-
BMJ Case Reports Jul 2021
Topics: Acute Disease; Cholangitis; Cholecystitis, Acute; Humans; Liver Diseases
PubMed: 34244194
DOI: 10.1136/bcr-2021-244912 -
Journal of Gastrointestinal Surgery :... Jul 2022To determine effects on admission, treatment, and outcome for acute cholecystitis during the course of the COVID-19 pandemic in 2020 and 2021.
Access to Surgery and Quality of Care for Acute Cholecystitis During the COVID-19 Pandemic in 2020 and 2021 - an Analysis of 12,545 Patients from a German-Wide Hospital Network.
PURPOSE
To determine effects on admission, treatment, and outcome for acute cholecystitis during the course of the COVID-19 pandemic in 2020 and 2021.
METHODS
Retrospective analysis of claims data from 74 German hospitals. Study periods were defined from March 5, 2020 (start of first wave) to June 20, 2021 (end of third wave) and compared to corresponding control periods (March 2018 to February 2020). All in-patients with acute cholecystitis were included. Distribution of cases, type of surgery, comorbidities, surgical outcome, and length of stay of all cases with acute cholecystitis and cholecystectomy were compared. In addition, we analyzed the type of treatment (non-surgical, cholecystostomy, or cholecystectomy) for all cases with main diagnosis of acute cholecystitis.
RESULTS
We could not demonstrate differences in daily admissions over the course of the pandemic (11.2-12.7 patients vs. 11.9-12.6 patients for control periods). Proportion of patients with non-surgical treatment was low and not increased (11.7-17.3% vs. 14.5-18.4%). Cholecystostomy was rare throughout all periods (0-0.5% of all patients). We did not observe an increase in open surgery (proportion of open cholecystectomies 3.4-5.5%). Mortality was generally low (1.5-1.9%) with no differences between periods. Median length of stay was 4 days throughout all periods.
CONCLUSION
The numerous restrictions during the COVID-19 pandemic did not result in an increase of admissions or surgery for acute cholecystitis. Laparoscopic cholecystectomy has been safely applied during the pandemic. Our results may assure the ability to maintain high quality of surgical care even in times of disruptions to the health care system.
Topics: COVID-19; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Cholecystostomy; Hospitals; Humans; Pandemics; Retrospective Studies; Treatment Outcome
PubMed: 35445322
DOI: 10.1007/s11605-022-05318-9 -
Revista Do Colegio Brasileiro de... Nov 2018to evaluate the results of laparoscopic cholecystectomy in the elderly compared with younger patients. (Comparative Study)
Comparative Study
OBJECTIVE
to evaluate the results of laparoscopic cholecystectomy in the elderly compared with younger patients.
METHODS
we retrospectively reviewed computerized medical records of all patients who underwent laparoscopic cholecystectomy for chronic or acute cholecystitis from January 1, 2011 to March 31, 2018 at a single teaching hospital. We stratified the patients into two groups: elderly (≥60 years of age) and younger (<60 years of age).
RESULTS
of 1,645 patients subjected to laparoscopic cholecystectomy, 1,161 (70.3%) were younger and 484 (29.7%) were elderly. The rate of male was higher in the elderly (n=185; 38.2%) group than in the younger (n=355; 30.6) (p=0.003). Jaundice was more common in the elderly (p=0.004). The rate of prior abdominal operation was also higher in the elderly (p<0.001). The percentage of patients with ASA score II, III, and IV was higher in the elderly group (p<0.001 in score II and III and 0.294 in score IV). Operative time was longer in the elderly (71.68±31.27) than in the younger group (p=0.001). The following perioperative data were higher in the elderly: acute cholecystitis (p<0.001), conversion rate (p=0.028), postoperative complications (p=0.042), and mortality (p=0.026).
CONCLUSION
the operative time is longer and the rate of acute cholecystitis, conversion to open cholecystectomy and postoperative complications are higher in the elderly patients submitted to laparoscopic cholecystectomy when compared with younger individuals.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Cholecystectomy, Laparoscopic; Cholecystitis; Cholecystitis, Acute; Chronic Disease; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 30462828
DOI: 10.1590/0100-6991e-20182020 -
Medicina (Kaunas, Lithuania) Dec 2023Gallbladder drainage is a treatment option in high-risk surgical patients with moderate or severe acute cholecystitis. It may be applied as a bridge to cholecystectomy... (Review)
Review
Gallbladder drainage is a treatment option in high-risk surgical patients with moderate or severe acute cholecystitis. It may be applied as a bridge to cholecystectomy or a definitive treatment option. Apart from the simple and widely accessible percutaneous cholecystostomy, new attractive techniques have emerged in the previous decade, including endoscopic transpapillary gallbladder drainage and endoscopic ultrasound-guided gallbladder drainage. The aim of this paper is to present currently available drainage techniques in the treatment of AC; evaluate their technical and clinical effectiveness, advantages, possible adverse events, and patient outcomes; and illuminate the decision-making path when choosing among various treatment modalities for each patient, depending on their clinical characteristics and the accessibility of methods.
Topics: Humans; Cholecystitis, Acute; Drainage; Cholecystostomy; Cholecystectomy; Treatment Outcome
PubMed: 38276039
DOI: 10.3390/medicina60010005 -
Scientific Reports Jun 2020The Tokyo Guidelines 2018 (TG18) recommend emergent cholecystectomy (EC) for acute cholecystitis. However, the number of patients on antithrombotic therapy (AT) has...
The Tokyo Guidelines 2018 (TG18) recommend emergent cholecystectomy (EC) for acute cholecystitis. However, the number of patients on antithrombotic therapy (AT) has increased significantly, and no evidence has yet suggested that EC should be performed for acute cholecystitis in such patients. The aim of this study was to evaluate whether EC is as safe for patients on AT as for patients not on AT. We retrospectively analyzed patients who underwent EC from 2007 to 2018 at a single center. First, patients were divided into two groups according to the use of antithrombotic agents: AT; and no-AT. Second, the AT group was divided into three sub-groups according to the use of single antiplatelet therapy (SAPT), double antiplatelet therapy (DAPT), or anticoagulant with or without antiplatelet therapy (AC ± APT). We then evaluated outcomes of EC among all four groups. The primary outcome was 30- and 90- day mortality rate, and secondary outcomes were morbidity rate and surgical outcomes. A total of 478 patients were enrolled (AT, n = 123, no-AT, n = 355) patients. No differences in morbidity rate (6.5% vs. 3.7%, respectively; P = 0.203), 30-day mortality rate (1.6% vs. 1.4%, respectively; P = 1.0) or 90-day mortality rate (1.6% vs. 1.4%, respectively; P = 1.0) were evident between AT and no-AT groups. Between the no-AT and AC ± APT groups, a significant difference was seen in blood loss (10 mL vs. 114 mL, respectively; P = 0.017). Among the three AT sub-groups and the no-AT group, no differences were evident in morbidity rate (3.7% vs. 8.9% vs. 0% vs. 6.5%, respectively; P = 0.201) or 30-day mortality (1.4% vs. 0% vs. 0% vs. 4.3%, respectively; P = 0.351). No hemorrhagic or thrombotic morbidities were identified after EC in any group. In conclusion, EC for acute cholecystitis is as safe for patients on AT as for patients not on AT.
Topics: Aged; Aged, 80 and over; Cholecystectomy; Cholecystitis, Acute; Female; Fibrinolytic Agents; Hemorrhage; Humans; Japan; Length of Stay; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 32572122
DOI: 10.1038/s41598-020-67272-3 -
BMJ Case Reports Sep 2018Haemorrhagic cholecystitis is a rare entity of acute cholecystitis that carries a high morbidity and mortality rate if management is delayed. Its clinical course can... (Review)
Review
Haemorrhagic cholecystitis is a rare entity of acute cholecystitis that carries a high morbidity and mortality rate if management is delayed. Its clinical course can mirror that of acute cholecystitis. Characteristic findings on ultrasound or CT scan are useful clues to early diagnosis. Urgent cholecystectomy is required prior to progressing to perforation of gallbladder. Most of the literature are case reports with causes associated with anticoagulation. Herein, we described a morbidly obese patient with poorly controlled diabetes presenting with non-specific right upper quadrant pain and was subsequently diagnosed with haemorrhagic cholecystitis. A review of the literature was also performed to summarise the potential clinical presentations, distinctive imaging findings and management options available for this rare condition.
Topics: Aged; Cholecystitis, Acute; Female; Hemorrhage; Humans; Obesity, Morbid
PubMed: 30244228
DOI: 10.1136/bcr-2018-226469 -
Revista Espanola de Enfermedades... Sep 2019We report a unique case of acute esophageal necrosis in association with perforated acute cholecystitis and secondary Klebsiella pneumoniae bacteremia. An 83-year-old...
We report a unique case of acute esophageal necrosis in association with perforated acute cholecystitis and secondary Klebsiella pneumoniae bacteremia. An 83-year-old male with history of diabetes mellitus, dyslipidemia, ischemic cardiomyopathy and recent right hemicolectomy for colon adenocarcinoma presented to emergency department with acute epigastric pain and hematemesis. The patient appeared cachectic and dehydrated. He was afebrile and hemodynamically stable. Laboratory studies revealed anemia, leukocytosis, hyponatremia and hyperlactatemia. Esophagogastroduodenoscopy displayed characteristic features of acute esophageal necrosis. Abdominal computerized tomography revealed acute cholecystitis with perforation contained by the liver. Percutaneous cholecystostomy was performed. Fluid therapy, intravenous pantoprazole and bowel rest were started. Klebsiella pneumoniae was cultured in blood and bile and broad-spectrum antibiotic therapy was administered. The patient improved clinically and, three weeks later, esophagogastroduodenoscopy demonstrated nearly complete healing of esophageal mucosa. To our knowledge, this is the first case of acute esophageal necrosis in association with acute cholecystitis.
Topics: Acute Disease; Aged, 80 and over; Cholecystitis, Acute; Endoscopy, Digestive System; Esophagus; Humans; Male; Necrosis
PubMed: 31333042
DOI: 10.17235/reed.2019.6154/2018 -
Surgical Endoscopy Sep 2022Patients undergoing elective laparoscopic cholecystectomy (ELLC) represent a heterogeneous group making it challenging to stratify risk. The aim of this paper is to...
INTRODUCTION
Patients undergoing elective laparoscopic cholecystectomy (ELLC) represent a heterogeneous group making it challenging to stratify risk. The aim of this paper is to identify pre-operative factors associated with adverse peri- and post-operative outcomes in patients undergoing ELLC. This knowledge will help stratify risk, guide surgical decision making and better inform the consent process.
METHODS
All patients who underwent ELLC between January 2015 and December 2019 were included in the study. Pre-operative data and both peri- and post-operative outcomes were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were divided into groups based on clinical indication (i.e. biliary colic versus cholecystitis) and adverse outcomes were compared. Multivariate regression models were generated for each adverse outcome using pre-operative independent variables.
RESULTS
Two-thousand one hundred and sixty-six ELLC were identified. Rates of peri- and post-operative adverse outcomes were significantly higher in the cholecystitis versus biliary colic group and increased with number of admissions of cholecystitis (p < 0.05). Rates of subtotal (29.5%), intra-operative complication (9.8%), post-operative complications (19.6%), prolonged post-operative stay (45.9%) and re-admission (16.4%) were significant in the group of patients with ≥ 2 admissions with cholecystitis.
CONCLUSION
Our data demonstrate that patients with repeated biliary admission (particularly cholecystitis) ultimately face an increased risk of a difficult ELLC with associated complications, prolonged post-operative stay and readmissions. These data provide robust evidence that individualised risk assessment and consent are necessary before ELLC. Strategies to minimise recurrent biliary admissions prior to LC should be implemented.
Topics: Bile Duct Diseases; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis; Cholecystitis, Acute; Colic; Gallbladder Diseases; Humans; Length of Stay; Retrospective Studies
PubMed: 35024925
DOI: 10.1007/s00464-021-08986-x -
Medicine May 2023It is difficult to differentiate between non-complicated acute cholecystitis (NCAC) and complicated acute cholecystitis (CAC) preoperatively, which are two separate...
It is difficult to differentiate between non-complicated acute cholecystitis (NCAC) and complicated acute cholecystitis (CAC) preoperatively, which are two separate pathologies with different management. The aim of this study was to create an algorithm that distinguishes between CAC and NCAC using the decision tree method, which includes simple examinations. In this retrospective study, the patients were divided into 2 groups: CAC (149 patients) and NCAC (885 patients). Parameters such as patient demographic data, American Society of Anesthesiologists (ASA) score, Tokyo grade, comorbidity findings, white blood cell (WBC) count, neutrophil/lymphocyte ratio, C-reactive protein (CRP) level, albumin level, CRP/albumin ratio (CAR), and gallbladder wall thickness (GBWT) were evaluated. In this algorithm, the CRP value became a very important parameter in the distinction between NCAC and CAC. Age was an important predictive factor in patients with CRP levels >57 mg/L, and the critical value for age was 42. After the age factor, the important parameters in the decision tree were WBC and GBWT. In patients with a CRP value of ≤57 mg/L, GBWT is decisive and the critical value is 4.85 mm. Age, neutrophil/lymphocyte ratio, and WBC count were among the other important factors after GBWT. Sex, ASA score, Tokyo grade, comorbidity, CAR, and albumin value did not have an effect on the distinction between NCAC and CAC. In statistical analysis, significant differences were found groups in terms of gender (34.8% vs 51.7% male), ASA score (P < .001), Tokyo grade (P < .001), comorbidity (P < .001), albumin (4 vs 3.4 g/dL), and CAR (2.4 vs 38.4). By means of this algorithm, which includes low-cost examinations, NCAC and CAC distinction can be made easily and quickly within limited possibilities. Preoperative prediction of pathologies that are difficult to manage, such as CAC, can minimize patient morbidity and mortality.
Topics: Humans; Retrospective Studies; Cholecystitis, Acute; Cholecystitis; Albumins; Decision Trees; C-Reactive Protein
PubMed: 37171346
DOI: 10.1097/MD.0000000000033749 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Dec 2022Acute cholecystitis (AC) is an acute inflammatory disease of gallbladder and it is one of the most common causes of acute abdominal pain. Determining the severity of AC...
BACKGROUND
Acute cholecystitis (AC) is an acute inflammatory disease of gallbladder and it is one of the most common causes of acute abdominal pain. Determining the severity of AC at hospital admission is extremely important to choose the most effective treatment method and predict vital prognosis. The aim of this study was to investigate the effectiveness of immature granulocyte percentage (IG%) in grading AC severity.
METHODS
This retrospective study was carried out on 528 patients hospitalized due to AC diagnosis. Demographic data, white blood cell (WBC) count, neutrophil lymphocyte ratio (NLR), IG%, C-reactive protein (CRP) levels, and imaging results of patients were recorded. Furthermore, patients' length of hospital stay was determined. Tokyo Guidelines were used to grade AC severity. According to this grading, patients were classified into three groups as grade 1 (mild), grade 2 (moderate), and grade 3 (severe) AC. Differences among groups were analyzed statistically.
RESULTS
There were 386 patients (73.1%) in the mild AC group, 102 patients (19.3%) in the moderate AC group, and 40 patients (7.6%) in the severe AC group. WBC, NLR, CRP and IG% were significant parameters in discriminating mild AC from moderate and severe AC. However, only IG% was a significant parameter in discriminating moderate AC from severe AC. Moreover, the power of IG% to discriminate between patients with mild and moderate AC and those with severe AC was dramatically higher than the other parameters.
CONCLUSION
Increased IG% is seen as an effective and reliable predictor in the early determination of AC severity.
Topics: Humans; Retrospective Studies; Granulocytes; Cholecystitis, Acute; Biomarkers; Neutrophils
PubMed: 36453788
DOI: 10.14744/tjtes.2021.86322