Meta-analysis and trial sequential analysis of randomized evidence comparing general anesthesia vs regional anesthesia for laparoscopic cholecystectomy

BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecystectomy,combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIM To evaluate comparative outcomes of RA and general anesthesia(GA)in patients undergoing laparoscopic cholecystectomy.METHODS A comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTS Thirteen randomized controlled trials enrolling 1111 patients were included.The study populations in the RA and GA groups were of comparable age(P=0.41),gender(P=0.98)and body mass index(P=0.24).The conversion rate from RA to GA was 2.3%.RA was associated with significantly less postoperative pain at 4 h[mean difference(MD):-2.22,P<0.00001],8 h(MD:-1.53,P=0.0006),12 h(MD:-2.08,P<0.00001),and 24 h(MD:-0.90,P<0.00001)compared to GA.Moreover,it was associated with significantly lower rate of nausea and vomiting[risk ratio(RR):0.40,P<0.0001].However,RA significantly increased postoperative headaches(RR:4.69,P=0.03),and urinary retention(RR:2.73,P=0.03).The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes,with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSION Our findings indicate that RA may be an attractive anesthetic modality for daycase laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA.However,its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.

Factors influencing agitation during anesthesia recovery after laparoscopic hernia repair under total inhalation combined with caudal block anesthesia

BACKGROUND Laparoscopic hernia repair is a minimally invasive surgery,but patients may experience emergence agitation(EA)during the post-anesthesia recovery period,which can increase pain and lead to complications such as wound reopening and bleeding.There is limited research on the risk factors for this agitation,and few effective tools exist to predict it.Therefore,by integrating clinical data,we have developed nomograms and random forest predictive models to help clinicians predict and potentially prevent EA.AIM To establish a risk nomogram prediction model for EA in patients undergoing laparoscopic hernia surgery under total inhalation combined with sacral block anesthesia.METHODS Based on the clinical information of 300 patients who underwent laparoscopic hernia surgery in the Nanning Tenth People’s Hospital,Guangxi,from January 2020 to June 2023,the patients were divided into two groups according to their sedation-agitation scale score,i.e.,the EA group(≥5 points)and the non-EA group(≤4 points),during anesthesia recovery.Least absolute shrinkage and selection operator regression was used to select the key features that predict EA,and incorporating them into logistic regression analysis to obtain potential pre-dictive factors and establish EA nomogram and random forest risk prediction models through R software.RESULTS Out of the 300 patients,72 had agitation during anesthesia recovery,with an incidence of 24.0%.American Society of Anesthesiologists classification,preoperative anxiety,solid food fasting time,clear liquid fasting time,indwelling catheter,and pain level upon awakening are key predictors of EA in patients undergoing laparoscopic hernia surgery with total intravenous anesthesia and caudal block anesthesia.The nomogram predicts EA with an area under the receiver operating characteristic curve(AUC)of 0.947,a sensi-tivity of 0.917,and a specificity of 0.877,whereas the random forest model has an AUC of 0.923,a sensitivity of 0.912,and a specificity of 0.877.Delong’s test shows no significant difference in AUC between the two models.Clinical decision curve analysis indicates that both models have good net benefits in predicting EA,with the nomogram effective within the threshold of 0.02 to 0.96 and the random forest model within 0.03 to 0.90.In the external model validation of 50 cases of laparoscopic hernia surgery,both models predicted EA.The nomogram model had a sensitivity of 83.33%,specificity of 86.84%,and accuracy of 86.00%,while the random forest model had a sensitivity of 75.00%,specificity of 78.95%,and accuracy of 78.00%,suggesting that the nomogram model performs better in predicting EA.CONCLUSION Independent predictors of EA in patients undergoing laparoscopic hernia repair with total intravenous anesthesia combined with caudal block include American Society of Anesthesiologists classification,preoperative anxiety,duration of solid food fasting,duration of clear liquid fasting,presence of an indwelling catheter,and pain level upon waking.The nomogram and random forest models based on these factors can help tailor clinical decisions in the future.

Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy

AIM:To investigate the effect of pain relief after infu-sion of ropivacaine at port sites at the end of surgery.METHODS:From October 2006 to September 2007,72 patients undergoing laparoscopic cholecystectomy(LC) were randomized into two groups of 36 patients.One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline.A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room,6 and 24 h after surgery,and before discharge.The amount of analgesics use was also recorded.The demographics,laboratory data,hospital stay,and perioperative complications were compared between the two groups.RESULTS:There was no difference between the two groups preoperatively in terms of demographic and lab-oratory data.After surgery,similar operation time,blood loss,and no postoperative morbidity and mortality were observed in the two groups.However,a significantly lower pain score was observed in the patients undergo-ing LC with local anesthesia infusion at 1 h after LC and at discharge.Regarding analgesic use,the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion.This group also had a shorter hospital stay.CONCLUSION:Local anesthesia with ropivacaine at the port site in LC patients signif icantly decreased post-operative pain immediately.This explains the lower meperidine use and earlier discharge for these patients.

Comparative Study between General Anesthesia versus General Anesthesia Combined with Thoracic Epidural Analgesia on Cytokine Response in Laparoscopic Cholecystectomy Patients

Background and Objectives: The main benefits of laparoscopic surgery in comparison to open surgery involve the rapid discharge from recovery room, decreased postoperative hospital stays, reduced postoperative discomfort, easier getting back to work and faster return to ordinary daily life as well as cosmetic surgical wounds. The anesthesia type has an essential role in attenuation of the surgical stress and achievement of these advantages. We aimed to determine the outcome of giving general anesthesia in conjunction with thoracic epidural analgesia (TEA) compared to general anesthesia alone on stress response to surgery and anesthesia by investigating cytokine reaction (interleukin 6 and 8 levels), hemodynamic changes (BP, HR, RR, SPO2), and Visual Analogue Scale (VAS) scores postoperatively in patients subjected for laparoscopic cholecystectomy. Methods: This study included 40 patients aged 20 - 60 years old with American Society of Anesthesiologists physical status (ASA) I and II. They were planned for laparoscopic cholecystectomy at Aswan University Hospital from April 2017 to March 2018. They were randomly allocated into two groups. Group A (n. 20) received general anesthesia only and Group B (n. 20) received general anesthesia in conjunction with thoracic epidural analgesia using fentanyl and bupivacaine in the epidural catheter. Chi-square was applied to differentiate categorical variables, whereas comparison between continuous variables was done by using t-test. Two-tailed p < 0.05 was estimated as statistically significant. Results: As regards IL-6 and IL-8 post-operative there is significant difference (p < 0.05) between two groups during 2nd and 4th hr and 24th hr postoperative, with significantly increased postoperative levels of IL-6 and IL-8 in comparison to their preoperative baseline values. The largest increase in IL6 & IL8 levels was in group A (GA group). VAS score showed significant lower values in TEA group in comparison to GA group. No significant difference between groups as regard intraoperative and postoperative hemodynamic changes. Conclusion: Regional techniques including TEA attenuate and decrease cytokine reaction secondary to surgery which decreases inflammatory process and improves patient outcome and reduces pain score postoperatively.

Effect of general anesthesia combined with epidural anesthesia on the postoperative immune function, stress state and coagulation function in patients with laparoscopic cholecystectomy

Objective:To study the effect of general anesthesia combined with epidural anesthesia on the postoperative immune function, stress state and coagulation function in patients with laparoscopic cholecystectomy.Methods: 98 patients undergoing selective laparoscopic cholecystectomy in our hospital between May 2014 and August 2016 were selected and randomly divided into the combined anesthesia group who accepted the general anesthesia combined with epidural anesthesia and the general anesthesia group who accepted the total intravenous anesthesia (n=49), peripheral blood was collected after operation to detect the number of CD3+CD4+CD8-T cells, CD3+CD4-CD8+T cells, CD16+CD56+NK cells and CD3-CD19+B cells, serum was collected to detect the levels of stress-related endocrine hormones norepinephrine (NE), cortisol (Cor), insulin (Ins), C-peptide (C-P), free triiodothyronine (FT3), free thyroxine (FT4) as well as coagulation function indexes rostaglandin I2 (PGI2), thromboxane A2 (TXA2), 6-ketone-prostaglandin F1α (6-K-PGI1α) and thromboxane B2 (TXB2).Results:The number of CD3+CD4+CD8-T cells, CD3+CD4-CD8+T cells, CD16+CD56+NK cells and CD3-CD19+B cells in peripheral blood of combined anesthesia group were significantly higher than those of intravenous anesthesia group (P<0.05);serum NE, Cor, Ins, C-P, FT3, FT4, TXA2 and TXB2 levels of combined anesthesia group were significantly lower than those of intravenous anesthesia group (P<0.05) while PGI2 and 6-K-PGI1αlevels were significantly higher than those of intravenous anesthesia group (P<0.05).Conclusions:General anesthesia combined with epidural anesthesia can improve the postoperative immune function, stress state and hypercoagulable state in patients with laparoscopic cholecystectomy.

Differences in the effects of intravenous inhalational anesthesia and total intravenous anesthesia on the systemic traumatic response after laparoscopic cholecystectomy

Objective: To study the effect of intravenous inhalational anesthesia under monitoring on systemic traumatic response after laparoscopic cholecystectomy. Methods: A total of 80 cases of patients with chronic cholecystitis who received laparoscopic cholecystectomy in our hospital between June 2016 and October 2016 were collected and divided into the control group who accepted total intravenous anesthesia and the observation group who accepted intravenous inhalational anesthesia after the anesthesia methods were reviewed. 6 h, 12 h and 24 h after operation, the RIA method was adopted to determine the serum contents of pain mediators, enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of inflammatory factors and stress hormones, and auto-coagulation analyzer was used to detect the plasma contents of coagulation function indexes. Results: 6 h, 12 h and 24 h after operation, serum pain mediators 5-HT, β-EP and NPY levels of observation group were lower than those of control group, inflammatory factors hs-CRP, IL-6, IL-8 and TNF-α levels were lower than those of control group, and stress hormones Cor, ALD and NE levels were lower than those of control group;plasma coagulation function indexes TXB2, D-D and PLT levels of observation group were lower than those of control group. Conclusion: Intravenous inhalational anesthesia under monitoring can reduce the systemic traumatic reaction after laparoscopic cholecystectomy and has positive clinical significance.

Effect of intravenous inhalational anesthesia under Narcotrend monitor on the systemic traumatic reaction after laparoscopic cholecystectomy

Objective:To study the effect of intravenous inhalational anesthesia under Narcotrend monitor on the systemic traumatic reaction after laparoscopic cholecystectomy.Methods:A total of 116 patients with gallstone who received laparoscopic surgery in our hospital between July 2012 and April 2016 were collected and divided into the combined anesthesia group (n=65) who accepted intravenous inhalational anesthesia under Narcotrend monitor and the intravenous anesthesia group (n=51) who accepted total intravenous anesthesia after the anesthesia methods and relevant test results were reviewed. 1 d after operation, enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of pain mediators and inflammation mediators;automatic biochemical analyzer was used to detect the levels of oxidative stress indexes.Results:1 d after operation, serum pain mediators 5-HT, PGE2, NO and HT levels of observation group were lower than those of control group;serum oxidation indexes AOPPs and LHP levels of observation group were lower than those of control group while anti-oxidation indexes CAT and GSH-Px levels were higher than those of control group;serum pro-inflammatory factors IL-6, IL-8 and CRP levels of observation group were lower than those of control group while anti-inflammatory factors IL-4, IL-10 and IL-13 levels were higher than those of control group.Conclusion:Intravenous inhalational anesthesia under Narcotrend monitor can reduce the postoperative systemic traumatic reaction degree in patients with laparoscopic cholecystectomy.

Study on Effect of Laryngeal Mask Anesthesia and Endotracheal Intubation Anesthesia on Elderly Patients Undergoing Laparoscopic Gallbladder Surgery

Objective:To analyze the effect of laryngeal mask anesthesia and endotracheal intubation anesthesia in elderly laparoscopic gallbladder surgery.Methods:100 subjects of the experiment came from elderly patients with gallbladder stones admitted from September 2016 to September 2019 in our hospital.There were group A and group B of 50 cases each,and were used tube anesthesia and laryngeal mask anesthesia,then comparing the anesthesia effect.Results:Statistical significance(P<0.05):Air pressure and end-respiratory carbon dioxide partial pressure index changes when immediately after insertion,immediately after removal,3 minutes after removal;heart rate,mean arterial pressure,airway pressure,and end-expiratory carbon dioxide index changes when 3 minutes after insertion and immediately before removal;blood glucose and cortisol changes when after insertion,immediately before removal and min after removal.No statistical significance(P>0.05):Changes in heart rate,mean arterial pressure,airway pressure,and endexpiratory carbon dioxide indexes before insertion;changes in blood glucose and cortisol indexes before insertion.Conclusion:It is more ideal for elderly patients with abdominal cavity and gallbladder surgery to have laryngeal mask anesthesia,which can effectively keep blood circulation stable and have promotion value.

SUMMARY OF CLINICAL STUDY ON ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA FOR CHOLECYSTECTOMY

Objective: TO study clinical effect and anesthetic method of acupuncture anesthesia combined with epidural administration of small dose of anesthetic for cholecystectomy. Methods: A total of 194 cases of cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia group (group A, n = 66), acupoint-skin electrical stimulation combined with epidural anesthesia group (group B, n = 63) and simple epidural anesthesia group (group C, n=65). Observations were conducted using single-bland method. Bilateral Neiguan (PC 6) and Zusanli (ST 36) were punctured and stimulated electrically in group A and only stimulated electrically via cutaneous electrodes in group B. Epidural anesthetic used was 1.5% Lidocaine and the anesthetic level was controlled to reach T4-11 . Results: The class-I (excellent) rates of group A, B and C were 75.76%, 60.32% and 13.85% respectively, showing significant differences between group A and C and group B and C (P <0.001). The initial dose, doses of every hour and every case of group A and B were lower than those of group C. The dose of every hour of group C was 36.23% and 3. 75% higher then group A and B respectively (P < 0. 001), suggesting that acupuncture or acupoint-skin electrical stimulation could strengthen anesthetic effect and reduce the dose of epidural anesthetic. During operation, indexes of the life signs as HR, MAP, RR, TV, MV, SpO2 and ECG kept basically stable and all patients in group A passed surgical operation safely. Conclusion: Acupuncture or acupoint-skin electrical stimulation combined with epidural anesthesia can be used as one of the anesthetic methods for cholecystectomy.

EFFECT OF ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA ON PLASMA CATECHOLAMINE CONTENT IN CHOLECYSTECTOMY PATIENTS

Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods: 33 cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia (A) group (n=11), acupoint skin electrical stimulation combined with epidural anesthesia (B) group (n=11) and simple epidural anesthesia (C) group (n=11). Acupoints used were bilateral Zusanli (ST 36) and Neiguan (PC 6) and stimulated with parameters of frequency 2/15 Hz, intermittent waves, electric current 2～3 mA for group A and 13mA for group B. Extradural anesthetic administered was 1.5% Lidocaine 5 mL. Venous blood samples were collected one day before, during and 3 days after operation for detecting plasma NE, E and DA contents. Results: ① During operation, plasma NE of group A and B lowered in comparison with pre operation, particularly group A (P<0.01), while in group C, plasma NE level increased slightly; plasma E of group A and B increased significantly compared with pre operation (P< 0.01). Plasma DA in the 3 groups all raised during operation. ② Three days after operation, plasma NE, E and DA levels recovered basically in comparison with those of one day before operation. It indicates that acupuncture or acupoint skin electrical stimulation is capable of regulating sympathetic activity during epidural anesthesia. The anesthetic effect has a closer relation with changes of plasma NE level rather than changes of plasma E or DA levels. Conclusion: Acupuncture or acupoint surface electrical stimulation combined with epidural anesthesia may be of reducing or releasing surgical operation generated stress response during cholecystectomy.

Effect of different anesthesia methods on immune function in patients of laparoscopic cholecystectomy in peri-operative period

Objective To compare effects of combined acupuncture and general anesthesia （CAGA） and general anesthesia （GA） on immune function in patients of laparoscopic cholecystectomy （LC） in peri-operative period. Methods Thirty-nine cases undergoing LC were randomly divided into a CAGA group and a GA group. The CAGA group was treated with electroacupuncture at Hegu （合谷- LI 4）, Neiguan （内关PC 6）, Zusanli （足三里ST 36） and Yanglingquan （阳陵泉 GB 34） for 15-30 minutes followed by the general anesthesia, and the continuous electroacupuncture stimulation was given till the operation finished. The GA group was treated with simple general anesthesia. Changes of T cell subsets, tumor necrosis factor-alpha （TNF-α） and interleukin-6 （IL-6） were observed before anesthesia induction, and 2 hours, 1st and 3 rd day after operation, and the adverse reaction after operation was recorded. Results At 2 hours after operation, the percentages of CD3 and CDs in both groups were significantly lower than those before anesthesia induction （all P〈0.05）, and the percentage of CD4 in the GA group decreased significantly （P〈0.05）, while the percentage of CD： did not significantly change and CD4/CD8 increased significantly in the CAGA group （P〈0.05）. At 3 days after operation, the level of TNF-α in the ACGA group decreased significantly as compared with that before anesthesia induction （P〈0.05）. The cases with nausea after operation in the CAGA group were significantly less than those in the GA group （P〈0.05）. Conclusion Acupuncture combined with general anesthesia has a little effect on immune function in patients of LC with less adverse reactions.

A new abdominal drainage tube fixation method for 3-port laparoscopic cholecystectomy improves patients’postoperative quality of life

Objective Laparoscopic surgery has become a routine general surgery with many advantages,such as alleviating abdominal pain.However,postoperative pain caused by abdominal drainage tubes has attracted little attention from medical staff.The aim of this study was to explore the influence of a new abdominal drainage tube fixation method for 3-port laparoscopic cholecystectomy(LC)on patients’postoperative quality of life.Methods Patients who underwent 3-port LC with abdominal drainage tubes in the Department of Hepatobiliary Surgery of Linyi People’s Hospital from March 1,2023 to October 31,2023 due to gallstones with chronic cholecystitis were selected for this study.The patients were randomly divided into an experimental group and a control group.In the experimental group,the new abdominal drainage tube fixation method was used,while in the control group,the traditional method was used.Afterward,the quality of life of patient in terms of pain,activity,recovery time,and mental health status was evaluated.The exudate around the patient’s drainage tube was collected for bacterial culture and analysis.Results A total of 139 patients were randomly divided into an experimental group(70 patients)and a control group(69 patients).The patients’baseline characteristics were not significantly different.The patients in the experimental group had better outcomes in quality of life,with higher pain scores(24.03±2.37 vs.15.48±2.29,p<0.001)and activity scores(20.57±1.78 vs.14.13±1.43,p<0.001),and a shorter postoperative recovery time(2.36±0.68 d vs.2.96±1.34 d,p<0.001).The same results were shown in linear regression analysis scores of the 2 groups.The positive rate of bacterial culture in the exudate around the patient’s drainage tube in the experimental group was significantly lower than that in the control group(12.9%vs.43.5%,p<0.001);and furthermore,the positive rate of conditional pathogenic bacteria was even lower(7.1%vs.33.3%,p<0.001)in the experimental group than in the control group.Conclusion This new abdominal drainage tube fixation method can effectively promote patient rehabilitation and improve the quality of life for patient following 3-port LC with abdominal drainage tubes.

Clinical efficacy of laparoscopic cholecystectomy plus cholangioscopy for the treatment of cholecystolithiasis combined with choledocholithiasis

BACKGROUND Currently,endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)is the main treatment for cholecystolithiasis combined with choledocholithiasis.However,the treatment is unsatisfactory,and the development of better therapies is needed.AIM To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis.METHODS Patients(n=243)with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University(910th Hospital of Joint Logistic Support Force)between January 2019 and December 2023 were included in the study;111 patients(control group)underwent ERCP+LC and 132 patients(observation group)underwent LC+laparoscopic common bile duct exploration(LCBDE).Surgical success rates,residual stone rates,complications(pancreatitis,hyperamylasemia,biliary tract infection,and bile leakage),surgical indicators[intraoperative blood loss(IBL)and operation time(OT)],recovery indices(postoperative exhaust/defecation time and hospital stay),and serum inflammatory markers[C-reactive protein(CRP)],tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were compared.RESULTS No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups.However,the complication rate,IBL,OT,postoperative exhaust/defecation time,and hospital stays were significantly reduced in the observation group compared with the control group.Furthermore,CRP,TNF-α,and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group.CONCLUSION These results indicate that LC+LCBDE is safer than ERCP+LC for the treatment of cholecystolithiasis combined with choledocholithiasis.The surgical risks and postoperative complications were lower in the observation group compared with the control group.Thus,patients may recover quickly with less inflammation after LCBDE.

Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients:Meta-analysis

BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.

Efficacy of multi-color near-infrared fluorescence with indocyanine green:A new imaging strategy and its early experience in laparoscopic cholecystectomy

BACKGROUND Near-infrared fluorescence imaging via using intravenous indocyanine green(ICG)has a wide range of applications in multiple surgical scenarios.In lapa-roscopic cholecystectomy(LC),it facilitates intraoperative identification of the biliary system and reduces the risk of bile duct injury.However,the usual single color fluorescence imaging(SCFI)has limitations in manifesting the fluorescence signal of the target structure when its intensity is relatively low.Moreover,sur-geons often experience visual fatigue.We hypothesized that a novel imaging stra-tegy,named multi-color fluorescence imaging(MCFI),could potentially address these issues by decreasing hepatic and background fluorescence pollution and improving biliary visualization.AIM To investigate the novel imaging strategy MCFI in LC.METHODS This was a single-center retrospective study conducted at Peking Union Medical College Hospital,Beijing,China.Patients who underwent LC from June 2022 to March 2023 by the same surgical team were enrolled.Demographic features,clinical and surgical information were collected.The clarity,visual comfort,and effectiveness of different imaging strategies were subjectively evaluated by surgeons.RESULTS A total of 155 patients were included,60 patients were in the non-ICG group in which only bright light illuminance without ICG was applied,60 patients were in the SCFI group,and 35 patients were in the MCFI group.No statist-ically significant differences were found in demographics or clinical history.Post-surgical complications were minimal in all 3 groups with no significant differences observed.MCFI improved the clarity of imaging and visual comfort.Clarity of imaging and visual comfort were improved with MCFI.CONCLUSION MCFI improves biliary visualization and reduces liver fluorescence contamination,which supports its routine use in LC.MCFI may also be a better choice than SCFI in other clinical settings.

Research on the prognostic value of adjusting intraperitoneal threedimensional quality evaluation mode in laparoscopic cholecystectomy patients

BACKGROUND Benign gallbladder diseases have become a high-prevalence condition not only in China but also worldwide.The main types of benign gallbladder diseases include gallbladder polyps,acute and chronic cholecystitis,and gallstones,with gallstones being the most common,accounting for over 70%of cases.Although the mortality rate of benign gallbladder diseases is low,they carry obvious potential risks.Studies have shown that an increased incidence of benign gallbladder diseases can increase the risk of cardiovascular diseases and gallbladder cancer,resulting in a substantial disease burden on patients and their families.AIM To assess the medical utility of the Configuration-Procedure-Consequence(CPC)three-dimensional quality evaluation model in modulating the prognosis of laparoscopic cholecystectomy patients.METHODS A total of 98 patients who underwent laparoscopic cholecystectomy in our hospital from February 2020 to January 2022 were selected as the subjects.According to the random number table method,they were divided into a study group and a control group,with 49 patients in each group.The control group received routine perioperative care,while the study group had the addition of the CPC three-dimensional quality evaluation.The postoperative recovery-related indicators(time to first flatus,time to oral intake,time to ambulation,hospital stay),stress indicators(cortisol and adrenaline levels),distinctions in anxiety and RESULTS The time to first flatus,time to oral intake,time to ambulation,and hospital stay of the study group patients were obviously lower than those of the control group patients,with statistical significance(P<0.05).On the 1st day after admission,there were no obvious distinctions in cortisol and adrenaline levels in blood samples,as well as in the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores between the study group and the control group(P>0.05).However,on the 3rd day after surgery,the cortisol and adrenaline levels,as well as SAS and SDS scores of the study group patients,were obviously lower than those of the control group patients(P<0.05).The study group had 2 cases of incisional infection and 1 case of pulmonary infection,with a total incidence of complications of 6.12%(3/49),which was obviously lower than the 20.41%(10/49)in the control group(P<0.05).CONCLUSION Implementing the CPC three-dimensional quality evaluation model for patients undergoing laparoscopic cholecystectomy can help accelerate their perioperative recovery process,alleviate perioperative stress symptoms,mitigate anxiety,depression,and other adverse emotions,and to some extent,reduce the incidence of perioperative complications.

Laparoscopic cholecystectomy with communicating accessory hepatic duct injury and management: A case report

BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of patients with gallstones.However,bile duct injury is one of the most serious complications of this surgery,with an incidence rate of 0.3%-0.7%.Variations in anatomical structures are one of the main reasons for such injuries.CASE SUMMARY We report a 26-year-old male patient who presented with repeated upper abdominal pain for 1 year.Ultrasound examination and blood tests indicated gallstones accompanied by chronic cholecystitis.The patient underwent laparo-scopic cholecystectomy.During the surgery,a communicating bile duct connec-ting the gallbladder neck and the right hepatic duct was discovered and injured.Meticulous dissection identified it as a communicating accessory hepatic duct,which was then definitively ligated.Postoperatively,the patient recovered well,magnetic resonance imaging and magnetic resonance cholangiopancreatography showed no intrahepatic or extrahepatic bile duct strictures.The pathology report showed chronic cholecystitis with gallstones.CONCLUSION Carefully manage communicating accessory bile ducts in cholecystectomy using cholangiography or meticulous separation,followed by ligation is effective.

Clinical efficacy of laparoscopic cholecystectomy combined with endoscopic papillary balloon dilation in treatment of gallbladder stones with common bile duct stones: A retrospective study

BACKGROUND The incidence of cholelithiasis has been on the rise in recent years,but the choice of procedure is controversial.AIM To investigate the efficacy of laparoscopic cholecystectomy(LC)combined with endoscopic papillary balloon dilation(EPBD)in patients with gallbladder stones(GS)with common bile duct stones(CBDS).METHODS The clinical data of 102 patients with GS combined with CBDS were selected for retrospective analysis and divided into either an LC+EPBD group(n=50)or an LC+endoscopic sphincterotomy(EST)group(n=52)according to surgical methods.Surgery-related indexes,postoperative recovery,postoperative complications,and expression levels of inflammatory response indexes were compared between the two groups.RESULTS Total surgical time,stone free rate,rate of conversion to laparotomy,and successful stone extraction rate did not differ significantly between the LC+EPBD group and LC+EST group.Intraoperative hemorrhage,time to ambulation,and length of hospitalization in the LC+EPBD group were lower than those of the LC+EST group(P<0.05).The rate of total complications of the two groups was 9.80%and 17.65%,respectively,and the difference was not statistically significant.No serious complications occurred in either group.At 48 h postoperatively,the expression levels of interleukin-6,tumor necrosis factor-α,high-sensitivity Creactive protein,and procalcitonin were lower in the LC+EPBD group than in the LC+EST group(P<0.05).At 3 d postoperatively,the expression levels of aspartate transaminase,alanine transaminase,and total bilirubin were lower in the LC+EPBD group than in the LC+EST group(P<0.05).CONCLUSION LC combined with EPBD and LC combined with EST are both effective procedures for the treatment of GS with CBDS,in which LC combined with EPBD is beneficial to shorten the patient’s hospitalization time,reduce the magnitude of elevated inflammatory response indexes,and promote postoperative recovery.

Laparoscopic cholecystectomy plus common bile duct exploration for extrahepatic bile duct stones and postoperative recurrenceassociated risk factors

BACKGROUND There remain controversies regarding the surgical treatment of extrahepatic bile duct stones(EHBDSs)in clinical practice.AIM To explore the curative effect of laparoscopic cholecystectomy(LC)plus common bile duct exploration(CBDE)for the surgical treatment of EHBDSs and to analyze the risk factors that affect postoperative stone recurrence.METHODS Eighty-two patients with EHBDSs admitted between March 2017 and March 2023 were selected.Among them,patients treated with open choledocholithotomy plus LC or open cholecystectomy(OC)were set as the control group(n=40),and those treated with LC plus CBDE served as the observation group(n=42).The surgical outcomes of the two groups were compared,the surgical complications and Gas-trointestinal Quality of Life Index(GIQLI)scores were counted,and the one-year prognostic recurrence was recorded.Independent factors for postoperative re-currence were determined using univariate and multivariate analyses.RESULTS The two groups were comparable in the stone residual rate(P>0.05).The ope-ration time(P<0.05),intraoperative bleeding(P<0.05),and total complication rate(P=0.005)were lower in the observation group than in the control group.The observation group exhibited a marked increase in the GIQLI score,which was higher than the control group(P<0.05).A lower one-year recurrence rate was determined in the observation group vs the control group(P=0.027).Sphincter of Oddi dysfunction[odds ratio(OR)=5.712,P=0.007]and the treatment scheme of open choledocholithotomy plus LC or OC(OR=6.771,P=0.008)were the independent risk factors for one-year recurrence in patients after surgery.CONCLUSION LC plus CBDE for patients with EHBDSs can reduce stone residuals,intraoperative bleeding,complications,and postoperative recurrence.

A Case Report and Literature Review: A Case of Delayed Bile Leakage Following Laparoscopic Cholecystectomy

Background: Delayed bile leakage after laparoscopic cholecystectomy, defined as occurring more than 72 hours after surgery, is a rare and serious complication of laparoscopic cholecystectomy, with an incidence rate of 0.060%. Case Declaration: This case report details a patient diagnosed with delayed bile leakage 43 days after laparoscopic cholecystectomy. The patient was discharged from our hospital after undergoing CT-guided puncture treatment, with no obvious complications identified. The patient was monitored for one year following the procedure, during which time no significant discomfort was reported. Objective: This case report is to analyse and review the clinical manifestations, diagnosis, treatment and prevention of delayed bile leakage after cholecystectomy, with reference to the relevant literature. Results: Delayed bile leakage after laparoscopic cholecystectomy can be prevented, although not eliminated. It is recommended that the operator treat the operation with caution, avoid taking risks, and adhere to careful procedures and strict separation according to the requirements. This approach is key to preventing late bile leakage in the postoperative period.