Cholecystectomy in the elderly: A prospective study

Houghton, P. W.; Jenkinson, Lloyd R.; Donaldson, L. A.

doi:10.1002/bjs.1800720327

Cited by 161 publications

(61 citation statements)

References 25 publications

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“…Urgent or early cholecystectomy is the standard therapy for acute cholecystitis (1,2). Cholecystectomy is generally a safe procedure, but the surgical risk is high in patients with severe medical or surgical comorbidities (3). In such high-risk patients, percutaneous der stenting (EGBS) is a promising alternative treatment option for critically ill patients with symptomatic acute cholecystitis (10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Endoscopic Gallbladder Stenting for Acute Cholecystitis in Patients with Concomitant Unresectable Cancer

et al. 2016

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Objective Endoscopic gallbladder stenting (EGBS) is an alternative treatment option for high-risk surgical patients with acute cholecystitis. However, there are no reports focusing on EGBS in patients with concomitant unresectable cancer. The aim of this study was thus to evaluate EGBS in such patients. Methods Twenty-two consecutive patients with acute cholecystitis and unresectable cancer were enrolled between September 2010 and December 2014. Their median age was 74.5 years (range: 51-95). Thirteen patients were men and nine were women. The primary cancers of the patients were biliary tract cancer (9), pancreas cancer (9), lung cancer (2), gastric cancer (1), and colon cancer (1). The causes of cholecystitis were calculus cholecystitis (7), obstruction by malignant tumor (13), and obstruction by fully covered stent (2). Results EGBS was successfully performed in 17 patients (77.2%). The technical success rates for calculus cholecystitis, obstruction by malignant tumor, and obstruction by fully covered stent were 85.7% (6/7), 69.2% (9/13), and 100% (2/2), respectively. No complications were observed. Percutaneous transhepatic gallbladder drainage was conducted on two patients in whom EGBS had failed and then we performed EGBS by a rendezvous approach. Of the 19 patients in whom we finally deployed EGBS, the median follow-up period was 229 days (range: 14-880 days). A recurrence of acute cholecystitis occurred in three (15.7%) patients 14, 130, and 440 days after EGBS placement. The rates of recurrence of cholecystitis at one and two years were 10.5% and 18.7%, respectively. Conclusion Our study demonstrated that EGBS is a safe and effective method for acute cholecystitis in patients with concomitant unresectable cancer.

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Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Endoscopic Gallbladder Stenting for Acute Cholecystitis in Patients with Concomitant Unresectable Cancer

et al. 2016

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“…Although cholecystectomy is considered a safe operation in most patients with cholecystitis, the morbidity and mortality of this procedure increase considerably in elderly patients at high risk, including patients with cardiopulmonary or renal disease, sepsis, or multiorgan failure (3). In such cases, conservative measures such as performing a percutaneous cholecystostomy, which permits an interval cholecystectomy or cholecystolithotomy, can be considered as an alternative to minimize surgical and anesthetic trauma (1).…”

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confidence: 99%

Chemical Ablation of the Gallbladder with Acetic Acid

Lee

Won

Bae

et al. 2009

Journal of Vascular and Interventional Radiology

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PURPOSE: Chemical ablation of the gallbladder may be a useful alternative to surgery for inoperable disease. The purpose of this study was to investigate the feasibility of chemical ablation of the gallbladder with acetic acid in a canine model. MATERIALS AND METHODS:Five beagle dogs underwent percutaneous transhepatic cholecystostomy. Percutaneous occlusion of the cystic duct was performed with use of n-butyl cyanoacrylate (NBCA) and coils. After confirmation of occlusion of the cystic duct, sclerotherapy of the gallbladder was performed with 4 -7 mL of 50% acetic acid through the drainage catheter. Acetic acid was retained for 20 minutes with intermittent position change. The drainage catheter was removed immediately after sclerotherapy. The dogs were euthanized 8 weeks after the procedure. The gallbladders and adjacent organs were evaluated grossly as well as microscopically.RESULTS: All dogs survived without serious complications during the experimental period. Sclerotherapy was technically successful in all dogs. Gross specimens of the gallbladder showed shrinkage and fibrotic change without retention of any bile, mucus, or pus. Histologic examinations from the body and fundus of the gallbladder demonstrated complete ablation of the mucosa. However, the neck region of the gallbladder near the cystic duct, where NBCA and coils for cystic duct occlusion were located, had focal areas of remnant or regenerating mucosa.CONCLUSIONS: Chemical ablation of the gallbladder with 50% acetic acid was effective and safe. Complete ablation was achieved in the majority of gallbladder mucosa except for a small portion located in the gallbladder neck.

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“…There was no operative death in this small series. Reported mortality ranges from less than 1% for patients less than 60 years of age to 6.7% for patients 60 years or older [10,[14][15][16]. Wound infection of 1% in this study falls within reported limits of up to 7% [1,7].…”

Section: Discussionmentioning

confidence: 51%

Antimicrobial Prophylaxis for Cholecystectomy in Diabetes

Chiedozi

Al-Hady

1993

Ann Saudi Med

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Two schedules of antimicrobial agents were compared in this prospective study of antimicrobial prophylaxis in diabetes mellitus patients undergoing cholecystectomy for symptomatic cholelithiasis. One hundred women grouped into two matched groups of 50 women each were studied. The results suggest that apart from a population of patients with identifiable risks of complications, a 24 hour, four dose antimicrobial prophylaxis is adequate and more cost effective than the five day schedule for most patients. Ann Saudi Med 1993;13(6):498-500.LC Chiedozi, FH Al-Hady, Antimicrobial Prophylaxis for Cholecystectomy in Diabetes. 1993; 13(6): 498-500 Impairment of, and alteration in, the intrinsic properties of polymorphonuclear leukocytes in indifferently controlled diabetics has been postulated as one reason for increased susceptibility to infections in diabetes mellitus patients [1,2]. Routine prophylactic antibiotics for patients undergoing biliary tract surgery in the presence of high risk factors (recent episode of acute cholecystitis, age greater than 60 years) is now well established [3,6]. Due to their increased risk of sepsis and other complications, diabetics undergoing cholecystectomy for symptomatic cholecystitis are candidates for antimicrobial prophylaxis [5,6]. Which antimicrobial agent, what dosage, and for how long, however, is not clear [6]. Because diabetes mellitus and chronic cholecystitis are common in our patient population, a clear antimicrobial prophylaxis policy for our diabetics undergoing cholecystectomy for symptomatic cholecystitis is important. This study attempts to fulfill that need. Material and MethodsTwo schedules of antimicrobial prophylaxis for diabetics undergoing cholecystectomy for symptomatic cholecystitis were compared in this prospective study in Prince Abdulrahman Ibn Ahmed Al Sudery Central Hospital, Al Jouf, Saudi Arabia. A total of 100 women, ages 25 to 75 years, were admitted to the study. Of these, 60 (60%) patients had non-insulin dependent diabetes mellitus (NIDDM) while 40 (40%) had insulin-dependent diabetes mellitus (IDDM). All patients had clinical presentation consistent with chronic cholecystitis and ultrasound evidence of cholelithiasis. Excluded from the study were patients who had ultrasound evidence of choledocholithiasis, concurrent or history of jaundice, acalcular or emphysematous cholecystitis, and sensivity to cephalosporins. The patients were paired in terms of age, insulin dependence status, and body habitus (ectomorphic, mesomorphic, and endomorphic) to achieve two well matched groups of 50 patients each, designated Groups 1 and 2, which comprised the two arms of the study.All patients underwent cholecystectomy including intraoperative cholangiogram via a catheter passed through the cystic duct. All patients who were 80 kilograms or more in weight received 5,000 units of heparin on call to the operating room and q. 12 hourly postoperatively until fully ambulatory (usually 48 to 72 hours). Group 1 patients received 1 gram of cephradine intravenously on ca...

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Cholecystectomy in the elderly: A prospective study

Cited by 161 publications

References 25 publications

Efficacy and Safety of Endoscopic Gallbladder Stenting for Acute Cholecystitis in Patients with Concomitant Unresectable Cancer

Efficacy and Safety of Endoscopic Gallbladder Stenting for Acute Cholecystitis in Patients with Concomitant Unresectable Cancer

Chemical Ablation of the Gallbladder with Acetic Acid

Antimicrobial Prophylaxis for Cholecystectomy in Diabetes

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