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Cizmic A, Killat D, Häberle F, Schwabe N, Hackert T, Müller-Stich BP, Nickel F. Simulation training of intraoperative complication management in laparoscopic cholecystectomy for novices-A randomized controlled study. Curr Probl Surg 2024; 61:101506. [PMID: 39098335 DOI: 10.1016/j.cpsurg.2024.101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/02/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Amila Cizmic
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - David Killat
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Frida Häberle
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Nils Schwabe
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Beat P Müller-Stich
- Department of Digestive Surgery, University Digestive Healthcare Center Basel, Basel, Switzerland
| | - Felix Nickel
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Hamid M, Kershaw M, Bhakthavalsalan R, Shivamurthy R, Davies S, Singhal R, Nijjar R, Wiggins T, Camprodon R, Ahmed Z. Pre-Operative Group and Save in Elective and Emergency Laparoscopic Cholecystectomy: Necessity, Cost-Effectiveness, and Own Experience. J Clin Med 2024; 13:2749. [PMID: 38792291 PMCID: PMC11122548 DOI: 10.3390/jcm13102749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/07/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Laparoscopic cholecystectomy is associated with a high safety profile. This study seeks to quantify the incidence of blood transfusion in both the elective and emergency settings, examine related patient outcomes, and investigate selection criteria for pre-operative Group and Save (G&S) sampling. Methods: A prospective multi-centre observational study was conducted to investigate patients undergoing either elective or emergency laparoscopic cholecystectomy in the UK between January 2020 and May 2021. Multivariate logistical regression models were used to identify patient factors associated with the risk of transfusion and explore outcomes linked to pre-operative G&S sampling. Results: This study comprised 959 patients, with 631 (65.8%) undergoing elective cholecystectomy and 328 (34.2%) undergoing emergency surgery. The median age was 48 years (range: 35-59), with 724 (75.5%) of the patients being female. Only five patients (0.5%) required blood transfusions, receiving an average of three units, with the first unit administered approximately six hours post-operatively. Among these cases, three patients (60%) had underlying haematological conditions. In adjusted models, male gender was significantly associated with the need for a blood transfusion (OR 11.31, p = 0.013), while the presence of a pre-operative Group and Save sample did not demonstrate any positive impact on patient outcomes. Conclusions: The incidence of blood transfusion following laparoscopic cholecystectomy is very low. Male gender and haematological conditions may present as independent risk factors. Pre-operative G&S sampling did not yield any positive impact on patient outcomes and could be safely excluded in both elective and emergency cases, although certain population subsets will warrant further consideration.
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Affiliation(s)
- Mohammed Hamid
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
- Dudley Group NHS Foundation Trust, Russell’s Hall Hospital, Pensnett Rd., Dudley DY1 2HQ, UK
| | - Marie Kershaw
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Resya Bhakthavalsalan
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rishika Shivamurthy
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Sian Davies
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rishi Singhal
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rajwinder Nijjar
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Tom Wiggins
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Ricardo Camprodon
- Dudley Group NHS Foundation Trust, Russell’s Hall Hospital, Pensnett Rd., Dudley DY1 2HQ, UK
| | - Zuhair Ahmed
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
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Ahmed SH, Usmani SUR, Mushtaq R, Samad S, Abid M, Moeed A, Atif AR, Farhan SA, Saif A. Role of laparoscopic surgery in the management of gallbladder cancer: Systematic review & meta-analysis. Am J Surg 2023; 225:975-987. [PMID: 36693774 DOI: 10.1016/j.amjsurg.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/26/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND This meta-analysis evaluates the safety and short-term oncological outcomes of laparoscopic vs. open surgery for gallbladder carcinoma(GBC). METHODS Meta-analysis was performed on laparoscopic(LG) and open group(OG) studies. Data for survival outcomes were extracted from Kaplan-Meier curves and combined with Tierney's method to estimate hazard ratios(HRs) and 95% CIs. RESULTS There was no significant difference in overall survival(HR: 1.01), disease-free survival(HR: 0.84), 30-day mortality(RR:1.10), overall recurrence(RR:0.93), intraoperative gallbladder violation(RR:1.17), operative time(WMD:8.32), number of patients receiving adjuvant chemotherapy(RR:1.06) and blood transfusion(RR: 0.81). A significant difference was seen in survival of T3 subgroup(HR:0.77) and number of lymph node dissections (LND)(WMD: 0.63) favoring OG, along with a decrease in postoperative complications(RR:0.65), greater incidence of R0 resections(RR:1.04), lower volume of intraoperative blood loss(WMD: 128.62), lower time in removing drainage tube(WMD: 1.35), shorter diet recovery time(WMD: 1.88), shorter hospital stay(WMD: 3.51), lower incidence of 90-day mortality(RR:0.49) favoring LG. A higher incidence of port-site recurrence(RR:1.99) was reported in LG. CONCLUSION Laparoscopic surgery is non-inferior to the open approach in terms of oncological outcomes and has an improved rate of postoperative complications.
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Affiliation(s)
- Syeda Hoorulain Ahmed
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan.
| | - Shajie Ur Rehman Usmani
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Rabeea Mushtaq
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Saba Samad
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Minaam Abid
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Abdul Moeed
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Abdul Raafe Atif
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Syed Ali Farhan
- Department of Surgery, Virginia Commonwealth University Health, 1200 E Marshall St, Richmond, VA, 23219, United States
| | - Areeba Saif
- Department of Surgery, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, United States
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Itagaki Y, Yamamoto K, Kikuchi T, Takano H, Nishigami K, Fukunaga A, Ichimura T, Manase H, Hirano S. Laparoscopic cholecystectomy after transcatheter arterial embolisation for haemobilia due to a pseudoaneurysm in the gallbladder: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231166777. [PMID: 37122424 PMCID: PMC10134114 DOI: 10.1177/2050313x231166777] [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: 11/12/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Pseudoaneurysms of the cystic artery are a rare but significant complication of acute cholecystitis. Laparoscopic cholecystectomy may be a safe alternative to open cholecystectomy in such cases. We report the case of a female patient in her seventies, who presented with anaemia, jaundice, and hepatic dysfunction during hospitalisation for right knee pyogenic arthritis. The patient had no pain in the right upper quadrant. Her serum haemoglobin level was 6.5 g/dL, and upper gastrointestinal endoscopy revealed no abnormalities. Six days later, jaundice worsened, and endoscopic retrograde cholangiopancreatography revealed bloody bile. An endoscopic biliary drainage tube was inserted at the discretion of the gastroenterology department. Contrast-enhanced computed tomography revealed a haematoma in the gallbladder and a pseudoaneurysm in the lateral wall of the gallbladder. On the same day, the endoscopic biliary drainage tube was replaced with an endoscopic nasobiliary drainage tube, which indicated the degree of haemorrhage and enabled lavage of the lumen in cases of obstruction. The next day, angiography revealed a pseudoaneurysm of the deep branch of the cystic artery and coil embolisation was performed at the periphery of the cystic artery. Uninterrupted laparoscopic cholecystectomy was performed. Although laparoscopic cholecystectomy is difficult when bleeding is uncontrolled, it was safely performed following haemostasis using transcatheter arterial embolisation. Laparoscopic cholecystectomy is feasible in haemodynamically stable patients with cystic artery pseudoaneurysms after transcatheter arterial embolisation.
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Affiliation(s)
- Yuki Itagaki
- Department of Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Yuki Itagaki, Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan.
| | - Kazuyuki Yamamoto
- Department of Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Tomoki Kikuchi
- Department of Surgical Pathology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Hironobu Takano
- Department of Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kohei Nishigami
- Department of Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Akira Fukunaga
- Department of Thoracic Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | | | - Hiroto Manase
- Department of Surgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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Ferritin, Serum Iron and Hemoglobin as Acute Phase Reactants in Laparoscopic and Open Surgery of Cholecystectomy: An Observational Prospective Study. PATHOPHYSIOLOGY 2022; 29:583-594. [PMID: 36278562 PMCID: PMC9624358 DOI: 10.3390/pathophysiology29040045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Cytokines are expressed by various cells after several stimuli such as surgical tissue damage, producing a systemic inflammatory response (SIR). C-reactive protein (CRP) is used extensively in clinical practice after operative injury, but proinflammatory cytokines, iron status, albumin, neutrophil-to-lymphocyte (N/L) ratio and hemoglobin, as acute phase reactants, have been poorly documented. This study aims to show how they behave after surgery, comparing laparoscopic (LC) versus open cholecystectomy (OC). In total, 55 patients were included in a prospective non-randomized form to undergo a cholecystectomy: 8 patients OC (50% females) and 47 patients LC (68% females). Before (A1) and 24 h after surgery (A2), blood samples were taken for an ordinary analysis and IL6, IL8 and TNFα determination. There were no differences between LC and OC groups concerning age, CRP, IL6 and TNFα at day A1. In the LC group at day A2, CRP, IL6, IL8, TNF, ferritin, leukocytes and N/L ratio increased; hemoglobin, lymphocytes, prothrombin and albumin decreased (p < 0.05). In the OC group at day A2, only IL6 (p < 0,07), ferritin, leukocytes, N/L ratio and CRP (p < 0.05) increased; serum iron, hemoglobin, lymphocytes and albumin (p < 0.05) decreased. At day A2, OC vs. LC group, higher values were observed in IL6, ferritin and CRP (p ≤ 0.05), and lesser values were observed in serum iron and prothrombin (p < 0.05). In conclusion, classic markers of inflammation are altered after surgery, in a milder way in laparoscopic surgery. Ferritin can be used as an inflammatory marker, as has been described in COVID-19 infection.
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Abstract
Cholecystectomy is one of the most common general surgery procedures performed worldwide. Complications include bile duct injury, strictures, bleeding, infection/abscess, retained gallstones, hernias, and postcholecystectomy syndrome. Obtaining a critical view of safety and following the other tenets of the Safe Cholecystectomy Task Force will aid in the prevention of bile duct injury and other morbidity associated with cholecystectomy.
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Affiliation(s)
- Xiaoxi Chelsea Feng
- Department of Surgery, Cedars Sinai Medical Center, 8635 W Third Street, West Medical Office Tower, Suite 795, Los Angeles, CA 90048, USA
| | - Edward Phillips
- Department of Surgery, Cedars Sinai Medical Center, 8635 W Third Street, West Medical Office Tower, Suite 795, Los Angeles, CA 90048, USA
| | - Daniel Shouhed
- Department of Surgery, Cedars Sinai Medical Center, 459 North Croft Avenue, Los Angeles, CA 90048, USA.
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Sousa JHBDE, Tustumi F, Steinman M, Santos OFPD. Laparoscopic cholecystectomy performed by general surgery residents. Is it safe? How much does it cost? Rev Col Bras Cir 2021; 48:e20202907. [PMID: 34008798 PMCID: PMC10683462 DOI: 10.1590/0100-6991e-20202907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE to evaluate the effectiveness and safety of laparoscopic cholecystectomies performed by residents of the first and second-year of a general surgery residency program. We studied the primary total cost of treatment and complication rates as primary outcomes, comparing the groups operated by senior and resident surgeons. METHODS this was a retrospective cohort study of patients who underwent laparoscopic cholecystectomy performed in a training hospital of large surgical volume in Brazil, in the period between June 1, 2018 and May 31, 2019. The study population comprised patients who underwent elective cholecystectomy due to uncomplicated chronic calculous cholecystitis or to the presence of gallbladder polyps with surgical indication. We divided the cases into three groups, based on the graduation of the main surgeon at the time of the procedure: first-year residents (R1), second-year residents (R2), and trained general surgeons (GS). RESULTS during the study period, 1,052 laparoscopic cholecystectomies were performed, of which 1,035 procedures met the inclusion criteria, with 78 (7.5%) patients operated on with the participation of first-year residents (R1), 500 (48.3%) patients with the participation of second-year residents (R2), and 457 (44.2%) with the participation of senior surgeons only. There was no difference in conversion rates, complications, and reporting of adverse events between groups. We observed a significant difference regarding hospitalization costs (p = 0.003), with a higher mean for the patients operated with the participation of R1, of US$ 2,671.13, versus US$ 2,414.60 and US$ 2,396.24 for the procedures performed by senior surgeons and R2, respectively. CONCLUSIONS laparoscopic cholecystectomy with the participation of residents is safe, even in their first years of training. There is an additional cost of about 10% in the treatment of patient operated with the participation of first-year residents. There was no significant difference in the cost of the group operated by second-year residents.
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Affiliation(s)
| | - Francisco Tustumi
- - Hospital Israelita Albert Einstein, Serviço de Cirurgia Geral - São Paulo - SP - Brasil
| | - Milton Steinman
- - Hospital Israelita Albert Einstein, Serviço de Cirurgia Geral - São Paulo - SP - Brasil
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Fong ML, Urriza Rodriguez D, Elberm H, Berry DP. Are Type and Screen Samples Routinely Necessary Before Laparoscopic Cholecystectomy? J Gastrointest Surg 2021; 25:447-451. [PMID: 31993966 DOI: 10.1007/s11605-020-04515-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/03/2020] [Indexed: 01/31/2023]
Abstract
AIMS Type and screen (T&S) samples are routinely requested before all laparoscopic cholecystectomies (LCs) at our centre despite the low reported risk of major vascular injury and peri-operative transfusion. Our retrospective case series aimed to identify local transfusion need to inform policy. METHODS Emergency and elective LC performed at a single tertiary centre between March 2014 and October 2016 (30 months) were analysed. This included all patients aged ≥ 16, and procedures converted to open where LC was the primary procedure. Peri-operative complications and transfusion data were obtained from electronic records. RESULTS In total, 1002 consecutive patients met inclusion criteria; 12 patients were transfused during index admission (1.20%). No patients required emergency transfusion or had major vascular injuries. Despite local policy, 106 patients (10.6%) did not have a valid T&S sample prior to their procedure. Transfused patients were more likely to be emergency admissions (n = 10/12). The most common indications for transfusion were pre-operative anaemia (n = 7/12) and septic coagulopathy (n = 2/12). CONCLUSIONS Peri-operative transfusions at our centre were low. No patients required intra-operative blood transfusions dependent on a pre-operative T&S sample. Patients requiring transfusion were predictable from their pre-operative clinical status. We propose that a highly selective T&S policy is safe and can reduce costs.
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Affiliation(s)
- M L Fong
- Department of Surgery, Southampton General Hospital, Tremona Rd, Southampton, SO16 6YD, UK.
| | - D Urriza Rodriguez
- Department of Surgery, Southampton General Hospital, Tremona Rd, Southampton, SO16 6YD, UK
| | - H Elberm
- Department of Surgery, Southampton General Hospital, Tremona Rd, Southampton, SO16 6YD, UK
| | - D P Berry
- Department of Surgery, Southampton General Hospital, Tremona Rd, Southampton, SO16 6YD, UK
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Management for Hemorrhage from the Gallbladder Bed Caused by Injury to the Middle Hepatic Vein During Laparoscopic Cholecystectomy. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01925-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Schembari E, Bortolussi C, Coco O, Teodoro M, Mattone E, Palumbo V, Magazù S, Di Carlo I. Peritoneal lavage: a simple tool to prevent bleeding during and after laparoscopic cholecystectomy. J Blood Med 2019; 10:279-281. [PMID: 31695538 PMCID: PMC6707385 DOI: 10.2147/jbm.s215438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/07/2019] [Indexed: 11/23/2022] Open
Abstract
Bleeding remains one of the most serious complications of laparoscopic cholecystectomy and can increase mortality. Even if several patient-related and intraoperative factors increase the risk of bleeding, complete hemostasis should be achieved at the end of each surgical procedure. Although irrigation is a standard step, its importance is often underestimated. This commentary highlights the efficacy of peritoneal lavage in identifying bleeding sources and the effect of saline temperature.
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Affiliation(s)
- Elena Schembari
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Catania 95126, Italy
| | - Carlo Bortolussi
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Catania 95126, Italy
| | - Ornella Coco
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Catania 95126, Italy
| | - Michele Teodoro
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Catania 95126, Italy
| | - Edoardo Mattone
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Catania 95126, Italy
| | - Valentina Palumbo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Catania 95126, Italy
| | - Sarita Magazù
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Catania 95126, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Catania 95126, Italy
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Bowling K, Leong S, El-Badawy S, Massri E, Rait J, Atkinson J, Srinivas G, Andrews S. A Single Centre Experience of Day Case Laparoscopic Cholecystectomy Outcomes by Body Mass Index Group. Surg Res Pract 2017; 2017:1017584. [PMID: 29094063 PMCID: PMC5637831 DOI: 10.1155/2017/1017584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/17/2017] [Accepted: 07/31/2017] [Indexed: 12/15/2022] Open
Abstract
AIM The purpose of this study was to evaluate whether patients with a high BMI can undergo safe day case LC for cholecystitis compared to groups of patients with a lower BMI. SETTING NHS District General Hospital, UK. METHODS A retrospective review of 2391 patients who underwent an attempted day case LC between 1 January 2009 and 15 August 2015 was performed. Patients were divided into five groups depending on their BMI. Inclusion criteria were patients undergoing elective day case laparoscopic cholecystectomy with cholecystitis on histology. The endpoints were complication requiring readmission and postoperative length of stay (LOS). RESULTS There were 2391 LCs performed in the time period of which 1646 were eligible for inclusion. These LCs were classified as 273 (16.9%), 608 (37.8%), 428 (26.6%), 208 (12.9%), and 91 (5.66%) patients in the groups with BMI values of 18.5-24.9, 25-29.9, 30-34.9, 35-39.9, and >40, respectively. Average BMI was 30.0 (±5.53, 19-51) with an average postoperative LOS of 0.86, and there was no difference between the BMI groups. Overall complication rate was 4.3%; there was no significance between BMI groups. CONCLUSIONS Increased BMI was not associated with worse outcomes after day case LC.
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Affiliation(s)
- Kirk Bowling
- Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Lawes Bridge, Torquay TQ2 7AA, UK
| | - Samantha Leong
- Peninsula Deanery, Derriford Hospital, Plymouth Healthcare Trust, Derriford Road, Plymouth PL6 8DH, UK
| | - Sarah El-Badawy
- Peninsula Deanery, Derriford Hospital, Plymouth Healthcare Trust, Derriford Road, Plymouth PL6 8DH, UK
| | - Erfan Massri
- Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Lawes Bridge, Torquay TQ2 7AA, UK
| | - Jaideep Rait
- Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Lawes Bridge, Torquay TQ2 7AA, UK
| | - Jay Atkinson
- Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Lawes Bridge, Torquay TQ2 7AA, UK
| | - Gandrapu Srinivas
- Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Lawes Bridge, Torquay TQ2 7AA, UK
| | - Stuart Andrews
- Peninsula Deanery, Torbay Hospital, South Devon Healthcare Trust, Lawes Bridge, Torquay TQ2 7AA, UK
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Impact of intraoperative cholangiography on postoperative morbidity and readmission: analysis of the NSQIP database. Surg Endosc 2016; 30:5395-5403. [PMID: 27105616 DOI: 10.1007/s00464-016-4896-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/26/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The debate regarding the merits of routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) continues to rage. We aim to analyze the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patterns of utilization of cholangiography during LC as well as its impact on patient outcomes. STUDY DESIGN This is a retrospective cohort study of patients undergoing LC with or without IOC in the 2012 and 2013 ACS NSQIP database. Only patients without any preoperative biochemical evidence of the CBD stone were included in the analysis. Comparison between two groups and data analysis focused on the following primary outcomes: 30-day mortality, readmission, return to operating room and NSQIP collected morbidity. RESULTS Twenty-one percentage of patients undergoing LC without any biochemical abnormality are undergoing IOC. There were no statistically significant differences in thirty-day outcomes between two patient populations with regard to mortality, morbidity, cardiac, central nervous system, wound, deep vein thrombosis, sepsis, respiratory and urinary tract complications. Patients undergoing LC plus IOC were found to have statistically significant reduction in the rate of readmission related to the first operation (adjusted odds ratio 0.80, 95 % CI 0.70-0.92; P value = 0.002). Readmissions related to biliary complications including retained CBD following cholecystectomy were 1.61 times more likely in patients who underwent LC without cholangiography. CONCLUSION The use of IOC at the time of LC appears to be associated with a statistically significant decrease in re-admission rates, especially readmissions related to biliary complications.
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