Laparoscopic Common Bile Duct Exploration for Treatment of Common Bile Duct Stones:Clinical Analysis of 158 Cases / 中国医学科学院学报

Objective To evaluate the safety and effectiveness of laparoscopic common bile duct exploration in the treatment of common bile duct stones. Methods A retrospective analysis was conducted for 158 patients with cholecystolithiasis and choledocholithiasis admitted to the Number One Hospital of Zhangjiakou from January 2015 to December 2019.The patients were assigned into three groups according to the diameters of cystic duct and common bile duct,degrees of abdominal infection and tissue edema,and operation method.Group A(16 cases):laparoscopic cholecystectomy,transcystic choledochoscopic exploration for stone removal;Group B(94 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,T tube drainage;Group C(48 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,primary closure of the common bile duct.The operation time,residual rate of stones,and complication(bleeding,bile leakage,and wound infection) rate were compared between groups. Results The operation time of groups A,B,and C was(95.1±14.7),(102.2±18.1),(110.1±16.4) minutes,respectively,which showed no statistical difference between each other(F=0.020,P=0.887).One case in group A had residual stones,while no residual stone appeared in groups B and C.The overall stone clearance rate was 99.4% and the overall complication rate was 1.9%.There was no perioperative death. Conclusion It is generally safe and effective to carry out laparoscopic cholecystectomy and common bile duct exploration for stone removal in suitable populations.

Consensus on the surgical management of benign gallbladder diseases(2021 edition) / 中华外科杂志

Benign gallbladder diseases are common in surgery department,and the incidence rate is increasing in recent years.Currently,nonstandard treatment existed in the surgical management of benign gallbladder diseases in China.Based on relevant domestic and foreign literature,guidelines,and expert consensus,this consensus expounds on the diagnosis and surgical treatment of common benign gallbladder diseases such as gallstone,cholecystitis,gallbladder polypoid,gallbladder adenomyosis,gallbladder variation and deformity,complications after cholecystectomy.Further,recommendations related to diagnosis and treatment were presented to improve the standardization of surgical diagnosis and treatment of benign gallbladder diseases in China,so as to eliminate the clinical harm of gallbladder diseases and reduce the incidence rate of gallbladder cancer and prevent the occurrence.

Íleo biliar, una causa poco frecuente de oclusión intestinal / Gallstone Ileus, A Rare Cause of Intestinal Occlusion

RESUMEN Introducción: El íleo biliar representa el 4 por ciento de las causas de obstrucción intestinal en la población general. Objetivo: Mostrar un paciente con cuadro de oclusión intestinal por íleo biliar que fue diagnosticado y tratado en el transoperatorio. Caso clínico: Paciente de 78 años de edad con un cuadro oclusivo por un íleo biliar, al cual se le realizó enterolitotomía como tratamiento definitivo. Conclusiones: El íleo biliar es una causa de oclusión intestinal que todo cirujano general debe tener presente ante un anciano con elementos clínicos e imaginológicos de oclusión y sin intervenciones quirúrgicas previas o hernias de la pared abdominal(AU)

ABSTRACT Introduction: Gallstone ileus represents 4 percent of the causes of intestinal obstruction in the general population. Objective: To present a patient with intestinal obstruction due to gallstone ileus and who was diagnosed and treated during the intraoperative period. Clinical case: The is presented of a 78-year-old patient with an occlusive condition due to gallstone ileus, who underwent enterolithotomy as definitive management procedure. Conclusions: Gallstone ileus is a cause of intestinal occlusion that every general surgeon should be aware of in the presence of an elderly with clinical and imaging elements of occlusion and without previous surgical interventions or hernias of the abdominal wall(AU)

Puntos críticos en la evaluación y tratamiento de octogenarios con colecistolitiasis / Critical points in the evaluation and treatment of octogenarians with colecistolitiasis

Resumen Introducción: Existe una tendencia global al envejecimiento y con ello un aumento de patologías asociadas. En Chile la prevalencia de la colelitiasis o colecistolitiasis aumenta con la edad, siendo la cole-cistectomía una de las cirugías más frecuentes. Existen escasos estudios latinoamericanos referentes a la realidad de la población octogenaria expuesta a este problema. Objetivo: Estudiar la morbimortalidad posoperatoria en pacientes octogenarios operados de colecistectomía. Definir la precisión de distintas herramientas diagnósticas preoperatorias, estudiar variables operatorias y precisar costos hospitalarios. Materiales y Método: Estudio observacional retrospectivo de la ficha clínica electrónica del Hospital Clínico de la Universidad de Chile, entre enero de 2012 y mayo de 2017. Se incluyeron pacientes con edad igual o mayor a 80 años, en quienes se realizó una colecistectomía electiva o de urgencia por patología benigna. Resultados: Se incluyeron 145 pacientes, 51,7% fueron mujeres, el promedio de edad fue de 84,1 años y un 74,5% presentaba comorbilidades. El 62,1% de los casos ingresó por urgencia. 26,2% de toda la muestra presentó coledocolitiasis. La colecistectomía fue laparoscópica en 73,8% de la muestra global, la tasa de conversión fue de 14,5% en población de urgencia y 1,8% en población electiva (p = 0,009). La población operada totalmente por vía laparoscópica con coledocolitiasis fue resuelta en un 95,2% a través de Rendez-vous, con una tasa de éxito del 100%. La tasa de complicaciones fue de 17,9% siendo en su mayoría médicas, la mortalidad quirúrgica fue de 2,1%, siendo todos casos de urgencia. El costo promedio de atención en salud hospitalaria fue de $5.888.104 pesos chilenos (U$9.000). Conclusión: El paciente octogenario con colecistolitiasis representa un desafío quirúrgico, dado un mayor número de comorbilidades, un cuadro clínico más agresivo y una elevada tasa de coledocolitiasis. Es aconsejable valorar el abordaje mínimamente invasivo y realizar una colangiografía intraoperatoria de rutina.

Introduction: There is a global tendency to aging and associated pathologies. In Chile, the prevalence of cholecystolithiasis increases with age, cholecystectomy is one of the most frequent surgeries in the contry. There are few latinamerican studies regarding the reality of the elderly exposed to this problem. Objective: Study postoperative morbimortality in octogenarian patients undergoing cholecystectomy. Define the accuracy of different preoperative diagnostic tools, study operative variables and specify hospital costs. Materials and Method: Retrospective observational study of the Clinical Hospital of the University of Chile, between January 2012 and May 2017. Patients with age equal to or greater than 80 years were included, in whom an elective or emergency cholecystectomy was performed for benign pathology. Results: A total of 145 patients were included, 51.7% were women, the average age was 84.1 years, and 74.5% had comorbidities. The admission was throw the emergency department in 62.1% of the cases. Choledocholithiasis was diagnosed in 26.2% of the entire sample. Cholecystectomy was fully laparoscopic in 73.8% of the overall sample, the conversion rate was 14.5% in the emergency population and 1.8% in the elective population (p = 0.009). The population operated fully laparoscopically, that had choledocholithiasis, was resolved in 95.2% through Rendezvous technique, with a 100% clearance rate of common bile duct. The complication rate was 17.9%, most being medical. The surgical mortality was 2.1%, all cases operated from emergency. The average cost of hospital health care was $5,888,104.3 Chilean pesos (U$9.000). Conclusion: The octogenarian patient with cholecystolithiasis represents a surgical challenge, given a greater number of comorbidities, a more aggressive clinical setting and a high rate of choledocolithiasis. It is advisable to assess the minimally invasive approach and perform routine intraoperative cholangiography. In the postoperative period, the cardiopulmonary status and the infectious complications of the surgical site should be monitored closely.

Fatores de risco para morbimortalidade em colecistectomia videolaparoscópica eletiva em idosos / Risk factors for elective laparoscopic cholecystectomy morbimortality in elderly

RESUMO Objetivo: identificar fatores de risco para a ocorrência de complicações pós-operatórias em colecistectomias videolaparoscópicas (CVL) em pacientes idosos. Métodos: estudo observacional com análise de prontuários médicos de pacientes com idade igual ou superior a 60 anos, submetidos à colecistectomia videolaparoscópica eletiva no Hospital Universitário Gaffrée e Guinle, entre os anos de 2006 e 2018. Cirurgias realizadas em regime de emergência ou convertidas para a técnica convencional foram excluídas do estudo. Resultados: foram incluídos no estudo 345 pacientes, sendo 80% do sexo feminino e 62% com idade entre 60 e 69 anos. Houve 39 casos de complicações pós-operatórias (11,3%), em sua maioria (87%) classificadas como tipo I ou II da escala de complicações cirúrgicas de Clavien-Dindo. Houve somente um caso de óbito. Presença e quantidade de doenças coexistentes e classificação de estado físico ASA II ou III conferiram risco maior para o desenvolvimento de complicações e mortalidade pós-operatórias. Conclusão: o estudo identificou a presença de doenças coexistentes e a gravidade das mesmas, segundo a classificação ASA, como fatores de risco para o desenvolvimento de complicações no pós-operatório de colecistectomias videolaparoscópicas em pacientes idosos. Entretanto, a CVL se mostrou uma técnica segura quando empregada nestes pacientes com taxas de morbimortalidade baixas.

ABSTRACT Objective: to identify risk factors for the occurrence of postoperative complications in laparoscopic cholecystectomies (LC) in elderly patients. Methods: an observational study with analysis of medical records of patients aged 60 years and older, submitted to elective LC at Gaffree e Guinle Universitary Hospital, from 2006 to 2018. Surgeries performed on an emergency basis or converted to the conventional technique were excluded from our study. Results: a total of 345 patients were included in our study, being 80% females and 62% aged 60-69 years. There were 39 cases of postoperative complications (11.3%), mostly (87%) classified as grades I or II of Clavien-Dindo surgical complication scale. There was only one death. The presence and the number of coexisting diseases and ASA II or III physical status classification of preoperative patients conferred a greater risk for the development of postoperative complications and mortality. Conclusion: our study identified the presence of coexisting diseases, as well as their severity, according to ASA classification, as risk factors for the development of postoperative complications of LC in elderly patients. However, LC proved to be a safe technique when used in these patients with low morbidity and mortality rates.

Outcome of laparoscopic cholecystectomy in patients with gallstone disease at a secondary level care hospital / Resultados da colecistectomia laparoscópica em pacientes com doença biliar em um hospital de nível secundário

ABSTRACT Background: Laparoscopic cholecystectomy is the most commonly performed operation of the digestive tract. )It is considered as the gold standard treatment for cholelithiasis. Aim: To evaluate the outcome of it regarding length of hospital stay, complications, morbidity and mortality at a secondary hospital. Methods: Data of 492 patients who underwent laparoscopic cholecystectomy were retrospectively reviewed. Patients' demographics, co-morbid diseases, previous abdominal surgery, conversion to open cholecystectomy, operative time, intra and postoperative complications, and hospital stay were collected and analyzed from patients' files. Results: Out of 492 patients, 386 (78.5%) were females and 106 (21.5%) males. The mean age of the patients was 49.35±8.68 years. Mean operative time was 65.94±11.52 min. Twenty-four cases (4.9%) were converted to open surgery, four due to obscure anatomy (0.8%), 11 due to difficult dissection in Calot's triangle (2.2%) and nine by bleeding (1.8%). Twelve (2.4%) cases had biliary leakage, seven (1.4%) due to partial tear in common bile duct, the other five due to slipped cystic duct stables. Mean hospital stay was 2.6±1.5 days. Twenty-one (4.3%) developed wound infection. Port site hernia was detected in nine (1.8%) patients. There was no cases of bowel injury or spilled gallstones. There was no mortality recorded in this series. Conclusions: Laparoscopic cholecystectomy is a safe and effective line for management of gallstone disease that can be performed with acceptable morbidity at a secondary hospital.

RESUMO Racional: A colecistectomia laparoscópica é a operação mais comum do aparelho digestivo. É considerada como o tratamento padrão-ouro para colecistolitíase. Objetivo: Avaliar o resultado dela quanto ao tempo de internação, complicações, morbidade e mortalidade em um hospital secundário. Métodos: Foram analisados ​​retrospectivamente dados de 492 doentes submetidos à colecistectomia laparoscópica. Os dados demográficos, as comorbidades, operação abdominal prévia, conversão para colecistectomia laparotômica, tempo cirúrgico, complicações intra e pós-operatórias e internação hospitalar foram coletados e analisados ​​a partir dos prontuários. Resultados: Dos 492 pacientes, 386 (78,5%) eram mulheres e 106 (21,5%) homens. A idade média foi de 49,35±8,68 anos. O tempo operatório médio foi de 65,94±11,52 min. Vinte e quatro casos (4,9%) foram convertidos em laparotomia quatro devido à anatomia obscura (0,8%), 11 por dissecção difícil no triângulo de Calot (2,2%) e nove por sangramento (1,8%). Doze (2,4%) casos apresentaram vazamento biliar, sendo sete (1,4%) devido a ruptura parcial do ducto biliar comum, e os outros cinco por soltura da clipagem do ducto cístico. A média de internação foi de 2,6±1,5 dias. Vinte e um (4,3%) pacientes desenvolveram infecção da ferida. Hérnia do local dos portais foi detectada em nove (1,8%) pacientes. Não houve casos de lesão intestinal ou cálculos biliares soltos na cavidade. Não houve mortalidade Conclusões: Colecistectomia laparoscópica é operação segura e eficaz no tratamento da colecistolitíase e pode ser realizada com morbidade aceitável em hospitais secundários.

A New Paradigm in Gallstones Diseases and Marked Elevation of Transaminases: An Observational Study

ABSTRACT Background. In clinical practice, it is assumed that a severe rise in transaminases is caused by ischemic, viral or toxic hepatitis. Nevertheless, cases of biliary obstruction have increasingly been associated with significant hypertransaminemia. With this study, we sought to determine the true etiology of marked rise in transaminases levels, in the context of an emergency department. Material and methods. We retrospectively identified all patients admitted to the emergency unit at Centro Hospitalar e Universitário de Coimbra between 1st January 2010 and 31st December 2010, displaying an increase of at least one of the transaminases by more than 15 times. All patient records were analyzed in order to determine the cause of hypertransaminemia. Results. We analyzed 273 patients - 146 males, mean age 65.1 ± 19.4 years. The most frequently etiology found for marked hypertransaminemia was pancreaticobiliary acute disease (n = 142;39.4%), mostly lithiasic (n = 113;79.6%), followed by malignancy (n = 74;20.6%), ischemic hepatitis (n = 61;17.0%), acute primary hepatocellular disease (n = 50;13.9%) and muscle damage (n = 23;6.4%). We were not able to determine a diagnosis for 10 cases. There were 27 cases of recurrence in the lithiasic pancreaticobiliary pathology group. Recurrence was more frequent in the group of patients who had not been submitted to early cholecystectomy after the first episode of biliary obstruction (p = 0.014). The etiology of hypertransaminemia varied according to age, cholestasis and glutamic-pyruvic transaminase values. Conclusion. Pancreaticobiliary lithiasis is the main cause of marked hypertransaminemia. Hence, it must be considered when dealing with such situations. Not performing cholecystectomy early on, after the first episode of biliary obstruction, may lead to recurrence.

Obstrucción colónica por cálculo / Colonic obstruction by gallstone

El íleo biliar es una rara complicación de la colelitiasis, que se caracteriza por presentar clínicamente una obstrucción intestinal mecánica intraluminal, secundaria a la impactación de un cálculo biliar en el tubo digestivo, debido a la existencia de una fístula bilio-entérica. El diagnóstico preoperatorio es difícil, ya que presenta síntomas y signos de obstrucción intestinal, los cuales son muy inespecíficos para sospechar un íleo biliar. El tratamiento de elección en el manejo del íleo biliar es el quirúrgico. Habitualmente se realiza una cirugía en dos tiempos, enterolitotomía como único gesto, sin embargo no hay una técnica quirúrgica definitiva estandarizada. Presentamos el caso de una paciente de 70 años que acude al Departamento de Urgencias con el diagnóstico clínico de obstrucción intestinal mecánica baja, de cuatro días de evolución, como consecuencia de un cálculo impactado en colon sigmoides.

Gallstone ileus is a rare complication of cholelithiasis, which is characterized by clinically presenting as an intraluminal mechanical intestinal obstruction secondary to the impaction of a gallstone in the digestive tract, due to the existence of a biliary-enteric fistula. The preoperative diagnosis is difficult, since it presents symptoms and signs of intestinal obstruction, which are very unspecific to suspect a Biliary Ileus. The treatment of choice in the management of gallstone ileus is surgery; usually is performed in two stages, whole lithotomy as the only gesture, however there is no standardized definitive surgical technique. We present the case of a 70-year-old patient, who attended the emergency department with the clinical diagnosis of low mechanical bowel obstruction, four days of evolution, as a result of a stone impacted in the sigmoid colon.

First Case Report of Bacteremia Due to Catabacter hongkongensis in a Korean Patient

No abstract available.

Open Surgery versus Endoscopic Intervention in the Management of Bile Duct Stones

Background: Choledocholithiasis or the presence of common bile duct stones [CBDS] is one of the medical conditions that requires surgical intervention

The management of Choledocholithiasis has evolved from open common bile duct exploration [OCBDE] to therapeutic endoscopic retrograde cholangiopancreatography [ERCP] to laparoscopic common bile duct exploration [LCBDE]. Each entails a degree of difficulty. In this review we aim to assess and compare the benefits and pitfalls of open surgery [OCBDE] versus endoscopic retrograde cholangiopancreatography [ERCP] in management of common bile duct stones

Methods: A systematic review of the electronically searched publications of the scientific literature. We searched the Cochrane HepatoBiliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE [1946 to 2016], EMBASE [1974 to 2016], and Science Citation Index Expanded [1900 to 2016]. Initially all randomized clinical trials which compared the results from open surgery versus endoscopic clearance for common bile duct stones were included, articles were selectively screened according to the eligibility criteria

Results: eight publications were selectively included with 761 participants compared to open surgical clearance with ERCP. All trials had a high risk of bias. There was no significant difference in the mortality between open surgery versus ERCP clearance [eight trials; 733 participants; 5/371 [1%] versus 10/358 [3%] OR 0.51;95% CI 0.18 to 1.44]. Neither was there a significant difference in the morbidity between open surgery versus ERCP clearance [eight trials; 733 participants; 76/371 [20%] versus 67/358 [19%] OR 1.12; 95% CI 0.77 to 1.62]

Participants in the open surgery group had significantly fewer retained stones compared with the ERCP group [seven trials; 609 participants; 20/313 [6%] versus 47/296 [16%] OR 0.36; 95% CI 0.21 to 0.62], P = 0.0002. Meta-analysis of the outcomes duration of hospital stay, quality of life, and cost of the procedures could not be performed due to lack of data

Conclusion: open surgery intervention in order to remove the gallbladder and trapped gallstones appears to be as safe as endoscopy and further suggested to be more successful than the endoscopic technique in clearing the duct stones

Primary adenosquamous carcinoma of the liver: a case report

Adenosquamous carcinoma of the liver is a rare variant of cholangiocarcinoma. It is known to be a highly aggressive tumor with a poor prognosis, but its pathogenesis remains unclear owing to limited data in the literature. We report a case of 56-year-old woman who presented with a 1-week history of epigastric pain. Magnetic resonance imaging revealed a 6.5-cm ill-defined mass with low signal intensity in the left lobe of the liver, which was suspicious of cholangiocarcinoma. The patient underwent left hemihepatectomy. Microscopically, the tumor consisted of malignant glandular and squamous components and staged as pT2aN1. Despite postoperative chemoradiation, the patient had recurrence 8 months after surgery.

Percutaneous treatment of complex biliary stone disease using endourological technique and literature review / Tratamento percutâneo da litíase biliar complexa intra-hepática com técnica endourológica e revisão da literatura

Most biliary stone diseases need to be treated surgically. However, in special cases that traditional biliary tract endoscopic access is not allowed, a multidisciplinary approach using hybrid technique with urologic instrumental constitute a treatment option. We report a case of a patient with complex intrahepatic stones who previously underwent unsuccessful conventional approaches, and who symptoms resolved after treatment with hybrid technique using an endourologic technology. We conducted an extensive literature review until October 2012 of manuscripts indexed in PubMed on the treatment of complex gallstones with hybrid technique. The multidisciplinary approach with hybrid technique using endourologic instrumental represents a safe and effective treatment option for patients with complex biliary stone who cannot conduct treatment with conventional methods.

A maioria das doenças litiásicas das vias biliares necessita de tratamento cirúrgico. No entanto, em casos especiais, que não permitem o acesso tradicional das vias biliares por via endoscópica, a abordagem multidisciplinar com técnica híbrida, que utiliza instrumentais endourológicos, apresenta-se como uma opção no tratamento. Relatamos aqui o caso de um paciente com litíase de via biliar complexa com múltiplas abordagens prévias, sem sucesso no tratamento com métodos convencionais, resolvido com abordagem híbrida com tecnologia endourológica. Realizamos uma extensa busca na literatura de artigos relacionados ao tratamento de litíase biliar complexa com técnica híbrida publicados no PubMed até outubro de 2012. A abordagem multidisciplinar com técnica híbrida, utilizando instrumental endourológico, representa uma opção segura e eficaz no tratamento de pacientes com litíase complexa de via biliar com impossibilidade de tratamento com métodos convencionais.

Prevalence of gallstones in 1,229 patients submitted to surgical laparoscopic treatment of GERD and esophageal achalasia: associated cholecystectomy was a safe procedure / Prevalência de colelitíase em 1.229 pacientes submetidos ao tratamento cirúrgico laparoscópico de DRGE e megaesôfago: a colecistectomia associada mostra-se segura

BACKGROUND: Association between esophageal achalasia/ gastroesophageal reflux disease (GERD) and cholelithiasis is not clear. Epidemiological data are controversial due to different methodologies applied, the regional differences and the number of patients involved. Results of concomitant cholecistectomy associated to surgical treatment of both diseases regarding safety is poorly understood. AIM: To analyze the prevalence of cholelithiasis in patients with esophageal achalasia and gastroesophageal reflux submitted to cardiomyotomy or fundoplication. Also, to evaluate the safety of concomitant cholecistectomy. METHODS: Retrospective analysis of 1410 patients operated from 2000 to 2013. They were divided into two groups: patients with GERD submitted to laparocopic hiatoplasty plus Nissen fundoplication and patients with esophageal achalasia to laparoscopic cardiomyotomy plus partial fundoplication. It was collected epidemiological data, specific diagnosis and subgroups, the presence or absence of gallstones, surgical procedure, operative and clinical complications and mortality. All groups/subgroups were compared. RESULTS: From 1,229 patients with GERD or esophageal achalasia, submitted to laparoscopic cardiomyotomy or fundoplication, 138 (11.43%) had cholelitiasis, occurring more in females (2.38:1) with mean age of 50,27 years old. In 604 patients with GERD, 79 (13,08%) had cholelitiasis. Lower prevalence occurred in Barrett's esophagus patients 7/105 (6.67%) (p=0.037). In 625 with esophageal achalasia, 59 (9.44%) had cholelitiasis, with no difference between chagasic and idiopathic forms (p=0.677). Complications of patients with or without cholecystectomy were similar in fundoplication and cardiomyotomy (p=0.78 and p=1.00).There was no mortality or complications related to cholecystectomy in this series. CONCLUSIONS: Prevalence of cholelithiasis was higher in patients submitted to fundoplication (GERD). Patients with chagasic or idiopatic ...

RACIONAL: São controversas as relações entre megaesôfago e doença do refluxo gastroesofágico (DRGE) com colelitíase, especialmente a forma mais adequada de conduzir pacientes com ambas. Dados epidemiológicos são díspares devido às diversas metodologias aplicadas, às diferenças regionais e à quantidade de pacientes envolvidos. OBJETIVO: Estudar a prevalência de colelitíase em pacientes submetidos às operações de refluxo gastroesofágico e megaesôfago (chagásicos ou não) e a segurança da colecistectomia estar associada. MÉTODO: Análise retrospectiva de 1410 pacientes operados entre 2000 e 2013. Eles foram divididos em dois grupos: os com DRGE e operados por hiatoplastia/fundoplicatura a Nissen laparoscópicas e os com acalásia por cardiomiotomia e fundoplicatura parcial laparoscópicas. Foram coletados dados epidemiológicos, diagnóstico, a presença ou não de litiase biliar, tratamento cirúrgico efetuado, complicações clínicas ou cirúrgicas e mortalidade. Todos os grupos e subgrupos foram comparados. RESULTADOS: Foram estudados 1229 pacientes portadores de megaesôfago e/ou DRGE, operados por fundoplicatura com hiatoplastia, nos casos de DRGE, e cardiomiectomia com fundoplicatura, nos casos de megaesôfago, no período de 2000 a 2013, verificando-se presença de colelítiase ou colecistectomia prévia. A colelítiase ocorreu mais no sexo feminino (2,38:1) e na faixa etária entre os 50 e 70 anos. A prevalência global foi de 11,43%; 13,08% na DRGE, menor nos portadores de esôfago de Barrett (6,67%) sendo a diferença significativa (p=0,037); e 9,44% no megaesôfago, não havendo diferença significativa entre os chagásicos e os idiopáticos (p=0,677). Não houve mortalidade ou complicações relacionadas à colecistectomia nesta série. CONCLUSÕES: A prevalência de colelitíase é maior nos pacientes com DRGE do que nos com megaesôfago. Não há diferenças na prevalência de colelitíase nos pacientes com megaesôfago chagásico e não chagásico. É mais frequente litíase ...

Íleo biliar: um relato de caso / Gallstone ileus: a case report

O presente trabalho relata o caso de uma paciente feminina, de 75 anos, que internou por um quadro de dor em hipocôndrio direito, vômitos e distensão abdominal com 5 dias de evolução. Secundariamente, apresentou rebaixamento do sensório, acidose metabólica, oligoanúria e hipotensão, necessitando de cuidados em unidade de terapia intensiva, com intubação orotraqueal (IOT), vasopressor e hemodiálise. A tomografia de abdome evidenciou presença de aerobilia e um cálculo misto na topografia do segmento ileal do intestino (AU)

This paper reports the case of a 75 y.o. female patient who was admitted for a painful condition in the right hypochondrium, vomiting and abdominal distension with 5 days of evolution. Secondly she presented sensorial loss, metabolic acidosis, oliguria and hypotension, requiring care in intensive care unit, with tracheal intubation (TI), vasopressor and hemodialysis. Abdominal CT scan revealed the presence of aerobilia and a mixed gallstone in the topography of the ileal segment of the intestine (AU)

Percutaneous Papillary Large Balloon Dilation during Percutaneous Cholangioscopic Lithotripsy for the Treatment of Large Bile-Duct Stones: A Feasibility Study

When access to a major duodenal papilla or endoscopic retrograde cholangiopancreatography has failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful for removing common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) during PTCS-L for the removal of large CBD stones has not been established. We aimed to determine the safety and efficacy of PPLBD for the treatment of large CBD stones. Eleven patients with large CBD stones in whom the access to the major papilla or bile duct had failed were enrolled prospectively. Papillary dilation was performed using a large (12-20 mm) dilation balloon catheter via the percutaneous transhepatic route. Post-procedure adverse events and efficacy of the stone retrieval were measured. The initial success rate of PPLBD was 100%. No patient required a basket to remove a stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 min and no adverse events occurred after PPLBD. Asymptomatic hyperamylasemia was not encountered in any patients. This study indicates that PPLBD is safe and effective for removal of large CBD stones.

Percutaneous Papillary Large Balloon Dilation during Percutaneous Cholangioscopic Lithotripsy for the Treatment of Large Bile-Duct Stones: A Feasibility Study

When access to a major duodenal papilla or endoscopic retrograde cholangiopancreatography has failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful for removing common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) during PTCS-L for the removal of large CBD stones has not been established. We aimed to determine the safety and efficacy of PPLBD for the treatment of large CBD stones. Eleven patients with large CBD stones in whom the access to the major papilla or bile duct had failed were enrolled prospectively. Papillary dilation was performed using a large (12-20 mm) dilation balloon catheter via the percutaneous transhepatic route. Post-procedure adverse events and efficacy of the stone retrieval were measured. The initial success rate of PPLBD was 100%. No patient required a basket to remove a stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 min and no adverse events occurred after PPLBD. Asymptomatic hyperamylasemia was not encountered in any patients. This study indicates that PPLBD is safe and effective for removal of large CBD stones.

Recent Advances in the Management of Recurrent Bile Duct Stones / 대한소화기학회지

Approximately 3-15% of patients who have undergone removal of bile duct stones with endoscopic sphincterotomy have recurrence of stones which often presents as acute cholangitis. Despite better understanding on the factors and mechanisms underlying the recurrence of bile duct stones achieved during the past few decades, endoscopic removal still remains the mainstay of management for recurrent bile duct stones. Recently investigated and suggested management of recurrent bile duct stones are highlighted in this review.

El cuidado enfermero como problema ético: concepto y principios prácticos aplicados al acto de cuidado / Nursing care as an ethical problem: concepts and principles applied to the act of caring / O cuidado de enfermagem como problema ético: conceitos e princípios aplicados ao ato de cuidar

En este trabajo los autores estudian la naturaleza del acto del cuidado, destacan la importancia de la ética en las profesiones vinculadas con la salud de las personas y desarrollan, a la luz de la tradición central de la filosofía moral occidental, un conjunto de principios que deben guiar la actividad de la enfermería.

In this paper the authors study the nature of the act of care, emphasize the importance of ethics in the professions related to the health of people and develop, in the light of the central tradition of Western moral philosophy, a set of principles that should guide nursing activity.

Neste trabalho, os autores refletem sobre a natureza do ato de cuidar, enfatizam a importância da ética nas profissões relacionadas com a saúde das pessoas e desenvolvem, à luz da tradição central da filosofia moral ocidental, um conjunto de princípios que deve orientar o trabalho de enfermagem.

Absceso retroperitoneal secundario a litiasis residual intraperitoneal tras una colecistectomía laparoscópica / Retroperitoneal abscess secondary to residual intraperitoneal lithiasis after laparoscopic cholecystectomy

El derrame biliar y la caída de cálculos a la cavidad abdominal es una complicación menor de las colecistectomías laparoscópicas. Sin embargo, puede asociarse a graves complicaciones posoperatorias si no se lava la cavidad y se extraen los cálculos. Se documenta el caso de una paciente operada mediante colecistectomía laparoscópica por litiasis vesicular, en la que se decidió la conversión a cirugía abierta dada la caída de cálculos hacia la cavidad abdominal. En el posoperatorio presentó infección de la herida y fístula cutánea, con salida de cálculos por la herida quirúrgica. Cuatro años después presentó síndrome febril y dolor lumbar, y se diagnosticó entonces un absceso del psoas cuya causa fue la presencia de cálculos biliares que se desplazaron hacia ese sitio. Se intervino quirúrgicamente y se le drenó el absceso por vía posterior. La evolución fue satisfactoria. Estas complicaciones refuerzan la necesidad de una extracción exhaustiva de todos los cálculos que caen a cavidad durante las colecistectomías laparoscópicas(AU)

The biliary effusion and stones falling into the abdominal cavity is a minor complication of laparoscopic cholecystectomy. However, it may be associated to severe postoperative complications if the cavity is not washed and the stones are not removed in a proper way. This is a female patient who underwent laparoscopic cholecystectomy for gallstones, and this time it was decided to resort to open surgery after the falling of stones into the abdominal cavity. In the postoperative phase, she suffered wound infection and cutaneous fistula, with the stones coming out of the surgical wound. Four years after the initial intervention, she presented with fever and back pain. Psoas abscess was then diagnosed; the cause was the presence of gallstones that migrated to that site. He was operated on and abscess drainage was performed through posterior approach. Her subsequent progress was satisfactory. This type of complications necessarily requires the complete removal of all the stones falling into a cavity during laparoscopic cholecystectomies(AU)