Cholecystitis In Patients Research Articles

A Comparative Study between Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis in a Tertiary Care Center of Nepal

Background: Laparoscopic Cholecystectomy is considered as a gold standard treatment for symptomatic cholelithiasis. The timing of surgery for acute Cholecystitis is still controversial, weather to go early surgery or wait for six to eight weeks after conservative management. Therefore, the aim of this study is to compare the clinical outcomes of early versus delayed laparoscopic cholecystectomy for acute Cholecystitis.
 Materials and Methods: A prospective study was conducted in Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Total of 80 patients with the diagnosis of acute Cholecystitis were enrolled in the study. The patients were equally divided in two groups: 40 underwent early laparoscopic cholecystectomy within 72 hours of admission (Group A) and next 40 underwent delayed laparoscopic cholecystectomy after 6-8 weeks of conservative management (Group B).
 Results: Out of 80 patients of acute Cholecystitis, mean age of the patients in Group A was 43.40±13.45 years and that in Group B was 44.80±14.36 years. The mean operative time in Group A was 90.22±2.81 minutes whereas in Group B it was 80.97±4.47 minutes. Mean duration of Hospital stay in Group A was 2.02±0.15 days whereas in Group B it was 2.15±0.36 days. Two patients in Group A and one patient in Group B converted to open cholecystectomy. Three patients of Group A and one patient of Group B landed in outpatient department with superficial surgical site infection. Group B patients underwent second hospital admission compared to Group A patients.
 Conclusion: Early Laparoscopic cholecystectomy for acute cholecystitis is almost comparable with delayedLaparoscopic cholecystectomy. However, early laparoscopic cholecystectomy reduces the morbidity of patients as well as it is cost-effectiveness.

Incidence, Risk Factors and Outcome of Gallbladder Perforation during Laparoscopic Cholecystectomy

Background and Aim: Gallbladder perforation has been recorded in patients undergoing laparoscopic cholecystectomy and associated with the development of gallstones and bile leakage. The present study investigated the incidence, risk factors, and outcome of gallbladder perforation in patients undergoing elective laparoscopic cholecystectomy. Patients and Methods: This prospective study was conducted on 156 patients who underwent laparoscopic cholecystectomy in the department of General Surgery, Federal Government Polyclinic Hospital, Islamabad from January 2021 to July 2022. Gallbladder stone patients with chronic symptoms such as vomiting, recurrent episodes of epigastric, nausea, and hypochondrial pain on right side were included. Acute cholecystitis patients with single or multiple gallstone disease were also enrolled. All the patients were prepared for laparoscopic cholecystectomy and investigations such as blood sugar, liver function test, CBC, blood urea and creatinine, ultrasound of gallbladder, and ECG were done. SPSS version 26 was used for data analysis. Results: Of the total 156 patients, there were 126 (80.8%) females and 30 (19.2%) male. Age-wise distribution of patients were as follows: 66 (42.3%) in 20-35 years, 52 (33.3%) in 36-50 years, and 38 (24.4%) in 51-65 years. The incidence of single gall stone (SGS), multi gallstones (MGS), and acute cholecystitis was 48 (30.8%), 88 (56.4%), and 20 (12.8%) respectively. The overall mean age was 36 years. The incidence of gallbladder perforation was 26.9% (n=42) among all patients. Patients distribution based on gallbladder perforation were as follows: 17 (10.9%) in MGS, 14 (9.0%) in SGS, and 11 (7.1%) in acute cholecystitis cases. Conclusion: The present study found that the prevalence of gallbladder perforation was 26.9% among SGS, MGS, and acute cholecystitis. Majority of GB perforation occurred during gallbladder bed dissection. Acute cholecystitis patients are more prone to GB perforation. GB perforation can be reduced by utilization of harmonic scalpel in laparoscopic cholecystitis. Keywords: Elective laparoscopic cholecystectomy, Gallbladder perforation, Outcomes

Long-term outcomes of endoscopic ultrasound-guided gallbladder drainage versus insitu or ex situ percutaneous gallbladder drainage in real-world practice.

Many studies showed better outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) when compared with percutaneous transhepatic gallbladder drainage (P-GBD) in which most tubes were left insitu. However, no studies have directly compared EUS-GBD with P-GBD after tube removal (ex situ). We compared the long-term outcomes of EUS-GBD and ex situ or insitu P-GBD in high surgical risk patients with acute cholecystitis. We reviewed the records of 182 patients (EUS-GBD, n=75; P-GBD, n=107) who underwent gallbladder drainage. The procedural outcomes, long-term outcomes, and adverse events were compared. The EUS-GBD group and the P-GBD group had similar rates of technical and clinical success. Early adverse events were less common in the EUS-GBD group (5.5% vs. 18.9%, P=0.010). The long-term outcomes were evaluated in 168 patients (EUS-GBD, n=67; P-GBD ex situ, n=84; P-GBD insitu, n=17). The rate of cholecystitis recurrence in the EUS-GBD group (6.0%) was similar to that in the P-GBD ex situ group (9.6%, P=0.422), but significantly lower than that in the P-GBD insitu group (23.5%, P=0.049). P-GBD insitu was a significant predictor of recurrent cholecystitis (hazard ratio 14.6; 95% confidence interval 2.9-72.8). The long-term recurrence rate of acute cholecystitis in patients who underwent EUS-GBD was comparable to that in patients whose P-GBD could be removed. However, patients in whom P-GBD could not be removed showed higher rates of recurrent cholecystitis than patients with EUS-GBD.

Long-term outcomes of endoscopic transpapillary gallbladder drainage using a novel spiral plastic stent in acute calculus cholecystitis

BackgroundEndoscopic transpapillary gallbladder stenting (EGBS) is considered for patients with contraindications to early surgery for acute calculus cholecystitis. However, evidence regarding the long-term outcomes of EGBS is insufficient to date. The aim of the study was to evaluate the feasibility of EGBS as a bridge to or alternative to surgery when there are contraindications.MethodsWe reviewed the cases of patients who underwent EGBS using a novel spiral-shaped plastic stent for acute calculus cholecystitis between January 2011 and December 2019. We retrospectively evaluated the long-term outcomes of EGBS using a novel spiral-shaped plastic stent.ResultsForty-nine patients were included. The clinical success rate of EGBS was 97%. After EGBS, 25 patients (surgery group) underwent elective cholecystectomy and 24 patients did not (follow-up group). In the surgery group, the median period from EGBS to surgery was 93 days. There was a single late adverse event with cholecystitis recurrence. In the follow-up group, the median follow-up period was 236 days. Late adverse events were observed in eight patients, including recurrence of cholecystitis (four patients), duodenal penetration by the distal stent end (two patients), and distal stent migration (two patient). In the follow-up group, the time to recurrence of biliary obstruction was 527 days.ConclusionsEGBS with a novel spiral-shaped plastic stent is safe and effective for long-term acute calculus cholecystitis. There is a possibility of EGBS to be a bridge to surgery and a surgical alternative for acute calculus cholecystitis in patients with contraindications to early cholecystectomy.

A surprising culprit for delayed gastrointestinal bleeding after endoscopic ultrasound-guided cholecystoduodenostomy: the double-pigtail stent.

Endoscopic ultrasound-guided gallbladder drainage using a lumen-apposing metal stent has emerged as an accepted option for the treatment of acute cholecystitis in patients unfit for surgery. While metal stents carry a risk of intra- and post-procedural bleeding, the coaxial placement of a double-pigtail stents through lumen-apposing metal stents has been proposed to lower the bleeding risk by preventing tissue abrasion against the stent flanges. We present a case of an 83year-old male who had previously undergone uncomplicated endoscopic ultrasound-guided cholecystoduodenostomy with this technique. Six months later, he presented with upper gastrointestinal bleeding due to a duodenal pressure ulcer from the coaxial 10-Fr double-pigtail stent originally employed to prevent such bleeding. The 10-Fr stent was replaced with two 7-Fr stents whose increased flexibility and distribution of pressure across multiple points of contact with the duodenal wall was theorized to reduce the likelihood of erosion or perforation. Following the procedure, the patient's clinical course improved significantly with complete resolution of his symptoms of choledocholithiasis and cholecystitis. While 10-Fr double-pigtail stents are generally preferred for this indication due to their stiffness that reduces out-migration, use of more flexible 7-Fr stents may be advisable in thin-walled structures such as the duodenum.

Outcomes of endoscopic retrograde cholangiopancreatography-guided gallbladder drainage compared to percutaneous cholecystostomy in acute cholecystitis.

Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients. We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC. After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707-97,978) compared to PTC, $40,413 (IQR $25,244-65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1-0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29-0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49-0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48-2.54; p < 0.001) with ERGD compared to PTC. ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

BackgroundThe incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not.MethodsData were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not.ResultsA total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001].ConclusionsThe incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.Graphical abstract

The Accuracy of Neutrophil-to-Lymphocyte Ratio and Abdominal Computed Tomography to Predict the Severity of Acute Cholecystitis.

Background In this study, we evaluated neutrophil-to-lymphocyte ratio (NLR) values and abdominal computed tomography (CT) scans in preoperative patients of acute cholecystitis (AC) and their significance in differentiating between severe and non-severe conditions. This study will help further in-depth investigation on both of these diagnostic modalities and timely assess severe AC to avoid the worst prognosis. Methodology This single-center, cross-sectional study was conducted at Government Villupuram Medical College from July 2021 to January 2022. We enrolled patients aged >18 years diagnosed with AC. The demographic variables and clinical features of the enrolled patients were collected. All enrolled patients were divided into two categories (severe or non-severe AC) based on the pathological and clinical findings. The data were collected and entered in SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA). The variation between the severe and non-severe AC groups was compared using Student's t-test to analyze continuous variables. The chi-square test was used to evaluate the association between the categorical variables. A p-value of <0.05 was considered significant. Results Among patients with severe AC, 29 (72.5%) were female, 29 (72.5%) were aged >50 years, 34 (85%) were alcoholics, and 26 (65%) were smokers. In patients with severe AC, the mean for NLR was 18.6500 ± 2.32655. On CT scans, 29 (72.5%) patients showed gallbladder distension,31 (77.5%) showed increased pericholecystic fat stranding, and18 (45%) showed pericholecystic fluid collection. CT scan findings and NLR values were significantly associated. Conclusions Gallbladder distension, increased pericholecystic fat stranding, and pericholecystic fluid collection on abdominal CT scan along with raised NLR are significant findings associated with assessing the severity of AC. Therefore, both testing modalities (CT scan and NLR) should be utilized together in hospitals to achieve better outcomes for AC and avoid complications.

Prognostic clinical indexes for prediction of acute gangrenous cholecystitis and acute purulent cholecystitis

BackgroundPreoperative prediction of severe cholecystitis (SC), including acute gangrenous cholecystitis (AGC) and acute purulent cholecystitis (APC), as opposed to acute exacerbation of chronic cholecystitis (ACC), is of great significance, as SC is associated with high mortality rate.MethodsIn this study, we retrospectively investigated medical records of 114 cholecystitis patients, treated in Shanghai No. 6 People’s Hospital from February 2009 to July 2020. Gallbladder wall thickness (GBWT), indexes of blood routine examination, including white blood cell (WBC), alkaline phosphatase (ALP), the percentage of neutrophil, alanine transaminase (ALT), aspartate aminotransferase (AST), fibrinogen (FIB), gamma-glutamyl transferase, prothrombin time and total bilirubin were evaluated. One-way analysis of variance (ANOVA) was used to evaluate significant differences between a certain kind of SC and ACC to select a prediction index for each kind of SC. Receiver operating characteristic (ROC) curve analysis was conducted to identify the prediction effectiveness of these indexes and their optimal cut-off values.ResultsHigher WBC and lower ALP were associated with AGC diagnosis (P < 0.05). Higher percentage of neutrophils was indicative of APC and AGC, while higher GBWT was significantly associated with APC diagnosis (P < 0.05) The optimal cut-off values for these indexes were established at 11.1*109/L (OR: 5.333, 95% CI 2.576–10.68, P < 0.0001, sensitivity: 72.73%, specificity: 66.67%), 79.75% (OR: 5.735, 95% CI 2.749–12.05, P < 0.0001, sensitivity: 77.92%, specificity: 61.9%) and 5.5 mm (OR: 22, 95% CI 4.757–83.42, P < 0.0001, sensitivity: 78.57%, specificity: 85.71%), respectively.ConclusionWe established a predictive model for the differentiations of APC and AGC from ACC using clinical indexes, such as GBWT, the percentage of neutrophil and WBC, and determined cut-off values for these indexes based on ROC curves. Index values exceeding these cut-off values will allow to diagnose patients as APC and AGC, as opposed to a diagnosis of ACC.

Comparison of severity and complication rates of acute cholecystitis during pandemic and pre-pandemic periods?

Cancellations of surgeries for elective cases and late admissions of symptomatic cases during the pandemic period might have increased the number of cases of acute cholecystitis and its complications. To compare the severity of acute cholecystitis and complication rates during the pandemic and pre-pandemic periods. We evaluated the computed tomography (CT) findings observed for the diagnosis of complications for both acute simple and acute complicated cholecystitis during both the pandemic and pre-pandemic periods. Patients admitted to the hospital between March 2020 and December 2020 made up the study group and the corresponding appropriate patients from one year earlier were studied as the control group. In addition to the CT findings, clinical and laboratory findings, co-morbidities such as diabetes, as well as the admission time to hospital from the onset of the initial symptoms to hospital admission were also evaluated. A total of 88 patients were evaluated (54 in the study group, 34 in the control group; mean age = 64.3 ± 16.3 years). The male-to-female ratio was 51/37. The number of patients diagnosed with complicated cholecystitis were significantly higher in the study group (P = 0.03). Murphy finding and diabetes status were similar between the two groups (P = 0.086 and P = 0.308, respectively). Admission time to the hospital was significantly different for study and control groups in simple cholecystitis patients (P = 0.045); with no significant difference in cases of complicated cholecystitis (P = 0.499). Our study reveals the course of acute cholecystitis during the pandemic period was much more serious with higher complications.

Prophylactic EUS-guided gallbladder drainage prevents acute cholecystitis in patients with malignant biliary obstruction and cystic duct orifice involvement: a randomized trial (with video)

Patients with distal malignant biliary obstruction (MBO) and cystic duct orifice tumoral involvement have an increased risk for the development of acute cholecystitis after self-expandable metallic stent (SEMS) placement. We aimed to determine whether primary EUS-guided gallbladder drainage prevents acute cholecystitis in these patients. This was a single-center, randomized control trial in patients with distal MBO enrolled from July 2018 to July 2020. Patients were randomized into 2 groups: an interventional group treated with conventional ERCP biliary drainage with SEMS placement and subsequent primary EUS-guided gallbladder drainage (EUS-GBD) and a control group treated with conventional biliary drainage alone. The primary outcome of the study was the occurrence of post-treatment acute cholecystitis, assessed for≤12 months or until death. The secondary outcomes were hospitalization length and median survival time. Forty-four patients were included in the study: 22 in each group. Five patients in the control group (22.7%) and none in the intervention group experienced acute cholecystitis. The median hospitalization time was significantly lower in the interventional group than in the control group (2 days vs 1 day, P= .017). There was no difference in the observed median survival rates in the primary EUS-GBD group (2.9 months) and the control group (2.8 months) (P= .580). In this single-center study of patients with unresectable MBO and occlusion of the cystic duct orifice, prophylactic EUS-GBD demonstrated a reduced incidence of acute cholecystitis.

Endoscopic ultrasound (EUS)-guided cholecystostomy versus percutaneous cholecystostomy (PTC) in the management of acute cholecystitis in patients unfit for surgery: a systematic review and meta-analysis.

Surgical cholecystectomy is the gold standard strategy for the management of acute cholecystitis (AC). However, some patients are considered unfit for surgery due to certain comorbid conditions. As such, we aimed to compare less invasive treatment strategies such as endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and percutaneous gallbladder drainage (PT-GBD) for the management of patients with AC who are suboptimal candidates for surgical cholecystectomy. A comprehensive search of multiple electronic databases was performed to identify all the studies comparing EUS-GBD versus PT-GBD for patients with AC who were unfit for surgery. A subgroup analysis was also performed for comparison of the group undergoing drainage via cautery-enhanced lumen-apposing metal stents (LAMS) versus PT-GBD. The outcomes included technical and clinical success, adverse events (AEs), recurrent cholecystitis, reintervention, and hospital readmission. Eleven studies including 1155 patients were included in the statistical analysis. There was no difference between PT-GBD and EUS-GBD in all the evaluated outcomes. On the subgroup analysis, the endoscopic approach with cautery-enhanced LAMS was associated with lower rates of adverse events (RD = - 0.33 (95% CI - 0.52 to -0.14; p = 0.0006), recurrent cholecystitis (- 0.05 RD (95% CI - 0.09 to -0.02; p = 0.02), and hospital readmission (- 0.36 RD (95% CI-0.70 to - 0.03; p = 0.03) when compared to PT-GBD. All other outcomes were similar in the subgroup analyses. EUS-GBD using cautery-enhanced LAMS is superior to PT-GBD in terms of safety profile, recurrent cholecystitis, and hospital readmission rates in the management of patients with acute cholecystitis who are suboptimal candidates for cholecystectomy. However, when cautery-enhanced LAMS are not used, the outcomes of EUS-GBD and PT-GBD are similar. Thus, EUS-GBD with cautery-enhanced LAMS should be considered the preferable approach for gallbladder drainage for this challenging population.

Impact of Peroperative Intravenous Lidocaine on Postoperative Analgesia in Laparoscopic Cholecystectomy

The present study was undertaken to evaluate the outcome of peroperative intravenous lidocaine in reducing the intensity of postoperative pain after laparoscopic cholecystectomy.This prospective randomized clinical trial study was conducted in the Department of Anaesthesiology, Sir Salimullah Medical College Mitford Hospital (SSMC MH), Dhaka between April 2014 to September 2014. A total of 80 patients of chronic cholecystitis or cholelithiasis undergoing laparoscopic cholecystectomy in SSMC MH, Dhaka were consecutively included in the study and were randomly assigned to two study groups. Patients in the study group received I/V lidocaine administration @ 3 mg/kg/h and those in the control group received normal saline (0.9% saline) in the same volume by a different observer. When compared the changes in haemodynamic variables from baseline to endpoint of the study shows that there was no significant difference between the groups in terms of heart rate, systolic, diastolic and mean blood pressures except a sudden rise of the parameters at 5 minutes after induction. However, the systolic blood pressure of study group experienced a slight reduction from 30 minutes onwards to the end of the observation and differed significantly from the corresponding SBPs of the control group. The mean BP of both the groups also showed similar trend like systolic BPs.The SpO2 in both study and control groups was maintained at 99 to 100% throughout the study. The study concluded that peroperative infusion of nontoxic dose of lidocaine decreases the intensity of postoperative pain and reduces the postoperative analgesics(inj. Pethidine) requirement without causing any significant adverse effects. Sir Salimullah Med Coll J 2022; 30: 148-154

A Comparative Analysis Of Interval Cholecystectomy And Early Cholecystectomy Among Patients Of Acute Cholecystitis At A Tertiary Care Centre

Background: Comparative evaluation of the efficacy of Interval Cholecystectomy and Early Cholecystectomy Among Patients of AcuteCholecystitis.Materials &amp; methods: A total of 100 patients with presence of acute cholecystitis were analysed. All the patients were broadly andrandomly divided into two study groups as follows: Group A: 50 patients who were schedule to undergo interval cholecystectomy,andGroup B: 50 patients who were schedule to undergo early cholecystectomyComplete history of all the patients was obtained. Allpatients were subjected to detailed history including, chief complaints, history of present and past illness, personal history, familyhistory, treatment and drug history. All the operative procedures were carried out under the hands of skilled and experienced surgeons.Follow-up was done and complications (if any) were recorded separately. All the results were recorded in Microsoft excel sheet andwere analysed by SPSS software.Results: Occurrence of postoperative wound infection and biliary leaks was higher among the patients of group B in comparison topatients of group A.Mean hospital stay among the patients of group A and group B was 5.6 days and 9.1 days respectively. Whilecomparing statistically, significant results were obtained.Conclusion: Interval Cholecystectomy shows better results in comparison to Early Cholecystectomy among patients of AcuteCholecystitis in terms of occurrence of postoperative complications and shorter duration of hospital stay.

Comparative Laparoscopic Cholecystectomy in Acute Cholecystitis in DHQ Abbottabad, KP-Pakistan

Background: Early laparoscopic cholecystectomy before 72 hours is ideal for the treatment of acute cholecystitis after 72 hours, acute or ongoing fibrosis presents careful issues. Aim: To compare the results of an acute cholecystitis blood pressure monitoring center and a specialist acute surgical service 72 hours after symptoms. Study design: Cross-sectional study. Place and duration of study: Department of General Surgery Benazir Bhutto Shaheed Hospital, (DHQ) Abbottabad from 1st October 2021 to 30th March 2022. Methodology: One hundred and eighty acute cholecystectomy patients who went through CEL were enrolled. Record was gathered which included postoperative confusions, length of medical clinic stay, and season of a medical procedure. To get comparable outcomes, subgroup examination of older patients was performed. Results: Eighty operations were performed within 72 hours of symptoms and 100 operations were performed after 72 hours, Patients who received early laparoscopic cholecystectomy for more than 72 hours had longer complication-free time” (125.4 vs. 116 minutes, P=0.035) and hospital stay (4.59 vs. 3.09 days, P=0.001). Postoperative sampling was higher in patients older than 75 years (P &lt; 0.001). Conclusion: Acute cholecystitis patients going through CLE in a careful unit might accomplish improved results even following 72 hours of side effects. In a subset of older patients, extensive hemostasis ought to be performed. Keywords: Acute cholecystitis, early laparoscopic cholecystectomy (ELC)

Is Antibiotic Therapy Necessary after Emergency Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis?

Background: While preoperative antibiotic therapy is standard to prevent surgical site infections in acute calculous cholecystitis, prescribing antibiotics after discharge is controversial. This study aimed to investigate the effect of antibiotic administration in discharge prescription on surgical site infections.&#x0D; Methods: Data from patients who underwent emergency laparoscopic cholecystectomy for acute calculous cholecystitis between January 2018 and February 2020 were retrospectively reviewed. Those with a decompensated systemic disease, those who were converted to open cholecystectomy, those with stage 3 disease, and those who underwent open cholecystectomy and cholecystostomy were excluded. Ampicillin-sulbactam 1 g was administered parenterally three times a day before and after surgery.&#x0D; The patients were divided into two groups according to their discharge prescriptions: those who were given antibiotics (AB group) and those who were not given antibiotics (NA group). The primary outcome was the development of surgical site infections.&#x0D; Results: 107 patients in the AB group and 109 in the NA group. Surgical site infection developed in 29 (13.4%) patients, 11 (10.3%) in the AB group, and 18 (16.5%) in the NA group. No significant difference was found between the two groups regarding surgical site infection rate (p&gt;0.05). In logistic regression analysis, obesity was a risk factor for surgical site infections.&#x0D; Conclusions: Failure to prescribe ampicillin-sulbactam to acute calculous cholecystitis patients discharged after laparoscopic surgery does not increase surgical site infections. However, prescribing ampicillin-sulbactam to obese patients may reduce surgical site infections.&#x0D; Keywords: Surgical site infections, acute calculous cholecystitis, emergency laparoscopic cholecystectomy, obesity

Characteristics and prevalence of acute cholecystitis in patients with hematologic malignancies

Characteristics and prevalence of acute cholecystitis in patients with hematologic malignancies

Surgery for acute cholecystitis in severely comorbid patients: a population-based study on acute cholecystitis

BackgroundInternational guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis.Method1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery.Results725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months.ConclusionPatients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery.Trial registration: Not applicable.

Influence of Percutaneous Drainage Surgery and the Interval to Perform Laparoscopic Cholecystectomy on Acute Cholecystitis through Genetic Algorithm-Based Contrast-Enhanced Ultrasound Imaging.

To discuss the optimal interval time between genetic algorithm-based ultrasound imaging-guided percutaneous drainage surgery (PTGD) and laparoscopic cholecystectomy (LC), 64 cholecystitis patients were selected as the research objects and evenly divided into experimental group (intelligent algorithm was adopted to recognize patients' ultrasonic images) and control group (professional doctors carried out diagnosis). 92 acute cholecystitis patients undergoing PTGD were divided into three groups. 30 out of the 92 patients received LC within 2 months and were defined as the early group. 32 were performed with LC within 2 to 4 months and were defined as the metaphase group. 28 underwent LC over 4 months and were defined as the late-stage group. The average operation time, the transition from LC to laparotomy, the average postoperative hospital stay, and the incidence of complications of the three groups were compared. The results revealed that the comparison of the diagnostic accuracy and comprehensive effectiveness between experimental group and control group demonstrated that the differences were statistically significant (P < 0.05). When the optimal interval of implementing LC after PTGD was realized, the corresponding values of the early group were 88.5 minutes, 16.67%, 8.13 days, and 13.75%. Those of the metaphase group were 49.91 minutes, 3.13%, 4.97 days, and 9.52%. Those of the late stage group were 68.78 minutes, 10.71%, 7.09 days, and 11.96%. To sum up, the diagnostic accuracy and comprehensive effectiveness of intelligent algorithm were higher than those of conventional ultrasound, and the optimal interval time of implementing LC after PTGD was 2 to 4 months.

Exosomal MicroRNA signature acts as an efficient biomarker for non-invasive diagnosis of gallbladder carcinoma

SummaryThrough a three-step study that relies on biomarker discovery, training, and validation, we identified a set of five exosomal microRNAs (miRNAs) that can be used to evaluate the risk of gallbladder carcinoma (GBC), including miR-552-3p, miR-581, miR-4433a-3p, miR-496, and miR-203b-3p. When validated in 102 GBC patients and 112 chronic cholecystitis patients from multiple medical centers, the AUC of this combinatorial biomarker was 0.905, with a sensitivity of 81.37% and a specificity of 86.61%. The performance of this biomarker is superior to that of the standard biomarkers CA199 and CEA and is suited for GBC early diagnosis. The multi-clinicopathological features and prognosis of GBC patients were significantly associated with this biomarker. After building a miRNA-target gene regulation network, cell functions and signaling pathways regulated by these five miRNAs were examined. This biomarker signature can be used in the development of a noninvasive tool for GBC diagnosis, screening and prognosis prediction.