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Asai K, Ohyama T, Watanabe M, Moriyama H, Kujiraoka M, Watanabe R, Shigeta K, Kakizaki N, Hagiwara O, Saida Y. Validation of a surgical difficulty grading system in laparoscopic cholecystectomy for acute cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:80-88. [PMID: 37803518 DOI: 10.1002/jhbp.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
BACKGROUND The surgical difficulty of laparoscopic cholecystectomy (LC) for acute cholecystitis varies from case to case, and appropriate intraoperative evaluation would help prevent bile duct injury (BDI). METHODS We analyzed 178 patients who underwent LC for acute cholecystitis. Expert surgeons and trainees individually evaluated the surgical difficulty. The inter-rater agreement was analyzed using Conger's κ and Gwet's agreement coefficient (AC). Furthermore, we analyzed the predictive surgical difficulty item for performing subtotal cholecystectomy (STC). RESULTS Regarding the inter-rater agreement between expert surgeons and trainees, 15 of the 17 surgical difficulty items had a Gwet's AC of 0.5 or higher, indicating "moderate" agreement or higher. Furthermore, the highest and total surgical difficulty scores were deemed "substantial" agreement. Scarring and dense fibrotic changes around the Calot's triangle area with easy bleeding with/without necrotic changes were predictive of whether STC should be performed. CONCLUSIONS This surgical difficulty grading system is expected to be a tool that can be used by any surgeon with LC experience. STC should be performed to prevent BDI according to the changes around the Calot's triangle area.
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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
| | - Hodaka Moriyama
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Manabu Kujiraoka
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Ryutaro Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kenta Shigeta
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nanako Kakizaki
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Osahiko Hagiwara
- 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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Valenti MR, Cavallaro A, Di Vita M, Zanghi A, Longo Trischitta G, Cappellani A. Gallbladder hemorrhage–An uncommon surgical emergency: A case report. World J Clin Cases 2022; 10:9734-9742. [PMID: 36186197 PMCID: PMC9516921 DOI: 10.12998/wjcc.v10.i27.9734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gallbladder hemorrhage is a life-threatening disorder. Trauma (accidental or iatrogenic such as a percutaneous biopsy or cholecystectomy surgery), cholelithiasis, biliary tract parasitosis, vasculitis, vascular malformations, autoimmune and neoplastic diseases and coagulopathies have been described as causes of hemorrhage within the lumen of the gallbladder. The use of non-steroidal anti-inflammatory drugs and anticoagulants may represent a risk factor.
CASE SUMMARY We report the case of a 76-year-old male patient. An urgent contrast computed tomography scan demonstrated relevant distension of the gallbladder filled with hyperdense non-homogeneous content. The gallbladder walls were of regular thickness. Near the anterior wall a focus of suspected active bleeding was observed. Due to the progressive decrease in hemoglobin despite three blood transfusions, this was an indication for urgent surgery.
CONCLUSION Early diagnosis of this potentially fatal pathology is essential in order to plan a strategy and eventually proceed with urgent surgical treatment.
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Affiliation(s)
- Maria Rosaria Valenti
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Andrea Cavallaro
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Maria Di Vita
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Antonio Zanghi
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Giovanni Longo Trischitta
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Alessandro Cappellani
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
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Diagnosis-Related Group (DRG)-Based Prospective Hospital Payment System can be well adopted for Acute Care Surgery: Taiwanese Experience with Acute Cholecystitis. World J Surg 2021; 45:1080-1087. [PMID: 33454793 DOI: 10.1007/s00268-020-05904-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 12/07/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is a common procedure for cholelithiasis paid by diagnostic-related groups (DRGs) systems. However, acute cholecystitis (AC) patients usually have heterogeneous conditions that compromise the successful implementation of DRGs. We evaluated the quality/efficiency of treating AC patients under the DRG system in Taiwan. METHODS All AC patients who underwent LC between October 2015 and December 2016 were included. Patient demographics, treatment outcomes, and financial results were analyzed. Patients were reimbursed by one of the two DRG schemes based on their comorbidities/complications (CC): DRG-1, LC without CC; and DRG-2, LC with CC. Hospitals were reimbursed the costs incurred if they were below the lower threshold (balanced sector); with the outlier threshold if costs were between the lower and outlier thresholds (profitable sector); and with the outlier threshold plus 80% of the exceeding cost if costs were higher than the outlier threshold (profit-losing sector). RESULTS Among 246 patients, 114 were paid by DRG-1, and 132 were by DRG-2. In total, 195 of 246 patients underwent LC within 1 day after admission, and patients with mild AC had shorter hospital stays than those with moderate or severe AC. The complication rate was 7.3% with only one mortality. In total, 92.1% of patients in DRG-1 and 90.9% of patients in DRG-2 were profitable. The average margin per patient was 11,032 TWD for DRG-1 and 24,993 TWD for DRG-2. CONCLUSIONS DRGs can be well adopted for acute care surgery, and hospitals can still provide satisfactory services without losing profit.
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Giles AE, Godzisz S, Nenshi R, Forbes S, Farrokhyar F, Lee J, Eskicioglu C. Diagnosis and management of acute cholecystitis: a single-centre audit of guideline adherence and patient outcomes. Can J Surg 2020; 63:E241-E249. [PMID: 32386475 DOI: 10.1503/cjs.002719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The Tokyo Guidelines were published in 2007 and updated in 2013 and 2018, with recommendations for the diagnosis and management of acute cholecystitis. We assessed guideline adherence at our academic centre and its impact on patient outcomes. Methods This is a retrospective chart review of patients with acute calculous cholecystitis who underwent cholecystectomy at our institution between November 2013 and March 2015. Severity of cholecystitis was graded retrospectively if it had not been documented preoperatively. Compliance with the Tokyo Guidelines' recommendations on antibiotic use and time to operation was recorded. Cholecystitis severity groups were compared statistically, and logistic regression was used to determine predictors of complications. Results One hundred and fifty patients were included in the study. Of these, 104 patients were graded as having mild cholecystitis, 45 as having moderate cholecystitis, and 1 as having severe cholecystitis. Severity was not documented preoperatively for any patient. Compliance with antibiotic recommendations was poor (18.0%) and did not differ by cholecystitis severity (p = 0.90). Compliance with the recommendation on time to operation was 86.0%, with no between-group differences (p = 0.63); it improved when an acute care surgery team was involved (91.0% v. 76.0%, p = 0.025). On multivariable analysis, comorbidities (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.19-1.85, p < 0.001) and conversion to laparotomy (OR 13.45, 95% CI 2.16-125.49, p = 0.01) predicted postoperative complications, while severity of cholecystitis, antibiotic compliance and time to operation had no effect. Conclusion In this study, compliance with the Tokyo Guidelines was acceptable only for time to operation. Although the poor compliance with recommendations relating to documentation of severity grading and antibiotic use did not have a negative affect on patient outcomes, these recommendations are important because they facilitate appropriate antibiotic use and patient risk stratification.
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Affiliation(s)
- Andrew E Giles
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Giles, Godzisz, Nenshi, Forbes, Farrokhyar, Lee, Eskicioglu); the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi, Eskicioglu); and the Department of Surgery, Hamilton Health Sciences, Hamilton, Ont. (Forbes)
| | - Sydney Godzisz
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Giles, Godzisz, Nenshi, Forbes, Farrokhyar, Lee, Eskicioglu); the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi, Eskicioglu); and the Department of Surgery, Hamilton Health Sciences, Hamilton, Ont. (Forbes)
| | - Rahima Nenshi
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Giles, Godzisz, Nenshi, Forbes, Farrokhyar, Lee, Eskicioglu); the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi, Eskicioglu); and the Department of Surgery, Hamilton Health Sciences, Hamilton, Ont. (Forbes)
| | - Shawn Forbes
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Giles, Godzisz, Nenshi, Forbes, Farrokhyar, Lee, Eskicioglu); the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi, Eskicioglu); and the Department of Surgery, Hamilton Health Sciences, Hamilton, Ont. (Forbes)
| | - Forough Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Giles, Godzisz, Nenshi, Forbes, Farrokhyar, Lee, Eskicioglu); the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi, Eskicioglu); and the Department of Surgery, Hamilton Health Sciences, Hamilton, Ont. (Forbes)
| | - Jennie Lee
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Giles, Godzisz, Nenshi, Forbes, Farrokhyar, Lee, Eskicioglu); the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi, Eskicioglu); and the Department of Surgery, Hamilton Health Sciences, Hamilton, Ont. (Forbes)
| | - Cagla Eskicioglu
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Giles, Godzisz, Nenshi, Forbes, Farrokhyar, Lee, Eskicioglu); the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi, Eskicioglu); and the Department of Surgery, Hamilton Health Sciences, Hamilton, Ont. (Forbes)
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Hernandez M, Murphy B, Aho JM, Haddad NN, Saleem H, Zeb M, Morris DS, Jenkins DH, Zielinski M. Validation of the AAST EGS acute cholecystitis grade and comparison with the Tokyo guidelines. Surgery 2018; 163:739-746. [PMID: 29325783 DOI: 10.1016/j.surg.2017.10.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/28/2017] [Accepted: 10/25/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Acute cholecystitis presents with heterogeneous severity. The Tokyo Guidelines 2013 is a validated method to assess cholecystitis severity, but the variables are multifactorial. The American Association for the Surgery of Trauma (AAST) developed an anatomically based severity grading system for surgical diseases, including cholecystitis. Because the Tokyo Guidelines represent the gold standard to estimate acute cholecystitis severity, we wished to validate the AAST emergency general surgery scoring system and compare the performance of both systems for several patient outcomes. METHODS Adults (≥18 years) with acute cholecystitis during 2013-2016 were identified. Baseline demographic characteristics, comorbidity severity as defined by Charlson Comorbidity Index score, procedure types, and AAST and Tokyo Guidelines 2013 grades were abstracted. Outcomes included duration of stay, 30-day mortality, and complications. Comparison of the Tokyo Guidelines and AAST grading system was performed using receiver operating characteristic (AUROC) curve C statistics. RESULTS There were 443 patients, with a mean (±standard deviation) age of 64.8 (±18) years, 59% male. The median (interquartile ratio) Charlson Comorbidity score was 3 (0-6). Management included laparoscopic (n = 307, 69.3%), open (n = 26, 6%), laparoscopy converted to laparotomy (n = 53, 12%), and cholecystostomy (n = 57, 12.7%). Comparison of AAST with Tokyo Guidelines AUROC C statistics indicated (P < .05) mortality (0.86 vs 0.73), complication (0.76 vs 0.63), and cholecystostomy tube utilization (0.80 vs 0.68). CONCLUSION Emergency general surgery grading systems improve disease severity assessment, may improve documentation, and guide management. Discrimination of disease severity using the AAST grading system outperforms the Tokyo Guidelines for key clinical outcomes. The AAST grading system requires prospective validation and further comparison.
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Affiliation(s)
- Matthew Hernandez
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Brittany Murphy
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Johnathan M Aho
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nadeem N Haddad
- Division Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Humza Saleem
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Zeb
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - David S Morris
- Division of General Surgery, Trauma, and Critical Care, Intermountain Medical Center, Murray, UT, USA
| | - Donald H Jenkins
- Division Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Martin Zielinski
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA
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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: 0.7] [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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Admission after the gold interval in acute calculous cholecystitis: Should we really cool it off? Eur J Trauma Emerg Surg 2016; 43:73-77. [PMID: 26742919 DOI: 10.1007/s00068-015-0617-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to compare early and delayed cholecystectomy for the treatment of acute calculous cholecystitis (ACC). MATERIALS AND METHODS The medical records of patients who were diagnosed to have ACC by combined clinical and radiological examination were evaluated retrospectively. The patients were divided into two non-randomized groups according to the duration between the onset of symptoms and cholecystectomy. Group 1 included the patients who underwent cholecystectomy within the first 72 h after the onset of symptoms and Group 2 those who underwent beyond the 72nd hour after the onset of symptoms. RESULTS We reviewed records for 203 patients. There were 109 patients in Group 1 and 74 patients in Group 2. Access-related complications occurred in four patients. One patient in Group 1 and two patients in Group 2 had trocar site bleeding. In one patient in Group 1, liver trauma occurred. Two patients had bile duct injury in Group 1 as Type D injury according to the Strasberg classification in one patient and E2 injury in other. CONCLUSION Early cholecystectomy in acute cholecystitis with biliary stones could be performed regardless of time with similar complication, mortality and conversion rates.
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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 2015; 30:1172-82. [DOI: 10.1007/s00464-015-4325-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
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Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case-control studies. Surg Endosc 2015; 30:1183. [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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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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: 1.0] [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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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: 17] [Impact Index Per Article: 1.7] [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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Heger E, Lammert F. [Biliary diseases in the elderly]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2014; 52:447-9. [PMID: 24824910 DOI: 10.1055/s-0034-1366158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gallstone disease is more common in the elderly. In this short review, we summarize guideline-based recommendations for the diagnosis and treatment of biliary diseases in elderly patients. Warning episodes of biliary colic represent a general indication for cholecystectomy to avoid stone-related complications. Elderly patients with mild and moderate acute cholecystitis should undergo urgent cholecystectomy. After endoscopic retrograde cholangiography and stone extraction as well as mild acute biliary pancreatitis, cholecystectomy should be performed during the same hospital admission. Since the elevated risk of gallstone carriers to develop biliary cancer increases with age, cholecystectomy also protects against cancer.
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Affiliation(s)
- E Heger
- Medizinische Klinik II, Asklepios Klinik, Langen
| | - F Lammert
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Homburg
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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: 4.6] [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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