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Surgical Endoscopy May 2022Complications following laparoscopic cholecystectomy (LC) and common bile duct exploration (CBDE) for the management of gallstones or choledocholithiasis impact... (Review)
Review
BACKGROUND
Complications following laparoscopic cholecystectomy (LC) and common bile duct exploration (CBDE) for the management of gallstones or choledocholithiasis impact negatively on patients' quality of life and may lead to reinterventions. This study aims to evaluate the causes and types of reintervention following index admission LC with or without CBDE.
METHODS
A prospectively maintained database of LC and CBDE performed by a single surgeon was analysed. Preoperative factors, difficulty grading and perioperative complications requiring reintervention and readmissions were examined.
RESULTS
Reinterventions were required in 112 of 5740 patients (2.0%), 89 (1.6%) being subsequent to complications. The reintervention cohort had a median age of 64 years, were more likely to be females (p < 0.0023) and to be emergency admissions (67.9%, p < 0.00001) with obstructive jaundice (35.7%, p < 0.00001). 46.4% of the reintervention cohort had a LC operative difficulty grade IV or V and 65.2% underwent a CBDE. Open conversion was predictive of the potential for reintervention (p < 0.00001). The most common single cause of reintervention was retained stones (0.5%) requiring ERCP followed by bile leakage (0.3%) requiring percutaneous drainage, ERCP and relaparoscopy. Relaparoscopy was necessary in 17 patients and open surgery in 13, 6 of whom not resulting from complications. There were 5 deaths.
CONCLUSION
This large series had a low incidence of reinterventions resulting from complications in spite of a high workload of index admission surgery for biliary emergencies and bile duct stones. Surgical or endoscopic reinterventions following LC alone occurred in only 0.8%. The most common form of reintervention was ERCP for retained CBD stones. This important outcome parameter of laparoscopic biliary surgery can be optimised through early diagnosis and timely reintervention for complications.
Topics: Bile Ducts; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy, Laparoscopic; Choledocholithiasis; Common Bile Duct; Female; Gallstones; Humans; Male; Middle Aged; Prospective Studies; Quality of Life
PubMed: 34076762
DOI: 10.1007/s00464-021-08568-x -
Clinical Medicine Insights.... 2022Deranged liver enzymes due to hyperthyroidism rather than intrinsic liver pathology are not uncommon. The reported prevalence of liver biochemical abnormalities in... (Review)
Review
Deranged liver enzymes due to hyperthyroidism rather than intrinsic liver pathology are not uncommon. The reported prevalence of liver biochemical abnormalities in patients with untreated thyrotoxicosis varies widely ranging from 15% to 76%. The suggested causes of liver dysfunction include direct hepatocyte injury, co-morbid heart failure, associated autoimmune conditions (especially in the setting of Graves' Disease), preexisting liver disease and drugs including antithyroid medications. Although, some patients may have a pattern of mild liver injury, about 1% to 2% can have fulminant hepatitis. Liver enzymes can return to normalcy in as many as 77% to 83% of patients once the initiations of thionamides are started in a timely fashion, which can help forestall complications and prevent or minimize multi-organ dysfunction. Clinicians should maintain a high index of suspicion for underlying hyperthyroidism in patients presenting with unexplained liver dysfunction or unexplained jaundice.
PubMed: 35153522
DOI: 10.1177/11795514221074672 -
Archives of Disease in Childhood Sep 1982The transcutaneous bilirubinometer was evaluated in 60 term and 10 preterm infants. A significant correlation was found between the transcutaneous index and the total...
The transcutaneous bilirubinometer was evaluated in 60 term and 10 preterm infants. A significant correlation was found between the transcutaneous index and the total serum bilirubin concentration for both term and preterm infants. The reliability of the transcutaneous bilirubinometer as a screening method was confirmed, and index criteria for serum bilirubin analysis have been suggested for term babies. The instrument was precise and accurate and the method both noninvasive and atraumatic. Since individual serum bilirubin levels and the transcutaneous index may correlate poorly the transcutaneous method cannot replace traditional serum bilirubin estimation.
Topics: Bilirubin; Evaluation Studies as Topic; Humans; Infant, Newborn; Infant, Premature, Diseases; Jaundice, Neonatal; Methods
PubMed: 7125691
DOI: 10.1136/adc.57.9.708 -
Perinatal and birth correlates of childhood irritability in Taiwan's national epidemiological study.Journal of Affective Disorders Feb 2022Childhood irritability, characterized by low frustration tolerance and developmentally-inappropriate temper outbursts, is a transdiagnostic symptom in child psychiatry....
BACKGROUND
Childhood irritability, characterized by low frustration tolerance and developmentally-inappropriate temper outbursts, is a transdiagnostic symptom in child psychiatry. Little is known regarding the influences of early experience and environmental exposure on irritability from a perinatal perspective. This study examined the associations between irritability and multiple perinatal and birth factors.
METHODS
Drawn Taiwan's National Epidemiological Study of Child Mental Disorders, 5124 children (2591 females) aged 7.7 to 14.6 years (mean 11.2 years) and their parents completed the Affective Reactivity Index, a well-established irritability measure. Parents completed a survey on parental, perinatal, and birth characteristics. Multiple linear regression models were performed to examine the associations between perinatal and birth characteristics and child irritability reported across informants.
RESULTS
Maternal smoking, vaginal bleeding, and pre-eclampsia during pregnancy and phototherapy for jaundice >3 days were associated with high irritability after adjusting for child's age, sex, and parental characteristics. Findings were consistent across parent- and child-rated irritability.
LIMITATIONS
Retrospective assessment of early exposures may be subject to recall bias despite previously-established validity and reliability. Longitudinal research with prospective assessments of early life exposures is recommended to confirm our findings. This exploratory approach of multiple survey items also precludes more in-depth assessments of perinatal risks for developing irritability.
CONCLUSIONS
This study provides novel evidence suggesting a perinatal link with irritability in a national sample of youths. Given that irritability predicts adverse mental health and life outcomes, identifying its perinatal and birth predictors may inform early etiology, guiding timely assessment and intervention.
Topics: Adolescent; Female; Humans; Irritable Mood; Mood Disorders; Prospective Studies; Reproducibility of Results; Retrospective Studies; Taiwan
PubMed: 34906640
DOI: 10.1016/j.jad.2021.12.016 -
World Journal of Gastroenterology Feb 2015To review the underlying pathophysiology and currently available treatments for pruritis associated with jaundice. English language literature was reviewed using... (Review)
Review
To review the underlying pathophysiology and currently available treatments for pruritis associated with jaundice. English language literature was reviewed using MEDLINE, PubMed, EMBASE and clinicaltrials.gov for papers and trails addressing the pathophysiology and potential treatments for pruritis associated with jaundice. Recent advances in the understanding of the peripheral anatomy of itch transmission have defined a histamine stimulated pathway and a cowhage stimulated pathway with sensation conveyed centrally via the contralateral spinothalamic tract. Centrally, cowhage and histamine stimulated neurons terminate widely within the thalamus and sensorimotor cortex. The causative factors for itch in jaundice have not been clarified although endogenous opioids, serotonin, steroid and lysophosphatidic acid all play a role. Current guidelines for the treatment of itching in jaundice recommend initial management with biliary drainage where possible and medical management with ursodeoxycholic acid, followed by cholestyramine, rifampicin, naltrexone and sertraline. Other than biliary drainage no single treatment has proved universally effective. Pruritis associated with jaundice is a common but poorly understood condition for which biliary drainage is the most effective therapy. Pharmacological therapy has advanced but remains variably effective.
Topics: Animals; Antipruritics; Cholagogues and Choleretics; Combined Modality Therapy; Drainage; Humans; Jaundice; Neural Pathways; Practice Guidelines as Topic; Pruritus; Risk Factors; Severity of Illness Index; Treatment Outcome
PubMed: 25663760
DOI: 10.3748/wjg.v21.i5.1404 -
Liver Research Dec 2018Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon but important cause of gastrointestinal hemorrhage. Reports of hemobilia date back to...
Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon but important cause of gastrointestinal hemorrhage. Reports of hemobilia date back to the 1600s, but due to its relative rarity and challenges in diagnosis, only in recent decades has hemobilia been more critically studied. The majority of cases of hemobilia are iatrogenic and caused by invasive procedures involving the liver, pancreas, bile ducts and/or the hepatopancreatobiliary vasculature, with trauma and malignancy representing the two other leading causes. A classic triad of right upper quadrant pain, jaundice, and overt upper gastrointestinal bleeding has been described ( Quincke's triad), but this is present in only 25%-30% of patients with hemobilia. Therefore, prompt diagnosis depends critically on having a high index of suspicion, which may be based on a patient's clinical presentation and having recently undergone (peri-) biliary instrumentation or other predisposing factors. The treatment of hemobilia depends on its severity and suspected source and ranges from supportive care to advanced endoscopic, interventional radiologic, or surgical intervention. Here we provide a clinical overview and update regarding the etiology, diagnosis, and treatment of hemobilia geared for specialists and subspecialists alike.
PubMed: 31308984
DOI: 10.1016/j.livres.2018.09.007 -
HPB Surgery : a World Journal of... Sep 1988The Mirizzi syndrome refers to benign obstruction of the common hepatic duct by a stone impacted within the neck or cystic duct of the gallbladder, which causes...
The Mirizzi syndrome refers to benign obstruction of the common hepatic duct by a stone impacted within the neck or cystic duct of the gallbladder, which causes extrinsic compression of the common hepatic duct and obstructive jaundice. Although a rare cause of obstructive jaundice, it remains a clinically and surgically challenging problem. Five patients with the Mirizzi syndrome were culled from over 9000 patients undergoing operation for gallstone disease. The management of these patients was detailed. Diagnosis requires a high index of clinical suspicion but can be confirmed with the use of ultrasonography and percutaneous transhepatic cholangiography. Cholecystectomy and common duct exploration are essential components of operative therapy, but additional procedures to repair non-circumferential bile duct defects or strictures must be anticipated.
Topics: Aged; Cholangitis; Cholecystitis; Cholelithiasis; Cholestasis; Cholestasis, Extrahepatic; Diagnosis, Differential; Female; Hepatic Duct, Common; Humans; Male; Middle Aged; Syndrome
PubMed: 3153777
DOI: 10.1155/1988/54294 -
Journal of Clinical Medicine May 2023Evidence regarding the adverse burden of severe neonatal jaundice (SNJ) in hospitalized neonates in resource-constrained settings is sparse. We attempted to determine... (Review)
Review
Evidence regarding the adverse burden of severe neonatal jaundice (SNJ) in hospitalized neonates in resource-constrained settings is sparse. We attempted to determine the prevalence of SNJ, described using clinical outcome markers, in all World Health Organization (WHO) regions in the world. Data were sourced from Ovid Medline, Ovid Embase, Cochrane Library, African Journals Online, and Global Index Medicus. Hospital-based studies, including the total number of neonatal admissions with at least one clinical outcome marker of SNJ, defined as acute bilirubin encephalopathy (ABE), exchange blood transfusions (EBT), jaundice-related death, or abnormal brainstem audio-evoked response (aBAER), were independently reviewed for inclusion in this meta-analysis. Of 84 articles, 64 (76.19%) were from low- and lower-middle-income countries (LMICs), and 14.26% of the represented neonates with jaundice in these studies had SNJ. The prevelance of SNJ among all admitted neonates varied across WHO regions, ranging from 0.73 to 3.34%. Among all neonatal admissions, SNJ clinical outcome markers for EBT ranged from 0.74 to 3.81%, with the highest percentage observed in the African and South-East Asian regions; ABE ranged from 0.16 to 2.75%, with the highest percentages observed in the African and Eastern Mediterranean regions; and jaundice-related deaths ranged from 0 to 1.49%, with the highest percentage observed in the African and Eastern Mediterranean regions. Among the cohort of neonates with jaundice, the prevalence of SNJ ranged from 8.31 to 31.49%, with the highest percentage observed in the African region; EBT ranged from 9.76 to 28.97%, with the highest percentages reported for the African region; ABE was highest in the Eastern Mediterranean (22.73%) and African regions (14.51%). Jaundice-related deaths were 13.02%, 7.52%, 2.01% and 0.07%, respectively, in the Eastern Mediterranean, African, South-East Asian and European regions, with none reported in the Americas. aBAER numbers were too small, and the Western Pacific region was represented by only one study, limiting the ability to make regional comparisons. The global burden of SNJ in hospitalized neonates remains high, causing substantial, preventable morbidity and mortality especially in LMICs.
PubMed: 37297932
DOI: 10.3390/jcm12113738 -
Gland Surgery Mar 2022Carcinoma of the head of pancreas has a high malignant degree and the 5-year survival rate at 5%. For unresectable pancreatic cancer, the 5-year survival rate is even...
BACKGROUND
Carcinoma of the head of pancreas has a high malignant degree and the 5-year survival rate at 5%. For unresectable pancreatic cancer, the 5-year survival rate is even lower. The clinical diagnosis of pancreatic cancer is difficult, and surgical indications are difficult to grasp. Moreover, perioperative and postoperative management is complex, and patients with different conditions need more attention to implement a comprehensive diagnosis and treatment strategy. In the diagnosis and treatment of pancreatic cancer and even other cancers, multi-disciplinary diagnosis and treatment can provide reasonable, personalized and more effective plans for patients so that cancer patients can receive better treatment and improve their quality of life. The multi-disciplinary diagnosis and treatment model can respond to the complex needs to individual patients.
CASE DESCRIPTION
This model is designed according to each patient's comprehensive situation, including their clinical symptoms, biochemical indicators, body mass index, and psychological status, and the tumor position, pathological tissue typing, and invasion scope. Complications of tumors can be reduced if treatment is controlled and if radical treatments are used within a broader comprehensive care model, thereby improving the quality of life of patients to prolong their survival. In our case report, the overall survival is much longer than un-resectable pancreatic cancer (median overall survival 6-9 months. The female patient was 53 years old. Her chief complaints were yellow skin, yellow urine, and absorption emaciation for 1 month. The preliminary diagnosis was postoperative pancreatic cancer. CT reexamination suggested portal vein liver metastasis. Repeated gastrointestinal bleeding occurs over the course of the disease. Postoperative review suggested recurrence, and she was admitted to First Affiliated Hospital, Army Medical University. During the treatment, the disease progressed to gastrointestinal bleeding, ascites, and jaundice.
CONCLUSIONS
After multidisciplinary treatment (MDT) discussion, targeted treatment strategies were developed to improve the symptoms and improve the quality of life of the patients.
PubMed: 35402202
DOI: 10.21037/gs-22-86 -
The Cochrane Database of Systematic... Sep 2012Patients with obstructive jaundice have various pathophysiological changes that affect the liver, kidney, heart, and the immune system. There is considerable controversy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Patients with obstructive jaundice have various pathophysiological changes that affect the liver, kidney, heart, and the immune system. There is considerable controversy as to whether temporary relief of biliary obstruction prior to major definitive surgery (pre-operative biliary drainage) is of any benefit to the patient.
OBJECTIVES
To assess the benefits and harms of pre-operative biliary drainage versus no pre-operative biliary drainage (direct surgery) in patients with obstructive jaundice (irrespective of a benign or malignant cause).
SEARCH METHODS
We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2012.
SELECTION CRITERIA
We included all randomised clinical trials comparing biliary drainage followed by surgery versus direct surgery, performed for obstructive jaundice, irrespective of the sample size, language, and publication status.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trials for inclusion and extracted data. We calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on the available patient analyses. We assessed the risk of bias (systematic overestimation of benefit or systematic underestimation of harm) with components of the Cochrane risk of bias tool. We assessed the risk of play of chance (random errors) with trial sequential analysis.
MAIN RESULTS
We included six trials with 520 patients comparing pre-operative biliary drainage (265 patients) versus no pre-operative biliary drainage (255 patients). Four trials used percutaneous transhepatic biliary drainage and two trials used endoscopic sphincterotomy and stenting as the method of pre-operative biliary drainage. The risk of bias was high in all trials. The proportion of patients with malignant obstruction varied between 60% and 100%. There was no significant difference in mortality (40/265, weighted proportion 14.9%) in the pre-operative biliary drainage group versus the direct surgery group (34/255, 13.3%) (RR 1.12; 95% CI 0.73 to 1.71; P = 0.60). The overall serious morbidity was higher in the pre-operative biliary drainage group (60 per 100 patients in the pre-operative biliary drainage group versus 26 per 100 patients in the direct surgery group) (RaR 1.66; 95% CI 1.28 to 2.16; P = 0.0002). The proportion of patients who developed serious morbidity was significantly higher in the pre-operative biliary drainage group (75/102, 73.5%) in the pre-operative biliary drainage group versus the direct surgery group (37/94, 37.4%) (P < 0.001). Quality of life was not reported in any of the trials. There was no significant difference in the length of hospital stay (2 trials, 271 patients; MD 4.87 days; 95% CI -1.28 to 11.02; P = 0.12) between the two groups. Trial sequential analysis showed that for mortality only a small proportion of the required information size had been obtained. There seemed to be no significant differences in the subgroup of trials assessing percutaneous compared to endoscopic drainage.
AUTHORS' CONCLUSIONS
There is currently not sufficient evidence to support or refute routine pre-operative biliary drainage for patients with obstructive jaundice. Pre-operative biliary drainage may increase the rate of serious adverse events. So, the safety of routine pre-operative biliary drainage has not been established. Pre-operative biliary drainage should not be used in patients undergoing surgery for obstructive jaundice outside randomised clinical trials.
Topics: Drainage; Humans; Jaundice, Obstructive; Postoperative Complications; Randomized Controlled Trials as Topic; Stents
PubMed: 22972086
DOI: 10.1002/14651858.CD005444.pub3