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1.
J Med Life ; 13(2): 206-210, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32742515

RESUMO

Nausea is a mental sensation of unease and discomfort before vomiting. Vomiting refers to the return of the contents of the upper gastrointestinal tract to the mouth caused by contractions of chest and abdomen muscles. Postoperative nausea and vomiting is an unpleasant experience with high treatment costs. Therefore, this study aimed to compare the effects of haloperidol, metoclopramide, dexmedetomidine, and ginger on postoperative nausea and vomiting after laparoscopy. This double-blind clinical trial was performed on all laparoscopy candidates at Valiasr hospital, Arak, Iran. The patients were randomly divided into four groups (haloperidol, metoclopramide, dexmedetomidine and ginger), and all patients underwent general anesthesia using fentanyl, midazolam, atracurium, and propofol. After intubation, tube fixation, and stable hemodynamic conditions, the patients received four ginger capsules with a hint of lemon. A group of patients received 25 µg of dexmedetomidine. In the Plasil group, 10 mg of metoclopramide was given 30 minutes before the completion of surgery. In addition, 0.5 cc of haloperidol (5 mg) was administered to a group of patients. Heart rate, blood pressure, and oxygen saturation were recorded from the beginning of surgery, every 15 minutes until the end of the surgery. Furthermore, the occurrence of nausea and vomiting was recorded during recovery, 2 and 4 hours after surgery. Data were then analyzed using the SPSS software v.23. Eighty-eight patients were enrolled in the study. The youngest and the oldest were 30 years and 70 years old, respectively, and the mean age was 48.02 ± 9.31 years. Moreover, the number of women in the four groups was higher than that of men. Blood pressure in the dexmedetomidine group was lower than the other four groups (P <0.05). The lowest heart rate was observed in the haloperidol group, while the highest heart rate was seen in the plasil group (P <0.05). The occurrence of vomiting and nausea was not significantly different between the four groups (P <0.05). Our results showed no significant difference in postoperative nausea and vomiting between the four drugs. Due to the hemodynamic changes induced by each drug, it is best to use these drugs based on the patient's condition. Ginger is also a herbal remedy that has fewer side effects, and this drug can be a good option for patients when there is no contraindication.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Dexmedetomidina/uso terapêutico , Gengibre/química , Haloperidol/uso terapêutico , Metoclopramida/uso terapêutico , Extratos Vegetais/uso terapêutico , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/etiologia , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Dexmedetomidina/farmacologia , Método Duplo-Cego , Feminino , Haloperidol/farmacologia , Humanos , Irã (Geográfico) , Masculino , Metoclopramida/farmacologia , Pessoa de Meia-Idade , Oxigênio/metabolismo
2.
Zhonghua Wai Ke Za Zhi ; 58(7): 490-493, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32610416

RESUMO

Incidental gallbladder cancer(IGBC) originated in the West more than half a century ago.IGBC was translated and introduced into China afterwards with widespread clinical application.With the popularization of laparoscopic cholecystectomy, the trend of "abuse" of IGBC has become increasingly apparent worldwide.Many advanced gallbladder cancers have been categorized as IGBC which actually become the synonym of "missed diagnosis" . From the point of the pathology, the diagnosis of IGBC may cause delays in treatment and adversely affect the patient's prognosis.For country like China with relatively high incidences of chronic cholecystitis, cholelithiasis, and gallbladder cancer, the concept of IGBC, however, is no longer applicable to our diagnosis treat model.For improving the prognosis of gallbladder patients, it is necessary to update and rename the concept of IGBC and more attention should be paid to improve the diagnostic level of early stage tumor.


Assuntos
Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/cirurgia , Diagnóstico Ausente , Terminologia como Assunto , China , Colecistectomia Laparoscópica , Colecistite/cirurgia , Colelitíase/cirurgia , Neoplasias da Vesícula Biliar/patologia , Humanos , Achados Incidentais , Estadiamento de Neoplasias , Prognóstico , Tempo para o Tratamento
3.
Magy Seb ; 73(2): 49-56, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32609630

RESUMO

Biliary injury is a rare but a very serious complication of laparoscopic cholecystectomy (LC). Our aim was to analyse the incidence of the biliary injuries and its therapeutic outcome on patients who underwent LC or converted LC. Our research was conducted at the 1st Department of Surgery, Semmelweis University, Budapest between 2006 and 2016, retrospectively. We analysed the LCs and converted LCs performed at our Department and as well as cases where the primary operations were conducted at other institutions but they were unable to provide the adequate therapy for the injury, thus the patients were transferred to our institution. At the 1st Department of Surgery complications occurred in 0,66% (30/4885) of all LCs. 327 converted LCs were done, complications occurred in 26 (7.95%) times. 22 patients were transferred to the 1st Department of Surgery from other institutions. Bilio-vascular injuries occurred in 61% (41/78). ERCP was performed in 25 cases with a 92% success rate. Reoperation was needed in 41% (28/41). Biliary reconstruction during the reoperation was performed via hepaticojejunostomy in 82% of all reoperations. The therapeutic solutions of LC's complications are complex. Therefore, the treatment is recommended only in institutions with appropriate experience.


Assuntos
Ductos Biliares/lesões , Sistema Biliar/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colelitíase/cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Adulto , Colecistectomia Laparoscópica/estatística & dados numéricos , Colelitíase/epidemiologia , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
4.
Med Glas (Zenica) ; 17(2): 275-278, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32662615

RESUMO

Aim The outbreak of the COVID-19 pandemic has had a major impact on the delivery of elective, as well as emergency surgery on a world-wide scale. Up to date few studies have actually assessed the impact of COVID-19 on the postoperative morbidity and mortality following emergency gastrointestinal surgery. Herein, we present our relevant experience over a 3-month period of uninterrupted provision of emergency general surgery services in George Eliot Hospital NHS Trust, the United Kingdom. Methods We performed a retrospective analysis of a prospective institutional database, which included the operation types, paraclinical investigations and postoperative complications of all patients undergoing emergency general surgery operations between March - May 2020. Results The occurrence of a 5% overall respiratory complication rate postoperatively, with 3% infection rate for COVID-19 was found; no patient had unplanned return to intensive care for ventilator support and there was no mortality related to COVID-19 infection. Conclusion When indicated, emergency surgery should not be delayed in favour of expectant/conservative management in fear of COVID-19-related morbidity or mortality risks.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório , Emergências , Mortalidade , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Respiratória/epidemiologia , Infecções Respiratórias/epidemiologia , Abscesso/cirurgia , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Betacoronavirus , Colecistectomia Laparoscópica , Comorbidade , Infecções por Coronavirus/terapia , Surtos de Doenças , Drenagem , Feminino , Herniorrafia , Humanos , Laparoscopia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/epidemiologia , Insuficiência Respiratória/terapia , Infecções Respiratórias/terapia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
5.
Croat Med J ; 61(3): 239-245, 2020 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-32643340

RESUMO

AIM: To assess the intrahepatic and extrahepatic bile duct diameter dilatation after laparoscopic cholecystectomy with magnetic resonance cholangiopancreatography. METHODS: Forty-eight patients (35 women, mean age 54.58±11.83 years) underwent laparoscopic cholecystectomy because of gallstones. The intrahepatic and extrahepatic bile ducts were measured before and three and six months after cholecystectomy. The diameter was measured in the anteroposterior and laterolateral direction at 14 points. RESULTS: When compared with the preoperative diameter, the common bile duct diameter at the proximal part was significantly wider three months (P=0.006) and six months (P=0.0001) after cholecystectomy; the common hepatic duct was significantly wider three months (P=0.001) and six months (P=0.003) after cholecystectomy; the right and left hepatic bile ducts were significantly wider six months after cholecystectomy (P<0.0001, P=0.01, respectively); and the segmental intrahepatic bile ducts in both hepatic lobes were significantly wider three months (P<0.0001) and six months after cholecystectomy (P<0.0001). CONCLUSION: This study showed that significant post-cholecystectomy dilatation occurred only at certain points and not along the whole extrahepatic bile duct. We also found a significant dilatation of the main intrahepatic and segmental intrahepatic bile ducts.


Assuntos
Ductos Biliares/diagnóstico por imagem , Colangiopancreatografia por Ressonância Magnética , Colecistectomia Laparoscópica , Cálculos Biliares/cirurgia , Adulto , Idoso , Ductos Biliares/patologia , Dilatação Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
6.
Int. j. morphol ; 38(3): 552-557, June 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1098286

RESUMO

La colecistectomía laparoscópica es el tratamiento de elección de la colelitiasis; sin embargo, se acompaña de comorbilidades y no está exenta de complicaciones mayores que pueden ser letales; la identificación del trígono cistohepático con disección y ligadura de la arteria cística son pasos obligatorios de la cirugía; la identificación de las variaciones de la arteria cística y los conductos biliares pueden minimizar las eventuales complicaciones. Al protocolo preoperatorio se implementó una angiotomografía con Tomógrafo Siemens Somatón Sensation ® de 64 cortes para identificar la arteria cística en pacientes con colelitiasis de la Unidad de Cirugía General del Hospital de Especialidades Teodoro Maldonado Carbo IESS de Guayaquil. Se escogieron 60 pacientes femeninos en forma aleatoria (edades 19-70 años, promedio 44,25 años) y la muestra se dividió en dos grupos de 30; al grupo estudio se aplicó angiotomografía hasta un mes antes de la cirugía y al grupo control se le aplicó el protocolo convencional. Se evaluó morbilidades relacionadas con: hemorragia operatoria por lesión de la arteria cística y en el posoperatorio: infección de herida operatoria, íleo y drenaje. La angiotomografía permitió identificar la arteria cística en el preoperatorio y contribuyó a disminuir comorbilidades que acompañan a la colecistectomía laparoscópica.


Laparoscopic cholecystectomy is the treatment of cholelithiasis of choice; however, it is accompanied by comorbidities and is not exempt from major complications that can be lethal; the identification of the cystohepatic trigone with dissection and ligation of the cystic artery are mandatory steps of surgery; the identification of the variations of the cystic artery and the bile ducts can minimize the possible complications. The preoperative protocol was implemented with an angiotomography with Siemens Somatón Sensation ® 64-slice Tomograph to identify the cystic artery in patients with cholelithiasis of the General Surgery Unit of the Teodoro Maldonado Carbo IESS Specialty Hospital of Guayaquil. 60 female patients were chosen at random (ages 19 -70 years, average 44.25 years) and the sample was divided into two groups of 30; Angiotomography was applied to the study group up to one month before surgery and the conventional protocol was applied to the control group. Morbidities related to: operative haemorrhage due to cystic artery and postoperative injury: operative wound infection, ileus and drainage were evaluated. Angiotomography allowed to identify the cystic artery in the preoperative period and contributed to decrease comorbidities that accompany laparoscopic cholecystectomy.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Colelitíase/cirurgia , Artéria Celíaca/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Colelitíase/diagnóstico por imagem , Comorbidade , Artéria Celíaca/anatomia & histologia , Colecistectomia Laparoscópica
7.
Khirurgiia (Mosk) ; (6): 49-52, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573532

RESUMO

OBJECTIVE: To study the incidence of gallbladder polyps and the possibilities of modern methods of diagnosis and surgical treatment of this disease. MATERIAL AND METHODS: There were 42 laparoscopic cholecystectomies in patients with diagnosed gallbladder polyps. The polyps were diagnosed preoperatively. Intraoperative diagnosis during surgery for gallstone disease was observed in 3 cases. A comparative analysis of preoperative examination did not reveal any advantages of certain diagnostic approach. RESULTS: Hyperplastic polyp was the most common type (n=20, 47.6%), adenomatous polyps occurred in 19 (45.3%) cases, cholesteric polyps - in 3 (7.1%) patients. All patients had signs of chronic inflammation of the gallbladder wall with its infiltration by lymphocytes and histiocytes. CONCLUSION: Further studies with clear criteria for the diagnosis of gallbladder polyps including ones for determining true polyps, precancerous and malignant polyps are required.


Assuntos
Doenças da Vesícula Biliar/cirurgia , Pólipos/cirurgia , Colecistectomia Laparoscópica , Colecistite/cirurgia , Doença Crônica , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Pólipos/diagnóstico , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/cirurgia
8.
Medicine (Baltimore) ; 99(24): e20239, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541450

RESUMO

To evaluate the timing, feasibility, and necessity of early laparoscopic cholecystectomy (LC) in the management of patients with acute calculous cholecystitis complicated with hepatic dysfunction.The clinical data of 60 patients with acute calculous cholecystitis complicated with hepatic dysfunction treated from January 2016 to January 2018 were analyzed retrospectively. A total of 32 patients underwent LC within 72 hours of the cholecystitis attack, 28 patients after 72 hours. The results were compared with those from 28 patients with delayed LC.All the patients were operated by experienced surgeons, and no LC transfer to open operation. No significant differences were detected in the operation time, postoperative complications, intraoperative blood loss, white TBIL, ALT, GGT before and after the operation between the 2 groups (P > .05). Patients who underwent early LC had a short hospital stay and fewer hospital costs (P < .05). All the patients were cured.It is safe, feasible, and necessary to perform LC within 72 hours in patients with acute calculous cholecystitis complicated with hepatic dysfunction. Such patients show a high positive correlation between the inflammation of acute calculous cholecystitis and the damage of hepatic function.


Assuntos
Colecistite Aguda/cirurgia , Cálculos Biliares/complicações , Hepatopatias/etiologia , Hepatopatias/cirurgia , Perda Sanguínea Cirúrgica , Estudos de Casos e Controles , Colecistectomia Laparoscópica/métodos , Estudos de Viabilidade , Feminino , Cálculos Biliares/patologia , Humanos , Tempo de Internação , Hepatopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Prevenção Secundária/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(25): e20565, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569180

RESUMO

RATIONALE: Ventriculoperitoneal shunt (VPS) is the most common treatment for idiopathic normal pressure hydrocephalus, a subtype of hydrocephalus characterized by gait disturbance, dementia, and urinary incontinence. However, while the malfunction of VPS is reported at a high rate, the involvement of chronic cholecystitis in shunt malfunction is rare. PATIENT CONCERNS: A 73-year-old woman with idiopathic normal pressure hydrocephalus who received a VPS but subsequently developed chronic cholecystitis. The patient suffered from drowsiness and was unable to walk. Her family found that she presented with poor appetite and was bloated. DIAGNOSES: Chronic cholecystitis was confirmed through abdominal computed tomography, which showed a swollen, and enlarged gallbladder, and flatulence. A head computed tomography scan indicated hydrocephalus with enlarged ventricular system and paraventricular edema. INTERVENTIONS: Laparoscopic cholecystectomy was performed successfully, requiring no further shunt manipulation. OUTCOMES: The patient's memory and cognitive ability were slightly impaired without a positive sign in the abdomen. No catheter or abdominal infection signs were observed during the following 3 months of follow-up. CONCLUSION: To the best of our knowledge, this report is the first to reveal that shunt malfunction may result from chronic cholecystitis, which induced the presently observed intra-abdominal hypertension.


Assuntos
Colecistite/complicações , Falha de Equipamento , Derivação Ventriculoperitoneal/efeitos adversos , Idoso , Colecistectomia Laparoscópica , Colecistite/dietoterapia , Colecistite/cirurgia , Feminino , Cabeça/diagnóstico por imagem , Humanos , Tomografia Computadorizada por Raios X
10.
Rev Col Bras Cir ; 47: e20202388, 2020 Jun 03.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32578818

RESUMO

OBJECTIVE: to assess clinical and epidemiological factors of patients undergoing video cholecystectomy at the Hospital da Cruz Vermelha do Paraná, Curitiba unit, operated from September 2016 to September 2018, as well as the influence of comorbidities, sex and advanced age on the postoperative prognosis, while in the hospital. METHODS: Analytic retrospective study. The analyzed variables were obtained by the review of medical records. Statistical analyses were performed considering the significance level p < 0.05. RESULTS: 389 patients, of whom 265 were women and 124 men, were included. The mean age was 51.5 years, 58.8% of the patients were diagnosed with at least one comorbidity, and 74.6% were overweight or obese. The incidence of intraoperative complications was 1.3%, postoperative 3.8% and, mortality, 0.3%. Some risk factors were identified as worse postoperative prognosis, such as Diabetes Mellitus, hypertension, presence of one or more comorbidities and mainly, advanced age, which was related to longer hospitalization times (p < 0,001), need of intensive therapy (p < 0,001), conversion to open surgery (p = 0,003) and postoperative complications (p < 0,001). Furthermore, the male sex was predictive of longer hospitalization times (p = 0,003) and need of intensive therapy (p = 0,01). CONCLUSION: the presence of comorbidities, male sex, and advanced age are predictive factors of bad prognosis for patients undergoing video laparoscopic cholecystectomy.


Assuntos
Colecistectomia Laparoscópica , Brasil , Colecistectomia , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Cirurgia Vídeoassistida
11.
Rev Esp Enferm Dig ; 112(6): 507-508, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32496116

RESUMO

We read the article published in the Spanish Journal of Gastroenterology and its accompanying editorial about the laparoscopic treatment of both cholecystolithiasis and choledocholithiasis in a single stage procedure. We would like to make some comments. Common bile duct (CBD) stones can lead to serious complications such as cholangitis and pancreatitis. So far, there is no standard surgical treatment for choledocholithiasis. Although, there are some ways to deal with CBD stones. Each method has its own advantages and disadvantages. In the era of advancements in minimally invasive technology, the treatment of CBD stones still remains controversial with regard to endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopic common bile duct exploration (LCBDE). Preoperative ERCP followed by laparoscopic cholecystectomy (LC) is frequently performed.


Assuntos
Colecistectomia Laparoscópica , Coledocolitíase , Cálculos Biliares/cirurgia , Laparoscopia , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Estudos de Coortes , Ducto Colédoco , Humanos , Estudos Retrospectivos
13.
Chirurgia (Bucur) ; 115(2): 208-212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369724

RESUMO

Cholelithiasis is twice more common in patients suffering from liver cirrhosis compared to overall population and in those patients, acute cholecystitis occurs significantly more often. Our goal was to review the literature and to overview the indications, contra-indications, and alternatives in the cirrhotic with biliary stones. We conducted a systematic review of the literature using the key words "Cirrhosis", "cholecystectomy", "laparoscopy"and "indications". Selected articles were reviewed for information specific to indications, contra-indications, and alternatives to laparoscopic cholecystectomy in cirrhotics. Results showed that laparoscopic cholecystectomy might offer several advantages in cirrhotic population, however cholecystectomy can be challenging: specific indications and alternatives to surgery must be discussed case by case. Laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis; special precautions are warranted regarding pneumoperitoneum pressure, trocar placement and increased safety with Indocyanine-green (ICG) fluorescence cholangiography. Nevertheless, in high-risk cirrhotic patients (Child C) and/or in common bile duct lithiasis endoscopic and non-surgical conservative treatments are preferable.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda/cirurgia , Colelitíase/cirurgia , Cirrose Hepática/complicações , Colangiografia , Colecistite Aguda/etiologia , Colelitíase/etiologia , Humanos
14.
Chirurgia (Bucur) ; 115(2): 213-219, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369725

RESUMO

Laparoscopic cholecystectomy is the gold standard procedure in patients with cirrhosis and symptomatic gallbladder disease or acute cholecystitis. In this retrospective study we evaluated laparoscopic cholecystectomy in patients with cirrhosis based on Child-Pugh score as a predictor of morbidity. In the First Surgical Clinic of Iasi, from 01 jan 2010 to 31 jan 2020, we performed 111 laparoscopic cholecystectomies in Child-Pugh A, B, and C cirrhotic patients. Intraoperative difficulty (grade 3 Cuschieri) was experienced in 32 patients (28.8%). Highly vascular sub hepatic adherences have been reported in a quarter of all patients. Intraoperative incidents were more frequent 27 (24.3%) compared to laparoscopic cholecystectomy performed in other patient groups. The conversion rate to open cholecystectomy was 6.3% (7 cases). Mean operative time was 84 min. Mean duration of hospitalization stay was 4.7 days. The morbidity rate was 16.2% of patients and included bleeding, intraabdominal fluid collections and wound complications more common in patients with Child-Pugh Cirrhosis B and C. The results are dependent of the perioperative management of the liver function.


Assuntos
Colecistectomia Laparoscópica/métodos , Doenças da Vesícula Biliar/cirurgia , Cirrose Hepática/complicações , Criança , Colecistectomia Laparoscópica/efeitos adversos , Doenças da Vesícula Biliar/etiologia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
15.
Am Surg ; 86(4): 341-345, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391758

RESUMO

Robotic surgery has been widely adopted by many specialties, including hepatobiliary surgery. However, robotic procedures generally require longer operative times and are costlier than their laparoscopic counterparts. The role for robotic cholecystectomy (RC), particularly in patients with advanced liver disease, has not been established. A retrospective analysis of the NSQIP database was performed, focusing on patients with chronic liver disease who underwent cholecystectomy. Patients were categorized based on their model for end-stage liver disease (MELD) score and the type of surgical procedure: open, laparoscopic, or RC. Rates of a variety of postoperative complications including length of stay (LOS) were analyzed. In patients with a MELD score of 21 to 30, open cholecystectomy was associated with a long hospital LOS (3 vs 1 vs 1; P -0.01). RC was equivalent to laparoscopic cholecystectomy in terms of perioperative mortality for higher MELD score patients but was associated with lower conversion rates and overall LOS. This data suggests that RC should be considered in patients with advanced liver disease needing cholecystectomy.


Assuntos
Colecistectomia/métodos , Colecistite/cirurgia , Hepatopatias/cirurgia , Procedimentos Cirúrgicos Robóticos , Adulto , Colecistectomia Laparoscópica , Doença Crônica , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Pontuação de Propensão , Estudos Retrospectivos
17.
Medicine (Baltimore) ; 99(20): e20039, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443308

RESUMO

The role of laparoscopic radical cholecystectomy (LRC) in the surgical management of T2 gallbladder carcinoma (GBC) is still controversial.The medical records of patients with T2 GBC treated with radical cholecystectomy were retrospectively reviewed. In this study, we compare the short- and long-term oncologic outcomes, using propensity score matching analysis, of patients with T2 GBC who underwent LRC and open radical cholecystectomy (ORC).Among 183 patients, 86 were selected by propensity score matching (LRC = 43 and ORC = 43). The ORC group underwent more extensive surgery (liver resections and extended lymph node dissections [ELND]) than the LRC group. The LRC group had less operative blood loss, shorter length of hospital stay, fewer complications, and had the earlier start of adjuvant chemotherapy. There was no significant difference between the laparoscopic and open surgery groups in terms of 5-year overall survival rate (64.6% vs 80.4%, P = .214) and disease-free survival rate (77.1% vs 82.2%, P = .641). A subgroup analyses showed that liver resection and ELND had no survival advantage compared to no liver resection and regional lymph node dissection, respectively.Our LRC approach is safe and effective, with long-term survival comparable to that of ORC.


Assuntos
Colecistectomia Laparoscópica , Neoplasias da Vesícula Biliar/cirurgia , Idoso , Feminino , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
18.
Medicine (Baltimore) ; 99(20): e20070, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443316

RESUMO

OBJECTIVE: To evaluate whether conventional postoperative drainage is more effective than not providing drainage in patients with non-complicated benign gallbladder disease following laparoscopic cholecystectomy (LC). METHODS: A search of the electronic databases MEDLINE, EMBASE, Web of science, Cochrane Library, and Chinese Biomedical Database (CBM) was conducted for randomized controlled trials (RCTs) reporting outcomes of LC surgery with and without an abdominal drain. RESULTS: Twenty-one RCTs involving 3246 patients (1666 with drains vs 1580 without) were included in the meta-analysis. There were no statistically significant differences in the rates of incidence of intra-abdominal fluid (RR: 1.10; 95% CI: 0.81-1.49; P = .54) or post-surgical mortality (RR: 0.44; 95% CI: 0.04-4.72; P = .50) between the two groups. Abdominal drains did not reduce the overall incidence of nausea and vomiting (RR: 1.16; 95% CI: 0.95-1.42; P = .15) or shoulder tip pain (RR: 1.03; 95% CI: 0.76-1.38; P = .86). The abdominal drain group displayed significantly higher pain scores (MD: 1.07; 95% CI: 0.69-1.46; P < .001) than the non-drainage patients. Abdominal drains prolonged the duration of the surgical procedure (MD: 5.69 min; 95% CI: 2.51-8.87; P = .005) and postoperative hospital stay (MD: 0.47 day; 95% CI: 0.14-0.80; P = .005). Wound infection was found to be associated with the use of abdominal drains (RR: 1.97; 95% CI: 1.11-3.47; P = .02). CONCLUSIONS: Currently, there is no evidence to support the use of routine drainage after LC in non-complicated benign gallbladder disease. Further well-designed randomized clinical trials are required to confirm this finding.


Assuntos
Colecistectomia Laparoscópica , Drenagem , Doenças da Vesícula Biliar/cirurgia , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Colecistectomia Laparoscópica/métodos , Drenagem/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Medicine (Baltimore) ; 99(20): e20177, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443335

RESUMO

BACKGROUND: Although many studies have reported the effects of dexmedetomidine on cognitive function (CF) in elderly patients after laparoscopic cholecystectomy (LCT), to this date, its effects are still not well understood. The aim of this study is to produce a qualitative synthesis of assessing the effects of dexmedetomidine on CF in elderly patients after LCT. METHODS: We will conduct a comprehensive search in Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, VIP Database, WANGFANG Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the commencement to March 31, 2020 without restrictions of language and publication status. In addition, we will also search grey literature, including conference abstracts, dissertations, reference lists of included studies and relevant reviews. All potential studies will be identified independently by 2 authors to determine their inclusion against previously defined eligibility criteria. The quality of selected papers will be assessed using Cochrane risk of bias tool. All statistical analysis will be performed using RevMan 5.3 software. RESULTS: This study will provide a synthesis of the current available data on assessing the effects of dexmedetomidine on CF in elderly patients after LCT. CONCLUSIONS: Its findings will provide qualitative evidence to better understand the effects of dexmedetomidine on CF in elderly patients after LCT.INPLASY Registration Number: INPLASY202040030.


Assuntos
Analgésicos não Entorpecentes/farmacologia , Colecistectomia Laparoscópica/métodos , Cognição/efeitos dos fármacos , Dexmedetomidina/farmacologia , Idoso , Analgésicos não Entorpecentes/uso terapêutico , China/epidemiologia , Dexmedetomidina/uso terapêutico , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança
20.
Surgery ; 168(1): 62-66, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32466829

RESUMO

BACKGROUND: We sought to prospectively identify risk factors for biliary complications and 30-day readmission after cholecystectomy for choledocholithiasis and gallstone pancreatitis across multiple US hospitals. METHODS: We performed a prospective, observational study of patients who underwent same admission cholecystectomy for choledocholithiasis and gallstone pancreatitis between 2016 and 2019 at 12 US centers. Patients with prior history of endoscopic retrograde cholangiopancreatography or diagnosis of cholangitis were excluded. We used logistic regression to determine associations between preoperative demographics, labs, and imaging on primary outcomes: postoperative biliary complications and 30-day readmission. RESULTS: There were 989 patients in the cohort. There were 16 (1.6%) patients with postoperative biliary complications, including intra-abdominal abscesses, endoscopic retrograde cholangiopancreatography-induced pancreatitis, and biliary leaks. Increasing operative time (odds ratio 1.01, 95% confidence interval 1.00-1.01, P = .02), worsening leukocytosis (odds ratio 1.16, 95% confidence interval 1.07-1.25, P = .0002), and jaundice (odds ratio 3.25, 95% confidence interval 1.01-10.42, P = .04) were associated with postoperative biliary complications. There were 36 (3.6%) patients readmitted within 30 days owing to a surgical complication. A prior postoperative biliary complication (odds ratio 7.8, 95% confidence interval 1.63-37.27, P = .01), male sex (odds ratio 2.42, 95% confidence interval 1.2-4.87, P = .01), and index operative duration (odds ratio 1.01, 95% confidence interval 1.00-1.01, P = .03) were associated with 30-day readmission. CONCLUSION: Among patients undergoing cholecystectomy for common bile duct stones, jaundice, worsening leukocytosis, and longer operations are associated with postoperative biliary complications. A prior biliary complication is also predictive of a 30-day readmission. Surgeons should recognize these factors and avoid prematurely discharging at-risk patients given their propensity to develop complications and require readmission.


Assuntos
Colecistectomia Laparoscópica , Cálculos Biliares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia
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