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Scientific Reports Jun 2024This study retrospectively evaluated the outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using novel electrocautery-enhanced lumen-apposing metal...
Revolutionizing outcomes: endoscopic ultrasound-guided gallbladder drainage using innovative electrocautery enhanced-lumen apposing metal stents for high-risk surgical patients.
This study retrospectively evaluated the outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using novel electrocautery-enhanced lumen-apposing metal stents (LAMS) in high-risk patients with acute cholecystitis (AC). Between January 1, 2021, and November 30, 2022, 58 high-risk surgical patients with AC underwent EUS-GBD with the novel electrocautery-enhanced LAMS. The technical success rate was 94.8% (55/58), with one case of duodenal perforation requiring surgery with complete stent migration and two of partial stent migration into the gallbladder. However, the clinical success rate was 100% (55/55). Recurrent AC occurred in 3.6% of the cases (2/55), managed with double pigtail plastic stents through the LAMS. Early AEs observed in 1.8% (1/55) due to stent obstruction. Late AEs occurred in 5.4% (3/55), including two cases of cholangitis and one of stent obstruction. For 33 patients followed over 6 months, LAMS maintenance was sustained in 30 cases. Two patients underwent double-pigtail plastic stent replacement after LAMS removal, and one underwent LAMS removal during surgery following tumor stage regression after chemotherapy for cholangiocarcinoma. The novel electrocautery-enhanced LAMS demonstrated high technical and clinical success rates in high-risk surgical patients with AC, maintaining effective gallbladder drainage with minimal AEs during long-term follow-up, thus highlighting its efficacy and safety in challenging patients.
Topics: Humans; Male; Female; Drainage; Aged; Electrocoagulation; Stents; Endosonography; Middle Aged; Retrospective Studies; Gallbladder; Aged, 80 and over; Treatment Outcome; Cholecystitis, Acute; Adult
PubMed: 38839798
DOI: 10.1038/s41598-024-63608-5 -
International Journal of Surgery Case... Jul 2024Bilobed gallbladder is a rare congenital anomaly characterized by the duplication of the gallbladder. It presents a unique challenge for surgeons due to its infrequency...
INTRODUCTION AND IMPORTANCE
Bilobed gallbladder is a rare congenital anomaly characterized by the duplication of the gallbladder. It presents a unique challenge for surgeons due to its infrequency and the potential for perioperative complications. Anatomical variations, including the presence of the subvesicle duct of Luschka, should be suspected in these cases.
CASE PRESENTATION
In our case report, we present the clinical details of a **23-year-old male** who presented with symptoms of acute cholecystitis and cholangitis. Preoperative imaging revealed a bilobed gallbladder, and incidentally, intraoperative evidence of the subvesicle duct/duct of Luschka was also observed during a successful laparoscopic cholecystectomy. Importantly, the patient experienced no postoperative complications.
CLINICAL DISCUSSION
This case highlights considering bilobed gallbladder as a differential diagnosis in patients with cholecystitis or cholangitis is crucial. Surgeons should be vigilant about this anomaly when evaluating patients with gallbladder-related symptoms.
CONCLUSION
We understand precise imaging plays a pivotal role in guiding surgical planning. Detecting bilobed gallbladder preoperatively allows for better assessment of biliary structures and helps prevent bile leaks during surgery. Although rare, awareness of bilobed gallbladder and its associated anatomical variants is essential for optimal patient management and successful surgical outcomes. Surgeons should remain attentive to such anomalies to ensure safe and effective procedures.
PubMed: 38838586
DOI: 10.1016/j.ijscr.2024.109807 -
World Journal of Emergency Surgery :... Jun 2024Robotic surgery has gained widespread acceptance in elective interventions, yet its role in emergency procedures remains underexplored. While the 2021 WSES position... (Observational Study)
Observational Study
The role of RObotic surgery in EMergency setting (ROEM): protocol for a multicentre, observational, prospective international study on the use of robotic platform in emergency surgery.
BACKGROUND
Robotic surgery has gained widespread acceptance in elective interventions, yet its role in emergency procedures remains underexplored. While the 2021 WSES position paper discussed limited studies on the application of robotics in emergency general surgery, it recommended strict patient selection, adequate training, and improved platform accessibility. This prospective study aims to define the role of robotic surgery in emergency settings, evaluating intraoperative and postoperative outcomes and assessing its feasibility and safety.
METHODS
The ROEM study is an observational, prospective, multicentre, international analysis of clinically stable adult patients undergoing robotic surgery for emergency treatment of acute pathologies including diverticulitis, cholecystitis, and obstructed hernias. Data collection includes patient demographics and intervention details. Furthermore, data relating to the operating theatre team and the surgical instruments used will be collected in order to conduct a cost analysis. The study plans to enrol at least 500 patients from 50 participating centres, with each centre having a local lead and collaborators. All data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. Ethical considerations and data governance will be paramount, requiring local ethical committee approvals from participating centres.
DISCUSSION
Current literature and expert consensus suggest the feasibility of robotic surgery in emergencies with proper support. However, challenges include staff training, scheduling conflicts with elective surgeries, and increased costs. The ROEM study seeks to contribute valuable data on the safety, feasibility, and cost-effectiveness of robotic surgery in emergency settings, focusing on specific pathologies. Previous studies on cholecystitis, abdominal hernias, and diverticulitis provide insights into the benefits and challenges of robotic approaches. It is necessary to identify patient populations that benefit most from robotic emergency surgery to optimize outcomes and justify costs.
Topics: Humans; Robotic Surgical Procedures; Prospective Studies; Emergencies; Observational Studies as Topic; Cholecystitis; Diverticulitis
PubMed: 38835071
DOI: 10.1186/s13017-024-00542-x -
International Journal of Surgery Case... Jul 2024The modern-day gold standard treatment of acute cholecystitis is laparoscopic surgery. It is, however, associated with a higher risk of bile duct injury (0.1 %-1.5 %)...
INTRODUCTION
The modern-day gold standard treatment of acute cholecystitis is laparoscopic surgery. It is, however, associated with a higher risk of bile duct injury (0.1 %-1.5 %) when compared to the open approach.
CASE PRESENTATION
We report a case of a patient with an acute cholecystitis in which we performed a laparoscopic cholecystectomy. We faced a destabilizing anatomy with what looked like the gallbladder and an unidentified mass, interpreted as a possible common bile duct cyst. Careful dissection allowed us to determine that what looked like a common bile duct cyst was a dilatation of "Hartmann's pouch" due to a large gallstone.
DISCUSSION
Laparoscopic cholecystectomy reduces length of hospitalization and enhance intra-operative and postoperative morbidity compared with open cholecystectomy. It may increase the risk of bile duct injury, notably in an acute setting due to inflammation and an unclear anatomy. Hartmann's pouch with the infundibulum can sometimes unexpectedly be present beneath the common hepatic duct. In order to avoid bile duct injury, notably in an acute setting, a surgical technique was developed, the Critical View of Safety. It is a method whose sole aim is to secure identification of the cystic structures.
CONCLUSION
Understanding the anatomy allowed for an ultimately safe laparoscopic cholecystectomy. It is strongly advised that, in the event of atypical anatomy, a second opinion is asked of another and/or more experimented surgeon.
PubMed: 38833902
DOI: 10.1016/j.ijscr.2024.109760 -
Radiology Case Reports Aug 2024Portal cavernoma cholangiopathy (PCC) refers to morphological changes in the intrahepatic, extrahepatic biliary system, along with the gallbladder (GB), induced by...
Portal cavernoma cholangiopathy (PCC) refers to morphological changes in the intrahepatic, extrahepatic biliary system, along with the gallbladder (GB), induced by portal cavernoma (PC). Acute acalculous cholecystitis (AAC) represents an infrequent clinical manifestation of PCC. Given the inadequacy of documentation within medical literature, AAC may go undiagnosed among patients with PC presenting symptoms of right upper quadrant pain. The current study aims to report a case of acute acalculous cholecystitis secondary to portal cavernoma, focusing on radiological findings, with a brief review of literature.
PubMed: 38832340
DOI: 10.1016/j.radcr.2024.04.072 -
Future Science OA 2024The aim is to evaluate laparoscopic cholecystectomy safety based on American Society of Anesthesiologists score for acute cholecystitis in patients with comorbidities....
The aim is to evaluate laparoscopic cholecystectomy safety based on American Society of Anesthesiologists score for acute cholecystitis in patients with comorbidities. This is retrospective study of patients who underwent laparoscopic cholecystectomy for acute cholecystitis between 2003 and 2021. According to their respective ASA-score, patients were divided into group 1: ASA1-2 and group 2: ASA3-4. We collected 578 patients. Even though the gangrenous forms were more frequent and the operative time was longer in group 2, laparoscopic cholecystectomy seems safe and effective. We didn't observe any differences in terms of intraoperative incidents, open conversion rate, or postoperative complications compared with other patients. ASA3-4 patients with acute cholecystitis don't face elevated risks of complications or mortality during laparoscopic cholecystectomy.
PubMed: 38827793
DOI: 10.2144/fsoa-2023-0185 -
Asian Journal of Surgery May 2024This study aimed to investigate the impact of preoperative gallbladder drainage and the specific drainage method used on surgical outcomes in patients undergoing surgery...
AIM
This study aimed to investigate the impact of preoperative gallbladder drainage and the specific drainage method used on surgical outcomes in patients undergoing surgery for acute cholecystitis.
METHODS
This single-center retrospective cohort study included 221 patients who underwent early cholecystectomy between January 2016 and December 2020. Clinical data and outcomes of 140 patients who did not undergo drainage, 22 patients who underwent preoperative percutaneous transhepatic gallbladder drainage (PTGBD), and 59 patients who underwent preoperative endoscopic naso-gallbladder drainage (ENGBD) were compared.
RESULTS
There was no difference in the operation time, blood loss, postoperative complications, or length of postoperative hospital stay between patients who did and did not undergo drainage. Among patients who underwent drainage, there was no difference between the ENGBD and PTGBD groups in operation time, blood loss, or postoperative complications; however, more patients in the PTGBD group underwent laparotomy and had a significantly longer postoperative hospital stay. The presence and type of drainage were not risk factors for postoperative complications.
CONCLUSION
The presence or absence of preoperative gallbladder drainage for acute cholecystitis and the type of drainage may not significantly affect surgical outcomes.
PubMed: 38824020
DOI: 10.1016/j.asjsur.2024.05.168 -
World Journal of Gastrointestinal... May 2024Acute cholecystitis (AC) is a common disease in general surgery. Laparoscopic cholecystectomy (LC) is widely recognized as the "gold standard" surgical procedure for...
Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients: Meta-analysis.
BACKGROUND
Acute cholecystitis (AC) is a common disease in general surgery. Laparoscopic cholecystectomy (LC) is widely recognized as the "gold standard" surgical procedure for treating AC. For low-risk patients without complications, LC is the recommended treatment plan, but there is still controversy regarding the treatment strategy for moderate AC patients, which relies more on the surgeon's experience and the medical platform of the visiting unit. Percutaneous transhepatic gallbladder puncture drainage (PTGBD) can effectively alleviate gallbladder inflammation, reduce gallbladder wall edema and adhesion around the gallbladder, and create a "time window" for elective surgery.
AIM
To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients, providing a theoretical basis for choosing reasonable surgical methods for AC patients.
METHODS
In this study, we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC. We performed searches in the following databases: PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database. The search encompassed literature published from the inception of these databases to the present. Subsequently, relevant data were extracted, and a meta-analysis was conducted using RevMan 5.3 software.
RESULTS
A comprehensive analysis was conducted, encompassing 24 studies involving a total of 2564 patients. These patients were categorized into two groups: 1371 in the LC group and 1193 in the PTGBD + LC group. The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD + LC group and the LC group in multiple dimensions: (1) Operative time: Mean difference (MD) = 17.51, 95%CI: 9.53-25.49, < 0.01; (2) Conversion to open surgery rate: Odds ratio (OR) = 2.95, 95%CI: 1.90-4.58, < 0.01; (3) Intraoperative bleeding loss: MD = 32.27, 95%CI: 23.03-41.50, < 0.01; (4) Postoperative hospital stay: MD = 1.44, 95%CI: 0.14-2.73, = 0.03; (5) Overall postoperative complication rate: OR = 1.88, 95%CI: 1.45-2.43, < 0.01; (6) Bile duct injury: OR = 2.17, 95%CI: 1.30-3.64, = 0.003; (7) Intra-abdominal hemorrhage: OR = 2.45, 95%CI: 1.06-5.64, = 0.004; and (8) Wound infection: OR = 0. These findings consistently favored the PTGBD + LC group over the LC group. There were no significant differences in the total duration of hospitalization [MD = -1.85, 95%CI: -4.86-1.16, = 0.23] or bile leakage [OR = 1.33, 95%CI: 0.81-2.18, = 0.26] between the two groups.
CONCLUSION
The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety, suggesting its broader application value in clinical practice.
PubMed: 38817274
DOI: 10.4240/wjgs.v16.i5.1407 -
Annals of Medicine Dec 2024Early diagnosis of acute gallstone pancreatitis severity (GSP) is challenging in clinical practice. We aimed to investigate the efficacy of CT features and radiomics for...
BACKGROUND
Early diagnosis of acute gallstone pancreatitis severity (GSP) is challenging in clinical practice. We aimed to investigate the efficacy of CT features and radiomics for the early prediction of acute GSP severity.
METHODS
We retrospectively recruited GSP patients who underwent CT imaging within 48 h of admission from tertiary referral centre. Radiomics and CT features were extracted from CT scans. The clinical and CT features were selected by the random forest algorithm to develop the ML GSP model for the identification of severity of GSP (mild or severe), and its predictive efficacy was compared with radiomics model. The predictive performance was assessed by the area under operating characteristic curve. Calibration curve and decision curve analysis were performed to demonstrate the classification performance and clinical efficacy. Furthermore, we built a web-based open access GSP severity calculator. The study was registered with ClinicalTrials.gov (NCT05498961).
RESULTS
A total of 301 patients were enrolled. They were randomly assigned into the training ( = 210) and validation ( = 91) cohorts at a ratio of 7:3. The random forest algorithm identified the level of calcium ions, WBC count, urea level, combined cholecystitis, gallbladder wall thickening, gallstones, and hydrothorax as the seven predictive factors for severity of GSP. In the validation cohort, the areas under the curve for the radiomics model and ML GSP model were 0.841 (0.757-0.926) and 0.914 (0.851-0.978), respectively. The calibration plot shows that the ML GSP model has good consistency between the prediction probability and the observation probability. Decision curve analysis showed that the ML GSP model had high clinical utility.
CONCLUSIONS
We built the ML GSP model based on clinical and CT image features and distributed it as a free web-based calculator. Our results indicated that the ML GSP model is useful for predicting the severity of GSP.
Topics: Humans; Pancreatitis; Female; Gallstones; Male; Machine Learning; Tomography, X-Ray Computed; Middle Aged; Retrospective Studies; Severity of Illness Index; Adult; Aged; Acute Disease; Predictive Value of Tests; Early Diagnosis; Algorithms; ROC Curve
PubMed: 38813815
DOI: 10.1080/07853890.2024.2357354 -
Heliyon May 2024To determine the accuracy of Tc-99 m sestamibi for the diagnosis of acute cholecystitis during a supply chain disruption of mebrofenin.
PURPOSE
To determine the accuracy of Tc-99 m sestamibi for the diagnosis of acute cholecystitis during a supply chain disruption of mebrofenin.
MATERIAL AND METHODS
During a national shortage of Tc-99 m mebrofenin in 2019, our institution initiated sestamibi imaging for suspected cases of acute cholecystitis using a standard hepatobiliary imaging protocol. Forty-one patients underwent hepatobiliary imaging with sestamibi, 39 to assess for acute cholecystitis. The examinations were initially interpreted by one nuclear medicine physician and subsequently overread by 5 blinded nuclear medicine physicians (8-30 years' experience). SPECT/CT was obtained for 8 of these patients at the discretion of the primary interpreter. An additional 23 asymptomatic patients (6 with prior cholecystectomy) underwent abdominal scintigraphy as a negative control to determine the normal time to sestamibi accumulation in the gallbladder. A composite reference standard was used (chart review by 3 physicians). Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were calculated with and without SPECT/CT (mean ± 95%CI).
RESULTS
Of 39 symptomatic patients, 17/39 had acute cholecystitis and 22 did not. The sensitivity, specificity, PPV and NPV for acute cholecystitis at planar imaging were 97.6 ± 4.6, 62.7 ± 5.2, 67.0 ± 3.6, and 97.3 ± 5.2 % (N = 39). The values changed to 95.7 ± 4.7, 77.9 ± 4.7, 72.1 ± 4.1, and 97.0 ± 3.3 % when control patients were included (N = 62). With SPECT/CT, these mildly improved to 98.8 ± 2.3 %, 69.1 ± 4.4 %, 71.3 ± 3.2 %, and 98.7 ± 2.6 % (N = 39), but not significantly different. On average, sestamibi activity was detected in the gallbladder in negative controls within 1 h.
CONCLUSION
Tc-99 m sestamibi has excellent sensitivity and NPV for diagnosing acute cholecystitis and can serve as an alternative when mebrofenin is unavailable for evaluating cystic duct obstruction during shortages of standard agents.
PubMed: 38813191
DOI: 10.1016/j.heliyon.2024.e31257