The recommended treatment for cholecystocholedocholithiasis is cholecystectomy (CCT) associated with endoscopic retrograde cholangiopancreatography (ERCP). CCT with intraoperative ERCP is associated with higher success rates and lower hospital stays and hospital costs. However, some case series do not describe the exact methodology used: whether ERCP or CCT was performed first.
Verify if there is a difference, in terms of outcomes and complications, when intraoperative ERCP is performed immediately before or after CCT.
This is a retrospective case-control study analyzing all patients who underwent CCT with intraoperative ERCP between January 2021 and June 2022, in a tertiary hospital in southern Brazil, for the treatment of cholecystocholedocholithiasis.
Out of 37 patients analyzed, 16 (43.2%) underwent ERCP first, immediately followed by CCT. The overall success rate for the cannulation of the bile duct was 91.9%, and bile duct clearance was achieved in 75.7% of cases. The post-ERCP pancreatitis rate was 10.8%. When comparing the "ERCP First" and "CCT First" groups, there was no difference in technical difficulty for performing CCT. The "CCT First" group had a higher rate of success in bile duct cannulation (p=0.020, p<0.05). Younger ages, presence of stones in the distal common bile duct and shorter duration of the procedure were factors statistically associated with the success of the bile duct clearance. Lymphopenia and cholecystitis as an initial presentation, in turn, were associated with failure to clear the bile duct.
There was no significant difference in terms of complications and success in clearing the bile ducts among patients undergoing CCT and ERCP in the same surgical/anesthetic procedure, regardless of which procedure was performed first. Lymphopenia and cholecystitis have been associated with failure to clear the bile duct.
Iatrogenic injury to the bile ducts is the most feared complication of cholecystectomy and several are the possibilities to occur.
To compare the cases of iatrogenic lesions of the biliary tract occurring in conventional and laparoscopic cholecystectomy, assessing the likely causal factors, complications and postoperative follow-up.
Retrospective cohort study with analysis of records of patients undergoing conventional and laparoscopic cholecystectomy. All the patients were analyzed in two years. The only criterion for inclusion was to be operative bile duct injury, regardless of location or time of diagnosis. There were no exclusion criteria. Epidemiological data of patients, time of diagnosis of the lesion and its location were analyzed.
Total of 515 patients with gallstones was operated, 320 (62.1 %) by laparotomy cholecystectomy and 195 by laparoscopic approach. The age of patients with bile duct injury ranged from 29-70 years. Among those who underwent laparotomy cholecystectomy, four cases were diagnosed (1.25 %) with lesions, corresponding to 0.77 % of the total patients. No patient had iatrogenic interventions with laparoscopic surgery.
Laparoscopic cholecystectomy compared to laparotomy, had a lower rate of bile duct injury.
Gallbladder polyps are becoming a common finding in ultrasound. The management has to consider the potential risk of malignant lesions.
The aim of this study was to analyze the ultrasound findings in patients undergoing cholecystectomy due to gallbladder polyps and compare them for histopathological findings (HPs).
Patients with an ultrasonographic diagnosis of gallbladder polyp and who underwent cholecystectomy from 2007 to 2020 were included in the study.
A total of 447 patients were included, of whom 58% were women. The mean age was 45±12 years. The mean size of polyps in US was 7.9±3.6 mm. Notably, 9% of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p=0.003). Histopathological findings confirmed the presence of polyps in 88.4%, with a mean size of 4.8±3.4 mm. In all, 16 cases were neoplastic polyps (4.1%), 4 of them being malignancies, and all were single and larger than 10 mm. We found a significant correlation between ultrasound and histopathological findings polyp size determination (r=0.44; p<0.001). The Bland-Altman analysis obtained an overestimation of the US size of 3.26 mm. The receiver operating characteristic (ROC) curve analysis between both measures obtained an area under the receiver operating characteristic curve (AUC) of 0.77 (95%CI 0.74–0.81). Ultrasound polyps size larger than 10 mm had an odds ratio (OR) of 8.147 (95%CI 2.56–23.40) for the presence of adenoma and malignancy, with a likelihood ratio of 2.78.
There is a positive correlation and appropriate diagnostic accuracy between ultrasound size of gallbladder polyps compared to histopathological records, with a trend to overestimate the size by about 3 mm. Neoplastic polyps are uncommon, and it correlates with size. Polyps larger than 10 mm were associated with adenoma and malignancy.
Laparoscopic cholecystectomy has traditionally been performed with four incisions to insert four trocars, in a simple, efficient and safe way.
To describe a simplified technique of laparoscopic cholecystectomy with two incisions, using basic conventional instrumental.
In one incision in the umbilicus are applied two trocars and in epigastrium one more. The use of two trocars on the same incision, working in "x" does not hinder the procedure and does not require special instruments.
Simplified laparoscopic cholecystectomy with two incisions is feasible and easy to perform, allowing to operate with ergonomy and safety, with good cosmetic result.
- The laparoscopic ventral hernia repair technique made possible surgeries with smaller skin incisions and smaller dissection of the soft tissue around the hernia, therefore with a better wound, a quicker postoperative recovery and a lower complication rate.
- To evaluate the applicability of a quality of life survey based on the molds of the American Hernia Society, European Hernia Society and Carolinas Equation for Quality of Life, through telephone in patients submitted to laparoscopic hernioplasty by IPOM technique.
- A retrospective cohort study was made to evaluate the quality of life of 21 patients that underwent anterior abdominal wall laparoscopic hernioplasty by intraperitoneal onlay mesh technique. Questionnaire was applied through telephone.
- Of the 21 patients, 19% felt that the hernia recurred. Also 19% passed through another abdominal wall surgery, and among these, 75% was related to the previously hernia correction. Finally, 81% of patients did not undergo any other abdominal wall surgery.
- It was possible to apply the quality of life questionnary by telephone on patients who underwent an anterior abdominal wall. The results, in its turn, were satisfactory and showed that patients, in general, were satisfied with the surgical procedure.
One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors.
This study aimed to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures.
This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection.
There were 7 (1.59%) cases of wound infection. No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection.
The non-use of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.
Laparoscopic cholecystectomy is widely used for cholelithiasis. Abdominal ultrasonography often precedes this operation and can prove diagnosis, as well as helps in showing possible complications during the perioperative period.
Evaluate the description of variables of gallbladder and bile ducts present in reports of preoperative abdominal ultrasonography in cholelithiasis comparing with surgical findings.
Were studied 91 patients who underwent elective laparoscopic cholecystectomy with previous abdominal ultrasonography. Variables such as identification and amount of gallstones involved were evaluated, both in preoperative ultrasonography and during surgery to evaluate sensitivity, specificity, concordance and positive and negative predictive values.
The reports did not mention diameter of vesicular light (98.9%), organ distension (62.6%), gallstone sizes (58.2%), wall thickness (41.8%) and evaluation of the common bile duct (39.6%). Ultrasound had high values for sensitivity, consistency and positive predictive value for identifying the presence/absence of gallstones: 98.8%, 96.7% and 97.8% respectively. As for the amount of stones, ultrasonography showed agreement in 82.7%, negative predictive value in 89.1% and specificity in 87.7%, with lower values for sensitivity (68.2%) and positive predictive value (65.2%).
The ultrasound reports were flawed in standardization. Significant percentage of them did not have variables that could predict perioperative complications and surgical conversion.
With the advancement of laparoscopic surgery, new techniques have been proposed and disseminated in order to reduce the surgical aggression and get better cosmetic results.
To present alternative technique for videocholecystectomy comparable to single port technique using conventional material for laparoscopic surgery.
Introduction of laparoscopic devices using two incisions; gallbladder traction with thread, exposition of Calot triangle, and ligature of cystic pedicle with polymer clips.
Nine operations were carried out with this method, without complications and no increase in operative time, being compared to conventional videocholecistectomy, however vastly superior in aesthetic results.
The technique is feasible, reproducible, showing benefits to patient´s safety
The search for less traumatic surgical procedures without compromising efficacy and safety, together with the technological advances and greater experience of the teams, led to the development of operative techniques with increasingly smaller incisions, the so-called “minimally invasive surgeries”.
To evaluate the technical aspects and results of single port cholecystectomy.
Were analyzed 170 patients between 18-74 years submitted to videolaparoscopic cholecystectomies by single port, regardless of elective or urgent indication, without restriction of patient selection.
Among the 170 operations, 158 were exclusively performed by single port, and the conversion rate was 7% (inclusion of other accessory trocars or conversion to multiportal). Conversion to open surgery occurred in three cases (1.76%). The mean surgical time was 67.97 min, showing a marked decrease when was reached close to 50 cases and a stabilization after 100 surgeries. The overall complication rate was 10%, with minor complications such as: incisional pain, hematomas, granulomas, port access hernias (9.41%).
Single port cholecystectomy can, after standardization and surgical team training, be a safe surgical procedure associated with a recognized aesthetic advantage.
Surgeries with single port access have been gaining ground among surgeons who seek minimally invasive procedures. Although this technique uses only one access, the incision is larger when compared to laparoscopic cholecystectomy and this fact can lead to a higher incidence of incisional hernias.
To compare the incidence of incisional hernia after laparoscopic cholecystectomy and by single port.
A total of 57 patients were randomly divided into two groups and submitted to conventional laparoscopic cholecystectomy (n=29) and laparoscopic cholecystectomy by single access (n=28). The patients were followed up and reviewed in a 40.4 month follow-up for identification of incisional hernias.
Follow-up showed 21,4% of incisional hernia in single port group and 3.57% in conventional technique.
There was a higher incidence of late incisional hernia in patients submitted to single port access cholecystectomy compared to conventional laparoscopic cholecystectomy.
HEADINGS:
Incisional hernia, Cholecystectomy, laparoscopic, Minimally invasive surgical procedures,
Desenvolvido por Surya MKT