Asociación entre metaplasia, displasia y cáncer de vesícula biliar en una EPS de Bogotá, Colombia / Association between metaplasia, dysplasia and gallbladder cancer in an EPS in Bogotá, Colombia

Introducción. El cáncer de vesícula biliar es el más común en el tracto biliopancreático y una importante causa de mortalidad. La metaplasia y la displasia han sido mencionados como probables precursores relacionados con la secuencia metaplasia-displasia-cáncer. El objetivo de este estudio fue establecer las posibles asociaciones entre estas alteraciones histopatológicas y su relación con la edad y el sexo de los pacientes. Métodos. Estudio observacional retrospectivo descriptivo, con un componente analítico de corte transversal. Se incluyeron los informes de patología de pacientes llevados a colecistectomía laparoscópica electiva y ambulatoria, entre enero de 2015 y diciembre de 2020, con colecistitis crónica, colelitiasis o pólipos vesiculares, mayores de 18 años. Se describieron las características demográficas por sexo y edad utilizando medias, desviaciones estándar y porcentajes. Se emplearon la prueba de chi cuadrado y la prueba exacta de Fisher para evaluar la asociación entre las variables cualitativas. Resultados. Se incluyeron 4871 informes de patología. En esta cohorte se encontró asociación estadísticamente significativa entre metaplasia, displasia y cáncer de vesícula (p<0,05), al igual que con el sexo y la edad de los pacientes. Conclusiones. Los resultados sugieren una asociación entre metaplasia, displasia y cáncer de vesícula biliar en la población estudiada. Se recomienda la realización de investigaciones complementarias para definir la posible causalidad entre metaplasia, displasia y cáncer de vesícula biliar en una población más heterogénea.

Introduction. Gallbladder cancer is the most common cancer in the biliopancreatic tract and an important cause of mortality. Metaplasia and dysplasia have been mentioned as probable precursors related to the metaplasia-dysplasia-cancer sequence. The objective of this study was to establish the possible associations between these histopathological alterations and their relationship with the age and sex of the patients. Methods. Descriptive retrospective observational study, with a cross-sectional analytical component. Pathology reports of patients undergoing elective and outpatient laparoscopic cholecystectomy were included between January 2015 and December 2020, with chronic cholecystitis, cholelithiasis, or gallbladder polyps, over 18 years of age. Demographic characteristics by sex and age was performed using means, standard deviations, and percentages. The chi2 test and Fisher's exact test were used to evaluate the association between the qualitative variables. Results. 4871 pathology reports were included. In this cohort, a statistically significant association was found between metaplasia, dysplasia, and gallbladder cancer (p<0.05), as well as with the sex and age of the patients. Conclusions. The results suggest an association between metaplasia, dysplasia and gallbladder cancer in the study population. Additional research is recommended to define the possible causality between metaplasia, dysplasia, and gallbladder cancer in a more heterogeneous population.

Morbilidad por lesión de la vía biliar en un servicio de cirugía / Morbility due to Bile Duct Lesion in a Surgery Service

Introducción: Las lesiones iatrogénicas de las vías biliares representan una complicación quirúrgica grave de la colecistectomía. Objetivo: Determinar la morbilidad de las lesiones de la vía biliar en el servicio de cirugía del Hospital Universitario "Manuel Ascunce Domenech". Métodos: Se realizó un estudio descriptivo, prospectivo y observacional de pacientes que ingresaron en el servicio de cirugía del Hospital Universitario "Manuel Ascunce Domenech" con diagnóstico de lesión de la vía biliar, desde septiembre del 2018 hasta enero del 2022. El universo estuvo conformado por 12 pacientes que cumplieron con los criterios de inclusión. Se utilizaron métodos estadísticos descriptivos y cálculos con valores porcentuales. Resultados: La mayor incidencia de los pacientes fue del sexo femenino y de piel blanca, con un 61,4 por ciento y 85,7 por ciento, respectivamente. Predom inó el tipo de cirugía convencional y diagnóstico intraoperatorio con un 66,7 por ciento y 50 por ciento, respectivamente. El tipo E1 y E2 de la clasificación de Strasberg y la hepaticoyeyunostomía fue la operación con mayor frecuencia con un 66,7 por ciento. La bilirragia fue la complicación que predominó con el 70 por ciento. Conclusiones: La mayoría de los pacientes son del sexo femenino y de piel blanca, donde la cirugía convencional y el diagnóstico intraoperatorio son los hallazgos más frecuentes. Más de la mitad de los pacientes son clasificados como tipo E1 y tipo E2 según clasificación de Strasberg. La hepaticoyeyunostomía en Y de Roux y en asa de Braum transmesocólica es el proceder realizado en casi la totalidad de los pacientes. La fuga biliar es la complicación más frecuente(AU(

Introduction: Iatrogenic bile duct lesions represent a serious surgical complication of cholecystectomy. Objective: To determine the morbility of bile duct lesions in the surgical service of Hospital Universitario "Manuel Ascunce Domenech". Methods: A descriptive, prospective and observational study was carried out with patients admitted to the surgery service of Hospital Universitario "Manuel Ascunce Domenech" with a diagnosis of bile duct lesion, from September 2018 to January 2022. The study universe consisted of twelve patients who met the inclusion criteria. Descriptive statistical methods and calculations with percentage values were used. Results: The highest incidence of patients corresponded to the female sex and the white skin, accounting for 61.4 percent and 85.7(Percent(, respectively. Conventional surgery and intraoperative diagnosis predominated, accounting for 66.7 % and 50 %, respectively. Types E1 and E2 according to the Strasberg classification, together with hepaticojejunostomy, was the most frequent surgery type, accounting for 66.7 %. Biliary bleeding was the predominant complication, accounting for 70 %. Conclusions: Most of the patients belong to the female sex and have white skin, in which cases conventional surgery and intraoperative diagnosis are the most frequent findings. More than half of the patients are classified as types E1 or E2 according to the Strasberg classification. Transmesocolic Braun loop and Roux-en-Y hepaticojejunostomy is the procedure performed in almost all patients. Biliary leakage is the most frequent complication(AU)

Asociación entre los factores socioeconómicos y las complicaciones postoperatorias de la colecistectomía / Association between socioeconomic factors and postoperative complications of cholecystectomy

El objetivo de este artículo es determinar si los factores socioeconómicos inciden en las complicaciones posoperatorias de la colecistectomía. Para ello, se definió realizar un estudio de tipo observacional, analítico y enfoque cuantitativo, en 100 pacientes en los que se les realizó colecistectomía. Se aplicó un modelo de regresión logística en el que se incorporaron como variables, factores de riesgo, características socioeconómicas, junto con una variable de control. Se aplicaron tres modelos con variables dependientes alternativas que están delimitadas por el tipo de complicación posoperatoria registrado. Los resultados encontrados mostraron que las mujeres manifiestan un mayor riesgo de presentar complicaciones posteriores a la colecistectomía, igual ocurre en los pacientes de mayor edad. Asimismo el riesgo es mucho menor en las personas con niveles de educación superior y en los pacientes en los que se realizó colecistectomía laparoscópica, alcanzando solo un 5% de riesgo de presentar complicaciones. Las complicaciones posoperatorias luego de la colecistectomía se minimizan al emplear la técnica laparoscópica y los factores socioeconómicos incidirían en el riesgo de padecer complicaciones posoperatorias luego de dicha cirugía, lo que la convierte a la colecistectomía laparoscópica en una operación segura y con muchos otros beneficios y ventajas sobre la cirugía tradicional o convencional.

The article ́s goal isto determine if socioeconomic factors influence the postoperative complications of cholecystectomy. For this, the observational study was defined, analytical and quantitative study was conducted in 100 patients who underwent cholecystectomy. A logistic regression model was applied in which risk factors, socioeconomic characteristics, along with a control variable, were incorporated as variables. Three models were run with alternative dependent variables that are delimited by the type of postoperative complication recorded. The results found showed that women show a higher risk of presenting complications after cholecystectomy, the same occurs in older patients. Likewise, the risk is much lower in people with higher education levels and in patients who underwent laparoscopic cholecystectomy, they only have a 5% risk of presenting complications. Postoperative complications after cholecystectomy are minimized by using the laparoscopic technique and socioeconomic factors would influence the risk of suffering postoperative complications after said surgery, which makes laparoscopic cholecystectomy a safe operation with many other benefits and advantages over traditional or conventional surgery.

Colangiocarcinoma, diagnóstico, tratamiento y evolución clínica. Presentación de un caso con sobrevida 5 años / Cholangiocarcinoma: diagnosis, treatment and clinical evolution. Presentation of a case with five-year survival

RESUMEN El colangiocarcinoma es un tumor maligno originado en el epitelio de los conductos biliares intra o extrahepáticos. En el cuadro clínico destacan el dolor en hipocondrio derecho, ictericia y baja de peso. Actualmente, el diagnóstico se ha facilitado por la disponibilidad de variados procedimientos imagenológicos y endoscópicos. Se presentó un caso al que se le realizó el diagnóstico de este tipo de tumor. Se sometió a tratamiento endoscópico, quirúrgico y oncológico con Gemcitabina, Cisplatino y Oxaliplatino. Fue seguido por equipo multidisciplinario y evolucionó con sobrevida de 5 años (AU).

ABSTRACT Cholangiocarcinoma is a malignant tumor originated in the epithelium of the intra or extra hepatic biliary ducts. Pain in the right hypochondrium, jaundice and low weight are the main clinical features. Currently, the diagnosis has been facilitated by the availability of different imaging and endoscopic procedures. The authors presented a case diagnosed with this kind of tumor. The patient underwent surgical, endoscopic and oncologic treatment with gemcitabine, cisplatine and oxaliplatine. He was followed up by a multidisciplinary team and evolved with five-year survival (AU).

Resultados del tratamiento quirúrgico de la perforación intestinal causada por ingestión de mondadientes: aportación de 3 casos / Results of surgical treatment of intestinal perforation caused by toothpick ingestion: contribution of 3 cases

RESUMEN: La ingestión de mondadientes (IM) constituye un evento poco frecuente (se han publicado alrededor de 157 casos a nivel mundial), pero puede causar perforaciones intestinales (PI), con peritonitis, sepsis e incluso muerte. Este hecho, determina la necesidad de intervenir quirúrgicamente a la mayoría de estos pacientes. El objetivo de este manuscrito fue informar resultados del tratamiento quirúrgico de 3 casos de PI por IM. Caso 1: hombre de 52 años, con perforación duodenal y de la vesícula biliar. Caso 2: Mujer de 54 años con perforación cecal. Caso 3: hombre de 72 años, con perforación de colon izquierdo y lesión esplénica. Todos fueron hospitalizados por dolor abdominal y fiebre. En dos casos el diagnóstico se verificó por tomografía y en uno por ecotomografía. Los tres casos fueron intervenidos quirúrgicamente a través de laparotomía. Intervenciones: Caso 1: se realizó colecistectomía y sutura duodenal. Caso 2: se realizó hemicolectomía derecha e ileotransverso anastomosis. Caso 3: se realizó hemicolectomía izquierda y esplenectomía. En todos los casos se encontró el mondadientes. Todos los pacientes evolucionaron de forma satisfactoria, sin complicaciones postoperatorias. La IPD es una emergencia quirúrgica. Las PI son comunes y la peritonitis asociada es frecuente. El pronóstico depende de un diagnóstico precoz y un tratamiento oportuno.

SUMMARY: Toothpick ingestion (TPI) is a rare event, but can cause intestinal perforation (IP), peritonitis, sepsis, and even death (approximately 157 cases have been published worldwide). This fact determines the need for surgical intervention in most of these patients. The aim of this manuscript was to report the results of the surgical treatment in 3 cases of IP by TPI. The report involves the following: Case 1: A 52-year-old man, with duodenal and gallbladder perforation. Case 2: A 54-year-old woman with cecal perforation. Case 3: A 72-year-old man, with perforation of the left colon and splenic rupture. All were hospitalized for abdominal pain and fever. In two of the cases the diagnosis was verified by tomography and in one by ultrasound. All three patients underwent laparotomy. In the first case (1), cholecystectomy and duodenal suture were performed; in the second case (2) right hemicolectomy and ileo-transverse anastomosis were performed, and in the third case (3), Left hemicolectomy and splenectomy were performed. Toothpick was found in all cases. The patients in this report all evolved satisfactorily without postoperative complications. In conclusion, TPI is a surgical emergency. IP are common and the associated peritonitis is high. Prognosis depends on early diagnosis and timely treatment.

Factores epidemiológicos en la conversión de la colecistectomía videolaparoscópica / Epidemiological factors in the conversion of videolaparoscopic cholecystectomy

Introducción: La colecistectomía videolaparoscópica es el proceder más idóneo para tratar la litiasis vesicular y sus complicaciones, pero existen factores epidemiológicos que pueden propiciar la conversión. Objetivo: Determinar los factores epidemiológicos que incidieron en la conversión de la colecistectomía videolaparoscópica. Métodos: Se realizó un estudio de tipo descriptivo y retrospectivo en el Hospital Militar "Octavio de la Concepción y de la Pedraja", desde enero de 2010 hasta mayo de 2019. Fueron estudiados 64 pacientes intervenidos de forma electiva o de urgencia, que fueron convertidos de mínimo acceso a vía convencional. Resultados: Se evidenció mayor número de conversiones urgencias, a predominio de hombres, con rango de edad entre 41 y 55 años. En la cirugía electiva sobresalió el sexo femenino, del mismo grupo etario. La conversión fue más habitual en los pacientes sobrepeso. La litiasis vesicular sintomática (cólico biliar) fue la condición más encontrada como antecedente. La diabetes mellitus fue la enfermedad crónica no trasmisible más asociada a la conversión. Conclusiones: Fue más frecuente la conversión en el grupo de edad entre 41 a 55 años, en pacientes del sexo masculino, sobrepeso, asociado a cólicos biliares y diabetes mellitus(AU)

Introduction: Videolaparoscopic cholecystectomy is the most suitable procedure to treat gallbladder lithiasis and its complications, but there are epidemiological factors that can promote conversion. Objective: To determine the epidemiological factors that influenced the conversion of videolaparoscopic cholecystectomy. Methods: A descriptive and retrospective study was carried out at the Hospital Militar "Octavio de la Concepción y de la Pedraja", from January 2010 to May 2019. 64 patients underwent elective or emergency surgery, who were converted with minimal access to conventional. Results: A greater number of conversions from emergency was evident, predominantly in men, with an age range between 41 and 55 years. In elective surgery, the female sex, from the same age group, stood out. Conversion was more common in overweight patients. Symptomatic gallbladder lithiasis (biliary colic) was the most commonly found condition as an antecedent. Diabetes mellitus was the chronic non-communicable disease most associated with conversion. Conclusions: Conversion was more frequent in the age group between 41 to 55 years, in male patients, overweight, associated with biliary colic and diabetes mellitus(AU)

Comparison between erector spinal plane block and epidural block techniques for postoperative analgesia in open cholecystectomies: a randomized clinical trial / Comparação entre as técnicas de bloqueio do plano do músculo eretor da espinha e bloqueio epidural para analgesia pós-operatória em colecistectomias abertas: um ensaio clínico randomizado

Abstract Introduction and objectives: Blockade of the Erector Spinal Muscle (ESP Block) is a relatively new block, initially described for chronic thoracic pain analgesia, but it has already been described for anesthesia and analgesia in thoracic surgical procedures and, more recently, for high abdominal surgeries. The aim of the study was to compare two techniques, ESP Block and Epidural Block, with morphine and local anesthetic for postoperative analgesia of open cholecystectomy surgeries. Methods: Controlled single-blind randomized clinical trial with 31 patients (ESP Block, n = 15; Epidural, n = 16), of both genders, ages between 27 and 77 years. The ESP block was performed at the T8 level with injection of 20 mL of 0.5% ropivacaine bilaterally. The epidural block was performed at the T8-T9 space with 20 mL of 0.5% ropivacaine and 1 mg of morphine. Results: The ESP Block group presented higher mean ​​Numeric Pain Scale (NPS) values for pain in the up to 2 hour (p = 0.001) and in the 24 hour (p = 0.001) assessments. The ESP Block group had a three-fold increased risk (43.7% vs. 13.3%) of rescue opioid use in the 24 postoperative hours when compared to the epidural group (RR = 3.72, 95% CI: 0.91 to 15.31, p = 0.046). Conclusion: ESP Block did not prove to be an effective technique for postoperative analgesia of open cholecystectomy, at the doses performed in this study, having required more use of rescue opioid, and without differences in NPS. More comprehensive studies are required to assess the efficacy of ESP block for the visceral and abdominal somatic component, considering the specific blockade level.

Resumo Justificativa e objetivo: O Bloqueio do Plano do Músculo Eretor da Espinha (ESP block) é um bloqueio relativamente novo, inicialmente descrito para analgesia de dor torácica crônica, porém já descrito para anestesia e analgesia em procedimentos cirúrgicos torácicos e, mais recentemente, para cirurgias abdominais altas. O estudo objetivou comparar as técnicas de bloqueio ESP e bloqueio Epidural com morfina e anestésico local para analgesia pós-operatória de cirurgias de colecistectomia aberta. Método: Estudo clínico randomizado controlado, unicego com 31 pacientes (ESP block, n = 15; Epidural, n = 16), de ambos os sexos, idades entre 27 e 77 anos. O ESP block foi realizado no nível de T8 com injeção de 20 mL de ropivacaína 0,5% bilateral. O bloqueio Epidural foi realizado no espaço T8-T9 com 20 mL de ropivacaína 0,5% e 1 mg de morfina. Resultados: O grupo ESP block apresentou valores médios de dor pela Escala Visual Numérica (EVN) maiores nas avaliações até 2 horas (p= 0,001) e em 24 horas (p= 0,001). O grupo ESP block apresentou um risco três vezes maior - 43,7%vs.13,3% - de uso de opioide de resgate em 24 horas pós-operatórias do que o grupo epidural (RR = 3,72; 95% IC 0,91 a 15,31; p= 0,046). Conclusão: Nas doses realizadas nesse estudo, o ESP block não se mostrou uma técnica efetiva para analgesia pós-operatória de colecistectomia aberta, com mais uso de opioide de resgate e sem diferenças na escala visual numérica de dor. Necessita-se de estudos mais abrangentes avaliando a eficácia do ESP block para o componente visceral e somático abdominal, considerando o nível do bloqueio específico.

Colelitíase na infância e adolescência: abordagem diagnóstica e tratamento / Cholelithiasis in childhood and adolescence: diagnostic approach and treatment

Com exceção dos casos decorrentes de doença hemolítica crônica, a colelitíase biliar é pouco comum na infância e adolescência quando comparada aos adultos. No entanto, nas últimas décadas observou-se importante aumento da incidência da doença na pediatria, principalmente em adolescentes do sexo feminino. Os fatores de risco associados à colelitíase têm se assemelhado àqueles encontrados nos adultos e o cálculo de colesterol é o principal responsável pelo aumento da prevalência. Acredita-se que a maioria dos pacientes pediátricos com colelitíase biliar apresente sintomas inespecíficos; a cólica biliar típica é encontrada mais frequentemente em crianças mais velhas. O tratamento padrão para a colelitíase sintomática é o tratamento cirúrgico com retirada da vesícula biliar, sendo a colecistectomia videolaparoscópica preferível à cirurgia aberta devido ao menor tempo de recuperação e de internação hospitalar. Contudo, na colelitíase assintomática o tratamento deve ser individualizado, sendo indicada a cirurgia em casos selecionados. O objetivo desta revisão é apresentar os principais aspectos da doença calculosa biliar na infância e contribuir para maior suspeição clínica da doença entre os pediatras, aprimorando a abordagem diagnóstica e a definição terapêutica adequada.

Excluding the cases resulting from chronic hemolytic disease, cholelithiasis is uncommon in childhood and adolescence when compared to adults. However, in recent decades there has been noted an increased incidence of the disease in pediatrics, especially in female adolescents. The risk factors associated with cholelithiasis have been similar to those found in adults and cholesterol stones are the main responsible for the increase of the prevalence. The majority of pediatric patients with cholelithiasis have no specific symptoms; typical biliary colic is found more often among older children. The standard treatment for symptomatic cholelithiasis is surgery to remove the gallbladder; the laparoscopic cholecystectomy is preferable to open surgery because of the shorter recovery time and hospital stay. However, in asymptomatic cholelithiasis treatment must be individualized and surgery is indicated in selected cases. The aim of this review is to present the main aspects of gallstone disease in childhood and contribute to greater clinical suspicion of the disease among pediatricians, improving the diagnostic approach and the appropriate therapeutic definition.

Alterações histológicas da vesícula biliar de doentes submetidos à colecistectomia por colelitíase / Gallbladder histological alterations in patients undergoing cholecystectomy for cholelithiasis

RESUMO Objetivo: descrever os achados histológicos das vesículas biliares de pacientes submetidos à colecistectomia e avaliar a presença de fatores associados ao câncer incidental da vesícula. Métodos: estudo descritivo, transversal e observacional de 1.278 exames anatomopatológicos de vesículas biliares oriundas de colecistectomias por colelitíase e de seus respectivos laudos, realizadas no período de janeiro de 2008 a dezembro de 2017. Resultados: o achado anatomopatológico mais frequente foi a colecistite crônica, presente em 1.251 pacientes (97,8%), seguido pela colesterolose em 131 (10,2%). O câncer de vesícula foi identificado em seis pacientes, com prevalência de 0,5% nesta amostra. Houve associação significativa entre a presença de câncer e idade ≥60 anos e com a espessura da parede ≥0,3cm. Conclusão: houve baixa prevalência de câncer de vesícula na população avaliada, maior ocorrência na população idosa e associação de tumor com espessamento da parede vesicular.

ABSTRACT Objective: to describe the histological findings of the gallbladders of patients undergoing cholecystectomy and to evaluate the presence of factors associated with gallbladder incidental cancer. Methods: we conducted a descriptive, cross-sectional, observational study with 1,278 histopathological exams of gallbladders coming from cholecystectomy for cholelithiasis and of their reports, held from January 2008 to December 2017. Results: the most common pathological finding was chronic cholecystitis, present in 1,251 patients (97.8%), followed by gallbladder cholesterolosis, in 131 (10.2%). Gallbladder cancer was identified in six patients, with a prevalence of 0.5% in this sample. There was a significant association between the presence of cancer and age ≥60 years and wall thickness ≥0.3cm. Conclusion: there was low prevalence of gallbladder cancer in this population, higher occurrence in the elderly and association of the tumor with gallbladder wall thickness.

Incidência comparativa de câncer incidental de vesícula biliar em colecistectomias de urgência versus colecistectomias eletivas / Comparative incidence of incidental gallbladder cancer in emergency cholecystectomies versus in elective cholecystectomies

RESUMO Objetivo: analisar, comparativamente, a incidência de câncer incidental de vesícula biliar em colecistectomias de urgência versus colecistectomias eletivas realizadas em hospitais públicos de Teresina-PI. Métodos: estudo observacional descritivo, quantitativo, com delineamento transversal, cujo cenário foram dois hospitais públicos de Teresina-PI. Foram analisados 6.329 prontuários de pacientes submetidos à colecistectomia, entre janeiro de 2011 e dezembro de 2017. Os dados coletados foram divididos em dois grupos e confrontados estatisticamente através do teste Z para diferença entre proporções. Resultados: detectou-se câncer incidental da vesícula biliar em 6,53% das colecistectomias de urgência e em 0,38% das eletivas. Quanto ao sexo, observou-se que, na cirurgia de urgência, 69% eram mulheres e 31%, homens, enquanto no procedimento eletivo, 78% eram mulheres e 22%, homens. Quanto à idade, a maioria dos pacientes possuía mais de 60 anos e, entre estes, 69,3% submetidos à colecistectomias de urgência e 82,6%, à eletivas. O tipo histopatológico "adenocarcinoma" foi encontrado em 84,6% das cirurgias de urgência e 100% das eletivas. Conclusão: câncer incidental de vesícula biliar foi mais frequente em colecistectomias de urgência em comparação às eletivas. O perfil dos pacientes com essa doença maligna nos dois tipos de procedimento foi do sexo feminino, maiores de 60 anos de idade e com diagnóstico histopatológico de adenocarcinoma.

ABSTRACT Objective: to comparatively analyse the incidence of incidental gallbladder cancer in emergency cholecystectomies versus in elective cholecystectomies performed in public hospitals in Teresina city, Piaui state (PI). Methods: descriptive, quantitative, observational, cross-sectional study, whose scenarios were two public hospitals in Teresina-PI. We analysed 6,329 medical records of patients undergoing cholecystectomy between January 2011 and December 2017. The collected data were divided into two groups and statistically compared using Z-test for difference between proportions. Results: incidental gallbladder cancer was detected in 6.53% of emergency cholecystectomies and in 0.38% of elective ones. Regarding gender, it was observed that in emergency surgeries 69% of patients were women and 31% men, while in elective procedures 78% were women and 22% men. Regarding age, most patients were over 60 years old, and, among these, 69.3% underwent emergency cholecystectomies and 82.6% underwent elective cholecystectomies. The histopathological type "adenocarcinoma" was found in 84.6% of patients who underwent emergency surgeries and in 100% of patients who underwent elective surgeries. Conclusion: incidental gallbladder cancer was more frequent in urgent cholecystectomies compared to elective cholecystectomies. The profile of patients with this malignant disease in both types of procedure was female, older than 60 years, and with histopathological diagnosis of adenocarcinoma.

Comparative evaluation of magnetic resonance cholangiopancreatography and perioperative cholangiography in patients with suspect choledocholithiasis / Avaliação comparativa da colangiopancreatografia por ressonância magnética e da colangiografia peroperatória na suspeita de coledocolitíase

ABSTRACT Background: Cholelithiasis is a highly prevalent condition, and choledocholitiasis is a high morbidity complication and requires accurate methods for its diagnosis. Aim: To evaluate the population of patients with suspected choledocholitiasis and check the statistical value of magnetic resonance cholangiopancreatography, ultrasonography, the laboratory and the clinic of these patients comparing them to the results obtained by perioperative cholangiography. Methods: This is a retrospective cohort study, which were evaluated 76 patients with cholelithiasis and suspected choledocholithiasis. Results: It was observed that the presence of dilatation of the biliary tract or choledocholithiasis in the ultrasonography was four and eight times increased risk of perioperative cholangiography for positive choledocholithiasis, respectively. For each unit increased in serum alkaline phosphatase was 0.3% increased the risk of perioperative cholangiography for positive choledocholithiasis. In the presence of dilatation of the bile ducts in the ultrasonography was four times greater risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. In the presence of pancreatitis these patients had five times higher risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. On the positive magnetic resonance cholangiopancreatography presence to choledocholithiasis was 104 times greater of positive perioperative cholangiography for choledocholithiasis. Conclusions: The magnetic resonance cholangiopancreatography is a method with good accuracy for propedeutic follow-up for the diagnosis of choledocholithiasis, consistent with the results obtained from the perioperative cholangiography; however, it is less invasive, with less risk to the patient and promote decreased surgical time when compared with perioperative cholangiography.

RESUMO Racional: A colelitíase é afecção de alta prevalência, sendo a coledocolitíase complicação de elevada morbidade e que necessita de métodos acurados para seu diagnóstico. Objetivo: Avaliar o perfil populacional de pacientes com suspeita de coledocolitíase e verificar o valor estatístico da colangiopancreatografia por ressonância magnética, da ultrassonografia, dos exames laboratoriais e da clínica desses pacientes e compará-los aos resultados obtidos pela colangiografia peroperatória. Métodos: Trata-se de estudo longitudinal, de coorte, retrospectivo, no qual foram avaliados 76 pacientes com diagnóstico de colelitíase e suspeita de coledocolitíase. Resultados: Observou-se que na presença de dilatação das vias biliares ou coledocolitíase na ultrassonografia havia risco quatro e oito vezes maior, respectivamente, de colangiografia peroperatória positiva para coledocolitíase. Para cada unidade de aumento na fosfatase alcalina sérica houve aumento em 0,3% no risco de colangiografia peroperatória positiva para coledocolitíase. Na presença de dilatação das vias biliares na ultrassonografia ou clínica de pancreatite havia risco quatro e cinco vezes maior, respectivamente, de colangiopancreatografia por ressonância magnética positiva para coledocolitíase. Na presença de colangiopancreatografia por ressonância magnética positiva para coledocolitíase o risco foi 104 vezes maior de colangiografia peroperatória positiva para coledocolitíase. Conclusão: A colangiopancreatografia por ressonância magnética para seguimento propedêutico tem boa acurácia para o diagnóstico de coledocolitíase, e concordante com os resultados obtidos na colangiografia peroperatória. O método é menos invasivo, com menores riscos ao paciente e com diminuição do tempo cirúrgico dispendido para realização da colangiografia peroperatória.

Transplante hepático no tratamento de lesão iatrogênica de via biliar após colecistectomia: um estudo em centro de referência no Nordeste do Brasil / Liver transplantation for treatment of biliary iatrogenic injury after cholecistectomy: a study in reference center in the Northeast of Brazil

Introdução: a lesão iatrogênica de via biliar é uma grave complicação cirúrgica que pode ocorrer durante a realização de colecistectomia. Os pacientes portadores desse tipo de lesão podem evoluir com cirrose biliar secundária a despeito de múltiplos tratamentos cirúrgicos, sendo necessário o transplante hepático como a última opção para tratamento. Objetivo: analisar o perfil dos pacientes em um centro de referência no Nordeste do Brasil submetidos a transplante hepático por lesão iatrogênica de via biliar. Métodos: foram analisados retrospectivamente 730 prontuários na Unidade de Transplante de Fígado do Hospital Universitário Oswaldo Cruz, no período de 2001 até 2015, e selecionados os oito pacientes submetidos a transplante hepático por lesão iatrogênica de via biliar. Resultados: a idade variou entre 26 e 61 anos, sendo seis indivíduos do sexo feminino. A cirurgia inicial foi a colecistectomia aberta em sete casos e videolaparoscópia em um caso. Em uma oportunidade, a lesão foi identificada durante a colecistectomia. Os sintomas se assemelharam com os descritos na literatura, incluindo colangite de repetição. Quatro pacientes eram portadores de lesão E2 e três de lesão tipo E3 de Strasberg. Seis pacientes já haviam sido submetidos a abordagens cirúrgicas prévias e o tempo entre a lesão inicial e o transplante variou entre três (3) e vinte e seis anos (26). Todos os pacientes eram portadores de Cirrose Biliar Secundária e o tempo na lista de espera para transplante variou entre 111 e 1123 dias. O MELD teve uma média de 16. O transplante foi realizado por técnica convencional em seis casos e Piggyback em dois, sendo a reconstrução por hepaticojejunostomia realizada em todos. Um paciente necessitou de retransplante, evoluindo a óbito. Conclusão: transplante hepático por lesão iatrogênica de via biliar é mais comum naqueles pacientes que demoraram a ser encaminhados para centro de referência e que foram submetidos a múltiplos procedimentos prévios.

Background: iatrogenic bile duct injury is a serious surgical complication that may occur during cholecystectomy.Patients with this type of lesion may develop secondary biliary cirrhosis, despite multiple surgical treatments, requiring liver transplantation as the last measure. Aim: analyze the patients submitted to hepatic transplantation due to iatrogenic bile duct injury in a referral center in the Northeast of Brazil. Results: the age ranged from 26 to 61 years, with six females. The initial surgery was open cholecystectomy in seven cases and videolaparoscopic in one case. In one patient the lesion was identified during cholecystectomy. The symptoms resembled those described in the literature, including recurrent cholangitis. Four patients had E2 lesions and three E3 lesions from Strasberg. Six patients had undergone previous surgical approaches and the time between initial injury and transplantation ranged from three to twenty-six years. All patients had secondary Biliary Cirrhosis and the time on the transplant waiting list varied between 111 and 1123 days. The MELD had an average of 16. The transplantation was performed by conventional technique in six cases and Piggyback in two, and reconstruction by hepaticojejunostomy performed in all. One patient needed a re-transplant and the same patient died one year later. Conclusion: hepatic transplantation due to iatrogenic bile duct injury is more common in those patients who were delayed to be referred to a referral center and who underwent multiple previous surgical procedures.

Tratamiento quirúrgico de las lesiones iatrogénicas de la vía biliar poscolecistectomía / Surgical treatment of iatrogenic bile duct injury post cholecystectomy

Introducción: Las lesiones de la vía biliar (LVB) iatrogénicas durante una colecistectomía constituyen una complicación grave, con una significativa morbimortalidad. El objetivo del estudio es analizar los resultados de la reparación de las LVB poscolecistectomía realizadas entre los años 2000 y 2015. Métodos: Estudio de serie de casos. Se consignaron en una base de datos: variables demográficas, el centro donde se realizó la colecistectomía, la vía de reparación, el tipo de LVB, el tipo de reparación efectuada, las complicaciones postoperatorias, la mortalidad operatoria y la sobrevida. Para el análisis estadístico se utilizó el software SPSS 22 (SPSS Inc., Chicago, IL, EE. UU.). Resultados: Se estudiaron 36 pacientes, de los cuales 33 (92%) fueron mujeres; la edad promedio fue de 48,5 ± 14 años. La colecistectomía que originó la iatrogenia fue laparoscópica en 24 (67%) casos. La LVB fue identificada en el intraoperatorio en 9 pacientes (25%). La LVB más frecuente se localizó a menos de 2cm de la confluencia (Bismuth-Strasberg tipo E2) en 14 (39%) pacientes. La derivación biliodigestiva con asa en Y de Roux fue la técnica más utilizada en la reparación de las LVB en 26 (72%) casos. A largo plazo, se observó una estenosis en 7 (19%) pacientes, con necesidad de una nueva reparación. Hubo mortalidad operatoria de un paciente (3%). Conclusiones: Las LVB poscolecistectomía fueron satisfactoriamente reparadas preferentemente con una derivación biliodigestiva con Y de Roux en nuestro centro.

Abstract Introduction: Iatrogenic bile duct injuries (BDI) during a cholecystectomy are a serious complication with significant morbidity and mortality. The aim of this study is to analyze the results BDI's repair post cholecystectomy which was performed between the years 2000-2015. Methods: Case series study. Demographic variables, the center where the cholecystectomy was performed, repair pathway, the type of bile duct injury, the type of reparation performed, postoperative complications, operative mortality and survival were entered in a database. For statistical analysis, software SPSS 22 was used. Results: Thirty-six patients were studied; 33 (92%) were women; mean age 48.5 ± 14 years. The Cholecystectomy that originated the iatrogenia was laparoscopic in 24 (67%) cases. BDI was identified intraoperatively in 9 patients (25%). The most common BDI was located less than 2 cm to confluence (Bismuth-Strasberg type E2) in 14 (39%) patients. The biliodigestive Roux-Y bypass was the most used technique in the repair of the BDI in 26 (72%) cases. In the long term, stenosis was observed in 7 (19%) patients with the need of a new repair. Operative mortality of 1 patient (3%). Conclusions: BDI post cholecystectomy were successfully repaired preferably with a biliodigestive Roux-Y bypass in our center.

Prevalência do câncer de vesícula biliar em pacientes submetidos à colecistectomia: experiência do Hospital de Clínicas da Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP / Prevalence of gallbladder cancer In patients submitted to cholecystectomy: experience of the University Hospital, Faculty of Medical Sciences, State University of Campinas - UNICAMP

RESUMO Objetivo: estudar a prevalência do câncer de vesícula biliar em pacientes submetidos à colecistectomia no Hospital de Clínicas da Universidade Estadual de Campinas. Métodos: estudo de prevalência retrospectivo a partir da análise de laudos de espécimes histopatológicos de pacientes submetidos à colecistectomia, no período de janeiro de 2010 a maio de 2015. Resultados: foram analisados 893 laudos de pacientes submetidos à colecistectomia, dos quais 144 de urgência e 749 eletivas (16,2% e 83,8%, respectivamente). Segundo o sexo, 72,8% correspondiam ao feminino e 27,2%, ao masculino. Em 12 pacientes (1,3%) foi evidenciado o diagnóstico de adenocarcinoma de vesícula biliar e, em um (0,1%), o diagnóstico de linfoma não Hodgkin. Dos 13 pacientes com neoplasia, sete (53,8%) apresentaram colecistolitíase associada. Em dois doentes (15,3%) foi constatado pólipo de vesícula biliar. Sete (53,8%) doentes foram operados com a hipótese diagnóstica de neoplasia de vesícula biliar. Conclusão: a prevalência do adenocarcinoma de vesícula biliar no presente estudo foi semelhante à dos estudos ocidentais e o principal fator de risco foi a colecistolitíase, seguido pela presença de pólipos de vesícula biliar.

ABSTRACT Objective: to evaluate the prevalence of gallbladder carcinoma in patients submitted to cholecystectomy for chronic cholecystitis at the University Hospital of the State University of Campinas. Methods: we conducted a retrospective prevalence study through the analysis of histological specimens from January 2010 to May 2015. Results: we analyzed 893 patient reports. Emergency cholecystectomies amounted to 144, and elective ones, 749 (16.2% and 83.8%, respectively). Regarding gender, 72.8% were female and 27.2% male. Gallbladder adenocarcinoma occurred in 12 patients (1.3%) and non-Hodgkin's lymphoma in one (0.1%). In patients with cancer, seven (53.8%) were associated with cholelithiasis and two (15.3%) with gallbladder polyps. Conclusion: prevalence results of gallbladder adenocarcinoma in this study were similar to those of Western studies and the main risk factor was cholelithiasis, followed by the presence of gallbladder polyps.

A New Paradigm in Gallstones Diseases and Marked Elevation of Transaminases: An Observational Study

ABSTRACT Background. In clinical practice, it is assumed that a severe rise in transaminases is caused by ischemic, viral or toxic hepatitis. Nevertheless, cases of biliary obstruction have increasingly been associated with significant hypertransaminemia. With this study, we sought to determine the true etiology of marked rise in transaminases levels, in the context of an emergency department. Material and methods. We retrospectively identified all patients admitted to the emergency unit at Centro Hospitalar e Universitário de Coimbra between 1st January 2010 and 31st December 2010, displaying an increase of at least one of the transaminases by more than 15 times. All patient records were analyzed in order to determine the cause of hypertransaminemia. Results. We analyzed 273 patients - 146 males, mean age 65.1 ± 19.4 years. The most frequently etiology found for marked hypertransaminemia was pancreaticobiliary acute disease (n = 142;39.4%), mostly lithiasic (n = 113;79.6%), followed by malignancy (n = 74;20.6%), ischemic hepatitis (n = 61;17.0%), acute primary hepatocellular disease (n = 50;13.9%) and muscle damage (n = 23;6.4%). We were not able to determine a diagnosis for 10 cases. There were 27 cases of recurrence in the lithiasic pancreaticobiliary pathology group. Recurrence was more frequent in the group of patients who had not been submitted to early cholecystectomy after the first episode of biliary obstruction (p = 0.014). The etiology of hypertransaminemia varied according to age, cholestasis and glutamic-pyruvic transaminase values. Conclusion. Pancreaticobiliary lithiasis is the main cause of marked hypertransaminemia. Hence, it must be considered when dealing with such situations. Not performing cholecystectomy early on, after the first episode of biliary obstruction, may lead to recurrence.

Factores predictivos de colecistitis aguda gangrenosa / Predictive factors of acute gangrenous cholecystitis

Introducción: La colecistitis aguda gangrenosa (CAG) es una complicación severa de la colecistitis aguda, afectando entre el 2 y 20% de las mismas. En la actualidad no hay disponibles guías definidas para detectar estos casos y definir su conducta quirúrgica con rapidez. El objetivo de este trabajo es contribuir al estudio de los factores predictivos de la CAG para identificar los pacientes que requieren cirugía de urgencia. Material y métodos: Se realizó una búsqueda retrospectiva de pacientes que fueron sometidos a colecistectomía con diagnóstico preoperatorio de colecistitis aguda en el Nuevo Hospital San Roque, entre enero de 2011 y diciembre de 2012. El Nuevo Hospital San Roque es un centro público de atención de tercer nivel al que acceden de forma gratuita los habitantes de la Ciudad de Córdoba (Argentina) y alrededores que no cuentan con cobertura de salud privada. Los factores de riesgo preoperatorios evaluados incluyeron sexo, edad, diabetes, obesidad, vómitos, fiebre, recuento de glóbulos blancos, eritrosedimentación, enzimas hepáticas, amilasa y hallazgos ecográficos como diámetro de la pared vesicular y líquido perivesicular. Los pacientes fueron divididos en 2 grupos de acuerdo con el diagnóstico anatomopatológico: el grupo 1 incluyó pacientes con CAG y el grupo 2, pacientes con colecistitis aguda no gangrenosa. Resultados: De un total de 183 pacientes sometidos a colecistectomía, 101 (55,1%) presentaron CAG. El análisis multivariado determinó que en nuestro grupo de estudio la razón de probabilidades de CAG asociadas a las variables fiebre, diabetes, y sexo masculino son mayores de 2 y estadísticamente significativas. Asimismo, la razón de probabilidades de CAG aumenta con el nivel de glóbulos blancos y eritrosedimentación. Conclusión: Las variables fiebre, diabetes, sexo masculino, glóbulos blancos, y eritrosedimentación pueden ser consideradas factores predictivos independientes en nuestro caso de estudio.

Introduction: Acute gangrenous cholecystitis (AGC) is a severe complication of acute cholecystitis affecting between 2 and 20% of them. To date, there are no defined guidelines available to triage high-risk surgical patients. Our objective is to contribute to the literature studying predictive factors of AGC aimed at identifying patients who require emergency surgery. Materials and methods: We conducted a retrospective search of patients who underwent cholecystectomies with preoperative diagnosis of acute cholecystitis at Nuevo Hospital San Roque between January 2011 and December 2012. Nuevo Hospital San Roque is a public hospital in Argentina that provides health services to non-privately insured residents of the Cordoba metropolitan area. The resulting sample was used to perform a multivariate analysis encompassing the following preoperative risk factors: gender, age, diabetes, obesity, vomiting, fever, white blood cell count, erythrocyte sedimentation rate, liver enzymes, amylase and sonographic findings like diameter of gallbladder wall and perivesicular liquid. Patients were divided into two groups according to pathological diagnosis: group 1 included patients with acute AGC and group 2 with no gangrenous acute cholecystitis. Results: One hundred and one patients presented AGC out of a total of 183 patients analyzed. Our multivariate analysis determined that the odds ratio of CAG associated with the variables fever, diabetes, and male gender are greater than 2 and statistically significant. Likewise, the odds ratio of CAG is increasing in the level of white blood cells and in the erythrocyte sedimentation rate. Conclusion: We found that fever, diabetes, male gender, white blood cells, and erythrocyte sedimentation rate can be considered independent predictors in our sample.

Relación entre litiasis biliar o colecistectomía con el síndrome metabólico en pacientes del hospital II - EsSalud, Huánuco 2014 / Relationship between bladder stones or cholecystectomy with metabolic syndrome in patients of hospital II - Essalud, Huánuco 2014

Objetivo: Determinar si existe relación entre el antecedente de litiasis biliar crónica o colecistectomía con Síndrome Metabólico premórbido en pacientes tamizados por el programa "Reforma de Vida". Materiales y Métodos: Estudio de casos y controles. Se escogieron a 360 pacientes asegurados en EsSalud, quienes fueron evaluados para detectar Síndrome Metabólico premórbido. Se incluyeron 180 personas con síndrome metabólico (casos) y 180 que no presentaban síndrome metabólico (controles). Se consultó a los pacientes sobre el antecedente de colecistitis crónica c/s colecistectomía, adicionalmente se recolectaron datos sociodemográficos (edad, género), tipo de alimentación, antecedentes patológicos familiares. Resultados: Se encontraron 21 casos de litiasis biliar (5.8%) y 44 pacientes que refirieron haber sido sometidos a colecistectomía (12.2%). No se encontró asociación estadísticamente significativa entre estas condiciones y el diagnostico de síndrome metabólico pre-mórbido en el modelo multivariado (OR: 0.81; IC 95%: 0.23-2.86, p=0.741), ni en el modelo ajustado por sexo masculino (OR: 1.12; IC 95%: 0.21-5.96, p=0.892). Conclusión: No hay una relación significativa entre colecistectomía o litiasis biliar con el diagnostico de síndrome metabólico premórbido.

Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy / Ventilação mecânica não invasiva e anestesia peridural em colecistectomia aberta de emergência

Abstract Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery.

Resumo Ventilação não invasiva é uma modalidade de tratamento aceita tanto em exacerbações agudas de doenças respiratórias quanto em doença pulmonar obstrutiva crônica. É comumente usada em unidades de terapia intensiva ou para suporte respiratório pós-cirúrgico em salas de recuperação pós-anestesia. Este relato descreve o suporte intraoperatório em ventilação não invasiva para bloqueio do neuroeixo em cirurgia abdominal alta de emergência.

Frequency of cholecystectomy and associated sociodemographic and clinical risk factors in the ELSA-Brasil study / Frequência de colecistectomia e fatores de risco sociodemográficos e clínicos associados no estudo ELSA-Brasil

ABSTRACT: CONTEXT AND OBJECTIVE: There are few data in the literature on the frequency of cholecystectomy in Brazil. The frequency of cholecystectomy and associated risk factors were evaluated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). DESIGN AND SETTING: Cross-sectional study using baseline data on 5061 participants in São Paulo. METHODS: The frequency of cholecystectomy and associated risk factors were evaluated over the first two years of follow-up of the study and over the course of life. A multivariate regression analysis was presented: odds ratio (OR) and 95% confidence interval (95% CI). RESULTS: A total of 4716 individuals (93.2%) with information about cholecystectomy were included. After two years of follow-up, 56 had undergone surgery (1.2%: 1.7% of the women; 0.6% of the men). A total of 188 participants underwent cholecystectomy during their lifetime. The risk factors associated with surgery after the two-year follow-up period were female sex (OR, 2.85; 95% CI, 1.53-5.32), indigenous ethnicity (OR, 2.1; 95% CI, 2.28-15.85) and body mass index (BMI) (OR, 1.10; 95% CI, 1.01-1.19 per 1 kg/m2 increase). The risk factors associated over the lifetime were age (OR, 1.03; 95% CI, 1.02-1.05 per one year increase), diabetes (OR, 1.92; 95% CI, 1.34-2.76) and previous bariatric surgery (OR, 5.37; 95% CI, 1.53-18.82). No association was found with parity or fertile age. CONCLUSION: Female sex and high BMI remained as associated risk factors while parity and fertile age lost significance. New factors such as bariatric surgery and indigenous ethnicity have gained importance in this country.

RESUMO CONTEXTO E OBJETIVO: Há escassez de dados na literatura sobre a frequência de colecistectomia no Brasil. Avaliou-se a frequência de colecistectomia e os fatores de risco associados no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). DESENHO E LOCAL: Estudo transversal com dados da linha de base de 5061 participantes em São Paulo. MÉTODOS: Avaliou-se a frequência de colecistectomia e fatores de risco associados nos dois primeiros anos de seguimento do estudo e ao longo da vida. Apresentou-se regressão logística [razão de chances (RC); intervalo de confiança de 95% (IC 95%)] multivariada. RESULTADOS: Um total de 4716 (93,2%) indivíduos com informação sobre colecistectomia foi incluído. Após 2 anos de seguimento, 56 participantes tinham sido operados (1,2%: 1,7% nas mulheres; 0,6% nos homens), totalizando 188 participantes com colecistectomia durante a vida. Os fatores de risco associados à cirurgia após dois dois anos de seguimento foram sexo feminino (RC, 2,85; IC 95%, 1,53-5,32), etnia indígena (RC, 2,1; IC 95%, 2,28-15,85) e índice de massa corpórea, IMC (RC, 1,10; IC 95%, 1,01-1,19 por aumento de 1 kg/m2); e, ao longo da vida: idade (RC, 1,03; IC 95%, 1,02-1,05 por um ano de aumento), diabetes (RC, 2,10; IC 95%, 1,34-2,76) e cirurgia bariátrica prévia (RC, 5.37; IC 95%, 1,53-18,82). Não se observou associação com paridade ou idade fértil. CONCLUSÃO: Sexo feminino e IMC elevado permanecem sendo fatores de risco associados à colecistectomia, mas paridade e idade fértil perderam significância. Novos fatores de risco, como cirurgia bariátrica prévia e etnia indígena, ganharam relevância no país.

Acceso a colecistectomía en un programa de tamizaje ecográfico de colelitiasis en centros de medicina familiar / Access to cholecystectomy among patients attended at primary family health centers

Background: Cholelithiasis (CL) represents a major health burden in Chile, with rates of cholecystectomy (CCT) of ~40.000 per year. The explicit health care guaranties (GES) program includes prioritized CCT for CL carriers between 35 and 49 years of age. Aim: To assess the access and opportunity of CCT in a screening program of CL in Family Medicine Centers, according to the age of the patients. Material and Methods: A systematic ultrasound screening program of CL was developed in Family Medicine Centers ANCORA-UC between March 2009 and March 2013 during which 1.450 individuals were assessed, (80% women) and 281 were identified as having CL (19.4%). After a minimum follow up interval of six months, patients with CL were contacted and surveyed by phone. They were categorized as being beneficiaries of the GES program (those aged between 35 to 49 years) or not (those aged < 35 o > 49 years). Results: Two hundred thirteen patients were contacted (76%), 81 beneficiaries of the program and 132 non-beneficiaries. The attending physician indicated CCT to 191 patients (89.6%). During a mean follow-up time of 641 days/person, 100 patients had CCT, 11% of which were emergency interventions due to complications. A greater proportion of program beneficiaries than non-beneficiaries had an elective CCT (74 and 21% respectively). The waiting interval for elective CCT was longer in non-beneficiaries compared with beneficiaries (340 ± 247 and 229 ± 201 days respectively). Only 46% of the elective CCT in GES patients were done within deadlines determined by the program (≤ 150 days). Conclusions: The age of patients at the moment of CL diagnosis conditions the access and opportunity to CCT. Beneficiaries of the explicit health care guaranties program have higher rates of cholecystectomy with less waiting time.