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Introduction: cases of umbilical endometriosis reported after gynecological laparoscopic surgery are rare, and sometimes they become a real diagnostic challenge. Clinical cases: we present two cases of patients with a history of gynecological laparoscopy (ovarian endometrioma and ovarian teratoma, respectively) that years later presented painful nodules secondary to an endometrial implant at the umbilicus. Discussion: it is necessary to distinguish between primary umbilical endometriosis (Villar's nodule) and those cases due to implants from surgical procedures. A high level of suspicion should be maintained in these types of patients. Surgical excision with wide margins is the technical choice, and the simultaneous performance of a laparoscopy is debated. Prophylaxis by removing the surgical piece into a bag is recommended., Introducción: una nueva infección ha llegado. Sus manifestaciones y afectaciones orgánicas todavía están en estudio. Presentamos dos casos recientes en nuestro hospital en los cuales los hallazgos analíticos del perfil hepatobiliar sugerían una colecistitis aguda, posteriormente no confirmada. Descripción de casos: dos varones con infección SARS-CoV2 grave presentaron alteración del perfil hepático y tras la realización de pruebas de imagen se orientó erróneamente como un cuadro de colecistitis aguda. Discusión: las alteraciones del perfil hepático podrían estar en relación con una insuficiencia hepática teniendo un riesgo mayor de desarrollar COVID-19 grave en comparación con los que tenían pruebas de función hepática normales.

Background International guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis. Method 1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery. Results 725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months. Conclusion Patients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery. Trial registration: Not applicable.

BACKGROUND: The organization of healthcare could have an impact on the outcome of patients treated for acute cholecystitis (AC). The aim of this study was to analyze the way in which patients with AC are managed relative to the level of care by the treating hospital. METHODS: Data were collected from the Swedish Register for Gallstone Surgery and ERCP (GallRiks). Cholecystectomies between 2010 and 2019 were included. The inclusion criterion was acute cholecystectomy in patients with AC operated at either tertiary referral centers (TRCs) or regional hospitals. RESULTS: A total of 24,194 cholecystectomies with AC met the inclusion criterion. The time between admission and acute surgery was significantly elongated at TRCs compared with regional hospitals (2.2 ± 1.7 days vs. 1.6 ± 1.4 days, mean ± SD; p < 0.0001). Patients with a history of AC were more frequent at TRC (10.1% vs. 8.9%, p < 0.0056) and had a higher adverse event rate compared with those at regional hospitals (OR 1.61; CI 1.40-1.84, p < 0.0001). Surprisingly, an increased number of hospital beds correlated slightly with an increased number of days between admission and surgery (R2 = 0.132; p = 0.0075). CONCLUSION: Compared with regional hospitals, patients with AC had to wait longer at TRCs before surgery. A history of AC significantly increased the risk of adverse events. These findings indicate that logistic and organizational aspects of hospital care may affect the management of patients with AC. However, whether these findings can be generalized to healthcare organizations outside Sweden requires further investigation.

BACKGROUND: The organization of healthcare could have an impact on the outcome of patients treated for acute cholecystitis (AC). The aim of this study was to analyze the way in which patients with AC are managed relative to the level of care by the treating hospital. METHODS: Data were collected from the Swedish Register for Gallstone Surgery and ERCP (GallRiks). Cholecystectomies between 2010 and 2019 were included. The inclusion criterion was acute cholecystectomy in patients with AC operated at either tertiary referral centers (TRCs) or regional hospitals. RESULTS: A total of 24,194 cholecystectomies with AC met the inclusion criterion. The time between admission and acute surgery was significantly elongated at TRCs compared with regional hospitals (2.2 ± 1.7 days vs. 1.6 ± 1.4 days, mean ± SD; p < 0.0001). Patients with a history of AC were more frequent at TRC (10.1% vs. 8.9%, p < 0.0056) and had a higher adverse event rate compared with those at regional hospitals (OR 1.61; CI 1.40-1.84, p < 0.0001). Surprisingly, an increased number of hospital beds correlated slightly with an increased number of days between admission and surgery (R2 = 0.132; p = 0.0075). CONCLUSION: Compared with regional hospitals, patients with AC had to wait longer at TRCs before surgery. A history of AC significantly increased the risk of adverse events. These findings indicate that logistic and organizational aspects of hospital care may affect the management of patients with AC. However, whether these findings can be generalized to healthcare organizations outside Sweden requires further investigation.

BACKGROUND: The organization of healthcare could have an impact on the outcome of patients treated for acute cholecystitis (AC). The aim of this study was to analyze the way in which patients with AC are managed relative to the level of care by the treating hospital. METHODS: Data were collected from the Swedish Register for Gallstone Surgery and ERCP (GallRiks). Cholecystectomies between 2010 and 2019 were included. The inclusion criterion was acute cholecystectomy in patients with AC operated at either tertiary referral centers (TRCs) or regional hospitals. RESULTS: A total of 24,194 cholecystectomies with AC met the inclusion criterion. The time between admission and acute surgery was significantly elongated at TRCs compared with regional hospitals (2.2 ± 1.7 days vs. 1.6 ± 1.4 days, mean ± SD; p < 0.0001). Patients with a history of AC were more frequent at TRC (10.1% vs. 8.9%, p < 0.0056) and had a higher adverse event rate compared with those at regional hospitals (OR 1.61; CI 1.40-1.84, p < 0.0001). Surprisingly, an increased number of hospital beds correlated slightly with an increased number of days between admission and surgery (R2 = 0.132; p = 0.0075). CONCLUSION: Compared with regional hospitals, patients with AC had to wait longer at TRCs before surgery. A history of AC significantly increased the risk of adverse events. These findings indicate that logistic and organizational aspects of hospital care may affect the management of patients with AC. However, whether these findings can be generalized to healthcare organizations outside Sweden requires further investigation.

Background International guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis. Method 1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery. Results 725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months. Conclusion Patients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery. Trial registration: Not applicable.

Background International guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis. Method 1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery. Results 725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months. Conclusion Patients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery. Trial registration: Not applicable.

BACKGROUND: The organization of healthcare could have an impact on the outcome of patients treated for acute cholecystitis (AC). The aim of this study was to analyze the way in which patients with AC are managed relative to the level of care by the treating hospital. METHODS: Data were collected from the Swedish Register for Gallstone Surgery and ERCP (GallRiks). Cholecystectomies between 2010 and 2019 were included. The inclusion criterion was acute cholecystectomy in patients with AC operated at either tertiary referral centers (TRCs) or regional hospitals. RESULTS: A total of 24,194 cholecystectomies with AC met the inclusion criterion. The time between admission and acute surgery was significantly elongated at TRCs compared with regional hospitals (2.2 ± 1.7 days vs. 1.6 ± 1.4 days, mean ± SD; p < 0.0001). Patients with a history of AC were more frequent at TRC (10.1% vs. 8.9%, p < 0.0056) and had a higher adverse event rate compared with those at regional hospitals (OR 1.61; CI 1.40-1.84, p < 0.0001). Surprisingly, an increased number of hospital beds correlated slightly with an increased number of days between admission and surgery (R2 = 0.132; p = 0.0075). CONCLUSION: Compared with regional hospitals, patients with AC had to wait longer at TRCs before surgery. A history of AC significantly increased the risk of adverse events. These findings indicate that logistic and organizational aspects of hospital care may affect the management of patients with AC. However, whether these findings can be generalized to healthcare organizations outside Sweden requires further investigation.

Background International guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis. Method 1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery. Results 725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months. Conclusion Patients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery. Trial registration: Not applicable.

BACKGROUND: The organization of healthcare could have an impact on the outcome of patients treated for acute cholecystitis (AC). The aim of this study was to analyze the way in which patients with AC are managed relative to the level of care by the treating hospital. METHODS: Data were collected from the Swedish Register for Gallstone Surgery and ERCP (GallRiks). Cholecystectomies between 2010 and 2019 were included. The inclusion criterion was acute cholecystectomy in patients with AC operated at either tertiary referral centers (TRCs) or regional hospitals. RESULTS: A total of 24,194 cholecystectomies with AC met the inclusion criterion. The time between admission and acute surgery was significantly elongated at TRCs compared with regional hospitals (2.2 ± 1.7 days vs. 1.6 ± 1.4 days, mean ± SD; p < 0.0001). Patients with a history of AC were more frequent at TRC (10.1% vs. 8.9%, p < 0.0056) and had a higher adverse event rate compared with those at regional hospitals (OR 1.61; CI 1.40-1.84, p < 0.0001). Surprisingly, an increased number of hospital beds correlated slightly with an increased number of days between admission and surgery (R2 = 0.132; p = 0.0075). CONCLUSION: Compared with regional hospitals, patients with AC had to wait longer at TRCs before surgery. A history of AC significantly increased the risk of adverse events. These findings indicate that logistic and organizational aspects of hospital care may affect the management of patients with AC. However, whether these findings can be generalized to healthcare organizations outside Sweden requires further investigation.

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Background: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. Methods: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. Results: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). Conclusions: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a cont

Background International guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis. Method 1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery. Results 725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months. Conclusion Patients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery. Trial registration: Not applicable.

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Bile duct disease is one of the most frequent pathologies in the Surgery service. Mirizzi Syndrome (MS) is one of the rare complications of these pathologies, more frequent in developing countries, reaching Latin America. MS occurs due to one or more stones impacted in the neck of the gallbladder or the cystic duct, which conditions extrinsic compression and obstruction of the common hepatic duct, producing an inflammatory reaction, and conditioning stenosis of the common hepatic duct. In order to expose the highlighted elements referred to in this rare syndrome, a bibliographic review of the findings and scientific updates published to date is presented. The results of exposure of clinical cases, publications before 2016 and those that were not in Spanish were excluded. The clinical manifestations and laboratory findings of MS are very nonspecific and unfortunately there are no pathognomonic signs. Patients may complain of typical colicky pain or present with the systemic symptoms of fever, such as: chills, tachycardia, and anorexia. The most frequent laboratory findings are elevated alkaline phosphatase and bilirubin. It has an incidence of less than 1%, the incidence of this pathology increases with age, however, it does not have a predilection for races. Preoperative diagnosis can be difficult, otherwise intraoperative recognition and proper management are essential to avoid the high incidence of bile duct injury. The treatment of patients with MS involves complex technical difficulties, compared with the treatment of uncomplicated gallbladder stone disease. The goal of treatment includes decompression of the bile duct and pre-venting recurrence of the condition. The prognosis of MS is very good for type I lesions. However, treatment of more serious lesions with fistulous destruction of the BVP increases postoperative morbidity by 10% or more, including biliary fistulas, BVP strictures, abscesses of neighborhood; that would require reoperations with the conseque, La enfermedad de vía biliar es una de las patologías más frecuentes en el servicio de Cirugía. El Síndrome de Mirizzi (SM) es una de las complicaciones poco frecuente de estas patologías, más frecuente en países en vías de desarrollo, alcanzando en Latinoamérica. El SM se produce a causa de uno o varios cálculos impactados en el cuello de la vesícula o el conducto cístico, lo que condiciona compresión extrínseca y obstrucción del conducto hepático común produciendo una reacción inflamatoria, y condicionando estenosis del conducto hepático común. Con el fin de exponer los elementos resaltantes referidos de este síndrome poco común se expone una revisión biblio-gráfica de los hallazgos y actualizaciones científicas publicadas a la fecha. Se excluyeron los resultados de exposición de casos clínicos, las publicaciones de antes del 2016 y las que no estuvieran en español. Las manifestaciones clínicas y los hallazgos de laboratorio del SM son muy inespecíficos y desafortunadamente no cuenta con signos patognomónicos. Los pacientes pueden aquejar dolor típico cólico o manifestarse con los síntomas sistémicos de la fiebre, como: escalofríos, taquicardia y anorexia. Los hallazgos de laboratorios más frecuentes, son la elevación de fosfatasa alcalina y bilirrubina. Presenta una incidencia de menos del 1%, la incidencia de esta pato-logía aumenta con la edad, sin embargo, no tiene predilección por razas. El diagnóstico preoperatorio puede ser difícil, caso contario es esencial el reconocimiento intraoperatorio y un manejo adecuado para evitar la alta incidencia de lesión de la vía biliar. El tratamiento de los pacientes afectos de SM infiere dificultades técnicas complejas, comparado con la terapéutica de la enfermedad litiásica vesicular no complicada. El objetivo del tratamiento incluye la descompresión de la vía biliar y prevenir la recurrencia de la afección. El pronóstico del MS es muy bueno para las lesiones tipo I. Sin embargo, el tratamiento de lesiones más serias con

Background: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. Methods: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. Results: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). Conclusions: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a cont

Background: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. Methods: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. Results: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). Conclusions: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a cont

BACKGROUND: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. METHODS: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. RESULTS: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). CONCLUSIONS: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a cont

BACKGROUND: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. METHODS: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. RESULTS: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). CONCLUSIONS: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a cont

Objective: To provide optimal health care for patients with acute cholecystitis in need of acute cholecystectomy, resource allocation has to be optimized. The aim of this study was to assess possible regional inequity regarding the treatment of acute cholecystitis and explore regional differences in the management of acute cholecystitis. Methods: Data were retrieved from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde CholangioPancreatography. Between January 2010 and December 2019, 22,985 patients who underwent cholecystectomy for acute cholecystitis and without prior history of acute cholecystitis were included in the study. The ratio of cholecystectomies with acute cholecystitis performed within two days of admission to hospital compared to population density was studied. Furthermore, the proportion of acute performed cholecystectomies within two days of admission in regions, with or without tertiary care centers, was also examined. Results: No correlation between population density and proportion of acute performed cholecystectomies was found. Regions without tertiary care centers had a higher proportion of acute cholecystectomies performed within two days (5–10%). The difference in the ratio of acute cholecystectomies within two days of admission was significant for all years investigated except 2010. Conclusions: The presence of a tertiary referral center within the region had a greater influence than the population density on the chance of undergoing acute cholecystectomy for patients with acute cholecystitis. There are several potential explanations for this, one being an interference of the needs of patients requiring tertiary referral center care with the needs of patients in need of acute care surgery.

Objective: To provide optimal health care for patients with acute cholecystitis in need of acute cholecystectomy, resource allocation has to be optimized. The aim of this study was to assess possible regional inequity regarding the treatment of acute cholecystitis and explore regional differences in the management of acute cholecystitis. Methods: Data were retrieved from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde CholangioPancreatography. Between January 2010 and December 2019, 22,985 patients who underwent cholecystectomy for acute cholecystitis and without prior history of acute cholecystitis were included in the study. The ratio of cholecystectomies with acute cholecystitis performed within two days of admission to hospital compared to population density was studied. Furthermore, the proportion of acute performed cholecystectomies within two days of admission in regions, with or without tertiary care centers, was also examined. Results: No correlation between population density and proportion of acute performed cholecystectomies was found. Regions without tertiary care centers had a higher proportion of acute cholecystectomies performed within two days (5–10%). The difference in the ratio of acute cholecystectomies within two days of admission was significant for all years investigated except 2010. Conclusions: The presence of a tertiary referral center within the region had a greater influence than the population density on the chance of undergoing acute cholecystectomy for patients with acute cholecystitis. There are several potential explanations for this, one being an interference of the needs of patients requiring tertiary referral center care with the needs of patients in need of acute care surgery.

Background: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. Methods: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. Results: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). Conclusions: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a cont

BACKGROUND: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. METHODS: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. RESULTS: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). CONCLUSIONS: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a cont

Objective: To provide optimal health care for patients with acute cholecystitis in need of acute cholecystectomy, resource allocation has to be optimized. The aim of this study was to assess possible regional inequity regarding the treatment of acute cholecystitis and explore regional differences in the management of acute cholecystitis. Methods: Data were retrieved from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde CholangioPancreatography. Between January 2010 and December 2019, 22,985 patients who underwent cholecystectomy for acute cholecystitis and without prior history of acute cholecystitis were included in the study. The ratio of cholecystectomies with acute cholecystitis performed within two days of admission to hospital compared to population density was studied. Furthermore, the proportion of acute performed cholecystectomies within two days of admission in regions, with or without tertiary care centers, was also examined. Results: No correlation between population density and proportion of acute performed cholecystectomies was found. Regions without tertiary care centers had a higher proportion of acute cholecystectomies performed within two days (5–10%). The difference in the ratio of acute cholecystectomies within two days of admission was significant for all years investigated except 2010. Conclusions: The presence of a tertiary referral center within the region had a greater influence than the population density on the chance of undergoing acute cholecystectomy for patients with acute cholecystitis. There are several potential explanations for this, one being an interference of the needs of patients requiring tertiary referral center care with the needs of patients in need of acute care surgery.

BACKGROUND: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. METHODS: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. RESULTS: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). CONCLUSIONS: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a cont

Background: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. Methods: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. Results: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). Conclusions: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a cont

BACKGROUND: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. METHODS: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. RESULTS: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). CONCLUSIONS: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a cont

Objective: To provide optimal health care for patients with acute cholecystitis in need of acute cholecystectomy, resource allocation has to be optimized. The aim of this study was to assess possible regional inequity regarding the treatment of acute cholecystitis and explore regional differences in the management of acute cholecystitis. Methods: Data were retrieved from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde CholangioPancreatography. Between January 2010 and December 2019, 22,985 patients who underwent cholecystectomy for acute cholecystitis and without prior history of acute cholecystitis were included in the study. The ratio of cholecystectomies with acute cholecystitis performed within two days of admission to hospital compared to population density was studied. Furthermore, the proportion of acute performed cholecystectomies within two days of admission in regions, with or without tertiary care centers, was also examined. Results: No correlation between population density and proportion of acute performed cholecystectomies was found. Regions without tertiary care centers had a higher proportion of acute cholecystectomies performed within two days (5–10%). The difference in the ratio of acute cholecystectomies within two days of admission was significant for all years investigated except 2010. Conclusions: The presence of a tertiary referral center within the region had a greater influence than the population density on the chance of undergoing acute cholecystectomy for patients with acute cholecystitis. There are several potential explanations for this, one being an interference of the needs of patients requiring tertiary referral center care with the needs of patients in need of acute care surgery.

Objective: To provide optimal health care for patients with acute cholecystitis in need of acute cholecystectomy, resource allocation has to be optimized. The aim of this study was to assess possible regional inequity regarding the treatment of acute cholecystitis and explore regional differences in the management of acute cholecystitis. Methods: Data were retrieved from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde CholangioPancreatography. Between January 2010 and December 2019, 22,985 patients who underwent cholecystectomy for acute cholecystitis and without prior history of acute cholecystitis were included in the study. The ratio of cholecystectomies with acute cholecystitis performed within two days of admission to hospital compared to population density was studied. Furthermore, the proportion of acute performed cholecystectomies within two days of admission in regions, with or without tertiary care centers, was also examined. Results: No correlation between population density and proportion of acute performed cholecystectomies was found. Regions without tertiary care centers had a higher proportion of acute cholecystectomies performed within two days (5–10%). The difference in the ratio of acute cholecystectomies within two days of admission was significant for all years investigated except 2010. Conclusions: The presence of a tertiary referral center within the region had a greater influence than the population density on the chance of undergoing acute cholecystectomy for patients with acute cholecystitis. There are several potential explanations for this, one being an interference of the needs of patients requiring tertiary referral center care with the needs of patients in need of acute care surgery.

The most common complication of gallstone disease is choledocholithiasis. Among those suffering from choledocholithiasis, the main contingent of patients is made up of elderly and senile people. Endoscopic papillosphincterotomy (EPST) and stone extraction are the surgery of choice in patients with choledocholithiasis. When performing EPST, the greatest difficulties were observed in patients with a point-shaped papilla, with a parapapillary and especially with an intra-diverticular arrangement of the OBD. The analysis of the results showed that in case of choledocholithiasis of elderly and senile age, a full-fledged study and the use of minimally invasive low-traumatic interventions are required as much as possible.

Cholecystocolonic fistula (CCF) is a rare complication of cholelithiasis. They are often asymptomatic, difficult to diagnose preoperatively, it despite radiological support, and they are discovered incidentally perioperatively. We present the case of a woman with acute cholecystitis, who was operated by laparoscopy, and a CCF was evidenced, it was resolved by conversion to open surgery. FCC can be complicated and simulate acute abdominal symptoms. It should be taken into account in older adults with a history of cholelithiasis and scleroatrophic vesicles with adhesions. Very few cases have been described in the literature, and none in our country. We present a case of FCC that was admitted as acute cholecystitis, and the diagnosis and treatment of it were during her surgery., La fístula colecistocolónica (FCC) es una complicación poco común de la colelitiasis. A menudo son asintomáticas, de difícil diagnóstico preoperatorio a pesar del apoyo radiológico, y se descubren de manera incidental perioperatoriamente. Presentamos el caso de una mujer con un cuadro de colecistitis aguda, la cual fue intervenida por laparoscopía, y se evidenció una FCC, la cual fue resuelta mediante conversión a cirugía abierta. La FCC puede complicarse y simular cuadros abdominales agudos. Se debe tener en cuenta en adultos mayores, con historia de colelitiasis, y vesículas escleroatróficas con adherencias. En la literatura se han descrito muy pocos casos, y ninguno en nuestro medio. Presentamos un caso de FCC que ingresó como una colecistitis aguda, y su diagnóstico y tratamiento fueron durante su cirugía

Background: Acute calculous cholecystitis (AC) is a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation. In the preoperative planning, the severity of AC should be considered as well as time of onset of symptoms and patient comorbidities. The aim of the present study was to investigate the role of an early PCT assessment in the emergency department in predicting the outcomes of laparoscopic surgery for AC. Study design: Retrospective, mono-centric study conducted in a teaching urban hospital. We evaluated all patients admitted to our ED from January 1st, 2015, to December 31st, 2019, underwent laparoscopic cholecystectomy for AC having a preoperative PCT determination in ED. Results: A total of 2285 patients in our ED were admitted for AC. Among them 822 patients were treated surgically, 174 had a PCT determination in ED. Median age was 63 [50–74]. Overall, 33 patients (19.0%) had major complications (MC): 32 needed an open surgery conversion, and 3 among them deceased. Multivariate analysis demonstrated that PCT, WBC, BUN, and CCI were significantly associated to MC in our cohort. When we calculated the area under the ROC curve with regard to MC, a procalcitonin value > 0.09 at admission had sensitivity = 84.8% [68.1–94.9] and specificity = 51.8% [43.2–60.3] for the occurrence of MC. Conclusion: Our results, suggest that a PCT > 0.09 ng/mL at ED admission, could be associated to a poor surgical outcome in patients treated by laparoscopic surgery for AC.

The most common complication of gallstone disease is choledocholithiasis. Among those suffering from choledocholithiasis, the main contingent of patients is made up of elderly and senile people. Endoscopic papillosphincterotomy (EPST) and stone extraction are the surgery of choice in patients with choledocholithiasis. When performing EPST, the greatest difficulties were observed in patients with a point-shaped papilla, with a parapapillary and especially with an intra-diverticular arrangement of the OBD. The analysis of the results showed that in case of choledocholithiasis of elderly and senile age, a full-fledged study and the use of minimally invasive low-traumatic interventions are required as much as possible.

The most common complication of gallstone disease is choledocholithiasis. Among those suffering from choledocholithiasis, the main contingent of patients is made up of elderly and senile people. Endoscopic papillosphincterotomy (EPST) and stone extraction are the surgery of choice in patients with choledocholithiasis. When performing EPST, the greatest difficulties were observed in patients with a point-shaped papilla, with a parapapillary and especially with an intra-diverticular arrangement of the OBD. The analysis of the results showed that in case of choledocholithiasis of elderly and senile age, a full-fledged study and the use of minimally invasive low-traumatic interventions are required as much as possible.

The most common complication of gallstone disease is choledocholithiasis. Among those suffering from choledocholithiasis, the main contingent of patients is made up of elderly and senile people. Endoscopic papillosphincterotomy (EPST) and stone extraction are the surgery of choice in patients with choledocholithiasis. When performing EPST, the greatest difficulties were observed in patients with a point-shaped papilla, with a parapapillary and especially with an intra-diverticular arrangement of the OBD. The analysis of the results showed that in case of choledocholithiasis of elderly and senile age, a full-fledged study and the use of minimally invasive low-traumatic interventions are required as much as possible.

The most common complication of gallstone disease is choledocholithiasis. Among those suffering from choledocholithiasis, the main contingent of patients is made up of elderly and senile people. Endoscopic papillosphincterotomy (EPST) and stone extraction are the surgery of choice in patients with choledocholithiasis. When performing EPST, the greatest difficulties were observed in patients with a point-shaped papilla, with a parapapillary and especially with an intra-diverticular arrangement of the OBD. The analysis of the results showed that in case of choledocholithiasis of elderly and senile age, a full-fledged study and the use of minimally invasive low-traumatic interventions are required as much as possible.

The most common complication of gallstone disease is choledocholithiasis. Among those suffering from choledocholithiasis, the main contingent of patients is made up of elderly and senile people. Endoscopic papillosphincterotomy (EPST) and stone extraction are the surgery of choice in patients with choledocholithiasis. When performing EPST, the greatest difficulties were observed in patients with a point-shaped papilla, with a parapapillary and especially with an intra-diverticular arrangement of the OBD. The analysis of the results showed that in case of choledocholithiasis of elderly and senile age, a full-fledged study and the use of minimally invasive low-traumatic interventions are required as much as possible.