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The objective of this study was to evaluate and compare the histopathological, clinical, and treatment characteristics of xanthogranulomatous cholecystitis (XGC) in patients undergoing cholecystectomy at a single center. Aim: We aim to enhance the understanding of its presentation and improve its differential diagnosis from other gallbladder pathologies. Methods: We retrospectively reviewed 6783 cholecystectomy cases performed between January 2015 and January 2023 at the General Surgery Clinic of Haydarpaşa Numune Training and Research Hospital, and a diagnosis of xanthogranulomatous cholecystitis was histopathologically established in 131 patients. In this retrospective study, we examined the clinicopathological characteristics, preoperative imaging methods and findings, histopathological images, surgical procedure methods, and postoperative complications of 131 patients. Results: The study included 131 patients, with ages ranging from 18 to 88 years, of which 74 (56.5%) were female and 57 (43.5%) were male. Ultrasound imaging was performed on 128 patients. Ultrasound imaging revealed wall thickening in 72.7% of cases, hypoechoic nodules in 13.3%, biliary tract pathologies in 10.9%, and adenomyomatosis in 3.1%. A total of 59 cases had MRI. On MRI, wall thickening was observed in 50.8% of cases, biliary tract pathologies in 33.9%, adenomyomatosis in 10.2%, hypoechoic nodules in 3.4%, and hypoechoic nodules + wall thickening (HN + WT) in 1.7%. Histopathological diagnosis was diffuse in 79.4% of cases and focal in 20.6%. In addition to cholecystectomy, non-surgical interventions were not required in 77.1% of the cases, while 11.5% underwent ERCP, 9.2% underwent percutaneous procedures, 1.5% underwent both ERCP and percutaneous procedures, and 0.8% underwent other non-surgical interventions. Of the surgeries, 93.1% were elective and 6.9% were emergency. Postoperative complications were not observed in 84% of the patients; 5.3% experienced surgical complications, 5.3% had surgical site infection, and 5.3% had other complications (pneumonia and urinary infection). The length of hospital stay ranged from 0 to 26 days, with a mean of 5.27 ± 4.59 days and a median of 4 days. Conclusions: Xanthogranulomatous cholecystitis is a rare disease of the gallbladder with no characteristic radiological or clinical findings and can often be confused with gallbladder cancer. Further studies involving larger populations are needed to improve the preoperative diagnosis. [ABSTRACT FROM AUTHOR]

Background: Transgender individuals frequently undergo gender-affirming hormone therapy (GAHT) during their gender transition which plays a vital role in gender identity affirmation. Cholelithiasis, a common condition affecting 10-15% of the US population, has been linked to estrogen therapy in cisgender women. Despite the fact that hormonal profiles achieved after GAHT are not always identical to cisgender individuals, the effects of GAHT on gallbladder disease (GBD) risk have not been evaluated in transgender populations. This research aims to address this gap utilizing a large nationwide database. Methods: The study analyzed medical records data from the TrinetX database from 52,847 trans men and 38,114 trans women. Four cohorts were created: trans women and men either receiving either hormone therapy or no intervention. Descriptive statistics were calculated before matching to estimate disease burden. The groups were then propensity score matched on known risk factors (age, race, BMI, etc.) and rates of GBD were compared. Results: Before matching, trans women on hormone therapy (TWHT) had a significantly higher 10-year GBD probability than those naïve to therapy (TWNI) (4.69% vs 1.88%). For trans men, there was no significant difference in 10-year rates between those on therapy (TMHT) and those not (TMNI) (3.15% vs 3.87%). Cholecystectomy rates were significantly higher for TWHT than TWNI (1.10% vs. 0.57%), but similar between TMHT and TMNI (0.95% vs. 1.10%). After accounting for risk factors, TWHT had increased GBD risk (HR 1.832), while TMHT showed no significant change. Discussion: This study suggests a link between estrogen GAHT and increased GBD risk in transgender women. Notably, testosterone GAHT did not offer protection against GBD in transgender men, contrary to expectations. This study is, to our knowledge, the first to describe the burden of GBD in the transgender population and to investigate the effects of GAHT on GBD risk. [ABSTRACT FROM AUTHOR]

Background Cholecystectomy, a type of surgery commonly performed globally, has possible mutual effects on the socioeconomic conditions of different countries due to various postoperative recovery times. Aims This study evaluated the medical and socioeconomic factors affecting delayed return-to-work (RTW) time after elective cholecystectomy. Methods This retrospective study analysed patients who underwent elective cholecystectomy for benign gallbladder diseases from January 2022 to April 2023. The patients' medical and socioeconomic data were collected to investigate the clinical and socioeconomic factors correlated with RTW time of >30 days after surgery. Results This study included 180 consecutive patients. Significant correlations were found between delayed RTW time (>30 days) and age (odds ratio [OR]: 1.059, 95% confidence interval [CI] 1.008–1.113, P  = 0.024), lack of medical insurance (OR: 2.935, 95% CI 1.189–7.249, P  = 0.02) and high-intensity labour jobs (OR: 3.649, 95% CI 1.495–8.909, P  = 0.004). Patients without medical insurance (26.6 versus 18.9 days) and those with high-intensity labour jobs (23.9 versus 18.8 days) had a higher mean RTW time than those with insurance and a less-intense labour job (P  < 0.001). Conclusions After cholecystectomy, older age, lack of medical insurance and high-intensity labour job were correlated with a delayed RTW time. Informing patients about their expected RTW time after surgery can help reduce costs. [ABSTRACT FROM AUTHOR]

The influence of metabolic dysfunction-associated steatotic liver disease (MASLD) on gallbladder polyp development in both sexes remains elusive. Therefore, to clarify the role of MASLD in gallbladder polyp development, we investigated the longitudinal association between MASLD and gallbladder polyps. In this observational study, we included 5,527 gallbladder polyp-free patients who underwent > 2 health check-ups over > 2 years. Generalized estimation equations were used to analyze associations between MASLD and gallbladder polyp development according to repeated measures at baseline and the most recent stage. Gallbladder polyp development rates in men and women were 7.5% and 5.6% (p < 0.01), respectively. MASLD was not significantly correlated with gallbladder polyp development. Regarding the association between gallbladder polyp development (men: ≥6 mm and women: ≥5 mm) and the number of MASLD components following lifestyle habits, men and women with ≥ 4 MASLD components had odds ratios of 3.397 (95% confidence interval: 1.096–10.53) and 5.338 (1.054–27.04), respectively. Higher nonalcoholic fatty liver disease fibrosis scores were associated with significant risk of gallbladder polyp development in women (1.991, 1.047–3.785). Although MASLD influence on gallbladder polyp development differs by sex, close monitoring of patients with an increasing number of MASLD components is essential to prevent gallbladder polyp development. Specifically, men with ≥ 4 MASLD components should be monitored for gallbladder polyps measuring ≥ 6 mm. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the safety profile of robotic cholecystectomy performed within the United Kingdom (UK) Robotic Hepatopancreatobiliary (HPB) training programme. Methods: A retrospective evaluation of prospectively collected data from eleven centres participating in the UK Robotic HPB training programme was conducted. All adult patients undergoing robotic cholecystectomy for symptomatic gallstone disease or gallbladder polyp were considered. Bile duct injury, conversion to open procedure, conversion to subtotal cholecystectomy, length of hospital stay, 30-day re-admission, and post-operative complications were the evaluated outcome parameters. Results: A total of 600 patients were included. The median age was 53 (IQR 65–41) years and the majority (72.7%; 436/600) were female. The main indications for robotic cholecystectomy were biliary colic (55.5%, 333/600), cholecystitis (18.8%, 113/600), gallbladder polyps (7.7%, 46/600), and pancreatitis (6.2%, 37/600). The median length of stay was 0 (IQR 0–1) days. Of the included patients, 88.5% (531/600) were discharged on the day of procedure with 30-day re-admission rate of 5.5% (33/600). There were no bile duct injuries and the rate of conversion to open was 0.8% (5/600) with subtotal cholecystectomy rate of 0.8% (5/600). Conclusion: The current study confirms that robotic cholecystectomy can be safely implemented to routine practice with a low risk of bile duct injury, low bile leak rate, low conversion to open surgery, and low need for subtotal cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: This study aimed to summarize evidence of ursodeoxycholic acid (UDCA) use in the management of hepatobiliary diseases, present indications for UDCA use in Korea, and reimbursement criteria for UDCA use in the country. Current Concepts: UDCA is currently approved for the treatment and prevention of gallstone in obese patients with rapid weight loss after post-bariatric surgery, primary biliary cirrhosis (PBC), chronic liver disease with markedly elevated liver function test values, and chronic hepatitis C. However, the approval and reimbursement criteria for UDCA depend on the dose, specific diseases, and circumstances. UDCA is administered at doses of 100, 200, and 300 mg. The 100 mg dose is available over-the-counter, whereas a prescription is required for the 200 and 300 mg doses. The approval standards differed by dose: UDCA 100 mg for biliary diseases and chronic liver disease; UDCA 200 mg for gallstone, PBC, and chronic hepatitis C; and UDCA 300 mg for PBC, gallstone prevention in obese patients, and patients who had undergone gastrectomy. Co-administration of UDCA with antiviral drugs may require patients to bear some costs. UDCA can be combined with either milk thistle or biphenyl dimethyl dicarboxylate but not both. Discussion and Conclusion: UDCA is a relatively safe medication with many benefits. The current reimbursement standards for hepatobiliary diseases include chronic liver disease with elevated liver enzyme levels, gallstone, PBC, chronic hepatitis B, and chronic hepatitis C. Because UDCA is administered at varied doses, it is important to know the appropriate dose and regimen for each condition. [ABSTRACT FROM AUTHOR]

Abstract The influence of metabolic dysfunction-associated steatotic liver disease (MASLD) on gallbladder polyp development in both sexes remains elusive. Therefore, to clarify the role of MASLD in gallbladder polyp development, we investigated the longitudinal association between MASLD and gallbladder polyps. In this observational study, we included 5,527 gallbladder polyp-free patients who underwent > 2 health check-ups over > 2 years. Generalized estimation equations were used to analyze associations between MASLD and gallbladder polyp development according to repeated measures at baseline and the most recent stage. Gallbladder polyp development rates in men and women were 7.5% and 5.6% (p

Objective: Rare disease Background: Gallbladder anomalies are rare congenital defects with an incidence rate of approximately 2% in the general population. Phrygian cap gallbladder is a common anatomical variant in which the fundus of the gallbladder folds on itself. Gallstone impaction is rare, and it can be associated with acute pancreatitis. This report describes a 42-year-old woman with recurrent pancreatitis associated with gallstones and Phrygian cap gallbladder. Case Report: We report the case of a 42-year-old woman with acute biliary pancreatitis and a history of repeated hospitalizations for episodes of pancreatitis. A preoperative MRI was conducted, which revealed the presence of a Phrygian cap gallbladder that had not been previously reported in imaging studies. The patient underwent cholecystectomy surgery with a laparo-endoscopic approach (rendezvous technique). No intra-or postoperative complications occurred. Conclusions: We report a case of acute biliary pancreatitis caused by stone migration and describe the anatomical variant of the Phrygian cap gallbladder with its clinical implications. The literature contains very few reports of cholecystitis or pancreatitis in patients with a gallbladder anomaly. Continuous reporting of anatomical variations of the gallbladder and biliary tract improves clinical knowledge, and knowledge of gallbladder anomalies is crucial to avoid injury to the biliary tract during laparoscopic cholecystectomy. This case emphasizes the importance of accurate preoperative evaluation to prevent serious surgical complications. [ABSTRACT FROM AUTHOR]

Percutaneous endoscopy of the biliary system (cholangioscopy) and gallbladder (cholecystoscopy) has significantly impacted diagnostic and therapeutic approaches to many diseases in interventional radiology, overcoming previous challenges related to scope size and rigidity. The current endoscopes offer enhanced maneuverability within narrow tubular structures such as bile ducts. Before endoscopy, reliance on 2D imaging modalities limited real-time visualization during percutaneous procedures. Percutaneous endoscopy provides 3D perspectives, enabling a better appreciation of normal structures, targeted biopsy of lesions, and accurate deployment of therapeutic interventions. This review aims to explore percutaneous endoscopic findings across various biliary and gallbladder pathologies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the characteristics of patients who required conversion from laparoscopic to open cholecystectomy. In addition, we compared the health outcomes of laparoscopic and converted cholecystectomy. Methods: This was a retrospective, cross-sectional study. The laparoscopic cholecystectomy procedures performed in hospitals of the Turkish Ministry of Health in 2016 were examined. Chi-square and Mann-Whitney U tests were used to analyze the data. Results: There were 103,387 laparoscopic cholecystectomy. Of these, 102,294 (98.9%) were laparoscopically completed, whereas 1,093 (1.1%) were converted to open cholecystectomy. The majority (75.9%) of the patients were female. The rate of conversion from laparoscopic to open cholecystectomy; in men ≥65 years of age, patients with chronic renal failure, hypertension, diabetes, malign neoplasm, and cerebrovascular disease were found to be statistically significantly higher than those in the opposing groups. Mortality, complications, intensive care unit treatment rates, and average hospitalization time were found to be statistically significant in cholecystectomy converted to open surgery. Conclusion: Patients who had converted cholecystectomy had more negative health outcomes than those who had completed the procedure laparoscopically. Old age, being male, and having comorbidities and malignancies increase the risk of conversion to open cholecystectomy. These factors can help determine the conversion risk of laparoscopic cholecystectomy to an open procedure. [ABSTRACT FROM AUTHOR]

Objective: Ceftriaxone and metronidazole (CEF/MET) combination therapy is commonly used in the empirical therapy of intra-abdominal infections (IAIs). We aimed to evaluate the treatment response in patients started on empirical CEF/MET therapy and contribute current treatment data on IAIs. Methods: A retrospective analysis was conducted on patients receiving parenteral antibiotic therapy in the general surgery department between 2016 and 2018. Patients aged 18 and older who received CEF/MET therapy for more than 24 hours with a diagnosis of IAI were included. Patient characteristics, antibiotic use and/or surgical history in the last three months, infection source, need for surgical intervention, and clinical and laboratory data were evaluated. Treatment response was analyzed in groups of patients with or without treatment changes. Results: 10,649 patients were evaluated; 591 (5.5%) received CEF/MET therapy, and 297 (50.2%) met the study criteria. Among them, 243 (81.8%) received only CEF/MET treatment (Group 1), while 54(18.2%) received additional antibiotics (median day 5) (Group 2). There was a statistically significant correlation between malignancy, antibiotic use in the last three months and history of surgical intervention and treatment change (p=0.001). The gallbladder (63%) or the biliopancreatic tract (12.1%) were the infection foci in 75.1% of all patients. Treatment was modified in 9.6% of the patients with an infection focused on the gallbladder and 55.6% of the patients with an infection focused on the biliopancreatic tract (p=0.001). Patients with treatment modification had more extended hospital stays and higher mortality rates (p=0.001). Conclusion: Empirical CEF/MET initiation is appropriate for IAIs with a gallbladder focus, yielding a favourable response in four out of five patients. However, CEF/MET therapy may be insufficient in patients with a biliopancreatic tract focus, a history of antibiotic use, malignancy, or surgical intervention, despite source control. Therefore, learning the source of infection and patient characteristics will contribute to the determination of the antibiotic to be selected in empirical treatment, increase treatment success, shorten the hospitalization period, and reduce mortality. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to update risk estimates of obesity related co-morbidities and to provide evidence of the importance of obesity prevention to decision makers. Methods: The study included 25- to 74-year-old participants (N =22,977) of the National FINRISK Studies in 1997, 2002 and 2007. Body mass index was calculated from measured weight and height at baseline. Data on morbidity were ascertained via linkage to the National Hospital Discharge Register, the Cancer Register and the records of the Social Insurance Institution of Finland until the end of year 2018. The Cox proportional hazards model was used to estimate associations between weight status and the risk of the end-point diseases during follow-up, with adjustment for age and smoking. Results: At baseline, 31% of participants had at least one of the investigated diseases. Overweight, obesity and severe obesity were associated with type 2 diabetes, gout, gallbladder diseases and knee and hip osteoarthritis during the follow-up in both men and women. The risk of coronary heart disease was increased in men who were overweight, obese and severely obese and in women who were obese and severely obese. Risk of asthma was increased only among women who were obese and severely obese. No associations were found between obesity and breast, prostate or colorectal cancer. Conclusions: The study showed a strong relationship between excess body weight and the prevalence and incidence of several diseases. Obesity prevention is essential to reduce disease burden in the future. [ABSTRACT FROM AUTHOR]

Background: Gallstone disease, traditionally associated with older, overweight females, is increasingly being observed in younger individuals. This shift necessitates a closer examination of the unique characteristics and risk factors associated with gallstone development in this demographic. While conventional risk factors such as gender, age, and genetic predispositions continue to play a role, emerging trends suggest that modifiable factors, including dietary habits, lifestyle choices, and medical conditions, are also influential. Methods: In this observational study conducted at Al Wahda Teaching Hospital in Derna, Libya, between January 2021 and January 2022, we retrospectively collected data from 182 patients diagnosed with gallbladder disease. The study focused on recording demographic information and assessing modifiable risk factors, including dietary habits, reproductive history, smoking, and associated chronic illnesses. Results: The majority of patients were female (92.3%), with the most commonly affected age group being 26 - 30 years. The average weight of the population was also notably high. Assessment of modifiable risk factors revealed a high prevalence of a high-fat diet (75.8%) and a sedentary lifestyle (73.6%), while surprisingly, 69.2% maintained a high-fiber diet. A range of chronic illnesses contributed to a small proportion of cases, including hemolytic anemia (13.2%), diabetes mellitus (5.5%), and liver disease (4.4%). The predominance of laparoscopic cholecystectomy (54.9%) indicates a shift in treatment approach. Complications were absent in the majority of cases (81.3%), suggesting a generally favorable outcome in gallstone disease management within this cohort. Conclusions: The evolving nature of gallstone disease in younger populations calls for a reassessment of understanding and management strategies. The observed trends highlight the need for further research to better understand the changing landscape of gallstone disease and to develop targeted preventive measures for this demographic. [ABSTRACT FROM AUTHOR]

Schistosomiasis is an infectious disease caused by parasitic flatworms of the genus Schistosoma. The species Schistosoma mansoni is associated with hepatosplenic disease. Schistosomiasis involving the gallbladder alone is highly unusual, with a few cases reported. Herein, we present the case of a woman from a region with endemic schistosomiasis who presented with a painless solid lesion and wall thickening of the gallbladder. She underwent an uneventful laparoscopic cholecystectomy. Microscopic examination of the surgical specimen revealed Schistosoma mansoni eggs associated with granulomatous reaction, leading to the diagnosis of schistosomiasis of the gallbladder, prompting subsequent treatment with praziquantel and follow-up. This case illustrates the importance of suspicion for this diagnosis in endemic areas, as it can be misdiagnosed with malignancy if not examined microscopically. Complications and treatment strategies are poorly characterized for the few cases of schistosomiasis; reporting this case can serve as a helpful reminder of a rare presentation of this disease.

Gallbladder (GB) neoplasms, although rare, are the most common group of malignant neoplasms of the biliary system and can be missed preoperatively as well as on gross examination. Detection of the type of GB neoplasm and reporting the depth of invasion are important for appropriate management. Histopathologic examination of all cholecystectomy specimens is a must, even if no malignancy is detected radiologically or grossly. We describe a series of eight incidentally detected GB neoplasms and discuss the morphological features, staging, and management along with clinical significance. [ABSTRACT FROM AUTHOR]

Background. Gallbladder diseases are relatively common, most of which are asymptomatic, others may be presented with right hypochondriac pain. Obesity, metabolic syndrome, long-term fasting, rapid weight reduction, bariatric surgery and drugs are associated with bile stasis and hence participate in gallstone formation. The study aimed to determine the variety of gallbladder disease detected by ultrasound in Iraqi patients. Methods. This study involved a randomly selected sample of 100 men and 100 women who attended the ultrasound clinic at Emamein Kadhimein Medical City for abdominal ultrasonography for various reasons in a period of 8 months (Oct 2022-Jul 2023). Data about age, sex, risk factors and symptoms were collected from those who had ultrasound features of gallbladder diseases. Results. It was found that gallbladder diseases are more common in women (23% of all examined women) than men (11% of all examined men). The most affected age groups are between 40-49, the percentage of women affected in this age group is 30.47% and men 12%. Most of the cases were without symptoms. The most common ultrasound finding is gallstones, where the percentage of affected women reached 82.6% and the affected men 81.8%. Conclusion. Ultrasound has a valuable role in screening, detection and follows up of gallbladder diseases. It is safe, available and cost-effective examination. Gallbladder diseases particularly gall stones are relatively common in Iraqi population, being more common in middle age women with clear association with obesity and multiparty among other risk factors. Most of patients were asymptomatic others presented with symptoms like abdominal pain. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy for benign gallbladder diseases is being practised as a day-care procedure in many centres around the world. This has been justified in view of the low rate of adverse events or complications following the surgery. There is a lack of uniform protocol for hospital admission and duration of hospital stay for elective laparoscopic cholecystectomy especially in developing countries in remote areas. The purpose of this study was to find out the possibility whether it was safe and feasible to discharge elective laparoscopic cholecystectomy patients as day-care (6 h) in a centre like ours where there is no dedicated unit for ambulatory surgery. It is a retrospective analysis of prospectively collected data. The study was conducted in the Department of general surgery in a rural healthcare setup. The suitability for discharge was assessed at 6 h after surgery. All patients were re-evaluated the following morning to rule out any negative outcomes that might have resulted from being released from the hospital at 6 h post-surgery. Total of 145 patients underwent elective laparoscopic cholecystectomy during the said period. The mean age is 39.6 years. Out of 145, 125 (86%) patients were dischargeable according to the modified Alderete score at 6 h. Duration of surgery (p-value-0.001), occurrence of postoperative nausea and vomiting (p-value-.002), critical view of safety visibility (p-value-.03) and need for foley's catheterization (p < 0.001) have significant associations with suitability for discharge at 6 h. Elective laparoscopic cholecystectomy surgery as a day-care procedure has its own advantages. According to the modified Alderete score, most of the patients in our study who were eligible for discharge after six hours did not experience any difficulties while they were hospitalised, making them candidates for same-day discharge. However, case selection should take care of patient and logistic factors. [ABSTRACT FROM AUTHOR]

Gallbladder diseases are very common, and their diagnosis is based on clinical–laboratory evaluation and imaging techniques. Considering the different imaging diagnostic tools, ultrasound (US) has the advantage of high accuracy combined with easy availability. Therefore, when a gallbladder disease is suspected, US can readily assist the clinician in the medical office or the emergency department. The high performance of US in the diagnosis of gallbladder diseases is mainly related to its anatomic location. The most frequent gallbladder pathological condition is gallstones disease, easily diagnosed via US examination. Acute cholecystitis (AC), a possible complication of gallstone disease, can be readily recognized due to its specific sonographic features. Additionally, a number of benign, borderline or malignant gallbladder lesions may be detected via US evaluation. The combined use of standard B-mode US and additional sonographic techniques, such as contrast-enhanced ultrasonography (CEUS), may provide a more detailed study of gallbladder lesions. Multiparametric US (combination of multiple sonographic tools) can improve the diagnostic yield during gallbladder examination. [ABSTRACT FROM AUTHOR]

Gallbladder polyps (GBP) are solid lesions originating from the gallbladder mucosa and extending into the gallbladder lumen. Preoperative diagnosis of GBP can be easily performed via USG; however, which patients should be followed up and which patients should be operated on is still a matter of discussion. This study aimed to investigate the histopathologic results and indications for surgery in patients diagnosed with GBP in the preoperative period and to present our clinical experience in light of current literature. Patients diagnosed with GBP and who had surgery in our general surgery clinic between July 2019 and July 2023 were retrospectively reviewed. A total of 57 patients were included in the study. The medical records, laboratory results, imaging results, and pathology reports of the patients were examined. The mean age of the patients was 47.1±11.7 years (23-78 years). The male/female ratio was 1.3/1. Polyp diameter was above 10 mm in 61.4% of patients and below 10 mm in 38.6%. The indication for surgery was the presence of coexisting cholelithiasis in 35.1% of the cases, symptomatic polyps in 33.3%, and increased polyp diameter in 21.1%. In histopathologic evaluation, cholesterol polyp was the most frequently encountered polyp (40.4%). The follow-up and treatment of GBP is still controversial. The most important factors to be considered in the surgical treatment of SCP are the polyp being over 10 mm and being symptomatic. In follow-up patients, further detailed clinical examination should be performed if necessary, and other imaging modalities should be preferred along with USG. Furthermore, it is required to establish up-to-date international algorithms for the follow-up and treatment of GBP. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) allows computers to self-develop decision-making algorithms through huge data analysis. In medical investigations, using computers to automatically diagnose diseases is a promising area of research that could change healthcare strategies worldwide. However, it can be challenging to reproduce or/and compare various approaches due to the often-limited datasets comprising medical images. Since there is no open access dataset for the Gallbladder (GB) organ, we introduce, in this study, a large dataset that includes 10,692 GB Ultrasound Images (UI) acquired at high resolution from 1,782 individuals. These UI include many disease types related to the GB, and they are organized around nine important anatomical landmarks. The data in this collection can be used to train machine learning (ML) and deep learning (DL) models for computer-aided detection of GB diseases. It can also help academics conduct comparative studies and test out novel techniques for analyzing UI to explore the medical domain of GB diseases. The objective is then to help move medical imaging forward so that patients get better treatment.

Abstract Background The clinical management of patients experiencing recurrent abdominal pain resembling biliary-type, but with negative findings on conventional transabdominal ultrasound (TUS), poses a challenge. In recent years, endoscopic ultrasound (EUS) has emerged as a valuable tool for diagnosing gallbladder diseases. This study aims to assess the role of EUS in the evaluation of gallbladder and biliary system diseases specifically in patients with normal transabdominal ultrasonography results. Methods This study was a cross-sectional analytic study that enrolled 150 patients with any complaints related to the gallbladder and biliary system necessitating transabdominal ultrasound and endosonography in the period between February 2021 and December 2021. Results The mean age of the studied patients was 46.1 ± 10.3 years; 46.7% were males and 53.3% were females. The main complaint was right abdominal pain in 78.0%; meanwhile, 74.7% had a picture of obstructive jaundice. EUS revealed gallbladder wall thickening in 15 patients (10%), mud and/or small stones inside the gallbladder in 73 patients (48.7%), positive GB mass and/or polyp findings in 30 patients (20%), and biliary lesions such as duct strictures and/or dilatations were detected in 48 patients (32%), while transabdominal ultrasound was normal in all those patients. Conclusion Endoscopic ultrasound (EUS) proves to be a valuable diagnostic modality in patients experiencing biliary-type abdominal pain, despite normal transabdominal ultrasonography results. It not only aids in the accurate diagnosis of underlying conditions but also has the potential to impact the management plan for these patients.

Gallbladder torsion is a rare cause of acute surgical abdomen. Early recognition and surgical intervention are important for reducing complications and improving postoperative patient outcomes, but standard imaging and laboratory evaluation typically are indistinguishable from those of acute cholecystitis. This article describes a patient with gangrenous cholecystitis secondary to torsion and summarizes recommendations for evaluation and management. [ABSTRACT FROM AUTHOR]

Objective: Some studies have found that cholecystectomy may increase the risk of colorectal cancer (CRC), while others have reached inconsistent conclusions. We thus performed a systematic review and meta-analysis to assess the incidence rate of CRC after cholecystectomy for patients with gallstones or gallbladder diseases, and whether the geographical location of the patients affected the results. Methods: We systematically searched PubMed, Embase, and Cochrane for studies reporting changes in the incidence rate of CRC after cholecystectomy published before January 12, 2023. Our main endpoint was the occurrence of CRC. Data were extracted and pooled, and the relative risk (RR) and 95% confidence interval (CI) were calculated. We assessed pooled data using a random-effects model. Results: In total, 477 articles were identified, and 6 articles were eligible, including 7 studies that included 797,917 participants. Overall, the summarized research results showed that the risk of CRC was reduced in patients with gallbladder diseases who underwent cholecystectomy (RR: 0.80, 95% CI: 0.65 to 0.99, p = 0.040; I2 = 85.0%). In the subgroup analysis based on different geographical locations, cholecystectomy was not associated with the risk of CRC in the Western population (RR: 0.90, 95% CI: 0.65 to 1.25, p = 0.522; I2 = 86.5%), but there was a negative correlation between cholecystectomy and the risk of CRC (RR: 0.66, 95% CI: 0.60 to 0.73, p = 0.000) in the Chinese population. Conclusions: Our findings support that for patients with gallstones or gallbladder diseases, the incidence of CRC after cholecystectomy is lower than that of patients who do not undergo cholecystectomy.

Background: Esketamine, recognized for its analgesic, sedative, and anti-inflammatory qualities, is integral in multimodal analgesia. However, the potential opioid-sparing effects of intravenous esketamine, along with its impact on inflammatory responses, and cognitive function during laparoscopic surgery, remain unexplored. Methods: In this study, 90 patients scheduled for laparoscopic cholecystectomy were equally randomized into three groups: a normal saline control group (NS), a low-dose esketamine group (LS) and a high-dose esketamine group (HS). Subsequently, we monitored several parameters: hemodynamics, levels of stress and inflammatory responses, intraoperative doses of sufentanil, remifentanil, and propofol, and 24-hour postoperative sufentanil requirements. We also evaluated alterations in cognitive function, perioperative indicators, and potential adverse reactions among the three groups. Results: Compared to their levels 5 minutes prior to anesthesia (T0) and 30 minutes post-operation (T4), the NS group exhibited a more significant decrease in Mean Arterial Pressure (MAP) and Heart Rate (HR) at various time intervals: 5 minutes after the skin incision (T1), 30 minutes post-incision (T2), and at the conclusion of the operation (T3), compared to the LS and HS groups(P < 0.05). Furthermore, the NS group exhibited a greater increase in levels of adrenaline (AD), noradrenaline (NE), endothelin (ET), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) at T1, T2, and T3, more so than the other two groups(P < 0.05). 24 hours after the surgery, patients in the LS group and HS group had significantly higher Montreal Cognitive Assessment (MoCA) scores than those in the NS group(P < 0.05). The LS and HS groups required lower doses of propofol, remifentanil, and sufentanil during surgery (P < 0.05), experienced shorter postoperative recovery times, and had lower incidences of nausea, vomiting, and respiratory depression compared to the NS group (P < 0.05). Conclusion: The administration of low-dose esketamine has been shown to be safe, effective, and dependable in the context of laparoscopic gallbladder surgery. It has the capacity to stabilize hemodynamic responses, ameliorate both stress and inflammatory reactions from surgery, and hastens anesthesia recovery. Furthermore, it fosters the restoration of postoperative cognitive function. Notably, when combined with nalbuphine, it exhibits opioid-sparing effects, reducing postoperative adverse outcomes. Trial registration: The trial is registered with the China Clinical Trials Registry Registration Number: ChiCTR2300067596. Retrospectively registered (date of registration: 12/01/2023). [ABSTRACT FROM AUTHOR]

Background: The clinical management of patients experiencing recurrent abdominal pain resembling biliary-type, but with negative findings on conventional transabdominal ultrasound (TUS), poses a challenge. In recent years, endoscopic ultrasound (EUS) has emerged as a valuable tool for diagnosing gallbladder diseases. This study aims to assess the role of EUS in the evaluation of gallbladder and biliary system diseases specifically in patients with normal transabdominal ultrasonography results. Methods: This study was a cross-sectional analytic study that enrolled 150 patients with any complaints related to the gallbladder and biliary system necessitating transabdominal ultrasound and endosonography in the period between February 2021 and December 2021. Results: The mean age of the studied patients was 46.1 ± 10.3 years; 46.7% were males and 53.3% were females. The main complaint was right abdominal pain in 78.0%; meanwhile, 74.7% had a picture of obstructive jaundice. EUS revealed gallbladder wall thickening in 15 patients (10%), mud and/or small stones inside the gallbladder in 73 patients (48.7%), positive GB mass and/or polyp findings in 30 patients (20%), and biliary lesions such as duct strictures and/or dilatations were detected in 48 patients (32%), while transabdominal ultrasound was normal in all those patients. Conclusion: Endoscopic ultrasound (EUS) proves to be a valuable diagnostic modality in patients experiencing biliary-type abdominal pain, despite normal transabdominal ultrasonography results. It not only aids in the accurate diagnosis of underlying conditions but also has the potential to impact the management plan for these patients. [ABSTRACT FROM AUTHOR]

Bilobed or duplicate gallbladders are the rare anomalies of the biliary system occurring between the 5th and 6th weeks of embryonic life, of which Type 2 ductular variant is the commonest. Patients may be asymptomatic or symptomatic, with majority of the cases being detected intraoperatively or during re-operation. Once suspected a detailed preoperative evaluation is a must to avoid both intraoperative and postoperative complications. We report a case of a 34-year-old female who presented with acute onset of abdominal pain and was detected with symptomatic bilobed gallbladder (H Type) with cholelithiasis, with a resolution of symptoms after a successful laparoscopic cholecystectomy. The case emphasizes the importance of detailed preoperative evaluation in the form of ultrasound and magnetic resonance cholangiopancreatography to be considered during the management of biliary pathologies to avoid any intra- and post-operative complications. [ABSTRACT FROM AUTHOR]

Abstract Background Thick wall gallbladder (TWGB) is not an uncommon finding on ultrasonography especially in region with high prevalence of gall stones disease like north India. On most occasion, these thickening could be because of benign disorders but malignancy are not a rare cause of it. Preoperative distinction between benign and malignant causes of TWGB is important as the surgical treatment entirely differ. Despite after thorough evaluation with various imaging modalities, a definitive diagnosis cannot be reached on many occasion. The aim of our study was to review the literature for the diagnosis and management approach in patients with TWGB. Methods We perform a thorough online search of full text articles related with thick wall GB published in English literature. After doing a critical appraisal of available literature, a comprehensive narrative review was described. Conclusions In this review, the authors have described a clinical algorithmic approach by detailing the diagnostic utility of various imaging modalities and also different surgical options for treatment especially in cases of ambiguity.

Background: Acute calculous cholecystitis is the obstruction of the cystic duct by a gallstone that leads to inflammation of the gallbladder necessitating cholecystectomy. Case Series: We present the cases of 2 patients with acute calculous cholecystitiswhowere deemed ineligible candidates for cholecystectomy because of their complicating medical histories. Both patients initially underwent cholecystostomy and drain placement with interventional radiology for management of acute calculous cholecystitis. Their large gallstones remained refractory to attempts at removal by electrohydraulic lithotripsy via the cholecystostomy access. The patients' gallstones were successfully removed via percutaneous ultrasonic lithotripsy during a collaborative procedure with interventional radiology and urology. Conclusion: An interdisciplinary approach using percutaneous cholecystolithotomywith rigid ultrasonic lithotripsy is an effective method for removing challenging gallstones in patients for whom traditional approaches fail. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose: The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Methods: Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Results: Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. Conclusions: LC can be performed using different techniques, although the use of EBVS is highly recommended.

Background: Thick wall gallbladder (TWGB) is not an uncommon finding on ultrasonography especially in region with high prevalence of gall stones disease like north India. On most occasion, these thickening could be because of benign disorders but malignancy are not a rare cause of it. Preoperative distinction between benign and malignant causes of TWGB is important as the surgical treatment entirely differ. Despite after thorough evaluation with various imaging modalities, a definitive diagnosis cannot be reached on many occasion. The aim of our study was to review the literature for the diagnosis and management approach in patients with TWGB. Methods: We perform a thorough online search of full text articles related with thick wall GB published in English literature. After doing a critical appraisal of available literature, a comprehensive narrative review was described. Conclusions: In this review, the authors have described a clinical algorithmic approach by detailing the diagnostic utility of various imaging modalities and also different surgical options for treatment especially in cases of ambiguity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Functional gallbladder disorder is most commonly defined by biliary colic and low ejection fraction (EF) on cholescintigraphy. Biliary hyperkinesia is a controversial type of functional gallbladder disorder, and its definition and the role of cholecystectomy in treating functional gallbladder disorder remains unclear. STUDY DESIGN: We conducted a retrospective review of patients who underwent cholecystokinin-stimulated cholescintigraphy and cholecystectomy at 3 Mayo Clinic sites between 2007 and 2020. Eligible patients were 18 years or older, presented with symptoms of biliary disease, had an EF greater than 50%, underwent cholecystectomy, and had no evidence of acute cholecystitis or cholelithiasis on imaging. We used receiver operating characteristics curve analysis to identify the optimal cutoff value that predicted symptom resolution within 30 days of cholecystectomy. RESULTS: A total of 2,929 cholecystokinin-stimulated cholescintigraphy scans were performed during the study period; the average EF was 67.5% and the median EF was 77%. Analyzing those with EFs greater than or equal to 50% yielded 1,596 patients with 141 (8.8%) going on to have cholecystectomy. No significant differences were found in age, sex, BMI, final pathology between patients with and without pain resolution. Using a cutoff EF of 81% was significantly associated with pain resolution after cholecystectomy (78.2% for EF greater than or equal to 81% vs 60.0% for EF less than 81%, p = 0.03). Chronic cholecystitis was found in 61.7% of the patients on final pathology. CONCLUSIONS: We determined that an EF cutoff of 81% is a reasonable upper limit of normal gallbladder EF. Patients with biliary symptoms and an EF greater than 81% but no evidence of biliary disease on ultrasound or scintigraphy can be classified as having biliary hyperkinesia. Based on our findings, we recommend cholecystectomy for this patient population. [ABSTRACT FROM AUTHOR]

Background: In children, laparoscopic cholecystectomy (LC) is now considered the gold standard for gallbladder (GB) removal. In the past, hemolytic disorders associated with cholelithiasis represented the most frequent conditions requiring LC; this is being overtaken by cholelithiasis and biliary conditions in overweight or ex-premature children. Aims: This study aims to describe current indications and timing for LC in pediatric patients. Methods: Retrospective study. Data on previous medical therapy, ultrasound, pre- and intraoperative aspects, and histology were collected for patients treated in 2020–2023. Results: In total, 45 patients were enrolled: 15 who underwent urgent surgery and 30 electives. Groups differed in terms of obesity rate, symptoms, ultrasound features, and intraoperative status. The most relevant risk factors for surgical complexity were age and pubertal stage, elevated cholestasis indexes, and gallbladder wall thickness > 3 mm at ultrasound. GB wall thickening ≥3 mm, US Murphy sign, fluid collections, and gallbladder distention on ultrasound correlated with high surgical scores. Conclusions: Indications for laparoscopic cholecystectomy in children seem to evolve caused by changing characteristics of the pediatric population. Patients with overweight/obesity may develop more complex GB diseases. Asymptomatic patients should be considered for surgery after observation, considering age and/or pubertal maturation when other risk factors are absent. [ABSTRACT FROM AUTHOR]

Objective: One of the purposes of laparoscopic surgery is being minimally invasive. In this context, we compared sling suture-assisted two-port techniques with the standard four-port technique in laparoscopic cholecystectomy. Materials and Methods: A retrospective clinical study was planned and 96 patients over 18 years of age with gallstone disease were recruited from Zeynep Kamil Women and Children's Diseases Training and Research Hospital between November 2019 and June 2021. Two-port laparoscopic cholecystectomy was performed in 48 patients (Group 1) and standard four-port laparoscopic cholecystectomy (Group 2) in other 48 patients. The duration of surgery, postoperative pain, cosmetic appearance, analgesic use, complication rates, the duration of hospital stay, and return to work times were compared. Results: The largest stone diameter, sac wall thickness, number of attacks, and pain radiating to back (p=0.007, p=0.001, p=0.013, and p=0.010, respectively) were significantly higher in the Group 2 than in the Group 1. The operation time was significantly lower (p=0.026) in the Group 2. The Numerical Rating Scale was used to assess postoperative pain. Although the 3rd day score was significantly higher (p=0.02) in the Group 2, no difference was found in the 3rd week evaluation (p=0.115). In the Group 2, postoperative symptoms, non-steroidal anti-inflammatory drug use, duration of hospital stay, and time to return to work were significantly higher (p<0.001, p<0.001, p=0.034, and p<0.001, respectively). Conclusion: For standard four-port cholecystectomy, the two-port and two-suture assisted technique is a good alternative for selected cases. It can be applied successfully and is cosmetically effective. [ABSTRACT FROM AUTHOR]

Copyright of Acibadem Saglik Bilimleri Dergisi is the property of Acibadem University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Presurgical anxiety is very common and is often treated with sedatives. Minimizing or avoiding sedation reduces the risk of sedation-related adverse events. Reducing sedation can increase early cognitive recovery and reduce time to discharge after surgery. The current case study is the first to explore the use of interactive eye-tracked VR as a nonpharmacologic anxiolytic customized for physically immobilized presurgery patients. Method: A 44-year-old female patient presenting for gallbladder surgery participated. Using a within-subject repeated measures design (treatment order randomized), the participant received no VR during one portion of her preoperative wait and interactive eye-tracked virtual reality during an equivalent portion of time in the presurgery room. After each condition (no VR vs. VR), the participant provided subjective 0–10 ratings and state–trait short form Y anxiety measures of the amount of anxiety and fear she experienced during that condition. Results: As predicted, compared to treatment as usual (no VR), the patient reported having 67% lower presurgical anxiety during VR. She also experienced "strong fear" (8 out of 10) during no VR vs. "no fear" (0 out of 10) during VR. She reported a strong sense of presence during VR and zero nausea. She liked VR, she had fun during VR, and she recommended VR to future patients during pre-op. Interactive VR distraction with eye tracking was an effective nonpharmacologic technique for reducing anticipatory fear and anxiety prior to surgery. The results add to existing evidence that supports the use of VR in perioperative settings. VR technology has recently become affordable and more user friendly, increasing the potential for widespread dissemination into medical practice. Although case studies are scientifically inconclusive by nature, they help identify new directions for future larger, carefully controlled studies. VR sedation is a promising non-drug fear and anxiety management technique meriting further investigation. [ABSTRACT FROM AUTHOR]

Biliary malignancies arise from anywhere along the biliary tract and broadly encompass gallbladder cancer and cholangiocarcinoma. Surgical resection with curative intent remains the mainstay treatment for biliary tract malignancies, but despite advances in treatment and management over the years, prognosis remains poor. The majority of patients present with nonspecific clinical symptoms and are diagnosed at late-stage disease when surgical resection is no longer an option. In the minority of patients presenting with early-stage disease, it is particularly important to determine accurate radiological staging and take a multidisciplinary approach to determine patients suitable for curative surgical resection. A range of imaging modalities is often used in combination, each providing complementary information to characterize and stage disease. Gallbladder cancer and cholangiocarcinoma are distinct entities and the approach to each of these will be discussed separately. [ABSTRACT FROM AUTHOR]

Background: The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy. Methods: We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment. Results: We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%. Conclusions: Our series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic cholecystectomy stands as the established surgical approach for gallbladder diseases. This study seeks to enhance the management of potential complications by anticipating the likelihood of operative complexity and the risk of requiring conversion to an open procedure. Methods: In this retrospective study, a total of 811 cholecystectomy procedures were undertaken, segregating patients into case and control groups. The case group comprised 24 patients who initiated laparoscopically but ultimately underwent open conversion. Exclusion criteria encompassed direct open procedures, patients below 18 years of age, and cholecystectomies performed concurrently with other surgeries. A control group of 276 patients was chosen, matched for age, gender, and body mass index, to evaluate the influential aspects governing conversion likelihood. Results: The study demonstrated a conversion rate of 3.09%. The preeminent determinant of conversion was the increased gallbladder wall thickness. Factors exerting influence on conversion included a history of endoscopic retrograde cholangiopancreatography, prior abdominal surgery, elevated C-reactive protein, lactate dehydrogenase, and direct bilirubin levels, instances of cholecystitis and cholangitis attacks, dense adhesions between the gallbladder and close organs, gallbladder hydrops, impacted stones, and a Callot dissection time exceeding 90 minutes. The Sugrue scoring system was also observed as a potentially valuable tool for predicting the likelihood of open conversion. Conclusion: The capacity to foresee potential complications proactively empowers optimal preoperative preparations. This approach ensures patients are well-informed about the surgery, potential complications, and the prospect of conversion to an open procedure. Moreover, it enables the possibility of conducting the operation within a more experienced medical center when warranted. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mental illness is associated with worse outcomes after emergency general surgery. To understand how preoperative processes of care may influence disparate outcomes, we examined rates of surgical consultation, treatment, and operative approach between older adults with and without serious mental illness (SMI). STUDY DESIGN: We performed a nationwide, retrospective cohort study of Medicare beneficiaries aged 65.5 years or more hospitalized via the emergency department for acute cholecystitis or biliary colic. SMI was defined as schizophrenia spectrum, mood, and/or anxiety disorders. The primary outcome was surgical consultation. Secondary outcomes included operative treatment and surgical approach (laparoscopic vs open). Multivariable logistic regression was used to examine outcomes with adjustment for potential confounders related to patient demographics, comorbidities, and rates of imaging. RESULTS: Of 85,943 included older adults, 19,549 (22.7%) had SMI. Before adjustment, patients with SMI had lower rates of surgical consultation (78.6% vs 80.2%, p < 0.001) and operative treatment (68.2% vs 71.7%, p < 0.001), but no significant difference regarding laparoscopic approach (92.0% vs 92.1%, p = 0.805). In multivariable regression models with adjustment for confounders, there was no difference in odds of receiving a surgical consultation (odds ratio 0.98 [95% CI 0.93 to 1.03]) or undergoing operative treatment (odds ratio 0.98 [95% CI 0.93 to 1.03]) for patients with SMI compared with those without SMI. CONCLUSIONS: Older adults with SMI had similar odds of receiving surgical consultation and operative treatment as those without SMI. As such, differences in processes of care that result in SMI-related disparities likely occur before or after the point of surgical consultation in this universally insured patient population. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Health & Sport is the property of Turkish Journal of Health & Sport and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Laparoscopic staplers (LS) have been suggested as a safe alternative to metal clips in laparoscopic cholecystectomy when the cystic duct is too inflamed or wide for complete clip occlusion. We aimed to evaluate the perioperative outcomes of patients whose cystic ducts were controlled by LS and evaluate the risk factors for complications. Methods: Patients who underwent laparoscopic cholecystectomy with LS used to control the cystic duct from 2005 to 2019 were retrospectively identified from an institutional database. Patients were excluded for open cholecystectomy, partial cholecystectomy, or cancer. Potential risk factors for complications were assessed using logistic regression analysis. Results: Among 262 patients, 191 (72.9%) were stapled for size and 71 (27.1%) for inflammation. In total, 33 (16.3%) patients had Clavien-Dindo grade ≥ 3 complications, with no significant difference when surgeons chose to staple for duct size versus inflammation (p = 0.416). Seven patients had bile duct injury. A large proportion had Clavien-Dindo grade ≥ 3 postoperative complications specifically related to bile duct stones [n = 29 (11.07%)]. Intraoperative cholangiogram was protective against postoperative complications [odds ratio (OR) = 0.18 (p = 0.022)]. Conclusion: Whether these high complication rates reflect a technical issue with stapling, more challenging anatomy, or worse disease, findings question whether the use of LS during laparoscopic cholecystectomy is truly a safe alternative to the already accepted methods of cystic duct ligation and transection. Based on these findings, an intraoperative cholangiogram should be performed when considering a linear stapler during laparoscopic cholecystectomy to: (1) ensure the biliary tree is free of stones; (2) prevent inadvertent transection of the infundibulum rather than the cystic duct; and, (3) allow opportunity for safe alternative strategies when an IOC is not able to confirm anatomy. Otherwise, surgeons employing LS devices should be aware that patients are at higher risk for complications. [ABSTRACT FROM AUTHOR]

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), as a kind of novel hypoglycemic agent, are widely used in patients with type 2 diabetes. GLP-1RAs are effective in glycemic control with low risk of hypoglycemia, significant weight loss, and cardiovascular benefit and renal protection. The most common adverse effects of GLP-1RAs are mild to moderate gastrointestinal symptoms, which generally resolve over time. The use of GLP-1RAs also increases the risk of gallbladder or biliary diseases, especially when used at higher doses, for longer durations, and for weight loss, but the absolute risk of gallbladder or biliary tract disease is small. Clinicians and patients need to carefully weigh the benefits and risks of GLP-1RAs to make decisions for the rational use of GLP-1RAs.

Abstract Lymphovascular invasion is a hallmark of malignant neoplasms, however the presence of benign epithelium within vessels has been reported in benign processes, albeit infrequently. The proposed mechanism to explain this phenomenon entails mechanical displacement of benign epithelium into the vascular spaces during surgical manipulation or diagnostic interventions. We report a case of numerous benign epithelial vascular emboli in a cholecystectomy specimen. A 29-year-old male presented with acute calculous cholecystitis. Surgery was delayed for several weeks due to COVID-19 infection. Histologic examination of the gallbladder showed subacute cholecystitis, widespread vascular epithelial emboli with associated fibrin deposition and bile embolism supporting an in vivo process. The epithelial emboli were localized in small veins and arterioles with D2–40−/CD31+/CD34+ endothelium. The displaced epithelium showed benign cytologic features, was negative for p53 expression, and had a Ki-67 labelling index like the benign background mucosa, supporting a benign process. There was no evidence of dysplasia or malignancy in the specimen after thorough sampling. Persistent inflammation, mucosal ulceration, transmural mucosal herniation (Rokitansky-Aschoff sinuses), and protracted surgical manipulation secondary to adhesive disease are favored to be the underlying causes of this unusual histologic finding. Although we presume an uneventful outcome, clinical follow up was recommended. COVID-19 infection likely contributed to this phenomenon by causing a delay in the surgical management.

Background: In this study, it was aimed to evaluate the efficacy, safety, and clinical results of percutaneous cholecystostomy (PK) in the treatment of patients with acute cholecystitis (AC). Materials and Methods: All patients older than 18 years of age who underwent PC in Mehmet Akif Inan Hospital and Harran University Hospital between January 2020 and May 2022 were analyzed retrospectively. Demographic data (age and gender), comorbidities, duration of catheter removal, length of hospital stay, American Society of Anesthesia (ASA) score, interval cholecystectomy, and mortality development status of the patients were recorded. According to the severity of AC, it was divided into three grade 1 (mild), grade 2 (moderate), and grade 3 (severe). Results: Of the 130 patients included in the study, 76 (58.5%) were female, and the mean age of the patients was 71.9 (range: 36-92) years. The most common comorbidities were hypertension (n=28, 21.5%) and coronary artery disease (n=26, 20.0%). Of the patients, 70 (53.8%) had calculous cholecystitis and 115 (88.5%) had hydropic gallbladder. The ASA score of 68 (52.3%) patients was 3-4 and 14 (10.8%) were grade 3 cholecystitis. The technical success of PK was 100%. The in-hospital mortality rate was 15.4% (n=20), and the mean age of patients who died was significantly higher than those who were discharged (81.2 ± 8.5 and 70.1 ± 13.8 years, p<0.001). The rate of severe (grade 3) AC and high ASA score (ASA 3 and 4) were significantly higher in patients who developed mortality compared to those who were discharged (40% vs. 5.5%, p<0.001 vs. 80% vs. 47.3%, p=0.006; respectively). Patients who died had a longer hospital stay (median value, 28 vs 13 days; p=0.002) and a significantly higher CRP (86.2 ±23.8 vs 11.4 ± 6.4 g/dl; p=0.032). Cholecystectomy was performed in 46.2% (n=60) of the patients after PC. Conclusions: PC can be used effectively and safely in both preoperative bridging and definitive treatment of patients with acute cholecystitis. In addition, it was found that the advanced age of the patients who underwent PC, had a high ASA score due to comorbidity diseases, and the presence of severe cholecystitis increased mortality. [ABSTRACT FROM AUTHOR]

Objectives: Differentiating benign gallbladder diseases from gallbladder cancer (GBC) remains a radiological challenge because they can appear very similar on imaging. This study aimed at investigating whether CT-based radiomic features of suspicious gallbladder lesions analyzed by machine learning algorithms could adequately discriminate benign gallbladder disease from GBC. In addition, the added value of machine learning models to radiological visual CT-scan interpretation was assessed. Methods: Patients were retrospectively selected based on confirmed histopathological diagnosis and available contrast-enhanced portal venous phase CT-scan. The radiomic features were extracted from the entire gallbladder, then further analyzed by machine learning classifiers based on Lasso regression, Ridge regression, and XG Boosting. The results of the best-performing classifier were combined with radiological visual CT diagnosis and then compared with radiological visual CT assessment alone. Results: In total, 127 patients were included: 83 patients with benign gallbladder lesions and 44 patients with GBC. Among all machine learning classifiers, XG boosting achieved the best AUC of 0.81 (95% CI 0.72–0.91) and the highest accuracy rate of 73% (95% CI 65–80%). When combining radiological visual interpretation and predictions of the XG boosting classifier, the highest diagnostic performance was achieved with an AUC of 0.98 (95% CI 0.96–1.00), a sensitivity of 91% (95% CI 86–100%), a specificity of 93% (95% CI 90–100%), and an accuracy of 92% (95% CI 90–100%). Conclusions: Machine learning analysis of CT-based radiomic features shows promising results in discriminating benign from malignant gallbladder disease. Combining CT-based radiomic analysis and radiological visual interpretation provided the most optimal strategy for GBC and benign gallbladder disease differentiation. Key Points: Radiomic-based machine learning algorithms are able to differentiate benign gallbladder disease from gallbladder cancer. Combining machine learning algorithms with a radiological visual interpretation of gallbladder lesions at CT increases the specificity, compared to visual interpretation alone, from 73 to 93% and the accuracy from 85 to 92%. Combined use of machine learning algorithms and radiological visual assessment seems the most optimal strategy for GBC and benign gallbladder disease differentiation. [ABSTRACT FROM AUTHOR]

Copyright of Türkiye Jeoloji Bülteni is the property of TMMOB JEOLOJI MUHENDISLERI ODASI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Gallbladder perforation is a rare but life-threatening complication of acute cholecystitis. A rapid diagnostic work-up helps in identifying the type of gallbladder perforation. All these measures help in deciding the most effective means of management. We reported a case of an elderly man, who had co-morbidities. He presented an intrahepatic perforation of the gall bladder (GB) and a liver abscess. The patient was managed initially by performing a percutaneous image-guided drainage of the abscess. Then, we performed an endoscopic retrograde cholangiopancreatography and an extraction of the common bile duct stone. The patient underwent a successful open cholecystectomy after stabilization.The GB perforation and a liver abscess were detected in an elderly patient with co-morbidities. Initially, this condition can be managed conservatively by performing a percutaneous drainage of the abscess. Thus, this technique acts as a bridge to surgery. [ABSTRACT FROM AUTHOR]