Management of Complicated Gallstone Disease

2019 ◽  
Author(s):  
Glenn Wakam ◽  
Dana Telem
Keyword(s):  
Bile Duct ◽  
Gallbladder Disease ◽  
Gallstone Ileus ◽  
Gallstone Disease ◽  
The United States ◽  
Biliary Colic ◽  
General Surgeon ◽  
Gallstone Pancreatitis ◽  
Complication Rates ◽  
Critical View Of Safety

Nearly 9% of men and 30% of women in the United States experience symptoms or complications of gallstone disease. As such, nearly every general surgeon in the country encounters patients with this pathology numerous times during his or her career. Cholelithiasis can cause complications such as acute cholecystitis, choledocholithiasis, gallstone pancreatitis, and the rare entities of Mirizzi syndrome and gallstone ileus. Patients with gallstones have a 1 to 3% risk per year of a complication, and that risk increases significantly to 30% in those with biliary colic. Surgical management of the complications of gallstones is especially intriguing because the cases are often perceived as low complexity; however, it is an operation that can challenge even the most seasoned attending and result in significant complications. Studies demonstrate complication rates up to 10% following cholecystectomy, with bile duct injury rates hovering at 4 in 1,000. This chapter aims to provide the reader with knowledge of the presentation, imaging, work-up, and framework for the management of complicate gallbladder disease. Furthermore, we hope to provide you with a foundation of how to perform a safe cholecystectomy in a variety of circumstances and impart a few tips and tricks for some challenging intraoperative situations. This review contains 2 figures, and 55 references. Key Words: cholecystitis, choledocholithiasis, cholescintigraphy, common bile duct exploration, critical view of safety, ERCP, gallstone pancreatitis, subtotal cholecystectomy

scholarly journals P-BN17 Laparoscopic subtotal cholecystectomy is a safe and effective treatment for gallstone disease

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Emily Leivers ◽  
Zaher Toumi
Keyword(s):  
Hospital Admissions ◽  
Gallbladder Disease ◽  
Gallstone Disease ◽  
Bile Leak ◽  
Biliary Colic ◽  
Critical View ◽  
Critical View Of Safety ◽  
Subtotal Cholecystectomy ◽  
Calot’S Triangle ◽  
Gallbladder Surgery

Abstract Background Laparoscopic cholecystectomy is the gold standard treatment of gallstones in fit patients with symptomatic gallbladder disease. If the critical view of safety cannot be achieved intra-operatively, there are few options, one of which is laparoscopic subtotal cholecystectomy. This study aims to ascertain the outcomes of subtotal cholecystectomy. Methods Retrospective review of all patients who underwent laparoscopic subtotal cholecystectomy by a single surgeon over a 5 year period. Results 37 consecutive patients who underwent subtotal cholecystectomy were included in this study; seventeen of which were males (49%); the median age was 69, and 18 were emergencies (49%).The most common reasons for conversion to laparoscopic subtotal cholecystectomy were adhesions (57%) and fibrotic Calot’s triangle (22%). One patient required ERCP and biliary stenting for ongoing bile leak and another returned to theatre for post operative bleeding during index admission. 6 patients (16%) required further hospital admissions for gallstone disease (1 for biliary colic, two for cholecystitis and three for CBD stones). 3 patients required ERCP. None required further gallbladder surgery. Conclusions Laparoscopic subtotal cholecystectomy is a safe and effective alternative to total cholecystectomy when the critical view of safety cannot be achieved. In our experience, only a small proportion of patients have recurrent biliary problems. 

scholarly journals 152 Evaluating the Incidence and Predictors of Readmission in Patients Awaiting Cholecystectomy for Previously Diagnosed Acute Gallstone Disease

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Noureldin ◽  
H Razzaq ◽  
K L Whelan ◽  
A Najdawi ◽  
L Wong ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Negative Impact ◽  
Gallstone Disease ◽  
Admission Rate ◽  
Major Complication ◽  
Waiting List ◽  
Biliary Colic ◽  
P Value ◽  
Gallstone Pancreatitis ◽  
Complication Rates

Abstract Introduction The prevalence of gallstones up to 15%.20-40% will develop symptomatic gallstones and occupy most of the surgical waiting list. The timing of a cholecystectomy remains controversial. Method Retrospective data analysis over 2 years, including: diagnosis, commodities, ASA class, investigations, readmissions numbers and causes, time to surgery, operative details, and rate of conversion to open procedures. Chi-square test was used for analysis. Results 532 cholecystectomies were performed.44% of the patients had commodities. Presentations were; Acute cholecystitis (41.7%), biliary colic (23.1%), acute pancreatitis (15.9), obstructive jaundice (9.2%). USS was performed in 97.3%, CT scan in 17.8% and MRCP in 45.8%. 14% had ERCP. Re admission rate was 56.4%, between 1-6 times, secondary to; cholecystitis (12.5%), biliary colic (26.7), gallstone pancreatitis (8.2%), obstructive jaundice (8.0%), other complications (0.5-1.5%). Emergency cholecystectomy was performed in 14.9% with conversion rate 1.4%.major complication rate was 2.7. The median time on waiting list was 12 (0-123) weeks. This prolonged to 25 (0-400) weeks, when calculated at time of diagnosis. Complicated gallstones disease (p-value 0.0001) was predictors of recurrent symptoms and readmissions. Conclusions Management plan is due to optimize the timing of cholecystectomy to decrease the negative impact on readmission and complication rates plus the hospitals’ bed capacity and costs.

scholarly journals Gallstones: new insights into an old story

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 1817 ◽  
Author(s):  
Evan Tiderington ◽  
Sum P. Lee ◽  
Cynthia W. Ko
Keyword(s):  
Gallstone Disease ◽  
Stone Disease ◽  
Biliary Colic ◽  
Cholesterol Stone ◽  
Gallstone Pancreatitis ◽  
Alcoholic Fatty Liver ◽  
Cholesterol Gallstones ◽  
Timing Of Cholecystectomy ◽  
Clinical Associations ◽  
Alcoholic Fatty Liver Disease

Gallstones, particularly cholesterol gallstones, are common in Western populations and may cause symptoms such as biliary colic or complications such as acute cholecystitis or gallstone pancreatitis. Recent studies have allowed for a better understanding of the risk of symptoms or complications in patients with gallstones. In addition, newer data suggest an association of gallstones with overall mortality, cardiovascular disease, gastrointestinal cancers, and non-alcoholic fatty liver disease. Knowledge of appropriate indications and timing of cholecystectomy, particularly for mild biliary pancreatitis, has gradually accumulated. Lastly, there are exciting possibilities for novel agents to treat or prevent cholesterol stone disease. This review covers new advances in our understanding of the natural history, clinical associations, and management of gallstone disease.

scholarly journals Acute Laparoscopic Cholecystectomy: Delays in Acute Surgery and Cost Analysis of Aproposed New Service

2011 ◽  
Vol 93 (7) ◽  
pp. 261-265
Author(s):  
AJ Cockbain ◽  
AL Young ◽  
E McGinnes ◽  
GJ Toogood
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Cochrane Review ◽  
Length Of Hospital Stay ◽  
Biliary Colic ◽  
Complication Rates ◽  
Acute Surgery ◽  
Symptomatic Gallstone Disease

Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for patients presenting with acute cholecystitis as supported by a recent meta-analysis and Cochrane review. Although the benefit of ALC is less clear in patients with biliary colic, few would disagree that earlier cholecystectomy is preferable for most patients with symptomatic gallstone disease. ALC has similar complication rates to elective laparoscopic cholecystectomy (ELC) and a reduced total length of hospital stay. Recurrent symptoms from untreated gallstone disease are common, with the risk of developing more severe complications such as acute cholecystitis, acute pancreatitis or cholangitis while waiting for an operation. It has been reported that patients awaiting ELC after an acute admission have significantly more general practitioner (GP) attendances than those who receive ALC, that they have an average of one emergency department attendance for symptom recurrence and that one in six requires hospital admission due to the severity of recurrent symptoms.

scholarly journals Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland

2010 ◽  
Vol 92 (4) ◽  
pp. 302-306 ◽  
Author(s):  
P Sanjay ◽  
C Kulli ◽  
FM Polignano ◽  
IS Tait
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Teaching Hospital ◽  
Gallbladder Disease ◽  
Critical View ◽  
Operative Cholangiography ◽  
Critical View Of Safety ◽  
Calot’S Triangle ◽  
Laparoscopic Cbd Exploration ◽  
Cbd Exploration

INTRODUCTION There is debate on optimal techniques that reduce bile duct injury during laparoscopic cholecystectomy (LC). A national survey of Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) members was carried out to determine current surgical practice for gallstones, including the use of intra-operative cholangiography (IOC) or critical view of safety to reduce the risk of bile duct injury. SUBJECTS AND METHODS An anonymous postal survey was sent to all 417 AUGIS members. Data on grade of surgeon, place of work (district general hospital, teaching), subspecialty, number LC per year, use of IOC, critical view of safety, and management of stones detected during surgery were collated. RESULTS There was a 36% (152/417) response – 134 (88%) from consultant surgeons (36, HPB; 106,OG; 64, DGH; 88, teaching hospital). Of these, 38% performed > 100 LC per year, 36% 50–100 LC per year, and 22% 25–50 LC per year. IOC was routine for 24%; and selective for 72%. Critical view of Calot's triangle was advocated by 82%. Overall, 55% first clip and divide the cystic artery, whereas 41% first clip and divide the cystic duct. Some 39% recommend IOC and 23% pre-oper-ative MRCP if dilated common bile duct (CBD) is noted on pre-operative ultrasound. When bile duct stones are identified on IOC, 61% perform laparoscopic CBD exploration (LCBDE), 25% advise postoperative ERCP, and 13% perform either LCBDE or ERCP. Overall, 88% (n = 134) recommend index cholecystectomy for acute pathology, and this is more likely in a teaching hospital setting (P= 0.003). Laparoscopic CBD exploration was more likely to be performed in university hospitals (P< 0.05). CONCLUSIONS A wide dissection of Calot's triangle to provide a critical view of safety is the technique most commonly recommended by AUGIS surgeons (83%) to minimise risk of bile duct injury, in contrast to 24% that recommend routine IOC. The majority (88%) of AUGIS surgeons advise index admission cholecystectomy for acute gallbladder disease.

scholarly journals P-BN27 Novel technique for safe and efficient cannulation of the cystic and common bile duct

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Khurram Khan ◽  
Morag McLellan ◽  
Sajid Mahmud
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Gallstone Disease ◽  
Common Bile Duct Exploration ◽  
Conversion To Open Surgery ◽  
Critical View Of Safety ◽  
Novel Technique ◽  
Increased Risk ◽  
Time Required

Abstract Background Concomitant stones in the common bile duct (CBD) at the time of laparoscopic cholecystectomy (LC) are present in up to 15% of patients.  In conjunction with intra-operative cholangiogram (IOC), transcystic common bile duct exploration (TCBDE) enables diagnosis and management of ductal stones in a single stage procedure.  However, cannulation of the cystic duct (CD) and CBD can be challenging.  With repeated attempts at cannulation, there is increased risk of iatrogenic injury by creating a false passage or perforating the duct.  We propose a novel technique for the safe cannulation of the CD and CBD. Methods Once critical view of safety is achieved, a clip is placed distally in the CD and opened with scissors.  A flexible tip 80cm guidewire is then preloaded into 5-French ureteric catheter. The complex is then passed into the introducer through the lateral port. A grasper placed at Hartmann’s pouch is used to retract the gallbladder and straighting the CD. Only the guidewire is advanced out of the catheter, traversing the CD and CBD. Once safely advanced, the catheter can then be slid over the guidewire and the guidewire can be removed. IOC and TCBDE can then be performed if indicated. Results This technique was performed on 18 patients who failed CD cannulation during elective and emergency LC for symptomatic gallstone disease in a single center performed by the same surgical team.  Median age was 46 years and there was 15 females.  A total of 34 cannulations were attempted (in 18 patients) which 100% success rate.  There was no added time required for the technique.  In majority of cases it decreased the operative time due to quick intubation of CBD.  None of the cases required conversion to open surgery. Conclusions The novel technique described for cannulation of the cystic duct uses a Seldinger ‘like’ approach. This is a safe an effective strategy for cannulation of the CD, making the skills more accessible and more time efficient. This should encourage more surgeons to perform IOC and TCBDE where indicated. 

scholarly journals 555 Should All Acutely Presenting Gallstone Disease Be Managed Surgically?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Rehman ◽  
A Khan ◽  
R Wunnava
Keyword(s):  
Elective Surgery ◽  
Waiting Times ◽  
Gallstone Disease ◽  
The Other ◽  
Gallstone Pancreatitis ◽  
Complication Rates ◽  
Retrospective Audit ◽  
History Of ◽  
Emergency Cholecystectomy ◽  
Elective Cholecystectomy

Abstract Aim This audit aims to assess if gallstone complications can be prevented by performing an emergency cholecystectomy in acutely presenting gallstone disease. Factors taken into consideration include number of presentations to hospital before surgery, secondary admissions of pancreatitis or cholangitis, subsequent requirements of ERCP as well as complication rates of elective and emergency surgery. Method Retrospective audit looking at 387 cholecystectomies carried out, within a year, at Walsall Manor Hospital. Results Approximately 20% of patients had an emergency cholecystectomy. A total of 192 patients had at least one admission, with 17% having a minimum second. Seven patients went on to develop gallstone pancreatitis subsequently, as well as eight requiring at least a minimum of one ERCP. The complication rate in elective surgery was higher at 4.1% compared to 2.7% in emergency cases. Long waiting times for surgery put patients at greater risk of complications. 96% (26/27) of elective cholecystectomy patients, who suffered an attack of pancreatitis, had to wait more than four weeks. Furthermore, 39% (47/119) of those who had a minimum of one admission had to wait more than 20 weeks. On the other hand, three-quarters of patients who were operated in emergency went home within 48 hours, with the figures being not too dissimilar from elective cases with a history of admission (76%). Conclusions Performing emergency cholecystectomies in the same admission or on a dedicated hot list would not only decrease the risk, but also the potential risk of developing gallstone complications.

Gallstone disease

2018 ◽  
pp. 401-414
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Obstructive Jaundice ◽  
Gallstone Disease ◽  
Acute Cholangitis ◽  
Biliary Colic ◽  
Ultrasound Scan ◽  
Bile Duct Stones ◽  
Clinical Presentations ◽  
Laparoscopic Bile Duct Exploration

Gallstone disease is common with clinical presentations including biliary colic, cholecystitis, and obstructive jaundice. Acute cholangitis and pancreatitis are other complications. Ultrasound scan and MRCP as well as endoscopic ultrasound are investigation modalities. Medical treatment of gallstones with ursodeoxycholic acid is discussed as well as laparoscopic cholecystectomy with its risks and benefits. The prevalence of bile duct stones is around 10–20%. Strategies for investigation and management are discussed, including ERCP and laparoscopic bile duct exploration.

Management of Uncomplicated Gallstones and Benign Gallbladder Disease

2017 ◽  
Author(s):  
Rebecca C Britt ◽  
Jessica R Burgess
Keyword(s):  
Gallbladder Disease ◽  
Gallstone Disease ◽  
Sphincter Of Oddi ◽  
General Surgeon ◽  
Sphincter Of Oddi Dysfunction ◽  
Gallbladder Polyps ◽  
Symptomatic Cholelithiasis ◽  
Common Problems ◽  
Oddi Dysfunction ◽  
Asymptomatic Gallstones

Gallbladder disease is one of the most common problems that the general surgeon will encounter. This comprehensive review discusses the management of uncomplicated gallstone disease, functional gallbladder disease, and gallbladder polyps. It provides indications for cholecystectomy in the asymptomatic patient. There is a thorough review of the diagnosis and management of symptomatic cholelithiasis, including special situations such as pregnancy and cirrhosis, and the latest evidence regarding routine versus selective cholangiography during cholecystectomy. This review also discusses the latest updates to the criteria for diagnosing functional gallbladder disease and sphincter of Oddi dysfunction.  This review contains 6 figures, 6 tables, and 99 references. Key words: asymptomatic gallstones, biliary dyskinesia, cholangiography, gallbladder polyps, laparoscopic cholecystectomy, sphincter of Oddi dysfunction, symptomatic cholelithiasis

scholarly journals Gallbladder Mucus Plug Mimicking Ascaris Worm: An Ambiguous Cause of Biliary Colic

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Salah Termos ◽  
Mohammad Alali ◽  
Majd Alkabbani ◽  
Abdullah AlDuwaisan ◽  
Ahmad Alsaleh ◽  
...  
Keyword(s):  
Bile Duct ◽  
Visceral Pain ◽  
English Literature ◽  
Gallbladder Disease ◽  
Ampulla Of Vater ◽  
Biliary Colic ◽  
First Case ◽  
Mucus Plug ◽  
Stool Analysis ◽  
Work Up

Biliary colic is a visceral pain caused by attempts of the gallbladder or bile duct to overcome the obstruction in the cystic duct or ampulla of Vater. Obstruction can be due to different etiologies such as stone, mass, worm, and rarely by mucus plug. We report the case of a 31-year-old gentleman who presented with recurrent biliary colic and weight loss. Work-up showed linear calcifications in the gallbladder extending to the common bile duct suggesting hepatobiliary ascariasis. Further investigations including stool analysis, upper endoscopy, endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) did not support our provisional diagnosis. Laparoscopic cholecystectomy was performed. Histopathological finding was grossly ambiguous; a rope-like mucus plug resembling ascaris worm was noted. The patient’s condition improved instantly after the procedure. To our knowledge, we are reporting the first case in the English literature describing this unique entity of symptomatic gallbladder disease to increase awareness and improve its management.

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