RESUMO
Introducción: La colecistectomía laparoscópica se ha convertido rápidamente en el procedimiento de elección de rutina para la enfermedad de la vesícula biliar, y actualmente es el procedimiento abdominal mayor que se realiza con mayor frecuencia en los países occidentales; la mayoría de los autores sugieren que es seguro observar a pacientes con cálculos biliares asintomáticos, y que la colecistectomía solo se realiza por aquellos pacientes que desarrollan síntomas. El quince por ciento de los pacientes persiste teniendo síntomas posteriores a la colecistectomía. Este estudio tuvo como objetivo evaluar el uso de la esofagogastroduodenoscopía previa a la colecistectomía laparoscópica y su impacto en el manejo. Método: Este fue un estudio clínico prospectivo que involucró a pacientes con cálculos biliares ingresados en el Hospital Docente de Al-Basra, Departamento de Cirugía General desde enero de 2016 hasta diciembre de 2019. Todos los pacientes fueron seguidos desde el momento del ingreso hasta seis meses después. Estos pacientes se dividieron en siete grupos según la edad. A todos los pacientes se les realizó una ecografía abdominal para diagnosticar la presencia de colelitiasis y descartar otros problemas abdominales. Todos los pacientes programados para colecistectomía laparoscópica se sometieron a una endoscopia del tracto gastrointestinal superior antes de la operación. Resultados: Se incluyeron un total de 1200 pacientes con rango de edad de 21 a 82 años (mujeres, 83,33%, hombres, 16,66%) con colelitiasis. La proporción de mujeres a hombres fue de 5:1. Se observaron hallazgos endoscópicos positivos en 380 (31,6%) pacientes. En estos pacientes se modificó el plan de manejo con hallazgos positivos por endoscopia y se pospuso su cirugía hasta recibir el tratamiento adecuado. Conclusión: El uso rutinario de esofagogastroduodenoscopia previa a la colecistectomía disminuiría la colecistectomía innecesaria en pacientes con colelitiasis y hallazgos endoscópicos positivos, lo que disminuye la persistencia de síntomas post colecistectomía.
Introduction: Laparoscopic cholecystectomy has rapidly become the procedure of choice for routine gallbladder disease, and it is currently the most performed major abdominal procedure in Western countries, most authors suggest that it's safe to observe patients with asymptomatic gallstones, with cholecystectomy only being performed for those patients who develop symptoms. Fifteen percent of patients persist to have post cholecystectomy symptoms. This study aimed to evaluate the use of oesophagogastroduodenoscopy prior to laparoscopic cholecystectomy, and its impact on the management. Method: This was a prospective clinical study involving patients with gallstone admitted to the Al-Basra Teaching Hospital, Department of General Surgery from January 2016 to December 2019. All patients were followed up from the time of admission until six months later. These patients were divided into seven groups according to age. All patients were having an abdominal ultrasound examination in order to diagnose the presence of cholelithiasis and to exclude other abdominal problems. All patients scheduled for laparoscopic cholecystectomy underwent upper GIT endoscopy preoperatively. Results: A total of 1200 patient age range from 21 to 82 years were included (women, 83.33%, men, 16.66%) had cholelithiasis. Female to male ratio was 5:1. Positive endoscopic findings were observed in 380(31.6 %) patients. The management plan was changed in these patients with positive findings by endoscopy and their surgery was postponed until they received proper treatment. Conclusion: The routine use of oesophagogastroduodenoscopy prior to cholecystectomy would decrease the unneeded cholecystectomy in patients with cholelithiasis and positive endoscopic findings, which decrease post cholecystectomy persistence of symptoms.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Colecistectomia Laparoscópica , Assistência ao Convalescente , Procedimentos Desnecessários , Doenças da Vesícula Biliar/terapiaRESUMO
The introduction and subsequent widespread adaptation of minimally invasive approaches for bariatric surgery have not only changed the outcomes of bariatric surgery but also called into question the management of co-morbid surgical conditions, in particular gallbladder disease. The American Society for Metabolic and Bariatric Surgery Foregut Committee performed a systematic review of the published literature from 1995-2018 on management of gallbladder disease in patients undergoing bariatric surgery. The papers reviewed generated the following results. (1) Routine prophylactic cholecystectomy at the time of bariatric surgery is not recommended. (2) In symptomatic patients who are undergoing bariatric surgery, concomitant cholecystectomy is acceptable and safe. (3) Ursodeoxycholic acid may be considered for gallstone formation prophylaxis during the period of rapid weight loss. (4) Routine preoperative screening and postoperative surveillance ultrasound is not recommended in asymptomatic patients. In the era of minimally invasive surgery, the management of gallbladder disease in patients undergoing bariatric surgery continues to evolve.
Assuntos
Cirurgia Bariátrica , Doenças da Vesícula Biliar , Procedimentos Cirúrgicos Minimamente Invasivos , Obesidade Mórbida , Colagogos e Coleréticos/uso terapêutico , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/tratamento farmacológico , Doenças da Vesícula Biliar/prevenção & controle , Doenças da Vesícula Biliar/terapia , Humanos , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Ácido Ursodesoxicólico/uso terapêuticoRESUMO
INTRODUCTION: Bariatric surgery is the most effective therapy for weight loss in patients with morbid obesity. One of the most common long-term complications includes cholelithiasis. There is not a clear consensus in how to treat an asymptomatic gallbladder disease before and after bariatric surgery. METHODS: Prospective study with every patient submitted to bariatric surgery from 2012 to 2014. The gallbladder status was assessed with an ultrasound before and after surgery (12 months), and a conservative management was conducted for patients with asymptomatic disease (preoperative and de novo); the need for delayed cholecystectomy was reported. Secondarily, an analysis of weight loss (%EWL) and gallbladder status was performed. RESULTS: Two-hundred and two bariatric surgeries were performed. The global incidence of preoperative gallbladder disease was 34.3 %, with 14.2 % presenting sludge, 20.1 % asymptomatic gallstones, and 2.3 % symptomatic gallstones. The final analysis was based on 146 patients; female sex comprised 81.1 % of cases with a mean age of 38.5 years. After 12 months, de novo gallbladder disease was observed in 21.2 %. The overall rate of cholecystectomy because of symptomatic disease after 12 months was 3.4 % (2 % developed acute cholecystitis). There were no differences in %EWL between patients with de novo gallbladder disease and those without. CONCLUSION: Conservative management of asymptomatic gallbladder disease in candidates to bariatric surgery is safe and can be offered in every case, based on the low percentage of patients requiring further cholecystectomy after 12 months. Also, a conservative management can be offered to patients developing de novo sludge/cholelithiasis without related symptoms.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Tratamento Conservador/métodos , Doenças da Vesícula Biliar/etiologia , Doenças da Vesícula Biliar/terapia , Obesidade Mórbida/cirurgia , Adulto , Doenças Assintomáticas , Cirurgia Bariátrica/estatística & dados numéricos , Colecistectomia/métodos , Colecistectomia/estatística & dados numéricos , Tratamento Conservador/estatística & dados numéricos , Feminino , Doenças da Vesícula Biliar/epidemiologia , Cálculos Biliares/epidemiologia , Cálculos Biliares/etiologia , Cálculos Biliares/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Período Pré-Operatório , Estudos ProspectivosRESUMO
Gallbladder disease is a highly prevalent disease in western countries as a consequence of several genetic, biochemical, and environmental factors. Females are a high risk group, and pregnancy increases this risk considerably. In fact, gallbladder diseases are the second most common indication for nonobstetric surgical intervention in pregnancy. In this review, we discuss the most important aspects of gallbladder disease and pregnancy as part of the Symposium on Liver and Pregnancy, co-sponsored by the Mexican Association of Hepatology and the Mexican Association of Gynecologists and Obstetrics.
Assuntos
Doenças da Vesícula Biliar , Complicações na Gravidez , Feminino , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/epidemiologia , Doenças da Vesícula Biliar/fisiopatologia , Doenças da Vesícula Biliar/terapia , Humanos , Gravidez , Fatores de RiscoRESUMO
En face d'une urgence de l'abdomen les gens de ma generation ne peuvent se retenir d'adresser une pensee emue à l'imperissable livre d'Henri Mondor, qui nous a marques autant par la precision de sa clinique que...(AU)
Assuntos
Doenças do Sistema Digestório , Emergências , Terapêutica Homeopática , Diarreia/terapia , Cólera/terapia , Dor Abdominal/terapia , Doenças da Vesícula Biliar/terapiaRESUMO
Le foie et la visicule biliaire representent un axe incontournable de la demarche therapeutique homeopathique. Le cadre trop vaste du sujet nous impose d'operer un choix, aussi eliminetons-nous ici, l'etude... (AU)
Assuntos
Hepatopatias/terapia , Drenagem , Matéria Médica Comparada , Doenças da Vesícula Biliar/terapiaRESUMO
OBJECTIVE: To analyze and compare our results with open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with cancer. DESIGN: Case-control study. SETTING: An oncologic referral center in Mexico City. PATIENTS: All patients with previous treatment for cancer and indication for cholecystectomy who where referred in a 60-month period. They were divided into two groups. Group OC with operation performed in the former 30 months and group LC with operation performed in the later 30 months. RESULTS: Lower morbidity and mortality rates and less hospital stay were found in group LC (55 cases) as compared with group OC (50 cases). Conversion rate in group LC was 14%. This rate is higher in patients with previous surgeries in upper abdomen. There were no differences in morbidity and mortality in patients with previous abdominal surgeries or with diabetes. Patients with liver cirrhosis in group OC had higher morbidity and mortality. CONCLUSIONS: LC can be performed safely in patients with history of cancer, laparotomy or abdominal radiation therapy and should be considered as first choice for symptomatic gallstones. LC should be considered also in diabetes and liver cirrhosis. When previous surgery in the upper abdomen is found we recommend to insert the first trocar under direct vision of peritoneal cavity. In this case conversion rate is high.
Assuntos
Colecistectomia , Doenças da Vesícula Biliar/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Doenças da Vesícula Biliar/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Se relatan dos pacientes quienes presentaron un cuadro clínico compatible con colelitiasis; y, en quienes el diagnóstico de ascariasis de la vesícula biliar fue hecho sonográficamente. En el primer paciente, la colecistectomía fue curativa, y corroboró la presencia del parásito. En el segundo paciente, se administró citrato de piperazina. Un segundo sonograma realizado después del tratamiento, no reveló dentro de la vesícula biliar; y el paciente permanece asintomático hasta ahora. Se pone énfasis en la utilidad que la ultrasonografía brinda en el diagnóstico de la ascariasis de la vesícula, y durante la vigilancia en aquellos pacientes quienes son manejados con terapia médica solamente
Assuntos
Humanos , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Ascaríase , Doenças da Vesícula Biliar , Ascaríase/terapia , Doenças da Vesícula Biliar/terapiaRESUMO
Se relatan dos pacientes quienes presentaron un cuadro clínico compatible con colelitiasis; y, en quienes el diagnóstico de ascariasis de la vesícula biliar fue hecho sonográficamente. En el primer paciente, la colecistectomía fue curativa, y corroboró la presencia del parásito. En el segundo paciente, se administró citrato de piperazina. Un segundo sonograma realizado después del tratamiento, no reveló dentro de la vesícula biliar; y el paciente permanece asintomático hasta ahora. Se pone énfasis en la utilidad que la ultrasonografía brinda en el diagnóstico de la ascariasis de la vesícula, y durante la vigilancia en aquellos pacientes quienes son manejados con terapia médica solamente (AU)
Assuntos
Humanos , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Ascaríase/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Ascaríase/terapia , Doenças da Vesícula Biliar/terapiaRESUMO
Two patients who complained of a clinical picture compatible with cholelithiasis; and in whom the diagnosis of ascariasis of the gallbladder was made sonographically, are reported. In the first patient, cholecystectomy was curative and corroborated the presence of the roundworm. In the second patient, piperazine citrate was given. A second sonogram performed after therapy showed no roundworm within the gallbladder; and the patient remains asymptomatic until now. The usefulness of ultrasonography in the diagnosis of gallbladder ascariasis, and during surveillance in those patients who are managed with medical therapy only, is emphasized.
Assuntos
Ascaríase/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Adulto , Ascaríase/terapia , Feminino , Doenças da Vesícula Biliar/terapia , Humanos , Pessoa de Meia-Idade , Gravidez , UltrassonografiaRESUMO
Se revisaron las historias clinicas de 153 pacientes operados en 1983 poe enfermedad vesicular; 61% eran mayores de 40 anos y las mujeres predominaron sobre los hombres en proporcion de 5:1. El sintoma y signo mas frecuente fue el dolor en el cuadrante superior derecho del abdomen. Hubo leucocitosis en 35% de los pacientes e ictericia en 15%. La colecistografia oral, solo, solo se practico a 50% de los enfermos y ecografia a 26.8%. Tenian colecistitis aguda, en sus difernetes formas de presentacion 45% de los pacienteas. A 3% se les extirpo la vesicula siendo normal. La colecistitis acalculosa aparecio en 9.2%. Los germenes mas comunmente aislados fueron Eschericha coli y Klebsiella pneumoniae. Tan solo se dejo un drenaje subhepatico en 5% de los casos. Hubo complicaciones post-operatorios en 13% y las mas frecuentes fueron: infeccion de la herida y litiasis desapercibida en el coledoco. La mortalidad fue 1.3%
Assuntos
Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Colecistite/terapia , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/terapia , Colecistite/complicações , Colecistite/mortalidade , Colômbia , Doenças da Vesícula Biliar/sangueRESUMO
This paper reports a study of cases seen at the University Hospital of the West Indies (U.H.W.I.) to determine the pattern of the disease in Jamaica. The notes were reviewed in regard to age and sex distribution, economic status and build of the patients and the course of the disease. The data are compared with that from North American centres. The results showed that 40 percent of patients were below the age of 40 years and 25 percent below the age of 30 years, as compared with 15 percent and 7 percent respectively from North American Centre. This age distribution was largely unaffected when patients with haemoglobinopathies were excluded. It was confirmed that the disease is one of affluence and overnutrition, in that most patients were obese. In spite of the fact that the vast majority of patients seen at U.H.W.I. are poor - 75 percent of patients with gall bladder disease came from middle and upper income brackets and from the urban areas. Of the poor patients with gall bladder disease 70 percent were domestics. The results of treatment showed that 40 percent of patients treated conservatively for acute cholecystitis required urgent imperative intervention for a variety of reasons. It is concluded that the disease is seen in a large proportion of young patients in Jamaica, that it is a disease of affluence and overnutrition, and that early operative intervention during an attack of acute cholecystitis is the best form of treatment (AU)