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Introducción. El síndrome post-colecistectomía fue descrito hace más de 70 años y se define como la presencia de síntomas gastrointestinales que pueden persistir después de la colecistectomía o aparecer como nuevos síntomas. Este síndrome, poco conocido, puede manifestarse desde pocos meses hasta varios años luego de la cirugía y ocurre entre 5 % y 40 % de los pacientes. Método. Estudio de cohorte prospectiva, que incluyó pacientes a quienes se les realizó colecistectomía laparoscópica en tres unidades quirúrgicas de Bogotá, D.C., Colombia, durante un período de ocho meses, con seguimientos periódicos durante dos años. El síndrome post-colecistectomía se definió como la presencia de al menos un síntoma gastrointestinal a partir del primer mes de la cirugía. Resultados. Se incluyeron 380 pacientes de los cuales 183 (48,2 %) desarrollaron el síndrome. La edad tuvo diferencia estadísticamente significativa entre aquellos que lo desarrollaron y los que no (p=0,024). La diarrea fue el único síntoma preoperatorio asociado al desarrollo del síndrome. El síndrome post-colecistectomía se encontró en el 42,1 % de los pacientes al primer mes de seguimiento y en el 17,4 % al segundo año. Conclusiones. El síndrome post-colecistectomía ocurre en un porcentaje importante de pacientes. En concordancia con la literatura, se encontró que la diarrea prequirúrgica es un factor de riesgo independiente para el desarrollo del síndrome. Se recomienda un adecuado seguimiento de los pacientes después de una colecistectomía
Introduction. Post-cholecystectomy syndrome (PCS) was described more than 70 years ago and is defined as the presence of gastrointestinal (GI) symptoms that may persist after cholecystectomy or can present as new symptoms. This little-known syndrome can appear from a few months to several years after surgery and occurs between 5% and 40% of patients. Method. Prospective cohort study, which included patients who underwent laparoscopic cholecystectomy in three surgical units in Bogotá, Colombia, during a period of eight months, with periodic follow-up for two years. PCS was defined as the presence of at least one GI symptom from the first month after surgery. Results. Three-hundred and eighty patients were included, of which 183 (48.2%) developed the syndrome. Age had a statistically significant difference between those who developed PCS and those who did not (p=0.024). Diarrhea was the only preoperative symptom associated with the development of PCS. Post-cholecystectomy syndrome was found in 42.1% at the first month of follow-up and in 17.4% at the second year. Conclusions. Post-cholecystectomy syndrome occurs in a significant percentage of patients. Consistent with the literature, preoperative diarrhea was found to be an independent risk factor for the development of the syndrome. Adequate follow-up of patients after cholecystectomy is recommended
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Humanos , Dolor Abdominal , Síndrome Poscolecistectomía , Cirugía General , Colecistectomía , DiarreaRESUMEN
Background: In laparoscopic cholecystectomy, cystic duct is typically separated closer to the gallbladder to prevent iatrogenic common bile duct damage, leaving behind a long cystic duct remnant that can potentially lead to postcholecystectomy syndrome. Methods: A retrospective analysis of the data from 2010 to 2021 was undertaken at SKIMS Medical College, Srinagar, Kashmir, India, of all the cases who had been surgically re-explored for cystic duct remnants post-laparoscopic cholecystectomy. Results: Twenty cases of both genders underwent surgical reintervention for cystic duct remnant. The mean time of presentation after an index cholecystectomy was 2 years. Surgical operations were conducted through an open approach in 17 (85%) and by laparoscopy in 3 (15%). 95% of patients were symptom-free in the follow-up period. Conclusions: Cystic duct remnants should be considered if a patient report with symptoms suggestive of postcholecystectomy syndrome. The condition once diagnosed, can be managed safely by surgical reintervention.
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Objective:To investigate the anxiety and depression in patients with gallbladder polyps, gallbladder stones and post-cholecystectomy.Methods:From December 2020 to August 2021, consecutive patients who visited the Department of Gastroenterology, First Affiliated Hospital of Air Force Medical University, were enrolled and divided into normal gallbladder group, gallbladder polyp group, gallbladder stone group and post-cholecystectomy group, with 100 patients in each group. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate patients′ anxiety or depression. Quality of life, sleep quality and severity of gastrointestinal symptom were assessed by short form 36 (SF-36), Pittsburgh sleep quality index (PSQI) scale and gastrointestinal symptom rating scale (GSRS) respectively. The incidence of anxiety or depression of patients in the 4 groups were compared, and the related risk factors of anxiety and depression were analyzed. Chi-square test and multiple logistic regression were used for statistical analysis.Results:Among 400 patients, 89 patients (22.2%) suffered from anxiety; and the incidences of anxiety of normal gallbladder group, gallbladder polyp group, gallbladder stone group and post-cholecystectomy group were 9.0% (9/100), 19.0% (19/100), 25.0% (25/100) and 36.0% (36/100) respectively. There was statistically significant difference in the incidence of anxiety among the 4 groups ( χ2=22.12, P<0.001). The incidence rates of anxiety of the gallbladder polyp group, gallbladder stone group and post-cholecystectomy group were all higher than that of the normal gallbladder group, and the differences were all statistically significant ( χ2=4.15, 9.07 and 20.90, P=0.042, 0.003 and <0.001). The incidence of anxiety of post-cholecystectomy group was higher than that of gallbladder polyp group, and the difference was statistically significant ( χ2=7.25, P=0.007). Among the 400 patients, 70 patients (17.5%) suffered from depression. The incidence rates of depression of the normal gallbladder group, gallbladder polyp group, gallbladder stone group and post-cholecystectomy group were 5.0% (5/100), 10.0% (10/100), 24.0% (24/100) and 31.0% (31/100) respectively. There was statistically significant difference in the incidence of depression among the 4 groups ( χ2=30.27, P<0.001). The incidences of depression of the gallbladder stone group and post-cholecystectomy group were both higher than that of the normal gallbladder group and gallbladder polyp group, and the differences were statistically significant ( χ2=14.56, 22.90, 6.94 and 13.53, P<0.001, <0.001, =0.008 and <0.001). The results of multivariate analysis showed that history of cholecystectomy, history of coronary heart disease, consumption of overnight food ≥3 times per week, PSQI score ≥ 8 and GSRS score ≥9 were independent risk factors for anxiety ( OR, 95%confidence interval: 4.02, 1.60 to 10.13; 10.01, 2.15 to 46.68; 4.15, 1.87 to 9.19; 4.69, 2.58 to 8.52; 3.02, 1.64 to 5.58; P=0.003, 0.003, <0.001, <0.001, and <0.001). Gallbladder stones history of cholecystectomy, consumption of overnight food ≥3 times per week, consumption of fresh fruit < 200 g/d, PSQI score ≥8 and GSRS score ≥9 were independent risk factors for depression ( OR, 95%confidence interval: 4.40, 1.38 to 14.06; 4.97, 1.54 to 16.12; 4.23, 1.61 to 11.08; 3.78, 1.32 to 10.85; 5.59, 2.78 to 11.27, 4.19, 1.94 to 9.04; P=0.012, 0.007, 0.003, 0.014, <0.001 and <0.001). Conclusions:The incidences of anxiety and depression in patients with gallbladder stones or post-cholecystectomy are higher than that of people with normal gallbladder. A history of cholecystectomy is the independent risk factor for anxiety and depression. Gallbladder stones is the independent risk factor of depression. Clinical attention should be paid to the mental state of patients with gallbladder polyps, gallbladder stones, especially post-cholecystectomy.
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Introduction: Postoperative pain prevention and treatmentcontinues to be a major challenge in postoperative care.Gabapentin has recently become a part of a wide array ofpostoperative multimodal analgesic regimens. Present studyevaluated the efficacy of oral gabapentin in relief of acutepost-operative pain in laparoscopic cholecystectomy and alsocompared the efficacy of oral Gabapentin with that of oralTramadol.Material and Methods: Sixty ASA I and II physicalstatus patients of both sexes between 20-60 years of agescheduled for elective laparoscopic cholecystectomy wereenrolled into this prospective, double blinded, randomizedsequential allocation study. Any patient who was unwillingand uncooperative, ASA III and IV physical status, patientshaving body weight exceeding 20% of ideal body weight,known hypersensitive to any drug, drug or alcohol abuse,pregnant patient, uncontrolled concomitant medical diseases,history of chronic pain conditions, impaired kidney or liverfunction, laparoscopic cholecystectomy converted to opencholecystectomy, in whom some kind of analgesics wereadministered within 48 hrs of planned surgery were excludedfrom the study.Result: Sixty patients (30 males) were enrolled in the studywith mean ages of all three groups range from 37.40±9.18to 41.70±6.84. However the mean age, weight and sexdistribution among different groups were statisticallyinsignificant (P>0.05). Mean heart rate in various groups atdifferent intervals were insignificant (p>0.05) in the intraoperative period. Among group I, II and III in the postoperativeperiod, changes in mean heart rate was statistically significant(p<0.05). The changes in mean SBP and DBP werestatistically insignificant (p>0.05) intraoperatively in the threegroups.Conclusion: Premedication with oral 300 mg gabapentinprovides better pain relief in the postoperative period ascompare to oral 100 mg tramadol and placebo group withminimal side effects.
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62 year old lady was presented with small painful swelling in inguinal regional. On examination, there was 2x2 cm swelling in the right inguinal region with overlying skin red in color. Swelling was tender to touch with raised local temperature, firm in consistency, non-reducible and non-compressible with no transmitted pulsations. FNAC report was showing only inflammatory cells. Ultrasound was normal for abdomen but it showed presence of foreign body deep inside the sinus tract. Sinus tract was excised along with foreign body. Gallstone abscess are although rare to develop but they are seen occasionally. As are seen in our case lap cholecystectomy was performed 9 months ago and a single 7 mm stone was extracted from abscess in inguinal region.
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ABSTRACT Background: The incidence of cholecystolithiasis is approximately 15% of the population. It is believed that between 30-40% of cholecystectomy patients have symptoms after surgery, being changes in bowel habits the most common among them. Aim: 1) Defining the prevalence, and 2) identifying predictors of changes in bowel habits after laparoscopic cholecystectomy. Methods: This is a retrospective cross-sectional study with an initial sample of 150 patients diagnosed with cholecystolithiasis operated between July and September 2014. Patients were submitted to a questionnaire about the presence of gastrointestinal symptoms and changes in stools consistency before and after the surgical procedure. They were divided into two groups (with or without changes in bowel habits) being combined with the following variables: high blood pressure, body mass index, hypothyroidism, adherence to postoperative dietary orientations, previous abdominal and bariatric surgery. Results: The prevalence of changes in bowel habits in the study population was 35.1%. The association between it and gastrointestinal symptoms was demonstrated to be statistically significant (‰2=7.981; p=0.005), and people who did not have gastrointestinal symptoms had 2.34 times the odds of not presenting changes in bowel habits. None of the other investigated factors had shown to be a predictor of risk for post-cholecystectomy changes in bowel habits. Conclusion: 1) There was a high prevalence of changes in bowel habits, and 2) there was association between changes in bowel habits and the presence of gastrointestinal symptoms.
RESUMO Racional: A incidência da colecistopatia calculosa é de aproximadamente 15% da população brasileira. Acredita-se que entre 30-40% dos pacientes colecistectomizados apresentem sintomas pós-operatório, sendo a alteração do hábito intestinal o mais comum. Objetivo: 1) Determinar a prevalência, e 2) identificar preditores de mudanças do hábito intestinal pós-colecistectomia videolaparoscópica. Métodos: Estudo transversal retrospectivo com amostra inicial de 150 pacientes diagnosticados com colecistopatia calculosa, operados entre julho e setembro de 2014. Os pacientes foram submetidos a um questionário sobre a presença de sintomas gastrointestinais após a operação, e a alterações do aspecto das fezes antes e depois do procedimento. A amostra foi dividida em dois grupos (com ou sem mudanças do hábito intestinal) sendo realizadas associações com as seguintes variáveis: hipertensão arterial, IMC, hipotireoidismo, seguimento de dieta no pós-operatório, operação abdominal prévia e operação bariátrica. Resultados: A prevalência de mudanças do hábito intestinal na população estudada foi de 35,1%. A associação entre elas e sintomas gastrointestinais demonstrou-se estatisticamente significativa (‰2=7,981; p=0,005), sendo que as pessoas que não apresentavam os sintomas tinham 2,34 vezes mais chances de não apresentarem mudanças do hábito intestinal. Nenhum dos demais fatores investigados demonstrou ser preditor de risco para mudanças do hábito intestinal pós-colecistectomia. Conclusões: 1) Observou-se alta prevalência de mudanças do hábito intestinal, e 2) houve associação entre mudança do hábito intestinal e a presença de sintomas gastrointestinais.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Complicaciones Posoperatorias/epidemiología , Colecistectomía Laparoscópica , Defecación , Enfermedades Gastrointestinales/epidemiología , Pronóstico , Prevalencia , Estudios Transversales , Estudios Retrospectivos , Autoevaluación DiagnósticaRESUMEN
Background: Cholecystectomy is one of the most frequently performed surgeries. The surgery is associated with many avoidable complications and hence requires a serious and cautious approach. Aim: The aim of this study was to know the outcome of post cholecystectomy biliary leaks and its management methods. Materials and methods: 10 cases of biliary leaks were studied from 100 open cholecystectomies and 100 laparoscopic cholecystectomies from 2013 January to 2014 January. Pre-operative workup with ultrasound abdomen, LFT and other biochemical investigations were done and diagnosis was established. The outcome of surgery and its most common post-operative complication - biliary leak was studied with following parameters: Post-operative diagnosis, Surgery - Lap or Open, Incision, Method of approach – Fundus or Classical method, CBD exploration, Intra-operative findings, Drains used, Post-operative symptoms, Amount of collections, Removal of drains, USG – Sub hepatic collections, ERCP etc. Results: In the present study of 10 cases, fundus first method was done in 3 cases of open cholecystectomies and none in laparoscopic cholecystectomies. Classical procedure was done in 7 cases out of which 3 cases were done in laparoscopy method and 16 cases in open method. Intraoperative detection of bile duct injury is noted in 3 cases of open cholecystectomies and non in laparoscopic method. In the present study, 56 % of the patients were treated conservatively who required no therapy and surgical placement of the drain itself was sufficient. P. Krishna Kishore, B. Manju Sruthi, G. Obulesu. Study of post cholecystectomy biliary leakage and its management. IAIM, 2016; 3(9): 222-227. Page 223 Conclusion: Pain abdomen, Jaundice, Nausea and Vomiting are the major complaints in case of bile leaks and fistulas. Pathologically, chronic cholecystitis is commonest cause of leaks after surgery mainly because of fibrosis at calots triangle. Incidence of Post-operative bile leaks is almost the same in open and laparoscopic cholecystectomy. Routine placement of drains is must because it permits post operative evacuation of serosanguineous exudates and monitoring of bleeding or leakage of bile. Abdominal collections, bilomas or sub-hepatic abscess are reported less with the placement of drains
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Objective To evaluate the value of endoscopy in etiological diagnosis and treatment of post - cholecystectomy syndrome. Methods Three hundred and twenty - six patients with post -cholecystectomy syndrome received ERCP. To reveral the etiology of post - cholecystectomy syndrome. For those with choledocholithiasis and those with papillary inflammatory stricture EST or EPBD were given those with papillary diverticulum and SOD EPBD were given, those with papillary tumor and hepatobiliary carcinoma EMBE were given and for those with bililary stricture in middle part of bile duct, purulent cholangitis, chloedocholithiasis(stones not excluded in one time)and bile leakage ENBD were used. Results ERCP was succeeded in 315 cases(96. 6%), 24 cases had no abnormal endoscopic findings view. 191 cases of choledocholithiasis 186 were totally get rid of stone after one to three times of opretion EST or EPBD was successfully given to 39 cases of 39 had papillary inflammatory stricture. Nine had papillary diverticulum which oppressed the papillary orifice, 7 had SOD, all of them were dealt with EPBD. Sixteen had stricture in the middle portion of bile duct, 11 of which were treated with ENBD. In 6 cases of papillary tumor and 5 hepatobiliary carcinoma patients jaundice improved significantly after received EMBE. Residual stones in cholecystic duct were seen in 4 cases. In 2 cases of bile leakage after cholecystectomy, ENBD was successfully carried out to avoid another operation. Complications were noted in 15 cases(4. 8%) of them. pancreatitis 11 cases, cholangitis 3 eases and hemorrhage of upper gastrointestinal tract one ease. Conclusion ERCP can find out the defenite cause of post - cholecystectomy syndrome at early stage and take corresponding endoscopic therapeutic measures. The complications of ERCP can be avoided by skillful operator.