Usefulness of microbiological bile analysis in grade II cholecystitis according to the Tokyo classification

2026-05-26T04:00:12+00:00

Background: The Tokyo Guidelines 2018 for the Management of Cholecystitis (TG18) recommend intraoperative microbiological bile analysis (MBA) in moderate cases (grades II) to identify microorganisms and adjust antibiotic therapy.
Objective: he aim of this study was to describe the results of samples obtained by intraoperative gallbladder aspiration for MBA and its association with comorbidities, PPI use, prior antibiotic therapy, and postoperative complications in patients with grade II cholecystitis.
Material and methods: This observational, prospective and descriptive study included adult patients (> 18 years) diagnosed with grade II acute cholecystitis according to the TG18 managed with laparoscopic cholecystectomy (LC). Patients were assigned to two groups based on a positive or negative MBA. The data analyzed included demographic variables, medical history, and surgical and microbiological characteristics. The chi-square test (χ²) was used to compare categorical variables. A p-value < 0.05 was considered statistically significant.
Results: Of the 272 patients who underwent LC, 51 had grade II acute cholecystitis; 29 (57%) were women, and mean age was 57 years (SD 18). The MBA was positive in 14 (27%) cases. Ten patients had a body mass index (BMI) of 25 or higher, 5 had comorbidities, and 7 used PPIs. None of the patients had received antibiotic therapy prior to hospitalization. E. coli was the most common germ involved (28%). All the germs were susceptible to ceftriaxone. There were no intraoperative adverse events resulting from gallbladder aspiration or postoperative complications.

Soft tissue sarcomas of the extremities and trunk. Surgical and oncological outcomes in patients with local disease

2026-05-26T04:11:08+00:00

Background: Local soft tissue sarcomas (STS) of the extremities and superficial trunk require multimodal treatment to achieve local control rates > 80%.
Objective: The aim of this study was to describe the long-term surgical and oncological outcomes of patients with STS of the extremities and trunk with local disease.
Materials and methods: We conducted a retrospective, descriptive and observational study of patients with STS of the extremities and trunk who underwent surgery between 2008 and 2024. Patients were divided into 3 groups: primary tumors (G!), local recurrences (G2) and margin widening following inadequate resections (G3). The clinical and pathological characteristics, type of resection and reconstruction, complications, and adjunctive treatment therapy were recorded. Local recurrence-free survival (LRFS) and overall survival (OS) were evaluated in each group.
Results: A total of 124 patients were included: 61 (49%) in group 1, 37 (30% in group 2, and 26 (21%) in group 3. Median tumor size was 8.5 cm (IQR 3.25-12). All the tumors were completely resected with limb preservation in 98.8%. Reconstructive procedures were performed in 36 cases (29%), with a higher incidence in groups G2 and G3. Radiation therapy was administered to 22 patients in G1, 6 as neoadjuvant therapy and 16 as adjuvant therapy. In G1, 5-year LRFS, distant metastases and OS were 82.8%, 63.5%, and 79.3%, respectively. In G2 and G3, the rates were 61.6%, 75%, and 85.3%.

Revista Argentina de Cirugía

Usefulness of microbiological bile analysis in grade II cholecystitis according to the Tokyo classification

Soft tissue sarcomas of the extremities and trunk. Surgical and oncological outcomes in patients with local disease