Browsing by Subject "BILE-DUCT STONES"

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  • Ansaloni, L.; Pisano, M.; Coccolini, F.; Peitzmann, A. B.; Fingerhut, A.; Catena, F.; Agresta, F.; Allegri, A.; Bailey, I.; Balogh, Z. J.; Bendinelli, C.; Biffl, W.; Bonavina, L.; Borzellino, G.; Brunetti, F.; Burlew, C. C.; Camapanelli, G.; Campanile, F. C.; Ceresoli, M.; Chiara, O.; Civil, I.; Coimbra, R.; De Moya, M.; Di Saverio, S.; Fraga, G. P.; Gupta, S.; Kashuk, J.; Kelly, M. D.; Koka, V.; Jeekel, H.; Latifi, R.; Leppaniemi, A.; Maier, R. V.; Marzi, I.; Moore, F.; Piazzalunga, D.; Sakakushev, B.; Sartelli, M.; Scalea, T.; Stahel, P. F.; Taviloglu, K.; Tugnoli, G.; Uraneus, S.; Velmahos, G. C.; Wani, I.; Weber, D. G.; Viale, P.; Sugrue, M.; Ivatury, R.; Kluger, Y.; Gurusamy, K. S.; Moore, E. E. (2016)
    Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of "high risk" patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.
  • Pisano, Michele; Allievi, Niccolo; Gurusamy, Kurinchi; Borzellino, Giuseppe; Cimbanassi, Stefania; Boerna, Djamila; Coccolini, Federico; Tufo, Andrea; Di Martino, Marcello; Leung, Jeffrey; Sartelli, Massimo; Ceresoli, Marco; Maier, Ronald; Poiasina, Elia; De Angelis, Nicola; Magnone, Stefano; Fugazzola, Paola; Paolillo, Ciro; Coimbra, Raul; Di Saverio, Salomone; De Simone, Belinda; Weber, Dieter G.; Sakakushev, Boris E.; Lucianetti, Alessandro; Kirkpatrick, Andrew W.; Fraga, Gustavo P.; Wani, Imitaz; Biffl, Walter L.; Chiara, Osvaldo; Abu-Zidan, Fikri; Moore, Ernest E.; Leppäniemi, Ari; Kluger, Yoram; Catena, Fausto; Ansaloni, Luca (2020)
    Background: Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. Materials and methods: The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see ). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. Results: The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. Conclusions, knowledge gaps and research recommendations: ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.
  • Hemminki, Kari; Hemminki, Otto; Försti, Asta; Sundquist, Kristina; Sundquist, Jan; Li, Xinjun (2017)
    Objectives Gallstone disease (cholelithiasis) has a familial component, but detailed data on the modification of familial risk are lacking. Using nationwide hospital and population records, we aimed to determine detailed familial risks for medically diagnosed gallstone disease. Design Subjects were obtained from the Multigeneration Register, which contains family data on the Swedish population, and patients with gallstone disease were identified from the Hospital Discharge Register (1964-2015) and the Outpatient Register (2001-2015). Standardised incidence ratios (SIRs) were calculated as the ratio of observed to expected number of cases. Results Gallstone disease was diagnosed in 660 732 patients, with an overall incidence of 131 per 100 000 person-years. Familial cases accounted for 36.0% of all patients with gallstone disease. Of these, 50.9% had a parental family history (SIR 1.62), 35.1% had a sibling history (SIR 1.75) and 14.0% had a parental+sibling history (SIR 2.58). Among a total of 54 630 affected siblings, 84.4% were sibling pairs (SIR 1.55). However, the remaining 15.6% of the affected siblings constituted the high-risk group of multiple affected siblings and an SIR >10; these persons accounted for 7.7% of all familial cases. The spousal risk was only slightly increased to 1.18. Conclusions Overall, the results point to the underlying genetic causes for the observed familial clustering, which may involve polygenic gene-environmental interactions for most familial cases but high-risk genes in close to 10% of cases. Family histories should be taken into account in the medical setting and used for counselling of at-risk individuals.