Surgery For Acute Cholecystitis Research Articles

The role of preoperative ultrasound in predicting conversion from laparoscopic cholecystectomy to open surgery in acute cholecystitis.

The aim of this study is to evaluate the role of pre-operative ultrasound findings for conversion from laparoscopic cholecystectomy to open surgery in patients with acute cholecystitis and to evaluate the effects of pre-operative ultrasound findings on operation time and length of stay. The study included 80 patients who underwent laparoscopic cholecystectomy for acute cholecystitis between January 1 and June 30, 2023. The relationship between gallbladder wall thickness and the presence of pericholecystic fluid on pre-operative ultrasonography and the duration of surgery, conversion to open surgery, and hospitalization was evaluated. The patient group undergoing open surgery exhibited a statistically significant increase in both the median gallbladder wall thickness (P<0.001) and the frequency of pericholecystic fluid on pre-operative ultrasound (P=0.012). Receiver operating characteristic (ROC) analysis was used to assess the discriminative power of gallbladder wall thickness for predicting the requirement to convert from laparoscopic surgery to open surgery. The area under the curve value was found to be 0.907, indicating a strong discriminative power. Based on the ROC curve, a gallbladder wall thickness of ≥5.75 millimeters showed a sensitivity of 85.7% and specificity of 84.9% in predicting the requirement for open surgery. Our study highlights the significance of two factors in predicting the conversion from laparoscopic cholecystectomy to open surgery in patients with acute cholecystitis. The presence of pericholecystic fluid and a gallbladder wall thickness of 5.75 mm or greater are indicators that the laparoscopic procedure may be more challenging in such cases. These results can aid surgeons in making informed decisions and planning the surgical approach accordingly for better patient outcomes.

Comparative study of early versus delayed laparoscopic cholecystectomy in acute cholecystitis and its associated complications

Background: Acute cholecystitis is a common surgical problem and was usually treated with conservative management followed by surgery after an interval of 6/8 weeks. The aim of the study was to compare the efficacy of immediate with delayed laparoscopic cholecystectomy. Methods: Randomized controlled trial in RRMCH from January 2019 to June 2019 was conducted on patients diagnosed to have acute cholecystitis. The 25 patients underwent immediate laparoscopic cholecystectomy within 24-72 hours of admission and 25 patients underwent DLC. Results: In the early surgery group intraoperative complications noted were adhesions, bleeding, GB perforation and bile duct injury. Although the percentage of complications was high in delayed group no statistical significance could be derived between the groups Conclusions: Early laparoscopic cholecystectomy (ELC) surgery had similar intra and postoperative complications compared to delayed surgery in acute cholecystitis but was associated with a shorter surgery and lesser stay in hospital.

Access to Surgery and Quality of Care for Acute Cholecystitis During the COVID-19 Pandemic in 2020 and 2021 — an Analysis of 12,545 Patients from a German-Wide Hospital Network

PurposeTo determine effects on admission, treatment, and outcome for acute cholecystitis during the course of the COVID-19 pandemic in 2020 and 2021. MethodsRetrospective analysis of claims data from 74 German hospitals. Study periods were defined from March 5, 2020 (start of first wave) to June 20, 2021 (end of third wave) and compared to corresponding control periods (March 2018 to February 2020). All in-patients with acute cholecystitis were included. Distribution of cases, type of surgery, comorbidities, surgical outcome, and length of stay of all cases with acute cholecystitis and cholecystectomy were compared. In addition, we analyzed the type of treatment (non-surgical, cholecystostomy, or cholecystectomy) for all cases with main diagnosis of acute cholecystitis. ResultsWe could not demonstrate differences in daily admissions over the course of the pandemic (11.2–12.7 patients vs. 11.9–12.6 patients for control periods). Proportion of patients with non-surgical treatment was low and not increased (11.7–17.3% vs. 14.5–18.4%). Cholecystostomy was rare throughout all periods (0–0.5% of all patients). We did not observe an increase in open surgery (proportion of open cholecystectomies 3.4–5.5%). Mortality was generally low (1.5–1.9%) with no differences between periods. Median length of stay was 4 days throughout all periods. ConclusionThe numerous restrictions during the COVID-19 pandemic did not result in an increase of admissions or surgery for acute cholecystitis. Laparoscopic cholecystectomy has been safely applied during the pandemic. Our results may assure the ability to maintain high quality of surgical care even in times of disruptions to the health care system.

A207 COMMON BILE DUCT OBSTRUCTION FROM RADIOGRAPHICALLY OCCULT LITHIASIS: A CASE REPORT AND CAUTIONARY TALE

BackgroundBiliary obstruction from choledocholithiasis (CDL) can lead to many serious complications, such as cholangitis and pancreatitis. Among noninvasive diagnostic tests for CDL, MRCP is superior to US and CT with a sensitivity of 89–95%. Despite this, MRCP may not always identify the cause of obstruction, leading to diagnostic dilemmas.AimsWe aim to review the various ways that CDL can hide on imaging, specifically MRCP.MethodsA 22-year-old male with pyruvate kinase deficiency was admitted to General Surgery for acute cholecystitis, for which he had a laparoscopic cholecystectomy. Preoperative MRCP showed a 3 mm common bile duct (CBD) with no stones; however, gross inspection of the gallbladder showed multiple green stones. Around one month later, he was readmitted to General Surgery for symptomatic biliary obstruction, with total bilirubin 923, ALP 457 and ALT 559. He was not febrile and did not require antibiotics. An MRCP showed a CBD of 10 mm with intra- and extrahepatic biliary dilation, but no obstructing focus was seen. Gastroenterology was consulted for undifferentiated hyperbilirubinemia. After further discussion, an ERCP with sphincterotomy was done the next day which also did not show obstruction. An abdominal US done the day after ERCP showed improvement in biliary dilation. After ERCP, the patient’s symptoms improved. Total bilirubin, ALP, and ALT one month later decreased to 121, 134, and 139 respectively. The hypothesis was that he had an obstructing gallstone that camouflaged within bile on imaging.Consent was obtained from the patient to present this case report.ResultsAlthough MRCP is one of the best noninvasive diagnostic tests for CDL, some stones may not appear on imaging. On MRCP, stones usually appear as hypointense spots surrounded by hyperintense bile on T2-weighted imaging. However, sludge can be isointense compared to bile. Additionally, stones impacted at the ampulla of Vater typically are not surrounded by bile and thus may evade detection on MRCP. Small stones <4 mm can be missed as well. CBD dilation greater than 10 mm is also associated with reduced sensitivity of MRCP for CDL. Even with ERCP, small stones may be missed unless seen on direct optical visualization after a blind balloon sweep.Even if no obstructing lesion is seen on imaging, other clinical features can still suggest CDL requiring ERCP. The ASGE 2019 Guidelines on CDL recommend prompt ERCP for patients with total bilirubin >68.4 µmol/L and CBD dilation on imaging. Other radiographic signs suggesting CDL include CBD dilation, papillitis, and pericholecystic fat infiltration on CT, and MRCP findings of CDL-associated inflammation such as biliary wall thickening and periductal edema.ConclusionsEven if MRCP does not show obvious obstruction, ERCP should still be considered if the likelihood of CDL remains high.Funding AgenciesNone

Efficacy of Bailout Surgery for Preventing Intraoperative Biliary Injury in Acute Cholecystitis

Introduction: Recent advancement of laparoscopic surgery made it possible to perform laparoscopic cholecystectomy (LC) for acute cholecystitis (AC). Bailout surgery (BOS; partial cholecystectomy, open conversion, fundus 1st approach) has been recommended in difficult cases. This study retrospectively aimed to validate the feasibility of bail out surgery in acute cholecystitis.

Clinical Analysis of Laparoscopic and Traditional Open Surgery for Acute Cholecystitis

Clinical Analysis of Laparoscopic and Traditional Open Surgery for Acute Cholecystitis

Laparoscopic Surgery in Acute Cholecystitis in General Surgery

Laparoscopic Surgery in Acute Cholecystitis in General Surgery

Dexmedetomidine in anaesthesia for laparoscopic surgery for acute cholecystitis

Background. In laparoscopic cholecystectomy (LCE), general anesthesia has its own characteristics due to the creation of pneumoperitoneum, changes in body position and adsorption of insufflated gas, which causes the occurrence of perioperative complications and requires improvement of anesthesiology programs.&#x0D; Objective: to determine the efficacy and safety of combined low opioid anesthesia based on dexmedetomidine in complex anesthesia in patients undergoing laparoscopic surgery for acute cholecystitis.&#x0D; Materials and methods. In total, the study included 163 patients undergoing LCE under general anesthesia. All patients were divided into 3 groups according to the anesthetic care scheme. In Group 1 (n=56), low-opioid anesthesia (dexmedetomidine, lidocaine, fentanyl 1–2 μg/kg/h) and artificial ventilation were performed; Group 2 (n=52): propofol with fentanyl (4–6 μg/kg/h) and artificial ventilation. In Group 3 (n=55): anesthesia with sevoflurane in combination with fentanyl and artificial ventilation.&#x0D; Results. Hyperdynamic reactions were observed in Group 2 and Group 3 at the beginning of the operation: heart rates and BP values after induction, with intubation in the 3rd, 5th and 7th minute of pneumoperitoneum, were slightly higher in Group 2 and 3 than in Group 1. However, moderate bradycardia was observed in Group 1 more often – in 5 patients (8.92%) than in patients in Group 2 and Group 3 – 2 cases (3.84%) and 2 cases (3.64%), respectively. The total number of injected analgesics during LCE was: in Group 1 – 141.52±23.64 μg, in Group 2 – 426.92±39.41 μg, in Group 3 – 354.75±28.63 μg (p &lt;0.01). Only one patient in Group 1 required ondansetron for the treatment of PONV compared to 5 and 4 in Group 2 and Group 3, respectively (p &lt;0.05). None of the patients in all groups reported “feeling” intraoperative events or “awakening during surgery”.&#x0D; Conclusions. The use of dexmedetomidine with lidocaine infusion three times reduced the use of opioids in the intraoperative period and to refuse their use in the postoperative period. With the use of low-opioid anesthesia in the postoperative period, the frequency of hypertensive reactions and tachycardia did not increase, but in the postoperative period, these p

Изменения липидного обмена в до- и послеоперационном периоде у больных с ожирением при лапароскопической холецистэктомии

Актуальность. Изменение показателей липидного обмена в до- и послеоперационном периоде обусловлено частыми нарушениями метаболизма у людей с ожирением и особыми трудностями в подборе целесообразной терапии для данных пациентов. В свою очередь, причиной изменения метаболизма в организме является влияние определенной экстремальной ситуации — хирургического вмешательства. Цель: изучение изменения липидного обмена в до- и послеоперационном периоде у больных с ожирением при лапароскопической холецистэктомии. Материалы и методы. Исследованы 50 пациентов (средний возраст — 47,0 ± 1,5 года), которым проведено оперативное вмешательство по поводу острого холецистита методом лапароскопической холецист­эктомии. Пациенты были распределены на две группы: 1-я — с ожирением, 2-я — без ожирения. У всех пациентов исследованы уровни триглицеридов, общего холестерина, липопротеинов высокой плотности (ЛПВП), липопротеинов низкой плотности (ЛПНП), липопротеинов очень низкой плотности (ЛПОНП), проведено сравнение в дооперационном периоде и на 1-е и 5-е сутки послеоперационного периода. Результаты. Показатели липидного обмена в до- и послеоперационном периоде во всех группах имели допустимые колебания с учетом того, что у пациентов с ожирением значения липидного спектра сначала были повышены по сравнению с пациентами без ожирения. В послеоперационном периоде в 1-й группе на 1-е сутки отмечалось снижение концентрации триглицеридов (1,1 ± 0,6 ммоль/л) от начального уровня, общего холестерина (4,5 ± 0,3 ммоль/л), повышение уровня ЛПВП (1,5 ± 0,2 ммоль/л), снижение уровня ЛПНП (2,9 ± 0,2 ммоль/л) и ЛПОНП (1,0 ± 0,2 ммоль/л). Во 2-й группе показатели триглицеридов (0,6 ± 0,2 ммоль/л), общего холестерина (3,4 ± 0,1 ммоль/л), ЛПНП (1,9 ± 0,3 ммоль/л) и ЛПОНП (0,8 ± 0,2 ммоль/л) также имели тенденцию к снижению, отмечалось повышение уровня ЛПВП (1,6 ± 0,1 ммоль/л), но данные значения независимо от варьирования находились в пределах нормы. В 1-й группе у 3 пациентов наблюдались когнитивные нарушения, что было обусловлено значительным повышением уровня ЛПНП над ЛПВП и возможным развитием атеросклероза, которое могло привести к нарушению мозгового кровообращения. Выводы. После проведения исследования между двумя группами, в которых изучался липидный спектр, выявлено варьирование его показателей в обеих группах, что связано с особенностями метаболизма у таких пациентов и влияния хирургического стресса. Исходя из этого контроль и регулирование значений липидного профиля необходимо проводить у всех пациентов с дислипидемией, а у пациентов с ожирением нужно дополнительно учитывать факторы риска, сопутствующие заболевания и возможные осложнения.

A fresh look at the correlation between timing of histological changes in acute cholecystitis and difficulty of cholecystectomy

Presenter: Roheena Panni MD, MPHS | Washington University, St. Louis Background: Difficulty of gallbladder surgery in Acute Cholecystitis (AC) increases with time after the onset of symptoms due to evolving inflammation. Clinical/pathological correlation has been confounded by timing findings from the date of admission to hospital rather than date of onset of symptoms and by inclusion of patients who had prior attacks of AC. The purpose of this study was to determine histologic changes for 10 days from onset of symptoms in a first attack of AC and correlate these changes to 3 time periods known to be associated with increasing difficulty of surgery. Methods: We identified patients with calculous AC who underwent cholecystectomy from 2005-2018 at our hospital. Initial review (n=7171) included selection of ICD-9 codes for AC followed by review of pathology to confirm the diagnosis. To confine the study to first attack of AC, patients were excluded if they had prior admissions for AC, biliary colic requiring ER visit or admission or choledocholithiasis. A blinded pathologic review was performed on stored specimens by a GI pathologist to define histological changes in the gallbladder wall. Statistical analysis was performed using SAS to determine the association between pathologic changes and duration of symptoms prior to surgery. Results: We identified 150 patients who were diagnosed with calculous AC and underwent cholecystectomy within ten days of onset of symptoms. 68 patients (45.3%) were males and 82 (54.7%) were females. Patients were divided into three groups; “Early” who underwent cholecystectomy between 1-3 days after onset of symptoms 61 patients (41%), “Intermediate” between 4-6 days, 63 patients (42%), and “Late” who had cholecystectomy between 7-10 days after onset of symptoms 26 patients (17%). Necrosis of the inner gallbladder wall layers (mucosa and muscularis) was found in 58% of Early specimens and rose to 88% in Late specimens (p=0.019). Both hyaline and liquefactive forms of necrosis were present. The latter type was infiltrated with neutrophils. The outer perimuscular layer of the wall (adventitia/subserosa) became necrotic infrequently. Mural hemorrhage in all layers was abundant in 56% of Early specimens which rose to 86% in Late specimens (p = 0.031). Fibrinous exudate was abundantly present on the surface of the peritonealized outer layer (serosa) in 38% of Early specimens and 65% pf Late ones (p = 0.013). The perimuscular layer (adventitia/subserosa) demonstrated edema, cellular infiltrate, predominately with lymphocytes and eosinophils, and early fibrosis in which myofibroblasts were prominent. Conclusion: Multiple inflammatory changes occur rapidly in the Early stage of AC. Large and significant increases from Early to Late periods in necrosis of the mucosa and muscularis, , mural hemorrhage and accumulation of serosal fibrinous exudate parallel increases in surgical difficulty in performing cholecystectomy for acute cholecystitis. Early fibrosis was already present in some specimens on days 1-3.

Antibiotic prophylaxis in acute cholecystectomy revisited: results of a double-blind randomised controlled trial

PurposeEvidence supporting the value of preoperative antibiotic prophylaxis (PAP) in surgery for acute cholecystitis is lacking. This study aimed to shed light on whether PAP in acute cholecystectomy for cholecystitis reduces the postoperative infectious complication (PIC) rate. Secondary outcomes were the prevalence of bacteriobilia, CRP values and leucocyte counts.MethodsThe study was performed as a single-centre, double-blinded, placebo-controlled, randomised study. Patients with acute cholecystitis amenable for acute laparoscopic cholecystectomy were randomly assigned to either PAP (piperacillin/ tazobactam) or placebo, and the subsequent clinical course was followed.ResultsA total of 106 patients were enrolled, 16 of whom were excluded due to protocol violation. PIC developed in 22 of the 90 patients included with no significant difference between the PAP and placebo groups (8 patients in the PAP group and 14 in the placebo arm, p = 0.193). The PIC rate was significantly higher in patients with a raised CRP at randomisation and on the day of surgery and in cases of conversion to an open procedure (p = 0.008, 0.004 and 0.017, respectively) but with no differences between the study groups.ConclusionPAP does not affect the risk for PIC in patients with acute cholecystitis. The major risk factors determining PIC in these patients need defining, in particular, the impact of bacteriobilia.Trial registrationThe study was registered at clinicaltrials.gov (NCT02619149) December 2, 2015.

Clinical effect of laparoscopic surgery for acute cholecystitis with calculi

Objective To investigate the clinical effect of laparoscopic surgery on acute cholecystitis with calculi. Methods Clinical data of 126 patients with acute cholecystitis and calculi treated with laparoscopic surgery from March 2014 to March 2018 were retrospectively analyzed. Results Of the 126 patients treated with laparoscopic surgery, 123 operations went smoothly, 3 cases were converted to laparotomy.One patient developed inflammatory intestinal obstruction 48 hours after surgery, the remaining 122 patients recovered smoothly after surgery, no complications occurred. Conclusion Laparoscopic surgery for acute cholecystitis with calculi has a significant effect on patients within 72 hours of the acute phase of the onset, while intraoperative laparotomy is the ultimate guarantee for the treatment of acute cholecystitis.In clinical treatment, the appropriate operation method should be selected according to the overall situation of patients. Key words: Cholecystitis, acute; Cholelithiasis; Cholecystectomy, laparoscope

Optimum timing of emergency cholecystectomy for acute cholecystitis in England: population-based cohort study

BackgroundCholecystectomy on index admission for acute cholecystitis is associated with improved patient outcomes. The timing of intervention is mainly driven by service provision. This population-based cohort study aimed to evaluate timing of emergency cholecystectomy in England.MethodsData from all consecutive patients undergoing surgery for acute cholecystitis on index admission in England from 1997 to 2012 were captured from the Hospital Episodes Statistics database. Data were analysed based on whether patients underwent surgery 0–3 days, 4–7 days or ≥ 8 days from admission. Outcome measures were rate of post-operative biliary complications, conversion to open and length of stay.ResultsForty-three thousand eight hundred and seventy patients underwent emergency cholecystectomy. 64.6% of patients underwent surgery between days 0 and 3 of admission, 24.3% between days 4–7 and 11.0% had surgery after day 8. Patients undergoing early surgery had significantly reduced rates of intra-operative laparoscopic conversion to open (0–3 days: 3.6%; 4–7 days: 4.0%; ≥ 8 days 4.7%, p = 0.001), post-operative ERCP (0–3 days: 1.1%; 4–7 days: 1.5%; ≥ 8 days 1.9%, p < 0.001) and bile duct injury (0–3 days: 0.6%; 4–7 days: 1.0%; ≥ 8 days 1.8%, p < 0.001). Early cholecystectomy was also associated with a shorter post-operative length of stay (LOS) [0–3 days group: median post-operative LOS 3 days (IQR: 1–6); 4–7 days group: 3 days (IQR 2–6); ≥ 8 days group: 4 days (IQR 2–9) (p < 0.001)]. High-volume centres undertook a significantly greater proportion of cholecystectomies within 3 days of presentation (high-volume: 67.3%; medium-volume: 64.8%; low-volume: 61.2%). In multivariate analysis greater time to surgery was independently associated with increased risk of post-operative ERCP and bile duct injury.ConclusionsEarly cholecystectomy within 3 days of admission reduces intra-operative conversion, post-operative biliary complications and length of stay. Centres undertaking the greatest numbers of emergency cholecystectomies perform a larger proportion within 3 days of admission.

Comparative analysis of the effect of various types of combined anaesthesia on the central hemodynamics in laparoscopic cholecystectomy

Introduction. At present, laparoscopic cholecystectomy is a type of minimally invasive intervention, mostly performed for the treatment of patients with cholelithiasis. A large number of procedures worldwide taken into consideration, the issue of the effect of various anaesthesia types on the central hemodynamics becomes increasingly important, since its state often determines possible complications of surgical intervention. Aim. Objective is to assess the effect of various combined anaesthesia types on the central hemodynamics in laparoscopic cholecystectomy. Material and methods. Examination included 119 patients (aged between 20 and 82) who had undergone surgery for acute cholecystitis. Laparoscopic cholecystectomy with the use of carboxy peritoneum (CP) was performed in all cases. Depending on the type of anaesthesia, patients were divided into 3 groups: Group 1 (n = 44) – those who were operated on under combined general intravenous anaesthesia (CGIA); Group 2 (n = 44) – the surgery was performed under combined inhalation anaesthesia (CIA) with sevoflurane; Group 3 (n = 31) – laparoscopic cholecystectomy was performed under combined spinal anaesthesia (CSA) with 0.5% bupivacaine. Subject to comparison were the indices of hemodynamic profile and intra-operative analgesia that was judged on the amount of narcotic analgesics used. The research was authorized by the Bio-ethical Commission of Kyiv City Hospital ? 4. Permission number is U22072016. All patients gave prior written permission to participate in this study. Results. Average systolic arterial pressure in the groups with carbon dioxide insufflated into abdominal cavity: Group 1 – 137.5 ± 18.9 mm Hg; Group 2 – 136.6 ± 17.7 mm Hg; Group 3 – 115.0 ± 13.7 mm Hg. In Group 3, systolic arterial pressure values differed statistically from those in groups 1 and 2 (p &lt; 0.001). Average systolic arterial pressure under carboxy peritoneum: Group 1 – 101.7 ± 14.1 mm Hg; Group 2 – 100.0 ± 12.2 mm Hg; Group 3 – 86.7 ± 10.4 mm Hg. Average doses of fentanyl used for anaesthesia in the groups were: Group 1 – 11.7 mcg/kg; Group 2 – 10.9 mcg/kg; Group 3 – 6.28 mcg/kg. Conclusions. The changes of central hemodynamics in the patients who had undergone combined spinal anaesthesia for laparoscopic cholecystectomy were found to be the least as compared with combined prevenous and endotracheal anaesthesia.

What is the effect of treatment modality on red blood cell distribution width in patients with acute cholecystitis?

The red blood cell distribution width (RDW) has recently been used as a marker to predict outcome in various patient groups. In this study, we aimed to examine how RDW is influenced during the treatment and follow-up of cases of acute cholecystitis which is a common inflammatory disease. Seventy-two patients who were treated for acute cholecystitis, were included into the study. The demographic data, leukocyte count, RDW, C-reactive protein (CRP) values and treatment protocols of these patients were prospectively recorded. The patients who received medical treatment for acute cholecystitis (Group A, n=33) and those who underwent surgery (Group B, n=39) were examined in separate groups. There were 27 male and 45 female patients with a mean age of 50.1±18 years (min-max: 21-94). In Group B, 33 patients underwent laparoscopic cholecystectomy, whereas 6 patients underwent open cholecystectomy. The RDW values on admission were not significantly different between two groups. However the post-treatment/pre-discharge RDW values were significantly lower in the surgical group (14.4±1.9 to 13.6±1.1, respectively, p<0.05). Also, no significant RDW change was identified in the medical treatment group based on an intra-group assessment, whereas a significant decrease was observed in Group B (on admission and following surgical treatment: 14.3±1.3, 13.6±1.1, respectively, p=0.015). No significant differences were observed between groups in terms of CRP and leucocyte values. There was a significant decrease in RDW values in patients who were treated with surgery for acute cholecystitis, while this response could not be observed with medical treatment.

Elevated plasma visfatin levels correlate with conversion of laparoscopic cholecystectomy to open surgery in acute cholecystitis

Visfatin correlates with inflammation and its levels in peripheral blood are associated with some inflammatory diseases. This study aimed to assess the relationship between plasma visfatin levels and conversion of laparoscopic cholecystectomy to open surgery in acute cholecystitis. One hundred and forty-six acute cholecystitis patients and 146 sex- and age-matched healthy controls were recruited and their plasma visfatin levels were determined using an enzyme immunoassay. 17 patients (11.6%) underwent conversion. Plasma visfatin levels were statistically significantly elevated in all patients (97.2±41.8ng/mL), those with (161.4±71.3ng/mL) or without conversion (88.7±26.9ng/mL), compared to controls (40.3±13.3ng/mL, all P<0.001). A linear regression analysis showed that plasma visfatin levels were positively associated with plasma C-reactive protein levels (t=0.510, P<0.001). A logistic-regression analysis showed that age [odds ratio (OR) 1.160, 95% confidence interval (CI) 1.011–1.332, P=0.035] and plasma visfatin levels (OR 1.035, 95% CI 1.005–1.066, P=0.022) appeared to be the independent predictors of conversion. A receiver operating characteristic curve analysis found that plasma visfatin levels predicted conversion with high area under curve (AUC) (AUC, 850; 95% CI, 0.781–0.903). The AUC of the visfatin concentration was similar to that of age (AUC, 0.738; 95% CI, 0.659–0.807) (P=0.188). Visfatin improved the AUC of age to 0.914 (95% CI, 0.856–0.954) (P=0.011) using a combined logistic-regression model. Thus, high plasma levels of visfatin are associated with systemic inflammation, and may independently predict conversion of laparoscopic cholecystectomy to open surgery in acute cholecystitis.

Patient Value Is Superior With Early Surgery for Acute Cholecystitis

Patient Value Is Superior With Early Surgery for Acute Cholecystitis

Hepato Splenic Tuberculosis in Acute Cholecystitis

Background: The tuberculosis is an endemic disease in our country; it remains a major public health problem. Liver and splenic tuberculosis is a classic disease which represents 1.5% of all gastrointestinal tuberculosis. Patients and Methods: We reported the case of a fifty-six years old patient admitted in the department of surgery for acute cholecystitis, and the biological balance showed a hyperleukocytosis at 16,000 elements/mm3 and a CRP at 25 with a light cholestasis. The abdominal scanner showed a micronodular splenomegaly with coelio mesenteric ganglions. We discovered a tuberculosis location in the liver and the spleen and we realized a cholecystectomy with a hepatic biopsy and a splenectomy. Results: A gallbladder ablation associated with an enlarged spleen and liver biopsy was diagnosed with liver and splenic tuberculosis. The patient was put under anti tubercular treatment with the good clinical and radiological evolution. Conclusion: The diagnosis of tuberculosis should always be considered especially in endemic countries.

Laparoscopic Cholecystectomy in Acute Cholecystitis

The aim was to enable prediction of risk for conversion in early laparoscopic cholecystectomy for acute cholecystitis. Multivariate analysis and receiver operating characteristic curve analysis were used to define independent predictors for conversion and optimal cutoffs. Using those, a scoring system was created to predict conversion. In 261 patients, conversion to open cholecystectomy was necessary in 62 cases (24%). Multivariate analysis revealed age and C-reactive protein (CRP) level to be independent predictors for conversion (odds ratio 1.02; P=0.02 and odds ratio 1.01; P<0.001). Using cutoffs obtained by receiver operating characteristic curve analysis resulted in an useful scoring system to predict conversion risk (age>65 y=1+CRP value>165 mg/L=1): score 0=12%, 1=29%, 2=67% (P<0.001). Higher age and elevated CRP level are independent predictors for conversion. Surgery for acute cholecystitis in patients with age >65 years and/or CRP level >165 mg/L should be considered as high risk for conversion.

Prospective Study On Biliary Bacteriology In Calcular Disease Of The Gall Bladder And The Role Of Common Newer Antibiotics

Objective: To study:• The various bacterial pathogens isolated from bile obtained during surgery.• The difference in the bacterial profile of organisms grown from bile collected during surgery for acute cholecystitis and comparison with those undergoing elective cholecystectomy for chronic cholecystitis.• The antibacterial sensitivity of newer antibiotics on the organisms isolated from the bile of patients with gallbladder stone disease undergoing cholecystectomy. Method: This prospective study which was conducted in the Acharya Shri Chander College of Medical Sciences and Hospital, Sidhra, Jammu, comprised 150 consecutive patients and included both open as well as laparoscopic cholecystectomy. Samples, about 3-5 ml of bile, were collected and transported to the microbiology laboratory for further studies. Gram staining, aerobic and anaerobic cultures were done and antimicrobial sensitivity was tested. Results: Escherichia coli (53.84%) was one of the most common isolated bacteria followed by Pseudomonas aeruginosa (26.92%) and Staphylococcus aureus (19.23%). The resistance to second generation cephalosporins has increased with time, while the bile showed sensitivity to thirdand fourth-generation cephalosporins, Conclusion: Positive bile culture was a common finding in patients with acute cholecystitis in this study. Escherichia coli was one of the most common isolated bacteria followed by Pseudomonas aeruginosa and Staphylococcus aureus. The resistance to second-generation cephalosporins has increased while thirdand fourth-generation cephalosporins show better promise and may be used as the first line of preoperative prophylaxis in operations for gallbladder stone disease.