Treatment Of Benign Gallbladder Diseases Research Articles

Systematic Review of Utilized Ports in Laparoscopic Cholecystectomy: Pushing the Boundaries.

Surgical procedures have undergone a paradigm shift in the last 3 decades, with minimally invasive surgery becoming standard of care for a number of surgeries, including the treatment of benign gallbladder diseases. By providing a thorough and impartial summary of the earlier published systematic reviews, the current systematic review is the first to present comparison results. This review illustrates the data of intraoperative and postoperative results of each laparoscopic cholecystectomy technique. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was meticulously followed to conduct the present systematic review. MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, and Web of Science were searched for eligible publications, and a total of 14 systematic reviews were included. A newly developed extraction table was utilized to obtain the predefined parameters from eligible systematic reviews, including operative time, conversion rate, estimated blood loss, bile leak, length of hospital stay, postoperative pain, and cosmetic results. All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) software, version 26.0. The analysis of dichotomous results was summarized using relative risks and 95% confidence intervals (95% CI), and continuous results were summarized using mean differences and 95% CIs. The proportions were compared using a single proportion z-test. The analysis of our primary and secondary outcomes revealed a statistically significant improvement in aesthetic results after single-incision laparoscopic cholecystectomy (SILC) in comparison to the multiport approach of laparoscopic cholecystectomy. This, however, is accompanied by extended operative timing and subsequently, prolonged exposure to anesthesia. Patients should be carefully selected for SILC to minimize technical difficulties and prevent complications both intraoperatively and shortly after the procedure. This trial is registered with CRD42023392037.

Cost-effectiveness analysis of robotic cholecystectomy in the treatment of benign gallbladder disease

BackgroundLaparoscopic cholecystectomy is the current standard of care treatment for benign gallbladder disease. Robotic cholecystectomy is another approach for performing cholecystectomy that offers a surgeon better dexterity and visualization. However, robotic cholecystectomy may increase cost without sufficient evidence to suggest an improvement in clinical outcomes. The purpose of this study was to construct a decision tree model to compare cost-effectiveness of laparoscopic cholecystectomy and robotic cholecystectomy. MethodsComplication rates and effectiveness associated with robotic cholecystectomy and laparoscopic cholecystectomy over a 1-year time frame were compared using a decision tree model populated with data from the published literature. Cost was calculated using Medicare data. Effectiveness was represented by quality-adjusted life-years. The primary outcome of the study was incremental cost-effectiveness ratio, which compares the cost per quality-adjusted life-year of the 2 interventions. The willingness-to-pay threshold was set at $100,000/quality-adjusted life-year. Results were confirmed with 1-way, 2-way, and probabilistic sensitivity analyses varying branch-point probabilities. ResultsThe studies used in our analysis included 3,498 patients who underwent laparoscopic cholecystectomy, 1,833 patients who underwent robotic cholecystectomy, and 392 patients who required conversion to open cholecystectomy. Laparoscopic cholecystectomy produced 0.9722 quality-adjusted life-years, costing $9,370.06. Robotic cholecystectomy produced an additional 0.0017 quality-adjusted life-years at an additional $3,013.64. These results equate to an incremental cost-effectiveness ratio of $1,795,735.21/quality-adjusted life-year. This exceeds the willingness-to-pay threshold, making laparoscopic cholecystectomy the more cost-effective strategy. Sensitivity analyses did not alter results. ConclusionTraditional laparoscopic cholecystectomy is the more cost-effective treatment modality for benign gallbladder disease. At present, robotic cholecystectomy is not able to improve clinical outcomes enough to justify its added cost.

Interpretation of consensus on the surgical management of benign gallbladder diseases (2021 edition)

Benign gallbladder diseases are common diseases in surgery,which are closely related to the occurrence of gallbladder cancer.Currently,nonstandard treatment exited in the surgical management of benign gallbladder diseases in China. Based on relevant domestic and foreign literature,guidelines,and expert consensus,consensus on the surgical management of benign gallbladder diseases(2021 edition) has been formulated. Further,recommendations related to diagnosis and treatment were presented to improve the standardization of surgical diagnosis and treatment of benign gallbladder diseases in China,so as to eliminate the clinical harm of gallbladder diseases and reduce the incidence rate of gallbladder cancer and prevent the occurrence. After the publication of the consensus,it has aroused heated discussion. This paper will interpret the hot issues.

Gallbladder Cryoablation: Clinical and Technical Considerations

AbstractAs many as 500,000 cholecystectomies are performed per year in the United States. Frail patients are at higher risk from cholecystectomy, with reported postoperative complication and mortality rates as high as 31 and 5% in patients older than 75 years. Percutaneous cholecystostomy drainage is commonly employed in high-risk patients with cholecystitis, with over 12,000 cases performed annually. Cholecystostomy, however, is not a definitive treatment, with up to 30% of patients having a recurrent episode of cholecystitis within 4 months after tube removal. Gallbladder cryoablation has emerged as a minimally invasive procedure that achieves transmural gallbladder wall necrosis in a single session resulting in gallbladder fibrosis and involution. Early clinical data have been promising, with reported technical success of 86% and clinical success of 100% at up to 500 days of follow-up. Several challenges and unknowns remain, however, including optimal patient selection and procedural technique, the potential need for adjunct procedures to occlude the cystic duct, the implications of the immunostimulatory effects of cryoablation, and the impact of the presence of gallstones on outcomes. This article reviews the rationale behind gallbladder cryoablation, updates early clinical outcomes, and discusses the challenges that remain for the adoption of the technique for the treatment of benign gallbladder disease.

Consensus on the surgical management of benign gallbladder diseases(2021 edition)

Benign gallbladder diseases are common in surgery department,and the incidence rate is increasing in recent years.Currently,nonstandard treatment existed in the surgical management of benign gallbladder diseases in China.Based on relevant domestic and foreign literature,guidelines,and expert consensus,this consensus expounds on the diagnosis and surgical treatment of common benign gallbladder diseases such as gallstone,cholecystitis,gallbladder polypoid,gallbladder adenomyosis,gallbladder variation and deformity,complications after cholecystectomy.Further,recommendations related to diagnosis and treatment were presented to improve the standardization of surgical diagnosis and treatment of benign gallbladder diseases in China,so as to eliminate the clinical harm of gallbladder diseases and reduce the incidence rate of gallbladder cancer and prevent the occurrence.

Intraoperative cholangiography and bile duct flushing in 47 dogs receiving laparoscopic cholecystectomy for benign gallbladder disease: A retrospective analysis.

To describe a laparoscopic approach for performing intraoperative cholangiography (IOC) and bile duct flushing (BDF) during laparoscopic cholecystectomy (LC) in dogs. To investigate the clinical outcomes of dogs undergoing these procedures for the treatment of benign gallbladder disease, ie gallbladder mucocele (GM) or cholecystitis. Retrospective study. Forty-seven client-owned dogs. Medical records of client-owned dogs with benign gallbladder diseases that underwent IOC and BDF during LC between September 2016 and December 2019 were reviewed. Of these dogs, only dogs with GM or cholecystitis were included in the study. The fundus dissection first method was used for LC. Intraoperative cholangiography and BDF procedures were performed laparoscopically using a catheter inserted into the cystic duct following dissection within the subserosal layer of the gallbladder. Videos recorded during each procedure were reviewed, and data on procedure duration, completion, outcome, and technical approach were recorded. Forty-seven dogs were included in the study. The median procedure time for BDF and IOC was 4 min (range, 2-48 min), and no intraoperative or postoperative complications occurred. During LC, BDF and IOC were performed safely and successfully. Intraoperative cholangiography identified obstructions and strictures in the common bile duct that were not detected using BDF alone. Our findings suggest that BDF and IOC are both safe and time effective and should be considered for routine use by surgeons during LC.

The surgical management of benign diseases of the gallbladder should be treated with caution

Surgical treatment of benign gallbladder disease seems relatively simple, but it causes many problems and controversies, which should not be ignored. According to the currently published related spirit of consensus guidelines and clinical practice, the treatment choices for five aspects of clinical problems should be paid attention to, and the problem for"blindly cholecystolithotomy"and "prudent choice cholecystectomy indications and surgical timing" were summarized and analyzed in order to cause enough attention for careful diagnostic and treatment of benign gallbladder diseases.

A COMPARATIVE STUDY OF SERUM TOTAL CHOLESTEROL IN PRE AND POST-CHOLECYSTECTOMY PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

Background:Laparoscopic cholecystectomy has many advantages over laparotomy like smaller incisions, reduced surgical trauma, less post-operative pain, faster recovery time, shorter hospital stay, and faster return to normal activities or routine work. So, it is considered as the gold standard for surgical treatment of benign gallbladder disease like cholelithiasis.The aim of this study was to elucidate the association of serum total cholesterol with cholelithiasis patients and effect of cholecystectomy on the same by laparoscopic procedure. Methodology: This study was conducted prospectively on 109 patients in a tertiary care hospital in eastern Uttar Pradesh, India. From January 2019 to December 2019, patients admitted for cholecystectomy in General surgery ward of this hospital were included in this study. Fasting blood samples of the patients were collected firstbefore surgery and then 12-24 hours after surgery and were analyzed in the biochemistry laboratory of the institute after proper control and calibration, meeting the quality standard of the laboratory. Values of serum total cholesterol thus obtained were compared with each other. Results: In our study, 84.4% patients were females with mean age of 43.1 years and 15.6% patients were males with mean age of 40.8 years. A reduction in mean value of serum total cholesterol was noted pre-operatively from 221.1 mg/dL to 203.5 mg/dL post-operatively. Conclusion: From our study, we concluded that laparoscopic cholecystectomy is beneficial in lowering down the serum total cholesterol and hence reduces the risk factors for associated diseases.

Long-term follow-up of the incisional hernia rate after single-incision laparoscopic cholecystectomy: a prospective observational study

Purpose To evaluate the long-term occurrence rate of incisional hernias following single-incision laparoscopic cholecystectomy (SILC). Background Since the 90 s, SILC has emerged as a less invasive alternative to standard laparoscopic cholecystectomy in selected patients. But concerns over port-incisional hernias have not been addressed. Methods Between February 2009 and February 2011, 142 patients referred for gallstones who agreed to undergo SILC were included in a monocenter prospective observational study. All of the procedures were carried out using a single-port access technique. The occurrence rates of incisional hernias were analyzed with the Kaplan-Meier actuarial method. Statistical significance was set at p < .05. Results A total of 142 patients with gallbladder pathology were included in the study; 138 of them underwent SILC and 4 were converted to standard multiport cholecystectomy. Twelve patients (8%) were found to have developed a port-site incisional hernia (PSH) by physical examination or by imaging. The Kaplan-Meier curve showed that the rate of PSH development was 83% in the first 2 years after surgery. After 2 years, this risk becomes quite low. Conclusions Our results indicate that the SILC procedure is a safe option for treatment of benign gallbladder diseases for selected patients, albeit with a high incisional hernia rate.

Evaluating the early impact of Medicaid expansion on trends in diagnosis and treatment of benign gallbladder disease in Kentucky.

In January 2014, Kentucky expanded Medicaid coverage in an effort to improve access to healthcare. This study evaluated the early impact of Medicaid expansion on diagnosis and treatment of benign gallbladder disease in Kentucky. Administrative claims data were queried for patients undergoing cholecystectomy for benign gallbladder disease between 2011 and 2015. Demographic, procedure, and outcome variables from 2011 to 2013 (PRE) and 2014-2015 (POST) were compared. After Medicaid expansion, patients were more likely to have their operation performed as an outpatient (80.0% vs. 78.2%, p < 0.001). A significant trend was noted toward a shorter hospital stay (p < 0.001) among inpatients. For both inpatients and outpatients, a significant shift was noted toward increased hospital charges (p < 0.001). The expansion of Kentucky Medicaid in 2014 has been associated with an increase in outpatient cholecystectomy, shorter hospital stays for inpatients, and increased hospital charges for both inpatients and outpatients. Increased charges for all procedures may represent a mechanism for hospitals to offset the cost of providing global care for more patients.

Laparoscopic Cholecystectomy in Patients With History of Gastrectomy.

Background and Objectives:Patients with previous gastrectomy have an increased incidence of gallstones and gallbladder morbidity requiring surgery. We investigated the possible risk factors that contribute to severe gallbladder disease in patients with previous gastrectomy and the role of laparoscopic cholecystectomy (LC) in the treatment of these patients.Methods:In this retrospective study, we reviewed a database of patients who underwent LC in our hospital during the period January 1, 2010, through May 1, 2015.Results:The average operation time in patients with previous gastrectomy was longer (P < .05), but the operation times of patients with a long interval (>5 years) between gastrectomy and LC showed no statistical difference from those of patients without a history of gastrectomy (P > .05). The conversion rate did not differ between the 2 groups (P > .05), but in patients with previous gastrectomy, the conversion rate was significantly reduced after we adopted a comprehensive preoperative evaluation procedure (P < .05). The frequency of cholecystitis attacks, rate of combination with gallbladder polyps, and rate of combination with pancreatitis were higher and gallstone formation time shorter, in the patients with malignant tumor, those undergoing Billroth II gastroenterostomy or esophagojejunostomy, and those with accompanying diabetes mellitus or hypercholesterolemia (P < .05).Conclusion:LC plays an important role in the treatment of benign gallbladder diseases in patients with a history of gastrectomy, and a comprehensive preoperative evaluation and accomplished surgical technique are necessary for successful outcomes. Previously identified clinical features may represent a risk factor for severe cholecystic morbidity in these patients.

Safety and Feasibility for Single-Incision Laparoscopic Cholecystectomy in Local Community Hospital

The aim of this study was to evaluate the safety and feasibility for single-incision laparoscopic cholecystectomy (SILC) by retrospective comparison with conventional laparoscopic cholecystectomy (CLC) in a local community hospital. SILC was introduced and performed in 57 patients for benign gallbladder diseases. Their clinical data were compared with those of 62 patients treated with CLC. They included patient demographic data and operative outcomes. SILC was attempted in 57 patients and 52 cases (91.2%) were successfully completed. There were no statistical differences between the 2 groups in terms of operative time, blood loss, and postoperative complications. The length of hospital stay in the SILC group was significantly shorter compared with CLC (P < 0.0001). SILC has been successfully introduced in a local community hospital. The safety and feasibility was also confirmed. The SILC procedure may become 1 standard option for the treatment of benign gallbladder diseases.

Prognosis of patients with pT1b/T2 gallbladder carcinoma who have undergone laparoscopic cholecystectomy as an initial operation.

Backgrounds/AimsLaparoscopic cholecystectomy (LC) has become a standard procedure for treatment of benign gallbladder diseases. There has been a small proportion of gallbladder cancer (GBC) which was incidentally found in the gallbladder specimen, and LC has been tried in some patients with faintly suspected GBC. This study intended to analyze the prognosis of patients with pT1b/T2 GBC who have undergone LC and the outcome of extended re-operation.MethodsAfter analyzing the institutional profiles of 500 GBC patients who have undergone surgical resection, we selected 64 patients who underwent LC initially from January 1996 to December 2008 and whose gallbladder pathology was confined to pT1b or pT2 lesions. Of them, 34 patients (53.1%) underwent extended reoperation. Their medical records were reviewed retrospectively.ResultsIn the LC only group (n=30), mean age of the 16 pT1 patients was 65.7±12.5 years and mean age of the 14 pT2 patients was 66.7±10.1 years. In the reoperation group (n=34), mean age of the 8 pT1b patients was 52.6±9.9 years and in 26 pT2 patients, mean age was 59.2±7.9 years. The reoperation group showed a younger patient age pattern than the LC only group (p=0.001). The types of reoperation were liver resection with lymph node (LN) dissection in 17, bile duct resection with LN dissection in 2, and hepatectomy and bile duct resection with LN dissection in 15. In the LC only group, the 5-year survival rate (5-YSR) was 70.3% in pT1b and 43.2% in pT2. In the reoperation group, 5-YSR was 62.5% in pT1b (n=8) and 59.5% in pT2 (n=26). A survival comparison between the two groups showed no significant survival gain in pT1 patients (p=0.69) and in pT2 patients (p=0.14). In our whole database analysis, 5-YSR of pT1bNx lesions was 70% after cholecystectomy and 78% after extended cholecystectomy. Lymph node metastasis was identified in 11% of pT1b lesions. For pT2N0 lesions, overall 5-YSR was 62% after R0 resection, showing no survival difference between primary extended surgery and LC-redo operation (p=0.45). ConclusionsThe survival gain of reoperation was not evident in pT1b lesions. In contrast, some noticeable but not statistically significant survival difference was observed in pT2 lesions. Thus, reoperation for pT1b/T2 GBC following LC is indicated for individualized reasons, especially in patients with pT1b lesions. Old age was one of the important factors in deciding not to reoperate.

Single-incision laparoscopic cholecystectomy: Initial experience with different multichannel ports

Single-incision laparoscopic cholecystectomy is a relatively new minimally invasive surgical technique in treatment of benign gallbladder diseases. It is considered a bridge technique between conventional laparoscopic cholecystectomy (LC) and NOTES. We are presenting our initial experiences in SILC (single-incision laparoscopic cholecystectomy). Seventeen patients underwent SILC (11 women and 6 men) with an average age of 43 years. Mean BMI score was 29,4 kg/m2. The mean operative time was 93,5 minutes. There were conversions to conventional LC in two cases (11,6%). Average pain score measured on visual-analogue scale (VAS) 8 h after the operation was 2,00. All patients expressed satisfaction with achieved cosmetic effect. We conclude that SILC is safe and feasible procedure, with excellent cosmetic effect, but further prospective studies are required before SILC can be generally accepted.

Learning Curve of Transumbilical Single Incision Laparoscopic Cholecystectomy (SILS): A Preliminary Study of 80 Selected Patients with Benign Gallbladder Diseases

Transumbilical single incision laparoscopic surgery (SILS) is a new laparoscopic procedure in which only one transumbilical incision is made, demonstrated as a scarless procedure. Here we report a single-center preliminary experience of transumbilical single incision laparoscopic cholecystectomy (SILC) in the treatment of benign gallbladder diseases, defining a single surgeon's learning curve. A total of 80 patients underwent SILC successfully by a single experienced laparoscopic surgeon. The operation was performed following the routine LC procedure. Then the perioperative demographics were recorded and the operative time was used to define the learning curve. The study group included 27 male and 53 female patients with gallstones (56 cases), cholesterol polyps (16 cases), an adenomatous polyp (3 cases), adenomyomatosis (1 case), or complex diseases (4 cases), and all consented to undergo SILC. No patient was converted to normal LC or open surgery. There were no perioperative port-related or surgical complications. The average operative time was 46.9 ± 14.6 min. The average postoperative hospital stay was 1.8 ± 1.3 days. The learning curve of the SILC procedures for this series of selected patients confirmed that SILC is a feasible, safe, and effective approach to the treatment of benign gallbladder diseases. For experienced laparoscopic surgeons, SILC is an easy and safe procedure. Patients benefit from milder pain, a lower incidence of port-related complications, better cosmesis, and fast recovery. The SILC procedure may become another option for the treatment of benign gallbladder diseases for selected patients.