Visceral adiposity but not subcutaneous fat associated with improved outcome of patients with acute cholecystitis.

BACKGROUND: The aim of this study to study the effect of visceral and subcutaneous fat tissue mass on short- and long-term prognosis of patients with acute calculus cholecystitis (ACC). METHODS: Retrospective analysis of medical records. Included were all patients admitted because of ACC. Computed tomography images at the level of L3 were analyzed for body composition using designated software (Slice-O-matic; TomoVision, Montreal, Quebec, Canada). General linear model was used to analyze the effect of body composition on length of hospital stay, and Cox regression analysis was used to ascertain the effect of the different parameters on 1-y survival. RESULTS: Included were 159 patients (mean age: 71.7 ± 15.8 y, 54.7% males). Fat was the most abundant tissue (401 ± 175 cm2 of the computed tomography slices surface area), and visceral fat was 45.8 ± 14.1% of the fat area measured. Using the general linear model, we found that American Society of Anesthesiologists score, disease severity index, and age were positively associated with higher length of stay, whereas high visceral fat was associated with lower length of stay (estimated marginal means at 7.4 ± 1.4 d compared to 12.7 ± 1.4 d among patients with lower visceral fat surface area, P = 0.010). The Cox regression model showed that 1-y survival risk was significantly reduced by age, the Charlson Comorbidity Index and high muscle mass. High visceral adiposity was associated with improved survival (odds ratio: 0.216, 95% confidence interval: 0.064-0.724, P = 0.013). Subcutaneous adiposity did not affect prognosis. CONCLUSIONS: Visceral adiposity is associated with shorter length of stay and improved 1-y survival among patients hospitalized with ACC.

[Coverage of the gallbladder cancer prevention strategy in Chile: results from the 2009-2010 National Health Survey]. / Cobertura de la estrategia preventiva de cáncer de vesícula biliar en Chile: Resultados de la Encuesta Nacional de Salud 2009-2010.

BACKGROUND: In Chile, gallbladder cancer (GBC) is one of the most important causes of death and gallstone disease (GSD) is its main risk factor. Abdominal ultrasonography (AU) is used for the diagnosis of GSD and cholecystectomy is used to prevent it. AIM: To estimate GSD prevalence in the general population and to assess the diagnostic and therapeutic coverage of GSD as a preventive strategy for GBC in Chile. MATERIAL AND METHODS: A standardized digestive symptoms questionnaire of the 2009-2010 Chilean National Health Survey was answered by 5412 adults over 15 years old. Self-reports of AU, GBD and cholecystectomies were recorded. RESULTS: The prevalence of biliary-type pain was 7.1%. During the last five years, the prevalence of AU was 16%. GSD was reported in 20% of these tests and 84% of them were asymptomatic. The prevalence of AU was significantly lower in Araucanía region and among people with less than 12 years of education. Life cholecystectomy prevalence was 11% and reached 40% in people aged over 60 years. Women accounted for 75% of total cholecystectomies. Twenty-one percent of individuals who referred biliary-type pain, were studied with an AU. Only 60% of people with GSD confirmed by AU underwent a cholecystectomy. CONCLUSIONS: GSD affects at least 27% of the Chilean adult population. Important deficits and inequities in GSD diagnostic and therapeutic coverage were identified.

[Clinical and laboratory diagnosis of an acute biliary pancreatitis].

In 126 patients, suffering an acute biliary pancreatitis (ABP), clinical examination was conducted. In 65 patients (1-st group) the isolated cholecystolithiasis was noted; in 35 (2-nd group)--cholelithiasis, which did not cause obturation of common biliary duct; in 26 (3-rd group)--cholelithiasis, which caused the biliary ways obturation (including calculi, which were incorporated into the duodenal papilla magna ostium). Clinical course of an ABP have differed depending on localization of calculi of extrahepatic biliary ducts. In patients, suffering ABP, a biochemical signs of hepatocytes functional disorders were observed, impacting the need for hepatoprotector preparations inclusion into complex of perioperative conservative therapy. Determination of activity of pancreatic α-amylase in the blood serum and conduction of the ACTIM Pancreatitis test con- stitute the most sensitive and specific methods of the ABP biochemical diagnosis.

Biliary dyskinesia and symptomatic gallstone disease in children: two sides of the same coin?

BACKGROUND: Despite lack of consensus criteria, biliary dyskinesia (BD) is an increasingly accepted pediatric diagnosis. AIMS: We compared patient characteristics, outcomes, and resource utilization (before and after surgery) between children with BD and symptomatic cholecystolithiasis (LITH). METHODS: Data from the electronic medical record were abstracted for children diagnosed with BD or LITH between December 1, 2002, and November 30, 2012, at Children's Hospital of Pittsburgh. RESULTS: Four hundred and ten patients were identified (BD: 213 patients, LITH: 197 patients). Patients with BD had significantly lower BMI, longer symptom duration, more dyspeptic symptoms, and were more likely to present with other symptoms. Forty-one patients (13.8%) with BD underwent cholecystectomy despite a normal gallbladder ejection fraction (GB-EF). In 32 of these, sincalide triggered pain compared to 75 of the 155 patients with low GB-EF. After surgery, patients with BD more commonly visited gastroenterology clinics and had more GI-related hospitalizations, while emergency room visits decreased in both groups. Only the nature of biliary disease independently predicted continuing pain after surgery, which in turn was the best predictor for higher resource utilization after cholecystectomy. CONCLUSIONS: A large percentage of children with BD did not meet the adult diagnostic standards. Compared to those with LITH, children with BD have more widespread symptoms and continue to use more clinical resources after surgery. These findings suggest that despite its benign prognosis, BD is increasingly treated like other potentially acute gallbladder diseases, although it has the typical phenotype of FGIDs and should be treated using approaches used in such disorders.

Prehepatocholedochal proper hepatic artery. Rare anatomical variant. Surgical considerations. Case report.

In classical anatomic variants, the proper hepatic artery (PHA)continues the common hepatic artery (CHA) after the gastroduodenal artery (GDA) detaches itself and divides into the right hepatic artery (RHA) and left hepatic artery (LHA), the proper hepatic artery being located to the left of the hepatocholedochal duct (HCD). This paper presents an abnormal positioning of the PHA placed before the HCD with an increased diameter of about 5-7 mm, which could be confused with the HCD. We present the case of a 57 year-old woman diagnosed with acute lithiasic cholecystitis, associated with hypersplenism and hypertension. The literature mentions manifold anatomical variants of arterial liver vascularization,including PHA. For this reason, this paper presents an overview of similar cases that can be found in medical literature. The aforementioned case is a rare topographic anatomy for the PHA that can easily pass for HCD especially during celioscopy, therefore it is crucial for this to be acknowledged by all surgeons.

Study of an elevated carbohydrate antigen 19-9 concentration in a large health check-up cohort in China.

BACKGROUND: Carbohydrate antigen 19-9 (CA19-9) is frequently tested in cancer patients. However, elevated CA19-9 can be found in many benign diseases. We investigated the relationship between elevated CA19-9 and diseases, and presented suggestions for its utility in a health check-up cohort. METHODS: From June 2008 to December 2008, we enrolled consecutive health check-up individuals with elevated CA19-9 (>37 U/mL). They were divided into three groups: group A (malignant diseases), group B (decreasing concentrations), and group C (increasing concentrations) according to the following criteria: (i) CA19-9 was rechecked monthly in the first 3 months; (ii) follow-up was completed if malignancy was found or if CA19-9 concentration dropped to normal; (iii) if CA19-9 kept increasing, it was monitored every 3 months; (4) total duration was 1 year. RESULTS: Among 33,867 individuals, 572 (1.7%) individuals showed elevated CA19-9 concentration. A total of 509 (90.0%) individuals finished at 1-year follow-up. In total, nine (1.8%) individuals were diagnosed with malignancies. For 336 (66.0%) individuals CA19-9 concentrations dropped to normal, whereas for 164 (32.2%) individuals it kept rising. Interestingly, we did not find any differences in concentration levels between group A and group C. The main associated benign diseases included fatty liver (25.3%), cholecystolithiasis (13.9%), and chronic hepatitis B (13.9%). CONCLUSIONS: Dynamic monitoring of CA19-9 is recommended in asymptomatic populations with elevated CA19-9 concentrations.

[Laparoscopic cholecystectomy as standardised teaching operation to treat symptomatic cholecystolithiasis]. / Die laparoskopische Cholezystektomie als standardisierter Lehreingriff zur Behandlung der symptomatischen Cholezystolithiasis.

Currently laparoscopic cholecystectomy is the gold standard of therapy for diseases related with gallstones, namely symptomatic cholecystolithiasis, acute and chronic cholecystitis and also as therapy for gallbladder adenoids. Together with laparoscopic appendectomy, this procedure often is one of the first laparoscopic operations performed by new interns. Therefore a standardised, reproducible approach to ensure the patient safety is necessary. The procedure can be subdivided into 10 substeps--so-called "nodal points"--which must be completed before the next substep can be started. This article and the attached video show the ten "nodal points" of a standardised laparoscopic cholecystectomy.

Minimally invasive treatment of cholecysto-choledochal lithiasis - "Rendez-vous" technique.

INTRODUCTION: In our paper we present the results of a study that was meant to provide a complex answer to the question:"Which is the most appropriate, most correct and least expensive treatment for mixt cholecysto-choledochal lithiasis(MCCL)?" MATERIAL AND METHODS: Based on a five year experience (2008-2012), analysed retrospectively, during which 143 patients with MCCL were treated, we are trying to find answers to some of the questions that we have asked ourselves from the very beginning of this period. The answers were guided by alternative therapeutic options, for a pathology that does not have a "gold standard", with respect to the solutions available. RESULTS: Given the fact that the period during which the study was conducted was chosen randomly and that the patients were included consecutively, the representativeness of the results is ensured for any other patient diagnosed with this pathology and admitted to a clinic with the same specialty, dimensions and equipment as the one presented. CONCLUSIONS: This paper compares the results of our study to those of others, in terms of different or similar approach therapeutic options, developed in other minimally invasive surgery centres in the world, the final conclusions being encouraging for the therapeutic sequence that we practice.

Laparoscopic middle pancreatectomy under a pancreatic duct-navigation surgery.

Recent developments of diagnostic modalities have increased detection of many benign and low malignant pancreatic lesions, and then various minimally invasive surgeries and/or pancreatic function preserving surgeries have been devised for such lesions. Laparoscopic pancreatic surgery has developed rapidly in recent years, and its minimal invasiveness is expected. This report describes a laparoscopic middle pancreatectomy under a pancreatic duct-navigation surgery for a localized main pancreatic duct stenosis, and this method is effective to benign and low malignant pancreatic lesions in the points of minimal invasiveness and function preservation.

[Detection of Clonorchis sinensis eggs in the ground gallbladder stones by microscopy].

Sera, feces, bile and gallbladder stones were collected from 179 patients who accepted gallbladder-preserving cholelithotomy during the period of January to June 2010 at the general surgery department in the Second People's Hospital of Panyu District in Guangzhou. Rapid colloidal gold immunochromatography was used to detect IgG against Clonorchis sinensis. C. sinensis eggs were examined by fecal direct smear, and in bile sediments and ground gallbladder stones. The results showed that the positive rate of rapid colloidal gold immunochromatographic assay for IgG was 51.4%, and the egg positive rate in feces, bile sediments and gallbladder stones was 30.7%, 44.7% and 69.8%, respectively. The detection rate of fecal direct smear was the lowest, while that of the gallbladder stone examination was the highest (P < 0.05). Those patients with egg-positive feces and/or bile sediments were all with egg-positive gallbladder stones.

[Two-stage clinical management of cholecystcholedocholithiasis].

This study aimed to evaluate the safety and short-term outcomes after two-stage medical tactics for 115 patients with gallstones and ductal calculi. The use of two-stage method of treatment has proved effective in 110 (95.7%) patients. There were 5 (4.3%) conversion in our series.

[Ultrasonography in the diagnosis of cholelithiasis and its complications].

The author presents the results of ultrasound investigation (USI) of 419 patients with cholecystocholedocholithiasis. The diagnostic accuracy of USI methods in patients with calculous cholecystitis was 98.8%. Direct signs of visualization of concrements in the common bile duct (CBD) were found but in 68.5% of patients. On the basis of USI results the common bile stones were found in 287 (68.5%) patients. The concrements omitted in transabdominal USI were diagnosed using endoscopic retrograde cholangiopancreaticography, magnetic resonance cholangio-pancreaticography, endoscopic ultrasonography as well as in operative intervention.

Multidetector computed tomography diagnosis of ileal and antropyloric gallstone ileus.

Gallstone-induced ileus is a rare complication of cholelithiasis, and gastric outlet obstruction is even rarer. We describe the multidetector computed tomographic diagnosis of small bowel obstruction resulting from a gallstone impacted in the distal ileum and of gastric outlet obstruction from a gallstone impacted in the pyloric antrum (Bouveret syndrome).

[Endoscopic treatment at cholangioscopic cholangiolitiasis].

The article shows a retrospective analysis of endoscopic cholangioscopic conducted as an independent intervention after endoscopic retrograde cholangiopancreatography, and as an auxiliary manipulation during open and laparoscopic surgery. Was demonstrated that cholangioscopic manipulation can be an effective tool both in diagnosis and in prevention and treatment of recurrent and residual cholangiolitiasis, particularly in difficult-to-standard endoscopic techniques of cases. Were refined indications for manipulation and evaluated the diagnostic value and therapeutic effectiveness of the cholangioscopic manipulations. Based on our experience, were refined features and advantages of the methodology and limitations were analyzed and the reasons for the failures and suggests ways to overcome them.

Diagnostic value of ultrasound combined with MRI in cholecystolithiasis: A protocol for systematic review and meta analysis.

BACKGROUND: Early diagnosis of cholecystolithiasis is significant for prevention of further development of situation. Ultrasound is the best choice for the diagnosis of cholecystolithiasis with a sensitivity of >95% and specificity of practically 100%. However, ultrasound is not perfect for it is not so clear sometimes. So, MRI is needed to assist the diagnosing of cholecystolithiasis. Some studies have been conducted to investigate the diagnostic value of ultrasound combined with MRI in cholecystolithiasis, however, the evidence was not enough. METHODS: We will search the following sources for the identification of trials: The Cochrane Library, PubMed, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database (CNKI), Chinese Science and Technique Journals Database (VIP), and the Wanfang Database. The searches were limited to articles published before 1st, April, 2021, and the language were limited to Chinese and English. Statistical analyses will be conducted with Sata 14.0 software and the evaluation of the quality of the included studies will be performed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). RESULTS: This study will provide a rational synthesis of current evidences for MRI combined with ultrasound for cholecystolithiasis. CONCLUSION: The conclusion of this study will provide evidence for the diagnostic value of MRI combined with ultrasound for cholecystolithiasis. ETHICS AND DISSEMINATION: This protocol will not evaluate individual patient information or affect patient rights and therefore does not require ethical approval. Results from this review will be disseminated through peer-reviewed journals and conference reports. PROSPERO REGISTRATION NUMBER: INPLASY202130003.

Laparoendoscopic rendezvous: an effective alternative to a failed preoperative ERCP in patients with cholecystocholedocholithiasis.

BACKGROUND: Although the ideal management of cholelithiasis and concomitant choledocholithiasis is controversial, the two-stage approach [endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, and common bile duct (CBD) clearance followed by laparoscopic cholecystectomy] is the most popular treatment regimen worldwide. However, sometimes ERCP fails to solve the problem of choledocholithiasis preoperatively. The aim of this study was to evaluate the use of intraoperative ERCP using the laparoendoscopic "rendezvous" technique in patients in whom preoperative ERCP has failed or was not possible to attempt. METHODS: Twenty-two patients (13 female, nine male), in whom ERCP failed or was not possible to be performed as a separate procedure before laparoscopic cholecystectomy, were treated with the one-stage approach of intraoperative ERCP during laparoscopic cholecystectomy using the so-called laparoendoscopic "rendezvous" technique. RESULTS: The one-stage approach was completed successfully in a median time of 110 min (range = 75-160 min) in 21 cases; however, in two cases the wire introduced via the cystic duct could not be advanced through Vater's ampulla into the duodenum and the CBD was cannulated from the endoscopic route, in the usual way. There was no mortality or morbidity and most patients were discharged within 48 h after the procedure. CONCLUSION: The laparoendoscopic "rendezvous" is a valuable alternative in treating patients with cholecystocholedocholithiasis. It appears to be a reliable method when preoperative ERCP fails to clear the CBD, while it also offers a one-stage solution to the problem.

Diagnosis and laparoscopic approach to gallbladder torsion and cholelithiasis.

Torsion of the gallbladder is common in elderly women. Different causes have been proposed for this rare condition. The presence of a long mesentery and loss of visceral fat are the main causes for the development of torsion. Patients present with a sudden, acute pain in the right upper quadrant, suggesting cholecystitis. Different imaging methods have shown particular findings, but the diagnosis is still complex. Today, just a few cases have been reported in the literature. The treatment for this condition consists of surgical detorsion and cholecystectomy. Gallbladder torsion is a very rare entity and should be suspected when these clinical findings are present.

Schwannoma of the gallbladder: report of a case.

We report a schwannoma of the gallbladder in a 58-year-old man who was diagnosed as cholecystolithiasis. He presented with recurrent episodes of abdominal pain in the right upper quadrant. The abdominal computed tomography scan and ultrasonography revealed stones about 15 mm in diameter in the gallbladder. Under the diagnosis of cholecystolithiasis, laparoscopic cholecystectomy was performed. The resected specimen showed chronic cholecystitis and no suspicion of neoplasm. Pathological examination revealed that the tumor consist of spindle cells without atypical appearance at small area of fundus. Immunohistologically, tumor cells were positive for S-100 protein and negative for alpha-SMA and c-kit, the lesion was diagnosed as schwannoma.