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Medicina
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Advances in Cholecystitis and Cholecystectomy
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Advances in Cholecystitis and Cholecystectomy

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 19843

Special Issue Editors

Prof. Dr. Dragos Serban

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Guest Editor
Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
Interests: laparoscopic surgery; inflammatory biomarkers; emergency surgery; colorectal cancer; diabetic foot
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Laurentiu Simion

E-Mail Website
Guest Editor
1. Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2. The Institute of Oncology in Bucharest, Bucharest, Romania
Interests: general surgery, oncology surgery, laparoscopic surgery; palliative care; health services management; hospitals evaluation and accreditation
Special Issues, Collections and Topics in MDPI journals
Dr. Bogdan Mastalier

E-Mail Website
Guest Editor
Surgical Clinic, Colentina Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, 020125 Bucharest, Romania
Interests: surgical oncology; hepato-biliar-pancreatic surgery; electrochemotherapy; abdominal wall surgery; endoscopic procedures; minimally invasive surgery; breast surgery; colorectal surgery; integrative medicine; translational medicine

Special Issue Information

Dear Colleagues,

Acute cholecystitis is the most frequent complication of cholelithiasis and accounts for one-third of surgical emergencies. Blocked stones at the level of the infundibulum or cystic duct generate inflammatory phenomena of variable intensity, from mild to severe, with organ failure and septic condition. Laparoscopic cholecystectomy has become the “gold standard” due to its undeniable advantages in reducing pain and postoperative complications, as well as the length of hospital stay. Together with the development of anesthesia and intensive care skills and techniques, laparoscopy can be safely performed even in elderly and patients with multiple comorbidities.

However, there are still challenges regarding the therapeutic approach in difficult cases. Although on a declining trend, with the implementation of critical view of safety (CVS) in the dissection of the elements that define Calot's triangle, bile duct injuries (BDI) are still a major concern in laparoscopic cholecystectomy, being one of the most frequent causes of postoperative morbidity.

The optimal timing of cholecystectomy, improving early recovery in the elderly after surgery, predictive biomarkers for postoperative complications, indications of percutaneous cholecystectomy, and the pathogenesis and management of acute acalculous cholecystitis are still subjects of research.

We look forward to receiving your contributions.

Prof. Dr. Dragos Serban
Prof. Dr. Laurentiu Simion
Dr. Bogdan Mastalier
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • laparoscopic cholecystectomy
  • cholecystitis
  • cholelithiasis
  • bile duct injury
  • indocyanine green
  • percutaneous cholecystostomy
  • acute acalculous cholecystitis
  • inflammatory biomarkers
  • enhanced recovery after surgery (ERAS)

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Published Papers (6 papers)

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Research

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11 pages, 1949 KiB  
Article
Tackling a Post-COVID-19 Cholecystectomy Waiting List: Are We Meeting the Challenge?
by Mohammed Hamid, Neginsadat Mirtorabi, Abdul Ghumman, Ayesha Khalid, Mohamed Saleem Noormohamed, Spyridon Kapoulas, Rishi Singhal, Rajwinder Nijjar, Martin Richardson and Tom Wiggins
Medicina 2023, 59(10), 1872; https://doi.org/10.3390/medicina59101872 - 21 Oct 2023
Viewed by 1718
Abstract
Background and Objectives: The COVID-19 pandemic has led to a tremendous backlog in elective surgical activity. Our hospital trust adopted an innovative approach to dealing with elective waiting times for cholecystectomy during the recovery phase from COVID-19. This study aimed to evaluate [...] Read more.
Background and Objectives: The COVID-19 pandemic has led to a tremendous backlog in elective surgical activity. Our hospital trust adopted an innovative approach to dealing with elective waiting times for cholecystectomy during the recovery phase from COVID-19. This study aimed to evaluate trends in overall cholecystectomy activity and the effect on waiting times. Materials and Methods: A prospective observational study was undertaken, investigating patients who received a cholecystectomy at a large United Kingdom hospital trust between February 2021 and February 2022. There were multiple phased strategies to tackle a 533-patient waiting list: private sector, multiple sites including emergency operating, mobile theatre, and seven-day working. The correlation of determination (R2) and Kruskal–Wallis analysis were used to evaluate trends in waiting times across the study period. Results: A total of 657 patients underwent a cholecystectomy. The median age was 49 years, 602 (91.6%) patients had an ASA of 1-2, and 494 (75.2%) were female. A total of 30 (4.6%) patients were listed due to gallstone pancreatitis, 380 (57.8%) for symptomatic cholelithiasis, and 228 (34.7%) for calculous cholecystitis. Median waiting times were reduced from 428 days (IQR 373–508) to 49 days (IQR 34–96), R2 = 0.654, p < 0.001. For pancreatitis specifically, waiting times had decreased from a median of 218 days (IQR 139–239) to 28 (IQR 24–40), R2 = 0.613, p < 0.001. Conclusions: This study demonstrates the methodology utilised to safely and effectively tackle the cholecystectomy waiting list locally. The approach utilised here has potential to be adapted to other units or similar operation types in order to reduce elective waiting times. Full article
(This article belongs to the Special Issue Advances in Cholecystitis and Cholecystectomy)
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Review

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14 pages, 324 KiB  
Review
A Review on Endoscopic Management of Acute Cholecystitis: Endoscopic Ultrasound-Guided Gallbladder Drainage and Endoscopic Transpapillary Gallbladder Drainage
by Albert P. Manudhane, Matthew D. Leupold, Hamza W. Shah, Raj Shah, Samuel Y. Han, Peter J. Lee, Jordan J. Burlen, Georgios I. Papachristou and Somashekar G. Krishna
Medicina 2024, 60(2), 212; https://doi.org/10.3390/medicina60020212 - 26 Jan 2024
Cited by 2 | Viewed by 2634
Abstract
A percutaneous cholecystostomy tube (PCT) is the conventionally favored nonoperative intervention for treating acute cholecystitis. However, PCT is beset by high adverse event rates, need for scheduled reintervention, and inadvertent dislodgement, as well as patient dissatisfaction with a percutaneous drain. Recent advances in [...] Read more.
A percutaneous cholecystostomy tube (PCT) is the conventionally favored nonoperative intervention for treating acute cholecystitis. However, PCT is beset by high adverse event rates, need for scheduled reintervention, and inadvertent dislodgement, as well as patient dissatisfaction with a percutaneous drain. Recent advances in endoscopic therapy involve the implementation of endoscopic transpapillary drainage (ETP-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), which are increasingly preferred over PCT due to their favorable technical and clinical success combined with lower complication rates. In this article, we provide a comprehensive review of the literature on EUS-GBD and ETP-GBD, delineating instances when clinicians should opt for endoscopic management and highlighting potential risks associated with each approach. Full article
(This article belongs to the Special Issue Advances in Cholecystitis and Cholecystectomy)
20 pages, 5778 KiB  
Review
Mirizzi Syndrome—The Past, Present, and Future
by Jonathan G. A. Koo, Hui Yu Tham, En Qi Toh, Christopher Chia, Amy Thien and Vishal G. Shelat
Medicina 2024, 60(1), 12; https://doi.org/10.3390/medicina60010012 - 21 Dec 2023
Cited by 4 | Viewed by 4565
Abstract
Mirizzi syndrome is a complication of gallstone disease caused by an impacted gallstone in the infundibulum of the gallbladder or within the cystic duct, causing chronic inflammation and extrinsic compression of the common hepatic duct or common bile duct. Eventually, mucosal ulceration occurs [...] Read more.
Mirizzi syndrome is a complication of gallstone disease caused by an impacted gallstone in the infundibulum of the gallbladder or within the cystic duct, causing chronic inflammation and extrinsic compression of the common hepatic duct or common bile duct. Eventually, mucosal ulceration occurs and progresses to cholecystobiliary fistulation. Numerous systems exist to classify Mirizzi syndrome, with the Csendes classification widely adopted. It describes five types of Mirizzi syndrome according to the presence of a cholecystobiliary fistula and its corresponding severity, and whether a cholecystoenteric fistula is present. The clinical presentation of Mirizzi syndrome is non-specific, and patients typically have a longstanding history of gallstones. It commonly presents with obstructive jaundice, and can mimic gallbladder, biliary, or pancreatic malignancy. Achieving a preoperative diagnosis guides surgical planning and improves treatment outcomes. However, a significant proportion of cases of Mirizzi syndrome are diagnosed intraoperatively, and the presence of dense adhesions and distorted anatomy at Calot’s triangle increases the risk of bile duct injury. Cholecystectomy remains the mainstay of treatment for Mirizzi syndrome, and laparoscopic cholecystectomy is increasingly becoming a viable option, especially for less severe stages of cholecystobiliary fistula. Subtotal cholecystectomy is feasible if total cholecystectomy cannot be performed safely. Additional procedures may be required, such as common bile duct exploration, choledochoplasty, and bilioenteric anastomosis. Conclusions: There is currently no consensus for the management of Mirizzi syndrome, as the management options depend on the extent of surgical pathology and availability of surgical expertise. Multidisciplinary collaboration is important to achieve diagnostic accuracy and guide treatment planning to ensure good clinical outcomes. Full article
(This article belongs to the Special Issue Advances in Cholecystitis and Cholecystectomy)
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17 pages, 1790 KiB  
Review
Assessment of Gallbladder Drainage Methods in the Treatment of Acute Cholecystitis: A Literature Review
by Dorotea Bozic, Zarko Ardalic, Antonio Mestrovic, Josipa Bilandzic Ivisic, Damir Alicic, Ivan Zaja, Tomislav Ivanovic, Ivona Bozic, Zeljko Puljiz and Andre Bratanic
Medicina 2024, 60(1), 5; https://doi.org/10.3390/medicina60010005 - 20 Dec 2023
Cited by 4 | Viewed by 2562
Abstract
Gallbladder drainage is a treatment option in high-risk surgical patients with moderate or severe acute cholecystitis. It may be applied as a bridge to cholecystectomy or a definitive treatment option. Apart from the simple and widely accessible percutaneous cholecystostomy, new attractive techniques have [...] Read more.
Gallbladder drainage is a treatment option in high-risk surgical patients with moderate or severe acute cholecystitis. It may be applied as a bridge to cholecystectomy or a definitive treatment option. Apart from the simple and widely accessible percutaneous cholecystostomy, new attractive techniques have emerged in the previous decade, including endoscopic transpapillary gallbladder drainage and endoscopic ultrasound-guided gallbladder drainage. The aim of this paper is to present currently available drainage techniques in the treatment of AC; evaluate their technical and clinical effectiveness, advantages, possible adverse events, and patient outcomes; and illuminate the decision-making path when choosing among various treatment modalities for each patient, depending on their clinical characteristics and the accessibility of methods. Full article
(This article belongs to the Special Issue Advances in Cholecystitis and Cholecystectomy)
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17 pages, 5362 KiB  
Review
When Critical View of Safety Fails: A Practical Perspective on Difficult Laparoscopic Cholecystectomy
by Catalin Alius, Dragos Serban, Dan Georgian Bratu, Laura Carina Tribus, Geta Vancea, Paul Lorin Stoica, Ion Motofei, Corneliu Tudor, Crenguta Serboiu, Daniel Ovidiu Costea, Bogdan Serban, Ana Maria Dascalu, Ciprian Tanasescu, Bogdan Geavlete and Bogdan Mihai Cristea
Medicina 2023, 59(8), 1491; https://doi.org/10.3390/medicina59081491 - 19 Aug 2023
Cited by 4 | Viewed by 5099
Abstract
The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a [...] Read more.
The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a narrative review which discusses from a contextual point of view the need to standardise the surgical approach in difficult laparoscopic cholecystectomies, the main strategic operative concepts and techniques, complementary visualisation aids for the delineation of anatomical landmarks, and the importance of cognitive maps and algorithms in performing safer LC. Extensive research was carried out in the PubMed, Web of Science, and Elsevier databases using the terms ”difficult cholecystectomy”, ”bile duct injuries”, ”safe cholecystectomy”, and ”laparoscopy in acute cholecystitis”. The key content and findings of this research suggest there is high intersocietal variation in approaching and performing LC, in the use of visualisation aids, and in the application of safety concepts. Limited papers offer guidelines based on robust data and a timid recognition of the human factors and ergonomic concepts in improving the outcomes associated with difficult cholecystectomies. This paper highlights the most relevant recommendations for dealing with difficult laparoscopic cholecystectomies. Full article
(This article belongs to the Special Issue Advances in Cholecystitis and Cholecystectomy)
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Other

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12 pages, 2833 KiB  
Case Report
Hepatico-Duodenal Fistula Following Iatrogenic Strasberg Type E4 Bile Duct Injury: A Case Report
by Bozhidar Hristov, Daniel Doykov, Desislav Stanchev, Krasimir Kraev, Petar Uchikov, Gancho Kostov, Siyana Valova, Eduard Tilkiyan, Katya Doykova and Mladen Doykov
Medicina 2023, 59(9), 1621; https://doi.org/10.3390/medicina59091621 - 7 Sep 2023
Cited by 2 | Viewed by 1928
Abstract
Introduction: Gallstone disease (GSD) is among the most common disorders worldwide. Gallstones are established in up to 15% of the general population. Laparoscopic cholecystectomy (LC) has become the “gold standard” for treatment of GSD but is associated with a higher rate of certain [...] Read more.
Introduction: Gallstone disease (GSD) is among the most common disorders worldwide. Gallstones are established in up to 15% of the general population. Laparoscopic cholecystectomy (LC) has become the “gold standard” for treatment of GSD but is associated with a higher rate of certain complications, namely, bile duct injury (BDI). Biliary fistulas (BF) are a common presentation of BDI (44.1% of all patients); however, they are mainly external. Post-cholecystectomy internal BF are exceedingly rare. Case report: a 33-year Caucasian female was admitted with suspected BDI after LC. Strasberg type E4 BDI was established on endoscopic retrograde cholangiopancreatography (ERCP). Urgent laparotomy established biliary peritonitis. Delayed surgical reconstruction was planned and temporary external biliary drains were positioned in the right and left hepatic ducts. During follow-up, displacement of the drains occurred with subsequent evacuation of bile through the external fistula, which resolved spontaneously, without clinical and biochemical evidence of biliary obstruction or cholangitis. ERCP established bilio-duodenal fistula between the left hepatic duct (LHD) and duodenum, with a stricture at the level of the LHD. Endoscopic management was chosen with staged dilation and stenting of the fistulous tract over 18 months until fistula maturation and stricture resolution. One year after stent extraction, the patient remains symptom free. Discussion: Management of post-cholecystectomy BDI is challenging. The optimal approach is determined by the level and extent of ductal lesion defined according to different classifications (Strasberg, Bismuth, Hannover). Type E BDI are managed mainly surgically with a delayed surgical approach generally deemed preferable. Only three cases of choledocho-duodenal fistulas following LC BDI currently exist in the literature. Management is controversial, with expectant approach, surgical treatment (biliary reconstruction), or liver transplantation being described. Endoscopic treatment has not been described; however, in the current paper, it proved to be successful. More reports or larger case series are needed to confirm its applicability and effectiveness, especially in the long term. Full article
(This article belongs to the Special Issue Advances in Cholecystitis and Cholecystectomy)
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