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Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Normally up to 95% of bile salts are reabsorbed by the enterohepatic circulation. Reduced absorption can lead to bile acid diarrhoea. The risk is increased after cholecystectomy. Selenium homocholic acid taurine (SeHCAT) testing is the most commonly used investigation.24 Retention of a radio-labelled substrate is measured after seven days. Low retention suggests bile salt malabsorption. Treatment is through a low-fat diet and a trial of a bile acid sequestrant (e.g. colestyramine).
General surgery
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Interventional options. ERCP/PTC (for CBD stones) +/- sphincterotomy +/- stenting (usually of a malignant stricture).Open stone removal with T-tube insertion.Delayed laparoscopic (or open) cholecystectomy – timing usually about six weeks post-acute episode, performed acutely in some centres.
General Surgery
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Specific complications of a cholecystectomy include: Bleeding from the cystic or hepatic arteryBile leakageBile duct injuryDamage to the intestinePostcholecystectomy syndrome (abdominal pain, dyspepsia, diarrhoea), which is thought to be secondary to retained small gallstones or sphincter of Oddi dysfunction
Patient-specific fluid–structure interaction model of bile flow: comparison between 1-way and 2-way algorithms
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Alex G. Kuchumov, Vasily Vedeneev, Vladimir Samartsev, Aleksandr Khairulin, Oleg Ivanov
Other risk factors for gallstone formation are female gender (gallstones are twice as common in women compared with men), obesity, estrogen supplementation, multiparous state, advancing age, hyperlipidemia, inborn disorders of bile metabolism, and family history of gallstones (Kay Washington 2009).Cholecystectomy is the most commonly performed abdominal operation for the treatment of patients suffering from gallbladder disease in Western countries (Ooi et al. 2004). Nevertheless, the operation outcome is not always positive (Kuchumov et al. 2011; Mohan et al. 2014) including bile duct injury; injuries to the intestine, bowel and blood vessels; bile leakage; deep vein thrombosis (Khan et al. 2007). Serious complications result in part from patient state, surgical inexperience, and the technical constraints.
Malignancy in elective cholecystectomy due to gallbladder polyps or thickened gallbladder wall: a single-centre experience
Published in Scandinavian Journal of Gastroenterology, 2021
Dennis Björk, Wolf Bartholomä, Kristina Hasselgren, David Edholm, Bergthor Björnsson, Linda Lundgren
Despite these limitations, the results indicate that the incidence of gallbladder cancer that required resection beyond cholecystectomy is low among patients without radiological features beyond gallbladder polyps or thickening of the gallbladder wall. We suggest that patients with gallbladder polyps 10–15 mm in diameter and no complicating factors, such as primary sclerosing cholangitis, or other malignant signs, and patients with gallbladder wall thickening without other malignant signs, should undergo adequate preoperative examinations and then be discussed by a multidisciplinary tumour board including hepatobiliary surgeons. Unless the suspicion of malignancy is strengthened these patients may undergo cholecystectomy at a general surgery clinic and thus does not need to be referred to a hepatobiliary centre. The preoperative radiological examinations should include a CT of the thorax and abdomen and an MRI of the gallbladder and bile ducts. Since accidental perforation of the gallbladder during cholecystectomy has been reported to be a negative prognostic factor for increased peritoneal carcinomatosis, higher recurrence rate and shorter disease-free survival [31–33], we propose that surgery should be performed by an experienced surgeon to decrease the risk of accidental perforation. The pathological examination should be a high priority. In cases of gallbladder malignancy ≥ pT1b, the patient should be referred immediately to a hepatobiliary centre for extended re-resection.
Quality of Care in Laparoscopic Cholecystectomy: Using Register Data Sensibly
Published in Journal of Investigative Surgery, 2020
The 30-day mortality and the number of adverse events, as hard indicators of the quality of care, should always be taken into account in the measurement of cholecystectomy procedure. In an international comparison, there are marginal differences in 30-day mortality. The range of 30-day mortality increases up to 0.49% [3]. Statements on adverse events during cholecystectomy in hospital, 30 days or 90 days after surgery are not available at a national level. As with any other surgical procedure, the follow-up of the patient after discharge is useful to identify subsequent complications or possible retreatments. This serves to determine the overall quality of care in a region. A recent study [4] showed that the duration of surgery alone cannot be used to assess the quality of care in laparoscopic cholecystectomy. Rather, the frequency of the surgeon's intervention is decisive [5] and various risk factors from existing structures and processes must be taken into account in order to evaluate the health care performance. The totality of these criteria should be considered to determine quality indicators for the treatment of gallbladder problems and thus to evaluate the quality of care.