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Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive imaging modality for cholecystitis. The gold standard treatment of ...
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Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive imaging modality for cholecystitis. The gold standard treatment of acute cholecystitis is laparoscopic cholecystectomy. Operating early in the disease course decreases overall hospital stay and avoids increased complications, conversion to open procedures, and mortality. Cholecystitis during pregnancy is a challenging problem for surgeons. Operative intervention is generally safe for both mother and fetus, given the improved morbidity of the laparoscopic approach compared with open, although increased caution should be exercised in women with gallstone pancreatitis.
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Xanthogranulomatous cholecystitis (XGC) is one presentation of cholecystitis and can be a cause of difficulty in cholecystectomy. We reviewed the clinical files of 12,426 patients who had undergone cholecystectomy. In this group, ...
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Xanthogranulomatous cholecystitis (XGC) is one presentation of cholecystitis and can be a cause of difficulty in cholecystectomy. We reviewed the clinical files of 12,426 patients who had undergone cholecystectomy. In this group, there were 182 cases of XGC, and 41 of these patients had undergone laparoscopic surgery. Patients with XGC represented 1.46% of the cholecystectomies that were performed. Of the 41 patients whounderwent laparoscopic surgery, 27 weremen (66%) and 14 were women (34%) (average age, 52 years). A total of 36 patients (88%) presented with a chronic condition. XGC was found to be associated with lithiasis in 85%, with jaundice in 22%, and with cancer in 2.4% (one patient). A total of 33 patients (80%) required conversion to open surgery, because of technical difficulties; of these patients, 64% underwent partial cholecystectomy. We conclude that XGC creates difficulty at laparoscopy and therefore any preoperative suspicion of XGC should cause the clinician to consider open cholecystectomy.
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Background/Aims: The role of laparoscopic cholecystectomy for patients with acute cholecystitis and symptoms for >3 days is debated. Our purpose was to compare the results of laparoscopic cholecystectomy in patients with acute cho...
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Background/Aims: The role of laparoscopic cholecystectomy for patients with acute cholecystitis and symptoms for >3 days is debated. Our purpose was to compare the results of laparoscopic cholecystectomy in patients with acute cholecystitis and symptoms for ≤3 days and >3 days. Methodology: Sixty patients with acute cholecystitis had a laparoscopic cholecystectomy performed by the same surgeon. There were 39 patients in the short group (symptoms ≤3 days) and 21 patients in the long group (symptoms >3 days). Demographic data, surgical findings and clinical results were analyzed. Results: There were no significant differences in age, gender, comorbidities, abnormal liver function tests, white bile, gallbladder empyema, blood loss, conversion rate, postoperative hospital stay or complication rates between the groups. The mean duration of acute cholecystitis was 1.9 days in the short group and 5.3 days in the long group (p<0.0001). The long group had a longer operating time (p=0.004) and a higher rate of subhepatic drains (p=0.014). Conclusions: Laparoscopic cholecystectomy is a safe and feasible procedure for patients with acute cholecystitis when the duration of symptoms is >3 days, however, a higher conversion rate is seen for acute chronic cholecystitis.
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Background and Aim: Angiogenesis plays a key role in growth, progression, and metastasis of various cancers. Vascular endothelial growth factor (VEGF) polymorphism has been associated with several cancers. Role of VEGF has not bee...
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Background and Aim: Angiogenesis plays a key role in growth, progression, and metastasis of various cancers. Vascular endothelial growth factor (VEGF) polymorphism has been associated with several cancers. Role of VEGF has not been reported in gallbladder cancer (GBC). Present study was designed to investigate the role of VEGF polymorphism in GBC and in other (benign) gallbladder diseases, that is chronic cholecystitis (CC) and xanthogranulomatous cholecystitis (XGC). Methods: Blood samples were collected from 195 GBC, 140 CC, and 47 XGC patients and 300 normal healthy controls. VEGF polymorphisms were investigated using amplification refractory mutation system polymerase chain reaction for g.43737830A>G and g.3437A>C, polymerase chain reaction-restriction fragment length polymorphism for c.*237C>T, and g.43736418delTinsG amplified by polymerase chain reaction. Results: At g.43737830A>G, GA genotype showed susceptibility (odds ratio [OR]=1.65 and OR=1.68) and GG genotype showed protective association (OR=0.58 and OR=0.50) with GBC and CC. Allele A of VEGF g.43737830A>G was risk associated with GBC and CC (OR=1.48 and OR=1.70), while G allele was risk protective for GBC and CC (OR=0.67 and OR=0.58). At g.3437A>C, genotype CA was risk protective for GBC (OR=0.61). TT genotype of c.*237C>T was susceptible for GBC and CC (OR=2.59 and OR=3.48), while CC genotype was risk protective for GBC and CC (OR=0.61 and OR=0.34). T allele of c.*237C>T polymorphism was risk associated with GBC and CC (OR=1.63 and OR=2.90), while C allele was risk protective for GBC and CC (OR=0.38 and OR=0.28). Haplotype I-C-A-C was risk protective for GBC (OR=0.27). Conclusion: The present study suggests that c.*237C>T and g.43737830A>G polymorphisms are useful markers of susceptibility to GBC.
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Follicular cholecystitis (FC) is a relatively rare entity with uncertain causal associations. In this study, we aimed to explore different clinicopathologic associations of FC, and to better characterize the entity. A retrospectiv...
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Follicular cholecystitis (FC) is a relatively rare entity with uncertain causal associations. In this study, we aimed to explore different clinicopathologic associations of FC, and to better characterize the entity. A retrospective review of archival hematoxylin and eosin slides and pertinent clinical information was undertaken for all cholecystectomy cases with a rendered diagnosis of "follicular cholecystitis," from 1991 to 2017. Concurrent conventional chronic cholecystitis (CC) and lymphocytic cholecystitis (LC) were documented. Forty-three consecutive patients were confirmed to have FC. The majority of the patients (88.4%) had at least one other his-tologic association in the gallbladder (LC, CC, or both). Remarkably, functional distal biliary obstruction (from choledocholithiasis, sclerosing cholangitis, distal biliary strictures, or malignancies of the pancreatic head or ampulla) was found in 76.7% of the patients, irrespective of the presence of other concurrent histologic findings. FC associated with CC was relatively more common in females (61%) and strongly associated with cholelithiasis (70%). However, those without CC were predominantly males (70%) and had a significant association with LC (75%). All four cases of FC without any other histologic associations who had clinical information available showed some form of distal biliary obstruction. FC cases without concurrent LC were often associated with CC (74%). FC is strongly associated with extrahepatic biliary obstruction distal to the gallbladder. Therefore, this finding at routine cholecystectomy may warrant further evaluation to rule out a cause for distal biliary tract obstruction. Additionally, it is commonly associated with other concomitant histologic abnormalities in the gallbladder such as CC and/or LC. (C) 2019 Elsevier Inc. All rights reserved.
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Purpose: To retrospectively determine the sensitivity and specificity of magnetic resonance (MR) imaging for differentiation between acute and chronic cholecystitis, with histopathologic analysis as the reference standard. Materia...
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Purpose: To retrospectively determine the sensitivity and specificity of magnetic resonance (MR) imaging for differentiation between acute and chronic cholecystitis, with histopathologic analysis as the reference standard. Materials and Methods: Institutional review board approval with waived informed consent was obtained for this HIPAA-compliant study. Four reviewers blinded to the cholecystitis type but aware that cholecystitis was present retrospectively evaluated MR images for predetermined findings in 32 patients (15 male, 17 female; mean age +/- standard deviation, 55 years +/- 20) with histopathologically proved acute or chronic cholecystitis. The final MR diagnoses and MR findings in both groups were compared with each other and with the histopathologic diagnoses to determine the sensitivity and specificity of MR imaging. chi(2) tests were used to detect differences in MR findings between the acute and chronic cholecystitis groups. Results: MR imaging sensitivity and specificity for detection of acute cholecystitis were 95% (18 of 19 patients) and 69% (nine of 13 patients), respectively. The sensitivities of increased gallbladder wall enhancement and increased transient pericholecystic hepatic enhancement were 74% (14 of 19 patients) and 62% (10 of 16 patients), respectively. Both findings had 92% (12 of 13 patients) specificity. Sensitivities of increased wall thickness, pericholecystic fluid, and adjacent fat signal intensity changes were 100% (19 of 19 patients), 95% (18 of 19 patients), and 95% (18 of 19 patients), respectively; specificities were 54% (seven of 13 patients), 38% (five of 13 patients), and 54% (seven of 13 patients), respectively. Pericholecystic abscess, intraluminal membranes, and wall irregularity or defect each had 100% (13 of 13 patients) specificity; sensitivities were 11% (two of 19 patients), 26% (five of 19 patients), and 21% (four of 19 patients), respectively. Increased gallbladder wall enhancement (P < .001) and increased transient pericholecystic hepatic enhancement (P = .003) were the most significantly different between acute and chronic cholecystitis. Conclusion: Increased gallbladder wall enhancement and increased transient pericholecystic hepatic enhancement had the highest combination of sensitivity and specificity for the diagnosis and differentiation of acute and chronic cholecystitis. (c) RSNA, 2007.
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BACKGROUND: In this paper, we report on a modified technique of laparoscopic cholecystectomy (LC), using three-trocars in cases of difficult anatomy at the Calot's triangle without the insertion of more additional trocars, in orde...
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BACKGROUND: In this paper, we report on a modified technique of laparoscopic cholecystectomy (LC), using three-trocars in cases of difficult anatomy at the Calot's triangle without the insertion of more additional trocars, in order to validate its feasibility, efficacy, and safety. PATIENTS AND METHODS: We retrospectively analyzed 67 consecutive cases of body-first LCs performed for gallbladder disease from January to December 2007. The surgical technique was compared with respect to operative times, conversion to open cholecystectomy, postoperative complications, and length of postoperative stay. RESULTS: The body-first LC was successful in 64 patients (95.6%). The median operating time was 32 minutes (range, 27-90) for chronic cholecystitis, 53 minutes (range, 41-145) for acute cholecystitis, and 62 minutes (range, 35-170) for interval cholecystectomy. The difference in duration of the surgical procedure between the chronic cholecystitis group and the other two groups was significant (P < 0.05). We did not find any significant difference in the average operating time between the acute cholecystitis group and the interval cholecystectomy. The average postoperative hospital stay was 1 day (range, 1-3). No common bile duct injuries and no complications occurred in the series reported in this paper. CONCLUSIONS: The body-first three-trocar LC is a safe option when dealing with patients with difficult anatomy at the Calot's triangle. It yields a low conversion rate and avoids the insertion of any additional trocars. Further studies are required on the long-term efficiency and reliability of this technique in order to fully evaluate its value.
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BACKGROUND: In this paper, we report on a modified technique of laparoscopic cholecystectomy (LC), using three-trocars in cases of difficult anatomy at the Calot's triangle without the insertion of more additional trocars, in orde...
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BACKGROUND: In this paper, we report on a modified technique of laparoscopic cholecystectomy (LC), using three-trocars in cases of difficult anatomy at the Calot's triangle without the insertion of more additional trocars, in order to validate its feasibility, efficacy, and safety. PATIENTS AND METHODS: We retrospectively analyzed 67 consecutive cases of body-first LCs performed for gallbladder disease from January to December 2007. The surgical technique was compared with respect to operative times, conversion to open cholecystectomy, postoperative complications, and length of postoperative stay. RESULTS: The body-first LC was successful in 64 patients (95.6%). The median operating time was 32 minutes (range, 27-90) for chronic cholecystitis, 53 minutes (range, 41-145) for acute cholecystitis, and 62 minutes (range, 35-170) for interval cholecystectomy. The difference in duration of the surgical procedure between the chronic cholecystitis group and the other two groups was significant (P < 0.05). We did not find any significant difference in the average operating time between the acute cholecystitis group and the interval cholecystectomy. The average postoperative hospital stay was 1 day (range, 1-3). No common bile duct injuries and no complications occurred in the series reported in this paper. CONCLUSIONS: The body-first three-trocar LC is a safe option when dealing with patients with difficult anatomy at the Calot's triangle. It yields a low conversion rate and avoids the insertion of any additional trocars. Further studies are required on the long-term efficiency and reliability of this technique in order to fully evaluate its value.
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Background: Ultrasonography has a high sensitivity and positive predictive value (PPV) for diagnosing cholecystitis in adults. The objective of this study was to determine the sensitivity and PPV of ultrasonography in the diagnosi...
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Background: Ultrasonography has a high sensitivity and positive predictive value (PPV) for diagnosing cholecystitis in adults. The objective of this study was to determine the sensitivity and PPV of ultrasonography in the diagnosis of pediatric cholecystitis. Methods: We performed a single-institution retrospective review of the records of all patients undergoing cholecystectomy with a preoperative ultrasound during 2005-2010. We calculated sensitivity, specificity, and PPV using pathologic findings as the standard for the diagnosis of cholecystitis.Results: In the 223 included patients, the median (interquartile range) age was 14 y (11-16 y); and 64% were female. Preoperative symptoms of abdominal pain were reported in 98% of patients. A diagnosis of cholecystitis was reported in 10% (23 of 223) of ultrasound readings. Pathologic diagnosis of cholecystitis was present in 80% (179 of 223) of cholecystectomy specimens, with 8% (15 of 179) having acute cholecystitis, 83% (148 of 179) chronic cholecystitis, and 9% (16 of 179) both. Sensitivity of ultrasound findings ranged from 6% for Murphy's sign to 66% for cholelithiasis. Positive predictive values ranged from 67% for Murphy's sign to 87% for gallbladder sludge. Presence of any one ultrasound sign had a sensitivity of 82% and PPV of 80%.
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Cholescintigraphy with 99mTc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodol...
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Cholescintigraphy with 99mTc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodology, and interpretative criteria have evolved over the years. This review will emphasize state-of-the-art methodology and diagnostic criteria for various clinical indications, including acute cholecystitis, chronic acalculous gallbladder disease, high-grade and partial biliary obstruction, and the postcholecystectomy pain syndrome, including sphincter-of-Oddi dysfunction and biliary atresia. The review will also emphasize the use of diagnostic pharmacologic interventions, particularly sincalide.
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