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Turk J Med Sci ; 51(6): 3067-3072, 2021 12 13.
Article in English | MEDLINE | ID: covidwho-1737119


Background/aim: Plastic biliary stents that remain in situ for more than 12 months, called forgotten biliary stents (FBSs), can cause complications such as cholangitis, stent migration, stent occlusion, and perforation. Materials and methods: The medical records of patients who underwent ERCP procedures from December 2016 to December 2020 were analysed retrospectively. Data on patient characteristics, indications for ERCP and stenting, stent types, stenting duration, complications, and causes of FBSs were obtained from the hospital's database. Results: A total of 48 cases with FBSs were analysed. The mean age (SD) of the patients was 71.23 years (±12.165), the male-to-female ratio was 23/25 (0.92), and the mean stenting duration was 27.12 months (range: 12­84 months). The most common indication for biliary stenting was irretrievable choledochal stones (40/48). Stone formation (79%) and proximal stent migration (26.4%) were the most frequent complications. The patients in the FBS group were significantly older than those from whom stents were removed in a timely manner (71.23 vs. 62.43 years, p < 0.001). Endoscopic treatment was possible in all cases; surgery was not required in any case. The most common cause of FBSs cited by patients was not having been informed about the need for long-term management of their stents (n = 14, 29.2%) Conclusion: FBSs are potentially problematic particularly in elderly patients. Communication with the patient to remind them of the need for stent management is important for preventing FBSs.

Biliary Tract Surgical Procedures/adverse effects , Cholelithiasis/surgery , Gallstones/surgery , Stents/adverse effects , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholelithiasis/diagnosis , Female , Foreign Bodies , Humans , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Treatment Outcome
Scand J Surg ; 111(1): 14574969211070389, 2022.
Article in English | MEDLINE | ID: covidwho-1701478


BACKGROUND: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. METHODS: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. RESULTS: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). CONCLUSIONS: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a continuation of a long-term trend toward more acute surgery remains unanswered. Further studies are needed to assess and evaluate how this has affected public health and health economics.

COVID-19 , Gallstones , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Female , Gallstones/complications , Gallstones/epidemiology , Gallstones/surgery , Humans , Male , Pandemics , SARS-CoV-2 , Sweden/epidemiology
BMJ Case Rep ; 13(12)2020 Dec 22.
Article in English | MEDLINE | ID: covidwho-1020892


An 87-year-old woman presented to us with a 5-day history of worsening epigastric pain and vomiting. Her medical history included known gallstones and a previous episode of acute cholecystitis complicated by a perforated gallbladder for which she had declined surgery 5 years prior. Radiological imaging confirmed a large gallstone impacted in the first part of the duodenum with gross gastric outlet obstruction and pneumobilia, confirming the diagnosis of Bouveret syndrome, an often overlooked and rare variant of gallstone ileus. Following an unsuccessful oesophagogastroduodenoscopy for stone retrieval, she underwent a laparotomy and gastrotomy with a successful outcome and discharged from hospital 4 weeks following the procedure.

Duodenal Obstruction/diagnosis , Gallstones/complications , Gastric Outlet Obstruction/diagnosis , Ileus/diagnosis , Aged, 80 and over , Duodenal Obstruction/etiology , Duodenal Obstruction/surgery , Duodenum/diagnostic imaging , Duodenum/surgery , Endoscopy, Digestive System , Female , Gallbladder/diagnostic imaging , Gallstones/diagnosis , Gallstones/surgery , Gastric Outlet Obstruction/etiology , Gastric Outlet Obstruction/surgery , Humans , Ileus/etiology , Ileus/surgery , Stomach/diagnostic imaging , Stomach/surgery , Syndrome , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography