Gall Bladder Empyema: Early Cholecystectomy during the Index Admission Improves Outcomes
| Autor: | Samer Zino, Hisham El Zanati, Ahmad H M Nassar, Ayman Abdellatif, Tarek Katbeh, Hwei J Ng |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male 050101 languages & linguistics medicine.medical_specialty Late referral medicine.medical_treatment Cholecystitis Acute Operative Time difficulty grading 050105 experimental psychology Time-to-Treatment Young Adult intraopertative cholangiography Patient Admission medicine Acute cholecystitis Cholecystitis Humans 0501 psychology and cognitive sciences Nassar scale laparoscopic cholecystectomy Aged Aged 80 and over Intention-to-treat analysis business.industry General surgery 05 social sciences Significant difference Length of Stay Middle Aged medicine.disease Empyema gallbladder empyema Outcome parameter Treatment Outcome Cholecystectomy Laparoscopic Surgery Cholecystectomy Female business Hospital stay Research Article |
| Zdroj: | JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons |
| ISSN: | 1938-3797 |
| Popis: | Objectives We aim to evaluate our policy of index admission management of gall bladder empyema and the effect of the timing of surgery on the outcomes. Methods We analyzed a series of 5400 laparoscopic cholecystectomies. Data were collected prospectively over 26 y. Patients were divided into two groups: group 1, intervention within 72 h, and group 2, intervention after 72 h of admission. We had a policy of intention to treat during the index admission, but delays sometimes occurred because of late referral, a need to optimize patients, availability of theater time, or the biliary surgeon being on leave. The groups were then compared with regard to the duration of surgery, the difficulty grading, complications, hospital stay, and conversion rate. Results A total of 372 patients were included; 160 (43%) operated on within 72 h (group 1) and 212 (57%) after 72 h (group 2). There was no statistically significant difference between the two groups with regard to the operation time, conversion rate, and complications rate. The difference in total hospital stay was, however, statistically significant. Conclusion Surgical management of empyema should be offered as soon as possible after admission as with any acute cholecystitis. Surgery carried out after 72 h of admission is only associated with longer hospital stay but no statistically significant differences in other outcome parameters. In the presence of specialist expertise, fitness for surgery should be the determining factor of whether or not to offer surgery to these patients, regardless of the interval since their admission. |
| Databáze: | OpenAIRE |
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