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He L, Chen Z, Wang Z, Pan Y. Enhancing patient outcomes through nursing care in laparoscopic common bile duct exploration; a randomized control trail. BMC Surg 2024; 24:360. [PMID: 39548400 PMCID: PMC11566461 DOI: 10.1186/s12893-024-02657-z] [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: 08/24/2024] [Accepted: 11/05/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND When compared to open surgery, laparoscopic common bile duct exploration (LCBDE) is known to cause less discomfort and a faster recovery. This study examines the effect of the Enhanced Recovery After Surgery (ERAS) strategy on LCBDE outcomes. METHODS In March 2021 to May 2024, 400 patients with LCBDE participated in randomized research. The six patient groups were: Multimodal Pain Management (n = 50), Standard Pain Management (n = 50), ERAS (n = 50), Preoperative Assessment (n = 100), Standard Preoperative Assessment (n = 100), and Standard Care (n = 50). The patient's satisfaction, long-term recovery, pain, anxiety, and complication rates were among the outcomes that were measured. RESULTS After the intervention, the mean anxiety level of the ERAS group was significantly lower (P < 0.05), and their rates of complications were also decreased. Reduced postoperative pain scores, which were 5 on day 1 and decreased to 3 by day 3, were the consequence of the multimodal pain management strategy inside ERAS. A 90% satisfaction rating and an average recovery period of five days were reported by the ERAS group. Long-term results in ERAS showed that the average time to return to work was only 25 days, and there was a decreased incidence of chronic pain. CONCLUSION The ERAS protocol enhances the short- and long-term course of recovery for patients with LCBDE, leading to increased satisfaction and better clinical outcomes. These results suggest that the ERAS method should be used as the gold standard for postoperative care for patients with LCBDE.
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Affiliation(s)
- Linxiang He
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Zhuming Chen
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Zhen Wang
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Yingchun Pan
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China.
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Koo JGA, Tham HY, Toh EQ, Chia C, Thien A, Shelat VG. Mirizzi Syndrome-The Past, Present, and Future. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:12. [PMID: 38276046 PMCID: PMC10818783 DOI: 10.3390/medicina60010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
Mirizzi syndrome is a complication of gallstone disease caused by an impacted gallstone in the infundibulum of the gallbladder or within the cystic duct, causing chronic inflammation and extrinsic compression of the common hepatic duct or common bile duct. Eventually, mucosal ulceration occurs and progresses to cholecystobiliary fistulation. Numerous systems exist to classify Mirizzi syndrome, with the Csendes classification widely adopted. It describes five types of Mirizzi syndrome according to the presence of a cholecystobiliary fistula and its corresponding severity, and whether a cholecystoenteric fistula is present. The clinical presentation of Mirizzi syndrome is non-specific, and patients typically have a longstanding history of gallstones. It commonly presents with obstructive jaundice, and can mimic gallbladder, biliary, or pancreatic malignancy. Achieving a preoperative diagnosis guides surgical planning and improves treatment outcomes. However, a significant proportion of cases of Mirizzi syndrome are diagnosed intraoperatively, and the presence of dense adhesions and distorted anatomy at Calot's triangle increases the risk of bile duct injury. Cholecystectomy remains the mainstay of treatment for Mirizzi syndrome, and laparoscopic cholecystectomy is increasingly becoming a viable option, especially for less severe stages of cholecystobiliary fistula. Subtotal cholecystectomy is feasible if total cholecystectomy cannot be performed safely. Additional procedures may be required, such as common bile duct exploration, choledochoplasty, and bilioenteric anastomosis. Conclusions: There is currently no consensus for the management of Mirizzi syndrome, as the management options depend on the extent of surgical pathology and availability of surgical expertise. Multidisciplinary collaboration is important to achieve diagnostic accuracy and guide treatment planning to ensure good clinical outcomes.
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Affiliation(s)
- Jonathan G. A. Koo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.G.A.K.); (H.Y.T.)
| | - Hui Yu Tham
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.G.A.K.); (H.Y.T.)
| | - En Qi Toh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
| | - Christopher Chia
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Amy Thien
- Department of General Surgery, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA 1710, Brunei;
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.G.A.K.); (H.Y.T.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
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Koizumi N, Matsumoto T, Kamada Y, Fujiki H, Sakakura C. Reduced port laparoscopic subtotal cholecystectomy for Mirizzi syndrome with a bilio-biliary fistula: A case report. Asian J Endosc Surg 2023. [PMID: 36882967 DOI: 10.1111/ases.13177] [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] [Received: 01/17/2023] [Revised: 02/11/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
A 65-year-old male diagnosed with Mirizzi syndrome with a bilio-biliary fistula was referred to our department and underwent single-incision laparoscopic surgery with an assistant trocar. As typical laparoscopic cholecystectomy could not be performed due to the coexistence of a bilio-biliary fistula, we performed laparoscopic subtotal cholecystectomy as a bail-out procedure according to the recommendation of the recent Tokyo Guidelines (TG18). The neck of the remnant gallbladder could be easily sutured with the effective use of an assistant trocar, and the surgery was completed without any complications. The patient was discharged 5 days after surgery without any complications. While little has been reported on the efficacy of reduced port surgery for Mirizzi syndrome, our surgical approach, i.e. reduced port surgery with an assistant trocar, enabled secure and easy suturing as a bail-out procedure and seemed to be an efficient method that is both less-invasive and safe.
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Affiliation(s)
- Noriaki Koizumi
- Department of Surgery, Akashi City Hospital, Akashi-city, Japan
| | | | - Yosuke Kamada
- Department of Surgery, Akashi City Hospital, Akashi-city, Japan
| | - Hiroshi Fujiki
- Department of Surgery, Akashi City Hospital, Akashi-city, Japan
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Wei L, Hong Q, Lin X, Chen Y, Yang F, Li F, Chen Y. Effect of comprehensive high-quality nursing care on postoperative complications, degree of pain, and nursing satisfaction in gallstone patients during perioperative period. Am J Transl Res 2021; 13:2678-2685. [PMID: 34017428 PMCID: PMC8129269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the influence of comprehensive high-quality nursing care on postoperative complications, degree of pain, and nursing satisfaction in gallstone patients during the perioperative period. METHODS A total of 77 gallstone patients admitted to our hospital were selected as the study subjects, and divided into a control group (n=38) and an experimental group (n=39) in accordance with the random number table method. During the perioperative period, the control group received conventional nursing, while the experimental group received comprehensive high-quality nursing and conventional nursing. The visual analogue scale (VAS) was adopted to score degree of pain in both groups at 6 h, 24 h, and 48 h after surgery. Nursing satisfaction questionnaires were used to evaluate the satisfaction of the two groups of patients. The changes of postoperative complications, pain degrees, and nursing satisfaction were observed in the two groups after nursing interventions during the perioperative period. RESULTS After comprehensive high-quality nursing intervention, the time to first flatus, time to first defecation, time to first off-bed activity and hospital stay in the experimental group were significantly shorter than those in the control group after surgery (P < 0.05). The number of postoperative complications in the experimental group was remarkably lower than that in the control group (P < 0.05). After intervention, degree of pain scores in the experimental group were lower than those of the control group (P < 0.05). After intervention, the scores of nursing satisfaction in the experimental group were higher than those of the control group (P < 0.05). CONCLUSION Comprehensive high-quality nursing can improve the incidence of postoperative complications, degree of pain, nursing satisfaction, and the quality of life of gallstone patients during the perioperative period.
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Affiliation(s)
- Liuyuan Wei
- Department of Blood Purification, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
| | - Qiao Hong
- Department of Emergency, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
| | - Xiaomei Lin
- Department of Emergency, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
| | - Yuyan Chen
- Department of Obstetrics and Gynecology, Haikou Fourth People’s HospitalHaikou 570311, Hainan Province, China
| | - Fan Yang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
| | - Fen Li
- Department of Emergency, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
| | - Yulin Chen
- Department of Emergency, The Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311, Hainan Province, China
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Zhao J, Fan Y, Wu S. Safety and feasibility of laparoscopic approaches for the management of Mirizzi syndrome: a systematic review. Surg Endosc 2020; 34:4717-4726. [PMID: 32661708 DOI: 10.1007/s00464-020-07785-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic approaches for the management of Mirizzi syndrome (MS) are controversial and challenging procedures for high conversion rate. This review aims at evaluating their safety and feasibility. METHODS We reviewed studies related to the laparoscopic approaches for the management of MS with detailed data of articles from January 2009 to December 2019 found in PubMed. RESULTS From 63 articles, we reviewed 17 articles detailing laparoscopic approaches for MS. There were 857 patients with MS; 432 of which were identified from 73,842 patients underwent cholecystectomy. Laparoscopic approaches were attempted in 440 patients and were successful in 290. The conversion rate was 34.09%. Various methods including laparoscopic cholecystectomy, laparoscopic subtotal cholecystectomy, laparoscopic common bile duct exploration (LCBDE) and (LTCBDE) were performed. The preoperative diagnosis of MS was made in 338 of 500 patients (67.60%). The mean operating time ranged from 49.7 ± 27.5 min to 270.5 ± 65.5 min, and the mean intraoperative bleeding varied from 21.1 ± 15.9 ml to 162.81 ± 40.83 ml. The mean hospital stay varied from 4.5 ± 3.7 to 7.21 ± 1.61 days. Postoperative complications occurred in 27 patients. CONCLUSIONS Various laparoscopic approaches are safe and feasible for the treatment of MS in the hands of experienced laparoscopic surgeons, especially for type I and II of Csendes classification. Definitive preoperative diagnosis and earlier management are essential.
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Affiliation(s)
- Jiannan Zhao
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Fan
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Shuodong Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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Funamizu N, Harada E, Ishiyama S. Comparison of outcomes of single-incision and conventional laparoscopic cholecystectomy for cholecystitis requiring percutaneous transhepatic gallbladder drainage. Asian J Endosc Surg 2020; 13:477-480. [PMID: 31820545 DOI: 10.1111/ases.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/30/2019] [Accepted: 11/12/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Single-incision laparoscopic cholecystectomy (SILC) has been accepted as a less invasive alternative to conventional laparoscopic cholecystectomy (CLC). However, the feasibility and safety of SILC for acute cholecystitis, especially in cases with percutaneous transhepatic gallbladder drainage (PTGBD), are still limited because of the technical difficulty of SILC. The aim of this study was to retrospectively evaluate the safety and feasibility of SILC compared to CLC for cholecystitis requiring PTGBD. METHODS From 1 July 2017 to 8 June 2019, eight patients underwent SILC with PTGBD, and nine underwent CLC with PTGBD. The patients' data, including the operative time, total blood loss, conversion rate to laparotomy, and perioperative complications, were compared. RESULTS In seven of eight patients, SILC was successfully performed. Only one patient required conversion to open surgery because necrosis prevented the cystic duct from being clipped. However, bile leakage occurred in this patient and was successfully treated with percutaneous drainage and antibiotics. In the CLC group, one patient required laparotomy but had no postoperative complications due to strong adhesion. One patient underwent reoperation for bile duct injury after the first operation. One other complication (ie, wound infection) was seen in the CLC group. There was no significant difference in the mean operative time and estimated blood loss between the SILC and CLC groups. CONCLUSION With our gallbladder retraction method, SILC may be a relatively safe and feasible alternative to CLC for cholecystitis, even in cases requiring PTGBD.
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Affiliation(s)
| | - Eriko Harada
- Department of Digestive Surgery, Shoikai Hospital, Tokyo, Japan
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Saad MR, Choi Y, Han HS, Yoon YS, Cho JY, Lee JS, Lee BR. Solo single-incision laparoscopic liver resection: a cohort series. ANZ J Surg 2020; 90:1108-1111. [PMID: 32378778 DOI: 10.1111/ans.15941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/19/2019] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Single-incision laparoscopic liver resection (SILLR) is still challenging due to the unstable surgical view, the crowding instruments and its crossover. In this study, we present a new option of solo SILLR for various liver tumours in order to overcome those difficulties. METHODS Solo SILLR is indicated for liver tumours located in the left liver or in the superficial right liver. Data for 54 consecutive patients, who underwent solo SILLR between October 2015 and October 2018, were collected and analysed prospectively. RESULTS A total of 30 patients (55.5%) underwent non-anatomical resection. Left hemi-hepatectomy was performed in 11 patients (20.4%) and left lateral was performed in 13 patients (24.1%). The median operative time was 114 (range 30-335) min with median blood loss of 400 (50-750) mL with no need of blood transfusion and no intraoperative complications. The median length of hospital stay was 3 (range 1-19) days. There was one case of post-operative intra-abdominal fluid collection and one case of incisional hernia during the follow-up. CONCLUSION Solo SILLR is more feasible and safer for liver tumours located in the superficial right liver or in the left one. Therefore, solo surgery can be an option in SILLR.
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Affiliation(s)
- Mohamed Rabie Saad
- Department of Surgery, Faculty of Medicine, Aswan University Hospital, Aswan, Egypt.,Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - YoungRok Choi
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Ho-Seong Han
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Yoo-Seok Yoon
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Jai Young Cho
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Jun Suh Lee
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Bo Ram Lee
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
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A Comparative Study of Needlescopic Grasper Assisted Single Incision versus Three-Port versus Pure Single Incision Laparoscopic Cholecystectomy. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2019; 22:171-176. [PMID: 35601375 PMCID: PMC8980142 DOI: 10.7602/jmis.2019.22.4.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/29/2019] [Accepted: 08/26/2019] [Indexed: 11/16/2022]
Abstract
Purpose Single incision laparoscopic cholecystectomy (SILC) is a surgical method to treat gallbladder disease designed to reduce postoperative pain and improve cosmetic results. However, pure SILC (pSILC) has several inherent limitations. In this study, we report the surgical outcomes of SILC with needlescopic grasper (nSILC) compared with those of pSILC and conventional three-port laparoscopic cholecystectomy (TPLC). Methods This retrospective study enrolled 103 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease in our hospital between January 2013 and January 2015. Among them, 33 patients underwent pSILC, 35 underwent nSILC, and 35 underwent TPLC. We collected demographic characteristics and operative data to analyze outcomes between groups. Results All procedures were done by laparoscopy and the gallbladder of each patient was completely removed. Women and younger patients were more to undergo SILC than TPLC. Analysis showed that the operation time of the nSILC group was longer than that of the TPLC group, but shorter than that of the pSILC group (skin to skin operation time [pSILC: 65.2±19.1 min, nSILC: 49.7±12.9 min, and TPLC: 43.4±14.7 min, p<0.001], and major procedure time [pSILC: 42.2±18.7 min, nSILC: 25.9±8.9 min, and TPLC: 23.4±12.7 min, p<0.001]). There were no significant differences between the groups for patient visual analogue scale score, length of hospital stay, or intraoperative blood loss. Conclusion nSILC is feasible surgical method in patients with benign gallbladder disease compared to TPLC, and that is an effective procedure to overcome the disadvantage of pSILC.
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