Incidence Of Acute Cholecystitis Research Articles

Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease.

The prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities. A total of 270 patients (90 with chronic kidney disease stages III-V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre-dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups. Hepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre-dialysis groups or between the hemodialysis and pre-dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre-dialysis group (p = 0.006). Our study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality.

Clinical correlation of cholelithiasis in patients undergoing percutaneous endoscopic gastrostomy

The risk factor for cholelithiasis include low physical activity. With an aging society, the number of bedridden patients who undergo percutaneous endoscopic gastrostomy (PEG) has increased, and cholelithiasis has often been found in these patients. This study aimed to evaluate the risk factors correlated with cholelithiasis in adults who underwent PEG. This retrospective single-center design study reviewed patients who underwent PEG and were confirmed to have cholelithiasis through imaging from March 1996 to December 2021. The investigated variables were age, sex, body mass index (BMI, kg/m2), cause of PEG insertion, initial physical activity status, laboratory findings on PEG insertion day, and incidence of acute cholecystitis. The differences between categorical and continuous variables were analyzed using Student’s t test and chi-square test. We enrolled 576 eligible patients who underwent PEG insertion. A total of 161 patients were detected with cholelithiasis (28.0%). The overall independent risk factors for cholelithiasis in patients who underwent PEG insertion were increased C-reactive protein (CRP) levels and decreased physical activity status (bedridden state). The incidence of cholelithiasis was increased by up to 30.7%, especially in patients with bedridden status. However, the incidence of acute cholecystitis among cholelithiasis group was only 5.6%. BMI and total cholesterol were positively correlated with the size of gallbladder (GB) stones. One of the major risk factors for cholelithiasis is decreased physical activity, especially in patients who underwent PEG insertion. Abdominal imaging is recommended to confirm the presence of cholelithiasis and to consider prophylaxis for cholelithiasis, especially in bedridden patients with elevated initial CRP levels at the time of PEG insertion.

Cholecystitis in older patients following hip fracture: a case series and literature review

ObjectiveThis study’s aim is to describe the characteristics of perioperative acute cholecystitis in older patients with hip fracture.MethodsFrom January 1, 2018, to April 30, 2023, 7,746 medical records were retrospectively collected for patients aged ≥ 65 years who were hospitalised for hip fracture in Beijing Jishuitan Hospital, Capital Medical University. We reviewed 10 cases with confirmed diagnoses of acute cholecystitis.ResultsOf these 10 cases, five femoral neck fractures and five intertrochanteric fractures received orthopaedic surgery. The ratio of males to females was 2:8, the median age was 83.1 years (71–91 years), and there was a median BMI of 25.35 (15.56–35.16). 50% of cases had a poor functional capacity before fracture of below four metabolic equivalents. The median onset time of acute cholecystitis was five days (2–14 days) after fracture, including five cases before orthopaedic surgery and five cases after orthopaedic surgery. All patients had anorexia and fever during the course of the disease. In seven cases of calculous cholecystitis, two underwent percutaneous transhepatic biliary drainage, and one underwent percutaneous cholecystostomy. Two cases of calculous cholecystitis had poor prognosis; one died 49 days after fracture operation, and the reason for death was multiple organ failure caused by severe infection. The other one developed acute cerebellar infarction after gallbladder surgery through treatment in an intensive care unit and neurology department. The case was discharged with dysphasia, and the duration from fracture to discharge was 92 days.ConclusionThis is the first study on the characteristics of acute cholecystitis in older patients with hip fracture in China. The incidence of acute cholecystitis in our study was 0.13%, with a high risk of in-hospital mortality and elevated hospitalisation costs. Our 10 cases with hip fractures accompanied by acute cholecystitis have common characteristics of poor-to-moderate functional capacity before fracture, increased blood glucose levels and enhanced protein metabolism after fracture. The death and the severe case have similar characteristics of low BMI, multiple underlying diseases, high plasma osmotic pressure and calculous cholecystitis, which occurred after orthopaedic surgery. These issues require attention and prompt, active intervention. Related issues require further research.

ORTAM SICAKLIĞI VE AKUT KOLESİSTİT ARASINDAKİ İLİŞKİ

Aims. Acute cholecystitis is one of the most common emergencies of general surgery. Although there is an increase in the incidence of acute cholecystitis in the summer season when the temperature increases, its cause is not fully understood. The aim of this study is to determine the relationship between acute cholecystitis and temperature.
 Material and Methods: 271 patients admitted to the general surgery service in 2021 were included in this study. Patient data were obtained retrospectively from patient files and data from national centers were used for meteorological data. Conformity of continuous variables to normal distribution was evaluated using visual and analytical methods.
 Results: According to the percentage distribution of cases, acute cholecystitis was most common in summer and least in winter. A very strong positive correlation was found between monthly mean temperature values and monthly incidence of acute cholecystitis (correlation coefficient: r= 0.759 and p=0.004).
 Conclusions: The incidence of acute cholecystitis also increases with increasing ambient temperature, and this is important in terms of planning health services.

The feasibility of percutaneous transhepatic gallbladder aspiration for acute cholecystitis after self-expandable metallic stent placement for malignant biliary obstruction: a 10-year retrospective analysis in a single center.

Patients with acute cholecystitis (AC) after metallic stent (MS) placement for malignant biliary obstruction (MBO) have a high surgical risk. We performed percutaneous transhepatic gallbladder aspiration (PTGBA) as the first treatment for AC. We aimed to identify the risk factors for AC after MS placement and the poor response factors of PTGBA. We enrolled 401 patients who underwent MS placement for MBO between April 2011 and March 2020. The incidence of AC was 10.7%. Of these 43 patients, 37 underwent PTGBA as the first treatment. The patients' responses to PTGBA were divided into good and poor response groups. There were 20 patients in good response group and 17 patients in poor response group. Risk factors for cholecystitis after MS placement included cystic duct obstruction (p<0.001) and covered MS (p<0.001). Cystic duct obstruction (p=0.003) and uncovered MS (p=0.011) demonstrated significantly poor responses to PTGBA. Cystic duct obstruction is a risk factor for cholecystitis and poor response factor for PTGBA, whereas covered MS is a risk factor for cholecystitis and an uncovered MS is a poor response factor of PTGBA for cholecystitis. The onset and poor response factors of AC after MS placement were different between covered and uncovered MS. PTGBA can be a viable option for AC after MS placement, especially in patients with covered MS.

Learning Curve of Laparoscopic Common Bile Duct Exploration: A Systematic Review.

Background: Single-stage laparoscopic common bile duct exploration (LCBDE) with cholecystectomy has superior outcomes over two-stage endoscopic retrograde cholangiopancreatogram with interval cholecystectomy. With decreasing trend of LCBDE, this study aims to summarize the literature on learning curve (LC) in LCBDE. Materials and Methods: PubMed, Embase, Scopus, and the Cochrane Library were systematically searched for articles from inception to June 3, 2022 (PROSPERO Ref No: CRD42022328451). Basic clinical demographics were collected. Poisson means (95% confidence interval [95% CI]) was used to determine the number of cases required to surmount the LC (NLC). Results: Eight articles (n = 2071 patients) reported LC outcomes in LCBDE with mean study period of 5.9 ± 2.8 years. Majority of studies (62.5%) used arbitrary methods of LC analysis. Most common outcomes reported were complications (any or major) (75%), open conversion (75%), length of stay (62.5%), and operating time (50%). Mean CBD diameter was 11.3 ± 4.8 mm (n = 1122 patients). Incidence of acute cholecystitis, acute cholangitis, and acute pancreatitis were 13.9% (n = 232/1668), 7.8% (n = 128/1629), and 13.7% (n = 229/1668), respectively. Pooled analysis of all the included studies showed NLC of 78.8 cases (95% CI: 71.9-86.3). Studies that used cumulative sum control chart analysis, nonarbitrary methods, and arbitrary-based LC had NLC of 152.0 (95% CI: 135.4-170.1), 108.0 (95% CI: 96.6-120.4), and 49.7 (95% CI: 42.0-58.3) cases, respectively. NLC was 37.0 cases (95% CI: 29.1-46.5) for single surgeon LC, and 99.8 cases (95% CI: 90.2-110.0) for institutional LC. Conclusion: Studies reporting NLC in LCBDE are heterogeneous. Further studies should use nonarbitrary methods of analysis for patient-reported outcome measures and procedure-specific morbidity.

Acute Cholecystitis: An Emerging Complication in Spinal Cord Injury Patients in the United States.

Spinal cord injury (SCI) is a significant medical condition associated with various secondary complications, including cholelithiasis. Cholelithiasis can cause biliary duct obstruction and result in acute cholecystitis. The development of acute cholecystitis in SCI patients has been well studied in the Taiwanese population, showing an increased risk of acute cholecystitis in patients with SCI. The development of cholecystitis has not been well studied in the United States. A retrospective review was performed on 3,939 propensity score-matched patients aged 18 to 85 years who had SCI/surgery from 2000 to 2019. Patients were divided based on the development of postoperative complications, specifically cholecystitis with cholecystectomy. SCI consisted of quadriplegia (42%), paraplegia (53%), unspecified lesion of cervical spinal cord (3%), and thoracic spinal cord (2%). All groups were comparable regarding age, gender, body mass index, smoking status, and Charlson comorbidity Index. The incidence of acute cholecystitis with subsequent cholecystectomy among patients with SCI was 43.0 per 10,000 person-years (95% confidence interval: 41.51-44.49). Median follow-up was 36 months. The development of cholecystitis was comparable among females (54.5%) and males (45.5%), and among African Americans (52.5%) and Caucasians (47.5%). There is an association between SCI and development of acute cholecystitis among U.S. As SCI patients do not present with the classic signs of biliary colic, risk assessment for the development of acute cholecystitis will guide patient management and allow neurosurgeons to weigh the risks and benefits of prophylactic treatment for gallbladder complications.

Ambient temperature and hospital admissions for acute cholecystitis: a nationwide inpatient database study in Japan.

The incidence of acute cholecystitis has a seasonal peak in summer. However, the reason for such seasonality remains unclear. This retrospective cohort study was performed to examine the association between ambient temperature and acute cholecystitis. We identified admissions for acute cholecystitis from January 2011 to December 2017 from a nationwide inpatient database in Japan. We performed a Poisson regression analysis to investigate the association between ambient temperature and admission for acute cholecystitis with adjustment for relative humidity, national holidays, day of the week, and year. We accounted for clustering of the outcome within prefectures using a generalized estimating equation. We analyzed 601665 admissions for acute cholecystitis. With an ambient temperature of 5.0°C-9.9°C as a reference, Poisson regression showed that the number of admissions increased significantly with increasing temperature (highest above 30°C; relative risk, 1.35; 95% confidence interval, 1.34-1.37). An ambient temperature of <5.0°C was also associated with higher admission for acute cholecystitis than an ambient temperature of 5.0°C-9.9°C (relative risk, 1.23; 95% confidence interval, 1.21-1.25). The present nationwide Japanese inpatient database study showed that high temperature (≥10.0°C) and low temperature (<5.0°C) were associated with increased admission for acute cholecystitis.

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.

A comparative study of interval cholecystectomy and early cholecystectomy in acute cholecystitis

Background: In the whole world including India, the incidence of acute cholecystitis is increasing day by day. Gall stones are the most common cause of acute cholecystitis in 90-95% of the cases. The management of acute cholecystitis was conservative earlier but now there are studies recommending early surgery as the treatment of choice.Methods: Our study was conducted on 60 patients divided into two groups of 30 each to compare the results of early surgery with the delayed surgery.Results: The overall post-operative complication rate was same in both the groups but there was significant difference in the total hospital stay and total cost of the therapy in both the groups. The average total hospital stay in early group was 6.50±4.44 days and in delayed group was 10.80±5.55 days without including the number of days in non-operating admission.Conclusions: So, early cholecystectomy was found to be more economical with less total hospital stay and less total cost of the therapy than interval cholecystectomy in acute cholecystitis.

Increased Risk of Acute Cholecystitis in Patients With Spinal Cord Injury

Retrospective cohort study. To evaluate the risk of acute cholecystitis (AC) in patients with spinal cord injury (SCI) based on a nationwide sample. Prior research evaluating the risk of AC in patients with SCI is limited. Moreover, since most previous studies on the association between AC and SCI used case-series designs, little is known about the relative risk of SCI patients developing AC from a longitudinal follow-up, compared with individuals without SCI. We used the data from Taiwan's National Health Insurance Research Database. The SCI group consisted of 11,523 patients with SCI aged between 20 and 90 years. Propensity score matching procedure was employed to minimize potential confounding effects arising from the imbalance in the baseline characteristics. A total of 23,046 propensity score-matched patients without SCI were enrolled in the non-SCI group. We compared the incidence of AC between these two groups, and assessed the impact of SCI on the risk of developing AC. In the SCI and non-SCI groups, the respective incidence rates of AC were 36.9 (95% confidence interval [CI], 30.0-44.8) and 25.2 (95% CI, 21.2-29.8) per 10,000 person-years. As compared with the non-SCI group, the hazard ratio for the SCI group of AC was 1.71 (95% CI, 1.22-2.41, P = 0.0018); and the cumulative incidence of AC of the SCI group was higher than that of the non-SCI group (P = 0.0036). This population-based cohort study showed that there was an increased risk of AC in patients with SCI. 3.

The Incidence and Surgical Treatment of Gallstone Cholecystitis in Rural Saudi Arabia

Cholecystolithiasis and its complications remain to be one of the leading burdens in general surgery which require surgical intervention in majority of cases. In Saudi Arabia, this pathology has huge impact on its health system and society. In current management of acute and chronic cholecystitis as a result of cholecystolithisis, laparoscopic cholecystectomy has become a procedure of choice. The aim of this cross-sectional study was to estimate the incidence of cholecystitis as the complication of cholecystolithiasis in central rural area of Saudi Arabia with relatively large population and analyze current management outcome in selected group of patients, who underwent laparoscopic cholecystectomy procedure. Multiple criteria including demographics, results of investigations and surgical outcome were analyzed and compared. The incidence of acute cholecystitis in this study was 4.4/100,000 of population per year with prevalence of 24% and female to male ratio 11.9:1. The results demonstrated satisfactory surgical outcomes with low complications rate and cost effectiveness.

An Assessment of Knowledge towards Acute Cholecystitis among General Population of Albaha City

Background: Acute cholecystitis is an acute inflammation of the gallbladder, and it is the most common cause of acute pain in the right upper quadrant. It is a critical clinical problem representing up to 5% of emergency room visits. Objective: The aim of the present study was to assess the knowledge of the general population of Albaha City, Saudi Arabia towards acute cholecystitis (AC). Methods: A representative sample of 634 subjects from both sexes, aged from 18-80 years who completed a standardized questionnaire was involved in the study. Results: Only 48 subjects had history of the disease with a prevalence rate of 7.57%. More than half of the participants (58.7%) recorded family history of AC in one of their direct relatives. Great percent of the study participants considered obesity, high cholesterol and high triglycerides responsible for increased incidence of AC (59.9%, 54.3% and 66.9%). A high percentage of the participants (55.2%, 48.3%, 38.2%, 62.8%, 36.9% and 54.3%) did not know whether their food or habits could predispose to AC. Higher percentages considered intolerance to fatty meals, nausea and vomiting as symptoms of AC (55.5%, 48.9 %and 46.7% respectively). Most of the participants (75.7%) did not receive any information about AC prevention. Their established information was highly or to some extent effective in changing the participants’ life style (39.0% and 42.9% respectively). Conclusion: This survey has been useful in determining the current regional knowledge towards AC among general population in Albaha city. Such study emphasizes the need for more efforts that focus on novel preventive strategies to overcome the onset of gallstones. Further much bigger collaborative national studies are recommended.

An Assessment of Knowledge towards Acute Cholecystitis among General Population of Albaha City

Background: Acute cholecystitis is an acute inflammation of the gallbladder, and it is the most common cause of acute pain in the right upper quadrant. It is a critical clinical problem representing up to 5% of emergency room visits. Objective: The aim of the present study was to assess the knowledge of the general population of Albaha City, Saudi Arabia towards acute cholecystitis (AC). Methods: A representative sample of 634 subjects from both sexes, aged from 18-80 years who completed a standardized questionnaire was involved in the study. Results: Only 48 subjects had history of the disease with a prevalence rate of 7.57%. More than half of the participants (58.7%) recorded family history of AC in one of their direct relatives. Great percent of the study participants considered obesity, high cholesterol and high triglycerides responsible for increased incidence of AC (59.9%, 54.3% and 66.9%). A high percentage of the participants (55.2%, 48.3%, 38.2%, 62.8%, 36.9% and 54.3%) did not know whether their food or habits could predispose to AC. Higher percentages considered intolerance to fatty meals, nausea and vomiting as symptoms of AC (55.5%, 48.9 %and 46.7% respectively). Most of the participants (75.7%) did not receive any information about AC prevention. Their established information was highly or to some extent effective in changing the participants’ life style (39.0% and 42.9% respectively). Conclusion: This survey has been useful in determining the current regional knowledge towards AC among general population in Albaha city. Such study emphasizes the need for more efforts that focus on novel preventive strategies to overcome the onset of gallstones. Further much bigger collaborative national studies are recommended.

Association of covered metallic stents with cholecystitis and stent migration in malignant biliary stricture

ERCP with self-expandable metallic stent (SEMS) placement provides reliable and durable relief of malignant biliary obstruction. Our objective was to compare efficacy and adverse outcomes between uncovered SEMSs (USEMSs) and covered SEMSs (CSEMSs). A retrospective cohort study was performed of all consecutive patients who underwent ERCP with SEMS placement for the management of a malignant bile duct stricture. Comparative analyses on clinical success, patency duration, stent dysfunction, and adverse outcomes were performed. Univariate and multivariable analyses were performed to identify factors associated with stent dysfunction. Six hundred forty-five patients underwent SEMS placement for the management of malignant bile duct stricture from 2008 to 2016. CSEMSs and USEMSs had similar rates of clinical success in relief of bile duct obstruction (93.0% vs 92.1%, respectively; P= .69) and patency duration (546.7 vs 557.9 days, P= .14). Among those with an intact gallbladder, the incidence of acute cholecystitis was higher in the CSEMS group compared with the USEMS group (7.8% vs 1.2%; P< .001). In the multivariable analysis, CSEMS use was associated with increased risk of stent migration (hazard ratio, 10.7; 95% confidence interval, 4.1-27.7). CSEMSs and USEMSs have similar clinical success rates and patency durations in management of malignant bile duct stricture. CSEMSs, however, are associated with increased rates of migration and cholecystitis. Comparable efficacy and superior safety profile of USEMSs render a compelling argument for its place as the preferred choice of SEMSs in the management of malignant biliary stricture.

Older age did not increase short-term surgical complications after laparoscopic cholecystectomy

Objective: We aimed to evaluate short-term results of laparoscopic cholecystectomy (LC) in patients over 60 years to provide additional information on best treatment of elderly patients. Methods: We retrospectively evaluated 334 patients over 60 years that underwent LC at our Institution. Complications were graduated according to Clavien–Dindo classification. Patients were allocated into 2 groups according to age: 60–70 (G1) and more than 70 years (G2). Results: The table shows 67.4% of patients were female (age of 67.46±6.47 y and BMI of 28.14±5.29 kg/m2, 82.03% had comorbidities, and 20.95% did not have biliary symptoms. The mean duration of surgery was 154.7±61.73 min, and 21.86% of patients had complications with median grade of highest complication of I (IV) and rate of early postoperative death of 0.60%. G2 patients showed decreased Karnofsky status [80 (50100) × 90 (40100)], and increased ASA score (2.15±0.56 × 1.98±0.53), incidence of acute cholecystitis (28.20% × 11.71%), admissions to ICU (20.51% × 7.81%), insertions of abdominal drains (26.92 × 10.15), and length of stay [2 (117) × 1 (117)] compared to G1. Conclusion: The study showed that elective LC is a safe procedure in aged patients. Patients over 70 years presented increased ASA scores and worse performance status compared to patients over 60. Despite presenting significantly more cases of acute cholecystitis, more admissions to ICU, more cases of abdominal drainage, and prolonged hospital stay, patients over 70 years did not presented increased morbidity and mortality. This suggests laparoscopic cholecystectomy is a safe procedure in aged patients. However elderly patients may be at risk of developing adverse events related to increased incidence of comorbidities.

Begin Treating Acute Cholecystitis Based on Point-of-Care Ultrasound Findings

The incidence of acute cholecystitis continues to increase. Its diagnosis in the emergency department (ED) is often made by clinician gestalt based on

Laparoscopic Cholecystectomy in Cirrhotic Patients

Background: Cholelithiasis is very common in cirrhotic patients (15-30%), occurring 1 to 3 times more often than in general population. The presence of cirrhosis, hepatocellular failure and/or portal hypertension increases the risk of postoperative complications in any type of surgery, especially biliary. Methods: A review of the literature over the last 8 years (2005-2013) was performed by searching the Medline database using the following keywords “Laparoscopic Cholecystectomy” and “cirrhosis”. We selected 11 studies that were considered well-documented and contained comparable data. We analyze the demographics, cholecystectomy indication and duration, incidence of perioperative complications and time of hospitalization in cirrhotic and noncirrhotic patients. Results: Analysis of the literature revealed a total of 842 cirrhotic patients that undergone laparoscopic cholecystectomy in group of 11 published studies. The incidence of acute cholecystitis as indication for LC (Laparoscopic Cholecystectomy) was extremely variable (3.6% to 52.38%). The ratio women to men were 1.06: 407 patients (48.34%) were men and 435 were women (51.66%). Mean of mean age reported by each series was of 53.77 years (range 21-86). Child-Pugh class was reported by 10 studies for a total of 577 patients, most of them being Child-Pugh class A (443 cases, 76.78%) and B (119 cases, 23.22%). The average operating time of reported mean values was of 94.14 minutes. Average overall morbidity rate was of 24.87%; a single study reported 75% morbidity, all other studies indicating rates of maximum 35%. The length of hospital stay was of 3.47 days (range: 1.87 to 7.2). Conclusions: LC, although initially contraindicated in cirrhotic patients, has gradually replaced open cholecystectomy as standard surgical procedure. The operative risk in patients with liver disease depends on the degree of preexistent hepatic dysfunction, nature of the procedure and comorbid conditions.

Effect of Diabetes on Outcomes in Patients Undergoing Emergency Cholecystectomy for Acute Cholecystitis

In this study, one of the most prevalent diseases meets one of the most frequently performed operations. This topic is becoming more and more important because of the increasing age of the surgical population, paralleling the increasing incidence of diabetes. Karamanos et al. [1] analyzed data collected between 2004 and 2010 in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, focusing on 5,460 patients who underwent emergency inpatient cholecystectomy for acute cholecystitis. The main aim of the study was to identify the prevalence of diabetes in this patient group and explore its effect on surgical outcomes. Multivariate analysis revealed significantly more adverse events in patients with diabetes than in nondiabetics, particularly regarding mortality, preoperative gallbladder perforation, and infectious complications. In light of the large database and robust multivariate analysis, the authors provide relevant support for their hypothesis. Of interest is the strong impact of diabetes mellitus on the presentation of cholecystitis, with a significantly increased incidence of preoperative gallbladder perforation. Potential causal interactions between the incidence of acute cholecystitis and diabetes will hopefully be addressed in future studies. Another interesting finding is the impact of insulin use on local and systemic infections compared to its effect on diabetic patients given oral medication and patients without diabetes mellitus. The elevated incidence of infections is unlikely to be explained by the higher incidence of perforations and longer hospital stays. Potentially complex interactions between diabetes and other aspects of the metabolic syndrome—obesity, fatty liver disease, consequences of arteriosclerosis—may influence the incidence of these outcome parameters. The impact of diabetes on some clinical outcome parameters may be explained in part by differences between the populations because despite being extensive multivariate analysis might not entirely correct for all factors that may have a causal effect on the observed events. The data of this study pave the way for new studies that address therapeutic aspects in patients with diabetes undergoing laparoscopic cholecystectomy. Optimal blood glucose levels and the intensity of the insulin treatment are of particular clinical interest in this population. With our current knowledge, it is unclear if local and systemic complications are altered by different approaches of intraoperative and postoperative glucose control, including tight glycemic control or standard care [2]. The present article addresses a frequent and highly relevant clinical scenario. In future, surgeons need to investigate further the relevance of the metabolic syndrome and associated diseases to the pathogenesis, outcomes, and clinical management of their patient population.

Hepatobiliary rim sign

The role of a 'rim sign' in increasing specificity for acute cholecystitis and sensitivity for complicated acute cholecystitis has been substantiated in many small retrospective studies. We sought to corroborate this correlation in a large population, as we have encountered doubt among surgeons about the emergent implications of this sign. We performed a small pilot interobserver reliability test with five nuclear medicine physicians from outside institutions. A total of 2881 consecutive hepatobiliary scans performed over 12 years for evaluation of acute cholecystitis were retrospectively reviewed. Available pathological (reference standard) and surgical reports were reviewed for all cases of acute cholecystitis (on scintigraphy) with a rim sign and for an equivalent set without a rim sign. There was no statistically significant interobserver agreement on the presence of a rim sign. There was a 32.4% incidence of acute cholecystitis, based on scintigraphy, and a 10.1% incidence of rim signs. Of 63 pathologic specimens from rim-sign-positive cases, 19 (30.2%) showed acute cholecystitis and 44 (69.8%) showed chronic cholecystitis. Six (9.5%) cases were complicated. Among 55 pathologic specimens from the acute scintigraphy cases without a rim sign, 21 (38.2%) showed acute cholecystitis and 34 (61.8%) showed chronic cholecystitis. There were eight (14.5%) complicated cases. There was no interobserver reliability in the identification of a rim sign. There was almost no difference in the incidence of pathologically acute, chronic, or complicated acute cholecystitis among scintigraphically acute cases with or without a rim sign, approximately two-thirds to three-quarters of which were chronic on pathological evaluation.