RESUMO
INTRODUCTION: Cholecystectomy (CCY) is the gold standard treatment of acute cholecystitis (AC). Nonsurgical management of AC includes percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). This study aims to compare outcomes of patients who undergo CCY after having received EUS-GBD vs PT-GBD. METHODS: A multicenter international study was conducted in patients with AC who underwent EUS-GBD or PT-GBD, followed by an attempted CCY, between January 2018 and October 2021. Demographics, clinical characteristics, procedural details, postprocedure outcomes, and surgical details and outcomes were compared. RESULTS: One hundred thirty-nine patients were included: EUS-GBD in 46 patients (27% male, mean age 74 years) and PT-GBD in 93 patients (50% male, mean age 72 years). Surgical technical success was not significantly different between the 2 groups. In the EUS-GBD group, there was decreased operative time (84.2 vs 165.4 minutes, P < 0.00001), time to symptom resolution (4.2 vs 6.3 days, P = 0.005), and length of stay (5.4 vs 12.3 days, P = 0.001) compared with the PT-GBD group. There was no difference in the rate of conversion from laparoscopic to open CCY: 5 of 46 (11%) in the EUS-GBD arm and 18 of 93 (19%) in the PT-GBD group ( P value 0.2324). DISCUSSION: Patients who received EUS-GBD had a significantly shorter interval between gallbladder drainage and CCY, shorter surgical procedure times, and shorter length of stay for the CCY compared with those who received PT-GBD. EUS-GBD should be considered an acceptable modality for gallbladder drainage and should not preclude patients from eventual CCY.
Assuntos
Colecistite Aguda , Humanos , Masculino , Idoso , Feminino , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/cirurgia , Drenagem/métodos , Colecistectomia , Ultrassonografia de IntervençãoAssuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda , Drenagem , Endossonografia/métodos , Vesícula Biliar , Fístula Intestinal , Idoso , Colecistite Aguda/complicações , Colecistite Aguda/diagnóstico , Colecistite Aguda/cirurgia , Drenagem/efeitos adversos , Drenagem/métodos , Tratamento Farmacológico/métodos , Duodeno/cirurgia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/lesões , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Gangrena/etiologia , Gangrena/cirurgia , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Masculino , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/tratamento farmacológico , Peritonite/etiologia , Peritonite/terapia , Ruptura/diagnóstico , Ruptura/etiologia , Ruptura/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Técnicas de Fechamento de FerimentosRESUMO
Primary adenocarcinomas of the presacral (retrorectal) space are rare. The diagnosis is usually delayed because of non-specific symptoms, and is made after a biopsy or surgery. These carcinomas arise from cystic lesions developing from remnants of the embryological postanal gut containing mucous-secreting epithelium, known as tail gut cysts. The potential for infection, perianal fistulas and most importantly, malignant change warrants an early complete surgical resection. From an oncologist's perspective, the management of these carcinomas has varied, and has included adjuvant chemotherapy and/or radiation therapy. We describe here a rare case of adenocarcinoma associated with a tail gut cyst that was discovered incidentally and resected by a posterior approach (Kraske procedure). The patient has had clinical and periodic radiologic surveillance without any evidence of cancer recurrence for over a year and a half.