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Zanchetta M, Adani GL, Micheletti G, Poto GE, Piccioni SA, Carbone L, Monteleone I, Sandini M, Marrelli D, Calomino N. Perforated Calculous Cholecystitis and Incidental Squamous Cell Carcinoma of the Gallbladder-A Complex Relationship with a Difficult Management in the Acute Setting. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:452. [PMID: 40142263 PMCID: PMC11944027 DOI: 10.3390/medicina61030452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Revised: 02/23/2025] [Accepted: 03/04/2025] [Indexed: 03/28/2025]
Abstract
The worldwide prevalence of gallstones (GSs) is estimated to be between 10% and 15% in the general population. Gallbladder carcinoma (GBC) is the most common biliary tract neoplasia, and it is characterized by highly aggressive behavior and poor overall prognosis. Long-standing GSs and chronic inflammatory state represent the most common risk factors for GBC, promoting a carcinogenic microenvironment. Long-standing GSs expose patients to potentially severe surgical and oncological complications. A 71-year-old gentleman, who had never experienced biliary symptoms and had diabetes mellitus (DM), presented with severe peritonitis due to perforated acute calculous cholecystitis. The patient underwent an emergent laparotomic cholecystectomy. Histopathology found a rare pT2b poorly differentiated squamocellular carcinoma of the gallbladder. Although more difficult due to the concomitant inflammatory context, it is critical to identify suspicious lesions during preoperative imaging in patients at high risk of malignancy presenting with complex acute gallbladder pathologies. A review of the literature was conducted to gain a deeper insight into the relationship between long-standing GSs and GBC, evaluating also the difficult diagnosis and management of malignancy in the acute setting. Considering the existing literature, the choice to pursue a prophylactic cholecystectomy may be justifiable in selected asymptomatic GS patients at high risk for GBC.
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Affiliation(s)
- Matteo Zanchetta
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Gian Luigi Adani
- Kidney Transplant Unit, Department of Medicine, Surgery and Neuroscience, Siena University Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Giorgio Micheletti
- Kidney Transplant Unit, Department of Medicine, Surgery and Neuroscience, Siena University Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Gianmario Edoardo Poto
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Stefania Angela Piccioni
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Ludovico Carbone
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Ilaria Monteleone
- Diagnostic Imaging Unit, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100 Siena, Italy
| | - Marta Sandini
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Natale Calomino
- Kidney Transplant Unit, Department of Medicine, Surgery and Neuroscience, Siena University Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
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Hayler R, Hanna S, Boerkamp A, Gao Y, Alhayo ST, Talbot ML. Economics of emergency laparoscopic cholecystectomy at an Australian tertiary centre in the post COVID-19 era. Am J Surg 2025; 241:116158. [PMID: 39740648 DOI: 10.1016/j.amjsurg.2024.116158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 12/03/2024] [Accepted: 12/19/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is a common operation performed worldwide. Indications include acute cholecystitis (AC), with a trend of increasing complexity post-COVID-19. We aim to evaluate the health expenditure on LC at an Australian tertiary centre. METHODS A retrospective chart review was performed for all LC between July 1, 2022-June 30, 2023 collecting demographics, costs and wait times and comparisons performed between elective and emergency LC. RESULTS 125 patients underwent emergency and 78 elective LC. There was no difference between age, sex or ASA. 67 patients (53.6 %) had emergency LC within their booking priority category. Average cost for emergency LC was $12,689.90 with a median stay of four days, compared to $7181.10 and one day for elective (p < 0.01). Operative related costs were the majority with emergency LC higher ($4866.5, 38.4 % v $3957.6, 55.1 % p = 0.02). The largest cost disparity was nursing costs ($2193.7, 17.3 % v 648.3, 9 % p < 0.01). CONCLUSION Costs are likely driven by access to emergency theatre time and increased length of stay. A semi-emergency theatre model could save costs.
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Affiliation(s)
- Raymond Hayler
- Upper GastroIntestinal Unit, Department of Surgery, St George Public Hospital, NSW Health, Australia; UNSW Department of Surgery, St George & Sutherland Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
| | - Sam Hanna
- Upper GastroIntestinal Unit, Department of Surgery, St George Public Hospital, NSW Health, Australia
| | - Andrea Boerkamp
- Upper GastroIntestinal Unit, Department of Surgery, St George Public Hospital, NSW Health, Australia
| | - Yijun Gao
- Upper GastroIntestinal Unit, Department of Surgery, St George Public Hospital, NSW Health, Australia; UNSW Department of Surgery, St George & Sutherland Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sam T Alhayo
- Upper GastroIntestinal Unit, Department of Surgery, St George Public Hospital, NSW Health, Australia; UNSW Department of Surgery, St George & Sutherland Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael L Talbot
- Upper GastroIntestinal Unit, Department of Surgery, St George Public Hospital, NSW Health, Australia; UNSW Department of Surgery, St George & Sutherland Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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Sharma K, Sakaray YR, S N S, Tandup C, Khare S, Savlania A, Gupta A, Bhujade H, Ram S, Kaman L. Effect of laparoscopic cholecystectomy on 25-hydroxyvitamin D levels and bone mineral density in post menopausal women. Acta Chir Belg 2025; 125:29-32. [PMID: 39046481 DOI: 10.1080/00015458.2024.2384687] [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: 12/13/2023] [Accepted: 07/22/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the gold standard management for benign gallbladder diseases. It has been observed that there is alteration in vitamin D levels and bone mineral density after cholecystectomy due to altered enterohepatic circulation. With increase in average age expectancy of the population, low levels of vitamin D levels and osteoporosis after cholecystectomies might cause increased health care burden. METHODS A prospective observational study was planned between 1 January 2022 and 30 June 2023 in the Department of General Surgery at PGIMER Chandigarh, a tertiary care hospital in north India. One hundred and three post-menopausal women who underwent LC and met the inclusion and exclusion criteria were included in the study. All participants underwent estimation of vitamin D and bone mineral density preoperatively and third-post operative month (POM). RESULTS The mean age of the patients was 58.46 ± 7.44. Pain abdomen was present in 68(66%) patients, 18 had epigastric discomfort and 17 had dyspepsia. The mean levels of vitamin D decreased from 21.92 at the baseline to 20.12 at third POM (p < .001). There was a significant change in t score Femoral Neck (-1.12 vs -1.15, p < .001) and Lumbar spine L1-L4 - 1.98 vs -1.98 (p = .033). z-scores of the femoral neck were -0.34 vs -0.54 (p < .001) and of lumbar spine L1-L4 were -0.95 vs 1.02 (p < .001). The decrease in fracture risk for the femoral neck (p = .344) and the lumbar spine (p = .223) was not statistically significant. CONCLUSION There is a significant decrease in vitamin D and BMD levels after LC in post-menopausal females.
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Affiliation(s)
- Kartik Sharma
- Department of General Surgery, PGIMER, Chandigarh, India
| | | | - Satish S N
- Department of General Surgery, PGIMER, Chandigarh, India
| | | | - Siddhant Khare
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Ajay Savlania
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Ashish Gupta
- Department of General Surgery, AIMS, Mohali, India
| | | | - Sant Ram
- Biochemistry, PGIMER Chandigarh, India
| | - Lileswar Kaman
- Department of General Surgery, PGIMER, Chandigarh, India
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Goswami AG, Basu S. Cracking the silent gallstone code: Wait or operate? World J Clin Cases 2024; 12:2692-2697. [PMID: 38899308 PMCID: PMC11185337 DOI: 10.12998/wjcc.v12.i16.2692] [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: 12/31/2023] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
The widespread availability of abdominal ultrasound has revealed the common occurrence of asymptomatic gallstones. While the treatment for symptomatic gallstones is clear, the benefits of minimally invasive laparoscopic cholecystectomy have sparked debate about the best approach to managing silent gallstones. The potential for asymptomatic gallstones to become symptomatic or lead to complications complicates the decision-making process regarding surgical intervention, as it's uncertain when or which patients might develop complications. Consequently, risk stratification appears to play a critical role in guiding decisions about silent gallstones. However, there is no definitive evidence to direct management, and a consensus-based on high-quality evidence is yet to be established.
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Affiliation(s)
- Aakansha Giri Goswami
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Somprakas Basu
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
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Jain K, Goyal D. Comparative Analysis of Monopolar Electrocautery and Ultrasonic Activated Scalpel in Laparoscopic Cholecystectomy: A Comprehensive Evaluation Using Clinical, Laboratory, and Imaging Techniques. Cureus 2024; 16:e61925. [PMID: 38978917 PMCID: PMC11228406 DOI: 10.7759/cureus.61925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction Laparoscopic cholecystectomy has long been the cornerstone of gallstone treatment. Both monopolar cautery and ultrasonically activated scalpel (UAS, also known as harmonic scalpel) have been employed in the dissection of the gallbladder from its fossa during laparoscopic cholecystectomy. Material and methods The prospective study was conducted in the Department of Surgery at Vivekananda Institute of Medical Sciences including 200 patients equally divided among the monopolar cautery and harmonic scalpel group. Patients were observed for 48 hours post-surgery, during which temperature and pain assessment were done. Acute phase reactants were measured during this period and compared with preoperative values. On the seventh day ultrasonography was done to look for the inflammatory changes. Results In a study involving 200 patients, the majority fell within the age bracket of 31 to 50 years, with females constituting the predominant demographic. Notably, patients who underwent surgery with a harmonic scalpel exhibited a reduced need for analgesics. Furthermore, the use of harmonic scalpels led to noteworthy alterations in acute phase reactants, including a significant decrease in the total leucocyte count (TLC) (p=0.03), neutrophils (p=0.005), and lymphocytes (p=0.02). Additionally, patients in the UAS group experienced a significantly lesser increase in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values (p=0.0001). Conversely, ultrasound imaging conducted on the seventh day post-surgery did not reveal any significant differences between the two groups. Conclusion Laparoscopic cholecystectomy performed with a harmonic scalpel is associated with a reduced tissue response and less tissue damage compared to the monopolar group.
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Affiliation(s)
- Kulbhushan Jain
- General Surgery, HealthCity Trauma Centre & Superspeciality Hospital, Lucknow, IND
| | - Divakar Goyal
- Trauma and Emergency, All India Institute of Medical Sciences, Bathinda, IND
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Parveen S, Singh Sodhi J, Dhar N, Nazir S, Sharma A, Mir TA, Acharya K, Khan MA, Gulzar GM, Shah AH, Yattoo GN, Raina KS. Increase in acute pancreatitis, especially gallstone related, as the cause for emergency admissions: Temporal trend from Kashmir, India. Indian J Gastroenterol 2024:10.1007/s12664-023-01509-7. [PMID: 38446349 DOI: 10.1007/s12664-023-01509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/19/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND The incidence of acute pancreatitis is increasing globally. Gallstones (GS) and ascariasis are the major causes for acute pancreatitis in the Kashmiri population. In recent years, we have observed an increase in the admission rate of acute pancreatitis. Many patients who present first time as gallstone pancreatitis have asymptomatic gallstones. We aimed at studying the etiology and yearly admission rate of acute pancreatitis with main focus on gallstone pancreatitis and the contribution of asymptomatic gallstones. METHODS This was a hospital-based, prospective, observational study from January 2015 to December 2019 for a period of five years. Patients of acute pancreatitis were evaluated for etiology and yearly admission rate. Patients of gallstone pancreatitis were evaluated in terms of clinical profile, risk factors, nature (symptomatic/asymptomatic, known/unknown gallstones), size of stones, treatment and outcome in terms of severity and mortality. The data was analyzed by Statistical Package for the Social Sciences (SPSS) version 20.0, as mean (SD), frequencies and percentages. RESULTS As many as 702 (8.5%) patients of acute pancreatitis were admitted among 8245 gastrointestinal emergencies in five years. The yearly admission rate of acute pancreatitis was 5.6%, 7.3%, 8.7%, 9.5% and 10.3%, respectively (p = 0.013). Gallstones, Ascariasis, alcohol and idiopathic acute pancreatitis were 47.7%, 6.9%, 1.2% and 33.7%, respectively. Gallstone pancreatitis increased from 31% in 2015 to 52.4% in 2019 (p = 0.045) and ascariasis-related acute pancreatitis declined from 14.4% to 1.6% (p = 0.034). Asymptomatic gallstones constituted 87.7% of cases. Known/unknown asymptomatic gallstones and symptomatic gallstones were 24.4%, 63.2% and 12.2%, respectively. Gallstones < 5 mm and > 5 mm were76.1% and 23.8% respectively (p = 0.027). Cholecystectomy rate in index admission was 4.7%. Mild, moderate and severe gallstone pancreatitis was 60.2%, 18.8% and 20.8%, respectively. Mortality in gallstone pancreatitis was 10.4%. CONCLUSION The incidence of acute pancreatitis is increasing due to gallstone pancreatitis. Ascariasis-related acute pancreatitis has declined. There is significant contribution of asymptomatic gallstones in patients who present for the first time as acute pancreatitis. Small gallstones < 5 mm are likely to be the risk factors for gallstone pancreatitis.
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Affiliation(s)
- Shaheena Parveen
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Jaswinder Singh Sodhi
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India.
| | - Neeraj Dhar
- Department of Gastroenterology and Hepatology, Sarvodya Hospital, Faridabad, 121 006, India
| | - Shaheen Nazir
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Ankush Sharma
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Tariq Abdullah Mir
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Kalpana Acharya
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Mushtaq Ahmed Khan
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Ghulam Mohd Gulzar
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Altaf Hussain Shah
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | | | - Kuldeep S Raina
- Department of Radiation Oncology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
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Shukla R, Chadha M, Shekh R, Tiwari RK. Role of probiotics in gallstone treatment. GALLSTONE FORMATION, DIAGNOSIS, TREATMENT AND PREVENTION 2024:169-187. [DOI: 10.1016/b978-0-443-16098-1.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Cancan G, Sarıbeyoğlu K, Pekmezci S. Acute pancreatitis: It can be the first sign of silent gallstones. Turk J Surg 2023; 39:162-168. [PMID: 38026915 PMCID: PMC10681110 DOI: 10.47717/turkjsurg.2023.5787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/12/2022] [Indexed: 12/01/2023]
Abstract
Objectives The management of asymptomatic cholelithiasis is controversial. Silent gallstones are generally assumed to cause complications after at least one episode of biliary colic. The ratio of those silent stones that had initially caused, -or were diagnosed as the etiological agent of- acute pancreatitis has not been reported in the literature yet. Our study was designed to investigate the ratio of asymptomatic cholelithiasis in acute biliary pancreatitis cases. Material and Methods One hundred and seventy-one patients of 305 cases, who were followed up with the diagnosis of acute biliary pancreatitis, were identified retrospectively. Demographic specifications, laboratory findings and clinical progressions of the patients were inspected. Clinical histories were detailed by phone calls. Gallstones were radiologically detected in 85 out of 171 cases. Those patients were divided as symptomatic and asymptomatic. Clinical findings and follow-ups were evaluated by "Chi-square" test. Results In the study group, 80% of the patients were asymptomatic (n= 68) and 16.47% of the patients (n= 14) had complicated pancreatitis. Regarding the severity of the clinical course, being symptomatic or not was not identified as a significant factor (p= 0.108). In regard of creating symptoms, the size of the stone was not significant (p= 0.561) and obtained no prediction about the clinical severity of the pancreatitis (p= 0.728). Conclusion Asymptomatic cholelithiasis patients had a major percentage in acute biliary pancreatitis cases. The "wait and see" approach should be re-evaluated for silent gallstones in prospective trials.
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Affiliation(s)
- Gülden Cancan
- Department of General Surgery, Istanbul University Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Kaya Sarıbeyoğlu
- Department of General Surgery, Istanbul University Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Salih Pekmezci
- Department of General Surgery, Istanbul University Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
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Morris-Stiff G, Sarvepalli S, Hu B, Gupta N, Lal P, Burke CA, Garber A, McMichael J, Rizk MK, Vargo JJ, Ibrahim M, Rothberg MB. The Natural History of Asymptomatic Gallstones: A Longitudinal Study and Prediction Model. Clin Gastroenterol Hepatol 2023; 21:319-327.e4. [PMID: 35513234 DOI: 10.1016/j.cgh.2022.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Despite the high prevalence of asymptomatic gallstones (AGs), there are limited data on their natural history. We aimed to determine the rate of symptom development in a contemporary population, determine factors associated with progression to symptomatic gallstones (SGs), and develop a clinical prediction model. METHODS We used a retrospective cohort design. The time to first SG was shown using Kaplan-Meier curves. Multivariable competing risk (death) regression analysis was used to identify variables associated with SGs. A prediction model for the development of SGs after 10 years was generated and calibration curves were plotted. Participants were patients with AGs based on ultrasound or computed tomography from the general medical population. RESULTS From 1996 to 2016, 22,257 patients (51% female) with AGs were identified; 14.5% developed SG with a median follow-up period of 4.6 years. The cumulative incidence was 10.1% (±0.22%) at 5 years, 21.5% (±0.39%) at 10 years, and 32.6% (±0.83%) at 15 years. In a multivariable model, the strongest predictors of developing SGs were female gender (hazard ratio [HR], 1.50; 95% CI, 1.39-1.61), younger age (HR per 5 years, 1.15; 95% CI, 1.14-1.16), multiple stones (HR, 2.42; 95% CI, 2.25-2.61), gallbladder polyps (HR, 2.55; 95% CI, 2.14-3.05), large stones (HR, 2.03; 95% CI, 1.80-2.29), and chronic hemolytic anemia (HR, 1.90; 95% CI, 1.33-2.72). The model showed good discrimination (C-statistic, 0.70) and calibration. CONCLUSIONS In general medical patients with AGs, symptoms developed at approximately 2% per year. A predictive model with good calibration could be used to inform patients of their risk of SGs.
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Affiliation(s)
- Gareth Morris-Stiff
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Shashank Sarvepalli
- Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Bo Hu
- Department of Quantitative Health Sciences
| | | | - Pooja Lal
- Department of Internal Medicine, Community Care
| | - Carol A Burke
- Department of Gastroenterology, Hepatology, and Nutrition
| | - Ari Garber
- Department of Gastroenterology, Hepatology, and Nutrition
| | - John McMichael
- Department of General Surgery, Digestive Disease and Surgical Institute
| | - Maged K Rizk
- Department of Gastroenterology, Hepatology, and Nutrition
| | - John J Vargo
- Department of Gastroenterology, Hepatology, and Nutrition
| | - Mounir Ibrahim
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey
| | - Michael B Rothberg
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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Abstract
Gallbladder cancer (GBC) is the most common cancer of the biliary tract, characterized by a very poor prognosis when diagnosed at advanced stages owing to its aggressive behaviour and limited therapeutic options. Early detection at a curable stage remains challenging because patients rarely exhibit symptoms; indeed, most GBCs are discovered incidentally following cholecystectomy for symptomatic gallbladder stones. Long-standing chronic inflammation is an important driver of GBC, regardless of the lithiasic or non-lithiasic origin. Advances in omics technologies have provided a deeper understanding of GBC pathogenesis, uncovering mechanisms associated with inflammation-driven tumour initiation and progression. Surgical resection is the only treatment with curative intent for GBC but very few cases are suitable for resection and most adjuvant therapy has a very low response rate. Several unmet clinical needs require to be addressed to improve GBC management, including discovery and validation of reliable biomarkers for screening, therapy selection and prognosis. Standardization of preneoplastic and neoplastic lesion nomenclature, as well as surgical specimen processing and sampling, now provides reproducible and comparable research data that provide a basis for identifying and implementing early detection strategies and improving drug discovery. Advances in the understanding of next-generation sequencing, multidisciplinary care for GBC, neoadjuvant and adjuvant strategies, and novel systemic therapies including chemotherapy and immunotherapies are gradually changing the treatment paradigm and prognosis of this recalcitrant cancer.
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Affiliation(s)
- Juan C Roa
- Department of Pathology, Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Patricia García
- Department of Pathology, Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vinay K Kapoor
- Department of Hepato-pancreato-biliary (HPB) Surgery, Mahatma Gandhi Medical College & Hospital (MGMCH), Jaipur, India
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, UT M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jill Koshiol
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Lee BJH, Yap QV, Low JK, Chan YH, Shelat VG. Cholecystectomy for asymptomatic gallstones: Markov decision tree analysis. World J Clin Cases 2022; 10:10399-10412. [PMID: 36312509 PMCID: PMC9602237 DOI: 10.12998/wjcc.v10.i29.10399] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
Gallstones are a common public health problem, especially in developed countries. There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging, with 22.6%-80% of gallstone patients being asymptomatic at the time of diagnosis. Despite being asymptomatic, this group of patients are still at life-long risk of developing symptoms and complications such as acute cholangitis and acute biliary pancreatitis. Hence, while early prophylactic cholecystectomy may have some benefits in selected groups of patients, the current standard practice is to recommend cholecystectomy only after symptoms or complications occur. After reviewing the current evidence about the natural course of asymptomatic gallstones, complications of cholecystectomy, quality of life outcomes, and economic outcomes, we recommend that the option of cholecystectomy should be discussed with all asymptomatic gallstone patients. Disclosure of material information is essential for patients to make an informed choice for prophylactic cholecystectomy. It is for the patient to decide on watchful waiting or prophylactic cholecystectomy, and not for the medical community to make a blanket policy of watchful waiting for asymptomatic gallstone patients. For patients with high-risk profiles, it is clinically justifiable to advocate cholecystectomy to minimize the likelihood of morbidity due to complications.
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Affiliation(s)
- Brian Juin Hsien Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore S308232, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117597, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore S308433, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117597, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore S308433, Singapore
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EL RIFAI AY, EL HECHI MW, NAJA KM, KHACHFE HH, HALLAL AH. Characteristics and prevalence of acute cholecystitis in patients with hematologic malignancies. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Incidence and Risk Factors for Hospital-acquired Cholecystitis. J Hosp Infect 2022; 128:13-18. [PMID: 35830937 DOI: 10.1016/j.jhin.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute cholecystitis can occur both inside and outside hospital settings. However, little is known about the clinical characteristics of hospital-acquired cholecystitis (HAC). AIM The objective of our study is to investigate the clinical characteristics of HAC in a tertiary academic hospital. METHODS This retrospective cohort study included hospitalized patients who were found to have gallstones without cholecystitis or cholangitis on admission between January 2018 and December 2021. We used multivariate logistic regression analysis to make comparisons between patients with and without HAC. FINDINGS A total of 890 patients met the inclusion criteria and were evaluated in this study. Forty-one patients (4.6%) developed HAC during the study period. Multivariate logistic regression analysis showed that a history of cholecystitis or cholangitis, fasting at least one day, and gallstones in the gallbladder neck were independently associated with increased risk of HAC. HAC occurred most frequently after about several weeks of admission, and only four patients (9.8%) had bacteremia. CONCLUSIONS HAC was relatively common among hospitalized patients. Physicians should be aware of the possibility of HAC in symptomatic hospitalized patients with certain risk factors.
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Weerakoon H, Vithanage I, Alahakoon O, Weerakoon K. Clinico-epidemiology and aetiopathogenesis of gallstone disease in the South Asian region: a scoping review protocol. BMJ Open 2022; 12:e057808. [PMID: 35697449 PMCID: PMC9196176 DOI: 10.1136/bmjopen-2021-057808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Pathogenesis of gallstones (GS) is multifactorial and is influenced by numerous environmental and genetic risk factors. As a result, clinico-epidemiology and aetiopathogenesis of GS vary in different populations. Understanding the aetiopathogenesis of GS for different populations is imperative in control and prevention of GS disease and its associated complications. This protocol describes the methodology of a scoping review which focuses on synthesising the most updated knowledge on GS disease in South Asia. METHODS AND ANALYSIS The scoping review proposed in this protocol will be guided by Arksey and O'Malley's framework and the Joanna Briggs Institute Reviewers' Manual. Accordingly, population, concept and context strategy will be used to formulate the scoping review question, eligibility criteria and search strategy. In the search, electronic databases, MEDLINE/PubMed, ScienceDirect, Scopus, Cochrane library, CINAHL, Trip, and Google scholar, as well as various grey literature sources will be used in synthesising and presenting the findings on clinico-epidemiology and aetiopathogenesis of GS disease in South Asia. ETHICS AND DISSEMINATION As secondary data will be used in the study, ethical approval will not be required. The scoping review proposed by this protocol will accurately summarise the current knowledge on GS disease in South Asia based on published and unpublished literature on the field. Thus, the evidence presented in the review will be important for healthcare providers to make decisions on the control and prevention of GS disease and as well as to identify future research priorities on GS disease in South Asia.
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Affiliation(s)
- Harshi Weerakoon
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Ishari Vithanage
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Oshadhi Alahakoon
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Kosala Weerakoon
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Bhaumik K. Asymptomatic Cholelithiasis in Children: Management Dilemma. J Indian Assoc Pediatr Surg 2021; 26:228-233. [PMID: 34385765 PMCID: PMC8323576 DOI: 10.4103/jiaps.jiaps_107_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/26/2020] [Accepted: 05/08/2020] [Indexed: 11/04/2022] Open
Abstract
Aims and Objectives: The incidence of cholelithiasis is now increasing in children. Besides hemolytic diseases, there are also nonhemolytic conditions and idiopathic group. A large number of children belong to asymptomatic group who do not present with gallstone-related symptoms. There is no consensus in the management of these children. The aim of this study is to evaluate the role of elective cholecystectomy in asymptomatic cases to prevent complications which leads to more morbidity. Materials and Methods: One hundred and seventy-eight children were treated over a period of 12 years and they were divided into two groups according to their age at presentation. Sixty-four children below 5 years belonged to Group A and 114 children between 5 and 12 years belonged to Group B. About 71.8% of children of Group A and 49.1% of children of Group B were asymptomatic. Cholecystectomy was advised in all cases of Group B and all symptomatic cases of Group A. In Group A asymptomatic cases, ursodeoxycholic acid (UDCA) was given for 6–12 months and followed up. Results: Laparoscopic cholecystectomy was performed in all cases except in five cases where conversion to open surgery was done as there was gross adhesions due to previous laparotomy. Of 46 asymptomatic cases of Group A, the stone disappeared in seven cases, 12 children developed symptoms, and there was no change in 27 patients. Stone reappeared again in three of seven children who were managed by cholecystectomy. Cholecystectomy was also performed in 12 cases that developed symptoms. In the rest of the 27 children, cholecystectomy was advised after 1 year trial of UDCA. Cholecystectomy was advised in both symptomatic and asymptomatic cases of Group B. Sixteen of 56 asymptomatic cases did not agree for cholecystectomy and 12 of them returned with complications. Endoscopic retrograde cholangio-pancreaticography (ERCP) and stone extraction was performed in four cases. In all the acute cases, cholecystectomy was performed after a period of conservative management. Conclusion: UDCA can be tried in the smaller age group below 5 years, but there is a chance of recurrent stone formation. Elective laparoscopic cholecystectomy should be the choice in all asymptomatic cases to prevent complications.
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Affiliation(s)
- Kuntal Bhaumik
- Department of Pediatric Surgery, Park Medical Research and Welfare Society, Kolkata, West Bengal, India
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16
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Liu PY, Kuo LW, Liao CH, Hsieh CH, Bajani F, Fu CY. Incidental Findings on Whole-body Computed Tomography in Major Trauma Patients: Who and What? Am Surg 2021; 88:1694-1702. [PMID: 33631944 DOI: 10.1177/0003134821998685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Whole-body computed tomography (WBCT) scans are frequently used for trauma patients, and sometimes, nontraumatic findings are observed. We aimed to investigate the characteristics of patients with nontraumatic findings on WBCT. METHODS From 2013 to 2016, adult trauma patients who underwent WBCT were enrolled. The proportions of nontraumatic findings in different anatomical regions were studied. Nontraumatic findings were classified and evaluated as clinically important findings and findings that needed no further follow-up or treatment. The characteristics of the patients with nontraumatic findings were analyzed and compared with those of patients without nontraumatic findings. RESULTS Two hundred seventeen patients were enrolled in this study during the 3-year study period, and 89 (41.0%) patients had nontraumatic findings. Nontraumatic findings were found more frequently in the abdomen (69.2%) than in the head/neck (17.3%) and chest regions (13.5%). In total, 31.3% of the findings needed further follow-up or treatment. Patients with nontraumatic findings that needed further management were significantly older than those without nontraumatic findings (57.3 vs. 38.9; P < .001), particularly those with abdominal nontraumatic findings (57.9 vs. 41.3; P < .001). A significantly higher proportion of women were observed in the group with head/neck nontraumatic findings that needed further management than in the group without nontraumatic findings (56.3% vs 24.9%; P = .015). CONCLUSIONS Whole-body computed tomography could provide alternative benefits for nontraumatic findings. Whole-body computed tomography images should be read carefully for nontraumatic findings, particularly for elderly patients or the head/neck region of female patients. A comprehensive program for the follow-up of nontraumatic findings is needed.
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Affiliation(s)
- Ping-Yuan Liu
- Department of Trauma and Emergency Surgery, 38014Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ling-Wei Kuo
- Department of Trauma and Emergency Surgery, 38014Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, 38014Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, 38014Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Francesco Bajani
- Department of Trauma and Emergency Surgery, 38014Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, 38014Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Koshiol J, Van De Wyngard V, McGee EE, Cook P, Pfeiffer RM, Mardones N, Medina K, Olivo V, Pettit K, Jackson SS, Paredes F, Sanchez R, Huidobro A, Villaseca M, Bellolio E, Losada H, Roa JC, Hildesheim A, Araya JC, Ferreccio C. The Chile Biliary Longitudinal Study: A Gallstone Cohort. Am J Epidemiol 2021; 190:196-206. [PMID: 33524121 DOI: 10.1093/aje/kwaa199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
Gallbladder cancer (GBC) is a highly fatal cancer that can be cured through cholecystectomy if identified early. The presence of gallstones is the primary risk factor for GBC, but few people with gallstones develop GBC. A key question is what drives the development of GBC among persons with gallstones. We initiated the Chile Biliary Longitudinal Study (Chile BiLS) to address this question. From 2016 to 2019, Chile BiLS enrolled 4,726 women aged 50-74 years with ultrasound-detected gallstones from southern-central Chile, accounting for an estimated 36% of eligible women with gallstones in the study area. The median age was 59 years; 25% of the women were Amerindian (Mapuche), 60% were obese, 25% had diabetes, and 6% had cardiovascular disease. Participants will be followed for gallbladder dysplasia or cancer for 6 years. As of April 30, 2020, over 91% of those eligible completed the year 2 follow-up visit. Data being collected include epidemiologic and sociodemographic information, anthropometric measurements, blood pressure, and tooth counts. Biosamples being taken include baseline plasma, buffy coat, red blood cells, serum, blood clot from serum, and PAXgene whole blood (PreAnalytiX GmbH, Hombrechtikon, Switzerland). Complete gallbladder sampling is conducted for most participants undergoing cholecystectomy. The Chile BiLS cohort study will increase our understanding of GBC etiology and could identify potential risk stratification and early detection strategies in high-risk areas.
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Dilek ON, Acar N. Prophylactic Surgery for Gallbladder and Biliary Tract Pathologies. PROPHYLACTIC SURGERY 2021:115-132. [DOI: 10.1007/978-3-030-66853-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Argiriov Y, Dani M, Tsironis C, Koizia LJ. Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management. Front Surg 2020; 7:42. [PMID: 32793627 PMCID: PMC7385246 DOI: 10.3389/fsurg.2020.00042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Gallstone disease accounts for the vast majority of acute surgical admissions in the UK, with a major treatment being cholecystectomy. Practice varies significantly as to whether surgery is performed during the acute symptomatic phase, or after a period of recovery. Differences in practice relate to operative factors, patient factors, surgeon factors and hospital and trust wide policies. In this review we summarize recent evidence on management of gallstone disease, particularly with respect to whether cholecystectomy should occur during index presentation or following recovery. We highlight morbidity and mortality studies, cost, and patient reported outcomes. We speculate on barriers to change in service delivery. Finally, we propose potential solutions to optimize care.
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Affiliation(s)
- Yanna Argiriov
- Cutrale Perioperative and Ageing Research Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Melanie Dani
- Cutrale Perioperative and Ageing Research Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Christos Tsironis
- Department of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Louis J Koizia
- Cutrale Perioperative and Ageing Research Group, Department of Bioengineering, Imperial College London, London, United Kingdom
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20
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Eslami S, Abedini L, Nouri NV, Rabiee M, Samani MK. Bile duct injury outcomes following cholecystectomy: a cross sectional study. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2020; 9:53-57. [PMID: 32704435 PMCID: PMC7364374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/29/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Considering the importance of the repairing time in patients with biliary duct injury, the aim of this study was to evaluate the outcomes of patents with bile duct injury following cholecystectomy. METHODS In this cross sectional study that was conducted on 64 patients with bile duct injury following cholecystectomy was referred to Shafa hospital in Tehran-Iran during 2010-2019 due to repair of biliary duct. Then patients were divided into two groups based on early and late referring time after bile duct injury, the postoperative outcomes were evaluated in two groups. RESULTS The alanine transaminase (ALT) and the aspartate aminotransferase (AST) in the late group were significantly higher than the early group. There were significant differences between the two groups based on the results of endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) (P < 0.05). The frequency of bile duct dilatation, cholangitis and itching in late group were significantly higher than early group, also the frequency of uncomplicated outcome in the early group were significantly more than late group (P < 0.05). CONCLUSION The postoperative complication of biliary duct injury reduced, if patients diagnosed and referred at the same early stages (early referral).
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Affiliation(s)
- Sepehr Eslami
- Department of Orthopedics, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Lotfallah Abedini
- Department of Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | | | - Mehdi Rabiee
- Department of Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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21
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Chan AW, Sabaratnam RM, Pillay Y. Massive gallstone in an asymptomatic Indigenous Canadian male: Case report and literature review. Int J Surg Case Rep 2020; 72:429-432. [PMID: 32698261 PMCID: PMC7306528 DOI: 10.1016/j.ijscr.2020.06.028] [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: 04/22/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Gallstones are present in 10-15% of North Americans, but only 20% become symptomatic. This case report describes a patient with a 7.5 cm gallstone detected incidentally while being investigated for cardiac pathology. This is the first report in the English literature of a stone this size that has remained clinically asymptomatic. This work is reported in line with the SCARE criteria. CASE REPORT The patient was a 71-year-old Indigenous Canadian male, with atrial fibrillation. His cardiologist ordered a CT scan of his chest, which incidentally identified a large gallstone. He was referred to surgery for asymptomatic cholelithiasis. An uncomplicated laparoscopic cholecystectomy was performed. Final pathology showed a 7.5 cm gallstone with features of chronic cholecystitis. DISCUSSION The patient's ethnicity and gallstone size placed him at increased risk for gallbladder cancer, gallstone fistulization and perforation. We reviewed the literature for asymptomatic patients who may benefit from cholecystectomy: transplant recipients and those with hemolytic disorders. Laparoscopic cholecystectomy is not currently indicated in diabetics and bariatric surgery patients. CONCLUSION This case report shows that there are asymptomatic patients with massive gallstones. A review of their history, risk factors for malignancy and future gallstone related complications must be carefully weighed and discussed prior to deciding on surgical versus expectant management.
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Affiliation(s)
- Angela W Chan
- 103 Hospital Drive, Royal University Hospital, Department of Surgery, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada.
| | - Rathi M Sabaratnam
- Department of Pathology and Laboratory Medicine, Victoria Hospital- 1200 24th St W, Prince Albert, SK, S6V 4N9, Canada.
| | - Yagan Pillay
- University of Saskatchewan, Victoria Hospital- 1200 24th St W, Prince Albert, SK, S6V 4N9, Canada.
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Kilander C, Lagergren J, Konings P, Sadr-Azodi O, Brusselaers N. Menopausal hormone therapy and biliary tract cancer: a population-based matched cohort study in Sweden. Acta Oncol 2019; 58:290-295. [PMID: 30656997 DOI: 10.1080/0284186x.2018.1549367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study tested the hypothesis that contemporary menopausal hormonal therapy (MHT) increases the risk of biliary tract cancer. The risk of cancer of the biliary tract (gallbladder and extra-hepatic bile ducts) may be increased following estrogen exposure. MATERIAL AND METHODS This was a nationwide population-based matched cohort study in Sweden. Data from the Swedish Prescribed Drug Register identified all women exposed to systemic MHT in 2005-2012. Group-level matching (1:3 ratio) was used to select women unexposed to MHT from the same study base, matched for history of delivery, thrombotic events, hysterectomy, age, smoking- and alcohol related diseases, obesity, and diabetes. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Comparing 290,186 women exposed to MHT with 870,165 unexposed, MHT did not increase the OR of biliary tract cancer. The OR of gallbladder cancer was rather decreased in MHT users (OR 0.58, 95% CI 0.43-0.79), but this association became attenuated and statistically non-significant after adjusting for gallstone disease (OR 0.84, 95% CI 0.60-1.15). The OR of extra-hepatic bile duct cancers was 0.83 (95% CI 0.61-1.15). There were no clear differences when the analyses were stratified for estrogen or estrogen/progestogen combinations. MHT increased the risk of gallstone disease (OR 6.95, 95% CI 6.64-7.28). CONCLUSIONS Contemporary MHT does not seem to increase the risk of biliary tract cancer. The decreased risk of gallbladder cancer may be explained by the increased use of surgery for symptomatic gallstones in MHT users.
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Affiliation(s)
- C Kilander
- a Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - J Lagergren
- a Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
- b Division of Cancer Studies , King's College London , London , UK
| | - P Konings
- a Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
- c Department of Quantitative Biology , Discovery Sciences, IMED Biotech Unit, AstraZeneca , Gothenburg , Sweden
| | - O Sadr-Azodi
- d Department of Environmental Medicine , Karolinska Institutet , Stockholm , Sweden
- e Center for Clinical Research: Sörmland , Uppsala University , Uppsala , Sweden
| | - N Brusselaers
- f Centre for Translational Microbiome Research, Department of Microbiology , Tumor and Cell biology, Karolinska Institutet, Karolinska Hospital , Stockholm , Sweden
- g Science for Life Laboratory , Stockholm , Sweden
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Kumar S, Bhoriwal S, Muduly D, Kar M, Sharma A, Pathy S, Shukla NK, Deo SVS. Multimodality management of incidentally detected gall bladder cancer: long term results from a tertiary care cancer centre. J Gastrointest Oncol 2019; 10:128-133. [PMID: 30788168 PMCID: PMC6351296 DOI: 10.21037/jgo.2018.09.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/14/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Gall bladder cancer (GBC) is the most common biliary tract malignancy in India. GBC present either with incidental diagnosis after simple cholecystectomy (SC) or with a primary gall bladder mass. Incidentally detected gall bladder cancer (ICGB) has traditionally been thought to be a relatively early stage disease but there are controversies associated with various aspects of its management. In this article we describe our experience with multimodality management of ICGB. METHODS A retrospective analysis of incidentally detected GBC patients was performed to analyze the profile of presentation and treatment outcome. After initial radiological evaluation for operability, all the patients underwent surgical exploration. If found resectable, revision surgery including 2 cm wedge resection of liver and lymphadenectomy was done followed by concurrent chemo-radiation for tumors T2 and above stages. RESULTS A total of 54 patients with incidentally detected GBC with a male to female ratio of 1:3 and mean age of 47.5 years were included in the study. Thirty-four (63%) patients underwent curative resection followed by adjuvant chemoradiotherapy. The remaining 20 patients had metastatic/unresectable disease. The 5 years disease free and overall survival (OS) for patients receiving curative treatment was 64% and 72% respectively. On univariate analysis, presence of residual disease in the gallbladder fossa and liver were significant risk factors for disease recurrence. Depth of invasion, adjuvant treatment received and stage were significant prognostic factors for OS. CONCLUSIONS Incidentally detected GBC is increasing in incidence. A multi-modality approach with revision surgery and adjuvant chemo-radiation treatment may yield better outcome. Presence of residual disease is a poor prognostic factor. Optimal evaluation before SC and early referral to specialty center is therefore important in patients with suspicion of gallbladder malignancy because first chance is probably the best chance.
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Affiliation(s)
- Sunil Kumar
- Department of Surgical Oncology, All India Institute of Medical sciences (AIIMS), New Delhi, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical sciences (AIIMS), New Delhi, India
| | - Dillip Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Bhubaneshwar, India
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Bhubaneshwar, India
| | - Atul Sharma
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical sciences (AIIMS), New Delhi, India
| | - Sushmita Pathy
- Department of Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical sciences (AIIMS), New Delhi, India
| | - Nootan Kumar Shukla
- Department of Surgical Oncology, All India Institute of Medical sciences (AIIMS), New Delhi, India
| | - S. V. Suryanarayana Deo
- Department of Surgical Oncology, All India Institute of Medical sciences (AIIMS), New Delhi, India
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Chen JH, Tsai MS, Chen CY, Lee HM, Cheng CF, Chiu YT, Yin WY, Lee CH. Bariatric Surgery Did Not Increase the Risk of Gallstone Disease in Obese Patients: a Comprehensive Cohort Study. Obes Surg 2018; 29:464-473. [PMID: 30417273 DOI: 10.1007/s11695-018-3532-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Is Concomitant Cholecystectomy Necessary for Asymptomatic Cholelithiasis During Laparoscopic Sleeve Gastrectomy? Obes Surg 2018; 28:469-473. [PMID: 28803397 DOI: 10.1007/s11695-017-2867-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is not any consensus on concomitant cholecystectomy for asymptomatic gallbladder stones during laparoscopic sleeve gastrectomy (LSG). The aim of this study was to evaluate the surveillance results of the LSG patients who have asymptomatic gallbladder stones and did not undergo cholecystectomy. METHODS Patients who underwent laparoscopic sleeve gastrectomy with preoperatively detected gallbladder stones and completed at least 6 months follow-up were included in the study. Concomitant cholecystectomy was performed for symptomatic patients while it was not performed for asymptomatic subjects. At the end of the follow-up time, symptoms and signs related to gallbladder disease were recorded. Clinical and demographic characteristics were compared between symptomatic and asymptomatic patients. RESULTS Between February 2012 and October 2016, 312 laparoscopic sleeve gastrectomies were performed. Among the patients, 24 were regarded as asymptomatic cholelithiasis, and cholecystectomy was not performed. The mean follow-up period was 27 (6-58) months. The mean preoperative BMI was 50.0 ± 7.6 kg/m2, and at the end of the follow-up time, it decreased to 35.6 ± 8.8 kg/m2. Five (20.8%) patients experienced biliary colic. Acute cholecystitis or obstructive jaundice was not observed in any of the patients. Characteristics of patients who developed symptomatic gallbladder disease (n = 5) were not significantly different from those of patients who remained asymptomatic (n = 19). CONCLUSIONS The risk of becoming symptomatic for asymptomatic cholelithiasis is very close to the healthy population after sleeve gastrectomy. Although further studies with a high number of cases are needed, we suggest only observation for asymptomatic gallbladder stones in patients who will undergo sleeve gastrectomy.
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Flores-Rangel GA, Chapa-Azuela O, Rosales AJ, Roca-Vasquez C, Böhm-González ST. Quality of Life in Patients with Background of Iatrogenic Bile Duct Injury. World J Surg 2018. [PMID: 29520485 DOI: 10.1007/s00268-018-4564-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND There are only a few reports regarding the quality of life of patients who underwent a complicated cholecystectomy with an iatrogenic bile duct injury (IBDI); the results have been heterogeneous and realized with unspecific measures. METHODS The objective was to determine whether the quality of life of the subjects with a history of IBDI repaired with bilioenteric derivation is modified in the long term with respect to a control group, for which a group of patients with a history of IBDI (group A) was compared with a group of patients with a history of uncomplicated cholecystectomy (group B). Two different measures were used: on the one hand, the SF-12 questionnaire and on the other hand, a questionnaire was implemented where the patient could determine by himself which variables define his quality of life. RESULTS A total of 46 patients were included in group A and 51 in group B. The analysis of the SF-12 questionnaire showed a statistical significant reduction in 4 of 8 of the evaluated parameters (general health, physical functioning, physical role and social functioning) in group A in comparison with group B. If a more specific questionnaire is used, the results are similar, with a statistically significant reduction in the quality of life within the group A (0.03). CONCLUSIONS We conclude that the quality of life of patients with a history of bilioenteric derivation due to an IBDI decreases significantly compared to patients with uncomplicated cholecystectomy.
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Affiliation(s)
- Gustavo Alain Flores-Rangel
- Departament of Hepatic Pancreatic Biliary (HPB) Surgery, General Hospital of México, Dr. Balmis 148, Doctores, 06726, Mexico City, Mexico.
| | - Oscar Chapa-Azuela
- Departament of Hepatic Pancreatic Biliary (HPB) Surgery, General Hospital of México, Dr. Balmis 148, Doctores, 06726, Mexico City, Mexico
| | - Alejandro José Rosales
- Departament of Hepatic Pancreatic Biliary (HPB) Surgery, General Hospital of México, Dr. Balmis 148, Doctores, 06726, Mexico City, Mexico
| | - Carmen Roca-Vasquez
- Departament of Hepatic Pancreatic Biliary (HPB) Surgery, General Hospital of México, Dr. Balmis 148, Doctores, 06726, Mexico City, Mexico
| | - Simone Teresa Böhm-González
- Departament of Hepatic Pancreatic Biliary (HPB) Surgery, General Hospital of México, Dr. Balmis 148, Doctores, 06726, Mexico City, Mexico
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Jara G, Rosciano J, Barrios W, Vegas L, Rodríguez O, Sánchez R, Sánchez A. Laparoscopic subtotal cholecystectomy: a surgical alternative to reduce complications in complex cases. Cir Esp 2017; 95:465-470. [PMID: 28918963 DOI: 10.1016/j.ciresp.2017.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy is a common procedure in general surgery, and in complex cases it is important for the surgeon to know all the alternatives with low associated morbidity. Laparoscopic subtotal cholecystectomy should be considered as an option when a critical view of safety cannot be obtained, because it has a low complication rate and gives the advantages of minimally invasive surgery. METHODS Retrospective study of laparoscopic subtotal cholecystectomies in an eight years period. RESULTS A total of 1,059 laparoscopic cholecystectomies were performed; 22 were subtotal cholecystectomies, without conversion. Biliary fistula (9%) and intraabdominal collections (4.5%) were the most common complications described. No iatrogenic bile duct injuries or deaths were reported. Our follow-up period was 32months, no recurrences were reported. CONCLUSIONS Laparoscopic subtotal cholecystectomy is a safe and effective procedure. It should be considered as an option in complex cases.
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Affiliation(s)
- Génesis Jara
- Hospital Universitario de Caracas, Caracas, Venezuela.
| | - José Rosciano
- Hospital Universitario de Caracas, Caracas, Venezuela
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Petrucciani N, Debs T, Kassir R, Ben Amor I, Gugenheim J. Gastric Bypass and Synchronous Cholecystectomy: a Matter of Numbers? Obes Surg 2017; 27:2174-2176. [PMID: 28555409 DOI: 10.1007/s11695-017-2758-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Niccolo Petrucciani
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France.
- Department of Medical and Surgical Sciences of Translational Medicine, Sapienza University, Rome, Italy.
| | - Tarek Debs
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Radwan Kassir
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
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Amirthalingam V, Low JK, Woon W, Shelat V. Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too. Surg Endosc 2017; 31:2892-2900. [PMID: 27804044 DOI: 10.1007/s00464-016-5300-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/14/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether early laparoscopic cholecystectomy (LC) is safe and feasible for patients diagnosed with moderate (grade 2) and severe (grade 3) acute cholecystitis (AC) according to the Tokyo Guidelines 2013 (TG13). BACKGROUND Early cholecystectomy is the current accepted standard of care for patients with mild (grade 1) and selected grade 2 AC based on TG13. For selected grade 2 and grade 3 AC, early percutaneous cholecystostomy (PC) followed by delayed cholecystectomy is recommended. METHODS Patients diagnosed with AC over a 14-month period were identified and divided into three grades of AC based upon chart review using the grading and severity indicators according to TG13. RESULTS A total of 149 patients underwent emergency LC. Eighty-two (55 %) patients were male. Eighty-four (56.4 %) patients were classified as grade 1 AC, 49 (32.9 %) as grade 2, and 16 (10.7 %) as grade 3. Eighty-three (98.8 %) patients with grade 1 AC underwent emergency LC, and 1 patient (1.2 %) underwent PC followed by emergency LC. The median length of hospital stay for grade 1 AC patients was 2 (1-11) days. There were 2 (2.4 %) readmissions with fever and no additional complications. Among the 65 patients identified with grade 2 or 3 AC, 6 (9.2 %) underwent PC followed by emergency LC. Fifty-nine (90.8 %) patients underwent emergency cholecystectomy: 58 (98.3 %) LC and one (1.7 %) open cholecystectomy. Among the 58 patients with LC, 3 (5.2 %) patients had open conversion and 10 (17.2 %) patients required subtotal cholecystectomy. One patient was converted to open due to bile duct injury and had hepaticojejunostomy repair. Two other patients were converted due to dense adhesions and inability to safely dissect Calot's triangle. The median length of hospital stay was 4 (1-28) days. There was one readmission for ileus. CONCLUSION Severity grading of AC is not the sole determinant of early LC. Patient comorbidity also impacts clinical decision. Confirmation in a larger cohort is warranted.
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Affiliation(s)
- Vinoban Amirthalingam
- Division of General Surgery-HPB, Department of General Surgery, Tan Tock Seng Hospital, Annex 1, Level 4 General Surgery Office, Singapore, Singapore.
| | - Jee Keem Low
- Division of General Surgery-HPB, Department of General Surgery, Tan Tock Seng Hospital, Annex 1, Level 4 General Surgery Office, Singapore, Singapore
| | - Winston Woon
- Division of General Surgery-HPB, Department of General Surgery, Tan Tock Seng Hospital, Annex 1, Level 4 General Surgery Office, Singapore, Singapore
| | - Vishalkumar Shelat
- Division of General Surgery-HPB, Department of General Surgery, Tan Tock Seng Hospital, Annex 1, Level 4 General Surgery Office, Singapore, Singapore
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Varga M, Kudla M, Vargova L, Fronek J. Cholecystectomy for Acute Cholecystitis After Renal Transplantation. Transplant Proc 2017; 48:2072-5. [PMID: 27569946 DOI: 10.1016/j.transproceed.2016.02.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/15/2016] [Accepted: 02/24/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of our study was to evaluate the rate of surgical complications, patient outcomes, and impact on graft function in renal transplant recipients in whom cholecystectomy for acute cholecystitis was performed. METHODS We reviewed data on transplant patients from January 1, 2006, to December 31, 2013. The subgroup of patients who required subsequent cholecystectomy for acute cholecystitis was assessed, and their data were further analyzed. RESULTS Thirty-one patients who underwent cholecystectomy for acute cholecystitis after renal transplantation were included in the study. Clinical signs such as pain in the right upper quadrant, temperature >38°C, and elevation in bilirubin levels occurred in 20 (64.5%), 8 (25.8%), and 3 (9.7%) patients, respectively. Ultrasound signs of acute cholecystitis were present in 27 patients (87.1%). In terms of laboratory values, white blood cell counts >10 × 10(9)/L occurred in 17 patients (54.8%), and C-reactive protein levels >40 mg/L were reported in 21 patients (67.7%). The conversion rate to open surgery was 32.3% (10 patients). In 13 cases, acalculous cholecystitis was present (41.9%). The average serum creatinine level 1 year after cholecystectomy had no statistically significant differences. One patient required temporary dialysis during the postoperative period (with subsequent graft recovery), and 1 graft was lost. CONCLUSIONS Acute cholecystitis in kidney transplant recipients is a serious complication, with frequent difficulties related to evaluation and diagnosis. Because clinical signs could be very mild compared with severity of gallbladder affliction, there is little room if any for conservative treatment in these patients. We have not noticed adverse impact of acute cholecystitis on 1-year graft function.
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Affiliation(s)
- M Varga
- Universitätsklinik für Chirurgie, Landeskrankenhaus Salzburg-Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich; Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
| | - M Kudla
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - L Vargova
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - J Fronek
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Muroni M, Loi V, Lionnet F, Girot R, Houry S. Prophylactic laparoscopic cholecystectomy in adult sickle cell disease patients with cholelithiasis: A prospective cohort study. Int J Surg 2015; 22:62-6. [PMID: 26278661 DOI: 10.1016/j.ijsu.2015.07.708] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 07/09/2015] [Accepted: 07/29/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Prophylactic laparoscopic cholecystectomy remains controversial and has been discussed for selected subgroups of patients with asymptomatic cholelithiasis who are at high risk of developing complications such as chronic haemolytic conditions. Cholelithiasis is a frequent condition for patients with sickle cell disease (SCD). Complications from cholelithiasis may dramatically increase morbidity for these patients. Our objective was to evaluate the effectiveness of prophylactic cholecystectomy in SCD patients with asymptomatic gallbladder stones. METHODS From January 2000 to June 2014, we performed 103 laparoscopic cholecystectomies on SCD patients. Fifty-two patients had asymptomatic cholelithiasis. The asymptomatic patients were prospectively enrolled in this study, and all underwent a prophylactic cholecystectomy with an intraoperative cholangiography. The symptomatic patients were retrospectively studied. Upon admission, all patients were administered specific perioperative management including intravenous hydration, antibiotic prophylaxis, oxygenation, and intravenous painkillers, as well as the subcutaneous administration of low-molecular-weight heparin. During the same period, 51 patients with SCD underwent a cholecystectomy for symptomatic cholelithiasis. We compared these 2 groups in terms of postoperative mortality, morbidity, and hospital stay. RESULTS There were no postoperative deaths or injuries to the bile ducts in either group. In the asymptomatic group, we observed 6 postoperative complications (11.5%), and in the symptomatic group, there were 13 (25.5%) postoperative complications. DISCUSSION Regarding the SCD complications, we observed 1 case (2%) of acute chest syndrome in an asymptomatic cholelithiasis patient, while there were 3 cases (6%) in the symptomatic group. Vaso-occlusive crisis was observed in 1 patient (2%) with asymptomatic cholelithiasis, and in 4 patients (8%) in the other group. The mean hospital stay averaged 5.8 (4-17) days for prophylactic cholecystectomy and 7.96 (4-18) days for the comparative symptomatic group. CONCLUSIONS Postoperative complications related to SCD were less frequent for asymptomatic patients who had a laparoscopic prophylactic cholecystectomy. This intervention, if performed with perioperative specific management, is safe and helps avoid emergency operations for acute complications including cholecystitis, choledocholithiasis, and cholangitis. For SCD patients, a prophylactic cholecystectomy reduces hospital stays.
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Affiliation(s)
- Mirko Muroni
- Hôpital Tenon, Department of Surgery, 4 rue de la Chine, 75020, Paris, France.
| | - Valeria Loi
- Hôpital Tenon, Department of Surgery, 4 rue de la Chine, 75020, Paris, France.
| | - François Lionnet
- Hôpital Tenon, Department of Hematology, 4 rue de la Chine, 75020, Paris, France.
| | - Robert Girot
- Hôpital Tenon, Department of Hematology, 4 rue de la Chine, 75020, Paris, France.
| | - Sidney Houry
- Hôpital Tenon, Department of Surgery, 4 rue de la Chine, 75020, Paris, France.
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Ansari-Moghaddam A, Khorram A, Miri-Bonjar M, Mohammadi M, Ansari H. The Prevalence and Risk Factors of Gallstone Among Adults in South-East of Iran: A Population-Based Study. Glob J Health Sci 2015; 8:60-7. [PMID: 26573029 PMCID: PMC4873599 DOI: 10.5539/gjhs.v8n4p60] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 06/26/2015] [Indexed: 01/03/2023] Open
Abstract
Objective: The present study aimed to evaluate the prevalence and possible risk factors of gallstone disease in the general population. Patients and Methods: This cross sectional study was carried out on a total of 1522 males and females aged ≥30 years in Zahedan district, South-East of Iran. Data were collected by a validated questionnaire and gallstone diagnosis was assessed by an experienced radiologist using ultrasonography. Logistic regression model was used to identify the association between selected variables and gallstone disease. Results: The overall prevalence of gallstone in participants was 2.4%. The risk of gallstone was 2.60 times higher in people age 45 and older than those aged 30 - 44 years (Odds Ratio = 2.60, 95% CI; 1.22 - 5.55). Females were 2.73 (95% CI; 1.34 - 5.56) times more likely to have disease compared to males as well. The risk in unmarried individuals was also three times higher than married ones (OR = 2.99: 95% CI 1.02 - 9.16). Additionally, daily physical activity reduced the risk of gallstone disease by 66% (95% CI; 0.18 - 0.86). Conclusion: In conclusion, increasing age and female gender were risk factors, whereas daily physical activity and marriage identified as protective factors in aetiology of gallstone disease.
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Mathur AV. Need for Prophylactic Cholecystectomy in Silent Gall Stones in North India. Indian J Surg Oncol 2015; 6:251-5. [PMID: 27217672 DOI: 10.1007/s13193-015-0418-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 05/19/2015] [Indexed: 01/03/2023] Open
Abstract
One of the criteria for recommending cholecystectomy for silent gall stones, is gall stones in regions with high incidence of gall bladder cancer. Both gall stones and gall bladder cancer are common in North India. All tertiary care centres in India report high rates of gall bladder cancer (GBC) incidence and poor treatment outcomes in the majority of cases due to advanced stage of presentation. Csendes of Chile has reported very high incidence of gallbladder cancer in Chile and Bolivia and advocated prophylactic cholecystectomy in asymptomatic patients. Incidence rate of gall bladder cancer in Indian males is equal to that of Chile, whereas in females, the rates are almost double the rates of Chile. Indians have also been found to have high concentrations of heavy metals in gall bladder wall, and antibodies to tumor suppressor genes. In India, gall bladder cancer is the commonest GI cancer in women and fourth commonest cancer overall in the female population. In view of the epidemiology and clinical scenario of gall bladder cancer and proven safety of laparoscopic cholecystectomy, there is a need to act before it is too late in the current rates of gall bladder cancer. This study looks at the evidence correlating gall stones and gall bladder cancer, in relation to India. There is pressing evidence today to justify a strategy of prophylactic cholecystectomy in silent gall stones in North India. Data for this study was selected through an internet based search for literature concerning gall stones and gall bladder cancer in India, and for prophylactic cholecystectomy.
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Affiliation(s)
- Alok Vardhan Mathur
- Department of Surgery, Shri Guru Ram Rai Insititute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand 248001 India
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Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G, Barlera S, Davoli M. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbecks Arch Surg 2015; 400:429-53. [PMID: 25850631 DOI: 10.1007/s00423-015-1300-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/24/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the gold standard technique for gallbladder diseases in both acute and elective surgery. Nevertheless, reports from national surveys still seem to represent some doubts regarding its diffusion. There is neither a wide consensus on its indications nor on its possible related morbidity. On the other hand, more than 25 years have passed since the introduction of LC, and we have all witnessed the exponential growth of knowledge, skill and technology that has followed it. In 1995, the EAES published its consensus statement on laparoscopic cholecystectomy in which seven main questions were answered, according to the available evidence. During the following 20 years, there have been several additional guidelines on LC, mainly focused on some particular aspect, such as emergency or concomitant biliary tract surgery. METHODS In 2012, several Italian surgical societies decided to revisit the clinical recommendations for the role of laparoscopy in the treatment of gallbladder diseases in adults, to update and supplement the existing guidelines with recommendations that reflect what is known and what constitutes good practice concerning LC.
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Affiliation(s)
- Ferdinando Agresta
- Department of Surgery, Presidio Ospedaliero di Adria (RO), Adria, RO, Italy,
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Park JS, Lee DH, Lim JH, Jeong S, Jeon YS. Morphologic factors of biliary trees are associated with gallstone-related biliary events. World J Gastroenterol 2015; 21:276-282. [PMID: 25574102 PMCID: PMC4284346 DOI: 10.3748/wjg.v21.i1.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/07/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the risk factors for gallstone-related biliary events.
METHODS: This retrospective cohort study evaluated magnetic resonance cholangiopancreatography images from 141 symptomatic and 39 asymptomatic gallstone patients who presented at a single tertiary hospital between January 2005 and December 2012.
RESULTS: Logistic regression analysis showed significant differences between symptomatic and asymptomatic patients with gallstones in relation to the number of gallstones, the angle between the long axis of the gallbladder and the cystic duct, and the cystic duct diameter. Multivariate analysis showed that the number of gallstones (OR = 1.27, 95%CI: 1.03-1.57; P = 0.026), the angle between the long axis of the gallbladder and the cystic duct (OR = 1.02, 95%CI: 1.00-1.03; P = 0.015), and the diameter of the cystic duct (OR = 0.819, 95%CI: 0.69-0.97; P = 0.018) were significantly associated with biliary events. The incidence of biliary events was significantly elevated in patients who had the presence of more than two gallstones, an angle of > 92° between the gallbladder and the cystic duct, and a cystic duct diameter < 6 mm.
CONCLUSION: These findings will help guide the treatment of patients with asymptomatic gallstones. Clinicians should closely monitor patients with asymptomatic gallstones who exhibit these characteristics.
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Cariati A. Gallstone Classification in Western Countries. Indian J Surg 2013; 77:376-80. [PMID: 26730029 DOI: 10.1007/s12262-013-0847-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 01/16/2013] [Indexed: 01/03/2023] Open
Abstract
In order to compare gallstone disease data from India and Asian countries with Western countries, it is fundamental to follow a common gallstone classification. Gallstone disease has afflicted humans since the time of Egyptian kings, and gallstones have been found during autopsies on mummies. Gallstone prevalence in adult population ranges from 10 to 15 %. Gallstones in Western countries are distinguished into the following classes: cholesterol gallstones that contain more than 50 % of cholesterol (nearly 75 % of gallstones) and pigment gallstones that contain less than 30 % of cholesterol by weight, which can be subdivided into black pigment gallstones and brown pigment gallstones. It has been shown that ultrastructural analysis with scanning electron microscopy is useful in the classification and study of pigment gallstones. Moreover, x-ray diffractometry analysis and infrared spectroscopy of gallstones are of fundamental importance for an accurate stone analysis. An accurate study of gallstones is useful to understand gallstone pathogenesis. In fact, bacteria are not important in cholesterol gallstone nucleation and growth, but they are important in brown pigment gallstone formation. On the contrary, calcium bilirubinate is fundamental in black pigment gallstone formation and probably also plays an important role in cholesterol gallstone nucleation and growth.
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Affiliation(s)
- Andrea Cariati
- General Surgery, San Martino, IST, University Hospital, Via Fratelli Coda 67/5 A, 16166 Genoa, Italy
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Is preventive cholecystectomy for gallbladder carcinoma in northern India cost effective? Indian J Surg 2012; 75:329-30. [PMID: 24426468 DOI: 10.1007/s12262-012-0601-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 06/05/2012] [Indexed: 01/03/2023] Open
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