Cholelithiasis: should we be more aggressive in transplant patients?
Giselle Guerra1, Phillipe Abreu1, Juliano Riella1, Lucas Ernani1, Rafael Miyashiro1, Vighnesh Venkatasamy1, Jose Figueiro1, Rodrigo Vianna1.
1Department of Transplantation Surgery, Jackson Memorial Hospital, University of Miami, Miami Transplant Institute, Miami, FL, United States
Introduction: Symptomatic cholelithiasis is usually a relative indication for cholecystectomy. When acute cholecystitis with potential liver abscess develops in a post-kidney transplant (KT) patient the consequences can be catastrophic, with high risk of graft loss. We report here a case series of 16 patients submitted to robotic-assisted cholecystectomies post-KT due to findings of gallstones or concerning polyps.
Methods: Prospectively collected data of patients submitted to robotic-assisted cholecystectomies at the Jackson Memorial Hospital, University of Miami, Miami Transplant Institute, in the period of Aug-2021 to Mar-2022, during the first phase of implantation of the Transplant Robotic Program. Data relative to the pre-operative, intra-operative and post-operative periods were collected, including clinic-demographic characteristic of the patients, surgical metrics, and pathology findings. Continuous variables were analyzed with Student t-test, categorical variables were analyzed with chi-square test. A p-value of less than 0.05 was considered to be statistically significant.
Results: 16 patients were included, of those 10 (62.5%) were male. The median age was 57 years old (IQR 50-67.8). Of all cases analyzed, 10 (62.5%) were indicated for surgery based on symptomatic cholelithiasis only, without preoperative radiologic signs of chronic or acute cholecystitis. There were 2 (12.5%) of acute cholecystitis, 2 (12.5%) of chronic cholecystitis, and 2 (12.5%) of gallbladder suspicious polyps. Symptoms were vague and non-specific in 8/10 (80%) of the cases. The median intra-operative robotic console time was 30 min (IQR 23-49). 12 patients presented with intra-operative macroscopic acute/chronic cholecystitis. The median length of stay was 0.9 (IQR 0.9-1.1) days. There were no postoperative readmissions or complications associated to the procedure. The pathology impressively revealed chronic or acute cholecystitis in 15 (93.8%) patients, with no cases of malignancy. There was no statistically significant difference between the groups analyzed.
Conclusion: Immunocompromised patients may not present with classic clinical symptoms. Robotic-assisted cholecystectomy is a relatively simple procedure associated with minor risk of complications, and should be considered for more liberal indication in oligosymptomatic patients.
right-click to download