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Lee EKS, Verhoeff K, Jogiat U, Mocanu V, Dajani K, Bigam D, Shapiro AMJ, Anderson B. Outcomes after cholecystectomy in patients aged ≥80 years: A National Surgical Quality Improvement Program analysis evaluating safety and risk factors for elderly patients. J Gastrointest Surg 2025; 29:102068. [PMID: 40262712 DOI: 10.1016/j.gassur.2025.102068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2025] [Revised: 04/14/2025] [Accepted: 04/18/2025] [Indexed: 04/24/2025]
Abstract
BACKGROUND Geriatric patients may be at an increased risk of complications after cholecystectomy; however, quantification of this risk is not defined. We aimed to evaluate outcomes after cholecystectomy in octogenarians and factors independently associated with complications in these patients. METHODS This is a retrospective study of 2017 to 2021 National Surgical Quality Improvement Program data evaluating patients undergoing cholecystectomy, comparing patients aged ≥80 years with those aged <80 years. We compared demographics and outcomes with multivariable logistic regression modeling to evaluate factors independently associated with serious complications and mortality or serious complications. RESULTS Overall, 288,705 patients were included with 4.9% being octogenarian. Octogenarians were more likely to have comorbidities, functional dependence, and lower body mass index. Octogenarians were more likely to receive open cholecystectomies (7.2% vs 2.8%; P <.001), and they had longer operative time (76.6 vs 70.2 min; P <.001) and hospital stay (4.1 vs 1.6 days; P <.001). They were also more likely to undergo reoperation (1.7% vs 0.9%; P <.001) or have serious complications (9.7% vs 2.9%; P <.001). Multivariable logistic regression demonstrated that being an octogenarian was an independent factor of increased risk of mortality (odds ratio [OR], 3.29; P <.001) and serious complications (OR, 1.54; P <.001). Specific to octogenarians, minimally invasive surgical approach was significantly protective against serious complications (OR, 0.30; P <.001) and mortality (OR, 0.29; P <.001), whereas functional dependence increased likelihood of morbidity (OR, 4.42; P <.001) and serious complications (OR, 2.08; P =.002). CONCLUSION Octogenarians have an increased risk of morbidity after cholecystectomy. Minimally invasive surgery seems protective for these patients. Assessment of the octogenarians' functional dependence would provide insight preoperatively into their markedly increased perioperative risk.
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Affiliation(s)
- Esther K S Lee
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Uzair Jogiat
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Khaled Dajani
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - David Bigam
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - A M James Shapiro
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Blaire Anderson
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Agarwal R, Prabhu VMD, Rao NAR. From the operating room: Surgeons' views on difficult laparoscopic cholecystectomies. Ann Hepatobiliary Pancreat Surg 2025; 29:150-156. [PMID: 40007164 PMCID: PMC12093243 DOI: 10.14701/ahbps.24-219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 01/12/2025] [Accepted: 01/22/2025] [Indexed: 02/27/2025] Open
Abstract
Backgrounds/Aims Assessing surgical difficulty in laparoscopic cholecystectomy (LC) is challenging due to variations in surgeon proficiency and institutional protocols. This study evaluates surgeons' perspectives on procedural difficulty and examines how intraoperative findings and preoperative imaging contribute to refining difficulty assessment criteria. Methods A cross-sectional survey was conducted among 50 laparoscopic surgeons in India, providing insights into tolerances for surgical duration and blood loss, reasons for conversion, and predictors of complexity. Responses were analyzed using SPSS, with statistical significance set at p < 0.05. Results Among surveyed surgeons, 82.0% were male, and 78.0% worked in private institutions and 52.0% had performed over 1,000 LCs. Conversion to open surgery was primarily influenced by significant blood loss (68.0%) and biliary injury (94.0%). While 38.0% preferred surgeries under 60 minutes, 26.0% imposed no time constraints. Key intraoperative challenges included dense adhesions, cholecysto-enteric fistulas, and fibrosis. Less experienced surgeons reported greater challenges with scarring adhesions and anatomical variations, but no significant differences were found for other factors like edematous or necrotic changes. Preoperative imaging was considered essential by most surgeons. Conclusions This study underscores the limited reliability of traditional parameters for assessing difficulty in LC. Surgeons highlighted the importance of objective intraoperative findings and preoperative imaging in predicting surgical challenges. Factors such as adhesions, fibrosis, and anatomical variations significantly impact LC difficulty, with decisions regarding conversion to open surgery largely driven by individual judgment rather than experience. Standardized grading systems incorporating these factors could improve surgical planning, reduce complications, and enhance patient outcomes.
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Affiliation(s)
- Ritika Agarwal
- Department of Radiodiagnosis, Ramaiah Medical College, Bangalore, India
| | | | - Nitin A. R. Rao
- Department of Surgical Gastroenterology, Ramaiah Medical College, Bangalore, India
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Yu Y, McKay SC, Bhimani N, Tranter-Entwistle I, Hugh TJ. Clinical and financial impact of a 'difficult' laparoscopic cholecystectomy. ANZ J Surg 2025; 95:926-933. [PMID: 40272059 DOI: 10.1111/ans.70113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Revised: 02/06/2025] [Accepted: 03/24/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND Difficult intra-operative findings during laparoscopic cholecystectomy (LC) may lead to poor clinical outcomes. This study aimed to compare pre-operative, intra-operative, and post-operative variables of patients with 'straightforward' versus 'difficult' intra-operative findings and to assess the relationship between intra-operative findings and post-operative outcomes. METHODS A retrospective cohort study of prospectively collected data from patients undergoing LC from August 1998 to December 2020 was conducted. Intra-operative findings were graded using the North Shore system, with Grade 1 or 2 classified as 'straightforward' LC and Grade 3 or 4 as 'difficult' LC. Logistic regression analyzed the relationship between poor post-operative outcomes and intra-operative findings. RESULTS Among 2633 patients, 2050 (78%) had 'straightforward' and 583 (22%) had 'difficult' intra-operative findings. Patients with 'difficult' findings were often younger, male, jaundiced, had higher Charlson Comorbidity Indexes (CCI), and were more likely to undergo urgent or semi-urgent operations in the public hospital. They experienced longer operation times, higher cholangiogram failure rates, more common bile duct explorations, longer hospital stays, higher conversion rates to open procedures, a greater risk of post-operative bile leaks, and higher rates of hospital readmission post-discharge. Higher CCI, pancreatitis, and intra-operative challenges such as CBD exploration and 'difficult' intra-operative findings were predictive of poor post-operative outcomes. The financial impact of 'difficult' intra-operative findings is significant. CONCLUSION There is an association between 'difficult' intra-operative findings and adverse clinical outcomes, confirming the negative financial impact of a less-than Textbook Outcome. This highlights the need to anticipate and make appropriate resources available for potentially challenging LCs.
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Affiliation(s)
- Yue Yu
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia
| | - Siobhan C McKay
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia
| | - Nazim Bhimani
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | | | - Thomas J Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Goumard C, Tranchart H. Non-programmed rehospitalizations after cholecystectomy. J Visc Surg 2025:S1878-7886(25)00039-6. [PMID: 40221327 DOI: 10.1016/j.jviscsurg.2025.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2025]
Abstract
Cholecystectomy is one the most frequent procedures in digestive surgery. While the operation is generally associated with low rates of morbidity and mortality, frequency of occurrence can vary considerably according to surgical indication, time elapsed between symptom appearance and surgical intervention, anatomical area under treatment, and the experience of the different centers. Rehospitalization after cholecystectomy remains potentially problematic in numerous units, due in part to the ongoing development of day hospital treatment and short-term hospitalization. The objective of this update is to assess not only the rate, causes and risk factors of non-programmed hospitalizations subsequent to cholecystectomy, but also the available ways and means of prevention and management in the patient's best interests.
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Affiliation(s)
- Claire Goumard
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Pitié Salpêtrière Hospital, AP-HP, 75013 Paris, France; Paris Sorbonne University, 75005 Paris, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, AP-HP, 92140 Clamart, France; Paris-Saclay University, 91405 Orsay, France.
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Alcover Navarro L, Romero García CS, Mateo Rodríguez E, Granero Castro P, De Andrés Ibáñez J. Utility of optic nerve sheath ultrasound during laparoscopic colorectal surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2025; 72:501672. [PMID: 39954732 DOI: 10.1016/j.redare.2025.501672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 10/02/2024] [Accepted: 10/07/2024] [Indexed: 02/17/2025]
Abstract
INTRODUCTION Abdominal laparoscopic surgery to treat colorectal cancer has been shown to be more effective than open surgery in terms of mobility, hospital stay, tumour recurrence and long-term survival. This surgical approach requires pneumoperitoneum and the Trendelenburg position (35-45º), both of which have a negative effect on the cardiovascular system and can even change the cerebrovascular physiology, leading to an increase in intracranial pressure (ICP). Ultrasound measurement of optic nerve sheath (ONS) diameter has shown excellent correlation with invasive ICP measurement. OBJECTIVE To correlate the increase in ONS diameter with surgical time and time to emergence after anaesthesia. The incidence of visual disturbances (visual acuity) and/or neurological complications (agitation, cognitive dysfunction) in the immediate postoperative period was also evaluated. MATERIAL AND METHODS 30 consecutive patients undergoing laparoscopic surgery for rectal or sigmoid adenocarcinoma were recruited. Pre-, intra- and postoperative ONS measurements were obtained and the Snellen test for visual acuity, Mini Mental Test for cognitive function, and the Richmond Agitation and Sedation Scale (RASS) were administered. RESULTS ONS increased intraoperatively in both eyes compared to baseline. However, this was not correlated with total surgical time or time to emergence, and there was no statistically significant correlation between ONS and postoperative neurological or visual alterations.
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Affiliation(s)
- L Alcover Navarro
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | - C S Romero García
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario de Valencia, Valencia, Spain
| | - E Mateo Rodríguez
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario de Valencia, Valencia, Spain
| | - P Granero Castro
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - J De Andrés Ibáñez
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario de Valencia, Valencia, Spain; Universidad de Valencia, Valencia, Spain
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Edblom M, Enochsson L, Nyström H, Sandblom G, Arnelo U, Hemmingsson O, Gkekas I. Cholecystectomy for acute cholecystitis during weekend compared with delayed weekday surgery: A nationwide population cohort study. Surgery 2025; 180:109019. [PMID: 39740602 DOI: 10.1016/j.surg.2024.109019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 11/08/2024] [Accepted: 11/26/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND The optimal timing of surgery for acute cholecystitis has been a subject of debate, but the predominant view supports early cholecystectomy. This study investigated the safety of early cholecystectomy during weekends compared with delayed surgery until a weekday. METHODS This was a population-based cohort study based on data from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). Data from 2006 to 2020 were analyzed, and patients with acute cholecystitis were included. Patients who underwent surgery during weekends were compared with patients in hospital during weekends and underwent surgery on any subsequent weekday. Statistical analyses were conducted using logistic regression analysis. RESULTS 15,730 patients were included, and complications were registered in 2,246 patients (14.3%). The proportion of complications was equal in both groups (14.0% vs 14.5%, P = .365). The proportion of open surgery was higher in the weekend surgery group (29.1% vs 26.3%), with an odds ratio of 1.32 in multivariate logistic regression analysis (P < .001). Meanwhile, the duration of surgery exceeding 2 hours was less common when surgery was performed on the weekend (32.7% vs 46.8%, P < .001, odds ratio: 0.69). CONCLUSION In this study, procedures performed during weekends had outcomes that did not substantially differ from those performed during weekdays. The results of our study support performing early cholecystectomies during the weekend without increasing the patients' risk of complications.
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Affiliation(s)
- Magnus Edblom
- Department of Diagnostics and Intervention, Surgery, Umeå Universitet, Sweden.
| | - Lars Enochsson
- Department of Diagnostics and Intervention, Surgery, Umeå Universitet, Sweden; Division of Orthopedics and Biotechnology, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Hanna Nyström
- Department of Diagnostics and Intervention, Surgery, Umeå Universitet, Sweden; Wallenberg Centre for Molecular Medicine, Umeå Universitet, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Urban Arnelo
- Department of Diagnostics and Intervention, Surgery, Umeå Universitet, Sweden; Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Oskar Hemmingsson
- Department of Diagnostics and Intervention, Surgery, Umeå Universitet, Sweden; Wallenberg Centre for Molecular Medicine, Umeå Universitet, Sweden
| | - Ioannis Gkekas
- Department of Diagnostics and Intervention, Surgery, Umeå Universitet, Sweden
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T K J, Rathod KJ, Saxena R, Pathak M, Jadhav AS, Nayak S, Varshney V, Soni SC, Sinha A. Indocyanine Green Fluorescence-Guided Surgery in Pediatric Hepatobiliary Procedures: A Feasibility Study for Improved Intraoperative Visualization. Eur J Pediatr Surg 2025. [PMID: 39753146 DOI: 10.1055/a-2509-4463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2025]
Abstract
INTRODUCTION Indocyanine green (ICG) fluorescence-guided surgery (FGS) is reported extensively in adult operations, but its safety and applications in pediatric populations remain to be comprehensively understood. The dose, administration protocols, and intraoperative imaging benefits in pediatric hepatobiliary operations are not clear. OBJECTIVES This study aimed to identify the feasibility and applications of ICG FGS in hepatobiliary surgeries (for biliary atresia, choledochal cyst, and cholelithiasis) in children. METHODS This is a prospective observational study conducted from January 2021 to December 2022. A standard ICG dose of 0.5 mg/kg/dose was administered intravenously to children undergoing operations for biliary atresia (18-24 hours), choledochal cyst (12-18 hours), and cholelithiasis (2-6 hours) before the operation. Intraoperative imaging features and adverse events were recorded. RESULTS ICG FGS was performed in 17 patients. In biliary atresia (n = 9), liver fluorescence varied in each case, the gallbladder did not show fluorescence, and there was increasing fluorescence as we reached the right depth during the excision of fibrous biliary remnants. In choledochal cyst (n = 6) operations and cholecystectomy (n = 2), real-time imaging provided anatomical details of the biliary tree and helped in safe dissection. No ICG-related adverse events occurred. CONCLUSION ICG FGS appears safe, feasible, and beneficial in pediatric hepatobiliary surgeries. For conditions like biliary atresia, choledochal cysts, and cholecystectomy, ICG facilitates safer surgical navigation and may reduce intraoperative complications. Future studies with standardized protocols and quantitative fluorescence assessment are needed to further refine its use and confirm its impact on surgical outcomes.
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Affiliation(s)
- Jayakumar T K
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Kirtikumar Jagdish Rathod
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Manish Pathak
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Avinash S Jadhav
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Shubhalaxmi Nayak
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Vaibhav Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Subhash Chandra Soni
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
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Sinha A, Mattson A, Njere I, Sinha CK. Comparison of laparoscopic cholecystectomy in children at paediatric centres and adult centres: a systematic review and meta-analysis. Ann R Coll Surg Engl 2025; 107:98-105. [PMID: 38445605 PMCID: PMC11785448 DOI: 10.1308/rcsann.2023.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Paediatric laparoscopic cholecystectomy (LC) is performed by both paediatric and adult surgeons. The aim of this review was to compare outcomes at paediatric centres (PCs) and adult centres (ACs). METHODS A literature search was conducted, in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, for papers published between January 2000 and December 2020. Statistical analysis was performed using Stata® version 16 (StataCorp, College Station, TX, US). RESULTS A total of 92 studies involving 74,852 paediatric LCs met the inclusion criteria. Over half (59%) of the LCs were performed at ACs. No significant differences were noted in the male-to-female ratio, mean age or mean body mass index between PCs and ACs. The main indications were cholelithiasis (34.1% vs 34.4% respectively, p=0.83) and biliary dyskinesia (17.0% vs 23.5% respectively, p<0.01). There was no significant difference in the median inpatient stay (2.52 vs 2.44 days respectively, p=0.89). Bile duct injury was a major complication (0.80% vs 0.37% respectively, p<0.01). Reoperation rates (2.37% vs 0.74% respectively, p<0.01) and conversion to open surgery (1.97% vs 4.74% respectively, p<0.01) were also significantly different. Meta-analysis showed no significant difference in overall complications (p=0.92). CONCLUSIONS The number of LCs performed, intraoperative cholangiography use and conversion rates were higher at ACs whereas bile duct injury and reoperation rates were higher at PCs. Despite a higher incidence of bile duct injury at PCs, the incidence at both PCs and ACs was <1%. In complex cases, a joint operation by both paediatric and adult surgeons might be a better approach to further improve outcomes. Overall, LC was found to be a safe operation with comparable outcomes at PCs and ACs.
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Affiliation(s)
- A Sinha
- East and North Hertfordshire NHS Trust, UK
| | - A Mattson
- St George’s University Hospitals NHS Foundation Trust, UK
| | - I Njere
- Royal Devon University Healthcare NHS Foundation Trust, UK
| | - CK Sinha
- St George’s University Hospitals NHS Foundation Trust, UK
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Mansor S, Zaidi A, Habibullah M, Hourani R, Aldali Y, Ghali MS, Dawdi S, Suliman I, Alobahi M, Jarboa L, Valiyapurayil M, Zarour A. Early Laparoscopic Cholecystectomy for Acute Cholecystitis. When Do Risks Seem Imminent? Asian J Endosc Surg 2025; 18:e70052. [PMID: 40328432 PMCID: PMC12055317 DOI: 10.1111/ases.70052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 03/05/2025] [Accepted: 03/20/2025] [Indexed: 05/08/2025]
Abstract
INTRODUCTION Surgery for acute cholecystitis is time-critical; the timing of laparoscopic cholecystectomy in acute cholecystitis patients has historically been controversial because of a perceived increased risk of complications. The aim is to evaluate the impact of operative timing within 7 days of symptom onset on patient outcomes. METHOD A retrospective cohort study of patients who underwent laparoscopic cholecystectomy within 7 days after being admitted for acute cholecystitis between January 2016 and December 2021 in the Acute Care Surgery section. The study was conducted by dividing the study population into seven groups based on the operation day for each patient to evaluate the impact of operative timing on postoperative outcomes and compare the clinical results to determine how long the operation will be safe. RESULTS Within the study period, 3299 acute cholecystitis patients underwent laparoscopic cholecystectomy. The mean age was 42.4 years, with 50.1% of them being women and 49.9% of them being men. The rate of patients older than 65 years was 6.2%. A total of 237 patients (7.18%) had complications; the conversion to open surgery occurred in 27 patients (0.8%); and the overall reoperation rate was 0.5% (17 patients). CONCLUSION Our study shows that delays in laparoscopic cholecystectomy scheduling for acute cholecystitis after 3 days from the onset of symptoms can lead to a longer operative duration as well as a longer hospital stay. However, it does not significantly impact overall complications and reoperation rates, allowing a feasible and safe procedure to be performed within 7 days.
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Affiliation(s)
- Salah Mansor
- Acute Care Surgery SectionHamad General Hospital, HMCDohaQatar
- General Surgery DepartmentAl‐Jalla Teaching Hospital, Benghazi UniversityBenghaziLibya
| | - Amine Zaidi
- College of MedicineQatar UniversityDohaQatar
| | | | | | | | - Mohamed Said Ghali
- Acute Care Surgery SectionHamad General Hospital, HMCDohaQatar
- General Surgery DepartmentAin Shams UniversityCairoEgypt
| | | | - Idress Suliman
- Acute Care Surgery SectionHamad General Hospital, HMCDohaQatar
| | - Mohammed Alobahi
- Acute Care Surgery SectionHamad General Hospital, HMCDohaQatar
- College of MedicineQatar UniversityDohaQatar
| | - Lutfi Jarboa
- Acute Care Surgery SectionHamad General Hospital, HMCDohaQatar
| | | | - Ahmad Zarour
- Acute Care Surgery SectionHamad General Hospital, HMCDohaQatar
- College of MedicineQatar UniversityDohaQatar
- Weill Cornell Medical CollegeDohaQatar
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Koh YX, Zhao Y, Tan IEH, Tan HL, Chua DW, Loh WL, Tan EK, Teo JY, Au MKH, Goh BKP. Optimal treatment strategies for gallbladder disease in pregnancy: a systematic review with dual network meta-analyses. Surg Endosc 2024; 38:7011-7023. [PMID: 39406972 DOI: 10.1007/s00464-024-11336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 10/02/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND This study sought to determine the optimal treatment strategy and timing for cholecystectomy in managing gallbladder diseases during pregnancy. It evaluated the effectiveness of conservative management (CM), laparoscopic cholecystectomy (LC), and open cholecystectomy (OC) in pregnancy and compared cholecystectomy outcomes across three trimesters. METHODS Studies comparing CM, LC, and OC or evaluating cholecystectomy outcomes across trimesters were included in a literature search until February 2024. Studies included were required to have at least 10 cases per treatment group and perform statistical comparisons. Two Bayesian network meta-analyses (NMAs) were conducted, and surface under cumulative ranking area (SUCRA) values, risk ratio (RR), mean difference (MD), and 95% credible intervals (CrIs) were calculated for outcomes of interest. RESULTS Our study included 17 studies with 63,523 pregnant patients. The first NMA included data from 12 studies involving 29,052 pregnant women, revealing that LC had the lowest risk for preterm delivery, significantly lower than CM (RR: 0.23, 95% CrI: 0.07-0.55). LC also had a significantly reduced risk of fetal complications (RR: 0.42, 95% CrI: 0.16-0.57) and maternal complications (RR: 0.44, 95% CrI: 0.15-0.50) compared to OC. LC was associated with a significantly shorter length of stay than OC (MD: -2.77, 95% CrI: -8.37 to -2.87). The second NMA analyzed data from five population-based studies with 34,471 pregnant patients, finding no significant differences in preterm delivery and abortion rates across the three trimesters following cholecystectomy. Cholecystectomy performed in the third trimester significantly increased the risk of maternal complications, with relative risks compared to first (RR: 0.48, 95% CrI: 0.22-1.00) and second trimesters (RR: 0.42, 95% CrI: 0.21-0.93). CONCLUSIONS LC is deemed the optimal treatment for gallbladder diseases during pregnancy. While cholecystectomy is safe to be performed across all trimesters, careful deliberation is recommended during the third trimester due to an increased risk of maternal complications.
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Affiliation(s)
- Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, Singapore, 169856, Singapore.
- Duke-National University of Singapore Medical School, Singapore, Singapore.
- Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore, Singapore.
| | - Yun Zhao
- Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore
| | - Ivan En-Howe Tan
- Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore
| | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Darren Weiquan Chua
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore, Singapore
| | - Wei-Liang Loh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Ek Khoon Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore, Singapore
| | - Jin Yao Teo
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Marianne Kit Har Au
- Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore
- Finance, SingHealth Community Hospitals, Singapore, 168582, Singapore
- Finance, Regional Health System & Strategic Finance, Singapore Health Services, Singapore, 168582, Singapore
| | - Brian Kim Poh Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore, Singapore
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11
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Wael M, Seif M, Mourad M, Altabbaa H, Ibrahim IM, Elkeleny MR. Early Versus Delayed Laparoscopic Cholecystectomy, after Percutaneous Gall Bladder Drainage, for Grade II Acute Cholecystitis TG18 in Patients with Concomitant Cardiopulmonary Disease. J Laparoendosc Adv Surg Tech A 2024; 34:1069-1078. [PMID: 39234751 DOI: 10.1089/lap.2024.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
Background: The advancement in medical care has led to an increase in patients with acute cholecystitis (AC) and cardiopulmonary comorbidities referred for surgery. Grade II AC, according to Tokyo Guidelines in 2018 (TG18), is characterized by severe local inflammation with no systemic affection. The optimal treatment for patients with high-risk grade II AC has not yet been clearly established, which is still a dilemma. For these patients, laparoscopic cholecystectomy (LC), despite being the only definitive treatment, is still a challenge. The introduction of percutaneous cholecystostomy as a temporary minimally invasive alternative technique allows an immediate gallbladder decompression with a rapid clinical improvement. However, the next step after percutaneous transhepatic gall bladder drainage (PTGBD) in these high-risk patients is still a debate, with no definitive consensus about the ideal treatment of choice as well as its optimal timing. In our study, we followed a treatment algorithm for high-risk patients that involved early gallbladder decompression by PTGBD, followed by LC at different intervals once the patient is considered fit for surgery. Method: A retrospective study of 58 patients with high-risk grade II AC with cardiopulmonary comorbidity from our medical records was included. They were managed initially with PTGBD, an LC was then performed either within 7 days after drain insertion (early group, 26 patients), while an LC was performed later for the remaining patients within 6-8 weeks after PTGBD (late group, 32 patients). The results of the two groups were analyzed. Result: Procalcitonin and C-reactive protein were significantly higher in the late group. No significant difference was found between both groups with regard to operative time, PTGBD-related complications, and major perioperative complications. Timing after PTGBD did not affect the incidence of operative complications. Total hospital stay was significantly shorter in the early group. Conclusion: PTGBD is a safe initial intervention for high-risk patients with AC with a low morbidity and high success rate. Urgent LC after PTGBD can be performed safely for well-selected high-risk patients with the timing of surgery is personalized according to each patient's clinical situation. Early LC (after PTGBD) has the advantage of shorter hospital stay, low cost, as well as avoiding the risk of biliary complications and mortality if waiting a delayed surgery with no significant difference in morbidity compared with late LC.
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Affiliation(s)
- Mohamed Wael
- Liver and GIT unit, Alexandria University Main Hospital, Alexandria, Egypt
- Alexandria University, Alexandria, Egypt
| | - Mostafa Seif
- Liver and GIT unit, Alexandria University Main Hospital, Alexandria, Egypt
- Alexandria University, Alexandria, Egypt
| | - Mohamed Mourad
- Liver and GIT unit, Alexandria University Main Hospital, Alexandria, Egypt
- Alexandria University, Alexandria, Egypt
| | | | - Ibrahim Mabrouk Ibrahim
- Liver and GIT unit, Alexandria University Main Hospital, Alexandria, Egypt
- Alexandria University, Alexandria, Egypt
| | - Mostafa Refaie Elkeleny
- Liver and GIT unit, Alexandria University Main Hospital, Alexandria, Egypt
- Alexandria University, Alexandria, Egypt
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12
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Hamaoka M, Kitamura Y, Shinohara M, Hashimoto M, Miguchi M, Misumi T, Fujikuni N, Ikeda S, Matsugu Y, Nakahara H. Surgical outcomes of patients with acute cholecystitis treated with gallbladder drainage followed by early cholecystectomy. Asian J Surg 2024; 47:4706-4710. [PMID: 38824020 DOI: 10.1016/j.asjsur.2024.05.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
AIM This study aimed to investigate the impact of preoperative gallbladder drainage and the specific drainage method used on surgical outcomes in patients undergoing surgery for acute cholecystitis. METHODS This single-center retrospective cohort study included 221 patients who underwent early cholecystectomy between January 2016 and December 2020. Clinical data and outcomes of 140 patients who did not undergo drainage, 22 patients who underwent preoperative percutaneous transhepatic gallbladder drainage (PTGBD), and 59 patients who underwent preoperative endoscopic naso-gallbladder drainage (ENGBD) were compared. RESULTS There was no difference in the operation time, blood loss, postoperative complications, or length of postoperative hospital stay between patients who did and did not undergo drainage. Among patients who underwent drainage, there was no difference between the ENGBD and PTGBD groups in operation time, blood loss, or postoperative complications; however, more patients in the PTGBD group underwent laparotomy and had a significantly longer postoperative hospital stay. The presence and type of drainage were not risk factors for postoperative complications. CONCLUSION The presence or absence of preoperative gallbladder drainage for acute cholecystitis and the type of drainage may not significantly affect surgical outcomes.
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Affiliation(s)
- Michinori Hamaoka
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan.
| | - Yoshihito Kitamura
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Makoto Shinohara
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Masakazu Hashimoto
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Masashi Miguchi
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Toshihiro Misumi
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Nobuaki Fujikuni
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Satoshi Ikeda
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Yasuhiro Matsugu
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Hideki Nakahara
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
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13
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Toppo S, Gaurav K, Kumar K, Kumar K, Verma S, Tudoo ST, Mehta MK, A P. Assessment of Predictors of Difficult Laparoscopic Cholecystectomy by Clinico-Radiological Parameters at a Tertiary Hospital in Eastern India. Cureus 2024; 16:e72512. [PMID: 39606514 PMCID: PMC11599633 DOI: 10.7759/cureus.72512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy has become the standard treatment for gallbladder (GB) stones, favored for its minimally invasive approach. Despite its benefits, the procedure sometimes requires conversion to open cholecystectomy due to intra-operative challenges, with conversion rates varying between 1% and 13%. There are various preoperative predictors that help in identifying such difficult cases and help to proceed safely. This study aims to identify the preoperative factors that could predict the difficulty of laparoscopic cholecystectomy, thus anticipating the need for conversion to open surgery. METHODS A prospective observational study was conducted at RIMS Ranchi, India, from May 2023 to May 2024, including a total of 93 patients with gallstone disease who underwent laparoscopic cholecystectomy. Clinical history including age, gender, presence of acute cholecystitis, previous attacks, and previous upper abdominal surgery; biochemical markers including white blood cell (WBC) count, total bilirubin and alkaline phosphatase (ALP), and ultrasonographic findings such as GB wall thickness, stone impacted at the neck of GB, contracted or distended GB, presence of pericholecystic fluid collection, Mirizzi's syndrome and others were analyzed to identify predictors of conversion. RESULTS Of the 93 patients included in our study, there were 28 males and 65 females with a ratio of 1:2.3. The age group varied from 14 to 72 years with conversion to open cholecystectomy seen between the age group of 31-70 (mean age 49 years). We observed that 10 patients (conversion rate of 10.75%) underwent conversion from laparoscopic to open cholecystectomy. Significant predictors included acute cholecystitis, multiple previous attacks, and ultrasonographic findings of contracted GB. CONCLUSION Preoperative identification of patients at higher risk for conversion can enhance surgical planning and patient counseling, potentially improving outcomes in laparoscopic cholecystectomy.
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Affiliation(s)
- Samir Toppo
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Kumar Gaurav
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Kamlesh Kumar
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Krishan Kumar
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Sanjana Verma
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Sunil T Tudoo
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Muklesh K Mehta
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Praveenkumar A
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
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14
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Fujinaga A, Hirashita T, Endo Y, Orimoto H, Amano S, Kawamura M, Kawasaki T, Masuda T, Inomata M. Prediction of intraoperative surgical difficulty during laparoscopic cholecystectomy using drip infusion cholangiography with computed tomography. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:637-646. [PMID: 39021321 DOI: 10.1002/jhbp.12044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Although findings from drip infusion cholangiography with computed tomography (DIC-CT) are useful in preoperative anatomic evaluation for laparoscopic cholecystectomy (LC), their relationship with intraoperative surgical difficulty based on the difficulty score (DS) proposed by Tokyo Guidelines 2018 is unclear. We examined this relationship. METHODS Data were collected from 202 patients who underwent LC for benign gallbladder (GB) disease with preoperative DIC-CT in our department. DIC-CT findings were classified into GB-positive and GB-negative groups based on GB opacification, and clinical characteristics were compared. DS assessed only on findings from around Calot's triangle was considered "cDS", and patients were divided into cDS ≤2 and ≥3 groups. Preoperative data including DIC-CT findings were evaluated using multivariate analysis. RESULTS DIC-CT findings showed 151 (74.8%) GB-positive and 51 (25.2%) GB-negative patients. Surgical outcomes were significantly better in the GB-positive versus GB-negative group for operation time (107 vs. 154 min, p < .001), blood loss (8 vs. 25 mL, p < .001), cDS (0.8 vs. 2.2, p < .001), and critical view of safety score (4.0 vs. 3.1, p < .001). cDS was ≤2 in 174 (86.1%) and ≥3 in 28 (13.9%) patients. By multivariate analysis, DIC-CT findings and alkaline phosphatase values were independent factors predicting intraoperative difficulty. CONCLUSION DIC-CT findings are useful for predicting cDS in LC.
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Affiliation(s)
- Atsuro Fujinaga
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hiroki Orimoto
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Shota Amano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
- Department of Diagnostic Pathology, Oita University Faculty of Medicine, Oita, Japan
| | - Masahiro Kawamura
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takahide Kawasaki
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takashi Masuda
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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15
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Killoran CB, de Costa A. Can open cholecystectomy be taught by cadaveric simulation? ANZ J Surg 2024; 94:1051-1055. [PMID: 38716495 DOI: 10.1111/ans.19025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the current standard of treatment for surgical gallbladder removal as it has an overall improved post-operative recovery compared to Open Cholecystectomy (OC). This has resulted in the loss of exposure to surgical trainees and the associated technical skills and decision-making required to convert to OC. The aim of this study is to provide construct validity to the proposition that cadaveric simulation can be used successfully to teach and learn open cholecystectomy. METHODS Participants (n = 25) were surveyed on a 9-point questionnaire using a 5-point Likert scale to determine their opinion on cadaveric simulation as a tool for teaching OC. RESULTS Overall respondents deemed the tool as highly translatable. There was no significant correlation in the responses between candidates versus tutors (P = 0.05, r = 0.51). CONCLUSIONS The outcome of the survey revealed that participants agreed that cadaveric simulation is a positive learning tool to aid in OC.
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Affiliation(s)
- Callie Breanne Killoran
- Department of Surgery, James Cook University College of Medicine and Dentistry, Surgery, Cairns Clinical School, Cairns, Queensland, Australia
| | - Alan de Costa
- Department of Surgery, James Cook University College of Medicine and Dentistry, Surgery, Cairns Clinical School, Cairns, Queensland, Australia
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16
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Wang S, Yuan W, Yu A, Gu W, Wang T, Zhang C, Zhang C. Efficacy of different indocyanine green doses in fluorescent laparoscopic cholecystectomy: A prospective, randomized, double-blind trial. J Surg Oncol 2024; 129:1534-1541. [PMID: 38736301 DOI: 10.1002/jso.27684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND AND OBJECTIVES Intraoperative bile duct injury is a significant complication in laparoscopic cholecystectomy (LC). Near-infrared fluorescence cholangiography (NIFC) can reduce this complication. Therefore, determining the optimal indocyanine green (ICG) dosage for effective NIFC is crucial. This study aimed to determine the optimal ICG dosage for NIFC. METHODS This was a prospective, randomized, double-blind clinical trial at a single tertiary referral center, including 195 patients randomly assigned to three groups: lower dose (0.01 mg/BMI) ICG (n = 63), medium dose (0.02 mg/BMI) ICG (n = 68), and higher dose (0.04 mg/BMI) ICG (n = 64). Surgeon satisfaction and detection rates for seven biliary structures were compared among the three dose groups. RESULTS Demographic parameters did not significantly differ among the groups. The medium dose (72.1%) and higher dose ICG groups (70.3%) exhibited superior visualization of the common hepatic duct compared to the lower dose group (41.3%) (p < 0.001). No differences existed between the medium and higher dose groups. Similar trends were observed for the common bile duct and cystic common bile duct junction. CONCLUSIONS In patients undergoing fluorescent laparoscopic cholecystectomy, the 0.02 mg/BMI dose of indocyanine green demonstrated better biliary structure detection rates than the 0.01 mg/BMI dose and was non-inferior to the 0.04 mg/BMI dose.
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Affiliation(s)
- Siyu Wang
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenkang Yuan
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Anhai Yu
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wang Gu
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianqi Wang
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chong Zhang
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chao Zhang
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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17
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Kobayashi S, Nakahara K, Umezawa S, Ida K, Tsuchihashi A, Koizumi S, Sato J, Tateishi K, Otsubo T. Elective Cholecystectomy After Endoscopic Gallbladder Stenting for Acute Cholecystitis: A Propensity Score Matching Analysis. Surg Laparosc Endosc Percutan Tech 2024; 34:171-177. [PMID: 38260964 DOI: 10.1097/sle.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/04/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To investigate the influence of endoscopic gallbladder stenting (EGBS) on subsequent cholecystectomy. We retrospectively compared the surgical outcomes of EGBS, followed by elective cholecystectomy with those of immediate cholecystectomy (IC). PATIENTS AND METHODS A total of 503 patients were included in this study. Patients who underwent EGBS as initial treatment for acute cholecystitis, followed by elective cholecystectomy, were included in the EGBS group and patients who underwent IC during hospitalization were included in the IC group. Propensity score matching analysis was used to compare the surgical outcomes. In addition, the factors that increased the amount of bleeding were examined by multivariate analysis after matching. RESULTS Fifty-seven matched pairs were obtained after propensity matching the EGBS group and the IC group. The rate of laparoscopic cholecystectomy in the EGBS versus IC groups was 91.2% versus 49.1% ( P < 0.001). The amount of bleeding was 5 mL in the EGBS versus 188 mL in the IC group ( P < 0.001). In the EGBS and IC groups, multivariate analysis of factors associated with more blood loss revealed IC (odds ratio: 4.76, 95% CI: 1.25-20.76, P = 0.022) as an independent risk factor. CONCLUSION EGBS as the initial treatment for acute cholecystitis and subsequent elective cholecystectomy after the inflammation has disappeared can be performed in minimally invasive procedures and safely.
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Affiliation(s)
- Shinjiro Kobayashi
- Department of Gastroenterological and General Surgery, School of Medicine, St. Marianna University, Kanagawa
| | - Kazunari Nakahara
- Department of Gastroenterology, School of Medicine, St. Marianna University, Kawasaki, Japan
| | - Saori Umezawa
- Department of Gastroenterological and General Surgery, School of Medicine, St. Marianna University, Kanagawa
| | - Keisuke Ida
- Department of Gastroenterological and General Surgery, School of Medicine, St. Marianna University, Kanagawa
| | - Atsuhito Tsuchihashi
- Department of Gastroenterological and General Surgery, School of Medicine, St. Marianna University, Kanagawa
| | - Satoshi Koizumi
- Department of Gastroenterological and General Surgery, School of Medicine, St. Marianna University, Kanagawa
| | - Junya Sato
- Department of Gastroenterology, School of Medicine, St. Marianna University, Kawasaki, Japan
| | - Keisuke Tateishi
- Department of Gastroenterology, School of Medicine, St. Marianna University, Kawasaki, Japan
| | - Takehito Otsubo
- Department of Gastroenterological and General Surgery, School of Medicine, St. Marianna University, Kanagawa
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18
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Fehlmann CA, Taljaard M, McIsaac DI, Suppan L, Andereggen E, Dupuis A, Rouyer F, Eagles D, Perry JJ. Incidence and outcomes of emergency department patients requiring emergency general surgery: a 5-year retrospective cohort study. Swiss Med Wkly 2024; 154:3729. [PMID: 38642364 DOI: 10.57187/s.3729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
AIMS Patients undergoing emergency general surgery are at high risk of complications and death. Our objectives were to estimate the incidence of emergency general surgery in a Swiss University Hospital, to describe the characteristics and outcomes of patients undergoing such procedures, and to study the impact of age on clinical outcomes. METHODS This was a retrospective cohort study of adult patients who visited the emergency department (ED) of Geneva University Hospitals between January 2015 and December 2019. Routinely collected data were extracted from electronic medical records. The primary outcome was the incidence of emergency general surgery among patients visiting the emergency department, defined as general surgery within three days of emergency department admission. We also assessed demographic characteristics, mortality, intensive care unit admission and patient disposition. Multivariable log-binomial regression was used to study the associations of age with intensive care unit (ICU) admission, one-year mortality and dependence at discharge. Age was modelled as a continuous variable using restricted cubic splines and we compared older patients (75th percentile) with younger patients (25th percentile). RESULTS Between January 2015 and December 2019, a total of 310,914 emergency department visits met our inclusion criteria. Among them, 3592 patients underwent emergency general surgery within 3 days of emergency department admission, yielding an annual incidence of 116 events per 10,000 emergency department visits (95% CI: 112-119), with a higher incidence in females and young patients. Overall, 5.3% of patients were admitted to ICU, 7.8% were dependent on rehabilitation or assisted living at discharge and 4.8% were dead after one year. Older patients had a higher risk of ICU admission (adjusted risk ratio (aRR) 2.9 [1.5-5.4]), dependence at discharge (aRR 15.3 [5.5-42.4]) and one-year mortality (aRR 5.4 [2.2-13.4]). CONCLUSION Emergency department visits resulting in emergency general surgery are frequent, but their incidence decreases with patient age. Mortality, ICU admission and dependence at discharge following emergency general surgery are more frequent in older patients. Taking into account the increased risk for older patients, a shared process is appropriate for making more informed decisions about their options for care.
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Affiliation(s)
- Christophe A Fehlmann
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Laurent Suppan
- Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Elisabeth Andereggen
- Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of General Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Arnaud Dupuis
- Department of General Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Frederic Rouyer
- Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Debra Eagles
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey J Perry
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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19
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Esposito C, Rathod KJ, Cerulo M, Del Conte F, Saxena R, Coppola V, Sinha A, Esposito G, Escolino M. Indocyanine green fluorescent cholangiography: The new standard practice to perform laparoscopic cholecystectomy in pediatric patients. A comparative study with conventional laparoscopic technique. Surgery 2024; 175:498-504. [PMID: 38007385 DOI: 10.1016/j.surg.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/01/2023] [Accepted: 10/25/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND This study aimed to compare outcomes of standard laparoscopic cholecystectomy and indocyanine green fluorescent cholangiography laparoscopic cholecystectomy over a 10-year period. METHODS From 2013 to 2023, 173 laparoscopic cholecystectomies were performed in 2 pediatric surgery units: 83 using standard technique (G1) and 90 using indocyanine green fluorescent cholangiography (G2). Patients included 96 girls and 77 boys, with a median age of 12.3 years (range 4-17) and a median weight of 51 kg (range 19-114). The 2 groups were compared regarding the following: (1) perioperative complications rate; (2) overall length of surgery (T1); (3) length of cystic duct isolation, clipping, and sectioning (T2); (4) time of gallbladder removal (T3); (5) degree of visualization of biliary tree; (6) safety and feasibility of indocyanine green fluorescent cholangiography; (7) incidence of anatomical anomalies detected intraoperatively. RESULTS All laparoscopic cholecystectomies were accomplished without conversion to open. The perioperative complications rate was significantly higher in G1 compared with G2 (12% vs 0%; P = .0007). Median T1, T2, and T3 were significantly longer in G1 (90, 37, 35 minutes) compared with G2 (55, 17, 19 minutes) (P = .0001), respectively. The visualization rate of the complete biliary tree was significantly higher in G2 (98.8%) than in G1 (80.7%) (P = .0001). No adverse reactions to indocyanine green were recorded. The incidence of biliary anomalies detected intraoperatively was significantly higher in G2 (7.8%) than in G1 (1.2%) (P = .03). CONCLUSION Indocyanine green fluorescent cholangiography can be considered the new standard practice to perform laparoscopic cholecystectomy in pediatrics. Indocyanine green fluorescence provided superior visualization of biliary anatomy, increased detection of anatomic variants, faster procedure, and fewer complications compared with conventional technique. Indocyanine green fluorescent cholangiography was safe, feasible, simple, inexpensive, and a timesaving tool.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy.
| | - Kirtikumar J Rathod
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mariapina Cerulo
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Fulvia Del Conte
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vincenzo Coppola
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Maria Escolino
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
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Lombardi PM, Mazzola M, Veronesi V, Granieri S, Cioffi SPB, Baia M, Del Prete L, Bernasconi DP, Danelli P, Ferrari G. Learning curve of laparoscopic cholecystectomy: a risk-adjusted cumulative summation (RA-CUSUM) analysis of six general surgery residents. Surg Endosc 2023; 37:8133-8143. [PMID: 37684403 DOI: 10.1007/s00464-023-10345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/30/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LapC) is one of the most frequently performed surgical procedures worldwide. Reaching technical competency in performing LapC is considered one essential task for young surgeons. Investigating the learning curve for LapC (LC-LapC) may provide important information regarding the learning process and guide the training pathway of residents, improving educational outcomes. The present study aimed to investigate LC-LapC among general surgery residents (GSRs). METHODS Operative surgical reports of consecutive patients undergoing LapC performed by GSRs attending the General Surgery Residency Program at the University of Milan were analysed. Data on patient- and surgery-related variables were obtained from the ICD-9-CM diagnosis codes and gathered. A multidimensional assessment of the LC was performed through Cumulative Sum (CUSUM) and Risk-Adjusted (RA)-CUSUM analysis. RESULTS 340 patients operated by 6 GSRs were collected. The CUSUM and RA-CUSUM graphs based on surgical failures allowed to distinguish two defined phases for all GSRs: an initial phase ending at the peak, so-called learning phase, followed by a phase in which there was a significant decrease in failure incidence, so-called proficiency phase. The learning phase was completed for all GSRs at most within 25 procedures, but the trend of the curves and the number of procedures needed to achieve technical competency varied among operators ranging between 7 and 25. CONCLUSIONS The present study suggested that at most 25 procedures might be sufficient to acquire technical competency in LapC. The variability in the number of procedures needed to complete the LC, ranging between 7 and 25, could be due to the heterogeneous scenarios in which LapC was performed, and deserves to be investigated through a prospective study involving a larger number of GSRs and institutions.
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Affiliation(s)
- Pietro Maria Lombardi
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Valentina Veronesi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Marco Baia
- Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Luca Del Prete
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico di Milan - General Surgery and Transplant Unit, Milan, Italy
- University of Milan - Translational Medicine PhD Program, Milan, Italy
| | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Functional Department for Higher Education, Research, and Development, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Piergiorgio Danelli
- Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Via Giovanni Battista Grassi 74, 20157, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
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21
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Tranter-Entwistle I, Simcock C, Eglinton T, Connor S. Prospective cohort study of operative outcomes in laparoscopic cholecystectomy using operative difficulty grade-adjusted CUSUM analysis. Br J Surg 2023; 110:1068-1071. [PMID: 36882185 PMCID: PMC10416680 DOI: 10.1093/bjs/znad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 03/09/2023]
Affiliation(s)
| | - Corin Simcock
- Department of Surgery, The University of Otago Medical School, Christchurch, New Zealand
| | - Tim Eglinton
- Department of Surgery, The University of Otago Medical School, Christchurch, New Zealand
- Department of General Surgery, Christchurch Hospital, CDHB, Christchurch, New Zealand
| | - Saxon Connor
- Department of General Surgery, Christchurch Hospital, CDHB, Christchurch, New Zealand
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22
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Porras Fimbres DC, Nussbaum DP, Mosca PJ. Racial disparities in time to laparoscopic cholecystectomy for acute cholecystitis. Am J Surg 2023; 226:261-270. [PMID: 37149406 DOI: 10.1016/j.amjsurg.2023.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/25/2023] [Accepted: 05/02/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Disparities in healthcare exist, yet few data are available on racial differences in time from admission to surgery. This study aimed to compare time from admission to laparoscopic cholecystectomy for acute cholecystitis between non-Hispanic Black and non-Hispanic White patients. METHODS Patients who underwent laparoscopic cholecystectomy for acute cholecystitis from 2010 to 2020 were identified using NSQIP. Time to surgery and additional preoperative, operative, and postoperative variables were analyzed. RESULTS In the univariate analysis, 19.4% of Black patients experienced a time to surgery >1 day compared with 13.4% of White patients (p < 0.0001). In the multivariable analysis, controlling for potential confounding factors, Black patients were found to be more likely than White patients to experience a time to surgery >1 day (OR 1.23, 95% CI 1.17-1.30, p < 0.0001). CONCLUSIONS Further investigation is indicated to better define the nature and significance of gender, race, and other biases in surgical care. Surgeons should be aware that biases may adversely impact patient care and should strive to identify and proactively address them to promote health equity in surgery.
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Affiliation(s)
| | - Daniel P Nussbaum
- Duke University School of Medicine, Duke University Health System, Durham, NC, USA; Department of Surgery, Duke University School of Medicine, Duke University Health System, Durham, NC, USA; Duke Network Services, Duke University Health System, Durham, NC, USA
| | - Paul J Mosca
- Duke University School of Medicine, Duke University Health System, Durham, NC, USA; Department of Surgery, Duke University School of Medicine, Duke University Health System, Durham, NC, USA; Duke Network Services, Duke University Health System, Durham, NC, USA.
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23
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Naito S, Kajiwara M, Nakashima R, Sasaki T, Hasegawa S. The Safety of Laparoscopic Cholecystectomy in Super-elderly Patients: A Propensity Score Matching Analysis. Cureus 2023; 15:e42097. [PMID: 37602119 PMCID: PMC10438169 DOI: 10.7759/cureus.42097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Although reports on the safety of laparoscopic cholecystectomy (LC) exist, few have included patients aged ≥ 85 years. Hence, our study aimed to evaluate surgical outcomes of LC in patients aged ≥ 85 years. METHODS After excluding patients who underwent other types of surgeries, 583 patients who underwent LC between 2015 and 2022 were included. Patients were classified into two groups based on age: < 85 years (control group, n = 551) and ≥ 85 years (super-elderly group, n = 32). Propensity score matching (PSM) was performed based on preoperative clinical parameters, and intraoperative and postoperative outcomes were compared. RESULTS After PSM, 28 patients were included in each group. Intraoperative blood loss (1 vs. 5 mL, respectively; P = .052) and frequency of serious postoperative complications (Clavien-Dindo class ≥ 2, 2/28 (7.1%) vs. 6/28 (21.4%), P = .252) were similar between the control and elderly groups. There was no significant difference in the length of postoperative stay (control group: 5 (4-24) days vs. super-elderly group: 7 (3-64) days, P = .236). Unfortunately, one case of pneumonia of unknown cause occurred postoperatively, resulting in the death of one patient in the super-elderly group. CONCLUSIONS There were no clinically significant differences in the short-term outcomes of LC between super-elderly patients aged ≥ 85 years and patients aged < 85 years. Hence, LC may be relatively safe even in patients aged ≥ 85 years. However, owing to many pre-existing diseases and deterioration of physiological function, careful management during the perioperative period is desirable.
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Affiliation(s)
- Shigetoshi Naito
- Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, JPN
| | | | - Ryo Nakashima
- Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, JPN
| | - Takahide Sasaki
- Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, JPN
| | - Suguru Hasegawa
- Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, JPN
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24
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Study Management Group, Varghese C, McGuinness M, Wells CI, Elliott BM, Gunawardene A, Edwards M, Expert Advisory Group, Vohra R, Griffiths EA, Connor S, Poole GH, Windsor JA, Wright D, Harmston C, Collaborating Authors, Wang JHS, Windsor J, Chen E, Ghate K, Lal S, Lekamalage B, Ratnayake M, Bansal A, Windsor J, von Keisenberg S, Hemachandran A, Singhal M, Joseph N, Bhat S, Rossaak J, Carson D, Dubey N, Pan M, Ferguson L, Watt I, Choi J, Mclauchlan J, Connor S, Nicholas E, Al-Busaidi I, Wood D, Haran C, Lin A, Fagan P, Bathgate A, Patel S, Mak J, Espiner E, Poole G, Hassan S, Javed Z, Randall M, Clough S, Cook W, Clark S, Finlayson C, Poole G, Bahl P, Singh S, Lin C, Wang C, Kittaka R, Morreau M, Ing A, Logan S, Guest S, Sutherland K, Lewis A, Roberts J, Watson B, Tietjens J, Teague R, Su'a B, Modi A, Modi V, Williams Y, Morreau J, Khoo C, Desmond B, Young M, Christmas R, Holm T, Harmston C, Long K, Garton B, Niki kau, Barber L, Amer M, Haddow J, Amer M, Fearnley-Fitzgerald C, Suresh K, Zeng E, Young-Gough A, Skeet J, El-Haddawi F, Alvarez M, Nguyen S, King J, et alStudy Management Group, Varghese C, McGuinness M, Wells CI, Elliott BM, Gunawardene A, Edwards M, Expert Advisory Group, Vohra R, Griffiths EA, Connor S, Poole GH, Windsor JA, Wright D, Harmston C, Collaborating Authors, Wang JHS, Windsor J, Chen E, Ghate K, Lal S, Lekamalage B, Ratnayake M, Bansal A, Windsor J, von Keisenberg S, Hemachandran A, Singhal M, Joseph N, Bhat S, Rossaak J, Carson D, Dubey N, Pan M, Ferguson L, Watt I, Choi J, Mclauchlan J, Connor S, Nicholas E, Al-Busaidi I, Wood D, Haran C, Lin A, Fagan P, Bathgate A, Patel S, Mak J, Espiner E, Poole G, Hassan S, Javed Z, Randall M, Clough S, Cook W, Clark S, Finlayson C, Poole G, Bahl P, Singh S, Lin C, Wang C, Kittaka R, Morreau M, Ing A, Logan S, Guest S, Sutherland K, Lewis A, Roberts J, Watson B, Tietjens J, Teague R, Su'a B, Modi A, Modi V, Williams Y, Morreau J, Khoo C, Desmond B, Young M, Christmas R, Holm T, Harmston C, Long K, Garton B, Niki kau, Barber L, Amer M, Haddow J, Amer M, Fearnley-Fitzgerald C, Suresh K, Zeng E, Young-Gough A, Skeet J, El-Haddawi F, Alvarez M, Nguyen S, King J, Crichton J, Welsh F, Edwards M, Tan J, Luo J, Banker K, Field X, Allan P, Rennie S, Ratnayake CB, Srinivasa S, Gloria Kim JH, Bradley S, Singh N, Kang G, Xu W, Srinivasa S, Cook H, Mistry V, Dabla K, de Oca AM, Yoganandarajah V, Lill M, Lu J, Bonnet LA, Uiyapat T. Variation in the practice of cholecystectomy for benign biliary disease in Aotearoa New Zealand: a population-based cohort study. HPB (Oxford) 2023:S1365-182X(23)00128-4. [PMID: 37198069 DOI: 10.1016/j.hpb.2023.04.011] [Show More Authors] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/26/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Cholecystectomy for benign biliary disease is common and its delivery should be standardised. However, the current practice of cholecystectomy in Aotearoa New Zealand is unknown. METHODS A prospective, national cohort study of consecutive patients having cholecystectomy for benign biliary disease was performed between August and October 2021 with 30-day follow-up, through STRATA, a student- and trainee-led collaborative. RESULTS Data were collected for 1171 patients from 16 centres. 651 (55.6%) had an acute operation at index admission, 304 (26.0%) had delayed cholecystectomy following a previous admission, and 216 (18.4%) had an elective operation with no preceding acute admissions. The median adjusted rate of index cholecystectomy (as a proportion of index and delayed cholecystectomy) was 71.9% (range 27.2%-87.3%). The median adjusted rate of elective cholecystectomy (as proportion of all cholecystectomies) was 20.8% (range 6.7%-35.4%). Variations across centres were significant (p < 0.001) and inadequately explained by patient, operative, or hospital-factors (index cholecystectomy model R2 = 25.8, elective cholecystectomy model R2 = 50.6). CONCLUSIONS Notable variation in the rates of index and elective cholecystectomy exists in Aotearoa New Zealand not attributable to patient, operative or hospital factors alone. National quality improvement efforts to standardise availability of cholecystectomy are needed.
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Sandal B, Hacioglu Y, Salihoglu Z, Yagiz N. Fuzzy Logic Preanesthetic Risk Evaluation of Laparoscopic Cholecystectomy Operations. Am Surg 2023; 89:414-423. [PMID: 34187181 DOI: 10.1177/00031348211029872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Pre-operative risk classification of patients undergoing anesthesia is an essential interest and has been the focus of many research and categorizations. On the other hand, the ideal categorization system, based on medical doctors' clinical experience and cooperation with other disciplines, has not been developed yet. METHODS In this study, 218 consecutive patient undergoing laparoscopic cholecystectomy operations were included. A novel fuzzy logic evaluation model consisting of 270 rules was constructed. Five major (pulmonary, cardiac, diabetes mellitus and renal or liver disease) and three minor criteria (patients' age, cigarette smoking and body mass index) were chosen to be used during high-risk groups determination. RESULTS The verification of the success of risk value decision with the proposed novel fuzzy logic algorithm is the main goal of this study. On the other hand, though not essential aim, a statistical consistency check was also included to have a deeper understanding and evaluation of the graphical results. During the statistical analysis the 0-30%, 30-60% and 60-90% risk ranges were found to be in a very strong positive relationship with complication occurrence. In this study, 172, 31, 15 patients were in 0-30, 30-60 and 60-90% risk ranges, respectively. Complication rates were 7/172 (4.07%) in 0-30% range, 3/31 (9.68%) in 30-60% range; and 2/15 (13.33%) in 60-90% range. CONCLUSIONS Fuzzy based risk classification model was successfully used to predict medical results for patients undergoing laparoscopic cholecystectomy operations and reliable deductions were reached.
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Affiliation(s)
- Baris Sandal
- Department of Mechanical Engineering, Faculty of Engineering, 532719Istanbul University-Cerrahpaşa, Avcilar-Istanbul, Turkey
| | - Yuksel Hacioglu
- Department of Mechanical Engineering, Faculty of Engineering, 532719Istanbul University-Cerrahpaşa, Avcilar-Istanbul, Turkey
| | - Ziya Salihoglu
- Department of Anesthesiology and Reanimation, Medical School of Cerrahpaşa, 532719Istanbul University-Cerrahpasa, Fatih-Istanbul, Turkey
| | - Nurkan Yagiz
- Department of Mechanical Engineering, Faculty of Engineering, 532719Istanbul University-Cerrahpaşa, Avcilar-Istanbul, Turkey
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26
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von Kroge PH, Duprée A, Mann O, Izbicki JR, Wagner J, Ahmadi P, Weidemann S, Adjallé R, Kröger N, Bokemeyer C, Fiedler W, Modemann F, Ghandili S. Abdominal emergency surgery in patients with hematological malignancies: a retrospective single-center analysis. World J Emerg Surg 2023; 18:12. [PMID: 36747231 PMCID: PMC9900956 DOI: 10.1186/s13017-023-00481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hematologic patients requiring abdominal emergency surgery are considered to be a high-risk population based on disease- and treatment-related immunosuppression. However, the optimal surgical therapy and perioperative management of patients with abdominal emergency surgery in patients with coexisting hematological malignancies remain unclear. METHODS We here report a single-center retrospective analysis aimed to investigate the impact of abdominal emergency surgery due to clinically suspected gastrointestinal perforation (group A), intestinal obstruction (group B), or acute cholecystitis (group C) on mortality and morbidity of patients with coexisting hematological malignancies. All patients included in this retrospective single-center study were identified by screening for the ICD 10 diagnostic codes for gastrointestinal perforation, intestinal obstruction, and ischemia and acute cholecystitis. In addition, a keyword search was performed in the database of all pathology reports in the given time frame. RESULTS A total of 56 patients were included in this study. Gastrointestinal perforation and intestinal obstruction occurred in 26 and 13 patients, respectively. Of those, 21 patients received a primary gastrointestinal anastomosis, and anastomotic leakage (AL) occurred in 33.3% and resulted in an AL-related 30-day mortality rate of 80%. The only factor associated with higher rates of AL was sepsis before surgery. In patients with suspected acute cholecystitis, postoperative bleeding events requiring abdominal packing occurred in three patients and lead to overall perioperative morbidity of 17.6% and surgery-related 30-day mortality of 5.9%. CONCLUSION In patients with known or suspected hematologic malignancies who require emergency abdominal surgery due to gastrointestinal perforation or intestinal obstruction, a temporary or permanent stoma might be preferred to a primary intestinal anastomosis.
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Affiliation(s)
- Philipp H. von Kroge
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Anna Duprée
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Oliver Mann
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jakob R. Izbicki
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jonas Wagner
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Paymon Ahmadi
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.13648.380000 0001 2180 3484Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sören Weidemann
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Raissa Adjallé
- grid.13648.380000 0001 2180 3484Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Nicolaus Kröger
- grid.13648.380000 0001 2180 3484Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Carsten Bokemeyer
- grid.13648.380000 0001 2180 3484Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Walter Fiedler
- grid.13648.380000 0001 2180 3484Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Franziska Modemann
- grid.13648.380000 0001 2180 3484Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.13648.380000 0001 2180 3484Mildred Scheel Cancer Career Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Susanne Ghandili
- grid.13648.380000 0001 2180 3484Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Matsumura M, Seyama Y, Takao M, Okinaga H, Ogawa R, Nemoto S, Tani K. Body-first approach of laparoscopic cholecystectomy for minimizing vasculobiliary injury: Initial experience. Asian J Endosc Surg 2023. [PMID: 36650019 DOI: 10.1111/ases.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Vasculobiliary injury (VBI) is a rare but critical complication of laparoscopic cholecystectomy (Lap-C). Dividing first the gallbladder body and then the gallbladder neck from the gallbladder bed (the "body-first approach") may decrease the possibility of VBI. METHODS The surgical outcome of 62 patients who underwent Lap-C with a body-first approach were evaluated. In this procedure, after serosal resection of the gallbladder, the gallbladder body is divided from the cystic plate; then the gallbladder neck and cystic duct are isolated. No connective tissue of the hepatic hilum is touched. RESULTS A total of five patients had anatomical anomalies of the biliary tract that raised concerns of cholecystectomy. Furthermore, seven patients underwent subtotal cholecystectomy. No patients required conversion to open surgery, and none developed VBI or postoperative complications of Clavien-Dindo grade 3a or worse. CONCLUSION The body-first approach may minimize the risk of VBI during Lap-C.
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Affiliation(s)
- Masaru Matsumura
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yasuji Seyama
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Mikiya Takao
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroko Okinaga
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Rei Ogawa
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Satoshi Nemoto
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Keigo Tani
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Gavriilidis P, Catena F, de'Angelis G, de'Angelis N. Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review. World J Emerg Surg 2022; 17:57. [PMID: 36324150 PMCID: PMC9632095 DOI: 10.1186/s13017-022-00456-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Complications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years. METHODS Embase, Pubmed, Medline, Google scholar and Cochrane library were systematically searched for pertinent literature. RESULTS Seventy five out of 181 articles were selected including 85 patients; of those 38% were men and 62% women. The median age of the cohort was 64 years old and ranged between 33 and 87 years. Only 23(27%) of the authors reported the incident of spillage of the gallstones during the operation. Time of onset of symptoms varied widely from the second postoperative day to 15 years later. Ten of 85 patients were asymptomatic and diagnosed with spilled gallstones incidentally. The rest of the patients presented with complications of severe morbidity and almost, 87% of the patients needed to be treated with surgical intervention and 12% with US ± CT scan guidance drainage. Only one perioperative death reported. CONCLUSIONS Symptomatic patients with lost gallstones present with severe morbidity complications and required mostly major surgical procedures. Therefore, standardisation of the management of spilled gallstones is needed urgently. Hospitals need to review their policy with audits and recommendations and clinical guidelines are needed urgently.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Surgery, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Gianluigi de'Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy.
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), University Paris Cité, Clichy, France
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Chevallay M, Liot E, Fournier I, Abbassi Z, Peloso A, Hagen ME, Mönig SP, Morel P, Toso C, Buchs N, Miskovic D, Ris F, Jung MK. Implementation and validation of a competency assessment tool for laparoscopic cholecystectomy. Surg Endosc 2022; 36:8261-8269. [PMID: 35705755 PMCID: PMC9613711 DOI: 10.1007/s00464-022-09264-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Achieving proficiency in a surgical procedure is a milestone in the career of a trainee. We introduced a competency assessment tool for laparoscopic cholecystectomy in our residency program. Our aim was to assess the inter-rater reliability of this tool. METHODS We included all laparoscopic cholecystectomies performed by residents under the supervision of board certified surgeons. All residents were assessed at the end of the procedure by the supervising surgeon (live reviewer) using our competency assessment tool. Video records of the same procedure were analyzed by two independent reviewers (reviewer A and B), who were blinded to the performing trainee's. The assessment had three parts: a laparoscopic cholecystectomy-specific assessment tool (LCAT), the objective structured assessment of technical skills (OSATS) and a 5-item visual analogue scale (VAS) to address the surgeon's autonomy in each part of the cholecystectomy. We compared the assessment scores of the live supervising surgeon and the video reviewers. RESULTS We included 15 junior residents who performed 42 laparoscopic cholecystectomies. Scoring results from live and video reviewer were comparable except for the OSATS and VAS part. The score for OSATS by the live reviewer and reviewer B were 3.68 vs. 4.26 respectively (p = 0.04) and for VAS (5.17 vs. 4.63 respectively (p = 0.03). The same difference was found between reviewers A and B with OSATS score (3.75 vs. 4.26 respectively (p = 0.001)) and VAS (5.56 vs. 4.63 respectively; p = 0.004)). CONCLUSION Our competency assessment tool for the evaluation of surgical skills specific to laparoscopic cholecystectomy has been shown to be objective and comparable in-between raters during live procedure or on video material.
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Affiliation(s)
- Mickael Chevallay
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Emilie Liot
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Ian Fournier
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Ziad Abbassi
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Andrea Peloso
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Monika E Hagen
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Stefan P Mönig
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Philippe Morel
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Nicolas Buchs
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Danilo Miskovic
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - Frederic Ris
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Minoa K Jung
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
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Lucocq J, Radhakishnan G, Scollay J, Patil P. Morbidity following emergency and elective cholecystectomy: a retrospective comparative cohort study. Surg Endosc 2022; 36:8451-8457. [PMID: 35201423 PMCID: PMC9613569 DOI: 10.1007/s00464-022-09103-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION An emergency laparoscopic cholecystectomy (EMLC) is commonly performed for all biliary pathology, yet EMLC can be challenging due to acute inflammation. Understanding the risks of EMLC is necessary before patients can make an informed decision regarding operative management. The aim of the present study was to compare rates of operative and post-operative outcomes between EMLC and elective LC (ELLC) using a large contemporary cohort, to inform the consent process and influence surgical decision making. METHODS All patients who underwent EMLC and ELLC in one UK health board between January 2015 and December 2019 were considered for inclusion. Data were collected retrospectively from multiple regional databases using a deterministic records-linkage methodology. Patients were followed up for 100 days post-operatively for adverse outcomes and outcomes were compared between groups using both univariate and multivariate analysis adjusting for pre-operative factors. RESULTS A total of 2768 LCs were performed [age (range), 52(13-92); M:F, 1:2.7]. In both the univariate and multivariate analysis, EMLC was positively associated with subtotal cholecystectomy (RR 2.0; p < 0.001), post-operative complication (RR 2.8; p < 0.001), post-operative imaging (RR 2.0; p < 0.001), post-operative intervention (RR 2.3; p < 0.001), prolonged post-operative hospitalisation (RR 3.8; p < 0.001) and readmission (RR 2.2; p < 0.001). EMLC had higher rates of post-operative mortality in univariate analysis (RR 10.8; p = 0.01). DISCUSSION EMLC is positively associated with adverse outcomes versus ELLC. Of course this study does not focus on a specific biliary pathology; nevertheless, it illustrates the additional risk associated with EMLC. This should be clearly outlined during the consent process but should be balanced with the risk of further biliary attacks. Further studies are required to identify particular patient groups who benefit from elective surgery.
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Affiliation(s)
- James Lucocq
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, UK
| | | | - John Scollay
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, UK
| | - Pradeep Patil
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, UK
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Fujinaga A, Hirashita T, Iwashita Y, Kawamura M, Nakanuma H, Kawasaki T, Kawano Y, Masuda T, Endo Y, Ohta M, Inomata M. An additional port in difficult laparoscopic cholecystectomy for surgical safety. Asian J Endosc Surg 2022; 15:737-744. [PMID: 35505453 DOI: 10.1111/ases.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/20/2022] [Accepted: 04/15/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Tokyo Guidelines 2018, clinical practice guidelines for acute cholangitis and cholecystitis, recommend bailout procedures to prevent bile duct injury (BDI) during laparoscopic cholecystectomy (LC) for difficult gallbladder. We first insert an additional port (AP) for difficult gallbladder that may require bailout procedures. Because the usefulness of an AP during LC is unclear, we therefore examined the efficacy of the AP during LC in this study. METHODS Data were collected from 115 patients who underwent LC for acute cholecystitis in our department. The indications for AP were excessive bleeding, scarring, and poor visual field around Calot's triangle. AP was inserted into the right middle abdomen so as not to interfere with other trocars and was used by the assistant. Surgical outcomes were evaluated based on AP use during LC. RESULTS AP was inserted in 19 patients during LC (AP group). The indications for AP were excessive bleeding in nine patients, scarring around Calot's triangle in seven patients, and poor visual field around Calot's triangle in three patients. Open conversion was performed in two patients in the non-AP group. BDI occurred in one patient in the non-AP group. In patients with Difficulty Score 3, operation time was significantly shorter (P = .038) and Critical View of Safety (CVS) score was significantly higher in the AP group (P = .046). CONCLUSION AP is useful in patients with excessive bleeding to shorten operation time and increase the CVS score. AP may be one useful option for difficult gallbladder.
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Affiliation(s)
- Atsuro Fujinaga
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Masahiro Kawamura
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hiroaki Nakanuma
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takahide Kawasaki
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yoko Kawano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takashi Masuda
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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Kim HC, Song Y, Lee JS, Jeong ME, Lee Y, Lim JH, Kim DH. Comparison of pharmacologic therapies alone versus operative techniques in combination with pharmacologic therapies for postoperative analgesia in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial. Int J Surg 2022; 104:106763. [PMID: 35803512 DOI: 10.1016/j.ijsu.2022.106763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) causes moderate pain. Various operative analgesic techniques and pharmacologic treatments can reduce postoperative pain. This single-center, single-surgeon randomized controlled study aimed to assess the efficacy of combined operative analgesic techniques and pharmacologic analgesia in decreasing pain in patients undergoing LC. MATERIALS AND METHODS Fifty-nine patients scheduled for LC were assigned into two groups. In the pharmacologic analgesia (P) group (n = 29), patients were treated with pharmacologic intervention, including preoperative celecoxib (200 mg), intraoperative acetaminophen (1 g), and dexamethasone (8 mg). In the operative analgesic treatments with pharmacologic analgesia (OP) group (n = 30), patients were treated with both operative analgesic techniques and pharmacologic analgesia, including low-pressure pneumoperitoneum, intraperitoneal normal saline irrigation, and aspiration of intraperitoneal carbon dioxide. The area under the curve (AUC) of pain score for postoperative 24 h was assessed at 0, 2, 6, and 24 h post-operation. The analgesic requirements and sleep quality at postoperative day 1 were assessed. RESULTS The AUC/24 h of pain scores at rest and on cough were lower in the OP group (p < 0.001 and p = 0.001, respectively). The pain scores at rest were lower in the OP group at postoperative 2, 6, and 24 h (p = 0.001, p = 0.001, and p = 0.048, respectively). The pain scores on cough were lower in the OP group at postoperative 2 and 6 h (p = 0.004 and p = 0.008, respectively). Analgesic requirements were comparable. The sleep quality score at postoperative day 1 was higher in the OP group (56 ± 18 vs. 67 ± 15, absolute difference, 10; 95% confidence interval, 2 to 19; p = 0.017). CONCLUSIONS Combined operative analgesic therapies and pharmacologic analgesia compared to pharmacologic analgesia alone decreased pain scores and increased sleep quality in patients undergoing LC.
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Affiliation(s)
- Hyun-Chang Kim
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Song
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Seok Lee
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeong Eun Jeong
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yongmin Lee
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Hong Lim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
| | - Do-Hyeong Kim
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Lucocq J, Patil P, Scollay J. Acute cholecystitis: Delayed cholecystectomy has lesser perioperative morbidity compared to emergency cholecystectomy. Surgery 2022; 172:16-22. [PMID: 35461704 DOI: 10.1016/j.surg.2022.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/02/2022] [Accepted: 03/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In comparison to delayed laparoscopic cholecystectomy, emergency laparoscopic cholecystectomy has a shorter length of stay and eliminates the risk of recurrent episodes of acute cholecystitis. Nevertheless, there is concern that emergency laparoscopic cholecystectomy is associated with higher morbidity in acute cholecystitis patients. The present large cohort study compares operation-related adverse outcomes between emergency and delayed laparoscopic cholecystectomy and determines the risk of readmission before delayed laparoscopic cholecystectomy to guide surgical decision-making. METHODS Patients diagnosed with acute cholecystitis who underwent emergency or delayed laparoscopic cholecystectomy between 2015 and 2019 were included. Perioperative outcomes were compared using univariate and multivariate analysis, adjusting for preoperative variables. The rate of readmission before delayed laparoscopic cholecystectomy was determined. RESULTS In total, 811 patients were included (median age, 58 years; male:female, 1:1.5): 227 emergency laparoscopic cholecystectomies (28.0%), 555 delayed laparoscopic cholecystectomies (68.4%), and 29 emergency laparoscopic cholecystectomies whilst awaiting delayed laparoscopic cholecystectomy (3.6%). Emergency laparoscopic cholecystectomy was associated with increased incidences of subtotal cholecystectomy (OR 1.94; P = .011), bile leak (OR 2.38; P = .013), intraoperative drains (OR 2.54; P < .001), prolonged postoperative length of stay (OR 7.26; P < .001), postoperative imaging (OR 1.83, P = .006), and postoperative readmission (OR 1.90; P = .005). There was a 13.5% risk of readmission over 2 months while waiting delayed laparoscopic cholecystectomy and a 22.5% risk over the median waiting time (5 months, 9 days). CONCLUSION Emergency laparoscopic cholecystectomy is positively associated with a multitude of operation-related adverse outcomes in acute cholecystitis, compared to delayed laparoscopic cholecystectomy. The benefit of delayed laparoscopic cholecystectomy should be balanced against the significant readmission risk before delayed laparoscopic cholecystectomy. Emergency laparoscopic cholecystectomy may be the most pragmatic strategy for centers dealing with high volumes of biliary admissions and long elective-surgery waiting times. When opting for delayed laparoscopic cholecystectomy, confirming the date of surgery before discharge may ensure timely intervention and avoid the morbidity and expense of readmission.
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Affiliation(s)
- James Lucocq
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, United Kingdom.
| | - Pradeep Patil
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, United Kingdom
| | - John Scollay
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, United Kingdom
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She WH, Cheung TT, Chan MY, Chu KW, Ma KW, Tsang SHY, Dai WC, Chan ACY, Lo CM. Routine use of ICG to enhance operative safety in emergency laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 2022; 36:4442-4451. [PMID: 35194663 DOI: 10.1007/s00464-021-08795-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/17/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To test the hypothesis that ICG fluorescence cholangiography (ICG-FC) helps to identify critical structures during laparoscopic cholecystectomy (LC) and hence reduce biliary injuries and conversions. In LC, biliary injury and conversion often happen if the biliary anatomy is misidentified. METHODS This was a single-center randomized controlled trial from 2017 to 2019. Patients with acute cholecystitis requiring LC were assessed for eligibility for the trial. Patients in the trial were randomized to undergo either conventional LC (conventional arm) or LC with ICG-FC (ICG arm). Conversion rate and biliary injury incidence were outcome measures. RESULTS Totally 92 patients participated (46 patients in each arm). The median age was 61 years in both arms (p = 0.472). The conventional arm had 22 men and 24 women; the ICG arm had 24 men and 22 women (p = 0.677). The two arms were comparable in all perioperative parameters. The time from ICG injection to surgery was 67 (16-1150) min. Both arms had an 8.7% conversion rate (p = 1.000). The median operative time was 140.5 min in the conventional arm and 149.5 min in the ICG arm (p = 0.086). The complication rate was 15.2% in the former and 10.9% in the latter (p = 0.536), and both had a 2.2% bile leakage rate. The median hospital stay was 3.5d in the former and 4.0d in the latter (p = 0.380). CONCLUSION ICG-FC did not make any difference in conversion or complication rate. Its routine use in LC is questionable. However, it may be helpful in difficult cholecystectomies and may be used as an adjunct. TRIAL REGISTRATION The trial was registered with the Institutional Review Board of University of Hong Kong/Hospital Authority Hong Kong West Cluster ( http://www.med.hku.hk/en/research/ethics-and-integrity/human-ethics ). Registration number: UW17-492.
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Affiliation(s)
- Wong Hoi She
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
| | - Miu Yee Chan
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Ka Wan Chu
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Ka Wing Ma
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Simon H Y Tsang
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Wing Chiu Dai
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Albert C Y Chan
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Chung Mau Lo
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
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Vogel PA. Der erfahrene Chirurg als unabhängiger Risikofaktor für die Morbidität nach Cholezystektomie. Eine multivariate Analyse von 710 Patienten. Zentralbl Chir 2022; 147:42-53. [PMID: 35235968 DOI: 10.1055/a-1712-4749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Einleitung Bei komplexeren chirurgischen Eingriffen wie der Kolonresektion, herzchirurgischen Eingriffen, arteriellen Rekonstruktionen oder Leberresektionen ist der Einfluss des
Chirurgen auf die postoperative Morbidität nachgewiesen. Bei Routineeingriffen wie der Cholezystektomie liegen bislang keine Erkenntnisse zum Zusammenhang von Operateur und Morbidität vor.
Insbesondere Untersuchungen bei erfahrenen Chirurgen fehlen.
Methoden Es wurden 710 konsekutive Patienten, die zwischen Januar 2014 und Dezember 2018 von erfahrenen Chirurgen (über n = 300 Cholezystektomien vor Beginn der Untersuchung, über 5
Jahre nach bestandener Facharztprüfung) cholezystektomiert wurden, untersucht. In einer univariaten Analyse wurde der Einfluss von Patientenmerkmalen, Laborparametern, chirurgischen
Parametern und des Operateurs auf die postoperative Morbidität analysiert. Die Variablen mit statistischer Signifikanzen wurden dann einer multivariaten logistischen Regressionsanalyse
unterzogen.
Ergebnisse Die Mortalität lag bei 5 von 710 (0,7%), die Morbidität bei 58 von 710 (8,2%). 37 von 710 Patienten erlitten eine chirurgische Komplikation, 21 von 710 Patienten eine
nicht chirurgische Komplikation. Hinsichtlich der Gesamtmorbidität waren in multivariater Analyse der Kreatininwert (OR 1,29; KI 1,01–1,648; p = 0,042), GOT (OR 1,0405; KI 1–1,01; p = 0,03),
offene und Konversions-Cholezystektomie (OR 4,134; KI 1,587–10,768; p = 0,004) und der individuelle Chirurg (OR bis 40,675; p = 0,001) ein unabhängiger Risikofaktor. Bei Analyse der
chirurgischen Komplikationen blieben offene und Konversions-Cholezystektomie (OR 8,104; KI 3,03–21,68; p < 0,001) sowie der individuelle Chirurg (OR bis 79,69; p = 0,005) ein statistisch
signifikanter unabhängiger Risikofaktor.
Schlussfolgerung Der individuelle Chirurg ist auch bei einem Routineeingriff wie der Cholezystektomie ein unabhängiger Risikofaktor für die Morbidität. Dies gilt auch für erfahrene
Chirurgen mit Facharztstatus und hoher Caseload. Im Hinblick auf die Patientensicherheit und Verbesserungen der Ergebnisqualität muss daher diskutiert werden, ob eine routinemäßige
risikoadjustierte Messung der individuellen Ergebnisse eines jeden Chirurgen als Basis eines gezielten Qualifizierungprogramms sinnvoll ist.
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Affiliation(s)
- Peter Alexander Vogel
- Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Klinikum Bad Hersfeld GmbH, Bad Hersfeld, Deutschland
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Mori T, Endo H, Misawa T, Yamaguchi S, Sakamoto Y, Inomata M, Sakai Y, Kakeji Y, Miyata H, Kitagawa Y, Watanabe M. Involvement of a skill-qualified surgeon favorably influences outcomes of laparoscopic cholecystectomy performed for acute cholecystitis. Surg Endosc 2022; 36:5956-5963. [DOI: 10.1007/s00464-022-09045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/08/2022] [Indexed: 02/01/2023]
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The effect of surgical strategy in difficult cholecystectomy cases on postoperative complications outcome: a value-based healthcare comparative study. Surg Endosc 2022; 36:5293-5302. [PMID: 35000001 DOI: 10.1007/s00464-021-08907-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/21/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND In patients undergoing laparoscopic cholecystectomy (LC) for complicated biliary disease, complication rates increase up to 30%. The aim of this study is to assess the effect of differences in surgical strategy comparing outcome data of two large volume hospitals. METHODS A prospective database was created for all the patients who underwent a LC in two large volume hospitals between January 2017 and December 2018. In cases of difficult cholecystectomy in clinic A, regular LC or conversion were surgical strategies. In clinic B, laparoscopic subtotal cholecystectomy was performed as an alternative in difficult cases. The difficulty of the cholecystectomy (score 1-4) and surgical strategy (regular LC, subtotal cholecystectomy, conversion) were scored. Postoperative complications, reinterventions, and ICU admission were assessed. For predicting adverse postoperative complication outcomes, uni- and multivariable analyses were used. RESULTS A total of 2104 patients underwent a LC in the study period of which 974 were from clinic A and 1130 were from clinic B. In total, 368 procedures (17%) were scored as a difficult cholecystectomy. In clinic A, more conversions were performed (4.4%) compared to clinic B (1.0%; p < 0.001). In clinic B, more subtotal laparoscopic cholecystectomies were performed (1.8%) compared to clinic A (0%; p = < 0.001). Overall complication rate was 8.2% for clinic A and 10.2% for clinic B (p = 0.121). Postoperative complication rates per group for regular LC, conversion, and subtotal cholecystectomy in difficult cholecystectomies were 45 (15%), 12 (24%), and 7 (35%; p = 0.035), respectively. The strongest predictor for Clavien-Dindo grade 3-5 complication was subtotal cholecystectomy. CONCLUSION Surgical strategy in case of a difficult cholecystectomy seems to have an important impact on postoperative complication outcome. The effect of a subtotal cholecystectomy on complications is of great concern.
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Bhandari TR, Khan SA, Jha JL. Prediction of difficult laparoscopic cholecystectomy: An observational study. Ann Med Surg (Lond) 2021; 72:103060. [PMID: 34815866 PMCID: PMC8591467 DOI: 10.1016/j.amsu.2021.103060] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic cholecystectomy (LC) is a gold standard treatment of symptomatic gallstone disease. Meanwhile, it is also a challenging procedure demanding excellent expertise for the best outcomes. Many times, difficult laparoscopic cholecystectomy is a nerve-wracking situation for surgeons. It endangers patients by causing potential injury to vital structures. Thus, we aimed to identify predictors for difficult LC. Methods A retrospective cross-sectional review of surgical records was done. Patients who underwent laparoscopic cholecystectomy on an elective basis from July 2017 to June 2021 were included in the study. We divided our patients into two groups based on operative findings of difficult LC; difficult LC group and non-difficult LC group. We compared patient's demographics, predictors, and perioperative details and analyzed the data. Results A total of 338 patients (82 males) with a median age of 47 years were studied. Total difficult LC was found in 52 patients (15.4%). The overall conversion rate was 8.9%. Logistic multivariable regression analysis revealed that; male gender (odds ratio (OR); 0.171, confidence interval (CI),(0.043-0.675), P; 0.012), past history of acute cholecystitis (OR; 0.038, CI; (0.005-0.309), P; 0.002), gall bladder wall thickness (≥4-5 mm) (OR; 0.074, CI; (0.008-0.666), P; 0.020), fibrotic gallbladder (OR; 166.6, CI; (7.946-3492), P; 0.001), and adhesion at Calot's triangle (OR; 0.021, CI (0.001-0.311), P; 0.005) were independent predictors of difficult LC. Conclusions Gender (male), past history of acute cholecystitis, gallbladder wall thickness (≥4-5 mm), fibrotic gallbladder, and adhesion at Calot's triangle are significant predictors for difficult LC. Moreover, an awareness about reliable predictors for difficult LC would be helpful for an appropriate treatment plan and application of the resources to anticipate difficult LC.
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Affiliation(s)
- Tika Ram Bhandari
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Sarfaraz Alam Khan
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
| | - Jiuneshwar Lal Jha
- Department of General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
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Efficacy of indocyanine green (ICG) fluorescent cholangiography to improve intra-operative visualization during laparoscopic cholecystectomy in pediatric patients: a comparative study between ICG-guided fluorescence and standard technique. Surg Endosc 2021; 36:4369-4375. [PMID: 34734300 DOI: 10.1007/s00464-021-08784-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the last few years, indocyanine green (ICG) fluorescent cholangiography (FC) has been adopted to perform intra-operative biliary mapping during laparoscopic cholecystectomy (LC). This study aimed to compare the results of LC with and without use of ICG-FC. METHODS All LC operated from June 2017 to June 2021 in our unit were retrospectively reviewed. Pre-operative workup included ultrasonography to assess dilation of main biliary tree. The ICG dosage was 0.35 mg/kg and the median timing of administration was 15.5 h pre-operatively. We evaluated, analyzing videorecorded procedures, 3 parameters in both groups: the total operative time (T1), the time of cystic duct isolation, clipping and sectioning (T2), and the time of gallbladder removal from hepatic fossa (T3). RESULTS Forty-three LC were operated in the study period: 22 using standard technique (G1) and 21 using ICG-FC (G2). There were 27 girls and 16 boys, with median age at surgery of 11.5 years (range 7-17) and median weight of 47 kg (range 31-110). No conversions were reported in our series. In all ICG cases (except one patient under therapy with phenobarbital) the biliary tree was perfectly visualized during dissection. Intra-operative complications occurred in 3 G1 patients (13.6%): 2 bleedings from the Calot's triangle and 1 bleeding from the liver bed during the gallbladder removal. LC was significantly faster in G2 than in G1 (p = 0.001). In fact, the parameters analyzed (T1, T2, T3) were all significantly greater in G1 than in G2 (p = 0.001). CONCLUSIONS Based upon our experience, we strongly recommend the use of ICG-FC in all pediatric patients undergoing LC. ICG-guided fluorescence provided an excellent real-time visualization of the extrahepatic biliary tree and allowed faster and safer dissection, minimizing the risk of bile duct injuries. Furthermore, ICG use was clinically safe, with no adverse reactions to the product.
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Jung JJ, Gee DW. Standard laparoscopy remains the routine approach to cholecystectomy. Surgery 2021; 170:1004-1005. [PMID: 34332781 DOI: 10.1016/j.surg.2021.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- James J Jung
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA.
| | - Denise W Gee
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA
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Keeratibharat N. Initial experience of intraoperative fluorescent cholangiography during laparoscopic cholecystectomy: A retrospective study. Ann Med Surg (Lond) 2021; 68:102569. [PMID: 34345426 PMCID: PMC8319025 DOI: 10.1016/j.amsu.2021.102569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Fluorescent cholangiography (FC) during laparoscopic cholecystectomy (LC) is a novel method to facilitate real-time visualization of extrahepatic biliary structures that avoiding risk of bile duct injury. Aims of this study are to investigate the feasibility and the safety of FC during LC. Method We evaluated the outcomes of FC during elective LC at our hospital from August 2017 to April 2018. Fifty-five patients who underwent FC during elective LC were enrolled in this study. Demographic and peri-operative data were recorded and analyzed. The primary endpoints were visualization rate of FC during LC. The secondary endpoint was the optimal conditions and technical details for FC included to detect any potential adverse event. Results The visualization rate after FC of the cystic duct, common hepatic duct and common bile duct were increased significantly compared to before FC. The identification rate of the cystic duct and common bile duct were not associated with BMI and history of acute cholecystitis. Conclusions FC enabled real-time visualization of extrahepatic biliary structures during LC. FC appears to be a safe and efficient approach for elective LC.
Bile duct injury is one of the most complication of laparoscopic cholecystectomy. Fluorescent cholangiography is offer real-time detection of the biliary anatomy. Cholangiogram was associated with a low incidence of bile duct injury.
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Affiliation(s)
- Nattawut Keeratibharat
- School of Surgery, Institute of Medicine, Suranaree University of Technology, 111 Mahawitthayalai Ave., Suranaree, Muang, Nakhon Ratchasima, 30000, Thailand
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Esposito C, Alberti D, Settimi A, Pecorelli S, Boroni G, Montanaro B, Escolino M. Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers. Surg Endosc 2021; 35:6366-6373. [PMID: 34231069 PMCID: PMC8523512 DOI: 10.1007/s00464-021-08596-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
Background Recently, we reported the feasibility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging to identify extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC) in pediatric patients. This paper aimed to describe the use of a new technology, RUBINA™, to perform intra-operative ICG fluorescent cholangiography (FC) in pediatric LC. Methods During the last year, ICG-FC was performed during LC using the new technology RUBINA™ in two pediatric surgery units. The ICG dosage was 0.35 mg/Kg and the median timing of administration was 15.6 h prior to surgery. Patient baseline, intra-operative details, rate of biliary anatomy identification, utilization ease, and surgical outcomes were assessed. Results Thirteen patients (11 girls), with median age at surgery of 12.9 years, underwent LC using the new RUBINA™ technology. Six patients (46.1%) had associated comorbidities and five (38.5%) were practicing drug therapy. Pre-operative workup included ultrasound (n = 13) and cholangio-MRI (n = 5), excluding biliary and/or vascular anatomical anomalies. One patient needed conversion to open surgery and was excluded from the study. The median operative time was 96.9 min (range 55–180). Technical failure of intra-operative ICG-NIRF visualization occurred in 2/12 patients (16.7%). In the other cases, ICG-NIRF allowed to identify biliary/vascular anatomic anomalies in 4/12 (33.3%), including Moynihan's hump of the right hepatic artery (n = 1), supravescicular bile duct (n = 1), and short cystic duct (n = 2). No allergic or adverse reactions to ICG, post-operative complications, or reoperations were reported. Conclusion Our preliminary experience suggested that the new RUBINA™ technology was very effective to perform ICG-FC during LC in pediatric patients. The advantages of this technology include the possibility to overlay the ICG-NIRF data onto the standard white light image and provide surgeons a constant fluorescence imaging of the target anatomy to assess position of critical biliary structures or presence of anatomical anomalies and safely perform the operation. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08596-7.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Daniele Alberti
- Division of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Settimi
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Silvia Pecorelli
- Division of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
| | - Giovanni Boroni
- Division of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
| | | | - Maria Escolino
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
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Reitano E, de'Angelis N, Schembari E, Carrà MC, Francone E, Gentilli S, La Greca G. Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review. ANZ J Surg 2021; 91:E554-E560. [PMID: 34180567 PMCID: PMC8518700 DOI: 10.1111/ans.17021] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/05/2021] [Accepted: 06/06/2021] [Indexed: 01/01/2023]
Abstract
Background Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. Methods A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle–Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. Results Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut‐off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. Conclusions The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy.
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Affiliation(s)
- Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Nicola de'Angelis
- Department of Minimally Invasive and Robotic Surgery, "F. Miulli" Regional General Hospital, Acquaviva delle Fonti (BA), Italy
| | - Elena Schembari
- Department of Biomedical and Biotechnological sciences, University of Catania, Catania, Italy
| | - Maria Clotilde Carrà
- Department of Odontology, Rothschild University Hospital, Paris, France.,University Paris Diderot, Paris, France
| | - Elisa Francone
- Division of General Surgery, Department of Health Science, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Sergio Gentilli
- Division of General Surgery, Department of Health Science, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Gaetano La Greca
- Department of Biomedical and Biotechnological sciences, University of Catania, Catania, Italy
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Nogoy DM, Padmanaban V, Balazero LL, Rosado J, Sifri ZC. Predictors of Difficult Laparoscopic Cholecystectomy on Humanitarian Missions to Peru Difficult LC in Surgical Missions. J Surg Res 2021; 267:102-108. [PMID: 34157489 DOI: 10.1016/j.jss.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the gold standard treatment of gallstone disease. On short-term surgical missions (STSMs), it is unclear what factors can predict safety of LC. This study evaluates patient risk factors of difficult LC in Northern Peru, towards optimizing outcomes. MATERIALS AND METHODS A retrospective review was performed of patients who underwent LC during short-term surgical missions to Peru from 2016-2019 under the International Surgical Health Initiative (ISHI). Difficult and routine LC groups were compared for: age, weight, gender, symptom duration, pain on presentation, history of abdominal or pelvic surgery, diabetes and hypertension. RESULTS 68 of 194 patients underwent LC; 42 patients (62%) were classified as difficult with OR (operating room) time > 70 min (90%), 2 cases converted to open (5%) and 2 aborted cases (5%). Higher weight class was found to correlate with difficult LC. CONCLUSION Increased patient weight was correlated to longer operative time during STSMs. Patients undergoing LC must be selected carefully to mitigate risks of difficult operations on STSMs.
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Affiliation(s)
- Danielle M Nogoy
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
| | - Vennila Padmanaban
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Jesus Rosado
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Image-guided percutaneous cholecystostomy: a comprehensive review. Ir J Med Sci 2021; 191:727-738. [PMID: 34021480 DOI: 10.1007/s11845-021-02655-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
Acute cholecystitis (AC) is a common emergency condition with severity ranging from mild to severe. Gallstones and critical illnesses are the common predisposing factors. Mild AC is primarily managed with medical therapy and early cholecystectomy. Moderate and severe AC require individualized treatment with a preference for early cholecystectomy. However, cholecystectomy may not always be feasible due to co-morbidities. Hence, this group of patients needs minimally invasive methods to drain the gallbladder (GB). Percutaneous cholecystostomy (PC) is the image-guided drainage of GB in the setting of moderate to severe AC. There are different approaches to PC. The technical aspects, success, and complications of PC as well as management of cholecystostomy catheter after the patient recovers from the acute episode should be thoroughly understood by the interventional radiologist. We present an extensive up-to-date review of the essential aspects of PC including indications, contraindications, techniques, and outcomes, including complications and success rates.
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Sousa JHBDE, Tustumi F, Steinman M, Santos OFPD. Laparoscopic cholecystectomy performed by general surgery residents. Is it safe? How much does it cost? Rev Col Bras Cir 2021; 48:e20202907. [PMID: 34008798 PMCID: PMC10683462 DOI: 10.1590/0100-6991e-20202907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
| | - Francisco Tustumi
- - Hospital Israelita Albert Einstein, Serviço de Cirurgia Geral - São Paulo - SP - Brasil
| | - Milton Steinman
- - Hospital Israelita Albert Einstein, Serviço de Cirurgia Geral - São Paulo - SP - Brasil
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Heart Failure Is a Poor Prognosis Risk Factor in Patients Undergoing Cholecystectomy: Results from a Spanish Data-Based Analysis. J Clin Med 2021; 10:jcm10081731. [PMID: 33923710 PMCID: PMC8072897 DOI: 10.3390/jcm10081731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The incidence of cholecystectomy is increasing as the result of the aging worldwide. Our aim was to determine the influence of heart failure on in-hospital outcomes in patients undergoing cholecystectomy in the Spanish National Health System (SNHS). Methods: We conducted a retrospective study using the Spanish National Hospital Discharge Database. Patients older than 17 years undergoing cholecystectomy in the period 2007–2015 were included. Demographic and administrative variables related to patients’ diseases as well as procedures were collected. Results: 478,111 episodes of cholecystectomy were identified according to the data from SNHS hospitals in the period evaluated. From all the episodes, 3357 (0.7%) were excluded, as the result the sample was represented by 474,754 episodes. Mean age was 58.3 (+16.5) years, and 287,734 (60.5%) were women (p < 0.001). A primary or secondary diagnosis of HF was identified in 4244 (0.89%) (p < 0.001) and mean age was 76.5 (+9.6) years. A higher incidence of all main complications studied was observed in the HF group (p < 0.001), except stroke (p = 0.753). Unadjusted in-hospital mortality was 1.1%, 12.9% in the group with HF versus 1% in the non HF group (p < 0.001). Average length of hospital stay was 5.4 (+8.9) days, and was higher in patients with HF (16.2 + 17.7 vs. 5.3 + 8.8; p < 0.001). Risk-adjusted in-hospital mortality models’ discrimination was high in both cases, with AUROC values = 0.963 (0.960–0.965) in the APRG-DRG model and AUROC = 0.965 (0.962–0.968) in the CMS adapted model. Median odds ratio (MOR) was high (1.538 and 1.533, respectively), stating an important variability of risk-adjusted outcomes among hospitals. Conclusions: The presence of HF during admission increases in hospital mortality and lengthens the hospital stay in patients undergoing cholecystectomy. However, mortality and hospital stay have significantly decreased during the study period in both groups (HF and non HF patients).
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Strohäker J, Wiegand L, Beltzer C, Königsrainer A, Ladurner R, Bachmann R. Routine postoperative blood tests fail to reliably predict procedure-related complications after laparoscopic cholecystectomy. Langenbecks Arch Surg 2021; 406:1155-1163. [PMID: 33760977 PMCID: PMC8208910 DOI: 10.1007/s00423-021-02115-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/02/2021] [Indexed: 11/26/2022]
Abstract
Purpose Laparoscopic cholecystectomy is a highly standardized surgical procedure with a low risk of complications. However, once complications develop, they can be life-threatening. The aim of this study was to evaluate the value of blood tests on postoperative day one regarding their potential to predict postoperative complications Methods A cohort study of 1706 consecutive cholecystectomies performed at a tertiary hospital and teaching facility over a 5-year period between 2014 and 2019. Results Patients that had open CCE or conversion CCE were excluded. One thousand five hundred eighty-six patients were included in the final analysis that received a laparoscopic cholecystectomy (CCE). One thousand five hundred twenty-three patients had blood tests on POD 1. Forty-one complications were detected including 14 bile leaks, 2 common bile duct injuries, 13 choledocholithiasis, 9 hematomas, and 2 active bleedings. Bilirubin was elevated in 351 patients on POD 1. A drop of more than 3 mg/dl of hemoglobin was reported in 39 patients. GPT was elevated 3 × above the upper limit in 102 patients. All three tests showed a low sensitivity and specificity in detecting postoperative complications. Conclusions Early postoperative blood tests alone show a low specificity in detecting postoperative complications after laparoscopic CCE. Their main benefit appears to be the negative predictive value, when they are normal. Routine blood testing appears to be unnecessary and should be based on the intraoperative diagnosis and postoperative clinical findings.
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Affiliation(s)
- Jens Strohäker
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
| | - Lisa Wiegand
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Christian Beltzer
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Ruth Ladurner
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Robert Bachmann
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
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Frailty Predicts Morbidity and Mortality After Laparoscopic Cholecystectomy for Acute Cholecystitis: An ACS-NSQIP Cohort Analysis. J Gastrointest Surg 2021; 25:932-940. [PMID: 32212087 PMCID: PMC7222970 DOI: 10.1007/s11605-020-04570-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/03/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current guidelines recommend laparoscopic cholecystectomy be offered for patients with acute cholecystitis except those deemed as high risk. Few studies have examined the impact of frailty on outcomes for patients undergoing laparoscopic cholecystectomy. Therefore, the aim of this study was to determine the association of frailty with postoperative morbidity and mortality in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. METHODS Patients undergoing laparoscopic cholecystectomy for acute cholecystectomy were identified from 2005 to 2010 in the American College of Surgeons National Surgical Quality Improvement Project (NSQIP). The Modified Frailty Index (mFI) was used a surrogate for frailty, and patients were stratified as non-frail (mFI 0), low frailty (mFI 1-2), intermediate frailty (mFI 3-4) and high frailty (mFI ≥ 5). Univariable and multivariable analyses were performed. Receiver operator curves (ROC) and an area under the curve (AUC) were generated to determine accuracy of mFI in predicting postoperative morbidity and mortality. RESULTS Of the 6898 patients undergoing laparoscopic cholecystectomy, 3245 (47%) patients were non-frail. There were 2913 (42%) patients with low-frailty, 649 (9%) patients with intermediate frailty, and 91 (2%) with high frailty. Clavien IV complications were higher for intermediate frail patients (OR 1.81, 95% CI 1.00-3.28, p = 0.050) and high-frail patients (OR 4.59, 95% CI 1.98-10.7, p < 0.001). Additionally, mortality was higher for patients with intermediate frailty (OR 4.69, 95% CI 1.37-16.0, p = 0.014) and high frailty (OR 12.2, 95% CI 2.67-55.5, p = 0.001). The mFI had excellent accuracy for mortality (AUC = 0.83) and Clavien IV complications (AUC = 0.73). CONCLUSION Frailty is associated with postoperative morbidity and mortality in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.
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Burke J, Rattan R, Sedighim S, Kim M. A Simple Risk Score to Predict Clavien-Dindo Grade IV and V Complications After Non-elective Cholecystectomy. J Gastrointest Surg 2021; 25:201-210. [PMID: 32030602 PMCID: PMC7415492 DOI: 10.1007/s11605-020-04514-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/02/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Non-elective cholecystectomies can lead to severe postoperative complications and mortality. Existing risk prediction tools do not meet the need to reliably predict these complications. METHODS Using the 2011-2016 American College of Surgeons National Surgical Quality Improvement Program datasets, we identified patients undergoing non-elective cholecystectomy with primary ICD 9/10 codes indicating the following diagnoses: symptomatic cholelithiasis, acute cholecystitis, choledocholithiasis, gallstone pancreatitis, and cholangitis. We randomly allocated patients to derivation and validation cohorts (80/20 split). Severe complications (Clavien-Dindo grades IV and V) included unplanned intubation, prolonged mechanical ventilation, pulmonary embolism, acute renal failure requiring dialysis, stroke, myocardial infarction, cardiac arrest, septic shock, and mortality. Logistic regression using backward selection identified predictors of severe complications and a risk score was generated based on this model. RESULTS Of 68,953 patients in the derivation cohort, 1.7% (N = 1157) suffered severe complications. The final multivariable risk score model included the following predictors: age (0-12 points), preoperative sepsis (5 points), planned open procedure (5 points), estimated glomerular filtration rate (0-13 points), and preoperative albumin level (0-8 points). The associated risk-score model yielded scores from 0 to 43 with 0.1-59.4% predicted probability of severe complications and had a C-statistic of 0.845 (95% CI 0.834, 0.857) in the derivation cohort and 0.870 (95% CI 0.851, 0.889) in the validation cohort. CONCLUSION A simple risk-score model predicts severe complications in patients undergoing unplanned cholecystectomy for common indications encountered in an acute care surgery service and identifies high-risk patients.
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Affiliation(s)
- Jonathan Burke
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY,University of Miami Miller School of Medicine, Miami, FL
| | - Rishi Rattan
- DeWitt Daughtry Family Department of Surgery, Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL
| | | | - Minjae Kim
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY,Department of Anesthesiology, Columbia University Medical Center, New York, NY
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