Comparative Operative Outcomes of Early and Delayed Cholecystectomy for Acute Cholecystitis

Mestral, Charles de; Rotstein, Ori D.; Laupacis, Andreas; Hoch, Jeffrey S.; Zagorski, Brandon; Alali, Aziz S.; Nathens, Avery B.

doi:10.1097/sla.0b013e3182a5cf36

Cited by 154 publications

(129 citation statements)

References 37 publications

(39 reference statements)

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“…However even with significant as well as slightly better outcomes noted in ELC, the study also finds for the fact that ELC is better than DLC which is consistent with other studies. 13,14,26 Conversely, considering that two symptoms showed significant difference while the other two did not show significant difference, it can be stated that there is not statistically significant difference between ELC and DLC. This too is consistent with some findings in the literature.…”

Section: Discussionmentioning

confidence: 94%

“…Another study de Mestral et al evaluates the operative outcomes of early versus delayed cholecystectomy in acute cholecystitis. 14 The study is a retrospective cohort evaluating the impact of these procedures on very rare complications of bile duct injury and mortality. The study was conducted on a total of 22, 202 patients.…”

Section: Early Versus Delayed Cholecystectomymentioning

confidence: 99%

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Abdominal symptoms and its outcome in gallbladder diseases following routine and emergency cholecystectomy

Giridharan

Madhivadhanam

2017

Int Surg J

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Background: Gallstones constitute for the most common causes of biliary tract diseases in the adult population. The study thus aims to describe the persistence rate of abdominal symptoms in patients after elective cholecystectomy and to understand which symptoms, improve after cholecystectomy.Methods: This observational study is based in Melmaruvatthur Medical College and Research Institute where 69 patients were a part of the study. A pre and post structured questionnaire was used to assess the decrease in the rate of symptoms. After fully informed and written consent the study participants were interviewed questioneired, examined according to the preformed and pretested proforma, patients with a clinical and ultrasonographic diagnosis of gallstones filled out a structured questionnaire on abdominal pain symptoms and functional gastrointestinal disorder before and at six months after cholecystectomy.Results: From the observed chi square value of 9.315 and p value of 0.002 which is less than 0.01 so it is declared that there is an association between the cholecystectomy and symptoms in the post-surgical group.Conclusions: The findings of the study thus suggest that while much of the findings lean toward ELC being better than DLC, the significance values show that no difference exist between the two. The study therefore states that more research is required to ascertain whether ELC or DLC is better at reducing the symptoms associated with gall bladder disease.

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Section: Discussionmentioning

confidence: 94%

Section: Early Versus Delayed Cholecystectomymentioning

confidence: 99%

Abdominal symptoms and its outcome in gallbladder diseases following routine and emergency cholecystectomy

Giridharan

Madhivadhanam

2017

Int Surg J

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“…The idea that delayed cholecystitis is technically simpler due to reduced inflammation is not correct. In fact, the risk of wounding the main biliary tract is lower in early stage surgery [25], and the probability of conversion of this condition into a standardized early stage surgery is 8-16%, which is not significantly different from delayed surgery. Twenty five per cent of patients waiting for a delayed cholecystectomy are re-admitted and 18 % require urgent surgical intervention [14,[25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed

González-Muñoz

Angoso

Sayagués

et al. 2014

Langenbecks Arch Surg

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Disclosure:The authors declare no conflict of interest. Number of text pages: 17Tables: 1 Figures: 2 Word count: 2222 AbstractPurpose Therapeutic recommendations of acute cholecystitis are not consistently implemented, which generates greater patient morbidity and higher health care costs.The aim of this article is to evaluate the burden of acute cholecystitis, to detect potentially modifiable variables and to propose a therapeutic strategy that will allow us to improve the quality of care.Methods We carried out a retrospective study of patients who were admitted to the hospital from January 2010 to December 2012 using a univariate analysis of parameters including the admitting department, age, treatment administered and length of stay.Results A total of 967 patients were admitted to the hospital with a diagnosis of acute cholecystitis, 692 (72%) to the Surgery department, 257 (26%) to Internal MedicineDigestive and 18 (2%) to other departments. 498 (51.5%) were operated on: 107 (21%) on an urgent basis, 111 (22%) at an early stage (<96 hours at diagnosis), 152 (30%) at a late stage (>96 hours at diagnosis) and 128 (26%) at a delayed date (other admission).Patients who were admitted into the surgery department were five times more likely to be operated on than patients admitted into other departments (p<0.01). Patients operated on at a late stage had a longer length of stay than early stage surgery patients (p<0.05) and than non operated ones (p<0.05). Patients <74 years old were more frequently operated than older ones (p<0.05). ConclusionsThe non-standardized treatment of acute cholecystitis causes high clinical and surgical variability, long average stay, more re-admissions and high hospital costs.Therefore, patients with a diagnosis of acute cholecystitis should be admitted to the Surgery department, thereby increasing the probability of receiving definite treatment.

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“…Laparoscopic cholecystectomy (LC) is widely accepted as the treatment of choice for acute cholecystitis [1][2][3]. However, patients with acute cholecystitis demonstrate a wide spectrum of clinical manifestations.…”

Section: Introductionmentioning

confidence: 99%

“…LC for patients with severe inflammation is generally deemed difficult. Evidence for factors that might contribute to surgical difficulty during LC are ambiguous despite several existing studies (preoperative radiological findings [4][5][6], the optimal timing for LC [3,7], indications of preoperative interventions such as percutaneous transhepatic gallbladder drainage [8,9], etc). Most of the previous publications have adopted either the duration of surgery [4][5][6] or open conversion rate [10][11][12][13][14] as surrogate markers for surgical difficulty.…”

Section: Introductionmentioning

confidence: 99%

An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

Iwashita

Hibi

Ohyama

et al. 2017

J Hepatobiliary Pancreat Sci

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Background We previously identified 25 intraoperative findings during laparoscopic cholecystectomy (LC) as potential indicators of surgical difficulty per nominal group technique. This study aimed to build a consensus among expert LC surgeons on the impact of each item on surgical difficulty. Methods Surgeons from Japan, Korea, and Taiwan (n = 554) participated in a Delphi process and graded the 25 items on a seven-stage scale (range, 0-6). Consensus was defined as (1) the interquartile range (IQR) of overall responses ≤2 and (2) ≥66% of the responses concentrated within a median AE 1 after stratification by workplace and LC experience level. Results Response rates for the first and the second-round Delphi were 92.6% and 90.3%, respectively. Final consensus was reached for all the 25 items. 'Diffuse scarring in the Calot's triangle area' in the 'Factors related to inflammation of the gallbladder' category had the strongest impact on surgical difficulty (median, 5; IQR, 1). Surgeons agreed that the surgical difficulty increases as more fibrotic change and scarring develop. The median point for each item was set as the difficulty score. Conclusions A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.

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Comparative Operative Outcomes of Early and Delayed Cholecystectomy for Acute Cholecystitis

Abstract: These results support the benefit of early overdelayed cholecystectomy for patients with acute cholecystitis.

Cited by 154 publications

References 37 publications

Abdominal symptoms and its outcome in gallbladder diseases following routine and emergency cholecystectomy

Abdominal symptoms and its outcome in gallbladder diseases following routine and emergency cholecystectomy

Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed

An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

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