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Masuda T, Takamori H, Ogata KI, Ogawa K, Shimizu K, Karashima R, Nitta H, Matsumoto K, Okino T, Baba H. The Success Rate Is Lower but Completion Rate of Laparoscopic Cholecystectomy Is higher in Endoscopic Transpapillary Gallbladder Drainage than Percutaneous Gallbladder Drainage for Acute Cholecystitis. Surg Laparosc Endosc Percutan Tech 2024; 34:413-418. [PMID: 38940254 DOI: 10.1097/sle.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/25/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND We investigated the success and complication rates of endoscopic transpapillary gallbladder drainage (ETGBD) and percutaneous transhepatic gallbladder drainage (PTGBD) and the outcomes of subsequent cholecystectomy for acute cholecystitis. METHODS Patients (N=178) who underwent cholecystectomy after ETGBD or PTGBD were retrospectively assessed. RESULTS ETGBD was successful in 47 (85.5%) of 55 procedures, whereas PTGBD was successful in 123 (100%) of 123 sessions ( P <0.001). Complications related to ETGBD and PTGBD occurred in 6 (12.8%) of 47 and 16 (13.0%) of 123 patients, respectively ( P =0.97). After propensity matching, 43 patients from each group were selected. Median time from drainage to cholecystectomy was 48 (14 to 560) days with ETGBD and 35 (1 to 90) days with PTGBD ( P =0.004). Laparoscopy was selected more often in the ETGBD group (97.7%) than in the PTGBD group (79.1%) ( P =0.007), and conversion from laparoscopy to open cholecystectomy was more common with PTGBD (41.2%) than with ETGBD (7.1%) ( P <0.001). Mean operation time was significantly shorter with ETGBD (135.8±66.7 min) than with PTGBD (195.8±62.2 min) ( P <0.001). The incidence of Clavien-Dindo grade ≥III postoperative complications was 9.3% with ETGBD and 11.6% with PTGBD ( P =0.99). CONCLUSIONS The success rate is lower but completion of laparoscopic cholecystectomy is more in endoscopic gallbladder drainage than percutaneous gallbladder drainage for acute cholecystitis.
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Affiliation(s)
- Toshiro Masuda
- Department of Surgery, Saiseikai Kumamoto Hospital, Minami-ku
| | | | - Ken-Ichi Ogata
- Department of Surgery, Saiseikai Kumamoto Hospital, Minami-ku
| | - Katsuhiro Ogawa
- Department of Surgery, Saiseikai Kumamoto Hospital, Minami-ku
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Kenji Shimizu
- Department of Surgery, Saiseikai Kumamoto Hospital, Minami-ku
| | | | - Hidetoshi Nitta
- Department of Surgery, Saiseikai Kumamoto Hospital, Minami-ku
| | | | - Tetsuya Okino
- Department of Surgery, Saiseikai Kumamoto Hospital, Minami-ku
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
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Sartelli M, Tascini C, Coccolini F, Dellai F, Ansaloni L, Antonelli M, Bartoletti M, Bassetti M, Boncagni F, Carlini M, Cattelan AM, Cavaliere A, Ceresoli M, Cipriano A, Cortegiani A, Cortese F, Cristini F, Cucinotta E, Dalfino L, De Pascale G, De Rosa FG, Falcone M, Forfori F, Fugazzola P, Gatti M, Gentile I, Ghiadoni L, Giannella M, Giarratano A, Giordano A, Girardis M, Mastroianni C, Monti G, Montori G, Palmieri M, Pani M, Paolillo C, Parini D, Parruti G, Pasero D, Pea F, Peghin M, Petrosillo N, Podda M, Rizzo C, Rossolini GM, Russo A, Scoccia L, Sganga G, Signorini L, Stefani S, Tumbarello M, Tumietto F, Valentino M, Venditti M, Viaggi B, Vivaldi F, Zaghi C, Labricciosa FM, Abu-Zidan F, Catena F, Viale P. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use. World J Emerg Surg 2024; 19:23. [PMID: 38851757 PMCID: PMC11162065 DOI: 10.1186/s13017-024-00551-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024] Open
Abstract
Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients' safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts' opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents the executive summary of the consensus conference and comprises three sections. The first section focuses on the general principles of diagnosis and treatment of IAIs. The second section provides twenty-three evidence-based recommendations for the antimicrobial therapy of IAIs. The third section presents eight clinical diagnostic-therapeutic pathways for the most common IAIs. The document has been endorsed by the Italian Society of Surgery.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100, Macerata, Italy.
| | - Carlo Tascini
- Infectious Diseases Clinic, Santa Maria Della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Azienda Ospedaliero Universitaria Pisana, University Hospital, Pisa, Italy
| | - Fabiana Dellai
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Luca Ansaloni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Massimo Antonelli
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Boncagni
- Anesthesiology and Intensive Care Unit, Macerata Hospital, Macerata, Italy
| | - Massimo Carlini
- Department of General Surgery, S. Eugenio Hospital, Rome, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Arturo Cavaliere
- Unit of Hospital Pharmacy, Viterbo Local Health Authority, Viterbo, Italy
| | - Marco Ceresoli
- General and Emergency Surgery, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Alessandro Cipriano
- Department of Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical Surgical and Critical Care, University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | | | - Francesco Cristini
- Infectious Diseases Unit, AUSL Romagna, Forlì and Cesena Hospitals, Forlì, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Eugenio Cucinotta
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
| | - Lidia Dalfino
- Anesthesia and Intensive Care Unit, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University of Bari, Bari, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Forfori
- Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Paola Fugazzola
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Lorenzo Ghiadoni
- Department of Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
- Department on Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonino Giarratano
- Department of Precision Medicine in Medical Surgical and Critical Care, University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Alessio Giordano
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, AOU Policlinico Umberto 1, Sapienza University of Rome, Rome, Italy
| | - Gianpaola Monti
- Department of Anesthesia and Intensive Care, ASST GOM Niguarda Ca' Granda, Milan, Italy
| | - Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Miriam Palmieri
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100, Macerata, Italy
| | - Marcello Pani
- Hospital Pharmacy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ciro Paolillo
- Emergency Department, University of Verona, Verona, Italy
| | - Dario Parini
- General Surgery Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Daniela Pasero
- Department of Emergency, Anaesthesia and Intensive Care Unit, ASL1 Sassari, Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Nicola Petrosillo
- Infection Prevention and Control Service, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Alessandro Russo
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
- Infectious and Tropical Disease Unit, "Renato Dulbecco" Teaching Hospital, Catanzaro, Italy
| | - Loredana Scoccia
- Hospital Pharmacy Unit, Macerata Hospital, AST Macerata, Macerata, Italy
| | - Gabriele Sganga
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Liana Signorini
- Unit of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy
| | - Mario Tumbarello
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Fabio Tumietto
- UO Antimicrobial Stewardship-AUSL Bologna, Bologna, Italy
| | | | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Bruno Viaggi
- Intensive Care Department, Careggi Hospital, Florence, Italy
| | | | - Claudia Zaghi
- General, Emergency and Trauma Surgery Department, Vicenza Hospital, Vicenza, Italy
| | | | - Fikri Abu-Zidan
- Statistics and Research Methodology, The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Fausto Catena
- Emergency and General Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Mishima K, Fujiyama Y, Wakabayashi T, Tsutsui A, Okamoto N, Marescaux J, Kitagawa Y, Wakabayashi G. Combining preoperative C-reactive protein values with the Tokyo Guidelines 2018 grading criteria can enhance the prediction of surgical difficulty in early laparoscopic cholecystectomy for acute cholecystitis. HPB (Oxford) 2024; 26:426-435. [PMID: 38135551 DOI: 10.1016/j.hpb.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/23/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Early laparoscopic cholecystectomy (ELC) is the standard treatment for acute cholecystitis (AC). However, predicting the difficulty of this procedure remains challenging. The present study aimed to develop an improved prediction model for surgical difficulty during ELC, surpassing the current Tokyo Guidelines 2018 (TG18) grading system. METHODS We analyzed data from 201 consecutive patients who underwent ELC for AC between 2019 and 2021. Surgical difficulty was defined as the failure to achieve the critical view of safety (non-CVS). We developed a scoring system by conducting multivariate analysis on demographics, symptoms, laboratory data, and radiographic findings. The predictive accuracy of our scoring system was compared to that of the TG18 grading system (Grade I vs. Grade II/III). RESULTS Through multivariate logistic regression analysis, a novel scoring system was formulated. This system incorporated preoperative C-reactive protein (CRP) values (≥5: 1 pt, ≥10: 2 pts, ≥15: 3 pts) and TG18 grading score (duration >72 h: 1 pt, image criteria for Grade II AC: 1 pt). Our model, a cutoff score of ≥3, exhibited a significantly elevated area under the curve (AUC) of 0.721 compared to the TG18 grading system alone (AUC 0.609) (p = 0.001). CONCLUSION Combining preoperative CRP values with TG18 grading criteria can enhance the accuracy of predicting intraoperative difficulty in ELC for AC.
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Affiliation(s)
- Kohei Mishima
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan; Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Research Institute against Digestive Cancer (IRCAD), Strasbourg, France.
| | - Yoshiki Fujiyama
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Taiga Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Atsuko Tsutsui
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Nobuhiko Okamoto
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), Strasbourg, France
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
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Alius C, Serban D, Bratu DG, Tribus LC, Vancea G, Stoica PL, Motofei I, Tudor C, Serboiu C, Costea DO, Serban B, Dascalu AM, Tanasescu C, Geavlete B, Cristea BM. When Critical View of Safety Fails: A Practical Perspective on Difficult Laparoscopic Cholecystectomy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1491. [PMID: 37629781 PMCID: PMC10456257 DOI: 10.3390/medicina59081491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a narrative review which discusses from a contextual point of view the need to standardise the surgical approach in difficult laparoscopic cholecystectomies, the main strategic operative concepts and techniques, complementary visualisation aids for the delineation of anatomical landmarks, and the importance of cognitive maps and algorithms in performing safer LC. Extensive research was carried out in the PubMed, Web of Science, and Elsevier databases using the terms "difficult cholecystectomy", "bile duct injuries", "safe cholecystectomy", and "laparoscopy in acute cholecystitis". The key content and findings of this research suggest there is high intersocietal variation in approaching and performing LC, in the use of visualisation aids, and in the application of safety concepts. Limited papers offer guidelines based on robust data and a timid recognition of the human factors and ergonomic concepts in improving the outcomes associated with difficult cholecystectomies. This paper highlights the most relevant recommendations for dealing with difficult laparoscopic cholecystectomies.
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Affiliation(s)
- Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dan Georgian Bratu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania; (D.G.B.)
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021Bucharest, Romania;
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Geta Vancea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Third Clinical Infectious Disease Department, Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes”, 030303 Bucharest, Romania
| | - Paul Lorin Stoica
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Ion Motofei
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania;
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
| | - Bogdan Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Ciprian Tanasescu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania; (D.G.B.)
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | - Bogdan Geavlete
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (G.V.); (I.M.); (C.T.); (C.S.); (B.S.); (A.M.D.); (B.G.); (B.M.C.)
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Yan Y, Hua Y, Yuan W, Zhu X, Du Y, Zhu S, Wang B. Utility of Tokyo Guidelines 2018 in early laparoscopic cholecystectomy for mild and moderate acute calculus cholecystitis: A retrospective cohort study. Front Surg 2023; 9:1022258. [PMID: 36726949 PMCID: PMC9885794 DOI: 10.3389/fsurg.2022.1022258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/24/2022] [Indexed: 01/19/2023] Open
Abstract
Background Tokyo Guidelines 2018 (TG18) proposed laparoscopic cholecystectomy (LC) for acute calculus cholecystitis (ACC) irrespective of the duration of symptoms. This retrospective study assessed the impact of utility of TG18 in early LC for ACC. Methods From 2018 to 2020, 66 patients with mild (grade I) and moderate (grade II) ACC who underwent early surgery were studied. Subgroup analyses were based on timing of surgery and operation time. Results A total of 32 and 34 patients were operated within and beyond 7 days since ACC onset. More patients with grade II ACC were in the beyond 7 days group (P < 0.05). More patients with enlarged gallbladder were in the within 7 days group (P < 0.05). The duration of symptoms to admission, symptoms to LC, and operation time were longer in the beyond 7 days group (P < 0.05). There were no significant differences regarding intraoperative blood loss, conversion to bail-out procedures, complication rate, hospital stay, and cost between the two groups (P > 0.05). Longer operation time was significantly associated with duration of symptoms to admission, symptoms to LC, and conversion to laparoscopic subtotal cholecystectomy (LSC) (P < 0.05). Conclusion In a subset of carefully selected patients, applying TG18 in early LC for mild and moderate ACC results in acceptable clinical outcomes. Standardized safe steps and conversion to LSC in difficult cases are important.
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Welsh S, Nassar AHM, Sallam M. The incidence, operative difficulty and outcomes of staged versus index admission laparoscopic cholecystectomy and bile duct exploration for all comers: a review of 5750 patients. Surg Endosc 2022; 36:8221-8230. [PMID: 35507063 PMCID: PMC9613731 DOI: 10.1007/s00464-022-09272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The timing of laparoscopic cholecystectomy (LC) for emergency biliary admissions remains inconsistent with national and international guidelines. The perception that LC is difficult in acute cholecystitis and the popularity of the two-session approach to pancreatitis and suspected choledocholithiasis result in delayed management. METHODS Analysis of prospectively maintained data in a unit adopting a policy of "intention to treat" during the index admission. The aim was to study the incidence of previous biliary admissions and compare the operative difficulty, complications and postoperative outcomes with patients who underwent index admission LC. RESULTS Of the 5750 LC performed, 20.8% had previous biliary episodes resulting in one admission in 93% and two or more in 7%. Most presented with biliary colic (39.6%) and acute cholecystitis (27.6%). A previous biliary history was associated with increased operative difficulty (p < 0.001), longer operating times (86.9 vs. 68.1 min, p < 0.001), more postoperative complications (7.8% vs. 5.4%, p = 0.002) and longer hospital stay (8.1 vs. 5.5 days, p < 0.001) and presentation to resolution intervals. However, conversion and mortality rates showed no significant differences. CONCLUSION Index admission LC is superior to interval cholecystectomy and should be offered to all patients fit for general anaesthesia regardless of the presenting complaints. Subspecialisation should be encouraged as a major factor in optimising resource utilisation and postoperative outcomes of biliary emergencies.
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Affiliation(s)
- Silje Welsh
- Laparoscopic Biliary Service, University Hospital Monklands, Monkscourt Avenue, Airdrie, Lanarkshire, ML6 0JS, Scotland, UK
| | - Ahmad H M Nassar
- Laparoscopic Biliary Service, University Hospital Monklands, Monkscourt Avenue, Airdrie, Lanarkshire, ML6 0JS, Scotland, UK.
| | - Mahmoud Sallam
- Laparoscopic Biliary Service, University Hospital Monklands, Monkscourt Avenue, Airdrie, Lanarkshire, ML6 0JS, Scotland, UK
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Akturk R, Serinsöz S. Determining a Method to Minimize Pain After Laparoscopic Cholecystectomy Surgery. Surg Laparosc Endosc Percutan Tech 2022; 32:441-448. [PMID: 35797664 DOI: 10.1097/sle.0000000000001071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although many studies have investigated control of postoperative pain, inadequacy of treatment still remains. In this study, we aimed to identify a method with the capacity to minimize abdominal and right shoulder pain after laparoscopic cholecystectomy. MATERIALS AND METHODS A total of 684 subjects, 77% (n=527) female and 23% (n=157) male, were included in this study. A T-drain was prescribed for patients requiring bile duct exploration and patients with acute cholecystitis were excluded from the study. Subjects were classified into groups as follows: Group 1: control group without drain and intraperitoneal analgesics; Group 2: a drain was placed but no intraperitoneal analgesic was applied; Group 3: no drain was placed and intraperitoneal subhepatic bupivacaine was applied; and Group 4: drain was placed and intraperitoneal subhepatic bupivacaine was applied. Parietal pain and visceral pain were evaluated with visual analog scale (VAS). RESULTS A drain was present in 51.9% (n=355) of the cases. A statistically significant difference was found between the preoperative pulse rate measurements of the cases according to the groups ( P =0.009; <0.01). Subhepatic bupivacaine was administered in 50.1% (n=355) of the cases. A statistically significant difference was found between the second, fourth, sixth, 12th, and 24th hour VAS scores of the cases according to the groups [2 h VAS scores (mean±SD): Group 1: 3.58±1.07, Group 2: 3.86±1.12, Group 3: 1.20±0.67, and Group 4: 1.50±1.21 ( P <0.001)]; [4 h VAS scores (mean±SD): Group 1: 2.55±1.26, Group 2: 2.87±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 ( P <0.001)]; [6 h VAS scores (mean±SD): Group 1: 2.50±0.91, Group 2: 2.53±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 ( P <0.001)]; [12 h VAS scores (mean±SD): Group 1: 3.24±1.2, Group 2: 3.49±1.14, Group 3: 2.83±0.98, and Group 4 : 2.99±1.36 ( P <0.001)]; and [24 h VAS scores (mean±SD): Group 1: 3.75±0.99, Group 2: 4.01±0.91, Group 3: 3.61±1.34, and Group 4: 4.01±1.08 ( P <0.001)]. CONCLUSION Bupivacaine spraying reduces postoperative abdominal pain, while drain placement minimizes shoulder pain by reducing CO 2 remaining under the diaphragm.
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Muradian AA, Sychev DA, Blagovestnov DA, Petrov DI, Skukin DS, Epifanova IP, Sozaeva ZA, Kachanova AA, Denisenko NP, Abdullaev SP, Grishina EA. Evaluation of the association of polymorphisms of the CYP2C8 gene with the efficacy and safety of ketorolac in patients with postoperative pain syndrome. TERAPEVT ARKH 2022; 94:610-615. [DOI: 10.26442/00403660.2022.05.201495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/22/2022]
Abstract
Aim. To evaluate the possible association of CYP2C8 gene polymorphisms with the clinical efficacy and safety of ketorolac in relation to postoperative pain.
Materials and methods. The study included 107 patients after video laparoscopic cholecystectomy, who received ketorolac (30 mg 2.0 w/m 3 r/d) as postoperative pain relief. All patients were genotyped for CYP2C8. The pain syndrome was assessed using the visual analog scale, the McGill pain questionnaire. The profile of adverse reactions was assessed by the dynamics of red blood counts, as a possible trigger for the development of gastrointestinal bleeding according to the method of global assessment of triggers (Global Trigger Tool GTT).
Results. According to visual analog scale data: in carriers of the genotype CYP2C8*3 (rs10509681) and CYP2C8*3 (rs11572080) after 12, 24, 36, 48 hours the intensity of pain syndrome is lower than in carriers of the wild type (p0.05). According to the McGill pain questionnaire, there were no statistically significant differences in pain intensity between the two groups.
Conclusion. In carriers of the genotype CYP2C8*3 (rs10509681) and CYP2C8*3 (rs11572080), the effectiveness of anesthesia with ketorolac is higher than in carriers of the wild type. Carriage of the genotype CYP2C8*3 (rs10509681) and CYP2C8*3 (rs10509681) does not affect the risk of developing adverse reactions after ketorolac anesthesia.
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9
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Memişoğlu E, Sarı R. Timing of cholecystectomy in recurrent attacks of acute cholecystitis. ULUS TRAVMA ACIL CER 2022; 28:508-512. [PMID: 35485525 PMCID: PMC10521003 DOI: 10.14744/tjtes.2022.81908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis, its optimal timing is still controversial. In this study, our aim is to determine the appropriate cholecystectomy time by comparing the results of emergency and elective cholecystectomy in patients presenting with recurrent acute cholecystitis. METHODS Between January 2019 and January 2022, the data of 434 patients who were scheduled for late cholecystectomy and were admitted to our hospital with recurrent cholecystitis attacks during the waiting period were retrospectively evaluated. Demo-graphic data of patients, stage according to Tokyo Guidelines 2018, duration of hospital stay before and after surgery, surgery dura-tion, open surgery rate, drain use, hollow organ injury, biliary tract injury, bleeding, wound infection, post-operative collection, and mortality rates were analyzed. RESULTS Emergency LC (group 1) was performed in 176 (40.5%) of 434 patients presenting with recurrent cholecystitis, and elec-tive LC (group 2) was performed in 258 (59.5%) patients. Pre-operative hospital stay was significantly longer in group 2, and mean surgery duration was significantly longer in group 1 (p=0.001 and p=0.035, respectively). Gastric or intestinal injury, biliary tract injury, wound infection, and mortality were not detected in either group. There was no significant difference between the groups in the rate of open surgery and postoperative collection rates (p>0.05). CONCLUSION In centers experienced in hepatobiliary surgery, LC can be safely performed in recurrent acute cholecystitis attacks, regardless of symptom duration and the number of attacks.
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Affiliation(s)
- Ecem Memişoğlu
- Departmant of General Surgery, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul-Turkey
| | - Ramazan Sarı
- Departmant of General Surgery, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul-Turkey
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10
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Single Incision Cholecystectomies for Acute Cholecystitis: A Single Surgeon Series from the Caribbean. Minim Invasive Surg 2022; 2022:6781544. [PMID: 35223097 PMCID: PMC8865982 DOI: 10.1155/2022/6781544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Single incision laparoscopic surgery (SILS) is accepted as a safe alternative to conventional multiport laparoscopic (MPL) cholecystectomy for benign gallbladder disease. Since many surgeons carefully select patients without inflammation, there are limited data on SILS for acute cholecystitis. We report a single surgeon experience with SILS cholecystectomy for patients with acute cholecystitis. Materials and Methods. After securing ethical approval, we performed an audit of all SILS cholecystectomies for acute cholecystitis by a single surgeon from January 1, 2009, to December 31, 2019. The following data were extracted: patient demographics, intraoperative details, surgical techniques, specialized equipment utilized, conversions (additional port placement), morbidity, and mortality. Data were analyzed using SPSS 12.0. Results. SILS cholecystectomy was performed in 25 females at a mean age of 35 ± 4.1 (SD) years and a mean BMI of 31.9 ± 3.8 (SD) using a direct fascial puncture technique without access platforms. The operations were completed in 83 ± 29.4 minutes (mean ± SD) with an estimated blood loss of 76.9 ± 105 (mean + SD). Three (12%) patients required additional 5 mm port placement (conversions), but no open operations were performed. The patients were hospitalized for 1.96 ± 0.9 days (mean ± SD). There were 2 complications: postoperative superficial SSI (grade I) and a diaphragmatic laceration (grade III). No bile duct injuries were reported. There were 9 patients with complicated acute cholecystitis, and this sub-group had longer mean operating times (109.2 ± 27.3 minutes) and mean postoperative hospital stay (1.3 ± 0.87 days). Conclusion. The SILS technique is a feasible and safe approach to perform cholecystectomy for acute cholecystitis. We advocate a low threshold to place additional ports to assist with difficult dissections for patient safety.
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11
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Mytton J, Daliya P, Singh P, Parsons SL, Lobo DN, Lilford R, Vohra RS. Outcomes Following an Index Emergency Admission With Cholecystitis: A National Cohort Study. Ann Surg 2021; 274:367-374. [PMID: 31567508 DOI: 10.1097/sla.0000000000003599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the differences between patients who undergo cholecystectomy following index admission for cholecystitis, and those who are managed nonoperatively. SUMMARY BACKGROUND DATA Index emergency cholecystectomy following acute cholecystitis is widely recommended by national guidelines, but its effect on clinical outcomes remains uncertain. METHODS Data collected routinely from the Hospital Episode Statistics database (all admissions to National Health Service organizations in England and Wales) were extracted between April 1, 2002 and March 31, 2015. Analyses were limited to patients aged over 18 years with a primary diagnosis of cholecystitis. Exclusions included records with missing or invalid datasets, patients who had previously undergone a cholecystectomy, patients who had died without a cholecystectomy, and those undergoing cholecystectomy for malignancy, pancreatitis, or choledocholithiasis. Patients were grouped as either "no cholecystectomy" where they had never undergone a cholecystectomy following discharge, or "cholecystectomy." The latter group was then subdivided as "emergency cholecystectomy" when cholecystectomy was performed during their index emergency admission, or "interval cholecystectomy" when a cholecystectomy was performed within 12 months following a subsequent (emergency or elective) admission. Propensity Score Matching was used to match emergency and interval cholecystectomy groups. Main outcome measures included 1) One-year total length of hospital stay due to biliary causes following an index emergency admission with cholecystitis. 2) One-year mortality; defined as death occurring within 1 year following the index emergency admission with acute cholecystitis. RESULTS Of the 99,139 patients admitted as an emergency with acute cholecystitis, 51.1% (47,626) did not undergo a cholecystectomy within 1 year of index admission. These patients were older, with more comorbidities (Charlson Comorbidity Score ≥ 5 in 23.5% vs. 8.1%, P < 0.001) when compared to patients who did have a cholecystectomy. While all-cause 1-year mortality was higher in the nonoperated versus the operated group (12.2% vs. 2.0%, P < 0.001), gallbladder-related deaths were significantly lower than all other causes of death in the non-operated group (3.3% vs. 8.9%, P < 0.001). Following matching, 1-year total hospital admission time was significantly higher following emergency compared with interval cholecystectomy (17.7 d vs. 13 d, P < 0.001). CONCLUSIONS Over 50% of patients in England did not undergo cholecystectomy following index admission for acute cholecystitis. Mortality was higher in the nonoperated group, which was mostly due to non-gallbladder pathologies but total hospital admission time for biliary causes was lower over 12 months. Increasing the numbers of emergency cholecystectomy may risk over-treating patients with acute cholecystitis and increasing their time spent admitted to hospital.
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Affiliation(s)
- Jemma Mytton
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Prita Daliya
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK
| | - Pritam Singh
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Simon L Parsons
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK
- MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | | | - Ravinder S Vohra
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK
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12
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Cawich SO, Mahabir AH, Griffith S, FaSiOen P, Naraynsingh V. Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice. Trop Doct 2021; 51:539-541. [PMID: 34162285 DOI: 10.1177/00494755211010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.
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Affiliation(s)
- Shamir O Cawich
- Professor of Liver and Pancreas Surgery, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad & Tobago, West Indies
| | - Avidesh H Mahabir
- Surgery House Officer, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad & Tobago, West Indies
| | - Sahle Griffith
- Consultant General Surgeon, Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados, West Indies
| | - Patrick FaSiOen
- Consultant General Surgeon, Department of Surgery, Sint Elizabeth Hospital, Curacao, Dutch Caribbean
| | - Vijay Naraynsingh
- Professor of Surgery, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad & Tobago, West Indies
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Cawich SO, Hassranah D, Thomas D, Simpson L. Emergency Laparoscopic Cholecystectomy Should be Performed for Acute Cholecystitis in Trinidad and Tobago. Popul Health Manag 2021; 24:633-634. [PMID: 34030483 DOI: 10.1089/pop.2021.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shamir O Cawich
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Dale Hassranah
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Dexter Thomas
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Lindberg Simpson
- Department of Surgery, Kingston Public Hospital, Kingston, Jamaica
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Borzellino G, Khuri S, Pisano M, Mansour S, Allievi N, Ansaloni L, Kluger Y. Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials. World J Emerg Surg 2021; 16:16. [PMID: 33766077 PMCID: PMC7992835 DOI: 10.1186/s13017-021-00360-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Early cholecystectomy for acute cholecystitis has proved to reduce hospital length of stay but with no benefit in morbidity when compared to delayed surgery. However, in the literature, early timing refers to cholecystectomy performed up to 96 h of admission or up to 1 week of the onset of symptoms. Considering the natural history of acute cholecystitis, the analysis based on such a range of early timings may have missed a potential advantage that could be hypothesized with an early timing of cholecystectomy limited to the initial phase of the disease. The review aimed to explore the hypothesis that adopting immediate cholecystectomy performed within 24 h of admission as early timing could reduce post-operative complications when compared to delayed cholecystectomy. Methods The literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complication rate after early and delayed cholecystectomy for acute cholecystitis were included. Studies were grouped based on the timing of cholecystectomy. The hypothesis that immediate cholecystectomy performed within 24 h of admission could reduce post-operative complications was explored by comparing early timing of cholecystectomy performed within and 24 h of admission and early timing of cholecystectomy performed over 24 h of admission both to delayed timing of cholecystectomy within a sub-group analysis. The literature finding allowed the performance of a second analysis in which early timing of cholecystectomy did not refer to admission but to the onset of symptoms. Results Immediate cholecystectomy performed within 24 h of admission did not prove to reduce post-operative complications with relative risk (RR) of 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, cholecystectomy performed within 72 h of symptoms was found to significantly reduce post-operative complications compared to delayed cholecystectomy with RR = 0.60 [95% CI 0.39;0.92]. Conclusion The present study failed to confirm the hypothesis that immediate cholecystectomy performed within 24 h of admission may reduce post- operative complications unless surgery could be performed within 72 h of the onset of symptoms.
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Affiliation(s)
- Giuseppe Borzellino
- Department of General Surgery, University Hospital of Verona, Piazzale A. Stefani 1, 37128, Verona, Italy.
| | - Safi Khuri
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michele Pisano
- 1st Surgical Unit, Department of Emergency, ASST Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Subhi Mansour
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Niccolò Allievi
- 1st Surgical Unit, Department of Emergency, ASST Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Luca Ansaloni
- 1st General Surgery Unit, University of Pavia, Pavia, Italy
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
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15
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Current Management of Acute Calculous Cholecystitis. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-020-00282-2] [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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Marziali I, Cicconi S, Marilungo F, Benedetti M, Ciano P, Pagano P, D'Emidio F, Guercioni G, Catarci M. Role of percutaneous cholecystostomy in all-comers with acute cholecystitis according to current guidelines in a general surgical unit. Updates Surg 2020; 73:473-480. [PMID: 33058055 DOI: 10.1007/s13304-020-00897-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022]
Abstract
Acute calculous cholecystitis (ACC) is a very common complication of gallstone-related disease. Its currently recommended management changes according to severity of disease and fitness for surgery. The aim of this observational study is to assess the short- and long-term outcomes in all-comers admitted with diagnosis of ACC, treated according to 2013 Tokyo Guidelines (TG13). A retrospective analysis was conducted on a prospectively maintained database of 125 patients with diagnosis of ACC consecutively admitted between January 2017 and September 2019, subdivided in three groups according to TG13: percutaneous cholecystostomy (PC group), cholecystectomy (CH group), and conservative medical treatment (MT group). The primary end point was a composite of morbidity and/or mortality rates; the secondary end points were ACC recurrence, readmission, need for cholecystectomy rates and overall length of hospital stay (LOS). After a median follow-up of 639 days, overall morbidity rate was 20.8% and mortality rate was 6.4%. Death was directly related to AC during the index admission in two out of eight cases. There were no significant differences in primary end point according to the treatment group. Concerning secondary end points, ACC recurrence rate was not significantly different after PC (10.0%) or MT (9.1%); the readmission rates were significantly higher (p < 0.0001) in the MT group (48.5%) and in the PC group (25.0%) than in the CH group (5.8%); need for cholecystectomy rates was significantly higher (p < 0.0001) in the MT group (42.4%) than in the PC group (20.0%); median overall LOS was significantly higher in the PC (16 days) than in the MT (9 days) and than in the CH group (5 days). PC is an effective and safe rescue procedure in high-risk patients with ACC, representing a definitive treatment in 80% of cases of this specific subgroup.
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Affiliation(s)
- Irene Marziali
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Simone Cicconi
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Fabio Marilungo
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Michele Benedetti
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Paolo Ciano
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Paolo Pagano
- Interventional Radiology Units, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Fabio D'Emidio
- Interventional Radiology Units, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Gianluca Guercioni
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy
| | - Marco Catarci
- General Surgery, "C. e G. Mazzoni" Hospital, ASUR Marche AV5, Via degli Iris snc, 63100, Ascoli Piceno, Italy.
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Bourgouin S, Monchal T, Julien C, d'Argouges F, Balandraud P. Early versus delayed cholecystectomy for cholecystitis at high risk of operative difficulties: A propensity score-matching analysis. Am J Surg 2020; 221:1061-1068. [PMID: 33066954 DOI: 10.1016/j.amjsurg.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/07/2022]
Abstract
BACKGROUND Numerous studies have demonstrated the superiority of early (EC) over delayed (DC) cholecystectomy for acute cholecystitis (AC). However, none have assessed the effect of operative difficulty when reporting on treatment outcomes. METHODS Outcomes of patients who underwent EC or DC between 2010 and 2019 were compared taking into account the operative difficulty evaluated by the Difficult Laparoscopic Cholecystectomy score (DiLC). For each patient, the DiLC score was retrospectively calculated and corresponded to the foreseeable operative difficulty measured on admission for AC. A propensity score was used to account for confounders. Primary endpoints were the length of stay (LOS) and the occurrence of a serious operative/post-operative event (SOE). RESULTS DC in patients with DiLC≥10 reduced the risk of SOE without increasing the LOS. Conversely, DC in patients with DiLC<10 increased the LOS without improving outcomes. Multivariate analysis found EC in patients with DiLC≥10 as the main independent predictor of SOE. CONCLUSIONS Provided prospective validation, DC for AC in patients with DiLC≥10 seems safer than EC and is not hospital-stay consuming.
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Affiliation(s)
- Stéphane Bourgouin
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France.
| | - Tristan Monchal
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France
| | - Clément Julien
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France
| | - Florent d'Argouges
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France
| | - Paul Balandraud
- Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
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Predictive factors for developing acute cholangitis and/or cholecystitis in patients undergoing delayed cholecystectomy: A retrospective study. Asian J Surg 2020; 44:280-285. [PMID: 32709456 DOI: 10.1016/j.asjsur.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/27/2020] [Accepted: 07/05/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND /Objective: We evaluated the risk of acute cholangitis and/or cholecystitis while waiting for cholecystectomy for gallstones. METHODS We retrospectively enrolled 168 patients who underwent cholecystectomy for gallstones after conservative therapy. We compared clinical data of 20 patients who developed acute cholangitis and/or cholecystitis while waiting for cholecystectomy (group A) with 148 patients who did not develop (group B). We investigated surgical outcomes and risk factors for developing acute cholangitis and/or cholecystitis. RESULTS Preoperatively, significant numbers of patients with previous history of acute grade II or III cholecystitis (55.0% vs 10.8%; p < 0.001) and biliary drainage (20.0% vs 2.0%; p = 0.004) were observed between groups A and B. White blood cell counts (13500/μL vs 8155/μL; p < 0.001) and C-reactive protein levels (12.6 vs 5.1 mg/dL; p < 0.001) were significantly higher in group A than in group B; albumin levels (3.2 vs 4.0 g/dL; p < 0.001) were significantly lower in group A. Gallbladder wall thickening (≥5 mm) (45.0% vs 18.9%; p = 0.018), incarcerated gallbladder neck stones (55.0% vs 22.3%; p = 0.005), and peri-gallbladder abscess (20.0% vs 1.4%; p = 0.002) were significantly more frequent in group A than in group B. A higher conversion rate to open surgery (20.0% vs 2.0%; p = 0.004), longer operation time (137 vs 102 min; p < 0.001), and higher incidence of intraoperative complications (10.0% vs 0%; p = 0.014) were observed in group A, compared with group B. CONCLUSION A history of severe cholecystitis may be a risk factor for acute cholangitis and/or cholecystitis in patients waiting for surgery; it may also contribute to increased surgical difficulty.
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Ninomiya S, Amano S, Ogawa T, Ueda Y, Shiraishi N, Inomata M, Shimoda K. The impact of dementia on surgical outcomes of laparoscopic cholecystectomy for symptomatic cholelithiasis and acute cholecystitis: A retrospective study. Asian J Endosc Surg 2020; 13:351-358. [PMID: 31389183 DOI: 10.1111/ases.12743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/03/2019] [Accepted: 07/17/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of this study was to clarify the impact of dementia on surgical outcomes of laparoscopic cholecystectomy for symptomatic cholelithiasis and acute cholecystitis. METHODS We reviewed medical data of 96 patients who underwent laparoscopic cholecystectomy for symptomatic cholecystitis and acute cholecystitis. The patients were divided into the dementia group (n = 18) and non-dementia group (n = 78). Clinical features of the patients and surgical outcomes were compared between the two groups. RESULTS Mean age and rates of The American Society of Anesthesiologists Physical Status classification score > 2 in the dementia group were significantly higher than those of the non-dementia group (P < .001, P = .008, respectively). Incidences of acute cholecystitis and the rate of percutaneous transhepatic gallbladder drainage in the dementia group were significantly higher than those of the non-dementia group (P = .009, P = .01, respectively). The rates of conversion to laparotomy and non-surgical complications in the dementia group were higher than those in the non-dementia group (P = .02, P = .03, respectively). Postoperative hospital stay in the dementia group was significantly longer than that in the non-dementia group (15.2 ± 9.3 vs 8.2 ± 3.2 days, P = .009). Subgroup analysis of patients with acute cholecystitis showed postoperative hospital stay in the dementia group to be significantly longer than that in the non-dementia group (18.7 ± 10.7 vs 10.3 ± 4.2 days, P = .03). CONCLUSION Patients with dementia who underwent laparoscopic cholecystectomy have a high incidence of acute cholecystitis and a high rate of percutaneous transhepatic gallbladder drainage, which may result in increased rates of conversion to laparotomy and prolong the postoperative hospital stay.
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Affiliation(s)
- Shigeo Ninomiya
- Department of Surgery, Cosmos Hospital, Usuki, Japan.,Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | - Shota Amano
- Department of Surgery, Cosmos Hospital, Usuki, Japan
| | - Tadashi Ogawa
- Department of Surgery, Cosmos Hospital, Usuki, Japan
| | - Yoshitake Ueda
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Norio Shiraishi
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
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20
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Goh SNS, Chia CLK, Ong JW, Quek JJX, Lim WW, Tan KY, Goo JTT. Improved outcomes for index cholecystectomy for acute cholecystitis following a dedicated emergency surgery and trauma service (ESAT). Eur J Trauma Emerg Surg 2020; 47:1535-1541. [PMID: 32020247 DOI: 10.1007/s00068-020-01308-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/20/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Si Ning Serene Goh
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
| | - Clement Luck Khng Chia
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Jing Wen Ong
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - John Jian Xian Quek
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Woan Wui Lim
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Jerry Tiong Thye Goo
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
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21
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Borzellino G, Khuri S, Pisano M, Mansour S, Allievi N, Ansaloni L, Kluger Y. Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis revised: Protocol of a systematic review and meta-analysis of results. World J Emerg Surg 2020; 15:1. [PMID: 31911813 PMCID: PMC6942279 DOI: 10.1186/s13017-019-0285-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/20/2019] [Indexed: 12/24/2022] Open
Abstract
Background Early laparoscopic cholecystectomy has been adopted as the treatment of choice for acute cholecystitis due to a shorter hospital length of stay and no increased morbidity when compared to delayed cholecystectomy. However, randomised studies and meta-analysis report a wide array of timings of early cholecystectomy, most of them set at 72 h following admission. Setting early cholecystectomy at 72 h or even later may influence analysis due to a shift towards a more balanced comparison. At this time, the rate of resolving acute cholecystitis and the rate of ongoing acute process because of failed conservative treatment could be not so different when compared to those operated with a delayed timing of 6-12 weeks. As a result, randomised comparison with such timing for early cholecystectomy and meta-analysis including such studies may have missed a possible advantage of an early cholecystectomy performed within 24 h of the admission, when conservative treatment failure has less potential effects on morbidity. This review will explore pooled data focused on randomised studies with a set timing of early cholecystectomy as a maximum of 24 h following admission, with the aim of verifying the hypothesis that cholecystectomy within 24 h may report a lower post-operative complication rate compared to a delayed intervention. Methods A systematic review of the literature will identify randomised clinical studies that compared early and delayed cholecystectomy. Pooled data from studies that settled the early intervention within 24 h from admission will be explored and compared in a sub-group analysis with pooled data of studies that settled early intervention as more than 24 h. Discussion This paper will not provide evidence strong enough to change the clinical practice, but in case the hypothesis is verified, it will invite to re-consider the timing of early cholecystectomy and might promote future clinical research focusing on an accurate definition of timing for early cholecystectomy for acute cholecystitis.
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Affiliation(s)
- Giuseppe Borzellino
- Department of General Surgery, University Hospital of Verona Italy, Piazzale A. STEFANI 1, 37128 Verona, Italy
| | - Safi Khuri
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michele Pisano
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Subhi Mansour
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Niccolò Allievi
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Luca Ansaloni
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
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22
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Rice CP, Vaishnavi KB, Chao C, Jupiter D, Schaeffer AB, Jenson WR, Griffin LW, Mileski WJ. Operative complications and economic outcomes of cholecystectomy for acute cholecystitis. World J Gastroenterol 2019; 25:6916-6927. [PMID: 31908395 PMCID: PMC6938729 DOI: 10.3748/wjg.v25.i48.6916] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent management of acute cholecystitis favors same admission (SA) or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings. We adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this practice. We hypothesized that the existence of complications, particularly among patients with a higher degree of disease severity, during SA cholecystectomy could negate the cost savings.
AIM To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.
METHODS Under an IRB-approved protocol, complications and charges for were obtained for SA, later after conservative management (Delayed), or elective cholecystectomies over an 8.5-year period. Patients were identified using the acute care surgery registry and billing database. Data was retrieved via EMR, operative logs, and Revenue Cycle Operations. The severity of acute cholecystitis was graded according to the Tokyo Guidelines. TG18 categorizes acute cholecystitis by Grades 1, 2, and 3 representing mild, moderate, and severe, respectively. Comparisons were analyzed with χ2, Fisher’s exact test, ANOVA, t-tests, and logistic regression; significance was set at P < 0.05.
RESULTS Four hundred eighty-six (87.7%) underwent a SA while 68 patients (12.3%) received Delayed cholecystectomy. Complication rates were increased after SA compared to Delayed cholecystectomy (18.5% vs 4.4%, P = 0.004). The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy (7.4%, P = 0.35). Mortality rates were 0.6% vs 0% for SA vs Delayed. Patients with moderate disease (Tokyo 2) suffered more complications among SA while none who were delayed experienced a complication (16.1% vs 0.0%, P < 0.001). Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach ($44500 ± $59000 vs $35300 ± $16700, P = 0.019). The relative risk of developing a complication was 4.2x [95% confidence interval (CI): 1.4-12.9] in the SA vs Delayed groups. Among eight patients (95%CI: 5.0-12.3) with acute cholecystitis undergoing SA cholecystectomy, one patient will suffer a complication.
CONCLUSION Patients with Tokyo Grade 2 acute cholecystitis had more complications and increased hospital charges when undergoing SA cholecystectomy. This data supports a selective approach to SA cholecystectomy for acute cholecystitis.
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Affiliation(s)
- Christopher P Rice
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | | | - Celia Chao
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Daniel Jupiter
- Department of Preventive Medicine and Community Health, Department of Biostatistics, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - August B Schaeffer
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Whitney R Jenson
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Lance W Griffin
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - William J Mileski
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
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23
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Nguyen CL, van Dijk A, Smith G, Leibman S, Mittal A, Albania M, de Reuver P, Hugh TJ. Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters. ANZ J Surg 2019; 90:295-299. [PMID: 31845500 DOI: 10.1111/ans.15603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/21/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is often performed during the index admission after emergency presentation for acute biliary pain. Many patients have acute cholecystitis (AC) that may increase operative difficulty and complications. Our primary aim was to assess the validity of Tokyo Guidelines (TG18) for diagnosing AC by comparison with the admitting team diagnosis, operative findings and histopathology. The secondary aim was to assess outcomes after same-admission or delayed LC. METHODS Retrospective analysis of patients who underwent LC after presenting to a tertiary hospital emergency department over a 12-month period was conducted. RESULTS A total of 139 patients underwent LC with no mortality or bile duct injury. A diagnosis of AC made by the admitting surgical team had sensitivity of 84% and specificity of 57%. The TG18 diagnosis had sensitivity of 84% and specificity of 53%. A diagnosis of AC by the admitting surgical team correlated well with TG18 criteria diagnosis. There was poor correlation between clinical and histopathological diagnoses. Nine percent of patients had complications and 4% required conversion to open procedure. Patients with a clinical diagnosis of AC had longer post-operative length of stay and more complications compared with those who had non-AC diagnosis. There was no difference in outcomes between same-admission LC or delayed LC. CONCLUSION TG18 diagnosis of AC does not improve accuracy of diagnosis or predictability of a poor outcome over the admitting surgical team diagnosis. Same-admission LC for patients with AC is associated with similar outcomes compared to those who undergo delayed LC.
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Affiliation(s)
- Chu Luan Nguyen
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Aafke van Dijk
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Garett Smith
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven Leibman
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Maria Albania
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Philip de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Thomas J Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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24
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Brunée L, Hauters P, Closset J, Fromont G, Puia-Negelescu S. Assessment of the optimal timing for early laparoscopic cholecystectomy in acute cholecystitis: a prospective study of the Club Coelio. Acta Chir Belg 2019; 119:309-315. [PMID: 30354853 DOI: 10.1080/00015458.2018.1529344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: The optimal timing for cholecystectomy in patients with acute cholecystitis remains controversial. The aim of this study is to assess prospectively the impact of the duration of symptoms on outcomes in early laparoscopic cholecystectomy (ELC) for acute cholecystitis. Methods: The series consisted of 276 consecutive patients who underwent ELC for acute cholecystitis in 2016. The patients were divided into three groups according to the timing of surgery: within the first 3 days (group 1), between 4 and 7 days (group 2) and beyond 7 days (group 3) from the onset of symptoms. Results: The percentage of surgical procedure rated as difficult was respectively: 12% in G1, 18% in G2 and 38% in G3 (p < .001). Accordingly, we observed an increased mean operative time within groups but no significant difference in the conversion rate. We noted a different overall postoperative complication rate within groups, respectively: 9% in G1, 14% in G2 and 24% in G3 (p < .04). The median hospital stay was also different within groups, respectively: 3 in G1, 4 in G2 and 6 days in G3 (p < .001). On univariate analysis, age ≥60, male gender, ASA 3, WBC ≥13.000/µL, CRP ≥100 mg/l and delay between onset of symptoms and surgery were factors statistically associated with increased morbidity rate. On multivariate analysis, the delay was the only independent predictive factor of postoperative morbidity (OR: 1,08, 95% CI: 1.01-1.61, p < .031). Conclusion: Our study confirms that it is ideal to perform ELC within 3 days of symptoms onset and reasonable between 4 to 7 days. We do not recommend performing ELC beyond 7 days because of more difficult procedure and significantly increased risk of post-operative complications.
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Affiliation(s)
| | | | - J. Closset
- Erasme University Hospital, Bruxelles – B, Belgium
| | - G. Fromont
- Hôpital de Bois-Bernard, Bois-Bernard – F, Belgium
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25
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Gallagher TK, Kelly ME, Hoti E. Meta-analysis of the cost-effectiveness of early versus delayed cholecystectomy for acute cholecystitis. BJS Open 2019; 3:146-152. [PMID: 30957060 PMCID: PMC6433303 DOI: 10.1002/bjs5.50120] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 10/15/2018] [Indexed: 01/03/2023] Open
Abstract
Background Acute calculous cholecystitis (ACC) is a common disease across the world and is associated with significant socioeconomic costs. Although contemporary guidelines support the role of early laparoscopic cholecystectomy (ELC), there is significant variation among units adopting it as standard practice. There are many resource implications of providing a service whereby cholecystectomies for acute cholecystitis can be performed safely. Methods Studies that incorporated an economic analysis comparing early with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were identified by means of a systematic review. A meta‐analysis was performed on those cost evaluations. The quality of economic valuations contained therein was evaluated using the Quality of Health Economic Studies (QHES) analysis score. Results Six studies containing cost analyses were included in the meta‐analysis with 1128 patients. The median healthcare cost of ELC versus DLC was €4400 and €6004 respectively. Five studies had adequate data for pooled analysis. The standardized mean difference between ELC and DLC was −2·18 (95 per cent c.i. −3·86 to −0·51; P = 0·011; I2 = 98·7 per cent) in favour of ELC. The median QHES score for the included studies was 52·17 (range 41–72), indicating overall poor‐to‐fair quality. Conclusion Economic evaluations within clinical trials favour ELC for ACC. The limited number and poor quality of economic evaluations are noteworthy.
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Affiliation(s)
- T K Gallagher
- Department of Hepatobiliary and Transplant Surgery St Vincent's University Hospital Elm Park, Dublin 4 Ireland, D04 T6F4
| | - M E Kelly
- Department of Hepatobiliary and Transplant Surgery St Vincent's University Hospital Elm Park, Dublin 4 Ireland, D04 T6F4
| | - E Hoti
- Department of Hepatobiliary and Transplant Surgery St Vincent's University Hospital Elm Park, Dublin 4 Ireland, D04 T6F4
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Serna JC, Patiño S, Buriticá M, Osorio E, Morales CH, Toro JP. Incidencia de lesión de vías biliares en un hospital universitario: análisis de más de 1.600 colecistectomías laparoscópicas. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kohga A, Suzuki K, Okumura T, Yamashita K, Isogaki J, Kawabe A, Kimura T. Outcomes of early versus delayed laparoscopic cholecystectomy for acute cholecystitis performed at a single institution. Asian J Endosc Surg 2019; 12:74-80. [PMID: 29611896 DOI: 10.1111/ases.12487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/22/2018] [Accepted: 03/05/2018] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Debate continues regarding the clinical outcomes of early laparoscopic cholecystectomy (ELC) versus delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis (AC). The aim of this retrospective study was to compare clinical outcomes of ELC and DLC. METHODS This study consisted of 465 patients who had undergone laparoscopic cholecystectomy for AC between January 2000 and February 2017. Patients were divided between an ELC group (patients who underwent laparoscopic cholecystectomy within 6 days of symptom onset, n = 288) and a DLC group (patients who underwent laparoscopic cholecystectomy at least 7 days from symptom onset, n = 177), and clinical outcomes were compared. RESULTS Operation time (105 vs 124 min), length of postoperative hospital stay (4 vs 4 days), conversion rate (1.3% vs 10.7%), bile leak (0.3% vs 3.3%), residual calculus (2.4% vs 6.7%), and readmission (1.0% vs 6.7%) were significantly better in the ELC group. A history of upper abdominal surgery, grade II or grade III AC, preoperative percutaneous transhepatic gallbladder drainage, and time between symptom onset and surgery of more than 7 days were independent risk factors for conversion. CONCLUSIONS ELC for AC yields more favorable clinical outcomes than DLC.
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Affiliation(s)
- Atsushi Kohga
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Kenji Suzuki
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Takuya Okumura
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Kimihiro Yamashita
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Jun Isogaki
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Akihiro Kawabe
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Taizo Kimura
- Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan
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Inoue K, Ueno T, Douchi D, Shima K, Goto S, Takahashi M, Morikawa T, Naitoh T, Shibata C, Naito H. Risk factors for difficulty of laparoscopic cholecystectomy in grade II acute cholecystitis according to the Tokyo guidelines 2013. BMC Surg 2017; 17:114. [PMID: 29183352 PMCID: PMC5706415 DOI: 10.1186/s12893-017-0319-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/20/2017] [Indexed: 01/11/2023] Open
Abstract
Background The Tokyo Guidelines 2013 classifies acute cholecystitis (AC) into three grades and recommends appropriate therapy for each grade. For grade II AC, either early laparoscopic cholecystectomy (LC) or percutaneous transhepatic gallbladder drainage (PTGBD) should be performed. This study aimed to identify the risk factors for difficulty of LC for treating grade II AC. Methods Totally, 122 patients who underwent LC for grade II AC were enrolled and divided into difficult LC (DLC) and nondifficult LC (NDLC) groups. The DLC group included patients who experienced one of the following conditions: conversion from LC to open cholecystectomy, operating time ≥ 180 min, or blood loss ≥300 ml. Preoperative characteristics and postoperative outcomes were analyzed. Results In univariate analysis, risk factors included male sex, interval between symptom onset and admission, interval between symptom onset and LC, and anticoagulant therapy. The incidence of postoperative complications was higher in the DLC group than in the NDLC group (23.5% vs. 4.6%, p = 0.0016). According to receiver operating characteristic curves, the optimal cutoff value was calculated, and multivariate analysis showed that male sex [odds ratio (OR), 5.76; 95% confidence interval (CI), 1.979–19.51; p = 0.0009) and interval between symptom onset and LC of over 96 h (OR, 6.32; 95% CI, 2.126–20.15; p = 0.0009) were independent risk factors for difficulty of LC. Conclusions In patients with grade II AC, LC was technically difficult when performed over 96 h after symptom onset. Moreover, male sex was a risk factor. Therefore, PTGBD should be considered in these patients. Electronic supplementary material The online version of this article (10.1186/s12893-017-0319-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Koetsu Inoue
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan.
| | - Tatsuya Ueno
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Daisuke Douchi
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Kentaro Shima
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Shinji Goto
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Michinaga Takahashi
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Takanori Morikawa
- Department of surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takeshi Naitoh
- Department of surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Chikashi Shibata
- Division of Gastroenterological Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Hukumuro Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
| | - Hiroo Naito
- Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
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Abstract
PURPOSE OF REVIEW Various aspects of the management of acute calculous cholecystitis, including type and timing of surgery, role of antibiotics, and nonoperative management, remain controversial. This review focuses on recently published studies addressing the timing of cholecystectomy, use of cholecystostomy tubes, and role of antibiotics in this condition. RECENT FINDINGS In most cases, the diagnosis of acute cholecystitis can be initially confirmed with an abdominal ultrasound. Early laparoscopic cholecystectomy (within 24-72 h of symptom onset) is better than delayed surgery (>7 days) for most patients with grade I and II diseases. Percutaneous cholecystostomy and novel endoscopic gallbladder drainage interventions may be used as a temporizing measure or as definitive therapy in those who are too sick to undergo surgery. Studies are conflicting as to whether antibiotics are required for the treatment of uncomplicated cases. SUMMARY Cholecystectomy remains the only definitive therapy for acute cholecystitis. Current guidelines recommend treatment on the basis of disease severity at presentation. Antibiotics and a variety of minimally invasive nonsurgical interventions, although not definitive, play an adjunctive role in the management of the disease.
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Endo I, Takada T, Hwang TL, Akazawa K, Mori R, Miura F, Yokoe M, Itoi T, Gomi H, Chen MF, Jan YY, Ker CG, Wang HP, Kiriyama S, Wada K, Yamaue H, Miyazaki M, Yamamoto M. Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-Taiwan multicenter cohort study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:346-361. [PMID: 28419741 DOI: 10.1002/jhbp.456] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. METHODS An international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. RESULTS The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0-3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30-day mortality in Grade I+II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30-day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. CONCLUSION Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity.
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Affiliation(s)
- Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsann-Long Hwang
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Kohei Akazawa
- Department of Medical Informatics, Niigata University, Niigata, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Harumi Gomi
- Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan
| | - Miin-Fu Chen
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Masaru Miyazaki
- Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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31
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P Blackwood B, Grabowski J. Chronic cholecystitis in the pediatric population: an underappreciated disease process. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2017; 10:125-130. [PMID: 28702136 PMCID: PMC5495900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM We hypothesize that chronic cholecystitis accounts for the majority of inflammatory diseases in the pediatric population and it is difficult to predict with preoperative ultrasound. BACKGROUND Despite the increase in gallbladder disease, there is a paucity of data on pediatric cholecystitis. Most pediatric studies focus on cholelithiasis and biliary dyskinesia rather than inflammatory gallbladder disease. METHODS We performed a single center retrospective review of all patients who underwent cholecystectomy from 1/1/10 - 1/1/15. Relevant data was extracted, including age, sex, acute vs. chronic presentation, duration of symptoms, preoperative imaging findings, and surgical pathology results. RESULTS Out of the 170 patients identified, there were 129 (75.9%) females and 41 (24.1%) males. The average age was 14 years (range 4-23 years). Seventy-six patients presented with acute symptoms with an average duration of pain of 2 days. Ninety-four patients presented with chronic symptoms and had an average duration of pain of 7.4 months. Eight patients (4.7%) had preoperative ultrasound that suggested inflammation, while the remaining showed only cholelithiasis. Pathology revealed chronic cholecystitis in 148 (87.1%). Among those who had pathologic evidence of chronic cholecystitis, preoperative inflammation was seen in only 5 patients (3.3%). CONCLUSION Chronic cholecystitis accounts for the majority of pediatric inflammatory diseases. These data suggest that most pediatric patients experience episodes of inflammation prior to cholecystectomy. Underappreciated gallbladder inflammation may delay surgical referral, increase emergency department and primary doctor visits, and lead to more difficult operations. Surgeons should consider early cholecystectomy when cholelithiasis and symptoms are present.
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Affiliation(s)
- Brian P Blackwood
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA,Department of General Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Julia Grabowski
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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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: 3.6] [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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33
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Song GM, Bian W, Zeng XT, Zhou JG, Luo YQ, Tian X. Laparoscopic cholecystectomy for acute cholecystitis: early or delayed?: Evidence from a systematic review of discordant meta-analyses. Medicine (Baltimore) 2016; 95:e3835. [PMID: 27281088 PMCID: PMC4907666 DOI: 10.1097/md.0000000000003835] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The laparoscopic cholecystectomy (LC) is an important approach of treating acute cholecystitis and the timing of performing this given treatment is associated with clinical outcomes. Although several meta-analyses have been done to investigate the optimal timing of implementing this treatment, the conflicting findings from these meta-analyses still confuse decision-making. And thus, we performed this systematic review to assess discordant meta-analyses and generate conclusive findings to facilitate informed decision-making in clinical context eventually. We electronically searched the PubMed, Cochrane Library, and EMBASE to include meta-analysis comparing early (within 7 days of the onset of symptoms) with delayed LC (at least 1 week after initial conservative treatment) for acute cholecystitis through August 2015. Two independent investigators completed all tasks including scanning and appraising eligibility, abstracting essential information using prespecified extraction form, assessing methodological quality using Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR) tool, and assessing the reporting quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), as well as implementing Jadad algorithm in each step for the whole process. A heterogeneity degree of ≤50% is accepted. Seven eligible meta-analyses were included eventually. Only one was Level I of evidence and remaining studies were Level II of evidence. The AMSTAR scores varied from 8 to 11 with a median of 9. The PRISMA scores varied from 19 to 26. The most heterogeneity level fell into the desired criteria. After implementing Jadad algorithm, 2 meta-analyses with more eligible RCTs were selected based on search strategies and implication of selection. The best available evidence indicated a nonsignificant difference in mortality, bile duct injury, bile leakage, overall complications, and conversion to open surgery, but a significant reduction in wound infection, hospitalization, and operation duration and improvement of the quality of life when compared early LC with delayed LC. However, number of work days lost, hospital costs, and patient satisfaction are warranted to be assessed further. With the best available evidence, we recommend early LC to be as the standard treatment option in treating acute cholecystitis.
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Affiliation(s)
- Guo-Min Song
- Department of Nursing, Tianjin Hospital, Tianjin
| | - Wei Bian
- Southwest Hospital/Southwest Eye Hospital, Southwest Hospital, Third Military Medical University, Chongqing
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital, Wuhan University, Wuhan
| | - Jian-Guo Zhou
- Department of Oncology, Affiliated Hospital to Zunyi Medical University, Zunyi, Guizhou
| | - Yong-Qiang Luo
- Emergency Department, Sichuan Anyue County People's Hospital, Anyue, Sichuan
| | - Xu Tian
- Department of Nursing, Chongqing Cancer Institute, Chongqing, China
- ∗Correspondence: Dr. Xu Tian, Department of Nursing, Chongqing Cancer Institute, 181 Hanyu Road, Shapingba District, Chongqing 404100, China (e-mail: )
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