INFORMATIVE VALUE OF COMPARATIVE ASSESSMENT OF GENERAL CLINICAL INDICATORS IN PATIENTS WITH DESTRUCTIVE CHOLECYSTITIS

Purpose: comparative assessment of clinical manifestations of the course of destructive calculous cholecystitis before surgical operation. Methods. The study involved 86 patients with destructive cholecystitis (55 women and 31 men). 18 patients with destructive cholecystitis made up group 1, and 14 healthy people formed the control group. Patients with cholecystitis underwent cholecystectomy. The age groups were as following: 18-25, 26-40, 41-60 and 61-75 years. Grouping patients by age and sex enabled to reveal related concomitant diseases and complications of cholecystitis. 48 patients underwent open cholecystectomy, and 38 had laparoscopic cholecystectomy. The study determined the quantitative parameters of various enzymes in blood samples from patients with destructive cholecystitis, and the control group. Results. Standard open cholecystectomy was performed on in 55.8% of cases; consequently, laparoscopic cholecystectomy was performed in 44.2% of cases. A retrospective analysis of the surgical interventions performed has demonstrated 54 (62.8% ) patients had gallstones as a leading cause in the development of cholecystitis; 15 (17.4%) patients had phlegmon, 11 (12.8%) patients had gangrene, 4 (4.7%) patients had polyps, and 2 (2.3%) had gallbladder hypertrophy and complete closure of the lumen. 18 patients who underwent cholecystectomy, had developed various preoperative complications: 13 of them had local peritonitis, 2 patients had partial intestinal obstruction, and 3 were diagnosed as having mechanical jaundice. Local peritonitis was found out as the most common preoperative complication. 16 people had various comorbidities and made 18.6% of all patients. 8 (9.3%) out of 16 of the patients had diagnosis of diabetes mellitus. Conclusion. It should be noted that among all patients who underwent cholecystectomy, various preoperative complications were diagnosed, but local peritonitis was the commonest one. Diabetes mellitus against the background of impaired motility or tone of the intestines, bile ducts and the gallbladder leads to cholestasis and gallbladder inflammation.

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FEATURES OF SURGICAL TACTICS OF TREATMENT OF ACUTE CALCULOUS CHOLECYSTITIS OCCURRING AGAINST THE BACKGROUND OF DIABETES MELLITUS

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2018-25-6-90-95 ◽

2018 ◽

Vol 25 (6) ◽

pp. 90-95

Author(s):

V. V. Zorik ◽

G. K. Karipidi ◽

A. V. Morozov

Keyword(s):

Diabetes Mellitus ◽

Laparoscopic Cholecystectomy ◽

Surgical Treatment ◽

Postoperative Complications ◽

Histological Study ◽

Open Cholecystectomy ◽

Control Group ◽

Acute Calculous Cholecystitis ◽

Patients With Diabetes ◽

Calculous Cholecystitis

Aim. The study was conducted to improve the results of the surgical treatment of acute calculous cholecystitis occurring against the background of diabetes mellitus. Materials and methods. In course of our study, we analyzed the treatment results of 687 patients with acute calculous cholecystitis. Depending on the presence of diabetes, all patients were divided into two groups. The main group with concomitant diabetes mellitus included 68 (9,9%) patients, whereas the control group without diabetes included 619 (90,1%) patients. Laparoscopic cholecystectomy was performed on 636 (92,6%) patients, and open cholecystectomy was performed on 51 (7,4%) patients. Results. According to the histological study, the greatest number of destructive forms occurs in patients with concomitant diabetes, operated after 24 hours. The least postoperative complications occur in patients of both groups operated from 12 to 24 hours. However, the incidence of complications is 4-5 times higher in patients with diabetes mellitus. Postoperative complications in patients with acute calculous cholecystitis occurring on the background of sugar diabetes were observed after open cholecystectomy in 33,3% of cases and in 6,5% of cases after laparoscopic surgery.Conclusion In patients with acute cholecystitis and concomitant diabetes, surgical treatment should be performed on the first day after the preoperative preparation during the first 12 hours, aimed at compensating for diabetes and improving microcirculation. The preference should be given to laparoscopic cholecystectomy, which reduces the number of postoperative complications by 5 times and mortality by 4.5 times.

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Clinical Effect and Effective Rate of Laparoscopic Cholecystectomy for Gallstones Complicated with Gallbladder Polyps

E3S Web of Conferences ◽

10.1051/e3sconf/202127103046 ◽

2021 ◽

Vol 271 ◽

pp. 03046

Author(s):

Xiaoming Deng ◽

Jinjun Jiang

Keyword(s):

Laparoscopic Cholecystectomy ◽

Clinical Efficacy ◽

Complication Rate ◽

Open Cholecystectomy ◽

Effective Rate ◽

Control Group ◽

Observation Group ◽

Clinical Indicators ◽

Gallbladder Polyps ◽

Operation Duration

This paperA total of 62 patients with gallstones and gallbladder polyps were selected from May 2019 to May 2020, who were divided into the observation group (n=31, laparoscopic cholecystectomy) and the control group (n=31, open cholecystectomy) in a 1:1 ratio. The clinical indicators, clinical efficacy, level of pain and complication rate of the two groups were recorded and compared. Results Indicators such as the operation duration (38.64±14.42min), blood loss (30.42±8.21ml), length of stay (4.71±1.82 d), first anal exhaust (21.82±6.65min), drainage volume (72.02±4.21ml), length of incision and the time for the recovery of gastrointestinal functions in the observation group were better than the control group (P<0.05). The clinical efficacy of the observation group (96.77%) was higher than that of the control group (80.65%), with statistical value =4.0260 (P<0.05). The level of pain of the observation group was lower than that of control group (P<0.05), while the complication rate in the observation group (3.22%) was also lower than that of the control group (22.58%) (P<0.05). Laparoscopic cholecystectomy is an effective treatment of gallstones complicated with gallbladder polyps, which can alleviate pain and improve the prognosis, and is thus worthy of promotion.

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Determinants for Predicting the Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy - A Prospective Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/614 ◽

2020 ◽

Vol 7 (50) ◽

pp. 3006-3009

Author(s):

Sandeep Kumar Goyal ◽

Gopal Singhal ◽

Bhanu Pratap Sharma ◽

Dinesh Mohan ◽

Savita Savita ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Scoring System ◽

Open Cholecystectomy ◽

Bladder Wall ◽

Age Groups ◽

Successful Outcome ◽

Difficulty Level ◽

Scoring Method ◽

Conversion Rates ◽

Group 3

BACKGROUND Laparoscopic surgery is a kind of minimal access surgery that obviates various complications which are encountered during open method, but the outcome of procedure varies according to condition of the patient. Knowledge of these factors may be used for the preoperative counselling of the patients regarding the successful outcome of the surgery as well as to herald the risk of conversion before undertaking patients. We wanted to evaluate the various preoperative factors for conversion of laparoscopic cholecystectomy to open cholecystectomy.c METHODS A total of 100 patients of both sexes, from all age groups and socio-economic status was included in the study. All routine investigations and USG (Ultrasonography) were done. Risk factors assessed were age, sex, abdominal tenderness, gall bladder wall thickness, any history of para-umbilical surgery. Clinical evaluation was done for each included patient and score was given according to their signs and symptoms. Patients were categorised subsequently into mild (group 1 & 2), moderate (group 3 & 4) and severe (group 5) difficulty as per scoring method. RESULTS The mean age was 46.21 ± 13.36, ranging between 20 years to 80 years (95 % CI 43.56 to 48.86) with 89 females and 11 males. Among the converted group, 3 (18.75 %) participants were > 60 years of age and 2 (2.38 %) participants were of age < 60 years. According to patient's expected level of difficulty in laparoscopic cholecystectomy and according to scoring system, patients were categorised as mild, moderate and severe. A total of 81 patients were categorised as mild, 17 as moderate and 2 as severe. Conversion rate is 0 % in mild difficulty group, 17.64 % in moderate difficulty group and 100 % in severe difficulty group. CONCLUSIONS Difficulty and conversion risk may be predicted accurately by using the scoring system. Surging scores indicated marked increase in difficulty levels intraoperatively and thus affects the conversion rates. Thus, it can be concluded that the scoring system accurately assessed the conversion rates of laparoscopic cholecystectomy preoperatively to open surgery. Higher scores indicated increase in difficulty level. KEYWORDS Laparoscopic Cholecystectomy, Open Cholecystectomy, Determinants

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THE USE OF A VITAMIN-MINERAL COMPLEX IN THE COMBINED THERAPY OF PATIENTS WITH OBESITY AND TYPE 2 DIABETES MELLITUS: A CLINICAL TRIAL

Trace Elements in Medicine (Moscow) ◽

10.19112/2413-6174-2021-22-1-60-71 ◽

2021 ◽

Vol 22 (1) ◽

pp. 60-71

Author(s):

I.A. Lapik ◽

◽

K.M. Gapparova ◽

A.V. Galchenko ◽

◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Combined Therapy ◽

Clinical Manifestations ◽

Micronutrient Deficiency ◽

The Body ◽

Control Group ◽

Mineral Complex ◽

Patients With Diabetes

Low caloric diet is used in the complex treatment of patients with diabetes mellitus and obesity. However, the reduced caloric food can inadvertently lead to decreased intake of micronutrients. The main goal of the research was to assess the necessity and effectiveness of the vitamin-mineral complex in the treatment of type 2 diabetes with obesity. Methods: 80 females suffering from type 2 diabetes and obesity, ranging from 40 to 65 years old participated in the study. The total patients were divided into two groups, each containing 40 patients. All patients were given a personalized diet and 1000mg of metformin every day. The experimental group, besides that, received vitamin-mineral complex. The biochemical analysis of the blood, composition of the body, and the complaint on micronutrient deficiency were taken before the experiment and after 14 days of the therapy. Results: Supplementation of the vitamin-mineral complex was associated with higher blood serum levels of vitamins B6, B12, B9, C, D, potassium, calcium, magnesium and zinc, and lower levels of glucose. Clinical manifestations, associated with micronutrient deficiency, were significantly decreased in patients who were given vitamin-mineral complex. All these changes were valid both in relation to the initial level in the study group and to the indicators after treatment in the control group. Conclusion: Micronutrient supplements may be a very important part of the combined therapy of patients with diabetes mellitus and obesity.

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A prospective evaluation of laparoscopic cholecystectomy in the treatment of chronic cholelithiasis: A five-year experience

Medicinski pregled ◽

10.2298/mpns1102077s ◽

2011 ◽

Vol 64 (1-2) ◽

pp. 77-83

Author(s):

Veselin Stanisic ◽

Milorad Bakic ◽

Milorad Magdelinic ◽

Hamdija Kolasinac ◽

Darko Vlaovic ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Lower Cost ◽

Average Duration ◽

Open Cholecystectomy ◽

Abdominal Cavity ◽

Safe Procedure ◽

Conversion To Open Cholecystectomy ◽

Duration Of Hospitalization ◽

Calculous Cholecystitis ◽

Gallbladder Removal

Introduction. Laparoscopic cholecystectomy is a method of choice in the treatment of symptomatic cholecystolithiasis because of less postoperative pain, shorter hospitalization and lower cost of treatment. The study was aimed at analysing the outcome of laparoscopic cholecystectomy in patients surgically treated for chronic calculous cholecystitis (symptomatic cholelithiasis). Material and methods. The research was done in the period from December 2003 to December 2008. In the prospective study of 386 patients, we analyzed operative and postoperative complications, the reasons for conversion to open cholecystectomy, duration of hospitalization and mortality. Results. The average duration of laparoscopic cholecystectomy was 31.9?14.5 min: dissection of adhesions 3.2?0.7 min., elements of Calot?s triangle 9.8?3.2 min., gallbladder releasing from its bed 12.8?2.8 min., the abdominal cavity lavage and removal of gall?bladder from the abdomen 6.8?0.9 min. Some operative difficulties emerged in 22 (5.7%) patients - 4 (1%) during releasing of gallbladder adhesions from the surrounding structures, 9 (2.3%) during dissection of elements of the Calot?s triangle, 6 (1.5%) during gallbladder releasing from its bed, 3 (0.7%) during gallbladder removal from the abdomen. Some post-operative complications, single or associated, occurred in 36 (9.3%) patients: perforation of gallbladder 21 (5.4%), bleeding from gallbladder bed 18(4.6%)/, injury of extra hepatic bile ducts 1 (0.2%), 9 (2.3%) spillage of stones; 3 (0.7%) conversions were made. The average duration of preoperative and postoperative hospitalization was 1.1?0.3 and 1.4?0.5 days, respectively. The pathohistological examination revealed 2 (0.5%) adenocarcinoma of gallbladder. There were no lethal outcomes. Conclusion. Laparoscopic cholecystectomy is a safe procedure and rational choice in the treatment of biliary dyskinesia and symptomatic biliary calculosis with an acceptable rate of conversion.

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Choice of tactics of surgical treatment of acute cholecystitis and its complications

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(3)-08 ◽

2018 ◽

Vol 22 (3) ◽

pp. 442-445

Author(s):

B.S. Zaporozhchenko ◽

K.V. Kravets ◽

I.E. Borodaev ◽

D.A. Bondarets ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Average Duration ◽

Abdominal Cavity ◽

Age Groups ◽

Total Duration ◽

Duration Of Treatment ◽

Surgical Interventions ◽

Emergency Operations ◽

Surgical Tactics

Acute cholecystitis ranks second in the incidence of urgent surgical diseases in hospitals in Ukraine. Despite a marked improvement in the treatment results, the lethality after emergency operations (9,4-37%) for acute cholecystitis complicated by peritonitis remains several times higher than with routine surgical interventions. Objectives — development of rational surgical tactics and evaluation of the effectiveness of treatment of acute cholecystitis and its complications in patients of different age groups, with different pathomorphological forms of acute cholecystitis. The result of treatment of 203 patients was presented: 75 (37,5%) were operated on an emergency basis, 73 (36,5%) urgently, and 52 (26%) in a deferred period. 173 (86.5%) patients were operated using laparoscopic technologies. Intraoperative cholangiography was performed in 16 (9,3%) patients during laparoscopic interventions. In 17 (8,5%) patients, “open” operations were performed. All patients underwent drainage of the abdominal cavity with one or more drains in view of the presence of peritonitis. The average duration of the preoperative period was 1.5 days, the total duration of treatment with LC was 4.5 days, and the total duration of treatment with OC was 10.8 days. So, in the early stages of the development of acute cholecystitis, laparoscopic cholecystectomy is effective. The use of lifting systems for laparoscopic cholecystectomy is advisable in elderly and senile patients, with concomitant diseases of the heart and lungs.

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RESULTS OF EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH AN ACUTE CALCULUS CHOLECYSTITIS AND ISCHEMIC HEART DISEASE

Medical Science of Ukraine (MSU) ◽

10.32345/2664-4738.3-4.2017.03 ◽

2018 ◽

Vol 13 (3-4) ◽

pp. 15-21

Author(s):

V.G. Mishalov ◽

S.O. Kondratenko ◽

L.Yu. Markulan

Keyword(s):

Heart Disease ◽

Laparoscopic Cholecystectomy ◽

Ischemic Heart Disease ◽

Open Cholecystectomy ◽

Group Versus ◽

Ischemic Heart ◽

Acute Calculous Cholecystitis ◽

Delayed Laparoscopic Cholecystectomy ◽

Conversion To Open Cholecystectomy ◽

Calculous Cholecystitis

Relevance. Determination of the optimal time for laparoscopic cholecystectomy (LCE) in patients with acute calculous cholecystitis (ACC) and ischemic heart disease (IHD) is still an actual and unresolved issue. Objective: to evaluate the results early versus delayed LCE in patients with ACC and IHD. Materials and methods. The study involved 107 patients with ACC and IHD: 56 (47,7 %) women and 51 (52,3 %) men aged 55 to 82 years, an average 70,2±0,6 years. The group with early LCE (ELCE) included 48 patients with LCE – up to 72 hours from the beginning of ACC (on average 41,9±2,1 hours), the group with delayed LCE (DLCE) – 59 patients, who were LCE for more than 72 hours (in average 90,2±1,6 hours) from the beginning of ACC. Groups of patients were representative according to the functional classes of heart failure, angina pectoris, severity and the histological form of ACC. All patients had a Charlson comorbidity index from 0 to 2 points. The endpoint of the study were: the frequency of conversion to open cholecystectomy, cardiac events in the intra – and early postoperative periods, the incidence of complications according to the Clavien-Dindo classification. Data analysis was performed using IBM SPSS Statistics. Results. The duration of LCE in the DLCE group was 45,2±2,1 minutes, in the ELCE group it was 40,9±1,4 min (p=0,115). Conversion to open cholecystectomy was required in 8 (13,6 %) patients of the DLCE group versus one (2,1 %) in the ELCE group, p=0,033. During the operation, myocardial ischemia occurred in 17 (28,8 %) patients of the DLCE group versus 6 (12,5%) the ELCE group, p=0,041, and a systolic blood pressure decrement lower than 70 mm hg. art. – in 24 (40,7 %) against 8 (16,7 %), p=0,007; saturation reduction episodes – in 33 (55,9 %) against 17 (35,4 %), p=0,034, respectively. In the early postoperative period, an increasing of HF class according to NYHA was observed in 12 (20,3 %) patients of the DLCE group versus one (2,1 %) in the ELCE group, p=0.004; the number of patients with complications according to Clavien-Dindo classification – 40 (67,8 %) versus 23 (47,9 %), p=0,038; pneumonia occurred in 26 (44,1 %) against 6 (12,5 %), p=0,001; exudative pleurisy – in 28 (47,5 %) against 9 (18,8 %), p=0,002, respectively. There were no lethal cases in the period up to 7 days in both groups. Conclusion. ELCE is a priority method of treatment patients with an acute calculous cholecystitis (ACC) and ischemic heart disease (IHD) with a different functional class (according to NYHA). Compared with DLCE, it is associated with reliable reduce of conversion (2,1 %), against 8 (13,6 %), intra- and early postoperative complications of the cardiovascular system and complications according to Clavien-Dindo classification – 23 (47,9 %) patients against 40 (67,8 %).

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Cholelithiasis: causative factors, clinical manifestations and management

International Surgery Journal ◽

10.18203/2349-2902.isj20192380 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2133

Author(s):

Renu Pimpale ◽

Pradeep Katakwar ◽

Murtaza Akhtar

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Management ◽

Open Cholecystectomy ◽

Clinical Manifestations ◽

Gastrointestinal Disorder ◽

Xanthogranulomatous Cholecystitis ◽

Biliary Leak ◽

Common Complaint ◽

Causative Factors ◽

Operative Complications

Background: Cholelithiasis is a common gastrointestinal disorder with an overall prevalence of 2-29%. This study aims to evaluate the evolution of demographic and etiological factors, the clinical manifestations of Cholelithiasis, the surgical management with its post-operative complications and the histopathological findings of the post-cholecystectomy specimen of gallbladder, in central India.Methods: Patients symptomatic or asymptomatic diagnosed ultrasonically as cholelithiasis were included in the study and patients with primary choledocholithiasis were excluded.Results: A total of 92 patients were enrolled, of which 62 (68.89%) were female, with mean age of 45.03yrs ± 13.59. Fifty four patients (58.69%) were having BMI >25. Pain was most common complaint seen in all patients. Jaundice was observed in 13 patients (14.13%) who had associated CBD calculus. Sickling was positive in 8.69% of patients. Lap cholecystectomy was done in 71 (77.17%) patients with a conversion rate of 6.57%. Nineteen (20.65%) were open cholecystectomy with or without CBD exploration and 2 underwent Lap cholecystostomy. Post operatively, surgical site infection was seen in 3 patients (4.22%) of laparoscopic cholecystectomy, 5 patients (26.31%) of open cholecystectomy and biliary leak was seen in 3 patients (15.78%) of open cholecystectomy. Histopathology of gallbladder was chronic cholecystitis in 70 patients (77.77%), malignancy was detected in 5 patients (5.55%) and Xanthogranulomatous cholecystitis in 2 patients (2.22%).Conclusions: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Laparoscopic cholecystectomy offers best surgical management with lesser complications.

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Significance of Preoperative Ultrasound Measurement of Gallbladder Wall Thickness

The American Surgeon ◽

10.1177/000313480707300922 ◽

2007 ◽

Vol 73 (9) ◽

pp. 926-929 ◽

Cited By ~ 1

Author(s):

James Majeski

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Wall Thickness ◽

Open Cholecystectomy ◽

Acalculous Cholecystitis ◽

Gallbladder Wall ◽

Chronic Cholecystitis ◽

Entire Series ◽

Calculous Cholecystitis ◽

Gallbladder Ultrasound

Evaluation of patients with signs and symptoms of biliary tract disease usually includes ultrasound assessment of the gallbladder. Does measurement of the thickness of the gallbladder wall yield any significant information to the clinical surgeon? The records of all my patients undergoing cholecystectomy since 1990 were reviewed. The entire series consists of 401 consecutive patients, in whom 388 procedures were completed laparoscopically, with 14 patients requiring conversion to an open cholecystectomy. Each patient's preoperative evaluation included a gallbladder ultrasound, which included measurement of the diameter of the gallbladder wall. The entire series of cholecystectomies was evaluated according to the ultrasound measured diameter of the gallbladder wall. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter. Of the 401 consecutive patients who underwent cholecystectomy for symptomatic gallbladder disease, 86 (21.5%) were removed laparoscopically for acalculous disease. Eleven per cent of patients with acalculous cholecystitis had acute cholecystitis and 89 per cent had chronic cholecystitis. Every patient with either a thin or thick gallbladder wall with acalculous cholecystitis had a successful laparoscopic cholecystectomy. Three-hundred fifteen patients had a laparoscopic cholecystectomy for calculous cholecystitis. In patients with calculous cholecystitis, 28.3 per cent had acute cholecystitis and 71.7 per cent had chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 38 per cent of patients with acute calculous cholecystitis and greater than 3 mm in 41 per cent of patients with chronic calculous cholecystitis. One-hundred, forty-two patients, out of a series total of 401, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 14 of these patients (10%) required conversion to an open cholecystectomy. A preoperative gallbladder ultrasound evaluation for symptomatic cholecystitis, which documents a thick gallbladder wall (≥3 mm) with calculi, is a clinical warning for the laparoscopic surgeon of the potential for a difficult laparoscopic cholecystectomy procedure which may require conversion to an open cholecystectomy procedure.

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