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Song G, Mou Y, Ren C, Zhou H, Wang J. Comparison and Selection of Three Methods of Minimally Invasive External Drainage for Children with Congenital Choledochal Cysts. J Laparoendosc Adv Surg Tech A 2021; 31:462-467. [PMID: 33595365 DOI: 10.1089/lap.2020.0222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Aim: Emergent biliary drainage is necessary due to acute symptoms of choledochal cysts. Percutaneous biliary drainage (PBD), laparoscopic bile duct drainage (LBD), and laparoscopic cholecystostomy (LC) are the three most common drainage treatments. So far, there is no comparative study on these three approaches, which all have been applied in our hospital. This article compares the drainage effects of these three approaches and illustrates their respective merits and demerits, with the aim of providing a reference for clinical application. Materials and Methods: We conducted a retrospective study of 20 children who underwent biliary drainage before their definitive surgery due to acute symptoms of choledochal cysts between June 2008 and May 2015. Among them, 6 underwent PBD, 8 underwent LBD, and 6 underwent LC. Results: Preoperative abdominal pain, fever, and jaundice symptoms were effectively relieved by the three approaches. There were no significant differences in terms of the recovery of liver functions. The average interval and duration of procedures of three groups were PBD (25.00 ± 4.47 minutes and 262.50 ± 35.74 minutes), LBD (84.37 ± 24.99 minutes and 283.75 ± 39.62 minutes), and LC (50.83 ± 13.57 minutes and 218.33 ± 28.58 minutes), respectively. Conclusions: LC has advantages of a comparatively simple operation and no foreign body sensation (external drain) in the hepatic duct, which is beneficial for relieving inflammation of the common bile duct, and thus is suitable for majority of patients needing external bile drainage. Meanwhile, PBD and LBD also have their respective applicable patients.
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Affiliation(s)
- Guoxin Song
- Department of Pediatric Surgery, Weihai Municipal Hospital, Shandong University, Weihai, China
| | - Yaru Mou
- Department of Cardiology, Shan Dong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chuantao Ren
- Department of Pediatric Surgery, Dezhou People's Hospital, Dezhou, China.,Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Haimeng Zhou
- Department of Pediatric Surgery, Weihai Municipal Hospital, Shandong University, Weihai, China
| | - Jian Wang
- Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, China
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Ten-year Audit of Safe Bail-Out Alternatives to the Critical View of Safety in Laparoscopic Cholecystectomy. World J Surg 2019; 43:2728-2733. [DOI: 10.1007/s00268-019-05082-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kaimba BM, Mahamat Y, Akouya SD. [Laparoscopic cholecystectomy for acute cholecystitis gallstones: about 22 cases compiled at the Rebirth hospital of Ndjamena]. Pan Afr Med J 2015; 21:311. [PMID: 26587159 PMCID: PMC4633810 DOI: 10.11604/pamj.2015.21.311.6823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/29/2015] [Indexed: 11/15/2022] Open
Abstract
Déterminer la faisabilité de la cholécystectomie laparoscopique pour cholécystite aiguë lithiasique dans notre contexte d'exercice, et d'en évaluer les résultats. Nous rapportons une série de 22 patients ayant bénéficié d'une cholécystectomie laparoscopique pour cholécystite aiguë lithiasique sur une période de 16 mois (Décembre 2013- Mars 2015). Sur 22 patients été opérés, il y avait une nette prédominance féminine (20 femmes soit 91%). La durée moyenne de l'intervention était de 90 mn avec des extrêmes de 38 et 142 mn. L’âge moyen de nos patients était de 42 ans avec des extrêmes de 16 à 65 ans. La durée d'hospitalisation a été de 2 à 6 jours avec une moyenne de 3 jours. Le taux de conversion en laparotomie était de 4.5%. Les suites opératoires immédiates ont été simples dans 90.9% des cas. Les complications concernaient 2 patients (9.1%) dont 1 suppuration pariétale et 1 hémorragie de paroi. La cholécystectomie laparoscopique pour cholécystite aigue lithiasique est faisable dans notre contexte au delà des 72 heures d’évolution sans majoration de risques.
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Affiliation(s)
- Bray Madoué Kaimba
- Service de Chirurgie, Hôpital de la Renaissance de Ndjamena, Ndjamena, Tchad
| | - Youssouf Mahamat
- Service de Chirurgie, Hôpital de la Renaissance de Ndjamena, Ndjamena, Tchad
| | - Seid Dounia Akouya
- Service de Chirurgie, Hôpital de la Renaissance de Ndjamena, Ndjamena, Tchad
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Chowbey P, Sharma A, Goswami A, Afaque Y, Najma K, Baijal M, Soni V, Khullar R. Residual gallbladder stones after cholecystectomy: A literature review. J Minim Access Surg 2015; 11:223-30. [PMID: 26622110 PMCID: PMC4640007 DOI: 10.4103/0972-9941.158156] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 10/25/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. MATERIALS AND METHODS Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up. RESULTS Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct. CONCLUSION Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic) is the most common treatment modality reported in the literature for the management of residual gallbladder stones.
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Affiliation(s)
- Pradeep Chowbey
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Anil Sharma
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Amit Goswami
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Yusuf Afaque
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Khoobsurat Najma
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Manish Baijal
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Vandana Soni
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Rajesh Khullar
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
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Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies. Langenbecks Arch Surg 2014; 400:421-7. [PMID: 25539703 DOI: 10.1007/s00423-014-1267-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database. MATERIALS AND METHODS This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database. RESULTS LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients. CONCLUSIONS We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.
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Simorov A, Ranade A, Parcells J, Shaligram A, Shostrom V, Boilesen E, Goede M, Oleynikov D. Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study. Am J Surg 2013; 206:935-40; discussion 940-1. [PMID: 24112675 DOI: 10.1016/j.amjsurg.2013.08.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/29/2013] [Accepted: 08/29/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Morbidity and mortality are very high for critically ill patients who develop acute acalculous cholecystitis (AAC). The aim of this study was to compare outcomes in extremely ill patients with AAC treated with percutaneous cholecystostomy (PC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC), which were also analyzed together in the LC-plus-OC (LO) group. METHODS Discharge data from the University HealthSystem Consortium database were accessed using International Classification of Diseases codes. The University HealthSystem Consortium's Clinical Data Base/Resource Manager allows member hospitals to compare patient-level, risk-adjusted outcomes. Multivariate regression models for extremely ill patients undergoing PC or LO for the diagnosis of AAC were created and analyzed. RESULTS A total of 1,725 extremely ill patients were diagnosed with AAC between October 2007 and June 2011. Patients undergoing PC (n = 704) compared with the LO group (n = 1,021) showed decreased morbidity (5.0% with PC vs 8.0% with LO, P < .05), fewer intensive care unit admissions (28.1% with PC vs 34.6% with LO, P < .05), decreased length of stay (7 days with PC vs 8 days with LO, P < .05), and lower costs ($40,516 with PC vs $53,011 with LO, P < .05). Although perioperative outcomes of PC compared with LC were statistically similar, PC had lower costs compared with LC ($40,516 vs 51,596, P < .005). Multivariate regression analysis showed that LC (n = 822), compared with OC (n = 199), had lower mortality (odds ratio [OR], .3; 95% confidence interval [CI], .1 to .6), lower morbidity (OR, .4; 95% CI, .2 to .7), reduced intensive care unit admission (OR, .3; 95% CI, .2 to .5), and similar 30-day readmission rates (OR, 1.0; 95% CI, .6 to 1.5). Also, decreased length of stay (7 days with LC vs 8 days with OC) and costs ($51,596 with LC vs $61,407 with OC) were observed, with a 26% conversion rate to an open procedure. CONCLUSIONS On the basis of this experience, extremely ill patients with AAC have superior outcomes with PC. LC should be performed in patients in whom the risk for conversion is low and in whom medical conditions allow. These results show PC to be a safe and cost-effective bridge treatment strategy with perioperative outcomes superior to those of OC.
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Affiliation(s)
- Anton Simorov
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE 68198-5126, USA
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Chowbey P, Soni V, Sharma A, Khullar R, Baijal M. Residual gallstone disease - Laparoscopic management. Indian J Surg 2010; 72:220-5. [PMID: 23133251 PMCID: PMC3452661 DOI: 10.1007/s12262-010-0058-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 12/09/2009] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND A few patients who continue to suffer antecedent symptoms following laparoscopic cholecystectomy (LC) may harbor residual gallstones. The incidence of residual gallstones following cholecystectomy is <2.5%. Many of these patients require a completion cholecystectomy to ameliorate their symptoms. MATERIALS AND METHODS We reviewed our experience of laparoscopic re-intervention for residual gallstones over a period of 10 years from January 1998 to December 2007. Twenty six patients underwent Laparoscopic completion cholecystectomy (LCC) for residual gallstone disease. Twelve patients had a previous LC (2 patients - subtotal cholecystectomy) and 9 patients had a previous open cholecystectomy (7 patients - subtotal cholecystectomy). Five patients had previously undergone a cholecystostomy. Diagnostic investigations included abdominal ultrasound, endoscopic ultrasound (EUS), magnetic resonance cholangio-pancreatography (MRCP) and endoscopic retrograde cholangio-pancreatography (ERCP). RESULTS Findings included a remnant gallbladder in 3 patients, long cystic duct stump with impacted stone in 18 patients and a contracted gallbladder in 5 patients. All procedures were successfully completed laparoscopically. The mean operative time was 62 minutes and mean blood loss 50cc. Ten patient required abdominal drains postoperatively. Two patients had bilious drainage lasting 9 days and 11 days respectively. One patient died a week following surgery of acute myocardial infarction. Another patient died 6 months later of unrelated causes. The remaining patients have remained symptom free at a mean follow up of 3.2 years (range 7 months to 9 years). CONCLUSION The possibility of residual gallstones increases with subtotal cholecystectomy and inadequate dissection of the Calot's triangle in the presence of acute inflammation. Laparoscopic re-intervention for treating residual gallstone disease is feasible and can be safely performed in centers of expertise.
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Affiliation(s)
- Pradeep Chowbey
- Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India
| | - Vandana Soni
- Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India
| | - Anil Sharma
- Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India
| | - Rajesh Khullar
- Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India
| | - Manish Baijal
- Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India
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Open cholecystectomy in the laparoendoscopic era. Am J Surg 2008; 195:108-14. [PMID: 18082551 DOI: 10.1016/j.amjsurg.2007.04.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 04/03/2007] [Accepted: 04/03/2007] [Indexed: 02/06/2023]
Abstract
Laparoscopic cholecystectomy has all but replaced the traditional open approach. Hence open cholecystectomy (OC) is principally reserved for cases in which laparoscopy fails, leaving fewer surgeons with experience in the procedure required for the most challenging cases. This review of OC includes discussion of the indications for a primary open approach, conversion from laparoscopy, technical aspects of OC, and alternatives (cholecystostomy and subtotal cholecystectomy). Strategies for safe OC must be formally addressed in residency programs.
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Misiakos EP, Karatzas G, Macheras A, Bistarakis D, Kakisis J, Brountzos EN, Liakakos T. Laparoscopic cholecystectomy after open cholecystostomy for gallbladder empyema: a case report. J Laparoendosc Adv Surg Tech A 2007; 17:655-8. [PMID: 17907982 DOI: 10.1089/lap.2006.0179] [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: 11/13/2022] Open
Abstract
The case of a patient with gallbladder empyema initially drained through a minilaparotomy procedure under local anesthesia with a tube cholecystostomy is reported in this paper. Eight weeks later, the patient underwent an elective interval laparoscopic cholecystectomy. At laparoscopy, the gallbladder and the cholecystostomy tube were dissected free from the abdominal wall and the greater omentum, which was attached to the gallbladder. The tube was removed from the gallbladder fundus, and the operation was completed laparoscopically without any major problems.
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Affiliation(s)
- Evangelos P Misiakos
- 3rd Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Athens, Greece.
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Chowbey PK, Venkatasubramanian R, Bagchi N, Sharma A, Khullar R, Soni V, Baijal M. Laparoscopic cholecystostomy is a safe and effective alternative in critically ill patients with acute cholecystitis: two cases. J Laparoendosc Adv Surg Tech A 2007; 17:43-6. [PMID: 17362178 DOI: 10.1089/lap.2006.05078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emergency cholecystectomy for acute cholecystitis in critically ill patients with organ failure and sepsis carries a high risk of morbidity and mortality. Temporizing interventions such as laparoscopic cholecystostomy can help the patient to recover from the critical illness by deferring the definitive procedure to a later, safer period. We describe our experience of laparoscopic cholecystostomy performed in two critically ill patients. In the first case, a 56-year-old man with hypertension, diabetes, and ischemic heart disease, was admitted for evaluation of malena. During the course of his stay, he developed acute calculous cholecystitis, acute renal failure, and right pleural effusion. In the second case, a 68-year-old man presented with diabetes, hypertension, diabetic nephropathy, acute chronic renal failure, and acute calculous cholecystitis. Both patients failed to improve with conservative measures and underwent laparoscopic cholecystostomy under local anesthesia and sedation in view of severe comorbidities and sepsis. Both patients recovered from sepsis. Laparoscopic cholecystectomy was performed uneventfully after six and eight weeks, respectively, and both patients were doing well at one-year follow-up.
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Affiliation(s)
- Pradeep K Chowbey
- Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India.
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Abstract
Only 20-30% of patients with gallstones have symptoms and the probability of a patient with silent gallstones developing biliary-related pain is 1-2%, while the risk of developing a serious complication (e.g. empyema, perforation, peritonitis etc.) is less than 0.1% per year. Imaging techniques are important in establishing the diagnosis and evaluating the patient. Laparoscopic cholecystectomy (LC) is the golden standard for the management of symptomatic gallstones and there are two surgical treatment options: early cholecystectomy (same hospital admission) and interval (delayed) cholecystectomy (6-8 weeks after resolution of acute attack). Early LC has medical and socioeconomic advantages over interval LC. LC can be undertaken for the majority of patients with AC and in some high risk groups the postoperative mortality can even be reduced. LC in AC is associated with longer operating time, a higher rate of conversion and bile damage. Early diagnosis and early operation can prevent the development of complications associated with AC.
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Affiliation(s)
- M Milicevic
- The First Surgical Clinic University Clinical Center of Belgrade, Serbia and Montenegro
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