Hydatid cyst of the gallbaldder: A systematic review of the literature

AIM To evaluate all the references about primary gallbladder hidatidosis looking for best treatment evidence.METHODS Search:1966-2015 in MEDLINE,Cochrane Library,SciELO,and Tripdatabase.Key words: "gallabladder hydatid disease" and "gallbladder hydatid cyst".We found 124 papers in our searches but only 14 papers including 16 cases were about hydatid cyst of the gallbladder(GBHC).RESULTS Eight cases of GBHC were women and seven men.One not mentioned.Median age was 48.3 years.The most frequent clinical symptom was abdominal pain(94%) usually in the right upper quadrant.Ultrasound was performed in ten patients(62.5%) but in most cases a combination of several techniques was performed.The location of the cysts was intravesicular in five patients.Five patients presented GBHC and liver hydatid cysts.Two patients presented cholelithiasis and one choledocholithiasis.The most frequent surgical technique was cholecystectomy by laparotomy(81.25%).Simultaneous surgery of liver cysts was carried out in five cases.Eleven patients did not present postoperative complications,but one died.The mean hospital stay was seven days.No recurrence of GBHC was recorded.CONCLUSION In GBHC,the most frequent symptom is right hypocondrium pain(evidence level V).Best diagnostic methods are ultrasound and computed tomography(level V,grade D).Suggested treatment is open cholecystectomy and postoperative albendazole(level V,grade D) obtaining good clinical results and none relapses.

Stem cell therapy applied for digestive anastomosis: Current state and future perspectives

BACKGROUND Digestive tract resections are usually followed by an anastomosis.Anastomotic leakage,normally due to failed healing,is the most feared complication in digestive surgery because it is associated with high morbidity and mortality.Despite technical and technological advances and focused research,its rates have remained almost unchanged the last decades.In the last two decades,stem cells(SCs)have been shown to enhance healing in animal and human studies;hence,SCs have emerged since 2008 as an alternative to improve anastomoses outcomes.AIM To summarise the published knowledge of SC utilisation as a preventative tool for hollow digestive viscera anastomotic or suture leaks.METHODS PubMed,Science Direct,Scopus and Cochrane searches were performed using the key words“anastomosis”,“colorectal/colonic anastomoses”,“anastomotic leak”,“stem cells”,“progenitor cells”,“cellular therapy”and“cell therapy”in order to identify relevant articles published in English and Spanish during the years of 2000 to 2021.Studies employing SCs,performing digestive anastomoses in hollow viscera or digestive perforation sutures and monitoring healing were finally included.Reference lists from the selected articles were reviewed to identify additional pertinent articles.METHODS Given the great variability in the study designs,anastomotic models,interventions(SCs,doses and vehicles)and outcome measures,performing a reliable meta-analysis was considered impossible,so we present the studies,their results and limitations.RESULTS Eighteen preclinical studies and three review papers were identified;no clinical studies have been published and there are no registered clinical trials.Experimental studies,mainly in rat and porcine models and occasionally in very adverse conditions such as ischaemia or colitis,have been demonstrated SCs as safe and have shown some encouraging morphological,functional and even clinical results.Mesenchymal SCs are mostly employed,and delivery routes are mainly local injections and cell sheets followed by biosutures(sutures coated by SCs)or purely topical.As potential weaknesses,animal models need to be improved to make them more comparable and equivalent to clinical practice,and the SC isolation processes need to be standardised.There is notable heterogeneity in the studies,making them difficult to compare.Further investigations are needed to establish the indications,the administration system,potential adjuvants,the final efficacy and to confirm safety and exclude definitively oncological concerns.CONCLUSION The future role of SC therapy to induce healing processes in digestive anastomoses/sutures still needs to be determined and seems to be currently far from clinical use.

Endovascular treatment for early hepatic artery occlusion after liver transplantation: Angioplasty or stent

To the Editor:We read with great interest the recent article by Zhu et al.[1].In the study,the authors analyzed the outcomes of 26 patients diagnosed with hepatic artery occlusion(HAO)and treated with an endovascular approach(EVT)within the first 30 days after ortho-topic liver transplantation(LT).The median interval from LT to EVT was 7 days,most patients were treated with angioplasty and only two(7.7%)needed stent placement.The authors should be congrat-ulated as they achieved a 100%of success rate with an 80.8%of 1-year survival rate.

Hydatidosis and the duodenum: A systematic review of the literature

BACKGROUND Injury to the duodenum(fistula formation,compression,or other complications)by a hydatid cyst(HC)is an exceptional complication.AIM To perform a systematic review of the literature on the fistulization of HC in the duodenum.METHODS Following PRISMA guidelines,a search for HC with duodenal involvement was carried out in the databases of PubMed,SCielo and EMBASE without time limits.RESULTS Fourteen patients were identified,seven men and seven women,with a mean age of 53.14 years(SD=17.65,range:28-78).Three out of the 14(21%)had HC relapse.The most frequent clinical manifestations were abdominal pain and nausea and/or vomiting.Various imaging studies were performed in almost all cases,the most commonly used being abdominal computed tomography(10/14,71%).A range of surgical techniques were reported,most frequently HC drainage(41%)and enucleations(16%).Ten of the 14 patients had no complications and one patient died.The follow-up period and recurrences could not be determined.CONCLUSION The most frequent symptoms were abdominal pain,nausea and vomiting.Computed tomography was the most used diagnostic imaging technique,and HC drainage and fistula closure via laparotomy was the most frequent treatment.However,all diagnostic and therapeutic options for HC fistulizing the duodenum had a low level of evidence.