P. Antypas, M. Corona, Cristian Eugeniu Boru, Chiara Eberspacher, D. Mascagni, F. Fiocca
Bile duct injuries represent a rare but potentially serious complication after laparoscopic cholecystectomy, that often need multidisciplinary therapeutic approaches. Additionally, post cholecystectomy clip migration into the biliary tree has been described, mainly because of local inflammatory processes. We present a case of a 65-year-old male with a bile duct injury and stricture after laparoscopic cholecystectomy treated endoscopically with sphincterotomy and stent positioning; initially with a plastic 10Fr stent and later with a totally covered metal stent. At the removal, the metal stent appeared proximally migrated and embedded with a surgical clip, the latter also migrated into the bile duct. The endoscopic retrieval of the stent was unsuccessful and thus a simultaneous right percutaneous transhepatic approach was adopted to liberate the stent and to facilitate the endoscopic procedure. The combined endoscopic-radiologic minimally-invasive approach seemed to be an effective and safe rescue technique, avoiding in this way complex surgical procedures.
{"title":"Combined Endoscopic-Radiologic Minimally Invasive Rescue Technique for the Removal of a Migrated and Embedded Biliary Metal Stent","authors":"P. Antypas, M. Corona, Cristian Eugeniu Boru, Chiara Eberspacher, D. Mascagni, F. Fiocca","doi":"10.21614/sgo-26-4-388","DOIUrl":"https://doi.org/10.21614/sgo-26-4-388","url":null,"abstract":"Bile duct injuries represent a rare but potentially serious complication after laparoscopic cholecystectomy, that often need multidisciplinary therapeutic approaches. Additionally, post cholecystectomy clip migration into the biliary tree has been described, mainly because of local inflammatory processes. We present a case of a 65-year-old male with a bile duct injury and stricture after laparoscopic cholecystectomy treated endoscopically with sphincterotomy and stent positioning; initially with a plastic 10Fr stent and later with a totally covered metal stent. At the removal, the metal stent appeared proximally migrated and embedded with a surgical clip, the latter also migrated into the bile duct. The endoscopic retrieval of the stent was unsuccessful and thus a simultaneous right percutaneous transhepatic approach was adopted to liberate the stent and to facilitate the endoscopic procedure. The combined endoscopic-radiologic minimally-invasive approach seemed to be an effective and safe rescue technique, avoiding in this way complex surgical procedures.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81116015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Marino, Adrian Chiow Kah Heng, G. Vaccarella, O. Potapov, Andrzej Lech Komorowski
Backgrounds: Several anastomoses have been described for the reconstruction of the pancreatic stump after pancreaticoduodenectomy. No technique showed a superiority over the others in terms of post-operative pancreatic fistula formation (POPF) in open neither during a minimally invasive approach. Methods: We compared the surgical outcomes of fourteen patients classified as high-risk for POPF who underwent a Blumgart anastomosis (BA) with that of patients who underwent a Cattell-Warren (CW). A 1:1 case-matched analysis was performed according to the variables of the risk score for post-operative pancreatic fistula (POPF) formation. Results: The overall operative time was similar (373±115 vs 398±127 min, p=0.567) while fashioning of the CW anastomosis required a longer time (38±21 vs 29±10, p<0.05). The overall morbidity rate was comparable among the two groups (p=0.273), while the incidence of clinically relevant-POPF was lower in the BA group (0 vs 3, p<0.05). No differences were observed in reoperation rate (p=0.445) and in postoperative length of stay (11.5 vs 12.6, p=0.367). Conclusion: The BA anastomosis is a potential alternative to the CW technique in a high-risk population for POPF formation. It shows benefits in terms of shorter anastomotic time and lower rate of clinically relevant-POPF.
背景:几种吻合方式用于胰十二指肠切除术后胰残端重建。在开放性和微创入路手术后胰瘘形成(POPF)方面，没有一种技术比其他技术优越。方法:我们比较了14例高危POPF患者行Blumgart吻合(BA)和行cattel - warren吻合(CW)的手术结果。根据术后胰瘘(POPF)形成风险评分变量进行1:1病例匹配分析。结果:两组总手术时间相近(373±115 min vs 398±127 min, p=0.567)，但CW吻合口形成时间较长(38±21 min vs 29±10 min, p<0.05)。两组总发病率相当(p=0.273)，而BA组临床相关- popf发生率较低(0 vs 3, p<0.05)。再手术率(p=0.445)和术后住院时间(11.5 vs 12.6, p=0.367)差异无统计学意义。结论:在POPF形成的高危人群中，BA吻合术是一种潜在的替代CW技术。它在缩短吻合时间和降低临床相关- popf率方面显示出益处。
{"title":"Modified Blumgart Anastomosis in Patients Undergoing Robotic Pancreaticoduodenectomy: The Results of a Preliminary Experience","authors":"M. Marino, Adrian Chiow Kah Heng, G. Vaccarella, O. Potapov, Andrzej Lech Komorowski","doi":"10.21614/sgo-26-4-393","DOIUrl":"https://doi.org/10.21614/sgo-26-4-393","url":null,"abstract":"Backgrounds: Several anastomoses have been described for the reconstruction of the pancreatic stump after pancreaticoduodenectomy. No technique showed a superiority over the others in terms of post-operative pancreatic fistula formation (POPF) in open neither during a minimally invasive approach. Methods: We compared the surgical outcomes of fourteen patients classified as high-risk for POPF who underwent a Blumgart anastomosis (BA) with that of patients who underwent a Cattell-Warren (CW). A 1:1 case-matched analysis was performed according to the variables of the risk score for post-operative pancreatic fistula (POPF) formation. Results: The overall operative time was similar (373±115 vs 398±127 min, p=0.567) while fashioning of the CW anastomosis required a longer time (38±21 vs 29±10, p<0.05). The overall morbidity rate was comparable among the two groups (p=0.273), while the incidence of clinically relevant-POPF was lower in the BA group (0 vs 3, p<0.05). No differences were observed in reoperation rate (p=0.445) and in postoperative length of stay (11.5 vs 12.6, p=0.367). Conclusion: The BA anastomosis is a potential alternative to the CW technique in a high-risk population for POPF formation. It shows benefits in terms of shorter anastomotic time and lower rate of clinically relevant-POPF.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85936705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Choi Chin Wa, Leong Chin Wan, Iao Kin Sang, Chu Man Leng, J. Costa-Maia, Pang Heong Keong
The incidence of distant metastasis from meningioma is reported to be rare. Only about 0.1% of meningiomas metastasize outside the central nervous system (1), with 11 cases of liver metastasis reported in PubMed. A consensus about screening programs and treatment plan for metastatic meningioma is still lacking. Surgical resection remains the first option for the treatment and should be performed in Centers with adequate experience. We report a case of metastatic liver tumor from an atypical meningioma and reviewed similar previously publishedcases, summarizing potential risk factors for liver metastasis and screening recommendations. 48-year-old female was diagnosed with meningioma in 2000 and underwent complete surgical resection with pathology indicating a fibrous meningioma.
{"title":"A Rare Liver Tumor: Case Report and Literature Review","authors":"Choi Chin Wa, Leong Chin Wan, Iao Kin Sang, Chu Man Leng, J. Costa-Maia, Pang Heong Keong","doi":"10.21614/sgo-ec-350","DOIUrl":"https://doi.org/10.21614/sgo-ec-350","url":null,"abstract":"The incidence of distant metastasis from meningioma is reported to be rare. Only about 0.1% of meningiomas metastasize outside the central nervous system (1), with 11 cases of liver metastasis reported in PubMed. A consensus about screening programs and treatment plan for metastatic meningioma is still lacking. Surgical resection remains the first option for the treatment and should be performed in Centers with adequate experience. We report a case of metastatic liver tumor from an atypical meningioma and reviewed similar previously publishedcases, summarizing potential risk factors for liver metastasis and screening recommendations. 48-year-old female was diagnosed with meningioma in 2000 and underwent complete surgical resection with pathology indicating a fibrous meningioma.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86554733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Successful liver transplantation requires proper mitigation of stress responses. Systemic effects caused by liver cirrhosis, invasive surgery, ischemia-reperfusion injury, rejection, and infection, all of which are relevant to liver transplantation, are mediated by inflammatory factors. Recently, the detailed mechanisms of inflammation have been elucidated. Damage-associated molecular patterns (DAMPs) released from cells damaged by ischemia or injury, or pathogen-associated molecular patterns (PAMPs) released by pathogens, are recognized by internal cell receptors or cell surface receptors, leading to the synthesis of inflammatory proteins including proinflammatory/anti-inflammatory cytokines, which are then secreted by the cells. These cytokines stimulate the production of additional cytokines, causing a vicious circle of inflammatory responses, such as innate immune responses by macrophages. In addition, lymphocytes activated by these cytokines stimulate adaptive immunity. During liver transplantation, the general preoperative condition of the patient and surgical invasiveness are associated with organ failure and ischemia-reperfusion injury, which can lead to transplant rejection. It has been suggested that progressive immunodeficiency and organ failure as a result of pre-transplant cirrhosis are associated with postoperative multiple organ failure and death, and that elevated intraoperative DAMPs correlate with organ failure. Furthermore, DAMP receptors and inflammatory cytokines are increased by ischemia-reperfusion injury, indicating its role in promoting innate and adaptive immunity. In addition, inflammatory signals induced by postoperative infections are similar to those induced by ischemia-reperfusion injury and rejection, indicating that pathogen-derived inflammation can also lead to rejection. In summary, most complications in liver transplantation can be explained in a unified manner by abnormal inflammatory responses; therefore, controlling inflammation might be of benefit for the struggle of safe and effective liver transplantation.
{"title":"Inflammatory Responses in Liver Transplantation","authors":"Kantoku Nagakawa, A. Soyama, S. Eguchi","doi":"10.21614/SGO-26-326","DOIUrl":"https://doi.org/10.21614/SGO-26-326","url":null,"abstract":"Successful liver transplantation requires proper mitigation of stress responses. Systemic effects caused by liver cirrhosis, invasive surgery, ischemia-reperfusion injury, rejection, and infection, all of which are relevant to liver transplantation, are mediated by inflammatory factors. Recently, the detailed mechanisms of inflammation have been elucidated. Damage-associated molecular patterns (DAMPs) released from cells damaged by ischemia or injury, or pathogen-associated molecular patterns (PAMPs) released by pathogens, are recognized by internal cell receptors or cell surface receptors, leading to the synthesis of inflammatory proteins including proinflammatory/anti-inflammatory cytokines, which are then secreted by the cells. These cytokines stimulate the production of additional cytokines, causing a vicious circle of inflammatory responses, such as innate immune responses by macrophages. In addition, lymphocytes activated by these cytokines stimulate adaptive immunity. During liver transplantation, the general preoperative condition of the patient and surgical invasiveness are associated with organ failure and ischemia-reperfusion injury, which can lead to transplant rejection. It has been suggested that progressive immunodeficiency and organ failure as a result of pre-transplant cirrhosis are associated with postoperative multiple organ failure and death, and that elevated intraoperative DAMPs correlate with organ failure. Furthermore, DAMP receptors and inflammatory cytokines are increased by ischemia-reperfusion injury, indicating its role in promoting innate and adaptive immunity. In addition, inflammatory signals induced by postoperative infections are similar to those induced by ischemia-reperfusion injury and rejection, indicating that pathogen-derived inflammation can also lead to rejection. In summary, most complications in liver transplantation can be explained in a unified manner by abnormal inflammatory responses; therefore, controlling inflammation might be of benefit for the struggle of safe and effective liver transplantation.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85015223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. A. Abd ELatti, Ahmed Ibrahim Mohammed, Walid Mouhamed Fathy, Abdel-Naser Abdel-Aty Gad Allah
{"title":"Study the Relation between Blood Ammonia Level and Esophageal Varices in Egyptian Patients with Liver Cirrhosis","authors":"E. A. Abd ELatti, Ahmed Ibrahim Mohammed, Walid Mouhamed Fathy, Abdel-Naser Abdel-Aty Gad Allah","doi":"10.21614/sgo-ec-348","DOIUrl":"https://doi.org/10.21614/sgo-ec-348","url":null,"abstract":"","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87175839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Malágo, D. Raptis, C. Imber, Giovanni Dalla Serra, O. Kornasiewicz
Hepatocellular carcinoma (HCC) is the second cause of cancer–related deaths worldwide constitutes a major global health problem. Although our understanding of the molecular pathogenesis of hepatocellular HCC has improved, detected driver mutations are not yet sufficiently reliable therapeutic targets. The modern management of HCC is conceived only within multidisciplinary schemes. Current systemic therapies are not curative and surgical treatments remain the only potential curative treatments for selected patients with early stage HCC. The role of parenchyma sparing liver resection for appropriately selected patients may vary in different environments according to organ availability,and liver resection remains a reliable curative method for HCC. Meta-analyses have shown that clinical outcomes of surgical resection are superior to ablative treatments in early stage HCC. Liver transplantation is still the standard treatment for patients with early stage HCC. Lately the Milan Criteria are considered too restrictive, still recognizing that the extension of transplantation criteria beyond Milano criteria increases the risk of HCC recurrence. Resection, ablation, transarterial embolization and trans-arterial radiation are commonly applied to bridge patients to transplant. Despite enormous advances in the therapy of HCC treatments at present, there are currently no genuine breakthroughs for patients with HCC. The Clinical Trials Planning Meeting (CTPM) in HCC convened by the American Society of Clinical Oncology identified the key knowledge gaps in HCC and define clinical research priorities. Major improvements in survival provided by multimodal treatments witnessed in other cancers are not yet available for HCC because effective systemic treatment modalities for HCC are still lacking. Integration of bio-genetic tumor information into current tested treatment schemes and truly multimodal surgery-based treatment schemes will enable the recruitment of less selected patients in larger numbers to curative treatments.
{"title":"Liver Transplantation and Surgery in the Management of Hepatocellular Carcinoma","authors":"M. Malágo, D. Raptis, C. Imber, Giovanni Dalla Serra, O. Kornasiewicz","doi":"10.21614/SGO-26-320","DOIUrl":"https://doi.org/10.21614/SGO-26-320","url":null,"abstract":"Hepatocellular carcinoma (HCC) is the second cause of cancer–related deaths worldwide constitutes a major global health problem. Although our understanding of the molecular pathogenesis of hepatocellular HCC has improved, detected driver mutations are not yet sufficiently reliable therapeutic targets. The modern management of HCC is conceived only within multidisciplinary schemes. Current systemic therapies are not curative and surgical treatments remain the only potential curative treatments for selected patients with early stage HCC. The role of parenchyma sparing liver resection for appropriately selected patients may vary in different environments according to organ availability,and liver resection remains a reliable curative method for HCC. Meta-analyses have shown that clinical outcomes of surgical resection are superior to ablative treatments in early stage HCC. Liver transplantation is still the standard treatment for patients with early stage HCC. Lately the Milan Criteria are considered too restrictive, still recognizing that the extension of transplantation criteria beyond Milano criteria increases the risk of HCC recurrence. Resection, ablation, transarterial embolization and trans-arterial radiation are commonly applied to bridge patients to transplant. Despite enormous advances in the therapy of HCC treatments at present, there are currently no genuine breakthroughs for patients with HCC. The Clinical Trials Planning Meeting (CTPM) in HCC convened by the American Society of Clinical Oncology identified the key knowledge gaps in HCC and define clinical research priorities. Major improvements in survival provided by multimodal treatments witnessed in other cancers are not yet available for HCC because effective systemic treatment modalities for HCC are still lacking. Integration of bio-genetic tumor information into current tested treatment schemes and truly multimodal surgery-based treatment schemes will enable the recruitment of less selected patients in larger numbers to curative treatments.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84629768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Guedes, D. Ferreira, José Ricardo Brandão, Jose Ramon Vizcaino, I. Pedroto
Obesity and its surgical treatment have been increasing in the last decade. Roux-en-Y gastric bypass (RYGB) is one of the most common procedures performed, resulting in an excluded stomach that can be the home of pre- and postoperative pathology. We present a case report of a 52 years-old man with melena and refractory anemia 2 years after RYGB. Although a possible etiology was found through esophagogastroduodenoscopy, the persistence of anemia determined the search for other causes. Additional abdominal CT revealed a tumoral mass in the excluded stomach with subsequent biopsy findings compatible with a gastrointestinal stromal tumor (GIST). Neoadjuvant imatinib therapy and surgery werewas performed confirming the diagnosis and showing GIST ulcerating the mucosa of the excluded stomach. After surgery, imatinib treatment was restarted and maintained so far with no recurrence of anemia. Malignancy of excluded stomach are frequently of epithelial origin and, to our knowledge, GIST occurrence is a very rare finding on an excluded stomach. This highlights the importance of considering the occurrence of hidden pathology in the excluded stomach, as well as the need for a high-qualityhigh quality EGD in pre-bariatric surgery evaluation.
{"title":"Unusual Presentation of a Gastrointestinal Tumor in Excluded Stomach - the Need to Think About the Hidden Enemy","authors":"T. Guedes, D. Ferreira, José Ricardo Brandão, Jose Ramon Vizcaino, I. Pedroto","doi":"10.21614/sgo-26-4-323","DOIUrl":"https://doi.org/10.21614/sgo-26-4-323","url":null,"abstract":"Obesity and its surgical treatment have been increasing in the last decade. Roux-en-Y gastric bypass (RYGB) is one of the most common procedures performed, resulting in an excluded stomach that can be the home of pre- and postoperative pathology. We present a case report of a 52 years-old man with melena and refractory anemia 2 years after RYGB. Although a possible etiology was found through esophagogastroduodenoscopy, the persistence of anemia determined the search for other causes. Additional abdominal CT revealed a tumoral mass in the excluded stomach with subsequent biopsy findings compatible with a gastrointestinal stromal tumor (GIST). Neoadjuvant imatinib therapy and surgery werewas performed confirming the diagnosis and showing GIST ulcerating the mucosa of the excluded stomach. After surgery, imatinib treatment was restarted and maintained so far with no recurrence of anemia. Malignancy of excluded stomach are frequently of epithelial origin and, to our knowledge, GIST occurrence is a very rare finding on an excluded stomach. This highlights the importance of considering the occurrence of hidden pathology in the excluded stomach, as well as the need for a high-qualityhigh quality EGD in pre-bariatric surgery evaluation.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81714378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Habeeb, Mahmoud Abdouyassin, Fady Mehaney Habib, Muhammad A. Baghdadi
{"title":"Emergency Laparoscopic Cholecystectomy with Low-Pressure Pneumo-Peritoneum in Cardiopulmonary Risk Patients: Fundus-Calot Cholecystectomy versus Calot First Cholecystectomy. Randomized Controlled Trial","authors":"T. Habeeb, Mahmoud Abdouyassin, Fady Mehaney Habib, Muhammad A. Baghdadi","doi":"10.21614/sgo-ec-370","DOIUrl":"https://doi.org/10.21614/sgo-ec-370","url":null,"abstract":"","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82292332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correlation of HIV Status to Non-HPV Associated Benign Surgical Perianal Pathologies","authors":"M. Motsumi, John Thato Tlhakanelo","doi":"10.21614/sgo-ec-221","DOIUrl":"https://doi.org/10.21614/sgo-ec-221","url":null,"abstract":"","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76480435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Elgarf, Tamer M. Elmahdy, M. Ghazaly, A. Swelam
Introduction: Laparoscopic cholecystectomy (LC) has replaced open technique as the main surgical intervention in the treatment of gall bladder stones. There are different clinical and radiological predictors that are indicators for technically difficult LC. Aim of the work: The aim of this study was to identify the clinical and radiological variables associated with difficult LC. Methods: During the period from March 2018 to March 2021, 452 adult patients who presented with symptomatic gall bladder stones underwent LC. Different clinical and radiological data were collected as: abdominal scar, palpable gall bladder, previous hospitalization, history of ERCP, total leucocyte count, thickness of the gall bladder wall, peri-cholecystic collection, solitary or multiple gall bladder stones, impacted stone and diameter of the CBD. Results: Age of 50 years or over (P value 0.001), male gender (P value 0.001), previous hospital admission (P value 0.001), impacted stones (P value 0.003), and leukocytosis (P value 0.031) were found statistically significant with area under ROC curve is 0.814 with 95 % confidence interval. Conclusion: These preoperative risk factors; old age, male gender, previous hospitalization for biliary problem, impacted stone, and leukocytosis could potentially predict difficult LC, and give surgeons and their assistants the chance to predict the risk of complications intraoperatively and the possibility to convert the maneuver to a bail-out one.
{"title":"Preoperative Clinical and Radiological Variables for Prediction of Difficult Laparoscopic Cholecystectomy","authors":"S. Elgarf, Tamer M. Elmahdy, M. Ghazaly, A. Swelam","doi":"10.21614/sgo-26-4-386","DOIUrl":"https://doi.org/10.21614/sgo-26-4-386","url":null,"abstract":"Introduction: Laparoscopic cholecystectomy (LC) has replaced open technique as the main surgical intervention in the treatment of gall bladder stones. There are different clinical and radiological predictors that are indicators for technically difficult LC. Aim of the work: The aim of this study was to identify the clinical and radiological variables associated with difficult LC. Methods: During the period from March 2018 to March 2021, 452 adult patients who presented with symptomatic gall bladder stones underwent LC. Different clinical and radiological data were collected as: abdominal scar, palpable gall bladder, previous hospitalization, history of ERCP, total leucocyte count, thickness of the gall bladder wall, peri-cholecystic collection, solitary or multiple gall bladder stones, impacted stone and diameter of the CBD. Results: Age of 50 years or over (P value 0.001), male gender (P value 0.001), previous hospital admission (P value 0.001), impacted stones (P value 0.003), and leukocytosis (P value 0.031) were found statistically significant with area under ROC curve is 0.814 with 95 % confidence interval. Conclusion: These preoperative risk factors; old age, male gender, previous hospitalization for biliary problem, impacted stone, and leukocytosis could potentially predict difficult LC, and give surgeons and their assistants the chance to predict the risk of complications intraoperatively and the possibility to convert the maneuver to a bail-out one.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73166326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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