Introduction: This study aims to investigate the role of main bile duct drainage and gallbladder transpapillary drainage in the treatment of patients who diagnosed with acute cholecystitis and acute cholangitis because of choledocholithiasis.Materials and Methods: Patients who were admitted to the hospital with the diagnosis of acute cholecystitis between January 2018 and December 2019, have hyperbilirubinemia in their laboratory tests, and who were diagnosed with choledochal stone by magnetic resonance imaging and magnetic resonance cholangiopancreatography imaging because of the findings of cholangitis were included in this study. These patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and choledochus stone extraction procedure and gallbladder drainage with the transpapillary pigtail. The demographic data, success rates, and complications of the patients were evaluated.Results: A total of 19 patients were included in the study. Choledochus was cannulated in all patients, but gallbladder drainage could not be achieved in 2 patients. These 2 patients were recorded under the unsuccessful method use. Although 2 patients could not be operated because of high comorbidity (American Society of Anesthesiologists IV), they underwent percutaneous cholecystostomy because of the development of cholecystitis arising from an obstruction in the pigtail catheter in the 11th and 12th weeks. Treatments of the remaining 15 patients and subsequent cholecystectomy procedures were successful. The mean age of the patients was 54.52 years. Of the patients, 9 were female and 6 were male. In the 6th week of follow-up, 15 patients underwent laparoscopic cholecystectomy with ERCP 1 day after removal of the stent and pigtail catheter.Conclusions: Transpapillary cholecystectomy with ERCP is a successful method of treatment in patients with acute cholecystitis with the symptoms of cholangitis because of choledochal stone.
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In this study, we aimed to evaluate the diagnostic value of thyroid imaging reporting and data system (TIRADS) in the estimation of malignancy and assess the concordance between TIRADS and the histopathology results of the postoperative specimens. Consecutive ultrasound imaging records of patients with multinodular goiter from January 2010 to December 2017 who underwent surgery were retrospectively reviewed. The risk of malignancy of each TIRADS category was determined, and correlation with pathology was assessed. The patients with malignant cytology findings (Bethesda 6) who were categorized TIRADS 6 were excluded from the study. The positive and negative predictive values, sensitivity, specificity, and accuracy of the TIRADS classification were calculated on a 2 x 2 table with their own formulas. A total of 1457 patients were evaluated, and 1122 of these were included in the study. The risk of malignancy for nodules evaluated as TIRADS 2 was 0.6 per cent, TIRADS 3 was 13.1 per cent, TIRADS 4a was 20 per cent, TIRADS 4b was 61.1 per cent, TIRADS 4c was 85.7 per cent, and TIRADS 5 was 93.3 per cent. The positive predictive value of TIRADS classification was found to be 43.4 per cent, negative predictive value was found to be 90.7 per cent, sensitivity was found to be 78 per cent, specificity was found to be 68.4 per cent, and accuracy was found to be 70.7 per cent for our institution. The TIRADS classification based on suspicious ultrasound findings is reliable in predicting thyroid malignancy and can be routinely used in daily practice.
Objective: The choice of laparoscopic technique in the treatment of complicated acute appendicitis (CAA) harbours debatable evidence because of higher rates of surgical complications such as postoperative intraabdominal abscess (POIIA). The aim of this study is to compare postoperative results of appendiceal stump (AS) ligation and its burial into the cecum using laparoscopic or open surgical techniques in patients with CAA. Method: This is a single-center and retrospective analysis of patients with CAA operated between May 2018 and April 2020. AS was intracorporeally knotted with silk and buried in the cecum with a purse-string suture (PSS). The patients were divided into open appendectomy (OA) and laparoscopic appendectomy (LA) groups. Data concerning demographic characteristics, intraoperative variables, hospital stay, surgical complications, morbidities, and postoperative findings were compared. Results: A total of 66 patients including 36 patients (54.54%) underwent LA and 30 patients had OA were enrolled in the study. Partial resection of cecum was performed in one patient in the OA group and two patients in the LA group with the help of a stapler due to cecal floor necrosis. The operative time and duration of hospital stay were significantly shorter in the LA group compared to the OA group. Surgical site infection and POIAA were significantlymore frequent in the OA group (p<0.001). Conclusion: In acute complicated appendicitis, laparoscopic method can be applied as an effective method by closing the appendiceal stump and burying into the cecum with a purse-string suture.
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