228 Outcomes of Gallstone Complications During the COVID Pandemic

Abstract Background The Intercollegiate General Surgery Guidance on COVID-19 recommended either non-surgical management or cholecystostomy drains for the management of acute biliary disease replacing gold standard practice of early laparoscopic cholecystectomy within 1 week of index admission with drainage reserved for high-risk patients where surgery is not appropriate. Method This is the retrospective study presenting the impact of gallstone disease in our unit during five months of the COVID- 19 pandemic (March 2020-August 2020) compared with the equivalent period in 2019. Results Patients presenting to the HPB unit with a coded diagnosis of gallstones were included and during the study period 1447 patients presented compared with 1413 in 2019. In 2020 compared with 2019 there was a significant decrease in patients presenting with cholecystitis (240 vs 313; p = 0.031) but no significant difference in patients presenting due to gallbladder perforation (44 vs 51). Interestingly the numbers of cholecystostomies were comparable, with 11 in 2020 and 15 in 2019 representing significantly less than the 7.2% figure published by Peckham-Cooper et al. Conclusions In our study there was a decrease in patients with cholecystitis and perforation and there was an increase in patients with gallstone pancreatitis, increase waiting lists with increase in the incidence of serious complications. In our trust we currently have 656 patients awaiting cholecystectomy compared to 280 in august 2019. With the recent elevation of the alert level to 4 and increased government restrictions, a consistent National approach is required to mitigate these risks.

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The Impact of a Dedicated “Hot List” on the In-Patient Management of Patients With Acute Gallstone-Related Disease

Frontiers in Surgery ◽

10.3389/fsurg.2021.643077 ◽

2021 ◽

Vol 8 ◽

Author(s):

Saurabh Jamdar ◽

Vishnu V. Chandrabalan ◽

Rami Obeidallah ◽

Panagiotis Stathakis ◽

Ajith K. Siriwardena ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gallstone Disease ◽

Operating Theatre ◽

Index Admission ◽

Biliary Disease ◽

Time Period ◽

Significant Difference ◽

Duration Of Surgery ◽

Time Periods ◽

The Impact

Background: Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. This study assesses the impact of dedicated theatre capacity provided by a specialist surgical team on rates of index admission cholecystectomy.Methods: This clinical cohort study compares the management of patients with symptomatic gallstone disease admitted to a tertiary care university teaching hospital over two equal but chronologically separate time periods. The periods were before and after service reconfiguration including a specialist HPB service with dedicated operating theatre time allocation.Results: There was a significant difference in the number of admissions over the two time periods with a greater proportion of patients having index admission surgery in the second time period with correspondingly fewer having more than one admission during this latter time period. In the second time period 43% of patients underwent index admission cholecystectomy compared to 23% in the first (P < 0.001). The duration of surgery was shorter for patients undergoing surgery during the second time period [135 (102–178) min in the first period and in the second period 106 (89–145) min] (P = 0.02).Discussion: This paper shows that the concentration of theatre resources and surgical expertise into regular theatre access for patients undergoing urgent laparoscopic cholecystectomy is an effective and safe model for dealing with acute biliary disease.

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Outcomes of gallstone complications during the COVID pandemic

British Journal of Surgery ◽

10.1093/bjs/znaa068 ◽

2020 ◽

Author(s):

J Isherwood ◽

B Karki ◽

W Y Chung ◽

T AlSaoudi ◽

J Wolff ◽

...

Keyword(s):

Gallstone Disease ◽

Gallstone Pancreatitis ◽

Surgical Practice ◽

Recent Increase ◽

Number Of Patients ◽

The Impact ◽

National Approach

As data and metadata from the SARS-CoV-2 pandemic mature, the true impact on non-cancer, non-emergency surgical practice is becoming apparent. The authors present data on the impact of gallstone disease in their unit during 5 months of the COVID-19 pandemic (March 2020 to August 2020) compared with the equivalent period in 2019. Although the total number of patients presenting with gallstone disease was comparable, there was a decrease in patients with cholecystitis and perforation (although it is possibly too early for these to have presented), and there was a small but worrying increase in patients with gallstone pancreatitis. With the recent increase in alert level to 4 and increased government restrictions in an attempt to avoid a second national lockdown, a consistent national approach is required to mitigate these risks.

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Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

Tropical Doctor ◽

10.1177/00494755211010002 ◽

2021 ◽

pp. 004947552110100

Author(s):

Shamir O Cawich ◽

Avidesh H Mahabir ◽

Sahle Griffith ◽

Patrick FaSiOen ◽

Vijay Naraynsingh

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Gold Standard ◽

Standard Treatment ◽

Gallstone Disease ◽

Acute Attack ◽

Early Laparoscopic Cholecystectomy ◽

Delayed Surgery ◽

Delayed Cholecystectomy ◽

Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

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Evaluation of suitability of simultaneous laparoscopic surgery for the treatment of diseases of the hepatobiliary system

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2020-24(3)-09 ◽

2020 ◽

Vol 24 (3) ◽

pp. 418-424

Author(s):

M. Halei ◽

I. Dzubanovsky ◽

I. Marchuk

Keyword(s):

Blood Pressure ◽

Gallstone Disease ◽

Recovery Period ◽

Duration Of Treatment ◽

Creatinine Concentration ◽

Oral Nutrition ◽

Results Of Treatment ◽

Significant Difference ◽

Duration Of Surgery ◽

The Impact

Annotation. Aim of work - to investigate the impact of the developed technique of simultaneous laparoscopic operations on the results of treatment of surgical hepatobiliary pathology, to analyze and compare the main indicators of efficiency and safety of own technique with the "French" technique of cholecystectomy. During period from 2013 to 2019, 253 patients with combined hepatobiliary pathology and gallstone disease were treated using our own simultaneous surgery technique (group 1) and 328 patients with only gallstone disease treated using standard 'French technique' (group 2). The comparison was made through the analysis and comparison of such indicators as the duration of treatment, duration of surgery, serum creatinine concentration, glycemia, blood pressure. Shapiro-Wilk statistical methods, Mann-Whitney criteria or U-test were used. The following results were obtained: the duration of the operation was 66.14±6.21 minutes in the first group against 42.6±4.72 minutes in the second and did not exceed 2 hours; blood creatinine concentration did not exceed the allowable 2 mg/dl in both groups and differed slightly (p = 0.937), normalized in the period 6-12 h; glycemia also did not differ between the study and control groups and normalized during the recovery period of oral nutrition (p=0.822); Blood pressure was monitored to maintain normotony, the difference between intraoperative parameters in both groups was insignificant (p=0.912); the length of stay had no statistically significant difference between the groups (p=0.784) and was 3.53 days for the first and 3.45 for the second group. The method is valid for modern requirements, and the technique justifies its use.

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Association between Atrial Fibrillation, Myocardial Infarction, Heart Failure and Mortality in Patients with Nontuberculous Mycobacterial Infection: a nationwide population-based study

Scientific Reports ◽

10.1038/s41598-019-51801-w ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Chan Soon Park ◽

Eue-Keun Choi ◽

Bongseong Kim ◽

Kyung-Do Han ◽

So-Ryoung Lee ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Mycobacterial Infection ◽

Population Based ◽

Newly Diagnosed ◽

Increased Risk ◽

Significant Difference ◽

Risk Patients ◽

The Impact

Abstract NTM infection demonstrates an increasing incidence and prevalence. We studied the impact of NTM in cardiovascular events. Using the Korean nationwide database, we included newly diagnosed 1,730 NTM patients between 2005 and 2008 and followed up for new-onset atrial fibrillation (AF), myocardial infarction (MI), heart failure (HF), ischemic stroke (IS), and death. Covariates-matched non-NTM subjects (1:5, n = 8,650) were selected and analyzed. Also, NTM infection was classified into indolent or progressive NTM for risk stratification. During 4.16 ± 1.15 years of the follow-up period, AF, MI, HF, IS, and death were newly diagnosed in 87, 125, 121, 162, and 468 patients. In multivariate analysis, NTM group showed an increased risk of AF (hazard ratio [HR] 2.307, 95% confidence interval [CI] 1.560–3.412) and all-cause death (HR 1.751, 95% CI 1.412–2.172) compared to non-NTM subjects, whereas no significant difference in MI (HR 0.868, 95% CI 0.461–1.634), HF (HR 1.259, 95% CI 0.896–2.016), and IS (HR 1.429, 95% CI 0.981–2.080). After stratification, 1,730 NTM patients were stratified into 1,375 (79.5%) indolent NTM group and 355 (20.5%) progressive NTM group. Progressive NTM showed an increased risk of AF and mortality than indolent NTM group. Screening for AF and IS prevention would be appropriate in these high-risk patients.

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Excellent Outcome Of MRD Low Risk Patients Is Sustained With Greater Than 10 Years Follow Up – Results Of UK ALL Trials 1997 -2003

Blood ◽

10.1182/blood.v122.21.2635.2635 ◽

2013 ◽

Vol 122 (21) ◽

pp. 2635-2635

Author(s):

Jack Bartram ◽

Rachel Clack ◽

Rachel Wade ◽

Ajay J Vora ◽

Jeremy Hancock ◽

...

Keyword(s):

Induction Chemotherapy ◽

Limit Of Detection ◽

Low Risk ◽

Childhood All ◽

Excellent Outcome ◽

Significant Difference ◽

Risk Patients ◽

The Impact

Abstract Background Sensitive measurement of minimal residual disease (MRD) at the end of induction, to a minimum limit of detection of 0.01% is known to highlight a large group of patients (>40%) with an excellent (>90%) short term EFS. The UKALL 2003 study showed treatment reduction is feasible in children and young adults with no MRD >0.01% at day 28 of therapy (Vora et al, Lancet Oncology 2013). Nevertheless, follow up in that study and other recent trials is relatively short, raising concerns about using this result to infer the safety of further therapy reduction in the future. In order to provide insight into the applicability of this result, we have studied the longer term outcome of patients with MRD <0.01% at day 28 in our non-interventional pilot studies; UK ALL 97, 97/99 and 2003. Methods We examined 225 patients treated on one of the 3 trials between 1997 and 2003 for whom MRD results were available. The UK Medical Research Council (MRC) protocol ALL97 (1997–1999) had a 5 year EFS of 74% and OS 83.5%, and its amended version ALL 97/99 (1999–2002) had a 5 year of EFS 80% and OS 88%. These studies both compared in a randomised fashion, the efficacy and toxicity of dexamethasone with prednisolone, and 6-thioguanine with 6-Mercaptopurine. The successor trial ALL 2003, had a 5 year EFS of 87.7% and an OS of 91.3%, using more intensive induction including dexamethasone for all patients and PEGylated asparaginase. These trials provided an opportunity to determine the impact of MRD clearance on EFS and OS, with extended follow-up. MRD status at the end of induction chemotherapy was defined as low risk if no MRD was detected by at least one marker sensitive to 0.01%. In the ALL 97 study, MRD was measured by radiolabelled allele specific oligoprobing (sensitive to 0.01%); in ALL 99 and 2003 it was measured using the Euro-MRD RQ PCR of antigen receptor genes (quantitative range 0.01%). Results 100 patients (44%) were low risk by MRD at end of induction. The median range of follow-up across the trials was 7 years 4 months to 12 years 11 months (longest individual follow up 14 years 1 month). There was no significant difference in NCI risk group between MRD positive and negative patients. Discussion Our pilot data defines a cohort of 44% of children with ALL who have a very good EFS and an excellent long term OS. Of 100 day 28 MRD low risk patients, 6 died: 1 because of toxicity at 1 month post diagnosis; and 1 from influenza 147 months post diagnosis whilst in CR; only 4 patients had relapses, at 17, 45, 74 and 125 months post diagnosis. Conclusion The excellent outcome for childhood ALL with low risk MRD after induction chemotherapy is sustained in the intermediate to long term. This result supports the potential for further reduction in therapy in subsequent trials for these children, without risk of worsening outcome. Disclosures: No relevant conflicts of interest to declare.

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The ideal timing of cholecystectomy for mild gallstone pancreatitis

International Surgery Journal ◽

10.18203/2349-2902.isj20195980 ◽

2019 ◽

Vol 7 (1) ◽

pp. 253

Author(s):

Satishkumar R. ◽

Anukethan J.

Keyword(s):

Hospital Stay ◽

Open Cholecystectomy ◽

Gallstone Disease ◽

Gall Stone ◽

Gallstone Pancreatitis ◽

Readmission Rates ◽

Duration Of Hospital Stay ◽

Significant Difference ◽

Conversion To Open Cholecystectomy ◽

The Ideal

Background: Gallstone disease is one of the most common problems affecting the digestive tract with a prevalence of 11% to 36% and is the most common cause of gall stone pancreatitis. The cholecystectomy is necessary to prevent recurrent pancreatitis in gallstone pancreatitis, but the ideal timing for cholecystectomy is controversial.Methods: This was a prospective randomized study with 59 patients conducted in the department of general surgery, KIMS, Bangalore from 2014 to 2019. All patient with mild gallstone pancreatitis, the following variables, duration and cost of hospital stay, readmission rates, intraoperative time, intra and postoperative complications and conversion to open cholecystectomy were studied.Results: A total of 59 patients in the age group of 21 to 71 years with mild gallstone pancreatitis were included in the study. Mean age of presentation was 57years. Out of 59 patients 28 underwent same admission cholecystectomy and 31 underwent interval cholecystectomy. There was a significant difference noted in terms of mean duration of hospital stay (9.28 versus 17.20 days), mean cost of hospital stay (19340 versus 28240rs) and readmission rate (0% versus 19.35%), but in terms of mean intraoperative time (85 min versus 92 min) and conversion rate (0% versus 6.4%) there was no statistically significant difference between two group.Conclusions: Same admission cholecystectomy for mild gallstone pancreatitis can significantly reduce cost and duration of hospital stay and readmission rates. With regard to intraoperative time, conversion to open, intraoperative and postoperative complication there is no statistically significant difference seen. Hence same admission cholecystectomy is safe, feasible and recommended.

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Mucosal inflammation predicts response to systemic steroids in immune checkpoint inhibitor colitis

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2019-000451 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000451 ◽

Cited By ~ 3

Author(s):

Meghan J Mooradian ◽

Daniel Y Wang ◽

Alexandra Coromilas ◽

Melissa Lumish ◽

Tianqi Chen ◽

...

Keyword(s):

Immune Checkpoint ◽

Clinical Decision Making ◽

Progression Free Survival ◽

Clinical Decision ◽

Mucosal Inflammation ◽

Therapeutic Implications ◽

Significant Difference ◽

Risk Patients ◽

Endoscopic Assessment ◽

The Impact

BackgroundImmune-related colitis is a common, often serious complication of immune checkpoint inhibition (ICI). Although endoscopy is not strictly recommended for any grade of diarrhea/colitis, emerging evidence suggests that endoscopic evaluation may have important therapeutic implications. In this retrospective study, we sought to comprehensively characterize the clinical and histologic features of ICI-induced colitis with a specific focus on evaluating the prognostic role of endoscopy.MethodsData were collected from the medical records of 130 patients with confirmed ICI-induced colitis. In a subset of patients (n=44) with endoscopic and pathologic data, endoscopic data were scored using the Mayo Endoscopic Score (MES) with scores ranging from 0 (no inflammation) to 3 (colonic ulceration). The impact of infliximab on antitumor outcomes was evaluated using progression-free survival (PFS) and overall survival (OS).ResultsWe identified 130 patients with ICI-induced colitis across two institutions. All patients were treated with corticosteroids. Additional and/or alternative immunosuppression was employed in 59 cases, with 52 patients (42%) requiring at least one infusion of infliximab 5 mg/kg. Endoscopic assessment with biopsy was performed in 123 cases of suspected colitis (95%), with 44 cases available for MES tabulation. Presence of ulceration (MES 3) was associated with use of infliximab (p=0.008) and MES was significantly higher in patients who received infliximab compared with those who did not (p=0.003) with a median score of 2.5; conversely, those with an MES of zero rarely required secondary immunosuppression. Notably, symptoms of colitis based on Common Terminology Criteria for Adverse Events grade had no association with endoscopic findings based on MES classification. After adjustment for baseline patient and disease characteristics, there was no significant difference in steroid duration or cancer-related outcomes in patients treated with infliximab.ConclusionsIn our study, we demonstrate the association of endoscopic features, specifically the MES, with immunosuppressive needs. Importantly, we also show that MES was not related to severity of patient symptoms. The data suggest that endoscopic features can guide clinical decision-making better than patient symptoms, both identifying high-risk patients who will require infliximab and those who are likely to respond to initial corticosteroids.

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Is gender a determinant for the outcome of laparoscopic cholecystectomy?

International Surgery Journal ◽

10.18203/2349-2902.isj20204992 ◽

2020 ◽

Vol 7 (12) ◽

pp. 3959

Author(s):

Akshay Bahadur ◽

S. D. Bisht ◽

Yanshul Rathi ◽

Ashish Shukla ◽

Aman Aggarwal

Keyword(s):

Risk Factor ◽

Laparoscopic Cholecystectomy ◽

Open Surgery ◽

Gallstone Disease ◽

Female Group ◽

Conversion To Open Surgery ◽

Significant Difference ◽

Male Sex ◽

Operative Findings ◽

The Impact

Background: Currently, laparoscopic cholecystectomy is one of the most desirable procedures to treat symptomatic gallstone disease. Yet, various risk factors govern its conversion to open surgery. The impact of male sex as a risk factor for conversion has been a questionable issue. The study aimed to evaluate the role of male sex on outcomes of laparoscopic cholecystectomy.Methods: As per inclusion and exclusion criteria, medical records of all the patients aged 18-70 years who underwent elective LC for a period of 14 months were accessed retrospectively. Data related to patients’ demographic details, intra-operative and post-operative findings was recorded and subjected to analysis.Results: Out of 232 selected cases, 17.67% were males and 82.32% were females. Mean age in both gender groups was similar (p=0.139). Body mass index was also found to be similar in both the groups (p=0.232). There was no significant difference (p=0.85) in the mean operative time between men (29.37±9.29) and women (28.88±15.66). Conversion to open surgery was seen only in female group (1.57%) but it is not significantly from the male group (p=0.42). No significant difference was observed in both groups regarding unwanted intra-operative events (p=0.231) and post-operative complications (p=0.70) and post- operative stay (p=0.50).Conclusions: This study suggests that male gender may not be considered as an independent risk factor for outcome of laparoscopic cholecystectomy. However, extensive research in future may cast further light on this issue.

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PET/CT com Fluorocolina-F18 em Doentes com Carcinoma da Próstata em Recidiva Bioquímica

Acta Médica Portuguesa ◽

10.20344/amp.7056 ◽

2016 ◽

Vol 29 (3) ◽

pp. 182

Author(s):

Paula Lapa ◽

Rodolfo Silva ◽

Tiago Saraiva ◽

Arnaldo Figueiredo ◽

Rui Ferreira ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Biochemical Recurrence ◽

Systemic Disease ◽

Intermediate Risk ◽

High Risk Patients ◽

Pet Ct ◽

Significant Difference ◽

Risk Patients ◽

The Impact

Introduction: In prostate cancer, after therapy with curative intent, biochemical recurrence frequently occurs. The purpose of this study was to evaluate the impact of PET/CT with 18F-fluorocholine in restaging these patients and in their orientation, and to analyze the effect of the risk stratification, the values of PSA and the hormone suppression therapy, in the technique sensitivity. Material and Methods: Retrospective analysis of 107 patients with prostate carcinoma in biochemical recurrence who underwent PET/CT with 18F-fluorocholine in our hospital, between December 2009 and May 2014. Results: The overall sensitivity was 63.2% and 80.0% when PSA > 2 ng/mL. It was possible to identify distant disease in 28% of the patients. The sensitivity increased from 40.0%, in patients with low and intermediate risk, to 55.2% in high-risk patients. Without hormonal suppression therapy, the sensitivity was 61.8%, while in the group under this therapy, was 67.7%. Discussion: PET/CT with 18F-fluorocholine provided important information even in patients with low levels of PSA, however, with significantly increased sensitivity in patients with PSA > 2 ng/mL. Sensitivity was higher in high-risk patients compared with low and intermediate risk patients, however, without a statistically significant difference. The hormone suppression therapy does not appear to influence uptake of 18F-fluorocholine in patients resistant to castration. Conclusions: In this study, PET/CT with 18F-Fluorocholine showed good results in restaging patients with prostate cancer biochemical recurrence, distinguishing between loco regional and systemic disease, information with important consequences in defining the therapeutic strategy.

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