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Virk S, Arora H, Patil P, Sarang B, Khajanchi M, Bains L, Kizhakke DV, Jain S, Nathani P, Dev Y, Gadgil A, Roy N. An Indian surgeon's perspective on management of asymptomatic gallstones. Asian J Endosc Surg 2024; 17:e13297. [PMID: 38439130 DOI: 10.1111/ases.13297] [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: 12/21/2023] [Revised: 01/27/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Cholelithiasis is widely prevalent in India, with a majority of patients being asymptomatic while a small proportion experiencing mild complications. In the laparoscopic era, the rate of cholecystectomies has increased owing to early recovery and fewer complications. In asymptomatic patients, the risk of complications must be balanced against the treatment benefit. Recent guidelines suggest no prophylactic cholecystectomy in asymptomatic patients. We aimed to find out the Indian surgeons' perspective on asymptomatic gallstone management. METHODS A cross-sectional e-survey was conducted of practicing surgeons, onco-surgeons and gastrointestinal-surgeons in India. The survey had questions regarding their perspective on laparoscopic cholecystectomy and treatment modalities in asymptomatic gallstones. RESULTS A total of 196 surgeons responded to the survey. Their mean age was 42.3 years. Overall, 111 (57%) respondents worked in the private sector. Most surgeons (164) agreed that the rate of cholecystectomy has increased since the advent of laparoscopy; 137 (70%) respondents agreed that they would not operate on patients without risk factors. Common bile duct stones, chronic hemolytic diseases, transplant recipients, and diabetes mellitus were the risk factors. Majority of the participants agreed on not performing a cholecystectomy in patients with asymptomatic gallstones. CONCLUSION There exists a lack of consensus among Indian surgeons on asymptomatic gallstone management in India. Where the majority of cases are asymptomatic and do not require surgery, certain comorbidities can influence the line of treatment in individual patients. Currently, the treatment guidelines for asymptomatic patients need to be established as cholecystectomies may be overperformed due to the fear of development of complications.
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Affiliation(s)
- Sargun Virk
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Anesthesiology, Weill Cornell School of Medicine, New York, New York, USA
| | - Harshit Arora
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Priti Patil
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of General Surgery, Bhabha Atomic Research Centre (BARC) and Hospital, Mumbai, India
| | - Bhakti Sarang
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Terna Medical College, Navi Mumbai, India
| | - Monty Khajanchi
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India
| | - Lovenish Bains
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Deepa Veetil Kizhakke
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Manipal Hospital, New Delhi, India
| | - Samarvir Jain
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, India
| | - Priyansh Nathani
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
| | - Ya Dev
- Department of Surgery, Government Medical College, Trivandrum, India
| | - Anita Gadgil
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of General Surgery, Bhabha Atomic Research Centre (BARC) and Hospital, Mumbai, India
| | - Nobhojit Roy
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Tranter-Entwistle I, Eglinton T, Connor S. Standardizing process in acute biliary disease. World J Surg 2024; 48:456-465. [PMID: 38686809 DOI: 10.1002/wjs.12049] [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: 11/09/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The perioperative management of biliary disease (BD) is variable across institutions with suboptimal outcomes for patients and health care systems. This results in inefficient utilization of limited resources. The aim of the current study was to identify modifiable factors impacting patients' time to theater, intraoperative time, and time to discharge as the constituents of length of stay to guide creation of a perioperative management protocol to address this variability. METHODS Data were prospectively captured at Christchurch Hospital for all adult patients presenting for cholecystectomy between May 2015 and May 2022. Pre, post, and intraoperative factors were assessed for their impact on time to theater, operative time, and postoperative hours to discharge. RESULTS Four thousand five hundred seventy-seven patients underwent cholecystectomy during the study period, of which 2807 (61%) were acute presentations and made up the cohort for analysis. Time to theater was significantly impacted by preoperative imaging type, while operative grade and the procedure type had the most clinically significant impact on operative time. Postoperatively time to discharge was significantly impacted by drain placement. CONCLUSIONS Standardizing management of BD would likely result in significant savings for the health care system and improved outcomes for patients. The data seen here evidence the importance of appropriate imaging selection, intraoperative difficulty operative grade identification, and low suction drain selection. These data have been incorporated in a perioperative management protocol as standardization of care across the patient workflow in BD is a sensible approach for ensuring optimal use of scarce resources.
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Affiliation(s)
| | - Tim Eglinton
- Department of Surgery, The University of Otago Medical School, Christchurch, New Zealand
- Department of General Surgery Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Saxon Connor
- Department of General Surgery Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
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Marichez A, Fernandez B, Belaroussi Y, Mauriac P, Julien C, Subtil C, Lapuyade B, Adam JP, Laurent C, Chiche L. Waiting for bile duct dilation before repair of bile duct injury: a worthwhile strategy? Langenbecks Arch Surg 2023; 408:409. [PMID: 37848704 DOI: 10.1007/s00423-023-03139-1] [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: 06/06/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Hepaticojejunostomy (HJ) is the gold standard procedure for repairing major bile duct injury (BDI). Dilation status of the BD before repair has not been assessed as a risk factor for anastomotic stricture. METHOD This retrospective single-centre study was performed on a population of 87 patients with BDI repaired by HJ between 2007 and 2021. Dilation status was assessed preoperatively, and dilation was defined as the presence of visible peripheral intrahepatic BDs with remaining BD diameter > 8 mm. The short- and long-term outcomes of HJ were assessed according to preoperative dilation status. RESULTS Before final repair, the BDs were dilated (dBD) in 56.3% of patients and not dilated (ND) in 43.7%. Patients with ND at the time of repair had more severe BDI injury than those with dBD (94.7% vs. 77.6%, p = 0.026). The rate of preoperative cholangitis was lower in patients with ND than in those with dBD (10.5% vs. 44.9%, p = 0.001). The rate of short-term morbidity after HJ was 33.3% (ND vs. dBD: 38.8% vs. 26.3%, p = 0.32). Long-term anastomotic stricture rate was 5.7% with a mean follow-up period of 61.3 months. There were no differences in long-term biliary complications according to dilation status (ND vs. dBD: 12.2% vs. 10.5%, p = 1). CONCLUSION Dilation status of the BD before HJ for BDI seemed to have no impact on short- or long-term outcomes. Both surgical and radiological external biliary drainages after BDI appear to be acceptable options to reduce cholangitis before repair without increasing risk for long-term anastomotic stricture.
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Affiliation(s)
- Arthur Marichez
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France.
- Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion", Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France.
| | - Benjamin Fernandez
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Yaniss Belaroussi
- Inserm, Bordeaux Population Health Research Center, ISPED, Bordeaux, France
| | - Paul Mauriac
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Céline Julien
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Clément Subtil
- Digestive Endoscopy Unit, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Bruno Lapuyade
- Department of Digestive Interventional Radiology, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Jean-Philippe Adam
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Christophe Laurent
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Laurence Chiche
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
- Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion", Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France
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Chaochankit W, Samphao S, Mahattanobon S, Sungworawongpana C. Clinical Predictive Score for Cholecystectomy Wound Infection: WEBAC Score. J Gastrointest Surg 2023; 27:1876-1882. [PMID: 37340105 DOI: 10.1007/s11605-023-05750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Most common surgical complications in cholecystectomy are surgical site infections (SSIs). SSIs have many factors, including patient, surgical, and disease factors. This study aims to find the factors which relate to SSIs 30 days after cholecystectomy and contribute to the scoring system to predict SSIs. METHODS AND MATERIAL The data of patients who underwent cholecystectomy from January 2015 to December 2019 were retrospectively collected from a prospectively collected infectious control registry. The SSI was defined following the CDC criteria and assessed before discharge and at a 1-month follow-up. Variables that were independently predictive of the increased SSIs were included in the risk score. RESULTS The patients who underwent cholecystectomy were 949, which were divided into 28 patients who had SSIs and 921 who had no SSIs. The rate of SSIs was 3%. The factors related to SSI in cholecystectomy were age ≥ 60 years (p = 0.045), history of smoking (p = 0.004), retrieval bag use (p = 0.005), preoperative ERCP (p = 0.02), and wound class III and IV (p = 0.007). Risk assessment was using five variables (WEBAC): (1) wound classifications, (2) preoperative ERCP, (3) retrieval plastic bag use, (4) aged ≥ 60 years, and (5) history of smoking (cigarette). If patients were aged ≥ 60 years and had a history of smoking, no plastic bag use, preoperative ERCP, or wound class III or IV, these parameters would all be scored 1 each. The WEBAC score revealed the probability of SSIs in cholecystectomy wounds. CONCLUSION The WEBAC score represents a convenient and simple tool to predict the probability of SSI in the patients who underwent cholecystectomy and might increase the surgeons' awareness of postoperative SSI.
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Affiliation(s)
- Wongsakorn Chaochankit
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Srila Samphao
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Somrit Mahattanobon
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chutida Sungworawongpana
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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Borie F, Sabbagh C, Fabre JM, Fuchshuber P, Gravié JF, Gugenheim J, Asbun H. SAGES SAFE CHOLE program changes surgeons practice in France-results of the FCVD implementation of SAFE CHOLE in France. Surg Endosc 2023; 37:6483-6490. [PMID: 37253869 DOI: 10.1007/s00464-023-10128-4] [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: 03/24/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND With the Society of Gastrointestinal and Endoscopic Surgeons supervision, the Safe Cholecystectomy Task Force (SAFE CHOLE) was translated into French by the the Federation of Visceral and Digestive Surgery (FCVD) and adopted to run on its national e-learning platform for surgical continuing medical education (CME). The objective of this study was to assess the impact of the SAFE CHOLE (SF) program on the knowledge and practice of French surgeons performing cholecystectomy and participating in the FCVD lead CME activity. METHODS To obtain CME certification, each participant must fill out three FCVD validated questionnaires regarding (1) the participants' routine practice for cholecystectomy, (2) the participants' knowledge and practice after successful completion of the program, and (3) the educational value of the SC program. RESULTS From 2021 to 2022, 481 surgeons completed the program. The overall satisfaction rate for the program was 81%, and 53% of the surgeons were practicing routine cholangiography before the SC program. Eighty percent declared having acquired new knowledge. Fifty-six percent reported a change in their practice of cholecystectomy. Of those, 46% started routinely using the critical view of safety, 12% used a time-out prior transection of vital structures, and 11% adopted routine intraoperative cholangiography. Sixty-seven percent reported performing a sub-total cholecystectomy in case the CVS was unobtainable. If faced with BDI, 45% would transfer to a higher level of care, 33% would seek help from a colleague, and 10% would proceed with a repair. Ninety percent recommended adoption of SC by all general surgeons and 98% reported improvement of patient safety. CONCLUSIONS Large-scale implementation of the SC program in France is feasible within a broad group of diverse specialty surgeons and appears to have a significant impact on their practice. These data should encourage other surgeons and health systems to engage in this program.
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Affiliation(s)
- Frederic Borie
- Federation of Visceral and Digestive Surgery (FCVD), 12 rue Bayard, 31000, Toulouse, France.
- Research Unit INSERM University of Montpellier, IDESP Institute Desbrest of Epidemiology and Public Health, Montpellier, France.
| | - Charles Sabbagh
- Federation of Visceral and Digestive Surgery (FCVD), 12 rue Bayard, 31000, Toulouse, France
| | - Jean-Michel Fabre
- Federation of Visceral and Digestive Surgery (FCVD), 12 rue Bayard, 31000, Toulouse, France
| | | | - Jean-François Gravié
- Federation of Visceral and Digestive Surgery (FCVD), 12 rue Bayard, 31000, Toulouse, France
| | - Jean Gugenheim
- Federation of Visceral and Digestive Surgery (FCVD), 12 rue Bayard, 31000, Toulouse, France
| | - Horacio Asbun
- Baptist Health Miami Cancer Institute, Miami, FL, USA
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Luo D, Chen XP, Dai Y, Kuang F, Kang MJ, Li B, Su S. Cholecystectomy and risk of liver disease: a systematic review and meta-analysis of 27 million individuals. Int J Surg 2023; 109:1420-1429. [PMID: 36999804 PMCID: PMC10389609 DOI: 10.1097/js9.0000000000000332] [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: 09/22/2022] [Accepted: 03/07/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND There is still a lack of knowledge on the association between cholecystectomy and liver disease. This study was conducted to summarize the available evidence on the association of cholecystectomy with liver disease and quantify the magnitude of the risk of liver disease after cholecystectomy. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched systematically from database inception to January 2023 to identify eligible studies that evaluated the association between cholecystectomy and the risk of liver disease. Meta-analysis was conducted to obtain a summary odds ratio (OR) and 95% confidence interval (CI) using a random-effects model. RESULTS We identified 20 studies with a total of 27 320 709 individuals and 282 670 liver disease cases. Cholecystectomy was associated with an increased risk of liver disease (OR: 1.63, 95% CI: 1.34-1.98). In particular, cholecystectomy was found to be significantly associated with a 54% increased risk of nonalcoholic fatty liver disease (OR: 1.54, 95% CI: 1.18-2.01), a 173% increased risk of cirrhosis (OR: 2.73, 95% CI: 1.81-4.12), and a 46% increased risk of primary liver cancer (OR: 1.46, 95% CI: 1.18-1.82). CONCLUSIONS There is an association between cholecystectomy and the risk of liver disease. Our results suggest that strict surgical indications should be implemented to reduce unnecessary cholecystectomy. Additionally, the routine assessment of liver disease is necessary for patients with a history of cholecystectomy. More prospective large-sample studies are required for better estimates of the risk.
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Affiliation(s)
- De Luo
- Department of General Surgery (Hepatopancreatobiliary Surgery)
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Sichuan
| | - Xin-Pei Chen
- Department of Hepatobiliary Surgery, People’s Hospital of Deyang City, Deyang
| | - Yang Dai
- Department of General Surgery, The First People’s Hospital of Xiangyang, Xiangyang, People’s Republic of China
| | - Fei Kuang
- Institute of Immunology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Mao-Ji Kang
- Department of General Surgery (Hepatopancreatobiliary Surgery)
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Sichuan
| | - Bo Li
- Department of General Surgery (Hepatopancreatobiliary Surgery)
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Sichuan
| | - Song Su
- Department of General Surgery (Hepatopancreatobiliary Surgery)
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Sichuan
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Hassan I, Hassan L, Alsalameh M, Abdelkarim H, Hassan W. Cost-effective scarless cholecystectomy using a modified endoscopic minimally invasive reduced appliance technique (Emirate). Front Surg 2023; 10:1200973. [PMID: 37181599 PMCID: PMC10169593 DOI: 10.3389/fsurg.2023.1200973] [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: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Abstract The current gold-standard surgical treatment for symptomatic gallstone disease is the conventional four-port laparoscopic cholecystectomy (CLC). In recent years, however, celebrities and social media have altered people's attitudes regarding surgery. Consequently, CLC has undergone several changes to reduce scarring and improve patient satisfaction. In this case-matched control study, the cost-effectiveness of a modified endoscopic minimally invasive reduced appliance technique (Emirate) that uses less equipment and three 5 mm reusable ports only at precisely specified anatomical sites was compared to CLC. Methods Single-center retrospective matched cohort analysis including 140 consecutive patients treated with Emirate laparoscopic cholecystectomy ("ELC-group"), matched 1:1 by sex, indications for surgery, surgeon expertise, and preop bile duct imaging, with 140 patients receiving CLC in the same period of time ("CLC group"). Results We performed a retrospective case-matched review of 140 patients who had Emirate laparoscopic cholecystectomy for gallstones between January 2019 and December 2022. The groups included 108 females and 32 males with an equal ratio of surgical expertise-115 procedures were performed by consultants and 25 by trainees. In each group, 18 patients had preoperative MRCP or ERCP and 20 had acute cholecystitis as indications for surgery. Preoperative characteristics such as age (39 years in the Emirates group and 38.6 years in the CLC group), BMI (29.3 years in the Emirates group and 30 years in the CLC group), stone size, or liver enzymes showed no statistical difference between the two groups. In both groups, the average hospital stay was 1.5 days, and there was no conversion to open surgery, nor was there any bleeding requiring blood transfusion, bile leakage, stone slippage, bile duct injury, or invasive intervention postoperatively. When compared to the CLC group, the ELC group had significantly faster surgery times (t-test, p = 0.001), lower levels of the bile duct enzyme ALP (p = 0.003), and much lower costs (t-test, p = 0.0001). Conclusion The Emirate laparoscopic cholecystectomy method is a safe alternative to the traditional four-port laparoscopic cholecystectomy that is also much faster and less expensive.
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Affiliation(s)
- Iyad Hassan
- Department of Surgery, Burjeel Hospital, Abu Dhabi, United Arab Emirates
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The Symptomatic Outcomes of Cholecystectomy for Gallstones. J Clin Med 2023; 12:jcm12051897. [PMID: 36902684 PMCID: PMC10004100 DOI: 10.3390/jcm12051897] [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: 02/07/2023] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/08/2023] Open
Abstract
Cholecystectomy is the definite treatment for symptomatic gallstones, and rates are rapidly rising. Symptomatic complicated gallstones are generally treated with cholecystectomy, but there is no consensus on the clinical selection of patients with symptomatic uncomplicated gallstones for cholecystectomy. The aim of this review is to describe symptomatic outcomes before versus after cholecystectomy in patients with symptomatic gallstones as reported in prospective clinical studies and to discuss patient selection for cholecystectomy. Following cholecystectomy, resolution of biliary pain is high and reported for 66-100%. Dyspepsia has an intermediate resolution of 41-91% and may co-exist with biliary pain but may also develop following cholecystectomy with an increase of 150%. Diarrhea has a high increase and debuts in 14-17%. Persisting symptoms are mainly determined by preoperative dyspepsia, functional disorders, atypical pain locations, longer duration of symptoms, and poor psychological or physical health. Patient satisfaction following cholecystectomy is high and may reflect symptom alleviation or a change in symptoms. Comparison of symptomatic outcomes in available prospective clinical studies is limited by variations in preoperative symptoms, clinical presentations, and clinical management of post-cholecystectomy symptoms. When selecting patients with biliary pain only in a randomized controlled trial, 30-40% still have persisting pain. Strategies for the selection of patients with symptomatic uncomplicated gallstones based on symptoms alone are exhausted. For the development of a selection strategy, future studies should explore the impact of objective determinants for symptomatic gallstones on pain relief following cholecystectomy.
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Marichez A, Adam JP, Laurent C, Chiche L. Hepaticojejunostomy for bile duct injury: state of the art. Langenbecks Arch Surg 2023; 408:107. [PMID: 36843190 DOI: 10.1007/s00423-023-02818-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Hepaticojejunostomy (HJ) is the gold standard procedure for the reconstruction of the bile duct in many benign and malignant situations. One of the major situation is the bile duct injury (BDI) after cholecystectomy, either for early or late repair. This procedure presents some specificities associated to a debated management of BDI. PURPOSE This article provides a state-of-the-art of the hepaticojejunostomy procedure focusing on bile duct injury including its indications and outcomes CONCLUSION: Performed at the right moment and respecting the technical rules, HJ provides a restoration of the biliary patency in the long term of 80 to 90%. It is the main surgical technique to repair BDI. Complications and failure of this procedure can be difficult to manage. That is why the primary repair requires an appropriate multidisciplinary approach associated with an expert high quality surgical technique.
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Affiliation(s)
- A Marichez
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France.,Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion". Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France
| | - J-P Adam
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - C Laurent
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - L Chiche
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France. .,Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion". Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France.
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Shabanzadeh DM, Martinussen T, Sørensen LT. Development of upper gastrointestinal cancer in patients with symptomatic gallstones, cholecystectomy, and sphincterotomy: A nationwide cohort study. Scand J Surg 2022; 111:39-47. [PMID: 36000728 DOI: 10.1177/14574969221116941] [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
BACKGROUND AND OBJECTIVE Exposures of gallstones and treatments thereof in relation to development of cancer have not been explored before in long-term follow-up studies. Our objective was to determine whether symptomatic gallstones, cholecystectomy, or sphincterotomy were associated with development of upper gastrointestinal cancers. METHODS This is a nationwide cohort study of persons born in Denmark 1930-1984 included from age 30 years with long-term follow-up (1977-2014). Exposures were hospital admissions with gallstones, cholecystectomy, and sphincterotomy. Time-varying covariates were included in analyses to allow the impact of exposures to change with time. Follow-up periods were 2-5 and > 5 years. Hazard ratios (HR) with 95% confidence intervals (CI) were reported. RESULTS A total of 4,465,962 persons were followed. We found positive associations between sphincterotomy and biliary (>5 years HR 4.34, CI [2.17-8.70]), gallbladder (2-5 years HR 20.7, CI [8.55-50.1]), and pancreatic cancer (2-5 years HR 3.68, CI [2.09-6.49]). Cholecystectomy was positively associated with duodenal (2-5 years HR 2.94, CI [1.31-6.58]) and small bowel cancer (2-5 years HR 2.75, CI [1.56-4.87]). Inverse associations were seen for cholecystectomy and biliary (>5 years HR 0.60, CI [0.41-0.87]), pancreatic (>5 years HR 0.45 CI [0.35-0.57]), esophageal (>5 years HR 0.57, CI [0.43-0.74]), and gastric cancer (>5 years HR 0.68, CI [0.55-0.86]) and for gallstones and pancreatic cancer (>5 years HR 0.66, CI [0.47-0.93]). Gallstones were positively associated with gallbladder (>5 years HR 3.51, CI [2.02-6.10]) and small bowel cancer (2-5 years HR 3.21, CI [1.60-6.45]). CONCLUSIONS A positive association between sphincterotomy and biliary cancer was identified. Cholecystectomy seems to be inversely associated with biliary, pancreatic, esophageal, and gastric cancer. Associations should be explored in similar large cohorts.
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Affiliation(s)
- Daniel M Shabanzadeh
- Research Unit, Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Torben Martinussen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars T Sørensen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Du J, Song D, Li J, Li Y, Li B, Li L. Paeonol triggers apoptosis in HeLa cervical cancer cells: the role of mitochondria-related caspase pathway. Psychopharmacology (Berl) 2022; 239:2083-2092. [PMID: 33710373 DOI: 10.1007/s00213-021-05811-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
Paeonol is a biologically active component purified from the root bark of Cortex Moutan that exerts pharmacological effects on the cervical cancer. In this study, we aim to evaluate the anti-cervical cancer capacity of paeonol and to investigate the mechanism driving its anti-cervical cancer effect. Paeonol administration markedly restrained the proliferation and caused apoptosis in HeLa cells. Furthermore, paeonol treatment resulted in a mitochondrial dysfunction in HeLa cells, including the inducing of mitochondrial membrane potential (MMP), reactive oxygen species (ROS) production, and the release of cytochrome c. Moreover, the Bcl-2/Bax proportion was obviously downregulated and cleaved caspase-3 expression was evaluated through paeonol treatment. Additionally, the expression of p-PI3K and p-Akt was noticeably reduced in response to paeonol treatment in HeLa cells. Our findings indicated that paeonol exerts an anticancer potential in HeLa cells, at least in a manner, via triggering the mitochondrial pathway of cellular apoptosis by inhibiting PI3K/Akt signaling. Thus, paeonol has great potential as a promising therapeutic compound to resist human cervical cancer.
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Affiliation(s)
- Jikun Du
- Central Research Laboratory, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen, China
| | - Daibo Song
- Dongguan Scientific Research Center, Department of Pharmacology, Guangdong Medical University, Dongguan, China
| | - Jinwen Li
- Dongguan Scientific Research Center, Department of Pharmacology, Guangdong Medical University, Dongguan, China
| | - Yuanhua Li
- Dongguan Scientific Research Center, Department of Pharmacology, Guangdong Medical University, Dongguan, China
| | - Baohong Li
- Dongguan Scientific Research Center, Department of Pharmacology, Guangdong Medical University, Dongguan, China
| | - Li Li
- Dongguan Scientific Research Center, Department of Pharmacology, Guangdong Medical University, Dongguan, China.
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12
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Demouron M, Selvy M, Dembinski J, Mauvais F, Cheynel N, Slim K, Sabbagh C, Regimbeau JM. Feasibility and Effectiveness of an Enhanced Recovery Program after Early Cholecystectomy for Acute Calculous Cholecystitis: A 2-Step Study. J Am Coll Surg 2022; 234:840-848. [DOI: 10.1097/xcs.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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13
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Gan D, Wang X, Xu X, Kang Q, Lu Z, Jia M, Ru Y, He X, Mou Y, He W, Zhu S. Sarcopenia and sarcopenic obesity after cholecystectomy: A population-based study. Obesity (Silver Spring) 2022; 30:482-490. [PMID: 34964307 DOI: 10.1002/oby.23334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The present study aimed to investigate the associations of cholecystectomy with low muscle mass, low muscle strength, sarcopenia, and sarcopenic obesity. METHODS This population-based study included data from 4,909 participants aged 18 to 80 years. History of cholecystectomy was diagnosed using abdominal ultrasonography. Muscle mass was evaluated using a dual-energy x-ray absorptiometry scan, and muscle strength was evaluated using an electronic hand dynamometer. Sarcopenia was defined as the presence of both low muscle mass and low muscle strength. Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Multivariable logistic regression models were performed to investigate the associations of cholecystectomy with low muscle mass, low muscle strength, sarcopenia, and sarcopenic obesity. RESULTS Participants with history of cholecystectomy were more likely than those without to have low muscle mass, low muscle strength, and sarcopenia. Furthermore, compared with cholecystectomy that occurred within 7 years (7 years is the median interval between cholecystectomy and the physical examination), participants with cholecystectomy that occurred more than 7 years ago had higher odds of sarcopenia. Finally, whether obesity was defined by BMI or body fat percentage, cholecystectomy was positively associated with sarcopenic obesity. CONCLUSIONS Cholecystectomy is associated with low muscle mass, low muscle strength, sarcopenia, and sarcopenic obesity.
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Affiliation(s)
- Da Gan
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoyan Wang
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaochen Xu
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qingcong Kang
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhonghua Lu
- Lanxi Red Cross Hospital, Lanxi, Zhejiang, China
| | - Menghan Jia
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yuan Ru
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xi He
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yun Mou
- Echocardiography and Vascular Ultrasound Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei He
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shankuan Zhu
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Rutherford D, Massie EM, Worsley C, Wilson MS. Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy. Cochrane Database Syst Rev 2021; 10:CD007337. [PMID: 34693999 PMCID: PMC8543182 DOI: 10.1002/14651858.cd007337.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pain is one of the important reasons for delayed discharge after laparoscopic cholecystectomy. Use of intraperitoneal local anaesthetic for laparoscopic cholecystectomy may be a way of reducing pain. A previous version of this Cochrane Review found very low-certainty evidence on the benefits and harms of the intervention. OBJECTIVES To assess the benefits and harms of intraperitoneal instillation of local anaesthetic agents in people undergoing laparoscopic cholecystectomy. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and three other databases to 19 January 2021 together with reference checking of studies retrieved. We also searched five online clinical trials registries to identify unpublished or ongoing trials to 10 September 2021. We contacted study authors to identify additional studies. SELECTION CRITERIA We only considered randomised clinical trials (irrespective of language, blinding, publication status, or relevance of outcome measure) comparing local anaesthetic intraperitoneal instillation versus placebo, no intervention, or inactive control during laparoscopic cholecystectomy, for the review. We excluded non-randomised studies, and studies where the method of allocating participants to a treatment was not strictly random (e.g. date of birth, hospital record number, or alternation). DATA COLLECTION AND ANALYSIS Two review authors collected the data independently. Primary outcomes included all-cause mortality, serious adverse events, and quality of life. Secondary outcomes included length of stay, pain, return to activity and work, and non-serious adverse events. The analysis included both fixed-effect and random-effects models using RevManWeb. We performed subgroup, sensitivity, and meta-regression analyses. For each outcome, we calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs). We assessed risk of bias using predefined domains, graded the certainty of the evidence using GRADE, and presented outcome results in a summary of findings table. MAIN RESULTS Eighty-five completed trials were included, of which 76 trials contributed data to one or more of the outcomes. This included a total of 4957 participants randomised to intraperitoneal local anaesthetic instillation (2803 participants) and control (2154 participants). Most trials only included participants undergoing elective laparoscopic cholecystectomy and those who were at low anaesthetic risk (ASA I and II). The most commonly used local anaesthetic agent was bupivacaine. Methods of instilling the local anaesthetic varied considerably between trials; this included location and timing of application. The control groups received 0.9% normal saline (69 trials), no intervention (six trials), or sterile water (two trials). One trial did not specify the control agent used. None of the trials provided information on follow-up beyond point of discharge from hospital. Only two trials were at low risk of bias. Seven trials received external funding, of these three were assessed to be at risk of conflicts of interest, a further 17 trials declared no funding. We are very uncertain about the effect intraperitoneal local anaesthetic versus control on mortality; zero mortalities in either group (8 trials; 446 participants; very low-certainty evidence); serious adverse events (RR 1.07; 95% CI 0.49 to 2.34); 13 trials; 988 participants; discharge on same day of surgery (RR 1.43; 95% CI 0.64 to 3.20; 3 trials; 242 participants; very low-certainty evidence). We found that intraperitoneal local anaesthetic probably results in a small reduction in length of hospital stay (MD -0.10 days; 95% CI -0.18 to -0.01; 12 trials; 936 participants; moderate-certainty evidence). No trials reported data on health-related quality of life, return to normal activity or return to work. Pain scores, as measured by visual analogue scale (VAS), were lower in the intraperitoneal local anaesthetic instillation group compared to the control group at both four to eight hours (MD -0.99 cm VAS; 95% CI -1.19 to -0.79; 57 trials; 4046 participants; low-certainty of evidence) and nine to 24 hours (MD -0.68 cm VAS; 95% CI -0.88 to -0.49; 52 trials; 3588 participants; low-certainty of evidence). In addition, we found two trials that were still ongoing, and one trial that was completed but with no published results. All three trials are registered on the WHO trial register. AUTHORS' CONCLUSIONS We are very uncertain about the effect estimate of intraperitoneal local anaesthetic for laparoscopic cholecystectomy on all-cause mortality, serious adverse events, and proportion of patients discharged on the same day of surgery because the certainty of evidence was very low. Due to inadequate reporting, we cannot exclude an increase in adverse events. We found that intraperitoneal local anaesthetic probably results in a small reduction in length of stay in hospital after surgery. We found that intraperitoneal local anaesthetic may reduce pain at up to 24 hours for low-risk patients undergoing laparoscopic cholecystectomy. Future randomised clinical trials should be at low risk of systematic and random errors, should fully report mortality and side effects, and should focus on clinical outcomes such as quality of life.
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Affiliation(s)
| | | | - Calum Worsley
- Department of General Surgery, NHS Forth Valley, Larbert, UK
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15
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Alvarenga LR, Sandy NS, Gomez GS, Hessel G, DE Tommaso AMA, Bellomo-Brandão MÂ. SYMPTOMATIC CHOLELITHIASIS AS THE PRESENTATION OF PEDIATRIC PRIMARY SCLEROSING CHOLANGITIS - CASE SERIES AND LITERATURE REVIEW. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:227-233. [PMID: 34287532 DOI: 10.1590/s0004-2803.202100000-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a rare hepatobiliary disorder, whose etiology remains not fully elucidated. Given how rare PSC is in childhood, until the recent publication of a multicenter international collaboration, even data on its characteristics and natural history were scarce. Symptomatic cholelithiasis has not been previously reported as the presentation of PSC. OBJECTIVE The aim of this study was the diagnosis of PSC following the initial unusual presentation with symptomatic cholelithiasis, that followed an atypical clinical course that could not be explained by cholelithiasis alone. A literature review was also conducted. METHODS We conducted a retrospective chart review of three patients, who were diagnosed and/or followed at the Clinics Hospital, University of Campinas - Sao Paulo/ Brazil, between 2014 and 2020. Data analyzed included gender, age of presentation, past medical history, imaging findings, laboratory results, endoscopic evaluation, response to medical therapy and follow-up. RESULTS Age at time of presentation with cholelithiasis varied from 10 to 12 years. In two of the cases reported, a more subacute onset of symptoms preceded the episode of cholelithiasis. Two patients were managed with cholecystectomy, not followed by any surgical complications, one patient was managed conservatively. Percutaneous liver biopsy was performed in all three cases, showing histological findings compatible with PSC. Associated inflammatory bowel disease (IBD) was not seen in any of the patients. The patients have been followed for a mean time of 3.4 years. CONCLUSION PSC and cholelithiasis are both rare in the pediatric population. This study reports on symptomatic cholelithiasis as a presentation of PSC and raises the importance of suspecting an underlying hepatobiliary disorder in children with cholelithiasis without any known predisposing factors and/or that follow an atypical clinical course for cholelithiasis alone.
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Affiliation(s)
- Lucas Rocha Alvarenga
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brasil
| | - Natascha Silva Sandy
- University of Toronto, Hospital for Sick Children, Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Toronto, ON, Canada
| | - Gabriela Souza Gomez
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brasil
| | - Gabriel Hessel
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brasil
| | - Adriana Maria Alves DE Tommaso
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brasil
| | - Maria Ângela Bellomo-Brandão
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brasil
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Ichimata S, Hata Y, Nishida N. Effects of sporadic transthyretin amyloidosis frequently on the gallbladder and the correlation between amyloid deposition in the gallbladder and heart: A forensic autopsy-based histopathological evaluation. Pathol Int 2021; 71:530-537. [PMID: 34154032 DOI: 10.1111/pin.13127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Abstract
The aim of the study is to evaluate the clinicopathological features of cholecystic ATTR deposition in patients with cardiac involvement, investigate the correlation of amyloid deposition severity in the gallbladder and the heart, and compare its prevalence in the gallbladder and other organs. Fifty patients with sporadic ATTR amyloidosis were identified. Of these, we evaluated 15 patients who underwent gallbladder sampling accurately. Among 10 patients (67%) with cholecystic deposition, six exhibited detectable deposition in the hematoxylin and eosin-stained specimens, and all of them displayed obstructive vascular deposition (VD). The severity of gall bladder VD was statistically correlated with that of cardiac VD and atrial interstitial deposition (ID). Additionally, all patients exhibiting cholecystic ID displayed severe ventricular and atrial IDs. In visceral organs excluding the heart, amyloid deposition was commonly observed in the lungs (93%), followed by the gastrointestinal tract (47%-80%), liver (60%) and periosteal tissues (53%). The involvement of the gallbladder was prevalent and comparable to that of the gastrointestinal tract. Moreover, the severity of cholecystic deposition was correlated with that of cardiac deposition. Therefore, pathologists should be aware that sporadic ATTR amyloidosis is a common condition and should not be overlooked.
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Affiliation(s)
- Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
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Ábrahám S, Németh T, Benkő R, Matuz M, Váczi D, Tóth I, Ottlakán A, Andrási L, Tajti J, Kovács V, Pieler J, Libor L, Paszt A, Simonka Z, Lázár G. Evaluation of the conversion rate as it relates to preoperative risk factors and surgeon experience: a retrospective study of 4013 patients undergoing elective laparoscopic cholecystectomy. BMC Surg 2021; 21:151. [PMID: 33743649 PMCID: PMC7981808 DOI: 10.1186/s12893-021-01152-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/11/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Our aim is to determine the relationships among patient demographics, patient history, surgical experience, and conversion rate (CR) during elective laparoscopic cholecystectomies (LCs). METHODS We analyzed data from patients who underwent LC surgery between 2005 and 2014 based on patient charts and electronic documentation. CR (%) was evaluated in 4013 patients who underwent elective LC surgery. The relationships between certain predictive factors (patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), acute cholecystitis (AC), abdominal surgery in the patient history, as well as surgical experience) and CR were examined by univariate analysis and logistic regression. RESULTS In our sample (N = 4013), the CR was 4.2%. The CR was twice as frequent among males than among females (6.8 vs. 3.2%, p < 0.001), and the chance of conversion increased from 3.4 to 5.9% in patients older than 65 years. The detected CR was 8.8% in a group of patients who underwent previous ERCP (8.8 vs. 3.5%, p < 0.001). From the ERCP indications, most often, conversion was performed because of severe biliary tract obstruction (CR: 9.3%). LC had to be converted to open surgery after upper and lower abdominal surgeries in 18.8 and 4.8% cases, respectively. Both AC and ERCP in the patient history raised the CR (12.3%, p < 0.001 and 8.8%, p < 0.001). More surgical experience and high surgery volume were not associated with a lower CR prevalence. CONCLUSIONS Patient demographics (male gender and age > 65 years), previous ERCP, and upper abdominal surgery or history of AC affected the likelihood of conversion. More surgical experience and high surgery volume were not associated with a lower CR prevalence.
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Affiliation(s)
- Szabolcs Ábrahám
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary.
| | - Tibor Németh
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Dániel Váczi
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Illés Tóth
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Aurél Ottlakán
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - László Andrási
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - János Tajti
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Viktor Kovács
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - József Pieler
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - László Libor
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Attila Paszt
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Zsolt Simonka
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - György Lázár
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
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Cao J, Liu B, Shi J, Meng X, Zhang H, Pan Y, Lu S. Safety of ambulatory laparoscopic cholecystectomy in the elderly. ANZ J Surg 2021; 91:597-602. [PMID: 33605041 DOI: 10.1111/ans.16656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aims to retrospectively analyse the safety of ambulatory laparoscopic cholecystectomy (ALC) and identify risk factors for delayed discharge after ALC in the elderly. METHODS Consecutive patients who were scheduled to undergo ALC were assigned to the elderly group (age ≥ 65 years) or the non-elderly group. The primary outcome was postoperative discharge within 24 h (D24). Secondary outcomes were perioperative mortality, reasons for delayed discharge (psychosocial reasons (DP), complications (DC), drainage (DD) and conversion to open surgery (DCO)), intraoperative data and readmission within 30 days after discharge (readmission). Differences were statistically significant when P < 0.05. RESULTS There were 7657 patients assigned to the elderly group (n = 1143) or the non-elderly group (n = 6514). The differences between elderly patients and non-elderly patients in the operation time (51.0 (37.0-70.0) versus 50.0 (35.0-65.0) min), blood loss (10.0 (5.0-10.0) versus 5.0 (5.0-10.0) mL), D24 (75.5% versus 81.7%) and DD (7.8% versus 3.2%) were statistically significant (P < 0.05, respectively). The differences between elderly patients and non-elderly patients in DP (8.2% versus 6.7%), DC (7.8% versus 7.9%), DCO (0.7% versus 0.5%) and readmission (0.5% versus 0.4%) were not statistically significant (P > 0.05, respectively). Independent risk factors for delayed discharge after ALC in the elderly were male sex, octogenarian status, prolonged operation time, arrhythmia, type 2 diabetes mellitus, a previous operation in the upper abdomen, acute inflammation of gallbladder and a gallbladder wall thicker than 3 mm (P < 0.05, respectively). CONCLUSION ALC in the elderly is feasible and safe.
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Affiliation(s)
- Junning Cao
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
| | - Bo Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jihang Shi
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xuan Meng
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
| | - Hangyu Zhang
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yingwei Pan
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
| | - Shichun Lu
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
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Escalante Arbeláez D, Bernal Gutiérrez M, Buitrago Gutiérrez G. Mortalidad perioperatoria y volumen quirúrgico de colecistectomías en el régimen contributivo en Colombia. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introducción. La patología biliar es una causa frecuente de intervención quirúrgica, Pero en Colombia no se cuenta con datos oficiales de mortalidad ni volumen quirúrgico asociados a este procedimiento.
El objetivo de este estudio fue determinar el volumen de colecistectomías y describir la tasa general de mortalidad perioperatoria en seis regiones geográficas del país, en el periodo de 2012 a 2016.
Métodos. Estudio de cohortes retrospectivo que incluyó pacientes mayores de 18 años, afiliados al régimen contributivo de salud, llevados a colecistectomía. Se utilizó la base de datos de suficiencia de la Unidad de Pago por Capitación (UPC), la base de estadísticas vitales del Departamento Administrativo Nacional de Estadística (DANE) y la del Sistema Integrado de Información de la Protección Social (SISPRO).
Resultados. Durante el periodo de estudio, se realizaron 192.080 colecistectomías, lo que corresponde a 206 colecistectomías por 100.000 habitantes. Se encontró mayor volumen quirúrgico en personas entre los 65 y 80 años, en el sexo femenino y en la ciudad de Bogotá. La mortalidad perioperatoria encontrada correspondió al 0,6 %, siendo mayor en los pacientes de sexo masculino, de edad avanzada, en aquellos en quienes se practicó laparotomía y en los pacientes operados en la ciudad de Bogotá.
Discusión. De acuerdo con los hallazgos, esta investigación puede servir de base para estudios posteriores, que muestren claramente las cifras oficiales de volumen quirúrgico y de mortalidad por colecistectomía en Colombia.
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Dong C, Condat B, Picon-Coste M, Chrétien Y, Potier P, Noblinski B, Arrivé L, Hauuy MP, Barbu V, Maftouh A, Gaouar F, Ben Belkacem K, Housset C, Poupon R, Zanditenas D, Chazouillères O, Corpechot C. Low-phospholipid-associated cholelithiasis syndrome: Prevalence, clinical features, and comorbidities. JHEP Rep 2020; 3:100201. [PMID: 33554096 PMCID: PMC7848766 DOI: 10.1016/j.jhepr.2020.100201] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/18/2020] [Accepted: 10/26/2020] [Indexed: 01/02/2023] Open
Abstract
Background & Aims Low-phospholipid-associated cholelithiasis (LPAC) syndrome, a rare genetic form of intrahepatic cholelithiasis in adults, is still poorly understood. We report the results of the largest-ever case-control study of patients with LPAC syndrome aiming to assess the prevalence, clinical features, and comorbidities of the disease. Methods We included all LPAC cases diagnosed between 2001 and 2016 in 11 French centres. Controls consisted of all patients who underwent a cholecystectomy for common gallstone disease in a single non-academic centre over 1 year. A logistic regression analysis was used to identify the clinical features associated with LPAC syndrome across several patient strata with increasing levels of diagnostic confidence. The ratio between the incident cases of LPAC syndrome and the total number of cholecystectomies for gallstones was used to assess the relative prevalence of the disease. Results In this study, 308 cases and 206 controls were included. LPAC syndrome accounted for 0.5–1.9% of all patients admitted with symptomatic gallstone disease. Age at first symptoms <40 years, absence of overweight, persistence of symptoms after cholecystectomy, intrahepatic micro- or macrolithiasis, common bile duct (CBD) lithiasis, and no history of cholecystitis were independently associated with LPAC diagnosis. ATP-binding cassette subfamily B member 4 (ABCB4) variants, present in 46% of cases, were associated with CBD lithiasis, chronic elevation of gamma-glutamyltransferase (GGT), and personal or family history of hepato-biliary cancer. Conclusions In this case-control study, LPAC syndrome accounted for approximately 1% of symptomatic cholelithiasis in adults. In addition to pre-established diagnostic criteria, normal weight, CBD lithiasis, and no history of cholecystitis were significantly associated with the syndrome. ABCB4 gene variations in patients with LPAC were associated with CBD lithiasis, chronic cholestasis, and a personal or family history of hepato-biliary cancer. Lay summary In the largest case-control study ever conducted in patients with LPAC syndrome, a rare genetic form of intrahepatic cholelithiasis in young adults, LPAC syndrome was found in approximately 1% of all patients admitted to the hospital for symptomatic gallstones and, in addition to the pre-established characteristics of the syndrome (age at first symptoms <40 years, recurrence of symptoms after cholecystectomy, and/or imaging evidence of intrahepatic microlithiasis), was associated with lower BMI, higher prevalence of common bile duct stones, and lower incidence of acute cholecystitis. ABCB4 gene variants, which were detected in about half of cases, were associated with common bile duct stones and a personal or family history of hepato-biliary cancer. Low-phospholipid-associated cholelithiasis (LPAC) syndrome affects approximately 1% of adults with symptomatic cholelithiasis. Normal weight, common bile duct stones, and lack of cholecystitis are clinical features significantly associated with this syndrome. ABCB4 variants in patients with LPAC may be associated with an increased personal or family risk of hepato-biliary cancer.
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Affiliation(s)
- Catherine Dong
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Bertrand Condat
- Division of Gastroenterology and Hepatology, French Polynesia Hospital, Pirae, French Polynesia
- Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux de France (ANGH), Montfermeil, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
| | - Magalie Picon-Coste
- Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux de France (ANGH), Montfermeil, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
- Division of Gastroenterology and Hepatology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Yves Chrétien
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Pascal Potier
- Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux de France (ANGH), Montfermeil, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
- Division of Gastroenterology and Hepatology, Orléans Hospital, Orléans, France
| | - Béatrice Noblinski
- Radiology Department, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Lionel Arrivé
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
- Radiology Department, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | | | - Véronique Barbu
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
- Molecular Biology and Genetics Laboratory, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Anware Maftouh
- Visceral Surgery Department, Saint-Camille Hospital, Bry-sur-Marne, France
| | - Farid Gaouar
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Karima Ben Belkacem
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
| | - Chantal Housset
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Raoul Poupon
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
| | - David Zanditenas
- Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux de France (ANGH), Montfermeil, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
- Division of Gastroenterology and Hepatology, Saint-Camille Hospital, Bry-sur-Marne, France
| | - Olivier Chazouillères
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Christophe Corpechot
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
- Corresponding author. Address: Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. Tel.: +33149282836, Fax: +33149282107.
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Mansour LT, Brien S, Reid J, Maddern GJ. Peri-operative Mortality Following Cholecystectomy in Australia: Potential Preventability of Adverse Events. World J Surg 2020; 45:681-689. [PMID: 33043383 DOI: 10.1007/s00268-020-05815-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cholecystectomy is a commonly performed procedure; however, it is not without risks. It is crucial to constantly audit surgical outcomes in order to improve quality of care. The aim of this retrospective population-based cohort study is to identify preventable issues of clinical management associated with adverse occurrences in order to reduce mortality of cholecystectomy patients. METHODS Data were obtained from the Australian and New Zealand Audit of Surgical Mortality (ANZASM). It encompasses peer-reviewed first and second line assessments of management of cholecystectomy patients who died from 2005 to 2015 in Australia. Clinical Management Issues (CMIs) were identified from text in assessments and grouped into communication failures, pre-operative, intra-operative and post-operative categories. These were further classified into subthemes using thematic analysis with a data-driven approach. RESULTS There were 359 deaths in the study period. CMIs were present in 71 cases, with a reported total of 124 concerns or adverse events. Post-operative CMIs were the most prevalent issue [50% (62/124)], with the most common theme being delay to recognise complications (19/124). Pre-operative concerns were the second most common (n = 34). Decision to operate was questioned in 14 cases, and delay to surgery was reported in 12 cases. CONCLUSION ANZASM analysis has allowed us to identify modifiable adverse occurrences. This audit shows that delay to recognise complications is the most common assessment recorded. Preventive measures should be taken to improve outcomes and reduce peri-operative mortality, with an emphasis on post-operative management and enhancing communication between members of the multidisciplinary team.
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Affiliation(s)
- Laure Taher Mansour
- Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia
| | - Sean Brien
- Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia
| | - Jessica Reid
- Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia
| | - Guy J Maddern
- Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia.
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