Although the risk of persistent biliary duct injury is low, cholecystectomy is one of the most commonly performed procedures worldwide. The occurrence of bile duct injury (BDI) results in complicated reconstructions, prolonged hospitalisation, repeated diagnostic examinations, and a high risk of long-term complications, leading to cost increase. A wide range of diagnostic methods are used to identify the damage and the associated complications. The aim of the study was to evaluate the impact of iatrogenic post-cholecystectomy BDI on the amount of diagnostic imaging and hospital re-admission rate. The retrospective cross-sectional study included the analysis of records of 38 patients undergoing laparoscopic cholecystectomy, referred to the Diagnostic Radiology Institute, Pauls Stradiņš Clinical University Hospital, who underwent diagnostic imaging. Among those who had iatrogenic BDI due to cholecystectomy, 57.9% (22 patients) underwent abdominal ultrasonography, 47.4% (18 patients) underwent endoscopic retrograde cholangiopancreatography, 47.4% (18 patients) underwent percutaneous transhepatic cholangiography (PTCA), 44.7% (17 patients) underwent computed tomography, 42.1% (16 patients) underwent magnetic resonance imaging, 13.2% (five patients) underwent US-guided puncture after cholecystectomy, and 15.8% (six patients) underwent fistulography. 18.4% (seven patients) were re-admitted to hospital once due to post-cholecystectomy complications, 34.2% (13 patients) twice, 15.8% (six patients) three times, 5.3% (two patients) four times, 13.2% (five patients) five times, 2.6% (one patient) seven times, 2.6% (one patient) ten times, 5.3% (two patients) eleven times and 2.6% (one patient) was re-admitted twenty-five times. Statistically significant strong correlation between hospital re-admission rate and PTCA (rs = 0.682, p < 0.001) was found. Iatrogenic post-cholecystectomy BDI significantly affects repeated diagnostic imaging and the hospital re-admission rate and, therefore, negatively affects hospital economics and patient welfare.
We analysed the age- and sex-specific incidence, disease-stage distribution, treatment modalities, and survival of patients with hepatocellular carcinoma (HCC) in Latvia from 1997 to 2017. Retrospective data from the Cancer Registry of Latvia identified 692 men and 427 women aged >19 years who were diagnosed with HCC, confirmed by autopsy, morphological, radiological, or clinical examinations. The total incidence of HCC increased from 2.63 to 3.75 cases per 100 000 person-years in 1997–2007 and 2008–2017, respectively. It was higher in men and increased with age. Two-thirds (65.9%) of patients were diagnosed with stage IV HCC. Overall, 935 patients died during follow-up. The survival rate was low: 32.5% and 22.2% of patients survived for 6 months and 1 year after diagnosis, respectively. Male sex, older age, and advanced stage at diagnosis were associated with poor prognosis. The proportion of radically treated patients was higher, and survival was better, in the period 2008–2017. Our epidemiological analysis of HCC over 20 years shows that the overall incidence of HCC has been increasing in Latvia since 1997; however, it is similar to that of other European countries. Advanced stage at diagnosis results in a low proportion of radically treated patients and poor overall survival.
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