Acute Calculous Cholecystitis Research Articles

Acute Cholecystitis Due to Lactococcus lactis and Single-Center Experience with Infections Due to Lactococcus spp.

Background: Lactococcus species are used to ferment milk to yogurt, cheese, and other products. The gram-positive coccus causes diseases in amphibia and fish and is a rare human pathogen. Patients and Methods: A 51-year-old male underwent laparoscopic cholecystectomy for acute and chronic calculous cholecystitis. Lactococcus lactis was isolated from pus from his gallbladder empyema. Results: Our institutional database was searched for other cases of Lactococcus spp. infections and four patients (2 males, 2 females; aged 51, 64, 78, and 80 years) were identified during a four-year period. The three other patients had positive blood cultures associated with pneumonia, toxic megacolon, and severe gastroenteritis. All isolates were monocultures with Lactococcus lactis (2), Lactococcus garvieae (1) and Lactococcus raffinolactis (1). Two patients died related to their sepsis. We report the second case of cholecystitis involving Lactococcus. Conclusions: Lactococcus is a very rare pathogen mainly causing blood stream infections but needs to be considered to cause serious surgical infections in humans.

Expanded Analysis for Patients with Acute Cholecystitis Indicates Outcomes Vary Based on COVID-19 Status and Treatment Modality

BackgroundThe impact of different phases of COVID-19 infection on outcomes from acute calculous cholecystitis is not well understood. Therefore, we examined outcomes of acute cholecystitis during the COVID-19 pandemic, comparing the effect of different treatment modalities as well as COVID-19 infection status. We hypothesized that acute COVID-19 patients would have worse outcomes than COVID-negative patients, but there would be no difference between COVID-negative and COVID-recovered patients. MethodsWe utilized 2020-2023 National COVID Cohort Collaborative data to identify adults with acute calculous cholecystitis. Treatment (antibiotics-only, cholecystostomy tube, or cholecystectomy), and COVID-19 status (negative, active, or recovered) were collected. Treatment failure of non-operative managements was noted. Adjusted analysis using a series of generalized linear models controlled for confounders (age, sex, BMI, Charlson comorbidity index, severity at presentation, and year) to better assess differences in outcomes between treatment groups, as well as between COVID-19 groups. ResultsIn total, 32,433¥ patients were included: 29,749 COVID-negative, 2,112 COVID-active, and 572¥ COVID-recovered. COVID-active had higher rates of sepsis at presentation. COVID-negative more often underwent cholecystectomy. Unadjusted, COVID-active had higher 30-day mortality, 30-day complication, and longer LOS than COVID-negative and COVID-recovered. Adjusted analysis revealed cholecystectomy carried lower odds of mortality for COVID-active and COVID-negative patients, compared with antibiotics or cholecystostomy. COVID-recovered patients’ mortality was unaffected by treatment modality. Treatment failure from antibiotics was more common for COVID-negative patients. ConclusionsAcute cholecystitis outcomes are impacted by phase of COVID-19 infection and treatment modality. Cholecystectomy does not lead to worse outcomes for COVID-active and COVID-recovered patients, compared with non-operative treatments, thus these patients can be considered for cholecystectomy if their physiology is not prohibitive.

Laparoscopic cholecystectomy in calculous cholecystitis: are antibiotics necessary?

Laparoscopic cholecystectomy in patients with cholecystitis is considered the best, appropriate and safe method of treatment for gallstone disease. However, the role of antibiotic administration before or after cholecystectomy to reduce infectious complications, particularly surgical site infections, or mortality is less clear. Many patients receive empiric antibiotics, but the feasibility of their use has not been proven. Some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any benefit to this practice in the absence of risk factors. This review examines the results of antibiotic use in laparoscopic cholecystectomy for chronic and acute calculous cholecystitis. Most studies argue against the need to use prophylactic antibiotics during elective surgery in low-risk patients. In cases of mild and moderate acute cholecystitis, the use of antibiotics to prevent postoperative infectious complications has no evidence of effectiveness, although these recommendations are also ambiguous. It is not recommended to use postoperative antibiotics after elective laparoscopic cholecystectomy, as well as for mild or moderate acute cholecystitis. However, additional studies with well-defined patient populations and comparable outcomes are needed to better assess the most appropriate timing and duration of antibiotic use in patients undergoing laparoscopic cholecystectomy. We used MedLine database on the PubMed platform and the Cochrane library to search for literature sources.

COVID-free surgical pathways for treating patients with acute calculous cholecystitis: a retrospective comparative study.

During the Sars-Cov-2 crisis, some of the resources committed to emergency surgery services were transiently reallocated to the care of patients with severe COVID-19, preserving immediate treatment of mostly non-deferrable conditions. Moreover, the fear of contracting infections or hindering the treatment of critical COVID-19 patients has caused many individuals to defer seeking emergency care. This situation has then possibly modified the standard of care of some common surgical conditions and the relative outcomes. Our aims was to highlight any difference in surgical outcomes in patients treated for acute cholecystitis before and during the COVID-19 outbreak. This is a retrospective study on a prospectively collected database that included all consecutive patients treated for acute cholecystitis from March 2019 to February 2021 at the Lugano Regional Hospital, a COVID-free hospital for general surgery patients. Patients were divided into pre-and post-COVID-19 outbreak groups. We collected thorough clinical characteristics and intra-and postoperative outcomes. We included 124 patients, of which 60 and 64 were operated on before and after the COVID-19 outbreak respectively. The two groups resulted similar in terms of patients' clinical characteristics (age, gender, body mass index, ASA score, and comorbidities). Patients in the post-outbreak period were admitted to the hospital 0.7 days later than patients in the pre-outbreak period (3.8 ± 6.0 days vs. 3.1 ± 4.1 days, p = 0.453). Operative time, recovery room time, complications, and reoperations resulted similar between groups. More patients in the post-outbreak period received postoperative antibiotic therapy (63.3% vs. 37.5%, p = 0.004) and for a longer time (6.9 ± 5.1 days vs. 4.5 ± 3.9 days, p = 0.020). No significant histopathological difference was found in operatory specimens. Despite more frequent antibiotic therapy that suggests eventually worse inflammatory local status, our results showed similar outcomes for patients treated for acute cholecystitis before and during the COVID-19 pandemic. The local COVID management, reallocating resources, and keeping COVID-free hospitals was key to offering patients a high standard of treatment.

Microbiological etiology and current resistance patterns in acute calculous cholecystitis

IntroductionThe current treatment for acute calculous cholecystitis (ACC) is early laparoscopic cholecystectomy, in association with appropriate empiric antibiotic therapy. In our country, the evolution of the prevalence of the germs involved and their resistance patterns have been scarcely described. The aim of the study was to analyze the bacterial etiology and the antibiotic resistance patterns in ACC. MethodsWe conducted a single-center, retrospective, observational study of consecutive patients diagnosed with ACC between 01/2012 and 09/2019. Patients with a concomitant diagnosis of pancreatitis, cholangitis, postoperative cholecystitis, histology of chronic cholecystitis or carcinoma were excluded. Demographic, clinical, therapeutic and microbiological variables were collected, including preoperative blood cultures, bile and peritoneal fluid cultures. ResultsA total of 1104 ACC were identified, and samples were taken from 830 patients: bile in 89%, peritoneal fluid and/or blood cultures in 25%. Half of the bile cultures and less than one-third of the blood and/or peritoneum samples were positive. Escherichia coli (36%), Enterococcus spp (25%), Klebsiella spp (21%), Streptococcus spp (17%), Enterobacter spp (14%) and Citrobacter spp (7%) were isolated. Anaerobes were identified in 7% of patients and Candida spp in 1%. Nearly 37% of patients received inadequate empirical antibiotic therapy. Resistance patterns were scrutinized for each bacterial species. The main causes of inappropriateness were extended-spectrum beta-lactamase–producing bacteria (34%) and Enterococcus spp (45%), especially in patients older than 80 years. ConclusionsUpdated knowledge of microbiology and resistance patterns in our setting is essential to readjust empirical antibiotic therapy and ACC treatment protocols.

Clinical Outcomes of Delayed Laparoscopic Cholecystectomy in Patients with Acute Calculous Cholecystitis: A Single Centre Study

Background: A delayed laparoscopic cholecystectomy is performed as an elective procedure several weeks after a conservative treatment which involves a course of intravenous antibiotics. Aims: To evaluate the clinical outcomes (i.e. hospital stay, mean operative time, re-admissions, and conversion) of delayed laparoscopic cholecystectomy among patients with acute calculous cholecystitis operated on in a tertiary care hospital. Methods: A six-month retrospective study was conducted at the Department of Surgery, Saint Luke’s General Hospital, Kilkenny, Ireland, from 28th August, 2017, to 1st March, 2018. It included 148 patients with acute calculous cholecystitis who underwent delayed laparoscopic cholecystectomy in the department from January, 2016 to December 2016 and who satisfied the inclusion and exclusion criteria. The data was analyzed using SPSS version 21. The age range of patients was between 26 and 59 years, and the overall mean (±SD) age of patients was 41.67 (± 8.23) years. The majority (59.5%) of patients enrolled were aged over 40 years. Among the 148 patients enrolled in this study, 34 (23%) were males and 114 (77%) were females. Only eight (5.4%) patients were converted to open cholecystectomy, and readmission was observed in 21.6% patients. The mean (SD) length of stay was 5.59 (4.42), while the mean length of operative duration was 107.69 (32.15) respectively. Conclusion: Delayed laparoscopic cholecystectomy among patients with acute calculous cholecystitis produces a significantly lower likelihood of conversion to open surgery.

Textbook outcome in urgent early cholecystectomy for acute calculous cholecystitis: results post hoc of the S.P.Ri.M.A.C.C study

IntroductionA textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis.ObjetiveThe objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO.Materials and methodsThis is a post hoc study of the SPRiMACC study. It´s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC.Outcomes1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC.ConclusionKnowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome.

Gallbladder perforation in acute acalculous vs. calculous cholecystitis: a retrospective comparative cohort study with 10-year single-center experience.

Gallstones are a well-known risk factor for acute cholecystitis. However, their role as a risk factor for gallbladder perforation (GBP) remains unclear. Therefore, this study aimed to determine the effect of gallstones on the development of GBP. This large-scale retrospective cohort study enroled consecutive patients who underwent cholecystectomy for acute cholecystitis. The primary endpoint was the role of gallstones as a risk factor for developing GBP. Secondary endpoints included the clinical characteristics of GBP, other risk factors for GBP, differences in clinical outcomes between patients with acalculous cholecystitis (AC) and calculous cholecystitis (CC), and the influence of cholecystectomy timing. A total of 4497 patients were included in this study. The incidence of GBP was significantly higher in the AC group compared to the CC group (5.6% vs. 1.0%, P <0.001). However, there were no differences in ICU admission and hospital stay durations. The incidence of overall complications was significantly higher in the AC group than in the CC group (2.2% vs. 1.0%, P <0.001). Patients with AC had a higher risk of developing GBP than those with CC (odds ratio, 5.00; 95% CI, 2.94-8.33). In addition, older age (≥60years), male sex, comorbidities, poor performance status, and concomitant acute cholangitis were associated with the development of GBP. Furthermore, the incidence of GBP was significantly higher in the delayed cholecystectomy group than in the early cholecystectomy group (2.0% vs. 0.9%, P <0.001). AC is a significant risk factor for GBP. Furthermore, early cholecystectomy can significantly reduce GBP-related morbidity and mortality.

Robotic Cholecystectomy Remains Safe and Effective After Regular Staffing Hours.

Background Robotic-assisted surgery continues to grow in popularity. Access during evenings and weekends for non-elective operations can be restricted out of safety concerns. We sought to analyze and compare outcomes of patients undergoing robotic cholecystectomy, a common urgent procedure for acute calculous cholecystitis, during regular hours versus evenings or weekends. Based on this comparison, we sought to determine if this restriction is justified. Methods We performed a retrospective analysis of 46 patients who underwent robotic cholecystectomy for acute calculous cholecystitis per 2018 Tokyo criteria by a single surgeon at a single institution between 2021 and 2022. Patients were grouped as undergoing "after-hours" cholecystectomy if the operation started at five pm or later, or anytime during the weekend (Saturday, Sunday). Demographic, perioperative, and outcome variables were tabulated and analyzed. For illustrative purposes, the data presented as median ± standard deviation were applicable. Results After-hours cholecystectomy occurred in 26 patients and regular-hours cholecystectomy occurred in 20 patients. There were no significant differences in perioperative variables between the two cohorts in terms of body mass index, age, gender, cirrhotic status, American Society of Anesthesiology score, white blood cell count, or neutrophil percentage. The after-hours group had more prior abdominal operations. There were no significant differences between the two groups in terms of operative time, estimated blood loss, or length of stay. There were no mortalities. There was one readmission in the after-hours cohort unrelated to the operation. Conclusion Robotic cholecystectomy can be safely performed on the weekends and evenings. Hospitals should make the robotic platform available during this time.

Subtotal cholecystectomy as an approach to preventing injury in the left-sided gallbladder in the emergency surgery setting: A case study

A left-sided gallbladder is an unusual anatomic variation that makes gallbladder surgery challenging. Two systematic reviews on surgery for left-sided gallbladder highlighted high iatrogenic bile duct injury rates of 4.4% and 7.3%. This paper reports a female in her 40s with symptoms of acute calculous cholecystitis admitted to a secondary health-care center. After inserting four ports through standard sites for conventional gallbladder surgery, laparoscopic inspection revealed a phlegmonous left-sided gallbladder. No discordant situs of abdominal viscera was noted. Laparoscopic surgery was converted to open subtotal closed-tract cholecystectomy. No post-operative complications related to the surgical site were observed. A left-sided gallbladder affected by severe inflammation and infection is an extraordinary condition that should be considered as a risk factor. If an inflamed left-sided gallbladder is encountered, emergency subtotal cholecystectomy is an alternative to total cholecystectomy when the circumstances to adopt the strategies of a culture of safety in cholecystectomy for complete removal of the gallbladder are unfavorable. Relevance for Patients: Subtotal cholecystectomy in patients with left-sided gallbladder reduces the risk for bile duct injuries, outweighing the potential side effects stemming from this surgical approach.

Surgical Safety Checklist as an optimal organizational model in ensuring the maximum degree of preparedness for intraoperative incidents (case report)

Objective. The use of checklists for quality and safety control of medical care is an effective tool for reducing the frequency of errors, dangers and complications in any section of medical practice.The aim is to demonstrate the possibilities of minimizing and leveling the potential risks accompanying surgical intervention using the example of routine application of the surgical safety checklist.Object and methods. Patient A., 55 years old, was admitted to the emergency department of Samara City Clinical Hospital №1 named after N.I. Pirogov on 24.04.2023. with complaints of pain in the right upper abdomen, nausea, vomiting, general weakness. The diagnosis was Cholelithiasis, acute calculous cholecystitis with the formation of a perivesical abscess. It required laparoscopic cholecystectomy operation. While filling in the surgical safety checklist (SSC) and analyzing possible intraoperative incidents, the attending physician executed an informed voluntary consent for transfusion of donor blood components. The corresponding components were ordered. Having weighted up the potential intraoperative risks specified in the part "Before anesthesia" of SSC, the anesthesiologist installed a catheter into one of the central veins and performed the urine bladder catheterization. Surgical intervention was complicated by bleeding, which required conversion of surgical approach. Upper median laparotomy, cholecystectomy, surgical hemostasis were performed. Total blood loss was 1000 ml, plasma and red blood cell were donated to the patient. The operation was completed by drainage of the subhepatic space and suturing of surgical wounds.Results. The clinical case describes the importance of a team approach at the stage before the operation, as well as the role of all specialists provided life support and medical care for the patient. It results from attentive work with the checklist which shows a clear liability for each member of the operating team at different stages of preparation and treatment of a surgical patient.Conclusions. The development of a culture of surgical safety is an important way to minimize the risks associated with surgical intervention for each individual patient and for the institution by optimizing the work of operating units.

Role of the cytokine system in patients with acute and chronic calculous cholecystitis

Introduction and Aim: Interleukin 1 (IL-1a and IL-1b), IL-6, and tumor necrosis factor-alpha (TNF-alpha), which are mostly released by monocytes and macrophages, are three cytokines that are effective, have multiple uses, and act as proinflammatory proteins during immune response and inflammation. The objective of this study was to evaluate the role of cytokine system in patients with acute calculous cholecystitis (ACC) and chronic calculous cholecystitis (CCC) when the disease got worse after medical and surgical treatment.   Materials and Methods:  One hundred and thirty-three patients with acute cholecystitis who were hospitalized in our department and were divided into two groups. 79 patients with ACC made up Group 1. 54 patients with CCC made up Group 2. Based on clinical symptoms and an ultrasound scan, the clinical diagnosis was confirmed.   Results: A comparison of cytokines revealed that in purulent cholecystitis, the value of IL-6 becomes considerably higher than in ACC, and TNF-alpha becomes significantly higher, whereas IL-1 and IL-4 do not reach significant levels. A comparison of the concentration-time patterns of cytokines in the two groups when they left the hospital showed that IL-1beta and TNF-alpha in group 2 patients were higher than in group 1, but IL-4 was lower.   Conclusion: Following drug and surgical treatment, ACC resolves with a significant drop in the levels of pro-inflammatory cytokines and a rise in anti-inflammatory IL-4.

Bedside Ultrasound-Guided Percutaneous Cholecystostomy in Critically Ill Patients—Outcomes in 51 Patients

Abstract Purpose The aim of this study was to report technical and clinical success of bedside ultrasound-guided percutaneous cholecystostomy (PC) tube placement in intensive care unit (ICU). Materials and Methods This is a retrospective study of 51 patients (36 males:15 females, mean age: 67 years) who underwent ultrasound-guided PC from May 2015 to January 2020. The indication for cholecystostomy tube placement, comorbidities, imaging finding, technical success, clinical success, timing of surgery post-cholecystostomy tube placement, indwelling catheter time, complications, and follow-up were recorded. Results Indications for cholecystostomy tube placement were acute calculous cholecystitis (n = 43; 84.3%), perforated cholecystitis (n = 5; 9.8%), and emphysematous cholecystitis (n = 3; 5.9%). Most of the patients had multiple comorbidities; these were diabetes mellitus, hypertension, cardiovascular disease, chronic renal disease, underlying malignancy, and multisystem disease with sepsis. All patients had undergone PC through transhepatic approach under ultrasound guidance in ICU. Technical success rate of the procedure was 100%. Clinical success rate was 92.1% (47/51) and among these 44/51 (86.2%) patients underwent definitive elective cholecystectomy, 3/51 (5.9%) patients had elective tube removal. Three of fifty-one (5.9%) patients did not improve; among these two underwent emergency surgery, while there was 1/51 (1.9%) mortality due to ongoing sepsis and multiorgan dysfunction. There were no procedure-related mortalities or procedure-related major complications. One patient had bile leak due to multiple attempts for cholecystostomy placement. Mean tube indwelling time was 13 days (range: 3–45 days). Conclusion Ultrasound-guided PC can be safely performed in ICU in critically ill patients unfit for surgery with high technical and clinical success rates. Early laparoscopic cholecystectomy should be preferred after stabilization of clinical condition following cholecystostomy.

Percutaneous Cholecystostomy for acute calculous cholecystitis. Analysis of complications.

Abstract Aims Acute cholecystitis (AC) is the second most frequent pathology in Surgical Emergencies.Laparoscopic cholecystectomy (LC) is the gold standard treatment, but not all patients are fit for surgery. Percutaneous Choleystostomy (PC) is an alternative to LC but has high comorbidity and the efficacy of bridge therapy is still in debate. This study aims to analyse the complications of non-surgical treatment in AC. Methods Single-centre retrospective study of 1652 adults with AC during 2011 to 2022, including baseline demographic characteristics, comorbidity severity defined as Charlson Comorbidity Index (CCI), ASA Score, Tokyo Guidelines’ severity classification. The primary outcome is to study the complications of non-surgical treatment. Results The 94,6% of the series had LC. Only 88 patients received NST, and were 12 yearls old older, had a higher CCI and the 44% were severe cholecystitis the 83% were pure-cholecystitis, and 44% were successfully treated with antibiotics alone. A 55% needed a PC, in 7 patients was for resuscitation before surgery. The Hospital stay was 6 days longer and the 45% had a complication. The mortality was 11%. Risk factors for complications were severe cholecystitis, diabetes, and age over 70. Only 3 patients were studied with a cholangiography before remove the drainage. The recurrence was 28%. Conclusions NST has a high complication rate, it should be only for a diminutive subgroup of patients with an AC. A severe cholecystitis, diabetes, and age over 70 are risk factors for complications. Resucitative cholecystostomy could be an option in selective patients.

Endoscopic gallbladder inside-stenting combined with aspirated lavage for calculous cholecystitis in poor surgical candidates: a prospective pilot study

Although long-term stent placement via endoscopic gallbladder stenting (EGBS) reportedly reduces cholecystitis recurrence in patients unfit to undergo cholecystectomy, it can increase the frequency of other late adverse events (AEs) such as cholangitis. This study aimed to examine the feasibility of endoscopic gallbladder inside-stenting (EGB-IS) with lavage and aspiration. This prospective, single-center, pilot study enrolled 83 patients with acute calculous cholecystitis who were poor candidates for surgery. A dedicated catheter with eight side holes was used for lavage and aspiration, and a dedicated single-pigtail stent equipped with a thread was used for EGB-IS. Outcomes such as technical success, clinical success, early AEs, recurrence of cholecystitis, and other symptomatic late AEs associated with EGB-IS with lavage and aspiration were evaluated. The technical and clinical success rates were 80.7% (67/83) and 98.5% (66/67), respectively. The rate of early AEs was 3.6% (3/83). The rate of recurrent cholecystitis was 4.5% (3/66) and that of symptomatic late AEs (besides cholecystitis) was 6.1% (4/66). Consequently, the rate of overall late AEs (cholecystitis plus other events) was 10.6% (7/66). The 1-, 2-, and 3-year cumulative incidence rates of all late AEs were 3.2%, 11.2%, and 18.9%, respectively. EGB-IS with lavage and aspiration for calculous cholecystitis showed promising results in poor surgical candidates. EGB-IS may be useful when EGBS with long-term stent placement is planned, since prevention of cholecystitis recurrence, without a rise in the incidence of other AEs, is anticipated.

EVOLUTION OF MORPHOLOGICAL CHANGES OF THE GALLBLADDER WALL AT DIFFERENT TERMS OF PERFORMANCE OF LAPAROSCOPIC CHOLECYSTECTOMY

Gallstones are present in approximately 10-15 % of the adult population in Western countries, with 1-4 % of patients experiencing symptoms each year. Recent guidelines have confi rmed that laparoscopic cholecystectomy is the mainstay of treatment for acute calculous cholecystitis, but the optimal timing of cholecystectomy is still a matter of debate and research. The purpose of the study is to improve the results of surgical treatment of patients with acute obturation calculous cholecystitis by clinical and morphological substantiation of the optimal terms of laparoscopic cholecystectomy.Material and methods. To increase the safety of laparoscopic cholecystectomy, a histological study of micropreparations of the gallbladder wall after laparoscopic cholecystectomy was conducted in 30 patients, who were divided into 2 groups: 1 group – features of morphological and structural changes in the gallbladder wall up to 7 days after the onset of an attack of biliary colic (18 patients; 60 %) and group 2 – peculiarities of the morpho- structural changes of the gallbladder after 7 days from the onset of an acute attack of biliary colic (12 patients, 40 %);The results. On the basis of microscopic examination of histological preparations, it can be stated that in the early stages of the fi rst attack of cholecystitis, acute infl ammation of various morphological types (non-destructive and destructive) occurs in the wall of the gallbladder. In the late period (after 7 days), sclerotic changes develop both in the organ wall and perivesical. The main role in the pathogenesis of the remodeling of the structural components of the gallbladder is played by deep hemodynamic disorders and the prolongation of the infl ammatory process. Circulatory hypoxia, increasing under such conditions, activates the sclerosing process.

Usefulness of intraoperative bile culture in patients with acute calculous cholecystitis with previous biliary events: does the postoperative management change?

The aim of our study wasto determine the usefulness of intraoperative gallbladder cultures in the postoperative course in surgically treated patients with acute calculous cholecystitis and previous biliary events (ACC-PBE). Retrospective unicenter study on surgically treated ACC-patients between January 2014 and December 2018. Clinical benefit was defined as a > 20% change in postoperative antibiotic treatment.Secondary endpoints: postoperative morbidity and length-of-stay (LOS) in ACC-PBE patients with positive intraoperative biliary culture (IBC). Statistical significance was defined as p < 0.05. Out of the initial 711 patients, 203 met the study's inclusion criteria, with 139 of them having IBC results (72 positive, 67 negative). Our analysis revealed no significant difference in the incidence of positive-IBC between patients with ACC-PBE. Among this group, only 6% changed postoperative antibiotic treatment based on IBC results. There were no statistically significant differences in postoperative complications (p: 0.21) or LOS (p: 0.23) in the ACC-PBE group. In multivariate analysis, age > 70years old (p: 0.00; HR 3.1, 95% IC [1.6-6.4]), prior ERCP (p: 0.02; HR 5.9, 95% IC [1.25-27.5]) and prior antibiotic treatment (p: 0.01; HR 3.6, 95% IC [1.32-9.86]) were identified as independent factors that influenced PBC. IBC in operated ACC-PBE do not alter postoperative management. While positive-IBC was associated with age, prior ERCP, and prior antibiotic treatment, these findings did not have a significant impact on postoperative morbidity or LOS.

The Significance of Preoperative Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Inflammatory Index (SII) in Predicting Severity and Adverse Outcomes in Acute Calculous Cholecystitis

The prediction of severity in acute calculous cholecystitis (AC) is important in therapeutic management to ensure an early recovery and prevent adverse postoperative events. We analyzed the value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory index (SII) to predict advanced inflammation, the risk for conversion, and postoperative complications in AC. Advanced AC was considered the cases with empyema, gangrene, perforation of the gallbladder, abscesses, or difficulties in achieving the critical view of safety. A 3-year retrospective was performed on 235 patients admitted in emergency care for AC. The NLR was superior to the PLR and SII in predicting advanced inflammation and risk for conversion. The best predictive value was found to be at an NLR “cut-off” value of &gt;4.19, with a sensitivity of 85.5% and a specificity of 66.9% (AUC = 0.824). The NLR, SII, and TG 13/18 correlate well with postoperative complications of Clavien–Dindo grade IV (p &lt; 0.001 for all variables) and sepsis. For predicting early postoperative sepsis, TG 13/18 grading &gt;2 and NLR &gt; 8.54 show the best predicting power (AUC = 0.931; AUC = 0.888, respectively), although not significantly higher than that of the PLR and SII. The NLR is a useful biomarker in assessing the severity of inflammation in AC. The SII and PLR may be useful in the prediction of systemic inflammatory response.

Liver function tests for detection of choledocholithiasis in patients with acute calculous cholecystitis

Liver function tests for detection of choledocholithiasis in patients with acute calculous cholecystitis

RISK FACTORS FOR THE DEVELOPMENT OF VENOUS THROMBOEMBOLISM IN PATIENTS WITH UNCOMPLICATED ACUTE CALCULOUS CHOLECYSTITIS

The aim is to identify and analyze risk factors for venous thromboembolism in patients diagnosed with uncomplicated acute calculous cholecystitis.&#x0D; Materials and Methods. A prospective analysis of clinical data of 71 patients diagnosed with uncomplicated acute calculous cholecystitis was conducted. Two clinical groups were formed: subgroup 1A (n=6) included patients diagnosed with venous thromboembolism, and subgroup 1B (n=65) included patients without venous thromboembolism.&#x0D; Results and Discussion. During the study, the coagulation potential of the patients was studied. The prothrombin index on the third day of the postoperative period and at the time of discharge was significantly higher in subgroup 1A patients (109.1% and 123.0%) compared to subgroup 1B patients (98.0% and 96.4%). The situation with total fibrinogen is similar: the mean level of this indicator during the entire observation period was significantly higher in patients of subgroup 1A (p&lt;0.05). The mean D-dimer level at the time of hospital discharge in subgroup 1A was 3.6 mg/ml higher compared to the level of this indicator on the first day after surgery, and in subgroup 1B it was only 0.5 mg/ml higher. The risk of venous thromboembolism according to the Caprini score in subgroup 1A was 7.5 [5.5; 9.0] points, compared to 6.0 [4.0; 8.0] points in subgroup 1B. Assessment of the risk of venous thromboembolism according to the Rogers scale showed similar results: 8.0 [6.3; 9.8] points for patients of subgroup 1A and 7.0 [6.0; 8.0] points for subgroup 1B. When assessing the interleukin 1 beta (IL1b) level, its increased value was detected in subgroup 1A - 14.0 [7.0; 33.7] pg/ml, as opposed to subgroup 1B, where it was 9.0 [3.5; 26.2] pg/ml. Similar results were found in the assessment of tumor necrosis factor TNF: the mean values of this cytokine level were also higher in subgroup 1A (13.9 [7.9; 15.8] pg/ml) than in subgroup 1B (8.8 [6.0; 13.1] pg/ml).&#x0D; Conclusions. According to the results of the study, the following factors for the development of venous thromboembolism in patients with uncomplicated acute calculous cholecystitis were determined: elevated levels of indicators of total fibrinogen, D-dimer, interleukin 1 beta (IL1b) and tumor necrosis factor (TNF) at the time of admission. The mean values of the total risk assessment points according to the Caprini score and Rogers scale were significantly higher (p&lt;0.05) in the subgroup of patients with uncomplicated acute calculous cholecystitis who later developed venous thromboembolism.