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1.
Medicine (Baltimore) ; 100(20): e25879, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011054

RESUMO

ABSTRACT: There might be a thick "protrusion" in the visceral surface of hepatic quadrate lobe during the laparoscopic cholecystectomy (LC), which affects the surgical fields and consequently triggers high risks of biliary tract injury. Although n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery for liver retraction, there is still no consensus on its safety and feasibility in LC. In this study, we investigated the safety, feasibility, and effectiveness of liver retraction using NBCA glue for these patients which have the thick "protrusion" on the square leaf surface of the liver during LC.Fifty-seven patients presenting thick "protrusion" hepatic quadrate lobe were included in our retrospective study. We performed LC in the presence of NBCA glue (n = 30, NBCA group) and absence of NBCA glue (n = 27, non-NBCA group), respectively. NBCA was used to fix the thick "protrusion" of the liver leaves to the hepatic viscera surface, which contributed to the revelation of the gallbladder triangle. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the 2 groups.Both the groups' patients accomplished the operation in the laparoscopy. There was no mortality and no additional incision during operation. No severe complications including bile duct injury were available after surgery and no postoperative NBCA-related complications occurred after 9- to 30 months' follow-up. The time of operation in NBCA group showed significant decrease compared with that of non-NBCA group (48.33 ±â€Š16.15 vs 65.00 ±â€Š22.15 minutes, P < .01). There were no significant differences in blood loss, postoperative hospital stays, and the preoperative and postoperative liver function between the two groups (P > .05). Besides, no significant differences were noticed in major clinical characteristics between the 2 groups (P > .05).Liver retraction using NBCA during LC for thick "protrusion" hepatic quadrate lobe patients is safe, effective, and feasible.


Assuntos
Colecistectomia Laparoscópica/métodos , Embucrilato/administração & dosagem , Complicações Intraoperatórias/prevenção & controle , Adesivos Teciduais/administração & dosagem , Adulto , Idoso , Ductos Biliares/lesões , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Colecistectomia Laparoscópica/efeitos adversos , Embucrilato/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/etiologia , Tempo de Internação/estatística & dados numéricos , Fígado , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento
2.
BMC Gastroenterol ; 21(1): 226, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011273

RESUMO

BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGBD) is recommended for acute cholecystitis patients at high risk for surgical treatment. However, there is no evidence about the best timing of surgery after PTGBD. Here, we retrospectively investigated the influence of the interval between PTGBD and surgery on perioperative outcomes and examined the optimal timing of surgery after PTGBD. METHODS: We performed a retrospective analysis of 22 patients who underwent cholecystectomy after PTGBD from January 2008 to August 2019. We examined perioperative factors between patients with an interval of ≤ 7 days between PTGBD and cholecystectomy (≤ 7-day group; n = 12) and those with an interval of ≥ 8 days (≥ 8-day group; n = 10). Moreover, we also examined perioperative factors between patients with an interval of ≤ 14 days from PTGBD to cholecystectomy (≤ 14-day group; n = 10) and those with an interval of ≥ 15 days (≥ 15-day group; n = 12). RESULTS: Of the 22 patients, 9 had Grade I cholecystitis, 12 had Grade II cholecystitis, and 2 had Grade III cholecystitis. Nine patients had high-grade cholecystitis before PTGBD and 13 had a poor general condition. We examined perioperative factors between patients with an interval of ≤ 7 days between PTGBD and cholecystectomy (≤ 7-day group; n = 12) and those with an interval of ≥ 8 days (≥ 8-day group; n = 10). The C-reactive protein (CRP) level before surgery was significantly higher (12.70 ± 1.95 mg/dL vs. 1.13 ± 2.13 mg/dL, p = 0.0007) and the total hospitalization was shorter (17.6 ± 8.0 days vs. 54.1 ± 8.8 days, p = 0.0060) in the ≤ 7-day group than in the ≥ 8-day group. We also examined perioperative factors between patients with an interval of ≤ 14 days from PTGBD to cholecystectomy (≤ 14-day group; n = 14) and those with an interval of ≥ 15 days (≥ 15-day group; n = 8). The CRP level before surgery was significantly higher (11.13 ± 2.00 mg/dL vs. 0.99 ± 2.64 mg/dL, p = 0.0062) and the total hospitalization was shorter (19.5 ± 7.2 days vs. 59.9 ± 9.5 days, p = 0.0029) in the ≤ 14-day group than in the ≥ 15-day group. However, there were no significant differences between the ≤ 14-day group and the ≥ 15-day group in the levels of hepatic enzymes before surgery, adhesion grade, amount of bleeding during surgery, operative duration, frequency of surgical complications, or length of hospitalization after surgery. CONCLUSIONS: The interval between PTGBD and surgery has little influence on perioperative outcomes.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Colecistectomia , Colecistite Aguda/cirurgia , Drenagem , Vesícula Biliar/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
3.
BMC Surg ; 21(1): 263, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34039316

RESUMO

BACKGROUND: The laparoscopic view of extrahepatic biliary tract and cystic artery is different anatomically from open approach. Consequently iatrogenic injuries due to inadverent damage to cystic artery are not uncommon. These complications can be prevented by careful dissection in Calots triangle and better knowledge of laparoscopic anatomy of cystic artery and its variations. The aim of this study is to establish the prevalence of variation in position of cystic artery in relation to cystic duct. This will help identify the safe area for dissecting peritoneum in Calots triangle and thus help young surgeons overcome the long learning curve associated with laparoscopy. MATERIALS AND METHODS: During a 10 year period from January 2009 to January 2019, 1850 laparoscopic cholecystectomies that were performed at a tertiary care hospital were studied. Patients with history of previous abdominal surgery were excluded from the study. Cystic artery was divided into four groups based on its relative position to cystic duct. It includes superomedial, superolateral, anterior and absent cystic artery relative to the cystic duct. RESULTS: Out of 1850 cases of laparoscopic cholecystectomy 1676 (90.59%) patients had cystic artery superomedial to cystic duct and 96 (5.19%) had a cystic artery at superolateral position to cystic duct. In 48 (2.59%) patients it was found anterior to cystic duct and in 30 (1.62%) patients it was absent. CONCLUSIONS: It is concluded that the most common position of cystic artery is superomedial while the least common position was found to be anterior to cystic duct. Hence it is postulated that blind dissection from anterior side is the safest approach to avoid injury to cystic artery.


Assuntos
Ductos Biliares Extra-Hepáticos , Colecistectomia Laparoscópica , Laparoscopia , Colecistectomia Laparoscópica/efeitos adversos , Ducto Cístico/diagnóstico por imagem , Ducto Cístico/cirurgia , Artéria Hepática , Humanos
4.
Rev Col Bras Cir ; 48: e20202907, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34008798

RESUMO

OBJECTIVE: to evaluate the effectiveness and safety of laparoscopic cholecystectomies performed by residents of the first and second-year of a general surgery residency program. We studied the primary total cost of treatment and complication rates as primary outcomes, comparing the groups operated by senior and resident surgeons. METHODS: this was a retrospective cohort study of patients who underwent laparoscopic cholecystectomy performed in a training hospital of large surgical volume in Brazil, in the period between June 1, 2018 and May 31, 2019. The study population comprised patients who underwent elective cholecystectomy due to uncomplicated chronic calculous cholecystitis or to the presence of gallbladder polyps with surgical indication. We divided the cases into three groups, based on the graduation of the main surgeon at the time of the procedure: first-year residents (R1), second-year residents (R2), and trained general surgeons (GS). RESULTS: during the study period, 1,052 laparoscopic cholecystectomies were performed, of which 1,035 procedures met the inclusion criteria, with 78 (7.5%) patients operated on with the participation of first-year residents (R1), 500 (48.3%) patients with the participation of second-year residents (R2), and 457 (44.2%) with the participation of senior surgeons only. There was no difference in conversion rates, complications, and reporting of adverse events between groups. We observed a significant difference regarding hospitalization costs (p = 0.003), with a higher mean for the patients operated with the participation of R1, of US$ 2,671.13, versus US$ 2,414.60 and US$ 2,396.24 for the procedures performed by senior surgeons and R2, respectively. CONCLUSIONS: laparoscopic cholecystectomy with the participation of residents is safe, even in their first years of training. There is an additional cost of about 10% in the treatment of patient operated with the participation of first-year residents. There was no significant difference in the cost of the group operated by second-year residents.


Assuntos
Colecistectomia Laparoscópica , Cirurgia Geral , Internato e Residência , Brasil , Colecistectomia , Cirurgia Geral/educação , Humanos , Estudos Retrospectivos
5.
Croat Med J ; 62(2): 137-145, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33938653

RESUMO

AIM: To explore the effects of an anterior quadratus lumborum block (QLB) on opioid consumption, pain, nausea, and vomiting (PONV) after ambulatory laparoscopic cholecystectomy. METHODS: This randomized controlled study recruited 70 patients scheduled for ambulatory laparoscopic cholecystectomy from January 2018 to March 2019. The participants were randomly allocated to one of the following groups: 1) anterior QLB (n=25) with preoperative ropivacaine 3.75 mg/mL, 20 mL bilaterally; 2) placebo QLB (n=22) with preoperative isotonic saline, 20 mL bilaterally; and 3) controls (n=23) given only standard intravenous and oral analgesia. The primary endpoint was opioid analgesic consumption. The secondary endpoints were pain (numeric rating scale 0-10) and PONV (scale 0-3, where 0=no PONV and 3=severe PONV). Assessments were made up to 48 hours postoperatively. RESULTS: The groups did not significantly differ in opioids consumption and reported pain at 1, 2, 24, and 48 hours postoperatively. PONV in the QLB group was lower than in the placebo and control groups. CONCLUSION: Preoperative anterior QLB for laparoscopic cholecystectomy did not affect postoperative opioid requirements and pain. However, anterior QLB may decrease PONV.


Assuntos
Analgesia , Colecistectomia Laparoscópica , Bloqueio Nervoso , Anestésicos Locais , Colecistectomia Laparoscópica/efeitos adversos , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle
6.
Ann Palliat Med ; 10(5): 5128-5136, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33977750

RESUMO

BACKGROUND: Laparoscopic cholecystectomy (LC) is a common surgical procedure for managing gallbladder disease. Prolonged length of stay (LOS) in the postanesthesia care unit (PACU) may lead to overcrowding and a decline in medical resource utilization. In this work, we aimed to develop and validate a predictive nomogram for identifying patients who require prolonged PACU LOS. METHODS: Data from 913 patients undergoing LC at a single institution in China between 2018 and 2019 were collected, and grouped into a training set (456, cases during 2018) and a test set (457, cases during 2019). The definition of PACU LOS is the duration between admission to discharge from PACU, which we can derive from the electronic medical record system. Using the least absolute shrinkage and selection operator regression model, the optimal feature was selected, and multivariable logistic regression analysis was used to build the prolonged PACU LOS risk model. The C-index, calibration plot, and decision curve analysis (DCA) were used in assessing the model calibration, discrimination, and clinical application value, respectively. For external validation, the test set data was evaluated. RESULTS: The predictive nomogram had 8 predictor variables for prolonged PACU LOS, including age, American Society of Anesthesiologists (ASA) grade, active smoker, gastrointestinal disease, liver disease, and cardiovascular disease. This model displayed efficient calibration and moderate discrimination with a C-index of 0.662 (95% confidence interval, 0.603 to 0.721) for the training set, and 0.609 (95% confidence interval, 0.549 to 0.669) for the test set. DCA demonstrated that the prolonged PACU LOS nomogram was reliable for clinical application when an intervention was decided at the possible threshold of 7%. CONCLUSIONS: We developed and validated a predictive nomogram with efficient calibration and moderate discrimination, and can be applied to identify patients most likely to be subjected to prolonged PACU LOS. This novel tool may shun overcrowding in PACU and optimize medical resource utilization.


Assuntos
Colecistectomia Laparoscópica , Nomogramas , China , Humanos , Tempo de Internação
7.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-33981137

RESUMO

Aim: This study aims to evaluate the incidence, indications, management, and long term follow up of cholecystectomy in patients with no gallstones, other than acalculous acute cholecystitis. Methods: Prospectively collected data of 5675 patients undergoing laparoscopic cholecystectomy (LC) over 28 years was extracted and analyzed. Patients with biliary symptoms, no stones on ultrasound scans and abnormal hepatobiliary iminodiacetic acid scans, and those with confirmed gallbladder polyps (GBP) were included. Results: Two percent of cholecystectomies were performed in patients with acalculous pathology [1.3% functional gallbladder disorder (FGBD) and 0.7% GBP]. The 114 patients were younger, had lower American Society of Anesthesiologists classification, and had fewer previous biliary admissions than those with gallstones (5560). The clinical presentations of FGBD were chronic biliary symptoms (93.1%) and acute biliary pain (6.9%). GBP patients presented with chronic biliary symptoms. LC in 98.6% FGBD and 92.8% GBP were significantly easier than those for gall stones (P < 0.0001). They were significantly (P < 0.0001 FGBD and P < 0.001 GBP) less likely to have adhesions to the gallbladder. This ease was reflected in shorter operation times and lower utilization of abdominal drains. Polyp numbers ranged from 1 to 30 and sizes from 1 mm to 11 mm. No malignant polyps were encountered. In 95.8% FGBD and 95% GBP, patients had a good symptomatic response to LC. Conclusions: FGBD and GBP are uncommon in patients undergoing LC. FGBD should be considered during evaluation of right upper quadrant pain with no gall stones. Laparoscopic cholecystectomy may be considered as it achieves long term symptomatic relief in most patients with FGBD and GBP.


Assuntos
Colecistectomia Laparoscópica , Doenças da Vesícula Biliar/cirurgia , Dor Abdominal/etiologia , Adulto , Colecistectomia Laparoscópica/estatística & dados numéricos , Feminino , Seguimentos , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/epidemiologia , Cálculos Biliares/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pólipos/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
8.
Cir Esp ; 99(5): 346-353, 2021 May.
Artigo em Espanhol | MEDLINE | ID: mdl-34024914

RESUMO

Introduction: The extraordinary impact of COVID-19 pandemic on Spanish hospitals has led to a redistribution of resources for the treatment of these patients, with a decreased capacity of care for other common diseases. The aim of the present study is to analyse how this situation has affected the treatment of cholecystitis and cholelythiasis. Methods: It is a descriptive national study after online voluntary distribution of a specific questionnaire with Google Drive™ to members of the Spanish Association of Surgeons (AEC). Results: We received 153 answers (one per hospital). Elective cholecystectomies have been cancelled in 96.7% of centres. Conservative treatment for acute cholecystitis has been selected in 90% (previously 18%), and if operated, 95% have been performed laparoscopically. Globally, only 49% perform preoperative diagnostic tests for SARS-CoV-2, and 58.5% recognize there have been cases confirmed postoperatively after other surgeries, with worse surgical outcomes in 54%. Conclusions: This survey shows that most of the Spanish centers are following the surgical societies suggestions during the pandemic. However, some data requires to be taken into account for the next phase of the pandemic.


Assuntos
COVID-19/diagnóstico , Colecistectomia/tendências , Colecistite Aguda/cirurgia , Colecistostomia/tendências , Colelitíase/cirurgia , Procedimentos Cirúrgicos Ambulatórios/tendências , Teste de Ácido Nucleico para COVID-19 , Colecistectomia Laparoscópica/tendências , Colecistite Aguda/epidemiologia , Colelitíase/epidemiologia , Tratamento Conservador/tendências , Procedimentos Cirúrgicos Eletivos/tendências , Hospitais Privados , Hospitais Públicos , Hospitais de Ensino , Humanos , Programas de Rastreamento , SARS-CoV-2 , Espanha/epidemiologia , Inquéritos e Questionários
9.
Khirurgiia (Mosk) ; (6): 24-29, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34029032

RESUMO

OBJECTIVE: To develop an algorithm for surgical treatment of acute destructive cholecystitis in elderly and senile patients and to improve postoperative outcomes in this cohort of patients. MATERIAL AND METHODS: A prospective analysis included 50 patients with acute destructive cholecystitis aged 60-90 years, who admitted to the Topchubashov Research Surgical Center for the period from 2015 to 2019. All patients had diabetes mellitus, obesity or cardiovascular diseases. Ultrasound was performed in all patients, CT - in 60% of patients, MRI - in 36% of cases. Thirty-six (72%) patients underwent laparoscopic cholecystectomy, 14 (28%) patients - open cholecystectomy. RESULTS: Intra- and postoperative complications were analyzed in both groups. In our opinion, subtotal 'fundus first' cholecystectomy should be preferred for safe cholecystectomy and prevention of iatrogenic lesions. Laparoscopic 'fundus first' cholecystectomy was carried out in 16% of patients (including 10% of subtotal cholecystectomies). Pribram subtotal cholecystectomy was performed in 5 (10%) patients. Iatrogenic damage to the common bile duct was absent. CONCLUSION: We have developed an algorithm for the diagnosis and surgical treatment of acute destructive calculous cholecystitis in advanced age patients.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Colecistectomia , Colecistectomia Laparoscópica/efeitos adversos , Colecistite Aguda/diagnóstico , Colecistite Aguda/etiologia , Colecistite Aguda/cirurgia , Ducto Colédoco , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
13.
Complement Ther Clin Pract ; 43: 101385, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33836405

RESUMO

BACKGROUND: The aim of the study was to examine the effect of Acupressure and Reiki application on patient's pain and comfort level after Laparoscopic cholecystectomy. MATERIALS AND METHODS: In this prospective, single blinded randomized controlled trial, subjects were 132 adult patients, hospitalized in the General Surgery clinics and underwent laparoscopic cholecystectomy of a Training and Research Hospital in Turkey. Subjects were then assigned including a Reiki group of 44 persons, an Acupressure group of 44 persons, and a control group of 44 persons. The pain and comfort levels of all the patients, before and after the Acupressure and Reiki treatments in the experimental group, and without any intervention in the control groups were determined at the 3rd postoperative hour, using Pain on Visual Analogue Scale (Pain on VAS), Perianesthesia Comfort Scale (PCS) and General Comfort Questionnaire (GCQ). The data analyses were performed using descriptive statistics, Shapiro Wilk test, paired samples t-test, Mann Whitney U test, ANOVA and LSD multiple comparison tests, Kruskal Wallis test and Wilcoxon test. RESULTS: In the patients who received reiki and acupressure treatment, the pain level decreased, comfort level increased and the difference between the groups was found to be significant (p < 0.05). CONCLUSION: Reiki and Acupressure applied to the patients after Laparoscopic cholecystectomy decreased the pain and increased the comfort level.


Assuntos
Acupressão , Colecistectomia Laparoscópica , Toque Terapêutico , Adulto , Colecistectomia Laparoscópica/efeitos adversos , Humanos , Dor , Dor Pós-Operatória/terapia , Estudos Prospectivos , Turquia
14.
BMC Surg ; 21(1): 184, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827521

RESUMO

BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGBD) is indicated for patients with acute cholecystitis (AC) who are not indicated for urgent surgery, but external tubes reduce quality of life (QOL) while waiting for elective surgery. The objective of the present study was to investigate the feasibility of laparoscopic cholecystectomy after endoscopic trans-papillary gallbladder stenting (ETGBS) comparing with after PTGBD. METHODS: Intraoperative and postoperative outcomes of patients with ETGBS and PTGBD were retrospectively compared. RESULTS: Eighteen ETGBS and ten PTGBD patients were compared. Differences in the duration of ETGBS and PTGBD [median 209 min (range 107-357) and median 161 min (range 130-273), respectively, P = 0.10], median blood loss [ETGBS 2 (range 2-180 ml) and PTGBD 24 (range 2-100 ml), P = 0.89], switch to laparotomy (ETGBS 11% and PTGBD 20%, P = 0.52), and median postoperative hospital stay [ETGBS 8 (range 4-24 days) and ETGBS 8 (range 4-16 days), P = 0.99]. Thickening of the cystic duct that occurred in 60% of the ETGBS patients and none of the PTGBD patients (P = 0.005) interfered with closure of the duct by clipping. No obstruction occurred in ETGBS patients. CONCLUSION: ETGBS did not make laparoscopic cholecystectomy less feasible than after PTGBD. This is a pilot study, and further investigations are needed to validate the results of the present study.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Cirurgia Assistida por Computador , Colecistite Aguda/cirurgia , Endoscopia , Estudos de Viabilidade , Vesícula Biliar/cirurgia , Humanos , Projetos Piloto , Estudos Retrospectivos , Stents , Cirurgia Assistida por Computador/métodos
15.
Medicina (Kaunas) ; 57(3)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33801408

RESUMO

Background and Objectives: This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. Materials and Methods: A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who underwent emergency cholecystectomy. The patients included in the study group were divided into four age subgroups: A ≤49 years; B: 50-64 years; C: 65-79 years; D ≥80 years. Results: Surgery after 72 h from onset (p = 0.007), severe forms, and higher American Society of Anesthesiologists Physical Status Classification and Charlson comorbidity index scores (p < 0.001) are well correlated with older age. Both cardiovascular and surgical related complications were significantly higher in patients over 50 years (p = 0.045), which also proved to be a turning point for increasing the rate of conversion and open surgery. However, the comparative incidence did not differ significantly between patients aged from 50-64 years, 65-79 years and over 80 years (6.03%, 9.09% and 5.8%, respectively). Laparoscopic cholecystectomy (LC) was the most frequently used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgery related complications, and the incidence of acute cardiovascular events in the early postoperative period (p < 0.001). Conclusions: The degree of systemic inflammation was the main factor that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with increased surgical and systemic postoperative morbidity, while stroke and chronic renal insufficiency were correlated with a high risk of cardiovascular complications. With adequate perioperative care, the elderly has much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Idoso , Colecistectomia Laparoscópica/efeitos adversos , Colecistite Aguda/epidemiologia , Colecistite Aguda/cirurgia , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
Medicina (Kaunas) ; 57(4)2021 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-33801705

RESUMO

Background and Objectives: We investigated the non-inferiority of patient-controlled analgesia (PCA), using either nefopam alone or combined nefopam-fentanyl for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: In this prospective, randomized, controlled study, 78 patients were allocated to receive nefopam 240 mg (Group N240) or nefopam 120 mg with fentanyl 600 µg (Group NF), equivalent to fentanyl 1200 µg, with a total PCA volume of 120 mL. Patients were given a loading dose (0.1 mL/kg) from the PCA device along with ramosetron (0.3 mg) and connected to a PCA device with a background infusion rate of 2 mL/h, bolus dose amount set at 2 mL, and lockout interval set at 15 min. Pain scores were obtained using the numeric rating scale (NRS) at 30 min after recovery room (RR) admission, as well as 8 and 24 h postoperatively. The primary outcome was analgesic efficacy evaluated using NRS-rated 8 h postoperatively. Other evaluated outcomes included the incidence rate of bolus demand, rescue analgesic and antiemetic requirements, and postoperative adverse effects. Results: NRS scores were not significantly different between the groups throughout the postoperative period (p = 0.539). NRS scores of group N240 were not inferior to those of group NF at 30 min after RR admission, or at 8 and 24 h postoperatively (mean difference [95% CI], -0.05 [-0.73 to 0.63], 0.10 [-0.29 to 0.50], and 0.28 [-0.06 to 0.62], respectively). Postoperative adverse effects were not significantly different between the two groups (p = 1.000) and other outcomes were also not significantly different between the two groups (p ≥ 0.225). Conclusions: PCA using nefopam alone has a non-inferior and effective analgesic efficacy and produces a lower incidence of postoperative adverse effects compared to a combination of fentanyl and nefopam after laparoscopic cholecystectomy.


Assuntos
Colecistectomia Laparoscópica , Nefopam , Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Fentanila/uso terapêutico , Humanos , Nefopam/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos
17.
J Med Case Rep ; 15(1): 152, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33823908

RESUMO

BACKGROUND: Raoultella Planticola is a facultative anaerobic, gram-negative, water- and soil-dwelling rod bacterium rarely reported as a cause of human disease. However, the number of reported R. planticola infections is growing, without a concomitant increase in research on the microbe or its pathogenesis. Previous genomic studies demonstrating genetic similarities between R. planticola and Klebsiella pneumoniae suggest that capsule biosynthesis, mucoid phenotype, biofilm production, and lipopolysaccharide (endotoxin) synthesis may all be potential virulence factors of R. planticola. We present a unique case of R. planticola infection of the biliary tract 5 years after biliary surgery in a patient with no previously documented risk factors. We also use in silico techniques to predict virulence factors of R. planticola. CASE PRESENTATION: This case report is the first to discuss a R. planticola infection in the biliary tract of late onset post-surgery (5 years) in a Caucasian patient with no previously documented risk factors. CONCLUSIONS: An in-depth search of the current literature did not yield other similar cases of R. planticola infections. Moreover, to the best of our knowledge, our case is the first case of R. planticola isolated from post-endoscopic retrograde cholangiopancreatography (ERCP) as part of biliary sepsis not associated with gastroenteritis. The late onset of the infection in our patient and the results of the in silico analysis suggest that R. planticola may have survived exposure to the host immune system through the creation of an intracellular biofilm or in a non-culturable but viable state (NCBV) for the 5-year period. The in silico analysis also suggests that biofilms, enterobactin, and mucoid phenotype may play a role in the pathogenesis of R. planticola. However, further research is needed to illuminate the significance of pili, capsule biosynthesis, and lipopolysaccharide (LPS) in the virulence of R. planticola. Lastly, as our patient did not have any risk factors previously associated with R. planticola, we suggest that biliary tract stricture, cholecystitis, and prior surgery may be possible novel risk factors.


Assuntos
Colangite , Colecistectomia Laparoscópica , Antibacterianos/uso terapêutico , Ductos Biliares Intra-Hepáticos , Colangite/tratamento farmacológico , Colecistectomia Laparoscópica/efeitos adversos , Constrição Patológica/tratamento farmacológico , Enterobacteriaceae , Humanos
18.
BMJ Case Rep ; 14(4)2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858887

RESUMO

A 50-year-old man presented to the emergency department with abdominal pain, vomiting and fever. He had been admitted 6 months ago with acute cholecystitis when he underwent endoscopic retrograde cholangiopancreatography (ERCP) to remove ductal gallstones. Elective cholecystectomy was performed 3 days prior to the current admission. CT demonstrated a fluid and gas containing collection in the gallbladder fossa, biliary gas and free intra-abdominal gas. ERCP revealed a retained common bile duct gallstone and leakage from the cystic duct remnant. We postulate that the gas within the collection originated from intrahepatic gas post-ERCP or from a gas forming organism. The free intra-abdominal gas originated from the collection rather than an intraoperative bowel injury. This complicated case highlights an unusual appearance of a common complication. It demonstrates the importance of discussion with the clinical team to ensure that an accurate diagnosis is made and the correct treatment is provided.


Assuntos
Colecistectomia Laparoscópica , Cálculos Biliares , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Ducto Cístico , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
19.
Clinics (Sao Paulo) ; 76: e2189, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33852651

RESUMO

OBJECTIVES: This study explored the effects of the timing of laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) on liver function, bile biochemical indices, inflammatory reactions, and cholecysto-choledocholithiasis patient prognoses. METHODS: A total of 103 cholecysto-choledocholithiasis patients were stratified into control (CG; n=51; LC at 4-7 d after ERCP) and observation groups (OG; n=52; LC at 1-3 d after ERCP) using a random number table. RESULTS: The surgical time was shorter and intraoperative blood loss was less in OG than in CG, and the two groups were not statistically different in terms of time to the first passage of gas through anus, length of postoperative hospital stay, conversion rate to laparotomy, and stone-free rate. Four weeks after LC, alanine aminotransferase (ALT), total bilirubin (TBil), albumin (ALB), and glutamyl transpeptidase (GGT) levels declined in both groups, but the difference was not statistically significant. Three days after LC, total bile acid (TBA) levels increased, and cholesterol (CHO), unconjugated bilirubin (UCB), and TBiL levels were reduced in both groups, but were not statistically different (p>0.05). Three days after LC, interleukin (IL)-6, procalcitonin (PCT), and high-sensitivity C-reactive protein (hs-CRP) levels in the serum and bile increased in both groups and were lower in OG. The total incidence of perioperative complications was 1.92% in OG, which was lower than 15.69% in the CG. CONCLUSION: For cholecysto-choledocholithiasis patients, LC at 1-3 d after ERCP can shorten surgical times, reduce intraoperative blood loss, improve liver function and bile biochemistry, relieve inflammatory reactions, reduce complications, and improve prognoses.


Assuntos
Colecistectomia Laparoscópica , Coledocolitíase , Bile , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Coledocolitíase/cirurgia , Humanos , Tempo de Internação , Fígado , Prognóstico
20.
BMC Gastroenterol ; 21(1): 186, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882844

RESUMO

BACKGROUND: In contrast to adults, for whom guidelines on the cholelithiasis treatment exist, there is no consistent treatment of pediatric patients with cholelithiasis throughout national and international departments, most probably due to the lack of evidence-based studies. METHODS: We evaluated the German management of pediatric cholelithiasis in a dual approach. Firstly, a retrospective, inter-divisional study was established, comparing diagnostics and therapy of patients of the pediatric surgery department with the management of patients aged < 25 years of the visceral surgery department in our institution over the past ten years. Secondarily, a nation-wide online survey was implemented through the German Society of Pediatric Surgery. RESULTS: Management of pediatric patients with cholelithiasis was primarily performed by pediatricians in the retrospective analysis (p < 0.001). Pediatric complicated cholelithiasis was not managed acutely in the majority of cases with a median time between diagnosis and surgery of 22 days (range 4 days-8 months vs. 3 days in visceral surgery subgroup (range 0 days-10 months), p = 0.003). However, the outcome remained comparable. The hospital's own results triggered a nation-wide survey with a response rate of 38%. Primary pediatric medical management of patients was confirmed by 36 respondents (71%). In case of acute cholecystitis, 22% of participants perform a cholecystectomy within 24 h after diagnosis. Open questions revealed that complicated cholelithiasis is managed individually. CONCLUSIONS: The management of pediatric cholelithiasis differs between various hospitals and between pediatricians and pediatric surgeons. Evidence-based large-scale population studies as well as a common guideline may represent very important tools for treating this increasing diagnosis.


Assuntos
Colecistectomia Laparoscópica , Colecistite , Colelitíase , Guias de Prática Clínica como Assunto/normas , Adolescente , Adulto , Criança , Colecistite/complicações , Colecistite/diagnóstico , Colecistite/cirurgia , Colecistite/terapia , Colelitíase/complicações , Colelitíase/diagnóstico , Colelitíase/cirurgia , Colelitíase/terapia , Feminino , Alemanha , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pediatras , Estudos Retrospectivos , Cirurgiões , Adulto Jovem
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