Congenital multiseptate gall bladder in a child: a rare case report

Congenital multiseptate gallbladder (CMGB), is a rare congenital anomaly of gall bladder and it may be associated with other abnormalities. The gallbladder has one or many septa that divides the cavity into multiple distinct sections. It is considered as a pseudo-duplication of the gallbladder. Septate gall-bladder has not been a well-documented entity as most of the patients are asymptomatic, and this is usually an incidental finding which is discovered accidentally during the evaluation of abdominal pain. Some patients may present to the clinician with the complaints of pain in the right hypochondrium and epigastrium or colicky abdominal pain. Rarely, there may be stone formation due to septations, which may lead to recurrent abdominal pain. The most accurate way to diagnose septate gall-bladder is to combine ultrasonography and magnetic resonance cholangiography (MRCP). Here we present a four-year-old female child with a multiseptate gall bladder who underwent laparoscopic cholecystectomy, and her abdominal pain resolved entirely.

Laparoscopic cholecystectomy in an adult patient with a ventriculoperitoneal shunt system

Adult patients with a ventriculoperitoneal shunt valve (VDVP) are not exempt from suffering from gastrointestinal diseases. Nowadays, with technological advances, it would be contradictory not to offer them the benefits of minimally invasive surgery. The case of a laparoscopic cholecystectomy of a 40-year-old male patient with VDVP who presented clinical signs of cholecystitis is presented. The patient's evolution was satisfactory and he was discharged home 72 hours after surgery. Currently, there are significant studies that demonstrate the benefit of minimally invasive surgery in patients with VDVP as a treatment for abdominal surgical pathologies, including biliary pathology. Therefore, in our experience and with the published cases, we conclude that patients with VDVP do benefit from minimally invasive surgery for any abdominal surgical pathology, including pathology of biliary origin.

Analgesia postoperatoria con nebulización intraperitoneal de ropivacaína en colecistectomía laparoscópica. Reporte de un caso y revisión de la literatura / Postoperative analgesia with intraperitoneal nebulization of ropivacaine in laparoscopic cholecystectomy. Case report and review of the literature

Resumen: Es frecuente que, durante el postoperatorio inmediato, el anestesiólogo se enfrente a pacientes con dolor posterior a una colecistectomía laparoscópica. La nebulización de anestésicos locales en la cavidad abdominal durante la cirugía laparoscópica parece ser un procedimiento prometedor para reducir el dolor en el postoperatorio, y de esta manera disminuir la cantidad de analgésicos y opioides administrados a los pacientes. Presentamos el caso de una mujer de 35 años de edad que fue sometida a una colecistectomía laparoscópica, a la cual se nebulizó ropivacaína en la cavidad abdominal al término de ésta, con lo que se redujo notablemente el dolor en el postoperatorio hasta el egreso de la paciente.

Abstract: It is common for the anesthesiologist to cope with patients in the immediate postoperative period with moderate to severe amount of pain after laparoscopic cholecystectomy. The nebulization of local anesthetics in the abdominal cavity during laparoscopic surgery seems to be a promising procedure to reduce pain in the postoperative period thus reducing the number of analgesics and opioids administered to patients. We present the case of a 35-year-old woman who underwent a laparoscopic cholecystectomy, nebulizing ropivacaine in the abdominal cavity at the end of it, significantly reducing postoperative pain until the patient's discharge.

A comparative study of single incision laparoscopic cholecystectomy versus four port laparoscopic cholecystectomy

Background: Since Langenbuch's pioneering open cholecystectomy in 1882, surgical approaches to gall bladder diseases have seen continual evolution. Laparoscopic surgery has emerged as the preferred method for treating benign gall bladder conditions, offering benefits like decreased postoperative discomfort and enhanced cosmetic outcomes. Variations to the traditional four-port laparoscopic cholecystectomy have been developed to further refine the procedure. Methods: A comparative randomized study was carried out at the Department of Surgery, Govt. Medical College and Hospital Jammu, spanning from November 1, 2018, to October 31, 2019. Thirty eligible patients were recruited, with 15 assigned to undergo single-incision laparoscopic cholecystectomy (SILC - Group A) and 15 assigned to undergo four-port laparoscopic cholecystectomy (Group B). Results: The study comprised patients aged between 20 and 60 years, with mean ages of 41.9 years for Group A and 40.3 years for Group B. Substantial variances were noted between the two groups concerning surgery duration, conversion rates, postoperative pain scores, and hospital stay. Conclusions: Based on our findings, single-incision laparoscopic cholecystectomy (SILC) cannot be deemed a standard operative procedure, mainly due to its cost implications and the necessity for specialized instruments. At present, SILC does not serve as a substitute for four-port laparoscopic cholecystectomy. Continued research and advancements are warranted to solidify SILC as a feasible alternative.

Asociación entre metaplasia, displasia y cáncer de vesícula biliar en una EPS de Bogotá, Colombia / Association between metaplasia, dysplasia and gallbladder cancer in an EPS in Bogotá, Colombia

Introducción. El cáncer de vesícula biliar es el más común en el tracto biliopancreático y una importante causa de mortalidad. La metaplasia y la displasia han sido mencionados como probables precursores relacionados con la secuencia metaplasia-displasia-cáncer. El objetivo de este estudio fue establecer las posibles asociaciones entre estas alteraciones histopatológicas y su relación con la edad y el sexo de los pacientes. Métodos. Estudio observacional retrospectivo descriptivo, con un componente analítico de corte transversal. Se incluyeron los informes de patología de pacientes llevados a colecistectomía laparoscópica electiva y ambulatoria, entre enero de 2015 y diciembre de 2020, con colecistitis crónica, colelitiasis o pólipos vesiculares, mayores de 18 años. Se describieron las características demográficas por sexo y edad utilizando medias, desviaciones estándar y porcentajes. Se emplearon la prueba de chi cuadrado y la prueba exacta de Fisher para evaluar la asociación entre las variables cualitativas. Resultados. Se incluyeron 4871 informes de patología. En esta cohorte se encontró asociación estadísticamente significativa entre metaplasia, displasia y cáncer de vesícula (p<0,05), al igual que con el sexo y la edad de los pacientes. Conclusiones. Los resultados sugieren una asociación entre metaplasia, displasia y cáncer de vesícula biliar en la población estudiada. Se recomienda la realización de investigaciones complementarias para definir la posible causalidad entre metaplasia, displasia y cáncer de vesícula biliar en una población más heterogénea.

Introduction. Gallbladder cancer is the most common cancer in the biliopancreatic tract and an important cause of mortality. Metaplasia and dysplasia have been mentioned as probable precursors related to the metaplasia-dysplasia-cancer sequence. The objective of this study was to establish the possible associations between these histopathological alterations and their relationship with the age and sex of the patients. Methods. Descriptive retrospective observational study, with a cross-sectional analytical component. Pathology reports of patients undergoing elective and outpatient laparoscopic cholecystectomy were included between January 2015 and December 2020, with chronic cholecystitis, cholelithiasis, or gallbladder polyps, over 18 years of age. Demographic characteristics by sex and age was performed using means, standard deviations, and percentages. The chi2 test and Fisher's exact test were used to evaluate the association between the qualitative variables. Results. 4871 pathology reports were included. In this cohort, a statistically significant association was found between metaplasia, dysplasia, and gallbladder cancer (p<0.05), as well as with the sex and age of the patients. Conclusions. The results suggest an association between metaplasia, dysplasia and gallbladder cancer in the study population. Additional research is recommended to define the possible causality between metaplasia, dysplasia, and gallbladder cancer in a more heterogeneous population.

Eficacia y seguridad de la técnica americana modificada en un puerto de trabajo para colecistectomía laparoscópica / Efficacy and safety of the modified american technique in a working port for laparoscopic

Objetivo: Evaluar la eficacia y seguridad de la técnica americana modificada con un puerto de trabajo (TAMPT) en línea media para colecistectomía laparoscópica. Métodos: Se elaboró estudio prospectivo, comparativo, descriptivo de corte transversal, en pacientes con litiasis vesicular en el servicio de Cirugía General del Hospital Universitario de Caracas, durante enero-agosto 2022. Resultados: se realizaron 79 colecistectomía laparoscópicas, 34 por técnica americana y 45 con TAMPT. La TAMPT (40.26%) se ejecutó con intervalo de 30-60 min. La estancia hospitalaria promedio global fue 1,75 ± 0,87 días. El promedio global de dolor a las 24 horas fue de 4,43 ± 0,68, según escala visual analógica (EVA). Los procedimientos realizados con TAMPT no presentaron complicaciones, con la técnica americana, se reportó dos: bilioma y lesión de víscera hueca, representando 2.54%. Conclusiones: La TAMPT, ha demostrado ser una técnica segura y eficaz como tratamiento quirúrgico de la litiasis vesicular, tanto para procedimientos electivos como de emergencia(AU)

Objective: To determine the efficacy and safety of the modified American technique in a working port (MATWP) for laparoscopic cholecystectomy. Methods: A prospective, comparative, descriptive, cross-sectional, descriptive study was elaborate. In patients with vesicular lithiasis in the General Surgery Service of the Hospital Universitario de Caracas, during January-August 2022.Results: 79 laparoscopic cholecystectomies were performed, 34 by American technique and 45 with modified technique. The modified technique (40.26%) was performed with an interval of 30-60 min. The overall average hospital stay was 1.75 ± 0.87 days.The global average pain at 24 hours was 4.43 ± 0.68, according to visual analog scale (VAS).The procedures performed with MATWP did notpresent complications; the American technique reported two bilioma and hollow viscera lesion, representing an overall rateof 2.54%. Conclusions: MATWP has proven to be a safe and effective technique for surgical treatment of gallbladder stones, both for elective and emergency procedure(AU)

Cáncer de vesícula biliar, experiencia del Servicio de Cirugía General del Hospital Nacional de Itauguá del 2010 al 2020 / Gallbladder cancer, experience in the General Surgery Service of the Itauguá National Hospital since 2010 to 2020

Introducción: El cáncer vesicular es una neoplasia infrecuente mundialmente, exceptuando países donde la mortalidad por su causa es alta como Chile, a pesar de ello es el tumor biliar más común, con una incidencia aproximada de 0,8-1,2% y casi exclusivamente en mujeres. Objetivos: Describir la frecuencia, perfil demográfico, clínica, tratamiento y hallazgos anatomopatológicos del cáncer vesicular en pacientes del Hospital Nacional de Itauguá del 2010 al 2020. Materiales y métodos: Se encontraron 19 casos confirmados por biopsia, pero solo 15 fichas estaban completas. El estudio fue retrospectivo, descriptivo y observacional, muestreo no probabilístico de corte transversal. Resultados: De la muestra final (N=15), 13 pacientes fueron mujeres, la edad promedio fue de 60 años. Del total, 4 pacientes ingresaron para cirugía programada con diagnóstico de colecistopatía crónica litiásica y los otros 11 tenían sospecha de tumor vesicular y/o ictericia o colangitis aguda de origen neoplásico probable, todos fueron operados, el motivo de consulta más frecuente fue dolor en hipocondrio derecho, el 99 % fueron adenocarcinomas por anatomía patológica. Conclusión: La etiología principal del cáncer vesicular fue la colelitiasis, es de baja incidencia a nivel nacional, la mayoría de nuestros pacientes se encontraban en estadios terminales, o con poca oportunidad para la resección R0, por lo cual son de mal pronóstico y hasta hoy en día son de difícil detección en etapa inicial. En algunos casos como en 4 de nuestras pacientes el diagnóstico es fortuito mediante el hallazgo histológico en piezas de colecistectomía que fueron intervenidos en principio por patología benigna.

Introduction: Gallbladder cancer is an infrequent neoplasm worldwide, except for countries where mortality from its cause is high, such as Chile. Despite this, it is the most common biliary tumor, with an approximate incidence of 0.8-1.2% and almost exclusively in women. Objectives: To describe the frequency, demographic profile, clinic, treatment and anatomopathological findings of gallbladder cancer in patients of the Itauguá National Hospital from 2010 to 2020. Materials and methods: 19 biopsy-confirmed cases were found, but only 15 files were complete. The study was retrospective, descriptive and observational, non-probabilistic cross-sectional sampling. Results: Of the final sample (N=15), 13 patients are women; the average age was 60 years. Of the total, 4 patients were admitted for scheduled surgery with a diagnosis of chronic gallstone gallbladder disease and the other 11 had suspected gallbladder tumor and/or jaundice or acute cholangitis of probable neoplastic origin, all were operated on, the most frequent reason for consultation was pain in the hypochondrium right, 99% were adenocarcinomas by pathology. Conclusion: The main etiology of gallbladder cancer was cholelithiasis, it has a low incidence nationwide, most of our patients were in terminal stages, or with little opportunity for R0 resection, for which they have a poor prognosis and up to today they are difficult to detect in the initial stage. In some cases, such as in 4 of our patients, the diagnosis is fortuitous through the histological finding in cholecystectomy specimens that were initially operated on for benign pathology.

Prevalencia de cáncer de vesícula en pacientes pos operados de colecistectomía en un Hospital de Tercer Nivel en el 2021 en Paraguay / Prevalence of gallbladder cancer in patients undergoing cholecystectomy in a Third-Level Hospital in 2021 in Paraguay

Introducción: El cáncer de vesícula biliar (CVB) es la neoplasia más frecuente de las vías biliares, su diagnóstico suele hacerse de forma tardía llevando a una reducción en las opciones terapéuticas y alta mortalidad. La importancia de hacer un diagnóstico oportuno es la mejoría en el pronóstico debido a mayores opciones terapéuticas e incluso curación de la enfermedad, lo que hace muy relevante conocer la prevalencia de CVB en pacientes colecistectomizados. Objetivos: Determinar la prevalencia del cáncer de vesícula en la anatomía patológica de pacientes colecistectomizados en el Hospital General de Barrio Obrero en el año de 2021. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo y de corte transversal, con datos colectados de los expedientes clínicos: edad, sexo, motivo de consulta, antecedentes patológicos personales y patologías basales, hallazgo operatorio y resultados de anatomía patológica. Los datos fueron cargados en una planilla Excel y analizados estadísticamente. Resultados: Se diagnosticaron 2 carcinomas mal diferenciados (3,5%) de todas las colecistectomías. El promedio de edad fue de 39a (DS +/- 14;16), sexo femenino (63%). Las comorbilidades más frecuentes fueron obesidad (58,7%), hipertensión arterial (33,8%), diabetes y dislipidemia (12,8% cada). Conclusión: El cáncer de vesícula biliar tiene una alta prevalencia regional, debido a factores de riesgo relacionados al estilo de vida y dieta. El hallazgo más llamativo fue encontrar con una mayor prevalencia en el grupo de edad entre 31-50 años en lugar de mayores a 60 años.

Introduction: Gallbladder cancer (CVB) is the most common neoplasm of the bile ducts; its diagnosis is usually made late, leading to a reduction in therapeutic options and high mortality. The importance of making a timely diagnosis is the improvement in prognosis due to greater therapeutic options and even cure of the disease, which makes it very relevant to know the prevalence of CVB in cholecystectomized patients. Objectives: Determine the prevalence of gallbladder cancer in the pathological anatomy of cholecystectomized patients at the Barrio Obrero General Hospital in the year 2021. Materials and methods: Observational, descriptive, retrospective and cross-sectional study, with data collected from clinical records: age, sex, reason for consultation, personal pathological history and baseline pathologies, operative finding and pathological anatomy results. The data were loaded into an Excel spreadsheet and analyzed statistically. Results: 2 poorly differentiated carcinomas were diagnosed (3.5%) of all cholecystectomies. The average age was 39 years (SD +/- 14;16), female (63%). The most frequent comorbidities were obesity (58.7%), high blood pressure (33.8%), diabetes and dyslipidemia (12.8% each). Conclusion: Gallbladder cancer has a high regional prevalence, due to risk factors related to lifestyle and diet. The most striking finding was a higher prevalence in the age group between 31-50 years rather than those over 60 years of age.

Assessment of bacteriological profile and wound infection in open and laparoscopic gall bladder surgery

Background: Cholecystectomy is one of the most frequent types of abdominal surgery performed in the world. Generally, there is minimal risk of serious postoperative complications. One of the complications is Surgical Site Infection, which can be caused by bile leakage and intraoperative contamination. Methods: This prospective study was conducted in department of General Surgery, SKIMS medical college Srinagar, from June 2020 to July 2023 comprising of 100 patients. All patients undergoing the procedure were observed for wound infection. Results: A total of 100 patients were studied with female to male ratio of 2:3. The mean age was 50.24�.25 with 54% elderly patients. The average hospital stay was 4.02�. 88% subjects belonged to ASA II Category with Hypertension and hyperthyroidism as common comorbidity. 11 patients got wound infection including 9 from open cholecystectomy and 02 from laparoscopic cholecystectomy with most patients belonging to elderly age group. Wound culture was positive in 9 out of 11 subjects of open cholecystectomy. E. coli was seen to be a major causal bacterial agent. Bile culture was positive in 8 patients. Both genders were almost equally affected by wound infection. Meropenem, Ceftriaxone, Gentamicin and Amikacin showed the highest number of antibiotic sensitivities tested in case of wound cultures. Conclusions: The prevalence of positive wound culture in uncomplicated laparoscopic cholecystectomy is low as compared to open procedure. Elderly age, co-morbid patients, patients who had history of jaundice, recent history of cholecystitis were at higher risk of wound infections.

Mejoría de la calidad de vida después de la reparación definitiva de la lesión de la vía biliar, evaluada con el cuestionario SF-36 / Improvement on quality of life after bile duct injury repair using the SF-36 Health Survey

RESUMEN Antecedentes: diferentes publicaciones han estudiado la fisiopatología de la lesión de la vía biliar (LVB), pero pocas han investigado los efectos psicosociales y de calidad de vida relacionados con su reparación. Objetivo: comparar la calidad de vida de pacientes antes y después de la reparación definitiva de una LVB. Material y métodos: se usó como instrumento para evaluar la calidad de vida relacionada con la salud (CVRS) el cuestionario de salud SF-36 en una serie de pacientes operados entre diciembre de 2015 y junio de 2019 para la reparación de LVB. Resultados: sobre 48 casos de reparaciones de LVB, contestaron la encuesta 22 (46%). Se compararon los ítems del formulario SF 36: diferencia en la función física, el rol físico, el dolor corporal, la salud general, la vitalidad, la función social, el rol emocional, la salud mental y el ítem de transición de salud, y todos mostraron una mejoría estadísticamente significativa (p < 0,001) después de la reparación. En el análisis univariado se observó que la salud mental se vio afectada por la presencia de una lesión compleja (p = 0,019), el rol físico y el rol emocional antes de la reparación, y mostró relación con el tipo de lesión según Strasberg (p = 0,001 y p = 0,032). Aquellos que asociaron lesión vascular presentaron una asociación negativa con la función física (p = 0,019), la vitalidad (p = 0,033), la salud mental (p = 0,005) y el dolor (p = 0,026) antes de la reparación. Conclusión: la resolución definitiva de la LVB en un centro especializado en patología hepatobiliopancreática mostró producir una significativa mejoría en la calidad de vida.

ABSTRACT Background: Different publications have examined the pathophysiology of bile duct injury (BDI), bur few studies have investigated the effects of BDIs and their subsequent repair on psychosocial and health-related quality of life Objective: The aim of this study was to compare the quality of life of patients before and after definitive BDI repair. Material and methods: The SF-36 Health Survey was used as an instrument to assess health-related quality of life (HRQL) in a series of patients operated on between December 2015 and June 2019 for BDI repair. Results: Of 48 patients who underwent BDI repair, 22 (46%) responded to the survey. The SF-36 items, which includes different domains (physical functioning, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning, mental health, and health transition) were compared. All domains demonstrated statistically significant improvement (p < 0.001) following repair. On univariate analysis, mental health was affected by the presence of a complex injury (p = 0.019), and physical and emotional role functioning before BDI repair were associated with the type of injury of the Strasberg classification (p = 0.001 and p = 0.032, respectively). An associated vascular injury had a negative correlation with physical functioning (p = 0.019), vitality (p = 0.033), mental health (p = 0.005), and pain (p = 0.026) prior to repair. Conclusion: The definitive resolution of BDIs at a center specialized in hepatobiliary and pancreatic surgery resulted in a significant improvement of patients' quality of life.

Laparoscopic cholecystectomy under spinal-epidural anesthesia versus general anaesthesia: a prospective randomized study

Background: The choice between spinal-epidural anesthesia and general anesthesia for laparoscopic cholecystectomy depends on various factors, including patient characteristics, surgical team expertise, and institutional guidelines. While both techniques have their advantages and disadvantages, spinal-epidural anesthesia offers an alternative to general anesthesia, potentially reducing complications and improving patient outcomes. Objective of the study was to compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy in healthy patients. Methods: This study was conducted at Sheikh Hasina Medical College, Hobiganj, Bangladesh. In this prospective comparative study, we enrolled one hundred patients diagnosed with symptomatic gallstone disease and classified as American Society of Anesthesiologists (ASA) status I or II. These patients were subjected to randomization, with fifty of them assigned to undergo laparoscopic cholecystectomy under spinal anesthesia, while the remaining fifty received general anesthesia. Subsequently, we conducted a comprehensive assessment, comparing various intraoperative parameters, postoperative pain levels, incidence of complications, recovery rates, and patient satisfaction during the follow-up period, with the aim of evaluating the differences between these two anesthesia methods. Results: All the procedures were completed by the allocated method of anesthesia, as there were no conversions from spinal to general anesthesia. Pain was significantly less at 4 hours (p<0.001), 8 hours (p<0.001), 12 hours (p<0.001), and 24 hours (p=0.02) after the procedure for the spinal anesthesia group compared with those who received general anesthesia. There was no difference between the 2 groups regarding complications, hospital stay, recovery, or degree of satisfaction at follow-up. Conclusions: Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesthesia without limiting recovery.

Can we predict difficult laparoscopic cholecystectomy preoperatively? A comprehensive study

Background: In the study, we have tried to assess some preoperative factors (history, clinical and ultrasonographic factors) that might make the laparoscopic cholecystectomy difficult. Objective was to study the predictive scoring pattern in difficult laparoscopic cholecystectomy cases. Methods: It was a prospective observational study. Ninety cases of suspected cholecystitis were identified for study presented to Jehangir hospital, Pune with upper abdominal pain or vomiting or dyspepsia or jaundice. Such patients were studied in detail clinically, admitted and investigated. Ultrasound abdomen was done in all patients. Results: Out of 90 cases studied, 64 patients (71.1%) had pre op score between 0-5 i.e. easy level, 21 patients (23.3%) had pre-op score between 6-10 i.e. difficult level and 5 patients (5.6%) had pre-op score between 11-15 i.e. very difficult level against intra-op scoring of 57 patients (63.33%) being easy, 28 patients (31.1) difficult and 05 patient (5.6%) had very difficult surgery. Conversion rate in present study to open surgery was 5.6%. For predicting easy laparoscopic cholecystectomy, accuracy of preop score was 85.6% and for predicting very difficult lap cholecystectomy, accuracy of preoperative score was 95.6%. Conclusions: Strongly significant factors predicting difficult laparoscopic cholecystectomy were number of hospitalisations, impacted stone and obesity. This study demonstrated that a scoring system predicting the difficulty in laparoscopic cholecystectomy is feasible and easy way. Identification of these factors preoperatively might help to psychologically prepare the patients for open surgery and for prolonged convalescence.

Cáncer incidental de vesícula: incidencia y factores asociados en pacientes de una institución de la ciudad de Medellín / Incidental gallbladder cancer: Incidence and associated factors in patients from an institution in the city of Medellín

Introducción. El cáncer de vesícula biliar es una de las neoplasias más frecuentes de la vía biliar y la mayoría de los casos se diagnostican de forma incidental o en estadios avanzados. En Colombia existen pocas publicaciones acerca de la prevalencia y características clínicas de pacientes con cáncer insospechado de vesícula biliar. El objetivo de este trabajo fue actualizar la información existente. Métodos. Estudio de tipo transversal basado en registros médicos. Como variable de resultado se definió el hallazgo incidental de patología maligna reportado por un patólogo y el subtipo histológico. Se midieron variables demográficas, clínicas y quirúrgicas. Se calcularon OR con sus respectivos intervalos de confianza (IC95%). Resultados. De los 2630 casos analizados, en cuatro se hizo diagnóstico de cáncer incidental de vesícula, con una prevalencia del 0,15 %. Se encontraron como características asociadas al cáncer incidental de vesícula, la edad, el antecedente de cáncer y la presencia de pólipos. Conclusiones. Esta es una patología poco frecuente en la población evaluada, lo que permite afirmar que no es necesario realizar estudios prequirúrgicos más amplios de forma rutinaria, a menos que el paciente presente alguno de los factores asociados.

Introduction. Gallbladder cancer is one of the most common neoplasms of the bile duct and most cases are diagnosed incidentally or in advanced stages. In Colombia, there are few publications about the prevalence and clinical characteristics of patients with unsuspected gallbladder cancer. The objective of this work was to update the existing information. Methods. Cross-sectional study based on medical records. The incidental finding of malignant pathology reported and the histological subtype were defined as the outcome variable. Demographic, clinical and surgical variables were measured. ORs were calculated with their respective 95% CI. Results. Of the 2630 cases analyzed, four were diagnosed with incidental gallbladder cancer, with a prevalence of 0.15%. Characteristics associated with incidental gallbladder cancer were age, history of cancer and the presence of polyps. Conclusions. This is a rare pathology in the population evaluated, which allows us to recommend that it is not necessary to routinely perform more extensive presurgical studies, unless the patient presents any of the associated factors.

Indocyanine green guided laparoscopic management of Mirizzi syndrome

Mirizzi syndrome is a rare condition caused by the obstruction of the common bile duct or common hepatic duct by external compression from multiple impacted gallstones or a single large impacted gallstone in the Hartman抯 pouch. A 60-year-old female patient presented with complaints of abdominal pain with deranged liver functions. Mirizzi syndrome was diagnosed after radiological imaging and managed by laparoscopic cholecystectomy. Previously, Mirizzi syndrome was considered to be the absolute contra-indication for laparoscopic cholecystectomy. However, recent advances in radiology with the usage of indocyanine green and increased familiarity of the pathophysiology of the disease have successfully improved its laparoscopic management.

Effect of acetaminophen combined with ketorolac tromethamine on analgesia after laparoscopic chol-ecystectomy / 临床麻醉学杂志

Objective To investigate the effectiveness and safety of acetaminophen combined with ketorolac tromethamine in pain management early after laparoscopic cholecystectomy(LC).Methods Ninety patients with LC under general anesthesia,42 males and 48 females,aged 18-78 years,BMI 18-28 kg/m2,ASA physical statusⅠorⅡ,were selected and randomly divided into two groups by random num-ber table method:the acetaminophen combined with ketorolac tromethamine group(group AK)and the nal-buphine group(group NA),45 patients in each group.Group AK received 500 mg(diluted to 50 ml)of acetaminophen injection and 30 mg of ketorolac tromethamine(diluted to 10 ml)injection pumped 15 mi-nutes before induction of anesthesia,and group NA received 50 ml of NS injection and 0.2 mg/kg of nalbu-phine(diluted to 10 ml)injection pumped at the same time.Postoperative pain was recorded 0.5,3,6,12,and 24 hours after surgery using VAS pain scores(the non-inferiority boundary Δ = 1.0 score).The sleep quality score on the night of surgery,the number of remedial analgesia cases within 24 hours after sur-gery,the Ramsay sedation score 0.5,3,and 6 hours after surgery,the occurrence of adverse reactions such as nausea and vomiting within 24 hours after surgery,and the overall satisfaction of patients were recorded.Results Compared with group NA,the VAS pain scores 0.5 hour after surgery was reduced in group AK(P＜0.05).The sleep quality score and overall satisfaction in group AK were significantly higher than those in group NA(P＜0.05).There were no significant differences in the rate of remedial analgesia,the score of Ramsay sedation at different time points and the incidence of nausea and vomiting within 24 hours after surgery between the two groups.Conclusion Acetaminophen combined with ketorolac tromethamine is not less effective than nalbuphine in relieving early postoperative pain after laparoscopic cholecystectomy without increasing the incidence of nausea and vomiting.Patients receiving acetaminophen combined with ketorolac tromethamine have higher sleep quality scores on the night of surgery and overall satisfaction.

Effect of right stellate ganglion block on shoulder pain after laparoscopic cholecystectomy / 临床麻醉学杂志

Objective To investigate the effect of right stellate ganglion block(SGB)on postoper-ative shoulder pain in patients receiving laparoscopic cholecystectomy(LC).Methods A total of 104 pa-tients scheduled for LC from April to August 2022,32 males and 72 females,aged 18-64 years,ASA phys-ical status Ⅰ orⅡ,were selected and randomized into two groups:the stellate ganglion block group(group S,n = 51)and the control group(group C,n = 53).Immediately after intubation,0.2%ropivacaine 4 ml was used for ultrasound-guided right SGB in group S,and saline 4 ml was injected at the same site in group C.The number of cases of post-laparoscopic shoulder pain(PLSP)and the duration of PLSP were re-corded within 48 hours after operation.The VAS pain scores of PLSP were recorded to assess the level of PLSP immediately after operation(T1),2 hours after operation(T2),6 hours after operation(T3),12 hours after operation(T4),24 hours after operation(T5),and 48 hours after operation(T6).The number of effective compressions of the PCIA pump and the salvage analgesia were recorded.The adverse reactions such as nausea,vomiting,and abdominal distension were recorded.Results The incidence of PLSP and the rate of patients with PLSP lasting more than 10 hours in group S was significantly lower than those in group C(P＜0.05),and the degree of PLSP in group S was significantly lower than that in group C at T3-T5(P＜0.05).The number of effective compressions of the PCIA pump and the salvage analgesia rate in group S was significantly lower than those in group C(P＜0.05).The incidence of nausea in group S was significantly lower than that in group C(P＜0.05).Conclusion Right stellate ganglion block can reduce the incidence of PLSP in patients receiving LC,relieve the pain degree of PLSP,and reduce the incidence of adverse reactions.

The application of indocyanine green fluorescence imaging in laparoscopic cholecystectomy for Mirizzi syndrome types Ⅱ and Ⅲ / 中华肝胆外科杂志

Objective:To analyze the clinical value of indocyanine green (ICC) fluorescence imaging in Mirizzi syndrome type Ⅱ-Ⅲ laparoscopic cholecystectomy (LC).Methods:A retrospective analysis was performed on 80 patients diagnosed with Mirizzi syndrome types Ⅱ-Ⅲ who underdoing LC in Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from October 2018 to February 2022, including 32 males and 48 females, aged (63.5±6.9) years. Patients were divided into two groups based on whether ICG fluorescence imaging technology was used, the control group ( n=38) that patients were treated with conventional LC and the experimental group ( n=42) patients were treated with LC guided by ICG fluorescence imaging. In the experimental group, the extrahepatic bile duct was identified by ICG fluorescence imaging during LC, and ICG was injected intraoperally to determine the reserved blood flow of gallbladder flap for fluorescence imaging and determine the resection line. Operation time, intraoperative blood loss, conversion rate of laparotomy and postoperative complications (bile leakage, incision infection, etc.) were compared between the two groups. Intraoperative fluorescence imaging and determination of the modified resection line of reserved gallbladder were analyzed in the observation group. Results:There was no significant difference in age, male proportion, type of Mirizzi syndrome and conversion rate of laparotomy between the two groups (all P>0.05). In the observation group, the operative time was (208.7±32.0) min, the intraoperative blood loss was (50.5±23.8) ml, and the biliary leakage was 7.1% (3/42), which was lower than that in the control group (228.2±33.9) min, (73.8±31.0) ml, 26.3% (10/38). The differences were statistically significant (all P<0.05). Of 37 cases (88%) showed common hepatic duct and common bile duct successfully in the observation group. In the observation group, ICG fluorescence imaging was used to determine the gallbladder resection line in 8 cases (19.0%). The gallbladder flap without fluorescence imaging was removed. Conclusion:ICG fluorescence imaging in LC for Mirizzi syndrome patients can identify the common bile duct and hepatic duct to guide surgical resection, determine the gallbladder flap resection line, reduce postoperative bile leakage and bleeding, and accelerate the surgical progress.

Efficacy of electroacupuncture on the recovery of gastrointestinal function after laparoscopic cholecystectomy:a systematic review / 针灸推拿医学（英文版）

Objective:To evaluate the efficacy of electroacupuncture(EA)in enhancing the recovery of gastrointestinal function after laparoscopic cholecystectomy(LC). Methods:Randomized controlled trials(RCTs)of EA treatment in the postoperative period of patients undergoing LC were searched.Studies were obtained from Excerpta Medica Database(EMBASE),PubMed,Cochrane Library,Wanfang Academic Journal Full-text Database(Wanfang),China National Knowledge Infrastructure(CNKI),China Biology Medicine Disc(CBM),and Chongqing VIP Database(CQVIP)from inception to December 10th,2022.RevMan 5.4.1 was used to perform the meta-analysis.The Cochrane tool was used to assess the risk of bias.Mean difference(MD)and confidence interval(CI)were used for statistical descriptions. Results:A total of 7 studies were included in the meta-analysis.The meta-analysis found that the EA group had a shorter time to the first flatus[P<0.001,MD=-5.32,95%CI(-6.42,-4.21)],bowel movement recovery[P<0.001,MD=-6.22,95%CI(-8.11,-4.34)],and the first defecation(P<0.001,MD=-11.08,95%CI(-15.78,-6.39)]than the control group. Conclusion:EA treatments can promote the recovery of gastrointestinal function after LC.

Giant adenoma of the gallbladder misdiagnosed as gallbladder carcinoma： A case report / 临床肝胆病杂志

One patient with gallbladder mass had transient jaundice and was diagnosed with gallbladder carcinoma by abdominal ultrasonography， contrast-enhanced CT， MRCP， and PET-CT. Surgical exploration showed enlarged gallbladder and a mass in the neck of the gallbladder pressing against the hilum of the liver， with no manifestation of tumor invasion， and there were no signs of liver metastasis. Only cholecystectomy was performed for the patient. The pathological diagnosis was tubular adenoma of the gallbladder without carcinogenesis. This case is characterized by a large gallbladder tumor， without marginal infiltration on imaging or malignant transformation based on pathology.

The role of virtual reality simulation training in laparoscopic skills training for young physicians / 中华医学教育探索杂志

Objective:To explore the significance of laparoscopic virtual reality simulation training by analyzing the learning curve of laparoscopic cholecystectomy among young general surgeons who had participated in laparoscopic skills training at our hospital.Methods:Fifty young surgeons were divided into two groups, with the intervention group participating in virtual reality simulation training and the control group participating in traditional laparoscopic clinical training. After completion of the training, 30 laparoscopic cholecystectomies were performed under the supervision of highly qualified surgeons with extensive laparoscopic experience. CUSUM analysis was applied to plot the trainees' surgical learning curve based on the completion rate, surgical score and operative time. " x" is the number of surgical cases and " k" is the slope. The value of x when k=0 was calculated and the surgical learning curves and intraoperative scores of the 2 groups of trainees were compared. SPSS 23.00 was performed for t-test and Chi-square test. Results:The intervention and control groups crossed the surgical learning curve at x=19.24±0.39 and x=21.72±0.73 respectively, with significant differences ( P<0.01); the intervention and control groups scored (10.82±2.73) and (9.71±2.69) for gallbladder exposure ( t=4.61, P<0.01), (12.59±3.12) and (8.87±2.99) for gallbladder dissection triangle ( t=6.21, P<0.01), and (10.69±3.38) and (8.80±3.55) for gallbladder dissection ( t=3.10, P<0.01). Conclusions:Virtual reality simulation training can facilitate the translation of basic laparoscopic training skills into clinical skills and can promote the growth of young general surgeons.