Early laparoscopic cholecystectomy is associated with less risk of complications after the removal of common bile duct stones by endoscopic retrograde cholangiopancreatography

Conectividade, Rede De Saúde E Cidadania: Projeto “Café, Palavras E Suspiros” – Uff

“…Pode ser realizado com segurança em 48 a 72 horas. Por outro lado, a cirurgia tardia da colecistectomia pode ser mais difícil de realizar e traz uma maior probabilidade de complicações, como também readmissão hospitalar devido a alterações fibróticas e inflamatórias (AZIRET et al, 2019).…”

“…Nesse contexto, a CPRE e a colecistectomia juntas reduzem o tempo de internação sem aumentar a morbidade pós-operatória e a taxa de sucesso da CPRE, independente de ter sido realizada antes ou depois da colecistectomia. (AL-TEMIMI et al, 2018;AZIRET et al, 2019). A colecistectomia precoce não aumenta mortalidade, complicações perioperatórias ou tempo de internação, pelo contrário, reduz o risco de recorrência e progressão da doença.…”

Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy

“…We found that a spleen volume higher than 400 cm 3 increases the risk of conversion to open surgery 22.5 times. Secondly, intraoperative hemorrhage from the splenic hilum has a 61-fold risk of conversion Minimal invasive surgery, whether robotic or laparoscopic, has become popular due to less postoperative abdominal pain, shortened length of hospital stay, and early return to normal daily activity (1)(2)(3)(4)(5)(6)(7)(8). Robotic surgery surpasses laparoscopic technique by providing more articulation and maneuverability (7,8).…”

“…Minimal invasive surgery (MIS) is feasible and safe with growing popularity in different clinical practices (1)(2)(3)(4)(5). Laparoscopic and robotic splenectomies are subgroups of MIS and have been increased due to good exposure of the surgical field, less bleeding, postoperative abdominal pain and shorter length of the hospital stay (6)(7)(8).…”

During which period should we avoid cholecystectomy in patients who underwent endoscopic retrograde cholangiopancreatography?

“…(13,14) Cholecystectomy must be performed safely, and inflammation resulting from the disease itself and manipulation during ERCP can hinder the surgery, increasing the operative time, the risk of bleeding and the conversion rate when compared with elective cholecystectomy without previous ERCP. (13,(15)(16)(17)(18)(19) Studies show that laparoscopic cholecystectomy (LC) and ERCP, performed more than 72 hours apart, lead to inflammation of the biliary tract, which may hinder the use of laparoscopy to approach the gallbladder and biliary ducts. (20)(21)(22)(23)(24)(25)(26) In view of the need to prevent intra-and postoperative complications and their implications, so that a greater number of patients with an indication for LC after preoperative ERCP can be scheduled and treated the best way possible, at a hospital with a high demand for beds and limited financial resources, such as the Hospital Geral do Grajaú (HGG), a secondary care hospital in the city of São Paulo, it was imperative to assess which was the best period to perform LC in these patients.…”