with a follow-up longer than one year, no recurrence of AC was observed. CONCLUSIONS EUS-GBD had high technical and clinical success rates, despite the non-negligible rate of AEs, thus representing an effective treatment option for fragile patients.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì-Cesena, Italy; (M.S.); (C.F.)
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S., Policlinico San Matteo Viale, 27100 Pavia, Italy;
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, Ospedale Ca’ Granda Niguarda, 20162 Milan, Italy;
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Imola, Italy; (P.F.); (A.L.)
| | - Raffaele Macchiarelli
- Gastroenterology Unit, A.O.U.S. Policlinico S. Maria alle Scotte, 53100 Siena, Italy;
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41121 Modena, Italy;
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS—Humanitas Research Hospital, 20089 Milan, Italy; (A.F.); (A.R.)
| | | | - Giovanni Aragona
- Gastroenterology and Hepatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy;
| | - Mauro Lovera
- Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25133 Brescia, Italy;
| | - Thomas Togliani
- Gastroenterology Unit, University Hospital Borgo Trento, 37126 Verona, Italy;
| | - Elia Armellini
- Digestive Endoscopy Unit, ASST Bergamo Est, 24060 Seriate, Italy;
| | - Arnaldo Amato
- Department of Gastroenterology, Valduce Hospital, 22100 Como, Italy;
| | | | - Roberta Badas
- Digestive Endoscopy Unit, University Hospital, 09123 Cagliari, Italy;
| | - Nicola Leone
- Digestive Endoscopy Unit, Humanitas Gradenigo, 10153 Turin, Italy;
| | - Germana de Nucci
- Gastroenterology and Endoscopy Unit, ASST Rhodense, 20024 Garbagnate Milanese, Italy;
| | | | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì-Cesena, Italy; (M.S.); (C.F.)
| | - Valeria Pollino
- Digestive Endoscopy Unit, S. Michele Hospital, 09126 Cagliari, Italy;
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Imola, Italy; (P.F.); (A.L.)
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy;
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Enna ‘Kore’, 94100 Enna, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietrapollastra Pisciotto, 90015 Cefalù, Italy;
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service, Italian Ministry of Health, 00153 Rome, Italy;
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS—Humanitas Research Hospital, 20089 Milan, Italy; (A.F.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì-Cesena, Italy; (M.S.); (C.F.)
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, 90100 Palermo, Italy;
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Mahdi RA, Naseeb AT, Almoataz MW, Hubail DR, Alsaffar YS. Biliary Disease in a Tertiary Care Hospital: A Review of Clinical and Radiological Burden. Cureus 2024; 16:e52927. [PMID: 38406075 PMCID: PMC10893906 DOI: 10.7759/cureus.52927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Gallbladder disease accounts for a significant percentage of surgical admissions per year. A review of these cases was done to assess their hospital impact with an evaluation of the efficacy of radiological modalities in terms of evaluation, ideal use, and clinical application. Therefore, this study aims to review the demographics of the disease, the diagnostic yield of radiological modalities, and the overall outcome in regards to the hospital policies and medical services provided in hopes of achieving suitable clinical pathways, increasing the efficiency of gallbladder disease assessment, and limiting unwarranted investigations. Methods This is a single-center, retrospective study that included all the surgical emergency admissions from January 1st to December 31st 2018, in the Salmaniya Medical Complex, Kingdom of Bahrain. A total sample of 163 emergency admissions (cases) was selected from those aged 14 and older with documented biliary stones or biliary-related disease. A review of radiological modalities for diagnosis included plain radiographs (AXR, CXR), US abdomen, CT scans, and MRCP/MRI, which were then correlated with histopathological findings confirming the presence of gallstone disease. In addition to evaluating readmissions and emergency visits in terms of hospital burden. Results One hundred and sixty-three (10.44%) of 1,562 surgical admission cases in 2018 were diagnosed with biliary tree disease (76 males, 87 females). A total of 419 different radiological investigations were requested in 161 of the cases evaluated: 53.7% of plain radiographs (AXR, CXR), 33.2% of US abdomen, 11.9% of CT scan, and 1.2% of MRCP/MRI. Ultrasound showed a sensitivity of 48.72% and a specificity of 100%, while CT scan sensitivity was 57.14% and a specificity of 100% when it came to detecting gallstones and gallbladder-related disease. Plain radiographs add no direct benefit to diagnosing biliary disease. Conclusion Gallbladder disease is very prevalent with a wide array of disease entities, requiring radiological assistance in diagnosis. Ultrasound is the ideal modality for the diagnosis of biliary disease due to its ease of use and availability; it has high sensitivity and specificity, and it can be complemented by other modalities such as CT scans and MRCP/MRI when it comes to assessing for complications. On the other hand, plain radiographs have no significant value in the detection of gallbladder-related disease, and their utilization should be limited to emergency cases with high clinical suspicion.
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Affiliation(s)
- Rawan A Mahdi
- General Practice, Royal College of Surgeons in Ireland-Bahrain, Manama, BHR
| | - Ali T Naseeb
- Internal Medicine, Salmaniya Medical Complex, Manama, BHR
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Wang Y, Liu Y, Lv P, Li H, Gong W. Bile duct injury with formation of right hepatic duct-duodenal fistula after cholecystectomy: A case report. Medicine (Baltimore) 2023; 102:e36565. [PMID: 38065856 PMCID: PMC10713169 DOI: 10.1097/md.0000000000036565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
RATIONALE The management of bile duct injury (BDI) remains a considerable challenge in the department of hepatobiliary and pancreatic surgery. BDI is mainly iatrogenic and mostly occurs in laparoscopic cholecystectomy (LC). After more than 2 decades of development, with the increase in experience and technological advances in LC, the complications associated with the procedure have decreased annually. However, bile duct injuries (BDI) still have a certain incidence, the severity of BDI is higher, and the form of BDI is more complex. PATIENT CONCERNS We report the case of a patient who presented with bile duct injury and formation of a right hepatic duct-duodenal fistula after LC. DIAGNOSES Based on the diagnosis, a dissection was performed to relieve bile duct obstruction, suture the duodenal fistula, and anastomose the right and left hepatic ducts to the jejunum. INTERVENTION Based on the diagnosis, a dissection was performed to relieve bile duct obstruction, suture the duodenal fistula, and anastomose the right and left hepatic ducts to the jejunum. OUTCOMES Postoperative recovery was uneventful, with normal liver function and no complications, such as anastomotic fistula or biliary tract infection. The patient was hospitalized for 11 days postoperatively and discharged. LESSONS The successful diagnosis and treatment of this case and the summarization of the imaging features and diagnosis of postoperative BDI have improved the diagnostic understanding of postoperative BDI and provided clinicians with a particular clinical experience and basis for treating such diseases.
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Affiliation(s)
- Yuxu Wang
- Weifang People’s Hospital, Hepatobiliary and Pancreatic Medicine Center, Weifang, Shandong, China
| | - Yanyan Liu
- Weifang People’s Hospital, Hepatobiliary and Pancreatic Medicine Center, Weifang, Shandong, China
| | - Pan Lv
- Weifang People’s Hospital, Hepatobiliary and Pancreatic Medicine Center, Weifang, Shandong, China
| | - Hao Li
- Weifang People’s Hospital, Hepatobiliary and Pancreatic Medicine Center, Weifang, Shandong, China
| | - Weiqiang Gong
- Weifang People’s Hospital, Hepatobiliary and Pancreatic Medicine Center, Weifang, Shandong, China
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Woong Choi JD, John Fong M, Shanmugalingam A, Aslam A, Aqeel Abbas Kazmi S, Kulkarni R, James Curran R. Safe postoperative outcomes following early cholecystectomy for acute calculus cholecystitis regardless of symptom onset. Turk J Surg 2023; 39:321-327. [PMID: 38694534 PMCID: PMC11057926 DOI: 10.47717/turkjsurg.2023.6165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/06/2023] [Indexed: 05/04/2024]
Abstract
Objectives There is growing evidence for reduced post-operative complications, and lower hospital costs associated with early cholecystectomy for acute calculus cholecystitis (AC) compared to delayed surgery. Limited high-quality evidence exists for how early, if at all, should surgeons be operating emergently for AC based on symptom onset. Material and Methods Seven hundred seventy-four patients who had cholecystectomy performed by a single surgeon between January 2015-October 2022 were retrospectively reviewed. Five hundred fourty-one patients were analysed. Patients were divided into three groups based on symptom onset: Group 1: 0-72 hours (n= 305), Group 2: 72 hrs-1 week (n= 154) and Group 3: >1 week (n= 82). Results Median operative time was most prolonged in Group 2 (96.5 minutes), and had the greatest proportion of reconstituting 95% cholecystectomies (n= 22/154, 14.29%) compared to Group 1 (p> 0.05). The conversion to open was between 0.65-1.64% in all groups. The greatest proportion of bile leak occurred in Group 1 (n= 7/305, 2.3%) followed by Group 3 (n= 1/82, 1.22%) (p> 0.05). All were successfully managed with ERCP and biliary stent. Median hospital stay was significantly prolonged in Group 2 (2.3 days) compared to Group 1 (2 days) (p= 0.03). The proportion of 95% cholecystectomies in Group 2 and 3 were not significant compared to Group 1. Conclusion Early cholecystectomy for calculus cholecystitis, irrespective of the timing of symptoms appears to have safe postoperative outcomes. Surgeons do not necessarily need to limit early cholecystectomy for within 72 hours of symptom onset.
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Affiliation(s)
- Joseph Do Woong Choi
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
- Discipline of Surgery, University of Sydney Faculty of Medicine and Health, New South Wales, Australia
| | - Matthew John Fong
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Aswin Shanmugalingam
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Anoosha Aslam
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Syed Aqeel Abbas Kazmi
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Rukmini Kulkarni
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
| | - Richard James Curran
- Department of Surgery, Blacktown and Mount Druitt Hospitals, Sydney, New South Wales, Australia
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Hanna K, Zangbar B, Kirsch J, Bronstein M, Okumura K, Gogna S, Shnaydman I, Prabhakaran K, Con J. Non-operative management of cirrhotic patients with acute calculous cholecystitis: How effective is it? Am J Surg 2023; 226:668-674. [PMID: 37482476 DOI: 10.1016/j.amjsurg.2023.07.019] [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: 03/26/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Nonoperative management (NOM) of acute calculous cholecystitis (ACC) in patients with cirrhosis was proposed. We examined the outcomes of cirrhotic patients with ACC treated with cholecystectomy compared to NOM. METHODS We analyzed the 2017-Nationwide Readmissions Database including cirrhotic patients with ACC. Patients were stratified: cholecystectomy, percutaneous cholecystostomy (PCT), and antibiotics only. PRIMARY OUTCOMES complications, failure of NOM. SECONDARY OUTCOMES mortality, length of stay (LOS), and charges. RESULTS 3454 patients were identified. 1832 underwent cholecystectomy, 360 PCT, and 1262 were treated with antibiotics. PCT patients had higher mortality 16.9% vs. the antibiotics group 10.9% vs. cholecystectomy group 4.2%. PCT patients had longer LOS, but lower charges compared to the operative group. Failure of NOM was 28.2%. On regression, PCT was associated with mortality. CONCLUSION ACC remains a morbid disease in cirrhosis patients. One in three failed NOM, had longer LOS, and higher mortality. Further studies are warranted to identify predictors of NOM failure. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Kamil Hanna
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Bardiya Zangbar
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Jordan Kirsch
- Department of Surgery, Westchester Medical Center, New York, USA.
| | | | - Kenji Okumura
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Shekhar Gogna
- Department of Surgery, Medstar Health, Washington, USA.
| | - Ilya Shnaydman
- Department of Surgery, Westchester Medical Center, New York, USA.
| | | | - Jorge Con
- Department of Surgery, Westchester Medical Center, New York, USA.
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Pavlidis ET, Pavlidis TE. Current management of concomitant cholelithiasis and common bile duct stones. World J Gastrointest Surg 2023; 15:169-176. [PMID: 36896310 PMCID: PMC9988640 DOI: 10.4240/wjgs.v15.i2.169] [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: 11/04/2022] [Revised: 11/27/2022] [Accepted: 01/17/2023] [Indexed: 02/27/2023] Open
Abstract
The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one- or two-stage procedure. It basically includes either laparoscopic cholecystectomy (LC) with laparoscopic common bile duct (CBD) exploration (LCBDE) in the same operation or LC with preoperative, postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy (ERCP-ES) for stone clearance. The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC, preferably on the next day. In cases where preoperative ERCP-ES is not feasible, the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated. The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES. However, there is no consensus on the superiority of laparoendoscopic rendezvous. This is equivalent to a traditional two-stage procedure. Endoscopic papillary large balloon dilation reduces recurrence. LCBDE and intraoperative ERCP have similar good outcomes. The risk of recurrence after ERCP-ES is greater than that after LCBDE. Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones. The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage, but the transcystic approach must be used where possible. LCBDE is a safe and effective choice when performed by an experienced surgeon. However, the requirement of specific equipment and advanced training are drawbacks. The percutaneous approach is an alternative when ERCP fails. Surgical or endoscopic reintervention for retained stones may be needed. For asymptomatic CBD stones, ERCP clearance is the first-choice method. Both one-stage and two-stage management are acceptable and can ensure improved quality of life.
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Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutic Department of Surgery, Hippocration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutic Department of Surgery, Hippocration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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Choi YJ. Updated evidence for optimal anesthesia following laparoscopic cholecystectomies. Korean J Anesthesiol 2023; 76:1-2. [PMID: 36746178 PMCID: PMC9902191 DOI: 10.4097/kja.23018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea,Corresponding author: Yoon Ji Choi, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, KoreaTel: +82-31-412-5289Fax: +82-31-412-5294
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10
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Diagnosis and Treatment of Acute Pancreatitis. Diagnostics (Basel) 2022; 12:diagnostics12081974. [PMID: 36010324 PMCID: PMC9406704 DOI: 10.3390/diagnostics12081974] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
The pancreas is a glandular organ that is responsible for the proper functioning of the digestive and endocrine systems, and therefore, it affects the condition of the entire body. Consequently, it is important to effectively diagnose and treat diseases of this organ. According to clinicians, pancreatitis—a common disease affecting the pancreas—is one of the most complicated and demanding diseases of the abdomen. The classification of pancreatitis is based on clinical, morphologic, and histologic criteria. Medical doctors distinguish, inter alia, acute pancreatitis (AP), the most common causes of which are gallstone migration and alcohol abuse. Effective diagnostic methods and the correct assessment of the severity of acute pancreatitis determine the selection of an appropriate treatment strategy and the prediction of the clinical course of the disease, thus preventing life-threatening complications and organ dysfunction or failure. This review collects and organizes recommendations and guidelines for the management of patients suffering from acute pancreatitis.
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11
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Atif QAA, Khan MA, Nadeem F, Ullah M. Health-Related Quality of Life After Laparoscopic Cholecystectomy. Cureus 2022; 14:e26739. [PMID: 35967144 PMCID: PMC9364761 DOI: 10.7759/cureus.26739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background This study aimed to determine the mean improvement in the quality of life (QoL) after laparoscopic cholecystectomy (LC) in patients with symptomatic cholelithiasis. Methodology After obtaining approval from the hospital’s ethical committee, the Gastrointestinal Quality of Life Index (GIQLI) proforma was filled on admission (T0) and at week six (T1) postoperatively. All data were collected, and GIQLI scores were calculated for individual patients. Results In our study, among the 70 patients undergoing LC, 20% (n = 14) were aged 18-30 years and 80% (n = 56) were aged 31-60 years, with the mean ± standard deviation calculated as 41.56 ± 10.13 years. Overall, 44.29% (n = 31) of patients were men and 55.71% (n = 39) were women. GIQLI scores were 94.64 ± 2.24 for pre-treatment and 106.09 ± 2.40 for post-treatment, with a mean change of 11.44 ± 3.29, and a p-value of 0.001, showing a significant difference. Conclusions The mean improvement in QoL after LC in patients with symptomatic cholelithiasis is significantly higher when compared with pretreatment.
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Aguiar RGPD, Souza Júnior FEAD, Rocha Júnior JLG, Pessoa FSRDP, Silva LPD, Carmo GCD. CLINICAL AND EPIDEMIOLOGICAL EVALUATION OF COMPLICATIONS ASSOCIATED WITH GALLSTONES IN A TERTIARY HOSPITAL. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:352-357. [PMID: 36102431 DOI: 10.1590/s0004-2803.202203000-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Gallstones are the presence of bile clay in the gallbladder or bile ducts. The disease can be asymptomatic or symptomatic and can lead to complications and consequently a worse prognosis, such as acute cholecystitis, choledocholithiasis, cholangitis, and acute pancreatitis. The risk of complications increases after the first episode of biliary colic. OBJECTIVE A clinical-epidemiological evaluation of patients admitted to a gastroenterology ward of a tertiary care hospital with gallstone-related complications. METHODS We evaluated 158 patients admitted through discharge reports and medical records analysis from January 1, 2013, to February 24, 2021. RESULTS The female sex was predominant (76.6%), and the mean age of patients was 51.6 years. Men were significantly older than women (P=0.005). Most (57.6%) had some comorbidity, the most frequent being systemic arterial hypertension, diabetes mellitus, and obesity. The mean hospitalization time was 24 days, significantly longer in men (P=0.046) but without a direct relationship with age (P=0.414). The most frequent complication was choledocholithiasis, and 55.7% of patients without previous cholecystectomy had a report of biliary colic before admission, on average 1.5 years previously. A history of a prior cholecystectomy was present in 17.1% of those evaluated. Abdominal ultrasonography followed by magnetic resonance cholangiography was the most frequently performed exam for diagnostic definition. Regarding therapeutic measures, endoscopic retrograde cholangiopancreatography was necessary for 47.3% of patients without previous cholecystectomy and 81.4% of patients who have already had a cholecystectomy. Among patients not yet cholecystectomized, 84% underwent the procedure before discharge. CONCLUSION The female patients were predominant. Men were significantly older than women and had more extended hospital stays. The most frequent complication was choledocholithiasis, and around half of the patients reported previous biliary colic. endoscopic retrograde cholangiopancreatography has been necessary for the majority of the patients.
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Affiliation(s)
| | | | | | | | | | - Gardênia Costa do Carmo
- Centro Universitário Christus (Unichristus), Fortaleza, CE, Brasil
- Hospital Geral de Fortaleza, Fortaleza, CE, Brasil
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Kaneta A, Sasada H, Matsumoto T, Sakai T, Sato S, Hara T. Efficacy of endoscopic gallbladder drainage in patients with acute cholecystitis. BMC Surg 2022; 22:224. [PMID: 35690750 PMCID: PMC9188174 DOI: 10.1186/s12893-022-01676-y] [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: 12/28/2021] [Accepted: 05/31/2022] [Indexed: 12/07/2022] Open
Abstract
Background Early cholecystectomy is recommended for patients with acute cholecystitis. However, emergency surgery may not be indicated due to complications and disease severity. Patients requiring drainage are usually treated with percutaneous transhepatic gallbladder drainage (PTGBD), whereas patients with biliary duct stones undergo endoscopic stones removal followed by endoscopic gallbladder drainage (EGBD). Herein, we investigated the efficacy of EGBD in patients with acute cholecystitis. Methods Overall, 101 patients receiving laparoscopic cholecystectomy between September 2019 and September 2020 in our department were retrospectively analyzed. Results The patients (n = 101) were divided into three groups: control group that did not undergo drainage (n = 68), a group that underwent EGBD (n = 7), and a group that underwent PTGBD (n = 26). Median surgery time was 107, 166, and 143 min, respectively. Control group had a significantly shorter surgery time, whereas it did not significantly differ between EGBD and PTGBD groups. The median amount of bleeding was 5 g, 7 g, and 7.5 g, respectively, and control group had significantly less bleeding than the drainage group. We further divided patients into the following subgroups: patients requiring a 5 mm clip to ligate the cystic duct, patients requiring a 10 mm clip due to the thickness of the cystic duct, patients requiring an automatic suturing device, and patients undergoing subtotal cholecystectomy due to impossible cystic duct ligation. There was no significant difference between EGBD and PTGBD regarding the clip used or the need for an automatic suturing device and subtotal cholecystectomy. Conclusions There was no significant difference between EGBD and PTGBD groups regarding surgery time or bleeding amount when surgery was performed after gallbladder drainage for acute cholecystitis. Therefore, EGBD was considered a useful preoperative drainage method requiring no drainage bag.
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Affiliation(s)
- Anri Kaneta
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan.
| | - Hirotaka Sasada
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan
| | - Takuma Matsumoto
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan
| | - Tsuyoshi Sakai
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan
| | - Shuichi Sato
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan
| | - Takashi Hara
- Department of Surgery, Kensei Hospital, 2 Ogimachi, Hirosaki, Aomori, 036-8511, Japan
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Ullah K, Dogar AW, Jan Z, Bilal H, Tahir MJ, Hamza A, Asghar MS, Yousuf Z. Role of antibiotic prophylaxis on surgical site infection prevention in a low-risk population undergoing laparoscopic cholecystectomy: A randomized controlled study. Ann Med Surg (Lond) 2022; 78:103804. [PMID: 35734648 PMCID: PMC9207002 DOI: 10.1016/j.amsu.2022.103804] [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] [Received: 04/13/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Study design Setting Methods Results Conclusion One of the postoperative complications following cholecystectomy is surgical site infections (SSIs). This study aimed to determine the effectiveness of preoperative antibiotic prophylaxis in preventing SSIs. We found that prophylactic antibiotics have no impact in preventing SSIs in low-risk individuals undergoing laparoscopic cholecystectomy.
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Affiliation(s)
- Kaleem Ullah
- Pir Abdul Qadir Shah Jillani Institute of Medical Sciences, Gambat, Pakistan
| | - Abdul Wahab Dogar
- Pir Abdul Qadir Shah Jillani Institute of Medical Sciences, Gambat, Pakistan
| | | | - Hafiz Bilal
- Pir Abdul Qadir Shah Jillani Institute of Medical Sciences, Gambat, Pakistan
| | | | - Ameer Hamza
- Pir Abdul Qadir Shah Jillani Institute of Medical Sciences, Gambat, Pakistan
| | - Muhammad Sohaib Asghar
- Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan
- Corresponding author. Department of Internal Medicine, Dow University of Health Sciences, Ojha Campus, B-328 Block 6, Gulshan-e-Iqbal, Karachi, 75300, Pakistan.
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Ullah S, Yang BH, Liu D, Lu XY, Liu ZZ, Zhao LX, Zhang JY, Liu BR. Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable? A propensity matched study. World J Gastrointest Surg 2022; 14:470-481. [PMID: 35734621 PMCID: PMC9160690 DOI: 10.4240/wjgs.v14.i5.470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/18/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones. However, another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.
AIM To compare the feasibility, safety and effectiveness of pure natural orifice transluminal endoscopic surgery (NOTES) gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy (LC) for symptomatic gallstones.
METHODS We adopted propensity score matching (1:1) to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones. We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020; 517 patients met the matching criteria (NOTES, 110; LC, 407), yielding 86 pairs.
RESULTS The technical success rate for the NOTES group was 98.9% vs 100% for the LC group. The median procedure time was 119 min [interquartile ranges (IQRs), 95-175] with NOTES vs 60 min (IQRs, 48-90) with LC (P < 0.001). The frequency of post-operative pain was similar between NOTES and LC: 4.7% (4/85) vs 5.8% (5/95) (P = 0.740). The median duration of post-procedure fasting with NOTES was 1 d (IQRs, 1-2) vs 2 d with LC (IQRs, 1-3) (P < 0.001). The median post-operative hospital stay for NOTES was 4 d (IQRs, 3-6) vs 4 d for LC (IQRs, 3-5), (P = 0.092). During follow-up, diarrhea was significantly less with NOTES (5.8%) compared to LC (18.6%) (P = 0.011). Gallstones and cholecystitis recurrence within a median of 12 mo (range: 6-40 mo) following NOTES was 10.5% and 3.5%, respectively. Concerns regarding the presence of abdominal wall scars were present in 17.4% (n = 15/86) of patients following LC (mainly women).
CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy. This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder. Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.
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Affiliation(s)
- Saif Ullah
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Bao-Hong Yang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Department of Oncology, Weifang People's Hospital, Weifang 261000, Shandong Province, China
| | - Dan Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xue-Yang Lu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Zhen-Zhen Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Li-Xia Zhao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Ji-Yu Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou 450052, Henan Province, China
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Gao Y, Huang J, Zheng Y, Han J. Effect of comfort nursing on postoperative quality of life, negative emotions and nursing satisfaction in patients undergoing laparoscopic surgery. Am J Transl Res 2021; 13:13825-13834. [PMID: 35035722 PMCID: PMC8748076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to explore the impacts of comfort nursing on postoperative quality of life, negative emotions and nursing satisfaction of patients undergoing laparoscopic surgery. METHODS Eighty-four patients who underwent laparoscopic cholecystectomy (LC) in Shengjing Hospital of China Medical University from September 2018 to November 2019 were analyzed retrospectively. Among them, 37 patients with routine nursing were assigned to the control group, while 47 patients receiving comfort nursing were assigned to the research group. The postoperative rehabilitation indexes, complication rate, pain degree at 12 h after surgery, postoperative quality of life, negative emotions and nursing satisfaction were compared between the two groups. RESULTS After nursing, compared with the control group, the research group experienced notably earlier first time of food intake, first defecation time, first time for ambulation, first anal exhaust time, and recovery time of gurgling sound, shorter length of stay, considerably lower incidence of postoperative complications and Visual Analogue Scale score at 12 h after surgery, and evidently higher scores of quality of life and nursing satisfaction. Moreover, Self-rating Depression Scale and Self-rating Anxiety Scale scores of the research group were significantly lower than those of the control group. CONCLUSION For patients undergoing laparoscopic surgery, comfort nursing can relieve their negative emotions, improve their quality of life and nursing satisfaction, reduce postoperative pain, and thus promote postoperative rehabilitation. Hence, it is worthy of clinical promotion.
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Affiliation(s)
- Yuan Gao
- Department of Gastroenterology, Shengjing Hospital of China Medical UniversityShenyang 110004, Liaoning Province, China
| | - Jing Huang
- Department of Operation Room, Cancer Hospital of China Medical UniversityShenyang 110042, Liaoning Province, China
| | - Yan Zheng
- Department of Operation Room, Cancer Hospital of China Medical UniversityShenyang 110042, Liaoning Province, China
| | - Jiacen Han
- Department of Operation Room, Cancer Hospital of China Medical UniversityShenyang 110042, Liaoning Province, China
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Cianci P, Restini E. Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches. World J Gastroenterol 2021; 27:4536-4554. [PMID: 34366622 PMCID: PMC8326257 DOI: 10.3748/wjg.v27.i28.4536] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/02/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
Gallstone disease and complications from gallstones are a common clinical problem. The clinical presentation ranges between being asymptomatic and recurrent attacks of biliary pain requiring elective or emergency treatment. Bile duct stones are a frequent condition associated with cholelithiasis. Amidst the total cholecystectomies performed every year for cholelithiasis, the presence of bile duct stones is 5%-15%; another small percentage of these will develop common bile duct stones after intervention. To avoid serious complications that can occur in choledocholithiasis, these stones should be removed. Unfortunately, there is no consensus on the ideal management strategy to perform such. For a long time, a direct open surgical approach to the bile duct was the only unique approach. With the advent of advanced endoscopic, radiologic, and minimally invasive surgical techniques, however, therapeutic choices have increased in number, and the management of this pathological situation has become multidisciplinary. To date, there is agreement on preoperative management and the need to treat cholelithiasis with choledocholithiasis, but a debate still exists on how to cure the two diseases at the same time. In the era of laparoscopy and mini-invasiveness, we can say that therapeutic approaches can be performed in two sessions or in one session. Comparison of these two approaches showed equivalent success rates, postoperative morbidity, stone clearance, mortality, conversion to other procedures, total surgery time, and failure rate, but the one-session treatment is characterized by a shorter hospital stay, and more cost benefits. The aim of this review article is to provide the reader with a general summary of gallbladder stone disease in association with the presence of common bile duct stones by discussing their epidemiology, clinical and diagnostic aspects, and possible treatments and their advantages and limitations.
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Affiliation(s)
- Pasquale Cianci
- Department of Surgery and Traumatology, Hospital Lorenzo Bonomo, Andria 76123, Italy
| | - Enrico Restini
- Department of Surgery and Traumatology, Hospital Lorenzo Bonomo, Andria 76123, Italy
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Asmar S, Bible L, Obaid O, Anand T, Chehab M, Ditillo M, Castanon L, Nelson A, Joseph B. Frail geriatric patients with acute calculous cholecystitis: Operative versus nonoperative management? J Trauma Acute Care Surg 2021; 91:219-225. [PMID: 33605704 DOI: 10.1097/ta.0000000000003115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Nonoperative management of acute calculous cholecystitis (ACC) in the frail geriatric population is underexplored. The aim of our study was to examine long-term outcomes of frail geriatric patients with ACC treated with cholecystectomy compared with initial nonoperative management. METHODS We conducted a 2017 analysis of the Nationwide Readmissions Database and included frail geriatric (≥65 years) patients with ACC. Frailty was assessed using the five-factor modified frailty index. Patients were stratified into those undergoing cholecystectomy at index admission (operative management [OP]) versus those managed with nonoperative intervention (nonoperative management [NOP]). The NOP group was further subdivided into those who received antibiotics only and those who received percutaneous drainage. Primary outcomes were procedure-related complications in the OP group and 6-month failure of NOP (readmission with cholecystitis). Secondary outcomes were mortality and overall hospital length of stay. RESULTS A total of 53,412 geriatric patients with ACC were identified, 51.0% of whom were frail: 16,791 (61.6%) in OP group and 10,472 (38.4%) in NOP group (3,256 had percutaneous drainage, 7,216 received antibiotics only). Patients were comparable in age (76 ± 7 vs. 77 ± 8 years; p = 0.082) and modified frailty index (0.47 vs. 0.48; p = 0.132). Procedure-related complications in the OP group were 9.3%, and 6-month failure of NOP was 18.9%. Median time to failure of NOP management was 36 days (range, 12-78 days). Mortality was higher in the frail NOP group (5.2 vs. 3.2%; p < 0.001). The NOP group had more days of hospitalization (8 [4-15] vs. 5 [3-10]; p < 0.001). Both receiving antibiotics only (odds ratio, 1.6 [1.3-2.0]; p < 0.001) and receiving percutaneous drainage (odds ratio, 1.9 [1.7-2.2]; p < 0.001) were independently associated with increased mortality. CONCLUSION One in five patients failed NOP and subsequently had complicated hospital stays. Nonoperative management of frail elderly ACC patients may be associated with significant morbidity and mortality. LEVEL OF EVIDENCE Therapeutic, level IV.
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Affiliation(s)
- Samer Asmar
- From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
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Laparoscopic surgery and robotic surgery for single-incision cholecystectomy: an updated systematic review. Updates Surg 2021; 73:2039-2046. [PMID: 33886106 DOI: 10.1007/s13304-021-01056-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/13/2021] [Indexed: 12/15/2022]
Abstract
The role of single-incision laparoscopic cholecystectomy (SILC) and single-incision robotic cholecystectomy (SIRC) is still unclear. We update the summarization of the feasibility and safety of SILC and SIRC. A comprehensive search of SILC and SIRC of English literature published on PubMed database between January 2015 and November 2020 was performed. A total of 70 articles were included: 41 covering SILC alone, 21 showing SIRC alone, 7 reporting both, and 1 study not specified. In total, 7828 cases were recorded (SILC/SIRC/not specified, 6234/1544/50); and the gender of 7423 cases was definitively reported: the female rate was 64.0% (SILC/SIRC/not specified, 62.1%/71.5%/74.0%). The weighted mean for body mass index (BMI), operative time, blood loss and post-operative hospital stay was 25.5 kg/m2 (SILC/SIRC, 25.0/27.0 kg/m2), 73.8 min (SILC/SIRC, 68.2/88.8 min), 12.6 mL (SILC/SIRC, 12.1/14.8 mL) and 2.5 days (SILC/SIRC, 2.8/1.9 days), respectively. The pooled prevalence of an additional port, conversion to open surgery, post-operative complications, intraoperative biliary injury, and incisional hernia was 4.1% (SILC/SIRC, 4.7%/1.9%), 0.9% (SILC/SIRC, 0.7%/1.5%), 5.9% (SILC/SIRC, 6.2%/4.1%), 0.1% (SILC/SIRC, 0.2%/0.09%), and 2.1% (SILC/SIRC, 1.4%/4.8%), respectively. Compared with conventional laparoscopic cholecystectomy, SIRC has experienced more postoperative incisional hernias (risk difference = 0.05, 95% confidence interval 0.02-0.07; P < 0.0001). By far, SILC and SIRC have not been considered a standard procedure. With the innovation of medical devices and gradual accumulation of surgical experience, feasibility and safety of performing SILC and SIRC will improve.
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Gunther KH, Smith J, Boura J, Sherman A, Siegel D. The Use of Bedside Ultrasound for Gallstone Disease Care within a Community-based Emergency Department: A Confirmation Bias. Spartan Med Res J 2021; 6:18182. [PMID: 33869999 PMCID: PMC8043902 DOI: 10.51894/001c.18182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Traditional evaluation for suspicion of gallstone or gallbladder-related disease includes evaluation with a formal technician-performed ultrasound. However, the use of point-of-care bedside ultrasounds (Bedside US) has been shown to be a viable alternative for the diagnosis of gallstones and gallbladder-related diseases. Purpose Statement: The purpose of this study was to evaluate the impact of Bedside US use in gallbladder evaluation on key patient care outcomes within our community-based emergency department setting. METHODS This retrospective study compared the use of no ultrasound (No US), a formal technician performed ultrasound (Tech US) and Bedside US for gallstone and gallbladder related diseases within a community hospital emergency department between January 1, 2015 and January 1, 2018. Initial vitals, lab work, patient socio-demographics, medical history, emergency department length of stay in hours and disposition were reviewed. RESULTS Of a total N = 449 patients included, patients who received a Bedside US had the fewest computerized tomography scans (No US 62% vs. Tech US 29% vs. Bedside US 16%; p < 0.0001), the shortest median emergency department length of stay (No US 4.5 days vs. Tech US 5.0 days vs. Bedside US 3.0 days; p < 0.0001), and were more likely to be discharged home (No US 41% vs. Tech US 55% vs. Bedside US 81%; p = 0.0006) compared to those that received no ultrasound or a formal ultrasound. Patients who received a Bedside US also had the statistically significant highest incidence of prior cholelithiasis (No US 29.4% vs Tech US 14.3% vs. Bedside US 31.3%; p = 0.001) and lowest total median bilirubin levels (No US 0.5 vs. Tech US 0.5 vs. Bedside US 0.3; p = 0.016) when compared to the other two groups. CONCLUSIONS Although there was a confirmation bias, these study results indicate that point-of-care bedside ultrasound could be a viable alternative for gallstones and gallbladder-related diseases with benefits of use in a community hospital setting.
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Akingboye A, Mahmood F, Ahmed M, Rajdev K, Zaman O, Mann H, Sellahewa SC. Outcomes From Routine Use of Intraoperative Cholangiogram in Laparoscopic Cholecystectomy: Factors Predicting Benefit From Selective Cholangiography. Cureus 2021; 13:e12555. [PMID: 33575136 PMCID: PMC7867225 DOI: 10.7759/cureus.12555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and objective Laparoscopic cholecystectomy is used for the treatment of symptomatic gallstones. Intraoperative cholangiogram (IOC) is used to diagnose common bile duct (CBD) stones. There is controversy surrounding routine vs selective use of IOC based on clinical, biochemical and ultrasound criteria. The aim of this study was to evaluate the outcomes from routine IOC and its utility in laparoscopic cholecystectomy. Materials and methods This was a UK-based single-centre retrospective study evaluating the outcomes from IOC for all laparoscopic cholecystectomies performed between May 2014 and February 2020. All adult patients undergoing elective, semi-elective or emergency operations were included. Demographics, biochemistry as well as radiological and endoscopic investigations were analysed. IOC was performed using a standardised technique and was interpreted by a single surgeon. Results A total of 744 out of 804 patients underwent IOC. The median age of the cohort was 51 years (SD: ±17.5); there were 468 females (62.9%) and 276 males (37.1%). Filling defects were identified in 43/744 (5.8%) patients, with 23/43 having stone extraction via endoscopic retrograde cholangiopancreatography (ERCP). Logistic regression analysis identified alkaline phosphatase (ALP) as a predictor of filling defects in IOC (OR: 1.003; 95% CI: 1.001-1.005, p=0.015). Conclusion Based on our findings, the routine use of IOC during laparoscopic cholecystectomy is safe and effective. Preoperative clinical, radiological and biochemical parameters apart from ALP have a limited role in predicting the diagnostic yield of IOC.
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Affiliation(s)
| | - Fahad Mahmood
- General and Colorectal Surgery, Russells Hall Hospital, Dudley, GBR
| | - Marriam Ahmed
- General and Colorectal Surgery, Russells Hall Hospital, Dudley, GBR
| | - Kishan Rajdev
- General and Colorectal Surgery, Russells Hall Hospital, Dudley, GBR
| | - Osama Zaman
- General and Colorectal Surgery, Russells Hall Hospital, Dudley, GBR
| | - Harvinder Mann
- General and Colorectal Surgery, Russells Hall Hospital, Dudley, GBR
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Graglia S, Shokoohi H, Loesche MA, Yeh DD, Haney RM, Huang CK, Morone CC, Springer C, Kimberly HH, Liteplo AS. Prospective validation of the bedside sonographic acute cholecystitis score in emergency department patients. Am J Emerg Med 2021; 42:15-19. [PMID: 33429186 DOI: 10.1016/j.ajem.2020.12.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Acute cholecystitis can be difficult to diagnose in the emergency department (ED); no single finding can rule in or rule out the disease. A prediction score for the diagnosis of acute cholecystitis for use at the bedside would be of great value to expedite the management of patients presenting with possible acute cholecystitis. The 2013 Tokyo Guidelines is a validated method for the diagnosis of acute cholecystitis but its prognostic capability is limited. The purpose of this study was to prospectively validate the Bedside Sonographic Acute Cholecystitis (SAC) Score utilizing a combination of only historical symptoms, physical exam signs, and point-of-care ultrasound (POCUS) findings for the prediction of the diagnosis of acute cholecystitis in ED patients. METHOD This was a prospective observational validation study of the Bedside SAC Score. The study was conducted at two tertiary referral academic centers in Boston, Massachusetts. From April 2016 to March 2019, adult patients (≥18 years old) with suspected acute cholecystitis were enrolled via convenience sampling and underwent a physical exam and a focused biliary POCUS in the ED. Three symptoms and signs (post-prandial symptoms, RUQ tenderness, and Murphy's sign) and two sonographic findings (gallbladder wall thickening and the presence of gallstones) were combined to calculate the Bedside Sonographic Acute Cholecystitis (SAC) Score. The final diagnosis of acute cholecystitis was determined from chart review or patient follow-up up to 30 days after the initial assessment. In patients who underwent operative intervention, surgical pathology was used to confirm the diagnosis of acute cholecystitis. Sensitivity, specificity, PPV and NPV of the Bedside SAC Score were calculated for various cut off points. RESULTS 153 patients were included in the analysis. Using a previously defined cutoff of ≥ 4, the Bedside SAC Score had a sensitivity of 88.9% (95% CI 73.9%-96.9%), and a specificity of 67.5% (95% CI 58.2%-75.9%). A Bedside SAC Score of < 2 had a sensitivity of 100% (95% CI 90.3%-100%) and specificity of 35% (95% CI 26.5%-44.4%). A Bedside SAC Score of ≥ 7 had a sensitivity of 44.4% (95% CI 27.9%-61.9%) and specificity of 95.7% (95% CI 90.3%-98.6%). CONCLUSION A bedside prediction score for the diagnosis of acute cholecystitis would have great utility in the ED. The Bedside SAC Score would be most helpful as a rule out for patients with a low Bedside SAC Score < 2 (sensitivity of 100%) or as a rule in for patients with a high Bedside SAC Score ≥ 7 (specificity of 95.7%). Prospective validation with a larger study is required.
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Affiliation(s)
- Sally Graglia
- Department of Emergency Medicine, UCSF-ZSFG, UCSF Medical School, San Francisco, CA, USA
| | - Hamid Shokoohi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Michael A Loesche
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Dante Yeh
- Ryder Trauma Center, Jackson Memorial Hospital, University of Miami, USA
| | - Rachel M Haney
- Department of Emergency Medicine, PeaceHealth Southwest Medical Center, Vancouver, WA, USA
| | - Calvin K Huang
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christina C Morone
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Caitlin Springer
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Heidi H Kimberly
- Department of Emergency Medicine, Newton Wellesley Hospital, Newton, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Andrew S Liteplo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Hela AH, Khandwaw HM, Kumar R, Samad MA. Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study. GALICIAN MEDICAL JOURNAL 2020. [DOI: 10.21802/gmj.2020.4.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Laparoscopic cholecystectomy is the most commonly performed surgical procedure of digestive tract. It has replaced open cholecystectomy as gold standard treatment for cholelithiasis and inflammation of gallbladder. It is estimated that approximately 90% of cholecystectomies in the United States are performed using a laparoscopic approach. The aim of this study was to evaluate the outcome of Laparoscopic cholecystectomy in context to its complications, morbidity and mortality in a tertiary care hospital.
Methods: This retrospective study was conducted on 1200 patients, who underwent laparoscopic cholecystectomies, during the period from January 2019 to December 2019, at Government Medical College Jammu J & K, India and necessary data was collected and reviewed.
Results: In our study, a total of 1200 patients were studied including 216 males (18%) and 984 females (82%). The mean age of the patients was 43.35±8.61. The mean operative time in our study was 55.5±10.60 minutes with range of 45 – 90 minutes. Conversion rate was 2.6%. 2 patients were re-explored. Bile duct injury was found in 6 patients (0.5%).
Conclusions: Gallstone disease is a global health problem. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first choice of treatment for gallstones. Gall stone diseases is most frequently encountered in female population. The risk factors for conversion to open cholecystectomy include male gender, previous abdominal surgery, acute cholecystitis, dense adhesions and fibrosis in Calot’ s triangle, anatomical variations, advanced age, comorbidity, obesity, suspicion of common bile duct stones, jaundice, and decreased surgeon experience. The incidence of surgical site infection has significantly decreased in laparoscopic cholecystectomy compared to open cholecystectomy. In our study we could not find any case of surgical site infection.
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Udekwu PO, Sullivan WG. Contemporary Experience with Cholecystectomy: Establishing ‘Benchmarks’ Two Decades after the Introduction of Laparoscopic Cholecystectomy. Am Surg 2020. [DOI: 10.1177/000313481307901215] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
With quality and public reporting of increasing importance, benchmarks are anticipated to grow in relevance. We studied cholecystectomy in a practice in an urban tertiary care hospital. A total of 1083 cholecystectomies were performed in 2008 and 2009. Laparoscopic cholecystectomy was performed in 97.8 per cent of patients with a 2.2 per cent conversion rate. A planned open procedure was performed in only 2.2 per cent of patients. Approximately half of procedures were urgent and performed during an acute hospitalization. Most patients (74%) were female and most patients were overweight or obese (64.8%). Ages into the tenth decade of life were represented. Comorbidities included hypertension, 28.7 per cent; coronary disease, 15.6 per cent; diabetes mellitus, 13.4 per cent; gastroesophageal reflux disease, 10.7 per cent; and asthma, 5.5 per cent. Of female patients, 98 (12.2%) were postpartum and five (0.6%) were pregnant. Of 137 patients without gallstones, 59.1 per cent had biliary dyskinesia and 27 per cent had acalculous cholecystitis. Preoperative magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) were performed in most patients with suspected choledocholithiasis. Intraoperative cholangiograms were performed in 6.9 per cent of patients, 3.3 per cent for abnormal liver function studies. Postoperative ERCP was used in most patients with positive intraoperative cholangiograms. All-cause mortality was 0.8 per cent and attributable mortality was 0.2 per cent. Complications occurred in 7.5 per cent of patients, including retained common bile duct stones in 1.1 per cent, bile duct leak in 0.3 per cent, and common bile duct injury in 0.1 per cent.
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Yahya Gumusoglu A, Ferahman S, Gunes ME, Surek A, Yilmaz S, Aydin H, Gezmis AC, Aliyeva Z, Donmez T. High-Volume, Low-Concentration Intraperitoneal Bupivacaine Study in Emergency Laparoscopic Cholecystectomy: A Double-Blinded, Prospective Randomized Clinical Trial. Surg Innov 2020; 27:445-454. [PMID: 32242764 DOI: 10.1177/1553350620914198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Laparoscopic cholecystectomy (LC) often results in postoperative pain, especially in the abdomen. Intraperitoneal local anesthesia (IPLA) reduces pain after LC. Acute cholecystitis-associated inflammation, increased gallbladder wall thickness, dissection difficulties, and a longer operative time are several reasons for assuming a benefit in pain scores in urgent LC with IPLA application. The aim was to determine the postoperative analgesic efficacy of high-volume, low-dose intraperitoneal bupivacaine in urgent LC. Materials and Methods. Fifty-seven patients who were American Society of Anesthesiologists physical status I or II were randomly assigned to receive either normal saline (control group) or intraperitoneal bupivacaine (test group) at the beginning or end of urgent LC. The primary outcome was the postoperative pain score of the Visual Analogue Scale (VAS). The secondary outcomes included Visual Rating Prince Henry Scale (VRS), patient satisfaction, and analgesic consumption. Results. Postoperative VAS scores at the first and fourth hours were significantly lower in the test group than in the control group (P < .001). Postoperative VRS scores at the first, fourth, and eighth hours were significantly lower in the test group than in the control group (P < .001, P = .002, P = .004, respectively). Analgesic use was significantly higher in the control group at the first postoperative hour (P < .001). Shoulder pain was significantly lower, and patient satisfaction was significantly higher in the test group relative to the control group (both P < .001). Conclusion. High-volume, low-concentration intraperitoneal bupivacaine resulted in better postoperative pain control and reduced incidence of shoulder pain and analgesic consumption in urgent LC.
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Affiliation(s)
| | - Sina Ferahman
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Emin Gunes
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Surek
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Serhan Yilmaz
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Husnu Aydin
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Abdul Celil Gezmis
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Zumrud Aliyeva
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Turgut Donmez
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Er S, Berkem H, Özden S, Birben B, Çetinkaya E, Tez M, Yüksel BC. Clinical course of percutaneous cholecystostomies: A cross-sectional study. World J Clin Cases 2020; 8:1033-1041. [PMID: 32258074 PMCID: PMC7103974 DOI: 10.12998/wjcc.v8.i6.1033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/11/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although cholecystectomy is the standard treatment modality, it has been shown that perioperative mortality is approaching 19% in critical and elderly patients. Percutaneous cholecystostomy (PC) can be considered as a safer option with a significantly lower complication rate in these patients.
AIM To assess the clinical course of acute cholecystitis (AC) in patients we treated with PC.
METHODS The study included 82 patients with Grade I, II or III AC according to the Tokyo Guidelines 2018 (TG18) and treated with PC. The patients’ demographic and clinical features, laboratory parameters, and radiological findings were retrospectively obtained from their medical records.
RESULTS Eighty-two patients, 45 (54.9%) were male, and the median age was 76 (35-98) years. According to TG18, 25 patients (30.5%) had Grade I, 34 (41.5%) Grade II, and 23 (28%) Grade III AC. The American Society of Anesthesiologists (ASA) physical status score was III or more in 78 patients (95.1%). The patients, who had been treated with PC, were divided into two groups: discharged patients and those who died in hospital. The groups statistically significantly differed only concerning the ASA score (P = 0.0001) and WBCC (P = 0.025). Two months after discharge, two patients (3%) were readmitted with AC, and the intervention was repeated. Nine of the discharged patients (13.6%) underwent interval open cholecystectomy or laparoscopic cholecystectomy (8/1) within six to eight weeks after PC. The median follow-up time of these patients was 128 (12-365) wk, and their median lifetime was 36 (1-332) wk.
CONCLUSION For high clinical success in AC treatment, PC is recommended for high-risk patients with moderate-severe AC according to TG18, elderly patients, and especially those with ASA scores of ≥ III. According to our results, PC, a safe, effective and minimally invasive treatment, should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.
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Affiliation(s)
- Sadettin Er
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Hüseyin Berkem
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Sabri Özden
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Birkan Birben
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Erdinç Çetinkaya
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Mesut Tez
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Bülent Cavit Yüksel
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
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Tyberg A, Jha K, Shah S, Kedia P, Gaidhane M, Kahaleh M. EUS-guided gallbladder drainage: a learning curve modified by technical progress. Endosc Int Open 2020; 8:E92-E96. [PMID: 31921991 PMCID: PMC6949177 DOI: 10.1055/a-1005-6602] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an efficacious and safe option for patients who cannot undergo cholecystectomy. It is a technically challenging procedure, requiring skills in EUS, and ERCP. The aim of this study was to define the learning curve for EUS-GBD. Patients and methods Consecutive patients undergoing EUS-GBD by a single operator were included from a prospective registry over 5 years. Demographics, procedure information, post-procedure follow-up data, and information on adverse events were collected. Non-linear regression and CUSUM analyses were conducted for the learning curve. Clinical success was defined as resolution of cholecystitis post-procedure. Results Forty-eight patients were included (58 % male, mean age 76 years). Twenty patients (42 %) had malignant cholecystitis. Most patients had lumen-apposing metal stents (LAMS) (15 mm, n = 29, 60 %; 10 mm, n = 8, 7 %). The remaining patients had FCSEMS (n = 9, 19 %) or plastic stents alone (n = 2, 4 %). Clinical success was achieved in 36 (86 %) of patients. Of the remaining 12, 7 were lost to follow-up and 5 had persistent cholecystitis. 9 patients (19 %) had adverse events including bleeding (n = 4), liver abscesses (n = 2), and hypotension. Two patients passed away post-procedure. Median procedure time was 41 minutes (range 16 - 121 min), with the 41-minute time occurring during the 19th procedure. Procedure durations further reduced, with the last 10 procedures being 20 minutes or under (nonlinear regression p value P < 0.0001). Conclusion Endoscopists experienced in EUS-GBD are expected to achieve a reduction in procedure time over successive cases, with efficiency reached at 41 minutes and a learning rate of 19 cases. Continued improvement is demonstrated with additional experience.
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Affiliation(s)
- Amy Tyberg
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Kopal Jha
- Cornell University, Ithaca, New York, United States
| | - Shawn Shah
- Weill Cornell Medicine, New York, New York, United Stats
| | | | - Monica Gaidhane
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States,Corresponding author Michel Kahaleh, MD, AGAF, FACG, FASGE Clinical Director of GastroenterologyChief of EndoscopyDirector Pancreas ProgramRutgers, The State University of New JerseyRobert Wood Johnson University Hospital1 RWJ Place, MEB 464New Brunswick, NJ 08901+1-732-235-5537
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Jia Z, Peng J, Wan X, He P, Luo D. Endoscopic minimally invasive cholecystolithotomy in a patient with duplicate gallbladder: a case report. J Int Med Res 2019; 48:300060519886973. [PMID: 31878802 PMCID: PMC7607051 DOI: 10.1177/0300060519886973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Gallstone disease is common in China and is generally treated with laparoscopic cholecystectomy. For some patients with normal contraction function and a small number of stones, endoscopic minimally invasive cholecystolithotomy is an additional possible treatment method that avoids complications related to laparoscopic cholecystectomy. Here, we describe a 45-year-old woman who underwent endoscopic minimally invasive cholecystolithotomy and was found to have duplicate gallbladder, which was not diagnosed preoperatively. We discuss the usefulness of the endoscopic minimally invasive cholecystolithotomy procedure and the management of duplicate gallbladder in patients undergoing endoscopic minimally invasive cholecystolithotomy.
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Affiliation(s)
- Zeming Jia
- Hepatobiliary and Enteric Surgery Research Center of Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Jian Peng
- Hepatobiliary and Enteric Surgery Research Center of Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Xiaoping Wan
- Hepatobiliary and Enteric Surgery Research Center of Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Panxiang He
- Hepatobiliary and Enteric Surgery Research Center of Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Dongren Luo
- Hepatobiliary and Enteric Surgery Research Center of Xiangya Hospital, Central South University, Changsha, P.R. China
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Sagami R, Hayasaka K, Ujihara T, Nakahara R, Murakami D, Iwaki T, Suehiro S, Katsuyama Y, Harada H, Amano Y. A New Technique of Endoscopic Transpapillary Gallbladder Drainage Combined with Intraductal Ultrasonography for the Treatment of Acute Cholecystitis. Clin Endosc 2019; 53:221-229. [PMID: 31684701 PMCID: PMC7137567 DOI: 10.5946/ce.2019.099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background/Aims: Endoscopic transpapillary gallbladder drainage (ETGBD) is useful for the treatment of acute cholecystitis; however, the technique is difficult to perform. When intraductal ultrasonography (IDUS) is combined with ETGBD, the orifice of the cystic duct in the common bile duct may be more easily detected in the cannulation procedure. The aim of this study was to evaluate the efficacy of ETGBD with IDUS compared with that of ETGBD alone.
Methods: A total of 100 consecutive patients with acute cholecystitis requiring ETGBD were retrospectively recruited. The first 50 consecutive patients were treated using ETGBD without IDUS, and the next 50 patients were treated using ETGBD with IDUS. Through propensity score matching analysis, we compared the clinical outcomes between the groups. The primary outcome was the technical success rate.
Results: The technical success rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (92.0% vs. 76.0%, p=0.044). There was no significant difference in procedure length between the two groups (74.0 min vs. 66.7 min, p=0.310). The complication rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (6.0% vs. 0%, p<0.001); however, only one case showed an IDUS technique-related complication (pancreatitis).
Conclusions: The assistance of IDUS may be useful in ETGBD.
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Affiliation(s)
- Ryota Sagami
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Kenji Hayasaka
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Tetsuro Ujihara
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Ryotaro Nakahara
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Daisuke Murakami
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Tomoyuki Iwaki
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Satoshi Suehiro
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | | | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, Chiba, Japan
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James TW, Krafft M, Croglio M, Nasr J, Baron T. EUS-guided gallbladder drainage in patients with cirrhosis: results of a multicenter retrospective study. Endosc Int Open 2019; 7:E1099-E1104. [PMID: 31475226 PMCID: PMC6715426 DOI: 10.1055/a-0965-6662] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/12/2019] [Indexed: 01/20/2023] Open
Abstract
Background and study aims Cirrhosis has historically been considered a relative, if not absolute, contraindication to cholecystectomy. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been developed for use in non-operative candidates with cholecystitis; however, little data exist for use of the procedure in patients with cirrhosis. Patients and methods This was a retrospective series involving two large tertiary referral centers performing EUS-GBD. Patients with cirrhosis who underwent EUS-GBD for cholecystitis between August 2014 and December 2018 were identified. The primary endpoint was the rate of technical success, defined as EUS-guided placement of a lumen-apposing metal stent (LAMS) from duodenum to gallbladder. Patient demographics, procedural details, adverse events (AEs), post-procedural symptoms, and clinical success were recorded. Results Fifteen patients (9 females, 6 males) with cirrhosis underwent EUS-GBD during the study period. Mean patient age was 61 ± 17.1yrs, mean MELD-Na 15 ± 7. Etiology of cirrhosis was HCV (n = 2), alcohol (n = 4), non-alcoholic fatty liver disease (n = 8), and autoimmune hepatitis (n = 1). The technical success rate was 93.3 % and mean procedure time was 64 ± 59 minutes. Initial puncture site was duodenum (n = 11), stomach (n = 3) and jejunum (n = 1) and portion of gallbladder used for drainage was neck (n = 4) and body (n = 11). Fourteen patients went on to clinical success and two AEs occurred in this cohort. One decompensation event occurred in a patient with Child-Pugh class C disease 3 weeks post-procedure. Mean length of follow-up was 373 ± 367.3 days; one death occurred due to underlying malignancy. Conclusion EUS-GBD is safe and efficacious in managing cholecystitis in patients with Child-Pugh A and B cirrhosis who are non-operative candidates. Further studies are needed to determine optimal patient selection and procedural technique.
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Affiliation(s)
- Theodore W. James
- University of North Carolina, Division of Gastroenterology & Hepatology, Chapel Hill, North Carolina, United States,Corresponding author Theodore W. James University of North CarolinaDivision of Gastroenterology & Hepatology101 Manning DriveChapel Hill, NC 27514
| | - Matthew Krafft
- West Virginia Ruby Memorial Hospital Digestive Diseases, Morgantown, West Virginia, United States
| | - Michael Croglio
- University of North Carolina, Department of Medicine, Chapel Hill, North Carolina, United States
| | - John Nasr
- West Virginia Ruby Memorial Hospital Digestive Diseases, Morgantown, West Virginia, United States
| | - Todd Baron
- University of North Carolina, Division of Gastroenterology & Hepatology, Chapel Hill, North Carolina, United States
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de Siqueira Corradi MB, D Ávila R, Duim E, Rodrigues CIS. Risk stratification for complications of laparoscopic cholecystectomy based on associations with sociodemographic and clinical variables in a public hospital. Am J Surg 2019; 219:645-650. [PMID: 31130212 DOI: 10.1016/j.amjsurg.2019.05.005] [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: 02/07/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cholelithiasis is the most common disease of the biliary tract. We aimed to associate complications resulting from laparoscopic cholecystectomy with patients' sociodemographic and clinical data, stratifying risk based on this association. METHODS We retrospectively reviewed the medical records of 2520 patients undergoing laparoscopic cholecystectomy from January 2013 to March 2017 at our institution. Sociodemographic, clinical, and surgical complication data were collected. Unadjusted and adjusted logistic regression models were used to determine independent factors associated with the outcomes of interest. Based on the results, we proposed a risk stratification model, a treatment flowchart, and a severity score. RESULTS Mean age was 48.9 years; 83.53% were female. Intraoperative complications occurred in 206 (8.17%) patients, and postoperative complications in 54 (2.14%). Male sex, older age, diabetes, multiple previous operations, and urgent surgery (odds ratio = 23.77) were significantly associated with surgical complications in both unadjusted and adjusted models. CONCLUSIONS We could propose a flowchart based on our risk stratification model and develop a severity score based on the association between complications of laparoscopic cholecystectomy and sociodemographic/clinical data.
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Affiliation(s)
| | - Ronaldo D Ávila
- Department of Medicine, Nephrology Division, School of Medical and Health Sciences, Pontifícia Universidade Católica de São Paulo (PUC-SP), R. Jouberte Wey, 290, Vergueiro, 18030-070, Sorocaba, SP, Brazil.
| | - Etienne Duim
- School of Public Health, Universidade de São Paulo (USP), Faculty of Health, Medicine and Life Sciences, Av. Dr Arnaldo, 715, 01246-904, São Paulo, SP, Brazil.
| | - Cibele Isaac Saad Rodrigues
- Department of Medicine, Nephrology Division and Education in Health Professions Master Program, School of Medical and Health Sciences, PUC-SP. R, Jouberte Wey, 290, Vergueiro, 18030-070, Sorocaba, SP, Brazil.
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Schlottmann F, Gaber C, Strassle PD, Patti MG, Charles AG. Cholecystectomy Vs. Cholecystostomy for the Management of Acute Cholecystitis in Elderly Patients. J Gastrointest Surg 2019; 23:503-509. [PMID: 30225792 DOI: 10.1007/s11605-018-3863-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/25/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Data comparing outcomes following cholecystectomy and cholecystostomy tube placement (CTP) in elderly patients are lacking. We aimed to compare the post-procedural outcomes between cholecystectomy and CTP in elderly patients with acute cholecystitis. METHODS We performed a retrospective, population-based analysis using the National Inpatient Sample for the period 2000-2014. Patients ≥ 65 years old admitted with a primary diagnosis of acute cholecystitis and who underwent either cholecystectomy or CTP during their hospitalization were included. Multivariable linear and logistic regression models were used to analyze post-procedural complications, mortality, length of stay, and total charges. The effect of procedure type on patient outcomes, stratified by acalculous and calculous cholecystitis, was also performed. RESULTS A total of 200,915 patients were included, of which 7516 underwent CTP and 193,399 underwent cholecystectomy. The median age of patients undergoing CTP and cholecystectomy was 80 (IQR 73-87) and 75 (IQR 70-81), respectively. Patients undergoing CTP were more likely to have post-procedural infection (OR 2.25; 95% CI 2.07, 2.45), bleeding (OR 1.28; 95% CI 1.19, 1.37), and inpatient mortality (OR 9.27; 95% CI 7.95, 10.81). On average, CTP patients stayed 1.25 days longer (95% CI 1.14, 1.37) in hospital after the procedure. The benefits of cholecystectomy were consistent in patients with acalculous and calculous cholecystitis. CONCLUSIONS Elderly patients with both acalculous and calculous acute cholecystitis managed with CTP have higher incidences of post-procedural morbidity and mortality, and longer post-procedure length of hospital stay, as compared to cholecystectomy. Unless prohibitive surgical risks exist, elderly patients with acute cholecystitis should undergo cholecystectomy.
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Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA.
- Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina.
| | - Charles Gaber
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paula D Strassle
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marco G Patti
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA
- Department of Medicine, |University of North Carolina, Chapel Hill, NC, USA
| | - Anthony G Charles
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA
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Percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract. Pol J Radiol 2019; 83:e183-e188. [PMID: 30627233 PMCID: PMC6323596 DOI: 10.5114/pjr.2018.75811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/23/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose In the present study, the effectiveness and safety of minimally invasive percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract were assessed. Material and methods Between 2000 and 2015, 12 patients (seven women and five men, mean age 78 ± 8 years) after open cholecystectomy with common bile duct exploration and T-tube drainage underwent percutaneous extraction of residual gallstones through the T-tube tract. Results The intervention was successful in 92% (11/12). In seven patients complete extraction of the retained gallstones was achieved, and in four cases partial extraction combined with passage of small residual fragments to the duodenum was obtained. In one case the extraction attempt was ineffective. Mild haemobilia was observed in two patients. No mortality or major complications were observed. Conclusions Our findings are consistent with literature data and confirm that percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract is an effective and safe treatment method. Although the presented technique is not a novel approach, it can be beneficial in patients unsuitable for open surgery or laparoscopic intervention when ERCP attempt occurs ineffective or there exist contraindications to ERCP.
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Leber und Gallenwege. NOTFÄLLE IN DER ALLGEMEIN- UND VISZERALCHIRURGIE 2019. [PMCID: PMC7123194 DOI: 10.1007/978-3-662-53557-8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patienten mit einer akuten Gallenblasenkolik müssen im Verlauf mit erneuten Beschwerden oder Komplikationen rechnen (siehe Übersicht). Sie sollten daher so bald wie möglich einer Cholezystektomie zugeführt werden, weil sich dadurch die Morbidität während der Wartezeit für eine elektive Cholezystektomie und wiederholte notfallmäßige Vorstellungen in der Notaufnahme vermeiden lassen. Die frühe laparoskopische Cholezystektomie scheint dabei mit einer niedrigeren Konversionsrate, einer kürzeren Operationszeit und einem kürzeren Krankenhausaufenthalt einherzugehen (Duncan u. Riall 2013).
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Ai XM, Ho LC, Yang NY, Han LL, Lu JJ, Yue X. A comparative study of ultrasonic scalpel (US) versus conventional metal clips for closure of the cystic duct in laparoscopic cholecystectomy (LC): A meta-analysis. Medicine (Baltimore) 2018; 97:e13735. [PMID: 30572514 PMCID: PMC6320032 DOI: 10.1097/md.0000000000013735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND laparoscopic cholecystectomy (LC) has become the gold standard surgery for benign gallbladder diseases. Metal clips are conventionally used to secure the cystic duct and artery, while monopolar electrocautery (ME) predominates during laparoscopic dissection. ultrasonic scalpel (US) has already been explored for sealing the cystic duct and artery as a sole instrument, which has been regarded as a reasonable alternative to clips. The aim of this study was to investigate the safety and effectiveness of US versus clips for securing the cystic duct during LC. METHODS We identified eligible studies in PubMed, Medline, Cochrane Library, Embase, and SpringerLink up to 1st May 2018, together with the reference lists of original studies. Meta-analysis was conducted using STATA 14.0. Q-based chi-square test and the I statistics were utilized to assess heterogeneity among the included studies. A P-value below .05 was set for statistical significance. Forest plots of combined Hazard ratios (HRs) with 95% confidence intervals (CIs) were also generated. RESULTS Eight studies met eligibility criteria in this meta-analysis eventually. A total of 1131 patients were included, of whom 529 were contained in the US group, compared to 602 in the clips group, which showed a significant difference (P = .025) without substantial statistical heterogeneity (I = 0.0%). No statistical significance was revealed regarding age (I = 0.0%, P = .957), and sex (I = 0.0%, P = .578) between both groups. The operative time and hospital stay in the US group were significantly shorter than that in the clips group, with I = 95.0%, P = .000 and I = 72.8%, P = .005, respectively. Concerning conversion (I = 48.6%, P = .084), perforation (I = 12.0%, P = .338), along with bile leakage (I = 0.0% P = .594), and overall morbidity (I = 19.1%, P = .289), comparison between both groups exhibited no statistical significance. CONCLUSIONS US enabled shorter operative time and hospital stay during LC, compared with clips. Additionally, US was comparable to clips regarding conversion, perforation, along with bile leakage and overall morbidity. Therefore, our meta-analysis concluded that US is clinically superior to the conventional clips in some aspects, or is at least as safe and effective as them, concerning closure of the cystic duct and artery.
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Carbotta G, Panebianco A, Laforgia R, Pascazio B, Balducci G, Bianchi FP, Tafuri S, Palasciano N. A new clinical-ultrasound score to predict difficult videolaparocholecystectomies: A prospective study. Ann Med Surg (Lond) 2018; 35:59-63. [PMID: 30294430 PMCID: PMC6170205 DOI: 10.1016/j.amsu.2018.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/11/2018] [Accepted: 09/16/2018] [Indexed: 11/25/2022] Open
Abstract
Background The gold standard treatment of symptomatic cholelithiasis is videolaparoscopic cholecystectomy (VLC). The aim of this study is to produce a predictive clinical ultrasound (US) score for difficult VLC to reduce the rate of conversion to open cholecystectomy surgery and intra and/or post-operative complications. Methods In this prospective study carried out in 2017 we enrolled 135 patients (pts) who underwent VLC in our General Surgery Unit. A specific pre-operative abdominal ultrasound scan was performed to assess gallbladder characteristics for each patient. All US and patients' characteristics were recorded in a standard form in order to obtain a preoperative score and were then added to the intra-operative variables. Results The analysis revealed a statistical significance between post-operative characteristics and parietal thickness, adhesions, stratifications and volume of gallstones. Comparing the degree of difficulty VLC assessed in the pre-operative stage to the intraoperative score, the sensitivity of the preoperative US scan test is 91.8% while the specificity is 76.7%. Conclusions The variables which proved statistically significant in predicting a difficult cholecystectomy were: age, parietal thickness >3 mm, adhesions, stratifications, gallstones >2 cm and fixed gallstones. We have definitively defined a predictive score for difficult VLC for which a VLC is to be considered potentially difficult whenever it presents a pre-operative score equal or greater than 4 (and a "easy" one with a pre-operative score less than 4). These findings may prove helpful in further reducing the conversion rate and the rate of intra- and/or post-operative complications. The treatment of symptomatic cholelithiasis is videolaparoscopic cholecystectomy. A clinical ultrasound score for difficult VLC can reduce conversion rate. Intra and post-operative complications is challenging for inexperienced surgeons.
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Affiliation(s)
- Giuseppe Carbotta
- General Surgery Unit "V. Bonomo", Department of Emergency and Transplantation of Organs, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| | - Annunziata Panebianco
- General Surgery Unit "V. Bonomo", Department of Emergency and Transplantation of Organs, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| | - Rita Laforgia
- General Surgery Unit "V. Bonomo", Department of Emergency and Transplantation of Organs, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| | - Bianca Pascazio
- General Surgery Unit "V. Bonomo", Department of Emergency and Transplantation of Organs, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| | - Giovanni Balducci
- General Surgery Unit "V. Bonomo", Department of Emergency and Transplantation of Organs, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| | - Francesco Paolo Bianchi
- Department of Biomedical Sciences and Human Oncology, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Sciences and Human Oncology, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
| | - Nicola Palasciano
- General Surgery Unit "V. Bonomo", Department of Emergency and Transplantation of Organs, University of Bari, P.zza G. Cesare 11, 70124, Bari, Italy
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Bahraini A, Odom JW, Talukder A. A case report of a patient with gallbladder agenesis resulting in a common bile duct injury. Int J Surg Case Rep 2018; 51:99-101. [PMID: 30149331 PMCID: PMC6111033 DOI: 10.1016/j.ijscr.2018.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/06/2018] [Accepted: 07/21/2018] [Indexed: 11/17/2022] Open
Abstract
Gallbladder agenesis can present with symptoms of biliary colic or cholecystitis. Imaging studies of a patient with gallbladder agenesis can be inconclusive. If operated on, the surgeon will be unable to visualize the gallbladder. In such cases, the procedure should be aborted, and further diagnostic testing should be done.
Introduction Congenital agenesis of the gallbladder is a rare embryological defect of the biliary system. While occurring equally in men and women, gallbladder agenesis is found clinically twice as often in women. Patients present with symptoms suggesting biliary colic. Abdominal ultrasound and cholecintigraphy or HIDA scan are usually inconclusive and, in some cases, may be read as positive for biliary colic. Patients can undergo surgery based on characteristics of pain. Presentation of case We report the case of a 60-year-old female presenting with symptoms of recurrent biliary colic and subsequently undergoing laparoscopic cholecystectomy after inconclusive workup. Discussion We offer a review of past reported cases as well as a new approach to such patients during the intraoperative period. An intraoperative decision should be made whether to continue and search for a possible ectopic gallbladder or investigate further with imaging studies. Conclusion Gallbladder agenesis is a rare clinical presentation that the surgeon must be aware of. With inconclusive studies, the surgeon should consider congenital absence of the gallbladder and pursue further imaging if the gallbladder cannot be localized during the intraoperative period.
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Affiliation(s)
- Anoosh Bahraini
- Department of Medicine, Medical College of Georgia, Augusta, USA.
| | - John W Odom
- Department of Medicine, Medical College of Georgia, Augusta, USA
| | - Asif Talukder
- Department of Medicine, Medical College of Georgia, Augusta, USA
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Taki-Eldin A, Badawy AE. OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH GALLSTONE DISEASE AT A SECONDARY LEVEL CARE HOSPITAL. ACTA ACUST UNITED AC 2018; 31:e1347. [PMID: 29947681 PMCID: PMC6049991 DOI: 10.1590/0102-672020180001e1347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/23/2018] [Indexed: 01/28/2023]
Abstract
Background: Laparoscopic cholecystectomy is the most commonly performed operation of the digestive tract. )It is considered as the gold standard treatment for cholelithiasis. Aim: To evaluate the outcome of it regarding length of hospital stay, complications, morbidity and mortality at a secondary hospital. Methods: Data of 492 patients who underwent laparoscopic cholecystectomy were retrospectively reviewed. Patients’ demographics, co-morbid diseases, previous abdominal surgery, conversion to open cholecystectomy, operative time, intra and postoperative complications, and hospital stay were collected and analyzed from patients’ files. Results: Out of 492 patients, 386 (78.5%) were females and 106 (21.5%) males. The mean age of the patients was 49.35±8.68 years. Mean operative time was 65.94±11.52 min. Twenty-four cases (4.9%) were converted to open surgery, four due to obscure anatomy (0.8%), 11 due to difficult dissection in Calot’s triangle (2.2%) and nine by bleeding (1.8%). Twelve (2.4%) cases had biliary leakage, seven (1.4%) due to partial tear in common bile duct, the other five due to slipped cystic duct stables. Mean hospital stay was 2.6±1.5 days. Twenty-one (4.3%) developed wound infection. Port site hernia was detected in nine (1.8%) patients. There was no cases of bowel injury or spilled gallstones. There was no mortality recorded in this series. Conclusions: Laparoscopic cholecystectomy is a safe and effective line for management of gallstone disease that can be performed with acceptable morbidity at a secondary hospital.
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Affiliation(s)
| | - Abd-Elnaser Badawy
- Biochemistry Department, Faculty of Medicine, Northern Border University, Arar, KSA (Saudi Arabia)
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Bhutiani N, Brown AN, Davis EG, Jones CM, Vitale GC, Scoggins CR, Martin RC, Bozeman MC. Correlation of Biliary Colic in the Absence of Cholelithiasis with Pancreaticobiliary Obstruction. Am Surg 2018. [DOI: 10.1177/000313481808400634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A small fraction of patients undergoing cholecystectomy for biliary colic are subsequently diagnosed with an obstructive pancreatic head mass. We review our experience with such patients to provide insight into improving evaluation before cholecystectomy. Retrospective chart review of patients undergoing cholecystectomy from 2004 to 2015 identified six patients who underwent laparoscopic cholecystectomy for biliary colic before being diagnosed with a pancreatic head neoplasm within six months after cholecystectomy. Charts were analyzed for presenting symptoms, evaluation before and after cholecystectomy, and operative findings. Patients ranged from 50 to 72 years of age and included five males and one female. None had evidence of cholelithiasis or acute cholecystitis on initial evaluation. Median time from cholecystectomy to diagnosis of pancreatic head mass was two months (range 1–5 months). Two patients eventually underwent pancreaticoduodenectomy. Patients with symptoms of biliary colic in the absence of evidence of cholecystitis or choledochal abnormality should undergo intraoperative cholangiogram at the time of cholecystectomy as well as close clinical follow-up to ensure resolution of symptoms. Abnormalities of either should prompt radiographic evaluation focused on identification of a pancreatic mass causing extrinsic compression of the bile duct.
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Affiliation(s)
- Neal Bhutiani
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | - Amber N. Brown
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | - Eric G. Davis
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | | | - Gary C. Vitale
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | - Charles R. Scoggins
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | - Robert C.G. Martin
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | - Matthew C. Bozeman
- From the University of Louisville Department of Surgery, Louisville, Kentucky
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A promising technique for easier single incision laparoscopic cholecystectomy: needle grasper traction of gallbladder. Wideochir Inne Tech Maloinwazyjne 2018; 13:358-365. [PMID: 30302149 PMCID: PMC6174160 DOI: 10.5114/wiitm.2018.75849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/26/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) is the primary treatment method for benign gallbladder diseases. Single incision laparoscopic cholecystectomy (SILC) was reported to be superior in terms of work return, cosmetic results, and post-operative pain, but limited maneuver capacity and overlapping of hand tools are technical difficulties associated with SILC that endanger patient safety. Aim To perform SILC using a needle grasper for gallbladder traction, thus simplifying the dissection of Calot's triangle. Material and methods The files of patients who underwent elective LC for gallbladder stone and polyps in general surgery clinics between December 2013 and December 2014 were analyzed retrospectively. The patients were divided into two groups: needle-grasper-assisted SILC (nSILC) and conventional laparoscopic cholecystectomy (CLC). Age, gender, height, weight, body mass index, visual analog scale (VAS) scores, ASA score, duration of operation, duration of post-operative hospital stay, complications, drain use, conversion to open and conventional technique, and oral feeding beginning time were analyzed. Results There were no per-operative or post-operative complications in either of the groups, and no significant differences were found between the groups in terms of complications. The mean duration of the operation was significantly longer in the nSILC group. There was no difference between the groups in terms of hospital stay. The mean visual analogue scale (VAS) scores in conventional nSILC were significantly lower for all hours. The patient satisfaction in terms of cosmetic results was better in the nSILC group. Conclusions Needle-grasper-assisted SILC reduces the number of tools that need to be held by surgeons; it also provides safe dissection, better cosmetic results, and less post-operative pain in elective cases.
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Yeh DD, Chang Y, Tabrizi MB, Yu L, Cropano C, Fagenholz P, King DR, Kaafarani HMA, de Moya M, Velmahos G. Derivation and validation of a practical Bedside Score for the diagnosis of cholecystitis. Am J Emerg Med 2018; 37:61-66. [PMID: 29724580 DOI: 10.1016/j.ajem.2018.04.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE We sought to develop a practical Bedside Score for the diagnosis of cholecystitis and test its accuracy against the Tokyo Guidelines (TG13). METHODS We conducted a retrospective study of 438 patients undergoing urban, academic Emergency Department (ED) evaluation of RUQ pain. Symptoms, physical signs, ultrasound signs, and labs were scoring system candidates. A random split-sample approach was used to develop and validate a new clinical score. Multivariable regression analysis using development data was conducted to identify predictors of cholecystitis. Cutoff values were chosen to ensure positive/negative predictive values (PPV, NPV) of at least 0.95. The score was externally validated in 80 patients at a different hospital undergoing RUQ pain evaluation. RESULTS 230 patients (53%) had cholecystitis. Five variables predicted cholecystitis and were included in the scores: gallstones, gallbladder thickening, clinical or ultrasonographic Murphy's sign, RUQ tenderness, and post-prandial symptoms. A clinical prediction score was developed. When dichotomized at 4, overall accuracy for acute cholecystitis was 90% for the development cohort, 82% and 86% for the internal and external validation cohorts; TG13 accuracy was 62%-79%. CONCLUSIONS A clinical prediction score for cholecystitis demonstrates accuracy equivalent to TG13. Use of this score may streamline work-up by decreasing the need for comprehensive ultrasound evaluation and CRP measurement and may shorten ED length of stay.
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Affiliation(s)
- D Dante Yeh
- Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, United States.
| | - Yuchiao Chang
- Massachusetts General Hospital, Department of Medicine, United States
| | | | - Liyang Yu
- Massachusetts General Hospital, Department of Medicine, United States
| | - Catrina Cropano
- Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, United States
| | - Peter Fagenholz
- Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, United States
| | - David R King
- Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, United States
| | - Haytham M A Kaafarani
- Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, United States
| | - Marc de Moya
- Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, United States
| | - George Velmahos
- Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, United States
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Kleinubing DR, Riera R, Matos D, Linhares MM. Selective versus routine intraoperative cholangiography for cholecystectomy. Hippokratia 2018. [DOI: 10.1002/14651858.cd012971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Diego R Kleinubing
- Universidade Federal do Pampa; Department of Surgery, Faculty of Medicine; Uruguaiana Rio Grande do Sul Brazil
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Cochrane Brazil; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
| | - Delcio Matos
- Escola Paulista de Medicina, Universidade Federal de São Paulo; Department of Gastroenterological Surgery; Rua Edison 278, Apto 61 Campo Belo São Paulo São Paulo Brazil 04618-031
| | - Marcelo Moura Linhares
- Universidade Federal de São Paulo; Department of Surgery; Rua Leandro Dupre, 334. Ap-21 Sao Paulo SP Brazil 04025011
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Stey AM, Greenstein AJ, Aufses A, Moskowitz AJ, Egorova NN. Managing acute cholecystitis among Medicaid insured in New York State: opportunities to optimize care. Surg Endosc 2018; 32:2212-2221. [PMID: 29435753 DOI: 10.1007/s00464-017-5693-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/22/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Identifying sources of unnecessary cost within Medicaid will help focus cost containment efforts. This study sought to identify differences in surgical management and associated costs of cholecystitis between Medicaid and privately insured in New York State. METHODS The New York State all-payer mandatory discharge database from 2003 to 2013, had 297,635 patients with Medicaid (75,512) and privately (222,123) insurance who underwent cholecystectomy for cholecystitis. Patients were stratified by insurance. Four surgical management approaches were delineated based on cholecystectomy timing: primary, interval, emergency, and delayed cholecystectomy. Delayed cholecystectomy was defined as more than one hospital visit from diagnosis to definitive cholecystectomy. Medicaid and privately insured patients were propensity score matched. Surgical management approach and associated costs were compared between matched cohorts. RESULTS A greater proportion of Medicaid patients underwent delayed cholecystectomy compared to matched privately insured patients, 8.5 versus 4.8%; P < 0.001. Primary initial cholecystectomy was performed in fewer Medicaid compared to privately insured patients, 55.4 versus 66.0%, P < 0.001. Primary initial cholecystectomy was the cheapest surgical management approach, with the median cost of $3707, and delayed cholecystectomy was the most expensive, $12,212, P < 0.001. The median cost per Medicaid patient was $6170 versus $4804 per matched privately insured patient, P < 0.001. The annual predicted cost savings for New York State Medicaid would be $13,097,371, if the distribution of surgical management approaches were proportionally similar to private insurance. CONCLUSIONS Medicaid patients with cholecystitis were more frequently managed with delayed cholecystectomy than privately insured patients, which had substantial cost implications for the New York Medicaid Program.
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Affiliation(s)
- Anne M Stey
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Alexander J Greenstein
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arthur Aufses
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan J Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lu P, Yang NP, Chang NT, Lai KR, Lin KB, Chan CL. Effect of socioeconomic inequalities on cholecystectomy outcomes: a 10-year population-based analysis. Int J Equity Health 2018; 17:22. [PMID: 29433528 PMCID: PMC5809951 DOI: 10.1186/s12939-018-0739-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/06/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although numerous epidemiological studies on cholecystectomy have been conducted worldwide, only a few have considered the effect of socioeconomic inequalities on cholecystectomy outcomes. Specifically, few studies have focused on the low-income population (LIP). METHODS A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2003-2012. The International Classification of ICD-9-CM procedure codes 51.2 and 51.21-51.24 were identified as the inclusion criteria for cholecystectomy. Temporal trends were analyzed using a joinpoint regression, and the hierarchical linear modeling (HLM) method was used as an analytical strategy to evaluate the group-level and individual-level factors. Interactions between age, gender and SES were also tested in HLM model. RESULTS Analyses were conducted on 225,558 patients. The incidence rates were 167.81 (95% CI: 159.78-175.83) per 100,000 individuals per year for the LIP and 123.24 (95% CI: 116.37-130.12) per 100,000 individuals per year for the general population (GP). After cholecystectomy, LIP patients showed higher rates of 30-day mortality, in-hospital complications, and readmission for complications, but a lower rate of routine discharge than GP patients. The hospital costs and length of stay for LIP patients were higher than those for GP patients. The multilevel analysis using HLM revealed that adverse socioeconomic status significantly negatively affects the outcomes of patients undergoing cholecystectomy. Additionally, male sex, advanced age, and high Charlson Comorbidity Index (CCI) scores were associated with higher rates of in-hospital complications and 30-day mortality. We also observed that the 30-day mortality rates for patients who underwent cholecystectomy in regional hospitals and district hospitals were significantly higher than those of patients receiving care in a medical center. CONCLUSION Patients with a disadvantaged finance status appeared to be more vulnerable to cholecystectomy surgery. This result suggested that further interventions in the health care system are necessary to reduce this disparity.
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Affiliation(s)
- Ping Lu
- School of Economics and Management, Xiamen University of Technology, Xiamen, 361024, China.,Department of Information Management, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Nan-Ping Yang
- Department of Surgery, Keelung Hospital, Ministry of Health and Welfare, Keelung, 20148, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Nien-Tzu Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
| | - K Robert Lai
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan.,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Kai-Biao Lin
- School of Computer & Information Engineering, Xiamen University of Technology, Xiamen, 361024, China
| | - Chien-Lung Chan
- Department of Information Management, Yuan Ze University, Taoyuan, 32003, Taiwan. .,Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, 32003, Taiwan.
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Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided drainage (EUS-GLB) is a minimally invasive option for patients with cholecystitis who are poor surgical candidates. Compared with percutaneous drainage (PC-GLB), earlier studies have demonstrated similar efficacy with improved quality of life. We present a multicenter, international experience comparing PC-GLB and EUS-GLB in nonsurgical patients with cholecystitis. METHODS All patients who underwent either PC-GLB drainage or EUS-GLB drainage from 7 centers between January 2010 and December 2015 were included. Technical success was defined as successful placement of a catheter or stent into the gallbladder. Clinical success was defined as resolution of clinical symptoms after intervention. Adverse events, length of stay, and the need for repeat interventions and/or hospitalizations were recorded for all patients. RESULTS A total of 155 patients were included (mean age 74±14.24 y; range, 31 to 96; 56% male). Forty-two patients underwent EUS-GLB and 113 patients underwent PC-GLB. Technical success was achieved in 40 patients (95%) in the EUS-GLB group and 112 patients (99%) in the PC-GLB group (P=0.179). Clinical success was achieved in 40 patients (95%) in the EUS-GLB group and 97 patients (86%) in the PC-GLB group (P=0.157). There was no difference in hospital readmission rates between the 2 groups (14% vs. 24%; P=0.194). However, there was significantly higher number of patients requiring repeat interventions in the PC-GLB group (n=28, 24%) compared with the EUS-GLB group (n=4, 10%) (P=0.037). There was no difference in adverse events between the 2 groups. CONCLUSIONS EUS-GLB is safe and efficacious, with comparable technical and clinical success rates and no difference in adverse events. In addition, EUS-GLB offers a potential cost-saving benefit and morbidity benefit by demonstrating a decreased number of repeat interventions.
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Zhao J, Yu Y, Luo M, Li L, Rong P. Bi-directional regulation of acupuncture on extrahepatic biliary system: An approach in guinea pigs. Sci Rep 2017; 7:14066. [PMID: 29070912 PMCID: PMC5656652 DOI: 10.1038/s41598-017-14482-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/11/2017] [Indexed: 01/30/2023] Open
Abstract
Clinically, acupuncture affects the motility of the extrahepatic biliary tract, but the underlining mechanisms are still unknown. We applied manual acupuncture (MA) and electrical acupuncture (EA) separately at acupoints Tianshu (ST25), Qimen (LR14), Yanglingquan (GB34), and Yidan (CO11) in forty guinea pigs (4 groups) with or without atropinization under anesthesia while Sphincter of Oddi (SO) myoelectric activities and gallbladder pressure were monitored. In both MA and EA groups, stimulation at ST25 or LR14 significantly increased the frequency and amplitude of SO myoelectrical activities and simultaneously decreased the gallbladder pressure as compared to the pre-MA and pre-EA (P < 0.05). On the contrary, stimulation at GB34 or CO11 significantly decreased SO myoelectricity and increased the gallbladder pressure (P < 0.05). Pretreatment with atropine could abolish the effect of stimulation at acupoints ST25, GB34 and LR14 (P > 0.05), although significant myoelectricity increases were still inducible with MA or EA stimulation at CO11 (P < 0.05). In summary, acupuncture has bi-directional effects to gallbladder pressure and SO function, which probably due to autonomic reflex and somatovisceral interactions.
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Affiliation(s)
- Jingjun Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yutian Yu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.,Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.,Rudolf Boehm Institute of Pharmacology and Toxicology, Universität Leipzig, Härtelstrasse 16-18, 04107, Leipzig, Germany
| | - Man Luo
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China. .,Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Comparison of the effects of spinal epidural and general anesthesia on coagulation and fibrinolysis in laparoscopic cholecystectomy: a randomized controlled trial: VSJ Competition, 2 nd place. Wideochir Inne Tech Maloinwazyjne 2017; 12:330-340. [PMID: 29062459 PMCID: PMC5649509 DOI: 10.5114/wiitm.2017.70249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/20/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) is usually performed under general anesthesia. Recently, laparoscopic cholecystectomy under regional anesthesia has become popular, but this creates a serious risk of thromboembolism because of pneumoperitoneum, anesthesia technique, operative positioning, and patient-specific risk factors. Aim This randomized controlled trial compares the effects of two different anesthesia techniques in laparoscopic cholecystectomy on coagulation and fibrinolysis. Material and methods This randomized prospective study included 60 low-risk patients with deep vein thrombosis (DVT) who underwent elective LC without thrombo-emboli prophylaxis. The patients were randomly divided into two groups according to the anesthesia technique: the general anesthesia (group 1, n = 30) and spinal epidural anesthesia (group 2, n = 30) groups. Measurement of the prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and blood levels of D-dimer (DD) and fibrinogen (F) were recorded preoperatively (pre), at the first hour (post 1) and 24 h (post 24) after the surgery. These results were compared both between and within the groups. Results The mean age was 51.5 ±16.7 years (range: 19–79 years). Pneumoperitoneum time was similar between group 1 (33.8 ±7.8) and group 2 (34.8 ±10.4). The TT levels significantly declined postoperatively in both groups. The levels of PT, aPTT, INR, D-dimer and fibrinogen dramatically increased postoperatively in both groups. Conclusions While there was not any DVT, there was a significant decline in TT. There was a dramatic rise in the PT, INR, D-dimer, fibrin degradation products (FDP), and fibrinogen following LC. This may be attributed to the effects of pneumoperitoneum and anesthesia techniques on portal vein flow.
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Sert İ, İpekci F, Engin Ö, Karaoğlan M, Çetindağ Ö. Outcomes of early cholecystectomy (within 7 days of admission) for acute cholecystitis according to diagnosis and severity grading by Tokyo 2013 Guideline. Turk J Surg 2017; 33:80-86. [PMID: 28740955 DOI: 10.5152/ucd.2016.3305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/01/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The timing of early cholecystectomy in acute cholecystitis is still controversial, and data regarding the use of Tokyo 2013 guideline for diagnosis and severity grading in Acute Cholecystitis is limited. The aim of this study was to evaluate the clinical and pathologic outcomes of early cholecystectomy after 72 hr and within seven days of index admission according to Tokyo 2013 guideline for diagnosis and severity grading of Acute cholecystitis (in patients with Acute cholecystitis. MATERIAL AND METHODS Medical charts of 172 patients who underwent early cholecystectomy after 72 hr and within 7 days of index admission with a diagnosis of Acute cholecystitis between Aug 2009 and Apr 2014 were retrospectively analyzed. Patients were classified according Tokyo 2013 guideline criteria. RESULTS The median age of the study group was 52 yr. The rates of open and laparoscopic cholecystectomies was 53.5% and 33.1%, respectively. Conversion to open cholecystectomy was performed in 19 patients (13.4 %). The median length of hospital stay was 7 days. Eighty-four patients (59.2%) met the criteria for a definite diagnosis of Acute cholecystitis according to Tokyo 2013 guideline. Longer postoperative and total length of hospital stay was determined in patients with a definite diagnosis. CONCLUSION Increased severity grading is correlated with longer pre- and post-operative hospital stay. Early cholecystectomy in Acute cholecystitis performed by experienced surgeons after 72 hr of admission and within 7 days maybe a feasible and safe procedure.
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Affiliation(s)
- İsmail Sert
- Clinic of General Surgery and Transplantation, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Fuat İpekci
- Clinic of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ömer Engin
- Clinic of General Surgery, Buca Seyfi Demirsoy State Hospital, İzmir, Turkey
| | - Muharrem Karaoğlan
- Clinic of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Özhan Çetindağ
- Clinic of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
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Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SDF. Acute calculous cholecystitis: Review of current best practices. World J Gastrointest Surg 2017; 9:118-126. [PMID: 28603584 PMCID: PMC5442405 DOI: 10.4240/wjgs.v9.i5.118] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/03/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72 h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.
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Liao G, Wen S, Xie X, Wu Q. Harmonic Scalpel versus Monopolar Electrocauterization in Cholecystectomy. JSLS 2017; 20:JSLS.2016.00037. [PMID: 27547026 PMCID: PMC4978547 DOI: 10.4293/jsls.2016.00037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Laparoscopic cholecystectomy (LC) using surgical electrocautery is considered to be the gold standard procedure for the treatment of uncomplicated cholecystitis and cholelithiasis. The objective of the current study was to evaluate the effectiveness and safety of the Harmonic scalpel, an advanced laparoscopic technique associated with less thermal damage in LC, when compared to electrocautery. METHODS From October 2010 through June 2013, a total of 198 patients were randomly allocated to LC with a Harmonic scalpel (experimental group, 117 patients) or conventional monopolar electrocautery (control group, 81 patients). The main outcome measures were operative time, blood loss, conversion to laparotomy, postoperative hospital stay, post-LC pain, and cost effectiveness. RESULTS The 2 groups were comparable with respect to baseline patient characteristics. When compared to conventional monopolar electrocautery, there were no significant reductions in the operative time, bleeding, frequency of conversion to laparotomy, and duration of postoperative recovery with the Harmonic scalpel (P > .05 for all). CONCLUSIONS Laparoscopic cholecystectomy using conventional monopolar electrocautery is as effective and safe as that with the Harmonic scalpel, for treating uncomplicated cholecystitis and cholelithiasis.
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Affiliation(s)
- Guanqun Liao
- Department of General Surgery, Foshan Municipal Hospital, Southern Medical University, Foshan, China
| | - Shunqian Wen
- Department of General Surgery, Foshan Municipal Hospital, Southern Medical University, Foshan, China
| | - Xueyi Xie
- Department of General Surgery, Foshan Municipal Hospital, Southern Medical University, Foshan, China
| | - Qing Wu
- Department of General Surgery, Foshan Municipal Hospital, Southern Medical University, Foshan, China
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