Aim/background: Elevated liver enzymes are observed occasionally in patients with acute cholecystitis who do not have choledocholithiasis. The etiology and mechanism of this phenomenon are not well known. We aimed to compare the clinical characteristics between acute cholecystitis with and without choledocholithiasis in patients with elevated liver enzymes.
Patients And Methods: The medical records of acute cholecystitis patients who underwent cholecystectomy between January 2001 and October 2011 were retrospectively reviewed. We retrieved data of patients who showed abnormal liver enzymes and underwent endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, or intraoperative cholangiography.
Results: We analyzed clinical characteristics and comorbidities in 424 patients. Among 424 cholecystectomy patients with abnormal liver enzymes, 178 (42%) patients did not have choledocholithiasis and 246 (58%) patients had choledocholithiasis. The median AST, ALT, and total bilirubin were 47, 82.5 IU/dl, and 1.21 mg/dl, respectively, in patients without choledocholithiasis and 58, 96 IU/dl, and 1.53 mg/dl, respectively, in patients with choledocholithiasis. In a multivariate logistic regression analysis, fatty liver [odds ratio (OR): 0.218; P<0.001], radiologic findings (OR: 0.414; P=0.001), and the level of total bilirubin (OR: 1.410; P=0.001) were independent predictors of choledocholithiasis.
Conclusion: Elevated liver enzymes in patients with cholecystitis who do not have choledocholithiasis are correlated with the presence of fatty liver and the severity of radiologic finding.
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http://dx.doi.org/10.1097/MEG.0000000000000053 | DOI Listing |
Background The critical view of safety (CVS) is a critical technique to minimize the risk of bile duct injuries (BDIs) during laparoscopic cholecystectomy (LC). This study evaluated the rate of CVS achievement and examined factors influencing its success. Methods This prospective study included 97 patients undergoing LC.
View Article and Find Full Text PDFArq Bras Cir Dig
January 2025
Antenor Orrego Private University, School of Medicine, Trujillo, La Libertad, Peru.
Background: Laparoscopic cholecystectomy is considered safe; however, it is not free from complications, such as bile duct injuries, bleeding, and infection of the surgical site.
Aims: The aim of this study was to determine the effectiveness of two prediction tools, the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) calculator and the surgical Apgar, in predicting post-cholecystectomy complications.
Methods: A cross-sectional, analytical, and comparative study was conducted on patients over 18 years old diagnosed with acute cholecystitis who underwent open or laparoscopic cholecystectomy at the Regional Teaching Hospital of Trujillo between 2015 and 2019.
Surg Open Sci
January 2025
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Background: The elderly population in the United States is rapidly expanding. Older patients over age 65 with acute cholecystitis may face greater perioperative risk compared to younger patients undergoing urgent laparoscopic cholecystectomy. We aimed to characterize trends in utilization and outcomes of inpatient cholecystectomy across the United States stratified by age.
View Article and Find Full Text PDFSurg Endosc
January 2025
Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Hasama-Machi, Yufu, Oita, 879-5593, Japan.
Background: The surgical difficulty of laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) and the risk of bile duct injury (BDI) depend on the degree of fibrosis and scarring caused by inflammation; therefore, understanding these intraoperative findings is crucial to preventing BDI. Scarring makes it particularly difficult to perform safely and increases the BDI risk. This study aimed to develop an artificial intelligence (AI) system to indicate intraoperative findings of scarring in LC for AC.
View Article and Find Full Text PDFAm J Case Rep
January 2025
Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
BACKGROUND Acalculous cholecystitis is a rare form of gallbladder inflammation that occurs without the presence of gallstones. It primarily affects critically ill patients and warrants prompt treatment given its association with high mortality. Pericarditis, an inflammation of the pericardium, typically arises from viral infections but can also be secondary to rheumatological, malignant, or bacterial causes.
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