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Raja S, Ali A, Kumar D, Raja A, Samo KA, Memon AS. Early vs. interval approach to laparoscopic cholecystectomy for acute cholecystitis: a retrospective observational study from Pakistan. Front Surg 2024; 11:1462885. [PMID: 39308853 PMCID: PMC11412953 DOI: 10.3389/fsurg.2024.1462885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 08/23/2024] [Indexed: 09/25/2024] Open
Abstract
Background Laparoscopic cholecystectomy (LC) is the preferred treatment for acute cholecystitis (AC). However, the optimal timing for LC in AC management remains uncertain, with early cholecystectomy (EC) and interval cholecystectomy (IC) being two common approaches influenced by various factors. Methods This retrospective study, conducted at a tertiary care teaching hospital in Karachi, Pakistan, aimed to compare the outcomes of EC vs. IC for AC management. Patient data from January 2019 to September 2019 were analyzed with a focus on operative complications, duration of surgery, and postoperative hospital stay. The inclusion criteria were based on the Tokyo Guidelines, and patients underwent LC within 3 days of symptom onset in the EC group and after 6 weeks in the IC group. Results Among 147 eligible patients, 100 underwent LC (50 in each group). No significant differences were observed in the sex distribution or mean age between the two groups. The EC group experienced fewer operative complications (12%) than the IC group (34%), with statistically significant differences observed. Nevertheless, no substantial variations in operative time or postoperative hospital stay were observed between the groups. Conclusion Reduced complications in the EC group underscore its safety and efficacy. Nonetheless, further validation through multicenter studies is essential to substantiate these findings.
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Affiliation(s)
- Sandesh Raja
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Azzam Ali
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Dileep Kumar
- Department of Surgery, Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
| | - Adarsh Raja
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Khursheed Ahmed Samo
- Department of Surgery, Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
| | - Amjad Siraj Memon
- Department of Surgery, Jinnah Sindh Medical University, Karachi, Pakistan
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Golod N, Saienko V, Liannoi M, Rusyn L, Yaniv O, Ivanovska O. The dynamics of recovery of external breathing function in patients after laparoscopic cholecystectomy in the acute period under the influence of the rehabilitation program. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:208-213. [PMID: 38592980 DOI: 10.36740/wlek202402104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Aim: To determine the dynamics of renewal of the function of external respiration in patients after laparoscopic cholecystectomy at the acute stage of rehabilitation under the influence of a rehabilitation program. PATIENTS AND METHODS Materials and Methods: The study is randomized, simple with blinded assessors. The forced vital capacity (FVC, l), forced expiratory volume in the first second (FEV1, l) and peak expiratory flow rate (PEFR, l/s) were assessed. Spirometry was performed 120 patients on the first day of admission of patients to the surgical department for surgical intervention, on the second day and on the day of discharge. Methods of mathematical statistics: arithmetic mean (M) and standard error of the mean (}m), Student's t-test were calculated, differences at p<0,05 were considered statistically significant. RESULTS Results: It has been established that laparoscopic cholecystectomy leads to a statistically significant decrease in the parameters of respiratory function in all age categories. More pronounced positive dynamics of respiratory function in the group of respiratory therapy. It was established that without respiratory therapy on the day of discharge there was no restoration (р<0.05) in groups of elderly patients of group of FVC l, FEV1 l, PEFR l/s; in middle-aged patients did no restoration FEV1, l, PEFR, l/s; in younger patients there was no recovery of FEV1, l. CONCLUSION Conclusions: The results of the study indicate the effectiveness of the introduction of diaphragmatic breathing exercises in combination with early mobilization at the acute and subacute stages of rehabilitation in patients after laparoscopic cholecystectomy in order to restore the function of the respiratory system.
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Affiliation(s)
- Nataliya Golod
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | | | - Mykhailo Liannoi
- SUMY STATE PEDAGOGICAL UNIVERSITY NAMED AFTER A. S. MAKARENKO, SUMY, UKRAINE
| | | | - Olesia Yaniv
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | - Olga Ivanovska
- NATIONAL UNIVERSITY OF PHYSICAL EDUCATION AND SPORTS OF UKRAINE, KYIV, UKRAINE
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Ohya H, Maeda A, Takayama Y, Takahashi T, Seita K, Kaneoka Y. Preoperative risk factors for technical difficulty in emergent laparoscopic cholecystectomy for acute cholecystitis. Asian J Endosc Surg 2022; 15:82-89. [PMID: 34291878 DOI: 10.1111/ases.12969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/26/2021] [Accepted: 07/05/2021] [Indexed: 12/11/2022]
Abstract
AIM We have routinely performed emergent laparoscopic cholecystectomy (LC) as soon as we diagnosed acute cholecystitis (AC), if patients could tolerate surgery. This study was conducted to identify the preoperative risk factors that predict the technical difficulty of emergent LC for AC. METHODS A retrospective review of patients with AC who underwent emergent LC between 2012 and 2019 was conducted. Technical difficulty was defined as the presence of the following conditions: open conversion, operative time ≥120 min, or blood loss ≥500 ml. RESULTS In all, 327 patients were included and divided into difficult LC (DLC, n = 61) and nondifficult LC (non-DLC, n = 266). Multivariate logistic analysis revealed that symptom duration ≥72 h was the only independent risk factor for DLC. Comparison of late LC (beyond 72 h, LLC) and early LC (within 72 h, ELC) showed a lower rate of creation of the critical view of safety and a longer hospital stay, as well as a longer operative time, a larger amount of bleeding, and a higher open conversion rate in LLC. However, the postoperative complication rates were equivalent. CONCLUSION LC for AC with symptom duration ≥72 h tends to be technically difficult. However, it is acceptable regarding operative outcomes.
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Affiliation(s)
- Hayato Ohya
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Atsuyuki Maeda
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yuichi Takayama
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Kazuaki Seita
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yuji Kaneoka
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
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Jamdar S, Chandrabalan VV, Obeidallah R, Stathakis P, Siriwardena AK, Sheen AJ. The Impact of a Dedicated "Hot List" on the In-Patient Management of Patients With Acute Gallstone-Related Disease. Front Surg 2021; 8:643077. [PMID: 34055866 PMCID: PMC8158421 DOI: 10.3389/fsurg.2021.643077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/14/2021] [Indexed: 01/25/2023] Open
Abstract
Background: Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. This study assesses the impact of dedicated theatre capacity provided by a specialist surgical team on rates of index admission cholecystectomy. Methods: This clinical cohort study compares the management of patients with symptomatic gallstone disease admitted to a tertiary care university teaching hospital over two equal but chronologically separate time periods. The periods were before and after service reconfiguration including a specialist HPB service with dedicated operating theatre time allocation. Results: There was a significant difference in the number of admissions over the two time periods with a greater proportion of patients having index admission surgery in the second time period with correspondingly fewer having more than one admission during this latter time period. In the second time period 43% of patients underwent index admission cholecystectomy compared to 23% in the first (P < 0.001). The duration of surgery was shorter for patients undergoing surgery during the second time period [135 (102-178) min in the first period and in the second period 106 (89-145) min] (P = 0.02). Discussion: This paper shows that the concentration of theatre resources and surgical expertise into regular theatre access for patients undergoing urgent laparoscopic cholecystectomy is an effective and safe model for dealing with acute biliary disease.
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Affiliation(s)
- Saurabh Jamdar
- Regional Hepato-Pancreato-Biliary Service, Manchester Royal Infirmary, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Vishnu V. Chandrabalan
- Regional Hepato-Pancreato-Biliary Service, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Rami Obeidallah
- Regional Hepato-Pancreato-Biliary Service, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Panagiotis Stathakis
- Regional Hepato-Pancreato-Biliary Service, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ajith K. Siriwardena
- Regional Hepato-Pancreato-Biliary Service, Manchester Royal Infirmary, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Aali J. Sheen
- Regional Hepato-Pancreato-Biliary Service, Manchester Royal Infirmary, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Centre of Biosciences, Manchester Metropolitan University, Manchester, United Kingdom
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Kohga A, Okumura T, Yamashita K, Isogaki J, Kawabe A, Kimura T. Does early surgery imply a critical risk for patients with Grade III acute cholecystitis? Asian J Endosc Surg 2021; 14:7-13. [PMID: 32207215 DOI: 10.1111/ases.12799] [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: 01/17/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND For patients with Grade III acute cholecystitis (AC), several factors have been proposed in the 2018 Tokyo guidelines as caution signs in performing early surgery. However, these factors have not been externally validated in detail. METHODS This retrospective study examined 35 patients who had been diagnosed with Grade III AC and treated with laparoscopic cholecystectomy between January 2008 and July 2019. The patients were allocated into an early group (patients who underwent surgery within 7 days of admission, n = 28) and a delayed group (patients who underwent surgery at least 8 days after admission, n = 7). Comparisons were made between these groups. RESULTS No patients died. Significantly more patients required a conversion to open surgery (0% vs 28.5%, P = .003) or conversion to subtotal cholecystectomy (25.0% vs 71.4%, P = .020) in the delayed group than in the early group, and the total length of postoperative stay was significantly longer in the delayed group (11.4 vs 27.2 days, P = .001). The presence of negative predictive factors or risk factors listed in the 2018 Tokyo guidelines was not associated with death or postoperative complications. CONCLUSIONS Early surgery was considered appropriate and feasible for select patients who had Grade III AC and preoperative risk factors.
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Affiliation(s)
- Atsushi Kohga
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Takuya Okumura
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Kimihiro Yamashita
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Jun Isogaki
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Akihiro Kawabe
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Taizo Kimura
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
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Does preoperative MRCP imaging predict risk for conversion to subtotal cholecystectomy in patients with acute cholecystitis? Surg Endosc 2020; 35:6717-6723. [PMID: 33258035 DOI: 10.1007/s00464-020-08175-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Subtotal cholecystectomy (SC) is a useful procedure for avoiding bile duct injury in patients with difficult gallbladder. However, risk factors for conversion to SC, especially preoperative magnetic resonance cholangiopancreatography (MRCP) findings that predict conversion to SC, have not been investigated in detail. METHODS A total of 290 patients with acute cholecystitis who underwent laparoscopic cholecystectomy at our hospital between November 2011 and March 2020 were included. Patient characteristics and perioperative outcomes were reviewed, and preoperative clinical factors predicting conversion to SC were investigated. RESULTS Forty-three patients underwent SC, whereas the remaining 247 patients underwent total cholecystectomy. An American Society of Anesthesiologists (ASA) score of 3 or greater (p = 0.011), surgery on or after 9 days from symptom onset (p < 0.001), obscuration of the gallbladder wall around the neck on MRCP images (p = 0.010) and disruption of the common hepatic duct on MRCP images (p < 0.001) were significantly associated with conversion to SC. Logistic regression analyses revealed that an ASA score of 3 or greater (odds ratio = 2.667, p = 0.020), surgery on or after 9 days from symptom onset (odds ratio = 4.229, p < 0.001) and disruption of the common hepatic duct on MRCP images (odds ratio = 4.478, p = 0.002) were independent predictors for conversion to SC. CONCLUSIONS Early surgery yielded a lower risk for conversion to SC. Disruption of the common hepatic duct on preoperative MRCP images is associated with a risk for conversion to SC.
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Risk factors for postoperative bile leak in patients who underwent subtotal cholecystectomy. Surg Endosc 2019; 34:5092-5097. [DOI: 10.1007/s00464-019-07309-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/28/2019] [Indexed: 12/24/2022]
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