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Lucocq J, Nassar AHM. The effects of previous abdominal surgery and the utilisation of modified access techniques on the operative difficulty and outcomes of laparoscopic cholecystectomy and bile duct exploration. Surg Endosc 2024:10.1007/s00464-024-10949-x. [PMID: 38951241 DOI: 10.1007/s00464-024-10949-x] [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: 02/28/2024] [Accepted: 05/20/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Early reports suggested that previous abdominal surgery was a relative contraindication to laparoscopic cholecystectomy (LC) on account of difficulty and potential access complications. This study analyses different types/systems of previous surgery and locations of scars and how they affect access difficulties. As modified access techniques to minimise risk of complications are under-reported the study details and evaluates them. METHOD Prospectively collected data from consecutive LC and common bile duct explorations (LCBDE) performed by a single surgeon over 30 years was analysed. Previous abdominal surgery was documented and peri-operative outcomes were compared with patients who had no previous surgery using Chi-squared analysis. RESULTS Of 5916 LC and LCBDE, 1846 patients (31.2%) had previous abdominal surgery. The median age was 60 years. Those with previous surgery required more frequent duodenal (RR 1.07; p = 0.023), hepatic flexure (RR 1.11; p = 0.043) and distal adhesiolysis (RR 3.57; p < 0.001) and had more access related bowel injuries (0.4% vs. 0.0%; p < 0.001). Previous upper gastrointestinal and biliary surgery had the highest rates of adhesiolysis (76.3%), difficult cystic pedicles (58.8%), fundus-first approach (7.2%), difficulty grades (64.9% Grades 3-5) and utilisation of abdominal drains (71.1%). Previous open surgery resulted in longer operative time compared to previous laparoscopic procedures (65vs.55 min; p < 0.001), increased difficulty of pedicle dissection (42.4% vs. 36.0%; p < 0.05) and required more duodenal, hepatic flexure and distant adhesiolysis (p < 0.05) and fundus-first dissection (4% vs 2%; p < 0.05). Epigastric and supraumbilical access and access through umbilical and other hernias were used in 163 patients (8.8%) with no bowel complications. CONCLUSION The risks of access and adhesiolysis in patients with previous abdominal scars undergoing biliary surgery are dependent on the nature of previous surgery. Previous open, upper gastrointestinal and biliary surgery carried the most significant risks. Modified access techniques can be adopted to safely mitigate these risks.
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Affiliation(s)
- James Lucocq
- Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Ahmad H M Nassar
- Laparoscopic Biliary Surgery Unit, University Hospital Monklands, Lanarkshire, Scotland.
- University of Glasgow, Glasgow, Scotland, UK.
- Golden Jubilee National Hospital, Glasgow, Scotland.
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2
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Ochoa-Ortiz LI, Cervantes-Pérez E, Ramírez-Ochoa S, Gonzalez-Ojeda A, Fuentes-Orozco C, Aguirre-Olmedo I, De la Cerda-Trujillo LF, Rodríguez-Navarro FM, Navarro-Muñiz E, Cervantes-Guevara G. Risk Factors and Prevalence Associated With Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Tertiary Care Hospital Experience in Western Mexico. Cureus 2023; 15:e45720. [PMID: 37868578 PMCID: PMC10590211 DOI: 10.7759/cureus.45720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) is a common procedure used for the treatment of different pathologies caused by gallstones in the gallbladder, and one of the most common indications is acute cholecystitis. The definitive treatment for acute cholecystitis is surgery, and LC is the gold standard. Nevertheless, transoperative complications (like intraoperative bleeding, anatomical abnormalities of the gallbladder, etc.) of LC and some other preoperative factors (like dilatation of bile duct, increased gallbladder wall thickness, etc.) can cause or be a risk factor for conversion to open cholecystectomy (OC). The objective of this study was to determine the risk factors and prevalence associated with the conversion from LC to OC in patients with gallbladder pathology and the indication for LC. Materials and methods This was a prospective cohort study. We included patients of both sexes over 18 years of age with gallbladder disease. To determine the risk factors associated with conversion, we performed a bivariate analysis and then a multivariate analysis. Results The rate of conversion to OC was 4.54%. The preoperative factors associated with conversion, in the bivariate analysis, were common bile duct dilatation (p=0.008), emergency surgery (p=0.014), and smoking (p=0.001); the associated intraoperative variables were: laparoscopic surgery duration (p <0.0001), Calot triangle edema (p=0.033), incapacity to hold the gallbladder with atraumatic laparoscopic tweezers (p=0.036), and choledocholithiasis (p=0.042). Laparoscopic Surgery duration was the only factor with a significant association in the multivariate analysis (p=0.0036); we performed a receiver operating characteristic (ROC) curve analysis and found a cut-off point of 120 minutes for the duration of laparoscopic surgery with a sensitivity and a specificity of 67 and 88%, respectively. Conclusion The prevalence of conversion from LC to OC is similar to that reported in the international literature. The risk factors associated with conversion to OC, in this study, should be confirmed in future clinical studies, in this same population, with a larger sample size.
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Affiliation(s)
- Lourdes I Ochoa-Ortiz
- Department of Surgery, Hospital Civil de Guadalajara Juan I. Menchaca, Guadalajara, MEX
| | - Enrique Cervantes-Pérez
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MEX
- Department of Clinics, Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Zuñiga, MEX
| | - Sol Ramírez-Ochoa
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MEX
| | - Alejandro Gonzalez-Ojeda
- Biomedical Research Unit 02, Specialties Hospital - Western National Medical Center, Mexican Institute of Social Security, Guadalajara, MEX
| | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Specialties Hospital - Western National Medical Center, Mexican Institute of Social Security, Guadalajara, MEX
| | - Itze Aguirre-Olmedo
- Department of Surgery, Hospital Civil de Guadalajara Juan I. Menchaca, Guadalajara, MEX
| | | | | | | | - Gabino Cervantes-Guevara
- Department of Welfare and Sustainable Development, Centro Universitario del Norte, Universidad de Guadalajara, Guadalajara, MEX
- Department of Gastroenterology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MEX
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3
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Alius C, Serban D, Bratu DG, Tribus LC, Vancea G, Stoica PL, Motofei I, Tudor C, Serboiu C, Costea DO, Serban B, Dascalu AM, Tanasescu C, Geavlete B, Cristea BM. When Critical View of Safety Fails: A Practical Perspective on Difficult Laparoscopic Cholecystectomy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1491. [PMID: 37629781 PMCID: PMC10456257 DOI: 10.3390/medicina59081491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a narrative review which discusses from a contextual point of view the need to standardise the surgical approach in difficult laparoscopic cholecystectomies, the main strategic operative concepts and techniques, complementary visualisation aids for the delineation of anatomical landmarks, and the importance of cognitive maps and algorithms in performing safer LC. Extensive research was carried out in the PubMed, Web of Science, and Elsevier databases using the terms "difficult cholecystectomy", "bile duct injuries", "safe cholecystectomy", and "laparoscopy in acute cholecystitis". The key content and findings of this research suggest there is high intersocietal variation in approaching and performing LC, in the use of visualisation aids, and in the application of safety concepts. Limited papers offer guidelines based on robust data and a timid recognition of the human factors and ergonomic concepts in improving the outcomes associated with difficult cholecystectomies. This paper highlights the most relevant recommendations for dealing with difficult laparoscopic cholecystectomies.
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Affiliation(s)
- Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dan Georgian Bratu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania; (D.G.B.)
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021Bucharest, Romania;
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Geta Vancea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Third Clinical Infectious Disease Department, Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes”, 030303 Bucharest, Romania
| | - Paul Lorin Stoica
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Ion Motofei
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania;
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
| | - Bogdan Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Ciprian Tanasescu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania; (D.G.B.)
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | - Bogdan Geavlete
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
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Muñoz Leija MA, Alemán-Jiménez MC, Plata-Álvarez H, Cárdenas-Salas VD, Valdez-López R. Laparoscopic Management of Cholecystoduodenal and Cholecystocolic Fistula: A Clinical Case Report. Cureus 2023; 15:e40657. [PMID: 37476135 PMCID: PMC10356180 DOI: 10.7759/cureus.40657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Biliary fistula is a rare (less than 8%) cholecystectomy complication, internal fistulae being the most common of them (mainly colonic and duodenal). However, the presence of two fistulas at the same time is extremely rare, with a small number of cases reported in the literature to date. Symptoms tend to be non-specific, leading to a difficult preoperative diagnosis. The standard treatment for bilioenteric fistulas is open cholecystectomy and subsequent closure of the fistula. Nonetheless, modern techniques including laparoscopic and endoscopic approaches have been reported lately for their treatment with favorable results. We present a case of concomitant cholecystoduodenal and cholecystocolic fistula successfully treated with subtotal cholecystectomy and primary closure of the fistulous tracts by laparoscopic approach in a female Hispanic patient.
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Affiliation(s)
- Milton Alberto Muñoz Leija
- General Surgery, Hospital General de Zona 6, Instituto Mexicano del Seguro Social, San Nicolas de los Garza, MEX
| | | | - Heliodoro Plata-Álvarez
- General Surgery, Hospital General de Zona 6, Instituto Mexicano del Seguro Social, San Nicolas de los Garza, MEX
| | - Victor Daniel Cárdenas-Salas
- General Surgery, Hospital General de Zona 6, Instituto Mexicano del Seguro Social, San Nicolas de los Garza, MEX
| | - Ramiro Valdez-López
- General Surgery, Hospital General de Zona 6, Instituto Mexicano del Seguro Social, San Nicolas de los Garza, MEX
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Magnano San Lio R, Barchitta M, Maugeri A, Quartarone S, Basile G, Agodi A. Preoperative Risk Factors for Conversion from Laparoscopic to Open Cholecystectomy: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:408. [PMID: 36612732 PMCID: PMC9819914 DOI: 10.3390/ijerph20010408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/08/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Laparoscopic cholecystectomy is a standard treatment for patients with gallstones in the gallbladder. However, multiple risk factors affect the probability of conversion from laparoscopic cholecystectomy to open surgery. A greater understanding of the preoperative factors related to conversion is crucial to improve patient safety. In the present systematic review, we summarized the current knowledge about the main factors associated with conversion. Next, we carried out several meta-analyses to evaluate the impact of independent clinical risk factors on conversion rate. Male gender (OR = 1.907; 95%CI = 1.254−2.901), age > 60 years (OR = 4.324; 95%CI = 3.396−5.506), acute cholecystitis (OR = 5.475; 95%CI = 2.959−10.130), diabetes (OR = 2.576; 95%CI = 1.687−3.934), hypertension (OR = 1.931; 95%CI = 1.018−3.662), heart diseases (OR = 2.947; 95%CI = 1.047−8.296), obesity (OR = 2.228; 95%CI = 1.162−4.271), and previous upper abdominal surgery (OR = 3.301; 95%CI = 1.965−5.543) increased the probability of conversion. Our analysis of clinical factors suggested the presence of different preoperative conditions, which are non-modifiable but could be useful for planning the surgical scenario and improving the post-operatory phase.
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Affiliation(s)
- Roberta Magnano San Lio
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy
| | - Serafino Quartarone
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy
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6
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Rangel-Olvera G, Alanis-Rivera B, Trejo-Suarez J, Garcia-Martin Del Campo JN, Beristain-Hernandez JL. Intraoperative complexity and risk factors associated with conversion to open surgery during laparoscopic cholecystectomy in eight hospitals in Mexico City. Surg Endosc 2022; 36:9321-9328. [PMID: 35414132 DOI: 10.1007/s00464-022-09206-w] [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: 09/02/2021] [Accepted: 03/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The conversion to open surgery (COS) during the Laparoscopic Cholecystectomy (LC) is reported to occur at a rate of 10-15%. Some preoperative risk factors (RF) have been postulated; however, few studies have evaluated these factors and the intraoperative complexity with the COS rate. The aim of the study was to evaluate the preoperative RF and intraoperative complexity using the Parkland grading scale (PGS) with the COS rate in LC. METHODS A retrospective study was done evaluating the demographic and surgical variables from the patients and LC videos from 8 different hospitals of Mexico City from December 2018 to January 2020. The evaluation of the PGS was done by 2 surgeons (one MI and one HPB surgeon); the PGS was also categorized as Non-Complex LC (nCLC, PGS1-2) and Complex LC (CLC, PGS 3-5). Logistic regression was used to evaluate the association of this factors with the COS rate. RESULTS 430 LC were analyzed; 358 (78.61%) were women, 261 (60.7%) were elective and 169(39.3%) urgent LC, the mean age was 44.06 (SD ± 13.16) years. 21 (4.8%) LC were COS; the mean age of this group was 55 (SD ± 12.95), 3 (0.7%) were nCLC and 18 (4.19%) CLC, mean PGS of 3.76 (SD ± 1.09), the mean time to COS was 48.67 (SD ± 41.9), the estimated blood loss (EBL) was 258 (SD ± 260.22) and 6 (1.4%) intraoperative BDI were recognized on this group. Univariate analysis showed a significant association with the COS with male sex, older age, age > 45 years, presence of comorbidities, a higher PGS, a CLC, higher EBL and possible BDI; multivariate analysis produced a model using male sex, age, presence of comorbidities and a CLC with a 0.809 area under the ROC curve. CONCLUSION The recognition of the associated RF and a CLC can guide the surgeon to establish preoperative and bailout strategies during the procedure, recognizing a higher risk of COS and its higher morbidity.
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Affiliation(s)
- Gabriel Rangel-Olvera
- Hospital General "Dr. Manuel Gea Gonzalez"/Hospital General Milpa Alta, Mexico City, Mexico.
| | - Bianca Alanis-Rivera
- Hospital de Especialidades Dr. Belisario Domínguez/Hospital General "Dr. Manuel Gea Gonzalez", Mexico City, Mexico
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7
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Video-based fully automatic assessment of open surgery suturing skills. Int J Comput Assist Radiol Surg 2022; 17:437-448. [PMID: 35103921 PMCID: PMC8805431 DOI: 10.1007/s11548-022-02559-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/03/2022] [Indexed: 01/09/2023]
Abstract
Purpose The goal of this study was to develop a new reliable open surgery suturing simulation system for training medical students in situations where resources are limited or in the domestic setup. Namely, we developed an algorithm for tools and hands localization as well as identifying the interactions between them based on simple webcam video data, calculating motion metrics for assessment of surgical skill. Methods Twenty-five participants performed multiple suturing tasks using our simulator. The YOLO network was modified to a multi-task network for the purpose of tool localization and tool–hand interaction detection. This was accomplished by splitting the YOLO detection heads so that they supported both tasks with minimal addition to computer run-time. Furthermore, based on the outcome of the system, motion metrics were calculated. These metrics included traditional metrics such as time and path length as well as new metrics assessing the technique participants use for holding the tools. Results The dual-task network performance was similar to that of two networks, while computational load was only slightly bigger than one network. In addition, the motion metrics showed significant differences between experts and novices. Conclusion While video capture is an essential part of minimal invasive surgery, it is not an integral component of open surgery. Thus, new algorithms, focusing on the unique challenges open surgery videos present, are required. In this study, a dual-task network was developed to solve both a localization task and a hand–tool interaction task. The dual network may be easily expanded to a multi-task network, which may be useful for images with multiple layers and for evaluating the interaction between these different layers. Supplementary Information The online version contains supplementary material available at 10.1007/s11548-022-02559-6.
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8
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Gadiyaram S, Nachiappan M. Laparoscopic 'D2 first' approach for obscure gallbladders. Ann Hepatobiliary Pancreat Surg 2021; 25:523-527. [PMID: 34845125 PMCID: PMC8639302 DOI: 10.14701/ahbps.2021.25.4.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/05/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic cholecystectomy has a reported incidence of 4%–15% of conversion to an open procedure and one of the main reasons behind the conversion is a gallbladder (GB) wrapped with dense adhesions. It is prudent to convert the procedure to an open operation in patients with particularly dense adhesions when the GB is not visible, preventing safe dissection which carries a potential risk of duodenal or colonic injury. The technique described, namely laparoscopic ‘D2 first’ approach, enables the completion of laparoscopic procedure in patients with ‘obscure’ GBs.
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Affiliation(s)
- Srikanth Gadiyaram
- Department of Surgical Gastroenterology and MIS, Sahasra Hospitals, Bangalore, India
| | - Murugappan Nachiappan
- Department of Surgical Gastroenterology and MIS, Sahasra Hospitals, Bangalore, India
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Abstract
The development of adhesions after gynecologic surgery is a severe problem with ramifications that go beyond the medical complications patients suffer (which most often include pain, obstruction and infertility), since they also impose a huge financial burden on the health care system and increase the workload of surgeons and all personnel involved in surgical follow-up care. Surgical techniques to avoid adhesion formation have not proven to be sufficient and pharmaceutical approaches for their prevention are even less effective, which means that the use of adhesion prevention devices is essential for achieving decent prophylaxis. This review explores the wide range of adhesion prevention products currently available on the market. Particular emphasis is put on prospective randomized controlled clinical trials that include second-look interventions, as these offer the most solid evidence of efficacy. We focused on adhesion scores, which are the most common way to quantify adhesion formation. This enables a direct comparison of the efficacies of different devices. While the greatest amount of data are available for oxidized regenerated cellulose, the outcomes with this adhesion barrier are mediocre and several studies have shown little efficacy. The best results have been achieved using adhesion barriers based on either modified starch, i.e., 4DryField® PH (PlantTec Medical GmbH, Lüneburg, Germany), or expanded polytetrafluoroethylene, i.e., GoreTex (W.L. Gore & Associates, Inc., Medical Products Division, Flagstaff, AZ), albeit the latter, as a non-resorbable barrier, has a huge disadvantage of having to be surgically removed again. Therefore, 4DryField® PH currently appears to be a promising approach and further studies are recommended.
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10
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Wijsman PJM, Voskens FJ, Molenaar L, van 't Hullenaar CDP, Consten ECJ, Draaisma WA, Broeders IAMJ. Efficiency in image-guided robotic and conventional camera steering: a prospective randomized controlled trial. Surg Endosc 2021; 36:2334-2340. [PMID: 33977377 DOI: 10.1007/s00464-021-08508-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Robotic camera steering systems have been developed to facilitate endoscopic surgery. In this study, a randomized controlled trial was conducted to compare conventional human camera control with the AutoLap™ robotic camera holder in terms of efficiency and user experience when performing routine laparoscopic procedures. Novelty of this system relates to the steering method, which is image based. METHODS Patients undergoing an elective laparoscopic hemicolectomy, sigmoid resection, fundoplication and cholecystectomy between September 2016 and January 2018 were included. Stratified block randomization was used for group allocation. The primary aim of this study was to compare the efficiency of robotic and human camera control, measured with surgical team size and total operating time. Secondary outcome parameters were number of cleaning moments of the laparoscope and the post-study system usability questionnaire. RESULTS A total of 100 patients were randomized to have robotic (50) versus human (50) camera control. Baseline characteristics did not differ significantly between groups. In the robotic group, 49/50 (98%) of procedures were carried out without human camera control, reducing the surgical team size from four to three individuals. The median total operative time (60.0 versus 53.0 min, robotic vs. control) was not significantly different, p = 0.122. The questionnaire showed a positive user satisfaction and easy control of the robotic camera holder. CONCLUSION Image-based robotic camera control can reduce surgical team size and does not result in significant difference in operative time compared to human camera control. Moreover, robotic image-guided camera control was associated with positive user experience.
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Affiliation(s)
- P J M Wijsman
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
- Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - F J Voskens
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
| | - L Molenaar
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
- Magnetic Detection & Imaging, University of Twente, Enschede, The Netherlands
| | | | - E C J Consten
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
| | - W A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - I A M J Broeders
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands.
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Ábrahám S, Németh T, Benkő R, Matuz M, Váczi D, Tóth I, Ottlakán A, Andrási L, Tajti J, Kovács V, Pieler J, Libor L, Paszt A, Simonka Z, Lázár G. Evaluation of the conversion rate as it relates to preoperative risk factors and surgeon experience: a retrospective study of 4013 patients undergoing elective laparoscopic cholecystectomy. BMC Surg 2021; 21:151. [PMID: 33743649 PMCID: PMC7981808 DOI: 10.1186/s12893-021-01152-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/11/2021] [Indexed: 01/11/2023] Open
Abstract
Background Our aim is to determine the relationships among patient demographics, patient history, surgical experience, and conversion rate (CR) during elective laparoscopic cholecystectomies (LCs). Methods We analyzed data from patients who underwent LC surgery between 2005 and 2014 based on patient charts and electronic documentation. CR (%) was evaluated in 4013 patients who underwent elective LC surgery. The relationships between certain predictive factors (patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), acute cholecystitis (AC), abdominal surgery in the patient history, as well as surgical experience) and CR were examined by univariate analysis and logistic regression. Results In our sample (N = 4013), the CR was 4.2%. The CR was twice as frequent among males than among females (6.8 vs. 3.2%, p < 0.001), and the chance of conversion increased from 3.4 to 5.9% in patients older than 65 years. The detected CR was 8.8% in a group of patients who underwent previous ERCP (8.8 vs. 3.5%, p < 0.001). From the ERCP indications, most often, conversion was performed because of severe biliary tract obstruction (CR: 9.3%). LC had to be converted to open surgery after upper and lower abdominal surgeries in 18.8 and 4.8% cases, respectively. Both AC and ERCP in the patient history raised the CR (12.3%, p < 0.001 and 8.8%, p < 0.001). More surgical experience and high surgery volume were not associated with a lower CR prevalence. Conclusions Patient demographics (male gender and age > 65 years), previous ERCP, and upper abdominal surgery or history of AC affected the likelihood of conversion. More surgical experience and high surgery volume were not associated with a lower CR prevalence.
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Affiliation(s)
- Szabolcs Ábrahám
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary.
| | - Tibor Németh
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Dániel Váczi
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Illés Tóth
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Aurél Ottlakán
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - László Andrási
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - János Tajti
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Viktor Kovács
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - József Pieler
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - László Libor
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Attila Paszt
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - Zsolt Simonka
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
| | - György Lázár
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Center, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary
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Fluorescent cholangiography significantly improves patient outcomes for laparoscopic cholecystectomy. Surg Endosc 2020; 35:5729-5739. [PMID: 33052527 DOI: 10.1007/s00464-020-08045-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the most common elective abdominal surgery in the USA, with over 750,000 performed annually. Fluorescent cholangiography (FC) using indocyanine green dye (ICG) permits identification of extrahepatic biliary structures to facilitate dissection without requiring cystic duct cannulation. Achieving the "critical view of safety" with assistance of ICG cholangiogram may support identification of anatomy, safely reduce conversion to open procedures, and decrease operative time. We assess the utility of FC with respect to anatomic visualization during LC and its effects on patient outcomes. METHODS A retrospective review of a prospectively maintained database identified patients undergoing laparoscopic cholecystectomy at a single academic center from 2013 to 2019. Exclusion criteria were primary open and single incision cholecystectomy. Patient factors included age, sex, BMI, and Charlson Comorbidity Index. Outcomes included operative time, conversion to open procedure, length of stay (LOS), mortality rate, and 30-day complications. A multivariable logistic regression was performed to determine independent predictors for open conversion. RESULTS A total of 1389 patients underwent laparoscopic cholecystectomy. 69.8% were female; mean age 48.6 years (range 15-94), average BMI 29.4 kg/m2 (13.3-55.6). 989 patients (71.2%) underwent LC without fluorescence and 400 (28.8%) underwent FC with ICG. 30-day mortality detected 2 cases in the non-ICG group and zero with ICG. ICG reduced operative time by 26.47 min per case (p < 0.0001). For patients with BMI ≥ 30 kg/m2, operative duration for ICG vs non-ICG groups was 75.57 vs 104.9 min respectively (p < 0.0001). ICG required conversion to open at a rate of 1.5%, while non-ICG converted at a rate of 8.5% (p < 0.0001). Conversion rate remained significant with multivariable analysis (OR 0.212, p = 0.001). A total of 19 cases were aborted (1.35%), 8 in the ICG group (1.96%) and 11 in the non-ICG group (1.10%), these cases were not included in LC totals. Average LOS was 0.69 vs 1.54 days in the ICG compared to non-ICG LCs (p < 0.0001), respectively. Injuries were more common in the non-ICG group, with 9 patients sustaining Strasberg class A injuries in the non-ICG group and 2 in the ICG group. 1 CBDI occurred in the non-ICG group. There was no significant difference in 30-day complication rates between groups. CONCLUSION ICG cholangiography is a non-invasive adjunct to laparoscopic cholecystectomy, leading to improved patient outcomes with respect to operative times, decreased conversion to open procedures, and shorter length of hospitalization. Fluorescence cholangiography improves visualization of biliary anatomy, thereby decreasing rate of CBDI, Strasberg A injuries, and mortality. These findings support ICG as standard of care during laparoscopic cholecystectomy.
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Thapar P, Salvi P, Killedar M, Roji P, Rokade M. Utility of Tokyo guidelines and intraoperative safety steps in improving the outcome of laparoscopic cholecystectomy in complex acute calculus cholecystitis: a prospective study. Surg Endosc 2020; 35:4231-4240. [PMID: 32875415 DOI: 10.1007/s00464-020-07905-w] [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: 05/25/2020] [Accepted: 08/17/2020] [Indexed: 12/07/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) in complicated acute calculus cholecystitis (ACC) poses multiple challenges. This prospective, observational study assessed the utility and safety of a set protocol and intraoperative steps in LC for complex ACC. METHODS All cases of ACC from 2008 to 2018 were graded as per Tokyo guidelines; moderate and severe ACC were termed as 'complex ACC (CACC).' Patients were subjected to upfront LC or percutaneous drainage (PCD) followed by LC. Seven intraoperative safety steps were used to achieve critical view of safety (CVS). Use of safety steps, duration of surgery, and length of hospital stay were compared between moderate and severe ACC; complications were classified using Clavien-Dindo classification. RESULTS We analyzed 145 patients with moderate (74.5%) and severe (25.5%) ACC. There were significantly more male (p = 0.0059) and older (p = 0.0006) patients with severe ACC. Upfront LC was performed in 81.4%; PCD required in 6.9%. Timing of LC from symptom onset was < 1 week (53.1%), 2-5 weeks (28.3%), and ≥ 6 weeks (18.6%). CVS was achieved in 97.2%, subtotal cholecystectomy performed in 2.8%, conversion rate was 1.4%, major postoperative complications (Clavien-Dindo Grade IIIa and IIIb) were seen in 4.1%, no bile duct injury, and mortality was 0.7%. The outcomes were similar irrespective of timing of intervention. CONCLUSION The study concludes that preoperative assessment by Tokyo guidelines, algorithmic plan of treatment and use of intraoperative safety steps results in favorable outcome of LC in ACC.
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Affiliation(s)
- Pinky Thapar
- Department of Minimal Invasive Surgery, Jupiter Hospital, Off Eastern Express Highway, Thane, Maharashtra, 400 601, India.
| | - Prashant Salvi
- Department of Minimal Invasive Surgery, Jupiter Hospital, Off Eastern Express Highway, Thane, Maharashtra, 400 601, India
| | - Madhura Killedar
- Department of Minimal Invasive Surgery, Jupiter Hospital, Off Eastern Express Highway, Thane, Maharashtra, 400 601, India
| | - Philip Roji
- Department of Minimal Invasive Surgery, Jupiter Hospital, Off Eastern Express Highway, Thane, Maharashtra, 400 601, India
| | - Muktachand Rokade
- Department of Radiology, Jupiter Hospital, Off Eastern Express Highway, Thane, Maharashtra, 400 601, India
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Conversions to open surgery greatly increase complications: an analysis of the MBSAQIP database. Surg Obes Relat Dis 2020; 16:634-643. [DOI: 10.1016/j.soard.2020.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/26/2019] [Accepted: 01/25/2020] [Indexed: 11/24/2022]
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15
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Strategies for management of acute cholecystitis in octogenarians. Eur Surg 2020. [DOI: 10.1007/s10353-020-00629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Massoumi RL, Sakai-Bizmark R, Tom CM, Howell E, Childers CP, Jen HC, Lee SL. Differences in Outcomes Based on Sex for Pediatric Patients Undergoing Pyloromyotomy. J Surg Res 2019; 245:207-211. [PMID: 31421364 DOI: 10.1016/j.jss.2019.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/14/2019] [Accepted: 07/16/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Males and females are known to have varied responses to medical interventions. Our study aimed to determine the effect of sex on surgical outcomes after pyloromyotomy. MATERIALS AND METHODS Using the Kids' Inpatient Database for the years 2003-2012, we performed a serial, cross-sectional analysis of a nationally representative sample of all patients aged <1 y who underwent pyloromyotomy for hypertrophic pyloric stenosis. The primary predictor of interest was sex. Outcomes included mortality, in-hospital complications, cost, and length of stay. Regression models were adjusted by race, age group, comorbidity, complications, and whether operation was performed on the day of admission with region and year fixed effects. RESULTS Of 48,834 weighted operations, 81.8% were in males and 18.2% were in females. The most common reported race was white (47.3%) and most of the patients were ≥29 days old (72.5%). There was no difference in the odds of postoperative complications, but females had a significantly longer length of stay (incidence rate ratio, 1.28; 95% confidence interval [95% CI], 1.18-1.39; P ≤ 0.01), higher cost (5%, 95% CI, 1.02-1.08; P ≤ 0.01), and higher odds of mortality (odds ratio, 3.26; 95% CI, 1.52-6.98; P ≤ 0.01). CONCLUSIONS Our study demonstrated that females had worse outcomes after pyloromyotomy compared with males. These findings are striking and are important to consider when treating either sex to help set physician and family expectations perioperatively. Further studies are needed to determine why such differences exist and to develop targeted treatment strategies for both females and males with pyloric stenosis.
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Affiliation(s)
- Roxanne L Massoumi
- Department of General Surgery, University Of California - Los Angeles, Los Angeles, California
| | - Rie Sakai-Bizmark
- Los Angeles Biomedical Research Institute, Torrance, California; Department of Pediatrics, Harbor-UCLA, Torrance, California
| | - Cynthia M Tom
- Department of General Surgery, Harbor-UCLA, Torrance, California
| | - Erin Howell
- Department of General Surgery, Harbor-UCLA, Torrance, California
| | - Christopher P Childers
- Department of General Surgery, University Of California - Los Angeles, Los Angeles, California
| | - Howard C Jen
- Department of General Surgery, University Of California - Los Angeles, Los Angeles, California; Department of Pediatric Surgery, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Steven L Lee
- Department of General Surgery, University Of California - Los Angeles, Los Angeles, California; Department of Pediatric Surgery, UCLA Mattel Children's Hospital, Los Angeles, California.
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Amreek F, Hussain SZM, Mnagi MH, Rizwan A. Retrospective Analysis of Complications Associated with Laparoscopic Cholecystectomy for Symptomatic Gallstones. Cureus 2019; 11:e5152. [PMID: 31523579 PMCID: PMC6741379 DOI: 10.7759/cureus.5152] [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] [Indexed: 11/25/2022] Open
Abstract
Introduction Gallstones are the major cause of global morbidity. Laparoscopic approach has well-established advantages as compared to the conventional open procedure. It promises better recovery, lower morbidity, and lower postoperative pain, shortens the duration of hospital stay, and has a lower mortality rate. The aim of this study is to assess the frequency of complications in laparoscopic cholecystectomies indicated for symptomatic gallstones and also evaluate the rate of conversion. Methods In this retrospective analysis, all records of laparoscopic cholecystectomy, in patients of age ≥18 years, for symptomatic gallstones, from January 2015 till December 2018 in one of the largest public tertiary care hospitals in Pakistan were included. Results The rate of complications associated with laparoscopic cholecystectomy was 6.8%. Older age, obesity, and multiple pre-operative risk factors were associated with complications. The most common intra-operative complication was hemorrhage (1.3%) and most common postoperative complication was surgical site infection (2.7%). Our conversion rate was 3.6%. Both intra-operative and postoperative complications were more common in procedures which were converted to open. Conclusion The rate of complication and conversion to open in laparoscopic cholecystectomy is not very high. Older age, obesity, and multi-morbidity was associated with complications. Complicated procedures were more commonly needed to be converted to open.
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Affiliation(s)
- Fnu Amreek
- General Surgery, New York University Langone Medical Center, New York, USA
| | | | - Munawar H Mnagi
- General Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, PAK
| | - Amber Rizwan
- Family Medicine, Dr. Ruth Pfau Hospital, Karachi, PAK
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18
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Gregory GC, Kuzman M, Sivaraj J, Navarro AP, Cameron IC, Irving G, Gomez D. C-reactive Protein is an Independent Predictor of Difficult Emergency Cholecystectomy. Cureus 2019; 11:e4573. [PMID: 31281756 PMCID: PMC6605972 DOI: 10.7759/cureus.4573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The objective of this study was to identify variables that predict a difficult laparoscopic cholecystectomy performed in an emergency setting. The secondary aim was to devise a pathway for patients admitted acutely that required a cholecystectomy. Methods Patients admitted to the Emergency General Surgery Department at Nottingham, the United Kingdom that had an emergency cholecystectomy performed during the one-year period from May 2016 to June 2017 were identified. Collected data included patient demographics, clinical presentation, biochemical analysis, radiological findings, subsequent interventions, surgical data, and clinical outcome. A difficult cholecystectomy was defined as operative time >60 minutes, conversion to an open procedure, or sub-total cholecystectomy performed. Results A total of 149 patients were included. Cholecystitis was the most common diagnosis (n = 86, 57.7%), followed by acute pancreatitis (n = 36, 24.1%). Fifty-five (36.9%) patients had an elevated C-reactive protein (CRP) >100 mg/dL. One hundred and twenty-one (81.2%) patients who had an emergency cholecystectomy were defined as “difficult”. The overall morbidity rate was 15.4% (n = 23), and there was no post-operative in-hospital mortality. Univariate analysis showed that age >60 years (p = 0.012), underlying diagnosis (p = 0.010), presence of heart rate >90 (p = 0.027), and an elevated pre-surgery CRP >100 (p < 0.001) was associated with a difficult emergency cholecystectomy. Multi-variate analysis demonstrated that an elevated pre-surgery CRP >100 was an independent predictor of a difficult emergency cholecystectomy (p = 0.041). Conclusions An elevated pre-operative CRP is an independent predictor of a technically more difficult cholecystectomy in the emergency setting.
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Affiliation(s)
- Gordon C Gregory
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Matta Kuzman
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Jayaram Sivaraj
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Alex P Navarro
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Iain C Cameron
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Glen Irving
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Dhanwant Gomez
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
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Laparoscopic Repair for Perforated Peptic Ulcer Disease Has Better Outcomes Than Open Repair. J Gastrointest Surg 2019; 23:618-625. [PMID: 30465190 DOI: 10.1007/s11605-018-4047-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Over the last 3 decades, laparoscopic procedures have emerged as the standard treatment for many elective and emergency surgical conditions. Despite the increased use of laparoscopic surgery, the role of laparoscopic repair for perforated peptic ulcer remains controversial among general surgeons. The aim of this study was to compare the outcomes of laparoscopic versus open repair for perforated peptic ulcer. METHODS A systemic literature review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted using MEDLINE, EMBASE, PubMed and Cochrane Database of all randomised controlled trials (RCT) that compared laparoscopic (LR) with open repair (OR) for perforated peptic ulcer (PPU). Data was extracted using a standardised form and subsequently analysed. RESULTS The meta-analysis using data from 7 RCT showed that LR for PPU has decreased overall post-operative morbidity (LR = 8.9% vs. OR = 17.0%) (OR = 0.54, 95% CI 0.37 to 0.79, p < 0.01), wound infections, (LR = 2.2% vs. OR = 6.3%) (OR = 0.3, 95% CI 0.16 to 0.5, p < 0.01) and shorter duration of hospital stay (6.6 days vs. 8.2 days, p = 0.01). There were no significant differences in length of operation, leakage rate, incidence of intra-abdominal abscess, post-operative sepsis, respiratory complications, re-operation rate or mortality. There was no publication bias and the quality of the studies ranged from poor to good. CONCLUSION These results demonstrate that laparoscopic repair for perforated peptic ulcer has a reduced morbidity and total hospital stay compared with open approach. There are no significant differences in mortality, post-operative sepsis, abscess and re-operation rates. LR should be the preferred treatment option for patients with perforated peptic ulcer disease.
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Lyu YX, Cheng YX, Jin HF, Jin X, Cheng B, Lu D. Same-admission versus delayed cholecystectomy for mild acute biliary pancreatitis: a systematic review and meta-analysis. BMC Surg 2018; 18:111. [PMID: 30486807 PMCID: PMC6263067 DOI: 10.1186/s12893-018-0445-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/08/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The timing of laparoscopic cholecystectomy (LC) performed after the mild acute biliary pancreatitis (MABP) is still controversial. We conducted a review to compare same-admission laparoscopic cholecystectomy (SA-LC) and delayed laparoscopic cholecystectomy (DLC) after mild acute biliary pancreatitis (MABP). METHODS We systematically searched several databases (PubMed, EMBASE, Web of Science, and the Cochrane Library) for relevant trials published from 1 January 1992 to 1 June 2018. Human prospective or retrospective studies that compared SA-LC and DLC after MABP were included. The measured outcomes were the rate of conversion to open cholecystectomy (COC), rate of postoperative complications, rate of biliary-related complications, operative time (OT), and length of stay (LOS). The meta-analysis was performed using Review Manager 5.3 software (The Cochrane Collaboration, Oxford, United Kingdom). RESULTS This meta-analysis involved 1833 patients from 4 randomized controlled trials and 7 retrospective studies. No significant differences were found in the rate of COC (risk ratio [RR] = 1.24; 95% confidence interval [CI], 0.78-1.97; p = 0.36), rate of postoperative complications (RR = 1.06; 95% CI, 0.67-1.69; p = 0.80), rate of biliary-related complications (RR = 1.28; 95% CI, 0.42-3.86; p = 0.66), or OT (RR = 1.57; 95% CI, - 1.58-4.72; p = 0.33) between the SA-LC and DLC groups. The LOS was significantly longer in the DLC group (RR = - 2.08; 95% CI, - 3.17 to - 0.99; p = 0.0002). Unexpectedly, the subgroup analysis showed no significant difference in LOS according to the Atlanta classification (RR = - 0.40; 95% CI, - 0.80-0.01; p = 0.05). The gallstone-related complications during the waiting time in the DLC group included gall colic, recurrent pancreatitis, acute cholecystitis, jaundice, and acute cholangitis (total, 25.39%). CONCLUSION This study confirms the safety of SA-LC, which could shorten the LOS. However, the study findings have a number of important implications for future practice.
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Affiliation(s)
- Yun-Xiao Lyu
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
| | - Yun-Xiao Cheng
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
| | - Hang-Fei Jin
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
| | - Xin Jin
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
| | - Bin Cheng
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
| | - Dian Lu
- Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China
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Quah GS, Eslick GD, Cox MR. Laparoscopic versus open surgery for adhesional small bowel obstruction: a systematic review and meta-analysis of case-control studies. Surg Endosc 2018; 33:3209-3217. [PMID: 30460502 DOI: 10.1007/s00464-018-6604-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Small bowel obstruction (SBO) due to adhesions is a common acute surgical presentation. Laparoscopic adhesiolysis is being performed more frequently. However, the clear benefits of laparoscopic adhesiolysis (LA) compared with traditional open adhesiolysis (OA) remain uncertain. The aim of this study was to compare the outcomes of LA versus OA for SBO due to adhesions. METHODS A systemic literature review was conducted using PRISMA guidelines. A search was conducted using MEDLINE, EMBASE, PubMed and Cochrane Databases of all randomised controlled trials (RCT) and case-controlled studies (CCS) that compared LA with OA for SBO. Data were extracted using a standardised form and subsequently analysed. RESULTS There were no RCT. Data from 18 CCS on 38,927 patients (LA = 5,729 and OA = 33,389) were analysed. A meta-analysis showed that LA for SBO has decreased overall mortality (LA = 1.6% vs. OA = 4.9%, p < 0.001) and morbidity (LA = 11.2% vs. OA = 30.9%, p < 0.001). Similarly, the incidences of specific complications are significantly lower in the LA group. There are significantly lower reoperation rate (LA = 4.5% vs. OA = 6.5%, p = 0.017), shorter average operating time (LA = 89 min vs. OA = 104 min, p < 0.001) and a shorter length of stay (LOS) (LA = 6.7 days vs. OA = 11.6 days, p < 0.001) in the LA group. In the CCS, there is likely to be a selection bias favouring less complex adhesions in the LA group that may contribute to the better outcomes in this group. CONCLUSIONS Although there is a probable selection bias, these results suggest that LA for SBO in selected patients has a reduced mortality, morbidity, reoperation rate, average operating time and LOS compared with OA. LA should be considered in appropriately selected patients with acute SBO due to adhesions.
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Affiliation(s)
- Gaik S Quah
- Discipline of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
| | - Guy D Eslick
- Discipline of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
| | - Michael R Cox
- Discipline of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia. .,Discipline of Surgery, The University of Sydney Nepean Hospital, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia.
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Al Masri S, Shaib Y, Edelbi M, Tamim H, Jamali F, Batley N, Faraj W, Hallal A. Predicting Conversion from Laparoscopic to Open Cholecystectomy: A Single Institution Retrospective Study. World J Surg 2018; 42:2373-2382. [PMID: 29417247 DOI: 10.1007/s00268-018-4513-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the standard surgical treatment for benign gallbladder disease. Nevertheless, conversion to open cholecystectomy (OC) is needed in some cases. The aim of this study is to calculate our institutional conversion rate and to identify the variables that are implicated in increasing the risk of conversion (LC-OC). MATERIALS AND METHODS We carried out a retrospective study of all cases of LC performed at the American University of Beirut Medical Center between 2000 and 2015. Each (LC-OC) case was randomly matched to a laparoscopically completed case by the same consultant within the same year of practice, as the LC-OC case, in a 1:5 ratio. Forty-eight parameters were compared between the two study groups. RESULTS Forty-eight out of 4668 LC were converted to OC over the 15-year study period; the conversion rate in our study was 1.03%. The variables that were found to be most predictive of conversion were male gender, advanced age, prior history of laparotomy, especially in the setting of prior gunshot wound, a history of restrictive or constrictive lung disease and anemia (Hb < 9 g/dl). The most common intraoperative reasons for conversion were perceived difficult anatomy or obscured view secondary to severe adhesions or significant inflammation. Patients who were in the LC-OC arm had a longer length of hospital stay. CONCLUSION Advance age, male gender, significant comorbidities and history of prior laparotomies have a high risk of conversion. Patients with these risk factors should be counseled for the possibility of conversion to open surgery preoperatively. Further research is needed to determine whether these high risks patients should be operated on by surgeons with more extensive experience in minimal invasive surgery.
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Affiliation(s)
- Samer Al Masri
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yaser Shaib
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mostapha Edelbi
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Faek Jamali
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nicholas Batley
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Walid Faraj
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Hepatobiliary and Pancreatic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Hallal
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Tan ECH, Yang MC, Chen CC. Effects of laparoscopic surgery on survival, quality of care and utilization in patients with colon cancer: a population-based study. Curr Med Res Opin 2018; 34:1663-1671. [PMID: 29863425 DOI: 10.1080/03007995.2018.1484713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Laparoscopy is a safe and effective treatment for colon cancer. However, its effects on short- and long-term health outcomes and medical utilization are not fully elucidated. This study aimed to compare short- and long-term utilization and health outcomes of colon cancer patients who underwent either laparoscopic or open surgery in a population-based cohort. METHODS This study was conducted by linking data from Taiwan Cancer Registry, National Health Insurance claims and Death Registry. Patients aged 18 and older with colon cancer between 2009 and 2012 were included in the study. Propensity score matching was used to minimize selection bias between laparoscopic and open surgery groups. Cox proportional hazard regression and generalized linear mixed logistic regression were used to test hypotheses. RESULTS Among the 11,269 colon cancer patients who underwent colectomy, 3236 (28.72%) received laparoscopy and 8033 (71.28%) underwent open surgery. Patients who received laparoscopic surgery had better overall survival (HR = 0.82; 95% CI: 0.70-0.97). These patients also had lower 30 day mortality (0.44% vs. 0.91%), lower 1 year mortality (2.83% vs. 4.68%), lower overall occurrence of complications (6.16% vs. 8.77%), shorter mean length of stay (12.53 vs. 14.93 days) and lower cost for index hospitalization (US$4325.34 vs. US$4453.90). No significant differences were observed in medical utilization over a period of 365 days after the surgery. CONCLUSIONS Our results demonstrate that, in both the short- and long-term post-operation periods, laparoscopic surgery reduced the likelihood of postoperative complications, 30 day, and 1 year mortality while being no more expensive than open surgery for colon cancer.
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Affiliation(s)
- Elise Chia-Hui Tan
- a Division of Clinical Chinese Medicine , National Research Institute of Chinese Medicine , Ministry of Health and Welfare , Taipei , Taiwan
- b Institute of Health Policy and Management , College of Public Health , National Taiwan University , Taipei , Taiwan
| | - Ming-Chin Yang
- b Institute of Health Policy and Management , College of Public Health , National Taiwan University , Taipei , Taiwan
| | - Chien-Chih Chen
- c Department of Surgery , Koo Foundation, Sun Yat-Sen Cancer Center , Taipei , Taiwan
- d College of Medicine , National Yang-Ming University , Taipei , Taiwan
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Mangieri CW, Hendren BP, Strode MA, Bandera BC, Faler BJ. Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era. Surg Endosc 2018; 33:724-730. [PMID: 30006843 DOI: 10.1007/s00464-018-6333-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the most commonly performed laparoscopic procedure. It is superior in nearly every regard compared to open cholecystectomies. The one significant aspect where the laparoscopic approach is inferior regards the association with bile duct injuries (BDI). The BDI rate with laparoscopic cholecystectomy is approximately 0.5%; nearly triple the rate compared to the open approach. We propose that 0.5% BDI rate with the laparoscopic approach is no longer accurate. METHODS The National Surgical Quality Improvement Program (NSQIP) registry was retrospectively reviewed. All laparoscopic cholecystectomies performed between 2012 and 2016 were extracted. A total of 217,774 cases meeting inclusion criteria were analyzed. The primary data points were the overall BDI incidence rate and time of diagnosis. BDI were identified by ICD-9 and ICD-10 codes. Secondary data points were variables associated with BDI. RESULTS The BDI rate was 0.19%. 77% of cases were diagnosed after the index surgical admission. Intra-operative cholangiography (IOC) use was associated with a higher BDI rate and higher identification rate of a BDI intraoperatively (P value < 0.0001). Resident teaching cases were protective with a RR score of 0.56 (P value < 0.0001). The presence of cholecystitis increased the risk of a BDI with a RR score of 1.20 (P value < 0.0001). There was a low conversion rate of 0.04% however converted cases had a nearly hundredfold increase in BDI at 15% (P value < 0.0001). CONCLUSIONS The performance of laparoscopic cholecystectomies in North America is no longer associated with higher BDI rates compared to open. IOC use still is not protective against BDI, and cholecystitis continues to be a risk factor for BDI. When a cholecystectomy requires conversion from a laparoscopic to an open approach the BDI increases a hundredfold; which may raise the concern if this approach is still a safe bailout method for a difficult laparoscopic dissection.
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Affiliation(s)
- Christopher W Mangieri
- Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA. .,General Surgery Department, Dwight D. Eisenhower Army Medical Center (DDEAMC), 300 East Hospital Road, Fort Gordon, GA, 30905, USA.
| | - Bryan P Hendren
- Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA
| | - Matthew A Strode
- Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA.,Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Bradley C Bandera
- Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA
| | - Byron J Faler
- Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA
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Ekici U, Yılmaz S, Tatlı F. Comparative Analysis of Laparoscopic Cholecystectomy Performed in the Elderly and Younger Patients: Should We Abstain from Laparoscopic Cholecystectomy in the Elderly? Cureus 2018; 10:e2888. [PMID: 30159214 PMCID: PMC6110625 DOI: 10.7759/cureus.2888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The elderly population is gradually increasing due to an increase in the quality of life and therefore the frequency of gallbladder stones in the population is also increasing. However, a considerable number of physicians tend to postpone or solve the problem with medical treatment instead of performing surgery in the elderly patients. In this study, we aim to compare the outcomes of laparoscopic cholecystectomy (LC) in the elderly and younger patients. MATERIAL AND METHODS The medical records of 665 patients undergoing LC were evaluated retrospectively. The patients were divided into two groups: ≥60 years of age and <60 years of age. Ages, genders, comorbid diseases, indications of surgery, American Society of Anesthesiologists scores, whether it is converted to an open cholecystectomy or not, reasons for conversion if it is converted, total duration of surgery, initiation of oral nutrition, duration of discharge, and postoperative complications of the patients in both groups were recorded. RESULTS The American Society of Anesthesiologists scores were statistically significantly higher in ≥60 years age group (p<0.001). The rate of experiencing acute cholecystitis with a stone in the gallbladder was significantly higher in the 60 years group (p=0.025). Comorbidity was statistically significantly higher in the ≥60 years age group (p<0.001). Hospitalization period, the mean hour of initiation of oral nutrition were statistically significantly higher in the ≥60 years age group (p<0.001, p=0.001). Conversion to an open cholecystectomy and postoperative complication rates of the ≥60 years age group were statistically significantly higher (p=0.034, p<0.001). CONCLUSION We think that LC can be safely performed in the elderly people as well. However, it should be kept in mind that comorbidity may make the surgery and postoperative follow-up period complicated.
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Affiliation(s)
- Ugur Ekici
- Health Science and Administratioon, İstanbul Gelisim University, İstanbul, TUR
| | - Serhan Yılmaz
- General Surgery, Bakirkoy Sadi Konuk Education and Research Hospital, İstanbul, TUR
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Izquierdo Y, Díaz Díaz N, Muñoz N, Guzmán O, Contreras Bustos I, Gutiérrez J. Preoperative factors associated with technical difficulties of laparoscopic cholecystectomy in acute cholecystitis. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Yang DJ, Lu HM, Guo Q, Lu S, Zhang L, Hu WM. Timing of Laparoscopic Cholecystectomy After Mild Biliary Pancreatitis: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2017; 28:379-388. [PMID: 29271689 DOI: 10.1089/lap.2017.0527] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the safety of cholecystectomy in early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC). METHODS We systematically searched PubMed, EMBASE, and Cochrane Library for studies that were published from January 1992 to March 2017. We included studies on patients with mild biliary pancreatitis and that reported the timing of cholecystectomy and the number of complications, readmissions, and conversion to open cholecystectomy. Moreover, we assessed the quality and bias risks of the included studies. RESULTS After screening 4651 studies, we included 3 randomized clinical trials and 10 retrospective studies. The included studies described 2291 patients, of whom 1141 (49.8%) underwent ELC and 1150 (50.2%) underwent DLC. The reported rate of complications for ELC (6.8%) was lower than that for DLC (13.45%). The reported rate of readmission for ELC was lower than that for DLC. The length of hospital stay was longer with DLC than with ELC. ELC and DLC did not have significantly different rates of conversion to open cholecystectomy and duration of surgery. CONCLUSION This meta-analysis provides evidence that ELC is better than DLC in many aspects for acute mild pancreatitis patients undergoing laparoscopic cholecystectomy. ELC associated with few complications and readmissions, as well as a short length of hospital stay.
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Affiliation(s)
- Du-Jiang Yang
- 1 Department of Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Hui-Min Lu
- 1 Department of Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Qiang Guo
- 2 Department of Vascular Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Shan Lu
- 1 Department of Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Ling Zhang
- 1 Department of Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Wei-Ming Hu
- 1 Department of Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, China
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Izquierdo YE, Díaz Díaz NE, Muñoz N, Guzmán OE, Contreras Bustos I, Gutiérrez JS. Preoperative factors associated with technical difficulties of laparoscopic cholecystectomy in acute cholecystitis. RADIOLOGIA 2017; 60:57-63. [PMID: 29173873 DOI: 10.1016/j.rx.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To identify preoperative factors associated with surgical time and conversion of the laparoscopic cholecystectomy (LC) to open surgery in subjects with acute cholecystitis (AC). METHOD We developed a cross-sectional study that included 99 subjects older than 17 years with definitive diagnosis of AC who had undergone to LC. Preoperative variables such as clinical data, laboratory markers and ultrasound findings as wall thickness, the size of the major calculus and the presence of: perivesicular fluid, multiple cholelithiasis, biliary mud or microlithiasis were registered. We consider indirect measures of technical difficulties of LC the total surgical time and the need for conversion to open surgery. We used the square chi and Mann-Whitney U test to stablish the correlation between preoperative variables and the technical difficulties of LC. We build ROC curves of the variables with significant statistical association (p ≤0.05 and 95% confidence interval [95%CI]) to determine the cut-off points of better sensitivity and specificity to predict conversion of LC to open surgery. RESULTS A gallbladder wall thickness ≥6mm detected by ultrasound has a sensitivity of 87.5% and a specificity of 62.6% with OR 11.71 (95%CI: 1.38-99; p = 0.008) for predict conversion to open surgery. There was no relationship between surgical time and the preoperative evaluated variables. CONCLUSION The gallbladder wall thickness detected by the ultrasound is associated with the need of conversion of LC to open surgery in subjects with AC, furthermore this finding could warn the surgeon on the complexity with a particular patient.
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Affiliation(s)
- Y E Izquierdo
- Facultad de Medicina, Universidad Nacional de Colombia, Bogotá D.C, Colombia.
| | - N E Díaz Díaz
- Servicio de Radiología, ESE Hospital El Tunal nivel III, Bogotá D.C, Colombia
| | - N Muñoz
- Servicio de Cirugía, ESE Hospital El Tunal nivel III, Bogotá D.C, Colombia
| | - O E Guzmán
- Facultad de Medicina, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - I Contreras Bustos
- Facultad de Medicina, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - J S Gutiérrez
- Facultad de Medicina, Universidad Nacional de Colombia, Bogotá D.C, Colombia
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Aksoy F, Demiral G, Ekinci Ö. Can the timing of laparoscopic cholecystectomy after biliary pancreatitis change the conversion rate to open surgery? Asian J Surg 2017; 41:307-312. [PMID: 28284749 DOI: 10.1016/j.asjsur.2017.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/17/2017] [Accepted: 02/02/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Biliary pancreatitis (BP) constitutes 30-55% of all cases of acute pancreatitis. Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease. We aimed to compare and evaluate the relation between the timing of LC and the rates and reasons of conversion to open surgery (OS) after BP. METHODS Data were collected of patients who presented for the first time with acute BP and underwent LC. The patients were divided into two groups: early cholecystectomy (Group 1), patients who underwent cholecystectomy during the first pancreatitis attack upon admission and before discharge from hospital (1-3 days); and late cholecystectomy (Group 2), patients who received medical treatment during their first pancreatitis episode and underwent surgery after 4-10 weeks. Sex, Ranson scores, American Society of Anesthesiology scores, and conversion reasons were compared. RESULTS Group 1 and Group 2 included 75 patients (20 men, 55 women) and 87 patients (25 men, 62 women), respectively. The mean age was 44.7 years (range, 21-82 years). Obscure anatomy with adhesions was detected in 16 patients (5 in Group 1, 11 in Group 2) as the leading cause of conversion to OS, but it was not statistically significant (p=0.054). Acute inflammation with empyema and peripancreatic liquid collection was observed in 14 patients (12 in Group 1, 2 in Group 2), and conversion to OS was statistically significantly higher in Group 1 (p=0.016). CONCLUSION Timing of LC does not influence the conversion rates to OS after BP.
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Affiliation(s)
- Fikret Aksoy
- General Surgery Department, Istanbul Oncology Hospital, Istanbul, Turkey
| | - Gökhan Demiral
- General Surgery Department, Recep Tayyip Erdogan University Educational and Research Hospital, Rize, Turkey.
| | - Özgür Ekinci
- General Surgery Department, Goztepe Education and Research Hospital, Medeniyet University, Istanbul, Turkey
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Beksac K, Turhan N, Karaagaoglu E, Abbasoglu O. Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery: A New Predictive Statistical Model. J Laparoendosc Adv Surg Tech A 2016; 26:693-6. [PMID: 27385483 DOI: 10.1089/lap.2016.0008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Although laparoscopic cholecystectomy is currently the standard treatment for benign gallbladder pathologies, some cases still require conversion to open cholecystectomy. Since open cholecystectomy has a significantly higher morbidity rate and a lengthier stay in the hospital compared with laparoscopic surgery, predicting this conversion would grant a great advantage in the management of cholecystitis. Therefore, in this study, we aimed to develop a predictive statistical model. MATERIALS AND METHODS Between August 2006 and January 2011, 1335 laparoscopic cholecystectomies were initiated at the General Surgery Department of Hacettepe University. One hundred four of these cases were started as laparoscopic surgeries, but converted to open cholecystectomies. In our study, we randomly chose 104 laparoscopically completed cases and compared them with the 104 converted cases. We used 31 parameters, including demographics, ultrasonographic findings, and laboratory values, to compare groups. These parameters were later included in a logistic regression analysis to create a statistical model that predicts conversion to open cholecystectomy. RESULTS Among the 1335 laparoscopically started cases, 104 (7.7%) were converted to open surgery. In our study, we found age, gender, ultrasonographic findings of acute cholecystitis, history of choledocolithiasis, history of abdominal surgery, and alkaline phosphatase (ALP) levels to be significant risk factors. By using a receiver operating characteristic curve, we found that the risk significantly increases after 55 years of age and an ALP over 80 IU/L. DISCUSSION Using four parameters-age, gender, history of abdominal surgery, and ALP-in our statistical model, we were able to predict the conversion from laparoscopic to open cholecystectomy with 70% sensitivity and 79% specificity.
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Affiliation(s)
- Kemal Beksac
- 1 Department of General Surgery, Hacettepe University , Ankara, Turkey
| | - Nihan Turhan
- 1 Department of General Surgery, Hacettepe University , Ankara, Turkey
| | - Ergun Karaagaoglu
- 2 Department of Biostatistics, Hacettepe University , Ankara, Turkey
| | - Osman Abbasoglu
- 1 Department of General Surgery, Hacettepe University , Ankara, Turkey
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Kulen F, Tihan D, Duman U, Bayam E, Zaim G. Laparoscopic partial cholecystectomy: A safe and effective alternative surgical technique in "difficult cholecystectomies". ULUSAL CERRAHI DERGISI 2016; 32:185-90. [PMID: 27528821 DOI: 10.5152/ucd.2015.3086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/16/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Laparoscopic cholecystectomy has become the "gold standard" for benign gallbladder diseases due to its advantages. In the presence of inflammation or fibrosis, the risk of bleeding and bile duct injury is increased during dissection. Laparoscopic partial cholecystectomy (LPC) is a feasible and safe method to prevent bile duct injuries and decrease the conversion (to open cholecystectomy) rates in difficult cholecystectomies where anatomical structures could not be demonstrated clearly. MATERIAL AND METHODS The feasibility, efficiency, and safety of LPC were investigated. The data of 80 patients with cholelithiasis who underwent LPC (n=40) and conversion cholecystectomy (CC) (n=40) were retrospectively examined. Demographic characteristics, ASA scores, operating time, drain usage, requirement for intensive care, postoperative length of hospital stay, surgical site infection, antibiotic requirement and complication rates were compared. RESULTS The median ASA value was 1 in the CC group and 2 in the LPC group. Mean operation time was 123 minutes in the CC group, and 87.50 minutes in the LPC group. Surgical drains were used in 16 CC patients and 4 LPC patients. There was no significant difference between groups in postoperative length of intensive care unit stay (p=0.241). When surgical site infections were compared, the difference was at the limit of statistical significance (p=0.055). Early complication rates were not different (p=0.608) but none of the patients in the LPC group suffered from late complications. CONCLUSION LPC is an efficient and safe way to decrease the conversion rate. LPC seems to be an alternative procedure to CC with advantages of shorter operating time, lower rates of surgical site infection, shorter postoperative hospitalization and fewer complications in high-risk patients.
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Affiliation(s)
- Fatih Kulen
- Clinic of General Surgery, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Deniz Tihan
- Clinic of General Surgery, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Uğur Duman
- Clinic of General Surgery, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Emrah Bayam
- Clinic of General Surgery, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Gökhan Zaim
- Clinic of General Surgery, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
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Aziz H, Pandit V, Joseph B, Jie T, Ong E. Age and Obesity are Independent Predictors of Bile Duct Injuries in Patients Undergoing Laparoscopic Cholecystectomy. World J Surg 2016; 39:1804-8. [PMID: 25663013 DOI: 10.1007/s00268-015-3010-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Iatrogenic bile duct injury is a serious complication of cholecystectomy. The aim of this study was to assess predictors of bile duct injury using a national database. METHODS The Nationwide Inpatient Sample (2010-2012) was queried for laparoscopic cholecystectomy. We used a) diagnoses for bile duct injury and b) bile duct injury repair procedure codes as a surrogate marker for bile duct injuries. RESULTS A total of 1,015 patients had bile duct injury. The mean age was 58.2 ± 19.7 years, 53.5 % were males, and median Charlson co-morbidity score was 2 [2, 3]. Multivariate analysis revealed morbid obesity [2.8 (2.1-4.3); p = 0.03] and age >65 [1.5 (1.05-2.1); p = 0.01] as the independent predictors for bile duct injury in patients undergoing cholecystectomy. CONCLUSION Our study finds a new association between obesity, aging, and bile duct injuries which has never been reported in literature before.
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Affiliation(s)
- Hassan Aziz
- Division of HepatoPancreaticoBiliary Surgery, University of Arizona, Tucson, AZ, USA,
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Admission after the gold interval in acute calculous cholecystitis: Should we really cool it off? Eur J Trauma Emerg Surg 2016; 43:73-77. [PMID: 26742919 DOI: 10.1007/s00068-015-0617-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to compare early and delayed cholecystectomy for the treatment of acute calculous cholecystitis (ACC). MATERIALS AND METHODS The medical records of patients who were diagnosed to have ACC by combined clinical and radiological examination were evaluated retrospectively. The patients were divided into two non-randomized groups according to the duration between the onset of symptoms and cholecystectomy. Group 1 included the patients who underwent cholecystectomy within the first 72 h after the onset of symptoms and Group 2 those who underwent beyond the 72nd hour after the onset of symptoms. RESULTS We reviewed records for 203 patients. There were 109 patients in Group 1 and 74 patients in Group 2. Access-related complications occurred in four patients. One patient in Group 1 and two patients in Group 2 had trocar site bleeding. In one patient in Group 1, liver trauma occurred. Two patients had bile duct injury in Group 1 as Type D injury according to the Strasberg classification in one patient and E2 injury in other. CONCLUSION Early cholecystectomy in acute cholecystitis with biliary stones could be performed regardless of time with similar complication, mortality and conversion rates.
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Conde LM, Tavares PM, Quintes JLD, Chermont RQ, Perez MCA. Laparoscopic management of cholecystocolic fistula. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:285-7. [PMID: 25626940 PMCID: PMC4743223 DOI: 10.1590/s0102-67202014000400013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/25/2014] [Indexed: 11/22/2022]
Abstract
Introduction Cholecystocolic fistula is a rare complication of gallbladder disease. Its
clinical presentation is variable and nonspecific, and the diagnosis is made,
mostly, incidentally during intraoperative maneuver. Cholecystectomy with closure
of the fistula is considered the treatment of choice for the condition, with an
increasingly reproducible tendency to the use of laparoscopy. Aim To describe the laparoscopic approach for cholecystocolic fistula and ratify its
feasibility even with the unavailability of more specific instruments. Technique After dissection of the communication and section of the gallbladder fundus, the
fistula is externalized by an appropriate trocar and sutured manually. Colonic
segment is reintroduced into the cavity and cholecystectomy is performed avoiding
the conversion procedure to open surgery. Conclusion Laparoscopy for resolution of cholecystocolic fistula isn't only feasible, but
also offers a shorter stay at hospital and a milder postoperative period when
compared to laparotomy.
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Suo G, Xu A. Clipless minilaparoscopic cholecystectomy: a study of 1,096 cases. J Laparoendosc Adv Surg Tech A 2013; 23:849-54. [PMID: 23980592 DOI: 10.1089/lap.2012.0561] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Low conversion rate, high safety, and good cosmetic result with less medical cost are chased by all laparoscopic surgeons. We used general laparoscopic instruments and combined with absorbable thread trying to perform a clipless minilaparoscopic cholecystectomy for benign gallbladder patients and got all the above-mentioned results. SUBJECTS AND METHODS From January 2008 to February 2011, 1096 minilaparoscopic cholecystectomies were performed for patients with uncomplicated or complicated benign gallbladder disease by our treatment team. The three-port technique with the help of an electrocautery hook, forceps, and suction was applied for laparoscopy cholecystectomy, and the cystic duct and vessels were ligated by absorbable thread rather than hemostasis clips and Harmonic(®) scalpels (Ethicon, Cincinnati, OH). The operative time, blood loss, subhepatic drain, conversion rate, drainage time, and hospital stay were reviewed and statistically analyzed. RESULTS Our conversion rate was 0.18%, which was much lower than those reported by many studies. The mean operating time was 28 minutes (range, 11-70 minutes). Mean blood loss was 12 mL (range, 5-200 mL). A subhepatic drain was placed in 63 patients, with a mean drainage time of 1.7 days (range, 1-6 days). The mean postoperative hospital stay was 2.5 days (range, 2-7 days). No postoperative bleeding, biliary leakage, intraabdominal infection, umbilical site infection, umbilical incision herniation, biliary duct or bowel injury, or mortality occurred. CONCLUSIONS Minilaparoscopic cholecystectomy using absorbable thread instead of clips and Harmonic scalpels offers a safe, effective, and economical surgical alternative for benign gallbladder patients.
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Affiliation(s)
- Guangjun Suo
- Department of Digestive Surgery, East Hospital, Tongji University School of Medicine , Shanghai, People's Republic of China
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Cwik G, Skoczylas T, Wyroślak-Najs J, Wallner G. The value of percutaneous ultrasound in predicting conversion from laparoscopic to open cholecystectomy due to acute cholecystitis. Surg Endosc 2013; 27:2561-8. [PMID: 23371022 PMCID: PMC3679415 DOI: 10.1007/s00464-013-2787-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 01/07/2013] [Indexed: 11/30/2022]
Abstract
Background Laparoscopic cholecystectomy has become the treatment of choice for gallstone disease. Advantages of the laparoscopic approach include lower morbidity and mortality rates, reduced length of hospital stay, and earlier return to work. In acute cholecystitis, severe inflammation makes laparoscopic dissection technically more demanding, with a higher risk of related complications that require conversion to open cholecystectomy. Methods We reviewed the records of 5,596 patients who underwent cholecystectomy between 1993 and 2011 in a single institution. A laparoscopic approach was undertaken in 4,105 patients (73.4 %). The ultrasound signs of acute cholecystitis were found in 542 patients (13.2 %) who underwent laparoscopic cholecystectomy. We analyzed the ultrasound presentations of acute cholecystitis in patients who required conversion to open cholecystectomy and compared them with the ultrasound signs of acute cholecystitis in patients who had a completed laparoscopic cholecystectomy. Results A conversion to open cholecystectomy in patients with acute cholecystitis was necessary in 24 % (n = 130) of the patients compared to 3.4 % of the patients with uncomplicated gallstone disease. The most frequent ultrasound findings in patients requiring conversion were a pericholecystic exudate in 42 %, a difficult identification of anatomical structures due to local severe inflammation in 34 %, and gallbladder wall thickening of >5 mm in 31 %. Additionally, when the duration of symptoms exceeded 3 days, more than half of the patients required conversion to open cholecystectomy and the conversion rate was fivefold higher than for those with a shorter duration of acute cholecystitis. Conclusions In patients with severe acute cholecystitis found on ultrasound, combined with gallbladder wall thickening to >5 mm, pericholecystic exudates or abscess adjacent to the gallbladder, difficulty identifying anatomical structures within Calot’s triangle, specifically when the duration of symptoms exceeds 3 days, cholecystectomy should be done as an open approach because of the high risk of conversion.
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Affiliation(s)
- Grzegorz Cwik
- Second Department of General & Gastrointestinal Surgery & Surgical Oncology of the Alimentary Tract, Medical University of Lublin, 20-081 Lublin, ul. Staszica 16, Poland.
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