Complication Of Cholelithiasis Research Articles

Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Abdominal Pain and Gallstones

The 1-year results of the SECURE trial, a randomized trial comparing a restrictive strategy vs usual care for select patients with symptomatic cholelithiasis for cholecystectomy, resulted in a significantly lower operation rate after restrictive strategy. However, a restrictive strategy did not result in more pain-free patients at 1 year. To gauge pain level and determine the proportion of pain-free patients, operation rate, and biliary and surgical complications at the 5-year follow-up. This randomized clinical trial was a multicenter, parallel-arm, noninferiority, prospective study. Between February 2014 and April 2017, patients from 24 hospitals with symptomatic, uncomplicated cholelithiasis were included. Uncomplicated cholelithiasis was defined as gallstone disease without signs of complicated cholelithiasis, ie, biliary pancreatitis, cholangitis, common bile duct stones, or cholecystitis. Follow-up data for this analysis were collected by telephone from July 11, 2019, to September 23, 2023. Patients were randomized (1:1) to receive usual care or a restrictive strategy with stepwise selection for cholecystectomy. The primary, noninferiority end point was proportion of patients who were pain free as evaluated by Izbicki pain score at the 5-year follow-up. A 5% noninferiority margin was chosen. The secondary end points included cholecystectomy rates, biliary and surgical complications, and patient satisfaction. Among 1067 patients, the median (IQR) age was 49.0 years (38.0-59.0 years); 786 (73.7%) were female, and 281 (26.3%) were male. At the 5-year follow-up, 228 of 363 patients (62.8%) were pain free in the usual care group, compared with 216 of 353 patients (61.2%) in restrictive strategy group (difference, 1.6%; 1-sided 95% lower confidence limit, -7.6%; noninferiority P = .18). After cholecystectomy, 187 of 294 patients (63.6%) in the usual care group and 160 of 254 patients (63.0%) in the restrictive strategy group were pain free, respectively (P = .88). The restrictive care strategy was associated with 387 of 529 cholecystectomies (73.2%) compared with 437 of 536 in the usual care group (81.5%; 8.3% difference; P = .001). No differences between groups were observed in biliary and surgical complications or in patient satisfaction. In the long-term, a restrictive strategy results in a significant but small reduction in operation rate compared with usual care and is not associated with increased biliary and surgical complications. However, regardless of the strategy, only two-third of patients were pain free. Further criteria for selecting patients with uncomplicated cholelithiasis for cholecystectomy and rethinking laparoscopic cholecystectomy as treatment is needed to improve patient-reported outcomes. CCMO Identifier: NTR4022.

Utility of near infrared fluorescent cholangiography in detecting biliary structures during challenging minimally invasive cholecystectomy.

Surgeons can minimize the risk of bile duct injury (BDI) during challenging mini-invasive cholecystectomy through technical standardization by means of a precise anatomical landmark identification (Critical View of Safety) and advanced technology for biliary visualization. Among these systems, the adoption of magnified stereoscopic 3-dimensional view provided by robotic platforms and near infrared fluorescent cholangiography (NIRF-C) is the most promising. In this prospective cohort study, we evaluated all consecutive minimally invasive cholecystectomies (laparoscopic and robotic) performed with NIRF-C between May 2022 and January 2023 at General Surgery Unit, Department of Health Sciences, University of Milan, San Paolo Hospital (Milan, Italy). Inclusions criteria were as follows: (1) acute cholecystitis (emergency group), (2) history of chronic cholecystitis or complicated cholelithiasis (deferred urgent group), (3) difficult cases (patients affected by cirrhosis, with scleroatrophic gallbladder or BMI > 35kg/m2). For each group, the detection rate and visualization order of the main biliary structures were reported (cystic duct, CD; common hepatic duct, CHD; common bile duct, CBD; and CD-CHD junction). A total of 101 consecutive patients were enrolled, including 83 laparoscopic and 18 robotic cholecystectomies. All patients were stratified into three subgroups: (a) emergency group (n = 33, 32.7%), (b) deferred urgent group (n = 46, 45.5%), (c) difficult group (n = 22, 21.8%). Visualization of at least one biliary structure was possible in 94.1% of cases (95/101). Interestingly, all four main structures were detected in 43.6% of cases (44/101). The CD was the structure identified most frequently, being recognized in 91/101 patients (90.1%), followed by CBD (83.2%), CHD (62.4%), and CD-CHD junction (52.5%). In the subset of patients that underwent emergency surgery for AC, the CD-CHD confluence was identified in only 45.5% of cases. However, early and precise identification of CBD (75.8%) and CD (87.9%) allowed safe isolation, clipping, and transection of the cystic duct. In the deferred urgent group, the CBD and the CD were easily identified as first structure in a high percentage of cases (65.2% and 41.3% respectively), whereas the CD-CHD junction was the third structure to be identified in 67.4% of cases, the highest value among the three subgroups. In the difficult group, NIRF-C did not prove to be a useful tool for biliary visualization. The rates of failure of visualization were elevated: CBD (27.3%), CD (18.2%), CHD (54.5%), and CD-CHD (68.2%). NIRF-C is a powerful real-time diagnostic tool to detect CBD and CD during minimally invasive cholecystectomy, especially when inflammation due to acute or chronic cholecystitis subverted the anatomy of the hepatoduodenal ligament.

Cholelithiasis Secondary to Mirizzi Syndrome: An Overview

Mirizzi syndrome (MS) is a relatively rare condition, accounting for a small percentage of biliary disorders. Even though this complication of cholelithiasis has a low prevalence, its morbidity rates, reflecting the overall burden of the disease, have been reported to range from 10% to 50%.

Ways to prevent acute postmanipulatory pancreatitis in endoscopic transpapillary interventions in patients with mechanical jaundice

To evaluate the effectiveness of preventive measures in relation to the development of acute postmanipulatory pancreatitis in patients after endoscopic transpapillary interventions. Materials and methods: In the period from September 2021 to June 2022, 73 endoscopic transpapillary interventions for benign pathology and malignant pathology were performed in patients. The analysis of the frequency of the development of acute postmanipulatory pancreatitis in different time intervals in patients who underwent prophylaxis in various ways, depending on the combination of risk factors. Results and discussion: Acute postmanipulatory pancreatitis developed in 2 (3.7 %) patients who underwent transpapillary interventions in various volumes for complicated cholelithiasis. Drug prophylaxis of acute postmanipulatory pancreatitis was carried out in the preoperative period for all patients. Preventive stenting of the main pancreatic duct was performed in the presence of a combination of risk factors. Conclusion: The analysis of the results of endoscopic transpapillary interventions made it possible to identify the most significant measures that allowed to reduce the number of developed to 3 acute postmanipulatory pancreatitis to 3.7 % and thereby increase the safety of transpapillary interventions.

Gallstone Obstruction In Jejunum: A Rare Case

Gallstone ileus refers to mechanical obstruction of the small intestine due to impaction of one or more gallstones. It occurs as a complication of cholelithiasis, more in elderly females [1]. CECT is the best diagnostic tool and the definitive treatment of gallstone ileus is surgical removal. The prevalence of cholelithiasis among American Indians may reach upto 70% and is much lower in Asians[6]. However most cases of cholelithiasis are asymptomatic and are found as an incidental finding and it is reported that on an average 1-2.3% of patients experience complications[8]. Gallstone ileus occurs due to inflammation and erosion of any part of the biliary tree leading to enterobiliary fistula through which the stone passes. Patients usually present with non-specific symptoms and acute cholecystitis is present in 10–30% cases[9]. Diagnosis clinically poses a challenge due to vague presentation with nonspecific symptoms but a radiological diagnosis on CECT and MRCP can be made. Enterolithotomy is a definitive procedure with or without cholecystectomy, fistula closure. The ongoing inflammation may complicate cholecystectomy and fistula repair. Considering that most patients are older with multiple comorbidities with added physiological stress, multiple procedures are not done in the same setting. Though laparoscopic/ laparoscopy assisted surgeries have reported better efficiency and lesser complications, less availability of equipment and surgeon’s skills and training are often a limiting factor. As there are variabilities in the surgical approaches the patient factors and surgeon factors must be kept well in mind and then to proceed with the surgery of choice. With all these at the back of the mind, higher success rates with lesser hospital stay, perioperative events and mortalities are achievable.

Antegrade minimally invasive technologies in treatment of complicated cholelithiasis

Aim. To evaluate the potential and effectiveness of antegrade X-ray surgical interventions as treatment choice to eliminate the cholecysto- and choledocholithiasis in the complicated cholelithiasis.Materials and methods. We carried out an analysis of the results of staged X-ray surgical treatment of 29 patients with cholecysto- and/or choledocholithiasis having relative or absolute counterindications to the implementation of laparoscopy, open surgery or endoscopy. Thirteen patients (44.8%) were revealed to have diverticulum of the major duodenal papilla; seven (24.1%) – coronary heart disease with chronic heart failure. Five patients (17.2%) had previously undergone gastrectomy. Severe diseases of the respiratory organs were detected in four cases (13.7%). The primary intervention included percutaneous microcholecystostomy and percutaneous transhepatic cholangiostomy. The drainage channel formation was followed by cholecysto- and choledocholangioscopy, mechanical and pneumatic lithotripsy, lithoextraction.Results. A total of 34 percutaneous minimally invasive interventions were performed. Percutaneous transhepatic biliary drainage was performed in 23 cases (67.6%), percutaneous microcholecystostomy – in seven (20.5%), and percutaneous drainage of peri- and intrahepatic abscesses was additionally carried out in four cases (11.9%). At the second stage, seven patients (24.4%) underwent cholecystoscopy and 20 (68.8%) – choledocholangioscopy. Both interventions were used in two cases (6.8%). In all cases, the work resulted in eliminating the complications of cholelithiasis, cholecystosis and/or choledocholithiasis with restorating the bile passage by means of percutaneous minimally invasive technologies. No fatal outcomes or complications were recorded.Conclusion. Antegrade X-ray surgical technologies are effective minimally invasive choice treatment to eliminate the cholecysto- and choledocholithiasis with counterindications to other surgical treatments in the complicated cholelithiasis.

Erratum for the article “Radical surgery for complicated cholelithiasis in elderly patients: three clinical cases”

.

Gallstone ileus in a middle-aged male with an atypical history: a case report

Currently, gallstone ileus is an unusual complication of cholelithiasis (0.3–3.0 %) and a rare cause of mechanical bowel obstruction (0.1–4.0 %). The rarity of the condition makes it impossible to plan the large prospective randomized clinical trials, so the analysis of case reports is significant for decision making in the management of gallstone ileus. We report a case of gallstone ileus in a middle-aged male who had a history of surgery for duodenal ulcer perforation in past. A combination of peptic ulcer disease and cholelithiasis is based on a reduced gastrointestinal hormones secretion. Clinical specialists need to consider information about the greater frequency and asymptomatic clinical course of gallstone disease against a background of duodenal ulcer. Duodenal ulcer scar and bulbar deformity may promote to the cholecystoduodenal fistula formation. In the presence of an acute bowel obstruction symptoms and the absence of gallbladder instrumental examination results, it is possible to recommend the prior gastroduodenoscopy for the pre-operative pneumobilia detection. The optimal surgical approaches for acute gallstone ileus are still controversial.

Gall stone ileus: An uncommon cause of small bowel obstruction at an unusual age: A Case report

Gallstone ileus is a rare complication of cholelithiasis. It is an uncommon cause of a mechanical small bowel obstruction. Repeated episodes of cholecystitis results adhesion of the gallbladder to the small bowel (usually duodenum) with eventual formation of cholecystoenteric fistula via which gallbladder stone enters the small bowel. It is most commonly seen in elderly females hence linked with high morbidity & mortality. Computed tomography (CT) imaging have made it easier to diagnose gallstone ileus effectively. Surgical intervention results in prompt relief of obstructive symptoms by removing stone & repairing fistula. Here is a case of gall stone ileus in a 27-year-young gentleman who presented to us with history of acute abdomen & without any comorbidities or biliary manifestation.

A206 GALLSTONE IMPACTION IN THE DESCENDING COLON WITH SUCCESSFUL ENDOSCOPIC REMOVAL

BackgroundGallstone impaction in the colon is a rare complication of cholelithiasis, typically because of gallstones migrating into the colon via a cholecystocolonic fistula. Gastrointestinal obstruction from gallstones only develops in 0.3–0.5% of patients with cholelithiasis and accounts for 0.095% of all mechanical bowel obstruction. Successful treatment has been described with endoscopic and surgical techniques.AimsThis report aims to present a case of colonic obstruction from gallstone that was successfully treated endoscopically.MethodsWe conducted a retrospective chart review on one patient including assessing the history of presenting illness along with biochemical, radiographic, and endoscopic results. We then conducted a narrative literature review on this subject matter.ResultsAn 85-year-old male with known cholelithiasis complicated by prior cholecystitis presented with a 2-day history of generalized abdominal pain. Computed tomography (CT) showed fistulisation between the gallbladder and hepatic flexure. Follow-up CT with rectal contrast showed lack of contrast beyond an impacted gallstone in the descending colon (Figure 1A, 1B). The patient was deemed a poor surgical candidate thus endoscopic gallstone extraction was attempted. With a pediatric colonoscope, the 41mm x 51mm gallstone was visualized 70cm from anal verge (1C). The stone was too large to be extracted en-block with snare or basket. Attempts to cut the stone at its surface with a polypectomy snare and other tools were unsuccessful because of the roundness and smoothness of the stone. Although we could chip away at the surface, we were unable to break the seal of the stone against the colon mucosa. We found the most effective method was tunneling through the stone’s centre using a closed rat-tooth forceps, then angling the tip of the scope and pulling the scope back to break off fragments from within. A polypectomy snare was used to further breakup larger fragments to prevent repeat impaction (1D). There was underlying diverticular disease and mild ischemic changes to the mucosa but no stricture. The patient did well post-procedure and was able to tolerate oral intake, pass flatus, and pass bowel movements. He was discharged 3 days later.A recent systematic review found a total of 38 cases of gallstone obstruction of the colon. Majority of patients (73.6%) ultimately required surgical intervention. Overall mortality is 13.1%.ConclusionsGallstone impaction in the colon is uncommon with successful endoscopic treatment seldomly described. This report describes a rare complication of gallstone disease that was successfully treated with widely available endoscopic tools. Funding AgenciesNone

Biliary fistulas

The results of the treatment of 27 patients with biliobiliary fistulas serious complications of cholelithiasis which for the most part were not diagnosed before operations and were unexpected during interventions as to cholecystitis or mechanical jaundice are given. The operative treatment presents difficulties and should be directed both to tte elimination of biliobiliary fistulas and to the correcti of patholigic changes in biliary ducts. Five cases of successful treatment of biliobiliary fistulas by miniaccess are given. The postoperative mort ality was 22,2%.

Endosonography of the pancreatobiliary area in pediatric patients. The first experience

Introduction. The diagnostics of malformations and diseases in the organs of pancreatobiliary area in children is an actual problem. An increase in the number of pediatric patients with pancreatobiliary anomalies, complications of cholelithiasis, acute and chronic pancreatitis requires the development of new techniques of non-invasive diagnostics which would allow to choose the optimal curative tactics.Material and methods. The article presents authors' experience of performing endosonography in 44 children, aged 2–17, during 2.5 years. Indications for endosonography were: complicated cholelithiasis, choledochal cyst, pancreatic duct dilatation, lithiasis of the Wirsung’s duct, cystic and solid formations in the pancreas and omental sac. Fine-needle aspirations under endosonography control were performed in 10 patients; transgastric drainage of pancreatic pseudocysts - in 6 children.Results. In all cases, endosonography turned out to be an informative diagnostic option. The curative tactics was changed in 21 (47.7%) patients after receiving endosonographic findings. Besides, such findings clarified anatomical and topographic features of organs in the pancreatobiliary zone in 15 (34.1%) patients; endosonographic findings helped to define the optimal volume of surgical intervention in 6 (13.6%) patients. There were no complications during diagnostic procedures. Bleeding into the lumen of pseudocyst was noted in a patient with transgastric drainage.Conclusion. Endosonography in children is an informative non-invasive technique for diagnosing malformations and diseases of the pancreatobiliary region because it allows to obtain the final picture of biliary and pancreatic ducts, of the site and nature of focal lesions in the pancreas, as well as to clarify indications for various interventions.

WAYS TO IMPROVE THE RESULTS OF TREATMENT OF PATIENTS WITH CHOLELITHIASIS AND MECHANICAL JAUNDICE.

Purpose. To create a personalized tactic of surgical treatment of patients with BSD and MJ considering the stage of the pathological process and thereby improve the results of treatment. Materials and methods. The experience of diagnosis and treatment of 537 patients with complications of cholelithiasis, manifested by mechanical jaundice, was analyzed. The first stage was 537 minimally invasive decompressions of the biliary tract, the second-500 different types of endosurgical interventions. Results. Depending on the tactical principles, all the subjects were divided into two groups. In one (control) group (n = 249), patients were admitted from 2010 to 2014. Their treatment was empirical: decompression of the bile tree was performed at different times, and surgery was performed without taking into account the stages of the pathological process and the severity of the patients. In the other analyzed group (n = 251), patients were admitted to the hospital from 2015 to 2019. Their treatment tactics were personalized: taking into account the stages of mechanical jaundice. individual terms of decompression of the bile ducts and the choice of surgical intervention were determined. When comparing the results obtained, the advantage of the personalized approach was established: a decrease in the percentage of postoperative complications and mortality was revealed. Conclusion. In patients with cholelithiasis and jaundice, the severity of the condition is due to hyperbilirubinemia. Stage 2 of mechanical jaundice-determined by the severity of cytolysis in hepatic insufficiency, manifested by hypertransaminasemia. The severity of cholangitis is determined by purulent-inflammatory, as well as septic signs of the disease, characterized by leukocytosis, circulating immune complexes and medium-weight molecules. In the cholestatic stage of jaundice development, treatment is planned, in the cytolytic stage — urgent, and in cholangitis-emergency. The use of personalized tactics for the treatment of patients with breast cancer has reduced the number of complications and mortality.

Is Immediate Laparoscopic Cholecystectomy after ERCP a Safe Treatment for Gallstone Complications?

Background: Laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) is a standard treatment for patients with complicated cholelithiasis. Currently, there is no conclusion about the optimal interval between LC and ERCP, especially in the case of emergent ERCP. Objective: The purpose of this study is to compare the outcome of patients treated with immediate, early, and delayed LC after ERCP. Materials and Methods: A total of 198 patients who received LC and ERCP between July 2017 and June 2019 were retrospectively reviewed. Patients were divided into 3 groups: immediate (single-staged LC with ERCP – 109 patients), early (LC <72 hr after ERCP – 20 patients) and delayed (LC >72 hr after ERCP – 69 patients). Patient demographics and primary endpoints (conversion rate to open cholecystectomy (OC), blood loss, operative time, complications, mortality and length of hospital stay) were recorded. The secondary endpoint was to analyze factors that influence the conversion to OC. Results: There were no statistical differences in the conversion rate (p=0.921) and major complications (p=0.548) between all three groups. However, the immediate group demonstrated shorter length of post-ERCP hospital stay than other groups (p=0.0001). The analysis of emergent ERCP cases showed no difference in the conversion rate and major complications (p=0.999 and 0.329). Patients with a history of previous ERCP tend to convert to OC but the difference was not statistically significant in the multivariate analysis (p=0.106). Conclusion: Performing LC immediately after ERCP is safe, does not increase the conversion rate, and results in shorter hospital stays even in emergent ERCP cases. Keywords: Laparoscopic cholecystectomy; Endoscopic retrograde cholangiopancreatography; LC; ERCP; Minimally invasive surgery

Radical surgery for complicated cholelithiasis in elderly patients: three clinical cases

Management of complicated cholelithiasis (gallstone disease) in elderly patients is often limited to the use of only minimally invasive interventions.Case report. We report three clinical cases of gallstone disease complications in patients over 75 years old who had previously undergone minimally invasive surgery and who was refused radical surgical treatment due to comorbidity. In two patients, this led to the development of purulent cholangitis and multiple organ failure, which required emergency hospitalization. At the first stage, biliary drainage was performed; then the multidisciplinary team managed to stabilize the condition of the patient; at the second stage, biliodigestive anastomoses were formed through laparotomic access on a loop turned off by the Ru. Complete relief of symptoms was achieved and no relapse was observed.In another case, cholecystoduodenal fistula with stone migration and complete obstruction of the small intestine was found during laparotomy in an asymptomatic patient hospitalized for elective surgery.Discussion. Comorbidity should not be considered as an absolute contraindication to radical surgery of complicated cholelithiasis in elderly patients: gallstone disease complications in most cases exceed the risks of surgical intervention. Radical surgery of complicated gallstone disease in patients over 75 years old is possible in condition of patient management by a multidisciplinary team.

Muscle-splitting mini-incision cholecystectomy under spinal anesthesia: cost-effective equitable minimally invasive surgery in laparoscopy era

Introduction: Conventional open cholecystectomy has been increasingly replaced by laparoscopy which requires resources for expensive equipment, training, and maintenance. Muscle-splitting mini-incision cholecystectomy under spinal anesthesia has comparable outcomes to laparoscopy and requires fewer resources. This study analyzes the feasibility and outcome of muscle-splitting mini-incision cholecystectomy under spinal anesthesia. Methods: All consecutive cases of muscle-splitting mini-incision cholecystectomy (MC) performed for symptomatic cholelithiasis during three years ending in December 2019, at a periphery hospital in Janakpur, province-2, Nepal, were included. Complicated cholelithiasis (biliary pancreatitis, jaundice, cholangitis, dilated common bile duct) was excluded. Written informed consents were obtained. The need for general anesthesia, complications during and after surgery, and patient satisfaction were analyzed descriptively. Ethical approval was obtained. Results: Out of 148 MC completed under spinal anesthesia, six (4.1%) required fentanyl for shoulder discomfort. Mild post-operative pain was reported by 124 (83.8%) at six hours and 146 (98.6%) at 12 hours. The intravenous drip was stopped after surgery and oral liquid with analgesics started in two hours in 143 patients (96.6%). Post-operative antibiotic was given in nine, for 2(1.4%) cholecysto-duodenal fistulas, 4(2.7%) diabetics, and 3(2%) mucoceles. The mean hospital stay was one night. Wound complications occurred in 6(2.8%). Overall, 144 (97.3%) were satisfied and would recommend the procedure to others. Histopathology revealed adenocarcinoma in one case. There was no bile-duct injury, re-surgery, or mortality. Conclusion: Muscle-splitting mini-incision open cholecystectomy (MC) under spinal anesthesia is safe and effective with early feeding, short hospital stays, less demand for resources, and good patient satisfaction.

Interventional radiology techniques in the treatment of cholangiolithiasis: indications, efficacy, accessibility

Our days, the problem of treating complicated forms of cholelithiasis continues to be relevant despite the undoubted successes in the field of hepatobiliary surgery. Cholangiolithiasis is one of the most frequent and dangerous complications of cholelithiasis, it is detected in 8–26 % of patients with cholelithiasis. In some cases, it is impossible to perform an endoscopic retrograde method, these special situations require the development of new original minimally invasive methods for resolving cholangiolithiasis, which have all the advantages of «small access». The analysis of the treatment of 466 operated patients with cholelithiasis complicated by cholangiolithiasis and mechanical jaundice in the period from 2013 to 2019 was carried out. The patients were divided into 3 groups: 1 — the endoscopic retrograde method was used (n = 369), 2 — laparotomic access (n = 26), 3 — antegrade X-ray interventional method (n = 71). The results obtained allow us to conclude that the antegrade interventional radiology technique for the treatment of choledocholithiasis has a high clinical efficacy comparable to the endoscopic technique. The use of this treatment option avoids traumatic laparotomies and open interventions on the bile ducts. The use of method is justified in cases of impossibility of performing endoscopic intervention, or its ineffectiveness.

Interventional radiology techniques in the treatment of cholangiolithiasis: indications, efficacy, accessibility

Our days, the problem of treating complicated forms of cholelithiasis continues to be relevant despite the undoubted successes in the field of hepatobiliary surgery. Cholangiolithiasis is one of the most frequent and dangerous complications of cholelithiasis, it is detected in 8–26 % of patients with cholelithiasis. In some cases, it is impossible to perform an endoscopic retrograde method, these special situations require the development of new original minimally invasive methods for resolving cholangiolithiasis, which have all the advantages of «small access». The analysis of the treatment of 466 operated patients with cholelithiasis complicated by cholangiolithiasis and mechanical jaundice in the period from 2013 to 2019 was carried out. The patients were divided into 3 groups: 1 — the endoscopic retrograde method was used (n = 369), 2 — laparotomic access (n = 26), 3 — antegrade X-ray interventional method (n = 71). The results obtained allow us to conclude that the antegrade interventional radiology technique for the treatment of choledocholithiasis has a high clinical efficacy comparable to the endoscopic technique. The use of this treatment option avoids traumatic laparotomies and open interventions on the bile ducts. The use of method is justified in cases of impossibility of performing endoscopic intervention, or its ineffectiveness.

Prevalence, Risk Factors, and Complications of Cholelithiasis in Adults With Short Bowel Syndrome: A Longitudinal Cohort Study.

Background: Patients with short bowel syndrome (SBS) are at a high risk of cholestasis or cholelithiasis. This study aimed to determine the incidence, risk factors, and clinical consequences of cholelithiasis in adults with SBS over an extended period.Methods: All eligible adults diagnosed with SBS and admitted to a tertiary hospital center between January 2010 and December 2019 were retrospectively identified from the hospital records database. Kaplan–Meier analysis was used to estimate the cumulative incidence of SBS during the 10-year period. For assessment the risk factors for cholelithiasis, we used multivariate Cox proportional hazards model with estimation of hazard ratio (HR) with 95% confidence intervals (95 %CI).Results: This study enrolled 345 eligible patients with SBS. Kaplan–Meier analysis revealed that 72 patients (20.9%) developed cholelithiasis during the 10-year observation period. In multivariate analyses using the Cox proportional hazard model revealed that the remnant jejunum (HR = 2.163; 95% confidence interval [CI]: 1.156–4.047, p = 0.016) and parenteral nutrition dependence (HR = 1.783; 95% CI: 1.077–2.952, p = 0.025) were independent risk factors for cholelithiasis in adults with SBS. Twenty-eight patients developed symptoms and/or complications in the cholelithiasis group. Proportions of acute cholecystitis or cholangitis and acute pancreatitis were significantly increased in the cholelithiasis group compared with the non-cholelithiasis group (31.9 vs. 7.7%, p < 0.01; and 6.9 vs. 1.1%, p = 0.003, respectively).Conclusion: Because of the adverse clinical consequences of cholelithiasis, adult patients with SBS should be closely monitored, and preventive interventions should be considered.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04867538.

Laparoscopic Treatment оf Mirizzi Syndrome

Background. Mirizzi syndrome (MS) is a relatively rare complication of cholelithiasis, which occurs in a wide range from 0.2 to 5% according to different authors. Today, the surgical treatment of MS remains a challenge.Aim of study. To determine the possibilities of laparoscopic interventions in the surgical correction of various types of MS.Material AND methods. The work is based on a prospective analysis of cases of laparoscopic treatment of 19 patients with MS who were treated in the emergency surgery departments of the Republican Scientific Center for Emergency Medical Care in 2017–2019. This is 22.9% of all admitted patients (83) with MS during this period. Type 1 MS was diagnosed in 3 patients (15.7%), type 2 was diagnosed in 16 patients (84.2%).Results. In all cases of type 1 MS, laparoscopic cholecystectomy was performed. A new method for the correction of type 2 MS by forming a sleeve from the gallbladder wall was suggested, which was performed in 10 patients with good results. In the postoperative period, no nonspecific complications were observed in patients undergoing laparoscopic interventions. One patient had residual choledocholithiasis, which was managed by day 5 after the surgery with endoscopic retrograde cholangiopancreatography and endoscopic papillosphincterotomy and the removal of the calculus from the common bile duct. The average duration of stay of patients in a hospital bed was 10.8 days. Fatal outcome was observed in 1 case (5.3%).Conclusion. 1. The inclusion of endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and magnetic resonance imaging cholangiography in the diagnostic scheme improves the accuracy and quality of recognition of Mirizzi syndrome and allows the indications for the use of video laparoscopy to be evaluated. 2. Indication for laparocopic treatment of type 2 Mirizzi syndrome is the presence of a single calculus in the supraduodenal part of the common bile duct, which makes it possible to reduce the number of conversion to laparotomy. 3. In cases of type 1 Mirizzi syndrome, the operation of choice is laparoscopic cholecystectomy. 4. The operation of choice in patients with type 2 Mirizzi syndrome is laparoscopic subtotal cholecystectomy, fistula plasty with a gallbladder flap on the Kehr’s T-tube drain with the formation of a “cystic duct”-type sleeve.