scholarly journals COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matteo Barabino ◽  
Gaetano Piccolo ◽  
Arianna Trizzino ◽  
Veronica Fedele ◽  
Carlo Ferrari ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Percutaneous Cholecystostomy ◽  
Disease Evolution ◽  
Tokyo Guidelines ◽  
Gallbladder Drainage ◽  
National Health Care ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Italian National Health ◽  
Grade Ii ◽  
The Mean

Abstract Background COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. Methods We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. Results Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. Conclusions Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.

scholarly journals COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy.

2020 ◽  
Author(s):  
Barabino Matteo ◽  
Piccolo Gaetano ◽  
Trizzino Arianna ◽  
Fedele Veronica ◽  
Ferrari Carlo ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Tokyo Guidelines ◽  
Gallbladder Drainage ◽  
National Health Care ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Italian National Health ◽  
Grade Ii ◽  
The Mean ◽  
Different Levels ◽  
Operative Monitoring

Abstract BACKGROUND.COVID-19 pandemic has impacted the Italian national health care system at many different levels, causing a complete reorganization of surgical wards. In this context, in this study we retrospectively analyzed our management strategy for patients with acute cholecystitis.METHODSWe analyzed all patients admitted to our Emergency Department for acute cholecystitis from February 27th to April 30th, 2020. We graded each case according to the 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. RESULTSThirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II and 8 grade III). According to Tokyo Guidelines 2018, patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in 29.7%, 21.6 % and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous drainage was of 87.5%, the mean post-procedural hospitalization length was 9 days, and no related adverse event were observed.CONCLUSIONS.Bedside cholecystostomy has shown to be an effective and safe treatment, which acquired an increased relevance in the present acute phase of the pandemic. This strategy will potentially be taken into consideration in future phases, when the coexistence with the virus will require us to respond in an even more virtuous fashion.

scholarly journals COVID-19 Outbreak and Acute Cholecystitis in a Hub Hospital in Milan: Wider Indications for Percutaneous Cholecystostomy.

2020 ◽  
Author(s):  
Matteo Barabino ◽  
Gaetano Piccolo ◽  
Arianna Trizzino ◽  
Veronica Fedele ◽  
Carlo Ferrari ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Tokyo Guidelines ◽  
Gallbladder Drainage ◽  
National Health Care ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Italian National Health ◽  
Grade Ii ◽  
The Mean ◽  
Different Levels ◽  
Operative Monitoring

Abstract BACKGROUND.COVID-19 pandemic has impacted the Italian national health care system at many different levels, causing a complete reorganization of surgical wards. In this context, in this study we retrospectively analyzed our management strategy for patients with acute cholecystitis.METHODS.We analyzed all patients admitted to our Emergency Department for acute cholecystitis from February 27th to April 30th, 2020. We graded each case according to the 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. RESULTS.Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II and 8 grade III). According to Tokyo Guidelines 2018, patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in 29.7%, 21.6 % and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous drainage was of 87.5%, the mean post-procedural hospitalization length was 9 days, and no related adverse event were observed.CONCLUSIONS.Bedside cholecystostomy has shown to be an effective and safe treatment, which acquired an increased relevance in the present acute phase of the pandemic. This strategy will potentially be taken into consideration in future phases, when the coexistence with the virus will require us to respond in an even more virtuous fashion.

Percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy for acute cholecystitis

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Minh Hai Pham ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Medical Center ◽  
Case Series ◽  
Morbidity Rate ◽  
Safe Procedure ◽  
Gallbladder Drainage ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Grade Ii ◽  
Grade Iii

Abstract Introduction: Laparoscopic cholecystectomy (LC) has been considered as main treatment for acute cholecystitis due to gallstones. However, LC is not entirely safe for patients with severe comorbidities, high risk of surgery. In such circumstances, two-stage treatment including percutaneous transhepatic gallbladder drainage (PTGBD) first and then LC is an appropriate choice. PTGBD followed by LC or LC after PTGBD might be technically difficult. This article was written to evaluate the feasibility and the safety of PTGBD followed by LC (PTGBD + LC). Materials and Methods: This case series report was conducted on patients who underwent PTGBD + LC in University Medical Center, Ho Chi Minh City, Vietnam, from June 2018 to June 2020. We applied TG 2018 criteria for diagnosis and severity grading of cholecystitis in all patients. The comorbidities were evaluted according to Charlson comorbidity index (CCI) and American Society of Anesthesiologists physical status (ASA-PS) classification. Indications for PTGBD were grade II or grade III acute cholecystitis and the presence of a severe comorbidities (CCI > 6 and/or ASA > III). Results: From June 2018 to June 2020, there were 13 cases performed PTGBD + LC. There were 84,6% of grade II cholecystitis cases and 15,4% of grade III cholecystitis cases according to Tokyo guidelines 2018 criteria with comorbidities (30,8% of cases with CCI > 6, 100% of cases with ASA > III). Mean operative time: 126 minutes; one case needed transfusion due to bleeding from gallbladder inflammatory; no conversion to open surgery; morbidity rate was 23,1% (1 bile leakage successfully treated with preservation, 1 surgical site infection, 1 pneumoniae); mean hospital stay was 5,25 days; no mortality was observed in this series. Conclusions: PTGBD followed up by LC is feasible and safe procedure for acute cholecystitis in selected patients.

scholarly journals Laparoscopic subtotal cholecystectomy after percutaneous transhepatic gallbladder drainage for grade II or III acute cholecystitis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masafumi Ie ◽  
Morihiro Katsura ◽  
Yukihiro Kanda ◽  
Takashi Kato ◽  
Kazuya Sunagawa ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Acute Cholecystitis ◽  
Gallbladder Drainage ◽  
Open Conversion ◽  
Subtotal Cholecystectomy ◽  
Conversion Rates ◽  
Significant Difference ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Grade Ii

Abstract Background Severe adhesions and fibrosis between the posterior wall of the gallbladder and liver bed often render total cholecystectomy after percutaneous transhepatic gallbladder drainage (PTGBD) difficult, leading to high open conversion rates. Since the publication of Tokyo Guidelines 2018 (TG18), our policy has shifted from open conversion to subtotal cholecystectomy (SC) when total laparoscopic cholecystectomy for difficult cases of cholecystitis is not feasible. Recently, SC has been frequently applied as bailout surgery for complicated cholecystitis. Nonetheless, the efficacy and validity of laparoscopic SC after PTGBD remain unclear. This study aimed to evaluate the safety and feasibility of laparoscopic SC after PTGBD for grade II or III acute cholecystitis (AC) by comparing two periods of altered surgical strategies. Methods This retrospective cohort study was conducted between January 2013 and December 2020. A total of 44 eligible patients with grade II or III AC were divided according to the time of cholecystitis onset into the pre-TG18 group (2013–2017, n = 17) and post-TG18 group (2018–2020, n = 27). Patients’ background demographics, surgical method, surgical results, and postoperative complications were compared. Results The interval between PTGBD and surgery was significantly longer in the post-TG18 group than in the pre-TG18 group (15 [interquartile range: 9–42] days vs. 8 [4–11] days; P = 0.010). The frequency of laparoscopic cholecystectomy significantly increased from 52.9% in the pre-TG18 group to 88.9% in the post-TG18 group (P = 0.007), whereas the frequency of SC was 23.5% and 40.7%, respectively, which showed no statistically significant difference (P = 0.241). However, the rate of laparoscopic SC significantly increased from 0 to 90.9% among 15 SC cases, whereas the rate of open SC significantly plummeted from 100 to 9.1% (P = 0.001). Significant differences in the operative time, amount of intraoperative bleeding, and incidence of postoperative complications (wound infection and subhepatic abscess) were not observed. Mortality, bile leakage, and bile duct injury did not occur in either group. Conclusions For grade II or III AC after PTGBD, aggressive adoption of SC increased the completion rate of laparoscopic surgery. Laparoscopic SC is a safe and feasible treatment option.

scholarly journals Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years’ experience at a tertiary care centre

2021 ◽  
Author(s):  
Szabolcs Ábrahám ◽  
Illés Tóth ◽  
Ria Benkő ◽  
Mária Matuz ◽  
Gabriella Kovács ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Cholecystitis ◽  
Conversion Rate ◽  
Clinical Success ◽  
Definitive Treatment ◽  
Success Rates ◽  
Female Ratio ◽  
Gallbladder Drainage ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Grade Iii

Abstract Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

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