1
|
Proctor DW, Goodall R, Borsky K, Salciccioli JD, Marshall DC, Shanmugarajah K, Shalhoub J. Temporal Analysis of the Incidence, Mortality and Disability-Adjusted Life Years of Benign Gallbladder and Biliary Diseases in High-Income Nations, 1990-2019. ANNALS OF SURGERY OPEN 2024; 5:e453. [PMID: 38911626 PMCID: PMC11191896 DOI: 10.1097/as9.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Objective The aim of this observational study was to analyze trends in the incidence, mortality, and disability-adjusted life years (DALYs) of benign gallbladder and biliary diseases across high-income countries between 1990 and 2019. Background Benign gallbladder and biliary diseases place a substantial burden on healthcare systems in high-income countries. Accurate characterization of the disease burden may help optimize healthcare policy and resource distribution. Materials and methods Age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and DALYs data for gallbladder and biliary diseases in males and females were extracted from the 2019 Global Burden of Disease (GBD) study. A mortality-incidence index (MII) was also calculated. Joinpoint regression analysis was performed. Results The median ASIRs across the European Union 15+ countries in 2019 were 758/100,000 for females and 282/100,000 for males. Between 1990 and 2019 the median percentage change in ASIR was +2.49% for females and +1.07% for males. The median ASMRs in 2019 were 1.22/100,000 for females and 1.49/100,000 for males with a median percentage change over the observation period of -21.93% and -23.01%, respectively. In 2019, the median DALYs was 65/100,000 for females and 37/100,000 among males, with comparable percentage decreases over the observation period of -21.27% and -19.23%, respectively. Conclusions International variation in lifestyle factors, diagnostic and management strategies likely account for national and sex disparities. This study highlights the importance of ongoing clinical efforts to optimize treatment pathways for gallbladder and biliary diseases, particularly in the provision of emergency surgical services and efforts to address population risk factors.
Collapse
Affiliation(s)
- Dominic W. Proctor
- From the Department of Undergraduate Medical Education, Royal Free London NHS Foundation Trust, London, UK
| | - Richard Goodall
- Department of Surgery and Cancer, Imperial College London, UK
| | - Kim Borsky
- Department of Plastic Surgery, Salisbury Hospital, Salisbury, UK
| | - Justin D. Salciccioli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | | | | | - Joseph Shalhoub
- Department of Surgery and Cancer, Imperial College London, UK
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
2
|
Innes K, Ahmed I, Hudson J, Hernández R, Gillies K, Bruce R, Bell V, Avenell A, Blazeby J, Brazzelli M, Cotton S, Croal B, Forrest M, MacLennan G, Murchie P, Wileman S, Ramsay C. Laparoscopic cholecystectomy versus conservative management for adults with uncomplicated symptomatic gallstones: the C-GALL RCT. Health Technol Assess 2024; 28:1-151. [PMID: 38943314 PMCID: PMC11228691 DOI: 10.3310/mnby3104] [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] [Indexed: 07/01/2024] Open
Abstract
Background Gallstone disease is a common gastrointestinal disorder in industrialised societies. The prevalence of gallstones in the adult population is estimated to be approximately 10-15%, and around 80% remain asymptomatic. At present, cholecystectomy is the default option for people with symptomatic gallstone disease. Objectives To assess the clinical and cost-effectiveness of observation/conservative management compared with laparoscopic cholecystectomy for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones in secondary care. Design Parallel group, multicentre patient randomised superiority pragmatic trial with up to 24 months follow-up and embedded qualitative research. Within-trial cost-utility and 10-year Markov model analyses. Development of a core outcome set for uncomplicated symptomatic gallstone disease. Setting Secondary care elective settings. Participants Adults with symptomatic uncomplicated gallstone disease referred to a secondary care setting were considered for inclusion. Interventions Participants were randomised 1: 1 at clinic to receive either laparoscopic cholecystectomy or observation/conservative management. Main outcome measures The primary outcome was quality of life measured by area under the curve over 18 months using the Short Form-36 bodily pain domain. Secondary outcomes included the Otago gallstones' condition-specific questionnaire, Short Form-36 domains (excluding bodily pain), area under the curve over 24 months for Short Form-36 bodily pain domain, persistent symptoms, complications and need for further treatment. No outcomes were blinded to allocation. Results Between August 2016 and November 2019, 434 participants were randomised (217 in each group) from 20 United Kingdom centres. By 24 months, 64 (29.5%) in the observation/conservative management group and 153 (70.5%) in the laparoscopic cholecystectomy group had received surgery, median time to surgery of 9.0 months (interquartile range, 5.6-15.0) and 4.7 months (interquartile range 2.6-7.9), respectively. At 18 months, the mean Short Form-36 norm-based bodily pain score was 49.4 (standard deviation 11.7) in the observation/conservative management group and 50.4 (standard deviation 11.6) in the laparoscopic cholecystectomy group. The mean area under the curve over 18 months was 46.8 for both groups with no difference: mean difference -0.0, 95% confidence interval (-1.7 to 1.7); p-value 0.996; n = 203 observation/conservative, n = 205 cholecystectomy. There was no evidence of differences in quality of life, complications or need for further treatment at up to 24 months follow-up. Condition-specific quality of life at 24 months favoured cholecystectomy: mean difference 9.0, 95% confidence interval (4.1 to 14.0), p < 0.001 with a similar pattern for the persistent symptoms score. Within-trial cost-utility analysis found observation/conservative management over 24 months was less costly than cholecystectomy (mean difference -£1033). A non-significant quality-adjusted life-year difference of -0.019 favouring cholecystectomy resulted in an incremental cost-effectiveness ratio of £55,235. The Markov model continued to favour observation/conservative management, but some scenarios reversed the findings due to uncertainties in longer-term quality of life. The core outcome set included 11 critically important outcomes from both patients and healthcare professionals. Conclusions The results suggested that in the short term (up to 24 months) observation/conservative management may be a cost-effective use of National Health Service resources in selected patients, but subsequent surgeries in the randomised groups and differences in quality of life beyond 24 months could reverse this finding. Future research should focus on longer-term follow-up data and identification of the cohort of patients that should be routinely offered surgery. Trial registration This trial is registered as ISRCTN55215960. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/71) and is published in full in Health Technology Assessment; Vol. 28, No. 26. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Karen Innes
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Irfan Ahmed
- Department of Surgery, NHS Grampian, Aberdeen, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rodolfo Hernández
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rebecca Bruce
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Victoria Bell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jane Blazeby
- Center for Surgical Research, NIHR Bristol and Western Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Samantha Wileman
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
3
|
Ahmed I, Hudson J, Innes K, Hernández R, Gillies K, Bruce R, Bell V, Avenell A, Blazeby J, Brazzelli M, Cotton S, Croal B, Forrest M, MacLennan G, Murchie P, Wileman S, Ramsay C. Effectiveness of conservative management versus laparoscopic cholecystectomy in the prevention of recurrent symptoms and complications in adults with uncomplicated symptomatic gallstone disease (C-GALL trial): pragmatic, multicentre randomised controlled trial. BMJ 2023; 383:e075383. [PMID: 38084426 PMCID: PMC10698555 DOI: 10.1136/bmj-2023-075383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To assess the clinical and cost effectiveness of conservative management compared with laparoscopic cholecystectomy for the prevention of symptoms and complications in adults with uncomplicated symptomatic gallstone disease. DESIGN Parallel group, pragmatic randomised, superiority trial. SETTING 20 secondary care centres in the UK. PARTICIPANTS 434 adults (>18 years) with uncomplicated symptomatic gallstone disease referred to secondary care, assessed for eligibility between August 2016 and November 2019, and randomly assigned (1:1) to receive conservative management or laparoscopic cholecystectomy. INTERVENTIONS Conservative management or surgical removal of the gallbladder. MAIN OUTCOME MEASURES The primary patient outcome was quality of life, measured by area under the curve, over 18 months using the short form 36 (SF-36) bodily pain domain, with higher scores (range 0-100) indicating better quality of life. Other outcomes included costs to the NHS, quality adjusted life years (QALYs), and incremental cost effectiveness ratio. RESULTS Of 2667 patients assessed for eligibility, 434 were randomised: 217 to the conservative management group and 217 to the laparoscopic cholecystectomy group. By 18 months, 54 (25%) participants in the conservative management arm and 146 (67%) in the cholecystectomy arm had received surgery. The mean SF-36 norm based bodily pain score was 49.4 (standard deviation 11.7) in the conservative management arm and 50.4 (11.6) in the cholecystectomy arm. The SF-36 bodily pain area under the curve up to 18 months did not differ (mean difference 0.0, 95% confidence interval -1.7 to 1.7; P=1.00). Conservative management was less costly (mean difference -£1033, (-$1334; -€1205), 95% credible interval -£1413 to -£632) and QALYs did not differ (mean difference -0.019, 95% credible interval -0.06 to 0.02). CONCLUSIONS In the short term (≤18 months), laparoscopic surgery is no more effective than conservative management for adults with uncomplicated symptomatic gallstone disease, and as such conservative management should be considered as an alternative to surgery. From an NHS perspective, conservative management may be cost effective for uncomplicated symptomatic gallstone disease. As costs, complications, and benefits will continue to be incurred in both groups beyond 18 months, future research should focus on longer term follow-up to establish effectiveness and lifetime cost effectiveness and to identify the cohort of patients who should be routinely offered surgery. TRIAL REGISTRATION ISRCTN registry ISRCTN55215960.
Collapse
Affiliation(s)
- Irfan Ahmed
- Department of Surgery, NHS Grampian, Aberdeen, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Karen Innes
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rodolfo Hernández
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rebecca Bruce
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Victoria Bell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jane Blazeby
- Centre for Surgical Research, NIHR Bristol and Western Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials,Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Samantha Wileman
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
4
|
Ahmed I, Innes K, Brazzelli M, Gillies K, Newlands R, Avenell A, Hernández R, Blazeby J, Croal B, Hudson J, MacLennan G, McCormack K, McDonald A, Murchie P, Ramsay C. Protocol for a randomised controlled trial comparing laparoscopic cholecystectomy with observation/conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-Gall trial). BMJ Open 2021; 11:e039781. [PMID: 33766835 PMCID: PMC7996370 DOI: 10.1136/bmjopen-2020-039781] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Gallstone disease (cholelithiasis) is common. In most people it is asymptomatic and does not require treatment, but in about 20% it can become symptomatic, causing pain and other complications requiring medical attention and/or surgery. A proportion of symptomatic people with uncomplicated gallstone disease do not experience further episodes of pain and, therefore, could be treated conservatively. Moreover, surgery carries risks of perioperative and postoperative complications. METHODS AND ANALYSIS C-Gall is a pragmatic, multicentre, randomised controlled trial and economic evaluation to assess whether cholecystectomy is cost-effective compared with observation/ conservative management (here after referred to as medical management) at 18 months post-randomisation (with internal pilot). PRIMARY OUTCOME MEASURE Patient-reported quality of life (QoL) (36-Item Short Form Survey (SF-36) bodily pain domain) up to 18 months after randomisation.The primary economic outcome is incremental cost per quality-adjusted life year gained at 18 months. SECONDARY OUTCOME MEASURES Secondary outcome measures include condition-specific QoL, SF-36 domains, complications, further treatment, persistent symptoms, healthcare resource use, and costs assessed at 18 and 24 months after randomisation. The bodily pain domain of the SF-36 will also be assessed at 24 months after randomisation.A sample size of 430 participants was calculated. Computer-generated 1:1 randomisation was used.The C-Gall Study is currently in follow-up in 20 UK research centres. The first patient was randomised on 1 August 2016, with follow-up to be completed by 30 November 2021. STATISTICAL ANALYSIS Statistical analysis of the primary outcome will be intention-to-treat and a per-protocol analysis. The primary outcome, area under the curve (AUC) for the SF-36 bodily pain up to 18 months, will be generated using the Trapezium rule and analysed using linear regression with adjustment for the minimisation variables (recruitment site, sex and age). For the secondary outcome, SF-36 bodily pain, AUC up to 24 months will be analysed in a similar way. Other secondary outcomes will be analysed using generalised linear models with adjustment for minimisation and baseline variables, as appropriate. Statistical significance will be at the two-sided 5% level with corresponding CIs. ETHICS AND DISSEMINATION The North of Scotland Research Ethics Committee approved this study (16/NS/0053). The dissemination plans include Health Technology Assessment monograph, international scientific meetings and publications in high-impact, open-access journals. TRIAL REGISTRATION NUMBER ISRCTN55215960; pre-results.
Collapse
Affiliation(s)
- Irfan Ahmed
- Department of Surgery, NHS Grampian, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Karen Innes
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Rumana Newlands
- Health Services Research Unit, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Rodolfo Hernández
- Health Economics Research Unit (HERU), University of Aberdeen, Aberdeen, UK
| | - Jane Blazeby
- Centre for Surgical Research and NIHR Bristol and Weston Biomedical Research Centre, University of Bristol, Bristol, UK
| | | | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Kirsty McCormack
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| | - Peter Murchie
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen Health Services Research Unit, Aberdeen, UK
| |
Collapse
|
5
|
Platt T, Smith K, Nixon M, Sinha S, Srinivas G, Andrews S. Success of intraoperative imaging and management of suspected choledocholithiasis without pre-operative bile duct imaging - A case series. Ann Med Surg (Lond) 2018; 36:173-177. [PMID: 30505436 PMCID: PMC6249395 DOI: 10.1016/j.amsu.2018.10.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 01/14/2023] Open
Abstract
Background Laparoscopic common bile duct exploration (LCBDE) is gaining popularity over endoscopic retrograde cholangiopancreatography (ERCP) for the management of common bile duct stones. However, its application has been almost exclusively following preoperative stone confirmation via magnetic retrograde cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) or ERCP. We present our series of LCBDE following detection of common bile duct stones with intraoperative imaging (IOI) alone, in consecutive elective and emergency patients with suspected choledocholithiasis. Materials and methods All patients with suspected but unconfirmed choledocholithiasis undergoing LC with intention to proceed to LCBDE between January 2015 and June 2017 were included. LCBDE was performed following the discovery of choledocholithiasis on IOI. Results 371 patients with suspected choledocholithiasis underwent LC with IOI. CBD stones or obstructing sludge was identified in 107 patients (29%), with sensitivity of 96.2% and specificity of 98.5%. 100 patients, median age 59, went on to have LCBDE as indicated by intraoperative imaging. 76% were performed as emergency cases and conversion to open rate was 2%. There were no mortalities. Bile leak and retained stones occurred in 4% and 3% respectively. 7/100 patients required re-intervention, with re-look laparoscopy (n = 4) and ERCP (n = 3). Median length of stay was 1.5 and 3 days for elective and emergency cases respectively, and 30 readmission rate was 8%. Discussion and conclusion Traditionally patients presenting with suspicion of choledocholithiasis undergo preoperative MRCP/EUS and/or ERCP prior to eventual LC. We propose an alternative, more streamlined, pathway of treatment without requiring preoperative cholangiography, applicable to both elective and emergency patients. Laparoscopic common bile duct exploration is a safe and effective treatment for bile duct stones. Intraoperative cholangiography is sensitive and specific in identification of bile duct stones. Bile duct exploration can be safely performed on the basis on intraoperative imaging alone. Intraoperative imaging provides sufficient information for real time decision making.
Collapse
Affiliation(s)
- Timothy Platt
- General Surgery, South Devon NHS Foundation Trust, United Kingdom
| | - Kristy Smith
- Core Surgical Trainee, Norfolk and Norwich University Hospitals NHS Foundation Trust, United Kingdom
| | - Martha Nixon
- StR General Surgery, Plymouth Hospitals NHS Trust, United Kingdom
| | - Surajit Sinha
- Locum Consultant Upper GI Surgery, South Devon NHS Foundation Trust, United Kingdom
| | - Gandrapu Srinivas
- Consultant Upper GI Surgeon, South Devon NHS Foundation Trust, United Kingdom
| | - Stuart Andrews
- Consultant Upper GI Surgeon, South Devon NHS Foundation Trust, United Kingdom
| |
Collapse
|
6
|
Mishra T, Lakshmi KK, Peddi KK. Prevalence of Cholelithiasis and Choledocholithiasis in Morbidly Obese South Indian Patients and the Further Development of Biliary Calculus Disease After Sleeve Gastrectomy, Gastric Bypass and Mini Gastric Bypass. Obes Surg 2017; 26:2411-7. [PMID: 26910024 DOI: 10.1007/s11695-016-2113-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evaluation of the prevalance of cholelithiasis, choledocholithiasis and there management after sleeve gastrectomy, gastric bypass and mini gastric bypass in Indian bariatric patients. METHODS We did a retrospective analysis of our bariatric patient from January 2007 to December 2013 (n = 1397), for prevalence of cholelithiasis and choledocholithiasis. We did synchronous cholecystectomy in all patients planned for bariatric surgery found to have cholelithiasis on USG. Post-operatively, we followed all the patients with gallbladder in situ for minimum of 18-88 months (mean -32.4) and reviewed data for subsequent development of cholelithiasis/choledocholithiasis. Only those patients who were symptomatic underwent intervention. RESULTS Prevalence of cholelithiasis and choledocholithiasis in our study was 21.76 and 9.63 %, respectively. The incidence of post-bariatric surgery development of cholelithiasis was 10.53 %; individually, it was 8.42 % in LSG group, 13.4 % in LRYGB group and 12.7 % in MGB patients. The incidence of symptomatic cholelithiasis requiring surgery was 1.94 % after LSG, 4.54 % after LRYGB and 4.25 % after MGB. Post-surgery, six patients developed choledocholithiasis. In our post-bariatric group, the 33 patients who developed symptomatic stones had percentage total weight loss of 30.99 + 4.1 (P < 0.001). The average time period for readmission of symptomatic patient was 11.26 + 2.67 months. CONCLUSIONS We recommend routine synchronous cholecystectomy with bariatric procedure. In spite of synchronous cholecystectomy, incidence of cholelithiasis in our post-bariatric patient is 10.53 % of which up to one third were symptomatic and required surgery, and incidence of choledocholithiasis is comparable to that of general population.
Collapse
Affiliation(s)
- Tapas Mishra
- Department of Minimal Access and Bariatric Surgery, Global Hospitals, Hyderabad, India.
| | - Kona Kumari Lakshmi
- Department of Minimal Access and Bariatric Surgery, Global Hospitals, Hyderabad, India
| | | |
Collapse
|
7
|
Abstract
Gallstone disease is one of the most common public health problems in the United States. Approximately 10%-20% of the national adult populations currently carry gallstones, and gallstone prevalence is rising. In addition, nearly 750,000 cholecystectomies are performed annually in the United States; direct and indirect costs of gallbladder surgery are estimated to be $6.5 billion. Cholelithiasis is also strongly associated with gallbladder, pancreatic, and colorectal cancer occurrence. Moreover, the National Institutes of Health estimates that almost 3,000 deaths (0.12% of all deaths) per year are attributed to complications of cholelithiasis and gallbladder disease. Although extensive research has tried to identify risk factors for cholelithiasis, several studies indicate that definitive findings still remain elusive. In this review, predisposing factors for cholelithiasis are identified, the pathophysiology of gallstone disease is described, and nonsurgical preventive options are discussed. Understanding the risk factors for cholelithiasis may not only be useful in assisting nurses to provide resources and education for patients who are diagnosed with gallstones, but also in developing novel preventive measures for the disease.
Collapse
|
8
|
Brazzelli M, Cruickshank M, Kilonzo M, Ahmed I, Stewart F, McNamee P, Elders A, Fraser C, Avenell A, Ramsay C. Clinical effectiveness and cost-effectiveness of cholecystectomy compared with observation/conservative management for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones or cholecystitis: a systematic review and economic evaluation. Health Technol Assess 2015; 18:1-101, v-vi. [PMID: 25164349 DOI: 10.3310/hta18550] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Approximately 10-15% of the adult population suffer from gallstone disease, cholelithiasis, with more women than men being affected. Cholecystectomy is the treatment of choice for people who present with biliary pain or acute cholecystitis and evidence of gallstones. However, some people do not experience a recurrence after an initial episode of biliary pain or cholecystitis. As most of the current research focuses on the surgical management of the disease, less attention has been dedicated to the consequences of conservative management. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of cholecystectomy compared with observation/conservative management in people presenting with uncomplicated symptomatic gallstones (biliary pain) or cholecystitis. DATA SOURCES We searched all major electronic databases (e.g. MEDLINE, EMBASE, Science Citation Index, Bioscience Information Service, Cochrane Central Register of Controlled Trials) from 1980 to September 2012 and we contacted experts in the field. REVIEW METHODS Evidence was considered from randomised controlled trials (RCTs) and non-randomised comparative studies that enrolled people with symptomatic gallstone disease (pain attacks only and/or acute cholecystitis). Two reviewers independently extracted data and assessed the risk of bias of included studies. Standard meta-analysis techniques were used to combine results from included studies. A de novo Markov model was developed to assess the cost-effectiveness of the interventions. RESULTS Two Norwegian RCTs involving 201 participants were included. Eighty-eight per cent of people randomised to surgery and 45% of people randomised to observation underwent cholecystectomy during the 14-year follow-up period. Participants randomised to observation were significantly more likely to experience gallstone-related complications [risk ratio = 6.69; 95% confidence interval (CI) 1.57 to 28.51; p = 0.01], in particular acute cholecystitis (risk ratio = 9.55; 95% CI 1.25 to 73.27; p = 0.03), and less likely to undergo surgery (risk ratio = 0.50; 95% CI 0.34 to 0.73; p = 0.0004), experience surgery-related complications (risk ratio = 0.36; 95% CI 0.16 to 0.81; p = 0.01) or, more specifically, minor surgery-related complications (risk ratio = 0.11; 95% CI 0.02 to 0.56; p = 0.008) than those randomised to surgery. Fifty-five per cent of people randomised to observation did not require an operation during the 14-year follow-up period and 12% of people randomised to cholecystectomy did not undergo the scheduled operation. The results of the economic evaluation suggest that, on average, the surgery strategy costs £1236 more per patient than the conservative management strategy but was, on average, more effective. An increase in the number of people requiring surgery while treated conservatively corresponded to a reduction in the cost-effectiveness of the conservative strategy. There was uncertainty around some of the parameters used in the economic model. CONCLUSIONS The results of this assessment indicate that cholecystectomy is still the treatment of choice for many symptomatic people. However, approximately half of the people in the observation group did not require surgery or suffer complications in the long term indicating that a conservative therapeutic approach may represent a valid alternative to surgery in this group of people. Owing to the dearth of current evidence in the UK setting a large, well-designed, multicentre trial is needed. STUDY REGISTRATION The study was registered as PROSPERO CRD42012002817. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Irfan Ahmed
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Elders
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
9
|
Abo-Ryia MH, Abd-Allah HS, El-Khadrawy OH, Moussa GI. Predictors of Gallstone Formation in Morbidly Obese Patients after Bariatric Surgery: A Retrospective Observational Study. SURGICAL SCIENCE 2014; 05:1-5. [DOI: 10.4236/ss.2014.51001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
10
|
Ahmad Z, Arshad H, Fatima S, Idrees R, Ud-Din N, Ahmed R, Ahmed A, Memon A, Minhas K, Arif M, Fatima S, Haroon S, Pervez S, Hasan S, Kayani N. Gastrointestinal, liver and biliary tract pathology: a histopathological and epidemiological perspective from Pakistan with a review of the literature. Asian Pac J Cancer Prev 2014; 14:6997-7005. [PMID: 24377639 DOI: 10.7314/apjcp.2013.14.11.6997] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To present an epidemiological and histological perspective of diseases of the gastrointestinal tract (including liver and biliary tract) at the Section of Histopathology, Department of Pathology, AKUH, Karachi, Pakistan. MATERIALS AND METHODS All consecutive endoscopic biopsies and resections between October 1 and December 31, 2012 were included. RESULTS A total of 2,323 cases were included. Carcinoma was overwhelmingly the commonest diagnosis on esophageal biopsies (69.1%); chronic helicobacter gastritis (45.6%) followed by adenocarcinoma (23.5%) were the commonest diagnoses on gastric biopsies; adenocarcinoma (27.3%) followed by ulcerative colitis (13.1%) were the commonest diagnoses on colonic biopsies; acute appendicitis (59.1%) was the commonest diagnosis on appendicectomy specimens; chronic viral hepatitis (44.8%) followed by hepatocellular carcinoma (23.4%) were the commonest diagnoses on liver biopsies; chronic cholecystitis was the commonest diagnosis (over 89%) on cholecystectomy specimens. CONCLUSIONS Squamous cell carcinoma comprised 88.8% of esophageal cancers. About 67% were in the lower third and 56.5% were moderately differentiated; mean ages 49.8 years for females and 55.8 years for males; 66% cases were from South West Pakistan. Over 67% patients with gastric adenocarcinoma were males; mean ages 59 and 44 years in males and females respectively, about 74% gastric carcinomas were poorly differentiated; and 62.2% were located in the antropyloric region. About 63% patients with colorectal adenocarcinoma were males; mean ages 46.1 and 50.5 years for males and females respectively; tumor grade was moderately differentiated in 54%; over 80% were located in the left colon. In 21.2% appendicectomies, no acute inflammation was found. Acute appendicitis was most common in young people. Hepatitis C (66.3%) was more common than hepatitis B (33.7%); about 78% cases of hepatocellular carcinoma occurred in males; females comprised 76.7% patients with chronic cholecystitis; and 77.8% patients with gall bladder carcinoma. All resection specimens showed advanced cancers. Most cancers occurred after the age of 50 years.
Collapse
Affiliation(s)
- Zubair Ahmad
- Pathology and Microbiology, Histopathology, Aga Khan University Hospital, Karachi, Pakistan E-mail :
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Nagem RG, Lázaro-da-Silva A, de Oliveira RM, Morato VG. Gallstone-related complications after Roux-en-Y gastric bypass: a prospective study. Hepatobiliary Pancreat Dis Int 2012; 11:630-5. [PMID: 23232635 DOI: 10.1016/s1499-3872(12)60236-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Gastric bypass is a widespread bariatric procedure that carries a high incidence of gallstone formation postoperatively. Controversy exists regarding the importance and consequences of gallstones in these patients. There are surgeons who consider gallstone-related complications after gastric bypass important enough to require routine removal of the gallbladder during gastric bypass (prophylactic cholecystectomy). However, this can lead to increased costs and risks. This study aimed to identify complications related to cholelithiasis after Roux-en-Y gastric bypass (RYGBP). METHODS This is a prospective observational study of 40 morbidly obese patients free of gallbladder disease. The patients underwent open RYGBP at a public hospital in Brazil from February to October 2007. They were followed up clinically and ultrasonographically at 6 months and 1, 2, and 3 years after surgery. Of the patients, 38 patients were followed up for 3 years. RESULTS Eleven patients (28.9%) developed cholelithiasis, four (10.5%) experienced biliary pain, and 2 suffered from acute biliary pancreatitis (5.3%). These patients had their gallbladders removed laparoscopically. No patient presented with acute cholecystitis, choledocholithiasis, or bile duct dilation during the follow-up period. There were no deaths. CONCLUSIONS Gallstone-related complications after RYGBP were relatively common. Some of these complications, like acute pancreatitis, are known to have potentially severe outcomes. It seems reasonable to perform cholecystectomy during gastric bypass in the presence of cholelithiasis or after this procedure if gallstones develop.
Collapse
Affiliation(s)
- Rachid G Nagem
- Division of General Surgery, Ipsemg Hospital, Belo Horizonte, Brazil.
| | | | | | | |
Collapse
|
12
|
Nagem R, Lázaro-da-Silva A. Cholecystolithiasis after Gastric Bypass: A Clinical, Biochemical, and Ultrasonographic 3-year Follow-up Study. Obes Surg 2012; 22:1594-9. [DOI: 10.1007/s11695-012-0710-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
13
|
Day case laparoscopic cholecystectomy carried out using the harmonic scalpel: analysis of a standard procedure. Surg Laparosc Endosc Percutan Tech 2011; 20:20-3. [PMID: 20173615 DOI: 10.1097/sle.0b013e3181cd45f2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Our aim was to determine the efficiency and safety of laparoscopic cholecystectomy carried out using the harmonic scalpel as a day case procedure. METHODS A prospective study was done on patients presenting for Laparoscopic cholecystectomy. The harmonic scalpel was used with retrograde dissection. All patients were considered for discharge the same day unless considered medically unfit. RESULTS Laparoscopic cholecystectomy using the harmonic scalpel was carried out on 100 patients. Major complications were as follows: conversion to open procedure -1%, common bile duct injury -1%, and bile leak from the cystic duct stump -1%. Our same day discharge rate was 65%, and age more than 65 was the only independent predictor of overnight admission (P=0.009). CONCLUSIONS Laparoscopic cholecystectomy using the harmonic scalpel is associated with a low complication rate and a high-same-day discharge rate when carried out as a day case procedure.
Collapse
|
14
|
Borowski D, Knox M, Kanakala V, Richardson S, Seymour K, Attwood S, Slater B. Referral pathways of patients with gallstones: a potential source of financial waste in the U.K. National Health Service? Int J Health Care Qual Assur 2011; 23:248-57. [PMID: 21388103 DOI: 10.1108/09526861011017139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Gallstone-related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone-disease is by laparoscopic cholecystectomy, which can be safely and cost-effectively performed during a short hospital stay or as day-case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings. DESIGN/METHODOLOGY/APPROACH The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment. FINDINGS Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co-morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least pounds 16,194. ORIGINALITY/VALUE A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.
Collapse
Affiliation(s)
- David Borowski
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
| | | | | | | | | | | | | |
Collapse
|
15
|
Ambe P, Esfahani BJ, Tasci I, Christ H, Köhler L. Is laparoscopic cholecystectomy more challenging in male patients? Surg Endosc 2011; 25:2236-40. [PMID: 21298538 DOI: 10.1007/s00464-010-1539-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Accepted: 12/02/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) seems to be more challenging in males than in females. The surgery seems to be longer in male patients. There also seems to be an increased rate of conversion to open surgery in male patients. We sought to objectively verify this widespread belief. METHODS We performed a retrospective analysis of laparoscopic cholecystectomies performed between January 2004 and November 2009 in our hospital. Within this period 1844 cholecystectomies were performed in our community-based hospital. After a strict inclusion procedure, 1571 cases of LC for symptomatic gallbladder disease were analyzed (501 males, 1071 females). The time for surgery, defined as the interval from placement of the Veress needle to wound closure in minutes, and the rate of conversion to open surgery were the main parameters considered. RESULTS The time for surgery in male patients was significantly longer compared to that for females (p<0.0001). The male cohort was significantly older than the female cohort at the time of surgery (p<0.001). The rate of conversion to open surgery was significantly higher in male patients (5.6%) compared to 2.9% for females (p<0.0001). CONCLUSION Based on our analysis, LC had a significantly longer duration of surgery in the male cohort. The rate of conversion to open surgery was also significantly higher in male cohort. Thus, LC could be more challenging in male patients.
Collapse
Affiliation(s)
- Peter Ambe
- Department of Surgery, St. Elisabeth-Kreiskrankenhaus Grevenbroich, Akademisches Lehrkrankenhaus der RWTH Aachen, Von-Werth-Straße 5, 41515, Grevenbroich, Germany.
| | | | | | | | | |
Collapse
|
16
|
Khan HN, Harrison M, Bassett EE, Bates T. A 10-year follow-up of a longitudinal study of gallstone prevalence at necropsy in South East England. Dig Dis Sci 2009; 54:2736-41. [PMID: 19160052 DOI: 10.1007/s10620-008-0682-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 12/23/2008] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to examine a previous increase in male gallstone disease and to consider the burden of gallstones in a necropsy study with matched controls over a decade. Gallstone prevalence in 5,050 males fell from 20.2% to 19.1% (P=0.022) and in 4,125 females fell from 30.4% to 29.0% (P=0.03). Female gallstone subjects had a higher BMI than controls 24.5 vs. 23.3 (P<0.01), but males did not. Gallstones were twice as common in diabetics, but not with coronary heart disease (CHD). A third of elderly patients of both sexes had gallstones, but cholecystectomy was more common in females, 17:10%. Gallstone-related mortality was 0.7%. The prevalence of gallstones fell slightly. The association between gallstones and diabetes was confirmed, but not for CHD, and for BMI this was confined to females. Gallstones are very common in the elderly, but most are unoperated and seldom cause death.
Collapse
Affiliation(s)
- Hamed N Khan
- The Breast Department, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | | | | | | |
Collapse
|
17
|
Huang J, Chang CH, Wang JL, Kuo HK, Lin JW, Shau WY, Lee PH. Nationwide epidemiological study of severe gallstone disease in Taiwan. BMC Gastroenterol 2009; 9:63. [PMID: 19698126 PMCID: PMC2746226 DOI: 10.1186/1471-230x-9-63] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 08/22/2009] [Indexed: 12/14/2022] Open
Abstract
Background Our study aimed to assess the nationwide trends in the incidence of severe gallstone disease in Taiwan among adults aged ≥20. Methods A retrospective longitudinal study was conducted using Taiwan National Health Insurance Research Database collected during 1997–2005. Patients with incident severe gallstone disease (acute cholecystitis, biliary pancreatitis, acute cholangitis) and gallstone-related procedures (elective and non-elective cholecystectomy, endoscopic retrograde cholangiopancreatography [ERCP]) that led to hospital admission were identified using ICD-9-CM diagnostic and procedure codes. Annual incidence rates of gallstone-related complications and procedures were calculated and their 95% confidence intervals (CI) were estimated assuming a Poisson distribution. Results The hospital admission rate for severe gallstone disease increased with advancing age and the age-standardized rate (95% CI) per 1000 population was 0.60 (0.59–0.60) for men and 0.59 (0.59–0.60) for women. Men had a higher rate of acute cholecystitis, probably due to the substantially lower rate of elective cholecystectomy among men than women. For those aged 20–39, hospital admissions for all gallstone-related complications and procedures increased significantly. For those aged ≥60, incidences of biliary pancreatitis, acute cholangitis, and hospital admission for gallstone receiving ERCP increased significantly without substantial change in the incidence of acute cholecystitis and despite a decreased rate of elective cholecystectomy. Conclusion This population-based study found a substantial increase in the rate of admission for severe gallstone disease among those aged 20–39. Concurrently, the incidences of biliary pancreatitis and acute cholangitis have risen among those aged ≥60.
Collapse
Affiliation(s)
- John Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
| | | | | | | | | | | | | |
Collapse
|
18
|
Samaraee AA, Khan U, Almashta Z, Yiannakou Y. Preoperative diagnosis of choledocholithiasis: the role of MRCP. Br J Hosp Med (Lond) 2009; 70:339-43. [DOI: 10.12968/hmed.2009.70.6.339] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Ahmad Al Samaraee
- Senior Clinical Fellow in the Department of General Surgery, Queen Elizabeth Hospital, Gateshead NE9 6SX
| | - Usman Khan
- Research Fellow in Gastroenterology, University Hospital of North Durham, Durham
| | - Zaid Almashta
- Senior Clinical Fellow in Accident and Emergency, Queen Mary's Hospital, Sidcup, Kent
| | - Yan Yiannakou
- Consultant Gastroenterologist, University Hospital of North Durham, Durham
| |
Collapse
|
19
|
Tenconi SM, Boni L, Colombo EM, Dionigi G, Rovera F, Cassinotti E. Laparoscopic cholecystectomy as day-surgery procedure: current indications and patients' selection. Int J Surg 2008; 6 Suppl 1:S86-8. [PMID: 19167938 DOI: 10.1016/j.ijsu.2008.12.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM OF THE STUDY To review the current indications, to establish predictive factors of success and the safety of LC as a day-surgery procedure. METHODS Randomized clinical trials were searched on PubMed between January 2000 and June 2008 using "laparoscopic cholecystectomy", "day-surgery" as keywords. RESULTS A total of 20 trials was identified and analyzed. The indications for LC in day-surgery unit were symptomatic and chronic cholelitiasis without evidence of common bile duct stones; acute cholecystitis and pancreatitis cases were excluded. The trials considered as inclusion criteria: ASA score, BMI, social aspect and the preoperative workout included: abdominal US, liver function tests and routine preoperative tests, while the results considered the reasons for hospital stays and for readmission and measured patient satisfaction; some trials included analyze of costs of LC as day-surgery procedure the role of the surgeon's experience. DISCUSSION The present study confirms that day-surgery LC is safe and feasibility in selected patients; serious complications are rare and most frequently prolonged hospital stay and the readmission are connected with minor and more easily controlled complications or social reasons. Outpatient surgery requires careful planning and preparation in order to reach acceptable patients' satisfaction: preoperative workout is extremely imports allowing to reduce errors selection. Considering surgical training, it has been demonstrated that in the centres in which the trainees are involved in day-surgery LC there not significant difference in terms of number of complications, patient outcomes, prolonged stay and readmission. The adequate control of pain, nausea or vomiting is essential component in day-case LC service and it is possible at home after LC. CONCLUSION Day-case laparoscopic cholecystectomy is feasible with an acceptable discharge rate and level of patient satisfaction. The success depends on appropriate patient selection and on well-trained staff and skilful operative technique together with safe anaesthesia.
Collapse
Affiliation(s)
- S M Tenconi
- Minimally Invasive Surgery Research Center, Department of Surgery Sciences, University of Insubria, Italy
| | | | | | | | | | | |
Collapse
|
20
|
Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P, Pazzi P, Mazzella G, Sama C, Roda E, Colecchia A. Incidence of gallstone disease in Italy: Results from a multicenter, population-based Italian study (the MICOL project). World J Gastroenterol 2008; 14:5282-9. [PMID: 18785280 PMCID: PMC2744058 DOI: 10.3748/wjg.14.5282] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate gallstone incidence and risk factors in a large population-based study.
METHODS: Gallstone incidence and risk factors, were evaluated by structured questionnaire and physical examination, respectively, in 9611 of 11 109 (86.5%) subjects who were gallstone-free at the cross-sectional study.
RESULTS: Six centers throughout Italy enrolled 9611 subjects (5477 males, 4134 females, aged 30-79 years), 9517 of whom were included into analysis: 424 subjects (4.4%) had gallstones and 61 (0.6%) had been cholecystectomized yielding a cumulative incidence of 0.67% per year (0.66% in males, 0.81% in females). Increasing age, a high body mass index (BMI), a history of diabetes, peptic ulcer and angina, and low cholesterol and high triglyceride levels were identified as risk factors in men while, in females, the only risk factors were increasing age and a high BMI. Increasing age and pain in the right hypochondrium in men and increasing age in females were identified as predictors of gallstones. Pain in the epigastrium/right hypochondrium was the only symptom related to gallstones; furthermore, some characteristics of pain (forcing to rest, not relieved by bowel movements) were significantly associated with gallstones. No correlation was found between gallstone characteristics and clinical manifestations, while increasing age in men and increasing age and BMI in females were predictors of pain.
CONCLUSION: Increasing age and BMI represent true risk factors for gallstone disease (GD); pain in the right hypochondrium and/or epigastrium is confirmed as the only symptom related to gallstones.
Collapse
|
21
|
Corte CD, Falchetti D, Nebbia G, Calacoci M, Pastore M, Francavilla R, Marcellini M, Vajro P, Iorio R. Management of cholelithiasis in Italian children: A national multicenter study. World J Gastroenterol 2008; 14:1383-8. [PMID: 18322952 PMCID: PMC2693686 DOI: 10.3748/wjg.14.1383] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the management of Italian children with cholelithiasis observed at Pediatric and Surgical Departments linked to Italian Society of Pediatric Gastroenterology Hepatology and Nutrition.
METHODS: One-hundred-eighty children (90 males, median age at diagnosis 7.3 years; range, 0-18 years) with echographic evidence of cholelithiasis were enrolled in the study; the data were collected by an anonymous questionnaire sent to participating centers.
RESULTS: One hundred seventeen patients were treated with ursodeoxycholic acid; in 8 children dissolution of gallstones was observed, but the cholelithiasis recurred in 3 of them. Sixty-five percent of symptomatic children treated became asymptomatic. Sixty-four patients were treated with cholecystectomy and in only 2 cases a postoperative complication was reported. Thirty-four children received no treatment and were followed with clinical and echographic controls; in no case the development of complications was reported.
CONCLUSION: The therapeutic strategies were extremely heterogeneous. Ursodeoxycholic acid was ineffective in dissolution of gallstones but it had a positive effect on the symptoms. Laparoscopic cholecystectomy was confirmed to be an efficacy and safe treatment for pediatric gallstones.
Collapse
|
22
|
Gurusamy K, Junnarkar S, Farouk M, Davidson BR. Meta-analysis of randomized controlled trials on the safety and effectiveness of day-case laparoscopic cholecystectomy. Br J Surg 2008; 95:161-8. [PMID: 18196561 DOI: 10.1002/bjs.6105] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although day-case laparoscopic cholecystectomy can save bed costs, its safety has to be established. The aim of this meta-analysis is to assess the advantages and disadvantages of day-case surgery compared with overnight stay in patients undergoing elective laparoscopic cholecystectomy. METHODS Randomized clinical trials addressing the above issue were identified from The Cochrane Library trials register, Medline, Embase, Science Citation Index Expanded and reference lists. Data were extracted from these trials by two independent reviewers. For each outcome the relative risk, weighted mean difference or standardized mean difference was calculated with 95 per cent confidence intervals based on available case analysis. RESULTS Five trials with 215 patients randomized to the day-case group and 214 to the overnight-stay group were included in the review. Four of the five trials were of low risk of bias. The trials recruited 49.1 per cent of patients presenting for cholecystectomy. There was no significant difference between day case and overnight stay with respect to morbidity, prolongation of hospital stay, readmission rates, pain, quality of life, patient satisfaction, and return to normal activity and work. In the day-case group 80.5 per cent of patients were discharged on the day of surgery. CONCLUSION Day-case laparoscopic cholecystectomy is a safe and effective treatment for symptomatic gallstones.
Collapse
Affiliation(s)
- K Gurusamy
- Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, University College London and Royal Free Hospital NHS Trust, London, UK.
| | | | | | | |
Collapse
|
23
|
Williams JG, Roberts SE, Ali MF, Cheung WY, Cohen DR, Demery G, Edwards A, Greer M, Hellier MD, Hutchings HA, Ip B, Longo MF, Russell IT, Snooks HA, Williams JC. Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence. Gut 2007; 56 Suppl 1:1-113. [PMID: 17303614 PMCID: PMC1860005 DOI: 10.1136/gut.2006.117598] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2006] [Indexed: 12/12/2022]
Affiliation(s)
- J G Williams
- Centre for Health Information, Research and EvaLuation (CHIRAL), School of Medicine, University of Wales, Swansea, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Cholecystectomy - When and Why? POLISH JOURNAL OF SURGERY 2007. [DOI: 10.2478/v10035-007-0101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
25
|
Papadopoulos AA, Kateri M, Triantafyllou K, Ladas D, Tzathas C, Koutras M, Ladas SD. Hospitalization rates for cholelithiasis and acute cholecystitis doubled for the aged population in Greece over the past 30 years. Scand J Gastroenterol 2006; 41:1330-5. [PMID: 17060127 DOI: 10.1080/00365520600616102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Gallbladder disease is becoming increasingly prevalent in Western countries and is a common cause of hospitalization. The objective of this study was to determine time trends in cholelithiasis and acute cholecystitis for hospitalization and disease case fatality in Greece between 1970 and 1998. MATERIAL AND METHODS Data were obtained from the Annual Bulletin for the Social Welfare and Health Statistics of the National Statistics Service of Greece. Percentage changes in time trends were estimated by comparing the median values of the initial (1970-78) to the last (1989-98) 10-year study period for cholelithiasis and acute cholecystitis at discharge and for all deaths attributed to the disease. RESULTS Over the study period, age-standardized hospitalization rates for cholelithiasis increased. The median hospitalization rate between the initial and last (178 and 258 per 100,000 of the population, respectively) 10-year study period increased by 44.7%, but peaked to 70.1% and 208.3% for the 70-79 and >80 years age groups, respectively. Case fatality rate declined by 56.8% and the median value was 0.24 per 100 patients hospitalized during the last 10-year period. CONCLUSIONS Hospitalization rates for cholelithiasis and/or acute cholecystitis increased by 45%, and doubled for elderly patients, while the case fatality rate of the disease halved in Greece over the past 30 years.
Collapse
Affiliation(s)
- Angelos A Papadopoulos
- Gastroenterology Unit, 2nd Department of Internal Medicine, Medical School, Athens University, Attikon University General Hospital, Athens, Greece
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Gallstone disease is common: >700,000 cholecystectomies and costs of approximately 6.5 billion dollars annually in the U.S. The burden of disease is epidemic in American Indians (60-70%); a corresponding decrease occurs in Hispanics of mixed Indian origin. Ten to fifteen per cent of white adults in developed countries harbour gallstones. Frequency is further reduced in Black Americans, East Asia and sub-Saharan Africa. In developed countries, cholesterol gallstones predominate; 15% are black pigment. East Asians develop brown pigment stones in bile ducts, associated with biliary infection or parasites, or in intrahepatic ducts (hepatolithiasis). Certain risk factors for gallstones are immutable: female gender, increasing age and ethnicity/family (genetic traits). Others are modifiable: obesity, the metabolic syndrome, rapid weight loss, certain diseases (cirrhosis, Crohn's disease) and gallbladder stasis (from spinal cord injury or drugs like somatostatin). The only established dietary risk is a high caloric intake. Protective factors include diets containing fibre, vegetable protein, nuts, calcium, vitamin C, coffee and alcohol, plus physical activity.
Collapse
Affiliation(s)
- Eldon A Shaffer
- Division of Gastroenterology, Health Science Centre, University of Calgary, 3330 Hospital Dr SW, Calgary, Alberta T2N4N1, Canada.
| |
Collapse
|
27
|
Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005. [PMID: 15802102 DOI: 10.1007/s1894-005-0051-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gallstone disease is common and costly, creating over 700,000 cholecystectomies annually. Its complications consume approximately $6.5 billion in the United States. Surveys using noninvasive ultrasonography have identified its true prevalence and the associated risk factors. In developed countries, at least 10% of white adults harbor cholesterol gallstones; women have twice the risk, and age further increases the prevalence in both sexes. Gallstones reach epidemic proportions in the North and South American Indian populations, accompanied by an increased risk for gallbladder cancer. In contrast, the rate in sub-Saharan Africa and Asia is quite low. Obesity, a major risk factor, likely relates to insulin resistance (the metabolic syndrome). Evolution and circumstance in American Indians may have ironically selected those with "thrifty" genes that conserve energy. Our abundant access to food places us at the increased risk of obesity and cholelithiasis. The general rise in obesity in many countries raises the specter of heightened disease, best identified by epidemiologic studies.
Collapse
Affiliation(s)
- Eldon A Shaffer
- Faculty of Medicine, GI Division, University of Calgary, Canada.
| |
Collapse
|
28
|
Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005; 7:132-40. [PMID: 15802102 DOI: 10.1007/s11894-005-0051-8] [Citation(s) in RCA: 287] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gallstone disease is common and costly, creating over 700,000 cholecystectomies annually. Its complications consume approximately $6.5 billion in the United States. Surveys using noninvasive ultrasonography have identified its true prevalence and the associated risk factors. In developed countries, at least 10% of white adults harbor cholesterol gallstones; women have twice the risk, and age further increases the prevalence in both sexes. Gallstones reach epidemic proportions in the North and South American Indian populations, accompanied by an increased risk for gallbladder cancer. In contrast, the rate in sub-Saharan Africa and Asia is quite low. Obesity, a major risk factor, likely relates to insulin resistance (the metabolic syndrome). Evolution and circumstance in American Indians may have ironically selected those with "thrifty" genes that conserve energy. Our abundant access to food places us at the increased risk of obesity and cholelithiasis. The general rise in obesity in many countries raises the specter of heightened disease, best identified by epidemiologic studies.
Collapse
Affiliation(s)
- Eldon A Shaffer
- Faculty of Medicine, GI Division, University of Calgary, Canada.
| |
Collapse
|
29
|
Kang JY, Ellis C, Majeed A, Hoare J, Tinto A, Williamson RCN, Tibbs CJ, Maxwell JD. Gallstones--an increasing problem: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 2003; 17:561-9. [PMID: 12622765 DOI: 10.1046/j.1365-2036.2003.01439.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The number of operations for cholelithiasis increased from the 1950s to the 1990s. AIMS To determine the time trends in cholelithiasis for hospital admissions, operations and in-hospital case fatalities in England between 1989/1990 and 1999/2000, and population mortality rates between 1979 and 1999. METHODS Hospital Episode Statistics for admissions were obtained from the Department of Health and mortality data were obtained from the Office for National Statistics. RESULTS Between 1989/1990 and 1999/2000, age-standardized hospital admission rates for cholelithiasis increased by 30% for males and 64% for females. The proportions of admissions undergoing an operation declined progressively over the study period. In 1999/2000, the frequency of operation was approximately 50-60% for most age groups, but decreased progressively with advancing age at > or = 65 years. The proportions of admissions undergoing therapeutic endoscopy increased several-fold, especially amongst older individuals. Case fatality rates declined. Mortality rates declined from 1979 to 1988, but showed no further change from 1989 to 1999. CONCLUSIONS There has been a steady increase in admission rates for cholelithiasis over the study period. Whilst the frequency of operation has declined, the proportion of patients undergoing therapeutic endoscopy has increased.
Collapse
Affiliation(s)
- J-Y Kang
- Department of Gastroenterology, St George's Hospital, London, UK.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Reshetnikov OV, Ryabikov AN, Shakhmatov SG, Malyutina SK. Gallstone disease prevalence in Western Siberia: cross-sectional ultrasound study versus autopsy. J Gastroenterol Hepatol 2002; 17:702-7. [PMID: 12100617 DOI: 10.1046/j.1440-1746.2002.02758.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The aims of this study were: (i) to evaluate the prevalence of gallstones in a Western Siberian urban population; and (ii) to compare the results of ultrasonographic screening of the living population with hospital autopsy data. METHODS A representative sample of 842 men and 870 women (aged 25-64 years) living in Novosibirsk, Western Siberia, was screened for the presence of gallstones by gallbladder ultrasonography. Participants were considered to have gallstone disease if they had already had cholecystectomy or if gallstones were revealed during the survey. Hospital autopsy data (n = 1124) were reviewed retrospectively for the 8-year period in the same region. RESULTS The prevalence of gallstone disease was significantly higher in women than in men and increased with age. Age-adjusted prevalence rates of gallstone disease for the 25-64-year age group were 1.9% in men and 9.5% in women in a cross-sectional ultrasonographic study. Corresponding values in the autopsy series were 2.2% in men and 11.2% in women. CONCLUSIONS The present report shows that the prevalence of gallstone disease in the female population is in the range of that reported from Western countries, whereas that in the male population is lower than that in other countries. The results of the ultrasonographic survey of the living population and of hospital autopsy data were comparable, with slightly higher gallstone detection rates in the autopsy study.
Collapse
Affiliation(s)
- Oleg V Reshetnikov
- Institute of Internal Medicine, Vladimirovsky spusk 2A, Novosibirsk 630003, Russia.
| | | | | | | |
Collapse
|
31
|
Bateson MC. Laparoscopic cholecystectomy. Lancet 2001; 357:473. [PMID: 11273086 DOI: 10.1016/s0140-6736(05)71274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|