Effects of physical activity on the gallbladder and biliary tract in health and disease
Roy J. Shephard in Physical Activity and the Abdominal Viscera, 2017
This chapter looks at the impact of acute and chronic physical activity upon biliary function in both health and disease. Although physical activity modifies the secretions and emptying of the healthy gall bladder, the responses to exercise have greater significance for the prevention of disease than for the enhancement of human performance. The potential benefits of physical activity as a means of augmenting emptying of the gallbladder, reducing stasis and protecting against biliary disease have as yet received surprisingly little attention. Nevertheless, a survey of the published literature found 11 reviews that concluded with varying enthusiasm that regular physical activity was helpful in preventing gallbladder disease. Gallstone formation, cholecystitis and cholecystectomy are closely intertwined problems, and many reports have examined the influence of regular physical activity upon all three conditions. Many cross-sectional studies have examined associations between habitual physical activity and some measure of gallbladder disease.
Cholecystectomy
S Asbury, A Mishra, KM Mokbel, M Fishman Jonathan in Principles of Operative Surgery, 2017
The prevalence is 10–15% of the adult population. Gallstones are more common in women (male:female ratio of 1:4). The indications for operative management: symptomatic gallstones causing biliary colic or pancreatitis, cholecystitis (can be performed early or late), acalculous cholecystitis, empyema of the gallbladder, and mucocoele of the gallbladder. Informed consent must be obtained prior to the operation, including permission to convert to an open procedure. A right upper transverse incision would be made over the lateral border of the rectus muscle. The chapter presents complications that may arise from either cholecystectomy operation. A preoperative endoscopic retrograde cholangiopancreatography (ERCP) would be considered in cases where there was a possibility of a common bile duct stone, indicated by the following: abnormal liver function tests, dilated common bile duct on ultrasound scan, and pancreatitis.
Spleen
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
The congenital anomaly occurs in two forms, one being the 'continuous' form with an associated band of fibrous connective tissue, the other being the 'discontinuous' form without any connection to the native spleen. The continuous form is often associated with other congenital anomalies, while the discontinuous form is usually isolated and sometimes considered simply an ectopic or accessory spleen. Splenectomy, either total or partial, is indicated in symptomatic individuals. Studies of children with splenic trauma recommend non-operative management of splenic lacerations given the frequent self-resolution of splenic haemorrhage and the significant morbidity of splenectomy in the paediatric population. Non-operative management of isolated splenic injuries is also associated with a lower mortality rate than splenectomy. Furthermore, both rates of transfusions and length of stay have decreased as non-operative management of paediatric splenic trauma has become the norm. It is prudent to obtain a preoperative ultrasound and to perform a cholecystectomy at the time of splenectomy when gallstones are present.
Safety and outcomes of laparoscopic cholecystectomy in the extremely elderly: a systematic review and meta-analysis
Published in Acta Chirurgica Belgica, 2019
Amy C. Lord, Georgina Hicks, Belinda Pearce, Lulu Tanno, P.H. Pucher
Background: Gallstones are a common cause of morbidity in the elderly. Operative treatment is often avoided due to concerns about poor outcomes but the evidence for this is unclear. We aim to consolidate available evidence assessing laparoscopic cholecystectomy outcomes in the extreme elderly (>80s) compared to younger patients. Methods: Studies comparing laparoscopic cholecystectomy in >80s with younger patients were considered. Total complications, mortality, conversion, bile duct injury, and length of stay were compared between the two groups. Results: Twelve studies including 366,522 patients were included. They were of moderate overall quality. The elderly group had more complicated gallbladder disease and also had more co-morbidities and a higher ASA grade. The risk of morbidity was lower in the younger group (RR 0.58 (95% CI 0.58–0.59)) with a slightly lower risk of conversion (RR 0.96 (0.94–0.98)) Length of stay was significantly longer for the elderly patients. Differences in mortality and bile duct injury were non-significant in all but one study. Conclusion: Laparoscopic cholecystectomy is safe and effective in the extreme elderly. Higher complication rates are predominantly related to increased co-morbidities and more complex gallbladder disease. Patients should be carefully selected, and cholecystectomy performed at an earlier stage to minimize these problems.
Gallbladder torsion: a cholecystectomy that cannot be delayed
Published in Acta Chirurgica Belgica, 2020
Mazy David, Bez Mattia, Gunes Seda, Nebbot Benjamin, Herve Jerome
Gallbladder torsion is a rare entity, where the gallbladder twisted around its mesentery. Unfortunately, the diagnosis is rarely done preoperatively. This paper aims, through a case report, to describe the risk factors and the radiological criteria used to diagnose gallbladder torsion, in order to avoid a rapidly unfavourable evolution and the need to proceed to emergency cholecystectomy.
Modified transumbilical laparoscopic cholecystectomy: Double-incision, triple-port access
Published in Minimally Invasive Therapy & Allied Technologies, 2013
Hai-Feng Zhang, Chun-Lei Lu, Ying Gao, Dong-Feng Chen, Wei-Jia Wang
Transumbilical laparoscopic cholecystectomy has been increasingly performed in recent years, using special access devices and instruments through one incision in the umbilicus. We have modified the technique by using a two-incision triple-port access approach and conventional laparoscopic instruments. A total of 52 patients accepted the modified transumbilical laparoscopic cholecystectomy, and all the procedures were completed successfully. The operative time was 150 minutes for the first case, 100 minutes and 90 minutes for the second and third cases, and an average of 50 ± 14 minutes for the following 49 cases. All patients were discharged on post-operative day 3. No complications were observed during a follow-up of at least three months. The umbilical incisions were nearly invisible, and all patients were satisfied with the abdominal cosmetic results.In conclusion, transumbilical laparoscopic cholecystectomy using a double-incision triple-port access approach and conventional laparoscopic instruments as described in this study is safe and feasible, and it reduces the conflict of instruments without using special devices.