Delayed Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis: Is it Time for a Change?
| Autor: | Natalia Simanovsky, Jonathan B. Yuval, Baha Siam, Ahmed Eid, Daniel J. Weiss, Alon J. Pikarsky, Eran Kuchuk, Ido Mizrahi, Haggi Mazeh, Miklosh Bala, Gidon Almogy |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Cholecystitis Acute Gallstones 030230 surgery 03 medical and health sciences 0302 clinical medicine Postoperative Complications medicine Humans Laparoscopic cholecystectomy Aged Retrospective Studies Bile duct business.industry Open surgery Vascular surgery Length of Stay Middle Aged medicine.disease Conversion to Open Surgery Surgery Cardiac surgery medicine.anatomical_structure Cholecystectomy Laparoscopic Cardiothoracic surgery 030220 oncology & carcinogenesis Cholecystitis Female business Abdominal surgery |
| Zdroj: | World journal of surgery. 41(7) |
| ISSN: | 1432-2323 |
| Popis: | Our aim was to evaluate the advantages and limitations of delayed laparoscopic cholecystectomy (LC) in a tertiary center. A retrospective analysis of all patients admitted to our institution with acute calculous cholecystitis (ACC) between January 2003 and December of 2012 was performed. Data collected included patient demographics and comorbidities, presenting symptoms, laboratory findings, imaging results, length of stay (LOS), time to surgery, and surgical complications. A total of 1078 patients were admitted with ACC. There were 593 females (55%), and the mean age was 57 ± 0.6 years. Mean LOS at initial admission, re-admission until surgery, and following surgery was 7.9 ± 0.2, 1.5 ± 0.1, and 3.4 ± 0.2 days, respectively. Percutaneous cholecystostomy (PC) tube was inserted in 24% of the patients. Only 640 (59%) patients eventually underwent LC. Mean time to surgery was 97 ± 9.8 days, and 16.4% of patients were readmitted in this time period resulting in a mean total LOS of 10.6 ± 0.2 days. Conversion rate to open surgery was 5.8% and bile duct injury occurred in 1.1%. Postoperative complications occurred in 9.8% of the patients, and 30-day mortality was 0.6%. Patients with more severe inflammation according to Tokyo Criteria grade were more likely to undergo PC, were more likely to be readmitted while waiting for LC, and also had more postoperative complications. Delayed LC is associated with significant loss of follow-up, long LOS, and higher than expected use of PC. Conversion rates are lower than in the literature while rates of bile duct injury and mortality are comparable. We believe these data as well as the available literature are sufficient to change our hospital policy regarding the surgical treatment of ACC from delayed to early same admission surgery in appropriate cases. |
| Databáze: | OpenAIRE |
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