• Acute cholecystitis
• Cholecystolithiasis
• Gallstones
• Laparoscopic cholecystectomy

• Humans
• Female
• Male
• Middle Aged
• Prospective Studies
• Cholecystitis, Acute/surgery
• Cholecystitis, Acute/mortality
• Cholecystectomy/methods
• Cholecystolithiasis/surgery
• Aged
• Adult
• Time-to-Treatment
• Postoperative Complications/epidemiology
• Time Factors
• Operative Time
• Length of Stay/statistics & numerical data
• Iraq
• Cholecystectomy, Laparoscopic
• Treatment Outcome

• ABDOMINAL PAIN
• CHOLECYSTECTOMY
• GASTROINTESTINAL SURGERY

• Humans
• Female
• Male
• Recurrence
• Cholecystitis, Acute/therapy
• Cholecystitis, Acute/complications
• Aged
• Middle Aged
• Gallstones/complications
• Gallstones/epidemiology
• Sweden/epidemiology
• Time Factors
• Risk Factors
• Adult
• Age Factors
• Registries
• Cholecystectomy/statistics & numerical data
• Retrospective Studies
• Aged, 80 and over
• Proportional Hazards Models
• Conservative Treatment/statistics & numerical data
• Conservative Treatment/methods

• Region Gävleborg
• Uppsala Universitet
• Uppsala County Council (ALF)
• Centre for Research

• HPB
• general surgery
• hepatopancreaticobiliary surgery
• outcomes

• Humans
• Conservative Treatment/methods
• Cholecystitis, Acute/therapy
• Treatment Failure
• Cholecystectomy
• Recurrence
• Male
• Female
• Risk Factors

• acute cholecystitis
• outcomes
• percutaneous catheter drainage
• percutaneous cholecystostomy
• tube cholecystostomy

• Humans
• Cholecystitis, Acute/surgery
• Cholecystostomy/methods
• Cholecystostomy/adverse effects
• Male
• Retrospective Studies
• Female
• Aged
• Middle Aged
• Patient Selection
• Postoperative Complications/epidemiology
• Aged, 80 and over
• Treatment Outcome
• Adult

• Acute cholecystitis
• Cholecystectomy
• Cholelithiasis
• Elective surgery
• Emergency
• Gallstone

• Humans
• Retrospective Studies
• Male
• Female
• Cholecystectomy/statistics & numerical data
• Tertiary Care Centers/statistics & numerical data
• Risk Factors
• Elective Surgical Procedures
• Middle Aged
• Saudi Arabia/epidemiology
• Adult
• Gallstones/surgery
• Gallstones/epidemiology
• Time-to-Treatment/statistics & numerical data
• Aged
• Emergencies

• Cholecystectomy
• Cholecystitis
• Outcomes

• Humans
• Ireland
• Male
• Female
• Cholecystitis, Acute/surgery
• Cholecystitis, Acute/therapy
• Aged
• Middle Aged
• Registries
• Cholecystectomy
• Length of Stay/statistics & numerical data
• Adult
• Aged, 80 and over
• Treatment Outcome
• Retrospective Studies
• Cholecystectomy, Laparoscopic

• Humans
• Retrospective Studies
• Female
• Male
• Aged
• Treatment Outcome
• Gallstones/diagnostic imaging
• Gallstones/surgery
• Middle Aged
• Aged, 80 and over
• Time Factors
• Endoscopy, Digestive System/instrumentation
• Risk Factors
• Cholecystitis, Acute/diagnostic imaging
• Cholecystitis, Acute/surgery
• Adult
• Radiography, Interventional

• Gallstone disease
• Health inequality
• Outcomes

• Humans
• Female
• Retrospective Studies
• Male
• Elective Surgical Procedures/statistics & numerical data
• Cholecystectomy/statistics & numerical data
• Middle Aged
• Emergency Service, Hospital/statistics & numerical data
• Cholelithiasis/surgery
• Patient Discharge/statistics & numerical data
• Adult
• Health Services Accessibility/statistics & numerical data
• Aged
• Social Determinants of Health

• Cholecystitis
• Early laparoscopic cholecystectomy
• Laparoscopic cholecystectomy
• Timing

• Humans
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystitis, Acute/surgery
• Time-to-Treatment
• Postoperative Complications/etiology
• Length of Stay
• Operative Time
• Time Factors

• acute cholecystitis
• antibiotic resistance
• antibiotic therapy
• antimicrobial therapy
• biliary infections
• microbiology

• Humans
• Cholecystitis, Acute/drug therapy
• Cholecystitis, Acute/surgery
• Anti-Bacterial Agents/therapeutic use
• Anti-Bacterial Agents/administration & dosage
• Antimicrobial Stewardship/methods

• biliary colic
• biliary pain
• cholangitis
• cholecystectomy
• cholecystitis
• cholelithiasis
• gallstones
• pancreatitis
• recurrences
• relapse

• Humans
• Male
• Aged
• Female
• Retrospective Studies
• Acute Disease
• Pancreatitis/etiology
• Risk Factors
• Choledocholithiasis/diagnosis
• Choledocholithiasis/epidemiology
• Choledocholithiasis/surgery
• Recurrence

• AEG young talent group grant - 2021 AEG

• Biliary drainage
• Choledochoduodenostomy
• Endoscopic ultrasound
• Hepaticogastrostomy
• Lumen apposing metal stents
• Necrotic fluid collections
• Pancreatic cyst ablation
• Pancreatic ductal drainage

• Cholecystitis
• Non-operative management
• Recurrent cholecystitis
• Recurrent gallstone-related events

Biliary colic is a common cause of emergency department (ED) visits; however, the natural history of the disease and thus the indications for urgent or scheduled surgery remain unclear. Limitations of previous attempts to elucidate this natural history at a population level are based on the reliance on the identification of biliary colic via administrative codes in isolation. The purpose of our study was to validate the use of International Statistical Classification of Diseases and Related Health Problems codes, 10th Revision, Canadian modification (ICD-10-CA) from ED visits in adequately differentiating patients with biliary colic from those with other biliary diagnoses such as cholecystitis or common bile duct stones.

We performed a retrospective validation study using administrative data from two large academic hospitals in Toronto. We assessed all the patients presenting to the ED between January 1, 2012 and December 31, 2018, assigned ICD-10-CA codes in keeping with uncomplicated biliary colic. The codes were compared to the individually abstracted charts to assess diagnostic agreement.

Among the 991 patient charts abstracted, 26.5% were misclassified, corresponding to a positive predictive value of 73% (95% confidence interval 73%–74%). The most frequent reasons for inaccurate diagnoses were a lack of gallstones (49.8%) and acute cholecystitis (27.8%).

Our findings suggest that the use of ICD-10 codes as the sole means of identifying biliary colic to the exclusion of other biliary pathologies is prone to moderate inaccuracy. Previous investigations of biliary colic utilizing administrative codes for diagnosis may therefore be prone to unforeseen bias.

International guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis.

1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery.

725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months.

Patients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery.

Trial registration: Not applicable.

The online version contains supplementary material available at 10.1186/s12876-022-02453-0.

• Acute cholecystitis
• Population-based
• Retrospective
• Survival
• Treatment

Introduction

This study aims to compare the patient demographics and management of acute manifestations of gallstone disease during the COVID-19 pandemic with an equivalent period in 2019 and assess the differences in recurrence patterns throughout the first and second waves of the pandemic in the UK.

Methods

A retrospective cohort study of all adult patients aged >16 years presenting to the emergency department at a large District General Hospital with symptoms related to gallstones. Data were obtained from electronic patient records. The primary outcomes were incidence and management of gallstone disease, while secondary outcomes studied included length of stay, readmission rate, and recurrence. Data were tabulated and analyzed using Excel (Microsoft, 2016 version). Chi-square and t-test were used as appropriate. One way ANOVA test was used to compare data of three groups.

Results

Fifty-one patients presented during the period of first-wave and 105 patients during the second wave as compared to 71 patients in the study period in 2019. The median age of patients during the first wave of COVID was significantly higher than pre-COVID in the second wave. During both the waves of the pandemic, there was no significant difference in patients presenting with cholecystitis compared with 2019 (47 and 94 in the first and second wave, respectively, versus 60 in 2019; p-value 0.39). There was no significant increase in the use of cholecystostomy, and the use of radiological investigations was comparable. There was no significant difference in recurrence and readmissions. The majority of the patients still await surgery.

Conclusion

During the pandemic, older patients with higher co-morbidity presented with acute gallstone disease. Conservative management was effective in the management of these patients.

• acute cholecystitis
• common bile duct stone
• diagnostic screening
• liver function test
• predictive value

• Adult
• Aged
• Cholecystitis, Acute/complications
• Chronic Disease
• Cohort Studies
• Databases, Factual
• Female
• Gallstones/complications
• Gallstones/physiopathology
• Humans
• Liver/physiopathology
• Liver Function Tests
• Male
• Middle Aged
• Predictive Value of Tests
• Quality Improvement
• Retrospective Studies

• acute cholecystitis
• cholelithiasis
• diabetes mellitus
• laparoscopic cholecystectomy

Acute calculus cholecystitis (ACC) is a frequently reported medical condition in general practice. Approximately 20% of patients with gallbladder stones experience ACC in their lifetime. Ayurveda and Yoga are ancient traditional systems of medicine used for treatment of diseases and improving and maintaining health. There has been an increased use of Ayurveda and Yoga in the management of several health conditions in India and worldwide. The present case study is of 34 years female patient who had ACC. Post diagnosis of ACC patient was advised to undergo cholecystectomy; however, she approached alternative therapies with c/o vomiting, nausea, abdominal pain, jaundice, itching, and abdominal bloating with deranged liver functions. Ayurveda and Yoga intervention protocol was designed. Ayurveda treatment consisted of mild purgation (mruduvirechana) with trivrittalehyam for consecutive seven days, followed by oral administration of Tab Liv 52, Bhunimbadi Kadha twice daily, and Amalaki Rasayana in the morning for 45 days. Patients received 8 teleyoga sessions over a period of 45 days. A therapeutic diet was advised during treatment period. After two months patient reported complete recovery in symptoms, and all laboratory investigations reached to normal range. This case study suggests the positive role of Ayurveda and yoga intervention in the management of ACC. This case report warrants future clinical studies on integrative medicine in ACC.

• Alternative medicine
• Integrative medicine
• Jaundice
• Rasayana
• Traditional medicine

• Bile duct exploration
• Choledocholithiasis
• Gallstones
• Intra-operative ultrasound
• Laparoscopic ultrasound
• Magnetic resonance cholangiopancreatography

• Acute cholecystitis
• Antibiotics
• Early and delayed cholecystectomy
• Gallbladder Drainage
• Guidelines
• High-risk patients
• Surgery

• Cholecystectomy/methods
• Cholecystectomy, Laparoscopic
• Cholecystitis, Acute/diagnosis
• Cholecystitis, Acute/surgery
• Drainage
• Humans

• the manuscript was invited by the EiC/Editor and the EiC has agree to waive the APC ( contractual waiver)

• Acute cholecystitis
• Delayed cholecystectomy
• Early cholecystectomy
• Operative difficulty
• Propensity score matching analysis

Acute complications of biliary calculi are common, morbid, and complex to manage. Variability exists in the techniques utilized to treat these conditions at an individual surgeon and unit level.

To identify, through an international prospective nonrandomized cohort study, the epidemiology and areas of practice variability in management of acute complicated calculous biliary disease (ACCBD) and to correlate them against reported outcomes.

A preplanned analysis of the European Society of Trauma and Emergency Surgery (ESTES) 2018 Complicated Biliary Calculous Disease audit was performed. Patients undergoing emergency hospital admission with ACCBD between 1 October 2018 and 31 October 2018 were included. All eligible patients with acute complicated biliary calculous disease were recorded contemporaneously using a standardized predetermined protocol and a secure online database and followed-up through to 60 days from their admission.

A two-stage data collection strategy collecting patient demographics, details of operative, endoscopic and radiologic intervention, and outcome metrics. Outcome measures included mortality, surgical morbidity, ICU stay, timing of operative intervention, and length of hospital stay.

Three hundred thirty-eight patients were included, with a mean age of 65 years and 54% were female. Diagnosis at admission were: cholecystitis (45.6%), biliary pancreatitis (21%), choledocholithiasis with and without cholangitis (13.9% and 18%). Index admission cholecystectomy was performed in just 50% of cases, and 28% had an ERCP performed. Morbidity and mortality were low.

This first ESTES snapshot audit, a purely descriptive collaborative study, gives rich ‘real world’ insights into local variability in surgical practice as compared to international guidelines, and how this may impact upon outcomes. These granular data will serve to improve overall patient care as well as being hypothesis generating and inform areas needing future prospective study.

• Cholecystectomy
• Cholecystitis
• Clinical practice guidelines
• Emergency surgery

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To assess the benefits and harms of antibiotics treatment versus placebo, no intervention, or another antibiotic for people with cholecystitis or cholangitis, or both.

• Gallstones/diagnosis
• Gallstones/therapy
• Humans
• Practice Guidelines as Topic
• Time Factors
• Treatment Outcome

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.

To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.

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.

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.

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.

• Acute cholecystitis
• Tokyo guidelines
• Cholecystectomy
• Complications
• Delayed cholecystectomy

• Adult
• Cholecystectomy/adverse effects
• Cholecystectomy/economics
• Cholecystitis, Acute/diagnosis
• Cholecystitis, Acute/economics
• Cholecystitis, Acute/surgery
• Clinical Decision-Making
• Cost Savings/statistics & numerical data
• Female
• Hospital Costs/statistics & numerical data
• Humans
• Length of Stay/economics
• Length of Stay/statistics & numerical data
• Male
• Middle Aged
• Patient Selection
• Postoperative Complications/economics
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Retrospective Studies
• Severity of Illness Index
• Tertiary Care Centers/economics
• Tertiary Care Centers/statistics & numerical data
• Time Factors
• Time-to-Treatment
• Treatment Outcome

• cholecystitis
• cholelithiasis
• gallbladder cancer
• unusual findings

Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide.

The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population.

The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences.

The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain.

The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.

• Acute calcolous cholecystitis
• Antibiotics
• Diagnosis
• Elderly
• Frailty
• High-risk patients
• Surgery

• Gallstone disease
• acute cholecystitis
• cholecystectomy
• cholelithiasis
• elderly
• recurrence

Acute calculous cholecystitis (ACC) is a common disease across the world and is associated with significant socioeconomic costs. Although contemporary guidelines support the role of early laparoscopic cholecystectomy (ELC), there is significant variation among units adopting it as standard practice. There are many resource implications of providing a service whereby cholecystectomies for acute cholecystitis can be performed safely.

Studies that incorporated an economic analysis comparing early with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were identified by means of a systematic review. A meta‐analysis was performed on those cost evaluations. The quality of economic valuations contained therein was evaluated using the Quality of Health Economic Studies (QHES) analysis score.

Six studies containing cost analyses were included in the meta‐analysis with 1128 patients. The median healthcare cost of ELC versus DLC was €4400 and €6004 respectively. Five studies had adequate data for pooled analysis. The standardized mean difference between ELC and DLC was −2·18 (95 per cent c.i. −3·86 to −0·51; P = 0·011; I² = 98·7 per cent) in favour of ELC. The median QHES score for the included studies was 52·17 (range 41–72), indicating overall poor‐to‐fair quality.

Economic evaluations within clinical trials favour ELC for ACC. The limited number and poor quality of economic evaluations are noteworthy.

The aim of this study was to evaluate the characteristics, management, and outcomes of acute cholecystitis in patients ≥80 years.

This was a retrospective analysis of data from a prospective single-center patient registry.

The study population was composed of 348 patients, which were divided into two groups: those younger (Group A) and those older (Group B) than the median age (85.4 years). Although demographic and clinical characteristics of the two groups were similar, the disease management was clearly different, with older patients undergoing cholecystectomy less frequently (n=80 46.0% in Group A vs n=39 22.4% in Group B; p < 0.001). The outcomes in both groups of age were similar, with 30-day mortality of 3.7%, morbidity of 17.2%, and readmissions of 4.2% and two-year AC recurrence in nonoperated patients of 22.5%. No differences were seen between operated and no operated patients. Severe (Grade III) AC was the only independent factor significantly associated with mortality (OR 86.05 (95% CI: 11–679); p < 0.001).

In elderly patients with AC, the choice of therapeutic options was not limited by the age per se, but rather by the disease severity (grade III AC) and/or poor physical status (ASA III-IV). In case of grade I-II AC, laparoscopic cholecystectomy can be safely performed and yield good results even in very old patients. Patients with grade III AC present high risk of morbidity and mortality, and the treatment should be individualized. ASA IV patients should avoid cholecystectomy, being antibiotic treatment and cholecystectomy the best option.

This study investigated the optimal timing and usefulness of early cholecystectomy for acute cholecystitis in patients with comorbid acute cholangitis.

In 2011–2016, 252 patients who underwent early cholecystectomy for acute cholecystitis and 7 who underwent delayed cholecystectomy were enrolled and compared. Patients with comorbid acute cholangitis were then divided into those who underwent urgent cholecystectomy (within 72 h after symptom onset), semi-urgent cholecystectomy (3–14 days after symptom onset), or delayed cholecystectomy (3 months after symptom onset).

There were no significant intergroup differences in postoperative complication rate (p = 0.561), operation time (p = 0.496), or intraoperative blood loss (p = 0.151) between those with and those without acute cholangitis. Postoperative stays were significantly longer in the comorbid acute cholangitis group (p = 0.004). In the patients with acute cholangitis, the urgent cholecystectomy, semi-urgent, and delayed cholecystectomy groups had comparable intra- and postoperative outcomes.

Early cholecystectomy within 14 days after symptom onset was safely performed for patients with concomitant acute cholecystitis and acute cholangitis after the successful treatment of acute cholangitis.

•

Feasibility and safety of early cholecystectomy for concomitant acute cholecystitis with acute cholangitis within 14 days after symptom onset.

• 2013 Tokyo guideline
• Acute cholangitis
• Acute cholecystitis
• Cholecystectomy

• acute calculous cholecystitis
• conservative management
• pancreatitis
• surgery