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Shiihara M, Sudo Y, Matsushita N, Kubota T, Hibi Y, Osugi H, Inoue T. Preoperative difficulty assessment of interval laparoscopic cholecystectomy for gallstones. Surgery 2024; 175:1503-1507. [PMID: 38521628 DOI: 10.1016/j.surg.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/29/2023] [Accepted: 02/14/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the gold standard treatment for benign gallbladder disease. However, few studies have reported the difficulty of interval cholecystectomy after cholecystitis because early cholecystectomy is recommended for acute cholecystitis. In this study, we evaluated the difficulties associated with interval cholecystectomy for cholecystitis with gallstones. METHODS We retrospectively analyzed patients with gallstones who underwent interval laparoscopic cholecystectomy for cholecystitis at our institution between January 2012 and December 2021. Patients were classified into laparoscopic total cholecystectomy and bailout procedure groups depending on whether they were converted to a bailout procedure, and their characteristics and outcomes were subsequently compared. Additionally, a logistic regression analysis of the preoperative factors contributing to bailout procedure conversion was performed. RESULTS Of the 269 participants, 39 converted to bailout procedure, and bile duct injury occurred in one case (0.4%). In patient characteristics comparison, patients in the bailout procedure group were significantly older, had more impacted stones, had higher post-treatment choledocholithiasis, had severe cholecystitis, and had a higher rate of percutaneous transhepatic gallbladder drainage. There were no differences in the bile duct injury or perioperative complications between the two groups. In logistic regression multivariate analysis of the factors contributing to the bailout procedure, post-treatment of choledocholithiasis (P < .001), impacted stone (P = .002), and age ≥71 (P = .007) were independent risk factors. CONCLUSION Impacted stones and choledocholithiasis are risk factors for conversion to bailout procedure and high difficulty in interval cholecystectomy. For such patients, interval cholecystectomy should be performed cautiously.
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Affiliation(s)
- Masahiro Shiihara
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan.
| | - Yasuhiro Sudo
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan
| | | | - Takeshi Kubota
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan
| | - Yasuhiro Hibi
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan
| | - Harushi Osugi
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan
| | - Tatsuo Inoue
- Department of Surgery, Kamifukuoka General Hospital, Saitama, Japan
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2
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Patel M, Tranter-Entwistle I, Sirimanna P, Hugh TJ. 3D visualization systems improve operator efficiency during difficult laparoscopic cholecystectomy: a retrospective blinded review of surgical videos. ANZ J Surg 2024; 94:1114-1121. [PMID: 38486432 DOI: 10.1111/ans.18949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND 3D visualization systems in laparoscopic surgery have been proposed to improve manual task handling compared to 2D, however, few studies have compared the intra-operative efficacy in laparoscopic cholecystectomy (LC). The aim of this study is to determine if there is a benefit in intra-operative efficiency when using a 3D visualization system in difficult LC compared to traditional 2D visualization systems. METHODS Retrospective analysis of 'difficult' LCs (Grades 3 or 4) was completed. The assessor was blinded as all cases were recorded and viewed in 2D only. Variables collected included time to complete steps, missed hook diathermy attempts, failed grasp attempts, missed clip attempts and preparation steps for intra-operative cholangiogram (IOC). Multiple linear regression was undertaken for time variables, Poisson regression or negative binomial regression was completed for continuous variables. RESULTS Fifty-two operative videos of 'difficult' LC were reviewed. 3D systems were associated with reduced operative times, although this was not statistically significant (CI: -2.93-14.93, P-value = 0.183). Dissection of the anterior fold to achieve the critical view of safety was significantly faster by 3.55 min (CI: 1.215-9.206, P-value = 0.002), and with considerably fewer errors when using 3D systems. Fewer IOC preparation errors were observed with a 3D system compared with a 2D system. CONCLUSIONS 3D systems appear to enhance operator efficiency, allowing faster completion of critical steps with fewer errors. This pilot study underscores the utility of video annotation for intra-operative assessment and suggests that, in larger multi-centre studies, 3D systems may demonstrate superior intra-operative efficiency over 2D systems during a 'difficult' LC.
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Affiliation(s)
- Meet Patel
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Northern Beaches Hospital, Frenches Forrest, New South Wales, Australia
| | | | - Pramudith Sirimanna
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Thomas J Hugh
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia
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Mishima K, Fujiyama Y, Wakabayashi T, Tsutsui A, Okamoto N, Marescaux J, Kitagawa Y, Wakabayashi G. Combining preoperative C-reactive protein values with the Tokyo Guidelines 2018 grading criteria can enhance the prediction of surgical difficulty in early laparoscopic cholecystectomy for acute cholecystitis. HPB (Oxford) 2024; 26:426-435. [PMID: 38135551 DOI: 10.1016/j.hpb.2023.12.002] [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: 05/16/2023] [Revised: 08/23/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Early laparoscopic cholecystectomy (ELC) is the standard treatment for acute cholecystitis (AC). However, predicting the difficulty of this procedure remains challenging. The present study aimed to develop an improved prediction model for surgical difficulty during ELC, surpassing the current Tokyo Guidelines 2018 (TG18) grading system. METHODS We analyzed data from 201 consecutive patients who underwent ELC for AC between 2019 and 2021. Surgical difficulty was defined as the failure to achieve the critical view of safety (non-CVS). We developed a scoring system by conducting multivariate analysis on demographics, symptoms, laboratory data, and radiographic findings. The predictive accuracy of our scoring system was compared to that of the TG18 grading system (Grade I vs. Grade II/III). RESULTS Through multivariate logistic regression analysis, a novel scoring system was formulated. This system incorporated preoperative C-reactive protein (CRP) values (≥5: 1 pt, ≥10: 2 pts, ≥15: 3 pts) and TG18 grading score (duration >72 h: 1 pt, image criteria for Grade II AC: 1 pt). Our model, a cutoff score of ≥3, exhibited a significantly elevated area under the curve (AUC) of 0.721 compared to the TG18 grading system alone (AUC 0.609) (p = 0.001). CONCLUSION Combining preoperative CRP values with TG18 grading criteria can enhance the accuracy of predicting intraoperative difficulty in ELC for AC.
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Affiliation(s)
- Kohei Mishima
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Research Institute against Digestive Cancer (IRCAD), Strasbourg, France.
| | - Yoshiki Fujiyama
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Taiga Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Atsuko Tsutsui
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Nobuhiko Okamoto
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), Strasbourg, France
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
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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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Tranter-Entwistle I, Simcock C, Eglinton T, Connor S. Prospective cohort study of operative outcomes in laparoscopic cholecystectomy using operative difficulty grade-adjusted CUSUM analysis. Br J Surg 2023; 110:1068-1071. [PMID: 36882185 PMCID: PMC10416680 DOI: 10.1093/bjs/znad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 03/09/2023]
Affiliation(s)
| | - Corin Simcock
- Department of Surgery, The University of Otago Medical School, Christchurch, New Zealand
| | - Tim Eglinton
- Department of Surgery, The University of Otago Medical School, Christchurch, New Zealand
- Department of General Surgery, Christchurch Hospital, CDHB, Christchurch, New Zealand
| | - Saxon Connor
- Department of General Surgery, Christchurch Hospital, CDHB, Christchurch, New Zealand
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Utsumi M, Inagaki M, Kitada K, Tokunaga N, Yunoki K, Sakurai Y, Hamano R, Tsunemitsu Y, Miyasou H, Otsuka S. C-reactive Protein-to-Albumin Ratio Predicts Conversion from Laparoscopic to Open Cholecystectomy in Acute Cholecystitis. In Vivo 2023; 37:887-893. [PMID: 36881091 PMCID: PMC10026666 DOI: 10.21873/invivo.13157] [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: 01/19/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM The aim of this study was to identify predictors of conversion from laparoscopic to open cholecystectomy, and to determine whether pre-operative C-reactive protein-to-albumin ratio (CAR) can predict conversion from laparoscopic to open cholecystectomy, in patients with acute cholecystitis diagnosed according to the Tokyo Guidelines 2018. PATIENTS AND METHODS We retrospectively analysed 231 patients who underwent laparoscopic cholecystectomy for acute cholecystitis between January 2012 and March 2022. Two hundred and fifteen (93.1%) patients were included in the laparoscopic cholecystectomy group; sixteen (6.9%) patients were included in the conversion from laparoscopic to open cholecystectomy group. RESULTS In univariate analysis, significant predictors of conversion from laparoscopic to open cholecystectomy included the interval between symptom onset and surgery (>72 h), C-reactive protein (≥15.0 mg/l) and albumin (<3.5 mg/l) levels, pre-operative CAR (≥5.54), gallbladder wall thickness (≥5 mm), pericholecystic fluid collection, and pericholecystic fat hyperdensity. In multivariate analysis, elevated pre-operative CAR (≥5.54) and the interval between symptom onset and surgery (>72 h) were independent predictors of conversion from laparoscopic to open cholecystectomy. CONCLUSION Pre-operative CAR as a predictor of conversion from laparoscopic to open cholecystectomy may be useful for pre-operative risk assessment and treatment planning.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Masaru Inagaki
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Koji Kitada
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Naoyuki Tokunaga
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Kosuke Yunoki
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Yuya Sakurai
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Ryosuke Hamano
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Yousuke Tsunemitsu
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Hideaki Miyasou
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Shinya Otsuka
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
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Tranter-Entwistle I, Eglinton T, Hugh TJ, Connor S. Use of prospective video analysis to understand the impact of technical difficulty on operative process during laparoscopic cholecystectomy. HPB (Oxford) 2022; 24:2096-2103. [PMID: 35961932 DOI: 10.1016/j.hpb.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND An understanding of the impact of operative difficulty on operative process in laparoscopic cholecystectomy is lacking. The aim of the present study was to prospectively analyse digitally recorded laparoscopic cholecystectomy to assess the impact of operative technical difficulty on operative process. METHODS Video of laparoscopic cholecystectomy procedures performed at Christchurch Hospital, NZ and North Shore Private Hospital, Sydney Australia were prospectively recorded. Using a framework derived from a previously published standard process video was annotated using a standardized template and stratified by operative grade to evaluate the impact of grade on operative process. RESULTS 317 patients had their laparoscopic cholecystectomy operations prospectively recorded. Seventy one percent of these videos (n = 225) were annotated. Single ICC of operative grade was 0.760 (0.663-0.842 p < 0.010). Median operative time, rate of operative errors significantly increased and rate of CVS decreased with increasing operative grade. Significant differences in operative anatomy, operative process and instrumentation were seen with increasing grade. CONCLUSION Operative technical difficulty is accurately predicted by operative grade and this impacts on operative process with significant implications for both surgeons and patients. Consequently operative grade should be documented routinely as part of a culture of safe laparoscopic cholecystectomy.
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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, New Zealand
| | - Thomas J Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Saxon Connor
- Department of General Surgery Christchurch Hospital, Te Whatu Ora, New Zealand
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Kurata Y, Hayano K, Imai Y, Ichinose M, Hirata A, Mizumachi R, Hirasawa S, Yonemoto S, Sasaki T, Kainuma S, Takahashi Y, Ohira G, Matsubara H. Apparent diffusion coefficient by magnetic resonance cholangiopancreatography is useful for grading cholecystitis and surgery planning. Asian J Endosc Surg 2022; 16:173-180. [PMID: 36180045 DOI: 10.1111/ases.13128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/18/2022] [Accepted: 09/09/2022] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy is a standard procedure for treating cholescytitis, but severe inflammation may cause complications. Our previous study showed that the apparent diffusion coefficient (ADC) values could predict difficult surgery. In the present study, relevance of ADC values in grading the severity of cholecystitis was pathologically investigated. METHODS We retrospectively analyzed a total of 50 patients who underwent laparoscopic cholecystectomy or laparotomic cholecystectomy/choledocholithotomy. The degree of inflammation in the neck of the gall bladder was pathologically graded into three tiers (grade 1, mild; grade 2, moderate; grade 3, severe), and ulceration, lymphoid follicle formation, and wall thickness of the gallbladder neck were recorded. All factors were statistically compared with the measured ADC values. RESULTS The ADC value was significantly lower in the severe inflammation group ( grade 3) than in the weak inflammation group (grades 1 and 2) (1.93 ± 0.22 vs 2.38 ± 0.67, respectively; P = .02). Ulceration and wall thickness in the gallbladder neck were significantly correlated with ADC values (P = .04 and .006, respectively), and lymphoid follicle formation was marginally correlated with ADC values (P = .06). The diagnostic utility of the ADC values decreased as the interval between imaging and cholecystectomy increased. [Correction added on 19 October 2022, after first online publication: [On the first sentence of the Results section, (grades 2 and 3) for weak inflammation group has been changed to (grades 1 and 2).] CONCLUSION: ADC values were inversely associated with the pathologic intensity of cholecystitis. We recommend that the ADC value be measured before surgery, so that the procedure can be accordingly planned.
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Affiliation(s)
- Yoshihiro Kurata
- Department of Digestive Surgery, International University of Health and Welfare Shioya Hospital, Tochigi, Japan.,Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuo Imai
- Department of Diagnostic Pathology, Ota Memorial Hospital, SUBARU Health Insurance Society, Ota, Japan
| | - Masanori Ichinose
- Department of Digestive Surgery, International University of Health and Welfare Shioya Hospital, Tochigi, Japan
| | - Atsushi Hirata
- Department of Digestive Surgery, International University of Health and Welfare Shioya Hospital, Tochigi, Japan.,Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryoya Mizumachi
- Department of Digestive Surgery, International University of Health and Welfare Shioya Hospital, Tochigi, Japan.,Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Soichiro Hirasawa
- Department of Digestive Surgery, International University of Health and Welfare Shioya Hospital, Tochigi, Japan.,Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shohei Yonemoto
- Department of Digestive Surgery, International University of Health and Welfare Shioya Hospital, Tochigi, Japan.,Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuma Sasaki
- Department of Digestive Surgery, International University of Health and Welfare Shioya Hospital, Tochigi, Japan.,Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunsuke Kainuma
- Department of Digestive Surgery, International University of Health and Welfare Shioya Hospital, Tochigi, Japan.,Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yumiko Takahashi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Utsumi M, Sakurai Y, Narusaka T, Tokunaga N, Kitada K, Hamano R, Tsunemitsu Y, Miyasou H, Otsuka S, Inagaki M. C-reactive protein to albumin ratio predicts difficult laparoscopic cholecystectomy in patients with acute cholecystitis diagnosed according to the Tokyo Guidelines 2018. Asian J Endosc Surg 2022; 15:487-494. [PMID: 35137536 DOI: 10.1111/ases.13035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/06/2022] [Accepted: 01/22/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Difficult laparoscopic cholecystectomy (DLC) may increase the risk of complications and extend the duration of hospitalization. The aims of this study were to evaluate the predictive value of C-reactive protein/albumin ratio (CAR) for DLC in patients with acute cholecystitis (AC) diagnosed according to the Tokyo Guidelines 2018 and to develop a preoperative predictive model for DLC. METHODS We retrospectively analyzed 205 patients who had laparoscopic cholecystectomy for AC between January 2012 and December 2020. We defined DLC cases as having one of the following factors: blood loss ≥50 mL, operative time ≥150 minutes, or conversion to open surgery. We classified the remaining cases into the non-DLC group. RESULTS Overall, 127 (62.0%) and 78 (38.0%) patients were grouped into the DLC and non-DLC groups, respectively. Patients in the DLC group had: higher severity grade, which was assessed using the Tokyo Guidelines 2018; higher incidence of postoperative complications; and more hospitalization days than those in the non-DLC group. Multivariate analysis revealed that male, CAR (≥3.20), and pericholecystic fat hyperdensity on computed tomography (CT) were independent predictors of DLC. We developed a predictive scoring system for DLC based on these three factors (cutoff value, 2.0; area under the curve, 0.75; sensitivity, 71.7%; and specificity, 70.5%). CONCLUSION CAR could predict DLC independently in AC patients. We identified male gender, CAR, and pericholecystic fat hyperdensity on CT as predictive factors for DLC and established a preoperative prediction system based on these three factors.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Yuya Sakurai
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Toru Narusaka
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Naoyuki Tokunaga
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Koji Kitada
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Ryosuke Hamano
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Yousuke Tsunemitsu
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Hideaki Miyasou
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Shinya Otsuka
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Masaru Inagaki
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
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Ma JLG, Yogaraj V, Siddiqui M, Chauhan K, Tobin VA, Pilgrim CHC. The impact of COVID-19 on emergency cholecystectomy. ANZ J Surg 2021; 92:409-413. [PMID: 34859559 DOI: 10.1111/ans.17406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUNDS The impact of the SARS-CoV-2 virus (COVID-19) upon the delivery of surgical services in Australia has not been well characterized, other than restrictions to elective surgery due to government directive-related cancellations. Using emergency cholecystectomy as a representative operation, this study aimed to investigate the impact of COVID-19 on emergency general surgery in Australia in relation to in-hours versus after-hours operating. METHODS A retrospective analysis was conducted of medical records for patients admitted with cholecystitis or biliary colic between 1 March 2019 and 28 February 2021 at Frankston Hospital, Australia. Patient demographics, admission data, imaging findings, operative and post-operative data were compared between pre-COVID-19 and COVID-19 periods. Variables were compared using the Wilcoxon-Mann-Whitney, Chi Squared or Fishers exact test. RESULTS During the COVID-19 period, emergency cholecystectomy was performed for a greater proportion of patients presenting with cholecystitis or biliary colic (93.5% versus 77.7%, p < 0.01). Despite this, there was concomitant reduction in after-hours cholecystectomy from 14.4% to 7.5% (p = 0.04). Patients requiring after-hours surgery during the COVID-19 period had more features of sepsis (23% more tachypnoeic, 18% more hypotensive), and were more likely to have certain features of cholecystitis on imaging (45% more likely to have pericholecystic fluid). CONCLUSION Following elective surgery cancellations during the COVID-19 period, an increase was seen in the proportion of patients presenting with gallstone disease who were managed with emergency cholecystectomy due to improved theatre access. Concurrently, there was a decrease in the requirement for surgery to be performed after-hours.
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Affiliation(s)
- Joyce Lok Gee Ma
- Department of Surgery, Frankston Hospital, Frankston, Victoria, Australia
| | - Vikash Yogaraj
- Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Mustafa Siddiqui
- Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Karanjeet Chauhan
- Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Vicky A Tobin
- Department of Surgery, Frankston Hospital, Frankston, Victoria, Australia
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Vannucci M, Laracca GG, Mercantini P, Perretta S, Padoy N, Dallemagne B, Mascagni P. Statistical models to preoperatively predict operative difficulty in laparoscopic cholecystectomy: A systematic review. Surgery 2021; 171:1158-1167. [PMID: 34776259 DOI: 10.1016/j.surg.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy operative difficulty is highly variable and influences outcomes. This systematic review analyzes the performance and clinical value of statistical models to preoperatively predict laparoscopic cholecystectomy operative difficulty. METHODS PRISMA guidelines were followed. PubMed, Embase, and the Cochrane Library were searched until June 2020. Primary studies developing or validating preoperative models predicting laparoscopic cholecystectomy operative difficulty in cohorts of >100 patients were included. Studies not reporting performance metrics or enough information for clinical implementation were excluded. Data were extracted according to CHARMS, and study quality was assessed using the PROBAST tool. RESULTS In total, 2,654 articles were identified, and 22 met eligibility criteria. Eighteen were model development, whereas 4 were validation studies. Eighteen studies were at high risk of bias. However, 11 studies showed low concern for applicability. Identified models predict 9 definitions of laparoscopic cholecystectomy operative difficulty, the most common being conversion to open surgery and operating time. The most validated models predict an intraoperative difficulty scale and procedures >90 minutes with an area under the curve of >0.70 and >0.76, respectively. Commonly used predictors include demographic variables such as age and gender (9/18 models) and ultrasound findings such as gallbladder wall thickness (11/18). Clinical implementation was never studied. CONCLUSION There is a longstanding interest in estimating laparoscopic cholecystectomy operative difficulty. Models to preoperatively predict laparoscopic cholecystectomy operative difficulty have generally good performance and seem applicable. However, an unambiguous definition of operative difficulty, validations, and clinical studies are needed to implement patients' stratification in laparoscopic cholecystectomy.
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Affiliation(s)
- Maria Vannucci
- University of Tor Vergata, Rome, Italy; Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France
| | - Giovanni Guglielmo Laracca
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France; Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Paolo Mercantini
- Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Silvana Perretta
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France; Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France; Department of Digestive and Endocrine Surgery, University of Strasbourg, France
| | - Nicolas Padoy
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France; ICube, University of Strasbourg, CNRS, Illkirch, France
| | - Bernard Dallemagne
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France; Department of Digestive and Endocrine Surgery, University of Strasbourg, France
| | - Pietro Mascagni
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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12
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Kurata Y, Hayano K, Ichinose M, Sasaki T, Kainuma S, Fukasawa K, Shimao H, Ohira G, Matsubara H. Preoperative prediction of difficult laparoscopic cholecystectomy based on diffusion-weighted magnetic resonance imaging. Asian J Endosc Surg 2021; 14:520-528. [PMID: 33393228 DOI: 10.1111/ases.12911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy is a common surgery with a varying difficulty level. Difficult laparoscopic cholecystectomy may be experienced by many surgeons. If difficult procedures are predicted preoperatively, surgeons may be able to plan the surgical approach and treatment accordingly. Studies have reported using blood and clinical imaging data to predict difficult cholecystectomy. However, to our knowledge, no studies have reported using MRI. The purpose of this study was to evaluate the usefulness of MRI as a predictor of difficult laparoscopic cholecystectomy. METHODS We retrospectively evaluated 25 patients with cholecystitis or biliary colic who had undergone diffusion-weighted whole-body imaging before laparoscopic cholecystectomy. The apparent diffusion coefficient value of the cystic duct was measured and its relationship with operative time and blood loss was examined to assess the capacity of diffuse-weighted whole-body imaging to predict difficult cholecystectomy. Further, we collected blood data and compared its usefulness as a predictor. RESULTS The apparent diffusion coefficient value of the cystic duct was significantly lower in patients with difficult laparoscopic cholecystectomy than in those with non-difficult procedures (P = .00007). White blood cell count and serum C-reactive protein level were significantly higher in patients with difficult cholecystectomy than in those with non-difficult procedures (P = .035, .030). In the receiver operating characteristic analysis, the apparent diffusion coefficient value was the best predictor. CONCLUSION Our results suggest that the apparent diffusion coefficient value of the cystic duct is a predictor of difficult laparoscopic cholecystectomy. In the future, it may be useful to study changes in coefficient values over time to determine optimal surgical timing.
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Affiliation(s)
- Yoshihiro Kurata
- Department of Digestive Surgery, International University of Health and Welfare, Shioya Hospital, Yaita, Japan.,Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masanori Ichinose
- Department of Digestive Surgery, International University of Health and Welfare, Shioya Hospital, Yaita, Japan
| | - Takuma Sasaki
- Department of Digestive Surgery, International University of Health and Welfare, Shioya Hospital, Yaita, Japan.,Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunsuke Kainuma
- Department of Digestive Surgery, International University of Health and Welfare, Shioya Hospital, Yaita, Japan.,Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kimiaki Fukasawa
- Department of Digestive Surgery, International University of Health and Welfare, Shioya Hospital, Yaita, Japan
| | - Hitoshi Shimao
- Department of Digestive Surgery, International University of Health and Welfare, Shioya Hospital, Yaita, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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13
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Srinivasa S, Hammill CW, Strasberg SM. How to do laparoscopic subtotal fenestrating cholecystectomy. ANZ J Surg 2020; 91:740-741. [PMID: 33200510 DOI: 10.1111/ans.16435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/08/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sanket Srinivasa
- Section of HPB and GI Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Chet W Hammill
- Section of HPB and GI Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Steven M Strasberg
- Section of HPB and GI Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St Louis, Missouri, USA
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14
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O'Neill RS, Wennmacker SZ, Bhimani N, Dijk AH, Reuver P, Hugh TJ. Unsuspected choledocholithiasis found by routine intra‐operative cholangiography during laparoscopic cholecystectomy. ANZ J Surg 2020; 90:2279-2284. [PMID: 32536007 DOI: 10.1111/ans.16016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Robert S. O'Neill
- Upper GI Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
| | - Sarah Z. Wennmacker
- Department of Surgery Radboud University Medical Center Nijmegen The Netherlands
| | - Nazim Bhimani
- Upper GI Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
| | - Aafke H. Dijk
- Department of Surgery Academic Medical Center Amsterdam The Netherlands
| | - Philip Reuver
- Department of Surgery Radboud University Medical Center Nijmegen The Netherlands
| | - Thomas J. Hugh
- Upper GI Surgery Unit Royal North Shore Hospital Sydney New South Wales Australia
- Northern Clinical School University of Sydney Sydney New South Wales Australia
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