Search Results (270)

Background/Objectives: Obesity is a major cause of repolarisation defects of the heart. The frontal QRS-T angle is a new parameter used for cardiac evaluation. This study aimed to evaluate the effects of a laparoscopic cholecystectomy and anaesthetic agents on the frontal QRS-T angle in individuals with obesity. Methods: A total of 91 patients who underwent a laparoscopic cholecystectomy surgery were included in this study. The patients were divided into two groups according to body mass index (BMI) < 30 (n = 68) and ≥30 (n = 23). The frontal QRS-T angle (FQRST), QT interval (QT), corrected QT, and other electrocardiography (ECG) findings were recorded at different time points. Results: In the BMI ≥ 30 group, the frontal QRS-T angle and QT interval measured during the intraoperative period were statistically higher than those of the BMI < 30 group (p < 0.001, p < 0.001). Additionally, the frontal QRS-T angle value was statistically higher in all patients postoperatively compared with the preoperative and intraoperative periods (p < 0.001). Furthermore, there was a positive correlation between the BMI and the frontal QRS-T angle. Our study found that the QRS-T angle and the QT interval duration measured during surgery in the BMI ≥ 30 group who underwent a laparoscopic cholecystectomy were significantly higher than in the BMI < 30 group. Conclusions: We recommend close haemodynamic monitoring during and after surgery for patients with obesity undergoing a laparoscopic cholecystectomy. Full article

Background/Objectives: Gallbladder cancer (GBC) is a lethal malignancy curable only by surgical resection in early stages (Tis, T1, T2). Significant controversy exists regarding the optimal extent of surgery. This review summarizes recent trends and evidence on surgical strategies for Tis, T1, and T2 GBC to guide practice and research. Methods: This narrative review synthesizes recent literature on surgical management of Tis, T1a, T1b, and T2 GBC based on American Joint Committee on Cancer (AJCC) 8th edition staging. It examines simple vs. extended cholecystectomy (simple cholecystectomy (SC) vs. extended/radical cholecystectomy (EC/RC)), the role of lymphadenectomy (LND) and hepatectomy, and minimally invasive surgery (MIS). Results: Simple cholecystectomy is curative for Tis/T1a GBC. For T1b, regional LND is essential for staging/potential benefit, especially examining ≥5–6 nodes. Tumor size is critical; SC alone may suffice for T1b < 1 cm (low lymph node metastasis (LNM) risk), while EC/RC with LND is indicated for ≥1 cm (higher LNM risk). Routine hepatectomy for T1b lacks survival support. For T2 GBC, mandatory regional LND (≥6 nodes) is required for both T2a and T2b substages due to high LNM rates; T2b has higher LNM than T2a. Routine hepatectomy for T2 is debated; evidence suggests no routine benefit for T2a beyond LND, with conflicting findings for T2b. R0 resection is paramount. MIS is feasible for early stages in experienced hands. Conclusions: Management of early GBC is moving towards risk stratification. SC is standard for Tis/T1a. Adequate regional LND is crucial for T1b (especially ≥1 cm) and mandatory for T2 GBC. Routine hepatectomy, particularly for T2b, remains controversial. Tailored surgery prioritizes R0 resection and comprehensive LND, necessitating further standardized research. Full article

(1) Medical training is changing, especially for surgeons. Virtual reality simulation is an excellent way to train surgeons safely. Studies show that surgeons who train with simulation have demonstrated improved technical skills in fundamental surgical procedures. The purpose of this study is to determine the overall impact of virtual reality training on laparoscopic cholecystectomy performance and to explore whether specific training protocols or the addition of feedback confer any advantages for future surgeons. (2) MEDLINE (PubMed), Embase (Ovid SP), Web of Science, Google Scholar, and Scopus were searched for the literature related to virtual reality training, immersive simulation, laparoscopic surgical skills training, and medical education. Study quality was assessed using the Cochrane Risk of Bias Tool and NIH Quality Assessment Tool. (3) A total of 55 full-text articles were reviewed. Meta-analysis showed that virtual reality training is an effective method for learning cholecystectomy surgical skills. (4) Conclusions: Performance, measured by objective structured assessments and time to task completion, is improved with virtual reality training compared with no additional training. Positive effects of simulation training were evident in global rating scores and operative time. Continuous feedback on movement parameters during laparoscopic cholecystectomy skills training impacts skills acquisition and long-term retention. Full article

The gallbladder pathology is mainly represented by cholelithiasis, treated with cholecystectomy, one of the most commonly performed surgical procedures, continues to raise some challenges. Despite the advancements in surgical techniques, especially in those patients presenting some particularities, such as cirrhotic patients or those with sclero-atrophic or acute gangrenous cholecystitis, difficulties continue to arise. This review, including an evaluation of the literature from the last 20 years, aims to explore the pathophysiological mechanisms and surgical approaches for these high-risk conditions. Emphasis is placed on tailoring management strategies in order to reduce complications and improve outcomes, offering insights for optimizing care in difficult cholecystectomies. Full article

Introduction: Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is now widely regarded as a valuable aid in decision-making for complex hepatobiliary procedures, with increasing support from recent studies. Methods: We performed a systematic review following PRISMA guidelines, utilizing PubMed, CINAHL, and EMBASE databases to locate studies on the perioperative use ICG in pediatric hepatobiliary surgeries. Two independent reviewers assessed all articles for eligibility based on predefined inclusion criteria. We collected data on study design, patient demographics, surgical indications, ICG dosing, timing of ICG injection, and perioperative outcomes. Results: Forty-three articles, including 930 pediatric patients, from 1989 to 2025 met the inclusion criteria for narrative synthesis in our systematic review, of which 22/43 (51.2%) were retrospective studies, 15/43 were case reports (34.9%), 3/43 (7.0%) were experimental studies, and the other three were prospective comparative studies (7.0%). The current clinical applications of ICG in hepatobiliary pediatric surgery include bile duct surgery (cholecystectomy, choledochal cyst, biliary atresia), reported in 17 articles (39.5%), liver tumor resection, reported in 15 articles (34.9%), liver transplantation, reported in 6 articles (14.6%), and liver function determination, reported in 5 articles (12.2%). Conclusions: ICG fluorescence navigation in pediatric hepatobiliary surgery is a highly promising and safe technology that allows for the intraoperative localization of anatomic biliary structures, aids in the identification and resection of liver tumors, and can accurately determine hepatic function. The lack of comparative and prospective studies, and the variability of the dose and timing of administration are the main limitations. Full article

Two geriatric (>9 years old) dogs presented with vomiting, depression, and anorexia and were diagnosed with extrahepatic biliary obstruction (EHBO) secondary to ruptured gallbladder mucoceles. Diagnosis was based on serum biochemical analysis, abdominal radiography, and ultrasonography, which revealed gallbladder rupture, peritonitis, and common bile duct dilation. Both dogs underwent emergency surgical intervention involving cholecystectomy and choledochal stent placement in the common bile duct without cholecystojejunostomy or cholecystoduodenostomy. Postoperatively, the clinical symptoms and serum chemistry values improved, and both dogs survived without recurrence for over one year. These cases demonstrate that choledochal stenting can be an effective adjunct to cholecystectomy for managing EHBO in dogs with ruptured gallbladder mucoceles, potentially preventing reocclusion and promoting recovery, especially when histopathological evaluation is not feasible in clinical settings. However, persistent elevation of liver enzymes may occur postoperatively, necessitating prolonged monitoring and medical management in some cases. Full article

Background: This systematic review aimed to comprehensively evaluate the clinical, diagnostic, and therapeutic features of synchronous acute cholecystitis (AC) and acute appendicitis (AAP). Methods: The review protocol was prospectively registered in PROSPERO (CRD420251086131) and conducted in accordance with PRISMA 2020 guidelines. A systematic search was performed across PubMed, MEDLINE, Web of Science, Scopus, Google Scholar, and Google databases for studies published from January 1975 to May 2025. Search terms included variations of “synchronous,” “simultaneous,” “concurrent,” and “coexistence” combined with “appendicitis,” “appendectomy,” “cholecystitis,” and “cholecystectomy.” Reference lists of included studies were screened. Studies reporting human cases with sufficient patient-level clinical data were included. Data extraction and quality assessment were performed independently by pairs of reviewers, with discrepancies resolved through consensus. No meta-analysis was conducted due to the descriptive nature of the data. Results: A total of 44 articles were included in this review. Of these, thirty-four were available in full text, one was accessible only as an abstract, and one was a literature review, while eight articles were inaccessible. Clinical data from forty patients, including two from our own cases, were evaluated, with a median age of 41 years. The gender distribution was equal, with a median age of 50 years among male patients and 36 years among female patients. Leukocytosis was observed in 25 of 33 patients with available laboratory data. Among 37 patients with documented diagnostic methods, ultrasonography and computed tomography were the most frequently utilized modalities, followed by physical examination. Twenty-seven patients underwent laparoscopic cholecystectomy and appendectomy. The remaining patients were managed with open surgery or conservative treatment. Postoperative complications occurred in five patients, including sepsis, perforation, leakage, diarrhea, and wound infections. Histopathological analysis revealed AAP in 25 cases and AC in 14. Additional findings included gangrenous inflammation and neoplastic lesions. Conclusions: Synchronous AC and AAP are rare and diagnostically challenging conditions. Early recognition via imaging and clinical evaluation is critical. Laparoscopic management remains the preferred approach. Histopathological examination of surgical specimens is essential for identifying unexpected pathology, thereby guiding appropriate patient management. Full article

Background and Objectives: Early cholecystectomy (EC) is widely regarded as the first-line treatment for acute calculous cholecystitis (ACC). Current debate centers on the feasibility of EC as an option even for elderly patients. This study aims to determine whether age alone is an independent risk prediction factor for prognosis after EC for ACC. Materials and Methods: This study is a post-hoc analysis of the S.P.Ri.M.A.C.C. WSES prospective international multicenter observational study database, including patients with ACC undergoing EC. Univariate and multivariate analyses were conducted, examining different risk factors for major morbidity and mortality after EC. Results: In the univariate analyses, age was found to be a statistically significant risk factor for both 30-day major complications (p < 0.001) and 30-day mortality (p = 0.003). However, in the multivariate analysis, age alone was not a significant predictor for either outcome, with p-values of 0.419 and 0.094, respectively. The only significant risk factor associated with both 30-day mortality and major morbidity in the multivariate model was the POSSUM Physiological Score (PS). Conclusions: Age alone cannot be considered a reliable risk predictor for a complicated postoperative course after EC in patients with ACC. Frailty, rather than chronological age, should be assessed to predict the outcome of these patients. Full article

Objectives: To analyze the factors associated with recurrent choledocholithiasis following endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy (BS). Methods: A retrospective, observational, and analytical cohort study was conducted. Patients who underwent ERCP with BS for benign biliary pathology and were followed for a minimum of two years were included. Demographic and clinical data were collected, including the indication for the procedure, endoscopic findings, performance and timing of cholecystectomy (before or after ERCP), and the need for repeat procedures. Episodes of choledocholithiasis were defined as those occurring at least six months after the initial ERCP. Follow-up continued until patient death, loss of follow-up, or the conclusion of the study. Results: A total of 576 patients were included, with a mean age of 71 years and an average follow-up duration of 131 months. Sixty-nine cases of recurrent choledocholithiasis were documented (11.96%). Multivariate analysis identified the following predictive factors for recurrence: age over 50 years, bile duct dilation upon initial evaluation, history of biliary surgery, cytology sampling, placement of biliary stents, repeated ERCP, biliary diversion procedures, and cholecystectomy prior to the index ERCP. Conclusions: Biliary duct dilation, advanced age, and any previous manipulation of the biliary tree are associated with an increased risk of recurrent choledocholithiasis. Cholecystectomy performed after the initial ERCP was not associated with a reduced recurrence risk. Full article

Background: Emergency laparoscopic cholecystectomy (ELC) has emerged as a viable alternative to delayed elective surgery for acute gallstone disease, although its widespread adoption is hindered by cultural barriers. This study compares outcomes between elective and emergency laparoscopic cholecystectomy and evaluates the impact of implementing an ELC pathway on elective waiting times, patient outcomes, and overall service delivery. Methods: A prospective cohort study was conducted between December 2021 and December 2023, including all patients undergoing emergency or elective laparoscopic cholecystectomy. One-to-one propensity score matching, correlation statistics, and multivariate logistic regression were used to analyse outcomes. Results: Of 585 patients, 314 (53.4%) underwent emergency and 271 (46.3%) elective cholecystectomies. After matching, 474 patients were analysed (237 per group). The ELC pathway achieved an 81.4% first-presentation procedure rate, with 69.2% managed as day cases and 84.4% discharged the following day. Emergency cases had longer operative times (+9 min), higher rates of subtotal cholecystectomy (8.9% vs. 3.0%, p < 0.001), and more frequent postoperative ERCP (16.9% vs. 4.6%, p < 0.001). Other outcomes were comparable. Introduction of the ELC pathway significantly reduced elective waiting times from a median of nine to three months (R = −0.219, R² = 0.059, p < 0.001) and preoperative admissions (IQR 0–1, R = −0.223, R² = 0.050, p = 0.002). Conclusions: An ELC pathway is a safe and effective alternative to elective gallstone surgery, offering substantial benefits to patients and healthcare systems, while serving as a strategic, cost-conscious approach to reducing surgical waiting times and preoperative admissions. Its success hinges upon surgical expertise in acute decision making, skill in performing subtotal cholecystectomy, and access to institutional resources such as advanced imaging and ERCP services. Full article

Objectives: Most studies assess risk factors for common bile duct (CBD) stones in patients with gallbladder in situ. We aimed to assess risk factors for CBD stones in patients with previous cholecystectomy in a proof-of-concept study. Methods: We enrolled consecutive patients undergoing EUS for suspected symptomatic CBD stones and recorded demographic variables, clinical presentation, liver function tests (LFTs), and transabdominal ultrasound (US) findings. EUS was used as gold standard for CBD stones. Multivariate analysis was used to identify risk factors in the training set; a model was created and tested on the validation set. Results: A total of 211 patients (25.6% male; median age, 66 [49–75] years old) were enrolled; 77.7% presented with abdominal pain, 30.3% with hyperbilirubinemia, 26.5% with pancreatitis, and 61.1% with LFT alterations. Ultrasound showed CBD dilation in 37.4% patients. Overall, 96 (45.5%) patients had CBD stones. According to multivariate analysis, male gender (OR 2.54 [1.26–5.09]; p = 0.009), age > 63 years (OR 3.06 [1.63–5.72]; p < 0.001), LFT alteration (OR 2.62 [1.40–4.91]; p = 0.003), and CBD dilation (OR 2.46 [1.31–4.65]; p = 0.005) were independently related to CBD stones. A model was created based on the number of risk factors on admission; patients with no risk factor had a 9.5% prevalence of CBD stones; those with one risk factor, 26.7%; two risk factors, 53.2%; three risk factors, 66.7%; and four risk factors, 100%. Conclusions: The results of this proof-of-concept study identify male gender, age, LFT alteration, and CBD dilation as risk factors for CBD stones in patients with previous cholecystectomy. An adequate assessment of the pre-test probability will guide patients’ subsequent management. Full article

Background/Objectives: Gallstone formation (cholelithiasis) is a common and important consequence following bariatric surgery, though regional data from the Northern Border Region are limited. This study aimed to investigate the incidence and risk factors of gallstones in this population, with the goal of optimizing postoperative treatment and reducing morbidity. Methods: We conducted a cross-sectional study using a non-probability convenience sampling technique to recruit 509 participants with varying degrees of obesity. Four hundred and ten study participants underwent bariatric surgery, of whom 73 were excluded for preoperative cholelithiasis and/or cholecystectomy. Data were collected through a self-administered, pre-validated questionnaire distributed via various social media platforms. These data included demographics, type/timing of surgery, pre/postoperative BMI, medical history, use of gallstone prophylaxis, and gallstone outcomes. Logistic regression analysis was used to identify independent predictors of gallstone formation. Results: Postoperative cholelithiasis developed in 60.8% of patients, most commonly within the first postoperative year, with risk peaking between 7 and 12 months after surgery. Rapid and substantial postoperative weight loss, as reflected in a lower current BMI and a transition to normal or overweight status within one year, was significantly associated with an increased incidence of gallstones. Female sex (OR: 2.62, 95% CI: 1.38–4.98, p = 0.003) and non-use of gallstone prevention medication (OR: 4.12, 95% CI: 1.34–12.64, p = 0.013) were independent predictors of gallstone formation. A longer time since surgery (OR: 0.76, 95% CI: 0.63–0.91, p = 0.004) and a lower current BMI (OR: 0.48, 95% CI: 0.28–0.83, p = 0.008) were associated with a reduced risk. Smoking status and comorbidities were not significantly related to the risk of gallstones. Conclusions: Gallstone formation after bariatric surgery in this population is influenced by female sex, rapid postoperative weight loss, and lack of prophylactic medication, while the type of surgical procedure does not significantly affect risk. Focused monitoring and preventive strategies, particularly in high-risk groups, are recommended to reduce gallstone-related complications following bariatric surgery. Full article

Background/Objectives: The use of opioid drugs in the elderly population is characterized by an increased risk of sedation and respiratory depression, and in the immediate postoperative period, it is associated with a higher incidence of postoperative delirium. The dilemma of opioid use as an element of acute postoperative pain therapy is crucial in elderly patients. Methods: This study was conducted in 80 patients qualified for laparoscopic cholecystectomy under general combined anesthesia. Two methods of analgesia were performed—Low-Opioid Analgesia (LOA) and Opioid-Based Analgesia (OBA)—and pain intensity based on the Numerical Rating Scale (NRS) was assessed at 0–2, 2–6, 6–12, and 12–24 h after surgery. The mean NRS in LOA and OBA was compared in age categories. Pain trajectory in patients over 60 years old was compared between LOA and OBA. Results: The trajectory of analgesia presented a negative slope in LOA for patients over 60 years of age, with reductions in pain intensity of 33%, 25%, and 66%. In OBA, a positive slope trajectory was noted, and pain intensity was higher within 12–24 h after surgery than within 0–2 and 2–6 h. Conclusions: Opioid analgesia in patients over 60 years of age presented a better effect in the immediate postoperative period. Non-opioid analgesia is indicated for patients over 60 years old in the later postoperative period. The model of combined minimal opioid anesthesia and non-opioid postoperative analgesia presents a favorable therapeutic effect for patients over 60 years old. Full article

Background/Objectives: Rapid weight loss after bariatric surgery is linked to a higher risk of symptomatic gallstone disease, which could require a cholecystectomy. This meta-analysis aimed to assess the efficacy and safety of conducting laparoscopic cholecystectomy concurrently with sleeve gastrectomy in morbid obese patients. Methods: Scopus, PubMed, ProQuest, Web of Science, and Google Scholar were searched for this review. Quality assessment was conducted using the Newcastle-Ottawa Scale for observational studies and ROB2 for randomized clinical trials. Eight of thirteen studies were high-quality. Pooling for BMI difference and LOS was used to measure efficacy, and the pooled proportion was utilized to assess safety through bleeding, wound infection, and leakage. Heterogeneity was explained via leave-one-out analysis and meta-regression. Results: The pooled standardized mean difference in BMI peri-operation was 3.26 (95% CI: 2.51–4.01, p < 0.01), where the age and initial BMI explained 98% of the heterogeneity through meta-regression. The pooled mean of LOS was 3.18 days (95% CI: 2.23–4.14, I² = 99%, p < 0.001), where age explained 33.22% of the heterogeneity through meta-regression. The pooled proportion of bleeding was 0.03 (95% CI: 0.02–0.04, I² = 2%, p = 0.42). The pooled wound infection was 0.04 (95% CI: 0.02–0.08, I² = 80%, p < 0.001), where age accounted for 99% of the heterogeneity. The pooled biliary/gastric leakage was 0.02 (95% CI: 0.01–0.05, I² = 0, p = 0.52). Conclusions: These findings indicate that the combined procedures can be executed with an acceptable safety profile. The heterogeneity in outcomes underscores the necessity of personalized patient care, standardized perioperative practices, and continuous research to enhance results and mitigate dangers. Full article

Background: Bile duct injury (BDI) during (laparoscopic) cholecystectomy has an incidence of up to 1.5%. This retrospective study aimed to report the outcomes of surgical repair of BDI due to these procedures at a tertiary referral center. Methods: A retrospective review of patients’ records was conducted. The BDI’s clinical presentations, Strasberg classification, surgical repairs, and outcomes were reported. Results: From 2003 to 2024, 47 BDIs were identified. In total, 34.0% were recognized intraoperatively. The BDI types included Strasberg types B (2, 4.3%), C (5, 10.6%), D (11, 23.4%), E1 (4, 8.5%), E2 (12, 25.5%), E3 (5, 10.6%), E4 (3, 6.4%), and E5 (5, 10.6%). The T-tube group included 6 (12.8%) patients, the primary repair and T-tube group included 10 (21.3%) patients, and the Biliodigestive anastomosis group included 31 (65.9%) patients. The overall morbidity rate was 40.4%, the major morbidity rate was 21.3%, and the mortality rate was 4.3%. Grade A patency was achieved in 95.6% of patients. In the Biliodigestive anastomosis group, the actuarial 1-, 5- and 10-year grade A patency rates were 77.0%, 70.0%, and 70.0%, respectively. Conclusion: The rate of BDI remains stable. The outcomes of repairs in terms of complications and patency rates are comparable to those in other reports. Full article