Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-ca...Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-calculous cholecystitis,gallbladder polyps larger than 1.0 cm,and porcelain gallbladder,etc.Currently,laparoscopic cholecystectomy(LC)constitutes over 95%of all cholecystectomy procedures,which is the preferred approach for gallbladder surgery[1,2].展开更多
BACKGROUND Although single-port laparoscopic cholecystectomy has been performed for over 25 years, it is still not popular. The narrow working space used in this surgery limits the movement of instruments and causes e...BACKGROUND Although single-port laparoscopic cholecystectomy has been performed for over 25 years, it is still not popular. The narrow working space used in this surgery limits the movement of instruments and causes ergonomic challenges. Robotic surgery not only resolves the ergonomic challenges of single-port laparoscopic surgery but is also considered a good option with its additional technical advantages, like a three-dimensional display and not being affected by tremors.However, the extent to which these technical and ergonomic advantages positively affect the surgical outcomes and how safe the single-port robotic surgeries need to be assessed for each particular surgery.AIM To evaluate the feasibility and safety of single-port robotic cholecystectomy for patients with cholelithiasis.METHODS The electronic records of the first 40 consecutive patients with gallbladder lithiasis who underwent single-port robotic cholecystectomy from 2013 to 2021 were analyzed retrospectively. In addition to the demographic characteristics of the patients, we analyzed American Society of Anesthesiologists(ASA) scores and body mass index. The presence of an accompanying umbilical hernia was also noted. The amount of blood loss during the operation, the necessity to place a drain in the subhepatic area, and the need to use grafts during the closure of the fascia of the port site were determined. Hospital stay, readmission rates, perioperative and postoperative complications, the Clavien-Dindo complication scores and postoperative analgesia requirements were also evaluated.RESULTS The mean age of the 40 patients included in the study was 49.5 ± 11.6 years, and 26 were female(65.0%). The umbilical hernia was present in 24(60.0%) patients,with a body mass index median of 29.3 kg/m^(2) and a mean of 29.7 ± 5.2 kg/m^(2). Fifteen(37.5%) of the patients were evaluated as ASA Ⅰ, 18(45.0%) as ASA Ⅱ, and 7(17.5%) as ASA Ⅲ. The mean bleeding amount during the operation was 58.4 ± 55.8 mL, and drain placement was required in 12patients(30.0%). After port removal, graft reinforcement during fascia closure was preferred in 14patients(35.0%). The median operation time was 93.5 min and the mean was 101.2 ± 27.0 min. The mean hospital stay was 1.4 ± 0.6 d, and 1 patient was readmitted to the hospital due to pain(2.5%).Clavien-Dindo I complications were seen in 14 patients(35.0%), and five(12.5%) complications were wound site problems.CONCLUSION In addition to the technological and ergonomic advantages robotic surgery provides surgeons, our study strongly supports that single-port robotic cholecystectomy is a feasible and safe option for treating patients with gallstones.展开更多
In this article,we discussed the article by Sohail et al,published in a recent issue of the World Journal of Gastrointestinal Endoscopy.This study highlights the benefits of performing cholecystectomy(CCY)during the s...In this article,we discussed the article by Sohail et al,published in a recent issue of the World Journal of Gastrointestinal Endoscopy.This study highlights the benefits of performing cholecystectomy(CCY)during the same hospitalization for patients with acute cholangitis(AC)associated with gallstones.Specifically,same-admission CCY is associated with significantly lower 30-day readmission rates compared with interval CCY.Furthermore,it has been associated with reduced mortality rates and reduced recurrence of biliary symptoms.Despite these advantages,the procedure is chosen in only a minority of eligible patients.This gap between evidence and practice highlights the need for updated clinical guidelines and further research to optimize the timing of CCY in the management of AC.展开更多
Cholecystectomy is a commonly performed surgical procedure globally,primarily for symptomatic cholelithiasis or related gallbladder conditions.Advances in surgical techniques,such as laparoscopic and robotic approache...Cholecystectomy is a commonly performed surgical procedure globally,primarily for symptomatic cholelithiasis or related gallbladder conditions.Advances in surgical techniques,such as laparoscopic and robotic approaches,have enhanced patient results and reduced hospital stays.However,postoperative care is crucial for optimizing recovery,preventing complications,and enhancing quality of life.Nurses have a critical role in achieving these objectives,starting from immediate postoperative evaluation through long-term monitoring.This review outlines essential nursing considerations and evidence-based practices for postoperative care following cholecystectomy.Key areas encompass pain control,respiratory assistance,early mobilization,wound and drain management,nutritional advice,psychosocial aid,and discharge preparation.By integrating current research and clinical guidelines,this review aims to serve as an authoritative resource to assist nurses in improving postoperative outcomes and patient satisfaction.展开更多
BACKGROUND With an aging society,older patients undergoing cholecystectomy often have multiple chronic diseases and require long-term multi-medication.Medication complexity significantly increases the risk of medicati...BACKGROUND With an aging society,older patients undergoing cholecystectomy often have multiple chronic diseases and require long-term multi-medication.Medication complexity significantly increases the risk of medication errors and adverse reactions,and effective nursing interventions are urgently required to ensure medication safety.AIM To investigate the efficacy of evidence-based nursing practices in mitigating polypharmacy risks among Suzhou Municipal Hospital Road Front Yard Area,thereby providing clinical guidance.METHODS The sixty older patients who underwent cholecystectomy between September 2024 and September 2025 treated with polypharmacy were enrolled.Using random number tables,hey were divided into study and control groups(n=30 each),who received routine medication nursing and evidence-based nursing,respectively.Pre-intervention and post-intervention comparisons were made between groups for medication knowledge,competence,and adherence scores.The incidences of duplicate medications,missed doses,self-discontinuation,unauthorized alterations,schedule changes,and adverse reaction rates assessed potential medication risks.RESULTS Both the study and control groups showed significant increases in medication knowledge,management competence,and adherence scores after intervention(all P<0.05).The study group had higher post-intervention scores(medication knowledge:87.29±5.09 vs 70.62±5.38;medication management competence:63.22±3.11 vs 56.19±4.08;medication adherence:7.13±1.04 vs 6.05±1.03,all P<0.05).The incidence of duplicate medication,missed doses,self-discontinuation,unauthorized dose alterations,and schedule modifications decreased in both groups post-intervention(all P<0.05),with lower rates in the study group(duplicate medication:13.33%vs 30.0%;missed doses:10.0%vs 26.67%;all P<0.05).The study group had a lower adverse reaction rate(3.33%vs 26.67%,P<0.05)and more patients with potential medication hazard level 0(83.33%vs 53.33%),while fewer patients had level 2 and 3 hazards(3.33%vs 16.67%and 0%vs 10.00%,respectively;all P<0.05).CONCLUSION Evidence-based nursing for polypharmacy risks in older adults undergoing cholecystectomy can enhance medication awareness,improve management and adherence,reduce adverse behaviors,and lower adverse reactions and hazard levels.展开更多
Inappropriate use of antibiotics leads to microbial resistance.Single-dose antibio-tic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk pati...Inappropriate use of antibiotics leads to microbial resistance.Single-dose antibio-tic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk patients despite some conflicting aspects.High-risk patients are those who are older than 70 years,have diabetes mellitus,whose operation time exceeded 120 minutes,have acute cholecystitis,experienced iatrogenic intraoperative gallbladder perforation resulting in bile or gallstone spillage,suffered from obstructive jaundice,or were deemed immuno-compromised.For gallbladder perforation,one dose of antibiotic prophylaxis is sufficient.Therefore,guidelines are needed and must be strictly followed.Prophy-lactic treatment is not needed for patients at low risk of developing sepsis fo-llowing elective laparoscopic cholecystectomy,although the opposite is suppor-ted.Similarly,superficial surgical infections are related to low morbidity.Patients without risk factors have a very low risk of infection.Thus,the routine use of anti-biotic prophylaxis in elective laparoscopic cholecystectomy is not recommended.展开更多
BACKGROUND Postoperative nausea-vomiting(PONV)occurs often after surgery performed under general anesthesia.Liberal fluid treatments are a low-cost and a low sideeffect alternative to pharmacological treatment in the ...BACKGROUND Postoperative nausea-vomiting(PONV)occurs often after surgery performed under general anesthesia.Liberal fluid treatments are a low-cost and a low sideeffect alternative to pharmacological treatment in the prevention of PONV.AIM To compare the effects of perioperative liberal and restrictive fluid therapy on PONV and recovery after laparoscopic cholecystectomy.METHODS A total of 160 patients were randomly allocated to two groups:Liberal fluid treatment group(group L),and restrictive fluid treatment group(group R).Three patients were excluded.Ringer’s lactate infusion was administered intravenously as follows:20 mL/kg/hour to group L,and 4 mL/kg/hour to group R.The primary outcomes were PONV incidence 24 hours postoperatively and the quality of recovery-15 scale at 24 hours postoperatively.RESULTS The incidence of PONV was significantly lower in group L(38.0%)compared with group R(70.5%)(relative risk:0.54,95%confidence interval:0.39-0.74,P<0.001).The quality of recovery-15 scale scores for overall satisfaction were significantly higher in group L compared with group R[137(135-141)vs 135(130-139),P=0.006].CONCLUSION Perioperative liberal fluid therapy reduced the incidence of PONV and improved the quality of postoperative recovery in patients undergoing laparoscopic cholecystectomy.展开更多
Background: Intraperitoneal instillation (IPI) of local anesthesia was reported to reduce postoperative pain after laparoscopic surgeries. We aim to evaluate the effectiveness of IPI of bupivacaine + dexmedetomidine v...Background: Intraperitoneal instillation (IPI) of local anesthesia was reported to reduce postoperative pain after laparoscopic surgeries. We aim to evaluate the effectiveness of IPI of bupivacaine + dexmedetomidine versus bupivacaine + dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy (LC). Methods: This randomized clinical trial was carried out on one hundred patients who underwent LC under general anesthesia. Patients were randomly divided into: Group (Dexa): IPI of bupivacaine with dexamethasone and Group (Dexmed): IPI of bupivacaine with dexmedetomidine. Results: The first time to request analgesia was significantly delayed in the dexmed group (P value Conclusions: Intraperitoneal Bupivacaine + Dexmedetomidine provided longer pain-free postoperative duration lower pain score over time, and lesser analgesic consumption.展开更多
To the Editor:Often patients who present with right upper quadrant abdominal pain may have biliary disease,such as biliary colic,acute cholecystitis,cholelithiasis,or choledocholithiasis.Other diagnoses include biliar...To the Editor:Often patients who present with right upper quadrant abdominal pain may have biliary disease,such as biliary colic,acute cholecystitis,cholelithiasis,or choledocholithiasis.Other diagnoses include biliary dyskinesia[gallbladder ejection fraction(EF)<35%][1],as well as biliary hyperkinesia(EF>80%),which is a less established diagnosis.Although the pathophysiology of biliary dyskinesia has a significant amount of evidence supporting surgical intervention,biliary hyperkinesia has not been investigated extensively.展开更多
BACKGROUND Post-operative nausea and vomiting(PONV)after cholecystectomy occurs in 40%-75%of patients,significantly affecting recovery and satisfaction.AIM To evaluate the effectiveness and safety of acupuncture at He...BACKGROUND Post-operative nausea and vomiting(PONV)after cholecystectomy occurs in 40%-75%of patients,significantly affecting recovery and satisfaction.AIM To evaluate the effectiveness and safety of acupuncture at Hegu(LI4)and Zusanli(ST36)acupoints in preventing PONV in patients undergoing cholecystectomy.METHODS This retrospective study included 240 patients undergoing cholecystectomy(January 2022 to December 2023),randomized to acupuncture(n=120)or control groups(n=120).The acupuncture group received bilateral LI4 and ST36 acupuncture immediately post-surgery and 6 hours later;controls received routine care.Primary outcomes included PONV incidence,severity(visual analogue scale score),and time to first occurrence.RESULTS The total PONV incidence in the acupuncture group was significantly lower than in the control group(28.3%vs 47.5%,P<0.01).Stratified analysis showed that in the laparoscopic group,the acupuncture group’s PONV incidence was 26.7%,significantly lower than the control group’s 45.6%(P<0.01);in the open surgery group,the acupuncture group was 33.3%,lower than the control group’s 53.3%(P<0.05).The acupuncture group showed significantly reduced symptom severity(visual analogue scale score 2.7±1.4 vs 4.5±1.8,P<0.01),delayed time to first occurrence(8.4±2.1 hours vs 4.2±1.5 hours,P<0.01),with the symptom-free period extended by 4.2 hours.The acupuncture group had a higher proportion of mild symptoms(76.5%vs 35.1%)and a significantly increased proportion of symptom-free patients within 6 hours post-surgery(67.6%vs 28.1%,P<0.01).Rescue antiemetic medication usage was significantly reduced in the acupuncture group(18.3%vs 35.8%,P<0.01).Patient satisfaction scores in the acupuncture group were significantly better than the control group(4.6±0.7 vs 3.8±0.9,P<0.01),with hospital stay shortened by 0.5 days(2.1±0.8 days vs 2.6±1.1 days,P<0.05).Subgroup analysis showed that acupuncture was more effective in patients≤45 years(incidence reduction 23.5%vs>45 years group 16.8%),with significant efficacy in high-risk patients(Apfel score≥3)(36.2%vs 62.2%,P<0.01).Safety analysis showed only 7 cases(5.8%)of mild adverse reactions in the acupuncture group,all self-resolved with no serious adverse events.CONCLUSION Acupuncture at LI4 and ST36 acupoints significantly reduces PONV incidence and severity after cholecystectomy,with an excellent safety profile.This non-pharmacological intervention offers particular value for high-risk patients and those with medication contraindications.展开更多
BACKGROUND Laparoscopic cholecystectomy(LC)is the primary treatment for acute calculous cholecystitis.Although rapid recovery nursing is commonly implemented in postoperative care,its effect on acute calculous cholecy...BACKGROUND Laparoscopic cholecystectomy(LC)is the primary treatment for acute calculous cholecystitis.Although rapid recovery nursing is commonly implemented in postoperative care,its effect on acute calculous cholecystitis after LC remains unclear.AIM To analyze the impact of rapid recovery nursing in patients with acute calculous cholecystitis undergoing LC.METHODS A retrospective study was conducted with a total of 120 patients with acute calculous cholecystitis who underwent LC at our hospital between October 2023 and October 2024.The patients were divided into two groups with 60 patients in each group according to the different nursing methods:Conventional nursing and rapid recovery nursing groups.Data was recorded from the electronic medical records.Gastrointestinal recovery,pain,quality of life,and nursing satisfaction were compared between the two groups before and after nursing.RESULTS Following nursing intervention,the visual analog scale scores on Days 3 and 7 post-surgery in the rapid recovery nursing group were notably lower than those of the conventional nursing group(P<0.05).The rapid recovery nursing group experienced significantly reduced times for bowel sound recovery,getting out of bed,hospital stay,passing flatus,and first defecation compared with the conventional nursing group(P<0.05),thereby experiencing significantly better quality of life and nursing satisfaction(P<0.05).CONCLUSION Rapid recovery nursing effectively promoted the recovery of gastrointestinal function,reducing pain and improving the quality of life of patients who underwent LC for acute calculous cholecystitis.展开更多
Cholecystectomy,one of the most common surgical procedures worldwide,is generally considered safe and effective.However,emerging evidence suggests a potential link between cholecystectomy and the development or progre...Cholecystectomy,one of the most common surgical procedures worldwide,is generally considered safe and effective.However,emerging evidence suggests a potential link between cholecystectomy and the development or progression of non-alcoholic fatty liver disease.This article examines the current understanding of this association,focusing on mechanisms such as altered bile acid metabolism,gut microbiota dysbiosis,and changes in lipid homeostasis.It addresses resolved challenges,including short-term metabolic effects,and highlights key unresolved questions,such as the long-term impact on liver health and specific at-risk populations.Finally,the review discusses future research directions and practical strategies for monitoring and managing liver health in patient’s post-cholecystectomy,aiming to improve outcomes and guide clinical practice.展开更多
BACKGROUND Although obesity is a well-established contributor to surgical risks,evidence regarding the specific outcomes of laparoscopic cholecystectomy(LC)in obese patients remains scarce.AIM To assess clinicopatholo...BACKGROUND Although obesity is a well-established contributor to surgical risks,evidence regarding the specific outcomes of laparoscopic cholecystectomy(LC)in obese patients remains scarce.AIM To assess clinicopathologic differences and 1-year outcomes following elective LC in patients with obesity and gallstone disease.METHODS This retrospective study analyzed data from 65 patients who underwent elective LC for gallstone disease between January 2020 and May 2022,with outcomes assessed at the 1-year follow-up.Patients were categorized as obese(body mass index≥25 kg/m^(2))or non-obese(body mass index<25 kg/m^(2)),and comparisons were made across preoperative laboratory values,intraoperative parameters,and patient-reported outcomes.RESULTS The obese group had significantly higher American Society of Anesthesiologists scores,higher glycated hemoglobin levels,and lower vitamin D levels than the non-obese group.Elevated triglycerides were more frequent in the obese group,whereas higher high-density lipoprotein levels were more common in the nonobese group.Intraoperative and postoperative outcomes did not differ between the groups.At the 1-year follow-up,24.6%of patients reported post-cholecystectomy symptoms,with no group differences.CONCLUSION Obese patients had higher American Society of Anesthesiologists scores,lower vitamin D,and elevated triglycerides preoperatively,but these differences did not significantly affect intraoperative findings or 1-year postoperative outcomes compared to non-obese patients.展开更多
BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluat...BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluate the effectiveness of prophylactic antibiotics in reducing these infections.METHODS A comprehensive retrospective evaluation was conducted on 400 patients who underwent LC from January 2022 to January 2024.Patients were divided into infected(n=36)and non-infected(n=364)groups based on the occurrence of SSIs.Data collected included age,diabetes mellitus status,use of prophylactic antibiotics,and specific surgical complications.Statistical analyses using SPSS(Version 27.0)involved univariate and multivariate logistic regression to determine factors influencing the risk of SSIs.RESULTS The use of prophylactic antibiotics significantly reduced the incidence of SSIs(χ²=68.34,P<0.01).Older age(≥60 years)and comorbidities such as diabetes mellitus were identified as significant risk factors.Surgical complications like insufficient cystic duct stump,gallbladder perforation,and empyema also increased SSI risk.Notably,factors such as intraoperative blood loss and operation time did not significantly impact SSI occurrence.CONCLUSION Prophylactic antibiotics are effective in reducing the risk of SSIs in patients undergoing LC.Age,diabetes mellitus,and certain surgical complications significantly contribute to the risk.Effective management of these risk factors is essential to improve surgical outcomes and reduce the incidence of SSIs.展开更多
BACKGROUND Laparoscopic cholecystectomy is the primary method for treating cholecystitis.Traditional postoperative care has poor outcomes for patient recovery.The enhanced recovery after surgery(ERAS)model is increasi...BACKGROUND Laparoscopic cholecystectomy is the primary method for treating cholecystitis.Traditional postoperative care has poor outcomes for patient recovery.The enhanced recovery after surgery(ERAS)model is increasingly applied in clinical settings.However,the impact of this nursing model on patients undergoing laparoscopic cholecystectomy remains unclear.AIM To evaluate the effects of ERAS on postoperative gastrointestinal recovery and quality of life in patients undergoing laparoscopic cholecystectomy.METHODS This is a retrospective study design in which we collected clinical data from 120 patients who underwent laparoscopic cholecystectomy at our hospital.Patients were divided into a control group(n=60)and a study group(n=60)based on the type of nursing intervention.The control group received conventional care,while the study group received ERAS.We assessed gastrointestinal recovery,quality of life,and nursing satisfaction before and after the nursing interventions in both groups.RESULTS After nursing care,the gastrointestinal recovery times(time to bowel sounds return,time to flatus,time to first bowel movement,and time to first meal)in the study group were significantly shorter than those in the control group,with statistically significant differences between the two groups(P<0.05).Additionally,the quality of life in the study group was significantly higher than that in the control group(P<0.05).The nursing satisfaction in the study group was also significantly higher than that in the control group,with statistically significant differences between the two groups(P<0.05).CONCLUSION In summary,compared to conventional nursing,ERAS can more rapidly promote gastrointestinal recovery and improve the quality of life in patients after laparoscopic cholecystectomy.Further clinical application of this approach is warranted.展开更多
BACKGROUND Among the rapidly developing single-incision laparoscopic cholecystectomy(LC)techniques,transumbilical single-incision LC is increasingly replacing the traditional LC,with advantages of minimal invasion,sli...BACKGROUND Among the rapidly developing single-incision laparoscopic cholecystectomy(LC)techniques,transumbilical single-incision LC is increasingly replacing the traditional LC,with advantages of minimal invasion,slight postoperative pain,faster recovery.Despite the advantages mentioned above,the currently available specialized single-port laparoscopic instruments are hindered by high costs and limited applications,challenging their widespread use in medical facilities.AIM To design a two-point lifting/retracting(TPLR)technique for transumbilical single-port LC(TUSPLC)based on the anatomical features of the Calot's triangle(or cystohepatic triangle)and investigate its surgical feasibility.METHODS The clinical data of 103 patients who underwent TUSPLC utilizing the TPLR technique in the Department of Hepatobiliary Surgery at our hospital between June 2023 and June 2024 were retrospectively analyzed.The patient cohort included 82 cases of cholelithiasis,11 cases of gallbladder polyps,6 cases of concurrent gallstones and polyps,and 4 cases of gallbladder adenomyomatosis.RESULTS All the surgical procedures were conducted using standard laparoscopic instruments.Surgery was successful in 98(95.14%)patients using the TPLR method,which effectively exposed the Calot's triangle during surgery.The operative time ranged from 35 to 70 minutes,with an average of 42.4±26.8 minutes.In 3 cases,an additional operative port was required below the xiphoid process,and 2 cases were converted to conventional three-port LC.No complications such as abdominal pain,fever,bile leakage,hemorrhage,or incisional infection were noted postoperatively.No discernible surgical scars were observed at the 2-week postoperative reexamination.Additionally,a 3-month follow-up period revealed no complications.CONCLUSION The TPLR technique,developed based on the anatomical features of the Calot's triangle,facilitates exposure of the Calot's triangle during surgery.It is a simple,safe,feasible,and cost-effective method,and a promising approach for single-port LC.展开更多
BACKGROUND Cholecystectomy is a common surgical procedure routinely performed for patients with benign gallbladder disease.The most common indications for cholecystectomy are acute or chronic cholecystitis with or wit...BACKGROUND Cholecystectomy is a common surgical procedure routinely performed for patients with benign gallbladder disease.The most common indications for cholecystectomy are acute or chronic cholecystitis with or without cholelithiasis.However,in rare instances,incidental findings ranging from benign to malignant conditions are encountered,of which gallbladder adenocarcinoma is an aggre-ssive and fatal disease.AIM To determine the prevalence of all incidental diagnoses in routinely performed cholecystectomy specimens,with a particular emphasis on adenocarcinoma,and to characterize the clinicopathological characteristics of malignant postoperative specimens.METHODS The electronic medical record and institutional pathology database were searched for analyses done on gallbladder specimens from patients who had a routine cholecystectomy for benign gallbladder disease during the study period(February 2000 to February 2023).A total of 30678 cholecystectomies performed across the study period were included for analysis.Patients who had preoperative findings or radiological results concerning malignancy were excluded.The demographic and clinical data including patient age and gender,preoperative diagnosis,ra-diographic results at time of diagnosis,gross and morphologic features of gallbladder specimens,and pathologic staging parameters according to the American Joint Committee on Cancer were recorded.RESULTS Of the 30678 cholecystectomy specimens received by the Department of Pathology from patients with who had cholecystectomy for putative benign gallbladder disease during the study period,42(0.14%)were determined to be incidental gallbladder adenocarcinoma and 1 was adenocarcinoma in situ.There were 2 benign incidental dia-gnoses,including 9 patients(0.02%)with accessory/ectopic liver lobe,and 3 with paraganglioma.CONCLUSION Thorough histopathological examination of routine gallbladder specimens is important to provide an early diagnosis of unexpected gallbladder cancer to ensure that patients receive timely care when the disease is treatable.展开更多
To the Editor:Common gallbladder diseases include gallstones,acute acalculous cholecystitis,chronic cholecystitis,functional gallbladder disorders,gallbladder polyps,gallbladder adenomyomatosis,and gallbladder cancer....To the Editor:Common gallbladder diseases include gallstones,acute acalculous cholecystitis,chronic cholecystitis,functional gallbladder disorders,gallbladder polyps,gallbladder adenomyomatosis,and gallbladder cancer.Laparoscopic cholecystectomy(LC)is the preferred treatment for gallstones with accompanying acute cholecystitis(AC),acute acalculous cholecystitis,chronic cholecystitis,gallbladder polyps(>10 mm),and gallbladder adenomyomatosis[1,2].In 1882,Professor Lamgenbuch completed the first cholecystectomy and placed a drain in the abdominal cavity as part of the surgical procedure[3].The placement of a drainage tube after cholecystectomy used to be a routine procedure.展开更多
BACKGROUND Gallbladder stones are a common occurrence,with a prevalence of approximately 10%in the Pakistani population.A rare but potentially fatal complication of gallstones is cholecystogastric fistulas.The underly...BACKGROUND Gallbladder stones are a common occurrence,with a prevalence of approximately 10%in the Pakistani population.A rare but potentially fatal complication of gallstones is cholecystogastric fistulas.The underlying mechanism involves chronic inflammation due to cholelithiasis,causing gradual erosion and eventually leading to fistula formation.CASE SUMMARY We present a rare case of a cholecystogastric fistula in a 40-year-old female patient,successfully managed with an open surgical approach.The patient initially presented with a 6-month history of intermittent epigastric pain,nausea,and vomiting,which worsened over time.Laboratory investigations and abdominal ultrasound confirmed cholelithiasis,and laparoscopic cholecystectomy was planned.However,intraoperative findings revealed a cholecystogastric fistula,a rare complication of chronic gallstone disease.Given the dense adhesions between the gallbladder and the stomach,the procedure was converted to an open surgery.The fistula was divided,and a cholecystectomy was performed,along with primary repair of the gastric defect using a double-layer suture and reinforcement with an omental patch.The patient recovered uneventfully and was discharged on the third postoperative day.CONCLUSION This case highlights the importance of considering cholecystogastric fistula in patients with vague gastrointestinal symptoms and chronic cholelithiasis.The report discusses diagnostic challenges,surgical approaches,and a review of the current literature on managing such rare but serious complications of gallstones.展开更多
BACKGROUND Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Cholecystectomy remains the definitive treatment of choice to prevent recurrence.The rate of early cholecystectomies during inde...BACKGROUND Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Cholecystectomy remains the definitive treatment of choice to prevent recurrence.The rate of early cholecystectomies during index admission remains low due toperceived increased risk of complications.AIMTo compare outcomes including length of stay, duration of surgery, biliarycomplications, conversion to open cholecystectomy, intra-operative, and postoperativecomplications between patients who undergo cholecystectomy duringindex admission as compared to those who undergo cholecystectomy thereafter.METHODSStatistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (randomeffects model).RESULTSInitial search identified 163 reference articles, of which 45 were selected andreviewed. Eighteen studies (n = 2651) that met the inclusion criteria were includedin this analysis. Median age of patients in the late group was 43.8 years while thatin the early group was 43.6. Pooled analysis showed late laparoscopiccholecystectomy group was associated with an increased length of stay by 88.96 h(95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled riskdifference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group.Pooled analysis showed no risk difference in intraoperative complications [riskdifference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [riskdifference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy[risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and latecholecystectomy groups. Pooled analysis showed the duration of surgery to beprolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy groupas compared to the early group.CONCLUSIONIn patients with mild gallstone pancreatitis early cholecystectomy leads to shorterhospital stay, shorter duration of surgery, while decreasing the risk of biliarycomplications. Rate of intraoperative, post-operative complications and chances ofconversion to open cholecystectomy do not significantly differ whethercholecystectomy was performed early or late.展开更多
文摘Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-calculous cholecystitis,gallbladder polyps larger than 1.0 cm,and porcelain gallbladder,etc.Currently,laparoscopic cholecystectomy(LC)constitutes over 95%of all cholecystectomy procedures,which is the preferred approach for gallbladder surgery[1,2].
文摘BACKGROUND Although single-port laparoscopic cholecystectomy has been performed for over 25 years, it is still not popular. The narrow working space used in this surgery limits the movement of instruments and causes ergonomic challenges. Robotic surgery not only resolves the ergonomic challenges of single-port laparoscopic surgery but is also considered a good option with its additional technical advantages, like a three-dimensional display and not being affected by tremors.However, the extent to which these technical and ergonomic advantages positively affect the surgical outcomes and how safe the single-port robotic surgeries need to be assessed for each particular surgery.AIM To evaluate the feasibility and safety of single-port robotic cholecystectomy for patients with cholelithiasis.METHODS The electronic records of the first 40 consecutive patients with gallbladder lithiasis who underwent single-port robotic cholecystectomy from 2013 to 2021 were analyzed retrospectively. In addition to the demographic characteristics of the patients, we analyzed American Society of Anesthesiologists(ASA) scores and body mass index. The presence of an accompanying umbilical hernia was also noted. The amount of blood loss during the operation, the necessity to place a drain in the subhepatic area, and the need to use grafts during the closure of the fascia of the port site were determined. Hospital stay, readmission rates, perioperative and postoperative complications, the Clavien-Dindo complication scores and postoperative analgesia requirements were also evaluated.RESULTS The mean age of the 40 patients included in the study was 49.5 ± 11.6 years, and 26 were female(65.0%). The umbilical hernia was present in 24(60.0%) patients,with a body mass index median of 29.3 kg/m^(2) and a mean of 29.7 ± 5.2 kg/m^(2). Fifteen(37.5%) of the patients were evaluated as ASA Ⅰ, 18(45.0%) as ASA Ⅱ, and 7(17.5%) as ASA Ⅲ. The mean bleeding amount during the operation was 58.4 ± 55.8 mL, and drain placement was required in 12patients(30.0%). After port removal, graft reinforcement during fascia closure was preferred in 14patients(35.0%). The median operation time was 93.5 min and the mean was 101.2 ± 27.0 min. The mean hospital stay was 1.4 ± 0.6 d, and 1 patient was readmitted to the hospital due to pain(2.5%).Clavien-Dindo I complications were seen in 14 patients(35.0%), and five(12.5%) complications were wound site problems.CONCLUSION In addition to the technological and ergonomic advantages robotic surgery provides surgeons, our study strongly supports that single-port robotic cholecystectomy is a feasible and safe option for treating patients with gallstones.
文摘In this article,we discussed the article by Sohail et al,published in a recent issue of the World Journal of Gastrointestinal Endoscopy.This study highlights the benefits of performing cholecystectomy(CCY)during the same hospitalization for patients with acute cholangitis(AC)associated with gallstones.Specifically,same-admission CCY is associated with significantly lower 30-day readmission rates compared with interval CCY.Furthermore,it has been associated with reduced mortality rates and reduced recurrence of biliary symptoms.Despite these advantages,the procedure is chosen in only a minority of eligible patients.This gap between evidence and practice highlights the need for updated clinical guidelines and further research to optimize the timing of CCY in the management of AC.
文摘Cholecystectomy is a commonly performed surgical procedure globally,primarily for symptomatic cholelithiasis or related gallbladder conditions.Advances in surgical techniques,such as laparoscopic and robotic approaches,have enhanced patient results and reduced hospital stays.However,postoperative care is crucial for optimizing recovery,preventing complications,and enhancing quality of life.Nurses have a critical role in achieving these objectives,starting from immediate postoperative evaluation through long-term monitoring.This review outlines essential nursing considerations and evidence-based practices for postoperative care following cholecystectomy.Key areas encompass pain control,respiratory assistance,early mobilization,wound and drain management,nutritional advice,psychosocial aid,and discharge preparation.By integrating current research and clinical guidelines,this review aims to serve as an authoritative resource to assist nurses in improving postoperative outcomes and patient satisfaction.
基金Supported by Suzhou Hepatobiliary Surgery Clinical Medical Center Construction Fund Project,No.szlcyxzxj202107。
文摘BACKGROUND With an aging society,older patients undergoing cholecystectomy often have multiple chronic diseases and require long-term multi-medication.Medication complexity significantly increases the risk of medication errors and adverse reactions,and effective nursing interventions are urgently required to ensure medication safety.AIM To investigate the efficacy of evidence-based nursing practices in mitigating polypharmacy risks among Suzhou Municipal Hospital Road Front Yard Area,thereby providing clinical guidance.METHODS The sixty older patients who underwent cholecystectomy between September 2024 and September 2025 treated with polypharmacy were enrolled.Using random number tables,hey were divided into study and control groups(n=30 each),who received routine medication nursing and evidence-based nursing,respectively.Pre-intervention and post-intervention comparisons were made between groups for medication knowledge,competence,and adherence scores.The incidences of duplicate medications,missed doses,self-discontinuation,unauthorized alterations,schedule changes,and adverse reaction rates assessed potential medication risks.RESULTS Both the study and control groups showed significant increases in medication knowledge,management competence,and adherence scores after intervention(all P<0.05).The study group had higher post-intervention scores(medication knowledge:87.29±5.09 vs 70.62±5.38;medication management competence:63.22±3.11 vs 56.19±4.08;medication adherence:7.13±1.04 vs 6.05±1.03,all P<0.05).The incidence of duplicate medication,missed doses,self-discontinuation,unauthorized dose alterations,and schedule modifications decreased in both groups post-intervention(all P<0.05),with lower rates in the study group(duplicate medication:13.33%vs 30.0%;missed doses:10.0%vs 26.67%;all P<0.05).The study group had a lower adverse reaction rate(3.33%vs 26.67%,P<0.05)and more patients with potential medication hazard level 0(83.33%vs 53.33%),while fewer patients had level 2 and 3 hazards(3.33%vs 16.67%and 0%vs 10.00%,respectively;all P<0.05).CONCLUSION Evidence-based nursing for polypharmacy risks in older adults undergoing cholecystectomy can enhance medication awareness,improve management and adherence,reduce adverse behaviors,and lower adverse reactions and hazard levels.
文摘Inappropriate use of antibiotics leads to microbial resistance.Single-dose antibio-tic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk patients despite some conflicting aspects.High-risk patients are those who are older than 70 years,have diabetes mellitus,whose operation time exceeded 120 minutes,have acute cholecystitis,experienced iatrogenic intraoperative gallbladder perforation resulting in bile or gallstone spillage,suffered from obstructive jaundice,or were deemed immuno-compromised.For gallbladder perforation,one dose of antibiotic prophylaxis is sufficient.Therefore,guidelines are needed and must be strictly followed.Prophy-lactic treatment is not needed for patients at low risk of developing sepsis fo-llowing elective laparoscopic cholecystectomy,although the opposite is suppor-ted.Similarly,superficial surgical infections are related to low morbidity.Patients without risk factors have a very low risk of infection.Thus,the routine use of anti-biotic prophylaxis in elective laparoscopic cholecystectomy is not recommended.
文摘BACKGROUND Postoperative nausea-vomiting(PONV)occurs often after surgery performed under general anesthesia.Liberal fluid treatments are a low-cost and a low sideeffect alternative to pharmacological treatment in the prevention of PONV.AIM To compare the effects of perioperative liberal and restrictive fluid therapy on PONV and recovery after laparoscopic cholecystectomy.METHODS A total of 160 patients were randomly allocated to two groups:Liberal fluid treatment group(group L),and restrictive fluid treatment group(group R).Three patients were excluded.Ringer’s lactate infusion was administered intravenously as follows:20 mL/kg/hour to group L,and 4 mL/kg/hour to group R.The primary outcomes were PONV incidence 24 hours postoperatively and the quality of recovery-15 scale at 24 hours postoperatively.RESULTS The incidence of PONV was significantly lower in group L(38.0%)compared with group R(70.5%)(relative risk:0.54,95%confidence interval:0.39-0.74,P<0.001).The quality of recovery-15 scale scores for overall satisfaction were significantly higher in group L compared with group R[137(135-141)vs 135(130-139),P=0.006].CONCLUSION Perioperative liberal fluid therapy reduced the incidence of PONV and improved the quality of postoperative recovery in patients undergoing laparoscopic cholecystectomy.
文摘Background: Intraperitoneal instillation (IPI) of local anesthesia was reported to reduce postoperative pain after laparoscopic surgeries. We aim to evaluate the effectiveness of IPI of bupivacaine + dexmedetomidine versus bupivacaine + dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy (LC). Methods: This randomized clinical trial was carried out on one hundred patients who underwent LC under general anesthesia. Patients were randomly divided into: Group (Dexa): IPI of bupivacaine with dexamethasone and Group (Dexmed): IPI of bupivacaine with dexmedetomidine. Results: The first time to request analgesia was significantly delayed in the dexmed group (P value Conclusions: Intraperitoneal Bupivacaine + Dexmedetomidine provided longer pain-free postoperative duration lower pain score over time, and lesser analgesic consumption.
文摘To the Editor:Often patients who present with right upper quadrant abdominal pain may have biliary disease,such as biliary colic,acute cholecystitis,cholelithiasis,or choledocholithiasis.Other diagnoses include biliary dyskinesia[gallbladder ejection fraction(EF)<35%][1],as well as biliary hyperkinesia(EF>80%),which is a less established diagnosis.Although the pathophysiology of biliary dyskinesia has a significant amount of evidence supporting surgical intervention,biliary hyperkinesia has not been investigated extensively.
文摘BACKGROUND Post-operative nausea and vomiting(PONV)after cholecystectomy occurs in 40%-75%of patients,significantly affecting recovery and satisfaction.AIM To evaluate the effectiveness and safety of acupuncture at Hegu(LI4)and Zusanli(ST36)acupoints in preventing PONV in patients undergoing cholecystectomy.METHODS This retrospective study included 240 patients undergoing cholecystectomy(January 2022 to December 2023),randomized to acupuncture(n=120)or control groups(n=120).The acupuncture group received bilateral LI4 and ST36 acupuncture immediately post-surgery and 6 hours later;controls received routine care.Primary outcomes included PONV incidence,severity(visual analogue scale score),and time to first occurrence.RESULTS The total PONV incidence in the acupuncture group was significantly lower than in the control group(28.3%vs 47.5%,P<0.01).Stratified analysis showed that in the laparoscopic group,the acupuncture group’s PONV incidence was 26.7%,significantly lower than the control group’s 45.6%(P<0.01);in the open surgery group,the acupuncture group was 33.3%,lower than the control group’s 53.3%(P<0.05).The acupuncture group showed significantly reduced symptom severity(visual analogue scale score 2.7±1.4 vs 4.5±1.8,P<0.01),delayed time to first occurrence(8.4±2.1 hours vs 4.2±1.5 hours,P<0.01),with the symptom-free period extended by 4.2 hours.The acupuncture group had a higher proportion of mild symptoms(76.5%vs 35.1%)and a significantly increased proportion of symptom-free patients within 6 hours post-surgery(67.6%vs 28.1%,P<0.01).Rescue antiemetic medication usage was significantly reduced in the acupuncture group(18.3%vs 35.8%,P<0.01).Patient satisfaction scores in the acupuncture group were significantly better than the control group(4.6±0.7 vs 3.8±0.9,P<0.01),with hospital stay shortened by 0.5 days(2.1±0.8 days vs 2.6±1.1 days,P<0.05).Subgroup analysis showed that acupuncture was more effective in patients≤45 years(incidence reduction 23.5%vs>45 years group 16.8%),with significant efficacy in high-risk patients(Apfel score≥3)(36.2%vs 62.2%,P<0.01).Safety analysis showed only 7 cases(5.8%)of mild adverse reactions in the acupuncture group,all self-resolved with no serious adverse events.CONCLUSION Acupuncture at LI4 and ST36 acupoints significantly reduces PONV incidence and severity after cholecystectomy,with an excellent safety profile.This non-pharmacological intervention offers particular value for high-risk patients and those with medication contraindications.
文摘BACKGROUND Laparoscopic cholecystectomy(LC)is the primary treatment for acute calculous cholecystitis.Although rapid recovery nursing is commonly implemented in postoperative care,its effect on acute calculous cholecystitis after LC remains unclear.AIM To analyze the impact of rapid recovery nursing in patients with acute calculous cholecystitis undergoing LC.METHODS A retrospective study was conducted with a total of 120 patients with acute calculous cholecystitis who underwent LC at our hospital between October 2023 and October 2024.The patients were divided into two groups with 60 patients in each group according to the different nursing methods:Conventional nursing and rapid recovery nursing groups.Data was recorded from the electronic medical records.Gastrointestinal recovery,pain,quality of life,and nursing satisfaction were compared between the two groups before and after nursing.RESULTS Following nursing intervention,the visual analog scale scores on Days 3 and 7 post-surgery in the rapid recovery nursing group were notably lower than those of the conventional nursing group(P<0.05).The rapid recovery nursing group experienced significantly reduced times for bowel sound recovery,getting out of bed,hospital stay,passing flatus,and first defecation compared with the conventional nursing group(P<0.05),thereby experiencing significantly better quality of life and nursing satisfaction(P<0.05).CONCLUSION Rapid recovery nursing effectively promoted the recovery of gastrointestinal function,reducing pain and improving the quality of life of patients who underwent LC for acute calculous cholecystitis.
文摘Cholecystectomy,one of the most common surgical procedures worldwide,is generally considered safe and effective.However,emerging evidence suggests a potential link between cholecystectomy and the development or progression of non-alcoholic fatty liver disease.This article examines the current understanding of this association,focusing on mechanisms such as altered bile acid metabolism,gut microbiota dysbiosis,and changes in lipid homeostasis.It addresses resolved challenges,including short-term metabolic effects,and highlights key unresolved questions,such as the long-term impact on liver health and specific at-risk populations.Finally,the review discusses future research directions and practical strategies for monitoring and managing liver health in patient’s post-cholecystectomy,aiming to improve outcomes and guide clinical practice.
基金Supported by Biomedical Research Institute Grant from Pusan National University Hospital,No.202500360001.
文摘BACKGROUND Although obesity is a well-established contributor to surgical risks,evidence regarding the specific outcomes of laparoscopic cholecystectomy(LC)in obese patients remains scarce.AIM To assess clinicopathologic differences and 1-year outcomes following elective LC in patients with obesity and gallstone disease.METHODS This retrospective study analyzed data from 65 patients who underwent elective LC for gallstone disease between January 2020 and May 2022,with outcomes assessed at the 1-year follow-up.Patients were categorized as obese(body mass index≥25 kg/m^(2))or non-obese(body mass index<25 kg/m^(2)),and comparisons were made across preoperative laboratory values,intraoperative parameters,and patient-reported outcomes.RESULTS The obese group had significantly higher American Society of Anesthesiologists scores,higher glycated hemoglobin levels,and lower vitamin D levels than the non-obese group.Elevated triglycerides were more frequent in the obese group,whereas higher high-density lipoprotein levels were more common in the nonobese group.Intraoperative and postoperative outcomes did not differ between the groups.At the 1-year follow-up,24.6%of patients reported post-cholecystectomy symptoms,with no group differences.CONCLUSION Obese patients had higher American Society of Anesthesiologists scores,lower vitamin D,and elevated triglycerides preoperatively,but these differences did not significantly affect intraoperative findings or 1-year postoperative outcomes compared to non-obese patients.
文摘BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluate the effectiveness of prophylactic antibiotics in reducing these infections.METHODS A comprehensive retrospective evaluation was conducted on 400 patients who underwent LC from January 2022 to January 2024.Patients were divided into infected(n=36)and non-infected(n=364)groups based on the occurrence of SSIs.Data collected included age,diabetes mellitus status,use of prophylactic antibiotics,and specific surgical complications.Statistical analyses using SPSS(Version 27.0)involved univariate and multivariate logistic regression to determine factors influencing the risk of SSIs.RESULTS The use of prophylactic antibiotics significantly reduced the incidence of SSIs(χ²=68.34,P<0.01).Older age(≥60 years)and comorbidities such as diabetes mellitus were identified as significant risk factors.Surgical complications like insufficient cystic duct stump,gallbladder perforation,and empyema also increased SSI risk.Notably,factors such as intraoperative blood loss and operation time did not significantly impact SSI occurrence.CONCLUSION Prophylactic antibiotics are effective in reducing the risk of SSIs in patients undergoing LC.Age,diabetes mellitus,and certain surgical complications significantly contribute to the risk.Effective management of these risk factors is essential to improve surgical outcomes and reduce the incidence of SSIs.
文摘BACKGROUND Laparoscopic cholecystectomy is the primary method for treating cholecystitis.Traditional postoperative care has poor outcomes for patient recovery.The enhanced recovery after surgery(ERAS)model is increasingly applied in clinical settings.However,the impact of this nursing model on patients undergoing laparoscopic cholecystectomy remains unclear.AIM To evaluate the effects of ERAS on postoperative gastrointestinal recovery and quality of life in patients undergoing laparoscopic cholecystectomy.METHODS This is a retrospective study design in which we collected clinical data from 120 patients who underwent laparoscopic cholecystectomy at our hospital.Patients were divided into a control group(n=60)and a study group(n=60)based on the type of nursing intervention.The control group received conventional care,while the study group received ERAS.We assessed gastrointestinal recovery,quality of life,and nursing satisfaction before and after the nursing interventions in both groups.RESULTS After nursing care,the gastrointestinal recovery times(time to bowel sounds return,time to flatus,time to first bowel movement,and time to first meal)in the study group were significantly shorter than those in the control group,with statistically significant differences between the two groups(P<0.05).Additionally,the quality of life in the study group was significantly higher than that in the control group(P<0.05).The nursing satisfaction in the study group was also significantly higher than that in the control group,with statistically significant differences between the two groups(P<0.05).CONCLUSION In summary,compared to conventional nursing,ERAS can more rapidly promote gastrointestinal recovery and improve the quality of life in patients after laparoscopic cholecystectomy.Further clinical application of this approach is warranted.
文摘BACKGROUND Among the rapidly developing single-incision laparoscopic cholecystectomy(LC)techniques,transumbilical single-incision LC is increasingly replacing the traditional LC,with advantages of minimal invasion,slight postoperative pain,faster recovery.Despite the advantages mentioned above,the currently available specialized single-port laparoscopic instruments are hindered by high costs and limited applications,challenging their widespread use in medical facilities.AIM To design a two-point lifting/retracting(TPLR)technique for transumbilical single-port LC(TUSPLC)based on the anatomical features of the Calot's triangle(or cystohepatic triangle)and investigate its surgical feasibility.METHODS The clinical data of 103 patients who underwent TUSPLC utilizing the TPLR technique in the Department of Hepatobiliary Surgery at our hospital between June 2023 and June 2024 were retrospectively analyzed.The patient cohort included 82 cases of cholelithiasis,11 cases of gallbladder polyps,6 cases of concurrent gallstones and polyps,and 4 cases of gallbladder adenomyomatosis.RESULTS All the surgical procedures were conducted using standard laparoscopic instruments.Surgery was successful in 98(95.14%)patients using the TPLR method,which effectively exposed the Calot's triangle during surgery.The operative time ranged from 35 to 70 minutes,with an average of 42.4±26.8 minutes.In 3 cases,an additional operative port was required below the xiphoid process,and 2 cases were converted to conventional three-port LC.No complications such as abdominal pain,fever,bile leakage,hemorrhage,or incisional infection were noted postoperatively.No discernible surgical scars were observed at the 2-week postoperative reexamination.Additionally,a 3-month follow-up period revealed no complications.CONCLUSION The TPLR technique,developed based on the anatomical features of the Calot's triangle,facilitates exposure of the Calot's triangle during surgery.It is a simple,safe,feasible,and cost-effective method,and a promising approach for single-port LC.
文摘BACKGROUND Cholecystectomy is a common surgical procedure routinely performed for patients with benign gallbladder disease.The most common indications for cholecystectomy are acute or chronic cholecystitis with or without cholelithiasis.However,in rare instances,incidental findings ranging from benign to malignant conditions are encountered,of which gallbladder adenocarcinoma is an aggre-ssive and fatal disease.AIM To determine the prevalence of all incidental diagnoses in routinely performed cholecystectomy specimens,with a particular emphasis on adenocarcinoma,and to characterize the clinicopathological characteristics of malignant postoperative specimens.METHODS The electronic medical record and institutional pathology database were searched for analyses done on gallbladder specimens from patients who had a routine cholecystectomy for benign gallbladder disease during the study period(February 2000 to February 2023).A total of 30678 cholecystectomies performed across the study period were included for analysis.Patients who had preoperative findings or radiological results concerning malignancy were excluded.The demographic and clinical data including patient age and gender,preoperative diagnosis,ra-diographic results at time of diagnosis,gross and morphologic features of gallbladder specimens,and pathologic staging parameters according to the American Joint Committee on Cancer were recorded.RESULTS Of the 30678 cholecystectomy specimens received by the Department of Pathology from patients with who had cholecystectomy for putative benign gallbladder disease during the study period,42(0.14%)were determined to be incidental gallbladder adenocarcinoma and 1 was adenocarcinoma in situ.There were 2 benign incidental dia-gnoses,including 9 patients(0.02%)with accessory/ectopic liver lobe,and 3 with paraganglioma.CONCLUSION Thorough histopathological examination of routine gallbladder specimens is important to provide an early diagnosis of unexpected gallbladder cancer to ensure that patients receive timely care when the disease is treatable.
基金supported by grants from the National Key Re-search and Development Program of China(2018YFC2000500)Research Project of Jinan Microecological Biomedicine Shandong Laboratory(JNL-2022022C)。
文摘To the Editor:Common gallbladder diseases include gallstones,acute acalculous cholecystitis,chronic cholecystitis,functional gallbladder disorders,gallbladder polyps,gallbladder adenomyomatosis,and gallbladder cancer.Laparoscopic cholecystectomy(LC)is the preferred treatment for gallstones with accompanying acute cholecystitis(AC),acute acalculous cholecystitis,chronic cholecystitis,gallbladder polyps(>10 mm),and gallbladder adenomyomatosis[1,2].In 1882,Professor Lamgenbuch completed the first cholecystectomy and placed a drain in the abdominal cavity as part of the surgical procedure[3].The placement of a drainage tube after cholecystectomy used to be a routine procedure.
文摘BACKGROUND Gallbladder stones are a common occurrence,with a prevalence of approximately 10%in the Pakistani population.A rare but potentially fatal complication of gallstones is cholecystogastric fistulas.The underlying mechanism involves chronic inflammation due to cholelithiasis,causing gradual erosion and eventually leading to fistula formation.CASE SUMMARY We present a rare case of a cholecystogastric fistula in a 40-year-old female patient,successfully managed with an open surgical approach.The patient initially presented with a 6-month history of intermittent epigastric pain,nausea,and vomiting,which worsened over time.Laboratory investigations and abdominal ultrasound confirmed cholelithiasis,and laparoscopic cholecystectomy was planned.However,intraoperative findings revealed a cholecystogastric fistula,a rare complication of chronic gallstone disease.Given the dense adhesions between the gallbladder and the stomach,the procedure was converted to an open surgery.The fistula was divided,and a cholecystectomy was performed,along with primary repair of the gastric defect using a double-layer suture and reinforcement with an omental patch.The patient recovered uneventfully and was discharged on the third postoperative day.CONCLUSION This case highlights the importance of considering cholecystogastric fistula in patients with vague gastrointestinal symptoms and chronic cholelithiasis.The report discusses diagnostic challenges,surgical approaches,and a review of the current literature on managing such rare but serious complications of gallstones.
文摘BACKGROUND Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Cholecystectomy remains the definitive treatment of choice to prevent recurrence.The rate of early cholecystectomies during index admission remains low due toperceived increased risk of complications.AIMTo compare outcomes including length of stay, duration of surgery, biliarycomplications, conversion to open cholecystectomy, intra-operative, and postoperativecomplications between patients who undergo cholecystectomy duringindex admission as compared to those who undergo cholecystectomy thereafter.METHODSStatistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (randomeffects model).RESULTSInitial search identified 163 reference articles, of which 45 were selected andreviewed. Eighteen studies (n = 2651) that met the inclusion criteria were includedin this analysis. Median age of patients in the late group was 43.8 years while thatin the early group was 43.6. Pooled analysis showed late laparoscopiccholecystectomy group was associated with an increased length of stay by 88.96 h(95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled riskdifference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group.Pooled analysis showed no risk difference in intraoperative complications [riskdifference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [riskdifference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy[risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and latecholecystectomy groups. Pooled analysis showed the duration of surgery to beprolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy groupas compared to the early group.CONCLUSIONIn patients with mild gallstone pancreatitis early cholecystectomy leads to shorterhospital stay, shorter duration of surgery, while decreasing the risk of biliarycomplications. Rate of intraoperative, post-operative complications and chances ofconversion to open cholecystectomy do not significantly differ whethercholecystectomy was performed early or late.
