Conservative Management of Gallstone Disease in the Elderly Population: Outcomes and Recurrence

Background & Aims: The prevalence of gallstone disease increases with age, being early cholecystectomy the most accepted treatment in the vast majority of patients in order to prevent complications and recurrence. The aim of this study is to determine the recurrence rate and its possible predictors after initial non-operative management. Materials and Methods: We reviewed a consecutive series of patients, older than 65 years, admitted for a gallstone-related disease and treated with a non-operative management between January 2010 and December 2013. We analyzed comorbidities, clinical data, diagnosis, management, recurrence, and its treatment. Median follow-up after the discharge was 2 years. Recurrence was analyzed by a Kaplan–Meier survival curve. Possible recurrence’s predictors were analyzed. Results: The study included 226 patients. Mean age was 80.4 ± 7.2 years, 127 (56%) were female. The main causes of index hospitalization were acute cholecystitis (58%) and biliary pancreatitis (18.1%). After 2 years of follow-up, the recurrence rate was 39.8%; mean time to recurrence was 255.2 ± 42.1 days, 81% of patients recurred within 1 year. Bile duct disease implied a higher recurrence rate than the gallbladder disease group (52% vs 33%, p < 0.001). Subjects with two or more diagnoses during index admission presented higher recurrence rate (32% vs 49%, p < 0.001). Conclusion: More than a third of elderly patients could present a recurrence within 2 years after initial non-operative management. Early cholecystectomy should be considered at index admission in order to prevent recurrence.

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Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management

Medicina ◽

10.3390/medicina57080734 ◽

2021 ◽

Vol 57 (8) ◽

pp. 734

Author(s):

Ivona Djordjevic ◽

Dragoljub Zivanovic ◽

Ivana Budic ◽

Ana Kostic ◽

Danijela Djeric

Keyword(s):

Splenic Abscess ◽

Operative Management ◽

High Energy ◽

Significant Difference ◽

Injury Grade ◽

Grade Ii ◽

The Mean ◽

Non Operative Management ◽

Grade Iii

Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.

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Selective non-operative management of anterior abdominal stab wounds with emphasis on the value of follow-up abdominal CT scanning

Trauma ◽

10.1177/1460408617706389 ◽

2017 ◽

Vol 20 (3) ◽

pp. 194-202

Author(s):

El Yamani Fouda ◽

Alaa Magdy ◽

Sameh Hany Emile

Keyword(s):

Ct Scan ◽

Ct Scanning ◽

Operative Management ◽

Abdominal Ct ◽

Management Group ◽

Abdominal Ct Scan ◽

Laparotomy Group ◽

Abdominal Stab Wounds ◽

Non Operative Management

Background and aim Selective non-operative management of patients with penetrating abdominal stabs is the preferred treatment strategy. The present study aimed to assess the efficacy and safety of non-operative management with emphasis on the value of follow-up abdominal CT scanning in management of patients with penetrating anterior abdominal stab. Patients and methods This is a retrospective chart review of stable patients with anterior abdominal stab wounds. Patients were divided in terms of initial decisions into two groups: laparotomy group and non-operative management group. Abdominal CT scan was performed for patients in the non-operative management group on admission and follow-up CT scanning was performed in cases of clinical and/or biochemical deterioration. Results The laparotomy group included 82 patients and 68.2% of them had unnecessary laparotomies. The non-operative management group comprised 97 patients and 90.7% of them did not require subsequent laparotomy. Abdominal CT scan had a sensitivity of 88.9% and specificity of 100% in detection of intra-abdominal injuries. Follow-up CT scanning detected bowel injuries missed by initial CT scan in three patients. The non-operative management group had significantly lower post-operative complication rate than the laparotomy group (4.1% vs. 18.3%), with a significantly shorter length of stay. Conclusions Non-operative management is the optimal management strategy for stable patients with penetrating anterior abdominal stab to decrease unnecessary laparotomy rates, hospital stay and costs. Follow-up abdominal CT scanning facilitated the decision making for patients selected for non-operative management and is highly sensitive in the diagnosis of patients who require subsequent exploration.

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Hepatobiliary surgery (DRAFT)

10.1093/med/9780198749813.003.0002 ◽

2018 ◽

Author(s):

Raj K. Prasad ◽

Imeshi Wijetunga

Keyword(s):

Hepatocellular Carcinoma ◽

Pancreatic Surgery ◽

Gallstone Disease ◽

Operative Management ◽

Vascular Injuries ◽

Hepatobiliary Surgery ◽

Surgical Trainee ◽

Surgical Trainees ◽

Ascending Cholangitis

This chapter discusses common elective and emergency presentations to hepatobiliary surgery. Gallstone disease, being the commonest hepatobiliary condition encountered by general surgical trainees, is discussed in detail. A separate section on acute ascending cholangitis is included with a brief description of the steps involved in laparoscopic cholecystectomy. Acute pancreatitis is discussed in Pancreatic Surgery Chapter 3. An overview of the assessment and management of post-cholecystectomy complications, such as bile duct injury and vascular injuries, is provided with illustrations. Management of common malignant conditions of the liver, such as colorectal liver metastasis, hepatocellular carcinoma, and cholangiocarcinoma, is included with detailed discussion of pre-operative imaging. Liver resection surgery and liver transplant surgery, as well as non-surgical management, are discussed. Details of post-operative management of hepatobiliary patients are aimed at the junior surgical trainee working in a tertiary hepatobiliary unit to aid day-to-day management of post-operative patients on the wards, as well as subsequent follow-up.

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Predictors of the failure of conservative treatment in patients with a thoracolumbar burst fracture

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02044-3 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Ehsan Alimohammadi ◽

Seyed Reza Bagheri ◽

Paniz Ahadi ◽

Sahar Cheshmehkaboodi ◽

Homa Hadidi ◽

...

Keyword(s):

Risk Factors ◽

Conservative Treatment ◽

Burst Fracture ◽

Binary Logistic Regression ◽

Operative Management ◽

Binary Logistic Regression Analysis ◽

Thoracolumbar Burst Fracture ◽

Potential Risk Factors ◽

Non Operative Management

Abstract Background There is a controversy about the management of patients with a thoracolumbar burst fracture. Despite the success of the conservative treatment in most of the cases, some patients failed the conservative treatment. The present study aimed to evaluate risk factors for the need for surgery during the follow-up period in these patients. Methods We retrospectively evaluated 67 patients with a traumatic thoracolumbar burst fracture who managed conservatively at our center between May 2014 and May 2019. Suggested variables as potential risk factors for the failure of conservative treatment including age, gender, body mass index (BMI), smoking, diabetes, vertebral body compression rate (VBCR), percentage of anterior height compression (PAHC), Cobb angle, interpedicular distance (IPD), canal compromise, and pain intensity as visual analog scale (VAS) were compared between patients with successful conservative treatment and those with failure of non-operative management. Results There were 41 males (61.2%) and 26 females (38.8%) with the mean follow-up time of 15.52 ± 5.30 months. Overall, 51 patients (76.1%) successfully completed conservative treatment. However, 16 cases (23.9%) failed the non-operative management. According to the binary logistic regression analysis, only age (risk ratio [RR], 2.21; 95% confidence interval [95%], 1.78–2.64; P = 0.019) and IPD (RR 1.97; 95% CI 1.61–2.33; P = 0.005) were the independent risk factors for the failure of the non-operative management. Conclusions Our results showed that older patients and those with greater interpedicular distance are at a higher risk for failure of the conservative treatment. As a result, a closer follow-up should be considered for them.

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Long-Term Follow-Up After Non-operative Management of Blunt Splenic and Liver Injuries: A Questionnaire-Based Survey

World Journal of Surgery ◽

10.1007/s00268-017-4336-5 ◽

2017 ◽

Vol 42 (5) ◽

pp. 1358-1363 ◽

Cited By ~ 2

Author(s):

Peter Moreno ◽

Matthias Von Allmen ◽

Tobias Haltmeier ◽

Daniel Candinas ◽

Beat Schnüriger

Keyword(s):

Operative Management ◽

Liver Injuries ◽

Long Term Follow Up ◽

Non Operative Management

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11. The safety of Vacuum assisted biopsy (VAB) / mammatome guided, non-operative management of B3 lesions without atypia a 7 year follow-up study

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2015.08.042 ◽

2015 ◽

Vol 41 (11) ◽

pp. S264

Author(s):

Alex Wilkins ◽

Peter Kneeshaw ◽

Penelope McManus ◽

Kartikae Grover ◽

Anne Hubbard

Keyword(s):

Operative Management ◽

Follow Up Study ◽

B3 Lesions ◽

Non Operative Management

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Safety of vacuum-assisted biopsy/mammatome guided, non-operative management of B3 lesions with atypia: a 7-year follow-up study

Breast Cancer Research ◽

10.1186/bcr3793 ◽

2015 ◽

Vol 17 (S1) ◽

Cited By ~ 1

Author(s):

Alex Wilkins ◽

Peter Kneeshaw ◽

Penelope McManus ◽

Kartikae Grover ◽

Caroline Bradley ◽

...

Keyword(s):

Operative Management ◽

Follow Up Study ◽

B3 Lesions ◽

Non Operative Management

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Lymphoedema: non-operative management

International Surgery Journal ◽

10.18203/2349-2902.isj20180832 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1067

Author(s):

Mukta Sukhadia ◽

Deepak Sethi ◽

Anjali Sethi

Keyword(s):

Early Diagnosis ◽

Operative Management ◽

Descriptive Study ◽

Intermittent Pneumatic Compression ◽

Comprehensive Care ◽

Rural Background ◽

Cancer Breast ◽

Compression Bandages ◽

Non Operative Management

Background: Lymphoedema is one of the most undesirable complication that is anticipated in patients of cancer breast post mastectomy. A comprehensive care of patient of lymphoedema is required which includes, prevention, early diagnosis and treatment. In the study conducted, efficacy of non-operative management of lymphoedema is observed.Methods: A descriptive study was conducted on women who presented with lymphoedema post-mastectomy. Thirty-three patients were studied for non-operative management. Treatment of patients was carried out with physiotherapy, massage, compression bandages and stockings and Intermittent pneumatic compression by pneumatic compression pump.Results: Patients were categorized according to the grades, duration of lymphoedema, type of treatment they received and effect of the treatment.Conclusions: Lymphoedema being dreaded complication, much attention needs to be given on its prevention post mastectomy. But in country like India, compliance and regular follow up is not possible for every patient, especially for the patients of the rural background. The same pattern of dearth in compliance follows in management of lymphoedema. Non-operative management is an effective mode of treatment in cases of post-mastectomy lymphoedema.

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Open sternoclavicular osteophyte debridement in the surgical management of sternoclavicular osteoarthritis: clinical outcome of a new procedure

Shoulder & Elbow ◽

10.1177/1758573220972093 ◽

2020 ◽

pp. 175857322097209

Author(s):

Charles I Ayekoloye ◽

Qi Yin ◽

Amanda Wood ◽

Simon Frostick

Keyword(s):

Clinical Outcome ◽

Conservative Management ◽

Operative Management ◽

Satisfaction Score ◽

Dash Score ◽

Patient Satisfaction Score ◽

Subjective Satisfaction ◽

Quick Dash ◽

Non Operative Management

Introduction Symptomatic sternoclavicular osteoarthritis is uncommon but remains the most frequent non-traumatic condition affecting the sternoclavicular joint and tends to have a predilection for middle-aged women. It responds well to conservative management. Surgery is indicated when conservative management fails. We present the clinical outcome of open symptomatic sternoclavicular osteophyte debridement, a new operation for treating recalcitrant symptomatic sternoclavicular osteoarthritis. Methods Five patients (five symptomatic sternoclavicular joints) with symptomatic sternoclavicular osteoarthritis underwent open sternoclavicular debridement following failure of conservative treatment. There were three females and two males. Mean age was 46.6 years (range 37.17–66). Four cases were primary osteoarthritis and one case was secondary to trauma. They were reviewed at mean follow-up at 35.4 months with minimum follow-up of 29 months. Assessment included Quick Disabilities of Arm Shoulder and Hand (DASH) and subjective patient satisfaction score. Results There was no post-operative complication. Mean Quick DASH score 10.9 (range 0–29.5) at mean 35.4-month follow-up (range 29–43 months). Three patients reported excellent and two reported good outcome as per subjective satisfaction score. Conclusions Open sternoclavicular debridement has proved to be a simple, safe and highly effective new surgical treatment for patients with symptomatic sternoclavicular osteoarthritis unresponsive to non-operative management.

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