Background:
Laparoscopic cholecystectomy (LC) has been associated with an increase in the incidence of biliary and vascular injuries. Pseudoaneurysms (PAs) following LC are rare life-threatening events with limited available experience regarding diagnosis and treatment.
Materials and Methods:
An extensive review of literature during a 26-year period (1994–2020) using MEDLINE
®
database and Google Scholar
®
academic search engine revealed 134 patients with at least one symptomatic PA following LC.
Results:
Nearly 81% of patients with PAs become symptomatic during the first 8 weeks following LC. The most common symptoms were gastrointestinal bleeding (74%) and abdominal pain (61%). In 28% of cases, there was a concomitant bile duct injury or leak from the cystic duct stump, whereas in about one-third of cases, PAs presented following an uneventful LC. The most common involved arteries were the right hepatic artery (70%), the cystic artery (19%) or both of them (3%). Trans-arterial embolisation was the favoured first-line treatment with a success rate of 83%. During a median follow-up of 9 months, the mortality rate was 7%.
Conclusion:
Clinicians should be aware of the PA occurrence following LC. Prompt diagnosis and treatment are essential.
Ghrelin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY) are involved in energy balance regulation and glucose homeostasis. Obesity is characterized by lower fasting levels and blunted postprandial responses of ghrelin, GLP-1, and possibly PYY. Both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have been shown to increase postprandial GLP-1 and PYY levels. Human studies have shown that enhanced postprandial GLP-1 and PYY release are associated with favorable weight loss outcomes after RYGB. However, studies in knockout mice have shown that GI hormones are not required for the primary metabolic effects of bariatric surgery. Here, we summarize the complex interaction between obesity, bariatric surgery, and GI hormones in order to determine the exact role of GI hormones in the success of bariatric surgery.
Aggressive angiomyxoma is a rare mesenchymal tumor occurring usually in women of reproductive age in pelvic-perineum region. These myofibroblastic tumors rarely affect men and non-pelvic-perineum anatomical sites. There are few literature references for aggressive angiomyxoma in men. We describe a case of a 57-year old male with aggressive angiomyxoma of the scrotum and its management.
Introduction
Percutaneous cholecystostomy (PC) represents a management option to control sepsis in patients with acute cholecystitis, who are unable to tolerate surgery.
Aim
This review aimed to evaluate the outcomes of elderly patients treated with PC and compare it with emergent cholecystectomy.
Material and methods
An electronic search of the Embase, Medline Web of Science, and Cochrane databases was performed. Percutaneous cholecystostomy was used as the reference group, and weighted mean differences (WMD) were calculated for the effect of PC on continuous variables, and pooled odds ratios (POR) were calculated for discrete variables.
Results
There were 20 trials included in this review. Utilisation of PC was associated with significantly increased mortality (POR = 4.85; 95% CI: 1.02–7.30;
p
= 0.0001) and increased re-admission rates (POR = 2.95; 95% CI: 2.21–3.87;
p
< 0.0001).
Conclusions
This pooled analysis established that patients treated with PC appear to have increased mortality and readmission rates relative to those managed with cholecystectomy.
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