scholarly journals Complex assessment of the laboratory and ultrasound methods of clinical examination including immunological markers in elderly patients with acute cholecystitis depending on the surgical treatment

2018 ◽  
Vol 11 (1) ◽  
pp. 24-32
Author(s):  
Maxim Borisovich Polyansky ◽  
Pyotr Mikhaylovich Nazarenko ◽  
Dmitry Petrovich Nazarenko ◽  
Tatjana Aleksandrovna Ishunina ◽  
Levan Lorikovich Kvachakhiya
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Gall Bladder ◽  
Elderly Patients ◽  
Acute Cholecystitis ◽  
Clinical Examination ◽  
Complex Analysis ◽  
Open Cholecystectomy ◽  
Blood Parameters ◽  
Cell Immunity

Relevance. The prevalence of cholelithiasis  increases with age and reaches 25-30% in elderly and senile patients [1]. The "golden standard" of surgical intervention for acute cholecystitis, by right, is considered to be video-laparoscopic cholecystectomy, but with severe concomitant pathology, video-laparoscopic cholecystectomy is limited. Even with the "open" cholecystectomy in patients older than 60 years, lethality is 5-10 times higher than in young people [4]. In connection with this, an alternative method of treatment of OX in patients of older age groups was proposed - thermal mucoclasiа of the gallbladder. Aim. To carry out complex analysis of the results of laboratory and ultrasound methods of clinical examination in elderly patients with acute cholecystitis (AC) depending on two main types of surgical treatment: video laparoscopic cholecystectomia or thermal mucoclasia of a gall bladder. Materials and methods. The results of the red and white blood counts, the assessment of biochemical blood parameters, immune markers and the outcomes of ultrasound examination of the gall bladder before operation and after different periods following this treatment were analyzed in elderly patients who were admitted urgently to the surgical units of the Kursk city hospitals. Results and its discussion. In patients who underwent traditional cholecystostomy with the thermal mucoclasia lower values of erythrocytes, hemoglobin and general protein levels were detected demonstrating the presence of anemia. In this group the secondary immunodeficiency with alterations of the T-cell immunity was noted. These changes are most probably related to aging since the average age of these patients was about 10 years more than in the VLHE group. Patients who were operated by VLHE were admitted to hospitals with more pronounced changes of biochemical blood parameters, i.e. with higher levels of bilirubin, ACT, ALT and amylase. Conclusions. The results of the present study can be used for the choice of the surgical operation and for the pre-operatory treatment of elderly patients with acute cholecystitis.

Unusual fistula demonstrating the need for an early cholecystectomy

2020 ◽  
Vol 13 (9) ◽  
pp. e235795
Author(s):  
Gregory Harrison ◽  
Roland Fernandes
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Early Cholecystectomy ◽  
Calot’S Triangle ◽  
Initial Episode ◽  
Laparoscopic Assisted ◽  
Definitive Management ◽  
Active Disease

A 79-year-old man developed a spontaneous cholecystocutaneous fistula 12 months after an initial episode of acute cholecystitis. A laparoscopic cholecystectomy procedure was twice abandoned due to extensive adhesions and active disease, limiting safe dissection of Calot's triangle. Abdominal collections formed and a spontaneous cholecystocutaneous fistula developed. Imaging revealed an 11 cm calculus and erosion of the fundus of the gall bladder through the sheath. Definitive management was achieved with a laparoscopic assisted open cholecystectomy.

scholarly journals Predictive factors for conversion from laparoscopic to open cholecystectomy: an institutional study

2018 ◽  
Vol 5 (8) ◽  
pp. 2894
Author(s):  
Digvijoy Sharma ◽  
Kunduru Nava Kishore ◽  
Gangadhar Rao Gondu ◽  
Venu Madhav Thumma ◽  
Suryaramachandra Varma Gunturi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Bladder Wall Thickness ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy ◽  
Gall Bladder Wall

Background: Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gallstones. However, a conversion to open surgery may be required to complete the procedure safely. The aim of this study is to identify the predictive factors of conversion from laparoscopic to open cholecystectomy in elective setting.Methods: A retrospective review of all patients underwent laparoscopic cholecystectomy electively for symptomatic gallstones from January 2016 to December 2017 was performed. Data considered for analysis were: demographic data, preoperative laboratory values of liver function tests, gall bladder wall thickness on ultrasound, preoperative ERCP, indication for surgery, history of acute cholecystitis, presence of intraoperative adhesions and frozen Calot's triangle. Conversion to open cholecystectomy was chosen as the dependent variable for both, univariate and multivariate analysis.Results: 546 patients underwent laparoscopic cholecystectomy. 333 were females (60.9%) and 213 (39.1%) males, with a mean age of 44.6 years. The most common indication for surgery was symptomatic cholelithiasis. Conversion to open cholecystectomy occurred in 48 cases (8.8%) and the most common reason for conversion was inability to define the Calot’s triangle anatomy due to inflammation/adhesions. Univariate and multivariate analyses of various variables demonstrated that male gender, gall bladder wall thickness >5 mm and presence of previous documented acute cholecystitis had statistically significant co-relation with higher rates of conversion (p<0.001).Conclusions: Presence of acute cholecystitis, gall bladder wall thickness >5mm on preoperative ultrasound and male gender were independent predictor factors for conversion from laparoscopic to open cholecystectomy. Such patients should be properly counselled about the increased risk for conversion and should be operated by surgeons experienced in laparoscopic procedures to reduce the rate of conversion and operative complications.

scholarly journals Determinants of conversion during laparoscopic cholecystectomy among a sample of Iraqi patients

2018 ◽  
Vol 5 (7) ◽  
pp. 2455
Author(s):  
Abutalib B. Alluaibi ◽  
Bahaa K. Hassan ◽  
Alaa H. Ali ◽  
Ahmed A. Muhsen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Male Gender ◽  
Visceral Injury ◽  
Previous Abdominal Surgery ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy

Background: Laparoscopic cholecystectomy has become a standard technique for gall bladder surgery of symptomatic cholelithiasis. However, conversion to open cholecystectomy is sometimes necessary. The aim of the present study was to assess the predictive factors that increase the possibility of conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: A total of 621 laparoscopic cholecystectomies were attempted at AL-Mawanee General Hospital and AL-Sader Teaching Hospital in Basrah, IRAQ from June 2012 till June 2016.Of these,43 had to be converted to open cholecystectomies. Patients assessed according to different factors, including age, sex, acute cholecystitis, adhesions of gallbladder and calot's triangle, obesity, previous abdominal surgery, anatomical variation of gallbladder and Calot's triangle and intraoperative complications (bleeding, bile duct injury, visceral injury).Results: Conversion to open cholecystectomy was performed in 43 patients (6.92%). The significant factors for conversions were adhesions of gallbladder and Calot's triangle(39.53%) followed by acute cholecystitis(34.88%). Rate of conversion in other factors are as the following i.e., isolated male gender (0%), age (0%), previous abdominal surgery (9.3%), obesity (2.33%), anatomical variations of gall bladder and calot's triangle (2.33%), intra operative complications including bleeding (4.65%), bile duct injury (4.65%), visceral injury (2.33%) were insignificant factors for conversion.Conclusions: Adhesions of gallbladder and calot's triangle is the most common predictive factor and cause for conversion from laparoscopic cholecystectomy to open cholecystectomy. Acute cholecystitis found to be the strongest factor for conversion despite its incidence is lower than adhesions of gall bladder and calots triangle. Male gender and age more than fifty years are not direct predictive factors for conversions.

scholarly journals Analysis of the surgical treatment results for an acute cholecystitis in the senile and elderly patients, depending on term of the operative intervention performance

2020 ◽  
Vol 87 (9-10) ◽  
pp. 9-13
Author(s):  
S. M. Zavgorodniy ◽  
M. B. Danylyuk ◽  
A. І. Rylov ◽  
M. A. Kubrak ◽  
N. O. Yareshko ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Elderly Patients ◽  
Acute Cholecystitis ◽  
Average Duration ◽  
Operative Intervention ◽  
Postoperative Treatment ◽  
Biliary Duct ◽  
Preoperative Preparation ◽  
Abdominal Drainage

Objective. To estimate the results of surgical treatment in the senile and elderly patients for an acute cholecystitis on background of biliary calculous disease in urgent abdominal surgery, depending on term of performance of operative intervention. Materials and methods. In the investigation there were included 89 patients, ageing 60-89 yrs old with diagnosis: an acute cholecystitis on background of biliary calculous disease. Median age of the patients have constituted (69.66 ± 7.30) yrs old. Results. All the patients were operated in urgent order, average duration of preoperative period was 20.00 (7.00; 27.00) h. Laparoscopic cholecystectomy with abdominal drainage was performed in 70 (78.7%) patients; laparotomy, cholecystectomy with abdominal drainage- in 14 (15.7%); laparotomy, cholecystectomy with drainage of common biliary duct - in 5 (5.6%). In 3 (4.3%) patients while performing of laparoscopic cholecystectomy the necessity have emerged for conversion due to hemorrhage from the gallbladder bed. Preoperative preparation in the senile and elderly patients during more than 24 h have led to significant improvement of their general state, comparing with those, who were operated in terms up to 24 h from the moment of admittance to hospital (U-criterion = 749.50; p = 0.0286). As well, in accordance to data, concerning postoperative period analysis, there was noted significant improvement of the patients’ state, preoperative preparation of whom lasted more than 24 h, comparing with the patients, preoperative preparation of whom lasted lesser than 24 h (U-criterion = 491.00; p < 0.0001). Average duration of stationary stay have differed in this two Groups (U-criterion = 919.00; p = 0.3984). Conclusion. The surgery deferred performance for an acute cholecystitis in the senile and elderly patients permits to improve the results of postoperative treatment and to reduce the frequency of postoperative complications significantly.

scholarly journals LAPAROSCOPY REPRESENTS THE GOLD STANDARD FOR ACUTE CHOLECYSTITIS EVEN IN ELDERLY PATIENTS

2015 ◽  
Vol 2 (2) ◽  
pp. 59-62
Author(s):  
I. Negoi ◽  
I. Tănase ◽  
B. Stoica ◽  
S. Păun ◽  
S. Hostiuc ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Gold Standard ◽  
Open Cholecystectomy ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Morbidity Rate ◽  
Open Approach

Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we are facing little evidence regarding the elderly patients. The purpose of this study is to define the benefits in terms of early outcome for laparoscopic cholecystectomy in patients over 70 years old and to compare them with the open cholecystectomy through a retrospective study of patients that underwent a cholecystectomy during 12 months in the Emergency Hospital of Bucharest, Romania. Out of 49 patients, 20 had a laparoscopic cholecystectomy (LC) and 29 an open approach (OC). The mean age was 74,6 ± 4,2 (LC) vs. 77,2 ± 5,4 (OC) (P>0.05). There were 7 (33,3%) (LC) vs. 2 (7,1%) (OC) catarrhal cholecystitis, 13 (62%) (LC) vs. 9 (32,1%) (OC) phlegmonous cholecystitis, and 1 (4,8%) (LC) vs. 17 (60,7%) (OC) gangrenous cholecystitis (P=0.001, Cramer’s V=0,590). The median operative time was 90 (LC) vs. 60 (OC) minutes (P=0.001). There were no differences regarding the ASA risk scale (P=0,253). The median number of days to resume the diet was 3 (LC) vs. 4 (OC) (P=0.009). The median length of hospital stay was 72 hours (LC) vs. 120 hours (OC) (P=0.011). One patient died in the OC group and none in the LC group.To conclude, the laparoscopic approach in acute cholecystitis of elderly patients is safe. It is followed by a lower morbidity rate, a shorter length of hospital stay and by a more rapid return to normal activities.

scholarly journals Gallstones in Elderly Patients: Impact of Laparoscopic Cholecystectomy

2000 ◽  
Vol 14 (11) ◽  
pp. 929-932 ◽  
Author(s):  
A Montori ◽  
M Boscaini ◽  
M Gasparrini ◽  
G Miscusi ◽  
L Masoni ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Common Bile Duct Stones ◽  
Safe Procedure ◽  
Bile Duct Stones ◽  
Class Iii

The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.2%) were attempted on elderly patients, 11 (35%) of which were on an emergency basis because of acute cholecystitis, cholangitis or acute biliary pancreatitis. Ten per cent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0%. Associated gallbladder and common bile duct stones were found in five (16%) patients (four preoperative LC endoscopic sphincterotomy and one transcystic approach). The success rate in both of these cases was 100%, overall morbidity was 29% and there was no mortality. These results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists’ class III because an excessive duration of operation is the most common reason for converting to an open cholecystectomy.

Laparoscopic Cholecystectomy in Acute Gall Bladder Disease

1970 ◽  
Vol 24 (1) ◽  
pp. 10-13
Author(s):  
TK Maitra ◽  
NA Alam ◽  
E Haque ◽  
MH Khan ◽  
HK Chowdhury
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Early Phase ◽  
Gall Bladder Disease ◽  
Laparoscopic Procedure ◽  
Bladder Disease ◽  
Complication Of Surgery

Laparoscopic cholecystectomy is one of the procedures through which gall bladder can be removed. Acute cholecystitis was considered a contraindication for laparoscopic procedure but with time and experience this shortcoming is now overcome. Here is a study of 32 patients who were selected for laparoscopic cholecystectomy. Among them, 29 patients were operated by laparoscopic method and rest three patients were converted. This study showed the appropriate time for surgery, technical difficulties and the complication of surgery. It may be concluded that laparoscopic cholecystectomy is feasible and beneficial to the patient with acute cholecystitis in its early phase, if necessary support and expertise is available. (J Bangladesh Coll Phys Surg 2006; 24: 10-13)

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

2019 ◽  
Author(s):  
Madan Goyal ◽  
R K Goel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Critical View Of Safety ◽  
Recent Onset ◽  
Conversion To Open Cholecystectomy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Collections ◽  
A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

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