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Panni RZ, Chatterjee D, Panni UY, Robbins KJ, Liu J, Strasberg SM. Sequential histologic evolution of gallbladder inflammation in acute cholecystitis over the first 10 days after onset of symptoms. J Hepatobiliary Pancreat Sci 2023; 30:724-736. [PMID: 36399043 DOI: 10.1002/jhbp.1274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/25/2022] [Accepted: 10/17/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The timing of cholecystectomy during acute cholecystitis (AC) is controversial, especially whether it is advisable to perform in patients with duration of symptoms between 3 and 10 days. The purpose of this study is to define clearly the sequential evolution of histological changes following symptoms onset to guide recommendations regarding timing of cholecystectomy. METHODS We identified patients with AC (2005-2018) who had cholecystectomy within 10 days of symptom onset of a first attack of AC. Histologic features of gallbladder injury including cellular and exudative inflammatory response to injury were determined on blinded pathologic slides. RESULTS One hundred and forty-nine patients were divided into three groups; early-who underwent cholecystectomy 1-3 days after symptom-onset, intermediate-4-6 days, and late-7-10 days. Key features of injury were necrosis and hemorrhage. A subgroup of patients in the early phase developed severe necrosis and hemorrhage of an extent associated with difficult cholecystectomy. Large spikes in extent of necrosis and hemorrhage occurred at 7-10 days. Major inflammatory responses to injury were eosinophilic and lymphocytic infiltration and early fibrosis. CONCLUSIONS Severe necrosis may develop rapidly and be present in the early period after symptom onset of AC. Cholecystectomy may be reasonable in some patients but by day 7-10, severe necrosis and hemorrhage may be expected to be present in most patients.
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Affiliation(s)
- Roheena Z Panni
- Section of Hepato-biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine, St. Louis, Missouri, USA
| | - Deyali Chatterjee
- Department of Pathology and Immunology, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine, St. Louis, Missouri, USA
| | - Usman Y Panni
- Section of Hepato-biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keenan J Robbins
- Section of Hepato-biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jingxia Liu
- Division of Public Health Sciences, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine, St. Louis, Missouri, USA
| | - Steven M Strasberg
- Section of Hepato-biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine, St. Louis, Missouri, USA
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Schuster KM, O'Connor R, Cripps M, Kuhlenschmidt K, Taveras L, Kaafarani HM, El Hechi M, Puri R, Mull J, Schroeppel TJ, Rodriquez J, Cullinane DC, Cullinane LM, Enniss TM, Sensenig R, Zilberman B, Crandall M. Multicenter validation of the American Association for the Surgery of Trauma grading scale for acute cholecystitis. J Trauma Acute Care Surg 2021; 90:87-96. [PMID: 33332782 DOI: 10.1097/ta.0000000000002901] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The American Association for the Surgery of Trauma (AAST) patient assessment committee has created grading systems for emergency general surgery diseases to assist with clinical decision making and risk adjustment during research. Single-institution studies have validated the cholecystitis grading system as associated with patient outcomes. Our aim was to validate the grading system in a multi-institutional fashion and compare it with the Parkland grade and Tokyo Guidelines for acute cholecystitis. METHODS Patients presenting with acute cholecystitis to 1 of 8 institutions were enrolled. Discrete data to assign the AAST grade were collected. The Parkland grade was collected prospectively from the operative surgeon from four institutions. Parkland grade, Tokyo Guidelines, AAST grade, and the AAST preoperative grade (clinical and imaging subscales) were compared using linear and logistic regression to the need for surgical "bailout" (subtotal or fenestrated cholecystectomy, or cholecystostomy), conversion to open, surgical complications (bile leak, surgical site infection, bile duct injury), all complications, and operative time. RESULTS Of 861 patients, 781 underwent cholecystectomy. Mean (SD) age was 51.1 (18.6), and 62.7% were female. There were six deaths. Median AAST grade was 2 (interquartile range [IQR], 1-2), and median Parkland grade was 3 (interquartile range [IQR], 2-4). Median AAST clinical and imaging grades were 2 (IQR, 2-2) and 1 (IQR, 0-1), respectively. Higher grades were associated with longer operative times, and worse outcomes although few were significant. The Parkland grade outperformed the AAST grade based on area under the receiver operating characteristic curve. CONCLUSION The AAST cholecystitis grading schema has modest discriminatory power similar to the Tokyo Guidelines, but generally lower than the Parkland grade, and should be modified before widespread use. LEVEL OF EVIDENCE Diagnostic study, level IV.
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Affiliation(s)
- Kevin M Schuster
- From the Department of Surgery (K.M.S., R.O.), Yale School of Medicine, New Haven, CT; Department of Surgery (M. Cripps, K.K., L.T.), University of Texas Southwestern School of Medicine, Dallas, TX; Department of Surgery (H.M.K., M.E.), Massachusetts General Hospital, Boston, MA; Department of Surgery (R.P., M. Crandall, J.M.), College of Medicine - Jacksonville, University of Florida, Jacksonville, FL; Department of Surgery (T.J.S., J.R.), UC Health, Colorado Springs, CO; Department of Surgery (D.C.C., L.M.C.), Marshfield Clinic, Marshfield, WI; Department of Surgery (T.M.E.), School of Medicine, University of Utah, Salt Lake City, UT; and Department of Surgery (R.S., B.Z.), Cooper Medical School of Rowan University, Camden, NJ
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Fujiwara K, Masatsugu T, Abe A, Hirano T, Sada M. Preoperative diagnoses and identification rates of unexpected gallbladder cancer. PLoS One 2020; 15:e0239178. [PMID: 32946469 PMCID: PMC7500683 DOI: 10.1371/journal.pone.0239178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022] Open
Abstract
Background Unexpected gallbladder cancer (UGBC) is sometimes found in the resected gallbladder of patients during or after surgery. Some reports have indicated UGBC identification rates for all gallbladder surgeries, but scarce data are available for the UGBC identification rates for specific gallbladder diseases. The present study was performed to clarify UGBC rates and the factors suspicious for UGBC categorized according to preoperative diagnoses, in patients undergoing laparoscopic cholecystectomy (LSC). Methods We recorded data for all LSC surgeries performed in the Department of Surgery, Sada Hospital, Japan since 1991, and analyzed the 28-year data. We used the chi-square test and Kaplan–Meier analysis for this retrospective case–control study. Results The UGBC identification rate was 0.69% (63/9186 patients). The UGBC identification rates categorized according to the preoperative diagnoses were 1.3% (13/969) for acute cholecystitis, 2.4% (16/655) for benign tumor, 2.0% (28/1383) for chronic cholecystitis or cholecystitis, and 0.054% (3/5585) for cholecystolithiasis. The percentage of older patients (≥ 60 years) was significantly higher in UGBCs compared with cases finally diagnosed as benign in each group categorized according to the preoperative diagnoses (p≤0.0014), except for cholecystolithiasis. In cases pre-diagnosed as benign tumor, UGBCs were associated with higher rates of thickened gallbladder wall compared with benign tumor (69.2% vs. 27.9%, respectively; p = 0.0011). UGBCs pre-diagnosed as acute cholecystitis had higher T2–T4 rates (100% vs. 64.3%, respectively; p<0.05) and lower survival rates (p = 0.0149) than UGBCs pre-diagnosed with chronic cholecystitis. Conclusions UGBC identification rates depend on the preoperative diagnosis and range from 0.054% to 2.4%. Older age (≥ 60 years) could be related to UGBC, and a pre-diagnosis of acute cholecystitis might indicate more advanced cancer compared with a pre-diagnosis of chronic cholecystitis.
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Affiliation(s)
- Kenji Fujiwara
- Department of Surgery, Sada Hospital, Fukuoka, Japan
- * E-mail:
| | | | - Atsushi Abe
- Department of Surgery, Sada Hospital, Fukuoka, Japan
| | | | - Masayuki Sada
- Department of Surgery, Sada Hospital, Fukuoka, Japan
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Łącka M, Obłój P, Spychalski P, Łaski D, Rostkowska O, Wieszczy P, Kobiela J. Clinical presentation and outcomes of cholecystectomy for acute cholecystitis in patients with diabetes - A matched pair analysis. A pilot study. Adv Med Sci 2020; 65:409-414. [PMID: 32823170 DOI: 10.1016/j.advms.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/06/2020] [Accepted: 08/06/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The primary aim of this study is to compare the clinical course and laboratory parameters of acute cholecystitis in patients with diabetes vs. patients without diabetes. MATERIALS AND METHODS The study involved patients who underwent emergency cholecystectomy in the Department of General, Endocrine and Transplant Surgery of University Clinical Center in Gdansk (Poland) between 2007 and 2017. There were 267 patients included in the study. The control group of 197 patients was age and sex matched at a 3:1 ratio. The following was compared between the groups: symptoms at admission, course of surgery, postoperative course, length of hospitalization, total costs of hospitalization and antibiotic therapy, other than routine perioperative prophylaxis. RESULTS There was no significant difference between the patients with and without diabetes regarding symptoms at admission. Operative and postoperative complication rates were significantly higher in the patients with diabetes. The operative time and length of hospitalization were significantly longer in the study group. The conversion rate was not higher in the study group, but classic surgery was performed significantly more often. The patients without diabetes had less pronounced symptoms with more locally advanced disease. CONCLUSIONS Our study demonstrates that patients with diabetes have a significantly more eventful course of acute cholecystitis than patients without diabetes. Patients with diabetes should therefore be qualified for cholecystectomy early in the course of acute cholecystitis.
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Affiliation(s)
- Monika Łącka
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland.
| | - Paweł Obłój
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland
| | - Piotr Spychalski
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland
| | - Dariusz Łaski
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland
| | - Olga Rostkowska
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland
| | - Paulina Wieszczy
- Central Coordination Center for Cervical Cancer Screening Program, Department of Cancer Prevention, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Jarek Kobiela
- Department of General, Endocrine and Transplant Surgery, University Clinical Center, Gdansk, Poland
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Kabir T, Ngaserin S, Koh FH, Huang J, Ong BC, Chew MH. The COVID-19 conundrum: SARS-CoV-2 is not present in bile. Br J Surg 2020; 107:e381. [PMID: 32779750 PMCID: PMC7404877 DOI: 10.1002/bjs.11820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022]
Affiliation(s)
- T Kabir
- Division of Surgery, Sengkang General Hospital, Singapore
| | - S Ngaserin
- Division of Surgery, Sengkang General Hospital, Singapore
| | - F H Koh
- Division of Surgery, Sengkang General Hospital, Singapore
| | - J Huang
- Department of Pathology, Sengkang General Hospital, Singapore
| | - B C Ong
- Department of Anaesthesiology, Chairman Medical Board, Sengkang General Hospital, Singapore
| | - M H Chew
- Division of Surgery, Sengkang General Hospital, Singapore
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Hirohata R, Abe T, Amano H, Hanada K, Kobayashi T, Ohdan H, Noriyuki T, Nakahara M. Identification of risk factors for open conversion from laparoscopic cholecystectomy for acute cholecystitis based on computed tomography findings. Surg Today 2020; 50:1657-1663. [PMID: 32627066 DOI: 10.1007/s00595-020-02069-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Laparoscopic cholecystectomy (LC) is performed widely for acute cholecystitis (AC). This study was conducted to identify the predictors for conversion cholecystectomy (CC) for AC. METHODS The subjects of this study were 395 patients who underwent emergency surgery for AC between 2011 and 2019. Univariate and multivariate analyses were performed to establish the significance of the risk factors for CC in patients with grades II and III AC. RESULTS There were 162 TG18 GII and GIII patients in the LC group and 31 in the CC group. Univariate analysis revealed significant differences in performance status (p = 0.039), C-reactive protein levels (p = 0.016), albumin levels (p = 0.002), gallbladder (GB) wall thickness (p = 0.045), poor contrast of the GB wall (p = 0.035), severe inflammation around the GB (p < 0.001), enhancement of the liver bed (p = 0.048), and duodenal edema (p < 0.001) between the groups. Multivariate analysis identified hypoalbuminemia (p = 0.043) and duodenal edema (p = 0.014) as independent risk factors for CC. CONCLUSIONS Most patients with grade I AC underwent LC and had better surgical outcomes than those with grades II and III AC. The most appropriate surgical procedure should be selected based on preoperative imaging of the GB and the neighboring organs and by the presence of hypoalbuminemia.
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Affiliation(s)
- Ryosuke Hirohata
- Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, Japan.
| | - Hironobu Amano
- Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, Japan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, Hiroshima, Japan
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, Hiroshima, Japan
| | - Toshio Noriyuki
- Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, Japan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, Hiroshima, Japan
| | - Masahiro Nakahara
- Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, Japan
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Mu P, Yue P, Li T, Bai B, Lin Y, Zhang J, Wang H, Liu Y, Yao J, Meng W, Li X. Comparison of endoscopic naso-gallbladder drainage and percutaneous transhepatic gallbladder drainage in acute suppurative cholecystitis: Study Protocol Clinical Trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19116. [PMID: 32080085 PMCID: PMC7034714 DOI: 10.1097/md.0000000000019116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Transitional drainage, which is followed by cholecystectomy plays a key role in the management of acute cholecystitis, especially in high-risk surgical patients. Endoscopic naso-gallbladder drainage (ENGBD) is an alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for patients who need temporary drainage. There is a lack of prospective comparison on the relevant outcomes of the two drainage methods during the period of drainage, especially the subsequent cholecystectomy. METHODS This is a randomized controlled two-arm non-blind single center trial. Patients with acute cholecystitis undergo emergent or early cholecystectomy and need drainage will be randomly assigned to group PTGBD or ENGBD. Pain score is defined as the primary endpoint, whereas several secondary endpoints, such as the rates of technical success, clinical remission, open conversion of cholecystectomy will be determined to elucidate more detailed differences between two groups. The general feasibility, safety, and quality checks required for high-quality evidence will be adhered to. DISCUSSION This study would provide the first type A evidence concerning the comparison of ENGBD versus PTGBD in surgically high-risk patients with acute cholecystitis, it will be the first trial designed to determine the impact of two drainage methods on not only peri-drainage but also peri-LC. TRIAL REGISTRATION NCT03701464. Registered on October 10, 2018.
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Affiliation(s)
- Peilei Mu
- The First Clinical Medical School of Lanzhou University
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Ping Yue
- The First Clinical Medical School of Lanzhou University
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Tianya Li
- The First Clinical Medical School of Lanzhou University
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Bing Bai
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Yanyan Lin
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Jinduo Zhang
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
| | - Haiping Wang
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation
| | - Ying Liu
- Foreign Languages Department of Lanzhou University
| | - Jia Yao
- Clinical Research and Project Management Office, The First Hospital of Lanzhou University
| | - Wenbo Meng
- The First Clinical Medical School of Lanzhou University
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation
| | - Xun Li
- The First Clinical Medical School of Lanzhou University
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
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Abstract
Schistosomal cholecystitis is remarkably uncommon disease which is associated with concomitant gallstone disease. The disease prevails with low socio-economic conditions of population. It is still not clear that the widespread fibrocalcific reaction in the wall of gallbladder and the cystic duct, observed for all the reports, predisposes to cholelithiasis or gallstones coexist. In the present study, we report a case of the Saudi male patient affected with schistosomal granulomatous lithiasic cholecystitis. The patient’s gallbladder was badly inflamed therefore performing a safe cholecystectomy in the patient was extremely difficult. Also, infection with schistosoma is related with chronic granulomatous inflammation making the cholecystectomy procedure difficult and risky, therefore, we mainly focused on preventing the injury of bile duct by being prepared that the patient will present a complicated case. This was achieved by using the technique of laparoscopy to safely excise the gall bladder.
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Affiliation(s)
- Shaker A Majrashi
- Department of General Surgery, East Jeddah Hospital, Ministry of Health, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Kwok A, Chern TY, Winn R. Acute cholecystitis and gallbladder perforation leading to massive haemoperitoneum in a patient taking rivaroxaban. BMJ Case Rep 2018; 2018:bcr-2018-226870. [PMID: 30373899 PMCID: PMC6214373 DOI: 10.1136/bcr-2018-226870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2018] [Indexed: 11/03/2022] Open
Abstract
We present the case of an 80-year old man taking rivaroxaban for atrial fibrillation who sustained massive intra-abdominal bleeding in the setting of acute cholecystitis. CT scan on admission revealed evidence of active bleeding into the gallbladder lumen and gallbladder perforation. Immediate resuscitation was commenced with intravenous fluids, antibiotics and blood products. Despite attempts to correct coagulopathy, the patient's haemodynamic status deteriorated and an emergency laparotomy was performed, with open cholecystectomy, washout and haemostasis. The patient had a largely uneventful recovery and was discharged on day 11 of admission. Patients with coagulopathies, whether pharmacological or due to underlying disease processes, are at very high risk of severe haemorrhagic complications and subsequent morbidity. As such, prompt recognition and operative management of haemorrhagic perforated cholecystitis is of crucial importance.
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Affiliation(s)
- Allan Kwok
- Department of Surgery, Wollongong Hospital, South Coast Mail Centre, New South Wales, Australia
| | | | - Robert Winn
- Department of Surgery, Wollongong Hospital, South Coast Mail Centre, New South Wales, Australia
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10
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Fasting MH, Young VS, Glomsaker T. [Necrotic gall bladder]. Tidsskr Nor Laegeforen 2018; 138:17-1003. [PMID: 29737778 DOI: 10.4045/tidsskr.17.1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Bohm AM, Westen M, Bisgaard T. [The surgical window for performing laparoscopic cholecystectomy may be extended to seven days after acute cholecystitis]. Ugeskr Laeger 2018; 180:V11170827. [PMID: 30348252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In Denmark, based on weak evidence from 2002, a surgical window of maximum four days after debut of symptoms has up till now been recommended. Based on 12 randomised controlled studies (RCTs) we conclude, that the surgical window may be extended to seven days. The main advantage is a significant reduction of total hospital stay and apparently without compromising safety. Unfortunately, evidence is based on mostly statistically underpowered RCTs of low or moderate methodological quality, and final conclusions on surgical results are still not possible.
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Lee W, Song DH, Lee JK, Park JH, Kim JY, Kwag SJ, Park T, Jeong SH, Ju YT, Jung EJ, Lee YJ, Hong SC, Choi SK, Jeong CY. Unsuspected Duplicated Gallbladder in a Patient Presenting with Acute Cholecystitis. J Korean Med Sci 2017; 32:552-555. [PMID: 28145662 PMCID: PMC5290118 DOI: 10.3346/jkms.2017.32.3.552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/07/2016] [Indexed: 11/24/2022] Open
Abstract
Duplicated gallbladder (GB) is a rare congenital disease. Surgical management of a duplicated GB needs special care because of concurrent bile duct anomalies and the risk of injuring adjacent arteries during surgery. An 80-year-old man visited an emergency room with right upper quadrant abdominal pain. Computed tomography (CT) revealed cholecystitis with a 2-bodied GB. Because of this unusual finding, magnetic resonance choledochopancreatography was performed to detect possible biliary anomalies. The 2 GB bodies were unified at the neck with a common cystic duct, a so-called V-shaped duplicated GB. The patient's right posterior hepatic duct joined the common bile duct (CBD) near the cystic duct. The patient underwent laparoscopic cholecystectomy without adjacent organ injury, and was discharged uneventfully. Surgeons should carefully evaluate the patient preoperatively and select adequate surgical procedures in patients with suspected duplicated GB because of the risk of concurrent biliary anomalies.
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Affiliation(s)
- Woohyung Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Dae Hyun Song
- Department of Pathology, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Jin Kwon Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Ji Ho Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Ju Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Seung Jin Kwag
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Sang Ho Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Young Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Eun Jung Jung
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Young Joon Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Soon Chan Hong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Sang Kyung Choi
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Chi Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea.
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Nasr MM. An Innovative Emergency Laparoscopic Cholecystectomy Technique; Early Results Towards Complication Free Surgery. J Gastrointest Surg 2017; 21:302-311. [PMID: 27783342 DOI: 10.1007/s11605-016-3308-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/11/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The performance of laparoscopic cholecystectomy could be a technical challenge. Procedure success depends on multiple factors namely: hepatobiliary anatomical variations, pathologic changes in the gallbladder and surrounding tissues, pre-operative interventional attempts, the individual surgeon's skill and finally patient co-morbidities. Anticipating the attendant challenges, can help to avoid several known complications associated with this procedure. Searching a more reliable anatomical topography to adopt during laparoscopic cholecystectomy is the basis for a safe surgical technique. METHODS Between January 2012 and August 2015, 525 cases were presented with acute cholecystitis. Patients were classified in to two groups regarding degree of dissection difficulty. The study concept is defined and applied by the author in all study cases. No single case was excluded from the study. RESULTS Results are processed in comparative way between both groups of the study. The increased risk results in Group B are related to technical difficulties. CONCLUSION The study has offered a novel anatomical concept and safe surgical technique avoiding exploration of Calot's triangle. The new concept has minimized dissection demands and risk of injury related to the traditional laparoscopic cholecystectomy. The study has proposed a potentially secure and empirical laparoscopic cholecystectomy technique that could be considered in every case.
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Affiliation(s)
- Mohamed Mahmood Nasr
- Endoscopic Surgery Unit, Department of General Surgery, King Fahad Hospital, Huffof, Al Ahsa, Kingdom of Saudi Arabia.
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Janikow C, Corti E, Menso N, Moretti G, Alé M, Sánchez M, Lada PE. Useful of Tokyo guidelines in the diagnosis of acute cholecystitis. Anatomopathologie correlationship. Rev Fac Cien Med Univ Nac Cordoba 2017; 74:88-92. [PMID: 28657526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND In the year 2007 a group of experts come together to discuss criteria for acute cholecystitis and to establish therapeutic guidelines and states of gravity in this disease. OBJECTIVES we correlated the criteria of the Tokyo Guidelines 2007 with the anatomopathology study of the surgical specimen. SETTING Service of Urgencies of the National Clinic Hospital in Córdoba, Argentine. METHODS We studied 324 patients (120 male and 204 female) older than 15 years and without limits of age with the criteria of acute cholecystitis a cord to the Tokyo guidelines 2007. 202 patients had a preoperative diagnosis of chronic cholecystitis and 89 of acute cholecystitis, all received cholecystectomy and studied the operative specimen in the anatomopathology department. Anatomopathology criteria for acute cholecystitis were the presence of polimorpho nuclear cells (PMN), for acute exacerbation of chronic cholecystitis the presence of PMN and monomorpho nuclear cells (MN), and for chronic cholecystitis the presence of MN with or without fibrosis. RESULTS This work showed 82,14% of sensitivity for the diagnostic criteria of Tokyo guidelines, 74,03% of specificity, and positive predictive value of 46%. With the Bayes Theorem the predictive value in Córdoba city was 18,49%. CONCLUSION There is an important difference in the specificity and positive predictive value between our work and the Tokyo guidelines for acute cholecystitis. There is an important group of patients in our work with acute exacerbation of chronic cholecystitis that is not classified in the diagnostic criteria for acute cholecystitis of Tokyo guidelines.
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Affiliation(s)
- Christian Janikow
- Surgeon of Urgencies. National Clinic Hospital. Faculty of Medicine. University National of Córdoba. Argentine
| | - Edgardo Corti
- Residents of Urgencies. National Clinic Hospital. Faculty of Medicine. University National of Córdoba. Argentine
| | - Nicolás Menso
- Residents of Urgencies. National Clinic Hospital. Faculty of Medicine. University National of Córdoba. Argentine
| | - Gastón Moretti
- Residents of Urgencies. National Clinic Hospital. Faculty of Medicine. University National of Córdoba. Argentine
| | - Martín Alé
- Surgeon of Urgencies. National Clinic Hospital. Faculty of Medicine. University National of Córdoba. Argentine
| | - Martín Sánchez
- Surgeon of Urgencies. National Clinic Hospital. Faculty of Medicine. University National of Córdoba. Argentine
| | - Paul Eduardo Lada
- Chef of Service of Urgencies. National Clinic Hospital. Faculty of Medicine. University National of Córdoba. Argentine
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Kania D. Ultrasound Measurement of the Gallbladder Wall Thickness in the Assessment of the Risk of Conversion from Elective Laparoscopic Cholecystectomy to Open Surgery - Olkusz County Experience. Pol Przegl Chir 2016; 88:334-345. [PMID: 28141556 DOI: 10.1515/pjs-2016-0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Indexed: 11/15/2022]
Abstract
The aim of the study was to assess the risk of intraoperative difficulties, conversion and biliary-intestinal fistula during laparoscopic cholecystectomy on the basis of an ultrasound-measured gall-bladder wall thickness. MATERIAL AND METHODS A prospective study was conducted in 50 patients undergoing laparoscopic cholecystectomy for chronic gallstone-induced cholecystitis. To calculate the relationships between categorical variables, a chi-square (χ2) independence test was used, and the results were interpreted for the significance threshold of α = 0.05. RESULTS The relationship between the gall-bladder wall thickness and the occurrence of intraoperative difficulties in the analysed set is deterministic (AUC = 1), and the wall thickness of ≥ 5 mm allows to predict their occurrence as soon as at the stage of diagnostic evaluation (p < 0.001). In addition, the ultrasound-measured GB wall thickness is a good predictor of conversion (AUC = 0.976; 95% CI 0.444-0.975; p < 0.001) and biliary-intestinal fistula (AUC = 0.935; 95% CI 0.121-0.738; p = 0.001). CONCLUSIONS The results allow prediction of technically difficult laparoscopic cholecystectomies in patients with CCh, and selection of the right surgical team helps to reduce the number of conversions and possible complications. In addition, bearing in mind the above results in everyday practice should facilitate planning and increase effectiveness in the operating room.
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Wang CH, Wu CY, Yang JCT, Lien WC, Wang HP, Liu KL, Wu YM, Chen SC. Long-Term Outcomes of Patients with Acute Cholecystitis after Successful Percutaneous Cholecystostomy Treatment and the Risk Factors for Recurrence: A Decade Experience at a Single Center. PLoS One 2016; 11:e0148017. [PMID: 26821150 PMCID: PMC4731150 DOI: 10.1371/journal.pone.0148017] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/12/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Percutaneous cholecystostomy tube (PCT) has been effectively used for the treatment of acute cholecystitis (AC) for patients unsuitable for early cholecystectomy. This retrospective study investigated the recurrence rate after successful PCT treatment and factors associated with recurrence. METHODS We reviewed patients treated with PCT for AC from October 2004 through December 2013. Patients with successful PCT treatment were those who were free from persistent PCT drainage. We used multivariable logistic regression analysis sequentially to identify factors associated with each outcome. RESULTS The study included 184 patients (mean age: 70.1 years). The average duration for parenteral antibiotics was 14.4 days and 20.0 days for PCT drainage. The one-year recurrence rate was 9.2% (17/184) with most recurrences occurring within two months (6.5%, 12/184) of the procedure. Complicated cholecystitis (odds ratio [OR]: 4.67; 95% confidence interval [CI]: 1.44-15.70; P = 0.01) and PCT drainage duration >32 days (OR: 4.92; 95% CI: 1.03-23.53; P = 0.05) positively correlated with one-year recurrence; parenteral antibiotics duration >10 days (OR: 0.21; 95% CI: 0.05-0.68; P = 0.01) was inversely associated with one-year recurrence. CONCLUSIONS The recurrence rate was low for patients after successful PCT treatment. Predictors for recurrence included the severity of initial AC and subsequently provided treatments.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Justin Cheng-Ta Yang
- Department of Medical Imaging, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- National Taiwan University Hospital, Hsin-Chu Branch and National Taiwan University, Hsinchu City, Taiwan
- * E-mail:
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
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Balayan AZ. [CLINICAL FEATURES DURING THE ACUTE CHOLECYSTITIS IN THE OLDER AGE GROUP OF PATIENTS]. Eksp Klin Gastroenterol 2016:60-64. [PMID: 30280556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
One of the most popular abdominal diseases is an acute cholecystitis. that’s why is very actual in acute cholecystitis the study of clinical features in the older age group of patients in improving of preoperative diagnosis and adequate option of treatment. In the research were involved 1273 patients, wiich were the patients during 2007-2014 years in Medical center of Yerevan, department of Laporacopic surgery, who suffered from acute cholecystitis. Research findings from the data analysis allows us to assume that the characteristics of the older age group of patients during the acute cholecystitis are difficult to do some surgical intervention and it needs very clever prediction for treatment.
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Abstract
AIM To define causes of difficult situations in various forms of acute cholecystitis depending on terms of disease and clinico-morphological changes in gall bladder area and to justify differentiated application of laparoscopic surgery for acute cholecystitis. MATERIAL AND METHODS It was reviewed 1132 medical records of patients with acute cholecystitis. It is found that morphological changes in gall bladder and surrounding tissues depend on duration of follow-up of patients with acute cholecystitis and type of inflammation. RESULTS In acute catarrhal cholecystitis "complicated" intraoperative situations are observed in 37.5% due to "loose" tissues infiltration, in phlegmonous and gangrenous forms of inflammation - in 44.6% and 63.6% respectively due to "dense" infiltrates development. CONCLUSION Technical variants of laparoscopic cholecystectomy for various "difficult" intraoperative situations are suggested.
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Affiliation(s)
- V P Sazhin
- Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University
| | - I V Sazhin
- Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University
| | - I A Pod''iablonskaia
- Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University
| | - D I Karlov
- Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University
| | - A V Nuzhdikhin
- Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University
| | - S A Aĭvazian
- Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University
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Guseinov AV. [PREVENTION OF INFLAMMATORY COMPLICATIONS AFTER CHOLECYSTECTOMY IF BROWN STONES IN THE GALL BLADDER AND ITS DESTRUCTIVE CHANGES]. Klin Khir 2016:11-14. [PMID: 30256566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The experience of treatment in the clinic of 47 patients with acute calculous cholecystitis was analysed. The removal of the gallbladder found brown pigment stones. The clinical course of the disease in such patients, ultrasound data and instrumental methods were described. The triple antibiotic therapy application helped to reduce the risk of infection of bile, the elimination of the inflammatory process.
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20
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Zakharash YM, Zakharash MP, Moroz VV. [DETERMINATION OF A FATTY ACIDS CONTENT IN BILIARY LIPIDS AS A PROGNOSTIC FACTOR FOR THE COMPLICATIONS OCCURRENCE IN PATIENTS AFTER OPERATIONS FOR AN ACUTE CHOLECYSTITIS IN A HIGH OPERATIVE—ANESTHESIOLOGICAL RISK]. Klin Khir 2016:22-25. [PMID: 30265499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Investigation was conducted with objective to establish a prognostic significance of the fatty acids content in biliary lipids for the complications occurrence in patients, operated on for an acute cholecystitis, while presence of high operative—anesthesiological risk. A fatty acids content in biliary lipids was analyzed in 64 patients in presence of moderate (grade ІІ) and severe (grade ІІІ) course of the disease. Coefficients К1 and К2 for prognostication of postoperative purulent—inflammatory complications occurrence were elaborated, their threshold level (К1=0.59, К2=1.8) was established. There was established, that excess of the threshold meaning of К1 and К2 in a bile of patients, suffering an acute cholecystitis while presence of high operative—anesthesiological risk, constitutes a prognostic criterion for the postoperative purulent—inflammatory complications occurrence
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Gudz IM, Tkachuk-Grygorchuk OO, Tkachuk OL. [HEMOSTASIOLOGIC INDICES AFTER LAPAROSCOPIC CHOLECYSTECTOMY FOR AN ACUTE CHOLECYSTITIS]. Klin Khir 2016:38-40. [PMID: 27249925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The indices of coagulometry and thromboelastography (THEG) were determined in 60 patients, suffering various forms of an acute cholecystitis. Preoperatively the coagulometry indices have had a hypercoagulation tendency while the disease severity enhances. After performance of laparoscopic cholecystectomy the most essential changes of indices were observed. In the patients after severe operation there was observed accelerated kinetics of the blood clotting, witnessed by the THEG indices. The risk of the hemorrhage occurrence restricts application of medicinal thromboprophylaxis.
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22
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Usenko AY, Yareshko VG, Nichitaylo ME, Mikheyev YA, Andreyeshchev SA. [TG13: THE UPDATED TOKYO'S CLINICAL RECOMMENDATIONS FOR TREATMENT OF AN ACUTE CHOLANGITIS AND CHOLECYSTITIS]. Klin Khir 2015:5-10. [PMID: 26946649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Basing on analysis of the multicenter clinical investigations results, as well as meta-analysis and consensuses, the main suggestions of the updated Tokyo's clinical recommendations for the treatment of an acute cholangitis and an acute cholecystitis (TG13), diagnostic criteria and the scales of estimation for the patients' state severity, were elaborated. Indications and the drainage methods of a gallbladder were substantiated - in an acute cholecystitis, and of biliary ducts - in an acute cholangitis, as well as peculiarities of surgical treatment of an acute cholecystitis. Empirical antibacterial therapy was enlightened, taking into account the characteristics for biliary infection microorganisms and the disease severity.
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23
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Stets N, Chernenko V. [EXPERIENCE OF TREATMENT OF PREGNANT WOMEN WITH ACUTE SURGICAL DISEASES OF THE ABDOMINAL CAVITY]. Lik Sprava 2015:100-104. [PMID: 27089725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article describes a generalized experience in the treatment of pregnant women with acute surgical diseases of the abdominal cavity.
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24
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Dudchenko MO, Kravtsiv MI, Lyulka MO, Lyakhovsky VI, Furman DD, Bondar LD. [TREATMENT OF ACUTE CALCULOUS CHOLECYSTITIS: "EARLY" OR "PLANNED" LAPAROSCOPIC CHOLECYSTECTMIVY]. Klin Khir 2015:19-21. [PMID: 26521459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The comparative analysis of results of surgical treatment of 82 patients with acute cholecystitis, which made "early" (ELCE) or "planned" (PLCE) laparoscopic cholecystectomy (LCE) in the surgical department for the period from 2012 to 2014. The analysis showed that LCE can be set in any time from the beginning of acute cholecystitis. However, priority should be given ELCE, providing significant reduction in duration of treatment of patients in hospitals and is more cost effective.
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Kim JC, Jin HM, Cho YN, Kwon YS, Kee SJ, Park YW. Deficiencies of Circulating Mucosal-associated Invariant T Cells and Natural Killer T Cells in Patients with Acute Cholecystitis. J Korean Med Sci 2015; 30:606-11. [PMID: 25931792 PMCID: PMC4414645 DOI: 10.3346/jkms.2015.30.5.606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/14/2015] [Indexed: 01/10/2023] Open
Abstract
Mucosal-associated invariant T (MAIT) cells and natural killer T (NKT) cells are known to play crucial roles in a variety of diseases, including autoimmunity, infectious diseases, and cancers. However, little is known about the roles of these invariant T cells in acute cholecystitis. The purposes of this study were to examine the levels of MAIT cells and NKT cells in patients with acute cholecystitis and to investigate potential relationships between clinical parameters and these cell levels. Thirty patients with pathologically proven acute cholecystitis and 47 age- and sex-matched healthy controls were enrolled. Disease grades were classified according to the revised Tokyo guidelines (TG13) for the severity assessment for acute cholecystitis. Levels of MAIT and NKT cells in peripheral blood were measured by flow cytometry. Circulating MAIT and NKT cell numbers were significantly lower in acute cholecystitis patients than in healthy controls, and these deficiencies in MAIT cells and NKT cell numbers were associated with aging in acute cholecystitis patients. Notably, a reduction in NKT cell numbers was found to be associated with severe TG13 grade, death, and high blood urea nitrogen levels. The study shows numerical deficiencies of circulating MAIT and NKT cells and age-related decline of these invariant T cells. In addition, NKT cell deficiency was associated with acute cholecystitis severity and outcome. These findings provide an information regarding the monitoring of these changes in circulating MAIT and NKT cell numbers during the course of acute cholecystitis and predicting prognosis.
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Affiliation(s)
- Jung-Chul Kim
- Department of Hepatobiliary Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Hye-Mi Jin
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Young-Nan Cho
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Yong-Soo Kwon
- Department of Pulmonary and Critical Care Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Seung-Jung Kee
- Department of Laboratory Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Yong-Wook Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
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Joffe Y, Stetsenko P, Tykhonov OA, Tarasyuk TV, Tsyura YP, Kryvopustov MS. [Application of principles of "fast track" surgery in treatment of calculous cholecystitis]. Klin Khir 2015:5-8. [PMID: 26072531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The "fast track" concept in surgery provides rapid rehabilitation of postoperative patients, using the operative trauma reduction, adequate anesthesia--for reduction of the organism stress answer on surgical intervention. Results of treatment were analyzed in 118 patients, in whom for calculous cholecystitis the one-port transumbilical laparoscopic cholecystectomy (OPTLCH) was performed. Duration of the patients stationary treatment without abdominal cavity drainage have constituted at average (1.49 ± 0.05) days, after drainage--2.22 days. Intensity of the pain impulsation, which was determined in accordance to concentration of proinflammatory cytokins, including interleukin-1 (IL-1) and a tumor necrosis factor-α (TNF-α) after standard laparoscopic cholecystectomy (LCH) was in 1.2 times higher, than after OPTLCH. In subjective estimation of the pain intensity in accordance to visual analogous scale in patients after OPTLCH have constituted (3.42 ± 0.16) cm, and after a standard one--(5.98 ± 0.19) cm (p < 0.05).
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Nichitayio MY, Bazyak AM, Klochan VV, Grusha PK, Goman AV. [Comparative analysis of application of highly intensive laser irradiation and electrocoagulation during laparoscopic cholecystectomy performed for destructive forms of an acute calculous cholecystitis]. Klin Khir 2015:29-31. [PMID: 25985692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Comparative analysis of results of the laser diode (the wave length 940 nm) and elec- trocoagulation application while performing laparoscopic cholecystectomy was con- ducted. For an acute calculous cholecystitis 52 patients were operated, in whom instead of electrocoagulation the laser was applied, provide for reduction of thermal impact on tissues, the complications absence, reduction of the patients stationary treatment duration postoperatively from (5.2 ± 1.2) to (4.9 ± 0.6) days.
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Yuldashev A. [HOW TO PERFORM THE CONVERSION DURING LAPAROSCOPIC CHOLECYSTECTOMY]. Lik Sprava 2015:93-97. [PMID: 26118035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the work was the rationale for the choice of access in the performance of conversion in laparoscopic cholecystectomy. In our study, conversion was performed in 34 (2.78%) cases of 1222 laparoscopic cholecystectomies: when the LCE for chronic cholecystitis--17 (1.6%) cases of 1065, for acute cholecystitis--17 (10.8%) of 157. The most common access for conversion are oblique access Kocher and upper-middle access. Choice of approach for the implementation of the conversion depends on the cause of conversion.
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Ohorodnyk PV, Kolomiĭtsev VI, Syroïd OM, Deĭnychenko AH. [Prognostication of the performance possibility for laparoscopic exploration of common biliary duct in an acute calculous cholecystitis]. Klin Khir 2014:5-8. [PMID: 25675777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The results of miniinvasive treatment of 319 patients, suffering complicated acute calculous cholecystitis, using laparoscopic technologies, were analyzed in retrospective investigation. The risk factors for unfaithful conduction of laparoscopic intervention on biliary ducts were determined. The chances for possibility of laparoscopic choledocholithoextraction performance on biliary ducts were established, using binary regressive analysis. Reduction of rate of unfaithful laparoscopic interventions, made on common biliary duct, from 18.6 to 5.9% was promoted by application of mathematically elaborated criteria in accordance to the prospective investigation data.
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Churpiĭ IK. [The nature of postoperative complications in patients with peritonitis]. Lik Sprava 2014:105-108. [PMID: 25906657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We studied the postoperative period in patients with peritonitis. The structure of the most important factors that slow down the healing process and lead to mortality. Among the factors that affect the healing process is the most important character of fluid, and the prevalence of peritonitis (causative factor), which causes complications on the part of the internal organs and wounds.
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31
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Ganzhiĭ VV, Novokhatniĭ PV. [Experience in treatment of abdominal complications after urgent laparoscopic cholecystectomy]. Klin Khir 2014:15-16. [PMID: 25097968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Experience of treatment of 24 patients, in whom complications after urgent laparoscopic cholecystectomy for an acute cholecystitis have occurred, was studied. An acute phlegmonous cholecystitis was diagnosed in 14 (58.3%) patients, an acute gangrenous one--in 10 (41.7%). Pathological accumulations of liquid in abdominal cavity, measuring (105.9 +/- 79.1) ml at average, was observed in 17 patients, in them interventional sonography in accordance to the free hand method was applied. While dilatation of common biliary duct (CBD), sizing more than 10 mm, videoendoscopic papillosphincterotomy, the CBD revision, using Dormia's basket, choledocholithoextraction were performed. Passability of extrahepatic biliary ducts was controlled, using fistulography and retrograde cholangiography. Endoscopic operations were successful. All the patients have recovered and dismissed on the 10 - 13-th day.
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Dolimov KS, Il'khamov FA, Abdumazhidov AS, Tukhtamuradov ZZ. [Infiltrate of a gallbladder]. Klin Khir 2014:23-24. [PMID: 25097993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Infiltrate of a gallbladder, as a complication of an acute cholecystitis constitute a separate form of the disease. In this case a destructive changes in gallbladder are restricted from surrounding tissues. While presence of infiltrate of a small size and favorable course under the influence of conservative therapy it is necessary to follow an expectant tactics up to complete dissolving of the infiltrate with a consequent obligate operative treatment in a "cold" period of the disease. Not rarely the infiltrate is transformed into a gallbladder oedema, what demands performance of a deferred operation. In a deep destructive process a gallbladder empyema may occur or paravesical abscess formated, what demands performance of urgent operative intervention.
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Zhang L, Pan C, Yang B, Xiao Y, Yu B. Enhanced expression of cystathionine β-synthase and cystathionine γ-lyase during acute cholecystitis-induced gallbladder inflammation. PLoS One 2013; 8:e82711. [PMID: 24349344 PMCID: PMC3857271 DOI: 10.1371/journal.pone.0082711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/28/2013] [Indexed: 12/20/2022] Open
Abstract
Background Hydrogen sulfide (H2S) has recently been shown to play an important role in the digestive system, but the role of endogenous H2S produced locally in the gallbladder is unknown. The aim of this study was to investigate whether gallbladder possesses the enzymatic machinery to synthesize H2S, and whether H2S synthesis is changed in gallbladder inflammation during acute acalculous cholecystitis (AC). Methods Adult male guinea pigs underwent either a sham operation or common bile duct ligation (CBDL). One, two, or three days after CBDL, the animals were sacrificed separately. Hematoxylin and eosin-stained slides of gallbladder samples were scored for inflammation. H2S production rate in gallbladder tissue from each group was determined; immunohistochemistry and western blotting were used to determine expression levels of the H2S-producing enzymes cystathionine β-synthase (CBS) and cystathionine γ-lyase (CSE) in gallbladder. Results There was a progressive inflammatory response after CBDL. Immunohistochemistry analysis showed that CBS and CSE were expressed in the gallbladder epithelium, muscular layer, and blood vessels and that the expression increased progressively with increasing inflammation following CBDL. The expression of CBS protein as well as the H2S-production rate was significantly increased in the animals that underwent CBDL, compared to those that underwent the sham operation. Conclusions Both CBS and CSE are expressed in gallbladder tissues. The expression of these enzymes, as well as H2S synthesis, was up-regulated in the context of inflammation during AC.
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Affiliation(s)
- Li Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chenwei Pan
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Infectious Disease, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bin Yang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yong Xiao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Baoping Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- * E-mail:
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Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan ACW, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2013; 20:35-46. [PMID: 23340953 DOI: 10.1007/s00534-012-0568-9] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo Guidelines Revision Committee concluded that acute cholecystitis should be suspected when Murphy's sign, local inflammatory findings in the gallbladder such as right upper quadrant abdominal pain and tenderness, and fever and systemic inflammatory reaction findings detected by blood tests are present but that definite diagnosis of acute cholecystitis can be made only on the basis of the imaging of ultrasonography, computed tomography or scintigraphy (HIDA scan). These proposed diagnostic criteria provided better specificity and accuracy rates than the TG07 diagnostic criteria. As for the severity assessment criteria in TG07, there is evidence that TG07 resulted in clarification of the concept of severe acute cholecystitis. Furthermore, there is evidence that severity assessment in TG07 has led to a reduction in the mean duration of hospital stay. As for the factors used to establish a moderate grade of acute cholecystitis, such as leukocytosis, ALP, old age, diabetes, being male, and delay in admission, no new strong evidence has been detected indicating that a change in the criteria used in TG07 is needed. Therefore, it was judged that the severity assessment criteria of TG07 could be applied in the updated Tokyo Guidelines (TG13) with minor changes. TG13 presents new standards for the diagnosis, severity grading and management of acute cholecystitis. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Masamichi Yokoe
- General Internal Medicine, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan.
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35
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Ioffe IV, Alekseev AV, Pepenin AV, Zaika AV, Torba AV. [A complex method for prophylaxis of laparoscopic cholecystectomy complications]. Klin Khir 2013:9-12. [PMID: 24283036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The clinical examination and treatment results were analyzed in 1282 patients, in whom laparoscopic cholecystectomy, using complex method of the complications prophylaxis, was performed for calculous cholecystitis. The complications have had occurred in 21 (1.64%) patients, the conversion necessity--in 10 (0.78%), 3 (0.23%) patients died.
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36
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Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Kiriyama S, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan ST, Singh H, de Santibanes E, Kusachi S, Murata A, Chen XP, Jagannath P, Lee S, Padbury R, Chen MF. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci 2013; 19:578-85. [PMID: 22872303 PMCID: PMC3429769 DOI: 10.1007/s00534-012-0548-0] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were published in 2007 as the world’s first guidelines for acute cholangitis and cholecystitis. The diagnostic criteria and severity assessment of acute cholecystitis have since been widely used all over the world. A validation study of TG07 has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. In addition, considerable new evidence referring to acute cholecystitis as well as evaluations of TG07 have been published. Consequently, we organized the Tokyo Guidelines Revision Committee to evaluate TG07, recognize new evidence, and conduct a multi-center analysis to revise the guidelines (TG13). Methods and materials We retrospectively analyzed 451 patients with acute cholecystitis from multiple tertiary care centers in Japan. All 451 patients were first evaluated using the criteria in TG07. The “gold standard” for acute cholecystitis in this study was a diagnosis by pathology. The validity of TG07 diagnostic criteria was investigated by comparing clinical with pathological diagnosis. Results Of 451 patients evaluated, a total of 227 patients were given a diagnosis of acute cholecystitis by pathological examination (prevalence 50.3 %). TG07 criteria provided a definite diagnosis of acute cholecystitis in 224 patients. The sensitivity of TG07 diagnostic criteria for acute cholecystitis was 92.1 %, and the specificity was 93.3 %. Based on the preliminary results, new diagnostic criteria for acute cholecystitis were proposed. Using the new criteria, the sensitivity of definite diagnosis was 91.2 %, and the specificity was 96.9 %. The accuracy rate was improved from 92.7 to 94.0 %. In regard to severity grading among 227 patients, 111 patients were classified as Mild (Grade I), 104 as Moderate (Grade II), and 12 as Severe (Grade III). Conclusion The proposed new diagnostic criteria achieved better performance than the diagnostic criteria in TG07. Therefore, the proposed criteria have been adopted as new diagnostic criteria for acute cholecystitis and are referred to as the 2013 Tokyo Guidelines (TG13). Regarding severity assessment, no new evidence was found to suggest that the criteria in TG07 needed major adjustment. As a result, TG07 severity assessment criteria have been adopted in TG13 with minor changes.
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Affiliation(s)
- Masamichi Yokoe
- General Internal Medicine, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi 466-8650, Japan.
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37
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Iakubovskiĭ SV, Anishchenko SL, Emel'ianova AA, Chaĭka LD. [Effect of succinate-containing medications on hepatic structural changes in acute experimental cholecystitis]. Arkh Patol 2012; 74:28-32. [PMID: 23383441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Histological and electron microscopic changes in the hepatic structure were studied in animals with acute experimental cholecystitis. The administration of the succinate-containing drugs reamberin and mexidole decreased the magnitude of morphological changes in the liver tissue. Morphometric examination revealed that reamberin versus mexidole showed a high efficacy in reducing the area of hepatocytic necrosis.
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38
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Affiliation(s)
- Jeffrey Forris Beecham Chick
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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40
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Bılıcı A, Şeker M, Öven Ustaalıoğlu BB, Keser SH, Cınaral F, Gümüş M. Gallbladder metastasis secondary to gastric cancer as a first site of recurrence presented with acute cholecystitis: case report and literature review. Turk J Gastroenterol 2012; 23:764-768. [PMID: 23864451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Metastasis to the gallbladder from other malignancies is extremely rare and is related with a very poor prognosis. Malignant melanoma has been reported to be the most common origin of gallbladder metastasis. Although only eight cases of gallbladder metastasis originating from gastric cancer have been documented in the literature based on small series, of these cases, only one case with signet ring cell carcinoma histology has been reported previously. We report the case of a 58-year-old male with early-stage signet ring cell carcinoma of the stomach who presented with acute cholecystitis previously treated with curative gastrectomy. After laparoscopic cholecystectomy, the diagnosis of gallbladder metastasis with signet ring cell histology secondary to gastric cancer was made. To our knowledge, this is only the second case of signet ring cell carcinoma of the stomach metastasized to the gallbladder as a first site of recurrence. We suggest that for patients with gastric cancer who complain of the findings of acute cholecystitis or cholecystolithiasis, gallbladder metastasis from gastric cancer should be considered in the differential diagnosis.
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Affiliation(s)
- Ahmet Bılıcı
- Dr. Lütfi Kırdar Kartal Education and Research Hospital, Department of Medical Oncology, İstanbul, Turkey.
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41
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Ioffe OI, Stetsenko OP, Tykhonov OA, Tarasiuk TV, Tsiupa IP, Mel'nyk RO, Kobzar AI. [A first experience of performance of a sigmoid colon laparoscopic resection, using a single transumbilical access]. Klin Khir 2012:68-69. [PMID: 22642095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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42
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Korotkyĭ VM, Soliaryk SO, Tsyganok AM, Sysak OM. [The pneumoperitoneum course forecasting and surgery tactic in the group of patients with acute and chronic cholecystitis and concomitant pathology of cardiovascular system]. Lik Sprava 2012:89-94. [PMID: 23035606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The share of elderly and senile patients with acute cholecystitis concomitant cardiovascular pathology whom the laparoscopic cholecystectomy has been provided is increased. The heightened intraabdominal pressure has negative influence at the cardiovascular system, so the alternative ways for treatment of this group of patients are used in clinic. We propose the pneumoperitoneum model using the pneumatic belt which is fixed at the abdomen in preoperative period in patients with an acute and chronic cholecystitis. This model is useful to forecast cardiovascular disorders during future laparoscopic cholecystectomy. The arterial pressure level, pulse score and ECG are monitored during the test (90 min). Myocardial ischemia appearance seems that the risk of laparoscopic cholecystectomy with pneumoperitoneum is high. The alternative method of surgery in such group of patients (no pneumoperitoneum is applied) is laparoscopic assisted cholecystectomya from miniaccess. This method allows to reducing frequency of intra- and postoperative complications connected with pneumoperitoneum negative influence at the patients with concomitant pathology of cardiovascular system.
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Choi SB, Han HJ, Kim CY, Kim WB, Song TJ, Suh SO, Kim YC, Choi SY. Early laparoscopic cholecystectomy is the appropriate management for acute gangrenous cholecystitis. Am Surg 2011; 77:401-406. [PMID: 21679545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications. We determined whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. The medical records of 116 patients with acute gangrenous cholecystitis admitted to the Korea University Guro Hospital between January 2005 and December 2009 were reviewed. The early operation group, those patients who had cholecystectomies within 4 days of the diagnosis, was compared with the delayed operation group, who had cholecystectomies 4 days after the diagnosis. Of the 116 patients, 57 were in the early operation group and 59 were in the delayed operation group. There were no statistical differences between the groups with respect to gender, age, body mass index, operative methods, major complications, duration of symptoms, mean operative time (98 vs 107 minutes), or postoperative hospital stay. However, the total hospital stay was significantly longer in the delayed operation group. More patients underwent preoperative percutaneous cholecystostomy in the delayed operation group (3.5 vs 15.3%). Early laparoscopic cholecystectomy for acute gangrenous cholecystitis is safe and feasible. There is no advantage to postponing an urgent operation in patients with acute gangrenous cholecystitis.
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Affiliation(s)
- Sae Byeol Choi
- Department of Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Gyeonggi-Do, Korea.
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44
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Bolton JS, Fuhrman GM. Early laparoscopic cholecystectomy for gangrenous cholecystitis. Am Surg 2011; 77:407-408. [PMID: 21679546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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45
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Abstract
Infections of the gastrointestinal tract can often involve the gallbladder. Infection probably plays a role in the formation of gallstones but is more commonly thought to contribute to acute illness in patients. Acute calculous cholecystitis caused by an impacted gallstone is often complicated by secondary bacterial infection and is a major cause of morbidity and even mortality in patients. A wide variety of organisms can be associated with acute acalculous cholecystitis, a less common but potentially more severe form of acute cholecystitis. This review focuses on infections and their role in the above-mentioned processes involving the gallbladder.
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Affiliation(s)
- Kabir Julka
- Division of Gastroenterology, University of Washington, Seattle, WA 98195, USA
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46
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Jain AK, Maxwell D. Hand-assisted laparoscopic cholecystectomy for acute gangrenous cholecystitis. Am Surg 2010; 76:1033-1034. [PMID: 20836364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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47
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Chen Y, Zheng WQ, Zhong JP, Wang JJ, He MX. [Acute myocarditis misdiagnosed as "acute cholecystitis"]. Zhonghua Bing Li Xue Za Zhi 2010; 39:114-116. [PMID: 20388378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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48
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Caputo P, Rossi G, Faccini M, Carzaniga P. Overcoming of a "surgical dogma" in acute cholecystitis treated in postponed emergency. Ann Ital Chir 2009; 80:287-292. [PMID: 19967887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM To demonstrate the overcoming of a surgical dogma related to acute cholecystitis treatment, in particular to the timing of the operation. METHODS One hundred cases of observed acute cholecystitis, submitted to an emergency postponed laparoscopic cholecystectomy surgery and histological control of specimens to evaluate rate of surgical complications and rate of reconver-tion to open surgery RESULTS The complications rate observed and the surgical conversion to open technique was only 1% where in 96% of the cases the histological examination of the specimen confirmed the state of acute inflammation. Therefore there was a substantial success rate of laparoscopic therapy even in emergency situations, in spite of an overcoming of the conventional timing within 72 hours of surgery for acute cases, which has few restrictions from some authors. The reasons allowing in safety that time extension were ascribed to the laparoscopic procedure, apt to overcome the anatomo-pathological barriers through an accurate vision of the operative field, and the use of specialized devices allowing the coagulative dissection of inflamed tissues. CONCLUSIONS Postponed colecistectomy in acute cholecystitis, in extention of the canonical coded timing of 72 hours, confirmed to be a safe and successful procedure, even in emergency, with only rare exceptions.
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Affiliation(s)
- Pierpaolo Caputo
- Unità Operativa di Chirurgia Generale, Ospedale Leopoldo Mandic, Merate, Italy.
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49
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Il'chenko AA. [Enzymatic cholecystitis]. Eksp Klin Gastroenterol 2009:68-71. [PMID: 20469709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The article presents basic information on little known to medical practitioners enzymatic cholecystitis.
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50
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Vasilev V, Lefterrov E, Popnikolov M, Atanasov A. [Intoxication syndrome in acute cholecystitis in elderly and old people]. Khirurgiia (Mosk) 2009:21-22. [PMID: 20506774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Acute cholecystitis in elderly and old patients is characterized by quickly developing intoxication syndrome. The aim of this survey is to assess the intoxication syndrome in 46 patients, suffering from acute cholecystitis--17 men and 29 women. Clinical signs/ present status, temperature, pulse, respiration, as well as laboratory results/leucocytes, blood count, leucocyte index of intoxication-- LII / are used. The value of LII correspond with the clinical status of the patient and histological findings.
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