Utility of Tokyo guidelines and intraoperative safety steps in improving the outcome of laparoscopic cholecystectomy in complex acute calculus cholecystitis: a prospective study
| Autor: | Muktachand Rokade, Prashant Salvi, Pinky M. Thapar, Philip Roji, Madhura Killedar |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Percutaneous Cholecystitis Acute Calculi 03 medical and health sciences 0302 clinical medicine Postoperative Complications Internal medicine medicine Calculus Humans Prospective Studies Prospective cohort study Tokyo Laparoscopic cholecystectomy Grade IIIa business.industry Bile duct Hepatology Length of Stay medicine.disease medicine.anatomical_structure Treatment Outcome nervous system Cholecystectomy Laparoscopic 030220 oncology & carcinogenesis Cholecystitis 030211 gastroenterology & hepatology Surgery business Abdominal surgery |
| Zdroj: | Surgical endoscopy. 35(8) |
| ISSN: | 1432-2218 |
| Popis: | Laparoscopic cholecystectomy (LC) in complicated acute calculus cholecystitis (ACC) poses multiple challenges. This prospective, observational study assessed the utility and safety of a set protocol and intraoperative steps in LC for complex ACC. All cases of ACC from 2008 to 2018 were graded as per Tokyo guidelines; moderate and severe ACC were termed as ‘complex ACC (CACC).’ Patients were subjected to upfront LC or percutaneous drainage (PCD) followed by LC. Seven intraoperative safety steps were used to achieve critical view of safety (CVS). Use of safety steps, duration of surgery, and length of hospital stay were compared between moderate and severe ACC; complications were classified using Clavien–Dindo classification. We analyzed 145 patients with moderate (74.5%) and severe (25.5%) ACC. There were significantly more male (p = 0.0059) and older (p = 0.0006) patients with severe ACC. Upfront LC was performed in 81.4%; PCD required in 6.9%. Timing of LC from symptom onset was |
| Databáze: | OpenAIRE |
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