Colecistitis enfisematosa: Manejo satisfactorio por vía laparoscópica / Emphysematour cholecystitis: satisfactory outcome by laparoscopically managment

La colecistitis enfisematosa es una rara forma de presentación de la colecistitis aguda. Es causada por isquemia vascular y se caracteriza por la presencia de gas en la pared, en la luz o en ambas, la cual puede evolucionar a un cuadro de extrema urgencia asociada a una alta tasa de morbilidad y mortalidad. Se presenta un caso de un paciente con un cuadro de dolor abdominal con síntomas gastrointestinales y signos de respuesta inflamatoria sistémica con diagnóstico presuntivo de colecistitis enfisematosa que se realizó una colecistectomía laparoscopia de urgencia, con una adecuada evolución postoperatoria

Emphysematous cholecystitis is an uncommon variant of acute cholecystitis. It is caused by a vascular ischemia and characterized by the presence of gas in the wall, in the lumen, or in both. It can evolve into a life-threatening condition associated with a high rate of morbidity and mortality. We present a case of a patient who presented with abdominal pain, gastrointestinal symptoms, and signs of a systemic inflammatory response with a presumptive diagnosis of emphysematous cholecystitis. An emergency laparoscopic cholecystectomy was performed, with an adequate postoperative evolution

Papel de la proteína C reactiva y la velocidad de sedimentación globular en la predicción de colecistectomía laparoscópica dificultosa: su aplicación en un programa de residencia universitario / Role of C-reactive protein and erythrocyte sedimentation rate to predict difficult laproscopic cholecystectomy in a university residency program

Antecedentes: la colecistectomía laparoscópica es uno de los procedimientos quirúrgicos más frecuentemente realizados. Las diferencias en la anatomía y en el grado de inflamación vesicular suelen causar dificultades técnicas intraoperatorias. Objetivo: determinar el valor de la proteína C reactiva (PCR) y la velocidad de sedimentación globular (VSG) como predictores de colecistectomía dificultosa y evaluar su aplicación en la planificación prequirúrgica de un programa de residencia universitario. Material y métodos: se confeccionó un estudio retrospectivo, analítico, en un hospital universitario de tercer nivel. Se incluyeron 104 pacientes adultos operados de colecistectomía laparoscópica por litiasis vesicular sintomática entre enero y julio de 2019. Se categorizó a los pacientes en un grupo de colecistectomías dificultosas y otro de colecistectomías no dificultosas. Resultados: se obtuvieron diferencias estadísticamente significativas al comparar los valores de VSG y PCR de ambos grupos (p < 0,001). La sensibilidad de la VSG fue del 100%, la especificidad del 45%, el VPP del 40% y el VPN de 100%. La sensibilidad de la PCR fue del 87,5%, la especificidad del 86,3%, el VPP del 70% y el VPN de 95%. Ambos parámetros se vieron elevados en 14 de 16 colecistectomías dificultosas y en 2 de 44 colecistectomías no dificultosas. La sensibilidad para ambos parámetros elevados fue del 87,5%, la especificidad del 95%, el VPP del 87,5% y el VPN de 95%. Conclusión: la VSG y la PCR han demostrado ser un método fiable en la predicción de colecistectomías dificultosas por litiasis vesicular sintomática. Esto podría ser aplicado en la programación de cirugías dentro de un programa de residencia universitario.

Background: laparoscopic cholecystectomy is one of the most common procedures performed in general surgery. The anatomical differences of the gallbladder and the presence of factors related to inflammation can cause technical issues during surgery. Objective: the aim of the present study was to determine the value of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as predictors of difficult cholecystectomy and to evaluate their application during presurgical planning within a university residency program. Material and methods: we conducted a retrospective and analytical study in a tertiary university hospital. A total of 104 adult patients undergoing laparoscopic cholecystectomy due to symptomatic cholelithiasis between January and July 2019 were included. The patients were categorized into two groups: difficult cholecystectomy and non-difficult cholecystectomy. Results: there were statistically significant differences in ESR and CRP values between both groups (p < 0.001). Sensitivity of ESR was 100%, specificity was 45%, with a PPV of 40% and NPV of 100%. Sensitivity of CRP was 87.5%, specificity was 86.3%, with a PPV of 70% and NPV of 95%. Both parameters were elevated in 14 of 16 difficult cholecystectomies and in 2 of 44 non-difficult cholecystectomies. Sensitivity of CRP was 87.5%, specificity was 86.3%, with a PPV of 70% and NPV of 95%. Conclusion: measuring ESR and CRP has proved to be a reliable method to predict difficult cholecystectomies due to symptomatic cholelithiasis. This could be applied for surgical planning within a university residency program.

Randomized Trial of Near-infrared Incisionless Fluorescent Cholangiography.

BACKGROUND: Incisionless near-infrared fluorescent cholangiography (NIFC) is emerging as a promising tool to enhance the visualization of extrahepatic biliary structures during laparoscopic cholecystectomies. METHODS: We conducted a single-blind, randomized, 2-arm trial comparing the efficacy of NIFC (n = 321) versus white light (WL) alone (n = 318) during laparoscopic cholecystectomy. Using the KARL STORZ Image1 S imaging system with OPAL1 technology for NIR/ICG imaging, we evaluated the detection rate for 7 biliary structures-cystic duct (CD), right hepatic duct (RHD), common hepatic duct, common bile duct, cystic common bile duct junction, cystic gallbladder junction (CGJ), and accessory ducts -before and after surgical dissection. Secondary calculations included multivariable analysis for predictors of structure visualization and comparing intergroup biliary duct injury rates. RESULTS: Predissection detection rates were significantly superior in the NIFC group for all 7 biliary structures, ranging from 9.1% versus 2.9% to 66.6% versus 36.6% for the RHD and CD, respectively, with odds ratios ranging from 2.3 (95% CI 1.6-3.2) for the CGJ to 3.6 (1.6-9.3) for the RHD. After dissection, similar intergroup differences were observed for all structures except CD and CGJ, for which no differences were observed. Significant odds ratios ranged from 2.4 (1.7-3.5) for the common hepatic duct to 3.3 (1.3-10.4) for accessory ducts. Increased body mass index was associated with reduced detection of most structures in both groups, especially before dissection. Only 2 patients, both in the WL group, sustained a biliary duct injury. CONCLUSIONS: In a randomized controlled trial, NIFC was statistically superior to WL alone visualizing extrahepatic biliary structures during laparoscopic cholecystectomy. REGISTRATION NUMBER: NCT02702843.