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Related Concept Videos

Chronic Pancreatitis II: Collaborative Care01:29

Chronic Pancreatitis II: Collaborative Care

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The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
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Acute Pancreatitis II: Clinical Manifestations and Management01:30

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Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
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Updated: May 20, 2025

The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation
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258

A Management Algorithm for High-Grade Acute Cholecystitis in High-Risk Patients.

Timothy J Morley1, Jeremy Fridling2, Jennifer M Brewer2

  • 1Department of Surgery, St Francis Hospital, Hartford, CT. (Drs. Morley, Gross, Montgomery, Miller, Posillico, Jeremitsky, Jayaraman, Roberts, Hill, Moutinho, Doben, and Greig).

JSLS : Journal of the Society of Laparoendoscopic Surgeons
|March 27, 2025
PubMed
Summary
This summary is machine-generated.

This study presents an evidence-based algorithm for managing acute cholecystitis (AC) in high-risk patients using percutaneous cholecystostomy tube (PCT) drainage followed by minimally invasive cholecystectomy (MIS-C). The protocol appears safe and effective, potentially reducing adverse outcomes like open conversion.

Keywords:
Acute cholecystitisAlgorithmsCholecystostomyLaparoscopic cholecystectomy

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Area of Science:

  • Surgical Management
  • Gastrointestinal Surgery
  • Acute Care Surgery

Background:

  • Acute cholecystitis (AC) is a common surgical emergency.
  • Laparoscopic cholecystectomy (LC) is standard but has suboptimal outcomes like bile duct injury, open conversion (OC), and subtotal cholecystectomy (SC).
  • Percutaneous cholecystostomy tube (PCT) drainage followed by interval cholecystectomy is an option for high-risk patients, but outcomes vary.

Purpose of the Study:

  • To describe an evidence-based algorithm for managing AC in high-risk patients.
  • To evaluate the safety and effectiveness of PCT followed by minimally invasive cholecystectomy (MIS-C).
  • To assess the algorithm's impact on OC and SC rates.

Main Methods:

  • Retrospective chart review of 29 high-risk patients treated with PCT and MIS-C from January 2020 to June 2023.
  • Primary outcome: OC or SC.
  • Secondary outcomes: bile leak, bile duct injury, perioperative complications.

Main Results:

  • One patient (3.4%) required SC; no patients required OC.
  • Three postoperative bile leaks (10.4%) occurred.
  • No bile duct injuries or deaths were reported; robotic-assisted cholecystectomy (RC) showed fewer complications than LC.

Conclusions:

  • The PCT followed by MIS-C protocol is safe and feasible for high-grade AC in high-risk patients.
  • The algorithm may reduce adverse events, with potential benefits observed for RC.
  • Further prospective studies are needed to validate and refine this management approach.