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Cholelithiasis in Home Parenteral Nutrition (Hpn) Patients – Complications of the Clinical Nutrition: Diagnosis, Treatment, Prevention

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Ławiński M., Jachnis A., Ukleja A., Pertkiewicz M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 3
111-115
EN
Long-term home parenteral nutrition (HPN) is an important factor for cholelithiasis. An individualized nutrition program, trophic enteral nutrition and ultrasound bile ducts monitoring is a necessity in those patients. The aim of the study was to evaluate the usefulness of prophylactic cholecystectomy in patients with asymptomatic cholelithiasis requiring HPN. Material and methods. 292 chronic HPN patients were analyzed in the period from 2005 to 2012. Patients were divided into four groups: A - without cholelithiasis, B - with asymptomatic cholelithiasis, C - urgent cholecystectomy because of cholecystisis caused by gallstones, D - cholecystectomy in patients without cholelithiasis performed during an operation to restore the continuity of the digestive tract. The patients were additionally divided depending on the extent of resection of the small intestine and colon. Results. 36.9% of chronic HPN patients had cholelithiasis confirmed using ultrasonographic examination. Cholecystectomy due to acute cholecystitis symptoms was performed in 14.4% of the patients. The remaining 22.6% patients had asymptomatic cholelithiasis. Prophylactic cholecystectomy was performed in 5.5% patients with no signs of cholelcystisis during the planned operation to restore the continuity of the digestive tract. Conclusions. Cholelithiasis in chronic HPN patients is a frequent phenomenon. It seems useful to perform prophylactic cholecystectomy during primary subtotal resection of the small intestine, because the risk of cholelithiasis in this group of patients is very high.
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Retroperitoneal abscess with retained gall-stones as a late complication of laparoscopic cholecystectomy

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Kamiński M., Nowicki M.
Polish Journal of Surgery
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2016
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vol. 88(1)
38-40
EN
Laparoscopic cholecystectomy is the golden standard, considering treatment of cholelithiasis. During the laparoscopic procedure one may often observe damage to the gall-bladder wall, as well as presence of gall-stones in the peritoneal cavity, as compared to classical surgery. These gall-stones may be associated with the occurrence of various complications following surgery. The study presented a rare case of a retroperitoneal abscess, as a consequence of retained gall-stones, in a female patient who was subject to laparoscopic cholecystectomy two years earlier.
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Reasons for Conversion of Laparoscopic Cholecystectomy - Evaluation of Risk Factors

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Ciesielczyk B., Cwaliński J., Janusz P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 4
202-208
EN
Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures. In spite of the progress in diagnostic methods and surgical techniques, some operations have to be converted into the laparotomy.The aim of the study was to analyse the reasons and determine predictive factors for conversion.Material and methods. The study was comprised of 765 patients were operated on with the laparoscopic procedure due to cholelithiasis in Franciszek Raszeia Hospital in Poznań from 1 January 1996 to 31 January 2007. Conversion was performed in 106 cases. Retrospective researches were based on descriptions of operations and case records. Statistical comparisons were performed by means of Mann-Withney, t-Student and Fisher tests (p<0.05).Results. The percentage of conversion was 13.85%. The following reasons for conversion were observed: uncertain anatomy 25.47%, dense adhesions 25.47%, inaccessible gall-bladder 9.43%, bleedings 9.43%, inflammatory-purulent lesions of the gallbladder 12.26%, lost gallstones 3.77%, bile leakage 3.77%, failed pneumoperitoneum 2.83%, suspicion of cancer 1.88%, anaesthetic difficulties 1.88, choledocholithiasis 1.88%, equipment failure 1.88%. The statistically significant risk factors for conversion were the following: operations performed by less experienced surgeons (p<0.0001), BMI≧30 (p<0.0001), results above the norm - AspAT (p=0.0288), AlAT (p=0.0013), bilirubin (p<0.0001), WBC (p<0.0001) and ultrasound results - thickened gallbladder wall (p<0.0001), gall-bladder bigger than 10 cm (p=0.0762), hyperechogenic bile (p=0.0003). Conversions were performed more often in the case of men (p=0.0001), people aged over 50 years (p=0.0001) and illness duration over 5 years (p=0.0007). Early postoperative complications occurred in 7 cases (0.91%). Late postoperative complications occurred in three patients (0.39%).Conclusions. A preoperative analysis of risk factors enables selection of a group of patients with higher probability of conversion during the laparoscopic cholecystectomy. A higher number of conversions decreases the number of complications after a laparoscopic cholecystectomy.
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Need Assessment for Gastroscopy in Patients with Gall-Stones

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Bartosz K., Głuszek S.
Polish Journal of Surgery
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2010
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vol. 82
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issue 8
469-478
EN
Cholelithiasis (gall-stones) occurs in 13% of the Polish population. Patients affected with gall-stones notify non-specific symptoms caused by pathology of the upper segment of the digestive track which coexists with gall-stones.The aim of the study was to analyze the risk of occurrence of pathological changes, within the part of the digestive track in patients affected with gall-stones, to assess the correlation between data of medical histories of patients and results of gastroscopy based diagnosis; to devise tactics of alterations to the planned measures in case a clinically significant disease has been diagnosed.Material and methods. The study group comprised 615 patients, qualified for cholecystectomy, with symptomatic gall-stones, verified by an ultrasound diagnosis. After being interviewed and examined, all the patients were subjected to gastroscopy, and when necessary biopsy was performed. The statistical analysis was performed using an multifactorial analysis (Pearson's correlation coefficient for categorical variables).Results. Among 615 patients, the subjects in the study, we found 183 ones (29.7%) with a normal upper digestive tract, we found pathology of the upper digestive system in 70.3% cases (432 patients). Serious pathology resulting in changing the planned treatment was found in 83 patients (13.5%): among those four ones had gastric carcinoma, sixty-three ones suffering from chronic peptic ulcer disease (gastric or/and duodenal), twelve patients were affected with hemorrhagic gastritis, four patients had GERD C and D. In a group of 83 patients cholocystectomy was postponed and the diagnosed disease was treated. Four patients were operated on because of gastric cancer, with intention of cure.Conclusions. 1. Routine gastroscopy performed before cholecystectomy is justified. The percentage of abnormalities diagnosed during gastroscopy proved the above mentioned thesis. 2. Medical histories and an object examination do not allow to state explicitly that there is another disease of the upper part of the digestive system which coexists with gall-stones. In case of diagnosing the other pathology it is necessary to take into consideration an alteration of tactics of management: to delay an operation and treat the other disease which has been diagnosed.
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