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Clapp B, Abi Mosleh K, Glasgow AE, Habermann EB, Abu Dayyeh BK, Spaniolas K, Aminian A, Ghanem OM. Bariatric surgery is as safe as other common operations: an analysis of the ACS-NSQIP. Surg Obes Relat Dis 2024; 20:515-525. [PMID: 38182525 DOI: 10.1016/j.soard.2023.11.017] [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: 09/14/2023] [Revised: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Metabolic and Bariatric Surgery (MBS) is the most effective management for patients with obesity and weight-related medical conditions. Nonetheless, some primary care physicians (PCPs) and surgeons from other specialties are reluctant to refer patients for MBS due to safety concerns. OBJECTIVES To compare the outcomes of patients who underwent MBS with those who underwent other common operations. SETTING American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). METHODS Patients who underwent laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB), classified as MBS, were compared to nine frequently performed procedures including hip arthroplasty and laparoscopic cholecystectomy, appendectomy, colectomy, hysterectomy, and hernia repairs, among others. A multivariable logistic regression was constructed to compare outcomes including readmission, reoperation, extended length of stay (ELOS) (>75th percentile or ≥3 days) and mortality. RESULTS A total of 1.6 million patients were included, with 11.1% undergoing MBS. The odds of readmission were marginally lower in the cholecystectomy (adjusted odds ratio [aOR] = .88, 95% confidence interval (CI) [.85, .90]) and appendectomy (aOR = .88, 95% CI [.85, .90]) cohorts. Similarly, odds of ELOS were among the lowest, surpassed only by same-day procedures such as cholecystectomies and appendectomies. The MBS group had significantly low odds of mortality, comparable to safe anatomical procedures such as hernia repairs. Infectious and thrombotic complications were exceedingly rare and amongst the lowest after MBS. CONCLUSIONS MBS demonstrates a remarkably promising safety profile and compares favorably to other common procedures in the short-term. PCPs and surgeons from other specialties can confidently refer patients for these low-risk, lifesaving operations.
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Affiliation(s)
- Benjamin Clapp
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas
| | | | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Ali Aminian
- Department of Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Furuke H, Takagi T, Kobayashi H, Fukumoto K. Laparoscopic cholecystectomy for patients with accessory liver lobe attached to the wall of the gallbladder: case reports. Surg Case Rep 2024; 10:118. [PMID: 38736003 PMCID: PMC11089018 DOI: 10.1186/s40792-024-01923-9] [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: 03/31/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is one of the most commonly undertaken procedures worldwide for cholecystolithiasis and cholecystitis. Accessory liver lobe (ALL) is a developmental anomaly defined as an excessive liver lobe composed of a normal liver parenchyma. Some ALL exist on the serosal side of the gallbladder. We herein present two cases of ALL incidentally detected during LC. CASE PRESENTATION The first case was a 69-year-old woman diagnosed with chronic cholecystitis. LC was performed. ALL was observed anterior to the wall of the gallbladder and resected after clipping. Pathological findings revealed liver tissue with Glisson's capsule and a lobular structure in ALL. However, communication between the bile ducts of ALL and the main liver was unclear due to surgical heat degeneration. The second case was a 56-year-old woman diagnosed with acute cholecystitis. LC was performed approximately one month after the attack, and ALL attached to the wall of gallbladder. ALL was clipped and completely resected. Pathological findings showed that the bile ducts of ALL might be connected within the wall of gallbladder. CONCLUSIONS We presented two cases of ALL attached to the gallbladder encountered during LC. Since ALL contains a normal liver parenchyma, postoperative bleeding or bile leakage may occur if it is inefficiently resected. Therefore, the complete resection of ALL is important to prevent these postoperative complications.
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Affiliation(s)
- Hirotaka Furuke
- Department of Surgery, Nishijin Hospital, 1035 Mizomae-cho, Kamigyo-ku, Kyoto, 6028319, Japan.
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Tsuyoshi Takagi
- Department of Surgery, Nishijin Hospital, 1035 Mizomae-cho, Kamigyo-ku, Kyoto, 6028319, Japan
| | - Hiroki Kobayashi
- Department of Surgery, Nishijin Hospital, 1035 Mizomae-cho, Kamigyo-ku, Kyoto, 6028319, Japan
| | - Kanehisa Fukumoto
- Department of Surgery, Nishijin Hospital, 1035 Mizomae-cho, Kamigyo-ku, Kyoto, 6028319, Japan
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3
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Olmedo NB, Dos Santos JS, Junior JE. The Frequency of Anatomical Variants of the Bile Ducts: A Review Based on a Single Classification as Support for Cholangiographic Examinations. Cureus 2024; 16:e58905. [PMID: 38800324 PMCID: PMC11118781 DOI: 10.7759/cureus.58905] [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: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Complications arising from hepatobiliary surgery can have adverse effects on both the quality of life and the survival of patients. Magnetic resonance cholangiography (MRC) techniques are highly effective at revealing anatomical variants of the bile ducts and thus play a vital role in minimizing the occurrence of complications. The aims of this review are threefold: to ascertain the classifications utilized for categorizing anatomical variants of the bile ducts, to present the reported results on the prevalence of these anatomical variants, and to explore the diagnostic modalities employed to visualize these anatomical variants and associated complications during surgical procedures. A review of the literature was carried out using the Cochrane Library database and the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Google Scholar platforms. We conducted a comprehensive review of relevant studies to categorize the different anatomical variants according to the Huang classification. According to the Huang classification, our study showed type A1, 60.44%; type A2, 11.76%; type A3, 11.73%; type A4, 5.47%; type A5, 0.26%; and type B, which was identified in insignificant numbers (0.16%) or does not appear; additionally, variants that do not fit into the Huang classification have also been identified (10.18%). The Huang classification serves as an invaluable presurgical guide, aiding in the strategic planning of biliary interventions and effectively reducing the risk of iatrogenic complications, morbidity, mortality, and postoperative length of stay. MRC is still considered the noninvasive gold standard method for evaluating the bile ducts and their anatomical variations.
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Affiliation(s)
- Norman B Olmedo
- Department of Imaging and Radiology, College of Medical Sciences, Central University of Ecuador, Quito, ECU
| | - José Sebastião Dos Santos
- Department of Surgery and Anatomy, Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, BRA
| | - Jorge Elías Junior
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Medical School, University of São Paulo, Ribeirão Preto, BRA
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4
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Stoica PL, Serban D, Bratu DG, Serboiu CS, Costea DO, Tribus LC, Alius C, Dumitrescu D, Dascalu AM, Tudor C, Simion L, Tudosie MS, Comandasu M, Popa AC, Cristea BM. Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis. Diagnostics (Basel) 2024; 14:346. [PMID: 38337862 PMCID: PMC10855974 DOI: 10.3390/diagnostics14030346] [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: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
Laparoscopic cholecystectomy (LC) is the gold standard treatment in acute cholecystitis. However, one in six cases is expected to be difficult due to intense inflammation and suspected adherence to and involvement of adjacent important structures, which may predispose patients to higher risk of vascular and biliary injuries. In this study, we aimed to identify the preoperative parameters with predictive value for surgical difficulties. A retrospective study of 255 patients with acute cholecystitis admitted in emergency was performed between 2019 and 2023. Patients in the difficult laparoscopic cholecystectomy (DLC) group experienced more complications compared to the normal LC group (33.3% vs. 15.3%, p < 0.001). Age (p = 0.009), male sex (p = 0.03), diabetes (p = 0.02), delayed presentation (p = 0.03), fever (p = 0.004), and a positive Murphy sign (p = 0.007) were more frequently encountered in the DLC group. Total leukocytes, neutrophils, and the neutrophil-to-lymphocyte ratio (NLR) were significantly higher in the DLC group (p < 0.001, p = 0.001, p = 0.001 respectively). The Tongyoo score (AUC ROC of 0.856) and a multivariate model based on serum fibrinogen, thickness of the gallbladder wall, and transverse diameter of the gallbladder (AUC ROC of 0.802) showed a superior predictive power when compared to independent parameters. The predictive factors for DLC should be assessed preoperatively to optimize the therapeutic decision.
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Affiliation(s)
- Paul Lorin Stoica
- Doctoral School, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, University Lucian Blaga Sibiu, 550169 Sibiu, Romania
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | - Crenguta Sorina Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (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
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania;
| | - Dan Dumitrescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania;
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania;
| | - Laurentiu Simion
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Department of Surgical Oncology, Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Mihail Silviu Tudosie
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
| | - Meda Comandasu
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania;
| | - Alexandru Cosmin Popa
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Department of General Surgery, Colentina Clinic Hospital, 020125 Bucharest, Romania
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
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Guo X, Fan Q, Guo Y, Li X, Hu J, Wang Z, Wang J, Li K, Zhang N, Amin B, Zhu B. Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC. BMC Gastroenterol 2024; 24:28. [PMID: 38195417 PMCID: PMC10777623 DOI: 10.1186/s12876-023-03117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND In the past quite a long time, intraoperative cholangiography(IOC)was necessary during laparoscopic cholecystectomy (LC). Now magnetic resonance cholangiopancreatography (MRCP) is the main method for diagnosing common bile duct stones (CBDS). Whether MRCP can replace IOC as routine examination before LC is still inconclusive. The aim of this study was to analyze the clinical data of patients undergoing LC for cholecystolithiasis, and to explore the necessity and feasibility of preoperative routine MRCP in patients with cholecystolithiasis. METHODS According to whether MRCP was performed before operation, 184 patients undergoing LC for cholecystolithiasis in the Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University from January 1, 2017 to December 31, 2018 were divided into non-MRCP group and MRCP group for this retrospective study. The results of preoperative laboratory test, abdominal ultrasound and MRCP, biliary related comorbidities, surgical complications, hospital stay and hospitalization expenses were compared between the two groups. RESULTS Among the 184 patients, there were 83 patients in non-MRCP group and 101 patients in MRCP group. In MRCP group, the detection rates of cholecystolithiasis combined with CBDS and common bile duct dilatation by MRCP were higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in non-MRCP group (8.43%) was significantly higher (P < 0.05) than that in MRCP group (0%). There was no significant difference in hospital stay (P > 0.05), but there was significant difference in hospitalization expenses (P < 0.05) between the two groups. According to the stratification of gallbladder stone patients with CBDS, hospital stay and hospitalization expenses were compared, and there was no significant difference between the two groups (P > 0.05). CONCLUSIONS The preoperative MRCP can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by abdominal ultrasound, which is helpful to plan the surgical methods and reduce the surgical complications. From the perspective of health economics, routine MRCP in patients with cholecystolithiasis before LC does not increase hospitalization costs, and is necessary and feasible.
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Affiliation(s)
- Xu Guo
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Qing Fan
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Yiman Guo
- School of Clinical Medicine, Hebei University, Wusi East Road 180th, Lianchi District, Hebei Province, 071000, Baoding City, China
| | - Xinming Li
- Department of Urology, Fuyang People's Hospital, Anhui Medical University, Sanqing Road 501th, Ying Zhou District, 236012, Fuyang City, Anhui Province, China
| | - Jili Hu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Dong Road, ErQi District, 450052, Zhengzhou City, Henan Province, China
| | - Zhuoyin Wang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Jing Wang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Kai Li
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Nengwei Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China
| | - Buhe Amin
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China.
| | - Bin Zhu
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road 10th, Yangfangdian Street, Haidian District, 100038, Beijing, China.
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6
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Zhong H, Li S, Wu X, Luo F. Posterior Calot's Triangle Approach First Would Be a Better Choice for Chronic Atrophic Cholecystitis: A Retrospective Controlled Study. J Laparoendosc Adv Surg Tech A 2023; 33:1211-1217. [PMID: 37787943 DOI: 10.1089/lap.2023.0328] [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] [Indexed: 10/04/2023] Open
Abstract
Objective: Compare the clinical efficacy of anterior and posterior Calot's triangle approach in laparoscopic cholecystectomy (LC) for chronic atrophic cholecystitis, to find out which approach is much safer and more reliable. Patients and Methods: From June 2020 to June 2022, 102 patients with chronic atrophic cholecystitis underwent LC in our hospital. They were divided into anterior Calot's triangle approach group and posterior Calot's triangle approach group. In addition, their clinical data, intraoperative conditions, surgical results, and postoperative recovery were analyzed. Results: LC was performed in 41 females and 28 males by the anterior Calot's triangle approach, and in 20 females and 13 males by the posterior Calot's triangle approach. There were no differences in age, gender, and body mass index between the two groups (P > .05). The probability of rupture of cystic artery between both groups was not significantly different (P = .549), and the intraoperative blood loss was more in the anterior group (P = .014). The operative time of the posterior approach appeared to be shorter (P = .013). Bile duct injury and conversion to open cholecystectomy revealed no significant difference (P > .05). The recovery time of gastrointestinal function, wound infection, white blood cell count, liver function, and postoperative hospital stay time were found to be not significantly different (P > .05). Conclusion: By the posterior Calot's triangle approach, LC is a convenient and feasible surgical procedure for chronic atrophic cholecystitis with less blood loss and can become easier without increasing the risk of surgery.
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Affiliation(s)
- Hua Zhong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaoyin Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojian Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fang Luo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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7
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Spiers HVM, Lam S, Machairas NA, Sotiropoulos GC, Praseedom RK, Balakrishnan A. Liver transplantation for iatrogenic bile duct injury: a systematic review. HPB (Oxford) 2023; 25:1475-1481. [PMID: 37633743 DOI: 10.1016/j.hpb.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/17/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Bile duct injury (BDI) is an infrequent but serious complication of cholecystectomy, often with life-changing consequences. Liver transplantation (LT) may be required following severe BDI, however given the rarity, few large studies exist to guide management for complex BDI. METHODS A systematic review was performed to assess post-operative complications, 30-day mortality, retransplant rate and 1-year and 5-year survival following LT for BDI in Medline, EMBASE, Web of Science or Cochrane Clinical Trials Database. RESULTS Seven articles met inclusion criteria, describing 179 patients that underwent LT for BDI. Secondary biliary cirrhosis (SBC) was the main indication for LT (82.2% of patients). Median model for end-stage liver disease (MELD) scores at time of LT ranged from 16 to 20.5. Median 30-day mortality was 20.0%. The 1-year and 5-year survival ranges were 55.0-84.3% and 30.0-83.3% respectively, and the overall retransplant rate was 11.5%. CONCLUSION BDI is rarely indicated for LT, predominantly for SBC following multiple prior interventions. MELD scores poorly reflect underlying morbidity, and exception criteria for waitlisting may avoid prolonged LT waiting times. 30-day mortality was higher than for non-BDI indications, with comparable long term survival, suggesting that LT remains a viable but high risk salvage option for severe BDI.
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Affiliation(s)
- Harry V M Spiers
- Department of Surgery, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom
| | - Shi Lam
- Department of Surgery, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom
| | - Nikolaos A Machairas
- 2nd Department of Propaedeutic Surgery, General Hospital Laiko, National and Kapodistrian University of Athens, Greece
| | - Georgios C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, General Hospital Laiko, National and Kapodistrian University of Athens, Greece
| | - Raaj K Praseedom
- Department of Surgery, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom
| | - Anita Balakrishnan
- Department of Surgery, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom.
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8
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Kalayarasan R, Sai Krishna P. Minimally invasive surgery for post cholecystectomy biliary stricture: current evidence and future perspectives. World J Gastrointest Surg 2023; 15:2098-2107. [PMID: 37969703 PMCID: PMC10642471 DOI: 10.4240/wjgs.v15.i10.2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 10/27/2023] Open
Abstract
Postcholecystectomy bile duct injury (BDI) remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs. Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI, the absolute number remains high as cholecystectomy is a commonly performed surgical procedure. Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent long-term results in most patients. As with many hepatobiliary disorders, a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery. Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy, laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive. While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management, most are retrospective analyses with small sample sizes. Also, long-term follow-up is available only in a limited number of studies. The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches. The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture. Despite increasing use, lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture. High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.
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Affiliation(s)
- Raja Kalayarasan
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605006, India
| | - Pothugunta Sai Krishna
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605006, India
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9
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Suárez M, Martínez R, Torres AM, Ramón A, Blasco P, Mateo J. Personalized Risk Assessment of Hepatic Fibrosis after Cholecystectomy in Metabolic-Associated Steatotic Liver Disease: A Machine Learning Approach. J Clin Med 2023; 12:6489. [PMID: 37892625 PMCID: PMC10607671 DOI: 10.3390/jcm12206489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/29/2023] Open
Abstract
Metabolic Associated Fatty Liver Disease (MASLD) is a condition that is often present in patients with a history of cholecystectomy. This is because both situations share interconnected metabolic pathways. This study aimed to establish a predictive model that allows for the identification of patients at risk of developing hepatic fibrosis following this surgery, with potential implications for surgical decision-making. A retrospective cross-sectional analysis was conducted in four hospitals using a database of 211 patients with MASLD who underwent cholecystectomy. MASLD diagnosis was established through liver biopsy or FibroScan, and non-invasive test scores were included for analysis. Various Machine Learning (ML) methods were employed, with the Adaptive Boosting (Adaboost) system selected to build the predictive model. Platelet level emerged as the most crucial variable in the predictive model, followed by dyslipidemia and type-2 diabetes mellitus. FIB-4 score proved to be the most reliable non-invasive test. The Adaboost algorithm improved the results compared to the other methods, excelling in both accuracy and area under the curve (AUC). Moreover, this system holds promise for implementation in hospitals as a valuable diagnostic support tool. In conclusion, platelet level (<150,000/dL), dyslipidemia, and type-2 diabetes mellitus were identified as primary risk factors for liver fibrosis in MASLD patients following cholecystectomy. FIB-4 score is recommended for decision-making, particularly when the indication for surgery is uncertain. This predictive model offers valuable insights into risk stratification and personalized patient management in post-cholecystectomy MASLD cases.
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Affiliation(s)
- Miguel Suárez
- Gastroenterology Department, Virgen de la Luz Hospital, 16002 Cuenca, Spain; (M.S.)
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, 160071 Cuenca, Spain
- Medical Analysis Expert Group, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
| | - Raquel Martínez
- Gastroenterology Department, Virgen de la Luz Hospital, 16002 Cuenca, Spain; (M.S.)
- Medical Analysis Expert Group, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
| | - Ana María Torres
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, 160071 Cuenca, Spain
- Medical Analysis Expert Group, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
| | - Antonio Ramón
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
| | - Pilar Blasco
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
| | - Jorge Mateo
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, 160071 Cuenca, Spain
- Medical Analysis Expert Group, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
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10
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Kurihara H, Binda C, Cimino MM, Manta R, Manfredi G, Anderloni A. Acute cholecystitis: Which flow-chart for the most appropriate management? Dig Liver Dis 2023; 55:1169-1177. [PMID: 36890051 DOI: 10.1016/j.dld.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 03/10/2023]
Abstract
Acute cholecystitis (AC) is a very common disease in clinical practice. Laparoscopic cholecystectomy remains the gold standard treatment for AC, however due to aging population, the increased prevalence of multiple comorbidities and the extensive use of anticoagulants, surgical procedures may be too risky when dealing with patients in emergency settings. In these subsets of patients, a mini-invasive management may be an effective option, both as a definitive treatment or as bridge-to-surgery. In this paper, several non-operative treatments are described and their benefits and drawbacks are highlighted. Percutaneous gallbladder drainage (PT-GBD) is one of the most common and widespread techniques. It is easy to perform and has a good cost/benefit ratio. Endoscopic transpapillary gallbladder drainage (ETGBD) is a challenging procedure that is usually performed in high volume centers by expert endoscopists, and it has a specific indication for selected cases. EUS-guided drainage (EUS-GBD) is still not widely available, but it is an effective procedure that could have several advantages, especially in rate of reinterventions. All these treatment options should be considered together in a stepwise approach and addressed to patients after an accurate case-by-case evaluation in a multidisciplinary discussion. In this review, we provide a possible flowchart in order to optimize treatments, resource and provide to patients a tailored approach.
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Affiliation(s)
- Hayato Kurihara
- Emergency Surgery Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Matteo Maria Cimino
- Emergency Surgery Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaele Manta
- Endoscopic Unit, Santa Maria Misericordia Hospital, Perugia 06122, Italy
| | - Guido Manfredi
- Gastroenterology and Endoscopy Department, ASST Maggiore Hospital Crema, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi 19, Pavia 27100, Italy.
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11
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Fu JN, Liu SC, Chen Y, Zhao J, Ma T. Analysis of risk factors for complications after laparoscopic cholecystectomy. Heliyon 2023; 9:e18883. [PMID: 37600366 PMCID: PMC10432690 DOI: 10.1016/j.heliyon.2023.e18883] [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] [Received: 03/22/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023] Open
Abstract
To analyze the risk factors of complications after laparoscopic cholecystectomy in 478 patients in our hospital. METHODS The clinical data of 478 patients who underwent laparoscopic cholecystectomy in our hospital from March 2018 to September 2022 were collected, and the occurrence of postoperative complications and related risk factors were analyzed. RESULTS A total of 36 patients (7.53%) had complications, including 9 cases (1.88%) of abdominal hemorrhage, 8 cases (1.67%) of bile duct injury, and 19 cases (3.97%) of biliary fistula. Univariate analysis showed that adhesions of Calot triangle, anatomical variation and gallbladder wall thickness greater than 5 mm were associated with postoperative complications (all P < 0.05). Multivariate analysis showed that: Calot triangle adhesion (OR = 3.041, 95%CI = 1.422-6.507), anatomical variation (OR = 4.368, 95%CI = 1.764-10.813) and gallbladder wall thickening (OR = 2.827, 95%CI = 1.422-6.507). 95%CI = 1.274-6.275) were independent risk factors for complications after laparoscopic cholecystectomy (all P < 0.05). CONCLUSION In order to reduce the occurrence of postoperative complications, the risk factors of LC should be well understood and the preoperative preparation should be made.
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Affiliation(s)
- Jing-nan Fu
- Department of Minimally Invasive Surgery, Characteristics Medical Center of Chinese People Armed Police Force, Tianjin, China
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Shu-chang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yi Chen
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Zhao
- Department of Intensive Care Unit, Tianjin Medical University General Hospital, Tianjin, China
| | - Tao Ma
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
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12
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Thomas R, Young E, Jayasena W, Raju SE. Significance of intra-operative cholangiogram and its application in suspected duodenal injuries - Case report. Int J Surg Case Rep 2023; 107:108386. [PMID: 37295243 DOI: 10.1016/j.ijscr.2023.108386] [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: 03/22/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Intraoperative cholangiogram has always been a critical procedure that allows identification of biliary anatomy, thereby reducing the risks of bile duct injuries. CASE PRESENTATION We present a unique case where the intraoperative cholangiogram highlighted a suspected duodenal injury. CLINICAL DISCUSSION This case discusses the intraoperative steps taken to ensure there was no injury, highlight the importance of cholangiogram interpretation as a skill for all surgeons. CONCLUSION Intraoperative cholangiogram is a crucial procedure to highlight both biliary and non-biliary anatomy and can be used to identify duodenal injuries as was assessed in our case.
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Affiliation(s)
- Rebecca Thomas
- Division of Surgical Specialties & Anaesthetics, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia.
| | - Edward Young
- Division of Surgical Specialties & Anaesthetics, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia.
| | - Warunika Jayasena
- Division of Surgical Specialities and Anaesthetics, Flinders Hospital, Adelaide, South Australia, Australia.
| | - Smita Esther Raju
- The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia; Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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13
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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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14
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Mazzone C, Sofia M, Sarvà I, Litrico G, Di Stefano AML, La Greca G, Latteri S. Awake laparoscopic cholecystectomy: A case report and review of literature. World J Clin Cases 2023; 11:3002-3009. [PMID: 37215416 PMCID: PMC10198068 DOI: 10.12998/wjcc.v11.i13.3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/21/2022] [Accepted: 11/10/2022] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is one of the most widely practiced surgical procedures in abdominal surgery. Patients undergo LC during general anaesthesia; however, in recent years, several studies have suggested the ability to perform LC in patients who are awake. We report a case of awake LC and a literature review.
CASE SUMMARY A 69-year-old patient with severe pulmonary disease affected by cholelithiasis was scheduled for LC under regional anaesthesia. We first performed peridural anaesthesia at the T8-T9 level and then spinal anaesthesia at the T12-L1 level. The procedure was managed in total comfort for both the patient and the surgeon. The intra-abdominal pressure was 8 mmHg. The patient remained stable throughout the procedure, and the postoperative course was uneventful.
CONCLUSION Evidence has warranted the safe use of spinal and epidural anaesthesia, with minimal side effects easily managed with medications. Regional anaesthesia in selected patients may provide some advantages over general anaesthesia, such as no airway manipulation, maintenance of spontaneous breathing, effective postoperative analgesia, less nausea and vomiting, and early recovery. However, this technique for LC is not widely used in Europe; this is the first case reported in Italy in the literature. Regional anaesthesia is feasible and safe in performing some types of laparoscopic procedures. Further studies should be carried out to introduce this type of anaesthesia in routine clinical practice.
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Affiliation(s)
- Chiara Mazzone
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Maria Sofia
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Iacopo Sarvà
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Giorgia Litrico
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Andrea Maria Luca Di Stefano
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Gaetano La Greca
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Saverio Latteri
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
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15
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Study Management Group, Varghese C, McGuinness M, Wells CI, Elliott BM, Gunawardene A, Edwards M, Expert Advisory Group, Vohra R, Griffiths EA, Connor S, Poole GH, Windsor JA, Wright D, Harmston C, Collaborating Authors, Wang JHS, Windsor J, Chen E, Ghate K, Lal S, Lekamalage B, Ratnayake M, Bansal A, Windsor J, von Keisenberg S, Hemachandran A, Singhal M, Joseph N, Bhat S, Rossaak J, Carson D, Dubey N, Pan M, Ferguson L, Watt I, Choi J, Mclauchlan J, Connor S, Nicholas E, Al-Busaidi I, Wood D, Haran C, Lin A, Fagan P, Bathgate A, Patel S, Mak J, Espiner E, Poole G, Hassan S, Javed Z, Randall M, Clough S, Cook W, Clark S, Finlayson C, Poole G, Bahl P, Singh S, Lin C, Wang C, Kittaka R, Morreau M, Ing A, Logan S, Guest S, Sutherland K, Lewis A, Roberts J, Watson B, Tietjens J, Teague R, Su'a B, Modi A, Modi V, Williams Y, Morreau J, Khoo C, Desmond B, Young M, Christmas R, Holm T, Harmston C, Long K, Garton B, Niki kau, Barber L, Amer M, Haddow J, Amer M, Fearnley-Fitzgerald C, Suresh K, Zeng E, Young-Gough A, Skeet J, El-Haddawi F, Alvarez M, Nguyen S, King J, Crichton J, Welsh F, Edwards M, Tan J, Luo J, Banker K, Field X, Allan P, Rennie S, Ratnayake CB, Srinivasa S, Gloria Kim JH, Bradley S, Singh N, Kang G, Xu W, Srinivasa S, Cook H, Mistry V, Dabla K, de Oca AM, Yoganandarajah V, Lill M, Lu J, Bonnet LA, Uiyapat T. Variation in the practice of cholecystectomy for benign biliary disease in Aotearoa New Zealand: a population-based cohort study. HPB (Oxford) 2023:S1365-182X(23)00128-4. [PMID: 37198069 DOI: 10.1016/j.hpb.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/26/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Cholecystectomy for benign biliary disease is common and its delivery should be standardised. However, the current practice of cholecystectomy in Aotearoa New Zealand is unknown. METHODS A prospective, national cohort study of consecutive patients having cholecystectomy for benign biliary disease was performed between August and October 2021 with 30-day follow-up, through STRATA, a student- and trainee-led collaborative. RESULTS Data were collected for 1171 patients from 16 centres. 651 (55.6%) had an acute operation at index admission, 304 (26.0%) had delayed cholecystectomy following a previous admission, and 216 (18.4%) had an elective operation with no preceding acute admissions. The median adjusted rate of index cholecystectomy (as a proportion of index and delayed cholecystectomy) was 71.9% (range 27.2%-87.3%). The median adjusted rate of elective cholecystectomy (as proportion of all cholecystectomies) was 20.8% (range 6.7%-35.4%). Variations across centres were significant (p < 0.001) and inadequately explained by patient, operative, or hospital-factors (index cholecystectomy model R2 = 25.8, elective cholecystectomy model R2 = 50.6). CONCLUSIONS Notable variation in the rates of index and elective cholecystectomy exists in Aotearoa New Zealand not attributable to patient, operative or hospital factors alone. National quality improvement efforts to standardise availability of cholecystectomy are needed.
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16
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Thomas AS, Gleit Z, Younan S, Genkinger J, Kluger MD. High rate of stone-related complications after stapling the cystic duct during laparoscopic cholecystectomy-an underrecognized risk. Surg Endosc 2023:10.1007/s00464-023-09947-2. [PMID: 36890412 DOI: 10.1007/s00464-023-09947-2] [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: 09/27/2022] [Accepted: 02/12/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Laparoscopic staplers (LS) have been suggested as a safe alternative to metal clips in laparoscopic cholecystectomy when the cystic duct is too inflamed or wide for complete clip occlusion. We aimed to evaluate the perioperative outcomes of patients whose cystic ducts were controlled by LS and evaluate the risk factors for complications. METHODS Patients who underwent laparoscopic cholecystectomy with LS used to control the cystic duct from 2005 to 2019 were retrospectively identified from an institutional database. Patients were excluded for open cholecystectomy, partial cholecystectomy, or cancer. Potential risk factors for complications were assessed using logistic regression analysis. RESULTS Among 262 patients, 191 (72.9%) were stapled for size and 71 (27.1%) for inflammation. In total, 33 (16.3%) patients had Clavien-Dindo grade ≥ 3 complications, with no significant difference when surgeons chose to staple for duct size versus inflammation (p = 0.416). Seven patients had bile duct injury. A large proportion had Clavien-Dindo grade ≥ 3 postoperative complications specifically related to bile duct stones [n = 29 (11.07%)]. Intraoperative cholangiogram was protective against postoperative complications [odds ratio (OR) = 0.18 (p = 0.022)]. CONCLUSION Whether these high complication rates reflect a technical issue with stapling, more challenging anatomy, or worse disease, findings question whether the use of LS during laparoscopic cholecystectomy is truly a safe alternative to the already accepted methods of cystic duct ligation and transection. Based on these findings, an intraoperative cholangiogram should be performed when considering a linear stapler during laparoscopic cholecystectomy to: (1) ensure the biliary tree is free of stones; (2) prevent inadvertent transection of the infundibulum rather than the cystic duct; and, (3) allow opportunity for safe alternative strategies when an IOC is not able to confirm anatomy. Otherwise, surgeons employing LS devices should be aware that patients are at higher risk for complications.
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Affiliation(s)
- Alexander S Thomas
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
- Division of GI and Endocrine Surgery, Surgery Resident and Postdoctoral Research Fellow, New York Presbyterian Hospital, 8th Floor, Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA.
| | - Zachary Gleit
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Younan
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeanine Genkinger
- Department of Epidemiology, Herbert Irving Comprehensive Cancer Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Michael D Kluger
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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17
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Ardito F, Lai Q, Savelli A, Grassi S, Panettieri E, Clemente G, Nuzzo G, Oliva A, Giuliante F. Bile duct injury following cholecystectomy: delayed referral to a tertiary care center is strongly associated with malpractice litigation. HPB (Oxford) 2023; 25:374-383. [PMID: 36739266 DOI: 10.1016/j.hpb.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bile duct injury (BDI) following cholecystectomy is associated with malpractice litigation. Aim of this study was to evaluate risk factors for litigation in patients with BDI referred in a tertiary care center. METHODS Patients treated for BDI between 1994 and 2016. Stabilized inverse probability therapy weighting was used and multivariable logistic regression analysis identified risk factors for malpractice litigation. RESULTS Of the 211 treated patients, 98 met the inclusion criteria: early-referral group (<20 days; 51.0%), late-referral (≥20 days; 49.0%). 36 patients (36.7%) initiated malpractice litigation with verdict in favor of plaintiff in 86.7% of cases (median payment = €90 500, up to €600 000). Attempts at surgical and endoscopic repair before referral were significantly higher in late-referral group. Failed postoperative management (delayed referral, attempts at repair before referral) was one of the strongest predictors for litigation. Risk of litigation progressively increased from 23.8%, when referral time was within 19 days, to 54.5% (61-120 days), to 60.0% (121-210 days) and to 65.1% (211-365 days). DISCUSSION Litigation rate after BDI was 37%. Delayed referral to tertiary care center was one of the strongest predictors for litigation. Prompt referral to tertiary experienced centers without any attempt at repair may reduce the risk of litigation.
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Affiliation(s)
- Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Italy
| | - Alida Savelli
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gennaro Clemente
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gennaro Nuzzo
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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18
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A retrospective analysis of bile duct injuries treated in a tertiary center: the utility of a universal classification-the ATOM classification. Surg Endosc 2023; 37:347-357. [PMID: 35948807 DOI: 10.1007/s00464-022-09497-z] [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: 05/12/2022] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Bile duct injuries (BDI) are the most feared complications that can occur after laparoscopic cholecystectomy (LC). BDI have a high variability and complexity, several classifications being developed along the years in order to correctly assess and divide BDI. The EAES ATOM classification encompasses all the important details of a BDI: A (for anatomy), To (for time of), and M (for mechanism) but have not gained universal acceptance yet. Our study intents to analyze the cases of BDI treated in our institution with a focus on the clinical utility of the ATOM classification. METHODS We conducted a retrospective study, on a 10-year period (2011-2020), including patients diagnosed with BDI after LC, with their definitive treatment performed in our tertiary center. All injuries were retrospectively classified using the Strasberg, Hannover, and ATOM classifications. RESULTS We included in our study 100 patients; 15% of the BDI occurred in our center. No classification system was used in 73% of patients; 23% of the BDI were classified by the Strasberg system, 3% were classified by the Bismuth classification, 1% being classified by the ATOM classification. After retrospectively assessing all BDI, we observed that especially the Strasberg classification, as well as Hannover, over-simplifies the characteristics of the injury, many types of BDI according to ATOM being included in the same Strasberg or Hannover category. Most main bile duct injuries underwent a bilio-digestive anastomosis (60%), as a definitive treatment. An important percentage of cases (31%) underwent a primary treatment in the hospital of origin, reintervention with definitive treatment being done in our department. CONCLUSION The ATOM classification is the best suited for accurately describing the complexity of a BDI, serving as a template for discussing the correct management for each lesion. Efforts should be made toward increasing the use of this classification in day-to-day clinical practice.
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19
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Cubisino A, Dreifuss NH, Cassese G, Bianco FM, Panaro F. Minimally invasive biliary anastomosis after iatrogenic bile duct injury: a systematic review. Updates Surg 2023; 75:31-39. [PMID: 36205829 DOI: 10.1007/s13304-022-01392-5] [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: 06/30/2022] [Accepted: 09/27/2022] [Indexed: 01/14/2023]
Abstract
Major bile duct injuries (BDIs) may require complex surgical repairs that are usually performed with a conventional open approach. This study aims to analyze current evidence concerning the safety and the outcomes of the minimally invasive (MI) approach for biliary anastomosis in post-cholecystectomy BDIs. A systematic search of MEDLINE, Embase, and Web-Of-Science indexed studies involving MI (laparoscopic or robotic) biliary anastomosis in patients with iatrogenic BDIs was performed. The quality of the studies was assessed using the MINORS criteria. A total of 13 studies involving 198 patients were included. One hundred and twenty-five patients (63.1%) underwent a laparoscopic biliary anastomosis, while 73 (36.1%) received an analogue robotic procedure. All the included BDIs were types D and E (E1-E5). The mean OT varied between 190 and 330 (mean = 227) minutes. Ten studies reported the mean intraoperative blood loss that ranged between 50 and 252 (mean = 135.9) mL. No conversions occurred in the robotic series, while four patients required conversion to open surgery among the laparoscopic ones. The mean length of postoperative hospital stay was 6.3 days. The reported overall morbidity was similar among the robotic and laparoscopic series. During the follow-up period, no surgery-related mortality occurred. A growing number of referral centers are showing the safety and feasibility of the MI approach for biliary anastomosis in patients with major BDIs. Further prospective comparative studies are needed to draw more definitive conclusions.
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Affiliation(s)
- Antonio Cubisino
- Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA.
| | - Nicolas H Dreifuss
- Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, Minimally Invasive and Robotic HPB Surgery Unit, Federico II University, Naples, Italy
| | - Francesco M Bianco
- Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Fabrizio Panaro
- Division of HBP Surgery and Transplantation, Department of Surgery, Hôpital Saint Eloi, CHU-Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier, France
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20
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Pryadko AS, Romashchenko PN, Maistrenko NA, Aliev AK, Aliev RK, Abasov SY. [Implementation of the «safe cholecystectomy» program in the Leningrad Region]. Khirurgiia (Mosk) 2023:109-116. [PMID: 37916564 DOI: 10.17116/hirurgia2023101109] [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] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To present a treatment program for patients with cholelithiasis in the region in accordance with modern requirements for the quality of medical care in the realities of a three-level system of surgical care. MATERIAL AND METHODS The results of treatment of patients with cholelithiasis at various levels of medical care were analyzed with an assessment of the indicators of operational activity of performing cholecystectomy by laparoscopic and open methods, the development of complications of surgery and inpatient mortality. RESULTS A programmatic approach has been developed to assist patients with cholelithiasis in the conditions of regional healthcare at different levels of surgical care. CONCLUSION The implementation of this program minimizes the number of postoperative complications and mortality at the second and third levels of surgical care. It is determined that a rational approach to reduce the number of bile duct injuries is their prevention by impeccable compliance with the technique of surgical intervention on the organs of the upper floor of the abdominal cavity, and to reduce the number of negative consequences - compliance with the proposed algorithm of diagnosis and treatment.
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Affiliation(s)
- A S Pryadko
- Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia
- Leningrad Regional Clinical Hospital, St. Petersburg, Russia
| | - P N Romashchenko
- Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia
| | - N A Maistrenko
- Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia
| | - A K Aliev
- Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia
| | - R K Aliev
- Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia
| | - Sh Yu Abasov
- Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia
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Fair L, Squiers JJ, Jacinto K, Perryman M, Misenhimer J, Blair S, Rodriguez C. Fast-Track Nonelective Laparoscopic Cholecystectomy is Safe and Feasible. J Surg Res 2023; 281:256-263. [PMID: 36219937 DOI: 10.1016/j.jss.2022.09.003] [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: 03/22/2022] [Revised: 08/11/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Ample evidence exists to support the safety of fast-track discharge after elective laparoscopic cholecystectomy (LC), but there is currently no data available to support the safety of fast-tracking patients undergoing nonelective LC. We sought to determine whether fast-tracking patients undergoing nonelective LC is safe and feasible. METHODS We performed a retrospective cohort review of 661 consecutive patients undergoing LC at a single teaching institution from April 2018 to January 2020. Subjects were divided into two groups: elective LC (ELC) and fast-track nonelective LC (FTLC). FTLC was defined as nonelective LC with total length of stay <36 h. Patients undergoing nonelective LC with length of stay exceeding 36 h were excluded. The primary outcome of interest was readmission within 30 d. The secondary outcomes included incidences of return to emergency department within 30 d, retained stone, bile leak, and wound infection. RESULTS Of 661 LC, 185 (27%) were ELC and 476 (72%) were nonelective. FTLC included 121 (25%) of the nonelective LC. Preoperative characteristics were similar among the groups. On final pathology, chronic cholecystitis was predominant in both groups, but FTLC exhibited higher rates of acute cholecystitis (P < 0.0001). There was no significant difference in the primary outcome among groups: readmission within 30 d occurred in 6 (3%) ELC patients and 4 (3%) FTLC patients (P = 1.0). There were no significant differences in rates of return to emergency department within 30 d, retained stone, bile leak, or wound infection. CONCLUSIONS With comparable postoperative complication rates to ELC, FTLC can be safely used in select patients. Additional studies are needed to determine preoperative predictors of FTLC suitability to prospectively identify appropriate patients.
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Affiliation(s)
- Lucas Fair
- Department of Surgery, John Peter Smith Hospital, Fort Worth, Texas; Department of Surgery, Baylor University Medical Center, Dallas, Texas.
| | - John J Squiers
- Department of Surgery, John Peter Smith Hospital, Fort Worth, Texas; Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Kimberly Jacinto
- Department of Surgery, John Peter Smith Hospital, Fort Worth, Texas; Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Matthew Perryman
- Department of Surgery, John Peter Smith Hospital, Fort Worth, Texas; Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Jennifer Misenhimer
- Department of Surgery, John Peter Smith Hospital, Fort Worth, Texas; Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Somer Blair
- Office of Clinical Research, John Peter Smith Hospital, Fort Worth, Texas
| | - Carlos Rodriguez
- Department of Surgery, John Peter Smith Hospital, Fort Worth, Texas; Department of Surgery, Texas Health Harris Methodist Hospital, Fort Worth, Texas
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Muacevic A, Adler JR, AlOtaibi WS, Almalki JH, Shalhoub MM, Nouh TA. Charlson Comorbidity Index as a Predictor of Difficult Cholecystectomy in Patients With Acute Cholecystitis. Cureus 2022; 14:e31807. [PMID: 36579241 PMCID: PMC9780507 DOI: 10.7759/cureus.31807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background The Charlson Comorbidity Index (CCI) has been validated as a predictor of overall survival and post-surgical mortality. CCI is adopted by Tokyo Guidelines as one of the main criteria in the management of acute cholecystitis. Our study evaluates the role of CCI in predicting difficult cholecystectomy. Methods All patients who underwent cholecystectomy for acute cholecystitis between January 2017 and September 2019 were included. CCI, Emergency Surgery Score (ESS), and American Society of Anesthesiologists (ASA) score were calculated and analyzed to assess their predictive value for difficult cholecystectomy. Results A total of 96 patients were included and allocated to difficult and non-difficult cholecystectomy groups. CCI was found to be a significant predictor of difficult cholecystectomy (OR 1.59; 59% CI, 1.04. 2.42; p= 0.031). Similarly, ESS was found to be a predictor tool of difficult cholecystectomy (OR 1.42; 59% CI, 1.05. 1.93; p= 0.024). There was no significant difference in adverse outcomes between the two groups. Conclusion CCI was able to predict a difficult cholecystectomy in our study population. However further studies are required to evaluate if it can be used as a predictor of adverse outcomes in the context of acute cholecystitis.
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Alexander H, Moore M, Hannam J, Poole G, Bartlett A, Merry A. Days alive and out of hospital after laparoscopic cholecystectomy. ANZ J Surg 2022; 92:2889-2895. [PMID: 36250953 PMCID: PMC9828827 DOI: 10.1111/ans.18099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Days alive and out of hospital (DAOH) is a metric that incorporates several outcomes into a single, standardized measure. This study aimed to explore the utility of DAOH in assessing the outcomes of a retrospective cohort of patients undergoing laparoscopic cholecystectomy (LC). METHODS Patients undergoing LC at Auckland City Hospital between 1 January 2010 and 31 August 2015 were included. DAOH values were calculated for the 90 days from the date of surgery (DAOH90 ) and described using median and interquartile ranges (IQR). DAOH90 distributions were compared using a two-tailed (non-parametric) Wilcoxon-Mann-Whitney test. RESULTS 1652 patients undergoing LC were studied. Patients experiencing complications (n = 70, 4.2%) had fewer DAOH90 (median 83, IQR 79, 86) than patients who underwent uncomplicated LC (median 88, IQR 86, 88), P < 0.001. Patients who were converted to open cholecystectomy (n = 70, 4.2%) also had fewer DAOH90 (median 82.5, IQR 79, 84) than patients who underwent uncomplicated LC, P < 0.001. Post-operative complications and conversion had a statistically significant effect on DAOH90 at each of the tested quantiles, except for conversion at the 0.1 quantile. CONCLUSION DAOH90 is readily calculable from existing New Zealand administrative data sources and is sensitive to the occurrence of complications after LC.
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Affiliation(s)
- Harry Alexander
- Department of Anaesthesiology, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
| | - Matthew Moore
- Department of Anaesthesiology, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
| | - Jacqueline Hannam
- Department of Anaesthesiology, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
| | - Garth Poole
- Department of Surgery, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
| | - Adam Bartlett
- Department of Surgery, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
| | - Alan Merry
- Department of Anaesthesiology, Faculty of Medical and Health SciencesUniversity of AucklandGraftonNew Zealand
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Effectiveness of Laparoscopic Cholecystectomy in Patients with Gallbladder Stones with Chronic Cholecystitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1434410. [PMID: 35966742 PMCID: PMC9374550 DOI: 10.1155/2022/1434410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 12/04/2022]
Abstract
Objective To assess the effectiveness of laparoscopic cholecystectomy in patients with gallbladder stones and chronic cholecystitis. Methods From July 2018 to January 2020, 90 patients with gallbladder stones and chronic cholecystitis assessed for eligibility were recruited and concurrently assigned (1 : 1) to receive either small-incision cholecystectomy (observation group) or laparoscopic cholecystectomy (experimental group). Outcome measures included operation time, intraoperative bleeding volume, postoperative hospital stay, c-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-α (TNF-α), gastrin (GAS), vasoactive intestinal peptide (VIP), motilin (MOT), and adverse events. Results Patients given laparoscopic cholecystectomy showed lower levels of operation-related indices versus those receiving small-incision cholecystectomy (P < 0.05). Laparoscopic cholecystectomy resulted in lower postoperative levels of CRP, IL-6, and TNF-α in the patients versus small-incision cholecystectomy (P < 0.05). Patients receiving laparoscopic cholecystectomy showed better GAS, VIP, and MOT levels than those receiving small-incision cholecystectomy (P < 0.05). The eligible patients after laparoscopic cholecystectomy had a significantly lower incidence of adverse events versus those after small-incision cholecystectomy (P < 0.05). Conclusion Laparoscopic cholecystectomy effectively shortens the operative time and length of hospital stay in patients with gallbladder stones and chronic cholecystitis, reduces intraoperative bleeding, attenuates the inflammatory response, and enhances the gastrointestinal function, with less surgical trauma and high safety. Clinical trials are, however, required prior to promotion.
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Effects of Individualized Nursing Based on Zero-Defect Theory on Perioperative Patients Undergoing Laparoscopic Cholecystectomy. DISEASE MARKERS 2022; 2022:5086350. [PMID: 35607441 PMCID: PMC9124088 DOI: 10.1155/2022/5086350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022]
Abstract
Objective This study is aimed at analyzing the effects of individualized nursing based on the zero-defect theory on perioperative patients undergoing laparoscopic cholecystectomy. Methods 174 patients who underwent laparoscopic cholecystectomy from 1st November 2019 to 30th November 2020 were enrolled as the research subjects and randomly divided into control and observation groups. The patients in the control group received conventional perioperative nursing care, and the patients in the observation group were treated with individualized nursing based on the zero-defect theory. Results The heart rate, diastolic blood pressure, and systolic blood pressure level of patients in two groups after nursing decreased significantly, and the reduction in the observation group was more significant than that in the control group. The depression and anxiety scores of the two groups after nursing were decreased, and the decrease in the observation group was significantly greater than that in the control group. The time to first postoperative exhaust, return to normal intake, out-of-bed activity, and hospital stay in the observation group was less than that in the control group. The incidence of postoperative complications in the observation group was substantially lower than that in the control group. The satisfaction degree of nursing care in the observation group was significantly higher than that in the control group. Conclusion Individualized nursing care based on zero-defect theory can effectively reduce the perioperative psychological stress response of patients with laparoscopic cholecystectomy. It helps to improve the negative emotions of depression and anxiety, promotes the recovery of disease, reduces postoperative complications, and improves nursing satisfaction, which is worthy of clinical promotion.
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Maalouf HH, Aby Hadeer R, Tabbikha O, Abou-Malhab C, Wakim R. Symptomatic Pneumomediastinum Following Laparoscopic Cholecystectomy: A Case Report and a Literature Review. Cureus 2022; 14:e24604. [PMID: 35651390 PMCID: PMC9138895 DOI: 10.7759/cureus.24604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/17/2022] Open
Abstract
Isolated pneumomediastinum is a rare complication after laparoscopic procedures. Herein, we present a case of a 38-year-old woman who presented two days after laparoscopic cholecystectomy with pleuritic chest pain and dyspnea and was found to have isolated pneumomediastinum. The patient was admitted for monitoring, oxygen therapy, and antibiotic prophylaxis and she was discharged on the fourth postoperative day when her symptoms resolved both subjectively and radiologically. Only two other cases of symptomatic isolated pneumomediastinum after laparoscopic cholecystectomy were reported in the literature and all of them were female patients, diagnosed radiologically, and treated conservatively. Therefore, isolated pneumomediastinum should be included in the differential diagnosis of dyspnea and chest pain after laparoscopic surgeries in order to have an early diagnosis, start early treatment, and prevent unnecessary investigations or advancement of the disease.
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Alavi Farzaneh B, Alipour M, Reisi-Vanani V. Post-operative ascites of unknown origin after laparoscopic cholecystectomy: Case report. Ann Med Surg (Lond) 2022; 76:103431. [PMID: 35284068 PMCID: PMC8914458 DOI: 10.1016/j.amsu.2022.103431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance Post Laparoscopic cholecystectomy ascites is a rare complication that might be due to biliary leak, lymph duct injuries, infections, peritoneal reaction bowel injuries, malignancies and etc. Case presentation Here we have reported post-cholecystectomy ascites presented with hypovolemic shock in a women of unknown origin. Different possible etiologies have been ruled out for her but her intra-peritoneal secretions had been decreased about one week of hospitalization and was discharged without figuring out its etiology. Clinical discussion Post-cholecystectomy ascites is a rare condition that could be caused by biliary leak, lymphatic leak, ovarian hyper stimulation syndrome, infections, peritoneal reactions and malignancies that all of them should be considered for these patients to manage their problem. Conclusion The exact cause of ascites in the presented case was still unknown and the condition was controlled by administration of corticosteroids, octreotide, albumin, and insertion of the stents in biliary ducts. More investigation esp. on immunologic causes are needed. Post laparoscopic ascites could be life-threatening with Iatrogenic and non-iatrogenic causes. Immunologic causes need to be studied more.
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Affiliation(s)
- Babak Alavi Farzaneh
- Department of Surgery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mehdi Alipour
- Department of Surgery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Vahid Reisi-Vanani
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Berlet M, Jell A, Bulian D, Friess H, Wilhelm D. [Clinical value of alternative technologies to standard laparoscopic cholecystectomy - single port, reduced port, robotics, NOTES]. Chirurg 2022; 93:566-576. [PMID: 35226123 DOI: 10.1007/s00104-022-01608-9] [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] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
Surgical interventions should ideally treat an existing disease curatively and achieve this with a low complication rate and minimal trauma. In this sense, laparoscopic cholecystectomy has become established as the recognized standard for the treatment of cholecystolithiasis. Newer procedures, such as single-port surgery or natural orifice transluminal endoscopic surgery (NOTES) have recently emerged to reduce the already low interventional trauma even further and to provide a better cosmetic outcome. With all new methods the main aim is the reduction of the transabdominal access points. Based on published results and diagnosis-related groups (DRG) data, this article examines whether this goal has been achieved, also with respect to the overall quality of treatment and the complication rates. In this context and in addition to the already mentioned approaches, robotic cholecystectomy and the reduced port approach are also considered.
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Affiliation(s)
- M Berlet
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - A Jell
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - D Bulian
- Klinik für Viszeral‑, Tumor‑, Transplantations- und Gefäßchirurgie, Zentrum für interdisziplinäre Viszeralmedizin (ZIV), Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - H Friess
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - D Wilhelm
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland.
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Mosenko V, Jurevičius S, Šileikis A. Enterocutaneous Fistula: Open Repair after Unsuccessful Stenting—A Case Report. Medicina (B Aires) 2022; 58:medicina58020223. [PMID: 35208547 PMCID: PMC8876532 DOI: 10.3390/medicina58020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and the skin; by some estimates, it represents 88.2% of all fistulae. It can either develop spontaneously due to underlying malignancy, inflammatory bowel disease, radiation exposure, or, more commonly, as a complication of gastrointestinal surgery. A 75-year-old woman was treated for a small bowel enterocutaneous fistula that developed after laparoscopic cholecystectomy using a HANAROSTENT self-expanding metal stent (SEMS) to cover the fistula. Seven months later, the patient was discharged. For the following 2 years, the patient refused the reconstructive surgery until stent obstruction occurred. After optimizing the patient’s nutritional status, laparotomy and small bowel resection were performed successfully. The use of SEMS in fistulas of the lower gastrointestinal tract is a heavily debated and fairly under-researched topic, especially in the context of enterocutaneous fistulas. No international guidelines officially recommend using SEMS in the small bowel ECF.
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Bhat S, Varghese C, Xu W, Barazanchi AWH, Ratnayake B, O'Grady G, Windsor JA, Wells CI. Outcomes following out-of-hours acute cholecystectomy: A systematic review and meta-analysis. J Trauma Acute Care Surg 2022; 92:447-455. [PMID: 34554140 DOI: 10.1097/ta.0000000000003402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cholecystectomy is one of the most commonly performed abdominal operations. Rising demands on acute operating theater availability and resource utilization in the daytime have led to acute cholecystectomy being performed out-of-hours (in the evenings, at night, or on weekends), although it remains unknown whether outcomes differ between out-of-hours and in-hours (during the daytime on weekdays) acute cholecystectomy. This systematic review and meta-analysis aimed to compare outcomes following out-of-hours versus in-hours acute cholecystectomy. METHODS The study protocol was prospectively registered on PROSPERO (ID: CRD42021226127). MEDLINE, EMBASE, and Scopus databases were systematically searched for studies comparing outcomes following out-of-hours and in-hours acute cholecystectomy in adults with any acute benign gallbladder disease. The outcomes of interest were rates of bile leakage, bile duct injury, overall postoperative complications, conversion to open cholecystectomy, specific intraoperative and postoperative complications, length of stay, readmission, and mortality. Subgroup (evening/night-time vs. daytime, weekend vs. weekday, acute surgical unit [ASU]-only, non-ASU, and laparoscopic-only) and sensitivity analyses of adjusted multivariate regression analysis results was also performed. RESULTS Eleven studies were included. There were no differences between out-of-hours and in-hours acute cholecystectomy for rates of bile leakage, bile duct injury, overall postoperative complications, conversion to open cholecystectomy, operative duration, readmission, mortality, and postoperative length of stay. Higher rates of postoperative sepsis (odds ratio, 1.58; 95% confidence interval, 1.04-2.41; p = 0.03) and pneumonia (odds ratio, 1.55; 95% confidence interval, 1.06-2.26; p = 0.02) were observed following out-of-hours acute cholecystectomy on univariate meta-analysis, but not after the adjusted multivariate meta-analysis. Higher conversion rates were observed when out-of-hours cholecystectomy was performed in centers without an ASU. CONCLUSION This systematic review and meta-analysis has not shown an increased risk in overall or specific complications associated with out-of-hours compared with in-hours acute cholecystectomy. However, future studies should assess the potential impact of structural hospital factors, such as an ASU, on outcomes following out-of-hours acute cholecystectomy. LEVEL OF EVIDENCE Systematic Review and Meta-Analysis Study, Level IV.
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Affiliation(s)
- Sameer Bhat
- From the Department of Surgery (S.B., C.V., W.X., A.W.H.B., B.R., G.O., J.A.W., C.I.W.), Faculty of Medical and Health Sciences, and Auckland Bioengineering Institute (G.O.), The University of Auckland, Auckland, New Zealand
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The effect of surgical strategy in difficult cholecystectomy cases on postoperative complications outcome: a value-based healthcare comparative study. Surg Endosc 2022; 36:5293-5302. [PMID: 35000001 DOI: 10.1007/s00464-021-08907-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/21/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND In patients undergoing laparoscopic cholecystectomy (LC) for complicated biliary disease, complication rates increase up to 30%. The aim of this study is to assess the effect of differences in surgical strategy comparing outcome data of two large volume hospitals. METHODS A prospective database was created for all the patients who underwent a LC in two large volume hospitals between January 2017 and December 2018. In cases of difficult cholecystectomy in clinic A, regular LC or conversion were surgical strategies. In clinic B, laparoscopic subtotal cholecystectomy was performed as an alternative in difficult cases. The difficulty of the cholecystectomy (score 1-4) and surgical strategy (regular LC, subtotal cholecystectomy, conversion) were scored. Postoperative complications, reinterventions, and ICU admission were assessed. For predicting adverse postoperative complication outcomes, uni- and multivariable analyses were used. RESULTS A total of 2104 patients underwent a LC in the study period of which 974 were from clinic A and 1130 were from clinic B. In total, 368 procedures (17%) were scored as a difficult cholecystectomy. In clinic A, more conversions were performed (4.4%) compared to clinic B (1.0%; p < 0.001). In clinic B, more subtotal laparoscopic cholecystectomies were performed (1.8%) compared to clinic A (0%; p = < 0.001). Overall complication rate was 8.2% for clinic A and 10.2% for clinic B (p = 0.121). Postoperative complication rates per group for regular LC, conversion, and subtotal cholecystectomy in difficult cholecystectomies were 45 (15%), 12 (24%), and 7 (35%; p = 0.035), respectively. The strongest predictor for Clavien-Dindo grade 3-5 complication was subtotal cholecystectomy. CONCLUSION Surgical strategy in case of a difficult cholecystectomy seems to have an important impact on postoperative complication outcome. The effect of a subtotal cholecystectomy on complications is of great concern.
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Melly C, McGeehan G, O’Connor N, Johnston A, Bass G, Mohseni S, Donohoe C, Bucholc M, Sugrue M. OUP accepted manuscript. BJS Open 2022; 6:6603491. [PMID: 35668711 PMCID: PMC9171002 DOI: 10.1093/bjsopen/zrac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare requires patient feedback to improve outcomes and experience. This study undertook a systematic review of the depth, variability, and digital suitability of current patient-reported outcome measures (PROMs) in patients undergoing laparoscopic cholecystectomy. Methods A PROSPERO-registered (registration number CRD42021261707) systematic review was undertaken for all relevant English language articles using PubMed version of MEDLINE, Scopus, and Web of Science electronic databases in June 2021. The search used Boolean operators and wildcards and included the keywords: laparoscopic cholecystectomy AND patient outcome OR patient-reported outcome OR patient-reported outcome measure OR PRO OR PROM. Medical Subjects Heading terms were used to search PubMed and Scopus. Articles published from 1 January 2011 to 2 June 2021 were included. Results A total of 4960 individual articles were reviewed in this study, of which 44 were found to evaluate PROMs in patients undergoing laparoscopic cholecystectomy and underwent methodological index for non-randomized studies (MINORS) grading. Twenty-one articles spanning 19 countries and four continents met all inclusion criteria and were included in the qualitative data synthesis. There was significant heterogeneity in PROMs identified with eight different comprehensive PROM tools used in the 21 studies. There was wide variation in the time points at which PROMs were recorded. Fourteen of 21 studies recorded PROMs before and after surgery, and 7 of 21 recorded PROMs only after surgery. Follow-up intervals ranged from 3 days to 2 years after surgery. Conclusions This study identified that while post-laparoscopic cholecystectomy PROMs are infrequently measured currently, tools are widely available to achieve this in clinical practice. PROMs may not capture all the outcomes but should be incorporated into future cholecystectomy outcome research. The EQ-5D™ (EuroQoL Group, Rotterdam, the Netherlands) provides a simple platform for the modern digital era.
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Affiliation(s)
| | - Gearoid McGeehan
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
- University of Limerick School of Medicine, University of Limerick, Limerick, Ireland
| | - Niall O’Connor
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - Alison Johnston
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - Gary Bass
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery Orebro University Hospital, & School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Claire Donohoe
- Department of Surgery, Trinity College Dublin, St James’ Hospital, Dublin, Ireland
| | - Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry-Londonderry, UK
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
- EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry-Londonderry, UK
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Review of automated performance metrics to assess surgical technical skills in robot-assisted laparoscopy. Surg Endosc 2021; 36:853-870. [PMID: 34750700 DOI: 10.1007/s00464-021-08792-5] [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: 07/13/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Robot-assisted laparoscopy is a safe surgical approach with several studies suggesting correlations between complication rates and the surgeon's technical skills. Surgical skills are usually assessed by questionnaires completed by an expert observer. With the advent of surgical robots, automated surgical performance metrics (APMs)-objective measures related to instrument movements-can be computed. The aim of this systematic review was thus to assess APMs use in robot-assisted laparoscopic procedures. The primary outcome was the assessment of surgical skills by APMs and the secondary outcomes were the association between APM and surgeon parameters and the prediction of clinical outcomes. METHODS A systematic review following the PRISMA guidelines was conducted. PubMed and Scopus electronic databases were screened with the query "robot-assisted surgery OR robotic surgery AND performance metrics" between January 2010 and January 2021. The quality of the studies was assessed by the medical education research study quality instrument. The study settings, metrics, and applications were analysed. RESULTS The initial search yielded 341 citations of which 16 studies were finally included. The study settings were either simulated virtual reality (VR) (4 studies) or real clinical environment (12 studies). Data to compute APMs were kinematics (motion tracking), and system and specific events data (actions from the robot console). APMs were used to differentiate expertise levels, and thus validate VR modules, predict outcomes, and integrate datasets for automatic recognition models. APMs were correlated with clinical outcomes for some studies. CONCLUSIONS APMs constitute an objective approach for assessing technical skills. Evidence of associations between APMs and clinical outcomes remain to be confirmed by further studies, particularly, for non-urological procedures. Concurrent validation is also required.
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Gach T, Bogacki P, Markowska B, Bonior J, Paplaczyk M, Szura M. Quality of life in patients after laparoscopic cholecystectomy due to gallstone disease – evaluation of long-term postoperative results. POLISH JOURNAL OF SURGERY 2021; 93:19-24. [DOI: 10.5604/01.3001.0015.4213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> Currently, the standard treatment of gallstone disease is laparoscopic cholecystectomy. Considering its availability, reduction of postoperative pain and shortened stay in the hospital, a constant upward trend in the number of such procedures is observed. However, about one third of patients undergoing such treatment report pain and dyspeptic disorders following the surgery. The assessment of the quality of life of patients undergoing laparoscopic cholecystectomy, based on standardized questionnaires, should be one of the elements allowing for the assessment of the impact of the applied treatment on patients' lives. </br></br> <b>Aim:</b> The aim of this retrospective study is to evaluate the impact of laparoscopic cholecystectomy on the quality of life of patients operated in one center. </br></br> <b>Materials and methods:</b> The study has been carried out retrospectively with the use of a GIQLI questionnaire completed online by the patients 6 months after undergoing laparoscopic cholecystectomy. The study included patients over 18 years of age who have not experienced any complications within the perioperative period and did not require open surgery. The study group has been divided into two subgroups depending on the presence of symptoms of acute gallstone disease in the pre-operative period. </br></br> <b>Results: </b>The study group consisted of 205 patients (53 men, 152 women, aged 19 to 87, with an average of 54.3). The subgroup with an asymptomatic gallstone disease (dyspeptic disorders, without biliary colic) consisted of 47 patients (18 men, 29 women, aged 19–87). Symptomatic gallstone disease occurred in 158 people (35 men, 123 women aged 22 to 81). There have been certain statistically significant differences in the post-operative health condition between the group of patients with symptoms of gallstone disease and the asymptomatic patients. 94.3% of symptomatic patients concluded that their condition has improved and 5.7% that it remained unchanged. Among asymptomatic patients, only 53.2% of patients stated that they felt better post-surgery, 44.7% reported no changes (p < 0.001). There have been no significant differences in the overall QIQLI scores between these subgroups, although symptomatic patients assessed their social functioning better (8.9 ±1.5 vs 8.11 ±2.08, p = 0.004). There have been certain differences between men and women in the assessment of the quality of life in the context of the presence of key symptoms (M: 28.87 ±4.23, F: 26.77 ±5.0, p = 0.007). </br></br> <b> Conclusion:</b> The patients with a symptomatic gallstone disease report they feel better after laparoscopic cholecystectomy as compared to the group of asymptomatic patients. The overall QOL score measured by the GIQLI form does not depend on the presence of symptoms in the preoperative period. Men benefited more from surgery as regards key symptoms.
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Affiliation(s)
- Tomasz Gach
- Department of Surgery, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
| | - Paweł Bogacki
- Department of Surgery, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
| | - Beata Markowska
- Department of Surgery, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
| | - Joanna Bonior
- Department of Medical Physiology, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
| | - Małgorzata Paplaczyk
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
| | - Mirosław Szura
- Department of Surgery, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
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de'Angelis N, Catena F, Memeo R, Coccolini F, Martínez-Pérez A, Romeo OM, De Simone B, Di Saverio S, Brustia R, Rhaiem R, Piardi T, Conticchio M, Marchegiani F, Beghdadi N, Abu-Zidan FM, Alikhanov R, Allard MA, Allievi N, Amaddeo G, Ansaloni L, Andersson R, Andolfi E, Azfar M, Bala M, Benkabbou A, Ben-Ishay O, Bianchi G, Biffl WL, Brunetti F, Carra MC, Casanova D, Celentano V, Ceresoli M, Chiara O, Cimbanassi S, Bini R, Coimbra R, Luigi de'Angelis G, Decembrino F, De Palma A, de Reuver PR, Domingo C, Cotsoglou C, Ferrero A, Fraga GP, Gaiani F, Gheza F, Gurrado A, Harrison E, Henriquez A, Hofmeyr S, Iadarola R, Kashuk JL, Kianmanesh R, Kirkpatrick AW, Kluger Y, Landi F, Langella S, Lapointe R, Le Roy B, Luciani A, Machado F, Maggi U, Maier RV, Mefire AC, Hiramatsu K, Ordoñez C, Patrizi F, Planells M, Peitzman AB, Pekolj J, Perdigao F, Pereira BM, Pessaux P, Pisano M, Puyana JC, Rizoli S, Portigliotti L, Romito R, Sakakushev B, Sanei B, Scatton O, Serradilla-Martin M, Schneck AS, Sissoko ML, Sobhani I, Ten Broek RP, Testini M, Valinas R, Veloudis G, Vitali GC, Weber D, Zorcolo L, Giuliante F, Gavriilidis P, Fuks D, Sommacale D. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg 2021; 16:30. [PMID: 34112197 PMCID: PMC8190978 DOI: 10.1186/s13017-021-00369-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital "F. Miulli", Strada Prov. 127 Acquaviva - Santeramo Km. 4, 70021 Acquaviva delle Fonti BA, Bari, Italy. .,Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France.
| | - Fausto Catena
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Riccardo Memeo
- Department of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Oreste M Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, Michigan, USA
| | - Belinda De Simone
- Service de Chirurgie Générale, Digestive, et Métabolique, Centre hospitalier de Poissy/Saint Germain en Laye, Saint Germain en Laye, France
| | - Salomone Di Saverio
- Department of Surgery, Cambridge University Hospital, NHS Foundation Trust, Cambridge, UK
| | - Raffaele Brustia
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Rami Rhaiem
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France
| | - Tullio Piardi
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France.,Department of Surgery, HPB Unit, Troyes Hospital, Troyes, France
| | - Maria Conticchio
- Department of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Francesco Marchegiani
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Nassiba Beghdadi
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Ruslan Alikhanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Shosse Enthusiastov, 86, 111123, Moscow, Russia
| | | | - Niccolò Allievi
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Giuliana Amaddeo
- Service d'Hepatologie, APHP, Henri Mondor University Hospital, Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- General Surgery, San Matteo University Hospital, Pavia, Italy
| | | | - Enrico Andolfi
- Department of Surgery, Division of General Surgery, San Donato Hospital, 52100, Arezzo, Italy
| | - Mohammad Azfar
- Department of Surgery, Al Rahba Hospital, Abu Dhabi, UAE
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Offir Ben-Ishay
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Giorgio Bianchi
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital "F. Miulli", Strada Prov. 127 Acquaviva - Santeramo Km. 4, 70021 Acquaviva delle Fonti BA, Bari, Italy
| | - Walter L Biffl
- Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Francesco Brunetti
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | | | - Daniel Casanova
- Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - Valerio Celentano
- Colorectal Unit, Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
| | - Marco Ceresoli
- Emergency and General Surgery Department, University of Milan Bicocca, Milan, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Roberto Bini
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC and Loma Linda University School of Medicine, Loma Linda, USA
| | - Gian Luigi de'Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Decembrino
- Gastroenterology and Endoscopy Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Andrea De Palma
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Carlos Domingo
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - Alessandro Ferrero
- Department of General and Oncological Surgery, Azienda Ospedaliera Ordine Mauriziano "Umberto I", Turin, Italy
| | - Gustavo P Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Gurrado
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Ewen Harrison
- Department of Clinical Surgery and Centre for Medical Informatics, Usher Institute, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | | | - Stefan Hofmeyr
- Division of Surgery, Surgical Gastroenterology Unit, Tygerberg Academic Hospital, University of Stellenbosch Faculty of Medicine and Health Sciences, Stellenbosch, South Africa
| | - Roberta Iadarola
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Jeffry L Kashuk
- Department of Surgery, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Reza Kianmanesh
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France
| | - Andrew W Kirkpatrick
- Department of Surgery, Critical Care Medicine and the Regional Trauma Service, Foothills Medical Center, Calgari, Alberta, Canada
| | - Yoram Kluger
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Filippo Landi
- Department of HPB and Transplant Surgery, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | - Serena Langella
- Department of General and Oncological Surgery, Azienda Ospedaliera Ordine Mauriziano "Umberto I", Turin, Italy
| | - Real Lapointe
- Department of HBP Surgery and Liver Transplantation, Department of Surgery, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Bertrand Le Roy
- Department of Digestive Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Alain Luciani
- Unit of Radiology, Henri Mondor University Hospital (AP-HP), Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Fernando Machado
- Department of Emergency Surgery, Hospital de Clínicas, School of Medicine UDELAR, Montevideo, Uruguay
| | - Umberto Maggi
- General Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Ronald V Maier
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics/Gynecologic, Regional Hospital, Limbe, Cameroon
| | - Kazuhiro Hiramatsu
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Carlos Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Universidad del Valle Cali, Cali, Colombia
| | - Franca Patrizi
- Unit of Gastroenterology and Endoscopy, Maggiore Hospital, Bologna, Italy
| | - Manuel Planells
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Andrew B Peitzman
- Department of Surgery, UPMC, University of Pittsburg, School of Medicine, Pittsburg, USA
| | - Juan Pekolj
- General Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fabiano Perdigao
- Liver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, Hôpital Pitié Salpêtrière, Paris, France
| | - Bruno M Pereira
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Patrick Pessaux
- Hepatobiliary and Pancreatic Surgical Unit, Visceral and Digestive Surgery, IHU mix-surg, Institute for Minimally Invasive Image-Guided Surgery, University of Strasbourg, Strasbourg, France
| | - Michele Pisano
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Juan Carlos Puyana
- Trauma & Acute Care Surgery - Global Health, University of Pittsburgh, Pittsburgh, USA
| | - Sandro Rizoli
- Trauma and Acute Care Service, St Michael's Hospital, Toronto, ON, Canada
| | - Luca Portigliotti
- Chirurgia Epato-Gastro-Pancreatica, Azienda Ospedaliera-Universitaria Maggiore della Carità, Novara, Italy
| | - Raffaele Romito
- Chirurgia Epato-Gastro-Pancreatica, Azienda Ospedaliera-Universitaria Maggiore della Carità, Novara, Italy
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Behnam Sanei
- Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Olivier Scatton
- Liver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, Hôpital Pitié Salpêtrière, Paris, France
| | - Mario Serradilla-Martin
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Anne-Sophie Schneck
- Digestive Surgery Unit, Centre Hospitalier Universitaire de Guadeloupe, Pointe-À-Pitre, Les Avymes, Guadeloupe, France
| | - Mohammed Lamine Sissoko
- Service de Chirurgie, Hôpital National Blaise Compaoré de Ouagadougou, Ouagadougou, Burkina Faso
| | - Iradj Sobhani
- Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Richard P Ten Broek
- Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Mario Testini
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Roberto Valinas
- Department of Surgery "F", Faculty of Medicine, Clinic Hospital "Dr. Manuel Quintela", Montevideo, Uruguay
| | | | - Giulio Cesare Vitali
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Luigi Zorcolo
- Department of Surgery, Colorectal Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Foundation "Policlinico Universitario A. Gemelli", IRCCS, Rome, Italy
| | - Paschalis Gavriilidis
- Division of Gastrointestinal and HBP Surgery, Imperial College HealthCare, NHS Trust, Hammersmith Hospital, London, UK
| | - David Fuks
- Institut Mutualiste Montsouris, Paris, France
| | - Daniele Sommacale
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
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Ng HJ, Nassar AHM. Reinterventions following laparoscopic cholecystectomy and bile duct exploration. A review of prospective data from 5740 patients. Surg Endosc 2021; 36:2809-2817. [PMID: 34076762 PMCID: PMC9001563 DOI: 10.1007/s00464-021-08568-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/18/2021] [Indexed: 01/24/2023]
Abstract
Background Complications following laparoscopic cholecystectomy (LC) and common bile duct exploration (CBDE) for the management of gallstones or choledocholithiasis impact negatively on patients’ quality of life and may lead to reinterventions. This study aims to evaluate the causes and types of reintervention following index admission LC with or without CBDE. Methods A prospectively maintained database of LC and CBDE performed by a single surgeon was analysed. Preoperative factors, difficulty grading and perioperative complications requiring reintervention and readmissions were examined. Results Reinterventions were required in 112 of 5740 patients (2.0%), 89 (1.6%) being subsequent to complications. The reintervention cohort had a median age of 64 years, were more likely to be females (p < 0.0023) and to be emergency admissions (67.9%, p < 0.00001) with obstructive jaundice (35.7%, p < 0.00001). 46.4% of the reintervention cohort had a LC operative difficulty grade IV or V and 65.2% underwent a CBDE. Open conversion was predictive of the potential for reintervention (p < 0.00001). The most common single cause of reintervention was retained stones (0.5%) requiring ERCP followed by bile leakage (0.3%) requiring percutaneous drainage, ERCP and relaparoscopy. Relaparoscopy was necessary in 17 patients and open surgery in 13, 6 of whom not resulting from complications. There were 5 deaths. Conclusion This large series had a low incidence of reinterventions resulting from complications in spite of a high workload of index admission surgery for biliary emergencies and bile duct stones. Surgical or endoscopic reinterventions following LC alone occurred in only 0.8%. The most common form of reintervention was ERCP for retained CBD stones. This important outcome parameter of laparoscopic biliary surgery can be optimised through early diagnosis and timely reintervention for complications.
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Affiliation(s)
- Hwei Jene Ng
- Laparoscopic Biliary Surgery Service, University Hospital Monklands, Airdrie, Scotland, UK
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Zhang D, Li Q, Zhang X, Jia P, Wang X, Geng X, Zhang Y, Li J, Yao C, Liu Y, Guo Z, Yang R, Lei D, Yang C, Hao Q, Yang W, Geng Z. Establishment of a nomogram prediction model for long diameter 10-15 mm gallbladder polyps with malignant tendency. Surgery 2021; 170:664-672. [PMID: 34090677 DOI: 10.1016/j.surg.2021.04.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Surgical indications for the treatment of gallbladder polyps are controversial. Evaluation of gallbladder polyps with malignant tendency and indications for cholecystectomy in patients with long diameter polyps of 10 to 15 mm require further analysis and discussion. In this study, our objective was to re-evaluate indications for the surgical resection of gallbladder polyps and construct a nomogram model for the prediction of gallbladder polyps with malignant tendency. METHODS Clinicopathologic data of 2,272 patients who had undergone cholecystectomy for gallbladder polyps were collected from 11 medical centers in China. Risk factor analyses and nomogram prediction model for gallbladder polyps with malignant tendency were conducted. RESULTS Excluding 311 patients with cholelithiasis and 488 patients with long diameter polyps ≤5 and >15 mm, factors that differed significantly among patients with gallbladder polyps having a long diameter of 6 to 9 mm (885 cases) and 10 to 15 mm (588 cases) were polyp detection time, CEA and CA19-9 levels, number of polyps, fundus, echogenicity, gallbladder wall thickness and postoperative pathologic features (P < .05). Among 588 patients with gallbladder polyps with a long diameter of 10 of 15 mm, multivariate analysis indicated the following independent risk factors of gallbladder polyps with malignant tendency: single polyps (OR = 0.286/P < .001), polyps with broad base (OR = 2.644/P = .001), polyps with medium/low echogenicity (OR = 2.387/P = .003), and polyps with short diameter of 7 to 9 or 10 to 15 mm (OR = 3.820/P = .005; OR = 2.220/P = .048, respectively). The C-index of the nomogram model and internal validation were .778 and .768, respectively. In addition, a sample online calculator for the nomogram prediction model had been created (https://docliqi.shinyapps.io/dynnom/). CONCLUSION Indications for cholecystectomy in patients with gallbladder polyps with a long diameter of 10 to 15 mm should be assessed by combining the information on short diameter, number of polyps, fundus, and echogenicity. The nomogram model can be used to predict the risk for the development of gallbladder polyps with malignant tendency.
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Affiliation(s)
- Dong Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaodi Zhang
- Department of Hepatobiliary Surgery, No.215 Hospital of Shaanxi Nuclear Industry, Xianyang, China
| | - Pengbo Jia
- Department of Hepatobiliary Surgery, The First People's Hospital of Xianyang City, Xianyang, China
| | - Xintuan Wang
- Department of Hepatobiliary Surgery, The First People's Hospital of Xianyang City, Xianyang, China
| | - Xilin Geng
- Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yu Zhang
- Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Junhui Li
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chunhe Yao
- Department of General Surgery, Xianyang Hospital of Yan'an University, Xianyang, China
| | - Yimin Liu
- Department of Hepatobiliary Surgery, People's Hospital of Baoji City, Baoji, China
| | - Zhihua Guo
- Department of Hepatobiliary Surgery, People's Hospital of Baoji City, Baoji, China
| | - Rui Yang
- Department of General Surgery, Central Hospital of Hanzhong City, Hanzhong, China
| | - Da Lei
- Department of Hepatobiliary Surgery, Central Hospital of Baoji City, Baoji, China
| | - Chenglin Yang
- Department of General Surgery, Central Hospital of Ankang City, Ankang, China
| | - Qiwei Hao
- Department of Hepatobiliary Surgery, The Second Hospital of Yulin City, Yulin, China
| | - Wenbin Yang
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhimin Geng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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National Readmissions Database characterization of post-cholecystectomy care for inpatients: Readmissions and bile duct repair. Am J Surg 2021; 222:1186-1188. [PMID: 34176599 DOI: 10.1016/j.amjsurg.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022]
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Shen Y, Cao J, Zhou X, Zhang S, Li J, Xu G, Zou X, Lu Y, Yao Y, Wang L. Endoscopic ultrasound-guided cholecystostomy for resection of gallbladder polyps with lumen-apposing metal stent. Medicine (Baltimore) 2020; 99:e22903. [PMID: 33120842 PMCID: PMC7581112 DOI: 10.1097/md.0000000000022903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Laparoscopic cholecystectomy is the routine method to treat gallbladder polyps. Nowadays, endoscopic ultrasound (EUS)-guided cholecystostomy as a bridge for per-oral transmural endoscopic resection of gallbladder polyps is introduced because preservation of gallbladder is increasingly getting attention. The aim of our study was to evaluate the approach in the treatment of patients with gallbladder polyps and symptomatic gallstones.EUS-guided cholecystostomy with the placement of a lumen-apposing metal stent (LAMS) was performed for those patients with accompanying gallbladder polyps and symptomatic gallstones. Several days after the cholecystostomy with LAMS, a gastroscope was introduced into the gallbladder to remove gallbladder polyps.All patients were successfully performed with the procedures of EUS-guided cholecystoduodenostomy (n = 3) or cholecystogastrostomy (n = 1) and endoscopic resection of gallbladder polyps. One patient experienced severe peritonitis. During the follow-up at 3 months, 1 patient was performed with laparoscopic cholecystectomy because ultrasonography examination showed the reappeared gallstones. No stone recurrence was found in other patients. During the follow-up of 3 to 15 months, no polyp recurrence was found in all the patients.The approach is novel for performing EUS-guided gallbladder fistulization, which can subsequently allow procedures of per-oral transmural endoscopic resection of gallbladder polyps to avoid cholecystectomy in the patients with gallbladder polyps and gallstones. However, further studies are needed before clinical recommendation because of the complications and stone recurrence.
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Shen YH, Zheng RH, Xie Y, Shi LL, Zhou XL, Zhan W, Zou XP, Xu GF, Zhou L, Wang L. Endoscopic ultrasound-guided gallbladder fistulization for cholecystolithotomy after endoscopic transpapillary cannulation of the gallbladder in patients with gallstones and common bile duct stones. J Dig Dis 2020; 21:422-425. [PMID: 32314462 DOI: 10.1111/1751-2980.12865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/12/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Yong Hua Shen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Ru Hua Zheng
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Ying Xie
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Liang Liang Shi
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Xiao Liang Zhou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Wei Zhan
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Xiao Ping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Gui Fang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Lin Zhou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
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Nakazawa A, Akamatsu N, Miyata Y, Komagome M, Maki A, Arita J, Ishizawa T, Kaneko J, Beck Y, Hasegawa K. Usefulness of preoperative drip infusion cholangiography with computed tomography for predicting surgical difficulty during laparoscopic cholecystectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:315-323. [PMID: 31971340 DOI: 10.1002/jhbp.718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/24/2019] [Accepted: 01/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Drip infusion cholangiography with computed tomography (DIC-CT) is a major preoperative modality used for patients undergoing laparoscopic cholecystectomy (LC). METHODS This study included 218 patients for whom preoperative DIC-CT images were obtained prior to undergoing LC. The association between gallbladder (GB) opacification in DIC-CT and the operative time was assessed. RESULTS The GB opacification on the DIC-CT images was classified as follows: Grade 0, homogeneous opacification; Grade 1, heterogeneous opacification; Grade 2, only cystic duct can be identified; and Grade 3, no opacification. Images obtained for the 218 patients showed 41 (18.8%) with Grade 0, 91 (41.7%) with Grade 1, 54 (24.8%) with Grade 2, and 32 (14.7%) with Grade 3. The operative time and intraoperative blood loss were significantly longer and larger, respectively, in cases classified as Grade 2 or 3 (GB negative) compared with cases classified as Grade 0 or 1 (GB positive). We created an LC difficulty score based on the following variables that were significant independent predictors of increased operative time: GB negativity in DIC-CT (P = .002, 2 points), GB wall thickness (P = .002, 2 points), body mass index (P = .015, 1 point), preoperative alkaline phosphatase value (P = .018, 1 point), and preoperative C-reactive protein value (P = .04, 1 point). The LC difficulty score (Grade A, score 0-2; Grade B, score 3-5; and Grade C, score 6-7) was significantly associated with a prolonged operative time. CONCLUSION Drip infusion cholangiography with computed tomography is useful for predicting the surgical difficulty of LC.
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Affiliation(s)
- Akiko Nakazawa
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoichi Miyata
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masahiko Komagome
- Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Akira Maki
- Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeaki Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshifumi Beck
- Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Kostis M, Patriarcheas V, Apergis S, Leontis M, Panayiotakopoulos G. Isolated pneumomediastinum following laparoscopic cholecystectomy: a rare complication. J Surg Case Rep 2019; 2019:rjz340. [PMID: 31768249 PMCID: PMC6865337 DOI: 10.1093/jscr/rjz340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
Development of postoperative pneumomediastinum is one of the most infrequent complications of laparoscopic procedures. We report a case of a 47-year-old woman who developed pneumomediastinum consequently to laparoscopic cholecystectomy. The patient was treated conservatively and was discharged on the fifth postoperative day. Early detection of this condition, differential diagnosis and careful monitoring of the patient are important, as it may lead to severe consequences, including the life-threatening tension pneumomediastinum.
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Affiliation(s)
- Minas Kostis
- Department of Pharmacology, University of Patras School of Medicine, Patras 26504, Greece
| | - Vasileios Patriarcheas
- Department of Pharmacology, University of Patras School of Medicine, Patras 26504, Greece
| | | | - Michail Leontis
- Department of Surgery, Metropolitan Hospital, Piraeus 18547, Greece
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Prophylactic Negative Pressure Wound Therapy in Closed Abdominal Incisions: A Meta-analysis of Randomised Controlled Trials. World J Surg 2019; 43:2779-2788. [DOI: 10.1007/s00268-019-05116-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Adverse outcomes and short-term cost implications of bile duct injury during cholecystectomy. Surg Endosc 2019; 34:628-635. [PMID: 31286250 DOI: 10.1007/s00464-019-06809-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bile duct injury (BDI) is an uncommon but major complication of cholecystectomy that has a poorly defined magnitude of effect on hospital costs. This study sought to calculate the healthcare costs, length of stay, and discharge status associated with bile duct injury in patients undergoing cholecystectomy in the United States. METHODS The Premier Healthcare Database, which comprises hospital-billing records from over 700 hospitals in the United States, was queried for all patients undergoing cholecystectomy between January 2010 and March 2018. BDI was defined by ICD-9-CM and ICD-10-CM codes. Patient demographics, clinical characteristics, and operative information were extracted. Hospital costs, length of stay, and discharge status were compared between BDI and non-BDI patients. Propensity score matching was used to minimize confounding factors. Multivariable regression models were used to estimate the association between BDI and the outcomes variables. RESULTS A total of 1,168,288 cholecystectomies were identified. BDI occurred in 878 patients (0.08%). Laparoscopy was the most common approach (> 95%). The majority of BDI occurred during inpatient admissions (71.0%). BDI patients had higher index admission hospital costs ($18,771 vs. $12,345, p < 0.0001), increased rate of discharge to an institutional post-acute care facility (odds ratio 3.89, 95% CI 2.92-5.19, p < 0.0001), and increased risk of readmission within 30 days after discharge (odds ratio 1.86, 95% CI 1.52-2.28, p < 0.0001), compared to patients without BDI. Among inpatient cholecystectomies, BDI was associated with increased length of stay (8.6 days vs. 4.8 days, p < 0.0001). CONCLUSION BDI is associated with significantly increased hospital costs, length of stay, 30-day readmission, and discharge to an institutional post-acute care facility.
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Gupta V, Gupta A, Yadav TD, Mittal BR, Kochhar R. Post-cholecystectomy acute injury: What can go wrong? Ann Hepatobiliary Pancreat Surg 2019; 23:138-144. [PMID: 31225415 PMCID: PMC6558122 DOI: 10.14701/ahbps.2019.23.2.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 12/14/2022] Open
Abstract
Backgrounds/Aims Most of the emphasis of postcholecystectomy injuries is laid on iatrogenic bilary trauma. However, they can involve a wide spectrum of injuries. Methods We prospectively evaluated 42 patients with postcholecystectomy injuries referred to us from July 2011 to December 2012. Based on spectrum of injuries, we proposed an algorithm of management. Results Injuries occurred following laparoscopy in 20 (2 converted) patients and open in 22 patients. Mean time of detection of injury was 4.32±2.33 days. The nature of drainage was bilious in 36, bile with blood in 2, only blood in 2, and enteric in 2. Nine had organ failure at presentation. Six (14%) needed re-operation. Source of hemorrhage was from right hepatic artery in three and small bowel mesentry in 1. Enteric injuries were one each to duodenum and colon. Six patient (14%) died. Advancing age and organ failure were the predictors of mortality. Persistant biliary fistula was seen in 5 (14%). Ten had lateral leaks that closed at 28.89±2.34 days. Twenty-two formed stricture which was successfully managed with definitive hepaticojejunostomy. Conclusions Post cholecystectomy acute injury does not limit itself to bile duct or vascular injury but it can traumatize adjacent hollow viscus or mesentery. It is important to diagnose and intervene enteric injury early. Presentation and management for such injury should be followed as per the proposed algorithm.
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Affiliation(s)
- Vikas Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mutignani M, Dioscoridi L, Pugliese F, Cintolo M, Massad M, Forti E. Primary endotherapy for Strasberg type C bile leaks. Surgery 2019; 166:286-289. [PMID: 31109658 DOI: 10.1016/j.surg.2019.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/03/2019] [Accepted: 03/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Endotherapy is considered by some as the treatment of choice for most external biliary fistulas after laparoscopic cholecystectomy except for those originating from isolated/disconnected ducts, as in Strasberg type C lesions. Endoscopic intervention is not generally considered among treatment options because the isolated duct cannot be opacified during cholangiography and is inaccessible with the usual endoscopic methods. METHODS Our interventional endotherapy for this type of complication consists of cannulating the isolated duct by passing a guidewire out of the cystic duct or the disruption of the common bile duct into the pathway of the biliary fistula. The key element of this endoscopic treatment is to restore the continuity of the biliary tree. Our case series (from March 2012 to September 2017) consists of 19 patients (9 males, 10 females) with Strasberg type C bile leaks. The access to the transected biliary duct was obtained by purposeful puncture of the cystic duct stump into the peritoneal cavity and then intubation of the biliary duct by a 0.035 hydrophilic guidewire. In 17 cases, we performed direct cannulation of the isolated transected duct. In 2 cases, we performed an endoscopic "step-up approach" (a 2-session variant of the technique). RESULTS Technical and clinical success rates were both 100%. Drainage form the abdominal drain stopped in a mean of 1.2 days. There was 1 recurrence after 4 weeks (attributable to displacement of the metal stent), but we were able to retreat the patient endoscopically. Our technique is minimally invasive but very effective in healing the fistulas. Operative repair, in contrast, is a major operation with increased morbidity, prolonged hospital stay, and is more costly. Moreover, on the basis of the available literature, endotherapy passing through the abdominal cavity became safe in expert centers. CONCLUSION The described endoscopic treatment is innovative, safe, and effective and is applicable in tertiary-level centers but requires considerable interventional endoscopic expertise. This minimally invasive procedure can increase the rate of fistula healing and decreases the need for more aggressive and risky operative procedures.
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Affiliation(s)
| | - Lorenzo Dioscoridi
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Francesco Pugliese
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Marcello Cintolo
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Mutaz Massad
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Edoardo Forti
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
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Alexander HC, Nguyen CH, Moore MR, Bartlett AS, Hannam JA, Poole GH, Merry AF. Measurement of patient-reported outcomes after laparoscopic cholecystectomy: a systematic review. Surg Endosc 2019; 33:2061-2071. [PMID: 30937619 DOI: 10.1007/s00464-019-06745-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 03/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient-reported outcome (PRO) measures (PROMs) are increasingly used as endpoints in surgical trials. PROs need to be consistently measured and reported to accurately evaluate surgical care. Laparoscopic cholecystectomy (LC) is a commonly performed procedure which may be evaluated by PROs. We aimed to evaluate the frequency and consistency of PRO measurement and reporting after LC. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for prospective studies reporting PROs of LC, between 2013 and 2016. Data on the measurement and reporting of PROs were extracted. RESULTS A total of 281 studies were evaluated. Forty-five unique multi-item questionnaires were identified, most of which were used in single studies (n = 35). One hundred and ten unique rating scales were used to assess 358 PROs. The visual analogue scale was used to assess 24 different PROs, 17 of which were only reported in single studies. Details about the type of rating scale used were not given for 72 scales. Three hundred and twenty-three PROs were reported in 162 studies without details given about the scale or questionnaire used to evaluate them. CONCLUSIONS Considerable variation was identified in the choice of PROs reported after LC, and in how they were measured. PRO measurement for LC is focused on short-term outcomes, such as post-operative pain, rather than longer-term outcomes. Consideration should be given towards the development of a core outcome set for LC which incorporates PROs.
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Affiliation(s)
- Harry C Alexander
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cindy H Nguyen
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matthew R Moore
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Adam S Bartlett
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jacqueline A Hannam
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Garth H Poole
- Department of Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
- Department of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand.
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Cholecystectomy-related malpractice litigation: predictive factors of case outcome. Updates Surg 2019; 71:463-469. [DOI: 10.1007/s13304-019-00633-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/12/2019] [Indexed: 12/12/2022]
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Ren HY, Zhu QK, Zhai B. How to perform laparoscopic cholecystectomy safely? Shijie Huaren Xiaohua Zazhi 2018; 26:2023-2028. [DOI: 10.11569/wcjd.v26.i35.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic cholecystectomy (LC) is a successful paradigm for modern minimally invasive surgery. Currently, there are few doctors and even patients who are willing to undergo open cholecystectomy. At the scientific level, LC is safe enough; however, given that the number of patients undergoing LC is large, even a lower incidence of complications can cause an amazing absolute number of patients with complications. The risk factors of LC are numerous, and laparoscopic-related risk factors are the key to deciding surgical indications for LC. In different types of cholecystitis, LC has shown minimally invasive advantages compared with open cholecystectomy. To carry out LC safely, we should emphasize the principle of adherence, attention to details, and timely adjustment. It is necessary to consider the "delayed strategy", which means repeated identification before the key points of surgery, such as vessel or tract identification and disconnection. In the process of tissue dissociation, we must wait for the assistant to adjust in time to avoid misjudgment under the fixed thinking and overlapping vision.
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Affiliation(s)
- Hai-Yang Ren
- Department of Hepatobiliary Tumor Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Qian-Kun Zhu
- Department of Hepatobiliary Tumor Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Bo Zhai
- Department of Hepatobiliary Tumor Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
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Abstract
The high prevalence of cholesterol gallstones, the availability of new information about pathogenesis, and the relevant health costs due to the management of cholelithiasis in both children and adults contribute to a growing interest in this disease. From an epidemiologic point of view, the risk of gallstones has been associated with higher risk of incident ischemic heart disease, total mortality, and disease-specific mortality (including cancer) independently from the presence of traditional risk factors such as body weight, lifestyle, diabetes, and dyslipidemia. This evidence points to the existence of complex pathogenic pathways linking the occurrence of gallstones to altered systemic homeostasis involving multiple organs and dynamics. In fact, the formation of gallstones is secondary to local factors strictly dependent on the gallbladder (that is, impaired smooth muscle function, wall inflammation, and intraluminal mucin accumulation) and bile (that is, supersaturation in cholesterol and precipitation of solid crystals) but also to "extra-gallbladder" features such as gene polymorphism, epigenetic factors, expression and activity of nuclear receptors, hormonal factors (in particular, insulin resistance), multi-level alterations in cholesterol metabolism, altered intestinal motility, and variations in gut microbiota. Of note, the majority of these factors are potentially manageable. Thus, cholelithiasis appears as the expression of systemic unbalances that, besides the classic therapeutic approaches to patients with clinical evidence of symptomatic disease or complications (surgery and, in a small subgroup of subjects, oral litholysis with bile acids), could be managed with tools oriented to primary prevention (changes in diet and lifestyle and pharmacologic prevention in subgroups at high risk), and there could be relevant implications in reducing both prevalence and health costs.
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Affiliation(s)
- Agostino Di Ciaula
- Division of Internal Medicine - Hospital of Bisceglie, ASL BAT, Bisceglie, Italy
| | - Piero Portincasa
- Clinica Medica “A. Murri”, Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Bari, Italy
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