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Albakri LA, Algarni RA, Alrajhi RK, Yousef YA, Zaidi SF. Laparoscopic Cholecystectomy Operative Time and Hospital Stay Differences Between Sicklers and Non-sicklers: A Five-Year Comparative Cross-Sectional Study at King Abdulaziz Medical City, Jeddah. Cureus 2022; 14:e30952. [PMID: 36465760 PMCID: PMC9713063 DOI: 10.7759/cureus.30952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 06/17/2023] Open
Abstract
Background Sickle cell disease (SCD) is one of the most important hemoglobinopathies that result in the formation of pigment gallstones. Laparoscopic cholecystectomy (LC) is a safe surgical procedure for gallstones in SCD. Currently, there is no standard or guidelines for the preoperative preparation of these patients. This study aims to estimate the difference in pre-operative length of stay, operative time, postoperative length of stay, and total hospitalization length of stay among patients with and without SCD in a tertiary hospital in Jeddah, Saudi Arabia. Such knowledge would aid in establishing a standard for the preoperative preparation of SCD patients for LC. Methods Data from all patients undergoing laparoscopic cholecystectomy between January 2013 and December 2018 were collected retrospectively with a comparative cross-sectional study design. Data included age, sex, BMI, clinical presentation, mode of admission (elective or emergency), preoperative length of stay, operative time, postoperative length of stay, total hospitalization length of stay, and type of surgery (day or inpatient). JMP 15.2.1 was used for statistical analysis. Results From 2013 to 2018, 793 patients underwent LC, and of those, 16 (2.018%) were SCD patients. The results showed significant differences in preoperative (p<0.001), postoperative (p<0.001), and total hospitalization stay time (p<0.001) between the SCD patients and non-SCD patients. However, the data show no significant difference in the operative time of LC between the two studied groups. Conclusion SCD is the most common hemoglobinopathy-causing gallstone. Challenges in these patients are mainly in peri-operative management. Further prospective cohort studies are needed to create a standardized approach for peri-operative management of SCD patients to facilitate delivery of the same level of care and shorten total hospitalization time.
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Affiliation(s)
- Lamair A Albakri
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Reem A Algarni
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Rawan K Alrajhi
- College of Medicine, King Saud Bin Abdulaziz University of Health Sciences, Jeddah, SAU
| | - Yasmin A Yousef
- Department of Surgery, Pediatric Surgery Section, King Abdulaziz Medical City, Jeddah, SAU
| | - Syed Faisal Zaidi
- Faculty of Eastern Medicine, Hamdard University, Islamabad Capital Territory, PAK
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Cawich SO, Burgess PE, Ranglin-Robinson D, Ewing R. Single-Incision Laparoscopic Cholecystectomy: Initial Report From the Turks and Caicos Islands. Cureus 2021; 13:e14891. [PMID: 34109080 PMCID: PMC8180239 DOI: 10.7759/cureus.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There has been no prior report of single-incision laparoscopic surgery (SILS) from the Caribbean island of Turks and Caicos. We report our initial experience with SILS cholecystectomy to show that SILS in this environment is feasible with minimal change to the existing hardware. It is a safe alternative to conventional multi-trocar laparoscopic cholecystectomy in this setting.
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Affiliation(s)
| | | | | | - Rufus Ewing
- Surgery, Cheshire Hall Medical Center, Providenciales, TCA
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Cawich SO, Dapri G, Fa Si Oen P, Thomas D, Naraynsingh V. Single Incision Laparoscopic Surgery: Feasibility of the Direct Fascial Puncture Technique Without Working Trocars. Cureus 2020; 12:e10742. [PMID: 33145144 PMCID: PMC7599059 DOI: 10.7759/cureus.10742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction As single-incision laparoscopic surgery (SILS) became popular, many access platforms and techniques emerged. When we initially described the direct fascial puncture (DFP) technique, many suggested it was not practical for three reasons: (1) increased hernia formation, (2) inability to complete operations without instrument changes and (3) insurmountable instrument drag. This study sought to determine whether the technique was a feasible approach by evaluating the outcomes with DFP-SILS in a single surgeon unit. Methods This was a retrospective audit of all consecutive patients who had unselected SILS operations by a single surgeon. For the DFP-SILS operation, a single optical trocar was used at the umbilicus, a second was rail-roaded beside the optical trocar and a third was directly passed across the fascia at the left-lateral extent of the skin wound. We recorded the number of conversions or failed operations and examined the patients routinely after operation to evaluate for incisional herniae. Results There were 50 DFP-SILS operations performed: 37 cholecystectomies, 12 appendectomies and one jejunal resection. The operations were successful in all cases with no conversions or mortality recorded. One patient (2%) developed a superficial surgical site infection after SILS-DFP appendectomy. The therapeutic outcomes were comparable to existing series of multi-port laparoscopy. There were no incisional herniae detected. Conclusion Even in the resource-poor setting, SILS operations are feasible and safe using the DFP technique. The theoretic concerns have not been realized in clinical practice.
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Affiliation(s)
| | - Giovanni Dapri
- Surgery, International School of Reduced Scar Laparoscopy, Brussels, BEL
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Leake PA, Reid M, Plummer J. A case series of cholecystectomy in Jamaican sickle cell disease patients - The need for a new strategy. Ann Med Surg (Lond) 2017; 15:37-42. [PMID: 28228943 PMCID: PMC5312456 DOI: 10.1016/j.amsu.2017.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 01/05/2023] Open
Abstract
High morbidity rates related to cholecystectomy in sickle cell disease (SCD) patients have been previously reported in the region. This study serves to assess the current outcomes related to cholecystectomy in a Jamaican SCD population. METHODS: A retrospective chart review of SCD patients undergoing elective cholecystectomy at the University Hospital of the West Indies over a 6-year period was performed providing relevant information for analysis. Patients were grouped on an intention-to-treat basis into an open and laparoscopic group. RESULTS: A total of 27 patients were included (18 laparoscopic and 9 open). Both groups were matched for age, gender and steady state hemoglobin. Only one patient (in the open group) received preoperative blood transfusion. The conversion rate for laparoscopy was 28%. Operative time was significantly longer in the open group (175.3 ± 62.1 vs. 125.9 ± 54.4 min, p = 0.0355). Bile duct exploration was undertaken in 66.7% of patients in the open group compared to 0% in the laparoscopic group. There was no significant difference between groups with respect to hospital stay, morbidity or mortality. The overall 30-day morbidity was 48.1% with acute chest syndrome being diagnosed in 6 patients and pneumonia in 7 patients. CONCLUSION: Morbidity rates related to cholecystectomy in the Jamaican SCD population remain high. Further studies to evaluate the factors contributing to such high morbidity in this population are warranted, with particular focus on laparoscopic cholecystectomy. Strategies such as preoperative transfusion and prophylactic cholecystectomy also need to be evaluated and considered in this patient group. Morbidity rates for cholecystectomy in Jamaican sickle cell patients remain high. There is a trend to higher morbidity for laparoscopic over open cholecystectomy. Preoperative transfusion is rarely employed in this patient population.
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Affiliation(s)
- Pierre-Anthony Leake
- Department of Surgery, Radiology, Anaesthetics & Intensive Care, University of the West Indies, Mona Campus, Jamaica
| | - Marvin Reid
- Tropical Metabolic Research Institute, University of the West Indies, Mona Campus, Jamaica
| | - Joseph Plummer
- Department of Surgery, Radiology, Anaesthetics & Intensive Care, University of the West Indies, Mona Campus, Jamaica
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Muroni M, Loi V, Lionnet F, Girot R, Houry S. Prophylactic laparoscopic cholecystectomy in adult sickle cell disease patients with cholelithiasis: A prospective cohort study. Int J Surg 2015; 22:62-6. [PMID: 26278661 DOI: 10.1016/j.ijsu.2015.07.708] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 07/09/2015] [Accepted: 07/29/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Prophylactic laparoscopic cholecystectomy remains controversial and has been discussed for selected subgroups of patients with asymptomatic cholelithiasis who are at high risk of developing complications such as chronic haemolytic conditions. Cholelithiasis is a frequent condition for patients with sickle cell disease (SCD). Complications from cholelithiasis may dramatically increase morbidity for these patients. Our objective was to evaluate the effectiveness of prophylactic cholecystectomy in SCD patients with asymptomatic gallbladder stones. METHODS From January 2000 to June 2014, we performed 103 laparoscopic cholecystectomies on SCD patients. Fifty-two patients had asymptomatic cholelithiasis. The asymptomatic patients were prospectively enrolled in this study, and all underwent a prophylactic cholecystectomy with an intraoperative cholangiography. The symptomatic patients were retrospectively studied. Upon admission, all patients were administered specific perioperative management including intravenous hydration, antibiotic prophylaxis, oxygenation, and intravenous painkillers, as well as the subcutaneous administration of low-molecular-weight heparin. During the same period, 51 patients with SCD underwent a cholecystectomy for symptomatic cholelithiasis. We compared these 2 groups in terms of postoperative mortality, morbidity, and hospital stay. RESULTS There were no postoperative deaths or injuries to the bile ducts in either group. In the asymptomatic group, we observed 6 postoperative complications (11.5%), and in the symptomatic group, there were 13 (25.5%) postoperative complications. DISCUSSION Regarding the SCD complications, we observed 1 case (2%) of acute chest syndrome in an asymptomatic cholelithiasis patient, while there were 3 cases (6%) in the symptomatic group. Vaso-occlusive crisis was observed in 1 patient (2%) with asymptomatic cholelithiasis, and in 4 patients (8%) in the other group. The mean hospital stay averaged 5.8 (4-17) days for prophylactic cholecystectomy and 7.96 (4-18) days for the comparative symptomatic group. CONCLUSIONS Postoperative complications related to SCD were less frequent for asymptomatic patients who had a laparoscopic prophylactic cholecystectomy. This intervention, if performed with perioperative specific management, is safe and helps avoid emergency operations for acute complications including cholecystitis, choledocholithiasis, and cholangitis. For SCD patients, a prophylactic cholecystectomy reduces hospital stays.
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Affiliation(s)
- Mirko Muroni
- Hôpital Tenon, Department of Surgery, 4 rue de la Chine, 75020, Paris, France.
| | - Valeria Loi
- Hôpital Tenon, Department of Surgery, 4 rue de la Chine, 75020, Paris, France.
| | - François Lionnet
- Hôpital Tenon, Department of Hematology, 4 rue de la Chine, 75020, Paris, France.
| | - Robert Girot
- Hôpital Tenon, Department of Hematology, 4 rue de la Chine, 75020, Paris, France.
| | - Sidney Houry
- Hôpital Tenon, Department of Surgery, 4 rue de la Chine, 75020, Paris, France.
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Gale HI, Setty BN, Sprinz PG, Doros G, Williams DD, Morrison TC, Kalajian TA, Tu P, Mundluru SN, Mehta MN, Castro-Aragon I. Implications of radiologic-pathologic correlation for gallbladder disease in children and young adults with sickle cell disease. Emerg Radiol 2015; 22:543-51. [PMID: 26109240 DOI: 10.1007/s10140-015-1326-5] [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: 03/10/2015] [Accepted: 05/19/2015] [Indexed: 11/25/2022]
Abstract
The purpose of this study is to describe gallbladder imaging findings in patients with sickle cell disease, and to determine how they correspond with occurrence of complications, need for cholecystectomy, and surgical pathology. This study is IRB approved and HIPAA compliant. Informed consent requirements were waived. We reviewed records of 77 children with sickle cell disease ages 0-18 years at the time of their first gallbladder imaging study. Demographics, hospital courses, and radiologic and pathologic reports were collected. Two pediatric radiologists independently and retrospectively reviewed the imaging studies. Statistical analysis was performed using kappa statistic, chi-squared test, and ANOVA F-test. Continuous variables were described with mean, median, variance, and range. Patients who underwent cholecystectomy (N = 25) were more likely than the patients who did not undergo cholecystectomy (N = 52) to have gallstones or sludge (100 versus 36.5 %, p = <0.0001) or other gallbladder or biliary abnormality (70.8 versus 1.9 %, p = <0.0001). Patients who did not undergo cholecystectomy more frequently had normal-appearing gallbladders and biliary tracts (63.5 versus 0 %, p = <0.0001). Ninety-two percent of patients with cholecystectomy had chronic cholecystitis on pathology, and 96 % had a complication, including chronic cholecystitis and sequelae of biliary obstruction. Young patients with sickle cell disease, cholelithiasis, and any other biliary imaging abnormality will almost certainly require cholecystectomy, and many will experience complications. The most common surgical pathologic diagnosis in this group is chronic cholecystitis, which has a variable radiologic appearance. Our findings support recommendations to perform elective cholecystectomy for children and young adults with sickle cell disease and cholelithiasis or gallbladder sludge.
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Affiliation(s)
- Heather I Gale
- Boston University/Boston Medical Center, 820 Harrison Avenue FGH Building 3rd Floor, Boston, MA, 02118, USA.
| | - Bindu N Setty
- Boston University/Boston Medical Center, 820 Harrison Avenue FGH Building 3rd Floor, Boston, MA, 02118, USA
| | - Philippa G Sprinz
- Boston University/Boston Medical Center, 850 Harrison Avenue, Yawkey, 4S01, Boston, MA, 02118, USA
| | - Gheorghe Doros
- Boston University, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Don D Williams
- Boston University/Boston Medical Center, 820 Harrison Avenue FGH Building 3rd Floor, Boston, MA, 02118, USA
| | - Trevor C Morrison
- Boston University/Boston Medical Center, 820 Harrison Avenue FGH Building 3rd Floor, Boston, MA, 02118, USA
| | - Tyler A Kalajian
- Medical Clinical Sciences/Graduate Medical Studies, Boston University School of Medicine, 820 Harrison Avenue FGH Building 3rd Floor, Boston, MA, 02118, USA
| | - Powen Tu
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Shankar N Mundluru
- Boston University School of Medicine, 820 Harrison Avenue FGH Building 3rd Floor, Boston, MA, 02118, USA
| | - Manisha N Mehta
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Ilse Castro-Aragon
- Boston University/Boston Medical Center, 820 Harrison Avenue FGH Building 3rd Floor, Boston, MA, 02118, USA
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Cawich SO, Mohanty SK, Simpson LK, Bonadie KO. Is emergent laparoscopic cholecystectomy for acute cholecystitis safe in a low volume resource poor setting? Int J Surg 2014; 12:798-802. [PMID: 24947946 DOI: 10.1016/j.ijsu.2014.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/01/2014] [Accepted: 06/05/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The outcomes of emergent laparoscopic cholecystectomy (LC) for acute cholecystitis have not been documented in the low-volume, resource-poor Caribbean setting. SETTINGS AND DESIGN This study was carried out in a low-resource setting across three islands in the Anglophone Caribbean. METHODS AND MATERIALS The records of all consecutive patients who had emergency LC for acute cholecystitis over 82 months were examined. The data were extracted and analysed using SPSS version 14. RESULTS There were 74 patients with acute cholecystitis at a mean age of 45 (SD 11.8) years. The mean duration of operation was 99 (SD 45) min. There were 3 (4.1%) conversions and 6 (8.1%) complications. No bile duct injuries or deaths were recorded. There was more morbidity in patients with complicated disease, longer mean operation times and longer mean intervals between admission and operation. CONCLUSIONS Emergent LC for acute cholecystitis is effective and safe in a low-volume setting in the Caribbean. However, the operations are technically demanding and should be performed by trained laparoscopic surgeons.
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Affiliation(s)
- Shamir O Cawich
- The Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago.
| | - Sanjib K Mohanty
- The Department of Surgery, Cayman Islands Hospital, Grand Cayman, British West Indies, Cayman Islands
| | | | - Kimon O Bonadie
- Department of Surgery, McGill University Hospital, Montreal, Quebec, Canada
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Aziz AM, Meshikhes AWN. Blood transfusion in patients with sickle cell disease requiring laparoscopic cholecystectomy. JSLS 2012; 15:480-5. [PMID: 22643502 PMCID: PMC3340956 DOI: 10.4293/108680811x13176785203996] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Laparoscopic cholecystectomy in patients with sickle cell disease was found to be safe without preoperative blood transfusion. Background: Surgery in patients with sickle cell disease is associated with high morbidity. To reduce this high morbidity, different preoperative transfusion regimens were introduced. However, blood transfusion is associated with problems. This prospective study aims to establish the safety of conducting laparoscopic cholecystectomy without transfusion in sickle cell disease patients. Methods: Forty patients (16 males and 24 females; mean age 26.6 years) undergoing laparoscopic cholecystectomy for cholelithiasis were divided into 2 matched groups: Group I “no transfusion” (n=24 patients; 60%) and Group II “transfusion” (n=16; 40%). In Group II, 9 patients (22.5%) received a simple transfusion and 7 (17.5%) a partial exchange transfusion. Results: Group II patients had significantly higher levels of Hb-S prior to transfusion. They developed a significantly higher complication rate (25% vs. 0%) and subsequently longer hospital stay (3.9±2 vs. 2.1±1.4). Moreover, there was no significant difference in the complications between the simple transfusion and partial exchange transfusion subgroups. Conclusion: Surgery in SCD patients is safe without a preoperative blood transfusion. Moreover, preoperative blood transfusion is associated with significantly higher postoperative complications and longer hospital stay. Hence, a “no transfusion” policy is recommended.
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Affiliation(s)
- Amr Mostafa Aziz
- Department of Surgery, King Fahad Specialist Hospital, Eastern Province, Saudi Arabia
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Dan D, Seetahal S, Harnanan D, Singh Y, Hariharan S, Naraynsingh V. Laparoscopic cholecystectomy in sickle cell disease patients: does operating time matter? Int J Surg 2008; 7:70-3. [PMID: 19038591 DOI: 10.1016/j.ijsu.2008.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Accepted: 10/27/2008] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To report the experience of performing laparoscopic cholecystectomy (LC) in patients suffering from sickle cell disease (SCD), and to assess if their postoperative complications can be minimized by shortening the operating time. METHODS Strict measures were taken to minimize the operating times and duration of pneumoperitoneum in SCD patients undergoing LC. Data collected included demographics, preoperative haemoglobin, the surgical technique used, operating times, insufflation pressures, perioperative complications and hospital length of stay. RESULTS In the 5-year period from July 2003 to June 2008, 19 patients with SCD underwent elective LC. Of these, 84% were female. The mean age was 21.5 years. The most common indication for surgery was symptomatic cholelithiasis (60%). The mean preoperative haemoglobin was 8.2g/dL. No preoperative blood transfusions were given. Four patients had preoperative endoscopic retrograde cholangiopancreatography (ERCP). Mean operating time was 27.9 min (range 20-45 min) which is 2.5-6 times quicker than most reports in the literature. There was no conversion to open surgery. Mean hospital length of stay was 2.5 days. Postoperative complications were noted in four patients with painful crises accounting for 50%. There was no mortality. CONCLUSION The study suggests that if stringent measures are taken to shorten the operating time, LC can be safely and effectively performed in SCD patients with minimal perioperative complications.
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Affiliation(s)
- Dilip Dan
- Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Mount Hope, West Indies, Trinidad and Tobago
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