Indications For Laparoscopic Cholecystectomy Research Articles

Laparoscopic Cholecystectomy in Children: The Experience of Two Centers Focusing on Indications and Timing in the Era of "New Technologies".

In children, laparoscopic cholecystectomy (LC) is now considered the gold standard for gallbladder (GB) removal. In the past, hemolytic disorders associated with cholelithiasis represented the most frequent conditions requiring LC; this is being overtaken by cholelithiasis and biliary conditions in overweight or ex-premature children. This study aims to describe current indications and timing for LC in pediatric patients. Retrospective study. Data on previous medical therapy, ultrasound, pre- and intraoperative aspects, and histology were collected for patients treated in 2020-2023. In total, 45 patients were enrolled: 15 who underwent urgent surgery and 30 electives. Groups differed in terms of obesity rate, symptoms, ultrasound features, and intraoperative status. The most relevant risk factors for surgical complexity were age and pubertal stage, elevated cholestasis indexes, and gallbladder wall thickness > 3 mm at ultrasound. GB wall thickening ≥3 mm, US Murphy sign, fluid collections, and gallbladder distention on ultrasound correlated with high surgical scores. Indications for laparoscopic cholecystectomy in children seem to evolve caused by changing characteristics of the pediatric population. Patients with overweight/obesity may develop more complex GB diseases. Asymptomatic patients should be considered for surgery after observation, considering age and/or pubertal maturation when other risk factors are absent.

Risk Factors and Prevalence Associated With Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Tertiary Care Hospital Experience in Western Mexico.

Introduction Laparoscopic cholecystectomy (LC) is a common procedure used for the treatment of different pathologies caused by gallstones in the gallbladder, and one of the most common indications is acute cholecystitis. The definitive treatment for acute cholecystitis is surgery, and LC is the gold standard. Nevertheless, transoperative complications (like intraoperative bleeding, anatomical abnormalities of the gallbladder, etc.) of LC and some other preoperative factors (like dilatation of bile duct, increased gallbladder wall thickness, etc.) can cause or be a risk factor for conversion to open cholecystectomy (OC). The objective of this study was to determine the risk factors and prevalence associated with the conversion from LC to OC in patients with gallbladder pathology and the indication for LC. Materials and methods This was a prospective cohort study. We included patients of both sexes over 18 years of age with gallbladder disease. To determine the risk factors associated with conversion, we performed a bivariate analysis and then a multivariate analysis. Results The rate of conversion to OC was 4.54%. The preoperative factors associated with conversion, in the bivariate analysis, were common bile duct dilatation (p=0.008), emergency surgery (p=0.014), and smoking (p=0.001); the associated intraoperative variables were: laparoscopic surgery duration (p <0.0001), Calot triangle edema (p=0.033), incapacity to hold the gallbladder with atraumatic laparoscopic tweezers (p=0.036), and choledocholithiasis (p=0.042). Laparoscopic Surgery duration was the only factor with a significant association in the multivariate analysis (p=0.0036); we performed a receiver operating characteristic (ROC) curve analysis and found a cut-off point of 120 minutes for the duration of laparoscopic surgery with a sensitivity and a specificity of 67 and 88%, respectively. Conclusion The prevalence of conversion from LC to OC is similar to that reported in the international literature. The risk factors associated with conversion to OC, in this study, should be confirmed in future clinical studies, in this same population, with a larger sample size.

Retrospective analysis of a single unit experience in laparoscopic cholecystectomy in Northern Sri Lanka during the Covid-19 pandemic

Introduction: Laparoscopic cholecystectomy is a surgical procedure that removes a diseased gallbladder for various indications. It is preferred over open cholecystectomy due to fewer complications and early recovery. However, it carries different operative and postoperative complications. In addition, the availability of resources and skillful surgeons limits its use worldwide. Analysing the experience of laparoscopic cholecystectomy will enhance the training and skills and improve the surgical outcome.&#x0D; Methods: All the laparoscopic cholecystectomies done from July 2020 to July 2022 were analysed retrospectively. &#x0D; Results: This study included eighty-seven surgeries with patients ages 8 to 84 years (mean 51.76 ±17.15). Male patients were 32.2% and females 67.8%. The indication for laparoscopic cholecystectomy was symptomatic gallstone disease in 72.4% acute/chronic cholecystitis in 14.9%, distal CBD stones in 5.7%, Gall bladder polyp in 3.4%, biliary colic in 18.4%, cholangitis in 1.2%, obstructive jaundice in 1.2% and pyocele in 1.2%. ERCP was performed by the surgeons of the same unit to manage 6.8% of the cases preoperatively and 2.2% post-operatively. Intra-operative difficulty or problems was seen in 24.13% of the cases, which included adhesions with adjacent organs in 14.9%, difficult identification of Calot's triangle in 3.4%, bile spillage 6.8% and abnormally distended gall bladder, adhered deep into the liver, and double gallbladder in 1.2% each. 1.2% of the cases needed conversion to open. Postoperative complications were noted in 20.68% of cases. 3.4% had Clavian Dindo grade I complications.&#x0D; Conclusion: Professorial unit Teaching hospital Jaffna is performing laparoscopic cholecystectomies even in the presence of limited resources. The outcomes were comparable with the international standards published up to date.&#x0D;

Asymptomatic limy bile gallstone in a 6-year-old boy

Limy bile gallstone is relatively rare condition in which the gallbladder contains white, calcified, radiopaque stones. This condition is even rarer in pediatric patients. We herein report a case of a 6-year-old male patient with asymptomatic limy bile gallstone who underwent laparoscopic cholecystectomy. A 6-year-old male patient was referred to our department due to gallstone with calcification, which was identified incidentally during medical surveillance for enuresis nocturnal. Ultrasonography revealed a calcified gallstone, whereas magnetic resonance cholangiopancreatography showed a filling defect in the gallbladder, no dilatation, and a filling defect in the common bile duct. Although the patient was asymptomatic, he underwent laparoscopic cholecystectomy. The procedure was performed safely with an uneventful postoperative course. Obstruction of the cystic duct was considered the etiology for the formation of the limy bile gallstone in the present. Given that indications for laparoscopic cholecystectomy among pediatric patients with asymptomatic gallstones remains controversial, physicians should consider conducting laparoscopic cholecystectomy when atypical findings are encountered in pediatric gallstone cases.

709 Covid-19 Pandemic: Audit on The Management of Acute Cholecystitis

BackgroundThe definitive management of acute cholecystitis is laparoscopic cholecystectomy on the same admission if the patient is fit. As the Covid-19 pandemic emerged, evidence suggested adverse outcomes for asymptomatic Covid positive patients undergoing surgery, including increased mortality risk. Risks to theatre staff were also highlighted. This prompted changes in acute cholecystitis management guidelines.MethodThe audit aim was to assess the impact of guideline change on clinical outcomes and readmission rate for acute cholecystitis. The revised Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) guidelines were the gold standard. All inpatient admissions for acute cholecystitis during the 4-week peak of the pandemic (17/04/2020 – 14/05/2020) were included.Result24 patients were admitted with acute cholecystitis. 10 patients (41.7%) were managed with antibiotics alone, 4 patients (16.6%) underwent cholecystostomy. 12 patients (50%) were discharged within 3 days. Lack of clinical progress/ongoing symptoms was the indication for laparoscopic cholecystectomy in 5 cases (20.8%). 5 conservatively managed patients (20.8%) were readmitted with ongoing cholecystitis or pancreatitis.Conclusions19 patients (80%) were managed non-surgically in accordance with AUGIS guidelines. However conservative management was not always appropriate. We recommend that laparoscopic cholecystectomy should remain a management option for acute cholecystitis during the ongoing Covid-19 pandemic.

Laparoscopic cholecystectomy by paediatric surgeons: can established standards of care be delivered?

Laparoscopic cholecystectomy (LC) case volume is low for paediatric surgeons relative to the adult sector; coupled with service differences, internationally accepted standards may be more challenging to meet. This study sought to determine (i) the outcomes of LC in children, and (ii) whether recognised care pathways (e.g. acute LC, access to cholangiogram/ERCP and day-case LC provision) can be delivered. Patients who underwent LC were identified retrospectively in a single institution between January 2009 and January 2019. Data are presented as median [IQR] and continuous variables compared using a t test. 101 cases were included (age 12.9 years [10.2–15]; female 65/101). Indications for LC were symptomatic gallstones (98/101) and polyps (2/101). ERCP and/or endoscopic ultrasound were performed in 23/101. For acute presentations, 7/24 (29%) had LC during the same admission. Trainees performed LC in 33/101. 4/101 required intra-operative cholangiogram. Operative time was 109.5 min [90.8–139.5]: consultant vs. trainee times were similar (114 [93.3–149.5] vs. 99.5 [81.5–125.3], p = 0.06). Length of stay was one day [1–1] with 10/101 being day-cases. There were no major complications or re-operations. We report good outcomes from LC. Furthermore, we have demonstrated the capacity to deliver recognised standards of care within a paediatric setting.

Diagnosis and treatment of acute cholecystitis

Diagnosis and treatment of acute cholecystitis Abstract. Acute cholecystitis is one of the most common acute surgical diseases. Typical clinical symptoms are pain in the upper abdomen, fever and leucocytosis. Ultrasonography may often be used to confirm the clinical diagnosis. There is a consensus that laparoscopic cholecystectomy is recommended as the treatment of choice and should be performed immediate after diagnosis independent of the onset of symptoms. The risk of complications is prevented by surgery. Surgery is the treatment of choice for acute cholecystits also in elderly patients with severe comorbidities. Conventional laparoscopic 3 - 4 port cholecystectomy is considered as a standard for removing the gallbladder. Laparoscopic cholecystectomy has become established as a safe standard procedure in the treatment of symptomatic cholecystolithiasis and cholecystitis with low mortality and morbidity. Nevertheless, this procedure is associated with typical complications. Bile duct injuries are among the most serious injuries. Most complications are the consequence of lack of experience or technical causes. By reasonably indication for laparoscopic cholecystectomy and a low inhibition rate of conversion, combined with adequate training (laparoscopy courses), the complication rate can be kept very low.

Feasibility and outcomes of 3-port laparoscopic cholecystectomy in the pediatric population

Objective: The objective of this retrospective study was to describe our experience with 3-port laparoscopic cholecystectomy in a total 20 pediatric patients. Method: Data on patient demographics, indication for cholecystectomy, surgical technique, operative time (minutes), complications and length of hospital stay (LOS, day) were recorded. Result: Mean (SD) operative time was 44.8 (9.5, range: 30.0-60.0) minutes and LOS was 2.1(1.2, range: 1.0-5.0) days. Surgery was successful in all patients without development of major complications. Apart from significantly shorter operative time in patients with cholelithiasis than those with other indications for laparoscopic cholecystectomy (median 42.2 vs. 55.0 min, p=0.001), no significant difference was noted in age, operative time and LOS with respect to gender or indications. Conclusion: Our findings indicate safety and efficacy and feasibility of 3-port laparoscopic cholecystectomy in the pediatric population, regardless of indication or gender along with significant advantages regarding the operative time, complication rates and hospital stay.

Fate of dyspeptic symptoms following Lap. cholecystectomy

Background: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstone disease. Symptoms of abdominal pain, nausea, food intolerance, and others are common, and their relationship to biliary disease is often well known but other Gastro-Intestinal conditions may cause them also. Continuation of such symptoms post-operatively is the target of this study. Aim of study: To assess the incidence, etiology, management and preventing measures of persistent dyspeptic symptoms following laparoscopic cholecystectomy.Patients and methods: This is a Prospective study performed in Al-Fallujah teaching hospital on One hundred thirty six patients undergoing laparoscopic cholecystectomy between September 2016 and September 2017. They were evaluated using a questionnaire for data collection; inquiring about: indication for laparoscopic cholecystectomy, characteristics of pain, and other associated dyspeptic and colonic symptoms. The patients were re-evaluated with the same questionnaires after surgery during a period from 2-12 weeks, and classified into two groups: first group includes patients get benefit of surgery (relieved symptoms) and those whom symptoms not eliminated by surgery (persistent symptoms). 21 patients were excluded from our analysis; five of them had conversion to open surgery & we lost contact with sixteen patients post-operatively.Results: The median age of the remaining 115 patients was 34.4 year (range 17-55) years; 20 were men. All were diagnosed to have symptomatic gall stones disease and all were scheduled for laparoscopic cholecystectomy (L.C.). 16 patients (13.9%) had persistent symptoms post-operatively during the follow-up period. Our study concentrated on the correlation between the preoperative presentation and the continuation of post-operative symptoms. Statistical analysis showed that food intolerance and nausea were more common among those with a poor outcome after laparoscopic cholecystectomy. Patients with persistent dyspeptic symptoms despite operation; their symptoms were indeed belongs to GERD and P.U disease in the majority of them. Conclusion: Nonspecific dyspeptic symptoms like heartburn, food intolerance and nausea are not adequate reasons for taking the decision of laparoscopic cholecystectomy. Patients with dyspeptic, or colonic symptoms should be thoroughly evaluated to avoid unnecessary cholecystectomy in those with other Gastro-Intestinal pathology that share the same symptoms of Gallstones.

Laparoscopic cholecystectomy with only two 5 mm trocars in a pregnant woman with biliary pancreatitis

Laparoscopic cholecystectomy (LC) during advanced pregnancy is challenging due to limited intraabdominal space. Patients may be at increased risk for a trocar site hernia. A 35-year-old female in her 22nd week of pregnancy was admitted with acute right upper quadrant pain. Amylase was elevated, LFTs were normal; ultrasound showed acute cholecystitis and no dilated biliary duct. Fetal ultrasound was normal. Antibiotics were started. Amylase peaked at >600 U/L before normalizing, indication for LC was made. MRCP and ERCP were not performed as the patient seemed to have passed a stone. Five mm trocars were placed in the left upper quadrant (LUQ) and umbilicus and a Teleflex minigrasper between the two. The uterus was at the umbilical level. The GB serosa was incised on both sides and a window was created behind the GB midportion and widened towards infundibulum and fundus. GB wall thickening and edema was noted. The critical view was obtained and cystic artery and duct were clipped and divided. The specimen was retrieved through the LUQ port site using a 5 mm endobag after dilatation to 12 mm due to the presence of two large stones. The port site fascia was closed using a suture passer. The postoperative course was uneventful and both mother and baby were well during follow up. In case of biliary pancreatitis during pregnancy, LC should be performed and if ultrasound shows a normal biliary system and amylase/lipase normalize, MRCP/ERCP and IOC may be avoidable. LC with two ports is feasible during pregnancy.

English

English

Conversion and complications of elective laparoscopic cholecystectomy in a West African population

Background Laparoscopic cholecystectomy (LC) is increasingly adopted in Nigeria, but the procedure is limited due to the low incidence of gallstone diseases. This study aims to determine the incidence of conversion and complications following elective LC. Patients and methods Consecutive patients undergoing elective LC at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, were the participants. Patients’ preoperative characteristics including ultrasonographic findings, instances of conversions, and intraoperative and postoperative complications were documented. The influence of gallbladder wall thickness on the outcome was analyzed. Results There were 150 patients, including 124 (82.7%) women and 26 (17.3%) men aged 18–82 years (mean=45.4, SD=13.38). Indications for LC were chronic calculous cholecystitis in 101 (67.3%), 45 (30%) acute calculous cholecystitis, whereas four (2.7%) had acalculous cholecystitis. Gallbladder wall thickness was normal (≤3 mm) in 98 (65.3%), thick (4–9 mm) in 35 (23.6%), and very thick (≥10 mm) in 17 (11.3%) patients, whereas 11 patients had pericholecystic fluid collection. Gallbladder mucocele was encountered in nine (6%), empyema in six (4%), and gangrenous gallbladder in two (1.3%) cases. Ten (6.7%) procedures were converted to laparotomy including two patients with hemoglobinopathies. Postoperatively, bile leaks occurred in two patients, bleeding requiring reeploration in one, and bile duct dilatation after 4 months in one patient. Acute cholecystitis, hemoglobinopathy, and thickened gallbladder wall significantly influenced conversions and occurrence of complications in this series. Conclusion We observed a low rate of conversion and complication following LC. Acute cholecystitis and thickened gallbladder wall significantly influence the conversion of LC to open procedure in our setting.

Діагностично-лікувальний алгоритм при гострому холециститі

На основі аналізу виконаних у Центрі лапароскопічних і малоінвазивних хірургічних втручань під контролем ендоскопії та сонографії імені Ю. Семенюка 12 432 лапароскопічних холецистектомії за період 1997–2016 рр. вивчено ускладнення, які виникають під час здійснення лапароскопічних операцій у хворих із гострим деструктивним холециститом, обґрунтовано застосування діагностично-лікувального алгоритму при даній патології, вдосконалено технічні підходи до виконання лапароскопічної холецистектомії, що в сукупності дозволило розширити показання до лапароскопічної холецистектомії у хворих із гострим деструктивним холециститом та його ускладненнями.

Nineteen-year trends in incidence and indications for laparoscopic cholecystectomy: the NY State experience.

Since the introduction of laparoscopic cholecystectomy (LC), there has been continued evolution in technique, instrumentation and postoperative management. With increased experience, LC has migrated to the outpatient setting. We asked whether increased availability and experience has impacted incidence of and indications for LC. The New York (NY) State Planning and Research Cooperative System longitudinal administrative database was utilized to identify patients who underwent cholecystectomy between 1995 and 2013. ICD-9 and CPT procedure codes were extracted corresponding to laparoscopic and open cholecystectomy and the associated primary diagnostic codes. Data were analyzed as relative change in incidence (normalized to 1000 LC patients) for respective diagnoses. From 1995 to 2013, 711,406 cholecystectomies were performed in NY State: 637,308 (89.58%) laparoscopic. The overall frequency of cholecystectomy did not increase (1.23% increase with a commensurate population increase of 6.32%). Indications for LC during this time were: 72.81% for calculous cholecystitis (n=464,032), 4.88% for biliary colic (n=31,124), 8.98% for acalculous cholecystitis (n=57,205), 3.01% for gallstone pancreatitis (n=19,193), and 1.59% for biliary dyskinesia (n=10,110). The incidence of calculous cholecystitis declined (-20.09%, p<0.0001) between 1995 and 2013; meanwhile, other diagnoses increased in incidence: biliary colic (+54.96%, p=0.0013), acalculous cholecystitis (+94.24%, p<0.0001), gallstone pancreatitis (+107.48%, p<0.0001), and biliary dyskinesia (+331.74%, p<0.0001). Outpatient LC incidence catapulted to 48.59% in 2013, from 0.15% in 1995, increasing >320-fold. Analysis of LC through 2014 revealed increasing rates of digestive, infectious, respiratory, and renal complications, with overall cholecystectomy complication rates of 9.29%. A shifting distribution of operative indications and increasing rates of complications should prompt careful consideration prior to surgery for benign biliary disease. For what is a common procedure, LC carries substantial risk of complications, thus requiring the patient to be an active participant and to share in the decision-making process.

Występowanie i przyczyny kamicy pęcherzyka żółciowego u dzieci i młodzieży

IntroductionCholelithiasis is a relatively rare disease in children. It causes difficulty in identification because of non-specific symptoms or asymptomatic course. In the case of asymptomatic cholelithiasis, the treatment with an Ursodeoxycholic acid (UDCA) is the most commonly used pharmacological therapy, and symptomatic cholelithiasis is an indication for laparoscopic cholecystectomy. AimThe primary objective was to research the frequency and causes of cholelithiasis in children. Material and methodsPerformed retrospective analysis of medical records of 1225 patients diagnosed with liver diseases and bile ducts diseases. ResultsCholelithiasis was diagnosed in 29 patients. Research suggests that the most common causes of its occurrence were prevalence of cholelithiasis in the family, prematurity, an intestine resection, and parenteral feeding. The incidence was similar in both genders; the disease is rarely diagnosed during infancy.

Laparoscopic Cholecystectomy in Patients Aged 80 Years and Older

The incidence of cholelithiasis increases with age. More octogenarian (≥80 y) patients are undergoing laparoscopic cholecystectomy (LC) operation throughout the world. A retrospective study was conducted on patients older than 80 years (group 1: 111 patients) and those in the 18 to 79 years age group (group 2: 185 patients), who underwent LC between July 2005 and October 2009. The variables analyzed were the presentation, demographics, comorbid illnesses, American Society of Anaesthesiology (ASA) scores, history of previous abdominal surgery, the operative time, postoperative morbidity and mortality, and the length of hospital stay. A comparison was made between the two groups. Data was evaluated by using the χ and the Fisher exact test. P<0.005 was considered significant. The difference in both groups in the mean age and ASA scores were significant. The indication for LC was gallstone disease in 87 (78.4%) patients, acute cholecystitis in 16 (14.4%), and gallstone pancreatitis in 8 (7.2%) of group 1 patients. The conversion rate was not statistically significant. The mean operative time was 77 minutes in group 1 patients, and this was significantly longer than that of group 2 patients. The postoperative oral intake within 24 hours of surgery was significantly earlier in group 2 patients. Other parameters were not significantly different between the 2 groups. LC in octogenarians is a relatively safe procedure that can be performed with low morbidity and mortality rates. The comorbidities and higher ASA scale are major risk factors for postoperative complications in this age group of patients.

Laparoscopic Cholecystectomy; It’s Complications and Causes of Conversion to Open Cholecystectomy.

Background: The laparoscopic cholecystectomy is the gold standard for treating the symptomatic cholelithiasis. Conversion is sometimes necessary due to finding unexpected pathology,intraoperative complications or unexpected technical errors .&#x0D; Objectives: The aims of this study were to determine the complications and the predictive factors of conversion in patients undergoing laparoscopic cholecystectomy for various indications in elective and acute settings in a general hospital in order to reduce the incidence rates of both , complications and conversion of laparoscopic cholecystectomy to the open technique .&#x0D; Patients and Methods: This is a prospective study included 128 patients [their ages ranged from18 -65 years; the mean =39.60 ± 11.37 SD years].Female patients were 111 (86.7 ) ,male patients were 17 (13.3 % ) . These patients underwent a laparoscopic cholecystectomy in AL-Karama Teaching Hospital / College of Medicine / Wasit University-Iraq,from April 2011 till December 2012. Recorded data were sex, age, indications for laparoscopic cholecystectomy , complications, conversion to the open technique , reasons of conversion, co- morbidity , length of the hospital stay and 30- day mortality.&#x0D; Results: The intraoperative complications were; bleeding from the cystic artery in 9 patients (7.03 %), perforation of the gallbladders in17 patients (13.28% ) and spillage of the stones from cystic duct stump in12 patients( 9.37% ).All these complications were successfully treated laparoscopically.This study has no postoperative complications during follow-up period . Conversion from a laparoscopic cholecystectomy to an open cholecystectomy was performed for 7 patients ( 5.49 % ). The reasons for conversion were ; dense fibrosis of Calot’s triangle in two patients ( 1.56 % ) and one patient(0.78 % ) for each of the following pathologies : cholecystoduodental fistula ,postoperative adhesions , impacted stone in the cystic duct , Mirrizzi’s syndrome and incidental CBD stone.The intaoperative findings and postoperative histopathologic diagnoses were: 114 patients( 89.1 % ) with chronic calculous cholecystitis, 5 patients ( 3.9 % ) with acute calculous cholecystitis, 5 patients( 3,9 % ) with empyema of the gall bladder, 4 patients ( 3.1 % ) with mucocele of the gall bladder .There was no mortality in this study . &#x0D; Conclusions: In this study,there were simple complications being laparoscopically treated .Male gender, age older than 50 years that were associated with dense fibrosis of Calot’s triangle , postoperative upper abdominal adhesions,cholecystoduodenal fistula Mirrizi’syndrome ,impaced stones in the cystic duct and incidental CBD stone were the main factors of conversion .

Indications for Laparoscopic Cholecystectomy or Oral Dissolution Therapy with Ursodeoxycholic Acid in Symptomatic Gallstone Disease

Unconjugated bilirubin plays an important role in cholesterol gallstone formation. Patients with symptomatic gallstone disease who have high bilirubin plasma levels and/or are homozygous for the rs6742078 TT variant of the bilirubin glucuronidating gene UGT1A1 should not undergo oral dissolution therapy with ursodeoxycholic acid. A large Danish study has shown that high bilirubin plasma levels and the genetic variant rs6742078 TT of the enzyme bilirubin glucuronidase UGT1A1 are associated with an increased risk of developing symptomatic gallstone disease. Recent reports regarding the significant association between bilirubin levels and symptomatic gallstone disease open a new chapter about the indication and exclusion criteria for oral dissolution therapy of symptomatic gallstone disease. A highly select subgroup of patients with small, single, radiolucent cholesterol gallstones who received oral dissolution therapy with ursodeoxycholic acid (UDCA) had a reported recurrence of symptomatic gallstone disease of 50% over five years. This is probably related to the persistence of other causal risk factors for gallstones in addition to that of cholesterol suprasaturation. A subgroup of patients with high plasma bilirubin levels and the UGT1A1 genetic variant rs6742078 have a greater risk of recurrence. In conclusion, oral dissolution therapy with UDCA might still be appropriate for patients that refuse laparoscopic cholecystectomy provided they have small (< 0.5 cm), radiolucent cholesterol gallstones and a functioning gallbladder, and have mean plasma bilirubin levels below 1.33 mg/dL and are not homozygous for the UGT1A1 rs6742078 TT genotype.

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.

Laparoscopic cholecystectomy in children

In 95 children (age 6-18 y) treated for gallstones between 2002-2010, 95 laparoscopic cholecystectomies were carried out. Symptomatic cholecystolithiasis was the indication for laparoscopic cholecystectomy in most of the cases. In three patients, there was a conversion to open cholecystectomy. Postoperative complications due to failure of bile drainage arose in three patients. Restored bile drainage was secured for two biliodigestive anastomosis. Bile leak in a third patient solved a temporary biliary stent. Laparoscopic cholecystectomy is the gold standard for gallstones (Ref. 8). gallstones, laparoscopic cholecystectomy, cholecystolithiasis, bile drainage.