Symptomatic Gallbladder Disease Research Articles

Assessment of fasting gastric volume using ultrasound in patients undergoing cholecystectomy and other elective surgeries: A prospective observational study

ABSTRACT Background: Prevention of pulmonary aspiration is an important aspect of anaesthesia practice. Strictly following the pre-operative fasting guidelines can pre-empt pulmonary aspiration in most patients undergoing elective surgeries. Ultrasonographic assessment of patients scheduled for laparoscopic cholecystectomy with symptomatic gall bladder disease has shown a higher incidence of a full stomach. Aim: The primary objectives of this study were to assess and compare gastric volume and contents in fasted patients undergoing elective laparoscopic cholecystectomy and other elective surgeries and to evaluate the relationship of fasting gastric volume and contents with other comorbidities and body mass index (BMI). Materials and Methods: On the day of surgery, hours of fasting were noted. Patients scheduled for laparoscopic cholecystectomy were in Group L, and patients scheduled for other surgeries were in Group O. Ultrasonography was performed before induction of anaesthesia in the pre-operative room by an experienced anaesthesiologist. The patients were classified based on the Perlas grading scale. To assess the risk of aspiration, the classification previously established by Ven de Putte and Perlas was used. Sixty patients were included in Group L and 60 patients in Group O. Results: The incidence of a full stomach was 3.33% in Group O and 20% in Group L. There was no significant association between BMI and gastric residual volume (GRV) in this study. There was no significant difference between GRV between diabetic and non-diabetic patients in Group L and Group O. Conclusion: Patients with gall bladder pathologies scheduled for cholecystectomy could have delayed gastric emptying; therefore, anaesthesiologists should be cautious, and bedside assessment tools such as ultrasound, which is easy and non-invasive, should be utilised to stratify the risk of aspiration in such patients.

Značaj tap bloka u perioperativnoj kontroli bola kod laparoskopske holecistektomije

Laparoscopic cholecystectomy is one of the most common minimally invasive operations in abdominal surgery and the gold standard in the treatment of symptomatic gallbladder diseases. Although it is a minimally invasive technique, the intensity of pain in the postoperative period can be significant, especially during the first 24 hours after surgery. Coping with this pain can be approached by traditional treatment with different classes of analgesics or by the use of multimodal analgesia, which includes their combination with regional anesthesia techniques. The most commonly used technique of regional anesthesia in laparoscopic cholecystectomy operations is the block of the transverse abdominal plane (TAP block). The TAP block is an ultrasound-guided local anesthetic injection technique in the plane between the internal oblique and transverse abdominal muscles, which leads to the involvement of the sensory nerves that innervate the anterior abdominal wall, thus achieving adequate perioperative pain control. The application of the TAP block dates back to the beginning of the 21st century, and since then it has been the subject of numerous studies that have dealt with the impact of the TAP block on the reduction of intraoperative opioid consumption, the intensity of postoperative pain, as well as on the reduction of the frequency of side effects caused by opioid analgesics. Due to its simple execution and great efficiency, the TAP block is used today as an analgesia strategy in numerous abdominal surgeries.

Factors causing conversion in laparoscopic cholecystectomy

Introduction and purpose: Laparoscopic cholecystectomy (LC) is the gold standard surgical procedure in the treatment symptomatic gall bladder disease. Conversion is not a failure or complication. It is only a step taken to ensure patient safety and to avoid complications. The objective of our study was to investigate the rate and the causative preoperative and intraoperative factors of conversion and to help surgeons have an idea about potential intraoperative challenges. Materials and methods: Laparoscopic cholecystectomy procedures performed on 4433 patients with signs and symptoms of cholelithiasis-cholecystitis who were diagnosed with abdominal ultrasonography were retrospectively reviewed. The patients were grouped on the basis of age, gender, length of hospitalization, history of preoperative endoscopic retrograde cholangiopancreaticography (ERCP), diabetes mellitus (DM), chronic fibrotic cholecystitis, gall bladder polyps, and urgent-elective surgery. The rate and causative factors of conversion were investigated. Statistical analyses were carried out using IBM SPSS for Windows, version 17.0 (IBM statistics for Windows version 17, IBM Corparation, Armonk, New York, United States) software package. Result: In our study, the conversion rate was 0.85%. Male gender, advanced age, increased length of hospitalization, history of preoperative ERCP, urgent surgery (acute-hydropic cholecystitis), and chronic fibrotic cholecystitis were the significant risk factors for conversion. DM had no effect on conversion. Conclusion: Conversion should not be necessarily regarded as a complication in laparoscopic cholecystectomy. Identifying patients with significant risk factors for conversion can significantly minimize the complications of the laparoscopic procedure. This may assist in identifying high-risk patients and reviewing surgical strategy in this patient group.

Prevalence of Symptomatic Gallbladder Disease After Bariatric Surgery: A Literature Review.

Introduction Gallbladder disease (GBD) encompasses several medical conditions, including gallbladder stone formation, biliary colic, and cholecystitis. These conditions may arise following bariatric surgery, including bypass or laparoscopic sleeve gastrectomy (LSG). The development of GBD after surgery may be attributed to various factors, including the formation of stones shortly after the procedure, the exacerbation of existing stones due to the surgery, or inflammation of the gallbladder. Rapid weight loss after surgery has also been proposed as a contributing factor. Methodology This observational study consisted of a review of retrospective hospital patient medical records of 350 adult participants who underwent LSG, with 177 participants included in the study after excluding those with cholecystectomy or GBD prior to surgery. The participants were followed for a median of two years, during which we recorded any hospitalizations, emergency department visits, clinic visits, and incidents of cholecystectomy or abdominal pain due to GBD. The participants were grouped into two: those with GBD and those without GBD after bariatric surgery, and quantitative data were summarized using mean and standard deviations. The data were analyzed using IBM SPSS Statistics for Windows, Version 20.0. (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp), with a statistical significance of P<0.05. Results In our retrospective study of 177 patients who underwent LSG, the incidence of GBD after bariatric surgery was 4.5%. Most patients with GBD after bariatric surgery were White, but this difference was not statistically significant. Patients with type 2 diabetes had a higher incidence of GBD after bariatric surgery than those without diabetes (8.3% vs. 3.6%, P=0.355). Patients with HTN had a lower incidence of GBD after bariatric surgery than those without HTN (1.1% vs. 8.2%, P=0.032). Anti-hyperglycemia medication use did not significantly increase the risk of GBD after bariatric surgery (7.5% vs. 3.8%, P=0.389). None of the patients on weight loss medication developed GBD after bariatric surgery, compared to 5% of patients who did not take weight loss medication. Our sub-data analysis showed that patients who developed GBD after bariatric surgery had a high BMI (above 40 kg/m2) before surgery, which decreased to 35 kg/m2 and below 30 kg/m2 at six months and 12 months post-surgery, respectively. Conclusions Our findings demonstrate that the prevalence of GBD after LSG is low and comparable to the general population without LSG. Thus, LSG does not increase the risk of GBD. We found that rapid weight loss after LSG is a significant risk factor for GBD. These findings suggest that patients who undergo LSG should be informed of the risks of GBD and undergo careful screening before surgery to detect any pre-existing gallbladder issues. Overall, our study highlights the importance of continued research into the factors associated with GBD after bariatric surgery and the need for standardized prophylactic measures to prevent this potentially serious complication.

Is concomitant cholecystectomy at the time of bariatric surgery justified? a retrospective study

Nowadays, sleeve Gastrectomy (SG) has become a cornerstone in treating morbid obesity, a condition that has turned into one of the most important health concerns worldwide. Nonetheless, gallbladder (GB) disease remains a frequently seen problem after weight loss. The performance of concomitant cholecystectomy with SG (SCC) is yet still controversial. The study's aim is to assess the safety of performing SCC, the operative time, length of hospital stay (LOS) and the postoperative complications. This is a retrospective case-control study, conducted in Lebanon, comparing patients treated with SG, as control group A, to patients who underwent SCC (group B). Out of 120 patients included in the study, 100 underwent SG and 20 underwent SCC. Those who underwent SCC had an abnormal abdominal ultrasound (US) preoperatively. Out of the patients who had a SG, 40 patients (13.7%) underwent a subsequent cholecystectomy due to GB disease. Eight out of 40 patients (20%) suffered from complications, mainly related to common bile duct stone migration, requiring endoscopic retrograde cholangiopancreatography (ERCP). The mean time until presentation for cholelithiasis post bariatric surgery was 13.03 (±10.01) months and the mean weight loss achieved was 29.9 (±8.8) Kilograms. The mean operative time was increased by 29.9 min (min) for SCC (146.7 min) compared to SG alone (116.8 min). Our study results showed that the incidence of symptomatic GB disease post bariatric surgery (BS) was relatively high and cholecystectomy at that time was not straightforward. Also, SCC performance was highly dependent on the result of the preoperative US.

Laparoscopic Management of Gall Bladder Diseases in Nigeria: A Systematic Review.

Globally, the incidence and mortality from gallbladder diseases is on the rise. The gold standard for the management of symptomatic gallbladder disease is laparoscopic cholecystectomy. The practice of laparoscopic cholecystectomy is at a nascent stage in Low and middle-income countries like Nigeria despite its obvious advantages over traditional open cholecystectomy. This systematic review aims to assess the extent to which laparoscopic cholecystectomy is performed for the management of gallbladder diseases in Nigeria. The review was guided by the PRISMA model. We searched MEDLINE, Embase, CINAHL, Scopus, and Global health databases. All searches were conducted in August 2023. All study designs reporting laparoscopic cholecystectomy in Nigeria, in the past 10 years were included. Three authors conducted the data extraction using data extraction tables and two authors independently assessed the data for accuracy and completeness. The Joanna Briggs Institute critical appraisal tool was used to assess the data quality. Twenty-two articles with 1569 patients were included in this review. Females accounted for 69.5% of the patients and 30.5% were males. Twelve (54.5%) of the studies were from the Southwest of the country, 3 (13.6%) each from the South East and North Central regions, 2 (9.1%) South-South, and 1 (4.5%) each from the North East and North West. Study designs were mostly cross-sectional with sample sizes from 1 to 400. The highest and lowest number of laparoscopic cholecystectomies reported were 300 and 1 respectively. The majority (95.2%) of laparoscopic cholecystectomies were on account of calculous cholecystitis and the methods reported were the 4-port and 3-port techniques. The follow-up period ranged from 3 weeks to 2 years with 54 (3.4%) complications reported. Laparoscopic cholecystectomy in Nigeria is relatively safe with minimal complications. Its demand and uptake are on the rise, though slowly owing to its relatively high cost.

Intermediate- to long-term outcomes of endoscopic transpapillary gallbladder stenting in patients with gallstone-related disease: a 10-year single-center experience.

Endoscopic transpapillary gallbladder stenting (ETGS) can be a bridging therapy to elective cholecystectomy or a permanent gallbladder drainage method in patients with symptomatic gallbladder disease who are awaiting cholecystectomy or are unfit for surgery, respectively. We evaluated the intermediate- to long-term outcomes of ETGS in these groups. We retrospectively reviewed 234 patients (acute cholecystitis = 147), who were unfit for surgery (n = 50) or had deferred cholecystectomy (n = 184) and who underwent ETGS between 2012 and 2021. A 7-Fr, 15-cm, double-pigtail plastic stent was placed for ETGS without scheduled stent exchange. Biliary event-free rates (i. e. cholecystitis and cholangitis) were determined at 6 months, 1 year, and ≥ 2 years. Technical and clinical success rates were 84.6 % (198/234) and 97.4 % (193/198), respectively. Kaplan-Meier analysis (n = 193) showed a biliary event-free rate of 99 % (95 %CI 0.95-1.00) at 6 months, 92 % (95 %CI 0.87-0.97) at 1 year, and 76 % (95 %CI 0.65-0.93) at ≥ 2 years, during a median follow-up period of 564 days (range 200-3001 days). ETGS is an effective biliary drainage method that should be considered in selected cases with common bile duct stone where cholecystectomy could not be performed or was deferred. The biliary event-free rates of ≥ 76 % up to ≥ 2 years further support the use of ETGS in these patient groups.

Gallstones: The thing in itself.

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The Generation of Pneumoperitonium by DCI Technique

Background: The safe and effective insertion of a primary port is the first and most crucial &amp; risky of a laparoscopy. Open laparoscopy, optical trocar insertion, direct trocar insertion (DTI) and direct cannula insertion ot traditional technique of insufflation following Veress needle (VN) insertion via the umbilicus. Aim: To assess the safety of DCI technique to generate the pneumoperitonium in our set up. Methodology: This prospective study was conducted at AIMEC sheikhupura from Feb.2019 to Feb.2020. All the150 patients with symptomatic gall bladder disease were admitted. All consecutive patients who underwent successful LC under the care of a single consultant. GA was used to operate in every case. After painting and draping, a 10 mm infra umbilical incision was made. With the use of towel clips, the anterior abdominal wall was raised, and a direct cannula was inserted into the abdominal cavity. All the LC was performed with four-port technique. Three doses of second-generation cephalosporin were administered in every case. Data was entered and analyzed in SPSS. Result: Total 150 patients were included. There were 30(20%) male and 130(80%) female. The mean age was 42.5±12.2 years. Out of 150(100%) patients 18(12%) were having acute gallbladder disease while rest 132(88%) were chronic cases. Most of the operated patients 81(54%) were discharged at 48 hours, 45(30%) at 24hours while rest of the patients stayed longer, including 15(10%) stayed for 72 hours,9(6%) for 96hours and one of the patients who was converted to open procedure for an accessory duct stayed for 7 days. Conclusion: The conclusion of the study that DCI technique to generate pneumoperitonium for laparoscopic procedures remains safe and rapid technique. Keywords: Laparoscopic surgery, DCI technique, pneumoperitonium, gall bladder disease

Metagenomic Sequencing of the Gallbladder Microbiome: Bacterial Diversity Does Not Vary by Surgical Pathology

IntroductionAlterations in the microbiome contribute to the pathogenesis of many gastrointestinal diseases. However, the composition of the microbiome in gallbladder disease is not well described. MethodsWe aimed to characterize the biliary microbiome in cholecystectomy patients. Bile and biliary stones were collected at cholecystectomy for a variety of surgical indications between 2017 and 2019. DNA was extracted and metagenomic sequencing was performed with subsequent taxonomic classification using Kraken2. The fraction of bacterial to total DNA reads, relative abundance of bacterial species, and overall species diversity were compared between pathologies and demographics. ResultsA total of 74 samples were obtained from 49 patients: 46 bile and 28 stones, with matched pairs from 25 patients. The mean age was 48 years, 76% were female, 29% were Hispanic, and 29% of patients had acute cholecystitis. The most abundant species were Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pasteurianus. The bacterial fraction in bile and stone samples was higher in acute cholecystitis compared to other non-infectious pathologies (p < 0.05). Neither the diversity nor differential prevalence of specific bacterial species varied significantly between infectious and other non-infectious gallbladder pathologies. Multivariate analysis of the non-infectious group revealed that patients over 40 years of age had increased bacterial fractions (p < 0.05). ConclusionsMetagenomic sequencing permits characterization of the gallbladder microbiome in cholecystectomy patients. Although a higher prevalence of bacteria was seen in acute cholecystitis, species and diversity were similar regardless of surgical indication. Additional study is required to determine how the microbiome can contribute to the development of symptomatic gallbladder disease.

Pre-operative predictors of difficult laparoscopic cholecystectomy: a comparative study between two scoring systems

Background: Laparoscopic cholecystectomy is considered as the gold standard in treating symptomatic gall bladder disease. It has now become the most common operation performed by general surgeons. At times laparoscopy becomes difficult and may need conversion to open cholecystectomy. Many scoring systems are developed to predict the difficulty of laparoscopic cholecystectomy pre operatively. Our study aims to determine factors predicting difficult cholecystectomy and validate 2 scoring systems i.e., risk score for conversion from laparoscopic to open cholecystectomy (RSCLO) vs. new scoring system (NSS).Methods: Patients presenting to Kempegowda institute of medical sciences from January 2014 to August 2015 with symptoms of gall stone disease were screened for cholelithiasis.100 patients undergoing laparoscopic cholecystectomy were randomly selected. Every patient was given pre-operative score, after applying their symptoms to the scoring system and these scores were compared with the intraoperative findings and post-operative outcome. Thereby, calculating the sensitivity and specificity of the scoring systems.Results: On univariate and multivariate logistic regression-BMI&gt;27.5 kg/m2 (p=0.010), Palpable gallbladder (p=0.022), previous hospitalization for acute cholecystitis (p=0.15), Sonology: wall thickness&gt;4 mm (p=0.0015), presence of pericholecystic edema, were found statistically significant. RSCLO system was better in predicting easy cholecystectomy i.e., low risk for conversion, while NSS was better in predicting difficult, very difficult cholecystectomies {converted cases}, its sensitivity being 100%.Conclusions: New scoring system can predict difficult cases reliably. Scoring patients preoperatively can decrease intra-op difficulties. Patients can pre-op be informed about possible risk of conversion to open cholecystectomy.

Patient decision-making in symptomatic gallbladder disease.

BackgroundOne in five people with gallstones develop symptoms (~ 13 million in the US), yet only a fraction undergo cholecystectomy. The frequency of and factors associated with patients choosing medical management for gallbladder disease are not well understood. The goal of this study was to assess patient decision-making regarding cholecystectomy, experiences with medical management, and interest in a clinical trial comparing cholecystectomy with medical management. MethodsWe conducted a cross-sectional survey from January 2020 through May 2020 using Amazon’s crowdsourcing platform, MTurk. After a brief screening survey to determine gallbladder disease history and cholecystectomy status, eligible users without prior cholecystectomy were invited to complete the full survey for US $2.50.ResultsThere were 148 responses included in analysis (93.7% of attempted). Participants were 54% female with a mean age of 36.2 (SD 11.3) years. 36% of participants had used medications or supplements to manage their symptoms with 17% using lecithin and 22% using ursodeoxycholic acid (Ursodiol®). 85% attempted lifestyle modifications to manage symptoms. Surgery was recommended for 60% of which 43% reported planning cholecystectomy. Among those recommended operation, most common reasons for pursuing were symptoms (50%) and symptoms interfering with care of family (42%), while most common reasons for not pursuing were risks of surgery/anesthesia (56%), ongoing medical management (50%), and symptom tolerance (38%). 67% reported willingness to participate in a clinical trial comparing medical management to cholecystectomy.ConclusionA significant portion of patients with symptomatic gallbladder disease choose not to undergo cholecystectomy. One of the most common reasons for avoiding surgery was the use of alternative therapies, despite limited evidence to support their use. The lack of prospective comparison of cholecystectomy to medical therapies for the management of gallbladder disease, along with patient interest, support the need for a clinical trial.

Management of gallstone disease prior to and after metabolic surgery: a single-center observational study.

Rapid weight loss after bariatric surgery is a risk factor for gallstone formation. There are different strategies regarding its management in bariatric patients, including prophylactic cholecystectomy (CCE) in all patients, concomitant CCE only in symptomatic patients, or concomitant CCE in all patients with known gallstones. We present the safety and long-term results of the last concept. Retrospective single-center analysis of a prospective database on perioperative and long-term results of patients with laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) over a 15-year period. The minimal follow-up was 24 months. Concomitant CCE was intended for all patients with gallstones detected by preoperative sonography. Academic teaching hospital in Switzerland. After exclusion of patients with a history of CCE (11.5%), a total of 1174 patients (69.6% LRYGB, 30.4% LSG) were included in the final analysis. Preoperative gallbladder pathology was detected in 21.2% of patients, of whom 98.4%, or 20.9% of the total patients, received a concomitant CCE. The additional procedure prolonged the average operation time by 38 minutes (not significant) and did not increase the complication rate compared with bariatric procedure without CCE (3.7% versus 5.7%, P = .26). No complication was directly linked to the CCE. Postoperative symptomatic gallbladder disease was observed in 9.3% of patients (LRYGB 7.0% versus LSG 2.3%, P = .15), with 19.8% of those patients initially presenting with a complication. The concept of concomitant CCE in primary bariatric patients with gallstones was feasible and safe. Nevertheless, 9.3% of primary gallstone-free patients developed postoperative symptomatic gallbladder disease and required subsequent CCE despite routine ursodeoxycholic acid prophylaxis.

P-BN17 Laparoscopic subtotal cholecystectomy is a safe and effective treatment for gallstone disease

Abstract Background Laparoscopic cholecystectomy is the gold standard treatment of gallstones in fit patients with symptomatic gallbladder disease. If the critical view of safety cannot be achieved intra-operatively, there are few options, one of which is laparoscopic subtotal cholecystectomy. This study aims to ascertain the outcomes of subtotal cholecystectomy. Methods Retrospective review of all patients who underwent laparoscopic subtotal cholecystectomy by a single surgeon over a 5 year period. Results 37 consecutive patients who underwent subtotal cholecystectomy were included in this study; seventeen of which were males (49%); the median age was 69, and 18 were emergencies (49%).The most common reasons for conversion to laparoscopic subtotal cholecystectomy were adhesions (57%) and fibrotic Calot’s triangle (22%). One patient required ERCP and biliary stenting for ongoing bile leak and another returned to theatre for post operative bleeding during index admission. 6 patients (16%) required further hospital admissions for gallstone disease (1 for biliary colic, two for cholecystitis and three for CBD stones). 3 patients required ERCP. None required further gallbladder surgery. Conclusions Laparoscopic subtotal cholecystectomy is a safe and effective alternative to total cholecystectomy when the critical view of safety cannot be achieved. In our experience, only a small proportion of patients have recurrent biliary problems.

P-BN62 Predictive factors for subtotal cholecystectomy in delayed elective cholecystectomy after acute biliary presentation

Abstract Background Laparoscopic cholecystectomy is introduced as a treatment option for symptomatic gall bladder disease in 1987 and it is now the gold standard treatment for symptomatic gall bladder disease. The rate of conversion from laparoscopic to open ranges between 5 and 10% .The step of paramount importance in cholecystectomy is the clear identification of the cystic duct and artery, which in some situations can be difficult especially in presence of dense adhesions or severely inflamed gall bladder, increasing the risk for common bile duct (CBD) injury. The traditional response to encountering a difficult laparoscopic cholecystectomy procedure is to perform conversion to an open procedure but the open conversion has its drawbacks; The subtotal cholecystectomy has been shown to reduce the need for conversion to an open procedure, thus reducing complications associated with the open cholecystectomy. Studies have also shown that this procedure decreases the bile duct injury rate . Subtotal cholecystectomy rates increased nationally over the past decade. The aim of our study is to identify factors which could predict the need for a subtotal cholecystectomy in the acute biliary admission group having delayed elective Laparoscopic cholecystectomy ,hence proper planning in terms on theatre timing, expertise and patients consenting Methods We conducted a retrospective analysis of patients who had delayed elective laparoscopic subtotal cholecystectomy after admission with Acute Biliary disease and managed conservatively in a tertiary London hospital, between 01/03/2019-29/02/2020 We collected data for all patients whose primary diagnosis was either Acute Cholecystitis, Cholelithiasis, Ascending Cholangitis, Choledocholithiasis and Gallstone Pancreatitis, and analysed these in terms of patient demographics, , duration of index admission, laboratory and radiological results during the acute admission and need to intervention during the acute phase either as a drain (cholecystostomy) or ERCP during initial management. Data were collected from electronic patient records, regarding age, gender, indication for surgery, operative notes, preoperative gall bladder wall thickness on US scan, laboratory results during acute admission. BMI, other interventions such as endoscopic retrograde cholangiopancreatography (ERCP) and cholecystostomy Odds ratios were calculated to assess the risk of patients having a subtotal cholecystectomy. Results 243 patients presented between 01/03/19-29/02/2020 which acute biliary pathology – 95 Male and 148 Female, 230 patients had delayed elective laparoscopic cholecystectomy at least 6 weeks post-acute admission Of 230 laparoscopic cholecystectomies, 22 (9.56%) cases had a subtotal cholecystectomy 13(59.9%) patients were male patients, median age 72 (54.5%) had BMI more than 30 No open conversion. The indication for cholecystectomy in the subtotal group was as follows: Acute cholecystitis 12 (54.54%), Ascending cholangitis 4 (18.18%), Choledocholithiasis 3(13.63%), gall stone pancreatitis 1(4.5%), Cholelithiasis 2 (9.09%)The subtotal cholecystectomy group had Gall bladder wall thickness during index admission documented 4 (18.18%)patients had Gall bladder wall thickness less than 4 or equal 4 mm, 18(81.81%) patients had Gall bladder wall thickness more 4 mm. Odds ratios were calculated to assess the correlation between several characteristics and the likelihood of having a subtotal cholecystectomy in the delayed elective cholecystectomy, we concluded that Older age, male sex, BMI more than 30, previous ERCP, thickened GB wall on ultrasound scan more than 4 mm WCC &amp;gt; 15000 during acute admission, all increased the likelihood of having a subtotal cholecystectomy Conclusions Older age, male sex, BMI more than 30, previous ERCP, thickened GB wall on ultrasound scan more than 4 mm WCC &amp;gt; 15000 during acute admission all increased the likelihood of having a subtotal cholecystectomy. We recommend all these information should be documented during planning for laparoscopic cholecystectomy to allow proper theatre time planning and patient consenting for the possibility of having a subtotal cholecystectomy.

EP.WE.47Cholecystectomy During COVID-19: A Single Centre Experience

BackgroundThe COVID-19 pandemic has significantly impacted healthcare delivery globally with consequent restructuring of surgical services during the peak period and prioritisation of emergency and cancer surgery over elective operations.We present outcomes for laparoscopic cholecystectomy during the peak period for COVID-19 in the UK and compare this with data for the same period in 2019MethodologyThis is a prospectively study. Analysis of collected data on patients who underwent laparoscopic cholecystectomy during the peak period for COVID-19 from 1st March 2020 – 30th June 2020 (study cohort) at the Royal Stoke University Hospital. Data from the same period in 2019 (control cohort) was compared and analysed.Results104 patients underwent a laparoscopic cholecystectomy during the peak period compared to 217 during the same period in 2019.Median age in the study cohort was 51.5 years (15-84 years) and 52 years (19-91 years) in the control cohort (p = 0.49). Male to Female ratio was 1:2 in the study cohort and 1:2.2 in the control cohort (p = 0.67)Emergency admissions constituted the majority of cases and there was no statistically significant difference between both groups (61.5% vs 61.8%, p = 0.49). Most cholecystectomies were for biliary colic (41.3% vs 35.5%) and cholecystitis (37.5% vs 43.8%), and there was no statistically significant difference between both groups (p = 0.31 and p = 0.29 respectively).ConclusionThis study demonstrates that laparoscopic cholecystectomy was feasible and safe in patients with symptomatic gall bladder disease during the peak period for COVID-19 when compared to a historic cohort in 2019.

OUTCOMES OF LAPAROSCOPIC CHOLECYSTECTOMY IN DIFFERENT GRADES OF GALL BLADDER INFLAMMATION A TERTIARY CARE CENTRE EXPERIENCE

Objective: To find the outcomes of laparoscopic cholecystectomy in gall bladders with all grades peri-operative inflammation.&#x0D; Study Design: Prospective observational study.&#x0D; Place and Duration of Study: Combined Military Hospital, Rawalpindi, from Nov 2018 to Aug 2019.&#x0D; Methodology: All patients with symptomatic gall bladder disease who underwent laparoscopic cholecystectomy (emergency/elective procedure) and American Anesthesiology Society (ASA) Score 1 or 2 were included in the study.&#x0D; Results: A total of 330 patients with a mean ± SD age of 48.01 ± 14.13 years underwent laparoscopic cholecystectomy. Out of 330 patients, 129 (39.1%) had acute inflammation of gall bladder while 201 (69.9%) cases were operated electively. The rate of conversion and complications were somehow lesser in both categories as the overall conversion rate was 15 (4.5%).&#x0D; Conclusion: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gall stones. Moreover, it is safe option in acute and chronic inflammation of Gall bladder if performed by a experienced laparoscopic surgeon.

Effect of Gall Bladder Retrieval via Epigestric Vs Umbilical Port in Laparoscopic Cholectystectomy

Background and Aim: The retrieval of the gallbladder is a key event in laparoscopic cholecystectomy and significantly contributes to postoperative infections and pain. The GB is extracted through an umbilical or epigastric port. The goal of this single-center study was to compare GB retrieval via epigastric versus umbilical port in terms of postoperative site pain and infections. Materials and Methods:In this single-center study, 60 Cholelithiasis patients under went laparoscopic cholectystectomy (LC) for symptomatic gallbladder disease during the period from November 2020 to April 2021 at surgery department of Gambat Institute of Medical Sciences, Gambat Sindh Pakistan. The patients were selected out of the operating room for GB retrieval via umbilical port (Group-I with n = 30) versus epigastric port (Group-II with n = 30) randomly.All 60 patients had routine blood tests such as CBC, SGOT, SGPT, PT, and urine examinations. Until their bowels recovered, all of the patients were kept nil by mouth and on parenteral fluids. They were closely monitored in the post-operative period, with special attention paid to recording the pulse rate, temperature, and level of pain on a 24-hour basis. Results:Chronic Cholecystitis patients chosen randomly from the cholecystectomy list to have their gallbladder delivered through an umbilical or epigastric port.Group I had median pain (IQR) of 5 (1.5), 4 (1), and 2 (1) when compared to group II's median pain (IQR) of 4 (1), 2 (1), and 1 (0.5) one day after the procedure (p-value=0.001), at the time of hospital discharge (p-value0.001), and one month post-surgery (p-value0.001).In group B, there was a clear regression in postoperative pain from the day of surgery until a month later (p-value0.001). Conclusion:According to our findings, umbilical ports are preferable to epigastric ports in terms of post-operative pain, but there is an increased port site infection and hernia risk. Keywords:Cholecystectomy, Umbilical port, Epigastric port, Gall bladder retrieval, Laparoscopic.

Endoscopic gallbladder drainage for symptomatic gallbladder disease: a cumulative systematic review meta-analysis.

Endoscopic ultrasound (EUS)-guided transmural or endoscopic retrograde cholangiography (ERC)-based transpapillary drainage may provide alternative treatment strategies for high-risk surgical candidates with symptomatic gallbladder (GB) disease. The primary aim of this study was to perform a systematic review and meta-analysis to investigate the efficacy and safety of endoscopic GB drainage for patients with symptomatic GB disease. Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed in accordance with PRISMA and MOOSE guidelines. Pooled proportions were calculated for measured outcomes including technical success, clinical success, adverse event rate, recurrence rate, and rate of reintervention. Subgroup analyses were performed for transmural versus transpapillary, transmural lumen apposing stent (LAMS), and comparison to percutaneous transhepatic drainage. Heterogeneity was assessed with I2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. Thirty-six studies (n = 1538) were included. Overall, endoscopic GB drainage achieved a technical and clinical success of 87.33% [(95% CI 84.42-89.77); I2 = 39.55] and 84.16% [(95% CI 80.30-87.38); I2 = 52.61], with an adverse event rate of 11.00% [(95% CI 9.25-13.03); I2 = 7.08]. On subgroup analyses, EUS-guided transmural compared to ERC-assisted transpapillary drainage resulted in higher technical and clinical success rates [OR 3.91 (95% CI 1.52-10.09); P = 0.005 and OR 4.59 (95% CI 1.84-11.46); P = 0.001] and lower recurrence rate [OR 0.17 (95% CI 0.06-0.52); P = 0.002]. Among EUS-guided LAMS studies, technical success was 94.65% [(95% CI 91.54-96.67); I2 = 0.00], clinical success was 92.06% [(95% CI 88.65-94.51); I2 = 0.00], and adverse event rate was 11.71% [(95% CI 8.92-15.23); I2 = 0.00]. Compared to percutaneous drainage, EUS-guided drainage possessed a similar efficacy and safety with significantly lower rate of reintervention [OR 0.05 (95% CI 0.02-0.13); P < 0.001]. Endoscopic GB drainage is a safe and effective treatment for high-risk surgical candidates with symptomatic GB disease. EUS-guided transmural drainage is superior to transpapillary drainage and associated with a lower rate of reintervention compared to percutaneous transhepatic drainage.

Randomised controlled trial to establish the clinical and cost-effectiveness of expectant management versus preoperative imaging with magnetic resonance cholangiopancreatography in patients with symptomatic gallbladder disease undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones (The Sunflower Study): a study protocol

IntroductionSurgery to remove the gallbladder (laparoscopic cholecystectomy (LC)) is the standard treatment for symptomatic gallbladder disease. One potential complication of gallbladder disease is that gallstones can pass into the common...