Hepatic or Cystic Artery Pseudoaneurysms Following a Laparoscopic Cholecystectomy: Literature review of aetiopathogenesis, presentation, diagnosis and management.
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SUBMITTER: Machado NO
PROVIDER: S-EPMC5488813 | biostudies-other | 2017 May
REPOSITORIES: biostudies-other
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Project description:IntroductionBiloma forms due to common bile duct (CBD) injury as a laparoscopic cholecystectomy complication. Spontaneous localized biloma forming cysts in the biliary duct is rare.Presentation of caseWe report a 47-year-old male with complaint of a painful lump in the upper abdomen two months after laparoscopic cholecystectomy. Magnetic resonance cholangiopancreatography (MRCP) found a large epigastric cyst mass, without any signs of CBD injury. Patient was managed with percutaneous drainage in the outpatient clinic and kept the contents of the drainage bag for evaluation. After two months follow-up the outcome was favorable.DiscussionBiloma forming cysts is a very rare complication post laparoscopic cholecystectomy. Biloma most common occurs as free fluid in the abdominal cavity. Clinical diagnostics, intraoperative historical evaluation and support with MRCP may determine the treatment options. Decision to manage with non-operative procedures by percutaneous drainage and evaluations of the patient in the outpatient clinic had a favorable outcome.ConclusionPost laparoscopic biloma cysts are a very rare case. Management with percutaneous drainage in an outpatient clinic and ambulatory drainage is an effective and safe procedure.
| S-EPMC8188253 | biostudies-literature
Project description:Clip migration following laparoscopic cholecystectomy (LC) is a rare and late complication of LC. The first case of surgical clip migration after LC was reported in 1992, and since then less than 100 cases have been reported in the literature. We report the case of cholangitis secondary to a surgical clip migration in an 83 years old male patient, 8 years after LC. Contrast-enhanced computed tomography of the abdomen (CT) showed intra and extrahepatic ducts dilatation secondary to a hyperdense object located in the distal common bile duct (CBD). It was removed successfully from the CBD by endoscopic retrograde cholangiopancreatography after sphincterotomy. At the last follow-up of one year after her admission, the patient is symptom-free with normal liver enzyme and abdominal CT. Surgical clip migration into CBD, should be included in the differential diagnosis while treating patients with the past surgical history of LC. Early diagnosis and treatment of this complication can avoid serious complications.
| S-EPMC7498729 | biostudies-literature
Project description:Single-incision laparoscopic surgery also known as laparo-endoscopic single-site surgery for cholecystectomy is performed using a single umbilical skin incision through which a laparoscope and two instruments are introduced. It is virtually a "scarless" surgery. The present study was undertaken to evaluate the efficacy of single-incision laparoscopic cholecystectomy using conventional instruments and compare it with three-port laparoscopic cholecystectomy. Thirty patients who underwent single-incision cholecystectomy were compared to an equal number of patients who underwent three-port cholecystectomy. Both groups were assessed on the basis of operative time, intraoperative complications, postoperative pain, ambulation, hospital stay, and body image at first and third week. Single-incision cholecystectomy had the advantage of less postoperative pain, early ambulation, and better body image as compared to three-port cholecystectomy; the results being statistically significant. There was no statistically significant difference in operative time and hospital stay between the two groups. Single-incision laparoscopic cholecystectomy using conventional instruments is a safe and effective surgery. It gives better cosmetic results, almost scarless surgery, without increasing the cost of surgery.
| S-EPMC4692840 | biostudies-literature
Project description:We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy (SILC) was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy (TLC). Moreover, the influencing factors of SILC were analyzed.A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC (n = 138) or TLC (n = 414). Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle.Among SILC group, 4 (2.9%) cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC (58.97 ± 21.56 vs. 43.38 ± 19.02 min, P < 0.001). The two groups showed no significant differences in analgesic dose, duration of hospital stay, or cost. Median pain scores were similar between the two groups 7 days after surgery, but SILC-treated patients had a significantly lower median pain score 6 h after surgery (10-point scale: 3 [2, 4] vs. 4 [3, 5], P = 0.009). Importantly, subgroup analyses of operative time for SILC showed that a longer operative time was associated with greater prevalence of pain score >5 (?100 min: 5/7 patients vs. <40 min, 3/16 patients, P = 0.015).The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery.
| S-EPMC4797506 | biostudies-literature
Project description:Several studies have reported short-term results for post-cholecystectomy symptoms and quality of life (QoL). However, reports on long-term results are still limited. This study aimed to identify risk factors affecting short- and long-term patient-reported outcome (PRO) following laparoscopic cholecystectomy.From 2016 to 2017, a total of 476 patients from 5 institutions were enrolled. PRO was examined using the Numeric Rating Scale (NRS) pain score and the Gastrointestinal (GI) QoL Index questionnaire at postoperative 1 month and 1 year.Most of patients recovered well at postoperative 1 year compared to postoperative 1 month for the NRS pain score, QoL score, and GI symptoms. A high operative difficulty score (HR 1.740, P = .031) and pathology of acute or complicated cholecystitis (HR 1.524, P = .048) were identified as independent risk factors for high NRS pain scores at postoperative 1 month. Similarly, female sex (HR 1.571, P = .003) at postoperative 1 month and postoperative complications (HR 5.567, P = .001) at postoperative 1 year were independent risk factors for a low QoL. Also, age above 50 (HR 1.842, P = .001), female sex (HR 1.531, P = .006), and preoperative gallbladder drainage (HR 3.086, P = .001) were identified as independent risk factors for GI symptoms at postoperative 1 month.Most patients showed improved long-term PRO measurement in terms of pain, QoL, and GI symptoms. There were no independent risk factors for long-term postoperative pain and GI symptoms. However, postoperative complications were identified to affect QoL adversely at postoperative 1 year. Careful and long-term follow up is thus necessary for patients who experienced postoperative complications.
| S-EPMC7458203 | biostudies-literature
Project description:PurposeLaparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma. Single incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy. In this study we aimed to compare results of SILS cholecystectomy and three port conventional laparoscopic (TPCL) cholecystectomy prospectively.MethodsIn this prospective study, 100 patients who underwent laparoscopic cholecystectomy for gallbladder disease were randomly allocated to SILS cholecystectomy (group 1) or TPCL cholecystectomy (group 2). Demographics, pathologic diagnosis, operating time, blood loss, length of hospital stay, complications, pain score, conversion rate, and satisfaction of cosmetic outcome were recorded.ResultsForty-four SILS cholesystectomies (88%) and 42 TPCL cholecystectomies (84%) were completed successfully. Conversion to open surgery was required for 4 cases in group 1 and 6 cases in group 2. Operating time was significantly longer in group 1 compared with group 2 (73 minutes vs. 48 minutes; P < 0.05). Higher pain scores were observed in group 1 versus group 2 in postoperative day 1 (P < 0.05). There was higher cosmetic satisfaction in group 1 (P < 0.05).ConclusionSILS cholecystectomy performed by experienced surgeons is at least as successful, feasible, effective and safe as a TPCL cholecystectomy. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempt the various procedures. Prospective randomized studies comparing single access versus conventional multiport laparoscopic cholecystectomy, with large volumes and long-term follow-up, are needed to confirm our initial experience. (ClinicalTrials.gov Identifier: NCT01772745.).
| S-EPMC3868679 | biostudies-literature
Project description:Trauma is a leading cause of death in younger individuals. Blunt abdominal trauma has the potential to mask severe injuries-there can be serious organ or vascular injury underneath intact skin. Increasingly, there is a trend toward nonoperative management of blunt abdominal trauma. We report the case of a left hepatic artery transection managed in the interventional radiology suite.
| S-EPMC5551999 | biostudies-other
Project description:Pancreatic cancer is one of the most lethal cancers, largely related to the difficulties with early detection, as it typically presents in later stages. Pancreatic cystic neoplasms (PCN) are commonly diagnosed as incidental findings on routine imaging. PCN is becoming more frequently detected with the increasing ease and frequency of obtaining cross-sectional images. Certain subtypes of pancreatic cysts have the potential to progress to malignancy, and therefore, clinicians are tasked with creating a patient-centered management plan. The decision of whether to undergo surgical resection or interval surveillance can be challenging given the criteria, including PCN size, pancreatic duct dilation, presence of a mural nodule, and clinical symptoms that play a potential role in risk stratification. Furthermore, the guidelines available from the major gastrointestinal societies all differ in their management recommendations. In this review, we detail an overview of the different types of PCNs and compare major guidelines for both diagnosis and management. We include emerging evidence for next-generation sequencing as well as confocal needle endomicroscopy to aid in the diagnosis and determination of malignancy potential and diagnosis.
| S-EPMC9857870 | biostudies-literature
Project description:BackgroundLaparoscopic cholecystectomy is frequently performed for acute cholecystitis and symptomatic cholelithiasis. Considerable variation in the execution of key steps of the operation remains. We conducted a systematic review of evidence regarding best practices for critical intraoperative steps for laparoscopic cholecystectomy.MethodsWe identified 5 main intraoperative decision points in laparoscopic cholecystectomy: (1) number and position of laparoscopic ports; (2) identification of cystic artery and duct; (3) division of cystic artery and duct; (4) indications for subtotal cholecystectomy; and (5) retrieval of the gallbladder. PubMed, EMBASE, and Web of Science were queried for relevant studies. Randomized controlled trials and systematic reviews were included for analysis, and evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation framework.ResultsFifty-two articles were included. Although all port configurations were comparable from a safety standpoint, fewer ports sometimes resulted in improved cosmesis or decreased pain but longer operative times. The critical view of safety should be obtained for identification of the cystic duct and artery but may be obtained through fundus-first dissection and augmented with cholangiography or ultrasound. Insufficient evidence exists to compare harmonic-shear, clipless ligation against clip ligation of the cystic duct and artery. Stump closure during subtotal cholecystectomy may reduce rates of bile leak and reoperation. Use of retrieval bag for gallbladder extraction results in minimal benefit. Most studies were underpowered to detect differences in incidence of rare complications.ConclusionKey operative steps of laparoscopic cholecystectomy should be informed by both compiled data and surgeon preference/patient considerations.
| S-EPMC9483801 | biostudies-literature
Project description:Background: The pain pattern after laparoscopic cholecystectomy (LC) is complex and distinct from postoperative pain after other laparoscopic procedures, suggesting that procedure-specific optimal analgesic management plans should be proposed. Duloxetine, a non-opioid neuromodulator, has been widely used to manage pain with dual central and peripheral analgesic properties. Aims: To assess the effect of preoperative administration of duloxetine compared to placebo on postoperative pain control in patients undergoing LC. Patients and Methods: This study was a randomized, parallel-group, placebo-controlled, double-blinded study performed on patients undergoing LC. Patients were randomly divided into two groups of 30 each on the day of surgery in the preoperative holding area, using a computer-generated random number to receive 60 mg duloxetine as a single oral dose 2 h before the procedure or placebo. The primary outcome was the difference in the mean of visual analogue scale (VAS) scores between the two studied groups, as measured by the area under the curve (AUC) of the VAS scores. Results: The derived AUC of VAS scores in the duloxetine group (757.89 ± 326.01 mm × h) was significantly lower than that calculated for the control group (1005.1 ± 432.5 mm × h). The mean postoperative VAS scores recorded at 4 and 24 h were statistically different between the study groups (p = 0.041 and 0.003, respectively). As observed in the survival curve analysis, there was no significant difference (p = 0.665) for the time until the patient's first request for rescue medications in the two groups. The frequency of postoperative nausea and vomiting (PONV) was lower in patients of the duloxetine group than that recorded in those allocated to the control group at 8 and 24-h time intervals (p = 0.734 and 0.572, respectively). Conclusion: Preoperative use of duloxetine reduces postoperative pain significantly compared with placebo. In addition, its use is associated with a reduction in PONV. These preliminary findings suggest that duloxetine could play a role in the acute preoperative period for patients undergoing LC. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT05115123, identifier NCT05115123].
| S-EPMC9557153 | biostudies-literature