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Ann Hepatobiliary Pancreat Surg 2022 Jun 7. Epub 2022 Jun 7.

Unit of Gastronterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy.

Diverticula of the choledochus, better known as Todani type II cysts, are very rare and represent a predominantly pediatric pathology. Their identification by radiological methods, even if occasional, requires clinical doctors to request a surgical consultation, even for asymptomatic subjects, to proceed with their removal, given the risk of associated neoplasms. The laparoscopic approach for surgical treatment of these cysts has been recently introduced with excellent results. Read More

J Neurol Surg A Cent Eur Neurosurg 2022 May 29. Epub 2022 May 29.

Department of Orthopedic Surgery, Albert Einstein College of Medicine/Montefiore Medical center, Bronx, New York, United States.

Background:  Spinal cord injury (SCI) is a significant medical condition associated with various secondary complications, including cholelithiasis. Cholelithiasis can cause biliary duct obstruction and result in acute cholecystitis. The development of acute cholecystitis in SCI patients has been well studied in the Taiwanese population, showing an increased risk of acute cholecystitis in patients with SCI. Read More

Surg Endosc 2022 May 4. Epub 2022 May 4.

Laparoscopic Biliary Service, University Hospital Monklands, Monkscourt Avenue, Airdrie, Lanarkshire, ML6 0JS, Scotland, UK.

Background: The timing of laparoscopic cholecystectomy (LC) for emergency biliary admissions remains inconsistent with national and international guidelines. The perception that LC is difficult in acute cholecystitis and the popularity of the two-session approach to pancreatitis and suspected choledocholithiasis result in delayed management.

Methods: Analysis of prospectively maintained data in a unit adopting a policy of "intention to treat" during the index admission. Read More

J Laparoendosc Adv Surg Tech A 2022 Apr 11. Epub 2022 Apr 11.

Department of Pediatric Surgery, Wake Forest Baptist Medical Center, Brenner Children's Hospital, Winston-Salem, North Carolina, USA.

Biliary dyskinesia is typically defined as a gallbladder ejection fraction (EF) <35% on hepatobiliary iminodiacetic acid scan with cholecystokinin stimulation (CCK-HIDA) testing. Cholecystectomy often leads to resolution of associated biliary colic symptoms. Alternatively, there is a subset of symptomatic patients with normal gallbladder EF on CCK-HIDA. Read More

Int J Surg Case Rep 2022 May 4;94:107026. Epub 2022 Apr 4.

Pediatric Gastroenterology Department, Pediatric Service, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.

Introduction And Importance: Agenesis of the gallbladder is an underdiagnosed entity. It can be an asymptomatic pathology, usually diagnosed incidentally as a finding on imaging techniques or in necropsies. There are symptomatic cases presenting as biliary colic too, attributed to cholecystitis or cholangitis, leading to exploratory surgeries. Read More

Medicina (Kaunas) 2022 Mar 5;58(3). Epub 2022 Mar 5.

Northern Ireland Centre for Stratified Medicine, Ulster University, C-TRIC Building, Altnagelvin Hospital Campus, Glenshane Road, Derry BT47 6SB, Northern Ireland, UK.

Gallstones affect 20% of the Western population and will grow in clinical significance as obesity and metabolic diseases become more prevalent. Gallbladder removal (cholecystectomy) is a common treatment for diseases caused by gallstones, with 1.2 million surgeries in the US each year, each costing USD 10,000. Read More

Cureus 2022 Jan 19;14(1):e21400. Epub 2022 Jan 19.

College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU.

Gallbladder disease is a very common condition that encompasses a heterogeneous group of diseases with a wide range of severity and clinical manifestations. Gallbladder disorders include biliary colic, acute cholecystitis, chronic cholecystitis, choledocholithiasis, Mirizzi syndrome, and gallstone ileus. We report the case of a 70-year-old man who presented to the emergency department complaining of worsening abdominal pain, located in the right upper quadrant and radiating to the right shoulder. Read More

Scand J Surg 2022 Jan-Mar;111(1):14574969211070389

Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå University Hospital, Umeå, Sweden.

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. Read More

Cureus 2022 Jan 13;14(1):e21187. Epub 2022 Jan 13.

Emergency Medicine, Hamad Medical Corporation, Doha, QAT.

Acute cholecystitis and cardiac ischemia can have a similar clinical presentation in some patients. Nonspecific electrocardiographic changes and arrhythmias can occur in acute cholecystitis and gallbladder disease that can confuse the treating physician leading to extensive cardiac workup. Emergency physicians and cardiologists should be aware of these changes so they can expedite the management of acute cholecystitis, which can lead to the resolution of these changes. Read More

J Clin Exp Hepatol 2022 Jan-Feb;12(1):129-134. Epub 2021 Mar 19.

SIMS Institute of Gastroenterology, Hepatology and Transplantation, SRM Institutes for Medical Science, India.

Background: Single-session endoscopic stone extraction (ESE) and laparoscopic cholecystectomy (LC) has the best outcome in managing concomitant cholelithiasis (gallstone disease [GSD]) and choledocholithiasis (common bile duct stone [CBDS]). Traditional rendezvous technique with an intraoperative cholangiogram is associated with various technical (bowel distention, frozen Calot's triangle, limitation of intraoperative cholangiogram and so on) and logistical difficulties (lack of trained personnel and equipment for ESE in the operating room). We modified our approach of ESE-LC (tandem ESE-LC) to study the safety of the approach and overcome these disadvantages of the traditional rendezvous approach. Read More

J Laparoendosc Adv Surg Tech A 2022 Jan 17. Epub 2022 Jan 17.

Department of Surgery, QEII Jubilee Hospital, Brisbane, Australia.

The implementation of the acute surgical unit (ASU) model has been demonstrated to improve care outcomes for the emergency general surgery patient in comparison to the traditional "on call" model. Currently, only few studies have evaluated surgical outcomes of the ASU model in patients with acute biliary pathologies. This is the first comparative study of two different emergency surgery structures in the acute management of patients with acute cholecystitis and biliary colic. Read More

Surg Endosc 2022 Jan 13. Epub 2022 Jan 13.

Department of General and Upper GI Surgery, Ninewells Hospital, University of Dundee, Dundee, UK.

Introduction: Patients undergoing elective laparoscopic cholecystectomy (ELLC) represent a heterogeneous group making it challenging to stratify risk. The aim of this paper is to identify pre-operative factors associated with adverse peri- and post-operative outcomes in patients undergoing ELLC. This knowledge will help stratify risk, guide surgical decision making and better inform the consent process. Read More

Cureus 2021 Oct 30;13(10):e19144. Epub 2021 Oct 30.

General Surgery, Western Reserve Hospital, Cuyahoga Falls, USA.

Mirizzi syndrome (MS) is a rare complication of chronic cholecystitis caused by the gallbladder wall compression of the common hepatic duct (MS1, based on McSherry classification) or as a cholecystocholedochal fistula (MS2). The incidence of MS in symptomatic cholelithiasis is very low. Patients often present with obstructive jaundice and right upper quadrant abdominal pain; symptoms not clinically unique from biliary colic or cholecystitis, and often misdiagnosed preoperatively. Read More

ANZ J Surg 2022 03 2;92(3):409-413. Epub 2021 Dec 2.

Department of Surgery, Frankston Hospital, Frankston, Victoria, Australia.

Backgrounds: The impact of the SARS-CoV-2 virus (COVID-19) upon the delivery of surgical services in Australia has not been well characterized, other than restrictions to elective surgery due to government directive-related cancellations. Using emergency cholecystectomy as a representative operation, this study aimed to investigate the impact of COVID-19 on emergency general surgery in Australia in relation to in-hours versus after-hours operating.

Methods: A retrospective analysis was conducted of medical records for patients admitted with cholecystitis or biliary colic between 1 March 2019 and 28 February 2021 at Frankston Hospital, Australia. Read More

IDCases 2021 8;26:e01333. Epub 2021 Nov 8.

Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal.

Gall bladder ascariasis is a rare entity. The causative organism for gall bladder ascariasis is Ascaris lumbricoides It usually presents as acute acalculous cholecystitis. Conservative management with anti-helminthic drugs is preferred while sometimes the patient may need surgical intervention. Read More

Cureus 2021 Sep 23;13(9):e18222. Epub 2021 Sep 23.

Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE.

Gallbladder agenesis is a rare anatomic congenital abnormality caused by the cystic bud failing to develop into the gallbladder. Gallbladder agenesis has a variable presentation, with 50% of patients presenting with symptoms mimicking biliary colic and 35% being incidentally discovered during surgery or autopsy, while another 15% can present with fatal fetal anomalies. In this article, we present a case of gallbladder agenesis in a young woman who presented with biliary-colic-like symptoms suggesting cholecystitis. Read More

Endosc Ultrasound 2021 Sep-Oct;10(5):381-386

Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.

Background And Objectives: Cholecystectomy is the gold standard for most gallbladder-related disease. However, many patients with gallbladder disease are poor surgical candidates. Current nonsurgical gallbladder drainage (GBD) methods include percutaneous cholecystostomy and endoscopic ultrasound-guided transluminal GBD (EUS-GBD). Read More

World J Gastrointest Surg 2021 Aug;13(8):859-870

Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, United States.

Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted both elective and acute medical care. Data from the early months suggest that acute care patient populations deferred presenting to the emergency department (ED), portending more severe disease at the time of presentation. Additionally, care for this patient population trended towards initial non-operative management. Read More

J Med Cases 2021 May 5;12(5):186-189. Epub 2021 Mar 5.

Department of UGI Surgery, Liverpool Hospital, Sydney, NSW 2170, Australia.

Cholelithiasis is a common gastrointestinal pathology with a prevalence of over 6% in the USA. Symptomatic patients can develop cholangitis, biliary colic, pancreatitis and cholecystitis. Surgical management involves laparoscopic or open cholecystectomy. Read More

Am J Case Rep 2021 Aug 23;22:e932784. Epub 2021 Aug 23.

Department of Surgery, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.

BACKGROUND Ectopic liver (EL) is liver tissue that is not attached to the mother liver, and is also known as choristoma and hepar succenturiatum. According to Watanabe's 1060-patient series, it has an incidence rate of less than 1% (0.47%). Read More

Transl Gastroenterol Hepatol 2021 25;6:36. Epub 2021 Jul 25.

Section of Pediatric Surgery, Wake Forest Baptist Medical Center, Brenner Children's Hospital, Winston-Salem, NC, USA.

Background: Biliary dyskinesia generally refers to a hypofunctioning gallbladder with an ejection fraction (EF) of <35% on hepatobiliary iminodiacetic acid scan with cholecystokinin stimulation (CCK-HIDA testing). In adults, biliary hyperkinesia has a defined association with biliary colic symptoms and can be relieved with surgical intervention. This clinical entity has not been well described in children or adolescents. Read More

Clin J Gastroenterol 2021 Oct 11;14(5):1308-1317. Epub 2021 Jun 11.

Consultant Upper GI Surgeon, North Cumbria University Hospitals NHS Trust, Carlisle, UK.

Biliary hyperkinesia is typically diagnosed in patients with biliary-like pain and no evidence of gall stones on imaging modalities but who have had biliary scintigraphy scan (HIDA) that shows ejection fraction ≥ 80%. This study aims to identify whether the removal of the gall bladder can alleviate the symptoms associated with biliary hyperkinesia. Systematic search following PRISMA guidelines was done from inception to January 2020 using PubMed/Medline, OVID, Embase, Cochrane database of systemic reviews, Cochrane central register of controlled trials, The Database of Abstracts of Reviews of Effects (DARE) and Cochrane library databases. Read More

Front Surg 2021 13;8:643077. Epub 2021 May 13.

Regional Hepato-Pancreato-Biliary Service, Manchester Royal Infirmary, Manchester, United Kingdom.

Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. Read More

Int J Surg Protoc 2021 Apr 27;25(1):61-65. Epub 2021 Apr 27.

Department of Surgery, Gaston Berger University of Saint-Louis, Senegal.

Introduction: Gallstone disease is a disorder characterised by the formation of stones in the biliary tract. It is the most common biliary condition accounting for more than 98% of all gallbladder and biliary tract disorders. In Africa, previous studies have shown a relative rarity of this condition with a prevalence less than 5%; since it is between 2 and 5 times higher in other continents. Read More

Cureus 2021 Apr 25;13(4):e14676. Epub 2021 Apr 25.

Gastroenterology and Hepatology, University Hospitals of Morecambe Bay National Health Service Foundation Trust, Lancaster, GBR.

Gallbladder duplication refers to the splitting of "gallbladder primordium" during the early embryonic development in the fifth or early sixth week. Although it is a very rare congenital abnormality and most of the patients will be asymptomatic, yet the symptomatic cases present with abdominal complaints like nausea vomiting, abdominal pain leads to cholecystitis, cholangitis, biliary colic, or pancreatitis. Herein, we present a case report of duplication of the gallbladder, which was difficult to diagnose on radiology. Read More

J Minim Access Surg 2022 Jan-Mar;18(1):45-50

Department of General Surgery, William Harvey Hospital, Ashford, Kent, UK.

Background: Despite NICE/AUGIS recommendations, the practice of early laparoscopic cholecystectomy (ELC) has been particularly poor in the UK offered only by 11%-20% surgeons as compared to 33%-67% internationally, possibly due to financial constraints, logistical difficulties and shortage of expertise, thus, reflecting the varied provision of emergency general surgical care. To assess whether emergency general surgeons (EGS) could provide a 'Hot Gall Bladder Service' (HGS) with an acceptable outcome.

Patients And Methods: This was a prospective HGS observational study that was protocol driven with strict inclusion/exclusion criteria and secure online data collection in a district general hospital between July 2018 and June 2019. Read More

Pediatr Gastroenterol Hepatol Nutr 2021 Mar 4;24(2):164-172. Epub 2021 Mar 4.

Department of Gastroenterology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey.

Purpose: The use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood.

Methods: Between December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively. Read More

Int J Surg Case Rep 2021 Mar 4;80:105612. Epub 2021 Feb 4.

Beaumont, 28050 Grand River Avenue, Farmington Hills, MI, 48336, United States. Electronic address:

Background: Traditional oncologic pattern of spread of breast cancer is metastasis to axillary lymph nodes, lung, liver and bone (Doval et al., 2006 [1]). Here we present a case of unknown synchronous breast cancer in a patient that was revealed on histopathologic assessment following elective cholecystectomy. Read More

J Robot Surg 2021 Dec 5;15(6):849-857. Epub 2021 Jan 5.

Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

The robotic platform for cholecystectomy has been extensively studied in comparison to its laparoscopic counterpart with acceptable outcomes. However, wide acceptance of a robotic approach to cholecystectomy has been limited by increased operative room (OR) times and substantially higher cost. This is a single-institution retrospective review of Veteran patients presenting for elective laparoscopic (LC) and robotic (RC) cholecystectomies for benign biliary disease at the Dallas VA Medical Center. Read More