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Zhao C, Wang Z, Yao Y, Yao W, Wang Z. Comparison of endoscopic retrograde cholangiopancreatography with laparoscopic surgery for patients with mild and moderately severe acute biliary pancreatitis. Heliyon 2024; 10:e36216. [PMID: 39247364 PMCID: PMC11379983 DOI: 10.1016/j.heliyon.2024.e36216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 07/11/2024] [Accepted: 08/12/2024] [Indexed: 09/10/2024] Open
Abstract
Acute biliary pancreatitis (ABP) is an acute inflammatory reaction that occurs as a result of abnormal reflux of bile into the pancreatic duct, which activates pancreatic digestive enzymes to produce pancreatic auto-digestion. Objectives To explore the advantages of Endoscopic Retrograde Cholangiopancreatography (ERCP) treatment compared with laparoscopic surgery in the management of patients with mild and moderately severe ABP, and to study the risk factors for recurrence of ABP and construct a risk prediction model to assist in resolving clinical decision-making and improving prognosis. Methods Patients with mild and moderately severe ABP treated at General Hospital of Ningxia Medical University from January 1, 2019 to July 1, 2022 were reviewed. A total of 327 patients were enrolled according to the inclusion criteria and exclusion criteria. According to the different treatment modalities, they were divided into the group treated via ERCP (n = 239) and the group treated via laparoscopic surgery (n = 88). Statistical analyses were performed to compare the differences between the average levels of preoperative and postoperative blood routine and blood biochemical indexes, as well as the time of recovery from clinical symptoms, length of hospital stay, and postoperative complications between the two groups of patients. The 280 patients who participated in the follow-up were divided into the recurrence group (n = 130) and the non-recurrence group (n = 150) according to whether they had recurrence or not. Independent samples t-test and binary logistic regression were used to analyze the causative monofactors and risk factors of recurrent biliary pancreatitis, and then to construct the model and assess the predictive accuracy of the model. Results On postoperative day 2, the incidence of local complications, Balthazar CT score, and the number of analgesia were lower in the patients in the group treated by ERCP than in the group treated by laparoscopic surgery (P < 0.001), and the duration of antibiotics, enzyme-suppressing medication, fasting, and hospital stay were shorter in the patients in the group treated by ERCP than in the group treated by laparoscopic surgery (P < 0.001). Personal history, gamma glutamyl transpeptidase (GGT), and treatment modality are risk factors for recurrence of biliary pancreatitis. The model constructed by combining GGT, personal history, and treatment modality had the best predictive ability for disease recurrence compared with the model with GGT, personal history, and treatment modality alone (area under the ROC curve 0.815). Conclusion Compared with the laparoscopic surgery group, ERCP treatment can effectively relieve symptoms and restore gastrointestinal function in advance in patients with ABP, and reduce hospitalisation time and related complications. Personal history, GGT, and treatment modality are risk factors for recurrence of biliary pancreatitis. Patients can prevent recurrence by abstaining from smoking and alcohol, eating a healthy diet, and exercising appropriately.
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Affiliation(s)
- Chengsi Zhao
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan City, Ning Xia Province, China
| | - Zuoquan Wang
- Department of General Surgery, the Third Affiliated Hospital of Xi'an Medical University, Xi'an City, Shan Xi Province, China
| | - Yanrong Yao
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan City, Ning Xia Province, China
| | - Weijie Yao
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan City, Ning Xia Province, China
| | - Zuozheng Wang
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan City, Ning Xia Province, China
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Xiong R, Xiong D, Wu Z, Xiao X. Meta-analysis of the effectiveness of early endoscopic treatment of Acute biliary pancreatitis based on lightweight deep learning model. BMC Gastroenterol 2024; 24:292. [PMID: 39198766 PMCID: PMC11351377 DOI: 10.1186/s12876-024-03361-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 08/08/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Acute biliary pancreatitis (ABP) is a clinical common acute abdomen. After the first pancreatitis, relapse rate is high, which seriously affects human life and health and causes great economic burdens to family and society. According to a great many research findings, endoscopic retrograde cholangiopancreatography (ERCP) is an effective treatment method. However, whether ERCP should be performed in early stage of ABP is still controversial in clinical practice. METHODS Related articles were retrieved from Pubmed, Web of Science core library, Nature, Science Direct, and other databases published from January 2000 until now. The keywords included early ERCP, delayed ERCP, ABP, laparoscopy, and cholecystectomy, all which were connected by "or" and "and". The language of articles was not restricted during the retrieval and Review Manager5.3 was employed to perform meta-analysis of experimental data. Finally, a total of 8 eligible articles were selected, including 8,801 patients. RESULTS The results of the meta-analysis demonstrated that no remarkable differences were detected in the incidence of complications, mortality, and operation time between patients undergoing ERCP in early stage and those receiving delayed ERCP. However, the hospitalization time of patients in experimental group was notably shorter than that among patients in control group. CONCLUSINS Early ERCP treatment is as safe as late ERCP treatment for biliary pancreatitis, and can significantly shorten the hospital stay. Hence, the therapy was worthy of clinical promotion. The research findings provided reference and basis for clinical treatment of relevant diseases.
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Affiliation(s)
- Rihui Xiong
- Department of Hepatopancreatobiliary Surgery, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang NO.1 People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Danjuan Xiong
- Department of Hepatopancreatobiliary Surgery, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang NO.1 People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Zhaoping Wu
- Department of Hepatopancreatobiliary Surgery, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang NO.1 People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Xifeng Xiao
- Department of Gastroenterology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang NO.1 People's Hospital, Jiujiang, 332000, Jiangxi, China.
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Ng AP, Seo YJ, Ali K, Coaston T, Mallick S, de Virgilio C, Benharash P. National analysis of outcomes in timing of cholecystectomy for acute cholangitis. Am J Surg 2024:115851. [PMID: 39107174 DOI: 10.1016/j.amjsurg.2024.115851] [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: 04/08/2024] [Revised: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND The present study aimed to compare outcomes between cholecystectomy on index versus delayed admission for acute cholangitis. METHODS The 2011-2020 Nationwide Readmissions Database was used to identify adult patients admitted for acute cholangitis who underwent cholecystectomy. Study cohorts were defined based on timing of surgery. Multivariable regressions and Royston-Parmar time-adjusted analysis were used to evaluate the association of cholecystectomy timing and outcomes. RESULTS Of 65,753 patients, 82.0 % received surgery on Index and 18.0 % on Delayed admissions. Following adjustment, Delayed operation was associated with significantly increased odds of mortality (AOR 1.67 [95 % CI 1.10-2.54]), complications (1.25 [1.13-1.40]), repair of bile duct injury (1.66 [1.15-2.41]), conversion to open (1.69 [1.48-1.93]), and 30-day readmission (3.52 [3.21-3.86]). The Delayed cohort experienced a +$14,200 increment in hospitalization costs relative to Index. CONCLUSIONS Delayed cholecystectomy for acute cholangitis is significantly associated with adverse postoperative outcomes, suggesting that index cholecystectomy may be safe to perform.
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Affiliation(s)
- Ayesha P Ng
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Young-Ji Seo
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Konmal Ali
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Troy Coaston
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Saad Mallick
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Peyman Benharash
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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McDermott J, Kao LS, Keeley JA, Nahmias J, de Virgilio C. Management of Gallstone Pancreatitis: A Review. JAMA Surg 2024; 159:818-825. [PMID: 38691369 DOI: 10.1001/jamasurg.2023.8111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Importance Gallstone pancreatitis (GSP) is the leading cause of acute pancreatitis, accounting for approximately 50% of cases. Without appropriate and timely treatment, patients are at increased risk of disease progression and recurrence. While there is increasing consensus among guidelines for the management of mild GSP, adherence to these guidelines remains poor. In addition, there is minimal evidence to guide clinicians in the treatment of moderately severe and severe pancreatitis. Observations The management of GSP continues to evolve and is dependent on severity of acute pancreatitis and concomitant biliary diagnoses. Across the spectrum of severity, there is evidence that goal-directed, moderate fluid resuscitation decreases the risk of fluid overload and mortality compared with aggressive resuscitation. Patients with isolated, mild GSP should undergo same-admission cholecystectomy; early cholecystectomy within 48 hours of admission has been supported by several randomized clinical trials. Cholecystectomy should be delayed for patients with severe disease; for severe and moderately severe disease, the optimal timing remains unclear. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) is only useful for patients with suspected cholangitis or biliary obstruction, although the concomitance of these conditions in patients with GSP is rare. Modality of evaluation of the common bile duct to rule out concomitant choledocholithiasis varies and should be tailored to level of concern based on objective measures, such as laboratory results and imaging findings. Among these modalities, intraoperative cholangiography is associated with reduced length of stay and decreased use of ERCP. However, the benefit of routine intraoperative cholangiography remains in question. Conclusions and Relevance Treatment of GSP is dependent on disease severity, which can be difficult to assess. A comprehensive review of clinically relevant evidence and recommendations on GSP severity grading, fluid resuscitation, timing of cholecystectomy, need for ERCP, and evaluation and management of persistent choledocholithiasis can help guide clinicians in diagnosis and management.
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Affiliation(s)
- James McDermott
- David Geffen School of Medicine, University of California, Los Angeles
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Jessica A Keeley
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Jeffry Nahmias
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
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Bhaskaran P, Swaminathan C, Krasicka D, Gilbert JA, Bhaskaran IP, Khan M. A Systematic Review and Meta-Analysis of the Management of Gallstone Cholecystitis and Common Biliary Duct Stones to Reduce the Incidence of Complications in Elderly Patients. Cureus 2024; 16:e63115. [PMID: 38947136 PMCID: PMC11211966 DOI: 10.7759/cureus.63115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/02/2024] Open
Abstract
As the age increases particularly above the age of 50 years, there is a significantly higher risk of developing gallstone-related complications especially cholecystitis and common bile duct stones with its associated consequences. Complications that arise after surgical operations for cholecystitis have been reported to have negative impacts on senior patients. These effects include a higher rate of complications, a longer hospital stay, higher expenditures, and decreased patient satisfaction. Therefore, finding the most effective treatment for cholecystitis in older patients is still a challenge. The aim of the study was carried out in order to identify many approaches that can be taken in the treatment of cholecystitis and stones in the common bile duct in older patients. A search was conducted through Medline (PubMed), EMBASE, ProQuest, and Cochrane using relevant Medical Subject Heading (MeSH) terms and keywords (elderly, age over 50, cholecystitis, bile duct stones, cholecystectomy, ERCP, surgical, conservative management, and open). The searches were limited to studies on elderly individuals over 50 who had cholecystectomy and endoscopic retrograde cholangiopancreatography between January 2000 and December 2022. The meta-analysis used the Mantel-Haenszel odds ratio (MHOR) and 95% confidence interval (CI). Aries Systems Corporation's Editorial Manager® (Aries Systems Corporation, North Andover, USA) and ProduXion Manager® (Aries Systems Corporation, North Andover, USA) facilitated the study. Out of 102 citations, 39 studies were selected for further study. After that, 18 studies were eliminated, leaving 21 for meta-analysis. The study found a protective risk of cholecystitis in cholecystectomy patients (MHOR = 0.16; 95%, CI = 0.10 to 0.25; p 0.001). Developing cholecystitis was substantially lower in early cholecystectomy patients (MHOR = 0.16; 95%, CI = 0.10 to 0.25; p 0.001). There was no significant difference in cholecystitis risk between open and laparoscopic surgery (MHOR = 0.65; 95%, CI = 0.41 to 1.04; p 0.07). Cholecystectomy performed at an earlier stage protects elderly patients from developing recurrent cholecystitis. In contrast to late cholecystitis, in which the patient would experience several attacks of cholecystitis, early cholecystectomy protects against the recurrence of the condition.
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Affiliation(s)
- Premjithlal Bhaskaran
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College London, London, GBR
| | - Christie Swaminathan
- Department of Gastrointestinal Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
| | - Dominika Krasicka
- Department of Gastrointestinal Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
| | - James A Gilbert
- Department of Surgery, The New Foscote Hospital, Banbury, GBR
- Department of Digestive Disease and General Surgery, Royal Sussex County Hospital, Brighton, GBR
| | - India P Bhaskaran
- Department of Cardiovascular Surgery, Imperial College London, London, GBR
| | - Mansoor Khan
- Department of General Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
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Lee IC, Li J. Indocyanine-green fluoresced imaging guided fundus-first approach for early laparoscopic cholecystectomy in a patient with acute biliary pancreatitis and a difficult gallbladder. Asian J Surg 2024; 47:626-627. [PMID: 37805333 DOI: 10.1016/j.asjsur.2023.09.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- I-Chin Lee
- Department of Surgery, Jiahui International Hospital, Jiahui Health, Shanghai, China
| | - Jun Li
- Department of Surgery, Jiahui International Hospital, Jiahui Health, Shanghai, China.
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7
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Bergeron E, Doyon T, Manière T, Désilets É. Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event. Surg Endosc 2023; 37:9546-9555. [PMID: 37726412 PMCID: PMC10709473 DOI: 10.1007/s00464-023-10423-0] [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: 03/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Gallstone disease will affect 15% of the adult population with concomitant common bile duct stone (CBDS) occurring in up to 30%. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for removal of CBDS, as cholecystectomy for the prevention of recurrent biliary event (RBE). RBE occurs in up to 47% if cholecystectomy is not done. The goal of this study was to evaluate the timing of occurrence of RBE after common bile duct clearance with ERCP and associated outcomes. METHODS The records of all patients who underwent ERCP for gallstone disease followed by cholecystectomy, in a single center from 2010 to 2022, were reviewed. All RBE were identified. Actuarial incidence of RBE was built. Patients with and without RBE were compared. RESULTS The study population is composed of 529 patients. Mean age was 58.0 (18-95). There were 221 RBE in 151 patients (28.5%), 39/151 (25.8%) having more than one episode. The most frequent RBE was acute cholecystitis (n = 104) followed by recurrent CBDS (n = 95). Median time for first RBE was 34 days. Actuarial incidence of RBE started from 2.5% at 7 days to reach 53.3% at 1 year. Incidence-rate of RBE was 2.9 per 100 person-months. Patients with RBE had significant longer hospitalisation time (11.7 vs 6.4 days; P < 0.0001), longer operative time (66 vs 48 min; P < 0.0001), longer postoperative stay (2.9 vs 0.9 days; P < 0.0001), higher open surgery rate (7.9% vs 1.3%; P < 0.0001), and more complicated pathology (23.8% vs 5.8%; P < 0.0001) and cholecystitis (64.2% vs 25.9%; P < 0.0001) as final diagnoses. CONCLUSIONS RBE occurred in 28.5% of the subjects at a median time of 34 days, with an incidence of 2.5% as early as 1 week. Cholecystectomy should be done preferably within 7 days after common bile duct clearance in order to prevent RBE and adverse outcomes.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles-LeMoyne Hospital, 3120, Boulevard Taschereau, Greenfield Park, QC, J4V 2H1, Canada.
| | - Théo Doyon
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
| | - Thibaut Manière
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
| | - Étienne Désilets
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
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Vázquez-Frias R, Rivera-Suazo Y, Aguayo-Elorriaga AK, Alfaro-Bolaños JE, Argüello-Arévalo GA, Cadena-León JF, Chávez-Sáenz JA, Consuelo-Sánchez A, Cruz-Romero EV, Espinosa-Saavedra D, Espriu-Ramírez MX, Flores-Calderón J, González-Ortiz B, Hernández-Rosiles V, Ignorosa-Arellano KR, Jaramillo-Esparza CM, Lozano-Hernández FR, Larrosa-Haro A, Leal-Quiroga U, Macias-Flores JA, Martínez-Leo BA, Martínez-Vázquez A, Mendoza-Tavera NMJ, Pacheco-Sotelo S, Reyes-Apodaca M, Sánchez-Ramírez CA, Sifuentes-Vela CA, Sosa-Arce M, Zárate-Mondragón FE. The Asociación Mexicana de Gastroenterología consensus on the diagnosis and treatment of acute pancreatitis in children and adolescents. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:267-281. [PMID: 37336694 DOI: 10.1016/j.rgmxen.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/12/2023] [Indexed: 06/21/2023]
Abstract
Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting.
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Affiliation(s)
- R Vázquez-Frias
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico.
| | - Y Rivera-Suazo
- Hospital Star Médica Infantil Privado, Mexico City, Mexico
| | - A K Aguayo-Elorriaga
- Hospital Pediátrico Coyoacán, Secretaría de Salud de la Ciudad de México, Mexico City, Mexico
| | - J E Alfaro-Bolaños
- Servicio de Gastroenterología, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | | | - J F Cadena-León
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - A Consuelo-Sánchez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
| | - E V Cruz-Romero
- Servicio de Cirugía, Centro Médico Naval, Mexico City, Mexico
| | - D Espinosa-Saavedra
- Departamento de Gastroenterología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - M X Espriu-Ramírez
- Servicio de Gastroenterología Pediátrica, Hospital General de Cancún Dr. Jesús Kumate Rodríguez, Cancún, Quintana Roo, Mexico
| | - J Flores-Calderón
- Departamento de Gastroenterología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - B González-Ortiz
- Departamento de Gastroenterología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - V Hernández-Rosiles
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
| | - K R Ignorosa-Arellano
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - C M Jaramillo-Esparza
- Departamento de Gastroenterología y Endoscopia Pediátrica, Hospital Ángeles Universidad, Mexico City, Mexico
| | - F R Lozano-Hernández
- Servicio de Gastroenterología Pediátrica, Centro Médico Naval, Mexico City, Mexico
| | - A Larrosa-Haro
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Departamento de Reproducción Humana Crecimiento y Desarrollo Infantil, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - U Leal-Quiroga
- Servicio de Gastroenterología, Christus Muguerza Hospital Sur, Monterrey, Nuevo León, Mexico
| | - J A Macias-Flores
- Departamento de Gastroenterología, Hospital Infantil de Especialidades de Chihuahua, Chihuahua, Chihuahua, Mexico
| | - B A Martínez-Leo
- Hospital Pediátrico Moctezuma, Secretaría de Salud de la Ciudad de México, Mexico City, Mexico
| | - A Martínez-Vázquez
- Departamento de Gastroenterología y Nutrición Pediátrica, Hospital para el Niño Poblano, Puebla, Puebla, Mexico
| | | | - S Pacheco-Sotelo
- Servicio de Gastroenterología y Nutrición Pediátrica, UMAE, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano de Seguro Social, Guadalajara, Jalisco, Mexico
| | - M Reyes-Apodaca
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | | | - M Sosa-Arce
- Departamento de Gastroenterología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - F E Zárate-Mondragón
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
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Predictors of poor outcomes after cholecystectomy in gallstone pancreatitis: NSQIP analysis of 30-day morbidity and mortality. LANGENBECK'S ARCHIVES OF SURGERY 2022; 408:5. [PMID: 36585495 DOI: 10.1007/s00423-022-02731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/15/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Contemporary nationwide outcomes of gallstone pancreatitis (GSP) managed by cholecystectomy at the index hospitalization are limited. This study aims to define the rate of 30-day morbidity and mortality and identify associated perioperative risk factors in patients undergoing cholecystectomy for GSP. METHODS Patients from the ACS-NSQIP database with GSP without pancreatic necrosis, who underwent cholecystectomy during the index hospitalization from 2017 to 2019 were selected. Factors associated with 30-day morbidity and mortality were analyzed. RESULTS Of the 4021 patients identified, 1375 (34.5%) were male, 2891 (71.9%) were White, 3923 (97.6%) underwent laparoscopic surgery, and 52.4 years (SD ± 18.9) was the mean age. There were 155 (3.8%) patients who developed morbidity and 15 (0.37%) who died within 30 days of surgery. In bivariate regression analysis, both 30-day morbidity and mortality were associated with older age, elevated pre-operative BUN, hypertension, chronic obstructive pulmonary disease, congestive heart failure, acute kidney injury, and dyspnea. ASA of I or II and laparoscopic surgery were protective against 30-day morbidity and mortality. In multivariable regression analysis, factors independently associated with increased 30-day morbidity included preoperative SIRS/sepsis [OR: 1.68 (95% CI: 1.01-2.79), p = 0.048], and age [OR: 1.03 (95% CI: 1.01-1.04), p = 0.001]. Factors associated with increased 30-day mortality included tobacco use [OR: 8.62 (95% CI: 2.11-35.19), p = 0.003] and age [OR: 1.10 (95% CI: 1.04-1.17), p = 0.002]. CONCLUSIONS Patients with GSP without pancreatic necrosis can undergo cholecystectomy during the index admission with very low risk of 30-day morbidity or mortality.
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10
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Evaluation of early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis: a prospective, randomized study. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:139-144. [PMID: 36601493 PMCID: PMC9763484 DOI: 10.7602/jmis.2022.25.4.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
Purpose Uncertainty exists about whether early laparoscopic cholecystectomy (LC) is an appropriate surgical treatment for acute calculous cholecystitis. This study aimed to compare early vs. late LC for acute calculous cholecystitis regarding intraoperative difficulty and postoperative outcomes. Methods This was a prospective randomized study carried out between December 2015 and June 2017; 60 patients with acute calculous cholecystitis were divided into two groups (early and delayed groups), each comprising 30 patients. Thirty patients treated with LC within 3 to 5 days of arrival at the hospital were assigned to the early group. The other 30 patients were placed in the delayed group, first treated conservatively, and followed by LC 3 to 6 weeks later. Results The conversion rates in both groups were 6.7% and 0%, respectively (p = 0.143). The operating time was 56.67 ± 11.70 minutes in the early group and 75.67 ± 20.52 minutes in the delayed group (p = 0.001), and both groups observed equal levels of postoperative complications. Early LC patients, on the other hand, required much fewer postoperative hospital stay (3.40 ± 1.99 vs. 6.27 ± 2.90 days, p = 0.006). Conclusion Considering shorter operative time and hospital stay without significant increase of open conversion rates, early LC might have benefits over late LC.
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Tozlu M, Karaca B, Acar S, Toka B, Karacaer C, Eminler AT, Köksal AS. Higher Complications During the Waiting Period for Interval Cholecystectomy in Patients With Mild Biliary Pancreatitis. Surg Laparosc Endosc Percutan Tech 2022; 32:655-660. [PMID: 36468890 DOI: 10.1097/sle.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/06/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Although current guidelines recommend cholecystectomy during the same admission in patients with mild acute biliary pancreatitis (ABP), it involves a waiting list most of the time. We aimed to assess the risk of complications and determine predictors during the waiting period for cholecystectomy after the first episode of ABP. METHODS A prospective observational study was conducted in patients with mild ABP. Follow-ups were done by phone calls or using electronic health records for a maximum of 6 months after discharge or until cholecystectomy. RESULTS A total of 194 patients were included in the study. Although all patients were referred to surgeons, only 81 (41.8%) underwent cholecystectomy within 6 months after discharge. During the observation period, gallstone-related biliary events (GRBEs) developed in 68 (35.1%) patients, which included biliary colic, recurrent ABP, acute cholecystitis, choledocholithiasis, gallbladder perforation, cholangitis, and liver abscess. The overall readmission rate was 25.2%, with 44.8% occurred within 4 weeks after discharge. The odds ratio of any complication was 1.58 (95% CI, 1.42 to 1.76, P =0.028) and 1.59 (95% CI, 1.42 to 1.78, P =0.009) in the patients who did not have surgery within 2 to 7 days and 8 to 15 days, respectively. A 4-fold increased risk of readmission was detected (95% CI, 1.16 to 13.70, P =0.019) if cholecystectomy was not performed within 31 to 90 days. The patients who developed complications had significantly higher C-reactive protein at admission, longer waiting time, and had 3 or more gallstones on imaging. CONCLUSIONS Interval cholecystectomy was associated with a high risk of complications during the waiting period in patients with mild ABP.
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Affiliation(s)
| | - Busra Karaca
- Internal Medicine, Sakarya University Faculty of Medicine, Sakarya
| | | | - Bilal Toka
- Department of Gastroenterology, Silivri Anadolu Hospital, Istanbul, Turkey
| | - Cengiz Karacaer
- Internal Medicine, Sakarya University Faculty of Medicine, Sakarya
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12
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Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, Beyer G, Sutton R. Acute Pancreatitis: Diagnosis and Treatment. Drugs 2022; 82:1251-1276. [PMID: 36074322 PMCID: PMC9454414 DOI: 10.1007/s40265-022-01766-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/11/2022]
Abstract
Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal cross-sectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.
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Affiliation(s)
- Peter Szatmary
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Wenhao Cai
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Rajarshi Mukherjee
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool , UK
| | - Chris Halloran
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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13
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Blundell JD, Gandy RC, Close J, Harvey L. Cholecystectomy for people aged 50 years or more with mild gallstone pancreatitis: predictors and outcomes of index and interval procedures. Med J Aust 2022; 217:246-252. [PMID: 35452133 PMCID: PMC9545298 DOI: 10.5694/mja2.51492] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/25/2022] [Indexed: 12/13/2022]
Abstract
Objectives To estimate the proportions of people aged 50 years or more with mild gallstone pancreatitis who undergo index cholecystectomy (during their initial hospital admission) or interval cholecystectomy (during a subsequent admission); to compare outcomes following index and interval cholecystectomy; and to identify factors associated with undergoing interval cholecystectomy. Design, setting, participants Analysis of linked hospitalisation and deaths data for all people aged 50 years or more with mild gallstone pancreatitis who underwent cholecystectomy in New South Wales within twelve months of their index admission, 1 July 2008 ‒ 30 June 2018. Main outcome measures Cholecystectomy classification (index or interval). Secondary outcomes: all‐cause mortality (30‒365 days), emergency re‐admissions with gallstone‐related disease (within 28 or 180 days of discharge); hospital lengths of stay (index admission, and all admissions with gallstone‐related disease over six months). Results A total of 1836 patients underwent index cholecystectomy (37.9%) and 3003 interval cholecystectomy (62.1%). Mortality to twelve months was similar in the two groups. Larger proportions of people who underwent interval cholecystectomy were re‐admitted within 28 days (246, 8.2% v 23, 1.3%) or 180 days (527, 17.6% v 59, 3.2%), or required open cholecystectomy (238, 7.9% v 69, 3.8%). Mean index admission length of stay was longer for index than interval cholecystectomy (7.7 [SD, 4.7] days v 5.3 [SD, 3.9] days), but six‐month total length of stay was similar (8.2 [SD, 5.6] days v 7.9 [SD, 5.8] days). Interval cholecystectomy was more likely for patients with three or more comorbid conditions (adjusted odds ratio [aOR], 1.29; 95% CI, 1.08‒1.55) or private health insurance (aOR, 1.31; 95% CI, 1.13‒1.51), and for those admitted to low surgical volume hospitals (aOR, 1.84; 95% CI, 1.03‒3.31). Conclusions Most NSW people over 50 with mild gallstone pancreatitis did not undergo index cholecystectomy, despite recommendations in international guidelines. Delayed cholecystectomy was associated with more frequent open cholecystectomy procedures and gallstone disease‐related emergency re‐admissions, as well as with low or medium hospital surgical volume, comorbidity, and having private insurance.
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Affiliation(s)
- Jian D Blundell
- Prince of Wales Hospital and Community Health Services Sydney NSW
- Falls, Balance and Injury Research Centre Neuroscience Research Australia Sydney NSW
| | - Robert C Gandy
- Prince of Wales Hospital and Community Health Services Sydney NSW
- Prince of Wales Clinical School University of New South Wales Sydney NSW
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre Neuroscience Research Australia Sydney NSW
- Prince of Wales Clinical School University of New South Wales Sydney NSW
| | - Lara Harvey
- Falls, Balance and Injury Research Centre Neuroscience Research Australia Sydney NSW
- University of New South Wales Sydney NSW
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14
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Liu JK, Braschi C, de Virgilio CM, Ozao-Choy J, Kim DY, Moazzez A. Early Cholecystectomy in Gallstone Pancreatitis Patients With and Without End Organ Dysfunction: A NQSIP Analysis. Am Surg 2022; 88:2579-2583. [PMID: 35767313 DOI: 10.1177/00031348221109488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION While literature widely supports early cholecystectomy for mild gallstone pancreatitis (GSP), this has not been reflected in clinical practice. Early cholecystectomy for GSP with end organ dysfunction remains controversial. OBJECTIVE This study aims to evaluate the rate and outcomes of early cholecystectomy (<3 days from admission) in mild GSP patients with end organ dysfunction (+EOD) and without (-EOD). METHODS Patients with GSP without necrosis were identified from 2017 to 2019 NSQIP database and categorized into GSP±EOD. Coarsened Exact Matching was used to match patients based on preoperative risk factors in each group, and outcomes were compared. RESULTS There was a total of 3104 patients -EOD and 917 +EOD in the aggregate cohort. Early cholecystectomy was performed in 1520 (49.0%) of GSP-EOD and in 407 (44.4%) of GSP+EOD. In the matched cohorts, there were no significant differences in 30-day mortality, morbidity, or reoperation for early cholecystectomy in either group. In GSP-EOD, early cholecystectomy was associated with shorter LOS (2.9 ± 1.5 vs. 5.6 ± 3.0 days, P < .001), shorter operative time (69.7 ± 34.4 vs. 73.3 ± 36.6 min, P = .045), and more concurrent biliary procedures (52.1% vs. 35.4%, P < .001). Similarly, early cholecystectomy in GSP+EOD was associated with shorter LOS (3.3 ± 1.8 vs. 6.9 ± 6.6 days, P < .001), shorter operative time (65.9 ± 32.1 vs. 76.0 ± 40.7, P < .001), and more concurrent biliary procedure (46.0% vs. 34.9%, P = .002). CONCLUSIONS This study supports early cholecystectomy in patients with mild GSP. Even with end organ dysfunction, early cholecystectomy appears to be safe given there is no difference in morbidity and mortality, and the potential benefit of reduced LOS.
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Affiliation(s)
- Jessica K Liu
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Caitlyn Braschi
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Junko Ozao-Choy
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Dennis Y Kim
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ashkan Moazzez
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
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15
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Early Versus Delayed Cholecystectomy for Acute Biliary Pancreatitis: A Systematic Review and Meta-Analysis. World J Surg 2022; 46:1359-1375. [DOI: 10.1007/s00268-022-06501-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/15/2022]
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16
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Hormati A, Ghadir MR, Alemi F, Eshraghi M, Dehghan K, Sarkeshikian SS, Ahmadpour S, Jabbari A, Sivandzadeh GR, Mohammadbeigi A. Efficacy of Common Bile Duct Stenting on the Reduction in Gallstone Migration and Symptoms Recurrence in Patients with Biliary Pancreatitis Who Were Candidates for Delayed Cholecystectomy. Dig Dis Sci 2022; 67:315-320. [PMID: 33742291 DOI: 10.1007/s10620-021-06904-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND In patients with severe biliary pancreatitis, delayed cholecystectomy associated with a high risk of recurrence is recommended. The current study aimed to evaluate the effect of common bile duct (CBD) stenting on reducing gallstones migration and recurrence of symptoms in patients with pancreatitis and delayed cholecystectomy candidates. METHODS To this purpose, the randomized, controlled clinical trial was performed on 40 patients with biliary pancreatitis who were candidates for delayed cholecystectomy. Patients were randomly divided into two groups of A and B that underwent CBD stenting after ERCP and received endoscopic treatment without stenting, respectively. A checklist recorded demographics and complications. Group A was followed up after four weeks to remove the stent and record the complications. Group B underwent MRCP to examine the migration of new gallstones as well as the complications. RESULTS Of the 40 patients, 20 subjects (11 males and 9 females) were allocated to each group, matched for demographic variables. In the one-month follow-up, only one subject in group A manifested symptoms of gallstone migration and recurrence, while in group B, recurrence was observed in 6 patients (P = 0.037). There was no significant difference in the success rate of ERCP and the incidence of complications between the two groups. CONCLUSION CBD stenting in patients with biliary pancreatitis and gallstone could reduce the risk of recurrence and remigration of gallstones in delayed cholecystectomy cases.
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Affiliation(s)
- Ahmad Hormati
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran.,Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ghadir
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Faezeh Alemi
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Mohsen Eshraghi
- Department of Surgery, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Khosro Dehghan
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Seyed Saeid Sarkeshikian
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran.
| | - Sajjad Ahmadpour
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Amir Jabbari
- Department of Internal Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Gholam Reza Sivandzadeh
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abolfazl Mohammadbeigi
- Department of Biostatistics and Epidemiology, School of Health Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
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17
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Gangu K, Bobba A, Chela HK, Basar O, Min RW, Tahan V, Daglilar E. Cutting out Cholecystectomy on Index Hospitalization Leads to Increased Readmission Rates, Morbidity, Mortality and Cost. Diseases 2021; 9:diseases9040089. [PMID: 34940027 PMCID: PMC8699900 DOI: 10.3390/diseases9040089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
Biliary tract diseases that are not adequately treated on index hospitalization are linked to worse outcomes, including high readmission rates. Delays in care for conditions such as choledocholithiasis, gallstone pancreatitis, and cholecystitis often occur due to multiple reasons, and this delay is under-appreciated as a source of morbidity and mortality. Our study is based on the latest Nationwide Readmissions Database review and evaluated the effects of postponing definitive management to a subsequent visit. The study shows a higher 30-day readmission rate in addition to increased mortality rate, intubation rate, vasopressor use in this patient population and significantly added financial burden.
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Affiliation(s)
- Karthik Gangu
- Division of Hospital Medicine, Department of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | - Aniesh Bobba
- Division of Hospital Medicine, Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL 60612, USA;
| | - Harleen Kaur Chela
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, USA; (H.K.C.); (O.B.)
| | - Omer Basar
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, USA; (H.K.C.); (O.B.)
| | - Robert W. Min
- Department of Medicine, Rush Medical Collage, Chicago, IL 60612, USA;
| | - Veysel Tahan
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, USA; (H.K.C.); (O.B.)
- Correspondence: (V.T.); (E.D.)
| | - Ebubekir Daglilar
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, USA; (H.K.C.); (O.B.)
- Correspondence: (V.T.); (E.D.)
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18
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Iida H, Maehira H, Mori H, Kodama H, Tokuda A, Takebayashi K, Kojima M, Kaida S, Miyake T, Tani M. Attenuation around the gallbladder on plain abdominal computed tomography as a predictor of surgical difficulty in laparoscopic cholecystectomy. Asian J Endosc Surg 2021; 14:724-731. [PMID: 33684962 DOI: 10.1111/ases.12930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/30/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study examined whether abdominal plain computed tomography (CT) can predict surgical difficulty in acute cholecystitis. METHODS We retrospectively analyzed 84 consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis between January 2015 and December 2018. We distinguished three degrees of surgical difficulty based on the operative time and blood loss: difficult, both ≥120 minutes and ≥ 100 mL, respectively (n = 27); moderate, either ≥120 minutes or ≥ 100 mL, respectively (n = 30); and easy, both <120 minutes and < 100 mL, respectively (n = 27). We calculated the attenuation around the gallbladder on CT before surgery and compared the values among the three groups. RESULTS Mean age, albumin levels, C-reactive protein levels, and the CT attenuation around the gallbladder (P < .001) were significantly different between groups. The surgical difficulty was unrelated to the timing of surgery. The postoperative complications were more frequent in operations more than 72 hours after disease onset (P = .04) and with CT attenuation around the gallbladder of ≥1.4 (P = .036). CONCLUSION High attenuation around the gallbladder on plain CT predicted a high surgical difficulty of laparoscopic cholecystectomy. We recommend measuring the CT attenuation around the gallbladder in patients with acute cholecystitis.
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Affiliation(s)
- Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Hirokazu Kodama
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Aya Tokuda
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | | | - Masatsugu Kojima
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
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19
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Bagepally BS, Haridoss M, Sasidharan A, Jagadeesh KV, Oswal NK. Systematic review and meta-analysis of gallstone disease treatment outcomes in early cholecystectomy versus conservative management/delayed cholecystectomy. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000675. [PMID: 34261757 PMCID: PMC8280848 DOI: 10.1136/bmjgast-2021-000675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/04/2021] [Indexed: 01/07/2023] Open
Abstract
Background The effectiveness of early cholecystectomy for gallstone diseases treatment is uncertain compared with conservative management/delayed cholecystectomy. Aims To synthesise treatment outcomes of early cholecystectomy versus conservative management/delayed cholecystectomy in terms of its safety and effectiveness. Design We systematically searched randomised control trials investigating the effectiveness of early cholecystectomy compared with conservative management/delayed cholecystectomy. We pooled the risk ratios with a 95% CI, also estimated adjusted number needed to treat to harm. Results Of the 40 included studies for systematic review, 39 studies with 4483 patients are included in meta-analysis. Among the risk ratios of gallstone complications, pain (0.38, 0.20 to 0.74), cholangitis (0.52, 0.28 to 0.97) and total biliary complications (0.33, 0.20 to 0.55) are significantly lower with early cholecystectomy. Adjusted number needed to treat to harm of early cholecystectomy compared with conservative management/delayed cholecystectomy are, for pain 12.5 (8.3 to 33.3), biliary pancreatitis >1000 (50–100), common bile duct stones 100 (33.3 to 100), cholangitis (100 (25–100), total biliary complications 5.9 (4.3 to 9.1) and mortality >1000 (100 to100 000). Conclusions Early cholecystectomy may result in fewer biliary complications and a reduction in reported abdominal pain than conservative management. PROSPERO registration number 2020 CRD42020192612.
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Affiliation(s)
- Bhavani Shankara Bagepally
- ICMR-NIE Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Madhumitha Haridoss
- ICMR-NIE Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Akhil Sasidharan
- ICMR-NIE Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Kayala Venkata Jagadeesh
- Health Technology Assessment in India (HTAIn) Secretariat, Department of Health Research, MoHFW, GOI, New Delhi, India
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20
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Mitsunaga TM, Jimenez LS, Soares PFDC, Gestic MA, Utrini MP, Chaim FDM, Callejas-Neto F, Chaim EA, Cazzo E. Effect of transient obstructive cholestasis on liver histology: a cross-sectional study. SAO PAULO MED J 2021; 139:351-363. [PMID: 34161522 PMCID: PMC9615596 DOI: 10.1590/1516-3180.2020.0536.r1.1502021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The role of transient obstructive cholestasis on liver histology remains undetermined. OBJECTIVE To investigate whether transient cholestasis impairs liver histology. DESIGN AND SETTING Cross-sectional study at a public university hospital (UNICAMP), Brazil. METHODS 169 individuals undergoing cholecystectomy, with or without cholestasis. were enrolled. Histopathological findings were correlated with clinical and biochemical characteristics. RESULTS Biliary hepatopathy was more frequent in individuals with resolved cholestasis than in those with active obstruction or no jaundice (P < 0.01), as also were fibrosis and ductular proliferation (P = 0.02). Cholestasis was commoner in individuals with resolved obstruction than in those with no history (P < 0.01) or active cholestasis (P < 0.05). Biliary hepatopathy was associated with longer duration of cholestasis (P < 0.001) and higher bilirubin levels (P = 0.02) in individuals with active obstruction; with lower body mass index (P = 0.02) and longer cholestasis (P < 0.001) in individuals with resolved obstruction; and with longer cholestasis (P < 0.001) and longer interval between endoscopic retrograde cholangiopancreatography and surgery (P = 0.03) overall. In individuals with active obstruction, duration of cholestasis (R = 0.7; P < 0.001) and bilirubin levels (R = 0.6; P = 0.004) were independently correlated with cholestasis severity. Duration of cholestasis (R = 0.7; P < 0.001) was independently correlated with ductular proliferation severity. CONCLUSIONS Transient cholestasis was associated with significant histopathological changes, even after its resolution. Longer duration of obstruction correlated with greater severity of histopathological changes, especially cholestasis and ductular proliferation. This emphasizes the need for early treatment of obstructive cholestasis.
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Affiliation(s)
- Thalita Mendes Mitsunaga
- MD. Resident Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Laísa Simakawa Jimenez
- MD. Resident Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Pedro França da Costa Soares
- MD, MSc. Postgraduate Student, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Martinho Antonio Gestic
- MD, MSc. Attending Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Murillo Pimentel Utrini
- MD. Attending Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Felipe David Mendonça Chaim
- MD, PhD. Attending Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Francisco Callejas-Neto
- MD, MSc. Assistant Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Elinton Adami Chaim
- MD, PhD. Full Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
| | - Everton Cazzo
- MD, PhD. Adjunct Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade de Campinas (FCM-UNICAMP), Campinas (SP), Brazil.
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21
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Zheng Z, Ding YX, Qu YX, Cao F, Li F. A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:69. [PMID: 33553362 PMCID: PMC7859757 DOI: 10.21037/atm-20-4802] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acute pancreatitis (AP) is an inflammatory disease that can progress to severe acute pancreatitis (SAP), which increases the risk of death. AP is characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. Other contributing factors may include calcium (Ca2+) overload, mitochondrial dysfunction, impaired autophagy, and endoplasmic reticulum (ER) stress. In addition, exosomes are also associated with pathophysiological processes of many human diseases and may play a biological role in AP. However, the pathogenic mechanism has not been fully elucidated and needs to be further explored to inform treatment. Recently, the treatment guidelines have changed; minimally invasive therapy is advocated more as the core multidisciplinary participation and "step-up" approach. The surgical procedures have gradually changed from open surgery to minimally invasive surgery that primarily includes percutaneous catheter drainage (PCD), endoscopy, small incision surgery, and video-assisted surgery. The current guidelines for the management of AP have been updated and revised in many aspects. The type of fluid to be used, the timing, volume, and speed of administration for fluid resuscitation has been controversial. In addition, the timing and role of nutritional support and prophylactic antibiotic therapy, as well as the timing of the surgical or endoscopic intervention, and the management of complications still have many uncertainties that could negatively impact the prognosis and patients' quality of life. Consequently, to inform clinicians about optimal treatment, we aimed to review recent advances in the understanding of the pathogenesis of AP and its diagnosis and management.
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Affiliation(s)
- Zhi Zheng
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yi-Xuan Ding
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yuan-Xu Qu
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Feng Cao
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
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Maurer LR, Maatman TK, Luckhurst CM, Horvath KD, Zyromski NJ, Fagenholz PJ. Risk of gallstone-related complications in necrotizing pancreatitis patients treated with a step-up approach: The experience of two tertiary care centers. Surgery 2020; 169:1086-1092. [PMID: 33323200 DOI: 10.1016/j.surg.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/15/2020] [Accepted: 11/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND A minimally invasive step-up approach to necrotizing biliary pancreatitis often requires multiple interventions, delaying cholecystectomy. The risk of gallstone-related complications during this time interval is unknown, as is the feasibility and safety of cholecystectomy after minimally invasive step-up treatment. In this paper, we analyzed both. METHODS Necrotizing pancreatitis patients treated with a minimally invasive step-up approach who underwent interval cholecystectomy at 2 tertiary care centers between 2014 and 2019 were included. Gallstone-related complications prior to cholecystectomy were examined, as were surgical approaches to cholecystectomy and complications. Necrotizing pancreatitis patients treated without mechanical intervention were also examined. RESULTS Seven of 31 patients developed gallstone-related complications between minimally invasive step-up treatment initiation and cholecystectomy. One patient developed biliary colic. Six patients developed acute cholecystitis. Two of these patients also developed choledocholithiasis, and 1 developed cholangitis, all requiring endoscopic retrograde cholangiopancreatography. Cholecystectomy was performed laparoscopically in 27 of 31 patients. One patient required open conversion, and 3 patients underwent planned cholecystectomy during another open operation. Four patients developed postoperative complications. Two of 14 necrotizing pancreatitis patients treated without mechanical intervention developed recurrent pancreatitis while awaiting cholecystectomy. CONCLUSION Over 20% of necrotizing pancreatitis patients treated by a minimally invasive step-up approach developed gallstone-related complications while awaiting cholecystectomy. Laparoscopic cholecystectomy is feasible and safe in the great majority of necrotizing pancreatitis patients treated by a minimally invasive step-up approach.
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Affiliation(s)
- Lydia R Maurer
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Thomas K Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | | | - Karen D Horvath
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Peter J Fagenholz
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA.
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The Role of Laparoscopic Cholecystectomy After Severe and/or Necrotic Pancreatitis in the Setting of Modern Minimally Invasive Management of Pancreatic Necrosis. Pancreas 2020; 49:935-940. [PMID: 32658078 DOI: 10.1097/mpa.0000000000001601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The trend toward minimally invasive procedures (MIP) in necrotizing pancreatitis is increasing. The optimal timing and technique of cholecystectomy in severe/necrotizing pancreatitis is unclear. This study aims to determine the role of laparoscopic cholecystectomy after severe/necrotizing pancreatitis in the context of MIP. METHODS Retrospective analysis of a prospective database was performed for consecutive patients after cholecystectomy for gallstone pancreatitis between January 2011 and January 2018 at Monash Health, Melbourne, Australia. RESULTS Three hundred fifty-five patients with gallstone pancreatitis underwent laparoscopic cholecystectomy with 2 conversions. Patients with severe pancreatitis were older (P = 0.002), with a more even sex distribution when compared with mild pancreatitis. Females predominated in the mild pancreatitis group.Patients with moderate/severe pancreatitis (P = 0.002) and necrosis (P > 0.001) were more likely to have delayed cholecystectomy compared with mild pancreatitis. There was no increase in biliary presentations while awaiting cholecystectomy. Length of stay for patients with severe/necrotizing pancreatitis (P = 0.001) was increased, surgical complications appeared similar. CONCLUSIONS Laparoscopic cholecystectomy can be performed safely and effectively for pancreatitis, irrespective of severity. The paradigm shift in the management of severe necrotizing pancreatitis away from open necrosectomy toward MIP can be extended to encompass laparoscopic cholecystectomy.
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The safety, feasibility, and cost-effectiveness of early laparoscopic cholecystectomy for patients with mild acute biliary pancreatitis: A meta-analysis. Surgeon 2020; 19:287-296. [PMID: 32709425 DOI: 10.1016/j.surge.2020.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 05/31/2020] [Accepted: 06/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND It remains controversial on the optimal timing of cholecystectomy for patients with mild acute biliary pancreatitis. This study aimed at comparing the safety, feasibility, and cost-effectiveness of early laparoscopic cholecystectomy (ELC, within 72 h after admission) versus delayed laparoscopic cholecystectomy (DLC, beyond 72 h after admission) for patients with mild acute biliary pancreatitis. METHODS We performed a systematic search in the following databases: PubMed, Embase, Web of Science, and Cochrane library. We only included articles from RCTs which designed to evaluate the complications, conversion to open cholecystectomy, recurrence of acute pancreatitis, the length of hospital stay, and costs between patients undergoing ELC and those undergoing DLC. We schemed to analyze data using STATA 15.0 with both the random-effects and the fixed-effect models. We computed relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI) based on the intention-to-treat (ITT) analysis. RESULTS A total of 4 studies involving 439 (215 vs 224) patients were included. The difference of complication rate [3.3% vs 3.2%; RR 1.03 (0.35, 3.01), P = 0.961] and rate of conversion to open cholecystectomy [3.8% vs 3.3%; RR 1.13 (0.37, 3.43), P = 0.830] are insignificant between patients who underwent ELC and ones who underwent DLC. The difference of rate of recurrence of acute pancreatitis is significant between ELC and DLC (2.17% vs 8.99%; RR 0.24 (0.08-0.70), P = 0.009). ELC does not shorten the length of hospital stay (random-effects model analysis: WMD -1.09 days (-2.67, 0.48), P = 0.173; fixed-effect model analysis: WMD -0.62 days (-1.00, -0.24), P = 0.001). CONCLUSION Compared to DLC, ELC is equally safe and feasible both in complication rate and rate of conversion to open procedure, and significantly reduces the recurrence rate of acute pancreatitis. PROSPERO REGISTRATION NUMBER CRD42018116239.
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Janjic G, Simatovic M, Skrbic V, Karabeg R, Radulj D. Early vs. Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis - Single Center Experience. Med Arch 2020; 74:34-38. [PMID: 32317832 PMCID: PMC7164737 DOI: 10.5455/medarh.2020.74.34-37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Laparoscopic cholecystectomy is now considered the procedure of choice that achieves a shorter recovery period after the surgery and reduction in the cost of treatment. Aim: The aim of the study is to prove which method: early or delayed laparoscopic cholecystectomy is the method of choice in the treatment of acute cholecystitis by examining: duration of hospitalization, conversion rate, duration of surgery, postoperative complications, and total cost. Methods: The study was conducted at the University Clinical Center of Republika Srpska as a retrospective-prospective study from May 1st 2013 until December 31st 2019. Patients diagnosed with acute cholecystitis were divided into two groups: Patients designated for early laparoscopic cholecystectomy within 72 hours of admission (group A–42 patients), Patients designated for initial conservative treatment followed by a delayed interval of 6-12 weeks until surgery (group B-42 patients). Results: In both groups, there were statistically significantly more female respondents. The results showed that the average cost of treatment in the early treated group was statistically significantly lower than the cost of treatment in the delayed treatment group. The patients in the early group had shorter hospitalization times (an average of 2.8 days and 5.6 days in the delayed group of patients), a smaller percentage of conversions (4.8% in the early and 16.7 in the delayed group of patients), the total cost of in the early group it was 1300.83 KM, while in the delayed group it was 1645.43 KM. Conclusion: Early laparoscopic cholecystectomy is a method to be preferred in surgical treatment.
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Affiliation(s)
- Goran Janjic
- Clinic for General and Abdominal Surgery, University Clinical Center Republic Srpska, Banja Luka, Bosna i Hercegovina
| | - Milan Simatovic
- Clinic for General and Abdominal Surgery, University Clinical Center Republic Srpska, Banja Luka, Bosna i Hercegovina
| | - Velimir Skrbic
- Clinic for General and Abdominal Surgery, University Clinical Center Republic Srpska, Banja Luka, Bosna i Hercegovina
| | - Reuf Karabeg
- Private Clinic "Karabeg",Sarajevo, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Dragan Radulj
- Clinic for General and Abdominal Surgery, University Clinical Center Republic Srpska, Banja Luka, Bosna i Hercegovina
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Davoodabadi A, Beigmohammadi E, Gilasi H, Arj A, Taheri Nassaj H. Optimizing cholecystectomy time in moderate acute biliary pancreatitis: A randomized clinical trial study. Heliyon 2020; 6:e03388. [PMID: 32099920 PMCID: PMC7031006 DOI: 10.1016/j.heliyon.2020.e03388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/16/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background In mild to moderate gallstone pancreatitis, cholecystectomy is the most appropriate treatment for prevention of further biliary attacks. However, the timing of cholecystectomy is not precisely determined. The present study was conducted to compare outcomes of very early (within 48 h) versus delayed (more than 1 week) laparoscopic cholecystectomy in patients with acute biliary pancreatitis (ABP). Methods This randomized clinical trial study was conducted in Shahid Beheshti Hospital of Kashan University of Medical Sciences from September 2016 to Mar 2019. Two hundred and eight cases with mild to moderate ABP were randomly assigned to 2 groups, with 104 patients in group 1 (operation within 48 h) and 104 in group 2 (operation after one week). Age, sex, biochemical parameters, clinical manifestation at the time of admission, operation time, recurrent biliary problems, relapse, peri-operative complications, conversion rate, and hospital length of stay in the two groups were recorded and compared. In addition, Ranson's score and Revised Atlanta criteria, the American Society of Anaesthesiologists Physical Status ASA-PS, Charlson Co-Morbidity Index (CCI), complexity of surgery and Clavien-Dindo score were also determined. Results There were no differences in demographics, peri-operative complications 4 (4%) vs. 4 (4%), P = 1), conversion rate (10.6% vs. 11.5%; P = 0.825) and procedure time (83 vs. 81 minutes, P = 0.110) between the two groups. There were no deaths in either group; however, the length of hospital stay was shorter in the early group compared to the delayed one, (3.66 ± 1.12 vs. 10.35 ± 1.76, P < 0.001). Conclusion Cholecystectomy within 48 h decreases significantly the length of hospital stay, without any difference in conversion rate, procedure time, or complication rate.
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Affiliation(s)
| | - Esmail Beigmohammadi
- Departments of surgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamidreza Gilasi
- Departments of Epidemiology& Biostatistics, Kashan University of Medical Sciences, Kashan, Iran
| | - Abbas Arj
- Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Taheri Nassaj
- Departments of surgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Departments of surgery, Kashan University of Medical Sciences, Kashan, Iran
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Giuffrida P, Biagiola D, Cristiano A, Ardiles V, de Santibañes M, Sanchez Clariá R, Pekolj J, de Santibañes E, Mazza O. Laparoscopic cholecystectomy in acute mild gallstone pancreatitis: how early is safe? Updates Surg 2020; 72:129-135. [PMID: 32009229 DOI: 10.1007/s13304-020-00714-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
The surgical strategy to resolve the underlying biliary pathology in patients with acute gallstone pancreatitis (AGP) remains controversial. The aim of this study was to evaluate the safety and effectiveness of early laparoscopic cholecystectomy (ELC) in patients with mild AGP. A retrospective cohort of consecutive patients diagnosed with mild AGP according to the Atlanta Guidelines from January 2009 to July 2019 was selected. Patients were assigned to surgery on the first available surgical shift, 48 h after the symptoms onset. Univariate analysis was performed to determine the association between AGP and grades of Balthazar (A, B and C) with time to surgery, days of hospitalization and postoperative complications. From 239 patients evaluated, 238 (99.58%) were operated by laparoscopic approach. Intraoperative cholangiogram was performed routinely. Choledocholithiasis, if present, was successfully treated by laparoscopic common bile duct exploration in all cases. A significant association was found between Balthazar grades and time to surgery (median of 3 days, p = 0.003), with length hospitalization and from surgery to discharge, with median of 4 days (p = 0.0001) and 2 days (p = 0.003), respectively. Mild postoperative complications (CD I/II) were observed in 22/239 patients (9.2%). This represents 2% of patients with grade A of Balthazar, 9% of grade B and 14% of grade C (p = 0.016). We observed no severe complications or mortality. ELC with routine intraoperative cholangiogram, performed on the first available surgical shift 48 h after the symptoms of pancreatitis onset, is a viable, effective and safe strategy for the resolution of mild AGP and its underlying biliary pathology in a single procedure.
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Affiliation(s)
- Pablo Giuffrida
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - David Biagiola
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Agustín Cristiano
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Victoria Ardiles
- HPB Surgery Section and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Martín de Santibañes
- HPB Surgery Section and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Rodrigo Sanchez Clariá
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Juan Pekolj
- HPB Surgery Section and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- HPB Surgery Section and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Oscar Mazza
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina.
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Zhong FP, Wang K, Tan XQ, Nie J, Huang WF, Wang XF. The optimal timing of laparoscopic cholecystectomy in patients with mild gallstone pancreatitis: A meta-analysis. Medicine (Baltimore) 2019; 98:e17429. [PMID: 31577759 PMCID: PMC6783238 DOI: 10.1097/md.0000000000017429] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/20/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The optimal timing of laparoscopic cholecystectomy (LC) in patients with mild acute gallstone pancreatitis (MAGP) is controversial. The aim of this study was to systematically evaluate and compare the safety and efficacy of early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) in patients with MAGP. METHODS A strict search was conducted of the electronic databases, including PubMed, MEDLINE Embase, the ISI Web of Science, and Cochrane Library for all relevant English literature and RevMan5.3 software for statistical analysis was used. RESULTS A total of 19 studies comprising 2639 patients were included. There was no significant difference in intraoperative complications [risk ratio (RR) = 1.46; 95% confidence interval (CI) = 0.88-2.41; P = .14)], postoperative complications (RR = 0.81; 95% CI = 0.58-1.14; P = .23), rate of conversion to open cholecystectomy (RR = 1.00; 95% CI = 0.75-1.33; P = .99), operative time (MD = 1.60; 95% CI = -1.36-4.56; P = .29), and rate of readmission (RR = 0.63; 95% CI = 0.19-2.10; P = .45) between the ELC and DLC groups. However, the ELC group was significantly correlated with lower length of hospital stay (MD = -2.01; 95% CI = -3.15 to -0.87; P = .0006), fewer gallstone-related events rates (RR = 0.17; 95% CI = 0.07-0.44; P = .0003), and lower endoscopic retrograde cholangiopancreatography (ERCP) usage (RR = 0.83; 95% CI = 0.71-0.97; P = .02) compared with the DLC group. CONCLUSION Early laparoscopic cholecystectomy is safe and effective for patients with MAGP, but the indications and contraindications must be strictly controlled.
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Affiliation(s)
- Fu-ping Zhong
- Department of Hepatobiliary Surgery, Pingxiang People's Hospital, Pingxiang
| | - Kai Wang
- Department of Hepatobiliary Surgery, Pingxiang People's Hospital, Pingxiang
- The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xue-qin Tan
- Department of Hepatobiliary Surgery, Pingxiang People's Hospital, Pingxiang
| | - Jian Nie
- Department of Hepatobiliary Surgery, Pingxiang People's Hospital, Pingxiang
| | - Wen-feng Huang
- Department of Hepatobiliary Surgery, Pingxiang People's Hospital, Pingxiang
| | - Xiao-fang Wang
- Department of Hepatobiliary Surgery, Pingxiang People's Hospital, Pingxiang
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Discolo A, Reiter S, French B, Hayes D, Lucas G, Tan L, Scanlan J, Martinez R. Outcomes following early versus delayed cholecystectomy performed for acute cholangitis. Surg Endosc 2019; 34:3204-3210. [DOI: 10.1007/s00464-019-07095-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
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Moody N, Adiamah A, Yanni F, Gomez D. Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis. Br J Surg 2019; 106:1442-1451. [PMID: 31268184 DOI: 10.1002/bjs.11221] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/14/2019] [Accepted: 04/03/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gallstones account for 30-50 per cent of all presentations of acute pancreatitis. While the management of acute pancreatitis is usually supportive, definitive treatment of gallstone pancreatitis is cholecystectomy. Guidelines from the British Society of Gastroenterology suggest definitive treatment on index admission or within 2 weeks of discharge, whereas joint recommendations from the International Association of Pancreatology and the American Pancreatic Association recommend definitive treatment on index admission. Evidence suggests that uptake of these guidelines is low. METHODS Embase, MEDLINE and Cochrane databases were searched for RCTs investigating early versus delayed cholecystectomy in patients with a confirmed diagnosis of mild gallstone pancreatitis. The pooled synthesis was undertaken using a random-effects meta-analysis of the primary outcome of recurrent biliary complications causing hospital readmission. Secondary outcomes included intraoperative and postoperative complications, and total length of hospital stay (LOS). All analyses were performed using RevMan5 software. RESULTS Five RCTs were identified, which included 629 patients (318 in the early cholecystectomy (EC) group and 311 in the delayed cholecystectomy (DC) group). Recurrent biliary events that required readmission were reduced in patients undergoing EC compared with the number in patients having DC (odds ratio (OR) 0·17, 95 per cent c.i. 0·09 to 0·33). There was no difference in the rate of intraoperative (OR 0·58, 0·17 to 1·92) or postoperative (OR 0·78, 0·38 to 1·62) complications. CONCLUSION EC following mild gallstone pancreatitis does not increase the risk of intraoperative or postoperative complications, but reduces the readmission rate for recurrent biliary complications.
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Affiliation(s)
- N Moody
- Department of Hepatobiliary and Pancreatic Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - A Adiamah
- Department of Hepatobiliary and Pancreatic Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - F Yanni
- Department of Hepatobiliary and Pancreatic Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - D Gomez
- Department of Hepatobiliary and Pancreatic Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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Lyu YX, Cheng YX, Jin HF, Jin X, Cheng B, Lu D. Same-admission versus delayed cholecystectomy for mild acute biliary pancreatitis: a systematic review and meta-analysis. BMC Surg 2018; 18:111. [PMID: 30486807 PMCID: PMC6263067 DOI: 10.1186/s12893-018-0445-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/08/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The timing of laparoscopic cholecystectomy (LC) performed after the mild acute biliary pancreatitis (MABP) is still controversial. We conducted a review to compare same-admission laparoscopic cholecystectomy (SA-LC) and delayed laparoscopic cholecystectomy (DLC) after mild acute biliary pancreatitis (MABP). METHODS We systematically searched several databases (PubMed, EMBASE, Web of Science, and the Cochrane Library) for relevant trials published from 1 January 1992 to 1 June 2018. Human prospective or retrospective studies that compared SA-LC and DLC after MABP were included. The measured outcomes were the rate of conversion to open cholecystectomy (COC), rate of postoperative complications, rate of biliary-related complications, operative time (OT), and length of stay (LOS). The meta-analysis was performed using Review Manager 5.3 software (The Cochrane Collaboration, Oxford, United Kingdom). RESULTS This meta-analysis involved 1833 patients from 4 randomized controlled trials and 7 retrospective studies. No significant differences were found in the rate of COC (risk ratio [RR] = 1.24; 95% confidence interval [CI], 0.78-1.97; p = 0.36), rate of postoperative complications (RR = 1.06; 95% CI, 0.67-1.69; p = 0.80), rate of biliary-related complications (RR = 1.28; 95% CI, 0.42-3.86; p = 0.66), or OT (RR = 1.57; 95% CI, - 1.58-4.72; p = 0.33) between the SA-LC and DLC groups. The LOS was significantly longer in the DLC group (RR = - 2.08; 95% CI, - 3.17 to - 0.99; p = 0.0002). Unexpectedly, the subgroup analysis showed no significant difference in LOS according to the Atlanta classification (RR = - 0.40; 95% CI, - 0.80-0.01; p = 0.05). The gallstone-related complications during the waiting time in the DLC group included gall colic, recurrent pancreatitis, acute cholecystitis, jaundice, and acute cholangitis (total, 25.39%). CONCLUSION This study confirms the safety of SA-LC, which could shorten the LOS. However, the study findings have a number of important implications for future practice.
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Affiliation(s)
- Yun-Xiao Lyu
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
| | - Yun-Xiao Cheng
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
| | - Hang-Fei Jin
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
| | - Xin Jin
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
| | - Bin Cheng
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
| | - Dian Lu
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
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Gómez-Torres GA, González-Hernández J, López-Lizárraga CR, Navarro-Muñiz E, Ortega-García OS, Bonnet-Lemus FM, Abarca-Rendon FM, De la Cerda-Trujillo LF. Intraoperative cholangiography versus magnetic resonance cholangiography in patients with mild acute biliary pancreatitis: A prospective study in a second-level hospital. Medicine (Baltimore) 2018; 97:e12976. [PMID: 30383648 PMCID: PMC6221722 DOI: 10.1097/md.0000000000012976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Cholecystectomy is the only definitive management of pancreatitis secondary to gallstone disease. Approximately 20% to 30% of patients with acute biliary pancreatitis (ABP) will have persistent common bile duct (CBD) stones. Therefore, choosing a method for the early diagnosis of choledocholithiasis is essential to reduce waiting days for surgery and hospital stay in these patients.The aim of this study was to compare the use of magnetic resonance cholangiography (MRC) and intraoperative cholangiography (IOC), and its impact on the length of the hospital stay in patients with mild ABP and an intermediate probability of choledocholithiasis.We prospectively evaluated all patients diagnosed with mild ABP and an intermediate probability of choledocholithiasis at admission and 48 hours after, from June, 2017 to December, 2017. Study subjects were identified upon admission and were classified into 2 groups of patients according to their choledocholithiasis predictors; a MRC was performed in the group 1, and an IOC was done in group 2.In all, 47 patients were enrolled in the final analysis of this study. Hospital stay in group 1 (CMR) patients was 8.29 (±2.69) days compared with 6.43 (±2.57) days in the group 2 (IOC) (P = .007). Mean waiting days for cholecystectomy was 17.14 (±26.04) days for group 1 and 5 (±2.69) days for group 2.We suggest an IOC as the election method for the diagnosis of CBD stones in patients with mild ABP in medical centers similar to ours because it reduces waiting days for surgery and hospital stay compared to the MRC.
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Tang JH, Jiang R. Nursing care of elderly patients with drug-induced severe pancreatitis by continuous closed high flow peritoneal lavage combined with continuous blood purification. Shijie Huaren Xiaohua Zazhi 2018; 26:849-855. [DOI: 10.11569/wcjd.v26.i14.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the nursing effect of closed high-flow peritoneal lavage combined with continuous blood purification in elderly patients with drug-induced severe pancreatitis.
METHODS A total of 50 elderly patients with drug-induced severe acute pancreatitis who received continuous closed high flow peritoneal lavage combined with blood purification between January 2017 and January 2018 at our emergency internal medicine department were enrolled as an experimental group. Fifty elderly patients with drug-induced severe pancreatitis who received basic nursing measures only were included as a control group. The average frequency of complications, number of treatment cycles, number of cycles required for serum amylase recovery, and duration of abdominal pain in the two groups were statistically analyzed. The changes of liver and kidney function, APACHE Ⅱ, and CTSI score were also recorded and compared.
RESULTS The average frequency of complications, number of treatment cycles, number of cycles required for serum amylase recovery, and duration of abdominal pain were significantly lower in the experimental group than in the control group (P < 0.05). The liver and kidney function of the patients in the experimental group were obviously superior to those before treatment (P < 0.05), while the difference in the control group did not reach statistical significance. The APACHE Ⅱ and CTSI scores in the experimental group were significantly lower than those in the control group (P < 0.05).
CONCLUSION Continuous closed high-flow peritoneal lavage combined with blood purification can effectively reduce symptoms, shorten the treatment cycle, and improve prognosis in elderly patients with drug-induced severe acute pancreatitis.
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Affiliation(s)
- Jian-Hong Tang
- the Third Ward of the Inpatient Department, Changxing County Hospital, Huzhou 313100, Zhejiang Province, China
| | - Rui Jiang
- Blood Purification Center, Huzhou Central Hospital, Huzhou 313100, Zhejiang Province, China
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Párniczky A, Abu-El-Haija M, Husain S, Lowe M, Oracz G, Sahin-Tóth M, Szabó FK, Uc A, Wilschanski M, Witt H, Czakó L, Grammatikopoulos T, Rasmussen IC, Sutton R, Hegyi P. EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis. Pancreatology 2018; 18:146-160. [PMID: 29398347 DOI: 10.1016/j.pan.2018.01.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/01/2018] [Accepted: 01/04/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pediatric pancreatitis is an underdiagnosed disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has increased, it is now 3.6-13.3 cases per 100,000 children. Up-to-date evidence based management guidelines are lacking for the pediatric pancreatitis. The European Pancreatic Club, in collaboration with the Hungarian Pancreatic Study Group organized a consensus guideline meeting on the diagnosis and management of pancreatitis in the pediatric population. METHODS Pediatric Pancreatitis was divided into three main clinical categories: acute pancreatitis, acute recurrent pancreatitis and chronic pancreatitis. Fifteen relevant topics (acute pancreatitis: diagnosis; etiology; prognosis; imaging; complications; therapy; biliary tract management; acute recurrent pancreatitis: diagnosis; chronic pancreatitis: diagnosis, etiology, treatment, imaging, intervention, pain, complications; enzyme replacement) were defined. Ten experts from the USA and Europe reviewed and summarized the available literature. Evidence was classified according to the GRADE classification system. RESULTS Within fifteen topics, forty-seven relevant clinical questions were defined. The draft of the updated guideline was presented and discussed at the consensus meeting held during the 49th Meeting of European Pancreatic Club, in Budapest, on July 1, 2017. CONCLUSIONS These evidence-based guidelines provides the current state of the art of the diagnosis and management of pediatric pancreatitis.
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Affiliation(s)
- Andrea Párniczky
- Heim Pál Children's Hospital, Budapest, Hungary; Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Maisam Abu-El-Haija
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sohail Husain
- Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark Lowe
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Grzegorz Oracz
- Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Miklós Sahin-Tóth
- Department of Molecular and Cell Biology, Center for Exocrine Disorders, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Flóra K Szabó
- Division of Gastroenterology and Nutrition, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA
| | - Aliye Uc
- Division of Pediatric Gastroenterology, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Heiko Witt
- Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Paediatric Nutritional Medicine, Technische Universität München, Freising, Germany
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tassos Grammatikopoulos
- Paediatric Liver, GI & Nutrition Centre, King's College Hospital, London, United Kingdom; Institute of Liver Studies, Division of Transplantation Immunology and Mucosal Biology, King's College London, London, United Kingdom
| | | | - Robert Sutton
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Liverpool Pancreatitis Research Group, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Péter Hegyi
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary; First Department of Medicine, University of Szeged, Szeged, Hungary.
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Yang DJ, Lu HM, Guo Q, Lu S, Zhang L, Hu WM. Timing of Laparoscopic Cholecystectomy After Mild Biliary Pancreatitis: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2017; 28:379-388. [PMID: 29271689 DOI: 10.1089/lap.2017.0527] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the safety of cholecystectomy in early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC). METHODS We systematically searched PubMed, EMBASE, and Cochrane Library for studies that were published from January 1992 to March 2017. We included studies on patients with mild biliary pancreatitis and that reported the timing of cholecystectomy and the number of complications, readmissions, and conversion to open cholecystectomy. Moreover, we assessed the quality and bias risks of the included studies. RESULTS After screening 4651 studies, we included 3 randomized clinical trials and 10 retrospective studies. The included studies described 2291 patients, of whom 1141 (49.8%) underwent ELC and 1150 (50.2%) underwent DLC. The reported rate of complications for ELC (6.8%) was lower than that for DLC (13.45%). The reported rate of readmission for ELC was lower than that for DLC. The length of hospital stay was longer with DLC than with ELC. ELC and DLC did not have significantly different rates of conversion to open cholecystectomy and duration of surgery. CONCLUSION This meta-analysis provides evidence that ELC is better than DLC in many aspects for acute mild pancreatitis patients undergoing laparoscopic cholecystectomy. ELC associated with few complications and readmissions, as well as a short length of hospital stay.
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Affiliation(s)
- Du-Jiang Yang
- 1 Department of Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Hui-Min Lu
- 1 Department of Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Qiang Guo
- 2 Department of Vascular Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Shan Lu
- 1 Department of Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Ling Zhang
- 1 Department of Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Wei-Ming Hu
- 1 Department of Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, China
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