Cholecystitis In Patients Research Articles

IgG4-Related Pancreato-Biliary Disease in the Disguise of Malignancy.

The Immunoglobulin G4-related disease (IgG4-RD) is a multisystem inflammatory condition. Pancreaticobiliary manifestations often present as mass lesions that mimic malignancies. The diagnosis is confirmed by histopathological examination, that shows lymphoplasmacytic infiltration, storiform fibrosis, obliterative phlebitis, and positive immunohistochemistry for IgG4. We encountered 3 such patients in a tertiary care hospital in India. Two patients presented with obstructive jaundice and the third with pain abdomen. They had resectable lesions involving the pancreatic head, the right hepatic duct, and gallbladder fundus, respectively, on imaging. Tumor markers were not significantly elevated in any of them. All 3 patients underwent radical surgeries, suspecting malignancy. Surgical specimens showed typical features of IgG4-RD on histomorphology. Serum IgG4 level was elevated in first 2 patients but was normal in sclerosing cholecystitis patient. To conclude, IgG4-RD is a malignant mimicker; hence, on clinical suspicion, liberal attempts for tissue diagnosis may avoid radical surgeries.

Acute cholecystitis: Delayed cholecystectomy has lesser perioperative morbidity compared to emergency cholecystectomy

BackgroundIn comparison to delayed laparoscopic cholecystectomy, emergency laparoscopic cholecystectomy has a shorter length of stay and eliminates the risk of recurrent episodes of acute cholecystitis. Nevertheless, there is concern that emergency laparoscopic cholecystectomy is associated with higher morbidity in acute cholecystitis patients. The present large cohort study compares operation-related adverse outcomes between emergency and delayed laparoscopic cholecystectomy and determines the risk of readmission before delayed laparoscopic cholecystectomy to guide surgical decision-making. MethodsPatients diagnosed with acute cholecystitis who underwent emergency or delayed laparoscopic cholecystectomy between 2015 and 2019 were included. Perioperative outcomes were compared using univariate and multivariate analysis, adjusting for preoperative variables. The rate of readmission before delayed laparoscopic cholecystectomy was determined. ResultsIn total, 811 patients were included (median age, 58 years; male:female, 1:1.5): 227 emergency laparoscopic cholecystectomies (28.0%), 555 delayed laparoscopic cholecystectomies (68.4%), and 29 emergency laparoscopic cholecystectomies whilst awaiting delayed laparoscopic cholecystectomy (3.6%). Emergency laparoscopic cholecystectomy was associated with increased incidences of subtotal cholecystectomy (OR 1.94; P = .011), bile leak (OR 2.38; P = .013), intraoperative drains (OR 2.54; P < .001), prolonged postoperative length of stay (OR 7.26; P < .001), postoperative imaging (OR 1.83, P = .006), and postoperative readmission (OR 1.90; P = .005). There was a 13.5% risk of readmission over 2 months while waiting delayed laparoscopic cholecystectomy and a 22.5% risk over the median waiting time (5 months, 9 days). ConclusionEmergency laparoscopic cholecystectomy is positively associated with a multitude of operation-related adverse outcomes in acute cholecystitis, compared to delayed laparoscopic cholecystectomy. The benefit of delayed laparoscopic cholecystectomy should be balanced against the significant readmission risk before delayed laparoscopic cholecystectomy. Emergency laparoscopic cholecystectomy may be the most pragmatic strategy for centers dealing with high volumes of biliary admissions and long elective-surgery waiting times. When opting for delayed laparoscopic cholecystectomy, confirming the date of surgery before discharge may ensure timely intervention and avoid the morbidity and expense of readmission.

Outcomes Following Percutaneous Cholecystostomy Tube Placement for Acalculous Versus Calculous Cholecystitis.

Acute acalculous cholecystitis (AAC) is often diagnosed in critically ill patients. Percutaneous cholecystostomy tube (PCT) placement facilitates less invasive gallbladder decompression in patients who are poor surgical candidates. Specific guidelines for optimal management of AAC patients following PCT placement remain to be defined. We hypothesize that AAC patients are at lower risk of recurrent cholecystitis than acute calculous cholecystitis (ACC) patients and do not require cholecystectomy after PCT placement. A retrospective review of patients who underwent PCT placement for AAC or ACC between 6/1/2007 and 5/31/2019 was performed. Primary outcome was recurrent cholecystitis and interval cholecystectomy for patients surviving 30days after PCT placement. Secondary outcome was 30day mortality. A cox regression model calculated the adjusted hazard ratio (AHR) for the outcomes. Eighty-four AAC and 85 ACC patients underwent PCT placement. Compared to ACC patients, more AAC patients were male (72.6 vs. 48.2%; p < 0.01), younger (median age 62 vs. 73years; p < 0.01), and required intensive care (69.0 vs. 52.9%; p = 0.04), with lower median Charlson Comorbidity Index (4.0 vs. 6.0; p < 0.01). 30day mortality was higher among AAC patients than ACC patients (45.2 vs. 21.2%; p < 0.01). 2/24 (8.3%) AAC patients and 5/31 (16.1%) ACC patients developed recurrent cholecystitis at a median 208.0days (IQR:64.0-417.0) after PCT placement and 115.0days (IQR:7.0-403.0) following PCT removal. Cox regression analysis demonstrated that AAC patients had lower likelihood of interval cholecystectomy compared to ACC patients (AHR 2.35; 95% CI:1.11,4.96). Recurrent cholecystitis is rare in patients surviving 30days following PCT placement. When compared with ACC patients, fewer AAC patients require cholecystectomy.

Value of nonenhanced CT combined with laboratory examinations in the diagnosis of acute suppurative cholecystitis treated with percutaneous cholecystostomy: a retrospective study

PurposesIn this study, we aimed to identify the distribution of presenting laboratory and nonenhanced computed tomography (CT) imaging features within 48 h before percutaneous cholecystostomy (PC) and create a model to appropriately guide the diagnosis of acute suppurative cholecystitis (ASC).MethodsThe study population included 204 acute cholecystitis patients who underwent PC. Based on the timing of the last laboratory and CT examinations before PC, the patients were divided into two groups: within 48 h before PC (Group 1, n = 138) and over 48 h before PC (Group 2, n = 63). The clinical features of the ASC patients in the two groups were compared. A multivariable model for the diagnosis of ASC in the patients in Group 1 was developed.ResultsThirty-nine patients in Group 1 had ASC (28.3%). Gallbladder stones, common bile duct stones, gallbladder wall thickness > 2.85 mm, and neutrophil granulocytes > 82.55% were confirmed to be independent risk factors for ASC. The receiver operating characteristic curve of the recurrence prediction model verified its accuracy (area under the curve: 0.803). Compared with the ASC patients in Group 2, the ASC patients in Group 1 had a higher proportion of pericholecystic exudation or fluid (P = 0.013) and thicker gallbladder walls (P = 0.033).ConclusionsUsing nonenhanced CT imaging features and cutoffs for neutrophil granulocytes, we were able to identify a simple algorithm to discriminate ASC. The degree of local inflammation of the gallbladder in ASC patients progressively increases over time, and these changes can be observed on nonenhanced CT images. However, the symptoms of abdominal pain are of little help in estimating the disease duration in elderly patients.

Case series of paediatric patients of acute acalculous cholecystitis associated with severe malaria in endemic region over past 3 years at single center

Although acute acalculous cholecystitis (AAC) is a rare occurrence in all age groups; its incidence in paediatric patients is 50-60%. Yet ACC in children with malarial parasitic infection is extremely rare with only 12 cases reported as per English literature. We report 7 children with severe malaria developing ACC in a single institute in India over past 3 years. They were managed conservatively under strict observation and recovered completely without any surgical intervention. At a mean follow up of 1.5 years they are asymptomatic with a normal ultrasound imaging.

Association of Serum C-Reactive Protein Level and Treatment Duration in Acute Cholecystitis Patients Treated Conservatively.

Background: Acute cholecystitis (AC) is one of the most common gastrointestinal diseases that require hospitalization and surgical treatment. The treatment of the disease depends upon the severity of the disease and the patients’ medical status.Objective: In this study, we aimed to investigate if there is an association between the serum C-reactive protein (CRP) value and treatment response and the duration and length of hospital stay in AC patients who are treated conservatively.Methodology: The medical records of all patients with the diagnosis of AC who were treated with conservative management were included in the study. The demographic and laboratory data including CRP level at first admission to hospital, length of hospital stay, and complications during the conservative treatment were obtained from the patients’ records. Patients were divided into two groups according to the treatment response and length of hospital stay. Group 1 patients were defined as patients who responded to the medical treatment in less than three days, and Group 2 patients were defined as patients who did not respond to the medical treatment in three days and stayed at the hospital for more than three days.Results: We identified 101 patients with AC treated medically. Mean age (51.3 ± 16.3, 59.5 ± 15.7; p = 0.013), total leukocyte count (11.8 ± 4.4, 8.2 ± 2.8; p = 0.0005), and CRP value (19.3 ± 13.9, 9.6 ± 5.2; p = 0.0003) were higher in Group 2 compared to Group 1. Correlation analyses demonstrated a significant positive association between the length of hospital stay, total leukocyte count (r = 0.35; p = 0.0002), and CRP value (r = 0.59; p = 0.0004).Conclusion: We found that CRP level is associated with treatment duration and hospital stay in AC patients. However, large-scale, prospective further studies are needed to confirm our results and to determine whether CRP levels can be used to discriminate which patient would benefit from medical treatment.

A Prospective Comparative Study Between Early And Interval Laparoscopic/open Cholecystectomy In Patients Of Acute Cholecystitis

OBJECTIVE: The present study is designed to compare early and interval laparoscopic/open cholecystectomy in patients of acute cholecystitis. The comparison was done on the basis of parameters such as intraoperative difficulty, perioperative bile duct injury and bile leak, time taken for operation, postoperative atelectasis, postoperative wound infection, duration of hospital stay and postoperative pain. METHODOLOGY: This is a prospective study conducted in Department of General surgery, GCS MEDICAL COLLEGE, HOSPITAL AND RESEARCH CENTRE from AUGUST 2018 to DECEMBER 2019. 56 patients were enrolled in the study from which 26 patients were randomly assigned to early lap/open cholecystectomy and 30 were assigned to interval lap/open cholecystectomy group. RESULT: There was no significant difference observed between the two groups. However, the duration of hospital stay was less in early laparoscopic/open cholecystectomy. CONCLUSION: Both the methods, early and interval have no significant benefit over each other but through review of all literature, early lap/open cholecystectomy is found to be beneficial overall with less hospital stay.

Assessment of the Simultaneous Presence of Helicobacter Pylori in the Gastric Mucosa and Gallbladder Mucosa in Patients Suffering from Cholecystitis: a cross Sectional Study

Aim: The current study was designed to assess the simultaneous presence of H. pylori in gastric and gallbladder mucosa in the patients of acute cholecystitis or symptomatic cholelithiasis. Study design: Cross sectional study Place and duration: This study was conducted at Liaquat University Hospital Hyderabad, Pakistan from March 2020 to March 2021. Methodology: A total of 43 patients suffering from acute cholecystitis and symptomatic cholelithiasis were selected. Their age, gender, and the presence of H. pylori in the gallbladder and gastric mucosa was determined and recorded. The results were statistically analyzed by SPSS version 22. Results: Out of the 43 patients, 20 were male, and 23 were female. Recorded mean age was 54.8±9.9 years and 22 (51.2%) had acute cholecystitis and the remaining 21 (48.8%) had cholelithiasis. In the gastric mucosa, in 14 patients (32.6%) H. pylori was positive. Similarly, in the gall bladder; it was positive in 19 patients (44.2%). In 6 patients (13.9%) i.e. in 4 men and 2 women, H pylori was simultaneously present in both gallbladder and gastric mucosa. No particular relationship was observed in the H. pylori’s presence or absence in gallbladder and gastric mucosa. Conclusion: The presence of H. pylori in gallbladder plays a critical role in the gallbladder’s infection. However, its simultaneous presence in gastric mucosa is not a good standard to assess biliary diseases. Keywords: H. pylori, Cholecystitis, Cholelithiasis, Gallbladder, Gastric mucosa

Diagnostic value of ROC curve evaluation of serum markers in acute cholecystitis with bacterial infection.

To explore correlation of serum markers human neutrophil lipocalin and C-reactive protein with acute cholecystitis associated with bacterial infection, and to evaluate the diagnostic value of the markers. The cross-sectional study was conducted from January 2018 to April 2020 at the Beijing Luhe Hospital, Capital Medical University, Beijing, China, and comprised acute cholecystitis patients who were divided into bacterial infection group A and non-bacterial infection group B. Serum human neutrophil lipocalin and C-reactive protein were measured for both the groups. Receiver operating characteristic curve was used to evaluate the diagnostic value of the two markers in acute cholecystitis associated with bacterial infection. Data was analysed using SPSS 25. Of the 145 patients, 65(45%) were in group A; 36(55.38%) males and 29(44.62%) females with a mean age of 45.79±2.50 years. In group B there were 80(55%) subjects; 45(56.25%) males and 35(43.75%) females with a mean age of 46.16±2.52 years (p>0.05). In group A, there were 60(92.31%) cases of acute calculous cholecystitis, and 5(7.69%) had acute acalculous cholecystitis compared to 73(91.25%) and 7(8.75%), respectively, in group B (p>0.05). Serum human neutrophil lipocalin and C-reactive protein levels in group A were higher than group B (p<0.001). Serum human neutrophil lipocalin showed a high positive correlation with C-reactive protein in group A (r=0.800, p<0.001), and a moderate positive correlation in group B (r=0.683, p<0.001). Area under the curve of serum human neutrophil lipocalin associated with C-reactive protein was 0.901 (95% confidence interval: 0.850-0.953), which was higher than that of serum human neutrophil lipocalin and C-reactive protein alone, with sensitivity 95.40% and specificity 80%. The combined use of serum human neutrophil lipocalin and C-reactive protein may be used as an effective indicator for early diagnosis, identification and monitoring of acute cholecystitis with bacterial infection.

Точність методів візуалізації в діагностиці гострого холециститу

Дослідження проведено для оцінки діагностичної точності при гострому холециститі, гострому холангіті та отримання зведених даних. Інформаційний пошук результатів клінічних досліджень, систематичних оглядів, метааналізів, клінічних настанов стосовно чутливості та специфічності гепатобіліарної сцинтиграфії, ультразвукового дослідження, магнітно-резонансної томографії, комп’ютерної томографії при гострому холециститі проводився в базі Cochrane library, Medline/PubMed та в інших пошукових системах за ключовими словами: gallstone disease, acute cholecystitis, US, cholescintigraphy, CT, MR, sensitivity, specificity з січня 2000 р. до лютого 2014 р. Критерії включення: а) чіткі критерії для визначення позитивного результату візуалізації; б) операції і/або клінічні спостереження були використані як еталон; в) достатньо наведено даних, щоб оцінити число істинно позитивних, негативних результатів, хибнопозитивних і хибнонегативних результатів.У дослідженнях з оцінкою гепатобіліарної сцинтиграфії чутливість (88,5 % (95% ДІ: 81–97 %)) і специфічність (91,8 % (95% ДІ: 86–93 %)) були порівнянні з даними 2012 року, але чутливість трохи нижча в нашому дослідженні. Для досліджень з оцінкою УЗД чутливість становила 84,4 % (95% ДІ: 76–93 %) при специфічності 85,1 % (95% ДІ: 78–91 %), що трохи вище порівняно з даними, отриманими в систематичному огляді 2012 року. Ми показали, що магнітно-резонансна томографія і ультразвукове дослідження не виявили статистично значимих відмінностей у діагностиці потовщення стінки жовчного міхура, наявності каменів у ньому, наявності перихолецистичної рідини або гострого холециститу (р &gt; 0,05). Чутливість для гострого холециститу становила 89,4 % (95% ДІ: 85–91 %) і специфічність — 87,2 % (95% ДІ: 83–99 %) для магнітно-резонансної томографії. Цей метод еквівалентний ультразвуковому дослідженню в діагностиці жовчнокам’яної хвороби, потовщення стінки жовчного міхура, визначенні наявності перихолецистичного набряку й гострого холециститу в пацієнтів із симптомами гострого болю в правому верхньому квадранті живота. Особливо в сонографічно складних пацієнтів магнітно-резонансна томографія може застосовуватися як більш швидкий і простий метод діагностики.

Percutaneous Cholecystostomy Tube Use for Acute Cholecystitis: A Population-Based Analysis of Practice Patterns and Outcomes

Introduction: Percutaneous cholecystostomy tube (PCT) insertion is a common rescue approach for the management of acute cholecystitis in patients with prohibitive operative risk. Practice patterns, outcomes and definitive cholecystectomy rates in these patients remain unclear. The primary aim of this study was to investigate these trends using a large population-based database.

THE PLACE OF LIFTING LAPAROSCOPIC INTERVENTIONS IN THE SURGICAL TREATMENT OF DESTRUCTIVE FORMS OF ACUTE CHOLECYSTITIS COMPLICATED WITH PERITONITIS

Introduction. The incidence of acute cholecystitis in Ukraine, as well as worldwide, has increased in recent years and averages 6.27 per 10 thousand population. The use of laparoscopy for diagnostic purposes in patients of older age groups restrains many surgeons around the world due to the large number of negative effects of intense carboxyperitoneum. In the presence of contraindications to laparolifting cholecystectomy, ie contraindications to laparoscopic cholecystectomy, in previous works of the department it was proposed to use a new development of the department for patients with acute cholecystitis in patients of older age groups — LLСE. Objective: to improve the results of comprehensive treatment of patients suffering from destructive forms of acute cholecystitis complicated by peritonitis through the use of modern surgical minimally invasive methods. Methods: general clinical, clinical and laboratory, biochemical, instrumental, pathomorphological, statistical. Results: the use of lifting techniques of laparoscopic cholecystectomy allowed to eliminate the negative impact of intense carboxyperitoneum on patients, to avoid critical changes in hemodynamics during surgery, to exclude the development of postoperative shoulder-scapular pain, expanding the indications for endoscopic surgery. Conclusions: in destructive cholecystitis complicated by local peritonitis, the application of the developed method of lifting laparoscopic cholecystectomy revealed a significant reduction in intra- and postoperative complications compared with the group of laparoscopic cholecystectomies 5.1% and 1.7%, respectively, in the cavity. Key words: acute destructive cholecystitis, complicated with peritonitis, laparolifting cholecystectomy.

Surgical Treatment of Acute Cholecystitis in Patients over 80 Years: 10-Year Experience

The prevalence of gallstones ranges from 20% to 30% in patients ≥ 60 years of age whereas it is higher in individuals ≥ 90 years of age. Elderly patients with gallstones tend to develop more complications such as gallbladder hydrops, empyema or perforation. Although perioperative morbidity and mortality is slightly high in elderly patients with acute cholecystitis, cholecystectomy is successfully performed for acute cholecystitis with regard to improvement in patients care. In this study, we aimed to evaluate the results of patients over 80 years of age who had cholecystectomy. The data of the 196 patients over 80 years of age who underwent cholecystectomy for acute cholecystitits between Jan 2011and August 2020 were retrospectively reviewed. The age of the patients in this study ranged from 80 to 97 years. The number of female patients was 111 and male patients was 85. 109 patients underwent laparoscopic cholecystectomy and 77 patients underwent open cholecystectomy. 10 patients converted from laparoscopic to open surgery. One patient who underwent open cholecystectomy died. We observed more wound infection in open cholecystectomy group. Laparoscopic cholecystectomy patients were discharged earlier. Age is not a contraindication for cholecystectomy in patients with acute cholecystitits. Cholecystectomy is a safe procedure in elderly patients with accepted morbidity.

Does high surgical risk affect the management and outcomes of percutaneous cholecystostomy in acute cholecystitis? A single-center retrospective analysis

We compared the management and results of percutaneous cholecystostomy (PC) in high surgical risk (HSR) and normal surgical risk (NSR) acute cholecystitis (AC) patients. The patients were divided into two groups: 60 patients with NSR and 30 patients with HSR. Pre-PC laboratory values, PC efficiency in terms of AC complications, catheter withdrawal method and duration, catheter-related complications, AC recurrence rate, mortality rate, presence of dyspeptic complaints in definitive PC, and cholecystectomy rate were compared. Technical and clinical success were achieved in 90 (100%) patients and, 85 (94.4%) patients with PC, respectively. The mortality developed in the HSR group; however, it was not seen in the NSR group (p=0.003). Five (83.3%) out of 6 (6.7%) patients with the American Society of Anesthesiology classification system (ASA) IV score developed mortality. With PC, clinical success was achieved in all 8 (100%) patients with suspected perforated cholecystitis and 6 (75%) of 8 patients with suspected emphysematous cholecystitis on abdominal CT in the non-acute abdomen. PC complications were seen in 8 (8.8%) and recurrent cholecystitis in 8 (12.5%) patients. The hospital stay was longer, and the rate of definitive treatment with PC was higher in the HSR group (p=0.019, p=0.008). C-reactive protein and procalcitonin levels were higher in the NSR group (p&lt;0.001, p=0.001). Dyspeptic complaints did not observe in 28 (73.7%) of the 38 patients without operation during the 33.3-month follow-up. The rate was not different between the groups (p=0.713). PC provides high clinical success in AC-related major complications, severe infection, and the presence of serious comorbid diseases. Mortality was observed only in ASA IV patients. The definitive cure rate of PC was higher in patients with HSR.

Predictive evaluation of SIRI, SII, PNI, and GPS in cholecystostomy application in patients with acute cholecystitis.

The aims of this study were to investigate the clinical significance of systemic inflammatory response index (SIRI), systemic inflammation index (SII), prognostic nutritional index (PNI), and Glasgow prognostic score (GPS) in deciding whether to perform cholecystostomy when determining if cholecystostomy is the right choice for acute cholecystitis (AC) patients. Between January 2018 and December 2020, 126 consecutive patients with AC with and without cholecystostomy were retrospectively recruited from the Trakya University in Edirne, Turkey. Group I included AC patients with cholecystostomy and Group II included AC patients without cholecystostomy. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) were calculated. The PNI and SII were calculated RESULTS: There is significant difference between the two groups by the comparison of SIRI, SII, PNI, and GPS values (p<0.001). In Group I, SIRI, SII, and GPS values are higher than the Group II and PNI value in Group I is lower than the Group II. Furthermore, the NLR and PLR ratios in Group I are significantly higher than Group II, and the LMR ratio in Group I is significantly lower than Group II. According to our study, we can say that NLR, PLR, SII, SIRI, and GPS are positive predictors and LMR and PNI are negative predictors for the severity of AC. Therefore, when we decide to treat AC medically, we may prefer the application of chole-cystostomy tube at the beginning of hospitalization by the help of evaluating NLR, PLR, LMR, SIRI, SII, GPS, and PNI values.

Ksantogranülomatöz kolesistitin cerrahi üzerine etkisi

Purpose: The aim of this study is to evaluate the incidence of pathologies causing biliary stasis together with xanthogranulomatous cholecystitis (XGC) and its effect on conversion to open cholecystectomy. Materials and Methods: This retrospective study reviewed the medical records of 11840 patients who underwent cholecystectomy at Seyhan State Hospital between January 2010 and June 2020. After examining the medical records, 40 (0.33%) of 11840 cholecystectomy cases were diagnosed as XGC pathologically. Results: In the last decade, 40 (0.33%) patients out of a total of 11840 patients who underwent cholecystectomy were diagnosed with XGC. The mean age of the cases was 58 (34-88). In 26 (65%) of 40 patients, surgery was completed laparoscopically. Open surgery was performed in 5 (12.5%) of them. Nine (22.5%) patients were converted from laparoscopic cholecystectomy to open surgery. In all cholecystectomy cases, the conversion cholecystectomy(CC) rate was 412/11840 (3.4%). Endoscopic retrograde cholangiopancreatography(ERCP) was performed in 13 (32.5%) patients for diagnosis and therapeutic purposes related to bile ducts. The gallbladder wall's average thickness was found to be 8.0 millimeters (± 3.87) on histopathological examination. 38 (95%) patients had an increase in gall bladder wall thickness of 4 millimeters or more. CC rate was found to be high in the subgroup analysis of pathology causing bile stasis and in patients who underwent emergency cholecystectomy. Conclusion: This study demonstrates that the pathologies causing bile stasis are observed more frequently in XGC patients than other cholecystitis patients, suggesting that these pathologies may be associated with XGC.

Failure of Laparoscopic Cholecystectomy Preoperative Factors as Predictors

Introduction: Laparoscopic cholecystectomy is the gold standard procedure for gall stone disease. Few cases of acute calculous cholecystitis require conversion to open procedure which can increase the morbidity and financial burden to patient. Hence, through this study we are trying decide regarding the parameters which would help to assess the patient preoperatively and predict the outcome of laparoscopic cholecystectomy. Aims and Objectives: To assess the preoperative parameters to predict conversion of laparoscopic cholecystectomy to open cholecystectomy in patients with acute calculous cholecystitis. Materials and Methods: A prospective study was conducted at a tertiary care hospital. Study was conducted after obtaining ethical committee clearance and informed consent from patients. 100 patients were included in the study. Results: 100 patients of acute calculous cholecystitis were taken for laparoscopic cholecystectomy of which 80 patients successfully completed the procedure and remaining 20 patients had to undergo conversion to open procedure. Conclusion: Male gender, older age, patients with higher pain (VAS) score, raised TLC, raised total bilirubin, raised serum ALP are associated with failure of laparoscopic cholecystectomy. Keywords: Acute calculous cholecystitis; Cholecystectomy; Laparoscopic cholecystectomy; Failure of laparoscopy; Conversion to open cholecystectomy.

P-EGS14 From Gallstone Disease to Cholecystectomy: An audit looking at the waiting times for cholecystectomy in a small District General Hospital

BackgroundGallstone-related disease accounts for a third of emergency general surgery admissions and referrals. The average waiting time for acute gallstone presentations to laparoscopic cholecystectomy is about 7 days in England. This audit aims to identify emergency admissions and compare local management to the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) guidelines standards with a focus on waiting times for laparoscopic cholecystectomy (LC). Where AUGIS standards were not met, number of re-admissions and complications were identified. A cost analysis was also completed looking at the overall costs of delayed treatment.MethodsWe identified all patients admitted as an emergency between September 2019 and September 2020 with gallstone-related pathology. Patients not referred to the surgical team, with negative Ultrasound Scans (USS) or known HPB malignancy were excluded. The patients were divided into a pre- COVID -19 and during COVID-19 category (respectively before and after March 2020), to identify whether the cancellation to non- urgent elective surgery (due to COVID-19) had caused further delays or complications. Each patient’s management was compared to AUGIS guidelines depending on their diagnosis at presentation (biliary colic, cholecystitis, cholangitis, gallstone-related pancreatitis), focusing on the timing between presentation and LC.ResultsA total of 99 patients were identified. Of the patients presenting with biliary colic (n = 9 pre-COVID, n = 5 during COVID), none underwent LC within 72 hours from presentation as recommended by AUGIS. Of the patients presenting with cholecystitis (n = 20 pre-COVID and n = 16 during COVID), none had LC within the recommended 72 hours. 5 patients in each COVID group had LC, with a significantly longer waiting time compared to the pre-COVID group. Re-admissions and complications were similar for the cholecystitis patients in both COVID groups. In the gallstone-related pancreatitis group, only 1 patient underwent LC within the recommended 2 weeks.ConclusionsThis audit showed that locally we are failing to meet AUGIS guidelines for LC within 72 hrs, 2 weeks or 6 weeks both pre and during COVID. This has caused re-admissions of patients with cholecystitis, pancreatitis and perforated gallbladders. Factors that cause delay are limited access to USS, limited staff and theatre availability. To improve outcomes, it is necessary to implement a hot gallbladder service with dedicated theatre slots. A change in the overall perception of LC is also needed: this is should be considered an emergency operation as its delay has a significant negative impact on patients’ outcomes.

P-BN61 Optimal timing of laparoscopic cholecystectomy for admitted acute cholecystitis patients

Abstract Background The Tokyo 2018 guidelines support emergency laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) over delayed laparoscopic cholecystectomy (DLC) for mild cholecystitis, substantiated by a lower total length of stay. The supporting studies are limited by small sample sizes, and clinically relevant findings may have been missed. The aims of the present paper were firstly, to compare the peri- and post-operative course following emergency and delayed LC for AC. Methods All patients who underwent ELC and DLC for AC following hospital admission between January 2015 and December 2019 were included in the study. Pre-operative, operative and post-operative data over a 100-day follow-up period were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were splint into groups based on previous admissions and outcomes were compared between ELC and DLC. Multivariate logistic regression models were then used on the entire cohort to adjust for other variables and to determine the impact of ELC versus DLC. Complications of the category Clavien-Dindo ≥2 were considered. Results In the group with no previous admissions (n = 630), DCL patients had lower rates of intra-/post-operative complications (8.0%vs.17.9%;p&amp;lt;0.001), lower rates of re-admission (6.6%vs.12.2%;p=0.04) and longer total length of stay (6dvs.5d;p=0.03). In patients with previous admissions (n = 181), DCL had lower rates of intra-/post-operative complications (14.1%vs.25.5%;p=0.06) but there was no significant difference in length of stay (13dvs.12d;p=0.81). The ELC group had a significantly lower admission CRP, ASA and age (p &amp;lt; 0.001). In the multivariate logistic regression models, ELC was positively associated with subtotal/conversion to open (OR,1.94;p=0.01), drain insertion (OR,2.54;p&amp;lt;0.001), bile leak (OR,2.38;p&amp;lt;0.001), post-operative imaging (OR,1.83;p=0.01), longer post-operative stay (OR,7.26,p&amp;lt;0.001) and readmission (OR-1.9;p=0.01). Conclusions DLC, once the period of active inflammation has settled, offers superior post-operative outcomes, including lower rates of complication, re-admission and post-operative length of stay; however is associated with longer total length of stay. DLC is only advised where the risk of re-admission is minimised (i.e surgery six weeks following the episode) and relies on the management of surgical waiting lists.

DETERMINATION OF PAIN IN PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS IN PATIENTS WITH CHRONIC HEPATITIS

The aim. To establish the diagnostic value of the scale for assessing the severity of pain by determining the intensity of pain in patients with acute calculous cholecystitis in patients with chronic viral hepatitis.&#x0D; Materials and methods of research. The study was conducted in the period from 2016 to 2021 in the Department of Emergency Surgery of the Military Medical Clinical Center. In the first stage, the diagnostic scheme included only surveys to identify potential risk factors for infection and anamnestic data on the presence of HCV diagnosed in the past. In the second stage, rapid tests for antigens and antibodies to HCV were introduced into the diagnostic scheme along with the survey.&#x0D; Research results. Patients respond differently to pain, and the sen sation of pain is individual and subjective.&#x0D; Conclusions. Quantitative assessment and registration of the inten sity of pain using a visual-analog scale can supplement the comprehensive information about the general condition of the patient, which is necessary to select the optimal treatment in emergency surgery.