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Favaro MDL, Moran SBS, Iamarino APM, Herrero BM, Gabor S, Ribeiro Junior MAF. During which period should we avoid cholecystectomy in patients who underwent endoscopic retrograde cholangiopancreatography? EINSTEIN-SAO PAULO 2020; 18:eAO5393. [PMID: 33111809 PMCID: PMC9586429 DOI: 10.31744/einstein_journal/2020ao5393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/16/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the period during which we should avoid cholecystectomy after endoscopic retrograde cholangiopancreatography. METHODS A retrospective analysis of electronic medical charts of 532 patients undergoing endoscopic retrograde cholangiopancreatography, between March 2013 and December 2017. RESULTS Approximately one-third of patients underwent the procedure between 4 and 30 days after endoscopic retrograde cholangiopancreatography. The conversion rate was 3.8%. The need for abdominal drainage and the finding of biliary tract injury after surgery were observed in 15.1% and 1.9% of patients, respectively. The length of stay was significantly shorter among patients undergoing surgery more than 30 days after endoscopic retrograde cholangiopancreatography. These patients had a median length of stay of one day, whereas the median length of stay in the group undergoing the procedure between 4 and 30 days after endoscopic retrograde cholangiopancreatography was 2 days. CONCLUSION The period during which we should avoid cholecystectomy is between 4 and 30 days after endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
| | | | | | | | - Silvio Gabor
- Universidade de Santo Amaro, São Paulo, SP, Brazil
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de Siqueira Corradi MB, D Ávila R, Duim E, Rodrigues CIS. Risk stratification for complications of laparoscopic cholecystectomy based on associations with sociodemographic and clinical variables in a public hospital. Am J Surg 2019; 219:645-650. [PMID: 31130212 DOI: 10.1016/j.amjsurg.2019.05.005] [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: 02/07/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cholelithiasis is the most common disease of the biliary tract. We aimed to associate complications resulting from laparoscopic cholecystectomy with patients' sociodemographic and clinical data, stratifying risk based on this association. METHODS We retrospectively reviewed the medical records of 2520 patients undergoing laparoscopic cholecystectomy from January 2013 to March 2017 at our institution. Sociodemographic, clinical, and surgical complication data were collected. Unadjusted and adjusted logistic regression models were used to determine independent factors associated with the outcomes of interest. Based on the results, we proposed a risk stratification model, a treatment flowchart, and a severity score. RESULTS Mean age was 48.9 years; 83.53% were female. Intraoperative complications occurred in 206 (8.17%) patients, and postoperative complications in 54 (2.14%). Male sex, older age, diabetes, multiple previous operations, and urgent surgery (odds ratio = 23.77) were significantly associated with surgical complications in both unadjusted and adjusted models. CONCLUSIONS We could propose a flowchart based on our risk stratification model and develop a severity score based on the association between complications of laparoscopic cholecystectomy and sociodemographic/clinical data.
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Affiliation(s)
| | - Ronaldo D Ávila
- Department of Medicine, Nephrology Division, School of Medical and Health Sciences, Pontifícia Universidade Católica de São Paulo (PUC-SP), R. Jouberte Wey, 290, Vergueiro, 18030-070, Sorocaba, SP, Brazil.
| | - Etienne Duim
- School of Public Health, Universidade de São Paulo (USP), Faculty of Health, Medicine and Life Sciences, Av. Dr Arnaldo, 715, 01246-904, São Paulo, SP, Brazil.
| | - Cibele Isaac Saad Rodrigues
- Department of Medicine, Nephrology Division and Education in Health Professions Master Program, School of Medical and Health Sciences, PUC-SP. R, Jouberte Wey, 290, Vergueiro, 18030-070, Sorocaba, SP, Brazil.
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Favaro MDL, Gabor S, Pedroso RFP, Ribeiro L, Rosa OM, Ribeiro-Junior MAF. SINGLE PORT LAPAROSCOPIC CHOLECYSTECTOMY: TECHNICAL ASPECTS AND RESULTS. ACTA ACUST UNITED AC 2018; 31:e1388. [PMID: 30133680 PMCID: PMC6097110 DOI: 10.1590/0102-672020180001e1388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/22/2018] [Indexed: 01/13/2023]
Abstract
Background: The search for less traumatic surgical procedures without compromising
efficacy and safety, together with the technological advances and greater
experience of the teams, led to the development of operative techniques with
increasingly smaller incisions, the so-called “minimally invasive
surgeries”. Aim: To evaluate the technical aspects and results of single port
cholecystectomy. Method: Were analyzed 170 patients between 18-74 years submitted to
videolaparoscopic cholecystectomies by single port, regardless of elective
or urgent indication, without restriction of patient selection. Results: Among the 170 operations, 158 were exclusively performed by single port, and
the conversion rate was 7% (inclusion of other accessory trocars or
conversion to multiportal). Conversion to open surgery occurred in three
cases (1.76%). The mean surgical time was 67.97 min, showing a marked
decrease when was reached close to 50 cases and a stabilization after 100
surgeries. The overall complication rate was 10%, with minor complications
such as: incisional pain, hematomas, granulomas, port access hernias
(9.41%). Conclusion: Single port cholecystectomy can, after standardization and surgical team
training, be a safe surgical procedure associated with a recognized
aesthetic advantage.
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Affiliation(s)
- Murillo de Lima Favaro
- General Surgery Department, University of Santo Amaro.,Private Clinic, São Paulo, SP, Brazil
| | - Silvio Gabor
- General Surgery Department, University of Santo Amaro.,Private Clinic, São Paulo, SP, Brazil
| | | | - Ligia Ribeiro
- General Surgery Department, University of Santo Amaro
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Martins T, Amante LN, Virtuoso JF, Sell BT, Wechi JS, Senna CVA. FATORES DE RISCO PARA INFECÇÃO DO SÍTIO CIRÚRGICO EM CIRURGIAS POTENCIALMENTE CONTAMINADAS. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180002790016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Objetivo: associar os fatores de risco do período pós-operatório de cirurgias potencialmente contaminadas, com a ocorrência da infecção do sítio cirúrgico no período pós-operatório hospitalar e domiciliar. Método: período de coleta de dados foi de fevereiro a junho de 2015, com 84 pacientes acompanhados nos três primeiros dias de pós-operatório e sete dias após a alta hospitalar, através de questionários elaborados para avaliação do sítio cirúrgico, das condições clínicas do paciente e da análise de prontuário. Para verificação dos fatores de risco influenciáveis e classificação das infecções do sítio cirúrgico, utilizou-se um questionário com variáveis que foram analisadas de forma descritiva através da frequência simples, porcentagem e medidas de posição e dispersão. Para a associação e nível de significância dos fatores de risco foram realizados testes estatísticos. Resultados: nenhum dos pacientes entrevistados desenvolveu infecção profunda do sítio cirúrgico ou de órgão/espaço, sendo que sete desenvolveram infecção do sítio cirúrgico superficial no pós-operatório hospitalar e 41 em domicílio. Os fatores de risco analisados não foram significativos para o desenvolvimento das infecções. Conclusões: recomenda-se que as instituições implantem um serviço de vigilância e acompanhamento pós-alta, a fim de que se melhore a confiabilidade das taxas de incidência das infecções do sítio cirúrgico; melhorar a qualidade dos cuidados com os pacientes; compreensão epidemiológica e identificação dos fatores de risco. Além disso, propõe-se facilitar o processo de referência e contra referência através de capacitações da Estratégia de Saúde da Família para identificação destes fatores de risco, atuando em rede.
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Affiliation(s)
- Tatiana Martins
- Estratégia de Saúde da Família do Município de Biguaçu, Brasil
| | | | | | - Bruna Telemberg Sell
- Secretaria Municipal de Saúde do Município de São José, Brasil; Hospital Governador Celso Ramos, Brasil
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Borges MDEC, Gouvea AB, Marcacini SFB, Oliveira PFDE, Silva AADA, Crema E. Pulmonary function in women: comparative analysis of conventional versus single-port laparoscopic cholecystectomy. Rev Col Bras Cir 2018; 45:e1652. [PMID: 29846465 DOI: 10.1590/0100-6991e-20181652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/16/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate the pulmonary function of women submitted to conventional and single-port laparoscopic cholecystectomy. METHODS forty women with symptomatic cholelithiasis, aged 18 to 70 years, participated in the study. We divided the patients into two groups: 21 patients underwent conventional laparoscopic cholecystectomy, and 19, single-port laparoscopic cholecystectomy. We assessed pulmonary function through forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the FEV1/FVC ratio, measured before and 24 hours after the procedure. RESULTS in both groups, FVC and FEV1 were lower in the postoperative period than those obtained in the preoperative period, with a greater reduction in the group undergoing conventional laparoscopic cholecystectomy. Regarding the FEV1/FVC (%) values, there was no statistically significant difference in any of the groups or times analyzed. CONCLUSION there was a greater decline in FVC and FEV1 in the postoperative group of patients submitted to conventional laparoscopic cholecystectomy.
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Affiliation(s)
| | - Aline Borges Gouvea
- Department of Surgery, Triângulo Mineiro Federal University, Uberaba, MG, Brazil
| | | | | | | | - Eduardo Crema
- Department of Surgery, Triângulo Mineiro Federal University, Uberaba, MG, Brazil
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Del Grande LDM, Leme LFP, Marques FP, Ramos AT, Ramos PT, Souza FAD. PREVALENCE AND PREDICTORS OF CHANGES IN BOWEL HABITS AFTER LAPAROSCOPIC CHOLECYSTECTOMY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:3-6. [PMID: 28489158 PMCID: PMC5424676 DOI: 10.1590/0102-6720201700010002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/15/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND: The incidence of cholecystolithiasis is approximately 15% of the population. It is believed that between 30-40% of cholecystectomy patients have symptoms after surgery, being changes in bowel habits the most common among them. AIM: 1) Defining the prevalence, and 2) identifying predictors of changes in bowel habits after laparoscopic cholecystectomy. METHODS: This is a retrospective cross-sectional study with an initial sample of 150 patients diagnosed with cholecystolithiasis operated between July and September 2014. Patients were submitted to a questionnaire about the presence of gastrointestinal symptoms and changes in stools consistency before and after the surgical procedure. They were divided into two groups (with or without changes in bowel habits) being combined with the following variables: high blood pressure, body mass index, hypothyroidism, adherence to postoperative dietary orientations, previous abdominal and bariatric surgery. RESULTS: The prevalence of changes in bowel habits in the study population was 35.1%. The association between it and gastrointestinal symptoms was demonstrated to be statistically significant (‰2=7.981; p=0.005), and people who did not have gastrointestinal symptoms had 2.34 times the odds of not presenting changes in bowel habits. None of the other investigated factors had shown to be a predictor of risk for post-cholecystectomy changes in bowel habits. CONCLUSION: 1) There was a high prevalence of changes in bowel habits, and 2) there was association between changes in bowel habits and the presence of gastrointestinal symptoms. RACIONAL: A incidência da colecistopatia calculosa é de aproximadamente 15% da população brasileira. Acredita-se que entre 30-40% dos pacientes colecistectomizados apresentem sintomas pós-operatório, sendo a alteração do hábito intestinal o mais comum. OBJETIVO: 1) Determinar a prevalência, e 2) identificar preditores de mudanças do hábito intestinal pós-colecistectomia videolaparoscópica. MÉTODOS: Estudo transversal retrospectivo com amostra inicial de 150 pacientes diagnosticados com colecistopatia calculosa, operados entre julho e setembro de 2014. Os pacientes foram submetidos a um questionário sobre a presença de sintomas gastrointestinais após a operação, e a alterações do aspecto das fezes antes e depois do procedimento. A amostra foi dividida em dois grupos (com ou sem mudanças do hábito intestinal) sendo realizadas associações com as seguintes variáveis: hipertensão arterial, IMC, hipotireoidismo, seguimento de dieta no pós-operatório, operação abdominal prévia e operação bariátrica. RESULTADOS: A prevalência de mudanças do hábito intestinal na população estudada foi de 35,1%. A associação entre elas e sintomas gastrointestinais demonstrou-se estatisticamente significativa (‰2=7,981; p=0,005), sendo que as pessoas que não apresentavam os sintomas tinham 2,34 vezes mais chances de não apresentarem mudanças do hábito intestinal. Nenhum dos demais fatores investigados demonstrou ser preditor de risco para mudanças do hábito intestinal pós-colecistectomia. CONCLUSÕES: 1) Observou-se alta prevalência de mudanças do hábito intestinal, e 2) houve associação entre mudança do hábito intestinal e a presença de sintomas gastrointestinais.
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de Menezes HL, Fireman PA, Wanderley VE, de Menconça AMMC, Bispo RKDA, Reis MR. Randomized study for assessment of hypolipidic diet in digestive symptoms immediately following laparoscopic cholecystectomy. Rev Col Bras Cir 2014; 40:203-7. [PMID: 23912367 DOI: 10.1590/s0100-69912013000300007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/16/2012] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To validate the need for prescribing low-fat diet in the prevention or reduction of dyspeptic symptoms in the postoperative period in patients undergoing laparoscopic cholecystectomy. METHODS We selected 40 patients, free of liver or pancreatic disease, biliary gallstones, gastritis, ulcer, diabetes and dyslipidemia, who were divided into two groups. We conducted dietary anamnesis, identification of dyspepsia before the onset of cholelithiasis and guidance on appropriate postoperatively feeding (normal or low-fat). We used the chi-square test and Pearson correlation for statistical assessment, considering p d" 0.05 as significant. RESULTS When comparing the two groups of patients without preoperative dyspepsia, it was observed that in group I seven patients (63.6%) were asymptomatic and in group II, four (66.7%). In group I, four (36.4%) had onset of symptoms and in group II, two (33.3%), p = 0.684. When correlating the two groups with preoperative dyspeptic symptoms, it was observed that there was permanence, appearance or disappearance of symptoms postoperatively, p = 0.114. CONCLUSION There was no significant effect of low-fat diet in the prevention of gastrointestinal symptoms, especially in preoperatively asymptomatic patients. Thus, there is no need of a low-fat diet. So, it is up to the surgeon to evaluate each patient individually and adjust the diet to his/her needs and clinical conditions.
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Daneze ER, Terra GA, Terra JA, Campos AGD, Silva AAD, Terra SA. Comparative study between ligature with thread or metallic clamping by means of laparoscopy with the purpose of experimental biliary obstruction in swines. Acta Cir Bras 2012; 26 Suppl 2:31-7. [PMID: 22030812 DOI: 10.1590/s0102-86502011000800007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To induce a total extra-hepatic obstructive jaundice in swines, by ligation of the common bile duct by laparoscopic surgery. METHODS Eight swines of the Landrace race, 36-day-old, originated from the same matrix, distributed in two groups. Group A: was used titanium metal clip to the common bile duct ligation in three animals; group B: were ligated with 2-0 cotton thread in five animals. RESULTS The ligation of the biliary ducts was performed successfully in all animals, with easy identification of the common bile duct by laparoscopy. There weren't difficulties in the procedures, mainly due to the increased surgical field provided by the excellent quality of light and image of the appliance. The clinical signs of jaundice were evident in the animals in seven days. In group A, two animals showed bile duct perforation near the clip, probably due to ischemic necrosis, progressing to peritonitis and death. In group B, five animals showed obstructive jaundice without any amendment. CONCLUSION Under the conditions of this study, we therefore recommend the use of unabsorbed wires to experimental biliary obstruction, in order to avoid complications, such as ischemia and necrosis, followed by perforation of the wall of the bile ducts.
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