Acute Cholecystitis

Gutt, Carsten N.; Encke, Jens; Köninger, Jörg; Harnoss, Julian-Camill; Weigand, Kilian; Kipfmüller, K.; Schunter, O; Götze, T.O.; Golling, M.; Menges, med.dent. Joachim; Klar, E.; Feilhauer, Katharina; Wg, Zoller; Ridwelski, K.; Ackmann, Sven; Baron, Alistair; Schön, Michael P.; Seitz, Helmut K.; Daniel, D.; Stremmel, Wolfgang; Büchler, Markus W.

doi:10.1097/sla.0b013e3182a1599b

Cited by 372 publications

(112 citation statements)

References 24 publications

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“…Gutt CN et al [17] believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients, as; laparoscopic cholecystectomy in their study within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs Also, Barcelo et al [18] concluded that, early cholecystectomy in acute cholecystitis can reduce the hospital stay without increase of the conversion rate or complications.…”

Section: Discussionmentioning

confidence: 99%

“…Bile leak and bile duct injury are the two most feared complications of laparoscopic cholecystectomy for acute cholecystitis; the reported incidence for bile leaks after laparoscopic cholecystectomy for acute cholecystitis is around 0.25% for elective laparoscopic cholecystectomy but rises to 2-3% in the presence of acute inflammation [11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

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Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis

Taha¹,

Yousef²,

Gaber³

2016

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Abstract:Introduction: Acute cholecystitis is a relatively common complication of gallstones It can lead to significant morbidity and mortality from potentially life-threatening complications such as empyema, gallbladder gangrene and gallbladder perforation It presents as a surgical emergency and usually requires hospitalization for management Laparoscopic cholecystectomy is advocated for acute cholecystitis; however, the timing of cholecystectomy and the value of the additional treatments have been a matter of controversy Aim: To compare the outcome of early versus delayed laparoscopic cholecystectomy in cases of non-complicated acute cholecystitis, as its place remains controversial in the management of acute cholecystitis due to a high reported incidence of bile leaks and conversion rate Design: Prospective interventional comparative study Methods: 120 Patients admitted to Qena and Aswan universities' hospitals with acute cholecystitis over two years period (2013)(2014)(2015) were included in this study An early laparoscopic cholecystectomy (ELC), within 7 days from onset of symptoms, for 50 patients, and delayed Laparoscopic cholecystectomy (DLC) after 6 weeks of conservative treatment for 70 patients was performed Demographic details, operative findings, conversion to open surgery, operative time, complications, timing of endoscopic retrograde cholangiopancreatography (ERCP) and hospital stay for all those patients were recorded Statistical analysis was performed by SPSS version 18 Results: There was insignificant difference in the conversion rates (2 in ELC group versus 2 DLC group, p value: 0.555), post-operative hospital stay (2 days vs 1.5days, p value: 0.375) However, operative time was significantly more in the ELC group (85 minutes versus 70 minutes, p value: 0.023) Postoperative ERCP was required in 2 patients in ELC group and one patient in DLC group Pre-operative ERCP was required in 2 patients in delayed group 40% of patients (48) had previous admissions with similar symptoms Conclusion: ELC for uncomplicated acute cholecystitis is technically demanding surgery, but it is safe and do not have increased complication rate than DLC It decreases re-admission rate and overall hospital stay.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis

Taha¹,

Yousef²,

Gaber³

2016

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“…The concern for increased morbidity by operating in a surgical field of acute inflammation still persists. While significantly decreased morbidity rates for patients undergoing EC (12.0%) compared to DC (33.3%) was demonstrated in the ACDC trial, these results were not replicated on a recent meta-analysis where similar morbidity rates between EC patients and DC patients (0.12% vs 0.27%) were observed [7,8] . In the elderly population, where the number of comorbidities is often higher, similar morbidity rates were shown between EC patients and DC patients [9] .…”

Section: The Dichotomy Of Laparoscopic Cholecystectomy Timingmentioning

confidence: 51%

“…In the elderly population, where the number of comorbidities is often higher, similar morbidity rates were shown between EC patients and DC patients [9] . However, decreased rates of cholangitis and persistent cholecystitis (1.3% vs 10.3%) and a decreased rate of septic shock (0.0% vs 1.3%) have been demonstrated in EC patients [7] . Most studies with the highest level of evidence demonstrated similar morbidity rates between EC and DC patients while some even show improved outcomes for EC patients [4,[7][8][9] .…”

Section: The Dichotomy Of Laparoscopic Cholecystectomy Timingmentioning

confidence: 99%

Training vs practice: A tale of opposition in acute cholecystitis

Patel

Daly

Velasco

2015

WJH

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“…According to up-to-date literature, first trouble accounts up to 16%, requiring an urgent LC, while an unnecessary delay results in a 23% recurrent rate, which can lead to an increased morbidity and mortality, increasing costs and need for facilities [4]. Total hospital stay was found to be shorter by 4 days in early treated patients.…”

mentioning

confidence: 99%

Commentary to paper “Feasibility of laparoscopic cholecystectomy for acute cholecystitis beyond 72 hours of symptom onset”

2016

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Cholelithiasis is a daily diagnosed pathology in clinical practice, all over the world. Gallstone disease is prevalent in 10% of the population, and up to 23% can develop into acute cholecystitis [1]. Laparoscopic cholecystectomy (LC) represents nowadays the ''gold standard'' for cholecystolithiasis since the late 1990s, but the best timing to treat a challenging concomitant condition, such as an acute cholecystitis, is still debated. As operating acutely was previously believed to be more technically challenging due to distorted anatomy from acute inflammation, a cooling off period has been advocated, employing a conservative treatment with empiric antibiotic therapy followed by elective surgery several weeks later. Conversely, this approach could require further readmissions for recurrent episodes; furthermore, chronic inflammation, leading to fibrosis and adhesions, may make for a difficult dissection in delayed LC. Following this background, several authors advocate an early surgery, within first 72 h from the onset of the symptoms, whereas others assume acceptable to wait even 4-6 weeks or more [1]. The debated key issues reside in intraoperative complications, needing a laparotomic conversion, operative time, cost containment, and reduction of length of stay (LOS), evaluating the subsequent quality of life, and improving the safety of the surgical act.A recent review by Gurusamy et al.[1] has shown as the proportion of people who developed a bile duct injury that was significantly lower in the early group, with no differences in other serious adverse events. However, the conversion rate was not significantly different. Similarly, also the operating time was comparable. Interestingly, Onoe et al. [2] have identified at univariate analysis C-reactive protein as predictive variable for laparotomic conversion; high CRP values ([10 mg/dl) have been related to the failure to create a critical view of safety, leading to a more accurate surgical strategy choice, in relation to the individual case.Pursuing the topic, a comprehensive meta-analysis by Cao et al. [3] demonstrates that these benefits will still present, although on a smaller scale, in the subgroup operated after 72 h, but within 7 days. This suggests that the ''72 h rule'' is an optimal timing; however, patients operated after this window still benefit from an early LC, rather than a non-operative management. This finding is particularly relevant because of the known logistical issues to schedule the procedures, lacking an appropriate access in our operating theaters.Two further disadvantages of delayed approach are the risk of unsuccessful conservative management and the chance of a recurrent episode. According to up-to-date literature, first trouble accounts up to 16%, requiring an urgent LC, while an unnecessary delay results in a 23% recurrent rate, which can lead to an increased morbidity and mortality, increasing costs and need for facilities [4]. Total hospital stay was found to be shorter by 4 days in early treated patients. Each day of saved h...

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Acute Cholecystitis

Cited by 372 publications

References 24 publications

Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis

Early Versus Delayed Laparoscopic Cholecystectomy for Uncomplicated Acute Cholecystitis

Training vs practice: A tale of opposition in acute cholecystitis

Commentary to paper “Feasibility of laparoscopic cholecystectomy for acute cholecystitis beyond 72 hours of symptom onset”

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