Search results

1

Surgical treatment of acute cholecystitis in obese patients

100%

Kebkalo A., Tkachuk O., Reyti A., Chanturidze A., Pashunskyi Y.

Polish Journal of Surgery

|

2020

|

vol. 92(5)

37-42

EN

Introduction: In today’s technological climate, science and medicine have entered a new era. At the level of technological progress, we have identified millennia of “new” problems and diseases. If earlier diseases had a certain individuality then, in the third millennium, we face compliance and synergistic influence of diseases. Obesity is a problem of the third millennium. It is known that obesity is the main factor in the development of various chronic diseases [1–3]. With excess weight and obesity, bile is oversaturated with cholesterol, resulting in an increase of its lipogenicity index. As a result, frequency of gallstone disease increases; findings from this study document an increase of disease frequency as high as 50% to 60% [4]. In 20% of patients, housing concerns are combined with obesity [5]. Thus, obesity is one of the factors in the development of cholelithiasis and cholecystitis [6]. The presence of acute cholecystitis represents the most difficult situation for patients with gallstones. When obesity is also present, the patient’s risk of surgical complications increases due to altered homeostasis and reduced reserve capacity [7]. A retrospective study of this issue [8] posed a number of questions about the possibility of influencing the course of disease in the preoperative period as well as the improvement and impact of surgical technicalities in patients with acute cholecystitis and obesity. Addressing these and additional questions is the main goal of this study. Aim: The aim of the study was to study and select the optimal method of surgery in patients with acute cholecystitis and obesity. Materials and methods: In our study, a prospective analysis was used. We analyzed 67 cases with diagnosis of acute cholecystitis and obesity; all were treated at Kyiv Regional Clinical Hospital in the period from September 2018 to March 2020. Patients with acute cholecystitis and obesity received either traditional or modified laparoscopic cholecystectomy. Results: Retrospective analysis indicates traditional laparoscopic cholecystectomy is technically difficult and costly in patients with acute cholecystitis and obesity. A modified laparoscopic cholecystectomy has been proposed to improve and enhance surgery in patients with acute cholecystitis and obesity. Surgical duration was shortened by 9.01 ± 0.41 minutes (p = 0.001; αα= 0.05) when a modified laparoscopic cholecystectomy was performed. Conclusions: Performing a modified laparoscopic cholecystectomy reduced the duration of surgery by 9.01 ± 0.41 minutes (p = 0.001; α = 0.05), prevents development of metabolic acidosis pH 7.39 ± 0.03 vs 7.30 ± 0.005 = 0.001; αα= 0.05, pCO2 5.05 ± 0.36 vs 6.03 ± 0.38 (p = 0.02; αα= 0.05), reducing the risk of hypercoagulation. Modified laparoscopic cholecystectomy (LHE) is effective in II and III degrees of obesity (p = 0.001; α = 0.05).

2

Duodenal diverticulum perforation mimicking acute cholecystitis- case reports and literature review

100%

Łącka M., Hać S.

European Journal of Translational and Clinical Medicine

|

2022

|

vol. 5

|

issue 1

64-70

EN

Background Duodenal diverticula affect a large part of the population. It is a congenital abnormality that develops over time. The incidence of duodenal diverticulum is estimated at 22% of the population in autopsies. Only 5% of patients present symptoms, and of those only 1%–2% require surgery.Material and methodsTwo patients are described who underwent surgery due to duodenal diverticulum perforation mimicking acute cholecystitis.ResultsPerforation of the duodenal diverticulum, combined the difficulty of treatment and potential for complications, is a disease with a high mortality rate. It is subtle and difficult to diagnose due to the lack of generalized peritonitis and unspecific symptoms. The rarity and the wide spectrum of the disease, in combination with additional factors to be considered in treating this disease, mean there is no standard treatment. Depending on the patient's general condition, disease advancement, age and pathological findings observable only during surgery, we can choose between conservative treatment and a wide spectrum of surgeries.ConclusionsDuodenal diverticular disease rarely gives any symptoms. However, even after the onset of symptoms, only 1-2% of patients require surgery. Our work is unique because we present two cases, each featuring different approaches - conservative and surgical.

3

Gender as a predictive factor in cholecystectomy — is it true or false?

75%

Osuch C., Dolecki M., Rogula W. P., Łapiak A., Matyja M., Czerwińska A., Rubinkiewicz M., Matyja A., Osuch C., Dolecki M., Rogula W. P., Łapiak A., Matyja M., Czerwińska A., Rubinkiewicz M., Matyja A.

Folia Medica Cracoviensia

|

2020

|

vol. 60

|

issue 2

4

Znaczenie ultrasonografii przy wyborze metody leczenia ostrego zapalenia pęcherzyka żółciowego

63%

Ćwik G., Wyroślak-Najs J., Skoczylas T., Wallner G.

|

issue 54

282-292

EN

Surgical removal of the gallbladder is indicated in nearly all cases of complicated acute cholecystitis. In the 1990s, laparoscopic cholecystectomy became the method of choice in the treatment of cholecystolithiasis. Due to a large inflammatory reaction in the course of acute inflammation, a laparoscopic procedure is conducted in technically difficult conditions and entails the risk of complications. The aim of this paper was: 1) to analyze ultrasound images in acute cholecystitis; 2) to specify the most common causes of conversion from the laparoscopic method to open laparotomy; 3) to determine the degree to which the necessity for such a conversion may be predicted with the help of ultrasound examinations. Material and methods: In 1993–2011, in the Second Department and Clinic of General, Gastroenterological and Oncological Surgery of the Medical University in Lublin, 5,596 cholecystectomies were performed including 4,105 laparoscopic procedures that constituted 73.4% of all cholecystectomies. Five hundred and forty-two patients (13.2%) were qualified for laparoscopic procedure despite manifesting typical symptoms of acute cholecystitis in ultrasound examination, which comprise: thickening of the gallbladder wall of > 3 mm, inflammatory infiltration in the Calot’s triangle region, gallbladder filled with stagnated or purulent contents and mural or intramural effusion. Results: In the group of operated patients, the conversion was necessary in 130 patients, i.e. in 24% of cases in comparison with 3.8% of patients with uncomplicated cholecystolithiasis (without the signs of inflammation). The conversion most frequently occurred when the assessment of the anatomical structures of the Calot’s triangle was rendered more difficult due to local inflammatory process, mural effusion and thickening of the gallbladder wall of >5 mm. The remaining changes occurred more rarely. Conclusions: Based on imaging scans, the most common causes of conversion included inflammatory infiltration in the Calot’s triangle region, mural effusion and wall thickening to > 5 mm. The classical cholecystectomy in acute cholecystitis should be performed in patients with three major local complications detected on ultrasound examination and in those, who manifest acute clinical symptoms.

PL

Operacyjne usunięcie pęcherzyka żółciowego jest wskazane praktycznie we wszystkich przypadkach powikłanego, ostrego zapalenia pęcherzyka żółciowego. W latach dziewięćdziesiątych metodą z wyboru w leczeniu objawowej kamicy pęcherzyka żółciowego stała się cholecystektomia laparoskopowa. Z uwagi na duży odczyn zapalny w przebiegu ostrego stanu zapalnego zabieg laparoskopowy jest przeprowadzany w trudnych technicznie warunkach i wiąże się z ryzykiem wystąpienia powikłań. Celem pracy były: 1) analiza obrazów ultrasonograficznych przypadków ostrego zapalenia pęcherzyka żółciowego; 2) ustalenie najczęstszych przyczyn konwersji z metody laparoskopowej do otwartej laparotomii; 3) określenie, w jakim stopniu za pomocą badania ultrasonograficznego można przewidzieć potrzebę konwersji. Materiał i metoda: W latach 1993–2011 w II Klinice i Katedrze Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego UM w Lublinie wykonano 5596 cholecystektomii, w tym 4105 zabiegów laparoskopowych, co stanowiło 73,4% wszystkich przeprowadzonych cholecystektomii. Pomimo typowych objawów ostrego zapalenia pęcherzyka w badaniu ultrasonograficznym, do których zaliczamy pogrubienie ściany pęcherzyka > 3 mm, naciek zapalny okolicy trójkąta Calota, wypełnienie pęcherzyka treścią zastoinową lub ropną, wysięk śródścienny lub przyścienny, 542 chorych (13,2%) zakwalifikowano do leczenia metodą laparoskopową. Wyniki: W grupie pacjentów operowanych konwersja była konieczna u 130 osób – w 24% przypadków w porównaniu z 3,8% chorych z niepowikłaną kamicą pęcherzyka żółciowego (bez cech zapalnych). Konwersji dokonywano najczęściej w przypadkach utrudnionej oceny struktur anatomicznych trójkąta Calota, wynikającej z miejscowego stanu zapalnego, wysięku przyściennego oraz pogrubienia ściany >5 mm. Pozostałe zmiany występowały rzadziej. Wnioski: Do najczęstszych przyczyn konwersji w badaniach obrazowych należały: zapalny naciek okolicy trójkąta Calota, wysięk przyścienny i pogrubienie ściany > 5 mm. Do cholecystektomii klasycznej w ostrym zapaleniu pęcherzyka żółciowego powinni być kwalifikowani pacjenci, u których w badaniu ultrasonograficznym stwierdza się trzy główne powikłania miejscowe oraz u których występują ostre objawy kliniczne.

Refine search results

1 European Journal of Translational and Clinical Medicine

1 Folia Medica Cracoviensia

1 Journal of Ultrasonography

1 Polish Journal of Surgery

1 2022

2 2020

1 2013

1 Chanturidze A.

1 Czerwińska A.

1 Dolecki M.

1 Hać S.

1 Kebkalo A.

1 Matyja A.

1 Matyja M.

1 Osuch C.

1 Pashunskyi Y.

1 Reyti A.

1 Rogula W. P.

1 Rubinkiewicz M.

1 Skoczylas T.

1 Tkachuk O.

1 Wallner G.

1 Wyroślak-Najs J.

1 Ćwik G.

1 Łapiak A.

1 Łącka M.

Surgical treatment of acute cholecystitis in obese patients

Duodenal diverticulum perforation mimicking acute cholecystitis- case reports and literature review

Gender as a predictive factor in cholecystectomy — is it true or false?

Znaczenie ultrasonografii przy wyborze metody leczenia ostrego zapalenia pęcherzyka żółciowego