ABSTRACT
OBJECTIVE: This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications. SUMMARY BACKGROUND DATA: Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level. METHODS: A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes. RESULTS: Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4,263 (19.7%), and 6,622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1,738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients and severe bile duct injuries (Strasberg grades B-E) were reported in 48 (0.2%) patients. Patient age, ASA physical status class, surgical setting, operative approach and Nassar operative difficulty grade were identified as the five predictors demonstrating the highest relative importance in predicting postoperative complications. CONCLUSION: This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy.
ABSTRACT
Introduction: Congenital renal arteriovenous fistula is an abnormal connection between the arterial and venous system. Since the first case described in 1928 by Varela et al, no more than 200 cases have been published. Material and methods: A 45-year-old woman consulted for severe abdominal and low-back pain associated with arterial hypertension. The CT scan showed an infrarenal retroperitoneal lesion with invasion of neighboring structures. Results: During the abdominal exploration, a vascular-looking lesion of 60 x 34 x 41 mm was identified. It was associated with right nephrectomy. Discussion: The etiology of congenital fistulas remains unknown; it is believed that a congenital arterial aneurysm erodes into an adjacent vein and gradually increases its size. Other authors believe that the fistula exists since birth and gradually increases its size until it causes symptoms. Conclusion: Congenital arteriovenous fistulas are rare entities, representing less than 25% of all renal arteriovenous malformations.
Introducción: La fístula arteriovenosa renal congénita es una conexión anómala entre el sistema arterial y venoso. Desde el primer caso descrito en 1928 por Varela y cols, no más de 200 casos han sido publicados. Material y Método: Mujer de 45 años consultó por dolor abdominal y lumbar severo, asociado a hipertensión arterial. En tomografía computada se observó lesión retroperitoneal infrarrenal con invasión de estructuras vecinas. Resultados: En exploración abdominal se identificó lesión de aspecto vascular de 60 x 34 x 41 mm. Se asoció a nefrectomía derecha. Discusión: La etiología de las fístulas congénitas sigue siendo desconocida, se cree que un aneurisma arterial congénito erosiona hacia una vena adyacente y aumenta su tamaño lentamente. Otros autores creen que la fístula existe desde el nacimiento e incrementa progresivamente de tamaño hasta producir síntomas. Conclusión: Las fístulas arteriovenosas congénitas son entidades raras, representando menos del 25% del total de las malformaciones arteriovenosas renales.
