Laparoscopic Cholecystectomy Group Research Articles

C-reactive Protein-to-Albumin Ratio Predicts Conversion from Laparoscopic to Open Cholecystectomy in Acute Cholecystitis.

The aim of this study was to identify predictors of conversion from laparoscopic to open cholecystectomy, and to determine whether pre-operative C-reactive protein-to-albumin ratio (CAR) can predict conversion from laparoscopic to open cholecystectomy, in patients with acute cholecystitis diagnosed according to the Tokyo Guidelines 2018. We retrospectively analysed 231 patients who underwent laparoscopic cholecystectomy for acute cholecystitis between January 2012 and March 2022. Two hundred and fifteen (93.1%) patients were included in the laparoscopic cholecystectomy group; sixteen (6.9%) patients were included in the conversion from laparoscopic to open cholecystectomy group. In univariate analysis, significant predictors of conversion from laparoscopic to open cholecystectomy included the interval between symptom onset and surgery (>72 h), C-reactive protein (≥15.0 mg/l) and albumin (<3.5 mg/l) levels, pre-operative CAR (≥5.54), gallbladder wall thickness (≥5 mm), pericholecystic fluid collection, and pericholecystic fat hyperdensity. In multivariate analysis, elevated pre-operative CAR (≥5.54) and the interval between symptom onset and surgery (>72 h) were independent predictors of conversion from laparoscopic to open cholecystectomy. Pre-operative CAR as a predictor of conversion from laparoscopic to open cholecystectomy may be useful for pre-operative risk assessment and treatment planning.

Insulin sensitivity and C-reactive protein levels after laparoscopic and open cholecystectomy - seven days follow-up

Introduction/Objective. The development of acute insulin resistance after surgery intervention is associated with the type and magnitude of operation and tissue injury. The aim of our study was to compare insulin sensitivity assessed by homeostatic model assessment of insulin resistance (HOMA-IR) and C-reactive protein (CRP) before and after laparoscopic and open cholecystectomy during seven days follow-up. Methods. In total, 92 patients were divided into two groups: laparoscopic cholecystectomy (Group 1) (n = 61) and open cholecystectomy (Group 2) (n = 31). Glucose, insulin and CRP levels were measured at day 0 and at postoperative days one, three and seven. Glucose, insulin and CRP were determined using commercial assay on Roche Cobas 6000 automated analyzer (Roche Diagnostics, Manheim, Germany). Results. There was no statistical difference between studied groups concerning age (p = 0.626), body mass index (p = 0.548), glucose (p = 0.947), insulin (p = 0.212), HOMA-IR (p = 0.390) and CRP (p = 0.546) at day 0. At day one, higher values of CRP were found in group 2 compared with group 1 (p = 0.046). At day three, significantly higher values of glucose and HOMA-IR were found in group 2 compared with group 1 (p = 0.025, p = 0.036, respectively). Conclusion. Increase in CRP precedes deterioration of insulin sensitivity measured by HOMA-IR after cholecystectomy. Impairment of insulin sensitivity was more pronounced at postoperative day three in group with open cholecystectomy. On the basis of our results, laparoscopic cholecystectomy induced less impairment in insulin sensitivity and lower inflammatory response.

Utility of Fluorescence with Indiocyanine Green (ICG) In Laparoscopic Radical Cholecystectomy En-Bloc for the Treatment of Gallbladder Cancer

Utility of Fluorescence with Indiocyanine Green (ICG) In Laparoscopic Radical Cholecystectomy En-Bloc for the Treatment of Gallbladder Cancer

Open versus Laparoscopic Radical Cholecystectomy for Gallbladder Cancer: A Chilean Single Center Experience

Open versus Laparoscopic Radical Cholecystectomy for Gallbladder Cancer: A Chilean Single Center Experience

Comparison between percutaneous transhepatic gallbladder drainage and upfront laparoscopic cholecystectomy in patients with moderate-to-severe acute cholecystitis: a propensity score-matched analysis.

In the Tokyo Guidelines 2018 (TG18), emergency laparoscopic cholecystectomy is recognized as a crucial early treatment option for acute cholecystitis. However, early laparoscopic intervention in patients with moderate-to-severe acute cholecystitis or those with severe comorbidities may increase the risk of complications. Therefore, in the present study, we investigated the association between early laparoscopic cholecystectomy and percutaneous transhepatic gallbladder drainage (PTGBD) in moderate-to-severe acute cholecystitis patients. We retrospectively analyzed 835 TG18 grade II or III acute cholecystitis patients who underwent laparoscopic cholecystectomy at 4 tertiary medical centers in the Republic of Korea. Patients were classified into 2 groups according to whether PTGBD was performed before surgery, and their short-term postoperative outcomes were analyzed retrospectively. The patients were divided into 2 groups, and 1:1 propensity score matching was conducted to establish the PTGBD group (n = 201) and the early laparoscopic cholecystectomy group (n = 201). The PTGBD group experienced significantly higher rates of preoperative systemic inflammatory response syndrome (24.9% vs. 6.5%, P < 0.001), pneumonia (7.5% vs. 3.0%, P = 0.045), and cardiac disease (67.2% vs. 57.7%, P = 0.041) than the early operation group. However, there was no difference in biliary complication (hazard ratio, 1.103; 95% confidence interval, 0.519-2.343; P = 0.799) between the PTGBD group and early laparoscopic cholecystectomy group. In most cases of moderate-to-severe cholecystitis, early laparoscopic cholecystectomy was relatively feasible. However, PTGBD should be considered if patients have the risk factor of underlying disease when experiencing general anesthesia.

Propensity Score Matched Comparison of Robotic Single-Site and Laparoscopic Cholecystectomy.

To demonstrate the feasibility and potential of robotic single-site cholecystectomy, the study aimed to compare it with conventional laparoscopic cholecystectomy. In total, 791 consecutive patients underwent conventional laparoscopic cholecystectomy or robotic single-site cholecystectomy at our center between 2019 and 2022. After 1:1 propensity score matching, 117 patients for each group were selected. After propensity score matching, the only statistically significant difference between conventional laparoscopic cholecystectomy and robotic single-site cholecystectomy was operative time, which was 29.15 ±11.45 min in the conventional laparoscopic cholecystectomy group versus 38.57 ± 12.59 min in the robotic single-site cholecystectomy group (P < 0.001). Because the difference in surgical time between the two groups was minimal, it has little clinical relevance. Using cumulative sum analysis, the maturation phase of the total operation and docking times occurred after the 53rd case. To reduce bias, a comparison of results with conventional laparoscopic cholecystectomy and cases of robotic single-site cholecystectomy was performed in the maturation phase, which revealed only total operative time as statistically significant (P < 0.001). Robotic single-site cholecystectomy is a technically feasible and safe method for treating benign gallbladder diseases, with a relatively short learning curve and reasonable operative time.

EFFICACY OF PERCUTANEOUS TRANSHEPATIC CHOLECYSTOSTOMY IN ACUTEOBSTRUCTIVE CHOLECYSTITIS

Acute obstructive cholecystitis is a common disease with a significant risk of mortality and complications. Active surgical tactics, such as open and laparoscopic access, pose a significant risk for elderly patients with concomitant diseases on the background of acute cholecystitis. The aim of our study is to analyze the effectiveness of percutaneous transhepatic cholecystostomy (PTCS) in acute obstructive cholecystitis (AOC) and subsequent laparoscopic cholecystectomy (LCE). Materials and methods. Retrospectively, we analyzed 64 patients treated with AOC in the period from 2017 to 2021 at the NSCS named after A.N. Syzganov. We divided them into 2 groups depending on surgical treatment. The first group: patients who were performedPTCS (n=29) at the first stage. The second stage, LCE was performed during the waiting period from 3 days to 72 days. The second group: patients who underwent LCE without drainage of the gallbladder (n=35). Also, the patients of the first group were divided into 3 subgroups depending on the waiting time: group A - LCE was performed within 10 days after PTCS, subgroup B - LCE was performed after from 2 to 4 weeks (n=12), patients of the subgroup C, LCE were performed after 4 weeks after PTCS. Preoperative, intraoperative data and postoperative complications were analyzed. Results. According to preoperative data, there was no significant difference in body temperature, laboratory data and concomitant diseases. The statistical difference was revealed only in the age of patients (65.3±9.0 vs 53.4±15.4). The duration of the operation in the second group of LCE was longer compared to the first group, but no significant difference was detected (108.1 ± 30.5 vs 117.9 ± 39.9). In the postoperative period after LCE, complications were observed in 5 (14.2%) cases: bleeding in 4 (11.4%) cases and suppuration of the postoperative wound in 1 (2.8%) case. Conversion was performed in 10 (15.6%) cases, and in one (1.5%) case, the choledochal wall was injured intraoperatively. There was no significant difference between groups A, B and C. Conclusion.The use of two-stage treatment significantly reduces the conversion to open surgery, significantly reduces postoperative complications and hospital stay in the postoperative period. According to the results of our research, the most optimal interval between PTCS and LCE is a period of more than 4 weeks.

Index Admission Cholecystectomy for Biliary Colic Precludes the Risk of Readmissions with Biliary Complications and should be Standard Treatment

BackgroundEmergency biliary colic admissions can be managed with an index or elective laparoscopic cholecystectomy (LC). Opting to perform an elective LC may have significant repercussions such as the risk of readmissions before operation with further attacks or with biliary complications (e.g. cholecystitis, pancreatitis, choledocholithiasis). The risk of readmission and biliary complications in patients admitted with biliary colic but scheduled for elective surgery has never been investigated. The secondary aim was to compare rates of peri-operative morbidity between the index admission, elective and readmission LC cohorts.MethodAll patients admitted with a diagnosis of biliary colic over a 5-year period and proceeding to LC were included in the study (n = 441). The risk of being readmitted and suffering further morbidity whilst awaiting elective LC was investigated. Peri-operative morbidity was compared between the index admission, elective and readmitted LC groups using univariate and multivariate analysis.ResultsFollowing a biliary colic admission, the risk of readmission whilst awaiting elective LC is significant (2 months-25%; 10 months-48%). In this group, the risks of subsequent biliary complications (18.0%) and the requirement for ERCP (6.5%) were significant. Patients who are readmitted before LC, suffer a more complicated peri-operative course (longer total length of stay, higher post-operative complications, imaging and readmission).DiscussionIndex admission LC for biliary colic avoids the significant risk of readmission and biliary complications before surgery and should be the gold standard. Readmitted patients are likely to have higher rates of peri-operative adverse outcomes. Patients should be counselled about these risks.

HPB P46 Does the CholeS pre-operative risk score for laparoscopic cholecystectomy correlate to operative time? A single centre experience

Abstract Background NHS waiting lists for elective surgeries including non-urgent laparoscopic cholecystectomies (LC) have severely escalated during the Covid-19 pandemic, with some patients waiting over 2 years for their operations. LCs are highly variable in terms of operative time, difficulty, and risk making theatre utilisation a challenge to effectively clear waiting lists. Nassar et al.[1] developed and validated a pre-operative risk prediction score for predicting the difficult LC using an objective operative difficulty grading system. We aimed to assess if application of CholeS could be used to predict which LC may have longer operative times, and so aid theatre utilisation planning. Methods Consecutive elective LCs performed between May and October 2021 at our institution's day surgery unit were included and analysed. Each patient was scored retrospectively using the CholeS pre-operative risk score from electronic patient records. Operative time was obtained from theatre electronic record systems. Data was collected on conversion to open surgery, post-operative day of discharge, and intra or post-operative complications. Outliers with operating time recorded as &amp;lt;20 minutes were considered data entry errors and excluded from analysis. A ROC analysis was used, which determined a threshold value of 3. This value was used to divide patients into a low-risk (≤3 points) and high-risk (four and above) group. Two-sample independent t-test was used to compare mean operative time between the high-risk and low-risk CholeS score groups. Levene's test was used to determine if variance was equal between groups. SPSS version 27[2] was used for data analysis and statistical tests and p&amp;lt;0.05 was deemed significant. Results 81 LC were included for analysis. 53 patients were low-risk and 26 patients were high-risk. There was a significantly lower operative time in the low-risk group: low-risk = 57.6 minutes (95% CI 52.4–63.0) vs high-risk = 75.8 minutes (95% CI 58.7–92.9), p=0.046. Nine patients had surgeries lasting &amp;gt;90 minutes; 66% of these were in the high-risk LC group. 95% of patients were discharged on day 0, two patients on day 1, and two on day 2 or later. Three patients had conversion to open cholecystectomy and five patients had post-operative complications. Two out of three patients who required conversion to open cholecystectomies were in high-risk patients with high CholeS scores (7 and 10). In one patient, a cholecystoduodenal fistula was found. Cystic duct avulsion occurred in the other. Three out of five patients with post-operative complications were in the high-risk group, with corresponding higher Clavien-Dindo scores (3b, 2 and 2) when compared to the low-risk group (1 for both patients). Conclusions The CholeS pre-operative scoring system could be used to optimise LC theatre allocation. A score of ≤3 has a shorter operative time than a patient with a score of four or more (mean difference = 18.1 mins, 95% CI 4.4–31.9). Prediction of which LCs will be shorter operations could improve theatre utilisation and allow extra cases booking on the operating list. This, in turn, could help reduce the number of patients on the waiting list. Additionally, CholeS could be used to predict patients with more challenging and prolonged operations as well as those at higher risk of open conversion and complications. This could allow such patients to be managed by allocation to inpatient specialist upper GI specialist lists. [1] Nassar, A.H.M., Hodson, J., Ng, H.J. et al. Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system. Surg Endosc 34, 4549–4561 (2020). [2] IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.

Early cholecystectomy following percutaneous transhepatic gallbladder drainage is effective for moderate to severe acute cholecystitis in the octogenarians

BackgroundAcute cholecystitis (AC) is a life-threatening infectious/inflammatory disease in older patients. This study aimed to investigate the safety and optimal timing of surgery in patients aged ≥ 80 years with moderate to severe AC who received percutaneous transhepatic gallbladder drainage (PTGBD). MethodsFrom January 2008 to February 2021, 152 patients were retrospectively enrolled. Clinical outcomes were compared among patients who received laparoscopic cholecystectomy (LC), open cholecystectomy (OC), and conversion surgery, and between those who received early (< 6 weeks after PTGBD) and delayed cholecystectomy (≥ 6 weeks after PTGBD). Logistic regression analysis was used to identify risk factors for recurrent AC, further biliary events, conversion, and perioperative complications. ResultsSixty-seven patients underwent LC, 62 underwent OC, and 23 underwent conversion surgery. Operation-related complications and mortality rates did not differ among the types of surgery; however, LC group had shorter operative time than the other groups. Eighty-two patients underwent early cholecystectomy, while 70 underwent delayed cholecystectomy. There were no differences in operative time, operation-related complications, and mortality rates between the groups. However, higher rates of recurrent AC and biliary events were observed in the delayed cholecystectomy group (52.9% vs. 4.9% and 57.1% vs. 8.5%, p < 0.001). On multivariate analysis, delayed cholecystectomy was a significant risk factor for recurrent AC (odds ratio [OR] = 19.42, p < 0.001) and further biliary events (OR = 15.95, p < 0.001). ConclusionsEarly cholecystectomy is recommended for patients aged ≥ 80 years with moderate to severe AC following PTGBD.

Is early laparoscopic cholecystectomy after clearance of common bile duct stones by endoscopic retrograde cholangiopancreatography superior?: A systematic review and meta-analysis of randomized controlled trials.

With medical advancement, common bile duct stones were treated by endoscopic retrograde cholangiopancreatography (ERCP), considered the standard treatment. However, ERCP might induce complications including pancreatitis and cholecystitis that could affect a subsequent laparoscopic cholecystectomy (LC), leading to conversion to open cholecystectomy perioperative complications. It is not yet known whether or not the time interval between ERCP and LC plays a role in increasing conversion rate and complications. Bides, in the traditional sense, after ERCP, for avoiding edema performing LC was several weeks later. Even no one study could definite whether early laparoscopic cholecystectomy after ERCP affected the prognosis or not clearly. Comparing some different surgical timings of LC after ERCP. Searching databases consist of all kinds of searching tools, such as Medline, Cochrane Library, Embase, PubMed, etc. All the included studies should meet the demands of this meta-analysis. In all interest outcomes below, we took full advantage of RevMan5 and WinBUGS to assess; the main measure was odds ratio (OR) with 95% confidence. Moreover, considering the inconsistency of the specific time points in different studies, we set a subgroup to analyze the timing of LC after ERCP. For this part, Bayesian network meta-analysis was done with WinBUGS. In the pool of conversion rate, the result suggested that the early LC group was equal compared with late LC (OR = 0.68, I2 = 0%, P = .23). Besides, regarding morbidity, there was no significant difference between the 2 groups (OR = 0.74, I2 = 0%, P = .26). However, early LC, especially for laparoscopic-endoscopic rendezvous that belonged to performing LC within 24 hours could reduce the post-ERCP pancreatitis (OR = 0.16, I2 = 29%, P = .0003). Considering early LC included a wide time and was not precise enough, we set a subgroup by Bayesian network, and the result suggested that performing LC during 24 to 72 hours was the lowest conversion rate (rank 1: 0%). In the present study, LC within 24 to 72 hours conferred advantages in terms of the conversion rate, with no recurrence of acute cholecystitis episodes.

A Systemic Review and Meta-analysis of Laparoscopic Surgery Versus Open Surgery for Gallbladder Cancer.

Laparoscopy in gallbladder cancer (GBC) has a possible role in staging, radical cure, and palliation in gallbladder cancer. However, a few studies have advocated the use of laparoscopic approach and concluded the safety of this approach. This present study was undertaken to determine the safety and feasibility between open and laparoscopic cholecystectomy in patients with the non-metastatic GBC. A systematic database search was performed in MEDLINE, Embase, and Google Scholar for relevant articles. As a result, a list of such studies, clinical trials, published in English up to May 2021, was obtained,14 studies were included and statistical analysis was conducted using RevMan software 5.3 (The Nordic Cochrane Centre). The 5-year survival rate was reported in 13 out of 14 studies (1388 patients), and all compared laparoscopic and open approach. There was no significant heterogeneity in between the studies (chi-square, 10.66; df, 12; I2, 0%). There was significant higher overall survival in open group (389/850 vs 194/538 or 1.45, 95% CI (1.12-1.88), P value, 0.005). There was no significant difference in recurrence rate, operative time, blood loss, lymph node yield, and postoperative complication in between open and laparoscopic groups. Our present study demonstrates that overall survival is significantly increased with open approach when compared with laparoscopic approach. There is no difference in recurrence rate, operative time, blood loss, lymph node yield, and postoperative complications between the open and laparoscopic cholecystectomy groups.

Systematic review and meta-analysis of early vs late interval laparoscopic cholecystectomy following percutaneous cholecystostomy.

High risk surgical patients with acute cholecystitis are commonly treated with percutaneous cholecystostomy (PTC) drainage. The optimal timing of subsequent interval laparoscopic cholecystectomy (LC) remains unclear. Medline, EMBASE, and Scopus were searched to identify studies published between 01/01/2000 and 31/12/2020, reporting on interval LC outcomes in patients initially treated by PTC. Early and late interval LC were defined as <30 and≥30 days respectively. The Methodological Index for Nonrandomized Studies was used for quality assessment. Meta-analysis of proportions was conducted using a random-effects model. A total of 512 studies were screened, 41 met the inclusion criteria. There were 22 studies in both early and late interval LC groups, with 3 included studies reporting both early and late groups. Following quality assessment, 29 studies were included in the meta-analysis. There were no significant differences between early and late interval LC in terms of conversion rates (7.2% vs 8.3%, p=0.854), 90-day morbidity (12.8% vs 15.9%, p=0.496), and 90-day mortality (0.25% vs 0.32%, p=0.704). Heterogeneity was significant (I2>50%) in all groups. Current evidence of interval LC within or beyond 30 days demonstrates no significant impact on outcomes. Patient factors, clinical experience, and hospital facilities may prove more important predictors.

Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Improves the Prognosis of Patients with Severe Acute Cholecystitis.

The aim of this study was to investigate the clinical efficacy of ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) for the treatment of severe acute cholecystitis (AC). The data of 40 patients diagnosed with severe AC at our hospital between August 2020 and June 2021 were retrieved and classified into a PTGD group, open cholecystostomy (OC) group, laparoscopic cholecystectomy (LC) group, and conventional conservative treatment (CT) group. Before treatment and on days 1, 3, 5, and 7 after treatment, their serum levels of alanine aminotransferase (ALT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), total bilirubin (TBIL), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), white blood cell count (WBC), IL-2, IL-4, IL-6, IL-8, and cancer antigen 19–9 (CA19-9) were measured. Additionally, clinical manifestations such as body temperature and pain score were monitored before treatment and at 24, 48, and 72 hours after treatment. The recovery time and complications/adverse reactions were statistically analyzed, and the Kaplan–Meier survival curve was plotted. After treatment, compared with the other three groups, the PTGD group had a significant reduction in serum indicators, including WBC and inflammatory factors, recovery time, pain score, and complications, and benefitted from better treatment efficacy and higher survival rate. Thus, ultrasound-guided PTGD was found to be more effective in treating severe AC patients and was associated with improved patient prognoses.

EP-617 Early vs delayed laparoscopic cholecystectomy for acute cholecystitis: A systemic review

Abstract Background Gallstones are present in approximately 10% to 15% of the adult western population with 1% to 4% of patients becoming symptomatic each year. Laparoscopic cholecystectomy for acute cholecystitis is usually performed after the acute cholecystitis episode settles because of the perceived fear of higher morbidity and of need for conversion from laparoscopic to open cholecystectomy. However, delaying surgery may expose the individual to gallstone-related complications. Aims &amp; objectives To compare early laparoscopic cholecystectomy, defined as less than seven days of clinical presentation with acute cholecystitis, versus delayed laparoscopic cholecystectomy more than six weeks after index admission and conservative treatment for acute cholecystitis. Search Criteria Clinical databases were searched for suitable studies. Randomised and non-randomised clinical trials comparing early versus delayed laparoscopic cholecystectomy in participants with acute cholecystitis published after 1994 were included. Results 16 studies were identified for this review and the outcomes measured were operation time, conversion to open surgery, postoperative complication, post operative pain and analgesia use, length of hospital stay, and duration of antibiotic therapy. For all but one of the criteria it has been found that early and delayed laparoscopic surgery were equivalent for these end points. The endpoint antibiotic duration post-surgery still remains an area of contention. Conclusion Early and delayed cholecystectomy for the treatment of uncomplicated acute cholecystitis is both safe and feasible. Early laparoscopic cholecystectomy is preferred over delayed laparoscopic cholecystectomy mainly because of decreased length of hospital stay in the early laparoscopic cholecystectomy group. This is a clear advantage.

A retrospective cohort study on the optimal interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.

Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) are the most important procedures for patients with choledocholithiasis and gallstones. Many studies recommend early LC after ERCP; however, there is still no consensus on the optimal interval between the two. The purpose of this study was to investigate the appropriate timing of LC after ERCP in patients with choledocholithiasis and cholecystolithiasis.We retrospectively reviewed all ERCPs in our institution from November 2014 to August 2021. All eligible 261 patients were divided into ERCP-LC1 (≤3 days), ERCP-LC2 (3–7 days), and ERCP-LC3 (>7 days). We also reviewed 90 patients with elective LC as the LC group. Procedures, treatment outcomes, and postoperative adverse events were evaluated.In a total of 1642 ERCPs, 261 eligible patients were divided into ERCP-LC1 (n = 102), ERCP-LC2 (n = 113), and ERCP-LC3 (n = 46). The ERCP-LC groups had no difference in operation time, postoperative adverse events, and open conversion rate with the LC group, but the total hospital stay and hospital stay after LC were longer than the LC group. There were no differences between the ERCP-LC groups in operation time, hospital stay after LC, open conversion rate, postoperative adverse events, and efficacy. However, LC within 7 days and even 3 days after ERCP had significant advantages in improvement in total length of stay and medical expenses. Furthermore, we also found an increased risk of gallbladder gangrene and perforation in LC >7 days after ERCP.LC within 7 days and even 3 days after ERCP is a safe, effective, and economical method for patients with choledocholithiasis and gallstones.

Impact on infectious outcomes during laparoscopic cholecystectomy with the use of home-made vs commercial gallbladder retrieval bag: a retrospective comparative study in a high-volume center.

Laparoscopic cholecystectomy (LC) is one of the most commonly performed emergency procedures, with approximately 600,000 patients undergoing the procedure every year in the United States. Although LC is associated with fewer complications when compared with open cholecystectomy, the risk for infectious complications, including surgical site infection and intra-abdominal abscess, remains a significant source of postoperative morbidity. The goal of this study is to determine whether the gallbladder retrieval technique during LC affects risk of infectious complications. We conducted a retrospective comparative study in a minimally invasive surgery high-volume center in Bogota, Colombia. Patients who underwent LC in 2018 to 2020 were identified. The patients were divided into three groups. One group of LC performed using home-made gallbladder retrieval bag (HMGRB), and another group of LC performed using commercial gallbladder retrieval bag (CGRB). The primary outcomes were infectious complications of superficial site infection and intra-abdominal abscess. A total of 68 (7.58%) patients underwent LC using an HMGRB, and 828 (92.41%) using a CGRB. There was no significant difference in preoperative sepsis, or sex distribution between patient groups. Using t test, we found differences on age distribution among groups (p < 0.01), surgical times (p < 0.01), and length of stay (p = 0.01). When using Chi square, we found differences in Tokyo and Parkland Grading Scale severity (p < 0.01), use of postoperative antibiotics (p < 0.01), and drain use (p < 0.01). Nonetheless, there was no difference in the rate of superficial surgical site infection (p = 0.92). HMGRB are not associated with increased risk of postoperative intra-abdominal abscess or superficial surgical site infection in comparison with CGRB but imply longer surgical times and length of stay. The use of HMGRB is safe, feasible, and has lower cost during LC.

Morbid Obesity Not a Risk for Serious Complications Following Outpatient Surgery.

Patients with class III obesity are often excluded from surgery in ambulatory surgery centers (ASCs). We hypothesize that class III obesity is not a risk factor for serious post-operative complications following outpatient operations. ACS-NSQIP database from 2012 to 2018 was queried. Patients undergoing outpatient inguinal hernia repair (IHR) and laparoscopic cholecystectomy (LC) were grouped by BMI. Baseline characteristics and 30-day outcomes were compared using univariate and multivariate analyses. Of these, 79,916 patients underwent IHR and 107,471 patients underwent LC. Multivariable analysis in IHR showed increased odds of superficial SSIs in all classes of obesity compared to normal weight (P < .0001). In the LC group, there were higher rates of SSIs with obesity (P < .0001). For both surgeries, a higher rate of readmissions to the hospital were observed in class II and IIIa obesity (both P < .0001), although rates were relatively low (<3%). Class III obesity demonstrates a statistically significant increase in SSI following IHR and LC. Severe complications requiring readmission are not mirrored, suggesting the morbidly obese patients should be considered for routine surgical procedures in outpatient settings.

Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable? A propensity matched study.

BACKGROUNDCholecystectomy is the preferred treatment option for symptomatic gallstones. However, another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.AIMTo compare the feasibility, safety and effectiveness of pure natural orifice transluminal endoscopic surgery (NOTES) gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy (LC) for symptomatic gallstones.METHODSWe adopted propensity score matching (1:1) to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones. We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020; 517 patients met the matching criteria (NOTES, 110; LC, 407), yielding 86 pairs.RESULTSThe technical success rate for the NOTES group was 98.9% vs 100% for the LC group. The median procedure time was 119 min [interquartile ranges (IQRs), 95-175] with NOTES vs 60 min (IQRs, 48-90) with LC (P < 0.001). The frequency of post-operative pain was similar between NOTES and LC: 4.7% (4/85) vs 5.8% (5/95) (P = 0.740). The median duration of post-procedure fasting with NOTES was 1 d (IQRs, 1-2) vs 2 d with LC (IQRs, 1-3) (P < 0.001). The median post-operative hospital stay for NOTES was 4 d (IQRs, 3-6) vs 4 d for LC (IQRs, 3-5), (P = 0.092). During follow-up, diarrhea was significantly less with NOTES (5.8%) compared to LC (18.6%) (P = 0.011). Gallstones and cholecystitis recurrence within a median of 12 mo (range: 6-40 mo) following NOTES was 10.5% and 3.5%, respectively. Concerns regarding the presence of abdominal wall scars were present in 17.4% (n = 15/86) of patients following LC (mainly women).CONCLUSIONNOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy. This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder. Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.

Comparison of Single Clip Laparoscopic Cholecystectomy (SCLC) and Two Clip Laparoscopic Cholecystectomy (TCLC): A randomized control study

Background: Advanced energy sources, such as the harmonic scalpel, though expensive, may provide the advantage of shorter operating time by reducing smoke, bloodless dissection in the GB bed, lower risk of bleeding from the cystic artery due to secure vessel sealing, and avoiding the use of a larger number of titanium clips. This study was undertaken to compare the advantages of Single clip laparoscopic cholecystectomy (SCLC) and Two Clip Laparoscopic Cholecystectomy (TCLC). Material and Methods: This prospective randomized study was conducted in the Department of Surgery IGMC, Shimla over a period of 1 year starting from 1st july 2019 to 30th june 2020. In this study 100 consecutive patients of symptomatic cholelithiasis confirmed by USG reporting were participated and randomized into 2 groups of 50 each. Group 1 patients underwent SCLC and Group 2 patients underwent TCLC. Outcomes were measured in terms of operative time, intra operative stone spillage, intra operative blood loss, amount of CO2 used , post operative pain , conversion into open cholecystectomy and post operative complications. Results: Among the total 100 patients, 24 were males and 76 were females. Among them, 10 males and 40 females underwent single clip laparoscopic cholecystectomy (SCLC) while 14 males and 36 females underwent Two Clips laparoscopic cholecystectomy (TCLC). Mean age of males were 48.50 ± 14.49 and females were 46.73 ± 16.16 in SCLC group while mean age of males were 45.36 ± 14.53 and females were 45.25 ± 15.97 in two clips laparoscopic cholecystectomy group. Present study showed that there was more Operative Time, more Mean CO2 used, more Approx. Blood Loss, more Intra Op. Stone spillage and more Use of Drain but less Average pain score at 6 and 24 hours and less Average Length of hospital stay in DCLC group as compared to SCLC group but this difference was not statistically significant. Similarly in both group equal number of patients Convered to Open Cholecystectomy and there was no Post op. Complications in both groups. Conclusion: Study concluded that there was no statistically significant difference among both SCLC and DCLC groups in terms of operative time , intra operative stone spillage , Use of Drain, intra operative blood loss , amount of CO2 used , post operative pain, Conversion to Open Cholecystectomy and post operative complications.