BACKGROUND An 81-year-old patient presented to our center with pancreatic head cancer,obstructive jaundice,and acute cholecystitis.Due to duodenal tumor infiltration,both endoscopic retrograde cholangiopancreatography...BACKGROUND An 81-year-old patient presented to our center with pancreatic head cancer,obstructive jaundice,and acute cholecystitis.Due to duodenal tumor infiltration,both endoscopic retrograde cholangiopancreatography and endoscopic ultrasound(EUS)-guided choledochoduodenostomy were technically challenging.CASE SUMMARY An EUS-guided gallbladder drainage along with an EUS-guided fine needle biopsy were performed,resulting in a diagnosis of pancreatic cancer resolution of jaundice and improvement in acute cholecystitis,all in a safe and effective single endoscopic session.CONCLUSION This case demonstrated the successful use of EUS-guided gallbladder drainage and EUS-guided fine needle biopsy in a patient with pancreatic cancer invading the duodenal wall.展开更多
BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency c...BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency cholecystectomy is the standard of care,it may not be feasible in unstable patients.Percutaneous transhepatic cholecystostomy(PTC)offers a minimally invasive alternative.AIM To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC.METHODS We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center.All patients underwent PTC as the initial intervention.Data collected included demographics,comorbidities,laboratory and imaging findings,complications,and clinical outcomes over a 24-month follow-up.Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy.RESULTS Thirty patients underwent PTC for APC.Half of the patients(n=15)were stabilized and later underwent cholecystectomy;the remaining 15 were managed non-operatively.Patients in the non-surgical group were significantly older(87.1±6.2 years vs 76.1±7.4 years;P<0.001).Clinical improvement was observed in 61.4%of non-operated patients,with eventual drain removal or closure.Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge.No significant differences were found in hospital stay or complication rates.During follow-up,three deaths occurred due to non-biliary causes.Only one patient required repeat drainage.CONCLUSION PTC is a safe and effective initial treatment for APC,particularly in elderly and comorbid patients for whom surgery poses excessive risk.It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients.These findings support the broader use of PTC in the management of APC,although larger prospective studies are warranted.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
BACKGROUND: In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cho...BACKGROUND: In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy.METHODS: In 91 patients(American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis ≥72 hours at hospital admission and who did not respond to nonoperative treatment(48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at ≥4 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average(range 7-29).RESULT: Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19(40%) vs 8(19%); P=0.029], a frequency of intraoperative bleeding ≥100 mL [16(33%) vs 4(9%); P=0.006],a mean postoperative hospital stay(5.3±3.3 vs 3.0±2.4 days;P=0.001), and a frequency of complications [17(35%) vs 4(9%);P=0.003].CONCLUSION: In patients with acute cholecystitis who presented to the hospital ≥72 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.展开更多
AIM： To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct （CBD） stone removal. METHODS： A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder （GB） i...AIM： To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct （CBD） stone removal. METHODS： A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder （GB） in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively. The following factors were considered while evaluating risk factors for the development of acute cholecystitis： age, gender, serum bUirubin level, GB wall thickening, cystic duct patency, presence of a GB stone, CBD diameter, residual stone, lithotripsy, juxtapapillary diverticulum, presence of liver cirrhosis or diabetes mellitus, a presenting illness of cholangitis or pancreatitis, and procedure-related complications. RESULTS： During a mean 18-mo follow-up, 28 （28%） patients developed biliary symptoms; 17 （17%） acute cholecystitis and 13 （13%） CBD stone recurrence. Of patients with acute cholecystitis, 15 （88.2%） received laparoscopic cholecystectomy and 2 （11.8%） open cholecystectomy. All recurrent CBD stones were successfully removed endoscopically. The mean time elapse to acute cholecystitis was 10.2 mo （1-37 mo） and that to recurrent CBD stone was 18.4 mo. Of the 17 patients who received cholecystectomy, 2 （11.8%） developed recurrent CBD stones after cholecystectomy. By multivariate analysis, a serum total bUirubin level of 〈1.3 mg/dL and a CBD diameter of 〈11 mm at the time of stone removal were found to predict the development of acute cholecystitis. CONCLUSION： After CBD stone removal, there is no need for routine prophylactic cholecystectomy. However, patients without a dilated bile duct （〈11 mm） and jaundice （〈1.3 mg/dL） at the time of CBD stone removal have a higher risk of acute cholecystitis and are possible candidates for prophylactic cholecystectomy.展开更多
AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patien...AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted. Data collected included demographic data, co-morbidities, symptoms and physical findings at presentation, laboratory and radiological investigations, length of stay, complications, and admission service (medical or surgical). Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis. Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures, presenting signs, and admitting service with time to surgery.RESULTS: Seventy cases met inclusion and exclusion criteria, among which 12 were admitted to the medical service and 58 to the surgical service. Mean ± SD time to surgery was 39.3 ± 43 h, with 87% of operations performed within 72 h of hospital arrival. In the adjusted models, longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP, P = 0.01) as well with admission to medical service without adjustment for ERCP (P < 0.05). Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery. Patients admitted to the surgical versus medical service underwent surgery earlier (30.4 ± 34.9 vs 82.7 ± 55.1 h, P < 0.01), had less post-operative complications (12% vs 58%, P < 0.01), and shorter length of stay (4.3 ± 3.4 vs 8.1 ± 5.2 d, P < 0.01).CONCLUSION: Admission to the medical service and performance of numerous diagnostic procedures, ERCP, or MRCP combined with CT scan were associated with longer time to surgery. Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.展开更多
BACKGROUND Recent management of acute cholecystitis favors same admission(SA)or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings.We adopted the practice of SA cholecystectomy ...BACKGROUND Recent management of acute cholecystitis favors same admission(SA)or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings.We adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this practice.We hypothesized that the existence of complications,particularly among patients with a higher degree of disease severity,during SA cholecystectomy could negate the cost savings.AIM To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.METHODS Under an IRB-approved protocol,complications and charges for were obtained for SA,later after conservative management(Delayed),or elective cholecystectomies over an 8.5-year period.Patients were identified using the acute care surgery registry and billing database.Data was retrieved via EMR,operative logs,and Revenue Cycle Operations.The severity of acute cholecystitis was graded according to the Tokyo Guidelines.TG18 categorizes acute cholecystitis by Grades 1,2,and 3 representing mild,moderate,and severe,respectively.Comparisons were analyzed withχ2,Fisher’s exact test,ANOVA,ttests,and logistic regression;significance was set at P<0.05.RESULTS Four hundred eighty-six(87.7%)underwent a SA while 68 patients(12.3%)received Delayed cholecystectomy.Complication rates were increased after SA compared to Delayed cholecystectomy(18.5%vs 4.4%,P=0.004).The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy(7.4%,P=0.35).Mortality rates were 0.6%vs 0%for SA vs Delayed.Patients with moderate disease(Tokyo 2)suffered more complications among SA while none who were delayed experienced a complication(16.1%vs 0.0%,P<0.001).Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach($44500±$59000 vs$35300±$16700,P=0.019).The relative risk of developing a complication was 4.2x[95%confidence interval(CI):1.4-12.9]in the SA vs Delayed groups.Among eight patients(95%CI:5.0-12.3)with acute cholecystitis undergoing SA cholecystectomy,one patient will suffer a complication.CONCLUSION Patients with Tokyo Grade 2 acute cholecystitis had more complications and increased hospital charges when undergoing SA cholecystectomy.This data supports a selective approach to SA cholecystectomy for acute cholecystitis.展开更多
AIM： To study the timing of laparoscopic cholecystectomy for patients with acute cholecystitis. METHODS： Between January 2002 and December 2005, all American Society of Anesthesiologists classification （ASA） Ⅰ ,...AIM： To study the timing of laparoscopic cholecystectomy for patients with acute cholecystitis. METHODS： Between January 2002 and December 2005, all American Society of Anesthesiologists classification （ASA） Ⅰ ,Ⅱ and Ⅲ patients with acute cholecystitis were treated laparoscopically during the urgent （index） admission. The patients were divided into three groups according to the timing of surgery： （1） within the first 3 d, （2） between 4 and 7 d and （3） beyond 7 d from the onset of symptoms. The impact of timing on the conversion rate, morbidity and postoperative hospital stay was studied. RESULTS： One hundred and twenty-nine patients underwent laparoscopic cholecystectomy for acute cholecystitis during the index admission. Thirty six were assigned to group 1, 58 to group 2, and 35 to group 3. The conversion rate and morbidity for the whole cohort of patients were 4.6% and 10.8%, respectively. There was no significant difference in the conversion rate, morbidity and postoperative hospital stay between the three groups.CONCLUSION： Laparoscopic cholecystectomy for acute cholecystitis during the index admission is safe, regardless of the time elapsed from the onset of symptoms. This policy can result in an overall shorter hospitalization.展开更多
BACKGROUND: Trans-umbilical single-port laparoscopic cholecystectomy for chronic gallbladder disease is becoming increasingly accepted worldwide. But so far, no reports exist about the challenging single-port surgery ...BACKGROUND: Trans-umbilical single-port laparoscopic cholecystectomy for chronic gallbladder disease is becoming increasingly accepted worldwide. But so far, no reports exist about the challenging single-port surgery for acute cholecystitis. The objective of this study was to describe our experience with single-port cholecystectomy in comparison to the conventional laparoscopic technique. METHODS: Between August 2008 and March 2010, 73 patients with symptomatic gallbladder disease and histopathological signs of acute cholecystitis underwent laparoscopic cholecystec- tomy at our institution. Thirty-six patients were operated on with the single-port technique (SP group) and the data were compared with a control group of 37 patients who were treated with the multi-port technique (MP group). RESULTS: The mean age in the SP group was 61.5 (range 21-81) years and in the MP group was 60 (range 21-94) (P=0.712). Gender, ASA status and BMI were not significantly different. The number of white blood cells was different before [SP: 9.2 (range 2.8-78.4); MP: 13.2 (range 4.4-28.6); P=0.001] and after the operation [SP: 7.8 (range 3.5-184.8); MP: 11.1 (range 5-20.8); P=0.002]. Mean operating time was 88 (range 34-174) minutes in the SP group vs 94 (range 39-209) minutes in the MP group (P=0.147). Four patients (5%) required conversion to an open procedure (SP: 1; MP: 3; P=0.320). During the follow- up period of 332 (range 29-570) days in the SP group and 428 (range 111-619) days in the MP group (P=0.044), eleven (15%) patients developed postoperative complications (P=0.745) and two patients in the SP group required reoperation (P=0.154). CONCLUSIONS: Trans-umbilical single-port cholecystectomy for beginning acute cholecystitis is feasible and the complicationrate is comparable with the standard multi-port operation. In spite of our good results, these operations are difficult to perform and should only be done in high-volume centers for laparoscopic surgery with experience in single-port surgery.展开更多
Acute acalculous cholecystitis(AAC)is a rare complication of gastric surgery.The most commonly accepted concepts regarding its pathogenesis are bile stasis,sepsis and ischemia,but it has not been well described how to...Acute acalculous cholecystitis(AAC)is a rare complication of gastric surgery.The most commonly accepted concepts regarding its pathogenesis are bile stasis,sepsis and ischemia,but it has not been well described how to identify and manage this disease in the early stage.We report three cases of AAC in elderly patients immediately after gastric surgery,which were treated with three different strategies.One patient died 42 d after emergency cholecystectomy,and the other two finally recovered through timely cholecystostomy and percutaneous transhepatic gallbladder drainage,respectively.These cases informed us of the value of early diagnosis and proper treatment for perioperative AAC after gastric surgery.We further reviewed reported cases of AAC immediately after gastric operation,which may expand our knowledge of this disease.展开更多
The safety and feasibility of early laparoscopic cholecystectomy(LC)for acute cholecystitis with mild pancreatitis were explored.A total of 973 patients with acute pancreatitis,including 651 mild cases and 322 moderat...The safety and feasibility of early laparoscopic cholecystectomy(LC)for acute cholecystitis with mild pancreatitis were explored.A total of 973 patients with acute pancreatitis,including 651 mild cases and 322 moderate or severe cases were retrospectively studied from July 2014 to December 2018 in our department.And 426 mild pancreatitis cases with acute cholecystitis were enrolled in this study,of which 328 patients underwent LC during the same-admission(early LC group),and 98 patients underwent LC a period of time after conservative treatment(delayed LC group).Clinical characteristics,operative findings and complications were recorded and followed up.The two groups were comparable in age,gender,the grade of American Society of Anesthesiologist(ASA),biochemical findings and Balthazar computer tomography(CT)rating(P>0.05).The operation interval and hospital stay in early LC group were significantly shorter than in delayed LC group(5.83+1.62 vs.41.3618.44 days;11.38+2.43 vs.16.49+3.48 days,P<0.01).There was no significant difference in the average operation time between the two groups.No preoperative biliary related events recurred in early LC group but there were 21 cases of preoperative biliary related events in delayed LC group(P<0.01).There was no significant difference in conversion rate(3.85 vs.5.10%,P=0.41)and surgical complication rate(3.95 vs.4.08%,P-0.95)between early LC group and delayed LC group.During the postoperative follow-up period of 375 cases,biliary related events recurred in 4 cases in early LC group and 3 cases in delayed LC group(P=0.37).The effect of early LC during the same-admission is better than delayed LC for acute cholecystitis with mild pancreatitis.展开更多
BACKGROUND Percutaneous transhepatic gallbladder drainage has been the most frequently performed treatment for acute cholecystitis for patients who are not candidates for surgery.Endoscopic transpapillary gallbladder ...BACKGROUND Percutaneous transhepatic gallbladder drainage has been the most frequently performed treatment for acute cholecystitis for patients who are not candidates for surgery.Endoscopic transpapillary gallbladder drainage(ETGBD)has evolved into an alternative treatment.There have been numerous retrospective and prospective studies evaluating ETGBD for acute cholecystitis,though results have been variable.AIM To evaluate the efficacy and safety of ETGBD in the treatment of inoperable patients with acute cholecystitis.METHODS We performed a systematic review of major literature databases including PubMed,OVID,Science Direct,Google Scholar(from inception to March 2021)to identify studies reporting technical and clinical success,and post procedure adverse events in ETGBD.Weighted pooled rates were then calculated using fixed effects models for technical and clinical success,and post procedure adverse events,including recurrent cholecystitis.RESULTS We found 21 relevant articles that were then included in the study.In all 1307 patients were identified.The pooled technical success rate was 82.62%[95%confidence interval(CI):80.63-84.52].The pooled clinical success rate was found to be 94.87%(95%CI:93.54-96.05).The pooled overall complication rate was 8.83%(95%CI:7.42-10.34).Pooled rates of post procedure adverse events were bleeding 1.03%(95%CI:0.58-1.62),perforation 0.78%(95%CI:0.39-1.29),peritonitis/bile leak 0.45%(95%CI:0.17-0.87),and pancreatitis 1.98%(95%CI:1.33-2.76).The pooled rates of stent occlusion and migration were 0.39%(95%CI:0.13-0.78)and 1.3%(95%CI:0.75-1.99)respectively.The pooled rate of cholecystitis recurrence following ETGBD was 1.48%(95%CI:0.92-2.16).CONCLUSION Our meta-analysis suggests that ETGBD is a feasible and efficacious treatment for inoperable patients with acute cholecystitis.展开更多
Many surgeons practice prophylactic drainage after cholecystectomy without reliable evidence,this study was conducted to answer the question whether to drain or not to drain after cholecystectomy for acute calculous c...Many surgeons practice prophylactic drainage after cholecystectomy without reliable evidence,this study was conducted to answer the question whether to drain or not to drain after cholecystectomy for acute calculous cholecystitis.A retrospective review of all patients who had cholecystectomy for acute cholecystitis in Aseer Central Hospital,Abha,Saudi Arabia,was conducted from April 2010 to April 2012.Data were extracted from hospital case files.Preoperative data included clinical presentation,routine investigations and liver function tests.Operative data included excessive adhesions,bleeding,bile leak,and drain insertion.Complicated cases such as pericholecystic collections,mucocele and empyema were also reported.Patients who needed therapeutic drainage were excluded.Postoperative data included hospital stay,volume of drained fluid,time of drain removal,and drain site problems.The study included 103 patients allocated into two groups;group A（n = 38） for patients with operative drain insertion and group B（n = 65） for patients without drain insertion.The number of patients with preoperative diagnosis of acute non-complicated cholecystitis was significantly greater in group B（80%） than group A（36.8%）（P 〈 0.001）.Operative time was significantly longer in group A.All patients who were converted from laparoscopic to open cholecystectomy were in group A.Multivariate analysis revealed that hospital stay was significantly（P 〈 0.001） longer in patients with preoperative complications.There was no added benefit for prophylactic drain insertion after cholecystectomy for acute calculous cholecystitis in non-complicated or in complicated cases.展开更多
Acute acalculous cholecystitis(AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. ...Acute acalculous cholecystitis(AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. Although this pathology was originally described in critically ill or post-surgical patients, most pediatric cases have been observed during several infectious diseases. In addition to cases caused by bacterial and parasitic infections, most pediatric reports after 2000 described children developing AAC during viral illnesses(such as Epstein-Barr virus and hepatitis A virus infections). Moreover, some pediatric cases have been associated with several underlying chronic diseases and, in particular, with immune-mediated disorders. Here, we review the epidemiological aspects of pediatric AAC, and we discuss etiology, pathophysiology and clinical management, according to the cases reported in the medical literature.展开更多
BACKGROUND： Unexpected gallbladder cancer may present with acute cholecystitis-like manifestat/ons. Some authors rec- ommended that frozen section analysis should be performed during laparoscopic cholecystectomy for ...BACKGROUND： Unexpected gallbladder cancer may present with acute cholecystitis-like manifestat/ons. Some authors rec- ommended that frozen section analysis should be performed during laparoscopic cholecystectomy for all cases of acute cholecystitis. Others advocate selective use of frozen section analysis based on gross examination of the specimen by the surgeon. The aim of the present study was to evaluate whether surgeons could effectively identify suspected gallbladder with macroscopic examination alone. If not, is routine frozen sec- tion analysis worth advocating？展开更多
AIM: To evaluate the eff icacy of a new nuclear imaging Infecton (Tc-99m ciprofloxacin) for the diagnosis of acute cholecystitis. METHODS: Sixteen patients thought to have acute cholecystitis were included in this stu...AIM: To evaluate the eff icacy of a new nuclear imaging Infecton (Tc-99m ciprofloxacin) for the diagnosis of acute cholecystitis. METHODS: Sixteen patients thought to have acute cholecystitis were included in this study. The diagnosis of acute cholecystitis was made based on clinical symptoms and ultrasonographic and pathologic f indings. RESULTS: The 16 patients were composed of 12 acute and 4 chronic cholecystitis patients. Twelve patients with acute cholecystitis were image-positive, including one false-positive. Four patients with chronic cholecystitis were image-negative, of whom three were true-negative. This nuclear imaging had a sensitivity of 91.7%, a specificity of 75%, a positive-predictive value of 91.7%, and a negative-predictive value of 75%. CONCLUSION: Tc-99m ciprofloxacin imaging is easy to perform and applicable for the diagnosis of acute cholecystitis.展开更多
BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients wit...BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.展开更多
BACKGROUND Impaired interstitial cells of Cajal(ICCs)are central to the pathophysiology of acute cholecystitis(AC).Common bile duct ligation is a common model of AC,producing acute inflammatory changes and decrease in...BACKGROUND Impaired interstitial cells of Cajal(ICCs)are central to the pathophysiology of acute cholecystitis(AC).Common bile duct ligation is a common model of AC,producing acute inflammatory changes and decrease in gallbladder contractility.AIM To investigate the origin of slow wave(SW)in the gallbladder and the effect of ICCs on gallbladder contractions during the process of AC.METHODS Methylene blue(MB)with light was used to establish selective impaired ICCs gallbladder tissue.Gallbladder motility was assessed using the frequency of SW and gallbladder muscle contractility in vitro in normal control(NC),AC12h,AC24h,and AC48h groups of guinea pigs.Hematoxylin and eosin and Massonstained gallbladder tissues were scored for inflammatory changes.ICCs pathological changes alterations were estimated using immunohistochemistry and transmission electron microscopy.The alterations of c-Kit,α-SMA,cholecystokinin A receptor(CCKAR),and connexin 43(CX43)were assessed using Western blot.RESULTS Impaired ICCs muscle strips resulted in the decrease in gallbladder SW frequency and contractility.The frequency of SW and gallbladder contractility were significantly lower in the AC12h group.Compared with the NC group,the density and ultrastructure of ICCs were remarkably impaired in the AC groups,especially in the AC12h group.The protein expression levels of c-Kit were significantly decreased in the AC12h group,while CCKAR and CX43 protein expression levels were significantly decreased in the AC48h group.CONCLUSION Loss ICCs could lead to a decrease in gallbladder SW frequency and contractility.The density and ultrastructure of ICCs were clearly impaired in the early stage of AC,while CCKAR and CX43 were significantly reduced at end stage.展开更多
BACKGROUND To date,the optimal timing for percutaneous transhepatic gallbladder drainage(PTGBD),particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy(LC)(within 72 hou...BACKGROUND To date,the optimal timing for percutaneous transhepatic gallbladder drainage(PTGBD),particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy(LC)(within 72 hours of symptom onset)has not been determined.AIM To study the effects of LC timing on outcomes of grade II/III acute cholecystitis(AC)in patients with delayed PTGBD.METHODS Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied.According to the interval between gallbladder drainage and cholecystectomy,the patients were divided into early and delayed LC groups.Outcomes including surgery time,postoperative complications and hospital stay,and patient satisfaction were analyzed and compared between the two groups using t-andχ^(2) tests.RESULTS There were no significant differences between the two groups in intraoperative blood loss,postoperative abdominal drainage tube placement time,pain index,or total disease duration(all P>0.05).Compared with those of the early LC group,the delayed group showed significant decreases in the length of procedure(surgery time),conversion rate to open surgery,degree of adhesions,surgical complications,postoperative hospital stay,and total treatment costs,and increased patient satisfaction despite a longer interval before PTGBD(all P<0.05).CONCLUSION For patients with grade II/III AC with delayed PTGBD,LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.展开更多
Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity hav...Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity have various effects in several diseases.We aimed to clarify the relationship between RAC and body parameters.Methods:Patients with AC who were treated at our hospital between January 2011 and March 2022 were enrolled.The psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of AC.The areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI groups.We performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of RAC.Results:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)groups.In the propensity score-matched cohort there were 57 patients in each group.In Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),respectively.Conclusions:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.展开更多
文摘BACKGROUND An 81-year-old patient presented to our center with pancreatic head cancer,obstructive jaundice,and acute cholecystitis.Due to duodenal tumor infiltration,both endoscopic retrograde cholangiopancreatography and endoscopic ultrasound(EUS)-guided choledochoduodenostomy were technically challenging.CASE SUMMARY An EUS-guided gallbladder drainage along with an EUS-guided fine needle biopsy were performed,resulting in a diagnosis of pancreatic cancer resolution of jaundice and improvement in acute cholecystitis,all in a safe and effective single endoscopic session.CONCLUSION This case demonstrated the successful use of EUS-guided gallbladder drainage and EUS-guided fine needle biopsy in a patient with pancreatic cancer invading the duodenal wall.
文摘BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency cholecystectomy is the standard of care,it may not be feasible in unstable patients.Percutaneous transhepatic cholecystostomy(PTC)offers a minimally invasive alternative.AIM To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC.METHODS We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center.All patients underwent PTC as the initial intervention.Data collected included demographics,comorbidities,laboratory and imaging findings,complications,and clinical outcomes over a 24-month follow-up.Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy.RESULTS Thirty patients underwent PTC for APC.Half of the patients(n=15)were stabilized and later underwent cholecystectomy;the remaining 15 were managed non-operatively.Patients in the non-surgical group were significantly older(87.1±6.2 years vs 76.1±7.4 years;P<0.001).Clinical improvement was observed in 61.4%of non-operated patients,with eventual drain removal or closure.Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge.No significant differences were found in hospital stay or complication rates.During follow-up,three deaths occurred due to non-biliary causes.Only one patient required repeat drainage.CONCLUSION PTC is a safe and effective initial treatment for APC,particularly in elderly and comorbid patients for whom surgery poses excessive risk.It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients.These findings support the broader use of PTC in the management of APC,although larger prospective studies are warranted.
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BACKGROUND: In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy.METHODS: In 91 patients(American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis ≥72 hours at hospital admission and who did not respond to nonoperative treatment(48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at ≥4 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average(range 7-29).RESULT: Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19(40%) vs 8(19%); P=0.029], a frequency of intraoperative bleeding ≥100 mL [16(33%) vs 4(9%); P=0.006],a mean postoperative hospital stay(5.3±3.3 vs 3.0±2.4 days;P=0.001), and a frequency of complications [17(35%) vs 4(9%);P=0.003].CONCLUSION: In patients with acute cholecystitis who presented to the hospital ≥72 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.
文摘AIM： To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct （CBD） stone removal. METHODS： A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder （GB） in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively. The following factors were considered while evaluating risk factors for the development of acute cholecystitis： age, gender, serum bUirubin level, GB wall thickening, cystic duct patency, presence of a GB stone, CBD diameter, residual stone, lithotripsy, juxtapapillary diverticulum, presence of liver cirrhosis or diabetes mellitus, a presenting illness of cholangitis or pancreatitis, and procedure-related complications. RESULTS： During a mean 18-mo follow-up, 28 （28%） patients developed biliary symptoms; 17 （17%） acute cholecystitis and 13 （13%） CBD stone recurrence. Of patients with acute cholecystitis, 15 （88.2%） received laparoscopic cholecystectomy and 2 （11.8%） open cholecystectomy. All recurrent CBD stones were successfully removed endoscopically. The mean time elapse to acute cholecystitis was 10.2 mo （1-37 mo） and that to recurrent CBD stone was 18.4 mo. Of the 17 patients who received cholecystectomy, 2 （11.8%） developed recurrent CBD stones after cholecystectomy. By multivariate analysis, a serum total bUirubin level of 〈1.3 mg/dL and a CBD diameter of 〈11 mm at the time of stone removal were found to predict the development of acute cholecystitis. CONCLUSION： After CBD stone removal, there is no need for routine prophylactic cholecystectomy. However, patients without a dilated bile duct （〈11 mm） and jaundice （〈1.3 mg/dL） at the time of CBD stone removal have a higher risk of acute cholecystitis and are possible candidates for prophylactic cholecystectomy.
文摘AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted. Data collected included demographic data, co-morbidities, symptoms and physical findings at presentation, laboratory and radiological investigations, length of stay, complications, and admission service (medical or surgical). Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis. Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures, presenting signs, and admitting service with time to surgery.RESULTS: Seventy cases met inclusion and exclusion criteria, among which 12 were admitted to the medical service and 58 to the surgical service. Mean ± SD time to surgery was 39.3 ± 43 h, with 87% of operations performed within 72 h of hospital arrival. In the adjusted models, longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP, P = 0.01) as well with admission to medical service without adjustment for ERCP (P < 0.05). Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery. Patients admitted to the surgical versus medical service underwent surgery earlier (30.4 ± 34.9 vs 82.7 ± 55.1 h, P < 0.01), had less post-operative complications (12% vs 58%, P < 0.01), and shorter length of stay (4.3 ± 3.4 vs 8.1 ± 5.2 d, P < 0.01).CONCLUSION: Admission to the medical service and performance of numerous diagnostic procedures, ERCP, or MRCP combined with CT scan were associated with longer time to surgery. Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.
文摘BACKGROUND Recent management of acute cholecystitis favors same admission(SA)or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings.We adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this practice.We hypothesized that the existence of complications,particularly among patients with a higher degree of disease severity,during SA cholecystectomy could negate the cost savings.AIM To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.METHODS Under an IRB-approved protocol,complications and charges for were obtained for SA,later after conservative management(Delayed),or elective cholecystectomies over an 8.5-year period.Patients were identified using the acute care surgery registry and billing database.Data was retrieved via EMR,operative logs,and Revenue Cycle Operations.The severity of acute cholecystitis was graded according to the Tokyo Guidelines.TG18 categorizes acute cholecystitis by Grades 1,2,and 3 representing mild,moderate,and severe,respectively.Comparisons were analyzed withχ2,Fisher’s exact test,ANOVA,ttests,and logistic regression;significance was set at P<0.05.RESULTS Four hundred eighty-six(87.7%)underwent a SA while 68 patients(12.3%)received Delayed cholecystectomy.Complication rates were increased after SA compared to Delayed cholecystectomy(18.5%vs 4.4%,P=0.004).The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy(7.4%,P=0.35).Mortality rates were 0.6%vs 0%for SA vs Delayed.Patients with moderate disease(Tokyo 2)suffered more complications among SA while none who were delayed experienced a complication(16.1%vs 0.0%,P<0.001).Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach($44500±$59000 vs$35300±$16700,P=0.019).The relative risk of developing a complication was 4.2x[95%confidence interval(CI):1.4-12.9]in the SA vs Delayed groups.Among eight patients(95%CI:5.0-12.3)with acute cholecystitis undergoing SA cholecystectomy,one patient will suffer a complication.CONCLUSION Patients with Tokyo Grade 2 acute cholecystitis had more complications and increased hospital charges when undergoing SA cholecystectomy.This data supports a selective approach to SA cholecystectomy for acute cholecystitis.
文摘AIM： To study the timing of laparoscopic cholecystectomy for patients with acute cholecystitis. METHODS： Between January 2002 and December 2005, all American Society of Anesthesiologists classification （ASA） Ⅰ ,Ⅱ and Ⅲ patients with acute cholecystitis were treated laparoscopically during the urgent （index） admission. The patients were divided into three groups according to the timing of surgery： （1） within the first 3 d, （2） between 4 and 7 d and （3） beyond 7 d from the onset of symptoms. The impact of timing on the conversion rate, morbidity and postoperative hospital stay was studied. RESULTS： One hundred and twenty-nine patients underwent laparoscopic cholecystectomy for acute cholecystitis during the index admission. Thirty six were assigned to group 1, 58 to group 2, and 35 to group 3. The conversion rate and morbidity for the whole cohort of patients were 4.6% and 10.8%, respectively. There was no significant difference in the conversion rate, morbidity and postoperative hospital stay between the three groups.CONCLUSION： Laparoscopic cholecystectomy for acute cholecystitis during the index admission is safe, regardless of the time elapsed from the onset of symptoms. This policy can result in an overall shorter hospitalization.
文摘BACKGROUND: Trans-umbilical single-port laparoscopic cholecystectomy for chronic gallbladder disease is becoming increasingly accepted worldwide. But so far, no reports exist about the challenging single-port surgery for acute cholecystitis. The objective of this study was to describe our experience with single-port cholecystectomy in comparison to the conventional laparoscopic technique. METHODS: Between August 2008 and March 2010, 73 patients with symptomatic gallbladder disease and histopathological signs of acute cholecystitis underwent laparoscopic cholecystec- tomy at our institution. Thirty-six patients were operated on with the single-port technique (SP group) and the data were compared with a control group of 37 patients who were treated with the multi-port technique (MP group). RESULTS: The mean age in the SP group was 61.5 (range 21-81) years and in the MP group was 60 (range 21-94) (P=0.712). Gender, ASA status and BMI were not significantly different. The number of white blood cells was different before [SP: 9.2 (range 2.8-78.4); MP: 13.2 (range 4.4-28.6); P=0.001] and after the operation [SP: 7.8 (range 3.5-184.8); MP: 11.1 (range 5-20.8); P=0.002]. Mean operating time was 88 (range 34-174) minutes in the SP group vs 94 (range 39-209) minutes in the MP group (P=0.147). Four patients (5%) required conversion to an open procedure (SP: 1; MP: 3; P=0.320). During the follow- up period of 332 (range 29-570) days in the SP group and 428 (range 111-619) days in the MP group (P=0.044), eleven (15%) patients developed postoperative complications (P=0.745) and two patients in the SP group required reoperation (P=0.154). CONCLUSIONS: Trans-umbilical single-port cholecystectomy for beginning acute cholecystitis is feasible and the complicationrate is comparable with the standard multi-port operation. In spite of our good results, these operations are difficult to perform and should only be done in high-volume centers for laparoscopic surgery with experience in single-port surgery.
基金Supported by Zhongshan Hospital,Fudan University,Shanghai,China
文摘Acute acalculous cholecystitis(AAC)is a rare complication of gastric surgery.The most commonly accepted concepts regarding its pathogenesis are bile stasis,sepsis and ischemia,but it has not been well described how to identify and manage this disease in the early stage.We report three cases of AAC in elderly patients immediately after gastric surgery,which were treated with three different strategies.One patient died 42 d after emergency cholecystectomy,and the other two finally recovered through timely cholecystostomy and percutaneous transhepatic gallbladder drainage,respectively.These cases informed us of the value of early diagnosis and proper treatment for perioperative AAC after gastric surgery.We further reviewed reported cases of AAC immediately after gastric operation,which may expand our knowledge of this disease.
基金This project was supported by the Scientific Research Project of Hubei Provincial Health and Family Planning Commission(No.wJ2017c0002)。
文摘The safety and feasibility of early laparoscopic cholecystectomy(LC)for acute cholecystitis with mild pancreatitis were explored.A total of 973 patients with acute pancreatitis,including 651 mild cases and 322 moderate or severe cases were retrospectively studied from July 2014 to December 2018 in our department.And 426 mild pancreatitis cases with acute cholecystitis were enrolled in this study,of which 328 patients underwent LC during the same-admission(early LC group),and 98 patients underwent LC a period of time after conservative treatment(delayed LC group).Clinical characteristics,operative findings and complications were recorded and followed up.The two groups were comparable in age,gender,the grade of American Society of Anesthesiologist(ASA),biochemical findings and Balthazar computer tomography(CT)rating(P>0.05).The operation interval and hospital stay in early LC group were significantly shorter than in delayed LC group(5.83+1.62 vs.41.3618.44 days;11.38+2.43 vs.16.49+3.48 days,P<0.01).There was no significant difference in the average operation time between the two groups.No preoperative biliary related events recurred in early LC group but there were 21 cases of preoperative biliary related events in delayed LC group(P<0.01).There was no significant difference in conversion rate(3.85 vs.5.10%,P=0.41)and surgical complication rate(3.95 vs.4.08%,P-0.95)between early LC group and delayed LC group.During the postoperative follow-up period of 375 cases,biliary related events recurred in 4 cases in early LC group and 3 cases in delayed LC group(P=0.37).The effect of early LC during the same-admission is better than delayed LC for acute cholecystitis with mild pancreatitis.
文摘BACKGROUND Percutaneous transhepatic gallbladder drainage has been the most frequently performed treatment for acute cholecystitis for patients who are not candidates for surgery.Endoscopic transpapillary gallbladder drainage(ETGBD)has evolved into an alternative treatment.There have been numerous retrospective and prospective studies evaluating ETGBD for acute cholecystitis,though results have been variable.AIM To evaluate the efficacy and safety of ETGBD in the treatment of inoperable patients with acute cholecystitis.METHODS We performed a systematic review of major literature databases including PubMed,OVID,Science Direct,Google Scholar(from inception to March 2021)to identify studies reporting technical and clinical success,and post procedure adverse events in ETGBD.Weighted pooled rates were then calculated using fixed effects models for technical and clinical success,and post procedure adverse events,including recurrent cholecystitis.RESULTS We found 21 relevant articles that were then included in the study.In all 1307 patients were identified.The pooled technical success rate was 82.62%[95%confidence interval(CI):80.63-84.52].The pooled clinical success rate was found to be 94.87%(95%CI:93.54-96.05).The pooled overall complication rate was 8.83%(95%CI:7.42-10.34).Pooled rates of post procedure adverse events were bleeding 1.03%(95%CI:0.58-1.62),perforation 0.78%(95%CI:0.39-1.29),peritonitis/bile leak 0.45%(95%CI:0.17-0.87),and pancreatitis 1.98%(95%CI:1.33-2.76).The pooled rates of stent occlusion and migration were 0.39%(95%CI:0.13-0.78)and 1.3%(95%CI:0.75-1.99)respectively.The pooled rate of cholecystitis recurrence following ETGBD was 1.48%(95%CI:0.92-2.16).CONCLUSION Our meta-analysis suggests that ETGBD is a feasible and efficacious treatment for inoperable patients with acute cholecystitis.
文摘Many surgeons practice prophylactic drainage after cholecystectomy without reliable evidence,this study was conducted to answer the question whether to drain or not to drain after cholecystectomy for acute calculous cholecystitis.A retrospective review of all patients who had cholecystectomy for acute cholecystitis in Aseer Central Hospital,Abha,Saudi Arabia,was conducted from April 2010 to April 2012.Data were extracted from hospital case files.Preoperative data included clinical presentation,routine investigations and liver function tests.Operative data included excessive adhesions,bleeding,bile leak,and drain insertion.Complicated cases such as pericholecystic collections,mucocele and empyema were also reported.Patients who needed therapeutic drainage were excluded.Postoperative data included hospital stay,volume of drained fluid,time of drain removal,and drain site problems.The study included 103 patients allocated into two groups;group A（n = 38） for patients with operative drain insertion and group B（n = 65） for patients without drain insertion.The number of patients with preoperative diagnosis of acute non-complicated cholecystitis was significantly greater in group B（80%） than group A（36.8%）（P 〈 0.001）.Operative time was significantly longer in group A.All patients who were converted from laparoscopic to open cholecystectomy were in group A.Multivariate analysis revealed that hospital stay was significantly（P 〈 0.001） longer in patients with preoperative complications.There was no added benefit for prophylactic drain insertion after cholecystectomy for acute calculous cholecystitis in non-complicated or in complicated cases.
文摘Acute acalculous cholecystitis(AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. Although this pathology was originally described in critically ill or post-surgical patients, most pediatric cases have been observed during several infectious diseases. In addition to cases caused by bacterial and parasitic infections, most pediatric reports after 2000 described children developing AAC during viral illnesses(such as Epstein-Barr virus and hepatitis A virus infections). Moreover, some pediatric cases have been associated with several underlying chronic diseases and, in particular, with immune-mediated disorders. Here, we review the epidemiological aspects of pediatric AAC, and we discuss etiology, pathophysiology and clinical management, according to the cases reported in the medical literature.
基金supported by grants from the Science & Technology Support Project of Sichuan Province(2011FZ0009 and 2014SZ0002-10)
文摘BACKGROUND： Unexpected gallbladder cancer may present with acute cholecystitis-like manifestat/ons. Some authors rec- ommended that frozen section analysis should be performed during laparoscopic cholecystectomy for all cases of acute cholecystitis. Others advocate selective use of frozen section analysis based on gross examination of the specimen by the surgeon. The aim of the present study was to evaluate whether surgeons could effectively identify suspected gallbladder with macroscopic examination alone. If not, is routine frozen sec- tion analysis worth advocating？
基金Supported by Inha University Research Funds of 2004
文摘AIM: To evaluate the eff icacy of a new nuclear imaging Infecton (Tc-99m ciprofloxacin) for the diagnosis of acute cholecystitis. METHODS: Sixteen patients thought to have acute cholecystitis were included in this study. The diagnosis of acute cholecystitis was made based on clinical symptoms and ultrasonographic and pathologic f indings. RESULTS: The 16 patients were composed of 12 acute and 4 chronic cholecystitis patients. Twelve patients with acute cholecystitis were image-positive, including one false-positive. Four patients with chronic cholecystitis were image-negative, of whom three were true-negative. This nuclear imaging had a sensitivity of 91.7%, a specificity of 75%, a positive-predictive value of 91.7%, and a negative-predictive value of 75%. CONCLUSION: Tc-99m ciprofloxacin imaging is easy to perform and applicable for the diagnosis of acute cholecystitis.
文摘BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.
基金Supported by the Pudong New Area Clinical Traditional Chinese Medicine of Top Discipline Project,No.PDZY-2018-0603 and the Featured Clinical Discipline Project of Shanghai Pudong,No.PWYts2021-06.
文摘BACKGROUND Impaired interstitial cells of Cajal(ICCs)are central to the pathophysiology of acute cholecystitis(AC).Common bile duct ligation is a common model of AC,producing acute inflammatory changes and decrease in gallbladder contractility.AIM To investigate the origin of slow wave(SW)in the gallbladder and the effect of ICCs on gallbladder contractions during the process of AC.METHODS Methylene blue(MB)with light was used to establish selective impaired ICCs gallbladder tissue.Gallbladder motility was assessed using the frequency of SW and gallbladder muscle contractility in vitro in normal control(NC),AC12h,AC24h,and AC48h groups of guinea pigs.Hematoxylin and eosin and Massonstained gallbladder tissues were scored for inflammatory changes.ICCs pathological changes alterations were estimated using immunohistochemistry and transmission electron microscopy.The alterations of c-Kit,α-SMA,cholecystokinin A receptor(CCKAR),and connexin 43(CX43)were assessed using Western blot.RESULTS Impaired ICCs muscle strips resulted in the decrease in gallbladder SW frequency and contractility.The frequency of SW and gallbladder contractility were significantly lower in the AC12h group.Compared with the NC group,the density and ultrastructure of ICCs were remarkably impaired in the AC groups,especially in the AC12h group.The protein expression levels of c-Kit were significantly decreased in the AC12h group,while CCKAR and CX43 protein expression levels were significantly decreased in the AC48h group.CONCLUSION Loss ICCs could lead to a decrease in gallbladder SW frequency and contractility.The density and ultrastructure of ICCs were clearly impaired in the early stage of AC,while CCKAR and CX43 were significantly reduced at end stage.
文摘BACKGROUND To date,the optimal timing for percutaneous transhepatic gallbladder drainage(PTGBD),particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy(LC)(within 72 hours of symptom onset)has not been determined.AIM To study the effects of LC timing on outcomes of grade II/III acute cholecystitis(AC)in patients with delayed PTGBD.METHODS Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied.According to the interval between gallbladder drainage and cholecystectomy,the patients were divided into early and delayed LC groups.Outcomes including surgery time,postoperative complications and hospital stay,and patient satisfaction were analyzed and compared between the two groups using t-andχ^(2) tests.RESULTS There were no significant differences between the two groups in intraoperative blood loss,postoperative abdominal drainage tube placement time,pain index,or total disease duration(all P>0.05).Compared with those of the early LC group,the delayed group showed significant decreases in the length of procedure(surgery time),conversion rate to open surgery,degree of adhesions,surgical complications,postoperative hospital stay,and total treatment costs,and increased patient satisfaction despite a longer interval before PTGBD(all P<0.05).CONCLUSION For patients with grade II/III AC with delayed PTGBD,LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.
基金This study was approved by the Ethics Committee of Kyushu Rosai Hospital Moji Medical Center(No:04-01,date of approval:June 2,2022).This study was conducted in compliance with the principles of the Declaration of Helsinki.
文摘Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity have various effects in several diseases.We aimed to clarify the relationship between RAC and body parameters.Methods:Patients with AC who were treated at our hospital between January 2011 and March 2022 were enrolled.The psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of AC.The areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI groups.We performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of RAC.Results:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)groups.In the propensity score-matched cohort there were 57 patients in each group.In Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),respectively.Conclusions:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.
