Association between the risk of increase in total cholesterol and the risk of cholelithiasis： A bidirectional Mendelian randomization study / 临床肝胆病杂志

ObjectiveTo investigate the association between the risk of increase in total cholesterol （TC） and the risk of cholelithiasis by using bidirectional Mendelian randomization （MR）. MethodsThe open gwas public database was used to obtain the single nucleotide polymorphism data associated with TC and cholelithiasis， and a secondary data analysis was performed for all summary data of genome-wide association studies. The genetic loci closely associated with TC or cholelithiasis were selected as exposure or outcome variables， and the bidirectional MR analysis was performed using the methods such as Egger regression， Weighted median， IVW random effects model， and IVW fixed effects model， with odds ratio （OR） values for evaluating the causal relationship between TC and cholelithiasis. ResultsWith TC as the exposure and cholelithiasis as the outcome， TC-cholelithiasis had an overall OR value of 0.91 （95% confidence interval ［CI］： 0.85‍ ‍—‍ ‍0.97） before elimination of heterogeneity and 0.93 （95%CI： 0.89‍ ‍—‍ ‍0.97） after elimination of heterogeneity. With cholelithiasis as the exposure and TC as the outcome， TC-cholelithiasis had an overall OR value of 0.20 （95%CI： 0.06‍ ‍—‍ ‍0.65） before elimination of heterogeneity and 0.28 （95%CI： 0.10‍ ‍—‍ ‍0.83） after elimination of heterogeneity. There was a bidirectional causal relationship between genetically predicted TC and cholelithiasis. ConclusionThis study confirms the bidirectional causal relationship between TC and cholelithiasis. The risk of cholelithiasis decreases with the increase in alleles associated with the elevation of TC level； on the contrary， the risk of elevated TC level decreases with the increase in alleles associated with the onset of cholelithiasis.

Colecistectomía con exploración de vías biliares laparoscópica en paciente con situs inversus totalis

Se presenta el caso de un paciente varón de 77 años con diagnóstico de colecistitis crónica calculosa y coledocolitiasis, con antecedente de situs inversus totalis. Se le realizó una colecistectomía con exploración de vías biliares laparoscópica, utilizando la "técnica francesa en espejo", con extracción de los cálculos. El paciente evolucionó favorablemente. El objetivo del presente trabajo es dar a conocer el caso clínico que es poco frecuente su reporte en la literatura mundial (solo 9 casos). Su importancia radica en que sería el primer reporte de caso clínico publicado de una colecistectomía y exploración de vías biliares laparoscópica con retiro del cálculo en colédoco en un paciente con situs inversus totalis, realizado en el Perú.

We present the case of a 77-year-old male patient with a diagnosis of chronic calculous cholecystitis and choledocholithiasis, with a history of situs inversus totalis. Therefore, a laparoscopic cholecystectomy with common bile duct exploration were performed, using the "french mirror technique", with stone extraction. Patient evolved favorably. The aim of this study is to present this clinical case that is rarely reported in the world literature (only 9 cases). Its importance lies in the fact that it would be the first published clinical case report of a laparoscopic cholecystectomy and bile duct exploration with removal of the common bile duct stones in a patient with situs inversus totalis, performed in Peru.

Íleo biliar: descripción de dos casos / Gallstone ileus: Description of two cases

Introducción. El íleo biliar es una complicación rara de la colelitiasis y su incidencia varía del 1 al 4 %. Consiste en la migración de un cálculo de la vesicular biliar al tracto gastrointestinal, generando obstrucción intestinal. Presenta síntomas inespecíficos dependiendo del nivel de la obstrucción, lo que hace que su diagnóstico no suela ser precoz, repercutiendo en el deterioro clínico del paciente. Es especialmente grave en pacientes de edad avanzada y con comorbilidades. Casos clínicos. Se reportan los casos de dos pacientes con dolor abdominal difuso, en quienes se diagnosticó íleo biliar por tomografía. Se realizó manejo quirúrgico, el primero mediante técnica abierta y estrategia de dos pasos, y el otro mediante técnica laparoscópica. Discusión. El íleo biliar es una etiología rara de obstrucción intestinal. El cálculo migra debido a una fistula colecisto-entérica y el nivel de obstrucción es con mayor frecuencia la válvula ileocecal. Los síntomas son inespecíficos y dependen del nivel de obstrucción: dolor abdominal difuso mal caracterizado, náuseas, vómito, ausencia de flatos. El diagnóstico se hace mediante tomografía abdominal, en la cual se evidencia la tríada de Rigler. El manejo es quirúrgico, con enterotomía para extraer el cálculo y resolver la obstrucción. Conclusión. El íleo biliar es una patología que debe ser considerada en el abordaje de la obstrucción intestinal, aunque sea poco frecuente. El manejo quirúrgico es clave para resolver el cuadro de obstrucción intestinal; aún así genera importante morbimortalidad en especial en pacientes de avanzada edad.

Introduction. Gallstone ileus is a rare complication of cholelithiasis, its incidence varies from 1% to 4%. It consists of the migration of a stone from the gallbladder to the gastrointestinal tract, causing intestinal obstruction. It presents with non-specific symptoms depending on the level of the obstruction, which means that its diagnosis is not usually early, with repercussions on the clinical deterioration of the patient, being serious especially in elderly patients and with comorbidities. Clinical cases. Two patients with diffuse abdominal pain are reported. A tomographic diagnosis was made showing gallstone ileus. Surgeries were performed, in the first case using an open technique and a 2-step strategy, and on the second one using a laparoscopic technique. Discussion. Gallstone ileus is a rare etiology of intestinal obstruction. Symptoms are usually poorly characterized: diffuse abdominal pain, nausea, vomiting, absence of flatus. The diagnosis is made by abdominal tomography in which Rigler's triad is evident. Management is surgical through enterotomy to remove the stone and resolve the obstruction. Conclusion. Gallstone ileus is a rare pathology that should be considered in the approach to intestinal obstruction. Surgical management is key to resolving intestinal obstruction. Even so, it generates significant morbidity and mortality, especially in elderly patients.

Factores asociados con la conversión a técnica abierta en la colecistectomía laparoscópica / Factors associated with conversion to open technique in laparoscopic cholecystectomy

Introducción. La colecistectomía laparoscópica es el estándar de oro para el manejo de la patología de la vesícula biliar con indicación quirúrgica. Durante su ejecución existe un grupo de pacientes que podrían requerir conversión a técnica abierta. Este estudio evaluó factores perioperatorios asociados a la conversión en la Clínica Central OHL en Montería, Colombia. Métodos. Estudio observacional analítico de casos y controles anidado a una cohorte retrospectiva entre 2018 y 2021, en una relación de 1:3 casos/controles, nivel de confianza 95 % y una potencia del 90 %. Se caracterizó la población de estudio y se evaluaron las asociaciones según la naturaleza de las variables, luego por análisis bivariado y multivariado se estimaron los OR, con sus IC95%, considerando significativo un valor de p<0,05, controlando variables de confusión. Resultados. El estudio incluyó 332 pacientes, 83 casos y 249 controles, mostrando en el modelo multivariado que las variables más fuertemente asociadas con la conversión fueron: la experiencia del cirujano (p=0,001), la obesidad (p=0,036), engrosamiento de la pared de la vesícula biliar en la ecografía (p=0,011) y un mayor puntaje en la clasificación de Parkland (p<0,001). Conclusión. La identificación temprana y análisis individual de los factores perioperatorios de riesgo a conversión en la planeación de la colecistectomía laparoscópica podría definir qué pacientes se encuentran expuestos y cuáles podrían beneficiarse de un abordaje mínimamente invasivo, en búsqueda de toma de decisiones adecuadas, seguras y costo-efectivas

Introduction. Laparoscopic cholecystectomy is the gold standard for the management of gallbladder pathology with surgical indication. During its execution, there is a group of patients who may require conversion to the open technique. This study evaluated perioperative factors associated with conversion at the OHL Central Clinic in Montería, Colombia. Methods. Observational analytical case-control study nested in a retrospective cohort between 2018 and 2021, in a 1:3 case/control ratio, 95% confidence level and 90% power. The study population was characterized and the associations were evaluated according to the nature of the variables, then the OR were estimated by bivariate and multivariate analysis, with their 95% CI, considering a value of p<0.05 significant, controlling for confounding variables. Results. The study included 332 patients, 83 cases and 249 controls, showing in the multivariate model that the variables most strongly associated with conversion were: the surgeon's experience (p=0.001), obesity (p=0.036), gallbladder wall thickening on ultrasonography (p=0.011), and a higher score in the Parkland classification (p<0.001). Conclusions. Early identification and individual analysis of the perioperative risk factors for conversion in the planning of laparoscopic cholecystectomy could define which patients are exposed, and which could benefit from a minimally invasive approach, in search of making safe, cost-effective, and appropriate decisions

Unusually large number of gall stones removed through laparoscopic cholecystectomy from a single patient- A case report

Gallstone disease is characterized by the formation of calculi in the gall bladder or the biliary tract. It may be asymptomatic or present as biliary colic or with complicated disease. Laparoscopic cholecystectomy is the mainstay of treatment for symptomatic gall stones. We describe a case of Gallstone disease in a 43-year-old female, where over seven thousand stones were removed through a Laparoscopic procedure. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Helicobacter pylori e as doenças hepatobiliares: atualização 2023 / Helicobacter and hepatobiliary diseases: update 2023

ABSTRACT Helicobacter Pylori (H. pylori) is one of the main infectious causes of gastroduodenal diseases, however, its role in developing different extragastric diseases has been proven. The possible involvement of H. pylori in the pathogenesis of cardiovascular, metabolic, neurodegenerative, skin, and hepatobiliary diseases is suggested. The bacterium has been found in tissue samples from the liver, biliary tract, and gallstones of animals and humans. However, the role of H. pylori infection in the pathogenesis of liver and biliary diseases has not been finally established. The histopathological confirmation of the positive effect of H. pylori eradication is needed. In addition, there are discussions on the clinical significance of other Helicobacter species. The review presents the data available for and against the involvement of H. pylori in hepatobi­liary disease development and progression.

RESUMO Helicobacter pylori (H. pylori) é uma das principais causas infecciosas de doenças gastroduodenais, no entanto, seu papel no desenvolvimento de diferentes doenças extragástricas tem sido comprovado. Sugere-se o possível envolvimento do H. pylori na patogênese de doenças cardiovasculares, metabólicas, neurodegenerativas, cutâneas e hepatobiliares. A bactéria tem sido encontrada em amostras de tecido do fígado, trato biliar e cálculos biliares de animais e humanos. No entanto, o papel da infecção por H. pylori na patogênese de doenças do fígado e das vias biliares ainda não foi estabelecido definitivamente. A confirmação histopatológica do efeito positivo da erradicação do H. pylori é necessária. Além disso, existem discussões sobre a importância clínica de outras espécies de Helicobacter. A revisão apresenta os dados disponíveis a favor e contra o envolvimento do H. pylori no desenvolvimento e progressão das doenças hepatobiliares.

Íleo biliar, causa no habitual de oclusión intestinal

El íleo biliar es una rara complicación de la litiasis vesicular, que se comporta como un cuadro de obstrucción intestinal mecánica, cuya causa es la impactación de uno o más cálculos biliares en su luz. Es evidente que, por lo infrecuente de esta entidad en los servicios quirúrgicos, el diagnóstico de la misma es demorado o no se realiza, incidiendo en la evolución del paciente de manera desfavorable. El objetivo de este trabajo es considerar que un diagnóstico precoz del íleo biliar -basado en el análisis de los antecedentes del enfermo, las manifestaciones clínicas y la interpretación correcta en busca de los signos de la tríada de Rigler- permite una mejor evolución de los pacientes. Los estudios imagenológicos y su interpretación son fundamentales en el diagnóstico de esta entidad.

Biliary ileus is a rare complication of gallbladder lithiasis, which behaves like a mechanic intestinal obstruction, the cause of which is the impaction of one or more gallstones in its lumen. It is evident that because of the infrequency of this entity in the surgical services, its diagnosis is delayed or not carried out, affecting the patient's evolution in an unfavorable way. The aim of this paper is to consider that a precocious diagnosis of biliary ileus-based on the analysis of the patient's history, the clinical manifestations and correct interpretation in search of the signs of Rigler's triad-allows a better evolution of patients. Imaging studies and their interpretation are fundamental in the diagnosis of this entity.

Colecistectomía laparoscópica en una paciente con situs inversus totalis. Reporte de un caso y revisión de la literatura

Introducción: El situs inversus totalis es una condición congénita en la cual los órganos torácicos y abdominales se encuentran en posición contraria a la posición habitual. En la literatura quirúrgica internacional se encuentran publicados no más de 55 casos de colecistectomía en pacientes con situs inversus totalis. La resolución laparoscópica de una paciente en nuestra Institución nos permite revisar esta particular condición patológica. Caso Clínico: Paciente femenino de 43 años de edad hospitalizada por una colecistitis aguda la cual es resuelta por vía laparoscópica sin incidentes. Material y Método: Se resume la literatura actual mediante una extensa revisión en PubMed de los reportes más relevantes. Considerando que todos los artículos publicados son casos clínicos o pequeñas series de casos, se presentan los resultados de esta revisión en tablas con estadística descriptiva básica. Discusión: Se discuten las características generales de estos pacientes, la presentación clínica, diagnóstico y técnica quirúrgica. Conclusión: La colecistectomía laparoscópica constituye el estándar de oro en pacientes con situs inversus y patología biliar, la cual debe ser realizada por un cirujano experimentado acomodando los trocares apropiadamente, debido a las dificultades técnicas que se encuentran en estos pacientes por las anomalías anatómicas propias de esta condición. El diagnóstico radiológico actual permite la planificación del abordaje y del procedimiento quirúrgico apropiado para cada paciente.

Introduction: Situs inversus totalis is a congenital condition in which the thoracic and abdominal organs are in the opposite position from normal anatomy. We found no more than 55 cases of cholecystectomy in patients with situs inversus totalis published in the international surgical literature. The laparoscopic resolution of a patient in our Institution allows us to review this particular pathological condition. Clinical Case: A 43-year-old female patient was admitted for acute cholecystitis and was resolved laparoscopically without any incidents. Material and Method: We summarized the current literature through an extensive PubMed review of the most relevant reports. Considering that all published articles are clinical cases or small case series, we present the results of this review in a table with basic descriptive statistics. Discussion: We discuss the general characteristics of these patients, clinical presentation, diagnosis, and surgical technique. Conclusions: Laparoscopic cholecystectomy is the gold standard in patients with situs inversus and biliary pathology, which must be performed by an experienced surgeon, properly accommodating the trocars due to the technical difficulties in these patients secondary to anatomical anomalies typical of this condition. Current radiological diagnosis allows planning the appropriate approach and surgical procedure for each patient.

Duración de la antibioticoterapia en pacientes con colecistitis aguda manejados con colecistostomía. ¿Afecta los desenlaces clínicos? / Duration of antibiotic therapy in patients with acute cholecystitis managed with cholecystostomy. Does it affect clinical outcomes?

Introducción. En pacientes con diagnóstico de colecistitis aguda tratados con colecistostomía, el tiempo óptimo de duración de la terapia antibiótica es desconocido. El objetivo de este trabajo fue comparar los resultados clínicos en pacientes con diagnóstico de colecistitis aguda manejados inicialmente con colecistostomía y que recibieron cursos cortos de antibióticos (7 días o menos) versus cursos largos (más de 7 días). Métodos. Se llevó a cabo un estudio de cohorte observacional, retrospectivo, que incluyó pacientes con diagnóstico de colecistitis aguda manejados con colecistostomía, que recibieron tratamiento antibiótico. Se hizo un análisis univariado y de regresión logística para evaluar la asociación de variables clínicas con la duración del tratamiento antibiótico. El desenlace primario por evaluar fue la mortalidad a 30 días. Resultados. Se incluyeron 72 pacientes. El 25 % (n=18) recibieron terapia antibiótica por 7 días o menos y el 75 % (n=54) recibieron más de 7 días. No hubo diferencias significativas en la mortalidad a 30 días entre los dos grupos ni en las demás variables estudiadas. La duración de la antibioticoterapia no influyó en la mortalidad a 30 días (OR 0,956; IC95% 0,797 - 1,146). Conclusión. No hay diferencias significativas en los desenlaces clínicos de los pacientes con colecistitis aguda que son sometidos a colecistostomía y que reciben cursos cortos de antibióticos en comparación con cursos largos

Introduction.In patients with acute cholecystitis who receive treatment with cholecystostomy, the optimal duration of antibiotic therapy is unknown. The objective of this study is to compare short courses of antibiotics (7 days or less) with long courses (more than 7 days) in this population. Methods. We performed a retrospective observational cohort study which included patients diagnosed with acute cholecystitis, who received antibiotic therapy and were taken to cholecystostomy. Univariate analysis and logistic regression were performed to evaluate the association between clinical variables and the duration. The main outcome evaluated was 30-day mortality. Results. Seventy-two patients were included, 25% (n=18) were given 7 or fewer days of antibiotics while 75% (n=54) were given them for more than 7 days. Demographic data between both groups were similar (age, severity of cholecystitis, comorbidities). There were no significant differences in 30-day mortality between both groups. Antibiotic duration did not influence mortality at 30 days (OR 0.956, 95% CI 0.797 - 1.146). Conclusion. There are no significant differences in the clinical outcomes of patients with acute cholecystitis who undergo cholecystostomy and receive short courses of antibiotics compared to long courses

Presiones de la vía biliar en pacientes con y sin colelitiasis

Introducción: El reflujo de enzimas pancreáticas hacia la vía biliar extra-hepática y la vesícula biliar es un fenómeno anormal que tiene un rol en la litogénesis y carcinogénesis. Debido a que la presión de la vía biliar depende entre otros factores, de las presiones del esfínter de Oddi. La disfunción de éste se vería reflejada en presiones elevadas de la vía biliar en pacientes con colelitiasis. Objetivo: El objetivo de este estudio es el de medir las presiones de la vía biliar extra-hepática en pacientes con y sin colelitiasis y relacionarlas con la presencia de reflujo pancreáticobiliar. Material y Método: Se diseñó un estudio pros-pectivo de casos y controles. La muestra está constituida por todos los pacientes operados con gastrectomía total por cáncer gástrico estadios I y II durante 30 meses. La medida de resultado primaria fue establecer diferencias en las presiones de la vía biliar entre pacientes con y sin colelitiasis. Resultados: Las presiones de la vía biliar extra-hepática en pacientes con colelitiasis fueron más elevadas (16,9 mmHg) que en los pacientes sin colelitiasis (3,3 mmHg) (p < 0,0001). Estas presiones se correlacionan con la presencia de amilasa y lipasa en la bilis de la vesícula; se encontraron niveles elevados de enzimas pancreáticas en pacientes con colelitiasis (p < 0,0001). Conclusiones: Las presiones de la vía biliar en pacientes con colelitiasis fueron, significativamente, mayores comparadas con las presiones de la vía biliar en pacientes sin colelitiasis. En los pacientes con colelitiasis, la presión elevada de la vía biliar se asocia a la presencia de reflujo pancreáticobiliar.

Background: The reflux of pancreatic enzymes into the bile duct and the gallbladder is an abnormal phenomenon that plays a role in lithogenesis and carcinogenesis. Because the pressure of the common bile duct depends on the pressures of the sphincter of Oddi, its dysfunction would be reflected in an increase in the pressure of the common bile duct in patients with cholelithiasis. Aim: The objective of this study was to measure the pressures of the common bile duct in patients with and without cholelithiasis and to relate them to the presence of pancreatobiliary reflux. Material and Method: A prospective case-control study was designed. The universe was constituted by all patients undergoing total gastrectomy for gastric cancer stages I and II during 30 months. The primary outcome measure was to establish differences between common bile duct pressures in patients with and without cholelithiasis. Results: Common bile duct pressures in patients with gallstones showed a significant elevation (16.9 mmHg) compared to patients without gallstones (3.3 mm Hg) (p < 0.0001). These pressures correlated with the levels of amylase and lipase in gallbladder bile; higher levels were found in patients with gallstones compared to patients without gallstones (p < 0.0001). Conclusions: Common bile duct pressure in patients with cholelithiasis was significantly higher compared to patients without cholelithiasis leading to pancreatobiliary reflux.

HISTOMORPHOLOGICAL STUDY OF CHOLECYSTECTOMIES IN A TERITIARY CARE CENTER

Introduction: Cholecystectomy is the most common surgical procedure performed for cholelithiasis (gall stones). Cholelithiasis is one of the most common gastro intestinal disorder worldwide. Usually asymptomatic, but commonly encountered symptoms may be right upper quadrant pain, dyspepsia and belching. The incidence of cholelithiasis is 2-4 times more in women than in men. The aim of the present study is to identify various morphological patterns and frequency of gall bladder lesions in cholecystectomy specimens. The Materials And Methods: present study was a cross sectional descriptive study of all cholecystectomy specimens received in the department of pathology, NRI Institute of Medical Sciences, Sangivalasa, Visakhapatnam, Andhra Pradesh; conducted over a period of 12 months from September 2021 to August 2022. The relevant and detailed clinical history were taken and processing was done in these specimens for histopathological examination. A total of 80 cholecystectomy specimens were received in the Results: department. Out of which, 79 were in?ammatory gall bladder lesions and only one case was reported as malignancy. The most common age group affected were in 4th to 5th decade with female preponderance comprising of 47cases (58.75%) while the gall bladder carcinoma was reported in 72 years of age. Among the in?ammatory lesions, most common one was chronic cholecystitis comprising of 64 cases, 80.5% (63.6% associated with gall stones) were chronic cholecystitis, followed by 10 cases (12.5%) of acute cholecystitis (100% associated with gall stones), 2cases (2.5%) of polyps & Adenomyomatosis each. Only one case (1.25%) of each Cholesterolosis & gall bladder adenocarcinoma was reported. Chronic cholecystitis is the Conclusion: most common gall bladder disease for which cholecystectomies are being done. The present had reported various morphological patterns encountered in the cholecystectomy specimens received in the department

A brief introduction of Evidence-based clinical practice guidelines for cholelithiasis 2021 by the Japanese Society of Gastroenterology / 临床肝胆病杂志

‍The Japanese Society of Gastroenterology （JSGE） first published evidence-based clinical practice guidelines for cholelithiasis in 2010， followed by a revision in 2016. In April 2023， JSGE published the 2021 edition of evidence-based clinical practice guidelines for cholelithiasis based on the clinical issues associated with cholelithiasis in the databases such as Medline， Cochrane， and Igaku Chuo Zasshi and the latest evidence in literature published in the past five years. The revised edition reviews related clinical questions in the previous edition from the aspects of the epidemiology， pathogenesis， diagnosis， treatment， prognosis， and complications of cholelithiasis and reclassifies them into three categories， with 52 questions in total， among which there are 29 background questions dealing with basic background knowledge， 19 clinical questions， and 4 future research questions requiring further accumulation of evidence， thereby providing guidance for decision making in the clinical management of patients with cholelithiasis.

Preclinical evaluation of Hibiscus cannabinus Linn. in the treatment of urolithiasis and cholelithiasis / 数字中医药（英文）

@#【Objective】  To investigate the therapeutic effect of Hibiscus cannabinus Linn. (H. cannabinus) leaves on cholelithiasis and urolithiasis. 【Methods】  The study evaluated the effect of aqueous leaf extract of H. cannabinus on thiouracil and cholesterol cholic acid diet induced cholelithiasis in BALB/c mice and ethylene glycol induced urolithiasis in Wistar rats. Three doses of aqueous extract (40, 80, and 160 mg/kg) were selected to evaluate the effectiveness in cholelithiasis in mice; another three doses of aqueous extract (400, 800, and 1 600 mg/kg) were administered for evaluating the effect on urolithiasis in rats. Biochemical parameters such as biliary cholesterol, biliary phospholipid, and bile acid were determined in cholelithiasis model. Similarly, 24-hour urine output, urinary parameters such as creatinine, uric acid, protein, urea, presence of calcium oxalate crystals, red blood cells (RBCs), and pyuria were determined in urolithiasis model. 【Results】  Statistically significant differences were noted in the biliary and urinary parameters after administrating three test doses of H. cannabinus aqueous extract (P < 0.05). 【Conclusion】 H. cannabinus was found to be effective against high fat lithogenic diet urolithiasis and cholelithiasis.

Effect of Dahuang Lingxian Formula（大黄灵仙方）on miRNA-30b Expression and Inflammation-fibrosis Related Factors in Biliary Duct Tissue of Cholecystitis Model Rats / 中医杂志

ObjectiveTo explore the possible mechanism of reducing cholecystitis and preventing cholelithiasis by Dahuang Lingxian Formula（大黄灵仙方， DLF）. MethodsFifty SD rats were randomly divided into blank group， model group， DLF group， DLF + blank inhibitor group， and DLF + inhibitor group， with 10 rats in each group. The rat model of cholecystitis was established by lipopolysaccharide （LPS） induction in all the groups except for the blank group. Rats in DLF group， DLF + blank inhibitor group and DLF + inhibitor group received intragastric administration of 320 mg/ （kg·d） of DLF 3 days before the preparation of cholecystitis model， while those in blank group and model group were given 2 ml/100 g of distilled water by gastric， twice a day， for 6 consecutive days. Hematoxylin-eosin （HE） staining was used to observe the histopathologic changes of bile duct tissues in each group. The expression of nuclear factor κB （NF-κB） protein in bile duct tissues was detected by immunohistochemistry. The expression levels of interleukin1β （IL-1β） and tumor necrosis factor α （TNF-α） in serum of rats were detected by enzym-linked immunosorbent assay （ELISA）. The mRNA expression levels of miRNA-30b， transforming growth factor β1 （TGF-β1）， nucleotide-binding oligomerization domain-like receptor protein 3 （NLRP3） and bone morphogenetic protein 2 （BMP2） in bile duct tissues were detected by real-time PCR， and the protein expression levels of TGF-β1， NLRP3 and BMP2 were detected by Western blot. ResultsCompared to those in the blank group， the structure of the bile duct in the model group was abnormal， and a large number of lymphocytes， plasma cell infiltration and bile canaliculi dilation were seen in the portal area； the positive expression of NF-κB protein increased； there was nuclear infiltration； the expressions of serum inflammatory factors IL-1β and TNF-α， as well as the mRNA and protein expressions of TGF-β1， NLRP3 and BMP2 in bile duct tissue significantly increased， while the expression level of miRNA-30b significantly decreased （P＜0.01）. Compared to those in the model group， the pathological morphology of the bile ducts in the DLF group and DLF + blank inhibitor group was improved， and the infiltration of inflammatory cells was reduced， with decreased positive expression of NF-κB and nuclear infiltration； expression levels of serum inflammatory factors IL-1β and TNF-α， and the mRNA and protein expressions of TGF-β1， NLRP3 and BMP2 in bile duct tissue decreased， while the expression level of miRNA-30b significantly increased （P＜0.05 or P＜0.01）. Compared to the model group， those indicators in the DLF + inhibitor group was not significantly improved （P＞0.05）. There was no significant difference in the indicators between the DLF group and the DLF + blank inhibitor group （P＞0.05）. ConclusionDLF may play a role in delaying the progression of cholelithiasis by regulating the expression of miRNA-30b and inflammation-fibrosis related factors.

Aplicación de guías tokio 2018 para diagnóstico y tratamiento de colangitis aguda en hospital escuela, honduras

Antecedentes: Las Guías Tokio 2018 son un conjunto de directrices médicas actualizadas y reconocidas que ofrecen recomendaciones detalladas para el diagnóstico y tratamiento de la colangitis aguda, una inflamación aguda de los conductos biliares que puede ser potencialmente grave. Objetivo: Examinar la utilidad de la aplicación de las Guías Tokio 2018 para el diagnóstico y tratamiento en pacientes con Colangitis Aguda ingresados al Hospital Escuela durante 2018-2019. Métodos: Estudio descriptivo transversal, se revisaron 54 expedientes clínicos que registraron datos sociodemográficos, antecedentes personales y patológicos, laboratoriales e imagenológicas. Los resultados se presentaron como frecuencias, porcentajes, promedios y rangos. Resultados: Las Guías de Tokio 2018 (TG18) fueron implementadas en un 94%. La colangitis aguda leve fue más frecuente en 48.1%. La concordancia en la estatificación de los casos según TG18 erró con mayor proporción en las colangitis grado 2 (15% No, 7% Si); la lesión renal siendo la falla orgánica más frecuente 25.9% (14). El manejo antibiótico concordó en el 70.0%. El drenaje biliar se realizó de forma oportuna en 14.0%. La causa más frecuente de colangitis fue la litiasis en un 48.2%. El promedio de hospitalización fue de 5-9 días en 31.5%. El 63.0% (34) de los pacientes egresó mejorado y el 24.0% (13) fallecieron. Conclusión: La utilización de lasTG18 por parte del Hospital Escuela demostró un enfoque en mejorar la precisión del diagnóstico y optimizar la administración de antibióticos. Sin embargo, su eficacia parece comparativamente disminuida cuando se aplica al aspecto fundamental del drenaje de los conductos biliares.

Background: The Tokyo 2018 Guidelines are a set of recognized and up-to-date medical guidelines that provide detailed recommendations for the diagnosis and treatment of acute cholangitis, an acute inflammation of the bile ducts that can be potentially serious. Objective: To examine the usefulness of the application of the Tokyo 2018 Guidelines for the diagnosis and treatment of patients with Acute Cholangitis admitted to the Hospital Escuela during 2018-2019. Methods: Cross-sectional descriptive study, reviewing 54 clinical records that recorded sociodemographic data, personal and pathological, laboratory and imaging history. Results were presented as frequencies, percentages, means, and ranges. Results: The Tokyo 2018 Guidelines (TG18) were implemented by 94%. Mild acute cholangitis was more frequent in 48.1%. The concordance in the staging of the cases according to TG18 erred with a greater proportion in grade 2 cholangitis (15% No, 7% Yes); kidney injury being the most frequent organic failure 25.9% (14). The antibiotic management agreed in 70.0%. Biliary drainage was performed in a timely manner in 14.0%. The most frequent cause of cholangitis was lithiasis in 48.2%. The average hospitalization was 5-9 days in 31.5%. 63.0% (34) of the patients discharged improved and 24.0% (13) died. Conclusion: The use of TG18 by the Hospital Escuela demonstrated a focus on improving diagnostic accuracy and optimizing the administration of antibiotics. However, its efficacy appears comparatively diminished when applied to the fundamental aspect of bile duct drainage.

Valor pronóstico del índice clínico de complejidad quirúrgica para el manejo clínico de la colecistectomía laparoscópica electiva / Prognostic value of the clinical index for surgical complexity for the clinical management of elective laparoscopic cholecystectomy

Objetivo: Múltiples factores preoperatorios pueden complicar una Colecistectomía Laparoscópica electiva. El índice clínico de complejidad quirúrgica agrupa esos factores y les otorga un puntaje que permite estimar la complejidad quirúrgica, permitiendo optimizar el manejo clínico de la colelitiasis, por eso, este trabajo busca determinar el rendimiento diagnóstico del índice clínico de complejidad quirúrgica en paciente operados en el Centro Médico Docente la Trinidad, de Litiasis Vesicular por colecistectomía laparoscópica electiva, en el tiempo comprendido entre el 2020 y 2021. Métodos: Estudio observacional retrospectivo que, mediante la obtención de datos de 63 historias de pacientes, se calculó el Índice Clínico de Complejidad Quirúrgica y sus subíndices: clínico-quirúrgico, edad y comorbilidades; para comparar cada variable, subíndice y puntaje total con el tiempo quirúrgico. Se calcularon medidas de posición, tendencia central y dispersión. Resultados: Un mayor puntaje en el índice clínico de complejidad quirúrgica se encontró asociado a un tiempo quirúrgico superior a dos horas. El punto de corte para tiempo quirúrgico mayor a 120 minutos fue de 5.5 puntos con una Sensibilidad de 53% y especificidad del 81%. Conclusiones: Un puntaje superior a 5 en el Índice Clínico de Complejidad Quirúrgica nos podría permitir estimar qué colecistectomías laparoscópicas van a tener una duración mayor a 2 horas y en ese sentido permitiría optimizar los planes quirúrgicos(AU)

Objective: Multiple preoperative factors can complicate elective laparoscopic cholecystectomy. The clinical index of surgical complexity groups these factors and gives them a score that allows estimating the surgical complexity, allowing optimizing the clinical management of cholelithiasis, therefore, this work seeks to determine the diagnostic performance of the clinical index of surgical complexity in patients operated at the Centro Médico Docente la Trinidad, of Cholelithiasis by elective laparoscopic cholecystectomy, in the time between 2020 and 2021. Methods: Retrospective observational study that, by obtaining data from 63 patient records, the Clinical Index of Surgical Complexity and its sub-indexes: clinical-surgical, age and comorbidities were calculated to compare each variable, sub-index and total score with the surgical time. Measures of position, central tendency and dispersion were calculated. Results: A higher score in the clinical index of surgical complexity was found to be associated with a surgical time of more than two hours. The cutoff point for surgical time greater than 120 minutes was 5.5 points with a Sensitivity of 53% and specificity of 81%. Conclusions: A score higher than 5 in the Clinical Index of Surgical Complexity could allow us to estimate which laparoscopic cholecystectomies are going to have a duration longer than 2 hours and, in that sense, would allow us to optimize surgical plans(AU)

Score preoperatorio para la predicción de colecistectomía difícil / Realization of a preoperative score for the prediction of difficult cholecystectomy

Introducción: La colecistectomía es una de las intervenciones quirúrgicas más frecuentes en la práctica médica diaria, la misma no está exenta de complicaciones, especialmente en algunos pacientes con mayor predisposición. Objetivo: Diseñar un score de puntuación preoperatoria para la predicción de la colecistectomía difícil en el área de emergencia y consulta del servicio de Cirugía General del Hospital General del Este "Dr. Domingo Luciani" Caracas - Venezzuela. Métodos: Estudio descriptivo, de diseño longitudinal. Realizado en el período agosto 2018 - agosto 2019. Contó con una muestra de 99 pacientes a los cuales se les aplicó un score predictivo preoperatorio donde se precisaron datos sobre el examen físico, antecedentes personales y quirúrgicos, enfermedades asociadas, exámenes de laboratorio y hallazgos en ultrasonido abdominal, previa firma del consentimiento informado se procedió a evaluar y hacer revisión de los paraclínicos de cada paciente, para luego ser reportado en el score. Resultados: Se registró una edad promedio muestral de 48,25 años ± 1,58, con una mediana de 47 años, el sexo femenino fue el más frecuente (60,61% = 60 casos), de aquellos pacientes clasificados con colecistectomía difícil según el score predictivo experimental predominaron aquellos con presencia de vesícula palpable y antecedentes de colecistitis, el hallazgo de laboratorio más importante fue la leucocitosis (≥ 15x106). Conclusión: El uso del score predictivo planteado permite predecir el riesgo de complicación en una colecistectomía difícil usando como base, las características clínicas y paraclínicas del paciente al momento de su evaluación preoperatoria(AU)

Introduction: Cholecystectomy is one of the most frequent surgical interventions in daily medical practice, it is not without complications, especially in some patients with greater predisposition.. Objective: Design a preoperative score for the prediction of difficult cholecystectomy in the emergency and medical consultation area of the General Surgery service of the Eastern General Hospital "Dr. Domingo Luciani". Methods: A descriptive study, longitudinal design. Performed in the period August 2018-August 2019. It had a sample of 99 patients who were given a preoperative predictive score requiring data on the physical examination, personal and surgical history, associated diseases, laboratory test and findings in abdominal ultrasound, upon signature of the informed consent was proceeded to evaluate and make revision of the paraclinical of each patient, and then be reported in the score. Results: An average sample age of 48.25 years ± 1.58, with a median age of 47 years, the female sex was the most common (60.61%=60 cases), in those patients classified with difficult cholecystectomy, according to the experimental predictive score, predominated those with the presence of palpable vesicle and history of cholecystitis, the most important laboratory finding was leukocytosis (≥ 15x106). Conclusion: The use of the predicted score allows to precise the risk of complication in a difficult cholecystectomy using the clinical and paraclinical characteristics of the patient at the time of their preoperative evaluation(AU)

Colecistectomia laparoscopica en el hospital municipal los pinos, 2012 - 2022 / Laparoscopic cholecystectomy at Los Pinos municipal hospital, 2012 - 2022

La colecistectomía laparoscópica es el estándar de oro para el tratamiento de la litiasis vesicular. El presente estudio tiene por objetivo difundir la experiencia de 10 años en colecistectomía laparoscópica del Hospital Municipal Los Pinos de La Paz, Bolivia. Se realizó la revisión de historias clínicas de pacientes internados y sometidos a colecistectomía laparoscópica de junio 2012 a julio 2022, la serie de casos estuvo compuesta por 1095 pacientes; 866 (79.3%) mujeres y 229 (20.7%) varones; el grupo etáreo con mayor casuística fue 31 a 40 años con 256 casos (23.3%), la edad promedio fue de 50,5 (10 a 81 años). La vía de ingreso de los pacientes fue por consulta externa 72.5% y emergencias 27.4%. El tiempo operatorio promedio fue de 85 min. (20 a 150 min.). El diagnostico de ingreso de mayor prevalencia fue la colecistitis crónica litiasica con 766 (69.9%). El factor de conversión a cirugía abierta fue la falta de identificación de estructuras anatómicas, con un índice de conversión de 6.9%. La estancia postoperatoria promedio fue de 3.5 días (1 a 6 días). Basado en los resultados obtenidos la colecistectomía laparoscópica demuestra ser aun el tratamiento seguro y efectivo en pacientes con colelitiasis.

Laparoscopic cholecystectomy is the Gold standard for the treatment of vesicular lithiasis. The present study aims to describe the experience in laparoscopic cholecystectomy of 10 years at Los Pinos Municipal Hospital in La Paz, Bolivia. A review of medical records of hospitalized patients undergoing laparoscopic cholecystectomy from June 2012 to July 2022 was carried out. Case series were 1095 patients; 866 (79.3%) female and 229 (20.7%) male; the age group with higher casuistry was 31 to 40 years (256 cases, 23.3%), the average age was 50.5 (10 to 81 years). The admission of patients was by outpatient 72.5% and emergency unit 27.4%. The average surgery time was 85 min. (20 to 150 min.). The highest prevalence diagnosis at admission was chronic lithiasic cholecystitis (766 cases, 69.9%). The conversion factor to open surgery was the anatomical structures identification difficulty, conversion rate of 6.9 %. The postoperative hospital stay average was 3.5 days (1 to 6 days). Based on the results obtained, laparoscopic cholecystectomy still proves to be the safe and effective treatment in patients with cholelithiasis.