Anibal J. Rondan, Marcelo Fasano, Rosana Trapani, Gustavo C Alarcia, Pablo J Miguel, Julieta Camelione, Alberto R. Ferreres. Bocalandro
GSD is one of the most frequent disorders affecting the gastrointestinal tract; its incidence in the adult population is above 58% for females and around 42% for males. Race and ethnicity play a major role in its development, more frequent in hispanics and native descendents.
Analyze the incidence, clinical presentation and course and prognosis of GSD in our patients.
Methods and materials
After approval of our institutional IRB a retrospective analysis of a prospective database of the patients admitted to the Division of Gastrointestinal Surgery of the University of Buenos Aires “Dr. Carlos A Bocalandro” Hospital. between January 2010 and January 2014, 4500 patients were admitted with diagnosis of GSD and/or its complications; 3456 (76.8%) were female and 1044 (23.2%) were male. 3825 (85%) of our patients were younger than 60 years. Our guidelines include a minimal invasive approach for the treatment of this illness and its complications
3465 (77%) patients were admitted for elective surgery (lap. chole. with intraoperative cholangiogram and/or CBD exploration), 1035 (23%) Patients were admitted for emergency surgery, who were scheduled for emergency surgery, 34 patients (3.28%) needed Percutaneus drainage cholecystostomy. Lap. chole. was completed in 4263 (94.74%), IOC was performed in 3897 cases (86.66%). The remaining 244 (5.42%) patients required conversion (right subcostal incision) due to: a) Mirizzi’s syndrome: 15 (0.33 %), b) Cholecystocolonic fistula: 5 (0.11%), C) Cholecystoduodenal fistula: 8 (0.17%), d) Intraoperative complications (bleeding, liver laceration): 216 (4.8%).
Incidence of CBD stones, biliary duct injury,
POP Complications: a) Surgical site infection: 38 (0.84%), b) Intraabdominal collections: 12 (0.26%), c) Retained CBD stones: 56 (1.24%), d) No bile duct injuries were registered.
The spectrum of BSD, its progress and complications impose a prompt diagnosis and surgical treatment in order to correct symptoms, prevent complications and avoid disability and sequelae. Elective treatment should be recommended when repeated gallstone symptoms have occurred before the development of acute cholecystitis and related complications.
Our results on large number of patients are similar to other series in the newer literature. The incidence of complications decreases with growing laparoscopic experience.