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Lim JSH, Lim ZY, Teo ZHT, Wang B, Tan YP, Junnarkar SP, Low JK, Huey CWT, Shelat V. Before and after COVID-19 pandemic: impact on hepatobiliary and pancreatic surgical services in a Singapore Tertiary Hospital. ANZ J Surg 2023; 93:2904-2909. [PMID: 37888881 DOI: 10.1111/ans.18748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Reallocation of healthcare resources to prioritize the COVID-19 pandemic-related incremental healthcare needs resulted in longer waiting times for routine elective clinical services. AIMS We aimed to analyze the effects of the pandemic on the hepatopancreatobiliary (HPB) unit's surgical workload. METHODS The HPB unit's surgical workload for the months of January-June from 2019 to 2022 was extracted, retrospectively compared, and analyzed. This study was registered in ClinicalTrials.gov (NCT05572866) and complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS Benign elective surgeries were impacted adversely, with elective gallbladder operations decreasing by 45.2% (146 in 2019 vs 80 in 2020, p = 0.89) before slowly increasing to 120 cases in 2021 and rebounding to 179 cases in 2022 (p = 0.001). Elective oncology operations paradoxically increased, with liver resections rising by 12.9% (31 in 2019 vs 35 in 2020, p = 0.002) and maintaining 37 cases in 2021 (p = 0.0337) and 34 cases in 2022 (p = 0.69). Elective pancreatic resections increased by 171.4% (7 in 2019 vs 19 in 2020, p < 0.0001) and were maintained at 15 cases in 2021 (p = 0.013) and 18 cases in 2022 (p = 0.022). The overall emergency workload decreased from 2019 (n = 198) to 2020 (n = 129) to 2021 (n = 122) before recovering to baseline in 2022 (n = 184). The month-on-month volume generally showed similar trends compared to the other years except for February 2022 and May 2021. CONCLUSION This audit shows that despite large-scale disruption of the local healthcare system, essential surgeries can still proceed with careful resource planning by steadfast and vigilant clinical teams.
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Affiliation(s)
- Joshua S H Lim
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zavier Yongxuan Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Bei Wang
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Yen Pin Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Vishal Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Surgical Science Training Centre, Tan Tock Seng Hospital, Singapore
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2
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Zheng Y, Guo R, Tian Q, Du Y, Wang L, Zhu Z, Yu E, Sun J, Yi X, Xu C. The efficacy of GnRH-a followed by SanJieZhenTong capsules in long-term management of endometriosis: Study protocol for a multicenter, double-blinded, double-dummy randomized clinical trial. Contemp Clin Trials Commun 2023; 34:101179. [PMID: 37409188 PMCID: PMC10319207 DOI: 10.1016/j.conctc.2023.101179] [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: 04/13/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023] Open
Abstract
Background Endometriosis is a common benign gynecological disorder with high risk of recurrence and adverse impact on fertility-sparing. This study aims to evaluate the effectiveness and safety of SanJieZhenTong Capsules, a traditional Chinese medicine, in the long-term management of endometriosis postoperatively. Methods and analysis: A prospective, double-blinded, double-dummy parallel-group randomized controlled trial will be conducted at three university-based medical centers in China. A total of 600 patients with rAFS III-IV endometriosis diagnosed by laparoscopy will be enrolled. After fundamental treatment (gonadotropin-releasing hormone agonists injection starts on the first day of menstruation postoperatively, and repeats 3 times every 28 days), participants will be randomly allocated to the oral contraceptive group (oral contraceptive + dummy A) or SanJieZhenTong Capsules group (SanJieZhenTong Capsules + dummy B) in a 1:1 ratio. All participants will be treated and followed up for 52 weeks. The primary outcome is a recurrence rate based on endometriosis-related symptoms, physical examination, and/or ultrasound/MRI findings. The secondary outcome includes changes in quality of life and organic function outcome via the 36-item Short-Form scores and gastrointestinal function score. Conclusion The current trial could provide rigorous evidence on SanJieZhenTong Capsules application in the long-term management of advanced-stage endometriosis.
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Affiliation(s)
- Yunxi Zheng
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Ruoyi Guo
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
- Department of Integrated Traditional & Western Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Qi Tian
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Yan Du
- Office of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Li Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
- Department of Integrated Traditional & Western Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Zhiling Zhu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
- Department of Integrated Traditional & Western Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Erkai Yu
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200011, PR China
| | - Jing Sun
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Shanghai, 200011, PR China
| | - Xiaofang Yi
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Congjian Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
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Jung JH, Kim HC, Cho JY, Jang JY, Lee JH, Lee H, Han IW, Lee HK, Heo JS. Propensity score matching analysis of perioperative outcomes including quality of life after multi-port vs. single port laparoscopic cholecystectomy: a nationwide prospective multicenter study in Korea. MINIM INVASIV THER 2023:1-8. [PMID: 36930866 DOI: 10.1080/13645706.2022.2153341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
INTRODUCTION The usefulness of single-port laparoscopic cholecystectomy (SPLC) as compared to multi-port laparoscopic cholecystectomy (MPLC) remains controversial. Between SPLC and MPLC, we compared outcomes, especially subjective aspects, such as quality of life (QoL). MATERIAL AND METHODS This multi-center study, involving 20 institutions from 2016 to 2017, enrolled 2507 patients who underwent laparoscopic cholecystectomy. Various perioperative outcomes, pain assessed by the numeric rating scale (NRS) score, and QoL evaluated by the gastrointestinal QoL index (GIQLI) questionnaire, were compared between the two procedures. We generated balanced groups after propensity score matching (PSM) using preoperative factors that influence the decision to perform MPLC or SPLC. RESULTS MPLC and SPLC were performed in 2176 and 331 patients, respectively. Nine hundred and twelve and 329 patients, respectively, were selected from the two groups by PSM. Operation time was longer and surgical difficulty was lower in SPLC. There were no significant differences in most outcomes, including biliary complications. Significant superiority of SPLC over MPLC was shorter hospitalization, lower NRS score, and favorable GIQLI. CONCLUSIONS From nationwide prospective data, SPLC showed outcomes comparable to MPLC. In SPLC, morbidity was not high and postoperative QoL was favorable. In the future, more implementations and studies are needed to ensure the safety and feasibility of SPLC.
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Affiliation(s)
- Ji Hye Jung
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyung Chul Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jin Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Huisong Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeon Kook Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Chan KS, Hwang E, Low JK, Junnarkar SP, Huey CWT, Shelat VG. On-table hepatopancreatobiliary surgical consults for difficult cholecystectomies: A 7-year audit. Hepatobiliary Pancreat Dis Int 2022; 21:273-278. [PMID: 35367147 DOI: 10.1016/j.hbpd.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/07/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cholecystectomy is considered a general surgical operation. However, general surgeons are not trained to manage severe complications such as bile duct injury (BDI) and should refer to hepatopancreatobiliary (HPB) surgeons when difficulty arises. This study aimed to investigate the outcomes of patients who had on-table HPB consults during cholecystectomy. METHODS This is an audit of 50 patients who required on-table HPB consult during cholecystectomy from 2011 to 2017. Consultations were classified as "proactive" and "reactive", where consults were made before or after surgical incision, respectively. Patient demographics and perioperative details were collected. RESULTS The median age of the patients was 62.5 years [interquartile range (IQR) 50.8-71.3 years]. Eight (16%) patients had underlying HPB co-morbidity. Gallbladder wall was thickened in all patients (median 5 mm, IQR 4-7 mm), and common bile duct was of normal caliber in all patients (median 5 mm, IQR 4-6 mm). Median length of operation and length of stay were 165 min (IQR 124-209 min) and five days (IQR 3-7 days), respectively. Subtotal cholecystectomy was performed in 18 (36%) patients. Forty-eight patients were initially managed by laparoscopic approach, 15 (31%) required open conversion; majority (9/15, 60%) were initiated before on-table consult. Majority of referrals (98%) were reactive. Common reasons for referral included unclear anatomy or anatomical variations (30%), presence of dense adhesions and/or contracted gallbladder (18%) and impacted stones in Hartmann's pouch (16%). Three (6%) patients were referred for BDI (2 Strasberg D and 1 Strasberg E1), and two (4%) were referred for torrential bleeding from arterial injury (1 cystic artery and 1 right hepatic artery). Any morbidity and 30-day readmission were 22% and 6%, respectively. There was no 90-day mortality. CONCLUSIONS Calling for help in BDI is obligatory, but in other instances is a personal choice. Calling for help prior to open conversion is lacking and this awareness should be raised. Whether surgical outcomes could be improved by early HPB consult needs to be determined by larger multicenter reports.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore
| | - Elizabeth Hwang
- Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore
| | - Sameer P Junnarkar
- Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore.
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5
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Teo ZH, Huey CWT, Low JK, Junnarkar SP, Vishalkumar GS. Impact of COVID-19 pandemic on Hepatobiliary and Pancreatic surgical services in Singapore: Experience Paper. JMIR Perioper Med 2022; 5:e29045. [PMID: 35486909 PMCID: PMC9128730 DOI: 10.2196/29045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 12/29/2021] [Accepted: 04/29/2022] [Indexed: 01/22/2023] Open
Abstract
Background At the height of the COVID-19 pandemic, the hepatopancreatobiliary (HPB) unit had to reorganize its surgical case volume due to the rationing of health care resources. We report on a local audit evaluating the impact of COVID-19 on the HPB unit and the HPB surgical oncology practice. Objective The aim of this study was to review the impact of the COVID-19 pandemic on the HPB unit’s elective and emergency surgical cases. The secondary aims were to investigate the impact on the HPB surgical oncology operative case volume. Methods We performed a comparative audit of the HPB unit surgical case volume for January-June 2019 (baseline) and 2020 (COVID-19). Elective and emergency cases performed under general anesthesia were audited. Elective cases included hernia and gallbladder operations and liver and pancreatic resections. Emergency cases included cholecystectomies and laparotomies performed for general surgical indications. We excluded endoscopies and procedures done under local anesthesia. The retrospective data collected during the 2 time periods were compared. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000040265). Results The elective surgical case volume decreased by 41.8% (351 cases in 2019 compared to 204 cases in 2020) during the COVID-19 pandemic. The number of hernia operations decreased by 63.9% (155 in 2019 compared to 56 in 2020; P<.001) and cholecystectomies decreased by 40.1% (157 in 2019 compared to 94 in 2020; P=.83). The liver and pancreatic resection volume increased by 16.7% (30 cases in 2019 compared to 35 cases in 2020; P=.004) and 111.1% (9 cases in 2019 compared to 19 cases in 2020; P=.001), respectively. The emergency surgical workload decreased by 40.9% (193 cases in 2019 compared to 114 cases in 2020). The most significant reduction in the emergency workload was observed in March (41 to 23 cases, a 43.9% reduction; P=.94), April (35 to 8 cases, a 77.1% reduction; P=.01), and May (32 to 14 cases, a 56.3% reduction; P=.39); however, only April had a statistically significant reduction in workload (P=.01). Conclusions The reallocation of resources due to the COVID-19 pandemic did not adversely impact elective HPB oncology work. With prudent measures in place, essential surgical services can be maintained during a pandemic. Trial Registration Chinese Clinical Trial Registry (ChiCTR2000040265); https://tinyurl.com/ms9kpr6x
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Affiliation(s)
- Zhe Hao Teo
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, SG
| | | | - Jee Keem Low
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, SG
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6
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Tan YP, Lim C, Junnarkar SP, Huey CWT, Shelat VG. 3D Laparoscopic common bile duct exploration with primary repair by absorbable barbed suture is safe and feasible. J Clin Transl Res 2021. [PMID: 34667894 PMCID: PMC8520704 DOI: 10.18053/jctres.07.202104.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and aim Endoscopic retrograde cholangiopancreatography (ERCP), with interval laparoscopic cholecystectomy (LC), is the most common treatment approach for common bile duct (CBD) stones. However, recent studies show that single-stage laparoscopic CBD exploration (LCBDE) is safe and feasible. Three-dimensional (3D) laparoscopy enhances depth perception and facilitates intracorporeal suturing. The application of 3D technology for LCBDE is emerging, and we report our case series of 3D LCBDE. Methods We audited the 27 consecutive 3D LCBDE performed from July 2017 to January 2020. We have a liberal policy for magnetic resonance cholangiopancreatography (MRCP) in patients with deranged liver function tests (LFT). All CBD explorations were done through choledochotomy with a 5 mm flexible choledochoscope and primarily repaired with an absorbable barbed suture without a stent or T-tube. Results The mean age of patients was 68 (range 44-91) years, and 12 (44%) were male. The indications for surgery were choledocholithiasis 67% (n=18), cholangitis 22% (n=6), and gallstone pancreatitis 11% (n=3). About 67% (n=18) had pre-operative ERCP. About 37% (n=10) had pre-operative biliary stent. Pre-operative MRCP was done in 74% (n=20), and the mean diameter of CBD was 14.5 mm (range 7-30). The median operative time was 160 (range 80-265) min. The operative drain was inserted in 18 patients. One patient each (4%) had a bile leak and a retained stone. There was no open conversion, readmission, or mortality. Conclusion 3D LCBDE with primary repair by an absorbable barbed suture is safe and feasible. Relevance for patients This paper emphasized that one stage LCBDE should be a treatment option which is comparable with two stage ERCP followed by LC to treat CBD stones. In addition, 3D technology and barbed sutures use in LCBDE are safe and useful.
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Affiliation(s)
- Yen Pin Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Cheryl Lim
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | | | - Vishalkumar G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
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7
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Serban D, Balasescu SA, Alius C, Balalau C, Sabau AD, Badiu CD, Socea B, Trotea AM, Dascalu AM, Motofei I, Ardeleanu V, Spataru RI, Sabau D, Smarandache GC. Clinical and therapeutic features of acute cholecystitis in diabetic patients. Exp Ther Med 2021; 22:758. [PMID: 34035855 DOI: 10.3892/etm.2021.10190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
The present study aimed to compare the clinical, paraclinical, intraoperative findings, and postoperative complications in acute cholecystitis in diabetic patients vs. non-diabetic patients. A 2-year retrospective study was performed on the patients who underwent emergency cholecystectomy for acute cholecystitis between 2017 and 2019 at the 4th Department of Surgery, Emergency University Hospital Bucharest. The diabetic subgroup numbered 46 eligible patients and the non-diabetic one 287 patients. Demographics, the severity of the clinical forms, biological variables (including white cell count, urea, creatinine, coagulation and liver function tests) comorbidity status, surgical approach, postoperative complications, and hospital stay were analyzed. Statistical analyses were performed to assess comparative results between the aforementioned data (SPSS V 13.0). The CCI and ASA risk classes were increased in the diabetic group, with 34.78% of patients having 3 or more associated comorbidities. No statistically significant associations were demonstrated between diabetes and the severity of the cholecystitis and risk for conversion. Postoperatively both minor complications such as surgical site infections and major cardiovascular events were more common in the diabetic subgroup (P=0.0254), well associated with the preoperative status and baseline cardiovascular comorbidities. Laparoscopic cholecystectomy is a safe procedure for diabetic patients, which can provide the best outcomes, by decreasing the risks of surgical wounds. Attentive perioperative care and good glycemic control must be provided to minimize the risk of complications.
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Affiliation(s)
- Dragos Serban
- 4th Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania.,Faculty of Medicine, University of Medicine and Pharmacy 'Carol Davila' Bucharest, 020021 Bucharest, Romania
| | | | - Catalin Alius
- 4th Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Cristian Balalau
- Faculty of Medicine, University of Medicine and Pharmacy 'Carol Davila' Bucharest, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Alexandru Dan Sabau
- 3rd Clinical Department, Faculty of Medicine, 'Lucian Blaga' University Sibiu, 550169 Sibiu, Romania
| | - Cristinel Dumitru Badiu
- Faculty of Medicine, University of Medicine and Pharmacy 'Carol Davila' Bucharest, 020021 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, University of Medicine and Pharmacy 'Carol Davila' Bucharest, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Andra Maria Trotea
- Faculty of Medicine, University of Medicine and Pharmacy 'Carol Davila' Bucharest, 020021 Bucharest, Romania
| | - Ana Maria Dascalu
- Faculty of Medicine, University of Medicine and Pharmacy 'Carol Davila' Bucharest, 020021 Bucharest, Romania
| | - Ion Motofei
- Faculty of Medicine, University of Medicine and Pharmacy 'Carol Davila' Bucharest, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Valeriu Ardeleanu
- The Faculty of Medicine, Doctoral School, 'Ovidius' University, 900527 Constanta, Romania.,Department of Surgery, General Hospital CFR, 800223 Galati, Romania.,Department of Plastic Surgery, Arestetic Clinic, BR4A, 800108 Galati, Romania
| | - Radu Iulian Spataru
- Faculty of Medicine, University of Medicine and Pharmacy 'Carol Davila' Bucharest, 020021 Bucharest, Romania.,Department of Pediatric Surgery, Emergency Clinic Hospital for Children 'Marie S. Curie', 077120 Bucharest, Romania
| | - Dan Sabau
- 3rd Clinical Department, Faculty of Medicine, 'Lucian Blaga' University Sibiu, 550169 Sibiu, Romania
| | - Gabriel Catalin Smarandache
- 4th Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania.,Faculty of Medicine, University of Medicine and Pharmacy 'Carol Davila' Bucharest, 020021 Bucharest, Romania
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8
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Jie TTZ, Shelat VG. Biliary Candidiasis Caused by Candida dubliniensis Causing Perforated Cholecystitis. Surg Infect (Larchmt) 2021; 22:469-470. [PMID: 32744926 DOI: 10.1089/sur.2020.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Thomas Teng Zheng Jie
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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9
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Chan KS, Mohan R, Low JK, Junnarkar SP, Huey CWT, Shelat VG. Elderly patients (≥ 80 years) with acute calculous cholangitis have similar outcomes as non-elderly patients (< 80 years): Propensity score-matched analysis. World J Hepatol 2021; 13:456-471. [PMID: 33959227 PMCID: PMC8080552 DOI: 10.4254/wjh.v13.i4.456] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/06/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute cholangitis (AC) is a disease spectrum with varying extent of severity. Age ≥ 75 years forms part of the criteria for moderate (Grade II) severity in both the Tokyo Guidelines (TG13 and TG18). Aging is associated with reduced physiological reserves, frailty, and sarcopenia. However, there is evidence that age itself is not the determinant of inferior outcomes in elective and emergency biliary diseases. There is a paucity of reports comparing clinical outcomes amongst elderly patients vs non-elderly patients with AC.
AIM To investigate the effect of age (≥ 80 years) on AC's morbidity and mortality using propensity score matching (PSM).
METHODS This is a single-center retrospective cohort study of all patients diagnosed with calculous AC (January 2016 to December 2016) and ≥ 80 years old (January 2012 to December 2016) at a tertiary university-affiliated teaching hospital. Inclusion criteria were patients who were treated for suspected or confirmed AC secondary to biliary stones. Patients with AC on a background of hepatobiliary malignancy, indwelling permanent metallic biliary stents, or concomitant pancreatitis were excluded. Elderly patients were defined as ≥ 80 years old in our study. A 1:1 PSM analysis was performed to reduce selection bias and address confounding factors. Study variables include comorbidities, vital parameters, laboratory and radiological investigations, and type of biliary decompression, including the time for endoscopic retrograde cholangiopancreatography (ERCP). Primary outcomes include in-hospital mortality, 30-d and 90-d mortality. Length of hospital stay (LOS) was the secondary outcome.
RESULTS Four hundred fifty-seven patients with AC were included in this study (318 elderly, 139 non-elderly). PSM analysis resulted in a total of 224 patients (112 elderly, 112 non-elderly). The adoption of ERCP between elderly and non-elderly was similar in both the unmatched (elderly 64.8%, non-elderly 61.9%, P = 0.551) and matched cohorts (elderly 68.8% and non-elderly 58%, P = 0.096). The overall in-hospital mortality, 30-d mortality and 90-d mortality was 4.6%, 7.4% and 8.5% respectively, with no statistically significant differences between the elderly and non-elderly in both the unmatched and matched cohorts. LOS was longer in the unmatched cohort [elderly 8 d, interquartile range (IQR) 6-13, vs non-elderly 8 d, IQR 5-11, P = 0.040], but was comparable in the matched cohort (elderly 7.5 d, IQR 5-11, vs non-elderly 8 d, IQR 5-11, P = 0.982). Subgroup analysis of patients who underwent ERCP demonstrated the majority of the patients (n = 159/292, 54.5%) had delayed ERCP (> 72 h from presentation). There was no significant difference in LOS, 30-d mortality, 90-d mortality, and in-hospital mortality in patients who had delayed ERCP in both the unmatched and matched cohort (matched cohort: in-hospital mortality [n = 1/42 (2.4%) vs 1/26 (3.8%), P = 0.728], 30-d mortality [n = 2/42 (4.8%) vs 2/26 (7.7%), P = 0.618], 90-d mortality [n = 2/42 (4.8%) vs 2/26 (7.7%), P = 0.618], and LOS (median 8.5 d, IQR 6-11.3, vs 8.5 d, IQR 6-15.3, P = 0.929).
CONCLUSION Mortality is indifferent in the elderly (≥ 80 years old) and non-elderly patients (< 80 years old) with AC.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- MOH Holdings, Singapore 099253, Singapore
| | - Ramkumar Mohan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Sameer P Junnarkar
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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10
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Borzellino G, Khuri S, Pisano M, Mansour S, Allievi N, Ansaloni L, Kluger Y. Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials. World J Emerg Surg 2021; 16:16. [PMID: 33766077 PMCID: PMC7992835 DOI: 10.1186/s13017-021-00360-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Early cholecystectomy for acute cholecystitis has proved to reduce hospital length of stay but with no benefit in morbidity when compared to delayed surgery. However, in the literature, early timing refers to cholecystectomy performed up to 96 h of admission or up to 1 week of the onset of symptoms. Considering the natural history of acute cholecystitis, the analysis based on such a range of early timings may have missed a potential advantage that could be hypothesized with an early timing of cholecystectomy limited to the initial phase of the disease. The review aimed to explore the hypothesis that adopting immediate cholecystectomy performed within 24 h of admission as early timing could reduce post-operative complications when compared to delayed cholecystectomy. Methods The literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complication rate after early and delayed cholecystectomy for acute cholecystitis were included. Studies were grouped based on the timing of cholecystectomy. The hypothesis that immediate cholecystectomy performed within 24 h of admission could reduce post-operative complications was explored by comparing early timing of cholecystectomy performed within and 24 h of admission and early timing of cholecystectomy performed over 24 h of admission both to delayed timing of cholecystectomy within a sub-group analysis. The literature finding allowed the performance of a second analysis in which early timing of cholecystectomy did not refer to admission but to the onset of symptoms. Results Immediate cholecystectomy performed within 24 h of admission did not prove to reduce post-operative complications with relative risk (RR) of 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, cholecystectomy performed within 72 h of symptoms was found to significantly reduce post-operative complications compared to delayed cholecystectomy with RR = 0.60 [95% CI 0.39;0.92]. Conclusion The present study failed to confirm the hypothesis that immediate cholecystectomy performed within 24 h of admission may reduce post- operative complications unless surgery could be performed within 72 h of the onset of symptoms.
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Affiliation(s)
- Giuseppe Borzellino
- Department of General Surgery, University Hospital of Verona, Piazzale A. Stefani 1, 37128, Verona, Italy.
| | - Safi Khuri
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michele Pisano
- 1st Surgical Unit, Department of Emergency, ASST Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Subhi Mansour
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Niccolò Allievi
- 1st Surgical Unit, Department of Emergency, ASST Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Luca Ansaloni
- 1st General Surgery Unit, University of Pavia, Pavia, Italy
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
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11
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Mahd-Ab.lah N, Kueh YC, Kuan G, Yahaya FH, Wong MS, Abd Samat NA, Hamid N, Mohamad Nor N, Whitehead WE, Thiwan SI, Lee YY. Validity and Reliability of the Malay Versions of Bloating Severity (BSQ-M) and Quality of Life (BLQoL-M) Questionnaires. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2487. [PMID: 33802426 PMCID: PMC7967615 DOI: 10.3390/ijerph18052487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022]
Abstract
Abdominal bloating (AB) is a prevalent and bothersome symptom, but there are no specific measures for severity and quality of life (QoL) other than the Bloating Severity Questionnaire (BSQ) and Bloating Quality of Life (BLQoL). We aimed to translate the BSQ and BLQoL into the Malay language and to validate them using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) approaches. The 12-item BSQ has two components, seven-item severity in general (SevGen) and five-item severity in the past 24 h (Sev24), and BLQOL has five items. Translation to the Malay language (BSQ-M and BLQoL-M) was performed using standard forward and backward processes. EFA followed by CFA were performed in participants with AB due to functional bowel disorders, with the purpose of examining the validity and reliability of the questionnaires translated into Malay. After EFA with 152 participants, all the items of BSQ-M remained in the model. Total variance extracted was 53.26% for BSQ-M and 58.79% for BLQoL-M. The internal consistency based on Cronbach's alpha values was 0.52 for SevGen, 0.86 for Sev24, and 0.81 for BLQoL-M. After performing CFA with another 323 participants, the final measurement model for BSQ-M and BLQoL-M fit the data well in terms of several fit indices (BSQ-M: root mean square error of approximation (RMSEA) = 0.050, Comparative Fit Index (CFI) = 0.966, Tucker-Lewis Fit Index (TLI) = 0.956, and standardized root mean squared residual (SRMR) = 0.051; BLQoL-M: RMSEA = 0.071, CFI = 0.985, TLI = 0.962, SRMR = 0.021). The composite reliability for BSQ-M and BLQoL-M were satisfactory (SevGen = 0.83, Sev24 = 0.89, BLQoL = 0.80). The intraclass correlation (ICC) results showed excellent stability for BSQ-M and BLQoL-M, ranging from 0.74 to 0.93. The Malay language versions of BSQ-M and BLQoL-M are valid and reliable instruments for measuring the severity and QoL of AB for the Asian population with functional bowel disorders.
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Affiliation(s)
- Nurzulaikha Mahd-Ab.lah
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Yee Cheng Kueh
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Garry Kuan
- Exercise and Sport Science, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Department of Life Sciences, Brunel University, London UB8 3PH, UK
| | - Fatan Hamamah Yahaya
- School of Distance Education, Universiti Sains Malaysia, USM, Penang 11800, Pulau Pinang, Malaysia;
| | - Mung Seong Wong
- Medical Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.S.W.); (N.A.A.S.); (N.H.); (N.M.N.)
| | - Nor Aslina Abd Samat
- Medical Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.S.W.); (N.A.A.S.); (N.H.); (N.M.N.)
| | - Nurhazwani Hamid
- Medical Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.S.W.); (N.A.A.S.); (N.H.); (N.M.N.)
| | - Nurhayati Mohamad Nor
- Medical Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.S.W.); (N.A.A.S.); (N.H.); (N.M.N.)
| | - William E. Whitehead
- Division of Gastroenterology and Hepatology CB 7080, Chapel Hill Department of Medicine, University of North Carolina, 4112 Bioinformatics Bldg, Chapel Hill, NC 27599-7080, USA;
| | - Syed Ismail Thiwan
- Department of Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA;
| | - Yeong Yeh Lee
- Medical Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.S.W.); (N.A.A.S.); (N.H.); (N.M.N.)
- Gut Research Group, Faculty of Medicine, National University of Malaysia, Kuala Lumpur 43600, Selangor, Malaysia
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12
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Posegger KR, Maeda CT, Taveira JP, Caetano EM, Ferraz MB, de Brito Rocha MJA, Lopes Filho GDJ, Linhares MM. Brazilian-Portuguese Validation Assessment of the Gastrointestinal Quality of Life Index for Patients After Laparoendoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2021; 32:125-131. [PMID: 33449870 DOI: 10.1089/lap.2020.0921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Cholelithiasis is currently one of the most common diagnosis in Brazil. The aim of this study was to validate the Gastrointestinal Quality of Life Index (GIQLI) as a quality-of-life (QoL) assessment among the Brazilian population with syntomatic gallstone. Materials and Methods: The questionnaire was translated and culturally adapted after the linguistic validation process determined by the international methodology. Sixty-three patients who underwent laparoscopic cholecystectomy responded to the GIQLI-Brazil and Short-Form Health Survey (SF-36) instruments. For the evaluation of reproducibility, 30 patients responded to GIQLI-Brazil two more times after 2 and 4 weeks. After the University of São Paulo Ethics Commitee Board approval (UNIFESP/CEP: 1270/2019), the study was carryed out between May 2019 and February 2020 at the Gastroenterology outpatient clinic of Hospital São Paulo-Federal University of São Paulo (UNIFESP). Cronbach's alpha, the calculation of the intraclass correlation coefficient (ICC), and Spearman's correlation were used to assess the validity and reproducibility of the instrument translated into Portuguese, and to measure correlation between the domains of the GIQLI-Brazil and SF-36 (P < .05). Results: Seven questions were modified during the process of translation and cultural adaptation. The Brazilian version of the instrument presented a Cronbach's alpha of 0.89, and excellent reproducibility through the ICC, with the following variation between domains: meteorism (ICC = 0.918; P < .001) and gastrointestinal function (lower tract) (ICC = 0.956; P < .001). The dimensions of the GIQLI-Brazil and SF-36 demonstrated a significant correlation (P < .001), except between the domains: functional aspects of the SF-36 and gastrointestinal function (lower tract) of the GIQLI-Brazil (r = 0.211). Conclusion: The GIQLI was translated and validated for Portuguese-Brazil and can be used to assess the QoL of adult patients with gastrointestinal diseases and/or disorders.
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Affiliation(s)
- Karin Romano Posegger
- Division of Gastroenterology, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos Toshinori Maeda
- Division of Gastroenterology, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Elesiário Marques Caetano
- Division of Gastroenterology, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marcos Bosi Ferraz
- Division of Medicine, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Gaspar de Jesus Lopes Filho
- Division of Gastroenterology, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Moura Linhares
- Division of Gastroenterology, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
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13
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Ishii Y, Nakayama A, Nakatani K, Nishihara S, Oikawa S, Usami T, Noguchi T, Mitsui Y, Yoshida H. Primary endoscopic bile duct stone removal for severe acute cholangitis: a retrospective study. Ther Adv Gastrointest Endosc 2021; 14:26317745211044009. [PMID: 34595474 PMCID: PMC8477704 DOI: 10.1177/26317745211044009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/16/2021] [Indexed: 12/07/2022] Open
Abstract
INTRODUCTION While the Tokyo Guidelines 2018 suggest primary stone removal for mild to moderate cholangitis, a guideline for severe acute cholangitis is not mentioned. We, therefore, investigated the clinical outcomes of patients with severe acute cholangitis to confirm the usefulness and safety of primary stone removal. METHOD This study included 104 severe acute cholangitis patients without gallstone pancreatitis diagnosed at our institution between January 2014 and December 2020. Patients with percutaneous transhepatic biliary drainage as the primary drainage, bile duct stenosis, and endoscopically unidentified bile duct stones were excluded from this study. The clinical results of 14 patients with primary stone removal (primary group) and 23 patients with elective stone removal (elective group) were then retrospectively examined (excluding abnormal values due to underlying diseases). RESULTS Upon comparing the patient characteristics between groups, the elective group had significantly higher cardiovascular dysfunction (57% vs 7%; p = 0.004), septic shock (39% vs 0%; p = 0.006), disseminated intravascular coagulation treatment (57% vs 14%; p = 0.016), and positive blood cultures (91% vs 43%; p = 0.006) than those in the primary group. Endoscopic sphincterotomy for naïve papilla (90% vs 21%; p = 0.01) and endoscopic nasobiliary drainage (50% vs 9%; p = 0.014) were higher in the primary group, while endoscopic biliary stenting (7% vs 87%; p < 0.001) was lower than that in the elective group. DISCUSSION There were no significant differences in adverse events or complete stone removal rates between the two groups. In the primary group, the period from the first endoscopic retrograde cholangiopancreatography to stone removal (0 days vs 12 days; p < 0.001) and hospitalization period (12 days vs 26 days; p = 0.012) were significantly shorter and the hospitalization cost ($7731 vs $18758; p < 0.001) was significantly lower than those in the elective group. CONCLUSION If patients are appropriately selected, bile duct stones may be safely removed for the treatment of severe acute cholangitis.
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Affiliation(s)
- Yu Ishii
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Akihiro Nakayama
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kei Nakatani
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shigetoshi Nishihara
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shu Oikawa
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tomono Usami
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshihiro Noguchi
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuta Mitsui
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hitoshi Yoshida
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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14
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Han IW, Lee HK, Park DJ, Choi YS, Lee SE, Kim H, Kwon W, Jang JY, Lee H, Heo JS. Long-term patient-reported outcomes following laparoscopic cholecystectomy: A prospective multicenter observational study. Medicine (Baltimore) 2020; 99:e21683. [PMID: 32871883 PMCID: PMC7458203 DOI: 10.1097/md.0000000000021683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Several studies have reported short-term results for post-cholecystectomy symptoms and quality of life (QoL). However, reports on long-term results are still limited. This study aimed to identify risk factors affecting short- and long-term patient-reported outcome (PRO) following laparoscopic cholecystectomy.From 2016 to 2017, a total of 476 patients from 5 institutions were enrolled. PRO was examined using the Numeric Rating Scale (NRS) pain score and the Gastrointestinal (GI) QoL Index questionnaire at postoperative 1 month and 1 year.Most of patients recovered well at postoperative 1 year compared to postoperative 1 month for the NRS pain score, QoL score, and GI symptoms. A high operative difficulty score (HR 1.740, P = .031) and pathology of acute or complicated cholecystitis (HR 1.524, P = .048) were identified as independent risk factors for high NRS pain scores at postoperative 1 month. Similarly, female sex (HR 1.571, P = .003) at postoperative 1 month and postoperative complications (HR 5.567, P = .001) at postoperative 1 year were independent risk factors for a low QoL. Also, age above 50 (HR 1.842, P = .001), female sex (HR 1.531, P = .006), and preoperative gallbladder drainage (HR 3.086, P = .001) were identified as independent risk factors for GI symptoms at postoperative 1 month.Most patients showed improved long-term PRO measurement in terms of pain, QoL, and GI symptoms. There were no independent risk factors for long-term postoperative pain and GI symptoms. However, postoperative complications were identified to affect QoL adversely at postoperative 1 year. Careful and long-term follow up is thus necessary for patients who experienced postoperative complications.
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Affiliation(s)
- In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon Kook Lee
- Department of Surgery, Ewha Womans University College of Medicine
| | - Dae Joon Park
- Division of Hepatobiliary-Pancreatic Surgery Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yoo Shin Choi
- Department of Surgery, Chung-Ang University College of Medicine
| | - Seung Eun Lee
- Department of Surgery, Chung-Ang University College of Medicine
| | - Hongbeom Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
- Department of Surgery, Dongguk University College of Medicine, Goyang, South Korea
| | - Wooil Kwon
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Jin-Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Huisong Lee
- Department of Surgery, Ewha Womans University College of Medicine
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
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15
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Bass GA, Gillis AE, Cao Y, Mohseni S. Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated calculous biliary disease. BJS Open 2020; 4:622-629. [PMID: 32418332 PMCID: PMC7397364 DOI: 10.1002/bjs5.50294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Complicated acute biliary calculous disease poses clinical challenges. The European Society of Trauma and Emergency Surgery (ESTES) snapshot audit of complicated biliary calculous disease aims to make novel comparisons between self-reported institutional adherence to the Tokyo guidelines (TG18) and 'real-world' contemporary practice across Europe. METHODS A preplanned analysis of a prospective observational multicentre audit that captured patients undergoing emergency admission for complicated biliary calculous disease (complicated cholecystitis, biliary pancreatitis, or choledocholithiasis with or without cholangitis) between 1 and 31 October 2018 was performed. An anonymized survey was administered to participating sites. RESULTS Following an open call for participation, 25 centres from nine countries enrolled 338 patients. All centres completed the anonymized survey. Fifteen centres (60 per cent) self-reported that a minority of patients were treated surgically on index admission, favouring interval cholecystectomy. This was replicated in the snapshot audit, in which 152 of 338 patients (45·0 per cent) underwent index admission cholecystectomy, 17 (5·0 per cent) had interval cholecystectomy, and the remaining 169 (50·0 per cent) had not undergone surgery by the end of the 60-day follow-up. Centres that employed a dedicated acute care surgery model of care were more likely to perform index admission cholecystectomy compared with a traditional general surgery 'on call' service (57 versus 38 per cent respectively; odds ratio 2·14 (95 per cent c.i. 1·37 to 3·35), P < 0·001). Six centres (24 per cent) self-reported routinely performing blood cultures in acute cholecystitis; patient-level audit data revealed that blood cultures were done in 47 of 154 patients (30·5 per cent). No centre self-reported omitting antibiotics in the management of acute cholecystitis, and 144 of 154 (93·5 per cent) of patients in the snapshot audit received antibiotics during their index admission. CONCLUSION Awareness of TG18 recommendations was high, but self-reported adherence and objective snapshot audit data showed low compliance with TG18 in patients with complicated acute biliary calculous disease.
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Affiliation(s)
- G A Bass
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland.,Surgery, Örebro University School of Medical Sciences, Örebro, Sweden
| | - A E Gillis
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Y Cao
- Departments of Clinical Epidemiology and Biostatistics, Örebro, Sweden
| | - S Mohseni
- Surgery, Örebro University School of Medical Sciences, Örebro, Sweden
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16
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Chan KS, Shelat VG, Tan CH, Tang YL, Junnarkar SP. Isolated gallbladder tuberculosis mimicking acute cholecystitis: A case report. World J Gastrointest Surg 2020; 12:123-128. [PMID: 32218895 PMCID: PMC7061240 DOI: 10.4240/wjgs.v12.i3.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/20/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Isolated tuberculosis of the gallbladder is extremely rare due to its intrinsic resistance to tuberculous infections. There are reports of gallbladder tuberculosis mimicking cholecystitis or malignancy. However, these presentations were chronic. The diagnosis of gallbladder tuberculosis warrants the need for investigation of additional sites of inoculation and contact tracing of all tuberculosis contacts. Gallbladder tuberculosis is a rare entity but should be suspected in patients from endemic regions with risk factors such as underlying immunosuppression or history of tuberculosis.
CASE SUMMARY We present a case of gallbladder tuberculosis presenting as acute cholecystitis. A 44-year-old Filipino lady presented with a 11-d history of right hypochondrium and epigastric pain which worsened after meals with no significant past medical history. She underwent laparoscopic cholecystectomy on the presumptive diagnosis of acute cholecystitis and diagnosed as gallbladder tuberculosis after histopathological examination. The patient did not have features of pulmonary or systemic tuberculosis nor was she immunocompromised. She recovered uneventfully. She was subsequently discharged and followed-up at a hospital in her home country due to financial and social reasons.
CONCLUSION Clinicians should have a high index of suspicion for patients in endemic regions presenting with cholecystitis.
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Affiliation(s)
- Kai Siang Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | | | - Sameer P Junnarkar
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Pathology, Tan Tock Seng Hospital, Singapore 308433, Singapore
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17
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Assessing long term quality of life in geriatric patients after elective laparoscopic cholecystectomy. Am J Surg 2019; 219:1039-1044. [PMID: 31526511 DOI: 10.1016/j.amjsurg.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION While cholecystectomy is shown to be safe in older patients, few existent studies investigate associated quality of life. This study examines quality of life in symptomatic geriatric patients after elective laparoscopic cholecystectomy. METHODS Patients ≥65 years of age who underwent elective laparoscopic cholecystectomy at a tertiary care center were administered the 12-Item Short Form Survey (SF-12) and a gastrointestinal survey pre-operatively and post-operatively (within 6 and 18 months of surgery). Quality of life characteristics were compared amongst visit type in univariate and multivariate settings, with a mixed-model regression. RESULTS Our sample included 30 patients. Pain frequency (p = 0.004) and pain severity (p = 0.013) scores improved with each subsequent visit type. SF-12 mental health aggregate score improved overall from pre-operative to long term follow-up (p = 0.0403). DISCUSSION Our findings suggest that health-related quality of life in geriatric patients improves after elective laparoscopic cholecystectomy in the short and long term. SUMMARY Quality of life was assessed in symptomatic geriatric patients undergoing elective laparoscopic cholecystectomy. Pain frequency, pain severity, and the SF-12 mental health aggregate scores improved overall from pre-operative to post-operative visit types.
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18
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Mak MHW, Chew WL, Junnarkar SP, Woon WWL, Low JK, Huey TCW, Shelat VG. Patient reported outcomes in elective laparoscopic cholecystectomy. Ann Hepatobiliary Pancreat Surg 2019; 23:20-33. [PMID: 30863804 PMCID: PMC6405362 DOI: 10.14701/ahbps.2019.23.1.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 12/12/2022] Open
Abstract
Backgrounds/Aims Traditional outcome measures (e.g., length of hospital stay, morbidity, and mortality) are used to determine the quality of care, but these may not be most important to patients. It is unclear which outcomes matter to patients undergoing elective laparoscopic cholecystectomy (ELC). We aim to identify patient-reported outcome measures (PROM) which patients undergoing ELC valued most. Methods A 45-item questionnaire with Four-point Likert-type questions developed from prior literature review, prospectively administered to patients treated with ELC at a tertiary institution in Singapore. Results Seventy-five patients participated. Most essential factors were technical skill and experience level of a surgeon, long-term quality of life (QoL), patient involvement in decision-making, communication skill of a surgeon, cleanliness of the ward environment, and standards of nursing care. Least important factors were hospitalization leave duration, length of hospital stay, a family's opinion of the hospital, and scar cosmesis. Employed patients were more likely to find hospitalization leave duration (p<0.001) and procedure duration (p=0.042) important. Younger patients (p=0.048) and female gender (p=0.003) were more likely to perceive scar cosmesis as important. Conclusions Patients undergoing ELC value long-term QoL, surgeon technical skill and experience level, patient involvement in decision-making, surgeon communication skill, cleanliness of the ward environment, and nursing care standards. Day-case surgery, medical leave, family opinion of hospital, and scar cosmesis were least important. Understanding what patients value will help guide patient-centric healthcare delivery.
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Affiliation(s)
- Malcolm H W Mak
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Woon Ling Chew
- School of Biological Sciences, Nanyang Technological University, Singapore
| | | | - Winston W L Woon
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Jee-Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Terence C W Huey
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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19
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Bhattacharya S, Richardson T, Naidoo G, Gillick K, Haddad S, Ghosh C, Brereton P. Financial implications of laparoscopic hot gallbladder service in a nontertiary District General Hospital. Int J Health Plann Manage 2018; 33:e1014-e1021. [PMID: 30028038 DOI: 10.1002/hpm.2579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 05/30/2018] [Accepted: 06/28/2018] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The service of providing index admission laparoscopic cholecystectomy (IALC), as recommended by NIC guidelines, often falls short in nontertiary centres because of a combination of limited resources and financial constraints. METHODS This retrospective study in a single-centre District General Hospital included 50 patients, eligible to undergo IALC, and calculated potential savings from performing IALC on the day of admission by considering admission tariffs, bed, and operating costs. RESULTS The IALC was provided in 19 patients (38%), with a mean delay from admission to operation of (median) 3 days. Mean surplus tariff was £1421 and £1571 in IALC and non-IALC groups, respectively. Performing immediate IALC (on the day of admission) for acute cholecystitis (AC) is predicted to increase mean surplus tariff to £2132 per patient, raising total predicted annual surplus by £53 000. Immediate IALC is also predicted to reduce waiting time for day-case LC by freeing up 53 day-case slots, attracting additional £95 600 annually, along with freeing up many inpatient bed days. CONCLUSIONS This study demonstrates that reduction of preoperative stay in AC by expediting operations in every eligible patient promises significant surplus revenue. Additional advantages include reducing inpatient bed days and freeing up operating lists that are otherwise taken up by patients for interval cholecystectomy.
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Affiliation(s)
- Sayantan Bhattacharya
- Department of General Surgery, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - Tom Richardson
- Department of General Surgery, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - Gerlin Naidoo
- Department of General Surgery, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - Kieran Gillick
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Saif Haddad
- Department of General Surgery, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | | | - Paula Brereton
- Clinical Coding Department, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
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