Management of symptomatic cholelithiasis: a systematic review

Abstract

Background Symptomatic cholelithiasis is a common surgical disease and accounts for half of the over one million cholecystectomies performed in the USA annually. Despite its prevalence, only one prior systematic review has examined the evidence around treatment strategies and it contained a narrow scope. The goal of this systematic review was to analyze the clinical effectiveness of treatment options for symptomatic cholelithiasis, including surgery, non-surgical therapies, and ED pain management strategies. Methods Literature search was performed from January 2000 through June 2020, and a narrative analysis was performed as studies were heterogeneous. Results We identified 12 publications reporting on 10 trials (9 randomized controlled trials and 1 observational study) comparing treatment methods. The studies assessed surgery, observation, lithotripsy, ursodeoxycholic acid, electro-acupuncture, and pain-management strategies in the emergency department. Only one compared surgery to observation. Conclusion This work presents the existing data and underscores the current gap in knowledge regarding treatment for patients with symptomatic cholelithiasis. We use these results to suggest how future trials may guide comparisons between the timing of surgery and watchful waiting to create a set of standardized guidelines. Providing appropriate and timely treatment for symptomatic cholelithiasis is important to streamline care for a costly and prevalent disease. Trial registration PROSPERO Protocol Number: CRD42020153153

ROBOtic Care Outcomes Project (ROBOCOP) for Acute Gallbladder Pathology

“…This study is currently the largest done in this area and does demonstrate a reduction in conversion rate to open with robotic cholecystectomy for emergent cases. In this study, although the absolute risk reduction of 0.6% may not seem significant, more than a million minimally invasive cholecystectomies are performed annually in the United States, and thus the potential benefits translate to a large number of patients 32 . Furthermore, patients exhibit a significant preference for minimally invasive surgical techniques 33 …”

“…In this study, although the absolute risk reduction of 0.6% may not seem significant, more than a million minimally invasive cholecystectomies are performed annually in the United States, and thus the potential benefits translate to a large number of patients. 32 Furthermore, patients exhibit a significant preference for minimally invasive surgical techniques. 33 Several other factors have been shown to increase the risk of conversion in our current study.…”

Investigación multidisciplinaria desde una visión multidisciplinar. Libro 1

“…La colecistitis aguda, es la obstrucción de la vesícula biliar ocasionada por un lito, el cual es el factor principal, por lo que genera una contracción intensa y distensión vesicular, lo que explica el dolor cólico abdominal característico de este cuadro. Esta obstrucción genera retención de la bilis, alteraciones vasculares por la compresión del conducto cístico, edema de la pared vesicular por la liberación de fosfolipasas, las cuales se encargan de convertir la lecitina en lisolecitina que genera citotoxicidad produciendo ácido araquidónico por medio de los fosfolípidos y que a su vez producen prostaglandinas que comienzan el proceso inflamatorio (Shenoy et al, 2022).…”

Colelitíase - uma revisão abrangente sobre a epidemiologia, fisiopatologia, diagnóstico, abordagem conservadora e cirúrgica

“…Além disso, as complicações potenciais da colelitíase podem representar um risco sério para a saúde, exigindo tratamento adequado e, em alguns casos, cirurgia de remoção da vesícula biliar. Portanto, é essencial que tanto os profissionais de saúde quanto o público em geral estejam cientes dos sintomas, fatores de risco e opções de tratamento disponíveis para esta condição comum, a fim de garantir o diagnóstico precoce e a gestão eficaz da doença (SHENOY et al, 2022, SUN et al, 2022, DAN et al, 2023.…”