Surgical Versus Conservative Management of Delayed Presentation of Acute Biliary Disease: A Systematic Literature Review.
| Autor: | Khalifa A; Surgery, University of Aleppo Medical College, Aleppo, SYR., Allami SJ; Surgery, University of Sharjah, Sharjah, ARE., Tahhan O; Urology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR., Alhaj SS; Graduate Medical Education, Dubai Health Care, Sharjah, ARE., Al Tahan MA; Pharmacy, Aston University, Birmingham, GBR., Elnogoomi I; Surgery, Kuwait Hospital, Sharjah, ARE. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2024 Nov 22; Vol. 16 (11), pp. e74237. Date of Electronic Publication: 2024 Nov 22 (Print Publication: 2024). |
| DOI: | 10.7759/cureus.74237 |
| Abstrakt: | Biliary sepsis, characterized by contamination and infection of the biliary tract, poses a serious medical issue with detrimental effects on the patients. While cholecystectomy is the usual treatment for symptomatic gallstones, the most desirable management approach for biliary sepsis remains debated, prompting a scientific evaluation of the long-term effects of cholecystectomy. To compare the long-term outcomes of biliary sepsis in patients undergoing cholecystectomy versus conservative management (CM), this study will systematically review the existing literature to clarify differences in recurrence rates, complication rates, and overall survival. PubMed and the Cochrane Library were searched thoroughly for the literature review. Studies were included if they reported the effects of surgical and conservative interventions on predefined patient outcomes. A critical appraisal of the studies included was performed using CASP criteria. Fourteen studies were included, comprising prospective cohort studies and randomized controlled trials, with sample sizes varying from 52 to 234 patients. Endoscopic sphincterotomy (ES), early versus delayed laparoscopic cholecystectomy (D-LC), combined endoscopic-laparoscopic techniques, and percutaneous cholecystostomy followed by early laparoscopic cholecystectomy (E-LC) were the analyzed interventions. The primary conclusions showed that, in comparison to D-LC, E-LC significantly reduced hospital stays (p < 0.05), since the times were 58 and 167 hours for E-LC and D-LC, respectively. Additionally, E-LC resulted in fewer recurrent biliary events (4.3 compared to 36.2% of D-LC) and lower overall costs. ES demonstrated efficacy in mitigating the requirement for emergency cholecystectomy in patients at high risk, as evidenced by its 94% success rate in endoscopic stone removal. Without increasing postoperative complications, combined endoscopic-laparoscopic techniques showed high success rates for stone removal (95.6% common bile duct clearance rate). This systematic review highlights the favorable long-term effects of cholecystectomy in managing biliary sepsis. It emphasizes the importance of individualized treatment processes and considers conservative control for patients with high surgical risk and significant comorbidities. It also highlights the need for advancement in CM and provides insights that can help clinical decision-making to optimize outcomes in affected patients. Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Khalifa et al.) |
| Databáze: | MEDLINE |
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