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Asai K, Watanabe M, Kusachi S, Matsukiyo H, Saito T, Ishii T, Kujiraoka M, Katagiri M, Katada N, Saida Y. Evaluating the timing of laparoscopic cholecystectomy for acute cholecystitis in an experienced center based on propensity score matching. Asian J Endosc Surg 2017; 10:166-172. [PMID: 28124824 DOI: 10.1111/ases.12353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This study evaluates the therapeutic outcomes for laparoscopic cholecystectomy for acute cholecystitis based on the time from symptom onset to surgery. METHODS This study enrolled 224 patients. Patients' characteristics and operative outcomes were compared between patient groups based on the timing of laparoscopic cholecystectomy from symptom onset: ≤72 h versus >72 h, and ≤7 days versus ≥8 days. Then, we performed propensity score matching of 13 relevant variables, including patient demographics, examination findings, and therapeutic factors. RESULTS The early surgery groups (≤72 h and ≤7 days) had significantly younger patients with fewer comorbidities and a shorter duration from symptom onset to presentation before performed propensity score matching. These groups also had shorter surgery, postoperative hospital stay, and total length of stay. Other operative outcomes, including blood loss, conversion to open surgery, bile duct injury, and postoperative complications, did not significantly differ among the groups. After propensity score matching, all therapeutic outcomes, including duration of surgery, showed no significant differences in either analysis. CONCLUSIONS In a center with sufficient experience, performing laparoscopic cholecystectomy at the earliest possible time after presentation was a safe therapeutic strategy for each patient with acute cholecystitis, regardless of the time from symptom onset.
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Affiliation(s)
- Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Manabu Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shinya Kusachi
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiroshi Matsukiyo
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tomoaki Saito
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tomotaka Ishii
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Manabu Kujiraoka
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Miwa Katagiri
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Natsuya Katada
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
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Hayama S, Ohtaka K, Shoji Y, Ichimura T, Fujita M, Senmaru N, Hirano S. Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis. JSLS 2017; 20:JSLS.2016.00065. [PMID: 27807397 PMCID: PMC5081400 DOI: 10.4293/jsls.2016.00065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Factors that contribute to difficult laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) that would affect the performance of early surgery remain unclear. The purpose of this study was to identify such risk factors. Methods: One hundred fifty-four patients who underwent LC for AC were retrospectively analyzed. The patients were categorized into early surgery and delayed surgery. Factors predicting difficult LC were analyzed for each group. The operation time, bleeding, and cases of difficult laparoscopic surgery (CDLS)/conversion rate were analyzed as an index of difficulty. Analyses of patients in the early group were especially focused on 3 consecutive histopathological phases: edematous cholecystitis (E), necrotizing cholecystitis (N), suppurative/subacute cholecystitis (S). Results: In the early group, the CDLS/conversion rate was highest in necrotizing cholecystitis. Its rate was significantly higher than that of the other 2 histopathological types (N 27.9% vs E and S 7.4%; P = .037). In the delayed-surgery group, a higher white blood cell (WBC) count and older age showed significant correlations with the CDLS/conversion rate (P = .034 and P = .004). Conclusion: In early surgery, histopathologic necrotizing cholecystitis is a risk factor for difficult LC in AC. A higher WBC count and older age are risk factors for delayed surgery.
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Affiliation(s)
| | | | | | | | - Miri Fujita
- Department of Pathology, Steel Memorial Muroran Hospital, Hokkaido, Japan
| | | | - Satoshi Hirano
- Department of Gastroenterology Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Saito R, Abe T, Hanada K, Minami T, Fujikuni N, Kobayashi T, Amano H, Ohdan H, Noriyuki T, Nakahara M. Impact of comorbidities on the postoperative outcomes of acute cholecystitis following early cholecystectomy. Surg Today 2017; 47:1230-1237. [PMID: 28255633 DOI: 10.1007/s00595-017-1499-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 02/12/2017] [Indexed: 01/10/2023]
Abstract
PURPOSES The purpose of this study was to evaluate the influence of comorbidities on the surgical outcomes of early cholecystectomy for acute cholecystitis. METHODS Data were retrospectively collected for patients with acute cholecystitis who underwent early cholecystectomy. Patients were separated into three groups based on the cholecystitis severity grade, and the surgical outcomes of early cholecystectomy were analyzed. Patients with mild and moderate cholecystitis were subdivided into a comorbidity group (n = 10) and a non-comorbidity group (n = 83). RESULTS There were 57 (55.3%) patients with mild cholecystitis, 36 (35.0%) with moderate cholecystitis, and 10 (9.7%) with severe cholecystitis. The surgical outcomes were significantly worse for patients with severe cholecystitis than for patients with mild or moderate cholecystitis. There were no postoperative deaths after cholecystectomy. There were no significant differences in the complication rate (P = 0.629), conversion rate (P = 0.114), or intraoperative blood loss (P = 0.147) between the comorbidity and non-comorbidity groups. CONCLUSION Our findings suggest that early cholecystectomy can be performed safely for patients with mild and moderate cholecystitis even if comorbidities are present. Early cholecystectomy may be an alternative treatment strategy for patients with severe cholecystitis who are candidates for anesthesia and surgery.
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Affiliation(s)
- Ryusuke Saito
- Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, Japan. .,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Tomoyuki Minami
- Department of Gastroenterology, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Nobuaki Fujikuni
- Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hironobu Amano
- Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshio Noriyuki
- Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, Japan
| | - Masahiro Nakahara
- Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, Japan
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Evidence-based clinical practice guidelines for cholelithiasis 2016. J Gastroenterol 2017; 52:276-300. [PMID: 27942871 DOI: 10.1007/s00535-016-1289-7] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 11/14/2016] [Indexed: 02/08/2023]
Abstract
Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.
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Zarour S, Imam A, Kouniavsky G, Lin G, Zbar A, Mavor E. Percutaneous cholecystostomy in the management of high-risk patients presenting with acute cholecystitis: Timing and outcome at a single institution. Am J Surg 2017; 214:456-461. [PMID: 28237047 DOI: 10.1016/j.amjsurg.2017.01.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/15/2017] [Accepted: 01/29/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cholecystectomy is the standard of care in acute cholecystitis (AC). Percutaneous cholecystostomy (PC) is an effective alternative for high-risk surgical cases. METHODS A retrospective analysis is presented of AC patients treated with PC drainage at a single tertiary institution over a 21 month period, assessing outcome and complications. RESULTS Of 119 patients, 103 had clinical improvement after PC insertion. There were 7 peri-procedural deaths (5.9%), all in elderly high-risk cases. Overall, 56/103 cases (54%) were definitively managed with PC drainage with 41 patients (40%) undergoing an elective cholecystectomy (75% performed laparoscopically). The timing of PC insertion did not affect AC resolution or drain-related complications, although more patients underwent an elective cholecystectomy if PC placement was delayed (>24 h after admission). CONCLUSIONS In AC, drainage by a PC catheter is a safe and effective procedure. It may be used either as a bridge to elective cholecystectomy or in selected cases as definitive therapy.
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Affiliation(s)
- Shiri Zarour
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| | - Ashraf Imam
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| | - Guennadi Kouniavsky
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| | - Guy Lin
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| | - Andrew Zbar
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
| | - Eli Mavor
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel; School of Medicine, Hebrew University, Jerusalem, Israel.
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Macedo FIB, Eid JJ, Mittal VK, Flynn J, Jacobs MJ, Pearlman R. Impact of medical or surgical admission on outcomes of patients with acute cholecystitis. HPB (Oxford) 2017; 19:99-103. [PMID: 27993464 DOI: 10.1016/j.hpb.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 11/03/2016] [Accepted: 11/22/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although acute cholecystitis (AC) is a surgical disease, patients with the condition may be admitted to medical-related services (MS). This may lead to delayed cholecystectomy thereby affecting outcomes and quality of care. METHODS Between July 2010 and March 2013, 329 patients under 70 years old presented to a community-based tertiary care hospital with AC and underwent same admission cholecystectomy. Outcomes were compared between patients admitted to MS and surgical services (SS). RESULTS Two hundred fifteen patients (65.3%) were admitted to a MS. Patients under the MS had longer LOS (3.0 days vs. 2.0 days, p < 0.001), waiting time to surgical consultation (7.3 h vs. 5.0 h, p < 0.001) and to cholecystectomy (1.0, 0-2 days vs. 1.0, 0-1 day, p < 0.001), and increased hospital costs ($3685 vs. $4,688, p < 0.001) compared to the SS. Readmission and mortality rates were not significantly different between groups. CONCLUSION Patients under 70 years old with AC undergoing cholecystectomy admitted to MS had increased LOS, delay to the operation, and hospital costs compared to those admitted to a SS. Admission of patients with AC to a SS needs to be emphasized to reduce costs and improve quality of care.
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Affiliation(s)
- Francisco Igor B Macedo
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA.
| | - Joseph J Eid
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Vijay K Mittal
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Jeffrey Flynn
- Division of Biostatistics, Department of Graduate Medical Education, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Michael J Jacobs
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Ralph Pearlman
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, Southfield, MI, USA
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Takemoto YK, Abe T, Amano H, Hanada K, Fujikuni N, Yoshida M, Kobayashi T, Ohdan H, Noriyuki T, Nakahara M. Propensity score-matching analysis of the efficacy of late cholecystectomy for acute cholecystitis. Am J Surg 2017; 214:262-266. [PMID: 28110913 DOI: 10.1016/j.amjsurg.2017.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/08/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Urgent cholecystectomy within 72 h from symptom onset is recommended. We assessed the feasibility of performing late cholecystectomy (4-7 days from symptom onset) for acute cholecystitis. METHODS One hundred sixty-four patients with grades 1 and 2 cholecystitis, who underwent urgent cholecystectomy within 7 days from symptom onset between June 2011 and June 2015 were enrolled. One hundred thirteen patients underwent operation within 72 h from symptom onset (early operation group), and 51 underwent operation between 4 and 7 days (late operation group). Surgical outcomes and postoperative complications were analyzed using propensity score-matching analysis. RESULTS The rate of conversion, intraoperative bleeding, and complications were comparable between the groups. After a one-to-two propensity score-matched analysis was performed, outcomes of the late operation group were not inferior to those of the early operation group. CONCLUSION Late cholecystectomy was acceptable for treating grades 1 and 2 acute cholecystitis.
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Affiliation(s)
- Yu-Ki Takemoto
- Department of Surgery, Onomichi General Hospital, Hirahara, Onomichi City, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Surgery, Onomichi General Hospital, Hirahara, Onomichi City, Hiroshima, Japan.
| | - Hironobu Amano
- Department of Surgery, Onomichi General Hospital, Hirahara, Onomichi City, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, Hirahara, Onomichi City, Hiroshima, Japan
| | - Nobuaki Fujikuni
- Department of Surgery, Onomichi General Hospital, Hirahara, Onomichi City, Hiroshima, Japan
| | - Makoto Yoshida
- Department of Surgery, Onomichi General Hospital, Hirahara, Onomichi City, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
| | - Toshio Noriyuki
- Department of Surgery, Onomichi General Hospital, Hirahara, Onomichi City, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
| | - Masahiro Nakahara
- Department of Surgery, Onomichi General Hospital, Hirahara, Onomichi City, Hiroshima, Japan
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Blohm M, Österberg J, Sandblom G, Lundell L, Hedberg M, Enochsson L. The Sooner, the Better? The Importance of Optimal Timing of Cholecystectomy in Acute Cholecystitis: Data from the National Swedish Registry for Gallstone Surgery, GallRiks. J Gastrointest Surg 2017; 21:33-40. [PMID: 27649704 PMCID: PMC5187360 DOI: 10.1007/s11605-016-3223-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023]
Abstract
Up-front cholecystectomy is the recommended therapy for acute cholecystitis (AC). However, the scientific basis for the definition of the optimal timing for surgery is scarce. The aim of this study was to analyze how the timing of surgery, after the admission to hospital for AC, affects the intra- and postoperative outcomes. Within the national Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks), all patients undergoing cholecystectomy for acute cholecystitis between January 2006 and December 2014 were identified. Data regarding patient characteristics, intra- and postoperative adverse events (AEs), bile duct injuries, and 30- and 90-day mortality risk were captured, and the correlation between the surgical timing and these parameters was analyzed. In total, data on 87,108 cholecystectomies were analyzed of which 15,760 (18.1 %) were performed due to AC. Bile duct injury, 30- and 90-day mortality risk, and intra- and postoperative AEs were significantly higher if the time from admission to surgery exceeded 4 days. The time course between surgery and complication risks seemed to be optimal if surgery was done within 2 days after hospital admission. Although AC patients operated on the day of hospital admission had a slightly increased AE rate as well as 30- and 90-day mortality rates than those operated during the interval of 1-2 days after admission, the bile duct injury and conversion rates were, in fact, significantly lower. The optimal timing of cholecystectomy for patients with AC seems to be within 2 days after admission. However, the somewhat higher frequency of AE on admission day may emphasize the importance of optimizing the patient before surgery as well as ensuring that adequate surgical resources are available.
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Affiliation(s)
- My Blohm
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ,Department of Surgery, Mora Hospital, 792 85 Mora, Sweden
| | | | - Gabriel Sandblom
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ,Center for Digestive Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Lars Lundell
- Center for Digestive Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Mats Hedberg
- Department of Surgery, Mora Hospital, 792 85 Mora, Sweden
| | - Lars Enochsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ,Center for Digestive Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden
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Comparison of Early and Interval Laparoscopic Cholecystectomy for Treatment of Acute Cholecystitis. Which is Better? A Multicentered Study: Retracted. Surg Laparosc Endosc Percutan Tech 2016; 26:e117-e121. [DOI: 10.1097/sle.0000000000000345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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60
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Terho PM, Leppäniemi AK, Mentula PJ. Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications. World J Emerg Surg 2016; 11:54. [PMID: 27891173 PMCID: PMC5112701 DOI: 10.1186/s13017-016-0111-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/11/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of the study was to identify risk factors for conversion of laparoscopic cholecystectomy and risk factors for postoperative complications in acute calculous cholecystitis. The most common complications arising from cholecystectomy were also to be identified. METHODS A total of 499 consecutive patients, who had undergone emergent cholecystectomy with diagnosis of cholecystitis in Meilahti Hospital in 2013-2014, were identified from the hospital database. Of the identified patients, 400 had acute calculous cholecystitis of which 27 patients with surgery initiated as open cholecystectomy were excluded, resulting in 373 patients for the final analysis. The Clavien-Dindo classification of surgical complications was used. RESULTS Laparoscopic cholecystectomy was initiated in 373 patients of which 84 (22.5%) were converted to open surgery. Multivariate logistic regression identified C-reactive protein (CRP) over 150 mg/l, age over 65 years, diabetes, gangrene of the gallbladder and an abscess as risk factors for conversion. Complications were experienced by 67 (18.0%) patients. Multivariate logistic regression identified age over 65 years, male gender, impaired renal function and conversion as risk factors for complications. CONCLUSIONS Advanced cholecystitis with high CRP, gangrene or an abscess increase the risk of conversion. The risk of postoperative complications is higher after conversion. Early identification and treatment of acute calculous cholecystitis might reduce the number of patients with advanced cholecystitis and thus improve outcomes.
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Affiliation(s)
- Petra Maria Terho
- Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00014 Helsinki, Finland
| | - Ari Kalevi Leppäniemi
- Department of Abdominal Surgery, Helsinki University Central Hospital, P.O.Box 340, 00029 HUS Helsinki, Finland
| | - Panu Juhani Mentula
- Department of Abdominal Surgery, Helsinki University Central Hospital, P.O.Box 340, 00029 HUS Helsinki, Finland
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Sutton AJ, Vohra RS, Hollyman M, Marriott PJ, Buja A, Alderson D, Pasquali S, Griffiths EA. Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology. Br J Surg 2016; 104:98-107. [PMID: 27762448 DOI: 10.1002/bjs.10317] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/29/2016] [Accepted: 08/15/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a 'delayed' operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease. METHODS Using data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost-utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impact of parameter uncertainty on the results obtained from the model. RESULTS Emergency cholecystectomy was found to be less costly (£4570 versus £4720; €5484 versus €5664) and more effective (0·8868 versus 0·8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60 per cent likely to be cost-effective across willingness-to-pay values for the QALY from £0 to £100 000 (€0-120 000). CONCLUSION Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.
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Affiliation(s)
- A J Sutton
- Health Economics Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,National Institute for Health Research Diagnostic Evidence Co-operative Leeds, Leeds, UK
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - M Hollyman
- West Midlands Surgical Research Collaborative, Birmingham, UK
| | - P J Marriott
- West Midlands Surgical Research Collaborative, Birmingham, UK.,Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - A Buja
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua
| | - D Alderson
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - S Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
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Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2016; 2016:4614096. [PMID: 27803512 PMCID: PMC5075635 DOI: 10.1155/2016/4614096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/07/2016] [Accepted: 09/18/2016] [Indexed: 01/30/2023]
Abstract
Objective. To evaluate if early cholecystectomy (EC) is the most appropriate treatment for acute cholecystitis compared to delayed cholecystectomy (DC). Patients and Methods. A retrospective cohort study of 1043 patients was carried out, with a group of 531 EC cases and a group of 512 DC patients. The following parameters were recorded: (1) postoperative hospital morbidity, (2) hospital mortality, (3) days of hospital stay, (4) readmissions, (5) admission to the Intensive Care Unit (ICU), (6) type of surgery, (7) operating time, and (8) reoperations. In addition, we estimated the direct cost savings of implementing an EC program. Results. The overall morbidity of the EC group (29.9%) was significantly lower than the DC group (38.7%). EC demonstrated significantly better results than DC in days of hospital stay (8.9 versus 15.8 days), readmission percentage (6.8% versus 21.9%), and percentage of ICU admission (2.3% versus 7.8%), which can result in reducing the direct costs. The patients who benefited most from an EC were those with a Charlson index > 3. Conclusions. EC is safe in patients with acute cholecystitis and could lead to a reduction in the direct costs of treatment.
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63
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Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103:1704-1715. [PMID: 27561954 DOI: 10.1002/bjs.10287] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/06/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all-cause 30-day readmissions and complications in a prospective population-based cohort. METHODS Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all-cause 30-day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2). RESULTS Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. CONCLUSION Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.
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Zhao L, Wang Z, Xu J, Wei Y, Guan Y, Liu C, Xu L, Liu C, Wu B. A randomized controlled trial comparing single-incision laparoscopic cholecystectomy using a novel instrument to that using a common instrument. Int J Surg 2016; 32:174-8. [DOI: 10.1016/j.ijsu.2016.06.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/14/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
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Economic Implications of Providing Emergency Cholecystectomy for All Patients With Biliary Pathology: A Retrospective Analysis. Surg Laparosc Endosc Percutan Tech 2016; 25:337-42. [PMID: 26121547 DOI: 10.1097/sle.0000000000000169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study assessed the safety and efficacy of acute laparoscopic cholecystectomy (ALC) in patients presenting with biliary pathology. The potential savings plus income generation for the hospital were calculated. METHODS All patients undergoing emergency cholecystectomy were identified from computerized and hand-written theater records to ensure complete capture. Length of stay, procedure time, patient demographics, and postoperative complications were recorded. Tariffs for conservative versus acute management were calculated. Total admissions and readmissions with biliary pathology (acute cholecystitis, biliary colic, gallstone pancreatitis, and obstructive jaundice) over a 12-month period were recorded. RESULTS Eighty-four patients undergoing ALC were identified. There was only 1 major complication (1 postoperative bleed managed laparoscopically). ALC for all admissions would result in savings of £ 695,918 over 12 months. The implementation of ALC for all patients would result in a small loss in revenue when compared with elective laparoscopic cholecystectomy (£ 15,495) provided that all operations could be accommodated on established operating lists. Implementing ALC on all appropriate biliary admissions could generate up to 3 cholecystectomies daily for a population base of 1 million. CONCLUSIONS ALC is cost-effective and safe. It can be offered to all patients with biliary pathology provided they are fit enough for surgery.
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Conversion cholecystectomy in patients with acute cholecystitis—it’s not as black as it’s painted! Langenbecks Arch Surg 2016; 401:479-88. [DOI: 10.1007/s00423-016-1394-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/29/2016] [Indexed: 12/07/2022]
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Jimenez Rodriguez RM, Segura-Sampedro JJ, Flores-Cortés M, López-Bernal F, Martín C, Diaz VP, Ciuro FP, Ruiz JP. Laparoscopic approach in gastrointestinal emergencies. World J Gastroenterol 2016; 22:2701-2710. [PMID: 26973409 PMCID: PMC4777993 DOI: 10.3748/wjg.v22.i9.2701] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/24/2015] [Accepted: 01/11/2016] [Indexed: 02/06/2023] Open
Abstract
This review focuses on the laparoscopic approach to gastrointestinal emergencies and its more recent indications. Laparoscopic surgery has a specific place in elective procedures, but that does not apply in emergency situations. In specific emergencies, there is a huge range of indications and different techniques to apply, and not all of them are equally settle. We consider that the most controversial points in minimally invasive procedures are indications in emergency situations due to technical difficulties. Some pathologies, such as oesophageal emergencies, obstruction due to colon cancer, abdominal hernias or incarcerated postsurgical hernias, are nearly always resolved by conventional surgery, that is, an open approach due to limited intraabdominal cavity space or due to the vulnerability of the bowel. These technical problems have been solved in many diseases, such as for perforated peptic ulcer or acute appendectomy for which a laparoscopic approach has become a well-known and globally supported procedure. On the other hand, endoscopic procedures have acquired further indications, relegating surgical solutions to a second place; this happens in cholangitis or pancreatic abscess drainage. This endoluminal approach avoids the need for laparoscopic development in these diseases. Nevertheless, new instruments and new technologies could extend the laparoscopic approach to a broader array of potentials procedures. There remains, however, a long way to go.
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Cao AM, Eslick GD, Cox MR. Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case-control studies. Surg Endosc 2016; 30:1172-1182. [PMID: 26139487 DOI: 10.1007/s00464-015-4325-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Since the advent of laparoscopic cholecystectomy (LC) there has been continued debate regarding the management of acute cholecystitis with either early or delayed LC. Nearly all studies have demonstrated that early LC has a significantly shorter total length of hospital stay compared with delayed LC. Although previous randomized controlled trials and meta-analysis have shown clinical outcomes to favour early surgery, clinical practice continues to vary significantly worldwide. In addition, there is much confusion in the optimal timing for early LC with definitions of early varying from 72 h to 7 days. There have been numerous case-control studies investigating the timing of LC in acute cholecystitis. The aim of this paper is to pool the results from all case-control studies to investigate outcomes including mortality rates, complication rates, length of hospital stay and conversion rates to open procedures. METHODS A search of electronic databases was performed for case-control studies published between 1985-February 2015. RESULTS Results from 77 case-control studies showed statistically significant reductions in mortality, complications, bile duct leaks, bile duct injuries, wound infections, conversion rates, length of hospital stay and blood loss associated with early LC. Although LC within the 72-h window is optimal, patients operated after this window still benefit from early surgery compared to delayed surgery. The duration of symptoms in acute cholecystitis should not influence the surgeons' willingness to operate acutely. CONCLUSIONS Early LC is clearly superior to delayed LC in acute cholecystitis. The most recent evidence-based practice strongly suggests that early LC should be standard of care in the management of acute cholecystitis.
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Affiliation(s)
- Amy M Cao
- The Whiteley-Martin Research Centre, Discipline of Surgery, Nepean Hospital, The University of Sydney, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, Nepean Hospital, The University of Sydney, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia.
| | - Michael R Cox
- The Whiteley-Martin Research Centre, Discipline of Surgery, Nepean Hospital, The University of Sydney, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia.
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Cao AM, Eslick GD, Cox MR. Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case-control studies. Surg Endosc 2016; 30:1172-1182. [PMID: 26139487 DOI: 10.1007/s00464-015-4471-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Since the advent of laparoscopic cholecystectomy (LC) there has been continued debate regarding the management of acute cholecystitis with either early or delayed LC. Nearly all studies have demonstrated that early LC has a significantly shorter total length of hospital stay compared with delayed LC. Although previous randomized controlled trials and meta-analysis have shown clinical outcomes to favour early surgery, clinical practice continues to vary significantly worldwide. In addition, there is much confusion in the optimal timing for early LC with definitions of early varying from 72 h to 7 days. There have been numerous case-control studies investigating the timing of LC in acute cholecystitis. The aim of this paper is to pool the results from all case-control studies to investigate outcomes including mortality rates, complication rates, length of hospital stay and conversion rates to open procedures. METHODS A search of electronic databases was performed for case-control studies published between 1985-February 2015. RESULTS Results from 77 case-control studies showed statistically significant reductions in mortality, complications, bile duct leaks, bile duct injuries, wound infections, conversion rates, length of hospital stay and blood loss associated with early LC. Although LC within the 72-h window is optimal, patients operated after this window still benefit from early surgery compared to delayed surgery. The duration of symptoms in acute cholecystitis should not influence the surgeons' willingness to operate acutely. CONCLUSIONS Early LC is clearly superior to delayed LC in acute cholecystitis. The most recent evidence-based practice strongly suggests that early LC should be standard of care in the management of acute cholecystitis.
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Affiliation(s)
- Amy M Cao
- The Whiteley-Martin Research Centre, Discipline of Surgery, Nepean Hospital, The University of Sydney, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, Nepean Hospital, The University of Sydney, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia.
| | - Michael R Cox
- The Whiteley-Martin Research Centre, Discipline of Surgery, Nepean Hospital, The University of Sydney, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia.
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Chuang SH, Lin CS. Single-incision laparoscopic surgery for biliary tract disease. World J Gastroenterol 2016; 22:736-747. [PMID: 26811621 PMCID: PMC4716073 DOI: 10.3748/wjg.v22.i2.736] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/19/2015] [Accepted: 10/17/2015] [Indexed: 02/06/2023] Open
Abstract
Single-incision laparoscopic surgery (SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy (SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials (RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration (CBDE) methods have been used for more than one hundred years, laparoscopic CBDE (LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and single-incision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques.
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Reply to: "Early Cholecystectomy for Acute Cholecystitis, How Early Should It Be?". Ann Surg 2015; 263:e59. [PMID: 26692075 DOI: 10.1097/sla.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Ambe PC, Weber SA, Christ H, Wassenberg D. Primary cholecystectomy is feasible in elderly patients with acute cholecystitis. Aging Clin Exp Res 2015; 27:921-6. [PMID: 25905472 DOI: 10.1007/s40520-015-0361-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 04/01/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND While early cholecystectomy is generally accepted as the standard procedure for young and fit patients with acute cholecystitis, controversy exits on the management of elderly and severely sick patients. We postulated that primary cholecystectomy is feasible in this subgroup. The aim of this study was to compare the outcomes of young and fit patients to those of elderly patients undergoing surgery for acute cholecystitis. METHODS The outcomes of elderly patients (≥70 years) undergoing surgery for acute cholecystitis in a primary care center in Germany were retrospectively compared to those of younger patients (<70 years). RESULTS 152 patients, 74 aged ≥ 70 years (study group) and 78 < 70 years (control) were included for analysis. The study group was significantly older at the time of surgery (78 vs. 68 years, p = 0.02). Severe cholecystitis was seen in a significant number of cases in the study group, p = 0.01. Equally, the mean WBC (19.5 vs. 17, p = 0.02), CRP (26 vs. 22, p = 0.04) and APACHE II score (17 vs. 8, p = 0.01) were significantly higher in the study group. There was no significant difference in the duration of anesthesia (123 vs. 133 min, p = 0.70) and surgery (72 vs. 81 min, p = 0.90) amongst both groups. There was no significant difference in rate of complication amongst both groups (24 vs. 14%, p = 0.11). Two cases of mortality were recorded (1.3%) in the study group. CONCLUSION The age of the patient cannot be the sole factor in deciding whether or not a patient with acute cholecystitis is fit for surgery.
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Polo M, Duclos A, Polazzi S, Payet C, Lifante JC, Cotte E, Barth X, Glehen O, Passot G. Acute Cholecystitis-Optimal Timing for Early Cholecystectomy: a French Nationwide Study. J Gastrointest Surg 2015; 19:2003-10. [PMID: 26264362 DOI: 10.1007/s11605-015-2909-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/02/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The recommended treatment for acute calculous cholecystitis combines antibiotics and cholecystectomy. To reduce morbidity and mortality, guidelines recommend early cholecystectomy. However, the optimal timing for surgery on first admission remains controversial. This study aims to determine the best timing for cholecystectomy in patients presenting with acute calculous cholecystitis. STUDY DESIGN The French national health-care database was analyzed to identify all patients undergoing cholecystectomy for acute cholecystitis during the same hospital stay between January 2010 and December 2013. Data regarding patients, procedures, and hospitals characteristics were collected. The relationship between surgery's timing and clinical outcome was evaluated by multiple logistic regressions. RESULTS Overall, 42,452 patients from 507 hospitals were included in the study. Postoperative complications requiring invasive treatment occurred in 961 patients (2.3 %), and the mortality rate was 1.1 %. Adverse postoperative outcomes-intensive care admission, reoperation, and postoperative sepsis-were significantly lower when surgery was performed between days 1 and 3 (3-3.3, 0.5-0.6, and 3.8-4.1 %, respectively) when compared to surgery performed on the day of admission (5.6, 1.2, and 5.2 %, p < 0.001) or from day 5 onward (4.5, 1, and 6.5 %, respectively; p < 0.001). Mortality was also significantly lower in patients undergoing cholecystectomy between days 1 and 3 after admission (0.8-1 %) when compared to patients operated on the day of admission or after day 3 (1.4 % on day 0, 1.2 % on day 4, and 1.9 % from day 5: all p < 0.001). CONCLUSION For patients with acute calculous cholecystitis, all efforts should be made to perform cholecystectomy within 3 days after hospital admission in order to decrease morbidity and mortality.
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Affiliation(s)
- Maxime Polo
- Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France
| | - Antoine Duclos
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
- EMR 3738 Université Lyon 1, F-69364, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital-Harvard Medical School, Boston, MA, USA
| | - Stéphanie Polazzi
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
| | - Cécile Payet
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
| | - Jean Christophe Lifante
- Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
- EMR 3738 Université Lyon 1, F-69364, Lyon, France
| | - Eddy Cotte
- Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
- EMR 3738 Université Lyon 1, F-69364, Lyon, France
| | - Xavier Barth
- Department of General Surgery, Hospices Civils de Lyon, Hop Ed. Herriot, 69003, Lyon, France
| | - Olivier Glehen
- Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France
- EMR 3738 Université Lyon 1, F-69364, Lyon, France
| | - Guillaume Passot
- Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France.
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France.
- EMR 3738 Université Lyon 1, F-69364, Lyon, France.
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Abstract
Laparoscopic surgery has emerged over the past two decades as the surgical approach of choice in the treatment of many digestive disorders. Laparoscopy has its place in the management of abdominal surgical emergencies since it provides the same benefits: less postoperative pain and shorter length of hospital stay when compared to laparotomy. However, its role in the management of abdominal emergencies has not yet been fully clarified. In this review, we focus on what has been validated concerning the role of emergency laparoscopy in the management of abdominal diseases.
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Affiliation(s)
- R M Lupinacci
- Service de chirurgie générale, viscérale et endocrinienne, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Menegaux
- Service de chirurgie générale, viscérale et endocrinienne, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France; Université Pierre-et-Marie-Curie - Paris VI, 105, boulevard de l'Hôpital, 75013 Paris, France
| | - C Trésallet
- Service de chirurgie générale, viscérale et endocrinienne, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France; Université Pierre-et-Marie-Curie - Paris VI, 105, boulevard de l'Hôpital, 75013 Paris, France.
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Paul Wright G, Stilwell K, Johnson J, Hefty MT, Chung MH. Predicting length of stay and conversion to open cholecystectomy for acute cholecystitis using the 2013 Tokyo Guidelines in a US population. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:795-801. [DOI: 10.1002/jhbp.284] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/14/2015] [Indexed: 12/11/2022]
Affiliation(s)
- G. Paul Wright
- General Surgery Residency Program; Grand Rapids Medical Education Partners; Grand Rapids MI USA
- Department of Surgery; Michigan State University College of Human Medicine; Grand Rapids MI USA
- Division of Surgical Oncology; University of Pittsburgh Medical Center; 5150 Centre Avenue, Suite 414 Pittsburgh PA 15232 USA
| | - Kellen Stilwell
- Department of Surgery; Michigan State University College of Human Medicine; Grand Rapids MI USA
| | - Jared Johnson
- Department of Surgery; Michigan State University College of Human Medicine; Grand Rapids MI USA
| | - Matthew T. Hefty
- General Surgery Residency Program; Grand Rapids Medical Education Partners; Grand Rapids MI USA
- Department of Surgery; Michigan State University College of Human Medicine; Grand Rapids MI USA
| | - Mathew H. Chung
- General Surgery Residency Program; Grand Rapids Medical Education Partners; Grand Rapids MI USA
- Department of Surgery; Michigan State University College of Human Medicine; Grand Rapids MI USA
- Division of Surgical Specialties; Spectrum Health Medical Group; Grand Rapids MI USA
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Wu XD, Tian X, Liu MM, Wu L, Zhao S, Zhao L. Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2015; 102:1302-13. [PMID: 26265548 DOI: 10.1002/bjs.9886] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/14/2015] [Accepted: 05/27/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Previous studies comparing early laparoscopic cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were incomplete. A meta-analysis was undertaken to compare the cost-effectiveness, quality of life, safety and effectiveness of ELC versus DLC. METHODS PubMed, Embase, the Cochrane Library and Web of Science were searched for randomized clinical trials (RCTs) that compared ELC (performed within 7 days of symptom onset) with DLC (undertaken at least 1 week after symptoms had subsided) for acute cholecystitis. RESULTS Sixteen studies reporting on 15 RCTs comprising 1625 patients were included. Compared with DLC, ELC was associated with lower hospital costs, fewer work days lost (mean difference (MD) -11·07 (95 per cent c.i. -16·21 to -5·94) days; P < 0·001), higher patient satisfaction and quality of life, lower risk of wound infection (relative risk 0·65, 95 per cent c.i. 0·47 to 0·91; P = 0·01) and shorter hospital stay (MD -3·38 (-4·23 to -2·52) days; P < 0·001), but a longer duration of operation (MD 11·12 (4·57 to 17·67) min; P < 0·001). There were no significant differences between the two groups in mortality, bile duct injury, bile leakage, conversion to open cholecystectomy or overall complications. CONCLUSION For patients with acute cholecystitis, ELC appears as safe and effective as DLC. ELC might be associated with lower hospital costs, fewer work days lost, and greater patient satisfaction.
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Affiliation(s)
- X-D Wu
- First College of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - X Tian
- Graduate College of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - M-M Liu
- Department of Clinical Medicine, Shandong University, Jinan, China
| | - L Wu
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota, USA
| | - S Zhao
- Graduate College of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - L Zhao
- Department of Graduate School, Guangxi Medical University, Nanning, China
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Chuang SH, Yang WJ, Chang CM, Lin CS, Yeh MC. Is routine single-incision laparoscopic cholecystectomy feasible? A retrospective observational study. Am J Surg 2015; 210:315-321. [PMID: 25916613 DOI: 10.1016/j.amjsurg.2014.12.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/15/2014] [Accepted: 12/22/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Single-incision laparoscopic cholecystectomy (SILC) has been shown to be safe for uncomplicated gallbladder diseases. Routinely applying SILC is debatable. METHODS Two hundred SILCs were performed with single-incision multiple-port longitudinal-array and self-camera techniques. RESULTS Eighty-eight (44%) procedures were scheduled for complicated diseases. The routine group had a higher comorbidity rate, a lower preoperative endoscopic retrograde cholangiopancreatography rate, a higher intraoperative cholangiography rate, a higher proportion of complicated gallbladder diseases, shorter operative time, more intraoperative blood loss, and lower postoperative pethidine dose than the selective group (the first 73 patients). The conversion and complication rates showed no statistical difference. It took fewer cases but longer time to pass the learning phase of SILC for complicated gallbladder diseases. The multivariate analysis showed that male sex and complicated gallbladder diseases were associated with a higher procedure conversion rate, and increased patient age was related to a higher complication rate. CONCLUSIONS Routine SILC for benign gallbladder diseases is feasible in the experienced phase. Practicing SILC for uncomplicated gallbladder diseases helps to achieve competence in this technique for complicated diseases.
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Affiliation(s)
- Shu-Hung Chuang
- Department of Surgery, Mackay Memorial Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsin-Chu, Taiwan
| | - Wen-Jui Yang
- Department of Biological Science and Technology, National Chiao Tung University, Hsin-Chu, Taiwan
| | - Chih-Ming Chang
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Nursing, Mackay Memorial Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chih-Sheng Lin
- Department of Biological Science and Technology, National Chiao Tung University, Hsin-Chu, Taiwan
| | - Meng-Ching Yeh
- Department of Surgery, Mackay Memorial Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
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Could the Tokyo guidelines on the management of acute cholecystitis be adopted in developing countries? Experience of one center. Surg Today 2015; 46:557-60. [DOI: 10.1007/s00595-015-1207-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/19/2015] [Indexed: 01/01/2023]
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Abstract
Background The treatment of acute cholecystitis has been controversially discussed in the literature as there are no high-evidence-level data yet for determining the optimal point in time for surgical intervention. So far, the laparoscopic removal of the gallbladder within 72 h has been the most preferred approach in acute cholecystitis. Methods We conducted a systematic review by including randomized trials of early laparoscopic cholecystectomy for acute cholecystitis. Results Based on a few prospective studies and two meta-analyses, there was consent to prefer an early laparoscopic cholecystectomy for patients suffering from acute calculous cholecystitis while the term ‘early’ has not been consistently defined yet. So far, there is new level 1b evidence brought forth by the so-called ‘ACDC’ study which has convincingly shown in a prospective randomized setting that immediate laparoscopic cholecystectomy – within a time frame of 24 h after hospital admission – is the smartest approach in ASA I-III patients suffering from acute calculous cholecystitis compared to a more conservative approach with a delayed laparoscopic cholecystectomy after an initial antibiotic treatment in terms of morbidity, length of hospital stay, and overall treatment costs. Concerning critically ill patients suffering from acute calculous or acalculous cholecystitis, there is no consensus in treatment due to missing data in the literature. Conclusion Laparoscopic cholecystectomy for acute cholecystitis within 24 h after hospital admission is a safe procedure and should be the preferred treatment for ASA I-III patients. In critically ill patients, the intervention should be determined by a narrow interdisciplinary consent based on the patient's individual comorbidities.
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Affiliation(s)
- Jochen Schuld
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
| | - Matthias Glanemann
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Homburg/Saar, Germany
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81
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Early versus delayed same-admission laparoscopic cholecystectomy for acute cholecystitis in elderly patients with comorbidities. J Trauma Acute Care Surg 2015; 78:801-7. [PMID: 25742252 DOI: 10.1097/ta.0000000000000577] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The optimal timing of same-admission laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) in elderly patients, especially those with significant comorbidities, is not clear. METHODS This is a National Surgical Quality Improvement Program study, which included patients older than 65 years undergoing LC for AC. Patients with choledocholithiasis were excluded. Patients were divided into two subgroups as follows: no significant comorbidities (American Society of Anesthesiologists [ASA] score ≤ 2) and significant comorbidities (ASA score > 2). Patients undergoing LC within 24 hours of admission (early LC) were compared with patients undergoing LC later than 24 hours after admission (delayed LC), using univariable and multivariable regression analyses. RESULTS A total of 4,011 patients were included in the study. Early LC was performed in 38.0% and delayed LC in 62.0% of the patients. Regression analysis identified early LC as an independent predictor for shorter anesthesia time and postoperative length of stay, overall and in the subgroup with an ASA score greater than 2. CONCLUSION Early, within 24 hours of admission, LC for AC in patients older than 65 years with significant comorbidities is associated with shorter postoperative stay and no increase in postoperative complications or conversion to open cholecystectomy. LEVEL OF EVIDENCE Therapeutic study, level IV.
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Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, Leandro G, Montori G, Ceresoli M, Corbella D, Sartelli M, Sugrue M, Ansaloni L. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg 2015; 18:196-204. [PMID: 25958296 DOI: 10.1016/j.ijsu.2015.04.083] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/19/2015] [Accepted: 04/29/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no definitive data on its use in AC has been published. CIAO and CIAOW studies demonstrated 48.7% of AC were still operated with the open technique. The aim of the present meta-analysis is to compare OC and LC in AC. MATERIAL AND METHODS A systematic-review with meta-analysis and meta-regression of trials comparing open vs. laparoscopic cholecystectomy in patients with AC was performed. Electronic searches were performed using Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR) and CINAHL. RESULTS Ten trials have been included with a total of 1248 patients: 677 in the LC and 697 into the OC groups. The post-operative morbidity rate was half with LC (OR = 0.46). The post-operative wound infection and pneumonia rates were reduced by LC (OR 0.54 and 0.51 respectively). The post-operative mortality rate was reduced by LC (OR = 0.2). The mean postoperative hospital stay was significantly shortened in the LC group (MD = -4.74 days). There were no significant differences in the bile leakage rate, intraoperative blood loss and operative times. CONCLUSIONS In acute cholecystitis, post-operative morbidity, mortality and hospital stay were reduced by laparoscopic cholecystectomy. Moreover pneumonia and wound infection rate were reduced by LC. Severe hemorrhage and bile leakage rates were not influenced by the technique. Cholecystectomy in acute cholecystitis should be attempted laparoscopically first.
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Affiliation(s)
- Federico Coccolini
- General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy.
| | - Fausto Catena
- Surgical Clinic, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Michele Pisano
- General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Federico Gheza
- Emergency Surgery Dept., Ospedale Maggiore, Viale Gramsci 14, 43126 Parma, Italy
| | - Stefano Fagiuoli
- Gastroenterology I Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | | | - Gioacchino Leandro
- Gastroenterology I Dept., IRCCS De Bellis Hospital, Castellana Grotte, 70013, Italy
| | - Giulia Montori
- General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Marco Ceresoli
- General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Davide Corbella
- General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | | | - Michael Sugrue
- Letterkenny Hospital and the Donegal Clinical Research Academy, Donegal, Ireland; University College Hospital, Galway, Ireland
| | - Luca Ansaloni
- General Surgery Dept., Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
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83
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Koti RS, Davidson CJ, Davidson BR. Surgical management of acute cholecystitis. Langenbecks Arch Surg 2015; 400:403-19. [PMID: 25971374 DOI: 10.1007/s00423-015-1306-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 05/04/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acute cholecystitis occurs in approximately 1% of patients with known gallstones. It presents as a surgical emergency and usually requires hospitalisation for treatment. It is associated with significant morbidity and mortality, particularly in the elderly. Cholecystectomy is advocated for acute cholecystitis; however, the timing of cholecystectomy and the value of the additional treatments have been a matter of debate. This review examines the available evidence regarding the optimal surgical management of patients with acute cholecystitis. METHODS A literature search was performed on the MEDLINE, EMBASE and WHO International Clinical Trials Registry Platform, databases for English language publications. The MeSH headings 'cholecystitis', 'acute', 'gallbladder', 'inflammation', 'surgery', 'cholecystectomy', 'laparoscopic', 'robotic', 'telerobotic' and 'computer-assisted' were used. RESULTS Data from eight randomised controlled trails and three population-based analyses show that early cholecystectomy for acute cholecystitis performed on the index admission is safe and not associated with increased conversion rates or morbidity in comparison to conservative treatment followed by elective cholecystectomy. Delaying cholecystectomy increases readmissions for gallstone-related events, complications, hospital stay and mortality in the elderly. Early cholecystectomy is also more cost-effective. Randomised trials addressing antibiotic use in acute cholecystitis suggest that antibiotics should be stopped on the day of cholecystectomy. Insufficient trials have been performed to address the optimal analgesia regime post cholecystectomy. Similarly, a lack of trials on intraoperative cholangiography and management of common bile duct stones in patients with acute cholecystitis means that treatment of concomitant bile duct stones should be based on institutional expertise and resource availability. As regards acute cholecystitis in elderly and high-risk patients, case series and retrospective studies would suggest that cholecystectomy is more effective and of lower mortality than percutaneous cholecystostomy. There is not enough evidence to support the routine use of robotic surgery, single-incision laparoscopic cholecystectomy or natural orifice transluminal endoscopic surgery (NOTES) in the treatment of acute cholecystitis. CONCLUSIONS Trial evidence would favour a policy of early laparoscopic cholecystectomy following admission with acute cholecystitis. The optimal approach to support early cholecystectomy is suggested but requires evidence from further randomised trials.
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Affiliation(s)
- Rahul S Koti
- University Department of Surgery, Royal Free Hospital and UCL Medical School, Pond Street, London, NW3 2QG, UK
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84
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Sato N, Kohi S, Tamura T, Minagawa N, Shibao K, Higure A. Single-incision laparoscopic cholecystectomy for acute cholecystitis: A retrospective cohort study of 52 consecutive patients. Int J Surg 2015; 17:48-53. [PMID: 25813307 DOI: 10.1016/j.ijsu.2015.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/21/2015] [Accepted: 03/04/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Single-incision laparoscopic cholecystectomy (SILC) has become increasingly popular but its role in acute cholecystitis remains controversial. METHODS We compared the clinical features and outcomes of SILC procedures between 52 patients with acute cholecystitis (the AC group) and 308 patients without acute cholecystitis (the NAC group). We also analyzed clinical variables to identify factors affecting difficulties associated with SILC for acute cholecystitis. RESULTS The patients in the AC group were significantly older than those in the NAC group (72 vs. 61 years, median, P = 0.0005). The preoperative levels of white blood cell counts were significantly higher in the AC group than in the NAC group (6600 vs. 5500/μL, P = 0.0004). The operative time was significantly longer in the AC group than in the NAC group (188 vs. 135 min, P < 0.0001). The volume of intraoperative blood loss was significantly larger in the AC group than in the NAC group (20 vs. 5 mL, P < 0.001). Furthermore, additional trocar insertion was required in 12% in the NAC group, whereas it was required in 60% in the AC group (P < 0.0001). Regarding the difficulties of SILC for acute cholecystitis, delayed operation (after 72 h from the onset) was significantly associated with a prolonged operative time, while a higher grade of acute cholecystitis (grade II or III) was significantly associated with an increased blood loss during surgery. CONCLUSIONS These findings suggest that when compared to SILC for gallbladder diseases without acute inflammation, SILC for acute cholecystitis was associated with a longer operative time, increased blood loss, higher rate of additional trocar requirement, higher rate of postoperative complications, and longer hospital stay. The difficulties associated with SILC for acute cholecystitis were affected by the timing of surgery and the grade of inflammation.
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Affiliation(s)
- Norihiro Sato
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan.
| | - Shiro Kohi
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Toshihisa Tamura
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Noritaka Minagawa
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Kazunori Shibao
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Aiichiro Higure
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
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85
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Törnqvist B, Strömberg C, Akre O, Enochsson L, Nilsson M. Selective intraoperative cholangiography and risk of bile duct injury during cholecystectomy. Br J Surg 2015; 102:952-8. [DOI: 10.1002/bjs.9832] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 02/16/2015] [Accepted: 03/17/2015] [Indexed: 01/11/2023]
Abstract
Abstract
Background
Whether intraoperative cholangiography can prevent iatrogenic bile duct injury during cholecystectomy remains controversial.
Methods
Data from the national Swedish Registry for Gallstone Surgery, GallRiks (May 2005 to December 2010), were analysed for evidence of iatrogenic bile duct injury during cholecystectomy. Patient- and procedure-related risk factors for bile duct injury with a focus on the rate of intended intraoperative cholangiography were analysed using multivariable logistic regression.
Results
A total of 51 041 cholecystectomies and 747 bile duct injuries (1·5 per cent) were identified; 9008 patients (17·6 per cent) were diagnosed with acute cholecystitis. No preventive effect of intraoperative cholangiography was seen in uncomplicated gallstone disease (odds ratio (OR) 0·97, 95 per cent c.i. 0·74 to 1·25). Operating in the presence (OR 1·23, 1·03 to 1·47) or a history (OR 1·34, 1·10 to 1·64) of acute cholecystitis, and open surgery (OR 1·56, 1·26 to 1·94), were identified as significant risk factors for bile duct injury. The intention to perform intraoperative cholangiography was associated with a reduced risk of bile duct injury in patients with concurrent (OR 0·44, 0·30 to 0·63) or a history of (OR 0·59, 0·35 to 1·00) acute cholecystitis.
Conclusion
Any proposed protective effect of intraoperative cholangiography was restricted to patients with (or a history of) acute cholecystitis.
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Affiliation(s)
- B Törnqvist
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Solna, Karolinska Institutet, Stockholm, Sweden
| | - C Strömberg
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Solna, Karolinska Institutet, Stockholm, Sweden
| | - O Akre
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - L Enochsson
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Solna, Karolinska Institutet, Stockholm, Sweden
| | - M Nilsson
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Solna, Karolinska Institutet, Stockholm, Sweden
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Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G, Barlera S, Davoli M. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbecks Arch Surg 2015; 400:429-53. [PMID: 25850631 DOI: 10.1007/s00423-015-1300-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/24/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the gold standard technique for gallbladder diseases in both acute and elective surgery. Nevertheless, reports from national surveys still seem to represent some doubts regarding its diffusion. There is neither a wide consensus on its indications nor on its possible related morbidity. On the other hand, more than 25 years have passed since the introduction of LC, and we have all witnessed the exponential growth of knowledge, skill and technology that has followed it. In 1995, the EAES published its consensus statement on laparoscopic cholecystectomy in which seven main questions were answered, according to the available evidence. During the following 20 years, there have been several additional guidelines on LC, mainly focused on some particular aspect, such as emergency or concomitant biliary tract surgery. METHODS In 2012, several Italian surgical societies decided to revisit the clinical recommendations for the role of laparoscopy in the treatment of gallbladder diseases in adults, to update and supplement the existing guidelines with recommendations that reflect what is known and what constitutes good practice concerning LC.
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Affiliation(s)
- Ferdinando Agresta
- Department of Surgery, Presidio Ospedaliero di Adria (RO), Adria, RO, Italy,
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87
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Viste A, Jensen D, Angelsen JH, Hoem D. Percutaneous cholecystostomy in acute cholecystitis; a retrospective analysis of a large series of 104 patients. BMC Surg 2015; 15:17. [PMID: 25872885 PMCID: PMC4357156 DOI: 10.1186/s12893-015-0002-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/05/2015] [Indexed: 01/07/2023] Open
Abstract
Background The purpose of this study was to evaluate the clinical course and possible benefit of a percutaneous cholecystostomy in patients with acute cholecystitis. Methods Retrospective study of 104 patients with severe cholecystitis or cholecystitis not responding to antibiotic therapy treated with percutaneous drainage of the gall bladder (PC) during the period 2007 – 2013. Primary outcome was relief of cholecystitis, complications following the procedure and need for later cholecystectomy. Results There were 57 men and 47 women with a median age of 73,5 years (range 22 – 96). 43% of the patients were ASA III or IV and 91% had cholecystitis Grade 2 or 3. About 60% of the patients had severe comorbidity (cardiovascular disease or active cancer). Drain insertion was successful in all but one patient and complications were mild, apart from two patients that needed percutaneous drainage of intraabdominal fluid collection due to bile leakage. The drain was left in place for 1 – 75 days (median 6,5). When evaluated clinically and by blood tests (CRP and white blood cell counts) we found resolution of symptoms in 101 patients (97,2%), whereas 2 patients had no obvious effect of drainage. Four patients died within 30 days, no deaths were related to the drainage procedure. Follow-up after drainage was median 12 months (range 0 – 78). During that time cholecystectomy was performed in 30 patients and 24 patients had died. Following cholecystectomy, two had died, both from cancer and more than one year after the operation. Conclusion Patients with acute cholecystitis were promptly relieved from their symptoms following PC. There were only minor complications following the procedure and only about 30% of the patients had a later cholecystectomy.
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Affiliation(s)
- Asgaut Viste
- Department of Acute and Gastrointestinal surgery, Haukeland University Hospital, N-5021, Bergen, Norway. .,Department of Clinical Medicine K1, University of Bergen, Bergen, Norway.
| | - Dag Jensen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Jon Helge Angelsen
- Department of Acute and Gastrointestinal surgery, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Dag Hoem
- Department of Acute and Gastrointestinal surgery, Haukeland University Hospital, N-5021, Bergen, Norway
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88
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Kaneko T, Kuwahara T, Harada T, Kawaoka T, Hiraki S, Fukuda S. Predictors of prolonged laparoscopic cholecystectomy in the treatment of low-grade acute cholecystitis: a single-center, retrospective, observational study. Acute Med Surg 2015; 2:190-194. [PMID: 29123719 DOI: 10.1002/ams2.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/19/2014] [Indexed: 12/07/2022] Open
Abstract
Aim Laparoscopic cholecystectomy is frequently used to treat low-grade acute cholecystitis. Improvements in technical skills have reduced the rate of conversion from laparoscopic to open surgery. In this study, we sought to identify factors that might predict the surgical time of laparoscopic cholecystectomy as possible markers for surgical difficulty. Methods We carried out a single-center retrospective analysis of a Japanese medical insurance database. Data were retrieved for 87 patients with acute cholecystitis. The analyzed factors included age, sex, body mass index, medical history, blood laboratory data, computed tomography findings, and time from disease onset to surgery. Multiple regression analysis was used to identify factors associated with surgical time. Results Edema of the gallbladder wall on computed tomography, neutrophil sequestration, body mass index, and history of acute cholangitis were significantly associated with surgical time (P = 0.014, 0.027, 0.043, and 0.047, respectively). The conversion rate from laparoscopic surgery to open surgery was 2%. Conclusions Our results suggest that edema of the gallbladder wall on computed tomography, neutrophil sequestration, body mass index, and history of acute cholangitis are associated with surgical time of laparoscopic cholecystectomy in the treatment of acute cholecystitis in our hospital.
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Affiliation(s)
- Tadashi Kaneko
- Department of Surgery Ube Industries Ltd. Central Hospital Ube Yamaguchi Japan
| | - Taichi Kuwahara
- Department of Surgery Ube Industries Ltd. Central Hospital Ube Yamaguchi Japan
| | - Toshio Harada
- Department of Surgery Ube Industries Ltd. Central Hospital Ube Yamaguchi Japan
| | - Toru Kawaoka
- Department of Surgery Ube Industries Ltd. Central Hospital Ube Yamaguchi Japan
| | - Sakurao Hiraki
- Department of Surgery Ube Industries Ltd. Central Hospital Ube Yamaguchi Japan
| | - Shintaro Fukuda
- Department of Surgery Ube Industries Ltd. Central Hospital Ube Yamaguchi Japan
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Peitzman AB, Watson GA, Marsh JW. Acute cholecystitis: When to operate and how to do it safely. J Trauma Acute Care Surg 2015; 78:1-12. [PMID: 25539197 DOI: 10.1097/ta.0000000000000476] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Andrew B Peitzman
- From the Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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90
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Bingener J, Thomsen KM, McConico A, Hess EP, Habermann EB. Success of elective cholecystectomy treatment plans after emergency department visit. J Surg Res 2015; 193:95-101. [PMID: 25043530 PMCID: PMC4268393 DOI: 10.1016/j.jss.2014.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/12/2014] [Accepted: 06/11/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Differentiation between patients with acute cholecystitis and patients with severe biliary colic can be challenging. Patients with undiagnosed acute cholecystitis can incur repeat emergency department (ED) visits, which is resource intensive. METHODS Billing records from 2000-2013 of all adults who visited the ED in the 30 d preceding their cholecystectomy were analyzed. Patients who were discharged from the ED and underwent elective cholecystectomy were compared with those who were discharged and returned to the ED within 30 d. T-tests, chi-square tests, and multivariable analysis were used as appropriate. RESULTS From 2000-2013, 3138 patients (34%) presented to the ED within 30 d before surgery, 63% were women, mean age 51 y, and of those 1625 were directly admitted from the ED for cholecystectomy, whereas 1513 patients left the ED to return for an elective cholecystectomy. Patients who were discharged were younger (mean age 49 versus 54 y, P < 0.001) and had shorter ED stays (5.9 versus 7.2 h, P < 0.001) than the patients admitted immediately. Of the discharged patients, 303 (20%) returned to the ED within 30 d to undergo urgent cholecystectomy. Compared with patients with successful elective cholecystectomy after the ED visit, those who failed the pathway were more likely to have an American Society of Anesthesiologists score ≥3 and were <40 or ≥60 compared with the successful group. CONCLUSIONS One in five patients failed the elective cholecystectomy pathway after ED discharge, leading to additional patient distress and use of resources. Further risk factor assessment may help design efficient care pathways.
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Affiliation(s)
| | - Kristine M Thomsen
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Erik P Hess
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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91
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Can it wait until morning? A comparison of nighttime versus daytime cholecystectomy for acute cholecystitis. Am J Surg 2014; 208:911-8; discussion 917-8. [DOI: 10.1016/j.amjsurg.2014.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 12/29/2022]
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92
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Kais H, Hershkovitz Y, Abu-Snina Y, Chikman B, Halevy A. Different setups of laparoscopic cholecystectomy: Conversion and complication rates: A retrospective cohort study. Int J Surg 2014; 12:1258-61. [DOI: 10.1016/j.ijsu.2014.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/21/2014] [Accepted: 10/14/2014] [Indexed: 12/25/2022]
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93
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Acute cholecystitis: WSES position statement. World J Emerg Surg 2014; 9:58. [PMID: 25422672 PMCID: PMC4242474 DOI: 10.1186/1749-7922-9-58] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/29/2014] [Indexed: 12/16/2022] Open
Abstract
Background The management of acute calculous cholecystitis still offers room for debate in terms of diagnosis, severity scores, treatment options and timing for surgery. Material and methods A systematic review about the treatment of acute cholecystitis has been completed. The recommendations of recent guidelines have also been examined taking into account the results of the review. Results The evidence available in the literature supports the recommendation about laparoscopic cholecystectomy as treatment of choice for acute cholecystitis. Surgery should be performed as soon as possible after the diagnosis because early treatment reduces total hospital stay and does not increase complication or conversion rates. The antibiotics can play different roles and attention should be posed to the risk of emerging resistance. A surgical or percutaneous drainage of the gallbladder is advocated by some authors in the advanced forms of inflammation or patients with severe co-morbidities; however, the available evidence does not support it, and further studies are necessary to clarify its role.
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Jiménez PP, Ruiz-Tovar J, Ramiro C, Molina JM, Morales V, Lobo E. Outcome of Laparoscopic Cholecystectomy in Patients 85 Years and Older. Am Surg 2014. [DOI: 10.1177/000313481408001105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pablo Priego Jiménez
- Department of General Surgery Hospital Universitario General Castellón Castellón, Spain
| | - Jaime Ruiz-Tovar
- Department of General Surgery Hospital Universitario Elche Elche, Spain
| | - Carmen Ramiro
- Department of General Surgery Hospital Universitario Guadalajara Guadalajara, Spain
| | | | - Vicente Morales
- Department of General Surgery Hospital Ramón y Cajal Cajal, Spain
| | - Eduardo Lobo
- Department of General Surgery Hospital Ramón y Cajal Cajal, Spain
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96
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Hwang H, Marsh I, Doyle J. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg 2014; 57:162-8. [PMID: 24869607 DOI: 10.1503/cjs.027312] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Acute cholecystitis is one of the most common diseases requiring emergency surgery. Ultrasonography is an accurate test for cholelithiasis but has a high false-negative rate for acute cholecystitis. The Murphy sign and laboratory tests performed independently are also not particularly accurate. This study was designed to review the accuracy of ultrasonography for diagnosing acute cholecystitis in a regional hospital. METHODS We studied all emergency cholecystectomies performed over a 1-year period. All imaging studies were reviewed by a single radiologist, and all pathology was reviewed by a single pathologist. The reviewers were blinded to each other's results. RESULTS A total of 107 patients required an emergency cholecystectomy in the study period; 83 of them underwent ultrasonography. Interradiologist agreement was 92% for ultrasonography. For cholelithiasis, ultrasonography had 100% sensitivity, 18% specificity, 81% positive predictive value (PPV) and 100% negative predictive value (NPV). For acute cholecystitis, it had 54% sensitivity, 81% specificity, 85% PPV and 47% NPV. All patients had chronic cholecystitis and 67% had acute cholecystitis on histology. When combined with positive Murphy sign and elevated neutrophil count, an ultrasound showing cholelithiasis or acute cholecystitis yielded a sensitivity of 74%, specificity of 62%, PPV of 80% and NPV of 53% for the diagnosis of acute cholecystitis. CONCLUSION Ultrasonography alone has a high rate of false-negative studies for acute cholecystitis. However, a higher rate of accurate diagnosis can be achieved using a triad of positive Murphy sign, elevated neutrophil count and an ultrasound showing cholelithiasis or cholecystitis.
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Affiliation(s)
- Hamish Hwang
- The Vernon Jubilee Hospital, Vernon, BC, and the Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Ian Marsh
- The Vernon Jubilee Hospital, Vernon, BC
| | - Jason Doyle
- The Vernon Jubilee Hospital, Vernon, BC, and the Faculty of Medicine, University of British Columbia, Vancouver, BC
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Pieniowski E, Popowicz A, Lundell L, Gerber P, Gustafsson U, Sinabulya H, Sjödahl K, Tsekrekos A, Sandblom G. Early versus delayed surgery for acute cholecystitis as an applied treatment strategy when assessed in a population-based cohort. Dig Surg 2014; 31:169-76. [PMID: 25034765 DOI: 10.1159/000363659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/13/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aims of this study were to describe the surgical management of acute cholecystitis (AC) in a well-defined population-based patient cohort, in particular adherence to and outcome of the early open/laparoscopic cholecystectomy (EC/ELC) strategy. METHODS The medical records of all patients residing in Stockholm County who were treated for AC during 2003 and 2008 were reviewed according to a standardized protocol. RESULTS In 2003, 799 patients were admitted 850 times for AC, and the respective figures for 2008 were 833 and 919. The number of patients who underwent EC/ELC increased from 42.9% in 2003 to 47.4% in 2008. In multivariate regression analysis adjusting for age, gender, severity of cholecystitis, maximal CRP and maximal WBC, EC/ELC was associated with shorter operation time but higher perioperative blood loss when compared to delayed open/laparoscopic cholecystectomy (DC/DLC). The odds ratio for completing the procedure laparoscopically was significantly higher in DC/DLC when adjusting for the same covariates. There were no significant differences in peri- or postoperative complications between the groups. CONCLUSION Strategies should be implemented in order to secure a more evidence-based approach to the surgical treatment of AC.
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99
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Time and cost analysis of gallbladder surgery under the acute care surgery model. J Trauma Acute Care Surg 2014; 76:710-4. [PMID: 24553538 DOI: 10.1097/ta.0000000000000117] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The acute care surgery (ACS) model has been shown to improve work flow efficiency and to reduce hospital stay. We hypothesized that, in patients with gallbladder (GB) disease who were admitted through our emergency department (ED) and then underwent surgery, the ACS model shortened the time to surgery, decreased the length of hospital stay, and reduced hospital costs. METHODS We retrospectively queried our GB surgery practice records for 2008 (before the establishment of the ACS model at our institution in 2009). We then performed time and cost comparison with our prospectively maintained GB surgery practice database for 2010. We excluded any inpatient GB surgeries and any GB surgeries that were performed for choledocholithiasis and acute pancreatitis. RESULTS Our study was composed of 94 patients from the pre-ACS period (2008) and 234 patients from the ACS period (2010). Patients' baseline characteristics were similar between the two periods, except for a higher percentage of females in the ACS period (77% vs. 66%, p = 0.04). Approximately one third of patients from both periods had acute cholecystitis. In the ACS period, the mean time to surgery, that is, from ED arrival to operating room arrival, was shorter (20.8 [13.8] hours vs. 25.7 [16.2] hours, p = 0.007); more patients underwent surgery within 24 hours after ED arrival (75% vs. 59%, p = 0.004); and more patients underwent surgery between 12:00 midnight and 7:00 AM (25% vs. 6.4%, p < 0.001). As a result, hospital length of stay was 1.4 days shorter in the ACS period, with cost saving per patient of approximately $1,000. CONCLUSION We found that implementation of ACS model led to benefits for patients who came to our ED with GB disease, including shorter time to surgery, shorter hospital stay, and decreased hospital costs. The ACS model benefits the health care system. LEVEL OF EVIDENCE Therapeutic study, level IV.
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Risk factors for conversion of laparoscopic cholecystectomy to open surgery associated with the severity characteristics according to the Tokyo guidelines. Surg Today 2014; 44:2300-4. [DOI: 10.1007/s00595-014-0838-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/16/2013] [Indexed: 01/10/2023]
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