Cholecystectomy For Benign Gallbladder Disease Research Articles

Clinical and socioeconomic factors predicting return-to-work times after cholecystectomy.

Cholecystectomy, a type of surgery commonly performed globally, has possible mutual effects on the socioeconomic conditions of different countries due to various postoperative recovery times. This study evaluated the medical and socioeconomic factors affecting delayed return-to-work (RTW) time after elective cholecystectomy. This retrospective study analysed patients who underwent elective cholecystectomy for benign gallbladder diseases from January 2022 to April 2023. The patients' medical and socioeconomic data were collected to investigate the clinical and socioeconomic factors correlated with RTW time of >30 days after surgery. This study included 180 consecutive patients. Significant correlations were found between delayed RTW time (>30 days) and age (odds ratio [OR]: 1.059, 95% confidence interval [CI] 1.008-1.113, P = 0.024), lack of medical insurance (OR: 2.935, 95% CI 1.189-7.249, P = 0.02) and high-intensity labour jobs (OR: 3.649, 95% CI 1.495-8.909, P = 0.004). Patients without medical insurance (26.6 versus 18.9 days) and those with high-intensity labour jobs (23.9 versus 18.8 days) had a higher mean RTW time than those with insurance and a less-intense labour job (P < 0.001). After cholecystectomy, older age, lack of medical insurance and high-intensity labour job were correlated with a delayed RTW time. Informing patients about their expected RTW time after surgery can help reduce costs.

Robotic-assisted cholecystectomy versus conventional laparoscopic cholecystectomy for benign gallbladder disease: a systematic review and meta-analysis.

Laparoscopic cholecystectomy (LC) is the established gold standard treatment for benign gallbladder diseases. However, robotic cholecystectomy is still controversial. Therefore, we aimed to compare intraoperative and postoperative outcomes in LC and robotic-assisted cholecystectomy (RAC) in patients with nonmalignant gallbladder conditions. PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for studies comparing RAC to LC in patients with benign gallbladder disease. Only randomized trials and non-randomized studies with propensity score matching were included. Mean differences (MDs) were computed for continuous outcomes and odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.2.3. A total of 13 studies comprising 22,440 patients were included, of whom 10,758 patients (47.94%) underwent RAC. The mean age was 48.5years and 65.2% were female. Compared with LC, RAC significantly increased operative time (MD 12.59min; 95% CI 5.62-19.55; p < 0.01; I2 = 79%). However, there were no significant differences between the groups in hospitalization time (MD -0.18days; 95% CI - 0.43-0.07; p = 0.07; I2 = 89%), occurrence of intraoperative complications (OR 0.66; 95% CI 0.38-1.15; p = 0.14; I2 = 35%) and bile duct injury (OR 0.99; 95% CI 0.64, 1.55; p = 0.97; I2 = 0%). RAC was associated with an increase in operative time compared with LC without increasing hospitalization time or the incidence of intraoperative complications. These findings suggest that RAC is a safe approach to benign gallbladder disease.

30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study.

This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications. Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level. A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes. Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4,263 (19.7%), and 6,622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1,738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients and severe bile duct injuries (Strasberg grades B-E) were reported in 48 (0.2%) patients. Patient age, ASA physical status class, surgical setting, operative approach and Nassar operative difficulty grade were identified as the five predictors demonstrating the highest relative importance in predicting postoperative complications. This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy.

OGBN P34 Telemedicine clinics are a safe and feasible alternative to preoperative face-to-face assessments for day case laparoscopic cholecystectomy surgery: a retrospective cohort study

Abstract Background The telemedicine clinic for follow ups after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to assess the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy. Methods We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates. Statistical analysis was done using JASP 0.16.2 software. Results We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 6.8% of patients had surgery cancelled on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal or higher than grade 3) were observed in 1% of patients. 30-day readmission rate was 11%. Conclusions Our series showed that it is feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, environmental impact, and healthcare economics to support its routine use in general surgery.

The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study

BackgroundThe telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy.MethodsWe conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment.ResultsWe identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%.ConclusionsOur series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery.

The effectiveness of extremely low-pressure pneumoperitoneum on pain reduction after robot-assisted cholecystectomy

BackgroundThe robot-assisted cholecystectomy could provide a sufficient surgical field with the extremely low-pressure pneumoperitoneum (ELPP; 4 mmHg) by the robot arm lifting the abdominal wall upward. This study aimed to investigate the effect of ELPP on the postoperative outcomes in benign gallbladder disease. MethodsA retrospective study was designed to compare the postoperative pain in addition with operation time, estimated blood loss, length of hospital stay, and complication of three types of cholecystectomy for benign gallbladder disease: 75 ELPP single site robot-assisted cholecystectomy (SSRC), 114 standard-pressure pneumoperitoneum (SPP) SSRC and 110 SPP conventional laparoscopic cholecystectomy (CLC). ResultsThere was no difference in whole operation time between ELPP SSRC and SPP SSRC group (p = 0.159). Postoperative pain score was significantly less in ELPP SSRC group as compared to SPP SSRC or SPP CLC group at 6, 12, and 24 h postoperatively (p = 0.004, p = 0.004, and p = 0.013 respectively). The incidence of shoulder pain was also significantly lower in ELPP SSRC group (p < 0.001). The rate of postoperative complication and length of stay were not different among the three groups. ConclusionsThis study shows that ELPP technique using robot is feasible without increasing postoperative complications in the process of cholecystectomy and the use of the ELPP can reduce postoperative pain and shoulder pain compared to the use of the SPP.

Single Incision Cholecystectomies for Acute Cholecystitis: A Single Surgeon Series from the Caribbean.

Introduction Single incision laparoscopic surgery (SILS) is accepted as a safe alternative to conventional multiport laparoscopic (MPL) cholecystectomy for benign gallbladder disease. Since many surgeons carefully select patients without inflammation, there are limited data on SILS for acute cholecystitis. We report a single surgeon experience with SILS cholecystectomy for patients with acute cholecystitis. Materials and Methods After securing ethical approval, we performed an audit of all SILS cholecystectomies for acute cholecystitis by a single surgeon from January 1, 2009, to December 31, 2019. The following data were extracted: patient demographics, intraoperative details, surgical techniques, specialized equipment utilized, conversions (additional port placement), morbidity, and mortality. Data were analyzed using SPSS 12.0. Results SILS cholecystectomy was performed in 25 females at a mean age of 35 ± 4.1 (SD) years and a mean BMI of 31.9 ± 3.8 (SD) using a direct fascial puncture technique without access platforms. The operations were completed in 83 ± 29.4 minutes (mean ± SD) with an estimated blood loss of 76.9 ± 105 (mean + SD). Three (12%) patients required additional 5 mm port placement (conversions), but no open operations were performed. The patients were hospitalized for 1.96 ± 0.9 days (mean ± SD). There were 2 complications: postoperative superficial SSI (grade I) and a diaphragmatic laceration (grade III). No bile duct injuries were reported. There were 9 patients with complicated acute cholecystitis, and this sub-group had longer mean operating times (109.2 ± 27.3 minutes) and mean postoperative hospital stay (1.3 ± 0.87 days). Conclusion The SILS technique is a feasible and safe approach to perform cholecystectomy for acute cholecystitis. We advocate a low threshold to place additional ports to assist with difficult dissections for patient safety.

Serum carcinoembryonic antigen and carbohydrate antigen 19-9 as preoperative diagnostic biomarkers of extrahepatic bile duct cancer.

BackgroundSerum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 have been proposed as useful preoperative biomarkers of extrahepatic bile duct cancer (EBDC). This study investigated the accuracy of CEA and CA19-9 for preoperative diagnosis of EBDC.MethodsPatients who underwent surgery for EBDC at a tertiary centre between 1995 and 2018 were studied, and those with concurrent hepatobiliary diseases (including gallbladder cancer, intraductal papillary mucinous neoplasms of pancreas), which could affect CEA or CA19-9 levels, were excluded. The control group included patients who underwent cholecystectomy for benign gallbladder diseases during the same period. Diagnostic accuracy was determined using sensitivity, specificity and area under the receiver operating characteristic curve (AUC).ResultsAfter excluding 23 patients, 687 patients (488 men and 199 women, mean age 65.8 years) were compared with the control group of 2310 patients. Median CEA and CA19-9 levels were 1.8 μg/l and 47.0 kU/l in patients with EBDC. CEA (cut-off 5.0 μg/l) showed AUC of 0.541, sensitivity 9.0 per cent and specificity 99.2 per cent, whereas CA19-9 (cut-off 37.0 kU/l) showed AUC of 0.753, sensitivity 56.2 per cent and specificity 94.5 per cent. Sensitivity of CA19-9 was lower in early (T stages 0–II) than advanced (T stages III and IV) cancer (47.0 versus 64.9 per cent), and also lower in N0 stage cancer than lymph node metastasis (50.1 versus 68.8 per cent).ConclusionSerum CEA and CA19-9 showed low sensitivity limiting their usefulness as diagnostic biomarkers of EBDC.

Intraoperative cholangiography and bile duct flushing in 47 dogs receiving laparoscopic cholecystectomy for benign gallbladder disease: A retrospective analysis.

To describe a laparoscopic approach for performing intraoperative cholangiography (IOC) and bile duct flushing (BDF) during laparoscopic cholecystectomy (LC) in dogs. To investigate the clinical outcomes of dogs undergoing these procedures for the treatment of benign gallbladder disease, ie gallbladder mucocele (GM) or cholecystitis. Retrospective study. Forty-seven client-owned dogs. Medical records of client-owned dogs with benign gallbladder diseases that underwent IOC and BDF during LC between September 2016 and December 2019 were reviewed. Of these dogs, only dogs with GM or cholecystitis were included in the study. The fundus dissection first method was used for LC. Intraoperative cholangiography and BDF procedures were performed laparoscopically using a catheter inserted into the cystic duct following dissection within the subserosal layer of the gallbladder. Videos recorded during each procedure were reviewed, and data on procedure duration, completion, outcome, and technical approach were recorded. Forty-seven dogs were included in the study. The median procedure time for BDF and IOC was 4 min (range, 2-48 min), and no intraoperative or postoperative complications occurred. During LC, BDF and IOC were performed safely and successfully. Intraoperative cholangiography identified obstructions and strictures in the common bile duct that were not detected using BDF alone. Our findings suggest that BDF and IOC are both safe and time effective and should be considered for routine use by surgeons during LC.

Postoperative outcomes after laparoscopic cholecystectomy in elderly

Gallstone disease is common morbidity in elderly (age ≥ 65 years old). Laparoscopic cholecystectomy is increasingly performed in an ever elderly. However, there are no clarified standards for treatment for asymptomatic cholelithiasis in elderly. The purpose of this study was to compare postoperative outcomes of elderly with those of younger populations and to suggest an appropriate age for preventive cholecystectomy before the risk increases. In a prospective Korea Cholecystectomy Quality Improvement Program cohort including 18 institutions from October 2016 to March 2017, 2,610 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease were enrolled. Various characteristics, preoperative findings, operative findings were compared between two groups (age < 65 years old versus age ≥ 65 years old). Increasing age was significantly associated with increased rates of overall complications (odds ratio [OR]: 1.79, CI 95%: 1.45-2.20), major complication (OR: 1.64, CI 95%: 1.35-2.08), risk of conversion to open cholecystectomy (OR: 2.00, CI 95%: 1.76-2.28), and was significantly associated with increased length of stay (MD: 2.56 days, CI 95%: 1.24-3.42). Differences in mortality and bile duct injury were non-significant. And most appropriate age that postoperative risk increases is 71 years old (AUC 0.74). Postoperative outcomes such as overall and major complications appear to be significantly higher in elderly. Even with asymptomatic cholelithiasis, if the size is more than 1 cm, it is better to recommend surgery before the patient's age reaches 71.

Who should avoid single incision laparoscopic cholecystectomy for benign gallbladder disease: Lesson learned from 1,405 consecutive patients in a single center

The purpose of this study is to recommend an optimal indication of single incision laparoscopic cholecystectomy (SILC). We retrospectively reviewed the 1,405 consecutive patients who underwent SILC at a single institution between April 2010 and June 2020. We defined difficult surgery (DS; conversion to multiport or open, adjacent organ injury, operation time ≥ 90 minutes, or estimated blood loss ≥ 100 milliliters) and poor postoperative outcomes (PPO; postoperative hospital stays ≥ 5 days, or postoperative complication ≥ grade II Clavien-Dindo classification). Subgroup analysis of acute cholecystitis (AC) was conducted according to the Tokyo guideline 18. Of the 1,405 patients, 338 were for gallbladder (GB) stone, 121 were for GB polyp, 478 were for chronic cholecystitis, and 423 were for AC. The conversion and postoperative complication rate were 2.4% and 3.5%, the mean operation time and length of postoperative hospital stay were 51.8 minutes and 2.5 days. 89 and 94 patients were included in DS group and PPO group, respectively. In multivariable analysis, both grade I or grade II/III AC, and body mass index ≥ 30 kg/m2 were statistically significant predictors of DS. Grade II/III AC and age ≥ 70 years were statistically significant predictors of PPO. In subgroup analysis of AC, grade II/III AC group had longer operation time (57.2 vs. 67.4 minutes, p < 0.001), postoperative hospital stays (2.7 vs. 3.7 days, p = 0.001), higher complication rate (4.2 vs. 15.8%, p < 0.001), and conversion rate (3.9 vs. 15.8%, p < 0.001) than grade I AC group. SILC should be avoided in patients with grade II/III AC for better surgical outcomes.

Limited usefulness of serum carcinoembryonic antigen and carbohydrate antigen 19-9 on the preoperative diagnosis of extrahepatic bile duct cancer

Littles is known about the role of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 on the detection of extrahepatic bile duct cancer (EBDC). This study evaluated the diagnostic accuracy of these biomarkers. A total of 710 patients who underwent surgery for EBDC at a tertiary center between 1995 and 2018 were included, with 23 patients excluded owing to concurrent pancreatobiliary diseases, which could affect serum CEA or CA19-9. For a control group, 2,310 patients who underwent cholecystectomy for benign gallbladder diseases during the same period were used. Diagnostic accuracy was evaluated using sensitivity, specificity, and area under the receiver operating characteristics curve (AUC). After excluding patients, 687 qualifying patients consisted of 488 men and 199 women with a mean age of 65.8 years. Median serum levels of CEA and CA19-9 were 1.8 ng/mL and 47.0 U/mL, respectively. CEA (cut-off: 5.0 ng/mL) showed AUC of 0.541, sensitivity of 9.0%, and specificity of 99.2%, and CA19-9 (cut-off: 37 U/mL) had AUC of 0.753, sensitivity of 56.2%, and specificity of 94.5%. According to AJCC stage, early T stage (stage 0-2) had lower sensitivity in CA19-9 (47.0% vs. 64.9%) than advanced T stage (stage 3 and 4). In addition, N0 stage showed lower sensitivity (50.1% vs. 68.8%) than lymph node metastasis. Serum CEA and CA19-9 have limited usefulness for the diagnosis of EBDC, particularly in early detection, because of their quite low sensitivity. A novel biomarker for the diagnosis of cancer will also be needed in the future.

Selective or Routine Histology of Cholecystectomy Specimens for Diagnosing Incidental Carcinoma of Gallbladder and Correlation with Careful Intraoperative Macroscopic Examination? A Systematic Review.

Background:Selective or Routine histology of cholecystectomy specimens for benign gallbladder disease has always been a matter of debate because of the low prevalence and bad prognosis associated with gall bladder carcinoma. The objective of this study is to ascertain whether selective histology can be preferred over Routine histology without any harm. Methods:This systematic review is conducted according to PRISMA’s checklist; relevant articles were searched in the database until September 1 2020 in PubMed, Scopus, Science Direct, and Web of Science databases, manually, with search queries and without date restrictions. Studies included in this systematic review involved patients who underwent cholecystectomy for benign gallbladder disease and were diagnosed with gallbladder carcinoma incidentally either after selective or routine histology of the gallbladder. Results:A total of 24 routine or selective histology recommending studies were selected for the systematic review after following the inclusion and exclusion criteria. These studies comprised 77,213 numbers of patients and 486 numbers of Malignancies. These studies correlate the number of IGBC diagnosed histologically with the number of IGBC’s that were suspected by the surgeons intraoperative by macroscopy. Routine recommending studies show a significant number of IGBC diagnosed histologically as missed by surgeons whereas the selective recommending studies show most of the histologically diagnosed IGBC already suspected by the surgeons intraoperative. When comparing the macroscopic details of the IGBC’s between routine and selective studies, we found that there was significant overlap. Most of the findings missed by the surgeons as suspicious in routine studies were suspected by the surgeons involved in selective histology recommending studies. Thereby, favouring selective histology and emphasizing the need for careful intraoperative macroscopy for suspecting IGBC. Conclusion:Selective Histological examination of cholecystectomy specimens can be preferred if a careful intraoperative macroscopic examination is done and patient risk factors are taken into consideration.

Outcomes of robotic and laparoscopic cholecystectomy for benign gallbladder disease in Veteran patients.

The robotic platform for cholecystectomy has been extensively studied in comparison to its laparoscopic counterpart with acceptable outcomes. However, wide acceptance of a robotic approach to cholecystectomy has been limited by increased operative room (OR) times and substantially higher cost. This is a single-institution retrospective review of Veteran patients presenting for elective laparoscopic (LC) and robotic (RC) cholecystectomies for benign biliary disease at the Dallas VA Medical Center. The primary goal was to interrogate 30-day morbidity as well as operative room times, estimated blood loss (EBL), hospital length of stay (LOS), and conversion rates. The entire cohort included 612 patients (age = 55.1 ± 12.9years, men = 77.9%, BMI = 31.2 ± 6.3kg/m2) undergoing elective cholecystectomy (LC = 441 and RC = 171) for benign biliary disease (biliary colic = 78.8%, history of biliary pancreatitis = 7.8%, history of cholecystitis = 5.7%). Univariate analysis comparing LC and RC showed the two groups to be of similar age (55.4 ± 12.4 vs. 54.4 ± 14.2years; p = 0.4), male gender (79.4% vs. 74.3%, p = 0.2), and BMI (31.1 ± 6.4 vs. 31.5 ± 6.3kg/m2; p = 0.5). Except for dyslipidemia (LC = 48.3% vs. RC = 36.8%; p = 0.01), both groups had the same rate of co-morbid conditions. ASA level III and IV (LC = 60.1 vs. RC = 69.0%, p = 0.04) was higher in the RC group. Both groups underwent surgical intervention for similar indications (biliary colic LC = 80.5% vs. RC = 74.3; p = 0.1). Hospital LOS (1.7 ± 3.2 vs. 0.3 ± 0.9days, p < 0.001), EBL (32.3 ± 52.3 vs. 17.0 ± 43.1; p = 0.001), and conversion to open (6.6% vs. 0.6%, p = 0.001) were all superior with the robotic platform. Thirty-day overall morbidity (9.8% vs. 12.3%, p = 0.4), skin-to-skin OR time (84.5 ± 33.5 vs. 88.0 ± 35.3min, p = 0.2), and total OR time (129.2 ± 36.8 vs. 129.7 ± 39.7, p = 0.9) were similar between the LC and RC groups. Despite being older and having more comorbidities, Veteran patients undergoing robotic cholecystectomy experienced equivalent OR time and a moderate improvement in conversion rate, EBL, and hospital LOS compared to those undergoing conventional laparoscopy, therein demonstrating the safety and efficacy of the robotic platform for this patient population.

Is There a Role for Selective Histological Examination of Gallbladders Following Cholecystectomy for Benign Gallbladder Disease? Results of S-GALLOP Study

Is There a Role for Selective Histological Examination of Gallbladders Following Cholecystectomy for Benign Gallbladder Disease? Results of S-GALLOP Study

A Snapshot of the Practice of Laparoscopic Common Bile Duct Exploration in the United Kingdom - (CholeS Data Set)

Introduction: The aim was to describe the utilisation/practice of laparoscopic bile duct exploration(LCBDE) option for the management of common bile duct stones across the UK. The data were obtained from a population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases (CholeS study). Methods: We used the CholeS Study DataSet to analyse the use of LCBDE in the UK. Descriptive analysis and graphs were used to illustrate the current practice of LCBDE in the UK. Results: Seventy-seven (46%) out of 167 Hospitals that took part in the CholeS study performed LCBDE. Their LCBDE workload was 5.4% out of the total Laparoscopic Cholecystectomies(LC) performed. Almost 90% of LCBDE was performed by hospitals who performed less than five LCBDE in two months. Only 5.2% of hospitals performed more than 10 LCBDEs; this accounts for 19.8% of their LC workload compared to between 2 and 8% for the rest. Out of 8820 LC, a total of 256(2.9%) and 932(10.6%) patients underwent LCBDE and pre-operative endoscopic retrograde cholangio-pancreatography and sphincterotomy(ERCP+ES) respectively for CBDS. Eighty-four per cent of LCBDEs were performed by Upper gastrointestinal surgeons and 16% by other specialities including 10% colorectal surgeons. Interestingly, only just under 5% of the LCBDEs were performed by trainees. Conclusions: In the UK, a significant proportion of patients with CBDS are still treated in two stages: a pre-operative ERCP followed by LC. LCBDE remains an underutilised resource in the UK. Further studies are required to examine the possible reasons for the low utilisation of LCBDE.

A meta-analysis of indocyanine green fluorescence image-guided laparoscopic cholecystectomy for benign gallbladder disease

This meta-analysis was conducted to evaluate the effectiveness and safety of indocyanine green fluorescence image-guided laparoscopic cholecystectomy for benign gallbladder disease. Clinical studies were retrieved from PubMed, Embase, Cochrane Library, Medline, and the Web of Science databases. Study-specific effect sizes and their 95 % confidence intervals (CIs) were combined to calculate the pooled values, using fixed-effects or random-effects models. Eleven studies with combined total of 2221 patients were included. Compared to the control group, the indocyanine green fluorescence imaging-guided group experienced shorter operative time (standardized mean difference [SMD] = -0.30; 95 % CI = -0.45 - -0.15; P < 0.001), shorter biliary anatomy identification time (SMD = -2.34; 95 % CI = -2.58 - -2.10; P < 0.001), lower blood loss (SMD = -0.14; 95 % CI = -0.26 - -0.01; P = 0.035), higher success rate of biliary tract imaging (odds ratio [OR] = 2.37; 95 % CI = 1.09-5.12; P = 0.029), lower rate of conversion to open surgery (OR = 0.10; 95 % CI = 0.04 - 0.28; P < 0.001), shorter hospital stay (SMD = -0.23; 95 % CI = -0.39 - -0.06, P = 0.008), and lower biliary tract imaging costs (SMD = -247.88; 95 % CI, -274.31--221.45, P = 0.000). Postoperative complications did not differ between the groups. This systematic review shows that indocyanine green fluorescence biliary tract imaging is a safe and feasible new way for biliary tract identification in laparoscopic cholecystectomy.

Impacts on outcomes and management of preoperative magnetic resonance cholangiopancreatography in patients scheduled for laparoscopic cholecystectomy: for whom it should be considered?

PurposeWe evaluated the impact of preoperative magnetic resonance cholangiopancreatography (MRCP) on patient outcomes, and found which patients should be considered for MRCP before cholecystectomy.MethodsWe performed retrospective analysis of 2,072 patients that underwent cholecystectomy for benign gallbladder disease from January 2014 to June 2017. Patients were grouped as CT only group (n = 737) and MRCP group (n = 1,335), including both CT and MRCP (n = 1,292) or MRCP only (n = 43). The main outcome measure was associated with complications after cholecystectomy, and the secondary outcomes were hospital stay, readmission, and events that could impact patient management due to addition of MRCP.ResultsThere were no statistical differences in occurrence of intraoperative or postoperative complications or readmission rate between the 2 groups. Hospital stay was about 0.6 days longer in the MRCP group. However, MRCP group was more susceptible to complications due to underlying patient demographics (older age, higher frequency of diabetes, and higher level of the inflammatory markers). MRCP diagnosed common bile duct (CBD) stones in 6.5% of patients (84/1,292) without CBD stones in CT, and bile duct anomalies were identified in 41 patients (3.2%). Elevated γ-GT was the only independent factor for additional detection of CBD stones (adjusted odds ratio [OR], 2.89; P = 0.029) and subsequent biliary procedures (adjusted OR, 3.34; P = 0.018) when additional MRCP was performed.ConclusionMRCP is valuable for identification of bile duct variation and CBD stones. Preoperative MRCP can be considered, particularly in patients with elevated γ-GT, for proper preoperative management and avoidance of complications.

A Comparative Study of Needlescopic Grasper Assisted Single Incision versus Three-Port versus Pure Single Incision Laparoscopic Cholecystectomy.

PurposeSingle incision laparoscopic cholecystectomy (SILC) is a surgical method to treat gallbladder disease designed to reduce postoperative pain and improve cosmetic results. However, pure SILC (pSILC) has several inherent limitations. In this study, we report the surgical outcomes of SILC with needlescopic grasper (nSILC) compared with those of pSILC and conventional three-port laparoscopic cholecystectomy (TPLC).MethodsThis retrospective study enrolled 103 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease in our hospital between January 2013 and January 2015. Among them, 33 patients underwent pSILC, 35 underwent nSILC, and 35 underwent TPLC. We collected demographic characteristics and operative data to analyze outcomes between groups.ResultsAll procedures were done by laparoscopy and the gallbladder of each patient was completely removed. Women and younger patients were more to undergo SILC than TPLC. Analysis showed that the operation time of the nSILC group was longer than that of the TPLC group, but shorter than that of the pSILC group (skin to skin operation time [pSILC: 65.2±19.1 min, nSILC: 49.7±12.9 min, and TPLC: 43.4±14.7 min, p<0.001], and major procedure time [pSILC: 42.2±18.7 min, nSILC: 25.9±8.9 min, and TPLC: 23.4±12.7 min, p<0.001]). There were no significant differences between the groups for patient visual analogue scale score, length of hospital stay, or intraoperative blood loss.ConclusionnSILC is feasible surgical method in patients with benign gallbladder disease compared to TPLC, and that is an effective procedure to overcome the disadvantage of pSILC.

Correction to: Authors' Reply: Routine Pathology and Postoperative Follow-Up are not Cost-Effective in Cholecystectomy for Benign Gallbladder Disease.

In the original article, Madelon J. H. Metman's given name is incorrect. It is correct as reflected here.