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1.
J Coll Physicians Surg Pak ; 32(1): 20-24, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34983142

RESUMO

OBJECTIVE: To investigate the effect of the timing of Percutaneous Cholecystostomy (PC) on morbidity and mortality. STUDY DESIGN: Comparative cross-sectional study. PLACE AND DURATION OF STUDY: Deparmant of Gastroenterological Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey from 2017 to 2020. METHODOLOGY: The study included 61 patients with ASA 3-4 score, who were underwent PC during the study period. The patients were separated into two groups as Group 1 (n = 23); who underwent PC in the first 24 hours; and Group 2 (n = 38), who underwent PC at 24-96 hours. Morbidity and mortality rates were compared between the groups. RESULTS: Morbidity was observed in 2 (8.7%) patients in Group 1 and 6 (15.8%) in Group 2 (p = 0.698) with 30-day mortality in 3 (13.04%) patients in Group 1 and 8 (21.1%) in Group 2 (p = 0.730). In the cholangiographic studies, more choledochus stones were determined in Group 2 (p = 0.041). Length of stay in hospital was calculated as mean 10.35 ± 9.50 days in Group 1 and 20.03 ± 45.28 days in Group 2 (p = 0.003). CONCLUSION: No statistically significant difference was found in the morbidity and mortality rates when PC was performed later. The length of stay in hospital was found to be shorter in patients applied with early PC. Key Words: Percutaneous cholecystostomy, Acute cholecystitis, Cholecystectomy, Morbidity, Mortality, Calculous cholecystitis, Acalculous cholecystitis.


Assuntos
Colecistite Aguda , Colecistostomia , Colecistectomia , Colecistite Aguda/cirurgia , Estudos Transversais , Humanos , Estudos Retrospectivos , Resultado do Tratamento
2.
Gan To Kagaku Ryoho ; 49(1): 106-108, 2022 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-35046377

RESUMO

A 88-year-old man presented with abdominal discomfort. Computed tomography(CT)images showed gallbladder tumor, and the patient was referred to our hospital. In addition to the above, CT images showed a tense gallbladder and EUS showed papillary raised lesions mainly from the cystic duct to the gallbladder neck. Based on the above, we diagnosed cystic duct cancer and performed full-thickness cholecystectomy, extrahepatic bile duct resection, regional lymph node dissection at our department. Macroscopic findings of the resected specimen showed a Villous ridge in the cystic duct. Histopathological findings revealed well-differentiated adenocarcinoma with an irregular papillary structure centered on the cystic duct. The depth of invasion remained within the epithelium, and a diagnosis of primary early cystic duct cancer was made. Primary cystic duct cancer is a relatively rare disease and often does not lead to preoperative diagnosis. This time, we experienced a case in which cystic duct cancer was diagnosed preoperatively due to complaints of abdominal discomfort and could be surgically resected.


Assuntos
Adenocarcinoma , Neoplasias dos Ductos Biliares , Ductos Biliares Extra-Hepáticos , Neoplasias da Vesícula Biliar , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/cirurgia , Colecistectomia , Ducto Cístico/cirurgia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Masculino
3.
JSLS ; 25(4)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34949908

RESUMO

Background and Objectives: Prior research shows an association between increased length of stay (LOS) and weekend surgical admissions, but none have looked at this relationship in children undergoing nonelective cholecystectomy for benign noncongenital biliary disease. We investigated whether weekend admissions lead to a longer LOS in this patient population. Methods: The Statewide Planning and Research Cooperative System database was queried for children ≤ 17 years undergoing cholecystectomy in New York State between January 1, 2009 and December 31, 2012. Parametric and nonparametric statistical testing was used for univariate analysis; multivariable binary logistic regression and linear regression models were used for multivariable analysis. Statistical significance was < 0.05. Results: A total of 1066 pediatric patients underwent nonelective cholecystectomy for gallstone pancreatitis (9.7%) and other benign biliary noncongenital diseases (90.3%), of which 22.1% of all patients were admitted over the weekend. Most cases (97.2%) were treated laparoscopically with an overall 3-day median LOS. Weekend admission was associated with an increased LOS of 4 days as opposed to 3 days during the weekday (p < 0.001). On a multivariable binary logistic regression model controlling for hospital factors, indication for surgery, and comorbidities, weekend admission was associated with 1.92 odds of increased length of stay (adjusted odds ratio of 1.924, 95% confidence interval: 1.386-2.673). Conclusion: Weekend admissions were associated with increased LOS and charges for children requiring nonelective cholecystectomy, despite the wide use of laparoscopic surgery.


Assuntos
Colecistectomia , Hospitalização , Criança , Mortalidade Hospitalar , Humanos , Tempo de Internação , Estudos Retrospectivos , Fatores de Tempo
4.
Acta Gastroenterol Belg ; 84(4): 563-569, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34965037

RESUMO

Background and study aim: In European Society of Gastrointestinal Endoscopy guidelines, biliary cannulation of naive papillae is defined as difficult in the presence of more than 5 papilla contacts, more than 5min cannulation time or more than one unintended pancreatic duct cannulation or opacification. It is not known whether cholecystectomy is a cause of difficult biliary cannulation. This study aimed to investigate whether cholecystectomy (CCY) is a cause of difficult biliary cannulation in patients who have undergone Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis. Patients and methods: Adult patients with naive papillae and those who underwent ERCP for common bile duct stones and/or sludge were included in this retrospective study. Patient demographics, clinical presentation (acute cholangitis, biliary pancreatitis or biliary colic), periprocedural data including laboratory and radiological findings and ERCP results were compared between no-CCY and post-CCY groups. Results: 438 patients were included in the present study and 347 of these patients were in the no-CCY group and 91 patients were in post-CCY group. A statistically significant difference was found in the number of patients with difficult cannulation in the post-CCY group (n=30, 33.0%) patients compared to the no- CCY group (n=67, 19.3%) (p=0.011). According the multivariate analyses results, presence of history of cholecystectomy was found an independent risk factor of difficult cannulation (Odds ratio: 2.014; 95 % Cl 1.205-3.366; p=0.008). Conclusions: The results showed that biliary cannulation was significantly more difficult in patients with cholecystectomy who underwent ERCP for common bile duct stones.


Assuntos
Cálculos Biliares , Pancreatite , Adulto , Cateterismo , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colecistectomia , Humanos , Pancreatite/epidemiologia , Pancreatite/etiologia , Estudos Retrospectivos , Esfinterotomia Endoscópica
5.
Acta Gastroenterol Belg ; 84(4): 675-677, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34965053

RESUMO

A 63-year old female patient with a medical history of hypereosinophilic syndrome with neurological and pulmonary involvement presented for a routine follow-up. The patient was asymptomatic but a routine scheduled ultrasound showed a gallbladder polyp of 19mm. One month later this polyp had grown to 36 mm. On magnetic resonance imaging of the liver there was a suspicion of gallbladder cancer and for this reason cholecystectomy was performed. Pathology however showed eosinophilic infiltration. Serum analysis showed an increase in her eosinophil count. The diagnosis of hypereosinophilic syndrome with eosinophilic infiltration of the gallbladder was made. The dose of corticosteroids was augmented and she recovered completely post-operatively with no residual flares of other organ damage during follow up.


Assuntos
Vesícula Biliar , Síndrome Hipereosinofílica , Colecistectomia , Feminino , Humanos , Fígado , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade
6.
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 161-166, Dec. 2021.
Artigo em Espanhol | LILACS | ID: biblio-1352984

RESUMO

Mujer de 54 años sometida a colecistectomía laparoscópica programada por colecistolitiasis sintomática, el procedimiento fue convertido a abordaje abierto por presencia de bilirragia perioperatoria no localizada, tratada con sutura primaria del lecho vesicular bajo sospecha de un conducto aberrante de Luschka. Al vigésimo día postoperatorio se diagnostica una fístula biliar tras la aparición de bilirragia a través de la herida quirúrgica. Una colangiografía transhepática percutánea mostró una pérdida completa de continuidad con fuga a ese nivel, confirmando la lesión del conducto hepático derecho, con un extremo cortado retraído del conducto hepático. Debido a la compleja lesión de la vía biliar proximal, a los 3 meses de la primera cirugía se realiza una hepatectomía derecha. Aunque la hepatectomía no es un procedimiento estándar para pacientes con lesiones quirúrgicas de la via biliar, debe considerarse como parte del arsenal quirúrgico para la reparación de un grupo seleccionado de pacientes en lesiones postcolecistectomía


A 54-year-old female underwent a planned laparoscopic cholecystectomy due to a symptomatic cholecystolithiasis, the procedure was converted to an open approach due to the presence of a not located perioperative bilirhagia, treated with a primary suture of the gallbladder bed under the suspicion of an aberrant duct of Luschka. On the 20th postoperative day, the patient is diagnosed with a biliary fistula after the appearance of bilirhagia through the surgical wound. A percutaneous transhepatic cholangiography showed a complete loss of continuity with leakage at that level, confirming the right hepatic duct injury, with a retracted cut end from the hepatic duct. Due to the complex proximal bile duct injury, 3 months after the first surgery, a right hepatectomy is performed. Although an hepatectomy is not a standard procedure for patients with IBDI, it should be considered as a part of the surgical armamentarium for the repair of a selected group of patients in postcholecystectomy injuries


Assuntos
Colecistectomia , Hepatectomia , Ductos Biliares
7.
Surg Clin North Am ; 101(6): 1053-1065, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774268

RESUMO

Laparoscopic cholecystectomy is a common operation; approximately 20 million Americans have gallstones, the most common indication. Surgeons who operate on the biliary tree must be familiar with the presentations and treatment options for acute and chronic biliary pathology. We focus on the difficult "bad" gallbladder. We explore the available evidence as to what to do when a gallbladder is too inflamed, too technically challenging, or a patient is too sick to undergo standard laparoscopic cholecystectomy. We discuss whether or not open cholecystectomy is a relevant tool and what can be done to manage common bile duct stones found unexpectedly intraoperatively.


Assuntos
Doenças da Vesícula Biliar/cirurgia , Colangiografia , Colecistectomia , Colecistectomia Laparoscópica , Colecistostomia , Coledocolitíase/cirurgia , Doenças da Vesícula Biliar/patologia , Humanos , Cuidados Intraoperatórios , Fatores de Tempo
8.
J Int Med Res ; 49(11): 3000605211059288, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34812075

RESUMO

OBJECTIVE: Cholecystostomy is a palliative treatment for patients unfit to undergo immediate cholecystectomy. Nevertheless, the role of cholecystostomy in the clinical management of such patients remains unclear. The Acute Physiology and Chronic Health Evaluation IV (APACHE IV) scoring system is useful for estimating the hospital mortality of high-risk patients. We evaluated the therapeutic effect of cholecystostomy by the APACHE IV scoring system in patients aged >65 years with acute cholecystitis. METHODS: In total, 597 patients aged >65 years with acute cholecystitis were retrospectively analyzed using APACHE IV scores. RESULTS: The fitness of the APACHE IV score prediction was good, with an area under the receiver operating characteristic curve of 0.894. The chi square independence test indicated that compared with conservative treatment, cholecystostomy may have different effects on mortality for patients whose estimated mortality rate was >10%. Comparison of the estimated mortality of patients before and after cholecystostomy indicated that the estimated mortality was significantly lower after than before puncture, both in the whole patient group and in the group with an estimated mortality of >10%. CONCLUSION: The APACHE IV scoring system showed that cholecystostomy is a safe and effective treatment for elderly high-risk patients with acute cholecystitis.


Assuntos
Colecistite Aguda , Colecistostomia , APACHE , Idoso , Colecistectomia , Colecistite Aguda/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
9.
Cir Cir ; 89(S1): 54-56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762633

RESUMO

Gallbladder cancer that presents as acute cholecystitis associated with hemocholecyst and hemobilia is a rare entity. There are few cases reported in the literature. We present a case of gallbladder carcinoma diagnosed after emergency cholecystectomy, performed due to hemobilia and acute cholecystitis due to hemocholecyst.


Assuntos
Colecistite Aguda , Doenças da Vesícula Biliar , Neoplasias da Vesícula Biliar , Hemobilia , Colecistectomia , Colecistite Aguda/complicações , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/cirurgia , Hemobilia/etiologia , Hemobilia/cirurgia , Humanos
10.
BMC Surg ; 21(1): 386, 2021 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-34717615

RESUMO

BACKGROUND: Severe adhesions and fibrosis between the posterior wall of the gallbladder and liver bed often render total cholecystectomy after percutaneous transhepatic gallbladder drainage (PTGBD) difficult, leading to high open conversion rates. Since the publication of Tokyo Guidelines 2018 (TG18), our policy has shifted from open conversion to subtotal cholecystectomy (SC) when total laparoscopic cholecystectomy for difficult cases of cholecystitis is not feasible. Recently, SC has been frequently applied as bailout surgery for complicated cholecystitis. Nonetheless, the efficacy and validity of laparoscopic SC after PTGBD remain unclear. This study aimed to evaluate the safety and feasibility of laparoscopic SC after PTGBD for grade II or III acute cholecystitis (AC) by comparing two periods of altered surgical strategies. METHODS: This retrospective cohort study was conducted between January 2013 and December 2020. A total of 44 eligible patients with grade II or III AC were divided according to the time of cholecystitis onset into the pre-TG18 group (2013-2017, n = 17) and post-TG18 group (2018-2020, n = 27). Patients' background demographics, surgical method, surgical results, and postoperative complications were compared. RESULTS: The interval between PTGBD and surgery was significantly longer in the post-TG18 group than in the pre-TG18 group (15 [interquartile range: 9-42] days vs. 8 [4-11] days; P = 0.010). The frequency of laparoscopic cholecystectomy significantly increased from 52.9% in the pre-TG18 group to 88.9% in the post-TG18 group (P = 0.007), whereas the frequency of SC was 23.5% and 40.7%, respectively, which showed no statistically significant difference (P = 0.241). However, the rate of laparoscopic SC significantly increased from 0 to 90.9% among 15 SC cases, whereas the rate of open SC significantly plummeted from 100 to 9.1% (P = 0.001). Significant differences in the operative time, amount of intraoperative bleeding, and incidence of postoperative complications (wound infection and subhepatic abscess) were not observed. Mortality, bile leakage, and bile duct injury did not occur in either group. CONCLUSIONS: For grade II or III AC after PTGBD, aggressive adoption of SC increased the completion rate of laparoscopic surgery. Laparoscopic SC is a safe and feasible treatment option.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Laparoscopia , Colecistectomia , Colecistite Aguda/cirurgia , Drenagem , Vesícula Biliar/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
11.
BMC Gastroenterol ; 21(1): 410, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34711183

RESUMO

BACKGROUND: Percutaneous cholecystostomy (PC) with interval cholecystectomy is an effective treatment modality in high-risk patients with acute cholecystitis. However, some patients still fail to undergo interval cholecystectomy after PC, with the reasons rarely reported. Hence, this study aimed to explore the factors that prevent a patient from undergoing interval cholecystectomy. METHODS: Data from patients with acute cholecystitis who had undergone PC from January 1, 2017 to December 31, 2019 in our hospital were retrospectively collected. The follow-up endpoint was the patient undergoing cholecystectomy. Patients who failed to undergo cholecystectomy were followed up every three months until death. Univariate and multivariate analyses were performed to analyze the factors influencing failure to undergo interval cholecystectomy. A nomogram was used to predict the numerical probability of non-interval cholecystectomy. RESULTS: Overall, 205 participants were identified, and 67 (32.7%) did not undergo cholecystectomy during the follow-up period. Multivariate analysis revealed that having a Tokyo Guidelines 2018 (TG18) grade III status (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.27-11.49; p = 0.017), acalculous cholecystitis (OR: 4.55; 95% CI: 1.59-12.50; p = 0.005), an albumin level < 28 g/L (OR: 4.15; 95% CI: 1.09-15.81; p = 0.037), and a history of malignancy (OR: 4.65; 95% CI: 1.62-13.37; p = 0.004) were independent risk factors for a patient's failure to undergo interval cholecystectomy. Among them, the presence of a history of malignancy exhibited the highest influence in the nomogram for predicting non-interval cholecystectomy. CONCLUSIONS: Having a TG18 grade III status, acalculous cholecystitis, severe hypoproteinemia, and a history of malignancy influence the failure to undergo cholecystectomy after PC in patients with acute cholecystitis.


Assuntos
Colecistite Acalculosa , Colecistite Aguda , Colecistostomia , Colecistite Acalculosa/cirurgia , Colecistectomia , Colecistite Aguda/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
12.
Rev Assoc Med Bras (1992) ; 67(8): 1155-1160, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34669862

RESUMO

OBJECTIVE: Acute calculous cholecystitis (AC) is a frequently encountered emergency surgery disease and its standard treatment is cholecystectomy. In patients with high risk in surgery, antibiotic treatment (AT) is important. In routine clinical practices, antibiotics are frequently used either as single or in combination in the treatment of AC. This study examined whether or not combined antibiotic treatment (CAT) had superiority over single antibiotic treatment (SAT) in AC. METHODS: Patients with cholecystitis who received treatment in the period of 2016-2019 were retrospectively examined. The treatment procedures applied, patient findings, and laboratory data were analyzed using relevant statistical software. The patients were categorized into groups based on the treatment approaches applied, and the effects of SAT and CAT on infection parameters were analyzed. RESULTS: In all, 184 patients received treatment for AC, with a mean age of 57.7, and the female-to-male ratio was 77:107. Of these, 139 patients received SAT and 45 received CAT. No significant difference was found in terms of effectiveness between the SAT and CAT in the patients who received early cholecystectomy treatment and those who received medical treatment with noninvasive intervention. CONCLUSIONS: In patients with AC, antibiotics are commonly used either as single or in combination for prophylaxis and therapeutic purposes. As no significant difference was observed between single and combined use in terms of treatment effectiveness and hospitalization duration, CAT is not recommended due to its possibility of allergic side effects, toxicity, and cost-increasing effects.


Assuntos
Colecistite Aguda , Antibacterianos/uso terapêutico , Colecistectomia , Colecistite Aguda/tratamento farmacológico , Colecistite Aguda/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
13.
Arq Bras Cir Dig ; 34(2): e1600, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34669889

RESUMO

BACKGROUND: Repair of inguinal hernia concomitant with cholecystectomy was rarely performed until more recently when laparoscopic herniorrhaphy gained more adepts. Although it is generally an attractive option for patients, simultaneous performance of both procedures has been questioned by the potential risk of complications related to mesh, mainly infection. AIM: To evaluate a series of patients who underwent simultaneous laparoscopic inguinal hernia repair and cholecystectomy, with emphasis on the risk of complications related to the mesh, especially infection. METHODS: Fifty patients underwent simultaneous inguinal repair and cholecystectomy, both by laparoscopy, of which 46 met the inclusion criteria of this study. RESULTS: In all, hernia repair was the first procedure performed. Forty-five (97,9%) were discharged within 24 h after surgery. Total mean cost of the two procedures performed separately ($2,562.45) was 43% higher than the mean cost of both operations done simultaneously ($1,785.11). Up to 30-day postoperative follow-up, seven (15.2%) presented minor complications. No patient required hospital re-admission, percutaneous drainage, antibiotic therapy or presented any other signs of mesh infection after three months. In long-term follow-up, mean of 47,1 months, 38 patients (82,6%) were revaluated. Three (7,8%) reported complications: hernia recurrence; chronic discomfort; reoperation due a non-reabsorbed seroma, one in each. However, none showed any mesh-related complication. Satisfaction questionnaire revealed that 36 (94,7%) were satisfied with the results of surgery. All of them stated that they would opt for simultaneous surgery again if necessary. CONCLUSION: Combined laparoscopic inguinal hernia repair and cholecystectomy is a safe procedure, with no increase in mesh infection. In addition, it has important advantage of reducing hospital costs and increase patient' satisfaction.


Assuntos
Hérnia Inguinal , Laparoscopia , Colecistectomia , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Recidiva , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento
15.
Int J Surg ; 94: 106109, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34536599

RESUMO

OBJECTIVE: To systematically review comparative studies on the acute surgical unit (ASU) model. METHODS: Searches were performed of Cochrane, Embase, Medline and grey literature. Eligible articles were comparative studies of the Acute Surgical Unit (ASU) model published 01/01/2000-12/03/2020. Amongst patients with any diagnosis, primary outcomes were length of stay, after-hours operating, complications and cost. Secondary outcomes were time to surgical review, time to theatre, mortality and re-admission for patients with any diagnosis, and cholecystectomy during index admission for patients with biliary disease. Additional analyses were planned for specific cohorts, such as patients with appendicitis or cholecystitis. RESULTS: Searches returned 9,677 results from which 77 eligible publications were identified, representing 150,981 unique patients. Cohorts were adequately homogenous for meta-analysis of all outcomes except cost. For patients with any diagnosis, compared with the Traditional model, the introduction of an ASU model was associated with reduced length of stay (mean difference [MD] 0.68 days; 95% confidence interval [CI] 0.38-0.98), after-hours operating rates (odds ratio [OR] 0.56; 95% CI 0.46-0.69) and complications (OR 0.48, 95% CI 0.33-0.70). Regarding cost, two studies reported savings following ASU introduction, while one found no difference. Amongst secondary outcomes, for patients with any diagnosis, ASU commencement was associated with reduced time to surgical review, time to theatre and mortality. Re-admissions were unchanged. For patients with biliary disease, ASU establishment was associated with superior rates of index cholecystectomy. CONCLUSION: Compared to the Traditional structure, the ASU model is superior for most metrics. ASU introduction should be promoted in policy for widespread benefit.


Assuntos
Apendicite , Centro Cirúrgico Hospitalar , Apendicite/cirurgia , Colecistectomia , Humanos , Razão de Chances , Estudos Retrospectivos
16.
World J Emerg Surg ; 16(1): 45, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496916

RESUMO

BACKGROUND: Aim of this study was to clarify the best laparoscopic subtotal cholecystectomy (LSTC) technique for finalizing a difficult cholecystectomy. PATIENTS AND METHODS: A review was performed (1987-2021) searching "difficulty cholecystectomy" AND/OR "subtotal cholecystectomy". The LSTC techniques considered were as follows: type A, leaving posterior wall attached to the liver and the remainder of the gallbladder stump open; type B, like type A but with the stump closed; type C, resection of both the anterior and posterior gallbladder walls and the stump closed; type D, like type C but with the stump open. Morbidity (including mortality) was analysed with Dindo-Clavien classification. RESULTS: Nineteen articles were included. Of the 13,340 patients screened, 678 (8.2%) had cholecystectomy finalized by LSTC: 346 patients (51.0%) had type A LSTC, 134 patients (19.8%) had type B LSTC, 198 patients (29.2%) had type C LSTC, and 198 patients (0%) had type D LSTC. Bile leakage was found in 83 patients (12.2%), and recorded in 58 patients (69.9%) treated by type A. Twenty-three patients (3.4%) developed a subhepatic collection, 19 of whom (82.6%) were treated by type A. Other complications were reported in 72 patients (10.6%). The Dindo-Clavien classification was four for grade I, 27 for grade II, 126 for grade IIIa, 18 for grade IIIb, zero for grade IV and three for grade V. CONCLUSION: In the case of LSTC, closure of the gallbladder stump represents the best method to avoid complications. Careful exploration of the gallbladder stump is mandatory, washing the abdominal cavity and leaving drainage.


Assuntos
Colecistectomia/métodos , Colecistite Aguda/cirurgia , Colecistectomia Laparoscópica , Humanos
17.
Chirurgia (Bucur) ; 116(4): 484-491, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34498567

RESUMO

Background: Cholecystectomy is the standard treatment for symptomatic gallstones, and the persistence of symptoms after surgery defines postcholecystectomy syndrome. Biliary causes of postcholecystectomy syndrome include subtotal cholecystectomy and remnant cystic duct stump stone; causes that are encountered with a low frequency, but which require diagnosis and provocative treatment. Laparoscopic management of such cases is recommended, but requires well-trained teams in laparoscopic surgery. Methods: This study is a retrospective analysis of patients who required surgical treatment for residual gallbladder and cystic duct stump stone after a cholecystectomy, hospitalized in the Surgery Department of Constanta County Hospital, who required completion of resection and were operated laparoscopically. Results: Between January 2010 and March 2020, 14 patients were hospitalized with residual gallbladder and cystic duct stump stone that required surgery. All patients underwent laparoscopic surgery. Symptomatology was dominated by recurrent biliary colic (50%). The period between the primary surgery and the surgery to complete the resection varied between 2-22 years. There were 4 cases of subtotal cholecystectomies, and 10 cases of remnant cystic duct stump stones. Intraoperative complications were encountered in only one case (7.14%), the number of days of hospitalization was on average 3 days. No patient showed any symptoms at 6-month postoperative follow-up. Conclusions: Postcholecystectomy syndrome is difficult to diagnose, symptomatic patients with remnant cystic duct stump stone/ subtotal cholecystectomy requiring surgery are difficult to manage. Laparoscopic surgery is preferred for the benefits that laparoscopic surgery brings, but requires an experienced surgeon in advanced laparoscopic techniques.


Assuntos
Colecistectomia Laparoscópica , Cálculos Biliares , Laparoscopia , Colecistectomia , Colecistectomia Laparoscópica/efeitos adversos , Ducto Cístico/cirurgia , Cálculos Biliares/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
18.
BMJ Case Rep ; 14(9)2021 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-34551912

RESUMO

Crohn's disease (CD) is a chronic inflammatory condition, which typically involves the small and large bowel but can affect any part of the gastrointestinal tract. Common symptoms include abdominal pain, diarrhoea, fatigue, weight loss and malnutrition. Complications of CD include gallstone formation and cholecystitis. Impaired reabsorption of bile salts in the small bowel and CD-related surgeries are key factors in the development of CD-related gallstones, although other factors are also important. Direct CD-related inflammation of the gallbladder is very unusual and the typical histological features of CD are rarely encountered in cholecystectomy specimens of individuals with CD. We present a case of a man in his early 60s with CD, previous right hemicolectomy and a history of gallstones, who presented with chronic cholecystitis. Following cholecystectomy, pathological examination of the gallbladder unexpectedly demonstrated typical features of CD, including lymphoid aggregates and non-caseating mucosal granulomata.


Assuntos
Colecistite , Doença de Crohn , Cálculos Biliares , Colecistectomia , Colecistite/etiologia , Colecistite/cirurgia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Masculino
19.
Surg Clin North Am ; 101(5): 889-910, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34537150

RESUMO

Cholecystectomy is one of the most common general surgery procedures performed worldwide. Complications include bile duct injury, strictures, bleeding, infection/abscess, retained gallstones, hernias, and postcholecystectomy syndrome. Obtaining a critical view of safety and following the other tenets of the Safe Cholecystectomy Task Force will aid in the prevention of bile duct injury and other morbidity associated with cholecystectomy.


Assuntos
Colecistectomia/efeitos adversos , Doenças da Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico , Cálculos Biliares/diagnóstico , Cálculos Biliares/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
20.
Pan Afr Med J ; 39: 157, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34539954

RESUMO

Herniation of liver segments through defects in the anterior abdominal wall is rare. To our knowledge, only three cases have been described in the literature. This study reports the case of a 84-year-old man presenting to the emergency department with strangulated hernia of the linea alba showing dullness to percussion with protrusion of a sensitive and firm mass. Laboratory test results were normal. Abdominal CT scan showed herniation of liver segment through the linea alba with calculous cholecystitis. The patient underwent retrograde cholecystectomy with subhepatic Redon drain and repair of the herniation by overlapping suture, associated with two subcutaneous vacuum suction Redon drains. The post-operative suite was simple and the patient was discharged on the second post-operative day. Six months after surgery, our patient was healthy. Herniation of liver segments through defects in the anterior abdominal wall is rare. Patients usually show little evidence if clinical signs. Abdominal CT scan is essential to assess the viability of parenchymal liver cells. Patients´ management is studied on a case-by-case basis, it can be surgical or non-surgical. Herniation of liver segments is rare; few cases have been reported in the literature and, in these cases, patients showed little evidence of clinical signs. CT scan is essential to assess the viability of parenchymal liver cells.


Assuntos
Colecistectomia/métodos , Hérnia Abdominal/diagnóstico por imagem , Fígado/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Parede Abdominal/diagnóstico por imagem , Idoso de 80 Anos ou mais , Colecistite/diagnóstico por imagem , Seguimentos , Hérnia Abdominal/cirurgia , Humanos , Fígado/citologia , Fígado/cirurgia , Masculino , Umbigo
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