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Suzuki Y, Yoshida M, Goto A, Yamazaki A, Arai T, Yoshida T, Kagiwata T, Funakoshi S, Kudo S, Kawaguchi S, Hasui N, Momose H, Matsuki R, Kogure M, Nakazato T, Sakata H, Hata S, Mori T, Sakamoto Y. Development and validation of a nomogram to predict the need for bailout procedure in laparoscopic cholecystectomy: A multicenter study of 1,898 cases. Surgery 2025; 182:109324. [PMID: 40101335 DOI: 10.1016/j.surg.2025.109324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 02/09/2025] [Accepted: 02/18/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the standard treatment for benign gallbladder disease. A bailout procedure is recommended for patients with severe inflammation. This study identified the preoperative factors that predict bailout procedures and developed a predictive nomogram. METHODS A total of 1,898 patients with laparoscopic cholecystectomy from 5 institutions (2015-2020) were divided into training (n = 1,518) and validation (n = 380) sets. Logistic regression was employed to predict bailout procedures and to develop a nomogram on the basis of the training set. The accuracy of the nomogram was evaluated using receiver operating characteristic curve analysis of the validation set. Postoperative outcomes were compared between qualified surgeons certified by the Japanese Society for Endoscopic Surgery and residents who had graduated from a medical university within the past 5 years. RESULTS Bailout procedures were performed in 262 (13.8%) patients. Multivariate analysis identified several significant predictors, including sex, age, gallbladder drainage, severity of acute cholecystitis, stone impaction of the gallbladder neck, and serum C-reactive protein. The nomogram achieved an area under the curve of 0.788 in the training set and 0.769 in the validation set. Intraoperative complications were significantly fewer in the qualified surgeon group than in the nonqualified surgeon group. CONCLUSION The nomogram aids surgeons in identifying high-risk patients and making informed decisions about bailout procedures, thereby ensuring patient safety. Involving qualified surgeons in case predicted to be difficult cholecystectomies may help prevent help to avoid intraoperative complications.
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Affiliation(s)
- Yutaka Suzuki
- Department of Gastroenterological Surgery, Kyorin University Suginami Hospital, Tokyo, Japan; Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan. https://twitter.com/yuta_suzuki_36
| | - Masao Yoshida
- Department of Public Health, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsuki Goto
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Aya Yamazaki
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Takaaki Arai
- Department of Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tomoyuki Yoshida
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Takara Kagiwata
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Saori Funakoshi
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Shohei Kudo
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Shohei Kawaguchi
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Nobuhiro Hasui
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Hirokazu Momose
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Ryota Matsuki
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Masaharu Kogure
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Tetsuya Nakazato
- Department of Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hiroki Sakata
- Department of Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Shojiro Hata
- Department of Surgery, Showa General Hospital, Tokyo, Japan
| | - Toshiyuki Mori
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yoshihiro Sakamoto
- Department of General and Gastroenterological Surgery, Kyorin University School of Medicine, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan.
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Ali G, Zeb M, Khattak A, Khan R, Dawar MK, Zaman K, Mulk NU, Khan J, Ullah S. Frequency and Predictors of Conversion From Laparoscopic to Open Cholecystectomy: A Single-Center Observational Study. Cureus 2024; 16:e76327. [PMID: 39850183 PMCID: PMC11756852 DOI: 10.7759/cureus.76327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2024] [Indexed: 01/25/2025] Open
Abstract
OBJECTIVE The study aimed to investigate the rate of conversion from laparoscopic cholecystectomy (LC) to open cholecystectomy (OC) in our population and determine the potential risk factors associated with it. Understanding these factors helps surgeons predict complex cases and plan surgeries, reducing patient risks and improving outcomes. METHODOLOGY A cross-sectional observational study was conducted from June 1, 2022, to May 31, 2023, at Hayatabad Medical Complex, Peshawar, on 349 patients undergoing elective LC. Data on demographics, clinical history, laboratory values, and imaging findings were recorded using a standardized proforma. Intraoperative findings, surgical outcomes, and complications were noted, with statistical analysis performed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Chi-squared, Mann-Whitney U, and logistic regression tests assessed the associations and risk factors of conversion to open surgery. RESULTS The rate of conversion from LC to OC was found to be 13 (3.7%). The multivariate analysis revealed several significant risk factors associated with the conversion. These included male gender, history of jaundice due to gallbladder stones, history of pancreatitis, gallbladder wall thickness greater than 3 mm, white blood cell counts greater than 1000 per microliter of blood, difficulty in handling the gallbladder with instruments intraoperatively, and dense adhesions with surrounding tissues (p<0.05). The risk factor summation pyramid showed a sensitivity of 84.6% and a specificity of 63.8% in predicting the likelihood of conversion, emphasizing the importance of considering each risk factor individually. CONCLUSION The rate of conversion to OC was 3.7%. Factors such as male gender, history of jaundice due to gallbladder stones, history of pancreatitis, thick gallbladder wall, high white blood cell count, difficulty in handling the gallbladder, and dense adhesions with surrounding tissues were significantly associated with conversion to OC.
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Affiliation(s)
- Gohar Ali
- General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Muhammad Zeb
- General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Almas Khattak
- Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Rashid Khan
- General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | | | - Khizer Zaman
- General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Nauman Ul Mulk
- General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Junaid Khan
- Orthopedics, Khyber Teaching Hospital, Peshawar, PAK
| | - Shakir Ullah
- General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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Sunagawa H, Teruya M, Ohta T, Hayashi K, Orokawa T. Standardization of a goal-oriented approach to acute cholecystitis: easy-to-follow steps for performing subtotal cholecystectomy. Langenbecks Arch Surg 2024; 409:251. [PMID: 39145913 DOI: 10.1007/s00423-024-03438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/05/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND A critical view of safety (CVS) is important to ensure safe laparoscopic cholecystectomy. When the CVS is not possible, subtotal cholecystectomy is performed. While considering subtotal cholecystectomy, surgeons are often concerned about preventing bile leakage from the cystic ducts. The two main types of subtotal cholecystectomy for acute cholecystitis are fenestrating and reconstituting. Previously, there were no selection criteria for these two; therefore, open conversion was performed. This study aimed to evaluate our goal-oriented approach to choose fenestrating or reconstituting subtotal cholecystectomy for acute cholecystitis. METHODS We introduced our goal-oriented approach in April 2019. Before introducing this approach, laparoscopic cholecystectomy for acute cholecystitis was performed without criteria for subtotal cholecystectomy. After our approach was introduced, laparoscopic cholecystectomy for acute cholecystitis was performed according to the subtotal cholecystectomy criteria. We retrospectively reviewed the medical records of patients who underwent laparoscopic cholecystectomy for acute cholecystitis between 2015 and 2021. Laparoscopic cholecystectomy for acute cholecystitis was performed by surgeons regardless of whether they were novices or veterans. RESULTS The period from April 2015 to March 2019 was before the introduction (BI) of our approach, the period from April 2019 to December 2021 was after the introduction (AI) of our approach. There were 177 and 186 patients with acute cholecystitis during the BI and AI periods, respectively. There were no significant differences between groups in terms of preoperative characteristics, operative time, and blood loss. No difference in the laparoscopic subtotal cholecystectomy rate between groups (10.2% [BI] vs. 13.9% [AI]; p = 0.266) was obserbed. The open conversion rate during the BI period was significantly higher than that during the AI period (7.4% vs. 1.6%; p = 0.015). CONCLUSIONS Our goal-oriented approach is feasible, safe, and easy for many surgeons to understand.
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Affiliation(s)
- Hiroki Sunagawa
- Department of Surgery, Nakagami Hospital, Noborikawa 610, Okinawa, 904-2195, Japan.
| | - Maina Teruya
- Department of Surgery, Nakagami Hospital, Noborikawa 610, Okinawa, 904-2195, Japan
| | - Takano Ohta
- Department of Surgery, Nakagami Hospital, Noborikawa 610, Okinawa, 904-2195, Japan
| | - Keigo Hayashi
- Department of Surgery, Nakagami Hospital, Noborikawa 610, Okinawa, 904-2195, Japan
| | - Tomofumi Orokawa
- Department of Surgery, Nakagami Hospital, Noborikawa 610, Okinawa, 904-2195, Japan
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Diaz-Martinez J, Pérez-Correa N. Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature. Euroasian J Hepatogastroenterol 2024; 14:44-50. [PMID: 39022195 PMCID: PMC11249893 DOI: 10.5005/jp-journals-10018-1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/12/2024] [Indexed: 07/20/2024] Open
Abstract
Backgrounds Laparoscopic cholecystectomy (LC) is the gold standard for treating gallstones; however, it is not free of complications. Postcholecystectomy duodenal injuries are rare but challenging complications after cholecystectomy. The objective of this study was to analyze the management of postcholecystectomy duodenal injuries and to review the related literature. Materials and methods An observational and retrospective study was conducted. We included all patients with postcholecystectomy duodenal injuries treated at a reference center, from January 2019 to December 2023. In addition, a review of the literature was carried out. Results Fifteen patients were found, mostly women; with gallbladder wall thickening on ultrasound (mean of 8 mm). The majority were emergency (n = 12, 80%) and LCs (n = 8, 53.33%). Cholecystectomies were reported to be associated with excessive difficulty (n = 10, 66.66%). The most injured duodenal portion was the first portion (n = 9, 60%), and blunt dissection was the most common mechanism of injury (n = 7, 46.66%). Most of these injuries were detected in the operating room (n = 9, 60%), and treated with primary closure (n = 11, 73.33%). Three patients with delayed injuries died (20%). According to the literature reviewed, 93 duodenal injuries were found, mostly detected intraoperatively, in the second portion, and treated with primary closure. A minority of patients were treated with more complex procedures, for a mortality rate of 15.38%. Conclusion Postcholecystectomy duodenal injuries are rare. Most of these injuries are detected and repaired intraoperatively. However, a high percentage of patients have high morbidity and mortality. How to cite this article Diaz-Martinez J, Pérez-Correa N. Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature. Euroasian J Hepato-Gastroenterol 2024;14(1):44-50.
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Affiliation(s)
- Jair Diaz-Martinez
- Department of General and HPB Surgery, Hospital de Alta Especialidad Centenario de la Revolución Mexicana ISSSTE, Zapata, Morelos, Mexico
| | - Nayelli Pérez-Correa
- Department of General Surgery, Hospital General Regional c/MF No. 1, IMSS, Cuernavaca, Morelos, Mexico
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Chin X, Mallika Arachchige S, Orbell-Smith J, Wysocki AP. Preoperative and Intraoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Systematic Review of 30 Studies. Cureus 2023; 15:e47774. [PMID: 38021611 PMCID: PMC10679842 DOI: 10.7759/cureus.47774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
This systematic review aims to review articles that evaluate the risk of conversion from laparoscopic to open cholecystectomy and to analyze the identified preoperative and intraoperative risk factors. The bibliographic databases CINAHL, Cochrane, Embase, Medline, and PubMed were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only English-language retrospective studies and systematic reviews with more than 200 patients were included. The time of publication was limited from 2012 to 2022. Our systematic review identified 30 studies with a total of 108,472 patients. Of those, 92,765 cholecystectomies were commenced laparoscopically and 5,477 were converted to open cholecystectomy (5.90%). The rate of conversion ranges from 2.50% to 50%. Older males with acute cholecystitis, previous abdominal surgery, symptom duration of more than 72 hours, previous history of acute cholecystitis, C-reactive protein (CRP) value of more than 76 mg/L, diabetes, and obesity are significant preoperative risk factors for conversion from laparoscopic to open cholecystectomy. Significant intraoperative risk factors for conversion include gallbladder inflammation, adhesions, anatomic difficulty, Nassar scale of Grades 3 to 4, Conversion from Laparoscopic to Open Cholecystectomy (CLOC) score of more than 6 and 10-point gallbladder operative scoring system (G10) score more than 3.
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Affiliation(s)
- Xinlin Chin
- General Surgery, Mackay Base Hospital, Mackay, AUS
- Medicine, Griffith University, Birtinya, AUS
- Medicine and Dentistry, James Cook University, Mackay, AUS
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Colvin HS, Kimura T, Iso H, Ikehara S, Sawada N, Tsugane S. Risk Factors for Gallstones and Cholecystectomy: A Large-Scale Population-Based Prospective Cohort Study in Japan. Dig Dis 2021; 40:385-393. [PMID: 34023821 DOI: 10.1159/000517270] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 05/17/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Studies investigating the risk of gallstones in the Japanese population are sparse. To our knowledge, this is the first prospective cohort study assessing risk factors of gallstones in Japan. METHODS A nationwide population-based prospective cohort of 112,109 men and women, aged 40-69 years, self-completed questionnaires at baseline regarding exposures to potential risk factors, between 1990 and 1994. The occurrence of gallstones and cholecystectomy for gallstones were ascertained from another questionnaire after 10 years. Odds ratios and the 95% confidence intervals were calculated using the multivariate logistic regression. RESULTS During the 10-year follow-up, 3,092 (5.0%) participants developed gallstones and 729 (1.2%) participants required cholecystectomy. Increasing age, high body mass index, and diabetes mellitus were associated with the risk of gallstones in both sexes. In men, weight gain or loss of >5 kg over the follow-up period and stress were associated with risk of gallstones, whereas alcohol intake was inversely associated with the risk. In women, weight gain of >5 kg during the follow-up period, smoking, menopause, and lipid-lowering drugs were associated with risk of gallstones, whereas late onset of menarche was inversely associated with risk of gallstones. The risk of cholecystectomy broadly reflected the risk of gallstones for both sexes respectively. CONCLUSION Risk factors for both gallstones and cholecystectomy for gallstones are multifactorial and differ between men and women. Novel findings in this study include an inverse association between late onset of menarche and gallstones, and an association between self-reported stress in men and gallstones.
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Affiliation(s)
- Hugh Shunsuke Colvin
- Department of General Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University, Sapporo, Japan
| | - Hiroyasu Iso
- Department of Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan
| | - Satoyo Ikehara
- Department of Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
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Rice CP, Vaishnavi KB, Chao C, Jupiter D, Schaeffer AB, Jenson WR, Griffin LW, Mileski WJ. Operative complications and economic outcomes of cholecystectomy for acute cholecystitis. World J Gastroenterol 2019; 25:6916-6927. [PMID: 31908395 PMCID: PMC6938729 DOI: 10.3748/wjg.v25.i48.6916] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent management of acute cholecystitis favors same admission (SA) or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings. We adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this practice. We hypothesized that the existence of complications, particularly among patients with a higher degree of disease severity, during SA cholecystectomy could negate the cost savings.
AIM To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.
METHODS Under an IRB-approved protocol, complications and charges for were obtained for SA, later after conservative management (Delayed), or elective cholecystectomies over an 8.5-year period. Patients were identified using the acute care surgery registry and billing database. Data was retrieved via EMR, operative logs, and Revenue Cycle Operations. The severity of acute cholecystitis was graded according to the Tokyo Guidelines. TG18 categorizes acute cholecystitis by Grades 1, 2, and 3 representing mild, moderate, and severe, respectively. Comparisons were analyzed with χ2, Fisher’s exact test, ANOVA, t-tests, and logistic regression; significance was set at P < 0.05.
RESULTS Four hundred eighty-six (87.7%) underwent a SA while 68 patients (12.3%) received Delayed cholecystectomy. Complication rates were increased after SA compared to Delayed cholecystectomy (18.5% vs 4.4%, P = 0.004). The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy (7.4%, P = 0.35). Mortality rates were 0.6% vs 0% for SA vs Delayed. Patients with moderate disease (Tokyo 2) suffered more complications among SA while none who were delayed experienced a complication (16.1% vs 0.0%, P < 0.001). Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach ($44500 ± $59000 vs $35300 ± $16700, P = 0.019). The relative risk of developing a complication was 4.2x [95% confidence interval (CI): 1.4-12.9] in the SA vs Delayed groups. Among eight patients (95%CI: 5.0-12.3) with acute cholecystitis undergoing SA cholecystectomy, one patient will suffer a complication.
CONCLUSION Patients with Tokyo Grade 2 acute cholecystitis had more complications and increased hospital charges when undergoing SA cholecystectomy. This data supports a selective approach to SA cholecystectomy for acute cholecystitis.
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Affiliation(s)
- Christopher P Rice
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | | | - Celia Chao
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Daniel Jupiter
- Department of Preventive Medicine and Community Health, Department of Biostatistics, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - August B Schaeffer
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Whitney R Jenson
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Lance W Griffin
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - William J Mileski
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
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Castro Salgado PC, Aragón López SA, Garzón González LN, Gutiérrez I, Mateus LM, Molina Ramírez ID, Fierro F, Valero JJ, Buitrago G. Characterization of Patients with Minimally Invasive Surgery Converted in a Pediatric Hospital. J Laparoendosc Adv Surg Tech A 2019; 29:1383-1387. [PMID: 31536444 DOI: 10.1089/lap.2019.0190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: Minimally invasive surgery (MIS) in pediatric surgery is now the standard of care for various surgical conditions. We have seen an increase in MIS with some of the procedures requiring intraoperative conversion to open surgery. Materials and Methods: This is a single-institution retrospective study of patients who underwent MIS between 2009 and 2017 requiring conversion to open surgery. Preoperative characteristics, cause of conversion, and postoperative factors were recorded. Results: A total of 154 patients had converted to MIS, 89.6% underwent laparoscopic procedures. Mean age was 8.5 years, 53.9% were male. Primary cause leading to surgery was not oncologic (89.6%), dirty contaminated wound was found in 49.35%, inflammatory response markers were altered, and 38.9% of our patients were American Society of Anesthesiologists physical status classification 3. Principal causes of conversion were failure in progression (53.25%) and loss of anatomic reference (24.5%). A total of 44.16% of the patients required postoperative pediatric intensive care unit admission, 29.2% required reintervention, and mortality rate was 0.65%. We detailed data regarding thoracoscopic, appendectomy, and laparoscopic procedures. Conclusion: Conversion to MIS is a decision the surgeon must make in different scenarios. This study allowed us to characterize our population regarding converted MIS procedures. Male gender, age group, altered inflammatory markers, not oncologic pathology, and dirty wound were frequently found, but we cannot establish any of them as risk factors. Main cause for conversion to open surgery was failure in the progression of the procedure in our study according to reported literature. We intend to develop further studies to determine risk factors.
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Affiliation(s)
| | | | | | - Isabel Gutiérrez
- Department of Pediatric Surgery, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Luis Miguel Mateus
- Department of Pediatric Surgery, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Iván Darío Molina Ramírez
- Department of Pediatric Surgery, Fundación Hospital Pediátrico La Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Fernando Fierro
- Department of Pediatric Surgery, Fundación Hospital Pediátrico La Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Juan Javier Valero
- Department of Pediatric Surgery, Fundación Hospital Pediátrico La Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Giancarlo Buitrago
- Department of Surgery, Clinical Research Institute, Universidad Nacional de Colombia, Bogotá, Colombia
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RETRACTED: Outcomes of Laparoscopic Cholecysectomy in Geriatric Population. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Inoue K, Ueno T, Douchi D, Shima K, Goto S, Takahashi M, Morikawa T, Naitoh T, Shibata C, Naito H. Risk factors for difficulty of laparoscopic cholecystectomy in grade II acute cholecystitis according to the Tokyo guidelines 2013. BMC Surg 2017; 17:114. [PMID: 29183352 PMCID: PMC5706415 DOI: 10.1186/s12893-017-0319-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/20/2017] [Indexed: 01/11/2023] Open
Abstract
Background The Tokyo Guidelines 2013 classifies acute cholecystitis (AC) into three grades and recommends appropriate therapy for each grade. For grade II AC, either early laparoscopic cholecystectomy (LC) or percutaneous transhepatic gallbladder drainage (PTGBD) should be performed. This study aimed to identify the risk factors for difficulty of LC for treating grade II AC. Methods Totally, 122 patients who underwent LC for grade II AC were enrolled and divided into difficult LC (DLC) and nondifficult LC (NDLC) groups. The DLC group included patients who experienced one of the following conditions: conversion from LC to open cholecystectomy, operating time ≥ 180 min, or blood loss ≥300 ml. Preoperative characteristics and postoperative outcomes were analyzed. Results In univariate analysis, risk factors included male sex, interval between symptom onset and admission, interval between symptom onset and LC, and anticoagulant therapy. The incidence of postoperative complications was higher in the DLC group than in the NDLC group (23.5% vs. 4.6%, p = 0.0016). According to receiver operating characteristic curves, the optimal cutoff value was calculated, and multivariate analysis showed that male sex [odds ratio (OR), 5.76; 95% confidence interval (CI), 1.979–19.51; p = 0.0009) and interval between symptom onset and LC of over 96 h (OR, 6.32; 95% CI, 2.126–20.15; p = 0.0009) were independent risk factors for difficulty of LC. Conclusions In patients with grade II AC, LC was technically difficult when performed over 96 h after symptom onset. Moreover, male sex was a risk factor. Therefore, PTGBD should be considered in these patients. Electronic supplementary material The online version of this article (10.1186/s12893-017-0319-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Koetsu Inoue
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan.
| | - Tatsuya Ueno
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Daisuke Douchi
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Kentaro Shima
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Shinji Goto
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Michinaga Takahashi
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Takanori Morikawa
- Department of surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takeshi Naitoh
- Department of surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Chikashi Shibata
- Division of Gastroenterological Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Hukumuro Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
| | - Hiroo Naito
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
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11
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Wang Y, Bo X, Wang Y, Li M, Shen S, Suo T, Pan H, Liu H, Liu H. Laparoscopic surgery for choledocholithiasis concomitant with calculus of the left intrahepatic duct or abdominal adhesions. Surg Endosc 2017; 31:4780-4789. [PMID: 28409369 DOI: 10.1007/s00464-017-5555-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) has been widely promoted in recent years as a safe and effective treatment for choledocholithiasis. However, there are no standard guidelines for the treatment of patients who have concomitant hepatolithiasis of the left liver and abdominal adhesions. The aim of the current research was to compare the outcomes of open versus laparoscopic common bile duct exploration with left hepatectomy (OCBDH vs. LCBDH) in patients with choledocholithiasis concomitant with left-sided hepatolithiasis, and to evaluate the safety and feasibility of laparoscopic surgery for choledocholithiasis in patients with abdominal adhesions. METHODS Between October 2012 and October 2015, a total of 321 consecutive patients with choledocholithiasis underwent surgical treatment. LCBDE was performed in 107 patients, and open common bile duct exploration (OCBDE) was performed in 111 patients. Further, 31 patients and 72 patients underwent LCBDH and OCBDH, respectively. A total of 133 patients who underwent LCBDE or OCBDE had abdominal adhesions, which were classified as mild, moderate, or severe according to an abdominal adhesion scoring system, which was validated in the LCBDE group and OCBDE group. The perioperative results were reviewed and analyzed retrospectively. RESULTS In the mild adhesion group, blood loss, postoperative recovery in the LCBDE group was lesser than those in the OCBDE group. In the moderate adhesion group, the postoperative recovery was significantly shorter in the LCBDE group than in the OCBDE group. In the severe adhesion group, the operation time and blood loss in the LCBDE group were higher than those in the OCBDE group. The postoperative recovery was significantly better in the LCBDH group than in the OCBDH group. CONCLUSION LCBDH can obviously improve recovery and shorten the hospitalization period. Further, LCBDE is safe and feasible for patients of choledocholithiasis with mild and moderate abdominal adhesions.
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Affiliation(s)
- Yueqi Wang
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Shanghai, 200032, China
| | - Xiaobo Bo
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Shanghai, 200032, China
| | - Yaojie Wang
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Shanghai, 200032, China
| | - Min Li
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Shanghai, 200032, China
| | - Sheng Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Shanghai, 200032, China
| | - Tao Suo
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Shanghai, 200032, China
| | - Hongtao Pan
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Shanghai, 200032, China
| | - Han Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Shanghai, 200032, China
| | - Houbao Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Shanghai, 200032, China.
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12
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Prognostic risk factors for conversion in laparoscopic cholecystectomy. Updates Surg 2017; 70:67-72. [DOI: 10.1007/s13304-017-0494-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 09/16/2017] [Indexed: 01/08/2023]
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13
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Coffin SJ, Wrenn SM, Callas PW, Abu-Jaish W. Three decades later: investigating the rate of and risks for conversion from laparoscopic to open cholecystectomy. Surg Endosc 2017; 32:923-929. [DOI: 10.1007/s00464-017-5767-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/14/2017] [Indexed: 01/06/2023]
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14
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Cheikhrouhou H, Jmal K, Kharrat A, Keskes M, Karoui A. [Acute acalculous gangrenous cholecystitis in postoperative period after orthopedic surgery: about a case]. Pan Afr Med J 2017; 27:8. [PMID: 28748010 PMCID: PMC5511717 DOI: 10.11604/pamj.2017.27.8.11526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/02/2017] [Indexed: 11/11/2022] Open
Abstract
La cholécystite gangreneuse alithiasique postopératoire est une complication grave et sévère, surtout chez les malades hospitalisés en réanimation. Elle survient le plus souvent au décours d'une chirurgie vasculaire ou digestive majeure, d'un polytraumatisme, dans un contexte septique ou dans un contexte de choc. Nous rapportons l'observation d'un homme âgé de 74 ans opéré d'une fracture du col du fémur, au sixième jour postopératoire il a développé un tableau clinique d'une cholécystite aigue dont les explorations radiologiques ont confirmé son caractère alithiasique. Après une cholécystectomie en urgence, l'étude anatomopathologique a conclu à une cholécystite gangreneuse alithiasique.
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Affiliation(s)
| | - Karim Jmal
- Département d'Anesthésie, CHU Habib Bourguiba, Sfax, Tunisie
| | - Amine Kharrat
- Département d'Anesthésie, CHU Habib Bourguiba, Sfax, Tunisie
| | - Meriem Keskes
- Département d'Anesthésie, CHU Habib Bourguiba, Sfax, Tunisie
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15
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Hu ASY, Menon R, Gunnarsson R, de Costa A. Risk factors for conversion of laparoscopic cholecystectomy to open surgery - A systematic literature review of 30 studies. Am J Surg 2017; 214:920-930. [PMID: 28739121 DOI: 10.1016/j.amjsurg.2017.07.029] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 07/10/2017] [Accepted: 07/16/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND The study aims to evaluate the methodological quality of publications relating to predicting the need of conversion from laparoscopic to open cholecystectomy and to describe identified prognostic factors. METHOD Only English full-text articles with their own unique observations from more than 300 patients were included. Only data using multivariate analysis of risk factors were selected. Quality assessment criteria stratifying the risk of bias were constructed and applied. RESULTS The methodological quality of the studies were mostly heterogeneous. Most studies performed well in half of the quality criteria and considered similar risk factors, such as male gender and old age, as significant. Several studies developed prediction models for risk of conversion. Independent risk factors appeared to have additive effects. CONCLUSION A detailed critical review of studies of prediction models and risk stratification for conversion from laparoscopic to open cholecystectomy is presented. One study is identified of high quality with a potential to be used in clinical practice, and external validation of this model is recommended.
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Affiliation(s)
- Alan Shiun Yew Hu
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, QLD, 4870, Australia.
| | - R Menon
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, QLD, 4870, Australia.
| | - R Gunnarsson
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, QLD, 4870, Australia; Research and Development Unit, Primary Health Care and Dental Care, Narhalsan, Southern Älvsborg County, Region Västra Götaland, Sweden; Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - A de Costa
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, QLD, 4870, Australia.
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16
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Hayama S, Ohtaka K, Shoji Y, Ichimura T, Fujita M, Senmaru N, Hirano S. Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis. JSLS 2017; 20:JSLS.2016.00065. [PMID: 27807397 PMCID: PMC5081400 DOI: 10.4293/jsls.2016.00065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Factors that contribute to difficult laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) that would affect the performance of early surgery remain unclear. The purpose of this study was to identify such risk factors. Methods: One hundred fifty-four patients who underwent LC for AC were retrospectively analyzed. The patients were categorized into early surgery and delayed surgery. Factors predicting difficult LC were analyzed for each group. The operation time, bleeding, and cases of difficult laparoscopic surgery (CDLS)/conversion rate were analyzed as an index of difficulty. Analyses of patients in the early group were especially focused on 3 consecutive histopathological phases: edematous cholecystitis (E), necrotizing cholecystitis (N), suppurative/subacute cholecystitis (S). Results: In the early group, the CDLS/conversion rate was highest in necrotizing cholecystitis. Its rate was significantly higher than that of the other 2 histopathological types (N 27.9% vs E and S 7.4%; P = .037). In the delayed-surgery group, a higher white blood cell (WBC) count and older age showed significant correlations with the CDLS/conversion rate (P = .034 and P = .004). Conclusion: In early surgery, histopathologic necrotizing cholecystitis is a risk factor for difficult LC in AC. A higher WBC count and older age are risk factors for delayed surgery.
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Affiliation(s)
| | | | | | | | - Miri Fujita
- Department of Pathology, Steel Memorial Muroran Hospital, Hokkaido, Japan
| | | | - Satoshi Hirano
- Department of Gastroenterology Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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17
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Prediction of Surgical Difficulty in Laparoscopic Cholecystectomy for Acute Cholecystitis Performed Within 24 Hours After Hospital Admission. Int Surg 2017. [DOI: 10.9738/intsurg-d-16-00014.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
The objective of this study was to identify preoperative factors predicting operative difficulty in patients who underwent laparoscopic cholecystectomy for acute cholecystitis within 24 hours after hospital admission. Many reports have described the superiority of performing laparoscopic cholecystectomy in the early phase of acute cholecystitis. Recently, even earlier cholecystectomy within 24 hours after hospital admission has been recommended. However, the factors that influence surgical difficulty in this patient population have not been well scrutinized. We analyzed patients who underwent laparoscopic cholecystectomy for acute cholecystitis within 24 hours of hospital presentation from 2007 to 2015. The primary outcome was the operation time. We also analyzed the amount of blood loss and the rate of conversion to open surgery. Seventy-three patients were enrolled. Mean age at surgery was 66 ± 16 years, and 52 patients were male. The mean operation time was 128 ± 59 minutes. Body mass index ≥25 kg/m2 [odds ratio (OR) = 3.6; 95% confidence interval (CI): 1.4–30.9] and dirty fat sign on preoperative computed tomography (OR = 5.3; 95% CI: 1.0–34.2) were significantly associated with increased operative time. Dirty fat sign was also significantly associated with increases in the amount of blood loss and conversion rate. Surgery should be performed more carefully in patients with these risk factors in laparoscopic cholecystectomy for acute cholecystitis performed within 24 hours of hospital presentation.
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18
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Nasr MM. An Innovative Emergency Laparoscopic Cholecystectomy Technique; Early Results Towards Complication Free Surgery. J Gastrointest Surg 2017; 21:302-311. [PMID: 27783342 DOI: 10.1007/s11605-016-3308-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/11/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The performance of laparoscopic cholecystectomy could be a technical challenge. Procedure success depends on multiple factors namely: hepatobiliary anatomical variations, pathologic changes in the gallbladder and surrounding tissues, pre-operative interventional attempts, the individual surgeon's skill and finally patient co-morbidities. Anticipating the attendant challenges, can help to avoid several known complications associated with this procedure. Searching a more reliable anatomical topography to adopt during laparoscopic cholecystectomy is the basis for a safe surgical technique. METHODS Between January 2012 and August 2015, 525 cases were presented with acute cholecystitis. Patients were classified in to two groups regarding degree of dissection difficulty. The study concept is defined and applied by the author in all study cases. No single case was excluded from the study. RESULTS Results are processed in comparative way between both groups of the study. The increased risk results in Group B are related to technical difficulties. CONCLUSION The study has offered a novel anatomical concept and safe surgical technique avoiding exploration of Calot's triangle. The new concept has minimized dissection demands and risk of injury related to the traditional laparoscopic cholecystectomy. The study has proposed a potentially secure and empirical laparoscopic cholecystectomy technique that could be considered in every case.
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Affiliation(s)
- Mohamed Mahmood Nasr
- Endoscopic Surgery Unit, Department of General Surgery, King Fahad Hospital, Huffof, Al Ahsa, Kingdom of Saudi Arabia.
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19
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Omitting perioperative urinary catheterization in laparoscopic cholecystectomy: a single-institution experience. Surg Today 2016; 47:928-933. [PMID: 27943036 DOI: 10.1007/s00595-016-1454-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
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20
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Bourgouin S, Mancini J, Monchal T, Calvary R, Bordes J, Balandraud P. How to predict difficult laparoscopic cholecystectomy? Proposal for a simple preoperative scoring system. Am J Surg 2016; 212:873-881. [PMID: 27329073 DOI: 10.1016/j.amjsurg.2016.04.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/25/2016] [Accepted: 04/13/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies have used operative time as a reflection of the surgical difficulty to create a preoperative score of operative difficulty in laparoscopic cholecystectomies (DiLCs score). METHODS Patients who benefited from cholecystectomy between 2010 and 2015 were reviewed. Difficult procedures were identified using the deviations from the operative time for simple cholecystectomies. Logistic regression analyses were carried out to build risk-assessment models and derive the DiLC score. RESULTS Overall, 644 patients were identified. Multivariate analyses identified male sex, previous cholecystitis attack, fibrinogen, neutrophil, and alkaline phosphatase count to be predictive of operative difficulties. Risk-assessment model was generated with an area under the receiver-operator curve of .80. Internal validation was performed using the bootstrap method. CONCLUSIONS The DiLC score is a simple and reliable tool which could be used to improve patient counseling, optimize surgical planning, detect procedures at risk, identify patients eligible for outpatient care, and enhance resident training.
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Affiliation(s)
- Stéphane Bourgouin
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France.
| | - Julien Mancini
- Aix-Marseille University, UMR912 SESSTIM, Inserm, IRD; APHM La Timone, Department of Public Health, Marseille, France
| | - Tristan Monchal
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France
| | - Ronan Calvary
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France
| | - Julien Bordes
- Sainte Anne Military Teaching Hospital, Department of Anesthesia and Intensive Care, Toulon, France
| | - Paul Balandraud
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France
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21
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Machado NO. Duodenal injury post laparoscopic cholecystectomy: Incidence, mechanism, management and outcome. World J Gastrointest Surg 2016; 8:335-344. [PMID: 27152141 PMCID: PMC4840174 DOI: 10.4240/wjgs.v8.i4.335] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/24/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the etiopathogenesis, management and outcome of duodenal injury post laparoscopic cholecystectomy (LC).
METHODS: A Medline search was carried out for all articles in English, on duodenal injury post LC, using the search word duodenal injury and LC. The cross references in these articles were further searched, for potential articles on duodenal injury, which when found was studied. Inclusion criteria included, case reports, case series, and reviews. Articles even with lack of details with some of the parameters studied, were also analyzed. The study period included all the cases published till January 2015. The data extracted were demographic details, the nature and day of presentation, potential cause for duodenal injury, site of duodenal injury, investigations, management and outcome. The model (fixed or random effect) for meta analyses was selected, based on Q and I2 statistics. STATA software was used to draw the forest plot and to compute the overall estimate and the 95%CI for the time of detection of injury and its outcome on mortality. The association between time of detection of injury and mortality was estimated using χ2 test with Yate’s correction. Based on Kaplan Meier survival curve concept, the cumulative survival probabilities at various days of injury was estimated.
RESULTS: Literature review detected 74 cases of duodenal injury, post LC. The mean age of the patients was 58 years (23-80 years) with 46% of them being males. The cause of injury was due to cautery (46%), dissection (39%) and due to retraction (14%). The injury was noted on table in 46% of the cases. The common site of injury was to the 2nd part of the duodenum with 46% above the papilla and 15% below papilla and in 31% to the 1st part of duodenum. Duodenorapphy (primary closure) was the predominant surgical intervention in 63% with 21% of these being carried out laparoscopically. Other procedures included, percutaneous drainage, tube duodenostomy, gastric resection, Whipple resection and pyloric exclusion. The day of detection among those who survived was a mean of 1.6 d (including those detected on table), compared to 4.25 d in those who died. Based on the random effect model, the overall mean duration of detection of injury was 1.6 (1.0-2.2) d (95%CI). Based on the fixed effect model, the overall mortality rate from these studies was 10% (0%-25%). On application of the Kaplan Meier survival probabilities, the cumulative probability of survival was 94%, if the injury was detected on day 1 and 80% if detected on day 2. In those that were detected later, the survival probabilities dropped steeply.
CONCLUSION: Duodenal injuries are caused by thermal burns or by dissection during LC and require prompt treatment. Delay in repair could negatively influence the outcome.
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Major bile duct injury requiring operative reconstruction after laparoscopic cholecystectomy: a follow-on study. Surg Endosc 2015; 30:1839-46. [PMID: 26275556 DOI: 10.1007/s00464-015-4469-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/23/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Bile duct injury (BDI) after laparoscopic cholecystectomy (LC) has significant cost impact and is a significant source of morbidity and mortality. We undertook a population-based assessment of the national experience with BDI between 2001 and 2011 and compared this to our report for the prior decade. METHODS Using the nationwide inpatient sample (NIS) for 2001-2011, we identified patients who underwent LC or partial cholecystectomy, with and without biliary reconstruction. Data were analyzed using methods that accounted for the hierarchical, stratified random sampling of the NIS. Both univariate modeling and multivariate modeling were performed. RESULTS LCs increased from 71.1 % in 2001 to 79.0 % in 2011 (p < 0.0001). Annual mortality decreased from 0.56 to 0.38 % (p = 0.002). In 2001, 0.11 % of LCs were associated with biliary reconstruction versus 0.09 % in 2011 (p = 0.15) with rates ranging from 0.08 to 0.12 %. The need for reconstruction was associated with an average in-hospital mortality rate of 4.4 %. Mortality rates from LC remained consistent across the study period (average mortality, 0.10 %, p = 0.57). Under multivariate analysis, admission to rural or urban non-teaching centers was associated with a decreased rate of injury; the majority of major BDIs were admitted from clinic or outpatient settings. These results are consistent with results from the prior decade. Neither emergent admission nor race was associated with increased odds of BDI, and this differs from our prior analysis. CONCLUSION LC continued to increase in utilization between 2001 and 2011. Although rates of BDI have decreased, the need for reconstruction continues to be associated with a significant mortality. In addition, mortality related to biliary reconstruction is also higher than previously published series and may reflect the complexity of managing biliary injury as well as the higher likelihood of these patients having comorbid conditions.
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Could the Tokyo guidelines on the management of acute cholecystitis be adopted in developing countries? Experience of one center. Surg Today 2015; 46:557-60. [DOI: 10.1007/s00595-015-1207-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/19/2015] [Indexed: 01/01/2023]
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Emergent laparoscopic cholecystectomy for acute acalculous cholecystitis revisited. Surg Today 2015; 46:309-12. [PMID: 25904560 DOI: 10.1007/s00595-015-1173-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/03/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE To compare the safety of emergent laparoscopic cholecystectomy for acute acalculous cholecystitis (AAC) with surgery for acute calculous cholecystitis (ACC). METHODS We retrospectively reviewed the perioperative records of 111 patients who underwent emergent laparoscopic cholecystectomy for acute cholecystitis under the care of the Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, between January 2010 and April 2014. Patients were divided into the AAC group (27 patients) and the ACC group (84 patients), and their perioperative outcomes were compared. RESULTS Patients in the AAC group had significantly higher disease severity and American Society of Anesthesiologists physical status scores (p = 0.001 and 0.037, respectively), lower blood hemoglobin and albumin concentrations (p = 0.0005 and 0.017, respectively), and lower hematocrit and platelet count (p < 0.0001 and 0.040, respectively) than those in the ACC group. When we compared perioperative outcomes, we also found that patients in the AAC group were more likely to have received a blood transfusion (p = 0.002) and to have required conversion to open surgery (p = 0.008). There were no significant differences in morbidity, mortality or length of hospital stay. CONCLUSIONS Early laparoscopic cholecystectomy is safe in acute acalculous as well as acute calculous cholecystitis.
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Shibasaki S, Takahashi N, Toi H, Tsuda I, Nakamura T, Hase T, Minagawa N, Homma S, Kawamura H, Taketomi A. Percutaneous transhepatic gallbladder drainage followed by elective laparoscopic cholecystectomy in patients with moderate acute cholecystitis under antithrombotic therapy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:335-42. [PMID: 24027011 DOI: 10.1002/jhbp.28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Standard treatment for acute cholecystitis (AC) in patients receiving antithrombotic drugs has not been established. We evaluated the safety of percutaneous transhepatic gallbladder drainage (PTGBD) followed by elective laparoscopic cholecystectomy (LC) in patients with moderate AC who were receiving antithrombotics. METHODS Seventy-five patients received PTGBD from January 2006 to March 2013 followed by elective LC for moderate AC. Patients were divided into Group A, which consisted of patients receiving antithrombotic therapy (n = 23), and Group B, which included the remaining patients (n = 52). We analyzed clinical outcomes and perioperative complications between groups. RESULTS No hemorrhagic events occurred during PTGBD insertion regardless of antithrombotic treatment. The open conversion rate was not significantly different between the two groups. Postoperative complications were found in 10 patients (13.3%). The rate of postoperative complications in Group A was slightly higher than that in Group B, but the difference was not significant (21.7% vs. 9.6%; P = 0.15). Complications associated with PTGBD occurred in six patients (8%). There were no significant differences in the incidence of these complications, operation time, intraoperative blood loss, or length of postoperative hospital stay. CONCLUSIONS Percutaneous transhepatic gallbladder drainage followed by elective LC may be an effective therapeutic strategy for moderate AC in patients receiving antithrombotic therapy.
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Affiliation(s)
- Susumu Shibasaki
- Department of Surgery, Hokushinkai Megumino Hospital, Eniwa, Hokkaido, Japan; Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N15 W7 Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
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