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Agawu A, Kanagawa C, Wong J, Shults J, Feudtner C, Bewtra M. Pediatric Cholelithiasis in the United States: National Hospitalization Trends, 2006 to 2019. J Pediatr Gastroenterol Nutr 2023; 77:741-747. [PMID: 37755879 DOI: 10.1097/mpg.0000000000003959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVES Previous studies have shown increasing hospitalizations for pediatric cholelithiasis, but recent trends are unknown. We conducted a national study of pediatric cholelithiasis to characterize recent hospitalization rate trends. METHODS Retrospective repeated cross-sectional analysis of pediatric (age < 18 years) cholelithiasis-associated hospitalizations combining data from the 2006 through 2019 Kids' Inpatient Database releases. The primary outcome of interest was the national hospitalization rate (per 100,000 children). We examined rates stratified by age group and sex and characterized hospitalization outcomes and characteristics for pediatric cholelithiasis. RESULTS Twenty-nine thousand one hundred two hospital records representing 42,282 gallstone-associated hospitalizations were identified. The hospitalization rate declined from 12.9 [95% confidence interval (CI): 12.6-13.2] in 2006 to 9.1 (95% CI: 8.8-9.3) in 2019. Consistent with the literature, hospitalizations occurred most often among teenagers (71%) and individuals with female sex (72%). The proportion of hospitalizations at freestanding children's hospitals increased significantly (from 18.2% to 35.1%). Finally, the proportion of hospitalizations involving a potentially medical predisposing condition increased significantly. CONCLUSIONS The estimated US hospitalization rate for pediatric cholelithiasis declined by 30% between 2006 and 2019. Female patients and teenagers had the largest decline, and hospitalizations increasingly occurred at freestanding children's hospitals. Potential explanations include potential changes in delivery of care as well as changes in population disease burden.
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Affiliation(s)
- Atu Agawu
- From the Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, the
| | | | - Janeline Wong
- the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Justine Shults
- From the Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, the
- the Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Chris Feudtner
- From the Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, the
| | - Meenakshi Bewtra
- the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- the Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Felippi DA, Franco PN, Bonatelli SP, da Silva JP, Guimarães VY, Breda MRS, Pagani R, Dos Santos B, Takahira RK, Rahal SC, Mamprim MJ. Prevalence of cholelithiasis in lion tamarins (Leontopithecus spp.) kept under human care by using abdominal ultrasound. J Med Primatol 2023; 52:17-23. [PMID: 36028986 DOI: 10.1111/jmp.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/27/2022] [Accepted: 08/13/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cholelithiasis is a digestive system disorder of multifactorial origin that occurs due to stones formed in the gallbladder. This study aimed at investigating by abdominal ultrasound examination the prevalence of cholelithiasis in lion tamarins kept under human care. METHODS Thirty lion tamarins from five Brazilian zoos, including 17 golden lion tamarins and 13 golden-headed lion tamarins, were evaluated. RESULTS Considering all lion tamarins, the overall frequency of cholelithiasis was 53.3% (16/30). There were no significant differences between species and sex. Cholelithiasis was predominant (75.0%) in lion tamarins older than 5 years. Septate gallbladder was observed in 86.6% (26/30) of the lion tamarins. Of these, 53.8% (14/26) had gallstones. Biochemical analysis revealed a moderate positive correlation between gamma-glutamyl transferase and the number of gallstones. CONCLUSIONS Asymptomatic cholelithiasis is frequent in lion tamarins kept under human care. Therefore, systematic monitoring through ultrasound should be part of the preventive care of these animals.
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Affiliation(s)
- Daniel Angelo Felippi
- Graduate Program in Wild Animals, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, Brazil
| | - Paolla Nicole Franco
- Graduate Program in Wild Animals, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, Brazil
| | - Shayra Peruch Bonatelli
- Graduate Program in Wild Animals, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, Brazil
| | - Jeana Pereira da Silva
- Graduate Program in Wild Animals, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, Brazil
| | - Victor Yunes Guimarães
- Graduate Program in Wild Animals, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, Brazil.,Veterinary Clinical Laboratory, Veterinary Clinic Department, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
| | - Maria Rosa Santos Breda
- Veterinary Clinical Laboratory, Veterinary Clinic Department, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil
| | - Rafael Pagani
- Hermann Weege Foundation (Pomerode Zoo), Pomerode, Brazil
| | - Bruna Dos Santos
- School of Veterinary Medicine and Animal Science, University of São Paulo (USP), São Paulo, Brazil
| | - Regina Kiomi Takahira
- Veterinary Clinical Laboratory, Veterinary Clinic Department, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, Brazil.,Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, Brazil
| | - Sheila Canevese Rahal
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, Brazil
| | - Maria Jaqueline Mamprim
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, Brazil
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Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: a Systematic Review and Network Meta-Analysis. J Gastrointest Surg 2018; 22:1193-1203. [PMID: 29556974 DOI: 10.1007/s11605-018-3739-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/05/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine the effectiveness and harms of using antibiotic prophylaxis (ABP) versus placebo/no intervention in patients undergoing elective laparoscopic cholecystectomy (eLCC) to prevent surgical site infection (SSI). METHODS We searched MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to October 2017. We included clinical trials which involved adults at low risk undergoing eLCC and compared ABP versus placebo/no intervention. The primary outcome was SSI and secondary outcomes were other infections and adverse effects. Cochrane Collaboration tool was used to assess the risk of bias. We performed the statistical analysis in R and reported information about risk difference (RD) with a 95% confidence interval (CI). Heterogeneity was evaluated using the I2 test. We produced network diagrams to show the amount of evidence available for each outcome and the most frequent comparison. RESULTS We included 18 studies in qualitative and quantitative analysis. The antibiotics most commonly studied were cefazolin and cefuroxime. We found high risk of detection bias in one study and attrition bias in another. Unclear risks of selection, performance, and detection bias were frequent. For SSI, we found no heterogeneity I2 = 0% and no inconsistency p = 0.9780. No significant differences were found when compared ABP versus placebo/no intervention. Cefazolin had a RD of - 0.00 (95% CI - 0.01 to 0.01). We found no differences in regular meta-analysis, with a RD of - 0.00 (95% CI - 0.01 to 0.01) as well as for intra-abdominal and distant infections. Adverse effects were only assessed in one study, without any case reported. CONCLUSIONS This systematic review demonstrated no differences between ABP versus placebo/no intervention when using to prevent SSI and intra-abdominal and distant infections in patients at low risk undergoing eLCC.
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Abstract
BACKGROUND Cholecystitis and gallstones affect a large segment of the population in developed nations, and a small proportion of affected individuals subsequently develop cancer of the gallbladder. However, little is known about the possible beneficial effects of physical activity. OBJECTIVE Accordingly, a systematic review examined the influence of both acute and chronic exercise on gallbladder motility, and relationships were examined between habitual physical activity, gallbladder disease, and gallbladder cancer. METHODS A search of Ovid/MEDLINE from 1996 to November 2014 yielded 67 articles relating to physical activity and gallbladder function or disease; 18 of these relevant to the objectives of the review were supplemented by 22 papers from personal files and other sources. Because of the limited volume of material, all were considered, although note was taken of the quality of activity measurement, care in excluding covariates, and experimental design (cross-sectional, case-control or randomized controlled trial). RESULTS The impact of physical activity upon gallbladder function remains unclear; acute activity could augment emptying by stimulating cholecystokinin release, and one of two training experiments found a small increase in gallbladder motility. The largest and most recent cross-sectional and case-control trials show a reduced risk of gallbladder disease in active individuals. A small number of randomized controlled trials in humans and one animal study generally support these trends, although the number of cases of gallstones are too few for statistical significance. Three studies of gallbladder cancer also show a non-significant trend to benefit from physical activity. CONCLUSIONS Although there remains a need for further research, regular physical activity seems likely to reduce the risk of both gallstones and gallbladder cancer. A substantial number of individuals must be persuaded to exercise in order to avoid one case of gallbladder disease, but the attempt appears warranted because of the other health benefits of regular physical activity.
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Affiliation(s)
- Roy J Shephard
- Faculty of Kinesiology and Physical Education, University of Toronto, PO Box 521, Brackendale, BC, V90N 1H0, Canada.
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Attitudes and Practices of Surgeons towards Spilled Gallstones during Laparoscopic Cholecystectomy: An Observational Study. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:381514. [PMID: 27355068 PMCID: PMC4897463 DOI: 10.1155/2014/381514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/14/2014] [Indexed: 11/24/2022]
Abstract
The sequelae of spilled gallstones after Laparoscopic cholecystectomy (LC) and the occurring complications may go unnoticed for a long time and can be a diagnostic challenge. The aim of this survey was to study the knowledge, attitude, and practices of surgeons regarding spilled gallstones during LC. An observational, cross-sectional survey, using a questionnaire based on 11 self-answered close-ended questions, was conducted among general surgeons. Of the 138 respondents only 29.7% had observed a complication related to gallstone spillage during LC. There was varied opinion of surgeons regarding management of spilled gallstones, documenting the same in operative notes and consent. It was observed that there is lack of knowledge regarding the complications related to gallstone spillage during LC. There is need to educate surgeons regarding safe practices during LC to avoid gallstone spillage, early diagnosis, and management of complications. There is need to standardize practice to retrieve lost gallstones to reduce complication and legal consequences.
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Zhang Y, Chen TW, Zhang XM, Wang YX, Chi XX, Li XH, Gao XF, Ji YF. Abdominal regional fat distribution on MRI correlates with cholecystolithiasis. PLoS One 2014; 9:e109776. [PMID: 25310024 PMCID: PMC4195699 DOI: 10.1371/journal.pone.0109776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/05/2014] [Indexed: 01/28/2023] Open
Abstract
AIMS To determine whether abdominal regional fat distribution pattern on MRI is correlated with cholecystolithiasis. METHODS Magnetic resonance imaging (MRI) of 163 patients with cholecystolithiasis and 163 non-cholecystolithiasis control subjects admitted to our institution between March 2011 and September 2013 were included in this cross-sectional evaluation. There were 98 women and 65 men in cholecystolithiasis group with an average age of 57±16 years (range 25-86 years). There were 87 women and 76 men in the control group with an average age of 41±16 years (range 14-77 years). Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (SAT) and total abdominal adipose tissue (TAT) of all the subjects at navel level were measured on abdominal MRI. According to the visceral adipose area (cut-off point VAT = 100 cm2), study subjects were divided into 1) increased accumulation of intra-abdominal fat and 2) normal distribution of intra-abdominal fat. Logistic regression was used to assess the association of fat with the presence of cholecystolithiasis, adjusted for age and sex. RESULTS The incidence of increased intra-abdominal fat accumulation in the cholecystolithiasis group was significantly higher than that of the control group (P = 0.000). After adjusting for age and sex, cholecystolithiasis was associated with a one standard deviation increment in the waist circumference (WC) (OR = 1.44; 95%CI: 1.01,1.93; p = 0.00), VAT (OR = 4.26; 95%CI: 1.85,5.29; p = 0.00), VAT/SAT (OR = 8.66; 95%CI: 1.60,12.63; p = 0.00), and VAT/TAT (OR = 6.73; 95%CI: 4.24,12.18; p = 0.00), but not with fat content in the abdominal subcutaneous fat (p = 0.19). CONCLUSIONS The visceral adipose tissue and distribution proportion of abdominal adipose tissue are correlates of cholecystolithiasis.
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Affiliation(s)
- Yang Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Province, China
| | - Tian Wu Chen
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Province, China
| | - Xiao Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Province, China
| | - Yi-Xiang Wang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong SAR, China
| | - Xiao Xiao Chi
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Province, China
| | - Xing Hui Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Province, China
| | - Xiao Feng Gao
- Department of Preventive Medicine, North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Yi Fan Ji
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Province, China
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Osuoji RI, Balogun BO, Olofinlade OO. Gallbladder Stones Following Ileal Resection for Gangrenous Intussusceptions: A Follow-up Study. Niger J Surg 2014; 20:19-22. [PMID: 24665197 PMCID: PMC3953628 DOI: 10.4103/1117-6806.127101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Intussusceptions are the most common causes of bowel obstruction in infancy and childhood in this environment they present late, resulting in gangrene of the intussusception consequently resection of the affected bowel and a limited or extended right hemicolectomy (RH) to establish bowel continuity. Aim: The aim of the following study is to follow-up these children that had a limited ileal resection for gangrenous intussusceptions and document the formation of stones in their gallbladders. Materials and Methods: A total of 14 patients who had limited ileal resection during infancy for gangrenous intussusceptions were matched with sixteen patients who had manual reduction for viable intussusceptions during infancy. Both groups had ultrasound scans of their gallbladders to document the formation of stones in their gallbladders. Results: No gallbladder stones were found in both groups, however, one male child that had a resection and a RH for a gangrenous intussusception at the age of 4 months and was seen at an interval of 72 months had a thickened gallbladder on ultrasonography, another child, a female child operated on at the age of 6 months and seen at an interval of 57 months also had a thickened gallbladder on ultrasonography. Conclusion: Although no stones were seen, we suggest a prolonged follow-up of these patients with either periodic ultrasonography of the their gallbladders or with the periodic estimation of their serum bile acids.
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Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev 2010:CD005265. [PMID: 21154360 DOI: 10.1002/14651858.cd005265.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cholecystectomy is a common surgical procedure. In the open cholecystectomy area, antibiotic prophylaxis showed beneficial effects, but it is not known if its benefits and harms are similar in laparoscopic cholecystectomy. Some clinical trials suggest that antibiotic prophylaxis may not be necessary in laparoscopic cholecystectomy. OBJECTIVES To assess the beneficial and harmful effects of antibiotic prophylaxis versus placebo or no prophylaxis for patients undergoing elective laparoscopic cholecystectomy. SEARCH STRATEGY We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2010), MEDLINE (1985 to August 2010), EMBASE (1985 to August 2010), SCI-EXPANDED (1985 to August 2010), LILACS (1988 to August 2010) as well as reference lists of relevant articles. SELECTION CRITERIA Randomised clinical trials comparing antibiotic prophylaxis versus placebo or no prophylaxis in patients undergoing elective laparoscopic cholecystectomy. DATA COLLECTION AND ANALYSIS Our outcome measures were all-cause mortality, surgical site infections, extra-abdominal infections, adverse events, and quality of life. All outcome measures were confined to within hospitalisation or 30 days after discharge. We summarised the outcome measures by reporting odds ratios and 95% confidence intervals (CI), using both the fixed-effect and the random-effects models. MAIN RESULTS We included eleven randomised clinical trials with 1664 participants who were mostly at low anaesthetic risk, low frequency of co-morbidities, low risk of conversion to open surgery, and low risk of infectious complications. None of the trials had low risk of bias. We found no statistically significant differences between antibiotic prophylaxis and no prophylaxis in the proportion of surgical site infections (odds ratio (OR) 0.87, 95% CI 0.49 to 1.54) or extra-abdominal infections (OR 0.77, 95% CI 0.41 to 1.46). Heterogeneity was not statistically significant. AUTHORS' CONCLUSIONS This systematic review shows that there is not sufficient evidence to support or refute the use of antibiotic prophylaxis to reduce surgical site infection and global infections in patients with low risk of anaesthetic complications, co-morbidities, conversion to open surgery, and infectious complications, and undergoing elective laparoscopic cholecystectomy. Larger randomised clinical trials with intention-to-treat analysis and patients also at high risk of conversion to open surgery are needed.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine-Universidad de La Sabana, Fundación Abood Shaio, Campus Puente del Comun km 21 via Chia, Chia, Cundinamarca, Colombia
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Hou L, Shu XO, Gao YT, Ji BT, Weiss JM, Yang G, Li HL, Blair A, Zheng W, Chow WH. Anthropometric measurements, physical activity, and the risk of symptomatic gallstone disease in Chinese women. Ann Epidemiol 2009; 19:344-50. [PMID: 19362277 PMCID: PMC3013626 DOI: 10.1016/j.annepidem.2008.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Revised: 10/28/2008] [Accepted: 12/02/2008] [Indexed: 12/20/2022]
Abstract
PURPOSE Gallstone disease is more common among overweight individuals, particularly in women. We conducted a cross-sectional case-control study of Chinese women nested in the Shanghai Women's Health Study (SWHS) to evaluate the association of gallstone disease with body mass index (BMI), waist to hip ratio (WHR), and physical activity (PA). METHODS The study included 8,485 women with self-reported, physician-diagnosed, prevalent gallstone disease and 16,970 frequency-matched controls by birth year and age at gallstone diagnosis (4-year intervals). Information on height, weight history, waist and hip circumferences, physical activities, and other exposures was obtained by in-person interview. RESULTS : Usual BMI (p trend < 0.001) and WHR (p trend < 0.001) were both related to a high prevalence of gallstone disease, and a significant interaction between BMI and WHR on gallstone risk was found (odds ratio [OR] = 3.82, 95%CI [95% confidence interval] 2.47-5.23 for those with both highest BMI and WHR relative to those with lowest BMI and WHR, p interaction = 0.03). Gallstone risk was positively associated with cumulative occupational sitting time (p trend = 0.01) and inversely associated with occupational cumulative energy expenditure (p trend = 0.03) as well as with household PA (p trend = 0.02). CONCLUSIONS Our findings further support that overall and central excessive adiposity is an independent risk factor for gallstones in women. In addition, regardless of adiposity level, being physically active may ameliorate the risk of this disease.
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Affiliation(s)
- Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Williams PT. Independent effects of cardiorespiratory fitness, vigorous physical activity, and body mass index on clinical gallbladder disease risk. Am J Gastroenterol 2008; 103:2239-47. [PMID: 18637096 PMCID: PMC2834243 DOI: 10.1111/j.1572-0241.2008.01944.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Incident self-reported physician-diagnosed clinical gallbladder disease was compared to BMI, body dimensions, physical activity (km/day run) and cardiorespiratory fitness (10 km race speed, meters per second [m/s]) in 29,110 male and 11,953 female runners. METHODS Physician-diagnosed gallbladder disease was reported by 166 men (0.57%) and 112 women (0.94%) during (mean +/- SD) 7.74 +/- 1.84 and 7.42 +/- 2.10 years of follow-up, respectively. RESULTS There was a progressive increase in age-adjusted risk with increasing BMI that accelerated sharply above 27.5 kg/m(2). Even among ostensibly healthy-weight women, the age-adjusted risk was significantly greater above 22.5 kg/m(2) vis-à-vis the leanest women (P= 0.04). Age-adjusted risk declined with increasing fitness in both sexes. Compared to the least fit men and women, men who ran faster than 4.75 m/s had 83% lower risk (75% lower when adjusted for km/day and BMI) and women who ran faster than 4 m/s had 93% lower risk (85% lower adjusted for km/day and BMI). The fittest men (> or =4.75 m/s) were at significantly less risk than men who ran <3.25 m/s (P < 0.003) and between 3.25 and 3.75 m/s (P= 0.03), and the fittest women (> or =4 m/s) were at significantly less risk than those who ran <2.8 m/s (P < 0.0001), between 2.8 and 3.2 (P= 0.0004), 3.2 and 3.6 (P= 0.002), and 3.6 and 4.0 m/s (P= 0.005). Adjustment for BMI accounted for more of the risk reduction associated with fitness in women than men. The risk for clinical gallbladder disease was also significantly related to usual running distance (men: P= 0.01; females: P= 0.008), which was attributable to the leanness of the longer-distance runners. CONCLUSION Clinical gallbladder disease risk was (a) concordantly related to BMI, (b) inversely related to usual running distance, and (c) inversely related to cardiorespiratory fitness independent of physical activity levels.
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Affiliation(s)
- Paul T Williams
- Donner Laboratory, Life Sciences Division, Ernest Orlando Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
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Storti KL, Brach JS, FitzGerald SJ, Zmuda JM, Cauley JA, Kriska AM. Physical activity and decreased risk of clinical gallstone disease among post-menopausal women. Prev Med 2005; 41:772-7. [PMID: 16038966 DOI: 10.1016/j.ypmed.2005.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Revised: 04/05/2005] [Accepted: 04/18/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Physical activity may play a role in preventing gallstone disease. METHODS The activity/gallstone relationship was examined in post-menopausal women from the Study of Osteoporotic Fractures (SOF; 1986-1988), a prospective study of fracture risk factors in 8010 women (mean age = 71.1 years, SD = 4.9). RESULTS Multivariate logistic regression indicated women in the lowest two quartiles of physical activity, according to questionnaire, had a 59% {OR = 1.59 (1.11-2.29), P = 0.02} and a 57% higher risk {OR = 1.57 (1.11-2.23), P = 0.01} of developing gallstone disease compared to women in the highest quartile of activity (PTrend = <0.0001). Additionally, this relationship was examined in a cohort of 182 post-menopausal women (mean age 74.2 years, SD = 4.1) who participated in a randomized controlled trial of a walking intervention. Women in the randomized clinical trial in the lowest tertile of physical activity determined by a physical activity monitor had a higher risk of developing gallstone disease than women in the highest tertile of physical activity, 13% {OR-1.13 (1.01-1.28), P = 0.05, PTrend = <0.04}. CONCLUSION Physical activity appears to be inversely related to the development of gallstone disease in post-menopausal women independent of body mass index.
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Affiliation(s)
- Kristi L Storti
- Department of Epidemiology, 505 Parran Hall, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
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Sari R, Balci N, Balci MK. Effects of exercise on gallbladder volume and motility in obese women. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:218-22. [PMID: 16047386 DOI: 10.1002/jcu.20117] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Comparatively few prospective studies have investigated the relationship between physical activity and gallbladder motility, and the results are controversial. Exercise may affect gallbladder motility via neural or hormonal mechanisms. The purpose of this study was to evaluate the possible effects of aerobic exercise on gallbladder motility in a group of obese women without gallstones. PATIENTS AND METHODS Twenty-three obese women (age 41.2+/-10.3 years, body mass index 40.7+/-6.7 kg/m(2)) were included in the study. Following an overnight fast, fasting and postprandial (15, 30, 45, 60, 75, 90, 120, and 150 minute) volumes and ejection fractions were evaluated with real-time ultrasonography before exercise. For all subjects, the exercise regimen consisted of daily 45-minute walking sessions at 60-80% of maximum heart rate for 4 weeks except weekends. Gallbladder volume and ejection fraction were again evaluated after exercise. RESULTS Fasting and postprandial (15, 30, 45, 60, 75, 90, 120, and 150 minute) volumes were 38.6+/- 10.9, 32.8+/- 8.8, 27.6/- 8.1, 22.7+/- 8.5, 21.4+/- 7.2, 20.8+/- 7.0, 22.8+/- 7.3, 29.6 +/- 7.0, and 36.8+/- 6.2 cm(3) before the exercise period, respectively, and 40.8+/- 18.9, 29.9+/-11.2, 25.3+/- 9.2, 22.4+/-8.5, 19.6+/-7.8, 17.7+/- 6.8, 17.8+/- 7.3, 23.1+/-10.8, and 29.0+/-14.4 cm(3) after the exercise period, respectively. Postprandial (15, 30, 45, 60, 75, 90, 120, and 150 minute) ejection fractions were 13.5+/-15.9, 27.4+/-15.4, 39.5+/-20.0, 43.2+/-16.7, 44.3+/-17.3, 37.5 +/- 23.5, 23.5 +/-25.1, and 5.5+/- 21.6% before the exercise period, respectively, and 22.6+/- 20.1, 34.6+/-14.5, 42.0+/-13.6, 49.2+/-12.6, 53.1+/-14.1, 52.6+/-16.1, 43.6+/-17.0, and 29.2+/- 26.5% after exercise, respectively. After the exercise period, the 75, 90, 120, and 150 minute volumes were lower (p< 0.05, p< 0.05, p< 0.05, p< 0.01) and the 90, 120, and 150 minute ejection fractions were higher than before exercise (p< 0.05, p < 0.05, p< 0.01). CONCLUSIONS Our study showed that exercise decreased late-phase postprandial gallbladder volume and increased late-phase postprandial gallbladder motility in these obese women.
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Affiliation(s)
- Ramazan Sari
- Internal Medicine, Endocrinology, Akdeniz University School of Medicine, Antalya, Turkey
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Sanabria A, Valdivieso E, Gomez G, Dominguez LC. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2004. [DOI: 10.1002/14651858.cd005265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Sari R, Balci MK, Coban E, Karayalcin U. Sonographic evaluation of gallbladder volume and ejection fraction in obese women without gallstones. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:352-357. [PMID: 12923879 DOI: 10.1002/jcu.10191] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Obese people have an increased incidence of gallstones. Although the exact pathogenic mechanisms of gallstone development are unknown, impaired gallbladder emptying has been suggested as a possible underlying mechanism. Our aim was to investigate this possibility by evaluating gallbladder motility and related factors in obese and nonobese women without gallstones. METHODS This study included 79 obese women and 25 nonobese healthy women. Using real-time sonography, we evaluated fasting and postprandial (15th-, 30th-, 45th-, 60th-, 75th-, 90th-, 120th-, and 150th-minute) gallbladder volumes and ejection fractions. The smallest postprandial volume was considered the residual volume. RESULTS Mean (+/- standard deviation) fasting and residual gallbladder volumes were 43.2 +/- 18.3 cm(3) and 21.4 +/- 11.2 cm(3), respectively, in the obese women and 28.1 +/- 12.3 cm(3) and 7.9 +/- 3.4 cm(3), respectively, in the nonobese women. Maximal ejection fraction was 49 +/- 19% in obese women and 63 +/- 29% in nonobese women (p = 0.001). The fasting and residual volumes and the postprandial volumes at all time points were higher in obese women than in nonobese women (p < 0.001). In addition, 15th-, 30th-, 45th-, 60th-, 75th-, and 90th-minute postprandial ejection fractions were lower in obese women than in nonobese women (p < 0.001). Positive correlations were found between fasting gallbladder volume and body mass index and body fat weight and between residual volume and body mass index, waist circumference, body fat percentage, and body fat weight (p < 0.05 for all comparisons). CONCLUSIONS Our results show that fasting and postprandial gallbladder volumes are higher and that postprandial gallbladder motility is lower in obese than in nonobese women. There are positive correlations between fasting gallbladder volume and body weight, body mass index, and body fat weight.
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Affiliation(s)
- Ramazan Sari
- Division of Endocrinology and Metabolism, Akdeniz University, School of Medicine, TR-07070 Antalya, Turkey
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Moro PL, Checkley W, Gilman RH, Lescano G, Bonilla JJ, Silva B, Garcia HH. Gallstone disease in high-altitude Peruvian rural populations. Am J Gastroenterol 1999; 94:153-8. [PMID: 9934747 DOI: 10.1111/j.1572-0241.1999.00787.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cholelithiasis is a common problem in hospitals of the Peruvian Andes; however, its prevalence in Andean communities is unknown. To estimate the prevalence of gallstone disease in this locale, we conducted a cross-sectional community study in three high-altitude Peruvian rural villages (i.e., > 3000 m above sea level). METHODS We examined 911 volunteers > 15 yr of age from three villages for gallstone disease by history and ultrasonography. Risk factors for gallstone disease were examined in 382 volunteers from one village. RESULTS The age-adjusted prevalence of gallstone disease ranged from 4-10% in men and from 18-20% in women. Women had significantly higher age-adjusted prevalence rates than did men. The prevalence of gallstone disease increased significantly with age and decreased significantly with alcohol consumption. Although not statistically significant, we found a positive association between gallstone disease and body mass index. CONCLUSION The results of this study indicate that gallstone disease, commonly perceived as a disease of the developed world, is also a common problem in high-altitude Peruvian communities.
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Affiliation(s)
- P L Moro
- Department of Pathology, Universidad Peruana Cayetano Heredia, Lima, Peru
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UTTER ALANC, GOSS FREDRICL, WHITCOMB DAVIDC, BROWN MANUELL, PUSATERI JOSEPHP, KRISKA ANDREAM, DASILVA SERGIOG, ROBERTSON ROBERTJ. The effects of acute exercise on gallbladder function in an adult female population. Med Sci Sports Exerc 1996. [DOI: 10.1249/00005768-199603000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Utter AC, Goss FL, Whitcomb DC, Brown ML, Pusateri JP, Kriska AM, Dasilva SG, Robertson RJ. The effects of acute exercise on gallbladder function in an adult female population. Med Sci Sports Exerc 1996; 28:280-4. [PMID: 8776215 DOI: 10.1097/00005768-199603000-00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It has been suggested that aerobic exercise influences gallstone disease pathogenesis through its effects on gallbladder motility. The purpose of the present investigation was to examine the effects of acute aerobic exercise on gallbladder emptying. Gallbladder function was evaluated, via cholescintigraphy, in 12 healthy females after undergoing two experimental trials [i.e., postprandial (P) and exercise + postprandial (E + P))]. In the E + P trial, 60 min after injection of 99mTc disofenin, subjects exercised for 30 min at 65.3 +/- 0.9%, (mean +/- SEM) of VO2 peak on a recumbent leg ergometer, and then ingested 8 oz of a liquid meal to promote gallbladder emptying. In the P trial the meal was administered at the same time relative to the E + P trial; however, for the 30 min prior to meal ingestion subjects remained in a resting supine position. Postprandial gallbladder ejection fraction (EF) was nonsignificantly higher in the E + P trial (49.4 +/- 5.1%) than in the P trial (46.6 +/- 6.7%). Results of this study also indicated that during a fasted state the gallbladder undergoes significant periods of spontaneous emptying both at rest EF = 25 +/- 5.6% (P < 0.02) and during exercise EF = 17 +/- 4.3% (P < 0.01). In conclusion, the results of this study indicate that 30 min of aerobic exercise at 65% of VO2 peak does not effect gallbladder motility in a healthy, premenopausal, female population.
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Affiliation(s)
- A C Utter
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
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Meyers WC, Peterseim DS, Pappas TN, Schauer PR, Eubanks S, Murray E, Suhocki P. Low insertion of hepatic segmental duct VII-VIII is an important cause of major biliary injury or misdiagnosis. Am J Surg 1996; 171:187-91. [PMID: 8554138 DOI: 10.1016/s0002-9610(99)80097-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The importance of variant anatomy is only mentioned generally in most articles in this era of laparoscopic cholecystectomy. We report a series of 14 patients in whom a seemingly low insertion of hepatic segmental duct VII-VIII was clinically important. METHODS The patients were managed at Duke University Medical Center. Two intraoperative videotapes of injury were reviewed. RESULTS Three categories of patients were identified: 6 patients who had injury in association with another major injury to the biliary system, 7 patients who had an isolated VII-VIII system injury, and 1 patient with a Klatskin tumor in whom the unobstructed variant duct was stented. After appropriate evaluation, all patients were successfully treated. Several lawsuits resulted, even when the injury was seemingly minor. Symptoms developed in all patients who filed lawsuits, but none in those who did not. CONCLUSION Appreciation of the VII-VIII biliary variant can lead to avoidance of injury or to a successful repair. The injury can easily occur despite "normal" cholangiography. Successful clinical outcome does not necessarily correlate with freedom from lawsuits.
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Affiliation(s)
- W C Meyers
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Shocket E. Abdominal abscess from gallstones spilled at laparoscopic cholecystectomy. Case report and review of the literature. Surg Endosc 1995; 9:344-7. [PMID: 7597612 DOI: 10.1007/bf00187783] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
One case is reported and 14 others are culled from the literature. Each patient experienced an intraperitoneal abscess with a gallstone nidus following laparoscopic cholecystectomy. Each required open surgical drainage weeks or months after the initial laparoscopic cholecystectomy. The natural biology of spilled intraperitoneal gallstones is not known. Two short-term animal studies suggest initial partial lysis and fibrotic encapsulation. At least 15% of completed laparoscopic cholecystectomies leave intraperitoneal gallstones. Almost all prove to be clinically innocuous but the rare instances of later intraabdominal abscess formation deserve recognition and reporting.
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Affiliation(s)
- E Shocket
- VA Medical Center, Bay Pines, FL 33504, USA
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Abstract
After a decade of effort to develop a minimalist alternative to standard cholecystectomy as the treatment for gallstone disease, laparoscopic cholecystectomy (LC) has emerged as the treatment of choice. Gallstone dissolution and lithotripsy failed to meet the tests of applicability and reliability. In fact, lithotripsy was denied approval by the US Food and Drug Administration in 1989. LC achieves the benchmark of treatment--removal of the diseased gallbladder and its stones--with less pain, disability, and disfigurement than standard surgery. The procedure is applicable in more than 90% of cases, being limited primarily by the severity of inflammation and the surgeon's experience. During the past 3 years, the special instrumentation has improved and operative techniques have been standardized resulting in fewer complications. For these reasons, laparoscopic surgical techniques are now being applied to a widening array of procedures including hernia repairs, bowel resections, antireflux procedures, common bile duct stone removal, lymph node dissections, and peptide ulcer disease treatment.
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Affiliation(s)
- J C Bowen
- Department of Surgery, Ochsner Clinic, New Orleans, LA 70121
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