Gallbladder wall thickness as a predictor of intraoperative events during laparoscopic cholecystectomy: A prospective study of 1089 patients

Kokoroskos, Nikolaos; Peponis, Thomas; Lee, Jae Moo; Hechi, Majed El; Naar, Leon; Elahad, Joana Abed; Nederpelt, Charlie; Bonde, Alexander; Meier, Karien; Mendoza, April E.; King, David R.; Fagenholz, Peter J.; Velmahos, George C.; Saillant, Noelle

doi:10.1016/j.amjsurg.2020.03.007

Cited by 9 publications

(9 citation statements)

References 15 publications

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“…In contrast to our study, Kokoroskos et al found that severe gallbladder wall thickening (>0.7 cm) was non-dependently accompanying with the rate of conversions to open and general intraoperative procedures (11) .…”

Section: Discussioncontrasting

confidence: 99%

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Safe Laparoscopic Cholecystectomy: Adoption of Universal Culture of Safety in Cholecystectomy

Ghalwash¹

2022

The Egyptian Journal of Hospital Medicine

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Background: Laparoscopic cholecystectomy (LC) has been the favored technique for treating symptomatic cholelithiasis. LC has several benefits over the normal open cholecystectomy: negligible traumas, reduced pains, shorter hospitalization, acceptable cosmetic outcomes, rapid recovery, and back to work. Aim and objectives: The aim of this study was to identify the predictors of safe LC. Patients and methods: This prospective study was performed among 500 patients underwent LC who was attending to Al-Hussein Hospital, Al-Azhar University from January 2019 to June 2021. Cases with cholecystitis either acute or chronic, patients with age equal or more than 18 years old, and both sexes were included. While patients with age lower than 18 years old, patients with common bile duct (CBD) stone, pregnancy or patients with bleeding tendency history were excluded. Results: Upon assessing factors associated with postoperative complications of laparoscopic cholecystectomy, the male gender was statistically significantly correlated with complications while a non-significant change was found among complications and other sociodemographic variables. A significant association was found among WBCs, total bilirubin, ALT, AST, and complications while a non-significant association was found among gall bladder thickness and complications. Conclusion:In conclusion, this study evaluated the parameters that expect the complications in LC. Patient factors included male sex, leukocytic count, ALT and AST.

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Section: Discussioncontrasting

confidence: 99%

“…Concerning the postoperative outcomes, cases with gallbladder wall thickening had lengthier median hospitalization. While nonsignificant, postoperative infections were more frequent in cases with thicker gallbladder wall (11) .…”

Section: Discussionmentioning

confidence: 75%

Safe Laparoscopic Cholecystectomy: Adoption of Universal Culture of Safety in Cholecystectomy

Ghalwash¹

2022

The Egyptian Journal of Hospital Medicine

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“…In the univariate and multivariate analysis, the degree of CC was found to be associated with the gallbladder wall thickness. In the prospective study by Kokoroskos et al [12] that included 548 (50.4%) patients with acute cholecystitis and 38 (3.5%) patients with CC, a correlation was found between the wall thickness measured in USG and abdominal computed tomography and the wall thickness measured histologically. In the multivariate analysis of the same study, the increase in gallbladder wall thickness was associated with increased risk of biliary tract injury and rate of postoperative complications, as well as prolonged hospital stay.…”

Section: Discussionmentioning

confidence: 89%

Can the degree of fibrosis in the gallbladder wall be predicted by preoperative routine examinations in chronic cholecystitis? Retrospective analysis

kayapinar¹

2022

Laparosc Endosc Surg Sci

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Introduction:Fibrosis caused by chronic inflammation in the gallbladder increases the risk of biliary tract injury. Our aim was to investigate a possible correlation between pre-operative routine examinations and the degree of chronic inflammation. Materials and Methods:Samples from 74 patients with chronic cholecystitis (CC) were reevaluated to determine the degree of chronic inflammation. The relationship of gallbladder wall thickness and gallbladder stone size in pre-operative abdominal ultrasonography (USG), pre-operative laboratory values, and endoscopic retrograde cholangiopancreatography (ERCP) history with the degree of histopathological chronic inflammation in the gallbladder wall was evaluated. In addition, adhesion of the surrounding tissues to the gallbladder, operation time, hospitalization period, biliary tract injury, and post-operative complications were examined in the context of degree of chronic inflammation.Results: Grade I CC was detected in 53 (69.8%) and Grade II in 21 (27.6%) patients. While the gallbladder wall was thick (>3 mm) on pre-operative USG in 7 (33.3%) patients with Grade II CC, it was normal in all patients with Grade I (p<0.001). A history of pre-operative ERCP was found in 2 (3.8%) patients in Grade I CC and in 7 (33.7%) patients in Grade II (p=0.002). In univariate and multivariate analysis, gallbladder wall thickness and history of ERCP were found to be significant in predicting the degree of chronic inflammation [(p<0.001 and p=0.002), (p=0.003 and p=0.014), respectively]. In multivariate analysis, an increase in AST value of 1 U/L increases the probability of CC grade II by 1.1 times compared to CC grade I (p=0.019). Conclusion:Increased gallbladder wall thickness, history of ERCP, and elevated AST value in CC increase the possibility of a high degree of chronic inflammation (fibrosis rate).

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“…A gallbladder with a size differing from this criteria was seen as abnormal. The gallbladder wall thickness, as an objective marker of cholecystitis severity and laparoscopic cholecystectomy (LC) complexity, was divided into two groups: ≤3 mm (normal) and >3 mm ( Kokoroskos et al., 2020 ). The characteristics of gallstones were represented by the number of gallstones, the diameter of gallstones and the gallstone shapes.…”

Section: Methodsmentioning

confidence: 99%

A nomogram for clinical estimation of acute biliary pancreatitis risk among patients with symptomatic gallstones: A retrospective case-control study

Guo

Lin

et al. 2022

Front. Cell. Infect. Microbiol.

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Background/PurposeCurrently, there are no effective tools to accurately assess acute biliary pancreatitis (ABP) risk in patients with gallstones. This study aimed to develop an ABP risk nomogram in patients with symptomatic gallstones.MethodsWe conducted a retrospective nested case-control study and data on 816 conservatively treated patients with symptomatic gallstones admitted to The First Affiliated Hospital of Harbin Medical University between January 6, 2007 and January 22, 2016 were retrospectively collected. We conducted a propensity-score matched (PSM) analysis based on follow-up time in a ratio of 1:4 between ABP group (n=65) and non-ABP group (n=260). These matched patients were randomly divided into study cohort (n=229) and validation cohort (n=96) according to a ratio of 7:3. In the study cohort, independent risk factors for ABP occurrence identified using Cox regression were included in nomogram. Nomogram performance and discrimination were assessed using the concordance index (C-index), area under the curve (AUC), calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC). The model was also validated in the validation cohort.ResultsNomogram was based on 7 independent risk factors: age, diabetes history, gallbladder wall thickness, gallstone diameter, coexisting common bile duct (CBD) stones, direct bilirubin (DBIL), and white blood cell count (WBC). The C-index of nomogram was 0.888, and the 10-year AUCs of nomogram was 0.955. In the validation cohort, nomogram still had good discrimination (C-index, 0.857; 10-year AUC, 0.814). The calibration curve showed good homogeneity between the prediction by nomogram and the actual observation. DCA and CIC demonstrated that nomogram was clinically useful.ConclusionsThe ABP risk nomogram incorporating 7 features is useful to predict ABP risk in symptomatic gallstone patients.

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Gallbladder wall thickness as a predictor of intraoperative events during laparoscopic cholecystectomy: A prospective study of 1089 patients

Cited by 9 publications

References 15 publications

Safe Laparoscopic Cholecystectomy: Adoption of Universal Culture of Safety in Cholecystectomy

Safe Laparoscopic Cholecystectomy: Adoption of Universal Culture of Safety in Cholecystectomy

Can the degree of fibrosis in the gallbladder wall be predicted by preoperative routine examinations in chronic cholecystitis? Retrospective analysis

A nomogram for clinical estimation of acute biliary pancreatitis risk among patients with symptomatic gallstones: A retrospective case-control study

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