Laparoscopic cholecystectomy for symptomatic cholelithiasis in children and adolescents: analysis of 50 cases from a single institution.

PURPOSE: To investigate the clinical characteristics of symptomatic cholecystolithiasis and laparoscopic cholecystectomy complications in pediatric patients. METHODS: The medical records of 50 children and adolescents who underwent laparoscopic cholecystectomy were analyzed. We evaluated gender, age, body mass index, preoperative clinical aspects, perioperative complications, and gallstone composition. RESULTS: Among the patients, 33 (66%) were female, and 17 (34%) were male. The mean age was 11.4 ± 3.6. All patients were diagnosed with cholecystolithiasis by abdominal ultrasonography. Twelve patients (24%) had hematological disease: eight (16%) with sickle cell anemia and four (8%) with hereditary spherocytosis. Thirteen patients (26%) were obese. Twelve patients (24%) had complicated biliary disease. During the intraoperative period, three patients (6%) had excessive bleeding in the hepatic hilum, and one had an accidental injury to the common bile duct. Three (6%) postoperative complications (acute pancreatitis, common bile duct stenosis, and intestinal obstruction) were observed. Among 28 patients (56%), 25 (50%) had cholesterol gallstones, and three (6%) had bile pigment gallstones. CONCLUSIONS: The evolution of cholecystolithiasis in the pediatric population can present serious complications, emphasizing the need to avoid temporizing cholecystolithiasis in children and adolescents because laparoscopic cholecystectomy in this group is safe, with low complication rates.

Laparoscopic cholecystectomy and laparoscopic common bile duct exploration for cholecystolithiasis and choledocholithiasis in a patient with situs inversus totalis: A case report.

Situs inversus complicates diagnosis and treatment due to the mirrored organ placement in relation to normal anatomy. This report describes a 78-year-old female patient with situs inversus totalis who underwent laparoscopic cholecystectomy and laparoscopic common bile duct exploration for cholecystolithiasis and choledocholithiasis. Utilizing the "French mirror technique" for port placement, the surgeon adeptly mirrored standard maneuvers with a 2-mm needle forceps in the left hand and a 5-mm forceps in the right in a reversed anatomical setting. This technique maintained familiar hand movements, despite the patient's unique anatomy. The surgeon applied transcystic ductal bile duct exploration, using choledochoscopy for duct exploration and a basket catheter for stone removal. Laparoscopic cholecystectomy and common bile duct exploration through the transcystic ductal route are viable and effective for patients with situs inversus.

Unraveling factors associated with textbook outcome after cholecystectomy in patients with uncomplicated cholecystolithiasis: A posthoc analysis of individual data of 1,124 patients.

BACKGROUND: A textbook outcome for the management of uncomplicated cholecystolithiasis is the targeted clinical scenario and is characterized by no recurrent biliary colic, absence of surgical and biliary complications, and absence or relief of abdominal pain. The aim of this study was to assess the incidence of textbook outcomes after cholecystectomy and identify associated baseline factors. METHODS: Patients from 2 Dutch multicenter prospective trials between 2014 and 2019 (SECURE and SUCCESS trial) were included. The primary outcome was the proportion of patients with textbook outcomes after cholecystectomy at 6-month follow-up. Regression analysis was used to identify which factors before surgery were associated with textbook outcomes. RESULTS: A total of 1,124 patients underwent cholecystectomy. A textbook outcome at 6-month follow-up was reached in 67.9% of patients. Persistent abdominal pain was the main reason for the failure to achieve textbook outcome. Patients who did achieve textbook outcomes more often reported severe pain attacks (89.4% vs 81.7%, P < .001) and/or biliary colic (78.6% vs 68.4%, P < .001) at baseline compared with patients without textbook outcomes. The presence of biliary colic at baseline (odds ratio = 1.56, 95% confidence interval: 1.16-2.09, P = .003) and nausea/vomiting at baseline (odds ratio = 1.33, 95% confidence interval: 1.01-1.74, P = .039) were associated with textbook outcome. The use of non-opioid analgesics (odds ratio = 0.76, 95% confidence interval: 0.58-0.99, P = .043) and pain frequency ≥1/month (odds ratio = 0.56, 95% confidence interval: 0.43-0.73, P < .001) were negatively associated with textbook outcome. CONCLUSION: Textbook outcome is achieved in two-thirds of patients who undergo cholecystectomy for uncomplicated cholecystolithiasis. Intensity and frequency of pain, presence of biliary colic, and nausea/vomiting at baseline are independently associated with achieving textbook outcomes. A more stringent selection of patients may optimize the textbook outcome rate in patients with uncomplicated cholecystolithiasis.

Efficacy and safety of double endoscopy combined with exploration in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis.

OBJECTIVE: To investigate the efficacy and safety of laparoscopy combined with choledochoscopy in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis. METHODS: A retrospective analysis of 114 patients admitted to our hospital from January 2020 to January 2023 was conducted. These patients underwent laparoscopic cholecystectomy combined with choledocholithiasis and were divided into an elderly group (≥ 60 years old) of 63 cases and a young and middle-aged group (< 60 years old) of 51 cases according to age. The efficacy and safety indicators of the two groups of patients were observed, and complications were followed up by telephone within 6 months after surgery. The follow-up deadline was June 2023. RESULTS: Among the eligible patients (53 men, 61 women, average age 57 years), all were successfully operated, and 1 case was converted to laparotomy. The elderly and young and middle-aged groups were compared concerning hospitalisation time, bowel sound recovery time, and total postoperative complications, and the differences were statistically significant (P-values were 0.009, 0.006, and 0.039). However, there was no statistically significant difference between the two groups of patients in terms of hospitalisation costs, intraoperative blood loss, operation time, drainage tube removal time, conversion to laparotomy rate, and stone clearance rate (P-values > 0 0.05). CONCLUSION: Strict adherence to surgical standards and enhanced postoperative care resulted in similar efficacy and safety results for double endoscopy combined with the exploration of treatment for elderly and young patients with cholecystolithiasis and choledocholithiasis.

Consideraciones técnicas durante la colecistectomía laparoscópica en paciente con situs inversus totalis / Technical considerations during laparoscopic cholecystectomy in a patient with situs inversus totalis

Introducción: La colecistectomía laparoscópica es uno de los procedimientos quirúrgicos más efectuados por el cirujano general. Esto ha permitido establecer una estrategia quirúrgica bien definida para su ejecución; sin embargo, ciertos factores pueden llevar a modificar la técnica. Los objetivos de este informe son describir y analizar las variaciones de la técnica quirúrgica y los resultados obtenidos con la colecistectomía laparoscópica en una paciente con situs inversus totalis. Caso clínico: Mujer de 70 años de edad con diagnósticos de colecistopatía crónica litiásica y situs inversus totalis. Detallamos los cambios en la técnica quirúrgica y describimos la variación en la distribución anatómica de los órganos intraabdominales observada durante el procedimiento quirúrgico. La paciente evolucionó satisfactoriamente y refirió alto grado de satisfacción con el resultado quirúrgico. Conclusiones: La variación en la distribución anatómica de los órganos intraabdominales, así como la alteración en la localización de la arteria cística y los cambios en la ubicación de los puertos de trabajo, nos indujeron a modificar la técnica de la colecistectomía laparoscópica, lo cual no alteró el resultado quirúrgico ni la evolución posoperatoria.

BACKGROUND: Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures by the general surgeon. This situation allows determining a defined surgical strategy in most patients. However, some factors may induce modification by the surgical team. Our objectives were to describe and analyze the variation of the surgical technique used during laparoscopic cholecystectomy in a female patient with situs inversus totalis. CLINICAL CASE: We report the case of a 70-year-old female with a diagnosis of chronic gallstone cholecystitis and situs inversus totalis. Modifications in the surgical technique are detailed, and anatomic variations of the intraabdominal organs are described. Postoperative evolution was satisfactory and the patient was highly satisfied with the surgical outcome. There was no associated morbidity. CONCLUSIONS: Variations in intraabdominal anatomy, alteration of cystic artery location and changes in position of the abdominal ports prompted us to modify the standard surgical technique for laparoscopic cholecystectomy. However, these factors did not alter results or the patient's postoperative evolution.

¿Cuál es la prevalencia de litiasis de la vía biliar principal en pacientes con colecistolitiasis sintomática? / Frequency of choledocholithiasis among patients with cholelithiasis and a clinical suspicion of common bile duct obstruction

INTRODUCCIÓN: La litiasis de la vía biliar principal (LVBP) es la complicación más frecuente de la colecistolitiasis sintomática. Existe controversia acerca de su prevalencia. El objetivo de este estudio es determinar la prevalencia de LVBP en colecistolitiasis sintomática. Material y Método: Estudio de corte transversal. Se estudiaron mediante colangiografía retrógrada endoscópica (CRE), pacientes con colecistolitiasis sintomática y con sospecha de LVBP atendidos en el Hospital Obrero N 1 de la Caja Nacional de Salud La Paz, Bolivia en el período 2005-2006. El tamaño de la muestra se calculó con base en un nivel de confianza de 95%, poder de 80%, frecuencia esperada de LVBP de 59%, y peor escenario de 54%; escenario que da una muestra de 313 pacientes. Se utilizó estadística descriptiva, se calculó prevalencia de LVBP y se aplicó estadística analítica para estudiar asociaciones. Resultados: De los 2001 pacientes internados por colecistolitiasis sintomática, se solicitaron 435 CRE, identificándose en 175 pacientes LVBP, lo que representa una prevalencia de 40,2%. El promedio de edad de los pacientes estudiados fue de 63,1 años y el 51,9% eran de género femenino. Clínicamente, el dolor abdominal, se presentó en 409 pacientes (94,0%), ictericia en 262 casos (60,2%) y alza térmica en 68 pacientes (15,6%). La CRE no identificó lesiones en 68 pacientes (15,6%) y LVBP en 175 casos (40.2%). La morbilidad asociada a la papilotomía endoscópica fue de 4,4%, y no se registró mortalidad. Se verificó asociación entre LVBP y niveles de fosfatasa alcalina (p=0,04), bilirrubina total (p=0,001) y bilirrubina directa (p=0,01). Conclusión: En pacientes portadores de colecistolitiasis sintomática con sospecha de LVBP, la realización de una CRE preoperatoria es una alternativa a considerar.

Background: Choledocholithiasis is the most common complication of symptomatic cholelithiasis. Aim: To evaluate the prevalence of choledocholithiasis among patients with symptomatic cholelithiasis. Patients and Methods: Patients admitted to the hospital with a symptomatic cholelithiasis confirmed by ultrasonography, were subjected to a endoscopic retrograde cholangiography if there was a clinical suspicion of choledocholithiasis. Results: Two thousand and one patients with symptomatic cholelithiasis were admitted and an endoscopic retrograde cholangiography was requested to 435 (age range 14 to 95 years, 226 females). Of these, 409 (94%) had abdominal pain, 263 (60%) had jaundice and 68 (16%) had fever. In 175 (40%) a choledocholithiasis was diagnosed. Sixteen patients (4%) had bleeding after the endoscopic papillotomy, that was self limited in 14, two had an acute pancreatitits and one had a duodenal perforation. There was an association between the presence of choledocholithiasis and serum alkaline phosphatases and bilirubin. Conclusions: Choledocholithiasis is common in patients with cholelithiasis and a clinical suspicion of common bile duct obstruction.

Gastric heterotopia together with squamous metaplasia in the gallbladder / Heterotopía gástrica y metaplasia escamosa en la vesícula biliar

Heterotopic gastric mucosa in the gallbladder is extremely unusual. In this study, we aimed to report a case of gastric heterotopia together with squamous metaplasia in the gallbladder of a 47-year-old female patient who experienced an intensive abdominal pain. He was admitted to the hospital for clinical treatment without any improvement. Ultrasonography showed a stone located in the gallbladder neck and dilatation of intrahepatic bile ducts, both hepatic ducts and common hepatic duct. Laparoscopic cholecystectomy was performed. In the microscopical examination, the epithelium of the gallbladder revealed an unspecified chronic cholecystitis. Besides, at the level of the gallbladder body, a heterotopic gastric mucosa contain chief, parietal and mucosal cells with cystic glands and squamous metaplasia was found. Actually the patient is in long-time follow-up, asymptomatic. We also review 96 other reports of HGM in the gallbladder in the international medical literature from 1934. As heterotopic tissue may promote carcinogenesis of the gallbladder, close attention should be paid to any occurrence of such lesions in this anatomical region. It appears that laparoscopic cholecystectomy may be unavoidable for patients affected by heterotopic gastric mucosa at the present time and care must be taken when a diagnosis is made based on intraoperative frozen sections.

La heterotopía de la mucosa gástrica (HGM) en vesícula biliar es extremadamente rara. En este estudio, reportamos un caso de heterotopía gástrica junto con metaplasia escamosa en vesícula biliar de un paciente femenino de 47 años que experimentó un dolor abdominal intenso. Lo admitieron al hospital para el tratamiento clínico sin ninguna mejoría. Ultrasonografía demostró un cálculo situado en el cuello de la vesícula y dilatación de conductos biliares intrahepáticos, los conductos hepáticos y conducto hepático común. Se realizó la colecistectomía por vía laparoscópica. En el exámen microscópico el epitelio reveló una colecistitis crónica inespecífica. Además, en el nivel del cuerpo de la vesícula biliar fue hallada una mucosa gástrica heterotópica con células principales, parietales, células mucosas con las glándulas enquistadas y metaplasia escamosa. El paciente está en el seguimiento a largo plazo, asintomático. Revisamos 96 informes de HGM en vesícula biliar en la literatura médica internacional a partir de 1934. El tejido heterotópico puede promover la carcinogénesis de la vesícula biliar, por lo cual se debe prestar atención a cualquier ocurrencia de tales lesiones en esta región anatómica. La colecistectomía laparoscópica puede ser inevitable para los pacientes afectados por la mucosa gástrica heterotópica actualmente y todo cuidado debe ser tomado cuando se hace un diagnóstico por secciones congeladas intraoperatorias.