scholarly journals Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy

2022 ◽  
Author(s):  
James Lucocq ◽  
John Scollay ◽  
Pradeep Patil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Adverse Outcomes ◽  
Clinical Indication ◽  
Biliary Colic ◽  
Surgical Decision ◽  
Operative Outcomes ◽  
Increased Risk ◽  
Difficult Cholecystectomy ◽  
Elective Laparoscopic Cholecystectomy ◽  
Surgical Decision Making

Abstract Introduction Patients undergoing elective laparoscopic cholecystectomy (ELLC) represent a heterogeneous group making it challenging to stratify risk. The aim of this paper is to identify pre-operative factors associated with adverse peri- and post-operative outcomes in patients undergoing ELLC. This knowledge will help stratify risk, guide surgical decision making and better inform the consent process. Methods All patients who underwent ELLC between January 2015 and December 2019 were included in the study. Pre-operative data and both peri- and post-operative outcomes were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were divided into groups based on clinical indication (i.e. biliary colic versus cholecystitis) and adverse outcomes were compared. Multivariate regression models were generated for each adverse outcome using pre-operative independent variables. Results Two-thousand one hundred and sixty-six ELLC were identified. Rates of peri- and post-operative adverse outcomes were significantly higher in the cholecystitis versus biliary colic group and increased with number of admissions of cholecystitis (p < 0.05). Rates of subtotal (29.5%), intra-operative complication (9.8%), post-operative complications (19.6%), prolonged post-operative stay (45.9%) and re-admission (16.4%) were significant in the group of patients with ≥ 2 admissions with cholecystitis. Conclusion Our data demonstrate that patients with repeated biliary admission (particularly cholecystitis) ultimately face an increased risk of a difficult ELLC with associated complications, prolonged post-operative stay and readmissions. These data provide robust evidence that individualised risk assessment and consent are necessary before ELLC. Strategies to minimise recurrent biliary admissions prior to LC should be implemented.

scholarly journals SP6.1.5 Morbidity following emergency and elective laparoscopic cholecystectomy for cholecystitis: a retrospective comparative cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
James Lucocq ◽  
Ganesh Radhakishnan ◽  
John Scollay ◽  
Pradeep Patil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Elective Surgery ◽  
Multivariate Regression Analysis ◽  
Operative Outcomes ◽  
Increased Risk ◽  
Biliary Pathology ◽  
Elective Laparoscopic Cholecystectomy ◽  
The Difference ◽  
Current Guidance ◽  
Emergency Cholecystectomy

Abstract Aims A comprehensive comparison of post-operative outcomes between emergency and elective laparoscopic cholecystectomy (LC) for cholecystitis has not been conducted and the relative morbidity associated with emergency LC remains uncertain. Our aim was to evaluate the difference in early post-operative outcomes between emergency and elective LC for patients with cholecystitis. Method LC performed for cholecystitis across three surgical units between January 2015 and January 2020 were analysed retrospectively from multiple regional databases using deterministic records-linkage methodology. Rates of complications, further imaging, re-intervention, prolonged post-operative stay and re-admissions over a 100-day follow-up period were compared between emergency and elective groups using univariate and multivariate analysis. Results LC were performed for cholecysitits in 962 cases (median age, 52 years; M:F, 1:2.7; emergency:elective; 1:3.9). Emergency cholecystectomy had higher rates of complication (15.8% versus 8.8%;p&lt;0.0001), prolonged post-operative stay (40.3% vs. 12.7%;p&lt;0.0001), post-operative imaging and intervention (19.1% vs. 9.4%;p&lt;0.0001) and readmission (11.1% vs. 7.0%;p=0.017). In the multivariate regression analysis, emergency LC was associated with prolonged admission (OR,5.7;p&lt;0.0001), complication (OR,2.97;p&lt;0.0001), post-operative imaging and intervention (OR,2.4;p=0.002) and readmission (OR,1.9; p = 0.06). Conclusions Despite current guidance, an emergency cholecystectomy remains a morbid procedure and we demonstrate increased risks of emergency LC versus elective LC. The increased risk of an emergency LC needs to be weighed up against the risk of further attacks from biliary pathology until elective surgery. Our data indicates that we need to readjust our selection criteria for the ‘emergency cholecystectomy patient’ and identify patients who will specifically benefit from earlier surgery.

Acute Surgical Decision-Making in Abdominal Trauma Is Not Altered by Race or Socioeconomic Status

2018 ◽  
Vol 84 (12) ◽  
pp. 1869-1875 ◽  
Author(s):  
Krista Haines ◽  
Clayton Rust ◽  
Benjamin Pham Nguyen ◽  
Suresh Agarwal
Keyword(s):  
Decision Making ◽  
Socioeconomic Status ◽  
Surgical Site Infection ◽  
Insurance Status ◽  
Site Infection ◽  
Colonic Injury ◽  
Surgical Decision ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Surgical Decision Making

Two main procedures are performed on patients suffering from colonic perforation, diverting colostomy and primary tissue repair. We investigated patient race, ethnicity, and socioeconomic status (SES) that predicted surgical outcomes after blunt or penetrating trauma. A retrospective analysis was performed using data from the National Trauma Data Bank for three years (2013–2015). We identified patients who presented with primary colonic injury and subsequent colon operation (n = 5431). Operations were grouped into three classes: colostomy, ileostomy, and nonostomy. Multiple linear and logistic regressions were performed to assess how race and insurance status are associated with the primary outcome of interest (ostomy formation) and secondary outcomes such as length of stay, time spent in ICU, and surgical site infection. Neither race/ethnicity nor insurance status proved to be reliable predictors for the formation of an ostomy. Patients who received either a colostomy or ileostomy were likely to have longer stays (OR [odds ratio]: 5.28; 95% CI [confidence interval]: 3.88–6.69) (OR: 11.24; 95% CI: 8.53–13.95), more time spent in ICU (2.73; 1.70–3.76) (7.98; 6.10–9.87), and increased risk for surgical site infection (1.32; 1.03–1.68) (2.54; 1.71–3.78). Race/ethnicity and SES were not reliable predictors for surgical decision-making on the formation of an ostomy after blunt and penetrating colonic injury. However, the severity of the injury as calculated by Injury Severity Score and the number of abdominal injuries were both associated with higher rates of colostomy and ileostomy. These data suggest that surgical decision-making is dependent on perioperative patient presentation and, not on race, ethnicity, or SES.

scholarly journals Laparoscopic Cholecystectomy in Cirrhotic Patient

HPB Surgery ◽  
1996 ◽  
Vol 10 (2) ◽  
pp. 79-82 ◽  
Author(s):  
Jean Gugenheim ◽  
Marco Casaccia ◽  
Davide Mazza ◽  
James Toouli ◽  
Vanna Laura ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Laparoscopic Cholecystectomy ◽  
Portal Hypertension ◽  
Blood Transfusion ◽  
Absolute Contraindication ◽  
Median Hospital Stay ◽  
Increased Risk ◽  
Cirrhotic Patients ◽  
Elective Laparoscopic Cholecystectomy ◽  
Median Hospital

Cholecystectomy is associated with increased risk in patients with liver cirrhosis. Moreover, cirrhosis and portal hypertension have been considered relative or absolute contraindication to laparoscopic cholecystectomy. As experience with laparoscopic cholecystectomy increased, we decided to treat cirrhotic patients via this approach. Between January 1994 and April 1995, nine patients with a Child-Pugh's stage A cirrhosis underwent elective laparoscopic cholecystectomy with intraoperative cholangiography. There was no significant per- or post-operative bleeding and no blood transfusion was necessary. There was no mortality and very low morbidity. Median hospital stay was 3 days. This series suggests that wellcompensated cirrhosis can not be considered a contraindication to laparoscopic cholecystectomy.

scholarly journals Angiodysplasia of the Gallbladder: An Unknown Risk Factor for Cholecystolithiasis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Ivan Švagelj ◽  
Mirta Vučko ◽  
Mato Hrskanović ◽  
Dražen Švagelj
Keyword(s):  
Risk Factor ◽  
Laparoscopic Cholecystectomy ◽  
Literature Review ◽  
Blood Vessels ◽  
Systematic Literature Review ◽  
Incidental Finding ◽  
Common Type ◽  
Biliary Colic ◽  
Unknown Risk ◽  
Elective Laparoscopic Cholecystectomy

Angiodysplasia is a common type of lesion characterized by malformed submucosal and mucosal blood vessels. Angiodysplasia of the gallbladder is extremely rare, usually an incidental finding, with only two cases reported. Laparoscopic cholecystectomy is a curative treatment for angiodysplasia of the gallbladder. Our report describes a case of angiodysplasia of the gallbladder in a patient who underwent elective laparoscopic cholecystectomy for biliary colic because of gallstones, and a systematic literature review. We surmise that angiodysplasia of the gallbladder could be a risk factor for gallstones in younger female patients.

EP.TH.665Where’s the gallbladder? A rare case of gallbladder agenesis with cystic duct stone

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Tiffany Cheung ◽  
Roberto Presa ◽  
Antonio Manzelli
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
De Novo ◽  
Stone Formation ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Filling Defect ◽  
Biliary Colic ◽  
Biliary Duct ◽  
Increased Risk ◽  
Gallbladder Agenesis

Abstract Aims Gallbladder agenesis is a rare congenital anatomical malformation with an incidence of 0.007-0.0027%. Although usually asymptomatic, clinically it may present similarly to biliary colic. There may be increased risk of de novo biliary duct stone formation due to biliary dyskinesia, subsequent duct dilatation and biliary stasis. We present a case of incidental gallbladder agenesis identified during intended laparoscopic cholecystectomy. Methods A 68 year-old female with no significant comorbidities presented with a 16 hour history of colicky right upper quadrant pain and vomiting. She had been awaiting cholecystectomy for increasingly symptomatic gallstones, most recently visualised within a contracted gallbladder on ultrasound two months prior. Recurrently obstructive LFT’s warranted urgent magnetic resonance cholangiopancreatography (MRCP), which identified a poorly-visualised contracted gallbladder and a 10mm common bile duct without filling defect. At index laparoscopic cholecystectomy, a very small thick-walled structure resembling the gallbladder was identified and safely excised in retrograde; a stone was seen within. Results Macroscopic examination revealed a 27 x 9 x 11mm piece of dark brown tissue containing soft orange material. Microscopic histological examination confirmed this to be cystic duct focally lined by mucinous epithelium with chronic inflammation. Findings were consistent with gallbladder agenesis. Conclusions Although rare, it is important for surgeons to maintain an index of suspicion for gallbladder agenesis, particularly if repeated imaging demonstrates a poorly-visualised or ‘contracted’ gallbladder despite adequate fasting. Furthermore, as in this case, the presence of ‘gallbladder’ stones radiologically does not preclude gallbladder agenesis. Anticipation of this malformation may aid interpretation of biliary anatomy, if incidentally found intra-operatively.

Intraoperative Diagnosis of Gallbladder Agenesis

2021 ◽  
pp. 000313482110604
Author(s):  
Maryselle Winters ◽  
Derek T. Clar ◽  
Kelly Van Fossen
Keyword(s):  
Ultrasound Examination ◽  
Rare Condition ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Colic ◽  
Imaging Findings ◽  
Intraoperative Diagnosis ◽  
Increased Risk ◽  
History Of ◽  
Elective Laparoscopic Cholecystectomy ◽  
Gallbladder Agenesis

Gallbladder agenesis is a congenital anomaly that often presents with symptoms of biliary colic. Due to the rarity of this condition, it is often difficult to diagnose pre-operatively. Here we present a case of a 33-yo female with a 6-month history of right upper quadrant abdominal pain and associated nausea. With false-positive imaging findings of cholelithiasis on ultrasound examination, an incidental intraoperative diagnosis of gallbladder agenesis was made during a routine elective laparoscopic cholecystectomy. This finding was confirmed with postoperative magnetic resonance cholangiopancreatography. The primary aim in reporting this case is to further promote awareness of this rare condition out of concern for increased risk of iatrogenic operative injury in the setting of a condition where conservative management is recommended.

scholarly journals P-BN13 How has the COVID pandemic affected outcomes in Elective Laparoscopic Cholecystectomy?An observational study in a UK Upper GI Surgical Unit

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
George Demetriou ◽  
Kasun Wanigasooriya ◽  
Ahmed Elmaradny ◽  
Ammar Al-Najjar ◽  
Mohammad Rauf ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Statistical Significance ◽  
Operating Time ◽  
Bile Leak ◽  
Biliary Colic ◽  
Gallstone Pancreatitis ◽  
Biliary Disease ◽  
Indications For Surgery ◽  
Elective Laparoscopic Cholecystectomy ◽  
Cbd Stone

Abstract Background COVID-19  has a significant impact on elective surgery for benign disease. When routine services resumed in April 2021, surgeons were faced with higher number of complicated cases. The aim of this study is to examine the effect of COVID-19 related delays on the outcomes of patients undergoing elective laparoscopic cholecystectomy (LC) in an upper gastrointestinal unit in the UK. Methods Data were collected retrospectively on consecutive patients undergoing elective LC between 1/3/19 to 1/5/19 (Pre-COVID) and 1/4/21 to 11/6/21 (resumption of elective operating following COVID). The indications for surgery, intraoperative details, postoperative complications, length of stay (LoS) and 30- day readmission were compared between the two cohorts. We divided indications for surgery as inflammatory (acute cholecystitis, gallstone pancreatitis, CBD stone with cholangitis) vs non-inflammatory (biliary colic, gallbladder polyps, CBD stone without cholangitis). Data were analysed using the Mann-Whitney U-test and Chi-square or Fisher’s exact test. A p value of &lt; 0.05 was used for statistical significance.  Results 159 patients were analysed, 106 in Pre-COVID vs 53 in Post-COVID. Both cohorts had similar age, gender, ASA-grade, BMI. 68 (64.2%) of the pre-COVID cohort were operated for a non-inflammatory pathology compared to 19(35.8%) of the post-COVID cohort (p &lt; 0.001). Less patients had total cholecystectomy (subtotal and failed surgery) in the post-COVID cohort [49(92.5%) vs 159 (100%) p = 0.01]. There was no difference in the operating time, conversion to open surgery, the need for drains, and no difference in the Clavien-Dindo grade complications. Two patients in pre- COVID cohort (1.8%) required re-operation for bile-leak and bowel injury and two in the post COVID cohort (3.7%) for bleeding and CBD-injury. There was no difference in day case discharge or 30-day readmission rate.  Conclusions Surgery in the post-COVID cohort was associated with a higher incidence of inflammatory biliary disease, subtotal cholecystectomy and procedure abandoned.  Although the numbers in our study are small they highlight the need for enhanced preoperative assessment in elective biliary surgery as the NHS emerges from the acute phase of the pandemic.

1228: Assessing the Surgical Decision-Making Ability of Novice and Proficient Urologists

2007 ◽  
Vol 177 (4S) ◽  
pp. 405-405
Author(s):  
Suman Chatterjee ◽  
Jonathon Ng ◽  
Edward D. Matsumoto
Keyword(s):  
Decision Making ◽  
Surgical Decision ◽  
Surgical Decision Making
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